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1.
Radiol Clin North Am ; 58(1): 151-165, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731898

RESUMO

Patients hospitalized in the intensive care unit (ICU) often have multiple support lines and devices that need routine imaging evaluation by radiologists. In patients with cardiogenic shock or depressed cardiac function, mechanical circulation support devices are used in combination with medical therapies to improve patient outcomes and sometimes can stabilize patients for surgical intervention. This article discusses some of the more commonly encountered mechanical circulation devices seen in ICU patients, including intra-aortic balloon pumps, Impella devices, extracorporeal membrane oxygenation cannulas, and ventricular assist devices. Normal appearance and commonly encountered device-related complications that can be diagnosed on imaging are reviewed.


Assuntos
Oxigenação por Membrana Extracorpórea/instrumentação , Coração Auxiliar , Coração/diagnóstico por imagem , Balão Intra-Aórtico/instrumentação , Tomografia Computadorizada por Raios X/métodos , Cuidados Críticos/métodos , Humanos , Radiografia/métodos
2.
Radiol Clin North Am ; 58(1): 93-103, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31731905

RESUMO

This article describes an approach to analyzing the distribution of intravenous contrast on chest computed tomography and illustrates the various pathologies and pitfalls that may be encountered by the imager, especially in the hospitalized patient. Understanding normal and abnormal distribution of intravenous contrast can be used as a clue to detect alterations in physiology and flow.


Assuntos
Meios de Contraste , Cardiopatias/diagnóstico por imagem , Pacientes Internados , Embolia Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X/métodos , Coração/diagnóstico por imagem , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Radiografia Torácica/métodos
3.
Undersea Hyperb Med ; 46(5): 633-634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683361

RESUMO

A 54-year-old man suffered a leg cramp while diving in the ocean at a depth of 20 meters. He began to surface, with his ascent based on a decompression table. He lost consciousness at the surface and was rescued by a nearby boat. The boat staff judged him to be in cardiac arrest, so they performed chest compressions. When the boat reached port where an ambulance was waiting, emergency medical technicians confirmed that the patient was in cardiac arrest; his initial rhythm was asystole. Treated with basic life support, the patient was then transported to a rendezvous point, where a physician-staffed helicopter waited. The patient remained in cardiac arrest, so the staff of the helicopter performed tracheal intubation with mechanical ventilation, securing a venous route, infusion of adrenaline, and mechanical chest compression. On arrival at our hospital 100 minutes after collapse, he remained in cardiac arrest. Continued advanced cardiac life support failed to obtain spontaneous circulation. Whole-body computed tomography (CT) at 120 minutes after the collapse showed multiple gas bubbles in the heart, aorta, inferior vena cava, cerebral artery, coronary artery and portal vein with lung edema. This is the first case to show gas in the bilateral coronary arteries on CT. The present case clearly demonstrates that decompression sickness can also induce acute coronary syndrome.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Doença da Descompressão/complicações , Embolia Aérea/diagnóstico por imagem , Síndrome Coronariana Aguda/etiologia , Aorta/diagnóstico por imagem , Reanimação Cardiopulmonar/métodos , Mergulho/efeitos adversos , Embolia Aérea/etiologia , Evolução Fatal , Coração/diagnóstico por imagem , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
4.
Br J Radiol ; 92(1104): 20190634, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31613647

RESUMO

OBJECTIVE: The aim of this study was to examine the local myocardial segments in hypertrophic cardiomyopathy (HCM) by MRI T1 and T2 mapping, and to investigate how tissue remodeling correlates with structural and functional remodeling in HCM. METHODS: 47 patients with HCM and 19 healthy volunteers were enrolled in this study. All subjects underwent cardiac MRI at 3.0 T. Native T1 and T2 values, end-diastolic wall thickness (EDTH), and percentage of systolic wall thickening (PSWT) were assessed in the left ventricular segments according to the American Heart Association model. Myocardial segments were categorized as normal, non-hypertrophic, mild-hypertrophic, moderate-hypertrophic, and severe-hypertrophic based on EDTH. The difference among all five groups, and the correlation between native T1 and T2 values, EDTH, and PSWT were evaluated. RESULTS: Native T1 and T2 values were significantly elevated in both non-hypertrophic and hypertrophic segments of HCM patients compared to controls (both p < 0.001). PSWT was preserved in non-hypertrophic segments (p = 0.838), while significantly impaired (p < 0.001) in hypertrophic segments. Native T1 value of severe hypertrophic segments in HCM was significantly higher than segments of mild and moderate hypertrophy (p < 0.05). CONCLUSION: In HCM patients, the non-hypertrophic myocardial segments already demonstrated significantly elevated T1 and T2 values, despite normal wall thickness and preserved contraction function. The finding suggests that tissue remodeling may precede morphological and functional remodeling in HCM. MRI native T1 and T2 mapping can provide additional value for HCM diagnosis at an early stage. ADVANCES IN KNOWLEDGE: Myocardial tissue remodeling, as detected by MRI native T1 and T2 mapping, occurs earlier than morphological and functional changes in HCM patients.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Coração/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Miocárdio/patologia , Adulto , Cardiomiopatia Hipertrófica/patologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
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
6.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 461-465, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642219

