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1.
Vasc Health Risk Manag ; 15: 539-550, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827327

RESUMO

Background: Left ventricular hypertrophy (LVH), as assessed by measurement of left ventricular mass (LVM), is one of the most important cardiovascular risk factors. It is commonly present in patients with ischemic heart disease (IHD), irrespective of the level of blood pressure; recently, oxidative stress has been shown to be an important factor in its development. The question then arises: can this risk factor be modified by antioxidant treatment (e.g., with allopurinol, a xanthine oxidase inhibitor)? Methods: This is an observational study with a cross-sectional design which explored the association between long-term (>12 months) allopurinol therapy and LV mass index (LVMI) as well as geometry in patients generally receiving standard treatments for IHD. The primary endpoint was LVMI measurement (by 2D-echocardiography) and secondary endpoints included the association of allopurinol use with LV function (ejection fraction), blood pressure, glycemic control, and lipid profile. Results: Ninety-six patients on standard anti-ischemic drug treatment (control group) and 96 patients who were additionally taking allopurinol (minimum dose 100 mg/day) were enrolled. Both groups were matched for age, sex, height, and co-morbidities, but poorer kidney function in the allopurinol group required further sub-group analysis based on renal function. Allopurinol treatment was associated with the lowest LVMI in the patients with normal serum creatinine (median LVMI; 70.5 g/m2): corresponding values were 76.0 and 87.0 in the control group with, respectively, normal and elevated serum creatinine, and 89.5 in the allopurinol group with elevated serum creatinine (P=0.027). In addition, allopurinol was associated with better glycemic control (HbA1c) with a difference of 0.8% (95% CI; 1.3, 0.2) (P=0.004) as compared with control patients. Conclusion: In our population, treatment with allopurinol (presumably because of its anti-oxidant properties) has shown a tendency to be associated with smaller LVM in IHD patients with normal serum creatinine, along with better glycemic control.


Assuntos
Alopurinol/uso terapêutico , Antioxidantes/uso terapêutico , Hipertrofia Ventricular Esquerda/tratamento farmacológico , Isquemia Miocárdica/tratamento farmacológico , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Alopurinol/efeitos adversos , Antioxidantes/efeitos adversos , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Estudos de Casos e Controles , Creatinina/sangue , Estudos Transversais , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
2.
Int Heart J ; 60(6): 1238-1244, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31735779

RESUMO

Recent clinical studies revealed that anatomical information assessed by coronary computed tomography angiography (CTA) may be used effectively to diagnose coronary artery disease (CAD). However, a physiological assessment, demonstrating myocardial ischemia, is required to justify a therapeutic strategy for CAD. This study aimed to investigate whether using CTA to assess myocardial supply area can improve the prediction of myocardial ischemia.We analyzed 201 vessels with moderate (luminal narrowing ≥ 50%, < 70%) and severe (luminal narrowing ≥ 70%, < 99%) stenosis on CTA from 174 patients, who were suspected of having stable angina and underwent measurement of fractional flow reserve (FFR). The myocardial area supplied by the coronary artery, distal to the stenosis, was evaluated with CTA, as reported previously (modified Alberta Provincial Project for Outcome Assessment in Coronary Heart score) and was classified into 3 groups (large, medium, and small).Both percentage area stenosis and myocardial supply area were significantly correlated with FFR (r = -0.46, P < 0.01, and r = -0.45, P < 0.01). Among patients who had coronary plaques, with moderate stenosis and a small myocardial supply area, only 3 of 42 lesions (7%) were identified as ischemic; deviation from the ischemic threshold (FFR = 0.80) was P < 0.01. The combined assessment of lesion stenosis and myocardial supply area, using CTA, improved the prediction of myocardial ischemia significantly compared to lesion stenosis alone (77% versus 59%, P < 0.01).Adding the assessment of myocardial supply area to standard CTA might help predict myocardial ischemia in patients with stable angina pectoris.


