Intervenção coronária percutânea com técnica mini culotte estadiada para reestenose ostial de grande ramo lateral / Percutaneous coronary intervention with the staged mini culotte technique for ostial restenosis of the large side branch

O conhecimento da anatomia e da fisiologia de uma bifurcação é essencial na área intervencionista atual. A lesão de bifurcação é uma das alterações coronárias mais desafiadoras no tratamento percutâneo. Foram investigadas muitas estratégias intervencionistas devido ao alto nível de interesse nessas lesões, mas os resultados dos procedimentos e de longo prazo foram relativamente ruins. As melhorias em implante de stents e outros procedimentos intervencionistas reduziram a probabilidade de desfechos clínicos adversos, criando o ambiente mais favorável para os stents realizarem seu trabalho. O implante de stent provisional tem sido amplamente aceito como técnica intervencionista inicial nas lesões de bifurcação coronária pela comunidade médica há mais de 15 anos. A reestenose de um grande ramo é possível após angioplastia do vaso principal utilizando uma abordagem provisional de um único stent. Embora a reestenose do ramo lateral após angioplastia de bifurcação seja menos comum nos procedimentos modernos de bifurcação, ela ainda ocorre em 5% dos casos durante o acompanhamento angiográfico baseado em sintomas. Em nossa série de casos de cinco pacientes, a reestenose grave de ramo lateral apresentou sintomas de angina recorrente, que necessitou de revascularização do vaso-alvo. Ao aplicar os princípios de bifurcação, aprimoramos a etapa do mini culotte estadiado da técnica culotte de bifurcação, tornando-a mais fácil de usar e reduzindo a exposição à radiação e o tempo de operação.

Understanding the anatomy and physiology of a bifurcation is crucial in today's interventional field. The bifurcation lesion is one of the most challenging coronary conditions to treat percutaneously. Numerous interventional strategies have been investigated because of the high level of interest in these lesions, but the relatively poor procedural and long-term results. Improvements in stenting and other interventional procedures have reduced the likelihood of adverse clinical outcomes, by creating the most favorable environment for stents to do their work. Provisional stenting has been widely accepted as the initial interventional technique for coronary bifurcation lesions by the medical community for over 15 years. Restenosis of a major branch is possible after angioplasty of the main vessel using a provisional one-stent approach. Although side branch restenosis following bifurcation angioplasty is less common with modern bifurcation procedures, it still occurs in 5% of cases during angiographic follow-up for symptoms. In our case series of five patients, severe side-branch restenosis presented with recuring anginal symptoms, which required target vessel revascularization. By applying bifurcation principles, we improved the "staged mini culotte" part of the culotte bifurcation stent technique, making it more user-friendly, and reducing exposure to radiation and operating time.

Chronic angina secondary to Takayasu arteritis. Report of one case / Síndrome coronario crónico secundario a aortitis y enfermedad coronaria ostial bilateral. Informe de un caso

Chronic coronary syndromes are usually considered uncommon in young women, related to slower progression of atherosclerotic coronary artery disease, have atypical clinical presentations, and experience less diagnostic investigation. Non-atherosclerotic causes of coronary artery disease should be considered in young women experiencing angina. We report a 25-year-old woman who consulted for five months of moderate exertion angina. Physical examination revealed a right carotid bruit and asymmetrical upper extremity peripheral pulses. Initial work-up and imaging allowed to diagnose aortitis with bilateral coronary ostial stenosis secondary to Takayasu's arteritis. The patient experienced an apparent clinical response to initial medical therapy. However, follow-up evaluation revealed persistence of significant ischemia and requirement for myocardial revascularization. A percutaneous coronary intervention was performed.

