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3.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 19-25, feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185849

RESUMO

Objetivo. La correcta identificación en el primer contacto médico de los pacientes con un síndrome coronario agudo (SCA) es esencial. No existe ninguna escala predictiva para el diagnóstico de SCA en los centros de coordinación de emergencias (CCE) que facilite la toma de decisiones al equipo médico. El objetivo primario es construir y validar una escala de estas características. Método. Estudio prospectivo, observacional, unicéntrico, realizado durante 1 año (2016). Se incluyeron los pacientes que consultaron telefónicamente por dolor torácico no traumático en un CCE. Los pacientes incluidos se repartieron en las muestras de derivación y validación de forma aleatoria. La escala predictiva –escala SCARE– se construyó mediante regresión logística, la discriminación y calibración del modelo se realizó con el cálculo del área bajo la curva (ABC) de la característica operativa del receptor y el test de Hosmer-Lemeshow. Resultado. La muestra de derivación incluyó 902 pacientes y 7 de las variables recogidas se relacionaron con un diagnóstico final de SCA: sexo masculino, edad, tabaquismo, dolor torácico de características típicas, primer episodio de dolor torácico, diaforesis y la intuición del médico que realizó la entrevista telefónica. La utilización de la escala desarrollada en los 465 pacientes de la muestra de validación obtuvo un ABC de 0,81 (intervalo de confianza al 95% 0,76-0,87) y el test de Hosmer-Lemeshow fue de 5,18 (p = 0,74). Conclusión. La escala SCARE mostró una correcta discriminación y calibración. Es necesaria una validación externa multicéntrica antes de implementar su uso en los CCE


Background and objective. Correctly identifying patients with acute coronary syndrome (ACS) on first contact is essential, yet emergency dispatchers currently lack a risk scale that can help predict an ACS diagnosis. Our main aim was to develop and validate such a risk scale. Methods. Prospective, observational single-center study in 2016 (January 1 to December 31). We included patients who called our emergency dispatch center to report nontraumatic chest pain. Included patients were randomly assigned to a development or a validation sample. The predictive SCARE scale was built with logistic regression analysis. Discrimination and calibration were analyzed by calculating the area under the receiver operating characteristic curve; calibration was assessed with the Hosmer-Lemeshow test. Results. The development sample included 902 patients. The regression model identified 7 variables associated with a final diagnosis of ACS: male sex, age, smoking, typical pain characteristics, first episode of chest pain, diaphoresis, and physician intuition (the teledispatcher’s suspicion). When we applied the scale in the validation sample of 465 patients the area under the curve was 0.81 (95% CI, 0.76-0.87). The Hosmer-Lemeshow statistic was 5.18 (P=.74). Conclusions. The SCARE scale had good discrimination and calibration properties. The scale should be further validated in an external sample from a multicenter study before it is implemented by emergency dispatch centers


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/diagnóstico , Serviços Médicos de Emergência/métodos , Técnicas de Apoio para a Decisão , Dor no Peito/diagnóstico , Estudos Prospectivos , Valor Preditivo dos Testes , Telefone/estatística & dados numéricos , Modelos Logísticos , Intuição , Inquéritos e Questionários
4.
Pan Afr Med J ; 33: 275, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692844

RESUMO

The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.


Assuntos
Dor no Peito/diagnóstico , Infarto do Miocárdio/diagnóstico , Embolia Pulmonar/diagnóstico , Adulto , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos
5.
Acute Med ; 18(3): 165-170, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536054

RESUMO

Non-cardiac chest pain (NCCP) is a common presenting complaint which can be better managed. This requires the recognition of clinical sub-groups with investigation and treatment tailored accordingly. The aim of this paper is to encourage more accurate diagnoses and the better recognition of the source of chest pain. We discuss the appropriate investigations and management of each clinical sub-group.


