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BACKGROUND: Diabetes mellitus (DM) is associated with a worse prognosis in patients with heart failure. Our aim was to analyze the clinical and imaging features of patients with DM and their association with outcomes in comparison to nondiabetic patients in a cohort of patients with nonischemic dilated cardiomyopathy (DCM). METHODS: This is a prospective cohort study of patients with DCM evaluated in a tertiary care center from 2018 to 2021. Transthoracic echocardiography and cardiac magnetic resonance findings were assessed. A high-risk late gadolinium enhancement (LGE) pattern was defined as epicardial, transmural, or septal plus free-wall. The primary outcome was a composite of heart failure hospitalizations and all-cause mortality. Multivariable analyses were performed to evaluate the impact of DM on outcomes. RESULTS: We studied 192 patients, of which 51 (26.6%) had DM. The median left ventricular ejection fraction was 30%, and 106 (55.2%) had LGE. No significant differences were found in systolic function parameters between patients with and without DM. E/e values were higher (15 vs. 11.9, p = 0.025), and both LGE (68.6% vs. 50.4%; p = 0.025) and a high-risk LGE pattern (31.4% vs. 18.5%; p = 0.047) were more frequently found in patients with DM. The primary outcome occurred more frequently in diabetic patients (41.2% vs. 23.6%, p = 0.017). DM was an independent predictor of outcomes (OR 2.01; p = 0.049) and of LGE presence (OR 2.15; p = 0.048) in the multivariable analysis. Patients with both DM and LGE had the highest risk of events (HR 3.1; p = 0.003). CONCLUSION: DM is related to a higher presence of LGE in DCM patients and is an independent predictor of outcomes. Patients with DM and LGE had a threefold risk of events. A multimodality imaging approach allows better risk stratification of these patients and may influence therapeutic options.
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Cardiomiopatía Dilatada , Diabetes Mellitus , Insuficiencia Cardíaca , Humanos , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/diagnóstico por imagen , Medios de Contraste , Volumen Sistólico , Gadolinio , Función Ventricular Izquierda , Estudios Prospectivos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Pronóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/complicaciones , Valor Predictivo de las Pruebas , Imagen por Resonancia CinemagnéticaRESUMEN
BACKGROUND: Reduction of variability through process reengineering can improve surgical results for patients with type A acute aortic syndrome. We compare short-term results before and after implementation of an Aorta Code for patients with type A acute aortic syndrome who underwent surgery. METHODS: The Aorta Code was implemented in a 5-hospital healthcare network in 2019. This critical pathway was based on a simple diagnostic algorithm, ongoing training, immediate patient transfer, and treatment by an expert multidisciplinary team. We retrospectively compared all patients operated on in our center before (2005-2018) and after (January 2019 to February 2023) its implementation. RESULTS: One hundred two and 70 patients underwent surgery in the precode and code periods, respectively. In the code period the number of patients operated on per year increased (from 7.3 to 16.8), and the median elapsed time until diagnosis (6.5 hours vs 4.2 hours), transfer (4 hours vs 2.2 hours), and operating room (2.7 hours vs 1.8 hours) were significantly shorter (P < .05). Aortic root repair and total arch replacement were more frequent (66.7% vs 82.9% [P = .003] and 20.6% vs 40% [P = .001]). Cardiopulmonary bypass and ischemia times were also shorter (179.7 minutes vs 148.2 minutes [P = .001] and 105 minutes vs 91.2 minutes [P = .022]). Incidence of prolonged mechanical ventilation (53.9% vs 34.3%, P = .011), major stroke (17.7% vs 7.1%, P = .047), and 30-day mortality (27.5% vs 7.1%, P = .001) decreased significantly. CONCLUSIONS: An Aorta Code can be successfully implemented by using a standardized protocol within a hospital network. The number of cases increased; time to diagnosis, transfer, and operating room were reduced; and 30- day mortality significantly decreased.
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Sindrome Aortico Agudo , Disección Aórtica , Humanos , Estudios Retrospectivos , Aorta/cirugía , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Puente Cardiopulmonar , Resultado del Tratamiento , Aorta Torácica/cirugíaRESUMEN
Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.
