Unexplained cardiac arrest after near drowning in a young experienced swimmer: insight from cardiovascular magnetic resonance imaging

Cardiac magnetic resonance imaging (cMRI) is a well-established noninvasive imaging modality in clinical cardiology. Its ability to provide tissue characterization make it well suited for the study of patients with cardiac diseases. We describe a multi-modality imaging evaluation of a 45-year-old man who experienced a near drowning event during swimming. We underline the unique capability of tissue characterization provided by cMRI, which allowed detection of subtle, clinically unrecognizable myocardial damage for understanding the causes of sudden cardiac arrest and also showed the small damages caused by cardiopulmonary resuscitation

Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus

Purpose: To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). Methods and Materials: 147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. Results: Diabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. Conclusions: Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics

Left and right ventricle assessment with Cardiac CT: validation study vs. Cardiac MR

Objectives To compare Magnetic Resonance (MR) and Computed Tomography (CT) for the assessment of left (LV) and right (RV) ventricular functional parameters. Methods Seventy nine patients underwent both Cardiac CT and Cardiac MR. Images were acquired using short axis (SAX) reconstructions for CT and 2D cine b-SSFP (balanced- steady state free precession) SAX sequence for MR, and evaluated using dedicated software. Results CT and MR images showed good agreement: LV EF (Ejection Fraction) (52±14% for CT vs. 52±14% for MR; r0 0.73; p>0.05); RV EF (47±12% for CT vs. 47±12% for MR; r00.74; p>0.05); LV EDV (End Diastolic Volume) (74± 21 ml/m 2 for CT vs. 76±25 ml/m 2 for MR; r00.59; p>0.05); RV EDV (84±25 ml/m 2 for CT vs. 80±23 ml/m 2 for MR; r0 0.58; p>0.05); LV ESV (End Systolic Volume)(37±19 ml/m 2 for CT vs. 38±23 ml/m 2 for MR; r00.76; p>0.05); RV ESV (46±21 ml/m 2 for CT vs. 43±18 ml/m 2 for MR; r00.70; p>0.05). Intra- and inter-observer variability were good, and the performance of CT was maintained for different EF subgroups. Conclusions Cardiac CT provides accurate and reproducible LVand RV volume parameters compared with MR, and can be considered as a reliable alternative for patients who are not suitable to undergo MR. Key Points • Cardiac-CT is able to provide Left and Right Ventricular function. • Cardiac-CT is accurate as MR for LV and RV volume assessment. • Cardiac-CT can provide accurate evaluation of coronary arteries and LV and RV function

Analisi molecolare con Risonanza Magnetica Nucleare del tessuto miocardico in pazienti affetti da malattia di Anderson-Fabry: valore aggiunto della Risonanza Magnetica Cardiaca nell'identificazione e nel follow-up dei pazienti affetti da malattia di Anderson-Fabry in trattamento con enzima ricombinante agalsidase beta a dopo "switch therapy" con agalsidase alfa

Scopo La malattia di Anderson-Fabry è determinata da un disordine multi-sistemico del metabolismo lipidico dovuta alla carenza dell’enzima idrolitico α-galactosidase A (α-Gal A), secondario ad una alterazione del cromosoma X, che provoca un accumulo di “globotriaosylceramide” (Gb3) nelle cellule e nei tessuti in genere per malfunzionamento dei lisosomi. Tale accumulo provoca danni al cuore, ai reni ed al sistema cerebro-vascolare. In particolare la mancata degradazione dei glicosfingolipidi a livello cardiaco agisce come “spina irritativa” provocando una vera e propria ipertrofia con conseguente riduzione della “compliance” ed infine una ridotta “performance” del cuore. Dal 2001 è disponibile una terapia enzimatica sostitutiva rappresentata principalmente da due farmaci 1) agalsidase beta (Fabrazyme®, Genzyme Corporation, Cambridge, MA, USA) e 2) agalsidase alfa (Replagal®, Shire Human Genetic Therapies AB, Lund, Sweden). Nel giugno 2009, in seguito ad una carenza su scala mondiale dell’agalsidase beta, la maggior parte dei pazienti sono stati costretti ad un cambiamento di terapia utilizzando l’agalsidase alfa, unico farmaco facilmente reperibile. Lo scopo del nostro studio è stato quello di monitorare con Risonanza Magnetica Cardiaca gli effetti della “switch therapy” in pazienti affetti da malattia di Anderson-Fabry trattati in primo luogo con agalsidase beta e successivamente “costretti” ad utilizzare l’agalsidase alfa. Materiali e metodi Dieci pazienti (7 uomini e 3 donne) con malattia di Anderson-Fabry geneticamente confermata, trattati in precedenza per una media di 46 mesi con agalsidase beta alla dose di 1mg/Kg ogni due settimane, sono stati successivamente trattati con agalsidase alfa alla dose di 0.2mg/Kg ogni due settimane per almeno 20 mesi. Un estensivo protocollo con Risonanza Magnetica Cardiaca ha permesso di analizzare i parametri funzionali ed indagare i cambiamenti che si verificano a livello molecolare nel miocardio. Risultati Tutti i pazienti sono rimasti in condizioni stabili durante i 20 mesi in cui vi è stato il cambiamento del farmaco; la risonanza magnetica cardiaca non ha documentato cambiamenti significativi nella performance del ventricolo sinistro (FE p>0.05); non si sono avuti incrementi della massa ventricolare né dei massimi spessori cardiaci (p>0.05); la tecnica utilizzata per mostrare i cambiamenti molecolari non ha evidenziato un peggioramento significativo (p>0.05). Conclusioni Possiamo concludere che lo “switch” di trattamento da agalsidase beta ad agalsidase alfa non ha prodotto una recrudescenza della malattia ed ha preservato tutti i benefici della terapia con agalsidase beta sul muscolo cardiaco

Uncommon Isolated Unilocular Myocardial Cyst in a Dog-Friendly Young Female Patient — Multimodality Imaging —

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Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction

Myocardial haemorrhage is a common complication following reperfusion of ST-segment-elevation acute myocardial infarction (MI). Although its presence is clearly related to infarct size, at present it is unknown whether post-reperfusion haemorrhage affects left ventricular (LV) remodelling. Magnetic resonance imaging (MRI) can be used to identify MI, myocardial haemorrhage, and microvascular obstruction (MVO), as well as measure LV volumes, function, and mass.status: publishe

Vaginal angiomatosis: Differential diagnosis of a rare case

Vaginal angiomatosis is regarded as part of a very rare entity of benign vascular tumors of the female genital tract. The incidence of these tumors is extremely low. The rarity of this disease and lack of distinctive features poses a problem of differential diagnosis. We present the case of a 51-year-old female with grade III uterine prolapse and a bleeding vaginal wall mass. Violaceous irregular soft tissue with hemorrhagic spots was observed in the lower third of the posterior vaginal wall. The patient underwent surgery for colpohysterectomy with vaginal wall mass excision. Surgical excision was curative, and no recurrences were observed after 12 months of follow-up. The aim of our study is to present a rare but representative case. This will hopefully increase the level of awareness regarding this condition so that physicans will keep it in mind during differential diagnosis of similar clinical cases. Furthermore, it highlights the important role of pathological examination for the definitive diagnosis of angiomatosis