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1.
Yonsei Med J ; 60(9): 816-823, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31433579

RESUMO

PURPOSE: The present study aimed to investigate the prevalence, characteristics, and clinical significance of concomitant specific cardiomyopathies in subjects with bicuspid aortic valves (BAVs). MATERIALS AND METHODS: A total of 1186 adults with BAV (850 males, mean age 56±14 years) at a single tertiary center were comprehensively reviewed. Left ventricular non-compaction, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy were confirmed when patients fulfilled current clinical and echocardiographic criteria. Clinical and echocardiographic characteristics, including comorbidities, heart failure presentation, BAV morphology, function, and aorta phenotypes, in BAV subjects with or without specific cardiomyopathies were compared. RESULTS: Overall, 67 subjects (5.6%) had concomitant cardiomyopathies: 40 (3.4%) patients with left ventricular non-compaction, 17 (1.4%) with hypertrophic cardiomyopathy, and 10 (0.8%) with dilated cardiomyopathy. BAV subjects with hypertrophic cardiomyopathy had higher prevalences of diabetes mellitus and heart failure with preserved ejection fraction, and tended to have type 0 phenotype, while BAV subjects with dilated cardiomyopathy showed higher prevalences of chronic kidney disease and heart failure with reduced ejection fraction. BAV subjects with left ventricular non-compaction were significantly younger and predominantly male, and had greater BAV dysfunction and a higher prevalence of normal aorta shape. In multiple regression analysis, cardiomyopathy was independently associated with heart failure (odds ratio 2.795, 95% confidential interval 1.603-4.873, p<0.001) after controlling for confounding factors. CONCLUSION: Concomitant cardiomyopathies were observed in 5.6% of subjects with BAV. A few different clinical and echocardiographic characteristics were found. The presence of cardiomyopathy was independently associated with heart failure.


Assuntos
Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/epidemiologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Adulto , Idoso , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Comorbidade , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fenótipo , Prevalência , Estudos Retrospectivos , Disfunção Ventricular Esquerda/fisiopatologia
2.
Vasc Health Risk Manag ; 15: 229-251, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413582

RESUMO

Purpose: Left ventricular (LV) mechanics by speckle-tracking echocardiography (STE) is prognostic in patients with cardiovascular diseases, but evidence related to community-dwelling individuals is uncertain. We therefore performed a systematic review and meta-analysis of STE as a predictor of adverse outcomes in the general population. Methods: PRISMA guidelines were followed and MEDLINE and EMBASE were searched to identify eligible studies. Primary outcome was all-cause mortality and secondary outcomes were composite cardiac and cardiovascular end-point. Random effects meta-analysis was performed, and a modified Newcastle-Ottawa Assessment Scale was used for quality assessment. Results: Eight papers matched the predefined criteria (total number of individuals studied=11,744). All publications assessed global longitudinal strain (GLS) by two-dimensional speckle-tracking echocardiography (2D-STE), one assessed circumferential, radial and transverse strains, and one assessed GLS-derived post-systolic shortening. None assessed LV rotational measures in association with outcomes. Two studies reported associations between GLS and all-cause mortality and composite cardiovascular end-point. Six papers reported an association between GLS and composite cardiac end-point, three of which were from the same study. Four papers were suitable for meta-analysis. GLS predicted all-cause mortality (pooled minimally adjusted HR per unit strain (%)=1.07 [95% CI 1.03-1.11], p=0.001), and composite cardiovascular (pooled maximally adjusted HR=1.18 [1.09-1.28], p<0.0001) and cardiac (HR=1.08 [1.02-1.14], p=0.006) end-points. GLS also predicted coronary heart disease (HR=1.15 [1.03-1.29], p=0.017) and heart failure (HR=1.07 [1.02-1.13], p=0.012). The quality of all studies was good. Conclusions: This study provides some evidence that STE may have utility as a measure of cardiac function and risk in the general population. 2D-STE-based GLS predicts total mortality, major adverse cardiac and cardiovascular end-points in community-dwelling individuals in a limited number of studies. Despite this, this systematic review also highlights important knowledge gaps in the current literature and further evidence is needed regarding the prognostic value of LV mechanics in unselected older populations.Registration number: CRD42018090302.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Contração Miocárdica , Função Ventricular Esquerda , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
4.
Emerg Med Clin North Am ; 37(3): 409-430, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262412

