Value of speckle tracking for the assessment of right ventricular function in patients operated on for tetralogy of fallot. Comparison with magnetic resonance imaging.

BACKGROUND: Right ventricular (RV) function is a major prognostic factor in patients (pts) with operated tetralogy of Fallot (TOF). We compared the results of RV speckle tracking (two-dimensional [2D] strain) with those of magnetic resonance imaging (MRI) in this setting. METHODS: At transthoracic echocardiogram (echo), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), velocity of S-wave at tricuspid annulus with tissue Doppler, and 2D strain (longitudinal maximal systolic strain) were recorded. Their results were compared to RV indexed end-diastolic volume (EDV), indexed end-systolic volume (ESV), and RV ejection fraction (EF) at MRI. RESULTS: Twenty-two pts (16 M) aged 11-62 years (mean 23.2 ± 10.8) were included. Parameters of RV systolic function were as follows: RVFAC = 40 ± 10%, TAPSE = 18 ± 4 mm, S-wave = 10 ± 0.2 cm/sec, and RV EF at MRI = 43 ± 11%. Global RV systolic strain was -15.5 ± 4.2%, free wall strain was -15.1 ± 6.3%, and septal strain was -15.8 ± 3.8% on average for the whole group. Echo indexed RV end-diastolic area correlated with EDV at MRI (r = 0.73), as well as echo indexed RV end-systolic area and ESV at MRI (r = 0.71). Global RV 2D strain correlated well with RV EF at MRI: r = 0.68; P < 0.05, and with ESV at MRI: r = 0.63. Feasibility, intra- and inter-observer reproducibility of 2D strain were adequate. CONCLUSIONS: Speckle tracking is a promising method to estimate RV systolic function in pts operated on for TOF.

Effect of macroscopic-positive thrombus retrieval during primary percutaneous coronary intervention with thrombus aspiration on myocardial infarct size and microvascular obstruction.

Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention improves myocardial perfusion and survival; however, the effect of effective thrombus retrieval remains unclear. We evaluated whether macroscopic-positive TA in patients with ST-segment elevation myocardial infarction would reduce the infarct size (IS) and microvascular obstruction (MVO), as assessed by contrast-enhanced magnetic resonance imaging. A total of 88 patients with ST-segment elevation myocardial infarction were prospectively recruited and assigned to the TA-positive group (n = 38) or TA-negative group (n = 50) according to whether macroscopic aspirate thrombus was visible to the naked eye. The primary end points were the extent of early and late MVO as assessed by contrast-enhanced magnetic resonance imaging performed during in-hospital stay and IS evaluated in the acute phase and at 6 months of follow-up. The incidence of early and late MVO and IS in the acute phase was lower in the TA-positive group than in the TA-negative group (early MVO 3.8 ± 1.1% vs 7.6 ± 2.1%, respectively, p = 0.003; late MVO 2.1 ± 0.9% vs 5.4 ± 2.9%, p = 0.006; and IS 14.9 ± 8.7% vs 28.2 ± 15.8%, p = 0.004). At the 6-month contrast-enhanced magnetic resonance imaging study, the final IS was significantly lower in the TA-positive group (12.0 ± 8.3% vs 22.3 ± 14.3%, respectively) than in the TA-negative group (p = 0.002). After multivariate adjustment, macroscopic-positive TA represented an independent predictor of final IS (odds ratio 0.34, 95% confidence interval 0.03 to 0.71, p = 0.01). In conclusion, effective macroscopic thrombus retrieval before stenting during percutaneous coronary intervention for ST-segment elevation myocardial infarction is associated with an improvement in myocardial reperfusion, as documented by a clear reduction in the MVO extent and IS.

The number of circulating CD14(+) cells is related to infarct size and postinfarct volumes in ST segment elevation myocardial infarction but not non-ST segment elevation myocardial infarction.

OBJECTIVE: To determine the relationship between the number of CD14(+) cells, myocardial infarct (MI) size and left ventricular (LV) volumes in ST segment elevation MI (STEMI) and non-ST segment elevation MI (NSTEMI) patients. METHODS: A total of 62 patients with STEMI (n=34) or NSTEMI (n=28) were enrolled. The number of CD14(+) cells was assessed at admission. Infarct size, left ventricular ejection fraction (LVEF) and LV volumes were measured using magnetic resonance imaging five days after MI and six months after MI. RESULTS: In STEMI patients, the number of CD14(+) cells was positively and significantly correlated with infarct size at day 5 (r=0.40; P=0.016) and after six months (r=0.34; P=0.047), negatively correlated with LVEF at day 5 (r=-0.50; P=0.002) and after six months (r=-0.46; P=0.005) and positively correlated with end-diastolic (r=0.38; P=0.02) and end-systolic (r=0.49; P=0.002) volumes after six months. In NSTEMI patients, no significant correlation was found between the number of CD14(+) cells and infarct size, LVEF or LV volumes at day 5 or after six months. CONCLUSIONS: The number of CD14(+) cells at admission was associated with infarct size and LV remodelling in STEMI patients with large infarct size, whereas in NSTEMI patients, no relationship was observed between numbers of CD14(+) cells and LV remodelling.

