Magnetic resonance in patients with cardiovascular devices. SEC-GT CRMTC/SEC-Heart Rhythm Association/SERAM/SEICAT consensus document.

Magnetic resonance has become a first-line imaging modality in various clinical scenarios. The number of patients with different cardiovascular devices, including cardiac implantable electronic devices, has increased exponentially. Although there have been reports of risks associated with exposure to magnetic resonance in these patients, the clinical evidence now supports the safety of performing these studies under specific conditions and following recommendations to minimize possible risks. This document was written by the Working Group on Cardiac Magnetic Resonance Imaging and Cardiac Computed Tomography of the Spanish Society of Cardiology (SEC-GT CRMTC), the Heart Rhythm Association of the Spanish Society of Cardiology (SEC-Heart Rhythm Association), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Cardiothoracic Imaging (SEICAT). The document reviews the clinical evidence available in this field and establishes a series of recommendations so that patients with cardiovascular devices can safely access this diagnostic tool.

A Multisensor Data Fusion Approach for Predicting Consumer Acceptance of Food Products.

Sensory experiences play an important role in consumer response, purchase decision, and fidelity towards food products. Consumer studies when launching new food products must incorporate physiological response assessment to be more precise and, thus, increase their chances of success in the market. This paper introduces a novel sensory analysis system that incorporates facial emotion recognition (FER), galvanic skin response (GSR), and cardiac pulse to determine consumer acceptance of food samples. Taste and smell experiments were conducted with 120 participants recording facial images, biometric signals, and reported liking when trying a set of pleasant and unpleasant flavors and odors. Data fusion and analysis by machine learning models allow predicting the acceptance elicited by the samples. Results confirm that FER alone is not sufficient to determine consumers' acceptance. However, when combined with GSR and, to a lesser extent, with pulse signals, acceptance prediction can be improved. This research targets predicting consumer's acceptance without the continuous use of liking scores. In addition, the findings of this work may be used to explore the relationships between facial expressions and physiological reactions for non-rational decision-making when interacting with new food products.

Experimental Infection of Syrian Hamsters With Aerosolized Nipah Virus.

Background: Nipah virus (NiV) is a paramyxovirus (genus Henipavirus) that can cause severe respiratory illness and encephalitis in humans. Transmission occurs through consumption of NiV-contaminated foods, and contact with NiV-infected animals or human body fluids. However, it is unclear whether aerosols derived from aforesaid sources or others also contribute to transmission, and current knowledge on NiV-induced pathogenicity after small-particle aerosol exposure is still limited. Methods: Infectivity, pathogenicity, and real-time dissemination of aerosolized NiV in Syrian hamsters was evaluated using NiV-Malaysia (NiV-M) and/or its recombinant expressing firefly luciferase (rNiV-FlucNP). Results: Both viruses had an equivalent pathogenicity in hamsters, which developed respiratory and neurological symptoms of disease, similar to using intranasal route, with no direct correlations to the dose. We showed that virus replication was predominantly initiated in the lower respiratory tract and, although delayed, also intensely in the oronasal cavity and possibly the brain, with gradual increase of signal in these regions until at least day 5-6 postinfection. Conclusion: Hamsters infected with small-particle aerosolized NiV undergo similar clinical manifestations of the disease as previously described using liquid inoculum, and exhibit histopathological lesions consistent with NiV patient reports. NiV droplets could therefore play a role in transmission by close contact.

Gender differences in right ventricular function in patients with non-ischaemic cardiomyopathy.

AIM: To evaluate sex-related differences in right ventricular (RV) function, assessed with cardiac magnetic resonance imaging, in patients with stable non-ischaemic dilated cardiomyopathy. METHODS: Prospective multicentre study. We included 71 patients (38 men) and 14 healthy volunteers. RESULTS: Mean age was 60.9 ± 12.2 years. Men presented higher levels of haemoglobin and white blood cell counts than women, and performed better in cardiopulmonary stress testing. A total of 24 patients (12 women) presented severe left ventricular (LV) systolic dysfunction, 32 (13 female) moderate and 15 (8 women) mild LV systolic dysfunction. In the group with severe LV systolic dysfunction, average right ventricular ejection fraction (RVEF) was normal in women (52 ± 4 %), whereas it was reduced in men (39 ± 3 %) p = 0.035. Only one woman (8 %) had severe RV systolic dysfunction (RVEF < 35 %) compared with 6 men (50 %) p < 0.001. In patients with moderate and mild LV dysfunction , the mean RVEF was normal in both men and women. In the 14 healthy volunteers, the lowest value of RVEF was 48 % and mean RVEF was normal in women (56 ± 2 %) and in men (51 ± 1 %), p = 0.08. CONCLUSIONS: In patients with dilated cardiomyopathy, RV systolic dysfunction is found mainly in male patients with severe LV systolic dysfunction.

