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1.
Medicine (Baltimore) ; 98(39): e17195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574826

RESUMO

The aim of this study was to evaluate comparative clinical outcomes of discordant electrocardiographic (ECG) and echocardiographic (Echo) findings compared with concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of coronary artery disease (CAD).A total of 1725 consecutive patients who underwent treadmill echocardiography with chest pain and no history of CAD were screened. The patients were classified into 4 groups: ECG-/Echo- (negative ECG and Echo), ECG+/Echo- (positive ECG and negative Echo), ECG-/Echo+, and ECG+/Echo+. Concomitant CAD was determined using coronary angiography or coronary computed tomography. Major adverse cardiac events (MACEs) were defined as a composite of coronary revascularization, acute myocardial infarction, and death.MACEs were similar between ECG-/Echo- and ECG+/Echo- groups. Compared with ECG+/Echo- group, ECG-/Echo+ group had more MACEs (adjusted hazard ratio [HR] adjusted by clinical risk factors [95% confidence interval {CI}], 3.57 [1.75-7.29], P < .001). Compared with ECG+/Echo+ group, ECG-/Echo+ group had lower prevalence of concomitant CAD and fewer MACEs (HR, 0.49 [0.29-0.81], P = .006).Positive exercise Echo alone during treadmill exercise echocardiography had worse clinical outcomes than positive ECG alone, and the latter had similar outcomes to both negative ECG and Echo. Positive exercise Echo alone also had better clinical outcomes than both positive ECG and Echo. Therefore, exercise Echo findings might be superior for predicting clinical outcomes compared with exercise ECG findings. Additional consideration of ECG findings on positive exercise Echo will also facilitate better prediction of clinical outcomes.


Assuntos
Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia/estatística & dados numéricos , Eletrocardiografia/estatística & dados numéricos , Infarto do Miocárdio/fisiopatologia , Adulto , Idoso , Dor no Peito/complicações , Angiografia Coronária , Doença da Artéria Coronariana/etiologia , Exercício/fisiologia , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Fatores de Risco , Tomografia Computadorizada por Raios X
2.
Vasc Health Risk Manag ; 15: 283-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496717

RESUMO

Angiography remains a widely utilized imaging modality during vascular procedures. Angiography, however, has its limitations by underestimating the true vessel size, plaque morphology, presence of calcium and thrombus, plaque vulnerability, true lesion length, stent expansion and apposition, residual narrowing post intervention and the presence or absence of dissections. Intravascular ultrasound (IVUS) has emerged as an important adjunctive modality to angiography. IVUS offers precise imaging of the vessel size, plaque morphology and the presence of dissections and guides interventional procedures including stent sizing, assessing residual narrowing and stent apposition and expansion. IVUS-guided treatment has shown to yield superior outcomes when compared to angiography-only guided therapy. The cost-effectiveness of the routine use of IVUS during vascular procedures needs to be further studied.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/terapia , Ultrassonografia de Intervenção , Doença da Artéria Coronariana/fisiopatologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Humanos , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Stents , Resultado do Tratamento
3.
Br J Radiol ; 92(1103): 20190384, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31479307

RESUMO

OBJECTIVE: Evaluation of coronary CT image blur using multi segment reconstruction algorithm. METHODS: Cardiac motion was simulated in a Catphan. CT coronary angiography was performed using 320 × 0.5 mm detector array and 275 ms gantry rotation. 1, 2 and 3 segment reconstruction algorithm, three heart rates (60, 80 and 100bpm), two peak displacements (4, 8 mm) and three cardiac phases (55, 35, 75%) were used. Wilcoxon test compared image blur from the different reconstruction algorithms. RESULTS: Image blur for 1, 2 and 3 segments in: 60 bpm, 75% R-R interval and 8 mm peak displacement: 0.714, 0.588, 0.571 mm (1.18, 0.6, 0.4 mm displacement) 80 bpm, 35% R-R interval and 8 mm peak displacement: 0.869, 0.606, 0.606 mm (1.57, 0.79,0.52 mm displacement) 100 bpm, 35% R-R interval and 4 mm peak displacement: 0.645, 0.588, 0.571 mm (0.98, 0.49, 0.33 mm displacement). The median image blur overall for 1 and 2 segments was 0.714 mm and 0.588 mm respectively (p < 0.0001). CONCLUSION: Two-segment reconstruction significantly reduces image blur. ADVANCES IN KNOWLEDGE: Multisegment reconstruction algorithms during CT coronary angiography are a useful method to reduce image blur, improve visualization of the coronary artery wall and help the early detection of the plaque.


