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RESUMEN Introducción: Las técnicas de inteligencia artificial han demostrado tener un gran potencial en el área de la cardiología, especialmente para identificar patrones imperceptibles para el ser humano. En este sentido, dichas técnicas parecen ser las adecuadas para identificar patrones en la textura del miocardio con el objetivo de identificar y cuantificar la fibrosis. Objetivos: Proponer un nuevo método de inteligencia artificial para identificar fibrosis en imágenes cine de resonancia cardíaca. Materiales y métodos: Se realizó un estudio retrospectivo observacional en 75 sujetos del Sanatorio San Carlos de Bariloche. El método propuesto analiza la textura del miocardio en las imágenes cine CMR (resonancia magnética cardíaca) mediante el uso de una red neuronal convolucional que determinar el daño local del tejido miocárdico. Resultados: Se observó una precisión del 89% para cuantificar el daño tisular local en el conjunto de datos de validación y de un 70% para el conjunto de prueba. Además, el análisis cualitativo realizado muestra una alta correlación espacial en la localización de la lesión. Conclusiones: El método propuesto permite identificar espacialmente la fibrosis únicamente utilizando la información de los estudios de cine de resonancia magnética nuclear, mostrando el potencial de la técnica propuesta para cuantificar la viabilidad miocárdica en un futuro o estudiar la etiología de las lesiones.
ABSTRACT Background: Artificial intelligence techniques have demonstrated great potential in cardiology, especially to detect imperceptible patterns for the human eye. In this sense, these techniques seem to be adequate to identify patterns in the myocardial texture which could lead to characterize and quantify fibrosis. Purpose: The aim of this study was to postulate a new artificial intelligence method to identify fibrosis in cine cardiac magnetic resonance (CMR) imaging. Methods: A retrospective observational study was carried out in a population of 75 subjects from a clinical center of San Carlos de Bariloche. The proposed method analyzes the myocardial texture in cine CMR images using a convolutional neural network to determine local myocardial tissue damage. Results: An accuracy of 89% for quantifying local tissue damage was observed for the validation data set and 70% for the test set. In addition, the qualitative analysis showed a high spatial correlation in lesion location. Conclusions: The postulated method enables to spatially identify fibrosis using only the information from cine nuclear magnetic resonance studies, demonstrating the potential of this technique to quantify myocardial viability in the future or to study the etiology of lesions.
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Objective • To investigate the influence of smoking on acute myocardial injury and long-term prognosis in the patients with ST-segment elevation myocardial infraction (STEMI) by cardiac magnetic resonance (CMR). Methods • Three hundred and forty-nine STEMI patients were retrospectively selected from a prospective cohort from May 2012 to August 2017, and were followed up for at least 2 years. The primary endpoint was a composite of all-cause death, reinfarction and stroke. The secondary endpoint was heart failure rehospitalization. The patients were divided into smoker group and non-smoker group according to the baseline status of smoking which was recorded at admission. The difference in the incidence of endpoint events was further analyzed in combination with the presence or absence of intramyocardial hemorrhage (IMH) between the two groups. Results • There were 221 patients in the smoker group, accounting for 63.3% of the total sample. The average age of onset in smokers were 4.66 years earlier than nonsmokers. However, smokers showed a lower incidence of left ventricular thrombosis and lower levels of brain natriuretic peptide than non-smokers (P=0.023, P=0.000). There was no difference in the left ventricular ejection fraction between the two groups (P>0.05), but the smokers had a better endsystolic and end-diastolic volume index (P=0.019, P=0.007). Smokers and non-smokers had similar clinical outcomes of all-cause death, reinfarction and stroke (P>0.05). The incidence of heart failure rehospitalization in smokers was quite lower than that of the non-smokers, but this kind of protective effect disappeared after differences in baseline being adjusted (P=0.167). In the patients with IMH, smoking had a protective effect on primary endpoints (HR=0.266, P=0.008), but in the patients without IMH, smokers had a worse outcome of all-cause death and reinfarction than non-smokers (P=0.024). Conclusion • In patients with STEMI, smoking has no protective effect on long-term prognosis. When IMH appears in STEMI patients, smoking has a protective effect on all-cause death, reinfarction and stoke. However, in patients without IMH, smokers have a worse prognosis than non-smokers.
