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1.
Artículo en Inglés | MEDLINE | ID: mdl-39317663

RESUMEN

AIM: Studies have demonstrated the importance of forward flow, and specifically of stroke volume (SV) and SV index (SVI), as prognostic markers in different cardiovascular diseases. Here we aimed to evaluate the association between SV and SVI thresholds and prognosis in patients with severe primary mitral regurgitation (MR). METHODS AND RESULTS: The association between either SV (<55, 55-70 and >70ml) or SVI (<30, 30-35 and >35mL/m²) thresholds and all-cause mortality and heart failure (HF) hospitalizations was examined in a retrospective analysis of 283 patients (60% male, median age 70 years, IQR 58-82) with severe primary MR, normal left ventricular size and systolic function and no other significant left-sided valvular abnormalities. Compared with normal values, SV<55ml was found to be associated with worse outcomes (HR 1.8, IQR 1.1-2.8, P=0.016), whereas SV between 55-70ml was not. A non-significant trend for worse outcomes was noted for SVI<35ml/m² compared with normal SVI. CONCLUSION: In patients with severe primary MR, SV<55ml was found to be associated with increased rates of HF hospitalization and all-cause mortality. This easily obtainable parameter may allow for better risk stratification of patients with primary MR.

2.
ESC Heart Fail ; 10(1): 601-615, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36380721

RESUMEN

AIMS: Clinical trials comparing LVADs vs. conservative therapy were performed before the availability of novel medications or used suboptimal medical therapy. This study aimed to report that long-term stabilization of patients entering a left ventricular assist device (LVAD) programme is possible with the use of aggressive conservative therapy. This is important because the excellent clinical stabilization provided by LVADs comes at the expense of significant complications. METHODS AND RESULTS: This study was a single-centre prospective evaluation of consecutive patients with advanced heart failure (HF) fulfilling criteria for LVAD implantation based on clinical and echocardiographic characteristics, cardiopulmonary exercise test, and right heart catheterization results. Their initial therapy included inotropes, thiamine, beta-blockers, digoxin, spironolactone, hydralazine, and nitrates followed by the introduction of novel HF therapies. Coronary revascularization and cardiac resynchronization therapy were performed when indicated, and all patients were closely followed at our outpatient clinic. During the study period, 28 patients were considered suitable for LVAD implantation (mean age 63 ± 10.8 years, 92% men, 78% ischaemic, median HF duration 4 years). Clinical stabilization was achieved and maintained in 21 patients (median follow-up 20 months, range 9-38 months). Compared with baseline evaluation, cardiac index increased from 2.05 (1.73-2.28) to 2.88 (2.63-3.55) L/min/m2 , left ventricular end-diastolic diameter decreased from 65.5 (62.4-66) to 58.3 (53.8-62.5) mm, and maximal oxygen consumption increased from 10.1 (9.2-11.3) to 16.1 (15.3-19) mL/kg/min. Three patients died and only four ultimately required LVAD implantation. CONCLUSIONS: Notwithstanding the small size of our cohort, our results suggest that LVAD implantation could be safely deferred in the majority of LVAD candidates.


Asunto(s)
Insuficiencia Cardíaca , Corazón Auxiliar , Masculino , Humanos , Persona de Mediana Edad , Anciano , Femenino , Tratamiento Conservador , Resultado del Tratamiento , Corazón Auxiliar/efectos adversos , Ecocardiografía
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