RESUMO
This position statement guides cardiovascular magnetic resonance (CMR) imaging program directors and learners on the key competencies required for Level II and III CMR practitioners, whether trainees come from a radiology or cardiology background. This document is built upon existing curricula and was created and vetted by an international panel of cardiologists and radiologists on behalf of the Society for Cardiovascular Magnetic Resonance (SCMR).
Assuntos
Cardiologia , Competência Clínica , Consenso , Currículo , Educação de Pós-Graduação em Medicina , Imageamento por Ressonância Magnética , Humanos , Educação de Pós-Graduação em Medicina/normas , Imageamento por Ressonância Magnética/normas , Cardiologia/educação , Cardiologia/normas , Doenças Cardiovasculares/diagnóstico por imagem , Cardiologistas/educação , Cardiologistas/normas , Valor Preditivo dos Testes , Radiologistas/educação , Radiologistas/normas , Radiologia/educação , Radiologia/normas , Sociedades Médicas/normasRESUMO
Imaging using cardiac computed tomography (CT) or magnetic resonance (MR) imaging has become an important option for anatomic and substrate delineation in complex atrial fibrillation (AF) and ventricular tachycardia (VT) ablation procedures. Computed tomography more common than MR has been used to detect procedure-associated complications such as oesophageal, cerebral, and vascular injury. This clinical consensus statement summarizes the current knowledge of CT and MR to facilitate electrophysiological procedures, the current value of real-time integration of imaging-derived anatomy, and substrate information during the procedure and the current role of CT and MR in diagnosing relevant procedure-related complications. Practical advice on potential advantages of one imaging modality over the other is discussed for patients with implanted cardiac rhythm devices as well as for planning, intraprocedural integration, and post-interventional management in AF and VT ablation patients. Establishing a team of electrophysiologists and cardiac imaging specialists working on specific details of imaging for complex ablation procedures is key. Cardiac magnetic resonance (CMR) can safely be performed in most patients with implanted active cardiac devices. Standard procedures for pre- and post-scanning management of the device and potential CMR-associated device malfunctions need to be in place. In VT patients, imaging-specifically MR-may help to determine scar location and mural distribution in patients with ischaemic and non-ischaemic cardiomyopathy beyond evaluating the underlying structural heart disease. Future directions in imaging may include the ability to register multiple imaging modalities and novel high-resolution modalities, but also refinements of imaging-guided ablation strategies are expected.
Assuntos
Consenso , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Humanos , Ablação por Cateter , Técnicas Eletrofisiológicas Cardíacas , Taquicardia Ventricular/cirurgia , Taquicardia Ventricular/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Valor Preditivo dos Testes , Europa (Continente) , Resultado do TratamentoRESUMO
Imaging plays an integral role in all aspects of managing heart disease and cardiac imaging is a core competency of cardiologists. The adequate delivery of cardiac imaging services requires expertise in both imaging methodology-with specific adaptations to imaging of the heart-as well as intricate knowledge of heart disease. The European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging have developed and implemented a successful education and certification programme for all cardiac imaging modalities. This programme equips cardiologists to provide high quality competency-based cardiac imaging services ensuring they are adequately trained and competent in the entire process of cardiac imaging, from the clinical indication via selecting the best imaging test to answer the clinical question, to image acquisition, analysis, interpretation, storage, repository, and results dissemination. This statement emphasizes the need for competency-based cardiac imaging delivery which is key to optimal, effective and efficient, patient care.
Assuntos
Cardiologia , Enfermagem Cardiovascular , Cardiopatias , Insuficiência Cardíaca , Humanos , CoraçãoRESUMO
AIMS: To evaluate the impact of a simplified, rapid cardiovascular magnetic resonance (CMR) protocol embedded in care and supported by a partner education programme on the management of cardiomyopathy (CMP) in low- and middle-income countries (LMICs). METHODS AND RESULTS: Rapid CMR focused particularly on CMP was implemented in 11 centres, 7 cities, 5 countries, and 3 continents linked to training courses for local professionals. Patients were followed up for 24 months to assess impact. The rate of subsequent adoption was tracked. Five CMR conferences were delivered (920 attendees-potential referrers, radiographers, reporting cardiologists, or radiologists) and five new centres starting CMR. Six hundred and one patients were scanned. Cardiovascular magnetic resonance indications were 24% non-contrast T2* scans [myocardial iron overload (MIO)] and 72% suspected/known cardiomyopathies (including ischaemic and viability). Ninety-eighty per cent of studies were of diagnostic quality. The average scan time was 22 ± 6â min (contrast) and 12 ± 4â min (non-contrast), a potential cost/throughput reduction of between 30 and 60%. Cardiovascular magnetic resonance findings impacted management in 62%, including a new diagnosis in 22% and MIO detected in 30% of non-contrast scans. Nine centres continued using rapid CMR 2 years later (typically 1-2 days per week, 30â min slots). CONCLUSIONS: Rapid CMR of diagnostic quality can be delivered using available technology in LMICs. When embedded in care and a training programme, costs are lower, care is improved, and services can be sustained over time.
