RESUMO
BACKGROUND AND AIMS: Vitamin D has mostly been tested in Western populations. We examined the effect of high dose vitamin D in a population drawn predominantly from outside of Western countries. METHODS AND RESULTS: This randomized trial tested vitamin D 60,000 IU monthly in 5670 participants without vascular disease but at increased CV risk. The primary outcome was fracture. The secondary outcome was the composite of CV death, myocardial infarction stroke, cancer, fracture or fall. Death was a pre-specified outcome. Mean age was 63.9 years, and 3005 (53.0%) were female. 3034 (53.5%) participants resided in South Asia, 1904 (33.6%) in South East Asia, 480 (8.5%) in South America, and 252 (4.4%) in other regions. Mean follow-up was 4.6 years. A fracture occurred in 20 participants (0.2 per 100 person years) assigned to vitamin D, and 19 (0.1 per 100 person years) assigned to placebo (HR 1.06, 95% CI 0.57-1.99, p-value = 0.86). The secondary outcome occurred in 222 participants (1.8 per 100 person years) assigned to vitamin D, and 198 (1.6 per 100 person years) assigned to placebo (HR 1.13, 95% CI 0.93-1.37, p = 0.22). 172 (1.3 per 100 person years) participants assigned to vitamin D died, compared with 135 (1.0 per 100 person years) assigned to placebo (HR 1.29, 95% CI 1.03-1.61, p = 0.03). CONCLUSION: In a population predominantly from South Asia, South East Asia and South America, high-dose vitamin D did not reduce adverse skeletal or non-skeletal outcomes. Higher mortality was observed in the vitamin D group. REGISTRATION NUMBER: NCT01646437.
Assuntos
Doenças Cardiovasculares , Fraturas Ósseas , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , Vitaminas/uso terapêutico , Vitamina D , Suplementos Nutricionais/efeitos adversos , Fatores de Risco de Doenças Cardíacas , Método Duplo-CegoRESUMO
BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. METHODS: Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. RESULTS: The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. CONCLUSIONS: Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs. (AU)
Assuntos
Sistemas de Saúde , Doenças Cardiovasculares , Seguro Saúde , Diabetes MellitusRESUMO
AbstractBACKGROUND:Cholesterol and blood pressure (BP) can be effectively and safely lowered with statin drugs and BP-lowering drugs, reducing major cardiovascular (CV) events by 20%-30% within 5 years in high-risk individuals. However, there are limited data in lower-risk populations. The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial is evaluating whether cholesterol lowering with a statin drug, BP lowering with low doses of 2 antihypertensive agents, and their combination safely reduce major CV events in individuals at intermediate risk who have had no previous vascular events and have average cholesterol and BP levels.METHODS:A total of 12,705 women 65 years or older and men 55 years or older with at least 1 CV risk factor, no known CV disease, and without any clear indication or contraindication to the study drugs were randomized to rosuvastatin 10 mg/d or placebo and to candesartan/hydrochlorothiazide 16/12.5 mg/d or placebo (2 × 2 factorial design) and will be followed for a mean of 5.8 years. The coprimary study outcomes are the composite of CV death, nonfatal myocardial infarction (MI), and nonfatal stroke and the composite of CV death, nonfatal MI, nonfatal stroke, resuscitated cardiac arrest, heart failure, and arterial revascularization.RESULTS:Participants were recruited from 21 countries in North America, South America, Europe, Asia, and Australia. Mean age at randomization was 66 years and 46% were women.CONCLUSIONS:The HOPE-3 trial will provide new information on cholesterol and BP lowering in intermediate-risk populations with average cholesterol and BP levels and is expected to inform approaches to primary prevention worldwide (HOPE-3 ClinicalTrials.govNCT00468923).
