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2.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4): 346-349, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1047206

RESUMO

Na nova era da Medicina de Precisão, a inteligência artificial (IA) - um conjunto de sistemas e programas que permitem às máquinas serem capazes de executar tarefas que habitual mente exigiriam a participação humana - emerge como ferramenta capaz de criar novas maneiras de analisar as imagens médicas além dos parâmetros morfológicos convencionais. Embora ainda não estejam completamente disponíveis para o uso clínico, essa nova abordagem tem grande potencial de aplicação na prática clínica e de pesquisa médica. A discussão dos conceitos básicos, potenciais aplicações e limitações das novas técnicas de IA no diagnóstico por imagem é importante para a interpretação adequada do potencial efeito que essa tecnologia teria na medicina, contrapondo-se à excessiva ansiedade despertada por abordagens superficiais e apressadas. Este artigo tem por objetivo apresentar uma visão equilibrada e atual sobre o tema, com especial foco no presente e no futuro da imagenologia cardíaca


In the new era of Precision Medicine, artificial intelligence (AI) - a set of systems and programs that enable machines to be able to perform cognitive tasks that would usually require human participation emerges as a tool that can create new ways of analyzing images beyond the conventional morphological parameters. Although not yet ready for clinical use, these tools have a potential effect on clinical and research practice. The discussion of the basic concepts, potential applications and limitations of new AI techniques in imaging diagnosis is important for a balanced interpretation of their results, as opposed to the excessive anxiety recently observed among professionals dealing with the subject. In this brief article, we aim to take a balanced and attentive look on this subject, with special focus on the horizon of modern cardiac imaging


Assuntos
Inteligência Artificial , Diagnóstico por Imagem/métodos , Informática Médica/métodos , Cardiologia , Medicina de Precisão/métodos , Aprendizado de Máquina
4.
Radiol Bras ; 52(3): 193-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210695

RESUMO

Coronary arteries originating from the contralateral (noncoronary) sinus and having an interarterial course, in which they run from the ascending aorta to the pulmonary trunk, is a potentially fatal anomaly. Computed tomography (CT) angiography facilitates the recognition and therapeutic planning of such anomalies because of its ability to acquire high-resolution images of the entire course of the coronary artery, as well as of the accompanying atherosclerotic involvement. The right coronary artery originating from the left coronary sinus is the most prevalent anomaly of this type and usually implies a better prognosis, the interarterial course being classified as "high" or "low", depending on whether it is above or below the level of the pulmonary valve, with consequent stratification of the risk and the treatment. However, it is known that there is a high risk of sudden death among patients with a left coronary artery of anomalous origin from the right sinus. In such cases, surgical treatment is recommended, regardless of whether there are symptoms or evidence of ischemia. Given the importance of those aspects, which can be identified on CT of the chest or CT angiography of the aorta, this pictorial essay aims to illustrate such anomalies to facilitate their recognition and description by radiologists who are not specialists in cardiac imaging.

5.
Insights Imaging ; 10(1): 62, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31197500

RESUMO

OBJECTIVES: To provide clinical validation of a recent 2D SENSE-based accelerated cardiovascular magnetic resonance (CMR) sequence (accelerated k-t SENSE), investigating whether this technique accurately quantifies left ventricle (LV) volumes, function, and mass as compared to 2D cine steady-state free precession (2D-SSFP). METHODS: Healthy volunteers (n = 16) and consecutive heart failure patients (n = 26) were scanned using a 1.5 T MRI system. Two LV short axis (SA) stacks were acquired: (1) accelerated k-t SENSE (5-6 breath-holds; temporal/spatial resolution: 37 ms/1.82 × 1.87 mm; acceleration factor = 4) and (2) standard 2D-SSFP (10-12 breath-holds; temporal/spatial resolution: 49 ms/1.67 × 1.87 mm, parallel imaging). Ascending aorta phase-contrast was performed on all volunteers as a reference to compare LV stroke volumes (LVSV) and validate the sequences. An image quality score for SA images was used, with lower scores indicating better quality (from 0 to 18). RESULTS: There was a high agreement between accelerated k-t SENSE and 2D-SSFP for LV measurements: bias (limits of agreement) of 2.4% (- 5.4% to 10.1%), 6.9 mL/m2 (- 4.7 to 18.6 mL/m2), - 1.5 (- 8.3 to 5.2 mL/m2), and - 0.2 g/m2 (- 11.9 to 12.3 g/m2) for LV ejection fraction, end-diastolic volume index, end-systolic volume index, and mass index, respectively. LVSV by accelerated k-t SENSE presented good agreement with aortic flow. Interobserver and intraobserver variabilities for all LV parameters were also high. CONCLUSION: The accelerated k-t SENSE CMR sequence is clinically feasible and accurately quantifies LV volumes, function, and mass, with short acquisition time and good image quality.