Assuntos
Cardiomiopatias , Sobrecarga de Ferro , Cardiomiopatias/diagnóstico por imagem , Monofosfato de Citidina , Países em Desenvolvimento , Humanos , Imageamento por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Espectroscopia de Ressonância MagnéticaRESUMO
BACKGROUND: In patients with stable angina, two strategies are often used to guide revascularization: one involves myocardial-perfusion cardiovascular magnetic resonance imaging (MRI), and the other involves invasive angiography and measurement of fractional flow reserve (FFR). Whether a cardiovascular MRI-based strategy is noninferior to an FFR-based strategy with respect to major adverse cardiac events has not been established. METHODS: We performed an unblinded, multicenter, clinical-effectiveness trial by randomly assigning 918 patients with typical angina and either two or more cardiovascular risk factors or a positive exercise treadmill test to a cardiovascular MRI-based strategy or an FFR-based strategy. Revascularization was recommended for patients in the cardiovascular-MRI group with ischemia in at least 6% of the myocardium or in the FFR group with an FFR of 0.8 or less. The composite primary outcome was death, nonfatal myocardial infarction, or target-vessel revascularization within 1 year. The noninferiority margin was a risk difference of 6 percentage points. RESULTS: A total of 184 of 454 patients (40.5%) in the cardiovascular-MRI group and 213 of 464 patients (45.9%) in the FFR group met criteria to recommend revascularization (P = 0.11). Fewer patients in the cardiovascular-MRI group than in the FFR group underwent index revascularization (162 [35.7%] vs. 209 [45.0%], P = 0.005). The primary outcome occurred in 15 of 421 patients (3.6%) in the cardiovascular-MRI group and 16 of 430 patients (3.7%) in the FFR group (risk difference, -0.2 percentage points; 95% confidence interval, -2.7 to 2.4), findings that met the noninferiority threshold. The percentage of patients free from angina at 12 months did not differ significantly between the two groups (49.2% in the cardiovascular-MRI group and 43.8% in the FFR group, P = 0.21). CONCLUSIONS: Among patients with stable angina and risk factors for coronary artery disease, myocardial-perfusion cardiovascular MRI was associated with a lower incidence of coronary revascularization than FFR and was noninferior to FFR with respect to major adverse cardiac events. (Funded by the Guy's and St. Thomas' Biomedical Research Centre of the National Institute for Health Research and others; MR-INFORM ClinicalTrials.gov number, NCT01236807.).
Assuntos
Angina Estável/diagnóstico , Angiografia Coronária , Reserva Fracionada de Fluxo Miocárdico , Angiografia por Ressonância Magnética , Adulto , Idoso , Angina Estável/complicações , Angina Estável/diagnóstico por imagem , Angina Estável/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
ABSTRACT: Modern cancer therapies have significantly improved survival leading to a growing population of cancer survivors. Similarly, both conventional and newer treatments are associated with a spectrum of cardiovascular disorders with potential long-term sequelae. Prompt detection and treatment of these complications is, therefore, pivotal to enable healthy survivorship and reduce cardiovascular morbidity. Advanced multimodality imaging is a valuable tool for stratifying patient risk, identifying cardiovascular toxicity during and after therapy, and predicting recovery. This review summarizes the potential cardiotoxic complications of anticancer therapies and the multimodality approaches available in each case with special focus on newer techniques and the added value of biomarkers ultimately leading to earlier diagnosis and better prognostication.
