RESUMO
Background After a loading dose of ticagrelor, the rate of high on-treatment platelet reactivity remains elevated, which increases periprocedural myocardial infarction and injury. This indicates that faster platelet inhibition with crushed ticagrelor (CTIC) or eptifibatide is needed to reduce high on-treatment platelet reactivity. The efficacy of CTIC versus eptifibatide bolus plus clopidogrel is unknown. Methods and Results A total of 100 P2Y12 naïve, troponin-negative patients with acute coronary syndrome were randomized to CTIC (180 mg) versus eptifibatide bolus (180 µg/kg×2 intravenous boluses) plus clopidogrel (600 mg) at the time of percutaneous coronary intervention. High on-treatment platelet reactivity was markedly higher with CTIC versus eptifibatide bolus plus clopidogrel (42% versus 0%; P<0.001) at 30 minutes and persisted up to 2 hours (12% versus 0%; P=0.01, respectively). Platelet aggregation by adenosine diphosphate dropped faster from baseline with eptifibatide bolus plus clopidogrel versus CTIC (0.5 versus 2 hours, respectively) and was higher with CTIC versus eptifibatide bolus plus clopidogrel at 0.5, 2, and 4 hours after loading dose (53±12% versus 1.3±2%; 35±11% versus 0.34±1.0%; and 23±9% versus 3.5±2%, respectively; P<0.001). Eptifibatide bolus plus clopidogrel, but not CTIC, significantly inhibited platelet aggregation induced by thrombin-receptor activating peptide. Periprocedural myocardial infarction and injury was higher with CTIC versus eptifibatide bolus plus clopidogrel (48% versus 28%, respectively; P=0.035). Post-percutaneous coronary intervention hemoglobin levels were not different between groups. Conclusions Eptifibatide bolus plus clopidogrel led to faster and more potent platelet inhibition than CTIC and reduced periprocedural myocardial infarction and injury in troponin-negative acute coronary syndrome patients undergoing percutaneous coronary intervention, with no significant hemoglobin drop after percutaneous coronary intervention. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02925923.
Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Clopidogrel/administração & dosagem , Eptifibatida/administração & dosagem , Inibidores da Agregação Plaquetária/administração & dosagem , Ticagrelor/administração & dosagem , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/cirurgia , Idoso , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Estudos Prospectivos , Método Simples-Cego , Troponina/sangueAssuntos
Feixe Acessório Atrioventricular/diagnóstico , Frequência Cardíaca , Taquicardia Reciprocante/diagnóstico , Taquicardia Supraventricular/diagnóstico , Feixe Acessório Atrioventricular/fisiopatologia , Feixe Acessório Atrioventricular/cirurgia , Potenciais de Ação , Ablação por Cateter , Eletrocardiografia Ambulatorial , Técnicas Eletrofisiológicas Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Taquicardia Reciprocante/fisiopatologia , Taquicardia Reciprocante/cirurgia , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/cirurgia , Fatores de TempoAssuntos
Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Cardiomiopatia de Takotsubo/diagnóstico , Estados Unidos/epidemiologia , Adulto JovemRESUMO
We describe an adult patient in whom live three-dimensional transthoracic echocardiography combined with intravenous use of an echo contrast agent was useful in making a definitive diagnosis of apical hypertrophic cardiomyopathy and in characterizing the nature and full extent of the hypertrophy.
Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ecocardiografia/métodos , Tórax/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Cardiomiopatia Hipertrófica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/etiologiaRESUMO
We report a case of a middle-aged woman in whom a transesophageal echocardiogram showed a mass-like lesion posteriorly near the descending thoracic aorta. We were able to make a definitive diagnosis of this mass as a hiatal hernia because of a thick inner lining measuring 6-9 mm in thickness similar to the stomach mucosa, and the presence of a few microbubbles within the mass. In addition, the microbubbles increased considerably after 10 cc of agitated normal saline flush via a nasogastric tube.