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INTRODUCTION: Epicardial adipose tissue (EAT) is known for its pro-inflammatory properties and association with Coronavirus Disease 2019 (COVID-19) severity. However, existing detection methods for COVID-19 severity assessment often lack consideration of organs and tissues other than the lungs, which limits the accuracy and reliability of these predictive models. MATERIAL AND METHODS: The retrospective study included data from 515 COVID-19 patients (Cohort 1, n=415; Cohort 2, n=100) from two centers (Shanghai Public Health Center and Brazil Niteroi Hospital) between January 2020 and July 2020. Firstly, a three-stage EAT segmentation method was proposed by combining object detection and segmentation networks. Lung and EAT radiomics features were then extracted, and feature selection was performed. Finally, a hybrid model, based on seven machine learning models, was built for detecting COVID-19 severity. The hybrid model's performance and uncertainty were evaluated in both internal and external validation cohorts. RESULTS: For EAT extraction, the Dice similarity coefficients (DSC) of the two centers were 0.972 (±0.011) and 0.968 (±0.005), respectively. For severity detection, the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) of the hybrid model increased by 0.09 (p<0.001), 19.3 % (p<0.05), and 18.0 % (p<0.05) in the internal validation cohort, and by 0.06 (p<0.001), 18.0 % (p<0.05) and 18.0 % (p<0.05) in the external validation cohort, respectively. Uncertainty and radiomics features analysis confirmed the interpretability of increased certainty in case prediction after inclusion of EAT features. CONCLUSION: This study proposed a novel three-stage EAT extraction method. We demonstrated that adding EAT radiomics features to a COVID-19 severity detection model results in increased accuracy and reduced uncertainty. The value of these features was also confirmed through feature importance ranking and visualization.
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Tejido Adiposo , COVID-19 , Pericardio , Índice de Severidad de la Enfermedad , Humanos , COVID-19/diagnóstico , COVID-19/diagnóstico por imagen , Tejido Adiposo/diagnóstico por imagen , Pericardio/diagnóstico por imagen , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , SARS-CoV-2 , Tomografía Computarizada por Rayos X/métodos , Aprendizaje Automático , Brasil/epidemiología , Anciano , China , Reproducibilidad de los Resultados , Adulto , Tejido Adiposo Epicárdico , RadiómicaRESUMEN
An 80-year-old man presented to the cardiology outpatient clinic due to shortness of breath. His past medical history included alcohol intake, hypertension, inferior wall myocardial infarction (five years ago), an ischemic stroke, and permanent atrial fibrillation (diagnosed three years before the current examination). A physical exam revealed a decreased intensity of S1 and S2, irregular rate and rhythm, and no murmurs nor friction rub. X-rays, Computed Tomography, and echocardiography exhibited pericardial calcification, involving mostly the inferior wall and protruding into the left ventricle. A diagnosis of constrictive pericarditis due to pericardial calcification was established and considered idiopathic. Even when it may be related to ischemic heart disease, post-infarction pericarditis could explain how the calcification extended to adjacent territory perfused by the circumflex coronary artery. Combined imaging studies were crucial not only for identifying calcium deposits in the pericardium but also in assessing a patient inherently prone to co-existing and exacerbating conditions. Even though pericardiectomy allows for removal of the clinical manifestations of congestive pericarditis in the most symptomatic patients with pericardial calcification, among patients like ours, with tolerable symptoms, cardiologists should discuss the therapeutic options considering the patient's choices, potentially including a rehabilitation plan as part of non-pharmacological management.
