Impact of early post-stress 99mTc sestamibi ECG-gated SPECT myocardial perfusion imaging on the detection of ischemic LV dyssynchrony: an early step in the stunning cascade.

Transient alterations in ventricular conduction and synchronized cardiac performance have been reported in experimental models of myocardial ischemia. In post-stress 99mTc-sestamibi-gated-SPECT myocardial perfusion imaging (MPI), the time elapsed between tracer injection and image acquisition could influence the detection of ischemic left ventricular mechanical dyssynchrony (LVMD). We aimed at evaluating whether early vs. delayed post-stress MPI improve ischemic LVMD detection using the phase analysis parameters standard deviation (SD) and histogram bandwidth (HB) and to assess the correlation between stress-induced changes in SD and HB and other functional parameters. We prospectively studied 32 control subjects (Group-1) and 60 ischemic patients (Group-2). Stress-induced changes were calculated as stress minus rest (Δ). LVMD was defined as post-stress increases of either SD or HB. Group-2 showed higher ΔSD and ΔHB in early than in delayed images: early ΔSD: 1.63 (- 0.37 to 4.83) vs. delayed ΔSD: - 0.39 (- 3.82 to 1.74); early ΔHB: 2.50 (- 4 to 12) vs. ΔHB delayed: - 4 (- 15.75 to 4), all p < 0.01. ΔSD and ΔHB correlated linearly with ΔLV-ejection-fraction (EF) and ΔLV-end systolic-volume (ESV) in early images, all p < 0.01. Early images detected LVMD in more patients than delayed scans (78% vs. 38%; p < 0.01) All patients with LVEF drop in early post-stress evaluation had LVMD. Early post-stress images improve ischemic LVMD detection. Ischemic LVEF and LVESV changes correlate with ΔSD and ΔHB.

Effect of poly (l-lactic acid) scaffolds seeded with aligned diaphragmatic myoblasts overexpressing connexin-43 on infarct size and ventricular function in sheep with acute coronary occlusion.

Diaphragmatic myoblasts (DM) are stem cells of the diaphragm, a muscle displaying high resistance to stress and exhaustion. We hypothesized that DM modified to overexpress connexin-43 (cx43), seeded on aligned poly (l-lactic acid) (PLLA) sheets would decrease infarct size and improve ventricular function in sheep with acute myocardial infarction (AMI). Sheep with AMI received PLLA sheets without DM (PLLA group), sheets with DM (PLLA-DM group), sheets with DM overexpressing cx43 (PLLA-DMcx43) or no treatment (control group, n = 6 per group). Infarct size (cardiac magnetic resonance) decreased ∼25% in PLLA-DMcx43 [from 8.2 ± 0.6 ml (day 2) to 6.5 ± 0.7 ml (day 45), p < .01, ANOVA-Bonferroni] but not in the other groups. Ejection fraction (EF%) (echocardiography) at 3 days post-AMI fell significantly in all groups. At 45 days, PLLA-DM y PLLA-DMcx43 recovered their EF% to pre-AMI values (PLLA-DM: 61.1 ± 0.5% vs. 58.9 ± 3.3%, p = NS; PLLA-DMcx43: 64.6 ± 2.9% vs. 56.9 ± 2.4%, p = NS), but not in control (56.8 ± 2.0% vs. 43.8 ± 1.1%, p < .01) and PLLA (65.7 ± 2.1% vs. 56.6 ± 4.8%, p < .01). Capillary density was higher (p < .05) in PLLA-DMcx43 group than in the remaining groups. In conclusion, PLLA-DMcx43 reduces infarct size in sheep with AMI. PLLA-DMcx43 and PLLA-DM improve ventricular function similarly. Given its safety and feasibility, this novel approach may prove beneficial in the clinic.

