RESUMO
The risk of infective endocarditis on pacemaker or ICD is not negligible and has increased in recent years. Several host-related, procedure-related, or device-related risk factors have been recognized. Owing to its potential severity, the possibility of infective endocarditis should be envisaged in patients with repeated pulmonary infections or documented bacteremia and transesophageal echocardiography should then be used. The most common germs causing pacemaker endocarditis are staphylococci. Treatment requires prolonged antibiotic therapy and retrieval of the pacemaker and leads.
Assuntos
Endocardite/terapia , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Antibacterianos/uso terapêutico , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/microbiologia , Remoção de Dispositivo , Endocardite/diagnóstico , Humanos , Marca-Passo Artificial/microbiologia , Infecções Relacionadas à Prótese/diagnósticoRESUMO
BACKGROUND: Elevated plasma homocysteine is a risk factor for coronary artery disease (CAD) and thromboembolic disorders that seems also to be associated with chronic heart failure. OBJECTIVE: To evaluate the association between homocysteine and left ventricular dysfunction and to assess whether it is independent of CAD. PATIENTS AND METHODS: A prospective study evaluated this relationship in 709 patients referred for diagnostic coronary angiography, including 515 CAD and 194 patients without evidence of coronary artery lesions. RESULTS: The homocysteine level was significantly higher in the 187 patients with a left ventricular ejection fraction (LVEF) dysfunction < 40% (P < 0.0001) than in those without ventricular dysfunction. LVEF, NYHA functional class II or III and CAD, stable angina and hypertension were clinical characteristics that influenced total homocysteine level in univariate analysis. Homocysteine was significantly associated with LVEF and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) in univariate regression (r = -0.267, 95% CI -0.33 to -0.19, P < 0.0001, and r = 0.381, 95% CI 0.28-0.47, P < 0.0001, respectively) and in multiple regression (P = 0.0022 and P = 0.0001, respectively). Other determinants were creatinine and vitamin B(12), but not folate. LVEF was a predictor of homocysteine > 15 micromol L(-1) in the whole population (P for trend < or = 0.0001) and in patients without documented CAD (P for trend = 0.0058). CONCLUSION: Our results showed an association of homocysteine with left ventricular systolic dysfunction and NT-pro-BNP that existed independently of documented CAD. Whether this association reflects a causative factor or a consequence of CHF and influences the prognosis of the disease remains an open question.
Assuntos
Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/complicações , Homocisteína/sangue , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/complicações , Idoso , Angiografia , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Volume Sistólico , Sístole , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Respecting market licensing authorisation recommendations is a prudent and preventive policy in respect of professional liability, but is not sufficient to avoid all of the doctor's responsibility. Conversely, not respecting the recommendations or off-indication prescribing does not necessarily make the practitioner liable. Although neither the recommendations, nor the market licensing authorisation are legally binding for the cardiologist, they can be invoked during a lawsuit. For this reason it seemed appropriate for us to study the medico-legal impact.
Assuntos
Legislação de Medicamentos , Responsabilidade Legal , Médicos/legislação & jurisprudência , Indústria Farmacêutica , Prescrições de Medicamentos , HumanosRESUMO
Heart failure is a severe illness, marked with a still too high morbidity and mortality. Therapeutic education, fundamental for any chronic pathology, is taking a more and more important place in heart failure. Its value has been proved, and its importance in the multidisciplinary management of heart failure patients has been confirmed in terms of improving the prescription of medical treatment and allowing a better quality of life. France was late to recognise this technique, but the successful development of the I-CARE programme should contribute to improving both the quality of care for patients and the understanding of this pathology.
