RESUMO
The 2016 SCCT/STR guideline for coronary artery calcification (CAC) scoring on non-cardiac chest CT (NCCT) scans explicitly calls for the reporting of CAC. Whether the publication of the 2016 SCCT/STR guideline has had any impact on CAC reporting in lung cancer screening (LCS) scans has not been investigated. Consecutive patients with a LCS scan were identified from the University of Minnesota LCS registry and evaluated for CAC reporting in 3 separate cohorts: 6 months before, 6 months after, and 1 year after the publication of the 2016 SCCT/STR guideline. Scans were evaluated for CAC and quantified using the Agatston method. CAC reporting, downstream testing and initiation of preventive therapy were assessed. Among 614 patients (50% male, mean age 64.1 ± 6.0 years), CAC was present in 460 (74.9%) with a median Agatston score of 62 (IQR 0, 230). Of these, 196 (31.9%) had a CAC score of 1-100, 125 (20.4%) had 101-300, and 118 (19.2%) had > 300. Overall, CAC was reported in 325 (70.7%) patients with CAC present. CAC reporting relative to publication of the 2016 SCCT/STR guideline was as follows: 6 months prior-74.1%, 6 months after-64.6%, and 1 year after-77.5%. In the 308 patients with a new diagnosis of sub-clinical CAD based on CAC presence, 6 (1.9%) patients were referred to cardiology, and 15 (4.9%) patients underwent testing for obstructive CAD. Only 6 (1.9%) and 9 (2.9%) patients were newly started on aspirin and statin respectively. CAC detected incidentally on lung cancer screening CT scans is prevalent, and rarely acted upon clinically. CAC reporting is fairly high, and publication of the 2016 SCCT/STR guideline for CAC scoring on NCCT scans did not have any significant impact on CAC reporting.
Assuntos
Doença da Artéria Coronariana , Neoplasias Pulmonares , Calcificação Vascular , Cálcio , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Detecção Precoce de Câncer , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagemAssuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Intervenção Coronária Percutânea/métodos , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Angiografia por Tomografia Computadorizada/efeitos adversos , Angiografia Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Lesões por Radiação/etiologia , Estudos Retrospectivos , Fatores de TempoAssuntos
Anemia Aplástica/complicações , Anemia Aplástica/terapia , Desferroxamina/uso terapêutico , Hemocromatose/tratamento farmacológico , Hemocromatose/etiologia , Quelantes de Ferro/uso terapêutico , Contração Miocárdica/efeitos dos fármacos , Piridonas/uso terapêutico , Reação Transfusional , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/tratamento farmacológico , Adulto , Deferiprona , Ecocardiografia , Humanos , Imageamento por Ressonância Magnética , MasculinoAssuntos
Sistema Nervoso Autônomo/fisiologia , Frequência Cardíaca/fisiologia , Meditação/métodos , Atenção Plena/métodos , Estresse Psicológico/terapia , Adulto , Feminino , Humanos , Masculino , Meditação/psicologia , Pessoa de Meia-Idade , Terapia de Relaxamento/métodos , Terapia de Relaxamento/psicologia , Taxa Respiratória/fisiologia , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologiaRESUMO
Primary cardiac tumors are far rarer than tumors metastatic to the heart. Angiosarcoma is the primary cardiac neoplasm most frequently detected; lymphomas constitute only 1% of primary cardiac tumors. We present the case of a 55-year-old woman with a recently diagnosed intracardiac mass who was referred to our institution for consideration of urgent orthotopic heart transplantation. Initial images suggested an angiosarcoma; however, a biopsy specimen of the mass was diagnostic for diffuse large B-cell lymphoma. The patient underwent chemotherapy rather than surgery, and she was asymptomatic 34 months later. We use our patient's case to discuss the benefits and limitations of multiple imaging methods in the evaluation of cardiac masses. Certain features revealed by computed tomography, cardiac magnetic resonance, and positron emission tomography can suggest a diagnosis of angiosarcoma rather than lymphoma. Cardiac magnetic resonance and positron emission tomography enable reliable distinction between benign and malignant tumors; however, the characteristics of different malignant tumors can overlap. Despite the great usefulness of multiple imaging methods for timely diagnosis, defining the extent of spread and the hemodynamic impact, and monitoring responses to treatment, we think that biopsy analysis is still warranted in order to obtain a correct histologic diagnosis in cases of suspected malignant cardiac tumors.
Assuntos
Neoplasias Cardíacas/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Imagem Multimodal/métodos , Antígenos CD20/análise , Biomarcadores Tumorais/análise , Biópsia , Diagnóstico Diferencial , Erros de Diagnóstico/prevenção & controle , Ecocardiografia Doppler em Cores , Feminino , Neoplasias Cardíacas/tratamento farmacológico , Neoplasias Cardíacas/imunologia , Humanos , Imuno-Histoquímica , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/imunologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios XRESUMO
Although cardiac manifestations such as pericardial, myocardial, and valvular involvement are common in patients with systemic lupus erythematosus (SLE), coronary artery involvement is less frequent. Clinical manifestations of coronary artery disease in SLE can result from accelerated atherosclerosis, arteritis, abnormal coronary flow reserve, spasm, and thrombosis. In SLE, the classic valvular abnormality consists of noninfective, verrucous vegetation. Thickening of the leaflets due to inflammation followed by fibrosis is common, occurring in about 50% of patients, whereas vegetations are present in about 40%. Mitral valve involvement is most common, with valvular regurgitation more frequent than valvular stenosis. The tricuspid valve and the aortic valve may also be affected. Its frequency varies widely: 13% to 74% in the general population. We report a case of a woman with acute myocardial infarction and normal coronary arteries, who was subsequently diagnosed with Libman-Sacks endocarditis and SLE.