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BACKGROUND: The effectiveness of primary percutaneous coronary intervention (PCI) in ST segment elevation myocardial infarction (STEMI) is well established. The clinical variables associated with poor prognosis in patients with STEMI have been extensively investigated. Right coronary artery (RCA) has two anatomical variations detected on coronary angiography namely C-shaped and sigma shaped RCA. The clinical importance of the shape of RCA in patients with STEMI has not been investigated before. PURPOSE: To investigate the prognostic value of RCA shape in patients with inferior STEMI treated with primary PCI. METHODS: Angiographic data of patients with inferior STEMI who were treated with primary PCI were retrospectively recruited. The differentiation of sigma and C-shaped RCAs was shown using single-frame angiograms, obtained during end-diastole of cardiac cycle in the left anterior oblique projection at 25° to 35° with no cranio-caudal angulation. Cardiovascular events at 30-days and on follow up were obtained through review of hospital records and telephone contact with the patient or the patient's relatives. Patients with C-shaped RCAs served as the control group. RESULTS: A total number of 824 patients with inferior STEMI who were treated with primary PCI for RCA were included. Sigma shaped RCA was observed in 15.1% of the subjects. In the sigma shaped RCA group, the door-to-balloon times were longer (32.5 ± 5.1 vs. 27.8 ± 4.6 min; P = 0.01) and TIMI 3 flow restoration rates were lower (76.8% vs. 94.1%; p=0.01) compared to the controls. Mean SYNTAX scores were significantly higher in patients with sigma shaped RCA. Four patients (3.2%) in the sigma shaped RCA group and 23 patients (3.3%) in the control group died by day 30. The incidence of stent thrombosis, recurrent MI, and target lesion revascularization, were similar between the groups. During the follow-up (mean 37.6 ± 13.4 months) 15 patients (12.3%) from the sigma shaped RCA group and 28 (4.1%) patients from the control group died (P = 0.01). The incidence of recurrent MI (27.2% vs. 13.7%; P = 0.01) and major adverse cardiovascular events (29.7% vs. 16.3%; P = 0.01) were significantly higher in the sigma shaped RCA group. In multivariate analysis, age, Killip class of >1, the presence of sigma shaped RCA, post PCI TIMI flow <3 and decreased left ventricular ejection fraction were the independent predictors of long term mortality. CONCLUSION: Presence of sigma shaped RCA is associated with more severe form of coronary artery disease and worse clinical outcome in patients with inferior STEMI.
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Angiografia Coronária/métodos , Doença da Artéria Coronariana/terapia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/terapia , Intervenção Coronária Percutânea/efeitos adversos , Tomografia Computadorizada por Raios X , Idoso , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Anomalias dos Vasos Coronários/mortalidade , Feminino , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/mortalidade , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Tempo para o Tratamento , Resultado do TratamentoRESUMO
Red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) have been found to be associated with cardiovascular diseases. Only a few trials have investigated the correlation of these parameters with postoperative atrial fibrillation (AF). However, the correlation of these parameters in non-valvular AF is still unclear. We retrospectively analyzed consecutive AF patients from medical records and included 117 non-valvular AF patients (103 paroxysmal and 14 chronic AF). All subjects underwent physical examination and echocardiographic imaging. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW, neutrophil and lymphocyte counts as well as mean corpuscular volume. Results of CBC tests within the previous year were also included and the averages were used. The demographic and echocardiographic properties of non-valvular AF group were comparable to the control group except for left atrial volumes which were increased in AF (median 33.1, IQR 26.3-41.1 cm(3) vs. median 26.4, IQR 24.2-28.9 cm(3); p = 0.01). RDW levels were significantly higher in the AF group (median 13.4 %, IQR 12.9-14.1 %) compared to the control (median 12.6 %, IQR 12.0-13.1 %; p = 0.01). NLR was not statistically different in the AF group and the controls (2.04 ± 0.94 vs. 1.93 ± 0.64, respectively; p = 0.32). Hs-CRP levels were higher in the AF group compared to the controls (median 0.84, IQR 0.30-1.43 mg/L vs. median 0.29, IQR 0.18-0.50 mg/L, respectively; p = 0.01). Multivariate logistic regression analysis revealed RDW (OR 4.18, 95 % CI 2.15-8.15; p = 0.01), hs-CRP (OR 3.76, 95 % CI 1.43-9.89; p = 0.01) and left atrial volume (OR 1.31, 95 % CI 1.06-1.21; p = 0.01) as the independent markers of non-valvular AF. Multivariate linear regression analysis revealed that hemoglobin levels (standardized ß coefficient = -0.252; p = 0.01) and the presence of AF (standardized ß coefficient = 0.336; p = 0.01) were the independent correlates of RDW levels. Elevated RDW levels, not NLR, may be an independent risk marker for non-valvular AF.
