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1.
Clin Cardiol ; 45(2): 152-161, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35077580

RESUMEN

BACKGROUND: In clinical practice, we encounter ischemic cardiomyopathy (ICM) with underlying viable, dysfunctional myocardium on a regular basis. Evidence from the Surgical Treatment for Ischemic Heart failure (STICH) and its Extension Study is supportive of improved outcomes with coronary revascularization, irrespective of myocardial viable status. However, Dobutamine stress echocardiography (DSE) and single-photon emission computed tomography (SPECT), used in STICH to assess myocardial viability may fail to distinguish hibernating myocardium from scar due to suboptimal image resolution and poor tissue characterization. HYPOTHESIS: Cardiac magnetic resonance (CMR) and positron emission tomography (PET) can precisely quantify myocardial scar and identify metabolically active, viable myocardium respectively. Unlike DSE and SPECT, CMR and PET allow examining myocardial status as a contiguous spectrum from viable to partially viable myocardium with varying degrees of subendocardial scar and nonviable myocardium with predominantly transmural scar, the therapeutic and prognostic determinants of ICM. METHODS: Under the guidance of CMR and PET imaging, myocardium can be distinguished viable from partially viable with subendocardial scar and predominantly transmural scar. In ICM, optimal medical therapy and coronary revascularization of viable/partially viable myocardium but not transmural scar may improve outcomes in patients with acceptable procedural risk. RESULTS: Coronary revascularization of partially viable and viable myocardial territory may improve clinical outcomes by preventing future ischemic, infarct events and further worsening of left ventricular remodeling and function. CONCLUSIONS: When deciding if coronary revascularization is appropriate in a patient with ICM, it is essential to take a patient-tailored, comprehensive approach incorporating myocardial viability, ischemia, and scar data with others such as procedural risk, and patient's comorbidities.


Asunto(s)
Cardiomiopatías , Isquemia Miocárdica , Disfunción Ventricular Izquierda , Cardiomiopatías/diagnóstico , Cardiomiopatías/terapia , Ecocardiografía/métodos , Humanos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/terapia , Revascularización Miocárdica , Miocardio/patología , Tomografía Computarizada de Emisión de Fotón Único/métodos
2.
Lung ; 198(1): 229-233, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31853638

RESUMEN

PURPOSE: Pleural effusion is a common finding in patients with congestive heart failure (CHF). The pathogenesis of pleural effusion in heart failure is multifactorial. However, the role of right and left ventricular function assessed by ECHO cardiogram has not been studied. Therefore, we explored the association between right and left ventricular parameters on echocardiogram in patients with heart failure with and without pleural effusion diagnosed using CT scan of chest. METHODS: A case-control study was utilized to explore the objectives. Using strict exclusion criteria, patients admitted with a single diagnosis of acute CHF were stratified into those with and without pleural effusion using CT scan of chest done at admission. Multiple logistic regression analysis was used to identify significant factors associated with pleural effusion. RESULTS: Among the 70 patients, 36 (51%) had pleural effusions. The mean E/A ratio in patients with effusion (2.53 ± 1.1) was significantly higher than in patients without effusion (1.15 ± 0.9), p < 0.01. Multiple logistic regression analysis showed that elevated E/A ratio was significantly associated with pleural effusion, OR 3.26 (95% CI 1.57-6.77, p < 0.009). Left ventricular ejection fraction (LVEF), septal E', lateral E', and medial E/E' ratio were not significantly different in patients with and without pleural effusion. CONCLUSION: Elevated E/A ratio is a risk factor for the formation of pleural effusion in patients with heart failure.


Asunto(s)
Velocidad del Flujo Sanguíneo , Insuficiencia Cardíaca/fisiopatología , Derrame Pleural/diagnóstico por imagen , Disfunción Ventricular Izquierda/fisiopatología , Estudios de Casos y Controles , Diástole , Ecocardiografía , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Derrame Pleural/epidemiología , Derrame Pleural/etiología , Factores de Riesgo , Tomografía Computarizada por Rayos X , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología
3.
Methodist Debakey Cardiovasc J ; 13(1): 37-38, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28413582

RESUMEN

Iatrogenic aortic dissection during percutaneous coronary intervention is a rare but serious complication. Both conservative and surgical approaches have been proposed as management strategies. We describe a case of an 87-year-old female who presented with an acute coronary syndrome complicated by the development of an ascending aortic dissection during percutaneous intervention, and we provide a brief review of the literature.


Asunto(s)
Síndrome Coronario Agudo/terapia , Aorta/lesiones , Aneurisma de la Aorta/etiología , Disección Aórtica/etiología , Hematoma/etiología , Enfermedad Iatrogénica , Intervención Coronaria Percutánea/efectos adversos , Lesiones del Sistema Vascular/etiología , Síndrome Coronario Agudo/diagnóstico por imagen , Anciano de 80 o más Años , Disección Aórtica/diagnóstico por imagen , Aorta/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Aortografía/métodos , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Ecocardiografía Transesofágica , Femenino , Hematoma/diagnóstico por imagen , Humanos , Lesiones del Sistema Vascular/diagnóstico por imagen
4.
J Cardiovasc Comput Tomogr ; 10(3): 246-50, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26869368

