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1.
Arq. bras. cardiol ; 118(2): 422-432, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364337

ABSTRACT

Resumo Fundamento Amiloidose sistêmica é uma doença com manifestações clínicas diversas. O diagnóstico envolve suspeita clínica, aliada a métodos complementares. Objetivo Descrever o perfil clínico, laboratorial, eletrocardiográfico e de imagem no acometimento cardíaco da amiloidose sistêmica. Métodos Estudo de uma amostra de conveniência, analisando dados clínicos, laboratoriais, eletrocardiográficos, ecocardiográficos, medicina nuclear e ressonância magnética. Considerou-se significância estatística quando p < 0,05. Resultados Avaliaram-se 105 pacientes (com mediana de idade de 66 anos), sendo 62 homens, dos quais 83 indivíduos apresentavam amiloidose por transtirretina (ATTR) e 22 amiloidose por cadeia leve (AL). Na ATTR, 68,7% eram de caráter hereditário (ATTRh) e 31,3% do tipo selvagem (ATTRw). As mutações mais prevalentes foram Val142Ile (45,6%) e Val50Met (40,3%). O tempo de início dos sintomas ao diagnóstico foi 0,54 e 2,15 anos nas formas AL e ATTR (p < 0,001), respectivamente. O acometimento cardíaco foi observado em 77,9% dos ATTR e 90,9% dos AL. Observaram-se alterações de condução atrioventricular em 20% e intraventricular em 27,6% dos pacientes, sendo 33,7 % na ATTR e 4,5% das AL (p = 0,006). A forma ATTRw apresentou mais arritmias atriais que os ATTRh (61,5% x 22,8%; p = 0,001). Ao ecocardiograma a mediana da espessura do septo na ATTRw x ATTRh x AL foi de 15 mm x 12 mm x 11 mm (p = 0,193). Observou-se BNP elevado em 89,5% dos indivíduos (mediana 249 ng/mL, IQR 597,7) e elevação da troponina em 43,2%. Conclusão Foi possível caracterizar, em nosso meio, o acometimento cardíaco na amiloidose sistêmica, em seus diferentes subtipos, através da história clínica e dos métodos diagnósticos descritos.


Abstract Background Systemic amyloidosis is a disease with heterogeneous clinical manifestations. Diagnosis depends on clinical suspicion combined with specific complementary methods. Objective To describe the clinical, laboratory, electrocardiographic, and imaging profile in patients with systemic amyloidosis with cardiac involvement. Methods This study was conducted with a convenience sample, analyzing clinical, laboratory, electrocardiographic, echocardiographic, nuclear medicine, and magnetic resonance data. Statistical significance was set at p < 0.05. Results A total of 105 patients were evaluated (median age of 66 years), 62 of whom were male. Of all patients, 83 had transthyretin (ATTR) amyloidosis, and 22 had light chain (AL) amyloidosis. With respect to ATTR cases, 68.7% were the hereditary form (ATTRh), and 31.3% were wild type (ATTRw). The most prevalent mutations were Val142Ile (45.6%) and Val50Met (40.3%). Time from onset of symptoms to diagnosis was 0.54 and 2.15 years, in the AL and ATTR forms, respectively (p < 0.001). Cardiac involvement was observed in 77.9% of patients with ATTR and in 90.9% of those with AL. Alterations were observed in atrioventricular and intraventricular conduction in 20% and 27.6% of patients, respectively, with 33.7% in ATTR and 4.5% in AL (p = 0.006). In the ATTRw form, there were more atrial arrhythmias than in ATTRh (61.5% versus 22.8%; p = 0.001). On echocardiogram, median septum thickness in ATTRw, ATTRh, and AL was 15 mm, 12 mm, and 11 mm, respectively (p = 0.193). Elevated BNP was observed in 89.5% of patients (median 249, ICR 597.7), and elevated troponin was observed in 43.2%. Conclusion In this setting, it was possible to characterize cardiac involvement in systemic amyloidosis in its different subtypes by means of clinical history and the diagnostic methods described.