6.
BMJ ; 365: l1945, 2019 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-31189617

RESUMO

OBJECTIVE: To determine whether coronary computed tomography angiography (CTA) should be performed in patients with any clinical probability of coronary artery disease (CAD), and whether the diagnostic performance differs between subgroups of patients. DESIGN: Prospectively designed meta-analysis of individual patient data from prospective diagnostic accuracy studies. DATA SOURCES: Medline, Embase, and Web of Science for published studies. Unpublished studies were identified via direct contact with participating investigators. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective diagnostic accuracy studies that compared coronary CTA with coronary angiography as the reference standard, using at least a 50% diameter reduction as a cutoff value for obstructive CAD. All patients needed to have a clinical indication for coronary angiography due to suspected CAD, and both tests had to be performed in all patients. Results had to be provided using 2×2 or 3×2 cross tabulations for the comparison of CTA with coronary angiography. Primary outcomes were the positive and negative predictive values of CTA as a function of clinical pretest probability of obstructive CAD, analysed by a generalised linear mixed model; calculations were performed including and excluding non-diagnostic CTA results. The no-treat/treat threshold model was used to determine the range of appropriate pretest probabilities for CTA. The threshold model was based on obtained post-test probabilities of less than 15% in case of negative CTA and above 50% in case of positive CTA. Sex, angina pectoris type, age, and number of computed tomography detector rows were used as clinical variables to analyse the diagnostic performance in relevant subgroups. RESULTS: Individual patient data from 5332 patients from 65 prospective diagnostic accuracy studies were retrieved. For a pretest probability range of 7-67%, the treat threshold of more than 50% and the no-treat threshold of less than 15% post-test probability were obtained using CTA. At a pretest probability of 7%, the positive predictive value of CTA was 50.9% (95% confidence interval 43.3% to 57.7%) and the negative predictive value of CTA was 97.8% (96.4% to 98.7%); corresponding values at a pretest probability of 67% were 82.7% (78.3% to 86.2%) and 85.0% (80.2% to 88.9%), respectively. The overall sensitivity of CTA was 95.2% (92.6% to 96.9%) and the specificity was 79.2% (74.9% to 82.9%). CTA using more than 64 detector rows was associated with a higher empirical sensitivity than CTA using up to 64 rows (93.4% v 86.5%, P=0.002) and specificity (84.4% v 72.6%, P<0.001). The area under the receiver-operating-characteristic curve for CTA was 0.897 (0.889 to 0.906), and the diagnostic performance of CTA was slightly lower in women than in with men (area under the curve 0.874 (0.858 to 0.890) v 0.907 (0.897 to 0.916), P<0.001). The diagnostic performance of CTA was slightly lower in patients older than 75 (0.864 (0.834 to 0.894), P=0.018 v all other age groups) and was not significantly influenced by angina pectoris type (typical angina 0.895 (0.873 to 0.917), atypical angina 0.898 (0.884 to 0.913), non-anginal chest pain 0.884 (0.870 to 0.899), other chest discomfort 0.915 (0.897 to 0.934)). CONCLUSIONS: In a no-treat/treat threshold model, the diagnosis of obstructive CAD using coronary CTA in patients with stable chest pain was most accurate when the clinical pretest probability was between 7% and 67%. Performance of CTA was not influenced by the angina pectoris type and was slightly higher in men and lower in older patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012002780.