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Fibrilação Atrial/sangue , Índices de Eritrócitos , Adulto , Fibrilação Atrial/fisiopatologia , Biomarcadores/sangue , Eletrocardiografia , Feminino , Humanos , Contagem de Linfócitos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/patologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: In patients with acute ST elevation myocardial infarction (STEMI), QRS fragmentation was determined as one of the indicators of mortality and morbidity. The development of fragmented QRS (fQRS) is related to defects in the ventricular conduction system and is linked to myocardial scar and fibrosis. MATERIAL AND METHODS: We prospectively enrolled 355 consecutive patients hospitalized in the coronary intensive care unit of our hospital with STEMI between the years 2010 and 2012 and their electrocardiographic features and the frequency of in-hospital cardiac events were evaluated. RESULTS: There were 217 cases in the fQRS group and 118 cases in the control group. QRS fragmentation was found to be a predictor for major cardiac events. In the fragmented QRS group, the frequency of in-hospital major cardiac events (MACE) and death were higher (MACE p<0.001; death p<0.003). In the fragmented QRS group, the cardiac enzymes (Troponin-I, CK-MB) were significantly higher than in the control group (p<0.001). In subgroup analyses, apart from the presence of fragmentation, the presence of more than 1 type of fragmentation and the number of fragmented deviations were also found to be related with MACE. A significant negative correlation was observed with the ejection fraction and, in particular, the number of fragmented deviations. CONCLUSIONS: Fragmented QRS has emerged as a practical and easily identifiable diagnostic tool for predicting in-hospital cardiac events in acute coronary syndromes. Patients who present with a fragmented QRS demonstrate increased rates of major cardiac events, death risk, and low ejection fraction. In patients with STEMI, the presence of fQRS on the ECG and number of fQRS derivations are a significant predictor of in-hospital major cardiac events.
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Eletrocardiografia , Hospitalização , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/cirurgia , Prognóstico , Volume Sistólico , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
OBJECTIVES: The prognostic importance of red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) in cardiovascular diseases has been shown. Ascending aortic dilatation (AAD) is a common cardiovascular disease and is associated with aortic wall inflammation and cystic degeneration. In this study, we aimed to investigate the relationship between serum levels of RDW, NLR and the presence of AAD. STUDY DESIGN: Two-hundred consecutive patients with AAD diagnosed by transthoracic echocardiography were prospectively recruited and were compared to 170 age-gender- matched subjects with normal aortic diameters. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW and NLR counts, as well as mean corpuscular volume (MCV). If possible, results of CBC tests within the previous two years were also included and the averages were used. RESULTS: RDW [median 13.9, interquartile range (IQR) 1.40 vs. median 13.3, IQR 1.05%, p=0.01], NLR (median 2.04, IQR 1.09 vs. median 1.78, IQR 0.90, p=0.01) and high-sensitive C-reactive protein (hs-CRP) (median 0.60, IQR 0.80 vs. median 0.44, IQR 0.68 mg/L, p=0.01) levels were significantly higher in the AAD group compared to the control group. In univariate correlation analysis, ascending aortic diameters were correlated with RDW levels (r=0.31, p=0.01), NLR levels (r=0.15, p=0.01) and hs-CRP levels (r=0.12, p=0.03). In multivariate logistic regression analysis, increased levels of RDW and hs-CRP remained as the independent correlates of AAD in the study population. Receiver operating characteristic (ROC) curve analysis revealed that a RDW measurement higher than >13.8% predicted AAD with a sensitivity of 49.5% and a specificity of 82.8% (area under the curve [AUC] 0.681, p=0.01). CONCLUSION: In patients with AAD, RDW and hs-CRP levels are increased, which may indicate the role of inflammation in the pathogenesis of AAD.