Assuntos
Instituições de Assistência Ambulatorial , Dor no Peito , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Humanos
6.
Int Heart J ; 60(5): 1184-1188, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484860

RESUMO

We report the case of a 79-year-old man with acute myocardial infarction caused by left main trunk lesion, who experienced cardiogenic shock during percutaneous coronary intervention (PCI). To reverse the cardiogenic shock, we initiated veno-arterial extra corporeal membrane oxygenation (VA-ECMO) without an intra-aortic balloon pump (IABP) due to the severe tortuosity of the left external iliac artery. Although PCI was successful, arterial pressure monitoring revealed that the pulse pressure was too low to recover from the cardiogenic shock of decreased cardiac contraction function (the left ventricular ejection fraction was 30%). Thus, we decided to use IABP from the brachial artery to improve the hemodynamics. Immediately after the deployment of a 6-Fr IABP system (Takumi) from the left brachial artery, the pulse pressure was restored and finally VA-ECMO was withdrawn from the patient without complications. Although using IABP in combination with VA-ECMO is a reasonable strategy for cardiogenic shock, the effectiveness of this combination remains controversial. In this case, IABP added to VA-ECMO clearly achieved an improvement of pulse pressure and vital signs. Based on this result, monitoring of the pulse waveform is an effective tool to determine whether the concomitant use of IABP with VA-ECMO is indicated. Moreover, when it is difficult to insert IABP from the femoral arteries, the use of a 6-Fr IABP system (Takumi) approaching from the brachial artery should be considered.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Balão Intra-Aórtico/métodos , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea/efeitos adversos , Choque Cardiogênico/terapia , Idoso , Pressão Sanguínea/fisiologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Terapia Combinada , Serviço Hospitalar de Emergência , Seguimentos , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Medição de Risco , Choque Cardiogênico/etiologia , Resultado do Tratamento
7.
Dtsch Med Wochenschr ; 144(17): 1223-1228, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31454846

RESUMO

Acute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.


Assuntos
Dor no Peito/diagnóstico , Doença Aguda , Dor no Peito/fisiopatologia , Diagnóstico Diferencial , Eletrocardiografia , Testes de Função Cardíaca , Humanos
8.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340942

RESUMO

Right ventricular thrombus (RVT) can be life-threatening, since it has the potential to embolise and cause saddle pulmonary embolism (PE). We present a patient who initially presented with haemodynamically stable PE with evidence of RVT on echocardiogram. She was placed on heparin drip; however, she later developed cardiac arrest and died due to embolisation of RVT to the pulmonary vasculature. Although management of haemodynamically stable PE in patients with RVT is still a matter of debate, 1 given the outcome we suggest that thrombolysis or emergent embolectomy at the presentation, in this case, may have had a favourable outcome.


Assuntos
Tomada de Decisão Clínica , Parada Cardíaca/mortalidade , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Trombose/diagnóstico por imagem , Trombose/terapia , Idoso de 80 Anos ou mais , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Embolectomia/métodos , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Parada Cardíaca/etiologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Hemodinâmica/fisiologia , Heparina/uso terapêutico , Humanos , Embolia Pulmonar/diagnóstico por imagem
9.
Rev Gastroenterol Mex ; 84(3): 372-397, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31213326

RESUMO

INTRODUCTION: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. AIM: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. METHODS: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i)definitions, epidemiology, and pathophysiology; (ii)diagnosis, and (iii)treatment. The statements underwent 3rounds of voting, utilizing the Delphi system. The final statements were those that reached >75% agreement, and they were rated utilizing the GRADE system. RESULTS AND CONCLUSIONS: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy.


Assuntos
Dor no Peito/terapia , Dor no Peito/diagnóstico , Consenso , Humanos , México
10.
Comput Methods Programs Biomed ; 173: 109-117, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31046985

