RESUMO
The usual assumption in direct dark matter searches is to consider only the spin-dependent or spin-independent scattering of dark matter particles. However, especially in models with light dark matter particles O(GeV/c^{2}), operators which carry additional powers of the momentum transfer q^{2} can become dominant. One such model based on asymmetric dark matter has been invoked to overcome discrepancies in helioseismology and an indication was found for a particle with a preferred mass of 3 GeV/c^{2} and a cross section of 10^{-37} cm^{2}. Recent data from the CRESST-II experiment, which uses cryogenic detectors based on CaWO_{4} to search for nuclear recoils induced by dark matter particles, are used to constrain these momentum-dependent models. The low energy threshold of 307 eV for nuclear recoils of the detector used, allows us to rule out the proposed best fit value above.
RESUMO
BACKGROUND: Compared to patients without a collateral supply, long-term cardiac mortality is reduced in patients with well-developed coronary collateral circulation (CCC). Cardiovascular risk markers, such as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP) and high-sensitive cardiac troponin T (hs-cTnT) are independent predictors for cardiovascular mortality. OBJECTIVES: The main goal of this study was to examine the relationship between CCC and cardiovascular risk markers. METHODS: We prospectively enrolled 427 stable coronary artery disease patients with chronic total occlusion (mean age: 57.5±11.1 years). The patients were divided into two groups, according to their Rentrop scores: (a) poorly developed CCC group (Rentrop 0 and 1) and (b) well-developed CCC group (Rentrop 2 and 3). NT-proBNP, hs-CRP, hs-cTnT, uric acid and other biochemical markers were also measured. The SYNTAX score was calculated for all patients. RESULTS: The patients in the poorly developed CCC group had higher frequencies of diabetes and hypertension (p<0.05 for both). Compared to the well-developed CCC group, the SYNTAX score, Hs-cTnT, hs-CRP, NT-proBNP, uric acid, neutrophil count and mean platelet volume (MPV) values were higher in patients with poorly developed CCC (p<0.05 for all). On multivariate logistic regression analysis, hs-cTnT (ß=0.658, 95% CI=0.589-0.735, p<0.001) and NT-proBNP (ß=0.991, 95% CI=0.987-0.995, p<0.001) as well as hs-CRP and diabetes were independent predictors of CCC. CONCLUSION: Cardiac risk markers, such as NT-proBNP, hs-cTnT and hs-CRP are independently associated with CCC in stable coronary artery disease with chronic total occlusion.
Assuntos
Proteína C-Reativa/metabolismo , Doença da Artéria Coronariana , Circulação Coronária , Oclusão Coronária , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Doença Crônica , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Oclusão Coronária/sangue , Oclusão Coronária/mortalidade , Oclusão Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
OBJECTIVE: Increased serum gamma-glutamyl transferase (GGT) activity is known to be associated with atherosclerotic diseases. Thoracic aortic intima-media thickness (IMT) was reported as a marker of preclinical atherosclerosis. However, there is a lack of research directly examining the relationship between serum GGT activity and thoracic aortic IMT. Therefore, we aimed to investigate the association between serum GGT activity and thoracic aortic IMT. PATIENTS AND METHODS: The study population consisted of 329 patients without coronary artery disease, who underwent transesophageal echocardiography (TEE) examination for various indications from January 2011 to April 2013. GGT, high-sensitivity C-reactive protein (hs-CRP) and other biochemical markers were measured in all patients. The patients were classified into tertiles according to their GGT activities (GGTlow < 19 U/l, GGTmid ≥ 19 U/l < 29 U/l, and GGThigh ≥ 29). RESULTS: The highest aortic IMT values were observed in the GGThigh group compared with the GGTmid and GGTlow groups (p < 0.05, for all). Also, aortic IMT values in the GGTmid group were higher than in the GGTlow group (p < 0.05). Multivariate regression analysis showed that GGT activity was independently associated with aortic IMT (ß = 0.487, p < 0.001) hs-CRP (ß = 0.282, p < 0.001), and triglyceride level (ß = 0.161, p = 0.007). CONCLUSION: The higher serum GGT concentrations within the "normal" range were associated with a greater IMT of the thoracic aorta. GGT activity may be a predictor of the extent of subclinical aortic atherosclerosis assessed with thoracic aortic IMT.
