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1.
J Cardiovasc Med (Hagerstown) ; 22(12): e37-e40, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34482326

RESUMO

Arterial vasospasm is a well known cause of ischemia and, if prolonged, of parenchymal infarction. The clinical presentation varies according to the involved arterial district. We describe a rare case, which occurred in a young lady, of recurrent and multisystem vasospasm, resulting in multiple cerebral and myocardial infarctions. Our patient was resistant to medical therapy, requiring stent implantation of the involved vessels.


Assuntos
Arteriopatias Oclusivas , Implante de Prótese Vascular , Encéfalo , Artérias Carótidas , Vasoespasmo Coronário , Vasoespasmo Intracraniano , Adulto , Arteriopatias Oclusivas/diagnóstico , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/terapia , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Bloqueadores dos Canais de Cálcio/uso terapêutico , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/fisiopatologia , Artérias Carótidas/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Vasoespasmo Coronário/diagnóstico por imagem , Vasoespasmo Coronário/etiologia , Vasoespasmo Coronário/fisiopatologia , Resistência a Medicamentos , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Recidiva , Stents , Resultado do Tratamento , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/fisiopatologia
2.
G Ital Cardiol (Rome) ; 22(9): 704-711, 2021 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-34463678

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has shown high morbidity and mortality and the relationship between pulmonary embolism (PE) and COVID-19 is well established in the literature. METHODS: We describe the characteristics of a cohort of COVID-19 patients (EP-COV) hospitalized at our Centre with PE, investigating how COVID-19 may have influenced their outcomes, as compared to patients without COVID-19 hospitalized for PE in the same months of 2020 (EP-2020) and 2019 (EP-2019). RESULTS: EP-COV patients (n=25) were younger (60.5 ± 8.5 vs 71.4 ± 14.5 vs 70.9 ± 11.8 years, p=0.003), more frequently male (76% vs 48% vs 35%, p=0.016), with a lower history of neoplasia (12% vs 47% vs 40%, p=0.028) and more clinically severe (SOFA score 3.4 ± 1.4 vs 2.2 ± 1.4 vs 1 ± 1.1, p<0.001 and PaO2/FiO2 ratio 223.8 ± 75.5 vs 306.5 ± 49.3 vs 311.8 ± 107.5) than EP-2020 (n=17) and EP-2019 patients (n=20). D-dimer and C-reactive protein were higher in EP-COV (p=0.038 e p<0.001, respectively). The rate of concomitant deep vein thrombosis associated with PE did not differ significantly between the three groups. EP-COV patients developed PE more frequently during in-hospital stay than non-COVID-19 patients (p = 0.016). The mortality rate was higher in EP-COV than in EP-2020 and EP-2019 patients (36% vs 0% vs 5%, p=0.019). CONCLUSIONS: In our study, the risk factors for PE in COVID-19 patients seem to differ from the traditional risk factors for venous thromboembolism; EP-COV patients are clinically more severe and display a higher mortality rate than EP-2020 and EP-2019 patients.


Assuntos
COVID-19 , Embolia Pulmonar , Tromboembolia Venosa , Idoso , COVID-19/complicações , COVID-19/diagnóstico , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , SARS-CoV-2
3.
Am J Cardiol ; 116(12): 1791-7, 2015 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-26602070

RESUMO

Statin pretreatment has been reported to have a cardioprotective effect in patients undergoing elective or urgent percutaneous coronary intervention (PCI). However, data on patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI are still controversial. We prospectively evaluated the effect of long-term statin therapy on infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) in consecutive patients with STEMI who underwent primary PCI. Two-hundred thirty patients with STEMI (mean age 61 ± 11 years, 183 men) who underwent primary PCI were evaluated with cardiac magnetic resonance (CMR) imaging during hospitalization (median 4 days after primary PCI). In all patients, we measured peak troponin I level, whereas IS, MSI, and MVO were determined by CMR. Fifty patients (22%) were on long-term statin therapy and showed a significantly lower troponin I peak value compared to patients without previous statins (54 ± 47 vs 88 ± 106 ng/ml; p = 0.02). At CMR evaluation, IS related to the index event was significantly smaller (12.5 ± 11.5 vs 18.5 ± 18.5 g, p = 0.05), and MSI was higher (0.68 ± 0.25 vs 0.52 ± 0.30; p <0.01) in patients with previous statin therapy. MVO was also less frequent (10% vs 20%; p = 0.14) in this group. At multivariate analysis, previous statin therapy remained significantly associated with IS and MSI (p = 0.05 and 0.02, respectively). In conclusion, this study suggests that long-term statin therapy before primary PCI in patients with STEMI is associated with smaller IS and higher MSI. Future studies are warranted to confirm these findings and to investigate potential clinical implications.


