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INTRODUCTION AND OBJECTIVES: The development of left ventricular dysfunction after mitral valve replacement is a common problem in patients with chronic severe mitral regurgitation. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. Our aim was to compare the value of the preoperative strain and strain rate derived by either speckle-tracking echocardiography or tissue Doppler imaging (TDI) for predicting the medium-term decrease in left ventricular ejection fraction (LVEF) following surgery. METHODS: This prospective study involved 38 consecutive patients with chronic severe mitral regurgitation who were scheduled for mitral valve replacement. The longitudinal strain and strain rate in the interventricular septum were measured preoperatively using speckle-tracking echocardiography and TDI. The LVEF was determined preoperatively and postoperatively using 3-dimensional echocardiography. Echocardiographic assessments were performed in the 48 hours prior to surgery and 6 months postoperatively. RESULTS: The patients' mean age was 59.9+/-11.3 years and 10 (29.4%) were male. Both speckle-tracking echocardiography and TDI were found to be predictors of a >10% decrease in LVEF at 6 months. However, the predictive value of speckle-tracking echocardiography was greater than that of TDI. The longitudinal strain at baseline in the interventricular septum as measured by speckle-tracking echocardiography was the most powerful predictor; the area under the curve was 0.85 and the optimal cut-off value was -0.11. CONCLUSIONS: Speckle-tracking echocardiography can be used to predict a decrease in LVEF over the medium term after mitral valve replacement. Moreover, the predictive accuracy of speckle-tracking echocardiography was greater than that of TDI.

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The presence of only a single coronary artery is a rare congenital coronary artery anomaly. In most cases, it is an incidental finding on coronary angiography and has no clinical significance. However, it can cause angina, myocardial infarction or even sudden death, particularly in young patients in whom the course of the artery runs between the aorta and pulmonary artery. In such cases, angiographic assessment may be difficult. Multislice coronary computed tomography might be better for visualizing the anatomy of the coronary artery tree in these patients. This article describes the cases of three patients with a single coronary artery and associated atherosclerotic coronary artery disease in whom a diagnosis was made using coronary angiography and multislice computed tomography.

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Introducción y objetivos. El desarrollo de disfunción ventricular izquierda tras la sustitución valvular mitral es un problema frecuente en pacientes con insuficiencia mitral grave crónica. El análisis de la deformación miocárdica permite estimar con precisión la contractilidad miocárdica. Nuestro objetivo fue comparar el valor predictivo de strain (S) y strain rate (SR) preoperatorios obtenidos por speckle-tracking y Doppler tisular (DTI) para predecir la disminución de la fracción de eyección del ventrículo izquierdo (FEVI) a medio plazo tras la cirugía. Métodos. Treinta y ocho pacientes consecutivos con insuficiencia mitral grave crónica programados para sustitución valvular mitral fueron incluidos prospectivamente. Se analizó el S y el SR longitudinal del septo interventricular en el periodo preoperatorio mediante speckle-tracking y DTI. La FEVI preoperatoria y postoperatoria se obtuvo por ecocardiografía tridimensional. Los estudios ecocardiográficos se realizaron dentro de las 48 h previas a la cirugía y 6 meses después de la cirugía. Resultados. La media de edad de los pacientes era 59,9 ± 11,3 años; 10 pacientes (29,4%) eran varones. Tanto el speckle-tracking como el DTI resultaron predictores de disminución de la FEVI > 10% a 6 meses. Sin embargo, el valor predictivo del speckle-tracking fue superior al del DTI. El S longitudinal del septo interventricular basal mediante speckle-tracking fue el parámetro con mayor poder predictivo, con un área bajo la curva de 0,85 y un punto de corte óptimo de -0,11. Conclusiones. El speckle-tracking permite predecir la disminución de la FEVI a medio plazo tras la sustitución valvular mitral. Además, el speckle-tracking es más preciso que el DTI para este fin (AU)

