Quantitative assessment of left ventricular size and function in cardiac transplant recipients: Side-by-side comparison of real time two-dimensional echocardiography, contrast-enhanced two-dimensional echocardiography, three-dimensional echocardiography, and contrast-enhanced three-dimensional echocardiography as compared to magnetic resonance imaging.

INTRODUCTION: We evaluate the ability of 2D non-contrast-enhanced echocardiography (CE-echo), 2DCE-echo, 3D-echo, 3D non-CE-echo, and 3DCE-echo to evaluate allograft function and dimensions in orthotropic heart transplantation (OHT). Cardiac resonance (CMR) was used as reference. METHODS: Twenty six consecutive OHT-recipients were prospectively recruited. Bland-Altman, Spearman rank, and concordance-correlation coefficients (CCC) were determined. RESULTS: Good CCCs were found between the four modalities and CMR for ejection fraction (r ≥ 0.72/P < 0.001; r ≥ 0.77/ P < 0.001; r ≥ 0.51/ P < 0.23; r ≥ 0.75/ P < 0.001, respectively). Highest intraclass correlation coefficient (ICC) was for 2D CE-echo(CCC = 0.77). End-diastolic volume(EDV) measurements statistically differed when 2D non-CE-echo, 2DCE-echo, and 3D non-CE-echo were compared with the cross-sectional imaging modalities, but they did not differ significantly from 3DCE-echo. End-systolic volume (ESV) and stroke volume (SV) differed statistically between the four modalities; however, SV measured by CMR and 3DCE-echo were comparable. Overall, 2D non-CE-echo, 2DCE-echo, and 3D non-CE-echo showed lower mean EDV, ESV, and SV than CMR. ICC was that of the ESV variable in the 4 techniques, with the values of the ICC of the 3DCE-echo technique superior to the rest. Overall, the best CCC were found for 3DCE(r = 0.88, 0.92 and 0.76 for EDV, ESV and SV, respectively). CONCLUSION: Routine use of 3DCE-echo may allow more comprehensive cardiac assessment in cardiac transplant recipients.

Prognostic role of stress cardiac magnetic resonance in the elderly.

INTRODUCTION AND OBJECTIVES: Several trials have tested the diagnostic and prognostic value of stress cardiac magnetic resonance (CMR) in ischemic heart disease. However, scientific evidence is lacking in the older population, and the available techniques have limitations in this population. The aim of this study was to evaluate the usefulness of stress CMR in the elderly. METHODS: We prospectively studied consecutive patients referred for stress CMR to rule out myocardial ischemia. The cutoff age for the elderly population was 70 years. Stress CMR study was performed according to standardized international protocols. Hypoperfusion severity was classified according to the number of affected segments: mild (1-2 segments), moderate (3-4 segments), or severe (> 4 segments). We analyzed the occurrence of major events during follow-up (death, acute coronary syndrome, or revascularization). Survival was studied with the Kaplan-Meier method and multivariate Cox regression models. RESULTS: Of an initial cohort of 333 patients, 110 were older than 70 years. In 40.9% patients, stress CMR was positive for ischemia. The median follow-up was 26 [18-37] months. In elderly patients there were 35 events (15 deaths, 10 acute coronary syndromes, and 10 revascularizations). Patients with moderate or severe ischemia were at a higher risk of events, adjusted for age, sex, and cardiovascular risk (HR, 3.53 [95%CI, 1.41-8.79]; P=.01). CONCLUSIONS: Moderate to severe perfusion defects in stress CMR strongly predict cardiovascular events in people older than 70 years, without relevant adverse effects.

[Is stress cardiovascular magnetic resonance really useful to detect ischemia and predict events in patients with different cardiovascular risk profile?] / ¿Es realmente útil la cardiorresonancia magnética de estrés para detectar isquemia y predecir eventos en pacientes con distinto perfil de riesgo cardiovascular?

OBJECTIVE: The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions. METHOD: We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model. RESULTS: 295 patients were studied. The positive LR was 3.40 and the negative one 0.47. The maximal usefulness of the test was found in patients without previous ischemic cardiomyopathy (positive LR 4.85), patients with atypical chest pain (positive LR 8.56), patients with low or intermediate cardiovascular risk (positive LR 3.87) and those with moderate or severe hypoperfusion (positive LR 8.63). Sixty cardiovascular major events were registered. The best survival prognosis was found in patients with a negative result (p=0.001) or mild hypoperfusion (p=0.038). In the multivariate analysis, a moderate or severe hypoperfusion increased cardiovascular event probability (HR=2.2; IC 95% 1.26-3.92), with no differences between a mild positive and a negative result (HR=0.93; IC 95% 0.38-2.28). CONCLUSIONS: Stress CMR was specially useful in patients with low or intermediate cardiovascular risk, patients with atypical chest pain, patients without previous ischemic cardiomyopathy and those with moderate or severe hypoperfusion. Hypoperfusion degree was the main issue factor to guide clinical decisions.

Update on cardiac imaging techniques 2014.

In this article, we review the contributions of the most important imaging techniques used in cardiology, reported in 2014. Echocardiography remains the cornerstone for diagnosing and monitoring valvular heart disease, and there has been a continuing effort to improve quantification of this condition and obtain prognostic parameters for follow-up. The study of regional myocardial function is anchored in the diagnosis of subclinical ventricular dysfunction, and 3-dimensional transesophageal echocardiography has become the perfect ally in interventional procedures for structural heart disease. Cardiac magnetic resonance imaging and cardiac computed tomography are the focus of most publications on cardiac imaging in ischemic heart disease, reflecting their consolidated use in clinical practice. Nuclear medicine excels in the study of myocardial viability after interventional treatment of acute coronary syndromes and its performance is validated in the diagnosis of ischemic heart disease.

