Role of sCD40L in the prediction of super response to cardiac resynchronization therapy / Rol de sCD40L en la predicción de súper respuesta a la terapia de resincronización cardiaca

Background: The aim of this paper is to analyze the roleof the biomarkers Interleukin 6, Tumoral Necrosis Factor α,sCD40L, high sensitive Troponin T, high sensitive C-ReactiveProtein and Galectin-3 in predicting super response (SR) toCardiac Resynchronization Therapy (CRT), as they have notbeen studied in this field before. Methods: Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year.SR was defined as reduction in LVESV ≥ 30% at one yearfollow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed. Results: 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p = 0.04),suffering from less ischemic cardiomyopathy (13 vs. 63%,p < 0.0001) and lateral (0 vs. 18%, p = 0.03), inferior (4 vs.33%, p = 0.01) and posterior infarction (0 vs. 22%, p = 0.01);absence of mitral regurgitation (47% vs. 22%, p = 0.04), wider QRS width (157.7 ± 22.9 vs. 140.8 ± 19.2ms, p = 0.01), higher concentrations of sCD40L (6.9 ± 5.1 vs. 4.4 ± 3.3 ng/mL,p = 0.02), and left ventricular lead more frequent in lateralmedial position (69 vs. 26%, p = 0.002). QRS width, lateralmedial position of the lead and absence of mitral regurgitation were independent predictors of SR. sCD40L showeda moderate direct correlation with SR (r = 0.39, p = 0.02) andwith the reduction of LVESV (r = 0.44, p = 0.02). Conclusion: sCD40L correlates significantly with SR to CRT.QRS width, absence of mitral regurgitation and lateral medial position of the lead are independent predictors of SRin this cohort.(AU)

Fundamento: Analizar los biomarcadores Interleuquina 6,factor de necrosis tumoral α, sCD40L, troponina T hipersensible, proteína Creactiva hipersensible y galectina-3 en lapredicción de súper-respuesta (SR) a la terapia de resincronización cardiaca (TRC), ya que no han sido valorados conanterioridad. Material y métodos: Se recopilaron datos clínicos, electrocardiográficos y ecocardiográficos preimplante y al año.Se definió SR como disminución del VTSVI ≥ 30% al añode seguimiento. Las muestras sanguíneas fueron extraídaspreimplante. Se realizó regresión logística multivariante ycurvas ROC. Resultados: Se incluyeron 50 pacientes, 23 (46%) fueronSR.Las características relacionadas con la SR fueron: ser mujer (35 vs. 11%, p = 0,04), sufrir menos cardiopatía isquémica(13 vs. 63%, p < 0,0001) e infarto lateral (0 vs. 18%, p = 0,03),inferior (4 vs. 33%, p = 0,01) y posterior (0 vs. 22%, p = 0,01); ausencia de insuficiencia mitral (47% vs. 22%, p = 0,04), mayor anchura del QRS (157,7 ± 22,9 vs. 140,8 ± 19,2 ms, p = 0,01), mayorconcentración de sCD40L (6,9 ± 5,1 vs. 4,4 ± 3,3 ng/mL, p = 0,02),y electrodo ventricular izquierdo más frecuentemente en posición lateral media (69 vs. 26%, p = 0,002). El QRS, la posiciónlateral media del electrodo y la ausencia de insuficiencia mitral fueron predictores independientes de SR. sCD40L mostróuna correlación moderada directa con SR (r = 0,39, p = 0,02) ycon la disminución del VTSVI (r = 0,44, p = 0,02). Conclusiones: sCD40L se correlaciona significativamentecon SR a la TRC. El QRS, la ausencia de insuficiencia mitraly la posición lateral media del electrodo son predictores independientes de SR en esta cohorte.(AU)

Role of sCD40L in the prediction of super-response to cardiac resynchronization therapy.

BACKGROUND: The aim of this paper is to analyze the role of the biomarkers Interleukin 6, Tumoral Necrosis Factor a, sCD40L, high sensitive Troponin T, high sensitive C-Reactive Protein and Galectin-3 in predicting super response (SR) to Cardiac Resynchronization Therapy (CRT), as they have not been studied in this field before. METHODS: Clinical, electrocardiographic and echocardiographic data was obtained preimplant and after one year. SR was defined as reduction in LVESV = 30% at one year follow-up. Blood samples were extracted preimplant. Multivariate logistic regression and ROC curves were performed. RESULTS: 50 patients were included, 23 (46%) were SR. Characteristics related to SR were: female (35 vs. 11%, p?=?0.04), suffering from less ischemic cardiomyopathy (13 vs. 63%, p?

