RESUMO
The global emergence of -COVID-19 has prompted rapid therapeutic and vaccine advancements; however, clinical evidence remains limited. With around a 50% fatality rate for COVID-19 patients with acute respiratory distress syndrome (ARDS), early intervention is crucial. This report details a severe case of post-COVID-19 thrombocytopenia in a 79-year-old man and emphasizes its critical nature. Despite negative initial COVID-19 test results, subsequent positive results led to treatment initiation, and severe thrombocytopenia persisted resulting in bleeding complications and death. Recognized as a hematological manifestation of COVID-19, thrombocytopenia in this geriatric patient highlights the need for extended post-COVID-19 monitoring and management. This underscores the importance of vigilance and timely intervention, especially in vulnerable populations, and emphasizes the need for further research to understand the intricate relationship between COVID-19 and thrombocytopenia.
Assuntos
COVID-19 , Trombocitopenia , Humanos , COVID-19/complicações , COVID-19/terapia , Idoso , Masculino , Trombocitopenia/etiologia , SARS-CoV-2 , Evolução FatalRESUMO
BACKGROUND: The aim of this study was to determine the sensitivity and specificity of a novel immunochromatographic (IC) assay (APD1806) using monoclonal antibodies against the matrix (M) protein of human metapneumovirus (hMPV) for detection of hMPV from nasopharyngeal swab samples based on the results of real-time RT-PCR. METHODS: Nasopharyngeal swab samples taken from 189 patients aged 0 - 5 years who were suspected of having respiratory tract infections associated with hMPV were used in this study. The samples were tested both by the IC assay and by real-time RT-PCR for detection of hMPV. RESULTS: The sensitivity and specificity of the IC assay for detection of hMPV were 88.8% (95/107) and 92.7% (76/82), respectively. CONCLUSIONS: The IC assay using monoclonal antibodies against the M protein of hMPV is an accurate and fast assay that is suitable as a diagnostic tool for hMPV infection. The optimal timing of the IC assay is 12 hours or more after the onset of fever due to hMPV infection.
Assuntos
Metapneumovirus , Infecções por Paramyxoviridae , Infecções Respiratórias , Proteínas da Matriz Viral/imunologia , Anticorpos Monoclonais , Humanos , Imunoensaio , Lactente , Metapneumovirus/genética , Nasofaringe , Infecções por Paramyxoviridae/diagnóstico , Infecções Respiratórias/diagnósticoRESUMO
BACKGROUND: The aim of this study was to determine the sensitivity and specificity of a novel immunochromatographic assay (ICA) kit, ALSONIC® Adeno (Alfresa Pharma Co., Osaka, Japan), for the detection of human adenovirus (HAdV) from throat swab samples based on the results of real-time PCR. The incubation time required for the novel assay kit (5 minutes) is shorter than that required for other ICA kits that are available in Japan. METHODS: Throat swab samples were taken from 151 patients aged 6 months to 15 years who were suspected of having respiratory tract infections caused by HAdV. RESULTS: The sensitivity and specificity of the ICA for detection of HAdV were 92.2% (83/90) and 95.1% (58/61), respectively, and the assay showed positive and negative predictive values of 96.5% (83/86) and 89.2% (58/65), respectively. CONCLUSIONS: ALSONIC® Adeno is suitable as a diagnostic tool in the acute phase of HAdV infection.