RESUMO

Resuscitative ultrasound describes point-of-care applications that provide diagnostic information, physiologic monitoring, and procedural guidance in critically ill patients. This article reviews the evaluation of ventricular function, identification of pericardial effusion and tamponade, evaluation of preload and fluid responsiveness, and hemodynamic monitoring, as some of the main applications where this modality can help emergency physicians during resuscitation of critically ill patients.


Assuntos
Ecocardiografia Transesofagiana , Ventrículos do Coração/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ressuscitação , Velocidade do Fluxo Sanguíneo , Tamponamento Cardíaco/diagnóstico por imagem , Estado Terminal , Medicina de Emergência , Serviço Hospitalar de Emergência , Hemodinâmica , Humanos , Monitorização Fisiológica , Derrame Pericárdico/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler , Veia Cava Inferior/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem
5.
Ceska Gynekol ; 84(3): 190-194, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324108

RESUMO

OBJECTIVES: To evaluate the occurrence and the significance of echogenic foci in the fetal heart and to assess the prognosis of the fetus and child. SETTING: Department of Pediatrics and Prenatal Cardiology, Department of Pediatrics, University Hospital, Faculty of Medicine, Ostrava. DESIGN: Original article. METHODS: A retrospective study was conducted between 2008-2017. Fetal echocardiography was performed in the second trimester of pregnancy in the study population. The identification of echogenic heart foci, and their follow up during and after the pregnancy were performed by a pediatric cardiologist. RESULTS: In the monitored period, a total of 27,633 fetuses were examined. Isolated cardiac hyperechogenic foci were detected in 3% (829/27,633) of the fetuses. The foci was found in 93%, 5%, and 2% in the left ventricle, mainly in valvular apparatus of the mitral valve, in the both ventricles, and in the right ventricle, respectively. In 1% (11/829) of the fetuses with cardiac echogenic foci, the others concomitant pathologies (tricuspid regurgitation, extrasystoles, renal pathology) were found. No genetic abnormalities were detected in the fetuses with cardiac hyperechogenic foci. CONCLUSION: The echogenic focus in fetal heart is a relatively common, mostly insignificant finding, with any serious consequences for the fetus and the child.


Assuntos
Ecocardiografia , Coração Fetal/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ultrassonografia Pré-Natal , Cardiologistas , Criança , Feminino , Monitorização Fetal , Humanos , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos
6.
World J Pediatr Congenit Heart Surg ; 10(4): 416-423, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307314

RESUMO

BACKGROUND: Investigations of ventricular dominance and outcomes after the Fontan procedure have shown conflicting results. This may be due to the inclusion of multiple modifications of the Fontan or the omission of recently identified complications of the procedure. We examined the association between right ventricular dominance (RVD) and morbidity/mortality in a contemporary cohort following the extracardiac (EC) Fontan. METHODS: We studied all pediatric patients at our center who underwent a predominantly fenestrated EC Fontan from 2004 to 2016. Outcomes assessed were freedom from (1) Fontan failure (death, takedown, listing for transplantation) and (2) complication (arrhythmia requiring medication, postoperative pacemaker, or implantable cardioverter defibrillator requirement, stroke, thrombosis in the Fontan circuit, protein losing enteropathy, plastic bronchitis, New York Heart Association class >2). We defined the perioperative period as occurring before hospital discharge or within 30 days of the Fontan. RESULTS: A total of 137 patients (median age: 34 months, 62% male, 60% RVD) underwent the EC Fontan. Median duration of follow-up was 5.8 years (interquartile range: 2.4-9.0). Freedom from any event was 82.5% (RVD = 77%, LVD = 91%, χ2(1) = 5.03, P = .025) and RVD was associated with reduced event-free survival (hazard ratio: 2.94, P = .02). No confounders were identified. In the perioperative period, RVD was associated with reduced complication-free survival (P = .004). After this period, RVD was associated with reduced failure-free survival (P = .003). CONCLUSIONS: In this contemporary, single-center cohort of EC Fontan patients, RVD was associated with inferior outcomes.


