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1.
Int J Cardiovasc Imaging ; 38(2): 289-296, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34498200

RESUMO

Myocardial perfusion defect, assessed with single photon emission computed tomography (SPECT), is useful for patient management and risk stratification. Left ventricle Global Longitudinal Strain (LV GLS) has gained interest for observing subclinical LV dysfunction. We aimed to investigate the utility of LV GLS in evaluating myocardial perfusion defect. A retrospective study of all patients who underwent SPECT and LV GLS at Tel Aviv Sourasky medical center. Overall, 86 patients were included. LV GLS and SPECT correlated in the base and apex sections for infraction, and in the apex only for ischemia. Adjusted analysis showed a significant correlation between LV GLS of both the mid and apical section and infarction by SPECT, but no association with ischemia. No associations were found by arterial supply territory. A sub-analysis of patients without left bundle branch block (LBBB) strengthened the correlations, with a 58-70% higher chance of both fixed and reversible defects for every 1-unit decrease LV GLS in the mid and apical sections. LV GLS effectively evaluated the presence of infarction by SPECT in the mid and apical sections, particularly in patients without LBBB. Due to its high availability, LV GLS may have a role in evaluating myocardial perfusion defect.


Assuntos
Ventrículos do Coração , Disfunção Ventricular Esquerda , Bloqueio de Ramo , Ventrículos do Coração/diagnóstico por imagem , Humanos , Perfusão , Valor Preditivo dos Testes , Estudos Retrospectivos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda
3.
Clin Res Cardiol ; 110(1): 50-60, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32296970

RESUMO

BACKGROUND: Immune checkpoint inhibitors (ICI) have transformed the standard care of cancer treatment. Recent case reports describe ICI-mediated myocarditis with an atypical presentation and fatal potential which lead to permanent interruption of immunotherapy. OBJECTIVES: To characterize ICI-mediated myocarditis and re-introduction to immunotherapy. METHODS: During 2019, 849 patients were treated with ICI at Tel Aviv Sourasky Medical Center for the diagnosis of lung adenocarcinoma, gastric adenocarcinoma, urothelial carcinoma, and hepatocellular carcinoma. Overall, seven (0.8%) patients were diagnosed with ICI-mediated myocarditis, according to the European Society of Cardiology guidelines of myocarditis 2013. We retrospectively evaluated their presentation, severity, and clinical outcomes. RESULTS: Among the seven patients, only one had a history of cardiac disease. The majority were diagnosed with lung adenocarcinoma and treated with anti-programmed death-1 antibody. All patients were treated with single-agent ICI. Most patients presented with cardiac symptoms, elevated troponin and typical cardiac magnetic resonance; however, only three had reduced ejection fraction. Overall, three patients were chosen for re-introduction with concomitant low dose steroids and weekly troponin follow-up. Two patients diagnosed with grade I and II renewed therapy successfully with no recurrence of symptoms and improvement in disease burden. The one patient diagnosed with grade III developed worsening of cardiac symptoms after the 1st cycle and, therefore, therapy was interrupted permanently. CONCLUSIONS: ICI-mediated myocarditis is potentially fatal and leads to permanent interruption of life-saving cancer therapy. The current data suggest that re-introduction may be considered in low-grade patients; however, a better definition of the diagnosis and grading is needed.


Assuntos
Inibidores de Checkpoint Imunológico/efeitos adversos , Imunoterapia/métodos , Miocardite/tratamento farmacológico , Neoplasias/tratamento farmacológico , Retratamento/métodos , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Eletrocardiografia , Feminino , Seguimentos , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Miocardite/induzido quimicamente , Miocardite/diagnóstico , Estudos Retrospectivos
4.
Eur Heart J Cardiovasc Imaging ; 22(5): 563-571, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32154881