Los síndromes coronaries crónicos son infrecuentes en mujeres jóvenes, quienes suelen presentar una lenta progresión de enfermedad coronaria aterosclerótica, tienen presentación clínica atípica y son menos sujetas a exploración diagnostica. Se deben considerar causas no ateroscleróticas de enfermedad coronaria en mujeres jóvenes con angina. Informamos una paciente de 25 años que consultó por cinco meses de angina con esfuerzos moderados. Al examen físico presentaba un soplo carotideo derecho y pulsos asimétricos de extremidades superiores. La exploración de laboratorio inicial y posterior evaluación multimodal permitió evidenciar la presencia de aortitis y estenosis de ambos ostium coronarios, concordante con el diagnóstico de una arteritis de Takayasu. Inició terapia medica con respuesta clínica aparentemente favorable. No obstante, la evaluación cardiológica no invasiva en el seguimiento permitió corroborar la persistencia de isquemia significativa y necesidad de revascularización miocárdica. Se realizó una intervención coronaria percutánea de ambos ostium, con una evolución favorable.

Redo Coronary Artery Bypass Grafting in the era of Advanced PCI.

OBJECTIVE: To review the evidence behind the role and relevance of redo coronary artery bypass grafting (CABG) in the current practice of percutaneous coronary intervention (PCI). METHODS: A comprehensive electronic literature search was performed to identify articles that discuss the practice of PCI and redo CABG in patients that require coronary revascularization. All relevant studies are summarized in narrative manner to reflect current indications and preference. RESULTS: The advancement in utilization of PCI has reduced the rate of redo CABG in patients with previous CABG that requires revascularization of an already treated coronary disease or a new onset of coronary artery stenosis. Redo CABG is associated with satisfactory perioperative outcomes but higher mortality at immediate postoperative period when compared to PCI. CONCLUSION: Redo CABG patients are less likely to develop comorbidities associated with revascularisation, but the operative mortality is higher and long-term survival rates are similar in comparison to PCI. There is a need for further research into the role of redo CABG in the current advanced practice of PCI.

Redo Coronary Artery Bypass Grafting in the era of Advanced PCI

Abstract Objective: To review the evidence behind the role and relevance of redo coronary artery bypass grafting (CABG) in the current practice of percutaneous coronary intervention (PCI). Methods: A comprehensive electronic literature search was performed to identify articles that discuss the practice of PCI and redo CABG in patients that require coronary revascularization. All relevant studies are summarized in narrative manner to reflect current indications and preference. Results: The advancement in utilization of PCI has reduced the rate of redo CABG in patients with previous CABG that requires revascularization of an already treated coronary disease or a new onset of coronary artery stenosis. Redo CABG is associated with satisfactory perioperative outcomes but higher mortality at immediate postoperative period when compared to PCI. Conclusion: Redo CABG patients are less likely to develop comorbidities associated with revascularisation, but the operative mortality is higher and long-term survival rates are similar in comparison to PCI. There is a need for further research into the role of redo CABG in the current advanced practice of PCI.

Evaluation of Left Ventricular Systolic Function in Patients with Coronary Microvascular Dysfunction by Three-Dimensional Speckle-Tracking Imaging

Abstract Introduction: The objective of this study is to evaluate the left ventricular systolic function of patients with coronary microvascular dysfunction (CMD) using the three-dimensional speckle-tracking imaging (3D-STI) technique. Methods: From June 2018 to June 2019,72 subjects from Huzhou Central Hospital were enrolled, including 42 CMD in-patients with typical chest pain or chest tightness and positive treadmill exercise stress test, but without coronary stenosis on coronary angiography, (the CMD group) and another 30 healthy individuals who were undergoing physical examinations in an outpatient clinic (the control group). Using 3D-STI technique, the global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), global area strain (GAS), and left ventricle were measured. Results: Compared with the control group, GLS and GAS were significantly reduced in the CMD group (P<0.05), while GRS and GCS were similar in both groups (P>0.05). Univariate logistic regression analysis showed that GLS and GAS were the influencing factors of CMD. For the diagnosis of CMD, the area under the receiver operating characteristic (ROC) curve of GLS was 0.883, and the area under the ROC curve of GAS was 0.875. GAS of -29.3% (log-rank test chi-square=34.245, P<0.001) was a strong predictor of major adverse cardiac events. Conclusion: 3D-STI technique has obvious advantages in the evaluation of the left ventricular systolic function for CMD patients. Moreover, 3D-STI parameters, especially GLS and GAS, can detect the early abnormal changes in the ischaemic myocardium. Being timelier and more sensitive than echocardiography, 3D-STI should be recommended for clinical application.

