Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 4 de 4
Filtrar
1.
J Endovasc Ther ; 22(5): 801-5, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26250746

RESUMO

PURPOSE: To evaluate the prognostic value of the renal resistive index (Ri) after renal artery revascularization in the context of flash pulmonary edema. METHODS: Between 2000 and 2008, 43 patients (mean age 72.1±10.9 years; 23 women) underwent renal artery angioplasty/stenting in the context of flash pulmonary edema. Intrarenal Ri was assessed using duplex ultrasound. The majority (97.7%) of patients had hypertension, and nearly half (46.5%) had diabetes mellitus. For this retrospective analysis, the patients were divided into 2 groups according to the median Ri (<0.8 and ≥0.8) of the population. A Cox proportional hazards model was used to identify predictors of all-cause mortality (primary endpoint) and rehospitalization for heart failure; the results are presented as the hazard ratio (HR) and 95% confidence interval (CI). The mean follow-up was 49.8±30.6 months. RESULTS: There was no difference between the groups regarding clinical characteristics. A high Ri was associated with the risk of all-cause death (HR 2.54, 95% CI 1.15 to 5.60, p=0.021). This relationship was still statistically significant after adjustment for age, gender, diabetes, glomerular filtration rate, and treatment with a renin-angiotensin system inhibitor (HR 1.74, 95%CI 1.08 to 2.81, p=0.032). A high Ri was also associated with cardiovascular death in unadjusted and adjusted analyses. In contrast, a high Ri was not associated with the risk of rehospitalization for heart failure. CONCLUSION: After renal artery revascularization for flash pulmonary edema, a high intrarenal Ri is independently associated with all-cause mortality. Determination of the intrarenal Ri after this procedure may be useful for identifying at-risk patients.


Assuntos
Angioplastia , Edema Pulmonar/etiologia , Obstrução da Artéria Renal/terapia , Circulação Renal , Idoso , Idoso de 80 Anos ou mais , Angioplastia/efeitos adversos , Angioplastia/instrumentação , Angioplastia/mortalidade , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Edema Pulmonar/diagnóstico , Edema Pulmonar/mortalidade , Edema Pulmonar/fisiopatologia , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/mortalidade , Obstrução da Artéria Renal/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Resistência Vascular
2.
Europace ; 16(11): 1587-94, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24596396

RESUMO

AIMS: To describe obstetric/neonatal and cardiac outcomes for a cohort of women carrying implantable cardioverter-defibrillators (ICDs) during pregnancy. METHODS AND RESULTS: All women in routine follow-up at our institution for ICD implantation who became pregnant between 2006 and 2013 were included in this study. All ICDs were pre-pectoral devices with bipolar endocardial leads. Obstetric/neonatal and cardiac outcomes were assessed during pregnancy and post-partum. Twenty pregnancies were conceived by 12 women carrying ICD devices, 14 of which resulted in live births and none in maternal death. Seven of these women had structural cardiomyopathies and five had channelopathies. No device-related complications were recorded. Twelve shocks (nine transthoracic and three from ICDs) were experienced during pregnancy by two women, one of whom miscarried shortly afterwards at 4 weeks gestation. One stillbirth, three miscarriages and one termination were recorded for women with long QT syndrome, repaired tetralogy of Fallot and repaired Laubry-Pezzi syndrome, respectively. Intrauterine growth restriction, low birth weight, and neonatal hypoglycaemia were recorded in four, three, and five pregnancies, respectively. CONCLUSIONS: Pregnancy had no effect on ICD operation and no evidence was found to link ICD carriage with adverse pregnancy outcomes, although one miscarriage may have been induced by ICD shock therapy. A worsening of cardiac condition occurs in specific cardiac diseases and ß-blocker therapy should be continued for all women carrying ICDs in pregnancy as the benefits outweigh the risks of taking this medication.


Assuntos
Cardiomiopatias/terapia , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Cardiopatias Congênitas/terapia , Complicações Cardiovasculares na Gravidez/terapia , Aborto Espontâneo/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Cardiomiopatias/congênito , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Progressão da Doença , Cardioversão Elétrica/efeitos adversos , Eletrocardiografia , Feminino , França , Idade Gestacional , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Nascido Vivo , Segurança do Paciente , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
3.
J Interv Card Electrophysiol ; 39(2): 177-84, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24338204

RESUMO

PURPOSE: This study aims to study the clinical implications of the concomitant use of a left ventricular assist device (LVAD) and an implantable cardioverter-defibrillator (ICD). METHODS: In this retrospective study, all patients who underwent LVAD (Heart Mate II) implantation with concomitant ICD therapy at our institution between June 2007 and August 2012 were included. We sought to investigate (1) the electromagnetic interference between LVAD and ICD telemetry, (2) the effect of LVAD implantation on right ventricular (RV) lead parameters and (3) the ventricular tachyarrhythmias (VAs) that occur post-LVAD implantation. RESULTS: Of the 23 patients (53 ± 9 years, 73 % male, LVEF 19 ± 9 %) included, ICD telemetry was lost in four patients post-LVAD implantation (Saint-Jude-Medical Atlas V-193, V-240, V-243, and Sorin CRT-8750), prompting either use of a metal shield (n = 1), a change in position of the programmer head (n = 1) or ICD replacement (n = 2). LVAD implantation was associated with a decrease in both RV signal amplitude (p = 0.04) and RV impedance (p < 0.01), and a trend towards an increased RV pacing threshold (p = 0.08), without affecting clinical outcome. Eleven patients (47.8 %) experienced VAs after LVAD implantation, which on the whole were well tolerated. Their occurrence was strongly linked to a history of VAs before device implantation (p < 0.01). CONCLUSIONS: Electromagnetic interference between LVADs and ICD telemetry may necessitate ICD replacement. LVAD placement is associated with significant changes in RV lead parameters that have minimal clinical significance. VAs occur in approximately half of LVAD patients seen and their occurrence is strongly related to a history of VAs prior to LVAD implantation.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Falha de Equipamento , Insuficiência Cardíaca/prevenção & controle , Coração Auxiliar/efeitos adversos , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/prevenção & controle , Adulto , Idoso , Terapia Combinada/efeitos adversos , Terapia Combinada/instrumentação , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
4.
Cardiovasc Pathol ; 21(4): 355-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22138424

RESUMO

A previously healthy 56-year-old man presented with chest pain. Echocardiography and cardiac magnetic resonance imaging revealed minimal pericardial effusion associated with an isolated myocardial mass, protruding into the left atrium. The tumor was surgically removed. Cardiac valve morphology was strictly normal. Histology revealed a well-differentiated neuroendocrine carcinoma. Positron emission tomography scan and thin-slice abdominal computed tomography demonstrated ileal tumor, without evidence of liver metastasis. Histological study of the removed ileal tumor confirmed a neuroendocrine carcinoma, and histology of liver biopsy was negative. Somatostatin analogue treatment was started. No tumoral recurrence was observed after 1 year of follow-up. In conclusion, we report an unusual presentation of neuroendocrine carcinoma, revealed by a large solitary atrial metastasis, in the absence of liver involvement or carcinoid syndrome.


Assuntos
Carcinoma Neuroendócrino/diagnóstico , Neoplasias Cardíacas/diagnóstico , Neoplasias do Íleo/diagnóstico , Miocárdio/patologia , Antineoplásicos Hormonais/uso terapêutico , Carcinoma Neuroendócrino/secundário , Carcinoma Neuroendócrino/terapia , Terapia Combinada , Ecocardiografia , Átrios do Coração/patologia , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/cirurgia , Humanos , Neoplasias do Íleo/terapia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA