Cross-sectional imaging findings of cardiac outpouchings

A cardiac outpouching (CO) is a protrusion in a heart chamber’s internal anatomical lining. Most COs are clinically insignificant, but some are of vital importance, requiring immediate surgery. Cross-sectional imaging findings of COs, such as location, morphology, size, and accompanying wall motion abnormalities, play an essential role in determining the correct diagnosis and appropriate clinical management. Therefore, radiologists should be familiar with them. This article reviews the key cross-sectional imaging findings and differential diagnoses of COs

Fast and Successful Management of Intraocular Inflammation with a Single Intravitreal Dexamethasone Implant

Purpose: To investigate the efficacy and safety of a single dexamethasone intravitreal implant (Ozurdex®, 700 µg). Methods: In this prospective noncomparative case series, 84 patients (54 females) received a dexamethasone intravitreal implant. At weeks 4, 12 and 24 after the injection, vitreous haze, macular thickness and best corrected visual acuity (BCVA) were assessed and adverse events reported. Results: Clearance of vitreous haze could be achieved after 4 weeks in 61% of all eyes (p < 0.001) and remained significant until week 24 (p < 0.001). This was paralleled by a reduction of central retinal thickness after 4 (p < 0.001), 12 (p < 0.001) and 24 weeks (p < 0.006). Significant and fast improvement of BCVA was already achieved after 4 weeks (p < 0.001) but vanished by week 24. Intraocular pressure reached ≥35 mm Hg in 3 eyes and was significantly more frequent in intermediate uveitis compared to posterior uveitis (p < 0.016). Conclusions: The dexamethasone implant is effective in controlling intraocular posterior segment inflammation and reduces central retinal thickness fast and effectively. © 2014 S. Karger AG, Basel

Ct angiography evaluation of the renal vascular pathologies: a pictorial review

The emergence of CT angiography (CTA) has a groundbreaking impact on the evaluation of renal vessels and is gradually replacing the conventional catheter angiography as the standard imaging procedure. In this review, we aimed to describe the renal CTA technique and imaging findings of several renal arterial (i.e. atherosclerosis, fibromuscular dysplasia, aneurysms of the renal arteries, dissection, vasculitidis, follow-up of patients with renal arterial stent) and venous (i.e. nut-cracker syndrome, pelvic congestion syndrome) pathologies

Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-source multislice computed tomographic coronary angiography

Background: Total white blood cell (WBC) count has been consistently shown to be an independent risk factor and predictor for future cardiovascular outcomes, regardless of disease status in coronary artery disease (CAD). The purpose of this study is to evaluate the relationship between total WBC count and the presence, severity and extent of coronary atherosclerosis detected in subjects undergoing multislice computed tomographic (MSCT) coronary angiography for suspected CAD. Methods: A total of 817 patients were enrolled in this cross-sectional study. Non-significant coronary plaque was defined as lesions causing &#163; 50% luminal narrowing, and significant coronary plaque was defined as lesions causing > 50% luminal narrowing. For each segment, coronary atherosclerotic lesions were categorized as none, calcified, non-calcified and mixed. All images were interpreted immediately after scanning by an experienced radiologist. Results: An association between hypertension, diabetes mellitus, age, gender, hyperlipidemia, smoking, total WBC counts and coronary atherosclerosis was found when patients were grouped into two categories according to the presence of coronary atherosclerosis (p < 0.05). Although plaque morphology was not associated with total WBC counts, the extent of coronary atherosclerosis was increased with higher total WBC quartiles (p = 0.006). Patients with critical luminal stenosis had higher levels of total WBC counts when compared to patients with non-critical luminal narrowing (7,982 &#177; 2,287 vs 7,184 &#177; 1,944, p < 0.05). Conclusions: Our study demonstrated that total WBC counts play an important role in inflammation and are associated with the presence, severity and extent of coronary atherosclerosis detected by MSCT. Further studies are needed to assess the true impact of WBC counts on coronary atherosclerosis, and to promote its use in predicting CAD. (Cardiol J 2011; 18, 4: 371&#8211;377

