Evaluation and implications of mitral regurgitation using cMRI in patients with hypertrophic cardiomyopathy.

OBJECTIVE: Mitral regurgitation (MR) represents an important feature in patients with hypertrophic cardiomyopathy (HCM) due to left ventricular outflow tract (LVOT) obstruction and mitral valve systolic anterior motion (SAM). Mitral valve anatomical variants associated with HCM also contribute to the severity of MR. The aim of this study is to evaluate MR severity and its correlation with different parameters in patients with HCM using cardiac magnetic resonance imaging (cMRI). PATIENTS AND METHODS: 130 patients with HCM underwent cMRI. Parameters assessed for the quantification of MR severity were mitral regurgitation volume (MRV) and mitral regurgitation fraction (MRF). cMRI was also used to characterize LV function, left atrium volume (LAV) index, filling pressures and structural abnormalities associated with HCM, all in correlation to MR. RESULTS: Patients with HCM had mild (26.9%), moderate (52.3%) or severe (20.7%) MR. Most relevant parameters related to MR severity were MRV and MRF; other parameters with strong correlation with MR were LAV index and E/E' ratio, both increasing with its severity. Patients with LVOT obstruction had more severe MR (70.3%), 79% of them due to SAM. LV ejection fraction (LVEF) increased proportionally with the severity of MR, while LV strain (LAS) was inversely correlated with it. Independent predictors for quantifying the severity of MR, after the adjustment for covariates, were MRV, MRF, SAM, LAV index and E/E'. CONCLUSIONS: cMRI can accurately assess MR in patients with HCM, especially by using novel indicators, MRV and MRF respectively, along with LAV index and E/E' ratio. Severe MR, due to SAM, is more frequent in the obstructive form of HCM (HOCM). Also, the severity of MR is significantly associated with significantly associated with MRV, MRF, LAV index and E/E' ratio.

Characterization of left atrial geometry and function in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study.

OBJECTIVE: Left atrial (LA) remodelling is an interesting pathological aspect in hypertrophic cardiomyopathy (HCM) which has not been yet fully understood. Also, a comprehensive evaluation of LA alterations in HCM is still lacking. Cardiac magnetic resonance imaging (cMRI) can precisely characterize LA function and structure. We sought to thoroughly assess LA remodelling using cMRI in patients with HCM. PATIENTS AND METHODS: We enrolled 105 patients with HCM and 105 healthy controls. LA parameters determined by cMRI comprise LA volume (LAV), total ejection fraction (LATF), total strain LA- εt, passive ejection fraction (LAPF), passive strain LA-εe, active ejection fraction (LAAF), active strain LA-εa. LA sphericity index (LASI) and LA strain were also determined. Parameters of LV systolic and diastolic functions were also assessed. RESULTS: LAV and LASI were significantly increased, while LA phasic functions were decreased in patients with HCM (p<.001). LATF was inversely correlated with LV long-axis strain (r= -0.466, p<.0001) and mass (r= -0.515, p<.0001), and as well with filling pressures, described by E/E' (r= -0.424, p<.0001). LA volumes, phasic functions and geometry were negatively associated with LV measurements, whereas a positive correlation between the LATF and LA strain (r = 0.496, p<.0001) was found. In addition, LAV was closely related to diastolic dysfunction severity (p<.0001). CONCLUSIONS: In patients with HCM, all three LA phasic functions were impaired, being directly related to LA enlargement. LASI and LA strain predicted LA reservoir function impairment.

Predictive ability of coronary computed tomography angiography parameters in patients suspected of obstructive coronary artery disease: a single-center cross-sectional study.

