Reference values for mid-diastolic right ventricular volume in population referred for cardiac computed tomography: An additional diagnostic value to cardiac computed tomography.
- 作者列表："Massalha S","Almufleh A","Walpot J","Ratnayake I","Qureshi R","Abbass T","Pena E","Inacio J","Rybicki FJ","Small G","Crean A","Chow BJW
BACKGROUND:While an assessment of the right ventricular (RV) size remains challenging, the entire RV is can be imaged on coronary computed tomography angiography (CCTA) studies. With prospective ECG-triggering, the RV end diastolic volume (RVEDV) cannot be measured; however, the RV mid-diastolic volume (RVMDV) can still be measured accurately from routine CCTA data sets. The objective of this study is to establish normal reference values for RVMDV. METHODS:Right ventricular mid-diastolic volumes were measured in 4855 consecutive patients undergoing prospectively ECG-triggered coronary CTA. All patients with known cardiac or pulmonary disease (coronary artery disease, myocardial infarction, revascularization, heart failure, pulmonary hypertension, congenital heart disease, valvular heart disease, atrial fibrillation, implantable cardiac defibrillator implantation, cardiac transplant, or cardiac surgery) or smoking history (3313 patients) were excluded. RESULTS:1542 patients were analyzed (mean age 56.4 ± 11.1 years, mean BSA 1.96 ± 0.26 and 47% male). The mean RVMDV for men and women was 168.6 ± 37.6 mL and 117.6 ± 26.4 mL, respectively. Mean BSA-indexed RVMDV was 80.0 ± 15.3 mL/m2 and 64.1 ± 12.2 mL/m2 for men and women, respectively. The presence of hypertension and diabetes did not have an impact on these values. RVMDV and BSA-indexed RVMDV were lower in women and in older individuals. CONCLUSION:Normal reference ranges for RVMDV were established using prospectively ECG-triggered coronary CTA studies. This data can be used to identify patients with abnormal RV volumes and potentially RV dysfunction, adding incremental diagnostic value to routine CCTA studies.
背景: 虽然右心室 (RV) 大小的评估仍然具有挑战性，但整个RV可以在冠状动脉计算机断层扫描血管造影 (CCTA) 研究中成像。使用前瞻性ECG触发，不能测量RV舒张末期容积 (RVEDV); 然而，仍然可以从常规CCTA数据集准确地测量RV舒张中期容积 (RVMDV)。本研究的目的是建立RVMDV的正常参考值。 方法: 对4855例接受前瞻性心电图触发冠状动脉CTA的患者测量右心室舒张中期容积。排除所有已知有心脏或肺部疾病 (冠状动脉疾病、心肌梗死、血运重建、心力衰竭、肺动脉高压、先天性心脏病、瓣膜性心脏病、心房颤动、植入式心脏除颤器植入、心脏移植或心脏手术) 或吸烟史的患者 (3313例患者)。 结果: 分析了1542例患者 (平均年龄56.4 ± 11.1岁，平均BSA 1.96 ± 0.26和47% 男性)。男性和女性的平均RVMDV分别为168.6 ± 37.6 mL和117.6 ± 26.4 mL。男性和女性的平均BSA指数RVMDV分别为80.0 ± 15.3 mL/m2和64.1 ± 12.2 mL/m2。高血压和糖尿病的存在对这些值没有影响。RVMDV和BSA指数RVMDV在女性和老年个体中较低。 结论: 使用前瞻性ECG触发的冠状动脉CTA研究建立了RVMDV的正常参考范围。该数据可用于识别具有异常RV体积和潜在RV功能障碍的患者，为常规CCTA研究增加了增量诊断价值。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.