Application of 3.0 T non-contrast coronary MR angiography in children with Kawasaki disease / 中华放射学杂志

Objective:To explore the diagnostic accuracy and application value of 3.0 T non-contrast coronary magnetic resonance angiography (CMRA) in evaluating coronary artery in children with Kawasaki disease (KD).Methods:From May 2019 to January 2022, 75 children diagnosed with KD in our hospital were enrolled. All the patients underwent CMRA and transthoracic echocardiography (TTE) in one week, twenty-six of whom underwent coronary CT angiography (CCTA) or invasive coronary angiography (ICA) within two weeks. The diagnostic performance of CMRA and TTE was evaluated with CCTA/ICA as reference standard by per-patient basis, per-vessel basis, per-segment basis. Sensitivity and specificity of CMRA and TTE was compared by paired chi square test.The distribution of coronary artery aneurysm (CAA), thrombosis and other pathological changes of coronary artery were recorded and compared between two methods. The patients′ height and weight were collected to calculate the Z value. Z value>2.5 was defined as CAA.Results:All patients successfully completed CMRA examinations. Among the 26 patients, the sensitivity of CMRA was significantly higher than that of TTE by per coronary artery[97.7%(43/44)vs.84.1%(37/44), χ2=4.17, P<0.05]. CMRA showed a higher sensitivity than that of TTE both by proximal segments and middle/distal segments [97.7%(43/44)vs. 84.1%(37/44), 100%(21/21) vs. 52.4%(11/21), χ2=10.08, 7.11, both P<0.05). A total of 115 CAAs was found by CMRA, while only 87 (75.7%) CAAs were observed by TTE. Of the 28 (24.3%) CAAs missed by TTE, 16 (57.1%) were located in right coronary artery (RCA), 2(7.1%) in left main coronary artery, 7(25.0%) in left anterior ascending coronary artery (LAD) and 3(10.7%) in left circumflex coronary artery (LCX). Eleven (39.3%) missed CAAs by TTE were located in the proximal segment of RCA, LMCA, LAD and LCX, and 17 (60.7%) missed CAAs were located in the middle and distal segments. TTE missed coronary thrombosis in 5 patients compared with CMRA. Conclusions:3.0 T non-contrast CMRA is non-invasive and non-radiation, and the image quality can meet the needs of diagnosis, especially for detection of CAAs in RCA or in middle and distal segments of coronary artery in KD patients.

Utilidad del protocolo focused assessment with transthoracic echocardiography (FATE) en la evaluación del paciente con shock / The usefulness of the (FATE) protocol focused assessment with transthoracic echocardiography in patients with shock

Determinar la utilidad del protocolo FATE (Focused Assessment with Transthoracic Echocardiography) en la evaluación de los pacientes en shock. ingresados al Servicio de Cuidados Intermedios del Hospital Central Universitario Dr. "Antonio María Pineda", Barquisimeto, Venezuela en el período agosto-octubre 2019, Métodos: se realizó un estudio descriptivo transversal, de 30 pacientes, con promedio de edad de 56,86 ± 15,85 años, Resultados: predominó el grupo de 71-80 años (23,33%), de sexo masculino (63,33%). Según la clasificación del shock por Weil y Shubin el 50% presentó shock distributivo (todos por sepsis), 20% cardiogénico, 16,67% hipovolémico y obstructivo. 13,33% Los principales hallazgos ecocardiográficos fueron presencia de derrame pleural bilateral (33,33%), derrame pleural unilateral (30%) y derrame pericárdico (23,33%). Además, 26,67% presentaron espesor miocárdico patológico, 33,33% dimensiones de VD-VI aumentadas, 46,67% función sistólica ventricular alterada; sumado al hecho que 70% de la contractibilidad y 60% de la visualización pulmonar eran patológicas. El valor cualitativo del protocolo FATE resultó en: 43,33% soportaba la información disponible, 26,67% añadió información decisiva a la terapéutica, 23,33% agregó nueva información y 6,67% información fue pobre por mala ventana. La mortalidad a los 7 días fue de 43,33%, siendo más frecuente en pacientes con shock distributivo (61,54%), seguido de cardiogénico (23,08%) y obstructivo (15,38%), no hubo defunciones por shock hipovolémico. Los valores cualitativos del protocolo FATE en pacientes fallecidos; por shock distributivo 37,5%, soportó la información disponible y agregó nueva información, respectivamente. En cambio en 100% de los fallecidos por shock cardiogénico y obstructivo, el protocolo FATE añadió información decisiva a la terapéutica. Los resultados demuestran la importancia del Protocolo FATE en el manejo de pacientes con shock(AU)

