ABSTRACT
BACKGROUND: Sudden cardiac death (SCD) is the leading cause of death in maintenance hemodialysis (HD) patients, but there is little information about underlying risk factors. OBJECTIVES: Evaluate the association between clinical and echocardiographic variables with SCD on HD patients. METHODS: Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression. RESULTS: We followed 153 patients (50 ± 15 years, 58% men) for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index) there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023) and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028) showed independent association with SCD events. CONCLUSIONS: HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients.
Subject(s)
Death, Sudden, Cardiac/etiology , Echocardiography, Doppler , Heart Failure/complications , Hypertrophy, Left Ventricular/complications , Renal Dialysis/adverse effects , Adult , Aged , Case-Control Studies , Diabetes Complications , Female , Follow-Up Studies , Heart Atria/pathology , Humans , Male , Middle Aged , Myocardial Infarction/complications , Retrospective Studies , Risk FactorsABSTRACT
Right atrium aneurysms are entities which are rarely reported in cardiologic practice, especially in intrauterine life, and may be mistaken with pericardial effusion and Ebstein's anomaly. We show a review of the literature and illustrate with a case of prenatal diagnosis of right atrium aneurysm running through with hydropsy signs.
Subject(s)
Heart Aneurysm/complications , Hydrops Fetalis/etiology , Adult , Ebstein Anomaly/diagnostic imaging , Echocardiography , Fatal Outcome , Female , Heart Aneurysm/diagnostic imaging , Humans , Hydrops Fetalis/diagnostic imaging , Pregnancy , Ultrasonography, PrenatalABSTRACT
Atrial aneurysms involving the free wall or atrial appendage are rare entities in cardiology practice and may be associated with atrial arrhythmias or embolic phenomena. We review the literature and report a case of aneurysm of the right atrial appendage in a young adult, whose diagnosis was established with echocardiography after an episode of paroxysmal atrial flutter.
Subject(s)
Atrial Appendage/diagnostic imaging , Heart Aneurysm/diagnostic imaging , Adult , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Anticoagulants/therapeutic use , Echocardiography/methods , Heart Aneurysm/drug therapy , Humans , MaleABSTRACT
Abstract Background: Sudden cardiac death (SCD) is the leading cause of death in maintenance hemodialysis (HD) patients, but there is little information about underlying risk factors. Objectives: Evaluate the association between clinical and echocardiographic variables with SCD on HD patients. Methods: Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression. Results: We followed 153 patients (50 ± 15 years, 58% men) for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index) there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023) and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028) showed independent association with SCD events. Conclusions: HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients.
Resumo Fundamento: Morte súbita cardiovascular (MSC) é a principal causa de óbito nos pacientes em hemodiálise (HD) de manutenção, mas há escassa informação sobre os fatores de risco associados. Objetivos: Avaliar a associação entre parâmetros clínicos e ecodopplercardiográficos com MSC em pacientes em HD. Métodos: Estudo retrospectivo de caso-controle aninhado em pacientes em HD prospectivamente acompanhados. O desfecho primário foi MSC. As variáveis foram comparadas por teste t de Student, Mann-Whitney ou qui-quadrado, e preditores independentes foram evidenciados por análise de regressão logística multivariada. Resultados: Foram acompanhados 153 indivíduos (idade 50 ± 15 anos, 58% homens) por 23 ± 14 meses, período em que ocorreram 35 mortes, das quais 17 MSC. Comparados ao grupo controle (pareado para sexo, idade e índice de massa corpórea) não houve diferenças no tempo de tratamento por HD, parâmetros laboratoriais usuais, pressão arterial, tabagismo, uso de drogas cardioprotetoras, fração de ejeção, dimensões do ventrículo esquerdo e índices de função diastólica. Por outro lado, encontrou-se no grupo MSC maior prevalência de insuficiência cardíaca prévia, infarto agudo do miocárdio e diabetes; maior massa ventricular esquerda indexada, tamanho do átrio esquerdo e menor desempenho miocárdico global. Após análise multivariada, diabetes (OR = 2,6; IC = 1,3-7,5; p = 0,023) e massa ventricular esquerda indexada (OR = 1,04; IC = 1,01-1,08; p = 0,028) mostraram associação independente com a ocorrência de MSC. Conclusões: Pacientes em HD com diabetes mellitus e hipertrofia ventricular esquerda parecem ter o maior risco de MSC. Estratégias preventivas e terapêuticas devem ser estimuladas na abordagem desses fatores de risco para diminuir a ocorrência de MSC.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Echocardiography, Doppler , Renal Dialysis/adverse effects , Death, Sudden, Cardiac/etiology , Hypertrophy, Left Ventricular/complications , Heart Failure/complications , Case-Control Studies , Retrospective Studies , Risk Factors , Follow-Up Studies , Diabetes Complications , Heart Atria/pathology , Myocardial Infarction/complicationsSubject(s)
Humans , Female , Pregnancy , Infant, Newborn , Tachycardia/diagnostic imaging , Echocardiography , Digoxin/adverse effectsABSTRACT
Os aneurismas de átrio direito são entidades raramente relatadas na prática cardiológica, especialmente em vida intra-uterina, e podendo ser confundidos com derrame pericárdico e anomalia de Ebstein da valva tricúspide. Apresentamos revisão da literatura e ilustramos com caso de diagnóstico pré-natal de aneurisma de átrio direito cursando com sinais de hidropisia.
Subject(s)
Pregnancy , Adult , Humans , Female , Heart Aneurysm , Hydrops Fetalis/etiology , Hydrops Fetalis , Pregnancy Complications, Cardiovascular , Ultrasonography, Prenatal , Ebstein Anomaly , Echocardiography , Fatal Outcome , Heart Aneurysm/complicationsABSTRACT
Atrial aneurysms involving the free wall or atrial appendage are rare entities in cardiology practice and may be associated with atrial arrhythmias or embolic phenomena. We review the literature and report a case of aneurysm of the right atrial appendage in a young adult, whose diagnosis was established with echocardiography after an episode of paroxysmal atrial flutter
Subject(s)
Humans , Male , Adult , Atrial Appendage , Heart Aneurysm , Amiodarone , Anti-Arrhythmia Agents , Anticoagulants , Echocardiography , Heart AneurysmABSTRACT
Relata-se um caso de feto com taquicardia supraventricular sustentada, associada a hidropsia. Apos falha em se reverter a taquicardia com a digoxina, optou-se pela amiodarona. Embora esta ultima tenha se mostrado eficaz no controle da taquicardia, o feto nao tolerou o longo periodo em taquiarritmia e evoluiu para o obito