Assuntos
Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Complicações Pós-Operatórias/etiologia , Função Ventricular Direita/fisiologia , Pré-Escolar , Intervalo Livre de Doença , Ecocardiografia , Feminino , Seguimentos , Técnica de Fontan/métodos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Morbidade/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
7.
Int Heart J ; 60(4): 862-869, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204376

RESUMO

According to recent guidelines, a new category of patients with heart failure (HF) with mid-range left ventricular ejection fraction (LVEF) (HFmrEF) (LVEF = 40%-49%) has been defined. The purpose of this study was to investigate the clinical characteristics and long-term outcomes of patients with HFmrEF. This was a single-center, retrospective, observational study in which we examined the clinical characteristics and outcomes of 494 consecutive patients with acute decompensated heart failure who were admitted to our institution between January 2014 and December 2016. Of this population, 282 (57.1%), 75 (15.2%), and 137 (48.6%) patients had heart failure with reduced ejection fraction (HFrEF), HFmrEF, and heart failure with preserved ejection fraction (HFpEF), respectively. Ischemic heart disease was the primary etiology in HFmrEF and HFrEF. At the time of discharge, ß-blockers and renin-angiotensin system inhibitors were more frequently prescribed in HFmrEF than in HFpEF. The composite outcome of cardiovascular mortality and HF readmission was significantly lower in HFmrEF than in HFrEF. Further studies are needed to determine the effectiveness of the management of coronary artery disease and cardioprotective medications for HFmrEF.


Assuntos
Ecocardiografia/métodos , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Doença Aguda , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Feminino , Seguimentos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Hospitalização/tendências , Humanos , Masculino , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
8.
Int Heart J ; 60(4): 974-978, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204378

RESUMO

A 72-year-old woman with hypertension, dyslipidemia, and diabetes mellitus presented to our hospital because of the sudden onset of chest pain. Emergency coronary angiography showed acute occlusion of the distal left anterior descending artery and coronary intervention with a drug-eluting stent was performed. Sudden cardiopulmonary arrest occurred on the sixth day of hospitalization, but coronary angiography showed no remarkable progression of the coronary artery diseases, including the site of stent implantation. An autopsy revealed that the cause of the sudden death was apical free wall rupture. In addition, the different timing of acute and sub-acute infarct findings were observed in the apical wall by histology, which indicated cardiac rupture was due to reinfarction at early phase of apical acute myocardial infarction. Although the rate of mechanical complications, including cardiac rupture, is decreasing in the era of primary coronary intervention, in addition to the well-known risk factors of cardiac rupture, the reinfarction of the culprit myocardial site in the early phase of acute myocardial infarction was considered as a possible risk factor of cardiac rupture.


Assuntos
Ruptura Cardíaca/etiologia , Ventrículos do Coração/diagnóstico por imagem , Miocárdio/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Evolução Fatal , Feminino , Ruptura Cardíaca/diagnóstico , Humanos , Recidiva , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
9.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 293-296, may.-june. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1006179

RESUMO

Ventricular non-compaction occurs due to failure in myocardial morphogenesis during the fetal period. Patients can have heart failure, as well as systemic complications due to thromboembolism and cardiac arrhythmias. Early diagnosis is essential. We present the case of an asymptomatic 49-year-old woman who initially manifested ventricular extrasystoles and heart failure with reduced ejection fraction and a myocardial noncompaction diagnosis