Subject(s)
Humans , Male , Female , Adult , Cardiology , Amyloid Neuropathies, Familial/diagnostic imaging , Amyloidosis/diagnostic imaging , Cardiomyopathies/diagnostic imaging , Referral and Consultation , Brazil , Prealbumin/genetics , Echocardiography
9.
Arq. bras. med. vet. zootec. (Online) ; 71(4): 1107-1115, jul.-ago. 2019. tab, graf
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1038604

ABSTRACT

Radiografias torácicas e ecocardiogramas de 104 caninos foram avaliados e correlacionados quanto ao aumento das câmaras cardíacas. Os achados radiográficos foram correlacionados estatisticamente a fim de se estabelecer a acurácia do exame radiográfico na detecção do aumento cardíaco em comparação ao ecocardiográfico - padrão-ouro não invasivo. A correlação entre os achados radiográficos indicativos de aumento cardíaco e os índices ecocardiográficos mostrou-se fraca, significativa somente para VHS versus relação átrio esquerdo/aorta (r=0,3136), eixo curto versus relação átrio esquerdo/aorta (r=0,3813) e eixo curto versus velocidade da onda E (r=0,2021). A acurácia da radiografia na determinação subjetiva de aumento das câmaras cardíacas foi razoável, variando entre 72,1% e 80,8%. Em contrapartida, o VHS apresentou baixa acurácia (50,9%) na detecção de cardiomegalia.(AU)


Thoracic radiographs and echocardiograms of 104 canines were evaluated and correlated regarding cardiac chambers enlargement. The radiographic findings were statistically correlated in order to establish the accuracy of the radiographic examination in the detection of cardiac enlargement in comparison with the echocardiogram - non-invasive gold standard. The correlation between the radiographic findings indicative of cardiac enlargement and echocardiographic indexes was weak, significant only for VHS versus left atrium to aorta ratio (r= 0.3136), short axis versus left atrium to aorta ratio (r= 0, 3813) and short axis versus E wave velocity (r= 0.2021). The radiographic accuracy in the subjective determination of cardiac chamber enlargement was reasonable, ranging from 72.1% to 80.8%. On the other hand, VHS presented low accuracy (50.9%) in the detection of cardiomegaly.(AU)


Subject(s)
Animals , Dogs , Radiography, Thoracic/veterinary , Cardiomegaly/veterinary , Cardiomegaly/diagnostic imaging , Cardiomyopathies/diagnostic imaging , Echocardiography/veterinary
10.
Med. infant ; 26(2): 197-204, Junio 2019. ilus
Article in Spanish | LILACS | ID: biblio-1021613

ABSTRACT

Los innegables progresos en la supervivencia de los pacientes con cardiopatía congénita en los últimos años fue acompañado de los avances en todas las áreas concurrentes a la cirugía cardiovascular, incluyendo la recuperación y los métodos diagnósticos que permiten una mejor comprensión de la patología cardíaca congénita o adquirida. La velocidad con que se desarrollan estas herramientas en el arsenal médico, exige una mejor comprensión a la hora de definir la estrategia diagnóstica para cada paciente en particular. Tradicionalmente, las imágenes diagnósticas de las cardiopatías congénitas eran dominio de la ecocardiografía y el cateterismo. En los últimos 10 años, la Resonancia y la Tomografía Computada fueron ganando terreno. La principal ventaja de la Resonancia es que no utiliza Rayos X para obtener las imágenes, diferencia de la angiografía por cateterismo y la tomografía axial computada. La resonancia magnética cardíaca se ha convertido en una herramienta importante para evaluar la enfermedad cardíaca congénita y también la adquirida en niños y adultos. La variedad y complejidad de la patología y sus posibilidades quirúrgicas hace indispensable la presencia del cardiólogo infantil durante la adquisición de las imágenes y su post procesamiento. En esta sección se presentarán algunas de las herramientas o secuencias que utiliza la Resonancia Magnética Cardíaca y su utilización práctica en el diagnóstico de las cardiopatías más frecuentes (AU)