Partial anomalous pulmonary venous connection with intact atrial septum in a child with ventricular septal defect: a case report

Partial anomalous pulmonary vein connection (PAPVC) is a rare congenital abnormal cardiac defect involving the pulmonary veins draining into the right atrium (RA) directly or indirectly by venous connection. Ninety percent of PAPVCs are accompanied by atrial septal defect (ASD). To our knowledge, there is no previous report of PAPVC with ventricular septal defect (VSD) without ASD in Korea, and in this paper, we report the first such case. A 2-day-old girl was admitted into the Chonnam National University Hospital for evaluation of a cardiac murmur. An echocardiogram revealed perimembranous VSD without ASD. She underwent patch closure of the VSD at 5 months of age. Although the VSD was completely closed, she had persistent cardiomegaly with right ventricular volume overload, as revealed by echocardiography. Three years later, cardiac catheterization and chest computed tomography revealed a PAPVC, with the right upper pulmonary vein draining into the right SVC. Therefore, correction of the PAPVC was surgically performed at 3 years of age. We conclude that it is important to suspect PAPVC in patients with right ventricular volume overload, but without ASD

Cholesterol efflux promoting function of high-density lipoproteins in calcific aortic valve stenosis

Background and aims: Cholesterol efflux capacity is a functional property of high-density lipoproteins (HDL) reflecting the efficiency of the atheroprotective reverse cholesterol transport process in humans. Its relationship with calcific aortic valve stenosis (CAVS) has not been fully assessed yet. Methods: We evaluated HDL-CEC in a patient population with varying degrees of aortic valvular calcific disease, assessed using echocardiography and cardiac computed tomography. Measurement of biomarkers that reflect osteogenic and tissue remodeling, along with dietary and gut microbiota-derived metabolites were performed. Results: Patients with moderate-severe CAVS had significantly lower HDL-CEC compared to both control and aortic sclerosis subjects (mean: 6.09%, 7.32% and 7.26%, respectively). HDL-CEC displayed negative correlations with peak aortic jet velocity and aortic valve calcium score, indexes of CAVS severity (ρ = -0.298, p = 0.002 and ρ = -0.358, p = 0.005, respectively). In multivariable regression model, HDL-CEC had independent association with aortic valve calcium score (B: -0.053, SE: 0.014, p &lt; 0.001), GFR (B: -0.034, SE: 0.012, p = 0.007), as well as with levels of total cholesterol (B: 0.018, SE: 0.005, p = 0.002). Conclusion: These results indicate an impairment of HDL-CEC in moderate-severe CAVS and may contribute to identify potential novel targets for CAVS management

EUCAST rapid antimicrobial susceptibility testing (RAST) in blood cultures: Validation in 55 european laboratories

Objectives: When bloodstream infections are caused by resistant bacteria, rapid antimicrobial susceptibility testing (RAST) is important for adjustment of therapy. The EUCAST RAST method, directly from positive blood cultures, was validated in a multi-laboratory study in Europe.Methods: RAST was performed in 40 laboratories in northern Europe (NE) and 15 in southern Europe (SE) from clinical blood cultures positive for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus or Streptococcus pneumoniae. Categorical results at 4, 6 and 8 h of incubation were compared with results for EUCAST standard 16-20 h disc diffusion. The method, preliminary breakpoints and the performance of the laboratories were evaluated.Results: The total number of isolates was 833/318 in NE/SE. The number of zone diameters that could be read (88%, 96% and 99%) and interpreted (70%, 81% and 85%) increased with incubation time (4, 6 and 8 h). The categorical agreement was acceptable, with total error rates in NE/SE of 2.4%/4.9% at 4 h, 1.1%/3.5% at 6 h and 1.1%/3.3% at 8 h. False susceptibility at 4, 6 and 8 h of incubation was below 0.3% and 1.1% in NE and SE, respectively, and the corresponding percentages for false resistance were below 1.9% and 2.8%. After fine-tuning breakpoints, more zones could be interpreted (73%, 89% and 93%), with only marginally affected error rates.Conclusions: The EUCAST RAST method can be implemented in routine laboratories without major investments. It provides reliable antimicrobial susceptibility testing results for relevant bloodstream infection pathogens after 4-6 h of incubation.</p