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Complexos Cardíacos Prematuros/diagnóstico , Miocárdio Ventricular não Compactado Isolado , Arritmias Cardíacas , Diagnóstico por Imagem , Ecocardiografia/métodos , Espectroscopia de Ressonância Magnética/métodos , Taquicardia Ventricular , Eletrocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Cardiomiopatias
11.
Int Heart J ; 60(3): 671-678, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105153

RESUMO

In fetal echocardiography, conventional parameters for assessing cardiac function are limited because of limited echocardiographic windows or the fetus' position. We aimed to evaluate the feasibility and reproducibility of fetal left ventricular (LV) twist by two-dimensional, speckle-tracking echocardiography (2DSTE) in a Japanese population.We included 55 normal fetuses at gestational ages between 21 and 36 weeks. Subjects with adverse maternal health issues were excluded. LV twist was calculated as the net difference between LV basal and apical rotation at end-systole estimated with 2DSTE.We were able to analyze the 2DSTE images in 44 cases (80%). The mean (±SE) apical rotation, basal rotation, and LV twist were 7.88 ± 0.77, -3.68 ± 0.50, and 11.1 ± 0.75 degrees, respectively. We could not analyze 11 cases (20%) because of poor image quality due to fetal position in five cases (45.5%), failure to track the endocardium because of blurred images in five cases (45.5%), and failure to obtain images of the heart due to the presence of the placenta in front of the fetus in one case (9.1%). There were no significant differences in the demographic data between pregnant women in whom LV twist analysis was feasible and not feasible. The intra- and interobserver intraclass correlation coefficients were 0.67 and 0.64, respectively.LV twist analysis by 2DSTE in the fetus was feasible in a substantial population and may provide new insight into cardiac function during the prenatal period. On the other hand, its reproducibility was moderate and needs to be improved.


Assuntos
Ecocardiografia/métodos , Feto/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Estudos de Viabilidade , Feminino , Feto/embriologia , Idade Gestacional , Ventrículos do Coração/embriologia , Ventrículos do Coração/fisiopatologia , Humanos , Japão/etnologia , Apresentação no Trabalho de Parto , Variações Dependentes do Observador , Gravidez , Cuidado Pré-Natal , Reprodutibilidade dos Testes , Rotação , Disfunção Ventricular Esquerda/fisiopatologia
12.
Mymensingh Med J ; 28(2): 370-377, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086153

RESUMO

Left ventricular dysfunction in diabetes mellitus (DM) patients is widely assessed and established by conventional diagnostic methods, whereas right ventricular (RV) function is not sufficiently evaluated. The aim of this study was to assess the right ventricular function in type 2 diabetic patients In this case control study, forty nine (49) diabetic patients and same number of (49) non-diabetic healthy volunteers were studied who were devoid of any other conditions that may influence the both systolic and diastolic function of the RV. In addition to 2D and M-mode evaluation, standard Doppler, pulsed tissue Doppler and 3D echocardiographic assessment of both ventricles were performed. Both right ventricular (RV) systolic and diastolic parameters were impaired in tissue Doppler analysis. Tissue Doppler derived IVA was significantly (p<0.05) lower in diabetic patients. Right ventricular early diastolic velocity (E') and late diastolic velocity (A'), E'/A' were significantly (p<0.05) lower in DM. MPI and E/E' was significantly (p<0.05) higher in diabetic patients. The RV parameters (E/E', IVA, MPI) showed positive relation with the LV similar parameters in tissue Doppler assessment. Diabetes is associated with both RV systolic and diastolic dysfunction. Pulsed tissue Doppler is a useful tool to detect the early changes. RV parameters (both systolic and diastolic) correlate well with those of the LV.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita/fisiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/diagnóstico , Diástole , Ecocardiografia Doppler de Pulso , Humanos
13.
Int J Cardiovasc Imaging ; 35(9): 1683-1689, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31037474

