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Role of Cardiovascular Magnetic Resonance Imaging in Early Detection of Myocarditis in Patients Recovered from COVID-19 心血管磁共振成像在COVID-19康复患者心肌炎早期检测中的作用
Pub Date : 2023-09-20 DOI: 10.19080/jocct.2023.18.555997
Mohamed Ibrahim Awadeen
Objective: To assess cardiac involvement in patients recovered from COVID-19 with no clinical evidence of myocarditis, using various non-invasive parameters including Transthoracic Two-dimensional Speckle Tracking Echocardiography (STE) and cardiac magnetic resonance imaging (CMR). Methods: This prospective study was conducted in the Cardiology Departments of Maadi Military Hospital and Benha University Hospitals. A total of 74 patients were initially enrolled during their hospital stay, but only 50 of them met the inclusion and exclusion criteria. The CMR examination was performed in conjunction with echocardiography, ECG, and laboratory investigations on the same day, which occurred 2-12 weeks after recovering from confirmed COVID-19 infection. Patient scheduling for CMR and other examinations depended on the availability of the CMR machine. Results: According to CMR diagnosis, 23 (46%) patients were diagnosed to have myocarditis by CMR, the patients were categorized into two groups based on these results: normal group (27 patients) & myocarditis group (23 patients). According to GLS, 21 (42%) patients were diagnosed to have myocarditis by STE (diagnosis of Myocarditis with Global longitudinal strain was considered with cut-off point of >-21.33 with Sensitivity of 91.30% and Specificity of 92.59% (P <0.0001). 2D STE showed 87.50% sensitivity, 92.31% specificity and 90.00% accuracy to diagnose myocarditis, while CMR showed a 95.83% sensitivity, 96.15% specificity of and 96.00% accuracy. Conclusion: Myocarditis was found in 46% of asymptomatic COVID-19-recovered patients. CMR is a valuable tool for early myocarditis detection when combined with 2D STE, offering high accuracy. Significant differences were observed between suspected myocarditis patients and those with normal results on both 2D STE and CMR.
目的:应用经胸二维散斑追踪超声心动图(STE)和心脏磁共振成像(CMR)等无临床证据的新型冠状病毒肺炎(COVID-19)患者康复后心脏受累情况评估。方法:本前瞻性研究在马地军队医院和滨海大学附属医院心内科进行。共有74名患者在住院期间被纳入研究,但其中只有50人符合纳入和排除标准。CMR检查与超声心动图、心电图和实验室检查在同一天进行,发生在COVID-19确诊感染恢复后2-12周。患者安排CMR和其他检查取决于CMR机器的可用性。结果:根据CMR诊断,23例(46%)患者被诊断为心肌炎,根据结果将患者分为正常组(27例)和正常组(27例);心肌炎组23例。根据GLS,有21例(42%)患者经STE诊断为心肌炎(考虑诊断为全局纵向应变心肌炎,截断点为>-21.33,敏感性为91.30%,特异性为92.59% (P <0.0001)。2D STE诊断心肌炎的敏感性为87.50%,特异性为92.31%,准确率为90.00%;CMR诊断心肌炎的敏感性为95.83%,特异性为96.15%,准确率为96.00%。结论:46%的新冠肺炎无症状康复患者存在心肌炎。CMR结合2D STE是早期心肌炎检测的宝贵工具,具有很高的准确性。疑似心肌炎患者与2D STE和CMR结果正常的患者之间存在显著差异。
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引用次数: 0
Ldl-c Levels In Secondary Prevention: The Lower The Better and The Sooner The Better 二级预防中的Ldl-c水平:越低越好,越早越好
Pub Date : 2021-06-04 DOI: 10.19080/jocct.2021.17.555954
R. Vázquez
Ischemic heart disease continues to be the leading cause of death worldwide. Low-density lipoproteins cholesterol (LDL-c) is the main responsible factor in its pathophysiology. Despite the great farmacological advance in lipid-lowering treatments (estatins, ezetimibe, PCSK9 inhibitors and those that remain to come bempedoic acid and inclisiran) most of our patients in secondary prevention present LDL-c levels over the recommended by the Clinical Practice Guidelines. For this reason, we developed a specific program in an attempt to achieve the goal of lowering LDL-c the lower and the sooner the better.
