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GÜLER A, ŞAHİN AA, AYDİN S, UÇAR SU, UYGUR B, ÇELİK Ö, ERTURK M. Hipertrofik kardiyomiyopati hastalarında atriyal fibrilasyon gelişimini öngörmede kardiyak manyetik rezonans görüntülemenin rolü. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1086581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç:, Bu çalışmada Hipertrofik kardiyomiyopati (HKMP) hastalarında geç kontrast tututulmu (GKT), toplam sol ventrikül kütlesi (TSVK), mitral yetersizlik ve sol atriyum (SA) hacmi dahil olmak üzere Kardiyak manyetik rezonans (KMR) görüntüleme parametreleri ile atriyal fibrilasyon (AF) arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: Bu çalışmaya HKMP tanısı alan, KMR çekimi yapılmış ve 48 saatlik Holter monitorizasyonu olan ardışık 122 hasta dahil edilmiştir. KMR tecrübesine sahip Radyoloji ve Kardiyoloji uzman hekimleri tarafından KMR görüntüleri değerlendirilmiştir. TSVK, SA hacmi, GKT varlığı ve yaygınlığı, mitral yetersizliği ve maksimum sol ventrikül kalınlığını içeren KMR parametreleri ile AF arasındaki korelasyon değerlendirilmiştir.
Bulgular: SA hacmi ve AF arasında anlamlı bir korelasyon gözlendi. Ek olarak TSVK, AF ile ilişkili bulundu. TSVK, SA hacmi ve GKT'nin kapsamını değerlendiren lojistik çok değişkenli analiz, yalnızca sol atriyal hacmin bağımsız öngörücü olduğunu ortaya koydu. GKT, TSVK, mitral yetersizlik ve SA hacminin varlığı ve yaygınlığı arasında anlamlı korelasyonlar gözlendi.
Sonuç: GKT'nin varlığı, SA hacmi ile pozitif korelasyon gösterdi. SA hacmi, HKMP hastalarında AF'nin en önemli bağımsız belirleyicisi gibi görünmektedir.
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Affiliation(s)
- Arda GÜLER
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | | | - Sinem AYDİN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Servet Umut UÇAR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Begüm UYGUR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Ömer ÇELİK
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Mehmet ERTURK
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL MEHMET AKİF ERSOY GÖĞÜS KALP VE DAMAR CERRAHİSİ SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Zhao X, Tan RS, Tang HC, Teo SK, Su Y, Wan M, Leng S, Zhang JM, Allen J, Kassab GS, Zhong L. Left Ventricular Wall Stress Is Sensitive Marker of Hypertrophic Cardiomyopathy With Preserved Ejection Fraction. Front Physiol 2018; 9:250. [PMID: 29643812 PMCID: PMC5882847 DOI: 10.3389/fphys.2018.00250] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/06/2018] [Indexed: 11/23/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) patients present altered myocardial mechanics due to the hypertrophied ventricular wall and are typically diagnosed by the increase in myocardium wall thickness. This study aimed to quantify regional left ventricular (LV) shape, wall stress and deformation from cardiac magnetic resonance (MR) images in HCM patients and controls, in order to establish superior measures to differentiate HCM from controls. A total of 19 HCM patients and 19 controls underwent cardiac MR scans. The acquired MR images were used to reconstruct 3D LV geometrical models and compute the regional parameters (i.e., wall thickness, curvedness, wall stress, area strain and ejection fraction) based on the standard 16 segment model using our in-house software. HCM patients were further classified into four quartiles based on wall thickness at end diastole (ED) to assess the impact of wall thickness on these regional parameters. There was a significant difference between the HCM patients and controls for all regional parameters (P < 0.001). Wall thickness was greater in HCM patients at the end-diastolic and end-systolic phases, and thickness was most pronounced in segments at the septal regions. A multivariate stepwise selection algorithm identified wall stress index at ED (σi,ED) as the single best independent predictor of HCM (AUC = 0.947). At the cutoff value σi,ED < 1.64, both sensitivity and specificity were 94.7%. This suggests that the end-diastolic wall stress index incorporating regional wall curvature—an index based on mechanical principle—is a sensitive biomarker for HCM diagnosis with potential utility in diagnostic and therapeutic assessment.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Ru-San Tan
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Hak-Chiaw Tang
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soo-Kng Teo
