Research progress on image-based calculation of coronary artery fractional flow reserve / 生物医学工程学杂志

Coronary artery fractional flow reserve (FFR) is a critical physiological indicator for assessment of impaired blood flow caused by coronary artery stenosis. The wire-based invasive measurement of blood flow pressure gradient across stenosis is the gold standard for clinical measurement of FFR. However, it has the risk of vascular injury and requires the use of vasodilators, increasing the time and overall cost of interventional examination. Coronary imaging is playing an important role in clinical diagnosis of stenotic lesions, evaluation of severity of lesions, and planning of therapies. In recent years, the computation of FFR based on the physiological information of blood flow obtained from routinely collected coronary image data has become a research focus in this field. This technique reduces the cost of physiological assessment of coronary lesions and the use of pressure wires. It is beneficial to strengthen the physiological guidance in interventional therapy. In order to better understand this emerging technique, this paper highlights its implementation principle and diagnostic performance, analyzes practical problems and current challenges in clinical applications, and discusses possible future development.

Diameter of the orifice of the left coronary artery: angiographic study / Diámetro del ostio de la arteria coronaria izquierda: estudio angiográfico

SUMMARY: The ongoing advances in the technology of coronary artery angiograms have put high demands on the basic knowledge of coronary arteries. This study describes the angiographic morphology of the ostium (orifice) of the left coronary artery among Sudanese with respect to sex, age, length, and BMI. The study design is a cross-sectional retrospective hospital-based conducted from 2014 to 2016. The inclusion criterion of participants is adult males and females presented to the cardiac centers for elective angiograms. The exclusion criteria are age below 18 years, documented congenital heart disease, and previous coronary bypass. Angiograms were done using a digital radiographic system. Data was collected through a predesigned data collection sheet. The data were entered and analyzed using SPSS v27. A test of correlation was done between the different variables. The data were presented in the form of tables. A P-value of <0.05 was considered statistically significant. The total number of participants was 441; males and females represent 42.9 % and 57,1 %, respectively. The mean age of participants was 56.24±8.68 years. The left coronary artery originated from the left aortic sinus. The mean diameter and length of the left coronary artery were 3.8±0.70 mm and 8.1576±4.32 mm, respectively. A significant negative correlation was reported between the diameter of the orifice and both age and length of the left coronary artery. A non-significant difference between males and females in the diameter of the left coronary artery at ostium (P=0.058) and a significant difference in the length (P=0.00). Sudanese have the smallest diameter of the orifice of the left coronary artery among Africans. Sudanese males have a smaller diameter of orifice than females; females have the longest arteries. A wider orifice of the left coronary artery is associated with a short arterial length.

RESUMEN: Los avances en la tecnología de los angiogramas de las arterias coronarias constituyen importantes exigencias al conocimiento básico de las arterias coronarias. Este estudio describe la morfología angiográfica del ostio de la arteria coronaria izquierda (ACI) entre los sudaneses respecto al sexo, la edad, la longitud y el IMC. El estudio es un diseño hospitalario retrospectivo transversal realizado entre 2014 y 2016. El criterio de inclusión de los participantes, hombres y mujeres adultos, fue aquellos que se realizaron angiografías electivas en los centros cardiológicos Los criterios de exclusión fueron: edad menor de 18 años, cardiopatía congénita documentada y bypass coronario previo. Los angiogramas se realizaron utilizando un sistema radiográfico digital. Los datos se obtuvieron a través de una ficha de datos prediseñada. Estos fueron ingresados y analizados con SPSS v27. Se realizó una prueba de correlación entre las diferentes variables. Los datos se presentaron en forma de tablas. Un valor P de <0,05 se consideró estadísticamente significativo. El número total de participantes fue de 441; Hombres y mujeres representanron el 42,9 % y 57,1 %, respectivamente. La edad media de los participantes fue de 56,24±8,68 años. La arteria coronaria izquierda se originaba en el seno aórtico izquierdo. El diámetro medio y la longitud de la arteria coronaria izquierda fueron 3,8±0,70 mm y 8,1576±4,32 mm, respectivamente. Se encontró una correlación negativa significativa entre el diámetro del ostio, la edad y la ACI. Además se encontró una diferencia no significativa entre hombres y mujeres en el diámetro del ostio de la ACI (P=0,058) y una diferencia significativa en la longitud (P=0,00). Los sudaneses tienen el diámetro del ostio de la arteria coronaria izquierda más pequeño entre los africanos. Los hombres sudaneses tienen un diámetro del ostio de la arteria coronaria izquierda más pequeña y las mujeres tienen las arterias más largas. Un ostio más ancho de la arteria coronaria izquierda se asocia con una longitud arterial corta.

