RESUMO
BACKGROUND: Stress myocardial perfusion imaging (MPI) is a well-established diagnostic and prognostic tool for coronary artery disease (CAD). However, fixed and/or reversible stress MPI defects vary considerably among patients with CAD. The usefulness of stress MPI and baseline clinical factors as independent predictors of cardiovascular events in patients with prior CAD were assessed. METHODS AND RESULTS: Stress MPI was performed in 354 patients with prior CAD. Their mean age was 71 years; the mean duration from first revascularization and/or myocardial infarction (MI) onset until stress MPI was 7.1 years; and the mean follow-up period was 34 months. Cardiovascular events were observed in 100 patients (28%), and were categorized as cardiac-related death, non-fatal MI, unstable angina, heart failure and late (>2 months from stress MPI) coronary revascularization. Multivariate Cox regression analysis revealed that peripheral arterial disease (hazard ratio [HR]=2.95; P<0.001), current smoking (HR=2.36; P=0.006), chronic kidney disease (HR=2.15; P<0.001), left ventricular ejection fraction (HR=0.98; P=0.017), and grade of myocardial ischemia assessed by stress MPI (HR=1.14; P=0.007) were independent and significant predictors of cardiovascular events. CONCLUSIONS: In patients with prior CAD, baseline clinical factors and grade of myocardial ischemia assessed by stress MPI results are significant predictors of cardiovascular events.
Assuntos
Doença da Artéria Coronariana , Teste de Esforço , Angiografia por Ressonância Magnética , Imagem de Perfusão do Miocárdio , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/etiologia , Angina Pectoris/mortalidade , Angina Pectoris/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Radiografia , Estudos RetrospectivosRESUMO
Intravascular ultrasound studies have shown that patients with unstable angina pectoris (UAP) more frequently had soft plaques in the culprit coronary arteries than patients with stable angina pectoris (SAP). We evaluated coronary plaque characteristics of culprit lesions in patients with UAP by 64-slice computed tomographic coronary angiography (64-slice CTCA). 64-slice CTCA (Aquilion 64, Toshiba Medical Systems, Otawara, Japan) was performed in 30 patients (UAP = 14, SAP = 16) before percutaneous coronary intervention (PCI). Coronary plaque area was measured by manual tracing for the difference between the area within the external elastic membrane and the area of the vessel lumen at the site of maximal luminal narrowing as observed on a cross-sectional 64-slice CTCA image where PCI was performed. Within this plaque area, CT low-density plaque area (< 50 Hounsfield units) was automatically calculated. There were no differences in stenotic rate and whole plaque area of the culprit lesion between patients with UAP and SAP. However, the CT low-density plaque area was significantly greater in patients with UAP than in those with SAP. A greater area of CT low-density plaque in the culprit lesion is associated with UAP rather than SAP. Measuring CT-low density plaque area on 64-slice CTCA images could be useful for understanding the clinical setting of UAP.
Assuntos
Angina Estável/diagnóstico por imagem , Angina Instável/diagnóstico por imagem , Angiografia Coronária/métodos , Placa Aterosclerótica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Angina Estável/etiologia , Angina Instável/etiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Vasos Coronários , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/complicações , Reprodutibilidade dos TestesRESUMO
COVID-19 vaccines have been used to counteract the global COVID-19 pandemic. While these are effective, adverse reactions have been reported, such as injection-site pain, muscle ache, fever, palpitation, and chest discomfort. The release of inflammatory cytokines, such as interleukin (IL)-6 and IL-1ß, is a potential mechanism for post-vaccine side-effects. Chest discomfort after the vaccination, including myocarditis and acute coronary syndrome, is a particularly serious adverse reaction. It is important to be familiar with the differential diagnoses of chest discomfort and organ-specific diseases associated with COVID-19 vaccines as the preparation for booster shots and vaccinations among children aged 5-11 years begins. High-intensity exercise, alcohol, tobacco smoking, and baths promote inflammatory cytokines, such as IL-6, which may exacerbate the adverse reactions after vaccination. Japanese data show that deaths during baths are the most common for several days after mRNA vaccination. Additionally, alcohol and tobacco smoking were identified as predictive factors of lower antibody titers after vaccination. In this review, we aimed to provide a few recommendations to prevent vaccine-associated disease.
