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Huang L, Zhao P, Tang D, Zhu T, Han R, Zhan C, Liu W, Zeng H, Tao Q, Xia L. Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging. JACC Cardiovasc Imaging 2020; 13:2330-2339. [PMID: 32763118 PMCID: PMC7214335 DOI: 10.1016/j.jcmg.2020.05.004] [Citation(s) in RCA: 357] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
Objectives This study evaluated cardiac involvement in patients recovered from coronavirus disease-2019 (COVID-19) using cardiac magnetic resonance (CMR). Background Myocardial injury caused by COVID-19 was previously reported in hospitalized patients. It is unknown if there is sustained cardiac involvement after patients' recovery from COVID-19. Methods Twenty-six patients recovered from COVID-19 who reported cardiac symptoms and underwent CMR examinations were retrospectively included. CMR protocols consisted of conventional sequences (cine, T2-weighted imaging, and late gadolinium enhancement [LGE]) and quantitative mapping sequences (T1, T2, and extracellular volume [ECV] mapping). Edema ratio and LGE were assessed in post-COVID-19 patients. Cardiac function, native T1/T2, and ECV were quantitatively evaluated and compared with controls. Results Fifteen patients (58%) had abnormal CMR findings on conventional CMR sequences: myocardial edema was found in 14 (54%) patients and LGE was found in 8 (31%) patients. Decreased right ventricle functional parameters including ejection fraction, cardiac index, and stroke volume/body surface area were found in patients with positive conventional CMR findings. Using quantitative mapping, global native T1, T2, and ECV were all found to be significantly elevated in patients with positive conventional CMR findings, compared with patients without positive findings and controls (median [interquartile range]: native T1 1,271 ms [1,243 to 1,298 ms] vs. 1,237 ms [1,216 to 1,262 ms] vs. 1,224 ms [1,217 to 1,245 ms]; mean ± SD: T2 42.7 ± 3.1 ms vs. 38.1 ms ± 2.4 vs. 39.1 ms ± 3.1; median [interquartile range]: 28.2% [24.8% to 36.2%] vs. 24.8% [23.1% to 25.4%] vs. 23.7% [22.2% to 25.2%]; p = 0.002; p < 0.001, and p = 0.002, respectively). Conclusions Cardiac involvement was found in a proportion of patients recovered from COVID-19. CMR manifestation included myocardial edema, fibrosis, and impaired right ventricle function. Attention should be paid to the possible myocardial involvement in patients recovered from COVID-19 with cardiac symptoms.
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Key Words
- ACE2, angiotensin-converting enzyme 2
- AHA, American Heart Association
- BSA, body surface area
- CI, cardiac index
- CMR, cardiac magnetic resonance
- CO, cardiac output
- COVID-19, coronavirus disease-2019
- ECV, extracellular volume
- EDV, end-diastolic volume
- EF, ejection fraction
- ER, edema ratio
- ESV, end-systolic volume
- FA, flip angle
- FOV, field of view
- IQR, interquartile range
- LGE, late gadolinium enhancement
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- PSIR, phase-sensitive inversion-recovery
- RT-PCR, reverse transcription and polymerase chain reaction
- RV, right ventricle
- RVEF, right ventricular ejection fraction
- SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
- SI, signal intensity
- SSFP, steady state free precession
- STIR, short tau inversion recovery
- SV, stroke volume
- T2WI, T2-weighted imaging
- TE, echo time
- TR, repetition time
- cardiac involvement
- cardiac magnetic resonance imaging
- coronavirus disease-2019
- hs-cTnI, high-sensitive cardiac troponin I
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MESH Headings
- Adult
- COVID-19
- China
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/therapy
- Edema, Cardiac/diagnostic imaging
- Edema, Cardiac/etiology
- Edema, Cardiac/pathology
- Female
- Fibrosis
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardium/pathology
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/therapy
- Predictive Value of Tests
- Remission Induction
- Retrospective Studies
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right
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Affiliation(s)
- Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peijun Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dazhong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tong Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Han
- Department of Radiology, Wuhan No.1 Hospital, Wuhan, China
| | - Chenao Zhan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiyong Liu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Qian Tao
- Division of Imaging Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Gilstrap LG, Stevenson LW, Small R, Parambi R, Hamershock R, Greenberg J, Carr C, Ghazinouri R, Rathman L, Han E, Mehra MR, Desai AS. Reasons for Guideline Nonadherence at Heart Failure Discharge. J Am Heart Assoc 2018; 7:e008789. [PMID: 30371240 PMCID: PMC6201460 DOI: 10.1161/jaha.118.008789] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/12/2018] [Indexed: 12/31/2022]
Abstract
Background Cardiology has advanced guideline development and quality measurement. Recognizing the substantial benefits of guideline-directed medical therapy, this study aims to measure and explain apparent deviations in heart failure ( HF ) guideline adherence by clinicians at hospital discharge and describe any impact on readmission rates. Methods and Results The extent of decongestion and prescription of neurohormonal therapy were recorded prospectively for 226 HF discharges, including 132 (58%) from an academic hospital and 94 (42%) from a community hospital. Among all discharges, 25% were discharged with residual congestion (30% academic versus 18% community, P=0.070). Among discharges of patients with HF with reduced ejection fraction, 37% (45% academic versus 18% community, P<0.001) were discharged without β-blocker therapy or with lower doses than at admission. Moreover, 46% of patients with HF with reduced ejection fraction (48% academic versus 39% community, P=0.390) were discharged without an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker or with lower doses than at admission. Renal dysfunction was the most common reason for discharge with congestion, and hypotension the most common reason for discharge with no or decreased neurohormonal therapy. There was a trend toward higher 90-day readmission rates after discharge with residual congestion. Conclusions Clinicians frequently deviate from guidelines in both academic and community hospitals; however, this deviation may not always indicate poor quality. Application of guidelines recommended for stable populations is increasingly limited for hospitalized patients by hypotension, renal dysfunction, and inotrope use. Patients with renal dysfunction, hypotension, and recent inotrope use merit further study to determine best practices and possibly to adjust quality metrics for HF severity.
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Affiliation(s)
| | | | - Roy Small
- Cardiovascular Medicine DivisionLancaster General HospitalLancasterPA
| | - Ron Parambi
- Institute for Relevant Clinical Data AnalyticsBostonMA
| | | | - Jeffrey Greenberg
- Cardiovascular Medicine DivisionBrigham and Women's HospitalBostonMA
| | - Christina Carr
- Cardiovascular Medicine DivisionBrigham and Women's HospitalBostonMA
| | - Roya Ghazinouri
- Cardiovascular Medicine DivisionBrigham and Women's HospitalBostonMA
| | - Lisa Rathman
- Cardiovascular Medicine DivisionLancaster General HospitalLancasterPA
| | - Elizabeth Han
- Cardiovascular Medicine DivisionBrigham and Women's HospitalBostonMA
| | - Mandeep R. Mehra
- Cardiovascular Medicine DivisionBrigham and Women's HospitalBostonMA
| | - Akshay S. Desai
- Cardiovascular Medicine DivisionBrigham and Women's HospitalBostonMA
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Thomas S, Silvernagel J, Angel N, Kholmovski E, Ghafoori E, Hu N, Ashton J, Dosdall DJ, MacLeod R, Ranjan R. Higher contact force during radiofrequency ablation leads to a much larger increase in edema as compared to chronic lesion size. J Cardiovasc Electrophysiol 2018; 29:1143-1149. [PMID: 29777548 PMCID: PMC6105416 DOI: 10.1111/jce.13636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Reversible edema is a part of any radiofrequency ablation but its relationship with contact force is unknown. The goal of this study was to characterize through histology and MRI, acute and chronic ablation lesions and reversible edema with contact force. METHODS AND RESULTS In a canine model (n = 14), chronic ventricular lesions were created with a 3.5-mm tip ThermoCool SmartTouch (Biosense Webster) catheter at 25 W or 40 W for 30 seconds. Repeat ablation was performed after 3 months to create a second set of lesions (acute). Each ablation procedure was followed by in vivo T2-weighted MRI for edema and late-gadolinium enhancement (LGE) MRI for lesion characterization. For chronic lesions, the mean scar volumes at 25 W and 40 W were 77.8 ± 34.5 mm3 (n = 24) and 139.1 ± 69.7 mm3 (n = 12), respectively. The volume of chronic lesions increased (25 W: P < 0.001, 40 W: P < 0.001) with greater contact force. For acute lesions, the mean volumes of the lesion were 286.0 ± 129.8 mm3 (n = 19) and 422.1 ± 113.1 mm3 (n = 16) for 25 W and 40 W, respectively (P < 0.001 compared to chronic scar). On T2-weighted MRI, the acute edema volume was on average 5.6-8.7 times higher than the acute lesion volume and increased with contact force (25 W: P = 0.001, 40 W: P = 0.011). CONCLUSION With increasing contact force, there is a marginal increase in lesion size but accompanied with a significantly larger edema. The reversible edema that is much larger than the chronic lesion volume may explain some of the chronic procedure failures.
