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Pubblicazioni recenti - cardiac magnetic resonance
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Prevalence and Vascular Distribution of Multiterritorial Atherosclerosis Among Community-Dwelling Adults in Southeast China.
JAMA Netw Open2022 Jun;5(6):e2218307. doi: 10.1001/jamanetworkopen.2022.18307.
Pan Yuesong, Jing Jing, Cai Xueli, Jin Zening, Wang Suying, Wang Yilong, Zeng Chunlai, Meng Xia, Ji Jiansong, Li Long, Lyu Lingchun, Zhang Zhe, Mei Lerong, Li Hao, Li Shan, Wei Tiemin, Wang Yongjun,
Abstract
Importance:
Data are limited on the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in community populations.
Objective:
To investigate the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in older, community-dwelling populations in China.
Design, Setting, and Participants:
This cross-sectional study was based on the baseline survey from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study, a population-based prospective cohort study that enrolled community-dwelling adults aged 50 to 75 years based on cluster sampling from 6 villages and 4 living communities of Lishui city in southeast China. Data were collected from May 2017 to September 2019 and analyzed from September to November 2021.
Main Outcomes and Measures:
Atherosclerotic plaque and stenosis at baseline were assessed in multiple vascular territories. Brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries; computed tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries; and ankle-brachial index for peripheral arteries were performed at baseline survey. The extent of atherosclerosis was assessed according to the number of these 8 vascular sites affected, and polyvascular lesions were defined as at least 2 affected sites.
Results:
A total of 3433 of 4202 invited individuals consented to participate in the study. After excluding 366 participants with contraindications for MRI or CTA scanning, with life expectancies of 4 years of fewer, or with mental disease, a total of 3067 community-dwelling adults were enrolled. The mean (SD) age was 61.2 (6.7) years; 1640 (53.5%) were women, and 74 (2.4%) had prevalent ASCVD. Most participants (2870 [93.6%]) had atherosclerotic plaques in at least 1 vascular territory. Atherosclerotic plaques were mostly detected in the aorta (2419 [79.6%]) and iliofemoral arteries (2312 [75.8%]), followed by subclavian (1500 [49.8%]), coronary (1366 [44.9%]), extracranial (1110 [36.4%]), renal (873 [28.7%]), and intracranial (542 [17.7%]) arteries. A substantial proportion of participants (1180 [38.5%]) had arterial stenosis of 50% or greater, predominantly affecting the coronary (542 [17.8%]) and iliofemoral (527 [17.3%]) arteries. Polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories, and polyvascular stenosis was observed in 412 patients (13.4%).
Conclusions and Relevance:
In this study, atherosclerotic plaque was highly prevalent in the older community population in China, and a substantial proportion of individuals reach stenosis of 50% or greater.
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Case report: hypoglycemia secondary to methimazole-induced insulin autoimmune syndrome in young Taiwanese woman with Graves' disease.
Medicine (Baltimore)2022 Jun;101(25):e29337. doi: 10.1097/MD.0000000000029337.
Wu Hsuan-Yu, Chen I-Hua, Lee Mei-Yueh,
Abstract
RATIONALE:
Hypoglycemia is an emergent condition with many causes, including underlying diabetes mellitus either with the use of insulin or oral anti-diabetic medications for glucose control, and organ (heart, hepatic, or renal) failure. Insulin autoimmune syndrome (IAS) can also cause hypoglycemia, however it is relatively difficult to diagnose as it is rare clinically. Although uncommon, IAS can be life threatening in patients with persistent hypoglycemia.
PATIENT CONCERN:
We report the case of a 27-year-old female with underlying Graves' disease who was treated with methimazole (MTZ). After 6?weeks of treatment, she developed hypoglycemia symptoms accompanied by dizziness and cold sweating. We excluded underlying diabetes mellitus, the use of insulin or oral anti-diabetic medications, and organ failure.
DIAGNOSES:
Laboratory data showed elevated insulin and C-peptide levels. Therefore, insulinoma and IAS were suspected. Abdominal computed tomography and magnetic resonance imaging ruled out insulinoma, and MTZ-induced IAS was finally diagnosed.
INTERVENTIONS AND OUTCOMES:
The hypoglycemia symptoms resolved after MTZ was switched to propylthiouracil, confirming the diagnosis of IAS.