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Calcinosis , Ecocardiografía , Pericarditis Constrictiva , Pericardio , Tomografía Computarizada por Rayos X , Humanos , Masculino , Calcinosis/diagnóstico por imagen , Calcinosis/patología , Anciano de 80 o más Años , Pericardio/patología , Pericardio/diagnóstico por imagen , Ecocardiografía/métodos , Pericarditis Constrictiva/diagnóstico por imagen , Pericarditis Constrictiva/patología , Tomografía Computarizada por Rayos X/métodos , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/diagnóstico por imagenRESUMEN
BACKGROUND AND AIM: The Dysfunctional Adiposity Index (DAI) is a clinical surrogate for evaluating adipose tissue functionality and cardiometabolic health. However, its association with Pericardial Fat Volume (PFV) has not been tested. The aim of this study was to evaluate DAI- PFV association, stratified by type 2 diabetes (T2D) status, and identify DAI thresholds for detecting increased PFV among patients without premature CVD. METHODS AND RESULTS: Participants from the GEA-Mexican study underwent a computed tomography scan to measure PFV. Adjusted logistic regression analyses tested the association between DAI and PFV. AUROC curves evaluated DAI's ability to identify elevated PFV (≥57.57 cm³), and the Youden method determined DAI thresholds, along with diagnostic metrics. The study analyzed 997 participants (women: 55%; mean age: 54 ± 9 years; median PFV: 42 cm³ [IQR: 29-58]), with a 13% prevalence of T2D. DAI was positively associated with elevated PFV (OR: 1.33, 95% CI: 1.07-1.70), which was more pronounced among subjects with T2D (OR: 3.01, 95% CI: 1.41-6.40). DAI thresholds were established for all participants (>1.176), individuals without T2D (>1.003), and with T2D (>1.936), yielding sensitivities of 71%, 81%, and 57%, and specificities of 48%, 38%, and 75%, respectively. The adjusted logistic regression tied DAI thresholds to a 1.68-fold elevation in PFV for all, 2.06-fold for those without T2D, and 6.81-fold for those with T2D. CONCLUSION: DAI was positively associated with increased PFV, particularly among participants with T2D. Established DAI thresholds demonstrated good diagnostic values for detecting increased PFV. DAI could serve as an accessible marker to identify PF in clinical settings.
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Adiposidad , Diabetes Mellitus Tipo 2 , Pericardio , Valor Predictivo de las Pruebas , Humanos , Femenino , Masculino , Persona de Mediana Edad , Pericardio/diagnóstico por imagen , Pericardio/fisiopatología , México/epidemiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/fisiopatología , Adulto , Prevalencia , Estudios Transversales , Anciano , Medición de Riesgo , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/fisiopatología , Obesidad/epidemiología , Obesidad/diagnóstico , Obesidad/fisiopatología , PronósticoRESUMEN
In recent years, research has highlighted the association between increased adipose tissue surrounding the human heart and elevated susceptibility to cardiovascular diseases such as atrial fibrillation and coronary heart disease. However, the manual segmentation of these fat deposits has not been widely implemented in clinical practice due to the substantial workload it entails for medical professionals and the associated costs. Consequently, the demand for more precise and time-efficient quantitative analysis has driven the emergence of novel computational methods for fat segmentation. This study presents a novel deep learning-based methodology that offers autonomous segmentation and quantification of two distinct types of cardiac fat deposits. The proposed approach leverages the pix2pix network, a generative conditional adversarial network primarily designed for image-to-image translation tasks. By applying this network architecture, we aim to investigate its efficacy in tackling the specific challenge of cardiac fat segmentation, despite not being originally tailored for this purpose. The two types of fat deposits of interest in this study are referred to as epicardial and mediastinal fats, which are spatially separated by the pericardium. The experimental results demonstrated an average accuracy of 99.08% and f1-score 98.73 for the segmentation of the epicardial fat and 97.90% of accuracy and f1-score of 98.40 for the mediastinal fat. These findings represent the high precision and overlap agreement achieved by the proposed methodology. In comparison to existing studies, our approach exhibited superior performance in terms of f1-score and run time, enabling the images to be segmented in real time.
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Enfermedades Cardiovasculares , Pericardio , Humanos , Pericardio/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Tejido Adiposo Epicárdico , Redes Neurales de la Computación , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
BACKGROUND AND AIMS: Systemic inflammatory diseases could act as an unfavorable condition in which epicardial adipose tissue (EAT) becomes harmful to cardiovascular health. The objectives were: (a) to quantitatively compare the presence of EAT between patients with systemic inflammatory diseases and controls; (b) to analyze the association between EAT and subclinical atheromatosis in individuals with systemic inflammatory diseases. METHODS: Studies that have quantified EAT in a population with systemic inflammatory diseases compared to a control group, or that describe the association between EAT and the presence of subclinical atheromatosis in patients with systemic inflammatory diseases were included. A quantitative analysis was performed for the first objective. This systematic review was performed according to PRISMA guidelines. RESULTS: Twenty-one studies including 1448 patients with systemic inflammatory diseases, were considered eligible for this study. Patients with systemic inflammatory disease have a higher volume (MD: 10.4cm3 [1.8-19.1]; p<0.01), higher thickness (MD: 1.0mm [0.8-1.2]; p<0.01), and a statistically non-significant higher area (MD: 3.1cm2 [1.0-5.2]; p=0.46) of EAT compared to the control group. Most studies reported a significant association between EAT and subclinical atheromatosis in patients with different systemic inflammatory diseases. CONCLUSION: This study demonstrated that EAT is increased in patients with systemic inflammatory diseases compared with healthy controls, and that EAT measurement is closely correlated with subclinical atherosclerosis in these patients. The causality of this association should be tested in prospective studies.