Disfunción del nódulo sinusal asociado a estenosis severa proximal de la arteria coronaria derecha y vasoespasmo coronario

RESUMEN La disfunción del nódulo sinusal (DNS) es generalmente secundaria a la senescencia del nodo sinusal y del miocardio auricular circundante. Estamos presentando un paciente de 59 años de edad, hipertenso sin tratamiento y con antecedente de síncope en dos oportunidades en los últimos 4 meses. Ingresa debido a un flutter auricular con conducción auriculoventricular 1:1 con una frecuencia cardiaca de 280 lat/min que cede con goteo de amiodarona. Un Holter de 24 horas demostró un ritmo sinusal predominante, episodios paroxísticos de fibrilación auricular con respuesta ventricular alta, bradicardia sinusal de 47 lat/min. Se realizó el diagnóstico de disfunción del nódulo sinusal, Rubenstein tipo III (Síndrome Bradicardia-Taquicardia). Una coronariografía constató una estenosis del 80% en segmento proximal de la arteria coronaria derecha con componente espástico. La arteria del nódulo sinusal emerge del segmento proximal de la coronaria derecha. Se realizó una angioplastia exitosa con stent medicado. Otro estudio Holter de 24 horas de control pos-angioplastia registró nuevamente episodios paroxísticos de fibrilación auricular con respuesta ventricular alta y episodios de pausas de hasta 3.100 milisegundos por lo que se implantó un marcapasos bicameral. A pesar del restablecimiento de un flujo sanguíneo adecuado a la arteria del nódulo sinusal con la angioplastia de la coronaria derecha no se obtuvo una mejoría de la disfunción del nódulo sinusal.

ABSTRACT Sinus node dysfunction (SND) is generally secondary to senescence of the sinus node and the surrounding atrial myocardium. We are presenting a 59-year-old patient, hypertensive without treatment and with a history of syncope on two occasions in the last 4 months. He was admitted due to a 1: 1 atrioventricular conduction atrial flutter with a heart rate of 280 beats/min that subsides with an amiodarone drip. A 24-hour Holter monitor showed predominant sinus rhythm, paroxysmal episodes of atrial fibrillation with high ventricular response, sinus bradycardia of 47 beats/min. The diagnosis of sinus node dysfunction, Rubenstein type III (Bradycardia-Tachycardia Syndrome) was made. A coronary angiography confirmed an 80% stenosis in the proximal segment of the right coronary artery with a spastic component. The sinus node artery emerges from the proximal segment of the right coronary artery. A successful angioplasty was performed with a medicated stent. Another 24-hour Holter study of post-angioplasty control again recorded paroxysmal atrial fibrillation with high ventricular response episodes and pause episodes of up to 3,100 milliseconds, for which a dual-chamber pacemaker was implanted. Despite the restoration of adequate blood flow to the sinus node artery with right coronary angioplasty, no improvement in sinus node dysfunction was obtained.

Evaluation of Left Ventricular Systolic Function in Patients with Coronary Microvascular Dysfunction by Three-Dimensional Speckle-Tracking Imaging.

