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1.
Rev. bras. cir. cardiovasc ; 39(1): e20220344, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1521672

ABSTRACT

ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.

2.
Article | IMSEAR | ID: sea-219306

ABSTRACT

A 12?year?old boy presented with bicuspid aortic valve, severe aortic regurgitation, and dilated dysfunctional left ventricle in heart failure. He underwent aortic valve replacement with a 23 mm TTK Chitra heart valve prosthesis (tilting disk). He was gradually weaned off milrinone and noradrenaline in the intensive care. Echocardiography showed severe left ventricular dysfunction with an ejection fraction of 24%. The radial pulse was regular and of normal volume but exactly half that of the heart rate. Evaluation of the rhythm and echocardiography revealed an interesting hemodynamic phenomenon with double alternans.

3.
Article | IMSEAR | ID: sea-225548

ABSTRACT

Takayasu arteritis (TA) is a rare, systemic, granulomatous primary vasculitis of medium and large arteries. The name comes from Dr. Mikito Takayasu, who reported the problem in 1905 for the first time. It is also called as Pulseless Disease or Aortic Arch Syndrome and usually seen before 40 years with female and male ratio being 10:1. Takayasu arteritis is a major cause of high blood pressure levels in teenagers and young adults. Around 75 percent of the people having Takayasu get diagnosed usually at an average age of 29 years though they begin to show the symptoms at their teenage years because the early symptoms of Takayasu are nonspecific and common. Heart failure as the first presentation of the TA is rare but has been reported. Angiographic studies help in the diagnosis of Takayasu and patients usually respond to steroid therapy. We report a 16 years old female presented with history of upper limb claudication, dyspnea, orthopnea, non palpable pulse in bilateral upper limbs with non recordable BP, lower limb with high blood pressure recordings and bilateral carotid Bruit present. Imaging studies revealed circumferential wall thickening of arch of aorta, bilateral carotids, left sub clavian, left axillary. 2D echo revealed global hypokinesia with severe left ventricular dysfunction. Takayasu arteritis with heart failure diagnosis was made and administration of steroids, diuretics and ACE inhibitor improved the condition.

4.
Article | IMSEAR | ID: sea-220312

ABSTRACT

Chronic heart failure (HF) is a major problem of public health in Morocco with few studies exploring HF particularities in this country where the prevalence of HF is estimated to be around 2.2%. Objective: The aim of this study was to evaluate the correlation between frequency of rehospitalization in our population with age, left ventricular ejection fraction (LVEF), heart rate (HR), and QRS duration, Since the number of rehospitalizations is strongly correlated to mortality as shown by many studies. Materials and Methods: Patients with HF were enrolled in this retrospective case control study regardless of their LVEF, patients with recent (<3months) myocardial infarction were excluded. They were all examined and questioned in the heart failure unit of our hospital between the period of October 2022 and December 2022. The correlations were calculated by PEARSON index using R Statistical Software. Results: 224 patients were included. The mean patient age was 59 years (57.2-63;IC 95%) with a male predominance of 60.1 % (56.8-71; IC 95%). 35.5% and 32.2% of patients were treated for hypertension and diabetes respectively. The mean LVEF was 35.2% (33.96-36.91;IC 95%). A positive correlation was found between rehospitalization frequency and age and high heart rate (+ 0.42 p = 0,04;+0.322, p<0.005) respectively . Conversely a negative correlation was found with LVEF (-0.312, p<0.005) while there was a positive correlation with QRS duration but without significance (+0.162 , p=0.03). Conclusion: This study shows strong correlation between rehospitalization and advanced age, higher HR and lower LVEF.

5.
Article | IMSEAR | ID: sea-220297

ABSTRACT

Non-compaction cardiomyopathy (NCC) is characterized by trabeculations in either one or both ventricles. Clinical presentation is highly variable: dyspnea, palpitation, thromboembolic events, arrhythmia, or sudden cardiac death. There are currently no universally-accepted criteria for classifying and diagnosing left ventricular non-compaction (LVNC) cardiomyopathy. Transthoracic echocardiography (TTE) is the diagnostic exam of choice. The diagnosis is often missed or delayed because of a lack of knowledge about this uncommon disease. Progression of LVNC is highly variable and prognosis is very difficult to predict. We report a case of a 50-year-old female patient with a history of total thyroidectomy under hormonal supplementation who consults for dyspnea and paroxysmal palpitations revealing an isolated LVNC. This case emphasizes the importance of imaging techniques, which are, TTE and cardiac magnetic resonance imaging (MRI) in early diagnosis, management, and follow-up.

