Diagnostic Imaging/trends

ABC

Editorial

The Conception of the Selvester Score: Interface with the Development of Electro-Vectorcardiography

At the Annual Conference of the International Society for Computerized Electrocardiology (ISCE) in 2015, in San José – Costa Rica, a session was organized to honor the extraordinary work and life of specialists in electrocardiology, among them Ron Selvester.

Ron Selvester was one of the best editors of the Journal of Electrocardiology. He recruited the best connoisseurs to be co-editors, leading the Journal to grow in content and improving its impact factor.

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ABC

Editorial

The Challenge of Making Cardiac Resonance a Global Reality

Hélder Jorge Andrade Gomes et al. Alcides Rocha de Figueredo Junior

Despite substantially reducing age-adjusted cardiovascular mortality rates in recent decades, cardiovascular disease remains the most common cause of death. Studies estimate that sudden cardiac death is responsible for approximately 50% of all deaths from cardiovascular causes, with ventricular tachycardia with degeneration to ventricular fibrillation and asystole being the most common fatal sequence of pathophysiological events.

The hard work done by authors of the article published in the Arquivos Brasileiros de Cardiologia illustrates the role of cardiac magnetic resonance (CMR) in the etiological elucidation of sudden death events encountered in clinical practice. In addition to the already expected Chagas and ischemic diseases, a wide variety of other diagnoses have been recognized: myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, arrhythmogenic heart disease, muscular dystrophy, hypertensive cardiomyopathy, metastases, non-compacted myocardium, and adrenergic cardiomyopathy (Takotsubo syndrome). The CMR was conclusive in more than 90% of cases and is a key tool for excluding structural heart disease and attributing the fatal event to extracardiac causes.

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ABC

Editorial

Therapeutic Echocardiography

David Le Bihan

Since its introduction by Edler and Hertz, echocardiography has become the main test of cardiologic propedeutic. Over the last 50 years, its evolution has been remarkable, from A-mode, M-mode, two-dimensional and Doppler images to modern three-dimensional reconstructions and softwares for studying myocardial deformation currently used. For this reason, echocardiography can provide diagnostic data and important prognostic information in virtually all heart diseases.

One of the major advances in echocardiography was the recognition of substances capable of increasing the ultrasound signal for better visualization of cardiac structures, popularly known as “echocardiographic contrasts.” Its beginning dates back to the late 1960s, with the first experience reported on the use of agitated saline solution associated with cardiac ultrasound. This technique (agitation of a saline solution so that it is aerated, allowing an increase in sound reflection) is still used to detect intracardiac communications. Still, it has as drawbacks the poor intravascular stability of the solution and the fact that air bubbles are eliminated from the body during the passage of blood through the lungs, thus preventing its use for visualization of structures of the left heart when the agitated saline solution is administered in a peripheral vein.

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ABCIC

Editorial

The Teaching of Echocardiography in 2018: Evolution from the Beginning and What Can We Improve?

Djair Brindeiro Filho

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ABC

Editorial

One-Stop Shop for Non-Invasive Cardiovascular Imagers?

Rodrigo Julio Cerci et al. Afonso Akio Shiosaki

Over the past fifteen years, coronary computed tomography angiography (CCTA) has witnessed rapid technological and scientific advances in the detection of anatomical coronary artery disease (CAD), leading to an improvement in patient care. Visual assessment of stenosis severity using CCTA has a high sensitivity and negative predictive value when compared to invasive angiography, making it an ideal test to exclude obstructive CAD. With its high diagnostic performance associated with an important prognostic impact in the management of CAD, CCTA has finally established itself as a Class I recommendation in international guidelines (European Society of Cardiology – ESC).

However, CCTA is limited by modest diagnostic specificity and only provides anatomical assessment, which does not inform hemodynamic significance of specific lesions. CCTA combined with stress tomography evaluation of myocardial perfusion (CTP) is an accurate modality to determine regional myocardial flow repercussions of coronary stenosis, though it usually requires additional acquisition and is still underused. Derived flow fractional reserve – computed tomography (FFR-CT) is another “physiologic” CT approach in which computational fluid dynamics is applied to standard CCTA data and has emerged as a promising tool for the functional assessment of coronary stenosis. The diagnostic value of remotely performed FFR-CT has been prospectively validated in several large multicenter studies, but requires the use of offsite supercomputers, which can be time-consuming and cost-intensive, limiting its widespread clinical utility.^–

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Viewpoint

Spontaneous Exercise-Related Coronary Artery Dissection among Young Patients Without Risk Factors or Atherosclerotic Disease

Pablo de Souza et al. Artur Haddad Herdy

Abstract

Spontaneous coronary artery dissection (SCAD) is considered an often underdiagnosed acute coronary syndrome, with few cases described in literature. Its association with physical exercise among young patients without risk factors or atherosclerotic disease (CAD) is even rarer. For this reason, a study was conducted on the subject, describing the clinical conditions, conduct and evolution regarding the suspicion of spontaneous exercise-related coronary artery dissection in three young patients without risk factors or CAD. Clinical conditions varied, with predominant recurrent chest pain. Age range from 20 to 31 years. All patients underwent coronary angiography, which showed no CAD but suggested SCAD. Investigations concerning other causes of coronary obstruction were negative. The right coronary artery was affected in two cases, and the anterior descending artery was affected in one case. Only one of the three patients had recurrent events within five years from the primary event. Technological advances will enable increased dissection identification in acute coronary syndromes. Improving the knowledge about the related clinical conditions is necessary, as an attempt to provide warnings and improve the suspicion of spontaneous exercise-related coronary artery dissection among those who have symptoms of coronary insufficiency, thus reducing the frequent underdiagnosis. The best treatment and prognosis for this disease remains uncertain.

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Limitations in the Diagnosis of Noncompaction Cardiomyopathy by Echocardiography

Viviane Tiemi Hotta et al. Sabrina Cunha Tendolo Ana Clara Tude Rodrigues Fábio Fernandes … Luciano Nastari Charles Mady

Critical analysis

The diagnostic criteria described by Jenni et al. and Chin et al. are based on the measurement of NCM and CM thicknesses. However, the criteria differ regarding the cardiac cycle point at which the measurements should be taken. Chin et al. propose the measurements of NCM and CM thickness be performed at end-diastole, while Jenni et al. propose them at end-systole.

The criteria proposed by Jenni et al. used an NCM/CM ratio > 2 at end-systole, generating higher specificity and lower sensitivity as compared to the criteria by Chin et al., who use the CM/(NCM + CM) ratio ≤ 0.5. However, the increase in sensitivity is due to a decrease in specificity, as compared to the criteria by Jenni et al.

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ABC

Editorial

Cardiovascular Computed Tomography and Magnetic Resonance: History and Growing Impact in Brazil and in the World

Marcelo Souto Nacif et al. Carlos Eduardo Rochitte

Growth in Brazil and in the World

Cardiovascular computed tomography and magnetic resonance are an important topic within the area of cardiovascular imaging in Brazil and in the world. In the Arquivos Brasileiros de Cardiologia this is not different, and despite the increased focus in clinical study, these two topics have grown in impact and scientific publications in recent years.

It is notorious the expansion of the national technological park with entrance of countless devices capable of performing advanced studies using cardiovascular tomography and magnetic resonance with increasing impetus for opening more centers specialized in these methods.

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