Assuntos
Angina Pectoris/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Angina Pectoris/etiologia , Doença da Artéria Coronariana/complicações , Estudos de Viabilidade , Humanos , Valor Preditivo dos Testes , Probabilidade
7.
Radiol. bras ; 52(3): 193-197, May-June 2019. graf
Artigo em Inglês | LILACS-Express | ID: biblio-1012936

RESUMO

Abstract Coronary arteries originating from the contralateral (noncoronary) sinus and having an interarterial course, in which they run from the ascending aorta to the pulmonary trunk, is a potentially fatal anomaly. Computed tomography (CT) angiography facilitates the recognition and therapeutic planning of such anomalies because of its ability to acquire high-resolution images of the entire course of the coronary artery, as well as of the accompanying atherosclerotic involvement. The right coronary artery originating from the left coronary sinus is the most prevalent anomaly of this type and usually implies a better prognosis, the interarterial course being classified as "high" or "low", depending on whether it is above or below the level of the pulmonary valve, with consequent stratification of the risk and the treatment. However, it is known that there is a high risk of sudden death among patients with a left coronary artery of anomalous origin from the right sinus. In such cases, surgical treatment is recommended, regardless of whether there are symptoms or evidence of ischemia. Given the importance of those aspects, which can be identified on CT of the chest or CT angiography of the aorta, this pictorial essay aims to illustrate such anomalies to facilitate their recognition and description by radiologists who are not specialists in cardiac imaging.


Resumo O trajeto interarterial das artérias coronárias com origem em seio contralateral/não coronariano é uma anomalia potencialmente fatal caracterizada pelo trajeto das coronárias entre a aorta ascendente e o tronco da artéria pulmonar. A angiotomografia auxilia no reconhecimento e planejamento terapêutico dessas alterações, em virtude da sua capacidade em adquirir imagens de alta resolução de todo o trajeto coronariano, assim como do envolvimento aterosclerótico associado. A artéria coronária direita originada no seio coronariano esquerdo costuma ser mais prevalente e relacionada a um melhor prognóstico, sendo classificada em curso interarterial "alto" ou "baixo" de acordo com a altura do seu trajeto em relação à valva pulmonar, com consequente estratificação de risco e tratamento distintos. Sabe-se, entretanto, que há um elevado risco de morte súbita entre pacientes com artéria coronária esquerda de origem anômala a partir do seio direito, sendo recomendado tratamento cirúrgico, independentemente de sintomas ou evidência de isquemia. Em razão da importância desses achados que podem ser encontrados em exames de tomografia de tórax e angiotomografias de aorta, o presente ensaio tem por objetivo ilustrar as anomalias de trajeto das artérias coronárias, para facilitar seu reconhecimento e sua descrição por médicos radiologistas não especialistas em imagem cardíaca.

8.
Mediators Inflamm ; 2019: 6513847, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31049026

RESUMO

Introduction: Atherosclerosis is a low-grade inflammatory disease. Among markers of inflammation, importance has been given to the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). The objective of this study was to examine the association between these hematological indices of inflammation and coronary atherosclerotic calcification in clinically asymptomatic patients. Methods: This study had clinical and laboratorial data collected from consecutive asymptomatic patients that underwent computed tomography coronary artery calcium (CAC) scoring. Risk factors, NLR, and PLR were evaluated at different categories of CAC scoring. Statistical tests included chi-square, linear regression, and logistic regression. Patients (N = 247; age 60.4 ± 8.0 years and 60.7% men) were allocated into four categories according to the CAC score. Results: Respective age, sex (male), NLR, and PLR distribution within groups were as follows: CAC = 0 (n = 98; 52.5 ± 13.6 years, 55%, 2.0 ± 1.0, and 121.5 ± 41.5), CAC 1-100 (N = 64; 61.3 ± 11.0 years, 60%, 2.2 ± 1.2, and 125.6 ± 45.6), CAC 101-400 (N = 37; 64.2 ± 11.6 years, 67%, 2.6 ± 1.3, and 125.4 ± 55.9), and CAC > 400 (N = 48; 69.3 ± 11.1 years, 66%, 3.3 ± 2.0, and 430.1 ± 1787.4). The association between risk factors and CAC score was assessed. Hypertension status and smoking status were similar within groups, while the presence of diabetes (P = 0.02) and older age (P ≤ 0.001) was more prevalent in the CAC > 400 group. LDL cholesterol was greater in the higher CAC score groups (P = 0.002). Multivariate logistic regression of the quartile analysis showed that age and NLR were independently associated with CAC > 100 (OR (CI), P value): 2.06 (1.55-2.73, P = 0.00001) and 1.82 (1.33-2.49, P = 0.0002), respectively. Conclusion: Within asymptomatic patients, NLR provides additional risk stratification, as an independent association between NLR extent and CAD extent was identified. Moreover, PLR was not an inflammation marker for CAD severity.