Assuntos
Infecções por Adenovirus Humanos/diagnóstico , Adenovírus Humanos/genética , Imunoensaio/métodos , Infecções Respiratórias/diagnóstico , Infecções por Adenovirus Humanos/virologia , Adenovírus Humanos/fisiologia , Adolescente , Criança , Pré-Escolar , DNA Viral/genética , Dosagem de Genes , Humanos , Imunoensaio/instrumentação , Lactente , Faringe/virologia , Kit de Reagentes para Diagnóstico , Reprodutibilidade dos Testes , Infecções Respiratórias/virologia , Sensibilidade e EspecificidadeRESUMO
The clinical effectiveness of four neuraminidase inhibitors (NAIs) (oseltamivir, zanamivir, laninamivir, and peramivir) for children aged 0 months to 18 years with influenza A and B were investigated in the 2014-2015 to 2016-2017 influenza seasons in Japan. A total of 1207 patients (747 with influenza A and 460 with influenza B) were enrolled. The Cox proportional-hazards model using all of the patients showed that the duration of fever after administration of the first dose of the NAI was shorter in older patients (hazard ratio = 1.06 per 1 year of age, p < 0.001) and that the duration of fever after administration of the first dose of the NAI was shorter in patients with influenza A infection than in patients with influenza B infection (hazard ratio = 2.21, p < 0.001). A logistic regression model showed that the number of biphasic fever episodes was 2.99-times greater for influenza B-infected patients than for influenza A-infected patients (p < 0.001). The number of biphasic fever episodes in influenza A- or B-infected patients aged 0-4 years was 2.89-times greater than that in patients aged 10-18 years (p = 0.010), and the number of episodes in influenza A- or B-infected patients aged 5-9 years was 2.13-times greater than that in patients aged 10-18 years (p = 0.012).
Assuntos
Ciclopentanos/administração & dosagem , Inibidores Enzimáticos/administração & dosagem , Guanidinas/administração & dosagem , Influenza Humana/tratamento farmacológico , Neuraminidase/antagonistas & inibidores , Oseltamivir/administração & dosagem , Zanamivir/análogos & derivados , Zanamivir/administração & dosagem , Ácidos Carbocíclicos , Adolescente , Criança , Pré-Escolar , Ciclopentanos/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Feminino , Guanidinas/uso terapêutico , Humanos , Lactente , Recém-Nascido , Vírus da Influenza A/efeitos dos fármacos , Vírus da Influenza A/genética , Betainfluenzavirus/efeitos dos fármacos , Betainfluenzavirus/genética , Japão , Masculino , Oseltamivir/uso terapêutico , Piranos , Estações do Ano , Ácidos Siálicos , Resultado do Tratamento , Zanamivir/uso terapêuticoRESUMO
A 72-year-old female was diagnosed as a stress-induced cardiomyopathy from apical ballooning pattern of left ventricular dysfunction without coronary artery stenosis after the mental stress. ECG showed the transient T-wave inversions after the ST-segment elevations. By the mental stress after 1 year, she showed a transient dysfunction with similar ECG changes again. T-wave inversions recovered earlier, and cardiac sympathetic dysfunction showed a lighter response corresponding to the less severe dysfunction than those after the first onset. Wellens' ECG pattern was associated with the degree of neurogenic myocardial stunning with sympathetic hyperinnervation caused by mental stress.
Assuntos
Miocárdio Atordoado/fisiopatologia , Cardiomiopatia de Takotsubo/fisiopatologia , 3-Iodobenzilguanidina , Idoso , Terremotos , Eletrocardiografia/métodos , Eletrofisiologia/métodos , Feminino , Humanos , Radioisótopos do Iodo , Acontecimentos que Mudam a Vida , Miocárdio Atordoado/complicações , Miocárdio Atordoado/diagnóstico por imagem , Cintilografia , Compostos Radiofarmacêuticos , Recidiva , Estresse Psicológico/complicações , Estresse Psicológico/fisiopatologia , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico por imagemRESUMO
BACKGROUND: Nocturnal and early morning hypertension are both significant risk factors for cardiovascular events. It remains unclear whether anxiety disorder affects nocturnal blood pressure (BP), early morning BP, or BP pattern in hypertensive patients. METHODS AND RESULTS: One hundred and twenty consecutive hypertensive outpatients (77 men and 43 women; mean age, 66±11 years) were divided into 2 groups based on Hospital Anxiety and Depression Scale (HADS) score: a control group (n=78; HADS ≤10) and an anxiety group (42 patients; HADS ≥11). Nocturnal BP, early morning BP, morning BP surge (defined as BP rise ≥50 mmHg), and BP pattern (extreme-dipper/dipper/non-dipper/riser) were measured on ambulatory BP monitoring. Clinical characteristics and BP were also evaluated at physician check-up. There was no significant difference between the 2 groups for BP check-up, but nocturnal and early morning BP were significantly higher in the anxiety group (142±16 mmHg and 152±21 mmHg) than in the control group (126±14 mmHg and 141±18 mmHg). With regard to patients with morning BP surge, nocturnal and early morning BP were also significantly higher in the anxiety group. The relative risk of existing anxiety disorders in riser-type hypertension was 4.48-fold higher (95% confidence interval: 1.58-12.74; P<0.005) than in dipper-type hypertension. CONCLUSIONS: Anxiety disorder is associated with nocturnal and early morning hypertension, and may be a risk factor for cardiovascular events.
