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1.
Heart Fail Clin ; 16(1): 53-60, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735315

RESUMO

Pulmonary hypertension (PH) often complicates chronic left-sided heart failure, with a remarkable impact on quality of life, exercise capacity, and survival. PH in chronic left-sided heart failure (PH-LHD) is not only caused by backward transmission of pressures but also involves impairment of atrial function, inflammation, and vasoconstriction. Once the left atrium loses its reservoir capacity, usually pulmonary vascular resistances increase. Right atrial dilation commonly represents the first sign of PH-LHD, before right ventricle dilatation and systolic dysfunction develop, leading to right heart insufficiency, and ultimately, right heart failure.


Assuntos
Insuficiência Cardíaca/complicações , Hipertensão Pulmonar/etiologia , Pressão Propulsora Pulmonar/fisiologia , Resistência Vascular/fisiologia , Função Ventricular Esquerda/fisiologia , Ecocardiografia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Imagem Cinética por Ressonância Magnética , Prognóstico , Qualidade de Vida
3.
Tex Heart Inst J ; 46(3): 215-218, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708707

RESUMO

Infected cardiac myxomas are rare and can have disastrous sequelae; urgent surgical resection is typically indicated. We report the case of a 43-year-old user of intravenous heroin who presented with weakness and dyspnea. He was diagnosed with infective endocarditis of a myxoma attached to the left ventricular lateral wall. The patient underwent successful surgical resection of the myxoma and then completed 4 weeks of antibiotic therapy. In addition to discussing this patient's case, we briefly review the relevant medical literature, in which we found only 4 previous reports of left ventricular myxoma associated with infective endocarditis.


Assuntos
Endocardite Bacteriana/etiologia , Neoplasias Cardíacas/complicações , Dependência de Heroína/complicações , Mixoma/complicações , Infecções Estafilocócicas/etiologia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Mixoma/diagnóstico , Mixoma/cirurgia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação
5.
J Comput Assist Tomogr ; 43(6): 919-925, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738205

RESUMO

OBJECTIVES: The objective of this study was to compare gadobutrol-enhanced gradient-echo sequence (GRE) acquisition with T2-prepared non-contrast-enhanced steady-state free precession (SSFP) in coronary magnetic resonance angiography at 1.5 T. METHODS: Twenty-one subjects successfully completed GRE and SSFP acquisition. Signal-to-noise ratio (SNR), contrast-to-noise ratio, image quality, sharpness, visibility, length, and lumen diameter of vessels were analyzed by 2 experienced radiologists. RESULTS: The SNR at whole left circumflex artery, left main artery, and proximal left descending artery (LAD) was significantly higher in SSFP acquisition (P < 0.05). The SNR of distal LAD was slightly higher in GRE acquisition (P < 0.05). The contrast-to-noise ratio at distal LAD, proximal and distal RCA were significantly higher with GRE acquisition (P < 0.05). CONCLUSIONS: Double-dose gadobutrol-enhanced GRE and unenhanced SSFP coronary magnetic resonance angiography at 1.5 T have their own characteristics, and the combined use of the 2 methods may be taken into consideration.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Imagem Tridimensional/métodos , Adulto , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Respiração , Razão Sinal-Ruído
6.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 471-477, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642221

RESUMO

OBJECTIVE: To determinethe diagnostic valuesand reliabilityof cardiac magnetic resonance tissue tracking (CMR-TT) derived two-dimensional(2D) and three-dimensional(3D) strains in assessing experimental autoimmunity myocarditis (EAM) in rats. METHODS: 20 Lewis rats were randomly divided into model and control groups. The animal model of autoimmune myocarditis was induced by injecting porcine cardiac myosin into the footpads of the rats.On day 35, all of the rats were examined using the 7.0T CMR cine scan. The cardiac function and global strain of the left ventricular of the rats were analyzed with specific cardiac post-processing. The rats were then sacrificed and myocardial samples were taken and stained with HE and Masson. The diagnostic values of the strain parameters were assessed by receiver operating characteristic (ROC) curves with the pathological results as diagnostic criteria.The reliability of the strain parameters were tested using interclass correlation coefficient (ICC), coefficients of variation (CV) and Bland-Altman. RESULTS: No abnormal pathological changes in myocardial cells were found in the control group. Myocarditis was successfully induced in all of the rats in the model group, showing myocardial fiber arrangement disorder, degeneration, necrosis, inflammatory cell infiltration and interstitial fibrosis. The ROC showed that 2D global strain parameters possessed higher diagnostic values than 3D strain parameters. The 2D had an area under the curve (AUC) of 0.96 in global circumferential strain (GCS), 0.95 in global radial strain (GRS), and 0.90 in global longitudinal strain (GLS), compared with 0.87 GCS, 0.85 GRS, and 0.77 GLS in the 3D, respectively.The reliability of the 2D strain parameters was high, except for inter-observer 2D GRS(ICC=0.893). The 3D strain parameters had lower reliability (ICCs:0.421-0.79) than the 2D strain parameters (ICCs:0.893-0.986). CONCLUSION: The diagnostic values of 2D strain parameters are higher than 3D strain parameters in diagnosing myocarditis.


