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1.
Nature ; 600(7889): 478-483, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34880497

RESUMO

Policy-makers are increasingly turning to behavioural science for insights about how to improve citizens' decisions and outcomes1. Typically, different scientists test different intervention ideas in different samples using different outcomes over different time intervals2. The lack of comparability of such individual investigations limits their potential to inform policy. Here, to address this limitation and accelerate the pace of discovery, we introduce the megastudy-a massive field experiment in which the effects of many different interventions are compared in the same population on the same objectively measured outcome for the same duration. In a megastudy targeting physical exercise among 61,293 members of an American fitness chain, 30 scientists from 15 different US universities worked in small independent teams to design a total of 54 different four-week digital programmes (or interventions) encouraging exercise. We show that 45% of these interventions significantly increased weekly gym visits by 9% to 27%; the top-performing intervention offered microrewards for returning to the gym after a missed workout. Only 8% of interventions induced behaviour change that was significant and measurable after the four-week intervention. Conditioning on the 45% of interventions that increased exercise during the intervention, we detected carry-over effects that were proportionally similar to those measured in previous research3-6. Forecasts by impartial judges failed to predict which interventions would be most effective, underscoring the value of testing many ideas at once and, therefore, the potential for megastudies to improve the evidentiary value of behavioural science.


Assuntos
Ciências do Comportamento/métodos , Ensaios Clínicos como Assunto/métodos , Exercício Físico/psicologia , Promoção da Saúde/métodos , Projetos de Pesquisa , Adulto , Feminino , Humanos , Masculino , Motivação , Análise de Regressão , Recompensa , Fatores de Tempo , Estados Unidos , Universidades
2.
Proc Natl Acad Sci U S A ; 119(6)2022 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-35105809

RESUMO

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was "waiting for you." Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.


Assuntos
Programas de Imunização , Vacinas contra Influenza/administração & dosagem , Farmácias , Vacinação/métodos , Idoso , COVID-19 , Feminino , Humanos , Influenza Humana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Farmácias/estatística & dados numéricos , Sistemas de Alerta , Envio de Mensagens de Texto , Vacinação/estatística & dados numéricos
3.
Catheter Cardiovasc Interv ; 103(4): 607-611, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38415912

RESUMO

A 51-year-old patient with progressive right heart dysfunction was found to have a large calcified right atrial mass on echocardiography. As part of the work up for an intracardiac mass he had a cardiac computed tomogram which detailed a large coronary cameral fistula from the circumflex coronary artery to the right atrium associated with a spherical calcific pseudo-aneurysmal sac. Transcatheter occlusion of the exit point into the atrium with a vascular plug was performed directly from a right atrial approach without the need for an arteriovenous wire loop. This case details a unique presentation of a coronary cameral fistula to an unusual position within the right atrium which facilitated the rare ability to occlude the fistula from a venous approach without creating an arteriovenous wire rail.


Assuntos
Doença da Artéria Coronariana , Fístula Vascular , Masculino , Humanos , Pessoa de Meia-Idade , Angiografia Coronária , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/terapia , Resultado do Tratamento , Cateterismo Cardíaco
4.
Proc Natl Acad Sci U S A ; 118(20)2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-33926993

RESUMO

Many Americans fail to get life-saving vaccines each year, and the availability of a vaccine for COVID-19 makes the challenge of encouraging vaccination more urgent than ever. We present a large field experiment (N = 47,306) testing 19 nudges delivered to patients via text message and designed to boost adoption of the influenza vaccine. Our findings suggest that text messages sent prior to a primary care visit can boost vaccination rates by an average of 5%. Overall, interventions performed better when they were 1) framed as reminders to get flu shots that were already reserved for the patient and 2) congruent with the sort of communications patients expected to receive from their healthcare provider (i.e., not surprising, casual, or interactive). The best-performing intervention in our study reminded patients twice to get their flu shot at their upcoming doctor's appointment and indicated it was reserved for them. This successful script could be used as a template for campaigns to encourage the adoption of life-saving vaccines, including against COVID-19.


