- 作者列表："Linde JJ","Kelbæk H","Hansen TF","Sigvardsen PE","Torp-Pedersen C","Bech J","Heitmann M","Nielsen OW","Høfsten D","Kühl JT","Raymond IE","Kristiansen OP","Svendsen IH","Vall-Lamora MHD","Kragelund C","de Knegt M","Hove JD","Jørgensen T","Fornitz GG","Steffensen R","Jurlander B","Abdulla J","Lyngbæk S","Elming H","Therkelsen SK","Jørgensen E","Kløvgaard L","Bang LE","Hansen PR","Helqvist S","Galatius S","Pedersen F","Abildgaard U","Clemmensen P","Saunamäki K","Holmvang L","Engstrøm T","Gislason G","Køber LV","Kofoed KF
BACKGROUND:In patients with non-ST-segment elevation acute coronary syndrome (NSTEACS), coronary pathology may range from structurally normal vessels to severe coronary artery disease. OBJECTIVES:The purpose of this study was to test if coronary computed tomography angiography (CTA) may be used to exclude coronary artery stenosis ≥50% in patients with NSTEACS. METHODS:The VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes) trial (NCT02061891) evaluated the outcome of patients with confirmed NSTEACS randomized 1:1 to very early (within 12 h) or standard (48 to 72 h) invasive coronary angiography (ICA). As an observational component of the trial, a clinically blinded coronary CTA was conducted prior to ICA in both groups. The primary endpoint was the ability of coronary CTA to rule out coronary artery stenosis (≥50% stenosis) in the entire population, expressed as the negative predictive value (NPV), using ICA as the reference standard. RESULTS:Coronary CTA was conducted in 1,023 patients-very early, 2.5 h (interquartile range [IQR]: 1.8 to 4.2 h), n = 583; and standard, 59.9 h (IQR: 38.9 to 86.7 h); n = 440 after the diagnosis of NSTEACS was made. A coronary stenosis ≥50% was found by coronary CTA in 68.9% and by ICA in 67.4% of the patients. Per-patient NPV of coronary CTA was 90.9% (95% confidence interval [CI]: 86.8% to 94.1%) and the positive predictive value, sensitivity, and specificity were 87.9% (95% CI: 85.3% to 90.1%), 96.5% (95% CI: 94.9% to 97.8%) and 72.4% (95% CI: 67.2% to 77.1%), respectively. NPV was not influenced by patient characteristics or clinical risk profile and was similar in the very early and the standard strategy group. CONCLUSIONS:Coronary CTA has a high diagnostic accuracy to rule out clinically significant coronary artery disease in patients with NSTEACS.
背景: 在非ST段抬高型急性冠状动脉综合征 (NSTEACS) 患者中，冠状动脉病变可能从结构正常的血管到严重的冠状动脉疾病。 目的: 本研究的目的是测试冠状动脉计算机断层扫描血管造影 (CTA) 是否可用于排除NSTEACS患者中冠状动脉狭窄 ≥ 50%。 方法: 结论 (在急性冠状动脉综合征患者中使用计算机断层扫描进行非常早期与延迟侵入性评估) 试验 (NCT02061891) 评估了1:1随机分配至非常早期 (12小时内) 或标准 (48至72小时) 侵入性冠状动脉造影 (ICA) 的确诊NSTEACS患者的结果。作为试验的观察部分，两组在ICA之前进行临床盲法冠状动脉CTA。主要终点是冠状动脉CTA在整个人群中排除冠状动脉狭窄 (≥ 50% 狭窄) 的能力，以阴性预测值 (NPV) 表示，使用ICA作为参考标准。 结果: 在1,023例患者中进行了冠状动脉CTA检查-早期，2.5 h (四分位距 [IQR]: 1.8 ~ 4.2 h)，n = 583; 标准，59.9 h (IQR: 38.9 ~ 86.7 h); NSTEACS诊断后n = 440。冠状动脉CTA发现冠状动脉狭窄 ≥ 50% 的患者占68.9%，ICA发现冠状动脉狭窄 ≥ 67.4%.冠状动脉CTA的每个患者NPV为90.9% (95% 置信区间 [CI]: 86.8% 至94.1%)，阳性预测值、灵敏度和特异性分别为87.9% (95% CI: 85.3% 至90.1%) 、96.5% (95% CI: 94.9% 至97.8%) 和72.4% (95% CI: 67.2% 至77.1%)，分别NPV不受患者特征或临床风险状况的影响，并且在早期和标准策略组中相似。 结论: 在NSTEACS患者中，冠状动脉CTA对排除有临床意义的冠心病具有较高的诊断准确性。
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.