The international journal of cardiovascular imaging
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Int J Cardiovasc Imaging · Mar 2009
ReviewCoronary CT angiography in emergency department patients with acute chest pain: triple rule-out protocol versus dedicated coronary CT angiography.
Immediate coronary catheterization is mandatory for high risk patients with typical chest pain in the emergency department (ED). In contrast, in ED patients with acute chest pain but low to intermediate risk, traditional management protocol includes serial ECG, cardiac troponins and radionuclide perfusion imaging. However, this protocol is time-consuming and expensive, and definite treatment of unstable angina is often delayed. ⋯ In ED patients with atypical chest pain and low to intermediate risk, the triple rule-out protocol may be preferred, especially in older patients who have relatively lower risk of lifelong radiation-induced cancer. However, the increased radiation dose resulting from the extended volume coverage with this protocol should be fully considered prior to performing this protocol. Therefore, in ED patients who have a low clinical suspicion of pulmonary embolism and acute aortic syndrome, especially younger patients, dedicated coronary CT angiography accompanied by modifications to reduce radiation dose is recommended.
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Int J Cardiovasc Imaging · Mar 2009
Correlation of right ventricular ejection fraction and tricuspid annular plane systolic excursion in tetralogy of Fallot by magnetic resonance imaging.
The correlation between right ventricular ejection fraction (RVEF) and tricuspid annular plane systolic excursion (TAPSE) by two-dimensional (2-D) echo has been repeatedly validated, but not by magnetic resonance imaging (MRI) nor in patients with congenital heart disease. We tested whether TAPSE measurements by MRI correlate with RVEF in surgically repaired tetralogy of Fallot (TOF) patients. TAPSE was measured from systolic displacement of the RV-freewall/tricuspid annular plane junction in the apical 4-chamber view in 7 normal subjects and 14 TOF patients. ⋯ Regional stroke volume in apical slices correlated inversely with RVEF such that patients with higher apical stroke volume had lower RVEF (P < 0.05). TAPSE is not a reliable measure of RVEF in TOF by MRI. TAPSE may be of limited use in conditions that exhibit abnormal regional contraction.
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Int J Cardiovasc Imaging · Feb 2009
Case ReportsEchocardiography and cardiovascular magnetic resonance diagnostic role in Takotsubo cardiomyopathy.
We presented the case of a diabetic 67-year old female patient suffering from "Takotsubo cardiomyopathy". She arrived at the emergency department with severe chest pain soon after acute emotional and physical stress. The echocardiography performed in the acute phase showed balloon-like left ventricular wall motion abnormality with severe global dysfunction that showed complete normalization 4 days after the onset of symptoms. Cardiovascular magnetic resonance in the acute phase showed a small subendocardial hypo-perfusion area in the inferior wall (no longer present at the 3 week follow-up evaluation) and delayed hyperenhancement after administration of intravenous gadolinium in the same region that showed a significant reduction after 3 weeks.
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Int J Cardiovasc Imaging · Jan 2009
Comparative StudyComparison of ECG-gated versus non-gated CT ventricular measurements in thirty patients with acute pulmonary embolism.
To prospectively compare cardiac ventricular measurements from non-gated CT and end-diastolic ECG-gated CT in patients with acute pulmonary embolism (PE). ⋯ The benefit from a separate ECG-gated CT scan for the evaluation of RV ventricular diameter, area, and volume measurements is minimal and does not justify its routine clinical use.
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Int J Cardiovasc Imaging · Dec 2008
Apical ballooning syndrome or aborted acute myocardial infarction? Insights from cardiovascular magnetic resonance imaging.
Apical Ballooning Syndrome (ABS) is a novel acute cardiac syndrome that mimics acute myocardial infarction (AMI). This study evaluates the diagnostic utility of cardiac magnetic resonance imaging (CMR) in patients with suspected ABS. ⋯ While ABS mimics AMI, AMI with spontaneous clot lysis may also mimic ABS, and at least in some patients, be mistaken for ABS. ABS is characterized by the absence of MDE and complete myocardial viability on CMR. The diagnosis of ABS can be excluded if CMR demonstrates MDE consistent with myocardial necrosis in a pattern and distribution consistent with AMI.