RESUMEN
PURPOSE OF REVIEW: Mitral stenosis remains clinically relevant in developing countries where rheumatic heart disease is the predominant culprit. In the western world, mitral annular and valvular calcification is an increasingly recognized cause, particularly in an aging population. Echocardiography plays a primary role in imaging mitral stenosis with a growing role for cardiac computed tomography and magnetic resonance imaging. In this review, we aim to revisit mitral stenosis assessment and quantification using multimodality imaging. RECENT FINDINGS: There is an increasing role for advanced cardiac imaging especially in the era of transcatheter mitral valve intervention. Also, when echocardiography is suboptimal or discordant with symptoms, computed tomography can provide anatomical data, whereas magnetic resonance imaging can provide anatomical along with hemodynamic data. SUMMARY: Diagnosis of mitral stenosis is crucial as it carries an increased morbidity and mortality risk. Echocardiography is the cornerstone imaging modality with alternative, complementary advanced imaging considered when images are suboptimal.
Asunto(s)
Estenosis de la Válvula Mitral , Cardiopatía Reumática , Anciano , Ecocardiografía , Hemodinámica , Humanos , Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/diagnóstico por imagen , Cardiopatía Reumática/diagnóstico por imagenRESUMEN
PURPOSE OF REVIEW: Left ventricular systolic dysfunction because of coronary artery disease is common, and ascertaining which patients will benefit from revascularization can be challenging. Viability testing is an accepted means by which to base this decision, with multiple noninvasive imaging modalities available for this purpose. This review aims to highlight the key role of cardiac magnetic resonance in myocardial viability assessment, with a focus on its unique strengths over other imaging modalities. RECENT FINDINGS: Transmural extent of hyperenhancement with late gadolinium imaging has been shown to be greater acutely in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention and regress at follow-up studies. An explanation for this reported phenomenon and an argument against redefining CMR viability criteria in the acute setting will be offered. SUMMARY: Although not universally available, cardiac magnetic resonance is an exceptionally powerful and well tolerated imaging modality that should be considered when viability testing will influence patient management. Although observational outcomes data suggest a promising prognostic role for viability, randomized studies in this area are needed.
Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Medios de Contraste , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/cirugía , Humanos , Miocardio/metabolismo , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/fisiopatología , Infarto del Miocardio con Elevación del ST/cirugía , Supervivencia Tisular , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/cirugíaAsunto(s)
Cardiomiopatía Hipertrófica/diagnóstico por imagen , Ecocardiografía/métodos , Electrocardiografía/métodos , Corazón/diagnóstico por imagen , Imagen Multimodal/métodos , Isquemia Miocárdica/diagnóstico por imagen , Adulto , Calcio/química , Circulación Coronaria , Vasos Coronarios/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Factores de RiesgoRESUMEN
Cells from multiple origins contribute to vascular smooth muscle cell (VSMC) development. Phenotypic heterogeneity of VSMCs is associated with their point of developmental origin; however, the mechanisms driving such differences are unknown. We here examined the mechanisms controlling vascular bed-specific differences in Rgs5 expression during development. Rgs5 levels were similar across different regions of the vasculature in neonatal animals but were >15-fold higher in descending aortas compared with carotid arteries of adult mice. Thus, vessel bed-specific changes in regulation of Rgs5 expression occurred during vessel maturation. Examination of adult Rgs5-LacZ reporter mice revealed lower Rgs5 expression in VSMCs originating from the third (carotid artery) branchial arch compared with those originating in the fourth and sixth (aortic B segment, right subclavian, and ductus arteriosus) branchial arches. Indeed, a mosaic Rgs5 expression pattern, with discreet LacZ boundaries between VSMCs derived from different developmental origins, was observed. Furthermore, Rgs5-LacZ expression was correlated with the site of VSMC origin (splanchic mesoderm ≈ local mesenchyme > somites > proepicardium > mesothelium). Surprisingly, Rgs5 reporter activity in cultured carotid artery- and descending aorta-derived cells did not recapitulate the differences observed in vivo. Consistent with a developmental origin-specific epigenetic mechanism driving the observed expression differences in vivo, the Rgs5 promoter showed increased methylation on CpG dinucleotides in carotid arteries compared with that in descending aortas in adult but not in neonatal mice. In vitro methylation of the Rgs5 promoter confirmed that its activity is sensitive to transcriptional down-regulation by CpG methylation. These data suggest that an origin-dependent epigenetic program regulates vascular bed- and maturation state-dependent regulation of VSMC-specific gene transcription.
