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1.
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
2.
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
3.
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
4.
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
6.
Eur Heart J Cardiovasc Imaging ; 16(2): 166-76, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25368207

RESUMO

AIMS: The aim of this study was to investigate the association of left ventricular mass (LVM) with coronary atherosclerosis and myocardial infarction (MI). METHODS AND RESULTS: Patients (n = 338) underwent 320 × 0.5 mm detector row coronary computed tomography (CT) angiography, invasive coronary angiography (ICA), and single-photon emission CT (SPECT) myocardial perfusion imaging. Quantitative coronary atheroma volume was obtained from the CT images for the entire coronary tree (19-segment model) with an arterial contour detection algorithm. Normalized total atheroma volume (NormTAV) was analysed to reflect quantitative total atheroma volume. LVM was measured on myocardial CT images and indexed to height to the power of 2.7 (LVMi). Patients with obstructive coronary artery disease (CAD) were defined as those with ≥50% diameter stenosis by quantitative ICA. Abnormal perfusion defect was defined as ≥1 abnormal myocardial segment by SPECT. The association of LVMi with coronary atherosclerosis and myocardial perfusion defect on SPECT at the patient level was determined with uni- and multivariable linear and logistic regression analyses. Obstructive CAD was present in 60.0% of enrolled patients. LVMi was independently associated with abnormal summed rest score [SRS; odds ratio (OR), 1.07; 95% confidence interval (CI), 1.03-1.09] and summed stress score (OR, 1.04; 95% CI, 1.01-1.07). An increase in LVMi was also independently associated with that in NormTAV (coefficient, 10.44; 95% CI, 1.50-19.39) and SRS ≥1 (OR, 1.05; 95% CI, 1.01-1.10), even after adjusting for cardiovascular risk factors in patients without previous MI. CONCLUSIONS: LVM was independently associated with the presence of coronary artery atherosclerosis and MI.


Assuntos
Técnicas de Imagem Cardíaca , Doença da Artéria Coronariana/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Isquemia Miocárdica/diagnóstico , Idoso , Algoritmos , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Estudos Prospectivos
7.
Arq Neuropsiquiatr ; 71(5): 320-6, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23689410

RESUMO

Coronary heart disease and ischemic stroke are frequent coexistent conditions that share risk factors and pose major burdens to global health. Even though a clear relation has been established between extracranial internal carotid artery atherosclerosis and symptomatic or asymptomatic coronary heart disease, there is a gap in knowledge about the association between intracranial atherosclerosis and coronary heart disease. Intracranial atherosclerosis is associated with high risks of stroke recurrence and vascular death. More research and clinical trials are needed to answer whether early diagnosis of asymptomatic coronary heart disease and aggressive treatment can decrease the risk of vascular death in patients with ischemic stroke caused by intracranial atherosclerosis.


Assuntos
Doença das Coronárias/etiologia , Arteriosclerose Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Doença das Coronárias/diagnóstico , Humanos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico
8.
Arq. neuropsiquiatr ; 71(5): 320-326, maio 2013. tab
Artigo em Inglês | LILACS | ID: lil-674215

RESUMO

Coronary heart disease and ischemic stroke are frequent coexistent conditions that share risk factors and pose major burdens to global health. Even though a clear relation has been established between extracranial internal carotid artery atherosclerosis and symptomatic or asymptomatic coronary heart disease, there is a gap in knowledge about the association between intracranial atherosclerosis and coronary heart disease. Intracranial atherosclerosis is associated with high risks of stroke recurrence and vascular death. More research and clinical trials are needed to answer whether early diagnosis of asymptomatic coronary heart disease and aggressive treatment can decrease the risk of vascular death in patients with ischemic stroke caused by intracranial atherosclerosis.


A doença coronária e o acidente vascular cerebral isquêmico são condições frequentemente associadas, que compartilham fatores de risco e representam grande sobrecarga à saúde mundial. Embora seja claramente reconhecida a relação entre a doença coronária sintomática ou assintomática e a aterosclerose da artéria carótida interna em sua porção extracraniana, há uma lacuna no conhecimento sobre a associação entre doença coronária e aterosclerose intracraniana, que por sua vez é associada a alto risco de recorrência de acidente vascular cerebral isquêmico e de morte por causas vasculares. é necessário avaliar se o diagnóstico precoce da doença coronária assintomática e seu tratamento agressivo podem diminuir o risco de morte por causas vasculares em pacientes com acidente vascular cerebral isquêmico ocasionado por aterosclerose intracraniana.


