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1.
J Ultrasound Med ; 42(12): 2715-2724, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37486260

RESUMO

OBJECTIVES: To evaluate the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) for detecting catheter-related right brachiocephalic vein (RBV) and superior vena cava (SVC) obstructions in patients undergoing hemodialysis (HD). METHODS: From June 1, 2021 to December 31, 2022, we enrolled 80 patients undergoing HD who had used or were using a central venous catheter as vascular access. We evaluated the diagnostic efficacy of conventional ultrasonography and CEUS for identifying RBV and SVC obstructions and compared them with that of digital subtraction angiography (DSA). In the stratified analysis, the SVC was divided into the upper and lower segments. In total, we analyzed 240 central venous segments, including the RBV. RESULTS: Among the RBV and SVC visualized by DSA, conventional ultrasonography and CEUS could visualize 67.92 and 100% of the vein segments, respectively; however, the lengths and diameters of the RBV and SVC were smaller than those recorded with DSA (P < .001). The diagnostic efficacy of CEUS for detecting catheter-related central venous obstruction was better than that of conventional ultrasonography, with a higher sensitivity (83.95 vs 41.98%), specificity (89.94 vs 53.46%), accuracy (87.92 vs 49.58%), and F1 score (82.42 vs 49.64%). CEUS showed good agreement (κ = 0.732) with DSA. In the stratified analyses, CEUS also showed higher sensitivity (83.93, 83.33, and 84.62%, respectively) and better agreement with DSA (κ = 0.635, 0.655, and 0.673, respectively) than conventional ultrasonography for detecting the RBV and the upper and lower segments of the SVC. CONCLUSIONS: CEUS had high sensitivity and specificity in diagnosing catheter-related RBV and SVC obstructions.


Assuntos
Cateteres Venosos Centrais , Síndrome da Veia Cava Superior , Humanos , Veia Cava Superior/diagnóstico por imagem , Veias Braquiocefálicas/diagnóstico por imagem , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/patologia , Projetos Piloto , Ultrassonografia , Diálise Renal/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos
2.
Clin Res Cardiol ; 106(2): 151-157, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27747373

RESUMO

Resistant hypertension is associated with increased risk for cardiovascular events. Coronary flow reserve (CFR) is impaired in patients with hypertension and an independent predictor of cardiac mortality. However, there are no published data on CFR in the subset of treatment-resistant hypertension. The aim of this study was to assess CFR in patients with resistant hypertension. Twenty-five consecutive patients with primary resistant hypertension, scheduled for renal denervation, 25 matched patients with controlled hypertension, and 25 healthy controls underwent transthoracic colour Doppler echocardiography at rest and during adenosine infusion. Patients with hypertension were pair-matched with regard to age, sex, ischemic heart disease, diabetes mellitus, smoking status, and body-mass index. Healthy controls were selected according to age and sex. Mean flow velocity was measured in the left coronary anterior descending artery. Baseline mean flow velocities were similar in patients with controlled and resistant hypertension. CFR was significantly lower in patients with resistant hypertension as compared to individuals with non-resistant hypertension (2.7 ± 0.6 vs. 3.1 ± 0.8; p = 0.03). Systolic office blood pressure was significantly higher in patients with resistant hypertension (169 ± 20 vs. 144 ± 21 mm Hg; p < 0.01). Heart rate, ventricular mass, and ejection fraction were similar in the two groups. Healthy controls showed significantly lower baseline velocity, higher CFR, and lower blood pressure as compared to hypertensives. Resistant hypertension was associated with impaired CFR as compared to individuals with non-resistant hypertension indicating impaired cardiac microvascular function which may contribute to the increased risk of adverse outcome in patients with resistant hypertension.


Assuntos
Pressão Sanguínea , Circulação Coronária , Vasos Coronários/diagnóstico por imagem , Resistência a Medicamentos , Ecocardiografia Doppler em Cores , Cardiopatias/diagnóstico por imagem , Hipertensão/complicações , Adenosina/administração & dosagem , Idoso , Anti-Hipertensivos/uso terapêutico , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea/efeitos dos fármacos , Estudos de Casos e Controles , Vasos Coronários/fisiopatologia , Feminino , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Microcirculação , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Vasodilatadores/administração & dosagem
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