Non ECG gated supine to prone left ventricular volume ratio: a novel marker for myocardial ischemia.
- 作者列表："Yew MS","Ong WSJ","Ong SJJ
:Transient ischemic dilation (TID), a marker of severe coronary artery disease (CAD), is the post-stress to rest left ventricular (LV) volume ratio quantified using non ECG gated single photon emission computerized tomography (SPECT). Although prone positioning causes physiological reduction of LV volume in normal subjects, we hypothesize this may not occur in TID with underlying severe CAD as cardiac hemodynamics worsen when prone. We aim to evaluate the utility of the non ECG gated supine to prone LV volume ratio (SPLVr) for identifying severe CAD. Retrospective data analysis from 130 patients with TID ratio ≥ 1.21 and both post-stress supine and prone images. SPLVr had a significant negative correlation with summed stress (r = - 0.221, p = 0.011) and rest (r = - 0.292, p = 0.001) scores. Of the 129 cases with follow-up invasive or computed tomography coronary angiography, 52 (40.3%) had severe CAD (left main ≥ 50% stenosis, 3-vessel with ≥ 70% stenosis or 2-vessel with proximal left anterior descending ≥ 70% stenosis). Mean SPLVr was significantly lower in severe CAD cases (1.05 ± 0.14 vs 1.12 ± 0.17, p = 0.012). SPLVr predicted severe CAD on univariate [OR 0.12 (95% CI 0.00-0.35) p = 0.01] but not in multivariate analysis. SPLVr is a novel marker that negatively correlates with extent of perfusion abnormalities and is lower amongst TID patients with severe CAD. Larger studies are needed to assess if SPLVr can reliably identify underlying severe CAD amongst TID cases.
: 短暂性缺血性扩张 (TID) 是严重冠状动脉疾病 (CAD) 的标志物，是使用非ECG门控单光子发射计算机断层扫描 (SPECT) 定量的应力后与静息左心室 (LV) 体积比。尽管在正常受试者中俯卧位导致LV体积的生理性减少，我们假设这可能不会发生在具有潜在的严重CAD的TID中，因为当俯卧时心脏血流动力学恶化。我们的目的是评估非ECG门控仰卧至俯卧LV容积比 (SPLVr) 用于识别严重CAD的效用。回顾性分析130例TID比率 ≥ 1.21的患者的资料，并同时进行应激后仰卧位和俯卧位图像。SPLVr与压力 (r = - 0.221，p = 0.011) 和休息 (r = - 0.292，p = 0.001) 总分呈显著负相关。在随访的129例有创或计算机断层扫描冠状动脉造影中，52例 (40.3%) 患有重度CAD (左主干 ≥ 50% 狭窄，3支血管 ≥ 70% 狭窄或2支血管近端左前降支 ≥ 70% 狭窄)。严重CAD病例的平均SPLVr显著较低 (1.05 ± 0.14 vs 1.12 ± 0.17，p = 0.012)。单变量 [OR 0.12 (95% CI 0.00-0.35) p = 0.01] 预测严重CAD，但在多变量分析中没有。SPLVr是一种新的标志物，其与灌注异常的程度负相关，并且在患有严重CAD的TID患者中较低。需要更大规模的研究来评估SPLVr是否能够在TID病例中可靠地识别潜在的严重CAD。
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.