INTRODUCTION: The objective of this study is to evaluate the left ventricular systolic function of patients with coronary microvascular dysfunction (CMD) using the three-dimensional speckle-tracking imaging (3D-STI) technique. METHODS: From June 2018 to June 2019,72 subjects from Huzhou Central Hospital were enrolled, including 42 CMD in-patients with typical chest pain or chest tightness and positive treadmill exercise stress test, but without coronary stenosis on coronary angiography, (the CMD group) and another 30 healthy individuals who were undergoing physical examinations in an outpatient clinic (the control group). Using 3D-STI technique, the global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), global area strain (GAS), and left ventricle were measured. RESULTS: Compared with the control group, GLS and GAS were significantly reduced in the CMD group (P<0.05), while GRS and GCS were similar in both groups (P>0.05). Univariate logistic regression analysis showed that GLS and GAS were the influencing factors of CMD. For the diagnosis of CMD, the area under the receiver operating characteristic (ROC) curve of GLS was 0.883, and the area under the ROC curve of GAS was 0.875. GAS of -29.3% (log-rank test chi-square=34.245, P<0.001) was a strong predictor of major adverse cardiac events. CONCLUSION: 3D-STI technique has obvious advantages in the evaluation of the left ventricular systolic function for CMD patients. Moreover, 3D-STI parameters, especially GLS and GAS, can detect the early abnormal changes in the ischaemic myocardium. Being timelier and more sensitive than echocardiography, 3D-STI should be recommended for clinical application.

Aumento do trabalho miocárdico desperdiçado como indicador de lesão coronariana significativa / Increased wasted myocardial work as an indicator of significant coronary lesion

Introdução: A avaliação dos índices de trabalho miocárdico global em condições basais pode ser útil para a estratificação clínica de pacientes com suspeita de obstrução coronariana. Objetivo: Correlacionar o valor do índice de trabalho miocárdico global e a presença de lesões obstrutivas coronarianas significativas. Método: Estudo transversal, com pacientes encaminhados para cinecoronarioangiografia eletiva. Foi realizado ecocardiograma com obtenção das medidas para cálculo do valor do trabalho miocárdico, sendo avaliada a presença de lesões obstrutivas coronarianas significativas à cinecoronarioangiografia. Resultados: A amostra foi composta de 30 pacientes, com a idade média de 64,2±12,8 anos, sendo a maioria do sexo masculino (63,3%), dos quais 68,4% apresentaram lesões obstrutivas coronarianas significativas. O índice de trabalho miocárdico global foi de 1.876mmHg%±253,8 no grupo com lesões obstrutivas coronarianas significativas e de 2.054,2mmHg%±417,3 naqueles sem lesões significativas (p=0,089). O trabalho miocárdio construtivo global nos pacientes sem lesões obstrutivas coronarianas significativas foi maior (2.329,3mmHg%±462,9) do que naqueles com lesões obstrutivas coronarianas significativas (2.109,5mmHg%±332,3; p=0,064). O trabalho miocárdio desperdiçado global foi maior nos pacientes com lesões obstrutivas coronarianas significativas (103,7mmHg%±47,1 versus 68,3mmHg%±33,8; p=0,038). O ponto de corte de 115mmHg% foi aquele com a melhor área sob a curva (0,625), com sensibilidade de 83,3%. Conclusão: O aumento do trabalho miocárdio desperdiçado global se correlacionou com a presença de lesões obstrutivas coronarianas significativas em nossa amostra.(AU)

Introduction: The assessment of global myocardial work indices under baseline conditions may be useful for the clinical stratification of patients with suspected coronary obstruction. Objective: To correlate the value of global myocardial work indices and the presence of significant obstructive coronary lesions. Method: Cross-sectional study, with patients referred for elective coronary angiography. An echocardiogram was performed to obtain measurements to calculate the value of myocardial work and evaluated the presence or presence of significant obstructive coronary lesions at coronary angiography. Results: The sample consisted of 30 patients, with a mean age of 64.2±12.8 years, the majority being male (63.3%), of which 68.4% had significant obstructive coronary lesions. The global myocardial work indices was 1,876mmHg%±253.8 in the group with significant obstructive coronary lesions and 2,054.2mmHg%±417.3 in those without significant lesions (p=0.089). Global constructive myocardial work in patients without significant obstructive coronary lesions was higher (2,329.3mmHg%±462.9) than in those with significant obstructive coronary lesions (2,109.5mmHg%±332.3; p=0.064). Global wasted myocardial work was higher in patients with significant obstructive coronary lesions (103.7mmHg%±47.1 versus 68.3mmHg%±33.8; p=0.038). The cutoff point of 115 mmHg% was the one with the best area under the curve (0.625), with a sensitivity of 83.3%. Conclusion: The increase in global wasted myocardial work correlated with the presence of significant obstructive coronary lesions in our sample. (AU)

