Utilidad de la tomografía de coherencia óptica como guía en el tratamiento del síndrome coronario agudo: reporte de un caso / Utility of optical coherence tomography to guide treatment in acute coronary syndromes: case report / Utilidade da tomografia de coerência óptica como guia no tratamento da síndrome coronariana aguda: relato de um caso

La tomografía de coherencia óptica (OCT) es una técnica de imagen endovascular con elevada resolución espacial que permite evaluar las diferentes estructuras que componen la pared de las arterias coronarias, caracterizar morfológicamente la placa aterosclerótica y establecer el mecanismo fisiopatológico subyacente en los síndromes coronarios agudos (SCA). Se presenta el caso clínico de un paciente con infarto agudo de miocardio, donde la OCT evidenció que la reducción de la luz arterial estaba determinada principalmente por la presencia de trombo, a la vez que demostró una disrupción endotelial (ruptura de placa) como mecanismo fisiopatológico subyacente. Se adoptó una estrategia invasivo-conservadora, donde finalmente no se implantó stent. La información surgida de la OCT en este caso particular fue fundamental en la toma de decisiones.

Optical coherence tomography (OCT) is an endovascular imaging technique with high spatial resolution. It allows to evaluate the different structures that compose coronary arteries' wall, morphologically characterize atherosclerotic plaques and establish the underlying pathophysiological mechanism in acute coronary syndromes (ACS). The case of a patient with acute myocardial infarction is presented, in which OCT showed that the reduction of arterial lumen was determined mainly by the presence of thrombus, while also demonstrated endothelial disruption (plaque rupture) as the underlying pathophysiological mechanism. An invasive-conservative strategy was adopted and finally stent was not implanted. The information that emerged from the OCT in this particular case was fundamental in decision-making.

A tomografia de coerência óptica (OCT) é uma técnica de imagem endovascular com alta resolução espacial que permite a avaliação das diferentes estruturas que compõem a parede das artérias coronárias, a caracterização morfológica da placa aterosclerótica e o estabelecimento do mecanismo fisiopatológico subjacente de síndrome coronariana aguda (SCA). Apresentamos o caso clínico de um paciente com enfarte agudo do miocárdio, onde a OCT mostrou que a redução do lúmen arterial foi determinada principalmente pela presença de trombo, ao mesmo tempo que demonstrou uma ruptura endotelial (ruptura da placa) como causa fisiopatológica subjacente. Adotou-se uma estratégia invasiva-conservadora, onde finalmente o stent não foi implantado. As informações obtidas da OCT neste caso específico foram fundamentais na tomada de decisão.

Fístula coronário-cavitária da artéria coronária circunflexa para o átrio esquerdo como provável etiologia de insuficiência cardíaca: relato de caso / Coronary­cavitary fistula of the circumflex coronary artery to the left atrium as a probable etiology of heart failure: a case report

Fístulas de artérias coronárias têm incidência baixa, sendo diagnosticadas mais frequentemente pelo ecocardiograma ou angiotomografia coronariana, embora a cineangiocoronariografia seja o método padrão-ouro. Têm origem mais comumente na artéria coronária direita, sendo a drenagem para câmaras de baixa pressão o mais habitual. O tratamento pode ser expectante, cirúrgico ou percutâneo. Este relato descreve o caso de uma rara apresentação de insuficiência cardíaca, dada por fístula da coronária circunflexa com drenagem para o átrio esquerdo. (AU)

Coronary artery fistulas have a low incidence and are often diagnosed by echocardiography or coronary computed tomography angiography, although coronary angiography is the gold standard. They commonly originate in the right coronary artery, with drainage to low-pressure chambers being the most frequent finding. Treatment can be expectant, surgical, or percutaneous. This report describes a case of a rare presentation of heart failure due to a fistula of the circumflex coronary artery with drainage into the left atrium. (AU)

A randomized comparison of estimated radiation exposure between Low and conventional dose protocol during invasive coronary angiography (ERICA trial): Pilot study.