LESSONS:
This case emphasizes the significance of life-threatening MTZ-induced IAS. IAS should be suspected in patients who develop spontaneous hypoglycemia, especially in those with underlying Graves' disease receiving MTZ who present with hyperinsulinism.
Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
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Cardiovascular Disease in Primary Sjögren's Syndrome: Raising Clinicians' Awareness.
Front Immunol2022 ;13():865373. doi: 10.3389/fimmu.2022.865373.
Casian Mihnea, Jurcut Ciprian, Dima Alina, Mihai Ancuta, Stanciu Silviu, Jurcut Ruxandra,
Abstract
In the ever evolving landscape of systemic immune mediated diseases, an increased awareness regarding the associated cardiovascular system impairment has been noted in recent years. Even though primary Sjögren's Syndrome (pSS) is one of the most frequent autoimmune diseases affecting middle-aged individuals, the cardiovascular profile of this specific population is far less studied, at least compared to other autoimmune diseases. Traditional cardiovascular risk factors and disease specific risk factors are inextricably intertwined in this particular case. Therefore, the cardiovascular risk profile in pSS is a multifaceted issue, sometimes difficult to assess. Furthermore, in the era of multimodality imaging, the diagnosis of subclinical myocardial and vascular damage is possible, with recent data pointing that the prevalence of such involvement is higher in pSS than in the general population. Nevertheless, when approaching patients with pSS in terms of cardiovascular diseases, clinicians are often faced with the difficult task of translating data from the literature into their everyday practice. The present review aims to synthesize the existing evidence on pSS associated cardiovascular changes in a clinically relevant manner.
Copyright © 2022 Casian, Jurcut, Dima, Mihai, Stanciu and Jurcut.
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Male and Female C57BL/6 Mice Respond Differently to Awake Magnetic Resonance Imaging Habituation.
Front Neurosci2022 ;16():853527. doi: 10.3389/fnins.2022.853527.
Lindhardt Thomas Beck, Gutiérrez-Jiménez Eugenio, Liang Zhifeng, Hansen Brian,
Abstract
Traditionally, preclinical magnetic resonance imaging (MRI) has been performed in anesthetized animals. However, anesthesia has been shown to perturb normal brain function and physiology. Such effects limit our ability to detect subtle physiological alterations in disease models and treatment studies, thus hampering discovery and compromising generality of findings. Therefore, methods for awake animal MRI are needed to study the rodent brain in its natural physiological state, free of anesthetics. Current setups for awake animal MRI rely on restraining systems to avoid animal movement during scanning. To reduce restraint stress, animals are habituated to the scanner environment prior to MRI data collection. To date, however, most awake MRI studies employ male rodents only. This is a fundamental limitation as results obtained may be pertinent only to half of the population. We characterized training and habituation responses of male and female mice to provide improved, sex-dependent training procedures for awake mouse MRI. We recorded heart rate, monitored behavioral responses (body weight and weight) and fecal corticosterone levels (FCM) as indicators of wellbeing and stress during a 14-day progressive habituation protocol. In addition, we also assessed discomfort levels and anxiety using the mouse grimace scale (MGS) and light/dark test (LDT), respectively. All scores were compared between both groups. We found that heart rate was significantly decreased after 10 and 11 days of training for both males and females, respectively. However, the specific time course for this decrease was significantly different between males and females, and females exhibited higher anxiety levels during habituation and 14 days after habituation than males. Lastly, we also found that mean FCM levels for both groups were decreased after 11 days of MRI habituation. The present work shows that mice can be successfully trained for extended MRI sessions which is necessary for many (particularly non-fMRI) studies. Importantly, we find that males and females differ in their response to awake MRI habituation, which should be considered in future awake MRI studies that aim to include male and female mice.
Copyright © 2022 Lindhardt, Gutiérrez-Jiménez, Liang and Hansen.
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Multimodality Imaging in Aortic Stenosis.
Heart Views;23(1):22-32. doi: 10.4103/heartviews.heartviews_32_22.
Karim Sabir Abdul, Helmy Sherif Mahmoud,
Abstract
Aortic stenosis (AS) is the most common cardiac valve lesion in the adult population, with an incidence increasing as the population ages. Accurate assessment of AS severity is necessary for clinical decision-making. Echocardiography is currently the diagnostic method of choice for assessing and managing AS. Transthoracic echocardiography is usually sufficient in most situations. Transesophageal echocardiography and stress echocardiography may also be utilized when there is inadequate image quality and/or discordance in the results and the clinical presentation. There is a role for other imaging modalities such as cardiac computed tomography, magnetic resonance imaging, and catheterization in selected cases. The following describes in some detail the role of these modalities in the diagnosis and assessment of AS.
