Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

Low-dose chest CT for preoperative screening for SARS-CoV-2 infection.

INTRODUCTION: This study aimed to evaluate the role of chest computed tomography (CT) in complementing reverse transcription polymerase chain reaction (RT-PCR) in asymptomatic candidates for elective surgery in the context of the COVID-19 pandemic. MATERIAL AND METHODS: We prospectively included 464 asymptomatic patients who underwent a triple screening workup for SARS-CoV-2 infection (health questionnaire, RT-PCR, and low-dose chest CT) during the 48 h prior to undergoing elective surgery. A positive RT-PCR and/or CT findings suggestive of COVID-19 (CO-RADS 4/5) were considered diagnostic criteria for SARS-CoV-2 infection. RESULTS: Most patients (64.7%) underwent otorhinolaryngology surgery. No patients had positive RT-PCR results or symptoms suggestive of SARS-CoV-2 in the health questionnaire. Only 22 (4.7%) had signs compatible with lung infection; in 20 of these, the CT findings were atypical or indeterminate for COVID-19 (CO-RADS 2/3) and in 2 they were compatible with COVID-19 pneumonia in resolution. In the immediate postoperative period, no cases of SARS-CoV-2 infection were confirmed. CONCLUSION: In our series of asymptomatic patients, low-dose CT did not add any value to the results of RT-PCR and a health questionnaire in preoperative screening for SARS-CoV-2.

TC torácica de baja dosis de radiación como técnica de cribado preoperatorio de infección por SARS-CoV-2 / Low-dose chest CT for preoperative screening for SARS-CoV-2 infection

Introducción: El objetivo del presente estudio fue evaluar el papel de la tomografía computarizada (TC) de tórax complementaria a la prueba de la reacción en cadena de la polimerasa con transcripción inversa (RT-PCR) en pacientes asintomáticos candidatos a cirugía electiva en el contexto de la pandemia de COVID-19. Material y métodos: Se incluyeron, de forma prospectiva, 464 pacientes asintomáticos que se sometieron a una triple estrategia de cribado de infección por SARS-CoV-2 (cuestionario de salud, prueba de RT-PCR y TC torácica de baja dosis) durante las 48 horas previas a la realización de una cirugía electiva. Un resultado positivo en la prueba de RT-PCR y/o la identificación de hallazgos tomográficos sugestivos de neumonía COVID-19 (categorías CO-RADS 4 y 5) fueron considerados criterios diagnósticos de infección por SARS-CoV-2. Resultados: La mayor parte de los pacientes se sometieron a cirugías de otorrinolaringología (64,7%). Ningún paciente presentó un resultado positivo en la prueba de RT-PCR ni síntomas sugestivos de infección por SARS-CoV-2 en el cuestionario de salud. Únicamente 22 (4,7%) mostraron signos compatibles con infección pulmonar; 20 de ellos atípica o indeterminada para COVID-19 (CO-RADS 2, 3) y 2 compatibles con neumonía COVID-19 en resolución. Durante el postoperatorio inmediato no se confirmó ningún caso positivo para SARS-CoV-2. Conclusión: En nuestra serie, la realización de una TC torácica de baja dosis de radiación en pacientes asintomáticos para el cribado preoperatorio de infección por SARS-CoV-2 no proporcionó un valor diagnóstico adicional a la RT-PCR y el cuestionario de salud.(AU)

Introduction: This study aimed to evaluate the role of chest computed tomography (CT) in complementing reverse transcription polymerase chain reaction (RT-PCR) in asymptomatic candidates for elective surgery in the context of the COVID-19 pandemic. Material and methods: We prospectively included 464 asymptomatic patients who underwent a triple screening workup for SARS-CoV-2 infection (health questionnaire, RT-PCR, and low-dose chest CT) during the 48hours prior to undergoing elective surgery. A positive RT-PCR and/or CT findings suggestive of COVID-19 (CO-RADS 4 / 5) were considered diagnostic criteria for SARS-CoV-2 infection. Results: Most patients (64.7%) underwent otorhinolaryngology surgery. No patients had positive RT-PCR results or symptoms suggestive of SARS-CoV-2 in the health questionnaire. Only 22 (4.7%) had signs compatible with lung infection; in 20 of these, the CT findings were atypical or indeterminate for COVID-19 (CO-RADS 2 / 3) and in 2 they were compatible with COVID-19 pneumonia in resolution. In the immediate postoperative period, no cases of SARS-CoV-2 infection were confirmed. Conclusion: In our series of asymptomatic patients, low-dose CT did not add any value to the results of RT-PCR and a health questionnaire in preoperative screening for SARS-CoV-2.(AU)