Slow Flow Phenomenon Impairs the Prognosis of Coronary Artery Ectasia as Well as Coronary Atherosclerosis.

INTRODUCTION: Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders and its prognosis is still debated. OBJECTIVE: We aimed to review long-term follow-up data in patients with CAE and to evaluate the prognosis of CAE patients with coronary slow flow phenomenon (CSFP). METHODS: This study had a prospective design and 143 patients with CAE were included. The angiographic and demographic characteristics were reviewed in detail. The patients were categorized, based on concomitant coronary artery stenosis detected by angiography, as CCAE group (n=87, ≥30% luminal stenosis) and ICAE group (n=56, <30% luminal stenosis) and also categorized by the coronary flow as CSFP group (n=51) and normal flow coronary ectasia - NCEA group (n=92). All patients were re-evaluated at 6-month intervals. Followup data, cardiovascular (CV) mortality, hospitalization and major adverse cardiac events (MACE) were collected. The level of statistical significance was set at 5%. RESULTS: Patients were followed up for an average of 56.9±7.4 months. During the follow-up, statistically significant differences were found in hospitalization, CV mortality and MACE between the CCAE and ICAE groups (P=0.038, P=0.003, P=0.001, respectively). The CSFP and NCEA groups were also compared. There was a statistical difference with respect to hospitalization between the CFSP and NCEA groups (P=0.001), but no difference was observed in terms of MACE and CV mortality (P=0.793 and P=0.279). CONCLUSION: CSFP accompanying CAE may be a predictor of hospitalization. Significant atherosclerotic plaques coexisting with CAE may be predictive for MACE.

Slow Flow Phenomenon Impairs the Prognosis of Coronary Artery Ectasia as Well as Coronary Atherosclerosis

Abstract Introduction: Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders and its prognosis is still debated. Objective: We aimed to review long-term follow-up data in patients with CAE and to evaluate the prognosis of CAE patients with coronary slow flow phenomenon (CSFP). Methods: This study had a prospective design and 143 patients with CAE were included. The angiographic and demographic characteristics were reviewed in detail. The patients were categorized, based on concomitant coronary artery stenosis detected by angiography, as CCAE group (n=87, ≥30% luminal stenosis) and ICAE group (n=56, <30% luminal stenosis) and also categorized by the coronary flow as CSFP group (n=51) and normal flow coronary ectasia - NCEA group (n=92). All patients were re-evaluated at 6-month intervals. Follow-up data, cardiovascular (CV) mortality, hospitalization and major adverse cardiac events (MACE) were collected. The level of statistical significance was set at 5%. Results: Patients were followed up for an average of 56.9±7.4 months. During the follow-up, statistically significant differences were found in hospitalization, CV mortality and MACE between the CCAE and ICAE groups (P=0.038, P=0.003, P=0.001, respectively). The CSFP and NCEA groups were also compared. There was a statistical difference with respect to hospitalization between the CFSP and NCEA groups (P=0.001), but no difference was observed in terms of MACE and CV mortality (P=0.793 and P=0.279). Conclusion: CSFP accompanying CAE may be a predictor of hospitalization. Significant atherosclerotic plaques coexisting with CAE may be predictive for MACE.