Assuntos
Angiografia por Tomografia Computadorizada/normas , Doença da Artéria Coronariana/diagnóstico por imagem , Algoritmos , Análise de Variância , Artefatos , Doença da Artéria Coronariana/fisiopatologia , Frequência Cardíaca/fisiologia , Humanos , Movimento , Imagens de Fantasmas , Projetos Piloto , Estudos Prospectivos , Intensificação de Imagem Radiográfica/métodos
4.
J Comput Assist Tomogr ; 43(5): 811-816, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31453979

RESUMO

OBJECTIVE: Knowledge-based iterative model reconstruction (IMR) yields diagnostically acceptable image quality in low-dose static computed tomography (CT). We aimed to evaluate the feasibility of IMR in dynamic myocardial computed tomography perfusion (CTP). METHODS: We enrolled 24 patients who underwent stress dynamic CTP using a 256-slice CT. Images were reconstructed using filtered back projection (FBP), hybrid IR, and IMR. Image quality and hemodynamic parameters were compared among three algorithms. RESULTS: Qualitative image quality and contrast-to-noise ratio were significantly higher by IMR than by FBP or hybrid IR (visual score: 4.1 vs. 3.0 and 3.5; contrast-to-noise ratio: 12.4 vs. 6.6 and 8.4; P < 0.05). No significant difference was observed among algorithms in CTP-derived myocardial blood flow (1.68 vs. 1.73 and 1.70 mL/g/min). CONCLUSIONS: The use of knowledge-based iterative model reconstruction improves image quality without altering hemodynamic parameters in low-dose dynamic CTP, compared with FBP or hybrid IR.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Hemodinâmica/fisiologia , Bases de Conhecimento , Tomografia Computadorizada Multidetectores/métodos , Idoso , Algoritmos , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Teste de Esforço , Estudos de Viabilidade , Feminino , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos
5.
Postgrad Med ; 131(7): 415-422, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31424301

RESUMO

Alzheimer's disease (AD) is the most common form of dementia manifesting as alterations in cognitive abilities, behavior, and deterioration in memory which is progressive, leading to gradual worsening of symptoms. Major pathological features of AD are accumulations of neuronal amyloid plaques and neurofibrillary tangles, with early lesions appearing primarily in the hippocampus, the area of the brain involved in memory and learning. Cardiovascular-related risk factors are believed to play a crucial role in disease development and the acceleration of cognitive deterioration by worsening cerebral perfusion, promoting disturbances in amyloid clearance. Current evidence supports hypertension, hypotension, heart failure, stroke and coronary artery diseases as potential factors playing a role in cognitive decline in patients with Alzheimer's dementia. Although dementia due to cardiovascular deficits is more strongly linked to the development of vascular dementia, a stepwise decline in cognition, recent researches have also discovered its deleterious influence on AD development.


Assuntos
Doença de Alzheimer/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Doenças Cardiovasculares/epidemiologia , Circulação Cerebrovascular , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Progressão da Doença , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipotensão/epidemiologia , Hipotensão/fisiopatologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia
6.
Br J Radiol ; 92(1101): 20180945, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31322906

