Clinical and Prognostic Implications of Right Ventricular Uptake on Bone Scintigraphy in Transthyretin Amyloid Cardiomyopathy

Background: The extent of myocardial bone tracer uptake with technetium pyrophosphate, hydroxymethylene diphosphonate, and 3,3-diphosphono-1,2-propanodicarboxylate in transthyretin amyloid cardiomyopathy (ATTR-CM) might reflect cardiac amyloid burden and be associated with outcome. Methods: Consecutive patients with ATTR-CM who underwent diagnostic bone tracer scintigraphy with acquisition of whole-body planar and cardiac single-photon emission computed tomography (SPECT) images from the National Amyloidosis Centre and 4 Italian centers were included. Cardiac uptake was defined according to the Perugini classification: 0=absent cardiac uptake; 1=mild uptake less than bone; 2=moderate uptake equal to bone; and 3=high uptake greater than bone. Extent of right ventricular (RV) uptake was defined as focal (basal segment of the RV free wall only) or diffuse (extending beyond basal segment) on the basis of SPECT imaging. The primary outcome was all-cause mortality. Results: Among 1422 patients with ATTR-CM, RV uptake accompanying left ventricular uptake was identified by SPECT imaging in 100% of cases at diagnosis. Median follow-up in the whole cohort was 34 months (interquartile range, 21 to 50 months), and 494 patients died. By Kaplan-Meier analysis, diffuse RV uptake on SPECT imaging (n=936) was associated with higher all-cause mortality compared with focal (n=486) RV uptake (77.9% versus 22.1%; P<0.001), whereas Perugini grade was not associated with survival (P=0.27 in grade 2 versus grade 3). On multivariable analysis, after adjustment for age at diagnosis (hazard ratio [HR], 1.03 [95% CI, 1.02-1.04]; P<0.001), presence of the p.(V142I) TTR variant (HR, 1.42 [95% CI, 1.20-1.81]; P=0.004), National Amyloidosis Centre stage (each category, P<0.001), stroke volume index (HR, 0.99 [95% CI, 0.97-0.99]; P=0.043), E/e' (HR, 1.02 [95% CI, 1.007-1.03]; P=0.004), right atrial area index (HR, 1.05 [95% CI, 1.02-1.08]; P=0.001), and left ventricular global longitudinal strain (HR, 1.06 [95% CI, 1.03-1.09]; P<0.001), diffuse RV uptake on SPECT imaging (HR, 1.60 [95% CI, 1.26-2.04]; P<0.001) remained an independent predictor of all-cause mortality. The prognostic value of diffuse RV uptake was maintained across each National Amyloidosis Centre stage and in both wild-type and hereditary ATTR-CM (P<0.001 and P=0.02, respectively). Conclusions: Diffuse RV uptake of bone tracer on SPECT imaging is associated with poor outcomes in patients with ATTR-CM and is an independent prognostic marker at diagnosis

Cardiac Tumors: Diagnosis, Prognosis, and Treatment

Cardiac masses frequently present significant diagnostic and therapeutic clinical challenges and encompass a broad set of lesions that can be either neoplastic or non-neoplastic. We sought to provide an overview of cardiac tumors using a cardiac chamber prevalence approach and providing epidemiology, imaging, histopathology, diagnostic workup, treatment, and prognoses of cardiac tumors

La patria grande insurgente : dignidad soberana del pensamiento plebeyo. Selección de ponencias del I Congreso de Pensamiento Político Latinoamericano

Los días 7 y 8 de octubre de 2011, el Centro de Investigaciones en Pensamiento Político Latinoamericano (CIPPLA), dependiente de la Secretaría de Investigación de la Universidad Popular Madres de Plaza de Mayo, organizó el I Congreso de Pensamiento Político Latinoamericano. Éste contó con la participación de más de trescientas personas, y a lo largo de sus dos jornadas se organizaron casi treinta foros de debate y cinco paneles de conferencias, a cargo de destacados intelectuales, dirigentes sociales, funcionarios públicos y profesionales de diversas disciplinas: Hugo Biagini, Zulma Palermo, Inés Vázquez, Florencia Saintout, Hugo Trinchero, Roberto Caballero, Norberto Galasso y Hebe de Bonafini, entre otros. Se presentaron a su vez más de cien ponencias, que abordaron variadas temáticas relacionadas con el pensamiento emancipador, los derechos humanos, el poscolonialismo, la descolonialidad, la comunicación y la educación. Este volumen reúne una selección de esos trabajos en los que, desde diversas perspectivas, se sostiene la dignidad del pensamiento plebeyo y su rol fundamental en la construcción de una Patria Grande Latinoamericana.5. Introducción 12. Fundamentación del CIPPLA 23. Frantz Fanon, los espectros y lo trágico por Alejandro De Oto & María Marta Quintana 35. La universalización de los derechos del Hombre. El ideario político de los esclavos rebeldes de Haití por Juan Francisco Martínez Peria 55. La trinidad filosófica Pueblo-Cultura-Liberación, entre la herejía y el dogma por Martín S. Forciniti 73. Descolonizar los corazones: discutiendo el modelo traumático para investigar un pasado genocida desde un presente militante por Diego Benegas Loyo 79. Polémicas culturales de los años sesenta en Cuba: historia, contextos y actualidad por María Ximena Vergara 91. Pretorianismo y femeneidad: un discurso fallido por Lilián Fernández del Moral 99. Cultura, política y modernización técnica en Kusch. Algunas observaciones por Daniel Eduardo Gutiérrez 111. La celebración del Bicentenario de México: Las razones para releer la historia por Juan José Carrillo Nieto 117. Aproximaciones históricas a los planteamientos políticos de la insugerencia colombiana por Sandra Díaz, Jenny Cristina Perdomo, Diana Ortiz y Mauricio Viloria 137. Acumulación por desposesión y democracia participativa: Excursus de una interrelación compleja en las antinomias del extractivismo argentino por Nicolás Di Genaro 145. Aproximación al pensamiento político de Agustín García Calvo por Marta Nogueroles Jové 155. Contribuciones del movimiento de los trabajadores rurales sin tierra (MTS, Brasil) en la re-conceptualización del desarrollo por Gabriel Rodrigues Lopes 169. Lecturas fanonianias sobre el armado de cuerpos por Cedriani Juan Pablo 177. Desarrollo y colonialidad: Vigencia estructural de la colonialidad en el discurso del desarrollo por Facundo Zorzoli 189. El bisturí y el megáfono por Juan Manuel Spinelli 195. Emancipaciones, resistencias y autonomías por Rebeca Peralta Mariñelarena 207. ¿Es posible, y es deseable, una ontología del oprimido? por Ezequiel Pinacchio 217. Filosofía política del movimiento obrero por Andrés Fortunato 225. La historia como discurso político por Martín López 233. Manuela Sáenz: Mujer y emancipación en el siglo XIX por Facundo Bindi 241. Des(bordes) institucionales por Mariana Serbent 253. Heterogeneidad espitémica y movimientos sociales latinomericanos por María Mercedes Palumbo y Laura Celina Vacca 275. Inflexiones de la comunidad nacional: las posiciones de la particularidad en el pensamiento de Carlos Astrada por Juan Antonio Delgado de la Rosa 283. Las dos caras de la dignidad por Diego Adrián Perez Sosa 287. ¿La Vida de quién? por Nayibe Agudelo Piza 295. Unfluencia de Esteban Echeverría en el diseño global imperial. Reflexiones desde el pensamiento descolonial por Soledad Ramati y María Mercedes Palumbo 303. La revolución boliviana de 1952 por Federico Li Rosi 311. El lenguaje y el derecho por Liliana Lisanti 319. Notas sobre el derecho por rodolfo Enrique Peláez 327. Nación y otredad: apuntes sobre la invención de lo extraño y peligroso en la Argentina moderna por Martín e. Díaz 337. La integración regional desde el pensamiento latino americano por Lucila Melendi 347. Pensar desde América Latina: arte y política por Carolina Wajnerma

