RESUMEN
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.
Asunto(s)
Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Trombosis Coronaria , Humanos , Angiografía por Tomografía Computarizada , Estudios Prospectivos , Constricción Patológica , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Angiografía Coronaria/métodos , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/terapia , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/terapia , Valor Predictivo de las PruebasRESUMEN
Some patients with COVID-19 pneumonia develop an associated cytokine storm syndrome that aggravates the pulmonary disease. These patients may benefit of anti-inflammatory treatment. The role of colchicine in hospitalized patients with COVID-19 pneumonia and established hyperinflammation remains unexplored. In a prospective, randomized controlled, observer-blinded endpoint, investigator-initiated trial, 240 hospitalized patients with COVID-19 pneumonia and established hyperinflammation were randomly allocated to receive oral colchicine or not. The primary efficacy outcome measure was a composite of non-invasive mechanical ventilation (CPAP or BiPAP), admission to the intensive care unit, invasive mechanical ventilation requirement or death. The composite primary outcome occurred in 19.3% of the total study population. The composite primary outcome was similar in the two arms (17% in colchicine group vs. 20.8% in the control group; p = 0.533) and the same applied to each of its individual components. Most patients received steroids (98%) and heparin (99%), with similar doses in both groups. In this trial, including adult patients with COVID-19 pneumonia and associated hyperinflammation, no clinical benefit was observed with short-course colchicine treatment beyond standard care regarding the combined outcome measurement of CPAP/BiPAP use, ICU admission, invasive mechanical ventilation or death (Funded by the Community of Madrid, EudraCT Number: 2020-001841-38; 26/04/2020).
Asunto(s)
Tratamiento Farmacológico de COVID-19 , COVID-19 , Adulto , COVID-19/complicaciones , Colchicina/uso terapéutico , Humanos , Unidades de Cuidados Intensivos , Estudios Prospectivos , Respiración ArtificialRESUMEN
In patients admitted for heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and a concomitant supraventricular tachyarrhythmia (SVT) it is a challenge to predict LVEF recovery and differentiate tachycardia-induced cardiomyopathy (TIC) from dilated cardiomyopathy (DCM). The role of the electrocardiogram (ECG) and cardiac magnetic resonance (CMR) and in this acute setting remains unsettled. Forty-three consecutive patients admitted for HF due to SVT and LVEF < 50% undergoing CMR in the acute phase, were retrospectively included. Those who had LVEF > 50% at follow up were classified as TIC and those with LVEF < 50% were classified as DCM. Clinical, CMR and ECG findings were analyzed to predict LVEF recovery. Twenty-five (58%) patients were classified as TIC. Patients with DCM had wider QRS (121.2 ± 26 vs 97.7 ± 17.35 ms; p = 0.003). On CRM the TIC group presented with higher LVEF (33.4 ± 11 vs 26.9 ± 6.4%; p = 0.019) whereas late gadolinium enhancement (LGE) was more frequent in DCM group (61 vs 16%; p = 0.004). On multivariate analysis, QRS duration ≥ 100 ms (p = 0.027), LVEF < 40% on CMR (p = 0.047) and presence of LGE (p = 0.03) were independent predictors of lack of LVEF recovery. Furthermore, during follow-up (median 60 months) DCM patients were admitted more frequently for HF (44 vs 0%; p < 0.001) than TIC patients. In patients with reduced LVEF admitted for HF due to SVT, QRS ≥ 100 ms, LVEF < 40% and LGE are independently associated with lack of LVEF recovery and worse clinical outcome.