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Affiliation(s)
- Samuel Thomas
- Department of Medicine, School of Medicine, University of Utah
- Department of Bioengineering, University of Utah
| | - Josh Silvernagel
- Department of Bioengineering, University of Utah
- Division of Cardiovascular Medicine, University of Utah
| | - Nathan Angel
- Department of Bioengineering, University of Utah
- Division of Cardiovascular Medicine, University of Utah
| | - Eugene Kholmovski
- UCAIR, Department of Radiology and Imaging Sciences, University of Utah
- CARMA Center, University of Utah
| | - Elyar Ghafoori
- Department of Medicine, School of Medicine, University of Utah
- Department of Bioengineering, University of Utah
- Division of Cardiovascular Medicine, University of Utah
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah
| | - Nan Hu
- Department of Medicine, School of Medicine, University of Utah
| | | | - Derek J. Dosdall
- Department of Bioengineering, University of Utah
- Division of Cardiovascular Medicine, University of Utah
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah
- Division of Cardiothoracic Surgery, University of Utah
| | - Rob MacLeod
- Department of Bioengineering, University of Utah
- Division of Cardiovascular Medicine, University of Utah
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah
| | - Ravi Ranjan
- Department of Medicine, School of Medicine, University of Utah
- Department of Bioengineering, University of Utah
- Division of Cardiovascular Medicine, University of Utah
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah
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Masci PG, Pavon AG, Muller O, Iglesias JF, Vincenti G, Monney P, Harbaoui B, Eeckhout E, Schwitter J. Relationship between CMR-derived parameters of ischemia/reperfusion injury and the timing of CMR after reperfused ST-segment elevation myocardial infarction. J Cardiovasc Magn Reson 2018; 20:50. [PMID: 30037343 PMCID: PMC6055335 DOI: 10.1186/s12968-018-0474-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/26/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To investigate the influence of cardiovascular magnetic resonance (CMR) timing after reperfusion on CMR-derived parameters of ischemia/reperfusion (I/R) injury in patients with ST-segment elevation myocardial infarction (STEMI). METHODS The study included 163 reperfused STEMI patients undergoing CMR during the index hospitalization. Patients were divided according to the time between revascularization and CMR (Trevasc-CMR: Tertile-1 ≤ 43; 43 < Tertile-2 ≤ 93; Tertile-3 > 93 h). T2-mapping derived area-at-risk (AAR) and intramyocardial-hemorrhage (IMH), and late gadolinium enhancement (LGE)-derived infarct size (IS) and microvascular obstruction (MVO) were quantified. T1-mapping was performed before and > 15 min after Gd-based contrast-agent administration yielding extracellular volume (ECV) of infarct. RESULTS Main factors influencing I/R injury were homogenously balanced across Trevasc-CMR tertiles. T2 values of infarct and remote regions increased with increasing Trevasc-CMR tertiles (infarct: 60.0 ± 4.9 vs 63.5 ± 5.6 vs 64.8 ± 7.5 ms; P < 0.001; remote: 44.3 ± 2.8 vs 46.1 ± 2.8 vs ± 46.1 ± 3.0; P = 0.001). However, T2 value of infarct largely and significantly exceeded that of remote myocardium in each tertile yielding comparable T2-mapping-derived AAR extent throughout Trevasc-CMR tertiles (17 ± 9% vs 19 ± 9% vs 18 ± 8% of LV, respectively, P = 0.385). Similarly, T2-mapping-based IMH detection and quantification were independent of Trevasc-CMR. LGE-derived IS and MVO were not influenced by Trevasc-CMR (IS: 12 ± 9% vs 12 ± 9% vs 14 ± 9% of LV, respectively, P = 0.646). In 68 patients without MVO, T1-mapping based ECV of infarct region was comparable across Trevasc-CMR tertiles (P = 0.470). CONCLUSION In STEMI patients, T2 values of infarct and remote myocardium increase with increasing CMR time after revascularization. However, these changes do not give rise to substantial variation of T2-mapping-derived AAR size nor of other CMR-based parameters of I/R. TRIAL REGISTRATION ISRCTN03522116 . Registered 30.4.2018 (retrospectively registered).
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Affiliation(s)
- Pier-Giorgio Masci
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Anna Giulia Pavon
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardio-Thoracic-Vascular Department, San Raffaele’s Scientific Institute, Milan, Italy
| | - Olivier Muller
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Juan-Fernando Iglesias
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Gabriella Vincenti
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Pierre Monney
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Brahim Harbaoui
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Eric Eeckhout
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
| | - Juerg Schwitter
- Centre of Cardiac Magnetic Resonance, University Hospital Lausanne-CHUV, Lausanne, Switzerland
- Cardiology Division, Heart & Vessels Department, Lausanne University Hospital-CHUV, BH-09-792 Rue de Bugnon 46, CH-1011 Lausanne, Vaud Switzerland
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5
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Krahn PRP, Singh SM, Ramanan V, Biswas L, Yak N, Anderson KJT, Barry J, Pop M, Wright GA. Cardiovascular magnetic resonance guided ablation and intra-procedural visualization of evolving radiofrequency lesions in the left ventricle. J Cardiovasc Magn Reson 2018; 20:20. [PMID: 29544514 PMCID: PMC5856306 DOI: 10.1186/s12968-018-0437-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 02/15/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Radiofrequency (RF) ablation has become a mainstay of treatment for ventricular tachycardia, yet adequate lesion formation remains challenging. This study aims to comprehensively describe the composition and evolution of acute left ventricular (LV) lesions using native-contrast cardiovascular magnetic resonance (CMR) during CMR-guided ablation procedures. METHODS RF ablation was performed using an actively-tracked CMR-enabled catheter guided into the LV of 12 healthy swine to create 14 RF ablation lesions. T2 maps were acquired immediately post-ablation to visualize myocardial edema at the ablation sites and T1-weighted inversion recovery prepared balanced steady-state free precession (IR-SSFP) imaging was used to visualize the lesions. These sequences were repeated concurrently to assess the physiological response following ablation for up to approximately 3 h. Multi-contrast late enhancement (MCLE) imaging was performed to confirm the final pattern of ablation, which was then validated using gross pathology and histology. RESULTS Edema at the ablation site was detected in T2 maps acquired as early as 3 min post-ablation. Acute T2-derived edematous regions consistently encompassed the T1-derived lesions, and expanded significantly throughout the 3-h period post-ablation to 1.7 ± 0.2 times their baseline volumes (mean ± SE, estimated using a linear mixed model determined from n = 13 lesions). T1-derived lesions remained approximately stable in volume throughout the same time frame, decreasing to 0.9 ± 0.1 times the baseline volume (mean ± SE, estimated using a linear mixed model, n = 9 lesions). CONCLUSIONS Combining native T1- and T2-based imaging showed that distinctive regions of ablation injury are reflected by these contrast mechanisms, and these regions evolve separately throughout the time period of an intervention. An integrated description of the T1-derived lesion and T2-derived edema provides a detailed picture of acute lesion composition that would be most clinically useful during an ablation case.
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Affiliation(s)
- Philippa R. P. Krahn
- Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
- Sunnybrook Research Institute, Toronto, ON Canada
| | - Sheldon M. Singh
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON Canada
- Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON Canada
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | | | | | - Nicolas Yak
- Sunnybrook Research Institute, Toronto, ON Canada
| | | | | | - Mihaela Pop
- Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
- Sunnybrook Research Institute, Toronto, ON Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Graham A. Wright
- Department of Medical Biophysics, University of Toronto, Toronto, ON Canada
- Sunnybrook Research Institute, Toronto, ON Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, ON Canada
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Granel B, Gaudy C, Serratrice J, Ene N, Mesana T, Bonnet JL, Lepidi H, Disdier P, Piana L, Weiller PJ. Severe Lower Limbs Lymphedema Following Breast Carcinoma Treatment Revealing Radiation-Induced Constrictive Pericarditis. Angiology 2016; 56:119-21. [PMID: 15678267 DOI: 10.1177/000331970505600118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors’ knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.
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Affiliation(s)
- B Granel
- Service de Médecine Interne, CHU Timone, Marseille, France
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7
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Hamshere S, Jones DA, Pellaton C, Longchamp D, Burchell T, Mohiddin S, Moon JC, Kastrup J, Locca D, Petersen SE, Westwood M, Mathur A. Cardiovascular magnetic resonance imaging of myocardial oedema following acute myocardial infarction: Is whole heart coverage necessary? J Cardiovasc Magn Reson 2016; 18:7. [PMID: 26803468 PMCID: PMC4724400 DOI: 10.1186/s12968-016-0226-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AAR measurement is useful when assessing the efficacy of reperfusion therapy and novel cardioprotective agents after myocardial infarction. Multi-slice (Typically 10-12) T2-STIR has been used widely for its measurement, typically with a short axis stack (SAX) covering the entire left ventricle, which can result in long acquisition times and multiple breath holds. This study sought to compare 3-slice T2-short-tau inversion recovery (T2- STIR) technique against conventional multi-slice T2-STIR technique for the assessment of area at risk (AAR). METHODS CMR imaging was performed on 167 patients after successful primary percutaneous coronary intervention. 82 patients underwent a novel 3-slice SAX protocol and 85 patients underwent standard 10-slice SAX protocol. AAR was obtained by manual endocardial and epicardial contour mapping followed by a semi- automated selection of normal myocardium; the volume was expressed as mass (%) by two independent observers. RESULTS 85 patients underwent both 10-slice and 3-slice imaging assessment showing a significant and strong correlation (intraclass correlation coefficient = 0.92;p < 0.0001) and a low Bland-Altman limit (mean difference -0.03 ± 3.21%, 95% limit of agreement,- 6.3 to 6.3) between the 2 analysis techniques. A further 82 patients underwent 3-slice imaging alone, both the 3-slice and the 10-slice techniques showed statistically significant correlations with angiographic risk scores (3-slice to BARI r = 0.36, 3-slice to APPROACH r = 0.42, 10-slice to BARI r = 0.27, 10-slice to APPROACH r = 0.46). There was low inter-observer variability demonstrated in the 3-slice technique, which was comparable to the 10-slice method (z = 1.035, p = 0.15). Acquisition and analysis times were quicker in the 3-slice compared to the 10-slice method (3-slice median time: 100 seconds (IQR: 65-171 s) vs. (10-slice time: 355 seconds (IQR: 275-603 s); p < 0.0001. CONCLUSIONS AAR measured using 3-slice T2-STIR technique correlates well with standard 10-slice techniques, with no significant bias demonstrated in assessing the AAR. The 3-slice technique requires less time to perform and analyse and is therefore advantageous for both patients and clinicians.