Assuntos
Humanos , Doença das Coronárias/etiologia , Arteriosclerose Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Doença das Coronárias/diagnóstico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico
10.
Rev. bras. ecocardiogr. imagem cardiovasc ; 24(1): 76-87, jan.-mar. 2011. ilus
Artigo em Português | LILACS | ID: lil-571188

RESUMO

A tomografia computadorizada de multidetectores (TCMD) iniciou sua aplicação dentro da cardiologia com a quantificação de cálcio das placas coronarianas, no estudo sem contraste, por meio do escore de cálcio, mostrando um importante preditor independente de futuros eventos cardíacos. O exame com contraste endovenoso, a angiotomografia de coronárias, surgiu posteriormente como um método não invasivo para avaliação da anatomia e da doença obstrutiva coronariana, caracterizando o grau de estenose e também a presença da placa aterosclerótica não calcificada, avaliando não somente o lúmen, mas também a parede do vaso. Com o advento de novos aparelhos com mais detectores e maior resolução temporal, tem ocorrido uma redução da dose de radiação e a possibilidade de novas aplicações.


Assuntos
Humanos , Vasos Coronários , Cálcio/análise , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/mortalidade , Tomografia/tendências , Fatores de Risco
11.
Eur J Echocardiogr ; 11(3): 257-63, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19969534

RESUMO

AIMS: To investigate by real-time 3D echocardiography (RT3DE) and cardiac computed tomography (CCT) the analysis of left ventricle ejection fraction (LVEF) and volumes. METHODS AND RESULTS: A total of 67 patients (37 males, 55 +/- 11 years) were studied prospectively by RT3DE and by 64-slice CCT. RT3DE data: LVEF ranged from 30 to 78.6% (63.1 +/- 7.33); left ventricular end-diastolic volume (LVEDV) from 44.1 to 210 (104.9 +/- 29.7) mL; left ventricular end-systolic volume (LVESV) from 11.4 to 149 ( 38.9 +/- 19.3) mL. CCT data: LVEF ranged from 28 to 86% (66 +/- 8.4); LVEDV from 51 to 212 (110.3 +/- 31.2) mL; LVESV from 7 to 152 (38.2 +/- 19.2) mL. Correlations relative to RT3DE and CCT were: LVEF (r: 0.79, P < 0.0001); LVEDV (r: 0.82, P < 0.0001); and LVESV (r: 0.91, P < 0.0001). CONCLUSION: It was observed adequate correlation between RT3DE and CCT ventricular systolic function and geometry assessment.


Assuntos
Ecocardiografia Tridimensional , Volume Sistólico , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sístole , Fatores de Tempo
12.
Arq Bras Cardiol ; 92(4): 294-301, 2009 Apr.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-19565138

RESUMO

BACKGROUND: Real-time three-dimensional echocardiography (RT-3D-Echo) and ultrafast computed tomography (CT) are two novel methods for the analysis of LV ejection fraction and volumes. OBJECTIVE: To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT. METHODS: Thirty nine consecutive patients (27 men, mean age of 57+/-12 years) were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. STATISTICAL ANALYSIS: coefficient of correlation (r: Pearson), Bland-Altman analysis, linear regression analysis, 95% CI, p<0.05. RESULTS: RT-3D-Echo measurements: LVEF ranged from 56.1 to 78.6 (65.5+/-5.58)%; end-diastolic volume ranged from 49.6 to 178.2 (87+/-27.8) ml; end-systolic volume ranged from 11.4 to 78 (33.1+/-13.6) ml. CT scan measurements: LVEF ranged from 53 to 86% (67.8+/-7.78); end-diastolic volume ranged from 51 to 186 (106.5+/-30.3) ml; end-systolic volume ranged from 7 to 72 (35.5+/-13.4)ml. Correlations between RT-3D-Echo and CT were: LVEF (r: 0.7888, p<0.0001, 95% CI 0.6301 to 0.8843); end-diastolic volume (r: 0.7695, p<0.0001, 95% CI 0.5995 to 0.8730); end-systolic volume (r: 0.8119, p<0.0001, 95% CI 0.6673 to 0.8975). CONCLUSION: Good correlation between LVEF and ventricular volume parameters as measured by RT-3D-Echo and 64-slice ultrafast CT was found in the present case series.