RESUMO

The acquisition of short-axis (SA) cine magnetic resonance (MR) images after the administration of contrast agent (CA) is a common, time-saving technique, but a decreased difference in the blood-myocardium contrast on these steady-state free precession (SSFP) cine scans could change the calculated parameters when using threshold-based papillary and trabecular muscle (PTM) quantification. We studied the effect of CA on the parameters calculated from pre- and post-CA SA cine images in noncompaction cardiomyopathy (NC-CMP) and healthy (H) participants using a threshold-based module. A total of 39 individuals (20 patients and 19 healthy) were included prospectively in this study. After the pre-CA SA images were acquired, i.v. gadobutrol (GA) or gadobenate dimeglumine (GD) (GA vs. GD: NC-CMP = 12 vs. 8; C = 12 vs. 7) was administered, and SA scans were repeated after two minutes. A threshold-based PTM software was used for postprocessing. Pre-CA and post-CA SA images were analyzed, and the parameters were compared in both the NC-CMP and H groups. The left ventricular volumes were significantly larger, while the left ventricular myocardial (LVmass) and trabecular mass (LVtrab) values were significantly smaller on the post-CA scans (NC-CMP: pre-CA vs. post-CA, EDV: 74.0 ± 13.6 vs. 81.1 ± 16.3 ml/m2, ESV: 25.3 ± 7.3 vs. 30.1 ± 11.2 ml/m2, LVmass-ED: 82.5 ± 17.5 vs. 75.7 ± 15.9 g/m2, LVtrab-ED: 25.0 ± 6.6 vs. 18.9 ± 4.7 g/m2; Healthy: preCA vs. post-CA, EDV: 69.7 ± 11.9 vs. 72.2 ± 10.7 ml/m2, ESV: 22.6 ± 5.7 vs. 23.9 ± 6.3 ml/m2, LVmass-ED: 71.3 ± 13.6 vs. 68.7 ± 13.9 g/m2, LVtrab-ED: 19.4 ± 2.6 vs. 16.2 ± 3.0 g/m2; p < 0.05). The decreased blood-myocardium contrast difference on post-CA SSFP SA cine images leads to altered cardiac parameters when using threshold-based software for evaluation.


Assuntos
Meios de Contraste/administração & dosagem , Ventrículos do Coração/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Meglumina/análogos & derivados , Compostos Organometálicos/administração & dosagem , Software , Volume Sistólico , Função Ventricular Esquerda , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Masculino , Meglumina/administração & dosagem , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
14.
ABC., imagem cardiovasc ; 32(2): 96-102, abr.-junh. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-994667

RESUMO

Fundamento: A pré-hipertensão e a hipertensão estágio I estão associadas ao remodelamento do ventrículo esquerdo (VE). No presente estudo, comparamos os parâmetros ecocardiográficos de lesão de órgãos-alvo pré-clínicos da hiper-tensão arterial em indivíduos com pré hipertensão e hipertensão estágio I selecionados a partir da mesma população. Métodos: Comparou-se as medidas ecocardiográficas basais dos participantes incluídos no estudo PREVER com pré-hi-pertensão (PREVER-prevention; n = 106) ou hipertensão estágio I (PREVER-treatment; n = 128). Investigou-se também as diferenças relacionadas ao sexo, verificadas nos parâmetros ecocardiográficos. Resultados: A pressão arterial sistólica e diastólica média mostrou-se significativamente maior no grupo hipertensão estágio I (141,0/90,4 mmHg) quando comparada com o grupo pré-hipertensão (129,3/81,5 mmHg, P<0,001 para ambos os grupos). A média de idade foi de 55 anos (30 a 70), com um número quase igual de homens e mulheres, dos quais 80% eram brancos e 7% tinham diabetes. A maioria dos parâmetros de massa do VE, dimensão do AE e função diastólica mostrou-se semelhante entre os grupos pré-hipertensão e hipertensão estágio I. Os indivíduos hipertensos apresentavam AE com maior diâmetro e maior espessura da parede posterior, além de menores velocidades laterais e, mesmo após ajuste para idade, sexo e índice de massa corporal. A análise em relação ao sexo mostrou VE com maior massa na hipertensão estágio I em comparação à pré-hipertensão apenas em mulheres (141,1 ± 34,1 gvs. 126,1 ± 29,1 g, P<0,05). Conclusões: Em indivíduos de meia-idade com baixo risco cardiovascular, as diferenças nos parâmetros ecocardiográficos relacionadas à lesão de órgãos-alvo são sutis entre a pré-hipertensão e a hipertensão estágio I, embora mulheres com hipertensão estágio I tenham VE com massa significativamente maior, o que pode indicar resposta adaptativa específica do sexo à pressão arterial em estágios iniciais de hipertensão


