Impact of minimal lumen segmentation uncertainty on patient-specific coronary simulations: A look at FFRCT.

We examined the effect of minimal lumen segmentation uncertainty on Fractional Flow Reserve obtained from Coronary Computed Tomography Angiography FFR CT . A total of 14 patient-specific coronary models with different stenosis locations and degrees of severity were enrolled in this study. The optimal segmented coronary lumens were disturbed using intra ± 6 % and inter-operator ± 15 % variations on the segmentation threshold. FFR CT was evaluated in each case by 3D-OD CFD simulations. The findings suggest that the sensitivity of FFR CT to this type of uncertainty increases distally and with the stenosis severity. Cases with moderate or severe distal coronary lesions should undergo either exact and thorough segmentation operations or invasive FFR measurements, particularly if the FFR CT is close to the cutoff (0.80). Therefore, we conclude that it is crucial to consider the lesion's location and degree of severity when evaluating FFR CT results.

Recurrent STEMI caused by multivessel spontaneous coronary dissection.

We present a case of a 52 year old female who suffered from a sudden syncope. A coronariography was performed and spontaneous coronary dissection was diagnosed in the posterior descending artery after an optical coherence tomography (OCT) was performed. A conservative management was decided. During hospitalization the patient presented with an episode of chest pain with an anterior ST elevation on ECG. Coronariography showed total occlusion of the left descending artery and again a dissection was diagnosed by OCT. This time, 2 stents were implanted in the affected artery. The hypothesis that the coronary adventitial volume of vasa vasorum is higher in patients with spontaneous coronary artery dissection has been demonstrated in a recent small study and it was observed in this patient. Conservative management is preferred in most cases, proceeding to revascularization for patients with ongoing chest pain, hemodynamic instability and ST elevation, mostly if it affects major arteries.

[Tako-tsubo syndrome: analysis of a series of 60 cases]. / Síndrome de Tako-tsubo: análisis de una serie de 60 casos.

BACKGROUND AND OBJECTIVE: The Tako-tsubo syndrome (TS) is a reversible acute cardiomyopathy simulating an infarction. We analyzed 60 patients admitted with TS in our center. PATIENTS AND METHOD: A percentage of 73.3 were women (mean age: 70.6 ± 11.8 years); 83.3% had some cardiovascular risk factor, 25% had an anxiety-depressive disorder and in 58.3% a precipitating factor was identified, emotional stress being the most frequent. A percentage of 15.3 showed complete left bundle branch block (LBBB). In 23.3% of patients, contractile abnormalities respected the apex (mid ventricular or diaphragmatic types). RESULTS: The anterior descending artery showed no significant lesions in 35% of patients and in 68.3% it had a diaphragmatic segment. Forty percent of patients developed heart failure (HF) and 18.3% cardiogenic shock (CS). The overall in-hospital mortality was 3.3%, while it was 8.3% among those patients who developed HF. The incidence of CS was higher among patients with LBBB (44.4 vs. 13.7%, P=.05) and males (43.8 vs. 9.1%, P=.005). CONCLUSIONS: Although in-hospital mortality in patients admitted due to TS is low, a significant percentage of these patients develop HF with a high mortality in this subgroup. Males and patients with LBBB had higher in-hospital morbidity.

Síndrome de Tako-tsubo: análisis de una serie de 60 casos / Tako-tsubo syndrome: Analysis of a series of 60 cases

Fundamentos y objetivo: El síndrome de Tako-tsubo (SmT) es una miocardiopatía aguda reversible que simula un infarto. Analizamos los 60 pacientes ingresados con SmT en nuestro centro. Pacientes y método: El 73,3% eran mujeres (edad media [DE] de 70,6 [8,11] años). El 83,3% tenía algún factor de riesgo cardiovascular, el 25% tenía trastorno ansiosodepresivo y en el 58,3% se identificó algún desencadenante, siendo el estrés emocional el más frecuente. El 15,3% mostró bloqueo completo de rama izquierda (BCRI). En el 23,3% las alteraciones de la contractilidad respetaban el ápex (formas medioventriculares o diafragmáticas). Resultados: La arteria descendente anterior mostró lesiones no significativas en el 35% de los pacientes, y en el 68,3% tenía trayecto diafragmático. El 40% desarrolló insuficiencia cardiaca (ICC) y el 18,3% shock cardiogénico (SC). La mortalidad hospitalaria global fue del 3,3%, siendo del 8,3% entre aquellos que desarrollaron ICC. La incidencia de SC fue mayor entre los pacientes con BCRI (44,4 frente a 13,7%; p=0,05) y los varones (43,8 frente a 9,1%; p=0,005). Conclusiones: Aunque la mortalidad hospitalaria del SmT es baja, un porcentaje importante de pacientes desarrollan ICC, siendo la mortalidad de este subgrupo elevada. Los pacientes varones y aquellos con BCRI presentaron mayor morbilidad hospitalaria

Background and objective: The Tako-tsubo syndrome (TS) is a reversible acute cardiomyopathy simulating an infarction. We analyzed 60 patients admitted with TS in our center. Patients and method: A percentage of 73.3 were women (mean age: 70.6±11.8 years); 83.3% had some cardiovascular risk factor, 25% had an anxiety-depressive disorder and in 58.3% a precipitating factor was identified, emotional stress being the most frequent. A percentage of 15.3 showed complete left bundle branch block (LBBB). In 23.3% of patients, contractile abnormalities respected the apex (mid ventricular or diaphragmatic types). Results: The anterior descending artery showed no significant lesions in 35% of patients and in 68.3% it had a diaphragmatic segment. Forty percent of patients developed heart failure (HF) and 18.3% cardiogenic shock (CS). The overall in-hospital mortality was 3.3%, while it was 8.3% among those patients who developed HF. The incidence of CS was higher among patients with LBBB (44.4 vs. 13.7%, P=.05) and males (43.8 vs. 9.1%, P=.005). Conclusions: Although in-hospital mortality in patients admitted due to TS is low, a significant percentage of these patients develop HF with a high mortality in this subgroup. Males and patients with LBBB had higher in-hospital morbidity