RESUMO
Coronary chronic total occlusions (CTOs) are known to cause significant patient morbidity. Over the past several years, the techniques and devices for treating these CTOs have advanced tremendously. The interventional management of CTOs within previously placed coronary stents, however, remains challenging. Here, we present a case of an in-stent restenosis of the right coronary artery CTO bypassed using a controlled subintimal dissection re-entry technique via antegrade approach creating side-by-side stents.
Assuntos
Oclusão Coronária/terapia , Reestenose Coronária/diagnóstico , Reestenose Coronária/terapia , Falha de Prótese , Stents/efeitos adversos , Doença Crônica , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico por imagem , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Retratamento/métodos , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
Takotsubo cardiomyopathy (TTC), also known as transient apical ballooning syndrome or stress-induced cardiomyopathy, is a distinctive reversible condition often affecting postmenopausal women after a stressful event. It is characterized by sudden temporary systolic dysfunction of the apical and/or mid-segments of the left ventricle. The underlying mechanisms have not yet been elucidated, but several hypotheses include catecholamine cardiotoxicity, microvascular dysfunction and coronary artery spasm. We conducted a retrospective descriptive study on patients with the discharge diagnosis of TTC from 2003 to 2012 at Danbury Hospital, Danbury, Conn., USA. A total of 78 patients met the Modified Mayo Criteria for the Diagnosis of TTC and were included in the study. Clinical characteristics at baseline, past surgical and medical history including psychiatric records were reviewed and recorded. The mean age was 70.5 ± 14 years, 87% (n = 68) were women, of which 11.7% (n = 8) were aged ≤55 years. Depression was present in 20.5% (n = 16) of the patients and anxiety in 30.8% (n = 24). Twenty-one patients (27.3%) reported a preceding emotional stressful event and 31 (40.3%) had a preceding physical stressor. Fifty patients (64.1%) presented with chest pain, 28 (35.9%) had ST-segment elevation upon admission and 5 (6.3%) died during their hospital stay. TTC is becoming an increasingly recognized condition and clinicians should include it in the differential diagnosis of patients presenting with a suspected acute coronary syndrome. It is frequent in postmenopausal women with preceding physical or emotional stress and overall prognosis is good among patients who survive the initial acute phase of heart failure.
Assuntos
Cardiomiopatia de Takotsubo/etiologia , Idoso , Angina Pectoris/etiologia , Fibrilação Atrial/etiologia , Biomarcadores/metabolismo , Dispneia/etiologia , Eletrocardiografia , Feminino , Humanos , Tempo de Internação , Masculino , Prognóstico , Estudos Retrospectivos , Estresse Psicológico/complicações , Volume Sistólico/fisiologia , Cardiomiopatia de Takotsubo/diagnósticoRESUMO
RATIONALE: The regenerative potential of the heart is insufficient to fully restore functioning myocardium after injury, motivating the quest for a cell-based replacement strategy. Bone marrow-derived mesenchymal stem cells (MSCs) have the capacity for cardiac repair that appears to exceed their capacity for differentiation into cardiac myocytes. OBJECTIVE: Here, we test the hypothesis that bone marrow derived MSCs stimulate the proliferation and differentiation of endogenous cardiac stem cells (CSCs) as part of their regenerative repertoire. METHODS AND RESULTS: Female Yorkshire pigs (n=31) underwent experimental myocardial infarction (MI), and 3 days later, received transendocardial injections of allogeneic male bone marrow-derived MSCs, MSC concentrated conditioned medium (CCM), or placebo (Plasmalyte). A no-injection control group was also studied. MSCs engrafted and differentiated into cardiomyocytes and vascular structures. In addition, endogenous c-kit(+) CSCs increased 20-fold in MSC-treated animals versus controls (P<0.001), there was a 6-fold increase in GATA-4(+) CSCs in MSC versus control (P<0.001), and mitotic myocytes increased 4-fold (P=0.005). Porcine endomyocardial biopsies were harvested and plated as organotypic cultures in the presence or absence of MSC feeder layers. In vitro, MSCs stimulated c-kit(+) CSCs proliferation into enriched populations of adult cardioblasts that expressed Nkx2-5 and troponin I. CONCLUSIONS: MSCs stimulate host CSCs, a new mechanism of action underlying successful cell-based therapeutics.
