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1.
Catheter Cardiovasc Interv ; 102(5): 823-833, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37668088

RESUMO

BACKGROUND: Severely calcified coronary lesions present a particular challenge for percutaneous coronary intervention. AIMS: The aim of this randomized study was to determine whether coronary intravascular lithotripsy (IVL) is non-inferior to rotational atherectomy (RA) regarding minimal stent area (MSA). METHODS: The randomized, prospective non-inferiority ROTA.shock trial enrolled 70 patients between July 2019 and November 2021. Patients were randomly (1:1) assigned to undergo either IVL or RA before percutaneous coronary intervention of severely calcified coronary lesions. Optical coherence tomography was performed at the end of the procedure for primary endpoint analysis. RESULTS: The primary endpoint MSA was lower but non-inferior after IVL (mean: 6.10 mm2 , 95% confidence interval [95% CI]: 5.32-6.87 mm2 ) versus RA (6.60 mm2 , 95% CI: 5.66-7.54 mm2 ; difference in MSA: -0.50 mm2 , 95% CI: -1.52-0.52 mm2 ; non-inferiority margin: -1.60 mm2 ). Stent expansion was similar (RA: 0.83 ± 0.10 vs. IVL: 0.82 ± 0.11; p = 0.79). There were no significant differences regarding contrast media consumption (RA: 183.1 ± 68.8 vs. IVL: 163.3 ± 55.0 mL; p = 0.47), radiation dose (RA: 7269 ± 11288 vs. IVL: 5010 ± 4140 cGy cm2 ; p = 0.68), and procedure time (RA: 79.5 ± 34.5 vs. IVL: 66.0 ± 19.4 min; p = 0.18). CONCLUSION: IVL is non-inferior regarding MSA and results in a similar stent expansion in a random comparison with RA. Procedure time, contrast volume, and dose-area product do not differ significantly.


Assuntos
Aterectomia Coronária , Doença da Artéria Coronariana , Litotripsia , Calcificação Vascular , Humanos , Aterectomia Coronária/efeitos adversos , Aterectomia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Constrição Patológica , Estudos Prospectivos , Angiografia Coronária/métodos , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia
2.
Herz ; 47(6): 518-523, 2022 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-36305916

RESUMO

In recent years, software-assisted imaging systems, such as computed tomography, have contributed to the improvement of noninvasive options for the diagnostics of coronary heart disease (CHD). In addition, the possibilities of individual morphological and functional atherosclerotic plaque evaluation could be further refined, e.g. by the use of optical coherence tomography or the quantitative flow ratio (QFR). Due to the development of robotic-assisted catheter systems, it has been possible to make coronary interventions more precise and with less radiation exposure for the examiner. It is to be expected that in the future even better algorithms will be developed by the analysis of very large amounts of data. These will enable a more exact, dynamic and personalized prediction of, e.g. treatment success or individual risk profiles, in order to positively and sustainably influence the treatment of patients with cardiovascular diseases.


Assuntos
Cardiologia , Doença da Artéria Coronariana , Placa Aterosclerótica , Robótica , Humanos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Robótica/métodos , Tomografia de Coerência Óptica/métodos , Angiografia Coronária
3.
Clin Res Cardiol ; 109(9): 1099-1106, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31989251