Myocarditis or "true" infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: A meta-analysis of individual patient data.

OBJECTIVE: Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) is common, but the causes are to a large extent unknown. Thus, we aimed to study the prevalence of myocarditis and "true" myocardial infarction determined by cardiac magnetic resonance (CMR) imaging in MINOCA patients, and risk markers for these two conditions in this population. METHODS: A search was made in the PubMed and Cochrane databases using the search terms "Myocardial infarction", "Coronary angiography", "Normal coronary arteries" and "MRI". All relevant abstracts were read and seven of the studies fulfilled the inclusion criteria; studies describing case series of patients fulfilling the diagnosis of acute myocardial infarction with normal or non-obstructive coronary arteries on coronary angiography that were investigated with CMR imaging. Data from five of these studies are presented. RESULTS: A total of 556 patients from 5 different sites were included. Fifty-one percent were men with a mean age of 52 ± 16 years. Thirty-three per cent of the patients had myocarditis (n = 183), whereas 21% of the patients had infarction on CMR (n = 115). Young age and a high CRP were associated with myocarditis whereas male sex, treated hyperlipidemia, high troponin ratio and low CRP were associated with "true" myocardial infarction. CONCLUSION AND RELEVANCE: The results of this meta-analysis of individual data showed that myocarditis and "true" myocardial infarction are common in MINOCA when determined by CMR imaging. This information emphasizes the importance of performing CMR imaging in MINOCA patients and can be used clinically to guide diagnostics and treatment of MINOCA patients.

Cardiac motion analysis from ultrasound sequences using nonrigid registration: validation against Doppler tissue velocity.

Early detection of cardiac motion abnormalities is one of the main goals of quantitative cardiac image processing. This article presents a new method to compute the 2-D myocardial motion parameters from gray-scale 2-D echocardiographic sequences, making special emphasis on the validation of the proposed technique in comparison with Doppler tissue imaging. Myocardial motion is computed using a frame-to-frame nonrigid registration technique on the whole sequence. The key feature of our method is the use of an analytical representation of the myocardial displacement based on a semilocal parametric model of the deformation using Bsplines. Myocardial motion analysis is performed to obtain displacement, velocity and strain parameters. Robustness and speed are achieved by introducing a multiresolution optimization strategy. To validate the method, velocity measurements in three different regions-of-interest in the septum have been compared with those obtained with Doppler tissue velocity in healthy and pathologic subjects. Regression and Bland-Altman analysis show very good agreement between the two different approaches, with the great advantage that the new method overcomes the angle-dependency limitations of the Doppler techniques, providing both longitudinal and radial measurements.

Evaluación de un paciente con origen anómalo congénito de las arterias coronarias mediante TC multidetector / Evaluation of a patient with congenital anomalous origins of coronary arteries using a multidetector CT (MDCT)

Se presenta el caso de un recién nacido atendido en el Servicio de Pediatría del Hospital Regional Universitario «Carlos Haya» por sepsis y enfermedad respiratoria, que desarrolló coagulopatía y shock en los primeros días, por lo que se le instauró antibioticoterapia y ventilación mecánica. La bronconeumonía inicial cursó con derrame pleural e imágenes persistentemente alteradas del hemidiafragma derecho. Al final y mediante ecografía, se estableció el diagnóstico de hernia diafragmática congénita derecha. Una vez superado el problema infeccioso, fue intervenido quirúrgicamente con éxito

We present the case of a newborn, treated in our unit for sepsis and respiratory disease. In his first few days of life, he developed coagulopathy and shock, requiring antibiotics and mechanical ventilation. The initial bronchopneumonia was associated with pleural effusion, and the imaging studies repeatedly revealed a defect in right hemidiaphragm that proved to be a congenital diaphragmatic hernia on ultrasound. Once the infection resolved, surgical repair was successfully performed

Evaluación de la afectación coronaria por enfermedad de Kawasaki mediante TC multidetector / Evaluation of coronary artery lesions secondary to Kawasaki disease using multidetector computed tomography