RESUMO

OBJECTIVE: This study aimed to evaluate the relationship between heart rate (HR) and optimal reconstruction phase in prospectively electrocardiogram (ECG)-triggered coronary CT angiography (CCTA) performed on a newly introduced 256-slice multidetector CT (MDCT). METHODS: All the cases were selected retrospectively from the patients scheduled for CCTA in our department between January and April 2017. The scanner selected the optimal exposure phase based on 10 s ECG recordings. To ensure the success of CCTA, the operator also checked patient's age, breathing control, emotional status and past medical history to decide whether the automatically selected scan phase needs manual adjustment or not. Images were reconstructed in 1% steps of the R-R interval to determine the cardiac phase with least coronary motion. If CCTA images showed moderate motion blurring or discontinuity in the course of coronary segments, a cardiac motion correction algorithm was applied to the reconstructed images. Subjective diagnostic image quality was evaluated with 4-point grading scale. RESULTS: A total of 87 consecutive CCTA examinations were investigated in this study. Diastolic reconstruction was applied to all vessel segments in patients with HR <63 bpm, where 36.5 and 77.8% of vessel segments were reconstructed with the use of motion correction in HR ≤57 and 58-62 bpm, respectively. As for patients with HR ≥63 bpm, 89.3 and 71.7% of vessel segments were reconstructed in diastole in HR 63-67 and ≥68 bpm, respectively, while 81 and 100% of vessel segments were reconstructed with the use of motion correction in the same HR groups. CONCLUSION: Based on our results, a HR less than 67 bpm can be used to identify appropriate patients for diastolic reconstruction. Although the motion correction algorithm is an effective approach to reduce the impact of cardiac motion in CCTA, HR control is still important to optimize the image quality of CCTA. The relationship between HR and optimal reconstruction phase established in this study could be further used to tailor the ECG pulsing window for dose reduction in patients undergoing CCTA performed on the 256-slice MDCT. ADVANCES IN KNOWLEDGE: The HR thresholds to identify patients who are the best suitable candidates for diastolic or systolic reconstruction are scanner specific. This study investigated the relationship between HR and optimal reconstruction phase in prospectively ECG-triggered CCTA for a newly introduced 256-slice MDCT. Once the relationship is established, it could be used to tailor the ECG pulsing window for radiation dose reduction.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Frequência Cardíaca/fisiologia , Tomografia Computadorizada Multidetectores/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
7.
Eur J Radiol ; 116: 90-97, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153580

RESUMO

PURPOSE: To evaluate the diagnostic performance of coronary computed tomography angiography derived fractional flow reserve (CT-FFR) with invasive fractional flow reserve (FFR) in patients with coronary artery disease" before "with invasive fractional flow reserve serving as the reference standard. MATERIALS AND METHODS: CT-FFR values based on a machine learning algorithm (cFFRML) in 183 vessels of 136 patients from four centers were measured with invasive FFR as reference standard. The diagnostic performance from our multicenter study was combined into a meta-analysis following a literature search in Web of Science, PubMed, Cochrane library to identify studies comparing diagnostic performance of coronary computed tomography angiography (CCTA) and CT-FFR. Sensitivity, specificity, accuracy were analyzed on both per-vessel and per-patient basis for intermediate lesions and by algorithm. RESULTS: Our multicenter study demonstrated sensitivities, specificities, and accuracies of cFFRML and CCTA of 0.85, 0.94, 0.90, and 0.95, 0.28, 0.55 on a per-vessel basis, respectively. For our meta-analysis, pooled sensitivities, specificities, and accuracies of CT-FFR and CCTA were 0.85, 0.82, 0.82, and 0.85, 0.57, 0.65 with AUC of 0.86 (95%CI: 0.83˜0.89) and 0.83 (95%CI: 0.79˜0.86) on a per-vessel basis, respectively. The sensitivity, specificity and accuracy for intermediate lesions using cFFRML were 0.84, 0.92, and 0.89. No significant difference was found among different algorithms of CT-FFR (P < 0.001). CONSLUSION: This multicenter study with meta-analysis showed that CT-FFR had a high diagnostic accuracy in determining ischemia-specific lesions and intermediate lesions. There was no significant difference when comparing the combined diagnostic performance of different algorithms of CT-FFR with invasive FFR as the reference standard.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Algoritmos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Nat Rev Dis Primers ; 5(1): 39, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171787

RESUMO

ST-segment elevation myocardial infarction (STEMI) is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of post-STEMI complications and heart failure. Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with STEMI; if PCI cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around-the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality from STEMI. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Biomarcadores/análise , Biomarcadores/sangue , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia/métodos , Eletrocardiografia/métodos , Humanos , Programas de Rastreamento/métodos , Intervenção Coronária Percutânea/métodos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Resultado do Tratamento , Troponina I/análise , Troponina I/sangue
9.
Int J Cardiovasc Imaging ; 35(7): 1265-1275, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31165941