RESUMO

OBJECTIVE: The aim of this study was to compare the outcome of nonagenarians (≥ 90 years) with that of younger (< 90 years) patients undergoing transcatheter aortic valve implantation (TAVI) in current practice. METHODS: Data are collected from the German Aortic Valve Registry (GARY), which was designed to evaluate current practice in the invasive treatment of patients with aortic valve diseases in Germany. Data were analyzed regarding procedural outcome, 30-day, and 1-year outcomes of nonagenarians in comparison to that of younger patients. RESULTS: Between 2011 and 2015, 2436/33,051 (7.3%) nonagenarians underwent TAVI and were included in GARY. Nonagenarians were significantly more often male (45.2% vs. 40.0%, p < 0.001), frail (38.7% vs. 34.7%, p < 0.001), and had higher EuroSCORE scores than younger patient group (23.2% vs. 17.0%). Nonagenarians were significantly less often treated via transapical access (16.3% vs. 22.3%, p < 0.001). Procedure was performed significantly less often in general anesthesia (58.2% vs. 60.7%, p = 0.02) in nonagenarians, while necessity of pacemaker implantation was significantly higher in nonagenarians (27.2% vs. 24.8%, p > 0.001). The incidence of other typical postprocedural complications such as severe bleeding events and vascular complications were comparable between groups. However, 30-day (5.2% vs. 3.9%) and 1-year (22.7% vs. 17.7%) mortality rates were significantly higher among nonagenarians and age ≥ 90 years could be identified as an isolated risk factor for mortality. CONCLUSION: TAVI is a highly standardized procedure that can be performed safely with high procedural success even in very old patients. Although mortality is significantly higher in these patients-most probably due to the intrinsic higher risk profile of the very old patients-the results are still acceptable. To optimize outcome, especially elderly patients seem to profit from a procedure under local anesthesia or conscious sedation, to minimize the rate of postoperative delirium and the length of stay and to facilitate early mobilization.


Assuntos
Anestesia Geral/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos , Fatores Etários , Idoso de 80 Anos ou mais , Estimulação Cardíaca Artificial/estatística & dados numéricos , Feminino , Alemanha , Humanos , Masculino , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
4.
Herz ; 45(Suppl 1): 95-104, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31209520

RESUMO

BACKGROUND: Limited data exist on bioresorbable scaffolds (BRS) in patients with acute coronary syndrome (ACS). The aim of the present study was to evaluate novolimus-eluting BRS (DESolve) as interventional treatment for patients with ACS, and to compare its 12-month outcomes with the everolimus-eluting bioresorbable scaffolds (Absorb). METHODS: In this retrospective study, patients with ACS (including unstable angina pectoris, ST-segment elevation myocardial infarction, or non-ST-segment elevation myocardial infarction) treated with either the Absorb or the DESolve BRS were evaluated in a 1:1 matched-pair analysis. Major adverse cardiac events (MACE), including death, myocardial infarction, and target lesion revascularization, were evaluated as a major endpoint. The occurrence of scaffold thrombosis was also assessed. RESULTS: A total of 102 patients were eligible for this analysis. The rate of MACE at 12 months was comparable between the Absorb and the DESolve group (8.3% vs. 6.8%, p = 0.738). The occurrence of target lesion revascularization (6.2% vs. 4.7%; p = 0.700) and scaffold thrombosis (4.1% vs. 2.1%; p = 0.580) was comparable as well. All instances of scaffold thrombosis occurred within 30 days of the index procedure. CONCLUSION: In this study, similar 12-month event rates were observed for both BRS types after implantation for the treatment of ACS.


Assuntos
Síndrome Coronariana Aguda , Fármacos Cardiovasculares , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Implantes Absorvíveis , Síndrome Coronariana Aguda/cirurgia , Everolimo , Humanos , Macrolídeos , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
6.
Herz ; 44(2): 161-169, 2019 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-29052748

RESUMO

To evaluate the awareness and knowledge of the German population regarding diseases in general, a survey of 1446 people aged 60 years or older was conducted in 14 German towns. The focus was on heart valve diseases with special emphasis on aortic valve stenosis (AS). While cancer was the disease that respondents were most concerned about (25.2%), only 3.3% were concerned about heart valve diseases. In this respect, the knowledge was broadly limited: only 7.4% of participants claimed to have some familiarity with heart valve diseases and only 12.5% could correctly describe the symptoms of AS. Even so, 35.0% of the participants could correctly name the number of human heart valves, 71.6% knew at least one therapy option for AS and 30.6% were familiar with transcatheter aortic valve implantation (TAVI). After providing a brief clarification of the prevalence, symptoms and course of AS, 45.6% of respondents were more concerned about the condition, 15.7% wanted to know more about the symptoms of AS and 4.7% even recognized the typical symptoms in themselves. Most of the participants would like to seek more information preferably in discussion with a specialist physician (77.2%), with their general practitioner (43.2%) or using the internet (29.7%). Despite its high prevalence, high morbidity and mortality, the vast majority of the German population were neither concerned nor fully aware of treatment options for AS. There is a strong case for public awareness campaigns that provide better knowledge of AS, and support check-ups that enable timely treatment and the avoidance of unnecessary hospitalization and death.