Assuntos
Angiografia por Tomografia Computadorizada , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Idoso , Circulação Coronária/fisiologia , Estenose Coronária/complicações , Feminino , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Valor Preditivo dos Testes , Estudos Retrospectivos
3.
Eur J Radiol ; 119: 108657, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31521876

RESUMO

PURPOSE: This study investigated the impact of gender differences on the diagnostic performance of machine-learning based coronary CT angiography (cCTA)-derived fractional flow reserve (CT-FFRML) for the detection of lesion-specific ischemia. METHOD: Five centers enrolled 351 patients (73.5% male) with 525 vessels in the MACHINE (Machine leArning Based CT angiograpHy derIved FFR: a Multi-ceNtEr) registry. CT-FFRML and invasive FFR ≤ 0.80 were considered hemodynamically significant, whereas cCTA luminal stenosis ≥50% was considered obstructive. The diagnostic performance to assess lesion-specific ischemia in both men and women was assessed on a per-vessel basis. RESULTS: In total, 398 vessels in men and 127 vessels in women were included. Compared to invasive FFR, CT-FFRML reached a sensitivity, specificity, positive predictive value, and negative predictive value of 78% (95%CI 72-84), 79% (95%CI 73-84), 75% (95%CI 69-79), and 82% (95%CI: 76-86) in men vs. 75% (95%CI 58-88), 81 (95%CI 72-89), 61% (95%CI 50-72) and 89% (95%CI 82-94) in women, respectively. CT-FFRML showed no statistically significant difference in the area under the receiver-operating characteristic curve (AUC) in men vs. women (AUC: 0.83 [95%CI 0.79-0.87] vs. 0.83 [95%CI 0.75-0.89], p = 0.89). CT-FFRML was not superior to cCTA alone [AUC: 0.83 (95%CI: 0.75-0.89) vs. 0.74 (95%CI: 0.65-0.81), p = 0.12] in women, but showed a statistically significant improvement in men [0.83 (95%CI: 0.79-0.87) vs. 0.76 (95%CI: 0.71-0.80), p = 0.007]. CONCLUSIONS: Machine-learning based CT-FFR performs equally in men and women with superior diagnostic performance over cCTA alone for the detection of lesion-specific ischemia.


Assuntos
Angiografia por Tomografia Computadorizada/normas , Estenose Coronária/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Angiografia Coronária/normas , Estenose Coronária/fisiopatologia , Métodos Epidemiológicos , Feminino , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Hemodinâmica/fisiologia , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Fatores Sexuais , Tomografia Computadorizada Espiral/métodos , Tomografia Computadorizada Espiral/normas
4.
Lakartidningen ; 1162019 Jul 17.
Artigo em Sueco | MEDLINE | ID: mdl-31334816

RESUMO

Elevation of troponin reflects myocardial infarction. The underlying causes should be assessed, as treatment and prognosis may differ widely. Myocardial damage with non-obstructive coronary arteries requires further evaluation including magnetic resonance tomography. We report a case of significant myocardial ischemia which was unnoticed by myocardial scintigraphy but detected by positron emission tomography (PET). The 15O-water tracer allows for quantitative assessment of myocardial perfusion including regional abnormalities and may thus diagnose microvascular dysfunction.


Assuntos
Isquemia Miocárdica/diagnóstico por imagem , Radioisótopos de Oxigênio , Tomografia por Emissão de Pósitrons/métodos , Água , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/tratamento farmacológico , Imagem de Perfusão do Miocárdio , Radioisótopos de Oxigênio/farmacocinética , Oligoelementos/farmacocinética
5.
BMC Med Imaging ; 19(1): 58, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349798

RESUMO

BACKGROUND: The reliable quantification of myocardial blood flow (MBF) with MRI, necessitates the correction of errors in arterial input function (AIF) caused by the T1 saturation effect. The aim of this study was to compare MBF determined by a traditional dual bolus method against a modified dual bolus approach and to evaluate both methods against PET in a porcine model of myocardial ischemia. METHODS: Local myocardial ischemia was induced in five pigs, which were subsequently examined with contrast enhanced MRI (gadoteric acid) and PET (O-15 water). In the determination of MBF, the initial high concentration AIF was corrected using the ratio of low and high contrast AIF areas, normalized according to the corresponding heart rates. MBF was determined from the MRI, during stress and at rest, using the dual bolus and the modified dual bolus methods in 24 segments of the myocardium (total of 240 segments, five pigs in stress and rest). Due to image artifacts and technical problems 53% of the segments had to be rejected from further analyses. These two estimates were later compared against respective rest and stress PET-based MBF measurements. RESULTS: Values of MBF were determined for 112/240 regions. Correlations for MBF between the modified dual bolus method and PET was rs = 0.84, and between the traditional dual bolus method and PET rs = 0.79. The intraclass correlation was very good (ICC = 0.85) between the modified dual bolus method and PET, but poor between the traditional dual bolus method and PET (ICC = 0.07). CONCLUSIONS: The modified dual bolus method showed a better agreement with PET than the traditional dual bolus method. The modified dual bolus method was found to be more reliable than the traditional dual bolus method, especially when there was variation in the heart rate. However, the difference between the MBF values estimated with either of the two MRI-based dual-bolus methods and those estimated with the gold-standard PET method were statistically significant.