La enfermedad de Kawasaki es la principal causa de cardiopatía adquirida en la edad pediátrica en los países desarrollados. El seguimiento evolutivo de los pacientes que han desarrollado como secuela aneurismas coronarios a pesar del tratamiento correcto es en la actualidad un problema no resuelto de indudable trascendencia clínica. Presentamos el caso clínico de una paciente de 16 años en la que el estudio con TC multidetector permitió valorar con precisión la anatomía coronaria, resolviendo las dudas diagnósticas planteadas por la evaluación convencional con ecocardiograma

Kawasaki disease is the principal cause of acquired heart disease in children in developed countries. The follow-up of patients who develop secondary coronary aneurysms despite proper treatment remains an unsolved problem of unquestionable clinical importance. We present the case of a 16-year-old patient in whom multidetector computed tomography enabled us to meticulously assess the coronary anatomy, resolving the diagnostic doubts raised by conventional ultrasound examination

Assessment of myocardial functional recovery in reperfused AMI: the clinical impact of visual and quantitative analysis in MCE.

The need far imaging methods to evaluate myocardial microcirculation in order to improve reperfusion therapy is increasingly recognized. Myocardial contrast echocardiography (MCE) is the most widely used technique far this purpose. Most of the reports published have focused on visual analysis of MCE. However, quantitative analysis may further improve the results of MCE in this setting, as has been demonstrated in experimental models and more recently in clinical studies. Several quantitative methods have been proposed, and these will be discussed in this report.

Portable spectral Doppler echocardiographic device: overcoming limitations.

BACKGROUND: There is evidence that new portable echocardiographic devices are useful in evaluating heart anatomy and function, but a lack of Doppler modes has up to now been an important limitation in obtaining haemodynamic data. OBJECTIVES: To report the Doppler capabilities of a new hand held echocardiographic device. DESIGN: Blinded comparison of two types of echocardiography machine. SETTING: Tertiary care centre. PATIENTS: 98 consecutive patients were randomly imaged with the hand held device, with a standard platform as reference. OUTCOME MEASURES: Pulsed wave transmitral Doppler inflow tract velocities, deceleration time, and continuous wave Doppler measurements of aortic ejection and tricuspid regurgitation peak velocities were recorded. RESULTS: There was excellent agreement between the hand held device and standard echocardiography for the evaluation of diastolic E and A waves, E/A ratio, and deceleration time with pulsed wave Doppler (intraclass correlation coefficients of 0.97, 0.93, 0.90, and 0.78, respectively). In addition, good agreement was found between continuous wave Doppler measurements of aortic ejection and tricuspid regurgitation velocities (intraclass correlation coefficients of 0.96 and 0.80). However, there was a significant difference between patients with tricuspid regurgitation measured with the hand held device (25.5%) and by standard echocardiography (65.3%), resulting in misdiagnosis of eight patients with pronounced pulmonary hypertension. CONCLUSIONS: New hand held devices with Doppler capabilities overcome previous limitations in evaluating haemodynamic variables. With colour Doppler they are now suitable for the complete evaluation of valvar disease and diastolic function. However, important limitations remain in the evaluation of pulmonary pressures.

Predictors of left atrial spontaneous echo contrast and thrombi in patients with mitral stenosis and atrial fibrillation.

The purpose of this study was to investigate the independent factors associated with the presence of left atrial (LA) spontaneous echo contrast (SEC) and thromboembolic events in patients with mitral stenosis (MS) in chronic atrial fibrillation (AF). Factors independently associated with LASEC, thrombi, and embolic events have been mainly investigated in patients with nonvalvular AF or inhomogeneous populations with rheumatic heart disease. Transesophageal and transthoracic echo studies were performed in 129 patients with MS in chronic AF. Previous embolic events were documented in 45 patients, 20 of them within 6 months, and 65 patients were receiving long-term anticoagulation. The intensity of LASEC and mitral regurgitation, the presence of thrombi and active LA appendage flow (peak velocities > or = 20 cm/s), and LA volume as well as other conventional echo-Doppler determinations were investigated in every patient. The prevalences of significant LASEC (degrees 3+ and 4+), thrombus, active LA appendage flow, and significant mitral regurgitation (>2+) were: 52% (67 patients), 29.5% (38 patients), 32% (41 patients), and 36% (47 patients), respectively. Multivariate analysis showed that decreasing mitral regurgitation severity, absence of active LA appendage flow, and mitral valve area were the independent correlates of LASEC (odds ratio [OR] 3.7, 5.4, and 0.17, respectively; all p <0.02). Active LA appendage flow and anticoagulant therapy were associated negatively, whereas the severity of LASEC was associated positively with the finding of LA thrombus (OR 9.6, 3.9, and 1.6, respectively; all p <0.05). The intensity of LASEC and previous anticoagulant therapy (OR 1.74 and 4.5, respectively; p <0.005) were the independent covariates of thrombi and/or recent embolic events. In conclusion, the severity of mitral regurgitation and lack of active LA appendage flow were, respectively, the strongest independent correlates of significant LASEC and thrombus in patients with MS in chronic AF. LASEC remains the cardiac factor most strongly associated with thrombus and/or recent embolic events in these patients.