Assuntos
Transtornos de Ansiedade/epidemiologia , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Ritmo Circadiano , Hipertensão/diagnóstico , Idoso , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Escalas de Graduação Psiquiátrica , Medição de Risco , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia , Fatores de TempoRESUMO
PURPOSE: Neuronal system activity plays an important role for the prognosis of patients with atrial fibrillation (AF). Using (123)I metaiodobenzylguanidine ((123)I-MIBG) scintigraphy, we investigated whether a cardiac sympathetic nervous system (SNS) abnormality would be associated with an increased risk of vascular events in patients with paroxysmal AF. METHODS: (123)I-MIBG scintigraphy was performed in 69 consecutive patients (67 + or - 13 years, 62% men) with paroxysmal AF who did not have structural heart disease. SNS integrity was assessed from the heart to mediastinum (H/M) ratio on delayed imaging. Serum concentration of C-reactive protein (CRP) was measured before (123)I-MIBG study. RESULTS: During a mean of 4.5 + or - 3.6 years follow-up, 19 patients had myocardial infarction, stroke or heart failure (range: 0.2-11.5 years). SNS abnormality (H/M ratio <2.7) and high CRP (> or = 0.3 mg/dl) were associated with the vascular events (58.3% in 14 of 24 patients with SNS abnormality vs 11.1% in 5 of 45 patients without SNS abnormality, p < 0.0001, 52.4% in 11 of 21 patients with high CRP vs 16.7% in 8 of 48 patients without high CRP, p < 0.0001). After adjustment for potential confounding variables such as age, left atrial dimension and left ventricular function, SNS abnormality was an independent predictor of vascular events with a hazard ratio of 4.1 [95% confidence interval (CI): 1.3-12.6, p = 0.014]. Further, SNS abnormality had an incremental and additive prognostic power in combination with high CRP with an adjusted hazard ratio of 4.1 (95% CI: 1.5-10.9, p = 0.006). CONCLUSION: SNS abnormality is predictive of vascular events in patients with idiopathic paroxysmal AF.
Assuntos
3-Iodobenzilguanidina , Fibrilação Atrial/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Radioisótopos do Iodo , Infarto do Miocárdio/epidemiologia , Compostos Radiofarmacêuticos , Acidente Vascular Cerebral/epidemiologia , Sistema Nervoso Simpático/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/sangue , Fibrilação Atrial/etiologia , Proteína C-Reativa/análise , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Prognóstico , Estudos Prospectivos , Risco , Acidente Vascular Cerebral/etiologiaRESUMO
BACKGROUND: Erythropoietin (EPO) has been found to have anti-apoptotic and tissue protective effects on the myocardium. The aim of the present pilot study was to observe the safety and efficacy of EPO administration for patients with acute myocardial infarction (AMI). METHODS AND RESULTS: Patients admitted with AMI had all undergone successful percutaneous coronary intervention (PCI). Patients were randomly assigned to 2 groups (control and EPO groups), and given 12,000 IU EPO iv or saline after PCI. The primary endpoints were the difference between the acute phase and chronic phase (6 months after the attack) regarding left ventricular function as measured on electrocardiogram-gated single-photon emission computed tomography. Thirty-six patients (control 16, EPO 20) were eligible for analysis. Left ventricular ejection fraction (LVEF) significantly increased in the EPO group (from 51.0+/-19.6% to 58.5+/-15.0%, P=0.0238), but not in the control group. Further analysis was separately undertaken in patients with occlusion in the left anterior descending artery (LAD) and others (non-LAD). LVEF was <50% in most patients in the LAD subgroup, and LVEF significantly increased in the EPO group (37.5+/-13.0 to 52.7+/-15.8, P=0.0049), but not in the control group. EPO administration did not trigger any adverse clinical events. CONCLUSIONS: EPO administration is a promising treatment for AMI.
