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2.
Int. j. cardiovasc. sci. (Impr.) ; 35(3): 329-339, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1375636

ABSTRACT

Abstract Background: Right ventricular dysfunction is a major complication in chronic obstructive pulmonary disease (COPD) and, despite its prognostic implications, is rarely considered in routine clinical analysis. Objectives: To compare RV function variables with standard and advanced echocardiographic techniques in patients with stable COPD and controls. Methods: Twenty COPD patients classified as GOLD ≥ II (13 men aged 68.4 ± 8.3 years) and 20 matched controls were compared. Myocardial strain/strain rate indices were obtained by tissue Doppler and two-dimensional speckle tracking echocardiography. Right ventricular ejection fraction was obtained with three-dimensional software. Free wall myocardial thickness (FWMT) and tricuspid annular systolic excursion (TAPSE) were also measured. Numerical variables were compared between groups with Student's t-test or the Mann-Whitney test. Associations between categorical variables were determined with Fisher's exact test. P-values < 0.05 were considered statistically significant. Results: All myocardial deformation indices, particularly global longitudinal strain (-17.2 ± 4.4 vs -21.2: ± 4.4 = 0.001) and 3D right ventricular ejection fraction (40.8 ± 9.3% vs 51.1 ± 6.4% p <0.001) were reduced in COPD patients. These patients presented higher right ventricular FWMT and lower TAPSE values than controls. Conclusion: Myocardial deformation indices, either tissue Doppler or speckle tracking echocardiography and 3D right ventricular ejection fraction, are robust markers of right ventricular dysfunction in patients with stable COPD. Assessing global longitudinal strain by speckle tracking echocardiography is a more practical and reproducible method.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Ventricular Dysfunction, Right/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Case-Control Studies , Cross-Sectional Studies , Ventricular Dysfunction, Right/etiology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/therapy , Myocardium
4.
Arq. bras. cardiol ; 117(4): 690-698, Oct. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1345226

ABSTRACT

Resumo Fundamento A ressonância magnética cardíaca (RMC) é o método de escolha para avaliar as dimensões e a função do ventrículo direito (VD), e a insuficiência pulmonar (IP). Objetivos Avaliar a acurácia da ecocardiografia bidimensional (ECO 2D) em estimar a função e as dimensões do VD e o grau de IP, e comparar os resultados obtidos pela ECO 2D com os da RMC. Métodos Comparamos os relatórios de ECO e RMC de pacientes cuja indicação para RMC havia sido para avaliar VD e IP. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados Incluímos 51 pacientes com cardiopatia congênita com idade mediana de 9,3 anos (7-13,3 anos). Observou-se uma baixa concordância entre ECO 2D e RMC quanto à classificação da dimensão (Kappa 0,19; IC 95% 0,05 a 0,33, p 0,004) e da função do VD (Kappa 0,16; IC 95% -0,01 a +0,34; p 0,034). O tamanho do VD foi subestimado pela ECO 2D em 43% dos casos, e a função do VD foi superestimada pela ECO 2D em 29% dos casos. O grau de concordância entre os métodos quanto à classificação da IP não foi significativo (Kappa 0,014; IC 95% -0,03 a +0,06; p 0,27). Houve uma tendência de a ECO 2D superestimar o grau da IP. Conclusões A ECO 2D mostrou baixa concordância com a RMC quanto às dimensões e função do VD, e grau de IP. Em geral, a ECO subestimou as dimensões do VD e superestimou a função do VD e o grau de IP quando comparada à RMC.


Abstract Background Cardiac magnetic resonance (CMR) is the method of choice for assessing right ventricular (RV) dimensions and function, and pulmonary insufficiency (PI). Objectives To assess the accuracy of two-dimensional echocardiography (2D ECHO) in estimating RV function and dimensions, and the degree of PI, and compare the 2D ECHO and CMR findings. Methods We compared ECHO and CMR reports of patients whose indication for CMR had been to assess RV and PI. A p-value < 0.05 was considered statistically significant. Results We included 51 congenital heart disease patients, with a median age of 9.3 years (7-13.3 years). There was poor agreement between 2D ECHO and CMR for classification of the RV dimension (Kappa 0.19; 95% CI 0.05 to 0.33, p 0.004) and function (Kappa 0.16; 95% CI -0.01 to +0.34; p 0.034). The RV was undersized by 2D ECHO in 43% of the cases, and RV function was overestimated by ECHO in 29% of the cases. The degree of agreement between the methods in the classification of PI was not significant (Kappa 0.014; 95% CI -0.03 to +0.06, p 0.27). 2D ECHO tended to overestimate the degree of PI. Conclusions The 2D ECHO showed a low agreement with CMR regarding the RV dimensions and function, and degree of PI. In general, ECHO underestimated the dimensions of the RV and overestimated the function of the RV and the degree of PI as compared with CMR.


