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1.
Am Heart J ; 224: 171-181, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32416332

RESUMO

BACKGROUND: Skeletal muscle wasting, or sarcopenia, affects a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). However, its influence on post-TAVR recovery and 1-year health-related quality of life (HR-QOL) remains unknown. We examined the relationship between skeletal muscle index (SMI), post-TAVR length of hospital stay (LOS), and 1-year QOL. METHODS: The study sample consisted of 300 consecutive patients undergoing TAVR from 2012 to 2018 who had pre-TAVR computed tomographic scans suitable for analysis of body composition. Skeletal muscle mass was quantified as cm2 of skeletal mass per m2 of body surface area from the cross-sectional computed tomographic image at the third lumbar vertebra. Sarcopenia was defined using established sex-specific cutoffs (women: SMI < 39 cm2/m2; men: < 55 cm2/m2). Multivariable linear regression analysis was used to determine the relationship between SMI, LOS, and HR-QOL using the Kansas City Cardiomyopathy Questionnaire. RESULTS: Sarcopenia was present in most (59%) patients and associated with older age (82 vs 76 years; P < .001) and lower body mass index (27 vs 33 kg/m2; P < .001). There were no other differences in baseline clinical or echocardiographic characteristics among the 4 quartiles of SMI. SMI was positively correlated with LOS and 1-year QOL. After adjusting for age, gender, race, and body mass index, SMI remained a significant predictor of both LOS (P = .01) and 1-year QOL (P = .012). For every 10 cm2/m2 higher SMI, there was an 8-point increase in Kansas City Cardiomyopathy Questionnaire score, a difference that is clinically meaningful. CONCLUSIONS: Sarcopenia is prevalent in TAVR patients. Higher SMI is associated with shorter LOS and better 1-year HR-QOL. To achieve optimal TAVR benefits, further study into how body composition influences post-TAVR recovery and durable improvement in QOL is warranted.


Assuntos
Estenose da Valva Aórtica/cirurgia , Nível de Saúde , Qualidade de Vida , Medição de Risco/métodos , Sarcopenia/epidemiologia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estudos Transversais , Feminino , Florida/epidemiologia , Seguimentos , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagem , Período Pós-Operatório , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Índice de Gravidade de Doença , Fatores de Tempo , Tomografia Computadorizada por Raios X
2.
Am Heart J ; 198: 75-83, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29653651

RESUMO

There exist limited data on the relative degree of acute injury and late healing of the radial artery after transradial artery (TRA) percutaneous coronary intervention (PCI) with a 7F sheathless guide catheter compared with a 6F sheath/guide combination. We used ultrahigh-resolution (55 MHz) vascular ultrasound to compare intimal-medial thickening (IMT) and early and late radial artery (RA) injury resulting from a sheathless 7F guide catheter versus a 6F sheath/guide combination for TRA-PCI. METHODS: Forty-one consecutive consenting patients undergoing elective nonemergent TRA-PCI at a single institution from June 2016 to December 2016 were included. Patients were randomized (stratified by sex) to undergo TRA-PCI using a 7F sheathless guide catheter versus a 6F sheath/6F guide combination. Ultrahigh-resolution vascular ultrasound (55MHz) of the RA access site was performed at 24hours and 90days post-TRA-PCI. The primary outcome of the study was a noninferiority comparison of radial artery IMT thickness at 90days. PCI success rates, fluoroscopy times, number of guides used, and crossover rates to a femoral approach were also compared. RESULTS: Baseline characteristics were similar between groups. Radial arterial IMT (mm) was similar between the 7F sheathless and 6F sheath/guide groups at 24hours (0.27 vs 0.29, respectively; P=.43) and at 90days (0.35 vs 0.34, respectively; P=.96). The P value for the noninferiority testing of a 0.07-mm limit was .002. Limited access site intimal tears were relatively common in both groups at 24hours (4 vs 5, P=.53) but often healed by 90days. Radial artery occlusion was infrequent at 90days (2 vs 1, P=.10), and no frank dissections were noted. PCI success rates (100% vs 95%, P=.59), fluoroscopy times (16 vs 12minutes, P=.17), number of guides used (1.1 vs 1.2, P=.48), and femoral crossover rates (0% vs 0%) were similar between the 2 respective groups. CONCLUSIONS: A 7F sheathless approach to TRA-PCI results in no more IMT and early or late RA trauma than a standard 6F sheath/guide combination, rendering the 7F sheathless technique an attractive option for complex TRA-PCI.