Assuntos
Eletrocardiografia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Intervenção Coronária Percutânea , Cuidados Pré-Operatórios/métodos , Angiografia Coronária , Circulação Coronária/efeitos dos fármacos , Feminino , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
4.
Radiology ; 271(3): 688-94, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24520943

RESUMO

PURPOSE: To compare the image quality, evaluability, diagnostic accuracy, and radiation exposure of high-spatial-resolution (HR, 0.23-mm) computed tomographic (CT) coronary angiography with standard spatial resolution (SR, 0.625-mm) 64-section imaging in patients at high risk for coronary artery disease (CAD) by using invasive coronary angiography (ICA) as the reference method. MATERIALS AND METHODS: Written informed consent was obtained from all patients, and the study protocol was approved by the institutional ethical committee. Patients at high risk for CAD (n = 184) who were scheduled for ICA were randomly assigned for study with SR (n = 91) or HR (n = 93) coronary CT angiography before they underwent ICA. To compare the two groups, the Student t test or Wilcoxon test were used to evaluate differences in continuous variables. The χ(2) test or Fisher exact test were used, as appropriate, for categorical data. The McNemar test was used to compare the diagnostic performance of coronary CT angiography versus that of ICA in each group. RESULTS: HR coronary CT angiography showed a higher image quality score (3.7 vs 3.4, P < .001) and evaluability (97% vs 92%, P < .002). In a segment-based analysis, HR coronary CT angiography showed a higher specificity, positive predictive value, and accuracy in comparison with SR coronary CT angiography (98%, 91%, and 99% vs 95%, 80%, and 95%, respectively; P < .001). Moreover, HR coronary CT angiography showed a better agreement with ICA for calcified plaques compared with SR coronary CT angiography and ICA (83% vs 53%, P < .001). In a patient-based analysis, HR coronary CT angiography showed higher specificity and accuracy compared with SR coronary CT angiography (91% and 98% vs 46% and 92%, respectively; P < .01). No differences in radiation exposure were found between the two groups. CONCLUSION: Improved evaluability and accuracy were seen with HR compared with SR coronary CT angiography of calcified coronary artery lesions, suggesting a potential use for this technology in patients at high risk for CAD.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Artefatos , Meios de Contraste , Feminino , Humanos , Iopamidol/análogos & derivados , Masculino , Valor Preditivo dos Testes , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Sensibilidade e Especificidade , Razão Sinal-Ruído
5.
Am J Cardiol ; 112(11): 1790-9, 2013 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-24045059

RESUMO

The evaluation of the aortic root in patients referred for transcatheter aortic valve implantation is crucial. The aim of the present study was to compare the accuracy of cardiac magnetic resonance (CMR) evaluation of the aortic annulus (AoA) with transthoracic and transesophageal echocardiography and multidetector computed tomography (MDCT) in patients referred for transcatheter aortic valve implantation. In 50 patients, maximum diameter, minimum diameter and AoA, length of the left coronary, right coronary, and noncoronary aortic leaflets, degree (grades 1 to 4) of aortic leaflet calcification, and distance between AoA and coronary artery ostia were assessed. AoA maximum diameter, minimum diameter, and area by CMR were 26.4 ± 2.8 mm, 20.6 ± 2.3 mm, 449.8 ± 86.2 mm(2), respectively. The length of left coronary, right coronary, and noncoronary leaflets by CMR were 13.9 ± 2.2, 13.3 ± 2.1, and 13.4 ± 1.8 mm, respectively, whereas the score of aortic leaflet calcifications was 2.9 ± 0.8. Finally, the distances between AoA and left main and right coronary artery ostia were 16.1 ± 2.8 and 16.1 ± 4.4 mm, respectively. Regarding AoA area, transthoracic and transesophageal echocardiography showed an underestimation (p <0.01), with a moderate agreement (r: 0.5 and 0.6, respectively, p <0.01) compared with CMR. No differences and excellent correlation were observed between CMR and MDCT for all parameters (r: 0.9, p <0.01), except for aortic leaflet calcifications that were underestimated by CMR. In conclusion, aortic root assessment with CMR including AoA size, aortic leaflet length, and coronary artery ostia height is accurate compared with MDCT. CMR may be a valid imaging alternative in patients unsuitable for MDCT.