6.
Article | IMSEAR | ID: sea-220293

ABSTRACT

Behcet’s disease is a systemic vasculitis of the vessels for all calibers, touching arterial and venous territories. The causes of disease are unknow. BD reaches young age subjects from 10 to 45 years and affects both men and women. BD is ubiquitous but more frequent in patients from Mediterranean basin, the middle East and Asia. The diagnosis of BD is essentially clinical. The diagnostic criteria make it possible to carry the diagnosis with good sensitivity and specifity. BD evolves by recurrent inflammatory attack. BD can affect all of the organs; cardiacs manifestations are dominated by intracardiac thrombosis, the damage of three tunics, coronaryarteritis with or without myocardial infarction, coronaries aneurysms and endomyocardial fibrosis. The vascular manifestations are dominated by arterial or venous thrombosis. The presence of dilated cardiomyopathy with reduced left ventricular ejection fraction is rare. It can be explained by ischemic or inflammatory origin by cytokines. We report a case of young woman aged of 33 years to the history of 3 episodes of bipolar aphtae which presented dilated cardiomyopathy with reduced left ventricular function, biventricular thrombosis, bilateral distal pulmonary embolism with pulmonary infarction.

7.
J Indian Med Assoc ; 2023 Mar; 121(3): 43-47
Article | IMSEAR | ID: sea-216705

ABSTRACT

Background and Objectives : Hypertension is a significant public health issue. Isolated Systolic Hypertension (ISH) was once considered to be a benign aspect among the aging population, but an association with an increased risk of Cardiovascular Disease is now known. ISH shows an increasing prevalence with increase in age. This study was undertaken to determine the incidence of ISH among adults in Eastern India. Methods : This study evaluated the adult population (aged 18-70 years) attending the NRS Medical College and Hospital, a Tertiary Care Center in East India. The clinical characteristics and echocardiographic findings were also evaluated. Results : A total of 800 patients met the inclusion criteria, of whom 75 (9.37%) had ISH. Blood Pressure increased with age. The most common echocardiographic change observed in ISH patients was increased Left Ventricular Mass Index (LVMI), while concentric Left Ventricular Hypertrophy (LVH) was more common in women than men with isolated Systolic Hypertension. The incidence of LVMI increased as the severity of ISH increased. Furthermore, patients with stage 3 ISH were nearly 4 times more likely to develop Proteinuria. Conclusion : The findings of this study are in line with previous studies evaluating the presence of ISH in the adult Indian population. There is need for effective population screening along with effective treatment for Blood Pressure to reduce morbidity and mortality. Primary prevention strategies may be the need of the hour in the Indian population which is at risk of cardiovascular Disease associated with Hypertension

8.
Rev. cuba. med ; 62(1)mar. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1449999

ABSTRACT

Introducción: La edad representa uno de los mayores predictores de riesgo de complicaciones cardiovasculares en pacientes con síndrome coronario agudo. La prevalencia de este síndrome en el grupo de los pacientes octogenarios es elevada. Métodos: Estudio prospectivo de cohortes analítico de todos los pacientes ingresados en la unidad de cuidados coronarios intensivos del Hospital Universitario "Comandante Manuel Fajardo" de la Habana, entre el año 2016 y el 2020. Objetivo: Caracterizar la población de pacientes octogenarios con síndrome coronario agudo y las posibles asociaciones entre la ocurrencia de complicaciones intrahospitalarias no letales y los factores de riesgo cardiovasculares. Resultados: Prevaleció el sexo femenino (64,2 %), los antecedentes de hipertensión arterial (89,7 %), cardiopatía isquémica (66,7 %), y el tabaquismo (32 %). Se encontraron asociaciones estadísticas significativas entre el tipo de síndrome coronario agudo y la presencia de complicaciones cardiovasculares de cualquier tipo (p=0,006); el aumento de la creatinina se asoció con la presencia de complicaciones hemodinámicas (Mdn=97; Rango=97,52; p=0,012), así como también la fracción de eyección del ventrículo izquierdo mostró una asociación muy significativa con la presencia de complicaciones cardiovasculares de cualquier tipo (Mdn=59; Rango=63,3; p<0,001) y hemodinámicas (Rango=55,2; p<0,001). Conclusiones: Se caracterizó la población de pacientes octogenarios con síndrome coronario agudo con elevación del segmento ST se asoció con un aumento de las complicaciones cardiovasculares intrahospitalarias, de la misma manera que sucedió con el valor de la fracción de eyección del ventrículo izquierdo.


