<b><i>Aims:</i></b> To conduct an evidence-based evaluation of diabetic retinopathy (DR) for the diagnosis of diabetic nephropathy (DN) in type 2 diabetics with kidney disease. <b><i>Methods:</i></b> We systematically searched PubMed, EMBASE, and the Cochrane Library from inception to June 27, 2018, including the reference lists of identified primary studies. A study was included if it (1) used DR as a diagnostic test for DN; and (2) used histological evaluation of renal tissues as the reference standard. <b><i>Results:</i></b> The analysis included 45 studies (4,561 patients). A bivariate analysis yielded a sensitivity of 0.67 (95% CI 0.61–0.74) and a specificity of 0.78 (95% CI 0.73–0.82). The summary receiver operating characteristic curve analysis provided an area under the curve (AUC) of 0.79 (95% CI 0.76–0.83). In a setting of 41% prevalence of DN, the probability of DN would be 68% if the test of DR was positive, and the probability of DN would be 23% if it was negative. In addition, although the mean specificity of proliferative DR for the detection of DN was 0.99 (95% CI 0.45–1.00), the mean sensitivity was 0.34 (95% CI 0.24–0.44), and the AUC was 0.58 (95% CI 0.53–0.62). <b><i>Conclusions:</i></b> DR is helpful in diagnosing DN in persons with type 2 diabetes and kidney disease, but the severity of DR may not parallel the presence of DN.
Cardiac magnetic resonance (CMR) is a diagnostic tool that provides precise and reproducible information about cardiac structure, function, and tissue characterization, aiding in the monitoring of chemotherapy response in patients with light-chain cardiac amyloidosis (AL-CA). This study aimed to evaluate the feasibility of CMR in monitoring responses to chemotherapy in patients with AL-CA.
Cardiac amyloidosis (CA) is characterized by amyloid infiltration in the myocardial extracellular space, causing heart failure. Patients with CA are currently underdiagnosed. Cardiac involvement is significantly associated with the prognosis and treatment decision‐making for CA. Early identification and accurate stratification are the crucial first step in patient management. Comprehensive cardiac MRI‐based evaluation of the cardiac structure, function, and myocardial tissue characterization assesses cardiac involvement by tracing disease processes. Emerging quantitative tissue characterization techniques have introduced new measures that can identify early staged CA and monitor disease progression or response after treatment. Quantitative cardiac MRI is becoming an instrumental tool in understanding CA, which leads to changes in individualized patient care. This review aimed to discuss the quantitative cardiac MRI‐based assessment of CA using established and emerging techniques. Evidence Level 5 Technical Efficacy Stage 3
A 66-year-old man was hospitalized with unknown origin of heart failure. In-hospital electrocardiogram showed consistent T-wave inversions on diffuse leads ( Panel A ). Transthoracic echocardiography revealed left ventricular (LV) and biatrial enlargement, moderate pericardial effusion, and mildly impaired LV systolic function (ejection fraction = 50%). Additionally, there were substantial disproportionate masses infiltrating from epicardial surface …
Objective: The objective of this study was to correlate early recurrence of atrial fibrillation (AF) after ablation with noninvasive imaging using cardiac computed tomography (CT). Methods: CT image data of 260 patients who had undergone wide area circumferential ablation (WACA) between October 2005 and August 2010 as well as from 30 subjects in sinus rhythm without a history of AF (control group) were retrospectively analyzed. To evaluate early outcome of AF ablation, all AF patients underwent follow-up with a 30-day event monitor 3 to 4 months after ablation. In addition, a cardiac CT was also performed 3 to 4 months after ablation to exclude pulmonary vein (PV) stenosis. The presence of early AF was correlated with anatomic and functional PV and left atrial parameters, as assessed by cardiac CT. Results: A total of 70 patients (26.9%) were found to have early recurrence of AF. However, we found no association between PV or left atrial anatomic or functional parameters derived from cardiac imaging with early AF recurrence. Furthermore, no correlation ( P >0.05) between AF recurrence and coronary artery stenosis, anatomic origin of the sinoatrial, or atrioventricular nodal arteries was observed. Finally, PV contraction did not predict AF recurrence. However, when comparing PV contraction in WACA patients with the control group, a significant ( P <0.05) reduction in left superior PV and right superior PV contractility was found in patients after radiofreqency ablation. Conclusions: In our relatively large cohort, cardiac CT did not yield any anatomic or functional markers for the prediction of early AF recurrence after undergoing WACA. However, our data may provide insights into functional changes that occur following ablation procedures.
To investigate the clinical value of 64-slice spiral CT (64SCT) in assessing global left ventricular function in patients with old myocardial infarction (OMI), with magnetic resonance imaging (MRI) as the reference standard.A total of 28 patients (23 men and 5 women) with OMI underwent contrast-enhanced 64SCT with retrospective electrocardiographic-gating, MRI, and transthoracic echocardiography (Echo). The data sets of 64SCT and MRI were reconstructed at both end-diastole and end-systole to measure left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejective fraction (EF), and myocardial mass at end-diastole (MM). The data acquired with 64SCT and Echo were compared with the results obtained on MRI as the standard of reference respectively.The parameters of global left ventricular function obtained with 64SCT were significantly correlated with the MRI data (r = 0.788-0.976, P < 0.001). EDV, ESV, SV, EF, and MM were slightly overestimated by 64SCT compared with MRI; however, there was no significant difference among the measurements. 64SCT was in good agreement with MRI. For the EDV, ESV, SV, and EF, the limits of agreement with Echo were significantly larger than with 64SCT compared with MRI (P < 0.05). The sensitivity, specificity, and accuracy of 64SCT to identify EF value less than 50% were 84.6%, 100% and 92.9%, respectively, whereas those of Echo were 61.5%, 66.7% and 64.3%, respectively. The accuracy of 64SCT was significantly higher than that of Echo (P < 0.01). There was a significantly larger overestimation of EDV, ESV, and SV with Echo than with 64SCT compared with MRI (P < 0.05), whereas EF was not significantly different.A strong correlation between 64SCT and MRI is found for all parameters. 64SCT agrees well with MRI, and allows more reliable and accurate evaluation of global left ventricular function in patients with OMI than Echo compared with MRI.
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