缺血性心脏病仍然是全球死亡的主要原因。低密度脂蛋白胆固醇(LDL-c)是其病理生理学的主要原因。尽管在降脂治疗方面取得了巨大的临床进展(依折麦布、PCSK9抑制剂以及那些即将出现的贝米多酸和inclisiran),但我们在二级预防中的大多数患者的LDL-c水平都超过了《临床实践指南》的建议。为此,我们开发了一个特定的程序,试图实现LDL-c越低、越快越好的目标。
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引用次数: 1
Ocular Ischemic Syndrome as a Clue for Carotid Artery Stenosis 颈动脉狭窄的眼部缺血性综合征
Pub Date : 2021-05-26 DOI: 10.19080/jocct.2021.17.555953
E. Khalilipur
In current medical practice, all symptoms of a patient could reveal a systemic involvement of an inflammatory condition which primary presentation might not be vivid enough for diagnosis of the original disease. In this case report, a painful eye of a patient lead us to diagnose stenosis of carotid artery and endovascular therapy consequently subsided patient visual acuity and prevented future devastating results.
在目前的医学实践中,患者的所有症状都可能显示炎症的全身性,而最初的表现可能不足以明确诊断原发疾病。在这个病例报告中,患者的眼睛疼痛导致我们诊断颈动脉狭窄并进行血管内治疗,从而降低了患者的视力,防止了未来的破坏性后果。
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引用次数: 0
Mechanical Pulmonary Valve Thrombosis: Recurrence and Response to Thrombolytic Therapy 机械性肺动脉瓣血栓形成的复发与溶栓治疗的反应
Pub Date : 2021-05-26 DOI: 10.19080/jocct.2021.17.555952
Zahra Hosseini
Prosthetic valve thrombosis (PVT) is a serious complication in the left-sided heart valve. However, in the right-side position, this complication may be completely asymptomatic or accompanied by only a few symptoms. Research on the prevalence of thrombosis in right-sided valves is still insufficient. We sought to retrospectively report our center’s experience concerning PVT and its management outcomes.
人工瓣膜血栓形成(PVT)是左心瓣膜的一种严重并发症。然而,在右侧位,这种并发症可能完全没有症状,或者只伴有少数症状。对右侧瓣膜血栓形成患病率的研究仍然不足。我们试图回顾性报告我们中心关于PVT的经验及其管理结果。
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引用次数: 0
The results of Percutaneous Transcatheter Pulmonary valvuloplasty in Adult Patients 成人经皮肺动脉瓣成形术的疗效
Pub Date : 2021-05-26 DOI: 10.19080/jocct.2021.17.555951
Zahra Hosseini
Background: Pulmonary valve stenosis (PS) is a rare congenital heart disease in adults. Commissural fusion and narrowing of the central lumen are the basic pathology in valvular PS. Methods: This trial is a retrospective observational cohort study which is performed from 2011 to 2020 in 107 adult patients with congenital pulmonary valve stenosis, who were referred to Rajaie Cardiovascular Medical and Research Center, the largest referral center for congenital heart disease in adults in Iran. Procedural technique, immediate and up to one year follow-up of these patients, and the definition of successful intervention are described. Results: (p = 0.032). The right ventricular systolic pressure (RVSP) decreased from 115.9 ± 34.1mmHg at baseline to 59.2 ± 20.1mmHg post procedure (p <0.001). Successful PTPC, based on transvalvular gradient (≤25 mmHg), was confirmed in 90 (85%) patients whereas when based on RVSP reduction>50%, the percentage of success rate was reduced to 42 (40%) of patients. The success rate after one year follow-up was 92.5%. After one year follow-up only 8 (7.5%) patients did not respond to PTPC (PVPG>25mmHg), of whom, about 4.5% had dysplastic valves and 3% had severe infundibular hypertrophy respectively. Also, in subgroup analysis we compared patients in two groups based on the RVSP reduction and transvalvular gradient. The PTPC is a safe and efficient procedure in adult patients with severe pulmonary valve stenosis. Irrespective of sub-valvular gradient, in majority of cases, the gradient would be decreased significantly during one-year follow-up after PTPC (92.5% in this study). The use of beta blockers in patients with infundibular hypertrophy could reduce the gradient dramatically; in such a way that after 1 year the degree of residual gradient is minimal; so, we demonstrated that if the successful criteria in adult patients after PTPC being just only on the RVSP reduction>50%, it would lead to underestimation of effectiveness of PTPC; so, we suggest that the best criteria of successful PTPC in adult patients is post procedure peak systolic valvular gradient<25mmHg.