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yi Su
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | - Min Wan
- School of Information Engineering, Nanchang University, Nanchang, Jiangxi, China
| | - Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Jun-Mei Zhang
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - John Allen
- Duke-NUS Medical School, Singapore, Singapore
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Zhao X, Tan RS, Tang HC, Leng S, Zhang JM, Zhong L. Analysis of three-dimensional endocardial and epicardial strains from cardiac magnetic resonance in healthy subjects and patients with hypertrophic cardiomyopathy. Med Biol Eng Comput 2017; 56:159-172. [PMID: 28674779 DOI: 10.1007/s11517-017-1674-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/10/2017] [Indexed: 11/29/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic disease that leads to left ventricle (LV) hypertrophy with or without the presence of LV outflow tract obstruction. The aim of this study was to find an easy and useful indicator based on cardiac magnetic resonance (CMR) images for control subjects and patients with and without obstruction. CMR scans were performed for 19 control subjects and 19 HCM patients. Endocardial strain was defined as [Formula: see text], with [Formula: see text] being the length of endocardium at end-diastole (end-systole); similarly for epicardial strain ([Formula: see text]). The strains were evaluated in cine CMR two-, three- and four-chamber views. Six atrioventricular junction (AVJ) points from three CMR views were semi-automatically tracked. The peak systolic velocity (Sm1), peak early diastolic velocity and late diastolic velocity (Em, Am) were extracted and analysed. Compared with control subjects, HCM patients had significantly smaller three-dimensional strains and AVJ motion incorporating measurements from three long-axis views (all P < 0.05). Moreover, ROC analysis found that three-dimensional global epicardial strain <17.2% had the best sensitivity 94.4% and specificity 94.7% to differentiate HCM from control (AUC = 0.97). Therefore, three-dimensional endocardial and epicardial strains provide an easy and effective approach to manage and triage hypertrophic cardiomyopathy patients.
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Affiliation(s)
- Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Ru San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Shuang Leng
- National Heart Centre Singapore, Singapore, Singapore
| | - Jun-Mei Zhang
- National Heart Centre Singapore, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
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Zhong L, Zhao X, Wan M, Zhang JM, Su BY, Tang HC, Tan RS. Characterization and quantification of curvature using independent coordinates method in the human left ventricle by magnetic resonance imaging to identify the morphology subtype of hypertrophy cardiomyopathy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:5619-22. [PMID: 25571269 DOI: 10.1109/embc.2014.6944901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The patterns of ventricular hypertrophy are critical determinants of blood flow and function, but are variable. Therefore, it is clinically relevant to assess the hypertrophic shape patterns to better characterize and identify the morphological subtypes. We proposed and developed an independent coordinates method (ICM) to quantify the regional shape of the left ventricle in terms of curvature. 19 normal subjects and 5 HCM (hypertrophic cardiomyopathy) patients with different morphological subtype (i.e., septal hypertrophy, mid-ventricular hypertrophy, reverse curvature septum hypertrophy and sigmoid septum hypertrophy) were recruited and underwent magnetic resonance scans. The curvature along the endocardial and epicardial surface was computed using ICM method and was compared in HCM patients against normal subjects. The results showed that curvature plots are variable in different morphological subtype. The curvature pattern demonstrated the utilities in delineating different subtype. In conclusion, ICM method to quantify regional curvature of the left ventricle from magnetic resonance imaging are feasible in normal subjects and those with hypertrophy cardiomyopathy, which may serve as a novel approach to depict local shape of the left ventricle and to assess the morphological subtype in clinical practice.
