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1.
Echocardiography ; 35(12): 2099-2103, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30338566

RESUMO

We present a case of 44-year-old woman who underwent effective pharmacological treatment of severe mitral stenosis. The patient was hospitalized due to rapidly progressive dyspnea. Her medical history included asthma, perennial rhinitis, and nasal polyps. Echocardiography showed a mass of the left ventricle involving the mitral valve; cardiac MRI suggested acute endocarditis. Severe peripheral blood eosinophilia was found. Eosinophilic granulomatosis with polyangiitis was diagnosed; treatment with prednisone and cyclophosphamide was started. Despite the clinical improvement, severe mitral stenosis persisted, surgical treatment was planned. However, evaluation after 6 cycles of cyclophosphamide pulse therapy revealed a significant regression of the valvular disease.


Assuntos
Síndrome de Churg-Strauss/complicações , Ciclofosfamida/uso terapêutico , Ecocardiografia Transesofagiana/métodos , Estenose da Valva Mitral/diagnóstico , Valva Mitral/diagnóstico por imagem , Prednisona/uso terapêutico , Adulto , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/tratamento farmacológico , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Estenose da Valva Mitral/tratamento farmacológico , Estenose da Valva Mitral/etiologia , Índice de Gravidade de Doença
2.
Nucl Med Rev Cent East Eur ; 20(2): 69-75, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28555447

RESUMO

BACKGROUND: The objective of this study was to semiquantitatively assess the degree of myocardial fluorodeoxyglucose (FDG) uptake in glucose-loaded myocardial viability positron emission tomography/computed tomography (PET/CT) scans, to calculate the myocardial to background index, and correlate the index with image quality assessed on the basis of visual qualitative assessment. MATERIAL AND METHODS: The myocardial FDG-PET/CT study was carried out in 69 non-diabetic patients, who had known coronary artery disease, by intravenous injection of 250 ± 70 MBq (range: 180-320 MBq) FDG. Images were interpreted visually and patients were divided into three groups according to the grade of myocardial uptake: optimal, suboptimal, and uninterpretable. Semiquantitative analysis was performed by calculating the standardized uptake value (SUVmax) for myocardium and background (blood pool) activity, and expressed as the myocardial to background (M/B) activity ratio. RESULTS: On the basis of visual (qualitative) analysis, 60/69 (86.96%) patients showed optimal quality of FDG cardiac uptake, 3/69 (4.35%) were suboptimal, and uninterpretable FDG PET scan results were found in 6/69 (8.70%) patients. The M/B index was found to be significantly higher in images of optimal vs. suboptimal quality (6.87 ± 3.99 vs. 1.65 ± 0.78 respectively; p < 0.0001). CONCLUSIONS: The index ratio of 2.2, which is consistent with the upper borderline value for visually uninterpretable images, was considered the cut-off value for scans of optimal and non-optimal quality.


Assuntos
Fluordesoxiglucose F18/metabolismo , Coração/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Miocárdio/metabolismo , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Software , Sobrevivência de Tecidos , Transporte Biológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/citologia , Controle de Qualidade
3.
Postepy Kardiol Interwencyjnej ; 13(4): 281-287, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29362569

RESUMO

INTRODUCTION: Patient-prosthesis mismatch (PPM) is relatively frequent after surgical aortic valve replacement (SAVR) and negatively impacts prognosis. AIM: We sought to determine the frequency and clinical effects of PPM after transcatheter aortic valve implantation (TAVI). MATERIAL AND METHODS: Overall, 238 patients who underwent TAVI were screened. Moderate PPM was defined as indexed effective orifice area (EOAi) between 0.65 and 0.85 cm2/m2, and severe PPM as < 0.65 cm2/m2. All-cause mortality and the Valve Academic Research Consortium 2 (VARC-2) defined composite of clinical efficacy at 1 year were the primary endpoints. RESULTS: Finally, 201 patients were included (mean age: 79.6 ±7.4 years, 52% females). The femoral artery served as the delivery route in 79% and most of the prostheses were self-expanding (68%). Any PPM was present in 48 (24%) subjects, and only 7 (3.5%) had severe PPM. Body surface area (BSA) independently predicted any PPM (OR = 16.9, p < 0.001) whereas post-dilation tended to protect against PPM (OR = 0.46, p = 0.09). All-cause mortality was similar in patients with moderate or severe PPM as compared to those with no PPM (14.6% vs. 14.3% vs. 13.1%, respectively, log-rank p = 0.98). Neither moderate (OR = 1.6, 95% CI: 0.8-3.2, p = 0.16) nor severe PPM (OR = 1.67, 95% CI: 0.36-7.7, p = 0.51) had a significant impact on composite endpoint, or its elements, with the exception of transvalvular pressure gradient > 20 mm Hg. CONCLUSIONS: Severe PPM after TAVI is rare, can be predicted by larger BSA and does not seem to affect mid-term mortality or composite clinical outcome. Larger studies are needed to find different independent predictors of PPM and elucidate its impact in terms of device durability and long-term clinical efficacy.

4.
Clin Imaging ; 39(4): 592-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25735450

RESUMO

PURPOSE: The purpose was to evaluate quality of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) myocardial scans and its correlation with background glucose (BG) after simplified 5% intravenous glucose load protocol. METHODS: An intravenous glucose load protocol was applied in 69 normoglycemic patients with confirmed coronary artery disease. The blood glucose level was measured every 15 min. RESULTS: Eighty-four percent of images were optimal, 8.7% suboptimal, and 7.3% uninterpretable. The quality of 18F-FDG-PET was BG independent and body mass index dependent (P=.0007). CONCLUSIONS: Simplified glucose load protocol is a safe and efficient method of preparation for FDG cardiac viability study in patients with normoglycemia.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Fluordesoxiglucose F18 , Coração/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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