RESUMO
BACKGROUND: The Naples prognostic score (NPS) is an effective inflammatory and nutritional scoring system widely applied as a prognostic factor in various cancers. However, the prognostic significance of NPS is unknown in ST-segment elevation myocardial infarction (STEMI). We aimed to analyze the prognostic value of the NPS in-hospital mortality in patients with STEMI. METHODS: The study consisted of 3828 patients diagnosed with STEMI who underwent primer percutaneous coronary intervention. As the primary outcome, in-hospital mortality was defined as all-cause deaths during hospitalization. The included patients were categorized into three groups based on NPS (group 1:NPSâ =â 0,1,2; group 2:NPSâ =â 3; group 3:NPSâ =â 4). RESULTS: Increased NPS was associated with higher in-hospital mortality rates( P â <â 0.001). In the multivariable logistic regression analysis, the relationship between NPS and in-hospital mortality continued after adjustment for age, male sex, diabetes, hypertension, Killip score, SBP, heart rate, left ventricular ejection fraction, myocardial infarction type and postprocedural no-reflow. A strong positive association was found between in-hospital mortality and NPS by multivariable logistic regression analysis [NPS 0-1-2 as a reference, ORâ =â 1.73 (95% CI, 1.04-2.90) for NPS 3, ORâ =â 2.83 (95% CI, 1.76-4.54) for NPS 4]. CONCLUSION: The present study demonstrates that the NPS could independently predict in-hospital mortality in STEMI. Prospective studies will be necessary to confirm the performance, clinical applicability and practicality of the NPS for in-hospital mortality in STEMI.
Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Prognóstico , Volume Sistólico , Estudos Prospectivos , Mortalidade Hospitalar , Função Ventricular EsquerdaRESUMO
There is a lack of evidence regarding the short-term predictive value of serum albumin to creatinine ratio (sACR) in patients with ST-segment elevation myocardial infarction (STEMI). This study aims to investigate the relationship between sACR and short-term outcomes in these patients. We retrospectively enrolled 3057 patients with STEMI who underwent primary percutaneous coronary interventions (PCI) (median age was 58 years, and 74.3% were male). In-hospital mortality occurred in 114 (3.7%) patients. Contrast-induced nephropathy (CIN) was reported in 381 (12.4%) patients. During a 30-day follow-up, stent thrombosis (ST) occurred in 28 (.9%) patients and 30-day death in 147 (4.8%) patients. Multivariable logistic regression analysis reported that sACR was inversely associated with 30-day mortality (adjusted odds ratio (aOR): .51, 95% confidence interval (CI) .31-.82, P < .001). The sACR was also inversely associated with in-hospital mortality (aOR: .71, 95% CI .56-.90, P = .009), CIN (aOR: .60, 95% CI .52-.68, P < .001), congestive heart failure (CHF) (aOR: .64, 95% CI .47-.87, P = .007), and ST (aOR .61, 95% CI .41-.92, P = .001) at 30 days. Our findings suggest that sACR is inversely associated with short-term clinical outcomes in patients with STEMI after PCI.
Assuntos
Nefropatias , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Creatinina , Feminino , Humanos , Nefropatias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica , Resultado do TratamentoRESUMO
Nose bleeding is a common situation seen in otorhinolaryngological practices. One of the greatest risk factors in nose bleeding is the use of anticoagulant medicine. With the medicine developed in recent years, the risk of nose bleeding due to the frequent use of anticoagulant and antiagregant is gradually increasing.The purpose of this study is to determine the effects of especially new-generation anticoagulants on nose bleeding. In addition, the use and complications of new-generation anticoagulants and antiagregants have been compiled in light of information obtained from the literature.Three hundred forty patients whose follow-up is conducted by the cardiology department and who use oral antithrombocytic medicine have been included in the study. It has been determined that 15% of these patients use new-generation oral anticoagulants (Rivaroksaban, apiksaban, dabigatran, danaparoid) and the other patients are treated with conventional antithrombocytic treatment (Aspirin, Warfarin, Enoksaparin sodium). The rate of nose bleeding in patients who use classical anticoagulants has been observed to be 28%. In 30 of these patients who had nose bleeding, while cauterization and buffering by otorhinolaryngology specialists, major intervention has not been necessary for any of the patients. While bleeding has been observed in 26% of the patients who use new-generation anticoagulants, bleeding that required operational intervention has taken place in 2 patients. Bleedings have been stopped surgically through a large number of cauterization and buffering.While the new-generation anticoagulants cause lower rate of bleeding, it has been observed that controlling these bleedings is more difficult.
Assuntos
Anticoagulantes/efeitos adversos , Epistaxe/induzido quimicamente , Epistaxe/epidemiologia , Procedimentos Cirúrgicos Otorrinolaringológicos , Assistência Perioperatória , Epistaxe/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: SYNTAX score (SXscore) has been developed to assess the severity and complexity of coronary artery disease. The aim of this study was to evaluate whether baseline SXscore was associated with contrast induced nephropathy (CIN) after primary percutaneous coronary intervention (p-PCI) in patients with ST-elevation myocardial infarction (STEMI). Secondarily we aimed to investigate the relation of the severity of CIN to long term prognosis. METHODS: We retrospectively enrolled 1893 patients with STEMI treated by p-PCI. We prospectively followed up the patients for a mean duration of 45 months. The patients were grouped according to the development of no nephropathy (grade 0, n: 1634), mild nephropathy (grade 1, n: 153) or severe nephropathy (grade 2, n: 106). RESULTS: SXscore was significantly higher (19.4±5.9 vs 15.6±4.8, p<0.001) in patients with CIN (grades 1 and 2) compared to those without CIN. SXscore was higher in patients with grade 2 CIN compared to those with grade 1 CIN (18.5±5.7 vs 20.7±5.9, p<0.001). In the multivariate analysis, SXscore was identified as an independent predictor of CIN (for one unit increment, OR: 1.06, 95% CI: 1.01-1.14, p=0.006). At long-term follow-up, death (p<0.001), stroke (p=0.006), reinfarction (p=0.024) and permanent HD requirement (p<0.001) were most frequent in grade 2 nephropathy group. HD was associated with very high in-hospital (60%) and long-term (83.3%) mortality rates. CONCLUSIONS: SXscore is an independent predictor of development and severity of CIN after p-PCI. CIN is associated with poor prognosis during both early and late postinfarction period.
Assuntos
Meios de Contraste/efeitos adversos , Nefropatias/diagnóstico , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/tendências , Índice de Gravidade de Doença , Idoso , Feminino , Seguimentos , Humanos , Nefropatias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Pathologic calcium deposition may be observed in the valve leaflets, valvular annulus, pericardial scar areas in chronic constructive pericarditis, and myocardial tissue. A direct x-ray may reveal the area of calcification in any of these tissues. The most common cause of myocardial calcification is myocardial infarction (MI) in which calcium accumulates in the infarcted tissue during myocardial healing process. The authors present a case of diffuse myocardial calcification located in the left ventricular apical aneurysm in a patient who had an MI 24 years ago, together with a diagnostic and therapeutic approach.
Assuntos
Calcinose/diagnóstico , Aneurisma Coronário/diagnóstico , Ventrículos do Coração/patologia , Idoso , Calcinose/tratamento farmacológico , Aneurisma Coronário/tratamento farmacológico , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Mitral regurgitation (MR) increases mortality in dilated cardiomyopathy (DCM). We investigated the prevalence of functional MR in non-ischemic DCM patients with narrow QRS intervals and its association with papillary muscle dyssynchrony. METHODS: Ninety-three patients were enrolled consecutively in this cross-sectional study. Patients were evaluated for the presence of intraventricular (DYS Sep-Lat Sys) and papillary muscle (DYS Inter PAP Sys) systolic dyssynchrony using tissue Doppler echocardiographic imaging (TDI). Two-dimensional and Doppler echocardiography were used for quantification of MR. Statistical analyses were performed using unpaired t test, Mann-Whitney U test, correlation and logistic regression analyses. RESULTS: Thirty-seven patients (39%) had significant DYS Sep-Lat Sys and 25 patients (26%) had DYS Inter PAP Sys. Patients with DYS Inter PAP Sys had lower basal septum systolic (p=0.007) and late diastolic velocities (p=0.049), greater MR volume (p=0.01), effective regurgitant orifice (ERO) (p=0.01), and E/A ratios (p=0.03) than the patients without DYS Inter PAP Sys. Fifty-five patients with narrow QRS intervals were also evaluated for DYS Inter PAP Sys. Patients with DYS Inter PAP Sys and narrow QRS had lower basal septum TDI peak systolic velocities (p=0.038), higher MR volume (p=0.03) and ERO (p=0.03). Logistic regression analysis revealed that NYHA Class III-IV (OR=6.4, 95% CI: 1.1-37.1, p=0.038) and DYS Inter PAP Sys (OR=9.5, 95% CI: 1.17-75.78, p=0.034) were the independent predictors of functional MR >20 ml. CONCLUSION: Papillary muscle systolic dyssynchrony is common and correlated with functional MR in non-ischemic DCM patients with sinus rhythm and narrow QRS. Papillary muscle systolic dyssynchrony may help predict patients who will benefit from cardiac resynchronization therapy.
Assuntos
Cardiomiopatia Dilatada/complicações , Sistema de Condução Cardíaco/fisiopatologia , Insuficiência da Valva Mitral/complicações , Músculos Papilares/fisiopatologia , Adulto , Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Cardiomiopatia Dilatada/terapia , Estudos Transversais , Ecocardiografia Doppler , Feminino , Humanos , Modelos Logísticos , Masculino , Insuficiência da Valva Mitral/terapia , Índice de Gravidade de DoençaRESUMO
Discrete membraneous subaortic stenosis is an uncommon cause of left ventricular outflow tract obstruction. Although its relationship to infective endocarditis is well defined, the expected site of vegetation is over the aortic valve. We report on a 46-year-old man who had a discrete membranous subaortic stenosis, complicated with infective endocarditis, in which the vegetation was over the subaortic membrane and the aortic valve was spared. To our knowledge, this is the first reported case of that entity.
Assuntos
Estenose Aórtica Subvalvar/complicações , Aortite/complicações , Endocardite/complicações , Antibacterianos/uso terapêutico , Estenose Aórtica Subvalvar/tratamento farmacológico , Aortite/tratamento farmacológico , Endocardite/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
We report herein a 20-year-old male who has apical myocardial infarction due to suturing of the distal left anterior descending artery and late ventricular septal defect after penetrating cardiac trauma repair.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estenose Coronária/etiologia , Traumatismos Cardíacos/cirurgia , Comunicação Interventricular/etiologia , Doença Iatrogênica , Ferimentos Perfurantes/cirurgia , Adulto , Angiografia Coronária , Estenose Coronária/diagnóstico , Estenose Coronária/cirurgia , Ecocardiografia , Imagem do Acúmulo Cardíaco de Comporta , Traumatismos Cardíacos/diagnóstico , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/cirurgia , Humanos , Masculino , Revascularização Miocárdica , Reoperação , Ferimentos Perfurantes/diagnósticoRESUMO
UNLABELLED: Coronary fractional flow reserve (FFR) as an invasive, and dobutamine stress echocardiography (DSE) as a noninvasive technique were used to detect critical coronary stenosis. This study was undertaken to assess correlation between these two techniques by using tissue Doppler, strain rate (SR), and strain imaging (S). METHODS: In 17 patients (aged 54.9+/-12.6, 4 F), a total of 22 vessels were studied. On dobutamine stress echocardiography, baseline and peak systolic (Sm), early (Em) and late (Am) diastolic myocardial velocities, SR and S were recorded from parasternal view (mid-posterior segment) for radial and apical view (mid-septum) for longitudinal deformation. Then coronary FFR was performed by using intracoronary adenosine infusion, and the value of < or = 0.75 was accepted as critical coronary stenosis. RESULTS: FFR was found to be significant in 10 vessels (FFR critical). Baseline Sm, Em/Am, SR, S values, and peak Em/Am, SR, S values were similar between critical or noncritical FFR groups. Baseline Sm and Em, and change between baseline and peak Sm and S were significantly higher in noncritical FFR group (p < 0.01, < 0.05, < 0.001, < 0.001, respectively). In all vessels, FFR after adenosine infusion showed a poor correlation with WMSI, Em, Am, Em/Am values, and the change in SR values (r = -0.22, 0.16, -0.14, 0.21, 18, respectively) showed a good correlation with the change in S (r = 0.51; p = 0.014), and a very good correlation with the change in Sm values (r = 0.77; p < 0.001) during DSE. When FFR values at left coronary system were analyzed for longitudinal SR and S values, it had a mild correlation with SR (r = 0.47, p = 0.044) and a good correlation with S (r = 0.66, p = 0.002). CONCLUSION: The quantification of regional myocardial deformation by using DSE rather than the motion would be more appropriate in detecting the ischemic dysfunctional segment supplied by the critical coronary stenosis. Strain measurement during the dobutamine infusion may provide an information on the FFR results of the culprit vessel.
Assuntos
Cateterismo Cardíaco , Cardiotônicos/administração & dosagem , Estenose Coronária/diagnóstico , Vasos Coronários/fisiopatologia , Dobutamina/administração & dosagem , Ecocardiografia Doppler em Cores , Ecocardiografia sob Estresse/métodos , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Velocidade do Fluxo Sanguíneo/fisiologia , Circulação Coronária/efeitos dos fármacos , Circulação Coronária/fisiologia , Estenose Coronária/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
Single atrium (SA) is a complex cardiac anomaly and generally a component of certain congenital syndromes. It is extremely rare for SA to be observed as an isolated defect. We report here a 13-year-old male patient with SA as an isolated cardiac defect, successfully corrected by surgery.
Assuntos
Anormalidades Múltiplas/cirurgia , Átrios do Coração/anormalidades , Cardiopatias Congênitas/cirurgia , Valva Mitral/anormalidades , Estenose da Valva Pulmonar/cirurgia , Veia Cava Superior/anormalidades , Anormalidades Múltiplas/diagnóstico por imagem , Adolescente , Procedimentos Cirúrgicos Cardíacos/métodos , Seguimentos , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Masculino , Estenose da Valva Pulmonar/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento , Ultrassonografia DopplerAssuntos
Neoplasias Cardíacas/complicações , Hipertensão Pulmonar/etiologia , Mixoma/complicações , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Átrios do Coração , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Pessoa de Meia-Idade , Mixoma/diagnóstico por imagem , Pressão Propulsora Pulmonar , Índice de Gravidade de DoençaRESUMO
A discrete subaortic membrane is an uncommon cause of left ventricular outflow tract (LVOT) obstruction in patients of advanced age. Here, a significant LVOT obstruction caused by a discrete membrane is reported in a 64-year-old woman. On echocardiographic examination the membrane had a cystic appearance. To the present authors' knowledge, this is the first reported case of a cystic subaortic membrane.