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1.
BMJ Open ; 12(6): e059945, 2022 06 23.
Artículo en Inglés | MEDLINE | ID: mdl-35738643

RESUMEN

INTRODUCTION: Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness. METHODS AND ANALYSIS: A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20 min plus 20 min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6 min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks). ETHICS AND DISSEMINATION: The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT05019157.


Asunto(s)
Rehabilitación Cardiaca , Enfermedad Coronaria , Telerrehabilitación , Dispositivos Electrónicos Vestibles , Rehabilitación Cardiaca/métodos , Enfermedad Coronaria/rehabilitación , Terapia por Ejercicio/métodos , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Método Simple Ciego , Telerrehabilitación/métodos
2.
Heart Fail Rev ; 26(6): 1345-1358, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-32468277

RESUMEN

Heart failure (HF) and atrial fibrillation (AF) often coexist, being closely interrelated as the one increases the prevalence and incidence and worsens the prognosis of the other. Their frequent coexistence raises several challenges, including under-diagnosis of HF with preserved ejection fraction in AF and of AF in HF, characterization and diagnosis of atrial cardiomyopathy, target and impact of rate control therapy on outcomes, optimal rhythm control strategy in the era of catheter ablation, HF-related thromboembolic risk and management of anticoagulation in patients with comorbidities, such as chronic kidney disease or transient renal function worsening, coronary artery disease or acute coronary syndromes, valvular or structural heart disease interventions and cancer. In the present document, derived by an expert panel meeting, we sought to focus on the above challenging issues, outlining the existing evidence and identifying gaps in knowledge that need to be addressed.


Asunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Tromboembolia , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/epidemiología , Consenso , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Humanos , Tromboembolia/etiología , Tromboembolia/prevención & control
3.
J Cardiovasc Pharmacol ; 74(4): 308-314, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31356556

RESUMEN

Stable angina affects a significant number of coronary artery disease patients, impairing their quality of life and worsening their prognosis. It manifests even despite a history of revascularization and is often poorly controlled with drug therapy. Comorbid conditions are frequently encountered in coronary artery disease patients, affecting their prognosis and rendering the diagnosis and management of angina more challenging. In this article, derived by an expert panel meeting, we attempt a practical approach to stable angina, focusing on symptomatic patients subjected to previous coronary revascularization or not suitable for revascularization and providing handy diagnostic and therapeutic algorithms and comorbidity-adjusted therapeutic approaches in accordance with existing evidence, current recommendations, and locally available therapeutic options.


Asunto(s)
Angina Estable/diagnóstico , Angina Estable/tratamiento farmacológico , Cardiología/normas , Fármacos Cardiovasculares/uso terapéutico , Pruebas de Función Cardíaca/normas , Angina Estable/epidemiología , Fármacos Cardiovasculares/efectos adversos , Toma de Decisiones Clínicas , Consenso , Técnicas de Apoyo para la Decisión , Humanos , Selección de Paciente , Valor Predictivo de las Pruebas
4.
Eur J Intern Med ; 65: 17-25, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31109847

RESUMEN

Heart Failure (HF) is a global pandemic with rapidly increasing prevalence. In an attempt to maintain patients well being, the therapeutic interest has expanded to the vicious cycles that confer to HF mortality and morbidity and a number of comorbidities have been targeted. Iron deficiency represents a common comorbid condition that affects outcomes in HF. The treatment of iron deficiency is strongly supported by the cardiologic societies all over the world. Intravenous iron, primarily ferric carboxymaltose, has shown clinical benefit in this setting, irrespective of the anemia status. Practical recommendations though are lacking. In this document, we have tried to cover the practical gap and provide useful details for intravenous iron use.


Asunto(s)
Anemia Ferropénica/diagnóstico , Anemia Ferropénica/etiología , Anemia Ferropénica/terapia , Insuficiencia Cardíaca/complicaciones , Hierro/administración & dosificación , Administración Intravenosa , Cardiología , Manejo de la Enfermedad , Europa (Continente) , Humanos , Guías de Práctica Clínica como Asunto , Sociedades Médicas , Estados Unidos
5.
J Thromb Thrombolysis ; 48(2): 225-232, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30830586