Copyright: © 2022 Heart Views.
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MRI Assessment of Cardiac Function and Morphology in Adult Patients With Growth Hormone Deficiency: A Systematic Review and Meta-Analysis.
Front Endocrinol (Lausanne)2022 ;13():910575. doi: 10.3389/fendo.2022.910575.
Bioletto Fabio, Prencipe Nunzia, Berton Alessandro Maria, Bona Chiara, Parasiliti-Caprino Mirko, Faletti Riccardo, Ghigo Ezio, Grottoli Silvia, Gasco Valentina,
Abstract
Background:
Adult GH deficiency (GHD) has been described as a heterogeneous condition characterized by many clinical modifications, such as metabolic alterations, impaired quality of life, and increased mortality. The clinical relevance of cardiac involvement remains, however, only partially elucidated.
Methods:
PubMed/Medline, EMBASE, Cochrane library, OVID and CINAHL databases were systematically searched until February 2022 for studies evaluating cardiac function and morphology by magnetic resonance imaging in adult patients with GHD. Effect sizes were pooled through a random-effect model.
Results:
Four studies were considered in the meta-analysis. With respect to the left ventricle, GHD patients were characterized by a lower stroke-volume-index (-3.6 ml/m, standardized mean difference (SMD) -0.60, 95%CI [-1.15,-0.05], p=0.03), lower end-diastolic-volume-index (-6.2 ml/m, SMD -0.54, 95%CI [-0.97,-0.10], p=0.02) and, after accounting for possible biases, lower mass-index (-15.0 g/m, SMD -1.03, 95%CI [-1.89,-0.16], p=0.02). With respect to the right ventricle, a lower end-diastolic-volume-index (-16.6 ml/m, SMD -1.04, 95%CI [-2.04,-0.03], p=0.04) and a borderline-significant lower stroke-volume-index (-5.0 ml/m, SMD -0.84, 95%CI [-1.77,0.08], p=0.07) could be observed. Data about the effect of GH replacement therapy highlighted a significant increase in left ventricular mass-index after treatment initiation (+3.7 g/m, 95%CI [1.6,5.7], p
Conclusion:
With respect to the left ventricle, our results confirmed those retrieved by echocardiographic studies. In addition, significant alterations were demonstrated also for the right ventricle, for which echocardiographic data are nearly absent. This supports the thesis of a biventricular cardiac involvement in patients with GHD, with a similar pattern of morphological and functional alterations in both ventricles.
Copyright © 2022 Bioletto, Prencipe, Berton, Bona, Parasiliti-Caprino, Faletti, Ghigo, Grottoli and Gasco.
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Clinical Manifestations, Monitoring, and Prognosis: A Review of Cardiotoxicity After Antitumor Strategy.
Front Cardiovasc Med2022 ;9():912329. doi: 10.3389/fcvm.2022.912329.
Huang Wei, Xu Rong, Zhou Bin, Lin Chao, Guo Yingkun, Xu Huayan, Guo Xia,
Abstract
The development of various antitumor drugs has significantly improved the survival of patients with cancer. Many first-line chemotherapy drugs are cytotoxic and the cardiotoxicity is one of the most significant effects that could leads to poor prognosis and decreased survival rate. Cancer treatment include traditional anthracycline drugs, as well as some new targeted drugs such as trastuzumab and ICIs. These drugs may directly or indirectly cause cardiovascular injury through different mechanisms, and lead to increasing the risk of cardiovascular disease or accelerating the development of cardiovascular disease. Cardiotoxicity is clinically manifested by arrhythmia, decreased cardiac function, or even sudden death. The cardiotoxicity caused by traditional chemotherapy drugs such as anthracyclines are significantly known. The cardiotoxicity of some new antitumor drugs such like immune checkpoint inhibitors (ICIs) is also relatively clear and requiring further observation and verification. This review is focused on major three drugs with relatively high incidence of cardiotoxicity and poor prognosis and intended to provide an update on the clinical complications and outcomes of these drugs, and we innovatively summarize the monitoring status of survivors using these drugs and discuss the biomarkers and non-invasive imaging features to identify early cardiotoxicity. Finally, we summarize the prevention that decreasing antitumor drugs-induced cardiotoxicity.