[Feasibility and safety of intracoronary ultrasound. Experience of a single center]. / Viabilidad y seguridad del empleo de la ecografía intracoronaria. Experiencia de un centro.

BACKGROUND AND OBJECTIVES: Intracoronary ultrasound provides a number of advantages in the quantification and characterization of coronary stenoses with regard to contrast angiography. However, previous studies have reported a 3.5 to 11% complication rate, and a 10-30% failure rate in performing this technique. The purpose of the study is to analyze the feasibility of performing intracoronary ultrasound and the incidence of complications associated with the use of contemporary, state of the art equipment. MATERIAL AND METHODS: The feasibility of performing intracoronary ultrasound, analyzed as the percentage of successes and failures in performing the examination was reviewed, as well as the complication rate associated with the technique in all the procedures carried out between July 1, 1994 and February 29, 1996 in which intravascular ultrasound was attempted. Complications were categorized as related, non-related and uncertainly related to the ultrasound study. RESULTS: 239 vessels were studied with intravascular ultrasound in 209 procedures (74% interventional) performed on 139 patients. Ultrasound examination was feasible in all the diagnostic studies and in 96% of the interventional procedures. The major and minor procedural complication rate was 2.4 and 10.5% respectively. No major complication was related to the ultrasound examination. Three patients experienced minor complications (1.4%) related to the ultrasound study. All three complications occurred in baseline studies during interventional procedures. CONCLUSIONS: Intracoronary ultrasound is feasible and safe in the vast majority of the procedures. Improvements in smaller catheter size and design and larger operator expertise have significantly reduced the complication rate, particularly the most frequent coronary spasm so far. Complications are associated with baseline studies during interventional procedures and with less operator expertise.

Combined effect of age and right ventricular involvement on acute inferior myocardial infarction prognosis.

BACKGROUND: In patients with acute inferior myocardial infarction (AIMI), right ventricular involvement (RVI) is one of the strongest predictors of in-hospital death. We hypothesized that the impact of RVI on AIMI prognosis depends on the patient's age. METHODS AND RESULTS: The in-hospital clinical outcome of 798 consecutive patients admitted to the coronary care unit within 48 hours of symptom onset with AIMI was analyzed according to patient age and to the presence of RVI diagnosed by ECG and/or echocardiographic criteria. The total incidence of RVI was 37%, and it increased as age advanced. Patients with RVI had a significantly higher incidence of major complications (45% versus 19%, P<0.0001) and a higher in-hospital mortality rate (22% versus 6%, P<0.0001). The prognostic effect of RVI was independent of sex, smoking, diabetes, shock on admission, left ventricular ejection fraction, and reperfusion therapy, all age-dependent predictors. A multivariate analysis showed a significant (P=0.03) interaction between age and RVI on AIMI mortality. RVI increased mortality risk only in the oldest patients. CONCLUSIONS: In patients with AIMI, RVI substantially increases mortality risk in elderly patients, whereas it has a nonsignificant effect in young subjects.

[The syndrome of mid-ventricular obstruction with apical aneurysm in hypertrophic myocardiopathy: presentation of a case]. / El "síndrome" de obstrucción medioventricular con aneurisma apical en la miocardiopatía hipertrófica: presentación de un caso.

We report an 81-year-old woman with hypertrophic cardiomyopathy, midventricular obstruction and associated apical aneurysm partially dyskinetic. At admission she showed a lateral acute myocardial infarction with sustained episodes of uniform ventricular tachycardia and subtle cardiac physical findings. Old apical infarction was suggested by resting thallium defects in the absence of obstructive coronary disease. The ECG revealed persistent ST elevation in the anteroapical leads without Q waves at discharge. This case report represents a rare example, in a previously asymptomatic elderly woman, of a distinct syndrome within the wide clinical spectrum of hypertrophic cardiomyopathy.