[Normal anatomy, anatomical variants, and anomalies of the origin and course of the coronary arteries on multislice CT]. / Anatomía normal, variantes anatómicas y anomalías del origen y trayecto de las arterias coronarias por tomografía computarizada multicorte.

Cardiovascular disease is the leading cause of death in adults in developed countries. Conventional coronary angiography is the technique of choice for the detection of coronary disease; however, this technique is not without complications. Nowadays, a significant proportion of conventional coronary angiography examinations are performed solely for diagnostic purposes. Multislice CT enables noninvasive study of the coronary arteries. This technique involves many professionals from different specialties and is constantly evolving. This article aims to provide an initiation to the fundamentals of multislice CT coronary angiography. We describe the classification of coronary arteries, as well as the normal anatomy, anatomical variants, and anomalies of the origin and course of the coronary arteries in axial images, in maximum intensity reconstructions, and in volumetric reconstructions. We also describe the myocardial segments and their vascularization.

Anatomía normal, variantes anatómicas y anomalías del origen y trayecto de las arterias coronarias por tomografía computarizada multicorte / Normal anatomy, anatomical variants, and anomalies of the origin and course of the coronary arteries on multislice CT

Las enfermedades cardiovasculares constituyen la primera causa de muerte en adultos en los países desarrollados. La técnica de elección para diagnosticar enfermedad coronaria es la coronariografía convencional, un procedimiento no exento de complicaciones. Actualmente, un porcentaje significativo de las exploraciones anuales se realizan únicamente con fines diagnósticos. La tomografía computarizada multicorte (TCMC) permite estudiar las arterias coronarias de forma no invasiva. Se trata de una técnica en continuo desarrollo, que involucra un gran número de profesionales de distintas especialidades. Como aproximación básica inicial a la coronariografía por TCMC en este trabajo se describen la clasificación de las arterias coronarias, la anatomía normal de las arterias coronarias en imágenes axiales, reconstrucciones de proyección de máxima intensidad y reconstrucciones volumétricas, y las variantes anatómicas y las anomalías del origen y trayecto de las arterias coronarias. Se describen, además, los segmentos miocárdicos y su correspondiente vascularización (AU)

Cardiovascular disease is the leading cause of death in adults in developed countries. Conventional coronary angiography is the technique of choice for the detection of coronary disease; however, this technique is not without complications. Nowadays, a significant proportion of conventional coronary angiography examinations are performed solely for diagnostic purposes. Multislice CT enables noninvasive study of the coronary arteries. This technique involves many professionals from different specialties and is constantly evolving. This article aims to provide an initiation to the fundamentals of multislice CT coronary angiography. We describe the classification of coronary arteries, as well as the normal anatomy, anatomical variants, and anomalies of the origin and course of the coronary arteries in axial images, in maximum intensity reconstructions, and in volumetric reconstructions. We also describe the myocardial segments and their vascularization (AU)

[Quantification of ventricular mass and function using real-time free-breathing SSFP sequences]. / Cuantificación de la función y masa ventricular con secuencias SSFP en tiempo real y respiración libre.

OBJECTIVES: To compare real-time free-breathing steady-state free precession (SSFP) sequences with conventional breath-hold segmented SSFP sequences on the quantification of ventricular mass and function. MATERIAL AND METHODS: Cardiac function and mass were assessed in 15 consecutive patients with cardiopathies who underwent MRI for diverse indications. Sequences were planned in the short axis to include the area from the base to the apex of the ventricle. Two sequences were used: 1) a conventional breath-hold segmented SSFP sequence with 7-mm-thick slices and 3-mm gap between slices and 2) a real-time free-breathing SSFP sequence with 10-mm-thick slices. The systolic and diastolic volumes (VTD, VTS) and ejection fraction (EF) of both ventricles were evaluated and the mass of the left ventricle (LVM) was measured. The correlation between the different sequences was studied for each variable. RESULTS: An excellent correlation was observed between the two sequences on the quantification of cardiac parameters in both ventricles (0.9; p < 0.01). The mean differences for EF, VTD, VTS, and stroke volume (VTD-VTS) were 2.5% (2.1), 5.6 ml (14.2), -0.8 ml (6.4), 6.4 ml (9.4), respectively, for the left ventricle and 1.7% (3.1), 1.8 ml (18.7), -1.9 ml (9.8), 3.7 ml (10.8), respectively, for the right ventricle. The mean difference between the LVM was 4.8 g (6.3). CONCLUSIONS: The real-time free-breathing SSFP sequence is useful for the quantification of ventricular mass and function. The correlation with conventional SSFP is excellent. Both sequences allow the cardiac parameters to be precisely quantified and the results are reproducible.

