Search

Aims Developments in myocardial perfusion cardiovascular magnetic resonance (CMR) allow improvements in spatial resolution and/or myocardial coverage. Whole heart coverage may provide the most accurate assessment of myocardial ischaemic burden, while high spatial resolution is expected to improve detection of subendocardial ischaemia. The objective of this study was to compare myocardial ischaemic burden as depicted by 2D high resolution and 3D whole heart stress myocardial perfusion in patients with coronary artery disease. Methods and results Thirty-eight patients [age 61 +/- 8 (21% female)] underwent 2D high resolution (spatial resolution 1.2 mm(2)) and 3D whole heart (in-plane spatial resolution 2.3 mm(2)) stress CMR at 3-T in randomized order. Myocardial ischaemic burden (%) was visually quantified as perfusion defect at peak stress perfusion subtracted from subendocardial myocardial scar and expressed as a percentage of the myocardium. Median myocardial ischaemic burden was significantly higher with 2D high resolution compared with 3D whole heart [16.1 (2.0-30.6) vs. 13.4 (5.2-23.2), P = 0.004]. There was excellent agreement between myocardial ischaemic burden (intraclass correlation coefficient 0.81; P < 0.0001), with mean ratio difference between 2D high resolution vs. 3D whole heart 1.28 +/- 0.67 (95% limits of agreement -0.03 to 2.59). When using a 10% threshold for a dichotomous result for presence or absence of significant ischaemia, there was moderate agreement between the methods (kappa = 0.58, P < 0.0001). Conclusion 2D high resolution and 3D whole heart myocardial perfusion stress CMR are comparable for detection of ischaemia. 2D high resolution gives higher values for myocardial ischaemic burden compared with 3D whole heart, suggesting that 2D high resolution is more sensitive for detection of ischaemia., European Heart Journal. Cardiovascular Imaging, 23 (6), ISSN:2047-2404, ISSN:2047-2412

Contains fulltext : 283507.pdf (Publisher’s version ) (Open Access) Background: Data to support the routine use of embolic protection devices for stroke prevention during transcatheter aortic valve replacement (TAVR) are controversial. Identifying patients at high risk for peri-procedural cerebrovascular events may facilitate effective patient selection for embolic protection devices during TAVR. Aim: To generate a risk score model for stratifying TAVR patients according to peri-procedural cerebrovascular events risk. Methods and results: A total of 8779 TAVR patients from 12 centers worldwide were included. Peri-procedural cerebrovascular events were defined as an ischemic stroke or a transient ischemic attack occurring ≤24 h from TAVR. The peri-procedural cerebrovascular events rate was 1.4% (n = 127), which was independently associated with 1-year mortality (hazards ratio (HR) 1.78, 95% confidence interval (CI) 1.06-2.98, p < 0.028). The TASK risk score parameters were history of stroke, use of a non-balloon expandable valve, chronic kidney disease, and peripheral vascular disease, and each parameter was assigned one point. Each one-point increment was associated with a significant increase in peri-procedural cerebrovascular events risk (OR 1.96, 95% CI 1.56-2.45, p < 0.001). The TASK score was dichotomized into very-low, low, intermediate, and high (0, 1, 2, 3-4 points, respectively). The high-risk TASK score group (OR 5.4, 95% CI 2.06-14.16, p = 0.001) was associated with a significantly higher risk of peri-procedural cerebrovascular events compared with the low TASK score group. Conclusions: The proposed novel TASK risk score may assist in the pre-procedural risk stratification of TAVR patients for peri-procedural cerebrovascular events.

The objectives of this investigation were to seek out the residue level of nitrofurans and chloramphenicol in cultured tilapia muscle in south west region of Bangladesh. Ninety samples were collected randomly from various fish farm of different Upazillas of Khulna, Satkhira and Bagerhat districts during August-December, 2017, where each district was contained 30 samples. Antibiotic residues level present in the animal muscles were detected using ELISA in the Quality Control Laboratory of the Department of Fisheries, Khulna, Bangladesh. To collect information about the status of feed type questionnaire interviews were performed during sample collection from the respective farmers. The overall results revealed that nitrofuran metabolites and CAP residue existed in all the samples within the MRL (Maximum Residue Level) with the exception of 3.33%, 6.66% and 3.33% samples of Khulna, Bagerhat and Satkhira district respectively. Antibiotic residue data showed all nitrofuran metabolites like SEM, AOZ, AMOZ, AHD and CAP were present in all samples in which SEM was highest in Shatkhira district and lowest in Khulna district. In case of AHD, highest residue was found in Khulna and lowest was Satkhira district. Additionally, AOZ was highest in Khulna district and lowest in Bagerhat district and AMOZ was highest in Bagerhat district and lowest Satkhira district. CAP was found highest in Satkhira district while that was lowest in Bagerhat district. The results of the also revealed that contamination of nitrofuran metabolites and chloramphenicol were more in tilapia farms where home-made feed was used compared to commercial feed. Asian Australas. J. Biosci. Biotechnol. 2019, 4 (2), 102-108

