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Farhad M, Masud MM, Beg A, Ahmad A, Memon S. Enhanced classification of left ventricular hypertrophy in cardiac patients using extended Siamese CNN. Phys Med Biol 2024; 69:145001. [PMID: 38838678 DOI: 10.1088/1361-6560/ad548a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/05/2024] [Indexed: 06/07/2024]
Abstract
Objective.Left ventricular hypertrophy (LVH) is the thickening of the left ventricle wall of the heart. The objective of this study is to develop a novel approach for the accurate assessment of LVH) severity, addressing the limitations of traditional manual grading systems.Approach.We propose the Multi-purpose Siamese Weighted Euclidean Distance Model (MSWED), which utilizes convolutional Siamese neural networks and zero-shot/few-shot learning techniques. Unlike traditional methods, our model introduces a cutoff distance-based approach for zero-shot learning, enhancing accuracy. We also incorporate a weighted Euclidean distance targeting informative regions within echocardiograms.Main results.We collected comprehensive datasets labeled by experienced echocardiographers, including Normal heart and various levels of LVH severity. Our model outperforms existing techniques, demonstrating significant precision enhancement, with improvements of up to 13% for zero-shot and few-shot learning approaches.Significance.Accurate assessment of LVH severity is crucial for clinical prognosis and treatment decisions. Our proposed MSWED model offers a more reliable and efficient solution compared to traditional grading systems, reducing subjectivity and errors while providing enhanced precision in severity classification.
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Affiliation(s)
- Moomal Farhad
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohammad Mehedy Masud
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Azam Beg
- Department of Transportation, Transportation Engineer (Electrical) Business Intelligence and Automation Group, Sacramento, CA, United States of America
| | - Amir Ahmad
- College of Information Technology, United Arab Emirates University, Al Ain, United Arab Emirates
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Tachibana T, Shiga Y, Tashiro K, Higashi S, Shibata Y, Kawahira Y, Kato Y, Kuwano T, Sugihara M, Miura SI. Association Between Major Adverse Cardiovascular Events and Left Ventricular Mass Index in Patients Who Have Undergone Coronary Computed Tomography Angiography: From the FU-CCTA Registry. Cardiol Res 2024; 15:134-143. [PMID: 38994229 PMCID: PMC11236349 DOI: 10.14740/cr1655] [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] [Received: 04/30/2024] [Accepted: 06/07/2024] [Indexed: 07/13/2024] Open
Abstract
Background Left ventricular mass (LVM) is a predictor of future cardiovascular risk. We determined the association between LVM measured by coronary computed tomography angiography (CCTA) and the prognosis in patients who have undergone CCTA for screening of coronary artery disease (CAD). Methods We performed a prospective cohort study. Five hundred twenty consecutive patients who underwent CCTA at Fukuoka University Hospital (FU-CCTA registry) were enrolled. They were clinically suspected of having CAD or had at least one cardiovascular risk factor, and were a follow-up of up to 5 years. Equal to more than 50% of coronary stenosis as assessed by CCTA was diagnosed as CAD. Using CCTA, LVM index (LVMI), LV ejection fraction (LVEF), LV end-diastolic volume (LVEDV) and LV end-systolic volume were measured. The primary endpoint was major adverse cardiovascular events (MACEs: including all causes of death, ischemic stroke, acute myocardial infarction and coronary revascularization). The patients were divided into non-MACEs and MACEs groups. Results The non-MACEs and MACEs groups consisted of 478 and 42 patients, respectively. Percent of CAD in the MACEs group was significantly higher than that in the non-MACEs group. The MACEs group showed significantly higher LVMI and tended to have a lower LVEF and LVEDV than the non-MACEs group. Although LVMI was not associated with MACEs in all patients, LVMI was independently associated with MACEs in males (odd ratio: 1.018, 95% confidence interval: 1.002 - 1.035, P = 0.030), but not females. Conclusions Evaluation of LVMI by CCTA may be useful for predicting MACEs in males.