Asunto(s)
Cardiomiopatías , Cardiomiopatía Dilatada , Insuficiencia Cardíaca , Arritmias Cardíacas , Cardiomiopatías/complicaciones , Cardiomiopatías/diagnóstico , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/diagnóstico , Cardiomiopatía Dilatada/patología , Medios de Contraste , Electrocardiografía , Gadolinio , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Humanos , Imagen por Resonancia Cinemagnética , Espectroscopía de Resonancia Magnética , Estudios Retrospectivos , Volumen Sistólico , Taquicardia , Función Ventricular IzquierdaRESUMEN
Hypertrophic cardiomyopathy (HC) is the most common cardiovascular inherited disease, and it is associated with arrhythmic events, heart failure, and death. Strain analysis by tissue tracking (TT) techniques on cardiac magnetic resonance (CMR) is a novel noninvasive diagnostic tool. However, the usefulness of CMR-TT to identify patients with HC at risk of adverse outcomes remains unknown. CMR strain parameters by CMR-TT were prospectively measured in a cohort of 136 consecutive patients with HC. Clinical (death or readmission for heart failure) and arrhythmic (any ventricular tachycardia) events during follow-up were prospectively recorded. Global radial systolic strain rate and global radial diastolic strain rate showed the best area under the receiver operating characteristic curve (ROC curve) to predict adverse clinical events. On Cox multivariate regression models, a global radial systolic strain rate value <1.4/s and a global radial diastolic strain rate value ≥ -1.38/s were independently associated with clinical events at follow-up (adjusted hazard ratio 6.57, 95% confidence interval [CI] 2.01 to 21.49, p = 0.002; adjusted hazard ratio 5.96, 95% CI 1.79 to 19.89, p = 0.004, respectively). Regarding arrhythmic events, global radial peak strain <27% showed the best area under the ROC curve and remained independently associated with ventricular tachycardia after adjustment for confounders (odds ratio 7.33, 95% CI 1.07 to 50.41, p = 0.043). CMR strain parameters by TT predict clinical and arrhythmic events in patients with HC.
Asunto(s)
Cardiomiopatía Hipertrófica , Insuficiencia Cardíaca , Taquicardia Ventricular , Arritmias Cardíacas , Cardiomiopatía Hipertrófica/diagnóstico , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Humanos , Imagen por Resonancia Cinemagnética/métodos , Espectroscopía de Resonancia Magnética , Valor Predictivo de las Pruebas , Taquicardia Ventricular/epidemiología , Función Ventricular IzquierdaAsunto(s)
Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/microbiología , Imagen por Resonancia Magnética , Miocarditis/diagnóstico por imagen , Miocarditis/microbiología , Infecciones Estafilocócicas/diagnóstico por imagen , Medios de Contraste , Angiografía Coronaria , Diagnóstico Diferencial , Ecocardiografía Transesofágica , Electrocardiografía , Humanos , Masculino , Persona de Mediana Edad , Tomografía de Coherencia ÓpticaRESUMEN
BACKGROUND: CHA2DS2-VASc score (congestive heart failure; hypertension; ages ≥ 74 years (2 points); diabetes; stroke, transient ischemic attack, or systemic embolism (2 points); vascular disease; ages 65 - 74 years; sex (female)) is a widely used clinical scale to estimate the risk of stroke in patients with non-valvular atrial fibrillation (AF). However, the relationship between the increase in CHA2DS2-VASc score and atrial remodeling remains unsettled. METHODS: Twenty-five consecutive patients undergoing cardiac computed tomography (CT) were recruited. The systolic and diastolic volumes of left atrium and left atrial appendage (LAA) were measured. Risk of stroke was estimated using the CHA2DS2-VASc score. The relationship of the CHA2DS2-VASc score with morphological and functional variables was analyzed by Pearson's correlation. RESULTS: A positive correlation was documented between the CHA2DS2-VASc score and systolic (r = 0.419, P = 0.037) and diastolic (r = 0.415, P = 0.039) LAA volumes. Atrial volumes and left atrial ejection fraction showed no significant correlations with CHA2DS2-VASc. CONCLUSIONS: This study shows, for the first time, a positive correlation between CHA2DS2-VASc score and LAA remodeling.
Asunto(s)
Cardiopatía Carcinoide/diagnóstico por imagen , Técnicas de Imagen Cardíaca , Insuficiencia de la Válvula Pulmonar/diagnóstico por imagen , Válvula Pulmonar/diagnóstico por imagen , Anciano , Cardiopatía Carcinoide/fisiopatología , Cardiopatía Carcinoide/cirugía , Ecocardiografía Doppler en Color , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Hemodinámica , Humanos , Imagen por Resonancia Magnética , Imagen Multimodal , Valor Predictivo de las Pruebas , Válvula Pulmonar/fisiopatología , Válvula Pulmonar/cirugía , Insuficiencia de la Válvula Pulmonar/fisiopatología , Insuficiencia de la Válvula Pulmonar/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Endocardio/diagnóstico por imagen , Fibrosis Endomiocárdica/diagnóstico por imagen , Imagen por Resonancia Magnética , Imagen de Perfusión Miocárdica , Miocardio/patología , Adulto , Endocardio/patología , Fibrosis Endomiocárdica/patología , Humanos , Masculino , Valor Predictivo de las PruebasRESUMEN
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.