The Impact of Warmed Intravenous Contrast Material on the Bolus Geometry of Coronary CT Angiography Applications

Objective This study was designed to investigate the effect of administration of warmed contrast material (CM) on the bolus geometry and enhancement as depicted on coronary CT angiography. Materials and Methods A total of 64 patients (42 men, 22 women; mean age, 56 years) were randomly divided into two groups. Group 1 included 32 patients administered CM (Omnipaque [Iohexol] 350 mg I/ mL; Nycomed, Princeton, NJ) saline solutions kept in an incubator at a constant temperature (37℃). Group 2 included 32 patients administered the CM saline solutions kept at constant room temperature (24℃). Cardiac CT scans were performed with a dual source computed tomography (DSCT) scanner. For each group, region of interest curves were plotted inside the ascending aorta, main pulmonary artery and descending aorta on test bolus images. Using enhancement values, time/enhancement diagrams were produced for each vessel. On diagrams, basal Hounsfield unit (HU) values were subtracted from sequentially obtained values. A value of 100 HU was accepted as a cut-off value for the beginning of opacification. The time to peak, the time required to reach 100 HU opacification, maximum enhancement and duration of enhancement above 100 HU were noted. DSCT angiography studies were evaluated for coronary vessel enhancement. Results Maximum enhancement values in the ascending aorta, descending aorta and main pulmonary artery were significantly higher in group 1 subjects. In the ascending aorta, the median time required to reach 100 HU opacification during the test bolus analysis was significantly shorter for group 2 subjects than for group 1 subjects. In the ascending aorta, the descending aorta and main pulmonary artery, for group 1 subjects, the bolus geometry curve shifted to the left and upwards as compared with the bolus geometry curve for group 2 subjects. Conclusion The use of warmed CM yields higher enhancement values and a shorter time to reach maximum enhancement duration, resulting in a shift of the bolus geometry curve to the left that may provide optimized image quality.PubMedWoSScopu

Worldwide survey of T2* cardiovascular magnetic resonance in Thalassaemia

Introduction Thalassaemia major (TM) affects hundreds of thousands of patients worldwide but only a minority have access to regular blood transfusion and chelation therapy. Cardiovascular magnetic resonance (CMR) T2* measurement provides an accurate, reproducible measurement of cardiac iron which is the cause of heart failure and early death in many transfused TM patients. This technique has been adopted as part of routine management in many countries where survival is now approaching normal but little is known about the severity and effects of myocardial iron loading in different geographical regions. Purpose The aim of this study was to describe the burden of disease of myocardial siderosis (measured by T2*) in different populations throughout the world and to assess the relationship between T2* and outcome such as heart failure and cardiac death. Methods 34 worldwide centres were involved in this survey of 3376 patients from Europe, the Middle East, North America, South America, North Africa, Australia and Asia. Anonymised data on myocardial T2* values were analysed in conjunction with clinical outcomes (heart failure and death). Results Overall, 57.5% of patients had no significant iron loading (T2* >20ms), 22.6% had moderate cardiac iron (10ms50%) in South-East Asia had cardiac iron (T2* >20ms) at baseline. At the time of the first scan, 100 patients (3.3%) had confirmed heart failure, the majority of whom (77.0%) had myocardial T2* <10ms with almost all (99%) having T2* <20ms. There were 113 patients who subsequently developed heart failure. 92.0% of these had T2* <10ms and 99.1% had a T2* <20ms. There were 39 deaths. Cardiac T2* values were <10ms in 79.5%, with 92.3% <20ms. Conclusions Even in this well-treated cohort with access to transfusion, chelation and CMR, there is a large proportion of TM patients with moderate to severe cardiac iron loading. Low T2* (<10ms) is associated with cardiac failure and death. There is a huge unmet worldwide need in terms of access to specialist medical care (including transfusion and chelation therapy) together with advanced monitoring techniques (such as CMR)