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1.
J Am Heart Assoc ; 10(16): e021428, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34365798

RESUMO

Background Cardiac dysfunction is a prominent feature of multisystem inflammatory syndrome in children (MIS-C), yet the etiology is poorly understood. We determined whether dysfunction is global or regional, and whether it is associated with the cytokine milieu, microangiopathy, or severity of shock. Methods and Results We analyzed echocardiographic parameters of myocardial deformation and compared global and segmental left ventricular strain between 43 cases with MIS-C ≤18 years old and 40 controls. Primary outcomes included left ventricular global longitudinal strain, right ventricular free wall strain), and left atrial strain. We evaluated relationships between strain and profiles of 10 proinflammatory cytokines, microangiopathic features (soluble C5b9), and vasoactive-inotropic requirements. Compared with controls, cases with MIS-C had significant impairments in all parameters of systolic and diastolic function. 65% of cases with MIS-C had abnormal left ventricular function (|global longitudinal strain|<17%), although elevations of cytokines were modest. All left ventricular segments were involved, without apical or basal dominance to suggest acute stress cardiomyopathy. Worse global longitudinal strain correlated with higher ratios of interleukin-6 (ρ -0.43) and interleukin-8 (ρ -0.43) to total hypercytokinemia, but not absolute levels of interleukin-6 or interleukin-8, or total hypercytokinemia. Similarly, worse right ventricular free wall strain correlated with higher relative interleukin-8 expression (ρ -0.59). There were no significant associations between function and microangiopathy or vasoactive-inotropic requirements. Conclusions Myocardial function is globally decreased in MIS-C and not explained by acute stress cardiomyopathy. Cardiac dysfunction may be driven by the relative skew of the immune response toward interleukin-6 and interleukin-8 pathways, more so than degree of hyperinflammation, refining the current paradigm of myocardial involvement in MIS-C.


Assuntos
Função do Átrio Esquerdo , COVID-19/complicações , Síndrome da Liberação de Citocina/etiologia , Citocinas/sangue , Cardiopatias/etiologia , Mediadores da Inflamação/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações , Função Ventricular Esquerda , Função Ventricular Direita , Adolescente , Fatores Etários , Biomarcadores/sangue , COVID-19/diagnóstico , COVID-19/imunologia , Criança , Estudos Transversais , Síndrome da Liberação de Citocina/diagnóstico , Síndrome da Liberação de Citocina/imunologia , Ecocardiografia , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/imunologia , Cardiopatias/fisiopatologia , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/imunologia
2.
Open Heart ; 8(2)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353958

RESUMO

OBJECTIVES: We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. METHODS: The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. RESULTS: Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. CONCLUSION: The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic.


Assuntos
COVID-19 , Técnicas de Imagem Cardíaca/tendências , Cardiologistas/tendências , Disparidades em Assistência à Saúde/tendências , Cardiopatias/diagnóstico por imagem , Padrões de Prática Médica/tendências , Europa (Continente) , Pesquisas sobre Serviços de Saúde , Humanos , Valor Preditivo dos Testes
3.
Open Heart ; 8(2)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34376573

RESUMO

OBJECTIVES: To describe the use of echocardiography in patients hospitalised with suspected coronavirus infection and to assess its impact on clinical management. METHODS: We studied 79 adults from a prospective registry of inpatients with suspected coronavirus infection at a single academic centre. Echocardiographic indications included abnormal biomarkers, shock, cardiac symptoms, arrhythmia, worsening hypoxaemia or clinical deterioration. Study type (limited or complete) was assessed for each patient. The primary outcome measure was echocardiography-related change in clinical management, defined as intensive care transfer, medication changes, altered ventilation parameters or subsequent cardiac procedures within 24 hours of echocardiography. Coronavirus-positive versus coronavirus-negative patient groups were compared. The relationship between echocardiographic findings and coronavirus mortality was assessed. RESULTS: 56 patients were coronavirus-positive and 23 patients were coronavirus-negative with symptoms attributed to other diagnoses. Coronavirus-positive patients more often received limited echocardiograms (70% vs 26%, p=0.001). The echocardiographic indication for coronavirus-infected patients was frequently worsening hypoxaemia (43% vs 4%) versus chest pain, syncope or clinical heart failure (23% vs 44%). Echocardiography changed management less frequently in coronavirus-positive patients (18% vs 48%, p=0.01). Among coronavirus-positive patients, 14 of 56 (25.0%) died during hospitalisation. Those who died more often had echocardiography to evaluate clinical deterioration (71% vs 24%) and had elevated right ventricular systolic pressures (37 mm Hg vs 25 mm Hg), but other parameters were similar to survivors. CONCLUSIONS: Echocardiograms performed on hospitalised patients with coronavirus infection were often technically limited, and their findings altered patient management in a minority of patients.