Radiofrequency neurolysis in the management of inguinal neuralgia: preliminary study.

PURPOSE: To evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency (RF) neurolysis (RFN) in the management of refractory inguinal neuralgia. MATERIALS AND METHODS: Local institutional review board approval was obtained and written informed consent was waived. Twelve patients 26-75 years of age with chronic (>6 months) inguinal pain refractory to specific medication were included between 2005 and 2011. Data on patient demographics, clinical history, and pain management history were retrospectively assessed. Pain was measured on a visual analog scale (VAS) from 0 to 10 before and immediately after the procedure and at 1, 3, 6, 9 and 12 months. Diagnosis was always confirmed by a positive nerve block test result. Ambulatory CT-guided RF was the rule. RESULTS: Sixteen RFN procedures were performed. Pain was present for an average of 3.2 years (range: 2-8 years) prior to initial RFN. Mean VAS score before the procedure was 7.75 of 10. Immediate pain relief of 100% was achieved in all patients. Pain reduction at 1-, 3-, 6-, 9-, and 12-month follow-up was statistically significant. Important pain reduction (≥80%) was obtained in 75% of RFN procedures at 6-month follow-up and in 50% of cases at 12 months. The mean duration of pain relief was 11.8 months after RFN, with a maximum average pain reduction of 84.5%. No complications were noted during or after the procedure. CONCLUSION: RFN with CT guidance is an effective technique in the management of refractory inguinal pain with lasting satisfactory pain reduction; it may be considered as an alternative treatment to surgery. These results should be confirmed in a controlled trial with a larger series of patients.

Evolution of acute coronary syndrome with normal coronary arteries and normal cardiac magnetic resonance imaging.

BACKGROUND: Acute coronary syndrome (ACS) with normal coronary angiography is a frequent clinical situation with an uncertain prognosis. Cardiac magnetic resonance imaging (CMRI) is a powerful tool for differential diagnosis between myocardial infarction (MI), acute myocarditis and Tako-tsubo cardiomyopathy (TTC). Data are sparse regarding the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI. AIMS: To evaluate the evolution of patients presenting an ACS with normal coronary arteries and normal CMRI, with a 1-year follow-up. METHODS: Eighty-seven consecutive patients (mean age, 53 years; 40.2% men) presenting an ACS with troponin elevation and normal coronary arteries by angiography were prospectively included. All patients underwent CMRI at 3-Tesla. Adverse events were recorded with 1-year follow-up. RESULTS: A likely aetiology for the acute clinical presentation was established by CMRI in 63.2% of patients (22.7% MI, 26.4% acute myocarditis, 11.5% TTC). During follow-up, one patient in the MI group had a stroke (1.2%). In the myocarditis group, there was one initial cardiogenic shock, one episode of congestive heart failure (1.2%) and nine patients had recurrent chest pain without troponin elevation (10.3%). Two TTC group patients initially presented with cardiogenic shock (2.4%); there were no other adverse events in this group during follow-up. In the remaining 36.7% patients, no clear diagnosis could be identified by CMRI, and no adverse events occurred during follow-up. CONCLUSION: CMRI is a useful tool for the management of ACS presenting with normal coronary angiography, as it helps to ascertain the diagnosis and adapt treatment in a large proportion of cases. Nonetheless, patients with no abnormalities identified by CMRI have an excellent evolution.

Presence of endothelial colony-forming cells is associated with reduced microvascular obstruction limiting infarct size and left ventricular remodelling in patients with acute myocardial infarction.

