Jordi Estornell-Erill

Diagnóstico etiológico de la disfunción ventricular izquierda con tomografía computarizada: comparación con coronariografía y cardiorresonancia

INTRODUCTION AND OBJECTIVES To evaluate the capability of multidetector computed tomography to diagnose the coronary etiology of left ventricular dysfunction compared with using invasive coronary angiography and magnetic resonance. METHODS Forty consecutive patients with left ventricular dysfunction of uncertain etiology underwent invasive coronary angiography and contrast magnetic resonance. All patients were evaluated with multidetector computed tomography including coronary calcium presence and score, noninvasive coronary angiography, and myocardial tissue assessment. RESULTS The sensitivity and specificity of the presence of coronary calcium to identify left ventricular dysfunction was 100% and 31%, respectively. If an Agatston calcium score of >100 is taken, specificity increases to 58% with sensitivity still 100%. Sensitivity and specificity for coronary angiography by multidetector computed tomography was 100% and 96%, respectively; for identifying necrosis in contrast acquisition it was 57% and 100%, respectively; and in late acquisition, 84% and 96%, respectively. To identify coronary ventricular dysfunction with necrosis, the sensitivity and specificity was 92% and 100%, respectively. CONCLUSIONS Of all the diagnostic tools available in multidetector computed tomography, coronary angiography is the most accurate in determining the coronary origin of left ventricular dysfunction. A combination of coronary angiography and myocardial tissue study after contrast allows a single test to obtain similar information compared with the combination of invasive coronary angiography and contrast magnetic resonance.

Mean platelet volume is associated with infarct size and microvascular obstruction estimated by cardiac magnetic resonance in ST segment elevation myocardial infarction.

Mean platelet volume (MPV) is an indicator of platelet activation. High MPV has been recently considered as an independent risk factor for poor outcomes after ST-segment elevation myocardial infarction (STEMI). We analyzed 128 patients diagnosed with first STEMI successfully reperfused during three consecutive years. MPV was measured on admission and a cardiac magnetic resonance (CMR) exam was performed within the first week in all patients. Myocardial necrosis size was estimated by the area of late gadolinium enhancement (LGE), identifying microvascular obstruction (MVO), if present. Clinical outcomes were recorded at 1 year follow-up. High MPV was defined as a value in the third tertile (≥9.5 fl), and a low MPV, as a value in the lower two. We found a slight but significant correlation between MPV and infarct size (r = 0.287, P = 0.008). Patients with high MPV had more extensive infarcted area (percentage of necrosis by LGE: 17.6 vs. 12.5%, P = 0.021) and more presence of MVO (patients with MVO pattern: 44.4 vs. 25.3%, P = 0.027). In a multivariable analysis, hazard ratio for major adverse cardiac events was 3.35 [95% confidence interval (CI) 1.1–9.9, P = 0.03] in patients with high MPV. High MPV in patients with first STEMI is associated with higher infarct size and more presence of MVO measured by CMR.

Prognostic value of pulmonary vascular resistance estimated by cardiac magnetic resonance in patients with chronic heart failure

AIMS Pulmonary arterial hypertension is known to be related to worse prognosis in patients with heart failure (HF). Quantification of pulmonary vascular resistance (PVR) still requires invasive right heart catheterization. Recent studies have shown an accurate method for non-invasive estimation of PVR by cardiac magnetic resonance (CMR). Our aim was to evaluate the prognostic value of PVR calculated by CMR in patients with congestive HF. METHODS AND RESULTS We calculated PVR by CMR in 132 patients [age 65.6 ± 13.1 years, left ventricular ejection fraction (LVEF) 35.1 ± 16.4%, ischaemic aetiology 40%] recently admitted for decompensated HF and derived to our cardiac imaging unit for diagnosis. Patients with cardiac events (readmission for HF or all-cause death) had higher values of PVR [6.77 ± 1.9 vs. 4.1 ± 1.6 Wood units (Wu), P < 0.001] during follow-up [mean 10.3 (1-31) months]. In multivariable Cox regression analysis, only a PVR ≥5.2 Wu [hazard ratio (HR) 4.27; 95% confidence interval (CI) 1.75-10.42; P < 0.001) and the presence of late gadolinium enhancement (LGE) on CMR (HR 2.24; 95% CI 1.03-4.86; P = 0.04) were independent predictors for adverse events at follow-up. CONCLUSION Non-invasive estimation of PVR by CMR might be useful for risk stratification of patients with chronic HF, irrespective of aetiology or LVEF.