Assuntos
Estenose Coronária/cirurgia , Intervenção Coronária Percutânea/métodos , Artéria Radial , Cirurgia Assistida por Computador/métodos , Ultrassonografia de Intervenção/métodos , Lesões do Sistema Vascular/prevenção & controle , Centros Médicos Acadêmicos , Idoso , Cateterismo Cardíaco/métodos , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Estudos Cross-Over , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
3.
Am Heart J ; 182: 21-27, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27914496

RESUMO

To determine the prevalence of low skeletal muscle mass in patients undergoing transcatheter aortic valve replacement (TAVR) and whether skeletal muscle mass measured from preoperative computed tomography (CT) images provides value in predicting postoperative length of stay (LOS). BACKGROUND: There are limited data on the use of body composition as a frailty measure in TAVR patients and no studies have determined if this measure predicts LOS. METHODS: We studied 104 consecutive patients who underwent TAVR at Tallahassee Memorial Hospital from 2012 to 2016. Patient demographics, standard frailty measures (hand grip, albumin, and 5-m walk test), clinical comorbidities, echocardiographic data, and Valve Academic Research Consortium II major complications were recorded prospectively. Skeletal muscle index (SMI) [skeletal muscle mass cross-sectional area at L3/height2] was measured from CT images using Slice-O-Matic software (Tomovision, Montreal, Quebec, Canada). Clinical outcomes were assessed and multivariate methods used to determine predictors of LOS. RESULTS: Sarcopenia was prevalent in men (83%) and women (56%). Patients who suffered from a major complication had significantly longer length of stay (13 vs 4.6days, P<.0001). Skeletal muscle index correlated with age, sex, body mass index, handgrip strength, and previous coronary artery bypass graft surgery, but not major complications. A multivariate model including all univariate predictors of LOS showed SMI, major complications, transapical access, atrial fibrillation, and chronic obstructive pulmonary syndrome as independent predictors of LOS. For every 14-cm2/m2 increase in SMI, there was a 1-day reduction in LOS. None of the standard measures of frailty predicted LOS. CONCLUSIONS: Skeletal muscle index, a measure of sarcopenia readily determined from pre-TAVR CT scans, independently predicts TAVR LOS better than standard frailty testing. Further evaluation of SMI as a frailty measure after TAVR and other cardiovascular procedures is warranted.


Assuntos
Estenose da Valva Aórtica/cirurgia , Idoso Fragilizado , Músculo Esquelético , Complicações Pós-Operatórias/diagnóstico , Sarcopenia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Feminino , Indicadores Básicos de Saúde , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Prognóstico , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Estados Unidos/epidemiologia
5.
Cardiovasc Revasc Med ; 21(3): 286-292, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31171471

RESUMO

BACKGROUND: Remodeling of the radial artery (RA) after transradial percutaneous coronary intervention (TRI) is under studied. OBJECTIVES: To examine the impact of TRI on RA diameter and intimal-medial thickness (IMT) in men and women using 55 Mhz ultrahigh frequency duplex ultrasound (UHFDU). METHODS: We performed UHFDU at 24 h and 90 days after non-emergent TRI in 41 patients (25 men, 16 women). Changes in RA diameter, IMT and RA injury were compared by patient gender. Multivariate linear regression was used to determine the predictors of RA diameter and IMT. RESULTS: Of the 41 patients, mean age was 66 ±â€¯9.8. Baseline RA diameter was larger in men vs. women (3.1 ±â€¯0.40 mm vs. 2.8 mm ±â€¯0.36, p = 0.02), however there were similar reductions in 90-day diameter (-0.57 ±â€¯0.32 mm vs. -0.64 ±â€¯0.40 mm, respectively; p = 0.48). Baseline IMT was also similar in men and women (0.28 ±â€¯0.04 vs. 0.27 ±â€¯0.06 mm; p = 0.37) and there were 0.073 ±â€¯0.11 mm (26%) and 0.05 ±â€¯0.080 mm (19%) increases in IMT noted, respectively (p < 0.0001 vs. baseline, p = 0.48 for men vs. women). Although UHFDU occasionally detected limited access site intimal tears (12%) at 90 days, frank dissections (2.4%), pseudoaneurysms (2.4%) and total occlusions (4.9%) were infrequent. Female gender correlated with smaller RA diameter at follow-up and there were no predictors of IMT. CONCLUSIONS: Following TRI, there is a 20% reduction in RA diameter and a 20-25% increase in IMT. Only gender predicted RA diameter. As a simple, noninvasive method to accurately depict the RA healing response following TRI, UHFDU may inform future clinical investigation in this area.


