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Luna-Alcala S, Garcia-Cardenas M, Guerra EC, Martinez-Dominguez P, Cabello-Ganem A, Proaño-Bernal L, Chava-Ponte CA, Hernandez-Pacherres A, Espinola-Zavaleta N. Ventricular predominance in biventricular arrhythmogenic cardiomyopathy: Should new subtype criteria be recognized? Radiol Case Rep 2024; 19:2457-2463. [PMID: 38585407 PMCID: PMC10998062 DOI: 10.1016/j.radcr.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Arrhythmogenic cardiomyopathy is a biventricular disease in which the effect on the left ventricle can be either equivalent to or more severe than that on the right ventricle. It is a rare disease due to its low reported prevalence and typically becomes clinically evident during the second to fourth decade of life. It represents 4% of sudden cardiac death cases referred for autopsy and 10% of cases of unexplained cardiac arrest. We present a challenging case report of a 68-year-old man who arrived at the emergency room with chest discomfort, palpitations, and light-headedness before a syncopal episode with urinary incontinence. During monitoring, ventricular tachycardia was detected and was treated with cardioversion. However, a follow-up electrocardiogram revealed low QRS voltages in limb leads and T-wave inversion in the left precordial leads. The patient underwent a transthoracic echocardiogram and a gadolinium-based magnetic resonance imaging study to evaluate the possibility of acute decompensated heart failure. Both imaging studies revealed low ejection fraction and systolic dysfunction in both right and left ventricles. Furthermore, in the late gadolinium enhancement study, extensive left ventricular subepicardial enhancement with septal predominance in a ring pattern and an irregular morphology of the right ventricular free wall were observed. A diagnosis of biventricular arrhythmogenic cardiomyopathy was established based on the 2020 Padua Criteria. Although there is not a recognized classification within these criteria to establish its subtype, in our case there was a left ventricular predominance due to the presence of additional left ventricular categories.
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Affiliation(s)
- Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | - Enrique C. Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- MD–PhD (PECEM) Program, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Pavel Martinez-Dominguez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Leonardo Proaño-Bernal
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | | | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
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Proaño-Bernal L, Gilabert-García A, Sharma-Sharma S, Mora-Barrera CM, Singer-De-la-Garza J, Beristain-de-la-Rosa PY, Basile-Alvarez MR, Guerra EC, Bermudez-Gonzalez JL, Luna-Alcala S, Espinola-Zavaleta N, Alexanderson-Rosas E. Positron emission tomography and its role in the assessment of vulnerable plaques in comparison to other imaging modalities. Front Med (Lausanne) 2024; 10:1293848. [PMID: 38425695 PMCID: PMC10902136 DOI: 10.3389/fmed.2023.1293848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024] Open
Abstract
The diagnosis and management of vulnerable plaques are topics of high interest in the cardiovascular field. Although imaging techniques like computed tomography angiography (MCTA) and ultrasonography (USG) can structurally evaluate atherosclerotic plaques, they are limited in examining internal cellular processes. Positron emission tomography (PET) molecular imaging, on the other hand, can highlight these cellular processes, including inflammation, angiogenesis, and lipid oxidation. Magnetic resonance imaging (MRI) is also a valuable non-invasive imaging technique that can provide detailed anatomical and functional information on the cardiovascular system. In this review, we compare the advantages and drawbacks of MCTA, USG and MRI imaging techniques with PET molecular imaging in evaluating vulnerable plaques. PET imaging allows physicians to measure different pathophysiological events within the plaque using intravenous radiotracers, of which 18F-fluorodeoxyglucose (18F-FDG) is the most validated one. By using 18F-FDG, physicians can understand the formation of the plaque, assess the accumulation of macrophages, and predict major cardiovascular events. However, some limitations exist in using 18F-FDG, including myocardial uptake and low sensitivity in imaging coronary arteries. We also mention other radiotracers that can help in evaluating vulnerable plaques, including 18F-NaF. Although PET imaging is still challenging, it has shown promise in evaluating vulnerable plaques and could be used to intervene in high-risk patients before major cardiovascular events occur.
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Affiliation(s)
- Leonardo Proaño-Bernal
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ana Gilabert-García
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | | | | | | | | | - Enrique C. Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jorge Luis Bermudez-Gonzalez
- Department of Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Michel-Vázquez AD, Luna-Alcala S, Guerra EC, Proaño-Bernal L, Cabello-Ganem A, Aparicio-Ortiz AD, Espinola-Zavaleta N. Routinary PET/CT imaging for oncological surveillance accompanied by echocardiography may identify early atherosclerotic cardiovascular disease: A case report. Echocardiography 2023; 40:1117-1121. [PMID: 37519285 DOI: 10.1111/echo.15661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023] Open
Abstract
Atherosclerosis is a disease where plaque builds up in arteries, resulting in harmful cardiovascular events. Inflammation has a significant role in its progression, starting from the initial stages. Cancer patients, due to their constant exposure to inflammatory processes caused by treatments or illnesses, are at a higher risk of developing this condition. Arterial inflammation can be quantified with 18 F-FDG PET/CT imaging. In this case report, we propose that routinary PET/CT imaging for oncological surveillance could be useful for cardiovascular risk stratification by reviewing a case of a patient with breast cancer whose imaging study revealed arterial inflammation and a subsequent echocardiogram evidenced grade II diastolic dysfunction (potentially, an initial manifestation of the ischemic cascade).
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Affiliation(s)
| | - Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico, Mexico
| | - Enrique C Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico, Mexico
- School of Medicine, National Autonomous University of Mexico, Mexico, Mexico
| | - Leonardo Proaño-Bernal
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico, Mexico
| | - Alexis D Aparicio-Ortiz
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico, Mexico
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Bermudez-Gonzalez JL, Gonzalez-Hernandez MA, Proaño-Bernal L, Gilabert-García A, Villarreal-Guerrero C, Luna-Alvarez-Amezquita JA, Espinola-Zavaleta N, Alexanderson-Rosas E. Impact of collateral circulation in a patient with chronic coronary occlusion. J Nucl Cardiol 2023; 30:844-847. [PMID: 34893963 DOI: 10.1007/s12350-021-02870-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jorge Luis Bermudez-Gonzalez
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Miguel Angel Gonzalez-Hernandez
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Leonardo Proaño-Bernal
- Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico City, Mexico
| | - Ana Gilabert-García
- Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico City, Mexico
| | | | - Jose Antonio Luna-Alvarez-Amezquita
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Erick Alexanderson-Rosas
- Nuclear Cardiology Department, National Institute of Cardiology Ignacio Chavez, Juan Badiano No 1, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
- Faculty of Medicine, Autonomous National University of Mexico (UNAM), Mexico City, Mexico.
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