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BACKGROUND:TheimpactofLVNCindilatedcardiomyopathyandleftventriclesystolicdysfunctionis controversial .METHODS: A retrospective study of 46 patients, over a period of 09 years between September 2009 and December 2018, performed in the cardiology department “B”, IBN SINA hospital, Rabat, Morocco. RESULTS: The mean age was 44 ± 16 years with extremes ranging from 10 years to 97 years. A slight predominance of male with 54% was observed. In TTE only 17,4% of patients had a suspected LVNC. The mean LVEDD was 68.6 ± 8.4 mm. The mean LVEDV was 223.1 ± 76.3 ml with a maximum of 443 ml and a minimum of 122 ml. The mean LVEF was 37.1 ± 12.7. Akinesia was observed in 28% of patients involving the infero-septal wall in 97% of cases. The non compaction was located in anterolateral wall was involved in 97.8 % of cases, and the inferoseptal wall was always spared. The median NC/C ratio was 2.8 [2.5-3], with extremes ranging from 2.3 to 5. LGE was present in 59 % of our patients; mostly located in the infero-septal. In multivariate analysis, NC/C ratio correlates significantly with the presence of LGE in the infero-lateral wall and the apex respectively (p: 0.04 and p: 0.002). NC / C ratio correlates with LVEF (OR: 0.03, CI [0.01-0.04], p: 0.02). CONCLUSION: This study shows the CMR profile of LVNC Moroccan patients. Our results affirm that the NC/C ratio in LVNC is a major determinant of LV fiosis and systolic dysfunction.
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El uso de la Resonancia Magnética Cardiaca (RMC), se ha convertido en los últimos años en una herramienta fundamental para el diagnóstico de diversas miocardiopatías, entre las cuales sobresale la miocarditis, entidad que cursa con manifestaciones y signos clínicos muy variables y poco específicos en la mayor parte de los casos, lo que la convierte en una patología difícil de reconocer sobre todo en sus episodios de presentación inicial, lo que probablemente conlleve a que sea subdiagnosticada. El desarrollo de nuevas modalidades de imagen ha permitido que ante la sospecha de esta entidad el uso de la RMC se convierta en la técnica ideal para el diagnóstico temprano. A continuación se presenta el caso clínico de un paciente masculino que acude con cuadro de dolor torácico agudo, enzimas cardiacas elevadas, electrocardiograma no concluyente y coronarias normales, mostrando el curso insidioso de esta patología así como de manera resumida el rol de la RMC en su diagnóstico y pronóstico.
The use of cardiac magnetic resonance (CMR) has become in recent years an essential tool for diagnosing various cardiomyopathies, among which stands myocarditis, an entity that presents with demonstrations and highly variable clinical signs and unspecific in most cases, which makes it a difficult disease to recognize especially in its initial filing episodes, which probably lead to be underdiagnosed. The development of new imaging modalities has allowed suspicion of this entity using the RMC becomes the ideal technique for early diagnosis. Next, the case of a male patient presenting with symptoms of acute chest pain, elevated cardiac enzymes inconclusive electrocardiogram and normal coronary showing insidious course of this disease and in summary the role of the RMC in its presented diagnosis and prognosis.