Assuntos
Eritropoetina/administração & dosagem , Infarto do Miocárdio/tratamento farmacológico , Idoso , Angioplastia Coronária com Balão , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Eritropoetina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Projetos Piloto , Proteínas Recombinantes , Volume Sistólico/efeitos dos fármacos , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Disfunção Ventricular Esquerda , Função Ventricular EsquerdaRESUMO
UNLABELLED: Severe left ventricular dysfunction or cardiac sympathetic nervous system (SNS) abnormality predicts cardiac death in various heart diseases, including arrhythmogenic disorders. However, it is not clear whether SNS abnormality predicts sudden cardiac death during long-term follow-up in patients with a history of ventricular tachyarrhythmia. We hypothesized that SNS abnormality would be associated with recurrent ventricular arrhythmic events. METHODS: 123I-metaiodobenzylguanidine (MIBG) scintigraphy was performed on 86 patients (mean age+/-SD, 46+/-19 y, 65.1% men) with a history of ventricular tachycardia or fibrillation. 123I-MIBG (111 MBq) was intravenously administered under resting conditions, and planar images were obtained 15 min and 4 h later (anterior view for 6 min; 512x512 matrices; zoom ratio, 1.0). SNS activity was assessed using the heart-to-mediastinum ratio on delayed imaging. RESULTS: During about 11 y of follow-up (mean+/-SD, 5.2+/-3.7 y), 3 patients (3.5%) had sudden cardiac death and 21 patients (24.4%) had sustained ventricular tachyarrhythmic events. SNS abnormality, defined as a heart-to-mediastinum ratio of less than 2.8, and left ventricular dysfunction, defined as a left ventricular ejection fraction of less than 50%, were associated with sudden cardiac death or recurrent ventricular tachyarrhythmic events (18/40 patients [45%] with SNS abnormality, vs. 6/46 patients [13%] without, P=0.004; 9/15 patients [60%] with left ventricular dysfunction, vs. 15/71 patients [21.1%] without, P=0.008). After adjustment for potential confounding variables such as age, sex, coronary risk factors, medication use, history of structural heart disease, and left ventricular function, SNS abnormality was a powerful predictor of recurrent arrhythmic events, with a hazard ratio of 3.6 [95% confidence interval, 1.4-9.2, P=0.007]). Further, SNS abnormality had incremental and additive prognostic power in combination with left ventricular dysfunction, with an adjusted hazard ratio of 4.4 [95% confidence interval, 1.9-9.9, P<0.0001]). CONCLUSION: SNS abnormality predicted recurrent ventricular tachyarrhythmic events during long-term follow-up. 123I-MIBG scintigraphic evaluations for SNS abnormality may be an option for screening patients at high risk for sudden cardiac death.