Echocardiography-derived measurements of maximum left ventricular (LV) wall thickness are important for both the diagnosis and risk stratification of hypertrophic cardiomyopathy (HC). Cardiac Magnetic Resonance (CMR) imaging is increasingly being used in the assessment of HC however, little is known about the relationship between wall thickness measurements made by the 2 modalities. We sought to compare measurements made with echocardiography and CMR and to assess the impact of any differences on risk stratification using the current European Society of Cardiology (ESC) guidelines. Maximum LV wall thickness measurements were recorded on 50 consecutive patients with HC. 69% of LV wall thickness measurements were recorded with echocardiography, compared to 69% from CMR (p

BACKGROUND: The use of coronary MR angiography (CMRA) in patients with coronary artery disease (CAD) remains limited due to the long scan times, unpredictable and often non-diagnostic image quality secondary to respiratory motion artifacts. The purpose of this study was to evaluate CMRA with image-based respiratory navigation (iNAV CMRA) and compare it to gold standard invasive x-ray coronary angiography in patients with CAD.METHODS: Consecutive patients referred for CMR assessment were included to undergo iNAV CMRA on a 1.5 T scanner. Coronary vessel sharpness and a visual score were assigned to the coronary arteries. A diagnostic reading was performed on the iNAV CMRA data, where a lumen narrowing >50% was considered diseased. This was compared to invasive x-ray findings.RESULTS: Image-navigated CMRA was performed in 31 patients (77% male, 56 ± 14 years). The iNAV CMRA scan time was 7 min:21 s ± 0 min:28 s. Out of a possible 279 coronary segments, 26 segments were excluded from analysis due to stents or diameter less than 1.5 mm, resulting in a total of 253 coronary segments. Diagnostic image quality was obtained for 98% of proximal coronary segments, 94% of middle segments, and 91% of distal coronary segments. The sensitivity and specificity was 86% and 83% per patient, 80% and 92% per vessel and 73% and 95% per segment.CONCLUSION: In this study, iNAV CMRA offered a very good diagnostic performance when compared against invasive x-ray angiography. Due to the short and predictable scan time it can add clinical value as a part of a comprehensive CAD assessment protocol.

Introduction Myocardial perfusion cardiovascular magnetic resonance (CMR) is a highly accurate non-invasive imaging modality in the diagnosis of coronary artery disease (CAD). High-resolution (hi-res) two-dimensional (2D) perfusion CMR can better detect sub-endocardial ischaemia although with the disadvantage of lesser myocardial coverage. Three-dimensional (3D) perfusion provides whole heart coverage but has a comparatively inferior resolution. The superiority of fractional flow reserve (FFR) over visual angiographic assessment in determining functional significance of a coronary stenosis is now well established. We studied the diagnostic agreement between hi-res 2D and 3D perfusion CMR in patients with significant multi-vessel flow limiting CAD as confirmed by FFR on a per patient and per vessel basis. Methods Patients with suspected stable CAD referred for invasive coronary angiography as part of their routine clinical care were prospectively recruited. Prior to revascularisation (if performed) all patients underwent both hi-res 2D adenosine vasodilator stress and 3D adenosine stress perfusion scans during the same sitting. Visually, coronary stenoses less than 50% were deemed not to be flow limiting, whereas those 80% or more were considered as flow limiting. For stenoses between 50%–80% FFR study was performed, with FFR of 0.8 or less considered functionally significant. Blinded, independent, qualitative visual analysis by two experienced readers was performed to confirm existence of true perfusion defects on both 2D and 3D perfusion CMR datasets. Vascular territories in relation to CMR perfusion defects were assigned as per AHA 16 segment classification. Results Prevalence of CAD was 62%. Of the 29 patients studied, 6 (21%) had single-vessel disease, 8 (27%) had two-vessel disease (2VD), 4 (14%) had three-vessel disease (3VD), and 11 (38%) had no significant CAD. In view of the small sample size qualitative analysis was undertaken to determine concordance between hi-res 2D and 3D perfusion CMR. Prevalence of perfusion defects relating to the three vascular territories have been detailed in Table 1. Conclusions Our study shows an excellent agreement for both modalities in detecting FFR positive CAD on a per patient basis. On a per vessel basis, between the two, agreement in the LAD territory appears to be best. Discrepancy appears to be most in the circumflex territory. 3D perfusion CMR appears to detect circumflex ischaemia more accurately possibly due to better coverage of the basal left ventricle. (Ref Fig 1 and Fig 2) The lateral wall is often the thinnest making it more difficult to detect perfusion abnormalities – better coverage with 3D may be beneficial here. However, in the circumflex vascular territory we also observe that, in the absence of flow limiting disease in the circumflex artery (comparatively with the LAD and RCA) perfusion defects appear to be more prevalent, reflecting a limitation of the AHA classification.