Assuntos
COVID-19/diagnóstico por imagem , Ecocardiografia Doppler , Cardiopatias/diagnóstico por imagem , Coração/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , COVID-19/fisiopatologia , COVID-19/terapia , COVID-19/virologia , Tomada de Decisão Clínica , Feminino , Coração/fisiopatologia , Coração/virologia , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Cardiopatias/virologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos
4.
J Card Surg ; 36(10): 3939-3943, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34309906

RESUMO

Inflammation and thrombogenic effects of coronavirus disease 2019 (COVID-19) can lead to cardiovascular complications in patients even after recovery from COVID-19. Intracardiac thrombus is life-threatening and can cause sudden death. Our study describes two patients who recovered from COVID-19 and presented with chronic intracardiac thrombus.


Assuntos
COVID-19 , Cardiopatias , Trombose , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , SARS-CoV-2 , Trombose/diagnóstico por imagem , Trombose/etiologia
5.
Arch Cardiovasc Dis ; 114(6-7): 490-503, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34274252

RESUMO

BACKGROUND: Cardiovascular magnetic resonance imaging (CMR) is an accurate technique for assessing ventricular function, myocardial perfusion and viability; its development remains limited mainly because of logistical and time constraints. Data regarding optimization of a dedicated stress CMR workflow are needed. AIMS: This study aimed to describe the optimization of a dedicated workflow, and to assess the feasibility and safety of stress CMR in a large registry of>35,000 patients. METHODS: A large single-centre French registry of vasodilator stress CMR included consecutive patients referred between 2008 and 2019 for the detection of inducible ischaemia. Stress CMR was performed at 1.5 Tesla using dipyridamole. Clinical and demographic data, test quality, CMR findings, haemodynamic data and complications were recorded prospectively. A locally optimized workflow was described and evaluated. RESULTS: Among the 35,862 patients referred for vasodilator stress CMR (mean age 68.9±11.8 years; 64.1% male), the stress CMR protocol was completed in 35,013 (97.6%) patients; 144 (0.3%) patients with missing baseline data were excluded. The mean examination duration was 27±5min, with image quality optimal in 90.8%, suboptimal in 7.1% and poor in 0.5% of cases. Images were diagnostic in 97.9% of patients. No patients died during or immediately after CMR. Fifty-six (0.16%) patients had severe complications. The incidence of non-severe complications was low (1.5%), whereas minor symptoms occurred frequently (35.5%). The presence of ischaemia was associated with a higher incidence of severe complications, non-severe complications and minor symptoms (all P<0.001). CONCLUSIONS: This single-centre prospective registry of>35,000 referral patients with known or suspected CAD showed that stress CMR was feasible in clinical routine practice, with high diagnostic image quality and an excellent safety profile. Inducible ischaemia was associated with severe complications, non-severe complications and minor symptoms.


Assuntos
Dipiridamol/administração & dosagem , Cardiopatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Imagem de Perfusão do Miocárdio , Vasodilatadores/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Circulação Coronária , Estudos de Viabilidade , Feminino , França , Cardiopatias/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sistema de Registros , Reprodutibilidade dos Testes , Função Ventricular , Fluxo de Trabalho
6.
Emerg Med Clin North Am ; 39(3): 509-527, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215400

RESUMO

Point-of-care ultrasound has become an essential part of pediatric emergency medicine training and practice. It can have significant clinical benefits, including improving diagnostic accuracy and decreasing length of stay, and does not require radiation exposure for patients. In this review, we summarize the current diagnostic point-of-care ultrasound applications in pediatric emergency medicine, their evidence, and techniques.