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Ecocardiografia/métodos , Pré-Hipertensão/diagnóstico , Hipertensão/diagnóstico , Prognóstico , Volume Sistólico , Doenças Cardiovasculares , Índice de Massa Corporal , Fatores Sexuais , Análise Multivariada , Fatores de Risco , Fatores Etários , Hipertrofia Ventricular Esquerda , Guias como Assunto/normas , Pressão Arterial , Átrios do Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem
15.
Int Heart J ; 60(3): 586-592, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019177

RESUMO

Previous studies reported a controversial left ventricular (LV) function impairment and pathophysiology in patients with coronary slow flow (CSF). Greater arterial load has been shown to increase aortic impedance and endothelial shear stress, potentially affecting coronary anatomy and function. We investigated LV systolic function by a new layer-specific strain technology and assessed the association between pulsatile arterial load and contractility.A total of 70 patients with CSF and 50 controls with normal coronary angiography were included in the study. Layer-specific longitudinal and circumferential strains were assessed from endocardium, mid-myocardium, and epicardium (global longitudinal strain (GLS)-endo, GLS-mid, GLS-epi and GCS-endo, GCS-mid, GCS-epi) by two-dimensional speckle tracking imaging (2D-STI). Pulsatile arterial load was estimated by indexed arterial compliance (ACI). Layer-specific GLS showed a decreasing gradient from the endocardium to the epicardium in both the controls and CSF group. GLS-endo and GLS-mid in the CSF group were significantly lower than the control group (all P < 0.05). Layer-specific longitudinal strain showed a good correlation with the number of affected coronary arteries (all P < 0.05) and the mean thrombolysis in the myocardial infarction frame count (TFC) (all P < 0.05). ACI was lower in patients with CSF (P = 0.005), and ACI was correlated negatively with layer-specific GLS (all P < 0.05).Layer-specific evaluation of the LV provides an understanding of the layer-specific properties of the LV wall and the possible process of the LV impairment in patients with CSF. Greater pulsatile arterial load, as manifested by a lower ACI, is coupled with worse LV longitudinal function in patients with CSF.


Assuntos
Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Adulto , Idoso , Angiocardiografia , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Função Ventricular Esquerda
16.
Medicine (Baltimore) ; 98(16): e15267, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008970

RESUMO

INTRODUCTION: Echinococcosis, also called hydatid disease, is a common parasitic infection of the liver. However, echinococcus lesions rarely involve the heart, especially in children. PATIENT CONCERNS: An 8-year-old child from grazing areas of northwest China was referred to our hospital for the complaint of inpersistent precordial chest pain and left upper quadrant pain for 3 years. Palpation showed hepatomegaly, abdominal palpable mass while inspection abdominal distension. Routine blood tests were within the normal ranges. DIAGNOSIS: Combining the life history in pasture area, imaging features and serology results, it was consistent with the diagnosis of cardiac echinococcosis. INTERVENTIONS: Surgery was performed to evacuate cyst liquid and remove the internal capsule of the cyst. OUTCOMES: There was no cystic lesion in heart on ultrasound and her physical condition improved significantly after the surgery. The patient died of hepatic hydatid cyst rupture due to refusing high-risk surgical treatment and other treatment. LESSONS: We presented a rare case of cystic echinococcosis involving left ventricle in a child, and surgery is an alternative and effective therapy for this lesion due to the cyst rupture or leakage that can result in anaphylaxis. The typical imaging features of the cardiac echinococcosis on cardiac magnetic resonance are presented. Patient prognosis relies on proper treatment of all lesions.