Assuntos
Insuficiência Cardíaca/terapia , Educação de Pacientes como Assunto , França , Humanos , Estilo de Vida , Qualidade de VidaRESUMO
UNLABELLED: The significance of atrial fibrillation (AF) in idiopathic dilated cardiomyopathy (IDCM) remains discussed. The purpose of the study was to evaluate the clinical significance of permanent atrial fibrillation in patients with IDCM. METHODS: Systematic noninvasive and invasive studies including Holter monitoring, measurement of left ventricular ejection fraction (LVEF), electrophysiological study and coronary angiography were performed in 323 patients with IDCM; all patients had a left ventricular ejection fraction (LVEF)<40%. The studies were indicated for spontaneous ventricular tachycardia (VT) in 69 patients, syncope in 103 patients and nonsustained VT on Holter monitoring in 151 asymptomatic patients. Sixty-five patients were in permanent AF (group I). Remaining patients were in sinus rhythm at the time of evaluation (group II). Programmed ventricular stimulation using up to 3 extrastimuli in control state and if necessary after isoproterenol was systematic. Patients were followed 3+/-2 years. RESULTS: Mean age was significantly older in group I (61+/-8 years) than in group II (52+/-12) (P<0.01). Syncope (31 vs 36%), spontaneous sustained VT (18 vs 23%); mean LVEF (28+/-9% vs 29+/-9%), VT induction (25 vs 35%) were similar in both groups. During the follow-up, there were no statistical differences between groups I and II concerning each event: sudden death occurred in 13 patients, 1.5% of group I patients and 5% of group II patients (NS); a death related to heart failure occurred 22 patients, 5% of group I patients and 7% of group II patients (NS); heart transplantation was performed in 13 patients, 8% of group I patients and 3% of group II patients (NS). CONCLUSIONS: An older age is the only significant clinical factor associated with the presence of a permanent atrial fibrillation in idiopathic dilated cardiomyopathy. The presence of permanent AF does not increase the induction of a sustained ventricular tachycardia and does not affect the general prognosis of IDCM.
Assuntos
Fibrilação Atrial/etiologia , Cardiomiopatia Dilatada/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Abdominal aortic aneurysms (AAA) are serious disease with a high fatality rate but recent epidemiologic data showed a decrease of AAA mortality. Our objective was to estimate, in France, the hospitalization, inhospital mortality and mortality rates due to AAA and to analyze their trends over time. METHODS: Hospitalization data were extracted from the hospital discharge summaries in the national database between 2002 and 2013. The analysis covered all patients hospitalized for AAA as a principal diagnosis. During the same period, all death certificates mentioning AAA as an initial cause of death were included in the study. Crude and standardized rates were calculated according to age and sex. Poisson regression was used to analyze the average annual percent change. RESULTS: In 2013, there were 8853 patients hospitalized for AAA in France (7986 unruptured and 867 ruptured). Between 2002 and 2013, the rate of patients hospitalized for unruptured AAA decreased slightly in men (-5.0%) but increased in women (+5.2%). By contrast, the rate of patients hospitalized for ruptured AAA has decreased by >20% in men and women. The proportion of endovascular treatment of unruptured AAA rose from <10% in 2005 to 35% in women and 40% in men in 2013. In 2013, 939 deaths from AAA were recorded. Mortality for this disease declined significantly from 2002 to 2013 in men and women. CONCLUSION: The unfavorable epidemiological trends in women and important evolution of the management of AAA call for an epidemiological surveillance of this disease.
Assuntos
Aneurisma da Aorta Abdominal , Hospitalização/estatística & dados numéricos , Idoso , Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/terapia , Bases de Dados Factuais/estatística & dados numéricos , Gerenciamento Clínico , Feminino , França/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Avaliação das Necessidades , Fatores SexuaisRESUMO
Heart failure is a major health problem which often concerns the elderly. Prevalence of heart failure with preserved systolic function is increasing and varies from 40 to 50%. In the literature, and in the large epidemiological studies, it is commonly designed with the term of "diastolic heart failure", even if a precise analysis of diastolic function is not performed. A diagnostic algorithm is proposed in order to better define the concept of heart failure with preserved systolic function. It consists of seven steps from symptoms and clinical signs to the echocardiographic analysis of diastolic function, in order to confirm the definition of heart failure with preserved systolic function.
