Diagnóstico etiológico de la disfunción ventricular izquierda con tomografía computarizada: comparación con coronariografía y cardiorresonancia / Etiological diagnosis of left ventricular dysfunction: computed tomography compared with coronary angiography and cardiac magnetic resonance

Introducción y objetivos. Evaluar la capacidad de la tomografía computarizada con multidetectores en el diagnóstico de la disfunción ventricular izquierda de origen coronario y valorar su exactitud diagnóstica comparándola con la combinación de coronariografía invasiva y resonancia magnética. Métodos. Se estudió a 40 pacientes consecutivos con disfunción ventricular izquierda de origen no filiado mediante coronariografía invasiva y resonancia con contraste. A todos ellos se les realizó además un estudio de tomografía computarizada con multidetectores incluyendo presencia de calcio coronario y su cuantificación, coronariografía y valoración tisular del miocardio. Resultados. La sensibilidad y la especificidad de la presencia de calcio coronario para identificar la disfunción ventricular izquierda de origen coronario fueron del 100 y el 31% respectivamente. Si se considera un score de calcio por Agatston>100, la especificidad sube al 58% manteniendo la sensibilidad del 100%. Los valores de sensibilidad y especificidad de la coronariografía por tomografía computarizada con multidetectores fueron del 100 y el 96% respectivamente; para la identificación de áreas de necrosis en la adquisición precoz, del 57 y el 100% y en la adquisición tardía, del 84 y el 96%. Para identificar a los pacientes coronarios con necrosis, la sensibilidad y la especificidad fueron del 92 y el 100% respectivamente. Conclusiones. De todas las herramientas diagnósticas disponibles en tomografía computarizada con multidetectores, la coronariografía es la que muestra mayor exactitud diagnóstica para determinar el origen coronario de la disfunción ventricular. La combinación del estudio coronariográfico y el estudio tisular del miocardio tras el contraste permite obtener en un solo examen información similar a la de la combinación de cateterismo y resonancia con contraste (AU)

Introduction and objectives. To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance. Methods. Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment. Results. The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively. Conclusions. Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance (AU)

Etiological diagnosis of left ventricular dysfunction: computed tomography compared with coronary angiography and cardiac magnetic resonance.

INTRODUCTION AND OBJECTIVES: To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance. METHODS: Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment. RESULTS: The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively. CONCLUSIONS: Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance.

Late gadolinium enhancement-cardiovascular magnetic resonance identifies coronary artery disease as the aetiology of left ventricular dysfunction in acute new-onset congestive heart failure.

AIMS: We evaluated the ability of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance (CMR) to identify acute new-onset heart failure (HF) with left ventricular systolic dysfunction (LVSD), whether or not in relation to underlying coronary artery disease (CAD), in patients with no clinical evidence of associated ischaemic cardiomyopathy. METHODS AND RESULTS: Hundred consecutive patients admitted with acute new-onset decompensated HF and EF <40%, with no clinical or electrocardiographic data suggestive of CAD. The patients were classified according to the presence or absence of significant CAD (stenosis > or =70% in at least one major vessel). Twenty-one patients (21%) had significant CAD. Seventy-nine (79%) had no lesions. Eighteen of the 21 patients (85%) with CAD had subendocardial/transmural LGE. In the diagnosis of CAD, LGE has a sensitivity of 85.7% (95% CI, 80-91) and specificity of 92.4% (95% CI, 87-96), respectively, with a negative predictive value of 96% (95% CI, 90-99). It has an area under the receiver operating characteristic curve of 0.906 (95% CI, 0.814-0.998). CONCLUSION: In patients with new-onset HF and LVSD for whom there are no clinical and exploratory data suggestive of ischaemic heart disease, CMR with LGE is an excellent means of ruling out significant CAD and is a valid alternative to angiography.

[Refractory psoriasis treatment with etanercept]. / Tratamiento de la psoriasis refractaria con etanercept.