RESUMO

Cardiac magnetic resonance (CMR) is a non-invasive imaging technology, which has been used widely in clinical and basic researches on cardiovascular disease in recent years. With the innovation and optimization of CMR technologies, significant progress has been developed in the evaluation of myocardial viability, the function of regions and global myocardium, and the myocardial texture characteristics. Therefore, with the discussion on the progress of CMR to draw more and more attention in clinics, we hope to improve the application of CMR not only in the basic research but also in the diagnosis and precise evaluation aspects of cardiovascular disease.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Imagem por Ressonância Magnética , Meios de Contraste , Coração/diagnóstico por imagem , Humanos , Miocárdio
7.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 478-482, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642222

RESUMO

OBJECTIVE: To determine the potential value of the two-dimensional (2D) cardiac magnetic resonance imaging (CMR) tissue tracking (CMR-TT) method in assessing the cardiac function of tree shrew at 7T. METHODS: Healthy adult tree shrews (male, n=8) and spraguedawley rats(male, n=8) were selected for this study. CMR was performed to acquire the short-axis images of left ventricle at 7T using the same appropriative coil and cine sequence for all experimental animals. The CMR images were processed using the professional cardiac analysis software, calculating ejection fraction (EF), radial peak sysolic strain (Err), circumferential peak sysolic strain (Ecc), radial peak sysolic displacement (DR), and LVM/BM 〔the ratio of left ventricular mass (LVM) to body mass (BM)〕. RESULTS: Cine imaging for the tree shrews was 100% successful following the CMR protocol for the rats, with clearly visible main segments of cardiac. Significant differences in EF, Err, Ecc and DR were found between the two groups of animals (P < 0.01). The tree shrews has lower EF, Err and Ecc than the rats. Err and Ecc appeared in the fifteenth phase in left ventriclar systole in the tree shrews, compared with the tenth phase in the rats.The tree shrews also had higher LVM/BM than the rats. CONCLUSION: The cardiac function of tree shrew can be assessed using the 2D CMR-TT method despite significant differences across species.


Assuntos
Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Tupaiidae , Função Ventricular Esquerda , Animais , Imagem por Ressonância Magnética , Masculino , Ratos , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Volume Sistólico , Sístole
8.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 494-499, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642225

RESUMO

OBJECTIVE: To determine the myocardial texture features of cardiac magnetic resonance (CMR) in healthy adult Han populations. METHODS: 59 healthy Han volunteers were recruited for this study from May 2016 to November 2017. CMR examinations were performed on the participants with a 3.0T scanner (Tim Trio, Siemens Medical Solution) to estimate the functional parameters, Native T1 value and ECV. Texture analysis (TA) was performed on the region of interest (ROI) in the left ventricle myocardium on T1 mapping images, with 40 myocardial texture features being extracted. Differences in the myocardial texture features across gender and age groups were analyzed through Student's t-tests or Wilcoxon signed-rank tests. Spearman correlations were analyzed between the myocardial texture features and age, native T1 value and extracellular volume (ECV). RESULTS: Of the 59 participants, 28 were women and 29 were in the younger age group (< 45 years old). The male participants had higher left ventricular mass index (Lvmassi) and lower native T1 than their female counterparts (P < 0.01). No gender differences in blood pressure, heart rate, left ventricular ejection fraction (LVEF) and ECV values were found. Ten of the forty myocardial texture features showed gender differences, including two first order features and eight Grey-level co-occurrence matrix (GLCM) features. Gender differences appeared in five first order features and eight GLCM features in the younger group (< 45 years old), but not in the older group (≥45 years old). Eight myocardial texture features were correlated with age, including five first order features and three GLCM features (all P < 0.01). Six first-order texture features were correlated with Native T1 values of the left ventricle middle myocardium. Three first-order texture features were correlated with ECV. CONCLUSION: Myocardial texture features in T1 mapping images vary by gender and age in healthy Han populations.


