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1.
Medicine (Baltimore) ; 98(49): e18193, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804339

RESUMO

RATIONALE: Primary cardiac angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. As there are currently no guidelines or effective therapeutic strategies, management of this condition depends on previous experiences of the clinician treating and the consideration of reported cases. PATIENT CONCERNS: A 65-year-old male presented to our department with a 4-day history of chest tightness, dyspnea, lower extremity weakness and occasional dizziness, and a transthoracic echo (TTE) revealed a right atrium occupying mass. DIAGNOSES: TTE showed right atrium occupation, and the post-operative histopathology showed the tumor to be a primary cardiac angiosarcoma. INTERVENTIONS: Right atrium tumor resection and right atrium reconstruction with a bovine pericardium were performed. OUTCOMES: The patient recovered from surgery and discharged but died 10 months after surgery because of complete resection was impossible and adjuvant therapy was not performed. LESSONS: Resection of primary cardiac angiosarcomas should be integrated with a combination of chemotherapy, radiotherapy, and targeted therapy based on tumor cell gene mutation and altered expression.


Assuntos
Neoplasias Cardíacas/patologia , Hemangiossarcoma/patologia , Idoso , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Masculino
2.
Medicine (Baltimore) ; 98(51): e18386, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861001

RESUMO

RATIONALE: Pulmonary embolisms (PEs) are caused by emboli, which mostly originate from deep venous thrombi that travel to and suddenly block the pulmonary arteries. The emboli are usually thrombi, and right atrial myxoma emboli are rare. PATIENT CONCERNS: A 55-year-old man presented with shortness of breath and syncope. We proceeded with computed tomography pulmonary angiography (CTPA) and transthoracic echocardiogram (TTE), the results of which suggested that the diagnosis was a right atrial mass. DIAGNOSIS: A definitive diagnosis compatible with a right atrial myxoma (RAM) with tumoral pulmonary emboli after surgical excision was made. INTERVENTION: Right atrial and pulmonary artery embolectomy. OUTCOMES: The patient followed an uneventful course during the 6 years of follow-up after surgery. According to a review of the literature, RAMs are often not diagnosed in a timely manner or even go completely undiagnosed. TTE, transesophageal echocardiography (TEE), CT, magnetic resonance imaging (MRI), and positron emission tomography/computed tomography may be helpful in the preoperative diagnosis. Surgical removal of the masses from the atrium and pulmonary arteries was relatively uneventful. LESSONS: RAMs should be considered unlikely reasons for fatal pulmonary embolisms.


Assuntos
Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Embolia Pulmonar/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/patologia , Mixoma/cirurgia , Embolia Pulmonar/cirurgia
3.
Medicine (Baltimore) ; 98(48): e18146, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770253

RESUMO

Left atrial (LA) remodeling has been identified to predict atrial fibrillation (AF) and heart failure. However, the role of LA diameter (LAD) in patients with heart failure (HF) with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF) remains poorly understood.A total of 142 patients including 71 subjects with AF (21 of HFpEF, 22 of HFmrEF, and 28 of HFrEF) and 71 ejection fraction (EF)-matched subjects with sinus rhythm (SR) were included in the study. Baseline characteristics and echocardiographic parameters including LAD were compared between both groups as well as among HFpEF, HFmrEF, and HFrEF.In receiver-operating characteristic (ROC) analyses, LAD predicted AF in HFpEF, HFmrEF, and HFrEF [area under the curve (AUC): 0.646; P = .03]. LAD was negatively association with left ventricular ejection fraction while positively with Nt-proNP and left ventricular end-diastolic diameter (regression coefficient: -0.239, P = .004; regression coefficient: 0.191, P = .023; regression coefficient: 0.357, P < .001). In ROC analyses, LAD predicted HFrEF among the 3 categories (AUC: 0.629, P = .01).In the setting of HF, LAD was higher in AF than in and SR, and predicted AF. Furthermore, LAD was associated with severity of HF in HFpEF, HFmrEF, and HFrEF, and also predicted HFrEF.