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Affiliation(s)
- Tetsuro Tachibana
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuhei Shiga
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kohei Tashiro
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Sara Higashi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuka Shibata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuto Kawahira
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuta Kato
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takashi Kuwano
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Makoto Sugihara
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shin-ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
- Department of Cardiology, Fukuoka University Nishijin Hospital, Fukuoka, Japan
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Shoaib MA, Chuah JH, Ali R, Hasikin K, Khalil A, Hum YC, Tee YK, Dhanalakshmi S, Lai KW. An Overview of Deep Learning Methods for Left Ventricle Segmentation. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2023; 2023:4208231. [PMID: 36756163 PMCID: PMC9902166 DOI: 10.1155/2023/4208231] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/25/2022] [Accepted: 11/24/2022] [Indexed: 01/31/2023]
Abstract
Cardiac health diseases are one of the key causes of death around the globe. The number of heart patients has considerably increased during the pandemic. Therefore, it is crucial to assess and analyze the medical and cardiac images. Deep learning architectures, specifically convolutional neural networks have profoundly become the primary choice for the assessment of cardiac medical images. The left ventricle is a vital part of the cardiovascular system where the boundary and size perform a significant role in the evaluation of cardiac function. Due to automatic segmentation and good promising results, the left ventricle segmentation using deep learning has attracted a lot of attention. This article presents a critical review of deep learning methods used for the left ventricle segmentation from frequently used imaging modalities including magnetic resonance images, ultrasound, and computer tomography. This study also demonstrates the details of the network architecture, software, and hardware used for training along with publicly available cardiac image datasets and self-prepared dataset details incorporated. The summary of the evaluation matrices with results used by different researchers is also presented in this study. Finally, all this information is summarized and comprehended in order to assist the readers to understand the motivation and methodology of various deep learning models, as well as exploring potential solutions to future challenges in LV segmentation.
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Affiliation(s)
- Muhammad Ali Shoaib
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Information and Communication Technology, BUITEMS, Quetta, Pakistan
| | - Joon Huang Chuah
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Raza Ali
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
- Faculty of Information and Communication Technology, BUITEMS, Quetta, Pakistan
| | - Khairunnisa Hasikin
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Azira Khalil
- Faculty of Science & Technology, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia
| | - Yan Chai Hum
- Department of Mechatronics and Biomedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Malaysia
| | - Yee Kai Tee
- Department of Mechatronics and Biomedical Engineering, Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Malaysia
| | - Samiappan Dhanalakshmi
- Department of Electronics and Communication Engineering, SRM Institute of Science and Technology, Kattankulathur, India
| | - Khin Wee Lai
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
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Zhang M, Chen X, Yang F, Song Y, Zhang D, Chen Q, Ma Y, Wang S, Ji D, Duan Z, Zhang L, Wang Q. Evaluation of Left Ventricular Mass in Different Cardiac Geometry Using Three-Dimensional Contrast-Enhanced Echocardiography. Int Heart J 2023; 64:885-893. [PMID: 37778991 DOI: 10.1536/ihj.22-663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
A total of 69 patients were enrolled in the study, including 23 patients with hypertrophic cardiomyopathy (HCM), 26 patients with Left Ventricle (LV) enlargement comprising 16 dilated cardiomyopathy (DCM) patients and 10 ischemic cardiomyopathy (ICM) patients, and 20 control subjects. All patients underwent 2DE, contrast-enhanced 2DE (Contrast-2DE), 3DE, Contrast-3DE, and single photon emission computed tomography (SPECT) examinations. The 2DE-AL and 3DE methods measured the left ventricular mass (LVM). The results were compared with those measured by SPECT. The measured LVM of the 69 patients was systematically overestimated by 2DE-AL (177.4 ± 56.2 g), Contrast-2DE-AL (174.5 ± 55.5 g), 3DE (167.3 ± 59.2 g), and Contrast-3DE (154.2 ± 46.7 g) when compared with SPECT (148.5 ± 52.4 g) (P < 0.05), while Contrast-3DE provided the best agreement with SPECT in LVM measurement (r = 0.898, P < 0.001) and had the smallest deviation (5.7 ± 23.1 g). 3DE overestimated LVM more compared to Contrast-3DE in LV hypertrophy group (165.5 ± 37.9 g versus 153.5 ± 27.6 g, P = 0.003) and LV enlargement group (204.5 ± 69.3 g versus 183.5 ± 53.5 g, P = 0.006). For 2DE methods, there was no significant difference between the LVM obtained with or without contrast enhancement in control group (132.3 ± 23.6 g versus 128.4 ± 23.3 g), LV hypertrophy group (177.7 ± 38.6 versus 178.3 ± 30.9 g, P = 0.889), and LV enlargement group (211.9 ± 63.2 g versus 206.5 ± 66.0 g, P = 0.386). The difference between LVM measured by 2DE-AL and SPECT was the greatest (27.9 ± 34.0 g), especially in LV hypertrophy group and LV enlargement group (LV hypertrophy group 39.7 ± 26.0 g; LV enlargement group 24.2 ± 42.8 g). To conclude, Contrast-3DE and SPECT show greater consistency in LVM measurement, especially in cardiomyopathy, when compared with 2DE. Administering contrast can effectively reduce the overestimation of LVM by non-contrast DE.
