Association of irisin levels with cardiac magnetic resonance, inflammatory, and biochemical parameters in patients with chronic heart failure versus controls.

BACKGROUND AND AIMS: Chronic heart failure (CHF) represents a significant cause of morbidity and mortality globally. Metabolic maladaptation has proven to be critical in the progression of this condition. Preclinical studies have shown that irisin, an adipomyokine involved in metabolic regulations, can induce positive cardioprotective effects by improving cardiac remodeling, cardiomyocyte viability, calcium delivery, and reducing inflammatory mediators. However, data on clinical studies identifying the associations between irisin levels and functional imaging parameters are scarce in CHF patients. The objective of this study was to determine the association of irisin levels with cardiac imaging measurements through cardiac magnetic resonance, inflammatory markers, and biochemical parameters in patients with CHF compared with control subjects. METHODS AND RESULTS: Thirty-two subjects diagnosed with CHF and thirty-two healthy controls were evaluated in a cross-sectional study. Serum irisin levels were significantly lower in patients with CHF than in controls. This is the first study to report a significant positive correlation between irisin levels and cardiac magnetic resonance parameters such as left ventricular ejection fraction, fraction shortening, and global radial strain. A negative correlation was demonstrated between irisin levels and brain natriuretic peptide, insulin levels, and Homeostatic model assessment for insulin resistance index. We did not observe significant correlations between irisin levels and inflammatory cytokines. CONCLUSIONS: Given the importance of fraction shortening and global radial strain as accurate markers of ventricular wall motion, these results support the hypothesis that irisin may play an essential role in maintaining an adequate myocardial wall architecture, deformation, and thickness.

Collaboration between the National Association of Cardiologists of Mexico, the Mexican Society of Cardiology, and the University of Guanajuato. COVID-19 and Cardiac Imaging Personnel: Review of Sanitary Practices in Early 2021 / Colaboración de la Asociación Nacional de Cardiólogos de México y de la Sociedad Mexicana de Cardiología con la Universidad de Guanajuato. COVID-19 y personal de imagen cardiaca: Revisión de prácticas sanitarias al inicio de 2021

The authors of the image chapters of the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC), as well as personnel from the Department of Medicine and Nutrition of the University of Guanajuato, together with prominent experts in cardiovascular imaging from Mexico, have collaborated in the review, analysis and expansion of the various health strategies published in the first year of the coronavirus disease 2019 (COVID-19) pandemic, to safely perform cardiac imaging studies. This update aims to reduce the risk of COVID-19 transmission among patients and health-care personnel in the CT, MRI, and nuclear cardiology services. This work was expanded with supplementary information available free of charge on the website www.ancam-imagen.com.

Los capítulos de imagen de la Asociación Nacional de Cardiólogos de México (ANCAM) y de la Sociedad Mexicana de Cardiología (SMC), así como personal del Departamento de Medicina y Nutrición de la Universidad de Guanajuato, en conjunto con destacados expertos de la imagen cardiovascular en México, han colaborado en la revisión, análisis y ampliación de las diversas estrategias sanitarias publicadas en los primeros 15 meses de la pandemia de enfermedad por coronavirus 2019 (COVID-19) para realizar con seguridad los estudios de imagen cardiaca; esta actualización tiene como objetivo principal disminuir el riesgo de transmisión de la COVID-19 entre los pacientes y el personal de salud en los servicios de tomografía, resonancia y cardiología nuclear. Este trabajo se amplió con información suplementaria disponible sin costo en el sitio www.ancam-imagen.com.

Evaluation of left ventricular function using volumetric computed tomography in the clinical setting.

OBJECTIVE: To correlate the left ventricular parameters obtained with 64-slice Volumetric Computed Tomography (VCT) with those obtained with the reference standard, cardiovascular magnetic resonance (CMR) imaging. METHODS: VCT and a 3.0T MRI scanner were used. Results from both studies were independently evaluated by two cardiologists. A linear correlation and a paired Student's t test were used to analyze the data with a P<0.05 being considered significant. RESULTS: Thirty consecutive patients were evaluated with VCT and CMR. The left ventricular indices for CMR and VCT were, respectively, mass 86.4±25.8 vs. 82.7±27.6g (P=0.31); ESV 45.5±27.8 vs. 48.7±40.4ml (P=.405); EDV 101.3±32.7 vs. 105.1±44.0ml (P=0.475); SV 55.9±16.1 vs. 56.8±15.6ml (P=0.713); LVEF 57.5±13.2% vs. 56.9±12.4% (P=0.630). No differences in intraobserver variability for both methods were found, CT r=0.96, r(2)=0.92 P<0.0001 and MR r=0.96 r(2)=0.93 P<0.0001. There was no significant statistical difference in the presence of artifacts. CONCLUSION: There is a close correlation between CMRI and VCT in the evaluation of LV function. VCT is as useful as 3T CMR, and could be incorporated as another resource for evaluating LV function.