Evaluación no invasiva de la significancia funcional de las lesiones coronarias mediante quantitative flow ratio (QFR): validación con reserva de flujo fraccional (FFR) / Functional significance of coronary artery lesions evaluated by quantitative flow ratio (QFR): a comparison fractional flow reserve (FFR)

RESUMEN: Introducción: La evaluación de lesiones coronarias mediante Reserva de Flujo Fraccional (FFR), es de elección para determinar su significancia funcional en el laboratorio de hemodinamia. La razón de flujo cuantitativo (Quantitative Flow Ratio, QFR) es una nueva técnica no invasiva para la evaluación de la significancia funcional de una estenosis coronaria, basada en el análisis de flujo a partir de la coronariografía diagnóstica, sin necesidad de hiperemia ni de la introducción de insumos adicionales. Objetivo: evaluar la correlación y valor predictivo del QFR comparado con FFR. Métodos: se seleccionaron arterias que contaban con medición de FFR realizados en nuestro centro y se analizó retrospectivamente el QFR a partir de las coronariografías de dichos estudios. Se excluyó lesiones de tronco y lesiones ostiales. La medición de FFR fue realizada con guía de presión ubicada distal al segmento afectado, mediante hiperemia con adenosina intracoronaria o intravenosa en infusión. Para el análisis de QFR se utilizan 2 proyecciones angiográficas ortogonales del vaso a interrogar con una separación de más de 25º entre ellas; ambas proyecciones deben coincidir en el eje para un correcto análisis. El análisis fue realizado por dos operadores, ciegos al resultado del FFR, utilizando el software QAngioXA (Medis ®, Netherland). Resultados: se analizaron 35 arterias, 57,1% Descendente Anterior (ADA), 20% Circunfleja (ACF) y 20% Derecha (ACD). El FFR promedio fue de 0,83±0,092 y 34,2% tuvieron como resultado un FFR ±0,80. El análisis retrospectivo del QFR se pudo realizar en 27 arterias; en las 8 restantes (22,9%) no fue posible su realización, ya sea por imágenes insuficientes o falta de perpendicularidad del segmento. El QFR promedio fue de 0,81±0,118. Hubo una buena correlación entre QFR y FFR (r =0,758; p0,8 pero QFR±0,8 en 3,7%; y FFR ±0,8 y QFR >0,8 en 3,7%. Así, el QFR tuvo una Sensibilidad: 90,9%, Especificidad: 93,8%; Valor Predictivo Positivo: 90,9%; Valor Predictivo Negativo: 93,8%; Likelihood Ratio Positivo: 14,55 y Likelihood Ratio Negativo: 0,1. La curva ROC mostró un área bajo curva: 0,923; 95% IC: 0,801-1,00. Conclusión: Los resultados del QFR en nuestra serie son similares a las mediciones de FFR. El uso de QFR podría ser una alternativa, rápida, económica y segura, en la evaluación fisiológica de lesiones coronarias. Se requieren mayores estudios clínicos para comprobar estos resultados.