Assuntos
Algoritmos , Insuficiência Cardíaca/diagnóstico , Sístole/fisiologia , Comorbidade , Diagnóstico Diferencial , Diástole/fisiologia , Átrios do Coração/patologia , Humanos , Hipertrofia Ventricular Esquerda/complicações , Função Ventricular EsquerdaRESUMO
Heart failure is a severe disease with high morbidity and mortality rates. The interest for multidisciplinary heart failure patient management is increasing in order to improve prescription of medical therapies and to allow a better quality of life. Proofs of reduction in morbi-mortality exist and some models of management have been assessed. The most important point remains the major role of therapeutic education. Training of health care professionals is needed. Tools for therapeutic education have been created and can be associated with complementary informative means. All these elements allow that a new approach of heart failure takes in place in France.
Assuntos
Prestação Integrada de Cuidados de Saúde , Insuficiência Cardíaca/terapia , Educação de Pacientes como Assunto , França , Insuficiência Cardíaca/mortalidade , Humanos , Relações Médico-Paciente , Qualidade de VidaRESUMO
A new class of cardiovascular drugs, angiotensin receptor neprilysin inhibitors, has shown its efficacy in the PARADIGM-HF study in replacement of renin-angiotensin blockers in symptomatic heart failure patients with reduced ejection fraction, and already treated according to the recommendations. Recent French epidemiological data in the literature allow assessing the number of French patients who could be concerned by the new treatment in taking account the different parameters from the PARADIGM-HF study.
Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Neprilisina/antagonistas & inibidores , Volume Sistólico/fisiologia , França/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Right ventricular function was studied by means of a thermodilution catheter before, during and after percutaneous transluminal angioplasty of the proximal right (group 1, n = 8), left anterior descending (group 2, n = 8) or left circumflex (group 3, n = 8) coronary artery. All patients had evidence of myocardial ischemia, with single-vessel disease affecting the proximal segment of one of the three major coronary arteries; no patient had had a previous myocardial infarction and all had normal cardiac function at baseline study. Cardiac index decreased during balloon inflation. Mean pulmonary artery pressure was unaffected in group 1 but increased in group 2 (from 19 +/- 5 to 31 +/- 11 mm Hg, p less than 0.01) and in group 3 (from 19 +/- 2 to 22 +/- 5 mm Hg, p less than 0.05). Right ventricular ejection fraction decreased from 62 +/- 9% to 52 +/- 10% (p less than 0.01) in group 1 and from 64 +/- 7% to 44 +/- 10% (p less than 0.005) in group 2, and returned to normal within 2 min after balloon deflation in both groups. In group 3, right ventricular ejection fraction was unchanged during balloon inflation (58 +/- 5% at baseline, 58 +/- 9% at 60 s, p = NS). Therefore, brief occlusion of the proximal segments of the left anterior descending or right coronary artery results in marked alteration of right ventricular performance that is probably caused by right ventricular free wall ischemia in the right coronary group and by the concomitant effects of septal ischemia and increased right ventricular afterload in the left anterior descending artery group.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Angioplastia Coronária com Balão , Doença das Coronárias/fisiopatologia , Função Ventricular Direita/fisiologia , Doença das Coronárias/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pressão Propulsora Pulmonar/fisiologia , Volume Sistólico/fisiologia , TermodiluiçãoRESUMO
OBJECTIVES: Characterize the incidence, clinical and etiologic features and outcomes of advanced congestive heart failure. BACKGROUND: This condition is frequent, severe and costly, yet no population-based epidemiological data are available that take into account modern advances in diagnosis and therapy. METHODS: The EPICAL (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) study was based on a comprehensive registration of patients with ACHF (defined as hospital admission for presence of NYHA class III or IV symptoms, radiological and/or clinical signs of pulmonary congestion and/or signs of peripheral edema, left ventricular ejection fraction <30% or a cardiothoracic ratio >60%) in patients aged 20-80 years during year 1994, in the community of the Lorraine region in France (n = 1,592,263). Average follow-up for readmission to hospital and mortality was 18 months (12-24 months). RESULTS: From 2,576 registered patients, 499 were enrolled into the study among which, 358 were new presentations. This represents a crude incidence rate of 225 per million. 46.3% had a coronary heart disease. One-year mortality rate was 35.4% and the rate of mortality and/or readmission to hospital was 81%. Patients were admitted to hospital 2.05 times per year (64% of these for worsening heart failure), spending 27.6 days per year in hospital. Twenty received a heart transplant (4%). On discharge, 74.8% were using ACE inhibitors and 49.6% digitalis. CONCLUSIONS: Mortality and hospitalization rate of advanced CHF remain very high despite recent therapeutic progress. Major therapeutic and managed-care research is required.