Asunto(s)
Cardiomiopatía Hipertrófica/diagnóstico por imagen , Disparidades en el Estado de Salud , Imagen por Resonancia Cinemagnética , Anciano , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/tratamiento farmacológico , Cardiomiopatía Hipertrófica/fisiopatología , Diuréticos/uso terapéutico , Femenino , Disparidades en Atención de Salud , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/fisiopatología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Volumen Sistólico , Factores de Tiempo , Función Ventricular IzquierdaAsunto(s)
Diabetes Mellitus , Edema Cardíaco/etiología , Cardiomiopatía de Takotsubo/complicaciones , Anciano , Anciano de 80 o más Años , Diabetes Mellitus/diagnóstico , Edema Cardíaco/diagnóstico por imagen , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Cardiomiopatía de Takotsubo/diagnóstico por imagenAsunto(s)
Tejido Adiposo/diagnóstico por imagen , Cardiomiopatía Hipertrófica/diagnóstico por imagen , No Compactación Aislada del Miocardio Ventricular/diagnóstico por imagen , Tabique Interventricular/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Cinemagnética , Persona de Mediana EdadAsunto(s)
Procedimientos Quirúrgicos Cardíacos , No Compactación Aislada del Miocardio Ventricular/diagnóstico por imagen , No Compactación Aislada del Miocardio Ventricular/cirugía , Adulto , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Ecocardiografía/métodos , Humanos , Imagen por Resonancia Magnética/métodos , MasculinoRESUMEN
We report the case of a pulsatile mass found in a patient who presented for a routine echocardiogram. The mass turned out to be an exceedingly rare mitral-subannular pseudoaneurysm involving the membranous atrioventricular septum with systolic expansion protruding into right atrium, discovered late after repeated multiple valve replacement surgery. Although these pseudoaneurysms may present asymptomatically, surgical intervention might be indicated because of the risk of rupture. This report describes this rare finding, discusses possible pathophysiological mechanisms, and underscores the importance of multimodality imaging to achieve correct identification and delimitation to guide surgical intervention in such cases.
Asunto(s)
Aneurisma Falso/etiología , Tabique Interatrial , Aneurisma Cardíaco/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Complicaciones Posoperatorias , Tabique Interventricular , Anciano , Aneurisma Falso/diagnóstico , Ecocardiografía , Estudios de Seguimiento , Aneurisma Cardíaco/diagnóstico , Humanos , Masculino , Reoperación/efectos adversos , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Myocardial infarction and sudden cardiac death are frequently the first manifestation of coronary artery disease. For this reason, screening of asymptomatic coronary atherosclerosis has become an attractive field of research in cardiovascular medicine. Necropsy studies have described histopathological changes associated with the development of acute coronary events. In this regard, thin-cap fibroatheroma has been identified as the main vulnerable coronary plaque feature. Hence, many imaging techniques, such as coronary computed tomography, cardiac magnetic resonance or positron emission tomography, have tried to detect noninvasively these histomorphological characteristics with different approaches. In this article, we review the role of these diagnostic tools in the detection of vulnerable coronary plaque with particular interest in their advantages and limitations as well as the clinical implications of the derived findings.
RESUMEN
Early gadolinium enhancement (EGE), one CMR diagnostic criteria in acute myocarditis, has been related with hyperemia and capillary leakage. The value of EGE in hypertrophic cardiomyopathy (HCM) remains unknown. Our aim was to determine the prevalence of EGE in patients with HCM, and its relation with late gadolinium enhancement (LGE). The association of EGE with morphological and clinical parameters was also evaluated. Sixty consecutive patients with HCM and CMR from our center were included. All the clinical and complementary test information was collected prospectively in our HCM clinic. Left ventricular (LV) measurements were calculated from cine sequences. EGE and LGE were quantified with a dedicated software. Clinical events were collected from medical records. A slow wash-out pattern on EGE was detected in up to 68 % of the patients, being an isolated finding without LGE in 10 (16 %). This cohort showed a greater maximal LV wall thickness (20.1 ± 4 vs. 18.1 ± 3.5 mm, p = 0.010) and asymmetry ratio (1.86 ± 0.42 vs. 1.62 ± 0.46; p = 0.039). The percentage of EGE/slice and the difference with the percentage LGE/slice demonstrated a significant positive correlation with the maximal LV wall thickness (Rho 0.450 and 0.386 respectively). EGE also correlated with number of segments with LVH (LV hypertrophy) and the asymmetry ratio. Neither EGE nor LGE were associated with classical risk factors, the risk score for sudden cardiac death, or with major clinical events. EGE was a frequent finding in HCM, even in absence of LGE. This phenomenon showed a positive correlation with morphological markers of disease burden.