Necessity of routine cardiac evaluation in patients receiving pegylated liposomal doxorubicin for gynecologic cancer.

OBJECTIVE: Pegylated liposomal doxorubicin (PLD) has similar reported clinical efficacy compared with conventional doxorubicin with less cardiotoxicity. The manufacturer of PLD advises that cardiac function should be evaluated with endomyocardial biopsy, echocardiography or multigated radionucleotide scan (MUGA) pre-treatment and during therapy. This study was designed to assess the necessity of pre-treatment cardiac evaluation in patients receiving PLD. METHODS: After IRB approval, a retrospective study of all women with gynecologic cancer who received PLD from 2006 to 2018 was performed. Demographic information, treatment records, cardiac risk factors, and cardiac surveillance testing were examined. Wilcoxon signed rank sum test and logistic regression were used to evaluate the association of cumulative PLD exposure with cardiotoxicity. RESULTS: A total of 235 patients received PLD for gynecologic cancer. Patients received a median of 3 cycles of PLD with a cumulative dosage of 237 mg over a median follow-up time of 24 months. Sixteen patients in the cohort (7%) had no cardiac surveillance at all. Of the remaining patients who underwent cardiac testing, 183 (84%) received MUGA scans and 36 (16%) had echocardiography. Of the 56 patients who had both pre- and post-treatment cardiac testing, there was no significant difference in median ejection fraction (p = 0.17). Three patients developed PLD-associated cardiac toxicity but only one patient had severe manifestations requiring discontinuation of PLD therapy. CONCLUSIONS: Routine cardiac testing before, during or after treatment with PLD may be unnecessary. Cardiac testing may be more appropriate for individual patients for whom the clinical suspicion of PLD-related cardiac toxicity is high.

A practical background correction method for an immediately repeated first-pass radionuclide angiography.

BACKGROUND: A satisfactory bolus injection is essential for a successful first-pass radionuclide angiography (FPRNA). Rescheduling the FPRNA study is usually needed due to high background interference caused by an unsatisfactory bolus injection. We developed a protocol to correct the pre-existing background activity subsequent to immediately repeating the study. METHODS: Seventy-four consecutive patients who had their bone scan and FPRNA scheduled on the same day were included for analysis. The initial 51 cases constituted the "validation-only" group. In the other 23 cases, the "validation plus clearance constants" group, a 5-min dynamic acquisition was performed during the 5-min equilibrium to obtain the background clearance curve and the clearance constants. For all included 74 cases ejection fraction (EF) analysis was proceeded using the images from the first injection, second injection, and second injection with the corrected background to yield EF1, EF2, and EF2', respectively. EF2 and EF2' were then compared to the ejection fraction without background interference, the EF1. RESULTS: For the LV, the mean difference between the EF1 and the uncorrected EF2 (|LVEF1-LVEF2| in mean ± SD) was 3.1 ± 2.0% and the difference between the EF1 and the corrected EF2' (|LVEF1-LVEF2'|) was 1.6 ± 2.1%, while the mean differences for RV are 2.2 ± 1.9% and 1.8 ± 1.8%, respectively. A significant difference (p < 0.05) was observed between the uncorrected and the corrected data for both the LV and RV. CONCLUSION: In FPRNA, when a bolus injection is immediately readministered, both LVEF and RVEF can be underestimated. With our correction method, the results are superior to those without correction.

2D-speckle tracking right ventricular strain to assess right ventricular systolic function in systolic heart failure. Analysis of the right ventricular free and posterolateral walls.

