RESUMO
BACKGROUND: Cardiac amyloidosis (CA) mimics left ventricular hypertrophy (LVH). It is treatable, but its prognosis is poor. A simple screening tool for CA would be valuable. CA is more precisely diagnosed with echocardiographic deformation parameters (e.g., relative apical sparing pattern [RASP]) than with conventional parameters. We aimed to 1) investigate incremental benefits of echocardiographic deformation parameters over established parameters for CA screening; 2) determine the resultant risk score for CA screening; and 3) externally validate the score in LVH patients. METHODS: We retrospectively studied 295 consecutive non-ischemic LVH patients who underwent detailed diagnostic tests. CA was diagnosed with biopsy or 99mTc-PYP scintigraphy. The base model comprised age (≥65 years [men], ≥70 years [women]), low voltage on the electrocardiogram, and posterior wall thickness ≥ 14 mm in reference to the literature. The incremental benefit of each binarized echocardiographic parameter over the base model was assessed using receiver operating characteristic curve analysis and comparisons of the area under the curve (AUC). RESULTS: Fifty-four (18%) patients had CA. RASP showed the most incremental benefit for CA screening over the base model. After conducting multiple logistic regression analysis for CA screening using four variables (RASP and base model components), a score was determined (range, 0-4 points). The score demonstrated adequate discrimination ability for CA (AUC = 0.86). This result was confirmed in another validation cohort (178 patients, AUC = 0.88). CONCLUSIONS: We developed a score incorporating RASP for CA screening. This score is potentially useful in the risk stratification and management of LVH patients.
Assuntos
Amiloidose , Hipertrofia Ventricular Esquerda , Idoso , Amiloidose/diagnóstico , Amiloidose/diagnóstico por imagem , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Estudos RetrospectivosRESUMO
BACKGROUNDS: The relative apical sparing pattern (RASP) of left ventricular (LV) longitudinal strain (LS) is frequently associated with cardiac amyloidosis (CA). However, the visual assessment of RASP is inconsistent, and the quantitative assessment of RASP is time-consuming. This study aimed to compare assessments of RASP for the identification of CA with conventional assessments and investigate their reproducibility and relevance on the assessments. METHODS: Forty patients with biopsy-proven CA were compared with 80 hypertrophied patients matched for mean LV wall thickness. We compared the discriminative abilities of three assessments of RASP to identify CA (visual, quantitative, and semiquantitative). Nine patterns of semiquantitative RASP were investigated; finally, it was defined as "reduction of LS" (≥ -10%) in ≥5 (of 6) basal segments, relative to "preserved LS" (< -15%) in at least one apical segment. RESULTS: The concordance between the two observers for visual RASP was modest (κ = 0.65). On the other hand, the consistency for semiquantitative RASP was perfect (κ = 1.00). The discriminative ability of semiquantitative RASP (area under the curve [AUC] = 0.74) was significantly better than that of visual RASP (AUC = 0.65) and equivalent to that of binary quantitative RASP. CONCLUSION: Semiquantitative RASP assessment is reproducible and accurately discriminates CA. This simple assessment may help readily refine the risk stratification of patients with diffuse LV hypertrophy.