RESUMO

AIMS: The prevalence and prognostic implications of left atrial appendage (LAA) thrombus (LAAT) in patients considered for transcatheter aortic valve replacement (TAVR) are incompletely defined. We, therefore, studied pre-procedural cardiac computed tomography angiography (CCTA) scans of TAVR candidates to determine the prevalence of LAAT and its association with late outcomes. METHODS AND RESULTS: Baseline clinical variables and CCTA findings from a prospective TAVR registry were analysed for the prevalence of pre-procedural LAAT and its impact on in-hospital outcomes and late mortality. LAAT was differentiated from LAA filling defects (LAAFD) reflecting stasis without clot. Patients (n = 561) with complete in-hospital and late mortality data were included in the study (median follow-up 31.6 months). LAAT and LAAFD were evidenced on pre-procedural CCTA in 24 (4.3%) and 26 (4.6%) patients, respectively. One hundred fourteen (20.3%) patients died during the study period. Though in-hospital adverse event rates (including stroke) did not differ among groups, mortality at long-term follow-up was higher among LAAT patients compared with those with or without LAAFD (58.3% vs. 11.5% vs. 19.0%, respectively; P < 0.003). By multivariable analysis, LAAT (but not LAAFD) was independently associated with all-cause mortality [hazard ratio (HR) = 3.33 (1.83-6.00), P < 0.001]. In patients with LAAT, oral anticoagulation at discharge was associated with lower mortality risk, independently of atrial fibrillation status. CONCLUSIONS: LAAT visualized by pre-procedural CCTA is an independent predictor of late mortality following TAVR, but not peri-procedural stroke. When reporting TAVR-CCTA, particular note should be made of LAA features and presence of LAAT which may have prognostic and management implications.


Assuntos
Estenose da Valva Aórtica , Apêndice Atrial , Trombose , Substituição da Valva Aórtica Transcateter , Valva Aórtica , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Estudos Prospectivos , Fatores de Risco , Trombose/diagnóstico por imagem , Trombose/epidemiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
5.
J Invasive Cardiol ; 32(5): E138, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32357137

RESUMO

After a series of tests, an 86-year-old patient was shown to have an infected thrombus on a TAVI valve and was referred to urgent surgery. The valve with the infected thrombus was removed and a biological prosthetic valve was implanted in its place.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Trombose , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Trombose/diagnóstico , Trombose/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos
6.
Eur Heart J Case Rep ; 4(1): 1-7, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32128479

RESUMO

BACKGROUND: Arrhythmogenic ventricular cardiomyopathy (AC) is a genetic progressive disease characterized by fibro-fatty replacement of either ventricles in isolation or in combination. Arrhythmogenic ventricular cardiomyopathy is frequently associated with ventricular tachycardia (VT) having a left bundle branch block (LBBB) morphology and much more rarely with VT having right bundle branch block (RBBB) morphology even when the left ventricle is involved. Cardiac magnetic resonance (CMR) imaging plays a key role in the diagnosis of AC. Sustained VT in AC may occur in the concealed stage of the disease before the manifestation of morphological abnormalities on echocardiogram; however, they almost always are accompanied by structural abnormalities of the ventricles on CMR. CASE SUMMARY: A 54-year-old man presented with sustained VT of LBBB configuration consistent with the diagnosis of AC but with no right ventricular (RV) anomalies at repeat CMR. Ten years later, he developed sustained VT with RBBB morphology and structural changes at CMR compatible with RV involvement in the setting of AC. Two years later, he suffered from recurrent identical sustained RBBB-VT with typical CMR signs of left ventricular involvement. Genetic analysis was negative for any known mutation. DISCUSSION: In the present report, we describe a patient with AC who first exhibited LBBB- and 10 years later RBBB-sustained VT. Contrasting with what is usually observed in patients with AC, documentations of the VT's arising from either ventricle were found to precede the structural anomalies in the respective cardiac chambers. This case highlights that normal CMR does not exclude underlying AC contrary to the perceptions of many clinicians. In addition, it strongly encourages repeating CMR after 1-2 years when the diagnosis of AC is highly suspected.

7.
Womens Health Rep (New Rochelle) ; 1(1): 393-401, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33786504

RESUMO

Background: Currently, normal values of the cardiac chambers' volumes are adjusted only for gender and body surface area (BSA). We aim to investigate the association between the heart rate and the volume of each of the four cardiac chambers using cardiac-gated computed tomography angiography (CCTA). Methods: A total of 350 consecutive patients without known cardiac diseases or significant (>50%) stenosis undergoing CCTA between January 2009 and June 2014 for suspected coronary artery disease were included. Cardiac chamber volumes adjusted to BSA were calculated using automated model-based segmentation analysis software of the CCTA data and correlated with patients' mean heart rate during the scan. Results: There were 240 men and 110 women, median interquartile range age was 55 years (47-61). Women were older 59.0 years (53.7-64) versus 52.0 years (45.0-59.0), had higher prevalence of hyperlipidemia, diabetes mellitus, anemia, and hypothyroidism, and higher median heart rates 64.0 (59.7-66.0) versus 60.0 (55.0-65.0) (p < 0.001). Men had a negative correlation between the volume of each cardiac chamber and the heart rate [r age_adj = (-0.4)-(-0.27), p < 0.001 for all], whereas such a correlation was not found in women. The multivariate analysis showed that a decrease of five beats per minute was associated with an increase of 4%-5% in volume of each chamber in men. There was no such association among females. Conclusions: Lower heart rate is associated with an increase of each cardiac chamber volume by CCTA in men. This association is not found in women. More extensive studies are required to further elaborate on these gender differences.