PURPOSE: Radiation exposure during coronary angiography is potentially harmful to patients and operators. However, there are limited data on the effects of a low-dose radiation angiography. We evaluated the feasibility and effectiveness of a reduced radiation dose protocol during invasive coronary angiography. METHODS: One hundred three consecutive patients who underwent coronary angiography were enrolled and randomized to low- or conventional dose protocols (LDP versus CDP). The LDP consists of 10 frames per second during fluoroscopy and half the radiation dose of CDP during cineangiography. Image quality was assessed using a Likert rating scale by an independent radiologist. The radiation dose was estimated with dose-area product (DAP) and air-kerma (AK). RESULTS: Body weight and waist circumference are well correlated with the level of DAP and AK. Exposure time and total images and frame counts in cineangiography were similar in both groups. There was a marked reduction of the estimated radiation dose (DAP and AK) in the LDP group compared to the CDP group without significant compromise in image quality (total DAP: LDP 1980.1 ±â€¯1163.7 vs. CDP 3434.2 ±â€¯2188.1 µGym2 p = 0.001; total AK: 279.6 ±â€¯159.3 vs. 493.8 ±â€¯280.6 mGy, p < 0.001). CONCLUSION: The LDP reduced the total estimated radiation dose compared to the CDP without a significant loss of diagnostic information. A LDP may be a viable strategy to protect patients and medical staff from the hazards of radiation in the cardiac catheterization laboratory.

Isquemia miocárdica sin lesiones coronarias obstructivas: MINOCA-INOCA: Revisión para la toma de decisiones GREECO (Grupo de Estudio de Enfermedades Coronarias) / Myocardial ischemia without coronary obstructions: MINOCA-INOCA. Review for decision making

Una de cada 4 coronariografías realizadas por isquemia miocárdica presenta lesiones menores al 50% Este dato desencadenó un creciente interés en la comunidad médica. La Sociedad Americana de Cardiología publicó recientemente un artículo que describe la posición consensuada de un grupo de expertos sobre la fisiopatología, el diagnóstico y el tratamiento de esta entidad. Nuestro trabajo refleja una revisión narrativa y la posición de un grupo de expertos pertenecientes a diferentes instituciones con servicios de Cardiología jerarquizados. Aborda aspectos fisiopatológicos y diagnósticos para comprender el enfoque actual del tratamiento, tanto en pacientes que ingresan con diagnóstico de MINOCA (infa rto de miocardio con lesiones angiográficas no graves) o de INOCA (angina e isquemia demostradas, pero sin lesiones coronarias que justifiquen este síndrome).

One in every four coronarographies performed to study myocardial ischemia shows coronary angiographic stenosis less than 50%. This data triggered an increasing interest in the medical community. The American Society of Cardiology recently published a position paper about the pathophysiology, diagnosis and treatment of this entity. Our group performed a narrative review reflecting the opinion of cardiology experts from different centers in Argentina. It aims physiopatologic and diagnostic aspect to understand the current approach in patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) e INOCA (demonstrated angina and ischemia but without coronary lesions that justify this syndrome).

The Impact of Novel X-Ray Systems and X-Ray System Optimization on Patient Radiation Dose Administered During Cardiac Catheterization.

INTRODUCTION: The effect of x-ray system optimization on patient radiation dose has received limited study. METHODS: We analyzed patient radiation dose in 1786 cardiac catheterization procedures (diagnostic coronary angiography and/or percutaneous coronary intervention [PCI]) performed at a single tertiary-care center before and after x-ray system optimization. RESULTS: After optimization, cineangiography dose-area product (DAP) dose was lower in the overall group of patients who underwent diagnostic angiography and/or PCI (1347 µGy•m² [IQR, 645-2345 µGy•m²] vs 1658 µGy•m² [IQR, 640- 2757 µGy•m²]; P=.03), as well as in the diagnostic angiography group (1795 µGy•m² [IQR, 1140-2994 µGy•m²] vs 2356 µGy•m² [IQR, 311-3576 µGy•m²]; P<.01) and PCI group (2152 µGy•m² [IQR, 1338-3477 µGy•m²] vs 2562 µGy•m² [IQR, 1681-3859 µGy•m²]; P=.02). Cineangiography DAP per exposure was also lower in the overall group (143 µGy•m² [IQR, 91-212 µGy•m²] vs 164 µGy•m² [IQR, 106-233 µGy•m²] per exposure; P<.01) and in the diagnostic angiography group (158 µGy•m² [IQR, 102-225 µGy•m²] vs 184 µGy•m² [IQR, 125-271 µGy•m²] per exposure; P<.01). After optimization, cineangiography air kerma (AK) dose (319 mGy [IQR, 197-531 mGy] vs 421 mGy [IQR, 241-600 mGy]; P=.01) and cineangiography AK per exposure (20.7 mGy [IQR, 12.9-29.0 mGy] vs 23.6 mGy [IQR, 14.1-32.9 mGy] per exposure; P=.03) were also lower in the PCI group. There was no significant change in fluoroscopy AK dose after optimization (20.7 mGy [IQR, 12.7-30.1 mGy] vs 20.4 mGy [IQR, 12.8-31.3 mGy] per minute; P=.71) and fluoroscopy DAP dose (156 µGy•m² [IQR, 101-242 µGy•m²] vs 156 µGy•m² [IQR, 102-236 µGy•m²] per minute; P=.91). CONCLUSION: X-ray system optimization was associated with lower cineangiography DAP, but similar fluoroscopy radiation dose.

