RESUMO
Video-based monitoring is essential nowadays in cattle farm management systems for automated evaluation of cow health, encompassing body condition scores, lameness detection, calving events, and other factors. In order to efficiently monitor the well-being of each individual animal, it is vital to automatically identify them in real time. Although there are various techniques available for cattle identification, a significant number of them depend on radio frequency or visible ear tags, which are prone to being lost or damaged. This can result in financial difficulties for farmers. Therefore, this paper presents a novel method for tracking and identifying the cattle with an RGB image-based camera. As a first step, to detect the cattle in the video, we employ the YOLOv8 (You Only Look Once) model. The sample data contains the raw video that was recorded with the cameras that were installed at above from the designated lane used by cattle after the milk production process and above from the rotating milking parlor. As a second step, the detected cattle are continuously tracked and assigned unique local IDs. The tracked images of each individual cattle are then stored in individual folders according to their respective IDs, facilitating the identification process. The images of each folder will be the features which are extracted using a feature extractor called VGG (Visual Geometry Group). After feature extraction task, as a final step, the SVM (Support Vector Machine) identifier for cattle identification will be used to get the identified ID of the cattle. The final ID of a cattle is determined based on the maximum identified output ID from the tracked images of that particular animal. The outcomes of this paper will act as proof of the concept for the use of combining VGG features with SVM is an effective and promising approach for an automatic cattle identification system.
Assuntos
Gravação em Vídeo , Animais , Bovinos , Gravação em Vídeo/métodos , Inteligência Artificial , Sistemas de Identificação Animal/métodos , Sistemas de Identificação Animal/instrumentação , Máquina de Vetores de Suporte , Indústria de Laticínios/métodos , Feminino , Processamento de Imagem Assistida por Computador/métodosRESUMO
Recent advancements in machine learning and deep learning have revolutionized various computer vision applications, including object detection, tracking, and classification. This research investigates the application of deep learning for cattle lameness detection in dairy farming. Our study employs image processing techniques and deep learning methods for cattle detection, tracking, and lameness classification. We utilize two powerful object detection algorithms: Mask-RCNN from Detectron2 and the popular YOLOv8. Their performance is compared to identify the most effective approach for this application. Bounding boxes are drawn around detected cattle to assign unique local IDs, enabling individual tracking and isolation throughout the video sequence. Additionally, mask regions generated by the chosen detection algorithm provide valuable data for feature extraction, which is crucial for subsequent lameness classification. The extracted cattle mask region values serve as the basis for feature extraction, capturing relevant information indicative of lameness. These features, combined with the local IDs assigned during tracking, are used to compute a lameness score for each cattle. We explore the efficacy of various established machine learning algorithms, such as Support Vector Machines (SVM), AdaBoost and so on, in analyzing the extracted lameness features. Evaluation of the proposed system was conducted across three key domains: detection, tracking, and lameness classification. Notably, the detection module employing Detectron2 achieved an impressive accuracy of 98.98%. Similarly, the tracking module attained a high accuracy of 99.50%. In lameness classification, AdaBoost emerged as the most effective algorithm, yielding the highest overall average accuracy (77.9%). Other established machine learning algorithms, including Decision Trees (DT), Support Vector Machines (SVM), and Random Forests, also demonstrated promising performance (DT: 75.32%, SVM: 75.20%, Random Forest: 74.9%). The presented approach demonstrates the successful implementation for cattle lameness detection. The proposed system has the potential to revolutionize dairy farm management by enabling early lameness detection and facilitating effective monitoring of cattle health. Our findings contribute valuable insights into the application of advanced computer vision methods for livestock health management.