Assuntos
Aorta Torácica/diagnóstico por imagem , Aortite/sangue , Aortite/diagnóstico por imagem , Aterosclerose/sangue , Aterosclerose/diagnóstico , Ecocardiografia/estatística & dados numéricos , gama-Glutamiltransferase/sangue , Adulto , Aortite/epidemiologia , Aterosclerose/epidemiologia , Biomarcadores/sangue , Espessura Intima-Media Carotídea/estatística & dados numéricos , Comorbidade , Ativação Enzimática , Feminino , Humanos , Masculino , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Turquia/epidemiologiaRESUMO
OBJECTIVE: A high N-terminal pro-brain natriuretic peptide (NT-proBNP) level provides significant prognostic information on patients with coronary artery disease (CAD). It is unclear whether aortic distensibility (AD), which reflects the aortic stiffness, and the extent and complexity of CAD, assessed with the SYNTAX score (SS), affect the secretion of NT-proBNP in stable CAD. We aimed to investigate the relationship between NT-proBNP levels and AD as well as with the extent and complexity of CAD in stable CAD patients. METHODS: The study included 411 patients with stable CAD (mean age = 61.7 ± 9.9 years, male/female = 247/164). The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group < 114 pg/ml and NT-proBNPhigh group ≥ 114 pg/ml). AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements. Coronary angiography was performed and SS was determined in all patients. NT-proBNP and other biochemical markers were measured in all subjects. RESULTS: The AD and ejection fraction values of the NT-proBNPhigh group were lower and their SS levels were higher compared with those from the NT-proBNPlow group (p < 0.05, for all). The NT-proBNP level was independently associated with AD (ß = -0.378, p < 0.001), SS (ß = 0.262, p < 0.001), and ejection fraction (ß = - 0.295, p < 0.001) on multiple linear regression analysis. CONCLUSION: NT-proBNP was independently associated with an impaired elastic property of the aorta and with the extent and complexity of CAD as well as with left ventricular systolic dysfunction.
Assuntos
Aorta/fisiopatologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Biomarcadores/sangue , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco , Sensibilidade e Especificidade , Turquia/epidemiologia , Rigidez Vascular , Disfunção Ventricular Esquerda/epidemiologiaRESUMO
OBJECTIVE: Atherosclerosis plays a major role in the development of coronary artery disease (CAD). It has been shown that mitochondrial open-reading-frame of the twelve S rRNA-c (MOTS-c), a mitochondrial-derived peptide, has preventive effects on atherosclerosis. The aim of this study was to determine the relationship between MOTS-c levels and CAD presence and severity using SYNTAX score (SS) in patients with stable angina pectoris. PATIENTS AND METHODS: Ninety-two consecutive patients with stable coronary artery disease (CAD+) and ninety-two consecutive patients with normal coronary artery (CAD-) were included. Presence and severity of coronary artery disease were determined using the SS. RESULTS: We observed that the MOTS-c levels was lower in the CAD group (111±13 vs. 161±23, p<0.001). The MOTS-c levels were also found to be significant independent predictors for CAD in multiple regression analysis (p<0.001). A MOTS-c levels ≥130.9 had 80.3% sensitivity and 73.2% specificity (area under the curve [AUC]: 0.858, 95% CI: 0.895-0.999, p<0.001) for predicting CAD. CONCLUSIONS: The authors revealed that there is a strong correlation between MOTS-c levels and CAD. Therefore, MOTS-c may help identify patients with CAD, thus allowing for early preventive treatment.
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Angina Estável , Aterosclerose , Doença da Artéria Coronariana , Angiografia Coronária , Humanos , Índice de Gravidade de DoençaRESUMO
The CRESST (Cryogenic Rare Event Search with Superconducting Thermometers) dark matter search experiment aims for the detection of dark matter particles via elastic scattering off nuclei in CaWO 4 crystals. To understand the CRESST electromagnetic background due to the bulk contamination in the employed materials, a model based on Monte Carlo simulations was developed using the Geant4 simulation toolkit. The results of the simulation are applied to the TUM40 detector module of CRESST-II phase 2. We are able to explain up to ( 68 ± 16 ) % of the electromagnetic background in the energy range between 1 and 40 keV .
RESUMO
This study investigated the effects of chronic arsenic exposure on QT- and QTc-interval prolongation, QTc dispersion (QTcd) and transmural dispersion of repolarization (TDR). We compared cardiac parameters from 40 male subjects chronically exposed to arsenic (group A) with those of 40 male subjects not exposed to arsenic (group B). Although subjects in both groups had non-corrected QT intervals within normal limits, subjects in group A had significantly longer QTc and QTcd intervals compared with group B. A total of 70% of group A compared with 10% of group B had QTcd values > 50 ms. The mean TDR value was also significantly higher in group A compared with group B. Although non-corrected QT intervals were within normal limits, those subjects chronically exposed to arsenic had a slight QT prolongation and a higher prevalence of subtle repolarization abnormalities, which might be clinically relevant.