RESUMEN

BACKGROUND: It is unknown whether axial non-gated CT can distinguish World Health Organization Group 2 pulmonary hypertension (pulmonary hypertension due to left heart disease) from non-Group 2 pulmonary hypertension. OBJECTIVE: The study was performed to identity imaging parameters in non-gated chest CT that differentiate Group 2 from non-Group 2 pulmonary hypertension. METHODS: Among 158 patients who underwent right heart catheterization for evaluation of pulmonary hypertension, 112 had sufficient data and chest CT for review. Invasive hemodynamic data and numerous variables obtained from axial CT images (maximum diameters of main, right, left pulmonary arteries, ascending aorta, main pulmonary artery to ascending aorta diameter ratio, right atrial diameter, left atrial area and right ventricular size) were collected. CT variables were validated against hemodynamic data to identify parameters that would allow to differentiate pulmonary hypertension due to left heart disease (Group 2) from non-Group 2 pulmonary hypertension. RESULTS: Based on right heart catheterization data, we identified 53 patients with Group 2 pulmonary hypertension, 50 patients with non-Group 2 pulmonary hypertension, and 9 subjects with no pulmonary hypertension. In patients with a dilated pulmonary artery (n = 84), the ROC curve for left atrial area (area under the ROC curve 0.76 ± 0.06) independently distinguished patients with Group 2 pulmonary hypertension (n = 42) from patients with non-Group 2 pulmonary hypertension (n = 42). A dilated left atrium (>20 mm(2)) in combination with a normal right ventriuclar size had a sensitivity of 77% and specificity of 94% for Group 2 pulmonary hypertension. CONCLUSIONS: In patients with a dilated pulmonary artery on chest CT, left atrial area and right ventricular dimensions may aid to diagnose pulmonary hypertension and to distinguish underlying cardiac disease from other causes.


Asunto(s)
Remodelación Atrial , Atrios Cardíacos/diagnóstico por imagen , Insuficiencia Cardíaca/complicaciones , Ventrículos Cardíacos/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico por imagen , Tomografía Computarizada Multidetector , Arteria Pulmonar/diagnóstico por imagen , Remodelación Ventricular , Área Bajo la Curva , California , Cateterismo Cardíaco , Distribución de Chi-Cuadrado , Diagnóstico Diferencial , Dilatación Patológica , Femenino , Atrios Cardíacos/fisiopatología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/fisiopatología , Hemodinámica , Humanos , Hipertensión Pulmonar/etiología , Hipertensión Pulmonar/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Arteria Pulmonar/fisiopatología , Curva ROC , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo
5.
J Voice ; 26(5): 604-6, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22521530

RESUMEN

OBJECTIVE: To compare the diagnostic yield, safety, and cost of biopsies of laryngopharyngeal tumor performed in an office setting with those performed in the operating room (OR) under general anesthesia. STUDY DESIGN: This was a retrospective review of patients' records at Boston Medical Center from 2006 to 2008. METHODS: In-office biopsies were performed using flexible digital videolaryngoscopy with cup forcep biopsies taken via the working channel in patients in whom cancer was strongly suspected. Patients whose in-office biopsies were nondiagnostic or suspected to be falsely negative were taken to the OR for biopsy under general anesthesia and served as the control group. RESULTS: Twelve patients fit the selection criteria and had in-office biopsies attempted. One patient could not tolerate the in-office biopsy. Seven of the 11 in-office biopsies performed were diagnostic for squamous cell carcinoma. The average cost (facility and professional otolaryngology charges) for an in-office biopsy was $2053.91. Five of these patients required further biopsy in the OR at an average cost (charges for surgeon, OR, anesthesia, and recovery room) of $9024.47. There were no significant complications reported for any of the procedures. CONCLUSIONS: In patients with strongly suspected laryngopharyngeal cancer, in-office cup forcep biopsies were 64% diagnostic. When compared with the OR, in-office cup biopsies of laryngopharyngeal tumor are safe and considerably more cost-effective. Although 36% of patients required operative biopsies, the cost would have been considerably higher in this cohort if all patients had gone to the OR for biopsies.


Asunto(s)
Biopsia/economía , Carcinoma de Células Escamosas/patología , Costos de Hospital , Hipofaringe/patología , Neoplasias Laríngeas/patología , Visita a Consultorio Médico/economía , Quirófanos/economía , Neoplasias Faríngeas/patología , Instrumentos Quirúrgicos/economía , Anestesia General/economía , Biopsia/efectos adversos , Biopsia/instrumentación , Biopsia/métodos , Boston , Carcinoma de Células Escamosas/economía , Análisis Costo-Beneficio , Femenino , Humanos , Neoplasias Laríngeas/economía , Laringoscopía/economía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/economía , Seguridad del Paciente , Neoplasias Faríngeas/economía , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Grabación en Video/economía
6.
Curr Treat Options Cardiovasc Med ; 12(4): 355-64, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20842559

RESUMEN

OPINION STATEMENT: Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina that is diagnosed more commonly in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease on cardiac catheterization. Data from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study show that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, and death. The gold standard diagnostic test for MCD is the invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test endothelial-dependent and -independent microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratification of patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce the risk of adverse cardiac events, ameliorate symptoms to improve quality of life, and decrease morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor management, including lifestyle counseling regarding smoking cessation, nutrition, and physical activity, should be initiated. Current pharmacotherapy for MCD may include treatment of microvascular endothelial dysfunction (with statins, angiotensin-converting enzyme inhibitors, or low-dose aspirin), as well as treatment for angina and myocardial ischemia (with ß-blockers, calcium channel blockers, nitrates, or ranolazine). Additional symptom management techniques may include tricyclic medication, enhanced external counterpulsation, hypnosis, and spinal cord stimulation. Although our current therapies are effective in treating angina and MCD, large randomized outcome trials are needed to optimize strategies to improve morbidity and mortality.

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