Assuntos
Aorta , Estenose da Valva Aórtica/diagnóstico , Valva Aórtica , Técnicas de Imagem Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Aorta/diagnóstico por imagem , Aorta/patologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Estenose da Valva Aórtica/cirurgia , Aortografia , Cateterismo Cardíaco , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada Multidetectores
6.
JACC Cardiovasc Imaging ; 6(6): 641-50, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23764093

RESUMO

OBJECTIVES: The aim of the study was to perform a comparison of the prognostic performance of computed tomography coronary angiography (CTA) and exercise electrocardiography (ex-ECG) in patients with suspected coronary artery disease (CAD). BACKGROUND: CAD is a major cause of mortality and morbidity, and its management consumes a large proportion of the health care budget. Therefore, identification of patients at high risk of adverse events is crucial. Despite its limited accuracy, ex-ECG is the most commonly used noninvasive test in CAD evaluation. CTA was recently introduced as alternative test. METHODS: We enrolled 681 patients (age 61.3 ± 10.4 years, 461 men) with atypical or typical angina and no history of CAD. All patients underwent ex-ECG and CTA and were followed for 44 ±12 months. The endpoints were all cardiac events, defined as nonfatal myocardial infarction, cardiac death, and revascularization, and hard cardiac events, defined as all cardiac events excluding revascularization. RESULTS: ex-ECG and CTA were rated as positive in 419 (61%) and 274 (40%) of 681 patients, respectively. In univariate analysis, both ex-ECG and CTA were predictors of all cardiac events (hazard ratio [HR]: 2.09, 95% confidence interval [CI]: 1.5 to 2.8; p < 0.0001 and HR: 21.1, 95% CI: 14.6 to 30.5; p < 0.0001, respectively) and hard cardiac events (HR: 1.9, 95% CI: 1.1 to 3.2; p = 0.02 and HR: 6.8, 95% CI: 3.9 to 11.0; p < 0.0001, respectively), whereas in a multivariate analysis, CAD with ≥50% stenoses detected by CTA was the only independent predictor of hard cardiac events. Stratifying our population by ex-ECG and CTA findings, Kaplan-Meier curves showed that ex-ECG provides only a further risk stratification in the subset of patients with positive findings on CTA and a low to intermediate likelihood of CAD. Moreover, positive findings on CTA identify a shorter event-free period, regardless the ex-ECG findings for both all cardiac events and hard cardiac events, respectively. CONCLUSIONS: CTA may have a higher prognostic value compared with ex-ECG in patients with suspected CAD, mainly in those with a low to intermediate pre-test likelihood of CAD.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Teste de Esforço , Tomografia Computadorizada Multidetectores , Idoso , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Progressão da Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Revascularização Miocárdica , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
7.
Int J Cardiol ; 167(6): 2889-94, 2013 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-22959395

RESUMO

BACKGROUND: The aims of this study are to evaluate the accuracy of low dose multidetector computed tomography coronary angiography (MDCT) versus invasive coronary angiography (ICA) in ruling out CAD in patients with mitral valve prolapse and severe mitral regurgitation (MVP) before cardiac surgery and to compare the overall effective radiation dose (ED) and cost of a diagnostic approach in which conventional ICA should be performed only in patients with significant CAD as detected by MDCT. METHODS: Eighty patients with MVP and without history of CAD were randomized to MDCT (Group 1) or ICA (Group 2) to rule out CAD before surgery. However, ICA was also performed as gold standard reference in Group 1 to test the diagnostic accuracy of MDCT. A diagnostic work-up A in whom all patients underwent low-dose MDCT as initial diagnostic test and those with positive findings were referred for ICA was compared with work-up B in which all patients were referred for ICA according to the standard of care in terms of ED and cost. RESULTS: The two groups were homogeneous in terms of gender, age and body mass index. The overall feasibility and accuracy in a patient-based model were 99% and 93%, respectively. The overall ED and costs were significantly lower in diagnostic work-up A compared to diagnostic work-up B. CONCLUSIONS: The accuracy of low dose MDCT for ruling out the presence of significant CAD in patients undergoing elective valve surgery for mitral valve prolapse is excellent with a reduction of overall radiation dose exposure and costs.