Copyright © 2022 Huang, Xu, Zhou, Lin, Guo, Xu and Guo.
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Baseline 4D Flow-Derived Hemodynamic Parameters Stratify Descending Aortic Dissection Patients With Enlarging Aortas.
Front Cardiovasc Med2022 ;9():905718. doi: 10.3389/fcvm.2022.905718.
Chu Stanley, Kilinc Ozden, Pradella Maurice, Weiss Elizabeth, Baraboo Justin, Maroun Anthony, Jarvis Kelly, Mehta Christopher K, Malaisrie S Chris, Hoel Andrew W, Carr James C, Markl Michael, Allen Bradley D,
Abstract
Purpose:
The purpose of our study was to assess the value of true lumen and false lumen hemodynamics compared to aortic morphological measurements for predicting adverse-aorta related outcomes (AARO) and aortic growth in patients with type B aortic dissection (TBAD).
Materials and Methods:
Using an IRB approved protocol, we retrospectively identified patients with descending aorta (DAo) dissection at a large tertiary center. Inclusion criteria includes known TBAD with ? 6 months of clinical follow-up after initial presentation for TBAD or after ascending aorta intervention for patients with repaired type A dissection with residual type B aortic dissection (rTAAD). Patients with prior descending aorta intervention were excluded. The FL and TL of each patient were manually segmented from 4D flow MRI data, and 3D parametric maps of aortic hemodynamics were generated. Groups were divided based on (1) presence vs. absence of AARO and (2) growth rate ? vs.
Results:
A total of = 51 patients (age: 58.4 ± 15.0 years, M/F: 31/20) were included for analysis of AARO. This group contained = 26 patients with TBAD and = 25 patients with rTAAD. In the overall cohort, AARO patients had larger baseline diameters, lower FL-RF, FL stasis, TL-KE, TL-FF and TL-PV. Among patients with TBAD, those with AAROs had larger baseline diameter, lower FL stasis and TL-PV. In both the overall cohort and in the subgroup of TBAD, subjects with aortic growth ? 3mm/year, patients had a higher KE ratio.
Conclusion:
Our study suggests that 4D flow MRI is a promising tool for TBAD evaluation that can provide information beyond traditional MRA or CTA. 4D flow has the potential to become an integral aspect of TBAD work-up, as hemodynamic assessment may allow earlier identification of at-risk patients who could benefit from earlier intervention.
Copyright © 2022 Chu, Kilinc, Pradella, Weiss, Baraboo, Maroun, Jarvis, Mehta, Malaisrie, Hoel, Carr, Markl and Allen.
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Multiple Biventricular Thrombi Associated With Methamphetamine-Associated Cardiomyopathy.
Ochsner J2022 ;22(2):192-195. doi: 10.31486/toj.21.0097.
Zaidi Syeda H, Khan Umair A, Sagheer Shazib, Sheikh Abubaker, Garcia Mark E,
Abstract
As methamphetamine use has increased around the world, cardiovascular mortality has also increased. Methamphetamine-associated cardiomyopathy (MACM) is one of the serious cardiovascular complications of methamphetamine use. Limited evidence has been published regarding the increased risk of thrombogenicity in the setting of methamphetamine use. We propose that increased thrombogenicity presents a risk factor for intracardiac thrombi. A 48-year-old female with a history of MACM was admitted to the hospital with acute decompensated heart failure. Transthoracic echocardiogram revealed multiple biventricular masses requiring further workup, but the patient left against medical advice on warfarin. The patient presented again 2.5 months later with decompensated heart failure. During the second admission, cardiac magnetic resonance imaging (CMR) characterized the masses in the left ventricle as thrombi, and computed tomography of the chest with contrast showed pulmonary embolism. Although the right ventricle mass was not seen on CMR, we believe the mass was a thrombus that either had migrated into the lungs or had resolved with warfarin use. MACM and biventricular thrombi are associated, but the association is rare and not well studied. Although the exact mechanism of this association is unknown, the increased circulating catecholamines are believed to be a contributing factor for increased thrombogenicity in the setting of active methamphetamine use. We suggest keeping a low threshold for surveillance echocardiography to screen for intracardiac thrombi in MACM patients with active methamphetamine use when they present with even mild symptoms of decompensated heart failure.
©2022 by the author(s); Creative Commons Attribution License (CC BY).
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Right ventricular calcified amorphous tumour.