8.
EuroIntervention ; 16(2): e121-e128, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31566570

RESUMO

AIMS: The aim of this study was to assess the prognostic implications of increased right ventricle volume index (RVVI) using cardiac-gated computed tomography angiography (CCTA) data among patients undergoing transcatheter valve replacement (TAVR). METHODS AND RESULTS: CCTA of 323 patients who underwent TAVR at Stanford University Medical Center (CA, USA) and Tel Aviv Medical Center (Israel) between 2013 and 2016 was analysed by an automatic four-chamber volumetric software and grouped into quartiles according to RVVI. Higher one-year mortality rates were noted for the upper quartiles - 5%, 4.9%, 8.6%, and 16% (p=0.039), in Q1 <59 ml/m2, Q2 59-69 ml/m2, Q3 69-86 ml/m2, and Q4 >86 ml/m2, respectively. However, the differences were not significant after propensity score adjustments. Sub-analyses of Q1 demonstrated an escalating risk for one-year mortality in concordance to RVVI: HR 2.28, HR 2.76, and HR 4.7, for the upper 25th, 15th, and 5th percentiles, respectively (p<0.05 for all comparisons). After propensity score adjustments for clinical and echocardiographic characteristics, only the upper 5th percentiles (RVVI >120 ml/m2) retained statistical significance (HR 2.82, 95% CI: 1.02-7.78, p=0.045). Notably, 68.7% of patients from this group were considered low-intermediate risk for surgery. CONCLUSIONS: Cardiac volumetric data by CCTA performed for procedural planning may help to predict outcome in patients undergoing TAVR.


Assuntos
Angiografia , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/cirurgia , Técnicas de Imagem de Sincronização Cardíaca , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Substituição da Valva Aórtica Transcateter/métodos , Valva Aórtica , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Humanos , Israel/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
9.
Cardiology ; 139(1): 11-16, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29130963

RESUMO

AIMS: Shift work disrupts the normal circadian rhythm and is associated with risk factors for coronary artery disease (CAD) and a higher incidence of CAD morbidity and mortality. Cardiac computed tomography angiography (CCTA) is a robust noninvasive modality for assessing the presence, extent, and severity of CAD. We sought to investigate whether shift workers are prone to a higher burden of CAD compared to non-shift workers. METHODS: We conducted a historically prospective study in consecutive patients who underwent CCTA and answered a telephonic questionnaire. Due to significant differences in age and gender, we compared 89 well-matched pairs of shift workers and non-shift workers with the use of propensity scores. RESULTS: Our cohort consisted of 349 participants, of whom 94 (26.9%) were shift workers. The mean age was 50.7 years, and 62.5% were males. After pairing, we showed that shift workers had a higher prevalence of CAD than non-shift workers (74.2 vs. 53.9%, respectively, p = 0.01), and a lower prevalence of coronary calcium scores of zero (46.8 vs. 63.4%, respectively, p = 0.034). Stenosis >50% was more prevalent in shift workers than in non-shift workers (20.2 vs. 11.2%, respectively, p = 0.006), and the extent of CAD (defined as the presence of ≥1-vessel disease) tended to be higher in shift workers than in non-shift workers (25.8 vs. 13.5%, respectively, p = 0.06). CONCLUSIONS: In this CCTA study, we showed in a well-matched cohort of consecutive patients that shift workers had a higher prevalence and extent of CAD than non-shift workers.