[Low-dose chest CT for preoperative screening for SARS-CoV-2 infection]. / TC torácica de baja dosis de radiación como técnica de cribado preoperatorio de infección por SARS-CoV-2.

Introduction: This study aimed to evaluate the role of chest computed tomography (CT) in complementing reverse transcription polymerase chain reaction (RT-PCR) in asymptomatic candidates for elective surgery in the context of the COVID-19 pandemic. Material and methods: We prospectively included 464 asymptomatic patients who underwent a triple screening workup for SARS-CoV-2 infection (health questionnaire, RT-PCR, and low-dose chest CT) during the 48 hours prior to undergoing elective surgery. A positive RT-PCR and/or CT findings suggestive of COVID-19 (CO-RADS 4 / 5) were considered diagnostic criteria for SARS-CoV-2 infection. Results: Most patients (64.7%) underwent otorhinolaryngology surgery. No patients had positive RT-PCR results or symptoms suggestive of SARS-CoV-2 in the health questionnaire. Only 22 (4.7%) had signs compatible with lung infection; in 20 of these, the CT findings were atypical or indeterminate for COVID-19 (CO-RADS 2 / 3) and in 2 they were compatible with COVID-19 pneumonia in resolution. In the immediate postoperative period, no cases of SARS-CoV-2 infection were confirmed. Conclusion: In our series of asymptomatic patients, low-dose CT did not add any value to the results of RT-PCR and a health questionnaire in preoperative screening for SARS-CoV-2.

Anatomic characteristics of the left atrium in subjects undergoing radiofrequency ablation for atrial fibrillation.

OBJECTIVE: To analyze the anatomic characteristics of the left atrium and pulmonary veins in individuals undergoing ablation for atrial fibrillation and to identify possible anatomic factors related with recurrence. MATERIAL AND METHODS: We retrospectively reviewed the CT angiography studies done to plan radiofrequency ablation for atrial fibrillation in 95 patients (57 men; mean age, 65 ±â€¯10 y). We reviewed the anatomy of the pulmonary veins and recorded the diameters of their ostia as well as the diameter and volume of the left atrium. We analyzed these parameters according to the type of arrhythmia and the response to treatment. RESULTS: In 71 (74.7%) patients, the anatomy of the pulmonary veins was normal (i.e., two right pulmonary veins and two left pulmonary veins). Compared to patients with paroxysmal atrial fibrillation, patients with persistent atrial fibrillation had slightly larger diameter of the left pulmonary veins (left superior pulmonary vein 17.9 ±â€¯2.6 mm vs. 16.7 ±â€¯2.2 mm, p = 0.04; left inferior pulmonary vein 15.3 ± 2 mm vs. 13.8 ±â€¯2.2 mm, p = 0.009) and larger left atrial volume (91.9 ±â€¯24.9 cm3 vs. 70.7 ±â€¯20.3 mm3, p = 0.001). After 22.1 ±â€¯12.1 months' mean follow-up, 41 patients had sinus rhythm. Compared to patients in whom the sinus rhythm was restored, patients with recurrence had greater left atrial volume (81.4 ±â€¯23.0 mm3 vs. 71.1 ±â€¯23.2 mm3, p = 0.03). No significant differences in pulmonary vein diameters or clinical parameters were observed between patients with recurrence and those without. CONCLUSION: The volume of the left atrium is greater in patients with persistent atrial fibrillation and in those who do not respond to ablation.