Assuntos
Volume Cardíaco/fisiologia , Doença da Artéria Coronariana , Ecocardiografia Tridimensional/métodos , Volume Sistólico/fisiologia , Tomografia Computadorizada por Raios X/métodos , Função Ventricular Esquerda/fisiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Cardiovasc Comput Tomogr ; 3(3): 170-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19527893

RESUMO

BACKGROUND: A number of studies have compared 64-slice multidetector row computed tomography (MDCT) and magnetic resonance imaging (MRI) for left ventricular (LV) function; however, none were performed in patients with reperfused acute myocardial infarction. OBJECTIVES: We compared global and regional LV function assessment by 64-slice CT (MDCT) with cardiac magnetic resonance (CMR) after reperfused ST elevation myocardial infarction. METHODS: Twenty-one patients were scanned after reperfusion with contrast-enhanced CMR and MDCT. Reconstructed short axis images were used to assess global (quantitative assessment of LF end-diastolic volume [LVEDV], end-systolic volume [LVESV], stroke volume [LVSV], ejection fraction [LVEF], and mass, by Simpson's method) and regional cardiac function (qualitative assessment on a 4-point scale [4=normal, 3=hypokinesia, 2=dyskinesia, 1=akinesia]) in a standard 17-segment myocardial model. RESULTS: We scanned 21 persons (age, 60+/-10 years; 19 men) with CMR and MDCT. Good correlation was observed for all global parameters between MDCT and CMR (LVEF, r=0.90; LVEDV, r=0.91; LVESV, r=0.94; LVSV, r=0.84; LV mass, r=0.91). Interobserver agreement for regional function was excellent (weighted kappa, 0.81). The interobserver agreement for regional function on MDCT and CMR were comparable (weighted kappa of 0.86 and 0.88, respectively). MDCT had a better sensitivity, specificity, positive predictive value, and negative predictive value for akinetic segments on CMR than did hypokinetic segments (71%, 91%, 68%, and 93% versus 84%, 97%, 81%, and 98%, respectively). CONCLUSION: MDCT provides an accurate and reproducible measurement of regional and global LV function in patients with reperfused acute myocardial infarction.


Assuntos
Imagem por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Traumatismo por Reperfusão Miocárdica/diagnóstico , Tomografia Computadorizada por Raios X , Função Ventricular Esquerda , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Tomografia Computadorizada por Raios X/métodos
14.
Arq. bras. cardiol ; 92(4): 294-301, abr. 2009. ilus, graf, tab
Artigo em Português, Inglês, Espanhol | LILACS | ID: lil-517301

RESUMO

FUNDAMENTO: O ecocardiograma tridimensional em tempo real (ECO 3D) e a tomografia computadorizada ultra-rápida (CT) são dois novos métodos de análise da fração de ejeção e dos volumes do VE. OBJETIVO: Comparar as medidas da FEVE e dos volumes do VE aferidos pelo ECO 3D e pela CT ultra-rápida. MÉTODOS: Foram estudados pelo ECO 3D e pela CT ultra-rápida de 64 cortes, 39 pacientes consecutivos (27 homens, média etária de 57±12 anos). Foram analisados: FEVE e volumes do VE. Análise estatística: coeficiente de correlação (r: Pearson), teste de Bland & Altman, teste de regressão linear, 95 por cento IC, p<0,05. RESULTADOS: Medidas do ECO 3D: a FEVE variou de 56,1 a 78,6 (65,5±5,58) por cento; volume diastólico final variou de 49,6 a 178,2 (87±27,8)ml; volume sistólico final variou de 11,4 a 78 (33,1±13,6)ml. Medidas da CT: a FEVE variou de 53 a 86 (67,8±7,78) por cento; volume diastólico final variou de 51 a 186 (106,5±30,3) ml; volume sistólico final variou de 7 a 72 (35,5±13,4)ml. As correlações entre ECO 3D e CT foram: FEVE (r: 0,7888, p<0,0001, 95 por cento IC 0,6301 a 0,8843); volume diastólico final (r: 0,7695, p<0,0001, 95 por cento IC 0,5995 a 0,8730); volume sistólico final (r: 0,8119, p<0,0001, 95 por cento IC 0,6673 a 0,8975). CONCLUSÃO: Nesta série, foi observada boa correlação entre as medidas da FEVE e entre os volumes ventriculares aferidos pelo ECO3D e pela CT ultra-rápida de 64 cortes.


