Assessment of late cardiomyopathy by magnetic resonance imaging in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and idarubicin.

Late cardiomyopathy CMP is regarded as a potential severe long-term complication after anthracycline-based regimens for acute promyelocitic leukaemia (APL). We assess by MRI the incidence and severity of clinical and subclinical long-term CMP in a cohort of adult APL patients in first complete remission with PETHEMA trials. Adult patients diagnosed with APL in first complete remission lasting ≥2 years underwent anamnesis and physical examination and were asked to perform a cardiac MRI. Clinical CMP was defined as radiographic and physical signs of heart failure accompanied by symptoms or by left ventricle ejection fraction (LVEF) <45% by MRI with or without symptoms. Subclinical CMP was defined as the following MRI abnormalities: LVEF 45-50% or late gadolinium enhancement or two or more of LVEF ≤55%, left ventricle end-diastolic volume index ≥98 ml/m2, left ventricle end-systolic volume index ≥38 ml/m2, right ventricle end-diastolic volume index ≥106 ml/m2 and regional wall motion abnormalities. Of the 82 patients enrolled in the study, median cumulative dose of anthracyclines (doxorubicin equivalence) was 650 mg/m2, and median time from APL diagnosis to the study was 87 months (range, 24-195). Seven out of 57 patients with available MRI (12%) had subclinical CMP (all of them showed late gadolinium enhancement in MRI), and none had clinical CMP. Among the 25 patients without MRI, none had CMP by chest X-ray and physical assessment. In summary, we found 12% of subclinical and no clinical late CMP assessed by MRI in APL patients treated with PETHEMA protocols. Due to the low number of patients, we must interpret our results cautiously.

Resonancia magnética cardiaca en miocardiopatía arritmogénica. Tipos de afección y patrones de realce tardío de gadolinio / Arrhythmogenic cardiomyopathy. Patterns of ventricular involvement using cardiac magnetic resonance

Introducción y objetivos. La miocardiopatía arritmogénica biventricular y la miocardiopatía arritmogénica izquierda han sido incluidas recientemente en el espectro de la miocardiopatía arritmogénica. El objetivo del estudio es describir con cardiorresonancia magnética el tipo de afección observada y describir los patrones de realce tardío de gadolinio. Métodos. Se revisaron las bases de datos y la historia clínica informatizada de tres hospitales, para obtener datos de enfermos consecutivos con miocardiopatía arritmogénica. Resultados. Se incluyó a 26 pacientes consecutivos, con una media de edad de 40 ± 16 años, de los que 16 eran varones (67%). Se observó afección de ventrículo derecho en 19 pacientes (73%), con volúmenes aumentados en 13 pacientes (50%), 11 pacientes (42%) con realce tardío de gadolinio en ventrículo derecho y 6 (23%) presentaban únicamente alteraciones de la contractilidad segmentaria. Se observó afección de ventrículo izquierdo en 24 pacientes (92%), todos con realce tardío de gadolinio; 15 pacientes (57%) presentaron disfunción sistólica ventricular izquierda. En 3 pacientes (11%) se observó dilatación de ventrículo izquierdo y ninguno de ellos fue diagnosticado de miocardiopatía arritmogénica izquierda. La localización del realce tardío de gadolinio fue predominantemente inferior (65%), inferolateral (61%) y lateral (57%), mientras que la localización septal fue menos frecuente (26%). El patrón de realce tardío de gadolinio fue fundamentalmente epicárdico (46%) y transmural (19%), raramente intramiocárdico (12%). Conclusiones. En esta muestra, la afección del ventrículo izquierdo es muy frecuente; el hallazgo observado en el mayor número de pacientes fue el realce tardío de gadolinio y el menos frecuente, la dilatación. El patrón de realce tardío de gadolinio es subepicárdico y afecta a territorios inferior, inferolateral y lateral (AU)