Endothelial colony-forming cells (ECFCs) are known to increase after acute myocardial infarction (AMI). We examined whether the presence of ECFCs is associated with preserved microvascular integrity in the myocardium at risk by reducing microvascular obstruction (MVO). We enrolled 88 patients with a first ST elevation AMI. ECFC colonies and circulating progenitor cells were characterized at admission. MVO was evaluated at 5 days and infarct size at 5 days and at 6-month follow-up by magnetic resonance imaging. ECFC colonies were detected in 40 patients (ECFC(pos) patients). At 5 days, MVO was of greater magnitude in ECFC(neg) versus ECFC(pos) patients (7.7 ± 5.3 vs. 3.2 ± 5%, p = 0.0002). At 6 months, in ECFC(pos) patients, there was a greater reduction in infarct size (-32.4 ± 33 vs. -12.8 ± 24%; p = 0.003) and a significant improvement in left ventricular (LV) volumes and ejection fraction. Level of circulating CD34+/VEGF-R2+ cells was correlated with the number of ECFC colonies (r = 0.54, p < 0.001) and relative change in infarct size (r = 0.71, p < 0.0001). The results showed that the presence of ECFC colonies is associated with reduced MVO after AMI, leading to reduced infarct size and less LV remodelling and can be considered a marker of preserved microvascular integrity in AMI patients.

Clinical safety of cardiac magnetic resonance imaging at 3 T early after stent placement for acute myocardial infarction.

The purpose of this study was to prospectively evaluate the safety of cardiac magnetic resonance (CMR) imaging at 3 T performed early (less than 14 days) after bare metal or drug-eluting coronary stent implantation in patients with acute myocardial infarction (AMI). Seventy-two consecutive patients with AMI treated by percutaneous revascularisation with a stent underwent CMR examination with a median delay of 6 days. Patients were followed-up for major adverse cardiac events, during hospitalisation and at 6 months. After CMR imaging, no acute stent thrombosis, death or repeated AMI were recorded at 6-month follow-up. Two symptomatic in-stent restenoses and two silent in-stent restenoses were recorded, at a mean delay of 106 days. In our population, we found a target revascularisation rate of 5.6%. This is consistent with the 6-month event rates after coronary artery stent (CAS) placement for AMI, evaluated by several studies. This preliminary clinical study supports the safety of 3-T CMR imaging performed early after coronary stent placement.

Feasibility study of 3-T MR imaging of the skin.

The purpose of this study was to assess the quality of 3-T magnetic resonance (MR) imaging of the skin, to describe skin anatomy at 3 T and to discuss future prospects of skin MRI. A 7-cm single-element surface receiver coil was developed for our 3-T MRI system. Thin sections were obtained with a three-dimensional FIESTA acquisition sequence and a spin-echo T1-weighted sequence (SET1). Prospective analysis was performed twice by two radiologists independently. Thirty-six healthy volunteers were included and underwent MRI on the face and the calf. Image quality was assessed regarding visibility of skin layers and quantification of artefacts. High field strength MR enables imaging of the skin with a high spatial in-plane resolution (87-180 microm), the total examination lasting 15-20 min. Image quality was excellent for the calf (mean SET1 quality = 96%) with a high intra- and interobserver correlation (SET1 kappa coefficient concerning visibility of epidermis, dermis and hypodermis > or = 0.84). Motion artefacts resulted in a small loss of quality and reproducibility for the face. In conclusion, 3-T MR allows high spatial resolution imaging of the skin and can potentially provide an accurate noninvasive means of analysing the skin.

Small-bowel obstruction from adhesive bands and matted adhesions: CT differentiation.

OBJECTIVE: The purpose of this study was to evaluate the CT findings that can help to differentiate small-bowel obstruction (SBO) due to adhesive bands from SBO caused by matted adhesions. MATERIALS AND METHODS: CT scans of 67 consecutive patients with adhesive SBO caused by either surgically confirmed adhesive bands or matted adhesions were analyzed. CT findings were compared between the two groups with regard to simple obstruction patterns (single abrupt transition zone, beak sign, "fat notch" sign), patterns of closed-loop obstruction (two adjacent beaks, C-shaped bowel, radial distribution of mesenteric vessels), the location of the obstruction in the abdominal cavity, and the presence of a whirl sign and a "small-bowel feces" sign. Statistical analyses were performed using the Fisher's exact test. RESULTS: Closed-loop patterns and a whirl sign were seen only in cases of SBO from adhesive bands. Compared with SBO cases from matted adhesions, significantly more SBO cases that were due to adhesive bands showed a beak sign (p = 0.0001) and fat notch sign (p = 0.0001). The small-bowel feces sign was more frequently seen in cases of SBO from matted adhesions (p = 0.014). Bowel ischemia and bowel necrosis were more frequent findings with adhesive bands than with matted adhesions (p = 0.011 and p = 0.049, respectively). The location in the pelvis of the adhesive structure (p = 0.039) and a higher rate of accidental bowel perforation (p = 0.031) were associated with matted adhesions. CONCLUSION: CT is useful for differentiating SBO caused by adhesive bands from SBO due to matted adhesions.