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BACKGROUND: Electrical isolation of pulmonary veins (PV) with high-power short-duration (HPSD) radiofrequency application (RFa) may reduce the duration of atrial fibrillation (AF) ablation, without compromising the procedural efficacy and safety in comparison with the conventional approach. This hypothesis has been generated in several observational studies; the POWER FAST III will test it in a randomized multicenter clinical trial. METHODS: It is a multicenter randomized, open-label and non-inferiority clinical trial with two parallel groups. AF ablation using 70 W and 9-10 s RFa is compared with the conventional technique using 25-40 W RFa guided by numerical lesion indexes. The main efficacy objective is the incidence of atrial arrhythmia recurrences electrocardiographically documented during 1-year follow-up. The main safety objective is the incidence of endoscopically detected esophageal thermal lesions (EDEL). This trial includes a substudy of incidence of asymptomatic cerebral lesions detected by magnetic resonance imaging (MRI) after ablation. RESULTS: A randomized clinical trial compares for the first time high-power short-duration and conventional ablation in order to obtain data about the efficacy and safety of the high-power technique in an adequate methodological context. CONCLUSIONS: The results of the POWER FAST III could support the use of the high-power short-duration ablation in clinical practice. REGISTRATION: ClinicalTrials.gov: NTC04153747.
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No disponible
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Bloqueio de Ramo/diagnóstico , Bradicardia/fisiopatologia , Marca-Passo Artificial , EletrocardiografiaAssuntos
Falso Aneurisma/etiologia , Endocardite/complicações , Aneurisma Cardíaco/etiologia , Valva Mitral , Idoso , Falso Aneurisma/diagnóstico por imagem , Angiografia Coronária , Ecocardiografia Transesofagiana , Endocardite/diagnóstico por imagem , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Ventrículos do Coração , Humanos , Valva Mitral/diagnóstico por imagemRESUMO
Introducción y objetivo: La resonancia magnética cardíaca con contraste (RMCC) permite la detección precoz de la afectación miocárdica por el Trypanosoma cruzi. El objetivo de nuestro estudio fue valorar el rendimiento diagnóstico del electrocardiograma de superficie (ECG) en la detección precoz de miocardiopatía chagásica (MCC) comparándolo con la RMCC. Métodos: Se incluyeron 43 pacientes asintomáticos (30 mujeres, edad media [DE] de 42 [9,8] años) diagnosticados de enfermedad de Chagas. Dividimos la muestra en 2 grupos, según la presencia (n = 17) o ausencia (n = 26) de alteraciones electrocardiográficas. Se realizó RMC a todos los pacientes y se consideró la captación tardía anómala de contraste miocárdico (CTC) como marcador de afectación precoz. Resultados: Seis pacientes (14%) presentaron CTC, siendo significativamente mayor en el grupo que presentaban alteraciones electrocardiográficas (29 frente a 4%, p < 0,05). Tomando la RMCC como método de referencia, el ECG presentó una sensibilidad del 83% y un valor predictivo negativo del 96% en la detección de MCC. Conclusiones: El ECG demostró ser una herramienta útil, de bajo coste y globalmente disponible para el cribado de MCC precoz en pacientes asintomáticos pero con afectación demostrada en la RMCC (AU)
Barckground and objective: Contrast-enhanced cardiac magnetic resonance imaging (CMR) allows early detection of myocardial involvement by Trypanosoma cruzi infection. The aim of our study was to assess the diagnostic performance of the surface electrocardiogram (ECG) in the early detection of Chagas cardiomyopathy (CCM) compared with CMR. Methods: We included 43 asymptomatic patients (30 women, 42 ± 9.8 years), diagnosed of Chagas disease. The sample was divided into 2 groups according to the presence (n = 17) or absence (n = 26) of electrocardiographic abnormalities. All patients underwent CMR and late gadolinium enhancement (LGE) was used as a marker of early myocardial involvement. Results: Six (14%) patients had a LGE significantly higher in the group who had electrocardiographic abnormalities (29 vs. 4%, P < .05). With CMR as the method of reference, the ECG had a sensitivity of 83% and a negative predictive value of 96% to detect CCM. Conclusion: ECG is a useful, inexpensive and globally available tool for the screening of CCM in asymptomatic patients but with proven myocardial involvement in CMR (AU)
Assuntos
Humanos , Feminino , Adulto , /diagnóstico , Doença de Chagas/diagnóstico , Espectroscopia de Ressonância Magnética , Eletrocardiografia , Diagnóstico PrecoceAssuntos
Divertículo/diagnóstico , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Cardiopatias/diagnóstico , Ventrículos do Coração , Imagem Cinética por Ressonância Magnética/métodos , Adolescente , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Humanos , Masculino , Monitorização Fisiológica , Doenças RarasRESUMO
BARCKGROUND AND OBJECTIVE: Contrast-enhanced cardiac magnetic resonance imaging (CMR) allows early detection of myocardial involvement by Trypanosoma cruzi infection. The aim of our study was to assess the diagnostic performance of the surface electrocardiogram (ECG) in the early detection of Chagas' cardiomyopathy (CCM) compared with CMR. METHODS: We included 43 asymptomatic patients (30 women, 42 ± 9.8 years), diagnosed of Chagas disease. The sample was divided into 2 groups according to the presence (n=17) or absence (n=26) of electrocardiographic abnormalities. All patients underwent CMR and late gadolinium enhancement (LGE) was used as a marker of early myocardial involvement. RESULTS: Six (14%) patients had a LGE significantly higher in the group who had electrocardiographic abnormalities (29 vs. 4%, P<.05). With CMR as the method of reference, the ECG had a sensitivity of 83% and a negative predictive value of 96% to detect CCM. CONCLUSION: ECG is a useful, inexpensive and globally available tool for the screening of CCM in asymptomatic patients but with proven myocardial involvement in CMR.