The undeniable progress in survival of patients with congenital heart defects in recent years has been accompanied by advances in all areas related to cardiovascular surgery, including recovery and diagnostic methods that allow for a better understanding of congenital or acquired heart disease. The speed with which these tools are developed in the medical arsenal requires a better understanding when defining the diagnostic strategy for each individual patient. Traditionally, diagnostic images of choice for congenital heart disease were echocardiography and catheterization. Over the last 10 years, MRI. and CT scan have become more important. The main advantage of MRI is that it does not use X-rays to obtain the images, unlike catheterization and computed tomography angiogram. Cardiac MRI has become an important tool for assessing congenital and acquired heart disease in children and adults. The variety and complexity of the disease and its surgical possibilities warrant the presence of the child cardiologist during imaging acquisition and processing. This section will present some of the MRI tools and sequences and their practical use in the diagnosis of the most common heart diseases (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Magnetic Resonance Imaging/instrumentation , Magnetic Resonance Imaging/trends , Heart Defects, Congenital/diagnostic imaging , Cardiomyopathies/diagnostic imaging , Diagnostic Techniques, Cardiovascular
12.
Braz. j. med. biol. res ; 52(6): e8009, 2019. graf
Article in English | LILACS | ID: biblio-1001539

ABSTRACT

The progression of myocardial injury secondary to hypertension is a complex process related to a series of physiological and molecular factors including oxidative stress. This study aimed to investigate whether moderate-intensity exercise (MIE) could improve cardiac function and oxidative stress in spontaneously hypertensive rats (SHRs). Eight-week-old male SHRs and age-matched male Wistar-Kyoto rats were randomly assigned to exercise training (treadmill running at a speed of 20 m/min for 1 h continuously) or kept sedentary for 16 weeks. Cardiac function was monitored by polygraph; cardiac mitochondrial structure was observed by scanning electron microscope; tissue free radical production was measured using dihydroethidium staining. Expression levels of SIRT3 and SOD2 protein were measured by western blot, and cardiac antioxidants were assessed by assay kits. MIE improved the cardiac function of SHRs by decreasing left ventricular systolic pressure (LVSP), and first derivation of LVP (+LVdP/dtmax and −LVdP/dtmax). In addition, exercise-induced beneficial effects in SHRs were mediated by decreasing damage to myocardial mitochondrial morphology, decreasing production of reactive oxygen species, increasing glutathione level, decreasing oxidized glutathione level, increasing expression of SIRT3/SOD2, and increasing activity of superoxide dismutase. Exercise training in SHRs improved cardiac function by inhibiting hypertension-induced myocardial mitochondrial damage and attenuating oxidative stresses, offering new insights into prevention and treatment of hypertension.


Subject(s)
Animals , Male , Rats , Blood Pressure/physiology , Oxidative Stress/physiology , Hypertension/physiopathology , Mitochondria, Heart/physiology , Cardiomyopathies/prevention & control , Physical Conditioning, Animal/physiology , Rats, Inbred SHR , Rats, Inbred WKY , Superoxide Dismutase/physiology , Microscopy, Electron, Scanning , Disease Models, Animal , Cardiomyopathies/physiopathology , Cardiomyopathies/diagnostic imaging
13.
Medicina (B.Aires) ; 78(6): 395-398, Dec. 2018. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-976136