Assuntos
Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Infarto do Miocárdio/patologia , Infarto do Miocárdio/terapia , Miócitos Cardíacos/citologia , Animais , Biópsia , Células da Medula Óssea/citologia , Células da Medula Óssea/metabolismo , Comunicação Celular/fisiologia , Diferenciação Celular/fisiologia , Divisão Celular/fisiologia , Células Cultivadas , Técnicas de Cocultura , Vasos Coronários/citologia , Vasos Coronários/fisiologia , Meios de Cultivo Condicionados/farmacologia , Feminino , Proteínas de Fluorescência Verde/genética , Células-Tronco Mesenquimais/metabolismo , Miócitos Cardíacos/metabolismo , Proteínas Proto-Oncogênicas c-kit/metabolismo , Regeneração/fisiologia , Sus scrofaRESUMO
BACKGROUND: There is paucity of data regarding conduction abnormalities in the Hispanic population with systolic heart failure (HF). We aimed to evaluate the prevalence of electrocardiogram (ECG) abnormalities in a systolic HF population, with attention to the Hispanic population. METHODS: A cross sectional study of 926 patients enrolled in a systolic HF disease management program. ECGS were obtained in patients with an ejection fraction (EF) ≤ 40% by echocardiography at enrollment. Univariate and multivariate analysis adjusted by ethnicities was performed. RESULTS: White patients exhibited higher prevalence of atrial fibrillation (14.7%) than black patients (8.0%, P = 0.01) whereas Hispanics presented higher prevalence of paced rhythm (14.3% in Hispanics vs. 6.5% in whites and 5.2% in blacks, P<0.01 for both comparisons), higher prevalence of left bundle branch block (LBBB, 14.5% in Hispanics vs. 8.8% in whites and 5.8% in blacks, P = 0.002) and increased frequency of abnormal QT intervals (76.7% in Hispanics) than whites (59.6%) and blacks (69%) patients (P< 0.01 for both comparisons). A QRS interval greater than 120 ms was less prevalent among blacks (15.8% vs. 26.0% in whites and 25.3% in Hispanics, P = 0.01 for both comparisons). Univariate and multivariate analysis disclosed no influence of other characteristics (age, sex, coronary artery disease, hypertension, ejection fraction, medications) in the ECG findings. CONCLUSIONS: Hispanics with Systolic HF presented with increased prevalence of paced rhythm, LBBB, and abnormal QT intervals. Attention should be addressed to these ECG variations to recommend additional guidance for therapeutic interventions and provide important prognostic information.
Assuntos
Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Insuficiência Cardíaca Sistólica/etnologia , Insuficiência Cardíaca Sistólica/fisiopatologia , Grupos Raciais/estatística & dados numéricos , Análise de Variância , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Fatores SexuaisRESUMO
The mechanism(s) underlying cardiac reparative effects of bone marrow-derived mesenchymal stem cells (MSC) remain highly controversial. Here we tested the hypothesis that MSCs regenerate chronically infarcted myocardium through mechanisms comprising long-term engraftment and trilineage differentiation. Twelve weeks after myocardial infarction, female swine received catheter-based transendocardial injections of either placebo (n = 4) or male allogeneic MSCs (200 million; n = 6). Animals underwent serial cardiac magnetic resonance imaging, and in vivo cell fate was determined by co-localization of Y-chromosome (Y(pos)) cells with markers of cardiac, vascular muscle, and endothelial lineages. MSCs engrafted in infarct and border zones and differentiated into cardiomyocytes as ascertained by co-localization with GATA-4, Nkx2.5, and alpha-sarcomeric actin. In addition, Y(pos) MSCs exhibited vascular smooth muscle and endothelial cell differentiation, contributing to large and small vessel formation. Infarct size was reduced from 19.3 +/- 1.7% to 13.9 +/- 2.0% (P < 0.001), and ejection fraction (EF) increased from 35.0 +/- 1.7% to 41.3 +/- 2.7% (P < 0.05) in MSC but not placebo pigs over 12 weeks. This was accompanied by increases in regional contractility and myocardial blood flow (MBF), particularly in the infarct border zone. Importantly, MSC engraftment correlated with functional recovery in contractility (R = 0.85, P < 0.05) and MBF (R = 0.76, P < 0.01). Together these findings demonstrate long-term MSC survival, engraftment, and trilineage differentiation following transplantation into chronically scarred myocardium. MSCs are an adult stem cell with the capacity for cardiomyogenesis and vasculogenesis which contribute, at least in part, to their ability to repair chronically scarred myocardium.
