RESUMEN
BACKGROUND: Quantitative flow ratio (QFR) is a novel, software-based method to evaluate the physiology of coronary lesions. The aim of this study was to compare QFR with the established invasive measurements of coronary blood flow using instantaneous wave-free ratio (iFR) or resting full-cycle ratio (RFR) in daily cathlab routine. METHODS: 102 patients with stable coronary artery disease and a coronary stenosis of 40%-90% were simultaneously assessed with QFR and iFR or RFR. QFR-computation was performed by two certified experts using the appropriate software (QAngio XA 3D 3.2). RESULTS: QFR showed a significant correlation (r = 0.75, p < 0.001) to iFR and RFR. The area under the receiver curve for all measurements was 0.93 (95% confidence interval, 0.87-0.98) for QFR compared to iFR or RFR. QFR based assessment required less time with a median of 501 s (IQR 421-659 s) compared to iFR or RFR which required a median of 734 s to obtain the result (IQR 512-967 s; p < 0.001). The median use of contrast medium was similar with 21 mL (IQR 16-30 mL) for the QFR-based and 22 mL (IQR 15-35 mL) for the iFR- or RFR-based diagnostic. QFR diagnostic required less radiation. The median dose area product for QFR was 307cGycm2 (IQR 151-429 cGycm2 ) compared to 599 cGycm2 (IQR 345-1082 cGycm2 ) for iFR or RFR, p < 0.001. CONCLUSION: QFR measurements of coronary artery blood flow correlate with iFR or RFR measurements and are associated with shorter procedure times and reduced radiation dose.
Asunto(s)
Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Humanos , Angiografía Coronaria/métodos , Valor Predictivo de las Pruebas , Resultado del Tratamiento , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estenosis Coronaria/diagnóstico por imagen , Cateterismo Cardíaco , Vasos Coronarios/diagnóstico por imagen , Índice de Severidad de la EnfermedadRESUMEN
We report the case of a 30-year-old man who presented to our emergency department with rapid heart beat and a narrow complex tachycardia at a rate of 215 beats per minute. With the working diagnosis of Wolf-Parkinson-White syndrome with paroxysmal orthodromic tachycardias, we performed an electrophysiological study. In this examination, there was a para-Hisian accessory pathway with very fast, prognostically relevant conduction properties. In order to protect the His bundle that is located deeper in the tissue and to avoid a deeper lesion, we decided to use high-power short-duration ablation. This method, which was recently used in three-dimensional-controlled radiofrequency ablation of pulmonary veins, causes more superficial lesions in order to protect the surrounding tissue. In our case, using the high-power short-duration method, we were able to successfully ablate the para-Hisian accessory pathway, while protecting the His bundle near the ablation site.
Asunto(s)
Fascículo Atrioventricular Accesorio , Ablación por Catéter , Síndrome de Wolff-Parkinson-White , Fascículo Atrioventricular Accesorio/cirugía , Fascículo Atrioventricular/cirugía , Electrocardiografía , Frecuencia Cardíaca , Humanos , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/cirugíaRESUMEN
PURPOSE: We aimed to assess long-term safety and performance of the Orsiro sirolimus-eluting coronary stent with biodegradable polymer in a large unselected population and in pre-specified subgroups. METHODS: BIOFLOW-III is a prospective, multicenter, international, observational registry with follow-up visits scheduled at 6 and 12â¯months, and at 3 and 5â¯years (NCT01553526). RESULTS: 1356 patients with 1738 lesions were enrolled. Of those, 392 (28.9%) declined to participate in the study extension from 18â¯months to 5â¯years, 37 (2.7%) withdrew consent, and 89 (6.6%) were lost to follow-up. At 5-years, Kaplan-Meier estimates of target lesion failure, defined as a composite of cardiac death, target-vessel myocardial infarction, coronary artery bypass grafting and clinically driven target lesion revascularization was 10.0% [95% confidence interval (CI): 8.4; 12.0] in the overall population, and 14.0% [95% CI: 10.5; 18.6], 10.3% [95% CI: 7.8; 13.5], 1.8% [95% CI: 0.3; 12.0], and 11.3% [95% CI: 8.5; 15.1] in the pre-defined risk groups of patients with diabetes mellitus, small vessels ≤2.75â¯mm, chronic total occlusion, and acute myocardial infarction. Definite stent thrombosis was observed in 0.3% [95% CI: 0.1; 0.9] of patients. CONCLUSION: These long-term outcomes provide further evidence on the safety and performance of a sirolimus-eluting biodegradable polymer stent within daily clinical practice. The very low definite stent thrombosis rate affirms biodegradable polymer safety and performance.
