La perspectiva del cardiólogo sobre la evaluación del dolor torácico agudo mediante ecocardiografía de ejercicio y tomografía computarizada multidetectores / Cardiologist point of view on the exercise echocardiography and multidetector computed tomography for the evaluation of acute chest pain

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Comentarios a la evaluación del dolor torácico agudo mediante ecocardiografía de ejercicio y tomografía computarizada multidetectores / Comments on exercise echocardiography and multidetector computed tomography for the evaluation of acute chest pain

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Image quality and radiation exposure with a low tube voltage protocol for coronary CT angiography results of the PROTECTION II Trial.

OBJECTIVES: The purpose of this study was to evaluate image quality and radiation dose using a 100 kVp tube voltage scan protocol compared with standard 120 kVp for coronary computed tomography angiography (CTA). BACKGROUND: Concerns have been raised about radiation exposure during coronary CTA. The use of a 100 kVp tube voltage scan protocol effectively lowers coronary CTA radiation dose compared with standard 120 kVp, but it is unknown whether image quality is maintained. METHODS: We enrolled 400 nonobese patients who underwent coronary CTA: 202 patients were randomly assigned to a 100 kVp protocol and 198 patients to a 120 kVp protocol. The primary end point was to demonstrate noninferiority in image quality with the 100 kVp protocol, which was assessed by a 4-point grading score (1 = nondiagnostic, 4 = excellent image quality). For the noninferiority analysis, a margin of -0.2 image quality score points for the difference between both scan protocols was pre-defined. Secondary end points included radiation dose and need for additional diagnostic tests during follow-up. RESULTS: The mean image quality scores in patients scanned with 100 kVp and 120 kVp were 3.30 ± 0.67 and 3.28 ± 0.68, respectively (p = 0.742); image quality of the 100 kVp protocol was not inferior, as demonstrated by the 97.5% confidence interval of the difference, which did not cross the pre-defined noninferiority margin of -0.2. The 100 kVp protocol was associated with a 31% relative reduction in radiation exposure (dose-length product: 868 ± 317 mGy × cm with 120 kVp vs. 599 ± 255 mGy × cm with 100 kVp; p < 0.0001). At 30-day follow-up, the need for additional diagnostic studies did not differ (13.4% vs. 19.2% for 100 kVp vs. 120 kVp, respectively; p = 0.114). CONCLUSIONS: A coronary CTA protocol using 100 kVp tube voltage maintained image quality, but reduced radiation exposure by 31% as compared with the standard 120 kVp protocol. Thus, 100 kVp scan protocols should be considered for nonobese patients to keep radiation exposure as low as reasonably achievable. (Prospective Randomized Trial on Radiation Dose Estimates of Cardiac CT Angiography in Patients Scanned With a 100 kVp Protocol [PROTECTION II]; NCT00611780).

[Evaluation of mitral regurgitation severity using a simplified method based on proximal flow convergence]. / Estimación de la severidad de la insuficiencia mitral según un método simplificado basado en el flujo de convergencia proximal.

INTRODUCTION AND OBJECTIVES: Calculation of the effective regurgitant orifice (ERO) is regarded as the most accurate way of assessing the severity of mitral regurgitation (MR), but the technique's complexity limits its use. Our objective was to modify and validate a previously published semiquantitative method of assessment based on measurement of the proximal isovelocity surface area (PISA) in order to adapt it to recent recommendations from American and European cardiology societies. METHODS: In the PISA method, maximum regurgitant flow (MRF) is a function of the radius and aliasing velocity (AV). Using this relationship, it is possible to construct a nomogram formed by lines of different MRF value, which can be easily derived by looking for radius values on the graph and observing where they cross with AV values. The MR severity limits on the nomogram were set to reflect the different severity grades and limits recommended for use with ERO measurements by American and European cardiology societies. RESULTS: We studied 76 patients with MR using Doppler echocardiography. There was an excellent correlation between MRF and ERO (r=0.98, P< .001). Estimates of MR severity made using the new nomogram were in good agreement with those derived from the ERO: for a scale with three severity grades, kappa was 0.951 and the standard error was 0.11; for four grades, kappa was 0.969 and the standard error, 0.11. CONCLUSIONS: Estimates of MR severity derived semiquantitatively from MRF using the nomogram proposed here were in excellent agreement with quantitative estimates obtained using the ERO, and the method was faster and easier to use.

Estimación de la severidad de la insuficiencia mitral según un método simplificado basado en el flujo de convergencia proximal / Evaluation of mitral regurgitation severity using a simplified method based on proximal flow convergence

Introducción y objetivos. El cálculo del orificio regurgitante efectivo (ORE) se considera el método más fiable para estimar la severidad de la insuficiencia mitral (IM), pero es poco usado por su complejidad. El objetivo fue modificar y validar un método semicuantitativo basado en la proximal isovelocity surface area (PISA), previamente publicado, para adaptarlo a las recientes recomendaciones de las sociedades americana y europea de cardiología. Métodos. Cuando usamos el método PISA, el flujo regurgitante máximo (FRM) es una función del radio y la velocidad de aliasing (Va). Esta relación permite la creación de un normograma formado por líneas de diferentes valores de FRM que se pueden obtener con facilidad al buscar en el gráfico los valores del radio y su cruce con los de Va. Los límites de severidad en esa tabla se han adaptado para que reflejen los grados y los límites de severidad recomendados por las sociedades americana y europea de cardiología según el valor de ORE. Resultados. Estudiamos a 76 pacientes con IM mediante eco-Doppler. Se encontró una correlación excelente entre FRM y ORE (r = 0,98; p < 0,001). La estimación de severidad mediante el nuevo normograma mostró una concordancia excelente con la determinada mediante el ORE, con un valor de kappa de 0,951 y un error estándar de 0,11 para una escala en 3 grados, y un valor de kappa de 0,969 y error estándar de 0,11 para la escala en 4 grados. Conclusiones. La estimación semicuantitativa de la severidad de la IM mediante el FRM mediante el normograma propuesto tiene un acuerdo excelente con la estimación cuantitativa por ORE, pero es mucho más simple y rápida

Introduction and objectives. Calculation of the effective regurgitant orifice (ERO) is regarded as the most accurate way of assessing the severity of mitral regurgitation (MR), but the technique's complexity limits its use. Our objective was to modify and validate a previously published semiquantitative method of assessment based on measurement of the proximal isovelocity surface area (PISA) in order to adapt it to recent recommendations from American and European cardiology societies. Methods. In the PISA method, maximum regurgitant flow (MRF) is a function of the radius and aliasing velocity (AV). Using this relationship, it is possible to construct a nomogram formed by lines of different MRF value, which can be easily derived by looking for radius values on the graph and observing where they cross with AV values. The MR severity limits on the nomogram were set to reflect the different severity grades and limits recommended for use with ERO measurements by American and European cardiology societies. Results. We studied 76 patients with MR using Doppler echocardiography. There was an excellent correlation between MRF and ERO (r=0.98, P<.001). Estimates of MR severity made using the new nomogram were in good agreement with those derived from the ERO: for a scale with three severity grades, kappa was 0.951 and the standard error was 0.11; for four grades, kappa was 0.969 and the standard error, 0.11. Conclusions. Estimates of MR severity derived semiquantitatively from MRF using the nomogram proposed here were in excellent agreement with quantitative estimates obtained using the ERO, and the method was faster and easier to use