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INTRODUCTION: Pregnancy is a process that can cause several physiologic changes to the cardiovascular system such as ventricular hypertrophy and dilation of cardiac chambers. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number. METHODS: This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups. RESULTS: In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the four independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10-1.20), body mass index (OR: 1.05, CI: 1.02-1.08), smoking (OR: 1.87, CI: 1.28-4.02), and giving a birth (OR: 3.94 CI: 1.82-8.81). There was also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders. CONCLUSION: Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.
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Disfunción Ventricular Derecha , Función Ventricular Derecha , Femenino , Corazón , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Hipertrofia Ventricular Derecha/complicaciones , Paridad , Embarazo , Estudios ProspectivosRESUMEN
INTRODUCTION: Although it is recommended that elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) should undergo an assessment for invasive revascularization, these patients undergo fewer coronary interventions despite the current guidelines. The aim of the study is to evaluate the effectiveness of percutaneous coronary intervention on all-cause mortalities monthly and annually in the population. METHODS: Three hundred and twenty-four patients with NSTEMI aged 65 years or older who underwent coronary angiography and treated with conservative strategy or percutaneous coronary intervention were included in the study. All demographic and clinical characteristics of the patients were recorded and one-month and one-year follow-up results were analysed. RESULTS: Two hundred eight cases (64.19%) were treated with percutaneous coronary intervention and 116 cases (35.81%) of the participant were treated with conservative methods. The mean age of the participants was 75.41 ± 6.65 years. The treatment strategy was an independent predictor for the mortality of one-year (HR: 1.965). Furthermore, Killip class ≥2 (HR:2.392), Left Ventricular Ejection Fraction (HR:2.637) and renal failure (HR: 3.471) were independent predictors for one-year mortality. CONCLUSION: The present study has revealed that percutaneous coronary intervention was effective on one-year mortality in NSTEMI patients over the age of 65. It is considered that percutaneous coronary intervention would decrease mortality in these patients but it should be addressed in larger population studies.
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Causas de Muerte , Tratamiento Conservador/estadística & datos numéricos , Infarto del Miocardio sin Elevación del ST/cirugía , Infarto del Miocardio sin Elevación del ST/terapia , Intervención Coronaria Percutánea/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Tratamiento Conservador/métodos , Angiografía Coronaria , Femenino , Humanos , Masculino , Infarto del Miocardio sin Elevación del ST/mortalidad , Estudios Prospectivos , Insuficiencia Renal/mortalidad , Resultado del Tratamiento , Turquía/epidemiologíaRESUMEN
BACKGROUND: There are various changes in cardiac physiology in athletes compared to the normal population. These physiological changes may differ according to the exercise content. The aim of this study was to compare the effects of different exercise methods on the heart. METHODS: A total of 122 male athletes from various sports were evaluated. Depending on the sorts of sports, these participants were split into aerobic, mixed, and resistance groups. Each athlete had to meet the inclusion criteria of having participated in the present sport for at least a year and having trained for at least 600 minutes per week over the previous three months. Transthoracic echocardiography was used to investigate the effects of different exercise types. RESULTS: The aerobic group's heart rate and ejection fraction were found to be lower than those of the resistance and mixed groups (F
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Cardiomegalia Inducida por el Ejercicio , Humanos , Masculino , Corazón/fisiología , Ejercicio Físico/fisiología , Ecocardiografía , Ventrículos Cardíacos/diagnóstico por imagen , AtletasRESUMEN
BACKGROUND: According to clinical practice guidelines, thrombolysis can be administered during the 14 days after the beginning of symptoms in PE. However, the role of the early thrombolysis in PE has not been comprehensively investigated. In this study we evaluated the effect of short symptom-to-thrombolysis time (STT) in these patients who received the thrombolytic therapy within the 48-h. METHOD: A total of 456 patients with pulmonary embolism who underwent thrombolytic therapy in a tertiary center were included in the current study. The patients were stratified into three groups according to STT as: <12 h (Group 1), 12 to 24 h (Group 2) and > 24 to 48 h (Group 3). In-hospital events and long-term mortality were compared between the groups. RESULTS: Group 3 had higher in-hospital mortality, acute kidney injury, cardiogenic shock, asystole, and the use mechanical ventilation and 3-year mortality compared to the other two groups. The 3-year overall survival for Group 1, 2 and 3 were 82.1%, 77.7% and 25.9% respectively. According to regression analysis, a STT > 24 h was independently associated with in-hospital and long-term mortality. Group 1 and 2 had similar in-hospital outcomes and long-term mortality. CONCLUSION: A short STT has a great importance in patients with PE who treated with thrombolytic therapy. The efficacy of systemic thrombolysis significantly drops after 24 h. Because of this situation, the period between the symptom onset and thrombolytic therapy should be kept short as much as possible.