Subject(s)
Humans , Child , Ventricular Dysfunction, Right/diagnostic imaging , Echocardiography, Three-Dimensional , Heart Defects, Congenital , Stroke Volume , Echocardiography , Magnetic Resonance Spectroscopy , Reproducibility of Results , Ventricular Function, Right , Magnetic Resonance Imaging, Cine , Heart Ventricles/diagnostic imaging
5.
Medicina (B.Aires) ; 81(4): 624-636, ago. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346516

ABSTRACT

Resumen La hipertensión arterial pulmonar (HAP) requiere procesos estructurados de diagnóstico y estratificación de riesgo, siendo la función del ventrículo derecho (VD) un marcador pronóstico central. Los principales objetivos terapéuticos en la HAP son mejorar y/o intentar revertir la disfunción del VD y mantener condición de bajo riesgo. Actualmente existen múltiples fármacos con diferentes mecanismos de acción cuya combinación en doble o triple terapia ha mostrado mejores resultados que la monoterapia. Evidencia actual demuestra la importancia de incorporar tempranamente prostanoides parenterales al esquema, mejorando la funcionalidad del VD y la supervivencia. En esta revisión se refleja el papel de la función del VD en el diagnós tico, pronóstico y seguimiento de la HAP. Se recomienda la evaluación sistemática y estandarizada del VD, así como el inicio temprano de tratamiento combinado en riesgo intermedio-alto para obtener las metas de alcanzar y mantener un riesgo bajo y/o evitar la progresión de la HAP.


Abstract Pulmonary arterial hypertension (PAH) requires structured processes of diagnosis and risk stratifica tion, being the function of the right ventricle (RV) a hallmark prognosis determinant. The main therapeutic goals in PAH are to improve and try to revert RV dysfunction and maintaining a low risk. Currently, there are multiple treatments with different mechanisms of action, the combination of which in double or triple therapy has shown improved results compared to monotherapy. Recent clinical evidence shows the importance of early incorpora tion of parenteral prostanoids to the scheme, improving RV function and survival. In this review, we discuss the role of the RV function in the diagnosis, prognosis, and follow-up of PAH. We recommend the systematic and standardised evaluation of the RV as well as the early initiation of combined treatment in cases of intermediate-high risk to try to reach and keep the patient with PAH at a low risk and / or avoid the progression of PAH.


Subject(s)
Humans , Ventricular Dysfunction, Right , Pulmonary Arterial Hypertension , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/drug therapy , Ventricular Function, Right , Heart Ventricles/diagnostic imaging
6.
Rev. Soc. Bras. Med. Trop ; 54: e03822021, 2021. tab, graf
Article in English | LILACS | ID: biblio-1340826

ABSTRACT

Abstract INTRODUCTION: Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. METHODS: Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models. RESULTS: Total 163 patients were enrolled, 59% were men, mean age 64±16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age≥63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91). CONCLUSION: Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.


Subject(s)
Humans , Male , Aged , Aged, 80 and over , Ventricular Dysfunction, Right , COVID-19 , Stroke Volume , Echocardiography , SARS-CoV-2 , Middle Aged
7.
ABC., imagem cardiovasc ; 34(2)2021. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1283765

