ABSTRACT
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Subject(s)
Humans , Acute Coronary Syndrome/surgery , Percutaneous Coronary Intervention/methods , Cyclosporine/pharmacokinetics , Ventricular Remodeling , Stroke/epidemiology , Drug-Eluting Stents , Heart Defects, Congenital/surgeryABSTRACT
Este artículo presenta una revisión de las publicaciones y los estudios más relevantes en el ámbito de la cardiología intervencionista en el año 2014. Dentro del intervencionismo coronario, el tratamiento integral del síndrome coronario agudo sigue siendo objeto de múltiples estudios que evalúan diferentes dispositivos y estrategias farmacológicas y mecánicas sin incrementar el riesgo de hemorragia ni la necesidad de reintervención. Algunos sustratos anatómicos particulares siguen generando un importante número de publicaciones, tanto por los resultados de diferentes stents como por el uso de técnicas específicas. Los stents farmacoactivos bioabsorbibles se emplean en lesiones cada vez más complejas con resultados prometedores. El intervencionismo cardiaco estructural avanza en su desarrollo: nuevas evidencias con las prótesis aórticas percutáneas, resultados de la reparación mitral percutánea o seguridad y eficacia de la oclusión de la orejuela izquierda. Finalmente, la denervación renal ha generado uno de los grandes debates del año (AU)
This article reviews the most relevant publications and studies in the field of interventional cardiology in 2014. In the area of coronary interventional procedures, integrated treatment of acute coronary syndrome continues to be the subject of numerous studies that evaluate different devices and pharmacological and mechanical strategies that can be used without increasing the risk of hemorrhage or the need for reintervention. Certain anatomical substrates continue to generate a considerable number of publications, both on the outcomes with different stents and on the use of specific techniques. Bioabsorbable drug-eluting stents are used in increasingly complex lesions with promising results. The development of interventional procedures for structural heart disease continues to advance, with new evidence on percutaneously placed aortic valve prostheses, the outcome of percutaneous mitral valve repair, and the safety and efficacy of left atrial appendage occlusion. Finally, renal denervation has generated one of the major debates of the year (AU)
Subject(s)
Humans , Ultrasonography, Interventional/methods , Myocardial Infarction , Acute Coronary Syndrome , Drug-Eluting Stents , Fractional Flow Reserve, Myocardial , Coronary RestenosisABSTRACT
This article reviews the most relevant publications and studies in the field of interventional cardiology in 2014. In the area of coronary interventional procedures, integrated treatment of acute coronary syndrome continues to be the subject of numerous studies that evaluate different devices and pharmacological and mechanical strategies that can be used without increasing the risk of hemorrhage or the need for reintervention. Certain anatomical substrates continue to generate a considerable number of publications, both on the outcomes with different stents and on the use of specific techniques. Bioabsorbable drug-eluting stents are used in increasingly complex lesions with promising results. The development of interventional procedures for structural heart disease continues to advance, with new evidence on percutaneously placed aortic valve prostheses, the outcome of percutaneous mitral valve repair, and the safety and efficacy of left atrial appendage occlusion. Finally, renal denervation has generated one of the major debates of the year.