Introduction: Age represents one of the greatest predictors of risk of cardiovascular complications in patients with acute coronary syndrome. The prevalence of this syndrome in the group of octogenarian patients is high. Objective: To characterize the population of octogenarian patients with acute coronary syndrome and the possible associations between the occurrence of non-lethal intrahospital complications and cardiovascular risk factors. Methods: This is a prospective analytical cohort study of all patients admitted to the intensive coronary care unit of Manuel Fajardo University Hospital in Havana, from 2016 to 2020. Results: The female sex (64.2%), a history of arterial hypertension (89.7%), ischemic heart disease (66.7%), and smoking habits (32%) outweighed. Significant statistical associations were found between the type of acute coronary syndrome and the presence of cardiovascular complications of any type (p=0.006); the increase in creatinine was associated with the presence of hemodynamic complications (Mdn=97; Range=97.52; p=0.012), as well as the left ventricular ejection fraction showed a highly significant association with the presence of cardiovascular complications of any type (Mdn=59; Range=63.3; p<0.001) and hemodynamic (Range=55.2; p<0.001). Conclusions: The octogenarian population of patients with ST-segment elevation acute coronary syndrome was characterized and was associated with an increase in in-hospital cardiovascular complications, in the same way that it happened with the value of the left ventricular ejection fraction.

9.
Rev. bras. cir. cardiovasc ; 38(1): 132-138, Jan.-Feb. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1423072

ABSTRACT

ABSTRACT Introduction: Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction (LVD) remains a surgical challenge and is still controversial. The aim of this study was to evaluate the effectiveness of CABG in patients with LVD. Methods: This retrospective study included a total of 160 consecutive patients (133 males, 27 females, mean age 62.1±10.12 years [range 37 to 86 years]) who had a left ventricular ejection fraction (LVEF) ≤ 45% determined by echocardiography and underwent elective isolated CABG between September 2013 and December 2018. Preoperative echocardiographic data, such as ejection fraction, left ventricular (LV) end-systolic diameter, and LV end-diastolic diameter, were collected and evaluated. Preoperatively, 85 (53.13%) patients were in New York Heart Association functional class III or IV and the mean LVEF was 38.65±5.72% (range 20 to 45). Results: The overall hospital mortality was 5% (eight patients). Late follow-up was obtained in 152 (90%) cases (median follow-up time was 56,5 [3-87] months postoperatively). During follow-up, mortality developed in 11.3% (16 patients). Mean LVEF increased significantly from 38.78±5.59% before surgery to 43.29±8.46% after surgery (P<0.01). Mean late survival, freedom from coronary reintervention, and congestive heart failure rates were 86.3±3.3%, 88.7±3.9%, and 89.4±3.1%, respectively. Conclusion: In patients with LVD, CABG can be performed with low postoperative morbidity and mortality rates. Patients with LVD could benefit from coronary bypass surgery regarding postoperative LV systolic function and higher quality of life.