Indian J Thorac Cardiovasc Surg2022 Jul;38(4):412-414. doi: 10.1007/s12055-021-01327-6.
Alok Kumar, Soham Das, Kanwaljeet Singh, Rohit Dutta,
Abstract
Calcified amorphous tumour is a rare variety of benign cardiac intra cavitary tumour. Only a handful of cases have been reported till date. We report a case of a 42 years old male without any known comorbidities who presented with history of syncope and dyspnoea on exertion. Transthoracic echocardiography and cardiac magnetic resonance imaging revealed pedunculated mobile well-defined right ventricular mass attached to its free wall by a thin pedicle. He underwent surgical excision of mass under normothermic bypass. Microscopic examination revealed necrotic material with rim of fibrocollagenous tissue; focal dystrophic calcification was seen.
© Indian Association of Cardiovascular-Thoracic Surgeons 2022.
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IgG4-related cardiovascular disease: imaging features on cardiac computed tomography and magnetic resonance imaging.
Indian J Thorac Cardiovasc Surg2022 Jul;38(4):451-453. doi: 10.1007/s12055-021-01310-1.
Chandrashekhara S H, Ojha Vineeta, Kumar Pramod, Goyal Aayush, Kumar Sanjeev,
Abstract
We present a case of diffuse involvement of cardiovascular structures in a patient with immunoglobulin4 (IgG4) vasculitis. We also highlight the important role of computed tomography (CT) angiography in diagnosing the same.
© Indian Association of Cardiovascular-Thoracic Surgeons 2022.
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GPU-Based Simulation of Echocardiography Volumes Using Quantitative Fiber-Angle-to-Backscatter Measurements.
Proc SPIE Int Soc Opt Eng2021 Feb;11602():. doi: 116020U.
Yociss Megan, Fei Baowei,
Abstract
The intensity of backscattered ultrasound signal from heart muscle is known to be related to the angle between cardiac fibers and the insonification direction. In this work, a GPU-based method of simulating three-dimensional (3D) echocardiographic images from an empirically derived angle-to-backscatter relationship is developed and validated. Images of a rotating fiber phantom are simulated, and it is validated that the angle-to-backscatter relationship is accurately reflected by the simulated envelope data. In a second experiment, echocardiography images are simulated from a diffusion tensor magnetic resonance imaging (DT-MRI) volume of a canine heart to demonstrate that the method produces view-dependent speckle. 3D volumes of a parametrically generated ideal left ventricle phantom are also simulated and processed into fiber orientation maps using the underlying quantitative parameters. Images are simulated based on the characteristics of a 35-by-32 two-dimensional (2D) matrix array probe and a clinical one-dimensional (1D) phased array probe. The processed fiber volumes exhibit good agreement with the virtual phantom's ground truth, having an average acute angle error (AAE) of less than 10 degrees for both probes. The simulation method is fast and opens a new approach for ultrasound fiber imaging.
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Multi-Domain Variational Autoencoders for Combined Modeling of MRI-Based Biventricular Anatomy and ECG-Based Cardiac Electrophysiology.
Front Physiol2022 ;13():886723. doi: 10.3389/fphys.2022.886723.
Beetz Marcel, Banerjee Abhirup, Grau Vicente,
Abstract
Human cardiac function is characterized by a complex interplay of mechanical deformation and electrophysiological conduction. Similar to the underlying cardiac anatomy, these interconnected physiological patterns vary considerably across the human population with important implications for the effectiveness of clinical decision-making and the accuracy of computerized heart models. While many previous works have investigated this variability separately for either cardiac anatomy or physiology, this work aims to combine both aspects in a single data-driven approach and capture their intricate interdependencies in a multi-domain setting. To this end, we propose a novel multi-domain Variational Autoencoder (VAE) network to capture combined Electrocardiogram (ECG) and Magnetic Resonance Imaging (MRI)-based 3D anatomy information in a single model. Each VAE branch is specifically designed to address the particular challenges of the respective input domain, enabling efficient encoding, reconstruction, and synthesis of multi-domain cardiac signals. Our method achieves high reconstruction accuracy on a United Kingdom Biobank dataset, with Chamfer Distances between reconstructed and input anatomies below the underlying image resolution and ECG reconstructions outperforming multiple single-domain benchmarks by a considerable margin. The proposed VAE is capable of generating realistic virtual populations of arbitrary size with good alignment in clinical metrics between the synthesized and gold standard anatomies and Maximum Mean Discrepancy (MMD) scores of generated ECGs below those of comparable single-domain approaches. Furthermore, we observe the latent space of our VAE to be highly interpretable with separate components encoding different aspects of anatomical and ECG variability. Finally, we demonstrate that the combined anatomy and ECG representation improves the performance in a cardiac disease classification task by 3.9% in terms of Area Under the Receiver Operating Characteristic (AUROC) curve over the best corresponding single-domain modeling approach.
