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2.
J Vasc Surg ; 74(1): 135-152.e4, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33592290

RESUMO

OBJECTIVE: Peripheral artery disease (PAD) is a highly prevalent disease that places major lifestyle limitations and mortality risk on affected individuals. As the understanding of the disease has grown in the medical community, it is unknown which literature has made the greatest impact on the knowledge of PAD. We performed a bibliometric analysis using the number of citations as an indication of impact to analyze the top 100 most influential articles on PAD management. METHODS: A retrospective search of the Web of Science (Thomson Reuters, New York, NY) database for English-only publications was conducted in November 2020. We identified initial references from the database using the search terms "Peripheral Arterial Disease," "Peripheral Vascular Disease," "Claudication," "Critical Limb Ischemia," "Chronic Limb Threatening Ischemia," "Rest Pain," "Ischemic Ulcer," "Toe Gangrene," "Ankle Brachial Index," and "Leg Ischemia" in Web of Science Core Collections. Articles were ranked based on the number of citations and then analyzed based on citation count and average number of citations per year. Additional metrics included the overall average number of publications per year, the journals, journal discipline, author (including degree and gender), institution, country, topic area, and the level of evidence. RESULTS: The most popular articles were published between 1959 and 2017, with 46,716 citations in total (average 27.26 citations/y). The most popular article had 2225 citations in total and was Rutherford's "Recommended standards for reports dealing with lower extremity ischemia: Revised version." Peak years of citations were 2016, 2014, and 2018 (2753, 2674, and 2639 citations, respectively). Top journals for the most cited publications were Circulation, Journal of Vascular Surgery, and the Lancet with 21, 13, and 7 articles, respectively. A majority of articles originated from the United States (58 articles), followed by the United Kingdom (15 articles) and Germany (13 articles). Major topic areas of interest and trends in the progressive understanding of PAD were noted. Top areas of focus included surgical interventions (29%), therapeutic angiogenesis (15%), epidemiological studies in PAD (14%), and diagnosis and evaluation (13%). In the top cited literature, 48% (14/29) of surgical articles investigated endovascular interventions for PAD. CONCLUSIONS: Overall, PAD research has evolved from basic epidemiological studies to advanced management with continued investigation toward future, improved treatments for PAD.


Assuntos
Pesquisa Biomédica/tendências , Técnicas de Diagnóstico Cardiovascular/tendências , Publicações Periódicas como Assunto/tendências , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/terapia , Procedimentos Cirúrgicos Vasculares/tendências , Bibliometria , Procedimentos Endovasculares/tendências , Humanos , Doença Arterial Periférica/epidemiologia , Estudos Retrospectivos , Fatores de Tempo
5.
Heart ; 106(23): 1798-1804, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32895314

RESUMO

Heart failure with preserved ejection fraction (HFpEF) affects half of all patients with heart failure. While previously neglected, the right ventricle (RV) has sparked interest in recent years as a means for better understanding this condition and as a potential therapeutic target.Right ventricular dysfunction (RVD) is present in 4%-50% of patients with HFpEF. The RV is intimately connected to the pulmonary circulation, and pulmonary hypertension is commonly implicated in the pathophysiology of RVD. The development of RVD in HFpEF may also be driven by comorbidities, such as chronic obstructive pulmonary disease, obesity, obstructive sleep apnoea and atrial fibrillation. The evaluation of RVD is particularly challenging due to anatomical and structural factors, as well as unique physiological characteristics of this chamber like load and interventricular dependency. Fractional area change, tricuspid annular plane systolic excursion and tricuspid annular systolic velocity are commonly used measurements of RV function. Speckle tracking echocardiography and cardiac magnetic resonance (CMR) are also gaining attention as important tools for the assessment of RV structure, fibre deformation and systolic performance. Further research is needed to confirm the utility and prognostic significance of RV [18F]fluorodeoxyglucose (FDG) positron emission tomography imaging as FDG accumulation is suggested to increase with progressive RVD. Targeted pharmacotherapy with phosphodiesterase inhibitors, guanylate-cyclase stimulators, nitrates and inhaled inorganic nitrites have yet to demonstrate improvement in RVD, compelling the need for evaluation and discovery of novel pharmacological interventions for this entity.