RESUMO

Assessment of global longitudinal strain (GLS) is superior to ejection fraction (EF) in the evaluation of left ventricular (LV) function in patients with stable coronary artery disease (CAD). However, the role of mechanical dispersion (MD) in this context remains unresolved. We aimed to evaluate the potential role of MD as a marker of LV dysfunction and long-term prognosis in stable CAD. EF, GLS and MD were assessed in 160 patients with stable CAD, 1 year after successful coronary revascularization. Serum levels of high-sensitivity cardiac troponin I (hs-cTnI) and amino-terminal pro B-type natriuretic peptide (NT-proBNP) were quantified as surrogate markers of LV dysfunction. The primary endpoint was defined as all-cause mortality, the secondary endpoint was defined as the composite of all-cause mortality and hospitalization for acute myocardial infarction or heart failure during follow-up. Whereas no associations between EF and the biochemical markers of LV function were found, both GLS and MD correlated positively with increasing levels of hs-cTnI (R = 0.315, P < 0.001 and R = 0.442, P < 0.001, respectively) and NT-proBNP (R = 0.195, P = 0.016 and R = 0.390, P < 0.001, respectively). Median MD was 46 ms (interquartile range [IQR] 37-53) and was successfully quantified in 96% of the patients. During a median follow-up of 8.4 (IQR 8.2-8.8) years, 14 deaths and 29 secondary events occurred. MD was significantly increased in non-survivors, and provided incremental prognostic value when added to EF and GLS. NT-proBNP was superior to the echocardiographic markers in predicting adverse outcomes. MD may be a promising marker of LV dysfunction and adverse prognosis in stable CAD.


Assuntos
Doença da Artéria Coronariana/cirurgia , Ecocardiografia , Revascularização Miocárdica , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Biomarcadores/sangue , Causas de Morte , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/mortalidade , Peptídeo Natriurético Encefálico/sangue , Readmissão do Paciente , Fragmentos de Peptídeos/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Troponina I/sangue , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
10.
N Engl J Med ; 380(25): 2418-2428, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31216398

RESUMO

BACKGROUND: In patients with stable angina, two strategies are often used to guide revascularization: one involves myocardial-perfusion cardiovascular magnetic resonance imaging (MRI), and the other involves invasive angiography and measurement of fractional flow reserve (FFR). Whether a cardiovascular MRI-based strategy is noninferior to an FFR-based strategy with respect to major adverse cardiac events has not been established. METHODS: We performed an unblinded, multicenter, clinical-effectiveness trial by randomly assigning 918 patients with typical angina and either two or more cardiovascular risk factors or a positive exercise treadmill test to a cardiovascular MRI-based strategy or an FFR-based strategy. Revascularization was recommended for patients in the cardiovascular-MRI group with ischemia in at least 6% of the myocardium or in the FFR group with an FFR of 0.8 or less. The composite primary outcome was death, nonfatal myocardial infarction, or target-vessel revascularization within 1 year. The noninferiority margin was a risk difference of 6 percentage points. RESULTS: A total of 184 of 454 patients (40.5%) in the cardiovascular-MRI group and 213 of 464 patients (45.9%) in the FFR group met criteria to recommend revascularization (P = 0.11). Fewer patients in the cardiovascular-MRI group than in the FFR group underwent index revascularization (162 [35.7%] vs. 209 [45.0%], P = 0.005). The primary outcome occurred in 15 of 421 patients (3.6%) in the cardiovascular-MRI group and 16 of 430 patients (3.7%) in the FFR group (risk difference, -0.2 percentage points; 95% confidence interval, -2.7 to 2.4), findings that met the noninferiority threshold. The percentage of patients free from angina at 12 months did not differ significantly between the two groups (49.2% in the cardiovascular-MRI group and 43.8% in the FFR group, P = 0.21). CONCLUSIONS: Among patients with stable angina and risk factors for coronary artery disease, myocardial-perfusion cardiovascular MRI was associated with a lower incidence of coronary revascularization than FFR and was noninferior to FFR with respect to major adverse cardiac events. (Funded by the Guy's and St. Thomas' Biomedical Research Centre of the National Institute for Health Research and others; MR-INFORM ClinicalTrials.gov number, NCT01236807.).


Assuntos
Angina Estável/diagnóstico , Angiografia Coronária , Reserva Fracionada de Fluxo Miocárdico , Angiografia por Ressonância Magnética , Adulto , Idoso , Angina Estável/complicações , Angina Estável/diagnóstico por imagem , Angina Estável/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
11.
Int J Cardiovasc Imaging ; 35(9): 1661-1670, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31049752

