Tricuspid annular plane systolic excursion for the evaluation of right ventricular function in functional cardiac CT compared to MRI.

AIM: To compare ejection fraction estimated by tricuspid annular plane systolic excursion (TAPSE) using cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) to the non-invasive reference standard, volumetric quantification of right ventricular ejection fraction (RVEF) by cardiac magnetic resonance imaging (MRI). MATERIALS AND METHODS: Thirty-one patients, who had undergone functional cardiac CT angiogram and cardiac MRI within 12 months, were evaluated retrospectively. Right ventricular (RV) volumes were processed using automated cardiac analysis software for CT, and manually processed by Simpson's method for MRI. MR-TAPSE was defined as the difference in length between two separate reference lines drawn at end diastole and end systole from the lateral tricuspid annulus to the right ventricular apex measured on four-chamber CINE images. CT-TAPSE was determined in an analogous manner on four-chamber reformatted images. RESULTS: MR-TAPSE correlated moderately with MR-RVEF, (r=0.57, p<0.001). CT-TAPSE was found to correlate moderately well with MR-RVEF (r=0.58, p<0.001) and CT-RVEF (r=0.63, p<0.001). Bland-Altman analysis repeated with various multiplication factors for CT-TAPSE and MR-RVEF, determined a multiplication factor of 2.7 resulted in the lowest bias (0.74%). CONCLUSION: CT-TAPSE is an easily obtainable parameter of RV function and is correlated with CT-RVEF and MR-RVEF. It can function as a quick check to rapidly validate CT right volumetry and estimate MR-RVEF.

Comparison of intramuscular artemether and intravenous quinine in the treatment of Sudanese children with severe falciparum malaria.

OBJECTIVES: To compare the efficacy of intramuscular artemether and intravenous quinine in the treatment of severe falciparum malaria. DESIGN: An open randomized controlled clinical trial. SETTING: New Halfa Teaching Hospital, Eastern Sudan, in the period November 2001-January 2002. SUBJECTS: Forty one male and female children; 21 on artemether and 20 on quinine. MAIN OUTCOME MEASURES: Fever clearance time, parasite clearance time, coma resolution time and side effects of the two drugs. RESULTS: The two groups (artemether and quinine) were well matched in the admission variable. The mean +/- (SD) fever clearance time was 30.5 +/- (20.9) hours in the artemether group, while it was 18.0 +/- (8.1) hours in the quinine group; the difference was highly significant (P=0.02). The mean parasite clearance time was shorter in the artemether group than in the quinine group, but it was not statistically significant, (16.0 vs. 22.4 hours; p>0.05). In comatose patients (three in the artemether group, three in the quinine group) the time of recovery from coma was significantly shorter in artemether group than in quinine group (12.5 vs. 20.16 hours; P<0.05). Recrudescence of P. falciparum (confirmed by polymerase chain reaction) occurred in one out of fifteen patients (6.6%) in the quinine group seen on day 28, which was successfully treated by sulphadoxine-pyrimethamine. In the quinine group, one patient died and one patient developed hypoglycaemia. CONCLUSION: Artemether caused faster parasite clearance than quinine, but quinine lowered the temperature in shorter time than artemether. The results obtained show that artemether can be used as safe and effective alternative drug for the treatment of severe falciparum malaria in the wake of the growing resistance to quinine in Sudan.