ABSTRACT

Introdução: As funções sistólica e diastólica do ventrículo direito influenciam no desfecho de doenças cardiovasculares. A avaliação sistemática das dimensões e da função das câmaras direitas, de acordo com sexo e idade, não é uniformemente realizada. Objetivo: Avaliar, ao ecocardiograma transtorácico, a correlação da função diastólica do ventrículo direito com idade e sexo, em uma população ambulatorial variada, com função sistólica dos ventrículos esquerdo e direito preservada. Métodos: Estudo observacional, transversal. Foram selecionados 97 pacientes, 61,5 ± 12,5 anos, sendo 56 mulheres. Foram avaliadas as seguintes medidas da função diastólica do ventrículo direito: velocidade de pico das ondas E e A, relação E/A, tempos de aceleração e desaceleração de onda E, integral velocidade-tempo da onda E, integral velocidade-tempo da onda A, além da pressão sistólica de artéria pulmonar, velocidade do refluxo tricúspide, diâmetro da veia cava inferior e volume do átrio direito. Resultados: Ocorreu redução da onda E com o aumento da idade (coeficiente de correlação de Pearson de -0,30; p=0,003) e da relação E/A (coeficiente de correlação de Pearson de -0,21; p=0,035). Houve associação positiva e significativa entre idade e os resultados das variáveis pressão sistólica de artéria pulmonar (coeficiente de correlação de Pearson de 0,40; p=0,004) e velocidade do refluxo tricúspide (coeficiente de correlação de Pearson de 0,36; p=0,008). Não houve diferença significativa na comparação entre os sexos em relação a variáveis ecocardiográficas. Conclusão: O presente estudo mostrou impacto da idade nos índices de função diastólica do ventrículo direito em indivíduos com função sistólica biventricular preservada, embora ainda com valores dentro da normalidade. O estudo não evidenciou diferença significativa entre os sexos em relação a função diastólica do ventrículo direito. (AU)


Introduction: Right ventricular (RV) systolic and diastolic functions influence the outcomes of cardiovascular diseases. However, right chamber size and function have not been uniformly assessed by age and sex. Objective: To evaluate RV diastolic function by age and sex in an outpatient population with preserved left ventricular (LV) and RV systolic function using transthoracic echocardiography. Method: This observational cross-sectional study included a total of 97 patients (56 women) aged 61.5 ± 12.5 years. The assessed parameters included RV E/A ratio; peak E-wave and A-wave velocity, E-wave acceleration and deceleration time, and integral E-wave and A-wave velocitytime; and pulmonary artery systolic pressure (PASP), tricuspid reflux velocity, inferior vena cava diameter, and right atrial volume. Results: A reduced E-wave was observed with increasing age (Pearson's correlation coefficient [PCC], -0.30; p = 0.003). The same was observed for the E/A ratio (PCC, -0.21; p = 0.035). There was a significant positive association between age and PASP results (PCC, 0.40; p = 0.004) and tricuspid reflux velocity (PCC, 0.36; p = 0.008). There was no significant intersex difference in echocardiography variables. Conclusion: The present study showed the impact of age on RV diastolic function indices, which remained within the normal range, in subjects with preserved LV and RV function. The study did not evidence a significant difference between genders in relation to the diastolic function of the right ventricle.(AU)


Subject(s)
Humans , Child , Adolescent , Adult , Middle Aged , Aged , Cardiovascular Diseases/complications , Ventricular Dysfunction, Right/physiopathology , Echocardiography , Echocardiography, Doppler , Comorbidity , Electrocardiography , Observational Study
9.
ABC., imagem cardiovasc ; 34(4): eabc256, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1359750

ABSTRACT

Fundamento: A ecocardiografia transtorácica (ETT) pode desempenhar um papel crucial na avaliação das manifestações cardíacas da COVID-19. Objetivo: Nosso objetivo foi relatar a prevalência das principais anormalidades ecocardiográficas em pacientes hospitalizados com COVID-19. Métodos: Realizou-se estudo observacional multicêntrico prospectivo com pacientes com COVID-19 submetidos a ETT durante a internação. Pacientes com insuficiência cardíaca prévia, doença arterial coronariana ou fibrilação atrial foram classificados como portadores de doença cardiovascular (DCV) prévia. Foram coletados dados clínicos e ecocardiográficos da estrutura e da função cardíaca. Resultados: Avaliamos 310 pacientes com COVID-19, com 62±16 anos de idade, 61% homens, 53% com hipertensão arterial, 33% com diabetes e 23% com DCV prévia. No total, 65% dos pacientes necessitaram de suporte em unidade de terapia intensiva. As alterações ecocardiográficas mais prevalentes foram hipertrofia do ventrículo esquerdo (VE) (29%), hipertensão pulmonar (25%), disfunção sistólida do VE (16,5%), disfunção sistólica do ventrículo direito (VD) (15,9%), disfunção diastólica do VE grau II/III (11%) e alteração da contratilidade regional do VE (11%). Derrame pericárdico foi incomum (7%). Hipertrofia do VE (25 vs. 45%, p=0,001), disfunção sistólica do VE (11 vs. 36%, p<0,001), alterações da contratilidade regional (6 vs. 29%, p<0,001), disfunção diastólica do VE grau II/III (9 vs. 19%, p=0,03) e hipertensão pulmonar (22 vs. 36%, p=0,019) foram menos comuns nos pacientes sem do que com DCV prévia. A disfunção sistólica do VD mostrou-se semelhante em pacientes sem e com DCV prévia (13 vs. 25%, p=0,07). Conclusões: Entre os pacientes hospitalizados com COVID-19, os achados ecocardiográficos anormais foram comuns, porém menos encontrados naqueles sem DCV. A disfunção sistólica do VD pareceu afetar de forma semelhante pacientes com e sem DCV prévia. (AU)


