Comparative effect of iso-osmolar versus low-osmolar contrast media on vascular attenuation, image quality, and heart rate changes in coronary CT angiography: A systematic review and meta-analysis.
- 作者列表："Alhelaly MM","Abdelhakim AM","Ellotf H","Khaled A","Soliman AM","Attia MM
OBJECTIVES:Comparison of iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) for vascular attenuation, image quality, heart rate changes, and common patient discomfort symptoms. METHODS:We searched PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL). We included only randomized controlled trials. Screening, data extraction, and quality assessment were done by three independent authors. RevMan 5.3 software was used for meta-analysis. RESULTS:Nine studies (n = 1831 participants) were found eligible and included in the meta-analysis. There was no difference between the both contrast media for vascular attenuation (mean difference = -21.31; 95% confidence interval -49.81 to 7.19; p = 0.14), image quality (standardized mean difference = 0.13; 95% confidence interval -0.07 to 0.33; p = 0.19), heart rate variability (standardized mean difference = -0.61; 95% confidence interval -1.30 to 0.09; p = 0.09), heat sensation (risk ratio = 0.79; 95% confidence interval 0.56 to 1.11; p = 0.17), and nausea or vomiting (risk ratio = 0.82; 95% confidence interval 0.52 to 1.28; p = 0.38). Moreover, IOCM resulted in a heart rate that was lower by 0.9 beat per minute (bpm) compared to LOCM (mean difference = -0.92; 95% confidence interval -1.81 to -0.03; p = 0.04). CONCLUSIONS:Both IOCM and LOCM have similar vascular enhancement, image quality, heart rate variability, and similar risk for patient discomfort. Furthermore, IOCM resulted in a slightly lower heart rate by 0.9 bpm.
目的: 比较等渗造影剂 (IOCM) 和低渗造影剂 (LOCM) 对血管衰减、图像质量、心率变化和常见患者不适症状的影响。 方法: 我们检索了PubMed、Web of Science、Scopus和Cochrane中心对照试验注册中心 (Central)。我们只纳入随机对照试验。筛选、数据提取和质量评估由3位独立作者完成。采用RevMan 5.3软件进行meta分析。 结果: 发现9项研究 (n = 1831名参与者) 符合条件并纳入荟萃分析。对于血管衰减 (平均差 = -21.31; 95% 置信区间-49.81至7.19; p = 0.14)，图像质量 (标准化平均差 = 0.13; 95% 置信区间-0.07至0.33; p = 0.19)，心率变异性 (标准化平均差 = -0.61;95% 置信区间-1.30至0.09; p = 0.09)，热感 (风险比 = 0.79; 95% 置信区间0.56至1.11; p = 0.17) 和恶心或呕吐 (风险比 = 0.82; 95% 置信区间0.52至1.28; p = 0.38)。此外，与LOCM相比，IOCM导致心率降低0.9次/分钟 (bpm) (平均差 = -0.92; 95% 置信区间-1.81至-0.03; p = 0.04)。 结论: IOCM和LOCM具有相似的血管增强、图像质量、心率变异性和相似的患者不适风险。此外，IOCM导致0.9 bpm的心率略微降低。
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.