RESUMO

Assessment of right ventricular (RV) function is crucial since RV failure with a reduced cardiac output (CO) is associated with compromised outcome in cardiac surgery. Echocardiographic evaluation of RV function is commonly used, but a reduction in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annulus tissue Doppler imaging (S') have been observed independently of clinical signs of RV failure. This has led to uncertainty of these variables' validity in cardiac surgery. To describe transesophageal echocardiographic (TEE) measures of RV function during coronary artery bypass graft surgery with detailed haemodynamic assessment using pulmonary artery catheter (PAC) measurements to describe "natural" changes in the absence of RV failure. We prospectively studied 30 patients with concomitant PAC and TEE measurements at four time-points, namely after: anaesthesia induction, sternotomy, cardiopulmonary bypass (CPB) and upon arrival in the intensive care unit. TAPSE and S' were significantly reduced by 43% (p < 0.0001) and 22% (p = 0.006), respectively after CPB without any change in stroke volume (SV). RV ejection fraction (RVEF), RV fractional area change (RVFAC) and global longitudinal strain (RV-GLS) remained unchanged. SV measured with 3D echocardiography correlated with PAC measured SV (r = 0.66[95% CI 0.50; 0.78], p < 0.0001), but 3D showed a minor, but statistically significant underestimation of SV (8.5 ml (95% CI 2.7 ml; 14 ml, p = 0.004). TAPSE and S' were both reduced after CPB despite maintained CO. RVFAC, RVEF and RV-GLS remained stable, however, these measures were unable to detect minor changes in SV. 3D-echocardiographyshowed a strong correlation with SV measured by thermodilution, but with a consistent underestimation of approximately 10%.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Volume Sistólico , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Idoso , Cateterismo de Swan-Ganz , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Termodiluição , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia
12.
Int J Cardiovasc Imaging ; 35(9): 1563-1572, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31053979

RESUMO

The measurement of fractional flow reserve (FFR) and superficial wall stress (SWS) identifies inducible myocardial ischemia and plaque vulnerability, respectively. A simultaneous evaluation of both FFR and SWS is still lacking, while it may have a major impact on therapy. A new computational model of one-way fluid-structure interaction (FSI) was implemented and used to perform a total of 54 analyses in virtual coronary lesion models, based on plaque compositions, arterial remodeling patterns, and stenosis morphologies under physiological conditions. Due to a greater lumen dilation and more induced strain, FFR in the lipid-rich lesions (0.81 ± 0.15) was higher than that in fibrous lesions (0.79 ± 0.16, P = 0.001) and calcified lesions (0.79 ± 0.16, P = 0.001). Four types of lesions were further defined, based on the combination of cutoff values for FFR (0.80) and maximum relative SWS (30 kPa): The level of risk increased from (1) plaques with mild-to-moderate stenosis but negative remodeling for lipid-rich (Type A: non-ischemic, stable) to (2) lipid-rich plaques with mild-to-moderate stenosis and without-to-positive remodeling (Type B: non-ischemic, unstable) or plaques with severe stenosis but negative remodeling for lipid-rich (Type C: ischemic, stable) to (3) lipid-rich plaques with severe stenosis and without-to-positive remodeling (Type D: ischemic, unstable). The analysis of FSI to simultaneously evaluate inducible myocardial ischemia and plaque stability may be useful to identify coronary lesions at a high risk and to ultimately optimize treatment. Further research is warranted to assess whether a more aggressive treatment may improve the prognosis of patients with non-ischemic, intermediate, and unstable lesions.


Assuntos
Cateterismo Cardíaco , Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Hemodinâmica , Modelos Cardiovasculares , Placa Aterosclerótica , Fenômenos Biomecânicos , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/patologia , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Humanos , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Ruptura Espontânea , Índice de Gravidade de Doença
13.
Rev Med Liege ; 74(S1): S22-S28, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31070312

RESUMO

Percutaneous or surgical coronary revascularization must only be realized if myocardial ischemia is clearly demonstrated. In practice, this ischemia is most often seeked by non-invasive tests. These ones are unfortunately not systematically realized or may bring equivocal results compared to angiographic images. Coronary angiography remains the test of choice for the evaluation of coronary disease, but visual analysis of coronary stenosis does not confirm their hemodynamic significance. The measurement of coronary flow reserve by FFR ("fractional flow reserve") or iFR («instantaneous wave-free ratio¼) is a simple method to invasively assess the hemodynamic impact of a coronary lesion. Spastic angina, when suspected by clinical history, can also be confirmed during coronary angiography by the provocative methylergonovine test.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Hemodinâmica , Humanos
14.
Int J Cardiovasc Imaging ; 35(9): 1733-1743, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31073698