Assuntos
Algoritmos , Doenças dos Bovinos , Coxeadura Animal , Máquina de Vetores de Suporte , Animais , Bovinos , Coxeadura Animal/diagnóstico , Doenças dos Bovinos/diagnóstico , Processamento de Imagem Assistida por Computador/métodos , Aprendizado Profundo , Aprendizado de Máquina , Gravação em Vídeo/métodosRESUMO
AIM: This study aimed to verify the real-world efficacy and safety of quetiapine fumarate extended-release tablets (Bipresso® 50 mg and 150 mg; marketing authorization holder is KYOWA Pharmaceutical Industry Co., Ltd., Osaka, Japan) in patients with bipolar depression. METHODS: We performed a post-marketing surveillance with an observation period of 12 weeks. RESULTS: In the safety analysis group (n = 345), adverse drug reactions (ADRs) occurred in 111 patients (32.17%). The most common ADRs (>1%) were somnolence in 55 patients (15.94%), akathisia in 11 (3.19%), dizziness in 10 (2.90%), weight increase in 6 (1.74%), thirst in 5 (1.45%), and hypersomnia, constipation, and nausea in 4 patients each (1.16%). The only severe ADR was one patient of suicidal ideation, and "longer time since the onset of the first episode" (p = 0.011) and "presence of complications" (p < 0.001) were identified as significant risk factors for the occurrence of ADRs. In the efficacy analysis group (n = 265), the average changes from baseline in the total Montgomery-Åsberg Depression Rating Scale (MADRS) score were -7.3 ± 8.8, -12.2 ± 10.7, -16.8 ± 12.7, and -13.2 ± 12.7 points after 4, 8, and 12 weeks, and at the last evaluation, respectively. The mean MADRS total score decrease had no significant association with maximum daily dose, diagnosis, and presence or absence of prior or concomitant treatment for bipolar disorder with mood stabilizers/antipsychotics/antidepressants. CONCLUSION: The efficacy of quetiapine fumarate extended-release tablets was confirmed in clinical practice, and no new safety concerns or risks were identified.
Assuntos
Antipsicóticos , Transtorno Bipolar , Preparações de Ação Retardada , Vigilância de Produtos Comercializados , Fumarato de Quetiapina , Humanos , Fumarato de Quetiapina/administração & dosagem , Fumarato de Quetiapina/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Masculino , Feminino , Preparações de Ação Retardada/administração & dosagem , Pessoa de Meia-Idade , Adulto , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Comprimidos , Idoso , Resultado do Tratamento , Adulto Jovem , Japão/epidemiologiaRESUMO
This study innovates livestock health management, utilizing a top-view depth camera for accurate cow lameness detection, classification, and precise segmentation through integration with a 3D depth camera and deep learning, distinguishing it from 2D systems. It underscores the importance of early lameness detection in cattle and focuses on extracting depth data from the cow's body, with a specific emphasis on the back region's maximum value. Precise cow detection and tracking are achieved through the Detectron2 framework and Intersection Over Union (IOU) techniques. Across a three-day testing period, with observations conducted twice daily with varying cow populations (ranging from 56 to 64 cows per day), the study consistently achieves an impressive average detection accuracy of 99.94%. Tracking accuracy remains at 99.92% over the same observation period. Subsequently, the research extracts the cow's depth region using binary mask images derived from detection results and original depth images. Feature extraction generates a feature vector based on maximum height measurements from the cow's backbone area. This feature vector is utilized for classification, evaluating three classifiers: Random Forest (RF), K-Nearest Neighbor (KNN), and Decision Tree (DT). The study highlights the potential of top-view depth video cameras for accurate cow lameness detection and classification, with significant implications for livestock health management.
RESUMO
Ensuring precise calving time prediction necessitates the adoption of an automatic and precisely accurate cattle tracking system. Nowadays, cattle tracking can be challenging due to the complexity of their environment and the potential for missed or false detections. Most existing deep-learning tracking algorithms face challenges when dealing with track-ID switch cases caused by cattle occlusion. To address these concerns, the proposed research endeavors to create an automatic cattle detection and tracking system by leveraging the remarkable capabilities of Detectron2 while embedding tailored modifications to make it even more effective and efficient for a variety of applications. Additionally, the study conducts a comprehensive comparison of eight distinct deep-learning tracking algorithms, with the objective of identifying the most optimal algorithm for achieving precise and efficient individual cattle tracking. This research focuses on tackling occlusion conditions and track-ID increment cases for miss detection. Through a comparison of various tracking algorithms, we discovered that Detectron2, coupled with our customized tracking algorithm (CTA), achieves 99% in detecting and tracking individual cows for handling occlusion challenges. Our algorithm stands out by successfully overcoming the challenges of miss detection and occlusion problems, making it highly reliable even during extended periods in a crowded calving pen.