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Fibrinolíticos , Embolia Pulmonar , Humanos , Pronóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamiento farmacológico , Terapia Trombolítica/efectos adversos , Resultado del TratamientoRESUMEN
The coexistence of Brugada syndrome and Wolff-Parkinson-White (WPW) syndrome is a very rare phenomenon. We describe a 31-year-old patient without any previous cardiac disorder admitted to our hospital due to palpitations and concomitantly diagnosed as WPW syndrome and treated with radiofrequency catheter ablation. He was later diagnosed with Brugada syndrome and followed-up 2 years without any symptoms. We discuss other previously reported cases in literature, in which these two conditions exist simultaneously.
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Síndrome de Brugada/complicaciones , Síndrome de Brugada/diagnóstico , Electrocardiografía/métodos , Síndrome de Wolff-Parkinson-White/complicaciones , Síndrome de Wolff-Parkinson-White/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
OBJECTIVE: Inflammation plays an important role in the initiation of postoperative atrial fibrillation (PoAF) in individuals undergoing cardiac surgery, Thus, this study aimed to investigate the predictive value of the systemic immune inflammation index (SII) to develop PoAF in such patients. METHODS: In total, 391 consecutive patients undergoing an isolated coronary artery bypass grafting (CABG) were retrospectively analyzed. PoAF was defined according to the current guideline. The SII is determined using the following equation: neutrophil (N) × platelet (P) ÷ lymphocyte (L). RESULTS: The incidence of PoAF in the present study was 24% (n=97 cases). Multivariate logistic regression analysis revealed that the SII was an independent predictor of PoAF (Odds ratio: 1.002 95% confidence interval: (1.001-1.002), p<0.01). The optimal value of the SII in detecting PoAF was established by a receiver operating characteristic curve assessment, and it was >807.8 with 60.8% sensitivity and 80.9% specificity [area under the curve (AUC): 0.7107]. The AUC value of SII in detecting PoAF was much greater than the AUC values of both the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) (AUC: 0.6740 and AUC: 0.6426, respectively). CONCLUSIONS: This study revealed that SII was an independent predictor of PoAF in patients who were operated on for isolated CABG. Additionally, SII had a better discriminative ability for PoAF compared to either NLR or PLR among these cases.
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OBJECTIVE: The present study aimed to compare the value of D-dimer measured on the 3rd day of hospitalization with admission D-dimer level in predicting in-hospital mortality in coronavirus disease 2019 (COVID-19) cases. METHOD: In total, 231 patients with COVID-19 disease were included in the study. D-dimer levels were estimated using immunoturbidimetric assay with normal range of 0-500 µg/mL. In the current research, the primary outcome was the in-hospital mortality. RESULTS: In the present research, 39 (16.8%) COVID-19 cases died during the index hospitalization. In a multivariable analysis; age, D-dimer (3rd day) (OR: 1.00, 95% CI: 1.00-1.00, p<0.001), WBC count, and creatinine were independent predictors of the in-hospital death for COVID-19 cases. The ideal value of D-dimer level on the 3rd day of hospitalization was 774 µq/mL (area under curve (AUC): 0.903, 95% CI: 0.836-0.968; p<0.01) with sensitivity of 83.2% and specificity of 83.6%. It was noted that D-dimer level on the 3rd day of hospitalization had a higher sensitivity (83.2% vs 67.6%, respectively) and AUC value than that of D-dimer level on admission (0.903 vs 0.799, respectively). CONCLUSION: The main finding in this investigation was that D-dimer elevation on the 3rd of hospitalization is more sensitive predictor of in-hospital mortality than D-dimer elevation on admission in COVID-19 patients. Even though further investigations are needed to forecast precise prognosis in patients with COVID-19 disease in terms of D-dimer levels, we believe that D-dimer levels on the 3rd day of hospitalization have an enhanced potential to be used as a prognostic marker in routine clinical practice.
