Jugular venous pressure: a cardinal sign Ferrante, Giuseppe, MD; Pugliese, Francesca, MD; Di Mario, Carlo, Prof
The Lancet (British edition),
09/2010, Letnik:
376, Številka:
9743
Journal Article
Recenzirano
A 40-year-old woman presented to our outpatient clinic for routine follow-up. 6 years earlier she had been diagnosed with a stenotic bicuspid aortic valve, which was treated with a 25 mm ...bioprosthesis implantation.
Older patients with severe aortic stenosis (AS) are increasingly identified as having cardiac amyloidosis (CA). It is unknown whether concomitant AS-CA has worse outcomes or results in futility of ...transcatheter aortic valve replacement (TAVR).
This study identified clinical characteristics and outcomes of AS-CA compared with lone AS.
Patients who were referred for TAVR at 3 international sites underwent blinded research core laboratory 99mtechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy (Perugini grade 0: negative; grades 1 to 3: increasingly positive) before intervention. Transthyretin-CA (ATTR) was diagnosed by DPD and absence of a clonal immunoglobulin, and light-chain CA (AL) was diagnosed via tissue biopsy. National registries captured all-cause mortality.
A total of 407 patients (age 83.4 ± 6.5 years; 49.8% men) were recruited. DPD was positive in 48 patients (11.8%; grade 1: 3.9% n = 16; grade 2/3: 7.9% n = 32). AL was diagnosed in 1 patient with grade 1. Patients with grade 2/3 had worse functional capacity, biomarkers (N-terminal pro-brain natriuretic peptide and/or high-sensitivity troponin T), and biventricular remodeling. A clinical score (RAISE) that used left ventricular remodeling (hypertrophy/diastolic dysfunction), age, injury (high-sensitivity troponin T), systemic involvement, and electrical abnormalities (right bundle branch block/low voltages) was developed to predict the presence of AS-CA (area under the curve: 0.86; 95% confidence interval: 0.78 to 0.94; p < 0.001). Decisions by the heart team (DPD-blinded) resulted in TAVR (333 81.6%), surgical AVR (10 2.5%), or medical management (65 15.9%). After a median of 1.7 years, 23% of patients died. One-year mortality was worse in all patients with AS-CA (grade: 1 to 3) than those with lone AS (24.5% vs. 13.9%; p = 0.05). TAVR improved survival versus medical management; AS-CA survival post-TAVR did not differ from lone AS (p = 0.36).
Concomitant pathology of AS-CA is common in older patients with AS and can be predicted clinically. AS-CA has worse clinical presentation and a trend toward worse prognosis, unless treated. Therefore, TAVR should not be withheld in AS-CA.
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Objectives We hypothesized that percutaneous coronary intervention (PCI) without additional contrast agents can be performed by directly integrating multislice computed tomography coronary ...angiography (CTCA) within the magnetic navigation system (MNS). Background Increasingly, CTCA is being used in the diagnostic work-up of patients with coronary disease. Its inherent 3-dimensional information should be exploited, as it potentially offers advantages over 2-dimensional radiography in guiding invasive diagnostic and therapeutic interventions. Methods CTCA-derived centerlines from 15 patients were coregistered and overlaid on real-time fluoroscopic images employing the MNS. Vessels were manually wired with a magnetically enabled guidewire assisted by variable local magnetic fields. Fractional flow reserve (FFR) determined the lesion severity, and the dimensions were quantified by intravascular ultrasound (IVUS). Locations of the IVUS catheter probe along the lesion were incorporated in software to facilitate stenting without contrast agents. Results The average crossing and fluoroscopic times were 105.3 ± 35.5 s and 83.4 ± 38.6 s, respectively, with no contrast agents used in 11 of 15 patients (73.3%). Contrast agents were used in only 1 of 10 patients (10%) in whom an IVUS was performed. In 4 patients, apart from a “blinded” safety check angiogram, the entire PCI (lesion crossing, stent sizing, positioning, and deployment) was performed without additional contrast agents following the coregistration of the IVUS probe position in the MNS. Conclusions The integration of pre-procedural CTCA within the MNS can facilitate PCI without additional contrast agents.
Cardiac computed tomography (CT) was introduced in the late 1990's. Since then, an increasing body of evidence on its clinical applications has rapidly emerged. From an initial emphasis on its ...technical efficiency and diagnostic accuracy, research around cardiac CT has now evolved towards outcomes-based studies that provide information on prognosis, safety, and cost. Thanks to the strong and compelling data generated by large, randomized control trials, the scientific societies have endorsed cardiac CT as pivotal diagnostic test for the management of appropriately selected patients with acute and chronic coronary syndrome. This consensus document endorsed by the European Association of Cardiovascular Imaging is divided into two parts and aims to provide a summary of the current evidence and to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. This first part focuses on the most established applications of cardiac CT from primary prevention in asymptomatic patients, to the evaluation of patients with chronic coronary syndrome, acute chest pain, and previous coronary revascularization.