Background: Transthoracic echocardiography (TTE) may play a crucial role in the evaluation of cardiac manifestations of coronavirus disease 2019 (COVID-19). Objective: We aimed to report the prevalence of the main echocardiographic abnormalities of hospitalized COVID-19 patients. Methods: We performed a prospective multicenter observational study in patients with COVID-19 who underwent TTE during hospitalization. Patients with pre-existing heart failure, coronary artery disease, or atrial fibrillation were categorized as having previous cardiovascular disease (CVD). Clinical and echocardiographic data about cardiac structure and function were collected. Results: We evaluated 310 patients with COVID-19 (mean age, 62±16 years; 61% men; 53% with arterial hypertension; 33% with diabetes; and 23% with previous CVD). Overall, 65% of the patients required intensive care unit support. The most prevalent echocardiographic abnormalities were LV hypertrophy (29%), pulmonary hypertension (25%), left ventricular (LV) systolic dysfunction (16.5%), right ventricular (RV) systolic dysfunction (15.9%), grade II/III LV diastolic dysfunction (11%), and LV regional wall motion abnormality (11%). Pericardial effusion was uncommon (7% of cases). LV hypertrophy (25% vs. 45%, p=0.001), LV systolic dysfunction (11% vs. 36%, p<0.001), regional wall motion abnormalities (6% vs. 29%, p<0.001), grade II/III LV diastolic dysfunction (9% vs. 19%, p=0.03), and pulmonary hypertension (22% vs. 36%, p=0.019) were less common in patients without previous CVD. RV systolic dysfunction occurred at similar frequencies in patients with versus without previous CVD (13% vs. 25%, p=0.07). Conclusions: Among patients hospitalized with COVID-19, abnormal echocardiographic findings were common, but less so among those without previous CVD. RV systolic dysfunction appeared to affect similar proportions of patients with versus without previous CVD. (AU)


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Echocardiography/statistics & numerical data , COVID-19/complications , COVID-19/physiopathology , COVID-19/diagnostic imaging , Heart Failure/classification , Cardiovascular Diseases/history , Epidemiologic Factors , Statistical Data , Hypertrophy, Left Ventricular/diagnostic imaging , Ventricular Dysfunction, Right/diagnostic imaging , Diabetes Mellitus/history , Hypertension/history , Hypertension, Pulmonary/diagnostic imaging
10.
Article in Chinese | WPRIM | ID: wpr-879251

ABSTRACT

Right ventricular (RV) failure has become a deadly complication of left ventricular assist device (LVAD) implantation, for which desynchrony in bi-ventricular pulse resulting from a LVAD is among the important factor. This paper investigated how different control modes affect the synchronization of pulse between LV (left ventricular) and RV by numerical method. The numerical results showed that the systolic duration between LV and RV did not significantly differ at baseline (LVAD off and cannula clamped) (48.52%


Subject(s)
Heart Failure/therapy , Heart-Assist Devices , Humans , Systole , Ventricular Dysfunction, Right , Ventricular Function, Right
12.
Rev. chil. cardiol ; 39(2): 165-167, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138530

ABSTRACT

Abstract: Right ventricular restrictive physiology (RVRP) occurs in diverse clinical scenarios, most frequently after repair of Tetralogy of Fallot (TOF). Cardiac magnetic resonance (CMR) can comprehensively evaluate RVRP using 4D flow along with anatomical and fibrosis characterization. Also, RVRP is associated with less pulmonary regurgitation and fewer right ventricle enlargement; its long term protective role is debated. RVRP is a challenging and relevant diagnosis, which hallmark is the presence of antegrade pulmonary arterial Flow in late diastole throughout the respiratory cycle. Also, other hemodynamic findings could aid such us flow in; caval veins, suprahepatic, coronary sinus and tricuspid valve. Obtaining all these flow curves is virtually impossible by echocardiography. CMR with 4DF is a unique and powerful technique enabling this comprehensive hemodynamic evaluation as depicted in this case.


