Objective
Prognosis in pulmonary hypertension is largely determined by right ventricular (RV) function. However, uncertainty remains about what metrics of RV function might be most clinically relevant. The purpose of this study was to assess the clinical relevance of metrics of RV functional adaptation to increased afterload.
Methods
Patients referred for pulmonary hypertension (PH) underwent right heart catheterization and RV volumetric assessment within 48 hours. A RV maximum pressure (Pmax) was calculated from the RV pressure curve. The adequacy of RV systolic functional adaptation to increased afterload was estimated either by a stroke volume (SV)/end-systolic volume (ESV) ratio, a Pmax/ mean pulmonary artery pressure (mPAP) ratio, or by ejection fraction (RVEF). Diastolic function of the RV was estimated by a diastolic elastance coefficient β. Survival analysis was via Cox proportional hazard ratio and Kaplan-Meier with the primary outcome of time to death or lung transplant.
Results
Patients (n=50; age 58±13) covered a range of mPAP (13–79 mmHg) with an average RVEF of 39±17% and ESV of 143±89 ml. Average estimates of the ratio of end-systolic ventricular to arterial elastance were 0.79±0.67 (SV/ESV) and 2.3±0.65 (Pmax/mPAP-1). Transplantation-free survival was predicted by right atrial pressure, mPAP, pulmonary vascular resistance, β, SV, ESV, SV/ESV, and RVEF but after controlling for right atrial pressure, mPAP, and SV, SV/ESV was the only independent predictor.
Conclusions
The adequacy of RV functional adaptation to afterload predicts survival in patients referred for pulmonary hypertension. Whether this can simply be evaluated using RV volumetric imaging will require additional confirmation.
The rates of acute adverse reactions to gadopentetate dimeglumine and gadobenate dimeglumine were 0.14% and 0.28%, respectively. The overall adverse reaction rate was 0.16% in our patient sample. Direct comparison of adverse reaction rates of the two agents was not possible because of the retrospective uncontrolled study design.
Sickle cell disease (SCD) is a hereditary red cell disorder with clinical manifestations secondary to sickling or crescent-shaped distortion of the red blood cells. Major clinical manifestations of SCD include haemolytic anaemia and vaso-occlusive phenomena resulting in ischaemic tissue injury and organ damage. Chronic sequelae of the anaemia and vaso-occlusive processes involving the musculoskeletal system include complications related to extramedullary haematopoiesis, osteonecrosis, myonecrosis and osteomyelitis. Sickle cell bone disease is one of the commonest clinical presentations. Awareness and knowledge of the imaging features related to these complications are essential for early diagnosis and prompt management. In this article, the pathophysiology and key imaging findings related to these complications are reviewed.
Background and Objectives: Success rates for initial image-guided biopsy of musculoskeletal (MSK) lesions have been well documented; evidence regarding success rates for repeat biopsy following initially nondiagnostic (ND) image-guided biopsy of MSK lesions is more limited. This study evaluates the outcomes of repeat computerized tomography-guided MSK biopsies following ND biopsies using a multidisciplinary approach. Materials and Methods: Electronic medical record search covering a 10-year period identified patients that received two or more biopsies for an MSK tumor or tumorlike process. The decision for initial and repeat image-guided biopsy of each lesion was made following multidisciplinary MSK tumor board review. Lesion location, histopathology results, size of biopsy needle when available, and change in technique between biopsy attempts was documented. Results: Repeat biopsy rate was 1.6%. 23 patients with repeat MSK biopsy were identified. A total of 17 of 23 (74%) repeat biopsy attempts were diagnostic. A total of 22 of 23 (96%) repeat biopsy attempts were clinically useful. Diagnostic repeat biopsies were described as employing one or more of five technical differences compared to the first biopsy attempt, the most common being improved targeting of the lesion itself. Conclusions: A multidisciplinary approach may yield improved repeat-biopsy rates and clinical utility of repeat MSK biopsies compared to prior reports.
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