Assuntos
Técnicas de Diagnóstico Cardiovascular , Insuficiência Cardíaca , Ventrículos do Coração , Conduta do Tratamento Medicamentoso , Disfunção Ventricular Direita , Técnicas de Diagnóstico Cardiovascular/classificação , Técnicas de Diagnóstico Cardiovascular/tendências , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Humanos , Volume Sistólico , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/tratamento farmacológico , Disfunção Ventricular Direita/fisiopatologia
6.
J Med Vasc ; 45(3): 114-124, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32402425

RESUMO

BACKGROUND: The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS: We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS: Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION: A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.


Assuntos
Amputação Cirúrgica/tendências , Amputados , Técnicas de Diagnóstico Cardiovascular/tendências , Hospitais Universitários , Extremidade Inferior/cirurgia , Doenças Vasculares/diagnóstico , Doenças Vasculares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Doenças Vasculares/epidemiologia
7.
Presse Med ; 48(12): 1439-1444, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31471092

RESUMO

Malignant hypertension has not disappeared, it has been forgotten. Its incidence is increasing again. It considerably worsens the prognosis of young patients (35 to 55 years old on average). There might be susceptibility factors, several hypotheses are under study. New diagnostic criteria and therapeutic options have been proposed and will have to be validated. Faced with these important challenges for patients, the first prospective multicentric register on this pathology will be set up in France in September 2019.


Assuntos
Hipertensão Maligna , Técnicas de Diagnóstico Cardiovascular/tendências , Suscetibilidade a Doenças/epidemiologia , França/epidemiologia , Humanos , Hipertensão Maligna/diagnóstico , Hipertensão Maligna/epidemiologia , Hipertensão Maligna/terapia , Incidência , Prognóstico , Sistema de Registros
8.
PLoS Med ; 16(5): e1002805, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31112552

RESUMO

BACKGROUND: Effective management of heart failure is complex, and ensuring evidence-based practice presents a major challenge to health services worldwide. Over the past decade, the United Kingdom introduced a series of national initiatives to improve evidence-based heart failure management, including a landmark pay-for-performance scheme in primary care and a national audit in secondary care started in 2004 and 2007, respectively. Quality improvement efforts have been evaluated within individual clinical settings, but patterns of care across its continuum, although a critical component of chronic disease management, have not been studied. We have designed this study to investigate patients' trajectories of care around the time of diagnosis and their variation over time by age, sex, and socioeconomic status. METHODS AND FINDINGS: For this retrospective population-based study, we used linked primary and secondary health records from a representative sample of the UK population provided by the Clinical Practice Research Datalink (CPRD). We identified 93,074 individuals newly diagnosed with heart failure between 2002 and 2014, with a mean age of 76.7 years and of which 49% were women. We examined five indicators of care: (i) diagnosis care setting (inpatient or outpatient), (ii) posthospitalisation follow-up in primary care, (iii) diagnostic investigations, (iv) prescription of essential drugs, and (v) drug treatment dose. We used Poisson and linear regression models to calculate category-specific risk ratios (RRs) or adjusted differences and 95% confidence intervals (CIs), adjusting for year of diagnosis, age, sex, region, and socioeconomic status. From 2002 to 2014, indicators of care presented diverging trends. Outpatient diagnoses and follow-up after hospital discharge in primary care declined substantially (ranging from 56% in 2002 to 36% in 2014, RR 0.64 [0.62, 0.67] and 20% to 14%, RR 0.73 [0.65, 0.82], respectively). Primary care referral for diagnostic investigations and appropriate initiation of beta blockers and angiotensin-converting-enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) both increased significantly (37% versus 82%, RR 2.24 [2.15, 2.34] and 18% versus 63%, RR 3.48 [2.72, 4.43], respectively). Yet, the average daily dose prescribed remained below guideline recommendations (42% for ACE-Is or ARBs, 29% for beta blockers in 2014) and was largely unchanged beyond the first 30 days after diagnosis. Despite increasing rates of treatment initiation, the overall dose prescribed to patients in the 12 months following diagnosis improved little over the period of study (adjusted difference for the combined dose of beta blocker and ACE-I or ARB: +6% [+2%, +10%]). Women and patients aged over 75 years presented significant gaps across all five indicators of care. Our study was limited by the available clinical information, which did not include exact left ventricular ejection fraction values, investigations performed during hospital admissions, or information about follow-up in community heart failure clinics. CONCLUSIONS: Management of heart failure patients in the UK presents important shortcomings that affect screening, continuity of care, and medication titration and disproportionally impact women and older people. National reporting and incentive schemes confined to individual clinical settings have been insufficient to identify these gaps and address patients' long-term care needs.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Técnicas de Diagnóstico Cardiovascular/tendências , Disparidades em Assistência à Saúde/tendências , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Padrões de Prática Médica/tendências , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos , Feminino , Pesquisas sobre Atenção à Saúde , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Lacunas da Prática Profissional/tendências , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Classe Social , Fatores de Tempo , Resultado do Tratamento , Reino Unido/epidemiologia
9.
Heart ; 105(4): 276-282, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30467194

