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Panovský R, Borová J, Pleva M, Feitová V, Novotný P, Kincl V, Holeček T, Meluzín J, Sochor O, Štěpánová R. The unique value of cardiovascular magnetic resonance in patients with suspected acute coronary syndrome and culprit-free coronary angiograms. BMC Cardiovasc Disord 2017; 17:170. [PMID: 28659139 PMCID: PMC5490179 DOI: 10.1186/s12872-017-0610-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/22/2017] [Indexed: 12/11/2022] Open
Abstract
Background Patients with chest pain, elevated troponin, and unobstructed coronary disease present a clinical dilemma. The purpose of this study was to investigate the incremental diagnostic value of cardiovascular magnetic resonance (CMR) in a cohort of patients with suspected acute coronary syndrome (ACS) and unobstructed coronary arteries. Results Data files of patients meeting the inclusion criteria in two cardiology centres were searched and analysed. The inclusion criteria included: 1) thoracic pain suspected with ACS; 2) a significant increase in the high-sensitive Troponin T value; 3) ECG changes; 4) coronary arteries without any significant stenosis; 5) a CMR examination included in the diagnostic process; 6) an uncertain diagnosis before the CMR exam; and 7) the absence of known CMR and contrast media contraindications. Special attention was paid to the benefits of CMR in determining the final diagnosis. In total, 136 patients who underwent coronary angiography for chest pain were analysed. The most frequent underlying causes were myocarditis (38%) and perimyocarditis (18%), followed by angiographically unrecognised acute myocardial infarction (18%) and Takotsubo cardiomyopathy (15%). The final diagnosis remained unclear in 6% of the patients. The contribution of CMR in determining the final diagnosis determination was crucial in 57% of the patients. In another 35% of the patients, CMR confirmed the suspicion and, only 8% of the CMR examinations did not help at all and had no influence on diagnosis or treatment. Conclusion CMR provided a powerful incremental diagnostic value in the cohort of patients with suspected ACS and unobstructed coronary arteries. CMR is highly recommended to be incorporated as an inalienable part of the diagnostic algorithms in these patients.
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Affiliation(s)
- Roman Panovský
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic. .,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic.
| | - Júlia Borová
- The Department of Cardiology, Heart Centre, Hospital Podlesi, Trinec, Czech Republic
| | - Martin Pleva
- The Department of Cardiology, Heart Centre, Hospital Podlesi, Trinec, Czech Republic
| | - Věra Feitová
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The Department of Medical Imaging, St. Anne's Faculty Hospital and Masaryk University, Brno, Czech Republic
| | - Petr Novotný
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - Vladimír Kincl
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - Tomáš Holeček
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The Department of Medical Imaging, St. Anne's Faculty Hospital and Masaryk University, Brno, Czech Republic
| | - Jaroslav Meluzín
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - Ondřej Sochor
- The Department of Cardiovascular Diseases, International Clinical Research Centre, St. Anne's Faculty Hospital, Brno, Czech Republic.,The 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre - ICRC, St. Anne's Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - Radka Štěpánová
- International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
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Panovsky R, Pleva M, Feitova V, Kruzliak P, Meluzin J, Kincl V, Novotny P, Vanicek J. Left atrium assessment. J Cardiovasc Med (Hagerstown) 2015; 16:671-80. [DOI: 10.2459/jcm.0000000000000155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Quaranta F, Guerra E, Sperandii F, De Santis F, Pigozzi F, Calò L, Borrione P. Myocarditis in athlete and myocardial bridge: An innocent bystander? World J Cardiol 2015; 7:293-8. [PMID: 26015860 PMCID: PMC4438469 DOI: 10.4330/wjc.v7.i5.293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/16/2015] [Accepted: 03/04/2015] [Indexed: 02/06/2023] Open
Abstract
Myocarditis is a bacterial or viral inflammatory disease, often unnoticed or misdiagnosed. Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sudden death. In the present report, we describe a case of an asymptomatic, apparently healthy, competitive athletes, who was diagnosed a myocarditis and as incidental finding a myocardial bridging. We focused the attention on the importance of anamnesis, electrocardiogram and athletes' entourage for the diagnosis of such insidious pathologies and we evaluated the follow up, focusing the attention on electrocardiogram changes as well as on restitution ad integrum and prognosis, especially for the athletes.