Assuntos
Medicina de Emergência Pediátrica , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Doenças Biliares/diagnóstico por imagem , Criança , Oftalmopatias/diagnóstico por imagem , Feminino , Avaliação Sonográfica Focada no Trauma , Doenças da Vesícula Biliar/diagnóstico por imagem , Gastroenteropatias/diagnóstico por imagem , Doenças dos Genitais Femininos/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Humanos , Nefropatias/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Masculino , Gravidez , Torção do Cordão Espermático/diagnóstico por imagem , Doenças da Bexiga Urinária/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem
7.
J Cardiothorac Surg ; 16(1): 164, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099012

RESUMO

BACKGROUND: Intracardiac blood cysts are very rare primary cardiac tumors. Blood cysts originated from the mitral valve represent a minority of cases, and previous cases have been mainly treated with conventional surgery through median sternotomy. When the tumor involves heart valves and histopathological diagnosis remains unknown preoperatively, minimally invasive surgical resection of an intracardiac tumor can be challenging, especially through an endoscopic approach. We herein present the first case of successful surgical resection for a rare mitral valve originated blood cyst in a minimally invasive, totally thoracoscopic approach. CASE PRESENTATION: An apparently healthy 38-year-old male presented to his local hospital with six months history of palpitation and exertional dyspnea. Transthoracic echocardiography showed a mobile round cystic mass inside the left ventricle, attached to the anterolateral papillary muscle and chordae tendineae of the mitral valve. The local doctor diagnosed an intracardiac tumor and suggested a surgical resection through median sternotomy. However, the patient refused to have a sternotomy. He was then referred to us seeking minimally invasive surgery. We assessed the location, appearance and relationship to nearby structures of the tumor with echocardiography, and made a diagnosis of a suspected primary cystic intracardiac tumor. Since we had enough experience of totally endoscopic mitral surgery, our surgical plan was to resect the tumor in the aid of thoracoscopy, and manage the possible deformation and dysfunction of the cardiac structure if necessary. Using femoro-femoral cannulation and cardiopulmonary bypass, we successfully resected the tumor through a thoracoscopic approach in a closed chest, and well preserved the subvalvular structure and valvular function. Postoperative recovery was quick and uneventful. Pathologic diagnosis confirmed a simple blood cyst. CONCLUSIONS: Surgical resection is warranted for symptomatic cases of intracardiac blood cysts. With prudent preoperative diagnosis and comprehensive surgical plan, we believe the thoracoscopic approach is a safe, curative and viable alternative for complete resection of cardiac valvular tumors.


Assuntos
Cistos/cirurgia , Cardiopatias/cirurgia , Valva Mitral/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/métodos , Adulto , Cistos/diagnóstico por imagem , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Humanos , Masculino , Valva Mitral/diagnóstico por imagem
8.
J Cardiovasc Pharmacol Ther ; 26(5): 399-414, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33949887

RESUMO

In the era of the coronavirus disease 2019 (COVID-19) pandemic, acute cardiac injury (ACI), as reflected by elevated cardiac troponin above the 99th percentile, has been observed in 8%-62% of patients with COVID-19 infection with highest incidence and mortality recorded in patients with severe infection. Apart from the clinically and electrocardiographically discernible causes of ACI, such as acute myocardial infarction (MI), other cardiac causes need to be considered such as myocarditis, Takotsubo syndrome, and direct injury from COVID-19, together with noncardiac conditions, such as pulmonary embolism, critical illness, and sepsis. Acute coronary syndromes (ACS) with normal or near-normal coronary arteries (ACS-NNOCA) appear to have a higher prevalence in both COVID-19 positive and negative patients in the pandemic compared to the pre-pandemic era. Echocardiography, coronary angiography, chest computed tomography and/or cardiac magnetic resonance imaging may render a correct diagnosis, obviating the need for endomyocardial biopsy. Importantly, a significant delay has been recorded in patients with ACS seeking advice for their symptoms, while their routine care has been sharply disrupted with fewer urgent coronary angiographies and/or primary percutaneous coronary interventions performed in the case of ST-elevation MI (STEMI) with an inappropriate shift toward thrombolysis, all contributing to a higher complication rate in these patients. Thus, new challenges have emerged in rendering a diagnosis and delivering treatment in patients with ACI/ACS in the pandemic era. These issues, the various mechanisms involved in the development of ACI/ACS, and relevant current guidelines are herein reviewed.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , COVID-19/epidemiologia , Infarto do Miocárdio/epidemiologia , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Fatores Etários , COVID-19/mortalidade , Técnicas de Imagem Cardíaca , Diagnóstico Diferencial , Cardiopatias/diagnóstico por imagem , Cardiopatias/epidemiologia , Humanos , Mediadores da Inflamação/metabolismo , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/mortalidade , SARS-CoV-2 , Fatores Sexuais , Estresse Psicológico/epidemiologia , Tempo para o Tratamento , Troponina I/sangue
9.
Echocardiography ; 38(6): 982-992, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33982820