Background Patients with ischaemic heart disease (IHD) often show a combination of inducible ischaemia and previous myocardial infarction, therefore is particularly relevant to reach an accurate assessment of myocardial viability and ischaemic burden, as this may results in more appropriate therapy and better outcome. Areas of scar frequently result in false-positive perfusion findings, we therefore hypothesised that combined cardiac magnetic resonance (CMR) high-resolution quantitative perfusion and late gadolinium enhancement (LGE) protocol will result in a more accurate evaluation of ischaemic burden, avoiding areas of scar. Methods 15 patients with IHD and ejection fraction (EF)

Single site left ventricular (LV) pacing in the absence of intrinsic ventricular activity can be as detrimental to LV function as right ventricular apical pacing. This report describes a patient with complete heart block who developed significant dyssynchrony and cardiomyopathy secondary to single site lateral LV pacing. The process was reversed by placement of a second anterior LV lead. (PACE 2013; 36:e35–e37)

Aim: To quantify the adherence to national guidance for the use of oxygen in patients presenting with chest pain to coronary care units (CCUs) across the UK. Design: Prospective survey. Methods: A total of 307 hospitals were contacted by telephone between August 2010 and October 2010. Of these, 48 had no CCUs, 10 units refused to take part and 18 hospitals were contacted on 2 occasions but were unable to provide the information due to paucity of time owing to heavy clinical workload. Overall 231 hospitals participated in the audit questionnaire. Results: A total of 30% of the units used oxygen titrated to saturations in accordance with national guidelines. There was no difference between units that had on-site availability of percutaneous coronary intervention and those that did not. Those hospitals where there was a policy for routine oxygen prescription were as unlikely to comply with the guidelines on oxygen use as hospitals where oxygen was not routinely prescribed. Conclusion: Only one-third of CCUs in the UK reported adherence to guidelines with regards to oxygen delivery in patients presenting with chest pain. Despite this figure seeming rather low, this is consistent with practice through a range of specialties and guidelines. The evidence base for the oxygen guidance remains insecure. Additional research is required but in the meantime we recommend oxygen is prescribed according to current guidelines.

Single site left ventricular (LV) pacing in the absence of intrinsic ventricular activity can be as detrimental to LV function as right ventricular apical pacing. This report describes a patient with complete heart block who developed significant dyssynchrony and cardiomyopathy secondary to single site lateral LV pacing. The process was reversed by placement of a second anterior LV lead.

Introduction Indications for cardiac resynchronisation therapy (CRT) are expanding; included in this are patients with symptomatic heart failure and chronic right ventricular pacing undergoing upgrade procedures. Previously reported data from the REPLACE registry suggest a much higher complication rate (18.7% overall) associated with CRT upgrade procedures than data regarding de novo implants. We report our 3 year experience at a regional pacing centre in North-East England. Methods We undertook a retrospective observational study in a UK tertiary pacing centre. We reviewed the electronic hospital records and pacing files of 183 consecutive patients who underwent their first attempted CRT implantation between January 1 st 2010 and December 31 st 2012. We compared de novo implants with upgrade procedures, recording all documented complications up to the most recent device clinic follow-up. Significance of between group differences were calculated using Fisher’s 2-tail test. Results Conclusions Our data compares favourably to previously reported data in terms of overall complication rates of LV lead implantation. What we found striking was that complication rates for upgrade procedures were not significantly different to de novo implants and may be because over a third (35%) of our CRT procedures are upgrades.

