RESUMO
Although exposure to particulate matter with aerodynamic diameters ≤ 2.5 µm (PM2.5) influences cardiovascular disease (CVD), its association with CVD-related hospitalizations of super-aged patients in Japan remains uncertain. We investigated the relationship between short-term PM2.5 exposure and CVD-related hospitalizations, lengths of hospital stays, and medical expenses. We analyzed the Japanese national database of patients with CVD (835,405) admitted to acute-care hospitals between 2012 and 2014. Patients with planned hospitalizations and those with missing PM2.5 exposure data were excluded. We classified the included patients into five quintiles based on their PM2.5 exposure: PM-5, -4, -3, -2, and -1 groups, in descending order of concentration. Compared with the PM-1 group, the other groups had higher hospitalization rates. The PM-3, -4, and -5 groups exhibited increased hospitalization durations and medical expenses, compared with the PM-1 group. Interestingly, the hospitalization period was longer for the ≥ 90-year-old group than for the ≤ 64-year-old group, yet the medical expenses were lower for the former group. Short-term PM2.5 exposure is associated with increased CVD-related hospitalizations, hospitalization durations, and medical expenses. The effects of incident CVDs were more marked in elderly than in younger patients. National PM2.5 concentrations should be reduced and the public should be aware of the risks.
Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Hospitalização/estatística & dados numéricos , Material Particulado/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/química , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/terapia , Monitoramento Ambiental/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Humanos , Incidência , Japão/epidemiologia , Pessoa de Meia-Idade , Tamanho da Partícula , Material Particulado/química , Prevalência , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricosRESUMO
The current guidelines recommend a minimum of 6 months of antithrombotic and antibiotic prophylaxis following septal occluding device placement for transcatheter closure of atrial septal defect. Full neoendothelialization is thought to be completed within 6 months of device implantation; however, there is no method available that can assess the level of neoendothelialization in vivo. This report therefore evaluates endothelialization in vivo and demonstrates that 6 months of postimplantation prophylactic therapy may not provide sufficient time for adequate endothelialization. Further investigations are warranted to determine the optimal duration of these treatments after atrial septal defect closure.
Assuntos
Angioscopia/métodos , Endotélio Vascular/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Idoso , Cateterismo Cardíaco , Feminino , Seguimentos , Comunicação Interatrial/diagnóstico , Humanos , Fatores de TempoRESUMO
Decreased Transthyretin (TTR) can be observed in heart failure patients with malnutrition evaluated by the Mini Nutritional Assessment (MNA). This study investigated whether a combination of different nutritional assessment methods would be useful for assessing prognosis in patients with acute decompensated heart failure (ADHF).This prospective study included 52 patients with ADHF (mean age, 71.1 ± 14.7 years; men 55.8%) who were admitted to our hospital between June 2012 and August 2013. On admission, nutritional status was evaluated according to levels of TTR and the MNA. Of 52 patients, 28 (53.8%) had TTR < 15 mg/dL, 39 (75.0%) had malnutrition or were at risk of malnutrition (MNA score ≤ 23.5), and 21 (40.4%) were categorized into group L (MNA score ≤ 23.5 and TTR < 15 mg/dL). Readmission due to worsening heart failure occurred in 12 patients (23.1%), and there were 4 (7.7%) allcause deaths. The 1-year event-free survival rates in group L and the remaining patients (group O) were 27.7% and 85.6%, respectively (P = 0.001). Using Cox multivariate analysis, group L also had a poorer prognosis (hazard ratio 4.35, 95% confidence interval 1.26-17.74, P = 0.020).MNA revealed that 75% of patients with ADHF had malnutrition or were at risk of malnutrition. The combination of low MNA and low TTR on admission can predict the prognosis of patients with ADHF.
Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Desnutrição/diagnóstico , Avaliação Nutricional , Admissão do Paciente , Pré-Albumina/metabolismo , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos ProspectivosRESUMO
We investigated the use of a catheter-based cryoablation system on atrioventricular (AV) junction ablation in dogs. In five dogs, the cryoablation catheter was introduced to the AV junction area in order to create transient high degree or complete AV block. Cryo-freezing energy was applied by lowering the temperature to -75 degrees C for five minutes as a single cycle. This cycle was repeated until significant impairment of the AV conduction appeared. Transient high degree and complete AV block was obtained in all five dogs without any adverse effects. The iceball formation was identified by intracardiac echocardiography. Ablation of the AV junction is effective with several freeze-thaw cycles using a transvenous catheter cryoablation system.