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Affiliation(s)
- Stephen Hamshere
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Daniel A Jones
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Cyril Pellaton
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Danielle Longchamp
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Tom Burchell
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Saidi Mohiddin
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - James C Moon
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Jens Kastrup
- Department of Cardiology, Rigshopitale, University of Copenhagen, Copenhagen, Denmark.
| | - Didier Locca
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- Service de Cardiologie et Département de Médecine Interne, Centre Hospitalier Universitaire, Vaudois, Lausanne, Switzerland.
| | - Steffen E Petersen
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Mark Westwood
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
| | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, St Bartholomews Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK.
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
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Jeserich M, Merkely B, Olschewski M, Kimmel S, Pavlik G, Bode C. Patients with exercise-associated ventricular ectopy present evidence of myocarditis. J Cardiovasc Magn Reson 2015; 17:100. [PMID: 26590904 PMCID: PMC4655086 DOI: 10.1186/s12968-015-0204-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/09/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The origin and clinical relevance of exercise-induced premature ventricular beats (PVBs) in patients without coronary heart disease or cardiomyopathies is unknown. Cardiovascular magnetic resonance enables us to non-invasively assess myocardial scarring and oedema. The purpose of our study was to discover any evidence of myocardial anomalies in patients with exercise-induced ventricular premature beats. METHODS We examined 162 consecutive patients presenting palpitations and documented exercise-induced premature ventricular beats (PVBs) but no history or evidence of structural heart disease. Results were compared with 70 controls matched for gender and age. ECG-triggered, T2-weighted, fast spin echo triple inversion recovery sequences and late gadolinium enhancement were obtained as well as LV function and dimensions. RESULTS Structural anomalies in the myocardium and/or pericardium were present in 85 % of patients with exercise-induced PVBs. We observed a significant difference between patients with PVBs and controls in late gadolinium enhancement, that is 68 % presented subepicardial or midmyocardial lesions upon enhancement, whereas only 9 % of the controls did so (p < 0.0001). More patients presented pericardial enhancement (35 %) or pericardial thickening (27 %) compared to controls (21 % and 13 %, p < 0.0001). Myocardial oedema was present in 37 % of the patients and in only one control, p < 0.0001. Left ventricular ejection fraction did not differ between patients and controls (63.1 ± 7.9 vs. 64.7 ± 7.0, p = 0.13). CONCLUSIONS The majority of patients with exercise-associated premature ventricular beats present evidence of myocardial disease consistent with acute or previous myocarditis or myopericarditis.
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Affiliation(s)
- Michael Jeserich
- Department for Cardiology and Angiology, Heart Center University of Freiburg, Albert-Ludwigs University Freiburg, Freiburg, Germany.
- , Koenigstr. 39, 90402, Nuernberg, Germany.
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor str, 68, 1122, Budapest, Hungary.
| | - Manfred Olschewski
- Department of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany.
| | - Simone Kimmel
- Medical Practice, Cardiology and Angiology, Koenigstr. 39, 90402, Nuernberg, Germany.
| | - Gabor Pavlik
- Department of Health Sciences and Sports Medicine, Universitiy of Physical Education, H-1123 Alkotás str. 44, Budapest, Hungary.
| | - Christoph Bode
- Department for Cardiology and Angiology, Heart Center University of Freiburg, Albert-Ludwigs University Freiburg, Freiburg, Germany.
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Fauchald P. Effects of ultrafiltration on body fluid volumes and transcapillary colloid osmotic gradient in hemodialysis patients. Contrib Nephrol 2015; 74:170-5. [PMID: 2702136 DOI: 10.1159/000417488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- P Fauchald
- Medical Department B, University Hospital, Oslo, Norway
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11
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Maceira AM, Ripoll C, Cosin-Sales J, Igual B, Gavilan M, Salazar J, Belloch V, Pennell DJ. Long term effects of cocaine on the heart assessed by cardiovascular magnetic resonance at 3T. J Cardiovasc Magn Reson 2014; 16:26. [PMID: 24758161 PMCID: PMC4026110 DOI: 10.1186/1532-429x-16-26] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cocaine is an addictive, sympathomimetic drug with potentially lethal effects. The prevalence and features of cocaine cardiotoxicity are not well known. We aimed to assess these effects using a comprehensive cardiovascular magnetic resonance (CMR) protocol in a large group of asymptomatic cocaine users. METHODS Consecutive (n = 94, 81 males, 36.6 ±7 years), non-selected, cocaine abusers were recruited and had a medical history, examination, ECG, blood test and CMR. The CMR study included measurement of left and right ventricular (LV, RV) dimensions and ejection fraction (EF), sequences for detection of myocardial oedema and late gadolinium enhancement (LGE). Images were compared to a cohort of healthy controls. RESULTS Years of regular cocaine use were 13.9 ± 9. When compared to the age-matched healthy cohort, the cocaine abusers had increased LV end-systolic volume, LV mass index and RV end-systolic volume, with decreased LVEF and RVEF. No subject had myocardial oedema, but 30% had myocardial LGE indicating myocardial damage. CONCLUSIONS CMR detected cardiovascular disease in 71% of this cohort of consecutive asymptomatic cocaine abusers and mean duration of abuse was related to probability of LV systolic dysfunction.
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MESH Headings
- Adult
- Asymptomatic Diseases
- Case-Control Studies
- Cocaine-Related Disorders/complications
- Contrast Media
- Edema, Cardiac/diagnosis
- Edema, Cardiac/etiology
- Edema, Cardiac/pathology
- Electrocardiography
- Female
- Fibrosis
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardium/pathology
- Predictive Value of Tests
- Prospective Studies
- Risk Factors
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Young Adult
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Affiliation(s)
- Alicia M Maceira
- Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
| | - Carmen Ripoll
- Addictions Treatment Unit of Campanar, La Fe Hospital, Valencia, Spain
| | - Juan Cosin-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Begoña Igual
- Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
| | - Mirella Gavilan
- Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
| | - Jose Salazar
- Department of Psychiatry, Consorcio Hospital General, Valencia, CIBERSAM, Spain
| | - Vicente Belloch
- Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
| | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Imperial College, London, UK
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12
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Ntusi NAB, Piechnik SK, Francis JM, Ferreira VM, Rai ABS, Matthews PM, Robson MD, Moon J, Wordsworth PB, Neubauer S, Karamitsos TD. Subclinical myocardial inflammation and diffuse fibrosis are common in systemic sclerosis--a clinical study using myocardial T1-mapping and extracellular volume quantification. J Cardiovasc Magn Reson 2014; 16:21. [PMID: 24593856 PMCID: PMC3996013 DOI: 10.1186/1532-429x-16-21] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/17/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is characterised by multi-organ tissue fibrosis including the myocardium. Diffuse myocardial fibrosis can be detected non-invasively by T1 and extracellular volume (ECV) quantification, while focal myocardial inflammation and fibrosis may be detected by T2-weighted and late gadolinium enhancement (LGE), respectively, using cardiovascular magnetic resonance (CMR). We hypothesised that multiparametric CMR can detect subclinical myocardial involvement in patients with SSc. METHODS 19 SSc patients (18 female, mean age 55 ± 10 years) and 20 controls (19 female, mean age 56 ± 8 years) without overt cardiovascular disease underwent CMR at 1.5T, including cine, tagging, T1-mapping, T2-weighted, LGE imaging and ECV quantification. RESULTS Focal fibrosis on LGE was found in 10 SSc patients (53%) but none of controls. SSc patients also had areas of myocardial oedema on T2-weighted imaging (median 13 vs. 0% in controls). SSc patients had significantly higher native myocardial T1 values (1007 ± 29 vs. 958 ± 20 ms, p < 0.001), larger areas of myocardial involvement by native T1 >990 ms (median 52 vs. 3% in controls) and expansion of ECV (35.4 ± 4.8 vs. 27.6 ± 2.5%, p < 0.001), likely representing a combination of low-grade inflammation and diffuse myocardial fibrosis. Regardless of any regional fibrosis, native T1 and ECV were significantly elevated in SSc and correlated with disease activity and severity. Although biventricular size and global function were preserved, there was impairment in the peak systolic circumferential strain (-16.8 ± 1.6 vs. -18.6 ± 1.0, p < 0.001) and peak diastolic strain rate (83 ± 26 vs. 114 ± 16 s-1, p < 0.001) in SSc, which inversely correlated with diffuse myocardial fibrosis indices. CONCLUSIONS Cardiac involvement is common in SSc even in the absence of cardiac symptoms, and includes chronic myocardial inflammation as well as focal and diffuse myocardial fibrosis. Myocardial abnormalities detected on CMR were associated with impaired strain parameters, as well as disease activity and severity in SSc patients. CMR may be useful in future in the study of treatments aimed at preventing or reducing adverse myocardial processes in SSc.