To determine the usefulness of the FATE protocol (Focused Assessment with Transthoracic Echocardiography) in the evaluation of patients in shock admitted to the Intermediate Care Unit of the "University Hospital Antonio Maria Pineda" in Barquisimeto, Venezuela, during the period August-October 2019, Methods: A descriptive cross-sectional study was done, selecting 30 patients, with an average age of 56.86 ± 15.85 years; the most affected group was 71-80 years old (23.33%), with a predominance of the male sex (63.33%) Results: According to the classification of shock by Weil and Shubin, 50% were found to have distributive shock (all due to sepsis), 20% cardiogenic, 16.67% hypovolemic and obstructive 13.33%. The main echocardiographic findings were the presence of bilateral pleural effusion (33.33%), unilateral pleural effusion (30%) and pericardial effusion (23.33%). In addition, 26.67% presented pathological myocardial thickness, 33.33% increased RV-LV dimensions, 46.67% impaired ventricular systolic function; also, 70% of contractibility and 60% of pulmonary visualization were pathological. The qualitative value of the FATE protocol resulted in: 43.33% supported the available information, 26.67% added decisive information to the therapy, 23.33% added new information and 6.67% information was poor due to a bad US window. (Mortality at 7 days was 43.33%, being more frequent in patients with distributive shock (61.54%), followed by cardiogenic (23.08%) and obstructive (15.38%); there were no deaths due to hypovolemic shock. The qualitative values of the FATE protocol in patients with distributive shock who died, was that 37.5% In contrast, in 100% of those who died by cardiogenic and obstructive shock, the FATE protocol added decisive information to the therapy. Conclusion:The results demonstrate the importance of the FATE Protocol in the management of patients with shock(AU)

Study of Angiography Findings in Diabetic and Non Diabetic Patients with Cardiac Symptoms

Introduction: Diabetes mellitus is a complex metabolicdisorder associated with an increased risk of microvascularand macrovascular disease. Type 2 diabetes mellitus is aprevalent metabolic disorder that often leads to cardiovasculardiseases and diabetic cardiomyopathy, which may lead tochronic pressure overload and myocardial infarction. Thepresent study aimed at studying the extent and complexity ofcardiovascular lesions among diabetic patients and comparesame with non-diabetic patients.Materials and methods: The present study was a CaseControl (Analytical and Interventional) Study conductedover 18 months (October 2016 to March 2018). Case groupconsisted of 250 Diabetic patients with cardiac symptoms,with or without ECG changes, who have undergone coronaryangiography. And Controls group consisted of 250 NonDiabetic patients with cardiac symptoms, with or withoutECG changes, have undergone coronary angiography.Results: In the present study, among diabetics, there were52.8% male patients and 47.2% female patients, similarlyamong non diabetic group, 57.2% were males and 42.8%cases were females. 12.4% people were found normal, 37.6%were suffering from Single vessel disease, 28.8% people withDouble vessel disease and 21.2% people with Triple vesseldisease.Conclusions: According to the present study, among coronaryangiography diagnosis, severe forms of coronary artery lesionswere found common among diabetic patients as compared tonon diabetic patients.

La posición de Trendelenburg no cambia el gasto cardíaco en voluntarios sanos / Trendelenburg position does not change Cardiac output in healthy volunteers

BACKGROUND: The Trendelenburg position (TP) has been empirically used to increase preload and thus cardiac output (CO). Transthoracic echocardiogram (TTE) is a noninvasive technique that estimates CO. We aimed to describe if the TP can improve CO. MATERIALS AND METHODS: We conducted a descriptive study in healthy subjects (ASA I), with TTE measurements of CO and the End-Diastolic Volume of the Left Ventricle (EDVLV) in supine and after 5 minutes in TP. RESULTS: There showed no significant changes in blood pressure, heart rate and pulse oximetry in 0° and after 5 minutes in 45°. The mean CO without inclination was 4.2 l/min ± 0.6, tat is the same results after 5 minutes in PT (p > 0.6). The EDVLV was 95 ± 12 ml at 0° and 101 ± 15 ml after 5 minutes in PT (p > 0.8). CONCLUSION: Trendelenburg position doesn't improve CO or preload in healthy subjects.