BACKGROUND: Real-time three-dimensional echocargiography (RT-3D-Echo) and ultrafast computed tomography (CT) are two novel methods for the analysis of LV ejection fraction and volumes. OBJECTIVE: To compare LVEF and volume measurements as obtained using RT-3D-Echo and ultrafast CT. METHODS: Thirty nine consecutive patients (27 men, mean age of 57±12 years) were studied using RT-3D-Echo and 64-slice ultrafast CT. LVEF and LV volumes were analyzed. Statistical analysis: coefficient of correlation (r: Pearson), Bland-Altman analysis, linear regression analysis, 95 percent CI, p<0.05. RESULTS: RT-3D-Echo measurements: LVEF ranged from 56.1 to 78.6 (65.5±5.58) percent; end-diastolic volume ranged from 49.6 to 178.2 (87±27.8) ml; end-systolic volume ranged from 11.4 to 78 (33.1±13.6) ml. CT scan measurements: LVEF ranged from 53 to 86 percent (67.8±7.78); end-diastolic volume ranged from 51 to 186 (106.5±30.3) ml; end-systolic volume ranged from 7 to 72 (35.5±13.4)ml. Correlations between RT-3D-Echo and CT were: LVEF (r: 0.7888, p<0.0001, 95 percent CI 0.6301 to 0.8843); end-diastolic volume (r: 0.7695, p<0.0001, 95 percent CI 0.5995 to 0.8730); end-systolic volume (r: 0.8119, p<0.0001, 95 percent CI 0.6673 to 0.8975). CONCLUSION: Good correlation between LVEF and ventricular volume parameters as measured by RT-3D-Echo and 64-slice ultrafast CT was found in the present case series.


FUNDAMENTO: La ecocardiografía tridimensional en tiempo real (Eco-3DTR) y la tomografía computarizada ultrarrápida (TC ultrarrápida) son dos nuevos métodos de análisis de la fracción de eyección (FE) y de los volúmenes del ventrículo izquierdo (VI). OBJETIVO: Comparar las mediciones de la fracción de eyección del ventrículo izquierdo (FEVI) y de los volúmenes del VI apurados por la Eco-3DTR y por la TC ultrarrápida. MÉTODOS: Se estudiaron, mediante la Eco-3DTR y la TC ultrarrápida de 64 cortes, a 39 pacientes consecutivos (27 varones, promedio de edad de 57±12 años). Se analizaron: FEVI y volúmenes del VI. Análisis estadístico: coeficiente de correlación (r: Pearson), prueba de Bland & Altman, prueba de regresión lineal, 95 por ciento IC, p<0,05. RESULTADOS: Valores de la Eco-3DTR: variación de la FEVI de 56,1 a 78,6 (65,5±5,58) por ciento; variación del volumen diastólico final de 49,6 a 178,2 (87±27,8)mL; variación del volumen sistólico final de 11,4 a 78 (33,1±13,6)mL. Valores de la TC ultrarrápida: variación de la FEVI de 53 a 86 (67,8±7,78) por ciento; variación del volumen diastólico final de 51 a 186 (106,5±30,3) mL; variación del volumen sistólico final de 7 a 72 (35,5±13,4) mL. Las correlaciones entre la Eco-3DTR y la TC ultrarrápida fueron: FEVI (r: 0,7888, p<0,0001, 95 por ciento IC 0,6301 a 0,8843); volumen diastólico final (r: 0,7695, p<0,0001, 95 por ciento IC 0,5995 a 0,8730); volumen sistólico final (r: 0,8119, p<0,0001, 95 por ciento IC 0,6673 a 0,8975). CONCLUSIÓN: En esta serie, se observó una buena correlación entre las mediciones de la FEVI y entre los volúmenes ventriculares apurados por la Eco-3DTR y por la TC ultrarrápida de 64 cortes.


