Are Aortic Root and Ascending Aorta Diameters Measured by the Pediatric versus the Adult American Society of Echocardiography Guidelines Interchangeable?

Ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. However, there is no uniformity among experts regarding ascending aorta diameter quantification by echocardiography. The aim of this study was to compare maximum aortic root and ascending aorta diameters determined by the diastolic leading edge (DLE) and the systolic inner edge (SIE) conventions in adult and pediatric patients with inherited cardiovascular diseases. Transthoracic echocardiograms were performed in 328 consecutive patients (260 adults and 68 children). Aorta diameters were measured twice at the root and ascending aorta by the DLE convention following the 2015 American Society of Echocardiography (ASE) adult guidelines and the SIE convention following the 2010 ASE pediatric guidelines. Comparison of the diameters measured by the two conventions in the overall population showed a non-significant underestimation of the diameter measured by the SIE convention at root level of 0.28 mm (CI -1.36; 1.93) and at tubular ascending aorta level of 0.17 mm (CI -1.69; 2.03). Intraobserver and interobserver variability were excellent. Maximum aorta diameter measured by the leading edge convention in end-diastole and the inner edge convention in mid-systole had similar values to a mild non-significant underestimation of the inner-to-inner method that permits them to be interchangeable when used in clinical practice.

Predictive Value of Cardiac Magnetic Resonance Feature Tracking after Acute Myocardial Infarction: A Comparison with Dobutamine Stress Echocardiography.

In acute ST-segment elevation myocardial infarction (STEMI) late gadolinium enhancement (LGE) may underestimate segmental functional recovery. We evaluated the predictive value of cardiac magnetic resonance (CMR) feature-tracking (FT) for functional recovery and whether it incremented the value of LGE compared to low-dose dobutamine stress echocardiography (LDDSE) and speckle-tracking echocardiography (STE). Eighty patients underwent LDDSE and CMR within 5-7 days after STEMI and segmental functional recovery was defined as improvement in wall-motion at 6-months CMR. Optimal conventional and FT parameters were analyzed and then also applied to an external validation cohort of 222 STEMI patients. Circumferential strain (CS) was the strongest CMR-FT predictor and addition to LGE increased the overall accuracy to 74% and was especially relevant in segments with 50-74% LGE (AUC 0.60 vs. 0.75, p = 0.001). LDDSE increased the overall accuracy to 71%, and in the 50-74% LGE subgroup improved the AUC from 0.60 to 0.69 (p = 0.039). LGE + CS showed similar value as LGE + LDDSE. In the validation cohort, CS was also the strongest CMR-FT predictor of recovery and addition of CS to LGE improved overall accuracy to 73% although this difference was not significant (AUC 0.69, p = 0.44). Conclusion: CS is the strongest CMR-FT predictor of segmental functional recovery after STEMI. Its incremental value to LGE is comparable to that of LDDSE whilst avoiding an inotropic stress agent. CS is especially relevant in segments with 50-74% LGE where accuracy is lower and further testing is frequently required to clarify the potential for recovery.

Stroke patients with cardiac atrial septal abnormalities: differential infarct patterns on DWI.

BACKGROUND: Stroke mechanism in patent foramen ovale (PFO) and/or atrioseptal aneurysm (ASA) remains unclear. We aimed to study the stroke pattern on diffusion weighted imaging (DWI), in cryptogenetic stroke according to septal abnormalities. METHODS: We prospectively evaluated 314 cryptogenetic strokes. Patients were categorized according to transesophageal echocardiography (TEE) findings: PFO with ASA, PFO alone, and no abnormalities. The study group consisted of 126 patients with acute DWI lesions within the first 7 days after the stroke onset. We considered the presence of scattered lesions or a cortico-subcortical territorial lesion as highly suggestive of an embolic pattern. RESULTS: PFO was identified in 77 patients (61%) and no alterations in 49 patients (39%). TEE revealed ASA in 42 patients (54.5% of PFO patients). An "embolic" pattern was depicted in 84 (66.7%) and subcortical in 42 (33.3%). An "embolic" pattern was significantly (P= .01) more frequently seen in PFO with ASA patients (n= 37;44%) as compared to PFO without ASA (n= 22; 26.2%) or no abnormalities (n= 25; 29.8%) on TEE. Univariate analysis revealed that age (P= .06), hyperlipidemia (P= .04), degree of shunt on TEE (P= .002), and the presence of an ASA (P= .008) were associated with an embolic pattern. After adjusting for sex, age, and vascular risk factors, only the presence of PFO, with ASA (OR 7.27; 95% CI 1.5-35.22 P= .014) was independently associated with an embolic pattern. CONCLUSION: In patients with cryptogenetic stroke, the presence of PFO with ASA, but not isolated PFO, is associated with an embolic pattern on DWI. These findings provide insights into the patho-mechanism of stroke in patients with PFO.

[Functional outcome after one year follow-up in cryptogenetic brain infarction and patent foramen ovale]. / Pronóstico funcional tras un año de seguimiento en pacientes con infarto cerebral de causa desconocida y foramen oval permeable.