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Qintar M, Morad A, Alhawasli H, Shorbaji K, Firwana B, Essali A, Kadro W. Pacing for drug-refractory or drug-intolerant hypertrophic cardiomyopathy. Cochrane Database Syst Rev 2012; 2012:CD008523. [PMID: 22592731 PMCID: PMC8094451 DOI: 10.1002/14651858.cd008523.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a genetic disease with an autosomal-dominant inheritance for which negative inotropes are the most widely used initial therapies. Observational studies and small randomised trials have suggested symptomatic and functional benefits using pacing and several theories have been put forward to explain why. Pacing, although not the primary treatment for HCM, could be beneficial to patients with relative or absolute contraindications to surgery or alcohol ablation. Several randomised controlled trials comparing pacing to other therapeutic modalities have been conducted but no Cochrane-style systematic review has been done. OBJECTIVES To assess the effects of pacing in drug-refractory or drug-intolerant hypertrophic cardiomyopathy patients. SEARCH METHODS We searched the following on the 14/4/2010: CENTRAL (The Cochrane Library 2010, Issue 1), MEDLINE OVID (from 1950 onwards ), EMBASE OVID (from 1980 onwards ), Web of Science with Conference Proceedings (from 1970 onwards). No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials of either parallel or crossover design that assess the beneficial and harmful effects of pacing for hypertrophic cardiomyopathy were included. When crossover studies were identified, we considered data only from the first phase. DATA COLLECTION AND ANALYSIS Data from included studies were extracted onto a pre-formed data extraction paper by two authors independently. Data was then entered into Review Manager 5.1 for analysis. Risk of bias was assessed using the guidance provided in the Cochrane Handbook. For dichotomous data, relative risk was calculated; and for continuous data, the mean differences were calculated. Where appropriate data were available, meta-analysis was performed. Where meta-analysis was not possible, a narrative synthesis was written. A QUROUM flow chart was provided to show the flow of papers. MAIN RESULTS Five studies (reported in 10 papers) were identified. However, three of the five studies provided un-usable data. Thus the data from only two studies (reported in seven papers) with 105 participants were included for this review. There was insufficient data to compare results on all-cause mortality, cost effectiveness, exercise capacity, Quality of life and Peak O2 consumption.When comparing active pacing versus placebo pacing on exercise capacity, one study showed that exercise time decreased from (13.1 ± 4.4) minutes to (12.6 ± 4.3) minutes in the placebo group and increased from (12.1 ± 5.6) minutes to (12.9 ± 4.2) minutes in the treatment group (MD 0.30; 95% CI -1.54 to 2.14). Statistically significant data from the same study showed that left ventricular outflow tract obstruction decreased from (71 ± 32) mm Hg to (52 ± 34) mm Hg in the placebo group and from (70 ± 24) mm Hg to (33 ± 27) mm Hg in the active pacing group (MD -19.00; 95% CI -32.29 to -5.71). This study was also able to show that New York Heart Association (NYHA) functional class decreased from (2.5 ± 0.5) to (2.2 ± 0.6) in the inactive pacing group and decreased from (2.6 ± 0.5) to (1.7 ± 0.7) in the placebo group (MD -0.50; 95% CI -0.78 to -0.22).When comparing active pacing versus trancoronary ablation of septal hypertrophy (TASH), data from one study showed that NYHA functional class decreased from (3.2 ± 0.7) to (1.5 ± 0.5) in the TASH group and decreased from (3.0 ± 0.1) to (1.9 ± 0.6) in the pacemaker group. This study also showed that LV wall thickness remained unchanged in the active pacing group compared to reduction from (22 ± 4) mm to (17 ± 3) mm in the TASH group (MD 0.60; 95% CI -5.65 to 6.85) and that LV outflow tract obstruction decreased from (80 ± 35.5) mm Hg in the TASH group to (49.3 ± 37.7) mm Hg in the pacemaker group. AUTHORS' CONCLUSIONS Trials published to date lack information on clinically relevant end-points. Existing data is derived from small trials at high risk of bias, which concentrate on physiological measures. Their results are inconclusive. Further large and high quality trials with more appropriate outcomes are warranted.