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Aterosclerosis , Pericardio , Humanos , Estudios Prospectivos , Pericardio/diagnóstico por imagen , Aterosclerosis/etiología , Tejido Adiposo/diagnóstico por imagenRESUMEN
Accumulation of epicardial adipose tissue (EAT) and Subclinical hypothyroidism (SH) are associated with increased cardio-metabolic risk. The objective of this study was to quantitatively compare EAT thickening between patients with SH and healthy controls. Therefore, after searching the PubMed/MEDLINE, Embase, Science Direct, Scopus, Google Scholar, and Cochrane databases; we analyzed a group of observational studies who compare the EAT changes between SH vs control groups. A total of 9 studies were included in the final analysis, for a total of 424 patients with SH and 330 controls. Random or fixed effects models were used. Pooled analysis revealed that HS increased EAT (MD: 1.0 mm [0.40; 1.50]; P < 0.01). This meta-analysis suggests that the amount of EAT is significantly increased in SH patients. EAT might be a marker of cardiovascular risk in patients with SH.
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Hipotiroidismo , Humanos , Hipotiroidismo/complicaciones , Obesidad/complicaciones , Pericardio/diagnóstico por imagen , Tejido Adiposo , Factores de Riesgo de Enfermedad Cardiaca , Factores de RiesgoRESUMEN
Intrapericardial teratoma is a rare tumor composed of tissue from the three germ cell layers with a rapid growth that may cause severe hemodynamic complications due to compressive effects. We present two clinical cases: the first case had severe fetal heart failure with fatal outcome, and the second underwent surgical treatment during the immediate postnatal period with a favorable evolution. Although teratomas are histologically benign tumors, rapid growth can cause serious hemodynamic complications. The importance of prenatal diagnosis is to allow appropriate monitoring of tumor growth and establish a prompt therapeutic plan. Opportune surgical treatment can prevent death and improve the prognosis of these patients.
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Neoplasias Cardíacas , Teratoma , Embarazo , Femenino , Humanos , Pericardio/cirugía , Pericardio/diagnóstico por imagen , Diagnóstico Prenatal , Teratoma/diagnóstico por imagen , Teratoma/cirugía , Pronóstico , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Ultrasonografía PrenatalRESUMEN
BACKGROUND: The increase in epicardial fat volume (EFV) is related to coronary artery disease (CAD), independent of visceral or subcutaneous fat. The mechanism underlying this association is unclear. Coronary artery calcium (CAC) score and endothelial dysfunction are related to coronary events, but whether EFV is related to these markers needs further clarification. OBJECTIVES: To evaluate the association between automatically measured EFV, cardiovascular risk factors, CAC, and endothelial function. METHODS: In 470 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with measures of EFV, CAC score and endothelial function, we performed multivariable models to evaluate the relation between cardiovascular risk factors and EFV (response variable), and between EFV (explanatory variable) and endothelial function variables or CAC score. Two-sided p <0.05 was considered statistically significant. RESULTS: Mean age was 55 ± 8 years, 52.3% of patients were men. Mean EFV was 111mL (IQ 86-144), and the prevalence of CAC score=0 was 55%. In the multivariable analyses, increased EFV was related to female sex, older age, waist circumference, and triglycerides (p<0.001 for all). Higher EFV was associated with worse endothelial function: as compared with the first quartile, the odds ratio for basal pulse amplitude were (q2=1.22, 95%CI 1.07-1.40; q3=1.50, 95%CI 1.30-1.74; q4=1.50, 95%CI 1.28-1.79) and for peripheral arterial tonometry ratio were (q2=0.87, 95%CI 0.81-0.95; q3=0.86, 95%CI 0.79-0.94; q4=0.80, 95%CI 0.73-0.89), but not with CAC score>0. CONCLUSION: Higher EFV was associated with impaired endothelial function, but not with CAC. The results suggest that EFV is related to the development of CAD through a pathway different from the CAC pathway, possibly through aggravation of endothelial dysfunction and microvascular disease.