Assuntos
Antineoplásicos , Doenças Cardiovasculares , Sistema Cardiovascular , Neoplasias , Antineoplásicos/efeitos adversos , Biomarcadores , Cardiotoxicidade/etiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/diagnóstico por imagem , Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológicoRESUMO
OPINION STATEMENT: Early detection and treatment of cardiotoxicity from cancer therapies is key to preventing a rise in adverse cardiovascular outcomes in cancer patients. Over-diagnosis of cardiotoxicity in this context is however equally hazardous, leading to patients receiving suboptimal cancer treatment, thereby impacting cancer outcomes. Accurate screening therefore depends on the widespread availability of sensitive and reproducible biomarkers of cardiotoxicity, which can clearly discriminate early disease. Blood biomarkers are limited in cardiovascular disease and clinicians generally still use generic screening with ejection fraction, based on historical local expertise and resources. Recently, however, there has been growing recognition that simple measurement of left ventricular ejection fraction using 2D echocardiography may not be optimal for screening: diagnostic accuracy, reproducibility and feasibility are limited. Modern cancer therapies affect many myocardial pathways: inflammatory, fibrotic, metabolic, vascular and myocyte function, meaning that multiple biomarkers may be needed to track myocardial cardiotoxicity. Advanced imaging modalities including cardiovascular magnetic resonance (CMR), computed tomography (CT) and positron emission tomography (PET) add improved sensitivity and insights into the underlying pathophysiology, as well as the ability to screen for other cardiotoxicities including coronary artery, valve and pericardial diseases resulting from cancer treatment. Delivering screening for cardiotoxicity using advanced imaging modalities will however require a significant change in current clinical pathways, with incorporation of machine learning algorithms into imaging analysis fundamental to improving efficiency and precision. In the future, we should aspire to personalized rather than generic screening, based on a patient's individual risk factors and the pathophysiological mechanisms of the cancer treatment they are receiving. We should aspire that progress in cardiooncology is able to track progress in oncology, and to ensure that the current 'one size fits all' approach to screening be obsolete in the very near future.
Assuntos
Cardiotoxicidade/diagnóstico por imagem , Cardiotoxicidade/etiologia , Diagnóstico por Imagem , Neoplasias/complicações , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores , Cardiotoxicidade/fisiopatologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/etiologia , Diagnóstico por Imagem/efeitos adversos , Diagnóstico por Imagem/métodos , Humanos , Imagem Multimodal/métodos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Neoplasias/tratamento farmacológico , Disfunção VentricularRESUMO
RATIONALE: Preclinical evidence demonstrates that inorganic nitrite, after its in situ conversion to nitric oxide, attenuates consequent myocardial reperfusion injury. OBJECTIVE: We investigated whether intracoronary injection of nitrite during primary percutaneous coronary intervention might improve infarct size in ST-elevated myocardial infarction. METHODS AND RESULTS: Patients undergoing primary percutaneous coronary intervention (n=80) were randomized to receive intracoronary (10 mL) sodium nitrite (1.8 µmol) or NaCl (placebo) before balloon inflation. The primary end point was infarct size assessed by measuring creatine kinase release. Secondary outcomes included infarct size assessed by troponin T release and by cardiac MRI on day 2. Baseline characteristics were similar between the groups. No evidence of differences in creatine kinase release (P=0.92), troponin T (P=0.85), or cardiac MRI-assessed infarct size (P=0.254) were evident. In contrast, there was an improvement [corrected] in myocardial salvage index (P=0.05) and reduction in [corrected] major adverse cardiac event at 1 year (2.6% versus 15.8%; P=0.04) in the nitrite group. In a 66-patient subgroup with thrombolysis in myocardial infarction ≤1 flow, there was reduced serum creatine kinase (P=0.030) and a 19% reduction in cardiac MRI-determined infarct size (P=0.034) with nitrite. No adverse effects of nitrite were detected. CONCLUSIONS: In this phase II study, intracoronary nitrite infusion did not alter infarct size, although a trend to improved myocardial salvage index and a significant reduction in major adverse cardiac event was evident. In a subgroup of patients with thrombolysis in myocardial infarction flow ≤1, nitrite reduced infarct size and major adverse cardiac event and improved myocardial salvage index, indicating that a phase III clinical trial assessing intracoronary nitrite administration as an adjunct to percutaneous coronary intervention in ST-elevated myocardial infarction patients is warranted. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01584453.