Assuntos
Doenças do Sistema Nervoso Autônomo/complicações , Coração/inervação , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Análise de Variância , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Taxa de Sobrevida , Taquicardia Ventricular/prevenção & controle , Fatores de TempoRESUMO
PURPOSE: Microcirculatory failure after reperfusion is clinically indicated to cause reperfusion injury whereas excessive intracellular calcium ion overload is experimentally proved as a key mechanism of reperfusion injury. We hypothesized that technetium-99m ((99m)Tc) pyrophosphate (Tc-PYP) uptake in injured but viable infarct-related myocardium with preserved myocardial perfusion after reperfusion estimated by thallium-201 ((201)Tl) uptake would be associated with final functional recovery. METHODS: Dual-isotope Tc-PYP/(201)Tl single-photon emission computed tomography (SPECT) was performed 2 days after successful reperfusion therapy in patients with first acute myocardial infarction, and 50 patients (63 +/- 13 years old, female 22%) with preserved (201)Tl uptakes of > or = 50% in reperfused myocardium was followed for 1 month. Tc-PYP uptake was assessed as the heart-to-sternum (H/S) ratio. Two-dimensional echocardiography was also performed 2 days and 1 month after reperfusion to evaluate functional recovery. RESULTS: High Tc-PYP uptake, defined as the H/S ratio > or = 0.81, was predictive of chronic phase no functional recovery (73.7% in 14 of 19 patients with high uptake vs 16.1% in five of 31 patients without those, p < 0.0001). After adjustment for potential confounding variables, including electrocardiographic persistent ST segment elevation at 1 h after reperfusion, high Tc-PYP uptake remained independently predictive of no functional recovery with odds ratio of 8.7 (95% confidential interval = 2 to 38.7; p = 0.005). CONCLUSION: High Tc-PYP uptake in reperfused but viable infarct-related myocardium was a powerful predictor of no functional recovery, which may reflect excessive intracellular calcium ion overload caused by reperfusion injury. Tc-PYP/(201)Tl dual-isotope SPECT imaging can provide prognostic information after reperfusion.
Assuntos
Infarto do Miocárdio/cirurgia , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Pirofosfato de Tecnécio Tc 99m , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Humanos , Infarto do Miocárdio/fisiopatologia , Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Recuperação de Função Fisiológica , Pirofosfato de Tecnécio Tc 99m/metabolismo , Radioisótopos de Tálio/metabolismoRESUMO
BACKGROUND: Delayed heart rate (HR) recovery after treadmill exercise testing predicts mortality. Patients with suspected ischemic heart disease who cannot perform adequate treadmill exercise are typically evaluated with pharmacological stress myocardial perfusion imaging (MPI) studies, but little prognostic significance has been attributed to the hemodynamic response to vasodilator stress testing with low-level exercise. We hypothesized that a delay in HR recovery after adenosine stress testing with arm exercise is associated with increased mortality. METHODS AND RESULTS: Technetium 99m-Sestamibi MPI was performed in 1,455 consecutive patients (70 +/- 12 years, 50.2% men) with adenosine stress and supplemental arm exercise. HRs were recorded at rest, continuously during infusion, and then 5 minutes post-infusion. Delayed HR recovery was defined as a decline of < or = 12 bpm from peak HR at 5 minutes after discontinuation of the infusion. Of 1,356 patients during 5 years of follow up, there were 135 deaths (10%). Delayed HR recovery was strongly predictive of all-cause mortality (16.5% vs 5.3% in those with normal HR recovery, P < .001) with an adjusted hazard ratio of 2.5 (95% CI, 1.7-3.6; P < .001). CONCLUSION: Delayed HR recovery after adenosine stress testing with arm exercise is a readily available and powerful predictor of all-cause mortality.
Assuntos
Adenosina , Teste de Esforço/estatística & dados numéricos , Frequência Cardíaca/efeitos dos fármacos , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/mortalidade , Tecnécio Tc 99m Sestamibi , Idoso , Braço , Feminino , Humanos , Masculino , Cintilografia , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Análise de Sobrevida , Taxa de Sobrevida , Estados Unidos/epidemiologia , VasodilatadoresRESUMO
In a 66-year-old male with subacute extensive anterior wall myocardial infarction, we report a change in ST vector orientation from a basal anterior to a mid anterior after coronary artery recanalization of the proximal left anterior descending coronary artery with rotational atherectomy. The ST vector shift on the frontal plane after recanalization was consistent with a change toward more distal location of the ischemia on thallium-201 single photon emission computed tomography images compared to the findings during an exercise test before intervention. These findings may be correlated with local occlusion caused by distal microvascular embolization which was not visualized on coronary angiography following recanalization.