Subject(s)
Cardiac Surgical Procedures/statistics & numerical data , Cardiology , Myocardial Infarction/surgery , Periodicals as Topic , HumansABSTRACT
Introducción y objetivos. Diferentes enfermedades pueden presentar síntomas similares a los del síndrome coronario agudo (SCA): dolor torácico, cambios en el ECG y elevación de marcadores de daño miocárdico. Incluso después de realizar una coronariografía, a veces es difícil establecer el diagnóstico. El objetivo del estudio fue valorar la utilidad de la resonancia magnética cardiaca (RMC) en el diagnóstico de los procesos que se presentan como un SCA y tienen coronarias normales. Métodos. Estudiamos a 80 pacientes con sospecha de SCA y coronarias normales. La media de edad fue 48 ± 15 años. La troponina T media fue 1,8 ± 0,9 ng/ml. Realizamos un estudio de RMC incluyendo secuencias potenciadas en T2 para detectar edema y secuencia I-R de realce tardío (RT) a los 10 min de la administración de gadolinio. Resultados. El diagnóstico final fue miocarditis aguda en 51 pacientes (63%). En todos estos casos observamos RT localizado en el subepicardio y las porciones medias de miocardio. En 12 pacientes (15%) el diagnóstico final fue infarto agudo de miocardio, todos ellos con RT subendocárdico o transmural. En 9 pacientes (11%) con alteraciones de la contractilidad en el ecocardiograma basal y normalización posterior, el estudio con RMC no mostró RT de contraste y se les diagnosticó síndromes de tako-tsubo. En 4 pacientes el diagnóstico final fue pericarditis aguda y en 4 no se pudo establecer un diagnóstico. Conclusiones. La miocarditis aguda y el síndrome de tako-tsubo pueden presentarse en la clínica de forma similar al SCA. La presencia y el patrón de RT de contraste en el estudio de RMC nos ayudan de forma importante a establecer el diagnóstico (AU)
Introduction and objectives. A number of different conditions can present with symptoms similar to acute coronary syndrome (ACS): chest pain, electrocardiographic changes, and elevated levels of markers of myocardial damage. Even after coronary angiography has been performed, differential diagnosis can be challenging. The aim of this study was to evaluate the usefulness of cardiac magnetic resonance (CMR) for diagnosing conditions that present like ACS but in which the coronary arteries are normal. Methods. The study involved 80 patients with suspected ACS and normal coronary arteries. Their mean age was 48 (15) years and their mean troponin-T (TnT) level was 1.8 (0.9) ng/mL. A CMR study, which involved T2 weighted imaging to detect edema and delayed contrast-enhancement (DCE) imaging 10 minutes after gadolinium administration, was performed. Results. In 51 patients (63%), the final diagnosis was acute myocarditis. In all these cases, DCE was observed in subepicardial and middle segments of the myocardium. The final diagnosis was acute myocardial infarction in 12 patients (15%), all of whom exhibited subendocardial or transmural DCE. In the 9 (11%) who exhibited abnormal contractility on baseline echocardiography with subsequent normalization, CMR did not show DCE, a finding that is characteristic of Takotsubo cardiomyopathy. In addition, 4 patients had a final diagnosis of pericarditis, while no diagnosis could be established in another 4. Conclusions. The clinical presentation of acute myocarditis and Takotsubo syndrome can be similar to that of ACS. The presence and distribution of DCE on CMR are of great help in establishing a diagnosis (AU)
Subject(s)
Humans , Male , Adult , Middle Aged , Magnetic Resonance Imaging/methods , Magnetic Resonance Imaging/trends , Acute Coronary Syndrome , Troponin T/therapeutic use , Biomarkers , Magnetic Resonance Imaging/instrumentation , Myocarditis/diagnosis , Myocarditis/drug therapyABSTRACT
INTRODUCTION AND OBJECTIVES: A number of different conditions can present with symptoms similar to acute coronary syndrome (ACS): chest pain, electrocardiographic changes and elevated levels of markers of myocardial damage. Even after coronary angiography has been performed, differential diagnosis can be challenging. The aim of this study was to evaluate the usefulness of cardiac magnetic resonance (CMR) for diagnosing conditions that present like ACS but in which the coronary arteries are normal. METHODS: The study involved 80 patients with suspected ACS and normal coronary arteries. Their mean age was 48+/-15 years and their mean troponin-T (TnT) level was 1.8+/-0.9 ng/ml. A CMR study, which involved T2-weighted imaging to detect edema and delayed contrast-enhancement (DCE) imaging 10 minutes after gadolinium administration, was performed. RESULTS: In 51 patients (63%), the final diagnosis was acute myocarditis. In all these cases, DCE was observed in subepicardial and middle segments of the myocardium. The final diagnosis was acute myocardial infarction in 12 patients (15%), all of whom exhibited subendocardial or transmural DCE. In the 9 (11%) who exhibited abnormal contractility on baseline echocardiography with subsequent normalization, CMR did not show DCE, a finding that is characteristic of Takotsubo cardiomyopathy. In addition, 4 patients had a final diagnosis of pericarditis, while no diagnosis could be established in another 4. CONCLUSIONS: The clinical presentation of acute myocarditis and Takotsubo syndrome can be similar to that of ACS. The presence and distribution of DCE on CMR are of great help in establishing a diagnosis.