RESUMEN

Scarce data are available on the effects of hospitalization on oral anticoagulation (OAC) patterns in patients with atrial fibrillation (AF). This study aimed to capture the evolving OAC patterns of patients with known non-valvular AF at high risk for stroke (CHA2DS2-Vasc score ≥ 2 for males and ≥ 3 for females) during hospitalization. A total of 561 eligible patients who were admitted to the cardiology ward of a tertiary hospital were studied. Pre- and post-hospitalization OAC patterns [vitamin-K antagonist (VKA), non-vitamin K oral anticoagulants (NOAC), no OAC], changes between these patterns (initiation, switch, discontinuation, no change) and the respective patient profiles and discharge diagnoses were assessed. During hospitalization, OAC administration increased from 73.1 to 86.6% of patients (p for trend < 0.001). NOAC use increased significantly (42.2-56.1%, p for trend < 0.001), whereas VKA use remained stable (30.8-30.5%). Of patients, 17.3% initiated OAC, 7.1% switched between OACs, 3.7% discontinued OAC treatment, while the rest underwent no change in anticoagulation status. Bleeding risk, use of concomitant antiplatelet therapy and incidence of primary discharge diagnosis of AF or ST-elevation myocardial infarction differed significantly between groups of initiation, switch, discontinuation and no change in OAC therapy. In conclusion, in patients with known AF at high risk for stroke, hospitalization was associated with an increase in OAC uptake, driven mainly by NOAC initiation. Three out of 10 patients initiated, switched or discontinued OAC treatment during hospitalization and this was associated with discrete epidemiologic parameters.


Asunto(s)
Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Hospitalización , Administración Oral , Adulto , Anciano , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Sustitución de Medicamentos/estadística & datos numéricos , Femenino , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/prevención & control
6.
J Nucl Cardiol ; 26(4): 1298-1308, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-29344922

RESUMEN

BACKGROUND: Renin-angiotensin-aldosterone system (RAAS) has an important role in atherosclerosis. We investigated the effects of six RAAS gene polymorphisms on myocardial perfusion. METHODS AND RESULTS: We examined 810 patients with known or suspected coronary artery disease (CAD) using stress-rest myocardial single-photon emission computed tomography. Summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), transient ischemic dilation (TID), and lung/heart ratio (LHR) were recorded. The following gene polymorphisms were investigated: angiotensin-converting enzyme (ACE) insertion/deletion (I/D), angiotensinogen (AGT) M235T and T174M, angiotensin II type 1 receptor (AT1R) A1166C, renin (REN) C5312T, and angiotensin II type 2 receptor (AT2R) C3123A. The heterozygotes or homozygotes on ACE D allele were 7.54 times more likely to have abnormal SSS, while the AGT (T174M) heterozygotes were 5.19 times more likely to have abnormal SSS. The homozygotes of ACE D had significantly higher values on TID and LHR, while the AGT (T174M) heterozygotes had higher values on TID. The AT1R heterozygotes had greater odds for having SSS ≥ 3. The patients carried AT1R homozygosity of C allele had significantly higher values on TID, while heterozygotes of AT1R had significantly higher values on LHR. CONCLUSIONS: Among the polymorphisms investigated, ACE D allele had the strongest association with abnormal myocardial perfusion.


Asunto(s)
Angiotensinógeno/genética , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Peptidil-Dipeptidasa A/genética , Polimorfismo Genético/genética , Receptores de Angiotensina/genética , Renina/genética , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/genética , Enfermedad de la Arteria Coronaria/fisiopatología , Circulación Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Imagen de Perfusión Miocárdica , Sistema Renina-Angiotensina , Tomografía Computarizada de Emisión de Fotón Único
7.
Cardiology ; 140(2): 126-132, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29975925

RESUMEN

Direct or new oral anticoagulants (NOACs), including the direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, have recently revolutionized the field of antithrombotic therapy for stroke and systemic embolism prevention in nonvalvular atrial fibrillation (NVAF). Randomized controlled trials have shown that these agents have at least comparable efficacy with vitamin K antagonists along with superior safety, at least in what concerns intracranial hemorrhage. As a result, NOACs are indicated as first-line anticoagulation therapy for NVAF patients with at least one risk factor for stroke or systemic embolism. The rapid introduction, however, of NOACs in a field dominated for decades by vitamin antagonists and the variety of agents and dosing schemes may create difficulties in decision making. In the present article, we attempt to determine a practical approach to the choice of agent and dose in different clinical scenarios by considering not only the results of seminal randomized trials and post hoc analyses but also data from real-world patient populations as well as the recently available possibility of rapid NOAC reversal.