Assuntos
Algoritmos , Processamento de Imagem Assistida por Computador , Bovinos , Animais , Gravação em VídeoRESUMO
BACKGROUND: Recently, post-exercise diastolic stunning (PES) has been reported as a new clinical marker of induced ischemia. Velocity vector imaging (VVI) has been developed to visualize regional wall motion abnormalities based on vectors detected by the tissue tracking technique, which has the potential to visualize PES. Thus, the aim of this study was to evaluate the usefulness of PES detection by VVI as an objective marker of ischemia compared to stress thallium-201 (Tl-201) single photon emission computed tomography (SPECT). METHODS: We studied consecutive patients who were scheduled to undergo exercise stress Tl-201 SPECT for the diagnosis of ischemic heart disease. Transthoracic echocardiography was recorded digitally before and 20 min after exercise for Tl-201 SPECT, and the data were used subsequently for VVI analysis. We defined PES regions as those with new abnormal vectors observed during isovolumic relaxation. RESULTS: After excluding 14 patients with old myocardial infarction and/or atrial fibrillation, echocardiograms suitable for VVI analysis were obtained from 62 of 65 patients (feasibility, 95 %; 44 men; mean age, 64 ± 11 years). SPECT revealed induced ischemia in 20 patients, whereas VVI identified PES in 18 patients. VVI detected inducible ischemia with 85 % sensitivity and 98 % specificity compared to SPECT. CONCLUSIONS: VVI detection of PES is a new clinical tool for induced ischemia. Regional diastolic wall motion abnormalities following induced ischemia can be noninvasively detected by VVI.
RESUMO
BACKGROUND: Anticoagulation therapy reduces the risk of thromboembolic events by two-thirds in patients with atrial fibrillation (AF). The prevalence of left atrial thrombus (LAT) in AF patients with anticoagulation therapy has not been fully investigated. PURPOSE: To investigate the prevalence of LAT and its impact on the outcomes in patients with nonvalvular AF after anticoagulation therapy. METHODS: This study consisted of 231 patients with nonvalvular AF who had transthoracic (TTE) and transesophageal echocardiographic (TEE) examinations more than 3 weeks after anticoagulation therapy. The clinical and echocardiographic characteristics were evaluated. RESULTS: LAT was observed in 13 (8.8%) of 148 patients with sub-therapeutic anticoagulation, and in 3 (3.6%) of 83 patients with sufficient anticoagulation. The presence of LAT was associated with higher CHADS(2) score, decreased LA volume changes and the presence of spontaneous echocardiographic contrast (SEC) in patients with sub-therapeutic anticoagulation. Patients with LAT after sufficient anticoagulation were male with permanent AF who had decreased left ventricular systolic and diastolic function and dilated LA on TTE and SEC, and reduced appendage flow velocity on TEE. Patients with LAT had worse cardiovascular outcomes compared with those without LAT (p=0.02). CONCLUSIONS: We demonstrated that LAT was a univariate risk factor associated with worse cardiovascular outcomes, which was observed in 8.8% of patients with sub-therapeutic anticoagulation and 3.6% of patients with sufficient anticoagulation.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/tratamento farmacológico , Átrios do Coração , Cardiopatias/diagnóstico por imagem , Cardiopatias/prevenção & controle , Trombose/diagnóstico por imagem , Trombose/prevenção & controle , Idoso , Fibrilação Atrial/complicações , Ecocardiografia Transesofagiana , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologiaRESUMO
Little is known about the changes in the coronary flow velocity reserve (CFVR) of the left anterior descending artery (LAD) before and after coronary artery bypass grafting (CABG). The present study aimed to evaluate the feasibility of measuring the CFVR of the LAD using transthoracic Doppler echocardiography before and after CABG. We prospectively measured the CFVR before and after CABG in 56 patients. The flow velocity in the LAD was measured using transthoracic Doppler echocardiography both at rest and during intravenous infusion of adenosine. The CFVR was calculated as the ratio of hyperemic to the basal peak and mean diastolic flow velocities. Coronary angiography was also performed to assess graft patency after CABG in all patients. Furthermore, we compared the differences between the pre- and postoperative CFVR in patients with and without a diffusely diseased LAD (lesion length >2 cm). All grafts were angiographically patent. The postoperative peak and mean CFVR were significantly increased compared to the preoperative peak and mean CFVR (both peak and mean 2.7 ± 0.9 vs 1.5 ± 0.6, respectively; p<0.0001). The preoperative peak CFVR was significantly lower in patients with a diffusely diseased LAD than in those without a diffusely diseased LAD (1.3 ± 0.5 vs 1.6 ± 0.5, respectively; p=0.04). The postoperative peak CFVR of the 2 groups was almost identical (2.5 ± 0.6 vs 2.9 ± 1.0; p=0.07). In conclusion, assessment of the CFVR of the LAD using transthoracic Doppler echocardiography was useful after CABG for confirming graft patency.