Assuntos
Átrios do Coração , Insuficiência Cardíaca , Volume Sistólico , Disfunção Ventricular Esquerda , Função Ventricular Esquerda/fisiologia , Idoso , Idoso de 80 Anos ou mais , China , Ecocardiografia/métodos , Ecocardiografia/estatística & dados numéricos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Tamanho do Órgão , Prognóstico , Estudos Retrospectivos , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
4.
J Cardiothorac Surg ; 14(1): 188, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694695

RESUMO

BACKGROUND: The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF). METHODS: This was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia. RESULTS: Fifty-five patients (78% males, mean age = 61.6 years) qualified for the study. The average duration in AF was 3.64 +/- 3.4 years, mean CHA2DS2-VASc Score was 2.0 +/- 1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% (n = 49/55), 85.5% (n = 47/55) and 76.9% (n = 40/52) at 6, 12 and 24 months, respectively. In the multivariate cox-proportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24 months, respectively. CONCLUSION: In this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.


Assuntos
Técnicas de Ablação/métodos , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Toracoscopia/métodos , Adulto , Idoso , Fibrilação Atrial/diagnóstico por imagem , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(45): e17940, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702683

RESUMO

Venous air embolism (VAE) can be observed in the right heart system on contrast-enhanced computed tomography (CT), following injection of contrast media with a power injector system. Although most VAEs are mostly asymptomatic, they may result in paradoxical air embolism (PAE).To evaluate whether the incidence of VAE on coronary CT angiography is associated with the process of preparation of the intravenous access route.We retrospectively evaluated 692 coronary CT examinations at 3 institutions. Trained CT nurses placed an intravenous cannula in the forearm. Tubes connected to the cannula were prepared in the following ways: A, using an interposed three-way cock and a 20-mL syringe filled with normal saline to collect air contamination in the tube; B, through direct connection to the power injector system without the interposed 3-way cock; and C, using an interposed three-way cock and a 100-mL normal saline drip infusion bottle system to keep the tube patent. The incidence and location of VAE and preparation of intravenous injection were assessed.The overall incidence of VAE was 55.3% (383/692), most frequently observed in the right atrium (81.5%, 312/383). Its incidence varied significantly across the 3 techniques (A: 21.6% (35/162), B: 63.2% (237/375) and C: 71.6% (111/155); P < .001). No patient demonstrated any symptom associated with VAE.Using a 3-way cock with syringe demonstrated the lowest incidence of VAE on coronary CT angiography. It is thus recommended to reduce potential complication risks related to intravenous contrast media injection.


Assuntos
Angiografia por Tomografia Computadorizada/efeitos adversos , Embolia Aérea/etiologia , Embolia Paradoxal/etiologia , Átrios do Coração/diagnóstico por imagem , Idoso , Meios de Contraste/administração & dosagem , Embolia Aérea/complicações , Embolia Aérea/epidemiologia , Embolia Paradoxal/epidemiologia , Humanos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Nihon Yakurigaku Zasshi ; 154(4): 171-177, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597895

RESUMO

Recent outstanding progress in microscopic imaging technology and the advent of fluorescent probes have enabled us to visualize high spatiotemporal dynamics of intracellular molecules in living tissues. Here I introduce our research outcomes on functional fluorescence imaging of the heart especially for understanding the pathogenesis of cardiac arrhythmias. On the in situ Ca2+ imaging of perfused rat heart by rapid-scanning confocal microscopy, we found that burst emergence of intracellular Ca2+ waves evokes arrhythmogenic triggered activity and subsequent oscillatory depolarizations via the Na+-Ca2+ exchanger. Besides, impairment of Ca2+ release from the sarcoplasmic reticulum leads to emergence of Ca2+ waves and spatiotemporally inhomogeneous Ca2+ dynamics on systole, resulting in beat-to-beat Ca2+ alternans. Such alternating behaviors of Ca2+ dynamics are partly due to poor development of the transverse tubules, which are identified in murine atria and failing ventricular myocytes. In addition, impairment of the gap junctional communication via connexin 43 induced by dominant negative inhibition of neonatal rat ventricular myocyte monolayers results in generation of spiral wave reentry, suggesting the pivotal role of intercellular communications in genesis of arrhythmias. Furthermore, alterations in atrial histoanatomy, e.g., density and arrangements of myocytes and distribution of Cx43, could provide intrinsic arrhythmogenic bases of atrial fibrillation, which was revealed by combined optical imaging of the atria and precise histoanatomical examinations. In combination, fluorescence imaging of the living organisms provides indispensable information for unveiling functions and disease states.