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Affiliation(s)
- Mohammed Qintar
- Cleveland Clinic, OH, USA, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic.
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Rheinboldt M, Poopat C. Asymmetric septal hypertrophic cardiomyopathy: a case report. Emerg Radiol 2011; 18:181-5. [DOI: 10.1007/s10140-010-0920-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
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Thai WE, Antonis PR, Hope SA, Meredith IT. Quantitative and Qualitative Changes in the Resting Electrocardiograph After Percutaneous Transluminal Septal Myocardial Ablation for the Treatment of Symptomatic Obstructive Hypertrophic Cardiomyopathy. Heart Lung Circ 2008; 17:364-9. [DOI: 10.1016/j.hlc.2008.03.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 03/13/2008] [Accepted: 03/19/2008] [Indexed: 10/21/2022]
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Mittnacht AJC, Fanshawe M, Konstadt S. Anesthetic Considerations in the Patient With Valvular Heart Disease Undergoing Noncardiac Surgery. Semin Cardiothorac Vasc Anesth 2008; 12:33-59. [DOI: 10.1177/1089253208316442] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Valvular heart disease can be an important finding in patients presenting for noncardiac surgery. Valvular heart disease and resulting comorbidity, such as heart failure or atrial fibrillation, significantly increase the risk for perioperative adverse events. Appropriate preoperative assessment, adequate perioperative monitoring, and early intervention, should hemodynamic disturbances occur, may help prevent adverse events and improve patient outcome. This review article aims to guide the practitioner in the various aspects of anesthetic management in the perioperative care of patients with valvular heart disease. The pharmacological approach to optimization of patient outcome with drugs, such as βblockers and lipid-lowering medications (statins), is an evolving field, and recent developments are discussed in this article.
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Affiliation(s)
| | | | - Steven Konstadt
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn New York
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Abstract
OBJECTIVE We present a two-part review about the use of MRI in patients with hypertrophic cardiomyopathy (HCM). This article, Part 1, focuses on the MRI appearances of HCM. CONCLUSION MRI has proven to be an important tool for the evaluation of patients suspected of having HCM because it can readily diagnose those with phenotypic expression of the disorder and can potentially identify the subset of patients at risk of sudden cardiac death.
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MRI of hypertrophic cardiomyopathy: part 2, Differential diagnosis, risk stratification, and posttreatment MRI appearances. AJR Am J Roentgenol 2007; 189:1344-52. [PMID: 18029870 DOI: 10.2214/ajr.07.2287] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE We present a two-part review about the use of MRI in patients with hypertrophic cardiomyopathy (HCM). This article, Part 2, covers the differential diagnosis, risk stratification, and posttreatment MRI follow-up appearances in these patients. CONCLUSION Cardiovascular MRI is a useful imaging tool for the diagnosis of HCM and follow-up of patients after either surgical myomectomy or septal ablation therapy. In addition, MRI can help to discriminate HCM from the differential diagnoses of other cardiomyopathies and cardiac disorders, and it can potentially identify the subset of patients at risk of sudden cardiac death.