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Affiliation(s)
- Ntobeko AB Ntusi
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom
| | - Stefan K Piechnik
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom
| | - Jane M Francis
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom
| | - Vanessa M Ferreira
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom
| | - Aitzaz BS Rai
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom
| | - Paul M Matthews
- GlaxoSmithKline Clinical Imaging Centre, London, UK
- Division of Brain Sciences, Department of Medicine, Imperial College, London, UK
| | - Matthew D Robson
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom
| | - James Moon
- Institute of Cardiovascular Science, University College London & Heart Hospital, London, UK
| | - Paul B Wordsworth
- Nuffield Department of Orthopaedics & NIHR Oxford Musculoskeletal Biomedical Research Unit, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre and John Radcliffe Hospital, Oxford, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom
| | - Theodoros D Karamitsos
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Level 0, John Radcliffe Hospital, University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford OX3 9DU, United Kingdom
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Montejo M, Goikoetxea J, Mularoni A, Blanco MJ, Gaafar A, Boado MV, Marín M, Aramendi JI. [Tropheryma wipplei endocarditis: a report of 3 cases]. Rev Esp Quimioter 2013; 26:168-170. [PMID: 23817658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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14
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Zorzi A, Perazzolo Marra M, Migliore F, De Lazzari M, Tarantini G, Iliceto S, Corrado D. Relationship between repolarization abnormalities and myocardial edema in atypical Tako-Tsubo syndrome. J Electrocardiol 2013; 46:348-51. [PMID: 23809207 DOI: 10.1016/j.jelectrocard.2013.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Indexed: 01/30/2023]
Abstract
In typical "apical" Tako-Tsubo syndrome (TTS), an association between dynamic T-wave inversion/QTc interval prolongation and myocardial edema as evidenced by cardiac magnetic resonance has been reported. We describe a patient with atypical "mid-ventricular" TTS who showed T-waves inversion/QTc prolongation confined to the lateral leads. Cardiac magnetic resonance revealed transmural myocardial edema with the highest signal intensity in the mid-lateral wall, in accordance with the ECG location of repolarization abnormalities. This finding indicates that the association of dynamic T-wave inversion/QTc interval prolongation with myocardial edema is demonstrable also in atypical variant of TTS and contributes to support the emerging concept of a cause-effect relationship between transient myocardial edema and dynamic repolarization changes.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy
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15
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Nensa F, Mahabadi AA, Erbel R, Schlosser TW. Myocardial edema during acute myocardial infarction visualized by diffusion-weighted MRI. Herz 2012; 38:509-10. [PMID: 23263243 DOI: 10.1007/s00059-012-3705-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/05/2012] [Accepted: 09/27/2012] [Indexed: 11/25/2022]
Affiliation(s)
- F Nensa
- Department of Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, Germany.
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Fávaro GAG, Assad RS, Abduch MCD, Silva GJJ, Gomes GS, Andrade JL, Krieger JE, Moreira LFP. Reversible pulmonary trunk banding: VII. Stress echocardiographic assessment of rapid ventricular hypertrophy in young goats. J Thorac Cardiovasc Surg 2012; 145:1345-1351.e4. [PMID: 22925567 DOI: 10.1016/j.jtcvs.2012.07.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 04/20/2012] [Accepted: 07/26/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ventricle retraining with abrupt systolic overload can cause myocardial edema and necrosis, followed by late ventricular failure. Intermittent systolic overload could minimize the inadequacy of conventional pulmonary artery banding. The present study compared ventricle function under dobutamine stress in 2 protocols of systolic overload in young goats. METHODS Nineteen young goats were divided into 3 groups: sham (n = 7; no systolic pressure overload), continuous (n = 6; systolic overload maintained for 96 hours), and intermittent (n = 6; 4 periods of 12-hour systolic overload, paired with a 12-hour resting period). Echocardiographic and hemodynamic evaluations were performed daily. The myocardial performance index and ejection fraction were evaluated at rest and during dobutamine stress. The goats were then killed for morphologic evaluation. RESULTS The intermittent group underwent less systolic overload than the continuous group (P < .05). Nevertheless, both groups had increased right ventricular and septal masses compared with the sham group (P < .0002). Echocardiography revealed a major increase in right ventricular wall thickness in the intermittent group (+64.8% ± 23.37%) compared with the continuous group (+43.9% ± 19.26%; P = .015). Only the continuous group remained with significant right ventricular dilation throughout the protocol (P < .001). The intermittent group had a significantly better myocardial performance index at the end of the protocol, under resting and dobutamine infusion, compared with the continuous group (P < .012). CONCLUSIONS Both systolic overload protocols have induced rapid right ventricular hypertrophy. However, only the intermittent group had better preservation of right ventricular function at the end of the protocol, both at rest and during dobutamine infusion.
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Affiliation(s)
- Gustavo A G Fávaro
- Radiology Institute, University of São Paulo Medical School, São Paulo, Brazil.
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17
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Ferreira VM, Piechnik SK, Dall’Armellina E, Karamitsos TD, Francis JM, Choudhury RP, Friedrich MG, Robson MD, Neubauer S. Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012; 14:42. [PMID: 22720998 PMCID: PMC3424120 DOI: 10.1186/1532-429x-14-42] [Citation(s) in RCA: 330] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 05/28/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND T2w-CMR is used widely to assess myocardial edema. Quantitative T1-mapping is also sensitive to changes in free water content. We hypothesized that T1-mapping would have a higher diagnostic performance in detecting acute edema than dark-blood and bright-blood T2w-CMR. METHODS We investigated 21 controls (55 ± 13 years) and 21 patients (61 ± 10 years) with Takotsubo cardiomyopathy or acute regional myocardial edema without infarction. CMR performed within 7 days included cine, T1-mapping using ShMOLLI, dark-blood T2-STIR, bright-blood ACUT2E and LGE imaging. We analyzed wall motion, myocardial T1 values and T2 signal intensity (SI) ratio relative to both skeletal muscle and remote myocardium. RESULTS All patients had acute cardiac symptoms, increased Troponin I (0.15-36.80 ug/L) and acute wall motion abnormalities but no LGE. T1 was increased in patient segments with abnormal and normal wall motion compared to controls (1113 ± 94 ms, 1029 ± 59 ms and 944 ± 17 ms, respectively; p < 0.001). T2 SI ratio using STIR and ACUT2E was also increased in patient segments with abnormal and normal wall motion compared to controls (all p < 0.02). Receiver operator characteristics analysis showed that T1-mapping had a significantly larger area-under-the-curve (AUC = 0.94) compared to T2-weighted methods, whether the reference ROI was skeletal muscle or remote myocardium (AUC = 0.58-0.89; p < 0.03). A T1 value of greater than 990 ms most optimally differentiated segments affected by edema from normal segments at 1.5 T, with a sensitivity and specificity of 92 %. CONCLUSIONS Non-contrast T1-mapping using ShMOLLI is a novel method for objectively detecting myocardial edema with a high diagnostic performance. T1-mapping may serve as a complementary technique to T2-weighted imaging for assessing myocardial edema in ischemic and non-ischemic heart disease, such as quantifying area-at-risk and diagnosing myocarditis.
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Affiliation(s)
- Vanessa M Ferreira
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Stefan K Piechnik
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Erica Dall’Armellina
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Theodoros D Karamitsos
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jane M Francis
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Robin P Choudhury
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Matthias G Friedrich
- Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
- Department of Cardiology, Université de Montréal, Montréal, Quebec, Canada
| | - Matthew D Robson
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Stefan Neubauer
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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Pedersen SF, Thrysøe SA, Paaske WP, Thim T, Falk E, Ringgaard S, Kim WY. Determination of edema in porcine coronary arteries by T2 weighted cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2011; 13:52. [PMID: 21936914 PMCID: PMC3192668 DOI: 10.1186/1532-429x-13-52] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 09/21/2011] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Inflammation plays a pivotal role in all stages of atherosclerosis. Since edema is known to be an integral part of inflammation, a noninvasive technique that can identify edema in the coronary artery wall may provide unique information regarding plaque activity. In this study, we aimed to determine whether edema induced in porcine coronary arteries by balloon injury could be reliably detected by cardiovascular magnetic resonance (CMR) using a water sensitive T2-weighted short tau inversion recovery sequence (T2-STIR). We also aimed to compare these results to those of conventional T2-weighted (T2W) imaging. METHODS Edema was induced in the proximal left anterior descending (LAD) coronary artery wall in seven pigs by balloon injury. At baseline, and 1-10 days (average four) post injury, the proximal LAD was assessed by water sensitive T2-STIR and conventional T2W sequences in cross-sectional planes. CMR images were matched to histopathology, validated against Evans blue as a marker of increased vessel wall permeability, and correlated with the arterial amount of fibrinogen used as an edema surrogate marker. RESULTS Post injury, the T2-STIR images of the injured LAD vessel wall showed a significant 72%, relative signal intensity (SI) increase compared with baseline (p = 0.028). Using a threshold value of SI 7 SD above the average SI of the myocardium, T2-STIR detected edema in the vessel wall (i.e. enhancement) with a sensitivity of 100 and a specificity of 71. Twelve out of the 14 (86%) T2-STIR images displaying coronary artery wall enhancement also showed Evans blue uptake in the corresponding histology. The relative signal intensity showed a linear correlation with the amount of fibrinogen detected on the corresponding histopathology (ρ = 0.750, p = 0.05). The conventional T2W images did not show significant changes in SI post injury. CONCLUSION T2-STIR CMR enabled detection of coronary artery wall edema and could therefore be a non-invasive diagnostic tool for evaluation of inflammatory coronary artery wall activity.
