RESUMO
BACKGROUND: Coronary artery ectasia (CAE) is an angiographic definition of coronary artery pathology in which the diameter of the ectatic segment measures more than 1.5 times the diameter of an adjacent healthy reference segment. No previous study has reported on the use of 3D-STE for assessing the left ventricular (LV) functions in patients with isolated CAE. As a result of this, we aimed to evaluate the effects of isolated CAE on LV functions using 3D-STE in the present study. METHODS: Ninety-one patients with isolated CAE and 90 controls who proved to have normal coronary angiograms were enrolled to the study. 3D-STE was performed and GLS, GCS, GAS, and GRS were obtained for every subject after coronary angiography. RESULTS: The mean age of the patients was 61.75 ± 10.02 years, and 71.8% were male. GLS, GCS, GAS, and GRS were significantly depressed in the isolated CAE group than in the control group (P < .001; P < .001; P = .001; and P = .001, respectively). ROC analyses were performed to find out the ideal strain cut off values to predict the presence of isolated CAE. A GLS value of >-16 has 92.1 % sensitivity, 88.5 % specificity; and a GCS value of >-20 has 86.7 % sensitivity, 89.2 % specificity to detect the presence of isolated CAE. CONCLUSION: Isolated CAE has a considerable negative effect on LV functions as evaluated by 3D-strain parameters, and 3D-STE could be an effective method to detect early stage myocardial impairment in patients with isolated CAE.
Assuntos
Aneurisma Coronário/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ventrículos do Coração/fisiopatologia , Contração Miocárdica/fisiologia , Função Ventricular Esquerda/fisiologia , Aneurisma Coronário/fisiopatologia , Angiografia Coronária/métodos , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Estudos RetrospectivosAssuntos
Dissecção Aórtica/diagnóstico , Aneurisma Coronário/diagnóstico , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Tomografia de Coerência Óptica/métodos , Idoso , Dissecção Aórtica/complicações , Aneurisma Coronário/complicações , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologiaRESUMO
Echocardiography is an excellent noninvasive imaging modality for evaluation and follow-up of cardiac lesions, especially coronary artery changes occurring as a result of Kawasaki disease. The information obtained has prognostic implications and can be complemented with other modes of imaging for risk stratification and optimization of both medical and interventional therapy. The aim of this article is to describe the time line of echocardiographic follow-up of patients affected with Kawasaki disease. The classification of coronary artery changes and transthoracic echocardiographic views recommended for detailed evaluation of the coronary arteries are delineated in detail in this report.
Assuntos
Aneurisma Coronário/diagnóstico , Vasos Coronários/diagnóstico por imagem , Ecocardiografia/métodos , Síndrome de Linfonodos Mucocutâneos/complicações , Aneurisma Coronário/etiologia , Humanos , Síndrome de Linfonodos Mucocutâneos/diagnósticoRESUMO
Patients with coronary artery aneurysms (CAAs) resulting from Kawasaki disease (KD) are at risk for thrombosis and myocardial infarction. Current guidelines recommend CAA diameter ≥8 mm as the criterion for initiating systemic anticoagulation. Transluminal attenuation gradient (TAG) analysis has been proposed as a noninvasive method for evaluating functional significance of coronary stenoses using computerized tomography angiography (CTA), but has not previously been used in CAA. We hypothesized that abnormal hemodynamics in CAA caused by KD could be quantified using TAG analysis. We studied 23 patients with a history of KD who had undergone clinically indicated CTA. We quantified TAG in the major coronary arteries and aneurysm geometry was characterized using maximum diameter, aneurysm shape index, and sphericity index. A total of 55 coronary arteries were analyzed, 25 of which had at least 1 aneurysmal region. TAG in aneurysmal arteries was significantly lower than in normal arteries (-23.5 ± 10.7 vs -10.5 ± 9.0, p = 0.00002). Aneurysm diameter, aneurysm shape index, and sphericity index were weakly correlated with TAG (r2 = 0.01, p = 0.6; r2 = 0.15, p = 0.06; r2 = 0.16, p = 0.04). This is the first application of TAG analysis to CAA caused by KD, and demonstrates significantly different TAG values in aneurysmal versus normal arteries. Lack of correlation between TAG and CAA geometry suggests that TAG may provide hemodynamic information not available from anatomy alone. TAG represents a possible extension to standard CTA for KD patients who may improve thrombotic risk stratification and aid in clinical decision making.