Assuntos
Doença da Artéria Coronariana/etiologia , Jornada de Trabalho em Turnos/efeitos adversos , Adulto , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Pontuação de Propensão , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Tolerância ao Trabalho Programado
10.
Clin Cardiol ; 40(10): 879-885, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28613405

RESUMO

BACKGROUND: Previous echocardiographic studies have revealed an association between enlarged cardiac chamber volumes and elevated troponin concentrations. An automatic 4-chamber volumetric analysis tool was adopted to investigate this association in patients who underwent cardiac-gated computed tomography angiography (CCTA). HYPOTHESIS: We hypothesized that troponin concentration within the normal range correlates with cardiac chambers' volumes. METHODS: Serum troponin was obtained from 157 ambulatory patients before undergoing CCTA for nonacute coronary artery evaluation. Volumes of the cardiac chambers and the left ventricular mass were automatically analyzed and indexed to body surface area. Patients with a troponin concentrations within the upper quartile (>0.007 ng/mL, n = 39) were compared to patients with a troponin concentrations within the 3 lower quartiles of troponin concentrations (≤0.007 ng/mL, n = 118). RESULTS: None of the patients had a troponin concentration >0.05 ng/mL (the 99th percentile of the general population). There were no significant differences in baseline characteristics between the groups. There were significant correlations between troponin and ventricular volumes after adjustments for age and gender. In an analysis that included 107 patients without any known heart diseases, including those pathological findings in the current CCTA, there were significant correlations between troponin and the left and right ventricular volumes after adjustments for age, gender, and baseline characteristics (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03-1.14, P = 0.002 and OR: 1.11, 95% CI: 1.04-1.19, P = 0.002; respectively). CONCLUSIONS: Using the technology of automatic volumetric analysis in individuals undergoing CCTA, an association between larger right and left cardiac chambers and higher levels of troponin concentration was shown.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Direita/sangue , Hipertrofia Ventricular Direita/diagnóstico , Tomografia Computadorizada Multidetectores , Troponina/sangue , Biomarcadores/sangue , Técnicas de Imagem de Sincronização Cardíaca , Vasos Coronários/diagnóstico por imagem , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros
11.
J Cardiovasc Med (Hagerstown) ; 18(6): 425-429, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28009641

RESUMO

AIMS: Conduction abnormalities following transcatheter aortic valve replacement (TAVR) are caused by damage of the aortoventricular conduction tissue during positioning of the valve. Therefore, our aim was to assess whether a higher difference between the long and short diameters of the elliptic aortoventricular annulus will possess higher forces on the annulus, and thus will be a predictor of pacemaker need following TAVR. METHODS: We retrospectively analyzed 123 patients who had the aortoventricular annulus measured by computed tomography angiography. The difference between maximal (Dmax) and minimal (Dmin) diameters of the annulus was considered the elliptic factor (ELFA), which was analyzed using t test to evaluate whether it differs between the group who received a pacemaker and the group without the need for a pacemaker. Then, using univariate and multivariate models adjusted for other confounders predicting the need for a pacemaker, we sought to evaluate whether a higher ELFA is a predictor of pacemaker implantation. RESULTS: Mean age was 82.2 ±â€Š6.4 years, and 62.6% were women. Average Dmax, Dmin and ELFA were 25.8, 20.8 and 5 mm, respectively. Fourteen patients (11.4%) underwent pacemaker implantation. Those patients had an ELFA of 5.9 mm compared with 4.9 mm in those who did not receive a pacemaker (P < 0.01). In multivariate analysis, a higher ELFA remained a statistically significant and independent predictor for the need of a pacemaker (P = 0.046). CONCLUSION: A high ELFA is an independent and significant predictor of the need for pacemaker implantation after TAVR and suggests further investigation whether it should be considered as a factor in managing TAVR patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/lesões , Fascículo Atrioventricular/lesões , Angiografia por Tomografia Computadorizada , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/lesões , Humanos , Israel , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Marca-Passo Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
12.
J Cardiovasc Electrophysiol ; 28(2): 240-248, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27763695