BACKGROUND: Right ventricular (RV) systolic function is a powerful prognostic factor in patients with systolic heart failure. The accurate estimation of RV function remains difficult. The aim of the study was to determine the diagnostic accuracy of 2D-speckle tracking RV strain in patients with systolic heart failure, analyzing both free and posterolateral walls. METHODS: Seventy-six patients with dilated cardiopathy (left ventricular end-diastolic volume≥75ml/m2) and left ventricular ejection fraction≤45% had an analysis of the RV strain. Feasibility, reproducibility and diagnostic accuracy of RV strain were analyzed and compared to other echocardiographic parameters of RV function. RV dysfunction was defined as a RV ejection fraction≤40% measured by radionuclide angiography. RESULTS: RV strain feasibility was 93.9% for the free-wall and 79.8% for the posterolateral wall. RV strain reproducibility was good (intra-observer and inter-observer bias and limits of agreement of 0.16±1.2% [-2.2-2.5] and 0.84±2.4 [-5.5-3.8], respectively). Patients with left heart failure have a RV systolic dysfunction that can be unmasked by advanced echocardiographic imaging: mean RV strain was -21±5.7% in patients without RV dysfunction and -15.8±5.1% in patients with RV dysfunction (p=0.0001). Mean RV strain showed the highest diagnostic accuracy to predict depressed RVEF (area under the curve (AUC) 0.75) with moderate sensitivity (60.5%) but high specificity (87.5%) using a cutoff value of -16%. CONCLUSIONS: RV strain seems to be a promising and more efficient measure than previous RV echocardiographic parameters for the diagnosis of RV systolic dysfunction.

Harmonic subtraction for evaluating right ventricle ejection fraction from planar equilibrium radionuclide angiography.

We report an initial investigation of a subtraction-based method to estimate right ventricle ejection fraction (RVEF) from ECG-gated planar equilibrium radionuclide angiography (ERNA) data. Twenty-six consecutive patients referred for scintigraphic evaluation of cardiac function prior to chemotherapy had ECG-gated first-pass (FP) imaging and ERNA imaging performed following the same radiotracer injection. RVEF was computed from FP images (RVEFFP) and separately from ERNA images (RVEFERNA). Standard methods for computing ejection fractions were used to obtain RVEFFP values. RVEFERNA values were obtained using harmonic subtraction of the left ventricular contribution from a biventricular region of interest contoured on the equilibrium images acquired in the shallow right anterior oblique projection. Clinically acquired chest CT data were used to derive information regarding the relative position of the left and right ventricle and about the presence of pulmonary artery enlargement. Computation of RVEFERNA was successful for each of the 26 patients. Computation of RVEFFP failed for four patients. For the 22 patients for which RVEF was computed using both methods, the average RVEFFP was 49% and the average RVEFERNA was 51%, with coefficients of variation of 11 and 7.5%, respectively. Low RVEFERNA values were associated with pulmonary artery dilation. Estimation of RVEFERNA, using a harmonic subtraction-based method of computation is clinically feasible and accurate in the patient population studied. The results support further investigation in patients with frank heart failure.

Rotura aneurismática aguda en paciente con HSA grave objetivada en AngioTC craneal / Acute aneurysmal rupture in a severe SAH patient seen on head CT angiography scan

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Quistes renales y aneurismas de aorta de gran tamaño / Renal cysts and large aortic aneurysms

INTRODUCCIÓN: Los quistes renales se han relacionado con una mayor presencia y un mayor diámetro de aneurismas de aorta abdominal (AAA). OBJETIVO: Evaluar la proporción de pacientes con AAA y con quiste simple renal (QSR) en nuestra población y valorar su relación con el diámetro aneurismático. MATERIAL Y MÉTODOS: Realizamos un estudio transversal de pacientes consecutivos diagnosticados de AAA infrarrenal con tomografía axial computarizada con contraste entre 2013 y 2016 en nuestro centro. Registramos sus datos demográficos, factores de riesgo para el desarrollo y el crecimiento del AAA y la presencia de QSR. Se realizó una estadística descriptiva con medidas de tendencia central, dispersión y un análisis de la relación del diámetro aneurismático con la presencia de QSR y su presencia uni- o bilateral. RESULTADOS: Incluimos a 135 pacientes con edad media de 74 años (DE: 11,3). El 54,8% (n=68) tenían QSR, de los cuales el 50,7% (n=35) eran bilaterales. El diámetro medio de los AAA de los pacientes sin QSR (n=67) fue de 59,2mm (DE: 12,3) en contraste con el diámetro aneurismático medio de los pacientes con QSR (n=68) que fue de 65,2mm (DE: 15,3) (p = 0,36). Tampoco se observaron diferencias significativas en el diámetro máximo de los AAA de los pacientes con QSR unilaterales (n=33) respecto a los pacientes con AAA y QSR bilaterales (n=35) (53,5 versus 59,1mm; p = 0,16). CONCLUSIÓN: En nuestra serie, no se encontró relación significativa entre presencia de QSR, bilateralidad y tamaño de los AAA