ABSTRACT: Background: FFR is a gold standard used evaluate the severity of coronary artery lesions. QFR is a new non invasive technique for the same purpose based on the analysis of flow directly derived from routine coronary angiography, without additional intervention and with no induction of hyperemia. The aim was to compare the results obtained by QFR to those obtained by FFR in in terms of its predictive value. Method: Retrospective analysis of FFR measurements in routine coronary angiographic studies were compared to results obtained by means of QFR. Main left lesions were excluded. FFR was evaluated using pressure guides across the lesion under hyperemia induced by intracoronary or intravenous adenosine. Two orthogonal projections with no more than 25o difference between them were analyzed. The analysis was performed by two independent and operators blind to the results of FFR. The QAngioXA (Medis ®, Netherland) software was used in the analysis. Results: 35 coronary arteries were analyzed: LAD 57.1%, RCA 20.9%; Cx 20%. QFR was available for 27 arteries, the rest being discarded due to inadequate orientation of the artery. Mean QFR was 0.81 (SD 0.118). Mean difference between QFR and DD FFR was 0,04 (SD 0,006) (NS). Interobserver correlation was good (r=0.95, P 0.07). In only 7.4% of arteries there was a notable though not statistically significant difference between FFR and QFR, either due to under estimation or overestimation of lesion severity by QFR compared to FFR. Using FFR as a gold standard method QFR revealed sensitivity 90.9%, specificity 93.8%, The respective numbers for either positive or negative predictive values were the same. Area under the ROC curve was 0.923 (95% C.I. 0.01-1.00). Conclusion: this study reveals similar results of QFR compared to FFE in the estimation of coronary lesion severity. Given that QFR is a significantly less invasive and less expensive method than FFR, it may lead to an increased use of flow analysis in the determination of coronary artery lesion severity.

Surgical Treatment for a Super-Giant Right Coronary Artery Aneurysm Induced by Kawasaki Disease

Abstract A 32-year-old man diagnosed with Kawasaki disease at the age of three years presented with coronary artery aneurysm (CAA). The aneurysm increased in size, and the patient was referred to our hospital for surgery. Preoperative computed tomography scan showed a super-giant right CAA and giant left CAAs; surgery was performed. The super-giant right CAA was resected, and the ostium of the right coronary artery was closed; then, coronary artery bypass grafting was performed. The left CAAs were not treated surgically because the risk of rupture was low. Here, we describe the successful surgical treatment of a right super-giant CAA.

Infarto De Miocardio Sin Lesiones Coronarias. Subanálisis Del Registro CONAREC XVII / Myocardial infarction without coronary arteries lesions. Insights from the CONAREC XVII Registry

Los síndromes coronarios agudos sin lesiones coronarias han cobrado relevancia en los últimos años, pero aún no se dispone de datos locales. Analizamos un registro de pacientes con infarto agudo de miocardio, en 45 centros del país con residencias de cardiología. Se analizaron 1182 participantes de los cuales 33 (2.8%) no presentaron lesiones coronarias en angiografía, mientras que 89.5% tenían lesiones graves y 7.7% lesiones intermedias. La edad promedio de los pacientes sin lesiones coronarias fue 64.5 ± 13.0 años, 69.7% eran varones, sin diferencias respecto a aquellos con enfermedad epicárdica. La presentación electrocardiográfica más frecuente fue la desviación del segmento ST (13 supradesnivel y 10 infradesnivel del segmento). Además, este subgrupo presentó biomarcadores más bajos (CPK pico 203.5 UI/l, rango [RIC] 102- 422.5 vs. 895.5 UI/l RIC 350-1891, p < 0.0001). La mediana de días de internación fue 4.0 (RIC 3-5.5), siendo menor que la del grupo con enfermedad coronaria intermedia y grave (5.5 días, RIC 4-7, y 6 RIC 4-7, p = 0.003). Al alta, aquellos sin lesiones coronarias recibieron menor prescripción de IECA/ARA II (54.6% vs. 78.0% y 79.7%, p = 0.002) y estatinas (78.8% vs. 87.9% y 91.9%, p = 0.017). Ninguno de este subgrupo falleció durante la inter nación. Nuestros datos sugieren que los infartos sin lesiones coronarias significativas son frecuentes en nuestro medio, aunque probablemente se encuentren subdiagnosticados. Si bien su pronóstico parece más favorable, resulta importante señalar que recibieron menos fármacos para prevenir su recurrencia. Nuevos estudios son necesarios para profundizar el conocimiento de esta enfermedad.

