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Perone F, Guglielmo M, Coceani M, La Mura L, Dentamaro I, Sabatino J, Gimelli A. The Role of Multimodality Imaging Approach in Acute Aortic Syndromes: Diagnosis, Complications, and Clinical Management. Diagnostics (Basel) 2023; 13:diagnostics13040650. [PMID: 36832136 PMCID: PMC9954850 DOI: 10.3390/diagnostics13040650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Acute aortic syndromes are life-threatening conditions with high morbidity and mortality. The principal pathological feature is acute wall damage with possible evolution towards aortic rupture. Accurate and timely diagnosis is mandatory to avoid catastrophic consequences. Indeed, misdiagnosis with other conditions mimicking acute aortic syndromes is associated with premature death. In this view, cardiovascular imaging is necessary for the correct diagnosis and management. Echocardiography, computed tomography, magnetic resonance imaging, and aortography allow for diagnosis, guarantee immediate treatment, and detect associated complications. Multimodality imaging is essential in the diagnostic work-up to confirm or rule out acute aortic syndromes. The aim of this review is to highlight the contemporary evidence on the role of single cardiovascular imaging techniques and multimodality imaging in the diagnosis and management of acute aortic syndromes.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Michele Coceani
- Diagnostic and Interventional Cardiology Unit, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80133 Naples, Italy
| | - Ilaria Dentamaro
- Cardiology Department and Cardiovascular Imaging Laboratory, Hospital Miulli, 70124 Bari, Italy
| | - Jolanda Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Correspondence:
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Yang Y, Li W, Liu M, Zhang X, Li Q. Prognostic value of estimated glomerular filtration rate and presence of proteinuria in type B aortic intramural hematoma. J Thorac Dis 2021; 13:946-954. [PMID: 33717567 PMCID: PMC7947484 DOI: 10.21037/jtd-20-2543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although aggressive medical treatment is recommended in patients with type B aortic intramural hematoma (IMH), a variety of aortic events can occur during the later period. For early identification of these patients, the present study was aimed at evaluating the prognostic validity of estimated glomerular filtration rate (eGFR) and the presence of proteinuria in type B aortic IMH. Methods Data of 61 patients with type B IMH in Peking University People's Hospital from January 2008 to December 2018 were retrospectively collected. The serum creatinine level and urine protein levels were measured at admission. And eGFR were calculated by the CKD-EPI equation. Adverse aortic-related events were defined as a composite of satisfaction of criteria for surgical conversion (with or without actual surgical intervention) and death from aortic rupture. Results Initial eGFR was significantly different between patients with adverse aortic-related events and those without (P=0.003). On multivariate analysis, eGFR <90 mL/min/1.73 m2 (OR, 8.726; 95% CI: 1.711-46.144; P=0.009) and ULP (OR, 17.516; 95% CI: 3.322-92.258; P=0.001) were independent predictors of adverse aorta-related events. Furthermore, eGFR <90 mL/min/1.73 m2 and proteinuria (+) (OR, 8.344; P=0.030) had significantly greater rates of aortic-related events. In addition, eGFR <90 mL/min/1.73 m2 and proteinuria (+) had incremental prognostic value (C-statistic, 0.860, P=0.039) compared with ulcer-like projection (C-statistic, 0.815) alone. Conclusions Initial eGFR and presence of proteinuria were able to provide incremental prognostic information in addition to ulcer-like projection in patients with type B aortic IMH.
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Affiliation(s)
- Yang Yang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Weihao Li
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Mingyuan Liu
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Qingle Li
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
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Normand C, Kaye DM, Povsic TJ, Dickstein K. Beyond pharmacological treatment: an insight into therapies that target specific aspects of heart failure pathophysiology. Lancet 2019; 393:1045-1055. [PMID: 30860030 DOI: 10.1016/s0140-6736(18)32216-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/30/2018] [Accepted: 09/05/2018] [Indexed: 12/14/2022]
Abstract
Heart failure is a common syndrome associated with substantial morbidity and mortality. The management of symptoms and the strategies for improving prognosis have largely been based on pharmacological treatments. The pathophysiology of heart failure is complex because of the multiple causes responsible for this syndrome. This Series paper presents some examples of advances in heart failure management, in which the treatment specifically targets the underlying pathophysiological mechanisms responsible for the symptoms. These treatments include treatment of electromechanical dyssynchrony and dysrhythmia by cardiac resynchronisation and implantable cardioverter-defibrillators; neurohumoral modification by baroreflex and vagal stimulation; prevention of adverse cardiac remodelling by interatrial shunts; and finally targeting the myocardium directly by cell therapy in an attempt to regenerate new myocardial cells.
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Affiliation(s)
- Camilla Normand
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, VIC, Australia
| | - Thomas J Povsic
- Duke Clinical Research Institute, Duke Department of Medicine, Durham, NC, USA
| | - Kenneth Dickstein
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway; Institute of Internal Medicine, University of Bergen, Bergen, Norway.
