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1.
Am J Cardiol ; 203: 414-426, 2023 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-37531685

RESUMO

Patients with isolated tricuspid valve (TV) disease have poor prognosis with no consensus on their management. Transcatheter TV intervention is emerging as a valid option in patients with prohibitive surgical risk. We analyzed studies of patients who underwent isolated TV surgery to identify the features associated with successful clinical outcomes. We performed a systematic review and meta-analysis of studies reporting clinical outcomes of isolated surgical TV intervention, namely TV repair, TV replacement with a bioprosthetic valve (TVR-B), or TV replacement with a mechanical valve (TVR-M). Twenty-seven studies involving 10,478 patients (4,931 TV repair, 3,821 TVR-B, and 1,713 TVR-M) were included. Early mortality occurred in 9% and did not differ between TV surgical approaches. Late mortality was 27% at a median follow-up of 4 (3 to 6) years and was significantly higher for all-TVR (30% vs 25%, rate ratio 1.18, 95% confidence interval 1.05 to 1.31, p = 0.004) and TVR-B (28% vs 24%, rate ratio 1.15, 95% confidence interval 1.02 to 1.30, p = 0.02) compared with TV repair. Late mortality did not differ between TVR-B and TVR-M. Across all studies, early complications included bleeding (7.4%), acute kidney injury (18.7%), permanent pacemaker (13.7%), cerebrovascular accidents (1.2%), and infection (8.9%). Late clinical outcomes included reintervention (3.7%), structural valve deterioration (2.4%), valve thrombosis (2.6%), and TV regurgitation recurrence after 1 year (15.0%). In conclusion, in isolated TV surgeries, TV repair has favorable long-term mortality compared with TV replacement. This supports the development and refinement of transcatheter TV repair approaches. Future research is recommended to provide comparative data for various transcatheter TV interventions.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide , Humanos , Valva Tricúspide/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Resultado do Tratamento , Insuficiência da Valva Tricúspide/complicações , Doenças das Valvas Cardíacas/complicações , Estudos Retrospectivos
2.
ESC Heart Fail ; 5(6): 1159-1164, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30175905

RESUMO

AIMS: This analysis evaluates gender differences in the Egyptian cohort of patients hospitalized for acute heart failure (AHF) in the European Society of Cardiology Heart Failure Long-Term Registry. METHODS AND RESULTS: From April 2011 to September 2014, 1634 patients hospitalized with AHF were enrolled by 20 hospitals all over Egypt. Of these patients, 1112 (68%) patients were male and 522 (32%) were female. Women presented with a higher admission systolic blood pressure and resting heart rate. Compared with men, women had a higher body mass index (32.5 ± 9.0 vs. 29.3 ± 4.9, P < 0.001), more frequent atrial fibrillation (34.7% vs. 22.4%, P < 0.001), and anaemia defined by haemoglobin < 12 g/dL (83.1% vs. 58.4%, P < 0.001). Women were more likely to present with heart failure with preserved ejection fraction (29.7% vs. 10.6%, P < 0.001). Women had more frequent diabetes mellitus (48.1% vs. 41.6%, P < 0.05) and hypertension (48.7% vs. 39.3%, P < 0.001) than had men, whereas smoking was rare among them (8.8% vs. 82.9%, P < 0.005). There was no significant difference in the primary aetiology of heart failure between both sexes. ACE inhibitors, beta-blockers, mineralocorticoid receptor antagonists, antiplatelets, statins, and nitrates were less frequently prescribed to women, whereas they more often received digoxin, amiodarone, anticoagulants, and calcium channel blockers. There was no significant difference in in-hospital (5.7% vs. 4.6%, P = 0.39) and 1 year mortality (27.9% vs. 25.9%, P = 0.48) between women and men, respectively. CONCLUSIONS: Men and women with AHF differ significantly in baseline clinical characteristics and management but not in adverse outcomes. These findings emphasize the importance of individualized management and need for more comprehensive recruitment of women in clinical trials.


Assuntos
Cardiologia , Insuficiência Cardíaca/etnologia , Pacientes Internados/estatística & dados numéricos , Sistema de Registros , Sociedades Médicas , Egito/etnologia , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Prospectivos , Distribuição por Sexo , Fatores Sexuais , Fatores de Tempo
3.
Echocardiography ; 28(3): 350-7, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21349103

RESUMO

BACKGROUND: In a prospective study design, we sought to assess the effect of dipyridamole on coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. METHODS: We enrolled 30 patients with ectasia of the left anterior descending (LAD) artery (study group), and 10 subjects with normal coronaries (control group). All subjects underwent transesophageal echocardiography to record flow velocities in the proximal LAD coronary artery, and velocity time integrals were calculated. The diameter of the proximal LAD coronary artery was measured and flow was calculated. Dipyridamole (0.56 mg/kg) was administered intravenously and measurements were repeated 5 minutes later. RESULTS: At baseline, systolic and diastolic velocities, systolic, diastolic, and total velocity time integrals were significantly higher in the control group (P < 0.05 for all), yet, systolic, diastolic, and total coronary flow were significantly higher in the study group (P < 0.05 for all). Following dipyridamole administration, systolic, diastolic, and total coronary flow were still significantly higher in the study group (P < 0.05 for all), yet, there was no significant difference between the two groups regarding the other parameters, and regarding coronary reserve values (P > 0.05 for all). CONCLUSIONS: We concluded that patients with isolated CAE have a higher resting coronary flow as compared to control subjects with normal coronaries. Intravenous dipyridamole administration in these patients maintained a significantly higher coronary flow, with a coronary flow reserve similar to controls.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária/efeitos dos fármacos , Dipiridamol , Ecocardiografia Transesofagiana/métodos , Vasodilatadores , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Dipiridamol/administração & dosagem , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Vasodilatadores/administração & dosagem
4.
Eur J Echocardiogr ; 12(4): 283-90, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21266379