ABSTRACT

La amiloidosis cardíaca del subtipo transtirretina (ATTR) es una cardiopatía restrictiva que causa insuficiencia cardíaca en un número considerable de pacientes. Su identificación temprana permitiría brindar tratamientos específicos. Sin embargo, el diagnóstico de ATTR es complejo y requiere métodos invasivos. Los fosfonatos marcados con 99mTecnecio han demostrado ser útiles para el diagnóstico, aunque en Argentina la experiencia es escasa. Nuestro objetivo fue evaluar la utilidad de este método para diagnosticar de forma no invasiva la ATTR. Se estudiaron 46 pacientes entre septiembre de 2016 y enero de 2018 por sospecha de amiloidosis cardíaca. Se evaluó el grado de captación cardíaca con relación al tejido óseo, a la hora, mediante dos métodos: semi-cuantitativo y cuantitativo. El diagnóstico definitivo de amiloidosis y el subtipo específico fue asignado por el centro de miocardiopatías de nuestra institución siguiendo recomendaciones internacionales. Una captación ≥ grado II presentó un valor predictivo positivo del 96% y negativo del 100% para el diagnóstico de amiloidosis cardíaca ATTR. El valor de corte de 1.38 en la relación corazón/pulmón presentó una sensibilidad del 96% y una especificidad del 100% para discriminar entre pacientes con ATTR de aquellos con amiloidosis por cadenas livianas u otras afecciones (área bajo la curva relación corazón/pulmón = 0.95 p < 0.001). La centellografía con fosfonatos marcados demostró ser un método no invasivo útil para diagnosticar ATTR. Dado que además de ser no invasiva, es una herramienta de bajo costo y ampliamente disponible en nuestro medio, su aplicación puede redundar en un beneficio clínico para muchos pacientes.


Transthyretin cardiac amyloidosis (ATTR) is a restrictive cardiomyopathy that leads to heart failure in considerable number of patients. Early diagnosis allows specific treatment options. However, ATTR diagnosis is complex and requires invasive procedures. The utility of 99mTc-phosphate tracers for non-invasive diagnosis is well-known but the experience in Argentina is insufficient. The aim of this work was to assess the utility of 99mTc-phosphate tracers for the diagnosis of ATTR. A total of 46 scintigraphies for detection of cardiac amyloidosis performed between September 2016 and January 2018 were analyzed. Cardiac retention after one hour was assessed in relation to bone uptake using two methods: A semi-quantitative visual score (grade 0 = absent, I = low II = moderate-III = high) and a quantitative method (heart/lung ratio). The final diagnosis and the amyloidosis subtype were carried out by our institution cardiomyopathy team according to international guidelines. The positive and negative predictive values for Grade ≥ II were 96% and 100% respectively for diagnosis of ATTR. Using 1.38 as cut-off value for heart/lung ratio the sensitivity and the specificity were 96% and 100%, respectively for differentiating transthyretin cardiac amyloidosis from light-chain cardiac amyloidosis and other cardiopathies. Scintigraphy with 99mTc-phosphate tracers enable noninvasive diagnosis and subtype classification of cardiac amyloidosis. The use of this non-invasive, inexpensive and widely available tool will result in better patient management.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Phosphates , Radionuclide Imaging/methods , Technetium Compounds , Amyloidosis/diagnostic imaging , Cardiomyopathies/diagnostic imaging , Predictive Value of Tests , Reproducibility of Results , Statistics, Nonparametric , Radiopharmaceuticals , Amyloidosis/physiopathology , Cardiomyopathies/physiopathology
14.
Arq. bras. cardiol ; 110(2): 124-131, Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-888018

