Comparison Between Anatomical and Functional Imaging Modalities for Evaluation of Chest Pain in the Emergency Department.
- 作者列表："Kargoli F","Levsky J","Bulcha N","Mustehsan MH","Brown-Manhertz D","Furlani A","Polanco D","Mizrachi S","Makkiya M","Golive A","Haramati L","Taub C","Garcia MJ
:Evaluation of chest pain in the emergency department (ED) frequently employs a noninvasive strategy, including coronary computed tomography angiography (CCTA), stress echocardiography (SE), or myocardial perfusion imaging (MPI). We sought to report the real-world experience of utilizing CCTA compared with SE and MPI at an urban hospital ED. We conducted a retrospective cohort study of consecutively enrolled patients presenting with chest pain who had normal or nondiagnostic electrocardiogram (ECG), negative initial troponin-T, at least intermediate risk based on modified Diamond-Forrester criteria, and who underwent CCTA, SE, or MPI based on their individual test eligibility criteria. The primary outcome was ED discharge time. Secondary outcomes included test utilization and 30-days rehospitalization rates. The 2,143 patients who were included (mean age was 56 ± 12 years; 55% women) utilization rate (test performed/eligible) was lower for CCTA (n = 354/1,329) and MPI (n = 530/1,435) compared with SE (n = 1,259/1,650), p <0.001. Mean ED discharge times for both CCTA and SE were 12.5 ± 7.4 versus 16 ± 7.3 hours for MPI (p <0.0001). Patients with SE and CCTA were less likely to undergo coronary angiography (29%, 25%, vs 52% for MPI). There was a 1% cardiac-related 30-days rehospitalization rate in the CCTA group versus 1% in SE and 3% in the MPI group (p <0.01). In conclusion, CCTA and SE were associated with faster ED discharge and lower frequency of diagnostic coronary angiography. Notwithstanding its clinical utility, CCTA was underutilized at our large urban ED setting.
: 急诊科 (ED) 中胸痛的评估经常采用无创策略，包括冠状动脉计算机断层扫描血管造影 (CCTA) 、负荷超声心动图 (SE) 或心肌灌注成像 (MPI)。我们试图报告在城市医院ED中使用CCTA与SE和MPI相比的真实世界经验。我们对连续入选的胸痛患者进行了一项回顾性队列研究，这些患者心电图 (ECG) 正常或非诊断性，初始肌钙蛋白-T阴性，根据改良的Diamond-Forrester标准至少有中等风险，并根据其个体测试资格标准接受了CCTA，SE或MPI.主要结局为ED出院时间。次要结局包括试验使用率和30天再住院率.纳入的2,143例患者 (平均年龄为56 ± 12岁; 55% 例女性) 与SE (n = 354/1/329) 相比，CCTA (n = 530/1，435) 和MPI (n = 1,259，1,650) 的使用率 (进行/符合条件的测试) 较低，p <0.001。CCTA和SE的平均ED放电时间分别为12.5 ± 7.4和MPI的16 ± 7.3小时 (p <0.0001)。SE和CCTA患者不太可能接受冠状动脉造影 (29%，25%，与MPI的52% 相比)。CCTA组心脏相关30天再住院率为1%，SE组为1%，MPI组为3% (p <0.01)。总之，CCTA和SE与更快的ED放电和更低的诊断性冠状动脉造影频率相关。尽管其临床实用性，但CCTA在我们的大型城市ED环境中未被充分利用。
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.