Assuntos
Angiografia Coronária/normas , Prolapso da Valva Mitral/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/normas , Cuidados Pré-Operatórios/normas , Doses de Radiação , Encaminhamento e Consulta/normas , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária/economia , Custos e Análise de Custo/economia , Custos e Análise de Custo/métodos , Feminino , Humanos , Masculino , Prolapso da Valva Mitral/economia , Prolapso da Valva Mitral/epidemiologia , Tomografia Computadorizada Multidetectores/economia , Cuidados Pré-Operatórios/economia , Encaminhamento e Consulta/economia
8.
Am Heart J ; 164(4): 576-84, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23067917

RESUMO

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgery in high-risk patients with severe aortic stenosis. Aortic annulus (AoA) sizing is crucial for TAVI success. The aim of the study was to compare AoA dimensions measured by multidetector computed tomography (MDCT) vs those obtained with transthoracic (TTE) and transesophageal echocardiography (TEE) for predicting paravalvular aortic regurgitation (PVR) after TAVI. METHODS: Aortic annulus maximum diameter, minimum diameter, and area were assessed using MDCT and compared with TTE and TEE diameter and area for predicting PVR after TAVI in 151 patients (45 men, age 81.2 ± 6.4 years). RESULTS: Aortic annulus maximum, minimum diameter, and area detected by MDCT were 25.04 ± 2.39 mm, 21.27 ± 2.10 mm, and 420.87 ± 76.10 mm(2), respectively. Aortic annulus diameter and area measured by TTE and TEE were 21.14 ± 1.94 mm and 353.82 ± 64.57 mm(2) and 22.04 ± 1.94 mm and 384.33 ± 67.30 mm(2), respectively. A good correlation was found between AoA diameters and area evaluated by MDCT vs TTE and TEE (0.61, 0.65, and 0.69 and 0.61, 0.65, and 0.70, respectively), with a mean difference of 3.90 ± 1.98 mm, 0.13 ± 1.67 mm, and 67.05 ± 55.87 mm(2) and 3.0 ± 2.0 mm, 0.77 ± 1.70 mm, and 36.54 ± 56.43 mm(2), respectively. Grade ≥2 PVR occurred in 46 patients and was related to male gender, higher body mass index, preprocedural aortic regurgitation, and lower mismatch between the nominal area of the implanted prosthesis and AoA area detected by MDCT. CONCLUSIONS: Mismatch between prosthesis area and AoA area detected by MDCT is a better predictor of PVR as compared with echocardiography mismatch. Specific MDCT-based sizing recommendations should be developed.


Assuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso de 80 Anos ou mais , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/patologia , Ecocardiografia/métodos , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Masculino , Tomografia Computadorizada Multidetectores/métodos , Tamanho do Órgão
9.
JACC Cardiovasc Imaging ; 5(7): 690-701, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22789937

RESUMO

OBJECTIVES: The aim of this study was to assess the long-term prognostic role of multidetector computed tomography coronary angiography (CTA) in patients with suspected coronary artery disease (CAD). BACKGROUND: Use of CTA is increasing in patients with suspected CAD. Although there is a large body of data supporting the prognostic role of CTA for major adverse cardiac events in the intermediate term, its long-term prognostic role in patients with suspected CAD is not well studied. METHODS: Between February 2005 and March 2008, 1,304 consecutive patients were prospectively studied with CTA for detecting the presence and assessing extent of CAD (disease extension and coronary plaque scores). Patients were classified according to the presence of normal coronaries and nonobstructive (<50%) and obstructive (>50%) coronary lesions. The composite rates of hard cardiac events (cardiac deaths and nonfatal myocardial infarctions) and all cardiac events (including late revascularization) were the endpoints of the study. RESULTS: Seventy patients were excluded because their CTA data were uninterpretable. Of the remaining 1,234 patients, clinical follow-up (mean 52 ± 22 months) was obtained for 1,196 (97%). A total of 475 events were recorded, with 136 hard events (18 cardiac deaths and 118 nonfatal myocardial infarctions) and 123 late revascularizations. A total of 216 patients with early elective revascularizations were excluded from the survival analysis. Significant independent predictors of events in multivariate analysis were multivessel disease and left main CAD. Cumulative event-free survival was 100% for hard and all events in patients with normal coronary arteries, 88% for hard events and 72% for all events in patients with nonobstructive CAD, and 54% for hard events and 31% for all events in patients with obstructive CAD. Multivessel CAD was associated with a higher rate of hard cardiac events. CONCLUSIONS: CTA provides prognostic information in patients with suspected CAD and unknown cardiac disease, showing excellent long-term prognosis when there is no evidence of atherosclerosis and allowing risk stratification when CAD is present.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Idoso , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/mortalidade , Estenose Coronária/complicações , Estenose Coronária/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Itália , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/etiologia , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
10.
Int J Cardiol ; 160(3): 155-64, 2012 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-21978473