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Aorta/patologia , Aneurisma Aórtico/sangue , Eritrócitos/patologia , Adulto , Idoso , Estudos de Casos e Controles , Índices de Eritrócitos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Background: Hypertrophic cardiomyopathy (HCM) is a genetic heart disease that can lead to heart failure, atrial fibrillation, and ischaemic symptoms. Managing patients with HCM and ischaemic symptoms is challenging, and several treatment options have been proposed. Case summary: A 30-year-old male patient presented with severe chest pain that had been ongoing for more than 30â min at rest. He was diagnosed with HCM and had periodic chest pain since the age of 14. He underwent two separate ethyl alcohol ablations of the first septal branches of the left anterior descending and posterior descending arteries, which relieved his symptoms. Discussion: This case report highlights the challenges in managing patients with HCM and ischaemic symptoms. In this patient, the use of ethyl alcohol ablation was effective in reducing left ventricular outflow tract obstruction and improving symptoms. Ethyl alcohol ablation is a minimally invasive procedure that has been shown to be effective in symptomatic patients with HCM. Overall, this case report emphasizes the importance of individualized treatment for patients with HCM and the potential benefits of alcohol ablation in this population.
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BACKGROUND: Nitric oxide (NO) plays a major role in the regulation of endothelial functions and reduced NO synthesis has been implicated in the development of coronary atherosclerosis. Endothelial nitric oxide synthase (eNOS) intron 4a/b polymorphism has been shown to be related to plasma nitric oxide concentrations and coronary artery disease in various population studies. The aim of this study is to assess the relationship between eNOS 4a/b polymorphism and premature CAD. MATERIAL AND METHODS: A total of 70 patients under age 35 who presented with ST-segment elevation myocardial infarction (STEMI) were included in this study.The control group included 50 age- and gender-matched subjects with normal coronary arteries on angiography.The eNOS 4a/b polymorphism was assessed with polymerase chain reaction (PCR).The frequencies of eNOS 4a/b genotypes and alleles were compared. Multivariate regression analysis was used for estimation of the independent predictors of premature CAD. RESULTS: Frequency of eNOS4a/b gene, aa and ab genotypes were significantly higher in STEMI patients when compared to control group. Presence of allele'a'of the eNOS gene was an independent predictor of STEMI in a young population (OR: 2.78 95% CI: 1.02-7.56 P = 0.044). A significant correlation of eNOS gene polymorphism with other clinical properties of subjects was not established. CONCLUSION: The eNOS4a/b gene polymorphism may be associated with early development of atherosclerosis and myocardial infarction possibly secondary to deterioration of the endothelial function.
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Doença da Artéria Coronariana/genética , DNA/genética , Endotélio Vascular/fisiopatologia , Predisposição Genética para Doença , Óxido Nítrico Sintase Tipo III/genética , Polimorfismo Genético , Vasodilatação/genética , Adulto , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/enzimologia , Eletrocardiografia , Endotélio Vascular/metabolismo , Feminino , Seguimentos , Frequência do Gene , Genótipo , Humanos , Masculino , Infarto do Miocárdio/enzimologia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/genética , Óxido Nítrico/sangue , Óxido Nítrico Sintase Tipo III/sangue , Reação em Cadeia da Polimerase , Prognóstico , Estudos ProspectivosRESUMO
BACKGROUND: Little is known about the pathogenesis and genetics of coronary artery ectasia (CAE). We studied eNOS gene intron 4a/b polymorphism in this patient population. METHODS: The study group included 30 patients with non-obstructive CAD besides CAE on coronary angiogram performed due to positive non-invasive diagnostic test results. The control group included 20 patients with normal coronary arteries. Agarose gel electrophoresis was used to identify eNOS gene polymorphisms. RESULTS: Only one coronary vessel was involved in most of the study cohort and the left anterior descending artery (LAD) was the most frequently involved vessel. The frequencies of eNOS gene phenotypes in the CAE group were 3.3% for"aa", 53.3% for"ab" and they were higher than in the control group. However, statistical significance was not reached (chi2 = 5.10, P = 0.08). When compared with the control group the presence of "a" type allele of eNOS gene was significantly more frequent in the CAE group (chi2 = 4.88, P = 0.027). By univariate analysis, eNOS gene polymorphism was correlated with CAE but this significance was attenuated after additional adjustment for potential confounding. CONCLUSION: Patients who have the "a" type allele of the eNOS gene may have an increased risk for CAE.