RESUMO

Artificial intelligence and machine learning approaches have become increasingly applied in the field of echocardiography to streamline diagnostic and prognostic assessments, and to support treatment decisions. Artificial intelligence and machine learning have been applied to aid image acquisition and automation. They have also been applied to the integration of clinical and imaging data. Applications of artificial intelligence and machine learning approaches in echocardiography in conjunction with health information databases may be promising in improving the classification and treatment of many cardiac conditions. This review article provides an overview of the applications of artificial intelligence and machine learning approaches in echocardiography.


Assuntos
Inteligência Artificial , Cardiopatias , Automação , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Humanos , Aprendizado de Máquina
10.
Curr Cardiol Rep ; 23(6): 65, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33961140

RESUMO

PURPOSE OF REVIEW: In this review, we summarize the major known cardiac toxicities of common chemotherapeutic agents and the role of nuclear cardiac imaging for the surveillance and assessment of cancer therapeutics-related cardiac dysfunction in routine clinical practice. RECENT FINDINGS: Cardiotoxicity from chemotherapy causes a significant mortality and limits potentially life-saving treatment in cancer patients. Close monitoring of cardiac function during chemotherapy is an accepted method for reducing these adverse effects especially in patients with cancer therapeutics-related cardiac dysfunction. Nuclear imaging is a sensitive, specific, and highly reproducible modality for assessment of cardiac function. Nuclear imaging techniques including equilibrium radio nucleotide angiography, myocardial perfusion imaging, and novel experimental molecular imaging are the various objective tools available in addition to conventional echocardiography and cardiac magnetic resonance imaging in the surveillance, assessment, and follow-up of cancer therapeutics-related cardiac dysfunction.


Assuntos
Antineoplásicos , Cardiopatias , Neoplasias , Antineoplásicos/efeitos adversos , Cardiotoxicidade/diagnóstico por imagem , Cardiotoxicidade/etiologia , Ecocardiografia , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico por imagem , Humanos , Neoplasias/tratamento farmacológico
11.
J Cardiovasc Magn Reson ; 23(1): 47, 2021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33896419

RESUMO

BACKGROUND: Cardiovascular magnetic resonance (CMR) sequences are commonly used to obtain a complete description of the function and structure of the heart, provided that accurate measurements are extracted from images. New methods of extraction of information are being developed, among them, deep neural networks are powerful tools that showed the ability to perform fast and accurate segmentation. Iq1n order to reduce the time spent by reading physicians to process data and minimize intra- and inter-observer variability, we propose a fully automatic multi-scan CMR image analysis pipeline. METHODS: Sequence specific U-Net 2D models were trained to perform the segmentation of the left ventricle (LV), right ventricle (RV) and aorta in cine short-axis, late gadolinium enhancement (LGE), native T1 map, post-contrast T1, native T2 map and aortic flow sequences depending on the need. The models were trained and tested on a set of data manually segmented by experts using semi-automatic and manual tools. A set of parameters were computed from the resulting segmentations such as the left ventricular and right ventricular ejection fraction (EF), LGE scar percentage, the mean T1, T1 post, T2 values within the myocardium, and aortic flow. The Dice similarity coefficient, Hausdorff distance, mean surface distance, and Pearson correlation coefficient R were used to assess and compare the results of the U-Net based pipeline with intra-observer variability. Additionally, the pipeline was validated on two clinical studies. RESULTS: The sequence specific U-Net 2D models trained achieved fast (≤ 0.2 s/image on GPU) and precise segmentation over all the targeted region of interest with high Dice scores (= 0.91 for LV, = 0.92 for RV, = 0.93 for Aorta in average) comparable to intra-observer Dice scores (= 0.86 for LV, = 0.87 for RV, = 0.95 for aorta flow in average). The automatically and manually computed parameters were highly correlated (R = 0.91 in average) showing results superior to the intra-observer variability (R = 0.85 in average) for every sequence presented here. CONCLUSION: The proposed pipeline allows for fast and robust analysis of large CMR studies while guaranteeing reproducibility, hence potentially improving patient's diagnosis as well as clinical studies outcome.