Assuntos
Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Algoritmos , Animais , Meios de Contraste , Modelos Animais de Doenças , Humanos , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Suínos
6.
Biol Sex Differ ; 10(1): 35, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31300046

RESUMO

BACKGROUND: Stress is an important contributor to myocardial ischemia and the progression of coronary artery disease (CAD), and women are more susceptible than men to these effects. Little is known, however, about the neural basis of these sex differences. METHODS: We investigated sex differences in neural correlates of mental stress in a sample of 53 female and 112 male participants (N = 165) with CAD, with and without mental stress-induced myocardial ischemia (MSI), during exposure to mental arithmetic tasks and public speaking stress tasks using high-resolution positron emission tomography (HR-PET) and radiolabeled water imaging of the brain. RESULTS: Women compared to men had significantly greater activation with stress in the right frontal (BA 9, 44), right parietal lobe (Area 3, 6, 40), right posterior cingulate gyrus (BA 31), bilateral cerebellum, and left temporal/fusiform gyrus (BA 37) and greater deactivation in bilateral anterior cingulate gyrus (BA 24, 32), bilateral medial frontal gyrus (BA 6, 8, 9, 10), right parahippocampal gyrus, and right middle temporal gyrus (BA 21). Women with MSI (but not those without MSI) showed significantly greater activation than men in the right posterior cingulate gyrus (BA 31) and greater deactivation in several frontal and temporal lobe areas. CONCLUSION: Men and women with CAD show differences in responses to stress in brain limbic areas that regulate emotion, and these functional responses differ by MSI status. Our results suggest that the cingulate gyrus may be involved in sex differences in MSI.


Assuntos
Encéfalo/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Caracteres Sexuais , Estresse Psicológico/fisiopatologia , Idoso , Encéfalo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/etiologia , Tomografia por Emissão de Pósitrons , Estresse Psicológico/complicações , Estresse Psicológico/diagnóstico por imagem
7.
Magn Reson Imaging Clin N Am ; 27(3): 491-505, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279452

RESUMO

Ischemic heart disease remains the foremost determinant of death and disability across the world. Quantification of the ischemia burden is currently the preferred approach to predict event risk and to trigger adequate treatment. Cardiac magnetic resonance (CMR) can be a prime protagonist in this scenario due to its synergistic features. It allows assessment of wall motility, myocardial perfusion, and tissue scar by means of late gadolinium enhancement imaging. We discuss the clinical and preclinical aspects of gadolinium-based, perfusion CMR imaging, including the relevance of high spatial resolution and 3-dimensional whole-heart coverage, among important features of this auspicious method.


Assuntos
Imagem por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Estresse Fisiológico/fisiologia , Estudos de Avaliação como Assunto , Humanos , Isquemia Miocárdica/fisiopatologia
8.
Magn Reson Imaging Clin N Am ; 27(3): 507-520, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279453

RESUMO

Cardiovascular magnetic resonance (CMR) perfusion imaging is a robust noninvasive technique to evaluate ischemia in patients with coronary artery disease (CAD). Although qualitative and semiquantitative methods have shown that CMR has high accuracy in diagnosing flow-obstructing lesions in CAD, quantitative ischemic burden is an important variable used in clinical practice for treatment decisions. Quantitative CMR perfusion techniques have evolved significantly, with accuracy comparable with both PET and microsphere evaluation. Routine clinical use of these quantitative techniques has been facilitated by the introduction of automated methods that accelerate the work flow and rapidly generate pixel-based myocardial blood flow maps.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Estresse Fisiológico/fisiologia , Estudos de Avaliação como Assunto , Humanos , Isquemia Miocárdica/fisiopatologia
9.
Turk Kardiyol Dern Ars ; 47(5): 350-356, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31311909