Assuntos
Amiloidose , Cardiomiopatias , Amiloidose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Esquerda , Reprodutibilidade dos Testes , Função Ventricular EsquerdaRESUMO
OBJECTIVE: To establish a simple screening method for diabetes based on myoinositol (MI) in urine samples collected at home. RESEARCH DESIGN AND METHODS: Initially, we evaluated the stability of urinary MI (UMI) at room temperature (RT; 25°C) and 37°C in 10 outpatients with type 2 diabetes. We then enrolled 115 volunteers without a current or history of diabetes. In all subjects, glucose intolerance was diagnosed by 75 g oral glucose tolerance test (75gOGTT). To assess the association between UMI or urine glucose (UG) and plasma glucose (PG), urine samples were also collected at 0 and 2 hours during 75gOGTT. All the subjects collected urine samples at home before and 2 hours after consuming the commercially available test meal. UMI levels at wake-up time (UMIwake-up), before (UMIpremeal) and 2 hours after the test meal (UMI2h-postprandial) were measured using an enzymatic method. ΔUMI was defined as UMI2h-postprandial minus UMIpremeal. RESULTS: Differing from UG, UMI was stable at RT and 37°C. UMI was increased linearly along with an increase in PG, and no threshold for UMI was observed. UMI was closely associated with blood glucose parameters obtained from a 75gOGTT and hemoglobin A1c (HbA1c) at hospital after adjustment for age, sex, body mass index and serum creatinine. UMIwake-up, UMIpremeal, UMI2h-postprandial and ΔUMI at home were higher in diabetic subjects than non-diabetic subjects even after the above adjustment. Receiver operating characteristics curve (ROC) analyses revealed that for the screening of diabetes, the area under the curve for ROC for UMI2h-postprandial and ΔUMI (0.83 and 0.82, respectively) were not inferior to that for HbA1c ≥48 mmol/mol, which is the American Diabetes Association (ADA) criteria for diabetes. CONCLUSIONS: MI measurement in urine samples collected at home before and after the meal would be a simple, non-invasive and valuable screening method for diabetes.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/urina , Testes Diagnósticos de Rotina/métodos , Inositol/urina , Programas de Rastreamento/métodos , Coleta de Urina/métodos , Adulto , Idoso , Glicemia/análise , Creatinina/sangue , Diabetes Mellitus Tipo 2/sangue , Jejum/urina , Feminino , Intolerância à Glucose/sangue , Intolerância à Glucose/diagnóstico , Teste de Tolerância a Glucose , Hemoglobinas Glicadas/análise , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Curva ROCRESUMO
Coronary artery disease(CAD) is often found concurrently in patients presenting with severe aortic stenosis(AS). Surgical aortic valve replacement(SAVR) and coronary artery bypass grafting(CABG) were usually selected with such patients. Recently, transcatheter aortic valve implantation (TAVI) is considered as a less invasive and more feasible treatment option in high-risk AS patients. A 74-year-old woman admitted due to acute myocardial infarction and treated with percutaneous coronary intervention revealed severe AS. Because of her comorbidities, concomitant transapical TAVI and CABG were performed with an excellent clinical course.
Assuntos
Estenose da Valva Aórtica/cirurgia , Ponte de Artéria Coronária , Implante de Prótese de Valva Cardíaca , Infarto do Miocárdio/cirurgia , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica , Feminino , Humanos , Resultado do TratamentoAssuntos
Cardiomiopatias/diagnóstico por imagem , Neoplasias Esofágicas/radioterapia , Achados Incidentais , Tomografia por Emissão de Pósitrons/métodos , Cardiomiopatias/etiologia , Transtornos de Deglutição , Ecocardiografia/métodos , Neoplasias Esofágicas/complicações , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Radioterapia/efeitos adversosAssuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Achados Incidentais , Angiografia Coronária , Ácidos Graxos não Esterificados , Fluordesoxiglucose F18 , Reserva Fracionada de Fluxo Miocárdico , Glucose/metabolismo , Humanos , Isquemia , Masculino , Pessoa de Meia-Idade , Radioisótopos de Nitrogênio , Oxigênio/química , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Compostos RadiofarmacêuticosAssuntos
Cardiomiopatias/diagnóstico por imagem , Músculo Esquelético/metabolismo , Sarcoidose/diagnóstico por imagem , Biópsia , Nádegas , Cardiomiopatias/patologia , Ecocardiografia , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Imagem Multimodal , Músculo Esquelético/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Sarcoidose/patologiaRESUMO
We report a rare case of a hemodialysis patient with a calcified amorphous tumor (CAT) on both sides of the atrioventricular valve annulus. A 70-year-old female who had received hemodialysis for 23 years because of chronic glomerulonephritis presented to our hospital with acute heart failure. Echocardiography indicated the presence of mobile cardiac masses on the mitral valve and tricuspid valve annulus. We suspected the presence of a cardiac tumor or vegetation. The patient received 3 g/day sulbactam-ampicillin and 60 mg/day gentamicin. Surgery was performed on the 14th day after hospital admission. The patient underwent mitral valve replacement, tricuspid annuloplasty, and tumor resection. Based on the pathological findings, the cardiac tumor was diagnosed as a CAT.
