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This position statement guides cardiovascular magnetic resonance (CMR) imaging program directors and learners on the key competencies required for Level II and III CMR practitioners, whether trainees come from a radiology or cardiology background. This document is built upon existing curricula and was created and vetted by an international panel of cardiologists and radiologists on behalf of the Society for Cardiovascular Magnetic Resonance (SCMR).
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Cardiologia , Competência Clínica , Consenso , Currículo , Educação de Pós-Graduação em Medicina , Imageamento por Ressonância Magnética , Humanos , Educação de Pós-Graduação em Medicina/normas , Imageamento por Ressonância Magnética/normas , Cardiologia/educação , Cardiologia/normas , Doenças Cardiovasculares/diagnóstico por imagem , Cardiologistas/educação , Cardiologistas/normas , Valor Preditivo dos Testes , Radiologistas/educação , Radiologistas/normas , Radiologia/educação , Radiologia/normas , Sociedades Médicas/normasRESUMO
ABSTRACT: Modern cancer therapies have significantly improved survival leading to a growing population of cancer survivors. Similarly, both conventional and newer treatments are associated with a spectrum of cardiovascular disorders with potential long-term sequelae. Prompt detection and treatment of these complications is, therefore, pivotal to enable healthy survivorship and reduce cardiovascular morbidity. Advanced multimodality imaging is a valuable tool for stratifying patient risk, identifying cardiovascular toxicity during and after therapy, and predicting recovery. This review summarizes the potential cardiotoxic complications of anticancer therapies and the multimodality approaches available in each case with special focus on newer techniques and the added value of biomarkers ultimately leading to earlier diagnosis and better prognostication.
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Antineoplásicos , Doenças Cardiovasculares , Sistema Cardiovascular , Neoplasias , Antineoplásicos/efeitos adversos , Biomarcadores , Cardiotoxicidade/etiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/diagnóstico por imagem , Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológicoAssuntos
Doença da Artéria Coronariana , Imagem de Perfusão do Miocárdio , Adenosina , Cálcio , HumanosRESUMO
Stroke prophylaxis in atrial fibrillation is an important consideration in patients with cancer. However, there is little consensus on the choice of anticoagulation, due to the numerous difficulties associated with active cancer. Direct oral anticoagulants (DOACs) have been shown to be a promising option. Here, we conduct a simple cross-sectional analysis of 29 cancer patients receiving DOACs for stroke prophylaxis in atrial fibrillation at a tertiary-care institution in London. Our study demonstrates an encouraging efficacy and safety profile of DOACs used in this setting. We conclude by suggesting that, while DOACs may be useful, anticoagulation in cancer patients should continue to be individualised.
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Cardiac masses are rare, but remain an important component of cardio-oncology practice. These include benign tumors, malignant tumors (primary and secondary) and tumor-like conditions (e.g., thrombus, Lambl's excrescences, and pericardial cyst). The advent of multimodality imaging has enabled identification of the etiology of cardiac masses in many cases, especially in conjunction with information from clinical settings. This paper provides a comprehensive review of the epidemiology, clinical presentation, imaging, diagnosis, management, and outcomes of cardiac masses.