Análisis simultáneo del strain 2D, de la reserva coronaria y de la contractilidad parietal durante el eco estrés con dipiridamol: Resultados comparativos / Simultaneous Analysis of Two-Dimensional Strain, Coronary Flow Reserve and Wall Motion during Dipyridamole Stress Echocardiography: Comparative Outcomes

Introducción El eco estrés con dipiridamol (ECODIP) es una prueba farmacológica aceptada para la evaluación de pacientes con cardiopatía isquémica; está demostrado que es una técnica ideal para combinar la información visual de la contractilidad con la reserva coronaria (RC), pero no se tiene información respecto del uso del strain 2D (deformación bidimensional) para el diagnóstico de isquemia miocárdica, por lo que su evaluación y la comparación de los resultados con otros métodos actuales para la determinación de isquemia regional puede ser de singular interés práctico. Objetivos Comparar, durante el ECODIP los resultados del análisis visual de la motilidad parietal con el valor de la RC de la arteria descendente anterior (ADA) y con el comportamiento del strain 2D longitudinal en el mismo territorio, utilizando la perfusión miocárdica con 99Tc sestamibi con SPECT simultáneo como patrón oro para el diagnóstico de isquemia. Material y métodos Se evaluaron 41 pacientes (16 hombres; edad promedio 68,5 años) derivados para ECODIP. Se promedió el strain 2D longitudinal obtenido en los 9 segmentos correspondientes a la ADA desde las tres vistas apicales tanto en reposo como en estrés, considerando como isquemia a la reducción en la deformación o un incremento menor del 5%. En el pico de efecto de 0,84 mg/kg de dipiridamol se evaluó también la motilidad parietal, la RC de la ADA (normal: > 2) y se inyectó 99Tc sestamibi para SPECT en estrés, completando su vista en reposo a las 24-48 horas. Resultados Se excluyeron 3 pacientes, uno por señal deficiente en la ADA y dos por ventana subóptima para el strain 2D. Doce pacientes con defectos reversibles con SPECT se consideraron isquémicos. Se observó concordancia de los cuatro parámetros evaluados en 6 pacientes con todos los estudios anormales y en 23 con todos los estudios normales. La deformación longitudinal en el territorio de la ADA en pacientes con SPECT normal fue de -19,9% (-18, -22) en reposo y de -22,5% (-21, -26) en el pico del ECODIP (p = 0,0003). En pacientes con SPECT isquémico, el strain 2D fue -19,35% (-17, -22) en reposo y -20,25% (-13, -21) en el pico del ECODIP (p = ns). La RC mostró una sensibilidad del 66,7% (IC 95% 35,4-88,7) y una especificidad del 100%; la contractilidad, una sensibilidad del 50% (IC 95% 22,3-77,7) y una especificidad del 100% y el strain 2D, una sensibilidad del 83,3% (IC 95% 50,9-97) y una especificidad del 88,5% (IC 95% 68,7-97). Conclusiones El strain 2D durante el eco estrés con dipiridamol resultó un método cuantitativo factible con una efectividad similar a la RC y superior al análisis visual de la contractilidad para detectar isquemia en el territorio de la ADA.

Background Dipyridamole stress echocardiography (DSE) is a pharmacological test accepted for the evaluation of patients with ischemic heart disease that has proved to be an ideal method that combines the visual information of wall motion with coronary flow reserve (CFR). However, the usefulness of 2D strain for the diagnosis of myocardial ischemia is still uncertain. In this sense, it seems interesting for daily practice to evalúate the results of this technique and compare them with those of other methods currently used for the evaluation of regional ischemia. Objectives To compare the results of visual analysis of wall motion and the valué of CFR of the left anterior descending (LAD) coronary artery during DSE with 2D longitudinal strain in the same territory using simultaneous 99mTc-sestamibi SPECT sean as the gold standard for the diagnosis of myocardial ischemia. Material and Methods We evaluated 41 patients (16 men; average age 68.5 years) referred for DSE. The average 2D longitudinal strain obtained of the 9 segments corresponding to the LAD coronary artery from the three apical views at rest and during stress was estimated. A drop in 2D strain valué or an average increase < 5% was considered an ischemic response. Wall motion and CFR in the LAD (normal: >2) were evaluated during the peak effect of 0.84 mg/kg of dipyridamole, when intravenous 99Tc sestamibi was injected and stress SPECT images were obtained. Rest images were acquired at 24 and 48 hours. Results Three patients were excluded: one due to poor pulsed Doppler signal in the LAD and two patients presented a suboptimal ultrasound window for 2D strain. Twelve patients presented reversible perfusión defeets in SPECT images (ischemic response). There was a good correlation in the four parameters evaluated in 6 patients in whom all the studies were abnormal and in 23 patients in whom all the studies were normal. In patients with normal SPECT images, 2D longitudinal strain in the territory of the LAD was -19.9% (-18, -22) at rest and -22.5% (-21, -26) during peak infusión of dipyridamole (p=0.0003). In patients with ischemia, 2D strain was -19.35% (-17, -22) at rest and -20.25% (-13, -21) during peak dipyridamole infusión (p=ns). The sensitivities and specificities obtained were: CFR, 66.7% (CI 95% 35.4-88.7) and 100%, respectively; wall motion, 50% (CI 95% 22.3-77.7) and 100%, respectively; and 2D strain, 83.3% (CI 95% 50.9-97) and 88.5% (CI 95% 68.7-97), respectively. Conclusions Simultaneous analysis of 2D strain during dipyridamole stress echocardiography proved to be a feasible quantitative method, as effective as CFR and better than the visual wall motion analysis for the diagnosis of ischemia in the territory of the LAD coronary artery.