BACKGROUND AND OBJECTIVES: Etanercept is a dimeric fusion protein that binds to tumor necrosis factor and blocks inflammatory response. The purpose of this study was to assess the effects of etanercept and its maintenance in patients with severe and refractory psoriasis. PATIENTS AND METHOD: Twenty two patients with severe and refractory psoriasis in an open-label clinical trial were studied. Patients received etanercept 50 mg/week subcutaneously during 6 months. PASI (Psoriasis Assessment and Severity Index) was used to monitor disease activity in each month of treatment and in the follow up. Results at weeks 12 and 24 are shown. RESULTS: 96% of patients improved their PASI basal score early at week 12. This improvement was maintained until week 24. Etanercept was well tolerated without any significant adverse reaction. Time until relapse was 2.27 +/- 0.59 months (CI 95%: 1.94-2.60). CONCLUSION: Etanercept seems an effective therapy for severe and refractory psoriasis yet long-term dosing and safety studies of etanercept in psoriasic patients are needed.

Tratamiento de la psoriasis refractaria con etanercept / Refractory psoriasis treatment with etanercept

Fundamento y objetivos: Determinar el número y la proporción de pacientes con psoriasis extensa y refractaria que mejoraron tras la administración de etanercept, así como el tiempo medio de respuesta mantenida tras su retirada. Pacientes y método: Se incluyó en el estudio a 22 pacientes con psoriasis grave refractaria a otros tratamientos sistémicos a los que se les administraron 50 mg de etanercept a la semana durante 24 semanas. Presentamos los resultados en el Psoriasis Assessment and Severity Index (PASI) en las semanas 12 y 24, y la duración media de la mejoría. Resultados: Veintiún pacientes (96%) disminuyeron su puntuación en el PASI ya en la semana 12 respecto de la basal (p < 0,01), 9 (41%) alcanzaron el objetivo principal (PASI75) y 16 (73%) el objetivo secundario (PASI50). Dieciocho (82%) de los pacientes mejoraron su PASI respecto del basal en la semana 24 (p < 0,01). Catorce (63%) alcanzaron el PASI50 y 13 (59%) el PASI75. El tiempo medio (desviación estándar) libre de enfermedad hasta el rebrote tras el cese del tratamiento fue de 2,27 (0,59) (intervalo de confianza del 95%, 1,94-2,60). Conclusión: El etanercept parece una buena opción de tratamiento en los pacientes con psoriasis extensa y refractaria. El perfil de seguridad es adecuado y tiene una administración fácil

Background and objectives: Etanercept is a dimeric fusion protein that binds to tumor necrosis factor and blocks inflammatory response. The purpose of this study was to assess the effects of etanercept and its maintenance in patients with severe and refractory psoriasis. Patients and method: Twenty two patients with severe and refractory psoriasis in an open-label clinical trial were studied. Patients received etanercept 50 mg/week subcutaneously during 6 months. PASI (Psoriasis Assessment and Severity Index) was used to monitor disease activity in each month of treatment and in the follow up. Results at weeks 12 and 24 are shown. Results: 96% of patients improved their PASI basal score early at week 12. This improvement was mantained until week 24. Etanercept was well tolerated without any significant adverse reaction. Time until relapse was 2.27 ± 0.59 months (CI 95%: 1.94-2.60). Conclusion: Etanercept seems an effective therapy for severe and refractory psoriasis yet long-term dosing and safety studies of etanercept in psoriasic patients are needed

[Treatment of severe refractory psoriasis with infliximab]. / Tratamiento de la psoriasis extensa y refractaria con infliximab.

BACKGROUND AND OBJECTIVE: Infliximab is a chimeric monoclonal antibody that binds to tumor necrosis factor alpha and blocks the inflammatory response. The purpose of this study was to assess the effects of infliximab in patients with severe and refractory psoriasis. PATIENTS AND METHOD: Eleven patients with severe and refractory psoriasis were included in an open-label clinical trial. Patients received infliximab 5 mg/kg intravenously at weeks 0, 2, 6 and every 8 weeks. Psoriasis Assessment and Severity Index (PASI) and BSA (Body Surface Assessment) were used to monitor disease activity with each dose. Results at weeks 6 and 30 are shown. RESULTS: 90% of patients improved their PASI and BSA basal scores early at sixth week, achieving 63.6% (PASI75) and 72.7% (BSA50). This improvement was maintained until the 30th week (54.5% and 72.7%, respectively). Infliximab was well tolerated and there was no significant adverse reaction. CONCLUSIONS: Infliximab seems an effective therapy for severe and refractory psoriasis.