RESUMEN
There are limited data on the head-to-head comparison of 99mTc-pyrophosphate (99mTc-PYP) and echocardiographic strain imaging in the assessment of transthyretin (TTR) cardiac amyloidosis. Methods: At Mayo Clinic Arizona, patients who had undergone both a 99mTc-PYP scan and a transthoracic echocardiogram within a 90-d period were retrospectively identified for chart review and strain imaging analysis. Patients were divided into 2 groups according to their 99mTc-PYP results (PYP-positive [PYP+] or PYP-negative [PYP-]) for the comparison. A standard 17-segment model was used for segmental, regional, and global longitudinal strain comparison. A P value of less than 0.05 was deemed significant. Results: In total, 64 patients were included, the mean age was 75.1 ± 13.0 y, and 57 (89.1%) were male. Comparing the PYP+ to the PYP- group, the left ventricular global longitudinal strain was significantly worse in the former (PYP+ vs. PYP-, -10.5 ± 2.6 vs. -13.1 ± 4.1; P = 0.003). PYP+ patients also had worse regional basal strain (-4.6 ± 2.6 vs. -8.8 ± 4.0, P < 0.001) and a trend toward worse midventricular strain (-9.6 ± 4.0 vs. -11.7 ± 4.4, P = 0.07), but there was no statistical difference in the apical region (-17.6 ± 4.73 vs. -19.0 ± 6.46, P = 0.35). This is consistent with an apex-sparing pattern shown by the relative apical longitudinal strain index (1.3 ± 0.5 vs. 1.0 ± 0.3, P = 0.008). Segment-to-segment analysis demonstrated a significant difference in strain between PYP+ and PYP- segments in 4 segments: basal inferior (P = 0.006), basal anterolateral (P = 0.01), apical septal (P = 0.002), and apical inferior (P = 0.001). Left ventricular diastolic dysfunction was significantly different, with 17 (77.3%) patients in the PYP+ group versus 15 (36.6%) in PYP- participants (P = 0.002). Conclusion: Our study suggested that 99mTc-PYP uptake is related to overall worse LV segmental, regional, and global longitudinal strain function, as well as diastolic function, compared with patients without 99mTc-PYP uptake. These data are important for helping clinicians learn about the echocardiographic function features related to 99mTc-PYP uptake and can help generate hypotheses for future studies.
Asunto(s)
Amiloidosis , Cardiomiopatías , Anciano , Anciano de 80 o más Años , Cardiomiopatías/diagnóstico por imagen , Difosfatos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prealbúmina , Radiofármacos , Estudios RetrospectivosRESUMEN
Pembrolizumab is a humanized monoclonal antibody that targets the programmed cell death 1 protein (PD-1) receptor and blocks the inhibitory checkpoint interaction between PD-1 and its ligands. This interaction leads to the upregulation of effector T-cells and downregulating regulatory T-cell production. Although this mechanism is essential for the management of cancer, it may lead to decreased self-tolerance with an autoimmune reaction toward healthy functioning tissue. One of the less commonly reported and less understood immune-related adverse events includes neuromuscular complications. We present a rare case of autoimmune demyelinating polyneuropathy and hydrocephalus secondary to pembrolizumab use for cutaneous squamous cell carcinoma of the cheek.
Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Hidrocefalia/inducido químicamente , Polineuropatías/inducido químicamente , Anciano , Carcinoma de Células Escamosas/tratamiento farmacológico , Humanos , Hidrocefalia/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Polineuropatías/diagnóstico por imagen , Neoplasias Cutáneas/tratamiento farmacológico , Linfocitos T Reguladores/efectos de los fármacos , Tomografía Computarizada por Rayos XRESUMEN
Antiphospholipid syndrome (APS) is an autoimmune disorder that has a strong propensity for a hypercoagulable state and is known to be associated with venous and arterial thromboembolism. We describe an uncommon case of APS in the setting of non-Hodgkin's lymphoma, with thromboembolism, and a rare complication after an uncommon etiology of myocardial infarction. This case highlights the importance of early and appropriate type of anticoagulation to reduce the morbidity and mortality in patients with APS.
Asunto(s)
Rotura Cardíaca/complicaciones , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Músculos Papilares/cirugía , Tromboembolia/complicaciones , Síndrome Antifosfolípido/complicaciones , Rotura Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/etiología , Músculos Papilares/lesionesRESUMEN
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke. However, hemorrhagic strokes, which are often seen with sympathomimetic illicit drugs (e.g. cocaine and amphetamines), have rarely been reported due to cannabis. Many cellular mechanisms within non-ischemic tissue post stroke may be augmented by heavy cannabis use. Here, we describe a rapid development of hemorrhage following thrombolytic therapy in a patient with heavy cannabis use with an ischemic stroke.