Abstract Acute coronary syndromes without coronary lesions have gained relevance in recent years. However, local data on this condition is scarce. We aimed to explore this entity in a National registry of acute myocardial infarction that was carried out prospectively in hospitals with cardiology residence programs from Ar gentina. We included 1182 patients from 45 centers, where 33 did not present coronary lesions on angiography. The mean age was 64.5 ±13.0 and 69.7% were male, without differences compared to participants with epicardial disease. The most common electrocardiographic presentation was ST segment deviation. In addition, presented lower biomarkers (peak CPK 203.5 IU / l, range [IQR] 102-422.5 vs. 895.5 IU / l IQR 350-1891, p < 0.0001). The median hospitalization was 4.0 days (IQR 3-5.5), lower than the group with intermediate and severe coronary disease (5.5 days, RIC 4-7, and 6, RIC 4-7, p = 0.003). At discharge, less use of ACE/ARB (54.6% vs.78.0% y 79.7%, p = 0.002) and statins (78.8% vs. 87.9% y 91.9%, p = 0.017). No deaths during hospitalization were reported. Our data suggested that infarcts without significant coronary lesions are frequent, although they are probably underdiagnosed. Their prognosis seems to be more favorable, but they receive fewer drugs to prevent recurrence. New studies are necessary to deepen the knowledge of the disease.

Coexistent mitral stenosis and left circumflex coronary artery to left atrial fistula in a patient with severe pulmonary hypertension

Abstract Coronary artery to left atrial fistula is rare in patients with mitral stenosis. We report an interesting case of a patient with concomitant mitral valve stenosis and coronary fistulae, originating from the left circumflex artery and drained into the left atrium with two terminal orifices.

A Associação da Relação Proteína C-Reativa/Albumina em Pacientes com Ectasia da Artéria Coronária Isolada / Association of C-Reactive Protein to Albumin Ratio in Patients with Isolated Coronary Artery Ectasia

Resumo Fundamento A ectasia da artéria coronária (EAC) é definida como a dilatação difusa ou localizada do lúmen da artéria coronária com diâmetro de 1,5 a 2,0 vezes o diâmetro da artéria coronária normal adjacente. A relação proteína C-reativa/albumina (CAR, sigla em inglês) é um marcador inflamatório útil que tem sido documentado em doença arterial coronariana. Objetivo Analisar a associação entre a EAC e a CAR. Métodos Um protocolo caso-controle foi utilizado neste estudo. Foram incluídos 102 pacientesconsecutivos com EAC isolada sem estenose (56 homens e 46 mulheres; idade média de 60,4 ± 8,8 anos). O grupo controle era constituido pelo mesmo número de pacientes pareados por sexo e idade com artérias coronárias normais (55 homens e 47 mulheres; idade média de 61,2 ± 9,1 anos). Características clínicas, achados laboratoriais e histórico de uso de medicamentos foram registrados. Foram realizados teste t de Student, teste U de Mann-Whitney, teste do qui-quadrado, análise de regressão linear e logística. Foi considerado estatisticamente significativo p bilateral < 0,05. Resultados A CAR estava aumentada nos pacientes com EAC em comparação com os controles (32 e 16; p < 0,001). Além disso, foi verificado que a CAR era um preditor independente da EAC (razão de chances = 2,202; intervalo de confiança 95%, 1,184 - 5,365; p < 0,001). Conclusão No presente estudo, determinamos que os níveis da CAR estavam significativamente mais altos no grupo EAC que no grupo controle e a CAR estava significativamente correlacionada com a EAC. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Coronary artery ectasia (CAE) is defined as diffuse or localized dilatation of coronary artery lumen with a diameter of 1.5 to 2.0 times the adjacent normal coronary artery. The C-reactive protein to albumin ratio (CAR) is a useful inflammatory marker, which has been documented in coronary artery disease. Objective To analyze the association of CAE and CAR. Methods A case-control protocol was used in this study. We included 102 consecutive patients with isolated CAE without stenosis (56 men and 46 women; mean age 60.4 ± 8.8 years). The control subjects consisted of an equal number of sex and age matched patients with normal coronary arteries (55 men and 47 women; mean age 61.2 ± 9.1 years). Clinical features, laboratory findings, and medication use history were recorded. Student's t test, Mann-Whitney U test, chi-square test, and linear and logistic regression analysis were performed. A 2-sided p < 0.05 was statistically considered significant. Results The CAR was increased in patients with CAE compared to the controls (32 and 16; p < 0.001). In addition, the CAR was found to be an independent predictor of CAE (OR = 2.202; 95% CI 1.184 - 5.365; p < 0.001). Conclusion In the present study, we determined that CAR levels were significantly higher in the CAE group than in the control group, and the CAR was significantly correlated with CAE. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Síndrome de ALCAPA em uma Mulher Jovem / ALCAPA Syndrome in a Young Woman