Assuntos
Estenose da Valva Aórtica , Conhecimentos, Atitudes e Prática em Saúde , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica , Cateterismo Cardíaco , Alemanha , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
7.
Int J Cardiol ; 265: 40-46, 2018 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-29885699

RESUMO

BACKGROUND: N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) levels correlate with higher peri-procedural mortality after transcatheter aortic valve replacement (TAVR). The long-term prognostic value of NT-proBNP within the first days after TAVR, however, remains unclear. This study examined early changes in NT-proBNP prior to and within 6 days after TAVR, the diagnostic value of this biomarker regarding aortic regurgitation (AR), and its prognostic value regarding one-year mortality. METHODS AND RESULTS: NT-proBNP concentrations were measured in 504 consecutive patients undergoing transapical (TA) or transfemoral (TF) TAVR before and directly after TAVR as well as 4 h and 1, 2, 3, and 6 days after TAVR. The follow-up period was 1 year. NT-proBNP was elevated in all patients at baseline (median 2141 ng/L [IQR 1021-5319 ng/L]). NT-proBNP changes in the first 6 days after TAVR showed significant differences depending on the approach, with a greater and more prolonged rise evident in TA-TAVR patients. NT-proBNP was an independent predictor of mortality in TA patients with AR, with an AUC of 0.794 (95% CI 0.663-0.925; P = 0.003) when measured on day 3 after TAVR. For TF patients with AR and reduced left ventricular systolic function, the AUC for prediction of mortality was 0.897 (95% CI 0.778-1.0; P = 0.004) on day 2. CONCLUSIONS: The prognostic information of early post-procedural NT-proBNP concentrations is superior to pre-procedural values regarding all-cause mortality within 1 year. Post-procedural NT-proBNP must be interpreted in relation to the TAVR approach. NT-proBNP predicts mortality in TF-TAVR patients with AR and reduced left ventricular function.


Assuntos
Insuficiência da Valva Aórtica/sangue , Insuficiência da Valva Aórtica/mortalidade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Substituição da Valva Aórtica Transcateter/mortalidade , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/cirurgia , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Masculino , Mortalidade/tendências , Estudos Prospectivos , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/tendências , Disfunção Ventricular Esquerda/cirurgia
8.
Herz ; 42(1): 51-57, 2017 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-27255115

RESUMO

Coronary computed tomography angiography (cCTA) has been established for the non-invasive diagnosis of coronary artery disease (CAD). Previous studies demonstrated the high diagnostic accuracy of cCTA, particularly for ruling out CAD. As a known limitation of cCTA a large number of visually significant coronary stenoses are found to be hemodynamically not relevant by invasive fractional flow reserve (FFR). CT-based FFR (CT-FFR) builds on recent advances in computational fluid dynamics and image simulation techniques. Along with CT myocardial perfusion imaging, CT-FFR is a promising approach towards a more accurate estimation of the hemodynamic relevance of coronary artery stenoses. CT-FFR is derived from regular CT datasets without additional image acquisitions, contrast material, or medication. Two CT-FFR techniques can be differentiated. The initial method requires external use of supercomputers and has gained approval for clinical use in the USA. Furthermore, a prototype-software has been introduced which is less computationally demanding via integration of reduced-order models for on-site calculation of CT-FFR. The present article reviews these methods in the context of available study results and meta-analyses. Furthermore, limitations and future concepts of CT-FFR are discussed.