Asunto(s)
Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Administración Oral , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Toma de Decisiones , Embolia/complicaciones , Embolia/tratamiento farmacológico , Embolia/prevención & control , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/prevención & control
11.
Eur J Heart Fail ; 20(3): 436-444, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29105899

RESUMEN

The limited myocardial fibre thickening and shortening alone cannot explain the marked left ventricular (LV) volume reduction during LV ejection. This can only be achieved with LV helical (spiral) orientation of myocardial fibres, which is determined by the non-contractile LV myocardial components (intrasarcomeric and extrasarcomeric cytoskeleton, extracellular matrix). Preservation of LV ejection fraction (LVEF) in heart failure (HF) is due to the presence of normal ellipsoid LV configuration and spiral myocardial fibre orientation. Conversely, reduction of LVEF in HF results from spherical LV configuration associated with impaired myocardial fibre orientation. These mechanisms are supported by the fact that biomarkers of inflammation and fibrosis are strong predictors of LV reverse remodelling in HF with reduced LVEF (HFrEF) and therapeutic interventions in HFrEF that retard or inhibit extracellular matrix remodelling are effective, whereas those that increase myocardial contractility are ineffective. Thus, current classification of HF, based on LVEF, should be revised, and future therapy in HF should focus on interventions affecting the non-contractile LV myocardial components rather than on LV myocardial contractility.


Asunto(s)
Insuficiencia Cardíaca/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Contracción Miocárdica/fisiología , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Remodelación Ventricular , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos
12.
Ther Adv Cardiovasc Dis ; 11(11): 283-295, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28830298

RESUMEN

Backround: Left atrial (LA) enlargement plays an important role in the development of heart failure (HF) and is a robust prognostic factor. Fibrotic processes have also been advocated to evoke HF through finite signalling proteins. METHODS: We examined the association of two such proteins, cystatin C (CysC) and galectin-3 (Gal-3), and other clinical, echocardiographic and biochemical parameters with LA volume index (LAVi) in patients with HF with severely impaired left ventricular ejection fraction (LVEF). Severe renal, liver, autoimmune disease and cancer were exclusion criteria. RESULTS: A total of 40 patients with HF (31 men, age 66.6 ± 1.7) with LVEF = 25.4 ± 0.9% were divided into two groups according to the mean LAVi (51.03 ± 2.9 ml/m2) calculated by two-dimensional transthoracic echocardiography. Greater LAVi was positively associated with LV end-diastolic volume ( p = 0.017), LV end-systolic volume ( p = 0.025), mitral regurgitant volume (MRV) ( p = 0.001), right ventricular systolic pressure (RVSP) ( p < 0.001), restrictive diastolic filling pattern ( p = 0.003) and atrial fibrillation ( p = 0.005). Plasma CysC was positively correlated with LAVi ( R2 = 0.135, p = 0.019) and log-transformed plasma Gal-3 ( R2 = 0.109, p = 0.042) by simple linear regression analysis. Stepwise multiple linear regression analysis showed that only MRV ( t = 2.236, p = 0.032), CysC ( t = 2.467, p = 0.019) and RVSP ( t = 2.155, p = 0.038) were significant predictors of LAVi. CONCLUSIONS: Apart from known determinants of LAVi, circulating CysC and Gal-3 were associated with greater LA dilatation in patients with HF with reduced LVEF. Interestingly, the correlation between these two fibrotic proteins was positive.


Asunto(s)
Cistatina C/sangre , Ecocardiografía Doppler de Pulso , Galectina 3/sangre , Atrios Cardíacos/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico , Disfunción Ventricular Izquierda/diagnóstico , Función Ventricular Izquierda , Anciano , Biomarcadores/sangre , Proteínas Sanguíneas , Femenino , Fibrosis , Galectinas , Grecia , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la Enfermedad , Volumen Sistólico , Sístole , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/fisiopatología
13.
Cardiovasc Diabetol ; 16(1): 81, 2017 07 06.
Artículo en Inglés | MEDLINE | ID: mdl-28683798

RESUMEN

BACKGROUND: Red blood cell distribution width (RDW) is an established prognostic marker in acute and chronic heart failure (HF). Recent studies have pointed out a link among RDW, diabetes mellitus (DM) and inflammation. We sought to investigate the prognostic value and longitudinal pattern of RDW in patients with concomitant HF and DM, which remains unknown. METHODS: A total of 218 patients (71 diabetics) who presented with acute HF had RDW measured at admission, discharge and 4, 8 and 12 months post-discharge. The study endpoint was all-cause mortality or rehospitalization for HF during 1-year follow-up. RESULTS: The study endpoint was met in 33 patients (46.5%) with DM and in 54 patients (36.7%) without DM. RDW at admission was associated with higher event rate both in HF patients with and without DM (adjusted HR: 1.349, p = 0.002, 95% CI 1.120-1.624 and adjusted HR: 1.142, p = 0.033, 95% CI 1.011-1.291 respectively). In addition, a significant interaction was found between diabetes and RDW longitudinal changes (ßinteraction = -0.002; SE = 0.001; p = 0.042). CONCLUSIONS: Despite the similar prognostic significance of RDW in diabetic and non-diabetic HF patients regarding the study endpoint, longitudinal changes were found to be significantly different between these two groups of HF patients. This might be due to the higher inflammatory burden that diabetic HF patients carry and may provide new insights to the pathophysiological mechanism of RDW increase in HF, which remains unknown.