RESUMO

OBJECTIVE: The SYNTAX score (SS) is not just a measure of the severity of coronary artery disease, but also complexity. The aim of this study was to evaluate the relationship between the SS and myocardial viability/non-viability assessed by positron emission tomography (PET) in patients with ischemic cardiomyopathy (IC). METHODS: A total of 107 IC patients who had undergone PET were enrolled in the study. The patients were divided into two groups according to the presence or absence of viable myocardium. SS was analyzed from recorded conventional coronary angiographies. RESULTS: Patients with a non-viable myocardium (n=21; 19.6%) had a significantly higher SS compared to those with a viable myocardium (17.6±3.7 vs. 14.1±5.2, respectively; p=0.004). Point-biserial correlation coefficient analysis indicated that the presence of myocardial non-viability was mildly correlated with a higher SS (rpb=-0.28, p=0.004). In multivariate logistic regression analysis, the SS was identified as the sole independent predictor of myocardial non-viability (odds ratio [OR]: 1.164, 95% confidence interval [CI]: 1.044-1.297; p =0.006]. Receiver operating characteristic analysis revealed a cutoff point of 16 for predicting a non-viable myocardium (area under curve: 0.71, 95% CI: 0.61-0.82) with a sensitivity of 76.2% and a specificity of 61.6%. CONCLUSION: The results of the present study indicates that a high SS is associated with the presence of a non-viable myocardium in IC patients.


Assuntos
Cardiomiopatias , Doença da Artéria Coronariana , Isquemia Miocárdica , Idoso , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Feminino , Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Tomografia por Emissão de Pósitrons , Prognóstico , Índice de Gravidade de Doença
10.
Braz J Cardiovasc Surg ; 34(4): 420-427, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31165611

RESUMO

OBJECTIVE: To evaluate the patency of individual and sequential coronary artery bypass in patients with ischemic heart disease. METHODS: We searched PubMed, Cochrane Library, Excerpta Medica Database, and ClinicalTrials.gov databases for controlled trials. Endpoints included graft patency, anastomosis patency, occluded rates in left anterior descending (LAD) system and right coronary artery (RCA) system, in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs) and standardized mean difference (SMD) were used to assess the relative data. RESULTS: Nine cohorts, including 7100 patients and 1440 grafts under individual or sequential coronary artery bypass. There were no significant differences between individual and sequential coronary artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16; I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%), occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%), occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%), in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%). CONCLUSION: No significant differences on clinical data were observed regarding anastomosis patency, occluded rate in LAD system, occluded rate in RCA system, in-hospital mortality, and follow-up mortality, indicating that the patency of individual and the patency of sequential coronary artery bypass are similar to each other.


Assuntos
Ponte de Artéria Coronária/métodos , Oclusão Coronária/terapia , Isquemia Miocárdica/cirurgia , Grau de Desobstrução Vascular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Fatores de Risco , Resultado do Tratamento
11.
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
12.
Magn Reson Imaging ; 62: 38-45, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31170429

RESUMO

MOLLI-based T1 mapping has been applied to a variety of cardiac pathologies. However, conventional MOLLI's requirement for rest periods between inversion groups increases scan time, and limits the choice of inversion groups. The recently developed inversion group (IG) fitting technique eliminates the rest period requirement, and permits complete flexibility of inversion groups. However, a limitation is that its T1 maps have low precision - up to 30% poorer than conventional 3-parameter methods. In the original IG method, T1 maps were derived from the first inversion group only. In the present study, a technique is presented which utilize data from all inversion groups to generate T1 maps. It is hypothesized this "composite-IG" fitting method will provided improved prevision over conventional-IG T1 mapping methods. Simulations, phantom, and in vivo experiments on nine clinical cardiac patients (congenital heart disease, ischemic- and non-ischemic cardiomyopathy) were performed. Imaging was performed on a 1.5 T Siemens scanner. Myocardial T1 mapping precision and reproducibility were calculated for conventional-IG, composite-IG, and 3-parameter techniques. Precision and reproducibility between the techniques was compared using the Wilcoxon Signed Rank test. Statistical significance was set at the 95% confidence level, with the Bonferroni correction for multiple comparisons employed. Composite-IG improves precision by 16-38% over conventional-IG (p < 0.01). Composite-IG T1 maps provided up to 5% better precision than 3-parameter fits (p < 0.01). Composite-IG had better reproducibility than conventional-IG (p < 0.01). However, there was no significant difference between composite-IG and conventional 5(3)3 3-parameter reproducibility.