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária , Idoso , Velocidade do Fluxo Sanguíneo , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: Delayed enhancement cardiovascular magnetic resonance (DE-CMR) can detect cardiac scarring and has the potential to visualize the progression of myocardial remodeling. We determined whether DE-CMR can predict cardiac events in dilated cardiomyopathy patients. MATERIALS AND METHODS: Transthoracic echocardiography, coronary arteriography, and DE-CMR studies were performed in 60 consecutive dilated cardiomyopathy (DCM) patients. Percent delayed enhancement (%DE) was determined as the ratio of the area showing delayed enhancement to the total myocardial area in three short-axis views. Patients were classified as advanced group (Group A) when %DE was 10% or higher, and as non-advanced group (Group NA) when %DE was less than 10%. The incidence of cardiac events and the clinical history were compared between Group A and Group NA. RESULTS: There were 11 patients in Group A and 49 patients in Group NA. The incidence of cardiac events was significantly higher in Group A (36%; 4/11 patients) than in Group NA (2.0%; 1/49 patients) (log rank, p=0.0001). CONCLUSION: DE-CMR is a useful tool to predict cardiac events in DCM patients.
Assuntos
Cardiomiopatia Dilatada/diagnóstico , Imageamento por Ressonância Magnética/métodos , Remodelação Ventricular , Doença Aguda , Idoso , Cardiomiopatia Dilatada/epidemiologia , Angiografia Coronária , Ecocardiografia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
A 74-year-old woman presented with effort-induced chest pain. Diagnostic coronary angiography revealed three-vessel disease. A successful angioplasty was performed with two sirolimus-eluting stents placed in the left anterior descending artery (LAD) and left circumflex artery (LCX). The right coronary artery (RCA) was treated with a bare-metal stent. Follow-up angiography and intravascular ultrasound (IVUS) assessment were performed 8 months later, which showed late stent malapposition (LSM) with marked positive vascular remodeling around the drug-eluting stents (DES) in both LAD and LCX lesions, but there was no evidence of ectatic area around the BMS in the RCA lesion. Compared with the baseline IVUS, a significant increase in external elastic membrane (EEM) cross-sectional area was found. Twenty-seven months later, we performed repeat follow-up angiography. Intravascular ultrasound still showed vessel malapposition. A previous report showed that aneurysmal dilatation of the stented segment with severe localized hypersensitivity reaction could be a potential cause of late thrombosis after DES implantation. If LSM is related to hypersensitivity of the DES, it may have a potential risk of adverse events. Although there is a paucity of data regarding malapposition as the cause of adverse events, careful long-term follow-up of patients with vessel enlargement after DES placement is recommended.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Stents , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Fármacos Cardiovasculares/administração & dosagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Stents Farmacológicos/efeitos adversos , Feminino , Humanos , Hipersensibilidade/etiologia , Hipersensibilidade/patologia , Metais , Desenho de Prótese , Índice de Gravidade de Doença , Sirolimo/administração & dosagem , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: The maze procedure for the treatment of atrial fibrillation (AF) is a widely used adjunctive therapy. It is necessary to define the precise indications for the procedure based on preoperative factors, but definitive parameters in terms of atrial function have not been well determined. METHODS AND RESULTS: In the present study, 55 consecutive patients undergoing the maze procedure for persistent AF in combination with operations for organic heart diseases were evaluated. After dividing the patients into successful (n=41) and unsuccessful procedure (n=14) groups, based on the postoperative rhythm, the preoperative left atrial (LA) emptying fraction measured by transthoracic 2-dimensional echocardiogram was compared between groups. The LA emptying fraction was calculated as [(LA maximum volume - LA minimum volume)/LA maximum volume]x100. The preoperative LA emptying fraction was higher in the successful procedure group than in the unsuccessful procedure group (31.2+/-8.5 vs 21.4+/-10.9%, P=0.0011). Based on receiver-perating characteristic curve analyses, LA emptying fraction >26% predicted successful maze procedure with 70.7% sensitivity and 78.6% specificity. CONCLUSIONS: LA emptying fraction should be considered in the precise indications of the maze procedure as adjunctive therapy.
