Relevance of subclinical right ventricular dysfunction measured by feature-tracking cardiac magnetic resonance in non-ischemic dilated cardiomyopathy.

BACKGROUND: Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker. METHODS: Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model. RESULTS: 98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (-21.6 ± 6.6% vs -31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%. CONCLUSIONS: In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.

Evaluación de un paciente con origen anómalo congénito de las arterias coronarias mediante TC multidetector / Evaluation of a patient with congenital anomalous origins of coronary arteries using a multidetector CT (MDCT)

Se presenta el caso de un recién nacido atendido en el Servicio de Pediatría del Hospital Regional Universitario «Carlos Haya» por sepsis y enfermedad respiratoria, que desarrolló coagulopatía y shock en los primeros días, por lo que se le instauró antibioticoterapia y ventilación mecánica. La bronconeumonía inicial cursó con derrame pleural e imágenes persistentemente alteradas del hemidiafragma derecho. Al final y mediante ecografía, se estableció el diagnóstico de hernia diafragmática congénita derecha. Una vez superado el problema infeccioso, fue intervenido quirúrgicamente con éxito

We present the case of a newborn, treated in our unit for sepsis and respiratory disease. In his first few days of life, he developed coagulopathy and shock, requiring antibiotics and mechanical ventilation. The initial bronchopneumonia was associated with pleural effusion, and the imaging studies repeatedly revealed a defect in right hemidiaphragm that proved to be a congenital diaphragmatic hernia on ultrasound. Once the infection resolved, surgical repair was successfully performed

Evaluación de la afectación coronaria por enfermedad de Kawasaki mediante TC multidetector / Evaluation of coronary artery lesions secondary to Kawasaki disease using multidetector computed tomography

La enfermedad de Kawasaki es la principal causa de cardiopatía adquirida en la edad pediátrica en los países desarrollados. El seguimiento evolutivo de los pacientes que han desarrollado como secuela aneurismas coronarios a pesar del tratamiento correcto es en la actualidad un problema no resuelto de indudable trascendencia clínica. Presentamos el caso clínico de una paciente de 16 años en la que el estudio con TC multidetector permitió valorar con precisión la anatomía coronaria, resolviendo las dudas diagnósticas planteadas por la evaluación convencional con ecocardiograma

Kawasaki disease is the principal cause of acquired heart disease in children in developed countries. The follow-up of patients who develop secondary coronary aneurysms despite proper treatment remains an unsolved problem of unquestionable clinical importance. We present the case of a 16-year-old patient in whom multidetector computed tomography enabled us to meticulously assess the coronary anatomy, resolving the diagnostic doubts raised by conventional ultrasound examination