RESUMO
We report a case of vasospastic angina (VSA) following COVID-19 mRNA vaccination. Despite the widespread occurrence of myocarditis, there have been few reports of post-vaccinal VSA. A 41-year-old male patient was referred for chest pain at rest following mRNA vaccination; he had never experienced chest pain prior to vaccination. He was diagnosed by an acetylcholine (Ach) provocation test that showed multivessel vasospasm. After the initiation of treatment with a calcium channel blocker and nitrate, no further exacerbation of chest pain was observed. To our knowledge, this constitutes the first reported case of VSA proven by Ach provocation test after COVID-19 vaccination. The vaccination may increase coronary artery spasticity. VSA should be ruled out in post-vaccine new onset resting chest pain.
RESUMO
Free-breathing, whole heart coronary magnetic resonance angiography (MRA) has gained great attention as a totally noninvasive diagnostic modality for the detection of coronary artery disease. We examined the accuracy of coronary MRA to identify the presence or absence of coronary artery stenosis in comparison with conventional coronary angiography. Free-breathing, whole heart coronary MRA was performed in 43 consecutive patients undergoing conventional coronary angiography. A total of 172 coronary arteries and 344 coronary artery segments were analyzed. In the coronary artery segment-based analysis, the sensitivity to detect coronary stenosis >/=50% was 82% and specificity was 100%. The accuracy, positive predictive value, and negative predictive value was 97%, 98%, and 96%, respectively. In the vessel-based analysis the sensitivity was 86%, specificity 99%, accuracy 95%, positive predictive value 98%, and negative predictive value 94%. In the patient-based analysis, the sensitivity to detect coronary stenosis <50% was 97% and the specificity to define luminal narrowing <50% was 90%. The accuracy, positive predictive value, and negative predictive value was 95%, 97%, and 90%, respectively. Free-breathing, whole heart coronary MRA yields excellent diagnostic accuracy to detect significant coronary artery disease and has the potential to become the routine diagnostic modality for patients with suspected coronary artery disease.
Assuntos
Angiografia Coronária , Estenose Coronária/diagnóstico , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Mecânica Respiratória , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Isolated noncompaction of the ventricular myocardium (INVM) is an unclassified cardiomyopathy and is thought to be due to arrest of myocardial morphogenesis. Although right ventricular involvement is not uncommon, the correct diagnosis is often difficult by echocardiography. In this report, we describe a patient with INVM in whom magnetic resonance imaging was useful to detect right ventricular morphological and functional abnormalities.
Assuntos
Cardiomiopatias/diagnóstico , Miocárdio/patologia , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/patologia , Angiografia Coronária , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/patologiaRESUMO
Anomalous origin of the right coronary artery (RCA) is a rare congenital anomaly, which may cause myocardial ischemia and sudden death. However, the causes of myocardial ischemia remain uncertain. Multidetector row computed tomography (MDCT) was performed in a 22-year-old woman who had exercise-induced myocardial ischemia. MDCT revealed a small orifice of the RCA in the left sinus of Valsalva, separate from the left main coronary artery, an acute-angled takeoff from the aorta, an intramural course of the proximal portion within the aortic wall, and a course between the great vessels. Three-dimensional virtual angioscopy also depicted a small orifice.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários , Isquemia Miocárdica/etiologia , Seio Aórtico/anormalidades , Seio Aórtico/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Feminino , HumanosRESUMO
A 68-year-old woman was admitted to our hospital because of left ventricular failure. Myocardial perfusion single-photon emission computed tomography demonstrated a non-reversible perfusion defect in the anterolateral left ventricular segments and reduced ejection fraction, findings consisted with ischemic cardiomyopathy accompanied by lateral wall infarction. Coronary angiogram was normal, but the left ventriculogram showed prominent trabeculations in the apical and anterolateral segments. The left ventricular ejection fraction was 28%. Cine magnetic resonance imaging demonstrated prominent trabeculations and deep intertrabecular recesses, findings consistent with noncompaction of the ventricular myocardium. Myocardial hypoperfusion or necrosis in the noncompacted myocardium may be the cause of myocardial damage and possibly the basis of left ventricular failure.