Assuntos
Linfócitos/metabolismo , Neutrófilos/metabolismo , Idoso , Plaquetas/metabolismo , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos
9.
Ann Vasc Surg ; 59: 173-183, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31028852

RESUMO

BACKGROUND: Ultrasound-guided thrombin injection (UGTI) has become the method of choice in the treatment of pseudoaneurysm caused by endovascular procedures because it is minimally invasive, costs less, and effective, with short hospitalization time. The objective was identify the morphological aspects of femoral pseudoaneurysms and clinical aspects of patients that may lead to the failure of UGTI in femoral pseudoaneurysms after cardiac catheterization. POPULATION AND METHOD: From December 2012 to December 2016, 60 patients with pseudoaneurysms caused by cardiac catheterization were referred to the interventional radiology unit to be treated with UGTI. Medical charts were retrospectively reviewed for comorbidities, use of antiplatelet agents, anticoagulation, indication of cardiac catheterization, and so forth. Morphological aspects of the pseudoaneurysms such as volume, diameter (anteroposterior, laterolateral, and longitudinal), length, and diameter of the neck were analyzed. RESULTS: Technical success of UGTI was achieved in 100%. No clinical aspects of the patients were statistically significant for UGTI failure in occlusion of the pseudoaneurysms. For morphological aspects of pseudoaneurysm: anteroposterior (P = 0.029), longitudinal (P = 0.020), and neck diameters (P = 0.004) were statistically significant for UGTI failure. Logistic regression analysis for longitudinal diameter showed that for each centimeter, there was a 2.66 chance of failure of pseudoaneurysm thrombosis in a single thrombin injection session (95% confidence interval: 1.33-5.30). For longitudinal and neck diameters greater than 1.8 cm and 0.55 cm, respectively, there is a greater probability of needing more than one UGTI session for complete thrombosis. CONCLUSIONS: Among variables, the longitudinal dimension was more significant, and in a larger diameter, the treatment with thrombin injection presented greater complexity.


Assuntos
Falso Aneurisma/tratamento farmacológico , Cateterismo Cardíaco/efeitos adversos , Cateterismo Periférico/efeitos adversos , Artéria Femoral , Trombina/administração & dosagem , Lesões do Sistema Vascular/tratamento farmacológico , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Cateterismo Cardíaco/métodos , Cateterismo Periférico/métodos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/lesões , Humanos , Injeções Intra-Arteriais , Masculino , Punções , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Trombina/efeitos adversos , Falha de Tratamento , Ultrassonografia de Intervenção , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
10.
Radiology ; 291(2): 340-348, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30888934

