ABSTRACT
Resumo Fundamento A insuficiência cardíaca com fração de ejeção reduzida (ICFEr) é uma doença de alta prevalência que requer hospitalizações repetidas e causa morbimortalidade significativa. Portanto, o reconhecimento precoce de preditores de resultados desfavoráveis é essencial para o manejo do paciente. Objetivo O objetivo do presente estudo é investigar a relação entre realce tardio pelo gadolínio (RTG) detectado por ressonância magnética cardíaca (RMC) e os parâmetros de repolarização, como o intervalo QT corrigido (QTc), intervalo Tp-e, ângulo QRS-T frontal detectado pelo eletrocardiograma (ECG) de 12 derivações na ICFEr. Método Neste estudo observacional, retrospectivo, de centro único, foram incluídos 97 pacientes consecutivos com ICFEr submetidos à RMC. A população do estudo foi dividida em dois grupos, de acordo com a presença de RTG. Foram registradas medidas ecocardiográficas e de RMC e características demográficas. Os intervalos QTc, intervalos Tp-e, e ângulos QRS-T frontais foram calculados a partir do ECG. Um valor de p <0,05 foi considerado estatisticamente significativo. Resultados O RTG foi detectado em 52 (53,6%) de 97 pacientes com ICFEr. Os intervalos QTc (p=0,001), intervalos Tp-e (p<0,001), e os ângulos QRS-T frontais (p<0,001) foram significativamente maiores no grupo RTG quando comparados ao grupo não-RTG. Na análise de regressão univariada realizada para investigar os preditores de RTG na ICFEr, todos os três parâmetros de repolarização alcançaram valores significativos, mas na análise multivariada o único parâmetro de repolarização que permaneceu significativo foi o intervalo Tp-e (OR = 1,085 IC 95% 1,032-1,140, p=0,001). Conclusão Com o prolongamento do intervalo Tp-e, pode-se prever a presença de fibrose miocárdica, a qual é um substrato arritmogênico, em pacientes com ICFEr.
Abstract Background Heart failure with reduced ejection fraction (HFrEF) is a highly prevalent disease that requires repeating hospitalizations, causes significant morbidity and mortality. Therefore, early recognition of poor outcome predictors is essential for patient management. Objective The aim of the present study is to investigate the relationship between late gadolinium enhancement (LGE) detected by cardiac magnetic resonance (CMR) and repolarization parameters such as corrected QT (QTc) interval, Tp-e interval, frontal QRS-T angle detected by 12 lead electrocardiograph (ECG) in HFrEF. Method In this single-center, retrospective observational study included 97 consecutive HFrEF patients who had CMR scan. Study population was divided into two groups according to the presence of LGE. Echocardiographic and CMR measurements and demographic features were recorded. QTc intervals, Tp-e intervals, frontal QRS-T angles were calculated from the ECG. A p-value less than 0.05 was considered statistically significant. Results LGE was detected in 52 (53.6%) out of 97 HFrEF patients. QTc intervals (p=0.001), Tp-e intervals (p<0.001), frontal QRS-T angles (p<0.001) were found to be significantly higher in LGE group when compared to non-LGE group. In univariate regression analysis which was performed to investigate the predictors of LGE in HFrEF, all three repolarization parameters were reached significant values but in multivariate analysis the only repolarization parameter remained significant was Tp-e interval (OR=1.085 95% CI 1.032-1.140, p=0.001). Conclusion With the prolongation of the Tp-e interval, the presence of myocardial fibrosis which is an arrhythmogenic substrate, can be predicted in patients with HFrEF.