Radiation dose reduction and static image quality assessment using a channelized hotelling observer on an angiography system upgraded with clarity IQ.

The goal of this paper was the comparison of radiation dose and imaging quality before and after the Clarity IQ technology installation in a Philips AlluraXper FD20/20 angiography system using a Channelized Hotelling Observer model (CHO). The core characteristics of the Allura Clarity IQ technology are its real-time noise reduction algorithms (NRT) combined with state-of-the-art hardware; this technology allows to implement acquisition protocols able to significantly reduce patient entrance dose. To measure the system performances in terms of image quality we used a contrast detail phantom in a clinical scatter condition. A Leeds TO10 phantom has been imaged between two 10 cm thick homogeneous solid water slabs. Fluoroscopy images were acquired using a cerebral protocol at 3 dose levels (low, medium and high) with a field- of view (FOV) of 31 cm. Cineangiography images were acquired using a cerebral protocol at 2 fps. Thus, 4 acquisitions were obtained for the conventional technology and 4 acquisitions were taken after the Clarity IQ upgrade, for a total of 8 different image sets. A validated 40 Gabor channels CHO with an internal noise model compared the image sets. Human observers' studies were carried out to tune the internal noise parameter. We showed that the CHO did not detect any significant difference between any of the image sets acquired using the two technologies. Consequently, this x-ray imaging technology provides a non-inferior image quality with an average patient dose reduction of 57% and 28% respectively in cineangiography and fluoroscopy. The Clarity IQ installation has certainly allowed a considerable improvement in patient and staff safety, while maintaining the same image quality.

Myocardial Perfusion by Coronary Computed Tomography in the Evaluation of Myocardial Ischemia: Simultaneous Stress Protocol with SPECT / Perfusão Miocárdica por Angiotomografia de Coronárias na Avaliação da Isquemia Miocárdica: Protocolo de Estresse Simultâneo com SPECT

Abstract Background: Functional assessment to rule out myocardial ischemia using coronary computed tomography angiography (CCTA) is extremely important and data on the Brazilian population are still limited. Objective: To assess the diagnostic performance of myocardial perfusion by CCTA in the detection of severe obstructive coronary artery disease (CAD) compared with single-photon emission computerized tomography (SPECT). To analyze the importance of anatomical knowledge to understand the presence of myocardial perfusion defects on SPECT imaging that is not identified on computed tomography (CT) scan. Method: A total of 35 patients were evaluated by a simultaneous pharmacologic stress protocol. Fisher's exact test was used to compare proportions. The patients were grouped according to the presence or absence of significant CAD. The area under the ROC curve was used to identify the diagnostic performance of CCTA and SPECT in perfusion assessment. P < 0.05 values were considered statistically significant. Results: For detection of obstructive CAD, CT myocardial perfusion analysis yielded an area under the ROC curve of 0.84 [a 95% confidence interval (CI95%): 0.67-0.94, p < 0.001]. SPECT myocardial perfusion imaging, on the other hand, showed an AUC of 0.58 (95% CI 0.40 - 0.74, p < 0.001). In this study, false-positive results with SPECT are described. Conclusion: Myocardial perfusion analysis by CTA displays satisfactory results compared to SPECT in the detection of obstructive CAD. CCTA can rule out false-positive results of SPECT.