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Introduction: The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods: A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95%CI:0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.
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OBJECTIVE: To determine the subclinical effects of isolated obesity and its duration on cardiac function by using routine echocardiography and tissue Doppler myocardial strain rate. METHODS: Forty-nine subjects were enrolled in this study; 29 with isolated obesity defined as a body mass index > or = 30 kg/m(2) with no other cardiovascular comorbidities, and 20 nonobese controls. All subjects underwent two-dimensional and Doppler echocardiography including tissue Doppler imaging and myocardial strain rate. RESULTS: The average duration of obesity was 12.1 years (4-18 years). Abnormalities of left ventricular (LV) wall thickness, mass, diastolic function, and left atrial size were detected in obese individuals, despite having preserved ejection fractions. The LV global longitudinal peak strain rate was significantly lower in obese subjects compared to nonobese control subjects (1.07 +/- 0.14 vs. 1.38 +/- 0.12, P < 0.001). Using multivariate analysis, the duration of obesity (ss=-0.76, P < 0.001), body mass index (ss=-0.35, P = 0.023), and age (ss=-0.29, P = 0.009) were independent predictors of the decreased LV global longitudinal peak strain rate, while the duration of obesity (ss=-0.66, P < 0.001) and body mass index (ss=-0.28, P = 0.037) were independent predictors of the decreased right ventricular (RV) peak strain rate. CONCLUSION: The presence and the duration of obesity were associated with impairment of subclinical biventricular systolic and diastolic function. These findings have the potential to increase awareness of subclinical cardiac manifestations in patients with isolated obesity and influence their early management.
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Ecocardiografía Doppler , Insuficiencia Cardíaca/diagnóstico por imagen , Corazón/fisiopatología , Obesidad/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Derecha/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Ecocardiografía , Ecocardiografía Tridimensional , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estándares de ReferenciaRESUMEN
OBJECTIVE: The aim of this study was to assess the effectiveness of a 12-week phase II cardiac rehabilitation (CR) program in Turkish patients aged between ≤65 years and >65 years using psychical parameters, echocardiography measurements, lipid profiles, and psychological parameters. METHODS: A total of 68 patients who completed a phase II CR program were enrolled in this retrospective study. The echocardiography measurements, as well as assessment of physical parameters, psychological state, and serum lipid level of the patients were evaluated before the entry into the program and just after the completion. Patients were divided into 2 groups: those aged 65 years and under and those over the age of 65, and the effects of the CR program were compared. RESULTS: There was a statistically significant difference in the average heart rate (HR), left ventricular ejection fraction (LVEF), Beck Depression Inventory (BDI) score, and State-Trait Anxiety Inventory (STAI) I-II scores of young patients before and after cardiac rehabilitation. The LVEF, high-density lipoprotein (HDL), BDI, STAI-I, and STAI-II parameters of older patients were statistically significant. In the comparison between those who were 65 years and under and those over the age of 65, the change in the mean HR (+11.24±12.62 bpm vs. +3.96±12.50 bpm; p=0.039), LVEF (+21.31±21.37% vs. +9.55±13.50%; p=0.035) and STAI I scores (-11.33±11.51 points vs. -23.25±14.08 points; p=0.025) were significantly different. CONCLUSION: The results of the present study revealed that patients in a Turkish population aged 65 and over benefited from CR as much as younger patients did in terms of physical parameters, echocardiography measurements, lipid profiles, and psychological parameters.