Assuntos
Coração/diagnóstico por imagem , Miocárdio , Função Ventricular Esquerda , Adulto , Fatores Etários , Meios de Contraste , Feminino , Voluntários Saudáveis , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores Sexuais
9.
Orv Hetil ; 160(43): 1711-1713, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31630552

RESUMO

A 42-year-old man is presented with acute coronary syndrome and De Winter ECG sign. The De Winter sign is a rare ECG manifestation of proximal LAD occlusion. The ECG sign was misinterpreted and the patient was transmitted to our percutan coronaria intervention centrum with 3 hours delay. The hyperacute T-waves and the precordial ST-depressions disappeared, but the biomarkers showed a marked elevation. Coronary angiography revealed LAD proximal thrombotic dissection treated with a drug-eluting stent. The authors suggest that in patients with this ECG pattern the immediate coronary intervention is the best treatment. Orv Hetil. 2019; 160(43): 1711-1713.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Angiografia Coronária/métodos , Stents Farmacológicos/efeitos adversos , Eletrocardiografia/métodos , Adulto , Coração/diagnóstico por imagem , Humanos , Masculino
10.
Medicine (Baltimore) ; 98(38): e17141, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567953

RESUMO

The aim of this study was to evaluate the application of transthoracic echocardiography for the diagnosis of infective endocarditis (IE) to provide a basis for the better treatment of IE. From October 2016 to October 2018, 87 consecutive patients with IE at our hospital were selected for this study. All the patients were subjected to transthoracic echocardiography. The morphology, structure, activity, and closure of the patients' heart valves were observed for vegetation identification, and the size, number, location, morphology, and echo intensity of vegetation, as well as degree of valve involvement, were determined.The 87 patients investigated in this study included 38 cases of congenital heart disease, 27 cases of nonrheumatic valvular heart disease, 12 patients who underwent valve surgery, 5 cases of rheumatic valvular heart disease, and 5 patients with no obvious signs of heart disease. The most common clinical manifestations were heart murmur in 80 cases and fever in 60 cases. The most common complications were heart failure in 35 cases, followed by organ embolism in 12 cases. There were 36 cases of positive blood cultures, including 26 cases of Gram-positive cocci and 10 cases of Gram-negative bacilli. Echocardiography showed aortic valve involvement in 37 cases, mitral valve involvement in 34 cases, tricuspid valve involvement in 10 cases, pulmonary valve involvement in 2 cases, and the involvement of an artificial valve in 5 cases. Twenty-six of these cases showed multiple valve involvement, and 20 patients exhibited serious complications. No significant differences were found between echocardiography and actual surgical observations with respect to their accuracy in detecting the size, number, and location of vegetation in the 69 patients who underwent surgery (P > .05). Echocardiography could detect the occurrence of severe complications, namely, the rupture of chordae tendineae, valve prolapse, valve perforation, and paravalvular abscess, and no significant difference in diagnostic accuracy was found between echocardiography and surgical observations (P > .05).Transthoracic echocardiography can rapidly and accurately detect IE vegetation and its complications and has important clinical value for guiding clinical treatment and determining prognosis.


Assuntos
Endocardite/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Ecocardiografia , Endocardite/diagnóstico , Endocardite/patologia , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Adulto Jovem
11.
Medicine (Baltimore) ; 98(38): e17256, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567998

