PET/TC con 18F-FDG en la sospecha de infección asociada a dispositivos intracardiacos: rendimiento y utilidad diagnóstica

Introduction and objectivesCardiac device-related infections (CDRI) may be life-threatening and require early and accurate diagnosis. The aims of this study were to analyze the performance of positron emission tomography-computed tomography (PET/CT) in suspected CDRI, to assess changes to the initial diagnosis, and to identify a clinical subgroup deriving the greatest benefit from this imaging modality.MethodsRetrospective study including patients evaluated by PET/CT for suspected CDRI from 2011 to 2018. We assessed PET/CT performance and the agreement between the initial, post-PET and definitive diagnoses. We also assessed changes in the diagnosis, depending on initial clinical suspicion, to identify patients deriving the greatest benefit from PET/CT.ResultsWe included 44 patients. The prevalence of endocarditis was 57%. The sensitivity and specificity of PET/CT for the diagnosis of infective endocarditis were 0.84 and 0.95, respectively. Post-PET diagnosis improved the initial diagnosis by 45%. PET/CT correctly reclassified 57% of patients with initial suspicion of generator pocket infection by detecting lead infection.ConclusionsPET/CT showed high diagnostic performance in suspected of CDRI and significantly improved the conventional diagnostic approach, especially in patients with initial suspicion of focal infection.     

Prognostic value of frontal QRS-T angle in predicting survival after primary percutaneous coronary revascularization/coronary artery bypass grafting for ST-elevation myocardial infarction

BackgroundFrontal QRS-T angle (FQRST) has previously been correlated with mortality in patients with stable coronary artery disease, but its role as survival predictor after ST-elevation myocardial infarction (STEMI) remains unknown.MethodsWe evaluated 267 consecutive patients with STEMI undergoing reperfusion or coronary artery bypass grafting. Data assessed included demographics, clinical presentation, electrocardiograms, medical therapy, and one-year mortality.ResultsOf 267 patients, 187 (70%) were males and most (49.4%) patients were Caucasian. All-cause mortality was significantly higher among patients with the highest (101–180°) FQRST [28% vs. 15%, p = 0.02]. Patients with FQRST 1–50° had higher survival (85.6%) compared with FQRST = 51–100° (72.3%) and FQRST = 101–180° (67.9%), [log rank, p = 0.01]. Adjusting for significant variables identified during univariate analysis, FQRST (OR = 2.04 [95% CI: 1.31–13.50]) remained an independent predictor of one-year mortality. FQRST-based risk score (1–50° = 0 points, 51–100° = 2 points, 101–180° = 5 points) had excellent discriminatory ability for one-year mortality when combined with Mayo Clinic Risk Score (C statistic = 0.875 [95%CI: 0.813–0.937]. A high (>4 points) FQRST risk score was associated with greater mortality (32% vs. 19%, p = 0.02) and longer length of stay (6 vs. 2 days, p < 0.001).ConclusionFQRST represents a novel independent predictor of one-year mortality in patients with STEMI undergoing reperfusion. A high FQRST-based risk score was associated with greater mortality and longer length of stay and, after combining with Mayo Clinic Risk Score, improved discriminatory ability for one-year mortality.     

HLA B27-associated rheumatic diseases with severe cardiac bradyarrhythmias. Clinical features and prevalence in 223 men with permanent pacemakers

A 15-fold increase in the prevalence of ankylosing spondylitis in a group of 223 men with permanent cardiac pacemakers has recently been demonstrated. In this study of the same patient group, the prevalence of other related rheumatic syndromes was investigated by clinical examination and HLA typing. The clinical picture and electrocardiographic features of all patients with HLA B27-associated rheumatic disease (seronegative spondarthritis) were analyzed. Altogether 28 patients, 12.6 percent (95 percent confidence limits: 8.2 to 17.0 percent), fulfilled inclusion criteria for seronegative spondarthritides; 15 had ankylosing spondylitis. The seronegative spondarthritides previously had been diagnosed in less than 50 percent of the patients. Twenty-two (85 percent) of the 26 HLA-typed patients were B27-positive, implying a very strong association with this genetically determined cell surface protein. Patients with severe bradyarrhythmias associated with the seronegative spondarthritides were thus found to constitute a large proportion of the 223 men with permanent pacemakers. A high frequency of aortic regurgitation and all kinds of bradyarrhythmias were found. Twenty patients had complete heart block--in a majority, occurring intermittently, but otherwise without distinguishing features.     

Cyclic adenosine monophosphate modulation of contractility via slow Ca2+ channels in chick heart

The catecholamines exert a positive inotropic effect associated with elevated tissue cyclic AMP levels and possibly with increase in the number of membrane slow cationic channels available for voltage activation. In the present study, catecholamines (isoproterenol, dopamine and dobutamine) were tested for their ability to affect the maximum upstroke velocity (+ V_max) of the slow action potentials, the first derivative ($\text{d}\text{T}\text{d}\text{t}$) of developed tension accompanying the slow responses, and the tissue cyclic AMP levels in the ventricular myocardium of isolated perfused chick hearts. To study the slow channels exclusively, the fast Na⁺ channels were voltage inactivated by elevated (25 mm) K⁺. In this condition of functional removal of the fast channels, the heart could not be excited by intense electrical stimulation. It was found that these catecholamines induced slow action potentials accompanied by contractions. Elevation of the concentration of these agents produced increases in + V_max, $\text{d}\text{T}\text{d}\text{t}$, and cyclic AMP in a dose-dependent fashion; a close correlation was obtained between the cyclic AMP level, + V_max and $\text{d}\text{T}\text{d}\text{t}$. These results support the hypothesis that the increases in + V_max of the slow action potentials and in contraction are explained by increase in the number of available slow channels mediated by intracellular cyclic AMP levels, and the resulting increase in the Ca²⁺ influx.     