The role of a multimodality imaging approach in diagnosis and stratification of aborted sudden cardiac death.

A 34-year-old man was admitted after an episode of aborted sudden cardiac death. The initial investigation including electrocardiogram, chest x-ray, transthoracic echocardiogram, and biomarkers were normal. Although coronary angiography showed nonsevere stenosis, optical coherence tomography revealed severe obstruction in the artery with a layered appearance of the vessel wall; it was consistent with the presence of mural thrombus.

Myopericarditis with predominantly right ventricular involvement with normal B-type natriuretic peptide and cardiac tamponade as the initial manifestation of systemic lupus erythematosus.

A previously healthy young man presented with a 12-hour history of sudden dyspnea and severe chest pain at rest. Initial findings of physical examination, electrocardiogram and chest radiography showed typical pericarditis and clinical instability. Echocardiogram revealed small pericardial effusion with right ventricle dilatation. The patient was admitted in the ICU; a new echocardiogram revealed moderate pericardial effusion and diagnosis of pericarditis complicated with acute cardiac tamponade was established. The patient transiently improved after pericardial window. In the following hours, the diagnosis of myocarditis with predominantly right ventricular involvement (MPRVI) with severe right heart failure was supported by clinical, chest radiography and echocardiogram data, despite normal B-type natriuretic peptide. On day 2, cardiac troponin I detection was observed. By day 3, B-type natriuretic peptide in the range of ventricular dysfunction was identified. Cardiovascular magnetic resonance findings supported the diagnosis of MPRVI. A systematic MEDLINE/PubMed from 1993 to 2013 does not identify any cases of MPRVI related to systemic lupus erythematosus. Simultaneous acute MPRVI with normal B-type natriuretic peptide and acute cardiac tamponade heralding the diagnosis of systemic lupus erythematosus, to the best of our knowledge, has not been previously described.

Pasos de la reconstrucción de arterias coronarias con tomografía multicorte / Steps for the coronary reconstruction with multislice cardiac tomography (MSCT)

El análisis de un estudio de angiotomografía coronaria requiere de habilidades especiales que se van adquiriendo durante el tiempo y con un adecuado entrenamiento. Para que el estudio sea de óptima calidad, debe tenerse en cuenta parámetros tanto técnicos como clínicos durante la adquisición del mismo, así como también, seguirse un orden específico para la correcta interpretación, y es lo que explicaremos a continuación.

The analysis of a coronary multislice cardiac tomography requires special skills to be acquired over time and with adequate training. For the study is optimal quality must be taken into account both technical and clinical parameters for the acquisition of the study, as well as follow a specific order for the correct interpretation of it, and that is what we explain below.

A multi-center, comparative, phase 3 study to determine the efficacy of gadofosveset-enhanced magnetic resonance angiography for evaluation of renal artery disease.

PURPOSE: To determine prospectively the safety and efficacy of the blood-pool contrast agent gadofosveset trisodium in renal artery magnetic resonance angiography (MRA). MATERIALS AND METHODS: Gadofosveset (0.03 mmol/kg) was administered to adult patients with known or suspected renal arterial disease in a multi-center phase 3 single dose study. The drug binds reversibly to albumin, prolonging the blood residence time, and allowing collection of images in the first-pass and steady-state phases. The combination of these images was compared to non-contrast MRA, using catheter X-ray angiography (XRA) as the standard of reference (SOR). All MRA images were collected at 1.5 T in one imaging session for direct comparison, and XRA within 30 days. Sensitivity, specificity, and accuracy for diagnosing significant disease (stenosis > or =50%) were calculated for MRA using three independent blinded readers. Patient safety was monitored for 72-96 h. RESULTS: A total of 145 patients at 18 centers were enrolled and received gadofosveset; the 127 with complete efficacy data entered the primary efficacy analysis. Gadofosveset-enhanced MRA led to significant improvement (p<0.01) in sensitivity (+25%, +26%, +42%), specificity (+23%, +25%, +29%), and accuracy (+23%, +28%, +29%) over non-enhanced MRA for the three readers. The rate of uninterpretable examinations decreased from 30% to less than 2%. There were no serious adverse events, and the most common adverse events were nausea, pruritus, and headache (8% each). No significant trends in clinical chemistry parameters, nor significant changes in serum creatinine, were found following administration of gadofosveset. CONCLUSION: In patients with known or suspected renal arterial disease, multi-phase gadofosveset-enhanced MRA significantly improves sensitivity, specificity, and accuracy versus non-enhanced MRA. Gadofosveset was safe and well tolerated in this patient population.

