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  • Author: Aleksandras Laucevičius x
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Comparison of retrospectively ECG-gated coronary computed tomography with and without adaptive tube voltage, tube current parameters and individualized contrast media injection protocol to reduce ionizing radiation dose

Objective: The aim of the study was to estimate the decrease in ionizing radiation exposure dose using adaptive tube voltage, tube current parameters and individualized contrast media injection protocol compared to basic retrospectively ECG-gated CCTA protocol and to compare image quality.

Methods: This retrospective study consisted of 30 consecutive patients who had body mass index (BMI) between 25 kg/m2 and 30 kg/m2 and underwent retrospectively ECG-gated CCTA. We have enrolled 15 patients which were scanned with an adaptive tube voltage, tube current and an individualized contrast media injection protocol (study group), the other 15 patients underwent basic retrospectively ECG-gated CCTA protocol (control group). Comparison of ionizing radiation effective dose, subjective and objective image quality was accomplished. Differences in ionizing radiation effective dose were deemed statistically significant if p < 0.01, for other variables we considered a p value of less than 0.05 to be statistically significant.

Results: he difference of a mean effective dose between study and control groups was statistically significant (6.39 ± 0.88 mSv and 17.44 ± 2.45 mSv, p < 0.01). Despite significantly higher image noise, significantly lower contrast-to-noise ratio and signal-to-noise ratio in a study group, both groups showed comparable average image quality (62.03±16.85 and 39.98±8.79, p < 0.01; 5.16±2.03 and 7.71±1.28, p < 0.01; 3 (2.5-3) and 2.75 (2.75-3), p = 0.95).

Conclusions: Despite higher image noise compared to basic retrospectively ECG-gated CCTA protocol, adaptive tube voltage, tube current parameters and individualized contrast media injection protocol allows substantial reduction in ionizing radiation exposure dose to a patient (up to 63%) with an adequate image quality for the evaluation of coronary arteries.

Summary

The aim of this study was to determine the frequency of extracardiac pathology in neonatal patients with suspected congenital heart disease referred to undergo multidetector computed tomography (MDCT) angiography in Vilnius University Hospital Santariskiu Klinikos. The safety of MDCT angiography (intravenous contrast media volume injected, scanning time and exposure to ionising radiation) was also evaluated.

Patients and Methods: During the period of 2006-2012, in Vilnius University Hospital Santariskiu Klinikos 186 pediatric patients were referred to undergo MDCT angiography of whom 71 were neonates with suspected complex congenital heart disease (CHD) and extracardiac pathology.

Results: Sixty nine (97.2%) of referred neonates were found to have extracardiac pathology (36 had extracardiac vascular pathology only, 4 - extracardiac non-vascular pathology only and 29 - both extracardiac vascular and non-vascular pathology). In 47 patients diagnosis of extracardiac pathology was verified intraoperatively. Remainder (n = 24) of the group were not operated (12 patients died because of hemodynamic instability and inoperable complex CHD, 9 patients were scheduled for later surgery, in 3 patients surgery was not indicated). Mean contrast media volume used was 4.18±1.03 ml, mean scanning time was 1.07±0.77 s and mean effective radiation dose was 2.8± 0.69 mSv. No adverse reactions or complications were observed.

Conclusions: MDCT angiography is accurate and safe method in diagnosis of complex congenital heart disease with extracardiac pathology.

Summary

Objectives: Metabolic syndrome (MetS) is linked to the development of type 2 diabetes and increased risk of cardiovascular disease (CVD). Physical inactivity is one of the main pathophysiological factors of MetS subjects. The aim of this study was to evaluate if 4-week supervised aerobic training had any impact on anthropometric, metabolic, hemodynamic and arterial wall parameters in MetS subjects.

Design and methods: 57 MetS subjects were randomly selected from a Lithuanian High Cardiovascular Risk (LitHiR) national primary prevention programme. Hemodynamic, cardiometabolic risk and arterial wall parameters were evaluated after the 4-week supervised aerobic training.

