RESUMO
The complete transposition of the great arteries (C-TGA) is a congenital cardiac anomaly characterized by the reversal of the main arteries. Early detection and precise management are crucial for optimal outcomes. This review emphasizes the integral role of multimodal imaging, including fetal echocardiography, transthoracic echocardiography (TTE), cardiovascular magnetic resonance (CMR), and cardiac computed tomography (CCT) in the diagnosis, treatment planning, and long-term follow-up of C-TGA. Fetal echocardiography plays a pivotal role in prenatal detection, enabling early intervention strategies. Despite technological advances, the detection rate varies, highlighting the need for improved screening protocols. TTE remains the cornerstone for initial diagnosis, surgical preparation, and postoperative evaluation, providing essential information on cardiac anatomy, ventricular function, and the presence of associated defects. CMR and CCT offer additional value in C-TGA assessment. CMR, free from ionizing radiation, provides detailed anatomical and functional insights from fetal life into adulthood, becoming increasingly important in evaluating complex cardiac structures and post-surgical outcomes. CCT, with its high-resolution imaging, is indispensable in delineating coronary anatomy and vascular structures, particularly when CMR is contraindicated or inconclusive. This review advocates for a comprehensive imaging approach, integrating TTE, CMR, and CCT to enhance diagnostic accuracy, guide therapeutic interventions, and monitor postoperative conditions in C-TGA patients. Such a multimodal strategy is vital for advancing patient care and improving long-term prognoses in this complex congenital heart disease.
RESUMO
Objectives: The UEFA 2020 European Football Championship held in multiple cities across Europe from June 11 to July 11, 2021, was won by Italy, providing an opportunity to examine the relationship between emotional stress and the incidence of acute cardiovascular events (ACE). Methods and results: Cardiovascular hospitalizations in the Cardiac Care Units of 49 hospital networks in Italy were assessed by emergency physicians during the UEFA Euro 2020 Football Championship. We compared the events that occurred during matches involving Italy with events that occurred during the remaining days of the championship as the control period. ACE was assessed in 1,235 patients. ACE during the UEFA Euro 2020 Football Championship semifinal and final, the most stressful matches ended with penalties and victory of the Italian team, were assessed. A significant increase in the incidence of Takotsubo Syndrome (TTS) by a factor of 11.41 (1.6-495.1, P < 0.003), as compared with the control period, was demonstrated during the semifinal and final, whereas no differences were found in the incidence of ACS [IRR 0.93(0.74-1.18), P = 0.57]. No differences in the incidence of ACS [IRR 0.98 (0.87-1.11; P = 0.80)] or TTS [IRR 1.66(0.80-3.4), P = 0.14] were found in the entire period including all matches of the UEFA Euro 2020 compared to the control period. Conclusions: The data of this national registry demonstrated an association between the semifinal and final of UEFA Euro 2020 and TTS suggesting that it can be triggered by also positive emotions such as the victory in the European Football Championship finals.
RESUMO
BACKGROUND AND OBJECTIVES: The most advanced technologies and continuous innovations in the medical field require a necessary interaction between the clinical and the engineering world. In this context, software applications are proposed as a bridge between the two scientific fields and, therefore, as powerful tools, easy to use, and with great analytical skills. In this work, we propose CBRA as an innovative software platform, moving towards personalized medicine, which aims to simplify and speed up the triage of patients and support doctors in the diagnostic and prognostic phase. METHODS: The computational core of the devised software application consists of a model-based identification algorithm, which enables the reconstruction of the cardiac biomarkers release curves in patients with ST-Elevation Acute Myocardial Infarction (STEMI). Identification and parametric optimization techniques allow the application of the proposed approach to each singular patient: based on a few experimental acquisitions, CBRA can extrapolate several quantitative features of high clinical relevance, thus facilitating and rendering more objective the clinical evaluation and therapeutic choices. A dedicated database to collect and manage patients clinical and personal data, as well as a graphical user interface, provides clinicians and researchers with an intuitive and user-friendly environment. RESULTS: In the following work, we present some examples of the possible applications of CBRA, ranging from the management of the cardiac biomarkers time-series, up to the real analysis of the clinical features that CBRA can extract from the reconstructed curve, such as, e.g., maximum concentration values of biomarkers in the plasma and relative times, in the distinct phases of the acute myocardial infarction, or identification of the time to onset of symptoms. CONCLUSIONS: CBRA makes it easy for clinicians to use modeling and parametric identification tools to reconstruct release curves. Furthermore, CBRA provides support to the clinical decision, thanks to its capability to extract information of high clinical relevance, not easily obtainable from the mere visual analysis of experimental samples. Having information about the previously listed clinical parameters could allow, e.g., identify in which stage of AMI the patient is, when She/He goes to the emergency room, with significant benefits in the therapy.