Introduction and objectives. Biventricular arrhythmogenic cardiomyopathy and left dominant arrhythmogenic cardiomyopathy forms had recently been included in the spectrum of arrhythmogenic cardiomyopathy. The aim of the study was to describe, using cardiovascular magnetic resonance, the patterns of ventricular involvement as well as late gadolinium enhancement in these conditions. Methods. Medical databases and records from the cardiology units of 3 hospitals were reviewed to obtain data from patients with arrhythmogenic cardiomyopathy. Results. Twenty-six consecutive patients were included (40 [16] years, 16 males). Right ventricle involvement was present in 19 patients (73%). Among them, 13 patients (50%) had volumes over the upper limit of normality, 11 (42%) patients had late gadolinium enhancement in right ventricle and 6 patients (23%) had just mild involvement with wall motion abnormalities or microaneurysms. Left ventricle involvement was present in 24 patients (92%), all of them with late gadolinium enhancement. In 15 patients (57%) left ventricular systolic dysfunction was observed, and dilatation in 3 patients (11%). Late gadolinium enhancement was more frequent in the inferior, lateral, and inferolateral walls (65%, 57%, and 61% of patients, respectively) while septum was seldom affected (26% of cases). The pattern of late gadolinium enhancement was mainly subepicardial (46% of patients) or transmural (19%), and was intramyocardial in only 12% of the cases. Conclusions. In this sample, left ventricle involvement is very common. The most frequent finding was late gadolinium enhancement, while the least frequent was dilatation. The pattern of late gadolinium enhancement was more frequently subepicardial and located in the inferior and inferolateral walls (AU)

[Arrhythmogenic cardiomyopathy. Patterns of ventricular involvement using cardiac magnetic resonance]. / Resonancia magnética cardiaca en miocardiopatía arritmogénica. Tipos de afección y patrones de realce tardío de gadolinio.

INTRODUCTION AND OBJECTIVES: Biventricular arrhythmogenic cardiomyopathy and left dominant arrhythmogenic cardiomyopathy forms had recently been included in the spectrum of arrhythmogenic cardiomyopathy. The aim of the study was to describe, using cardiovascular magnetic resonance, the patterns of ventricular involvement as well as late gadolinium enhancement in these conditions. METHODS: Medical databases and records from the cardiology units of 3 hospitals were reviewed to obtain data from patients with arrhythmogenic cardiomyopathy. RESULTS: Twenty-six consecutive patients were included (40 [16] years, 16 males). Right ventricle involvement was present in 19 patients (73%). Among them, 13 patients (50%) had volumes over the upper limit of normality, 11 (42%) patients had late gadolinium enhancement in right ventricle and 6 patients (23%) had just mild involvement with wall motion abnormalities or microaneurysms. Left ventricle involvement was present in 24 patients (92%), all of them with late gadolinium enhancement. In 15 patients (57%) left ventricular systolic dysfunction was observed, and dilatation in 3 patients (11%). Late gadolinium enhancement was more frequent in the inferior, lateral, and inferolateral walls (65%, 57%, and 61% of patients, respectively) while septum was seldom affected (26% of cases). The pattern of late gadolinium enhancement was mainly subepicardial (46% of patients) or transmural (19%), and was intramyocardial in only 12% of the cases. CONCLUSIONS: In this sample, left ventricle involvement is very common. The most frequent finding was left ventricular late gadolinium enhancement, while the least frequent was dilatation. The pattern of late gadolinium enhancement was more frequently subepicardial and located in the inferior and inferolateral walls.

Late gadolinium-enhanced cardiovascular magnetic resonance identifies patients with standardized definition of ischemic cardiomyopathy: a single centre experience.

BACKGROUND: Definition of ischemic cardiomyopathy (IC) is not always obvious, which is why new criteria based on prognosis and the extent of the coronary artery disease (CAD) have been proposed. In the present study, we assess the capability of late gadolinium-enhanced cardiovascular magnetic resonance (CMR) for predicting IC as determined by standardized criteria previously reported. METHODS AND RESULTS: 123 patients with heart failure (HF) and left ventricular (LV) systolic dysfunction, underwent both late gadolinium-enhanced CMR and coronary angiography 37/123 (30%) of patients were assigned to the IC group and 86/123 (70%) to the non-IC group. Subendocardial late gadolinium enhancement (LGE) was found in 35/37 (94%) of patients in the IC group, whereas only 12/86 (14%) had this distribution in the non-IC group (p<0.001). There was a significant positive correlation between the extent of subendocardial LGE and that of the CAD as determined by the CAD Prognostic Index (r=0.78, p<0.01), the number of coronary stenoses > or = 50% (r=0.76, p<0.01) and the number of coronary stenoses of any percentage (r=0.70, p<0.01). CONCLUSION: In patients with HF and LV systolic dysfunction presence of subendocardial LGE makes an excellent indicator of underlying significant CAD, and the extent of the LGE correlates with the severity of the disease. It is therefore appealing as a method for diagnosing IC.

