RESUMEN
BACKGROUND: We compared the diagnostic accuracy of longitudinal strain (LS) imaging during stress echocardiography with visual assessment of wall motion (WM) for detecting significant coronary artery disease (CAD). METHODS: Our systematic search included studies reporting diagnostic measures for LS imaging and visual assessment of WM for detecting significant CAD during stress echocardiography. Summary diagnostic accuracy measures including area under the curve (AUC), sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios (LRs) were estimated. RESULTS: In thirteen studies with 978 patients, ten studies used invasive coronary angiography as the reference standard. Pooled AUC for diagnosing significant CAD was 0.92 (95% confidence interval [CI] 0.89-0.94) for LS imaging as compared to 0.83 (95% CI 0.80-0.86), P < 0.001 for visual assessment of WM. LS imaging had higher sensitivity (88% [95% CI 84-92] vs 74% [95% CI 68-80], P < 0.001) and comparable specificity to visual assessment of WM (80% [95% CI 72-87] vs 83% [95% CI 74-90], P = 0.592). The DOR for LS imaging and visual assessment of WM was 31 and 15, P = 0.254, respectively. The positive LR was 4.5 for both; negative LR was 0.14 and 0.31, P = 0.002 for LS imaging and visual assessment of WM, respectively. CONCLUSIONS: Longitudinal strain imaging during stress echocardiography has better diagnostic accuracy for detecting significant CAD as compared to visual assessment of WM. Studies using larger sample size and standardized techniques of strain measurement are required to further ascertain the added advantage of strain measurement over visual assessment alone.
Asunto(s)
Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Ecocardiografía de Estrés/métodos , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico por imagen , Anciano , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Transcatheter aortic valve replacement has recently become a suitable alternative for senile aortic stenosis in patients not suitable for surgery. With growing operative experience, appropriate patient selection, advances in imaging evaluation, and technical refinements, the outcomes have improved. Despite its less invasive nature, a unique set of complications and events are encountered during the transcatheter aortic valve replacement procedure and in the postoperative period. Knowledge of these complications, their prompt detection, and quick adequate treatment are critical in reducing the mortality and morbidity.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Diagnóstico por Imagen , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Complicaciones Posoperatorias/diagnóstico , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Ecocardiografía Transesofágica , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
Pulmonary endarterectomy (PEA) can significantly increase long-term survival in patients with chronic thromboembolic pulmonary hypertension; however, the role of PEA for chronic thromboembolic pulmonary hypertension due to pulmonary valve endocarditis is controversial. A critically ill 61-year-old man with intractable right ventricular heart failure was found to have chronic thromboembolic pulmonary hypertension due to Streptococcus bovis pulmonary valve endocarditis and underwent successful pulmonary valve replacement and PEA. The successful outcome in this case suggests that PEA should be considered in patients with this condition.
Asunto(s)
Endarterectomía , Endocarditis Bacteriana/complicaciones , Hipertensión Pulmonar/etiología , Embolia Pulmonar/complicaciones , Embolia Pulmonar/cirugía , Infecciones Estreptocócicas/complicaciones , Streptococcus bovis , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/microbiologíaRESUMEN
Streptococcus pneumoniae endocarditis is most commonly associated with pneumonia. It is relatively uncommon disease but its severity makes it clinically relevant. We present a case and review of sinusitis complicated by both pneumococcal endocarditis and cavernous sinus thrombosis. Both endocarditis and dural sinus thrombosis are known complications of facial infections. To our knowledge, this is the first reported case of both S. pneumoniae endocarditis and dural sinus thrombosis complicating sinusitis. A case report and review of the literature is presented.