RESUMO

We conducted a meta-analysis evaluating the critical ratio between effective radiation dose (ED), feasibility (Fe) and diagnostic accuracy (Ac) of multidetector computed tomography (MDCT) for the detection of significant coronary artery disease. By using our predetermined criteria, we selected human studies published in English in which the ED and raw data of Ac vs. invasive coronary angiography in a segment based model were specified. Data from 31 studies including 3661 patients (mean age 61.9 ± 4.5 years, heart rate 62.5 ± 6.7 bpm) and 50,236 coronary artery segments were analysed and are reported. Overall, Fe, sensitivity, specificity, negative predictive value, positive predictive value, Ac and ED were 95%, 90%, 96%, 99%, 69%, 95% and 10.4 ± 5.4 mSv, respectively. Multivariate analysis showed that prospective ECG-gating (-8.8 mSv CI95% -13.4 to -4.3 mSv, p=0.001), dual-source (-3.7 mSv CI95% -7.9 to 0 mSv, p=0.05) and BMI-adapted scanning protocols (-4.5 mSv CI95% -8.7 to -2.7 mSv, p=0.03) were independent predictors of ED reduction. In patients with low heart rate, the best compromise between ED, Fe and Ac (2.5 mSv, 97% and 98%, respectively) was obtained combining prospective ECG-gating and BMI-adapted scanning protocols, while in patients with high heart rate the strategy associated with the best results (10 mSv, 98% and 97%, respectively) was the use of dual-source MDCT with retrospective ECG gating and modulation dose. In conclusion, careful selection of CT scanning protocols according to the patient's characteristics is critical for keeping the radiation exposure "as low as reasonably achievable" (ALARA) without impairing Fe and Ac.


Assuntos
Estenose Coronária/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/normas , Doses de Radiação , Estenose Coronária/epidemiologia , Estenose Coronária/patologia , Humanos , Tomografia Computadorizada Multidetectores/efeitos adversos , Estudos Prospectivos , Estudos Retrospectivos
12.
Am Heart J ; 161(6): 1106-13, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21641357

RESUMO

BACKGROUND: The aim of this study was to assess the accuracy of a comprehensive multidetector computed tomography (MDCT) evaluation of the aortic annulus (AoA), coronary artery disease (CAD), and peripheral vessels in patients referred for transcatheter aortic valve implantation (TAVI). METHODS: In 60 patients referred for TAVI, the following parameters were assessed with 64-slices MDCT and compared with transesophageal echocardiography (TEE), invasive coronary angiography (ICA), and peripheral angiography: AoA maximum diameter (Max-AoA-D(MDCT)), minimum diameter (Min-AoA-D(MDCT)), and area; lumen morphology index ([Max-AoA-D(MDCT)/Min-AoA-D(MDCT)]); length of the left, right, and non-coronary aortic leaflets; degree (grades 1-4) of aortic leaflet calcifications; distance between AoA and left main coronary ostium and between AoA and right coronary ostium CAD and peripheral vessel disease. RESULTS: The Max-AoA-D(MDCT) and Min-AoA-D(MDCT) were 25.1 ± 2.8 and 21.2 ± 2.2 mm, respectively, with high correlation versus AoA diameter measured with TEE (r = 0.82 and 0.86, respectively). The area of AoA, systolic and diastolic lumen morphology index were 410 ± 81.5 mm(2), 1.19 ± 0.1 and 1.22 ± 0.11, respectively. Aortic leaflet calcification score was 3.3 ± 0.5. The lengths of left, right, and non-coronary aortic leaflets were 14.2 ± 2.4, 13.7.1 ± 2.1, and 14.5 ± 2.6 mm, whereas distances between AoA and the left main coronary ostium and between AoA, and the right coronary ostium were 13.7 ± 2.9 and 15.8 ± 3.5 mm, respectively. Feasibility, negative predictive value, and accuracy for CAD detection versus ICA were 87%, 100% (CI 100-100), and 96% (95% CI 94-100), respectively. All patients (N = 17) who were ineligible for TAVI were correctly detected by MDCT. CONCLUSIONS: A comprehensive MDCT evaluation of patients referred for TAVI is feasible, provides more accurate assessment than TEE of AoA morphology, and may replace peripheral angiography in all patients and ICA in patients without significant CAD.