BACKGROUND AND OBJECTIVE: The presence of patent foramen ovale (PFO) and atrioseptal aneurysm (ASA)has been described as a risk factor in cryptogenetic stroke. Patients with unknown origin stroke and PFO have less severe symptoms compared to the rest of cryptogenetic stroke patients. We evaluated the clinical situation in stroke patients with PFO and describe the factors predictive of a better outcome after a year. PATIENTS AND METHOD: 1118 patients between 18 and 70 years old were evaluated, and 223 were classified as having cryptogenetic stroke. Our protocol Included transcranial Doppler, a transesophageal echocardiography (TEE) and a cranial RM. We used the NIH Stroke Scale (NIHSS) to evaluate the clinical situation, and the modified Ranking Scale for the functional outcome. RESULTS: A total of 117 patients had all inclusion criteria. 66 (56.4%) showed a PFO. We observed a younger age, a higher percentage of females (48.4% in PFO vs. 25.5% in no-PFO) and less risk factors in PFO patients, except for migraine (24.6% in PFO vs. 5.9% in no-PFO; p = 0.01). PFO patients had less severe strokes (NIHSS: 3--median--in PFO vs. 5 in no-PFO; p = 0.010) and a lower grade of sequelae (p 0.024). Worse outcome was related to male, initial neurological evaluation (NIHSS) and presence of ASA. After a logistic regression, only the initial clinical situation (NIHSS) and the presence of ASA were associated with sequelae. CONCLUSIONS: PFO patients showed a less severe stroke and better functional outcome. The initial neurological involvement and the presence of ASA are predictive of the clinical situation after a year.

Single intracoronary injection of encapsulated antagomir-92a promotes angiogenesis and prevents adverse infarct remodeling.

BACKGROUND: Small and large preclinical animal models have shown that antagomir-92a-based therapy reduces early postischemic loss of function, but its effect on postinfarction remodeling is not known. In addition, the reported remote miR-92a inhibition in noncardiac organs prevents the translation of nonvectorized miR-targeted therapy to the clinical setting. We investigated whether a single intracoronary administration of antagomir-92a encapsulated in microspheres could prevent deleterious remodeling of myocardium 1 month after acute myocardial infarction AUTHOR: Should "acute" be added before "myocardial infarction" (since abbreviation is AMI)? Also check at first mention in main text (AMI) without adverse effects. METHODS AND RESULTS: In a percutaneous pig model of reperfused AMI, a single intracoronary administration of antagomir-92a encapsulated in specific microspheres (9 µm poly-d,-lactide-co-glycolide [PLGA]) inhibited miR-92a in a local, selective, and sustained manner (n=3 pigs euthanized 1, 3, and 10 days after treatment; 8×, 2×, and 5×-fold inhibition at 1, 3, and 10 days). Downregulation of miR-92a resulted in significant vessel growth (n=27 adult minipigs randomly allocated to blind receive encapsulated antagomir-92a, encapsulated placebo, or saline [n=8, 9, 9]; P=0.001), reduced regional wall-motion dysfunction (P=0.03), and prevented adverse remodeling in the infarct area 1 month after injury (P=0.03). Intracoronary injection of microspheres had no significant adverse effect in downstream myocardium in healthy pigs (n=2), and fluorescein isothiocyanate albumin-PLGA microspheres were not found in myocardium outside the left anterior descending coronary artery territory (n=4) or in other organs (n=2). CONCLUSIONS: Early single intracoronary administration of encapsulated antagomir-92a in an adult pig model of reperfused AMI prevents left ventricular remodeling with no local or distant adverse effects, emerging as a promising therapeutic approach to translate to patients who suffer a large AMI.

[Coronary angiography by 16-slice computed tomography prior to valvular surgery]. / Coronariografía mediante tomografía computarizada de 16 detectores antes de la cirugía de recambio valvular.

INTRODUCTION AND OBJECTIVES: Multislice computed tomography is an excellent technique for the detection of significant coronary artery lesions. Our purpose was to assess whether computed tomography could replace routine invasive coronariography before valvular surgery. METHODS: We studied 106 consecutive patients (mean age: 67 [10]): 76% aortic valvular disease (62% stenosis, 14% regurgitation), 20% mitral valvular disease (4% stenosis, 16% regurgitation), and 4% mitro-aortic disease. Non-invasive studies were performed by helical computed tomography. Eighty-four percent of patients were in sinus rhythm (40% using beta-blockers, 32% nitrates). Findings from both techniques were analyzed according to a predetermined segmented anatomical model of the coronary artery (a total of 1802 segments). RESULTS: The incidence of coronary artery disease in these patients was 30%. Using computed tomography, 96.8% of segments could be evaluated and 3.2% could not. Calcium score ranged from 0 to 7572 (median: 182). In the per patient analysis, computed tomography showed a sensitivity of 95%, specificity 94%, positive predictive value 84%, and negative predictive value 98%. CONCLUSIONS: Computed tomography is an excellent technique for ruling out coronary lesions prior to valvular surgery, making an invasive study unnecessary if the quality of the study is good and the result is negative.