INTRODUCTION: Renal cysts have been associated with an increase in the presence abdominal aortic aneurysm (AAA) and also with a larger aneurysmal sac diameter. OBJECTIVE: To study the proportion of patients with AAA and simple renal cyst (SRC) in our population and study their relationship with the aneurysmal diameter. MATERIAL AND METHODS: A cross-sectional study was conducted on consecutive patients diagnosed with infrarenal AAA using contrast computed tomography between 2013 and 2016 in our centre. Information was collected on the demographics of participants, including risk factors associated with AAA development, growth rates of AAA, and the presence of renal cysts. Descriptive statistics were performed with measurements of central tendency and dispersion, and an analysis of the relationship between aneurysmal diameter and the presence of uni- or bilateral renal cysts. RESULTS: A total of 135 patients were included, with a mean age of 74 years (SD 11.3). Renal cysts were present in 54.8% (n=68) of cases, with 50.7% (n=35) of these being bilateral SRC. The mean diameter of the AAA in patients (n=67) without a SRC was 59.2mm (SD 12.3), as opposed to a mean AAA diameter of 65.2mm (SD 15.3) in patients (n=68) with a SRC (P=.36). No significant differences were observed in the maximum diameter of the AAA in patients (n=33) with a unilateral SRC compared to patients with a bilateral SRC (n=35) (53.5 versus 59.1mm; P=.16). CONCLUSION: No significant relationship was found in this series between the presence of an SRC, bilateralism, and the size of the AAA

Catorce años de experiencia con injertos a la arteria pedia / Fourteen years of experience with pedal bypasses

OBJETIVO: Revisar nuestros resultados en injertos a la arteria pedia, realizados por isquemia crítica, en un periodo de 14 años. MÉTODOS: Se realizó un análisis retrospectivo de los injertos realizados a la arteria pedia en nuestro centro entre agosto de 2000 y enero de 2014. Registramos las siguientes variables clínicas: edad, sexo, factores de riesgo cardiovascular y comorbilidad renal. Analizamos, como variables resultado: permeabilidades primaria, asistida y secundaria, tasa libre de amputación y mortalidad a 1 y 3 años. Realizamos un análisis estadístico uni y multivariante utilizando los tests no paramétricos de Mann-Whitney y Kruskal-Wallis. RESULTADOS: Se analizaron 59 injertos en 49 pacientes. La edad media fue de 72 años (rango 41-90). El 59% (n = 35) eran varones, el 83% (n=49) eran diabéticos y el 20% (n = 12) estaban en diálisis. La indicación fue en todos los casos isquemia crítica. Los 59 injertos utilizados incluyeron 49%(n = 28) venas safenas invertidas, 29% (n = 17) venas safenas in situ, 12% (n = 7) venas de brazo y 12% (n = 7) injertos compuestos. Las arterias donantes fueron: femoral común (9%, n = 5), femoral superficial (27%, n = 16), 1.ª porción de poplítea (3%, n = 2), 3.ª porción de poplítea (35%, n = 21), arteria tibial anterior (5%, n = 3) e injerto previo (20%, n = 12). La mortalidad perioperatoria fue del 3% (n = 2). El seguimiento medio fue de 27 meses (rango 1- 96 meses). Las permeabilidades primaria, asistida, secundaria y el salvamento de la extremidad al año fueron del 53, del 73, del 80 y del 82%, respectivamente. A los 3 años, la permeabilidad secundaria fue del 79% y la supervivencia libre de amputación, del 78%. CONCLUSIÓN: Los injertos a la arteria pedia son una opción válida en isquemia crítica, con buenas tasas de permeabilidad y salvamento de extremidad a uno y 3 años