Assuntos
Intervenção Coronária Percutânea , Lesões do Sistema Vascular , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Artéria Radial/diagnóstico por imagem , Artéria Radial/lesões , Ultrassonografia
6.
Med Clin North Am ; 103(5): 835-846, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31378329

RESUMO

Atrial fibrillation (AF) is the most common arrhythmia and its management may be organized into risk stratification and/or treatment of heart failure, stroke prevention, and symptom control. At the core of symptom control, treatment is tailored to either allow AF continue with controlled heart rates, so-called rate control, versus restoring and maintaining sinus rhythm or rhythm control. Rate control strategies mainly use rate-modulating medications, whereas rhythm control treatment includes therapy aimed at restoring sinus rhythm, including pharmacologic and direct current cardioversion, as well as maintenance of sinus rhythm, including antiarrhythmic medications and ablation therapy.


Assuntos
Antiarrítmicos/administração & dosagem , Fibrilação Atrial/terapia , Ablação por Radiofrequência/métodos , Antiarrítmicos/uso terapêutico , Ablação por Cateter/métodos , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Humanos , Medição de Risco
7.
Cardiovasc Revasc Med ; 20(8): 642-648, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31171470

RESUMO

BACKGROUND: Patients with peripheral arterial disease (PAD) often have walking impairment due to insufficient oxygen supply to skeletal muscle. In aged rats, we have shown that daily stretching of calf muscles improves endothelium-dependent dilation of arterioles from the soleus muscle and increases capillarity and muscle blood flow during exercise. Therefore, we hypothesized that daily muscle stretching of calf muscles would improve endothelium-dependent vasodilation of the popliteal artery and walking function in PAD patients. METHODS: We performed a randomized, non-blinded, crossover study whereby 13 patients with stable symptomatic PAD were randomized to undergo either 4 weeks of passive calf muscle stretching (ankle dorsiflexion applied 30 min/d, 5 days/wk) followed by 4 weeks of no muscle stretching and vice versa. Endothelium-dependent flow-mediated dilation (FMD) and endothelium-independent nitroglycerin-induced dilation of the popliteal artery and 6 minute walk test (6MWT) were evaluated at baseline and after each 4 week interval. RESULTS: After 4 weeks of muscle stretching, FMD and 6MWT improved significantly in the muscle stretching group vs. the control (FMD: 5.1 ±â€¯0.5% vs. 3.7 ±â€¯0.3%, P = 0.005; 6MWT continuous walking distance: 304 ±â€¯43 m vs. 182 ±â€¯34 m; P = 0.0006). No difference in nitroglycerin-induced dilation was found between groups (10.9 ±â€¯1.2 vs. 9.9 ±â€¯0.4%, P = 0.48). Post-stretching, 6MWT total walking distance was positively correlated with normalized FMD (R = 0.645, P = 0.02). CONCLUSIONS: Passive calf muscle stretching enhanced vascular endothelial function and improved walking function in elderly patients with stable symptomatic PAD. These findings merit further investigation in a prospective randomized trial.


Assuntos
Endotélio Vascular/fisiopatologia , Tolerância ao Exercício , Claudicação Intermitente/terapia , Exercícios de Alongamento Muscular , Músculo Esquelético/irrigação sanguínea , Doença Arterial Periférica/terapia , Artéria Poplítea/fisiopatologia , Vasodilatação , Teste de Caminhada , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Feminino , Florida , Humanos , Claudicação Intermitente/diagnóstico por imagem , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Prospectivos , Recuperação de Função Fisiológica , Fluxo Sanguíneo Regional , Fatores de Tempo , Resultado do Tratamento
8.
Case Rep Vasc Med ; 2013: 382485, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23984178

RESUMO

Pseudoaneurysms of the carotid artery are very uncommon complications following carotid endarterectomy. Pseudoaneurysms are usually caused by any kind of blunt injury or trauma during carotid artery surgery. CEA has become an increasingly more common vascular surgery performed in the United States. The standard of treatment for a carotid PA has been open surgical repair with excision of the defect and then a graft reconstruction of the artery. Advancements in endovascular intervention have helped to make it a more popular choice in treatment because of the positive results and less invasive approach. This case report describes the successful obliteration of a large post-CEA PA using a stent graft. The PA was likely secondary to the use of a Pruitt-lnahara Shunt because it was found to be distal to the endarterectomized area of the carotid artery which means that the defect was likely caused by the balloon portion of the shunt. This case demonstrates the feasibility of using endovascular interventional techniques to treat a PA using a stent graft.

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