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Cardiología , Desfibriladores Implantables , Cardiopatías , Humanos , Consenso , Imagen por Resonancia Magnética , Espectroscopía de Resonancia MagnéticaRESUMEN
Aortic intramural hematoma (AIH) is an entity within the acute aortic syndrome. Combination of a priori probability, clinical history, laboratory blood test and imaging techniques are the basis for diagnosis of AIH. This review is focused on all aspects related to diagnosis of patients with AIH, from clinical to imaging and analytical.
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Aorta , Enfermedades de la Aorta/diagnóstico , Hematoma/diagnóstico , Aorta/diagnóstico por imagen , Aorta/patología , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/terapia , Biomarcadores/sangre , Biopsia , Diagnóstico Diferencial , Hematoma/diagnóstico por imagen , Hematoma/patología , Hematoma/terapia , Humanos , Valor Predictivo de las Pruebas , Pronóstico , Factores de RiesgoRESUMEN
Some coronary artery anomalies are associated with increased risk of sudden cardiac death and myocardial infarction in young patients. There are few data on the clinical and prognostic relevance of isolated origin of the left circumflex artery from the pulmonary artery, an extraordinarily rare variant of anomalous left coronary artery from the pulmonary artery. (Level of Difficulty: Intermediate.).
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Gliomatosis cerebri is a diffuse infiltrating glioma of neuroepithelial origin that affects more than 2 cerebral lobes. This is rarely seen in pediatric patients. The clinical presentation and imaging are very unspecific, and a biopsy is typically needed for the diagnosis. Given the widespread nature of the disease, surgical treatment is not possible and has a poor overall prognosis. A pediatric patient presented with elevated intracranial pressure. All initial studies were negative, and the imaging showed a symmetrical affection involving the supratentorial and infratentorial regions. A biopsy ultimately confirmed gliomatosis cerebri. This case describes a unique clinical presentation of gliomatosis cerebri in a pediatric patient.
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Neoplasias Encefálicas/diagnóstico , Neoplasias Neuroepiteliales/diagnóstico , Convulsiones/etiología , Adolescente , Encéfalo/patología , Neoplasias Encefálicas/complicaciones , Diagnóstico Diferencial , Humanos , Hipertensión Intracraneal/etiología , Imagen por Resonancia Magnética , Masculino , Neoplasias Neuroepiteliales/complicacionesRESUMEN
INTRODUCTION AND OBJECTIVES: Multidetector computed tomography (MDCT) has been demonstrated as a feasible alternative to invasive coronary angiography (ICA). However, contradictory results have been reported regarding the effect of coronary artery calcium score (CS) on the diagnostic accuracy of MDCT. Our aim was to assess the agreement of MDCT and ICA and to evaluate the influence of CS on this agreement. METHODS: We enrolled 266 consecutive patients who underwent evaluation with 64-slice MDCT and ICA. Standard CS software tools were used to calculate the Agatston score. Stenosis was qualitatively classified as mild, moderate, or severe by 1 blinded observer and the results were compared with those of ICA, which was used as the gold standard. RESULTS: The mean age of the patients was 65.4 ± 11.2 years, and 188 patients (70.3%) were men. A total of 484 segments with coronary stenosis ≥ mild were qualitatively evaluated and quantified with MDCT. Noninvasive measurements were concordant with ICA in 402 stenoses (83.05%; Kappa, 0.684), with no significant differences between vessels and with no statistically significant influence of CS on this agreement (OR, 0.93; 95%CI, 0.76-1.09; P = .21). Multidetector computed tomography had high sensitivity, specificity, positive predictive value, and negative predictive value on a per-segment, per-vessel, and per-patient basis. CONCLUSIONS: Non-ICA using MDCT showed good agreement with ICA in the qualitative quantification coronary stenosis and CS had no significant impact on this agreement.