10.
Article | IMSEAR | ID: sea-220303

ABSTRACT

Background: Hypertension is considered as the silent killer of human because the hypertensive patient may be not aware that he has hypertension and death can occur at any time without the reason being known. We aim to study the effect of gray zone hypertension [SBP from 120-139] and or [DBP from 80-89] which was classified as prehypertension under JNC-7 on the structure, geometry, and operation of the left ventricle using echocardiography Methods: This study included 100 patients who asymptomatic apparent healthy subjects visited cardiology outpatient department (OPD) for routine checkup. Patients were grouped into two equal groups: Group A whose blood pressure was in the gray zone hypertension [SBP from 120-139] and or [DBP from 80-89], and group B with SBP <120 mmHg & DBP <80 mmHg. Results: The two groups being studied were statistically significant different as regard LV geometrical pattern (p=0.028). They were also statistically significant in LV geometrical pattern between the males and females (p<0.05). The two groups were statistically significant different regarding GLS (p =0.001). Conclusions: Gray zone hypertension affects ventricular diastolic function and LV geometry, although systolic function was normal; GLS showed that subclinical LV dysfunction can occur.

11.
Article | IMSEAR | ID: sea-220299

ABSTRACT

LVNC (left ventricular non-compaction) is a rare congenital cardiomyopathy with a reported incidence of 0.05% in adults. It can occur in isolation or affect both ventricles. It’s characterized by prominent LV trabeculae and deep intertrabecular recesses which are filled with blood from the ventricular cavity without evidence of communication to the epicardial coronary artery system. Frequent premature supra ventricular tachycardia as unique finding in LVNC cardiomyopathy is rare manifestation of this disease. We report a case of a frequent persistent supraventricular tachycardia as first manifestation of a patient with LVNC cardiomyopathy in a young healthy woman who despite radio frequency ablation therapy of the supraventricular tachycardia remains symptomatic. The patient was later placed on medical therapy based on a non-cardio selective beta-blocker with a good clinical outcome without recurrent of supra-ventricular arrythmias.

12.
Article | IMSEAR | ID: sea-220292

ABSTRACT

Background: Cirrhosis is a long-term inflammatory process of hepatic tissue condition that mainly affects people aged 50 to 60. This study aims to assess Left ventricular diastolic dysfunction (LVDD) in cases with cirrhotic liver by conventional, tissue Doppler and two-dimensional speckle tracking echocardiography to clarify the correlation between the severity of cirrhotic liver and LVDD. Methods: A prospective case-control research involved 100 adult cases with confirmed HCV and HBV. Cases were divided into 4 equal group: Group A: Child A cases, group B: Child B cases, group C: Child C cases and group D (Controls): healthy non-hepatic subjects of the same age and sex who have normal blood pressure, nonsmoking participants with no further concomitant problems. Results: Number of cases with LVDD had a statistical noticeable increase in Child A, B, and C (p =0.004, <0.001, and <0.001 respectively. LAVi had a statistical noticeable increase in Child C / B (p =0.013 and p =0.014). Conclusion: Left atrial volume index (LAVi) had a statistical noticeable increase in Child C / B in comparison to the controls but E m, E l were statistical noticeable lower in Child C / B. /E had a statistical noticeable increase in Child C group, LVSRe had a statistical noticeable decrease in Child C group but it was insignificantly different across Child A / B/ C and controls and across Child B / C and controls.

13.
Article | IMSEAR | ID: sea-217433

ABSTRACT

Introduction: Blood pressure transient spikes have been considered to be noise and only a hindrance to a proper assessment of typical blood pressure, which is defined as the actual underlying average blood pres-sure over a long period of time. The current study aimed to see if the highest Self measured Systolic blood Pressure could be utilized to forecast the occurrence of Target organ damage and evaluate the independent association between the maximum Self measured Systolic blood Pressure and Target organ damage in indi-viduals with untreated hypertension. Method: We evaluated the urine albumin/creatinine ratio (UACR) and carotid intima-media thickness (IMT) using ultrasonography in 462 hypertensive individuals who had never taken treatment for their hypertension. Residential blood pressure was recorded. Result: The maximal Self measured Systolic blood Pressure had considerably higher association coefficients with left ventricular mass index (LVMI) and carotid intima-media thickness than the mean Self measured Sys-tolic blood Pressure. Irrespective of the mean Self measured Blood pressure level, multivariate regression studies showed that the maximal Self measured Systolic blood Pressure was independently related with left ventricular mass index and carotid intima-media thickness. Conclusion: Transiently high blood pressure measurements recorded at Self measured shouldn't be dis-missed as noise but rather taken seriously as significant warning signs of hypertensive Target organ damage in the heart and arteries.