High-resolution real-time spiral MRI for guiding vascular interventions in a rabbit model at 1.5 T.

PURPOSE: To study the feasibility of a combined high spatial and temporal resolution real-time spiral MRI sequence for guiding coronary-sized vascular interventions. MATERIALS AND METHODS: Eight New Zealand White rabbits (four normal and four with a surgically-created stenosis in the abdominal aorta) were studied. A real-time interactive spiral MRI sequence combining 1.1 x 1.1 mm(2) in-plane resolution and 189-msec total image acquisition time was used to image all phases of an interventional procedure (i.e., guidewire placement, balloon angioplasty, and stenting) in the rabbit aorta using coronary-sized devices on a 1.5 T MRI system. RESULTS: Real-time spiral MRI identified all rabbit aortic stenoses and provided high-temporal-resolution visualization of guide-wires crossing the stenoses in all animals. Angioplasty balloon dilatation and deployment of coronary-sized copper stents in the rabbit aorta were also successfully imaged by real-time spiral MRI. CONCLUSION: Combining high spatial and temporal resolution with spiral MRI allows real-time MR-guided vascular intervention using coronary-sized devices in a rabbit model. This is a promising approach for guiding coronary interventions.

[Evaluation of left ventricular function with a 16-slice multidetector tomograph (MDCT-16): correlation with cardiovascular magnetic resonance imaging]. / Valoración de la función ventricular con tomografía computarizada de 16 detectores (TCMD-16): correlación con resonancia magnética cardiovascular.

UNLABELLED: The evaluation of Left ventricular function has both prognostic as well as therapeutic implications in patients with heart disease. Non-invasive coronary angiography with computed tomography using 16 slices (MDCT-16) allows to obtain images of the coronary anatomy due to its high spatial and temporal resolution, and also, to obtain data regarding Left ventricular function. The objective of this study was to correlate the use of MDCT-16 for the evaluation of the Left ventricular parameters using MRI as the Standard of reference. METHODS: MRI: Se A 1.5 Tesla GE CvI Scanner optimized for cardiovascular applications was used. Using an ECG gated steady state fast precession sequence (SSFP, Thickness 10 mm, Flip Angle 45, FOV 36 cm. NEX 1, Frequency 256, Phase 128, Partial FOV 0.75, 16VPS), 6 to 8 short axis images of from base to apex of the left ventricle were obtained. Tomography: Using a 16 slice Multidetector tomograph (GE Lightspeed) and using ECG synchronization, images of the heart were obtained after the administration of 80 mls. of no-ionic contrast. The images were reconstructed off-line to obtain from 6 to 8 slices in a similar fashion to that of MR. Both studies were independently analyzed by 2 operators who obtained the ventricular function data. Linear correlation and a Paired T Student test was used to analyze the data and was considered significant when p < 0.05. RESULTS: 20 consecutive patients were evaluated with MDCT-16 and MRI, 18 males, mean age 52 +/- 15 years. There was no significant difference among the measurements for cardiac CT and MRI of the end-diastolic volume (EDV) and end-sistolic volume (ESV), stroke volume (SV), LV Mass or LV ejection fraction (LVEF). CONCLUSION: This results show a high correlation among the clinically relevant ventricular function parameters evaluated by cardiovascular CT and MRI. This findings suggest that ventricular function can be successfully evaluated along with the coronary anatomy using MDCT-16.