RESUMO

RATIONALE: Cardiac amyloidosis, considered for the last years to be a rare disease, is one of the determinants of HFpEF. The non-specific clinical presentation and the difficulties related to endomyocardial biopsy have made cardiac amyloidosis an underdiagnosed clinical entity. Improvement of non-invasive diagnostic techniques and the development of new therapies increased clinical awareness for this form of restrictive cardiomyopathy. We here summarize echocardiography and Tc-HDP scintigraphy findings in 6 cases of cardiac amyloidosis and review the literature data of this progressive and fatal cardiomyopathy. PATIENTS CONCERNS: The main clinical manifestations were fatigue, low exercise tolerance and edemas. The right heart failure symptoms usually dominated the clinical picture. DIAGNOSES: All cases were evaluated by echocardiography; 3 cases were further examined by bone scintigraphy and 4 cases a peripheral biopsy was performed. Electrocardiography showed low-voltage QRS complexes and "pseudo-infarct" pattern in the precordial leads, contrary to the echocardiographic aspect, which revealed thickening of ventricle walls. Biatrial dilation and diastolic disfunction were observed. Impaired systolic function was detected in advanced stages of the disease. Tc-HDP scintigraphy revealed cardiac uptake of radiopharmaceutical and managed to confirm the diagnosis in 1 case of cardiac amyloidosis in which salivary gland biopsy was negative. INTERVENTIONS: The treatment was based on managing fluid balance, with the mainstream therapy represented by diuretics. Neurohormonal agents, usually used in heart failure treatment were avoided, due to poor tolerance and worsening of disease course. The management of these 6 cases was challenging due to the refractory manifestation of congestive heart failure. OUTCOMES: During follow-up, 4 of the 6 patients from the current study died in the first year after the final diagnosis was established. LESSONS: Nuclear imaging of cardiac amyloidosis has a revolutionary development nowadays. Bone scintigraphy presents promising results for identifying patients at early stages of disease and to differentiate between cardiac amyloidosis types. Further studies are necessary for the standardization of imaging protocol and development of non-invasive diagnostic tools, especially in assessing the response to treatment and disease progression, for which little is known.


Assuntos
Amiloidose/diagnóstico por imagem , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Cintilografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico , Amiloidose/patologia , Difosfonatos , Feminino , Coração/diagnóstico por imagem , Cardiopatias/diagnóstico , Cardiopatias/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Compostos de Organotecnécio
12.
Isr Med Assoc J ; 21(9): 603-606, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542905

RESUMO

BACKGROUND: With the recent introduction of high-sensitivity troponin (hsTn), the incremental benefit of stress myocardial perfusion imaging (MPI) in the evaluation of patients who present to the emergency department (ED) with acute coronary syndrome (ACS) is unclear. OBJECTIVES: To assess the added value of stress MPI in low-risk ACS patients with normal range hsTnI. METHODS: We analyzed all patients who were hospitalized at our medical center from February 2016 to November 2017, who presented with low-risk ACS and underwent stress MPI, and in whom hsTnI was in the normal range after the introduction of hsTnI. RESULTS: During the study period, 161 patients were admitted with a diagnosis of unstable angina (i.e., ACS with normal range hsTnI) and underwent stress MPI during index admission. The study population included 52/161 patients (31.7%) with low-risk ACS who had no indication for initial invasive strategy. No patients had positive MPI. One patient underwent coronary angiography due to suggestive history; however, he did not have a significant coronary artery disease and had no indication for percutaneous coronary intervention. CONCLUSIONS: In patients with low-risk ACS and normal range hsTnI without additional high-risk features, stress MPI has little additional value for the correct diagnosis and management. Prospective studies are warranted to confirm whether resting hsTnI could serve as a powerful triage tool in chest pain patients in the ED before diagnostic testing and thus, improve patient management.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Troponina/sangue , Idoso , Estudos de Coortes , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco
13.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31543951

RESUMO

Over the last 15 years, cardiovascular magnetic resonance (CMR) imaging has progressively evolved to become an indispensable tool in cardiology. It is a non-invasive technique that enables objective and functional assessment of myocardial tissue. Recent innovations in magnetic resonance imaging scanner technology and parallel imaging techniques have facilitated the generation of T1 and T2 parametric mapping to explore tissue characteristics. The emergence of strain imaging has enabled cardiologists to evaluate cardiac function beyond conventional metrics. Significant progress in computer processing capabilities and cloud infrastructure has supported the growth of artificial intelligence in CMR imaging. In this review article, we describe recent advances in T1/T2 mapping, myocardial strain, and artificial intelligence in CMR imaging.


Assuntos
Cardiopatias , Coração , Espectroscopia de Ressonância Magnética , Miocárdio , Coração/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Valor Preditivo dos Testes
14.
Hypertension ; 74(4): 826-832, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476911