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença da Artéria Coronariana , Volume Cardíaco/fisiologia , Ecocardiografia Tridimensional/métodos , Volume Sistólico/fisiologia , Tomografia Computadorizada por Raios X/métodos , Função Ventricular Esquerda/fisiologia , Doença da Artéria Coronariana , Doença da Artéria Coronariana , Métodos Epidemiológicos
15.
Rev. bras. ecocardiogr ; 21(4): 23-29, out.-nov. 2008. ilus, tab, graf
Artigo em Português | LILACS | ID: lil-497519

RESUMO

Fundamento e objetivo: O ecocardiograma tridimensional (ECO 3D) e a tomografia computadorizada ultra-rápida (CT) constituem 2 novos métodos de análise da fração de ejeção e dos volumes do ventrículo esquerdo (VE). Existem poucos estudos dirigidos à comparação da análise da fração de ejeção do VE aferidos por ambos os métodos. O objetivo deste estudo foi comparar as medidas da FEVE e dos volumes do VE ECO 3D em tempo real e pela CT ultra rápida. Método: Foram estudados pelo ECO 3D e pela CT ultra rápida de 64 cortes, 41 pacientes (29 homens, média etária de 58 + - 111 anos). Foram analisados com ambas as técnicas: FEVE, volumes sistólico final e diastólico final do VE. Os parâmetros aferidos com o ECO3D e com a CT foram comparados com o emprego do coeficiente de determinação (r:Pearson), do teste de Bland & Altman e do teste de regressão linear, 95 por cento IC, p<0,05. Resultados: Medidas do ECO 3D: a FEVE variou de 56,7 a 78,9 (65,3 + - 5,7) por cento; volume diastólico final variou de 49,6 a 178,2 (88+ - 27,5) mL; volume sistólico final variou de 11,4 a 78 (33,9 + - 13,7) mL. Medidas da CT: a FEVE variou de 7 a 72 (35,1 + - 13,8) mL. As correlações entre ECO 3D e CT foram: FEVE (r: 0,7877, p>0,0001, 95 por cento IC 0,6327 a 0,8853); volume diastólico final (r:0,7671, p< 0,0001, 95 por cento IC 0,5974 a 0,8745); volume sistólico final (r: 0,8121, p< 0,0001, 95 por cento IC 0,6659 a 0,8957). Conclusão: Foi evidenciada boa correlação entre as medidas da FEVE e entre os volumes ventriculares aferidos pelo ECO3D em tempo real e pela CT ultra rápida de 64 cortes.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Coração/anatomia & histologia , Volume Sistólico/fisiologia , Estudo Comparativo , Ecocardiografia Tridimensional/métodos , Ecocardiografia Tridimensional , Tomografia/métodos , Tomografia
16.
Circulation ; 118(8): 837-44, 2008 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-18678772

RESUMO

BACKGROUND: Cardiac magnetic resonance (CMR) imaging permits early triage of patients presenting to the emergency department with acute chest pain but has been limited by the inability to differentiate new from old myocardial infarction. Our objective was to evaluate a CMR protocol that includes T2-weighted imaging and assessment of left ventricular wall thickness in detecting patients with acute coronary syndrome in the emergency department. METHODS AND RESULTS: In this prospective cohort observational study, we enrolled patients presenting to the emergency department with acute chest pain, negative cardiac biomarkers, and no ECG changes indicative of acute ischemia. The CMR protocol consisted of T2-weighted imaging, first-pass perfusion, cine function, delayed-enhancement magnetic resonance imaging, and assessment of left ventricular wall thickness. The clinical outcome (acute coronary syndrome) was defined by review of clinical charts by a consensus panel that used American Heart Association/American College of Cardiology guidelines. Among 62 patients, 13 developed acute coronary syndrome during the index hospitalization. The mean CMR time was 32+/-8 minutes. The new CMR protocol (with the addition of T2-weighted and left ventricular wall thickness) increased the specificity, positive predictive value, and overall accuracy from 84% to 96%, 55% to 85%, and 84% to 93%, respectively, compared with the conventional CMR protocol (cine, perfusion, and delayed-enhancement magnetic resonance imaging). Moreover, in a logistic regression analysis that contained information on clinical risk assessment (c-statistic=0.695) and traditional cardiac risk factors (c-statistic=0.771), the new CMR protocol significantly improved the c-statistic to 0.958 (P<0.0001). CONCLUSIONS: The present study indicates that a new CMR protocol improves the detection of patients with acute coronary syndrome in the emergency department and adds significant value over clinical assessment and traditional cardiac risk factors.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Técnicas de Diagnóstico Cardiovascular/normas , Serviços Médicos de Emergência/métodos , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Dor no Peito/etiologia , Estudos de Coortes , Feminino , Ventrículos do Coração/patologia , Humanos , Imagem por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Triagem/métodos
17.
Radiology ; 248(2): 466-75, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18641250