Cuantificación de la función y masa ventricular con secuencias SSFP en tiempo real y respiración libre / Quantification of ventricular mass and function using real-time free-breathing SSFP sequences

Objetivos. Comparar la cuantificación de la función y masa ventricular en estudios de resonancia magnética (RM) cardíaca realizados con una secuencia SSFP en tiempo real y respiración libre (SSFP-RL) con respecto a la secuencia SSFP segmentada convencional (SSFP-apnea). Material y métodos. Se analizó la función y masa cardíaca en 15 pacientes consecutivos con cardiopatía a los que se realizó RM por diversas indicaciones. Las secuencias se planificaron en plano eje corto, incluyendo desde la base hasta el ápex ventricular. Se emplearon dos secuencias: secuencia segmentada SSFP convencional en apnea, de 7 mm de grosor de corte e intervalo de 3 mm y secuencia SSFP en tiempo real y respiración libre de 10 mm de grosor de corte. Se evaluaron los volúmenes (volumen telediastólico [VTD] y volumen telesistólico [VTS]) y fracción de eyección (FE) de ambos ventrículos y la masa ventricular izquierda (MVI). Se estudió la correlación entre las distintas secuencias para cada variable. Resultados. Se observó una correlación excelente entre las dos secuencias realizadas para la cuantificación de parámetros cardíacos en ambos ventrículos (0,9; p < 0,01). Las diferencias medias para la FE, VTD, VTS y volumen latido fueron 2,5% (2,1); 5,6 ml (14,2); -0,8 ml (6,4); 6,4 ml (9,4) para el ventrículo izquierdo y 1,7% (3,1); 1,8 ml (18,7); -1,9 ml (9,8); 3,7 ml (10,8) para el ventrículo derecho. La diferencia media de la masa ventricular izquierda (MVI) fue de 4,8 g (6,3). Conclusiones. La secuencia SSFP en tiempo real y respiración libre es útil para cuantificar la función y masa ventricular. La correlación es excelente con respecto a la secuencia SSFP convencional. Ambas secuencias permiten la cuantificación de los parámetros cardíacos de forma exacta y reproducible

Objectives. To compare real-time free-breathing steady-state free precession (SSFP) sequences with conventional breath-hold segmented SSFP sequences on the quantification of ventricular mass and function. Material and methods. Cardiac function and mass were assessed in 15 consecutive patients with cardiopathies who underwent MRI for diverse indications. Sequences were planned in the short axis to include the area from the base to the apex of the ventricle. Two sequences were used: 1) a conventional breath-hold segmented SSFP sequence with 7-mm-thick slices and 3-mm gap between slices and 2) a real-time free-breathing SSFP sequence with 10-mm-thick slices. The systolic and diastolic volumes (VTD, VTS) and ejection fraction (EF) of both ventricles were evaluated and the mass of the left ventricle (LVM) was measured. The correlation between the different sequences was studied for each variable. Results. An excellent correlation was observed between the two sequences on the quantification of cardiac parameters in both ventricles (0.9; p < 0.01). The mean differences for EF, VTD, VTS, and stroke volume (VTD-VTS) were 2.5% (2.1), 5.6 ml (14.2), -0.8 ml (6.4), 6.4 ml (9.4), respectively, for the left ventricle and 1.7% (3.1), 1.8 ml (18.7), -1.9 ml (9.8), 3.7 ml (10.8), respectively, for the right ventricle. The mean difference between the LVM was 4.8 g (6.3). Conclusions. The real-time free-breathing SSFP sequence is useful for the quantification of ventricular mass and function. The correlation with conventional SSFP is excellent. Both sequences allow the cardiac parameters to be precisely quantified and the results are reproducible

[Cardiac magnetic resonance imaging of congenital heart defects in adults]. / Resonancia magnética cardíaca de las cardiopatías congénitas en el adulto.