Assuntos
Eletrocardiografia/métodos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Reperfusão Miocárdica/métodos , Idoso , Humanos , Masculino , Resultado do TratamentoRESUMO
BACKGROUND Intracardiac thrombosis has been known to be associated with not only hepatocellular carcinoma but also with amyloidosis and use of a cardiac implantable electronic device. We report a case of a continuous tumor thrombus with hepatocellular carcinoma from the portal vein and hepatic vein to the right atrium via the inferior vena cava in a patient with a cardiac amyloidosis and an implanted cardiac resynchronization therapy (CRT) device. CASE REPORT A 68-year-old female first admitted to our hospital because of heart failure with an AL type primary cardiac amyloidosis. After 3 years, she underwent an implantation of a CRT device for biventricular pacing following repeated episodes of heart failure and low left ventricular ejection fraction of 34% with NYHA class III. Again, she presented with symptoms of heart failure and cardiomegaly on chest x-ray at 7 years after the CRT device implantation. The echocardiography showed a huge echogenic mass occupying the right atrium, and 64 multi-detector computed tomography showed a lobulated heterogeneously enhancing mass of hepatocellular carcinoma in the right upper lobe of her liver and a continuous tumor thrombus from the portal vein and hepatic vein to the right atrium via the inferior vena cava. CONCLUSIONS Intracardiac thrombosis and heart failure occurred in a patient with hepatocellular carcinoma and cardiac amyloidosis, who had an implanted CRT device, which resulted not only in hypercoagulability by the hepatocellular carcinoma itself and the accumulation of various risk factors, but also the progression of myocardial damage with the development of amyloidosis.
Assuntos
Amiloidose/complicações , Carcinoma Hepatocelular/complicações , Cardiopatias/complicações , Insuficiência Cardíaca/complicações , Neoplasias Hepáticas/complicações , Trombose/complicações , Idoso , Amiloidose/cirurgia , Dispositivos de Terapia de Ressincronização Cardíaca , Ecocardiografia , Feminino , Cardiopatias/cirurgia , Insuficiência Cardíaca/cirurgia , Humanos , Fatores de Risco , Trombofilia , Trombose/cirurgia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Patients with structural heart disease, severe left ventricular dysfunction, or history of cardiac arrest are at increased risk of sudden cardiac death. However, a useful marker for predicting sudden cardiac death is not clarified in low-risk patients without those conventional risks. We hypothesized that cardiac sympathetic nerve system (SNS) abnormality would be associated with ventricular tachyarrhythmic events in low-risk patients with ventricular tachycardia (VT). METHODS: Iodine-123 metaiodobenzylguanidine ((123)I-MIBG) scintigraphy was performed in 50 patients (mean+/-standard deviation, age 54 +/- 16 years, 52% males) with VT who did not have structural heart disease, severe left ventricular dysfunction, or history of cardiac arrest, and SNS activity was assessed from heart/mediastinal (H/M) ratio on delayed images. RESULTS: Over 11 years of follow-up, three patients had sudden deaths (6%) and nine patients had sustained ventricular tachyarrhythmic events (18%). SNS abnormality, defined as H/M ratio <2.8, was predictive of sudden death or ventricular tachyarrhythmic events (45% in nine of 20 patients with SNS abnormality vs 16.7% in three of 30 patients without SNS abnormality, p = 0.005). After adjustment for potential confounding variables including slight left ventricular dysfunction, SNS abnormality remained independently predictive of ventricular tachyarrhythmic events with a hazard ratio of 5.3 (95% confidence interval = 1.4 to 20.8, p = 0.016). CONCLUSION: SNS abnormality is a readily available and powerful predictor of recurrent ventricular tachyarrhythmic events in patients with VT who did not have conventional risk of sudden cardiac death. (123)I-MIBG scintigraphy can provide prognostic information of VT patients without conventional risk.