OBJECTIVE: Coronary computed tomography angiography (CCTA) is becoming increasingly useful for the diagnosis of coronary artery disease (CAD). Coronary calcium score (CCS), epicardial fat volume (EFV), and number of coronary plaques (NoP) add important information for the risk stratification and prognosis prediction of these patients. However, evidence about their ability to predict obstructive CAD is limited. We sought to evaluate the ability of CCTA parameters in predicting obstructive CAD. PATIENTS AND METHODS: We conducted a cross-sectional, single-center study on patients at risk to develop CAD. CAD was defined as coronary stenosis > 50% after the other one (CCS, EFV and NoP were determined by CCTA). CCS was then ranked 5 severity groups: 0, 1-99, 100-399,400-999, and ≥1000. NoPs were classified in four categories: no plaques, 1-5, 6-10 and ≥10. Logistic regression analyses were performed, and statistical analysis was considered significant if p<0.05. RESULTS: Of all 540 patients (55.8±11.1 years) who met the enrolment criteria, 98 had obstructive CAD. CCS, EFV and NoP were significantly associated with the presence of obstructive CAD (p<0.0001). The area under the receiver operating characteristics (ROC) analysis revealed significant cut-off values (p<0.0001) of CCS (70.3), EFV (40.8), NoP (4) for predicting obstructive CAD. Their association proved to have an AUC of 0.969, and a specificity of 95%. A scoring system based on regression coefficients which proved to have statistical significance for obstructive CAD as further constructed. It included EFV, CCS and left ventricular ejection fraction. This scoring system significantly predicted obstructive CAD for a cut-off value of 62.46, with a NPV of 96.3%. CONCLUSIONS: The combined use of CCS, EFV and NoPs increases the predictive ability for obstructive CAD of each parameter used alone. These could be useful for developing a novel scoring system.

Aging influences pulmonary artery flow and stiffness in healthy individuals: non-invasive assessment using cardiac MRI.

AIM: To investigate age-related changes of the pulmonary artery (PA) using cardiac magnetic resonance imaging (cMRI) in healthy subjects. MATERIALS AND METHODS: A cross-sectional observational study was conducted on apparently healthy subjects who underwent PA velocity-encoded cMRI. cMRI was used to determine PA stiffness parameters such as PA elasticity, relative area change (PA-RAC) and pulse-wave velocity (PA-PWV), and PA flow parameters by subtracting simultaneous forward flow (FF) and backward flow (BF) velocity across the PA cross-section. Data were presented in five age and sex matched groups. RESULTS: One hundred and fifty subjects (20-70 years, 75 men) met the enrolment criteria. PA elasticity and PA-RAC significantly decreased with age (p<0.001), while PA-PWV, regurgitant volume (Vreg) and backward flow volume (VBF) increased in the elderly (p<0.001). Linear regression analysis indicated that PA elasticity (r=-0.441, p<0.0001) and PA-RAC (r=-0.484, p<0.0001) were indirectly and negatively associated with advancing age, whereas PAmin (r=0.331, p<0.0001), PA-PWV (r=0.490, p<0.0001), VReg (r=0.335, p<0.0001) and VBF (r=0.349, p<0.0001) were directly associated with age. Multivariate analysis indicated that age was independently associated with Vreg and VBF, and the addition of PAmin and PA-PWV marginally increased its predictive capacity. CONCLUSION: Aging significantly increases cMRI-based PA flow and stiffness parameters. These could become relevant markers of subclinical changes of the PA geometry in healthy subjects.

Thrombolysis rate and impact of a stroke code: a French hospital experience and a systematic review.