Assuntos
Aorta/anatomia & histologia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Cateterismo/instrumentação , Angiografia Coronária , Vasos Coronários/anatomia & histologia , Ecocardiografia Transesofagiana , Estudos de Viabilidade , Feminino , Humanos , Masculino , Ajuste de Prótese
13.
Eur Radiol ; 21(7): 1430-8, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21331594

RESUMO

OBJECTIVES: The accuracy of computed tomography (CT) for assessment of coronary stents is as yet unproven and radiation exposure has been a concern. The aim of our study is to compare radiation dose and diagnostic performance of CT with prospective ECG-triggering versus retrospective ECG-triggering for the detection of in-stent restenosis (ISR). METHODS: We enrolled 168 consecutive patients with suspected ISR, 83 studied using CT with prospective ECG-triggering (group 1) and 85 using retrospective ECG-triggering (group 2). RESULTS: Prevalence of ISR according to catheter angiography was 24% in both groups. The overall evaluability was similar (93% in group 1 vs 95% in group 2). Artefact sub-analysis showed a significantly lower number of blooming and higher number of slice misalignment in group 1 vs group 2. In the stent-based analysis using only evaluable stents, specificity, positive predictive value and accuracy were significantly higher in group 1 (100%, 100% and 99%, respectively) than in group 2 (97%, 91% and 95%, respectively, p < 0.05). Group 1 was exposed to a lower radiation dose compared with group 2 (4.3 ± 1.4 mSv vs 18.5 ± 5.5 mSv, p < 00.1). CONCLUSIONS: CT with prospective ECG-triggering can improve diagnostic accuracy of non-invasive imaging of coronary stents with a significant reduction in radiation exposure.


Assuntos
Angiografia Coronária/métodos , Reestenose Coronária/diagnóstico por imagem , Oclusão de Enxerto Vascular/diagnóstico por imagem , Stents , Tomografia Computadorizada por Raios X/métodos , Distribuição de Qui-Quadrado , Meios de Contraste , Eletrocardiografia , Feminino , Humanos , Iopamidol/análogos & derivados , Modelos Lineares , Masculino , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
Cardiovasc Diabetol ; 9: 80, 2010 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-21114858

RESUMO

BACKGROUND: Diabetics have high prevalence of subclinical coronary artery disease (CAD) with typical characteristics (diffuse disease, large calcifications). Although 64-slice multidetector computed tomography (MDCT) coronary angiography has high diagnostic accuracy to detect CAD, its diagnostic performance in diabetics with suspected CAD is unknown. To compare the diagnostic performance of 64-slice MDCT between diabetics and non-diabetics with suspected CAD scheduled for invasive coronary angiography (ICA). METHODS: We enrolled one hundred and five diabetic patients (92 men, age 65 +/- 9 years, Group 1) and 105 non-diabetic patients (63 men, age 63+/-5 years, Group 2) with indication to ICA for suspected CAD undergoing coronary 64-slice MDCT before ICA. RESULTS: In Group 1, the overall feasibility of coronary artery visualization was 93.8%. The most frequent artifact was blooming due to large coronary calcifications (54 artifacts, 67%). In Group 2, the overall feasibility was significantly higher vs. Group 1 (97%, p < 0.0001). In Group 1, the segment-based analysis showed a MDCT sensibility, specificity, positive predictive value, negative predictive value and accuracy for the detection of ≥50% luminal narrowing of 77%, 90%, 70%, 93% and 87%, respectively. In Group 2, all these parameters were significantly higher vs. Group 1. In the patient-based analysis, specificity, negative predictive value and accuracy were significantly lower in Group 1 vs. Group 2. CONCLUSIONS: Although MDCT has high sensitivity for early identification of significant CAD in diabetics, its diagnostic performance is significantly reduced in these patients as compared to non-diabetics with similar clinical characteristics.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Complicações do Diabetes/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Artefatos , Calcinose/diagnóstico por imagem , Diagnóstico Precoce , Estudos de Viabilidade , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade
16.
J Clin Oncol ; 28(25): 3910-6, 2010 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-20679614