RESUMO

BACKGROUND AND AIMS: Hospital admission rate for the patients with chest pain has already been increased worldwide but no existing risk score has been designed to stratify non-ST-elevation myocardial infarction (NSTEMI) from non-cardiogenic chest pain. Clinical diagnosis of chest pain in the emergency department is always highly subjective and variable. We, therefore, aimed to develop an artificial intelligence approach to predict stable NSTEMI that would give valuable insight to reduce misdiagnosis in the real clinical setting. METHODS: A standard protocol was developed to collect data from chest pain patients who had visited the emergency department between December 2016 and February 2017. All the chest pain patients with aged <20 years were primarily included in this study. However, STEMI, previous history of ACS, and out-of-hospital cardiac arrest were excluded from our study. An artificial neural network (ANN) model was then developed to predict NSTEMI patients. The accuracy, sensitivity, specificity, and receiver operating characteristic curve was used to measure the performance of this model. RESULTS: A total of 268 chest pain patients were included in this study; of those, 47 (17.5%) was stable NSTEMI, and 221 (82.5%) was unstable angina patients. Serval risk factors such as cardiac risk factor, systolic blood pressure, hemoglobin, corrected QT interval (QTc), PR interval, glutamic-oxaloacetic transaminase, glutamic pyruvic transaminase and troponin were independently associated with stable NSTEMI. The area under the receiver operating characteristic (AUROC) and accuracy of ANN were 98.4, and 92.86. Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value of the ANN model was 90.91, 93.33, 76.92, and 97.67 respectively. CONCLUSION: Our prediction model showed a higher accuracy to predict NSTEMI patients. This model has a potential application in disease detection, monitoring, and prognosis of chest pain at risk of AMI.


Assuntos
Dor no Peito/diagnóstico , Eletrocardiografia , Serviço Hospitalar de Emergência , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Idoso , Área Sob a Curva , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Curva ROC , Análise de Regressão , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade
12.
Internist (Berl) ; 60(6): 564-570, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31062038

RESUMO

In emergency situations, patients present with symptoms rather than diagnoses. Due to its high prevalence, the acute coronary syndrome (ACS) dominates acute diagnostics as a consequence of its chief complaint chest pain. The challenge for the attending physicians is that only a minor part of patients with chest pain are finally diagnosed with an acute myocardial infarction (AMI) and that other rare but dangerous differential diagnoses have to be kept in mind and-vice versa-severely ill patients with AMI may present with symptoms other than chest pain. Against this background, the initial evaluation of patients requires a process-orientated view beyond the key roles of clinical assessment and biomarkers. The use of cardiac troponin is mandatory for the diagnosis of ACS, but challenging in broader utilization due to the reduced clinical specificity. Further relevant biomarkers are copeptin in combination with cardiac troponin or natriuetic peptides, which help to diagnose relevant cardiac dysfunction in (acute) heart failure. In addition, patients who present with the symptom of a suspected cardiac syncope need the differential diagnosis of an underlying arrhythmia, which may be due to an ACS or reduced left ventricular (LV) function and other causes like pulmonary embolism or structural heart disease (e. g. aortic valve stenosis). This highlights that biomarker-based diagnostics are often crucial to decide after the initial clinical evaluation whether early imaging is needed or early discharge is possible.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Biomarcadores/sangue , Dor no Peito/etiologia , Emergências , Glicopeptídeos/sangue , Peptídeos Natriuréticos/sangue , Troponina/sangue , Síndrome Coronariana Aguda/sangue , Dor no Peito/diagnóstico , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Embolia Pulmonar
13.
Dtsch Med Wochenschr ; 144(10): 659-664, 2019 05.
Artigo em Alemão | MEDLINE | ID: mdl-31083734

RESUMO

Acute chest pain is a frequent reason for encounter in primary care. In contrast to hospital/emergency departments serious diseases like acute coronary syndrome or a pulmonary embolism are relative rare in primary care. This overview presents the diagnostic work up and decisions for transfer to the hospital setting in patients with acute chest pain.


Assuntos
Dor no Peito , Doença Aguda , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/terapia , Humanos
14.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31138594

RESUMO

A Caucasian woman aged 58 years with history of asthma and surgically repaired congenital diaphragmatic hernia presented to the emergency department (ED) with persistent cough, pleuritic chest pain, shortness of breath, in spite of recent treatment for influenza A virus. On physical examination, a large bulge was protruding from her left posterior thorax. She was found to have a large abnormal radiographic lucency on lateral chest X-ray posterior to the thoracic cavity, confirmed with chest CT to represent a large lung herniation in between the left seventh and eighth ribs. The patient was evaluated by a thoracic surgeon and offered surgical repair but ultimately decided on conservative management which to date has been ineffective.