Assuntos
Arritmias Cardíacas/fisiopatologia , Sinalização do Cálcio , Coração/diagnóstico por imagem , Imagem Óptica , Animais , Células Cultivadas , Átrios do Coração/diagnóstico por imagem , Miócitos Cardíacos/citologia , Ratos , Trocador de Sódio e Cálcio/metabolismo
7.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(3): 390-395, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31631609

RESUMO

Objective: To observe the changes of left atrial structure and function in patients with paroxysmal atrial fibrillation (PAF) after radiofrequency catheter ablation by two-dimensional speckle tracking imaging (STI) and real-time three-dimensional imaging technology (RT-3D) in order to provide basis for clinical evaluation of surgery. Methods: Thirty two (32) cases of PAF patients with catheter ablation from October 2016 to December 2017 in our hospital were enrolled. According to sinus rhythm whether or not be restored after operation, the patients were divided into sinus rhythm group (SR group, 24 cases) and atrial brillation group (AF group, 8 cases). All PAF patients received echocardiography before and 1, 6 months after surgery. Left atrial structure and functional parameters were measured by STI and RT-3D, including left atrial diameter, volume, left ventricular systole, early diastolic, left atrial systolic peak strain rate and ejection fraction. Results: All parameters in AF group were not changed significantly after surgery ( P>0.05). In SR group, at 6 month after surgery, the levels of Left atrial anteroposterior diameter (LAAPD), Left atrial up and down diameter (LAUDD), Left atrial left and right diameter (LALRD), minimum volume of left atrium (LAV min), Left atrial presystolic volume (LAV p) and max volume of left atrium (LAV max) were significantly decreased, the levels of Left atrial ejection fraction (LAEF), Left atrial active ejection fraction (LAAEF), Left atrial passive ejection fraction (LAPEF) were significantly increased, the strain rates (SRS, SRE, SRA) in the lateral wall base segment, interval middle segment and middle segment of the lateral wall and overall strain parameters (GLSR S, GLSR E, GLSR A) were significantly increased (all P<0.05); and the other segment strain rates were not significantly changed ( P>0.05). In AF group, at 6 month after surgery, the levels of LAV min, LAV p and LAV max were significantly decreased at 6 month after operation, the levels of LAEF, LAAEF were significantly increased, all above had statistical difference ( P<0.05); and the other parameters were not significantly changed ( P>0.05). Conclusion: STI and RT-3D could quantitatively analyze the structure and function of left atrium before and after radiofrequency ablation in PAF patients. After ablation, the diameter of LA decreases and the ejection fraction increases in the patients with sinus rhythm; the volume of LA increases and the function reduces in the patients with atrial fibrillation recurrence.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Função do Átrio Esquerdo , Ablação por Cateter/efeitos adversos , Átrios do Coração/diagnóstico por imagem , Humanos , Imagem Tridimensional
8.
Medicine (Baltimore) ; 98(38): e17250, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567993