Assuntos
Vasos Coronários/patologia , Íntrons , Óxido Nítrico Sintase Tipo III/genética , Polimorfismo Genético , Dilatação Patológica/genética , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Background: Prosthetic valve thrombosis (PVT) is a rare but one of the most dreaded complications of implanted mechanical valves. Although surgery is the first-line treatment modality particularly in symptomatic obstructive mechanical valve thrombosis, it is associated with high rates of morbidity and mortality. Thrombolytic therapy has also been used as an alternative to surgical treatment. The risk for cerebral thromboembolism associated with thrombolytic therapy seems to be the main limitation for its use in left-sided mechanical valve thrombosis. To the best of our knowledge, this is the first case of implantation of embolic protection devices during thrombolytic therapy of PVT. Case summary: Our report describes management of patient with obstructive PVT of the aortic valve. Fluoroscopy showed an immobile anterior disc of the aortic prosthesis. Transoesophageal echocardiography (TOE) detected the severely restricted prosthetic valve motions and a huge mass at the supravalvular site. A patient had very high surgical risks. Although, thrombolytic treatment was not without risk due to the large thrombus (>10â mm) increasing the risk of thromboembolism. We implanted embolic protection devices into both internal carotid arteries followed by the administration of a thrombolytic therapy with 50â mg Alteplase. After the procedure an embolized thrombus was detected at the apex at the left-sided placed device. There were no signs of transient ischaemic attack nor stroke, and the procedure was ended uneventful. The TOE performed on the next day confirmed successful resolution of the thrombus. Discussion: Mechanical left-sided prosthetic valve obstruction is a serious complication with high mortality and morbidity and requires urgent therapy. The choice between surgery, thrombolysis, and escalation of anticoagulation is considered on an individual basis. In patients with high surgical risk and high risk of embolization, an embolic protection device may be used in conjunction with thrombolytic therapy to decrease the risk of embolic cerebral events.
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OBJECTIVE: To identify the frequency of atrioventricular (AV) conduction improvement after discontinuation of the culprit drug in patients with AV block. BACKGROUND: AV blockers are considered as reversible causes of AV block that do not require pacemaker (PM) implantation. However, controversial reports declared that a major part of these drug-induced AV blocks are persistent or recurrent. METHODS: Of 668 consecutive patients with symptomatic type II second- or third-degree AV block, 2:1 AV block, atrial fibrillation, and bradyarrhythmia, 108 patients (62 patients enrolled prospectively) using AV blockers without myocardial infarction, electrolyte abnormalities, digitalis toxicity, and vasovagal syncope were enrolled into the present study. The level of AV block (AV-nodal or infranodal) was defined according to electrocardiographic characteristics. RESULTS: The most frequent culprit medications were ß-blockers followed by digoxin. Drug discontinuation was followed by resolution of AV block in 72% of cases, whereas spontaneous resolution of AV block occurred in only 6.6% of patients who had AV block in the absence of medications. However, 27% of patients with improved AV conduction experienced a recurrence of AV block despite discontinuation of the culprit drug. Twenty-one of 24 carvedilol-induced AV blocks resolved after discontinuation of the drug and never recurred, whereas 24 of 36 metoprolol-induced AV blocks persisted or recurred. A digoxin-induced AV block usually improved (28 of 39) after withdrawal of the drug. Roughly half of the patients with drug-induced AV block underwent permanent PM implantation. CONCLUSION: Drug-induced AV block is a serious disease that requires a permanent PM for almost half of the patients.
Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Bloqueio Atrioventricular/induzido quimicamente , Bloqueio Atrioventricular/prevenção & controle , Marca-Passo Artificial/estatística & dados numéricos , Idoso , Bloqueio Atrioventricular/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Resultado do Tratamento , Turquia/epidemiologiaRESUMO
BACKGROUND: Symptomatic cardiac injury after blunt chest trauma is relatively rare, and valvular injury is even more rare. The valves most commonly affected are tricuspid. Automobile accidents are mostly responsible for this type of injury. OBJECTIVES: Unlike with the mitral valve, post-traumatic tricuspid heart valve insufficiency is usually well tolerated. Indeed, severe tricuspid regurgitation can resolve spontaneously. CASE REPORT: A 68-year-old woman with no previous cardiac or medical history was brought to our Emergency Department after an automobile accident. She had chest pain and shortness of breath upon admission. Transthoracic echocardiographic examination revealed severe tricuspid regurgitation with rupture of the chordae tendineae and prolapse of the valve cusps into the right atrium during systole. An electrocardiogram was consistent with second-degree Mobitz II atrioventricular block on admission, which subsequently progressed to complete atrioventricular block on day 3. During follow-up with close hemodynamic monitoring, her symptoms disappeared and repeat echocardiography revealed a regression in the severity of tricuspid regurgitation. Operative repair of the tricuspid valve was deemed unnecessary and the patient was discharged with medical therapy on the eighth day after admission. CONCLUSIONS: It is important to be aware of traumatic tricuspid regurgitation after non-penetrating chest trauma. Close follow-up may suffice in some patients with stable hemodynamic conditions, and regression of tricuspid regurgitation can be expected during follow-up.
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Acidentes de Trânsito , Bloqueio Atrioventricular/etiologia , Traumatismos Torácicos/complicações , Insuficiência da Valva Tricúspide/etiologia , Ferimentos não Penetrantes/complicações , Idoso , Bloqueio Atrioventricular/diagnóstico , Cateterismo Cardíaco , Dor no Peito/etiologia , Dispneia/etiologia , Ecocardiografia , Feminino , Humanos , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico , Conduta ExpectanteRESUMO
Myotonic dystrophy type 1 (DM1) is the most frequent muscular dystrophy in adults. It is a multisystem disorder also affecting the heart with an increased incidence of sudden cardiac death. We present a young female patient with ventricular tachycardia (VT) who had no cardiac complaints previously. In this patient, the phenotypic characteristics implying DM1, neuromuscular testing and genetic analysis all confirmed the diagnosis of DM1 and because of the malignant nature of VT, she received an implantable cardioverter/defibrillator.
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Distrofia Miotônica/complicações , Taquicardia Ventricular/complicações , Desfibriladores Implantáveis , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Distrofia Miotônica/diagnóstico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Adulto JovemRESUMO
OBJECTIVES: We evaluated in-hospital and long-term clinical results of female patients following primary angioplasty for ST-elevation myocardial infarction (STEMI), in comparison with male patients. STUDY DESIGN: We reviewed 2,644 patients (2,188 males, 456 females) who underwent primary angioplasty for STEMI between October 2003 and March 2008. Data on female patients concerning demographic and clinical characteristics, primary angioplasty results, in-hospital and 25-month follow-up results were compared with those of male patients. RESULTS: Hypertension, diabetes mellitus, anemia, shock, and renal failure were more common in female patients, while smoking was more frequent in males (p<0.05). The mean age was higher in female patients (63.9±11.7 vs. 55.2±11.3 years, p<0.001). Females also presented with higher values of glucose, mean platelet volume, and platelet count, and lower hemoglobin and hematocrit values (p<0.05). The frequencies of multivessel disease and procedure failure were significantly higher, and pain-to-balloon time was significantly longer in females (p<0.05). Mortality associated with cardiovascular causes occurred in 148 patients (5.6%), being significantly higher in females (9.4% vs. 4.8%, p<0.001). In-hospital mortality, major cardiac events, stroke, cardiogenic shock, and major bleeding were more frequent in women (p<0.05). Long-term mortality rate was also significantly higher in females (10% vs. 4.5%, p<0.001). Multivariate analysis showed female gender as one of the independent predictors of mortality (odds ratio=1.75, 95% CI 1.02-2.99; p<0.04). CONCLUSION: Female patients with STEMI undergoing primary angioplasty have a higher risk profile and poorer in-hospital and follow-up clinical results. Therefore, female patients should be treated more aggressively.
