RESUMEN
PURPOSE: We sought to evaluate the behavior of cardiac mechanical synchrony as measured by phase SD (PSD) derived from gated MPI SPECT (gSPECT) in patients with super-response after CRT and to evaluate the clinical and imaging characteristics associated with super-response. METHODS: 158 subjects were evaluated with gSPECT before and 6 months after CRT. Patients with an improvement of LVEF > 15% and NYHA class I/II or reduction in LV end-systolic volume > 30% and NYHA class I/II were labeled as super-responders (SR). RESULTS: 34 patients were classified as super-responders (22%) and had lower PSD (32° ± 17°) at 6 months after CRT compared to responders (45° ± 24°) and non-responders 46° ± 28° (P = .02 for both comparisons). Regression analysis identified predictors independently associated with super-response to CRT: absence of previous history of CAD (odds ratio 18.7; P = .002), absence of diabetes mellitus (odds ratio 13; P = .03), and history of hypertension (odds ratio .2; P = .01). CONCLUSION: LV dyssynchrony after CRT implantation, but not at baseline, was significantly better among super-responders compared to non-super-responders. The absence of diabetes, absence of CAD, and history of hypertension were independently associated with super-response after CRT.
Asunto(s)
Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Hipertensión , Terapia de Resincronización Cardíaca/métodos , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/terapia , Humanos , Hipertensión/complicaciones , Oportunidad Relativa , Tomografía Computarizada de Emisión de Fotón Único/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Gated myocardial perfusion scintigraphy (GMPS) phase analysis is an important tool to investigate the physiology of left ventricular (LV) dyssynchrony. We aimed to test the performance of GMPS LV function and phase analysis in different clinical settings and on a diverse population. METHODS: This is a post hoc analysis of a prospective, non-randomized, multinational, multicenter cohort study. Clinical evaluation and GMPS prior to cardiac resynchronization therapy (CRT)(baseline) and 6-month post CRT (follow-up) were done. LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV ejection fraction (LVEF), LV phase standard deviation (LVPSD), and percentage of left ventricle non-viable (PLVNV) were obtained by 10 centers and compared to the core lab. RESULTS: 276 GMPS studies had all data available from individual sites and from core lab. There were no statistically significant differences between all variables except for LVPSD. When subjects with no mechanical dyssynchrony were excluded, LVPSD difference became non-significant. LVESV, LVEF, LVPSD and PLVNV had strong correlation in site against core lab comparison. Bland-Altman plots demonstrated good agreement. CONCLUSIONS: The presented correlation and agreement of LV function and dyssynchrony analysis over different sites with a diverse sample corroborate the strength of GMPS in the management of heart failure in clinical practice.
Asunto(s)
Disfunción Ventricular Izquierda , Estudios de Cohortes , Humanos , Perfusión , Estudios Prospectivos , Reproducibilidad de los Resultados , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
BACKGROUND: Placing the left ventricular (LV) lead in a viable segment with the latest mechanical activation (vSOLA) may be associated with optimal cardiac resynchronization therapy (CRT) response. We assessed the role of gated SPECT myocardial perfusion imaging (gSPECT MPI) in predicting clinical outcomes at 6 months in patients submitted to CRT. METHODS: Ten centers from 8 countries enrolled 195 consecutive patients. All underwent gSPECT MPI before and 6 months after CRT. The procedure was performed as per current guidelines, the operators being unaware of gSPECT MPI results. Regional LV dyssynchrony (Phase SD) and vSOLA were automatically determined using a 17 segment model. The lead was considered on-target if placed in vSOLA. The primary outcome was improvement in ≥1 of the following: ≥1 NYHA class, left ventricular ejection fraction (LVEF) by ≥5%, reduction in end-systolic volume by ≥15%, and ≥5 points in Minnesota Living With Heart Failure Questionnaire (MLHFQ). RESULTS: Sixteen patients died before the follow-up gSPECT MPI. The primary outcome occurred in 152 out of 179 (84.9%) cases. Mean change in LV phase standard deviation (PSD) at 6 months was 10.5°. Baseline dyssynchrony was not associated with the primary outcome. However, change in LV PSD from baseline was associated with the primary outcome (OR 1.04, 95% CI 1.01-1.07, P = .007). Change in LV PSD had an AUC of 0.78 (0.66-0.90) for the primary outcome. Improvement in LV PSD of 4° resulted in the highest positive likelihood ratio of 7.4 for a favorable outcome. In 23% of the patients, the CRT lead was placed in the vSOLA, and in 42% in either this segment or in a segment within 10° of it. On-target lead placement was not significantly associated with the primary outcome (OR 1.53, 95% CI 0.71-3.28). CONCLUSION: LV dyssynchrony improvement by gSPECT MPI, but not on-target lead placement, predicts clinical outcomes in patients undergoing CRT.