Assuntos
Doenças Autoimunes/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Miocardite/diagnóstico por imagem , Animais , Modelos Animais de Doenças , Distribuição Aleatória , Ratos , Ratos Endogâmicos Lew , Reprodutibilidade dos Testes , Suínos , Função Ventricular Esquerda
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): 489-493, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642224

RESUMO

OBJECTIVE: To determine segmental myocardial changes in cardiovascular magnetic resonance feature-tracking (CMR-FT) in the early phase of reperfused myocardial infarction in patients and rats. METHODS: Ten patients receiving percutaneous coronary interventions (2-10 d) and 10 rats with 60 min induced myocardial ischemia followed by reperfusions (48 h and 7 d) were investigated by MRI. The steady state free precession cine and late gadolinium enhancement (LGE) sequences were measured to evaluate the standard short axis of the whole heart after an injection of gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA, Magnevist, Bayer Health Care Pharmaceuticals) at a dose of 0.1 mmol/kg. The infarction sizes (all areas were expressed as a percentage of the whole myocardial tissues of left ventricle (LV), end-diastolic volume (EDV) and ejection fractions (EF) were calculated. The MRI cine images were analyzed using the myocardial feature tracking software CVI, estimating the peak value of radial strains (RS) and circumferential strains (CS) of the 16 AHA segments excluding apex cordis. The complete myocardial infarction (CMI) segments, partial myocardial infarction (PMI) segments and non-myocardial infarction (NMI) segments were identified and compared. RESULTS: Patients: The radial strain and circumferential strain of the CMI and PMI segments were smaller than the NMI segment (both P < 0.01). However, there was no significant difference between the CMI and the PMI segment (P>0.05). Rats: No significance differences were found in EF and EDV between the two time period 48 h and 7 d (both P>0.05). The radial strain and circumferential strain of the CMI and PMI segments were smaller than the NMI segment (all P < 0.01). But there was no significance difference between the CMI segment and the PMI segment (P>0.05). No significant changes in the global radial strain and the circumferential strain were found over time (both P>0.05). But the segmental radial strain and circumferential strain became larger over time (all P < 0.05). CONCLUSIONS: The systolic ability of myocardium decreases as a result of reperfusion injury in the early phase of reperfused myocardial infarction. But it can gradually recover over time with reperfusion.


Assuntos
Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Animais , Meios de Contraste , Gadolínio , Gadolínio DTPA , Humanos , Ratos
11.
Hypertension ; 74(5): 1192-1199, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31522619

RESUMO

Black Americans suffer disproportionately from hypertension and hypertensive heart disease. Out-of-office blood pressure (BP) is more predictive for cardiovascular complications than clinic BP; however, the relative abilities of clinic and out-of-office BP to predict left ventricular hypertrophy in black and white adults have not been established. Thus, we aimed to compare associations of out-of-office and clinic BP measurement with left ventricular hypertrophy by cardiac magnetic resonance imaging among non-Hispanic black and white adults. In this cross-sectional study, 1262 black and 927 white participants of the Dallas Heart Study ages 30 to 64 years underwent assessment of standardized clinic and out-of-office (research staff-obtained) BP and left ventricular mass index. In multivariable-adjusted analyses of treated and untreated participants, out-of-office BP was a stronger determinant of left ventricular hypertrophy than clinic BP (odds ratio per 10 mm Hg, 1.48; 95% CI, 1.34-1.64 for out-of-office systolic BP and 1.15 [1.04-1.28] for clinic systolic BP; 1.71 [1.43-2.05] for out-of-office diastolic BP, and 1.03 [0.86-1.24] for clinic diastolic BP). Non-Hispanic black race/ethnicity, treatment status, and lower left ventricular ejection fraction were also independent determinants of hypertrophy. Among treated Blacks, the differential association between out-of-office and clinic BP with hypertrophy was more pronounced than in treated white or untreated participants. In conclusion, protocol-driven supervised out-of-office BP monitoring provides important information that cannot be gleaned from clinic BP assessment alone. Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00344903.