Chest computed tomography findings in different phases of SARS-CoV-2 infection. / Hallazgos en la tomografía computarizada de tórax en las fases evolutivas de la infección por SARS-CoV-2.

OBJECTIVE: To compare the findings on chest computed tomography (CT) in patients with COVID-19 during different phases of the disease and to evaluate the reproducibility of a visual radiologic score for estimating the extent of lung involvement. METHODS: We retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (≥10 days). We analyzed the frequency of each radiologic finding, as well as the pattern, appearance, and predominant distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the extent of involvement in each lobe and in the total lung volume. RESULTS: The predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase (25%), whereas ground-glass opacities were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.92 for the appearance, 0.84 for the distribution, 0.70 for the predominant pattern, and 0.89 for the visual score. CONCLUSION: The CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography / Resultados quirúrgicos de un programa de cribado de cáncer de pulmón utilizando tomografía computarizada de baja dosis

OBJECTIVE: Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. METHODS: We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. RESULTS: Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64 ± 9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2 ± 7.6 mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n = 39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n = 17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%-98%) and 83% (95% CI: 65%-92%), respectively. CONCLUSION: Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively

OBJETIVO: El cáncer de pulmón (CP) es la principal causa de muerte por cáncer en todo el mundo. En España se diagnostican anualmente más de 27.000 CP y la mayoría son irresecables. La detección y el tratamiento tempranos reducen la mortalidad por CP. Este estudio describe los resultados quirúrgicos en una cohorte de cribado de CP de larga duración en España. MÉTODOS: Llevamos a cabo un estudio retrospectivo de los resultados quirúrgicos de un programa de cribado de CP (CCP) usando tomografía computarizada de baja dosis (LDCT, por sus siglas en inglés) en marcha desde el año 2000. Se realizó un análisis descriptivo de los parámetros clínicos y radiológicos, presencia o ausencia de un diagnóstico preoperatorio, estadificación patológica, morbilidad, mortalidad y supervivencia. RESULTADOS: Se diagnosticaron 97 (2,5%) CP entre 3.825 sujetos cribados. Veinte personas con CP no se sometieron a cirugía debido a un estado avanzado de la enfermedad o a una histología de células pequeñas. Se llevaron a cabo 87 procedimientos quirúrgicos por sospecha de CP o CP demostrado mediante biopsia, detectados en la LDCT. La mayoría de los pacientes operados fueron varones (57 [85%]) de 64 años ± 9,1 años. Nueve pacientes se sometieron a una segunda operación por un cáncer de pulmón primario metacrónico. El tamaño medio del tumor fue de 15,2 ± 7,6 mm. Ocho nódulos fueron benignos (9,2%). Se realizó lobectomía en 56 casos (83,6%). El adenocarcinoma (n = 39; 58,2%) fue el tipo histológico más frecuente seguido por el carcinoma de células escamosas (n = 17; 25,4%); 59 (88%) tumores se encontraban en estadio I. Trece pacientes (15,4%) tuvieron 16 complicaciones. Las tasas de supervivencia estimadas a los 5 y 10 años para el estadio I fueron del 93% (IC 95%: 79 al 98%) y del 83% (IC 95%: 65 al 92%), respectivamente. CONCLUSIÓN: El CCP se asoció con excelentes resultados quirúrgicos y con tasas de supervivencia a los 5 y 10 años superiores al 90 y al 80%, respectivamente

[Chest computed tomography findings in different phases of SARS-CoV-2 infection]. / Hallazgos en la tomografía computarizada de tórax en las fases evolutivas de la infección por SARS-CoV-2.

Objective: To compare the findings on chest computed tomography (CT) in patients with COVID-19 during different phases of the disease and to evaluate the reproducibility of a visual radiologic score for estimating the extent of lung involvement. Methods: We retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (≥10 days). We analyzed the frequency of each radiologic finding, as well as the pattern, appearance, and predominant distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the extent of involvement in each lobe and in the total lung volume. Results: The predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase (25%), whereas ground-glass opacities were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.92 for the appearance, 0.84 for the distribution, 0.70 for the predominant pattern, and 0.89 for the visual score. Conclusion: The CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography.