Assuntos
Intoxicação por Arsênico/fisiopatologia , Exposição Ambiental , Sistema de Condução Cardíaco/fisiopatologia , Abastecimento de Água , Adulto , Estudos de Casos e Controles , Doença Crônica , Demografia , Eletrocardiografia , Humanos , MasculinoRESUMO
Forty patients with mild to moderate hypertension were divided into two groups, 20 patients (group A) received 240 mg verapamil and 20 patients (group B) received 20 mg nitrendipine daily during the first six weeks. During the second six weeks, all 40 patients were given 10 mg nitrendipine plus 120 mg verapamil. After the combination therapy, group B received verapamil, 240 mg and group A nitrendipine 20 mg for a further period of six weeks. When verapamil and nitrendipine were used alone, BP decreased significantly in each group. However, BP decreased more when the combination therapy was used and increased when the treatment was changed to single drug therapy from the two-drug combination. In addition, side-effects were three to four times fewer during the combination therapy. It is concluded that the combination of two different calcium antagonists in the treatment of hypertension provides a new dimension to therapy.
Assuntos
Hipertensão/tratamento farmacológico , Nitrendipino/uso terapêutico , Verapamil/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Quimioterapia Combinada , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Nitrendipino/efeitos adversos , Verapamil/efeitos adversosRESUMO
BACKGROUND: P-Selectin mediates adhesive interactions between platelets, leukocytes and endothelium to form thrombi. Our purpose was to investigate plasma soluble(s) P-selectin levels in patients with acute myocardial infarction (aMI) and the effect of thrombolysis on P-selectin levels. METHODS: Patients with aMI within the first 6 h of chest pain were enrolled prospectively. sP-selectin levels were determined by ELISA in the plasma of patients with aMI (n=32), stable angina (n=18), and healthy controls (n=15). Samples were obtained before, 3 and 24 h after reperfusion therapy with tissue plasminogen activator. Seven patients showed recurrent angina or failure to reperfuse. RESULTS: sP-selectin levels were significantly higher in aMI group than other groups (86.7+/-8.7 ng/ml, P<0.05). sP-selectin levels were similar in stable angina and control groups (28.8+/-4.4 vs. 25.4+/-7.3 ng/ml, P=NS). A significant increase in sP-selectin levels was observed 3 h after successful thrombolysis and this was followed by a decrease to near the baseline level late after reperfusion. But patients with failed reperfusion showed sustained high sP-selectin levels after 24 h of thrombolysis (P<0.05). CONCLUSION: The plasma sP-selectin level is elevated in aMI and it increases further following thrombolytic therapy. This increase is probably induced by activation of endothelial cells or platelets after myocardial ischemia and reperfusion during aMI. As the elevated levels are sustained in patients with failed reperfusion, serial P-selectin levels may be used as a non-invasive indicator of successful thrombolysis in aMI.
Assuntos
Monitoramento de Medicamentos , Infarto do Miocárdio/tratamento farmacológico , Selectina-P/efeitos dos fármacos , Terapia Trombolítica , Angina Pectoris/sangue , Biomarcadores , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Selectina-P/sangue , Estudos Prospectivos , Estatísticas não ParamétricasRESUMO
Takayasu arteritis is a non-specific inflammatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.
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Comparação Transcultural , Arterite de Takayasu/diagnóstico , Adolescente , Adulto , Angioplastia com Balão , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Arterite de Takayasu/classificação , Arterite de Takayasu/terapia , Resultado do Tratamento , TurquiaRESUMO
A young male with Wolff-Parkinson-White syndrome whose electrocardiographic pattern was suggestive of acute anterior myocardial infarction is described. A 21-year-old male with a history of ventricular fibrillation after being successfully resuscitated was admitted to the coronary care unit. His electrocardiogram showed ST elevation in the precordial leads (V1-V6). This condition was erroneously interpreted as an acute myocardial infarction. At the fourth day, while ST elevations returned to baseline, short PR interval and delta waves were observed on the ECG. Myocardial infarction was excluded by biochemical tests, echocardiography, and coronary angiography. Electrophysiologic study confirmed Wolff-Parkinson-White syndrome with two accessory pathways.