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Fibrose Endomiocárdica/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Taquicardia Supraventricular/diagnóstico , Idoso de 80 Anos ou mais , Angiografia/métodos , Fator Natriurético Atrial/sangue , Meios de Contraste/administração & dosagem , Ecocardiografia/métodos , Eletrocardiografia/métodos , Fibrose Endomiocárdica/complicações , Fibrose Endomiocárdica/patologia , Feminino , Gadolínio/administração & dosagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Síndrome Hipereosinofílica/diagnóstico por imagem , Síndrome Hipereosinofílica/patologia , Espectroscopia de Ressonância Magnética/métodos , Prognóstico , Precursores de Proteínas/sangue , Respiração , Volume Sistólico/fisiologia , Taquicardia Supraventricular/etiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
OPINION STATEMENT: Early detection and treatment of cardiotoxicity from cancer therapies is key to preventing a rise in adverse cardiovascular outcomes in cancer patients. Over-diagnosis of cardiotoxicity in this context is however equally hazardous, leading to patients receiving suboptimal cancer treatment, thereby impacting cancer outcomes. Accurate screening therefore depends on the widespread availability of sensitive and reproducible biomarkers of cardiotoxicity, which can clearly discriminate early disease. Blood biomarkers are limited in cardiovascular disease and clinicians generally still use generic screening with ejection fraction, based on historical local expertise and resources. Recently, however, there has been growing recognition that simple measurement of left ventricular ejection fraction using 2D echocardiography may not be optimal for screening: diagnostic accuracy, reproducibility and feasibility are limited. Modern cancer therapies affect many myocardial pathways: inflammatory, fibrotic, metabolic, vascular and myocyte function, meaning that multiple biomarkers may be needed to track myocardial cardiotoxicity. Advanced imaging modalities including cardiovascular magnetic resonance (CMR), computed tomography (CT) and positron emission tomography (PET) add improved sensitivity and insights into the underlying pathophysiology, as well as the ability to screen for other cardiotoxicities including coronary artery, valve and pericardial diseases resulting from cancer treatment. Delivering screening for cardiotoxicity using advanced imaging modalities will however require a significant change in current clinical pathways, with incorporation of machine learning algorithms into imaging analysis fundamental to improving efficiency and precision. In the future, we should aspire to personalized rather than generic screening, based on a patient's individual risk factors and the pathophysiological mechanisms of the cancer treatment they are receiving. We should aspire that progress in cardiooncology is able to track progress in oncology, and to ensure that the current 'one size fits all' approach to screening be obsolete in the very near future.
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Cardiotoxicidade/diagnóstico por imagem , Cardiotoxicidade/etiologia , Diagnóstico por Imagem , Neoplasias/complicações , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores , Cardiotoxicidade/fisiopatologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Diagnóstico por Imagem/efeitos adversos , Diagnóstico por Imagem/métodos , Humanos , Imagem Multimodal/métodos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Neoplasias/tratamento farmacológico , Disfunção VentricularAssuntos
Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/patologia , Ecocardiografia/métodos , Histiocitose Sinusal/diagnóstico por imagem , Histiocitose Sinusal/patologia , Adulto , Biópsia por Agulha , Tamponamento Cardíaco/diagnóstico , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Histiocitose Sinusal/diagnóstico , Humanos , Imuno-Histoquímica , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Doenças Raras , Medição de Risco , Reino UnidoRESUMO
Background Advanced cardiac imaging permits optimal targeting of cardiac treatment but needs to be faster, cheaper, and easier for global delivery. We aimed to pilot rapid cardiac magnetic resonance ( CMR ) with contrast in a developing nation, embedding it within clinical care along with training and mentoring. Methods and Results A cross-sectional study of CMR delivery and clinical impact assessment performed 2016-2017 in an upper middle-income country. An International partnership (clinicians in Peru and collaborators from the United Kingdom, United States, Brazil, and Colombia) developed and tested a 15-minute CMR protocol in the United Kingdom, for cardiac volumes, function and scar, and delivered it with reporting combined with training, education and mentoring in 2 centers in the capital city, Lima, Peru, 100 patients referred by local doctors from 6 centers. Management changes related to the CMR were reviewed at 12 months. One-hundred scans were conducted in 98 patients with no complications. Final diagnoses were cardiomyopathy (hypertrophic, 26%; dilated, 22%; ischemic, 15%) and 12 other pathologies including tumors, congenital heart disease, iron overload, amyloidosis, genetic syndromes, vasculitis, thrombi, and valve disease. Scan cost was $150 USD, and the average scan duration was 18±7 minutes. Findings impacted management in 56% of patients, including previously unsuspected diagnoses in 19% and therapeutic management changes in 37%. Conclusions Advanced cardiac diagnostics, here CMR with contrast, is possible using existing infrastructure in the developing world in 18 minutes for $150, resulting in important changes in patient care.