Assuntos
Coração/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética , Isquemia Miocárdica/diagnóstico por imagem , Algoritmos , Cardiomiopatias/diagnóstico por imagem , Simulação por Computador , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Modelos Estatísticos , Método de Monte Carlo , Movimento (Física) , Miocárdio/patologia , Imagens de Fantasmas , Reprodutibilidade dos Testes , Software , Tempo
13.
Am J Case Rep ; 20: 810-815, 2019 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-31177265

RESUMO

BACKGROUND Response to cardiac resynchronization therapy (CRT) is variable among patients. Extensive scar tissue burden has been characterized as a negative predictor of significant response. Whereas mid-term and long-term response has been thoroughly investigated in randomized clinical trials; however, little is known about acute hemodynamic effects of biventricular pacing. CASE REPORT We report a case of an elderly female patient with severe ischemic cardiomyopathy and a large anterior wall aneurysm, who received right ventricular and biventricular pacing during ablation of incessant pleomorphic ventricular tachycardia. During the procedure, biventricular pacing was associated with a 20% acute increase in systolic blood pressure compared to right ventricular pacing, although there was no acute or long-term effect on left ventricular function. CONCLUSIONS The acute hemodynamic effect of CRT in our patient suggests an effect of CRT even in patients with negative predictors of CRT response such as severe ischemic cardiomyopathy with a large aneurysm. Although no marked increase in left ventricular function might be observed, the acute effect of CRT might contribute to stabilization of heart failure in these patients.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Ablação por Cateter/métodos , Aneurisma Cardíaco/complicações , Hemodinâmica/fisiologia , Isquemia Miocárdica/diagnóstico por imagem , Taquicardia Ventricular/cirurgia , Idoso de 80 Anos ou mais , Dispneia/diagnóstico , Dispneia/etiologia , Eletrocardiografia/métodos , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Humanos , Imagem Tridimensional/métodos , Multimorbidade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/terapia , Prognóstico , Medição de Risco , Taquicardia Ventricular/diagnóstico por imagem , Resultado do Tratamento
14.
J Cardiovasc Magn Reson ; 21(1): 33, 2019 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-31230593

RESUMO

BACKGROUND: Adenosine is used in stress perfusion cardiac imaging to reveal myocardial ischemia by its vasodilator effects. Caffeine is a competitive antagonist of adenosine. However, previous studies reported inconsistent results about the influence of caffeine on adenosine's vasodilator effect. This study assessed the impact of caffeine on the myocardial perfusion reserve index (MPRI) using adenosine stress cardiovascular magnetic resonance imaging (CMR). Moreover, we sought to evaluate if the splenic switch-off sign might be indicative of prior caffeine consumption. METHODS: Semiquantitative perfusion analysis was performed in 25 patients who underwent: 1) caffeine-naïve adenosine stress CMR demonstrating myocardial ischemia and, 2) repeat adenosine stress CMR after intake of caffeine. MPRI (global; remote and ischemic segments), and splenic perfusion ratio (SPR) were assessed and compared between both exams. RESULTS: Global MPRI after caffeine was lower vs. caffeine-naïve conditions (1.09 ± 0.19 vs. 1.24 ± 0.19; p <  0.01). MPRI in remote myocardium decreased by caffeine (1.24 ± 0.19 vs. 1.49 ± 0.19; p <  0.001) whereas MPRI in ischemic segments (0.89 ± 0.18 vs. 0.95 ± 0.23; p = 0.23) was similar, resulting in a lower MPRI ratio (=remote/ischemic segments) after caffeine consumption vs. caffeine-naïve conditions (1.41 ± 0.19 vs. 1.64 ± 0.35, p = 0.01). The SPR was unaffected by caffeine (SPR 0.38 ± 0.19 vs. 0.38 ± 0.18; p = 0.92). CONCLUSION: Caffeine consumption prior to adenosine stress CMR results in a lower global MPRI, which is driven by the decreased MPRI in remote myocardium and underlines the need of abstinence from caffeine. The splenic switch-off sign is not affected by prior caffeine intake.