Subject(s)
Humans , Gadolinium , Heart Failure/diagnostic imaging , Stroke Volume , Predictive Value of Tests , Contrast MediaABSTRACT
Objective: The aim of this study was to evaluate the effect of four different mouthrinses on the surface roughness of two nanohybrid resin composites. Material and Methods: Fifty samples were prepared for each of the resin composites (2x8 mm) and a profilometer was used to determine the initial surface roughness (Ra) of each sample. Then, they were divided into 5 subgroups (n= 10), and exposed to the following mouthrinses (12h, 37 ºC): containing alcohol and essential oils; alcohol and chlorhexidine; alcohol-free and essential oils; alcohol free and cetil prydinium chlorite; or distilled water (control). The surface roughness of each sample was measured again. Statistical analyses of the data were performed via two-way ANOVA and Bonferroni tests. Results: Overall, statistically significant differences were not found between the resin composites (p> 0.05), but significant differences were found among the mouthrinses (p< 0.05). Interactions between the mouthrinses and the resin composites was statistically significant (p< 0.05). Both of the resin composites had the highest surface roughness after exposure to mouthrinse with alcohol and essential oils (p< 0.05), followed by mouthrinse with alcohol and chlorhexidine. Both alcohol-free mouthrinses caused surface roughness either similar to distilled water (p> 0.05) or lower than distilled water (p< 0.05) on the nanohybrid resin composites used. Conclusion: The mouthrinses affected the surface roughness of the resin composites in different ways. This was dependent on mouthrinse contents and the chemical structure of the resin composites. Alcohol-containing mouthrinses caused the most changes in the surface roughness of both resin composites (AU)
Objetivo: O objetivo deste estudo foi avaliar o efeito de quatro diferentes enxaguatórios bucais sobre a rugosidade superficial de duas resinas compostas nano-híbridas. Material e Métodos: Cinquenta amostras foram preparadas para cada uma das resinas compostas (2x8 mm) e um perfilômetro foi utilizado para determinar a rugosidade superficial inicial (Ra) de cada amostra. Em seguida, foram divididos em 5 subgrupos (n = 10) e expostos aos seguintes enxaguatórios (12h, 37 ºC): contendo álcool e óleos essenciais; álcool e clorexidina; Óleos sem álcool e essenciais; sem álcool e cloreto de cetilpridínio; ou água destilada (controle). A rugosidade da superfície de cada amostra foi medida novamente. As análises estatísticas dos dados foram realizadas por meio de ANOVA de dois fatores e testes de Bonferroni. Resultados: No geral, não foram encontradas diferenças estatisticamente significativas entre as resinas compostas (p> 0,05), mas diferenças significativas foram encontradas entre os enxaguatórios bucais (p <0,05). As interações entre os enxaguatórios bucais e as resinas compostas foram estatisticamente significativas (p <0,05). Ambas as resinas compostas apresentaram maior rugosidade superficial após exposição ao enxaguatório bucal com álcool e óleos essenciais (p <0,05), seguido do enxaguatório com álcool e clorexidina. Ambos os enxaguatórios bucais sem álcool causaram rugosidade superficial semelhante à da água destilada (p> 0,05) ou menor do que a água destilada (p <0,05) nas resinas compostas nano-híbridas usadas. (AU)
Subject(s)
Oils, Volatile , Chlorhexidine , Composite Resins , MouthwashesABSTRACT
Abstract Objective: To evaluate the prognostic value of C-reactive protein to albumin ratio (CAR) in patients with severe aortic valve stenosis undergoing surgical aortic valve replacement (AVR). Methods: Four hundred seventy-six patients with severe degenerative aortic stenosis who underwent successful isolated surgical AVR were enrolled. Hospitalization due to heart failure, surgical aortic reoperation, paravalvular leakage rates, and long-term mortality were evaluated in the whole study group. The participants were divided into two groups, as 443 patients without mortality (group 1) and 33 patients with mortality (group 2) during the follow-up time. Results: CAR was lower in patients without mortality than in those with mortality during the follow-up time (0.84 [0.03-23.43] vs. 2.50 [0.22-26.55], respectively, P<0.001). Age (odds ratio [OR]: 1.062, confidence interval [CI]: 1.012-1.114, P=0.014), CAR (OR: 1.221, CI: 1.125-1.325, P<0.001), ejection fraction (OR: 0.956, CI: 0.916-0.998, P=0.042), and valve type (OR: 2.634, CI: 1.045-6.638, P=0.040) were also found to be independent predictors of long-term mortality. Additionally, rehospitalization (0.86 [0.03-26.55] vs. 1.6 [0.17-24.05], P=0.006), aortic reoperation (0.87 [0.03-26.55] vs. 1.6 [0.20-23.43], P=0.016), and moderate to severe aortic paravalvular leakage (0.86 [0.03-26.55] vs. 1.86 [0.21-19.50], P=0.023) ratios were associated with higher CAR. Conclusion: It was firstly described that CAR was strongly related with increased mortality rates in patients with isolated severe aortic stenosis after surgical AVR. Additionally, rehospitalization, risk of paravalvular leakage, and aortic reoperation rates were higher in patients with increased CAR than in those without it.