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Países em Desenvolvimento , Cardiopatias/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico por imagem , Amiloidose/terapia , Cardiomiopatias , Meios de Contraste , Estudos Transversais , Atenção à Saúde , Feminino , Custos de Cuidados de Saúde , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/terapia , Cardiopatias/terapia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/terapia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/terapia , Humanos , Cooperação Internacional , Sobrecarga de Ferro/diagnóstico por imagem , Sobrecarga de Ferro/terapia , Imageamento por Ressonância Magnética/economia , Imageamento por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/economia , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico por imagem , Miocardite/terapia , Peru , Projetos Piloto , Fatores de Tempo , Vasculite/diagnóstico por imagem , Vasculite/terapia , Adulto JovemRESUMO
PURPOSE OF REVIEW: To understand the variety of conditions in which the pericardium may be affected in cancer patients. RECENT FINDINGS: Cancer may affect the pericardium directly (primary cancer; uncommon) or through metastases (commoner). Cancer treatment (chemotherapy and radiotherapy) may affect the pericardium leading to pericarditis and myopericarditis. Pericardial effusions, tamponade and constrictive pericarditis are complications that can also occur. A variety of techniques (predominantly cardiac imaging related) are used to make the diagnosis with the treatment strategy dependent on whether the pericardial disease is due to cancer or as a result of cancer treatment. A variety of pericardial diseases may be caused by cancer and cancer treatment. Determining the aetiology and providing effective treatment can often be challenging.
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Sobrecarga de Ferro/diagnóstico por imagem , Ferro/análise , Imageamento por Ressonância Magnética/métodos , Talassemia/diagnóstico por imagem , Adulto , Feminino , Coração/diagnóstico por imagem , Humanos , Cooperação Internacional , Sobrecarga de Ferro/etiologia , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tailândia , Talassemia/complicações , Talassemia/terapia , Fatores de Tempo , Reação Transfusional , Reino Unido , Adulto JovemRESUMO
AIMS: Clinical trials suggest that intracoronary delivery of autologous bone marrow-derived cells (BMCs) 1-7 days post-acute myocardial infarction (AMI) may improve left ventricular (LV) function. Earlier time points have not been evaluated. We sought to determine the effect of intracoronary autologous BMC on LV function when delivered within 24 h of successful reperfusion therapy. METHODS AND RESULTS: A multi-centre phase II randomized, double-blind, and placebo-controlled trial. One hundred patients with anterior AMI and significant regional wall motion abnormality were randomized to receive either intracoronary infusion of BMC or placebo (1:1) within 24 h of successful primary percutaneous intervention (PPCI). The primary endpoint was the change in left ventricular ejection fraction (LVEF) between baseline and 1 year as determined by advanced cardiac imaging. At 1 year, although LVEF increased compared with baseline in both groups, the between-group difference favouring BMC was small (2.2%; 95% confidence interval, CI: -0.5 to 5.0; P = 0.10). However, there was a significantly greater myocardial salvage index in the BMC-treated group compared with placebo (0.1%; 95% CI: 0.0-0.20; P = 0.048). Major adverse events were rare in both treatment groups. CONCLUSION: The early infusion of intracoronary BMC following PPCI for patients with AMI and regional wall motion abnormality leads to a small non-significant improvement in LVEF when compared with placebo; however, it may play an important role in infarct remodelling and myocardial salvage.
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Infarto Miocárdico de Parede Anterior/terapia , Transplante de Medula Óssea/métodos , Infarto Miocárdico de Parede Anterior/patologia , Infarto Miocárdico de Parede Anterior/fisiopatologia , Angiografia por Tomografia Computadorizada , Método Duplo-Cego , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Intervenção Coronária Percutânea/métodos , Qualidade de Vida , Terapia de Salvação/métodos , Volume Sistólico/fisiologia , Transplante Autólogo , Disfunção Ventricular Esquerda/diagnósticoRESUMO
Mycoplasma pneumoniae primarily causes respiratory tract infections. Extrapulmonary manifestations are seen in 20-25% of cases. Cardiac involvement is rarely reported. We present a unique case of a pericardial mass and cardiac tamponade associated with a Mycoplasma pneumoniae pneumonia. This required emergency pericardial fenestration. The patient improved dramatically postoperatively on antibiotics and there was no recurrence of the pericardial effusion on follow up. This case highlights the often forgotten invasive properties of a common respiratory tract pathogen and emphasises the need to consider this easily treatable entity in the differential diagnosis of idiopathic pericardial effusions.