Assuntos
Coração/inervação , Sistema Nervoso Simpático/anormalidades , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , 3-Iodobenzilguanidina , Adulto , Morte Súbita Cardíaca , Feminino , Humanos , Masculino , Prognóstico , Cintilografia , Risco , Sistema Nervoso Simpático/fisiopatologia , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico por imagem , Fatores de TempoAssuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Idoso , Angiografia , Humanos , Masculino , Veias Pulmonares/cirurgia , Fluxo Sanguíneo Regional/fisiologia , Stents , Tomografia Computadorizada Espiral , Resultado do TratamentoRESUMO
BACKGROUND: Rotational atherectomy (rotablation) has been proposed as a potentially superior strategy for percutaneous coronary intervention (PCI) in complex and severely calcified lesions. OBJECTIVES: We hypothesized that a per-lesion coronary artery calcium score determined by multidetector computed tomography (MDCT) would be useful for predicting the requriement for rotablation during PCI. METHODS: MDCT was performed in patients with stable angina pectoris who were scheduled for first PCI. In 116 consecutive subjects (168 target lesions) with successful PCI, MDCT and quantitative coronary angiography (QCA) data were retrospectively evaluated regarding their ability to predict rotablation. RESULTS: PCI without rotablation was performed in 105 patients (154 lesions), and rotablation was added in 11 patients (14 lesions). Patients with rotablation had significantly higher SYNTAX scores (p = 0.007) and total calcium scores (p < 0.001) than those without rotablation. Per-lesion, a lesion length ≥20 mm and diameter stenosis ≥74% on QCA as well as a per-lesion calcium score ≥453 and calcification arc ≥270 in MDCT predicted rotablation. After adjustment for potential confounding variables, a high per-lesion calcium score was an independent predictor of rotablation (odds ratio 31.3, 95% confidence interval 2.8-345, p = 0.005, sensitivity 93% and specificity 88%). CONCLUSION: The extent of target lesion calcification in MDCT, a simple marker of calcified plaque, is useful for predicting the need for rotablation during PCI.
Assuntos
Angina Estável/diagnóstico por imagem , Angina Estável/terapia , Aterectomia Coronária , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Intervenção Coronária Percutânea , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Seleção de Pacientes , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Our data shows the regional coronary artery calcium scores (lesion CAC) on multidetector computed tomography (MDCT) and the cross-section imaging on MDCT angiography (CTA) in the target lesion of the patients with stable angina pectoris who were scheduled for percutaneous coronary intervention (PCI). CAC and CTA data were measured using a 128-slice scanner (Somatom Definition AS+; Siemens Medical Solutions, Forchheim, Germany) before PCI. CAC was measured in a non-contrast-enhanced scan and was quantified using the Calcium Score module of SYNAPSE VINCENT software (Fujifilm Co. Tokyo, Japan) and expressed in Agatston units. CTA were then continued with a contrast-enhanced ECG gating to measure the severity of the calcified plaque condition. We present that both CAC and CTA data are used as a benchmark to consider the addition of rotational atherectomy during PCI to severely calcified plaque lesions.
RESUMO
BACKGROUND: The aim of this study was to evaluate the relationship between exercise-induced QT dispersion and condition of infarct-related myocardium including myocardial scar after angioplasty assessed with exercise perfusion single photon emission computed tomography (SPECT). METHODS: Exercise thallium-201 SPECT was performed 6 months after successful direct angioplasty in 67 male patients (60.6 +/- 11.5 years), who had Q wave infarction resulting from single vessel disease, and the number of perfusion defect areas (DS) was measured at rest and exercise together with QT (QTc) dispersion. RESULTS: In 52 patients with resting perfusion defects, the exercise-induced change in DS was correlated to the change in QT (or QTc) dispersion (r = -0.51 or r = -0.531, p < 0.0001). When the patients were grouped according to the patterns of transient perfusion defect, there were significant differences in DeltaQT dispersion and DeltaQTc dispersion among infarct-related three groups (reverse, fixed, and partial redistributions) and normal volunteers (DeltaQT dispersion; -5.7 +/- 12.7 ms in 13 patients with reverse redistribution, -16.3 +/- 13.1 ms in 30 patients with fixed redistribution, -28.9 +/- 29.5 ms in 9 patients with partial redistribution, and +3.4 +/- 20.9 ms in 12 normal volunteers, p = 0.0098; DeltaQTc dispersion; +18.2 +/- 20.8 ms, +1.4 +/- 16.7 ms, -15.4 +/- 30 ms, and +19 +/- 27.5 ms, p = 0.0017, respectively). DeltaQTc dispersion estimated the SPECT image patterns (p = 0.0002) with a sensitivity of 67.3%, a specificity of 83.7% and an accuracy of 78.2%. CONCLUSIONS: The change with exercise in QT dispersion may help detect the condition of infarct-related myocardium after angioplasty.