RESUMO

Vasodilator-stress CT perfusion imaging in addition to CT coronary angiography (CTCA) may provide a single-test alternative to nuclear stress testing, commonly used to assess hemodynamic significance of stenosis. Another alternative is fractional flow reserve (FFR) calculated from cardiac CT images. We studied the concordance between these two approaches and their relationship to outcomes. We prospectively studied 150 patients with chest pain, who underwent CTCA and regadenoson CT. CTCA images were interpreted for presence and severity of stenosis. Fused 3D displays of subendocardial X-ray attenuation with coronary arteries were created to detect stress perfusion defects (SPD) in each coronary territory. In patients with stenosis > 25%, CT-FFR was quantified. Significant stenosis was determined by: (1) combination of stenosis > 50% with an SPD, (2) CT-FFR ≤ 0.80. Patients were followed-up for 36 ± 25 months for death, myocardial infarction or revascularization. After excluding patients with normal arteries and technical/quality issues, in final analysis of 76 patients, CTCA depicted stenosis > 70% in 13/224 arteries, 50-70% in 24, and < 50% in 187. CT-FFR ≤ 0.80 was found in 41/224 arteries, and combination of SPD with > 50% stenosis in 31/224 arteries. Inter-technique agreement was 89%. Despite high incidence of abnormal CT-FFR (30/76 patients), only 7 patients experienced adverse outcomes; 6/7 also had SPDs. Only 1/9 patients with CT-FFR ≤ 0.80 but normal perfusion had an event. Fusion of CTCA and stress perfusion can help determine the hemodynamic impact of stenosis in one test, in good agreement with CT-FFR. Adding stress CT perfusion analysis may help risk-stratify patients with abnormal CT-FFR.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Hemodinâmica , Imagem Tridimensional/métodos , Imagem de Perfusão do Miocárdio/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/mortalidade , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Vasodilatadores/administração & dosagem
15.
Int Heart J ; 60(3): 554-559, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105144

RESUMO

It has been shown in several studies that coronary artery calcium (CAC) burden or CAC progression is associated with heart failure. We tested the hypothesis that the extent of CAC is associated with left ventricular (LV) diastolic parameters derived from gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with no evidence of myocardial ischemia.157 patients undergoing coronary computed tomography (CT), gated SPECT, and transthoracic echocardiography (TTE) were enrolled in this study. The CAC score was calculated according to the Agatston method. The peak filling rate (PFR) and the one-third mean filling rate (1/3MFR) were obtained as LV diastolic parameters.There were 139 patients with CAC and 18 patients without. The CAC score ranged from 0 to 4,976. There were no significant differences in the LV end-diastolic volume (LVEDV) (61 ± 21 mL versus 62 ± 22 mL, P = 0.79) and LV ejection fraction (LVEF) (66 ± 9% versus 68 ± 9%, P = 0.43). Patients with CAC had lower PFR than those without (2.2 ± 0.5 EDV/s versus 2.6 ± 0.7 EDV/s, P = 0.03). Multivariate linear regression analysis showed that ln (CAC score + 1) was significantly associated with PFR (ß = -0.20, P = 0.01) and 1/3MFR (ß = -0.18, P = 0.049).Our data suggest that the extent of CAC is inversely associated with LV diastolic parameters derived from gated SPECT independent of myocardial ischemia.


Assuntos
Cálcio/metabolismo , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/metabolismo , Isquemia Miocárdica/diagnóstico por imagem , Idoso , Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/metabolismo , Isquemia Miocárdica/fisiopatologia , Análise de Regressão , Tomografia Computadorizada de Emissão de Fóton Único , Função Ventricular Esquerda
16.
Int J Cardiovasc Imaging ; 35(7): 1319-1325, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093894