14.
Arq. bras. cardiol ; 120(3): e20220077, 2023. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1429777

ABSTRACT

Resumo Fundamento A terapia de ressincronização cardíaca (TRC) pode beneficiar pacientes com insuficiência cardíaca (IC) avançada. O índice de excentricidade anormal por gated SPECT está relacionado a alterações estruturais e funcionais do ventrículo esquerdo (VE). Objetivo O objetivo do presente estudo foi avaliar a viabilidade do implante de eletrodos do VE guiado por análise de fase e sua relação com o remodelamento ventricular. Métodos Dezoito pacientes com indicação de TRC foram submetidos à cintilografia miocárdica para orientar o implante, avaliando-se os parâmetros de excentricidade e forma ventricular. P < 0,05 foi adotado como significância estatística. Resultados Na linha de base do estudo, a maioria dos pacientes foi classificada como NYHA 3 (n = 12). Após a TRC, 11 dos 18 pacientes foram reclassificados para um menor grau de limitação funcional. Além disso, a qualidade de vida dos pacientes melhorou após a TRC. Foram observadas reduções significativas na duração do QRS, intervalo PR, índice de forma diastólica final, índice de forma sistólica final, volume sistólico e massa miocárdica pós-TRC. O eletrodo do VE da TRC foi posicionado concordante, adjacente e discordante em 11 (61,1%), 5 (27,8%) e 2 (11,1%) pacientes, respectivamente. A excentricidade sistólica e diastólica final demonstrou remodelamento reverso após a TRC. Conclusões O implante de eletrodo do VE em TRC guiado por cintilografia gated SPECT é viável. A colocação do eletrodo concordante ou adjacente ao último segmento a se contrair foi um determinante do remodelamento reverso.


Abstract Background Cardiac resynchronization therapy (CRT) may benefit patients with advanced heart failure (HF). Abnormal eccentricity index by gated SPECT is related to structural and functional alterations of the left ventricle (LV). Objective The aim of this study is to evaluate the feasibility of LV lead implantation guided by phase analysis and its relationship to ventricular remodeling. Methods Eighteen patients with indication for CRT underwent myocardial scintigraphy for implant orientation, and eccentricity and ventricular shape parameters were evaluated. P < 0.05 was adopted as statistical significance. Results At baseline, most patients were classified as NYHA 3 (n = 12). After CRT, 11 out of 18 patients were reclassified to a lower degree of functional limitation. In addition, patients' quality of life was improved post-CRT. Significant reductions were observed in QRS duration, PR interval, end-diastolic shape index, end-systolic shape index, stroke volume, and myocardial mass post-CRT. The CRT LV lead was positioned concordant, adjacent, and discordant in 11 (61.1%), 5 (27.8%), and 2 (11.1%) patients, respectively. End-systolic and end-diastolic eccentricity demonstrated reverse remodeling post-CRT. Conclusions LV lead implantation in CRT guided by gated SPECT scintigraphy is feasible. The placement of the electrode concordant or adjacent to the last segment to contract was a determinant of reverse remodeling.