ABSTRACT

Abstract Background: Previous data has shown that patients in the indeterminate form of Chagas disease may present myocardial fibrosis as shown on through magnetic resonance imaging (MRI). However, there is little information available regarding the degree of severity of myocardial fibrosis in these individuals. This variable has the potential to predict the evolution of Chagas' disease into its cardiac form. Objectives: To describe the frequency and extent of myocardial fibrosis evaluated using an MRI in patients in the indeterminate form, and to compare it with other forms of the disease. Methods: Patients were admitted one after another. Their clinical history was collected and they were submitted to laboratory exams and an MRI. Results: Sixty-one patients with Chagas' disease, with an average age of 58 ± 9 years old, 17 patients in the indeterminate form, 16 in the cardiac form without left ventricular (LV) dysfunction and 28 in the cardiac form with LV dysfunction were studied. P <0.05 was considered to be statistically significant. Late enhancement was detected in 37 patients (64%). Myocardial fibrosis was identified in 6 individuals in indeterminate form (41%; 95% CI 23-66) in a proportion similar to that observed in cardiac form without LV dysfunction (44%); p = 1.0. Among the individuals with fibrosis, the total area of the affected myocardium was 4.1% (IIQ: 2.1 - 10.7) in the indeterminate form versus 2.3% (IIQ: 1-5) in the cardiac form without LV (p = 0.18). The left ventricular fraction ejection in subjects in the indeterminate form was similar to that of the individuals in the cardiac form without ventricular dysfunction (p = 0.09). Conclusion: The presence of fibrosis in the indeterminate form of Chagas' disease has a frequency and extension similar to that of in the cardiac form without dysfunction, suggesting that the former is part of a subclinical disease spectrum, rather than lacking cardiac involvement.


Resumo Fundamento: Dados prévios têm demonstrado que pacientes na forma indeterminada podem apresentar fibrose miocárdica à ressonância magnética (RM). No entanto, são poucas as informações disponíveis quanto ao grau de fibrose miocárdica apresentada por esses indivíduos, o que guardaria relação com o potencial dessa variável na predição de evolução para a forma cardíaca da doença de Chagas. Objetivos: Descrever a frequência e extensão da fibrose miocárdica avaliada por RM em pacientes da forma indeterminada, comparando com as outras formas da doença. Métodos: Pacientes consecutivamente admitidos tiveram história clínica colhida e foram submetidos à realização de exames laboratoriais e RM. Resultados: Foram estudados 61 pacientes portadores da doença de Chagas, com média de idade de 58 ± 9 anos, sendo 17 pacientes na forma indeterminada, 16 na forma cardíaca sem disfunção do ventrículo esquerdo (VE) e 28 na forma com disfunção do VE. Foi considerado estatisticamente significante p < 0,05. Realce tardio foi detectado em 37 pacientes (64%). Foi identificada fibrose miocárdica em 6 indivíduos na forma indeterminada (41%; IC95% 23 - 66), proporção semelhante à observada na forma cardíaca sem disfunção do VE (44%); p = 1,0. Entre os indivíduos com fibrose, a área total do miocárdio acometida foi de 4,1% (IIQ: 2,1 - 10,7) na forma indeterminada versus 2,3% (IIQ: 1 - 5) na forma cardíaca sem disfunção do VE (p = 0,18). A fração de ejeção do ventrículo esquerdo nos indivíduos na forma indeterminada foi semelhante aos portadores da forma cardíaca sem disfunção ventricular (p = 0,09). Conclusão: A presença de fibrose na forma indeterminada da doença de Chagas tem frequência e extensão semelhante à forma cardíaca sem disfunção, o que sugere que a primeira faz parte de um espectro de doença subclínica, em vez da ausência de acometimento cardíaco.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Fibrosis/diagnostic imaging , Magnetic Resonance Imaging/methods , Cardiomyopathies/diagnostic imaging , Fibrosis/physiopathology , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/diagnostic imaging , Cardiomyopathies/physiopathology
15.
Arq. bras. cardiol ; 108(5): 458-469, May 2017. tab, graf
Article in English | LILACS | ID: biblio-838739

ABSTRACT

Abstract The study of myocardial viability is of great importance in the orientation and management of patients requiring myocardial revascularization or angioplasty. The technique of delayed enhancement (DE) is accurate and has transformed the study of viability into an easy test, not only for the detection of fibrosis but also as a binary test detecting what is viable or not. On DE, fibrosis equal to or greater than 50% of the segmental area is considered as non-viable, whereas that below 50% is considered viable. During the same evaluation, cardiac magnetic resonance (CMR) may also use other techniques for functional and perfusion studies to obtain a global evaluation of ischemic heart disease. This study aims to highlight the current concepts and broadly emphasize the use of CMR as a method that over the last 20 years has become a reference in the detection of infarction and assessment of myocardial viability.