RESUMO

Background Patient preference is pivotal for widespread adoption of tests in clinical practice. Patient preferences for invasive versus other noninvasive tests for coronary artery disease are not known. Purpose To compare patient acceptance and preferences for noninvasive and invasive cardiac imaging in North and South America, Asia, and Europe. Materials and Methods This was a prospective 16-center trial in 381 study participants undergoing coronary CT angiography with stress perfusion, SPECT, and invasive coronary angiography (ICA). Patient preferences were collected by using a previously validated questionnaire translated into eight languages. Responses were converted to ordinal scales and were modeled with generalized linear mixed models. Results In patients in whom at least one test was associated with pain, CT and SPECT showed reduced median pain levels, reported on 0-100 visual analog scales, from 20 for ICA (interquartile range [IQR], 4-50) to 6 for CT (IQR, 0-27.5) and 5 for SPECT (IQR, 0-25) (P < .001). Patients from Asia reported significantly more pain than patients from other continents for ICA (median, 25; IQR, 10-50; P = .01), CT (median, 10; IQR, 0-30; P = .02), and SPECT (median, 7; IQR, 0-28; P = .03). Satisfaction with preparation differed by continent and test (P = .01), with patients from Asia reporting generally lower ratings. Patients from North America had greater percentages of "very high" or "high" satisfaction than patients from other continents for ICA (96% vs 82%, respectively; P < .001) and SPECT (95% vs 79%, respectively; P = .04) but not for CT (89% vs 86%, respectively; P = .70). Among all patients, CT was preferred by 54% of patients, compared with 18% for SPECT and 28% for ICA (P < .001). Conclusion For cardiac imaging, patients generally favored CT angiography with stress perfusion, while study participants from Asia generally reported lowest satisfaction. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Woodard and Nguyen in this issue.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Preferência do Paciente/estatística & dados numéricos , Idoso , Angiografia por Tomografia Computadorizada/efeitos adversos , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/psicologia , Angiografia Coronária/efeitos adversos , Angiografia Coronária/métodos , Angiografia Coronária/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Processual , Estudos Prospectivos
11.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.243-253.
Monografia em Português | LILACS | ID: biblio-1009339
12.
Radiol Bras ; 51(5): 321-327, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30369660

RESUMO

The diagnosis of idiopathic interstitial pneumonias (IIPs) involves a multidisciplinary scenario in which the radiologist assumes a key role. The latest (2013) update of the IIP classification by the American Thoracic Society/European Respiratory Society proposed some important changes to the original classification of 2002. The novelties include the addition of a new disease (idiopathic pleuroparenchymal fibroelastosis) and the subdivision of the IIPs into four main groups: chronic fibrosing IIPs (idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia); smoking-related IIPs (desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease); acute or subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia); rare IIPs (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis); and the so-called "unclassifiable" IIPs. In this study, we review the main clinical, tomographic, and pathological characteristics of each IIP.

13.
Radiol. bras ; 51(5): 321-327, Sept.-Oct. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-976739

RESUMO

Abstract The diagnosis of idiopathic interstitial pneumonias (IIPs) involves a multidisciplinary scenario in which the radiologist assumes a key role. The latest (2013) update of the IIP classification by the American Thoracic Society/European Respiratory Society proposed some important changes to the original classification of 2002. The novelties include the addition of a new disease (idiopathic pleuroparenchymal fibroelastosis) and the subdivision of the IIPs into four main groups: chronic fibrosing IIPs (idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia); smoking-related IIPs (desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease); acute or subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia); rare IIPs (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis); and the so-called "unclassifiable" IIPs. In this study, we review the main clinical, tomographic, and pathological characteristics of each IIP.


Resumo O diagnóstico das pneumonias intersticiais idiopáticas (PIIs) envolve um cenário multidisciplinar no qual o radiologista assume papel fundamental. A última atualização (2013) da classificação das PIIs pela American Thoracic Society/European Respiratory Society propõe algumas mudanças importantes em relação à classificação original de 2002. Dentre as novidades, destacam-se o acréscimo de uma nova doença (fibroelastose pleuroparenquimatosa idiopática) e a subdivisão das PIIs em quatro grupos principais: PIIs crônicas fibrosantes (fibrose pulmonar idiopática e pneumonia intersticial não específica); PIIs relacionadas ao tabagismo (pneumonia intersticial descamativa e bronquiolite respiratória com doença intersticial pulmonar); PIIs agudas/subagudas (pneumonia em organização e pneumonia intersticial aguda); PIIs raras (pneumonia intersticial linfocítica e fibroelastose pleuroparenquimatosa idiopática); além das ditas "inclassificáveis". Foram revisadas, de forma didática neste estudo, as principais características clínicas, tomográficas e patológicas de cada uma das PIIs.