Utilidad de la reserva de flujo fraccional para guiar la revascularización en un paciente con síndrome coronario agudo sin elevación del segmento ST / Utility of fractional flow reserve to guide revascularization in patients with acute coronary syndrome without ST segment elevation / Utilidade da reserva fracionária de fluxo para guiar a revascularização em paciente com síndrome coronariana aguda sem supradesnivelamento do segmento ST

Resumen: La reserva de flujo fraccional (FFR) es el patrón oro para evaluar la severidad funcional de una estenosis coronaria epicárdica. La revascularización guiada por fisiología coronaria ha demostrado su utilidad en la cardiopatía estable, pero también en el síndrome coronario agudo (SCA). Presentamos el caso de un paciente de 58 años con SCA, que presentó en la cineangiocoronariografía dos estenosis angiográficamente significativas, decidiéndose realizar una revascularización guiada por fisiología coronaria. Mediante la utilización de FFR, se determinó la necesidad de revascularizar solo una de las lesiones, llevando a un cambio en la conducta terapéutica que ejemplifica la virtud de contar con herramientas de estudio de la fisiología coronaria para la toma de decisiones.

Summary: Fractional flow reserve is the gold standard for evaluating the functional severity of an epicardial coronary stenosis. Coronary physiology-guided revascularization has been shown to be useful in stable heart disease, but also in acute coronary syndrome. We present the case of a 58-year-old patient with acute coronary syndrome, who presented two angiographically significant stenosis. We decided to perform revascularization guided by coronary physiology. Using fractional flow reserve, the need to revascularize only one of the lesions was determined, leading to a change in therapeutic behavior that exemplifies the virtue of having coronary physiology tools for decision-making.

Resumo: A reserva fracionária de fluxo é o padrão-ouro para avaliar a gravidade funcional de uma estenose coronariana epicárdica. A revascularização guiada pela fisiologia coronariana demonstrou ser útil em doenças cardíacas estáveis, mas também na síndrome coronariana aguda. Apresentamos o caso de um paciente de 58 anos com síndrome coronariana aguda, que apresentou duas estenoses angiograficamente significativas na angiografia coronariana, e decidiu realizar revascularização orientada pela fisiologia coronariana. Com o uso da reserva fracionária de fluxo, foi determinada a necessidade de revascularizar apenas uma das lesões, levando a uma mudança no comportamento terapêutico, que exemplifica a virtude de possuir ferramentas de fisiologia coronariana para a tomada de decisão.

Inflammasome activation by NLRP1 and NLRC4 in patients with coronary stenosis.

OBJECTIVE AND DESIGN: We performed an experimental, analytical and prospective study to evaluate the systemic activation of inflammasome in atherosclerosis' patients, in order to shed light into responsible mechanisms for plaque formation. SUBJECTS: We included sixty individuals distributed into 3 groups: 2 groups based on the report from the angiography (severe lesions - SL and primary lesions - PL) and 1 group enclosing healthy individuals (HC). METHODS: The expression assays of inflammasome genes NLRP1, NLRC4, CASP-1 and IL-1ß were performed using Real Time qPCR, with specific Taqman Assays. IL-1ß serum levels were analysed by commercial kit. Were applied the Shapiro-Wilk and Student's T-test as statistical tests. Statistical significance was set to p ≤ 0.05. RESULTS: Upregulation of NLRP1 (+3.47 FC, p = 0.0001), NLRC4 (+7.06 FC, p = 6.792 × 10-09) and IL-1ß (+2.43 FC, p = 0.005) was observed in all atherosclerosis patients when compared to HC. According to stenosis severity, patients with primary lesions showed upregulation of inflammasome genes NLRP1 (+2.87 FC, p = 0.0008), NLRC4 (+6.34 FC, p = 4.134 × 10-07) and IL-1ß (+3.39 FC, p = 0.0012) with respect to the HC group. No statistical difference was found in IL-1ß serum levels according the assessed groups. CONCLUSIONS: Inflammasome activation in atherosclerosis's patients can be systemic altered and may be triggered by NLRP1 and NLRC4 receptors. IL-1ß gene expression was identified in our study as an important systemic detectable marker of plaque severity.