Assuntos
Cardiopatias/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Imagem Cinética por Ressonância Magnética , Automação , Estudos de Casos e Controles , Aprendizado Profundo , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Humanos , Miocárdio/patologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Volume Sistólico , Função Ventricular Esquerda , Função Ventricular Direita
13.
Gen Thorac Cardiovasc Surg ; 69(7): 1147-1150, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33846933

RESUMO

Cardiac echinococcosis is a rare manifestation of Echinococcus infection, affecting 0.5-2% of the patients. Since it may be a life-threatening condition, surgical treatment should be always considered. Herein, here we present a case of a 66-year-old male with chest pain. Subsequent exams confirmed the diagnosis of multiple cardiac hydatic cysts. The patient initiated treatment with albendazole and was submitted to a surgical resection with cardiopulmonary bypass. A complete surgical resection was achieved, and patient remains asymptomatic without disease signs of recurrence on imaging exams. We highlight the necessity of cardiac screening in echinococcosis cases and the surgical management in this case.


Assuntos
Cistos , Equinococose , Cardiopatias , Idoso , Dor no Peito , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Masculino , Recidiva Local de Neoplasia
14.
Am J Med Sci ; 361(6): 786-790, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33892916

RESUMO

Pulmonary embolism (PE) is considered a major cause of morbidity and mortality in both inpatient and outpatient settings. PE can be presented in different clinical pictures. However, the association between PE and right atrial thrombus is not frequently reported. PE is categorized based on size, location and clinical presentation. Although management changes between different PE sub-types, optimal medical therapy is not well established for coexisting PE with right atrial thrombus. Herein, we present a unique case of a 58-year-old male with bilateral PE and atrial thrombus, with no known underlying risk factors.


Assuntos
Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Trombose/complicações , Trombose/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Cardiopatias/tratamento farmacológico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Trombose/tratamento farmacológico
15.
J Stroke Cerebrovasc Dis ; 30(6): 105731, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33751990

RESUMO

OBJECTIVES: The present study investigated the potential usefulness of delayed-phase, low-dose, non-gated, chest spectral CT scans (DSCT) for the early triage of cardioembolic (CE) sources in patients admitted with acute ischemic stroke (AIS), and for the simultaneous detection of myocardial disease and thrombotic complications. MATERIAL AND METHODS: Since July 2020 and promoted by the COVID-19 pandemic, we implemented the use of DSCT after cerebrovascular CT angiography (CTA) among patients with AIS using a dual-layer spectral CT. We explored the presence of CE sources, as well as late myocardium iodine enhancement (LIE) and pulmonary thromboembolism. Among patients further undergoing transesophageal echocardiogram (TEE) or cardiac CTA, we explored the diagnostic performance. RESULTS: Fifty consecutive patients with AIS who underwent DSCT after cerebrovascular CTA comprised the patient population. The confidence degree for excluding cardiac thrombi was significantly higher than for LIE (4.4±0.8 vs. 3.4±1.3, p<0.0001). DSCT identified a CE source in 4 (8%) and LIE in 24 (48%) patients. The iodine ratio of CE sources was significantly lower compared to the left atrial appendage of patients with no CE sources (0.25±0.1 mg/mL vs. 0.91±0.2 mg/mL, p<0.0001). TEE/cardiac CT, performed in 20 (40%) patients, identified a CE source in 5 (25%) cases, whereas DSCT identified 4 (20%), leading to a sensitivity and specificity of 80% (95% CI 28-99%) and 100% (95% CI 78-100%) respectively (kappa 0.86). CONCLUSIONS: In this pilot study, we identified DSCT as a potential unsophisticated approach for the early triage of CE sources among patients with AIS undergoing CTA upon admission.


Assuntos
Embolia/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , AVC Isquêmico/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Triagem/métodos , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Ecocardiografia Transesofagiana , Embolia/terapia , Feminino , Cardiopatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Admissão do Paciente , Projetos Piloto , Estudos Prospectivos , Sensibilidade e Especificidade , Tórax
16.
Clin Radiol ; 76(6): 471.e17-471.e25, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33663913