Mulher de 18 anos com histórico de síncope, angina e palpitações há um ano. Uma indicação crucial era artéria coronária direita dilatada na ecocardiografia transtorácica. Os achados da tomografia computadorizada resultaram no diagnóstico da origem anômala da artéria coronariana esquerda proveniente da síndrome da artéria pulmonar.(AU)

Role of Dual-layer Detector Energy Spectral CT in Resting Myocardial Perfusion Imaging for Patients with Normal Coronary Artery / 中国医学科学院学报

Objective To investigate the role of dual-layer detector energy spectral CT in resting myocardial perfusion imaging for patients with normal coronary artery. Methods One hundred and fifty-six patients with suspected coronary heart disease underwent dual-layer detector energy spectral CT coronary angiography,and resting myocardial perfusion imaging was performed for 28 patients with normal coronary artery.According to American Heart Association's 17-segmentmodel,the iodine density and effective atomic number(Z

Coronary artery calcification and dietary intake in asymptomatic men

Dietary factors may influence the process of atherosclerosis and coronary artery calcification (CAC). This study assessed CAC and its association with dietary intake in asymptomatic men. We evaluated 150 asymptomatic men with mean age of 58.2±5.3 years. The dietary intake was assessed by the Food Consumption Register method. CAC was measured through multidetector computed tomography (MDCT) and assessed in accordance with the Agatston score. Modified Poisson regression model was used to estimate the effects of intake of different nutrients that are prevalent in moderate/severe CAC, adjusted for calorie intake and CAC risk factors by means of prevalence ratios and 95% confidence intervals [95%CI]. An association was found between the intake of some nutrients and moderate/severe CAC. Lower carbohydrate intake (P=0.021) and higher lipid intake (P=0.006) were associated with moderate/severe CAC. After adjustment, the nutrients associated with the prevalence of moderate/severe CAC were carbohydrates (P=0.040), lipids (P=0.005), and saturated fatty acids (SFA) (P=0.013). A 1% increase in lipids and SFA intake caused an increase of 4% [95%CI: 1-7%] and 8% [95%CI: 2-14%] in the prevalence of moderate/severe CAC, respectively. A 1% increase of carbohydrate intake led to a 2% decrease in the likelihood of moderate/severe CAC [95%CI: 1-4%]. These conclusions showed that the higher intake of total lipids and SFA was associated with higher CAC scores, whereas higher carbohydrate intake was associated with lower CAC scores in asymptomatic men.

Comparison of one-catheter strategy versus conventional two-catheter strategy on the volume of radiological contrast and diagnostic coronary catheterization performance by transradial access: A systematic review and meta-analysis of randomized clinical trials / Comparación de la estrategia de catéter único versus la estrategia convencional de dos catéteres sobre el volumen de contraste radiológico y el rendimiento del cateterismo coronario diagnóstico por acceso transradial: una revisión sistemática y meta-análisis de ensayos clínicos aleatorizados

Abstract Background: One-catheter strategy, based in multipurpose catheters, allows exploring both coronary arteries with a single catheter. This strategy could simplify coronary catheterization and reduce the volume of contrast administration, by reducing radial spasm. To date, observational studies showed greater benefits regarding contrast consumption and catheterization performance than controlled trials. The aim of this work is to perform the first systematic review and meta-analysis of randomized clinical trials (RCT) to adequately quantify the benefits of one-catheter strategy, with multipurpose catheters, over conventional two-catheter strategy on contrast consumption, and catheterization performance. Methods: A search in PubMed, CINALH, and CENTRAL databases was conducted to identify randomized trials comparing one-catheter and two-catheter strategies. The primary outcome was volume of iodinated contrast administrated. Secondary endpoints, evaluating coronary catheterization performance included: arterial spasm, fluoroscopy time, and procedural time. Results: Five RCT were included for the final analysis, with a total of 1599 patients (802 patients with one-catheter strategy and 797 patients with two-catheter strategy). One-catheter strategy required less administration of radiological contrast (difference in means [DiM] [95% confidence interval (CI)]; −3.831 mL [−6.165 mL to −1.496 mL], p = 0.001) as compared to two-catheter strategy. Furthermore, less radial spasm (odds ratio [95% CI], 0.484 [0.363 to 0.644], p < 0.001) and less procedural time (DiM [95% CI], −72.471 s [−99.694 s to −45.249 s], p < 0.001) were observed in one-catheter strategy. No differences on fluoroscopy time were observed. Conclusions: One-catheter strategy induces a minimal reduction on radiological contrast administration but improves coronary catheterization performance by reducing arterial spasm and procedural time as compared to conventional two-catheter strategy.