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Affiliation(s)
- Steen Fjord Pedersen
- Dept. of Cardiothoracic and Vascular Surgery T, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
- MR-center, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
| | - Samuel A Thrysøe
- MR-center, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
| | - William P Paaske
- Dept. of Cardiothoracic and Vascular Surgery T, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
| | - Troels Thim
- Dept. of Cardiology, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
| | - Erling Falk
- Dept. of Cardiology, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
| | - Steffen Ringgaard
- MR-center, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
| | - Won Yong Kim
- Dept. of Cardiology, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
- MR-center, Aarhus University Hospital Skejby, Brendstrupsgaardsvej 100, DK-8200 Aarhus N, Denmark
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Essa E, Velez MR, Smith S, Giri S, Raman SV, Gumina RJ. Cardiovascular magnetic resonance in wet beriberi. J Cardiovasc Magn Reson 2011; 13:41. [PMID: 21838901 PMCID: PMC3175447 DOI: 10.1186/1532-429x-13-41] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 08/12/2011] [Indexed: 11/23/2022] Open
Abstract
The clinical presentation of beriberi can be quite varied. In the extreme form, profound cardiovascular involvement leads to circulatory collapse and death. This case report is of a 72 year-old male who was admitted to the Neurology inpatient ward with progressive bilateral lower extremity weakness and parasthesia. He subsequently developed pulmonary edema and high output cardiac failure requiring intubation and blood pressure support. With the constellation of peripheral neuropathy, encephalopathy, ophthalmoplegia, unexplained heart failure, and lactic acidosis, thiamine deficiency was suspected. He was empirically initiated on thiamine replacement therapy and his thiamine level pre-therapy was found to be 23 nmol/L (Normal: 80-150 nmol/L), consistent with the diagnosis of beriberi. Cardiovascular magnetic resonance (CMR) showed severe left ventricular systolic dysfunction, markedly increased myocardial T2, and minimal late gadolinium enhancement (LGE). After 5 days of daily 100 mg IV thiamine and supportive care, the hypotension resolved and the patient was extubated and was released from the hospital 3 weeks later. Our case shows via CMR profound myocardial edema associated with wet beriberi.
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Affiliation(s)
- Essa Essa
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Michael R Velez
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Sakima Smith
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Shivraman Giri
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Subha V Raman
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
| | - Richard J Gumina
- Division of Cardiovascular Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
- Department of Internal Medicine, The Ohio State University, Davis Heart & Lung Research Institute, Suite 200, 473 W. 12th Avenue, Columbus, Ohio USA, 43210-1252
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Quarta G, Holdright DR, Plant GT, Harkness A, Hausenloy D, Hyare H, Moon JC. Cardiovascular magnetic resonance in cardiac sarcoidosis with MR conditional pacemaker in situ. J Cardiovasc Magn Reson 2011; 13:26. [PMID: 21539747 PMCID: PMC3108926 DOI: 10.1186/1532-429x-13-26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/03/2011] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular implantable electronic devices represent important limitations to magnetic resonance imaging (MRI). Recently, MRI-conditional dual chamber pacemakers and leads have become available. We describe a case of a patient with neuro-sarcoidosis presenting with diplopia and hydrocephalus requiring an MRI-conditional programmable ventriculo-peritoneal shunt, who developed complete heart block. In view of the ongoing need for neuro-imaging, MRI-conditional dual chamber pacemaker and leads were implanted. Cardiac and brain MRI were requested to guide immunosupression. Overall the scans demonstrated stable neurological disease, but confirmed cardiac sarcoid, with oedema on T2 weighted images suggesting active disease and extensive sub-endocardial late gadolinium enhancement, including the basal septum. This case illustrates why sarcoid patients who develop bradyarrhythmias should ideally have an MRI-conditional pacing system.
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Affiliation(s)
- Giovanni Quarta
- Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London. W1G 8PH, UK
- Department of Cardiology, S. Andrea Hospital, University "La Sapienza", Rome, Italy
| | - Diana R Holdright
- Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London. W1G 8PH, UK
| | - Gordon T Plant
- National Hospital for Neurology and Neurosurgery Queen Square, University College London Hospitals NHS Trust London WC1N 3BG, UK
| | - Allan Harkness
- Department of Cardiology, Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Derek Hausenloy
- Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London. W1G 8PH, UK
| | - Harpreet Hyare
- Department of Imaging, University College London Hospitals NHS Trust, 250 Euston Road, London. NW1 2PG, UK
- MRC Prion Unit, Department of Neurodegenerative Diseases, UCL Institute of Neurology, Queen Square, London. WC1N 3BG, UK
| | - James C Moon
- Department of Cardiology, The Heart Hospital, part of University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London. W1G 8PH, UK
- Department of Medicine, University College London, London, UK
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22
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Steffel J, Brunckhorst C. [CME ECG 33. Pacemaker rhythm or no pacemaker rhythm. Sinus rhythm with mainly normal conduction]. Praxis (Bern 1994) 2011; 100:564-565. [PMID: 21526479 DOI: 10.1024/1661-8157/a000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
MESH Headings
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Atrioventricular Node/physiopathology
- Bundle of His/physiopathology
- Cardiac Resynchronization Therapy
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Diagnosis, Differential
- Dyspnea/etiology
- Edema, Cardiac/etiology
- Electrocardiography
- Heart Ventricles/physiopathology
- Humans
- Male
- Signal Processing, Computer-Assisted
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
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Affiliation(s)
- Jan Steffel
- Klinik für Kardiologie, Abteilung für Rhythmologie, Universitätsspital Zurich.
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23
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Roghi A, Pedrotti P, Milazzo A, Bonacina E, Bucciarelli-Ducci C. Adrenergic myocarditis in pheochromocytoma. J Cardiovasc Magn Reson 2011; 13:4. [PMID: 21223554 PMCID: PMC3025878 DOI: 10.1186/1532-429x-13-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 01/11/2011] [Indexed: 12/02/2022] Open
Abstract
The clinical presentation of pheochromocytoma is variable and many biochemical and imaging methods have been suggested to improve the diagnostic accuracy of what has been termed "the great masquerader". This case-report is of a middle-aged woman with a non-specific clinical presentation suggesting acute coronary syndrome or subacute myocarditis. Cardiovascular magnetic resonance (CMR) at presentation showed myocardial edema and intramyocardial late gadolinium enhancement (LGE). An adrenal mass was seen, which was confirmed as pheochromocytoma and surgically removed. Our case shows evidence for acute adrenergic myocarditis, with resolution of both the edema and the LGE after surgical excision.
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Affiliation(s)
- Alberto Roghi
- Non-invasive Cardiac Imaging Laboratory, CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Patrizia Pedrotti
- Non-invasive Cardiac Imaging Laboratory, CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Angela Milazzo
- Non-invasive Cardiac Imaging Laboratory, CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Edgardo Bonacina
- Pathology Laboratories, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, NIHR Cardiovascular Biomedical Research Unit, University Hospitals Bristol Foundation Trust, Bristol, UK
- Royal Brompton Hospital Foundation Trust, NIHR Cardiovascular Biomedical Research Unit, Imperial College, London, UK
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24
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Grzelakowski P, Lugowski T, Kurzyna M, Missima M, Maciejewski M, Balcerzak M, Romanek R, Stelak M, Lugowski A, Goch A. [Acute intermediate-risk pulmonary embolism with right-sided free-floating intracardiac thrombus, systemic inflammatory reaction syndrome, multiple organ dysfunction syndrome, disseminated intravascular coagulation and acute ischaemia of a limb]. Kardiol Pol 2010; 68:1140-1144. [PMID: 20967711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A case of a 64 year-old woman admitted to ICCU because of severe dyspnoea and oedema of left lower limb is presented. We diagnosed coincidence of acute pulmonary embolism with right-sided free-floating heart thrombi, systemic inflammatory reaction syndrome, multiple organ dysfunction syndrome, disseminated intravascular coagulation and acute ischaemia of the right lower limb. Due to atypical clinical presentation therapeutic strategies were discussed with ZATPOL registry coordinator. The patient was treated pharmacologically, underwent cardiosurgical evacuation of right-sided intracardiac thrombus and lower limb amputation. At follow up visit 6 months after discharge from hospital she was in good general condition with no complaints.
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Affiliation(s)
- Paweł Grzelakowski
- Klinika Kardiologii i Kardiochirurgii, 10. Wojskowy Szpital Kliniczny z Polikliniką, Bydgoszcz.
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25
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Logeart D. [Diagnosis of heart failure]. Rev Prat 2010; 60:921-929. [PMID: 21033484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The diagnosis of heart failure is based on strict process using clinical examination as well as other tests. The fine analysis of cardinal symptoms - tiredness and dyspnea--as well as of various signs is required. In cases of uncertainty, blood testing of BNP or NT-pro-BNP improves the diagnostic accuracy. Then the diagnosis is confirmed only after the assessment of evidence of cardiac abnormalities, using cardiac echography among others. Such process will be repeated in cases of significant changes in symptoms. The diagnostic process is associated with etiological investigations as well as the strict assessment of precipitating factors, because of their potential consequences on treatment.
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Affiliation(s)
- Damien Logeart
- Service de cardiologie, Inserm U942, hôpital Lariboisière, AP-HP, 75475 Paris Cedex 10.