15.
Arq. bras. cardiol ; 120(4): e20220185, 2023. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1429798

ABSTRACT

Resumo Fundamento O exercício exerce um papel positivo na evolução da doença cardíaca isquêmica, melhorando a capacidade funcional e prevenindo o remodelamento ventricular. Objetivo Investigar o impacto do exercício sobre a mecânica de contração do ventrículo esquerdo (VE) após um infarto agudo do miocárdio (IAM) não complicado. Métodos Um total de 53 pacientes foram incluídos e alocados aleatoriamente em um programa de treinamento supervisionado (grupo TREINO, n=27) ou em um grupo CONTROLE (n=26) que recebeu recomendações usuais sobre a prática de exercício físico após um IAM. Todos os pacientes realizaram um teste cardiopulmonar e um ecocardiograma com speckle tracking para medir vários parâmetros da mecânica de contração do VE em um mês e cinco meses após o IAM. Um valor de p <0,05 foi considerado para significância estatística nas comparações das variáveis. Resultados Não foram encontradas diferenças nas análises dos parâmetros de strain circunferencial, radial ou longitudinal do VE entre os grupos após o período de treinamento. Após o programa, a análise da mecânica de torção revelou uma redução na rotação basal do VE no grupo TREINO em comparação ao grupo CONTROLE (5,9±2,3 vs. 7,5±2.9o; p=0,03), bem como na velocidade rotacional basal (53,6±18,4 vs. 68,8± 22,1 º/s; p=0,01), velocidade de twist (127,4±32,2 vs. 149,9±35,9 º/s; p=0,02) e na torção (2,4±0,4 vs. 2,8±0, º/cm; p=0,02). Conclusões A atividade física não causou melhora significativa nos parâmetros de deformação longitudinal, radial ou circunferencial do VE. No entanto, o exercício teve um impacto significativo sobre a mecânica de torção do VE, que consistiu em uma redução na rotação basal, na velocidade de twist, na torção, e na velocidade de torção, que pode ser interpretada como uma "reserva" de torção ventricular nessa população.


Abstract Background Exercise plays a positive role in the course of the ischemic heart disease, enhancing functional capacity and preventing ventricular remodeling. Objective To investigate the impact of exercise on left ventricular (LV) contraction mechanics after an uncomplicated acute myocardial infarction (AMI). Methods A total of 53 patients was included, 27 of whom were randomized to a supervised training program (TRAINING group), and 26 to a CONTROL group, who received usual recommendations on physical exercise after AMI. All patients underwent cardiopulmonary stress testing and a speckle tracking echocardiography to measure several parameters of LV contraction mechanics at one month and five months after AMI. A p value < 0.05 was considered statistically significant for the comparisons of the variables. Results No significant difference were found in the analysis of LV longitudinal, radial and circumferential strain parameters between groups after the training period. After the training program, analysis of torsional mechanics demonstrated a reduction in the LV basal rotation in the TRAINING group in comparison to the CONTROL group (5.9±2.3 vs. 7.5±2.9o; p=0.03), and in the basal rotational velocity (53.6±18.4 vs.68.8±22.1 º/s; p=0.01), twist velocity (127.4±32.2 vs. 149.9±35.9 º/s; p=0.02) and torsion (2.4±0.4 vs. 2.8±0.8 º/cm; p=0.02). Conclusions Physical activity did not cause a significant improvement in LV longitudinal, radial and circumferential deformation parameters. However, the exercise had a significant impact on the LV torsional mechanics, consisting of a reduction in basal rotation, twist velocity, torsion and torsional velocity which can be interpreted as a ventricular "torsion reserve" in this population.