Assuntos
Equinococose/diagnóstico , Cardiopatias/parasitologia , Ventrículos do Coração/parasitologia , Criança , Equinococose/diagnóstico por imagem , Equinococose/patologia , Ecocardiografia , Feminino , Cardiopatias/diagnóstico , Cardiopatias/diagnóstico por imagem , Cardiopatias/patologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Tomografia Computadorizada por Raios X
17.
Eur J Radiol ; 114: 6-13, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31005178

RESUMO

BACKGROUND: This study was designed to investigate the agreement of 2D transthoracic echocardiography (2D TTE) with cardiovascular magnetic resonance imaging (CMR) in a contemporary population of ST-elevation myocardial infarction (STEMI) patients. METHODS: In this subanalysis of the GIPS-III trial, a randomized controlled trial investigating the administration of metformin in STEMI patients to prevent reperfusion injury, we studied 259 patients who underwent same-day CMR and 2D TTE assessments four months after hospitalization for a first STEMI. Bland-Altman analyses were performed to assess agreement between LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), and LV mass measurements. Sensitivity and specificity of 2D TTE to detect categories of LVEF (≤35%, 35-50%, ≥50%) was determined. Linear regression of absolute differences in measurements between imaging modalities was used to investigate whether patient characteristics impact measurement bias. RESULTS: Pairwise difference (bias) and 95% limits of agreement between CMR and 2D TTE measurements were +84 (37, 147) ml for LVEDV, +39 (6, 85) ml for LVESV, -1.1 ± 13.5% for LVEF, and -75 (-154, -14) g for LV mass. Sensitivity and specificity of 2D TTE to detect subjects with moderately depressed LVEF (35-50%) as measured by CMR were 52% and 88% respectively. We observed a significant effect of enzymatic infarct size on bias between 2D TTE and CMR in measuring LVESV and LVEF (P = 0.029, P = 0.001 respectively), of age and sex on bias between 2D TTE and CMR in measuring LV mass (P = 0.027, P < 0.001) and LVEDV (P = 0.001, P = 0.039), and of heart rate on bias between 2D TTE and CMR in LV volume measurements (P = 0.004, P = 0.016). CONCLUSIONS: Wide limits of agreement, underestimation of LV volumes and overestimation of LV mass was observed when comparing 2D TTE to CMR. Enzymatic infarct size, age, sex, and heart rate are potential sources of bias between imaging modalities.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Fármacos Cardiovasculares/administração & dosagem , Esquema de Medicação , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Metformina/administração & dosagem , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Traumatismo por Reperfusão Miocárdica/diagnóstico , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Reprodutibilidade dos Testes , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/diagnóstico
18.
Sensors (Basel) ; 19(8)2019 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-31013869

RESUMO

Automatic detection of left ventricle myocardium is essential to subsequent cardiac image registration and tissue segmentation. However, it is considered challenging mainly because of the complex and varying shape of the myocardium and surrounding tissues across slices and phases. In this study, a hybrid model is proposed to detect myocardium in cardiac magnetic resonance (MR) images combining region proposal and deep feature classification and regression. The model firstly generates candidate regions using new structural similarity-enhanced supervoxel over-segmentation plus hierarchical clustering. Then it adopts a deep stacked sparse autoencoder (SSAE) network to learn the discriminative deep feature to represent the regions. Finally, the features are fed to train a novel nonlinear within-class neighborhood preserved soft margin support vector (C-SVC) classifier and multiple-output support vector ( ε -SVR) regressor for refining the location of myocardium. To improve the stability and generalization, the model also takes hard negative sample mining strategy to fine-tune the SSAE and the classifier. The proposed model with impacts of different components were extensively evaluated and compared to related methods on public cardiac data set. Experimental results verified the effectiveness of proposed integrated components, and demonstrated that it was robust in myocardium localization and outperformed the state-of-the-art methods in terms of typical metrics. This study would be beneficial in some cardiac image processing such as region-of-interest cropping and left ventricle volume measurement.