Peri-procedural myocardial injury: 2005 update.

During the past three decades, percutaneous coronary intervention has become one of the cardinal treatment strategies for stenotic coronary artery disease. Technical advances, including the introduction of new devices such as stents, have expanded the interventional capabilities of balloon angioplasty. At the same time, there has been a decline in the rate of major adverse cardiac events, including Q-wave acute myocardial infarction, emergency coronary artery bypass grafting, and cardiac death. Despite these advances, the incidence of post-procedural cardiac marker elevation has not substantially decreased since the first serial assessment 20 years ago. As of now, these post-procedural cardiac marker elevations are considered to represent peri-procedural myocardial injury (PMI) with worse long-term outcome potential. Recent progress has been made for the identification of two main PMI patterns, one near the intervention site (proximal type, PMI type I) and one in the distal perfusion territory of the treated coronary artery (distal type, PMI type II) as well as for preventive strategies. Integrating these new developments into the wealth of clinical information on this topic, this review aims at giving a current perspective on the entity of PMI.     

Over the wire lead extraction and focused force venoplasty to regain venous access in a totally occluded subclavian vein

Introduction  Venoplasty allows the addition or replacement of leads despite subtotal or total subclavian occlusion. Methods  The threshold of the LV pacing lead implanted for biventricular pacing over a period of 18 months increased to greater than 5 V. A pre implant venogram revealed total subclavian occlusion. Venous access was maintained by extraction of the 4 F LV lead over a wire. Subsequently the sheath would not advance despite 6mm balloon inflation to 30 atm with no residual waist. A wire was placed beside the balloon and the balloon was reinflated. Results  The subclavian obstruction was eliminated without damage to the existing leads. Conclusion  The obstruction formed by the fibrous track around an extracted lead may persist despite what appears to be successful balloon dilation. Inflation with a wire beside the balloon increases the effect eliminating the resistant obstruction without damaging the leads. Acknowledgements of Sources of Financial Support:Dr. Worley receives compensation in various forms from Medtronic, Pressure Products, Guidant, and St Jude Medical. Dr. Gohn receives compensation in various forms from Medtronic. No financial support was provided for the creation of this case report     

卡维地洛改善充慢性心力衰竭患者心功能的临床研究

目的：观察卡维地洛(Carvedilol)治疗慢性心力衰竭(CHF)的临床疗效。方法：将80例NYHA心功能Ⅱ～Ⅳ级CHF患者随机分为两组：Carvedilol组40例,采用常规治疗(ACEI、利尿剂、血管扩张剂、有或无洋地黄)+Carvedilol；Betaloc组40例,常规治疗+Betaloc。随访1～2年,观察两组治疗前后血流动力学、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、6min步行距离(6-MWD)及心功能变化。结果：两组治疗后心率(HR)、收缩压(SBP)、心肌耗氧量(HR×SBP)、LVEDD、LVESD、LVEF、左室短轴缩短分数(LVFS)、NYHA心功能分级均较治疗前显著改善(P＜0．01),而Carvedilol组在血流动力学及心功能改善上较Betaloc组更明显(P＜0．05)；但治疗后组间HR降低无显著差异(P＞0．05)。两组治疗后6-MWD也均较治疗前显著增加(P＜0．01),尤其Carvedilol组(P＜0．05)。Carvedilol组无不良反应出现。结论：联用Carvedilol治疗CHF安全有效。     

MicroRNA-21 via Dysregulation of WW Domain-Containing Protein 1 Regulate Atrial Fibrosis in Atrial Fibrillation

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血管紧张素（1～7）对血管加压素诱导心脏成纤维细胞增殖的影响及其与钙调神经磷酸酶的关系

目的探讨血管紧张素(1～7)[Ang(1～7)]对血管加压素(AVP)诱导心脏成纤维细胞(CFs)增殖的影响及其与钙调神经磷酸酶(CaN)的关系。方法分离培养SD仔鼠CFs,四氮唑盐(MTT)比色法检测细胞增殖,采用流式细胞分析仪技术测定细胞周期,发色底物法测定细胞内CaN的活性。结果(1)10-7mol/LAVP干预24h后,CFs的MTT吸光度值(0.24±0.01)较对照组(0.14±0.01)明显增高(P<0.01);给予10-9～10-6mol/LAng(1～7)和AVP共同干预后,CFs的吸光度值呈递减趋势,分别为0.22±0.01、0.21±0.01、0.18±0.01和0.16±0.01,均较AVP组降低,差异有统计学意义(P<0.01)。(2)AVP刺激后,CFs的S期百分率(14.00±0.94)和增殖指数(23.4±1.8)较对照组(分别为5.4±0.7和10.8±2.4)明显增高(P<0.01);10-7mol/LAng(1～7)和AVP共同作用后S期百分率(8.5±0.7)和增殖指数(16.2±2.0)较AVP组降低,差异有统计学意义(P<0.01)。(3)AVP组CFs内CaN活性(0.27±0.02kU/mg)较对照组(0.12±0.01)kU/mg明显增加(P<0.01),给予10-9～10-6mol/LAng(1～7)和AVP共同干预后,CaN活性分别为0.25±0.01、0.20±0.02、0.17±0.01和0.15±0.02(kU/mg),均较AVP组降低,差异有统计学意义(P<0.01)。结论Ang(1～7)能抑制AVP诱导CFs增殖,CaN活性降低可能是其分子生物学机制之一。