Resumen Antecedentes: La estrategia de catéter único permite explorar ambas coronarias con un solo catéter. Nuestro objetivo es realizar la primera revisión sistemática y meta-análisis de ensayos clínicos aleatorizados para cuantificar adecuadamente los beneficios de la estrategia de catéter único, con catéteres multipropósito, sobre la estrategia convencional de dos catéteres. Métodos: Se realizó una búsqueda en PubMed, CINALH y CENTRAL, identificando ensayos aleatorizados que compararan estrategias de un catéter y dos catéteres. El resultado primario fue volumen de contraste administrado. Los secundarios, que evaluaron el rendimiento del cateterismo, incluyeron: espasmo radial, tiempo de fluoroscopia y de procedimiento. Resultados: Se incluyeron cinco ensayos, totalizando 1,599 pacientes (802 con estrategia de un catéter y 797 con estrategia de dos catéteres). La estrategia de catéter único requirió menos contraste (diferencia-de-medias; −3.831 mL [−6.165 mL a −1.496 mL], p = 0.001), presentando menos espasmo radial (odds ratio, 0.484 [0.363 a 0.644], p < 0.001) y menos tiempo de procedimiento (diferencia-de-medias; −72.471 s [−99.694 s a −45.249 s], p < 0.001). No hubo diferencias en el tiempo de fluoroscopia. Conclusiones: La estrategia de catéter único induce una reducción mínima en la administración de contraste, pero mejora el rendimiento del cateterismo al reducir el espasmo radial y el tiempo de procedimiento en comparación con la estrategia convencional.

Biometric analysis of healthy coronary arteries in a Chilean population: an angiographic study / Análisis biométrico de arterias coronarias sanas en población chilena: un estudio angiográfico

SUMMARY: Thorough knowledge and understanding of coronary arteries and their anatomy is essential when performing cardiac surgery such as a coronary bypass. Coronary angiography is a minimally invasive method used to evaluate the anatomy and obtain different measurements of the coronary arteries. This study was designed to evaluate the endoluminal diameter, trunk length and anatomical distribution of coronary arteries in Chilean subjects without apparent angiographic lesions. Measurements were carried out by 3 trained examiners using Leonardo® software program in 238 Chilean subjects of both sexes with an age-range of 45 to 78 years. Ostium and the distal luminal segments diameters were measured, as well as trunk length of both right and left coronary arteries. Ostium of the anterior interventricular artery, dominance and tortuosity were also registered. In the right coronary artery, the diameters (3.8 ± 1.2 mm and 3.6 ± 1.0 mm) differed according to sex and dominance, and the length (35.2 ± 12.5 mm) differed according to age. In the left coronary artery, the diameters (4.9 ± 1.1 mm and 4.7 ± 1.0 mm) were greater in males than in females. The left coronary artery showed greater diameters and length than the right coronary artery. The prevalence of right arterial dominance was 88.0 %. Patients with right arterial dominance presented greater distal caliber in the right coronary artery than those with left arterial dominance (p<0.05), especially in older patients. Significant arterial tortuosity was observed in seven subjects.