RESUMO

Pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) can be reversed by early shunt closure, but this potential is lost beyond a certain point of no return. Therefore, it is crucial to accurately assess the reversibility of this progressive pulmonary arteriopathy in an early stage. Reversibility assessment is currently based on a combination of clinical symptoms and haemodynamic variables such as pulmonary vascular resistance. These measures, however, are of limited predictive value and leave many patients in the grey zone. This review provides a concise overview of the mechanisms involved in flow-dependent progression of PAH in CHD and evaluates existing and future alternatives to more directly investigate the stage of the pulmonary arteriopathy. Structural quantification of the pulmonary arterial tree using fractal branching algorithms, functional imaging with intravascular ultrasound, nuclear imaging, putative new blood biomarkers, genetic testing and the potential for transcriptomic analysis of circulating endothelial cells and educated platelets are being reviewed.


Assuntos
Técnicas de Imagem Cardíaca , Técnicas de Diagnóstico Cardiovascular , Cardiopatias Congênitas , Hipertensão Arterial Pulmonar , Técnicas de Imagem Cardíaca/métodos , Técnicas de Imagem Cardíaca/tendências , Técnicas de Diagnóstico Cardiovascular/classificação , Técnicas de Diagnóstico Cardiovascular/tendências , Progressão da Doença , Diagnóstico Precoce , Testes Genéticos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Hipertensão Arterial Pulmonar/diagnóstico , Hipertensão Arterial Pulmonar/etiologia , Hipertensão Arterial Pulmonar/fisiopatologia
11.
J Clin Monit Comput ; 32(2): 189-196, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29484529

RESUMO

Hemodynamic monitoring provides the basis for the optimization of cardiovascular dynamics in intensive care medicine and anesthesiology. The Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform to publish research related to hemodynamic monitoring technologies, cardiovascular (patho)physiology, and hemodynamic treatment strategies. In this review, we discuss selected papers published on cardiovascular and hemodynamic monitoring in the JCMC in 2017.


Assuntos
Técnicas de Diagnóstico Cardiovascular/instrumentação , Técnicas de Diagnóstico Cardiovascular/tendências , Ecocardiografia/tendências , Técnicas de Diluição do Indicador/tendências , Monitorização Fisiológica/tendências , Publicações Periódicas como Assunto/tendências , Animais , Determinação da Pressão Arterial , Sistema Cardiovascular , Ecocardiografia/instrumentação , Hemodinâmica , Humanos , Técnicas de Diluição do Indicador/instrumentação , Monitorização Fisiológica/instrumentação , Volume Sistólico
14.
Nat Rev Cardiol ; 14(4): 209-223, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28127033

RESUMO

Although echocardiography remains the mainstay imaging technique for the evaluation of patients with valvular heart disease (VHD), innovations in noninvasive imaging in the past few years have provided new insights into the pathophysiology and quantification of VHD, early detection of left ventricular (LV) dysfunction, and advanced prognostic assessment. The severity grading of valve dysfunction has been refined with the use of Doppler echocardiography, cardiac magnetic resonance (CMR), and CT imaging. LV ejection fraction remains an important criterion when deciding whether patients should be referred for surgery. However, echocardiographic strain imaging can now detect impaired LV systolic function before LV ejection fraction reduces, thus provoking the debate on whether patients with severe VHD should be referred for surgery at an earlier stage (before symptom onset). Impaired LV strain correlates with the amount of myocardial fibrosis detected with CMR techniques. Furthermore, accumulating data show that the extent of fibrosis associated with severe VHD has important prognostic implications. The present Review focuses on using these novel imaging modalities to assess pathophysiology, early LV dysfunction, and prognosis of major VHDs, including aortic stenosis, mitral regurgitation, and aortic regurgitation.