Assuntos
Calcinose/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Idoso , Valva Aórtica , Ecocardiografia , Feminino , Próteses Valvulares Cardíacas , Humanos , Valva Mitral , Insuficiência da Valva Mitral , Valva Tricúspide , Insuficiência da Valva TricúspideRESUMO
We evaluated the relationship between coronary calcification and plaque characteristics using integrated backscatter-intravascular ultrasound (IB-IVUS), focusing on spotty calcification. Seventy-two patients with culprit plaques containing spotty calcification were evaluated. The average degree of all the spotty calcifications (averaged arc) negatively correlated with the % lipid volume (LV) on IB-IVUS. Multivariate analysis showed the averaged arc was an independent predictor of % LV. Our observations suggest that smaller plaque calcifications are associated with lipid-rich characteristics in patients with a spotty calcification pattern.
Assuntos
Calcinose/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Metabolismo dos Lipídeos/fisiologia , Placa Aterosclerótica/diagnóstico por imagem , Idoso , Calcinose/metabolismo , Cardiomiopatias/metabolismo , Doença da Artéria Coronariana/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/metabolismo , UltrassonografiaRESUMO
OBJECTIVE: The study objective was to compare the left ventricular (LV) dyssynchrony and torsional behavior between right ventricular apical (RVA) and right ventricular septal (RVS) pacing. METHODS: Forty-six patients with symptomatic sick sinus syndrome and preserved LV function were assigned to 2 groups: RVA (n = 23) and RVS (n = 23). Echocardiographic study including two-dimensional speckle tracking imaging was performed in the AAI and DDD modes. RESULTS: Mean QRS width during DDD mode was significantly longer with RVA pacing than with RVS pacing. Dyssynchrony, torsion, and untwisting rate during DDD mode were significantly worse with RVA than with RVS pacing. In patients with RVA pacing, there was an increase in longitudinal dyssynchrony from AAI to DDD mode that significantly correlated with the deterioration of untwisting rate. CONCLUSION: In bradyarrhythmic patients with preserved LV function, RVS pacing resulted in a reduced LV dyssynchrony and better torsional behavior than RVA pacing.
Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/métodos , Septos Cardíacos/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Anormalidade Torcional/etiologia , Anormalidade Torcional/prevenção & controle , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/prevenção & controle , Doença Aguda , Idoso , Bradicardia/complicações , Bradicardia/diagnóstico por imagem , Bradicardia/prevenção & controle , Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Masculino , Anormalidade Torcional/diagnóstico por imagem , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
An 81-year-old man with effort angina pectoris underwent coronary artery bypass grafting operation using the bilateral internal thoracic arteries and the right gastroepiploic artery (GEA). Angiography after operation showed that the bilateral internal thoracic arteries were patent. Abdominal angiography showed severe ostial stenosis in the celiac trunk. The GEA was not opacified by the celiac trunk but by the superior mesenteric artery, by collaterals. GEA flow could be detected from the epigastric lesion by contrast-enhanced Doppler echocardiography, and moreover, the flow velocity reserve of the graft was 2.4. This case suggests that the GEA graft can provide sufficient blood flow to the coronary artery despite ostial stenosis of the celiac trunk.
Assuntos
Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Meios de Contraste , Ponte de Artéria Coronária , Ecocardiografia Doppler , Artéria Gastroepiploica/diagnóstico por imagem , Artéria Gastroepiploica/fisiopatologia , Abdome/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/fisiopatologia , Angina Pectoris/cirurgia , Circulação Coronária/fisiologia , Artéria Gastroepiploica/transplante , Oclusão de Enxerto Vascular/diagnóstico , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/fisiopatologia , Artéria Torácica Interna/transplante , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Radiografia AbdominalRESUMO
BACKGROUND: Visual or quantitative assessment of coronary angiography may not exactly predict the physiological significance of intermediate (40-70%) coronary stenosis. Coronary flow reserve is a well-established marker of the functional significance of coronary stenosis. OBJECTIVES: The aim of this study was to compare the coronary flow velocity reserve (CFVR) using contrast-enhanced transthoracic Doppler echocardiography (CE-TTDE) with thallium-201 imaging in assessment of intermediate lesions in the left anterior descending coronary artery (LAD). METHODS: A consecutive series of 50 patients with intermediate stenosis in the LAD underwent pharmacological stress thallium-201 imaging and CFVR measured by CE-TTDE. RESULTS: CFVR could be measured in 49 of 50 patients by the present method. A CFVR <2.0 predicted the presence of a stress thallium defect in 12 of 14 patients (agreement=90%, kappa=0.76, P < 0.001). The sensitivity and specificity of CFVR for stress thallium-201 results were 86 and 91%, respectively. In contrast, significant stenosis (>50% by diameter) showed fair agreement for stress thallium defects (agreement=59%, kappa=0.28, P < 0.05). CONCLUSIONS: In the evaluation of intermediate lesions in the LAD, CFVR as assessed by CE-TTDE could accurately predict the presence of ischemia on stress thallium imaging, whereas angiographic stenosis did not yield reliable results.