RESUMO

AIMS: The aim of this study was to test the hypothesis that, unlike calculation of the mitral valve area (MVA) with the pressure half-time method (PHT), the proximal isovelocity surface area method (PISA) is not affected by changes in net atrioventricular compliance (C(n)). METHODS AND RESULTS: We studied 51 patients with mitral stenosis (MS) from two centres. MVA was assessed with the PISA (MVA(PISA)), PHT (MVA(PHT)), and planimetry (MVA(PLN), serving as the gold standard) method. C(n) was calculated with a previously validated equation using 2D echocardiography. MVA(PISA) closely correlated with MVA(PLN) (r = 0.96, P < 0.0001), while MVA(PHT) and MVA(PLN) showed a weaker but still good correlation (r = 0.69, P < 0.0001). The correlation between MVA(PHT) and MVA(PLN) for patients with C(n) between 4 and 6 mL/mmHg (considered to be normal) was excellent (r = 0.93, P < 0.0001), but that for patients with C(n) of less than 4 or more than 6 mL/mmHg was not as good (r = 0.64, P < 0.0001). Importantly, a significant inverse correlation was detected between the percentage difference among MVA(PHT), MVA(PLN), and C(n) (r = -0.77, P < 0.0001), but the line of fit was nearly flat for the percentage difference among MVA(PISA), MVA(PLN), and C(n) (r = 0.1, P = 0.388). CONCLUSION: MVA calculated with both the PISA and PHT methods correlated well with MVA calculated with the planimetry method. However, the PISA rather than PHT is recommended for patients with MS and extreme C(n) values because PISA, unlike PHT, is not affected by changes in C(n).


Assuntos
Ecocardiografia/métodos , Estenose da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Ecocardiografia Doppler em Cores/métodos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estenose da Valva Mitral/fisiopatologia , Estudos Prospectivos , Índice de Gravidade de Doença
5.
Echocardiography ; 27(8): 1004-10, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20849487

RESUMO

BACKGROUND: We sought to assess coronary flow parameters in patients with isolated coronary artery ectasia (CAE) as compared to subjects with normal coronaries. METHODS: Consecutively, we enrolled 30 patients with ectasia of the left anterior descending (LAD) coronary artery (study group), and 10 subjects with normal coronaries (control group). All patients underwent transesophageal echocardiography to visualize the LAD. Spectral recordings of proximal LAD flow velocities were made and velocity time integrals were calculated. The diameter of the proximal LAD was measured and LAD blood flow was calculated. Nitroglycerin (0.3 mg) was administered intravenously and measurements were repeated 5 minutes later. RESULTS: The mean age of the whole series was 48.6 ± 8 years, 39 (97.5%) being males. A significantly higher baseline systolic, diastolic, and total coronary blood flow was found in the study group as compared to the control group (46.1 ± 34.3 vs. 23.1 ± 8.2, 123.9 ± 73.3 vs. 68.1 ± 21.6, 170.1 ± 97.9 vs. 91.1 ± 26.8 cm(3) /min, respectively, P < 0.05 for all). Within the study group, nitroglycerin administration caused a significant decrease in peak diastolic velocity; systolic, diastolic, and total velocity time integrals; and both diastolic and total coronary blood flow (P < 0.05 for all). Meanwhile, within the control group, nitroglycerin administration caused a significant increase in the total coronary blood flow (P < 0.05). CONCLUSIONS: Patients with CAE have higher resting coronary blood flow in comparison with subjects with normal coronaries. Intravenous nitroglycerin administration causes significant reduction of coronary blood flow in ectatic coronary arteries.


Assuntos
Circulação Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/tratamento farmacológico , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/tratamento farmacológico , Ecocardiografia Transesofagiana/métodos , Nitroglicerina/administração & dosagem , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Vasodilatadores/administração & dosagem
6.
EuroIntervention ; 6(2): 227-32, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20562073

RESUMO

AIMS: We sought to explore the immediate and long-term outcome of combined percutaneous valvuloplasty of the mitral and/or aortic and/or tricuspid valves in a series of patients with rheumatic valvular stenosis. METHODS AND RESULTS: A total of 11 patients (three underwent percutaneous mitral valvuloplasty [PMV], percutaneous aortic valvuloplasty [PAV] and percutaneous tricuspid valvuloplasty [PTV], six underwent PMV and PAV, and two underwent PMV and PTV) were enrolled. PMV was performed by the standard double balloon technique. PAV was always performed after PMV, employing the retrograde approach in eight patients and the antegrade approach in one patient. PTV was performed by the double balloon technique. Echocardiographic assessment was performed before and after the procedures. Follow-up was performed in all patients for a period that ranged from 12 and up to 60 months. PMV was successful in 10 out of 11 cases (91%); PAV was successful in all nine procedures (100%), while PTV was successful in four out of five cases (80%). At long-term follow-up, one case of restenosis occurred following PMV (9%), two following PTV (40%), and no restenosis occurred following PAV. CONCLUSIONS: Percutaneous balloon dilatation of rheumatic valvular stenosis is feasible with fairly adequate immediate and long-term outcome.


Assuntos
Estenose da Valva Aórtica/terapia , Cateterismo , Estenose da Valva Mitral/terapia , Cardiopatia Reumática/terapia , Estenose da Valva Tricúspide/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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