Does moderate coronary stenosis affect the fate of the left internal thoracic artery graft?

Abstract Introduction: In this study we try to observe the fate of the left internal thoracic artery grafts that were bypassed to left anterior descending artery with moderate stenosis identified with fractional flow reserve (FFR) technique. Doppler ultrasonography was chosen as a noninvasive screening method. Methods: A total of 30 patients who underwent coronary artery bypass grafting depending on results of the fractional flow reserve between January 2007 and January 2012, were subjected to transthoracic color Doppler ultrasonographic evaluation irrespective of the presence of symptoms, and the presence of a systolic-diastolic flow pattern was investigated using the supraclavicular approach. Results: The left internal thoracic artery graft was found to be functional in 63.3% of patients within a mean period of 35.1±19.7 months between coronary bypass and color Doppler ultrasonography. This period was found to be 29.4±19.6 months in the functional graft group, and 44.7±16.6 months in the dysfunctional graft group (P=0.046). Preoperative complaints of angina were reported to fall from 88.9% to 16.7% in the functional graft group, when compared to the postoperative period (P<0.001), but fell from 90.9% to 36.4% in the dysfunctional graft group (P=0.034). Conclusion: Functional left internal thoracic artery graft rates of the study population were found to be lower than the studies reported in the literature.

Off-pump coronary artery bypass grafting in moyamoya disease: a case report

Abstract Moyamoya disease is a rare, idiopathic, progressive, occlusive disease of the internal carotid artery characterized by the development of collateral vasculature in the brain base. In patients with accompanying coronary artery disease, cardiopulmonary bypass posses a potential risk for perioperative cerebral ischemic complication. Herein, we report a 53-year-old male case of Moyamoya disease and coronary artery disease who was treated with off-pump coronary artery bypass grafting.

Estudio Transversal: Correlación entre la Puntuación del Calcio y la Tomografía Multidetector Coronaria / Cross-Sectional Research: Correlation between Calcium Score and Coronary Multidetector Tomography

INTRODUCCIÓN: El desarrollo tecnológico con los equipos de Tomografía Multidetector permite evaluar la formación de placas de calcio en las arterias coronarias, categorizarlas y relacionarlas con los factores de riesgo. El objetivo fue determinar la asociación de la puntuación de calcio con la hipertensión arterial, sobrepeso y obesidad, dislipidemia (colesterol total, LDL, HDL), diabetes mellitus tipo 2 y tabaquismo. MÉTODOS: Se trata de un estudio transversal con 67 pacientes a quienes se realizó el examen la puntuación de calcio con Tomografía Multidetector de 64 cortes y sincronización de la frecuencia cardíaca 60 ± 5 latidos por minuto, en el Departamento de Imagenología del Hospital de Especialidades José Carrasco Arteaga, entre Marzo - Agosto de 2016. Se aplicó una encuesta adaptada para este estudio y con el consentimiento informado. Los datos fueron analizados con el Software SPSS versión 20, la cuantificación del calcio fue de 0 negativo y > 0 positivo. RESULTADOS: La mediana de edad fue 62 años, el 55.2 % fueron hombres, el 50.7 % estaban entre 45 a 64 años, se identificó a 9 pacientes con hipertensión arterial (13.4 %), 35 pacientes tenían sobrepeso (52.2 %) y 41 pacientes con triglicéridos elevados (61.2 %). Se determinó asociación entre la variable "presión arterial sistólica en mmHg ≥ 140" RP 1.76 (IC 95 %: 1.01 ­ 3.08 P: 0.036); el resto de variables no fueron significativas. CONCLUSIONES: La puntuación de calcio positivo está asociada a la presión arterial sistólica ≥ 140 mmHgtudio Transversal: Correlación entre la Puntuación del Calcio y la Tomografía Multidetector Coronaria