Assuntos
Estenose Coronária/diagnóstico , Ecocardiografia , Aumento da Imagem , Trifosfato de Adenosina , Idoso , Artérias/diagnóstico por imagem , Artérias/fisiopatologia , Velocidade do Fluxo Sanguíneo/fisiologia , Angiografia Coronária , Circulação Coronária/fisiologia , Estenose Coronária/epidemiologia , Estenose Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Ecocardiografia Doppler/métodos , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
The exact mechanisms responsible for the progression of heart failure remain unclear. We investigated the in vivo relationship between the incidence of apoptotic cell death and left ventricular function serially from the beginning of hypertension to decompensated heart failure in Dahl salt-sensitive rats. Dahl salt-resistant and Dahl salt-sensitive rats were fed on a high-salt diet from 6 weeks of age. Systolic blood pressure was recorded by the tail-cuff method every week. Cardiac function in vivo was evaluated by echocardiography and cardiac catheterization. Cardiomyocyte apoptosis was detected by the TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling) method. The gene expression of Bax, Bcl-2 and Bcl-xL was analysed by Northern blotting. The TUNEL method revealed that the incidence of cardiomyocyte apoptosis was significantly increased in the hearts of 18-week-old Dahl salt-sensitive rats (apoptotic index 1.3 +/- 0.1%). Northern blot analysis revealed that the Bcl-xL mRNA level increased gradually during the progression towards heart failure. In conclusion, these data suggest that cardiomyocyte apoptosis is a terminal event, and plays a role as an aggravating factor in the vicious cycle of heart failure.
Assuntos
Apoptose , Insuficiência Cardíaca/fisiopatologia , Coração/fisiopatologia , Hipertensão/fisiopatologia , Disfunção Ventricular Esquerda , Remodelação Ventricular , Análise de Variância , Animais , Northern Blotting , Genes bcl-2 , Marcação In Situ das Extremidades Cortadas , Masculino , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas c-bcl-2/genética , RNA Mensageiro/análise , Ratos , Ratos Endogâmicos Dahl , Cloreto de Sódio , Proteína X Associada a bcl-2 , Proteína bcl-XRESUMO
BACKGROUND: This study assessed the feasibility of transthoracic Doppler scan echocardiography (TTDE) combined with echo-contrast agent in measuring coronary flow velocity (CFV) and coronary flow velocity reserve (CFVR) in the left anterior descending artery. METHODS: In 68 consecutive patients who underwent cardiac angiography, TTDE was recorded before and after induction of a hyperemic condition with intravenous administration of adenosine triphosphate (0.14 mg/kg/min). After CFV values returned to baseline, the same measurements were repeated while an echo-contrast agent was continuously infused. CFVR was assessed as the ratio of hyperemic to basal CFV. The pulsed wave Doppler scan quality was graded from 1 to 3 (TTDE score: 1, no signal detection; 2, poor definition of outline; 3, optimal outline definition). RESULTS: Before enhancement, CFVR could not be measured in 20 patients. Prevalence of delayed stenosis (Thrombolysis In Myocardial Infarction [TIMI] II grade flow) in these patients (30%) was significantly greater than in those whose CFVRs could be measured without enhancement (2%; P <.01). TTDE scores both at baseline and after hyperemia were significantly improved with contrast enhancement (before, 2.8 +/- 0.6; after, 3.0 +/- 0.3; P <.01; before, 2.6 +/- 0.7; after, 3.0 +/- 0.3; P <.01; respectively). Overall contrast enhancement increased the rate of successful CFVR measurement from 70% to 97% (P <.01). Sensitivity and specificity of significant left anterior descending artery stenosis detection with CFVR of <2.0 were 94.4% and 87.8%, respectively. CONCLUSION: These data suggest that administration of echo-contrast agent improves pulse wave Doppler scan quality and thus the feasibility of measuring CFVR.