Assuntos
Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Angiografia Coronária , Eletrocardiografia , Feminino , Seguimentos , França/epidemiologia , Insuficiência Cardíaca/diagnóstico , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Vigilância da População , Prognóstico , Estudos Prospectivos , Taxa de SobrevidaRESUMO
OBJECTIVES: This study sought to evaluate the prognostic role of exercise thallium-201 (Tl-201) single-photon emission computed tomography (SPECT) in patients with known or suspected coronary artery disease. BACKGROUND: Compared with planar Tl-201 scintigraphy, Tl-201 SPECT allows enhanced assessment of myocardial perfusion abnormalities. However, the long-term prognostic value of exercise Tl-201 SPECT has not been ascertained and compared with that of other techniques of investigation. METHODS: Predictors of ischemic events were sought in 217 patients with known or suspected coronary artery disease who underwent exercise Tl-201 SPECT, coronary angiography and rest radionuclide angiography and who initially received medical therapy. Predictive values were determined using Cox proportional hazards regression models. RESULTS: During a mean (+/- SD) follow-up period of 70 +/- 19 months, 29 patients had a major ischemic event (cardiac death or myocardial infarction). Total extent of exercise defects was the best independent predictor by Tl-201 SPECT of major events (p < 0.001) and provided additional prognostic information compared with clinical, exercise testing and catheterization variables (p < 0.02). Extent of reversible Tl-201 SPECT perfusion defects provided additional prognostic information compared with extent of irreversible defects (p < 0.001) and was the sole Tl-201 SPECT variable providing additional prognostic information compared with radionuclide left ventricular ejection fraction (p < 0.02). CONCLUSIONS: Total extent of exercise Tl-201 SPECT defects is a powerful long-term predictor of major ischemic events that enhances the prediction provided by clinical, exercise testing and coronary angiographic data. In view of its prognostic significance, extent of reversible Tl-201 SPECT defects might provide original information about improving prognosis by coronary revascularization.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/epidemiologia , Coração/diagnóstico por imagem , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Fatores Etários , Cateterismo Cardíaco , Angiografia Coronária , Doença das Coronárias/diagnóstico , Eletrocardiografia , Teste de Esforço , Feminino , Seguimentos , Imagem do Acúmulo Cardíaco de Comporta , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVES: We compared the ability of rest single-photon emission computed tomography (SPECT) with [123I]-16-iodo-3-methylhexadecanoic acid (MIHA) and the thallium-201 (Tl-201) rest-reinjection technique to detect myocardial viability after infarction. BACKGROUND: After myocardial infarction, MIHA frequently shows increased uptake in the areas with exercise Tl-201 defects (mismatch), even in patients with an irreversible Tl-201 reinjection defect. Whether such increased uptake is indicative of ischemic but viable myocardium is not known. METHODS: We studied 38 patients who 1) underwent exercise SPECT Tl-201 with rest-reinjection and rest SPECT with MIHA before undergoing percutaneous transluminal coronary angioplasty (PTCA) of an infarct-related coronary artery, and 2) were found to have successful revascularization at follow-up angiography. The relation between SPECT results before PTCA and subsequent improvement in left ventricular wall motion was assessed. RESULTS: A mismatch was evident before PTCA in 51 of 76 infarct-related segments and correlated with subsequent improvement in wall motion (overall accuracy 71%), even for the 27 segments whose exercise defects remained irreversible after Tl-201 reinjection (overall accuracy 81%). The finding of a mismatch clearly enhanced the results provided by the finding of > or = 50% Tl-201 uptake as determined at redistribution (p < 0.05), but not as determined at reinjection, although there was a trend toward a better specificity for the findings of a mismatch. CONCLUSIONS: MIHA is an efficient marker of viability inside exercise-underperfused areas after infarction, even in patients with irreversible Tl-201 reinjection defects. Assessment by conventional SPECT of a mismatch between results obtained with a metabolic tracer (MIHA) and a flow tracer analyzed at exercise (Tl-201) as a marker of myocardial viability is a promising area of research.