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Rehabilitación Cardiaca/métodos , Rehabilitación Cardiaca/estadística & datos numéricos , Ecocardiografía/métodos , Insuficiencia Cardíaca/rehabilitación , Lípidos/sangre , Pruebas Psicológicas/normas , Factores de Edad , Anciano , Ansiedad/epidemiología , Ansiedad/psicología , Rehabilitación Cardiaca/clasificación , Estudios de Casos y Controles , Depresión/epidemiología , Depresión/psicología , Femenino , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/psicología , Frecuencia Cardíaca/fisiología , Humanos , Lipoproteínas HDL/sangre , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Pruebas Psicológicas/estadística & datos numéricos , Estudios Retrospectivos , Volumen Sistólico/fisiología , Turquía/epidemiología , Función Ventricular Izquierda/fisiologíaRESUMEN
OBJECTIVES: This study aimed to assess autonomic dysfunction parameters and anxiety levels in patients with mitral valve prolapse (MVP). STUDY DESIGN: We evaluated 33 patients (mean age 25+/-5 years) with MVP and 14 healthy subjects (mean age 25+/-4 years). The patients were divided into two groups according to the presence (anatomical MVP, n=11) or absence (MVP syndrome, n=22) of abnormal leaflet thickening (>5 mm). Spielberger's Situational Anxiety Scale (SSAS) and Continuous Anxiety Scale (SCAS) were administered to all the subjects, and heart rates (HR) and arterial blood pressures (BP) were measured in the supine and standing positions. RESULTS: Mid-systolic click and late systolic murmur were significantly more frequent in patients with anatomical MVP, while nonspecific symptoms such as dyspnea, vertigo, and atypical chest pain were more frequent in patients with MVP syndrome (p<0.05). Mitral insufficiency (mild) was significantly more frequent in patients with anatomical MVP (72.7% vs. 22.7%; p<0.009). Patients with MVP syndrome had significantly higher SSAS and SCAS scores (41.0+/-15.6 and 38.5+/-15.5) compared to patients with anatomical MVP (15.8+/-7.5 and 17.0+/-9.1) and controls (14.9+/-7.4 and 16.9+/-8.7, respectively; for both p<0.001). Orthostatic differences in BP and HR were significantly greater in patients with MVP syndrome than those having anatomical MVP (p<0.001 and p=0.032, respectively). Orthostatic HR differences showed a significant correlation with SSAS in both MVP groups (r=0.536, p=0.001) and a significant correlation with SCAS in patients with MVP syndrome (r=0.523, p=0.002). There was an inverse correlation between orthostatic BP differences and anxiety parameters in all MVP patients (r=-0.391, p=0.025 for SSAS, and r=-0.320, p=0.048 for SCAS). CONCLUSION: Our data suggest that patients with MVP syndrome have increased autonomic dysfunction and anxiety scores compared to patients with anatomical MVP.
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Prolapso de la Válvula Mitral/fisiopatología , Prolapso de la Válvula Mitral/psicología , Adulto , Ansiedad , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Enfermedades del Sistema Nervioso Autónomo/psicología , Presión Sanguínea , Electrocardiografía , Femenino , Soplos Cardíacos/fisiopatología , Soplos Cardíacos/psicología , Frecuencia Cardíaca , Humanos , Entrevistas como Asunto , Masculino , Escalas de Valoración Psiquiátrica , Valores de Referencia , Sístole , Adulto JovenRESUMEN
Rupture of the mitral papillary muscle due to infective endocarditis is a very rare complication. There is no report regarding anterolateral papillary muscle rupture as a complication of infective endocarditis in the literature. We decided to report a case of anterolateral papillary muscle rupture due to infective endocarditis. Our case, which will be discussed later on, differs also in many ways from that in the literature.
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Endocarditis/complicaciones , Endocarditis/diagnóstico por imagen , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/lesiones , Adulto , Humanos , Masculino , Rotura/diagnóstico por imagen , Rotura/etiología , UltrasonografíaRESUMEN
OBJECTIVE: The primary aim of this study was to assess the effect of glucometabolic disorders on coronary collateral vessels in patients with occlusive coronary artery disease. METHODS AND RESULTS: Hundred and ninety-five consecutive patients with at least single-vessel occlusion were enrolled in this study prospectively. The standard oral glucose tolerance test was performed according to the criteria of the World Health Organization. Collateral circulation was graded according to the Rentrop classification. The mean Rentrop scores in normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes were 1.40 +/- 1.02, 1.05 +/- 0.84, 1.00 +/- 0.98, respectively (P = 0.043). The percentage of patients without collateral circulation (Rentrop-0) was greatest in the diabetic group (44.4%), while the percentage was 21.8% in the IGT group and 22.0% in the NGT group. Ninety-five patients with at least one totally occluded coronary artery were analysed as a subgroup. In the totally occluded artery subgroup postprandial glycaemia was the only parameter that was associated with the Rentrop score in the univariate analysis (r = -0.34, P = 0.002) CONCLUSIONS: In conclusion, our study results, which are in agreement with previous results, indicate that not only diabetic glucose tolerance but also impaired glucose tolerance has an adverse impact on the development of coronary collaterals.