Assuntos
Infarto do Miocárdio/tratamento farmacológico , Nitrito de Sódio/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitrito de Sódio/administração & dosagem , Nitrito de Sódio/efeitos adversosRESUMO
AIMS: Clinical trials suggest that intracoronary delivery of autologous bone marrow-derived cells (BMCs) 1-7 days post-acute myocardial infarction (AMI) may improve left ventricular (LV) function. Earlier time points have not been evaluated. We sought to determine the effect of intracoronary autologous BMC on LV function when delivered within 24 h of successful reperfusion therapy. METHODS AND RESULTS: A multi-centre phase II randomized, double-blind, and placebo-controlled trial. One hundred patients with anterior AMI and significant regional wall motion abnormality were randomized to receive either intracoronary infusion of BMC or placebo (1:1) within 24 h of successful primary percutaneous intervention (PPCI). The primary endpoint was the change in left ventricular ejection fraction (LVEF) between baseline and 1 year as determined by advanced cardiac imaging. At 1 year, although LVEF increased compared with baseline in both groups, the between-group difference favouring BMC was small (2.2%; 95% confidence interval, CI: -0.5 to 5.0; P = 0.10). However, there was a significantly greater myocardial salvage index in the BMC-treated group compared with placebo (0.1%; 95% CI: 0.0-0.20; P = 0.048). Major adverse events were rare in both treatment groups. CONCLUSION: The early infusion of intracoronary BMC following PPCI for patients with AMI and regional wall motion abnormality leads to a small non-significant improvement in LVEF when compared with placebo; however, it may play an important role in infarct remodelling and myocardial salvage.
Assuntos
Infarto Miocárdico de Parede Anterior/terapia , Transplante de Medula Óssea/métodos , Infarto Miocárdico de Parede Anterior/patologia , Infarto Miocárdico de Parede Anterior/fisiopatologia , Angiografia por Tomografia Computadorizada , Método Duplo-Cego , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Intervenção Coronária Percutânea/métodos , Qualidade de Vida , Terapia de Salvação/métodos , Volume Sistólico/fisiologia , Transplante Autólogo , Disfunção Ventricular Esquerda/diagnósticoRESUMO
BACKGROUND: AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ventricle, which can result in long acquisition times and multiple breath holds. This study sought to compare 3-slice T2-short-tau inversion recovery (T2- STIR) technique against conventional multi-slice T2-STIR technique for the assessment of area at risk (AAR). METHODS: CMR imaging was performed on 167 patients after successful primary percutaneous coronary intervention. 82 patients underwent a novel 3-slice SAX protocol and 85 patients underwent standard 10-slice SAX protocol. AAR was obtained by manual endocardial and epicardial contour mapping followed by a semi- automated selection of normal myocardium; the volume was expressed as mass (%) by two independent observers. RESULTS: 85 patients underwent both 10-slice and 3-slice imaging assessment showing a significant and strong correlation (intraclass correlation coefficient = 0.92;p < 0.0001) and a low Bland-Altman limit (mean difference -0.03 ± 3.21%, 95% limit of agreement,- 6.3 to 6.3) between the 2 analysis techniques. A further 82 patients underwent 3-slice imaging alone, both the 3-slice and the 10-slice techniques showed statistically significant correlations with angiographic risk scores (3-slice to BARI r = 0.36, 3-slice to APPROACH r = 0.42, 10-slice to BARI r = 0.27, 10-slice to APPROACH r = 0.46). There was low inter-observer variability demonstrated in the 3-slice technique, which was comparable to the 10-slice method (z = 1.035, p = 0.15). Acquisition and analysis times were quicker in the 3-slice compared to the 10-slice method (3-slice median time: 100 seconds (IQR: 65-171 s) vs. (10-slice time: 355 seconds (IQR: 275-603 s); p < 0.0001. CONCLUSIONS: AAR measured using 3-slice T2-STIR technique correlates well with standard 10-slice techniques, with no significant bias demonstrated in assessing the AAR. The 3-slice technique requires less time to perform and analyse and is therefore advantageous for both patients and clinicians.