Assuntos
Cardiomiopatias/patologia , Isquemia/patologia , Células-Tronco Mesenquimais/citologia , Cromossomo Y/metabolismo , Actinas/metabolismo , Animais , Células da Medula Óssea , Diferenciação Celular , Sobrevivência Celular , Feminino , Fator de Transcrição GATA4/metabolismo , Proteína Homeobox Nkx-2.5 , Proteínas de Homeodomínio/metabolismo , Masculino , Placebos , Suínos , Porco Miniatura , Fatores de Transcrição/metabolismoRESUMO
OBJECTIVES: This study assessed if patients enrolled in a heart failure disease management program (HFDMP) reach the JNC VII target goals for blood pressure (BP) control, eliminate disparities in hypertension control by race/ ethnicity and the impact BP control has on survival. METHODS: Patients (N = 898) with an ejection fraction <40% were enrolled into two HFDMPs and screened for hypertension, defined as BP > 130/80. RESULTS: Mean baseline systolic BP (SBP) 132 ± 25.5 mm Hg and diastolic BP (DBP) 79 ± 16.8 mm Hg. Final mean SBP decreased to 129.6 mm Hg, DBP 77.6 mm Hg. Whites had the highest rate of achieving BP goals. Mortality reduction was associated with minority race, history of hypertension, increase ejection fraction and statin use. CONCLUSION: HFDMPs are an effective way to reduce BP in hypertensive patients. Disparities by race and ethnicity were not seen after adjustment for disease modifiers. There was no mortality difference in those who reached BP goal.
Assuntos
Negro ou Afro-Americano , Disparidades em Assistência à Saúde/etnologia , Insuficiência Cardíaca/tratamento farmacológico , Hispânico ou Latino , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Idoso , Pressão Sanguínea , Feminino , Florida , Insuficiência Cardíaca/complicações , Humanos , Hipertensão/complicações , Hipertensão/mortalidade , Modelos Logísticos , Louisiana , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , População BrancaAssuntos
Próteses Valvulares Cardíacas/efeitos adversos , Trombose/complicações , Trombose/diagnóstico por imagem , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia , Valva Tricúspide/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Falha de Prótese , Resultado do Tratamento , Valva Tricúspide/cirurgiaRESUMO
We observed left ventricular microbubbles associated with Impella support in the setting of a high-risk coronary intervention. Left ventricular microbubbles may indicate exaggerated shear stress and cavitation phenomenon, potentially leading to hemolysis.
Assuntos
Coração Auxiliar , Hemólise , Microbolhas , Idoso , Ventrículos do Coração/diagnóstico por imagem , Coração Auxiliar/efeitos adversos , Humanos , MasculinoRESUMO
PURPOSE: The pullback gradient technique is commonly used to evaluate pulmonic stenosis; however, it only represents a one-time measurement of valvular stenosis. Instead, simultaneous peak-to-peak gradients account for the data variability being best suited to discern the severity of the stenosis, but requires two different venous accesses. Here, we demonstrate the feasibility and high fidelity hemodynamic tracings of a new technique for evaluation of pulmonary valve stenosis by using a single venous access. METHODS: We present a patient scenario suggesting pulmonic stenosis. Given the possible therapeutic intervention, we decided to use a single large bore (8-French) venous access. RESULTS: Simultaneous peak-to-peak gradients were obtained from high fidelity hemodynamic tracings measured using two small-size catheters located in the right ventricle (RV) and pulmonary artery (PA), respectively. The procedure had no complications. CONCLUSIONS: We present a technique using single venous access for simultaneous RV and PA pressure measurement that is easy to perform and, importantly, it may be safer than exposing the patient to multiple venous accesses.