Assuntos
Infarto do Miocárdio/complicações , Síndrome de Wolff-Parkinson-White/complicações , Adulto , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologiaRESUMO
Relationship between dyslipidemia, C-Reactive Protein (CRP) and serological evidence of Chlamydia pneumoniae was investigated in a Turkish population with coronary artery disease. This prospective, randomized, blinded study was carried out in Florence Nightingale Hospital which is affiliated to Kadir Has University, Medical Faculty. Thirty-two patients with acute coronary artery diseases (ACAD), 32 patients with chronic coronary artery diseases (CCAD) and 26 healthy controls (HC) were included in the study. We detected serum concentrations of C. pneumoniae IgG, IgA and IgM by ELISA method. We measured total cholesterol, trigliseride, LDL and HDL- cholesterol levels to determine dyslipidemia which was defined as total cholesterol >200 mg/dL, trigliserid > 150 mg/dL, LDL >130 mg/dL, HDL <45 mg/dL. CRP levels were also measured. Seropositivity to C. pneumoniae IgG was 84.3%, 100% and 65.3%; seropositivity to IgA was 9.3%, 6.2%, and 3.8%; and seropositivity to IgM was 12.5%, 15.3%, and 15.4% in patients with ACAD, CCAD and HC, respectively. Dyslipidemia was found as 93.7%, 78. 1% and 0% of patients with ACAD, CCAD and HC, respectively. CRP level was high in all patients (ACAD, CCAD) but not in healthy controls. As a conclusion, we found a significant association between seropositivity to C. pneumoniae IgG and dyslipidemia and CRP levels in ACAD and CCAD patients (p<0.05). C. pneumoniae IgG antibodies should be evaluated together with serum lipids and CRP levels in patients with ACAD and CCAD in Turkish population. This may help clinicians in treatment of C. pneumoniae infection and decrease the risk of coronary artery diseases.
Assuntos
Anticorpos Antibacterianos/sangue , Proteína C-Reativa/análise , Infecções por Chlamydophila/complicações , Chlamydophila pneumoniae/imunologia , Doença da Artéria Coronariana/complicações , Hiperlipidemias , Adulto , Idoso , Infecções por Chlamydophila/imunologia , Colesterol/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Triglicerídeos/sangue , Turquia/epidemiologiaRESUMO
The authors report the prevalence of mitral valve prolapse in bipolar affective disorder. 22 bipolar patients (13 men and 9 women; age 17-75 years, mean 42.3) were selected at random from 41 bipolar patients for echocardiographic examination. Diagnosis of mitral valve prolapse was made if prolapsus of the anterior or posterior valve to the left atrium was seen in the two-dimensional echocardiography and if mid-to late-systolic posterior motion of the mitral valve was greater than 2 mm in M-mode echocardiography. Of the 22 bipolar patients, only two had mitral valve prolapse. This rate does not differ significantly from the 5% rate found in the general population.
Assuntos
Transtorno Bipolar/complicações , Prolapso da Valva Mitral/epidemiologia , Adolescente , Adulto , Idoso , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico , TurquiaRESUMO
Balloon mitral valvuloplasty with Inoue technique was performed in two group of patients. In group I (n = 40) valvuloplasty was performed under fluoroscopy without using echocardiography, whereas in group II (n = 13) valvuloplasty was performed under the guidance of transesophageal echocardiography alone, without using fluoroscopy. Patients in two groups were comparable with regard to clinical variables and hemodynamic parameters. Two female patients in group II were pregnant. Transmitral pressure gradient decrease did not differ significantly between two groups (pressure gradient: 17 +/- 5 to 4 +/- 1 in group I and 15 +/- 4 to 3 +/- 1 mm Hg in group II). Mitral valvular area increase was also not different in two groups (1.09 +/- 0.2 cm2 to 2.3 +/- 0.5 cm2 in group I and 0.9 +/- 0.2 to 2 +/- 0.3 cm2 in group II). In 14 cases from group 1 and 2 cases from group II mitral regurgitation increased after valvuloplasty (p < .05). Left atrial perforation occurred in one patient from group 1 and 2 patients from group II. In conclusion, mitral balloon valvuloplasty under transesophageal echocardiographic guidance alone is a safe and effective procedure in the treatment of mitral stenosis.