RESUMO

To demonstrate the potential for differentiating normal and diseased myocardium without Gadolinium using rest and stress T1-mapping. Patients undergoing 1.5T magnetic resonance imaging (MRI) as part of clinical work-up due to suspicion of coronary artery disease (CAD) were included. Adenosine stress perfusion MRI and late gadolinium enhancement (LGE) imaging were performed to identify ischemic and infarcted myocardium. Patients were retrospectively categorized into an ischemic, infarct and control group based on conventional acquisitions. Patient with both ischemic and infarcted myocardium were excluded. A total of 64 patients were included: ten with myocardial ischemia, 15 with myocardial infarction, and 39 controls. A native Modified Look-Locker Inversion Recovery (MOLLI) T1-mapping acquisition was performed at rest and stress. Pixel-wise myocardial T1-maps were acquired in short-axis view with inline motion-correction. Short-axis T1-maps were manually contoured using conservative septal sampling. Regions of interest were sampled in ischemic and infarcted areas detected on perfusion and LGE images. T1 reactivity was calculated as the percentage difference in T1 values between rest and stress. Remote myocardium was defined as myocardium without defects in the ischemic and infarcted group whereas normal myocardium is found in the control group only. Native T1-values were significantly higher in infarcted myocardium in rest and stress [median 1044 ms (interquartile range (IQR) 985-1076) and 1053 ms (IQR 989-1088)] compared to ischemic myocardium [median 961 ms (IQR 939-988) and 958 ms (IQR 945-988)]. T1-reactivity was significantly lower in ischemic and infarcted myocardium [median 0.00% (IQR - 0.18 to 0.16) and 0.41% (IQR 0.09-0.86)] compared to remote myocardium [median 3.54% (IQR 1.48-5.78) and 3.21% (IQR 1.95-4.79)]. Rest-stress T1-mapping is able to distinguish between normal, ischemic, infarcted and remote myocardium using native T1-values and T1-reactivity, and holds potential as an imaging biomarker for tissue characterization in MRI.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Miocárdio/patologia , Adenosina/administração & dosagem , Idoso , Meios de Contraste/administração & dosagem , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária , Diagnóstico Diferencial , Feminino , Gadolínio DTPA/administração & dosagem , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sobrevivência de Tecidos , Vasodilatadores/administração & dosagem
17.
Ter Arkh ; 91(3): 22-26, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31094454

RESUMO

AIM: The aim of this study was to evaluate the state of the vascular wall in patients with chronic obstructive pulmonary disease (COPD) combined with chronic coronary artery disease (CAD). MATERIALS AND METHODS: The study included 108 patients: 37 patients with COPD and CAD and 71 patients with COPD without CAD. Endothelial function was studied in tests with reactive hyperemia and nitroglycerin. The number of blood plasma desquamated endotheliocytes were determined by the Hladovec method. In patients with COPD identified are signs of vascular wall remodeling: thickening wall of the brachial artery, reduction of the flow-mediated vasodilation. Patients with COPD in combination with CHD demonstrated higher impairments of the vasoregulatory dysfunction of endothelial of the vascular wall. CONCLUSION: In patients with COPD combined with chronic coronary heart disease more pronounced endothelial dysfunction with disturbance of endothelium-dependent vasomotor reactions.


Assuntos
Doença da Artéria Coronariana , Endotélio Vascular , Doença Pulmonar Obstrutiva Crônica , Artéria Braquial , Doença da Artéria Coronariana/fisiopatologia , Endotélio Vascular/fisiopatologia , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Vasodilatação
18.
J Ayub Med Coll Abbottabad ; 31(2): 189-191, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094114

RESUMO

BACKGROUND: Hypertension is a leading cause of morbidity among developing and developed countries. Hypertensive Retinopathy is a micro vascular complication of long standing hypertension while CAD is a macro vascular complication. The main objective of the study was to determine the association between worsening grade of hypertensive retinopathy with angiographic severity of coronary artery disease (CAD) measured by Syntax Score. METHODS: This was a cross sectional study which was conducted after approval from IRB. All patients with history of hypertension, who underwent coronary angiography, were included in the study. After a detailed history and physical exam, all included patients were subjected to fundoscopy. Patients were categorized into 4 groups according to Keith et al classification of hypertensive retinopathy: No HR, Mild HR, Moderate HR and Severe HR. Patients were also categorized into three groups on the basis of angiographic severity of CAD by syntax score (SS): Mild CAD (SS<22), Moderate CAD (SS: 22-32) and Severe CAD (SS>32). Data was analysed in SPSS Version 20.0. Categorical and continuous variables were described as frequencies/percentages and Mean±SD respectively. RESULTS: A total of 370 patients were included in the study out of which 205 were males with a mean age of 55.3±10.07 years. Mean duration of hypertension was 8.1±2.7 years with a mean SBP of 130.1±37.2 mmHg and mean DBP of 90.3±17.3 mmHg. Patients with no HR, mild HR, moderate HR and severe HR had a mean SS of 11.7±4.5, 17.1±3.9, 26.3±5.1 and 37.9±5.1 respectively. Significant association was found between HR and severity of CAD with a chi square value of 285.53 (p<0.001). PORs for worsening grade of HR with severity of CAD increased from 0.341 (p<0.001) for mild HR to 2.33 (p<0.001) times for severe HR. CONCLUSIONS: A higher grade of hypertensive retinopathy is significantly associated to a higher angiographic severity of CAD by syntax score.