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Affiliation(s)
- Meiqing Zhang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Xu Chen
- Medical School of Chinese PLA
| | - Feifei Yang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital
| | - Yanjie Song
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Dai Zhang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Qiang Chen
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Yongjiang Ma
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Shuhua Wang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Dongdong Ji
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
| | - Zhongxiang Duan
- Department of Nuclear Medicine, Fourth Medical Center of Chinese PLA General Hospital
| | - Liwei Zhang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital
| | - Qiushuang Wang
- Department of Cardiology, Fourth Medical Center of Chinese PLA General Hospital
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Doost A, Rangel A, Nguyen Q, Morahan G, Arnolda L. Micro-CT scan with virtual dissection of left ventricle is a non-destructive, reproducible alternative to dissection and weighing for left ventricular size. Sci Rep 2020; 10:13853. [PMID: 32807896 PMCID: PMC7431593 DOI: 10.1038/s41598-020-70734-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022] Open
Abstract
Micro-CT scan images enhanced by iodine staining provide high-resolution visualisation of soft tissues in laboratory mice. We have compared Micro-CT scan-derived left ventricular (LV) mass with dissection and weighing. Ex-vivo micro-CT scan images of the mouse hearts were obtained following staining by iodine. The LV was segmented and its volume was assessed using a semi-automated method by Drishti software. The left ventricle was then dissected in the laboratory and its actual weight was measured and compared against the estimated results. LV mass was calculated multiplying its estimated volume and myocardial specific gravity. Thirty-five iodine-stained post-natal mouse hearts were studied. Mice were of either sex and 68 to 352 days old (median age 202 days with interquartile range 103 to 245 days) at the time of sacrifice. Samples were from 20 genetically diverse strains. Median mouse body weight was 29 g with interquartile range 24 to 34 g. Left Ventricular weights ranged from 40.0 to 116.7 mg. The segmented LV mass estimated from micro-CT scan and directly measured dissected LV mass were strongly correlated (R2 = 0. 97). Segmented LV mass derived from Micro-CT images was very similar to the physically dissected LV mass (mean difference = 0.09 mg; 95% confidence interval − 3.29 mg to 3.1 mg). Micro-CT scanning provides a non-destructive, efficient and accurate visualisation tool for anatomical analysis of animal heart models of human cardiovascular conditions. Iodine-stained soft tissue imaging empowers researchers to perform qualitative and quantitative assessment of the cardiac structures with preservation of the samples for future histological analysis.
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Affiliation(s)
- Ata Doost
- Australian National University Medical School, Canberra, ACT, Australia
| | - Alejandra Rangel
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Building 32, Wollongong, NSW, 2522, Australia
| | - Quang Nguyen
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia
| | - Grant Morahan
- Centre for Diabetes Research, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia
| | - Leonard Arnolda
- Australian National University Medical School, Canberra, ACT, Australia. .,Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Building 32, Wollongong, NSW, 2522, Australia.