Asunto(s)
Aorta Torácica , Arterias Carótidas , Epigénesis Genética/fisiología , Neovascularización Fisiológica/genética , Proteínas RGS/genética , Proteínas RGS/metabolismo , Factores de Edad , Animales , Aorta Torácica/citología , Aorta Torácica/crecimiento & desarrollo , Aorta Torácica/fisiología , Arterias Carótidas/citología , Arterias Carótidas/crecimiento & desarrollo , Arterias Carótidas/fisiología , Diferenciación Celular/fisiología , Metilación de ADN/fisiología , Operón Lac/genética , Ratones , Ratones Endogámicos C57BL , Ratones Mutantes , Músculo Liso Vascular/citología , Músculo Liso Vascular/crecimiento & desarrollo , Músculo Liso Vascular/fisiología , Especificidad de Órganos , Fenotipo , Regiones Promotoras Genéticas/fisiología , ARN Mensajero/metabolismo , Transducción de Señal/fisiologíaRESUMEN
The diagnosis and management of myocardial infarction with nonobstructive coronary arteries (MINOCA) are difficult due to its variable presentations, different causes, and challenging diagnostic approaches. Cardiac imaging modalities including cardiac magnetic resonance (CMR) are very useful tools for diagnosing and managing MINOCA. Myocardial infarction (MI) can be caused by coronary emboli that can be contributed to atrial fibrillation (AF). Rarely, coronary embolism with resultant MINOCA can occur after directâ¯currentâ¯cardioversion (DCCV) even in fully anticoagulatedâ¯patients.â¯We present aâ¯rare case of a coronaryâ¯embolism following DCCV as well as a CMR finding ofâ¯microvascular obstructionâ¯(MVO),â¯which hasâ¯not previously been reportedâ¯after DCCV. This case also emphasizes theâ¯valueâ¯of obtaining a CMR for patients with MINOCA.
RESUMEN
A 77-year-old woman presented for assessment of symptomatic mitral regurgitation. Multimodality cardiac imaging revealed severe mitral regurgitation secondary to mitral valve prolapse. Significant mitral annular calcification with dramatic intramyocardial calcification was also incidentally discovered. She was then given a diagnosis of idiopathic cardiac osseous metaplasia and was managed conservatively. (Level of Difficulty: Advanced.).
RESUMEN
Pulmonary hypertension (PH) in adults with congenital heart disease (CHD) and significant systemic-to-pulmonary shunting is a significant cause of morbidity and mortality. Its pathophysiology is incompletely understood, but involves a flow-induced pulmonary arteriopathy characterized by endothelial cell dysfunction and vascular remodeling that alters pulmonary arterial vasoreactivity. There is a paucity of literature linking PH with left-to-right shunting due to ruptured sinus of Valsalva aneurysms (SOVA). We present a unique case of reversible, flow-associated PH due to a ruptured congenital right SOVA fistulizing into the right atrium (RA), with emphasis on non-invasive and invasive assessment of pulmonary hemodynamics before and after surgical intervention.
RESUMEN
BACKGROUND: The protective effect of beta-blockers in patients with inherited Long-QT syndrome is well established. Recent reports have suggested that beta-blockers are not equally effective in Long-QT (LQT). Bisoprolol is an attractive candidate for use in LQT because of its cardioselective properties and favorable side-effect profile. METHODS: We performed a retrospective cohort study of 114 consecutive patients with gene-positive Long-QT syndrome type 1 (LQT1) or Long-QT syndrome type 2 (LQT2) treated with bisoprolol, nadolol or atenolol with a total of 580 person-years of follow-up. Electrocardiogram (ECG) parameters and cardiac events during follow-up were compared. In addition, exercise treadmill testing was performed in bisoprolol-treated patients. RESULTS: Fifty-nine patients were treated with bisoprolol, 39 with atenolol and 16 with nadolol. Overall, 59 % were females and 62 % had LQT1. Baseline heart rate and corrected QT (QTc) interval were similar between the groups. QTc shortening was observed in individuals on bisoprolol (ΔQTc -5 ± 31 ms; p = 0.049) and nadolol (ΔQTc -13 ± 16 ms; p = 0.02) but not on atenolol (ΔQTc +9 ± 24 ms; p = 0.16). Median follow-up was similar for bisoprolol and nadolol (3 years), but longer for atenolol (6 years; p = 0.03); one cardiac event occurred in the bisoprolol group (1.7 %) and two events occurred in the atenolol group (5.1 %; p = 0.45), whereas none occurred in nadolol-treated patients. Beta-blocker efficacy was not affected by the underlying genotype. The antiadrenergic effect of bisoprolol correlated with the reduction of peak heart rates at exercise testing. CONCLUSIONS: Bisoprolol treatment results in QTc shortening in gene-positive LQT1 and LQT2 patients and is well tolerated during long-term administration. The equivalence of bisoprolol for protection from ventricular arrhythmia in LQT patients compared to established beta-blockers remains unknown. Further large-scale studies are required.