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Visita a Consultório Médico/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Atenção Primária , Sistemas de Alerta , Envio de Mensagens de Texto , Vacinação/psicologia
5.
Eur Heart J ; 44(34): 3278-3291, 2023 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-37592821

RESUMO

BACKGROUND AND AIMS: For patients with congenitally corrected transposition of the great arteries (ccTGA), factors associated with progression to end-stage congestive heart failure (CHF) remain largely unclear. METHODS: This multicentre, retrospective cohort study included adults with ccTGA seen at a congenital heart disease centre. Clinical data from initial and most recent visits were obtained. The composite primary outcome was mechanical circulatory support, heart transplantation, or death. RESULTS: From 558 patients (48% female, age at first visit 36 ± 14.2 years, median follow-up 8.7 years), the event rate of the primary outcome was 15.4 per 1000 person-years (11 mechanical circulatory support implantations, 12 transplantations, and 52 deaths). Patients experiencing the primary outcome were older and more likely to have a history of atrial arrhythmia. The primary outcome was highest in those with both moderate/severe right ventricular (RV) dysfunction and tricuspid regurgitation (n = 110, 31 events) and uncommon in those with mild/less RV dysfunction and tricuspid regurgitation (n = 181, 13 events, P < .001). Outcomes were not different based on anatomic complexity and history of tricuspid valve surgery or of subpulmonic obstruction. New CHF admission or ventricular arrhythmia was associated with the primary outcome. Individuals who underwent childhood surgery had more adverse outcomes than age- and sex-matched controls. Multivariable Cox regression analysis identified older age, prior CHF admission, and severe RV dysfunction as independent predictors for the primary outcome. CONCLUSIONS: Patients with ccTGA have variable deterioration to end-stage heart failure or death over time, commonly between their fifth and sixth decades. Predictors include arrhythmic and CHF events and severe RV dysfunction but not anatomy or need for tricuspid valve surgery.


Assuntos
Insuficiência Cardíaca , Transposição dos Grandes Vasos , Insuficiência da Valva Tricúspide , Disfunção Ventricular Direita , Adulto , Humanos , Feminino , Criança , Adulto Jovem , Pessoa de Meia-Idade , Masculino , Transposição das Grandes Artérias Corrigida Congenitamente , Estudos Retrospectivos , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/cirurgia , Insuficiência da Valva Tricúspide/complicações , Disfunção Ventricular Direita/complicações , Insuficiência Cardíaca/complicações
6.
Pediatr Cardiol ; 44(6): 1209-1216, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37219586

RESUMO

Hypertension (HTN) is common in patients with a history of coarctation of the aorta (CoA) and remains underrecognized and undertreated. Studies in the non-coarctation otherwise healthy adult population have correlated an exaggerated blood pressure response during mild to moderate exercise with subsequent diagnosis of HTN. The goal of this study was to determine if blood pressure response to submaximal exercise in normotensive CoA patients correlated with development of HTN.Retrospective chart review was performed in individuals ≥ 13 years old with CoA and no diagnosis of HTN at time of cardiopulmonary exercise testing (CPET). Systolic blood pressure (SBP) during CPET at rest, submax 1 (stage 1 Bruce or minute 2 bicycle ramp), submax 2 (stage 2 Bruce or minute 4 bicycle ramp), and peak were recorded. The primary composite outcome was HTN diagnosis or initiation of anti-hypertensive medications at follow up.There were 177 patients (53% female, median age 18.5 years), of whom 38 patients (21%) met composite outcome during a median follow up of 46 months. Men were more likely to develop hypertension. Age at repair and age at CPET were not significant covariates. At each stage of CPET, SBP was significantly higher in those who met the composite outcome. Submax 2 SBP ≥ 145 mmHg was 75% sensitive, 71% specific in males and 67% sensitive, 76% specific in females for development of composite outcome.Our study shows an exaggerated SBP response to submaximal exercise may portend an increased risk of developing hypertension during short- to mid-term follow up.