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Humans , Male , Aged , Magnetic Resonance Spectroscopy , Computed Tomography Angiography , Myocarditis , Diagnosis , ElectrocardiographyABSTRACT
OBJECTIVE: To test whether the method utilizing three-dimensional (3D) whole-heart MRI has an additional benefit over that utilizing conventional two-dimensional (2D) cine MRI in quantifying ventricular volumes. MATERIALS AND METHODS: In 110 patients with congenital heart disease, a navigator-gated, 3D whole-heart MRI during end-systole (ES) and end-diastole (ED), 2D short-axis cine MRI, and phase contrast MRI of the great arteries were acquired. Ventricular volumes were measured by using a 3D threshold-based segmentation for 3D whole-heart MRI and by using a simplified contouring for 2D cine MRI. The cardiac trigger delays of 3D whole-heart MRI were compared with those of a 2D cine MRI. The stroke volumes calculated from the ventricular volumes were compared with the arterial flow volumes, measured by phase contrast MRI. RESULTS: The ES and ED trigger delays of whole-heart MRI were significantly less than cine MRI for both the left ventricle (−16.8 ± 35.9 ms for ES, −59.0 ± 90.4 ms for ED; p < 0.001) and the right ventricle (−58.8 ± 30.6 ms for ES, −104.9 ± 92.7 ms for ED; p < 0.001). Compared with the arterial flow volumes, 2D cine MRI significantly overestimated the left ventricular stroke volumes (8.7 ± 8.9 mL, p < 0.001) and the 3D whole-heart MRI significantly underestimated the right ventricular stroke volumes (−22.7 ± 22.9 mL, p < 0.001). CONCLUSION: Three-dimensional whole-heart MRI is often subject to early timing of the ED phase, potentially leading to the underestimation of the right ventricular stroke volumes.
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Humans , Arteries , Heart Defects, Congenital , Heart Ventricles , Magnetic Resonance Imaging , Magnetic Resonance Imaging, Cine , Methods , Stroke VolumeABSTRACT
Objective • To evaluate the strain parameters measured by two-dimensional speckle tracking echocardiography (2D-STE) in predicting myocardial segment functional recovery and left ventricular (LV) remodeling. Methods • Eighty-one patients with first acute ST-elevation myocardial infarction were enrolled. All patients underwent cardiac magnetic resonance (CMR) within 8 days after reperfusion therapy to detect the percentage of necrotic myocardium and the presence of microvascular obstruction or intra myocardial hemorrhage. Echocardiography examination for the first time was performed on the same day as CMR. Segmental and global circumferential strain (CS), radial strain, and longitudinal strain were measured by 2D-STE. Echocardiography was performed again after an average follow-up of 14 months. Results • The segments with functional recovery were associated with higher absolute values of strain parameters at baseline compared to those without functional recovery. The receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of CS≤-7.77% to predict the functional recovery of myocardial segment were 77.17% and 61.40%, respectively (AUC=0.74, P=0.000). Multiple Logistic regression showed that the percentage of necrotic myocardium and global CS (GCS) were the powerful predictors of LV remodeling (P<0.05). According to ROC curve analysis, GCS≥-17.48% had sensitivity of 88.33% and specificity of 69.23%(AUC=0.80, P=0.000) in predicting LV remodeling. Conclusion • Among the strain parameters of 2D-STE, CS may be an ideal predictor of segment functional recovery and LV remodeling after myocardial infarction.
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Objective To localize the upper airway obstruction of patients with obstructive sleep apnea hypopnea syndrome (OSAHS)with the Cinema Magnetic Resonance(Cine-MR) and fiber optic laryngoscope with Müller maneuver(FLMM)before operation and discuss the clinical application values.Methods Before operation, FLMM and Cine-MR were applied to 22 patients diagnosed as OSAHS by Polysomnography(PSG).Medical examinations conducted in this study from September 2015 to April 2016 to examine the obstruction of the soft palate region, the lingual region and epiglottis.Results There were complete agreements between the Cine-MR and FLMM at locating obstruction sites of the soft palate (n=22/n=22),and there were moderate agreements between the Cine-MR and FLMM in locating obstruction sites of the retroglottal region(n=13/n=6),epiglottal region (n=4/n=2)and multiple level(n=13/n=6), respectively.Conclusion For those moderate and severe OSAHS patients with multiple sites obstruction , the preoperative application of the Cine-MR and FLMM together will be better in locating the obstruction sites.