BACKGROUND: Intravenous rt-PA is effective in hyperacute ischemic stroke (HAIS) but is administered only in few patients. OBJECTIVES: To report the thrombolysis rate in our stroke unit using a stroke code (SC) protocol with a prenotification system and to analyze the SC impact on the thrombolysis rate in a systematic review. METHODS: We report, from 2005 to 2009, the intravenous rt-PA rate in our prospective registry of hyperacute strokes suspicions. The systematic review was conducted in searching PubMed and EMBASE for prospective studies reporting thrombolysis rates and their use of a SC. We categorized SC between those with a prenotification by the Emergency Medical Services and those with only an in-hospital SC system. RESULTS: Among the 1450 stroke patients hospitalized in our stroke unit, 349 were admitted via the SC protocol as suspicions of hyperacute strokes. Intravenous rt-PA rates were: 12.9% of the ischemic strokes, 36% of the suspicions of hyperacute strokes and 59.6% of the HAIS. We found 23 studies reporting thrombolysis rates ranging from 10.3% to 58% of HAIS. Ten studies gave data concerning the use of a SC in case of HAIS. Thrombolysis rate was higher in hospitals with a prenotification system (54.7%) compared with both those with no specific organization (18.2%) (OR=5.43, 95% CI: 3.84-7.73) and those with an in-hospital restricted SC (37.9%) (OR=1.97, 95% CI: 1.53-2.54). CONCLUSIONS: Thrombolysis rate of HAIS is improved by a SC, especially when a prenotification system of thrombolysis candidates by Emergency Medical Services to the stroke unit is used.

Cerebral abscess due to an abnormal drainage of the superior vena cava.

INTRODUCTION: Causes of brain abscesses are multiple and often unclear. We present the case of a pregnant woman who developed a temporal brain abscess revealed by an epileptic seizure. OBSERVATION: Perfusion lung scan was performed because she had a mild hypoxemia: absence of contrast into the pulmonary arteries was suggestive of a massive intracardiac shunt or an anomalous drainage of the superior vena cava. Contrast-enhanced echography showed an abnormal drainage of the superior vena cava into the left atrium. CONCLUSION: Although rare, this anomaly can exist in adults. This report emphasizes the necessity of effective cardiologic investigations in case of unexplained brain abscess.

[Fluoroethylthyrosine 18F PET in the detection of brain tumours]. / TEP à la fluoroéthyltyrosine (18F) pour la détection des tumeurs cérébrales.

UNLABELLED: PET with fluoroethylthyrosine (FET), amino-acid analogue, has been performed in Germany since the beginning of the decade for molecular and metabolic imaging of brain tumours, since FDG, the glucose analogue which is the reference tracer for clinical PET, has this drawback to be taken-up intensely by cerebral cortex. We report on our preliminary results on the comparison of PET/CT with FET and FDG in 10 evaluable patients presenting with a brain lesion either at diagnosis or after treatment. In an attempt to optimise specificity, FET PET/CT has been acquired as a static image 1h after injection, while the most current practice is a dynamic 40 min acquisition starting at FET injection. With our acquisition protocol, diagnostic performance of FET was 88% sensitivity and 80% accuracy vs 13% and 30% respectively for FDG. CONCLUSION: FET is a radiopharmaceutical with clinical usefulness for the diagnosis, delineation and monitoring of brain tumours. Association with FDG allows identification of high-grade lesions or components, but it could be avoided providing that acquisition and quantification procedures of FET PET/CT would have been better optimised and standardised.

Undersea psychophysiologic reactions of human organism.

The determinations carried out on 12 divers during the immersion into the sea to a depth between 7 and 29 m, as well as on controls in immersions at 4 m revealed a significant prolongation of the visual reaction time and a marked tachycardia. The changes were more marked at great depths and if exercise was superimposed over hyperbaric stress. A rise in the urinary excretion of 17-HOCS and vanillylmandelic acid and an impairment of the manual dexterity were also found during immersions. The results stress the importance of divers' monitoring during their underwater activity and the necessity of improving their physical training.

Incidence of hepatitis B surface antigen (HBsAg) in some areas of Romania.

The incidence of HBsAg in several areas of Romania was studied by 253,460 routine determinations performed from 1973 to 1975. HBsAg incidence was of 1.5% in blood donors and reached the highest value in acute viral hepatitis patients undifferentiated according to the clinical form. The values obtained were in agreement with the results of other studies covering more limited zones of the country. Considerable differences in HBsAg incidence depending on geographic area were observed.