RESUMO

INTRODUCTION: A new imaging software (CARTO® Segmentation Module, Biosense Webster) allows preprocedural 3-D reconstruction of all heart chambers based on cardiac CT. We describe our initial experience with the new module during ablation of ventricular arrhythmias. METHODS AND RESULTS: Eighteen consecutive patients with idiopathic ventricular arrhythmias or ischemic ventricular tachycardia (VT) were studied. In the latter group, a combined endocardial and epicardial ablation was performed. Of the 14 patients with idiopathic arrhythmias, 12 were ablated in the outflow tract (OT), 1 in the midseptal left ventricle, and 1 at the left posterior fascicular area; acute successful ablation was achieved in 11 (78.6%) patients. The procedure was discontinued due to close proximity of the arrhythmia origin to the coronary arteries (CA) in 2 patients. Acute successful uncomplicated ablation was achieved in all 4 patients with ischemic VT. During ablation in the coronary cusps commissures, the CARTO® Segmentation Module accurately defined the cusps anatomy. The precise anatomic location provided by the module assisted in successfully ablating when information from activation mapping was not optimal, by ablating at the opposite side of the cusps. In addition, by demonstrating the precise location of the CA, it allowed safe ablation of arrhythmias that originated in close proximity to the CA both in the OT area and the epicardium, eliminating the need for repeat angiography. CONCLUSIONS: The CARTO® Segmentation Module is useful for accurate definition of the exact anatomic location of ventricular arrhythmias and for safely ablating them especially in close proximity to the CA.


Assuntos
Arritmias Cardíacas/cirurgia , Ablação por Cateter/métodos , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Imageamento Tridimensional/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Design de Software , Cirurgia Assistida por Computador/métodos , Taquicardia Ventricular/cirurgia , Fibrilação Ventricular/cirurgia , Potenciais de Ação , Adulto , Idoso , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/fisiopatologia , Técnicas de Imagem de Sincronização Cardíaca , Ablação por Cateter/efeitos adversos , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cirurgia Assistida por Computador/efeitos adversos , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico por imagem , Fibrilação Ventricular/fisiopatologia
13.
Heart Rhythm ; 13(10): 2064-9, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27430898

RESUMO

BACKGROUND: Delayed pulmonary artery (PA) perforation and tamponade caused by implantable left atrial appendage (LAA) closure devices has been reported in patients with close proximity between these structures. The LAA and PA anatomic relationship (LAA-PAar) has not been analyzed systematically. OBJECTIVE: The purpose of this study was to identify LAA-PAar variants potentially susceptible to this complication using cardiac-gated computed tomography angiography. METHODS: We studied 100 consecutive patients with atrial fibrillation undergoing cardiac-gated computed tomography angiography of the left atrium. The LAA-PAar was classified into 3 types on the basis of the location, length, and thickness of the segment of contact between the PA and/or its branches and the LAA: type 1, no contact; type 2, contact involving the proximal LAA (defined as the proximal 15 mm extending into the LAA from its ostium, or the LAA proximal to the first major bend arising <15 mm from the ostium); and type 3, contact limited to the distal LAA. RESULTS: LAA-PAar types 1, 2, and 3 were present in 7 (7%), 28 (28%), and 65 (65%) patients, respectively. For LAA-PAar type 2, the mean contact segment thickness and length were 0.6 ± 0.3 and 18.1 ± 10.6 mm, respectively. For LAA-PAar type 3, the distance between the LAA orifice and the segment of contact was <30 mm in 52 patients (80%). CONCLUSION: In this series, the LAA came in direct contact with the main PA in the majority of patients. Contact involved the proximal LAA (where the fixation components of most LAA closure devices are positioned) in 28% of patients, posing potential vulnerability to PA perforation.


Assuntos
Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial , Angiografia por Tomografia Computadorizada/métodos , Complicações Intraoperatórias/prevenção & controle , Implantação de Prótese/efeitos adversos , Artéria Pulmonar/diagnóstico por imagem , Lesões do Sistema Vascular/prevenção & controle , Idoso , Apêndice Atrial/patologia , Fibrilação Atrial/patologia , Fibrilação Atrial/cirurgia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/patologia , Israel , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Artéria Pulmonar/lesões , Artéria Pulmonar/patologia , Dispositivo para Oclusão Septal , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/patologia
14.
Cardiovasc Ther ; 34(5): 325-9, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27273567