Insuficiencia cardíaca en miocardiopatía no compactada: mejoría luego de la terapia de resincronización / Heart failure in non-compacted cardiomyopathy: improvement after cardiac resynchronization therapy / Insuficiência cardíaca na cardiomiopatia não compactada: melhoria após a terapia de ressincronização cardíaca: Apresentação de imagens de um caso

Se presenta el caso de una paciente de 36 años de edad que consulta por presentar palpitaciones y disnea de esfuerzo, diagnosticándose una insuficiencia cardíaca debida a una miocardiopatía no compactada y severo deterioro de la función sistólica ventricular izquierda. Ante la falta de mejoría a pesar del tratamiento médico máximo tolerado, se decide la colocación de un cardiodesfibrilador implantable con resincronizador. Al año de la colocación del dispositivo, la paciente se encuentra asintomática con franca mejoría de los parámetros ecocardiográficos.

We present a case of a 36 years-old female patient who presents palpitations and dyspnea, with heart failure due to non-compacted cardiomyopathy and severe left ventricular systolic deterioration. Due to the absence of improvement instead of full medical tolerated treatment, we decided to install cardiac resynchronization therapy device with an implantable cardioverter defibrillator device. One year after placement of the device, the patient is asymptomatic with clear improvement of echocardiographic parameters.

Nós relatamos o caso de uma paciente de 36 anos de idade, com palpitações e dispnéia, e o diagnóstico de insuficiência cardíaca por cardiomiopatia não-compactada e comprometimento grave da função sistólica do ventrículo esquerdo. Decidiu-se a colocação de um desfibrilador cardioversor implantável com terapia de ressincronização. Um ano após a colocação do aparelho, o paciente fica assintomática, com melhora dos parâmetros ecocardiográficos.

Amiloidosis cardíaca: Hallazgos en resonancia magnética cardíaca / Cardiac amyloidosis: Findings in cardiovascular magnetic resonance / Amiloidose cardíaca: Achados em ressonância magnética cardiovascular

Se presentan las imágenes de la resonancia magnética cardíaca (RMC) de un paciente de 38 años portador de una amiloidosis cardíaca con clínica de insuficiencia cardíaca congestiva. La RMC debería considerarse ante la sospecha diagnóstica de amiloidosis cardíaca y podría ser útil para monitorizar la respuesta al tratamiento.

We present images of cardiac magnetic resonance (CMR) of a 38 years old patient carrying a cardiac amyloidosis with clinic of congestive heart failure. CMR should be considered before the suspected diagnosis of cardiac amyloidosis and may be useful to monitor treatment response.

Apresentamos imagens de ressonância magnética cardíaca (RMC) de um paciente de 38 anos carregando uma amiloidose cardíaca com clínica de insuficiência cardíaca congestiva. CMR deve ser considerado suspeito antes do diagnóstico de amiloidose cardíaca e pode ser útil para monitorar a resposta ao tratamento.

Resonancia magnética nuclear en la evaluación de la hipertensión pulmonar / Ressonância magnética nuclear na avaliação da hipertensão pulmonar / Nuclear magnetic resonance in pulmonary hypertension evaluation

Se presentan las imágenes de resonancia magnética nuclear de una paciente de 38 años portadora de hipertensión pulmonar idiopática.

We present the images of nuclear magnetic resonance of a 38-year-old woman with idiopathic pulmonary hypertension.

Apresentam-se as imagens de ressonância magnética nuclear de uma paciente de 38 anos portadora de hipertensão pulmonar idiopatica.