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Vascular rings which can cause symptoms related the trachea and esophagus compression occur in less than 1% of all cardiovascular malformations. Double incomplete aortic arch with right-sided aorta and aberrant left subclavian artery is the rarest one, and its present in 0.04-0.1% of autopsy series. A case of this malformation with a Kommerell's Diverticulum is presented. This diverticulum has risk of severe complications such as dissection and/or rupture.
Los anillos vasculares pueden causar síntomas relacionados a compresión de tráquea y esófago y ocurren en menos del 1% de todas las malformaciones cardiovasculares. El doble arco aórtico incompleto con arco aórtico a la derecha y arteria subclavia izquierda aberrante es la forma más rara y se presenta en el 0.04 a 0.1% de las series de autopsia. Se presenta un caso de esta malformación con un divertículo de Kommerell. El divertículo tiene riesgo de complicaciones severas como disección y/o ruptura.
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Humans , Infant , Male , Abnormalities, Multiple , Aorta, Thoracic/abnormalities , Cough/etiology , Diverticulum/complications , Subclavian Artery/abnormalities , Chronic DiseaseABSTRACT
Background: Cardiovascular magnetic resonance imaging (CMR) has recently been accepted as a preferential method for evaluation left ventricular ejection fraction (LVEF). The LVEF analysis by CMR is usually performed by trained technologists in many institutions of Thailand. Objective: Assess the reproducibility of LVEF measured by a cardiovascular radiologist and a trained technologist using CMR in patients with post-myocardial infarction (MI). Methods: Twenty-one MI patients (18 men and 3 women) were recruited, where nine patients underwent CMR and left ventriculography to follow-up LVEF two times in six months. Both CMR and left ventriculography were examined within two weeks. LVEF from CMR were measured by a cardiovascular radiologist and a trained technologist and the correlation between the left ventriculography and CMR was determined. Results: In 30 CMR studies, interobserver reliability (intraclass correlation coefficient ICC=0.94) and intraobserver reliability (ICC=0.96) was excellent. LVEF measured by left ventriculography was higher compared with that by CMR, and their correlation was moderate (ICC=0.56). Conclusion: The LVEF measurement by a cardiovascular radiologist and a trained technologist using CMR was very reproducible, but the correlation between CMR and left ventriculography was moderate.
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Purpose: Dregea volubilis Benth, commonly known as Jukti in Bengal, is used in the treatment of boils and abscesses from ancient times. The purpose of this study is to elucidate the active compounds and as well as their anti-leishmanial and anti-tumour activities. Methods: Dried and crushed fruits of Dregea volubilis were extracted by petroleum ether (40 - 60°C); the best solvent system had first been verified by analytical Thin Layer Chromatography (TLC). The extract was subjected to TLC and column chromatography (CC) to isolate the pure compounds. Spectra data were obtained by Infra Red pectroscopy, Mass Spectroscopy and Nuclear Magnetic Resonance - Proton Magnetic Resonance (PMR), Carbon Magnetic Resonance (CMR) and Distortionless Enhancement by Polarization Transfer (DEPT) - for structure elucidation of the isolated compound(s). One of the compounds isolated was screened for anti-leishmanial activity against promastigotes of Leishmania donovani and anti-tumour activity on K562 leukemic cell line. Results: A pentacyclic triterpenoid compound was isolated and designated as taraxerone, and then characterized as d-friedoolean-14-en, 3 one together with ß-sitosterol and a long chain lipid fraction.. This compound showed in vitro anti-leishmanial activity against promastigotes of Leishmania donovani(strain AG 83) and anti-tumour activity on K562 leukemic cell line. Conclusion: A pentacyclic triterpenoid compound designated as taraxerone and characterized as Dfriedoolean-14-en, 3 one together was successfully isolated. The structure was determined on the basis of spectral analysis (IR, MASS, NMR (PMR, CMR and DEPT) and the compound demonstrated in vitro anti-leishmanial and anti-tumour activities