Clinical outcomes of calcified nodules detected by optical coherence tomography: a sub-analysis of the CLIMA study.
- 作者列表："Prati F","Gatto L","Fabbiocchi F","Vergallo R","Paoletti G","Ruscica G","Marco V","Romagnoli E","Boi A","Fineschi M","Calligaris G","Tamburino C","Crea F","Ozaki Y","Alfonso F","Arbustini E
AIMS:The goal of the present post hoc analysis of the CLIMA registry was to establish the relationship between calcified nodules (CNs) with (CND) or without (CNWD) disruption of the superficial intimal fibrous layer and one-year occurrence of target lesion myocardial infarction (MI) and/or cardiac death. METHODS AND RESULTS:CND and CNWD were identified based on the presence or absence of superficial irregularities indicative of disruption of the intimal fibrous layer, with possible overlying local thrombus. In total, 222 CNs were found in the 1,776 non-culprit LAD plaques. CND had larger maximum calcific arc and smaller lumen area. Cardiac death and MI occurred in 20% of patients in the CND group versus 2.7% in the CNWD group and 3.3% in the group without CN (p<0.001). This figure was mainly due to the 13.3% incidence of cardiac death in the CND group versus 2.0% in the CNWD group and versus 2.2% in the group without CN (p<0.001). The presence of CND was confirmed as an independent predictor of events (HR 6.58, 95% CI: 2.7-15.8, p<0.001). CONCLUSIONS:The presence of CND was associated with a high one-year incidence of cardiac death and/or target lesion MI.
目的: 目前CLIMA登记的事后分析的目的是建立钙化结节 (CNs) 与 (CND) 或不破坏 (CNWD) 浅表内膜纤维层和一年靶病变心肌梗死 (MI) 和/或心源性死亡之间的关系。 方法和结果: CND和CNWD是基于存在或不存在指示内膜纤维层破裂的表面不规则性 (可能覆盖局部血栓) 来鉴定的。在222个非罪犯LAD斑块中总共发现1,776个CNs。CND最大钙化弧较大，管腔面积较小。CND组20% 的患者发生心源性死亡和MI，CNWD组为2.7%，无CN组为3.3% (p<0.001)。这一数字主要是由于CND组心源性死亡的发生率为13.3%，CNWD组为2.0%，无CN组为2.2% (p<0.001)。CND的存在被证实是事件的独立预测因素 (HR 6.58，95% CI: 2.7-15.8，p<0.001)。 结论: CND的存在与心源性死亡和/或靶病变MI的一年高发生率相关。
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.