Resumo O estudo de viabilidade miocárdica é de grande importância para a orientação e manejo de pacientes que necessitam de cirurgia de revascularização miocárdica ou angioplastia. A técnica de realce tardio (RT) é precisa e transformou o estudo de viabilidade em um teste fácil, não só para a detecção de fibrose, mas também como um modelo binário para a detecção do que é ou não é viável. Uma fibrose identificada pelo RT é considerada como não viável quando igual ou maior do que 50% da área segmentar e como viável quando menor que 50%. A ressonância magnética cardíaca (RMC) também pode lançar mão de outras técnicas para estudo funcional e de perfusão para uma avaliação global da doença isquêmica do coração no mesmo exame. Este estudo tem como objetivo destacar os conceitos atuais e enfatizar amplamente o uso da RMC como um método que nos últimos 20 anos se tornou referência na detecção de infarto e avaliação de viabilidade miocárdica.


Subject(s)
Humans , Tissue Survival/physiology , Magnetic Resonance Imaging/methods , Myocardial Infarction/diagnostic imaging , Magnetic Resonance Imaging/standards , Magnetic Resonance Imaging/trends , Contrast Media/standards , Myocytes, Cardiac/pathology , Cardiomyopathies/physiopathology , Cardiomyopathies/diagnostic imaging , Myocardial Infarction/physiopathology , Myocardial Revascularization
16.
Arch. cardiol. Méx ; 86(4): 305-312, oct.-dic. 2016. tab, graf
Article in Spanish | LILACS | ID: biblio-838393

ABSTRACT

Resumen Objetivo Explorar las diferencias segmentarias de los espesores parietales (EP) en las miocardiopatías más prevalentes y en individuos sin cardiopatía estructural por resonancia magnética cardíaca. Método Pacientes mayores de 18 años referidos a resonancia magnética cardíaca durante el periodo comprendido entre enero de 2014 y septiembre de 2014, con diagnóstico de miocardiopatía hipertrófica, miocardiopatía dilatada idiopática, miocardiopatía isquémico-necrótica y miocarditis fueron seleccionados retrospectivamente de nuestra base de datos. Resultados Se incluyeron 120 pacientes. El grupo control presentó un EP medio de 5.9 ± 1.1 mm, con un índice de espesor relativo de 2.9 ± 0.8. Se identificaron EP significativamente menores en los segmentos apicales tanto en el grupo control (basal 6.7 ± 1.3 vs. medio 6 ± 1.3 vs. apical 4.6 ± 1 mm, p < 0.0001) como en todas las miocardiopatías evaluadas (miocardiopatía hipertrófica: basal 10.5 ± 2.4 vs. medio 10.8 ± 2.7 vs. apical 7.3 ± 3.3 mm, p < 0.0001; miocardiopatía dilatada idiopática: basal 7.7 ± 1.7 vs. medio 7.6 ± 1.3 vs. apical 5.4 ± 1.3 mm, p < 0.0001; miocardiopatía isquémico-necrótica: basal 7.4 ± 1.7 vs. medio 7.5 ± 1.9 vs. apical 5.5 ± 1.8 mm, p < 0.0001; miocarditis: basal 7.1 ± 1.5 vs. medio 6.4 ± 1.1 vs. apical 5.1 ± 0.8, p < 0.0001). También se evidenciaron diferencias significativas entre hombres y mujeres respecto al EP tanto en el grupo control (6.5 ± 2.1 vs. 5.2 ± 1.7 mm, p < 0.0001), como en la miocardiopatía hipertrófica (10.5 ± 5.3 vs. 8.5 ± 5.7 mm, p < 0.0001) y en la miocarditis (6.6 ± 2 vs. 5.2 ± 1.6 mm, p < 0.0001). Conclusiones En este estudio observacional encontramos un prevalencia relativamente elevada de segmentos comúnmente considerados como adelgazados en individuos sin cardiopatía estructural. Además, observamos una marcada asimetría y gradiente longitudinal en cuanto a EP tanto en controles como en las distintas miocardiopatías evaluadas.


