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1.
Coron Artery Dis ; 34(3): 167-176, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-36762665

RESUMO

BACKGROUND: Cardiac computed tomography angiography (CCTA) is precise in noninvasive coronary atherosclerosis characterization but its value in the diagnosis of intracoronary thrombus remains unknown. Therefore, our aim was to evaluate CCTA for intracoronary thrombus and stenosis detection in patients with acute coronary syndromes with high thrombus burden selected for a deferred stenting strategy. METHODS: We systematically performed a CCTA in consecutive patients following a deferred stenting strategy, 24 h before the scheduled repeated coronary angiography including optical coherence tomography (OCT) imaging. Intracoronary thrombus and residual stenosis were blindly and independently evaluated by both techniques. Agreement was determined per lesion using the weighted Kappa ( K ) coefficient and absolute intraclass correlation coefficient (ICC). A stratified analysis according to OCT-detected thrombus burden was also performed. RESULTS: Thirty lesions in 28 consecutive patients were analyzed. Concordance between CCTA and repeated coronary angiography in thrombus detection was good ( K = 0.554; P < 0.001), but both showed poor agreement with OCT. CCTA needed >11.5% thrombus burden on OCT to obtain adequate diagnostic accuracy. The lesions detected by angiography were more frequently classified as red thrombus (76.5 vs. 33.3%; P = 0.087) on OCT. CCTA showed an excellent concordance with coronary angiography in diameter measurement (ICC = 0.85; P < 0.001) and was able to identify all the patients with severe residual stenosis. CONCLUSIONS: Although CCTA showed just a good concordance with angiography in intracoronary thrombus detection, the agreement in residual stenosis was excellent. Thus, in patients with a high-thrombus burden selected for a deferred stenting strategy CCTA may substitute repeat angiography.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Trombose Coronária , Humanos , Angiografia por Tomografia Computadorizada , Estudos Prospectivos , Constrição Patológica , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Angiografia Coronária/métodos , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/terapia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Valor Preditivo dos Testes
4.
Int J Cardiovasc Imaging ; 36(9): 1751-1759, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32405733

RESUMO

Whether sex differences exist in cardiac magnetic resonance (CMR) findings in patients with hypertrophic cardiomyopathy (HCM) remain unknown. We sought to assess and compare CMR characteristics in male and female patients with HCM. From January-2006 to October-2017, 165 consecutive HCM patients evaluated with CMR were included. All clinical and complementary test information was prospectively collected. At the time of CMR evaluation women were older (70 [57-75] vs. 61 [47-72] years, p = 0.02) and more symptomatic in terms of dyspnea (New York Heart Association class II-IV 47.2 vs. 24.1%, p = 0.003) and palpitations (19.6 vs. 4.6%, p = 0.006) and received more frequently treatment with diuretics (49.1% vs. 23.4%, p = 0.001). On echocardiographic examination more women had obstructive physiology (45.1 vs. 20.6%, p = 0.002). On CMR evaluation, women showed smaller left ventricular end-systolic volume index (13 [10-15] vs. 16 [13-21] ml/m2, p < 0.001), higher left ventricular ejection fraction (77 [74-80] vs. 72 [66-78]%, p = 0.004), more marked left ventricular outflow tract acceleration (54.7 vs. 26.4%, p < 0.001) and mitral regurgitation (33.3 vs. 12.7%, p = 0.002). In multivariable analysis, female sex [OR 2.44 (1.04-5.73), p = 0.04] and left ventricular end-systolic volume index [OR 1.60 (1.08-2.38), p = 0.018] were independently associated with obstructive physiology. Women with HCM have more frequently obstructive physiology, a finding that could be related to the smaller left ventricular end-systolic volume.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Disparidades nos Níveis de Saúde , Imagem Cinética por Ressonância Magnética , Idoso , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/tratamento farmacológico , Cardiomiopatia Hipertrófica/fisiopatologia , Diuréticos/uso terapêutico , Feminino , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda
5.
Rev Esp Cardiol ; 56(7): 721-33, 2003 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-12855155

RESUMO

Information on myocardial viability can be useful to decide when coronary artery revascularization is indicated for patients with acute myocardial infarction (AMI) and left regional or global ventricular dysfunction. Difficulties in assessing viability arise because the same part of the ventricular wall can have a mixture of necrotic tissue and viable myocardium. Diagnostic markers of myocardial viability are: the preservation of wall thickness, the presence of contractility reserve, the presence of blood perfusion reserve, integrity of the wall cells, and preservation of cellular metabolism. Echocardiography and thallium or technetium imaging are methods currently used to assess myocardial viability because of their availability and relatively low cost. Although positron emission tomography (PET) has been considered the gold standard, its unavailability may limit its clinical use. Recent publications have demonstrated the accuracy of cardiac magnetic resonance imaging (cardiac MRI) in assessing myocardial viability, together with noninvasive procedures to study the markers of viability noted above. Late contrast enhancement with gadolinium is the most accurate and simplest method. The late open artery hypothesis recommends, on the basis of scant evidence, systematic revascularization of the culprit artery. Although no large randomized studies focused on prognosis are available yet, several small studies provide sufficient evidence of functional recovery of viable myocardium after coronary artery revascularization of the culprit artery in patients with global or regional ventricular dysfunction. The assessment of myocardial viability to decide whether culprit artery revascularization is indicated is a strategy currently based on more evidence than the more indiscriminate recommendations based on the late open artery hypothesis.


Assuntos
Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Revascularização Miocárdica , Cuidados Pré-Operatórios , Algoritmos , Humanos
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