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26
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27
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Mahnken AH, Bruners P, Bornikoel CM, Krämer N, Guenther RW. Assessment of myocardial edema by computed tomography in myocardial infarction. JACC Cardiovasc Imaging 2010; 2:1167-74. [PMID: 19833305 DOI: 10.1016/j.jcmg.2009.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 05/07/2009] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to analyze whether cardiac computed tomography (CT) permits the assessment of myocardial edema in acute myocardial infarction (MI). BACKGROUND Several studies proved the value of detecting myocardial edema from T2-weighted cardiac magnetic resonance (CMR) for differentiating acute from chronic MI. Computed tomography is suited for depicting MI, but there are no data on CT imaging of myocardial edema. We hypothesized that areas of reduced attenuation in acute MI may correspond to edema. METHODS In 7 pigs (55.2 +/- 7.3 kg), acute MI was induced using a closed chest model. Animals underwent unenhanced arterial and late-phase dual source computed tomography (DSCT) followed by T2-weighted and delayed contrast-enhanced CMR. Animals were sacrificed, and the excised hearts were stained with 2,3,5-triphenyltetrazolin chloride (TTC). Size of MI, contrast-to-noise ratio, and percent signal difference were compared among the different imaging techniques with concordance-correlation coefficients (rho(c)), Bland-Altman plots, and analysis of variance for repeated measures. RESULTS Infarction was transmural on all slices. On unenhanced, arterial, and late-phase DSCT, mean sizes of MI were 27.2 +/- 8.5%, 20.1 +/- 6.9%, and 23.1 +/- 8.2%, respectively. Corresponding values on T2-weighted and delayed enhanced CMR were 28.5 +/- 7.8% and 22.2 +/- 7.7%. Size of MI on TTC staining was 22.6 +/- 7.8%. Best agreement was observed when comparing late-phase CT (rho(c) = 0.9356) and delayed enhanced CMR (rho(c) = 0.9248) with TTC staining. There was substantial agreement between unenhanced DSCT and T2-weighted CMR (rho(c) = 0.8629). Unenhanced DSCT presented with the lowest percent signal difference (46.0 +/- 18.3) and the lowest contrast-to-noise ratio (4.7 +/- 2.0) between infarcted and healthy myocardium. CONCLUSIONS Unenhanced DSCT permits the detection of myocardial edema in large acute MI. Further studies including smaller MI in different coronary artery territories and techniques for improving the contrast-to-noise ratio are needed.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, RWTH Aachen University, Aachen, Germany.
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28
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Giri S, Chung YC, Merchant A, Mihai G, Rajagopalan S, Raman SV, Simonetti OP. T2 quantification for improved detection of myocardial edema. J Cardiovasc Magn Reson 2009; 11:56. [PMID: 20042111 PMCID: PMC2809052 DOI: 10.1186/1532-429x-11-56] [Citation(s) in RCA: 499] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 12/30/2009] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND T2-Weighted (T2W) magnetic resonance imaging (MRI) pulse sequences have been used to detect edema in patients with acute myocardial infarction and differentiate acute from chronic infarction. T2W sequences have suffered from several problems including (i) signal intensity variability caused by phased array coils, (ii) high signal from slow moving ventricular chamber blood that can mimic and mask elevated T2 in sub-endocardial myocardium, (iii) motion artifacts, and (iv) the subjective nature of T2W image interpretation. In this work we demonstrate the advantages of a quantitative T2 mapping technique to accurately and reliably detect regions of edematous myocardial tissue without the limitations of qualitative T2W imaging. METHODS Methods of T2 mapping were evaluated on phantoms; the best of these protocols was then optimized for in vivo imaging. The optimized protocol was used to study the spatial, view-dependent, and inter-subject variability and motion sensitivity in healthy subjects. Using the insights gained from this, the utility of T2 mapping was demonstrated in a porcine model of acute myocardial infarction (AMI) and in three patients with AMI. RESULTS T2-prepared SSFP demonstrated greater accuracy in estimating the T2 of phantoms than multi-echo turbo spin echo. The T2 of human myocardium was found to be 52.18 +/- 3.4 ms (range: 48.96 ms to 55.67 ms), with variability between subjects unrelated to heart rate. Unlike T2W images, T2 maps did not show any signal variation due to the variable sensitivity of phased array coils and were insensitive to cardiac motion. In the three pigs and three patients with AMI, the T2 of the infarcted region was significantly higher than that of remote myocardium. CONCLUSION Quantitative T2 mapping addresses the well-known problems associated with T2W imaging of the heart and offers the potential for increased accuracy in the detection of myocardial edema.
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Affiliation(s)
- Shivraman Giri
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
- Dorothy M Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | | | - Ali Merchant
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Georgeta Mihai
- Dorothy M Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Sanjay Rajagopalan
- Dorothy M Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Subha V Raman
- Dorothy M Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Orlando P Simonetti
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
- Dorothy M Davis Heart & Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Radiology, The Ohio State University, Columbus, Ohio, USA
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29
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Dziemianko I, Kuzniar J, Dorobisz A, Zynek-Litwin M, Garcarek J, Klinger M. Critical Bilateral Renal Arterial Stenosis Presenting as Cardio-Renal Syndrome: Isolated Ultrafiltration Preceding Percutaneous Transluminal Revascularization. ACTA ACUST UNITED AC 2009; 15:96-8. [PMID: 19379457 DOI: 10.1111/j.1751-7133.2009.00052.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
MESH Headings
- Aldosterone/blood
- Angioplasty, Balloon
- Aortography
- Edema, Cardiac/diagnosis
- Edema, Cardiac/etiology
- Edema, Cardiac/therapy
- Heart Failure/diagnosis
- Heart Failure/etiology
- Heart Failure/therapy
- Hemofiltration
- Humans
- Hypertension, Renovascular/diagnosis
- Hypertension, Renovascular/etiology
- Hypertension, Renovascular/therapy
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/therapy
- Kidney Function Tests
- Male
- Middle Aged
- Renal Artery Obstruction/diagnosis
- Renal Artery Obstruction/therapy
- Renin/blood
- Stents
- Syndrome
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Affiliation(s)
- Ilona Dziemianko
- Department of Nephrology and Transplantation Medicine, Wroclaw Medicine University, Wroclaw, Poland
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30
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Affiliation(s)
- M Gulich
- Institut für Allgemeinmedizin der Universität Ulm.
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31
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Yamaguchi S, Watanabe G, Tomita S, Tabata S. Lidocaine-magnesium blood cardioplegia was equivalent to potassium blood cardioplegia in left ventricular function of canine heart. Interact Cardiovasc Thorac Surg 2006; 6:172-6. [PMID: 17669802 DOI: 10.1510/icvts.2006.137240] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study evaluated the effects of lidocaine-magnesium blood cardioplegia on left ventricular function compared with potassium blood cardioplegia. Crystalloid cardioplegia which contains lidocaine has been reported but blood cardioplegia is rare. Thirteen dogs received 60 min of global ischemia under hypothermic cardioplumonary bypass (30 degrees C). Potassium blood cardioplegia was administered every 20 min in group A (n=6), and lidocaine-magnesium blood cardioplegia in group B (n=7). We compared the ratio of Emax obtained during IVC occlusion at pre- and post-global ischemia (%Emax) and LVSW (%LVSV). Cardiac function was evaluated prior to CPB and 60 min after reperfusion. There was no difference in time required for cardiac arrest between the two groups (group A: 78+/-3 s, group B: 89+/-9 s). Percentage maximal elastance was significantly better in group B (group A: 63+/-3%, group B: 76+/-4%, P<0.05). Percentage tissue water content of the myocardium after CPB was significantly lower in group B (group A: 82.3+/-4%, group B: 75.5+/-2%, P<0.05). Lidocaine-magnesium blood cardioplegia was equivalent to potassium blood cardioplegia in systolic left ventricular function and reduced myocardial edema in canine heart.
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Affiliation(s)
- Shohjiro Yamaguchi
- Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Takaramachi 13-1, Kanazawa 920-8641, Japan.
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32
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Affiliation(s)
- Hazem B Fallouh
- Cardiac Surgery Department, St. Thomas' Hospital, London SE1 7EH, United Kingdom
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33
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Abstract
The effect of chronic cardiac lymphatic obstruction on the myocardial synthesis of collagen type I and III was investigated in a rabbit model. In the lymphatic obstruction group (n=16), plasma C-terminal propeptide type I procollagen (PICP) and N-terminal propeptide type III procollagen (PIIINP) were elevated at 7, 14 and 30 days after the operation (p<0.05). The elevated PICP and PIIINP returned to the pre-operation values 60 days after the operation. The myocardial expression of collagen type I and III mRNA were also enhanced in the lymphatic flow obstruction group. Plasma PICP, PIIINP and myocardial collagen type I and III mRNA remained unchanged in the control group (n=16). We concluded that chronic obstruction of cardiac lymph flow leads to enhanced myocardial collagen synthesis in rabbits. The enhanced collagen synthesis starts within seven days after lymphatic obstruction and subsides after 60 days.
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Affiliation(s)
- D Kong
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia.
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34
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Qin YZ. [Enhance clinical study on cardiogenic acute pulmonary edema]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2006; 18:321-2. [PMID: 16784552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Ying-zhi Qin
- Department of Intensive Care Unit, Tianjin Third Central Hospital, Tianjin 300170, China
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35
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Affiliation(s)
- Kevin E Steel
- Department of Cardiology, Wilford Hall Medical Center, Lackland AFB, Texas, USA.
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36
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Odeh M, Sabo E, Oliven A. Circulating levels of tumor necrosis factor-α correlate positively with severity of peripheral oedema in patients with right heart failure. Eur J Heart Fail 2006; 8:141-6. [PMID: 16112904 DOI: 10.1016/j.ejheart.2005.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 04/04/2005] [Accepted: 05/16/2005] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Several previous studies have shown that circulating levels of tumor necrosis factor-alpha (TNF) are elevated in patients with advanced congestive heart failure. However, the relationship between circulating levels of TNF and severity of peripheral oedema in these patients has not been previously evaluated. AIMS To investigate the relationship between circulating levels of TNF, and severity of peripheral oedema in patients with right-sided heart failure (RHF). METHODS AND RESULTS Circulating levels of TNF were measured in 15 healthy volunteers, and in 83 patients with RHF with various levels of peripheral oedema. At presentation, 13 patients had no peripheral oedema (grade 0), 22 patients had mild peripheral oedema (grade 1), 23 patients had moderate peripheral oedema (grade 2), and 25 patients had severe peripheral oedema (grade 3). The values of circulating TNF levels (mean +/- S.E.M.) at presentation in the control group and in the RHF patients (oedema grades 0-3) were 2.98+/-0.21, 4.22+/-0.55, 4.67+/-0.29, 7.66+/-0.44, and 10.94+/-0.67 pg/mL respectively. There was a significant difference between the groups (p < 0.0001, ANOVA), and a significant positive correlation was found between circulating TNF levels and severity of peripheral oedema (r = 0.77, p<0.0001). CONCLUSION A significant relationship is present between circulating levels of TNF and severity of peripheral oedema in patients with RHF.
