24 research outputs found
Uncommon cause of ST-segment elevation in V1-V3: incremental value of cardiac magnetic resonance imaging
No full textAlthough ST-segment elevation in precordial leads is a
characteristic of anterior left ventricular infarction (LVI), it
may also be observed in patients with proximal right coronary
occlusion. An isolated right ventricular infarction
(RVI) accounts for only 3 % of all myocardial infarctions
(MI) [1]; in these cases, the ST-segment elevation in the
precordial leads V1–V3 also may occur in the absence of
inferior electrocardiographic changes [2], whereas the
combination of RVI with inferior LVI suppresses ST-segment
elevation in the precordial leads and yields an STsegment
elevation in leads DII, DIII, and aVF [3].
Although certain electrocardiographic features have been
suggested to help differentiate ST-segment elevation secondary
to isolated RVI from LVI [3], it may be impossible
to make a differential diagnosis on the basis of electrocardiography
alone because these features are not pathognomonic.
Furthermore, when a patient is admitted for
typical chest pain, slight ST-segment elevation in leads
V1–V3 and significant increase of cardiac troponin but
with normal coronary main vessels at the coronary angiography,
the diagnosis of a RVI is challenging; taking into
account the multiple causes of myocardial injury and
treatment consequences, there is great clinical need to
clarify the underlying reason for cardiac troponin release.
Although some studies report that echocardiography is a
valuable clinical tool for the evaluation of global RV
function [4], geometric assumptions in modeling the
complex RV shape restricts the ability of this technique in
accurate and precise quantification of RV function; furthermore,
RV function assessment can be difficult in
patients with poor acoustic window or when minor alterations
of RV function are present.
Cardiac magnetic resonance (CMR) provides a comprehensive,
multifaceted view of the heart and can be
useful to characterize an infarct site and size accurately [5].
CMR in this particular setting can confirm the presence of
a minor RVI and aid to exclude other potential causes of
troponin rise with normal coronary main vessels at the coronary
angiography, such as embolic myocardial infarction or
myocarditis [6]. Acute MI treatment [7–10] and traditional
predictors of long-term mortality after acute MI are well
characterized [11–14] but with introduction of CMR, new
predictors of cardiovascular events are emerging [15, 16] and
the evaluation of RV function using CMR can improve risk
stratification and potentially refine patient management after
MI [17]. Moreover, the extent of myocardial scar characterized
by CMR is significantly associated with the occurrence
of spontaneous ventricular arrhythmias [18].
There have been few reports of anterior ST-segment
elevation caused by isolated RVI due to right ventricle
branch occlusion [19–21]. Occlusion of the conus branch
has been described essentially as a complication of coronary
angioplasty or during cardiac surgery [19–21]. Only
one report described a spontaneous RVI with culprit lesion
in the conus branch [22]. Assessment of isolated RVI due
to a critical stenosis of the conus branch by magnetic resonance
is never been reported
Pitfalls in arrhythmogenic left ventricular cardiomyopathy (ALVC). A review of the literature with considerations on a single case of sudden death in a juvenile athlete
No full textSudden cardiac death (SCD) in young athletes represents a challenging issue in forensic practice. The pathologist is frequently asked to establish the cause of death basing upon anatomical findings and to evaluate the role of the physician in preparticipation evaluation (PPE) and eligibility decision. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a leading cause of SCD during sport activity. However, in the last few years, forms with predominant or even isolated involvement of the left ventricle (LV) have progressively been correlated with a high risk of SCD. We present a case of SCD in an apparently healthy 19-year-old semi-professional football player. Annual PPEs performed in accordance with international and Italian recommendations, were unremarkable. At autopsy, a 1-cm area of subepicardial fibro-fatty replacement was observed at the postero-lateral wall of the LV. The finding was diagnostic of arrhythmogenic left ventricular cardiomyopathy (ALVC). A review of this rare pathology has been performed under a forensic perspective, focusing on the evaluation of the medico-legal responsibility of the physician in the PPE and on the morphological aspects of the disease. Current diagnostic criteria and recommendations result to be focused on the right ventricular pattern, with a risk of misdiagnosis for isolated LV forms. Furthermore, few detailed autopsies cases concerning ALVC have been published. There is a need, therefore, to study this rare disease with a careful and revised approach
Right Ventricular Strain and Dyssynchrony Assessment in Arrhythmogenic Right Ventricular Cardiomyopathy: Cardiac Magnetic Resonance Feature-Tracking Study
No full textBACKGROUND:
Analysis of right ventricular (RV) regional dysfunction by cardiac magnetic resonance (CMR) imaging in arrhythmogenic RV cardiomyopathy (ARVC) may be inadequate because of the complex contraction pattern of the RV. Aim of this study was to determine the use of RV strain and dyssynchrony assessment in ARVC using feature-tracking CMR analysis.