Assuntos
Afro-Americanos/estatística & dados numéricos , Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Imagem Cinética por Ressonância Magnética/métodos , Adulto , Fatores Etários , Anti-Hipertensivos/uso terapêutico , Teorema de Bayes , Determinação da Pressão Arterial/métodos , Estudos Transversais , Eletrocardiografia/métodos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etnologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Texas
12.
Int J Cardiovasc Imaging ; 35(11): 2057-2065, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31402413

RESUMO

This study was aimed to investigate the correlation between left ventricular (LV) myocardial strain and LV geometry in healthy adults using cardiovascular magnetic resonance-feature tracking (CMR-FT). 124 gender-matched healthy adults who underwent healthy checkup using CMR cine imaging were retrospectively analyzed. Peak global radial, circumferential, longitudinal strain (GRS, GCS and GLS) for left ventricle were measured. LV geometry was assessed by the ratio of LV mass (LVM) and end-diastolic volume (EDV). GRS, GCS and GLS were 34.18 ± 6.71%, - 22.17 ± 2.28%, - 14.76 ± 2.39% for men, and 33.40 ± 6.95%, - 22.49 ± 2.27%, - 15.72 ± 2.36% for women. Multiple linear regression showed that LVM/EDV was associated with decreased GLS (ß = - 0.297, p = 0.005), but was not significantly associated with GRS and GCS (both p > 0.05). There was an increase in the magnitude of GRS, GCS and GLS with advancing age (ß = 0.254, ß = 0.466 and ß = 0.313, all p < 0.05). Greater BMI was associated with decreased GRS, GCS and GLS (ß = - 0.232, ß = - 0. 249 and ß = - 0.279, all p < 0.05). In conclusion, compared with GRS and GCS, GLS is more sensitive to assess LV concentric remodeling in healthy adults. GRS, GCS and GLS are all independently positively associated with age and negatively associated with BMI. Sex-based LV strain reference values for healthy Chinese adults are established.


Assuntos
Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Contração Miocárdica , Função Ventricular Esquerda , Remodelação Ventricular , Adulto , Fatores Etários , Índice de Massa Corporal , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores Sexuais
13.
BMC Med Imaging ; 19(1): 59, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370821

RESUMO

BACKGROUND: T1 mapping sequences such as MOLLI, ShMOLLI and SASHA make use of different technical approaches, bearing strengths and weaknesses. It is well known that obtained T1 relaxation times differ between the sequence techniques as well as between different hardware. Yet, T1 quantification is a promising tool for myocardial tissue characterization, disregarding the absence of established reference values. The purpose of this study was to evaluate the feasibility of native and post-contrast T1 mapping methods as well as ECV maps and its diagnostic benefits in a clinical environment when scanning patients with various cardiac diseases at 3 T. METHODS: Native and post-contrast T1 mapping data acquired on a 3 T full-body scanner using the three pulse sequences 5(3)3 MOLLI, ShMOLLI and SASHA in 19 patients with clinical indication for contrast enhanced MRI were compared. We analyzed global and segmental T1 relaxation times as well as respective extracellular volumes and compared the emerged differences between the used pulse sequences. RESULTS: T1 times acquired with MOLLI and ShMOLLI exhibited systematic T1 deviation compared to SASHA. Myocardial MOLLI T1 times were 19% lower and ShMOLLI T1 times 25% lower compared to SASHA. Native blood T1 times from MOLLI were 13% lower than SASHA, while post-contrast MOLLI T1-times were only 5% lower. ECV values exhibited comparably biased estimation with MOLLI and ShMOLLI compared to SASHA in good agreement with results reported in literature. Pathology-suspect segments were clearly differentiated from remote myocardium with all three sequences. CONCLUSION: Myocardial T1 mapping yields systematically biased pre- and post-contrast T1 times depending on the applied pulse sequence. Additionally calculating ECV attenuates this bias, making MOLLI, ShMOLLI and SASHA better comparable. Therefore, myocardial T1 mapping is a powerful clinical tool for classification of soft tissue abnormalities in spite of the absence of established reference values.