Assuntos
Angiografia por Tomografia Computadorizada/métodos , Aneurisma Coronário/diagnóstico , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Fluxo Sanguíneo Regional/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Aneurisma Coronário/etiologia , Aneurisma Coronário/fisiopatologia , Vasos Coronários/fisiopatologia , Seguimentos , Humanos , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Accurate risk prediction of coronary artery aneurysms (CAAs) in North American children with Kawasaki disease remains a clinical challenge. We sought to determine the predictive utility of baseline coronary dimensions adjusted for body surface area (z scores) for future CAAs in Kawasaki disease and explored the extent to which addition of established Japanese risk scores to baseline coronary artery z scores improved discrimination for CAA development. METHODS AND RESULTS: We explored the relationships of CAA with baseline z scores; with Kobayashi, Sano, Egami, and Harada risk scores; and with the combination of baseline z scores and risk scores. We defined CAA as a maximum z score (zMax) ≥2.5 of the left anterior descending or right coronary artery at 4 to 8 weeks of illness. Of 261 patients, 77 patients (29%) had a baseline zMax ≥2.0. CAAs occurred in 15 patients (6%). CAAs were strongly associated with baseline zMax ≥2.0 versus <2.0 (12 [16%] versus 3 [2%], respectively, P<0.001). Baseline zMax ≥2.0 had a C statistic of 0.77, good sensitivity (80%), and excellent negative predictive value (98%). None of the risk scores alone had adequate discrimination. When high-risk status per the Japanese risk scores was added to models containing baseline zMax ≥2.0, none were significantly better than baseline zMax ≥2.0 alone. CONCLUSIONS: In a North American center, baseline zMax ≥2.0 in children with Kawasaki disease demonstrated high predictive utility for later development of CAA. Future studies should validate the utility of our findings.
Assuntos
Aneurisma Coronário/etiologia , Vasos Coronários/diagnóstico por imagem , Técnicas de Apoio para a Decisão , Ecocardiografia , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Fatores Etários , Pré-Escolar , Aneurisma Coronário/diagnóstico , Feminino , Humanos , Imunossupressores/uso terapêutico , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , América do Norte , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND: The pathophysiology of coronary artery dissection (CD) remains poorly under-stood and little is known about the factors predicting mortality in these patients. We aimed to study the epidemiology of CD and predictors of mortality in these patients. METHODS: All patients diagnosed with CD in the Nationwide Inpatient Sample 2009-2010 database using International Classification of Diseases ninth revision 414.12 were included in the study. Chronic conditions included in the analysis were diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease (CAD), obesity, alcohol use, smoking, heart failure and ventricular arrhythmias. Non-cardiovascular conditions were connective tissue disorders, fibromuscular dysplasia, Ehlers-Danlos syndrome, Marfan's syndrome, sarcoidosis, Crohn's disease, polycystic kidney disease, rheumatoid arthritis, vasculitis including giant cell arteritis, polyarteritis nodosa and Takayasu's disease, cocaine use, early or premature labor. RESULTS: The prevalence of CD in the United States was 0.02% (n = 11,255), based on the hospital admissions reviewed in the database. The mean age was 63.25 years with women (64.62 years) being older than men (62.25 years) (p < 0.001). In-hospital mortality rate was 4.2%, with women (5.5%) having higher mortality than men (3.2%) (p = 0.009). Ventricular arrhythmias (OR 5.86, p < 0.001) predicted higher mortality, while hyperlipidemia (OR 0.26, p < 0.001) and CAD (OR 0.31, p = 0.001) predicted lower mortality in multivariate analysis. CONCLUSIONS: Our study demonstrated that CD was more prevalent in men but women had higher mortality than men. Age, heart failure and ventricular arrhythmias were independent predictors of increased mortality but hyperlipidemia CAD predicted lower mortality in patients with CD.
Assuntos
Dissecção Aórtica/mortalidade , Aneurisma Coronário/mortalidade , Mortalidade Hospitalar , Pacientes Internados/estatística & dados numéricos , Fatores Etários , Idoso , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/terapia , Comorbidade , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/terapia , Bases de Dados Factuais , Feminino , Disparidades nos Níveis de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologiaRESUMO
Giant coronary aneurysms secondary to Kawasaki disease are rare, but a very severe complication. Delayed diagnosis and appropriate treatment of the disease is a well-known risk factor for coronary aneurysms.