17.
Belo Horizonte; s.n; 2023. 59 p.
Thesis in Portuguese | LILACS | ID: biblio-1518900

ABSTRACT

INTRODUÇÃO: a insuficiência cardíaca (IC) é uma das três causas mais comuns de doenças cardiovasculares (DCV), grupo de enfermidades que é a principal causa de morbimortalidade no mundo. O eletrocardiograma (ECG) é um dos exames utilizados na avaliação da IC, sendo de baixo custo e amplamente acessível. Quando associado à inteligência artificial, o ECG pode ser uma poderosa ferramenta para triagem de indivíduos com maior probabilidade de IC. O objetivo foi avaliar o desempenho de um algoritmo de IA, aplicado ao ECG, para detecção de DSVE e compará-lo ao das alterações maiores ao ECG (AME), de acordo com o código de Minnesota. MÉTODOS: estudo transversal retrospectivo de acurácia diagnóstica que utilizou a população do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). Foram avaliados 2567 indivíduos que possuíam ecocardiograma (ECO) e ECG válidos e valores de predição para disfunção sistólica do ventrículo esquerdo (DSVE) estimadas por um algoritmo de inteligência artificial (IA). A DSVE foi definida como Fração de Ejeção do Ventrículo Esquerdo (FEVE) menor que 40%, calculada utilizando o ECO. A prevalência de DSVE foi de 1,13% na população estudada (29 indivíduos). Foram calculados sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN), razão de verossimilhança positivo (RVP), razão de verossimilhança negativa (RVN), diagnostic odds ratio (DOR) para o algoritmo e para as AME. Calculou-se também a área sob a curva ROC (ASC-ROC) para o algoritmo. RESULTADOS: a população estudada possui mediana de 62 anos, sendo 47,2% do sexo masculino. A ASC-ROC do algoritmo para predição de IC foi de 0,947 (IC 95% 0,913 ­ 0,981). A sensibilidade, especificidade, VPP, VPN, RVP, RVN e DOR para o algoritmo foi de 0,690; 0,976; 0,244; 0,996; 27,6; 0,32 e 88,74, respectivamente. Para as AME foi 0,172; 0,837; 0,012; 0,989; 1,09; 0,990 e 1,07 respectivamente. CONCLUSÕES: A IA aplicada ao ECG é uma fermenta promissora para identificação de pacientes com maior probabilidade de IC e que devem ser priorizados para realização de ECO. Isso poderia aprimorar o diagnóstico de IC em nosso meio e, assim, permitir o início precoce do tratamento, com possível impacto na redução da morbidade e mortalidade.


INTRODUCTION: Heart failure (HF) is one of the three most common causes of cardiovascular diseases (CVD), which are the leading causes of morbidity and mortality worldwide. The electrocardiogram (ECG) is one of the tests used in the evaluation of HF, combining low-cost and wide accessibility. When combined with artificial intelligence, the ECG can be a powerful tool for screening individuals with a higher risk of HF. Our objective was to assess the performance of an AI algorithm applied to the ECG for the detection of left ventricular systolic dysfunction (LVSD) and compare it to the performance of major ECG abnormalities (MEA) according to the Minnesota code. METHODS: This was a retrospective cross-sectional diagnostic accuracy study using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil). A total of 2567 individuals with valid echocardiograms (ECO) and ECGs and probability values for left ventricular systolic dysfunction (LVSD) estimated by an artificial intelligence (AI) algorithm, were evaluated. LVSD was defined as a left ventricular ejection fraction (LVEF) less than 40%, calculated using ECO. The prevalence of LVSD was 1.13% in the studied population (29 individuals). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated for the algorithm and MEA. The area under the ROC curve (AUC-ROC) was also calculated for the algorithm. RESULTS: The study population had a median age of 62 years, with 47.2% being male. The AUC-ROC for the algorithm to predict HF was 0.947 (95% CI 0.913 ­ 0.981). Sensitivity, specificity, PPV, NPV, PLR, NLR, and DOR for the algorithm were 0.690, 0.976, 0.244, 0.996, 27.6, 0.32, and 88.74, respectively. For MEA, it was 0.172, 0.837, 0.012, 0.989, 1.09, 0.990, and 1.07, respectively. CONCLUSIONS: AI applied to the ECG is a promising tool for identifying patients with a higher likelihood of HF who should be prioritized for ECO. This could improve the diagnosis capacity of HF in our setting and thus enable early treatment initiation, with possible impact on reducing morbidity and mortality.


Subject(s)
Humans , Male , Female , Artificial Intelligence , Ventricular Dysfunction, Left , Electrocardiography , Heart Failure
19.
Organ Transplantation ; (6): 93-2023.
Article in Chinese | WPRIM | ID: wpr-959025