Valoración de la función ventricular con tomografía computarizada de 16 detectores (TCMD-16): Correlación con resonancia magnética cardiovascular / Evaluation of left ventricular function with a 16-slice multidetector tomograph (MDCT-16): Correlation with cardiovascular magnetic resonance imaging

La evaluación de parámetros funcionales del VI tienen implicaciones tanto pronosticas como terapéuticas en pacientes con cardiopatías. La angiotomografía coronaria con TCMD-16 permite obtener imágenes de la anatomía coronaria y por su alta resolución temporal y espacial, obtener datos de la función ventricular izquierda. El objetivo de este estudio fue correlacionar el uso de la TCMD-16 para la valoración de parámetros de función ventricular izquierda, utilizando la RM como estándar de referencia. Métodos: Resonancia: Se utilizó un resonador GE Cvl, de 1.5 Teslas optimizado para aplicaciones cardiovasculares. Mediante una secuencia de precesión rápida de estado fijo de manera sincronizada al ECG, (SSFP, Grosor de corte de 10 mm, Flip Angle 45, FOV 36 cm., NEX 1, Frecuencia 256, Fase 128, FOV parcial 0.75, 16 VPS), se obtuvieron de 6 a 8 imágenes en eje corto desde la base hasta el ápex del VI. Tomografía: Con un TCMD-16 GE Lightspeed sincronizado al ECG, se obtuvieron imágenes del corazón tras la administración de 80 mis. de contraste no-iónico. Las imágenes fueron reconstruidas para obtener de 6 a 8 cortes de manera similar a la RM. Ambos estudios fueron independientemente analizados por 2 operadores quienes obtuvieron los parámetros ventriculares. Las comparaciones fueron analizadas mediante la prueba de t de Student pareada y las correlaciones mediante regresión linear, considerando significativo cuando p<0.05. Resultados: Se evaluaron 20 pacientes consecutivos con TAC y RM cardiaca, 18 del sexo masculino, con una edad promedio de 52 ± 15 años. No hubo diferencia significativa entre las mediciones por TAC y por RM cardiaca del volumen telediastólico (VTD) y telesistólico (VTS) del VI, ni en el volumen latido (VL), la masa ventricular izquierda o la fracción de expulsión del VI (FEVI). Conclusión: Los resultados demuestran una alta correlación entre los parámetros de función ventricular sistólica clínicamente relevantes evaluados por TAC y por RM cardiaca. Esto sugiere que puede evaluarse la función ventricular en forma satisfactoria al mismo tiempo que se estudian estructuralmente las coronarias mediante el TCMD-16.

The evaluation of Left ventricular function has both prognostic as well as therapeutic implications in patients with heart disease. Non-invasive coronary angiography with computed tomography using 16 slices (MDCT-16) allows to obtain images of the coronary anatomy due to its high spatial and temporal resolution, and also, to obtain data regarding Left ventricular function. The objective of this study was to correlate the use of MDCT-16 forthe evaluation of the Left ventricular parameters using MRI as the Standard of reference Methods: MRI: Se A 1.5 Tesla GE Cvl Scanner optimized for cardiovascular applications was used. Using an ECG gated steady state fast precession sequence (SSFP, Thickness 10 mm, Flip Angle 45, FOV 36 cm. NEX 1, Frequency 256, Phase 128, Partial FOV 0.75, 16 VPS), 6 to 8 short axis images of from base to apex of the left ventricle were obtained. Tomography: Using a 16 slice Multidetector tomograph (GE Lightspeed) and using ECG synchronization, images of the heart were obtained after the administration of 80 mis. of no-ionic contrast. The images were reconstructed off-line to obtain from 6 to 8 slices in a similar fashion to that of MR. Both studies were independently analyzed by 2 operators who obtained the ventricular function data. Linear correlation and a Paired T Student test was used to analyze the data and was considered significant when p < 0.05. Results: 20 consecutive patients were evaluated with MDCT-16 and MRI, 18 males, mean age 52 ± 15 years. There was no significant difference among the measurements for cardiac CT and MRI of the end-diastolic volume (EDV) and end-sistolic volume (ESV), stroke volume (SV), LV Mass or LV ejection fraction (LVEF). Conclusion: This results show a high correlation among the clinically relevant ventricular function parameters evaluated by cardiovascular CT and MRI. This findings suggest that ventricular function can be successfully evaluated along with the coronary anatomy using MDCT-16.

Noninvasive assessment of coronary vasodilation using magnetic resonance angiography.