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Dörr K, Kammer M, Reindl-Schwaighofer R, Lorenz M, Loewe C, Marculescu R, Erben R, Oberbauer R. Effect of etelcalcetide on cardiac hypertrophy in hemodialysis patients: a randomized controlled trial (ETECAR-HD). Trials 2019; 20:601. [PMID: 31651370 PMCID: PMC6813957 DOI: 10.1186/s13063-019-3707-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/06/2019] [Indexed: 02/15/2023] Open
Abstract
Background Fibroblast growth factor 23 (FGF23) is associated with left ventricular hypertrophy (LVH) in patients with chronic kidney disease, and calcimimetic therapy reduces plasma concentrations of FGF23. It remains unknown whether treatment with the calcimimetic etelcalcetide (ETL) reduces LVH in patients on hemodialysis. Methods/design This single-blinded randomized trial of 12 months duration will test the effects of ETL compared with alfacalcidol on LVH and cardiac fibrosis in maintenance hemodialysis patients with secondary hyperparathyroidism. Both treatment regimens will be titrated to equally suppress secondary hyperparathyroidism while alfacalcidol treatment causes an increase and ETL a decrease in FGF23, respectively. Patients treated thrice weekly with hemodialysis for ≥ 3 months and ≤ 3 years with parathyroid hormone levels ≥ 300 pg/ml and LVH will be enrolled in the study. The primary study endpoint is change from baseline to 12 months in left ventricular mass index (LVMI; g/m2) measured by cardiac magnetic resonance imaging. Sample size calculations showed that 62 randomized patients will be necessary to detect a difference in LVMI of at least 20 g/m2 between the two groups at 12 months. Due to the strong association of volume overload and LVH, randomization will be stratified by residual kidney function, and regular body composition monitoring will be performed to control the volume status of patients. Study medication will be administered intravenously by the dialysis nurses after every hemodialysis session, thus omitting adherence issues. Secondary study endpoints are cardiac parameters measured by echocardiography, biomarker concentrations of bone metabolism (FGF23, vitamin D, parathyroid hormone, calcium, phosphate, s-Klotho), cardiac markers (pro-brain natriuretic peptide, pre- and postdialysis troponin T) and metabolites of the renin–angiotensin–aldosterone cascade (angiotensin I (Ang I), Ang II, Ang-(1–7), Ang-(1–5), Ang-(1–9), and aldosterone). Discussion The causal inference and pathophysiology of LVH regression by FGF23 reduction using calcimimetic treatment has not yet been shown. This intervention study has the potential to discover a new strategy for the treatment of cardiac hypertrophy and fibrosis in patients on maintenance hemodialysis. It might be speculated that successful treatment of cardiac morphology will also reduce the risk of cardiac death in this population. Trial registration European Clinical Trials Database, EudraCT number 2017-000222-35; ClinicalTrials.gov, NCT03182699. Registered on
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Affiliation(s)
- Katharina Dörr
- Department of Nephrology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Kammer
- Department of Nephrology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.,Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Section for Clinical Biometrics, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | | | - Matthias Lorenz
- Vienna Dialysis Center, Kapellenweg 37, 1220, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Intervention, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Rodrig Marculescu
- Laboratory Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Reinhold Erben
- Physiology, Pathophysiology, and Experimental Endocrinology, VetMed Vienna, Veterinärplatz 1, Vienna, Austria
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Gheorghe AG, Fuchs A, Jacobsen C, Kofoed KF, Møgelvang R, Lynnerup N, Banner J. Cardiac left ventricular myocardial tissue density, evaluated by computed tomography and autopsy. BMC Med Imaging 2019; 19:29. [PMID: 30979363 PMCID: PMC6461811 DOI: 10.1186/s12880-019-0326-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/12/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Left ventricular mass (LVM) is an independent risk factor for the prediction of cardiac events. Its assessment is a clinically important diagnostic procedure in cardiology and may be performed by Computed Tomography (CT). The aim of this study was to assess the correlation between the cardiac left ventricular shell volume (LVShV) determined by postmortem Computed Tomography (PMCT) and the anatomic LVM obtained at autopsy and to calculate the myocardial tissue density. METHODS A total of 109 deceased individuals were examined with a 64-slice CT scanner and LVShV was determined. At autopsy, the left ventricle was dissected and weighted. The correlation between LVShV and the anatomic LVM was analysed. Asymmetric left ventricular (LV) hypertrophy was recorded. Inter-observer variability was evaluated, and a density value for myocardial tissue was calculated. RESULTS The mean age of the deceased was 55 ± 16 years, and 58% was men. We found 30 cases of asymmetric LV hypertrophy. A highly positive correlation existed between LVShV and anatomic LVM (r = 0.857; p < 0.0001), regardless of hypertrophy, asymmetric hypertrophy and gender. The mean difference in the inter-observer variability for LVShV assessment was - 4.4 ml (95% CI: -26.4; 17.6). A linear regression analysis was performed, resulting in a value of 1.265 g/ml for myocardial tissue density. Applying the hitherto used myocardial tissue density of 1.055 g/ml underestimated the anatomic LVM by 18.1% (p < 0.0001). CONCLUSION PMCT is a helpful tool for the assessment of LVM, and LVShV is highly correlated with LVM as assessed by subsequent autopsy. The correlation between the two was independent of gender, hypertrophy and LV asymmetric hypertrophy. We found a higher myocardial tissue density of 1.265 g/ml compared to previous studies. We show that PMCT combined with autopsy may contribute not only to anatomical but also clinical knowledge.