FUNDAMENTO: O aumento no volume de gordura epicárdica (VGE) está relacionado com doença arterial coronariana (DAC), independentemente de gordura visceral ou subcutânea. O mecanismo dessa associação não é claro. O escore de cálcio coronariano (CC) e a disfunção endotelial estão relacionados com eventos coronarianos, mas não está bem esclarecido se o VGE está relacionado com esses marcadores. OBJETIVOS: Avaliar a associação entre VGE medido por método automatizado, fatores de risco cardiovasculares, escore de CC, e função endotelial. Métodos: Em 470 participantes do Estudo Longitudinal de Saúde do Adulto LSA-Brasil com medidas de VGE, escore de CC e função endotelial, realizamos modelos multivariados para avaliar a relação entre fatore de risco cardiovascular e VGE (variável resposta), e entre VGE (variável explicativa), e função endotelial ou escore de CC. Valor de p<0,05 bilateral foi considerado estatisticamente significativo. RESULTADOS: A idade média foi 55 ± 8 anos, e 52,3% dos pacientes eram homens. O VGE médio foi 111mL (86-144), e a prevalência de escore de CC igual a zero foi 55%. Nas análises multivariadas, um VGE mais alto relacionou-se com sexo feminino, idade mais avançada, circunferência da cintura, e triglicerídeos (p<0,001 para todos). Um VGE mais alto foi associado com pior função endotelial: em comparação ao primeiro quartil, os valores de odds ratio para a amplitude de pulso basal foram (q2=1,22; IC95% 1,07-1,40; q3=1,50, IC95% 1,30-1,74; q4=1,50, IC95% 1,28-1,79) e para a razão de tonometria arterial periférica foram (q2=0,87; IC95% 0,81-0,95; q3=0,86, IC95% 0,79-0,94; q4=0,80, IC95% 0,73-0,89), mas não com escore de CC maior que zero. CONCLUSÃO: Um VGE mais alto associou-se com comprometimento da função endotelial, mas não com escore de CC. Os resultados sugerem que o VGE esteja relacionado ao desenvolvimento de DAC por uma via diferente da via do CC, possivelmente pela piora da disfunção endotelial e doença microvascular.
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Calcinosis , Enfermedad de la Arteria Coronaria , Masculino , Humanos , Adulto , Femenino , Persona de Mediana Edad , Estudios Longitudinales , Brasil/epidemiología , Factores de Riesgo , Enfermedad de la Arteria Coronaria/epidemiología , Pericardio/diagnóstico por imagen , Tejido AdiposoRESUMEN
Abstract Pericardial agenesis is a rare congenital anomaly found predominantly in men, and its complete form is extremely rare and difficult to diagnose. This report describes the case of a pregnant patient with complete pericardial agenesis in which mode of delivery and sterilization raised debate among specialists.
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Humanos , Femenino , Embarazo , Adulto , Pericardio/anomalías , Parto Obstétrico , Pericardio/diagnóstico por imagen , Esterilización Reproductiva , EcocardiografíaRESUMEN
BACKGROUND: Increased adiposity and visceral obesity have been linked to adverse COVID-19 outcomes. The amount of epicardial adipose tissue (EAT) may have relevant implications given its proximity to the heart and lungs. Here, we explored the role of EAT in increasing the risk for COVID-19 adverse outcomes. METHODS: We included 748 patients with COVID-19 attending a reference center in Mexico City. EAT thickness, sub-thoracic and extra-pericardial fat were measured using thoracic CT scans. We explored the association of each thoracic adipose tissue compartment with COVID-19 mortality and severe COVID-19 (defined as mortality and need for invasive mechanical ventilation), according to the presence or absence of obesity. Mediation analyses evaluated the role of EAT in facilitating the effect of age, body mass index and cardiac troponin levels with COVID-19 outcomes. RESULTS: EAT thickness was associated with increased risk of COVID-19 mortality (HR 1.18, 95% CI 1.01-1.39) independent of age, gender, comorbid conditions and BMI. Increased EAT was associated with lower SpO2 and PaFi index and higher levels of cardiac troponins, D-dimer, fibrinogen, C-reactive protein, and 4 C severity score, independent of obesity. EAT mediated 13.1% (95% CI 3.67-28.0%) and 5.1% (95% CI 0.19-14.0%) of the effect of age and 19.4% (95% CI 4.67-63.0%) and 12.8% (95% CI 0.03-46.0%) of the effect of BMI on requirement for intubation and mortality, respectively. EAT also mediated the effect of increased cardiac troponins on myocardial infarction during COVID-19. CONCLUSION: EAT is an independent risk factor for severe COVID-19 and mortality independent of obesity. EAT partly mediates the effect of age and BMI and increased cardiac troponins on adverse COVID-19 outcomes.