Assuntos
Técnicas de Imagem Cardíaca , Ventrículos do Coração/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Miocárdio/patologia , Ventrículos do Coração/patologia , Humanos , Imagem por Ressonância Magnética/tendências , Máquina de Vetores de Suporte
19.
Biomed Res Int ; 2019: 6074984, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31001557

RESUMO

Background: Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is a noninvasive novel imaging technology that can be used to visualise and assess right ventricular function. The aim of this systematic review is to summarise the literature available on 4D flow CMR methods used to determine right ventricular diastolic function. Methods: A systematic review of current literature was carried out to ascertain what is known about right ventricular assessment by quantification of 4D flow CMR. Structured searches were carried out on Medline and EMBASE in December 2018. PG and NB screened the titles and abstracts for relevance. Results: Of the 20 articles screened, 5 studies met eligibility for systematic review. After a further search on pubmed 1 more relevant article was found and added to the review. Conclusions: These proposed methods using 4D flow CMR can quantify right ventricular diastolic assessment. The evidence gathered is mainly observational, featuring single-centred studies. Larger, multicentre studies are required to validate the proposed techniques, evaluate reproducibility, and investigate the clinical applicability that 4D flow CMR offers compared to standard practices. PROSPERO registration number is CRD42019121492.


Assuntos
Diástole , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Imagem Cinética por Ressonância Magnética , Função Ventricular Direita , Feminino , Humanos , Masculino
20.
Int J Cardiovasc Imaging ; 35(8): 1453-1463, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30937683

RESUMO

To compare contrast-enhanced magnetic resonance angiography (ceMRA) and 3D steady-state free precession (SSFP) during systole and diastole for assessment of the right ventricle outflow tract (RVOT) in patients considered for percutaneous pulmonary valve implantation (PPVI) after tetralogy of Fallot (TOF) repair. We retrospectively evaluated 89 patients (male: 45, mean age 19 ± 8 years), who underwent cardiac-MRI after surgical TOF-repair. Datasets covering the whole heart in systole and diastole were acquired using ECG-gated 3D SSFP and non-gated ceMRA. Measurements were performed in SSFP-sequences and in ceMRA in the narrowest region of the RVOT to obtain the minimum, maximum and effective diameter. Invasive balloon sizing as the gold standard was available in 12 patients. The minimum diameter in diastolic SSFP, systolic SSFP and ceMRA were 21.4 mm (± 6.1 mm), 22.6 mm (± 6.2 mm) and 22.6 mm (± 6.0 mm), respectively. Maximum diameter was 29.9 mm (± 9.5 mm), 30.0 mm (± 7.0 mm) and 28.8 mm (± 8.1 mm) respectively. The effective diameter was 23.2 mm (± 5.7 mm), 27.4 mm (± 6.7 mm) and 24.4 mm (± 6.2 mm), differing significantly between diastole and systole (p < 0.0001). Measurements in ECG-gated SSFP showed a better inter- and intraobserver variability compared to measurements in non-ECG-gated ceMRA. Comparing invasive balloon sizing with our analysis, we found the highest correlation coefficients for the maximum and effective diameter measured in systolic SSFP (R = 0.99 respectively). ECG-gated 3D SSFP enables the identification and characterization of a potential landing zone for PPVI. The maximum and effective systolic diameter allow precise sizing for PPVI. Patients with TOF-repair could benefit from cardiac MRI before PPVI.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca/métodos , Ventrículos do Coração/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Valvuloplastia com Balão , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Técnicas de Imagem de Sincronização Cardíaca , Criança , Meios de Contraste/administração & dosagem , Eletrocardiografia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Ventrículos do Coração/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Imagem Tridimensional , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Desenho de Prótese , Valva Pulmonar/fisiopatologia , Valva Pulmonar/cirurgia , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/cirurgia , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Resultado do Tratamento , Função Ventricular Direita , Adulto Jovem
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