RESUMO

RATIONALE: Central retinal artery occlusion (CRAO) due to cardiac myxoma primarily occurs in elderly individuals. Early detection and surgical resection of myxoma are extremely important because CRAO causes complete blindness in most cases. However, due to the extremely low incidence of CRAO caused by cardiac myxoma in the pediatric age group, such condition is rarely reported. PATIENT CONCERNS: A 16-year-old female patient visited our hospital due to sudden onset of vision loss in the left eye, dysarthria, and right-sided hemiplegia. DIAGNOSES: She was diagnosed with CRAO via fundoscopy. Results showed a cherry-red spot, indicating CRAO. Brain magnetic resonance imaging (MRI) revealed multifocal diffusion-restricted foci, particularly in the left frontal lobe. Echocardiography revealed a left atrial mass measuring 4.21 cm × 2.25 cm. The mass was attached to the interseptum and moved along the inflow of the mitral valve. Cardiac computed tomography (CT) revealed an enhanced mass measuring 3 cm × 2.2 cm × 3 cm and with irregular margin on the anterior wall of the left atrium and the border of the fossa ovalis. INTERVENTIONS: The patient underwent surgical excision under general anesthesia. Intraoperative finding showed a huge, jelly-like, and extremely friable mass. Pathological examination confirmed myxoma. OUTCOMES: During a follow-up of 2 years after diagnosis, she did not present with other neurological deficits and no residual mass was observed on echocardiography. However, visual impairment of the left eye persisted. LESSONS: Most patients with CRAO may present with other mild symptoms that are often be neglected before CRAO development. We recommend that patients who present with frequent syncopal attack or symptoms of transient ischemic attack should undergo echocardiography.


Assuntos
Cegueira/etiologia , Átrios do Coração , Neoplasias Cardíacas/complicações , Mixoma/complicações , Adolescente , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Mixoma/diagnóstico por imagem , Mixoma/patologia , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Tomografia Computadorizada por Raios X
9.
Braz J Med Biol Res ; 52(9): e8446, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482999

RESUMO

Left atrial diameter (LAD) has been considered an independent risk factor for atrial fibrillation (AF) relapse after pulmonary vein isolation (PVI). However, whether LAD or other factors are more predictive of late recurrence in patients with paroxysmal AF remains unclear. We aimed to evaluate the value of pulmonary vein (PV) parameters for predicting AF relapse 1 year after patients underwent cryoablation for paroxysmal AF. Ninety-seven patients with paroxysmal AF who underwent PVI successfully were included. PV parameters were measured through computed tomography scans prior to PVI. A total of 28 patients had recurrence of AF at one-year follow-up. The impact of several variables on recurrence was evaluated in multivariate analyses. LAD and the time from first diagnosis of AF to ablation maintained its significance in predicting the relapse of AF after relevant adjustments in multivariate analysis. When major diameter of right inferior pulmonary vein (RIPV) (net reclassification improvement (NRI) 0.179, CI=0.031-0.326, P<0.05) and cross-sectional area (CSA) of RIPV (NRI: 0.122, CI=0.004-0.240, P<0.05) entered the AF risk model separately, the added predictive capacity was large. The accuracy of the two parameters in predicting recurrence of AF were not inferior (AUC: 0.665 and 0.659, respectively) to echocardiographic LAD (AUC: 0.663). The inclusion of either RIPV major diameter or CSA of RIPV in the model increased the C-index (0.766 and 0.758, respectively). We concluded that major diameter of RIPV had predictive capacity similar to or even better than that of LAD for predicting AF relapse after cryoablation PVI.


Assuntos
Fibrilação Atrial/etiologia , Átrios do Coração/anatomia & histologia , Veias Pulmonares/anatomia & histologia , Idoso , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/diagnóstico por imagem , Recidiva , Fatores de Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
J Vet Cardiol ; 24: 36-47, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405553

RESUMO

INTRODUCTION/OBJECTIVES: Myocardial diseases are the most common acquired cardiac diseases in cats and may result in left atrial enlargement and congestive heart failure (CHF). Volume calculations have replaced linear measurements for chamber quantification in humans but are not commonly measured in cats. The aims of this retrospective study were to compare the left atrial (LA) size by two-dimensional linear measurements to two-dimensional LA volumes (LAV). ANIMALS: One hundred sixty-two client-owned cats were included. MATERIALS AND METHODS: Cats with complete echocardiographic examinations were included and categorized into one of the three groups: healthy, cardiomyopathy (CM), and CHF. Seven measurements of the LA size were performed including minimal and maximal LA-to-aortic ratio (LA:Ao) and LAV and also maximal left atrial diameter (LAD). RESULTS: Cats were classified as healthy (n = 56), CM (n = 62), and CHF (n = 44). The minimal LA:Ao (LA:Aomin) and minimal LAV from the left apical view (LAVmin-LAP) best differentiated the CM and CHF groups. The LA:Aomin value with the optimal sensitivity and specificity to distinguish CM and CHF cats was 1.64 (sensitivity 84% and specificity 75%). CONCLUSIONS: Left atrial volumes were not superior to linear measurements of LA size in distinguishing CM and CHF cats in this study. Minimal LA size and volumes resulted in a larger area under the curve than each corresponding maximal value. Minimum LA size may be a better prognostic factor of CHF in cats with CM.


Assuntos
Cardiomiopatias/veterinária , Doenças do Gato/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/veterinária , Animais , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico por imagem , Doenças do Gato/fisiopatologia , Gatos , Ecocardiografia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Masculino , Curva ROC , Sensibilidade e Especificidade
11.
J Vet Cardiol ; 24: 64-77, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405556

RESUMO

INTRODUCTION: We hypothesized that real-time three-dimensional echocardiography (RT-3DE) was superior to two-dimensional echocardiography for the estimation of left atrial volume (LAV), using electrocardiographic (ECG)-gated multidetector computed tomography angiography (MDCTA) as a volumetric gold standard. The aim was to compare maximum LAV (LAVmax) and minimum LAV (LAVmin) measured by biplane area-length method (ALM), biplane method of disk (MOD) and RT-3DE with 64-slice ECG-gated MDCTA in dogs ANIMALS: The study included twenty dogs, anaesthetized for various diagnostic purposes and without evidence of cardiovascular disease. METHODS: Left atrial volume was estimated by ALM, MOD and RT-3DE following ECG-gated MDCTA. The results were compared with LAV from MDCTA and correlations were performed. The limits of agreement (LoA) between methods were evaluated using Bland-Altman analysis and intraclass correlations. Coefficients of variation were calculated. RESULTS: Area-length method (r = 0.79 and 0.72), MOD (r = 0.81 and 0.70) and RT-3DE (r = 0.94 and 0.82) correlated with MDCTA for LAVmax and LAVmin, respectively (all p < 0.05). Biases for LAVmax (-0.96 mL, 95% LoA: -5.6 to 3.7) and LAVmin (-0.67 mL, 95% LoA: -5.4 - 4.1) were minimal with RT-3DE, reflecting a slight underestimation. Conversely, MOD (LAVmaxbias = 3.19 mL, 95% LoA: -5.7 - 12.1; LAVminbias = 1.96 mL, 95% LoA: -4.6 - 8.5) and ALM (LAVmaxbias = 4.05, 95% LoA: -5.7 - 13.8; LAVminbias = 2.80 mL, 95% LoA: -3.9 - 9.5) suggested LAV overestimation. Intraobserver and interobserver variability were adequate. CONCLUSIONS: Real-time three-dimensional echocardiography is a non-invasive, accurate and feasible method with superior accuracy to two-dimensional methods.


Assuntos
Cães/anatomia & histologia , Átrios do Coração/anatomia & histologia , Animais , Ecocardiografia/veterinária , Ecocardiografia Tridimensional/veterinária , Feminino , Átrios do Coração/diagnóstico por imagem , Masculino , Tomografia Computadorizada Multidetectores/veterinária , Estudos Prospectivos , Valores de Referência
13.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352392

RESUMO

A 53-year-old female patient known to have Cowden disease (PTEN mutation positive) was found to have a mass at the left atrium on a CT coronary angiography performed as part of a preoperative workup for an unrelated surgery. Further radiological characterisation of the lesion was achieved using MRI and positron emission tomography. Interval growth prompted surgical excision; however, surgery was expedited after the patient presented with haemopericardium and cardiac tamponade. The patient was discharged home 8 days postoperatively, and no intraoperative or postoperative complications were encountered. A diagnosis of cavernous haemangioma was made on histology.