Resumo Fundamento: A avaliação funcional para descartar a isquemia miocárdica utilizando a angiotomografia computadorizada (angio-TC) de coronárias é de extrema importância e dados na população brasileira ainda são escassos. Objetivo: Avaliar o desempenho diagnóstico da perfusão miocárdica pela angio-TC de coronárias na detecção de doença arterial coronariana (DAC) obstrutiva significativa em comparação com a tomografia computadorizada por emissão de fóton único (SPECT; do inglês, single photon emission computerized tomography). Analisar a importância do conhecimento anatômico para entender a presença de defeito de perfusão miocárdica pela SPECT que não é identificado pela tomografia computadorizada (TC). Método: Trinta e cinco pacientes foram avaliados por um protocolo de estresse farmacológico simultâneo. O teste exato de Fisher foi utilizado para comparação entre as proporções. Os pacientes foram agrupados de acordo com a presença ou não de DAC significativa. A área sob a curva foi utilizada para identificar o desempenho diagnóstico da avaliação da perfusão pela angio-TC de coronárias e pela SPECT. Os valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Para detecção de DAC obstrutiva a avaliação da perfusão miocárdica pela TC teve uma área sob a curva de 0,84 [intervalo de confiança de 95% (IC95%): 0,67 a 0,94, p < 0,001]. Já o estudo da perfusão miocárdica pela SPECT foi de 0,58 (IC95%: 0,40 a 0,74, p < 0,001). Neste estudo, foram descritos falso-positivos pela SPECT. Conclusão: A avaliação da perfusão miocárdica pela angio-TC apresenta resultados satisfatórios em comparação com os da SPECT na detecção de DAC obstrutiva. A angio-TC de coronárias tem capacidade de afastar falso-positivos da SPECT.

Long-Term Traumatic and Asymptomatic Aorto-Right Atrial Fistula.

Aorto-atrial fistulas due to cardiac trauma are rare, and survivors require immediate surgical correction. Here, we report a case of an aorto-right atrial fistula due to penetrating trauma after a 16-year evolution, which developed symptoms of acute coronary syndrome and was treated with myocardial revascularization and correction of the aorto-cameral fistula.

Long-term traumatic and asymptomatic aorto-right atrial fistula

Abstract Aorto-atrial fistulas due to cardiac trauma are rare, and survivors require immediate surgical correction. Here, we report a case of an aorto-right atrial fistula due to penetrating trauma after a 16-year evolution, which developed symptoms of acute coronary syndrome and was treated with myocardial revascularization and correction of the aorto-cameral fistula.

Assessing the level of radiation experienced by anesthesiologists during transfemoral Transcatheter Aortic Valve Implantation and protection by a lead cap.

OBJECTIVE: Transfemoral Transcatheter Aortic Valve Implantation (TAVI) has become a standard therapy for patients with aortic valve stenosis. Fluoroscopic imaging is essential for TAVI with the anesthesiologist's workplace close to patient's head side. While the use of lead-caps has been shown to be useful for interventional cardiologists, data are lacking for anesthesiologists. METHODS: A protective cap with a 0.35 lead-equivalent was worn on 15 working days by one anesthesiologist. Six detectors (three outside, three inside) were analyzed to determine the reduction of radiation. Literature search was conducted between April and October 2018. RESULTS: In the observational period, 32 TAVI procedures were conducted. A maximum radiation dose of 0.55 mSv was detected by the dosimeters at the outside of the cap. The dosimeters inside the cap, in contrast, displayed a constant radiation dose of 0.08 mSv. CONCLUSION: The anesthesiologist's head is exposed to significant radiation during TAVI and it can be protected by wearing a lead-cap.

Left Ventricular Function After Repair of Totally Anomalous Pulmonary Venous Connection.