ECG/echo indexes in the diagnostic approach to amyloid cardiomyopathy: A head-to-head comparison from the AC-TIVE study

Background and aims: The discordance between QRS voltages on electrocardiogram (ECG) and left ventricle (LV) wall thickness (LVWT) on echocardiogram (echo) is a recognized red flag (RF) of amyloid cardiomyopathy (AC) and can be measured by specific indexes. No head-to-head comparison of different ECG/echo indexes among subjects with echocardiographic suspicion of AC has yet been undertaken. The study aimed at evaluating the performance and the incremental diagnostic value of different ECG/echo indexes in this subset of patients. Methods: Electrocardiograms of subjects with LV hypertrophy, preserved ejection fraction and ≥&nbsp;1 echocardiographic RF of AC participating in the AC-TIVE study, an Italian prospective multicenter study, were independently analyzed by two cardiologists. Low QRS voltages and 8 different ECG/echo indexes were evaluated. Cohort specific cut-offs were computed. Results: Among 170 patients, 55 (32&nbsp;%) were diagnosed with AC. Combination of low QRS voltages with interventricular septum ≥&nbsp;1,6&nbsp;cm was the most specific (specificity 100&nbsp;%, positive predictive value 100&nbsp;%) ECG/echo index, while the ratio between the sum of all QRS voltages and LVWT &lt;7,8 was the most sensitive and accurate (sensitivity 94&nbsp;%, negative predictive value 97&nbsp;%, accuracy 82&nbsp;%). When the latter index was added to a model using easily-accessible clinical variables, the diagnostic accuracy for AC greatly increased (AUC from 0,84 to 0,95; p&nbsp;=&nbsp;0,007). Conclusions: Among patients with non-dilated hypertrophic ventricles with normal ejection fraction and echocardiographic RF of AC, easily-measurable ECG/echo indexes, mainly when added to few clinical variables, can help the physician orient second level investigations. External validation of the results is warranted

Unmasking the prevalence of amyloid cardiomyopathy in the real world: results from Phase 2 of the AC-TIVE study, an Italian nationwide survey

Aim To investigate the prevalence of amyloid cardiomyopathy (AC) and the diagnostic accuracy of echocardiographic red flags of AC among consecutive adult patients undergoing transthoracic echocardiogram for reason other than AC in 13 Italian institutions. Methods and results This is an Italian prospective multicentre study, involving a clinical and instrumental work-up to assess AC prevalence among patients &gt;= 55 years old with an echocardiogram suggestive of AC (i.e. at least one echocardiographic red flag of AC in hypertrophic, non-dilated left ventricles with preserved ejection fraction). The study was registered at (NCT04738266). Overall, 381 patients with an echocardiogram suggestive of AC were identified among a cohort of 5315 screened subjects, and 217 patients completed the investigations. A final diagnosis of AC was made in 62 patients with an estimated prevalence of 29% (95% confidence interval 23%-35%). Transthyretin-related AC (ATTR-AC) was diagnosed in 51 and light chain-related AC (AL-AC) in 11 patients. Either apical sparing or a combination of &gt;= 2 other echocardiographic red flags, excluding interatrial septum thickness, provided a diagnostic accuracy &gt;70%. Conclusion In a cohort of consecutive adults with echocardiographic findings suggestive of AC and preserved left ventricular ejection fraction, the prevalence of AC (either ATTR or AL) was 29%. Easily available echocardiographic red flags, when combined together, demonstrated good diagnostic accuracy