Assuntos
Tamponamento Cardíaco/complicações , Síndrome do Hamartoma Múltiplo , Átrios do Coração/patologia , Hemangioma Cavernoso/patologia , Achados Incidentais , Angiografia Coronária , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , PTEN Fosfo-Hidrolase , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Int Heart J ; 60(4): 788-795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31353344

RESUMO

Severe ventricular arrhythmias such as high-grade atrioventricular block and ventricular tachycardia may cause lethal conditions or sudden death in patients with cardiac sarcoidosis (CS). Physicians should examine patients carefully for these conditions and treat them appropriately. As arrhythmias are being better diagnosed and treated, physicians are increasingly aware of atrial arrhythmias, which have not been focused upon as CS-related conditions, in patients with CS. This article reports a case of atrial flutter in sarcoidosis, and discusses literature findings on atrial arrhythmias and atrial involvement of CS. It is highly likely that atrial arrhythmia and supraventricular conduction disorder associated with or caused by CS are more common than previously thought. Physicians should pay careful attention for these conditions in the diagnosis and treatment of CS.


Assuntos
Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Cardiomiopatias/complicações , Átrios do Coração/fisiopatologia , Sarcoidose/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Ablação por Cateter , Ecocardiografia , Eletrocardiografia Ambulatorial , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico , Sarcoidose/fisiopatologia
17.
Curr Med Sci ; 39(4): 541-545, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31346988

RESUMO

The difference in the atrial organizational structure between patients with atrial fibrillation (AF) and those with sinus rhythm was investigated. In order to analyze the rationality in explaining the electrocardiogram (ECG) characteristics of AF with statistics data or tissue remodeling model, and the logical relationship between the hypothesis of pulmonary veins (PV) muscle sleeves and that of multi wavelets in mechanism of AF, we examined the expression of collagen volume fraction of type I (CVF-I) with picrosirius red staining, connexin 40 (Cx40) by immunohistochemistry, and intercalated disc (ID) using transmission electron microscope in atrial tissue. The results showed that there was significant difference in the expression of CVF-I (t=3.827, P<0.01), Cx40 (t=4.21, P<0.01), and groups of the ID that keeping the electrical transmission and atrial electrical coupling synchronization (t=15.116, P<0.001), but no significant difference was found in total IDs (t=0.611, P=0.543) between patients with AF and those with sinus rhythm. The quantitative differences in the tissue remodeling could not explain the ECG characteristics of AF. The number of normal IDs and abnormal distribution are the structural basis to trigger and maintain atrial electrical remodeling, and induce and maintain AF. Such histological reconstruction supports the hypothesis of multi wavelets and can also explain ECG features.


Assuntos
Fibrilação Atrial/metabolismo , Remodelamento Atrial/fisiologia , Conexinas/genética , Átrios do Coração/fisiopatologia , Adulto , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Remodelamento Atrial/genética , Eletrocardiografia , Feminino , Coração/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Miocárdio/metabolismo , Miocárdio/patologia , Veias Pulmonares/metabolismo , Veias Pulmonares/patologia , Adulto Jovem
18.
Scand Cardiovasc J ; 53(6): 317-322, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31321990

RESUMO

Objectives. Left atrial fibrosis represents a substrate for atrial fibrillation (AF) and cardioembolic events. White matter hyperintensities (WMH) are commonly found on magnetic resonance imaging (MRI) and are regarded, at least partly as ischemic brain lesions. Aortic excess pressure (excessPTI) represents an extra work performed by the left ventricle and is a new risk metric associated with cardiovascular complications. The aim of our study was to assessed whether there is a correlation between the degree of LA fibrosis, aortic excess pressure, and WMH in patients without a history of atrial fibrillation but the presence of risk factors for cardiovascular complications. Design. Thirty-eight subjects (10, females, 28 males, median age 64 years) with risk factors (hypertension, diabetes, heart failure, vascular disease) but no history of AF were recruited. Left atrial fibrosis and brain WMH were estimated by MRI. Aortic excess pressure was obtained non-invasively. Results. Atrial fibrosis correlated significantly with aortic excess pressure (r = 0.65, p < .0001) and was significantly associated with periventricular white matter lesion volume (r = 0.34, p = .036). In multiple regression analysis, atrial fibrosis and age were positively associated with periventricular white matter lesions, while aortic excess pressure was not quite significant associated with WMH. This model explains the 30% variance in white matter lesions volume observed in the study. Left atrial fibrosis was independently associated with excessPTI but not with age and mean BP. This model explained 42% of the variance in an area of atrial fibrosis. Conclusions. Atrial fibrosis in subjects with cardiovascular risk factors and no history of AF is associated with white matter hyperintensities and aortic excess pressure.