Assuntos
Técnicas de Diagnóstico Cardiovascular , Doenças das Valvas Cardíacas , Valvas Cardíacas/diagnóstico por imagem , Técnicas de Diagnóstico Cardiovascular/classificação , Técnicas de Diagnóstico Cardiovascular/tendências , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Invenções , Prognóstico , Índice de Gravidade de Doença
15.
Aust Fam Physician ; 45(10): 761-764, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27695729

RESUMO

BACKGROUND: Imaging of the heart is important in the diagnosis and follow-up of a broad range of cardiac pathology. The authors discuss the growing role of cardiac magnetic resonance imaging (CMR) in cardiology practice and its relevance to primary healthcare. OBJECTIVE: In this article we discuss the advantages of CMR over other imaging modalities, and give a brief description of the common CMR techniques and cardiac pathologies where CMR is especially useful. DISCUSSION: CMR provides specific advantages over other cardiac imaging modalities when evaluating pathology in congenital heart disease, cardiac masses, cardiomyopathies, and in some aspects of ischaemic and valvular heart diseases. The strength of CMR in these pathologies includes its precise ana-tomical delineation of structures, characterisation of myocardial tissue, and accurate, reproducible measurements of blood volume and flow. CMR is used in inpatient and outpatient settings, and is available primarily in major hospitals.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico , Técnicas de Diagnóstico Cardiovascular/instrumentação , Imageamento por Ressonância Magnética/métodos , Doenças da Aorta/diagnóstico , Doenças da Aorta/diagnóstico por imagem , Técnicas de Imagem Cardíaca/instrumentação , Cardiologia/métodos , Cardiologia/tendências , Cardiomiopatias/diagnóstico , Cardiomiopatias/diagnóstico por imagem , Técnicas de Diagnóstico Cardiovascular/tendências , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/diagnóstico por imagem , Aumento da Imagem/métodos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/diagnóstico por imagem , Miocardite/diagnóstico , Miocardite/diagnóstico por imagem , Pericardite/diagnóstico , Pericardite/diagnóstico por imagem
18.
J Clin Monit Comput ; 30(2): 129-39, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26868121

RESUMO

Hemodynamic monitoring is essential in critically ill patients. In this regard, the Journal of Clinical Monitoring and Computing (JCMC) has become an ideal platform for publishing cardiovascular and hemodynamic monitoring-related research, as reflected by an increasing number of articles related to this topic and published in the recent years. To highlight this new progress, every New Year the journal prints a descriptive review on some important papers published last year in the JCMC and related to blood, cardiovascular function and hemodynamic monitoring.


Assuntos
Técnicas de Diagnóstico Cardiovascular/instrumentação , Técnicas de Diagnóstico Cardiovascular/tendências , Ecocardiografia/tendências , Técnicas de Diluição do Indicador/tendências , Monitorização Fisiológica/tendências , Publicações Periódicas como Assunto/tendências , Animais , Ecocardiografia/instrumentação , Ecocardiografia/métodos , Hemodinâmica , Humanos , Técnicas de Diluição do Indicador/instrumentação , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos
19.
Herz ; 40(8): 1061-9, 2015 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-26644393

RESUMO

Eleven years after the publication of the first guidelines worldwide on pericardial diseases by the European Society of Cardiology (ESC), the international expert group of the ESC has updated the original document of 28 pages with 275 references. The final version of the new guidelines is more voluminous with 44 pages of recommendations but only 233 references. A continuing medical education (CME) certified update of the 2004 guidelines was published in the journal Herz volume 7/2014. In comparison to 2004 the 2015 guidelines have remained virtually unchanged in the sections detailing diagnostics, differential diagnosis, pathology and pathophysiology. Substantial progress has been made in magnetic resonance imaging (MRI) of pericarditis and epicarditis and in the practically universal recommendation of colchicine for all forms of pericarditis and pericardial effusion, whether acute, chronic or recurrent. This can truly be called progress; however, little has changed since 2004 even in tertiary referral centers or universities with respect to the etiological classification of acute or recurrent forms of pericarditis or pericardial effusion. By classifying pericardial syndromes much too often as idiopathic when a malignant or bacterial cause has been excluded, the underlying cause is often overlooked. Standstill in diagnosis is in the end regress because we too often lag behind our actual diagnostic and interventional possibilities.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Cardiologia/normas , Técnicas de Diagnóstico Cardiovascular/normas , Pericardite/diagnóstico , Pericardite/terapia , Cardiologia/tendências , Diagnóstico Diferencial , Técnicas de Diagnóstico Cardiovascular/tendências , Europa (Continente) , Medicina Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto
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