Assuntos
Adenosina/administração & dosagem , Cafeína/administração & dosagem , Circulação Coronária/efeitos dos fármacos , Imagem Cinética por Ressonância Magnética , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Antagonistas de Receptores Purinérgicos P1/administração & dosagem , Vasodilatação/efeitos dos fármacos , Vasodilatadores/administração & dosagem , Idoso , Cafeína/efeitos adversos , Feminino , Humanos , Hiperemia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Antagonistas de Receptores Purinérgicos P1/efeitos adversos , Reprodutibilidade dos Testes
15.
J Cardiovasc Comput Tomogr ; 13(3): 11-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040061

RESUMO

AIMS: This study describes the real-world referral pattern of patients to a CT myocardial perfusion service, the technical issues associated with providing the service, the results of the studies, and the subsequent downstream utilization of other investigations, and patient outcomes. METHODS AND RESULTS: 115 consecutive patients underwent CTA, dynamic rest and dipyridamole-stress perfusion scanning. There were 29 (25%) and 14 (12%) patients who had reversible defects and fixed defects respectively, indicating abnormal flow reserve and previous infarction respectively. In the patients with fixed defects, delayed hyperenhancement was noted in all, indicative of prior infarction, scarring and non-viability. With the existing CTA Appropriateness Criteria, the categorization of "Appropriate," "Of Uncertain Appropriateness", and "Inappropriate" would have been applied to 25%, 25% and 50% of the present studies respectively. Up to 72% could have been referred for ischemia evaluation with other modalities of functional imaging after the non-diagnostic CT angiogram. Follow up was complete in 113 subjects (98%) over a period of 14 ±â€¯8 months. In the 29 patients with abnormal flow reserve and CAD, 62% underwent invasive angiography and 94%, angioplasty within a 90-day period. In the patients who underwent angioplasty, all remained free of myocardial infarction or death and 88% remained free of myocardial infarction, death or readmission over a mean of 14 ±â€¯8 months. CONCLUSION: A CT-myocardial perfusion service provided measures of ischemia and infarct detection over that of CTA alone. The information was utilized clinically by doctors to support a strategy of referral to revascularization versus conservative medical management.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Circulação Coronária , Vasos Coronários/diagnóstico por imagem , Hemodinâmica , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Idoso , Tomada de Decisão Clínica , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/terapia , Valor Preditivo dos Testes , Prognóstico , Encaminhamento e Consulta , Sistema de Registros , Reprodutibilidade dos Testes , Fatores de Tempo
16.
Int J Cardiovasc Imaging ; 35(9): 1651-1659, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31053980

RESUMO

We investigated the influence of the extent of viability using low dose dobutamine wall motion score index (WMS) on the survival benefit of surgical revascularization (CABG) versus medical therapy. In the STICH trial, viability assessment was not helpful in determining the benefit of CABG. However, the extent of viable myocardium with contractile function was not assessed in the trial. Dobutamine echocardiography was performed in 250 patients with ischemic left ventricular dysfunction (125-medically treated, 125-CABG). The mean ejection fraction (EF) was 32% in both groups. WMS during low dose dobutamine infusion was used to classify patients into groups with extensive (WMS < 2.00), intermediate (WMS 2.00-2.49), and limited (WMS ≥ 2.50) viability. Survival free of cardiac death was assessed at 2 years and for the complete duration of follow-up. There were 44 (35.2%) and 67 (53.6%) cardiac deaths in the revascularized and medically treated patients respectively (follow-up of 5.7 ± 5.8 years). Revascularized and medically treated patients with extensive viability had similar 2-year survival (p = 0.567) but revascularized patients had improved long-term survival (p = 0.0001). In those with intermediate viability, revascularization improved both 2 year (p = 0.014) and long-term survival (p = 0.0001). In patients with limited viability, 2-year survival was worse in revascularized patients (p = 0.04) and long-term survival was similar (p = 0 .25) in revascularized and medically treated groups. Patients with extensive and intermediate amounts of viability have improved survival with CABG but those with limited viability have poorer short-term outcome and no long-term benefit.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Cardiotônicos/administração & dosagem , Ponte de Artéria Coronária , Dobutamina/administração & dosagem , Ecocardiografia sob Estresse/métodos , Isquemia Miocárdica/diagnóstico por imagem , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Cardiomiopatias/cirurgia , Fármacos Cardiovasculares/uso terapêutico , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Miocárdio/patologia , Seleção de Pacientes , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Sobrevivência de Tecidos , Resultado do Tratamento , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/cirurgia
17.
Nucl Med Commun ; 40(7): 773-774, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31107409