Abstract Objective To explore regional differences in myocardial wall thickness (WT) among the most prevalent cardiomyopathies and in individuals without structural heart disease using cardiac magnetic resonance. Methods Patients older than 18 years referred to cardiac magnetic resonance during the period between January 2014 and September 2014, with a diagnosis of hypertrophic cardiomyopathy, idiopathic dilated cardiomyopathy, ischemic cardiomyopathy, and myocarditis were retrospectively selected from our database. Results One hundred twenty patients patients were included. The control group had an average WT of 5.9 ± 1.1 mm, with a WT index of 2.9 ± 0.8. Significantly lower mean WT in the apical segments were identified in both the control group (basal 6.7 ± 1.3 vs. mid 6.0 ± 1.3 vs. apical 4.6 ± 1.0 mm, P < .0001) and in all evaluated cardiomyopathies (hypertrophic cardiomyopathy: basal 10.5 ± 2.4 vs. mid 10.8 ± 2.7 vs. apical 7.3 ± 3.3 mm, P < .0001; idiopathic dilated cardiomyopathy: basal 7.7 ± 1.7 vs. mid 7.6 ± 1.3 vs. apical 5.4 ± 1.3 mm, P < .0001; ischemic cardiomyopathy: basal 7.4 ± 1.7 vs. mid 7.5 ± 1.9 vs. apical 5.5 ± 1.8 mm, P < .0001; myocarditis: basal 7.1 ± 1.5 vs. mid 6.4 ± 1.1 vs. apical 5.1 ± 0.8, P < .0001). Significant gender differences were also evident regarding the mean WT both in the control group (male 6.5 ± 2.1 vs. female 5.2 ± 1.7 mm, P < .0001), as in hypertrophic cardiomyopathy (10.5 ± 5.3 vs. 8.5 ± 5.7 mm, P < .0001) and myocarditis (6.6 ± 2.0 vs. 5.2 ± 1.6 mm, P < .0001). Conclusion We found a relatively high prevalence of segments commonly deemed thinned among patients without structural heart disease. We also observed a marked asymmetry and longitudinal gradient in wall thickness both in controls and in the various cardiomyopathies evaluated.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Magnetic Resonance Imaging , Cardiac Imaging Techniques , Cardiomyopathies/pathology , Cardiomyopathies/diagnostic imaging , Myocardium/pathology , Retrospective Studies
18.
Yonsei Medical Journal ; : 900-904, 2016.
Article in English | WPRIM | ID: wpr-63334

ABSTRACT

PURPOSE: As cardiomyopathy is more prevalent and currently the leading cause of death in Duchenne muscular dystrophy (DMD), early detection of myocardial involvement is important. The purpose of this study was to analyze myocardial strain in DMD children, for the possibility of early detection of myocardial dysfunction. MATERIALS AND METHODS: We reviewed medical records of DMD patients who were >10 years of age (15.6±1.6 years, 12.5-18 years), from March 2013 to June 2014. Data of 24 DMD children who underwent echocardiography with three-layer specific myocardial strain were compared with 24 controls (age: 9.3±4.0 years, 5.5-17 years). RESULTS: Epicardial longitudinal strain was lower in DMD (DMD: -9.3±3.8%; control: -12.3±4.3%; p=0.012). Radial strain (DMD: 24.1±11.1%; control: 37.3±25.9%; p=0.027) and strain rate (SR) (DMD: 1.68±0.91; control: 2.42±0.84; p=0.006) on parasternal short axis view were lower in DMD. Circumferential strains in the endocardium (DMD: -17.5±4.7%; control: -24.2±5.3%; p<0.001), myocardium (DMD: -12.7±3.8%; control: -18.0±4.0%; p<0.001), and epicardium (DMD: -8.4±4.0%; control: -12.2±5.0%; p=0.006) were significantly decreased in DMD. Circumferential SRs were lower in the endocardial (DMD: -1.46±0.38; control: -1.78±0.27; p=0.002) and myocardial layers (DMD: 1.02±0.27; control: -1.28±0.22; p=0.001). CONCLUSION: In DMD patients, deteriorations in myocardial circumferential strain might be an indicator for predicting cardiomyopathy.