Subject(s)
Humans , Magnetic Resonance Imaging , Ventricular Dysfunction, Right/diagnostic imaging , Imaging, Three-Dimensional/methods , Pulmonary Artery/pathology , Regional Blood Flow , Tetralogy of Fallot/complications , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/physiopathology , Hemodynamics
14.
Arq. bras. cardiol ; 114(4): 638-644, Abr. 2020. tab, graf
Article in English, Portuguese | LILACS, SES-SP | ID: biblio-1131195

ABSTRACT

Abstract Background: The practice of screening for complications has provided high survival rates among heart transplantation (HTx) recipients. Objectives: Our aim was to assess whether changes in left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) are associated with cellular rejection. Methods: Patients who underwent HTx in a single center (2015 - 2016; n = 19) were included in this retrospective analysis. A total of 170 biopsies and corresponding echocardiograms were evaluated. Comparisons were made among biopsy/echocardiogram pairs with no or mild (0R/1R) evidence of cellular rejection (n = 130 and n = 25, respectively) and those with moderate (2R) rejection episodes (n=15). P-values < 0.05 were considered statistically significant Results: Most patients were women (58%) with 48 ± 12.4 years of age. Compared with echocardiograms from patients with 0R/1R rejection, those of patients with 2R biopsies showed greater LV posterior wall thickness, E/e' ratio, and E/A ratio compared to the other group. LV systolic function did not differ between groups. On the other hand, RV systolic function was more reduced in the 2R group than in the other group, when evaluated by TAPSE, S wave, and RV fractional area change (all p < 0.05). Furthermore, RV GLS (−23.0 ± 4.4% in the 0R/1R group vs. −20.6 ± 4.9% in the 2R group, p = 0.038) was more reduced in the 2R group than in the 0R/1R group. Conclusion: In HTx recipients, moderate acute cellular rejection is associated with RV systolic dysfunction as evaluated by RV strain, as well as by conventional echocardiographic parameters. Several echocardiographic parameters may be used to screen for cellular rejection.


Resumo Fundamento: A prática de triagem para complicações tem proporcionado altas taxas de sobrevida entre pacientes que receberam transplante cardíaco (TC). Objetivos: Visamos avaliar se alterações no strain longitudinal global (SLG) do ventrículo esquerdo (VE) e do ventrículo direito (VD) estão associadas à rejeição celular. Métodos: Pacientes que foram submetidos à TC em um único centro (2015 - 2016; n = 19) foram incluídos nesta análise retrospectiva. Foram avaliados um total de 170 biópsias com ecocardiogramas correspondentes. Foram realizadas comparações entre pares de biópsia/ecocardiograma com nenhuma ou leve (0R/1R) evidência de rejeição celular (n = 130 e n = 25, respectivamente) e aqueles com episódios de rejeição moderada (2R) (n = 15). Foram considerados estatisticamente significativos os valores de p < 0,05. Resultados: A maioria dos pacientes eram mulheres (58%) com idade média de 48 ± 12,4 anos. Em comparação com os ecocardiogramas dos pacientes com rejeição 0R/1R, os pacientes com biópsias 2R apresentaram maior espessura da parede posterior do VE, relação E/e' e relação E/A, em comparação com o outro grupo. A função sistólica do VE não diferiu entre os grupos. Por outro lado, a função sistólica do VD foi reduzida no grupo 2R em comparação ao outro grupo, quando avaliada por TAPSE, onda S e variação fracional da área do VD. Adicionalmente, SLG VD (−22,97 ± 4,4% no grupo 0R/1R vs. −20,6 ± 4,9% no grupo 2R, p = 0,038) foi reduzido no grupo 2R, em comparação com o grupo 0R/1R. Conclusão: Em pacientes de TC, rejeição celular aguda moderada está associada à disfunção sistólica do VD, avaliado pelo strain do VD, bem como por parâmetros ecocardiográficos convencionais. Vários parâmetros ecocardiográficos podem ser utilizados para realizar triagem para rejeição celular.


