1,720,994 research outputs found
Aortic elasticity indices by magnetic resonance predict progression of ascending aorta dilation
No full textObjectives: Aortic distensibility and pulse-wave velocity (PWV) are under investigation as parameters by which to evaluate the indication for ascending aorta (AA) replacement. The maximum rate of systolic distension (MRSD) was proposed as a new index of aortic elasticity. The aim of this study was to assess the role of aortic elasticity parameters to predict AA growth rates in patients with AA dilation (AAD). Methods: Magnetic resonance imaging (MRI) was performed annually in 65 patients with AA dilation (median follow-up 17 months; 25–75th percentile; range 12–30 months). A significant increase in AA diameter was defined as a ≥2-mm increase. Results: An increase in AA diameter was found in 42 (68 %) patients (AAD+ group) and absent in 20. Median increase was 0.16 (25–75th percentile; range 0.32–0.7) mm/month. The AAD+ group had a lower MRSD (4.6 ± 2.2 vs 7.4 ± 2.0, p < 0.001) but the same PWV and distensibility. MRSD showed 93.7 % specificity and 75.6 % sensitivity for prediction of increase. Patients with MRSD ≤ 6 had lower progression-free survival times (p < 0.002). After a follow-up of 4.1 years, patients who underwent surgical therapy had lower MRSD and distensibility than others. Conclusions: MRSD is an index of aorta elastic properties and is a valuable predictor for progression in AAD. Key Points: • MRI-derived parameters of aortic wall elasticity predict progression of ascending aorta dilation.• Maximal rate of systolic distension (MRSD) was the best predictor of progression.• Patients with MRSD ≤ 6 had lower progression-free survival (PFS) times.• Patients who underwent surgical therapy had lower MRSD and distensibility.• MRI-derived parameters identify patients with fast progression of Ascending Aorta Dilation
Role of stress echocardiography in operated fallot: feasibility and detection of right ventricular response
No full textPatients with repaired tetralogy of Fallot often present residual hemodynamic abnormalities leading to right ventricular (RV) burden. Semisupine exercise echocardiography (Ex-Echo) is a validated method for diagnosis and prognosis in ischemic and valvular heart diseases and has potential for the evaluation of RV burden, pressure, and function. The aims of this study were to assess the effect of exercise on the right ventricle in adults with repaired tetralogy of Fallot and to identify factors associated with decreased RV function at peak exercise in an observational study
Usefulness of Combined Functional Assessment by Cardiac Magnetic Resonance and Tissue Characterization Versus Task Force Criteria for Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy
No full textCurrent task force criteria (TFC) of cardiac magnetic resonance (CMR) for the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC/D) were generated by comparing probands (mean age of 44 years) to healthy participants of the multi-ethnic study of atherosclerosis (mean age of 60 years). These age differences may be a selection bias because right ventricular end-diastolic volume index decreases 4.6% per decade. Moreover, fat infiltration and late gadolinium enhancement were not included. We evaluated the diagnostic accuracy of TFC using the same methodology used by the task force but comparing probands and age- and gender-matched healthy controls and considering also other morphofunctional and tissue abnormalities detected by CMR. Forty-seven probands with previous diagnosis of ARVC/D (excluding probands if CMR was used for diagnosis) were compared with 216 age- and gender-matched healthy controls. TFC had optimal specificity (100%) but poor sensitivity (20% for major and 13% for minor criteria). The presence of any pre- and post-contrast signal abnormalities had 100% specificity and 81% sensitivity. The best diagnostic accuracy (98%) was achieved by the combined evaluation of any right ventricular wall motion abnormality (excluding hypokinesia) with any signal abnormality (including left ventricular fat infiltration and late gadolinium enhancement) yielding a 100% specificity and 96% sensitivity. Left ventricular was involved in 45% of the probands. Current TFC for CMR presented optimal specificity but poor sensitivity to identify patient with ARVC/D. Signal and wall motion parameters of CMR should be considered together to achieve the best diagnostic accuracy for the diagnosis of ARVC/D
Effective Cardiac Index and Systemic-Pulmonary Collaterals Evaluated by Cardiac Magnetic Resonance Late After Fontan Palliation