Assuntos
Cardiomiopatia Chagásica/diagnóstico , Eletrocardiografia , Imageamento por Ressonância Magnética , Adulto , Infecções Assintomáticas , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
AIMS: Pulmonary arterial hypertension is known to be related to worse prognosis in patients with heart failure (HF). Quantification of pulmonary vascular resistance (PVR) still requires invasive right heart catheterization. Recent studies have shown an accurate method for non-invasive estimation of PVR by cardiac magnetic resonance (CMR). Our aim was to evaluate the prognostic value of PVR calculated by CMR in patients with congestive HF. METHODS AND RESULTS: We calculated PVR by CMR in 132 patients [age 65.6 ± 13.1 years, left ventricular ejection fraction (LVEF) 35.1 ± 16.4%, ischaemic aetiology 40%] recently admitted for decompensated HF and derived to our cardiac imaging unit for diagnosis. Patients with cardiac events (readmission for HF or all-cause death) had higher values of PVR [6.77 ± 1.9 vs. 4.1 ± 1.6 Wood units (Wu), P < 0.001] during follow-up [mean 10.3 (1-31) months]. In multivariable Cox regression analysis, only a PVR ≥5.2 Wu [hazard ratio (HR) 4.27; 95% confidence interval (CI) 1.75-10.42; P < 0.001) and the presence of late gadolinium enhancement (LGE) on CMR (HR 2.24; 95% CI 1.03-4.86; P = 0.04) were independent predictors for adverse events at follow-up. CONCLUSION: Non-invasive estimation of PVR by CMR might be useful for risk stratification of patients with chronic HF, irrespective of aetiology or LVEF.
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Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Imagem Cinética por Ressonância Magnética/métodos , Resistência Vascular , Idoso , Doença Crônica , Angiografia Coronária/métodos , Ecocardiografia/métodos , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade , Volume Sistólico , Função Ventricular EsquerdaAssuntos
Falso Aneurisma/diagnóstico , Ecocardiografia Transesofagiana/métodos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Interpretação de Imagem Assistida por Computador , Artéria Pulmonar , Insuficiência da Valva Pulmonar/diagnóstico , Adulto , Falso Aneurisma/cirurgia , Dispneia/diagnóstico , Dispneia/etiologia , Endocardite/diagnóstico , Endocardite/cirurgia , Seguimentos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Imagem Multimodal , Falha de Prótese , Insuficiência da Valva Pulmonar/cirurgia , Reoperação/métodos , Medição de Risco , Abuso de Substâncias por Via Intravenosa , Resultado do TratamentoAssuntos
Ruptura Aórtica/diagnóstico por imagem , Seio Aórtico , Adulto , Humanos , Masculino , UltrassonografiaRESUMO
This case shows a rare complication of a migrated atrial lead into the pulmonary artery incidentally detected during a comprehensive evaluation of coronary CT angiography.
Assuntos
Eletrodos Implantados/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Marca-Passo Artificial/efeitos adversos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/lesões , Tomografia Computadorizada por Raios X/métodos , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Achados Incidentais , MasculinoRESUMO
Mean platelet volume (MPV) is an indicator of platelet activation. High MPV has been recently considered as an independent risk factor for poor outcomes after ST-segment elevation myocardial infarction (STEMI). We analyzed 128 patients diagnosed with first STEMI successfully reperfused during three consecutive years. MPV was measured on admission and a cardiac magnetic resonance (CMR) exam was performed within the first week in all patients. Myocardial necrosis size was estimated by the area of late gadolinium enhancement (LGE), identifying microvascular obstruction (MVO), if present. Clinical outcomes were recorded at 1 year follow-up. High MPV was defined as a value in the third tertile (≥9.5âfl), and a low MPV, as a value in the lower two. We found a slight but significant correlation between MPV and infarct size (r = 0.287, P = 0.008). Patients with high MPV had more extensive infarcted area (percentage of necrosis by LGE: 17.6 vs. 12.5%, P = 0.021) and more presence of MVO (patients with MVO pattern: 44.4 vs. 25.3%, P = 0.027). In a multivariable analysis, hazard ratio for major adverse cardiac events was 3.35 [95% confidence interval (CI) 1.1-9.9, P = 0.03] in patients with high MPV. High MPV in patients with first STEMI is associated with higher infarct size and more presence of MVO measured by CMR.
Assuntos
Angioplastia Coronária com Balão , Plaquetas/patologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/patologia , Adulto , Idoso , Tamanho Celular , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Acquired left ventricular-right atrial communication (Gerbode-type defect) is a rare complication of infective endocarditis. Although transesophageal echocardiography remains the technique of choice for the evaluation of complications of endocarditis this case highlights the usefulness of cardiac computed tomography in this scenario, particularly in cases where assessment of coronary anatomy is required before surgery.