OBJECTIVE: To review our results in pedal bypasses performed in critical ischaemic limbs during a 14 year period. METHODS: A retrospective study was conducted to evaluate pedal bypasses that were performed in our centre between August 2000 and January 2014. A record was made of the following clinical variables: age, sex, cardiovascular risk factors, and renal comorbidity. An analysis was made of the primary, assisted and secondary patency, amputation-free survival mortality at 1 and 3 years. A uni- and multi-variate statistical analysis was performed, using Mann-Whitney and Kruskal- Wallis non-parametric tests. RESULTS: The analysis included 49 bypasses on 59 patients. The mean age was 72 years (range 41-90). Fifty-nine percent of them were male patients (n = 35), 83% (n = 49) diabetics, and 20% (n = 12) were in a haemodialysis program. The surgical indication was critical limb ischaemia in all cases. The grafts included: 49% (n = 28) reversed saphenous vein, 29% (n = 17) in situ, 12% (n = 7) arm veins, and 12% (n = 7) composite grafts. The inflow arteries were as follows: common femoral artery (9%, n = 5), superficial femoral (27%, n = 16), first popliteal portion (3%, n = 2), third popliteal portion (36%, n = 21), anterior tibial artery (5%, n = 3), and previous graft (20%, n = 12). Peri-operative mortality was 3% (n = 2). The follow up period was 27 months (range from 1 to 96 months). Primary, assisted and secondary patency, and limb salvage were 53%, 73%, 80%, and 82%, respectively, at 1 year. At 3 years, secondary patency was 79%, and amputation free survival was 78%. CONCLUSION: Pedal bypasses are a valid option for critical limb ischaemia with good patency rates and limb salvage at one and three years

Fístulas arteriovenosas de los troncos supraaórticos / Arteriovenous fistulas of supra-aortic trunks

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Uso de sistema de endograpado para prevención y tratamiento de fugas proximales de endoprótesis aórticas abdominales / Use of endostaples for prevention and treatment of proximal endoleaks in abdominal aortic endografting

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[Reliability of venous blood gas analysis and radionuclide angiography in post-traumatic dystrophy]. / Reliabilität der venösen Blutgasanalyse und Radionuklidangiographie bei Posttraumatischer Dystrophie.

BACKGROUND: The diagnosis "post-traumatic dystrophy" (PTD) was first defined with clinical and paraclinical criteria by Scola et al. in 2013. OBJECTIVES: The objectivity and reliability of the paraclinical criteria (venous blood gas analysis [vBGA], radionuclide angiography [RNA]), and recommendations for therapy should be assessed in a prospective study. MATERIALS AND METHODS: In five patients with clinical signs of post-traumatic nonbacterial inflammation of the hand, both diagnosis and a 3­week hospital treatment were carried out in accordance with the publication mentioned above. The primary traumata (four fractures and one soft-tissue injury) were located in either the hand or the forearm. Unsuccessful outpatient treatment always led to hospital admission. One patient with severe osteopenia in the hand skeleton was treated with bisphosphonates for 6 months. RESULTS: All patients fulfilled the clinical and paraclinical criteria for the diagnosis of PTD. On admission, an elevated venous partial pressure of oxygen was found by vBGA in the affected hand (∆pO2 mean 22 ± 3 mm Hg) and a hyperperfusion due to arteriovenous shunts was measured using RNA (mean 75 ± 47%). The symptomatic treatment was extremely well tolerated; by the time of discharge, all patients achieved full functioning of the hand with minor loss of strength (venous ∆pO2 mean 5 ± 3 mm Hg). The osteopenia in the one patient treated with bisphosphonates showed recalcification after 6 months. CONCLUSION: The reliability of clinical and paraclinical criteria for PTD were confirmed. vBGA and RNA seem to be good parameters for confirming the diagnosis of PTD. "Rubor," a symptom traditionally interpreted as "hyperemia," contradicts the paraclinical findings and leads to the assumption that the cause of this post-traumatic syndrome is microvascular dysfunction.

