The international journal of cardiovascular imaging
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Int J Cardiovasc Imaging · Feb 2014
Pre-operative left atrial strain predicts post-operative atrial fibrillation in patients undergoing aortic valve replacement for aortic stenosis.
Post-operative atrial fibrillation (AF) is a common and serious complication in patients undergoing aortic valve replacement (AVR). Speckle tracking echocardiography (STE) has recently enabled the quantification of longitudinal myocardial left atrial (LA) deformation dynamics. Our aim was to investigate LA preoperative mechanical function in patients undergoing AVR for aortic stenosis using STE and determine predictors of post-operative AF. 76 patients with aortic stenosis in sinus rhythm, undergoing AVR, were prospectively enrolled. ⋯ LA volume indexed and E/e' ratio had lower diagnostic accuracy (AUC 0.76 and 0.51, respectively). On multivariate analysis global PALS remains a significant predictor of postoperative AF (p < 0.0001). STE analysis of LA myocardial deformation is considered a promising tool for the evaluation of LA subclinical dysfunction in patients undergoing AVR, giving a potentially better risk stratification for the occurrence of postoperative AF.
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Int J Cardiovasc Imaging · Feb 2014
Left atrial booster-pump function as a predictive parameter for new-onset postoperative atrial fibrillation in patients with severe aortic stenosis.
Postoperative atrial fibrillation (POAF) is associated with increased risk of embolic events and heart failure, but its associated factors remains unknown. Left atrial (LA) subclinical mechanical dysfunction caused by the acute stress of surgery may be clinically manifested as POAF. The purpose of our study was therefore to test the hypothesis that preoperative LA subclinical myocardial dysfunction is a potential predictor of development of POAF in patients with aortic stenosis (AS). ⋯ Of the 15 patients with POAF, one developed paroxysmal AF during long-term follow-up. In conclusions, SR-LAa helped to detect subtle LA booster-pump dysfunction and was associated with new-onset POAF in patients with severe AS. These findings may be useful for risk stratification and management of such patients.
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Int J Cardiovasc Imaging · Jan 2014
Comparative StudyUse of multi-slice computed tomography in patients with chest-pain submitted to the emergency department.
This study evaluates calcium scoring (CS) and computed tomography angiography (MSCTA) in patients >50 years with chest-pain submitted to the emergency department utilising CS as a "diagnostic filter" upfront. Results of CS and MSCTA performed by a 64-slice CT scanner were compared to invasive coronary angiography (ICA). 289 consecutive symptomatic patients (185 men, mean age 71.3 ± 6.4 years) were included. In patients with CS = 0 (Group I; n = 60) or CS > 400 (Group III; n = 95) we refrained from MSCTA, whereas patients with CS 1-400 (Group II; n = 134) underwent subsequent MSCTA. ⋯ Still server calcifications impair image quality in MSCTA. Thus direct referral to ICA might be a reasonable approach in case of high CS. In patients with intermediate CS, MSCTA is able to rule out significant CAD with a high NPV.
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Int J Cardiovasc Imaging · Jan 2014
Global longitudinal strain in patients with suspected heart failure and a normal ejection fraction: does it improve diagnosis and risk stratification?
Many patients have clinical, structural or bio-marker evidence of heart failure (HF) but a normal left ventricular ejection fraction (LVEF; HeFNEF). Measurement of global longitudinal strain (GLS) may add diagnostic and prognostic information. Patients with symptoms suggesting heart failure and LVEF ≥50% were studied: 76 had no substantial cardiac dysfunction (left atrial diameter (LAD) <40 mm and amino-terminal pro-brain natriuretic peptide (NTproBNP) <400 ng/l); 99 had "possible HeFNEF" (LAD ≥40 mm or NTproBNP ≥400 ng/l); and 138 had "definite HeFNEF" (LAD ≥40 mm and NTproBNP ≥400 ng/L). ⋯ In univariable analysis, GLS but not LVEF predicted events. However, in a multi-variable analysis, only urea, NTproBNP, left atrial volume, inferior vena cava diameter and atrial fibrillation independently predicted adverse outcome. GLS is abnormal in patients who have other evidence of HeFNEF, is associated with a worse prognosis in this population but is not a powerful independent predictor of outcome.
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Int J Cardiovasc Imaging · Jan 2014
Coronary artery angiography and myocardial viability imaging: a 3.0-T contrast-enhanced magnetic resonance coronary artery angiography with Gd-BOPTA.
With improving MR sequence, phase-array coil and image quality, cardiac magnetic resonance imaging is becoming a promising method for a comprehensive non-invasive evaluation of coronary artery and myocardial viability. The study aimed to evaluate contrast-enhanced whole-heart coronary MR angiography (CE WH-CMRA) at 3.0-Tesla for the diagnosis of significant stenosis (≥50%) and detection of myocardial infarction (MI) in patients with suspected coronary artery disease (CAD). CE WH-CMRA was performed in consecutive 70 patients with suspected CAD by using a 3.0-T MR system. ⋯ Only one MI patient was judged inconsistent between WH-CMRA and 2D-PSIR-SSFP, who was confirmed by clinical and electrocardiogram results. The enhancement pattern in this patient was spotted and focal in 2D-PSIR-SSFP, but was dismissed by WH-CMRA. It is feasible to obtain information about coronary artery stenosis and myocardial viability in a single CE WH-CMRA with administration of Gd-BOPTA.