[Magnetic resonance imaging evidence of the effectiveness of combination chelation therapy in iron overload cardiomyopathy]. / Evidencia por resonancia magnética de la eficacia del tratamiento quelante combinado en la miocardiopatía por depósito férrico.

Heart failure secondary to iron overload is the main cause of death in patients with beta-thalassemia major. Combination therapy with deferoxamine and deferiprone has been shown to be more effective than either drug used alone in patients with beta-thalassemia major and symptomatic cardiomyopathy. Although monitoring the response to chelation therapy is usually carried out by indirect measurement of the serum ferritin level or by direct determination of tissue iron content in biopsy specimens, magnetic resonance imaging (MRI) seems to be useful for noninvasive qualitative and quantitative assessment of iron deposition. We present a case in which the efficacy of double chelation therapy in a patient with beta-thalassemia major and heart failure was demonstrated by MRI.

Evidencia por resonancia magnética de la eficacia del tratamiento quelante combinado en la miocardiopatía por depósito férrico / Magnetic resonance imaging evidence of the effectiveness of combination chelation therapy in iron overload cardiomyopathy

La insuficiencia cardíaca secundaria a la miocardiopatía por sobrecarga de hierro es la principal causa de muerte en los pacientes con â-talasemia mayor. Estudios recientemente publicados demuestran que el tratamiento combinado con deferoxamina y deferiprona es más eficaz que la monoterapia en pacientes con â-talasemia mayor y miocardiopatía sintomática. Aunque el control de la respuesta al tratamiento quelante se realiza habitualmente mediante la determinación de ferritina sérica o de hierro tisular en las muestras de biopsia, la resonancia magnética (RM) parece ser capaz de identificar de forma no invasiva el depósito de hierro en diferentes órganos y, además, hacer una estimación cuantitativa de éste. Presentamos un caso que demuestra la eficacia del tratamiento quelante combinado en un paciente con â-talasemia mayor e insuficiencia cardíaca objetivada por RM

Heart failure secondary to iron overload is the main cause of death in patients with â-thalassemia major. Combination therapy with deferoxamine and deferiprone has been shown to be more effective than either drug used alone in patients with â-thalassemia major and symptomatic cardiomyopathy. Although monitoring the response to chelation therapy is usually carried out by indirect measurement of the serum ferritin level or by direct determination of tissue iron content in biopsy specimens, magnetic resonance imaging (MRI) seems to be useful for noninvasive qualitative and quantitative assessment of iron deposition. We present a case in which the efficacy of double chelation therapy in a patient with â-thalassemia major and heart failure was demonstrated by MRI

[Non-invasive assessment of coronary artery bypass grafts by computed tomography: comparison with conventional coronary angiography]. / Valoración no invasiva de injertos coronarios con tomografía computarizada: comparación con la angiografía convencional.

INTRODUCTION AND OBJECTIVES: Although it has been demonstrated that the diagnostic accuracy of computed tomography in the non-invasive assessment of major epicardial coronary arteries is high, only a few studies have evaluated the technique's reliability in assessing coronary artery bypass grafts. The aim of this study was to determine the diagnostic accuracy of multidetector computed tomography in the assessment of coronary grafts. PATIENTS AND METHOD: We prospectively evaluated 117 coronary grafts in 38 patients who had undergone coronary artery bypass graft surgery and who had a clinical indication for angiographic graft assessment. All patients were in sinus rhythm and had a heart rate below 75 bpm. A 16-detector scanner was used for non-invasive assessment of the coronary grafts at a slice thickness of 1.2 mm. The diagnostic accuracy of computed tomography in the non-invasive assessment of significant lesions (i.e., occluded lesions or those with a stenosis greater than 50%) in coronary artery bypass grafts was evaluated by comparison with the results of conventional angiography. RESULTS: Of the 117 grafts evaluated, 99 (84.6%) were visualized by conventional angiography and 109 (93.2%) by computed tomography. Overall, 98 grafts were analyzed using both techniques. The sensitivity and specificity of computed tomography in detecting significant lesions were: 92% and 97.3%, respectively, for all grafts; 89.5% and 97.6%, respectively, for venous grafts; and 100% and 96.8%, respectively, for arterial grafts. CONCLUSIONS: The diagnostic accuracy of multidetector computed tomography in coronary artery bypass graft assessment was high.

