Assuntos
Trombose/etiologia , Trombose/patologia , Filtros de Veia Cava/efeitos adversos , Idoso , Humanos , MasculinoRESUMO
Iatrogenic aortic dissection during percutaneous coronary intervention is a rare but serious complication. Both conservative and surgical approaches have been proposed as management strategies. We describe a case of an 87-year-old female who presented with an acute coronary syndrome complicated by the development of an ascending aortic dissection during percutaneous intervention, and we provide a brief review of the literature.
Assuntos
Síndrome Coronariana Aguda/terapia , Aorta/lesões , Aneurisma Aórtico/etiologia , Dissecção Aórtica/etiologia , Hematoma/etiologia , Doença Iatrogênica , Intervenção Coronária Percutânea/efeitos adversos , Lesões do Sistema Vascular/etiologia , Síndrome Coronariana Aguda/diagnóstico por imagem , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Aorta/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Ecocardiografia Transesofagiana , Feminino , Hematoma/diagnóstico por imagem , Humanos , Lesões do Sistema Vascular/diagnóstico por imagemRESUMO
BACKGROUND: It is unknown whether axial non-gated CT can distinguish World Health Organization Group 2 pulmonary hypertension (pulmonary hypertension due to left heart disease) from non-Group 2 pulmonary hypertension. OBJECTIVE: The study was performed to identity imaging parameters in non-gated chest CT that differentiate Group 2 from non-Group 2 pulmonary hypertension. METHODS: Among 158 patients who underwent right heart catheterization for evaluation of pulmonary hypertension, 112 had sufficient data and chest CT for review. Invasive hemodynamic data and numerous variables obtained from axial CT images (maximum diameters of main, right, left pulmonary arteries, ascending aorta, main pulmonary artery to ascending aorta diameter ratio, right atrial diameter, left atrial area and right ventricular size) were collected. CT variables were validated against hemodynamic data to identify parameters that would allow to differentiate pulmonary hypertension due to left heart disease (Group 2) from non-Group 2 pulmonary hypertension. RESULTS: Based on right heart catheterization data, we identified 53 patients with Group 2 pulmonary hypertension, 50 patients with non-Group 2 pulmonary hypertension, and 9 subjects with no pulmonary hypertension. In patients with a dilated pulmonary artery (n = 84), the ROC curve for left atrial area (area under the ROC curve 0.76 ± 0.06) independently distinguished patients with Group 2 pulmonary hypertension (n = 42) from patients with non-Group 2 pulmonary hypertension (n = 42). A dilated left atrium (>20 mm(2)) in combination with a normal right ventriuclar size had a sensitivity of 77% and specificity of 94% for Group 2 pulmonary hypertension. CONCLUSIONS: In patients with a dilated pulmonary artery on chest CT, left atrial area and right ventricular dimensions may aid to diagnose pulmonary hypertension and to distinguish underlying cardiac disease from other causes.
Assuntos
Remodelamento Atrial , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/complicações , Ventrículos do Coração/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Artéria Pulmonar/diagnóstico por imagem , Remodelação Ventricular , Área Sob a Curva , California , Cateterismo Cardíaco , Distribuição de Qui-Quadrado , Diagnóstico Diferencial , Dilatação Patológica , Feminino , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Hemodinâmica , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Artéria Pulmonar/fisiopatologia , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de RiscoRESUMO
UNLABELLED: The purpose of this study was to determine whether stress myocardial perfusion (SPECT) optimized with stress-only (SO) imaging is comparable to cardiac CT angiography (CTA) for evaluating patients with acute chest pain (ACP). METHODS: This was a prospective randomized observational study in 598 ACP patients who underwent CTA versus SPECT. The primary endpoint was length of hospital stay, and secondary endpoints were test feasibility, time to diagnosis, diagnostic accuracy, radiation exposure, and overall cost. Median follow-up was 6.5 mo, with a 3.8% cardiac event rate defined as death or an acute coronary syndrome. RESULTS: Of 2,994 patients screened, 1,703 (56.9%) were not candidates for CTA because of prior cardiac disease (41%) or imaging contraindications (16%). Time to diagnosis (8.1 ± 8.5 vs. 9.4 ± 7.4 h) and length of hospital stay (19.7 ± 27.8 vs. 23.5 ± 34.4 h) were significantly shorter with CTA than with SPECT (P = 0.002). However, time to diagnosis (7.0 ± 6.2 vs. 6.8 ± 5.9 h, P = 0.20), length of stay (15.5 ± 17.2 vs. 16.7 ± 15.3 h, P = 0.36), and hospital costs ($4,242 ± $3,871 vs. $4,364 ± 1781, P = 0.86) were comparable with CTA versus SO SPECT, respectively. SO was also superior to conventional SPECT regarding all of the above metrics and significantly reduced radiation exposure (5.5 ± 4.4 vs. 12.5 ± 2.7 mSv, P < 0.0001). CONCLUSION: Stress SPECT when optimized with SO imaging is similar to CTA in time to diagnosis, length of hospital stay, and cost, with improved prognostic accuracy and less radiation exposure. Our results emphasize the importance of SO imaging, particularly in low-intermediate-risk emergency room patients who are a population likely to have a normal test result.
Assuntos
Dor no Peito/diagnóstico por imagem , Coração/diagnóstico por imagem , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Idoso , Dor no Peito/economia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Teste de Esforço , Feminino , Seguimentos , Humanos , Longevidade , Angiografia por Ressonância Magnética/economia , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Tomografia Computadorizada de Emissão de Fóton Único/economia , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
BACKGROUND: Noncontrast cardiac computed tomography allows calculation of coronary artery calcium score (CACS) and measurement of epicardial adipose tissue (EATv) and intrathoracic fat (ITFv) volumes. It is unclear whether fat volume information contributes to risk stratification. METHODS AND RESULTS: Cardiac computed tomography was performed in 760 consecutive patients with acute chest pain admitted thorough the emergency department. None had prior coronary artery disease. CACS was calculated using the Agatston method. EATv and ITFv were semiautomatically calculated. Median patient follow-up was 3.3 years. Mean patient age was 54.4±13.7 years and Framingham risk score 8.2±8.2. The 45 patients (5.9%) with major acute cardiac events (MACE) were older (64.8±13.9 versus 53.7±13.4 years), more frequently male (60% versus 40%), and had a higher median Framingham risk score (16 versus 4) and CACS (268 versus 0) versus those without events (all P<0.01). The MACE group had a higher median of EATv (154 versus 116 mL) and ITFv (330 versus 223 mL), and a higher prevalence of EATv >125 mL (67% versus 44%) and ITFv >250 mL (64% versus 42%) (all P<0.01). CACS, EATv, and ITFv were all independently associated with MACE. CACS was associated with MACE after adjustment for fat volumes (P<0.0001), whereas EATv and ITFv improved the risk model only in patients with CACS >400. CONCLUSIONS: CACS and fat volumes are independently associated with MACE in acute chest pain patients and beyond that provided by clinical information alone. Although fat volumes may add prognostic value in patients with CACS >400, CACS is most strongly correlated with outcome.