Assuntos
Cardiomiopatias/diagnóstico , Ventrículos do Coração/patologia , Isquemia Miocárdica/diagnóstico , Miocárdio/patologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Angiografia Coronária/métodos , Diagnóstico Diferencial , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Necrose , Perfusão , Disfunção Ventricular Esquerda/terapiaRESUMO
PURPOSE: Patients with normal stress myocardial perfusion imaging (MPI) results generally have an excellent prognosis with <1% cardiovascular events/year. Chronic kidney disease (CKD) is an established risk factor for cardiovascular events. However, the estimated glomerular filtration rate (eGFR) varies considerably among patients with CKD. We evaluated the prognostic value of eGFR for patients with CKD who did not undergo hemodialysis and had no evidence of coronary artery disease (CAD). METHODS AND SUBJECTS: Patients with CKD (n=108; 58 males; mean age: 74 years) with no CAD [no previous CAD and normal stress MPI results; summed stress score (SSS) <4] and with no history of hemodialysis were followed-up (mean duration: 24 months). CKD was defined by eGFR of <60 ml/min/1.73 m(2) and/or persistent proteinuria. Cardiovascular events included cardiac death, non-fatal myocardial infarction, and unstable angina. RESULTS: Cardiovascular events were observed in 8 patients with CKD (7%). The following were determined as significant predictors of these events: age (hazard ratio=1.14; p=0.019), hemoglobin levels (hazard ratio=0.69; p=0.021), eGFR (hazard ratio=0.94; p=0.008), SSS (hazard ratio=2.31; p=0.012), and summed difference score (hazard ratio=2.33; p=0.014). CONCLUSIONS: Patients with CKD and with no previous CAD and normal stress MPI results (SSS<4) may not exhibit an excellent cardiovascular prognosis. Further, a lower eGFR and stress MPI results may be the predictors of cardiovascular events. Thus, patients with a lower eGFR and/or normal stress MPI results (SSS<4) may require continuous follow-up.
Assuntos
Angina Instável/etiologia , Morte , Infarto do Miocárdio/etiologia , Imagem de Perfusão do Miocárdio , Diálise Renal , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Fatores Etários , Feminino , Previsões , Taxa de Filtração Glomerular , Hemoglobinas/metabolismo , Humanos , Masculino , Prognóstico , Insuficiência Renal Crônica/fisiopatologia , Fatores de RiscoRESUMO
Cardiovascular prognosis in patients under normal stress myocardial perfusion images (MPI) is generally excellent. However, this is not true for patients with chronic kidney disease (CKD) treated by hemodialysis. This study evaluated prognostic factors of adverse cardiovascular events in hemodialysis patients in whom stress MPI was performed. Pharmacological stress MPI was performed in 88 hemodialysis patients, and we retrospectively followed-up for 26 months. Cardiovascular events included cardiac death, nonfatal myocardial infarction, and unstable angina. Cardiovascular events occurred in 16 patients (18%). Univariate Cox regression analysis revealed that peripheral artery disease (PAD) and parameters of stress MPI were significant predictors of cardiovascular events. Multivariate Cox regression analysis revealed that only PAD (hazard ratio=6.54; P=0.002), and abnormal stress MPI (hazard ratio=8.26; P=0.008) were independent and significant predictors of cardiovascular events. Kaplan-Meier analysis showed better prognosis in patients with normal stress MPI than in patients with abnormal stress MPI (P<0.001, log-rank test). However, in patients with normal stress MPI, cardiovascular events occurred in 10 of the 76 patients (13%). Among patients with normal stress MPI, Kaplan-Meier analysis showed that patients with no PAD had better prognosis than patients with PAD (P=0.001, log-rank test). In hemodialysis patients, both PAD and stress MPI were powerful cardiovascular predictors. Normal stress MPI alone cannot guarantee good prognosis in terms of cardiovascular events. Consideration of PAD may improve the predictive value of stress MPI in some patients.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Diálise Renal/métodos , Idoso , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Masculino , Imagem de Perfusão do Miocárdio/métodos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Radioisótopos de Tálio , Resultado do TratamentoRESUMO
