Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças Vasculares/congênito , Síndrome Coronariana Aguda/terapia , Adulto , Angiografia Coronária , Ponte de Artéria Coronária , Anomalias dos Vasos Coronários/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/terapiaRESUMO
Autoimmune rheumatic diseases are inflammatory disorders that can involve multiple organs, including the heart. The high risk of cardiovascular pathology in these patients is not only due to traditional cardiovascular risk factors, but also to chronic inflammation and autoimmunity. All cardiac structures may be affected during the course of systemic autoimmune diseases (valves, the conduction system, the myocardium, endocardium and pericardium, and coronary arteries), and the cardiac complications have a variety of clinical manifestations. As these are all associated with an unfavourable prognosis, it is essential to detect subclinical cardiac involvement in asymptomatic systemic autoimmune disease patients and begin adequate management and treatment early. In this review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders and available management strategies.
Assuntos
Doenças Autoimunes , Doenças Cardiovasculares , Cardiopatias , Doenças Reumáticas , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/epidemiologia , Autoimunidade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Humanos , Miocárdio , Doenças Reumáticas/complicaçõesRESUMO
INTRODUCTION AND OBJECTIVES: To assess the risk factors of cytomegalovirus (CMV) infection after heart transplant (HT) and its influence on long-term prognosis. METHODS: We conducted a retrospective single-centre study of 222 HT recipients. Risk factors for CMV infection were identified by means of multivariable CoxÌs regression. Kaplan-Meier analysis and CoxÌs regression were used to assess the long-term prognostic impact of CMV infection during the first post-transplant year. RESULTS: Donor-recipient CMV serologic matching (hazard ratio [HR] 1.92, 95% confidence interval [95% CI] 1.2-3.09, p=.007), recipient age (HR 1.02, 95% CI: 1.00-1.1, p=.02), diabetes mellitus (HR 1.86, 95% CI: 1.4-3.05, p=.01), pre-transplant circulatory support (HR 1.59, 95% CI: 1.06-2.38, p=.03) and the use of tacrolimus (HR 1.64, 95% CI: 1.13-2.36, p=.009) were independently associated with increased risk of CMV infection. CMV infection during the first year post-HT was not associated with worse transplant outcomes in terms of mortality, incidence of heart failure, cardiac allograft vasculopathy or acute rejection. CONCLUSIONS: CMV infection was not associated with impaired long-term prognosis after HT.
Assuntos
Infecções por Citomegalovirus , Transplante de Coração , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/etiologia , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Transplante de Coração/efeitos adversos , Humanos , Incidência , Prognóstico , Estudos Retrospectivos , Fatores de RiscoAssuntos
Falso Aneurisma/diagnóstico por imagem , Técnicas de Imagem Cardíaca , Aneurisma Cardíaco/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Falso Aneurisma/cirurgia , Técnicas de Imagem Cardíaca/métodos , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
INTRODUCTION AND OBJECTIVES: We sought to compare the predictive value of the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC), Primary Angioplasty in Myocardial Infarction (PAMI), and Global Registry for Acute Coronary Events (GRACE) scores for the outcome of ST-segment elevation acute coronary syndrome undergoing urgent percutaneous coronary intervention. METHODS: We performed a retrospective analysis of a cohort composed of all consecutive patients with ST-segment elevation acute coronary syndrome treated by urgent percutaneous coronary intervention between 2006 and 2010 (n=1503). TIMI, PAMI, CADILLAC, and GRACE risk scores were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for death, reinfarction, and target-vessel revascularization at 30 days and 1 year, using the C statistic, which was obtained by means of logistic regression and ROC curves. RESULTS: The TIMI, PAMI, CADILLAC and GRACE showed an excellent predictive value for 30-day and 1-year mortality (C statistic range, 0.8-0.9), with superiority of the TIMI, CADILLAC, and GRACE risk models. The performance of these 4 scores was poor for both reinfarction and target-vessel revascularization (C statistic, 0.5-0.6). CONCLUSIONS: The TIMI, PAMI, CADILLAC, and GRACE scores provide excellent information to stratify the risk of mortality in patients treated by percutaneous coronary intervention. The TIMI, CADILLAC, and GRACE models have higher predictive accuracy. The usefulness of these models for reinfarction and target-vessel revascularization prediction is questionable.