OBJECTIVE: Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. METHODS: We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. RESULTS: Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%-98%) and 83% (95% CI: 65%-92%), respectively. CONCLUSION: Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Valoración del índice de reserva de perfusión miocárdica por resonancia magnética en pacientes con trasplante cardíaco / Cardiac magnetic resonance imaging myocardial perfusion reserve index in heart transplant patients

OBJETIVO: Comparar el índice de reserva de perfusión miocárdica (IRPM) medido por resonancia magnética cardíaca de estrés (RMC-estrés) con regadenosón en sujetos trasplantados frente a no trasplantados. MATERIAL Y MÉTODOS: Se compararon, de forma retrospectiva, 20 trasplantados cardíacos consecutivos, asintomáticos y sin sospecha clínica de enfermedad microvascular, a quienes se realizó RMC-estrés con regadenosón y coronariografía por TC (CTC) para descartar enfermedad vascular del injerto (EVI) respecto a 16 sujetos no trasplantados, con RMC-estrés realizada por indicación clínica, negativa para isquemia y sin signos de cardiopatía estructural. El IRPM se estimó de forma semicuantitativa tras calcular el valor de la pendiente durante la perfusión de primer paso y dividir el valor obtenido en estrés respecto al reposo. Se comparó IRPM en ambos grupos. Los pacientes con RMC-estrés positiva para isquemia o CTC con estenosis coronaria significativa fueron derivados a coronariografía convencional. RESULTADOS: Más de la mitad de los sujetos permanecieron asintomáticos durante la prueba de estrés. La RMC-estrés resultó positiva para isquemia en dos trasplantados, que se confirmó mediante CTC y coronariografía convencional. Los pacientes trasplantados presentaron menor volumen telediastólico indexado (59,3 ±15,2 ml/m2 frente a 71,4±15,9 ml/m2, p = 0,03), menor IRPM (1,35±0,19 vs. 1,6±0,28, p = 0,003 y menor respuesta hemodinámica al regadenosón que los no trasplantados (incremento medio de la frecuencia cardíaca de 13,1±5,4 lpm frente a 28,5±8,9 lpm, p < 0,001). CONCLUSIÓN: La RMC-estrés con regadenosón es una técnica segura. En ausencia de enfermedad coronaria epicárdica significativa, los trasplantados presentan menor IRPM que los no trasplantados, lo que sugiere enfermedad microvascular. En pacientes trasplantados, la respuesta hemodinámica esperable al regadenosón es menor que en no trasplantados

OBJECTIVE: To compare the myocardial perfusion reserve index (MPRI) measured during stress cardiac magnetic resonance imaging (MRI) with regadenoson in patients with heart transplants versus in patients without heart transplants. MATERIAL AND METHODS: We retrospectively compared 20 consecutive asymptomatic heart transplant patients without suspicion of microvascular disease who underwent stress cardiac MRI with regadenoson and coronary computed tomography angiography (CTA) to rule out cardiac allograft vasculopathy versus 16 patients without transplants who underwent clinically indicated stress cardiac MRI who were negative for ischemia and had no signs of structural heart disease. We estimated MPRI semiquantitatively after calculating the up-slope of the first-pass enhancement curve and dividing the value obtained during stress by the value obtained at rest. We compared MPRI in the two groups. Patients with positive findings for ischemia on stress cardiac MRI or significant coronary stenosis on coronary CTA were referred for conventional coronary angiography. RESULTS: More than half the patients remained asymptomatic during the stress test. Stress cardiac MRI was positive for ischemia in two heart transplant patients; these findings were confirmed at coronary CTA and at conventional coronary angiography. Patients with transplants had lower end-diastolic volume index (59.3±15.2 ml/m2 vs. 71.4±15.9 ml/m2 in those without transplants, p = 0.03), lower MPRI (1.35±0.19 vs. 1.6±0.28 in those without transplants, p = 0.003), and a less pronounced hemodynamic response to regadenoson (mean increase in heart rate 13.1±5.4 bpm vs. 28.5±8.9 bpm in those without transplants, p <0.001). CONCLUSION: Stress cardiac MRI with regadenoson is safe. In the absence of epicardial coronary artery disease, patients with heart transplants have lower MPRI than patients without transplants, suggesting microvascular disease. The hemodynamic response to regadenoson is less pronounced in patients with heart transplants than in patients without heart transplants

Cardiac magnetic resonance imaging myocardial perfusion reserve index in heart transplant patients. / Valoración del índice de reserva de perfusión miocárdica por resonancia magnética en pacientes con trasplante cardíaco.