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Affiliation(s)
- Alexandra G Gheorghe
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 1 sal, 2100, Copenhagen, Denmark.
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Jacobsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 1 sal, 2100, Copenhagen, Denmark
| | - Klaus F Kofoed
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Radiology, Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels Lynnerup
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 1 sal, 2100, Copenhagen, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 1 sal, 2100, Copenhagen, Denmark
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Ramos-Leví AM, Marazuela M. Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them? Front Endocrinol (Lausanne) 2019; 10:120. [PMID: 30930848 PMCID: PMC6423916 DOI: 10.3389/fendo.2019.00120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 12/20/2022] Open
Abstract
Patients with acromegaly frequently develop cardiovascular comorbidities, which significantly affect their morbidity and contribute to an increased all-cause mortality. In this regard, the most frequent complications that these patients may encounter include hypertension, cardiomyopathy, heart valve disease, arrhythmias, atherosclerosis, and coronary artery disease. The specific underlying mechanisms involved in the pathophysiology of these comorbidities are not always fully understood, but uncontrolled GH/IGF-I excess, age, prolonged disease duration, and coexistence of other cardio-vascular risk factors have been identified as significant influencing predisposing factors. It is important that clinicians bear in mind the potential development of cardiovascular comorbidities in acromegalic patients, in order to promptly tackle them, and avoid the progression of cardiac abnormalities. In many cases, this approach may be performed using straightforward screening tools, which will guide us for further diagnosis and management of cardiovascular complications. This article focuses on those cardiovascular comorbidities that are most frequently encountered in acromegalic patients, describes their pathophysiology, and suggests some recommendations for an early and optimal diagnosis, management and treatment.
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10
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Bogomolov SN, Kulikov AN, Tikhonova JA, Solntsev VN, Rybakova MG, Gudkova AY, Kuchmin AN. Intravital and postmortem diagnostics of myocardial hypertrophy of the left ventricle:identity or convention? TERAPEVT ARKH 2018; 90:73-80. [PMID: 30701739 DOI: 10.26442/terarkh201890973-80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM The aim of the study is to assess the compliance of the results of electrocardiographic (ECG) and echocardiographic diagnostic methods of hypertrophy of left ventricular myocardium (LVH) with the postmortem finding of measurement of left ventricular myocardium mass (LVM). MATERIALS AND METHODS We examined the data of intravital study of anthropometric measurements [age, height, weight, body mass index (BMI)], instrumental results [12-lead ECG, EchoCG], as well as the postmortem finding (direct measurement of LVM at autopsy) in 15 patients of general therapy department. While analyzing ECG we studied as conventional ECG criteria for the detection of LVH as well as the author's own criteria based on two models (regression and discriminant analyses), including voltage, sex and age criteria. Echocardiographic diagnostic method used to calculate LVM (according to ASE formula) and left ventricular mass index (LVMI). Postmortem finding of LVM was carried out according to the standard measurement method. According to the absence of the single conventional postmortem finding of measurement of LVH, we considered three different variants of the postmortem finding of LVH: the criterion of K. Bove et al. (CB); the criterion of A.M. Lifshitz, also called ventricular index (VI) and the criterion of P. Casale - the left ventricular mass index at autopsy (LVMI). RESULTS Conventional ECG criteria for the detection of LVH showed high specificity (71-100%) using any method of the postmortem finding of measurement, but were characterized by extremely low sensitivity (0-37.5%). Their overall diagnostic accuracy was higher on using K. Bove or A.M. Lifshitz criteria (40-66.7%) and low - on using the criterion of P. Casale (13.3-40%). The author's ECG criteria were less specificity (50-100%) and had higher sensitivity (54-75%), and their diagnostic accuracy remained higher and showed small dependence on the method of the postmortem finding of measurement of LVH (60-66.7%). CONCLUSION Usually the ECG criteria to diagnose left ventricular hypertrophy were expectedly showed low sensitivity using any method of the postmortem finding of measurement. Meanwhile, the author's own ECG criteria associated with the most sensitive electrocardiographic characteristics to LVH and sex and age-specific indexes of the examined patients exceeded the conventional ECG criteria in sensitivity and diagnostic accuracy.