Assuntos
Pressão Arterial , Cateterismo Cardíaco/métodos , Cateterismo de Swan-Ganz/métodos , Artéria Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico , Função Ventricular Direita , Pressão Ventricular , Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Cateterismo de Swan-Ganz/instrumentação , Ecocardiografia Doppler em Cores , Desenho de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estenose da Valva Pulmonar/fisiopatologiaRESUMO
Ascending Aortic pseudoaneurysms (AAP) are often formed as a result of prior thoracic surgery. In patients with large AAP, surgical correction is the established therapy. However, a group of patients are not suitable surgical candidates because of advanced age or multiple comorbidities. Instead, endovascular approach represents a viable option in this population. Here, we review the literature of the surgical and trans-catheter therapy for AAP. Additionally, we complement the review with a case presentation of a prohibitive surgical risk case that was treated with endovascular options including an unsuccessful septal occluder deployment, but final excellent angiographic AAP exclusion with coil embolization.
Assuntos
Falso Aneurisma/terapia , Aneurisma Aórtico/terapia , Embolização Terapêutica , Procedimentos Endovasculares/métodos , Falso Aneurisma/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: Revascularization of the peripheral arteries remains technically challenging. By decreasing the volume of the atherosclerotic plaque, debulking procedures may confer superior primary patency after revascularization. AIMS: To assess the impact of atherectomy on primary patency rates at 12 months compared to balloon angioplasty and/or stent placement alone in patients with infrainguinal arterial disease. METHODS: A database search for "directional," "orbital," "rotational," and "laser atherectomy" in peripheral arterial disease (PAD) was performed. Studies were screened according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) critical appraisal tool and summarized by population, methodology, and outcomes (primary patency and major adverse events). RESULTS: Only two randomized studies were found. Most of the data were obtained from single-arm studies and registries. The primary patency with directional atherectomy approaches 60% at 12 months as a stand-alone technique, whereas orbital atherectomy in conjunction with balloon angioplasty and stenting achieved primary patency rates of 90%. Laser atherectomy is universally employed with balloon angioplasty and stenting for in-stent restenosis lesions with a primary patency rate of 64%. Although there are data for the safe use of rotational atherectomy, robust data to support its effectiveness are lacking. The combination of drug-coated balloons and atherectomy for the treatment of heavily calcified lesions in patients with critical limb ischemia is under evaluation. CONCLUSION: Despite the successful procedural outcomes reported in clinical registries, the available data do not support the use of atherectomy alone in PAD. Larger randomized controlled studies are warranted to define its role in contemporary endovascular practice.
Assuntos
Aterectomia/métodos , Canal Inguinal/irrigação sanguínea , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/terapia , Grau de Desobstrução Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão , Terapia Combinada , Bases de Dados Factuais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do TratamentoRESUMO
BACKGROUND: The left renal vein (LRV) entrapment syndrome is a rare condition. Here, we present a 22-year-old female presenting with recurrent nausea, vomiting, weight loss and evidence of the LRV compression by the superior mesenteric artery and the abdominal aorta. Hemodynamic assessment confirmed a pressure gradient of >3 mmHg between the LRV and the inferior vena cava. A self-expandable stent was then deployed in the LRV. Subsequent clinical follow-ups ensure full resolution of the patient's symptoms. METHODS: Multilingual search was performed in PubMed, Google scholar, Scielo, Korea Med and EMBASE with the medical subheadings "nutcracker syndrome", "nutcracker phenomenon" and "compression vein syndrome" from January 1983 to September 2013. RESULTS: Review of the literature exhibited a plethora of individual case reports (291 citations). Importantly, few retrospective case series [5] comprising a total of 157 patients included successful endovascular interventions. CONCLUSION: Endovascular therapy for nutcracker syndrome represents a safe and suitable treatment option, but prospective studies are needed to confirm these data.
Assuntos
Aorta Abdominal/cirurgia , Síndrome do Quebra-Nozes/cirurgia , Veias Renais/cirurgia , Aorta Abdominal/diagnóstico por imagem , Procedimentos Endovasculares , Humanos , Masculino , Radiografia , Síndrome do Quebra-Nozes/diagnóstico , Estudos Retrospectivos , Risco , Adulto JovemRESUMO
BACKGROUND: The safety and efficacy of endovascular therapies for ascending aortic pseudoaneurysms (AAPs) are still controversial. METHODS: We report an endovascular correction of an AAP in a high-risk surgical patient and present the results of a literature review focusing on AAP treatment strategies. A multilingual search of AAP therapy was performed with limiting dates of January 1980 to May 2014. The studies were classified by intervention. RESULTS: A 79-year-old male with a 9 × 10 × 7 cm AAP in the anterior mediastinum was considered too high risk for surgery. An endovascular closure with a 12 mm Amplatzer septal occluder device (St. Jude Medical) was performed, and computed tomography angiography at 3-month follow-up exhibited a thrombosed AAP with minimal residual shunt. In our literature search, we identified 355 cases of AAPs, mostly case reports (91.5%) and a few patient series (8.5%). Surgical correction accounted for 73.8% of the cases, 5% of the patients were conservatively treated or considered too critically ill for any intervention, and 21.2% were treated with endovascular techniques. The most commonly reported endovascular techniques were stent grafts (9.8%) and septal occluder devices (9.8%). CONCLUSION: Although endovascular closure of AAPs with off-label devices is a reliable option for controlling the expansion and symptoms in high-risk surgical patients, solid data on survival are lacking. Efforts to promote discussion within the heart team to expand the application of endovascular techniques can provide groundbreaking evidence to support the use of endovascular techniques as guideline therapy when facing these complicated cases.