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Angioplastia Coronária com Balão , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Fatores Etários , Idoso , Angioplastia Coronária com Balão/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
OBJECTIVE: The objective of this study was to evaluate the effect of admission hyperglycaemia and/or diabetes mellitus (DM) on the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). METHODS: 2482 consecutive patients with STEMI (mean age 56.5 +/- 11.9, years, 2064 men) undergoing primary PCI between October 2003 and March 2008 were retrospectively enrolled into the present study. Hyperglycaemia was defined as a venous plasma glucose level > or =200 mg/dl on admission. Patients were classified into four groups: non-diabetic/non-hyperglycaemic (NDNH, n=1806) patients; diabetic/non-hyperglycaemic (DNH, n=271) patients; non-diabetic/hyperglycaemic (NDH, n=64); and diabetic/hyperglycaemic (DH, n=341). RESULTS: In-hospital mortality was higher in NDH (12.5%) compared to DH (8.5%), DNH (6.3%), and NDNH (0.9%) patients (P < 0.001). The composite end points including death, reinfarction, and target-vessel revascularization (major adverse cardiac events [MACE]) in the hospital were also higher in NDH (18.8%) compared with other patients (DH, 13.8% vs. DNH, 10.3% vs. NDNH, 3.7%, P < 0.001). The median follow-up time was 21 months.The Kaplan-Meier survival plot for long-term cardiovascular death was worst for DH patients (log rank P < 0.001). After adjustment for potentially confounding factors, NDH (OR 3.04, 95% CI 1.06-8.73; P = 0.03), and DH (OR 2.3,95% CI 1.29-4.09; P = 0.005), but not DNH (OR 1.22,95% CI 0.57-2.6; P = 0.6) status, remained independent predictors of long-term cardiovascular mortality. CONCLUSIONS: STEMI patients with NDH represent the highest risk population for in-hospital mortality, and MACE. The worst outcomes for long-term cardiovascular mortality occur in DH patients.
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Angioplastia Coronária com Balão , Diabetes Mellitus Tipo 2/complicações , Hiperglicemia/complicações , Infarto do Miocárdio/terapia , Idoso , Distribuição de Qui-Quadrado , Angiografia Coronária , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Prognóstico , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de Risco , Stents , Resultado do TratamentoRESUMO
BACKGROUND: Topical beta-blockers have a well-established role in the treatment of glaucoma. We aimed to investigate the outcome of patients who developed symptomatic atrioventricular (AV) block induced by topical beta-blockers. METHODS: All patients admitted or discharged from our institution, the Siyami Ersek Training and Research Hospital, between January 2009 and January 2013 with a diagnosis of AV block were included in the study. Subjects using ophthalmic beta-blockers were recruited and followed for permanent pacemaker requirement during hospitalisation and for three months after discontinuation of the drug. A permanent pacemaker was implanted in patients in whom AV block persisted beyond 72 hours or recurred during the follow-up period. RESULTS: A total of 1 122 patients were hospitalised with a diagnosis of AV block and a permanent pacemaker was implanted in 946 cases (84.3%) during the study period. Thirteen patients using ophthalmic beta-blockers for the treatment of glaucoma and no other rate-limiting drugs were included in the study. On electrocardiography, eight patients had complete AV block and five had high-degree AV block. The ophthalmic beta-blockers used were timolol in seven patients (55%), betaxolol in four (30%), and cartelol in two cases (15%). The mean duration of ophthalmic beta-blocker treatment was 30.1 ± 15.9 months. After drug discontinuation, in 10 patients the block persisted and a permanent pacemaker was implanted. During follow up, one more patient required pacemaker implantation. Therefore in total, pacemakers were implanted in 11 out of 13 patients (84.6%). The pacemaker implantation rate did not differ according to the type of topical beta-blocker used (p = 0.37). The presence of infra-nodal block on electrocardiography was associated with higher rates of pacemaker implantation. CONCLUSION: Our results indicate that topical beta-blockers for the treatment of glaucoma may cause severe conduction abnormalities and when AV block occurs, pacemaker implantation is required in a high percentage of the patients.