Assuntos
Ecocardiografia Doppler/métodos , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/cirurgia , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/cirurgiaRESUMO
This paper investigates the relative role of the impairment of insulin secretion and action in the pathogenesis of Type 2 diabetes mellitus (T2DM). The parameters indicating insulin secretion and action were calculated from the data obtained during oral glucose tolerance test (OGTT), in 156 age- and sex-matched T2DM patients divided in 4 groups according to their body mass index (BMI, I = 20.0-24.9, II = 25.0-29.9, III = 30.0-39.9 and IV > 40.0 kg/m2). After obtaining baseline biomedical parameters (plasma glucose, serum insulin, cholesterol, HDL-cholesterol, triglycerides, BMI, and amount of fat tissue), the rates of insulin secretory capacity and insulin action were obtained from OGTT and compared between the T2DM patients with normal body weight and different grades of obesity. Beta-cell secretory capacity of the participants was found to be proportionally and significantly higher in graded obese than that of the normal body weight patients. The rates of hepatic as well as peripheral insulin resistance in obese groups proportionally and significantly rise in comparison with that of non-obese diabetics. In addition, these parameters are shown to be related to the body fat, presumably visceral in origin. In conclusion, hyperglycemia-hyperinsulinemia observed in obese and T2DM patients might be due, in part, to increased capacity of insulin secretion, and to exaggerated hepatic glucose production because of hepatic insulin resistance, respectively.
Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus/fisiopatologia , Insulina/metabolismo , Insulina/farmacologia , Obesidade , Abdome , Tecido Adiposo , Adulto , Glicemia/análise , Composição Corporal , Constituição Corporal , Índice de Massa Corporal , Peso Corporal , Colesterol/sangue , HDL-Colesterol/sangue , Glucose/biossíntese , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Resistência à Insulina , Secreção de Insulina , Ilhotas Pancreáticas/metabolismo , Fígado/efeitos dos fármacos , Fígado/metabolismo , Pessoa de Meia-Idade , Triglicerídeos/sangueRESUMO
BACKGROUND: The presence of ventricular late potentials (LP) is an important indicator for the development of ventricular tachyarrhythmias due to ischemic heart disease. The effect of myocardial revascularization on LP has remained controversial. The purpose of this study was to determine whether complete myocardial surgical revascularization (CABG) documented by myocardial perfusion scintigraphy might alter the substrate responsible for LP. METHODS: Prospectively, enrolled patients undergoing elective CABG were evaluated with thallium-201 myocardial perfusion scintigraphy and signal- averaged ECG pre- and postoperatively. SAECG recordings were obtained serially: before, 48-72 hours and 3 months after CABG. LPS were defined as positive if SAECG met at least two of Gomes criteria. Scintigraphies were performed pre- and 3 months postoperatively for determination of the success of revascularization. Changes observed in SAECG recordings after CABG were compared between those with and without successful revascularization. RESULTS: CABG resulted in successful revascularization in 23 patients and was unsuccessful in 17 (no change or deterioration of the perfusion defects). Preoperative SAECG values were not different between groups except for RMS values. The incidence of LP decreased significantly postoperatively in patients with improved myocardial perfusion, whereas there were no changes in patients who did not have postoperative perfusion improvement (McNemar test, P < 0.05). CONCLUSIONS: LPs disappear following the elimination of myocardial ischemia by complete surgical revascularization. Persistence of ischemia following CABG usually results in the persistence of late potentials. The incidence of ventricular arrhythmias is expected to be unchanged in these patients and they should be reevaluated for reinterventions.
Assuntos
Potenciais de Ação , Ponte de Artéria Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/fisiopatologia , Eletrocardiografia , Processamento de Sinais Assistido por Computador , Tomografia Computadorizada de Emissão de Fóton Único , Função Ventricular Esquerda , Adulto , Idoso , Análise de Variância , Ponte de Artéria Coronária/métodos , Doença das Coronárias/etiologia , Doença das Coronárias/cirurgia , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único/normas , Resultado do TratamentoRESUMO
A 34-year-old man presenting with angina both at rest and on exertion was investigated. He developed severe ST segment elevation and a brief period of ventricular tachycardia during an exercise tolerance test. On coronary angiography, 60% fixed luminal narrowing was observed in the proximal left anterior descending coronary artery and a severe spasm developed at this site, leading to temporary total occlusion of the vessel. Successful coronary angioplasty (PTCA) was performed on this lesion, with a residual 15% narrowing. However, the patient had a recurrence of angina 3 weeks later, despite being administered high doses of nitrate and calcium antagonist. During control angiography, the lesion severity was unchanged, but spasm developed again following contrast injection. At this time, a Palmaz-Schatz stent was implanted. Calcium antagonist, nitrate, Ticlopidine and low molecular weight heparin therapy was started. There was no recurrence of symptoms during a 3-month follow-up. The exercise tolerance test, and myocardial perfusion scintigraphy findings were normal and the stent was patent without restenosis at the end of the 3-month follow-up. Intracoronary stent implantation for persistent coronary spasm refractory to conventional medical therapy can be considered a feasible and attractive treatment modality for the control of symptoms.