No abstract

Digital subtraction angiography (DSA) allows quantitative analysis of ventricular function via densitometric and parametric imaging techniques. However, DSA is limited by the artifacts in temporal subtraction images that result from patient and cardiac motion. Dual-energy subtraction imaging is insensitive to motion. This study evaluated the initial application of dual-energy subtraction in cardiac patients. The image quality of dual-energy subtraction left ventriculograms obtained from a pulmonary artery injection of contrast was assessed in 13 patients, ranging in weight from 54 to 100 kg. The dual-energy images were compared with left ventricular images obtained using standard left ventricular injection cine angiography. End-systolic and end-diastolic ventricular volumes calculated from the cine (C) and dual-energy (DE) images using the Area-Length method were compared. The resulting regression line was DE = 0.98 C+ 7.0 ml, and the r value was 0.987. Dual-energy subtraction provided good left ventricular visualization, free from misregistration artifacts, even during patient motion.

The evidence for a role of sleep-disordered breathing (SDB) in cardiovascular disease (CVD) is inconclusive and limited to clinic-based studies or population-based studies using historical CVD data. The authors investigated cross-sectional association of SDB, assessed by overnight polysomnography and described by frequency of apnea/hypopnea episodes (Apnea-Hypopnea Index, AHI), with screen-detected CVD consisting of cardiologist-confirmed, electrocardiographically indicated coronary artery disease (ECG-CAD), left ventricular hypertrophy (ECG-LVH), arrhythmias, and conduction abnormalities in a general population. Using multiple logistic regression with adjustments for covariables, there was no significant association of AHI with ECG-CAD, ECG-LVH by voltage, arrhythmias, or conduction abnormalities. There was, however, an association between AHI and ECG-LVH by Cornell criteria. Using AHI as categorical variable, the adjusted odds of ECG-CAD in AHI >or= 5 vs <5 was increased, but not significantly, at 1.30, 95% confidence interval (CI) 0.67, 2.51. The adjusted odds of ECG-LVH by Cornell criteria in AHI >or= 15 vs <5 was significant at 3.19, 95% CI 1.16, 8.76. The authors found a weak or no association between screen-detected CVD and sleep apnea, but did find a threefold increased odds of screen-detected LVH, using Cornell criteria, in moderate or worse SDB. These findings contribute to accumulating evidence of possible association between CVD and sleep apnea in the general population and underscore the need to better understand how SDB affects cardiovascular pathology.

Background: Thoracic paravertebral blockade is an accepted anesthetic and analgesic technique for breast surgery. However, real-time ultrasound visualization of landmarks in the paravertebral space remains challenging. We aimed to compare ultrasound-image quality, performance times, and clinical outcomes between the traditional parasagittal ultrasound-guided paravertebral block and a modified approach, the ultrasound-guided proximal intercostal block. Methods: Women with breast cancer undergoing mastectomy (n = 20) were randomized to receive either paravertebral (n = 26) or proximal intercostal blocks (n = 32) under ultrasound-guidance with 2.5 mg/kg ropivacaine prior to surgery. Block ultrasound images before and after needle placement, and anesthetic injection videoclips were saved, and these images and vidoes independently rated by separate novice and expert reviewers for quality of visualization of bony elements, pleura, relevant ligament/membrane, needle, and injectate spread. Block performance times, postoperative pain scores, and opioid consumption were also recorded. Results: Composite visualization scores were superior for proximal intercostal compared to paravertebral nerve block, as rated by both expert (p = 0.008) and novice (p = 0.01) reviewers. Notably, both expert and novice rated pleural visualization superior for proximal intercostal nerve block, and expert additionally rated bony landmark and injectate spread visualization as superior for proximal intercostal block. Block performance times, needle depth, opioid consumption and postoperative pain scores were similar between groups. Conclusions: Proximal intercostal block yielded superior visualization of key anatomical landmarks, possibly offering technical advantages over traditional paravertebral nerve block. Trial registration: ClinicalTrials.gov, NCT02911168. Registred on the 22nd of September 2016.