OBJECTIVE: To compare the myocardial perfusion reserve index (MPRI) measured during stress cardiac magnetic resonance imaging (MRI) with regadenoson in patients with heart transplants versus in patients without heart transplants. MATERIAL AND METHODS: We retrospectively compared 20 consecutive asymptomatic heart transplant patients without suspicion of microvascular disease who underwent stress cardiac MRI with regadenoson and coronary computed tomography angiography (CTA) to rule out cardiac allograft vasculopathy versus 16 patients without transplants who underwent clinically indicated stress cardiac MRI who were negative for ischemia and had no signs of structural heart disease. We estimated MPRI semiquantitatively after calculating the up-slope of the first-pass enhancement curve and dividing the value obtained during stress by the value obtained at rest. We compared MPRI in the two groups. Patients with positive findings for ischemia on stress cardiac MRI or significant coronary stenosis on coronary CTA were referred for conventional coronary angiography. RESULTS: More than half the patients remained asymptomatic during the stress test. Stress cardiac MRI was positive for ischemia in two heart transplant patients; these findings were confirmed at coronary CTA and at conventional coronary angiography. Patients with transplants had lower end-diastolic volume index (59.3±15.2 ml/m2 vs. 71.4±15.9 ml/m2 in those without transplants, p=0.03), lower MPRI (1.35±0.19 vs. 1.6±0.28 in those without transplants, p=0.003), and a less pronounced hemodynamic response to regadenoson (mean increase in heart rate 13.1±5.4 bpm vs. 28.5±8.9 bpm in those without transplants, p <0.001). CONCLUSION: Stress cardiac MRI with regadenoson is safe. In the absence of epicardial coronary artery disease, patients with heart transplants have lower MPRI than patients without transplants, suggesting microvascular disease. The hemodynamic response to regadenoson is less pronounced in patients with heart transplants than in patients without heart transplants.

Seguridad del empleo de regadenosón como fármaco vasodilatador en resonancia magnética cardíaca de estrés / Safety of regadenoson for vasodilation in cardiac MRI stress tests

OBJETIVO: Describir la seguridad del regadenosón como fármaco vasodilatador en estudios de resonancia magnética cardíaca (RMC) de estrés realizados para detectar isquemia miocárdica. MATERIAL Y MÉTODOS: Se analizaron de manera retrospectiva los estudios de 120 pacientes (88 varones, edad media 67 ±11,6 años) con sospecha de cardiopatía isquémica o con enfermedad coronaria conocida e indicación clínica para RMC de estrés. Los estudios se realizaron en un equipo de 1,5 Tesla (MAGNETOM Aera, Siemens Healthineers) empleando regadenosón (5ml, 0,4mg) como agente vasodilatador. En todos los pacientes se recogieron los factores de riesgo cardiovascular, fármacos que tomaban e indicación de la prueba, además de las constantes vitales en situación de reposo y bajo estrés y los síntomas y efectos adversos inducidos por el fármaco. RESULTADOS: El 52,6% de los pacientes permanecieron asintomáticos. Los síntomas más frecuentes fueron la opresión centrotorácica (25%) y la disnea (12%). Durante el pico de estrés, el incremento medio de la frecuencia cardíaca fue de 23,9±11,4 lpm y el descenso medio de la presión arterial sistólica y diastólica de 7,1±18,8mmHg y 5,3±9,2mmHg, respectivamente (p < 0,001). En pacientes obesos y diabéticos se objetivó menor respuesta hemodinámica al regadenosón, mientras que los pacientes sintomáticos presentaron mayor incremento de la frecuencia cardíaca (27,4±11,2 lpm frente a 20,6±10,7 lpm, p = 0,001). No se evidenció ningún efecto adverso grave. CONCLUSIÓN: El regadenosón es un fármaco bien tolerado que se puede utilizar con seguridad en RMC de estrés