Introduction and objectives. The development of left ventricular dysfunction after mitral valve replacement is a common problem in patients with chronic severe mitral regurgitation. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. Our aim was to compare the value of the preoperative strain and strain rate derived by either speckle-tracking echocardiography or tissue Doppler imaging (TDI) for predicting the medium-term decrease in left ventricular ejection fraction (LVEF) following surgery. Methods. This prospective study involved 38 consecutive patients with chronic severe mitral regurgitation who were scheduled for mitral valve replacement. The longitudinal strain and strain rate in the interventricular septum were measured preoperatively using speckle-tracking echocardiography and TDI. The LVEF was determined preoperatively and postoperatively using 3-dimensional echocardiography. Echocardiographic assessments were performed in the 48 hours prior to surgery and 6 months postoperatively. Results. The patients’ mean age was 59.9±11.3 years and 10 (29.4%) were male. Both speckle-tracking echocardiography and TDI were found to be predictors of a >10% decrease in LVEF at 6 months. However, the predictive value of speckle-tracking echocardiography was greater than that of TDI. The longitudinal strain at baseline in the interventricular septum as measured by speckle-tracking echocardiography was the most powerful predictor; the area under the curve was 0.85 and the optimal cut-off value was –0.11. Conclusions. Speckle-tracking echocardiography can be used to predict a decrease in LVEF over the medium term after mitral valve replacement. Moreover, the predictive accuracy of speckle-tracking echocardiography was greater than that of TDI (AU)

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La arteria coronaria única es una anomalía coronaria congénita muy infrecuente. En la mayoría de los casos es un hallazgo ocasional de la coronariografía sin repercusión clínica, si bien puede producir angina, infarto de miocardio o incluso muerte súbita, especialmente en pacientes jóvenes con trayectos entre la aorta y la arteria pulmonar. En algunos casos el diagnóstico angiográfico puede plantear dificultades. La tomografía coronaria multidetector puede resultar de utilidad para definir mejor la anatomía del árbol coronario en estos pacientes. En el presente artículo describimos tres casos de arteria coronaria única con enfermedad coronaria aterosclerótica asociada, en los que el diagnóstico se realizó mediante coronariografía y tomografía coronaria multidetector (AU)

The presence of only a single coronary artery is a rare congenital coronary artery anomaly. In most cases, it is an incidental finding on coronary angiography and has no clinical significance. However, it can cause angina, myocardial infarction or even sudden death, particularly in young patients in whom the course of the artery runs between the aorta and pulmonary artery. In such cases, angiographic assessment may be difficult. Multislice coronary computed tomography might be better for visualizing the anatomy of the coronary artery tree in these patients. This article describes the cases of three patients with a single coronary artery and associated atherosclerotic coronary artery disease in whom a diagnosis was made using coronary angiography and multislice computed tomography (AU)

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The main risk factor for contrast nephropathy is the presence of poor renal function. Plasma creatinine level is not a reliable measure of renal function as its value could lie within the normal range despite the presence of significant nephropathy. The purpose of this study was to evaluate the creatinine clearance rate as a predictor of contrast nephropathy in patients with a normal plasma creatinine level. The study included 273 consecutive patients with non-ST elevation acute coronary syndrome (NSTEACS) and a normal plasma creatinine level at admission who underwent coronary angiography. Patients who developed contrast nephropathy had a lower creatinine clearance rate at admission (66.3 mL/min vs. 83.4 mL/min; P<.001). A creatinine clearance rate < 80 mL/min had a sensitivity of 81% for predicting contrast nephropathy. Creatinine clearance should be measured routinely in patients with NSTEACS who are scheduled for coronary angiography.

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El principal factor de riesgo de nefropatía por contraste (NC) es la presencia de una función renal deteriorada. La creatinina plasmática (Cp) es una medida poco exacta de la función renal y puede ser normal en presencia de nefropatía significativa. El objetivo del estudio es evaluar el valor del aclaramiento de creatinina (ACr) como predictor de NC en pacientes con Cp normal. Se incluyó a 273 pacientes consecutivos con síndrome coronario agudo sin elevación del segmento ST (SCASEST), con Cp normal en el momento ingreso y en los que se realizó una coronariografía. El ACr fue significativamente menor en el grupo de pacientes que presentaron NC (66,3 frente a 83,4 ml/min: p < 0,001). Un ACr < 80 ml/min presentó una sensibilidad de 81% para predecir el desarrollo de NC. El ACr se debería obtener de manera sistemática en pacientes con SCASEST (AU)

The main risk factor for contrast nephropathy is the presence of poor renal function. Plasma creatinine level is not a reliable measure of renal function as its value could lie within the normal range despite the presence of significant nephropathy. The purpose of this study was to evaluate the creatinine clearance rate as a predictor of contrast nephropathy in patients with a normal plasma creatinine level. The study included 273 consecutive patients with non-ST elevation acute coronary syndrome (NSTEACS) and a normal plasma creatinine level at admission who underwent coronary angiography. Patients who developed contrast nephropathy had a lower creatinine clearance rate at admission (66.3 mL/min vs. 83.4 mL/min; P<.001). A creatinine clearance rate < 80 mL/min had a sensitivity of 81% for predicting contrast nephropathy. Creatinine clearance should be measured routinely in patients with NSTEACS who are scheduled for coronary angiography (AU)

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