RESUMO

PURPOSE: Treatment of breast cancer with trastuzumab is complicated by cardiotoxicity in up to 34% of the patients. In most patients, trastuzumab-induced cardiotoxicity (TIC) is reversible: left ventricular ejection fraction (LVEF) improves after trastuzumab withdrawal and with, or sometimes without, initiation of heart failure (HF) therapy. The reversibility of TIC, however, is not foreseeable, and identification of patients at risk and of those who will not recover from cardiac dysfunction is crucial. The usefulness of troponin I (TNI) in the identification of patients at risk for TIC and in the prediction of LVEF recovery has never been investigated. PATIENTS AND METHODS: In total, 251 women were enrolled. TNI was measured before and after each trastuzumab cycle. LVEF was evaluated at baseline, every 3 months during trastuzumab therapy, and every 6 months afterward. In case of TIC, trastuzumab was discontinued, and HF treatment with enalapril and carvedilol was initiated. TIC was defined as LVEF decrease of > 10 units and below 50%. Recovery from TIC was defined as LVEF increase above 50%. RESULTS: TIC occurred in 42 patients (17%) and was more frequent in patients with TNI elevation (TNI+; 62% v 5%; P < .001). Twenty-five patients (60%) recovered from TIC. LVEF recovery occurred less frequently in TNI+ patients (35% v 100%; P < .001). At multivariate analysis, TNI+ was the only independent predictor of TIC (hazard ratio [HR], 22.9; 95% CI, 11.6 to 45.5; P < .001) and of lack of LVEF recovery (HR, 2.88; 95% CI,1.78 to 4.65; P < .001). CONCLUSION: TNI+ identifies trastuzumab-treated patients who are at risk for cardiotoxicity and are unlikely to recover from cardiac dysfunction despite HF therapy.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/metabolismo , Cardiopatias/induzido quimicamente , Troponina I/metabolismo , Adulto , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Interações Medicamentosas , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Risco , Trastuzumab , Resultado do Tratamento , Disfunção Ventricular Esquerda/induzido quimicamente
17.
Int J Cardiol ; 145(2): 388-390, 2010 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-20223531

RESUMO

It is unknown whether multidetector computed tomography (MDCT) has an additional clinical value compared to invasive coronary angiography (ICA) in the characterization of congenital coronary artery anomalies (CAA). We studied 2757 consecutive patients with 64-slice MDCT and classified CAA according to anatomical criteria and pathophysiology-clinical relevance. The prevalence of anatomical variants was: left dominance circulation (8%), absence of left main artery (1.3%), presence of intermediate ramus (22.6%), origin of conus branch from aorta (10.6%) and of the sinus node branch from the left circumflex coronary artery (15.3%). Among 380 CAA (13.8 %) detected with MDCT, 322 (85%) were an occasional finding. In the remaining 58 patients, MDCT performed after ICA confirmed CAA in 40 (69%) cases and detected or provided additional and more detailed informations in 18 (31%). Of these 18 patients, 14 showed malignant CAA. MDCT is the ideal method for the evaluation of CAA, not only allowing a precise anatomic visualization of coronary tree, but also adding important details in malignant congenital anomalies.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Int J Cardiol ; 144(2): 340-3, 2010 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-19339064

RESUMO

It is unknown whether dilated cardiomyopathy (DCM) etiology influences cardiac veins (CVs) anatomy. By multidetector computed tomography (MDCT) we studied CVs of 93 patients with normal cardiac function (Group1) and of 99 DCM patients. In the latter we used a standard scanning coronary artery protocol (Group2, n=62) or a protocol specifically tailored to assess CVs in DCM (Group3, n=37). We also performed in all patients invasive coronary angiography. Group 1 had more CVs (83%) vs. DCM patients (72% and 76% in Groups 2 and 3 respectively, p<0.05). Group 2 had a higher percentage of CVs with insufficient imaging quality score (43 out of 224 veins, 19%) vs. Group 1 (6%, p<0.01) and Group 3 (11%, p<0.05) mainly due to low signal/noise ratio (32 out of 43 veins, 74%). Ischemic DCM patients had a lower CVs number (86/135, 64%) vs. both Group 1 patients and vs. non-ischemic DCM. Therefore MDCT is feasible for assessing CVs in DCM using scanning CVs tailored protocols. Ischemic DCM patients have a lower number of CVs compared to normal systolic function or non-ischemic DCM patients.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Cardiomiopatia Dilatada/etiologia , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Flebografia/métodos , Tomografia Computadorizada por Raios X/métodos
19.
Circ Cardiovasc Imaging ; 2(3): 199-205, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19808593