Assuntos
Dor no Peito/etiologia , Tosse/etiologia , Pneumopatias/patologia , Tórax/patologia , Dor no Peito/diagnóstico , Tratamento Conservador , Tosse/diagnóstico , Feminino , Hérnia/patologia , Humanos , Pneumopatias/diagnóstico por imagem , Pessoa de Meia-Idade , Radiografia , Doenças Raras , Costelas/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
Sao Paulo Med J ; 137(1): 54-59, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31116271

RESUMO

BACKGROUND: The chest pain classifications that are currently in use are based on studies that are several decades old. Various studies have indicated that these classifications are not sufficient for determining the origin of chest pain without additional diagnostic tests or tools. We describe a new chest pain scoring system that examines the relationship between chest pain and ischemic heart disease (IHD). DESIGN AND SETTING: Cross-sectional study conducted in a tertiary-level university hospital and two public hospitals. METHODS: Chest pain scores were assigned to 484 patients. These patients then underwent a treadmill stress test, followed by myocardial perfusion scintigraphy if necessary. Coronary angiography was then carried out on the patients whose tests had been interpreted as positive for ischemia. Afterwards, the relationship between myocardial ischemia and the test score results was investigated. RESULTS: The median chest pain score was 2 (range: 0-7) among the patients without IHD and 6 (1-8) among those with IHD. The median score of patients with IHD was significantly higher than that of patients without IHD (P = 0.001). Receiver operating characteristic analysis showed that the score had sensitivity of 97% and specificity of 87.5% for detecting IHD. CONCLUSION: We developed a pre-test chest pain score that uses a digital scoring system to assess whether or not the pain was caused by IHD. This scoring system can be applied easily and swiftly by healthcare professionals and can prevent the confusion that is caused by other classification and scoring systems.


Assuntos
Dor no Peito/diagnóstico , Isquemia Miocárdica/diagnóstico , Medição da Dor/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Dor no Peito/fisiopatologia , Estudos Transversais , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Reprodutibilidade dos Testes , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Centros de Atenção Terciária , Adulto Jovem
16.
Bull Hosp Jt Dis (2013) ; 77(2): 146-152, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31128586

RESUMO

INTRODUCTION: Autoimmune hepatitis (AIH) is a cause of chronic liver disease. It is usually suspected based on clinical presentation and laboratory findings, but the diagnosis relies on the presence of specific autoantibodies and characteristic histology. Other unexplained findings should always prompt investigation for coexisting syndromes. CASE PRESENTATION: The patient is a 60-year-old Hispanic female with a history of mild asthma presented with exertional and pleuritic chest pain with weight loss, arthralgia, subjective fever, and night sweats for the last 3 months. Given the nonspecific nature of the presentation, further workup was pursued. Laboratory results indicated pancytopenia, elevated INR, and positive autoimmune panel including ANA, anti-chromatin, anti-histone, and rheumatoid factor as well as abnormal C3 and C4. Subsequent liver biopsy with interface hepatitis lead to a diagnosis of AIH with concurrent systemic lupus erythematosus suspected. CONCLUSION: The diagnostic work up for AIH is multimodal and aims to differentiate other etiologies such as congestive hepatopathy, iron overload, viral hepatitis, and other autoimmune liver diseases. In this particular case, unusual clinical and laboratory findings led to diagnosis of the overlap syndrome. Treatment for both was necessary to prevent further progression of disease.


Assuntos
Autoanticorpos , Hepatite A , Hepatite Autoimune , Hidroxicloroquina/administração & dosagem , Fígado/patologia , Lúpus Eritematoso Sistêmico , Prednisona/administração & dosagem , Fator Reumatoide/sangue , Antirreumáticos/administração & dosagem , Artralgia/diagnóstico , Artralgia/etiologia , Autoanticorpos/sangue , Autoanticorpos/classificação , Biópsia/métodos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Diagnóstico Diferencial , Feminino , Hepatite A/diagnóstico , Hepatite A/imunologia , Hepatite A/fisiopatologia , Hepatite A/terapia , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/imunologia , Hepatite Autoimune/fisiopatologia , Hepatite Autoimune/terapia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/terapia , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Resultado do Tratamento
17.
J Surg Res ; 242: 336-341, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31129243