Subject(s)
Humans , Male , Female , Adult , Heart Transplantation , Ventricular Dysfunction, Right/surgery , Echocardiography , Retrospective Studies , Ventricular Function, Right , Ventricular Dysfunction, Left , Graft Rejection , Heart Ventricles , Middle Aged
15.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 263-267, Mar. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136213

ABSTRACT

SUMMARY OBJECTIVES Acute pulmonary embolism (APE) is an important cause of cardiovascular mortality, due mainly to hemodynamic instability. In these cases, the recommendation is to perform some reperfusion procedure, with systemic thrombolysis being the main therapy used. However, national data evaluating the efficacy and safety of thrombolysis are scarce. METHODS Retrospective analysis of a case series. We included 13 patients diagnosed with high-risk APE and 4 patients with intermediate-high risk from a single-center, who were treated with alteplase 100mg. RESULTS The mean age of the patients was 55 years, most of them female (76.4%). Among the risk factors for VTE were immobilization (41.17%), contraceptive use (35.29%), cancer (17.63%), and previous history of DVT (11.76%). The most frequent clinical manifestations of APE were dyspnea (88.23%), hypoxia (82.35%), hypotension (82.35%), and tachycardia (64.70%). 82.35% of the patients had echocardiographic signs of right ventricular dysfunction, and 52.94% had increased troponin and BNP. Severe bleeding associated with thrombolysis occurred in 17.54% of cases. No patient died due to bleeding. There were 8 deaths from right ventricular failure (47%), 6 in the cases of patients presenting as high-risk APE (35.3%), and 2 in the cases of intermediate-high risk (11.8%). CONCLUSION Thrombolysis in patients with high-risk APE or intermediate-high risk had a severe bleeding rate of 17.6%. However, the high mortality of this population (47%) due to right ventricular failure justifies the use of this therapeutic modality.


RESUMO OBJETIVOS A embolia pulmonar aguda (EAP) é uma causa importante de mortalidade cardiovascular ao causar instabilidade hemodinâmica. Nesses casos, a recomendação é a realização de algum procedimento de reperfusão, sendo a trombólise sistêmica a principal terapia utilizada. No entanto, dados nacionais avaliando a eficácia e a segurança da trombólise são escassos. MÉTODO Análise retrospectiva de uma série de casos. Foram incluídos 13 pacientes com o diagnóstico de EAP de alto risco e quatro pacientes de risco intermediário-alto, de um único centro, e que foram tratados com alteplase 100 mg. RESULTADOS A média de idade dos pacientes foi 55 anos, sendo a maioria do gênero feminino (76,4%). Dos fatores de risco para TEV, estavam presentes a imobilização (41,17%), o uso de anticonceptivos (35,29%), câncer (17,63%) e história prévia de TVP (11,76%). As manifestações clínicas mais frequentes da EAP foram dispneia (88,23%), hipóxia (82,35%), hipotensão (82,35%) e taquicardia (64,70%); 82,35% dos pacientes apresentaram sinais ecocardiográficos de disfunção ventricular direita e 52,94% apresentaram aumento da troponina e BNP. Sangramento grave associado à trombólise ocorreu em 17,54% dos casos. Nenhum paciente faleceu em decorrência de sangramento. Houve oito mortes por insuficiência ventricular direita (47%): seis nos casos de paciente que se apresentaram como EAP de alto risco (35,3%) e duas nos casos de risco intermediário-alto (11,8%). CONCLUSÃO A trombólise nos pacientes com EAP de alto risco ou risco intermediário-alto apresentou uma taxa de sangramento grave de 17,6%. No entanto, a alta mortalidade dessa população (47%) por insuficiência ventricular direita justifica o uso desta modalidade terapêutica.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Pulmonary Embolism/drug therapy , Thrombolytic Therapy/methods , Ventricular Dysfunction, Right/drug therapy , Fibrinolytic Agents/therapeutic use , Antifibrinolytic Agents/therapeutic use , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Acute Disease , Retrospective Studies , Risk Factors , Treatment Outcome , Tissue Plasminogen Activator/therapeutic use , Ventricular Dysfunction, Right/complications , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/mortality , Risk Assessment , Fibrinolytic Agents/adverse effects , Hemorrhage/chemically induced , Middle Aged , Antifibrinolytic Agents/adverse effects
16.
Rev. bras. cir. cardiovasc ; 34(5): 511-516, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042045

