Concordancia de la motilidad segmentaria evaluada por ecocardiograma transtorácico y resonancia magnética cardíaca en pacientes con infarto agudo de miocardio / Comparison of segmental contractility evaluated by transthoracic echocardiogram and cardiac magnetic resonance in patients with acute myocardial infarction

Resumen Introducción: La evaluación de la contractilidad segmentaria es un marcador importante para determinar la extensión de la enfermedad coronaria manifestada a través de un evento isquémico cardiaco. La resonancia magnética cardíaca es el patrón estándar para evaluar dicha motilidad; sin embargo, debido al elevado número de exámenes, la disponibilidad de equipos de resonancia magnética y el costo de los exámenes de resonancia magnética, el uso del ecocardiograma transtorácico es el método diagnóstico de elección. Objetivo: Evaluar la concordancia de la evaluación de la motilidad de diferentes segmentos miocárdicos y de agrupación de segmentos por territorios de irrigación arterial obtenidos por resonancia magnética cardiaca y ecocardiograma transtorácico en pacientes hospitalizados por infarto agudo de miocardio. Métodos: A un grupo de pacientes que llegaron al servicio de emergencia por infarto agudo de miocardio, se les realizó ecocardiograma transtorácico y resonancia magnética cardiaca y se compararon los resultados. La resonancia magnética cardiaca fue el valor de referencia a comparar para fracción de eyección y contractilidad segmentaria. Las pruebas comparativas se hicieron a un 95% de confianza mediante el coeficiente de Kappa-Cohen para evaluar la concordancia entre las medidas. Resultados: No se encontraron diferencias entre la fracción de eyección del ventrículo izquierdo medida por ecocardiograma transtorácico y resonancia magnética cardiaca. Los territorios irrigados por las arterias coronarias descendente anterior y circunfleja tenían una concordancia mediana y buena. En aquellos asociados con la arteria coronaria derecha la concordancia fue baja y media. Conclusiones: La evaluación de la fracción de eyección por ecocardiograma transtorácico no difiere de la evaluación por resonancia magnética cardiaca. En la evaluación de la motilidad segmentaria, la resonancia magnética cardiaca es mejor que el ecocardiograma.

Abstract Introduction: The evaluation of segmental contractility is an important marker to determine the extent of the coronary disease manifested by an ischaemic event. Cardiac magnetic resonance is the standard pattern to evaluate this contractility. However, due to lower availability of magnetic resonance equipment, as well as the increased cost of magnetic resonance tests, the use of the transthoracic echocardiogram is the diagnostic method of choice. Objective: The aim of the study is to compare the evaluation of the motility of different myocardial segments and segments grouped by coronary artery supply territories obtained by cardiac magnetic resonance and transthoracic electrocardiogram performed on patients admitted to hospital with acute myocardial infarction. Methods: A cardiac magnetic resonance and transthoracic electrocardiogram was performed on a group of patients that arrived in the Emergency Department due to an acute myocardial infarction, and the results were compared. The cardiac magnetic resonance was the reference value to compare for the ejection fraction and segmental contractility. Comparative tests were performed with 95% confidence limits using a Kappa-Cohen coefficient to evaluate the agreement between the measurements. Results: No differences were found between the left ventricular ejection fraction measured by cardiac magnetic resonance and transthoracic electrocardiogram. There was average and good agreement in the coronary and circumflex artery supply territories, respectively. In those associated with the right coronary artery, the concordance was low and average. Conclusions: There was no difference between the evaluation of the ejection fraction by transthoracic electrocardiogram or that by cardiac magnetic resonance. In the evaluation of segmental motility, cardiac magnetic resonance was better than transthoracic electrocardiogram.

Factors associated with delayed cardiac tamponade after cardiac surgery

Context: Cardiac tamponade (CT) following cardiac surgery is a potentially fatal complication and the cause of surgical reintervention in 0.1%–6% of cases. There are two types of CT: acute, occurring within the first 48 h postoperatively, and subacute or delayed, which occurs more than 48 h postoperatively. The latter does not show specific clinical signs, which makes it more difficult to diagnose. The factors associated with acute CT (aCT) are related to coagulopathy or surgical bleeding, while the variables associated with subacute tamponade have not been well defined. Aims: The primary objective of this study was to identify the factors associated with the development of subacute CT (sCT). Settings and Design: This report describes a case (n = 80) and control (n = 160) study nested in a historic cohort made up of adult patients who underwent any type of urgent or elective cardiac surgery in a tertiary cardiovascular hospital. Methods: The occurrence of sCT was defined as the presence of a compatible clinical picture, pericardial effusion and confirmation of cardiac tamponade during the required emergency intervention at any point between 48 hours and 30 days after surgery. All factors potentially related to the development of sCT were taken into account. Statistical Analysis Used: For the adjusted analysis, a logistical regression was constructed with 55 variables, including pre-, intra-, and post-operative data. Results: The mortality of patients with sCT was 11% versus 0% in the controls. Five variables were identified as independently and significantly associated with the outcome: pre- or post-operative anticoagulation, reintervention in the first 48 h, surgery other than coronary artery bypass graft, and red blood cell transfusion. Conclusions: Our study identified five variables associated with sCT and established that this complication has a high mortality rate. These findings may allow the implementation of standardized follow-up measures for patients identified as higher risk, leading to either early detection or prevention.

Lesiones renales producidas por bothrops yarará / Kidney injuries by snake bothrops yarara bites

Se presentan dos casos de pacientes mordidos por serpientes del género Bothrops con evolución diferente que tuvieron paralelismo con su biopsia que mostraron necrosis cortical difusa (fallecido) y el otro caso necrosis tubular aguda (recuperado)