OBJECTIVE: To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia. MATERIAL AND METHODS: We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67±11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5ml, 0.4mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug. RESULTS: No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9±11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1±18.8mmHg and 5.3±9.2mmHg, respectively (p <0.001). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4±11.2 bpm vs. 20.6±10.7 bpm in asymptomatic patients, p = 0.001). No severe adverse effects were observed. CONCLUSION: Regadenoson is well tolerated and can be safely used for cardiac MRI stress tests

Safety of regadenoson for vasodilation in cardiac MRI stress tests. / Seguridad del empleo de regadenosón como fármaco vasodilatador en resonancia magnética cardíaca de estrés.

OBJECTIVE: To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia. MATERIAL AND METHODS: We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67±11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5ml, 0.4mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug. RESULTS: No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9±11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1±18.8mmHg and 5.3±9.2mmHg, respectively (p <0.001). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4±11.2 bpm vs. 20.6±10.7 bpm in asymptomatic patients, p=0.001). No severe adverse effects were observed. CONCLUSION: Regadenoson is well tolerated and can be safely used for cardiac MRI stress tests.

¿Podría ser útil la resonancia magnética de estrés en pacientes con baja probabilidad de cardiopatía isquémica? / Could stress magnetic resonance imaging be useful in patients with a low probability of ischemic heart disease?

Objetivo: Evaluar la utilidad de la resonancia magnética cardiaca de estrés (RMCE) con adenosina en la detección de cardiopatía isquémica en pacientes con baja probabilidad preprueba. Material y Métodos: Se evaluó la utilidad de la RMCE en una selección de pacientes con baja probabilidad preprueba (riesgo cardiovascular bajo o moderado, dolor torácico atípico o ausencia de cardiopatía isquémica previa) mediante el uso del cociente de probabilidad. Resultados: Se incluyeron 295 pacientes, con un seguimiento de 28 (19-36) meses. Un total de 60 pacientes presentaron un evento. Se observó una mayor utilidad de la RMCE en los pacientes con una probabilidad preprueba baja: dolor torácico atípico (cociente de probabilidad [CP] positivo 8,56), ausencia de cardiopatía isquémica previa (CP positivo 4,85) y riesgo cardiovascular bajo o moderado (CP positivo 3,87). Conclusiones: La RMCE puede ser una técnica útil en el diagnóstico de cardiopatía isquémica en pacientes con baja probabilidad preprueba

Objective: To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. Material and methods: We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). Results: We included 295 patients followed up for a median of 28 (19-36) months. A total de 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). Conclusions: Cardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability

Reconstrucción cinemática en imagen cardiovascular / Kinematic reconstruction in cardiovascular imaging

Objetivo: El avance en aplicaciones clínicas en tomografía computarizada se ha acompañado de mejoras en herramientas de posproceso avanzado. Además de las reconstrucciones multiplanares, planares curvas, de proyección de máxima intensidad y de las reconstrucciones volumétricas, muy recientemente se ha desarrollado la reconstrucción cinemática como técnica que, basada en modelos matemáticos que simulan la de propagación de los haces de luz a través de un volumen de datos, permite obtener imágenes tridimensionales de gran realismo. En este trabajo se ilustran y comparan ejemplos de reconstrucciones cinemáticas respecto a reconstrucciones volumétricas clásicas en pacientes con patología cardiovascular, de manera que se pueden establecer fácilmente las diferencias entre ambos tipos de reconstrucción. Conclusión: la reconstrucción cinemática es un nuevo modo de representar la imagen tridimensional, que facilita la explicación y la comprensión de los hallazgos

