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1.
Coron Artery Dis ; 31(3): 293-299, 2020 05.
Article in English | MEDLINE | ID: mdl-31658141

ABSTRACT

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS); however, its detection carries relevant clinical implications. Cardiac computed tomography (CCT) has been found to be useful for follow-up, but data during the acute phase are scarce. Thus, our aim was to evaluate the early diagnostic ability of CCT to detect SCAD. METHODS: We retrospectively analyzed all the in-hospital CCT performed in a prospective cohort of patients with SCAD from 2012 to 2016. An independent expert blindly evaluated the studies and described the radiologic characteristics of the lesions. These features were compared with the invasive coronary angiography (ICA) and optical coherence tomography (OCT) findings. RESULTS: 18 lesions were analyzed from 12 episodes identified in 11 patients (100% females; median age of 57 years old). CCT recognized the presence of SCAD in 14 (78%) of the lesions, with four different morphological patterns. Most commonly (10, 71%) SCAD presented as a diffuse lumen narrowing surrounded by a 'sleeve-like' wall thickening, which corresponded to intramural hematoma in OCT evaluation. When compared with ICA, CCT showed a positive correlation (Spearman's Rho = 0.775; P = 0.001) and excellent concordance (ICC = 0.8; P = 0.004) in stenosis grading, but not for lesion length and minimal luminal area. CONCLUSION: CCT was able to identify the presence of SCAD in most of the patients in the acute phase of this elusive and challenging clinical entity. In addition, in this setting, CCT revealed unique and distinct radiologic features and provided a precise assessment of lesion severity.


Subject(s)
Coronary Angiography , Coronary Vessel Anomalies/diagnostic imaging , Tomography, Optical Coherence , Tomography, X-Ray Computed , Vascular Diseases/congenital , Cohort Studies , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/physiopathology , Female , Humans , Middle Aged , Non-ST Elevated Myocardial Infarction/etiology , Non-ST Elevated Myocardial Infarction/physiopathology , Retrospective Studies , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/physiopathology , Vascular Diseases/complications , Vascular Diseases/diagnostic imaging , Vascular Diseases/physiopathology
2.
Rev Esp Cardiol (Engl Ed) ; 71(9): 703-708, 2018 Sep.
Article in English, Spanish | MEDLINE | ID: mdl-29122513

ABSTRACT

INTRODUCTION AND OBJECTIVES: Tako-tsubo syndrome is a potentially serious disease during the acute phase. It mimics myocardial infarction, but with no potentially causative coronary lesions. The aim of this study was to analyze the clinical course and outcome of patients with tako-tsubo syndrome by sex. METHODS: We analyzed the characteristics of patients included in the RETAKO registry from 2003 to 2015, a multicenter registry with participation of 32 Spanish hospitals. RESULTS: Of 562 patients included, 493 (87.7%) were women. Chest pain was less frequent as an initial symptom in men than in women (43 [66.2%] vs 390 [82.8%]; P < .01). The prognosis was worse in men, with higher in-hospital mortality (3 [4.4%] vs 1 [0.2%]; P < .01), longer intensive care stay (4.2 ± 3.7 vs 3.2 ± 3.2 days; P = .03) and a higher frequency of severe heart failure (22 [33.3%] vs 95 [20.3%]; P = .02). However, dynamic obstruction at the left-ventricular outflow tract occurred exclusively in women (39 [7.9%] vs 0 [0.0%]; P = .02). The incidence of functional mitral regurgitation was also higher in women (52 [10.6%] vs 2 [2.9%]; P = .04). CONCLUSIONS: Tako-tsubo syndrome shows wide differences by sex in terms of its incidence, presentation, and outcomes. Prognosis is worse in men.


Subject(s)
Heart Ventricles/physiopathology , Mitral Valve Insufficiency/epidemiology , Myocardial Infarction/etiology , Takotsubo Cardiomyopathy/epidemiology , Ventricular Function, Left/physiology , Aged , Coronary Angiography , Diagnosis, Differential , Disease Progression , Electrocardiography , Female , Follow-Up Studies , Heart Ventricles/diagnostic imaging , Hospital Mortality/trends , Humans , Incidence , Male , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/etiology , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Prognosis , Retrospective Studies , Spain/epidemiology , Takotsubo Cardiomyopathy/complications , Takotsubo Cardiomyopathy/diagnosis
4.
Can J Cardiol ; 32(8): 1039.e3-5, 2016 08.
Article in English | MEDLINE | ID: mdl-27084073

ABSTRACT

Left ventricular free wall rupture (FWR) is a rare but dreadful complication after acute myocardial infarction (AMI). A coronary "milking-like" effect has been previously related to ventricular pseudoaneurysm or true aneurysm but not yet with other mechanical complications such as left ventricular FWR. We describe 2 patients with AMI showing a coronary milking-like effect in the infarct-related artery at the time of primary percutaneous coronary intervention. Left ventricular FWR eventually developed and the patients died. We propose that a coronary milking-like effect in the infarct-related artery is a marker of patients at high risk for this life-threatening mechanical complication.


Subject(s)
Coronary Angiography , Heart Rupture, Post-Infarction/diagnosis , Heart Ventricles/injuries , ST Elevation Myocardial Infarction/complications , Aged , Aged, 80 and over , Cardiac Tamponade/etiology , Fatal Outcome , Heart Rupture, Post-Infarction/etiology , Humans , Male , Pericardial Effusion/etiology , Systole , Troponin T/blood
5.
Can J Cardiol ; 32(6): 830.e1-3, 2016 06.
Article in English | MEDLINE | ID: mdl-26774232

ABSTRACT

Neoatherosclerosis has been described as a cause of in-stent restenosis (ISR), particularly in patients treated with drug-eluting stents (DESs). Although neoatherosclerosis may present as calcified plaques, the occurrence of a "calcified nodule" within the stent has not been previously reported. We describe optical coherence tomographic findings in a patient presenting with a calcified nodule causing "undilatable" ISR 2 years after implantation of a DES. The clinical and technical implications of this novel pattern of neoatherosclerosis are discussed.


Subject(s)
Coronary Restenosis/etiology , Drug-Eluting Stents/adverse effects , Tomography, Optical Coherence , Aged , Coronary Artery Disease/therapy , Coronary Restenosis/therapy , Humans , Male , Neointima/pathology , Risk Factors , Time Factors , Tomography, Optical Coherence/methods , Treatment Outcome
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