14.
PLoS One ; 13(8): e0202738, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30138356

RESUMO

BACKGROUND: Coronary artery calcification (CAC) and atherosclerotic inflammation associate with increased risk of myocardial infarction (MI). Vascular calcification is regulated by osteogenic proteins (OPs). It is unknown whether an association exists between CAC and plasma OPs and if they are affected by atherothrombotic inflammation. We tested the association of osteogenic and inflammatory proteins with CAC and assessed these biomarkers after MI. METHODS: Circulating OPs (osteoprotegerin, RANKL, fetuin-A, Matrix Gla protein [MGP]) and inflammatory proteins (C-reactive protein, oxidized-LDL, tumoral necrosis factor-α, transforming growth factor [TGF]-ß1) were compared between stable patients with CAC (CAC ≥ 100 AU, n = 100) and controls (CAC = 0 AU, n = 30). The association between biomarkers and CAC was tested by multivariate analysis. In patients with MI (n = 40), biomarkers were compared between acute phase and 1-2 months post-MI, using controls as a baseline. RESULTS: MGP and fetuin-A levels were higher within individuals with CAC. Higher levels of MGP and RANKL were associated with CAC (OR 3.12 [95% CI 1.20-8.11], p = 0.02; and OR 1.75 [95% CI 1.04-2.94] respectively, p = 0.035). After MI, C-reactive protein, OPG and oxidized-LDL levels increased in the acute phase, whereas MGP and TGF-ß1 increased 1-2 months post-MI. CONCLUSIONS: Higher MGP and RANKL levels associate with CAC. These findings highlight the potential role of these proteins as modulators and markers of CAC. In addition, the post-MI increase in OPG and MGP, as well as of inflammatory proteins suggest that the regulation of these OPs is affected by atherothrombotic inflammation.


Assuntos
Proteínas de Ligação ao Cálcio/sangue , Doença da Artéria Coronariana/metabolismo , Proteínas da Matriz Extracelular/sangue , Infarto do Miocárdio/metabolismo , Osteoprotegerina/sangue , Ligante RANK/sangue , Adulto , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Lipoproteínas LDL/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Fator de Crescimento Transformador beta1/sangue , Fator de Necrose Tumoral alfa/sangue , alfa-2-Glicoproteína-HS/metabolismo
15.
Eur Heart J ; 39(41): 3715-3723, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30165629

RESUMO

Aims: Advances of cardiac computed tomography angiography (CTA) have been developed for dose reduction, but their efficacy in clinical practice is largely unknown. This study was designed to evaluate radiation dose exposure and utilization of dose-saving strategies for contrast-enhanced cardiac CTA in daily practice. Methods and results: Sixty one hospitals from 32 countries prospectively enrolled 4502 patients undergoing cardiac CTA during one calendar month in 2017. Computed tomography angiography scan data and images were analysed in a central core lab and compared with a similar dose survey performed in 2007. Linear regression analysis was performed to identify independent predictors associated with dose. The most frequent indication for cardiac CTA was the evaluation of coronary artery disease in 89% of patients. The median dose-length product (DLP) of coronary CTA was 195 mGy*cm (interquartile range 110-338 mGy*cm). When compared with 2007, the DLP was reduced by 78% (P < 0.001) without an increase in non-diagnostic coronary CTAs (1.7% in 2007 vs. 1.9% in 2017 surveys, P = 0.55). A 37-fold variability in median DLP was observed between the hospitals with lowest and highest DLP (range of median DLP 57-2090 mGy*cm). Independent predictors for radiation dose of coronary CTA were: body weight, heart rate, sinus rhythm, tube voltage, iterative image reconstruction, and the selection of scan protocols. Conclusion: This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.