Assuntos
Edema Cardíaco/patologia , Imagem Cinética por Ressonância Magnética/métodos , Infarto do Miocárdio/patologia , Miocárdio/patologia , Idoso , Ensaios Clínicos como Assunto , Meios de Contraste , Edema Cardíaco/etiologia , Europa (Continente) , Feminino , Humanos , Masculino , Meglumina , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Variações Dependentes do Observador , Compostos Organometálicos , Intervenção Coronária Percutânea , Valor Preditivo dos Testes , Reprodutibilidade dos TestesRESUMO
The Ni(I) hydrogen oxidation catalyst [Ni(P(Cy)2N(tBu)2)2](+) (1(+); P(Cy)2N(tBu)2 = 1,5-di(tert-butyl)-3,7-dicyclohexyl-1,5-diaza-3,7-diphosphacyclooctane) has been studied using a combination of electron paramagnetic resonance (EPR) techniques (X-, Q-, and D-band, electron-nuclear double resonance, hyperfine sublevel correlation spectroscopy), X-ray crystallography, and density functional theory (DFT) calculations. Crystallographic and DFT studies indicate that the molecular structure of 1(+) is highly symmetrical. EPR spectroscopy has allowed determination of the electronic g tensor and the spin density distribution on the ligands, and revealed that the Ni(I) center does not interact strongly with the potentially coordinating solvents acetonitrile and butyronitrile. The EPR spectra and magnetic parameters of 1(+) are found to be distinctly different from those for the related compound [Ni(P(Ph)2N(Ph)2)2](+) (4(+)). One significant contributor to these differences is that the molecular structure of 4(+) is unsymmetrical, unlike that of 1(+). DFT calculations on derivatives in which the R and R' groups are systematically varied have allowed elucidation of structure/substituent relationships and their corresponding influence on the magnetic resonance parameters.
Assuntos
Hidrogênio/química , Modelos Moleculares , Níquel/química , Fósforo/química , Catálise , Cristalografia por Raios X , Espectroscopia de Ressonância de Spin Eletrônica , Oxirredução , Teoria QuânticaAssuntos
Fibrose Endomiocárdica/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico , Taquicardia Supraventricular/diagnóstico , Idoso de 80 Anos ou mais , Angiografia/métodos , Fator Natriurético Atrial/sangue , Meios de Contraste/administração & dosagem , Ecocardiografia/métodos , Eletrocardiografia/métodos , Fibrose Endomiocárdica/complicações , Fibrose Endomiocárdica/patologia , Feminino , Gadolínio/administração & dosagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Humanos , Síndrome Hipereosinofílica/diagnóstico por imagem , Síndrome Hipereosinofílica/patologia , Espectroscopia de Ressonância Magnética/métodos , Prognóstico , Precursores de Proteínas/sangue , Respiração , Volume Sistólico/fisiologia , Taquicardia Supraventricular/etiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
AIMS: Myocardial revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) carries the risk of serious complications. Observational data suggest that outcomes may be improved by experienced operators, but there are few studies that have analysed the relationship between mortality and primary operator grade. The aim of this study was to investigate the effect of operator grade (trainee vs. consultant) upon outcomes of revascularization procedures. METHODS AND RESULTS: This was an observational study at a tertiary cardiology centre with accredited training programmes, between 2003 and 2011. A total of 22 697 consecutive patients undergoing either CABG or PCI were included. Associations between operator grade and mortality were assessed by hazard ratios, estimated by Cox regression analyses; 6689 patients underwent CABG, whereas 16 008 underwent PCI. Trainees performed 1968 (29.4%) CABG procedures and 8502 (53.1%) PCI procedures. The proportion of procedures performed by trainees declined over time for both CABG (30.2% in 2003 vs. 26.0% in 2010) and for PCI (58.1% in 2003 vs. 44.5% in 2010). In the unadjusted Cox analysis, consultant operator grade was associated with an increased 5-year mortality after both CABG [HR: 1.26 (95% CI: 1.07-1.47)] and PCI procedures [HR: 1.34 (95% CI: 1.22-1.47)] compared with a trainee operator. However, following multiple adjustment, consultant grade was no longer associated with mortality after either procedure [CABG: HR: 1.02 (95% CI: 0.87-1.20), PCI: HR: 1.08 (95% CI: 0.98-1.20)]. CONCLUSION: There was no observed detrimental effect on patient outcomes arising from procedures undertaken by trainees working in a structured training environment compared with consultants.