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Glucemia/metabolismo , Circulación Colateral , Circulación Coronaria , Enfermedad Coronaria/patología , Vasos Coronarios/crecimiento & desarrollo , Trastornos del Metabolismo de la Glucosa/patología , Biomarcadores/sangre , Angiografía Coronaria , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico por imagen , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Trastornos del Metabolismo de la Glucosa/sangre , Trastornos del Metabolismo de la Glucosa/complicaciones , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: In this study, we sought to determine whether insulin resistance, which is investigated by homeostatic modelling, is related to slow coronary flow (SCF). MATERIALS AND METHODS: A total of 24 patients with SCF (4 females/20 males, mean age 47 +/- 12 years) and 32 patients with normal coronary artery (10 females/22 males, mean age 52 +/- 12 years) were included in the study. Baseline glucose, insulin and plasma lipid levels were measured. A standard oral glucose tolerance test (OGTT) was performed and post-challenge insulin levels were also measured. The index of insulin resistance was calculated with the homeostatic modelling [homeostatic model assessment for insulin resistance index (HOMA-IR)]. RESULTS: There were no differences between the 2 groups with regard to age, lipid levels, blood pressure levels, history of smoking, fasting and post-challenge plasma glucose. Baseline insulin levels were augmented in the SCF group (9.64 +/- 5.93 vs 7.04 +/- 3.26, P = 0.041). HOMA-IR levels were not different between the study groups (2.20 +/- 1.44 vs 1.69 +/- 0.86, P = 0.129). Manifest insulin resistance was significantly higher in the CSF group as compared with the control group (25% vs 3%, P = 0.01). CONCLUSION: Manifest insulin resistance is seen more frequently in patients with SCF.
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Velocidad del Flujo Sanguíneo , Circulación Coronaria/fisiología , Homeostasis , Resistencia a la Insulina/fisiología , Glucemia/análisis , Presión Sanguínea , Índice de Masa Corporal , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Insulina/sangre , Lípidos/sangre , Masculino , Persona de Mediana Edad , Modelos BiológicosRESUMEN
OBJECTIVES: We investigated mean platelet volume (MPV) in patients with slow coronary flow (SCF) and its possible relationship with clinical presentation. STUDY DESIGN: The study included 50 patients with SCF and otherwise normal coronary arteries and 22 patients (control group) with normal coronary arteries. In the SCF group, there were 26 patients with stable angina pectoris (SAP), and 24 patients with unstable angina pectoris (USAP). Coronary blood flow was measured using the TIMI frame count. To determine MPV, blood samples with K3 EDTA were processed after one hour of venipuncture. The relationship between MPV and SCF was sought. RESULTS: The mean TIMI frame count was markedly increased in patients with SCF compared to controls (p<0.0001). No significant differences existed between the groups with regard to white blood cell and platelet counts. Patients with SCF had significantly higher MPV values compared to controls (9.4+/-2.3 fl vs 8.1+/-2.0 fl, p=0.014). In subgroup analysis, MPV was significantly increased only in patients presenting with USAP, compared to patients with SAP (p=0.044) and controls (p=0.002). There was a positive correlation between the mean TIMI frame count and MPV in patients with SCF (r=0.32, p=0.01). In multivariate analysis, MPV was the only independent predictor of SCF (p=0.006, odds ratio=1.305, 95% CI=0.985-1.730). CONCLUSION: Our findings show that MPV is increased in patients with SCF, and SCF patients presenting with USAP exhibit significantly increased MPV values, suggesting an altered platelet reactivity and aggregation which may require effective anti-platelet therapy in this patient subgroup.