Assuntos
Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Angiografia Coronária/estatística & dados numéricos , Doses de Radiação , Exposição à Radiação , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Exposição à Radiação/prevenção & controle , Exposição à Radiação/estatística & dados numéricos
16.
J Cardiovasc Comput Tomogr ; 12(4): 312-315, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29653764

RESUMO

BACKGROUND: The importance of bolus tracking (BT) regarding total effective radiation dose (ERD) in the era of advanced coronary computed tomography angiography (CTA) has been ignored. We aimed to investigate whether adjusting BT parameters reduces ERD. METHODS: Adults consecutively referred to CTA (n = 289) in a 320 detector-row scanner were distributed into four BT protocols according to delay time and time between intermittent scans, as follows: A (n = 70, delay 10s, intermittent scans 1s); B (n = 79, delay 10s, intermittent scans 2s); C (n = 68, delay 15s, intermittent scans 1s); and D (n = 72, delay 15s, intermittent scans 2s). Image quality was assessed. RESULTS: The overall ERD in BT and AP were 0.32 ±â€¯0.14 mSv and 6.06 ±â€¯0.66 mSv, respectively. ERD in BT was different among protocols (A:0.44 ±â€¯0.14 mSv; B:0.32 ±â€¯0.10 mSv; C:0.28 ±â€¯0.14 mSv; D:0.23 ±â€¯0.09 mSv; p < 0.001), with no loss in image quality. Adjusted for potential confounders (heart rate, tube current and acquisition window), protocol D provided the highest reduction in total ERD (ß = -0.33, p = 0.004). CONCLUSION: Delaying initiation of BT images (and acquiring them less frequently) reduces radiation dose and does not impair image quality.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Doses de Radiação , Exposição à Radiação/prevenção & controle , Idoso , Angiografia por Tomografia Computadorizada/efeitos adversos , Angiografia Coronária/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/efeitos adversos , Valor Preditivo dos Testes , Estudos Prospectivos , Exposição à Radiação/efeitos adversos , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo
17.
Eur Heart J Cardiovasc Imaging ; 19(8): 888-895, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29518212

RESUMO

Aims: From pathophysiological mechanisms to risk stratification and management, much debate and discussion persist regarding left ventricular non-compaction cardiomyopathy (LVNC). This study aimed to characterize myocardial T1 mapping and extracellular volume (ECV) fraction by cardiovascular magnetic resonance (CMR), and investigate how these biomarkers relate to left ventricular ejection fraction (LVEF) and ventricular arrhythmias (VA) in LVNC. Methods and results: Patients with LVNC (n = 36) and healthy controls (n = 18) were enrolled to perform a CMR with T1 mapping. ECV was quantified in LV segments without late gadolinium enhancement (LGE) areas to investigate diffuse myocardial fibrosis. Patients with LVNC had slightly higher native T1 (1024 ± 43 ms vs. 995 ± 22 ms, P = 0.01) and substantially expanded ECV (28.0 ± 4.5% vs. 23.5 ± 2.2%, P < 0.001) compared to controls. The ECV was independently associated with LVEF (ß = -1.3, P = 0.001). Among patients without LGE, VAs were associated with higher ECV (27.7% with VA vs. 25.8% without VA, P = 0.002). Conclusion: In LVNC, tissue characterization by T1 mapping suggests an extracellular expansion by diffuse fibrosis in myocardium without LGE, which was associated with myocardial dysfunction and VA, but not with the amount of non-compacted myocardium.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Imagem Cinética por Ressonância Magnética/métodos , Adulto , Estudos de Casos e Controles , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Seguimentos , Cardiopatias Congênitas , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Medição de Risco , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia
18.
Eur Radiol ; 28(6): 2665-2674, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29352381