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Antagonistas Adrenérgicos beta/efeitos adversos , Bloqueio Atrioventricular/induzido quimicamente , Glaucoma/tratamento farmacológico , Sistema de Condução Cardíaco/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Administração Oftálmica , Antagonistas Adrenérgicos beta/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Eletrocardiografia , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , TurquiaRESUMO
Isolated left ventricular non-compaction is a rare genetic disorder manifesting mainly with heart failure, ventricular arrhythmias and systemic embolism. Isolated ventricular tachycardia originating from the right ventricular outflow tract is an arrhythmia that can be treated medically and/or by radiofrequency catheter ablation. Here, we report a case of an asymptomatic 16-year-old boy with a new diagnosis of dilated cardiomyopathy, left ventricular noncompaction and right ventricular outflow tract tachycardia. Electrophysiological studies and radiofrequency ablation of the right ventricular outflow tract tachycardia resulted in normalisation of left ventricular systolic function. This is the first case reporting left ventricular non-compaction in association with tachycardia-induced cardiomyopathy secondary to repetitive monomorphic right ventricular outflow tract tachycardia.
Assuntos
Cardiomiopatias/fisiopatologia , Ablação por Cateter/efeitos adversos , Ventrículos do Coração/fisiopatologia , Taquicardia Ventricular/fisiopatologia , Complexos Ventriculares Prematuros/fisiopatologia , Adolescente , Arritmias Cardíacas/complicações , Arritmias Cardíacas/fisiopatologia , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Ablação por Cateter/métodos , Humanos , Masculino , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Função Ventricular Esquerda/fisiologia , Complexos Ventriculares Prematuros/complicações , Complexos Ventriculares Prematuros/diagnósticoRESUMO
BACKGROUND: Early repolarization (ER) is associated with increased risk of sudden cardiac death and ventricular fibrillation (VF) in patients with/without structural heart disease. In this trial we examined the short- and long-term prognostic value of ER on admission electrocardiogram (ECG) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). METHOD: Consecutive 521 patients with acute STEMI who underwent primary PCI were enrolled prospectively. Twelve-lead ECGs obtained during the initial diagnosis were scanned and stored digitally. The leads showing the typical ST segment elevation due to the acute infarction were excluded and the remaining ECG leads were included in the analysis for the presence of ER. RESULTS: The study group included 61 STEMI patients (55 male; mean age 57.6±12.6 years) with ER and 460 STEMI patients (378 male; mean age 57.1±12.5) without ER on ECG. In the ER group, 14 patients (22.9%) had notching, 10 patients (16.4%) had slurring, and 37 patients (60.7%) had only J-point elevation. When analyzing regional leads, ER was observed mostly in inferior leads (n=40, 65.6%). During the hospitalization period, ventricular tachycardia or VF occurred more frequently in the ER group (19.6% vs. 10.9%; p=0.04) and 6 patients (6.9%) from the ER group and 14 patients (3%) from the control group died (p=0.01). During a follow-up period of 21.1±10.2 months, mortality was significantly higher in the ER group (12.7% vs. 4.2%; p=0.01). When total mortality rates were considered, highest mortality was observed in patients with notching pattern (5/14 subjects; 35.7%) when compared to patients with slurring (3/10 subjects; 30%), patients with only J-point elevation patterns (5/37subjects; 13.5%) and the control group (33/460 subjects; 7.1%). Presence of notching and slurring pattern on admission ECG was found as independent predictors of long-term mortality; whereas presence of only J-point elevation was not. CONCLUSION: Presence of ER pattern in admission ECG in patients with STEMI is associated with both in-hospital and long-term mortality.