METHODS AND RESULTS:
Thirty-two consecutive patients with ARVC referred to CMR imaging were included. Thirty-two patients with idiopathic RV outflow tract arrhythmias and 32 control subjects, matched for age and sex to the ARVC group, were included for comparison purpose. CMR imaging was performed to assess biventricular function; feature-tracking analysis was applied to the cine CMR images to assess regional and global longitudinal, circumferential, and radial RV strains and RV dyssynchrony (defined as the SD of the time-to-peak strain of the RV segments). RV global longitudinal strain (-17±5% versus -26±6% versus -29±6%; P-23.2%, SD of the time-to-peak RV longitudinal strain >113.1 ms, and SD of the time-to-peak RV circumferential strain >177.1 ms allowed correct identification of 88%, 75%, and 63% of ARVC patients with no or only minor CMR criteria for ARVC diagnosis.
CONCLUSIONS:
Strain analysis by feature-tracking CMR helps to objectively quantify global and regional RV dysfunction and RV dyssynchrony in patients with ARVC and provides incremental value over conventional cine CMR imaging
Long-term outcome after drug-eluting stent implantation in unselected population: ROME and UDINE Experience (The RUDI Registry)
No full textObjectives: The aim of our study is to evaluate the safety and efficacy of DES implantation in an unselected, real world, high-risk population. Background: Several clinical trials showed that drug-eluting stents (DESs) implantation is safe and effective in selected population. In spite of these encouraging results, there are some concerns about real world utilization of these stents. Methods: One thousand four hundred and fifty-five off-label patients have been included in our registry. Primary end-points were: long-term clinical incidence of major adverse cardiac and cerebrovascular events (MACCE) and thrombosis (ST). We detected the difference between uniDES vs. multiDES implantation in terms of MACCE, death, nonfatal-MI, the composite of death/nonfatal-MI and target lesion revascularization (TLR) and the difference between DES type in term of MACCE. Results: At 36 months follow-up we found: cardiac death occurred in 20 patients (1.6%); 33 patients (2.6%) had a nonfatal MI and 81 patients (6.3%) had a TLR. We observed one (0.1%) acute, 9 subacute (0.6%), 6 late (0.6%), and 1 (0.5%) very late definite ST. No difference were found in terms of overall MACCE, MI, death and composite of death/nonfatal-MI between uni- and multiDES implantation but multiDES group had a higher incidence of TLR. No difference between DES type in term of MACCE was detected. Conclusions: DES utilization shows their safety and efficacy in off-label patients with complex clinical and angiographic profile in terms of long-term incidence of MACCE. MultiDES implantation is associated with a higher risk of long-term TLR. No difference between DES type was found. (c) 2011 Wiley Periodicals, Inc
The value of clinical wisdom in randomised studies, real-world registries and new hypotheses
No full textCRT-36 Plaque Modification Versus Debulking Strategy In Calcified Coronary Lesions. Long-term Clinical Outcome And Technical Determinants Of The Rotational Atherectomy (the Rotablator Udine Registry)
No full textUsefulness of the cryolife o’brien stentless suprannular aortic valve to prevent prosthesis-patient mismatch in the small aortic root
No full textAbstractObjectivesThis study evaluated the occurrence of prosthesis-patient mismatch (PPM) after Cryolife O’Brien (CLOB) suprannular stentless valve replacement in patients with a small aortic root and its repercussions on the patient’s hemodynamic status and left ventricular mass regression.BackgroundThe correct management of the small aortic annulus is still controversial. Small aortic prostheses can lead to a PPM, which results in high gradients with important repercussions on the hemodynamic status.MethodsSeventy-two patients (mean age: 72.5 ± 6.2 years, 73.6% women) with a small aortic root (≤21 mm intraoperatively measured aortic annulus) had a CLOB valve implanted in the aortic position between November 1993 and July 2001 at our institution. Mean prosthesis size was 22.0 ± 0.8 mm. Patients underwent echocardiography preoperatively, at discharge, six months, one year and yearly thereafter.ResultsThe incidence of PPM at discharge was 22.2% (16/72); 18.7% were severe (effective orifice area index [EOAI] ≤0.65 cm/m2), 43.7% were moderate (EOAI = 0.66 to 0.75 cm/m2) and 37.6% were mild (0.76 to 0.85 cm/m2). At multivariable analysis, gender (p < 0.001), age (p = 0.015), body surface area (p < 0.001) and patient’s annulus index (p < 0.001) were significant factors influencing the occurrence of “transient” PPM. At one year the incidence of PPM was 0%.ConclusionsSuprannular CLOB valve yielded excellent hemodynamic results in patients with small aortic roots. This study demonstrates that PPM can be completely avoided when using the CLOB valve. The superior hemodynamics of this stentless valve are likely to be related to its suprannular design
Early and midterm results of model 300 CryoLife O’Brien stentless porcine aortic bioprosthesis
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