Asunto(s)
Terapia de Resincronización Cardíaca , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/terapia , Imagen de Perfusión Miocárdica , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
BACKGROUND: Left ventricular diastolic dyssynchrony (LVDD) can be assessed by gated myocardial perfusion single-photon emission computed tomography (GMP-SPECT). LVDD is an area of interest in subjects who underwent cardiac resynchronization therapy (CRT). The aim of this post hoc analysis was to assess the role of LVDD in subjects with CRT who were followed up at 6-month period. MATERIAL & METHODS: Left ventricular diastolic dyssynchrony was assessed by GMP-SPECT at baseline and after CRT procedure in 160 subjects from 10 different cardiological centers. CRT procedure was performed as per current guidelines. Outcomes were defined as improvement in ≥1 New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF) by 5%, and reduction in end-systolic volume (ESV) by 15% and 5% points in Minnesota Living with Heart Failure Questionnaire. LVDD was defined as diastolic phase standard deviation ≥40 ± 14°. RESULTS: Improvement in NYHA functional class occurred in 105 (65.6%), LVEF in 74 (46.3%), decrease in ESV in 86 (53.8%), and Minnesota score in 85 (53.1%) cases. Baseline LV diastolic standard deviation was 53.53° ± 20.85 and at follow-up 40.44° ± 26.1283; (P < 0.001). LVDD was not associated with improvement in clinical outcomes at follow-up. CONCLUSION: CRT improves both systolic and diastolic dyssynchrony values at 6-month follow-up. LVDD at baseline is correlated with cardiac functionality at follow-up, but not with overall favorable clinical outcomes.
Asunto(s)
Terapia de Resincronización Cardíaca , Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca , Imagen de Perfusión Miocárdica , Disfunción Ventricular Izquierda/diagnóstico por imagen , Anciano , Diástole , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Volumen Sistólico , Disfunción Ventricular Izquierda/terapiaAsunto(s)
Tomografía Computarizada por Emisión de Fotón Único Sincronizada Cardíaca , Insuficiencia Cardíaca/diagnóstico por imagen , Imagen de Perfusión Miocárdica , Disfunción Ventricular Izquierda/diagnóstico por imagen , Algoritmos , Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca/terapia , Humanos , Selección de Paciente , Volumen Sistólico , Disfunción Ventricular Izquierda/terapiaRESUMEN
El carcinoma broncogénico, es una causa frecuente de insuficiencia respiratoria y obstrucción central de la vía aérea, observándose hasta en un 30 por ciento de los pacientes que se encuentran en estadíos avanzados; sin embargo, las metástasis traqueobronquiales de otros tumores son menos frecuentes, correspondiendo solo al 20 por ciento de los casos que requieren resección endoscópica por neoplasia maligna. Los carcinomas de mama, colon, riñón, melanoma y linfomas son los más frecuentemente involucrados en este cuadro clínico. Presentamos el caso de una paciente de 57 años, con antecedente de carcinoma de mama, de tipo ductal infiltrante a quien se le realizó resección endoscópica de dos lesiones endoluminales en forma exitosa. (Nota: el enlace a Internet opera para todo el fasciculo 2/2008).
Asunto(s)
Broncoscopía , Carcinoma Broncogénico , Metástasis de la NeoplasiaRESUMEN
La resonancia mágnetica cardiovascular y la tomografía computarizada de multiples detectores ha evolucionado de una forma muy rápida mostrando una gran utilidad en la práctica clínica de la cardiología en todo el mundo a través de estos últimos años. En nuestro país se ha iniciado una nueva era de la cardiología moderna con el advenimiento de estos nuevos métodos, y es por ello que en este artículo queremos resaltar de una forma clara y resumida cuáles son las alternativas que nos pueden brindar estas herramientas en el diagnóstico y manejo de las enfermedades cardiovasculares.
Cardiovascular magnetic resonance (CMR) and multislice computed tomography (MSCT) have evolved very quickly over the last few years, showing to be very useful in the clinical practice of cardiology around the world. Cardiology has entered a new era in our country with the advent of these new methods, and that is the main reason why we emphasize in this article, in a clear and summary manner, the options that these tools provide in the diagnosis and management of cardiovascular diseases.
Asunto(s)
Humanos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares , Espectroscopía de Resonancia Magnética/métodos , Espectroscopía de Resonancia Magnética , Tomografía Computarizada de Emisión/métodos , Diagnóstico por Computador , Equipo para DiagnósticoRESUMEN
En los últimos años se ha logrado un gran progreso en el manejo de pacientes con demencia, debido a la implementación y desarrollo de las neuroimágenes, especialmente de los estudios funcionales que permiten obtener información acerca de las propiedades bioquímicas, fisiológicas o eléctricas cerebrales. Su principal aplicación es colaborar al diagnostico diferencial de los pacientes con alteraciones cognitivas. Dentro del grupo de estudios funcionales se encuentra el SPECT cerebral de perfusión, que permite evaluar el flujo sanguíneo cerebral regional, mediante la utilización de trazadores radioactivos y mostrar de manera indirecta la actividad metabólica y sus alteraciones. Esta técnica evidencia los rasgos de los diferentes tipos de demencia: Alzheimer, alteraciones vasculares, frontotemporales, asociadas a SIDA y otras. Una ventaja adicional del SPECT es su amplia disponibilidad y su costo razonable