BACKGROUND: Although high-molecular-weight (HMW) adiponectin is believed to protect against atherosclerosis, the association between HMW adiponectin and the composition of coronary plaques is unknown. We evaluated whether the HMW to total adiponectin ratio was associated with the presence of coronary plaque and its composition using multi-slice computed tomography coronary angiography (MSCTCA). METHODS: Serum total and HMW adiponectin levels were measured in 53 consecutive patients (age, 71) with >50% coronary artery stenosis detected by MSCTCA. A low-attenuation coronary plaque was defined as a plaque with a mean CT density <50 Hounsfield units. Multivariate logistic regression analyses were performed to evaluate the predictors of the presence of low-attenuation coronary plaques, which is thought to be high risk, on CT. RESULTS: Decreased serum levels of total as well as HMW adiponectin were significantly associated with the presence of at least one calcified or non-calcified coronary artery plaque (total adiponectin level: odds ratio 0.76, 95% CI 0.58-0.99, P = 0.048; HMW adiponectin level: odds ratio 0.65, 95% CI 0.42-0.99, P = 0.047). A low ratio of HMW to total adiponectin was significantly associated with the presence of low-attenuation coronary plaques (4.55, 1.94-21.90, P = 0.049). However, neither the total adiponectin nor the HMW adiponectin level was associated with the presence of low-attenuation coronary plaques. CONCLUSION: Lower total or HMW adiponectin levels are associated with the presence of calcified and non-calcified coronary plaques, whereas a lower ratio of HMW to total adiponectin associated with the presence of low-attenuation coronary plaques (thought to be high risk). Measurement of total and HMW adiponectin levels and the HMW to total adiponectin ratio may be useful for risk stratification of coronary artery plaques.
Assuntos
Adiponectina/metabolismo , Aterosclerose/metabolismo , Adiponectina/sangue , Idoso , Aterosclerose/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peso MolecularRESUMO
Pretest probability of coronary artery disease (CAD) facilitates diagnosis and risk stratification of CAD. Stress myocardial perfusion imaging (MPI) and chronic kidney disease (CKD) are established major predictors of cardiovascular events. However, the role of CKD to assess pretest probability of CAD has been unclear. This study evaluates the role of CKD to assess the predictive value of cardiovascular events under consideration of pretest probability in patients who underwent stress MPI. Patients with no history of CAD underwent stress MPI (n = 310; male = 166; age = 70; CKD = 111; low/intermediate/high pretest probability = 17/194/99) and were followed for 24 months. Cardiovascular events included cardiac death and nonfatal acute coronary syndrome. Cardiovascular events occurred in 15 of the 310 patients (4.8 %), but not in those with low pretest probability which included 2 CKD patients. In patients with intermediate to high pretest probability (n = 293), multivariate Cox regression analysis identified only CKD [hazard ratio (HR) = 4.88; P = 0.022) and summed stress score of stress MPI (HR = 1.50; P < 0.001) as independent and significant predictors of cardiovascular events. Cardiovascular events were not observed in patients with low pretest probability. In patients with intermediate to high pretest probability, CKD and stress MPI are independent predictors of cardiovascular events considering the pretest probability of CAD in patients with no history of CAD. In assessing pretest probability of CAD, CKD might be an important factor for assessing future cardiovascular prognosis.