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Calcinosis/complicaciones , Calcio/metabolismo , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico , Vasos Coronarios/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Tomografía Computarizada Multidetector/métodos , Anciano , Calcinosis/diagnóstico , Calcinosis/metabolismo , Estenosis Coronaria/etiología , Estenosis Coronaria/metabolismo , Vasos Coronarios/metabolismo , Femenino , Humanos , Masculino , Curva ROC , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Although several hypotheses have been proposed, the true origin and pathogenesis of aortic intramural hematoma (IMH) remain unclear. Evolution of patients with aortic IMH is highly variable. Progression to classic aortic dissection, aneurysm or to complete resolution have been described. Our purpose was to assess in-hospital and mid-term evolution of patients with aortic IMH. METHODS: From 2000 to 2015, 40 patients with aortic IMH were prospectively and consecutively recruited in a tertiary care referral center. Aortic IMH was defined as the presence of a circular or crescent-shaped thickening of the aortic wall (≥5mm) in the absence of detectable blood flow inside, within the context of acute aortic syndrome. RESULTS: Twenty three patients (57.5%) had type A, and 17 (42.5%) type B IMH. Up to 34.7% of patients with type A and 47.1% with type B IMH showed intimal tears in the imaging test at admission. In-hospital mortality was higher in the type A IMH group. All-cause mortality after discharge was 20%, without significant differences among groups. Out of hospital death was related to the aortic pathology in just one patient. At follow-up, radiological persistence of IMH was observed in 35.7% of patients with type A and 60% of those with type B IMH. CONCLUSIONS: IMH related mortality takes place primarily during the acute phase of the disease. Clinical evolution after discharge is favorable, either in cases of reabsorption or persistence of the IMH. Imaging test findings rekindle the debate on the true training mechanism of the aortic IMH.
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Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/fisiopatología , Hematoma/diagnóstico por imagen , Hematoma/fisiopatología , Anciano , Anciano de 80 o más Años , Disección Aórtica/epidemiología , Aneurisma de la Aorta/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hematoma/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
OBJECTIVES: To demonstrate non-inferiority of iobitridol 350 for coronary CT angiography (CTA) compared to higher iodine content contrast media regarding rate of patients evaluable for the presence of coronary artery stenoses. METHODS: In this multicentre trial, 452 patients were randomized to receive iobitridol 350, iopromide 370 or iomeprol 400 and underwent coronary CTA using CT systems with 64-detector rows or more. Two core lab readers assessed 18 coronary segments per patient regarding image quality (score 0 = non diagnostic to 4 = excellent quality), vascular attenuation, signal and contrast to noise ratio (SNR, CNR). Patients were considered evaluable if no segment had a score of 0. RESULTS: Per-patient, the rate of fully evaluable CT scans was 92.1, 95.4 and 94.6 % for iobitridol, iopromide and iomeprol, respectively. Non-inferiority of iobitridol over the best comparator was demonstrated with a 95 % CI of the difference of [-8.8 to 2.1], with a pre-specified non-inferiority margin of -10 %. Although average attenuation increased with higher iodine concentrations, average SNR and CNR did not differ between groups. CONCLUSIONS: With current CT technology, iobitridol 350 mg iodine/ml is not inferior to contrast media with higher iodine concentrations in terms of image quality for coronary stenosis assessment. KEY POINTS: ⢠Iodine concentration is an important parameter for image quality in coronary CTA. ⢠Contrast enhancement must be balanced against the amount of iodine injected. ⢠Iobitridol 350 is non-inferior compared to CM with higher iodine concentrations. ⢠Higher attenuation with higher iodine concentrations, but no SNR or CNR differences.
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Calcinosis/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico por imagen , Adulto , Anciano , Medios de Contraste , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Método Doble Ciego , Femenino , Humanos , Yodo , Yohexol/análogos & derivados , Yopamidol/análogos & derivados , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector/métodos , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Cardiopatías/diagnóstico , Quiste Mediastínico/diagnóstico , Anciano , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Quiste Mediastínico/complicaciones , Quiste Mediastínico/diagnóstico por imagen , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
When pertussis is associated with hyperleukocytosis, mortality approaches to 80%. Immature leukocytes have been identified in pulmonary arterioles, small arteries and venules. Techniques aimed at reducing leukocyte mass might improve the prognosis of these patients. We report our experience with 3 patients in whom a leukoreduction was performed in the context of severe pertussis and hyperleukocytosis.