Gerbode-type left ventricular outflow tract to right atrial fistula complicating prosthetic aortic valve replacement identified by cardiac computed tomographic angiography.

Acquired left ventricular-right atrial communication (Gerbode-type defect) is a rare complication of infective endocarditis. Although transesophageal echocardiography remains the technique of choice for the evaluation of complications of endocarditis this case highlights the usefulness of cardiac computed tomography in this scenario, particularly in cases where assessment of coronary anatomy is required before surgery.

Pulsatile thoracic mass after transcatheter aortic valve implantation

A 85-year-old woman was referred to our hospital with a pulsatile mass in the surgical wound of a previous left thoracotomy ( A ; Supplementary data online, Video S1 ). Three months earlier, the patient underwent transcatheter aortic valve implantation via subclavian access with a 26-mm CoreValve prosthesis (Medtronic, Inc., Minneapolis, USA) due to severe aortic …

Prognostic Value of Pulmonary Vascular Resistance by Magnetic Resonance in Systolic Heart Failure

Background Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. Objective We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). Methods Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVRwere calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. Results 105 patients (average LVEF 26.0 ±7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). Conclusions In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.

The prognostic value of red cell distribution width in ST segment elevation myocardial infarction is independent of necrosis size.

Letter to the Editor Red blood cell distribution width (RDW), a measurement of the variability in size of circulating erythrocytes, has emerged as a strong prognostic factor in patients with heart failure and coronary disease, although the value considered as a risk factor is not yet known. Its relationship with the necrosis area in patients with ST-segment elevation acute myocardial infarction (STEMI) has not been previously evaluated. The aim of this study was to determine whether the prognostic impact of RDW in cardiovascular event rate in patients with STEMI was associated with the extent of myocardial necrosis.

Chest pain with minimal activities and flexion of trunk: a rare case of angina.

A 53-year-old woman presented with effort-induced chest pain during daily activities and similar symptoms with trunk flexion. A treadmill exercise test revealed a Mobitz II atrioventricular block. Coronarography and computed tomography confirmed the diagnosis of anomalous origin of the right coronary artery from the left coronary sinus, so surgical revascularization was indicated. We discuss the peculiarity of the clinical presentation and its possible pathogenic mechanism.

Isolated RV diverticulum: diagnosis by cardiac magnetic resonance and 3D TEE

A 16-year-old male was referred to our hospital because of exertional chest pain. There was no personal or family history of any cardiovascular disease. Findings on physical examination and vital signs were normal. An ECG showed a right bundle superoanterior zonal block pattern with low potentials in frontal plane and intraventricular conduction delay (QRS Complex 120 msg) with pseudo-epsilon wave in V1 …

Left Ventricular Pseudoaneurysm Secondary to Mitral Valve Endocarditis

A follow-up transesophageal echocardiography (TEE) was performed on a 76-year-old woman with a recent history of mitral valve endocarditis after 4 weeks of antibiotic treatment. TEE showed a pulsatile perivalvular echo-free space of 32 × 23 mm with a narrow orifice which communicated to the left ventricle at the posterior mitral subannular position consistent with the pseudoaneurysm (Panel A). The real-time three-dimensional TEE allowed us to see its relationship with the neighboring structures (Panels B and C). Subsequently, a coronary CT angiogram confirmed these findings and revealed no significant coronary stenosis (Panels D and E). Therefore, surgery was indicated and a bovine pericardium patch was implanted with good results.