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Tamponamento Cardíaco , Neoplasias Cardíacas , Pneumonia por Mycoplasma , Adulto , Humanos , Masculino , Derrame PericárdicoRESUMO
We describe a case of a young woman presenting with lethargy and pleuritic chest pain. She had a medical history of leukaemia treated successfully 20 years ago with chemotherapy via a long line. Although initial investigations suggested a diagnosis of pulmonary embolism (PE; on CT pulmonary angiogram (CTPA)) and a possible thrombus in the right atrium, her symptoms appeared out of proportion in relation to this diagnosis. Further imaging using transthoracic echocardiography suggested the presence of a calcified mass in the right atrium. She underwent successful surgical resection of the mass which was found to be attached to the lateral wall of the right atrium. She made an uneventful recovery and continued on warfarin therapy for 6 months in view of the diagnosis of PE on CTPA. We believe the calcified mass was probably caused by the presence of a long line at the time of her chemotherapy.
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Apêndice Atrial/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Cardiopatias/etiologia , Neoplasias Cardíacas/diagnóstico por imagem , Adulto , Calcinose/etiologia , Cálcio , Ecocardiografia , Feminino , Cardiopatias/diagnóstico por imagem , Neoplasias Cardíacas/etiologia , Neoplasias Cardíacas/cirurgia , Humanos , Achados Incidentais , Leucemia/tratamento farmacológico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Trombose/diagnósticoRESUMO
AIMS: Myocardial revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) carries the risk of serious complications. Observational data suggest that outcomes may be improved by experienced operators, but there are few studies that have analysed the relationship between mortality and primary operator grade. The aim of this study was to investigate the effect of operator grade (trainee vs. consultant) upon outcomes of revascularization procedures. METHODS AND RESULTS: This was an observational study at a tertiary cardiology centre with accredited training programmes, between 2003 and 2011. A total of 22 697 consecutive patients undergoing either CABG or PCI were included. Associations between operator grade and mortality were assessed by hazard ratios, estimated by Cox regression analyses; 6689 patients underwent CABG, whereas 16 008 underwent PCI. Trainees performed 1968 (29.4%) CABG procedures and 8502 (53.1%) PCI procedures. The proportion of procedures performed by trainees declined over time for both CABG (30.2% in 2003 vs. 26.0% in 2010) and for PCI (58.1% in 2003 vs. 44.5% in 2010). In the unadjusted Cox analysis, consultant operator grade was associated with an increased 5-year mortality after both CABG [HR: 1.26 (95% CI: 1.07-1.47)] and PCI procedures [HR: 1.34 (95% CI: 1.22-1.47)] compared with a trainee operator. However, following multiple adjustment, consultant grade was no longer associated with mortality after either procedure [CABG: HR: 1.02 (95% CI: 0.87-1.20), PCI: HR: 1.08 (95% CI: 0.98-1.20)]. CONCLUSION: There was no observed detrimental effect on patient outcomes arising from procedures undertaken by trainees working in a structured training environment compared with consultants.