Results: After 4 weeks of aerobic training there was statistically significant decrease in body mass index from 30.58 ± 3.7 to 30.3 ± 3.55 kg/m2 (p = 0.010), waist circumference from 104.24 ± 9.46 to 102.9 ± 9.48 cm (p = 0.003), decrease of LDL cholesterol from 4.21 ± 1.15 to 3.78 ± 1 mmol/l (p = 0.032) and high sensitivity C-reactive protein from 2.01 ± 2.36 to 1.64 ± 1.92 mg/l (p = 0.009), decrease of diastolic blood pressure (BP) from 83.06 ± 10.18 to 80.38 ± 8.98 mmHg (p = 0.015), mean BP from 100.03 ± 10.70 to 97.31 ± 8.88 mmHg (p = 0.027) and aortic stiffness, assessed as carotid-femoral pulse wave velocity, from 8.34 ± 1.26 to 7.91 ± 1.15 m/s (p = 0.034).

Conclusions: In subjects with MetS even short-duration (4-week) supervised aerobic exercise training is associated with improvement of some anthropometric, metabolic and hemodynamic parameters as well as the decrease in aortic stiffness. This training modality could be recommended for initiation of physical training and could increase motivation for further physical activity.

Summary

Increased awareness of chronic kidney disease stimulates an interest towards early detection and prevention. The true prevalence of kidney injury varies from 10 to 40%, mostly depending on the methodology of the study and the population enrolled. A screening strategy targeting the highest risk groups, those with diabetes or hypertension, family history of diabetes, hypertension, or kidney disease, is likely to be most efficient and cost effective. Quantification for albuminuria should be performed using laboratorymethods or albumin to creatinine ratio and should be monitored at regular intervals. The most correct equations calculating glomerular filtration rate differ in separate populations, and the most accurate equations in patients with high cardiovascular risk are MDRD and CKD-EPI. Markers of early kidney damage have association with other target organs damage, even in subclinical or preclinical mode. Individuals at stage 4 and 5 chronic kidney disease, with higher levels of proteinuria, proteinuria together with haematuria, rapidly declining glomerular filtration rate, or poorly controlled hypertension should be referred to a nephrologist in order to identify the cause, provide recommendations, slow progression, or treat complications.

Summary

Objectives:The aim of this study was to assess the diagnostic value of exercise stress testing to detect coronary heart disease (CHD) in the group of patients with metabolic syndrome.

Design and methods: 2803 patients without prior diagnosis of CHD and identified metabolic syndrome were investigated. Subjects underwent electrocardiogram (ECG) stress testing and, depending on the results, coronary angiography and/or coronary computed tomography angiography to detect hemodynamically significant stenosis. CHD was confirmed, if lumen narrowing ≥ 50% of coronary arteries was found.

Results: Exercise stress testing was interpreted as positive in 12% patients (71.7% women and 28.3% men). CHD was diagnosed in 45 patients (1.6%), 23 of them had positive exercise stress testing. ECG stress testing was more frequently positive in patients, who had typical/atypical anginal chest pain, dyspnea and/or non-anginal chest pain, in comparison to asymptomatic patients (16.6% vs 8.9%, p <0.001). CHD was more often diagnosed in symptomatic patients compared to patients with no symptoms (6.1% vs 0.7%, p < 0.001, women 5.3% vs 0.6%, p < 0.001, men respectively 8% vs 0.8%, p < 0.001).

Conclusions: Diagnostic value of exercise stress testing for detecting CHD is limited in population with metabolic syndrome. CHD was more prevalent in patients with chest pain or dyspnea than in asymptomatic patients.

Summary

Cardiovascular diseases are the main cause of premature death worldwide. More than half of deaths were caused by cardiovascular diseases in 2017 in Lithuania. Primary prevention programmes encourage both medical staff and general population to pay attention to potential health issues as well as attempt to eradicate risk factors causing cardiovascular diseases. “A Funding Programme for the Screening and Preventive Management of the High Cardiovascular Risk Individuals” published in Lithuania has been implemented as of 2006.

Analysis of the results of the programme shows that the prevalent cases of arterial hypertension are gradually declining. However, the prevalence of dyslipidaemia is still not decreasing. The prevalence of other modifiable cardiovascular disease risk factors has erratic trends with a slight overall decline. Consequently, mortality rate of cardiovascular diseases has decreased by more than one third among middle-age population over the past 10 years.

Having higher availability of the anti-hypertensive and anti-lipid medications already achieved, the future plans include the aim of further reducing elevated blood pressure and effectively treating dyslipidaemia. In order to implement a strategy that focuses on smoking prevention, promotion of healthy nutrition and physical activity, a significant contribution is required from the state authorities.