Assuntos
Coartação Aórtica , Hipertensão , Adulto , Masculino , Humanos , Feminino , Adolescente , Estudos Retrospectivos , Hipertensão/epidemiologia , Aorta , Pressão Sanguínea/fisiologia , Teste de Esforço
8.
J Cardiovasc Electrophysiol ; 30(9): 1560-1568, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31111602

RESUMO

BACKGROUND: Ventricular tachycardia (VT) is frequently encountered in patients with repaired and unrepaired congenital heart disease (CHD), causing significant morbidity and sudden cardiac death. Data regarding underlying VT mechanisms and optimal ablation strategies in these patients remain limited. OBJECTIVE: To describe the electrophysiologic mechanisms, ablation strategies, and long-term outcomes in patients with CHD undergoing VT ablation. METHODS: Forty-eight patients (mean age 41.3 ± 13.3 years, 77.1% male) with CHD underwent a total of 57 VT ablation procedures at two centers from 2000 to 2017. Electrophysiologic and follow-up data were analyzed. RESULTS: Of the 77 different VTs induced at initial or repeat ablation, the underlying mechanism in 62 (81.0%) was due to scar-related re-entry; the remaining included four His-Purkinje system-related macrore-entry VTs and focal VTs mainly originating from the outflow tract region (8 of 11, 72.7%). VT-free survival after a single procedure was 72.9% (35 of 48) at a median follow-up of 53 months. VT-free survival after multiple procedures was 85.4% (41 of 48) at a median follow-up of 52 months. There were no major complications. Three patients died during the follow-up period from nonarrhythmic causes, including heart failure and cardiac surgery complication. CONCLUSION: While scar-related re-entry is the most common VT mechanism in patients with CHD, importantly, nonscar-related VT may also be present. In experienced tertiary care centers, ablation of both scar-related and nonscar-related VT in patients with CHD is safe, feasible, and effective over long-term follow-up.


Assuntos
Ablação por Cateter , Cardiopatias Congênitas/complicações , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Potenciais de Ação , Adulto , Antiarrítmicos/uso terapêutico , Ablação por Cateter/efeitos adversos , Colorado , Técnicas Eletrofisiológicas Cardíacas , Feminino , Seguimentos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia , Intervalo Livre de Progressão , Recidiva , Reoperação , Estudos Retrospectivos , Fatores de Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo
9.
Catheter Cardiovasc Interv ; 93(2): 324-329, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30351525

RESUMO

OBJECTIVES: To describe a multicenter experience of percutaneous transcatheter pulmonary valve replacement (TPVR) using the Edwards SAPIEN S3 valve without the use of a prior stent ("pre-stenting"). BACKGROUND: The SAPIEN S3 and XT valves have durable cobalt-chromium stent frames which may allow for TPVR in large diameter dysfunctional right ventricular outflow tracts (RVOTs) without pre-stenting the landing zone. METHODS: A retrospective review was performed of all patients with Congenital Heart Disease and dysfunctional RVOT who underwent TPVR using the SAPIEN valve without the use of a pre-stent. Imaging data, procedural elements, and clinical follow-up data were collected to evaluate short and intermediate-term results. RESULTS: Fifty-seven patients underwent percutaneous placement of the SAPIEN valve in the pulmonary position without the use of pre-stenting. The anatomical substrate varied: native RVOTs (n = 41), conduits (n = 10), and bioprosthetic valves (n = 6). There were no cases in which the valve could not be implanted and no cases of valve embolization or misplacement. On follow-up (range 1 month to 2.2 years, median 5.3 months), no patients had significant obstruction or regurgitation around the valve. There were no frame fractures. There were no procedural deaths. Major complications included severe aortic compression (n = 1) requiring surgical explantation and tricuspid valve injury requiring surgical intervention (n = 2). CONCLUSIONS: This limited multi-institutional experience demonstrates that the SAPIEN valve can be used for TPVR without the use of a pre-stent without medium-term risk of frame fracture, paravalvar leak, or embolization. Longer term follow-up is required to fully assess this method.


Assuntos
Cateterismo Cardíaco/instrumentação , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valva Pulmonar/cirurgia , Stents , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Adulto , Idoso , Cateterismo Cardíaco/efeitos adversos , Criança , Pré-Escolar , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Adulto Jovem
10.
Pacing Clin Electrophysiol ; 42(8): 1155-1157, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30945754

RESUMO

BACKGROUND: Outflow tract ventricular tachycardias (OTVT) most commonly occur in the absence of structural abnormalities. We present two cases in which a structural variant in the outflow tract was critical to the OTVT. CASES: Subaortic muscular bands were identified using intracardiac echocardiography (ICE) in each of our cases with history of VSD and VT. Mapping demonstrating their critical involvement to the tachycardia and ablation along the muscular bands rendered the ventricular tachycardias non-inducible. CONCLUSION: In rare instances, a structural variant may be involved in OTVTs. The use of ICE along with electroanatomic mapping can assist in successful ablation of these ventricular tachycardias.


Assuntos
Anormalidades Múltiplas , Comunicação Interventricular/complicações , Ventrículos do Coração/anormalidades , Taquicardia Ventricular/etiologia , Adulto , Idoso de 80 Anos ou mais , Humanos , Masculino
11.
Circulation ; 136(20): e348-e392, 2017 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-28993401

RESUMO

Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.


Assuntos
American Heart Association , Gerenciamento Clínico , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Adulto , Fatores Etários , Cardiopatias Congênitas/complicações , Humanos , Nefropatias/diagnóstico , Nefropatias/etiologia , Nefropatias/terapia , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Hepatopatias/terapia , Estados Unidos
12.
J Youth Adolesc ; 46(10): 2169-2180, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28689347

RESUMO

Youth's career attainment is associated with socioeconomic background, but may also be related to their beliefs about causes of success. Relationships between 17-year-olds' socioeconomic status (SES) and causal beliefs about success, and whether these beliefs predict career attainment after completing a vocational or university degree were examined using data from the German Socio-Economic Panel Study (n = 997, 48.5% female). Youth with higher SES parents and those who attended higher levels of high schools were less likely to believe that success in society is due to external causes, but SES was unrelated to the belief that success is due to personal merit or ability. Youth who believe that success is due to external causes attained lower income, occupational prestige, and job autonomy, and slower increases in income over time. There were also significant indirect effects of youth's parents' SES and their own high school levels on career attainment through such external causal beliefs; merit beliefs, by contrast, were largely unrelated to career attainment. These results suggest that beliefs about external causes of success may uniquely contribute to the transmission and maintenance of SES across generations and over time.


Assuntos
Comportamento do Adolescente/psicologia , Aspirações Psicológicas , Autorrelato , Percepção Social , Adolescente , Feminino , Humanos , Renda , Masculino , Pais , Autonomia Pessoal , Autocontrole , Classe Social
13.
Biochim Biophys Acta ; 1847(10): 1119-28, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26055662

RESUMO

The effect of carbonyl-cyanide m-chlorophenyl-hydrazone (CCCP) on intracytoplasmic membrane (ICM) assembly was examined in the purple bacterium Rhodobacter sphaeroides. CCCP blocks generation of the electrochemical proton gradient required for integral membrane protein insertion. ICM formation was induced for 8h, followed by a 4-h exposure to CCCP. Measurements of fluorescence induction/relaxation kinetics showed that CCCP caused a diminished quantum yield, a cessation in expansion of the functional absorption cross-section and a 4- to 10-fold slowing in the electron transfer turnover rate. ICM vesicles (chromatophores) and an upper-pigmented band (UPB) containing ICM growth initiation sites, were isolated and subjected to clear-native electrophoresis. Proteomic analysis of the chromatophore gel bands indicated that CCCP produced a 2.7-fold reduction in spectral counts in the preferentially assembled light-harvesting 2 (LH2) antenna, while the RC-LH1 complex, F1FO-ATPase and pyridine nucleotide transhydrogenase decreased by 1.7-1.9-fold. For 35 soluble enzymes, the ratio of 0.99 for treated/control proteins demonstrated that protein synthesis was unaffected by CCCP, suggesting that the membrane complex decline arose from the turnover of unassembled apoproteins. In the UPB fraction, an ~2-fold accumulation was observed for the preprotein translocase SecY, the SecA translocation ATPase, SecD and SecF insertion components, and chaperonins DnaJ and DnaK, consistent with the possibility that these factors, which act early in the assembly process, have accumulated in association with nascent polypeptides as stabilized assembly intermediates.

14.
J Adolesc ; 53: 95-106, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27664569

RESUMO

Associations between youths' reported relationships with their parents, beliefs about how success is attained, educational aspirations, and university completion were examined. Data come from the German Socioeconomic Panel. At age 17, youth (n = 3284) reported on their relationships with their parents, beliefs about success, and educational aspirations. University completion was assessed up to eight years later. At age 17, perceptions of parental warmth and interest in youths' academics were associated with beliefs that success is due to merit (positively) and that success is due to external factors or dominance over others (negatively). Beliefs that success is due to merit and external factors were associated with educational aspirations positively and negatively respectively. Educational aspirations positively predicted university completion up to eight years later. Relationships with parents had stronger associations with achievement when parents completed a university degree; beliefs about success had stronger associations with aspirations when parents did not.


Assuntos
Aspirações Psicológicas , Escolaridade , Relações Pais-Filho , Pais , Autorrelato , Estudantes/psicologia , Adolescente , Feminino , Humanos , Masculino , Predomínio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Universidades , Adulto Jovem
15.
Catheter Cardiovasc Interv ; 86(6): 1092-6, 2015 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-26356137

RESUMO

The emergence of transcatheter valve technology over the last decade has made significant impact on the treatment of patients with valvular heart disease. There has been increasing experience with both native and valve-in-valve indications with promising results. We present the case of a young woman with congenital heart disease who underwent the Ross procedure for bicuspid aortic valve endocarditis with subsequent reoperation and surgical aortic valve replacement for neo-aortic root dilation who experienced worsening symptoms related to both pulmonary and aortic valve dysfunction. She was successfully treated with percutaneous pulmonary and aortic valve replacement with excellent early term technical results and marked improvement in symptoms.


Assuntos
Insuficiência da Valva Aórtica/terapia , Valva Aórtica/anormalidades , Cateterismo Cardíaco/métodos , Doenças das Valvas Cardíacas/cirurgia , Insuficiência da Valva Pulmonar/terapia , Stents , Adulto , Angiografia/métodos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Doença da Válvula Aórtica Bicúspide , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Seguimentos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Doenças das Valvas Cardíacas/congênito , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
Fam Community Health ; 38(1): 77-86, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25423246

RESUMO

Community-based participatory research is predicated on building partnerships that tackle important issues to the community and effectively improve these issues. Community-based participatory research can also be an empowering experience, especially for children. This article describes a university-community partnership in which students at a low-income middle school worked to improve the quality of the cafeteria food provided to the 986 students eligible for free and reduced price lunches. The project led to menu changes, improved communication between youth, school administrators, and district staff, and enabled youth to enact school improvements that were beneficial for their health.