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Cardiologia/normas , Competência Clínica/normas , Doença da Artéria Coronariana/cirurgia , Corpo Clínico Hospitalar/normas , Revascularização Miocárdica/mortalidade , Intervenção Coronária Percutânea/mortalidade , Cardiologia/estatística & dados numéricos , Consultores/estatística & dados numéricos , Tratamento de Emergência/mortalidade , Métodos Epidemiológicos , Feminino , Mortalidade Hospitalar , Humanos , Capacitação em Serviço , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Revascularização Miocárdica/normas , Revascularização Miocárdica/estatística & dados numéricos , Duração da Cirurgia , Intervenção Coronária Percutânea/normas , Intervenção Coronária Percutânea/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Diálise Renal/mortalidade , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/mortalidade , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Resultado do TratamentoRESUMO
INTRODUCTION: We tested the hypothesis that cardiovascular magnetic resonance (CMR) imaging can reliably distinguish the presence or absence of left atrial (LA) ablation lesions by blinded analysis of pre- and postablation imaging. METHODS: Consecutive patients at 2 centers undergoing pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation by either wide area circumferential radiofrequency ablation (WACA) or ostial ablation with a cryoballoon underwent CMR late gadolinium enhancement (LGE) imaging pre- and 3 months postablation. Imaging was anonymized for blinded analysis of (1) LGE images, and (2) a 3D fusion image with LGE projected onto a segmented LA surface. Scans were categorized using both assessment techniques separately as pre- or postablation, and if postablation, whether lesions were in an ostial or WACA distribution. RESULTS: LGE imaging was performed in 50 patients (aged 60 ± 10 years, 68% male, 24 underwent WACA and 26 had cryoablation). Sensitivity and specificity for detection of ablation lesions was 60% and 96% on LGE imaging. Sensitivity was higher using 3D fusion imaging (88%; P = 0.003). The proportion in whom lesions were both detected and the distribution correctly assessed as WACA or ostial was higher with 3D fusion imaging compared to LGE imaging (54% vs 28%; P = 0.014). There was no difference in the detection of radiofrequency ablation lesions compared to cryoablation lesions (58% vs 62%; P = 1.000). CONCLUSION: LGE imaging of atrial scar is not yet sufficiently accurate to reliably identify ablation lesions or to determine lesion distribution.
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Fibrilação Atrial/cirurgia , Ablação por Cateter , Cicatriz/patologia , Criocirurgia , Imageamento por Ressonância Magnética , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/patologia , Ablação por Cateter/efeitos adversos , Distribuição de Qui-Quadrado , Cicatriz/etiologia , Meios de Contraste , Criocirurgia/efeitos adversos , Feminino , Gadolínio DTPA , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Modelos Logísticos , Londres , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Razão de Chances , Valor Preditivo dos Testes , Veias Pulmonares/patologia , Reprodutibilidade dos Testes , Resultado do TratamentoAssuntos
Aneurisma Coronário/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Imagem Cinética por Ressonância Magnética , Tomografia Computadorizada Multidetectores , Infarto do Miocárdio/diagnóstico , Adulto , Meios de Contraste , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/genética , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/genética , Seguimentos , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagem , Síndrome de Klippel-Trenaunay-Weber/genética , Anormalidades Linfáticas/diagnóstico , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/genética , Inibidores da Agregação Plaquetária/uso terapêutico , Valor Preditivo dos Testes , Doenças Raras , Fatores de Risco , Sensibilidade e Especificidade , Resultado do Tratamento , Malformações Vasculares/diagnósticoRESUMO
BACKGROUND: In patients with stable coronary artery disease (CAD), decisions regarding revascularisation are primarily driven by the severity and extent of coronary luminal stenoses as determined by invasive coronary angiography. More recently, revascularisation decisions based on invasive fractional flow reserve (FFR) have shown improved event free survival. Cardiovascular magnetic resonance (CMR) perfusion imaging has been shown to be non-inferior to nuclear perfusion imaging in a multi-centre setting and superior in a single centre trial. In addition, it is similar to invasively determined FFR and therefore has the potential to become the non-invasive test of choice to determine need for revascularisation. TRIAL DESIGN: The MR-INFORM study is a prospective, multi-centre, randomised controlled non-inferiority, outcome trial. The objective is to compare the efficacy of two investigative strategies for the management of patients with suspected CAD. Patients presenting with stable angina are randomised into two groups: 1) The FFR-INFORMED group has subsequent management decisions guided by coronary angiography and fractional flow reserve measurements. 2) The MR-INFORMED group has decisions guided by stress perfusion CMR. The primary end-point will be the occurrence of major adverse cardiac events (death, myocardial infarction and repeat revascularisation) at one year. Clinical trials.gov identifier NCT01236807. CONCLUSION: MR INFORM will assess whether an initial strategy of CMR perfusion is non-inferior to invasive angiography supplemented by FFR measurements to guide the management of patients with stable coronary artery disease. Non-inferiority of CMR perfusion imaging to the current invasive reference standard (FFR) would establish CMR perfusion imaging as an attractive non-invasive alternative to current diagnostic pathways.