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Affiliation(s)
- Majed Odeh
- Department of Internal Medicine B and, Bnai Zion Medical Center, P.O. Box 6477, Haifa 31063, Israel.
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37
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Zhang Y, Hu XS, Chen JZ, Wu ZG, Huang GZ, Hu YL, Huang XS, Lin WQ, Zheng JC. [Efficacy and safety of azosemide in patients with edema and ascites]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2005; 34:459-64. [PMID: 16216060 DOI: 10.3785/j.issn.1008-9292.2005.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of azosemide in patients with edema and ascites. METHODS A multicentral, randomized, double-blind, controlled clinical trial was applied. All 223 patients (cardiac edema 92, hepatogenic edema 63, renal edema 68) were randomized to azoesmide and furosemide group, and all patients were treated for 2 weeks. Patients with cardiac or renal edema took azosemide (30 mg/d) or furosemide (20 mg/d); patients with hepatogenic edema took azosemide (60 mg/d) or furosemide (40 mg/d). The dosage were adjusted to azosemide 60 mg/d (cardiac, renal edema), 90 mg (hepatogeic edema); or furosemide 40 mg/d (cardiac, renal edema), 60 mg (hepatogeic edema), if diuretic effects were not obtained at the end of third day. RESULTS At the end of the study, the weight changes were (2.87+/-3.10) kg and (2.81 +/-2.84) kg; the total effective rate of edema lessen was 89.19% and 89.81%; the total effective rate of heart function improvement was 64.44% and 66.66%; the 24 h urine output increased (321.85 +/-669.52) ml and (273.80 +/-645.72) ml for azosemide and furosemide, respectively. The total effective rate of ascites lessen (tested by B-ultrasound) was 89.28% and 86.66%; abdominal girth decreased (5.20 +/-3.58) cm and (5.03 +/-3.74) cm for azosemide and furosemide, respectively. The adverse event rate was 23.01% in azosemide group and 21.01% in furosemide group; the main adverse effects were hypokalemia, hyperuricemia, hypertriglyceridemia and thirsty. CONCLUSION Azosemide could effectively lessen edema, improve heart function and decrease ascitesûit is well tolerated and is particularly useful for the diuretic treatment.
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Affiliation(s)
- Yun Zhang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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38
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Abstract
This report illustrates a magnetic resonance image of aborted myocardial infarction after primary angioplasty. Myocardial oedema in the absence of late enhancement seems to be the magnetic resonance marker of the myocardium at risk of infarction that has been reperfused within 30 minutes and aborted in the clinic.
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Affiliation(s)
- G Tarantini
- Department of Cardiology, University of Padova, Policlinico Universitario, Via Giustiniani, 2, 35128 Padua, Italy.
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39
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Abstract
The most common causes of pulmonary edema are cardiac failure, renal failure and injury edema (diffuse alveolar damage). The injury edema typically shows airspace consolidation due to exsudation of fluid in the periphery of the lung with air bronchograms, no interstitial fluid accumulation can be found and only rarely pleural effusions are present. Cardiac and renal edemas often show a mixed interstitial and alveolar transudation without air bronchograms. Pleural effusions are often present. Both usually have an increased heart-size and an increased vascular pedicle width. To distinguish them better one has to look at the distribution of the pulmonary edema: The cardiac edema typically shows a gravitational and the renal edema a central distribution.
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Affiliation(s)
- A Christe
- Diagnostische, interventionelle und pädiatrische Radiologie, Inselspital, Universität Bern.
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40
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Gheorghiade M, Niazi I, Ouyang J, Czerwiec F, Kambayashi JI, Zampino M, Orlandi C. Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: results from a double-blind, randomized trial. Circulation 2003; 107:2690-6. [PMID: 12742979 DOI: 10.1161/01.cir.0000070422.41439.04] [Citation(s) in RCA: 310] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In this study, we evaluated the effects of tolvaptan (OPC-41061), a novel, oral, nonpeptide vasopressin V2-receptor antagonist in patients with chronic heart failure (CHF). METHODS AND RESULTS This was a double-blind study investigating the effects of three doses of tolvaptan and placebo in patients with CHF. After a run-in period, 254 patients were randomly assigned to placebo (n=63) or tolvaptan [30 mg (n=64), 45 mg (n=64), or 60 mg (n=63)] once daily for 25 days. Patients were not fluid-restricted and were maintained on stable doses of furosemide. At day 1, when compared with baseline, a decrease in body weight of -0.79+/-0.99, -0.96+/-0.93, and -0.84+/-0.02 kg was observed in the 30-, 45-, and 60-mg tolvaptan groups, respectively, and a body weight increase of +0.32+/-0.46 kg in the placebo group (P<0.001 for all treatment groups versus placebo). Although the initial decrease in body weight was maintained during the study, no further reduction was observed beyond the first day. An increase in urine volume was observed with tolvaptan when compared with placebo (3.9+/-0.6, 4.2+/-0.9, 4.6+/-0.4, and 2.3+/-0.2 L/24 hours at day 1 for 30-, 45-, and 60-mg tolvaptan groups, and placebo, respectively; P<0.001). A decrease in edema and a normalization of serum sodium in patients with hyponatremia were observed in the tolvaptan group but not in the placebo group. No significant changes in heart rate, blood pressure, serum potassium, or renal function were observed. CONCLUSIONS In patients with CHF, tolvaptan was well tolerated; it reduced body weight and edema and normalized serum sodium in the hyponatremic patients.
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Affiliation(s)
- Mihai Gheorghiade
- Northwestern University Feinberg School of Medicine, 201 East Huron St, Galter 10-240, Chicago, Ill 60611, USA.
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Abstract
Myocardial tissue edema attributable to increased microvascular fluid loss contributes to cardiac dysfunction after myocardial ischemia, cardiopulmonary bypass, hypertension, and sepsis. Recent studies suggest that carbohydrate structures on the luminal surface of microvascular endothelium are essential to prevent tissue edema. We carefully preserved these structures for visualization with electron microscopy, revealing that the rat myocardial capillary endothelial surface is coated with a 0.2- to 0.5-microm-thick carbohydrate layer and that its degradation instantly results in notable myocardial tissue edema.
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Affiliation(s)
- Bernard M van den Berg
- Department of Medical Physics, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
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Stubanus M, Luchner A, Krämer BK, Elsner D, Schunkert H, Riegger GAJ, Notheis W. [64-year-old patient with dyspnea at risk and ankle edema in recurrent tachycardia. Heart failure]. Internist (Berl) 2002; 43:1597-601. [PMID: 12607399 DOI: 10.1007/s00108-002-0595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Stubanus
- Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg.
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Abstract
Selenium is a potent reproductive and teratogenic environmental contaminant and there are concerns over possible reproductive effects of selenium on the Sacramento splittail (Pogonichthys macrolepidotus) population, a threatened species, in California, USA. In this study, the teratogenic effects of selenium were examined in splittail embryos exposed to 0.0, 5.0, and 15.0 mg l(-1) sodium selenite for 48-h at 18.0 degrees C under static conditions, with renewal every 12 h. Embryo development was evaluated daily for abnormalities from initiation of exposure (stage 27) to initiation of exogenous feeding. At the end of evaluation, prelarvae were preserved for histological analysis. There were no significant differences in mortality or hatching success between control and exposed embryos. Exposed fish had pericardial edema and deformities of skeletal tissues (loss of tail, lordosis, scoliosis, and kyphosis). Other histological alterations were limited to dysplasia, hyperplasia and metaplasia of skeletal tissues in the deformed fish. This study showed that a short exposure of embryos during somite development has significant effects on the musculoskeletal development.
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Affiliation(s)
- Swee J Teh
- Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California-Davis, 95616, USA.
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Schroeder AP, Houlind K, Pedersen EM, Nielsen TT, Egeblad H. Serial magnetic resonance imaging of global and regional left ventricular remodeling during 1 year after acute myocardial infarction. Cardiology 2002; 96:106-14. [PMID: 11740140 DOI: 10.1159/000049092] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Biplane long-axis cine MRI was performed in 51 patients 1, 13, 26, and 52 weeks after their first AMI. LV mass index (LVMI) was significantly increased 1 week after AMI (84.3 +/- 16.9 vs. 68.1 +/- 11.4 g/m(2) controls, n = 48, p < 0.001), presumably owing to edema of the infarcted myocardium. Six months after AMI, LVMI decreased to 76.5 +/- 16.4 g/m(2), but had again augmented after 1 year (81.8 +/- 17.3 g/m(2), p < 0.05), suggesting late, compensatory left ventricular hypertrophy. In patients treated with primary percutaneous transluminal coronary angioplasty, LVMI decreased 5% over 1 year, while LVMI increased 10% in patients receiving thrombolysis (p < 0.05). In the entire population, the global increase in LVMI 1 year after AMI seemed to reflect global cavity dilatation with unchanged thickness of the vital myocardium. In conclusion, in patients receiving contemporary treatment, LV remodeling only partially complied with the classical patho-anatomical concept.