Introduction In high-risk patients with severe symptomatic aortic stenosis (AS) surgical AVR (sAVR) or Transcatheter Aortic Valve Implanation (TAVI) are established treatment options. Rates of permanent pacemaker (PPM) insertion post TAVI are dependent on valve type and vary from22.5% for Medtronic CoreValve to 5.9% for the Edwards heart valve system. We examined PPM rates in a real world registry of 136 consecutive TAVI patients to explore pre-TAVI and post-TAVI PPM implantation rates. We also used a comparator group of patients who underwent sAVR following heart team evaluation. Method Our unit is a regional referral centre with a catchment population of 1.5 million. Data was collected prospectively on all patients with severe symptomatic AS assessed in our TAVI heart team MDT (between 2009–2012). TAVI indications were either logistic Euroscore >20% or inoperable status as judged by direct surgical review and heart team discussion. PPMs were implanted prior to TAVI if patients had class I or II indications for pacing. The Edwards Sapien or Sapien XT heart-valve system was used in all TAVI procedures. Prospectively collected data included: co-morbidities, logistic Euroscore, and incidence of urgent/emergency PPM implantation post procedure. Results 136 patients underwent TAVI and 59 underwent sAVR following heart team review. TAVI patients were older and higher risk than sAVR patients (mean age 82 ± 7 vs 80yrs; mean log Euroscore 25 ± 13% vs 15 ± 9.7 %). Patients with existing PPM at baseline in the TAVI and sAVR cohort were 6.6% (n = 9) and 3.4% (n = 2), respectively. Six (4.4%) patients had a PPM electively implanted pre TAVI after heart team review. The incidence of PPM insertion following TAVI and sAVR was 3.7% (n = 5) and 5.1% (n = 3), respectively. In the TAVI cohort, three patients had PPM implanted peri-procedure and two were implanted within five days. sAVR patients had their PPM implanted electively at a mean 118 days post procedure. Conclusion/Implications Standard indications for PPM insertion in elderly patients pre-TAVI are common. Our post TAVI pacing rates are low and compare favourably to those seen in tightly controlled clinical trials. Requirement for PPM insertion post TAVI is also similar to sAVR.

Background Rapid delivery of reperfusion therapy with PPCI is the gold standard treatment in STEMI. Systems have been developed, such as direct admission to a PCI-capable hospital, to minimise the time from diagnosis to PPCI. Despite this, a significant minority of patients are initially admitted to non-PCI capable hospitals. The aim of this study was to determine whether patients differed in their characteristics, time to PPCI, and outcome by route of admission. Methods The study was performed in a single tertiary centre in North England. Data are collected routinely on all patients undergoing PPCI and include demographic, clinical and procedural variables. In-hospital MACCE (death, re-infarction or CVA) and mortality are collected providing relevant outcome measures. Baseline clinical variables by route of admission were compared and unadjusted in-hospital MACCE rates determined. One-year mortality by route of admission was calculated using the K-M product limit estimate. In-hospital and 1-year outcomes were analysed after adjustment for factors known to be predictors of early mortality following STEMI (models 1 and 3). To determine the relative importance of delays in treatment, call-to-balloon time was added (models 2 and 4). Logistic regression was used for the adjusted in-hospital outcomes, and Cox-proportional regression for adjusted 1-year mortality. Results 2268 patients were included in the analysis. 510 patients (22.5%) were treated with PPCI following transfer from a non-PCI capable centre. Analysis of baseline variables (Abstract 1 table 1) showed the transfer group were more likely to have an LAD occlusion treated, and previous MI. Despite shorter DTB times, the transfer group had a greater median CTB time (52 minutes longer) compared with direct admissions. Other baseline variables were statistically no different between groups. There were 110 in-hospital MACCE events, and 168 deaths within 1-year follow-up. The transfer group had significantly higher unadjusted in-hospital MACCE rates (2.4% absolute, 58% relative increase (Abstract 1 table 2)). At 1 year, the transfer group had significantly higher unadjusted mortality (2.7% absolute, 48% relative increase (Abstract 1 table 2)). After adjustment for relevant co-variates (models 1 and 3) route of admission remained a significant predictor of in-hospital and 1-year mortality. With the addition of call-to-balloon time, no significant difference in outcome was noted by route of admission for either in-hospital or 1-year events. Conclusion In this study, patients who presented directly had superior in-hospital and 1-year outcomes compared with those who required transfer from other hospitals. Adjustment for longer call-to-balloon times attenuated the finding of poorer outcomes in these patients, suggesting that delays in treatment are critical. Systems of care should be designed to avoid admission of STEMI patients to non-PCI hospitals, and facilitate more rapid transfer of patients where this has not been possible.