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Affiliation(s)
| | - A N Kulikov
- Military Medical Academy, St. Petersburg, Russia.,Pavlov Medical University, St. Petersburg, Russia
| | | | - V N Solntsev
- Almazov Federal Medical Research Centre, St. Petersburg, Russia
| | - M G Rybakova
- Pavlov Medical University, St. Petersburg, Russia
| | - A Y Gudkova
- Pavlov Medical University, St. Petersburg, Russia.,Almazov Federal Medical Research Centre, St. Petersburg, Russia
| | - A N Kuchmin
- Military Medical Academy, St. Petersburg, Russia
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11
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Varna M, Xuan HV, Fort E. Gold nanoparticles in cardiovascular imaging. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2017; 10. [DOI: 10.1002/wnan.1470] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 02/01/2017] [Accepted: 02/25/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Mariana Varna
- Institut LangevinESPCI Paris, CNRS, PSL Research UniversityParisFrance
- Institut Galien Paris‐Sud UMR 8612, CNRSUniversité Paris‐Sud/Paris‐Saclay Faculté de PharmacieChâtenay‐MalabryFrance
| | - Hoa V. Xuan
- Institut LangevinESPCI Paris, CNRS, PSL Research UniversityParisFrance
- Faculty of Physics and TechnologyThai Nguyen University of Science (TNUS)Thai NguyenVietnam
| | - Emmanuel Fort
- Institut LangevinESPCI Paris, CNRS, PSL Research UniversityParisFrance
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12
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Korre M, Porto LGG, Farioli A, Yang J, Christiani DC, Christophi CA, Lombardi DA, Kovacs RJ, Mastouri R, Abbasi S, Steigner M, Moffatt S, Smith D, Kales SN. Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters. Am J Cardiol 2016; 118:1769-1773. [PMID: 27687051 PMCID: PMC5312771 DOI: 10.1016/j.amjcard.2016.08.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/14/2016] [Accepted: 08/14/2016] [Indexed: 01/19/2023]
Abstract
Left ventricular (LV) mass is a strong predictor of cardiovascular disease (CVD) events; increased LV mass is common among US firefighters and plays a major role in firefighter sudden cardiac death. We aim to identify significant predictors of LV mass among firefighters. Cross-sectional study of 400 career male firefighters selected by an enriched randomization strategy. Weighted analyses were performed based on the total number of risk factors per subject with inverse probability weighting. LV mass was assessed by echocardiography (ECHO) and cardiac magnetic resonance, and normalized (indexed) for height. CVD risk parameters included vital signs at rest, body mass index (BMI)–defined obesity, obstructive sleep apnea risk, low cardiorespiratory fitness, and physical activity. Linear regression models were performed. In multivariate analyses, BMI was the only consistent significant independent predictor of LV mass indexes (all, p <0.001). A 1-unit decrease in BMI was associated with 1-unit (g/m1.7) reduction of LV mass/height1.7 after adjustment for age, obstructive sleep apnea risk, and cardiorespiratory fitness. In conclusion, after height-indexing ECHO-measured and cardiac magnetic resonance–measured LV mass, BMI was found to be a major driver of LV mass among firefighters. Our findings taken together with previous research suggest that reducing obesity will improve CVD risk profiles and decrease on-duty CVD and sudden cardiac death events in the fire service. Our results may also support targeted noninvasive screening for LV hypertrophy with ECHO among obese firefighters.