Assuntos
Cardiopatias/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Volume Cardíaco , Meios de Contraste , Estudos de Viabilidade , Cardiopatias/fisiopatologia , Humanos , Sensibilidade e Especificidade
15.
Eur J Radiol ; 118: 264-270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439253

RESUMO

PURPOSE: A multiphasic cine sequence performed during magnetic resonance enterography (MRE) has been shown to increase diagnostic accuracy of MRE demonstrating limited movement in inflamed intestine in patients with Crohn's disease (CD). Our aim was to confirm in our study population that intestinal inflammation was associated with decreased motility and determine if factors suggestive of complicated disease such as the presence of a stricture or fistula were associated with decreased motility on the MRE cine sequence. METHODS: This was a retrospective study of 59 patients (mean age 40.8 ±â€¯16.1) with Crohn's disease who had a small bowel lesion on MRE. Two gastrointestinal radiologists independently scored MRE findings using a qualitative, subjective scoring system. Univariate and multivariable ordered logistic regression models were used to evaluate the associations between cine sequence score, radiologic image findings, and clinical data. RESULTS: On univariate analysis, radiologic findings reflecting active inflammation, the presence of a stricture, and penetrating disease were associated with decreased motility. On multivariable analysis, hyper-enhancement, the presence of a comb sign, and global evidence of active inflammation remained associated with decreased motility. Of the factors suggesting complicated disease, the presence of stricture (Odds Ratio 0.40, 95% Confidence Interval 0.17-0.95, p-value 0.038) was associated with decreased motility. CONCLUSIONS: As previously shown, well-established radiologic findings of bowel inflammation were associated with decreased small bowel motility. In this study, we have added that the radiologic finding of a fixed stricture is also associated with decreased motility.


Assuntos
Doença de Crohn/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Intestino Delgado , Adulto , Idoso , Constrição Patológica/patologia , Constrição Patológica/fisiopatologia , Doença de Crohn/patologia , Fístula Cutânea/etiologia , Fístula Cutânea/patologia , Fístula Cutânea/fisiopatologia , Feminino , Humanos , Inflamação/patologia , Fístula Intestinal/etiologia , Fístula Intestinal/patologia , Fístula Intestinal/fisiopatologia , Obstrução Intestinal/patologia , Intestinos/patologia , Modelos Logísticos , Imagem por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
16.
Am J Case Rep ; 20: 1120-1123, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31353363

RESUMO

BACKGROUND Pericarditis is common in rheumatoid arthritis, mostly occurring as an extra-articular manifestation of the disease. We describe a patient with stable rheumatoid arthritis who presented with a large pericardial effusion and a compressive fibrotic pericardial mass. The patient had recently started treatment with a tumor necrosis factor-alpha (TNF-alpha) antagonist. CASE REPORT The patient was a 58-year-old woman with rheumatoid arthritis who presented with right ventricular compression caused by a pericardial fibrotic mass and a large pericardial effusion. The patient did not have active arthritis at the time of presentation. She had been started on treatment with a tumor necrosis factor-alpha (TNF-alpha) antagonist 4 months prior to this presentation. She was successfully treated with surgical pericardiectomy and resection of the pericardial mass. Pathologic analysis of the pericardial mass demonstrated fibrosis and no evidence of active inflammation, rheumatoid arthritis, opportunistic infection, or malignancy. CONCLUSIONS We describe a patient with stable rheumatoid arthritis who developed subacute right heart compression syndrome secondary to pericardial effusion and fibrous pericardial mass. The exact cause of pericarditis and the pericardial mass remain uncertain. There is a need for increased awareness of the association between use of TNF-alpha antagonists and the possible development of an intrapericardial fibrotic mass and effusion.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Tamponamento Cardíaco/etiologia , Derrame Pericárdico/diagnóstico por imagem , Pericardite/patologia , Pericárdio/patologia , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/cirurgia , Ecocardiografia , Feminino , Fibrose , Humanos , Imagem Cinética por Ressonância Magnética , Pessoa de Meia-Idade , Derrame Pericárdico/cirurgia , Pericardiectomia , Pericardite/cirurgia , Pericárdio/cirurgia , Fator de Necrose Tumoral alfa/antagonistas & inibidores
17.
J Cardiovasc Magn Reson ; 21(1): 43, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31340834