RESUMO
The process of vascular aging encompasses alterations in the function of endothelial (ECs) and vascular smooth muscle cells (VSMCs) via oxidation, inflammation, cell senescence and epigenetic modifications, increasing the probability of atherosclerosis. Aged vessels exhibit decreased endothelial antithrombogenic properties, increased reactive oxygen species generation, inflammatory signaling and migration of VSMCs to the subintimal space, impaired angiogenesis and increased elastin degradation. The key initiating step in atherogenesis is subendothelial accumulation of apolipoprotein B-containing low-density lipoproteins resulting in activation of ECs and recruitment of monocytes. Activated ECs secrete 'chemokines' that interact with cognate chemokine receptors on monocytes and promote directional migration. Recruitment of immune cells establishes a proinflammatory status, further causing elevated oxidative stress, which in turn triggers a series of events including apoptotic or necrotic death of vascular and nonvascular cells. Increased oxidative stress is also considered to be a key factor in mechanisms of aging-associated changes in tissue integrity and function. Experimental evidence indicates that insulin-like growth factor-1 exerts antioxidant, anti-inflammatory and pro-survival effects on the vasculature, reducing atherosclerotic plaque burden and promoting features of atherosclerotic plaque stability.
Assuntos
Envelhecimento/fisiologia , Aterosclerose/fisiopatologia , Células Endoteliais/fisiologia , Fator de Crescimento Insulin-Like I/metabolismo , Músculo Liso Vascular/fisiologia , Miócitos de Músculo Liso/fisiologia , Proteínas Adaptadoras de Transdução de Sinal/fisiologia , Animais , Anti-Inflamatórios/farmacologia , Apolipoproteínas E/deficiência , Movimento Celular , Senescência Celular , Endotelina-1/fisiologia , Humanos , Hipertensão/fisiopatologia , Lipoproteínas LDL , Camundongos , Monócitos , Estresse Oxidativo , Placa Aterosclerótica/prevenção & controle , Receptor IGF Tipo 1/metabolismo , RegeneraçãoRESUMO
OBJECTIVE: To determine the prolonged effect of Hurricane Katrina on the incidence and timing of acute myocardial infarction (AMI) in the city of New Orleans. PATIENTS AND METHODS: Our study population consisted of 1476 patients with AMI before (August 29, 1999, to August 28, 2005) and after (February 14, 2006, to February 13, 2012) Hurricane Katrina at Tulane University Health Sciences Center to determine post-Katrina alterations in the occurrence and timing of AMI. RESULTS: Compared with pre-Katrina values, there was a more than 3-fold increase in the percentage of admissions for AMI during the 6 years after Hurricane Katrina (P<.001). The percentage of admissions for AMI after Hurricane Katrina increased significantly on nights (P<.001) and weekends (P<.001) and decreased significantly on mornings (P<.001), Mondays (P<.001), and weekdays (P<.001). Patients with AMI after Hurricane Katrina also had significantly higher rates of psychiatric comorbidities (P=.01), smoking (P<.001), lack of health insurance (P<.05), and unemployment (P<.001). CONCLUSION: These results indicate that the effect of natural disasters on the occurrence of AMI may persist for at least a 6-year period and may be related to various factors including population shifts, alterations in the health care system, and the effects of chronic stress and associated behaviors.