Assuntos
Colesterol , Doenças Cardiovasculares , Pressão Arterial , Prevenção Primária , Prevenção de DoençasRESUMO
AIMS/HYPOTHESIS: Although diabetes is an established risk factor for myocardial infarction (MI), disease control may vary. HbA(1c) is a reliable index of ambient glucose levels and may provide more information on MI risk than diabetes status. METHODS: The relationship between HbA(1c) levels in MI patients and controls who participated in the 52 country INTERHEART study was analysed. RESULTS: In 15,780 participants with a HbA(1c) value (1,993 of whom had diabetes), the mean (SD) levels for HbA(1c) were 6.15% (1.10) in the 6,761 MI patients and 5.85% (0.80) in the control participants. After adjustment for age, sex and nine major MI risk factors (including diabetes), higher HbA(1c) fifths above the lowest fifth (HbA(1c) <5.4%) were associated with progressively higher OR of MI, with OR for the highest HbA(1c) fifth (≥ 6.12%) being 1.55 (95% CI 1.37-1.75). When analysed as a continuous variable after adjustment for the same factors, every 1% higher HbA(1c) value was associated with 19% (95% CI 14-23) higher odds of MI, while every 0.5% higher HbA(1c) was associated with 9% higher odds of MI (95% CI 7-11). Concordant relationships were noted across subgroups, with a higher OR noted in younger people, patients without diabetes or hypertension, and those from some regions and ethnicities. CONCLUSIONS/INTERPRETATION: The HbA(1c) value provides more information on MI odds than self-reported diabetes status or many other established risk factors. Every 1% increment independently predicts a 19% higher odds of MI after accounting for other MI risk factors including diabetes.
Assuntos
Etnicidade , Transtornos do Metabolismo de Glucose/complicações , Transtornos do Metabolismo de Glucose/etnologia , Infarto do Miocárdio/etnologia , Infarto do Miocárdio/etiologia , Adulto , Idoso , Biomarcadores/análise , Estudos de Casos e Controles , Etnicidade/estatística & dados numéricos , Feminino , Transtornos do Metabolismo de Glucose/sangue , Transtornos do Metabolismo de Glucose/epidemiologia , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/epidemiologia , Razão de Chances , Prevalência , Fatores de RiscoAssuntos
Adenoma de Glândula Sudorípara/patologia , Carcinoma in Situ/patologia , Doença de Paget Extramamária/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Siringoma/patologia , Adenoma de Glândula Sudorípara/metabolismo , Idoso de 80 Anos ou mais , Carcinoma in Situ/metabolismo , Cistadenocarcinoma Papilar/metabolismo , Cistadenocarcinoma Papilar/patologia , Epiderme/química , Epiderme/patologia , Feminino , Humanos , Queratina-7 , Queratinas/análise , Doença de Paget Extramamária/metabolismo , Neoplasias das Glândulas Sudoríparas/metabolismo , Siringoma/metabolismoRESUMO
OBJECTIVE: To determine the epidemiology, clinical manifestations and laboratory results at onset of type 1 diabetes mellitus in children aged 0-14 years from January 2001 to December 2002. PATIENTS AND METHODS: All children younger than 14 years old living in Galicia (Spain) and admitted to one of the hospitals of the Galician health service with a diagnosis of type 1 diabetes mellitus from 2001-2002 were included. A questionnaire was administered to collect data on age, sex, place of residence, associated autoimmune disorders, family history, clinical manifestations before onset and their duration, and biochemical parameters at diagnosis (glycemia, HbA1c, pH and bicarbonate). RESULTS: A total of 109 children were diagnosed (48 girls and 61 boys). The annual incidence (per 100,000 pediatric inhabitants) was 17.6. A higher frequency was found in winter (33 %) and spring (26 %) than in autumn (21.3 %) and summer (20.3 %). Admissions were most frequent among 5-9 year-olds (40.3 %), followed by 10-14 year-olds (33 %) and 0-4 year-olds (26.6 %). The most frequent clinical manifestations were polyuria and polydipsia (95.8 %). Nycturia or enuresis and weight loss were also described. The mean duration of these symptoms was 25.4 days in the group of children aged between 10-14 years old, 21.7 days in those aged 5-9 years old and 13.6 days in those younger than 4 years old. In one-third of the patients, the initial presentation was ketoacidosis. CONCLUSIONS: The incidence of type 1 diabetes mellitus among Galician children is high. The interval between the onset of the first symptoms and diagnosis is long. In 31.7 % of the patients, the initial event was ketoacidosis.
Assuntos
Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Estudos Prospectivos , Espanha/epidemiologiaRESUMO
BACKGROUND: In Asian patients undergoing surgery, the incidence of venous thromboembolism (VTE) is thought to be low relative to Western patients, and the routine use of thromboprophylaxis is controversial. OBJECTIVES: The aim of this work was to study the epidemiology of VTE in Asian patients undergoing orthopedic surgery without thromboprophylaxis. PATIENTS AND METHODS: We performed a prospective observational study of a cohort of consecutive Asian patients hospitalized for total hip or knee replacement or hip fracture surgery without thromboprophylaxis. The primary study outcome was the incidence of the composite of symptomatic VTE or sudden death at hospital discharge. This outcome was also assessed at 1 month's follow-up. RESULTS: Between April 2001 and July 2002, 2420 patients were enrolled. Median age was 68 years and the median duration of hospital stay was 13 days. The rate of symptomatic VTE or sudden death as notified by investigators was 2.3%[55 patients, 99% confidence interval (CI) 1.6, 3.2] and 1.2% (28 patients, 99% CI 0.7, 1.8) after adjudication by an independent committee. Chronic heart failure, varicose veins and a history of VTE were independent risk factors (P < 0.05) for the occurrence of the primary endpoint. At 1 month's follow-up, the incidence of adjudicated symptomatic VTE or sudden death was 1.5% (35/2264 patients). CONCLUSION: In Asian patients, the incidence of symptomatic VTE after major orthopedic surgery is not low, consistent with the rates observed in Western countries. The use of thromboprophylaxis should be considered in Asian patients undergoing such high-risk surgical procedures.