Assuntos
Angina Estável/diagnóstico , Angina Estável/fisiopatologia , Velocidade do Fluxo Sanguíneo , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Reserva Fracionada de Fluxo Miocárdico , Medicina Baseada em Evidências , Humanos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
9.
Herz ; 42(3): 316-324, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27491767

RESUMO

This analysis of the data of the obligatory quality assurance programme AQUA shows the perioperative risk as well as the procedural outcome evaluated by the observed versus expected in-hospital mortality ratio (O/E ratio) of 62,872 patients undergoing isolated surgical (sAVR), transcatheter transvascular (TV-), or transapical (TA-) aortic valve replacement (TAVI) from 2012 to 2014 in Germany. The number of TAVI procedures increased from 9,352 in 2012 to 13,278 in 2014, whereas the number of sAVR remained constant (2012: 9,949; 2014: 9,953). Between 2012 and 2014, the number of TAVI implanted in patients with a logistic EuroScore I (logESI) of ≤10 % (2012: 21 %; 2014: 26 %) as well as with a logESI <20 % (2012: 57 %; 2014: 64 %) increased. In-hospital mortality in TAVI patients decreased from 5.2 % (TV: 5.0 %; TA: 7.4 %) in 2012 to 4.2 % (TV: 3.8 %; TA: 5.5 %) in 2014, whereas it was stable for sAVR patients (2012: 2.8 %; 2014: 2.6 %). The O/E ratio of TAVI patients decreased from 0.91 (TV: 0.79; TA: 1.2) to 0.73 (TV: 0.69; TA: 0.89), whereas this ratio remained constant for sAVR patients (2012: 0.92; 2014: 0.93). In summary, estimated surgical risk, in-hospital mortality, as well as the O/E ratio for patients undergoing TAVI declined constantly during the last 3 years.


Assuntos
Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/mortalidade , Anuloplastia da Valva Cardíaca/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Substituição da Valva Aórtica Transcateter/mortalidade , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anuloplastia da Valva Cardíaca/tendências , Feminino , Alemanha/epidemiologia , Próteses Valvulares Cardíacas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Prevalência , Taxa de Sobrevida , Substituição da Valva Aórtica Transcateter/tendências , Resultado do Tratamento
10.
Herz ; 41(7): 572-578, 2016 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-27717991

RESUMO

Bifurcation lesions are a therapeutic challenge in the interventional treatment of coronary artery disease. Thus, consideration of anatomical aspects and selection of the most appropriate strategy for an individual bifurcation have an impact on the interventional outcome. Accordingly, assessment of the type of bifurcation stenosis, including the relevance of the side branches, vessel diameter and the angle between the two branches are critical for the optimal choice of interventional strategy. The fractional flow reserve (FFR) is a parameter that provides a measure of the severity of coronary stenosis and despite some limitations, FFR can be applied to bifurcation lesions. In addition, intravascular imaging tools, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) can be used to determine anatomical configurations.


Assuntos
Estenose Coronária/diagnóstico , Estenose Coronária/cirurgia , Intervenção Coronária Percutânea/métodos , Cuidados Pré-Operatórios/métodos , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Medicina Baseada em Evidências , Humanos , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Internist (Berl) ; 54(12): 1469-81; quiz 1482-3, 2013 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-24253389

RESUMO

Aortic valve stenosis (AS) is the most common acquired valve disease in the industrialized countries. Most patients--especially young and low-risk patients--can be safely and effectively operated with aortic valve replacement. Due to increasing life expectancy, however, the number of elderly patients with AS and various concomitant diseases will increase in the coming decades. For those elderly high-risk patients, transfemoral or transapical aortic valve implantation (TAVI) has evolved as a valuable alternative to conventional surgery. The TAVI approach has been shown to be superior to standard medical treatment in these high-risk patients. All patients considered for TAVI should be discussed in a consensus conference consisting of cardiac surgeons and cardiologists (heart team). Furthermore, for successful treatment with transcatheter techniques, sophisticated pre-interventional imaging is required to screen patients. Available data on TAVI from randomized trials and large-scale registries demonstrate that this method is very promising.


Assuntos
Valva Aórtica/cirurgia , Cateterismo Cardíaco/instrumentação , Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Doença da Válvula Aórtica Bicúspide , Ensaios Clínicos como Assunto , Medicina Baseada em Evidências , Humanos , Resultado do Tratamento
13.
Herz ; 38(5): 513-26; quiz 527-8, 2013 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-23897600

RESUMO

Coronary artery disease (CAD) is a leading cause of morbidity and mortality in western countries and is of significant socio-economic importance due to its increasing prevalence. Until percutaneous coronary interventions (PCI) were established, CAD could only be treated by surgical revascularization or pharmacological therapy. In-stent restenosis remains a major problem after stent implantation. However, the use of new materials and stent coatings have led to a significant reduction in in-stent restenosis. Thus, surgical revascularization and PCI are currently of equal value for the treatment of CAD. The decision-making for PCI or surgical revascularization depends on various factors such as number of diseased vessels, complexity of the coronary stenoses, concomitant diseases, and the patient's general condition. The therapeutic regime of every patient should be adjusted to the recommendations of the European and German Society for Cardiology, while controversial and complex cases should be discussed in an interdisciplinary case conference ("heart team").