Assuntos
Atitude Frente a Saúde , Pesquisa Participativa Baseada na Comunidade/métodos , Serviços de Alimentação/normas , Promoção da Saúde/métodos , Almoço , Instituições Acadêmicas , Estudantes , Adolescente , California , Criança , Coleta de Dados , Feminino , Humanos , Masculino , Pobreza , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estudantes/psicologia , População Urbana
18.
J Electrocardiol ; 48(2): 141-4, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25483288

RESUMO

INTRODUCTION: Vectorcardiography (VCG) may have predictive value in Tetralogy of Fallot (TOF) patients undergoing ventricular arrhythmia inducibility (VAI) electrophysiology studies (EPs). MATERIALS AND METHODS: Blinded, retrospective analyses of 37 adult TOF patients undergoing EPs prior to pulmonary valve replacements were performed (21 female, median age 37years). VAI was evaluated from EPs and resting 12-lead electrocardiograms, respectively using QRS and heart rate adjusted Q-T intervals, spatial QRS-T angles (peaks), T-wave and QRS-wave (QRSwave vc) component vector root mean squares. Differences were assessed (Student t-tests, Mann Whitney U-tests, Analysis of Variance). Relative risks were calculated. RESULTS: 16 patients had VAI (6 monomorphic, 10 polymorphic). Only the QRSwave vc showed significant differences between those with and without VAI, 10.5±2.4 dmV vs. 13.9±4.5dmV, respectively (p=0.002), area under the ROC curve of 0.78 and relative risk of 2.52. CONCLUSION: VCG evidence of depolarization differences was significant between TOF patients with and without inducible VA.


Assuntos
Taquicardia Ventricular/etiologia , Tetralogia de Fallot/complicações , Vetorcardiografia , Adulto , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Taquicardia Ventricular/fisiopatologia , Tetralogia de Fallot/fisiopatologia
19.
Eur Heart J ; 35(11): 676-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24772458

RESUMO

Cardiologists from the USA provide information from earlier experiences in this emerging specialty.


Assuntos
Cardiologia/tendências , Cardiopatias Congênitas/cirurgia , Humanos
20.
Circulation ; 127(2): 172-9, 2013 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-23224208

RESUMO

BACKGROUND: Although aortic root pathology has been described in patients with tetralogy of Fallot, the scope of the problem remains poorly defined. We sought to determine the prevalence and predictors of aortic root dilatation in adults with repaired tetralogy of Fallot. METHODS AND RESULTS: A multicenter cross-sectional study was conducted with standardized reassessment of echocardiographic parameters in 474 adults (≥18 years) with surgically repaired tetralogy of Fallot or pulmonary atresia with ventricular septal defect. The aortic root was measured in a parasternal long-axis view, in diastole, at the level of the sinus of Valsalva. Prevalence and predictors of an absolute diameter ≥40 mm and of an observed-to-expected ratio >1.5 were assessed. The aortic root dimension was ≥40 mm in 28.9% (95% confidence interval, 26.9%-30.9%). In multivariate analyses, the only independently associated factor was male sex (odds ratio, 4.48; 95% confidence interval, 1.55-12.89; P=0.006). The prevalence of an observed-to-expected aortic root dimension ratio >1.5 was 6.6% (95% confidence interval, 5.3%-7.9%). It was associated with pulmonary atresia and moderate or severe aortic regurgitation in univariate analyses, but no independent predictor was identified. The side of the aortic arch was not associated with aortic root dimension. The prevalence of moderate or severe aortic regurgitation was 3.5% (95% confidence interval, 2.7%-4.2%). CONCLUSIONS: Although nearly one third of adults with repaired tetralogy of Fallot have an aortic root diameter ≥40 mm, the prevalence of a dilated aortic root, when defined by an indexed ratio of observed-to-expected values, is low. Similarly, moderate or severe aortic regurgitation is uncommon.


Assuntos
Aorta/patologia , Doenças da Aorta/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Tetralogia de Fallot/epidemiologia , Tetralogia de Fallot/cirurgia , Adulto , Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/epidemiologia , Estudos Transversais , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/epidemiologia , Feminino , Comunicação Interventricular/epidemiologia , Comunicação Interventricular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Valor Preditivo dos Testes , Prevalência , Atresia Pulmonar/epidemiologia , Atresia Pulmonar/cirurgia , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Ultrassonografia , Adulto Jovem
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