Valor pronóstico de la tomografía computarizada en la tromboembolia pulmonar aguda / Prognostic value of computed tomography in acute pulmonary thromboembolism

Además de ser la prueba de referencia para diagnosticar la tromboembolia pulmonar aguda, la angiografía mediante tomografía computarizada de arterias pulmonares puede ofrecernos información acerca del pronóstico del paciente. Aunque la controversia sigue abierta acerca de los hallazgos radiológicos con y sin valor pronóstico, los signos de disfunción ventricular derecha evaluados en tomografía computarizada ya forman parte de los algoritmos empleados para el manejo clínico de la tromboembolia pulmonar. Sin embargo, aún está por definir el método óptimo de obtener estas medidas manteniendo el equilibrio entre la agilidad necesaria para incluir su valoración en nuestra actividad diaria sin perder la precisión en su capacidad predictiva. Además, hay otras variables asociadas a la tromboembolia pulmonar, a menudo desapercibidas, que pueden complementar la información pronóstica que podemos ofrecer al clínico. Esta revisión tiene como objetivo clarificar algunos de los aspectos más controvertidos sobre el valor pronóstico de la tomografía computarizada en el paciente con embolia pulmonar según la evidencia disponible. Conocer qué variables están adquiriendo más importancia pronóstica, cómo detectarlas y por qué es importante reflejarlas en nuestros informes podrá mejorar el manejo de estos pacientes (AU)

In addition to being the standard reference for the diagnosis of acute pulmonary thromboembolism, CT angiography of the pulmonary arteries can also provide valuable information about the patient's prognosis. Although which imaging findings are useful for prognosis remains controversial, signs of right ventricular dysfunction on CT are now included in clinical algorithms for the management of pulmonary thromboembolism. However, the optimal method for obtaining these measurements while maintaining a balance between the ease of use necessary to include their evaluation in our daily activity and the loss of precision in its predictive capacity remains to be determined. Moreover, other variables associated with pulmonary thromboembolism that often go unobserved can complement the prognostic information we can offer to clinicians. This review aims to clarify some of the more controversial aspects related to the prognostic value of CT in patients with pulmonary embolisms according to the available evidence. Knowing which variables are becoming more important in the prognosis, how to detect them, and why it is important to include them in our reports will help improve the management of patients with pulmonary embolism (AU)

Anatomic variations of the aortic arch depicted on 444 CT angiographies

With a view to describing the different anatomic variations of aortic arch branching, their prevalence, the demographic characteristics of the sample, and to propose a new classification for aortic arch branching patterns, 460 thoracic computed tomography angiographies (CTA) with 3D reconstruction were reviewed from January 2012 to December 2014. A total of 444 subjects were included in the study. Of those, 153 (34.4%) were male. Anatomic variations were found in 178 (40.1%) subjects. Prevalence by type of aortic arch (AA) branching pattern were found as follows: Type 1 or "Normal branching": Brachiocephalic trunk (BT), left common carotid artery (LCC), left subclavian artery (LS), in this order, was 59.9% (266/444 subjects); Type 2 or "Bovine arch": BT and LCC arising from the AA in a common trunk, was 27.9% (124/444 subjects); Type 3: LCC originating separately from the BT, was 9.9% (44/444 subjects); Type 4, left vertebral artery arising from the AA, was 2.2% (10/444 subjects). The prevalence of anatomic variations was higher in females than in males (42.3% versus 35.9%). This is the largest study of aortic arch anatomic variations in a South American population. These anatomic variants are not rare and should be addressed before a surgical or interventional procedure that involves the head, neck, thorax and/or upper limbs

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Disección retrógrada de aorta torácica ascendente tras tratamiento endovascular de disección aórtica tipo B complicada / Retrograde ascending thoracic aortic dissection after endovascular treatment by type B aortic dissection

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Does diastolic dysfunction precede systolic dysfunction in trastuzumab-induced cardiotoxicity? Assessment with multigated radionuclide angiography (MUGA).