Assuntos
Artroplastia de Quadril/efeitos adversos , Ortopedia , Tromboembolia/epidemiologia , Tromboembolia/etiologia , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Idoso , Ásia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Digitalis glycosides have been in clinical use in the treatment of congestive heart failure (CHF) for more than 200 years. In recent years several trials have been conducted to address concerns about efficacy and toxicity. Although a systematic review of the literature was published in 1990, an update is required to include more current trials. OBJECTIVES: To examine the effectiveness of digitalis glycosides in treating CHF in patients with normal sinus rhythm. To examine the effect of digitalis in patients taking diuretics, angiotensin converting enzyme inhibitors, and beta-blockers; patients with varying severity and duration of disease; patients with prior exposure to digitalis vs. no prior exposure; and patients with "CHF due to systolic dysfunction" vs. "CHF with preserved systolic function." SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL) 2003 Issue 4, MEDLINE (1966 to December 2003) and EMBASE (1990 to December 2003) were searched. Dissertation Abstracts and annual meeting abstracts of the American Heart Association, American College of Cardiology, and European Society of Cardiology were also searched from 1996-2003. In addition, reference lists provided by the pharmaceutical industry (Glaxo Wellcome Inc.) were searched. SELECTION CRITERIA: Included were randomized placebo-controlled trials of 20 or more adult patients of either sex with symptomatic CHF who were studied for seven weeks or more. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of CHF such as acute ischemic heart disease or myocarditis was present. DATA COLLECTION AND ANALYSIS: Articles selected from the searches described above were evaluated as a joint effort of the coauthors. The staff of the Cochrane Heart Group ran searches on the Cochrane Central Register of Controlled Trials. MAIN RESULTS: Thirteen articles meeting the defined criteria were identified, and major endpoints of mortality, hospitalization, and clinical status, based respectively upon 8, 4, and 12 of these selected studies, were recorded and analyzed. The data show that there is no evidence of a difference in mortality between treatment and control groups, whereas digitalis therapy is associated with a lower rate of hospitalization and of clinical deterioration. REVIEWERS' CONCLUSIONS: The literature indicates that digitalis has a useful role in the treatment of patients with CHF who are in normal sinus rhythm.
Assuntos
Cardiotônicos/uso terapêutico , Glicosídeos Digitálicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca , Estudos Cross-Over , Método Duplo-Cego , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Chelation therapy is being promoted and practiced all over the world as a form of alternative medicine in the treatment of atherosclerotic cardiovascular disease. It has been recommended as a safe, relatively inexpensive and non-surgical method of restoring blood flow in atherosclerotic vessels. At present the benefit of chelation therapy remains controversial at best. OBJECTIVES: The objective of this review is to assess the effects of ethylene diamine tetraacetic acid (EDTA) chelation therapy on clinical outcomes among patients with atherosclerotic cardiovascular disease. SEARCH STRATEGY: The reviewers searched the Cochrane Peripheral Vascular Diseases Group Trials Register, (last searched July 2002), the Cochrane Controlled Trials Register, (Cochrane Library Issue 2, 2002), MEDLINE and EMBASE for published articles and other relevant articles. Studies were also requested through correspondence with known Filipino practitioners of the procedure. SELECTION CRITERIA: Studies were included if they were randomized controlled trials of EDTA chelation therapy versus placebo or no treatment in patients with atherosclerotic cardiovascular disease. Main outcome measures considered included either total or cause-specific mortality, non-fatal cardiovascular events, direct or indirect measurement of disease severity, subjective measures of improvement or adverse events. DATA COLLECTION AND ANALYSIS: Two reviewers (MVV, FT) extracted data and assessed trial quality independently. Unresolved issues were considered by a third reviewer (ALD). Discrepancies were discussed until a consensus was reached. Authors were contacted for additional information. MAIN RESULTS: A total of five studies was included in the review. Mortality, non-fatal events, and cerebrovascular events were not reported in any of the studies. Four of the studies, with a total recruitment rate of 250 participants, showed no significant difference in the following outcomes: direct or indirect measurement of disease severity and subjective measures of improvement. One of the studies, which included only 10 patients, was interrupted prematurely, because of an apparent treatment effect. However, relevant data were not available in the report and have been requested from the authors. REVIEWER'S CONCLUSIONS: At present, there is insufficient evidence to decide on the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes of patients with atherosclerotic cardiovascular disease. This decision must be preceded by conducting randomized controlled trials that would include endpoints that show the effects of chelation therapy on longevity and quality of life among patients with atherosclerotic cardiovascular disease.