RESUMO

BACKGROUND: Direct mechanical compression of the frame struts on the adjacent bundle branch with local inflammatory reaction might cause conduction system disturbances and need for pacemaker implantation following transcatheter aortic valve implantation (TAVI). We assessed the impact of preprocedural anti-inflammatory steroid therapy on the occurrence of conduction disturbances following TAVI. METHODS AND RESULTS: From a cohort of 324 patients who underwent transfemoral TAVI, 39 (12%) were pretreated with steroids because of iodine allergy (n=29) or active obstructive pulmonary disease (n=10). We compared the rate of occurrence of new conduction disturbances and pacemaker implantation between TAVI patients with (n=39) and without (n=285) steroid treatment, using Cox logistic regression estimates and proportional hazards models. The overall occurrence of new conduction defects and the need for new pacemaker implantation were similar among steroid and non-steroid-treated patients (38.4% vs 37.5% and 25.6% vs 25.3%, respectively). New conduction disturbances were more prevalent in patients treated with CoreValve prosthesis, low implantation, and smaller aortic annulus diameter (P<.001, P<.001, and P=.006, respectively). Thirty-day mortality and complication rates were similar between the groups. CONCLUSION: Although safe, steroid treatment prior to TAVI failed to reduce the incidence of new conduction defects and the need for pacemaker implantation.


Assuntos
Estenose da Valva Aórtica/terapia , Valva Aórtica , Arritmias Cardíacas/prevenção & controle , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hidrocortisona/administração & dosagem , Prednisona/administração & dosagem , Esteroides/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/mortalidade , Estimulação Cardíaca Artificial , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Esquema de Medicação , Quimioterapia Combinada , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Hidrocortisona/efeitos adversos , Israel , Modelos Logísticos , Masculino , Marca-Passo Artificial , Prednisona/efeitos adversos , Modelos de Riscos Proporcionais , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Esteroides/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
17.
Am J Cardiol ; 114(11): 1670-5, 2014 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-25288500

RESUMO

The Diamond-Forrester (DF) algorithm overestimates the likelihood of significant coronary artery disease (≥50% stenosis, CAD50). The aim of the present study was to evaluate whether the addition of a diagonal earlobe crease (DELC) enhances the predictive ability of DF to detect CAD50 by coronary computed tomographic angiography (CTA). We evaluated 430 patients referred for CTA for symptoms, cardiovascular risk factors, and CAD50 likelihood using DF. Observers blinded to CTA findings evaluated the presence of DELC. The diagnostic accuracy and relation of DF, DELC, and DF + DELC for predicting CAD50 in patients with chest pain were evaluated using receiver operating characteristics curve (area under curve) analyses and multivariate logistic regression analyses. In 199 patients with chest pain, the sensitivity and specificity for CAD50 were 96% and 20% for DF (AUC 0.59, p = 0.59), 91% and 32% for DELC (AUC 0.62, p = 0.03), and 91% and 41% for DF + DELC (AUC 0.66, p = 0.004). On multivariate analyses DELC was the only independent predictor of CAD50 (odds ratio 3.6, 95% confidence interval 1 to 12.9, p = 0.048). DF + DELC increased the predictive ability to detect CAD50 above cardiovascular risk factors (odds ratio 5.6, 95% confidence interval 1.6 to 19.8, p = 0.007). In patients with chest pain, the presence of DELC is related to CAD50 beyond DF. A combined variable of DF + DELC provides superior discriminatory ability for detecting CAD50 than either method alone.


Assuntos
Algoritmos , Doença da Artéria Coronariana/diagnóstico , Estenose Coronária/diagnóstico , Pavilhão Auricular/anatomia & histologia , Idoso , Dor no Peito/etiologia , Estudos de Coortes , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Exame Físico , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Medição de Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
18.
Acad Radiol ; 21(6): 797-804, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24809320

RESUMO

RATIONALE AND OBJECTIVES: Blooming artifact from calcified plaques often renders measurement of stenosis impossible on coronary computed tomographic angiography (CTA). We sought to evaluate the impact of modifying window level on reducing blooming artifact, and its impact on stenosis quantification. MATERIALS AND METHODS: We analyzed 125 calcified segments from 53 patients who underwent CTA and invasive coronary angiography (ICA). Segmental stenosis on CTA was measured using three window settings: width of 1000 Hounsfield units (HU) and level of 200 HU ("default"), 1500/200 HU ("widened"), and width and level based on the mean HU of the calcified plaque and pericoronary fat ("calcium-specific"). Segmental stenosis on ICA was quantified by a blinded experienced reader. RESULTS: ICA found ≥50% stenosis in 30 segments. Displaying segments with widened and calcium-specific settings improved overall accuracy of detecting ≥50% stenosis (P's < 0.001) by increasing the rate of accurately quantifying <50% stenosis (P's < 0.001), and improved correlation of stenosis quantification to ICA (P's < 0.05). There was no difference in stenosis quantification accuracy between widened and calcium-specific window settings. Limits of agreement between CTA stenosis quantification and ICA narrowed with widened and calcium-specific settings. CONCLUSIONS: We showed for the first time that in calcified segments, widening display window width significantly improved CTA quantification of stenosis compared to ICA.