Asunto(s)
Implantes Absorbibles , Angioplastia Coronaria con Balón/instrumentación , Fármacos Cardiovasculares/administración & dosificación , Enfermedad de la Arteria Coronaria/terapia , Oclusión Coronaria/terapia , Stents Liberadores de Fármacos , Infarto del Miocardio/terapia , Poliésteres/química , Sirolimus/administración & dosificación , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Fármacos Cardiovasculares/efectos adversos , Enfermedad Crónica , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/fisiopatología , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/fisiopatología , Trombosis Coronaria/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Estudios Prospectivos , Diseño de Prótesis , Recurrencia , Sistema de Registros , Factores de Riesgo , Sirolimus/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Chronic inflammation due to autoimmune diseases is associated with a higher rate of supraventricular and ventricular arrhythmias leading to an increased risk for cardiovascular morbidity and mortality. Involvement of the cardiac conduction system is common in patients with chronic autoimmune diseases, although the penetrance of clinical signs and symptoms is variable and complete heart block with need for therapy is rare. The combination of the increased prevalence of structural cardiovascular disease and the direct impact of inflammatory mechanisms on cardiac electrophysiology seems to be responsible for the higher rate of tachyarrhythmias. In particular, fibroblast activation, gap junction impairment via changes in connexin composition and abnormalities in intracellular calcium-handling are mentioned. Electrocardiographic markers of an increased arrhythmogenic potential in patients with chronic autoimmune disorders may include prolonged Pwave duration as well as abnormal QTc interval and reduced heart rate variability. Thus, minimizing the inflammatory burden through tight control of disease activity may help reduce the arrhythmic load.
Asunto(s)
Arritmias Cardíacas , Enfermedades Autoinmunes , Electrocardiografía , Sistema de Conducción Cardíaco , Humanos , TaquicardiaRESUMEN
Estimating the time since death of the deceased is a main goal in forensic investigations, but this can be challenging due to contradictory results derived from different investigations at the scene of death. We present a case of a 78-year-old woman, found dead in a small forest with broad-leaved trees, whose husband had a history of domestic violence. Routinely performed investigations, such as postmortem rectal temperature and lividity, yielded inconsistent time since death results between only a few and longer than 20 h. This difficulty was most likely caused by high ambient temperatures of up to 38.0°C, which negatively influenced the informative value of the applied nomogram method. Additionally, performed entomological investigation of fly maggots (Lucilia illustris) recovered from the corpse and the assessment of heart pacemaker data revealed consistent and incontrovertible results. The presented case highlights the benefits of information provided by entomological investigations and data evaluation of cardiac implantable electronic devices and the combined use of the two techniques.
Asunto(s)
Dípteros , Conducta Alimentaria , Marcapaso Artificial , Cambios Post Mortem , Lesión Renal Aguda/diagnóstico , Anciano , Animales , Femenino , Humanos , Larva , TemperaturaRESUMEN
After His bundle electrography was established in 1967, the step from invasive electrophysiologic diagnosis of arrhythmias to interventional treatment by catheter ablation was imminent. The time interval of 15 years between the diagnosis and treatment of arrhythmias was even shorter than the 19 years between the first selective coronary angiography in 1958 at the Cleveland Clinic in the USA and the first percutaneous coronary intervention in 1977 in Zurich. During each time period, a great amount of knowledge was gained in cardiac surgery, which proved to be very helpful for the development of the interventional treatment. The history of endovascular treatment is an impressive reminder that the preparation and support of cardiovascular surgeons and their handling of complications played a decisive role in the further development of cardiovascular internal medicine. The history of catheter ablation teaches us that the joint work of cardiologists and cardiovascular surgeons is of great importance for the choice and further development of the best possible treatment as for future development of the techniques of therapy.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Ablación por Catéter , Arritmias Cardíacas , Humanos , Intervención Coronaria PercutáneaRESUMEN
Published registries give limited information on age-dependent complication rates. There are several reasons for this, including limited numbers of patients in subgroups (e.g., contractility management), experience-dependent procedures (e.g., catheter ablation), or in changing indications (e.g., resynchronization). Finally, severely ill and very old patients with limited prognosis are often excluded from electrophysiologic procedures. Therefore, published data are difficult to interpret. Meta-analyses of randomized trials give more precise information on included patient cohorts, but do not necessarily reflect daily practice because elderly patients are often excluded from trials. Therefore, the individual risk of elderly patients has to be estimated on an individual case basis. In summary, the age of patients is not relevant regarding possible complications; thus, there is no age limit for electrophysiologic interventions. Therefore, there is no alternative to the individual estimation of procedural risks of interventions of an informed patient by an experienced cardiologist.
Asunto(s)
Terapia de Resincronización Cardíaca/efectos adversos , Ablación por Catéter/efectos adversos , Medicina Basada en la Evidencia/métodos , Evaluación Geriátrica/métodos , Consentimiento Informado , Evaluación de Resultado en la Atención de Salud/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Anciano , Anciano de 80 o más Años , Técnicas Electrofisiológicas Cardíacas/efectos adversos , Femenino , Alemania , Humanos , MasculinoRESUMEN
Web 2.0 is changing the study of medicine by opening up totally new ways of learning and teaching in an ongoing process. Global social networking services like Facebook, YouTube, Flickr, Google Drive and Xing already play an important part in communication both among students and between students and teaching staff. Moreover, local portals (such as the platform [http://www.leipzig-medizin.de] established in 2003) have also caught on and in some cases eclipsed the use of the well-known location-independent social media. The many possibilities and rapid changes brought about by social networks need to be publicized within medical faculties. Therefore, an E-learning and New Media Working Group was set up at the Faculty of Medicine of Universität Leipzig in order to harness the opportunities of Web 2.0, analyse the resulting processes of change in the study of medicine, and curb the risks of the Internet. With Web 2.0 and the social web already influencing the study of medicine, the opportunities of the Internet now need to be utilized to improve the teaching of medicine.