ABSTRACT

Abstract Objective: This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. Methods: A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. Results: Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. Conclusion: In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Tricuspid Valve/surgery , Ebstein Anomaly/surgery , Postoperative Complications/etiology , Reoperation/statistics & numerical data , Time Factors , Tricuspid Valve Insufficiency/etiology , Severity of Illness Index , Retrospective Studies , Treatment Outcome , Ventricular Dysfunction, Right/etiology , Ebstein Anomaly/complications , Ebstein Anomaly/mortality , Kaplan-Meier Estimate , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/mortality
17.
ABC., imagem cardiovasc ; 32(4): 318-30, out.-dez. 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1024061

ABSTRACT

A doença pulmonar hipertensiva pode ser definida como um conjunto de alterações fisiopatológicas pulmonares que resultam em uma patologia grave, progressiva e com alta morbimortalidade. O ecocardiograma transtorácico é um método de imagem de fácil acesso e essencial para avaliação desta doença, principalmente na faixa pediátrica, na qual há limitações para realização frequente e de rotina do cateterismo direito. Nesta revisão, abordaremos as principais técnicas ecocardiográficas para o diagnóstico e a avaliação hemodinâmica da hipertensão pulmonar na população pediátrica. O diagnóstico precoce e o adequado estadiamento no acompanhamento das intervenções clínicas são fundamentais para escolha assertiva da abordagem terapêutica e, consequentemente, melhora do desfecho clínico


Subject(s)
Humans , Male , Female , Pediatrics , Echocardiography/methods , Child , Hypertension, Pulmonary/mortality , Pulmonary Artery , Tricuspid Valve , Vena Cava, Inferior , Cardiac Catheterization , Echocardiography, Doppler/methods , Ventricular Dysfunction, Right , Ventricular Dysfunction, Left , Heart Atria , Heart Ventricles
18.
Rev. costarric. cardiol ; 21(1): 14-22, ene.-jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1042859

ABSTRACT

Resumen El ventrículo derecho, históricamente, ha sido en gran medida olvidado e y la gran mayoría de las técnicas diagnósticas,los abordajes terapéuticos y las investigaciones clínicas están dirigidas al ventrículo izquierdo. Con una anatomía y fisiologíamuy diferente a su contraparte izquierda, el ventrículo derecho dispone de limitadas opciones terapéuticas cuando éste falla, lo cual empeora enormemente el pronóstico del paciente. La presente revisión pretende hacer un análisis de la anatomía, fisiología, fisiopatología, estudios de imagen y tratamiento de la falla ventricular derecha con el fin de retomar su importancia en la cardiología actual.


Abstract The right ventricle has been, historically, largely forgotten and the vast majority of diagnostic techniques, therapeutic approaches and clinical research are directed to the left ventricle. With a very different anatomy and physiology from its left counterpart, the right ventricle has limited therapeutic options when it fails, which greatly worsens the patient's prognosis. The present review intends to analyze the anatomy, physiology, physiopathology, imaging studies and treatment of right ventricular failure in order to resume its importance in current cardiology.


Subject(s)
Humans , Ventricular Dysfunction, Right , Costa Rica , Heart Failure , Heart Ventricles/anatomy & histology , Heart Ventricles/physiopathology , Heart Ventricles/pathology
19.
Arq. bras. cardiol ; 112(3): 249-257, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-989346

ABSTRACT

Abstract Background: Few reports exist on the relationship of the left ventricular diastolic dysfunction (LVDD) with its most important features including enlargement of the left atrium and left ventricular hypertrophy (LVH), and with the right ventricular (RV) function. Objective: To determine the correlation between the left atrial size and the RV function and dimensions in patients with and without LVDD and LVH. Methods: Fifty patients were included, 25 (40% men) of them with LVDD, aged 67.1 ± 10.6 years (study group) and 25 without LVDD (52% men) aged 49.9 ± 16.3 years (control group). Patients underwent transthoracic echocardiography with evaluation of the left atrial size and volume (LAV), LVDD, LVH, and RV function and dimensions. P-values < 0.05 were considered statistically significant. Results: LAV > 34 mL/m2 and left atrial size > 40 mm were associated with lower absolute values of tricuspid annular plane systolic excursion (TAPSE) and RV lateral S' (p ≤ 0.001, Pearson's correlation coefficient -0.4 and -0.38, respectively) in the study group. Patients in the study group showed higher incidence of LVH (p = 0.02) and greater left atrial diameter (p = 0.03) compared with the control group. In addition, greater left atrial diameter (p = 0.02) and LAV (p = 0.01) values were found in patients with LVDD grade II compared with LVDD grade I. Conclusions: The present study determined, for the first time, the correlation of left atrial enlargement with progressive RV dysfunction in patients with LVDD.