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Nakahara S, Takayanagi K, Toratani N, Seino M, Sakai Y, Kobayashi S, Matsumoto K. DDD Pacing Therapy Could Serve as a Dual Purpose Treatment in Hypertrophic Obstructive Cardiomyopathy —A Case Report Which Suggests the Importance of Lead Position and the Mechanism—. J Arrhythm 2007. [DOI: 10.1016/s1880-4276(07)80007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Nakahara S, Takayanagi K, Toratani N, Seino M, Sakai Y, Kobayashi S, Matsumoto K. DDD Pacing Therapy Could Serve as a Dual Purpose Treatment in Hypertrophic Obstructive Cardiomyopathy-A Case Report Which Suggests the Importance of Lead Position and the Mechanism-. J Arrhythm 2007. [DOI: 10.4020/jhrs.23.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Komsuoglu B, Vural A, Agacdiken A, Ural D. Effect of biventricular pacing on left ventricular outflow tract pressure gradient in a patient with hypertrophic cardiomyopathy and normal interventricular conduction. J Cardiovasc Electrophysiol 2006; 17:207-9. [PMID: 16533259 DOI: 10.1111/j.1540-8167.2005.00291.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of hypertrophic obstructive cardiomyopathy (HOCM) that was markedly improved by biventricular pacing. A 55-year-old woman with HOCM presented with palpitation and presyncope. Electrophysiologic study revealed an atrioventricular nodal reentrant tachycardia. After radiofrequency catheter ablation, a Mobitz type II atrioventricular block developed and a permanent pacemaker implantation was decided. Cardiac catheterization showed a left ventricular outflow tract (LVOT) gradient of 130 mmHg. Right dual-chamber and atrial-synchronous left ventricular epicardial pacing failed to reduce the gradient. After biventricular pacing, LVOT gradient decreased to 20 mmHg. Biventricular pacing may be an alternative therapy for patients with HOCM.
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Affiliation(s)
- Baki Komsuoglu
- Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey
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Nanz D, Andreisek G, Fröhlich JM, Weishaupt D, Treiber K, Ess S, Pfammatter T. Contrast Material–enhanced Visualization of the Ablation Medium for Magnetic Resonance– monitored Ethanol Injection Therapy: Imaging and Safety Aspects. J Vasc Interv Radiol 2006; 17:95-102. [PMID: 16415138 DOI: 10.1097/01.rvi.0000187100.19700.dd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study was performed to test whether the dissociation rate of free Gd3+ ions from gadoterate meglumine is significantly increased when the contrast agent is dissolved in ethanol and whether the magnetic resonance (MR) signal of gadolinium/ethanol solutions is enhanced to a degree that promises reliable detection during MR imaging-guided intralesional administration, such as for the treatment of low-flow venous malformations. MATERIALS AND METHODS The apparent gadoterate meglumine-induced enhancement of the longitudinal proton relaxation rate of sterile ethanol/water solutions, stored at a temperature of 24 degrees C +/- 5 degrees C in the dark, was monitored for 2 weeks. The content of dissociated Gd3+ ions was determined after 6 and 8.5 months of storage. The signal difference between contrast agent/ethanol solutions and muscle tissue was assessed with imaging at 0.5 T and 1.5 T. RESULTS Commercialized gadoterate meglumine diluted with 94% ethanol was not shown to have released toxic Gd3+ during storage times that exceed its physiologic circulation and excretion times after intravenous injection by a factor of more than 100. A maximum dissociation rate of 0.05% per month was estimated from the detection limit of the analysis. The apparent molar relaxivity of the contrast agent in the mixtures varied by less than 0.1 L/mmol per second with no temporal trend. Gradient-echo ethanol/muscle contrast increased with Gd concentrations to maximums of 15 mmol/L (at 0.5 T) and 25 mmol/L (at 1.5 T). CONCLUSIONS Neither limited solubility nor release of Gd3+ ions could be identified as a general safety hazard associated with the application of gadoterate meglumine/ethanol solutions at Gd concentrations of 0.5-25 mmol/L, and such ablation mixtures could be efficiently and reliably visualized.
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Affiliation(s)
- Daniel Nanz
- Division of Cardiology and Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
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Abstract
This article reviews medicolegal issues in sports medicine. Nonmusculoskeletal medical conditions discussed include cardiac abnormalities, heat illness, and concussion in the athlete. Musculoskeletal injuries with the greatest potential for litigation, knee dislocation, and cervical spine trauma, are also reviewed. We provide legal case examples and discuss evaluation and treatment strategies to assist the medical team in the care of athletes.
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Affiliation(s)
- Alison K Sanders
- Duke Sports Medicine, 317 Finch-Yeager Building, Durham, NC 27708, USA
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