Collateral circulation in aortic coarctation shown by 64 channel multislice computed tomography angiography

Abstract

Objective: To determine whether ventricular arrhythmia related to nocturnal hypoxaemia during CheyneStokes respiration (CSR) explains the observation that CSR is an independent marker of death in heart failure. Design: Prospective, observational study. Patients: 101 patients at high risk of clinical serious ventricular arrhythmia fitted with an implantable cardioverter-defibrillator (ICD). Measurements: Patients were studied at baseline for CSR during sleep. Arrhythmia requiring device discharge was used as a surrogate marker for possible sudden cardiac death. Results: 101 patients (42 with CSR) were followed up for a total of 620 months. Twenty six patients experienced 432 ICD discharge episodes. Twenty four (6%), 210 (49%), 125 (29%), and 73 (17%) episodes occurred across the time quartiles 0000-0559, 0600-1159, 1200-1759, and 1800-2359, respectively. Kaplan-Meier analysis showed a relative risk of 1 (95% confidence interval 0.5 to 2.2, p = 1) for device discharge in the CSR group. The average (SED) numbers of nocturnal ICD discharges per patient per month of follow up were 0.01 (0.01) and 0.04 (0.02) for patients with and without CSR, respectively (p = 0.6). Conclusion: These findings refute the proposition that CSR is related to heart failure death through nocturnal serious ventricular arrhythmia.

Diagnostic work-up of unselected patients with suspected coronary artery disease: complementary role of multidetector computed tomography, symptoms and electrocardiogram stress test

“…Moreover, the visualization of main vessels was very close to 100% and most undiagnosed images concerned secondary branch because of small size (second diagonal and second marginal vessels). The accuracy of MDCT in our populations was 91%, a value that is similar to previous studies with 16-row CT [7][8][9][10][11][12] and surprisingly better than in some of studies with 64-slice CT [13][14][15]. This may be explained by the fact that in most studies with 64-slice CT no segments were excluded, reducing the overall accuracy of the technique.…”

“…The introduction of 16-row and, more recently, 64-row scanners, provides promising results in the assessment of CAD [7][8][9][10][11][12][13][14][15]: these studies have shown high feasibility (from 84 to 100%), sensitivity (from 80 to 95%) and specificity (from 95 to 98%) but almost all of them are based on small cohorts of well-selected patients, and are based on the less clinically relevant segment model. To test the real clinical role, in our study we performed cardiac-CT in 144 consecutive nonselected patients referred to our hospital to perform a CA for suspected chest pain without previous history of significant CAD, excluding patients with absolute contraindications to MDCT (e.g.…”

“…intolerance to iodated agents or atrial fibrillation). Unlike other studies [7][8][9][10][11][12][13][14][15], we used high doses of intravenous b-blockers in a large number of patients (51% of the population). They were administered to every patient with a heart rate over 60 beats/min, without any collateral effects.…”

“…One of the major arguments against this practice is the huge cost [5]. To prevent unnecessary invasive tests, the latest generations of 16 and 64-slice CT [multidetector computed tomography (MDCT)] seem to be the most promising method [7][8][9][10][11][12][13][14][15]. Most studies, based, however, generally on segment-based model analysis, included a small cohort of well preselected patients (e.g.…”

Coarctation of the aorta: Management from infancy to adulthood

“…Patients with less severe coarctation may not be diagnosed until later in childhood when a murmur is heard or hypertension noted. In these patients, collateral vessels develop from the internal thoracic and subclavian arteries, thyrocervical trunks, and vertebral and anterior spinal arteries to supply blood to the descending aorta [21,22] . For those who enter adulthood undiagnosed, hypertension is the most common presenting symptom [23] .…”