No full textThe regulation of cardiac output in the Fontan circuit is not completely understood. Systemic-pulmonary collaterals (SPCs) are frequent in patients with univentricular heart, and their clinical significance and management remain controversial. The aims of our study were to identify factors associated with SPCs' flow at late follow-up after Fontan and evaluate the relation between SPCs flow (QSPCs) and the effective cardiac index (CI). From our cardiac magnetic resonance database, we identified all Fontan patients with a complete set of flow measurements allowing calculation of QSPCs and effective CI. QSPCs was calculated as (left pulmonary veins flow + right pulmonary veins flow) â (right pulmonary artery flow + left pulmonary artery flow). Effective CI was calculated as (Aortic flow (QAo) â QSPCs)/BSA. Medical, surgical history, and clinical status were recorded. Sixty-four post-Fontan patients (36 male; mean age 19 ± 10 years) were included in the study. Median QSPCs was 0.7 L/min/m2 (interquartile [IQ] range 0.386â0.983) accounting for a median of 21% (IQ range 13â28) of aortic flow. The effective CI in our population was 2.4 ± 0.6 L/min/m2. QSPCs inversely correlate with left pulmonary artery area (r = â0.37, p = 0.004) and total antegrade pulmonary flow (r = â0.32, p = 0.01). QSPCs correlate with indexed aortic flow (r = 0.6, p <0.001) and inversely correlate with effective CI (r = â0.39, p = 0.002). Effective CI inversely correlates with age at study and age at the Fontan palliation (r = â0.35, p = 0.005, and r = â0.29, p = 0.02, respectively) and positively with ventricular ejection fraction (r = 0.3, p = 0.01). In conclusion, SPCs are common in Fontan patients, correlate inversely with effective CI, and are associated with a reduced antegrade pulmonary flow. In cardiac magnetic resonance evaluation of post-Fontan patients, effective CI should be taken into account rather than the total CI
Implications of atrial volumes in surgical corrected Tetralogy of Fallot on clinical adverse events
No full textBackground: While left atrial (LA) size has been shown as a strong predictor of cardiovascular diseases in various studies, the role of right atrial (RA) enlargement, especially in the growing population of patients with congenital heart diseases (CHD) is largely unknown. We sought to evaluate (1) RA and LA volumes in patients with repaired Tetralogy of Fallot (TOF) and assess correlations to (2) functional parameters and (3) clinical adverse events. Methods: 169 patients with repaired TOF were enrolled following a targeted protocol for Cardiovascular magnetic resonance imaging (CMR), Cardiopulmonary exercise tests (CPET), Echocardiography and Measurement of NT-proBNP. Clinical history was assessed at enrollment and during a median Follow-up of 23 months (IQR 9–40). The primary clinical endpoint was a composite of all cause mortality, aborted sudden cardiac death and sustained VT. Prespecified secondary surrogate endpoint included worsening heart failure (NYHA III–IV), non-sustained VT and sustained supraventricular tachycardia. Results: RA Systolic indexed volume (RASVi) correlated with LA Systolic indexed volume (LASVi) (r = 0.59, p 58 ml/m 2 ) had higher NT-proBNP levels, longer QRS duration, larger ventricle diameters, higher RV mass and lower peak oxygen uptake. RASVi was associated with the primary composite adverse event at univariate Cox-regression analysis (HR: 1.044, CI: 1.008–1.08, p = 0.01). Bayesian Multivariate model averaging revealed RASVi as predictor of secondary surrogate adverse outcome (HR: 1.06, CI: 1.053–1.068, Pb = 0,889). Conclusion: Among patients with repaired TOF, RA dilatation is an independent predictor for adverse clinical events. As such, routine assessment of RA volumes could be useful to further improve decision-making and management of these patients in the future
Advanced Cardiac Magnetic Resonance Parameters in Repaired Tetralogy of Fallot: Association Between Native T1 Mapping, Pulmonary Transit Time, and Pulmonary Blood Volume
No full textThe management of patients with repaired Tetralogy of Fallot (rToF) remains challenging due to the complex spectrum of residual lesions and long-term complications. Cardiac magnetic resonance (CMR) has emerged as an accurate and indispensable tool for evaluating ventricular morphology, function, and hemodynamics. Beyond traditional CMR parameters, increasing attention is being directed toward its role in tissue characterization and the hemodynamic insights it may provide. T1 mapping, a CMR technique that quantifies the intrinsic myocardial T1 relaxation time on a pixel-by-pixel basis, has the potential to detect diffuse structural alterations in the myocardium. Pulmonary transit time (PTT) is a novel CMR measure defined as the time required for blood to travel from the right ventricle to the left atrium through the pulmonary vasculature. Pulmonary blood volume (PBV), representing the volume of blood within the pulmonary vasculature, is calculated as the product of PTT and the pulmonary artery stroke volume.