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2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Radiol 2016; 13:e1-e29. [PMID: 26810814 DOI: 10.1016/j.jacr.2015.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 01/02/2023]
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Rybicki FJ, Udelson JE, Peacock WF, Goldhaber SZ, Isselbacher EM, Kazerooni E, Kontos MC, Litt H, Woodard PK. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol 2016; 67:853-79. [PMID: 26809772 DOI: 10.1016/j.jacc.2015.09.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Aortic intramural hematoma: An unpredictable evolution. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ponte M, Dias Ferreira N, Bettencourt N, Caeiro D, Fonseca M, Albuquerque A, Vouga L, Gama V. Hematoma intramural da aorta: evolução (im)previsível? Rev Port Cardiol 2014; 33:467.e1-7. [DOI: 10.1016/j.repc.2014.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/16/2014] [Accepted: 01/29/2014] [Indexed: 11/16/2022] Open
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To ACY, Schoenhagen P, Desai MY. Role of tomographic imaging in preoperative planning and postoperative assessment in cardiovascular surgery. Heart 2013; 99:1048-60. [DOI: 10.1136/heartjnl-2012-301751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Akutes Aortensyndrom. Radiologe 2012; 52:844-8. [DOI: 10.1007/s00117-012-2357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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CT Angiography of the Aorta and Aortic Diseases. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sebastià C, Evangelista A, Quiroga S, Cuellar H, Aguilar R, Muntanyà X. Predictive value of small ulcers in the evolution of acute type B intramural hematoma. Eur J Radiol 2012; 81:1569-74. [DOI: 10.1016/j.ejrad.2011.04.055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/21/2011] [Indexed: 11/26/2022]
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Nishikawa M, Shimpo M, Hashimoto T, Murata M, Shimada K, Kario K. A case of infected aortic aneurysm with possible intramural abscess resolved through discharge into the vascular lumen without surgical intervention. J Cardiol Cases 2011; 3:e163-e166. [PMID: 30532858 PMCID: PMC6265094 DOI: 10.1016/j.jccase.2011.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 02/17/2011] [Accepted: 03/07/2011] [Indexed: 11/23/2022] Open
Abstract
Infected aortic aneurysms are difficult to treat and, in the absence of aortic resection, are almost always fatal. We report a case of an infected aortic aneurysm cured by antibiotic treatment alone. In this case, the intramural abscess was supposed to be naturally resolved by the discharge of pus into the vascular lumen and infection was suppressed by the antibiotic treatment.
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Affiliation(s)
| | - Masahisa Shimpo
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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Kumamaru KK, Hoppel BE, Mather RT, Rybicki FJ. CT angiography: current technology and clinical use. Radiol Clin North Am 2010; 48:213-35, vii. [PMID: 20609871 DOI: 10.1016/j.rcl.2010.02.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Since 1958, catheter angiography has assumed the role of gold standard for vascular imaging, despite the invasive nature of the procedure. Less invasive techniques for vascular imaging, such as computed tomographic angiography (CTA), have been developed and have matured in conjunction with developments in catheter arteriography. In a few cases, such as imaging, the aorta and the pulmonary arteries, CTA has supplanted catheter angiography as the gold standard. The expanding role of CTA emphasizes the need for deep, broad-based understanding of physical principles. This review describes CT hardware and associated software for angiography. The fundamentals of CTA physics are complemented with several clinical examples.
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Naggara O, Louillet F, Touzé E, Roy D, Leclerc X, Mas JL, Pruvo JP, Meder JF, Oppenheim C. Added value of high-resolution MR imaging in the diagnosis of vertebral artery dissection. AJNR Am J Neuroradiol 2010; 31:1707-12. [PMID: 20595374 DOI: 10.3174/ajnr.a2165] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The optimal imaging method for the diagnosis of VAD remains undefined. Our aim was to evaluate the added value of HR-MR imaging for the diagnosis of VAD. MATERIALS AND METHODS We retrospectively extracted 35 consecutive patients suspected of having acute VAD who had the following: 1) a focal lumen abnormality of the VA on CE-MRA, 2) HR-MR imaging during the initial hospital stay, and 3) clinical and imaging follow-up within 6 months. Two neurologists classified patients as either VAD (group A) or non-VAD (group B) by reviewing all the available data at hospital discharge, except HR-MR imaging data. On HR-MR imaging, 2 radiologists searched for signs of acute VAD. The 2 classifications were compared. In case of discordance, CE-MRA follow-up and axial fat-suppressed T1WI, used to obtain supportive evidence for or against VAD, were considered as the standard of reference. RESULTS In 4/18 patients in group A, HR-MR imaging did not demonstrate any signs of acute VAD and perivertebral signal-intensity changes were attributed to venous plexus, with an unchanged lumen on follow-up. In 4/17 patients in group B, HR-MRI demonstrated a mural hematoma, with lumen normalization on follow-up CE-MRA. CONCLUSIONS Our results encourage the use of HR-MR imaging as a second-line diagnostic tool in the event of suspicion of acute VAD and doubtful findings on standard imaging.
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Affiliation(s)
- O Naggara
- Department of Neuroradiology, Paris-Descartes University, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, Paris, France.
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