The study of congenital cardiopathies (CC) is one of the most clearly established indications of cardiac magnetic resonance imaging (CMRI). Different sequences, including anatomic, functional, flow (phase contrast), and 3D angiographic sequences, enable the diagnosis, treatment planning, and follow-up of these conditions. CMRI allows the anatomy, function, and alterations of flow in these cardiopathies to be evaluated in a single examination. Three-dimensional MR angiography enables the study of the great vessels and the anomalies associated to congenital heart defects in adults. This article describes an examination protocol and provides examples of MR images of the most common CC in adults: atrial septal defect, interventricular communication, atrioventricular canal, tetralogy of Fallot, transposition of the great arteries, congenitally corrected transposition of the great arteries, bicuspid aortic valve, subaortic stenosis, aortic coarctation, and Ebstein's anomaly.

Resonancia magnética cardíaca de las cardiopatías congénitas en el adulto / Diffusion-weighted whole-body MRI (virtual PET) in screening for osseous metastases

Objetivo. Presentar nuestra experiencia preliminar en resonancia magnética de cuerpo entero (RMCE) en el cribado de metástasis óseas, añadiendo la secuencia de difusión de todo el cuerpo. Material y métodos. Veinticuatro pacientes con neoplasias malignas fueron estudiados con gammagrafía ósea (GO) y RM de cuerpo entero añadiendo secuencia de difusión. La RMCE se realizó con un equipo de 1.5 T en 3 estaciones en el plano coronal FSE T1 y STIR y plano sagital FSE T1 del raquis. Se añadió la secuencia de difusión (b: 600 s/mm2) de RMCE en el plano axial en 5 estaciones diferentes y presentación iconográfica en reconstrucción en el plano coronal con inversión del contraste para obtener una imagen similar a la de la tomografía por emisión de positrones (PET) (PET virtual). Los hallazgos de la GO y la RM fueron comparados para la existencia o no de metástasis óseas, valorando al paciente tanto globalmente como por regiones óseas. Las lesiones metastásicas se confirmaron por biopsia o seguimiento en 6-8 meses Resultados. Globalmente, la RMCE con difusión fue superior a la GO, sensibilidad 100% (GO 71%), especificidad 90% (GO 80%) y fiabilidad 96% (GO 75%). Valorando por regiones óseas, la RM tuvo también unos resultados superiores a la GO: sensibilidad 96% (GO 52%). En difusión las metástasis líticas fueron hiperintensas en todos los casos, con un valor ADC superior al hueso sano pero inferior a las lesiones con edema agudo de etiología benigna. La RMCE mostró, además, hallazgos extraóseos desconocidos relacionados con el tumor y en un 42% de los pacientes metástasis extraóseas. Conclusiones. La RMCE añadiendo la secuencia de difusión es un método eficaz para detectar metástasis óseas con fiabilidad superior a la gammagrafía; aportando además información sobre lesiones extraóseas. Las metástasis líticas se comportan de forma hiperintensa en difusión y tienen un valor ADC inferior al edema benigno (AU)

Objective. To present our preliminary experience in whole-body MRI with an added diffusion-weighted sequence in screening for osseous metastases. Material and methods. 24 patients with malignant neoplasms underwent bone scintigraphy and whole-body MRI with the addition of a diffusion-weighted sequence. Whole-body MRI was performed on a 1.5 T unit using a three-station protocol; coronal T1-weighted FSE and STIR sequences and sagittal T1-weighted FSE of the spine were acquired. A diffusion-weighted sequence (b: 600 s/mm2) was added in the axial plane at five different stations and iconographic presentation in coronal-plane reconstructions with contrast inversion was used to obtain an image similar to that provided by PET (virtual PET). The findings at bone scintigraphy (BS) and MRI were compared for the presence of osseous metastases, evaluating the results for each patient both globally and for different osseous regions. Metastatic lesions were confirmed by biopsy or by six to eight months' follow-up. Results. Globally, whole-body MRI with diffusion-weighted sequences was superior to bone scintigraphy, with a sensitivity of 100% (BS 71%), specificity 90% (BS 80%), and reliability 96% (BS 75%). In the evaluation by osseous region, the results of MRI were also better than those of bone scintigraphy: sensitivity 96% (BS 52%). In the diffusion-weighted sequence, lytic metastases were hyperintense in all cases, with an apparent diffusion coefficient (ADC) value higher than normal bone but lower than lesions with acute edema of benign etiology. Whole-body MRI also revealed unknown extraosseous findings related to the tumors and extraosseous metastases in 42% of the patients. Conclusions. Whole-body MRI with an added diffusion-weighted sequence is an efficacious method of detecting osseous metastases and is more reliable than bone scintigraphy. Moreover, whole-body MRI provides information about extraosseous lesions. Lytic metastases are hyperintense in diffusion-weighted sequences and have a lower ADC than benign edema (AU)