OBJECTIVES: The purpose of this study was to investigate the use of coronary magnetic resonance angiography (MRA) for assessing human epicardial coronary artery vasodilation. BACKGROUND: Coronary vasodilation plays a vital role in the human coronary circulation. Previous studies of epicardial coronary vasodilation have used invasive coronary angiography. Coronary MRA may provide an alternative noninvasive method to directly assess changes in coronary size. METHODS: Thirty-two subjects were studied: 12 patients (age 55 +/- 18 years) and 20 healthy subjects (age 34 +/- 4 years). High-resolution multi-slice spiral coronary MRA (in-plane resolution of 0.52 to 0.75 mm) was performed before and after sublingual nitroglycerin (NTG). Quantitative analysis of coronary vasodilation was performed on cross-sectional images of the right coronary artery (RCA). A time-course analysis of coronary vasodilation was performed in a subset of eight subjects for 30 min after NTG. Signal-to-noise ratio was also measured on the in-plane RCA images. RESULTS: Coronary MRA demonstrated a 23% increase in cross-sectional area after NTG (16.9 +/- 7.8 mm2 to 20.8 +/- 8.9 mm2, p <0.0001), with significant vasodilation between 3 and 15 min after NTG on time-course analysis. The MRA measurements had low interobserver variability (< or =5%) and good correlation with X-ray angiography (r=0.98). The magnitude of vasodilation correlated with baseline cross-sectional area (r=0.52, p=0.03) and age (r=0.40, p=0.019). Post-NTG images also demonstrated a 31% improvement in coronary signal-to-noise ratio (p = 0.002). CONCLUSIONS: Nitroglycerin-enhanced coronary MRA can noninvasively measure coronary artery vasodilation and is a promising noninvasive technique to study coronary vasomotor function.

[Myocardial reperfusion injury]. / Daño miocárdico por reperfusión.

Myocardial reperfusion injury is defined as the adverse effects that ensue upon restoration of the circulation, which allows blood and nutrients to reach cells previously subjected to ischemia. Restoration of blood flow can be accompanied by the release of oxygen free radicals, the appearance of intracellular calcium overload, and alterations in cell metabolism -all situations that can give rise to functional or structural myocardial injury. Clinical signs of injury may appear after circulation is restored or after the use of extracorporeal circulation during heart surgery, and are manifested as stunned or hibernating myocardium after acute coronary syndromes, as the no-reflow phenomenon (microvascular injury) after blood flow is restored during angioplasty or after <>, and especially after surgical revascularization. This review examines the pathophysiological substrates, clinical manifestations and current approaches to treatment for each of these entities.

Prolonged ST segment depression after stress testing: does it really identify more severe disease?

BACKGROUND: It is generally perceived that the persistence of ST segment depression for more than 5 min after treadmill exercise testing (ETT) signifies a strongly positive test and predicts more severe ischemia and coronary artery disease. AIM: The aim of this study was to determine if prolonged ST segment changes (>5 min) after ETT identifies patients with more severe ischemia and thus severe coronary artery disease. METHODS: Twenty five patients (19 males, mean age 58+/-10 years) with >1 mm ST segment depression and recovery time 1 mm ST segment depression and recovery time >5 min (group 2) undergoing ETT and single photon emission computed tomography were prospectively enrolled. Summed stress and difference scores, stress and reversible extent % of perfusion abnormalities, and lung heart ratio was calculated. RESULTS: There was no significant difference in the mean summed stress score (9+/-9 versus 13+/-10, P=0.13), summed difference score (4+/-3 versus 6+/-5, P=0.13), stress extent % (14+/-16 versus 19+/-13, P=0.13), extent of reversibility % (7+/-9 versus 7+/-7, P=0.93), or lung heart ratio (0.48+/-0.07 versus 0.46+/-0.07, P=0.50) between the two groups. There was no significant difference in the incidence of severe ischemia (summed difference score >13) in the 2 groups (24% versus 40%, P=0.36). CONCLUSION: We conclude that utilizing the commonly used cutoff for prolonged ST segment depression: >5 min in recovery, does not identify patients with more severe ischemia or coronary artery disease and, therefore, at increased risk. Thus, it appears unnecessary to give special consideration to these patients by way of prolonged monitoring in recovery, or a more aggressive non-invasive ischemia imaging approach after the ETT.