Echocardiography Core Laboratory Validation of a Novel Vendor-Independent Web-Based Software for the Assessment of Left Ventricular Global Longitudinal Strain.

BACKGROUND: Global longitudinal strain (GLS) is an accurate and reproducible parameter of left ventricular (LV) systolic function which has shown meaningful prognostic value. Fast, user-friendly, and accurate tools are required for its widespread implementation. We aim to compare a novel web-based tool with two established algorithms for strain analysis and test its reproducibility. METHODS: Thirty echocardiographic datasets with focused LV acquisitions were analyzed using three different semi-automated endocardial GLS algorithms by two readers. Analyses were repeated by one reader for the purpose of intra-observer variability. CAAS Qardia (Pie Medical Imaging) was compared with 2DCPA and AutoLV (TomTec). RESULTS: Mean GLS values were -15.0 ± 3.5% from Qardia, -15.3 ± 4.0% from 2DCPA, and -15.2 ± 3.8% from AutoLV. Mean GLS between Qardia and 2DCPA were not statistically different (p = 0.359), with a bias of -0.3%, limits of agreement (LOA) of 3.7%, and an intra-class correlation coefficient (ICC) of 0.88. Mean GLS between Qardia and AutoLV were not statistically different (p = 0.637), with a bias of -0.2%, LOA of 3.4%, and an ICC of 0.89. The coefficient of variation (CV) for intra-observer variability was 4.4% for Qardia, 8.4% 2DCPA, and 7.7% AutoLV. The CV for inter-observer variability was 4.5%, 8.1%, and 8.0%, respectively. CONCLUSIONS: In echocardiographic datasets of good image quality analyzed at an independent core laboratory using a standardized annotation method, a novel web-based tool for GLS analysis showed consistent results when compared with two algorithms of an established platform. Moreover, inter- and intra-observer reproducibility results were excellent.

Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR).

BACKGROUND: Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. METHODS AND RESULTS: The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. CONCLUSIONS: Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.

Rationale and design of a multicenter, international and collaborative Coronary Artery Aneurysm Registry (CAAR).

Coronary artery aneurysm is defined as a coronary dilation that exceeds the diameter of adjacent segments or the diameter of the patient's largest normal coronary vessel by 1.5×. It is an uncommon disease that has been diagnosed with increasing frequency since the widespread appearance of coronary angiography. The published incidence varies from 1.5% to 5%, suggesting male dominance and a predilection for the right coronary artery. Although several causes have been described, atherosclerosis accounts for ≥50% of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture, and vasospasm, causing ischemia, heart failure, or arrhythmias. The natural history and prognosis remain unknown, as definitive data are scarce. Controversies persist regarding the use of medical management (antithrombotic therapy) or interventional/surgical procedures. Only some case reports or small case series are available about this condition. The Coronary Artery Aneurysm Registry (CAAR; http://www.ClinicalTrials.gov NCT02563626) is a multicenter international ambispective registry that aims to provide insights on anatomic, epidemiologic, and clinical aspects of this substantially unknown entity. In addition, the registry will assess management strategies (conservative, interventional, or surgical) and their short- and long-term results in a large cohort of patients. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov. Unique identifier: NCT02563626.

Usefulness of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide as biomarkers for heart failure in young children with single ventricle congenital heart disease.

Children with single ventricle (SV) physiology have increased ventricular work and are at risk of heart failure (HF). However, a HF diagnosis is especially difficult, because few objective measures of HF have been validated in this cohort. We have previously shown that plasma B-type natriuretic peptide (BNP) levels are sensitive and specific for detecting HF in a small, heterogeneous SV cohort. The aim of the present study was to define the effect of SV morphology and stage of palliation on the correlation between BNP and HF. We also examined the utility of N-terminal pro-BNP (NT-proBNP), a more stable product of pre-BNP processing, as a biomarker of HF in these patients. A cross-sectional observational study of SV children aged 1 month to 7 years was conducted. The presence of HF was defined as a Ross score > 2. The association of BNP or NT-proBNP with HF was assessed using logistic regression analysis and receiver operating characteristic curves. Of the 71 included children, 22 (31%) had clinical HF. A doubling of BNP was associated with an odds ratio for HF of 2.20 (95% confidence interval 1.36 to 3.55, p = 0.001) with a c-statistic > 75%, yielding a detection threshold of ≥ 45 pg/ml. This threshold was preserved when patients were stratified by the right ventricular morphology or stage of surgical palliation. Similarly, a doubling of NT-proBNP was associated with an odds ratio for HF of 1.92 (95% confidence interval 1.17 to 3.14, p = 0.009). In contrast to BNP, the threshold value of NT-proBNP for predicting HF decreased with the stage of palliation. In conclusion, plasma BNP and NT-proBNP are reliable tests for clinical HF in young children with SV physiology, specifically those with right ventricular morphology, regardless of the stage of palliation.

