ABSTRACT
BACKGROUND: Ambulatory patients with uncertain functional capacity may benefit from combined exercise and vasodilator stress protocols for myocardial perfusion imaging (MPI). The safety and MPI image quality with regadenoson administered during symptom-limited exercise have not been prospectively evaluated. METHODS AND RESULTS: A total of 140 patients (mean age 61 years, 48% female) referred for exercise with vasodilator stress MPI were randomized 2:1 to a strategy of exercise with regadenoson-as-necessary (Ex-Reg, n = 96) or dipyridamole with exercise (Dip-Ex, n = 44) after Duke Activity Status Index (DASI) scoring (median score 28 vs 24, P = .09). Ex-Reg subjects commenced treadmill exercise and regadenoson was administered only if the subject was unable to reach standard endpoints. Dip-Ex subjects received dipyridamole prior to symptom-limited exercise. Hemodynamics were recorded throughout. Subjects completed symptom questionnaires and MPI image quality was assessed by blinded read. Ex-Reg subjects were more likely to achieve ≥85% age-predicted maximum heart rate than Dip-Ex subjects (57% vs 32%, P < .01). Only 50% of subjects meeting inclusion criteria and randomized to Ex-Reg required regadenoson and none had symptomatic hemodynamic changes. Severe side effects or adverse events occurred in 16% of Ex-Reg and 24% of Dip-Ex subjects (P = .12). MPI image quality was "good" or "excellent" in 88% of Ex-Reg subjects and 86% of Dip-Ex subjects (P = .33). CONCLUSION: A strategy of exercise with regadenoson-as-needed for MPI offers similar safety and side effect profile with similar image quality compared to dipyridamole with exercise, with reduced pharmaceutical use.
Subject(s)
Coronary Artery Disease/diagnostic imaging , Exercise Test/methods , Image Enhancement/methods , Myocardial Perfusion Imaging/methods , Purines , Pyrazoles , Tomography, Emission-Computed, Single-Photon/methods , Adenosine A2 Receptor Agonists , Female , Humans , Male , Middle Aged , Purines/adverse effects , Pyrazoles/adverse effects , Reproducibility of Results , Sensitivity and Specificity , Vasodilator AgentsABSTRACT
Vascular closure devices are commonly used to obtain arterial access site closure after cardiovascular procedures. They are popular as they decrease time to hemostasis and ambulation while improving patient comfort by eliminating need for compression. However, complications due to vascular closure devices are not uncommon. We report a case of possible intravascular distal embolization of water-soluble PEG polymer that is deployed extravascular using the Mynx vascular closure device.
Subject(s)
Coronary Angiography/instrumentation , Embolism/etiology , Femoral Artery/surgery , Hemostatic Techniques/instrumentation , Aged, 80 and over , Equipment Design , Equipment Safety , Female , Humans , Polyethylene GlycolsABSTRACT
BACKGROUND: Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction (HFNEF) remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes. METHODS: Patients of new CHF and left ventricular ejection fraction > 50% were included. Exclusion criteria were recent myocardial infarction, severe valvular heart disease, severe left ventricular hypertrophy (septum >1.8 cm), or a technically insufficient echocardiogram. Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free. RESULTS: One hundred consecutive patients with a 1st admission for HFNEF from January 1, 2004 through December 31, 2007, inclusive, were analyzed. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls. However, systolic strain did not differ significantly between the two groups (-11.7% for those readmitted compared with -12.9% for those free from readmission, P = 0.198) and systolic strain rates also were similar (-1.05 s-1 versus -1.09 s-1, P = 0.545). E/e' was significantly higher in readmitted patients compared with those who remained free from readmission (14.5 versus 11.0, P = 0.013). E/e' (OR 1.189, 95% CI 1.026-1.378; P = 0.021) was found to be an independent predictor for HFNEF readmission. CONCLUSIONS: Among patients with new onset HFNEF, SS and SR rates are reduced compared with patients free of HFNEF, but do not predict hospital readmission. Elevated E/e' is a predictor of readmission in these patients.
Subject(s)
Aging/physiology , Atrial Function, Left/physiology , Echocardiography/methods , Heart Atria/diagnostic imaging , Image Interpretation, Computer-Assisted/methods , Pattern Recognition, Automated/methods , Adolescent , Adult , Algorithms , Child , Child, Preschool , Female , Humans , Image Enhancement/methods , Male , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
Bicuspid aortic valve is a relatively common cause of congestive heart failure in young patients. In a young population, symptoms mnay not correlate with the severity of disease. We report a case of bicuspid aortic valve presenting with clinical features of unicuspid aortic valve, and mild symptoms despite severe hemodynamic compromise.