Abstract
By deciding to condition the access of research organizations to its €95.5 billion Horizon Europe funding programme (2021–7) on providing evidence of a gender equality plan, the European ...Commission has made the challenge of certifying the gender equality performance of research organizations extremely urgent, not least to avoid the risk that such plans become a mere formality (‘box-ticking’). This challenge should not be underestimated, considering the extremely complex nature of the dynamics surrounding gender equality. In this article, we analyse the feasibility of establishing a European certification scheme that would assess gender equality policies and outcomes of research organizations, and present four alternative scenarios for its set-up, co-created with a wide range of stakeholders in a participatory step-by-step process. The results of the two-stage validation process of the four scenarios are also presented, providing policy implications and recommendations to support the effective roll-out of the certification schemes.
Abstract
Cardiac computed tomography (CT) was initially developed as a non-invasive diagnostic tool to detect and quantify coronary stenosis. Thanks to the rapid technological development, cardiac CT ...has become a comprehensive imaging modality which offers anatomical and functional information to guide patient management. This is the second of two complementary documents endorsed by the European Association of Cardiovascular Imaging aiming to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. In this article, emerging CT technologies and biomarkers, such as CT-derived fractional flow reserve, perfusion imaging, and pericoronary adipose tissue attenuation, are described. In addition, the role of cardiac CT in the evaluation of atherosclerotic plaque, cardiomyopathies, structural heart disease, and congenital heart disease is revised.
Graphical Abstract
Clinical applications of cardiac CT. For more details, please refer to Table 1 which summarizes the main applications of cardiac CT. CAD, coronary artery disease; CT, computed tomography; CTP, computed tomography perfusion; FFRCT, CT-derived fractional flow reserve; LAA, left atrial appendage; TAVI, transcatheter aortic valve implantation.
Aortic valve stenosis (AVS) is one of the most prevalent pathologies affecting the heart that can curtail expected survival and quality of life if not managed appropriately.
Cardiac computed ...tomography (CT) has long played a central role in this subset, mostly for severity assessment and for procedural planning. Although not as widely accepted as other imaging modalities for functional myocardial assessment i. e., transthoracic echocardiogram (TTE), cardiac magnetic resonance (CMR), this technique has recently increased its clinical application in this regard.
The ability to provide morphological, functional, tissue, and preprocedural information highlights the potential of the "all-in-one" concept of cardiac CT as a potential reality for the near future for AVS assessment. In this review article, we sought to analyze the current applications of cardiac CT that allow a full comprehensive evaluation of aortic valve disease.
· Noninvasive myocardial tissue characterization stopped being an exclusive feature of cardiac magnetic resonance.. · Emerging acquisition methods make cardiac CT an accurate and widely accessible imaging modality.. · Cardiac CT has the potential to become a "one-stop" exam for comprehensive aortic stenosis assessment..
· Gama FF, Patel K, Bennett J et al. Myocardial Evaluation in Patients with Aortic Stenosis by Cardiac Computed Tomography. Fortschr Röntgenstr 2023; 195: 506 - 513.
The clinical analysis of myocardial dynamic computed tomography myocardial perfusion imaging lacks standardization. The objective of this prospective study was to compare different analysis ...approaches to diagnose ischemia in patients with stable angina referred for invasive coronary angiography.
Patients referred for evaluation of stable angina symptoms underwent adenosine-stress dynamic computed tomography myocardial perfusion imaging with a second-generation dual-source scanner. Quantitative perfusion parameters, such as blood flow, were calculated by parametric deconvolution for each myocardial voxel. Initially, perfusion parameters were extracted according to standard 17-segment model of the left ventricle (fully automatic analysis). These were then manually sampled by an operator (semiautomatic analysis). Areas under the receiver-operating characteristic curves of the 2 different approaches were compared. Invasive fractional flow reserve ≤0.80 or diameter stenosis ≥80% on quantitative coronary angiography was used as reference standard to define ischemia. We enrolled 115 patients (88 men; age 57±9 years). There were 72 of 286 (25%) vessels causing ischemia in 52 of 115 (45%) patients. The semiautomatic analysis method was better than the fully automatic method at predicting ischemia (areas under the receiver-operating characteristic curves, 0.87 versus 0.69;
<0.001) with readings obtained in the endocardial myocardium performing better than those in the epicardial myocardium (areas under the receiver-operating characteristic curves, 0.87 versus 0.72;
<0.001). The difference in performance between blood flow, expressed as relative to remote myocardium, and absolute blood flow was not statistically significant (areas under the receiver-operating characteristic curves, 0.90 versus 0.87;
=ns).
Endocardial perfusion parameters obtained by semiautomatic analysis of dynamic computed tomography myocardial perfusion imaging may permit robust discrimination between coronary vessels causing ischemia versus not causing ischemia.
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