Feasibility of single breath-hold left ventricular function with 3 Tesla TSENSE acquisition and 3D modeling analysis

<p>Abstract</p> <p>Background</p> <p>A single breath-hold evaluation of ventricular function would allow assessment in cases where scan time or patient tolerance is limited. Spatiotemporal acceleration techniques such as TSENSE decrease cardiovascular MR acquisition time, but standard slice summation analysis requires enough short axis slices to cover the left ventricle (LV). By reducing the number of short axis slices, incorporating long axis slices, and applying a 3D model based analysis, it may be possible to obtain accurate LV mass and volumes. We evaluated LV volume, mass and ejection fraction at 3.0T using a 3D modeling analysis in 9 patients with a history of myocardial infarction and one healthy volunteer. Acquisition consisted of a standard short axis SSFP stack and a 15 heart-beat single breath-hold six slice multi-planar (4 short and 2 long axis) TSENSE SSFP protocol with an acceleration factor of <it>R </it>= 4.</p> <p>Results</p> <p>Differences (standard minus accelerated protocol mean ± s.d.) and coefficients of variation (s.d. of differences as a percentage of the average estimate) were 7.5 ± 9.6 mL and 6% for end-diastolic volume (p = 0.035), 0.4 ± 5.1 mL and 7% for end-systolic volume (p = NS), 7.1 ± 8.1 mL and 9% for stroke volume (p = 0.022), 2.2 ± 2.8% and 5% for ejection fraction (p = 0.035), and -7.1 ± 6.2 g and 4% for LV mass (p = 0.005), respectively. Intra- and inter-observer errors were similar for both protocols (p = NS for all measures).</p> <p>Conclusion</p> <p>These results suggest that clinically useful estimates of LV function can be obtained in a TSENSE accelerated single breath-hold reduced slice acquisition at 3T using 3D modeling analysis techniques.</p

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6·35 years (SD 4·50) were included. The incidence of perioperative severe critical events was 5·2% (95% CI 5·0-5·5) with an incidence of respiratory critical events of 3·1% (2·9-3·3). Cardiovascular instability occurred in 1·9% (1·7-2·1), with an immediate poor outcome in 5·4% (3·7-7·5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0·88, 95% CI 0·86-0·90; p <0·0001), medical history, and physical condition (1·60, 1·40-1·82; p <0·0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0·99, 0·981-0·997; p <0·0048 for respiratory critical events, and 0·98, 0·97-0·99; p=0·0039 for cardiovascular critical events), rather than the type of health institution or providers. This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia. European Society of Anaesthesiolog

Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia