RESUMO
OBJECTIVE: Abnormal iron handling complicates pulmonary hypertension (PH), causes functional limitation and poor outcomes. Although preliminary results in group 1 PH patients support the use of iron replacement, whether this applies to other PH subgroups is not known. METHODS: A total of 58 patients with an established diagnosis of group 1 or 4 PH, who had a serum ferritin of <100 ng/mL or 100 to 300 ng/mL in combination with a transferrin saturation (TSAT) <20% and received 500 to 1000 mg of ferric carboxymaltose (FCM) were included in the study. The change in ferritin levels and TSAT were calculated at 12- and 24-weeks follow-up. A six-minute walk test (6MWT) is undertaken at the first, 12-week and 24-week follow-up visits. RESULTS: In group 1 PH patients, ferritin levels increased from 14 ng/mL-1 to 133 and 90 ng/mL-1 at 12- and 24-weeks, respectively ( P < .001 for both). In group 4 PH patients, ferritin levels increased from 22.1 ng/mL-1 to 145 and 88.9 ng/mL-1 at 12- and 24-weeks, respectively ( P < .001 for both). 6MWT distances were 356, 412, and 350 m in group 1 PH patients and 260, 315 and 290 m in group 4 PH patients. Although the difference between baseline and 12-week 6MWT was significant in both groups ( P < .001 for both), this difference was lost at 24-week. CONCLUSION: Our study indicates that there is no difference in response to iron replacement in patients with group 1 and group 4 PH patients, in terms of treatment success and functional status.
Assuntos
Anemia Ferropriva , Hipertensão Pulmonar , Ferritinas , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/tratamento farmacológico , Ferro/uso terapêutico , TransferrinasRESUMO
BACKGROUND: Although chemotherapy-induced cardiotoxicity is an emerging problem, limited information is available on the effects of chemotherapy on left ventricular (LV) mechanical functions in patients with non-small cell lung cancer (NSCLC). OBJECTIVE: We aimed to explore chemotherapy-induced alterations in cardiac mechanical functions in patients with NSCLC using speckle tracking echocardiography (STE). METHODS: Seventy-one patients with NSCLC and 34 age and sex matched control subjects were consecutively included. Based on their good performance status (Eastern Cooperative Oncology Group performance status), 39 patients were treated with paclitaxel plus carboplatin (PC) regimen and 32 patients were treated with vinorelbine plus cisplatin (VC) regimen. All patients and controls underwent conventional two-dimensional echocardiography and STE at baseline to assess their LV functions. The echocardiographic examinations of NSCLC patients were repeated after the chemotherapy regimens. RESULTS: None of the NSCLC patients developed any signs or symptoms of clinical heart failure during or after the chemotherapy. There were not any significant differences in LV ejection fraction between NSCLC patients and controls before and after chemotherapy. There were not any significant differences in baseline LV global longitudinal strain (GLS), radial strain (RS), and circumferential strain (CS) between NSCLC patients and controls. However, all LV GLS, RS and CS significantly decreased in patients treated with the PC regimen resulting in a significant difference compared to both VC group and controls while no significant decreases were observed in strain measures in VC group. CONCLUSION: Paclitaxel plus carboplatin, but not VC, may induce subclinical cardiotoxicity in patients with NSCLC, which may be detected by STE.
RESUMO
BACKGROUND: Postoperative atrial fibrillation (POAF) may develop after coronary artery bypass grafting (CABG). The aim of the study was to explore the relationship between preoperative left atrial function and atrial fibrosis and POAF after CABG. METHODS: Forty-eight consecutive patients undergoing CABG (mean age: 61.6±8.9 years, 39 male) were included. All patients were in sinus rhythm during surgery. Patients were followed by continuous electrocardiography monitoring and daily electrocardiogram. Left atrial function was assessed by both conventional and speckle tracking echocardiography. Atrial fibrosis was determined by samples taken from right atrium. RESULTS: Postoperative atrial fibrillation was detected in 13 patients. Female sex and number of bypassed vessels were significantly higher and cardiopulmonary bypass time was significantly longer in patients with POAF. Left atrial volume index (LAVI) was significantly higher while left atrial reservoir strain was significantly lower in POAF patients. The percentage of patients with severe fibrosis was higher in the POAF group. Regression analysis revealed fibrosis and LAVI as independent predictors of POAF. Left atrial volume index ≥36mL/m(2) predicted POAF with a sensitivity of 84.6% and specificity of 68.6% in our cohort. CONCLUSION: Patients who developed POAF after CABG had more fibrosis, increased LAVI and lower left atrial reservoir strain. Preoperative echocardiography might be helpful in discriminating these patients.