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Angina de Pecho/sangre , Angina Inestable/sangre , Velocidad del Flujo Sanguíneo/fisiología , Circulación Coronaria , Trombocitosis/sangre , Angina de Pecho/diagnóstico por imagen , Angina Inestable/diagnóstico por imagen , Plaquetas , Estudios de Casos y Controles , Intervalos de Confianza , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Recuento de Plaquetas , Valor Predictivo de las Pruebas , Flujo Sanguíneo Regional , Trombocitosis/diagnóstico por imagenAsunto(s)
Hiperglucemia , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/diagnóstico , Pronóstico , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/terapiaAsunto(s)
Enfermedades Renales , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Biomarcadores , Humanos , Inflamación/inducido químicamente , Inflamación/diagnóstico , Enfermedades Renales/inducido químicamente , Enfermedades Renales/diagnóstico , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST/diagnóstico por imagenRESUMEN
The aim of this study was to assess left ventricular diastolic function and forearm endothelial function in patients with erectile dysfunction (ED) without overt cardiovascular disease. Forearm endothelial function and diastolic Doppler parameters, including tissue Doppler imaging, were studied in 32 men with ED and 27 age-matched, healthy, male control subjects. Left ventricular diastolic function in patients with ED and the relation between endothelium-dependent vasodilation and the Doppler parameters of left ventricular diastolic function, including tissue Doppler imaging, were assessed. Endothelium-dependent vasodilation (4.1+/-3.3% vs 9.7+/-4.2%, p<0.001) as well as the mitral inflow E velocity (0.66+/-0.17 vs 0.80+/-0.16 m/s, p=0.01), the E/A ratio (the ratio of mitral inflow E velocity to mitral inflow A velocity; 0.91+/-0.3% vs 1.22+/-0.26%, p<0.001), and the E/Em ratio (the ratio of mitral A-wave velocity to early diastolic velocity in the annulus derived by tissue Doppler imaging; 7.4+/-2.7% vs 6.6+/-1.6%, p=0.03) were smaller in the ED group than in the control group. Deceleration time (228.6+/-61.6 vs 192.9+/-44.6 ms, p=0.03) and isovolumetric relaxation time (112.8+/-18 vs 94+/-15.9 ms, p<0.001) were also prolonged in the ED group compared with the control group. The mitral E-wave velocity (r=0.40, p=0.022), the E/A ratio (r=0.40, p=0.027), and the E/Em ratio (r=-0.52, p= 0.003) were related to endothelium-dependent vasodilation by nivariate analysis. Only the E/Em ratio was correlated with endothelium-dependent vasodilation by multivariate analysis. In conclusion, this study indicates that endothelial function and left ventricular diastolic function are impaired in patients with ED without overt cardiovascular disease.
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Diástole/fisiología , Endotelio Vascular/fisiopatología , Disfunción Eréctil/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología , Velocidad del Flujo Sanguíneo/fisiología , Arteria Braquial/diagnóstico por imagen , Arteria Braquial/fisiología , Estudios de Casos y Controles , Ecocardiografía Doppler , Endotelio Vascular/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Vasodilatación/fisiología , Disfunción Ventricular Izquierda/diagnóstico por imagenAsunto(s)
Aneurisma Cardíaco , Taquicardia Ventricular , Biomarcadores , Endotelina-1 , Humanos , InfartoRESUMEN
BACKGROUND: One of the major concerns remaining in the treatment with stenting of patients with acute myocardial infarction (AMI) is the occurrence of stent thrombosis (ST). The aim of the current study is to investigate the incidence, predictors, and long-term outcomes of early ST after primary coronary stenting for AMI in a large population. METHODS: We reviewed 1960 consecutive patients (mean age 56 +/- 11.6 years, 1658 males) treated with primary coronary stenting for AMI between 2003 and 2008. All clinical, angiographic, and follow-up data were retrospectively collected. Early ST was defined as thrombosis that occurred in the first 30 days after primary coronary stenting. RESULTS: Early ST was observed in 89 (4.5%) patients. Five variables, selected from the multivariate analysis, were weighted proportionally to their respective odds ratio (OR) for early ST (premature clopidogrel therapy discontinuation [10 points], stent diameter < or =3 mm [5 points], current smoker [4 points], diabetes mellitus [DM; 3 points], and age >65 years [2 points]). Three strata of risks were defined (low risk, score 0-4; intermediate risk, score 5-12; and high risk, score 13-24) and had a strong association with early ST and long-term cardiovascular mortality. Long-term cardiovascular mortality was 5-fold more in patients with early ST than that without ST (24.1% vs 4.7%, respectively, P < .001). CONCLUSIONS: Early ST after primary coronary stenting in AMI is strongly related with increased long-term cardiovascular mortality. Premature clopidogrel therapy discontinuation is the most powerful predictor of early ST.