Late gadolinium-enhanced cardiovascular magnetic resonance identifies patients with standardized definition of ischemic cardiomyopathy: a single centre experience.

BACKGROUND: Definition of ischemic cardiomyopathy (IC) is not always obvious, which is why new criteria based on prognosis and the extent of the coronary artery disease (CAD) have been proposed. In the present study, we assess the capability of late gadolinium-enhanced cardiovascular magnetic resonance (CMR) for predicting IC as determined by standardized criteria previously reported. METHODS AND RESULTS: 123 patients with heart failure (HF) and left ventricular (LV) systolic dysfunction, underwent both late gadolinium-enhanced CMR and coronary angiography 37/123 (30%) of patients were assigned to the IC group and 86/123 (70%) to the non-IC group. Subendocardial late gadolinium enhancement (LGE) was found in 35/37 (94%) of patients in the IC group, whereas only 12/86 (14%) had this distribution in the non-IC group (p<0.001). There was a significant positive correlation between the extent of subendocardial LGE and that of the CAD as determined by the CAD Prognostic Index (r=0.78, p<0.01), the number of coronary stenoses > or = 50% (r=0.76, p<0.01) and the number of coronary stenoses of any percentage (r=0.70, p<0.01). CONCLUSION: In patients with HF and LV systolic dysfunction presence of subendocardial LGE makes an excellent indicator of underlying significant CAD, and the extent of the LGE correlates with the severity of the disease. It is therefore appealing as a method for diagnosing IC.

Right-to-left interatrial shunt despite normal pulmonary artery pressure. Anatomical implications.

Platypnea-orthodeoxia is a rare syndrome characterized by dyspnea induced by the upright position and relieved by supine position and an arterial deoxygenation increased by the upright position which improves during recumbency. In many cases, this syndrome has been associated with patent foramen ovale and right-to-left shunt. Several anatomical factors that can alter the atrial anatomy and facilitate shunting through an interatrial communication have been related with this syndrome. We present a case in which an enlarged aortic root was the main anatomical factor that contributed to transient right-to-left shunting induced by postural changes.

Septal rupture with right ventricular wall dissection after myocardial infarction.

BACKGROUND: In patients with inferior myocardial infarction, septal rupture generally involves basal inferoposterior septum, and the communicating tract between left and right ventricle is often serpiginous with a variable degree of right ventricular wall extension. Right ventricular wall dissection following septal rupture related with previous myocardial infarction has been reported in a very few cases, in many of them this condition has been diagnosed in post-mortem studies. In a recent report long-term survival has been achieved after promptly echocardiographic diagnosis and surgical repair. CASE PRESENTATION: We present a case of a 59-year-old man who had a septal rupture with right ventricular wall dissection after inferior and right ventricular myocardial infarction. Transthoracic echocardiography, as first line examination, established the diagnosis, and prompt surgical repair allowed long-term survival in our patient. CONCLUSION: Outcomes after right ventricular intramyocardial dissection following septal rupture related to myocardial infarction has been reported to be dismal. Early recognition of this complication using transthoracic echocardiography at patient bedside, and prompt surgical repair are the main factors to achieve long-term survival in these patients.

[Non-invasive assessment of coronary artery bypass grafts by computed tomography: comparison with conventional coronary angiography]. / Valoración no invasiva de injertos coronarios con tomografía computarizada: comparación con la angiografía convencional.

INTRODUCTION AND OBJECTIVES: Although it has been demonstrated that the diagnostic accuracy of computed tomography in the non-invasive assessment of major epicardial coronary arteries is high, only a few studies have evaluated the technique's reliability in assessing coronary artery bypass grafts. The aim of this study was to determine the diagnostic accuracy of multidetector computed tomography in the assessment of coronary grafts. PATIENTS AND METHOD: We prospectively evaluated 117 coronary grafts in 38 patients who had undergone coronary artery bypass graft surgery and who had a clinical indication for angiographic graft assessment. All patients were in sinus rhythm and had a heart rate below 75 bpm. A 16-detector scanner was used for non-invasive assessment of the coronary grafts at a slice thickness of 1.2 mm. The diagnostic accuracy of computed tomography in the non-invasive assessment of significant lesions (i.e., occluded lesions or those with a stenosis greater than 50%) in coronary artery bypass grafts was evaluated by comparison with the results of conventional angiography. RESULTS: Of the 117 grafts evaluated, 99 (84.6%) were visualized by conventional angiography and 109 (93.2%) by computed tomography. Overall, 98 grafts were analyzed using both techniques. The sensitivity and specificity of computed tomography in detecting significant lesions were: 92% and 97.3%, respectively, for all grafts; 89.5% and 97.6%, respectively, for venous grafts; and 100% and 96.8%, respectively, for arterial grafts. CONCLUSIONS: The diagnostic accuracy of multidetector computed tomography in coronary artery bypass graft assessment was high.