BACKGROUND: Trastuzumab is successfully used for the treatment of HER2-positive breast cancer. Because of its association with cardiotoxicity, LVEF is monitored by MUGA, though this is a relatively late measure of cardiac function. Diastolic dysfunction (DD) is believed to be an early predictor of cardiac impairment. We evaluate the merit of MUGA-derived diastolic function parameters in the early detection of trastuzumab-induced cardiotoxicity (TIC). METHODS AND RESULTS: 77 trastuzumab-treated patients with normal baseline systolic and diastolic function were retrospectively selected (n = 77). All serial MUGA examinations were re-analyzed for systolic and diastolic function parameters. 36 patients (47%) developed SD and 45 patients (58%) DD during treatment. Both systolic and diastolic parameters significantly decreased. Of the patients with SD, 24 (67%) also developed DD. DD developed prior to systolic impairment in 54% of cases, in 42% vice versa, while time to occurrence did not differ significantly (P = .52). This also applied to the subgroup of advanced stage breast cancer patients (P = .1). CONCLUSIONS: Trastzumab-induced SD and DD can be detected by MUGA. An impairment of MUGA-derived diastolic parameters does not occur prior to SD and therefore cannot be used as earlier predictors of TIC.

Assessment of left ventricular ejection fraction using low radiation dose computed tomography.

BACKGROUND: Cardiac CT is a non-invasive modality with the ability to estimate LVEF. However, given its limited temporal resolution and radiation, there has been initial resistance to use CT to measure LVEF. Developing an accurate, fast, low radiation dose protocol is desirable. OBJECTIVE: The objective of this study is to demonstrate that a 'low radiation dose' 64 slice cardiac computed tomography (CT) protocol is feasible and can accurately measure left ventricular ejection fraction (LVEF) while delivering a radiation dose lower than radionuclide angiography (RNA). METHODS: Patients undergoing RNA were prospectively screened and enrolled to undergo a 'low-dose' 64 slice CT LVEF protocol. LVEF measures, duration of each study and radiation dose between CT and RNA were compared. RESULTS: A total of 77 patients (mean age = 61.8 ± 12.2 years and 58 men) were analyzed. The mean LVEF measured by CT and RNA were 41.9 ± 15.2% and 39.4 ± 13.9%, respectively, (P = 0.154) with a good correlation (r = 0.863). Bland-Altman plot revealed a good agreement between the CT and RNA LVEF (mean difference of -2.4). There was good agreement between CT LVEF and RNA for identifying patients with LVEF ≤30% (kappa = 0.693) and LVEF ≥50% (kappa = 0.749). The mean dose estimated effective dose for CT and RNA were 4.7 ± 1.6 and 9.5 ± 1.0 mSv, respectively. The mean CT LVEF imaging duration (4:32 ± 3:05 minutes) was significantly shorter than the RNA image acquisition time (9:05 ± 2:36 minutes; p < 0.001). CONCLUSION: The results of our study suggest that low-dose CT LVEF protocol is feasible, accurate, and fast while delivering a lower radiation dose than traditional RNA.

[Phantom kidney at angionephroscintigraphy].

Based on the analysis of the data available in the literature and own clinical observations, the authors consider the diagnostic value of the little known scintigraphic phantom kidney phenomenon, a vascular pool that is detected at the angiographic stage of 99mTc-DTPA dynamic renal scintigraphy and that mimics a removed or absent kidney. The paper describes two cases of the phantom kidney. In one case, the phantom kidney detected on the side of nephrectomy manifested a kidney cancer recurrence in the bed of the removed organ; in the other, the kidney-like vascular pool in the patient with left-sided pelvic dystopic kidney was due to the recording of the intestinal vasculature at the site of the expected kidney location. Adherence to a number of methodical conditions for conducting a study, as well as combined single-photon emission computed tomography/computed tomography examination will be able to avoid interpretation errors and to ensure an adequate further diagnostic algorithm.