RESUMO

OBJECTIVES: Despite advances in non-invasive myocardial perfusion imaging (MPI) evaluation, computed tomography (CT) multiphase MPI protocols have not yet been compared with the highly accurate rubidium-82 positron emission tomography (82RbPET) MPI. Thus, this study aimed to evaluate agreement between 82RbPET and 320-detector row CT (320-CT) MPI using a multiphase protocol in suspected CAD patients. METHODS: Forty-four patients referred for MPI evaluation were prospectively enrolled and underwent dipyridamole stress 82RbPET and multiphase 320-CT MPI (five consecutive volumetric acquisitions during stress). Statistical analyses were performed using the R software. RESULTS: There was high agreement for recognizing summed stress scores ≥ 4 (kappa 0.77, 95% CI 0.55-0.98, p < 0.001) and moderate for detecting SDS ≥ 2 (kappa 0.51, 95% CI 0.23-0.80, p < 0.001). In a per segment analysis, agreement was high for the presence of perfusion defects during stress and rest (kappa 0.75 and 0.82, respectively) and was moderate for impairment severity (kappa 0.58 and 0.65, respectively). The 320-CT protocol was safe, with low radiation burden (9.3 ± 2.4 mSv). CONCLUSIONS: There was a significant agreement between dipyridamole stress 320-CT MPI and 82RbPET MPI in the evaluation of suspected CAD patients of intermediate risk. The multiphase 320-CT MPI protocol was feasible, diagnostic and with relatively low radiation exposure. KEY POINTS: • Rubidium-82 PET and 320-MDCT can perform MPI studies for CAD investigation. • There is high agreement between rubidium-82 PET and 320-MDCT for MPI assessment. • Multiphase CT perfusion protocols are feasible and with low radiation. • Multiphase CT perfusion protocols can identify image artefacts.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Compostos Radiofarmacêuticos , Radioisótopos de Rubídio , Angiografia por Tomografia Computadorizada , Vasos Coronários/diagnóstico por imagem , Dipiridamol/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Imagem de Perfusão do Miocárdio/métodos , Tomografia por Emissão de Pósitrons/métodos , Estudos Prospectivos , Software , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Vasodilatadores/farmacologia
20.
J Cardiothorac Surg ; 12(1): 122, 2017 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-29284532

RESUMO

BACKGROUND: The diagnosis of peri-procedural myocardial infarction is complex, especially after the emergence of high-sensitivity markers of myocardial necrosis. METHODS: In this study, patients with normal baseline cardiac biomarkers and formal indication for elective on-pump coronary bypass surgery were evaluated. Electrocardiograms, cardiac biomarkers, and cardiac magnetic resonance imaging with late gadolinium enhancement were performed before and after procedures. Myocardial infarction was defined as more than ten times the upper reference limit of the 99th percentile for troponin I and for creatine kinase isoform (CK-MB) and by the findings of new late gadolinium enhancement on cardiac magnetic resonance. We assessed the release of cardiac biomarkers in patients with no evidence of myocardial infarction on cardiac magnetic resonance. RESULTS: Of 75 patients referred for on-pump coronary bypass surgery, 54 (100%) did not have evidence of myocardial infarction on cardiac magnetic resonance. However, all had a peak troponin I above the 99th percentile; 52 (96%) had an elevation 10 times higher than the 99th percentile. Regarding CK-MB, 54 (100%) patients had a peak CK-MB above the 99th percentile limit, and only 13 (24%) had an elevation greater than 10 times the 99th percentile. The median value of troponin I peak was 3.15 (1.2 to 3.9) ng/mL, which represented 78.7 times the 99th percentile. CONCLUSION: In this study, different from CK-MB findings, troponin was significantly increased in the absence of myocardial infarction on cardiac magnetic resonance. Thus, CK-MB was more accurate than troponin I for excluding procedure-related myocardial infarction. These data suggest a higher troponin cutoff for the diagnosis of coronary bypass surgery related myocardial infarction. CLINICAL TRIAL REGISTRATION: http://www.isrctn.com/ISRCTN09454308 . Registered 08 May 2012.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Creatina Quinase Forma MB/sangue , Infarto do Miocárdio/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Troponina I/sangue , Idoso , Biomarcadores/sangue , Eletrocardiografia , Feminino , Gadolínio , Coração/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Miocárdio/patologia , Necrose/diagnóstico , Complicações Pós-Operatórias/sangue
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