RESUMO

AIM: To investigate the value of motion-corrected (MOCO) phase-sensitive inversion recovery (PSIR) late gadolinium enhancement (LGE) compared with single-shot balanced steady-state gradient echo ("TrueFISP", Siemens) PSIR in free breathing paediatric patients. MATERIALS AND METHODS: In this retrospective study, 238 paediatric patients underwent clinical contrast-enhanced cardiovascular magnetic resonance imaging (CMRI). Both the single-shot TrueFISP PSIR and MOCO PSIR sequences were performed on each child. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Two radiologists rated the quality of the images on a scale of 1-5 (1 = poor, 5 = very good). Bland-Altman, linear regression, and intraclass correlation coefficient were used to compared the extent of LGE of the single-shot TrueFISP PSIR and MOCO PSIR. Imaging artefacts were described and compared. RESULTS: Children ranged in age from 60 days to 17 years with an average age of 8.1 ± 3.8 years. MOCO PSIR had higher SNR and CNR than the single-shot TrueFISP PSIR (p<0.001). Mean quality ratings for short-axis imaging were 4 (interquartile range, 3-4) for single-shot TrueFISP PSIR and 4 (interquartile range, 4-5) for MOCO PSIR (p<0.001). The scan time was faster for single-shot TrueFISP PSIR than for MOCO PSIR. The myocardial LGE results were similar with high agreement between the single-shot TrueFISP PSIR and MOCO PSIR (ICC = 0.955-0.986). CONCLUSION: The MOCO PSIR sequence is feasible in children. MOCO PSIR is robust at high heart rates and can be performed without breath-holding with higher image-quality ratings than the single-shot TrueFISP PSIR.


Assuntos
Meios de Contraste , Gadolínio , Cardiopatias/diagnóstico por imagem , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Coração/diagnóstico por imagem , Humanos , Lactente , Masculino , Respiração , Estudos Retrospectivos
17.
J Cardiovasc Magn Reson ; 23(1): 23, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33691727

RESUMO

BACKGROUND: Secondary hyperparathyroidism is a common complication of end-stage renal disease (ESRD), which may be associated with cardiovascular diseases. Thus, this study aimed to explore myocardial damage using non-contrast cardiovascular magnetic resonance (CMR) in ESRD patients undergoing hemodialysis and further investigate its relationship with parathyroid hormone (PTH) toxicity. METHODS: Seventy-two adult ESRD patients receiving regular hemodialysis and 30 healthy subjects underwent CMR examination. Continuous CMR cine sections from the mitral valve level to the left ventricular (LV) apex in the short-axis plane, cine series of vertical two-chamber long-axis plane, and horizontal four-chamber plane were acquired. Native T1 mapping was obtained using modified Look-Locker inversion recovery (MOLLI) sequences. Native T1 values and myocardial strain were analyzed.  Immunoreactive parathyroid hormone (iPTH) was obtained from all enrolled patients. RESULTS: Forty (55.6%) hemodialysis ESRD patients were found to have increased iPTH levels. LV ejection fraction (LVEF) of both ESRD patients with targeted and increased iPTH levels was decreased compared with healthy subjects (55.9 ± 12.0% vs. 65.0 ± 4.5%; 51.7 ± 12.8 vs. 65.0 ± 4.5%, both P < 0.05). The mean peak radial strain (PRS), peak circumferential strain (PCS), and peak longitudinal strain (PLS) were lowest in ESRD patients with increased iPTH; however, no significant difference was observed among these three groups. Segmentally, from base to apex, the native T1 of ESRD patients with increased iPTH levels tended to be higher than those with targeted iPTH and healthy subjects (all P < 0.05). In ESRD patients with targeted iPTH, both native T1 of basal and middle segments were significantly higher than normal subjects (basal, 1304 ± 41 ms vs. 1238 ± 36 ms, P = 0.001; middle, 1300 ± 43 ms vs. 1242 ± 50 ms, P < 0.001). Comparing global native T1 values in the three groups, ESRD patients with targeted and increased iPTH level showed increased native T1 (1305 ± 41 ms vs. 1251 ± 49 ms, P = 0.001; 1334 ± 40 ms vs. 1251 ± 49 ms, P < 0.001, respectively). Native T1 values of the basal segment and global native T1 were moderately associated with iPTH (r = 0.4, P < 0.001; r = 0.5, P < 0.001). Multiple linear regression analysis showed that global native T1 values (beta = 1.0, P = 0.01) were independently associated with iPTH. CONCLUSIONS: Elevated iPTH level was associated with and was an independent risk factor for myocardial damage in ESRD patients undergoing maintenance hemodialysis. TRIAL REGISTRATION: Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ) ChiCTR-DND-17012976, 13/12/2017, retrospectively registered.