RESUMO

BACKGROUND: We hypothesize that dobutamine-induced stress impacts intracardiac hemodynamic parameters and that this may be linked to decreased exercise capacity in Fontan patients. Therefore, the purpose of this study was to assess the effect of pharmacologic stress on intraventricular kinetic energy (KE), viscous energy loss (EL) and vorticity from four-dimensional (4D) Flow cardiovascular magnetic resonance (CMR) imaging in Fontan patients and to study the association between stress response and exercise capacity. METHODS: Ten Fontan patients underwent whole-heart 4D flow CMR before and during 7.5 µg/kg/min dobutamine infusion and cardiopulmonary exercise testing (CPET) on the same day. Average ventricular KE, EL and vorticity were computed over systole, diastole and the total cardiac cycle (vorticity_volavg cycle, KEavg cycle, ELavg cycle). The relation to maximum oxygen uptake (VO2 max) from CPET was tested by Pearson's correlation or Spearman's rank correlation in case of non-normality of the data. RESULTS: Dobutamine stress caused a significant 88 ± 52% increase in KE (KEavg cycle: 1.8 ± 0.5 vs 3.3 ± 0.9 mJ, P < 0.001), a significant 108 ± 49% increase in EL (ELavg cycle: 0.9 ± 0.4 vs 1.9 ± 0.9 mW, P < 0.001) and a significant 27 ± 19% increase in vorticity (vorticity_volavg cycle: 3441 ± 899 vs 4394 ± 1322 mL/s, P = 0.002). All rest-stress differences (%) were negatively correlated to VO2 max (KEavg cycle: r = - 0.83, P = 0.003; ELavg cycle: r = - 0.80, P = 0.006; vorticity_volavg cycle: r = - 0.64, P = 0.047). CONCLUSIONS: 4D flow CMR-derived intraventricular kinetic energy, viscous energy loss and vorticity in Fontan patients increase during pharmacologic stress and show a negative correlation with exercise capacity measured by VO2 max.


Assuntos
Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Circulação Coronária/efeitos dos fármacos , Dobutamina/administração & dosagem , Teste de Esforço , Tolerância ao Exercício/efeitos dos fármacos , Técnica de Fontan , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Hemodinâmica/efeitos dos fármacos , Imagem Cinética por Ressonância Magnética , Imagem de Perfusão do Miocárdio/métodos , Consumo de Oxigênio/efeitos dos fármacos , Adolescente , Feminino , Cardiopatias Congênitas/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
J Cardiovasc Magn Reson ; 21(1): 39, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31303178

RESUMO

BACKGROUND: Patients with single ventricle physiology are at increased risk for developing liver fibrosis. Its extent and prevalence in children with bidirectional cavopulmonary connection (BCPC) and Fontan circulation are unclear. Extracellular volume fraction (ECV), derived from cardiovascular magnetic resonance (CMR) and T1 relaxometry, reflect fibrotic remodeling and/or congestion in the liver. The aim of this study was to investigate whether pediatric patients with single ventricle physiology experience increased native T1 and ECV as markers of liver fibrosis/congestion. METHODS: Hepatic native T1 times and ECV, using a cardiac short axis modified Look-Locker inversion recovery sequence displaying the liver, were measured retrospectively in children with BCPC- and Fontan circulations and compared to pediatric controls. RESULTS: Hepatic native T1 time were increased in Fontan patients (n = 62, 11.4 ± 4.4 years, T1 762 ± 64 ms) versus BCPC patients (n = 20, 2.8 ± 0.9 years, T1 645 ± 43 ms, p = 0.04). Both cohorts had higher T1 than controls (n = 44, 13.7 ± 2.9 years, T1 604 ± 54 ms, p < 0.001 for both). ECV was 41.4 ± 4.8% in Fontan and 36.4 ± 4.8% in BCPC patients, respectively (p = 0.02). In Fontan patients, T1 values correlated with exposure to cardiopulmonary bypass time (R = 0.3, p = 0.02), systolic and end diastolic volumes (R = 0.3, p = 0.04 for both) and inversely with oxygen saturations and body surface area (R = -0.3, p = 0.04 for both). There were no demonstrable associations of T1 or ECV with central venous pressure or age after Fontan. CONCLUSION: Fontan and BCPC patients have elevated CMR markers suggestive of hepatic fibrosis and/or congestion, even at a young age. The tissue changes do not appear to be related to central venous pressures. TRIAL REGISTRATION: Retrospectively registered data.