Resumo Fundamentos: A relação entre a disfunção diastólica do ventrículo esquerdo (DDVE), seus achados mais importantes, como aumento do átrio esquerdo e hipertrofia ventricular esquerda (HVE), e a função do ventrículo direito (VD) tem pouca documentação na literatura científica. Objetivo: Avaliar a correlação entre o tamanho atrial esquerdo em indivíduos com e sem DDVE e HVE e função e dimensões do VD. Métodos: Foram selecionados 50 pacientes, sendo 25 com DDVE (grupo de estudo [GE]; 67,1 ± 10,6 anos; 40% homens) e 25 sem DDVE (grupo-controle [GC]; 49,9 ± 16,3 anos; 52% homens). Os pacientes foram submetidos a ecocardiografia transtorácica com avalição do tamanho e volume atrial esquerdo (VAE), DDVE, HVE, dimensões e função do VD. Valores de p < 0,05 indicaram significância estatística. Resultados: VAE > 34 ml/m2 e tamanho atrial esquerdo > 40 mm apresentaram menores valores absolutos de excursão sistólica do plano do anel tricúspide (TAPSE) e S' lateral do VD (p ≤ 0,001, coeficiente de correlação de Pearson de -0,4 e -0,38, respectivamente) no GE. O GE apresentou maior incidência de HVE e maior diâmetro atrial esquerdo quando comparado ao GC (p = 0,02 e p = 0,03, respectivamente). O GE apresentou maior diâmetro e VAE nos indivíduos com DDVE grau II quando comparados aos indivíduos com DDVE grau I (p = 0,02 e p = 0,01, respectivamente). Conclusões: O presente estudo permitiu correlacionar de maneira inédita o aumento atrial esquerdo com diminuição progressiva da função ventricular direita em pacientes com disfunção diastólica de VE.


Subject(s)
Humans , Male , Middle Aged , Aged , Ventricular Function, Right/physiology , Ventricular Dysfunction, Right/diagnostic imaging , Heart Atria/diagnostic imaging , Organ Size , Stroke Volume , Echocardiography, Doppler , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Left/physiopathology , Heart Ventricles/diagnostic imaging
20.
Int. j. cardiovasc. sci. (Impr.) ; 32(1): 41-47, jan.-fev. 2019. tab
Article in English | LILACS | ID: biblio-981574

ABSTRACT

Background: Congenital heart disease in adults shares some features with heart failure (HF), including exercise intolerance, ventilatory inefficiency, inflammatory and neurohormonal activation, cardiac arrhythmias and myocardial fibrosis. Over the last years, cardiopulmonary exercise test has gained importance in the diagnostic and prognostic evaluation of congenital heart diseases, as has already occurred in HF. Objective: To describe the behavior of hemodynamic, metabolic and ventilatory parameters in response to exercise in adults with congenital heart disease. Methods: Observational cross-sectional study evaluating 31 adults with congenital acyanotic or cyanotic heart disease, treated clinically, surgically or percutaneously, referred for cardiopulmonary exercise test. A descriptive analysis of the data was performed. Results: Patients aged 35.7 ± 14.2 years were included. Oxygen consumption (VO2) was 44.86 ± 18.01% of predicted at peak exercise and 36.92 ± 12.93% of predicted maximal VO2 at anaerobic threshold. We found an oxygen uptake efficiency slope (OUES) of 1.49 ± 0.89 (61.43 ± 26.63% of predicted), oxygen pulse of 58.90 ± 22.24% and increment in systolic arterial pressure during exercise was 31.42 ± 21.60 mmHg. Conclusion: Adults with congenital heart disease had similar responses to heart failure patients during exercise ­ reduced aerobic capacity, ventilatory inefficiency for oxygen consumption and limited inotropic response to exercise, characterized by reduced oxygen pulse and small increase in systolic arterial pressure


Subject(s)
Humans , Male , Female , Adult , Exercise , Heart Defects, Congenital/metabolism , Hemodynamics , Metabolism , Oxygen Consumption , Data Interpretation, Statistical , Ventricular Dysfunction, Right , Ventricular Dysfunction, Left , Cyanosis , Exercise Test , Arterial Pressure , Observational Study , Heart Failure
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