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Affiliation(s)
- A P Schroeder
- Department of Cardiology, Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark.
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Nilsson JC, Nielsen G, Groenning BA, Fritz-Hansen T, Sondergaard L, Jensen GB, Larsson HB. Sustained postinfarction myocardial oedema in humans visualised by magnetic resonance imaging. Heart 2001; 85:639-42. [PMID: 11359743 PMCID: PMC1729755 DOI: 10.1136/heart.85.6.639] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To demonstrate postinfarction myocardial oedema in humans with particular reference to the longitudinal course, using magnetic resonance imaging (MRI). DESIGN Prospective observational study. Subjects were studied one week, one month, three months, six months, and one year after presenting with a myocardial infarct. SETTING Cardiology and magnetic resonance departments in a Danish university hospital. PATIENTS 10 patients (three women, seven men), mean (SEM) age 58.2 (3.20) years, with a first transmural myocardial infarct. MAIN OUTCOME MEASURES Location and duration of postinfarction myocardial oedema. RESULTS All patients had signs of postinfarction myocardial oedema. The magnetic resonance images were evaluated by two blinded procedures, employing two MRI and two ECG observers: (1) MRI determined oedema location was compared with the ECG determined site of infarction and almost complete agreement was found; (2) the time course of postinfarction myocardial oedema was explored semiquantitatively, using an image ranking procedure. Myocardial oedema was greatest at the initial examination one week after the infarction, with a gradual decline during the following months (Spearman's rank correlation analysis: rho(observer 1) = 0.94 (p < 0.0001) and rho(observer 2) = 0.97 (p < 0.0001)). The median duration of oedema was six months. CONCLUSIONS Postinfarction myocardial oedema seems surprisingly long lasting. This observation is of potential clinical interest because the oedema may have prognostic significance.
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Affiliation(s)
- J C Nilsson
- Danish Research Centre of Magnetic Resonance, H:S Hvidovre Hospital, University of Copenhagen, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark.
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Abstract
OBJECTIVES To characterize myocardial swelling in response to application of endocardial radio-frequency ablation lesions. BACKGROUND In individual patients, we have observed that ablation in the posterior right atrium was associated with echocardiographic evidence of atrial and contiguous right pulmonary vein wall swelling. METHODS 1. Human Subjects: "linear" ablation was performed in the posterior right atrium in 10 subjects; a portion of the ablation lesion was contiguous to the right pulmonary vein; this area was defined as the "contiguity zone". In the contiguity zone, right atrial wall thickness and pulmonary vein lumen diameter were measured utilizing intracardiac echocardiography. Measurements were made just prior to (baseline) and immediately after ablation.2. Porcine Subjects: linear ablation was performed in the posterior right atrium of 14 pigs. In the contiguity zone, atrial wall thickness, interstitial space thickness, right pulmonary vein wall thickness and lumen diameter were measured using intracardiac echocardiography. Measurements were made at baseline, immediately after ablation, and at 1, 4, 8 or 12 weeks after ablation (followup). Post-mortem pathologic evaluation of the contiguity zone was performed. RESULTS 1. Human Subjects: Immediately after ablation, relative to baseline right atrial wall thickness was significantly increased (9.4+/-3.1mm versus 5.4+/-1.5 mm) and right pulmonary vein lumen diameter was significantly decreased (6.2+/-2.9 mm versus 8.1+/-2.9 mm).2. Porcine Subjects: Immediately after ablation, right atrial wall thickness (4.1+/-1.2 mm), interstitial space thickness (1.9+/-1.1mm), and right pulmonary vein wall thickness (1.2+/-0.4 mm) were each significantly increased relative to baseline (1.0+/-0.3 mm, 0+/-0 mm, and 0.7+/-0.2 mm, respectively) and pulmonary vein lumen diameter was significantly decreased (5.0+/-1.4 mm versus 6.9+/-2.2 mm). Similar findings were made at the 1 week followup interval. At 4, 8 and 12 week followup intervals, thicknesses and lumen diameter were not significantly different from baseline. At post-mortem examination, direct measurements of wall thickness were significantly correlated with echocardiographic measurements. Histologic analysis demonstrated edema to be the cause of the early wall thickness and lumen diameter changes. Ablation lesions were transmural in the right atria of all animals; in some animals, lesion formation was also observed in the pulmonary vein wall. CONCLUSIONS Cardiac edema resulting from right atrial linear ablation results in swelling of atrial and contiguous right pulmonary vein walls, as well as the interposed extracardiac interstitial space. These changes are associated with a decrease in pulmonary vein lumen diameter. Swelling evolves rapidly and resolves within 4 weeks.
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Affiliation(s)
- D Schwartzman
- Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, PA, USA.
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Abstract
The various options for treatment of diuretic-resistant edema in heart failure and report on their experience with on line bicarbonate daily hemofiltration (135 min) in 16 patients with congestive heart failure IV class NYHA is discussed. The outcome was excellent. Only 6 patients died. Survival averaged 25 weeks in 4 patients. A total of 6 patients are still alive on dialysis after 18 to 52 weeks.
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Affiliation(s)
- L Iorio
- Division of Nephrology and Dialysis, G. De Bosis Hospital, Cassino, Italy
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Blankfield RP, Hudgel DW, Tapolyai AA, Zyzanski SJ. Bilateral leg edema, obesity, pulmonary hypertension, and obstructive sleep apnea. Arch Intern Med 2000; 160:2357-62. [PMID: 10927734 DOI: 10.1001/archinte.160.15.2357] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pulmonary hypertension is usually due to an underlying cardiac or pulmonary condition. An association between unexplained pulmonary hypertension and bilateral leg edema in primary care patients was found previously. We undertook this study to identify the frequency of obstructive sleep apnea (OSA) in ambulatory, adult patients with pulmonary hypertension who initially presented with bilateral leg edema. METHODS Twenty ambulatory adults with bilateral leg edema, echocardiocardiographic evidence of pulmonary hypertension (estimated pulmonary artery systolic pressure >30 mm Hg) without left ventricular dysfunction, and no clinically apparent pulmonary disease [corrected] were enrolled from a suburban family practice and an inner-city family practice during a 3-year period. Spirometric assessment, pulse oximetry, rheumatologic evaluation, polysomnography, and questionnaire information regarding risk factors for pulmonary hypertension were obtained for each subject. RESULTS Fifteen patients (75%) completed the study. Almost all of the subjects were obese. Nine (60%) of the 15 had OSA. None of the subjects demonstrated an obstructive pattern on spirometric evaluation results, but 9 (60%) had a restrictive spirometry pattern, consistent with their obesity. None of the subjects had daytime hypoxemia. Systemic hypertension was present in two-thirds of the subjects with OSA, and was absent in all of the subjects who lacked OSA. CONCLUSIONS Bilateral leg edema in obese primary care patients is associated with both OSA and modest pulmonary hypertension. If these findings are generalizable, then bilateral leg edema may be an important clinical marker for underlying OSA.
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Affiliation(s)
- R P Blankfield
- University Hospitals Primary Care Physician Practice, Williamsport Plaza, Berea, OH 44017, USA
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Affiliation(s)
- D L Mann
- Department of Medicine, Baylor College of Medicine and Houston Veterans Administration Medical Center, TX 77030, USA
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Niebauer J, Volk HD, Kemp M, Dominguez M, Schumann RR, Rauchhaus M, Poole-Wilson PA, Coats AJ, Anker SD. Endotoxin and immune activation in chronic heart failure: a prospective cohort study. Lancet 1999; 353:1838-42. [PMID: 10359409 DOI: 10.1016/s0140-6736(98)09286-1] [Citation(s) in RCA: 586] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Immune activation in patients with chronic heart failure may be secondary to endotoxin (lipopolysaccharide) action. We investigated the hypothesis that altered gut permeability with bacterial translocation and endotoxaemia would be increased in patients with oedema secondary to congestive heart failure. METHODS We compared 20 patients who had chronic heart failure with recent-onset peripheral oedema (mean age 64 years [SD 10], New York Heart Association [NYHA] class 3.3 [0.7]), 20 stable non-oedematous patients with chronic heart failure (mean age 63 years [19], NYHA class 2.6 [0.7]), and 14 healthy volunteers (mean age 55 years [16]). Biochemical markers of endotoxaemia, inflammation, and immune activation were measured. Ten patients were studied within 1 week of complete resolution of oedema. Five patients survived longer than 6 months and were restudied again after remaining free of oedema for more than 3 months. FINDINGS Mean endotoxin concentrations were higher in oedematous patients with chronic heart failure than in stable patients with chronic heart failure (0.74 [SD 0.45] vs 0.37 EU/mL [0.23], p=0.0009) and controls (0.46 EU/mL [0.21], p=0.02). Oedematous patients had the highest concentrations of several cytokines. After short-term diuretic treatment, endotoxin concentrations decreased from 0.84 EU/mL [0.49] to 0.45 EU/mL [0.21], p<0.05) but cytokines remained raised. After freedom of oedema for more than 3 months after oedema resolved, endotoxin concentrations remained unchanged from the previous visit (0.49 EU/mL [0.06], p=0.45). INTERPRETATION Raised concentrations of endotoxin and cytokines are found in patients with chronic heart failure during acute oedematous exacerbation. Intensified diuretic treatment can normalise endotoxin concentrations. Our preliminary findings suggest that endotoxin may trigger immune activation in patients with chronic heart failure during oedematous episodes.
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Affiliation(s)
- J Niebauer
- Cardiac Medicine, National Heart and Lung Institute, Imperial College School of Medicine, London, UK
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