Valoración no invasiva de injertos coronarios con tomografía computarizada: comparación con la angiografía convencional / Non-invasive assessment of coronary artery bypass grafts by computed tomography: comparison with conventional coronary angiography

Introducción y objetivos. Aunque la tomografía computarizada (TC) muestra una elevada exactitud diagnóstica en la valoración no invasiva de las arterias coronarias principales, son todavía escasos los trabajos que valoren su fiabilidad en el estudio de los injertos coronarios. El objetivo de este estudio es determinar la exactitud diagnóstica de la TC con detectores múltiples en la valoración de los injertos coronarios. Pacientes y método. Se evaluó de manera prospectiva a 38 pacientes revascularizados quirúrgicamente (117 injertos coronarios según la hoja operatoria), con indicación clínica de evaluación angiográfica de sus injertos. Todos los pacientes se encontraban en ritmo sinusal y con una frecuencia cardíaca 50% u oclusión) y los resultados se compararon con los de la angiografía convencional. Resultados. De los 117 injertos referidos se visualizaron 99 (84,6%) mediante angiografía convencional y 109 (93,2%) mediante TC. Se analizaron los 98 injertos valorados por ambas técnicas. Los valores de sensibilidad y especificidad de la TC para el total de injertos fueron del 92 y del 97,3%, para los injertos venosos del 89,5 y del 97,6%, y para los injertos arteriales del 100 y del 96,8%, respectivamente. Conclusiones. La TC con detectores múltiples muestra una elevada exactitud diagnóstica en la valoración de los injertos coronarios

Introduction and objectives. Although it has been demonstrated that the diagnostic accuracy of computed tomography in the non-invasive assessment of major epicardial coronary arteries is high, only a few studies have evaluated the technique's reliability in assessing coronary artery bypass grafts. The aim of this study was to determine the diagnostic accuracy of multidetector computed tomography in the assessment of coronary grafts. Patients and method. We prospectively evaluated 117 coronary grafts in 38 patients who had undergone coronary artery bypass graft surgery and who had a clinical indication for angiographic graft assessment. All patients were in sinus rhythm and had a heart rate below 75 bpm. A 16-detector scanner was used for non-invasive assessment of the coronary grafts at a slice thickness of 1.2 mm. The diagnostic accuracy of computed tomography in the non-invasive assessment of significant lesions (i.e., occluded lesions or those with a stenosis greater than 50%) in coronary artery bypass grafts was evaluated by comparison with the results of conventional angiography. Results. Of the 117 grafts evaluated, 99 (84.6%) were visualized by conventional angiography and 109 (93.2%) by computed tomography. Overall, 98 grafts were analyzed using both techniques. The sensitivity and specificity of computed tomography in detecting significant lesions were: 92% and 97.3%, respectively, for all grafts; 89.5% and 97.6%, respectively, for venous grafts; and 100% and 96.8%, respectively, for arterial grafts. Conclusions. The diagnostic accuracy of multidetector computed tomography in coronary artery bypass graft assessment was high

Noninvasive diagnosis of coronary artery disease in patients with heart failure and systolic dysfunction of uncertain etiology, using late gadolinium-enhanced cardiovascular magnetic resonance.

OBJECTIVES: We evaluated the feasibility of using late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) to distinguish left ventricular (LV) systolic dysfunction related or not to coronary artery disease (CAD) in patients with heart failure (HF) but without clinical suspicion of CAD as the underlying cause. BACKGROUND: In patients with known CAD, LGE-CMR is capable of distinguishing LV systolic dysfunction related to CAD from dilated cardiomyopathy. METHODS: Seventy-one patients with HF and LV systolic dysfunction, without a previous history of myocardial infarction, with neither Q waves nor clinical data suggesting CAD, underwent both LGE-CMR and coronary angiography. RESULTS: Twenty-six patients (37%) had angiographically proven CAD (>/=70% stenosis of a major epicardial vessel) (angio [+] group), and 45 (63%) had unobstructed coronary arteries (angio [-] group). Twenty-one patients in the angio (+) group (21 of 26, 81%) showed subendocardial and/or transmural enhancement, whereas only 4 (9%) of 45 in the angio (-) group showed it (p < 0.001). In 7 patients (7 of 71, 10%), we found a different pattern of mid-wall enhancement-namely, 3 of 26 patients in the angio (+) group and 4 of 45 in the angio (-) group (11% vs. 9%, p = 0.7). Mid-wall enhancement in the angio (+) group was distributed in segments other than those which had subendocardial enhancement. CONCLUSIONS: In patients with HF and LV systolic dysfunction without clinical suspicion of CAD, LGE-CMR is an excellent tool for classifying patients in relation to the presence or absence of underlying CAD. Thus, CMR might offer a valid alternative to coronary angiography for the detection of CAD in these patients.