Valoración no invasiva de injertos coronarios con tomografía computarizada: comparación con la angiografía convencional / Non-invasive assessment of coronary artery bypass grafts by computed tomography: comparison with conventional coronary angiography

Introducción y objetivos. Aunque la tomografía computarizada (TC) muestra una elevada exactitud diagnóstica en la valoración no invasiva de las arterias coronarias principales, son todavía escasos los trabajos que valoren su fiabilidad en el estudio de los injertos coronarios. El objetivo de este estudio es determinar la exactitud diagnóstica de la TC con detectores múltiples en la valoración de los injertos coronarios. Pacientes y método. Se evaluó de manera prospectiva a 38 pacientes revascularizados quirúrgicamente (117 injertos coronarios según la hoja operatoria), con indicación clínica de evaluación angiográfica de sus injertos. Todos los pacientes se encontraban en ritmo sinusal y con una frecuencia cardíaca 50% u oclusión) y los resultados se compararon con los de la angiografía convencional. Resultados. De los 117 injertos referidos se visualizaron 99 (84,6%) mediante angiografía convencional y 109 (93,2%) mediante TC. Se analizaron los 98 injertos valorados por ambas técnicas. Los valores de sensibilidad y especificidad de la TC para el total de injertos fueron del 92 y del 97,3%, para los injertos venosos del 89,5 y del 97,6%, y para los injertos arteriales del 100 y del 96,8%, respectivamente. Conclusiones. La TC con detectores múltiples muestra una elevada exactitud diagnóstica en la valoración de los injertos coronarios

Introduction and objectives. Although it has been demonstrated that the diagnostic accuracy of computed tomography in the non-invasive assessment of major epicardial coronary arteries is high, only a few studies have evaluated the technique's reliability in assessing coronary artery bypass grafts. The aim of this study was to determine the diagnostic accuracy of multidetector computed tomography in the assessment of coronary grafts. Patients and method. We prospectively evaluated 117 coronary grafts in 38 patients who had undergone coronary artery bypass graft surgery and who had a clinical indication for angiographic graft assessment. All patients were in sinus rhythm and had a heart rate below 75 bpm. A 16-detector scanner was used for non-invasive assessment of the coronary grafts at a slice thickness of 1.2 mm. The diagnostic accuracy of computed tomography in the non-invasive assessment of significant lesions (i.e., occluded lesions or those with a stenosis greater than 50%) in coronary artery bypass grafts was evaluated by comparison with the results of conventional angiography. Results. Of the 117 grafts evaluated, 99 (84.6%) were visualized by conventional angiography and 109 (93.2%) by computed tomography. Overall, 98 grafts were analyzed using both techniques. The sensitivity and specificity of computed tomography in detecting significant lesions were: 92% and 97.3%, respectively, for all grafts; 89.5% and 97.6%, respectively, for venous grafts; and 100% and 96.8%, respectively, for arterial grafts. Conclusions. The diagnostic accuracy of multidetector computed tomography in coronary artery bypass graft assessment was high

Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance.

OBJECTIVES: We evaluated the feasibility of using late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) to distinguish left ventricular (LV) systolic dysfunction related or not to coronary artery disease (CAD) in patients with heart failure (HF) but without clinical suspicion of CAD as the underlying cause. BACKGROUND: In patients with known CAD, LGE-CMR is capable of distinguishing LV systolic dysfunction related to CAD from dilated cardiomyopathy. METHODS: Seventy-one patients with HF and LV systolic dysfunction, without a previous history of myocardial infarction, with neither Q waves nor clinical data suggesting CAD, underwent both LGE-CMR and coronary angiography. RESULTS: Twenty-six patients (37%) had angiographically proven CAD (>/=70% stenosis of a major epicardial vessel) (angio [+] group), and 45 (63%) had unobstructed coronary arteries (angio [-] group). Twenty-one patients in the angio (+) group (21 of 26, 81%) showed subendocardial and/or transmural enhancement, whereas only 4 (9%) of 45 in the angio (-) group showed it (p < 0.001). In 7 patients (7 of 71, 10%), we found a different pattern of mid-wall enhancement-namely, 3 of 26 patients in the angio (+) group and 4 of 45 in the angio (-) group (11% vs. 9%, p = 0.7). Mid-wall enhancement in the angio (+) group was distributed in segments other than those which had subendocardial enhancement. CONCLUSIONS: In patients with HF and LV systolic dysfunction without clinical suspicion of CAD, LGE-CMR is an excellent tool for classifying patients in relation to the presence or absence of underlying CAD. Thus, CMR might offer a valid alternative to coronary angiography for the detection of CAD in these patients.

Tromboembolia pulmonar y tomografía multicorte / Pulmonary thromboembolism and multislice tomography

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