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Leucocitosis/sangre , Leucocitosis/terapia , Tos Ferina/sangre , Tos Ferina/terapia , Recambio Total de Sangre , Resultado Fatal , Femenino , Humanos , Hipoxia/sangre , Lactante , Unidades de Cuidado Intensivo Pediátrico , Leucaféresis , MasculinoRESUMEN
OBJECTIVE: The aim of this study was to evaluate the use of procalcitonin (PCT) and C-reactive protein (CRP) on admission as predictors of the severity of appendicitis in children. METHODS: We prospectively studied 111 consecutive patients admitted with a diagnosis of acute appendicitis between July 2009 and February 2010 and recorded the following variables: age, sex, time since diagnosis, laboratory data, complications (abscess, intestinal obstruction), presence of hemodynamic instability, mortality, length of stay, and need for admission to the pediatric intensive care unit. Patients were divided into 2 groups according to the diagnosis confirmed during surgery (group 1, appendicitis; group 2, localized or generalized peritonitis). RESULTS: Group 1 comprised 69 patients, and group 2 comprised 42 patients. Procalcitonin and CRP values were significantly lower in group 1 than in group 2 (0.15 vs 4.95 ng/mL [P < 0.001] and 3 vs 14.3 mg/dL [P < 0.001]). For a diagnosis of peritonitis, a PCT cutoff of 0.18 ng/mL gave a sensitivity of 97%, specificity of 80%, positive predictive value of 72%, and negative predictive value of 89.3%. The equivalent values for a CRP cutoff of 3 mg/dL were 95%, 74%, 68%, and 96.2%. Complications and the need for admission to the pediatric intensive care unit were more common in patients with peritonitis. CONCLUSIONS: On admission, CRP and PCT predict the outcome of pediatric patients with appendicitis. Children with CRP greater than 3 mg/dL and/or PCT greater than 0.18 ng/mL have a greater risk of complications; thus, intervention should be early, and patients should be monitored closely.
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Apendicitis/sangre , Apendicitis/diagnóstico , Proteína C-Reactiva/metabolismo , Calcitonina/sangre , Precursores de Proteínas/sangre , Enfermedad Aguda , Adolescente , Biomarcadores/sangre , Péptido Relacionado con Gen de Calcitonina , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Pleuropulmonary blastoma (PPB) is the most common lung neoplasms in childhood. Usually presents as recurrent respiratory infections and in some cases as pneumothorax. CASE REPORT: We report the case of a 2-year-old patient that was diagnosed with PPB, that first manifested as recurrent pneumothorax. Three chest computed tomography were necessary for the diagnosis. The first 2 tomographies showed no abnormalities suggestive of malignancy. The patient had a family history of both PPB and leukemia. Three years and a half after completion of treatment, the patient is in complete remission. CONCLUSIONS: PPB is an uncommon disease but is the most common pulmonary neoplasms in childhood. We must suspect it in patients with a suggestive family history and recurrent pneumothorax in the same location.
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Neoplasias Pulmonares/complicaciones , Neumotórax/etiología , Blastoma Pulmonar/complicaciones , Preescolar , Femenino , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Blastoma Pulmonar/patología , Blastoma Pulmonar/terapiaRESUMEN
Cystic adenomatoid malformation of the lung is a rare malformation of the lung airway which often performed diagnosed in the prenatal period by ultrasound. Ultrasound monitoring should be performed during pregnancy to assess lung development. We report the case of a 4-year-old patient with prenatal diagnosis of cystic adenomatoid malformation of the lung, not confirmed by chest radiograph at birth. The patient underwent surgery at 4 years of age after diagnosis was made for presenting recurrent pneumonia. A normal chest radiograph at birth does not exclude this malformation and a computerized tomography at 4 weeks of birth must be done to confirm or rule out this anomaly. Once the diagnosis is made, surgical treatment should be prompted to avoid complications.
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Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico por imagen , Ultrasonografía Prenatal , Preescolar , Femenino , Humanos , EmbarazoRESUMEN
La malformación adenomatoidea quística pulmonar (MAQP)es una anomalía de la vía aérea pulmonar poco frecuente cuyodiagnóstico suele realizarse en el período prenatal medianteecografía. Durante el embarazo, debe realizarse seguimiento ecográfico para valorar el desarrollo pulmonar. Presentamos el caso clínico de una paciente de 4 años con diagnóstico prenatal de MAQP, no confirmado mediante radiografía de tóraxrealizada al nacimiento, lo cual retrasó el diagnóstico definitivo; fue intervenida con 4 años de edad tras haber presentado varias neumonías a repetición. Una radiografía de tórax normal realizada al nacimiento no descarta la presencia de estamalformación, por lo que es necesario realizar una tomografía computarizada a las 4 semanas del nacimiento para confirmar o descartar la MAQP. Una vez diagnosticada, el tratamiento quirúrgico debe ser precoz para evitar complicaciones.