Assuntos
Prótese Vascular/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/prevenção & controle , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Stents/efeitos adversos , Doença da Artéria Coronariana/complicações , Humanos , Resultado do Tratamento
15.
Curr Vasc Pharmacol ; 11(1): 5-12, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23391417

RESUMO

Chronic arterial occlusion leads to growth of collaterals - a process termed arteriogenesis, in which macrophages play a prominent role in remodelling and growth. However, a detailed analysis which of distinct macrophage subpopulations involved in arteriogenesis has never been performed. In the present study the temporal and spatial distribution of macrophage subtypes during arteriogenesis in a rat model with chronically elevated fluid shear stress (FSS) is investigated. Local macrophage subpopulations were histologically immuno-phenotyped using CD68 (a ubiquitous macrophage marker) and CD163, a specific M2 macrophage marker. Without occlusion few M2-macrophages reside in the perivascular space. Early after occlusion (12h) the number of M2 macrophages increases strongly and M1 macrophages begin emerging into the collateral. After 3 days they appear in the perivascular space. Both macrophage subtypes increase until 28d after treatment, whereas M2 macrophages dominate at the site of collateral growth. The local distribution of the subpopulations changes during the arteriogenic process. Whereas M1 macrophages are detected directly adjacent to the media, M2 macrophages are present in the most outer perivascular region of the growing collateral vessel. Systemic alterations of blood leucocytes in mice after femoral artery ligature (FAL) were investigated by FACS analysis of serial blood samples. During collateral remodelling histological changes were not reflected in circulating monocytes in the peripheral blood. The activation state of macrophages in mice with FAL was modulated by injections of either dexamethasone or the interleukins IL10 or IL3/IL14. The arteriogenic response was assessed by hind limb perfusion with laser Doppler measurements after 3, 7 and 14d. Suppressing inflammatory monocyte subtypes (M1) with dexamethasone led to impaired perfusion recovery after FAL in mice, whereas IL10 or IL4/IL13 application significantly increased perfusion recovery. This investigation demonstrates that a forced shift towards M2 macrophages improves the arteriogenic response. The distinct early increase and spatial distribution of M2 macrophages support the idea that this subtype plays a predominant role during collateral remodelling.


Assuntos
Circulação Colateral/fisiologia , Artéria Femoral/fisiologia , Macrófagos/fisiologia , Animais , Artéria Femoral/metabolismo , Interleucinas/metabolismo , Leucócitos/metabolismo , Leucócitos/fisiologia , Ligadura/métodos , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fenótipo , Ratos , Ratos Sprague-Dawley , Resistência ao Cisalhamento/fisiologia , Análise Espaço-Temporal
16.
Internist (Berl) ; 54(1): 28-34, 36-8, 2013 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-23263747

RESUMO

Due to increasing life expectancy in the coming decades the number of elderly patients with aortic valve stenosis (AS) and various concomitant diseases will increase. Conventional surgical aortic valve replacement represents the treatment of choice in patients with severe and symptomatic AS. Transfemoral and transapical aortic valve implantation (T-AVI) has evolved as a standard procedure for patients with severe AS who are technically inoperable or at very high risk for surgical valve replacement. The T-AVI approach has been shown to be superior to the standard medical treatment in these high-risk patients. All patients to be considered for T-AVI should be discussed in a consensus conference consisting of cardiac surgeons and cardiologists (heart team).