BACKGROUND: Poor left ventricular (LV) growth and diastolic dysfunction long after simple total anomalous pulmonary venous connection (TAPVC) repair has been well documented and is believed to originate from insufficient preoperative volume preload. The objective of the study was to confirm these findings. METHODS: Of 61 patients undergoing simple TAPVC repair between 1996 and 2016, 42 patients undergoing postoperative catheter examinations were enrolled. The mean age at the time of repair was 39 ± 117 days. Postoperative catheter examinations were conducted at a mean duration of 1.1 years after the repair. LV end-diastolic volume (LVEDV) was calculated by biplane cineangiography with the use of Simpson's method as a Graham modification. RESULTS: LV ejection fraction, LV end-diastolic pressure (LVEDP), and cardiac index were 72% ± 5%, 10.3 ± 2.7 mm Hg, and 4.0 ± 0.7 L •·min-1 • m-2, respectively. LVEDV was 102% ± 16% of the predictive normal value, and it strongly correlated with the predictive normal value of LV end-diastolic diameter (LVEDd) calculated by two-dimensional echocardiography (R2 = 0.29, p = 0.005). LVEDd maintained a normal range thereafter during the entire follow-up period. LVEDP correlated linearly with age at the time of TAPVC repair (R2 = 0.18, p = 0.007) but not with LVEDV (p = 0.67). CONCLUSIONS: LV size maintained a normal range after the repair of simple TAPVC. High LVEDP was frequently observed a year after repair; it did not correlate with LV size but had a strong negative correlation with age at the time of repair.

Significance of nailfold videocapillaroscopy in patients with idiopathic inflammatory myopathies.

Objective: The aim of this study was to investigate the clinical and immunological significance of nailfold videocapillaroscopy (NVC) abnormalities in patients with idiopathic inflammatory myopathies (IIMs). Methods: Seventy consecutive Japanese patients with untreated IIMs, enrolled between April 2014 and August 2017, were prospectively studied. Clinical features, NVC findings, autoantibody profile by immunoprecipitation and ELISA, and histopathological findings of skin biopsies of DM rash were assessed at baseline and after 1-year of immunosuppressive therapy. Results: NVC abnormalities were found in 55.7% (39/70) of IIM patients, with significantly higher prevalence in DM (65.4%) compared with PM (27.8%) (P = 0.01). In subsets of patients classified by autoantibody specificities, the prevalence of NVC abnormalities was significantly higher in patients with anti-MDA5 (87.5%) and anti-transcriptional intermediary factor 1γ (88.9%) vs anti-aminoacyl-tRNA synthetase (26.9%, P < 0.001). Perivascular lymphocytic infiltration in the upper dermis of skin rash biopsy of DM was more severe in patients with NVC abnormalities (P < 0.05). Unexpectedly, NVC abnormalities disappeared in 75% of IIM patients after 1-year of immunosuppressive therapy in contrast to stable NVC changes seen in scleroderma patients. Conclusion: Nailfold microvascular abnormalities were common in DM patients, associated with anti-MDA5 and transcriptional intermediary factor 1γ antibodies, and perivascular inflammation in skin histology. NVC abnormalities in IIMs may become clinically useful markers for defining subsets of DM and understanding the pathogenesis of the clinical features seen in these patients.

Lateral costal artery: clinical importance of an accessory thoracic artery

Abstract The lateral costal artery has sometimes been identified as the culprit for the "steal phenomenon" after coronary artery bypass grafting, besides being occasionally used for myocardial revascularization. Its branches make anastomoses with the internal thoracic artery through lateral intercostal arteries. We aim to report, on three cases, the clinical significance of a well-developed lateral costal artery after coronary artery bypass grafting. Two out of three patients who underwent coronary artery bypass graft surgery in our center between June 2010 and August 2017, applied to us with stable angina pectoris, while the third one was diagnosed with acute coronary syndrome after applying to the emergency department. In coronary cineangiography, in all three cases, a well-developed accessory vessel arising from the proximal 2.5 cm segment of the left internal thoracic artery coursed as far as the 6th rib was detected, and it was confirmed to be the lateral costal artery. A stable angina pectoris in two of the patients was thought to be the result of steal phenomenon caused by the well-developed lateral costal artery. In the two cases with stable angina pectoris the lateral costal artery was obliterated via coil embolization. In the other case with the proximal left anterior descending artery stenosis, before percutaneous coronary intervention, the lateral costal artery was obliterated via coil embolization and the occluded subclavian artery was stented. Routine visualization in cineangiography and satisfactory surgical exploration of the left internal thoracic artery could be very helpful to identify any possible accessory branch of the left internal thoracic artery like the lateral costal artery.