Assuntos
Arteriosclerose/terapia , Quelantes/uso terapêutico , Terapia por Quelação/métodos , Ácido Edético/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Digitalis glycosides have been in clinical use in the treatment of congestive heart failure for more than 200 years. In recent years several trials have been conducted to address concerns about efficacy and toxicity. Although a systematic review of the literature was recently published, an update is required to include more current trials. OBJECTIVES: To examine the effectiveness of digitalis glycosides in treating congestive heart failure in patients with normal sinus rhythm. To examine the effect of digitalis in patients taking diuretics, angiotensin converting enzyme (ACE) inhibitors, and beta blockers; patients with varying severity and duration of disease; patients with prior exposure to digitalis vs. no prior exposure; and patients with diastolic vs. systolic dysfunction. SEARCH STRATEGY: Electronic databases were searched between 1966 and 2000. Dissertation Abstracts and annual meeting abstracts of the American Heart Association, American College of Cardiology, and European Society of Cardiology were searched from 1996-2000. In addition, reference lists provided by the pharmaceutical industry (Glaxo Wellcome Inc.) were searched. SELECTION CRITERIA: Included were randomized placebo-controlled trials of 20 or more adult patients of either sex with symptomatic congestive heart failure who were studied for seven weeks or more. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of heart failure such as acute ischemic heart disease or myocarditis was present. DATA COLLECTION AND ANALYSIS: Articles selected from the searches described above were reviewed by one of the coauthors, and validated by staff from the central office of the Heart Collaborative Review Group in Bristol, UK. MAIN RESULTS: Eleven articles meeting the defined criteria were identified, and major endpoints of mortality, hospitalization, and clinical status, based respectively upon 8, 4, and 10 of these selected studies, were recorded and analyzed. The data show that there is no difference in mortality between treatment and control groups, whereas digitalis therapy is associated with a lower rate of hospitalization and of clinical deterioration. REVIEWER'S CONCLUSIONS: The literature indicates that digitalis has a useful role in the treatment of patients with congestive heart failure who are in normal sinus rhythm.
Assuntos
Cardiotônicos/uso terapêutico , Glicosídeos Digitálicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca , Estudos Cross-Over , Método Duplo-Cego , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Digitalis glycosides have been in clinical use in the treatment of congestive heart failure for more than 200 years. In recent years several trials have been conducted to address concerns about efficacy and toxicity. Although a systematic review of the literature was recently published, an update is required to include more current trials. OBJECTIVES: To examine the effectiveness of digitalis glycosides in treating congestive heart failure in patients with normal sinus rhythm. To examine the effect of digitalis in patients taking diuretics, ACE inhibitors, and beta blockers; patients with varying severity and duration of disease; patients with prior exposure to digitalis vs. no prior exposure; and patients with diastolic vs. systolic dysfunction. SEARCH STRATEGY: Electronic databases were searched between 1966 and 2000. Dissertation Abstracts and annual meeting abstracts of the American Heart Association, American College of Cardiology, and European Society of Cardiology were searched from 1996-2000. In addition, reference lists provided by the pharmaceutical industry (Glaxo Wellcome Inc.) were searched. SELECTION CRITERIA: Included were randomized placebo-controlled trials of 20 or more adult patients of either sex with symptomatic congestive heart failure who were studied for seven weeks or more. Excluded were trials in which the prevalence of atrial fibrillation was 2% or greater, or in which any arrhythmia that might compromise cardiac function or any potentially reversible cause of heart failure such as acute ischemic heart disease or myocarditis was present. DATA COLLECTION AND ANALYSIS: Articles selected from the searches described above were reviewed by one of the coauthors, and validated by staff from the central office of the Heart Collaborative Review Group in Bristol, UK. MAIN RESULTS: Eleven articles meeting the defined criteria were identified, and major endpoints of mortality, hospitalization, and clinical status, based respectively upon on 8, 4, and 10 of these selected studies, were recorded and analyzed. The data show that there is no difference in mortality between treatment and control groups, whereas digitalis therapy is associated with a lower rate of hospitalization and of clinical deterioration. REVIEWER'S CONCLUSIONS: The literature indicates that digitalis has a useful role in the treatment of patients with congestive heart failure who are in normal sinus rhythm.