Assuntos
Cardiologia/normas , Competência Clínica/normas , Doença da Artéria Coronariana/cirurgia , Corpo Clínico Hospitalar/normas , Revascularização Miocárdica/mortalidade , Intervenção Coronária Percutânea/mortalidade , Cardiologia/estatística & dados numéricos , Consultores/estatística & dados numéricos , Tratamento de Emergência/mortalidade , Métodos Epidemiológicos , Feminino , Mortalidade Hospitalar , Humanos , Capacitação em Serviço , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Revascularização Miocárdica/normas , Revascularização Miocárdica/estatística & dados numéricos , Duração da Cirurgia , Intervenção Coronária Percutânea/normas , Intervenção Coronária Percutânea/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Diálise Renal/mortalidade , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/mortalidade , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Resultado do TratamentoRESUMO
INTRODUCTION: We tested the hypothesis that cardiovascular magnetic resonance (CMR) imaging can reliably distinguish the presence or absence of left atrial (LA) ablation lesions by blinded analysis of pre- and postablation imaging. METHODS: Consecutive patients at 2 centers undergoing pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation by either wide area circumferential radiofrequency ablation (WACA) or ostial ablation with a cryoballoon underwent CMR late gadolinium enhancement (LGE) imaging pre- and 3 months postablation. Imaging was anonymized for blinded analysis of (1) LGE images, and (2) a 3D fusion image with LGE projected onto a segmented LA surface. Scans were categorized using both assessment techniques separately as pre- or postablation, and if postablation, whether lesions were in an ostial or WACA distribution. RESULTS: LGE imaging was performed in 50 patients (aged 60 ± 10 years, 68% male, 24 underwent WACA and 26 had cryoablation). Sensitivity and specificity for detection of ablation lesions was 60% and 96% on LGE imaging. Sensitivity was higher using 3D fusion imaging (88%; P = 0.003). The proportion in whom lesions were both detected and the distribution correctly assessed as WACA or ostial was higher with 3D fusion imaging compared to LGE imaging (54% vs 28%; P = 0.014). There was no difference in the detection of radiofrequency ablation lesions compared to cryoablation lesions (58% vs 62%; P = 1.000). CONCLUSION: LGE imaging of atrial scar is not yet sufficiently accurate to reliably identify ablation lesions or to determine lesion distribution.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Cicatriz/patologia , Criocirurgia , Imageamento por Ressonância Magnética , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/patologia , Ablação por Cateter/efeitos adversos , Distribuição de Qui-Quadrado , Cicatriz/etiologia , Meios de Contraste , Criocirurgia/efeitos adversos , Feminino , Gadolínio DTPA , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Modelos Logísticos , Londres , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Razão de Chances , Valor Preditivo dos Testes , Veias Pulmonares/patologia , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
A polycrystalline sample of La3Ni2SbO9 has been synthesized using a standard ceramic method and characterized by neutron diffraction and magnetometry. The compound adopts a monoclinic, perovskite-like structure with space group P2(1)/n and unit cell parameters a = 5.0675(1), b = 5.6380(1), c = 7.9379(2) Å, ß = 89.999(6)° at room temperature. The two crystallographically distinct six-coordinate sites are occupied by Ni(2+) and a disordered distribution of Ni(2+)/Sb(5+), respectively; the Ni(2+) and Sb(5+) cations occupy the disordered site in a 1:2 ratio. Both ac and dc magnetometry indicate the presence of a spontaneous magnetization below 105 K. A magnetization of 1.5 µB per formula unit was measured at 2 K in a field of 40 kOe. However, no magnetic scattering was observed in neutron diffraction data collected at 5 K. It is proposed that, as a consequence of the cation disorder, La3Ni2SbO9 behaves as a relaxor ferromagnet, analogous to a relaxor ferroelectric, with magnetic domains too small to be detected by neutron diffraction forming below 105 K.
RESUMO
With an ever-expanding field of advanced cardiac imaging, clinicians tend to underestimate the importance of a detailed clinical history in reaching the correct diagnosis. This case illustrates 1 such example. (Level of Difficulty: Intermediate.).
RESUMO
Undertaking a period of research in cardiology is considered a vital part of training. This has many advantages including enhancing skills that better equip the clinician for patient care. However, in modern cardiology training, the feasibility and necessity of undertaking a period of formal research during training should be considered on an individual basis. The first of this four-part editorial series will explore the benefits of and obstacles to pursuing research in cardiology, with the aim of equipping the reader with an understanding of the options around research during cardiology training in the UK.