Correlación entre estudios electrocardiográficos y cinecoronariográficos en enfermedades coronarias / Connection between electrocardiographic and cinecoronariographic studies in coronary diseases

Las enfermedades cardiovasculares son la principal causa de muerte en Chile. Los Síndromes Coronarios Agudos (SCA), obligan a los sistemas de salud a destinar recursos de elevado costo para su diagnóstico. Procedimientos como el electrocardiograma (ECG) y la cinecoronariografía (CCG) orientan en el diagnóstico de dichas patologías, siendo el ECG un examen no invasivo de fácil ejecución y de bajo costo. El objetivo de este estudio fue relacionar el examen ECG con la CCG para mejorar la precisión diagnóstica de obstrucción coronaria. El estudio fue de tipo descriptivo de corte transversal, constituido por 44 pacientes adultos de ambos sexos que presentaron infarto de miocardio con elevación de segmento ST (STEMI), derivados al Servicio de Hemodinamia de la Clínica Iquique, Chile, para intervención coronaria. Los 44 pacientes tenían un ECG previo y se les realizó una CCG. Los resultados establecieron una fuerte correlación entre los diagnósticos por ECG y por CCG del total de las arterias obstruidas (según prueba de Correlación de Pearson = 0,80; p < 0,001). Se demostró relación entre ambos exámenes en un 92,3 % (p = 0,001) para la obstrucción de la arteria coronaria derecha (ACD) con hallazgo electrocardiográfico que correspondía a infarto de pared inferior. Relación de 100 % para la obstrucción de la rama circunfleja de la arteria coronaria izquierda (ACI) (p = 0,036) y 100 % para la obstrucción de la rama interventricular anterior de la ACI o arteria coronaria descendente anterior (p = 0,001) correspondiente a infarto de pared lateral. Se concluyó que existe relación significativa entre el infarto de pared anterior según los hallazgos electrocardiográficos y la obstrucción de la ACD y la rama circunfleja de la ACI según CCG; además, la relación es significativa entre los infartos de pared lateral y pared anterior con hallazgos por ECG y la obstrucción de la rama interventricular anterior de la arteria coronaria izquierda diagnosticada por CCG. Es fundamental la interpretación correcta del ECG para mejorar la atención del infarto agudo al miocardio.

Cardiovascular diseases are the leading cause of death in Chile. Acute Coronary Syndrome (ACS) forces health systems to allocate high-cost resources for diagnosis. Procedures like Electrocardiogram (ECG) and cinecoronariography (CCG) guide the diagnosis of these pathologies, with ECG being a noninvasive exam easy to perform and of low cost. The aim of this study was to connect ECG exams with CCG to improve the diagnostic accuracy of coronary obstruction. This was a descriptive cross-sectional study, consisting of 44 adult patients of both sexes which presented myocardial infarction with ST-segment elevation (STEMI) referred to the Hemodynamic Service from Iquique Clinic, Chile, for coronary operation. All 44 patients had previous ECG and they were conducted a CCG. Results established a strong correlation between ECG and CCG diagnosis from the total of Clogged Arteries (according to Pearson correlation test = 0.80; p < 0.001). The correlation demonstrated in both exams was 92.3 % (p = 0.001) for blockage in the right coronary artery (RCA) with electrocardiographic finding corresponding to inferior wall infarction. 100 % relationship for the obstruction of the circumflex branch of the left coronary artery (LCA) (p = 0.036) and 100 % for the obstruction of RCA anterior interventricular branch or anterior descending coronary artery (p = 0.001) corresponding to a lateral wall infarction. It is concluded that there is a significant relationship between anterior wall infarction according to electrocardiographic findings and RCA obstruction and LCA circumflex branch according to CCG. In addition, there is a significant relationship between lateral wall infarction and interior walls by ECG findings and the obstruction of the anterior interventricular branch of the left coronary artery diagnosed by CCG. The correct interpretation of ECG is essential to improve the care of acute myocardial infarction.

Variability in radiation dose and image quality: A comparison across fluoroscopy-system vendors, generations of equipment and institutions.

