Caracterización de la fisiología restrictiva del ventrículo derecho mediante flujo 4D / 4-D flow characterization of right ventricular restrictive physiology

Abstract: Right ventricular restrictive physiology (RVRP) occurs in diverse clinical scenarios, most frequently after repair of Tetralogy of Fallot (TOF). Cardiac magnetic resonance (CMR) can comprehensively evaluate RVRP using 4D flow along with anatomical and fibrosis characterization. Also, RVRP is associated with less pulmonary regurgitation and fewer right ventricle enlargement; its long term protective role is debated. RVRP is a challenging and relevant diagnosis, which hallmark is the presence of antegrade pulmonary arterial Flow in late diastole throughout the respiratory cycle. Also, other hemodynamic findings could aid such us flow in; caval veins, suprahepatic, coronary sinus and tricuspid valve. Obtaining all these flow curves is virtually impossible by echocardiography. CMR with 4DF is a unique and powerful technique enabling this comprehensive hemodynamic evaluation as depicted in this case.

Evaluación del dolor torácico agudo mediante ecocardiografía de ejercicio y tomografía computarizada multidetectores / Exercise echocardiography and multidetector computed tomography for the evaluation of acute chest pain

Introducción y objetivos Un 4% de los pacientes con dolor torácico agudo y troponinas y electrocardiograma normales presentan eventos cardiacos adversos como consecuencia del síndrome coronario agudo no diagnosticado. El presente estudio compara la utilidad diagnóstica de la tomografía cardiaca y el ecocardiograma de ejercicio en pacientes con probabilidad baja-intermedia de enfermedad coronaria. Métodos Se incluyó prospectivamente a 69 sujetos con dolor torácico agudo y troponinas y electrocardiograma normales a los que se realizó una tomografía cardiaca y un ecocardiograma de ejercicio. Los pacientes con al menos una lesión ≥ 50% o una puntuación de calcio de Agatston ≥ 400 en la tomografía cardiaca, ecocardiograma de ejercicio positivo o con resultados no concluyentes ingresaron para completar estudio. Resultados: El síndrome coronario agudo se confirmó en 17 casos (24,6%), cifra inferior al 42% sospechado según los hallazgos de la tomografía cardiaca (p<0,05) y no significativamente diferente del 29% sospechado por el ecocardiograma de ejercicio (p=0,56). El ecocardiograma de ejercicio fue normal en el 37% de los casos con tomografía cardiaca patológica. La tomografía cardiaca proporcionó una sensibilidad superior (el 100 frente al 82,3%; p=0,21) pero una especificidad inferior (el 76,9 frente al 88,4%; p=0,12) que el ecocardiograma de ejercicio, aunque sin significación estadística. Un valor de corte de estenosis coronaria del 70% mejoró la especificidad de la tomografía cardiaca al 88,4% manteniendo la sensibilidad del 100%. Conclusiones: La tomografía cardiaca es una alternativa válida al ecocardiograma de ejercicio para el diagnóstico de síndrome coronario agudo en pacientes con probabilidad baja-intermedia de enfermedad coronaria. La combinación de ambas técnicas podría mejorar el diagnóstico

Introduction and objectives Up to 4% of patients with acute chest pain, normal electrocardiogram, and negative troponins present major adverse cardiac events as a result of undiagnosed acute coronary syndrome. Our aim was to compare the diagnostic performance of multidetector computed tomography and exercise echocardiography in patients with a low-to-intermediate probability of coronary artery disease. Methods We prospectively included 69 patients with acute chest pain, normal electrocardiogram, and negative troponins who underwent coronary tomography angiography and exercise echocardiography. Patients with coronary stenosis ≥ 50% or Agatston calcium score ≥ 400 on coronary tomography angiography or positive exercise echocardiography, or with inconclusive results, were admitted to rule out acute coronary syndrome. Results: An acute coronary syndrome was confirmed in 17 patients (24.6%). This was lower than the suspected 42% based on coronary tomography angiography (P < .05) and not significantly different than the suspected 29% based on the results of exercise echocardiography (P = .56). Exercise echocardiography was normal in up to 37% of patients with pathological findings on coronary tomography angiography. The latter technique provided a higher sensitivity (100% vs 82.3%; P = .21) but lower specificity (76.9% vs 88.4%; P=.12) than exercise echocardiography for the diagnosis of acute coronary syndrome, although without reaching statistical significance. Increasing the stenosis cutoff point to 70% increased the specificity of coronary tomography angiography to 88.4%, while maintaining high sensitivity. Conclusions: Coronary tomography angiography offers a valid alternative to exercise echocardiography for the diagnosis of acute coronary syndrome among patients with low-to-intermediate probability of coronary artery disease. A combination of both techniques could improve the diagnosis of acute coronary síndrome

Mujer de 44 años con artralgias y neumopatía intersticial / Arthralgia and interstitial neuropathy in a 44-year-old woman

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