Assuntos
Fibrilação Atrial/cirurgia , Circulação Sanguínea/fisiologia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Átrios do Coração/fisiopatologia , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: In the era of drug-eluting stents, percutaneous coronary intervention (PCI) has been considered an established therapeutic modality for patients with coronary artery disease (CAD). However, little is known about the long-term prognosis. METHODS AND RESULTS: Using data obtained from a single-center registry for cases of first-generation bare metallic stent (BMS) implantation, a 10-year follow-up study in patients with CAD was performed. Data for 125 serial patients (aged 62+/-9 years, 104 males) in whom a BMS was successfully implanted was analyzed. Cardiac death (n=16 [12.8%]), including sudden cardiac death (n=9 [7.2%]), non-cardiac death (n=17 [13.6%]) and non-fatal acute myocardial infarction (n=16 [12.8%]) were documented. At 10 years, cumulative probabilities of target and non-target lesion revascularization were 20.5% and 41.5%, respectively, and only 39.2% of the patients were free from cardiac events (cardiac death/myocardial infarction/unplanned revascularization). Age and left ventricular ejection fraction (LVEF) were significant predictors of total death, and LVEF and the use of diuretics were predictors of cardiac events. CONCLUSIONS: Stabilization of the initial stented site was relatively good and the majority of cardiac events might have originated in non-target lesions. Prevention of systemic arteriosclerosis progression is important for patients with CAD, even after successful PCI.
Assuntos
Angioplastia Coronária com Balão , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Doença Aguda , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Arteriosclerose/mortalidade , Arteriosclerose/prevenção & controle , Doença da Artéria Coronariana/complicações , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Stents Farmacológicos/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Sistema de Registros , Taxa de Sobrevida , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/terapiaRESUMO
Our series of studies aimed to examine the possibility of interactions between prescription drugs and over-the-counter (OTC) drugs by monitoring plasma drug concentrations in rats. When a levodopa preparation indicated for patients with Parkinson's disease was administered in combination with Takeda Kampo Ichoyaku K-matsu (A), Taisho Kampo Ichoyaku (B), or Kanebo Kampo Ichoyaku H(C), which are OTC kampo medicines for upset stomach, the plasma levodopa concentration-time curves were shifted downward and the AUC for levodopa was significantly lowered. These results indicate that there may be some interactions between the levodopa preparation and these OTC kampo medicines when ingested together, which leads to a reduction in the bioavailability of levodopa. On the other hand, concomitant administration of the levodopa preparation with Takeda Kampo Ichoyaku A-matsu (D) did not alter any of the pharmacokinetic parameters for levodopa. According to the package inserts for the OTC kampo medicines, A, B and C, but not D, contain metallic additives, such as aluminum silicate and magnesium stearate. In addition, combination with a kampo basis of D (Koshaheiisan-ka-shakuyaku) showed no detectable change in levodopa bioavailability. From these results, it was concluded that metallic additives may play an essential role in generating the drug-interaction between levodopa preparation and OTC kampo medicine for upset stomach.
