ABSTRACT
We report the case of a 74-year-old man having angioplasty following admission with a troponin positive acute coronary syndrome. Due to heavy coronary artery calcification, rotablation was used. The procedure was complicated by a stuck burr ("Kokeshi phenomenon"). We employed a novel method to safely remove the burr and complete the procedure.
ABSTRACT
Acute aortic dissection is an important differential diagnosis to exclude in the emergency presentation of patients with acute chest pain. Misdiagnosis can be fatal if treatment with antithrombotic agents (for presumed acute coronary syndrome) is administered. We present a series of two patients who presented to our center with acute DeBakey Type III (or Stanford Type B) aortic dissection where transthoracic echocardiography was useful in making the diagnosis, which was later confirmed by computed tomography contrast angiography of the aorta. Although transthoracic echocardiography has a lower sensitivity compared with other imaging techniques, it may still be helpful in the emergency setting, particularly in hemodynamically unstable patients, for whom there are sometimes unavoidable delays in getting contrast-enhanced computed tomography or more invasive investigations like transesophageal echocardiography to establish the diagnosis.
Subject(s)
Aortic Dissection/diagnostic imaging , Aortic Rupture/diagnostic imaging , Echocardiography/methods , Acute Disease , Aged , Diagnosis, Differential , Humans , MaleABSTRACT
OBJECTIVES: We aimed to assess a novel measure of left ventricular (LV) dyssynchrony, a cardiovascular magnetic resonance-tissue synchronization index (CMR-TSI), in patients with heart failure (HF). A further aim was to determine whether CMR-TSI predicts mortality and major cardiovascular events (MCE) after cardiac resynchronization therapy (CRT). BACKGROUND: Cardiac dyssynchrony is a predictor of mortality in patients with HF. The unparalleled spatial resolution of CMR may render CMR-TSI a predictor of clinical benefit after CRT. METHODS: In substudy A, CMR-TSI was assessed in 66 patients with HF (age 60.8 +/- 10.8 years, LV ejection fraction 23.9 +/- 12.1% [mean +/- SD]) and 20 age-matched control subjects. In substudy B, CMR-TSI was assessed in relation to clinical events in 77 patients with HF and with a QRS > or =120 ms undergoing CRT. RESULTS: In analysis A, CMR-TSI was higher in patients with HF and a QRS <120 ms (79.5 +/- 31.2 ms, p = 0.0003) and in those with a QRS > or =120 ms (105.9 +/- 55.8 ms, p < 0.0001) than in control subjects (21.2 +/- 8.1 ms). In analysis B, a CMR-TSI > or =110 ms emerged as an independent predictor of the composite end points of death or unplanned hospitalization for MCE (hazard ratio [HR] 2.45; 95% confidence interval [CI] 1.51 to 4.34, p = 0.0002) or death from any cause or unplanned hospitalization for HF (HR 2.15; 95% CI 1.23 to 4.14, p = 0.0060) as well as death from any cause (HR: 2.6; 95% CI 1.29 to 6.73, p = 0.0061) and cardiovascular death (HR 3.82; 95% CI 1.63 to 16.5, p = 0.0007) over a mean follow-up of 764 days. CONCLUSIONS: Myocardial dyssynchrony assessed by CMR-TSI is a powerful independent predictor of mortality and morbidity after CRT.