Objective: Advances in clinical applications of computed tomography have been accompanied by improvements in advanced post-processing tools. In addition to multiplanar reconstructions, curved planar reconstructions, maximum intensity projections, and volumetric reconstructions, very recently kinematic reconstruction has been developed. This new technique, based on mathematical models that simulate the propagation of light beams through a volume of data, makes it possible to obtain very realistic three dimensional images. This article illustrates examples of kinematic reconstructions and compares them with classical volumetric reconstructions in patients with cardiovascular disease in a way that makes it easy to establish the differences between the two types of reconstruction. Conclusion: Kinematic reconstruction is a new method for representing three dimensional images that facilitates the explanation and comprehension of the findings

Could stress magnetic resonance imaging be useful in patients with a low probability of ischemic heart disease? / ¿Podría ser útil la resonancia magnética de estrés en pacientes con baja probabilidad de cardiopatía isquémica?

OBJECTIVE: To assess the usefulness of cardiac stress magnetic resonance imaging (MRI) with adenosine in the detection of ischemic heart disease in patients with a low pretest probability of disease. MATERIAL AND METHODS: We used the probability ratio to analyze the usefulness of cardiac stress MRI in a selection of patients with a low pretest probability of ischemic heart disease (low or moderate cardiovascular risk, atypical chest pain, or absence of prior ischemic heart disease). RESULTS: We included 295 patients followed up for a median of 28 (19-36) months. A total de 60 patients had an event. Cardiac stress MRI was more useful in patients with a low pretest probability: atypical chest pain (probability ratio [PR] positive 8.56), absence of prior ischemic heart disease (PR positive 4.85), and low or moderate cardiovascular risk (PR positive 3.87). CONCLUSIONS: Cardiac stress MRI can be useful in the diagnosis of ischemic heart disease in patients with a low pretest probability.

Kinematic reconstruction in cardiovascular imaging. / Reconstrucción cinemática en imagen cardiovascular.

OBJECTIVE: Advances in clinical applications of computed tomography have been accompanied by improvements in advanced post-processing tools. In addition to multiplanar reconstructions, curved planar reconstructions, maximum intensity projections, and volumetric reconstructions, very recently kinematic reconstruction has been developed. This new technique, based on mathematical models that simulate the propagation of light beams through a volume of data, makes it possible to obtain very realistic three dimensional images. This article illustrates examples of kinematic reconstructions and compares them with classical volumetric reconstructions in patients with cardiovascular disease in a way that makes it easy to establish the differences between the two types of reconstruction. CONCLUSION: Kinematic reconstruction is a new method for representing three dimensional images that facilitates the explanation and comprehension of the findings.

[Cardiovascular magnetic resonance imaging in patients with acute chest pain]. / Resonancia magnética cardiovascular en pacientes con dolor torácico agudo.

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.

Resonancia magnética cardiovascular en pacientes con dolor torácico agudo / Cardiovascular magnetic resonance imaging in patients with acute chest pain

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)

Valoración de la comorbilidad cardíaca en pacientes con enfermedad pulmonar obstructiva crónica mediante tomografía computarizada multidetector / Multidetector computed tomography assessment of cardiac comorbidity in patients with chronic obstructive pulmonary disease

La comorbilidad cardíaca es uno de los factores pronósticos más importantes en las enfermedades pulmonares, particularmente en la enfermedad pulmonar obstructiva crónica (EPOC). Entre las distintas técnicas de imagen disponibles para estudiar dicha manifestación sistémica concomitante a la EPOC se incluyen el cateterismo cardíaco, la ecocardiografía transtorácica y la resonancia magnética. La tomografía computarizada multidetector (TCMD) ha supuesto un progreso significativo en este campo, al permitir obtener estudios simultáneos de la anatomía cardiopulmonar que van más allá del análisis anatómico-morfológico e incluyen una aproximación funcional a dicha afectación. En este trabajo se repasan aspectos prácticos necesarios para valorar la comorbilidad cardíaca en pacientes con EPOC, tanto desde el punto de vista de la hipertensión pulmonar, como del análisis de la disfunción ventricular y de la enfermedad coronaria (AU)

Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease (AU)