Assuntos
Técnica de Fontan , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Cirrose Hepática/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Estudos de Viabilidade , Feminino , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Hemodinâmica , Humanos , Lactente , Cirrose Hepática/etiologia , Cirrose Hepática/fisiopatologia , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
J Cardiovasc Magn Reson ; 21(1): 41, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31315625

RESUMO

BACKGROUND: The associations between cardiovascular disease (CVD) risk factors and the biventricular geometry of the right ventricle (RV) and left ventricle (LV) have been difficult to assess, due to subtle and complex shape changes. We sought to quantify reference RV morphology as well as biventricular variations associated with common cardiovascular risk factors. METHODS: A biventricular shape atlas was automatically constructed using contours and landmarks from 4329 UK Biobank cardiovascular magnetic resonance (CMR) studies. A subdivision surface geometric mesh was customized to the contours using a diffeomorphic registration algorithm, with automatic correction of slice shifts due to differences in breath-hold position. A reference sub-cohort was identified consisting of 630 participants with no CVD risk factors. Morphometric scores were computed using linear regression to quantify shape variations associated with four risk factors (high cholesterol, high blood pressure, obesity and smoking) and three disease factors (diabetes, previous myocardial infarction and angina). RESULTS: The atlas construction led to an accurate representation of 3D shapes at end-diastole and end-systole, with acceptable fitting errors between surfaces and contours (average error less than 1.5 mm). Atlas shape features had stronger associations than traditional mass and volume measures for all factors (p < 0.005 for each). High blood pressure was associated with outward displacement of the LV free walls, but inward displacement of the RV free wall and thickening of the septum. Smoking was associated with a rounder RV with inward displacement of the RV free wall and increased relative wall thickness. CONCLUSION: Morphometric relationships between biventricular shape and cardiovascular risk factors in a large cohort show complex interactions between RV and LV morphology. These can be quantified by z-scores, which can be used to study the morphological correlates of disease.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/normas , Função Ventricular Esquerda , Função Ventricular Direita , Remodelação Ventricular , Idoso , Pontos de Referência Anatômicos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Reino Unido/epidemiologia
20.
Int J Cardiovasc Imaging ; 35(12): 2213-2219, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31321653

RESUMO

Cardiac MR (CMR) is increasingly used to assess for cardiac involvement in patients with Duchenne muscular dystrophy (DMD). The frequent use of gadolinium based contrast agents (GBCAs) has been called into question with reports of intracranial gadolinium deposition in patients receiving multiple administrations. We adopted a conservative GBCA administration policy, limiting the frequency of GBCA exposure in patients with previously documented late gadolinium enhancement. The aim of our study was to evaluate the clinical effects of this policy change. Data were retrospectively reviewed on 405 consecutive patients with DMD who underwent CMR evaluation. Patients were grouped into conservative GBCA administration or historical control. CMR reports were evaluated and clinical reports were reviewed to determine actionable changes. Ohio Medicaid reimbursements were used to estimate costs. A total of 187 patients comprised the conservative GBCA group and 218 patients the historical cohort. The conservative GBCA group had lower contrast administration rates (84% vs. 99%, p < 0.0001), shorter scan times (35.2 vs. 39.0 min, p < 0.0001), and lower estimated medical costs ($339 vs. $351/study). There was no change regarding the initial presence of first-time late gadolinium enhancement, and no difference in actionable change. Contrast administration substantially decreased 7 months post-policy change (65%) compared to the initial 7 months (96%, p < 0.0001). In the current era with unclear concern for intracranial gadolinium deposition, thoughtful GBCA administration is warranted in patients anticipated to undergo multiple CMRs. Our updated approach has resulted in fewer patients receiving contrast, shorter scan times, and less medical costs, without appreciable changes to patient management.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Imagem Cinética por Ressonância Magnética , Meglumina/administração & dosagem , Distrofia Muscular de Duchenne/complicações , Compostos Organometálicos/administração & dosagem , Adolescente , Cardiomiopatias/economia , Cardiomiopatias/etiologia , Criança , Meios de Contraste/economia , Redução de Custos , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Imagem Cinética por Ressonância Magnética/economia , Masculino , Meglumina/economia , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/economia , Compostos Organometálicos/economia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Fluxo de Trabalho
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