ABSTRACT

Objective To evaluate the effect of extracorporeal membrane oxygenation (ECMO) on early allograft dysfunction (EAD) after heart transplantation. Methods Clinical data of 614 heart transplant recipients were retrospectively analyzed. All recipients were divided into the ECMO group (n=43) and non-ECMO group (n=571) according to postoperative application of ECMO. In the ECMO group, the conditions of recipients undergoing ECMO after heart transplantation were summarized. Perioperative status and long-term prognosis of recipients were compared between two groups. Results Among 43 recipients undergoing ECMO, 17 cases underwent thoracotomy due to bleeding, 10 cases of infection, 4 cases of venous thrombosis of the lower limbs, and 1 case of stroke, respectively. Twenty-six recipients were recovered and discharged after successful weaning from ECMO, six died during ECMO support, six died after weaning from ECMO, five received retransplantation due to unsuccessful weaning from ECMO, and only one survived after retransplantation. Compared with the non-ECMO group, intraoperative cardiopulmonary bypass duration was significantly longer, the proportion of recipients requiring postoperative intra-aortic balloon pump (IABP), dialysis due to renal insufficiency, reoperation for hemostasis, infection, mechanical ventilation time≥96 h and tracheotomy was significantly higher, and the length of postoperative intensive care unit (ICU) stay was significantly longer in the ECMO group (all P < 0.05). The survival rate after discharge and 90-d survival rate in the ECMO group were 63% and 96%, significantly lower than 97% and 100% in the non-ECMO group (both P < 0.05). Survival analysis showed that the long-term survival rate in the ECMO group was significantly lower than that in the non-ECMO group (P < 0.05). After excluding the recipients who died within 90 d after heart transplantation, no significant difference was observed in the long-term survival rate (P > 0.05). Conclusions ECMO is an effective treatment of EAD after heart transplantation. The short-term survival rate of recipients using ECMO after heart transplantation is lower than that of those who do not use ECMO, and there is no significant difference in long-term survival of recipients surviving 90 d after heart transplantation.

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Article in English | WPRIM | ID: wpr-982355

ABSTRACT

OBJECTIVES@#Early detection of asymptomatic diastolic dysfunction is essential to prevent the development of heart failure in hypertensive patients. Current studies suggest that left atrial strain contributes to the evaluation of left ventricular diastolic function, but there are fewer studies on the correlation between left atrial strain and diastolic function in hypertensive patients. In this study, we applied a two-dimensional speckle tracking technique to evaluate the changes in left atrial strain in hypertensive patients, and to investigate the relationship between left atrial strain and left ventricular diastolic function.@*METHODS@#A total of 82 hypertensive patients who were visited the Department of Cardiology at the Third Xiangya Hospital of Central South University from July 2021 to January 2022, were enrolled for this study, and 59 healthy subjects served as a control group. According to the number of left ventricular diastolic function indexes recommended by the 2016 American Society of Echocardiography Diastolic Function Guidelines (mitral annular e´ velocity: Septal e´<7 cm/s, lateral e´<10 cm/s, E/e´ ratio>14, left atrial volume index>34 mL/m2, peak tricuspid regurgitation velocity>2.8 m/s), the hypertensive patients were divided into 3 groups: Group Ⅰ (0 index, n=36 ), Group Ⅱ (1 index, n=39), and Group Ⅲ (2 indexes, n=7). Two-dimensional speckle tracking technique was used to measure left atrial reservoir strain (LASr), conduit strain, and contraction strain, and to analyze the correlation between left atrial strain and left ventricular diastolic function in hypertensive patients.@*RESULTS@#The LASr, left atrial conduit strain (LAScd), and LASr/(E/septal e´) of the hypertension group were lower than those of the control group, and E/LASr was higher than that of the control group. There was no significant difference in left atrium volume index between the 2 groups (P>0.05). Compared with Group Ⅰ, LASr, LAScd, and LASr/(E/septal e´) were decreased in Group Ⅱ and Group Ⅲ, LASr/(E/septal e´) was also decreased in Group Ⅲ compared with Group Ⅱ (all P<0.05). Compared with Group Ⅰ, E/LASr was increased in Group Ⅲ. LASr was positively correlated with septal e´, lateral e´, E, and E/A, and negatively correlated with E/septal e´.@*CONCLUSIONS@#The changes of left atrial function in patients with early hypertension are earlier than those of left atrial structure. Left atrial strain and its combination with conventional ultrasonographic indices [LASr/(E/septal e´)] of diastolic function are potentially useful in assessing left ventricular diastolic function in hypertensive patients.


Subject(s)
Humans , Atrial Fibrillation , Atrial Appendage , Heart Atria/diagnostic imaging , Hypertension/complications , Diastole
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