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Affiliation(s)
- Federico Quaranta
- Federico Quaranta, Emanuele Guerra, Fabio Sperandii, Francesco De Santis, Fabio Pigozzi, Paolo Borrione, Department of Movement, Human and Health Science, University of Rome "Foro Italico", 00194 Rome, Italy
| | - Emanuele Guerra
- Federico Quaranta, Emanuele Guerra, Fabio Sperandii, Francesco De Santis, Fabio Pigozzi, Paolo Borrione, Department of Movement, Human and Health Science, University of Rome "Foro Italico", 00194 Rome, Italy
| | - Fabio Sperandii
- Federico Quaranta, Emanuele Guerra, Fabio Sperandii, Francesco De Santis, Fabio Pigozzi, Paolo Borrione, Department of Movement, Human and Health Science, University of Rome "Foro Italico", 00194 Rome, Italy
| | - Francesco De Santis
- Federico Quaranta, Emanuele Guerra, Fabio Sperandii, Francesco De Santis, Fabio Pigozzi, Paolo Borrione, Department of Movement, Human and Health Science, University of Rome "Foro Italico", 00194 Rome, Italy
| | - Fabio Pigozzi
- Federico Quaranta, Emanuele Guerra, Fabio Sperandii, Francesco De Santis, Fabio Pigozzi, Paolo Borrione, Department of Movement, Human and Health Science, University of Rome "Foro Italico", 00194 Rome, Italy
| | - Leonardo Calò
- Federico Quaranta, Emanuele Guerra, Fabio Sperandii, Francesco De Santis, Fabio Pigozzi, Paolo Borrione, Department of Movement, Human and Health Science, University of Rome "Foro Italico", 00194 Rome, Italy
| | - Paolo Borrione
- Federico Quaranta, Emanuele Guerra, Fabio Sperandii, Francesco De Santis, Fabio Pigozzi, Paolo Borrione, Department of Movement, Human and Health Science, University of Rome "Foro Italico", 00194 Rome, Italy
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Upadhyay RK. Emerging risk biomarkers in cardiovascular diseases and disorders. J Lipids 2015; 2015:971453. [PMID: 25949827 PMCID: PMC4407625 DOI: 10.1155/2015/971453] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/24/2015] [Accepted: 02/25/2015] [Indexed: 12/16/2022] Open
Abstract
Present review article highlights various cardiovascular risk prediction biomarkers by incorporating both traditional risk factors to be used as diagnostic markers and recent technologically generated diagnostic and therapeutic markers. This paper explains traditional biomarkers such as lipid profile, glucose, and hormone level and physiological biomarkers based on measurement of levels of important biomolecules such as serum ferritin, triglyceride to HDLp (high density lipoproteins) ratio, lipophorin-cholesterol ratio, lipid-lipophorin ratio, LDL cholesterol level, HDLp and apolipoprotein levels, lipophorins and LTPs ratio, sphingolipids, Omega-3 Index, and ST2 level. In addition, immunohistochemical, oxidative stress, inflammatory, anatomical, imaging, genetic, and therapeutic biomarkers have been explained in detail with their investigational specifications. Many of these biomarkers, alone or in combination, can play important role in prediction of risks, its types, and status of morbidity. As emerging risks are found to be affiliated with minor and microlevel factors and its diagnosis at an earlier stage could find CVD, hence, there is an urgent need of new more authentic, appropriate, and reliable diagnostic and therapeutic markers to confirm disease well in time to start the clinical aid to the patients. Present review aims to discuss new emerging biomarkers that could facilitate more authentic and fast diagnosis of CVDs, HF (heart failures), and various lipid abnormalities and disorders in the future.
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Affiliation(s)
- Ravi Kant Upadhyay
- Department of Zoology, DDU Gorakhpur University, Gorakhpur 273009, India
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Baumann S, Jabbour C, Huseynov A, Borggrefe M, Haghi D, Papavassiliu T. Myocardial scar detected by cardiovascular magnetic resonance in a competitive bodybuilder with longstanding abuse of anabolic steroids. Asian J Sports Med 2014; 5:e24058. [PMID: 25741416 PMCID: PMC4335477 DOI: 10.5812/asjsm.24058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 04/01/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction: The self-administration intake of anabolic-androgenic steroids (AAS) is a widespread practice in competitive bodybuilders. Structural changes within the myocardium following AAS abuse including hypertrophy, restricted diastolic function as well as systolic dysfunction and impaired ventricular inflow have been reported. Case Presentation: We present the case of a 39-year-old bodybuilder with a more than 20-year history of anabolic-androgenic steroids (AAS) abuse presenting with increasing exertional dyspnoea and fatigue. Diagnostic work-up of the patient’s current symptoms included a cine cardiovascular magnetic resonance (CMR). Using a T1-weighted inversion-recovery sequence 10 minutes after application of 0.1 mmol/kg gadolinium with diethylenetriaminepentaacetic acid (gadolinium DTPA), patchy midwall enhancement in the septal and posterolateral region of the left ventricle was demonstrated. This enhancement pattern is different from the enhancement pattern found in patients with ischemic heart disease. Conclusions: The present case illustrates for the first time, by CMR, myocardial scarring with severe left ventricular hypertrophy in a patient with normal coronary arteries after long lasting abuse of AAS. With that finding we could demonstrate a link between AAS abuse and the occurrence of myocardial scarring in humans. This finding may help raise awareness of the consequences of AAS use.
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Affiliation(s)
- Stefan Baumann
- Department of Medicine, Mannheim Hospital, Mannheim University, Mannheim, Germany
| | - Claude Jabbour
- Department of Medicine, Mannheim Hospital, Mannheim University, Mannheim, Germany
- Corresponding author: Claude Jabbour, Department of Medicine, Mannheim Hospital, Mannheim University, Mannhei, Germany. Tel: +49-621383-2204, Fax: +49-6203833821, E-mail:
| | - Aydin Huseynov
- Department of Medicine, Mannheim Hospital, Mannheim University, Mannheim, Germany
| | - Martin Borggrefe
- Department of Medicine, Mannheim Hospital, Mannheim University, Mannheim, Germany
| | - Dariusch Haghi
- Department of Medicine, Mannheim Hospital, Mannheim University, Mannheim, Germany
| | - Theano Papavassiliu
- Department of Medicine, Mannheim Hospital, Mannheim University, Mannheim, Germany
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