Assuntos
Cardiopatias/diagnóstico por imagem , Hiperparatireoidismo Secundário/sangue , Falência Renal Crônica/terapia , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Hormônio Paratireóideo/sangue , Diálise Renal , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Cardiopatias/etiologia , Cardiopatias/patologia , Cardiopatias/fisiopatologia , Humanos , Hiperparatireoidismo Secundário/diagnóstico , Hiperparatireoidismo Secundário/etiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Diálise Renal/efeitos adversos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima , Função Ventricular Esquerda
18.
J Cardiovasc Magn Reson ; 23(1): 20, 2021 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-33691739

RESUMO

BACKGROUND: Cardiovascular magnetic resonance (CMR) cine displacement encoding with stimulated echoes (DENSE) measures heart motion by encoding myocardial displacement into the signal phase, facilitating high accuracy and reproducibility of global and segmental myocardial strain and providing benefits in clinical performance. While conventional methods for strain analysis of DENSE images are faster than those for myocardial tagging, they still require manual user assistance. The present study developed and evaluated deep learning methods for fully-automatic DENSE strain analysis. METHODS: Convolutional neural networks (CNNs) were developed and trained to (a) identify the left-ventricular (LV) epicardial and endocardial borders, (b) identify the anterior right-ventricular (RV)-LV insertion point, and (c) perform phase unwrapping. Subsequent conventional automatic steps were employed to compute strain. The networks were trained using 12,415 short-axis DENSE images from 45 healthy subjects and 19 heart disease patients and were tested using 10,510 images from 25 healthy subjects and 19 patients. Each individual CNN was evaluated, and the end-to-end fully-automatic deep learning pipeline was compared to conventional user-assisted DENSE analysis using linear correlation and Bland Altman analysis of circumferential strain. RESULTS: LV myocardial segmentation U-Nets achieved a DICE similarity coefficient of 0.87 ± 0.04, a Hausdorff distance of 2.7 ± 1.0 pixels, and a mean surface distance of 0.41 ± 0.29 pixels in comparison with manual LV myocardial segmentation by an expert. The anterior RV-LV insertion point was detected within 1.38 ± 0.9 pixels compared to manually annotated data. The phase-unwrapping U-Net had similar or lower mean squared error vs. ground-truth data compared to the conventional path-following method for images with typical signal-to-noise ratio (SNR) or low SNR (p < 0.05), respectively. Bland-Altman analyses showed biases of 0.00 ± 0.03 and limits of agreement of - 0.04 to 0.05 or better for deep learning-based fully-automatic global and segmental end-systolic circumferential strain vs. conventional user-assisted methods. CONCLUSIONS: Deep learning enables fully-automatic global and segmental circumferential strain analysis of DENSE CMR providing excellent agreement with conventional user-assisted methods. Deep learning-based automatic strain analysis may facilitate greater clinical use of DENSE for the quantification of global and segmental strain in patients with cardiac disease.


Assuntos
Aprendizado Profundo , Cardiopatias/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador , Imagem Cinética por Ressonância Magnética , Função Ventricular Esquerda , Função Ventricular Direita , Automação , Estudos de Casos e Controles , Cardiopatias/fisiopatologia , Humanos , Londres , Valor Preditivo dos Testes , Estados Unidos
19.
Theranostics ; 11(10): 4710-4727, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33754023

