RESUMEN
AIM: Cardiopulmonary bypass (CPB) generates a systemic capillary leak syndrome with pulmonary edema. Lung ultrasound (LUS) could be useful to monitor it. Primary objective was to compare sensitivity, specificity, positive and negative predictive values of chest X-ray and LUS to detect pulmonary edema using a new score (LUCAS). Secondary objectives were to evaluate correlation between LUCAS score and respiratory and inotropic support. METHODS: Prospective intervention study including patients <2 months admitted to the Pediatric Intensive Care Unit after CPB. LUS was performed with a lineal probe, screening 3 points in each lung (parasternal, anterolateral and posterior area), pre and post-CPB. Pulmonary edema was evaluated clinically, through LUCAS score and with X-ray. RESULTS: 17 patients were included. LUS achieved higher sensitivity than X-ray to detect pulmonary edema (91.7 versus 44.0%) and greater predictive negative value (88.2 versus 53.3%). There was correlation between higher LUCAS score prior to surgery and longer mechanical ventilation. High values of LUCAS score after surgery correlated with longer CPB time, inotropic support, and FiO2 need. CONCLUSION: LUS detected pulmonary edema better than chest X-ray, with greater sensitivity and negative predictive value. LUCAS score was useful to predict more inotropic support and longer mechanical ventilation.Key notesCardiopulmonary bypass during cardiac surgery, generates a systemic capillary leak syndrome with pulmonary edema.In this prospective study performed in the Pediatric Intensive Care Unit, lung ultrasound detected pulmonary edema better than X-ray, with greater sensitivity and negative predictive value.LUCAS score was useful to predict more inotropic support and longer mechanical ventilation.
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Procedimientos Quirúrgicos Cardíacos , Edema Pulmonar , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Niño , Humanos , Pulmón/diagnóstico por imagen , Estudios Prospectivos , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/etiología , UltrasonografíaRESUMEN
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Humanos , Masculino , Niño , Miositis/complicaciones , Miositis , Inflamación , Fluorodesoxiglucosa F18/administración & dosificación , Tomografía de Emisión de Positrones , Edema , Sarcoidosis Pulmonar/tratamiento farmacológico , Sarcoidosis Pulmonar , Músculos/patología , Músculos , Corticoesteroides/uso terapéutico , Metotrexato/uso terapéutico , Hidroxicloroquina/uso terapéuticoRESUMEN
Introducción y objetivo. Las concentraciones plasmáticas de colesterol unido a lipoproteínas de alta densidad (cHDL) descendidas constituyen un indicador de mal pronóstico en pacientes con síndrome coronario agudo. Hemos evaluado la relación entre las cifras de cHDL y la extensión de la necrosis miocárdica estimada por cardiorresonancia magnética en pacientes con infarto agudo de miocardio y elevación persistente del segmento ST en quienes se indicó reperfusión miocárdica. Pacientes y métodos. Análisis retrospectivo de 139 pacientes (edad media: 59,8 años; hombres: 79%) ingresados por infarto agudo de miocardio con elevación persistente del segmento ST y a quienes se efectuó una cardiorresonancia magnética. Las imágenes indicativas de necrosis miocárdica (realce tardío del gadolinio) se cuantificaron y relacionaron con la concentración de cHDL. Resultados. Los pacientes con cHDL≤40mg/dl (69% del total), en comparación con los que tenían un cHDL >40mg/dl, mostraron un área de necrosis miocárdica más extensa: el número de segmentos miocárdicos con patrón de necrosis transmural fue significativamente mayor (4,7 vs. 2,1; p<0,001), al igual que el porcentaje de necrosis miocárdica de la masa miocárdica total (18,2 vs. 11,3%; p=0,01). Los pacientes con disminución de cHDL tuvieron una menor fracción de eyección del ventrículo izquierdo (49,7 vs. 57,2%; p<0,001). Conclusiones. La concentración de cHDL disminuido es muy frecuente en los pacientes con infarto agudo de miocardio y elevación persistente del segmento ST. Este descenso de cHDL se asoció a una mayor área de necrosis y peor fracción de eyección del ventrículo izquierdo(AU)
Introduction and aim. Low plasma levels of high-density lipoprotein cholesterol (HDLC) is a prognostic factor in patients with acute coronary syndrome. The aim of this study was to evaluate the relationship between HDLC and myocardial necrosis estimated by cardiac magnetic resonance (CMR) in patients with acute ST-segment elevation myocardial infarction (STEMI) and reperfusion strategy. Methods. Retrospective analysis of 139 patients (mean age 59.8 years; 79% men) admitted with STEMI who underwent a CMR in the first week. Results. With a comparable reperfusion strategy used and time of ischemia, patients with HDLC ≤ 40mg/dL (69% of total) had more extensive areas of myocardial necrosis after STEMI, in number of segments with late gadolinium enhancement (RTG) with transmural necrosis pattern (4.7 vs. 2.1, P<.001) and in percentage of RTG with respect total mass myocardial (18.2 vs. 11.3%, P<.01), and worst left ventricular ejection fraction (LVEF) (49.7 vs. 57.2%, P<.001). Conclusions. We conclude that low HDLC are very common in patients with STEMI and associated with increased necrosis and a worse LVEF in the CRM study(AU)
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Lipoproteínas HDL/análisis , Lipoproteínas HDL , Lipoproteínas HDL/farmacocinética , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo , Infarto del Miocardio/fisiopatología , Infarto del Miocardio , Estudios RetrospectivosRESUMEN
INTRODUCTION AND AIM: Low plasma levels of high-density lipoprotein cholesterol (HDLC) is a prognostic factor in patients with acute coronary syndrome. The aim of this study was to evaluate the relationship between HDLC and myocardial necrosis estimated by cardiac magnetic resonance (CMR) in patients with acute ST-segment elevation myocardial infarction (STEMI) and reperfusion strategy. METHODS: Retrospective analysis of 139 patients (mean age 59.8 years; 79% men) admitted with STEMI who underwent a CMR in the first week. RESULTS: With a comparable reperfusion strategy used and time of ischemia, patients with HDLC ≤40 mg/dl (69% of total) had more extensive areas of myocardial necrosis after STEMI, in number of segments with late gadolinium enhancement (RTG) with transmural necrosis pattern (4.7 vs. 2.1%, p < .001) and in percentage of RTG with respect to total mass myocardial (18.2 vs. 11.3%, p < .01), and worst left ventricular ejection fraction (LVEF) (49.7 vs. 57.2%, p < .001). CONCLUSIONS: We conclude that low HDLC are very common in patients with STEMI and associated with increased necrosis and a worse LVEF in the CRM study.