Assuntos
Aorta/fisiopatologia , Pressão Arterial , Função do Átrio Esquerdo , Remodelamento Atrial , Doenças Cardiovasculares/complicações , Átrios do Coração/fisiopatologia , Leucoencefalopatias/etiologia , Idoso , Aorta/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Feminino , Fibrose , Átrios do Coração/diagnóstico por imagem , Humanos , Leucoencefalopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Função Ventricular Esquerda
19.
Int J Cardiovasc Imaging ; 35(11): 2009-2018, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31300935

RESUMO

Classic echocardiographic methodologies offer limited opportunities in assessing right atrial (RA) morphology and function. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a novel imaging method with objective 3D capability in assessing volumetric and functional properties of heart chambers. Normal reference values of different 3DSTE-derived RA strains are not available, therefore the aim of this prospective study was to establish these parameters in healthy subjects. The present study comprised 295 healthy volunteers, from which 110 were excluded due to inadequate image quality. The final population consisted of 185 healthy subjects in the present study (mean age: 32.1 ± 12.2 years, 89 males). Complete two-dimensional echocardiography and 3DSTE have been performed in all cases. While radial strain (RS) does not change significantly over the years in males, in female subjects it increases with age most significantly between at the age of 40-49, and it starts to decline at the age of 50 in females. While females have higher circumferential (CS) and area (AS) strain values, CS and AS decrease with age in both gender. While LS remains almost unchanged in females until ages 40-49 years with a decline above the age of 50, it decreases over the decades in males. 3D strain (3DS) increases with age in both gender, but almost doubles in females in older ages. Specific pattern of strains at atrial contraction could also be demonstrated. 3DSTE-derived RA normal reference values with age-, gender-dependency and regional values are demonstrated in a healthy population.


Assuntos
Função do Átrio Direito , Ecocardiografia Tridimensional/normas , Átrios do Coração/diagnóstico por imagem , Adulto , Fatores Etários , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Valores de Referência , Fatores Sexuais , Adulto Jovem
20.
J Vet Intern Med ; 33(5): 1909-1920, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31313382

RESUMO

BACKGROUND: Broadly applicable reference intervals (RIs) for measurements of left atrial (LA) and left ventricular (LV) size and function generated prospectively using statistically appropriate methods are limited. OBJECTIVES: To generate body size-independent RIs for linear, area, and volume measurements of LA size and LV size and function. ANIMALS: Healthy adult dogs (n = 122) of variable size and somatotype. METHODS: Prospective study. All dogs underwent an echocardiogram performed by the same examiner. Effects of body weight, sex, age, and heart rate were evaluated by regression and correlation analyses. Scaling exponents and prediction intervals were generated for linear measurements using the allometric equation. After normalization to body weight, 95% RIs were determined using nonparametric methods with 2.5 and 97.5 percentiles serving as the lower and upper limits (each with 90% confidence intervals), respectively. RESULTS: Linear LA and LV measurements were strongly correlated (R2 ≥ 0.79) with body weight. Scaling exponents were close to the expected 1/3 (0.299-0.392). Prediction intervals for linear measurements of LV chamber size were considerably narrower than previously reported. Weak correlations (r = -0.42 to -0.50) among LV fractional shortening, fractional area change, and ejection fraction and body weight were identified. No other meaningful relationships were identified between the measurements and sex, age, and heart rate. CONCLUSIONS AND CLINICAL IMPORTANCE: Body size-independent RIs for several linear, area, and volume measurements of LA and LV size and function were generated prospectively from a large and diverse reference population and are available for clinical use.


Assuntos
Cães/anatomia & histologia , Ecocardiografia/veterinária , Átrios do Coração/anatomia & histologia , Ventrículos do Coração/anatomia & histologia , Animais , Peso Corporal , Feminino , Átrios do Coração/diagnóstico por imagem , Frequência Cardíaca , Ventrículos do Coração/diagnóstico por imagem , Masculino , Estudos Prospectivos , Valores de Referência
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