Assuntos
Meios de Contraste , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Calcinose/diagnóstico por imagem , Feminino , Humanos , Iohexol , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
19.
J Cardiovasc Comput Tomogr ; 7(2): 125-32, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23622507

RESUMO

BACKGROUND: Associations of epicardial fat volume (EFV) measured on noncontrast cardiac CT (NCT) include coronary plaque, myocardial ischemia, and adverse cardiac events. OBJECTIVES: This study aimed to define the relationship of EFV to coronary plaque type, severe coronary stenosis, and the presence of high-risk plaque features (HRPFs). METHODS: We retrospectively evaluated 402 consecutive patients, with no prior history of coronary artery disease, who underwent same day NCT and coronary CT angiography (CTA). EFV was measured on NCT with the use of validated, semiautomated software. The coronary arteries were evaluated for coronary plaque type (calcified [CP], noncalcified [NCP], or partially calcified [PCP]) and coronary stenosis severity ≥70% with the use of coronary CTA. For patients with NCP and PCP, 2 high-risk plaque features were evaluated: low-attenuation plaque and positive remodeling. RESULTS: There were 402 patients with a median age of 66 years (range, 23-92 years) of whom 226 (56%) were men. The EFV was greater in patients with CP (112 ± 55 cm(3) vs 89 ± 39 cm(3)), PCP (110 ± 57 cm(3) vs 98 ± 45 cm(3)), and NCP (115 ± 44 cm(3) vs EFV 100 ± 52 cm(3)). In the 192 patients with PCP or NCP, on multivariable analysis, after adjusting for conventional cardiovascular risk factors, EFV was an independent predictor of ≥70% coronary artery stenosis (odds ratio [OR], 3.0; 95% CI, 1.3-6.6; P = 0.008), any high-risk plaque features (OR, 1.7; 95% CI, 0.9-3.4; P = 0.04), and low attention plaque (OR, 2.4; 95% CI, 1.1-5.1; P = 0.02) but not of positive remodeling. CONCLUSIONS: EFV is greater in patients with CP, PCP, and NCP. In patients with NCP and PCP, EFV is significantly associated with severe coronary stenosis, high-risk plaque features, and low attenuation plaque.


Assuntos
Adiposidade , Angiografia Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/epidemiologia , Pericárdio/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Adulto Jovem
20.
Am J Cardiol ; 109(9): 1283-7, 2012 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-22335855

RESUMO

Controversy exists concerning the relation between diagonal ear lobe crease (DELC) and coronary artery disease (CAD). We examined whether DELC is associated with CAD using coronary computed tomography (CT) angiography. We studied 430 consecutive patients without a history of coronary artery intervention who underwent CT angiography on a dual-source scanner. Presence of DELC was agreed by 2 blinded observers. Two blinded readers evaluated CT angiography images for presence of CAD and for significant CAD (≥50% stenosis). Chi-square and t tests were used to assess demographic differences between subgroups with and without DELC and the relation of DELC to 4 measurements of CAD: any CAD, significant CAD, multivessel disease (cutoff ≥2), and number of segments with plaque (cutoff ≥3). Multivariable logistic regression was performed to adjust for CAD confounders: age, gender, symptoms, and CAD risk factors. Mean age was 61 ± 13 and 61% were men. DELC was found in 71%, any CAD in 71%, and significant CAD in 17% of patients. After adjusting for confounders, DELC remained a significant predictor of all 4 measurements of CAD (odds ratio 1.8 to 3.3, p = 0.002 to 0.017). Sensitivity, specificity, and positive and negative predictive values for DELC in detecting any CAD were 78%, 43%, 77%, and 45%. Test accuracy was calculated at 67%. Area under the receiver operator characteristic curve was 61% (p = 0.001). In conclusion, in this study of patients imaged with CT angiography, finding DELC was independently and significantly associated with increased prevalence, extent, and severity of CAD.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Pavilhão Auricular/anatomia & histologia , Tomografia Computadorizada por Raios X/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
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