Assuntos
Síndrome Coronariana Aguda/epidemiologia , Tempestades Ciclônicas , Desastres , Hospitalização/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/psicologia , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/psicologia , Nova Orleans , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Análise de Sobrevida , Fatores de TempoRESUMO
Coronary artery spasm has been reported during adenosine stress testing. Herein, we describe a transient ST-segment elevation following adenosine therapy for supraventricular tachycardia. A 38-year-old male presented to the emergency department with palpitations. Electrocardiogram showed supraventricular tachycardia with short RP interval. Vagal maneuvers were unsuccessful. Adenosine was then administered in two successive injections of 6 and 12 mg dosages, respectively. A subsequent 12-lead electrocardiogram revealed ST-segment elevation in inferior leads with reciprocal changes. Coronary angiography disclosed nonobstructive coronary disease. A postprocedure electrocardiogram exhibited normal sinus rhythm with nonspecific T wave abnormalities. Cardiac biomarkers were elevated with a peak troponin I of 0.32. Echocardiogram depicted bicuspid aortic valve and normal systolic function. Electrophysiological study revealed a concealed left accessory pathway and successful radiofrequency ablation was performed. Given the dynamic changes in the electrocardiogram, we hypothesize that this event was most likely a coronary vasospasm. The mechanism of coronary spasm following adenosine injection remains uncertain. Potential mediators include KATP channels and adenosine-2 receptors.
RESUMO
Off-label "double-wire" technique for closure of large-bore vascular access has been reported in the setting of percutaneous aortic valvuloplasty. We present 5 cases of high-risk percutaneous coronary intervention (HRPCI) supported by a 2.5 LP Impella assist device with 13 and 14 Fr size femoral access. Following successful HRPCI, vessel closure was complicated by unsuccessful deployment of a suture-mediated closure device. Subsequently, deployment of two successive collagen-based closure devices with a "double-wire" technique was performed. Our cases warrant further studies to test the feasibility of using double-closure device as an alternative for vessel closure when left ventricular assist devices are needed to support HRPCI.
Assuntos
Cardiomiopatias/terapia , Doença da Artéria Coronariana/terapia , Coração Auxiliar , Intervenção Coronária Percutânea/métodos , Idoso , Angiografia , Técnicas Hemostáticas , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Suturas , Resultado do TratamentoRESUMO
The goal of the study was to assess longitudinal changes in quality of life among patients who screened positive for depression and patients who did not enroll in an outpatient heart failure disease management program (HFDMP). Patients with an ejection fraction ≤40% and clinical signs and symptoms of heart failure were enrolled over 11 months from August 2007 to July 2008. Study participants (n=314) were divided at baseline into "depressed" (9-Question Patient Health Questionnaire [PHQ-9] ≥10) and "nondepressed" (PHQ-9 <10) groups. The two cohort groups had quality of life assessed by the Minnesota Living With Heart Failure Questionnaire at baseline and at 1 year while enrolled in the HFDMP. Both groups showed improved quality of life scores, with the depressed group experiencing a greater mean score decrease (14.4 vs 10.8 for nondepressed patients; P<.01). Both patients who screened positive for depression and those who did not enroll in an HFDMP improved their quality of life scores, with depressed patients experiencing a statistically significant greater mean score reduction (better quality of life).
Assuntos
Depressão/psicologia , Insuficiência Cardíaca/psicologia , Qualidade de Vida/psicologia , Depressão/epidemiologia , Depressão/etiologia , Gerenciamento Clínico , Feminino , República da Geórgia/epidemiologia , Indicadores Básicos de Saúde , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais , Estudos Prospectivos , Psicometria , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de TempoRESUMO
Review of symptoms (ROS) is a time-honored tradition in medicine and has proved to be a case-finding maneuver in general medicine patients. The authors sought to investigate the prevalence of noncardiovascular symptoms in heart failure clinics by assessment of the ROS. Of the collected ROS, shortness of breath (SOB) represented the most frequent recalled symptom (8.6%), whereas fatigue (5.3%) was the most common noncardiac symptom. Multivariate regression analysis revealed that New York Heart Association class could, at least in part, explain the occurrence of SOB (R(2) =.4; P<.05). Importantly, alarm symptoms such as hemoptysis and bloody stools were present in <1% of the cohort. ROS evaluation remains a valuable tool for diagnostics; however, symptom-focused questionnaires should be routinely considered as a time-efficient strategy in the ambulatory specialty clinic.