Assuntos
Coração/diagnóstico por imagem , Radioisótopos do Iodo , Infarto do Miocárdio/diagnóstico por imagem , Ácidos Palmíticos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Idoso , Angioplastia Coronária com Balão , Sobrevivência Celular , Constrição Patológica , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Miocárdio/patologia , Estudos Prospectivos , Radioisótopos de TálioRESUMO
OBJECTIVES: The purpose of this study was to determine whether antianginal medications modify the prognostic significance of exercise single photon emission computed tomography (SPECT) ischemia. BACKGROUND: Antianginal medications (especially beta-adrenergic blocking agents) limit exercise SPECT ischemia, but it is not known whether such medications also modify the prognostic effect of exercise SPECT ischemia. METHODS: We included 352 patients with coronary heart disease, who had exercise Tl-201 SPECT and coronary angiography, and who were initially treated medically. Survival Cox models were applied in patients for whom classes of antianginal medications taken at exercise SPECT were the same as those prescribed for follow-up (GI; n = 136), and in patients for whom new classes of antianginal medications, including beta-blockers (GII; n = 79) or not including beta-blockers (GIII; n = 113), were added for follow-up. RESULTS: During a mean 5.3+/-1.6 years of follow-up, 45 patients had cardiac death or myocardial infarction. Variables reflecting necrosis (irreversible defect extent, left ventricular ejection fraction) and those from coronary angiography provided equivalent prognostic information in the three groups. In contrast, the SPECT variable reflecting ischemia (reversible defect extent), which provided comparable prognostic information in GI (p = 0.005) and GIII (p = 0.004), lost its prognostic significance (p = 0.54) in GII, and was associated with a lower relative risk in GII than in GI or GIII (both p < 0.05). CONCLUSIONS: In patients with coronary heart disease, the introduction of antianginal medications, when including beta-blockers, appears to have a favorable effect on the deleterious prognostic effect of exercise ischemia.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/tratamento farmacológico , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Bloqueadores dos Canais de Cálcio/uso terapêutico , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Molsidomina/uso terapêutico , Nitratos/uso terapêutico , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Resultado do Tratamento , Vasodilatadores/uso terapêuticoRESUMO
Therapeutic education is becoming increasingly important in the management of chronic diseases including cardiac failure. The I-CARE programme consists of an evaluation of the role of therapeutic education in France, creating standardised tools and setting up training sessions for therapeutic education in the context of cardiac failure. Approximately two thirds of the French centres contacted perform therapeutic education with their available means. The lack of personnel, space, and training tools represent obstacles to the development of therapeutic education. The tools developed in the programme fall into 5 areas: diagnosis education, understanding the illness, diet, physical activity/daily life, and treatment. Training sessions were organised for the teams, consisting of at least one cardiologist and nurse. The I-CARE programme should allow the expansion of therapeutic education for cardiac failure and improve the multidisciplinary management of this disease which increasingly affects often elderly subjects.
Assuntos
Insuficiência Cardíaca , Educação de Pacientes como Assunto , Relações Médico-Paciente , Atividades Cotidianas , Dieta , Exercício Físico , França , Humanos , Estilo de Vida , Desenvolvimento de ProgramasRESUMO
Congestive heart failure remains a severe condition. Risk stratification is necessary to assess the prognosis and discuss the potential timing of heart transplant. Numerous criteria have been used, which may be combined to define prognostic scores which, however, are rarely used in routine. A few items, however, may be used to stratify the risk of mortality and sudden death.