RESUMO

We aimed to estimate the effects of a lifelong exposure to high systolic blood pressure (SBP) on left ventricular (LV) structure and function using Mendelian randomization. A total of 5596 participants of the UK Biobank were included for whom cardiovascular magnetic resonance imaging and genetic data were available. Major exclusion criteria included nonwhite ethnicity, major cardiovascular disease, and body mass index >30 or <18.5 kg/m2. A genetic risk score to estimate genetically predicted SBP (gSBP) was constructed based on 107 previously established genetic variants. Manual cardiovascular magnetic resonance imaging postprocessing analyses were performed in 300 individuals at the extremes of gSBP (150 highest and lowest). Multivariable linear regression analyses of imaging biomarkers were performed using gSBP as continuous independent variable. All analyses except myocardial strain were validated using previously derived imaging parameters in 2530 subjects. The mean (SD) age of the study population was 62 (7) years, and 52% of subjects were female. Corrected for age, sex, and body surface area, each 10 mm Hg increase in gSBP was significantly (P<0.0056) associated with 4.01 g (SE, 1.28; P=0.002) increase in LV mass and with 2.80% (SE, 0.97; P=0.004) increase in LV global radial strain. In the validation cohort, after correction for age, sex, and body surface area, each 10 mm Hg increase in gSBP was associated with 5.27 g (SE, 1.50; P<0.001) increase in LV mass. Our study provides a novel line of evidence for a causal relationship between SBP and increased LV mass and with increased LV global radial strain.


Assuntos
Pressão Sanguínea/fisiologia , Coração/fisiopatologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Idoso , Índice de Massa Corporal , Feminino , Coração/diagnóstico por imagem , Humanos , Hipertensão/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Análise da Randomização Mendeliana , Pessoa de Meia-Idade
15.
Internist (Berl) ; 60(11): 1209-1214, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31501912

RESUMO

BACKGROUND: Clozapine is an alternative antipsychotic medication used to control symptoms of schizophrenia and to reduce risks of suicidal behavior in patients who did not adequately respond to standard medication. Due to severe side effects including cardiomyopathy and myocarditis its clinical use is limited. CASE REPORT: A 31-year-old man of east European descent presented to the emergency medical department with fatigue, shortness of breath and chest pain. Due to a schizoaffective disorder he was treated with clozapine and lithium. Echocardiography revealed severely impaired left ventricular systolic function. After exclusion of coronary artery disease by coronary angiography an endomyocardial biopsy was performed according to the guidelines. This confirmed the clinically suspected toxic cardiomyopathy. Therefore, antipsychotic treatment was immediately changed and state of the art heart failure medication was started resulting in a clear improvement of left ventricular function. CONCLUSION: In patients treated with clozapine or lithium and clinical signs of heart failure, toxic cardiomyopathy should be considered.


Assuntos
Antipsicóticos/efeitos adversos , Cardiomiopatias/induzido quimicamente , Dor no Peito/etiologia , Clozapina/efeitos adversos , Dispneia/etiologia , Fadiga/etiologia , Transtornos Psicóticos/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Biópsia , Clozapina/uso terapêutico , Ecocardiografia , Coração/diagnóstico por imagem , Humanos , Masculino , Miocárdio/patologia , Resultado do Tratamento
16.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(4): 573-580, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31441257

RESUMO

Taking advantages of the sparsity or compressibility inherent in real world signals, compressed sensing (CS) can collect compressed data at the sampling rate much lower than that needed in Shannon's theorem. The combination of CS and low rank modeling is used to medical imaging techniques to increase the scanning speed of cardiac magnetic resonance (CMR), alleviate the patients' suffering and improve the images quality. The alternating direction method of multipliers (ADMM) algorithm is proposed for multiscale low rank matrix decomposition of CMR images. The algorithm performance is evaluated quantitatively by the peak signal to noise ratio (PSNR) and relative l 2 norm error (RLNE), with the human visual system and the local region magnification as the qualitative comparison. Compared to L + S, kt FOCUSS, k-t SPARSE SENSE algorithms, experimental results demonstrate that the proposed algorithm can achieve the best performance indices, and maintain the most detail features and edge contours. The proposed algorithm can encourage the development of fast imaging techniques, and improve the diagnoses values of CMR in clinical applications.


Assuntos
Algoritmos , Coração/diagnóstico por imagem , Imagem por Ressonância Magnética , Humanos , Razão Sinal-Ruído
18.
N Engl J Med ; 381(8): 739-748, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31433921