Assuntos
Cardiotônicos/uso terapêutico , Glicosídeos Digitálicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca , Estudos Cross-Over , Método Duplo-Cego , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoAssuntos
Antiarrítmicos/uso terapêutico , Arritmia Sinusal/tratamento farmacológico , Glicosídeos Digitálicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Arritmia Sinusal/etiologia , Medicina Baseada em Evidências , Insuficiência Cardíaca/complicações , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoAssuntos
Diarreia/etiologia , Infecções por Escherichia coli/diagnóstico , Escherichia coli O157 , Hemorragia Gastrointestinal/etiologia , Síndrome Hemolítico-Urêmica/diagnóstico , Pré-Escolar , Infecções por Escherichia coli/complicações , Feminino , Síndrome Hemolítico-Urêmica/microbiologia , HumanosRESUMO
Your patient is a 60-year-old hypertensive, alcoholic woman whose symptomless atrial fibrillation was first documented 3 months ago. An echocardiogram shows an enlarged left atrium, rendering successful cardioversion unlikely. She tells you that both of her parents had severe strokes that made the last years of their lives horrible, and she is terrified of having a stroke. You know that a meta-analysis of 5 randomized trials of warfarin in nonvalvular atrial fibrillation demonstrated a 68% relative risk reduction (RRR) in stroke (1). You consider prescribing warfarin for this patient but know that she would not have qualified for the study because alcoholism increases her risk for major hemorrhage (2).
Assuntos
Competência Clínica , Medicina Baseada em Evidências , Idoso , Alcoolismo/complicações , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Transtornos Cerebrovasculares/prevenção & controle , Ensaios Clínicos como Assunto , Feminino , Humanos , Hipertensão/complicações , Varfarina/uso terapêuticoRESUMO
OBJECTIVE: To develop a standardized method for measuring the width of the apex beat and to determine its precision and accuracy in detecting echocardiographically determined left ventricular dilation. DESIGN: In the reproducibility study, two cardiologists blinded to each other's findings measured the apex beat. To determine accuracy, blind, independent assessment of apex beat measurement was compared with left ventricular enlargement determined by echocardiogram. PATIENTS: One hundred and four patients referred for echocardiogram for a wide variety of suspected cardiac abnormalities. MEASUREMENTS: The apex beat was measured with patients in a 45 degrees left lateral decubitus position; medial and lateral aspects of the impulse and the width were identified using electrocardiographic callipers. Echocardiographic left ventricular dilation was defined as a measure exceeding the 95% prediction limits as determined for the patient's age and body surface area. RESULTS: The intraclass correlation measuring agreement on apex beat size between two cardiologists in 13 patients was 0.95. Of the 104 patients, 57 had a measurable apex beat of whom 50 had a technically adequate echocardiogram. The sensitivity of the measurement, using a cut-point of 40 mm, was 0.48 and the specificity 0.96.
Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia , Cinetocardiografia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Fatores Etários , Idoso , Superfície Corporal , Cardiomiopatia Dilatada/fisiopatologia , Método Duplo-Cego , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
A case of tricuspid atresia with a concordant ventriculoarterial connection associated with hypoplasia of the aortic isthmus and malformation of left atrioventricular valve is presented. Hyoplasia of aortic isthmus in absence of transposition of great vessels was explained by a posterior deviation of infundibular septum that reduced subaortic outflow tract and created an ample bulboventricular orifice. In the left atrioventricular valve an anterolateral papillary muscle that was prolonged in a thick chorda tendineaee fused to ventricular face of the cusp up to its insertion in the atrioventricular ring was observed. A systolic murmur of high tonality compatible with regurgitation of the left atrioventricular valve and a notch that was registered in postmortem angiography were attributed to this anomalous chorda tendinea. In the posterior wall of the heart there were two descending coronary arteries. One descended fro the crux cordis; the other, to its right, adjacent ot the acute margin, followed the insertion of the trabecular septum, delimited the outlet chamber, and was anastomosed to the anterior descending coronary artery.