RESUMO

BACKGROUND: Individuals with sickle cell disease (SCD) are at high risk of developing life-threatening complications, particularly acute chest syndrome (ACS) postoperatively. The perioperative factors associated with the development of ACS in children with SCD after splenectomy have not been clearly identified. MATERIALS AND METHODS: We retrospectively reviewed medical records of all children who underwent splenectomy at our institution between 1997 and 2017 with the goal of identifying perioperative factors associated with postoperative ACS. Categorical and noncategorical variables were compared using Fisher's exact test and Student's two-tailed t-test, respectively. RESULTS: Sixty-five patients with SCD underwent splenectomy at a median of 4.0 (interquartile range [IQR] 2.0-8.0) years of age. A laparoscopic approach was used for 64 (98.5%) patients. Fifty-six (86.2%) underwent laparoscopic total splenectomy, and eight (12.3%) underwent laparoscopic partial splenectomy, of which two were converted to open. One had an open partial splenectomy (1.5%). Of the 65 patients, 10 (15.4%) developed ACS with a mean time to diagnosis of 49.0 ± 34.5 h. Children who developed ACS had a higher postoperative median pain score of 6.8 (IQR 5.1-9.1) versus 2.7 (IQR 1.6-4.2), P < 0.001, higher median pain score area under the curve 111.5 (IQR 76.9-169.1) versus 47.3 (IQR 30.5-78.3), P = 0.01, and received more total morphine equivalents (median 1.4 [IQR 0.4-2.7] versus 0.5 [IQR 0.3-0.9] mg/kg, respectively; P = 0.003), compared with children who did not develop ACS. CONCLUSIONS: Significant postoperative pain may be an early sign of ACS that could be worsened by opioid use, supporting the investigation of nonopioid pain control options in this patient population.


Assuntos
Síndrome Torácica Aguda/epidemiologia , Anemia Falciforme/cirurgia , Dor no Peito/epidemiologia , Dor Pós-Operatória/epidemiologia , Esplenectomia/efeitos adversos , Síndrome Torácica Aguda/diagnóstico , Síndrome Torácica Aguda/etiologia , Analgésicos Opioides/uso terapêutico , Anemia Falciforme/complicações , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Lactente , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Esplenectomia/métodos
18.
Clin Imaging ; 57: 7-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31078917

RESUMO

PURPOSE: Quantitative computed tomography (QCT) may be useful in detecting high-risk patients with coronary atherosclerosis. Assessment of plaque composition using fixed Hounsfield unit (HU) thresholds is influenced by luminal contrast density. A method using adaptive HU thresholds has therefore been developed. This study investigates agreement between plaque volumes derived using fixed and adaptive HU thresholds and the influence of luminal contrast density on the determination of plaque composition. METHODS: We performed QCT in 260 patients with recent acute-onset chest pain without acute coronary syndrome. Plaque volumes of necrotic core (NC), fibrous fatty (FF), fibrous (FI) and dense calcium (DC) tissue were measured in 1161 coronary segments. Agreement between plaque volumes using fixed and adaptive HU thresholds was tested using the Bland-Altman method. Additionally, patients were stratified into tertiles of ascending aortic luminal contrast density and plaque volumes were compared. RESULTS: Bland-Altman plots revealed that fixed HU thresholds underestimated FI and FF plaque volumes and overestimated NC and DC plaque volumes compared to adaptive HU thresholds. Volumes of dense calcium plaque differed with increasing tertiles of luminal contrast density when using fixed HU thresholds but not when using adaptive HU thresholds: DC for fixed HU thresholds (mm3, median (95%CI)): 7.73 (5.17;12.31), 9.83 (6.55;13.57), 12.02 (8.26;16.24); DC for adaptive HU thresholds (mm3, median (95%CI)): 7.34 (5.12;12.03), 7.78 (5.40;12.61), 8.56 (5.22;12.69). CONCLUSIONS: Plaque volumes by fixed and adaptive HU thresholds differed. Plaque volumes by adaptive HU thresholds were more independent of luminal contrast density for higher attenuation tissues compared to fixed HU thresholds.


Assuntos
Doença da Artéria Coronariana/patologia , Placa Aterosclerótica/patologia , Tomografia Computadorizada por Raios X , Idoso , Dor no Peito/diagnóstico , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas
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