ABSTRACT
OBJECTIVE: This is a prospective study of patients with LVEF ≤40%, with the objective of correlating CV events to LGE detected and quantified by CMRI. METHODS: Heart Failure (HF) patients with LVEF <40% who underwent CMRI were included. LGE volume of ≥6% of the myocardial volume was considered significant. Data of appropriate ICD shocks, CV hospitalizations and mortality were recorded. RESULTS: There were 133 HF (72 ICM & 62 NIDCM) patients with a mean age of 54 ± 12 years, mean LVEF of 34 ± 6% and a follow up of 24 ± 3 months. Totally 46 CV events were recorded in 30 patients, 44 in LGE +ve & 2 in LGE -ve groups (HR 17.8, 95% CI-8.03-39.3, P = 0.000095). All the 7 deaths were in LGE +ve group. CV events were 22 (30.5%) in ICM group and 8 (13.1%) in NIDCM group (p = 0.03). All the 22 ICM patients and 6 of the 8 NIDCM with CV events were LGE +ve. The distribution of CV events amongst LGE +ve and LGE -ve were 35 vs 0 (ICM) and 9 vs 2 (NIDCM); p < 0.005.CV events in LVEF ≤ 30% group, were seen in 19 (47.5%) vs 1 (5.8%) in LGE +ve vs LGE -ve and no of events were 29 vs 1 (p = 0.003). In those with LVEF >30% the corresponding figures were 9 (22.5%) vs 1 (2.8%) and 15 vs 1 respectively (p = 0.02). CONCLUSION: Demonstration of significant LGE by CMRI indicates high risk occurrence of CV events (CV hospitalization, appropriate shocks and total mortality) in NIDCM & ICM patients with LVEF < 40%.
Subject(s)
Heart Failure/diagnosis , Magnetic Resonance Imaging, Cine/methods , Meglumine/pharmacology , Risk Assessment/methods , Stroke Volume/physiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left/physiology , Contrast Media/pharmacology , Female , Follow-Up Studies , Heart Failure/epidemiology , Heart Failure/etiology , Humans , Incidence , India/epidemiology , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Time Factors , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/diagnosisABSTRACT
PURPOSE: Preoperative evaluation of the hepatic vasculature is necessary to minimize mortality and morbidity during various surgeries due to the complexity of liver anatomy. The purpose of our investigation is to determine the anatomical variations in the hepatic vascular system by using multidetector computed tomography. METHODS: In this observational study, 500 patients aged between 1 and 86 years were randomly chosen from a patient population referred for computed tomography angiography for various clinical indications. Multidetector computed tomography angiography examinations were performed using a 128 detector scanner. The area from the lower thoracic spine to symphysis pubis level, with the patient in a supine position, was adopted as the field of view. The percentage of occurrence of each of the vascular variant was determined. RESULTS: Normal arterial anatomy [Type I] was seen in 306 patients [61.2%]. Replaced left hepatic artery from the left gastric artery was the most common variant in our study, which was seen in 57 patients [11.4%]. Classic hepatic venous anatomy was found in 261 [52.2%] patients. An accessory inferior right hepatic vein was found in 110 [22%] patients. A large early branch of segment VIII into middle hepatic vein was found in 157 patients [31.4%]. Extraparenchymal branching of the right anterior portal vein from the left portal vein was the most common anomaly found in 12 [2.4%] patients. CONCLUSIONS: Computed tomography angiography can be used in preoperative evaluation in various hepatobiliary surgeries and interventional procedures, which give a lot of information regarding parenchyma and vascular system.