RESUMO

Background: Telomere shortening and dysfunction may cause metabolic disorders, tissue damage and age-dependent pathologies. However, little is known about the association of telomere-associated protein Rap1 with mitochondrial energy metabolism and cardiac aging. Methods: Echocardiography was performed to detect cardiac structure and function in Rap1+/+ and Rap1-/- mice at different ages (3 months, 12 months and 20 months). Telomere length, DNA damage, cardiac senescence and cardiomyocyte size were analyzed using the real-time PCR, Western blotting, senescence associated ß-galactosidase assay and wheat germ agglutinin staining, respectively. Western blotting was also used to determine the level of cardiac fatty acid metabolism related key enzymes in mouse and human myocardium. Chromatin immunoprecipitation assay was used to verify the direct link between p53 and PPARα. The p53 inhibitor, Pifithrin-α and PPARα activator WY14643 were utilized to identify the effects of Rap1/p53/PPARα signaling pathway. Results: Telomere was shortened concomitant with extensive DNA damage in aged Rap1-/- mouse hearts, evidenced by reduced T/S ratios and increased nuclear γH2AX. Meanwhile, the aging-associated phenotypes were pronounced as reflected by altered mitochondrial ultrastructure, enhanced senescence, cardiac hypertrophy and dysfunction. Mechanistically, acetylated p53 and nuclear p53 was enhanced in the Rap1-/- mouse hearts, concomitant with reduced PPARα. Importantly, p53 directly binds to the promoter of PPARα in mouse hearts and suppresses the transcription of PPARα. In addition, aged Rap1-/- mice exhibited reduced cardiac fatty acid metabolism. Pifithrin-α alleviated cardiac aging and enhanced fatty acid metabolism in the aged Rap1-/- mice. Activating PPARα with WY14643 in primarily cultured Rap1-/- cardiomyocytes restored maximal oxygen consumption rates. Reduced Rap1 expression and impaired p53/PPARα signaling also presented in aged human myocardium. Conclusion: In summary, Rap1 may link telomere biology to fatty acid metabolism and aging-related cardiac pathologies via modulating the p53/PPARα signaling pathway, which could represent a therapeutic target in preventing/attenuating cardiac aging.


Assuntos
Envelhecimento/genética , Cardiomegalia/genética , Senescência Celular/genética , Miócitos Cardíacos/metabolismo , PPAR alfa/genética , Proteínas de Ligação a Telômeros/genética , Proteína Supressora de Tumor p53/genética , Animais , Benzotiazóis/farmacologia , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/fisiopatologia , Dano ao DNA , Ecocardiografia , Ácidos Graxos/metabolismo , Cardiopatias/diagnóstico por imagem , Cardiopatias/genética , Cardiopatias/fisiopatologia , Histonas/metabolismo , Camundongos , Camundongos Knockout , Mitocôndrias Cardíacas/metabolismo , Mitocôndrias Cardíacas/ultraestrutura , Teste de Campo Aberto , PPAR alfa/metabolismo , Proliferadores de Peroxissomos/farmacologia , Pirimidinas/farmacologia , Transdução de Sinais , Telômero/metabolismo , Homeostase do Telômero , Proteínas de Ligação a Telômeros/metabolismo , Tolueno/análogos & derivados , Tolueno/farmacologia , Proteína Supressora de Tumor p53/antagonistas & inibidores , Proteína Supressora de Tumor p53/metabolismo
20.
Cerebrovasc Dis ; 50(4): 429-434, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33784670

RESUMO

BACKGROUND: To validate the hypothesis that cryptogenic stroke with multiple infarcts included embolic stroke due to left atrial appendage (LAA) dysfunction, the present retrospective observational study was aimed to clarify the association between LAA flow velocity (LAA-FV) and multiple infarcts in patients with cryptogenic stroke. METHODS: From consecutive patients with cryptogenic stroke admitted to our hospital within 7 days after onset, patients without brain magnetic resonance imaging (MRI) on admission or without transesophageal echocardiography (TEE) during acute hospitalization were excluded, and the remaining patients were enrolled. Multiplicity of fresh infarcts was assessed using diffusion-weighted images from brain MRI. LAA-FV was defined as LAA peak emptying flow velocity on TEE. RESULTS: Of 786 enrolled patients, 522 patients (66%) had a single infarct, and the remaining 264 patients (34%) had multiple infarcts. The percentage of multiple infarcts decreased with increasing quartiles of LAA-FV (p for trend <0.001). The adjusted odds ratio for multiple infarcts decreased with increasing quartiles of LAA-FV (adjusted odds ratio in the fourth quartile, 0.39; 95% confidence interval, 0.25-0.60; compared with the first quartile). LAA-FV as a continuous variable was negatively associated with multiple infarcts (adjusted odds ratio per 10 cm/s, 0.87; 95% confidence interval, 0.81-0.92). CONCLUSIONS: Reduced LAA-FV on TEE was associated with multiple infarcts in patients with cryptogenic stroke. The present findings indicate that cryptogenic stroke with multiple infarcts includes embolic stroke due to LAA dysfunction.


Assuntos
Apêndice Atrial/fisiopatologia , Função do Átrio Esquerdo , AVC Embólico/etiologia , Cardiopatias/complicações , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/diagnóstico por imagem , Ecocardiografia Doppler de Pulso , Ecocardiografia Transesofagiana , AVC Embólico/diagnóstico por imagem , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
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