背景:肺动脉瓣狭窄是一种罕见的成人先天性心脏病。融合和中央管腔狭窄是瓣膜性PS的基本病理学。方法:本试验是一项回顾性观察队列研究,于2011年至2020年对107名成人先天性肺动脉瓣狭窄患者进行,这些患者被转诊至Rajaie心血管医学研究中心,伊朗最大的成人先天性心脏病转诊中心。介绍了手术技术、这些患者的即时随访和长达一年的随访,以及成功干预的定义。结果:(p=0.032)。右心室收缩压(RVSP)从基线时的115.9±34.1mmHg降至术后的59.2±20.1mmHg(p为50%,成功率降至42(40%)。一年随访成功率为92.5%。一年随访后,只有8名(7.5%)患者对PTPC(PVPG>25mmHg)没有反应,其中约4.5%的患者患有瓣膜发育不良,3%的患者患有严重的漏斗肥大。此外,在亚组分析中,我们根据RVSP降低和跨瓣梯度对两组患者进行了比较。PTPC是一种安全有效的治疗成人严重肺动脉瓣狭窄的方法。无论瓣下梯度如何,在大多数情况下,在PTPC后的一年随访中,梯度都会显著降低(本研究中为92.5%)。在漏斗肥大患者中使用β受体阻滞剂可以显著降低梯度;使得在1年之后残余梯度的程度最小;因此,我们证明,如果成人患者PTPC后的成功标准仅是RVSP降低>50%,则会低估PTPC的有效性;因此,我们建议成年患者成功PTPC的最佳标准是术后峰值收缩瓣膜梯度<25mmHg。
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引用次数: 0
A Giant Caseous Calcification of the Mitral Annulus with Uncommon Presentation 二尖瓣环巨大干酪样钙化,表现不寻常
Pub Date : 2021-04-20 DOI: 10.19080/jocct.2021.16.555950
V. Boasi
We described the case of a 73 years old woman who underwent an abdomen CT for a renal problem and a giant cardiac calcification was detected. The patient bad no cardiac symptoms except for occasional palpitations. The ECG showed sinusal rhythm with right bundle block. The echocardiography showed a mild mitral regurgitation without stenosis and a not well defined “enlargement of the mitral anulus and of myocardium in the posterior inter-ventricular sept” with an increased hyperechogenicity but not a clear calcification.
我们描述了一例73岁的女性,她因肾脏问题接受了腹部CT检查,并检测到巨大的心脏钙化。病人除了偶尔心悸外,没有任何心脏症状。心电图显示窦性心律伴右束传导阻滞。超声心动图显示轻度二尖瓣反流,无狭窄,“二尖瓣环和室间隔后部心肌扩大”不明确,并伴有高回声增加,但没有明显钙化。
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引用次数: 0
Double Trouble of Severe Hyperkalemia: Syncope and No Significant ECG Changes 严重高钾血症的双重困扰:晕厥和无明显心电图改变
Pub Date : 2021-03-31 DOI: 10.19080/jocct.2021.16.555949
R. Chaddad
Potassium is an important ion capable to maintain intra-extracellular electric gradient. Hyperkalemia is a common and potential life-threatening electrolyte disorder in patients presenting to the emergency setting. Variations in the intra-extracellular ionic flow may alter cells functions, skeletal and smooth muscle contractility and electric activity of myocardial cells. Hyperkalemia can be difficult to diagnose clinically because symptoms may be vague. Patients may be asymptomatic or report non-specific symptoms such as generalized fatigue, weakness, paralysis or palpitations. Syncope is unusual neurological manifestation. An increase in serum potassium levels is followed by progressively severe electrophysiological derangements in cardiac impulse generation and conduction, which are reflected in the electrocardiogram (ECG).