Update on cardiac imaging techniques 2013.

Cardiac imaging is a cornerstone of diagnosis in heart conditions, and an essential tool for assessing prognosis and establishing treatment decisions. This year, echocardiography stands out as a guide in interventional procedures and in choosing the size of the prosthesis. It is also proving to be a valuable technique in low-flow, low-gradient aortic stenosis. Three-dimensional echocardiography is advancing our knowledge of cardiac anatomy and valvular measurements. The parameters indicating tissue deformation have predictive power in valve disease and in the follow-up of drug-induced cardiotoxicity. Single-photon emission computed tomography and positron emission tomography are proving useful in ischemic heart disease and in the diagnosis of cardiac inflammation and infections. The role of computed tomography has been strengthened in noninvasive coronary angiography, the emergency room management of chest pain, assessment of chronic occlusions, and morphologic study of coronary plaque. Cardiac magnetic resonance imaging remains the gold standard for tissue characterization in ischemic heart disease and cardiomyopathies, and is assuming a greater role in stress studies and in the assessment of myocardial viability.

Update on cardiac imaging techniques 2012.

Cardiac imaging is one of the basic pillars of modern cardiology. The potential list of scenarios where cardiac imaging techniques can provide relevant information is simply endless so it is impossible to include all relevant new features of cardiac imaging published in the literature in 2012 in the limited format of a single article. We summarize the year's most relevant news on cardiac imaging, highlighting the ongoing development of myocardial deformation and 3-dimensional echocardiography techniques and the increasing use of magnetic resonance imaging and computed tomography in daily clinical practice.

¿Es realmente útil la cardiorresonancia magnética de estrés para detectar isquemia y predecir eventos en pacientes con distinto perfil de riesgo cardiovascular? / Is stress cardiovascular magnetic resonance really useful to detect ischemia and predict events in patients with different cardiovascular risk profile?

Resumen: Objetivo: Evaluar la utilidad diagnóstica y pronóstica de la cardiorresonancia magnética de estrés (RMCE) en pacientes con distinto perfil de riesgo cardiovascular y la importancia del grado de hipoperfusión en la toma de decisiones clínicas. Método: Se analizaron los pacientes sometidos a RMCE con adenosina por sospecha de isquemia miocárdica. Se evaluó su precisión diagnóstica mediante los cocientes de probabilidad (CP) y su valor pronóstico mediante curvas de supervivencia y regresión de Cox. Resultados: Se estudió a 295 pacientes. El CP positivo fue 3.40 y el negativo 0.47. Se demostró una mayor utilidad de la resonancia en: pacientes sin cardiopatía isquémica conocida (CP positivo 4.85); pacientes con dolor torácico atípico (CP positivo 8.56);pacientes con riesgo cardiovascular bajo o intermedio (CP positivo 3.87), y pacientes con hipoperfusión moderada o grave (CP positivo 8.63). Se registraron 60 eventos cardiovasculares mayores. Los pacientes con resultado negativo (p = 0.001) o hipoperfusión leve (p = 0.038) presentaron una supervivencia mayor. En el análisis multivariante, un resultado moderado o grave aumentó la probabilidad de sufrir eventos (hazard ratio [HR] = 2.2; IC 95% 1.26-3.92), sin diferencias entre resultado positivo leve y negativo (HR = 0.93; IC 95% 0.38-2.28). Conclusiones: La RMCE tuvo una mayor utilidad en pacientes con riesgo cardiovascular bajo o intermedio, con dolor torácico atípico, sin cardiopatía isquémica conocida y en aquellos con hipoperfusión moderada o grave. Además, el grado de hipoperfusión fue el principal factor para guiar las decisiones clínicas.

Abstract: Objective: The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions. Method: We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model. Results: 295 patients were studied. The positive LR was 3.40 and the negative one 0.47. The maximal usefulness of the test was found in patients without previous ischemic cardiomyopathy (positive LR 4.85), patients with atypical chest pain (positive LR 8.56), patients with low or intermediate cardiovascular risk (positive LR 3.87) and those with moderate or severe hypoperfusion (positive LR 8.63). Sixty cardiovascular major events were registered. The best survival prognosis was found in patients with a negative result (p = 0.001) or mild hypoperfusion (p = 0.038). In the multivariate analysis, a moderate or severe hypoperfusion increased cardiovascular event probability (HR = 2.2; IC 95% 1.26-3.92), with no differences between a mild positive and a negative result (HR = 0.93; IC 95% 0.38-2.28). Conclusions: Stress CMR was specially useful in patients with low or intermediate cardiovascular risk, patients with atypical chest pain, patients without previous ischemic cardiomyopathy and those with moderate or severe hypoperfusion. Hypoperfusion degree was the main issue factor to guide clinical decisions.

Echocardiographic findings and NT-proBNP level in type-2 diabetic patients with and without ischemic heart disease.

The aim of this study was to determine whether there are differences in echocardiographic findings or in the level of a biochemical marker (i.e. N-terminal probrain natriuretic peptide [NT-proBNP]) between controls and type-2 diabetic patients with or without ischemic heart disease. Echocardiography was used to assess left ventricular function and morphology. In addition, the plasma NT-proBNP concentration was measured. The prevalence of diastolic dysfunction was greater in diabetics without ischemic heart disease than in controls (88% vs. 74%, respectively; P< .001) and the NT-proBNP concentration was higher (350.6+/-197.8 vs. 281.7+/-190.4 fmol/mL; P< .001). Diabetics with ischemic heart disease had a higher NT-proBNP concentration than those without (720.4+/-278.1 vs. 350.6+/-197.8 fmol/mL, respectively; P< .001). An NT-proBNP concentration >490 fmol/mL had a sensitivity of 84% and a specificity of 75% for detecting ischemic heart disease in diabetics.