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Ozdemir S, Tan YZ, Gazi E. Is the Increased Septal Perfusion the Signal of Asymmetrical Septal Hypertrophy? World J Nucl Med 2016; 15:184-9. [PMID: 27651739 PMCID: PMC5020792 DOI: 10.4103/1450-1147.174706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In this study, we have compared scintigraphic and echocardiographic data in order to investigate whether increased septal perfusion represents asymmetrical septal hypertrophy (ASH), which is a symptom followed in the scintigraphy of myocardial perfusion. The study consists of a total of 186 patients (120 females and 66 males with an average age of 59.45 ± 11.54 years) who had normal myocardial perfusion scintigraphy and echocardiography examinations. Statistical comparison of septal wall thickness measurements obtained from echocardiography and septal-to-lateral wall ratios (S/L ratio) was performed scintigraphically. Left ventricular mass values were obtained as both scintigraphic and echocardiographic data and their correlations were evaluated in order to assess the presence of left ventricular hypertrophy (LVH). In statistical analyses, the values of interventricular septal thickness in diastole (IVSd), left ventricle posterior wall thickness in diastole (LVPWd), left ventricle mass (LVM), and left ventricle mass index (LVMI) were found to be significantly higher in group 2 (S/L ratio >1) compared to group 1 (S/L ratio <1). In addition, S/L ratio is significantly correlated with echocardiographic IVSd, LVPWd, LVM, LVMI, and scintigraphic LVM (rest) values. Furthermore, echocardiographic LVM and LVMI values were significantly correlated with LVM and LVMI values obtained from scintigraphy. It should be known that increased S/L ratio that can be monitored during scintigraphic studies can be an indicator of septal hypertrophy and/or LVH, however, further examination and close follow-ups should be performed in necessary cases.
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Affiliation(s)
- Semra Ozdemir
- Department of Nuclear Medicine, Canakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Yusuf Ziya Tan
- Department of Nuclear Medicine, Canakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Emine Gazi
- Department of Cardiology, Canakkale Onsekiz Mart University, Çanakkale, Turkey
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Klein R, Ametepe ES, Yam Y, Dwivedi G, Chow BJ. Cardiac CT assessment of left ventricular mass in mid-diastasis and its prognostic value. Eur Heart J Cardiovasc Imaging 2016; 18:95-102. [PMID: 26850628 DOI: 10.1093/ehjci/jev357] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/22/2015] [Indexed: 12/11/2022] Open
Abstract
AIMS To determine the influence of cardiac motion on measurements of left ventricular (LV) mass obtained with 64-slice computed tomography (CT) and to elucidate the prognostic value of LV mass on major adverse cardiac events (MACE) and all-cause mortality. Increased LV mass has been linked with MACE. Although Cardiac CT allows measurement of LV anatomy, it is susceptible to motion artefacts often requiring image acquisition during diastasis. There is a need to understand variability in LV mass measurements across phases of the cardiac cycle, and whether mid-diastolic measurements have prognostic value. METHODS AND RESULTS The study comprised two equally sized cohorts of patients that had undergone retrospectively gated cardiac CT: patients who had MACE and/or all-cause death at follow-up and a matched (age, sex, and risk factors) event-free cohort. LV mass was measured at mid-diastole, end-diastole, and end-systole. Correlation and agreement between phases were determined. The incremental value of mid-diastolic hypertrophy (LVH) over the National Cholesterol Education Programme (NCEP) risk was performed for LV mass indices normalized to body surface area (LVMIBSA) or weight (LVMIWeight). Of 166 patients, 31.3% experienced MACE and 28.9% died of any cause (follow-up 22.9 ± 13.4 months). LV mass at all cardiac phases were strongly correlated (r > 0.94). Mean mid-diastolic LVMIBSA was higher in the cohort with events (93.7 vs. 80.7 g/m2, P= 0.008) as was LVMIWeight (2.26 vs. 1.88 g/kg, P = 0.001). LVMIBSA and LVMIWeight had prognostic value incremental to NCEP with 1.85 and 2.47 hazard ratios, respectively. CONCLUSIONS Measurement of LV mass can be obtained by cardiac CT images obtained at mid-diastasis. LV mass measurements obtained at mid-diastasis have prognostic value.
