Regression of Cardiac Lymphoma With Chemotherapy.

A patient was admitted for chest pain with electrocardiographic changes, and cardiac magnetic resonance showed focal myocardial hypertrophy secondary to edema. Combined positron emission tomography and computed tomography corroborated foci of myocardial hypermetabolism, as well as multiple adenopathies consistent with lymphoma in the biopsy. Hypertrophy and edema regressed with chemotherapy.

Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study.

BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention. METHODS: Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48-72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality. RESULTS: We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%). CONCLUSION: This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, obtained in a pilot study, suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes. Trial registration Clinicaltrials.gov identifier: NCT03438448 (19/02/2018).

Usefulness of Cardiac Computed Tomography in Coronary Risk Prediction: A Five-Year Follow-Up of the SPICA Study (Secure Prevention with Imaging of the Coronary Arteries).

Accurate identification of individuals at high coronary risk would reduce acute coronary syndrome incidence and morbi-mortality. We analyzed the effect on coronary risk prediction of adding coronary artery calcification (CAC) and Segment Involvement Score (SIS) to cardiovascular risk factors. This was a prospective cohort study of asymptomatic patients recruited between 2013-2017. All participants underwent a coronary computed tomography angiography to determine CAC and SIS. The cohort was followed-up for a composite endpoint of myocardial infarction, coronary angiography and/or revascularization (median = five years). Discrimination and reclassification of the REGICOR function with CAC/SIS were examined with the Sommer's D index and with the Net reclassification index (NRI). Nine of the 251 individuals included had an event. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0, none of them had an event. The addition of SIS or of SIS and CAC to the REGICOR risk function significantly increased the discrimination capacity from 0.74 to 0.89. Reclassification improved significantly when SIS or both scores were included. CAC and SIS were associated with five-year coronary event incidence, independently of cardiovascular risk factors. Discrimination and reclassification of the REGICOR risk function were significantly improved by both indexes, but SIS overrode the effect of CAC.

Drenaje venoso pulmonar anómalo con cor triatriatum / Abnormal pulmonary venous drainage with cor triatriatum

No disponible

Sustracción cálcica: ¿nuevo horizonte para la TC cardiaca? / Calcium subtraction: a new horizon for cardiac ct?

No disponible

Permeabilidad de los injertos de arteria radial mediante tomografía computarizada cardiaca de 256 cortes y su impacto pronóstico a medio plazo / Assessment of radial artery graft patency through 256-slice cardiac computed tomography, and the mid-term prognostic impact of graft occlusion

No disponible

Coronary computed tomographic angiographic findings in asymptomatic patients with heterozygous familial hypercholesterolemia and null allele low-density lipoprotein receptor mutations.

Heterozygous familial hypercholesterolemia (HeFH) can be associated with early coronary artery disease (CAD) in asymptomatic patients. The objectives of the present study were to assess the prevalence and magnitude of subclinical CAD in patients with HeFH using coronary computed tomographic angiography (CCTA) and to determine the clinical and genetic profile of those at the greatest risk of CAD. The study included 50 consecutive patients with HeFH diagnosed according to the Dutch Lipid Clinic Network criteria and a control group of 70 healthy subjects. The findings from CCTA for the patients with HeFH were compared with those from the control group, who had been referred for CCTA as a part of a preventive medical examination. In 82% of the patients with HeFH, genetic DNA was screened for low-density lipoprotein receptor (LDLR) gene mutations using a microarray. CCTA revealed a significantly greater Agatston calcium score in the study group than in the control group (260 vs 46; p = 0.002). The prevalence of CAD in the patients with HeFH was 48%. It was significant in 26%, involving mainly the proximal segments of the coronary arteries. In the control group, the prevalence of CAD was 33% and was significant in 5% (p <0.05 for prevalence and severity of CAD compared to patients with HeFH). In those with HeFH, increased age, null allele LDLR mutations, and low high-density lipoprotein blood levels at diagnosis showed a statistically significant association with CAD (p <0.05). In conclusion, patients with HeFH present with a greater prevalence, extension, and severity of subclinical CAD than the general population. Increased age, low high-density lipoprotein levels, and LDLR null allele mutations are related to the occurrence of CAD. CCTA has emerged as a useful technique for the screening of subclinical CAD in patients with HeFH.

Estudio de la permeabilidad de los injertos de arteria mamaria interna: utilidad de los ecopotenciadores para identificar la señal de flujo mediante ecocardiografía-doppler color / Assessment of the Internal Mammary Artery Graft Patency: Usefulness of Echo-Enhancer Agents to Identify the Flow Signal by Color Doppler Echocardiography

Objetivo. a) Estudiar la capacidad de la técnica Doppler color de alta frecuencia para identificar la señal de flujo de los injertos de arteria mamaria interna izquierda; b) valorar la utilidad de un ecopotenciador para facilitar la identificación de la señal, y c) evaluar la permeabilidad del injerto según el patrón del perfil de velocidades por Doppler pulsado. Métodos. Se estudiaron 39 pacientes consecutivos. Se utilizó un equipo Hewlett-Packard 5500 con sonda de alta frecuencia (S12) aplicada a nivel paraesternal izquierdo alto. Si tras un período predeterminado (5 min) no se identificaba señal de flujo del injerto, se inyectaban por vía intravenosa 4 g de Levovist® (Schering, España) a 400 mg/ml. Según lo descrito en estudios previos, se consideró un injerto con permeabilidad normal el de perfil diastólico predominante, y alterada aquel de predominio sistólico. Resultados. El flujo del injerto se identificó por Doppler color en 33/39 pacientes (85 por ciento). La adición de ecopotenciador en los 6 casos no visualizados aumentó la proporción a 38/39 (97 por ciento). Se apreció un patrón normal de velocidades en 34/38 (89 por ciento). Los 4 pacientes con patrón anormal presentaron infarto de miocardio (n = 1) o bien oclusión distal del injerto (n = 1) o flujo competitivo (n = 2) en el cateterismo. Conclusiones. La técnica Doppler color de alta frecuencia permite detectar la señal de flujo de los injertos de mamaria en la mayoría de pacientes. La administración de un ecopotenciador facilita dicha detección en aquellos basalmente no visualizados. Un patrón anormal de la curva de velocidades determinada por Doppler pulsado es indicativo de disfunción del injerto (AU)