The primary aim of our study was to assess T1 mapping in a cohort of patients with rToF and its correlation with PTT and PBV, in addition to classical CMR and clinical parameters, to determine whether widespread structural alterations in the left ventricular myocardium, contribute to hemodynamic changes.
La gestione dei pazienti con Tetralogia di Fallot riparata (rToF) rimane complessa a causa dello spettro di lesioni residue e delle complicanze a lungo termine. La risonanza magnetica cardiaca (CMR) è emersa come uno strumento preciso e indispensabile per la valutazione della morfologia ventricolare, della funzione e dell’emodinamica. Oltre ai parametri tradizionali della CMR, si sta dando sempre maggiore attenzione al suo ruolo nella caratterizzazione tissutale e alle informazioni emodinamiche che può fornire. Il T1 mapping, una tecnica CMR che quantifica il tempo di rilassamento intrinseco T1 del miocardio su base pixel per pixel, ha il potenziale di rilevare alterazioni strutturali diffuse nel miocardio. Il tempo di transito polmonare (PTT) è una misura innovativa della CMR definita come l'intervallo di tempo necessario affinché il flusso sanguigno raggiunga l'atrio sinistro dal ventricolo destro attraverso la vascolarizzazione polmonare. Il volume ematico polmonare (PBV), che rappresenta il volume di sangue polmonare, viene calcolato come il prodotto di PTT e del volume di eiezione dell'arteria polmonare. L'obiettivo primario del nostro studio è stato quello di valutare il T1 mapping in una coorte di 140 pazienti adulti con rToF e la sua correlazione con PTT e PBV, oltre ai parametri classici di CMR e clinici, per determinare se le alterazioni strutturali diffuse nel miocardio del ventricolo sinistro contribuiscano alle alterazioni emodinamiche
Cardiac Magnetic Resonance Evaluation of Pulmonary Transit Time and Blood Volume in Adult Congenital Heart disease
No full textBackground: Management of adults with repaired congenital heart disease (CHD) is still challenging. Heart failure secondary to residual anatomical sequels or arrhythmic events is not rare in this population. MRI has emerged as an accurate tool to quantify pulmonary transit time (PTT) of intravenous contrast agents and pulmonary blood volume (PBV). Purpose: To determine the relationship between PTT, and conventional indexes of ventricular dysfunction and heart failure in a cohort of adults with CHD and to assess its association with adverse outcomes. Study Type: Retrospective. Subjects: 89 adult CHD patients (56 males, age 34 ± 11 years) and 14 age- and sex-matched healthy subjects. Field Strength/Sequence: First-pass perfusion and standard sequences for ventricular volumes and function and flow analysis at 1.5T. Assessment: PTT was calculated as the time required for a bolus of contrast agent to pass from the right ventricle to the left atrium, expressed both in seconds (PTTS) and number of heartbeats (PTTB). The pulmonary blood volume index (PBVI) was measured by the product of PTTB and the pulmonary artery stroke volumes. Statistical Tests: Student's independent t-test analysis of variance (ANOVA) and Mann–Whitney nonparametric; Pearson's or Spearman's correlation; Kaplan–Meier method. Results: PTTS and PTTB were significantly higher in patients than in controls (7.6 ± 3 vs. 5.6 ± 1.2 sec, P = 0.01 and 8 ± 3 vs. 6 ± 1 bpm, P = 0.01, respectively). PTTS showed negative correlation with left ventricle ejection fraction (LVEF) and cardiac index (CI) (r = –0.3, P = 0.004, and r = –0.4, P 8 bpm was associated with significant increased risk of adverse outcome at mid-term follow-up. Moreover, patients with both increased PTTB and PBV have higher amino-terminal portion of the prohormone brain natriuretic peptide (NT-proBNP) and lower LVEF. Data Conclusion: PTT is prolonged in adult CHD in comparison with healthy subjects, likely reflecting reduced CI and ventricular dysfunction. Level of Evidence: 3. Technical Efficacy: Stage 3. J. Magn. Reson. Imaging 2019