RESUMEN: Un factor clave durante los procedimientos quirúrgicos cardiacos tal como el bypass coronario, es el conocimiento exhaustivo de las arterias coronarias y su anatomía. La angiografía coronaria es un método mínimamente invasivo que se utiliza para evaluar la anatomía y obtener diferentes medidas. El presente estudio fue diseñado para evaluar el diámetro endoluminal, la longitud del tronco y la distribución anatómica de las arterias coronarias en sujetos chilenos sin lesiones angiográficas significativas. Las mediciones fueron realizadas en 238 sujetos chilenos de ambos sexos con un rango etario entre 45 a 78 años. Tres examinadores preparados llevaron a cabo las mediciones utilizando el software Leonardo®. Se midieron los ostios y los diámetros luminales distales de los troncos coronarios derecho e izquierdo, como también las longitudes del tronco de las arterias coronarias derecha e izquierda. Además, se identificaron los ostios de la arteria interventricular anterior, dominancia y tortuosidad. En la arteria coronaria derecha, los diámetros (3,8 ± 1,2 mm y 3,6 ± 1,0 mm) se observaron variaciones según el sexo y la dominancia, y la longitud (35,2 ± 12,5 mm) difirió según la edad. En la arteria coronaria izquierda, los diámetros (4,9 ± 1,1 mm y 4,7 ± 1,0 mm) fueron mayores en los hombres que en las mujeres. La arteria coronaria izquierda mostró mayor diámetro y longitud que la arteria coronaria derecha. La prevalencia de dominancia arterial derecha fue del 88,0 %. Los pacientes con dominancia arterial derecha presentaron mayor calibre distal en la arteria coronaria derecha que aquellos con dominancia arterial izquierda (p <0,05), especialmente en pacientes mayores. En siete sujetos se observó una tortuosidad arterial significativa.

Valor de la resonancia magnética cardíaca para el diagnóstico diferencial en pacientes con sospecha de infarto agudo de miocardio con elevación del segmento ST y arterias coronarias normales

Background: Patients hospitalized with suspected ST-segment elevation myocardial infarction (STEMI) who have normal coronary arteries (CAs) on invasive coronary angiography (ICA) may have an AMI or another acute cardiac disease that mimics it. Aim: To evaluate the usefulness of cardiac magnetic resonance imaging (CMRI) for diagnosing conditions resembling AMI with normal CAs. Material and Methods: We studied 424 consecutive patients admitted with suspected STEMI who underwent ICA. Those with normal CAs underwent CMRI involving cine-CMRI sequences to evaluate segmental wall motion, T2-weighted short-tau inversion-recovery imaging to detect oedema and delayed contrast enhancement (DCE) after gadolinium administration to identify necrosis/fibrosis. Patients with previous myocardial infarction were excluded. Results: Twenty-six patients (6.1%) had normal CAs. Definitive diagnosis after CMRI was acute myocarditis in 11 patients (42.3%) whose DCE was localized in the subepicardium or intramyocardially but not in the endocardium, AMI in nine patients (34.6%) who had subendocardial or transmural DCE, and Takotsubo cardiomyopathy (TCM) in six patients (23.1%), whose CMRI showed regional contractility abnormalities of the left ventricle and myocardial oedema but not DCE. Conclusions: Cardiac magnetic resonance imaging allows a precise diagnosis of acute myocardial infarction in patients with angiographically normal coronary arteries.

Isquemia miocárdica sin lesiones coronarias obstructivas: MINOCA-INOCA: Revisión para la toma de decisiones GREECO (Grupo de Estudio de Enfermedades Coronarias) / Myocardial ischemia without coronary obstructions: MINOCA-INOCA. Review for decision making

Una de cada 4 coronariografías realizadas por isquemia miocárdica presenta lesiones menores al 50% Este dato desencadenó un creciente interés en la comunidad médica. La Sociedad Americana de Cardiología publicó recientemente un artículo que describe la posición consensuada de un grupo de expertos sobre la fisiopatología, el diagnóstico y el tratamiento de esta entidad. Nuestro trabajo refleja una revisión narrativa y la posición de un grupo de expertos pertenecientes a diferentes instituciones con servicios de Cardiología jerarquizados. Aborda aspectos fisiopatológicos y diagnósticos para comprender el enfoque actual del tratamiento, tanto en pacientes que ingresan con diagnóstico de MINOCA (infa rto de miocardio con lesiones angiográficas no graves) o de INOCA (angina e isquemia demostradas, pero sin lesiones coronarias que justifiquen este síndrome).

One in every four coronarographies performed to study myocardial ischemia shows coronary angiographic stenosis less than 50%. This data triggered an increasing interest in the medical community. The American Society of Cardiology recently published a position paper about the pathophysiology, diagnosis and treatment of this entity. Our group performed a narrative review reflecting the opinion of cardiology experts from different centers in Argentina. It aims physiopatologic and diagnostic aspect to understand the current approach in patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) e INOCA (demonstrated angina and ischemia but without coronary lesions that justify this syndrome).