Copyright © 2022 Beetz, Banerjee and Grau.
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Unusual case of cerebral embolism after initiation of selexipag for sarcoidosis-related pulmonary hypertension: a case report.
Radiol Case Rep2022 Sep;17(9):3009-3014. doi: 10.1016/j.radcr.2022.05.064.
Inoue Naoya, Morikawa Shuji,
Abstract
: Pulmonary hypertension is a rare complication of sarcoidosis. The pathogenesis of sarcoidosis-related pulmonary hypertension is multifactorial, and patients with sarcoidosis-related pulmonary hypertension can have variable treatment responses and prognoses. While selexipag (Nippon Shinyaku / Kyoto / Japan) was recently approved in Japan for the treatment of pulmonary hypertension, the risk of cerebral infarction has not been clearly reported. : A 63-year-old Asian female with a diagnosis of ocular and cutaneous sarcoidosis developed shortness of breath and was referred to our department to rule out cardiac sarcoidosis. Swan-Ganz catheterization was performed, and she was diagnosed with pulmonary arterial hypertension and started on selexipag. A few days after starting treatment, she presented with hemiplegia and was diagnosed with cardiogenic cerebral embolism by using magnetic resonance imaging. As there was no evidence of pre-existing intracardiac thrombosis, we suspected unusual cerebral embolism. Echocardiography revealed a deep venous thrombus and a bubble study revealed a right-left shunt through a patent foramen ovale. : The initiation of selexipag improved pulmonary blood flow and caused cerebral embolism, which was an unusual and unexpected event. This report highlights the importance of confirming the presence of patent foramen ovale and a deep venous thrombus before starting treatment for pulmonary hypertension.
© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
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COVID-19 presenting with myocardial infarction with nonobstructive coronary arteries.
Proc (Bayl Univ Med Cent)2022 ;35(4):514-516. doi: 10.1080/08998280.2022.2057158.
Ismayl Mahmoud, Butt Dua Noor, Balakrishna Akshay Machanahalli, Kousa Omar, Kabach Amjad,
Abstract
Cardiovascular complications contribute to approximately 40% of all COVID-19-related deaths. Thrombosis in COVID-19 infection is a well-known phenomenon, and the spectrum of thromboembolic diseases related to COVID-19 is wide, with venous thromboembolism being the most common manifestation. We describe a case of myocardial infarction with nonobstructive coronary arteries (MINOCA) that developed in the setting of mild COVID-19 infection. Our case illustrates how COVID-19 can present with MINOCA and highlights the importance of cardiac magnetic resonance imaging in identifying the underlying etiology.
Copyright © 2022 Baylor University Medical Center.
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Effect of sodium-glucose co-transporter-2 inhibitors on arterial stiffness: A systematic review and meta-analysis of randomized controlled trials.
Vasc Med2022 Jun;():1358863X221101653. doi: 10.1177/1358863X221101653.
Patoulias Dimitrios, Papadopoulos Christodoulos, Kassimis George, Fragakis Nikolaos, Vassilikos Vassilios, Karagiannis Asterios, Doumas Michael,
Abstract
BACKGROUND:
Arterial stiffness represents an established cardiovascular risk marker. Sodium-glucose co-transporter-2 (SGLT-2) inhibitors have significant cardio-protective effects. Herein we sought to determine the effect of SGLT-2 inhibitors on pulse wave velocity (PWV).
METHODS:
We searched PubMed, Cochrane Library, and grey literature from inception to 7 February 2022 for randomized controlled trials (RCTs) enrolling adult subjects with or without type 2 diabetes mellitus (T2DM), assigned to a SGLT-2 inhibitor versus control and addressing their effect on PWV. We set as primary efficacy outcome the change in PWV with SGLT-2 inhibitors versus placebo or control.