Assuntos
Angioplastia , Eletrocardiografia , Teste de Esforço , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Reperfusão Miocárdica , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Cardiovascular disease is the leading cause of death in dialysis patients and is significantly associated with poor survival in incident dialysis patients. However, little is known about the pathogenesis of cardiovascular disease in these populations. (123) I-15-(p-iodophenyl)-3(R,S)- methylpentadecanoic acid (BMIPP) imaging is useful for detection of ischemic heart disease. We examined imaging characteristics to identify potential pathologies of cardiac disease, other than ischemic heart disease. The subjects were 42 incident dialysis patients without histories of ischemic heart disease such as acute coronary syndrome. All the patients underwent BMIPP imaging in addition to a screening examination. Patients with positive findings in BMIPP imaging underwent myocardial perfusion imaging within 2 weeks after BMIPP imaging to evaluate the possibility of ischemic heart disease. Twenty-two patients were BMIPP-positive and 10 of these patients had negative findings on perfusion imaging and were defined as mismatch cases. Compared with patients who were BMIPP- and perfusion-positive, the mismatch cases had higher parathyroid hormone (PTH), serum albumin, and alkaline phosphatase levels. The mismatch cases also formed the largest proportion in the highest PTH tertile. A histologic examination of a mismatch case with no stenotic lesions in the coronary artery revealed the presence of cardiac hypertrophy and fibrosis. These findings suggest that a perfusion-metabolism mismatch may be present in incident dialysis patients without a history of ischemic heart disease. This mismatch is associated with PTH, which suggests potential involvement of uremic cardiomyopathy in the pathology of cardiac disease in these patients.
Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Diálise Renal , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Ácidos Graxos , Feminino , Humanos , Iodobenzenos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Albumina Sérica/análiseRESUMO
BACKGROUND: The significance of differences in electrocardiographic morphology that occur during the recovery phase after exercise has not been clarified. We investigated the relationship between postexercise electrocardiographic morphology and the pattern of residual ischemia measured at that time. METHODS: Exercise dual-isotope single photon emission computed tomography was performed on 171 consecutive patients with chest pain syndrome. After injection of technetium-99m tetrofosmin at peak exercise and thallium-201 at 3 minutes after exercise, dual-isotope single photon emission computed tomographic images were obtained simultaneously. After cross-talk compensation, the extent of ischemia and its localization were measured at both peak exercise and after exercise. RESULTS: When 64 patients with angiographically and scintigraphically proven ischemic heart disease were grouped by morphology of ST-segment depressions at 3 minutes after exercise, 38 patients with the downsloping type had ischemia localized mainly to the middle and basal levels as compared with the more rapid resolution of ischemia in 12 patients with horizontal type and 14 patients with no ischemic electrocardiographic response (apical level 18.4% [7/38], 8.3% [1/12], and 0% [0/14], P = not significant, middle level 47.4% [18/38], 16.7% [2/12], and 7.1% [1/14], P <.01, basal level 57.9% [22/38], 33.3% [4/12], and 14.3% [2/14], P <.02, respectively) independent of the extent or localization of any ischemia noted during exercise (all levels, P = not significant). CONCLUSION: Electrocardiographic morphology during the recovery phase of exercise reflects the extent and localization of residual ischemia at that time independent of ischemic changes noted during exercise.