I. Simón-Yarza

Assessment of left ventricular parameters in orthotopic heart transplant recipients using dual-source CT and contrast-enhanced echocardiography: Comparison with MRI

OBJECTIVES To establish the accuracy and reliability of cardiac dual-source CT (DSCT) and two-dimensional contrast-enhanced echocardiography (CE-Echo) in estimating left ventricular (LV) parameters with respect to cardiac magnetic resonance imaging (CMR) as the reference standard. METHODS Twenty-five consecutive heart transplant recipients (20 male, mean age 62.7±10.4 years, mean time since transplantation 8.1±5.9 years) were prospectively recruited. Two blinded readers independently assessed LV ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) for each patient after manual tracing of the endo- and epicardial contours in DSCT, CE-Echo and CMR cine images. Students t-test for paired samples for differences, and Bland and Altman plots and Lins concordance-correlation coefficients (CCC) for agreement were calculated. RESULTS There was no statistical difference between left ventricular parameters determined by DSCT and CMR. CE-Echo resulted in significant underestimation of left ventricular volumes (mean difference EDV: 15.94±14.19 ml and 17.1±17.06 ml, ESV: 8.5±9.3 and 7.32±9.14 ml with respect to DSCT and CMR), and overestimation of EF compared with the cross-sectional imaging modalities (3.78±8.47% and 2.14±8.35% with respect to DSCT and CMR). Concordance correlation coefficients for LV parameters using DSCT and CMR were higher (CCC≥0.75) than CCC values observed between CE-Echo and DSCT- or CMR-derived data (CCC≥0.54 and CCC≥0.49, respectively). Interobserver agreement was higher for DSCT and CMR values (CCC≥0.72 and CCC≥0.87, respectively). CONCLUSION In orthotopic heart transplantation cardiac DSCT allows accurate and reliable estimation of LV parameters compared with CMR, whereas CE-Echo seems to be insufficient to obtain precise measurements.

Incidental computed tomography diagnosis of a rare triad consisting of absence of coronary sinus, persistent left superior vena cava, and scimitar syndrome

We report a case of an unusual congenital triad consisting of absence of coronary sinus, persistent left superior vena cava and scimitar syndrome incidentally found in a CT-scan performed on a female complaining of exertional dyspnea.

Feasibility of epicardial adipose tissue quantification in non-ECG-gated low-radiation-dose CT: comparison with prospectively ECG-gated cardiac CT:

Background Epicardial adipose tissue (EAT) is an important indicator of cardiovascular risk. This parameter is generally assessed on ECG-gated computed tomography (CT) images. Purpose To evaluate feasibility and reliability of EAT quantification on non-gated thoracic low-radiation-dose CT examinations with respect to prospectively ECG-gated cardiac CT acquisition. Material and Methods Sixty consecutive asymptomatic smokers (47 men; mean age 64 ± 9.8 years) underwent low-dose CT of the chest and prospectively ECG-gated cardiac CT acquisitions (64-slice dual-source CT). The two examinations were reconstructed with the same range, field of view, slice thickness, and convolution algorithm. Two independent observers blindly quantified EAT volume using commercially available software. Data were compared with paired sample Student t-test, concordance correlation coefficients (CCC), and Bland-Altman plots. Results No statistically significant difference was observed for EAT volume quantification with low-dose-CT (141.7 ± 58.3 mL) with respect to ECG-gated CT (142.7 ± 57.9 mL). Estimation of CCC showed almost perfect concordance between the two techniques for EAT-volume assessment (CCC, 0.99; mean difference, 0.98 ± 5.1 mL). Inter-observer agreement for EAT volume estimation was CCC: 0.96 for low-dose-CT examinations and 0.95 for ECG-gated CT. Conclusion Non-gated low-dose CT allows quantifying EAT with almost the same concordance and reliability as using dedicated prospectively ECG-gated cardiac CT acquisition protocols.

Obstrucción del drenaje venoso hepático tras trasplante: resultados del tratamiento con endoprótesis autoexpandibles

OBJECTIVES To evaluate the safety and patency of self-expanding stents to treat hepatic venous outflow obstruction after orthotopic liver transplantation. To evaluate differences in the response between patients with early obstruction and patients with late obstruction. MATERIAL AND METHODS This is a retrospective analysis of 16 patients with hepatic venous outflow obstruction after liver transplantation treated with stents (1996-2011). Follow-up included venography/manometry, ultrasonography, CT, and laboratory tests. We did a descriptive statistical analysis of the survival of patients and stents, technical and clinical success of the procedure, recurrence of obstruction, and complications of the procedure. We also did an inferential statistical analysis of the differences between patients with early and late obstruction. RESULTS The mean follow-up period was 3.34 years (21-5,331 days). The technical success rate was 93.7%, and the clinical success rate was 81.2%. The rate of complications was 25%. The survival rates were 87.5% for patients and 92.5% for stents. The rate of recurrence was 12.5%. The rate of primary patency was 0.96 (95% CI 0.91-1) at 3 months, 0.96 (95% CI 0.91-1) at 6 months, 0.87 (95% CI 0.73-1) at 12 months, and 0.87 (95% CI 0.73-1) at 60 months. There were no significant differences between patients with early and late obstruction, although there was a trend toward higher rates of primary patency in patients with early obstruction (P=.091). CONCLUSIONS Treating hepatic venous outflow obstruction after orthotopic transplantation with self-expanding stents is effective, durable, and effective. There are no significant differences between patients with early obstruction and those with late obstruction.

Valoración de la comorbilidad cardíaca en pacientes con enfermedad pulmonar obstructiva crónica mediante tomografía computarizada multidetector

Cardiac comorbidity is one of the most important prognostic factors in lung disease, especially in chronic obstructive pulmonary disease (COPD). The imaging techniques available for the study of this systemic manifestation concomitant with COPD include heart catheterization, transthoracic echocardiography, and magnetic resonance imaging. Multidetector computed tomography (MDCT) represents a significant advance in this field because it enables the acquisition of simultaneous studies of the cardiopulmonary anatomy that go beyond anatomic and morphologic analysis to include a functional approach to this condition. In this article, we review the practical aspects necessary to evaluate cardiac comorbidity in patients with COPD, both from the point of view of pulmonary hypertension and of the analysis of ventricular dysfunction and coronary heart disease.