Assuntos
Medicamentos de Ervas Chinesas/farmacologia , Fármacos Gastrointestinais/farmacologia , Interações Ervas-Drogas , Levodopa/farmacocinética , Adjuvantes Farmacêuticos , Alumínio , Animais , Disponibilidade Biológica , Medicamentos de Ervas Chinesas/química , Fármacos Gastrointestinais/química , Magnésio , Masculino , Medicina Kampo , Medicamentos sem Prescrição , Ratos , Ratos WistarRESUMO
OBJECTIVES: This study investigated the relationship between serum homocysteine level and coronary artery disease in Japanese. METHODS: Serum homocysteine level was measured in 200 consecutive patients who underwent coronary angiography for the assessment of ischemic heart disease. Patients with acute myocardial infarction were excluded, so 197 patients were included in this study. The patients were classified into four groups based on number of diseased vessels identified by coronary angiography: no significant stenosis group (non-vessel group), one-vessel group, two-vessel group, and three-vessel group. More than 50% stenosis was defined as diseased vessels. RESULTS: Serum homocysteine level in the three-vessel group (13.5 +/- 8.0 microM) was significantly higher than that in the non-vessel group (9.9 +/- 2.7 microM), one-vessel group (9.1 +/- 2.3 microM), and two-vessel group (10.4 +/- 3.3 microM). Patients were classified into quartile groups according to the serum homocysteine level. The number of diseased vessels and frequency of three-vessel disease tended to be higher with increasing serum homocysteine level. There was no significant relationship between serum homocysteine level and coronary risk factors (diabetes mellitus, hyperlipidemia, smoking habit) except hypertension. Multivariate analysis for the predictor of number of diseased vessels showed diabetes mellitus, hypertension, and serum homocysteine level were independent predictors. CONCLUSIONS: Elevation of plasma homocysteine level is related to the severity of coronary artery disease in Japanese.
Assuntos
Doença da Artéria Coronariana/sangue , Homocisteína/sangue , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Diabetes Mellitus/sangue , Feminino , Humanos , Hiperlipidemias/sangue , Hipertensão/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Radiografia , Fatores de Risco , Índice de Gravidade de Doença , Fumar/sangueRESUMO
A 56-year-old man presented with sustained chest pain. Coronary angiography revealed total occlusion of the distal right coronary artery and left anterior descending branch. Left ventriculography depicted a mobile mass in the right sinus of Valsalva originating from the ostium of the right coronary artery. Transesophageal echocardiography (TEE) showed a mobile mass in the sinus of Valsalva and another mobile mass in the aortic arch. The mass at the right sinus of Valsalva was surgically resected, and histologic examination revealed an organized thrombus. Coagulation study showed protein S deficiency. This is the first case of acute myocardial infarction as a result of multiple coronary embolism caused by thrombosis in the right sinus of Valsalva with a second aortic arch thrombosis, contributed by protein S deficiency.
Assuntos
Embolia/complicações , Infarto do Miocárdio/etiologia , Seio Aórtico/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Angiografia Coronária , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Ecocardiografia Transesofagiana , Embolia/diagnóstico por imagem , Embolia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Varfarina/uso terapêuticoRESUMO
To assess the coronary flow velocity - pressure relationship distal to a stenosis, and to evaluate the influence of microvascular abnormalities on this relationship, coronary flow velocity and coronary pressure were measured simultaneously in 38 patients (42 vessels). The instantaneous peak coronary flow velocity was plotted against the simultaneous measured distal coronary pressure, and the slope of the relation in the phase of diastolic flow decrease was calculated as the flow - pressure slope index (FPSI) and the X-intercept of the slope was calculated as zero-flow pressure (Pzf). The slope of the curve increased from 2.0+/-2.6 to 4.5+/-4.1 (p<0.001) and the X-intercept decreased from 42+/-16 to 27+/-13 mmHg (p<0.001) after papaverine injection. After successful coronary intervention, Pzf increased from 23+/-10 to 35+/-11 (p<0.01) and FPSI decreased from 6.8+/-5.1 to 3.5+/-1.8 (p<0.05). Pzf was higher in patients with an old myocardial infarction. It is feasible to assess the relationship between coronary flow and pressure distal to a stenosis in the clinical setting, and the relationship may provide additional information regarding coronary microcirculation. Microvascular abnormalities may play an important role in the coronary flow - pressure relationship distal to stenosis.