Assuntos
Adenosina , Doença da Artéria Coronariana/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Insuficiência Renal Crônica/complicações , Tomografia Computadorizada de Emissão de Fóton Único , Vasodilatadores , Síndrome Coronariana Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Angina Instável/etiologia , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/etiologia , Valor Preditivo dos Testes , Probabilidade , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/mortalidade , Medição de Risco , Fatores de Risco , Fatores de TempoAssuntos
Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste , Angiografia Coronária , Diagnóstico Diferencial , Humanos , Iopamidol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
BACKGROUND: Stress myocardial perfusion imaging (MPI) is an established means of predicting cardiovascular events and is suitable in chronic kidney disease (CKD) patients. We aimed to evaluate the prognostic value of CKD parameters and an abnormal stress MPI for cardiovascular events. METHODS: A total of 495 patients with suspected coronary artery disease (CAD) or history of CAD including 130 CKD patients not undergoing hemodialysis, underwent stress MPI (313 males, mean age 70 years) and were followed up for 14 months (mean period). CKD was defined as an estimated GFR of <60 ml/min/1.73 m(2) and/or persistent proteinuria. Cardiovascular events were defined as sudden cardiac death, acute coronary syndrome and congestive heart failure requiring hospitalization. RESULTS: Cardiovascular events occurred in 41 (8.3%) patients. Multivariate Cox regression analysis indicated that CKD [hazard ratio (HR) = 3.76, p < 0.001] and a stress MPI summed difference score (SDS) of ≥2 (HR = 3.78, p < 0.001) were independent predictors of cardiovascular events; CKD plus abnormal stress MPI was also a strong predictor of cardiovascular events (non-CKD and SDS <2 vs. CKD and SDS ≥2, HR = 15.9, p < 0.001). CONCLUSION: Both CKD and myocardial ischemia detected by stress MPI are independent predictors for cardiovascular events. Coexistence of CKD and myocardial ischemia detected by stress MPI is more useful for short-term risk stratification of cardiovascular events.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Nefropatias/complicações , Imagem de Perfusão do Miocárdio , Estresse Fisiológico , Idoso , Doenças Cardiovasculares/complicações , Doença Crônica , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Humanos , Masculino , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Estudos Retrospectivos , Radioisótopos de TálioRESUMO
OBJECTIVE: Normal stress myocardial perfusion imaging (MPI) studies generally suggest an excellent prognosis for cardiovascular events. Chronic kidney disease (CKD), diabetes and peripheral artery disease (PAD) have been established as the risk factors for cardiovascular events. However, whether these risk factors significantly predict cardiovascular events in patients with normal stress MPI is unclear. The purpose of this study was to evaluate the prognostic value of these risk factors in patients with normal stress MPI. METHODS: Patients with normal stress MPI (n = 372, male = 215 and female = 157, age = 69 years, CKD without hemodialysis = 95, diabetes = 99, PAD = 19, previous coronary artery disease = 116) were followed up for 14 months. Normal stress MPI was defined as a summed stress score of <4 and a summed difference score of <2. CKD was defined by an estimated glomerular filtration rate of <60 ml/min/1.73 m(2) and/or persistent proteinuria. Cardiovascular events included cardiac death, non-fatal myocardial infarction and congestive heart failure requiring hospitalization. RESULTS: Cardiovascular events occurred in 20 of 372 patients (5.4%). In univariate Cox regression analysis, PAD, diabetes, diabetic retinopathy, insulin use, anemia, hypoalbuminemia, CKD, left ventricular ejection fraction and pharmacological stress tests were significant predictors of cardiovascular events. In multivariate Cox regression analysis, PAD, diabetes and CKD were independent and significant predictors for cardiovascular events, and their number was the strongest predictor for cardiovascular events (hazard ratio = 21.7, P < 0.001). CONCLUSIONS: PAD, diabetes and CKD are coexisting, independent and significant risk factors for cardiovascular events, CKD being the strongest predictor. The number of coexisting risk factors is important in predicting cardiovascular events in patients with normal stress MPI.
Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico por imagem , Complicações do Diabetes/diagnóstico por imagem , Nefropatias/complicações , Imagem de Perfusão do Miocárdio , Doença Arterial Periférica/complicações , Estresse Fisiológico , Idoso , Doenças Cardiovasculares/fisiopatologia , Doença Crônica , Complicações do Diabetes/fisiopatologia , Feminino , Humanos , Masculino , Prognóstico , Fatores de RiscoRESUMO
Anomalous origin of the right coronary artery is a relatively rare coronary artery anomaly which is known to cause myocardial ischemia and sudden death. Association of anomalous origin of the right coronary artery with congenital bicuspid aortic valve is even rarer with only a few cases being reported previously. We describe, for the first time, MDCT findings of anomalous origin of the right coronary artery associated with congenital bicuspid aortic valve.
Assuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/anormalidades , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Seio Aórtico/anormalidades , Tomografia Computadorizada por Raios X/métodos , Valva Aórtica/diagnóstico por imagem , Humanos , Masculino , Seio Aórtico/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adulto JovemRESUMO
BACKGROUND: Normal stress myocardial perfusion images (MPI) generally show good prognosis for cardiovascular events. However, chronic kidney disease (CKD) is one of the important risk factors for coronary artery disease (CAD), and the interpretation of normal stress MPI has not been well established in CKD patients with no evidence of CAD. The purpose of this study was to evaluate the long-term prognostic value of stress MPI in CKD patients with no evidence of myocardial ischemia or infarction. METHODS: Patients who had no history but were suspected of CAD and had normal stress MPI (n=307, male=208, age=67 years, CKD/non-CKD=46/261) were followed-up for 4.5 years. CKD was defined as a glomerular filtration ratio of <60 ml/min/1.73 m(2) and/or persistent proteinuria. Cardiac death, non-fatal myocardial infarction, and unstable angina requiring hospitalization were defined as major cardiac events. RESULTS: Major cardiac events were observed in 3 of 261 (1.1%) non-CKD patients and 6 of 46 (13%) CKD patients (p<0.001, with log-rank test). CKD was an independent risk factor for major cardiac events (hazard ratio=13.1, p<0.001, multivariate Cox regression analysis). CONCLUSIONS: Normal stress MPI does not always promise a good prognosis for major cardiac events. Even in patients with no evidence of CAD from stress MPI, CKD can be an independent and significant risk factor for major cardiac events.
Assuntos
Doença da Artéria Coronariana/etiologia , Imagem de Perfusão do Miocárdio , Insuficiência Renal Crônica/complicações , Idoso , Feminino , Humanos , Masculino , Imagem de Perfusão do Miocárdio/métodos , Prognóstico , Fatores de RiscoRESUMO
Double left anterior descending artery arising from the left and right coronary arteries is an extremely rare congenital coronary anomaly. We describe a patient with anterior myocardial infarction, in whom whole-heart coronary magnetic resonance angiography detected double left anterior descending artery.
Assuntos
Infarto Miocárdico de Parede Anterior/patologia , Vasos Coronários/patologia , Imageamento Tridimensional , Angiografia por Ressonância Magnética/métodos , Idoso , Humanos , MasculinoRESUMO
A 58-year-old man presented with left ventricular failure. Coronary angiography revealed normal coronary arteries and endomyocardial biopsy from the right ventricular apex was normal. Echocardiogram showed marked trabeculation and deep intertrabecular recesses most prominent in the left ventricular apex, anterior and the lateral wall. Cine magnetic resonance imaging showed double-layered appearance on long-axis, 4-chamber and short-axis views. These findings were consistent with isolated noncompaction of the ventricular myocardium (INVM). Gadolinium-diethylenetriomine pentaacetic acid-enhanced imaging revealed delayed enhancement in the both left and right ventricular myocardium.
Assuntos
Ventrículos do Coração/patologia , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , NecroseRESUMO
Isolated subvalvular pulmonary stenosis (ISPS) is a rare condition, and it is often accompanied by hypertrophic cardiomyopathy. However, diagnosis of ISPS is obscure because of difficulty in comprehension of three-dimensional cardiac anatomy. Whole-heart magnetic resonance imaging (MRI) is a new, totally non-invasive technique which allows not only depiction of the coronary artery system, but also three-dimensional comprehension of the cardiac structure. We describe a patient with ISPS associated with hypertrophic cardiomyopathy, in whom whole-heart MRI was useful to detect and evaluate the cause of ISPS.