ABSTRACT
Acute chest pain is a common reason for presentation to the emergency department. It can be caused by a wide variety of diseases, some of which are potentially lethal, so it must be diagnosed quickly. The rise of computed tomography to evaluate patients with acute chest pain is noteworthy. However, computed tomography is not without limitations in this context. Cardiovascular magnetic resonance imaging is a potentially useful technique in this group of patients, although its availability and the time required for examinations restrict its use to specific indications.
Subject(s)
Cardiovascular Diseases/diagnosis , Chest Pain/diagnosis , Magnetic Resonance Imaging , Acute Disease , Adult , Aged , Cardiovascular Diseases/complications , Chest Pain/etiology , Female , Humans , Male , Middle AgedABSTRACT
El dolor torácico agudo es una causa frecuente de consulta en los servicios de urgencias. Puede estar ocasionado por una amplia variedad de enfermedades, algunas potencialmente letales, por lo que tienen que diagnosticarse rápidamente. El auge de la tomografía computarizada para estudiar a pacientes con dolor torácico agudo es notable. Sin embargo, se trata de una exploración no exenta de limitaciones. La resonancia magnética cardiovascular es una técnica potencialmente útil en este grupo de pacientes, aunque la disponibilidad y la duración de las exploraciones restringen su uso a determinadas indicaciones. En este trabajo se ilustran los hallazgos de la resonancia magnética en pacientes con dolor torácico agudo y se describen los protocolos de adquisición. Además, se resaltan los datos semiológicos más característicos de las causas isquémicas y no isquémicas que pueden provocar estos síntomas (AU)
Acute chest pain is a common reason for presentation to the emergency department. It can be caused by a wide variety of diseases, some of which are potentially lethal, so it must be diagnosed quickly. The rise of computed tomography to evaluate patients with acute chest pain is noteworthy. However, computed tomography is not without limitations in this context. Cardiovascular magnetic resonance imaging is a potentially useful technique in this group of patients, although its availability and the time required for examinations restrict its use to specific indications In this article, we illustrate the magnetic resonance imaging findings in patients with acute chest pain and describe the protocols for MRI acquisition in this context. Furthermore, we highlight the most characteristic signs of ischemic and nonischemic causes of chest pain (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Chest Pain/diagnosis , Magnetic Resonance Spectroscopy/methods , Heart Diseases/diagnosis , Myocardial Ischemia/diagnosis , Emergency Medical Services/statistics & numerical data , Emergency Treatment/methods , Angina, Unstable/diagnosis , Coronary Disease/diagnosisABSTRACT
AIM: Only a few papers with patients surviving more than 15 years after heart transplantation have been reported. Herein we report the characteristics of patients transplanted between 1984 and 1989 who are long-term survivors (>20 years). Survival after transplant, recipient and donor age and aetiology of heart failure were also compared with patients transplanted in the decades 1990-1999 and 2000-2009. METHODS: Our Heart Transplant Program Database and medical records of all cardiac transplants performed in our centre from July 1984 to 1989 were reviewed. Primary endpoint of the study was the long-term survival and secondary end points were the incidence of transplant-related complications over time. RESULTS: Forty-five transplants were performed in 1984-1989, 41 patients were male, median age was 46 years (IQR: 39-55), median donor age was 24 years (19-29) and mean graft ischemic time was 134±64 minutes. The actuarial survival of this cohort was 77.8%, 64.4%, 48.9%, 35.6% and 24.2% at 1, 5, 10, 15 and 20 years, respectively. Univariate Cox regression analysis revealed the female gender, the graft ischemic time, the recipient-donor gender mismatch, a diagnosis of diabetes and the number of acute rejection episodes during the first year post-transplant as significant risk factors adversely affecting long-term survival. Cardiac allograft vasculopathy is the main cause of death. The mean recipient and donor age and the graft ischemic time have progressively increased over time but survival has not changed. CONCLUSION: The long-term outcome of heart transplantation is noteworthy. The main limiting factor for survival is the allograft vasculopathy. Considering the tremendous advances in the immunosuppressive therapy and in the understanding of CAV pathophisyology, we can hope for even better results in the next years.
Subject(s)
Heart Transplantation/mortality , Survivors/statistics & numerical data , Adult , Chi-Square Distribution , Female , Heart Transplantation/adverse effects , Humans , Incidence , Kaplan-Meier Estimate , Male , Middle Aged , Postoperative Complications/mortality , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Risk Factors , Spain/epidemiology , Survival Rate , Time Factors , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To compare the accuracy of cardiac dual-source CT (DSCT) reconstructions obtained at 5% and 10% of the cardiac cycle and MRI for quantifying global left ventricular (LV) function and mass in heart transplant recipients. MATERIAL AND METHODS: We prospectively included 23 heart transplant recipients (21 male, mean age 60±11.7 years) who underwent cardiac DSCT and MRI examinations. We compared LV parameters on cardiac DSCT reconstructions obtained at 5% (0%-95%) and 10% (0%-90%) intervals of the cardiac cycle and on double-oblique short-axis MR images. We determined ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and myocardial mass using commercially available semiautomated segmentation analysis software for DSCT datasets and conventional manual contour tracing for MR studies. RESULTS: Using different reconstruction intervals to quantify LV parameters at DSCT resulted in non-significant differences (P>.05). Compared to MRI, DSCT slightly overestimated LV-EDV, ESV, and mass when both 5% (11.5±25.1ml, 6.8±10.9ml, and 28.3±21.6g, respectively) and 10% (mean difference 15.3±26.3ml, 7.4±11.5ml, and 29.3±18.7g, respectively) reconstruction intervals were used. DSCT and MRI estimates of EF and SV were not significantly different. CONCLUSION: In heart transplant recipients, DSCT allows reliable quantification of LV function and mass compared with MRI, even using 10% interval reconstructions.