Asunto(s)
Complicaciones de la Diabetes , Diabetes Mellitus/diagnóstico , Eritrocitos/metabolismo , Insuficiencia Cardíaca/diagnóstico , Anciano , Anciano de 80 o más Años , Complicaciones de la Diabetes/patología , Índices de Eritrocitos/efectos de los fármacos , Eritrocitos/patología , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Inflamación/complicaciones , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo
14.
Int J Cardiol ; 243: 389-395, 2017 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-28571618

RESUMEN

Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach. In these settings, levosimendan has potential advantages over conventional inotropes (catecholamines and phosphodiesterase inhibitors), such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life. However, previous clinical studies of intermittent infusions of levosimendan were not powered to show statistical significance on key outcome parameters. A panel of 45 expert clinicians from 12 European countries met in Rome on November 24-25, 2016 to review the literature and envision an appropriately designed clinical trial addressing these needs. In the earlier FIGHT trial (daily subcutaneous injection of liraglutide in heart failure patients with reduced ejection fraction) a composite Global Rank Score was used as primary end-point where death, re-hospitalization, and change in N-terminal-prohormone-brain natriuretic peptide level were considered in a hierarchical order. In the present study, we tested the same end-point post hoc in the PERSIST and LEVOREP trials on oral and repeated i.v. levosimendan, respectively, and demonstrated superiority of levosimendan treatment vs placebo. The use of the same composite end-point in a properly powered study on repetitive levosimendan in advanced heart failure is strongly advocated.


Asunto(s)
Cardiotónicos/administración & dosificación , Conferencias de Consenso como Asunto , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/epidemiología , Hidrazonas/administración & dosificación , Piridazinas/administración & dosificación , Administración Oral , Ensayos Clínicos como Asunto/métodos , Ensayos Clínicos como Asunto/normas , Esquema de Medicación , Europa (Continente)/epidemiología , Medicina Basada en la Evidencia/normas , Medicina Basada en la Evidencia/tendencias , Insuficiencia Cardíaca/diagnóstico , Humanos , Infusiones Intravenosas , Ciudad de Roma/epidemiología , Simendán
15.
Angiology ; 68(10): 899-906, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28367644

RESUMEN

ß-Thalassemia minor (ß-Τm) is associated with rheological and biochemical alterations that can affect cardiovascular function. We aimed to evaluate the elastic arterial properties and the pulse wave augmentation indices in a population of patients with ß-Τm. Seventy-five individuals with ß-Τm (age 55.5 [42.75-65.25], women 48%) and 127 controls (age 57 years [48-63], women 55.1%) underwent comprehensive echocardiographic evaluation and applanation tonometry of the radial and femoral artery. Pulse wave analysis revealed that augmentation pressure, augmentation index (AIx), and heart rate-corrected AIx were significantly lower (median [interquartile range]: 8.75 [4.625-13] vs 11 [6.5-14.5], P = .017; 26.5 [17.5-33.375] vs 30.5 [20.75-37.5], P = .014; and 22.25 [15.125-29.5] vs 27 [20.5-33], P = .008, respectively) in the ß-Τm group compared to controls. The left atrial active emptying volume was significantly lower and the isovolumic relaxation time was shorter in the ß-Τm group compared to the control group (10.2 [7.4-14.4] vs 12.0 [8.6-15.8], P = .040 and 78 [70-90] vs 90 [70-104], P = .034, respectively). ß-Thalassemia minor is associated with favorable pulse wave augmentation indices and left ventricular diastolic function profile in asymptomatic individuals with cardiovascular risk factors.