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Adenosina , Angina Estável/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Circulação Coronária , Imagem Cinética por Ressonância Magnética , Imagem de Perfusão/métodos , Projetos de Pesquisa , Vasodilatadores , Angina Estável/fisiopatologia , Angina Estável/terapia , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Europa (Continente) , Reserva Fracionada de Fluxo Miocárdico , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de TempoRESUMO
BACKGROUND: Thalassaemia major (TM) patients need regular blood transfusions that lead to accumulation of iron and death from heart failure. Deferiprone has been reported to be superior to deferoxamine for the removal of cardiac iron and improvement in left ventricular (LV) function but little is known of their relative effects on the right ventricle (RV), which is being increasingly recognised as an important prognostic factor in cardiomyopathy. Therefore data from a prospective randomised controlled trial (RCT) comparing these chelators was retrospectively analysed to assess the RV responses to these drugs. METHODS: In the RCT, 61 TM patients were randomised to receive either deferiprone or deferoxamine monotherapy, and CMR scans for T2* and cardiac function were obtained. Data were re-analysed for RV volumes and function at baseline, and after 6 and 12 months of treatment. RESULTS: From baseline to 12 months, deferiprone reduced RV end systolic volume (ESV) from 37.7 to 34.2 mL (p=0.008), whilst RV ejection fraction (EF) increased from 69.6 to 72.2% (p=0.001). This was associated with a 27% increase in T2* (p<0.001) and 3.1% increase in LVEF (p<0.001). By contrast, deferoxamine showed no change in RVESV (38.1 to 39.1 mL, p=0.38), or RVEF (70.0 to 69.9%, p=0.93) whereas the T2* increased by 13% (p<0.001), but with no change in LVEF (0.32%; p=0.66). Analysis of between drugs treatment effects, showed significant improvements favouring deferiprone with a mean effect on RVESV of -1.82 mL (p=0.014) and 1.16% for RVEF (p=0.009). Using regression analysis the improvement in RVEF at 12 months was shown to be greater in patients with lower baseline EF values (p<0.001), with a significant difference in RVEF of 3.5% favouring deferiprone over deferoxamine (p=0.012). CONCLUSION: In this retrospective analysis of a prospective RCT, deferiprone monotherapy was superior to deferoxamine for improvement in RVEF and end-systolic volume. This improvement in the RV volumes and function may contribute to the improved cardiac outcomes seen with deferiprone.
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Cardiomiopatias/tratamento farmacológico , Desferroxamina/uso terapêutico , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Miocárdio/metabolismo , Piridonas/uso terapêutico , Sideróforos/uso terapêutico , Reação Transfusional , Função Ventricular Direita/efeitos dos fármacos , Talassemia beta/terapia , Adulto , Análise de Variância , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Cardiomiopatias/metabolismo , Cardiomiopatias/fisiopatologia , Deferiprona , Feminino , Grécia , Humanos , Sobrecarga de Ferro/diagnóstico , Sobrecarga de Ferro/etiologia , Sobrecarga de Ferro/metabolismo , Sobrecarga de Ferro/fisiopatologia , Itália , Imageamento por Ressonância Magnética , Masculino , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Volume Sistólico/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/efeitos dos fármacos , Adulto Jovem , Talassemia beta/sangueRESUMO
A 38-year-old man with a history of uncontrolled hypertension was investigated for atypical chest pains and found to have an aneurysm of the ascending aorta and a coexisting coarctation of the aorta. The timing and sequence of surgical repair of these 2 pathologies are controversial. We report an elective single-stage operation in which the ascending aorta was replaced and an extracardiac bypass from the ascending to the descending aorta was performed with excellent results.