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Affiliation(s)
- Ran Klein
- Division of Nuclear Medicine, The Ottawa hospital, 1053 Carling Ave, Ottawa, ON, Canada, Canada, K1Y 4E9
| | | | - Yeung Yam
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON, Canada K1Y 4W7
| | - Girish Dwivedi
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON, Canada K1Y 4W7
| | - Benjamin J Chow
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON, Canada K1Y 4W7
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dos Santos Silva CM, Gottlieb I, Volschan I, Kasuki L, Warszawski L, Balarini Lima GA, Xavier SS, Pedrosa RC, Neto LV, Gadelha MR. Low Frequency of Cardiomyopathy Using Cardiac Magnetic Resonance Imaging in an Acromegaly Contemporary Cohort. J Clin Endocrinol Metab 2015; 100:4447-55. [PMID: 26431508 DOI: 10.1210/jc.2015-2675] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Left ventricular hypertrophy (LVH) and myocardial fibrosis are considered common findings of the acromegaly cardiomyopathy in echocardiography studies. OBJECTIVE To evaluate the frequency of LVH, systolic dysfunction and myocardial fibrosis was undertaken in patients with acromegaly using cardiac magnetic resonance imaging (CMRi) before and after 12 months of octreotide long-acting repeatable treatment. PATIENTS AND METHODS Consecutive patients with active acromegaly submitted to biochemical analysis and CMRi before and after 12 months of treatment. Additionally, echocardiography was performed before treatment. RESULTS Forty consecutive patients were evaluated using CMRi at baseline and 30 patients were reevaluated after 12 months of treatment. Additionally, 29 of these patients were submitted to echocardiography. Using CMRi, the frequency of LVH was 5%. The mean left ventricular mass index (LVMi) was 61.73 ± 18.8 g/m(2). The mean left ventricular ejection fraction (LVEF) was 61.85 ± 9.2%, and all patients had normal systolic function. Late gadolinium enhancement was present in five patients (13.5%), and one patient (3.5%) had an increased extracellular volume. After treatment, 12 patients (40%) had criteria for disease control. No clinically relevant differences in cardiac variables before and after treatment were observed. Additionally, there was no difference in LVMi and LVEF among patients with and without disease control. Using echocardiography, 31% of the patients had LVH, mean LVMi was 117.8 ± 46.3 g/m(2) and mean LVEF was 67.3 ± 4.4%. All patients had normal systolic function. CONCLUSIONS We demonstrated by CMRi, the gold-standard method, that patients with active acromegaly might have a lower prevalence of cardiac abnormalities than previously reported.
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Affiliation(s)
- Cintia Marques dos Santos Silva
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Ilan Gottlieb
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Isabela Volschan
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Leila Warszawski
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Giovanna Aparecida Balarini Lima
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Sergio Salles Xavier
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Roberto Coury Pedrosa
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Leonardo Vieira Neto
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section (C.M.d.S.S., L.K., L.V.N., M.R.G.) and Cardiology Section (I.V., S.S.X., R.C.P.), Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Clínica de Diagnóstico por Imagem/Multi-Imagem (I.G.), Rio de Janeiro, Brazil; Radiology Department (I.G.), Casa de Saude São Jose, Rio de Janeiro, Brazil; Endocrine Section (L.K.), Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil; Endocrine Section (L.W.), Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione, IEDE, Rio de Janeiro, Brazil; Endocrine Section (G.A.B.L.), Medical School and Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil; Endocrine Section (L.V.N.), Hospital Federal da Lagoa, Rio de Janeiro, Brazil
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Guevara JL, Holmes ES, Reetz J, Holt DE. Porcupine Quill Migration in the Thoracic Cavity of a German Shorthaired Pointer. J Am Anim Hosp Assoc 2015; 51:101-6. [DOI: 10.5326/jaaha-ms-6093] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 7 yr old German shorthaired pointer presented with progressive respiratory distress and lethargy. Two weeks prior to presentation, the dog had porcupine quills removed from the left forepaw, muzzle, and sternal area. At the time of presentation, the dog had bounding pulses and friction rubs in the right dorsal lung field. Harsh lung sounds and decreased lung sounds were ausculted in multiple lung fields. Radiographs revealed a pneumothorax and rounding of the cardiac silhouette suggestive of pericardial effusion. Computed tomographic imaging was performed and revealed multiple porcupine quills in the thoracic cavity. Surgery was performed and quills were found in multiple lung lobes and the heart. Following surgery the dog remained hypotensive. A post-operative echocardiogram revealed multiple curvilinear soft-tissue opacities in the heart. Given the grave prognosis the dog was subsequently euthanized and a postmortem examination was performed. A single porcupine quill was discovered in the left atrium above the mitral valve annulus. The quill extended across the aortic root, impinging on the coronary artery below the level of the aortic valve. To the authors' knowledge, this is the first known report of porcupine quill migration through the heart.
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Affiliation(s)
- Jose L. Guevara
- From the Dallas Veterinary Surgical Center, Dallas, TX (J.G.); Veterinary Specialty Hospital of the Carolinas, Cary, NC (E.H.); and the University of Pennsylvania, Philadelphia, PA (J.R., D.H.)
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Hipertrofia ventricular izquierda como factor de riesgo cardiovascular en el paciente hipertenso. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70372-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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