Assuntos
Doença da Artéria Coronariana , Retinopatia Hipertensiva , Adulto , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Estudos Transversais , Feminino , Humanos , Retinopatia Hipertensiva/complicações , Retinopatia Hipertensiva/epidemiologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
19.
Trials ; 20(1): 208, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975195

RESUMO

BACKGROUND: Benefits from cardiac rehabilitation (CR) programs are evidence-based and widely recognized. Less than 50% of people who participate in hospital-based CR programs maintain an exercise regime for as long as six months after completion. Little is known about interventions making the patients continue to exercise after the hospital-based formal program has ended. Methods to ensure sustained benefits of CR need to be tackled. Exercise periodization is a method typically used in sports training, but the impact of periodized exercise to yield optimal beneficial effects in cardiac patients is unclear. Therefore, the purpose of this trial is to evaluate the effects of a long-term exercise periodization on health-related physical fitness components such as cardiorespiratory endurance, muscular strength, skeletal muscle function, and body composition. METHODS: Fifty patients with coronary artery disease will be recruited among those who underwent the hospital-based CR phase. These patients will be randomized (1:1) into one of the following exercise groups: (1) periodized group; and (2) non-periodized group (exercise prescription based on standard guidelines). There will be four assessment time points: at baseline, and 3, 6, and 12 months after starting the exercise training program. At each time point, maximal and submaximal cardiorespiratory fitness, skeletal muscle deoxygenation dynamics, body composition by dual energy radiographic absorptiometry, functional fitness, maximal isometric and dynamic strength, physical activity, and quality of life will be assessed. This experimental design will last for 48 weeks with a frequency of three times per week for both groups. DISCUSSION: Most medium- to long-term exercise-based CR programs do not employ periodization or exercise progression. Randomized controlled trials are necessary to evaluate long-term periodization outcomes and assess the length of change observed in supervised CR programs. This study will contribute to generate evidence-based exercise prescription approaches to prolong the exercise training after the end of hospital-based CR programs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03335319 . Registered on 22 October 2017.


Assuntos
Reabilitação Cardíaca/métodos , Doença da Artéria Coronariana/reabilitação , Exercício , Aptidão Física , Ensaios Clínicos Controlados Aleatórios como Assunto , Composição Corporal , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Força Muscular , Músculo Esquelético/metabolismo , Qualidade de Vida
20.
Turk J Med Sci ; 49(2): 617-623, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30997977

RESUMO

Background/aim: Psoriasis is a chronic inflammatory disease. The effect of psoriasis on the cardiovascular system has not been studied in children before. We studied ventricular strain and vascular functions to assess early cardiovascular effects of psoriasis during childhood. Materials and methods: The study population consisted of 20 psoriatic and 20 age- and sex-matched control subjects. Two-dimensional echocardiography images, longitudinal and global strain, and carotid and brachial ultrasound studies were performed. Results: The mean age of psoriatic children was 14 ± 0.89 years and that of the controls was 14.05 ± 0.88. There were significant increases in terms of interventricular septum diastolic and left ventricular posterior wall diastolic diameter and decreases in mitral E, mitral A, and E/A values between groups. Tissue Doppler imaging revealed significant differences between groups in terms of lateral annulus E', A', E'/A, isovolumetric contraction time, and ejection time. Aortic stiffness was significantly higher and global circumferential strain and longitudinal strain were significantly lower in the psoriasis group. Carotid intima media thickness and flow-mediated dilatation did not differ significantly between the groups. Conclusion: Cardiac left ventricular and arterial functions are affected in psoriatic children and may be an alarming sign of atherosclerotic heart disease in the long term. Early detection of these changes may be helpful for eliminating other risk factors.


Assuntos
Artérias Carótidas/fisiopatologia , Doença da Artéria Coronariana/etiologia , Psoríase/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Adolescente , Artérias Carótidas/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/prevenção & controle , Diagnóstico Precoce , Ecocardiografia , Ecocardiografia Doppler , Elasticidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Psoríase/complicações , Psoríase/diagnóstico por imagem , Medição de Risco , Disfunção Ventricular Esquerda/diagnóstico por imagem
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