RESULTS:
We pooled data from six trials in a total of 452 enrolled participants assigned either to SGLT-2 inhibitor or control. Overall, SGLT-2 inhibitor treatment compared to control resulted in a nonsignificant decrease in PWV. Exclusion of a trial utilizing cardiac magnetic resonance imaging for the assessment of PWV demonstrated that SGLT-2 inhibitors induce a significant reduction in PWV by 0.21 m/s. When we restricted our analysis to RCTs enrolling subjects with T2DM, we observed that SGLT-2 inhibitor compared to control resulted in a significant decrease in PWV by 0.17 m/s.
CONCLUSION:
SGLT-2 inhibitors do not decrease PWV in patients with established cardiovascular disease or cardiovascular risk factors. However, we have shown that SGLT-2 inhibitors lead to a slight, but significant decrease in PWV in patients with T2DM. The latter finding is of great value, based on the significant correlation between PWV and micro- and macro-vascular complications of T2DM.
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Free-running cardiac and respiratory motion-resolved 5D whole-heart coronary cardiovascular magnetic resonance angiography in pediatric cardiac patients using ferumoxytol.
J Cardiovasc Magn Reson2022 Jun;24(1):39. doi: 10.1186/s12968-022-00871-3.
Roy Christopher W, Di Sopra Lorenzo, Whitehead Kevin K, Piccini Davide, Yerly Jérôme, Heerfordt John, Ghosh Reena M, Fogel Mark A, Stuber Matthias,
Abstract
BACKGROUND:
Coronary cardiovascular magnetic resonance angiography (CCMRA) of congenital heart disease (CHD) in pediatric patients requires accurate planning, adequate sequence parameter adjustments, lengthy scanning sessions, and significant involvement from highly trained personnel. Anesthesia and intubation are commonplace to minimize movements and control respiration in younger subjects. To address the above concerns and provide a single-click imaging solution, we applied our free-running framework for fully self-gated (SG) free-breathing 5D whole-heart CCMRA to CHD patients after ferumoxytol injection. We tested the hypothesis that spatial and motion resolution suffice to visualize coronary artery ostia in a cohort of CHD subjects, both for intubated and free-breathing acquisitions.
METHODS:
In 18 pediatric CHD patients, non-electrocardiogram (ECG) triggered 5D free-running gradient echo CCMRA with whole-heart 1 mm isotropic spatial resolution was performed in seven minutes on a 1.5T CMR scanner. Eleven patients were anesthetized and intubated, while seven were breathing freely without anesthesia. All patients were slowly injected with ferumoxytol (4 mg/kg) over 15 minutes. Cardiac and respiratory motion-resolved 5D images were reconstructed with a fully SG approach. To evaluate the performance of motion resolution, visibility of coronary artery origins was assessed. Intubated and free-breathing patient sub-groups were compared for image quality using coronary artery length and conspicuity as well as lung-liver interface sharpness.
RESULTS:
Data collection using the free-running framework was successful in all patients in less than 8 min; scan planning was very simple without the need for parameter adjustments, while no ECG lead placement and triggering was required. From the resulting SG 5D motion-resolved reconstructed images, coronary artery origins could be retrospectively extracted in 90% of the cases. These general findings applied to both intubated and free-breathing pediatric patients (no difference in terms of lung-liver interface sharpness), while image quality and coronary conspicuity between both cohorts was very similar.
CONCLUSIONS:
A simple-to-use push-button framework for 5D whole-heart CCMRA was successfully employed in pediatric CHD patients with ferumoxytol injection. This approach, working without any external gating and for a wide range of heart rates and body sizes provided excellent definition of cardiac anatomy for both intubated and free-breathing patients.
© 2022. The Author(s).
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Predicting Patients With Troponin Positive Chest Pain and Unobstructed Coronary Arteries With Electrocardiogram, Troponin Kinetics and GRACE Score.
Heart Lung Circ2022 Jun;():. doi: S1443-9506(22)00268-2.
Rao Karan, De Silva Kasun, Sood Ashish, Denniss A Robert, Hsu Chi-Jen,
Abstract
BACKGROUND:
Troponin positive chest-pain with unobstructed coronary arteries (TPCP-UCA), occurs in 6% of cases of patients presenting with acute coronary syndrome (ACS). Whilst TPCP-UCA patients are known to be younger with less cardiovascular risk factors when compared to obstructive coronary disease (MICAD), no validated methods exist to reliably delineate these two conditions prior to coronary angiography.