Assuntos
Insuficiência Cardíaca/mortalidade , Angiografia Coronária , Ecocardiografia , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hipertensão/complicações , Falência Hepática/complicações , Peptídeo Natriurético Encefálico/sangue , Consumo de Oxigênio , Insuficiência Renal/complicações , Medição de Risco , Volume SistólicoRESUMO
UNLABELLED: Rest SPECT imaging with [123I]-16-iodo-3-methylhexadecanoic acid (MIHA) frequently shows an increased level of uptake in areas with irreversible defects on exercise 201TI SPECT. Such mismatch patterns between flow (201TI) and metabolic (MIHA) tracers might correspond to areas with ischemic but viable myocardium misidentified by 201TI imaging. METHODS: Eighty-three patients with myocardial infarction underwent exercise SPECT 201TI with rest-reinjection and rest SPECT with MIHA. Defect areas on the exercise images were reversible on MIHA but not on 201TI reinjection images that were determined visually. The presence and extent of these areas were quantified from normalized uptake values for both tracers. RESULTS: In areas with irreversible 201TI reinjection defects, MIHA detected exercise defect reversibility in 59% of patients. In areas with irreversible 201TI reinjection defects, the extent of visually determined defect reversibility on MIHA scans was related to the quantified extent of areas with 201TI uptake > or = 50% of normal; the correlation, however, was weak. In 86% of patients, areas with > or = 50% 201TI uptake were larger than those that were reversible on MIHA. CONCLUSION: After myocardial infarction, rest SPECT with MIHA often enables visual detection of increased uptake in areas with irreversible 201TI reinjection defects.
Assuntos
Teste de Esforço , Coração/diagnóstico por imagem , Radioisótopos do Iodo , Infarto do Miocárdio/diagnóstico por imagem , Ácidos Palmíticos , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Fifteen patients undergoing routine follow-up angiography 5 months after successful percutaneous transluminal coronary angioplasty (PTCA) without angina and with normal exercise thallium scintigraphy were selected for analysis. The coronary flow reserves of these patients were compared with those of 24 patients with angiographically normal coronary arteries to establish whether PTCA can restore to normal the coronary flow reserve of patients with chronic coronary artery disease. The quantitative cineangiographic changes and the concomitant alterations in coronary flow reserve as an immediate result of the PTCA and the subsequent changes 5 months later are described. Coronary flow reserve was measured with digital subtraction cineangiography. PTCA resulted in an increase in minimal obstruction area (mean +/- standard deviation) from 0.8 +/- 0.3 to 3.4 +/- 0.7 mm2 and in coronary flow reserve from 1.0 +/- 0.3 to 2.5 +/- 0.6. Five months later a further substantial and significant (p less than 0.05) late increase in obstruction area (3.8 +/- 0.9 mm2) and flow reserve (3.6 +/- 0.5) had occurred. In 11 of 15 patients coronary flow reserve was restored to normal. Changes in stenosis geometry are likely to be 1 of the major determinants of this late normalization of coronary flow reserve.
Assuntos
Angioplastia com Balão , Circulação Coronária , Doença das Coronárias/terapia , Adulto , Idoso , Cineangiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Among 265 patients with severe coronary artery stenoses amenable to percutaneous transluminal coronary angioplasty, 13 (5%) developed new total coronary occlusion of the vessel to be dilated during the period between diagnostic coronary angiography and repeat coronary angiography at the time of the operation. Time from diagnostic to "therapeutic" angiography (76 +/- 74 vs 31 +/- 31 days, p less than 0.0001), degree of coronary stenosis on diagnostic angiography (85 +/- 7 vs 80 +/- 8%, p less than 0.05) and impaired coronary flow distal to the narrowing (Thrombolysis in Myocardial Infarction grade 2: 38 vs 10%, p less than 0.01) were the only variables related to the occurrence of spontaneous coronary occlusion. The clinical course of the patients who developed new total coronary occlusion was remarkably favorable. Twelve of the 13 patients had unchanged or improved anginal symptoms. The electrocardiogram at rest remained unchanged in 11 patients and there was no transmural myocardial infarction. Eight patients had 2 ventriculograms and the mean ejection fraction remained unchanged (only 2 patients had greater than 5% decrease in ejection fraction between the 2 examinations). Spontaneous occlusion of high degree coronary artery stenoses is not unusual and is usually well tolerated, presumably due to the development of collateral circulation.