RESUMO
Follow-up after acute myocarditis is important to detect persisting myocardial dysfunction. However, recovery of atrial function has not been evaluated after acute myocarditis so far. Thirty-five patients with strictly defined acute myocarditis underwent cardiovascular magnetic resonance (CMR, 1.5 T) in the acute stage at baseline (BL) and at 3 months follow-up (FU). The study population included 13 patients with biopsy-proven "cardiomyopathy-like" myocarditis (CLM) and 22 patients with "infarct-like" (ILM) clinical presentation. CMR feature tracking (FT) was performed on conventional cine SSFP sequences. Median LA-GLS increased from 33.2 (14.5; 39.2) at BL to 37.0% (25.2; 44.1, P = 0.0018) at FU in the entire study population. Median LA-GLS also increased from 36.7 (26.5; 42.3) at BL to 41.3% (34.5; 44.8, P = 0.0262) at FU in the ILM subgroup and from 11.3 (6.4; 21.1) at BL to 21.4% (14.2; 30.7, P = 0.0186) at FU in the CLM subgroup. Median RA-GLS significantly increased from BL with 30.8 (22.5; 37.0) to FU with 33.7% (26.8; 45.4, P = 0.0027) in the entire study population. Median RA-GLS also significantly increased from 32.7 (25.8; 41.0) at BL to 35.8% (27.7; 48.0, P = 0.0495) at FU in the ILM subgroup and from 22.8 (13.1; 33.9) at BL to 31.0% (26.0; 40.8, P = 0.0266) at FU in the CLM subgroup. Our findings demonstrate recovery of LA and RA function by CMR-FT strain analyses in patients after acute myocarditis independent from clinical presentation. Monitoring of atrial strain could be an important tool for an individual assessment of healing after acute myocarditis.
Assuntos
Miocardite , Humanos , Miocardite/diagnóstico por imagem , Valor Preditivo dos Testes , Imageamento por Ressonância Magnética , Função Atrial , Espectroscopia de Ressonância MagnéticaRESUMO
The ability of magnetic resonance imaging (MRI) to accurately define the functional anatomy of mitral regurgitation was assessed. Transesophageal echocardiography (TEE) and cine MRI were performed on 43 patients with mitral regurgitation and were compared for the jet number, location, direction and presence of a prolapse (atrial displacement, malapposition or a flail). In 36 patients, diagnostic accuracy in reference to surgery was assessed. Comparing TEE and MRI the jet number and location were judged in concordance in 86% of patients. Jet location did not show a significant difference (Wilcoxon: P = 0.66) and both modalities correlated strongly (Spearman: r = 0.68, P<0.0001). Jet direction was judged with high concordance (kappa=0.63). Additionally, prolapse evaluation showed high concordance (kappa: valve, 0.63; anterior mitral leaflet, 0.70; posterior mitral leaflet, 0.73). Compared with surgery, the sensitivity for the detection of malapposition of any leaflet or one of both leaflets ranged between 75% and 93% for TEE and 71% and 89% for MRI. Specificities ranged between 88 and 96% for TEE and 88 and 100% for MRI. TEE detected torn chordae in all ten patients, six of which were missed by MRI. MRI is comparable with TEE in prolapse and jet evaluation. MRI is inferior to TEE in depicting anatomical details such as torn chordae.