Evaluación del aneurisma apical del ventrículo izquierdo por ecocardiografía bidimensional / Evaluation of apical left ventricular aneurysm with two-dimensional echocardiography

Una complicación frecuente del infarto del miocardio es el aneurisma apical del ventrículo izquierdo (AAVI) que se distiende durante la contracción y secuestra parte del volumen latido y predispone a complicaciones graves. Se estudiaron 20 pacientes postinfarto del miocardio, 10 con AAVI y 10 sin esta complicación, con evaluación cardiológica completa y especial enfoque en la ecocardiografía bidimensional (E 2-D), para el análisis de la contracción ventricular izquierda global, regional y segmentaria. En el grupo con AAVI fue más frecuente el infarto anteroseptal, la regurgitación mitral y la insuficiencia cardiaca (P <0.05). Fue mayor el número de segmentos discinéticos, con valores negativos del acortamiento radial segmentario (P <0.01), con fracción de expulsión global similar en ambos grupos, pero la región apical fue mucho menor (P <0.01). El seguimeinto por dos años mostró que la mortalidad fue mayor en presencia de AAVI (P <0.01) y de los sobrevivientes el 60 por ciento presentaba insuficiencia cardiaca. Se demuestra que la evolución depende principalmente de la cantidad de músculo no afectado, que sea capaz de mantener adecuado gasto después de la resección quirúrgica del AAVI, lo cual es evaluable satisfactoriamente mediante la E 2-D.

Registro electrocardiográfico continuo durante el primer salto en paracaídas / Electrocardiographic recording of the first parachute jump

Mediante registro electrocardiográfico continuo, se estudio el comportamiento del ritmo cardiaco en 13 individuos jóvenes aparentemente sanos, miembros del club de paracaidismo de la Universidad Nacional Autónoma de México, durante su primer salto en paracaidas; 12 del sexo masculino (92.3%) y una mujer (7.6%) con edad promedio de 22.8 años. Dos semanas antes del salto se ralizó historia clínica completa, electrocardiograma de 12 derivaciones y prueba de esfuerzo. Para el registro electrocardiográfico se utilizaron grabadoras Holter de dos derivaciones que se colocaron 30 minutos antes de abordar la avioneta y se obtuvieron registros de aproximadamente una hora. La frecuencia cardiaca promedio se calculó en las siguientes fases: dos semanas antes de la maniobra (64.5 lat/min), durante la prueba de esfuerzo (143.3 lat/min), antes de abordar la avioneta (112.8 lat/min), durante la caída (170 lat/min) y durante el aterrizaje (122.8 lat/min) y se compararon por medio de la desviación estándar, el valor predictivo (p) y los límites de confianza. La diferencia entre cada una de las fases fue estadísticamente significativo con p < 0.001. En todos los casos el ritmo cardiaco fue calificado como taquicardia sinusal, y en 6 casos (43.6%) se observaron 22 episodios de disminución súbita de al frecuencia cardiaca. No se presentaron trastornos graves del ritmo ni la conducción cardiaca. En nueve casos se registro el nivel de catecolaminas urinarias inmediatamente después del salto (x 51.2 ug/100 ml) y dos semanas (x56.0 ug/100 ml), sin encontrar diferencia estadísticamente significativa. Se concluyó que el estrés intenso de duración limitada, no es capaz de provocar alteraciones graves del ritmo cardiaco en sujetos jóvenes aparentemente sanos. Las características del estuido permiten clasificarlo como longitudinal, descriptivo, experimental y prolectivo

Paragangliomatosis multiple: el problema de su localización; informe del primer caso estudiado con (131I) meta-iodobenzilguanidina en nuestro medio y revisión de la literatura / Multiple chromaffin tumors: report of a case studied with (131i) meta iodo-benzyl-guanidine and review of the literature

Los tumores de tejido cromafín, hormonalmente activos y capaces de producir daño a varios órganos e incluso la muerte, con frecuencia permanecen insospechados ejerciendo por períodos prolongados su efecto deletéreo. Con frecuencia son múltiples y al problema de su diagnóstico se agrega el de su localización. Describimos el caso de una mujer joven, con historia de episodios paroxísticos de palpitaciones, disnea, opresión precordial e hipertensión arterial de ocho años de evolución. El diagnóstico de tumor cromafín fue realizado a través de determinación de catecolaminas séricas y urinarias. Fué intervenida quirúrgicamente en tres ocasiones después de efectuar ultrasonografía de abdomen y pelvis, tomografía axial computada de torax, abdomen y pelvis, muestreo hormonal a través de cavografía; arteriografía selectiva y empleo de metaiodo-benzyl-guanidina 131. Enfatizamos la incapacidad de los métodos empleados, cruentos e incruentos y la ausencia del procedimiento ideal cuando se emplean aisladamente. Recomendamos también el estudio de la respuesta presora al ejercicio en banda sinfín para evaluar el comportamiento de las resistencias periféricas en sí, una vez conseguida la curación quirúrgica