Cystic adenomatoid malformation of the lung is a rare malformation of the lung airway which often performed diagnosed in the prenatal period by ultrasound. Ultrasound monitoring should be performed during pregnancy to assess lung development. We report the case of a 4-year-old patient with prenatal diagnosis of cystic adenomatoid malformation of the lung, not confirmed by chest radiograph at birth. The patient underwent surgery at 4 years of age after diagnosis was made for presenting recurrent pneumonia. A normal chest radiograph at birth does not exclude this malformation and a computerized tomography at 4 weeks of birth must be done to confirm or rule out this anomaly. Once the diagnosis is made, surgical treatment should be prompted to avoid complications.
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Humanos , Femenino , Preescolar , Diagnóstico Diferencial , Diagnóstico Prenatal , Malformación Adenomatoide Quística Congénita del Pulmón/cirugía , Malformación Adenomatoide Quística Congénita del Pulmón/diagnóstico , Malformación Adenomatoide Quística Congénita del Pulmón , NeumoníaRESUMEN
OBJECTIVES: Left ventricle trabeculae (LVT) are frequently seen in different cardiac diseases. Normal reference values of LVT in different cardiac conditions are not known. The aim of the study was to quantify with cardiac magnetic resonance (CMR), LVT mass (LVTM) and LVTM percentage (LVTM%) in different heart diseases and to evaluate their influence on left ventricular morphological and functional parameters. METHODS: Fifty-nine patients (14 controls, 17 ischemic cardiomyopathy, 15 nonischemic dilated cardiomyopathy, 7 valvular heart disease and 6 with left ventricle hypertrophy) were enrolled. Cine-MR images were acquired with steady-state free-precession sequence in a short-axis view. LVTM was calculated as the difference between LVM excluding/including trabecuale from the blood cavity. LVTM% was calculated as the percentage of the whole left ventricle mass excluding trabeculae from the blood cavity. RESULTS: Mean age was 47.60 +/- 22.03 years; male 62.7%. Mean LVTM was of 33.38 +/- 16.1 g with mean LVTM% of 19.22 +/- 6.5%. Significant differences between groups for both parameters with P values of 0.02 were obtained. Nonischemic dilated cardiomyopathy showed the highest degree of LVTM (44.73 +/- 16.0 g) and LVTM% (23.26 +/- 6%). Significant differences were noted in left ventricular morphological and functional parameters with inclusion/exclusion of LVT in the myocardial mass. CONCLUSIONS: Reference values and differences of LVTM and LVTM% in various cardiac conditions are given for the first time. Quantification of these parameters with CMR may be clinically useful in the differential diagnosis between left ventricular noncompaction and other cardiac diseases. Exclusion of LVT from myocardium alters left ventricular morphological and functional parameters, which have significant clinical importance.
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Cardiopatías/diagnóstico , Ventrículos Cardíacos/patología , Imagen por Resonancia Cinemagnética , Función Ventricular Izquierda , Adulto , Anciano , Cardiomiopatías/diagnóstico , Cardiomiopatías/fisiopatología , Diagnóstico Diferencial , Femenino , Cardiopatías/fisiopatología , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/diagnóstico , Hipertrofia Ventricular Izquierda/fisiopatología , No Compactación Aislada del Miocardio Ventricular/diagnóstico , No Compactación Aislada del Miocardio Ventricular/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
PURPOSE: The purpose of this study is to evaluate the MR findings in patients with long-term ankylosing spondylitis (AS) and acute cervical spine fractures. MATERIALS AND METHODS: The magnetic resonance imaging (MRI) studies of five patients with AS and acute cervical spine fractures were retrospectively reviewed for the presence of cervical spine instability, spinal cord compression, and epidural hematoma. RESULTS: Spinal fractures were unstable in all five patients. Three patients had neurological symptoms and abnormal signal within the spinal cord. All patients with neurological deficits had epidural hematomas posterior to the dural sac. CONCLUSION: MRI is useful for assessment of the integrity of intervertebral disks and spinal ligaments and, therefore, of the instability of the spinal fracture. MRI is mandatory in patients with neurological symptoms, especially in those with a symptom-free interval and those with neurological deterioration after established spinal cord injury, when suspicion for epidural hematoma is high.