RESUMO

PURPOSE: To evaluate the accuracy of 64-section multidetector computed tomography (CT) for the assessment of perfusion defects (PDs), regional wall motion (RWM), and global left ventricular (LV) function. MATERIALS AND METHODS: All myocardial infarction (MI) patients signed informed consent. The IRB approved the study and it was HIPAA-compliant. Cardiac multidetector CT was performed in 102 patients (34 with recent acute MI and 68 without). Multidetector CT images were analyzed for myocardial PD, RWM abnormalities, and LV function. Global LV function and RWM were compared with transthoracic echocardiography (TTE) by using multidetector CT. PD was detected by using multidetector CT and was correlated with cardiac biomarkers and single photon emission CT (SPECT) myocardial perfusion imaging. Multidetector CT diagnosis of acute MI was made on the basis of matching the presence of PD with RWM abnormalities compared with clinical evaluation. RESULTS: Correlation between multidetector CT and TTE for global function (r = 0.68) and RWM (kappa = 0.79) was good. The size of PD on multidetector CT had a moderate correlation against SPECT (r = 0.48, -7% +/- 9). There was good to excellent correlation between cardiac biomarkers and the percentage infarct size by using multidetector CT (r = 0.82 for creatinine phosphokinase, r = 0.76 for creatinine phosphokinase of the muscle band, and r = 0.75 for troponin). For detection of acute MI in patients, multidetector CT sensitivity was 94% (32 of 34) and specificity was 97% (66 of 68). Multidetector CT had an excellent interobserver reliability for ejection fraction quantification (r = 0.83), as compared with TTE (r = 0.68). CONCLUSION: Patients with acute MI can be identified by using multidetector CT on the basis of RWM abnormalities and PD.


Assuntos
Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Biomarcadores/análise , Distribuição de Qui-Quadrado , Meios de Contraste , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Sensibilidade e Especificidade , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único , Ácidos Tri-Iodobenzoicos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
18.
Radiology ; 247(1): 49-56, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18372464

RESUMO

PURPOSE: To prospectively compare 64-section multidetector computed tomography (CT) and cardiac magnetic resonance (MR) imaging for the early assessment of myocardial enhancement and infarct size after acute reperfused myocardial infarction (MI). MATERIALS AND METHODS: The study was HIPAA compliant and was approved by the institutional review board. All participants gave written informed consent. Twenty-one patients (18 men; mean age, 60 years +/- 13 [standard deviation]) were examined with 64-section multidetector CT and cardiac MR imaging 5 days or fewer after a first reperfused MI. Multidetector CT was performed during the first pass of contrast material to assess myocardial perfusion and detect microvascular obstruction (no reflow). In 15 patients, a second scan was performed 7 minutes later to assess total infarct size by using delayed hyperenhancement. Early hypoenhancement and delayed hyperenhancement were compared between multidetector CT and cardiac MR imaging with Pearson correlation coefficient and Bland-Altman analysis. RESULTS: Early hypoenhancement was recognized on all multidetector CT and cardiac MR images. Delayed hyperenhancement was observed with cardiac MR imaging at all examinations and with multidetector CT at 11 of 15 examinations. While signal intensity differences between hypoperfused and normal myocardium were comparable for first-pass multidetector CT and cardiac MR imaging, cardiac MR imaging had a far better contrast-to-noise ratio (CNR) for delayed acquisitions than did CT (P < .001). Hypoenhanced areas (as a percentage of left ventricular mass) at first-pass multidetector CT (11% +/- 6) correlated well with those at first-pass cardiac MR imaging (7% +/- 4, R(2) = 0.72). Delayed-enhancement multidetector CT (13% +/- 9) correlated well with delayed-enhancement cardiac MR imaging (15% +/- 7, R(2) = 0.55). Quantification of delayed hypoenhancement (n = 12) had very good correlation between multidetector CT (4% +/- 4) and cardiac MR imaging (3% +/- 2) (R(2) = 0.85). CONCLUSION: Early and late hypoenhancement showed good CNR and correlated well between multidetector CT and cardiac MR imaging.