Assuntos
Eletrocardiografia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Idoso , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Testes Diagnósticos de Rotina , Feminino , Previsões , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Prognóstico , Estudos Prospectivos , Risco , Tempo , Fibrilação Ventricular/epidemiologia , Fibrilação Ventricular/etiologiaRESUMO
BACKGROUND: Resistin is a peptide hormone that is secreted from lipid cells and is linked to type-2 diabetes, obesity, and inflammation. Being an important adipocytokine, resistin was proven to play an important role in cardiovascular disease. We compared resistin levels in patients with and without atrial fibrillation (AF) to demonstrate the relationship between plasma resistin levels and AF. METHOD: One hundred patients with AF and 58 control patients who were matched in terms of age, gender, and risk factors were included in the trial. Their clinical risk factors, biometric measurements, echocardiographic work up, biochemical parameters including resistin and high-sensitivity C-reactive protein (hs-CRP) levels were compared. RESULTS: In patients with AF, plasma resistin levels (7.34±1.63ng/mL vs 6.67±1.14ng/mL; p=0.003) and hs-CRP levels (3.01±1.54mg/L vs 2.16±1.28mg/L; p=0.001) were higher than control group. In subgroup analysis, resistin levels were significantly higher in patients with paroxysmal (7.59±1.57ng/mL; p=0.032) and persistent AF (7.73±1.60ng/mL; p=0.006), but not in patients with permanent AF subgroups (6.86±1.61ng/mL; p=0.92) compared to controls. However, hs-CRP levels were significantly higher only in permanent AF patients compared to control group (3.26±1.46mg/L vs 2.16±1.28mg/L; p=0.02). In multivariate regression analysis using model adjusted for age, gender, body mas index, hypertension, diabetes mellitus, and creatinine levels, plasma resistin levels [odds ratio (OR): 1.30; 95% confidence interval (CI): 1.01-1.70; p=0.04] and hs-CRP levels (OR: 1.44; 95% CI: 1.12-1.86; p=0.004) were the only independent predictors of AF. CONCLUSION: The elevated levels of plasma resistin were related to paroxysmal AF group and persistent AF group, but not to permanent AF group.
Assuntos
Fibrilação Atrial/diagnóstico , Resistina/sangue , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
BACKGROUND: Concomitant thyroid and heart disease are frequently encountered in clinical practice. There are many studies evaluating thyroid function in acute and critical conditions. Information on thyroid dysfunction in ST-segment elevation myocardial infarction (STEMI) is limited; its correlation with short and long-term outcome is not fully known. METHODS: Four hundred and fifty seven patients diagnosed with STEMI in our emergency department were included in the study. Patients were divided into two groups: patients with normal thyroid function (euthyroid) and patients with thyroid dysfunction. STEMI was diagnosed with 12 derivation surface electrocardiogram. Thyroid hormone levels (TSH, free T3 and free T4) were measured. Patients with other acute coronary syndromes and endocrine pathologies except diabetes mellitus were excluded. Two patient groups were compared in terms of in-hospital and long-term outcome. RESULTS: Out of 457, 72 (15%) patients with thyroid dysfunction were detected. The other patients were euthyroid and constituted the control group. In-hospital cardiogenic shock (15% vs. 3% in the control group; p < 0.01) and death (7% vs. 1% in the control group; p < 0.01) were more frequently observed in the thyroid dysfunction group. In the subgroup analysis, it was observed that patients with sick euthyroid syndrome have the poorest outcome. Other markers for poor outcome were anemia and renal failure. CONCLUSIONS: Thyroid dysfunction, particularly sick euthyroid syndrome, was found to be related to in-hospital and long term mortality in patients with STEMI undergoing primary percutaneous intervention.