RESUMEN
This study aimed to investigate the role of secondary mitral regurgitation (MR) and tricuspid regurgitation (TR) in the pathogenesis of cardiorenal syndrome (CRS). Worsening renal function in patients with acute decompensated heart failure receiving diuretic therapy is defined as CRS and is related to central venous congestion. The role of secondary MR and TR is not well studied. We retrospectively reviewed the electronic medical records of 80 consecutive patients hospitalized with acute decompensated heart failure. Patients were divided into 2 groups: group 1 (CRS) if creatinine increased >0.3 mg/dl from baseline and group 2 (no CRS) if creatinine remained stable or improved with diuretic therapy. Admission creatinine was higher in group 1 compared with group 2 (1.5 vs 1.2 mg/dl, p = 0.033). The magnitude of MR and TR were higher by both visual assessment (moderate to severe [3+] or severe [4+] MR in 68% of patients in group 1 vs 3% in group 2, p <0.0001; 3+ or 4+ TR in 48% of patients in group 1 vs 10% in group 2, p = 0.0004) and by vena contracta (MR 0.6 ± 0.2 cm in group 1 vs 0.4 ± 0.1 cm in group 2, p <0.0001; TR 0.5 ± 0.2 cm in group 1 vs 0.4 ± 0.2 cm in group 2, p = 0.0013). By using receiver operating characteristic curves, MR and TR were the most sensitive parameters in predicting CRS. In conclusion, renal function on admission and moderate to severe or severe MR and TR are highly predictive of the risk of developing CRS.
Asunto(s)
Síndrome Cardiorrenal , Insuficiencia Cardíaca , Insuficiencia de la Válvula Mitral , Insuficiencia de la Válvula Tricúspide , Síndrome Cardiorrenal/complicaciones , Síndrome Cardiorrenal/etiología , Creatinina , Diuréticos/uso terapéutico , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/complicacionesRESUMEN
Beta blockers improve left ventricular (LV) ejection fraction but patient responses are heterogenous. We investigated the role of contractile reserve (CR) in predicting beta-blocker response in ischemic and nonischemic cardiomyopathy. Resting and low-dose dobutamine echocardiograms were recorded in 32 patients with heart failure (LV ejection fraction Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico
, Cardiomiopatía Dilatada/fisiopatología
, Contracción Miocárdica/fisiología
, Isquemia Miocárdica/fisiopatología
, Disfunción Ventricular Izquierda/tratamiento farmacológico
, Disfunción Ventricular Izquierda/fisiopatología
, Adulto
, Anciano
, Anciano de 80 o más Años
, Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico
, Cardiomiopatía Dilatada/complicaciones
, Cardiomiopatía Dilatada/tratamiento farmacológico
, Femenino
, Estudios de Seguimiento
, Humanos
, Masculino
, Persona de Mediana Edad
, Isquemia Miocárdica/complicaciones
, Isquemia Miocárdica/tratamiento farmacológico
, Valor Predictivo de las Pruebas
, Estudios Prospectivos
, Factores de Tiempo
, Disfunción Ventricular Izquierda/complicaciones
RESUMEN
BACKGROUND: Previous studies have demonstrated the development of impaired systolic function and new segmental wall motion abnormalities following completion of ultraendurance events. Limited information is available on the effect of an endurance event such as a marathon on the left ventricular indices and hemodynamics. METHODS: We examined 45 patients (26 men, 19 women with the average age of 35+/- 8 years) who successfully trained and completed the 2001 Chicago Marathon (26.2 miles). Transthoracic 2-dimensional and Doppler echocardiography (TTE) was preformed prior to the marathon (17+/-10.7 days), immediately following the marathon (71+/-42 minutes), and at follow-up (29+/-12.9 days). RESULTS: Left ventricular end diastolic volumes declined immediately post marathon and returned to baseline at the one-month follow-up. Ejection fraction was maintained and no regional wall motion abnormalities were identified at any time point. Diastolic parameters decreased immediately post marathon but returned to baseline during follow-up principally reflecting a change in volume status. CONCLUSION: Marathon running by a group of well-trained recreational athletes does not result in impairment of left ventricular systolic or diastolic function.
Asunto(s)
Ventrículos Cardíacos/diagnóstico por imagen , Resistencia Física/fisiología , Esfuerzo Físico/fisiología , Carrera/fisiología , Función Ventricular Izquierda/fisiología , Función Ventricular , Adulto , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función/fisiología , Volumen Sistólico/fisiologíaRESUMEN
Appetite suppressants fenfluramine, dexfenfluramine, and phentermine have been used alone or in combination as an alternative to diet and surgery in the management of obesity. This therapy was halted in 1997 after reports of valvular lesions affecting almost one third of patients treated with these drugs. Fortunately, most cases of appetite suppressant-related valve disease are mild or moderate and rarely required valve repair or replacement. Follow-up studies have suggested improvement in valvulopathy after discontinuation of the treatment. The mechanism of valve disease induced by these drugs is speculative and may be related to their serotonergic effects. Echocardiographic features are similar to carcinoid heart disease and valvulopathy associated with ergot use. Most cases require only follow-up and endocarditis prophylaxis; surgery is rarely needed.