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COVID-19 , Tejido Adiposo/diagnóstico por imagen , Tejido Adiposo/metabolismo , Adiposidad , Adulto , Índice de Masa Corporal , Humanos , Pericardio/diagnóstico por imagen , Pericardio/metabolismo , Adulto JovenRESUMEN
BACKGROUND: Epicardial fat thickness (EFT) in adults and children has been related to the metabolic syndrome and other cardiovascular risk factors; however, scarce studies have evaluated it in infants of diabetic mothers (IDM) in whom, alterations in the thickness of the interventricular septum have been reported. This study compares the EFT in IDM versus infants of non-diabetic mothers (INDM) and its association with others echocardiographic parameters. METHODS: We performed a cross sectional study in 93 infants (64 IDM and 29 INDM). To evaluate EFT dimensions, an echocardiogram was performed within the first 24h of extrauterine life in both groups. In diabetic mothers, HbA1c was also determined. RESULTS: There was no significant difference in birth weight between the groups although gestational age was lower in IDM. The EFT (3.6 vs. 2.5 mm, pâ<â0.0001), the interventricular septum thickness (IVST) (6.2 vs. 5.2 mm, pâ<â0.0001) and the IVST / left ventricle posterior wall (1.3 vs. 1.1, pâ=â0.001) were higher in the IDM; while the left ventricular expulsion fraction [LVFE] (71.1 vs. 77.8; pâ<â0.0001) was lower than in the INDM, respectively. We found a positive correlation between EFT with IVST (râ=â0.577; pâ=â0.0001), LVPW (râ=â0.262; pâ=â0.011), IVST/LVPW index (râ=â0.353; pâ=â0.001), and mitral integral early velocity (râ=â0.313; pâ=â0.002), while a negative correlation with LVFE was observed (râ=â-0.376; pâ=â0.0001). CONCLUSIONS: The EFT is higher in IDM than in INDM. It was positively related with echocardiographic parameters of left ventricular thickness and negatively with left ventricular ejection function.
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Diabetes Mellitus , Madres , Tejido Adiposo/diagnóstico por imagen , Adulto , Niño , Estudios Transversales , Femenino , Humanos , Lactante , Pericardio/diagnóstico por imagenRESUMEN
BACKGROUND: Pericardial neoplastic involvement is rarely related to primary tumors of the pericardium and is most often caused by spread from other primary sites, such as lung and breast carcinomas, hematological malignancies (lymphoma and leukemia), and melanoma. Although pericardial metastasis from infradiaphragmatic tumors (such as colon cancers) are rare and poorly described in literature, any neoplasm has the potential to metastasize to the pericardium and heart by either contiguity, lymphatic, or hematological spread. CASE PRESENTATION: A 44-year-old previously healthy male Causasian patient had a sudden onset of dyspnea and wheezing. During investigation with echocardiogram, computed tomography and repeated pericardiocentesis, the cause of malignant pericardial effusion was confirmed as primary manifestation of metastatic colon cancer. The patient was treated with appropriate chemotherapy and presented satisfactory disease control. CONCLUSIONS: This report emphasizes the importance of considering the diagnostic hypothesis of occult neoplasia in a patient with pericardial effusion.
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Neoplasias del Colon , Neoplasias Cardíacas , Derrame Pericárdico , Adulto , Neoplasias del Colon/complicaciones , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/etiología , Pericardiocentesis , Pericardio/diagnóstico por imagenAsunto(s)
Humanos , Masculino , Femenino , Pericardio/diagnóstico por imagen , Tejido Adiposo , Circunferencia de la CinturaRESUMEN
Resumen Paciente masculino de 18 años, quien es valorado en el Servicio de Cardiología del Hospital Víctor Manuel Sanabria Martínez referido del primer nivel de atención por cuadro crónico de dolor torácico atípico acompañado de pectus excavatum y desplazamiento izquierdo del latido de punta a la exploración física. La radiografía de tórax posteroanterior evidencia una cardiomegalia moderada con levocardia máxima. El ecocardiograma transtorácico con función sistólica biventricular conservada, dilatación moderada del ventrículo derecho, sin signos de hipertensión pulmonar e imagen cardiaca de "corazón en lágrima". Angiotomografía computarizada de tórax con contraste que documenta malformación de la caja torácica con hundimiento de la región esternal, en relación con pectus excavatum. Corazón aumentado de tamaño en relación con cardiomegalia grado I y desplazamiento hacia el hemitórax izquierdo. No se observa pericardio en ninguna región. Aurícula derecha levemente dilatada con un ventrículo derecho con diámetro aumentado en su porción media y deformidad de su tracto de salida debido a la forma de la caja torácica, de tal manera que se corrobora el diagnóstico de una agenesia pericárdica completa.