RESUMO

BACKGROUND: The role of assessment of myocardial viability in identifying patients with ischemic cardiomyopathy who might benefit from surgical revascularization remains controversial. Furthermore, although improvement in left ventricular function is one of the goals of revascularization, its relationship to subsequent outcomes is unclear. METHODS: Among 601 patients who had coronary artery disease that was amenable to coronary-artery bypass grafting (CABG) and who had a left ventricular ejection fraction of 35% or lower, we prospectively assessed myocardial viability using single-photon-emission computed tomography, dobutamine echocardiography, or both. Patients were randomly assigned to undergo CABG and receive medical therapy or to receive medical therapy alone. Left ventricular ejection fraction was measured at baseline and after 4 months of follow-up in 318 patients. The primary end point was death from any cause. The median duration of follow-up was 10.4 years. RESULTS: CABG plus medical therapy was associated with a lower incidence of death from any cause than medical therapy alone (182 deaths among 298 patients in the CABG group vs. 209 deaths among 303 patients in the medical-therapy group; adjusted hazard ratio, 0.73; 95% confidence interval, 0.60 to 0.90). However, no significant interaction was observed between the presence or absence of myocardial viability and the beneficial effect of CABG plus medical therapy over medical therapy alone (P = 0.34 for interaction). An increase in left ventricular ejection fraction was observed only among patients with myocardial viability, irrespective of treatment assignment. There was no association between changes in left ventricular ejection fraction and subsequent death. CONCLUSIONS: The findings of this study do not support the concept that myocardial viability is associated with a long-term benefit of CABG in patients with ischemic cardiomyopathy. The presence of viable myocardium was associated with improvement in left ventricular systolic function, irrespective of treatment, but such improvement was not related to long-term survival. (Funded by the National Institutes of Health; STICH ClinicalTrials.gov number, NCT00023595.).


Assuntos
Ponte de Artéria Coronária , Coração/fisiologia , Isquemia Miocárdica/cirurgia , Volume Sistólico , Idoso , Ecocardiografia sob Estresse , Feminino , Seguimentos , Coração/diagnóstico por imagem , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Função Ventricular Esquerda
19.
Am J Vet Res ; 80(9): 840-845, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31449449

RESUMO

OBJECTIVE: To evaluate and report measurements of the radiographic cardiac silhouette of healthy juvenile and adult ospreys (Pandion haliaetus). ANIMALS: 54 ospreys (22 adults, 19 juveniles, and 13 birds of undetermined age) without clinical signs of cardiac disease and with adequate ventrodorsal radiographic images for cardiac silhouette assessment. PROCEDURES: Radiographs of ospreys were assessed to determine cardiac width at the widest point as well as sternal width and thoracic width at the same level. Two-way mixed-effects models were used to evaluate interrater reliability for mean rating. Multivariable linear regression analysis was used to create predictive models of cardiac width and to establish a theoretical reference range for healthy ospreys. RESULTS: Cardiac width of healthy ospreys was approximately 90% to 92% of sternal width and 67% to 69% of thoracic width. Both sternal width and thoracic width were significant predictors of cardiac width in independent predictive models as well as in a combined model after controlling for age. Thirty-four of 41 (83%) measured cardiac widths were within the theoretical reference range. CONCLUSIONS AND CLINICAL RELEVANCE: Ospreys are sentinels used in monitoring environmental health. Environmental factors may have an impact on the cardiac health of ospreys, but reference values for healthy ospreys have not been established for use in assessing cardiomegaly in this species. The radiographic ratios and predictive model obtained in this study may be useful for objective evaluation of cardiomegaly in ospreys.


Assuntos
Falconiformes/anatomia & histologia , Coração/diagnóstico por imagem , Animais , Feminino , Masculino , Radiografia/veterinária , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos
20.
Br J Anaesth ; 123(4): 408-420, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31320115

RESUMO

Preoperative cardiac function is an important predictor of postoperative outcomes. Patients with heart failure are at higher risk of perioperative morbidity and mortality. Left ventricular ejection fraction, derived by standard echocardiography, is most frequently used to assess cardiac function in the intraoperative and postoperative periods. Myocardial strain analysis, a measurement of myocardial deformation, can provide additional information to left venricular eject fraction estimation. Here, we provide an overview of myocardial strain and different methods used to evaluate strain, including speckle tracking echocardiography. Speckle tracking echocardiography is an imaging modality that can analyse and track small segments of the myocardium, which provides greater detail for assessing global and regional cardiac motion and function. We further review the literature to illustrate the value of speckle tracking echocardiography-derived myocardial strain in describing cardiac function and its association with adverse surgical outcomes in the perioperative period, including low cardiac output states, need for inotropic support, postoperative arrhythmias, subclinical myocardial ischaemia, and length of hospital stay.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Coração/diagnóstico por imagem , Assistência Perioperatória/métodos , Ecocardiografia , Testes de Função Cardíaca , Humanos , Interpretação de Imagem Assistida por Computador , Miocárdio , Volume Sistólico
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