OBJECTIVES: To evaluate differences in radiation dose and image quality across institutions, fluoroscope vendors and generations of fluoroscopes for pediatric cardiac catheterization. BACKGROUND: Increased recognition of the potentially harmful effects of ionizing radiation has spurred technological advances in fluoroscopes, as well as increased focus on optimizing fluoroscope performance. There is currently little understanding of variability in the dose-image quality relationship across institutions, fluoroscope vendor and/or generation of equipment. METHODS: We evaluated latest generation fluoroscopes from Phillips, Siemens, GE, and Toshiba, and an older generation Phillips fluoroscope (release date 2003) at three different institutions. Radiation dose was measured using an anthropomorphic dose-assessment phantom with effective dose in mSv estimated from Monte Carlo simulations. Image quality phantom images were scored on a 12-point scale by three blinded reviewers. RESULTS: Fluoroscope effective doses ranged from 0.04 to 0.14 mSv/1,000 pulses for fluoroscopy with associated composite image quality scores ranging from 8.0 ± 0.6 to 10.4 ± 1.3. For cineangiography, effective doses ranged from 0.17 to 0.57 mSv/1,000 frames with image quality scores ranging from 10.1 ± 0.3 to 11.1 ± 0.3. There was modest correlation between effective dose and image quality (r = 0.67, P = 0.006). The older generation fluoroscope delivered consistently higher doses than the newer generation systems (2.3- to 3.5-fold higher for fluoroscopy; 1.1- to 3.4-fold higher for cineangiography) without appreciable differences in image quality. CONCLUSION: Technological advances have markedly improved fluoroscope performance. Comparing latest generation systems across vendors and institutions, we found variability in the dose-IQ relationship and speculate that this reflects both equipment and institutional optimization practices.

Perfil de pacientes internados com diagnóstico de síndrome coronariana aguda / Profile of patients admitted to hospital with diagnosis of acute coronary syndrome

OBJETIVO: Descrever o perfil de pacientes internados com diagnóstico de síndrome coronariana aguda. MÉTODOS: Estudo analítico, observacional e transversal, com dados obtidos da análise dos prontuários de cem pacientes internados em um hospital, de fevereiro de 2014 a janeiro de 2015, os quais tiveram diagnóstico de síndrome coronariana aguda e foram regulados para a realização da cineangiocoronariografia. Foi traçado o perfil epidemiológico e fisiopatológico desta população. RESULTADOS: Em nossa amostra, 49 (55,7%) pacientes eram do sexo masculino, com média de idade de 63,88±13,3 anos, sendo 60,2% acima de 60 anos. O quadro clínico mais prevalente foi angina instável (41%). Constatou-se maior prevalência de portadores de hipertensão arterial (88,7%), além de associação positiva entre os pacientes com idade avançada e doença multiarterial. Também foi encontrada obstrução coronariana significativa em cerca de 90% dos pacientes diabéticos. Cineangiocoronariografia sem lesão significativa foi duas vezes mais identificada, em comparação com dados da American College of Cardiology. CONCLUSÃO: Fatores de risco modificáveis devem ser controlados, visando à redução do número de casos de doenças cardiovasculares agudas e daqueles com desfechos desfavoráveis. Sugere-se que a divulgação dos sintomas de infarto seja ampliada, para que os pacientes cheguem à emergência em tempo hábil de receber o tratamento.(AU)

OBJECTIVE: To describe the profile of patients admitted to Hospital with a diagnosis of acute coronary syndrome METHODS: This is an analytical, observational and crosssectional study with data obtained from the analyses of the medical records of 100 patients admitted to a hospital from February/2014 to January / 2015), who were diagnosed with acute coronary syndrome, and were regulated for undergoing coronary angiography. The epidemiological and pathophysiological profile of this population was described. RESULTS: In our sample, there were 49 (55.7 %) male patients with a mean age of 63.88±13.3 years, with 60.2 % being over 60 years. The most prevalent clinical condition was unstable angina (41%). A higher prevalence of patients with hypertension (88.7 %) was found, as well as a positive association of patients with advanced age and multivessel disease. We also find significant coronary obstruction in about 90 % of diabetic patients. Coronary angiographywith no significant lesion was twice as identified if compared with the American College of Cardiology data. CONCLUSION: The modifiable risk factors should be monitored, in order to reduce the number of cases of acute cardiovascular disease and those with unfavorable outcomes. The dissemination of information about infarction should be enhanced for the patients to search for emergent care in a timely manner.(AU)