钾是一种能够维持细胞外电梯度的重要离子。高钾血症是急诊患者中常见的、可能危及生命的电解质紊乱。细胞外离子流的变化可能会改变细胞功能、骨骼肌和平滑肌的收缩力以及心肌细胞的电活动。高钾血症在临床上很难诊断,因为症状可能很模糊。患者可能无症状或报告非特异性症状,如全身疲劳、虚弱、瘫痪或心悸。晕厥是一种不寻常的神经系统表现。血清钾水平升高后,心脏脉冲的产生和传导出现逐渐严重的电生理紊乱,这反映在心电图中。
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引用次数: 0
Unique Presentation of Methamphetamine- Induced Cardiomyopathy with Multiple Bilateral Pulmonary Emboli 甲基苯丙胺诱发的伴双侧多发性肺栓塞的心肌病的独特表现
Pub Date : 2021-03-16 DOI: 10.19080/JOCCT.2021.16.555947
J. Mojarrab
Methamphetamine is an amphetamine type stimulant that adversely impacts multiple organ systems and is a growing public health problem worldwide. We present a case of a 35-year-old farmer with no previous cardiac history, yet significant history of methamphetamine abuse who experienced worsening shortness of breath, productive cough with hemoptysis, bilateral leg swelling, and orthopnea. Initial laboratory testing were remarkable for mildly elevated levels of troponin, C-reactive protein, beta natriuretic peptide, and D-dimer. Chest radiography revealed cardiomegaly and a small, right-sided pleural effusion. Further diagnostic imaging by computed tomography angiography highlighted bilateral sub-segmental pulmonary embolism (PE) while cardiac echocardiography detected severely dilated cardiomyopathy of all chambers with severely reduced ejection fraction (EF). Additional cardiac and hematological workups were negative for ischemic disease, infection, or thromboembolic disease. The patient was diagnosed with methamphetamine-associated cardiomyopathy (MAC) and PE and treated for new onset heart failure with reduced ejection fraction. Though symptoms improved with cessation of drug use, follow up imaging at two years revealed sustained cardiac damage. MAC can rarely present in association with PE in patients with a history of methamphetamine abuse. A high index of clinical suspicion is necessary to identify this life-threatening combination in young adults.
甲基苯丙胺是一种苯丙胺类兴奋剂,对多个器官系统产生不利影响,是世界范围内日益严重的公共卫生问题。我们报告了一个35岁的农民的病例,他以前没有心脏病史,但有严重的甲基苯丙胺滥用史,他经历了呼吸急促恶化、生产性咳嗽伴咳血、双侧腿部肿胀和呼吸暂停。肌钙蛋白、C反应蛋白、β-钠尿肽和D-二聚体水平轻度升高的初步实验室检测结果显著。胸部造影显示心脏肥大,右侧有少量胸腔积液。计算机断层扫描血管造影术的进一步诊断成像突出了双侧亚节段肺栓塞(PE),而心脏超声心动图检测到所有心室的严重扩张型心肌病,射血分数(EF)严重降低。缺血性疾病、感染或血栓栓塞性疾病的其他心脏和血液检查均为阴性。该患者被诊断为甲基苯丙胺相关性心肌病(MAC)和PE,并接受了射血分数降低的新发心力衰竭治疗。尽管症状随着药物使用的停止而改善,但两年后的随访成像显示持续的心脏损伤。在有甲基苯丙胺滥用史的患者中,MAC很少与PE相关。为了在年轻人中识别这种危及生命的组合,有必要进行高指数的临床怀疑。
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引用次数: 1
Is Additional Cardiac Procedure A Catastrophic Risk During Bentall Operation? Long Term Results in A Tertiary Center 在Bentall手术期间,额外的心脏手术是一种灾难性的风险吗?第三系中心的长期结果
Pub Date : 2021-02-26 DOI: 10.19080/jocct.2021.16.555946
M. Yeşiltaş
The aim of this study was to assess the influences of concomitant cardiac surgery on the risk for mortality and morbidity after Bentall procedure. This retrospective study was a review of patients who underwent Bentall procedure from a single center experience over a 7-year period. Demographic features, surgical data, postoperative period and outcomes were analyzed. Patients with isolated Bentall surgery (Group A) were compared and concomitant cardiac surgery with Bentall procedure were compared (Group B).
本研究的目的是评估心脏手术对Bentall手术后死亡率和发病率的影响。这项回顾性研究是对在7年内接受Bentall手术的患者的回顾性研究。分析人口统计学特征、手术数据、术后时间和结果。比较单独Bentall手术的患者(A组)和同时进行心脏手术和Bentall程序的患者(B组)。
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引用次数: 0
Analysis of Patients’ Perceptions Living with Implantable Cardioverter Defibrillators on Decision-Making, Satisfaction, Quality, and End of Life: Is there a Difference Between Primary and Secondary Prevention? 植入式心律转复除颤器患者对决策、满意度、质量和生命终结的看法分析:一级预防和二级预防有区别吗?
Pub Date : 2021-02-24 DOI: 10.19080/jocct.2021.16.555945
Swaroop Varghese
The psychological impact of ICDs results in severe physical and psychosocial impairment. This study attempts to analyze patients’ perceptions on decision making, satisfaction, security and end of life (EOL) as well as explore the similarities and differences between primary and secondary prophylaxis groups.
icd的心理影响导致严重的身体和心理障碍。本研究试图分析患者对决策、满意度、安全性和生命终结(EOL)的看法,并探讨初级预防组和二级预防组之间的异同。
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引用次数: 0
期刊
Journal of cardiology & cardiovascular therapy
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