Subject(s)
Adolescent , Cardiomyopathies/diagnostic imaging , Case-Control Studies , Child , Child, Preschool , Early Diagnosis , Echocardiography , Female , Humans , Male , Muscular Dystrophy, Duchenne/complications , Predictive Value of Tests
19.
Rev. chil. cardiol ; 34(3): 207-213, 2015. ilus
Article in Spanish | LILACS | ID: lil-775490

ABSTRACT

La amiloidosis corresponde a un conjunto de enfermedades que tienen en común el depósito de amiloide en uno o más órganos. El hallazgo típico del compromiso cardíaco secundario a la amiloidosis es la presencia de insuficiencia cardíaca rápidamente progresiva. La historia natural de esta enfermedad en ausencia de tratamiento es de un rápido compromiso con alta mortalidad. Reportamos el caso de una paciente con esta enfermedad, describiendo su historia, manejo y seguimiento.


Cardiac amyloidosis refers to a set of diseases characterized by amyloid deposit in one or more organs. The typical finding of cardiac involvement secondary to amyloidosis is the presence of rapidly progressive heart failure. The natural story of this disease in the absence of treatment leads to rapid deterioration with a high mortality rate We report the case of a patient with amyloidosis and cardiac invol-vement, describing the clinical history, management and follow up.


Subject(s)
Humans , Female , Middle Aged , Amyloidosis/diagnosis , Cardiomyopathies/diagnosis , Amyloidosis/diagnostic imaging , Cardiomyopathies/diagnostic imaging
20.
Indian J Pediatr ; 2010 May; 77(5): 523-528
Article in English | IMSEAR | ID: sea-142573

ABSTRACT

Objective. To study role of Tissue Doppler imaging (TDI) in identification of cardiomyopathy before development of ventricular dysfunction. Methods. Twenty-five patients with Duchenne’s (DMD) and 10 with Becker’s (BMD) muscular dystrophy along with 20 controls were evaluated using TDI. Results. Pulse Tissue Doppler signals of the lateral left ventricle wall (lateral mitral annulus) revealed reduced systolic velocities in the DMD patients (mean ± SD: 7.8 ± 1.1 cm/sec vs. 8.6 ± 1.1 cm/sec in controls) in patients of DMD. 60% of the non ambulatory DMD (ejection fraction 45±9%) patients had mild LV dysfunction and reduced systolic velocities (6.96± 1.7 cm/sec, p<0.05 vs controls). The ambulatory DMD patients also had reduced systolic velocities (7.8+1.1cm/sec ) though ejection fraction was normal. Reduced tissue Doppler systolic velocities in the ambulatory DMD patients with normal conventional echocardiography would suggest that perhaps some of these patients (20% had velocities less than Mean – 2 SD of controls) have early myocardial dysfunction (picked up only as abnormal myocardial velocities). Conclusions. TDI picked up systolic dysfunction of the lateral wall in DMD even when overall LV function was normal conventional echocardiography. Tissue Doppler imaging is a useful technique to pick up early ventricular dysfunction and should be evaluated in larger studies and also with other techniques like magnetic resonance imaging.


Subject(s)
Analysis of Variance , Cardiomyopathies/physiopathology , Cardiomyopathies/diagnostic imaging , Case-Control Studies , Child , Diastole , Echocardiography, Doppler , Humans , Male , Female , Muscular Dystrophies/physiopathology , Muscular Dystrophies/diagnostic imaging , Systole , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/diagnostic imaging
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