INTRODUCCIÓN: Empíricamente se ha utilizado la posición de Trendelenburg (PT) para aumentar la precarga y posteriormente el gasto cardiaco (GC). La ecografía transtorácica (ETT) es una técnica no invasiva que puede estimar el GC. Realizamos un estudio descriptivo para evaluar si la PT afecta el CG. MATERIALES Y MÉTODOS: Examinamos pacientes ASA I, se hicieron mediciones del GC y del volumen de fin de diástole (VDFVI) en posición supina y luego de cinco minutos en PT. RESULTADOS: No se observaron cambios significativos en la presión arterial, frecuencia cardíaca y saturometría en los voluntarios a 0º y a 45º. El GC sin inclinación fue en promedio 4,2 l/min ± 0,6, el mismo resultado tras cinco minutos en PT, sin ser estadísticamente significativo (p > 0,6). El VDFVI a 0º fue en promedio 95 ± 12 ml y tras cinco minutos en PT 101 ± 15 ml, que tampoco alcanzó diferencia estadísticamente significativa (p > 0,8). CONCLUSIÓN: La posición de Trendelenburg no varía el gasto cardiaco ni la precarga en voluntarios sanos.

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.

A deadly tear to fear: An interesting case presentation

Objectives@#1) To present a case of a patient with aortic dissection. 2) To show how the case arrived to its plausible diagnosis. 3) To discuss other illnesses discovered in the case.@*Case Summary@#This is a case of a 54-year old, female, Filipino, Catholic, who presented with severe chest pain, substernal in location, with pain intensity of 8/10 associated with diaphoresis and dyspnea leading to fainting spells. Initial impression was cardiogenic shock secondary to Non-ST elevated myocardial infarction. On physical examination, the patient was drowsy and in cardio-respiratory distress. She had symmetrical chest expansion and no retractions were noted. Clear breath sounds were noted in all lung fields. She had an adynamic precordium with normal rate and regular rhythm, however with distant heart sounds. There was no murmur, heave or thrill appreciated. Vital signs at the emergency room showed a blood pressure of 110/80 which eventually became 80/50 mmH, respiratory rate of 22 cycles per minute, heart rate of 80-100 beats per minute and was febrile. Patient was scheduled for a stat coronary angiography, however on further reassessment, repeat ECG showed resolution of the inferolateral wall ischemia but this could not explain her fluctuating blood pressure. When the patient underwent the scheduled bedside 2D echo, a moderate cardiac tamponade was discovered with a 4.5 cm aortic dissection. With these findings, patient underwent aortic repair, graft insertion with evacuation of hematoma. She was discharged stable and with no recurrence of chest pain.

Takotsubo cardiomyopathy in a patient with oral cancer

A patient with squamous cell carcinoma on the left mandible presented with symptoms similar to acute coronary syndrome just after surgery. The exact etiology was unclear, but following transthoracic echocardiogram, takotsubo cardiomyopathy was diagnosed. This is a rare, acute, and reversible form of heart failure, and the patient recovered completely within weeks. Related risk factors are believed to include extended surgery times and extended time under general anesthesia. Early recognition, followed by postoperative control of pain and anxiety are crucial to patient recovery.

Takotsubo cardiomyopathy in a patient with oral cancer

A patient with squamous cell carcinoma on the left mandible presented with symptoms similar to acute coronary syndrome just after surgery. The exact etiology was unclear, but following transthoracic echocardiogram, takotsubo cardiomyopathy was diagnosed. This is a rare, acute, and reversible form of heart failure, and the patient recovered completely within weeks. Related risk factors are believed to include extended surgery times and extended time under general anesthesia. Early recognition, followed by postoperative control of pain and anxiety are crucial to patient recovery.

Comparative study on between echocardiographic and transcatheter assessment of ductal diameter and pulmonary artery pressure in patients with PDA / 重庆医学

Objective To evaluate the relevance between transthoracic echocardiography(TTE)and cardiac catheterization in measuring diameter of patent ductus arteriosus(PDA)and assessing pulmonary artery pressure.Methods The diameter of PDA and the pulmonary artery pressure in 105 patients were observed by TTE and cardiac catheterization,respectively.Results The di-ameter of the narrowest segment of the ductus and pulmonary artery pressure measurements by TTE and cardiac catheterization showed excellent correlation(r=0.782,P<0.01;r=0.810,P<0.01,respectively).Conclusion TTE and cardiac catheterization for measuring diameter of PDA and pulmonary artery pressure show excellent correlation.TTE plays an important role in evaluating pulmonary artery pressure and selecting patients efficiency of PDA occlusion.