Assuntos
Ecocardiografia Transesofagiana , Imagem Cinética por Ressonância Magnética , Insuficiência da Valva Mitral/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Sensibilidade e Especificidade , Estatísticas não ParamétricasRESUMO
Contrast-enhanced MRI using the delayed-enhancement technique (DE-MRI) is widely applied in the clinical work-up of myocardial diseases. Myocardial diseases of varying etiology result in myocardial changes, such as necrosis, fibrosis, edema and metabolite deposition, which can be visualized by DE-MRI. Acute and chronic ischemic diseases based on a coronary artery disease as well as non-ischemic cardiomyopathies display DE. Cardiomyopathies often show a characteristic enhancement pattern. While ischemic lesions are localized in the subendocardium, non-ischemic cardiomyopathies often display an intramyocardial or subepicardial pattern. The typical pattern for dilated cardiomyopathies is band-like and intramyocardial with septal involvement. Arrhythmogenic right-ventricular dysplasias/cardiomyopathies are frequently associated with right-ventricular DE. In the case of amyloid cardiomyopathies which are often restrictive cardiomyopathies, subendocardial and circular DE is typically observed. Hypertrophic cardiomyopathies display patchy intramyocardial DE usually in the anteroseptal region. Acute myocarditis is typically accompanied by intramyocardial or subepicardial DE affecting the lateral wall. In the case of chronic myocarditis, intramyocardial or subepicardial DE is observed most frequently. Cardiac sarcoidosis typically entails patchy subepicardial DE with right- and left-ventricular involvement. Since there is an overlap between the enhancement patterns of cardiomyopathies, the diagnostic accuracy of DE-MRI is limited and the diagnosis must be based on additional clinical and MRI findings. The amount of DE often corresponds with cardiac functional parameters as well as with the frequency of cardiac events so that DE-MRI may be useful for risk stratification. Furthermore, DE-MRI can be helpful in the planning and evaluation of myocardial biopsies and electrophysiological examinations.
Assuntos
Cardiomiopatias/diagnóstico , Imageamento por Ressonância Magnética/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Amiloidose/diagnóstico , Displasia Arritmogênica Ventricular Direita/diagnóstico , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Restritiva/diagnóstico , Doença Crônica , Meios de Contraste , Diagnóstico Diferencial , Feminino , Gadolínio DTPA , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico , Medição de Risco , Sarcoidose/diagnósticoAssuntos
Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico , Imageamento por Ressonância Magnética/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Medula Espinal/patologia , Neoplasias da Coluna Vertebral/diagnóstico , Adulto , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/prevenção & controle , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Contraindicações , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Imageamento por Ressonância Magnética/normas , Masculino , Monitorização Fisiológica/métodos , Monitorização Fisiológica/normas , Marca-Passo Artificial/normas , Transtornos de Sensação/etiologia , Transtornos de Sensação/fisiopatologia , Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/secundário , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/secundário , Neoplasias Renais/patologia , Imageamento por Ressonância Magnética , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Papillary fibroelastomas are rare and normally benign cardiac tumors typically attached to cardiac valves. This report describes two patients who were evaluated for intermittent dyspnea in one case and for the source of cerebral embolism in the other. In both patients transthoracic echocardiography revealed a pedunculated mobile mass adjacent to an atrioventricular valve, suggestive of papillary fibroelastoma. Postoperative histology was confirmatory of papillary fibroelastoma with a typical hyalinized hypocellular stroma covered by a single layer of endocardial cells.
Assuntos
Ecocardiografia , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Adulto , Idoso , Feminino , Fibroma/patologia , Fibroma/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Valva Mitral/patologia , Valva Mitral/cirurgia , Valva Tricúspide/patologia , Valva Tricúspide/cirurgiaRESUMO
A prospective study was performed to investigate the role of the endogenous fibrinolytic system and platelet function for the occurrence of reocclusion after successful recanalization of chronic coronary occlusions. At control coronary angiography 8 +/- 2 weeks after recanalization, reocclusion was found in 10 (21%) of 47 patients. After correction for angiographic and clinical confounding factors, endogenous concentrations of tissue plasminogen activator (TPA) were lower in patients with reocclusion than in patients without. In contrast, plasma levels of plasminogen activator inhibitor-1 and alpha 2-antiplasmin were similar in the two groups. The mean platelet volume was significantly higher in patients with reocclusion than in patients without. In addition, agonist-induced platelet aggregation in platelet-rich plasma was enhanced in the patients with reocclusion. Decreased endogenous plasma TPA concentrations and enhanced platelet reactivity may contribute to the occurrence of reocclusion after primarily successful coronary artery recanalization.