Assuntos
Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Humanos , Desenho de Prótese
17.
Internist (Berl) ; 53(9): 1063-75; quiz 1076-8, 2012 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-22836917

RESUMO

Coronary artery disease (CAD) is a leading cause of morbidity and mortality in western countries and is of significant socio-economic importance due to its increasing prevalence. Until percutaneous coronary interventions (PCI) were established, CAD could only be treated by surgical revascularization or pharmacological therapy. In-stent restenosis remains a major problem after stent implantation. However, the use of new materials and stent coatings have led to a significant reduction in in-stent restenosis. Thus, surgical revascularization and PCI are currently of equal value for the treatment of CAD. The decision-making for PCI or surgical revascularization depends on various factors such as number of diseased vessels, complexity of the coronary stenoses, concomitant diseases, and the patient's general condition. The therapeutic regime of every patient should be adjusted to the recommendations of the European and German Society for Cardiology, while controversial and complex cases should be discussed in an interdisciplinary case conference ("heart team").


Assuntos
Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/métodos , Humanos , Resultado do Tratamento
19.
J Cell Mol Med ; 15(1): 52-62, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19941631

RESUMO

Recently, we demonstrated that a fully differentiated tissue developed on a ventricular septal occluder that had been implanted due to infarct-related septum rupture. We suggested that this tissue originated from circulating stem cells. The aim of the present study was to evaluate this hypothesis and to investigate the physiological differentiation and transdifferentiation potential of circulating stem cells. We developed an animal model in which a freely floating membrane was inserted into each the left ventricle and the descending aorta. Membranes were removed after pre-specified intervals of 3 days, and 2, 6 and 12 weeks; the newly developed tissue was evaluated using quantitative RT-PCR, immunohistochemistry and in situ hybridization. The contribution of stem cells was directly evaluated in another group of animals that were by treated with granulocyte macrophage colony-stimulating factor (GM-CSF) early after implantation. We demonstrated the time-dependent generation of a fully differentiated tissue composed of fibroblasts, myofibroblasts, smooth muscle cells, endothelial cells and new blood vessels. Cells differentiated into early cardiomyocytes on membranes implanted in the left ventricles but not on those implanted in the aortas. Stem cell mobilization with GM-CSF led to more rapid tissue growth and differentiation. The GM-CSF effect on cell proliferation outlasted the treat ment period by several weeks. Circulating stem cells contributed to the development of a fully differentiated tissue on membranes placed within the left ventricle or descending aorta under physiological conditions. Early cardiomyocyte generation was identified only on membranes positioned within the left ventricle.


Assuntos
Diferenciação Celular , Fator Estimulador de Colônias de Granulócitos e Macrófagos/farmacologia , Mobilização de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas , Células-Tronco Pluripotentes , Disfunção Ventricular Esquerda/tratamento farmacológico , Animais , Western Blotting , Fibroblastos/metabolismo , Técnicas Imunoenzimáticas , Miócitos Cardíacos/citologia , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Miócitos de Músculo Liso/metabolismo , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Suínos , Engenharia Tecidual
20.
J Int Med Res ; 39(6): 2169-77, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22289532

RESUMO

Little is known about the impact of early invasive treatment in patients following out-of-hospital cardiac arrest (OHCA). The present study investigated the clinical characteristics and long-term prognosis of 1254 patients with suspected acute coronary syndrome, including 65 with OHCA who underwent successful cardiopulmonary resuscitation (CPR) and 1189 patients who did not require CRP. All patients underwent immediate coronary angiography even if clear signs of myocardial infarction (MI) were absent. The incidence of ST-elevation and non-ST-elevation MI did not differ between the two groups. Cardiac biomarkers were significantly higher in CPR patients despite a shorter period from symptom onset to admission. The 6-month mortality rate was 29% in the CPR group and 4% in the non-CPR group, with > 90% of fatalities occurring ≤ 3 weeks after admission. In summary, early invasive treatment leads to a considerably reduced mortality and improved prognosis in patients after OHCA.


Assuntos
Parada Cardíaca Extra-Hospitalar/terapia , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Idoso , Biomarcadores/metabolismo , Pressão Sanguínea/fisiologia , Reanimação Cardiopulmonar , Feminino , Alemanha/epidemiologia , Frequência Cardíaca/fisiologia , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Medição de Risco , Volume Sistólico/fisiologia , Resultado do Tratamento
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