Meta-Analysis of Diagnostic Performance of Coronary Computed Tomography Angiography, Computed Tomography Perfusion, and Computed Tomography-Fractional Flow Reserve in Functional Myocardial Ischemia Assessment Versus Invasive Fractional Flow Reserve.

We sought to compare the diagnostic performance of coronary computed tomography angiography (CCTA), computed tomography perfusion (CTP), and computed tomography (CT)-fractional flow reserve (FFR) for assessing the functional significance of coronary stenosis as defined by invasive FFR in patients with known or suspected coronary artery disease (CAD). CCTA has proved clinically useful for excluding obstructive CAD because of its high sensitivity and negative predictive value (NPV); however, the ability of CTA to identify functionally significant CAD has remained challenging. We searched PubMed/Medline for studies evaluating CCTA, CTP, or CT-FFR for the noninvasive detection of obstructive CAD compared with catheter-derived FFR as the reference standard. Pooled sensitivity, specificity, PPV, NPV, likelihood ratios, and odds ratio of all diagnostic tests were assessed. Eighteen studies involving a total of 1,535 patients were included. CTA demonstrated a pooled sensitivity of 0.92, specificity 0.43, PPV of 0.56, and NPV of 0.87 on a per-patient level. CT-FFR and CTP increased the specificity to 0.72 and 0.77, respectively (p = 0.004 and p = 0.0009) resulting in higher point estimates for PPV 0.70 and 0.83, respectively. There was no improvement in the sensitivity. The CTP protocol involved more radiation (3.5 mSv CCTA vs 9.6 mSv CTP) and a higher volume of iodinated contrast (145 ml). In conclusion, CTP and CT-FFR improve the specificity of CCTA for detecting functionally significant stenosis as defined by invasive FFR on a per-patient level; both techniques could advance the ability to noninvasively detect the functional significance of coronary lesions.

Comparison of radionuclide angiographic synchrony analysis to echocardiography and magnetic resonance imaging for the diagnosis of arrhythmogenic right ventricular cardiomyopathy.

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable arrhythmia syndrome entailing a high risk of sudden cardiac death. Discernment from benign arrhythmia disorders, particularly right ventricular outflow tract ventricular tachycardia (RVOT VT), may be challenging, providing an impetus to explore alternative modalities that may facilitate evaluation of patients with suspected ARVC. OBJECTIVE: We evaluated the role of equilibrium radionuclide angiography (ERNA) as a diagnostic tool for ARVC. METHODS: ERNA measures of ventricular synchrony-synchrony (S) and entropy (E)-were examined in patients with ARVC (n = 16), those with RVOT VT (n = 13), and healthy controls (n = 49). The sensitivity and specificity of ERNA parameters for ARVC diagnosis were compared with those of echocardiography (ECHO) and cardiovascular magnetic resonance (CMR). RESULTS: ERNA right ventricular synchrony parameters in patients with ARVC (S = 0.91 ± 0.07; E = 0.61 ± 0.1) differed significantly from those in patients with RVOT VT (S = 0.99 ± 0.01 [P = .0015]; E = 0.46 ± 0.05 [P < .001]) and healthy controls (S = 0.97 ± 0.02 [P = .003]; E = 0.48 ± 0.07 [P = .001]). The sensitivity of ERNA synchrony parameters for ARVC diagnosis (81%) was higher than that for ECHO (38%; P = .033) and similar to that for CMR (69%; P = .162), while specificity was lower for ERNA (89%) than that for ECHO and CMR (both 100%; P = .008). CONCLUSION: ERNA right ventricular synchrony parameters can distinguish patients with ARVC from controls with structurally normal hearts, and its performance is comparable to that of ECHO and CMR for ARVC diagnosis. These findings suggest that ERNA may serve as a valuable imaging tool in the diagnostic evaluation of patients with suspected ARVC.