RESUMO

Next to myocardial perfusion, single-photon emission computed tomography (SPECT) also allows for the assessment of nonperfusion parameters such as transient ischemic dilatation (TID) and a reduction of ejection fraction (EF) with stress imaging. This study aimed to evaluate the diagnostic value of TID and EF reserve for the detection of significant multivessel coronary artery disease (CAD). A total of 206 patients with suspected stable CAD prospectively underwent gated stress-rest Tc-tetrofosmin SPECT and invasive coronary angiography with routine fractional flow reserve (FFR) measurements, irrespective of imaging results. Left ventricular volumes, TID, and EF reserve were assessed and compared with FFR-defined severity of CAD. According to FFR, 92 (45%) patients had significant CAD, whereas 25 (12%) showed 2-vessel disease (VD) and 22 (11%) showed 3-VD. With an increasing extent of CAD, TID values and EF reserve did not change significantly (P=0.07 and 0.42 for trend, respectively). Conversely, absolute left ventricular volumes and EF differed significantly among groups of CAD severity (P<0.01 for all trends). SPECT-derived TID and EF reserve did not differ between patients with high-risk CAD (3-VD) and low risk or no significant CAD. Therefore, the present results advocate exerting caution when using these ancillary findings in clinical practice.


Assuntos
Adenosina , Doença da Artéria Coronariana/complicações , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Volume Sistólico , Tomografia Computadorizada de Emissão de Fóton Único , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Fatores de Tempo
18.
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
19.
Medicine (Baltimore) ; 98(20): e15618, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096471

RESUMO

To explore the prevalence and risk factors of silent myocardial ischemia (SMI) detected by using single photon emission computed tomography (SPECT) in Chinese asymptomatic patients with type 2 diabetes (T2D).In this hospital-based retrospective study, 821 T2D patients who were screened for SMI detected by stress myocardial perfusion imaging using SPECT between June 2014 and July 2016 were investigated. Clinical indicators were compared between the patients with SMI and controls without SMI. Risk factors for SMI were evaluated by univariate and multivariate analysis.In this study, there were 131 patients with SMI in asymptomatic diabetes and the prevalence of SMI was 21.3% of 614 individuals. Logistic regression analysis indicated that diabetic retinopathy (OR = 1.474, 95%CI: 1.113-1.951, P = .007), male gender (OR = 1.805, 95%CI: 1.183-2.747, P = .006), and low-density lipoprotein (LDL) cholesterol (OR = 1.298, 95%CI: 1.042-1.615, P = .02) were risk factors associated with SMI. Besides, the prevalence of SMI increased in associated with the progression of retinopathy (P = .041). The percentage of SMI diagnosed in patients with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) were 18.5% (75/405), 25.2% (37/147), and 30.6% (19/62), respectively. The percentage of SMI in male (24.5%, 85/347) was higher than that in female (17.2%, 46/267), P = .029.Physicians should be aware of these conditions when examining male patients with type 2 diabetes, especially with DR and/or high level of low-density lipoprotein cholesterol (LDL cholesterol), even if otherwise asymptomatic. A routine screening for SMI may thus be considered advisable in these patients.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Adulto , Fatores Etários , Idoso , China/epidemiologia , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Lipídeos/sangue , Masculino , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Razão de Chances , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Tomografia Computadorizada de Emissão de Fóton Único
20.
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
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