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Bisoprolol/administración & dosificación , Electrocardiografía/efectos de los fármacos , Síndrome de QT Prolongado/tratamiento farmacológico , Síndrome de Romano-Ward/diagnóstico , Síndrome de Romano-Ward/tratamiento farmacológico , Antagonistas de Receptores Adrenérgicos beta 1 , Adulto , Canadá , Cardiotónicos/administración & dosificación , Estudios de Cohortes , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Síndrome de QT Prolongado/diagnóstico , Masculino , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Aorta Torácica/diagnóstico por imagen , Aorta Torácica/patología , Aortitis/diagnóstico por imagen , Aortitis/patología , Angiografía por Resonancia Magnética , Adulto , Aorta Torácica/fisiopatología , Aorta Torácica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/cirugía , Aortitis/fisiopatología , Aortitis/cirugía , Biopsia , Implantación de Prótesis Vascular , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Valor Predictivo de las Pruebas , Resultado del TratamientoAsunto(s)
Neoplasias Cardíacas/diagnóstico por imagen , Lipoma/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada por Tomografía de Emisión de Positrones , Femenino , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/terapia , Humanos , Lipoma/patología , Lipoma/terapia , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Carga Tumoral , Espera VigilanteAsunto(s)
Imagen por Resonancia Magnética , Fenómeno de no Reflujo/diagnóstico por imagen , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST/terapia , Anciano , Angiografía Coronaria , Diagnóstico Diferencial , Stents Liberadores de Fármacos , Humanos , Masculino , Fenómeno de no Reflujo/etiología , Fenómeno de no Reflujo/fisiopatología , Intervención Coronaria Percutánea/instrumentación , Valor Predictivo de las Pruebas , Recurrencia , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/fisiopatología , Resultado del TratamientoAsunto(s)
Neoplasias Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Válvula Mitral/cirugía , Recurrencia Local de Neoplasia/cirugía , Reoperación , Sarcoma/cirugía , Trasplante Autólogo , Adulto , Ecocardiografía Transesofágica , Femenino , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/patología , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Imagen por Resonancia Magnética , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/patología , Válvula Mitral/trasplante , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/patología , Reoperación/métodos , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Trasplante Autólogo/métodosAsunto(s)
Anticoagulantes/uso terapéutico , Cardiomiopatía Hipertrófica/patología , Aneurisma Cardíaco/patología , Complicaciones Posoperatorias/patología , Obstrucción del Flujo Ventricular Externo/patología , Warfarina/uso terapéutico , Procedimientos Quirúrgicos Cardíacos , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Ecocardiografía , Femenino , Aneurisma Cardíaco/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Resultado del Tratamiento , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/etiología , Obstrucción del Flujo Ventricular Externo/cirugíaRESUMEN
Arrhythmogenic right ventricular cardiomyopathy/dysplasia is an inherited cardiomyopathy that is transmitted in autosomal dominant and autosomal recessive forms and involves mutations in desmosomal and extradesmosomal genes. We present a case of arrhythmogenic right ventricular cardiomyopathy that cosegregates in a Lebanese family with a previously unreported desmocollin-2 mutation (c.712_714delGAT). We believe this newly described genetic variant displays autosomal recessive inheritance without the cutaneous manifestations expected in recessive genotypes, and represents the latest addition to the compendium of desmosomal mutations with pathogenic potential.