METHODS:
We analysed 142 patients with MICAD and 127 patients with TPCP-UCA from 2015 to 2019. Several key predetermined clinical, biochemical and electrocardiograph (ECG) parameters, as well as Global Registry of Acute Coronary Events (GRACE) score, were collected for all patients. All TPCP-UCA patients underwent cardiac magnetic resonance imaging (cMRI).
RESULTS:
Patients with TPCP-UCA were younger than MICAD (44 vs 68 yrs, p
CONCLUSIONS:
TPCP-UCA is an important differential for patients presenting with ACS, and has several key demographic, biochemical and electrocardiographic differences. The present findings are hypothesis generating, thus prospective studies are required to determine and validate potential clinical utility.
Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
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Use of a single dose of 70mg/kg chloral hydrate as a hypnotic in nuclear magnetic resonance. A prospective study of 3132 cases.
Rev Esp Anestesiol Reanim (Engl Ed)2022 Jun;():. doi: S2341-1929(22)00097-X.
Sistac Ballarín J M, Solé Guixes J, Groizard Botella M J, Sistac Palacín J M,
Abstract
OBJECTIVE:
To assess the mean time to hypnosis, hemodynamic stability, and incidence of complications associated with the administration of 70mg/kg oral chloral hydrate in children scheduled for magnetic resonance imaging (MRI).
MATERIAL AND METHODS:
Prospective study conducted from January 2000 to January 2020 in which 3132 patients aged between one day and 5 years underwent MRI under anaesthesia in an outpatient setting. The study population was divided into 4 subgroups: A) aged between one and 30 days; B) aged between one month and one year; C) aged between one and 3 years, and D) aged between 3 and 5 years. Study variables were: sex, age, type of examination, mean imaging time, mean time to awakening, heart rate before and after MRI, SatO, and incidence of complications such as respiratory depression (SatO below 90%), agitation during the MRI or on awakening (intense crying lasting more than 2min), prolonged sedation measured on the Steward scale, and nausea and/or vomiting during the MRI, on awakening, or at home.
RESULTS:
No notable hemodynamic alterations were observed. The incidence of desaturation was .41%, awakening during the test was .16%, prolonged sedation was 1.08%, and agitated awakening was 1.46%. Nausea and vomiting at the end of the test had an incidence of .73%. The P value in all cases was <.05>
CONCLUSIONS:
Chloral hydrate at a dose of 70mg/kg continues to be suitable in sedation lasting no more than one hour for non-invasive procedures in children, and is associated with adequate haemodynamic stability with practically no side effects.
Copyright © 2021 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.
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Regional hypothalamic, amygdala, and midbrain periaqueductal gray matter recruitment during acute pain in awake humans: a 7-tesla functional magnetic resonance imaging study.
Neuroimage2022 Jun;():119408. doi: S1053-8119(22)00525-0.
Robertson Rebecca V, Crawford Lewis S, Meylakh Noemi, Macey Paul M, Macefield Vaughan G, Keay Kevin A, Henderson Luke A,
Abstract
Over the past two decades, magnetic resonance imaging (MRI) studies have explored brain activation patterns during acute noxious stimuli. Whilst these human investigations have detailed changes in primarily cortical regions, they have generally not explored discrete changes within small brain areas that are critical in driving behavioural, autonomic, and endocrine responses to pain, such as within subregions of the hypothalamus, amygdala, and midbrain periaqueductal gray matter (PAG). Ultra-high field (7-Tesla) MRI provides enough signal-to-noise at high spatial resolutions to investigate activation patterns within these small brain regions during acute noxious stimulation in awake humans. In this study we used 7T functional MRI to concentrate on hypothalamic, amygdala, and PAG signal changes during acute noxious orofacial stimuli. Noxious heat stimuli were applied in three separate fMRI scans to three adjacent sites on the face in 16 healthy control participants (7 females). Images were processed using SPM12 and custom software, and blood oxygen level dependent signal changes within the hypothalamus, amygdala, and PAG assessed. We identified altered activity within eight unique subregions of the hypothalamus, four unique subregions of the amygdala, and a single region in the lateral PAG. Specifically, within the hypothalamus and amygdala, signal intensity largely decreased during noxious stimulation, and increased in the lateral PAG. Furthermore, we found sex-related differences in discrete regions of the hypothalamus and amygdala. This study reveals that the activity of discrete nuclei during acute noxious thermal stimulation in awake humans.
Copyright © 2022. Published by Elsevier Inc.
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