Asunto(s)
Diástole/fisiología , Análisis de la Onda del Pulso , Disfunción Ventricular Izquierda/fisiopatología , Talasemia beta/fisiopatología , Adulto , Anciano , Biomarcadores/sangre , Estudios de Casos y Controles , Ecocardiografía , Femenino , Grecia , Frecuencia Cardíaca/fisiología , Humanos , Lípidos/sangre , Masculino , Manometría , Persona de Mediana Edad , Rigidez Vascular/fisiología
16.
Health Policy ; 121(4): 363-377, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28314467

RESUMEN

OBJECTIVE: To determine the association between copayment, medication adherence and outcomes in patients with Heart failure (HF) and Diabetes Mellitus (DM). METHODS: PubMed, Scopus and Cochrane databases were searched using combinations of four sets of key words for: drug cost sharing; resource use, health and economic outcomes; medication adherence; and chronic disease. RESULTS: Thirty eight studies were included in the review. Concerning the direct effect of copayment changes on outcomes, the scarcity and diversity of data, does not allow us to reach a clear conclusion, although there is some evidence indicating that higher copayments may result in poorer health and economic outcomes. Seven and one studies evaluating the relationship between copayment and medication adherence in DM and HF population, respectively, demonstrated an inverse statistically significant association. All studies (29) examining the relationship between medication adherence and outcomes, revealed that increased adherence is associated with health benefits in both DM and HF patients. Finally, the majority of studies in both populations, showed that medication adherence was related to lower resource utilization which in turn may lead to lower total healthcare cost. CONCLUSION: The results of our systematic review imply that lower copayments may result in higher medication adherence, which in turn may lead to better health outcomes and lower total healthcare expenses. Future studies are recommended to reinforce these findings.


Asunto(s)
Seguro de Costos Compartidos/economía , Diabetes Mellitus/tratamiento farmacológico , Insuficiencia Cardíaca , Cumplimiento de la Medicación , Evaluación del Resultado de la Atención al Paciente , Enfermedad Crónica/economía , Diabetes Mellitus/economía , Costos de los Medicamentos , Costos de la Atención en Salud , Humanos
18.
Heart Fail Rev ; 22(2): 243-261, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28150111

RESUMEN

Heart failure is a common clinical syndrome associated with significant morbidity and mortality worldwide. Ischemic heart disease is the leading cause of heart failure, at least in the industrialized countries. Proper diagnosis of the syndrome and management of patients with heart failure require anatomical and functional information obtained through various imaging modalities. Nuclear cardiology techniques play a main role in the evaluation of heart failure. Myocardial single photon emission computed tomography (SPECT) with thallium-201 or technetium-99 m labelled tracers offer valuable data regarding ventricular function, myocardial perfusion, viability, and intraventricular synchronism. Moreover, positron emission tomography (PET) permits accurate evaluation of myocardial perfusion, metabolism, and viability, providing high-quality images and the ability of quantitative analysis. As these imaging techniques assess different parameters of cardiac structure and function, variations of sensitivity and specificity have been reported among them. In addition, the role of SPECT and PET guided therapy remains controversial. In this comprehensive review, we address these controversies and report the advances in patient's investigation with SPECT and PET in ischemic heart failure. Furthermore, we present the innovations in technology that are expected to strengthen the role of nuclear cardiology modalities in the investigation of heart failure.


Asunto(s)
Insuficiencia Cardíaca , Corazón/diagnóstico por imagen , Isquemia Miocárdica , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada de Emisión de Fotón Único/métodos , Progresión de la Enfermedad , Salud Global , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Humanos , Morbilidad/tendencias , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiología , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Tasa de Supervivencia/tendencias
20.
Eur J Heart Fail ; 18(11): 1307-1320, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27813305

RESUMEN

The left atrium plays an important role in the maintenance of cardiovascular and neurohumoral homeostasis in heart failure. However, with progressive left ventricular dysfunction, left atrial (LA) dilation and mechanical failure develop, which frequently culminate in atrial fibrillation. Moreover, LA mechanical failure is accompanied by LA endocrine failure [deficient atrial natriuretic peptide (ANP) processing-synthesis/development of ANP resistance) and LA regulatory failure (dominance of sympathetic nervous system excitatory mechanisms, excessive vasopressin release) contributing to neurohumoral overactivity, vasoconstriction, and volume overload (global LA failure). The purpose of the present review is to describe the characteristics and emphasize the clinical significance of global LA failure in patients with heart failure.


Asunto(s)
Fibrilación Atrial/fisiopatología , Función del Atrio Izquierdo , Atrios Cardíacos/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Fibrilación Atrial/etiología , Factor Natriurético Atrial/metabolismo , Atrios Cardíacos/metabolismo , Insuficiencia Cardíaca/metabolismo , Humanos , Sistema Nervioso Simpático/fisiopatología , Vasoconstricción , Vasopresinas/metabolismo , Disfunción Ventricular Izquierda/complicaciones
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