RESUMO

BACKGROUND: The goal of this study was to assess the safety, feasibility, and diagnostic accuracy of 64-slice multidetector computed tomography (MDCT) for the evaluation of coronary arteries in dilated cardiomyopathy (DCM) of unknown etiology. Sixteen-slice MDCT is useful in patients affected by DCM. However, technical limitations, such as cardiac arrhythmias, an inability of patients to sustain a long breath-hold, and the need of a high dose of contrast agent may limit its accuracy and widespread use. METHODS AND RESULTS: Invasive coronary angiography (ICA) and MDCT coronary angiography were performed on 132 consecutive patients (82 men; age 63+/-11 years) affected by DCM (ejection fraction, 34+/-10%) of unknown etiology. In 2 patients (1.5%), MDCT was not feasible because of atrial fibrillation. Of the remaining 130 patients, 88 exhibited normal and 42 exhibited diseased coronary arteries in both MDCT and ICA. All patients with coronary artery disease except for 1 were correctly classified by MDCT as 1-vessel (11 cases), 2-vessel (13 cases), and 3-vessel (18 cases) disease. In the segment-based analyses, the overall feasibility for MDCT was 98.5% (1902 of 1930 segments). Segment-based and patient-based analyses for the detection of luminal stenosis of >50% and >70% were performed. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT for the detection of >50% stenosis were 98.1%, 99.9%, 98.7%, 99.8%, and 99.7%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT for the detection of >70% stenosis were 99.5%, 98.6%, 94.1%, 99.9%, and 99.4%, respectively. CONCLUSIONS: Excellent feasibility and diagnostic accuracy, combined with low invasiveness, make 64-slice MDCT an ideal imaging modality for the anatomic evaluation of coronary circulation in patients with DCM of unknown etiology.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/patologia , Tomografia Computadorizada por Raios X , Idoso , Cardiomiopatia Dilatada/etiologia , Doença da Artéria Coronariana/complicações , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença
20.
J Am Coll Cardiol ; 54(4): 346-55, 2009 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-19608033

RESUMO

OBJECTIVES: The aim of this study was to compare the diagnostic performance of multidetector computed tomography (MDCT) with prospective electrocardiogram (ECG) triggering versus retrospective ECG triggering. BACKGROUND: MDCT allows the noninvasive visualization of the coronary arteries. However, radiation exposure is a reason for concern. METHODS: One hundred eighty consecutive patients scheduled for invasive coronary angiography were enrolled in this study. Twenty patients were excluded due to contraindications to sustain MDCT. Of the 160 remaining patients, 80 were studied with MDCT with prospective ECG triggering (Group 1) and 80 with a retrospective ECG triggering (Group 2). The individual radiation dose exposure was estimated. RESULTS: In nonstented segments, the evaluability of Groups 1 and 2 was 96% versus 97%, respectively (p = 0.05), the accuracy in segment-based model was 93% versus 96%, respectively (p < 0.05) including diagnostic segments and 91% versus 94%, respectively (p < 0.01) including all segments, whereas the accuracy in a patient-based model was 98% in both groups. In stented segments the evaluability in Groups 1 and 2 was 92% versus 94%, respectively, and the accuracy was 93% versus 92%, respectively, including diagnostic stented segments and 90% versus 89%, respectively, including all stented segments. Group 1 presented lower radiation dose compared with Group 2 (5.7 +/- 1.5 mSv vs. 20.5 +/- 4.3 mSv, p < 0.01). CONCLUSIONS: Prospective ECG-triggering computed tomography allows an accurate detection of coronary stenosis, despite a slight reduction of diagnostic performance, with a low radiation dose.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Doses de Radiação , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
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