222 research outputs found
LUNG ULTRASOUND FOR THE SCREENING OF INTERSTITIAL LUNG DISEASE IN VERY EARLY SYSTEMIC SCLEROSIS
No full textBackground: Many systemic sclerosis (SSc) patients develop interstitial lung disease (ILD) during the course of the disease. Promising data have recently shown that lung ultrasound (LUS) is able to detect ILD by the evaluation of B-lines, the sonographic sign of lung interstitial syndrome.Objectives: To evaluate whether B-lines assessed by LUS are reliable in the screening of ILD in patients with SSc.Methods: Fifty consecutive SSc patients (47 females) who underwent a clinically-driven chest high resolution computed tomography (HRCT) were evaluated by LUS for detection of B-lines. Among them, 27 patients fulfilled the criteria for a Very Early Diagnosis Of SSc (VEDOSS).Results: At least mild ILD was present at HRCT in 76% of the total population and in 70% of the VEDOSS population. A significant difference in B-lines number was found in patients with and without ILD on HRCT (62±54 vs 11±10; p<.0001), with a concordance rate of 88%. All discordant cases were false positive at LUS. When considering only the VEDOSS population, the concordance rate between the two exams was 89%, with a sensitivity of 100%, a negative predictive value of 100%, specificity of 50% and positive predictive value of 87.5%.Conclusions: ILD appears very early in SSc patients. Presence of B-lines at LUS examination correlates with ILD at HRCT. LUS is very sensitive to detect early ILD even in patients with very early diagnosis of SSc. The use of LUS as a screening tool for ILD seems feasible to guide further investigation with HRCT
Ultrashort Echo-Time Magnetic Resonance Imaging Sequence in the Assessment of Systemic Sclerosis-Interstitial Lung Disease
No full textPurpose: To test respiratory-triggered ultrashort echo-time (UTE) Spiral VIBE-MRI sequence in systemic sclerosis-interstitial lung disease assessment compared with computed tomography (CT). Material and Methods: Fifty four SSc patients underwent chest CT and UTE (1.5 T). Two radiologists, independently and in consensus, verified ILD presence/absence and performed a semiquantitative analysis (sQA) of ILD, ground-glass opacities (GGO), reticulations and honeycombing (HC) extents on both scans. A CT software quantitative texture analysis (QA) was also performed. For ILD detection, intra-/inter-reader agreements were computed with Cohen K coefficient. UTE sensitivity and specificity were assessed. For extent assessments, intra-/inter-reader agreements and UTE performance against CT were computed by Lin's concordance coefficient (CCC). Results: Three UTE were discarded for low quality, 51 subjects were included in the study. Of them, 42 QA segmentations were accepted. ILD was diagnosed in 39/51 CT. UTE intra-/inter-reader K in ILD diagnosis were 0.56 and 0.26. UTE showed 92.8% sensitivity and 75.0% specificity. ILD, GGO, and reticulation extents were 14.8%, 7.7%, and 7.1% on CT sQA and 13.0%, 11.2%, and 1.6% on CT QA. HC was <1% and not further considered. UTE intra-/inter-reader CCC were 0.92 and 0.89 for ILD extent and 0.84 and 0.79 for GGO extent. UTE RET extent intra-/inter-reader CCC were 0.22 and 0.18. UTE ILD and GGO extents CCC against CT sQA and QA were ≥0.93 and ≥0.88, respectively. RET extent CCC were 0.35 and 0.22 against sQA and QA, respectively. Conclusion: UTE Spiral VIBE-MRI sequence is reliable in assessing ILD and GGO extents in systemic sclerosis-interstitial lung disease patients
Echocardiographic and biohumoral characteristics in patients with AL and TTR amyloidosis at diagnosis
No full textBACKGROUND: Few studies have analyzed the clinical and echocardiographic differences between light-chain (AL) and transthyretin (TTR) amyloidosis. HYPOTHESIS: The aim of the present research was to compare, in a real-world setting, the clinical and echocardiographic profiles of these kinds of amyloidosis, at the time of diagnosis, using new-generation echocardiography. METHODS: Seventy-nine patients with AL and 48 patients with TTR amyloidosis were studied. RESULTS: According to the criterion of mean left ventricular (LV) thickness >12 mm, 45 AL (C-AL) and all TTR patients had cardiac amyloidotic involvement, whereas 34 AL patients did not. TTR patients had increased right ventricular (RV) and LV chambers with increased RV and LV wall thickness and reduced LV ejection fraction and fractional shortening. Furthermore, TTR patients showed lower N-terminal pro Brain Natriuretic Peptide concentrations and New York Heart Association functional class when compared with C-AL. CONCLUSIONS: Our data show that at time of first diagnosis, TTR patients have a more advanced amyloidotic involvement of the heart, despite less severe symptoms and biohumoral signs of heart failure. We can hypothesize that we observed different diseases at different stages. In fact, AL amyloidosis is a multiorgan disease with quick progression rate, that becomes rapidly symptomatic, whereas TTR amyloidosis might have a slow progression rate and might remain poorly symptomatic for a greater amount of time
Pulmonary Circulation on the Crossroads Between the Left and Right Heart in Systemic Sclerosis: A Clinical Challenge for Cardiologists and Rheumatologists
No full textInvolvement of the right heart-pulmonary circulation system in systemic sclerosis is a typical feature, with critical prognostic implications. Pulmonary hypertension may occur in association with interstitial lung disease or as a result of an isolated pulmonary vascular disease that may affect both the precapillary arterioles and the postcapillary venules, as well as a consequence of left heart involvement. These apparently different phenotypes often underlie a significant pathophysiologic overlap, which makes the diagnosis and management of these patients highly complex and uncertai
Early detection of myocardial and pulmonary oedema with MRI in an asymptomatic systemic sclerosis patient: successful recovery with pulse steroid
No full textCardiac involvement is frequent in SSc, accounting for
a substantial proportion of the mortality of the disease.
In these patients, cardiac involvement is usually asymptomatic, but when it becomes clinically evident, extensive damage to the myocardium is already established and the treatment is rarely effective. These patients are exposed to the risk of sudden death due to malignant arrhythmias, therefore an early diagnosis is of paramount importance. MRI has been demonstrated to be useful in the detection of subclinical heart involvement
Response to Letter to the Editor by Rui Baptista, MD, Rogerio Teixeira, MD
No full textResponse to Letter to the Editor by Rui Baptista,
M.D., Rogério Teixeira, M.D
The resistive and pulsatility indices of the dorsal metatarsal artery for the screening of peripheral lower artery disease in patients with and without diabetes
No full textThe classification of hospitalized patients with hyperglycemia and its implication on outcome: results from a prospective observational study in Internal Medicine
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