Assuntos
Aneurisma Coronário/diagnóstico , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Pré-Escolar , Aneurisma Coronário/etiologia , Aneurisma Coronário/prevenção & controle , Angiografia Coronária , Diagnóstico Tardio , Ecocardiografia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Tempo para o TratamentoAssuntos
Falso Aneurisma/diagnóstico , Aneurisma Coronário/diagnóstico , Angiografia Coronária/métodos , Vasos Coronários/lesões , Infarto do Miocárdio/etiologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Falso Aneurisma/complicações , Aneurisma Coronário/complicações , Humanos , MasculinoRESUMO
BACKGROUND: Edge dissections after coronary stent implantation are associated with increased short-term risk of major adverse cardiovascular events. The incidence and outcome of edge dissections after coronary stent implantation were reportedly different using different imaging techniques. We used optical coherence tomography (OCT) to assess the incidence, morphological findings and related factors of edge dissections after drug-eluting stent (DES) implantation. METHODS: Totally 42 patients with 43 de novo lesions in 43 native arteries undergoing DES implantation with OCT imaging were enrolled in this study. RESULTS: Nine edge dissections were detected in 43 arteries after DES implantation. There were four morphological patterns of stent edge dissections indentified in this study: (1) superficial intimal tears (n = 3), (2) subintimal dissections (n = 4), (3) split of media (n = 1), (4) disruption of the fibrotic cap of plaque (n = 1). Stent edge expansion and stent expansion were both higher in the group with dissections than those in the group without dissections (1.682 ± 0.425 vs. 1.229 ± 0.285, P = 0.0290; 1.507 ± 0.445 vs. 1.174 ± 0.265, P = 0.0072). CONCLUSIONS: The incidence of stent edge dissections detected by OCT was 21%. Stent edge dissection is related with stent edge expansion and stent expansion.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Dissecção Aórtica/diagnóstico , Aneurisma Coronário/diagnóstico , Stents Farmacológicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Tomografia de Coerência Óptica/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Dissecção Aórtica/diagnóstico , Aneurisma Coronário/diagnóstico , Vasos Coronários/lesões , Imageamento por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico , Traumatismos Torácicos/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Acidentes de Trânsito , Adolescente , Dissecção Aórtica/complicações , Aneurisma Coronário/complicações , Angiografia Coronária , Diagnóstico Diferencial , Humanos , Masculino , Infarto do Miocárdio/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnósticoAssuntos
Dissecção Aórtica/diagnóstico , Biópsia por Agulha , Aneurisma Coronário/diagnóstico , Angiografia Coronária , Infarto do Miocárdio/diagnóstico , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/patologia , Ultrassonografia de IntervençãoAssuntos
Dissecção Aórtica/diagnóstico , Aneurisma Coronário/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/cirurgia , Tomografia Computadorizada Espiral , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Adolescente , Dissecção Aórtica/complicações , Dissecção Aórtica/cirurgia , Aneurisma Coronário/complicações , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Infarto do Miocárdio/diagnóstico , Medição de Risco , Traumatismos Torácicos/complicações , Resultado do TratamentoRESUMO
Although most patients with coronary artery aneurysms are asymptomatic, manifestations of myocardial ischemia may occur. However, the role that a coronary aneurysm may play in impairing arterial flow of an otherwise normal coronary circulation is not completely known. A 64-year-old woman with previous anteroseptal myocardial infarction was found to have a large aneurysm of the proximal left anterior descending (LAD) coronary artery without angiographic evidence of atherosclerotic disease. IVUS evaluation revealed an 18 mm long and 12.2 x 10.8 mm wide aneurysm without atherosclerosis, thrombus or calcification. Pulsed wave Doppler showed significant reduction of LAD flow reserve, which normalized after successful obliteration of the aneurysm with polytetrafluoroethylene (PTFE)-covered stent implantation. Severe in-stent graft restenosis was found at 7-month angiographic and intravascular ultrasound follow-up, which was managed successfully with minimally invasive direct coronary bypass surgery. The patient did well, without symptoms over the following year.
Assuntos
Aneurisma Coronário/etiologia , Infarto do Miocárdio/complicações , Implante de Prótese Vascular , Materiais Revestidos Biocompatíveis/uso terapêutico , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/terapia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Politetrafluoretileno/uso terapêutico , Stents , Ultrassonografia Doppler Dupla , Ultrassonografia de IntervençãoRESUMO
We present a patient with an aneurysm that included both the aortic root and the ascending aorta. Visualization of the coronary arteries by x-ray angiography was not technically feasible. Magnetic resonance angiography (MRA) was thus performed and allowed an accurate evaluation of the involvement of the coronary arteries in the aneurysm and the patency of the proximal coronaries, as well as visualization of the aneurysm itself.