Abstract An 18-year-old male patient who is evaluated in the Cardiology Department of the Víctor Manuel Sanabria Martínez Hospital, referred to the first level of attention due to chronic symptoms of atypical chest pain accompanied by pectus excavatum and left displacement of the peak beat. Chest X-ray Posteroanterior with moderate cardiomegaly with maximum levocardia. Transthoracic echocardiogram with preserved biventricular systolic function, moderate dilatation of the right ventricle, without signs of pulmonary hypertension and cardiac image of "tear heart". Thoracic Computed Angiotomography with contrast documenting malformation of the rib cage with sinking of the external region, in relation to pectus excavatum. Heart enlarged in relation to grade I cardiomegaly and displacement towards the left hemithorax. No pericardium is observed in any region. Slightly dilated right atrium with a right ventricle with an increased diameter in its middle portion and deformity of its outflow tract due to the shape of the rib cage. Corroborating the diagnosis of complete pericardial agenesis.
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Humanos , Masculino , Adolescente , Pericardio/anomalías , Cardiomegalia/diagnóstico por imagen , Levocardia/diagnóstico por imagen , Pericardio/diagnóstico por imagenRESUMEN
BACKGROUND: Large intracardiac bronchogenic cysts are rare mediastinal masses. However, they must always be considered in the differential diagnosis of heart failure with abnormal chest X-ray. CASE PRESENTATION: We present a 60-year-old female patient with de novo atrial fibrillation, heart failure and a very large intrapericardial mass. The patient underwent successful surgical resection, with pathological findings confirming a bronchogenic cyst. CONCLUSIONS: Large bronchogenic cysts located intrapericardially are very rare. However, they should be included in the differential diagnosis of patients presenting with atrial fibrillation and heart failure with abnormal radiologic studies.
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Fibrilación Atrial/etiología , Quiste Broncogénico/diagnóstico , Insuficiencia Cardíaca/complicaciones , Pericardio/diagnóstico por imagen , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Quiste Broncogénico/complicaciones , Quiste Broncogénico/cirugía , Diagnóstico Diferencial , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Imagen por Resonancia Magnética , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: It has been described that Trypanosoma cruzi is capable of promoting metabolic disturbances currently considered as cardiovascular risk factors. Moreover, it has been observed that the protozoa can remain in adipose tissue and alter its immune endocrine functions. The aim of this study was to characterize the thickness of epicardial adipose tissue (EAT) in patients with chronic Chagas disease (CCD) concerning their cardiovascular metabolic risk profile compared with those without CCD. METHODS: A cross-sectional study was performed including T. cruzi seropositive individuals categorized according to a standard CCD classification and a matched seronegative control group. Complete clinical examination, metabolic laboratory tests and transthoracic echocardiography to assess cardiac function and to quantify EAT were performed. RESULTS: Fifty-five individuals aged 46.7±11.9 y, 34 with CCD and 21 in the control group, were included. The CCD group presented higher EAT thickness in relation to controls (4.54±1.28 vs 3.22±0.99 mm; p=0.001), which was significantly associated with the presence of insulin resistance (OR=3, 95% CI 1.58 to 5.73; p<0.001). This group presented lower levels of plasmatic adiponectin than controls, especially in those patients with EAT ≥4.5 mm (p=0.005) who also presented with heart failure more frequently (p=0.01). CONCLUSION: In patients with CCD, a higher EAT thickness is observed and is associated with an increased metabolic risk profile indicated mainly by insulin resistance.
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Enfermedad de Chagas , Insuficiencia Cardíaca , Tejido Adiposo/diagnóstico por imagen , Enfermedad de Chagas/complicaciones , Estudios Transversales , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Humanos , Pericardio/diagnóstico por imagenRESUMEN
Bronchogenic cysts are congenital anomalies of the respiratory tract, which can affect children or adults. In adults, these cysts may be asymptomatic or present with symptoms, most often pain or cough. Intrapericardial cysts are rare and represent 27% of bronchogenic cysts. We present the case of a symptomatic adult with an intrapericardial bronchogenic cyst, who underwent surgical resection of the cyst, which successfully relieved his symptoms.