The different surgical impact of the superior cavoatrial incision in children and adults
No full textIntroduction:The single- and double-patch repairs are undoubtedly the most commonly used techniques for the surgical management of partial anomalous pulmonary venous connection associated with sinus venosus atrial septal defect. The aim of this study was to retrospectively compare early and long-term surgical outcomes in paediatric and adult patients, focusing in particular on the occurrence of ectopic atrial rhythm.Material and methods:Seventy patients (male: 38, 54.2%) underwent surgical repair for partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. Forty-nine patients (70%) underwent surgical repair in paediatric age (<16 years old), while 21 of (30%) patients were operated in adulthood. Thirty patients (42.8%) underwent single-patch repair and 39 patients (55.7%) underwent double-patch repair. In only one patient, the Warden procedure was performed (1.4%). Median follow-up time was 52 months (IQ 15.1-113).Results:The type of surgical technique didn't affect the incidence of ectopic atrial rhythm (26.6% in single-patch group and 25.6% in double-patch groups, p = 0.9). At long-term follow-up, ectopic atrial rhythm, as an expression of sinoatrial node disturbance, was however significantly more frequent in the paediatric population (28.8% paediatric group and 4.7% adult group, p = 0.02).Conclusions:The higher incidence of ectopic atrial rhythm in children is probably related to the closer position of the sinus node to the superior cavoatrial incision, which makes irreversible iatrogenic traumatism more likely to occur. Surgical techniques that avoid any manipulation on the superior cavoatrial junction should, therefore, be preferred for children undergoing partial anomalous pulmonary venous connection repair
Tumori cardiaci: Il ruolo della risonanza magnetica
No full textThe incidental finding of a cardiac or paracardiac mass constitutes for cardiologists a relevant diagnostic and therapeutic problem. In fact, although primary cardiac tumors are infrequently, metastases, as well as non-neoplastic masses and pseudomasses, are much more frequent. A key role is played by echocardiography, but the latter is not always nullifying. Sometimes even the currently used imaging techniques may be limited in oncology. Cardiac magnetic resonance (CMR) is a multi-parametric technique of imaging considered nowadays the gold standard for n
Trans-catheter closure of a rare cause of pre-tricuspid left-to-right shunt: A "double" levoatriocardinal vein without left heart obstructive lesions
No full text: The levoatriocardinal vein is a rare vascular anomalous connection between the left atrium and the superior vena cava (or left innominate vein). This defect is usually associated with left heart obstructive lesions, while it is rarely found in an isolated form. In the former case, the anomalous connection causes a pre-tricuspid left-to-right shunt with right-heart volume overload. We describe the first case of "double" homolateral levoatriocardinal vein in a child with signs and symptoms of right-heart failure and pulmonary blood-flow overload. A trans-catheter closure of both vascular connections was performed with two Amplatzer Vascular Plug type II (Abbott, Plymouth, MN, USA). The percutaneous approach proved to be safe and effective, with early improvement in the signs and symptoms of heart failure.
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