RESUMEN
BACKGROUND: Our aim was to determine if end-stage liver disease (ESLD) is associated with an attenuated response to vasodilator-stress or dobutamine-stress using 82Rb-PET MPI with blood flow quantification. METHODS AND RESULTS: Pre-liver transplant patients who had a normal dipyridamole-stress (n = 27) or dobutamine-stress (n = 26) 82Rb PET/CT MPI study with no identifiable coronary artery calcium were identified retrospectively and compared to a prospectively identified low-risk of liver disease dipyridamole-stress control group (n = 20). The dipyridamole-stress liver disease group had a lower myocardial flow reserve (MFR) (1.89 ± 0.79) than the control group (2.79 ± 0.96, P < .05). The dobutamine-stress group had a higher MFR than both other groups (3.69 ± 1.49, P < .05). A moderate negative correlation between MELD score and MFR was demonstrated for the dipyridamole-stress liver disease group (r = - 0.473, P < .05). This correlation was not observed for the dobutamine-stress liver disease group (r = - 0.253, P = .21). The liver failure group as a whole (n = 53) had a higher resting myocardial blood flow (0.97 ± 0.33 mL/min/g) than the control group (0.82 ± 0.26, P < .05). CONCLUSION: Dipyridamole demonstrates an attenuated vasodilatory response in ESLD patients compared to a non-ESLD control group related to higher resting blood flow and comparatively reduced stress blood flow. Dobutamine does not demonstrate this effect implying it may be the preferred pharmacologic MPI stress agent for ESLD patients.
Asunto(s)
Dobutamina , Enfermedad Hepática en Estado Terminal/diagnóstico por imagen , Fallo Hepático/diagnóstico por imagen , Imagen de Perfusión Miocárdica/métodos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Radioisótopos de Rubidio , Vasodilatación , Adulto , Anciano , Circulación Coronaria/fisiología , Dipiridamol , Femenino , Humanos , Fallo Hepático/cirugía , Trasplante de Hígado , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , VasodilatadoresRESUMEN
Laser lead extraction is a relatively new adjunct in managing patients with chronically implanted devices. It carries the potential for a number of procedure-related complications which can present acutely or in a delayed fashion. We present a case of a rather uncommon delayed complication of laser lead extraction and its management with a successful outcome.
Asunto(s)
Fístula Arteriovenosa/etiología , Traumatismos de las Arterias Carótidas/etiología , Arteria Carótida Común , Desfibriladores Implantables , Remoción de Dispositivos/efectos adversos , Terapia por Láser/efectos adversos , Isquemia Miocárdica/terapia , Vena Subclavia/lesiones , Anciano , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/terapia , Traumatismos de las Arterias Carótidas/diagnóstico por imagen , Traumatismos de las Arterias Carótidas/terapia , Arteria Carótida Común/diagnóstico por imagen , Humanos , Masculino , Radiografía , Stents , Vena Subclavia/diagnóstico por imagen , Resultado del TratamientoRESUMEN
OBJECTIVE: Contrast-induced renal dysfunction is an iatrogenic complication that occurs more frequently in patients with preexisting renal dysfunction. A prospective, double-blind, randomized, placebo, controlled trial was completed to assess the efficacy of N-acetylcysteine in decreasing the incidence of contrast-induced renal dysfunction in patients with an acute coronary syndrome and renal insufficiency who underwent coronary angiography with or without percutaneous coronary intervention. METHODS: With similar intravenous hydration protocols, 20 patients received N-acetylcysteine (treatment group) and 20 patients received placebo (control group) in a twice per day dosing regimen with one dose before and three doses after contrast media exposure. RESULTS: The two groups were similar at baseline on demographic and clinical characteristics, and preexisting renal insufficiency. Contrast-induced renal dysfunction, defined as an increase in serum creatinine greater than 44 micromol/L (.5 mg/dL) and/or 25% above baseline within 48 hours, occurred in 7.5% of the cohort, with 2.5% in the treatment group, and 5% in the control group, for an absolute difference of 2.5%. There was no difference in serum creatinine or creatinine clearance at 24 hours or at 48 hours between the treatment and control groups. CONCLUSION: These results suggest that this cohort gained no added protection to renal function with the use of N-acetylcysteine.