Assuntos
Meios de Contraste , Imagem por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Reperfusão Miocárdica , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Circulação Coronária , Feminino , Gadolínio DTPA , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Miocárdio/patologia , Ácidos Tri-Iodobenzoicos
19.
Am J Cardiol ; 100(2): 211-6, 2007 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-17631072

RESUMO

Cardiac magnetic resonance (CMR) has been shown to predict left ventricular (LV) recovery in patients after acute ST-segment elevation myocardial infarction. The purpose of this investigation was to determine the relative values of infarct transmurality and microvascular obstruction (MVO) using delayed enhancement CMR to predict LV recovery. We studied 17 patients (mean age 60 +/- 10 years, 14 men) presenting with first acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention who underwent CMR within 6 days after presentation and again at 6 months. In total 680 myocardial segments were evaluated, of which 267 (39%) demonstrated delayed hyperenhancement (DHE) and 116 (18%) demonstrated MVO. Unadjusted odds ratio (OR) for any improvement in regional LV function with increasing DHE category (<50%, 51% to 75%, >75% transmurality) was 0.20 (95% confidence interval [CI] 0.13 to 0.30, p <0.0001), whereas it was 0.40 (95% CO 0.28 to 0.55, p <0.0001) with increasing MVO category (0, <50th, >50th percentile). However, when coadjusted together, the relation remained robust with regard to degree of transmurality of DHE (OR 0.21, 95% CI 0.13 to 0.36, p <0.0001), but the relation was lost for MVO (OR 0.90, 95% CI 0.58 to 1.40, p = 0.64). In conclusion, when using the delayed enhancement technique for assessment of DHE and MVO, degree of infarct transmurality appears to be a more powerful predictor of LV recovery by CMR.


Assuntos
Angioplastia com Balão , Eletrocardiografia , Imagem por Ressonância Magnética , Infarto do Miocárdio/terapia , Função Ventricular Esquerda/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Razão de Chances , Estudos Prospectivos
20.
Am J Cardiol ; 98(3): 303-8, 2006 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-16860013

RESUMO

Clinical use of cardiac computed tomography is rapidly expanding, and its purpose may reach beyond noninvasive coronary angiography. We investigated the ability of 64-slice multidetector computed tomography to differentiate between recent and long-standing myocardial infarction (MI). Contrast-enhanced coronary computed tomographic (CT) scans (Siemens Sensation 64) of patients with a recent MI (< 7 days, n = 16), long-standing MI (> 12 months, n = 13), and no MI (n = 13) were retrospectively evaluated. To anticipate transmural variation of myocardial perfusion and to neutralize image noise, a series of thin, overlapping slices was created in parallel alignment to the myocardial wall. Within each of these slices, a small region of interest was placed at a constant in-plane position to measure the CT attenuation (Hounsfield units [HU]) at consecutive transmural locations of injured and normal remote myocardium. In addition, wall thickness and the myocardial cavity were measured. Significantly lower CT attenuation values were found in patients with long-standing MI (-13 +/- 37 HU) than in those with acute MI (26 +/- 26 HU) and normal controls (73 +/- 14 HU, p < 0.001). The attenuation difference between infarcted and remote myocardia was larger in patients with long-standing MI than in patients with recent MI (89 +/- 41 and 55 +/- 33 HU, respectively, p < 0.001). In addition, long-standing MI was associated with wall thinning (p < 0.01), and ventricular dilation (p < 0.05), whereas recent MI was not (p > 0.05). In conclusion, recent and long-standing MIs may be differentiated by computed tomography based on myocardial CT attenuation values and ventricular dimensions.


Assuntos
Ventrículos do Coração/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Angiografia Coronária , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo
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