BACKGROUND: The technological development with the Multidetector Tomography Equipment allows evaluating the formation of calcium plaques in the coronary arteries, categorizing them and relating them to the risk factors. The aim was to determine the calcium score with hypertension, overweight and obesity, dyslipidemia (total cholesterol, LDL, HDL), type 2 diabetes mellitus and smoking. METHODS: It is a cross-sectional study with 67 patients who underwent the examination of the calcium score with 64-slice Multidetector Tomography with synchronization of the heart rate 60 ± 5 beats per minute, in the Department of Imaging of the José Carrasco Arteaga Specialties Hospital between March - August, 2016. A survey adapted for this study and with informed consent was applied. The data were analyzed with SPSS Software version 20, the calcium quantification was 0 negative and > 0 positive. RESULTS: The median age was 62 years, 55.2 % were men, 50.7 % between 45 and 64 years, 9 patients with hypertension (13.4 %), 35 overweight patients (52.2 %) and 41 patients with high triglycerides (61.2 %). An association was determined between the variable "systolic blood pressure in mmHg ≥ 140" RP 1.76 (95 % CI: 1.01 - 3.08 P: 0.036); the rest of the variables were not significant. CONCLUSIONS: The positive calcium score is associated with systolic blood pressure ≥ 140 mmHg.

Coronary arterial disease after electroconvulsive therapy: a case report / Doença arterial coronariana após eletroconvulsoterapia: um relato de caso

Objectives Unipolar depression (UPD) is a leading cause of global burden of diseases, particularly among the elderly, whose treatment may be challenging. In such cases, ECT is often recommended due to its safety and efficacy. This report presents a case of a 67-year-old male inpatient that developed a rare cardiac complication during ECT. Methods Clinical case report with patient’s consent and bibliographic review. Results A 67-year-old male inpatient with recurrent severe psychotic depression was hospitalized and ECT was indicated after failure of the pharmacological treatment. A comprehensive clinical pre-evaluation revealed only nonspecific ST-segment changes in electrocardiogram. During the 7th ECT session, it was observed transitory ST-segment depression followed by a discrete increase of plasma troponin I. Severe tri-vessel coronary artery stenosis was found and a percutaneous coronary angioplasty was performed, with satisfactory psychiatric and cardiac outcomes. Conclusions Unipolar depression (UPD) and cardiovascular disease are often coexistent conditions, especially among the elderly. In the current case, myocardial ischemia was detected lately during ECT therapy and its treatment allowed the UPD treatment to be completed adequately. .

Objetivos Depressão unipolar é uma das principais causas de sobrecarga global de doenças, particularmente entre os idosos, cujo tratamento pode ser desafiador. Nesses casos, a eletroconvulsoterapia (ECT) é frequentemente indicada, por causa de sua segurança e eficácia. Este relato apresenta o caso de um paciente de 67 anos internado e que desenvolveu uma complicação cardíaca rara após ECT. Métodos Relato de caso clínico e revisão da literatura. Resultados Um homem de 67 anos com transtorno depressivo grave, com sintomas psicóticos recorrentes, foi hospitalizado, sendo indicada ECT após falha do tratamento farmacológico. Foi realizada uma pré-avaliação clínica, a qual revelou alterações não específicas do segmento ST ao eletrocardiograma. Durante a sétima sessão de ECT, foi observada depressão transitória do segmento ST seguida por discreto aumento da troponina I sérica. Foi diagnosticada estenose coronária triarterial, sendo realizada angioplastia coronária percutânea, com boa evolução clínica e psiquiátrica. Conclusões Depressão unipolar e doença cardiovascular são condições que coexistem com frequência, especialmente entre os idosos. No presente relato, isquemia miocárdica foi detectada tardiamente durante a ECT e a sua correção permitiu que a depressão unipolar fosse tratada adequadamente. .