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1.
Minerva Cardioangiol ; 58(1): 1-10, 2010 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20145590

RESUMEN

AIM: The aim of this study was to assess cardiac mortality in patients with reduced ejection fraction (EF< or =45%) and anemia (Hb< or =12 g/dL) undergoing coronary stenting and to investigate whether iron-deficiency anemia influenced outcome when compared to non-anemic patients or patients with other types of anemia. METHODS: One hundred twenty consecutive patients undergoing percutaneous coronary intervention (PCI) between April 2003 and December 2005 were identified and followed for a median of 30 months. Patients were divided into 2 groups, anemic (Hb< or =12 g/dL) and non-anemic. Anemic patients were then divided into 3 sub-groups based on laboratory analysis and anemia work-up: iron-deficiency, malignancy-associated, and anemia of chronic disease (including chronic kidney disease). Mortality rates and cause of death were retrieved using both the Social Security database and the hospital records. RESULTS: Thirty-one percent of patients had iron deficiency, 24% had a malignancy-associated anemia and 45% had anemia of chronic disease. Overall mortality was 12% of which 29% was cardiac death. All-cause and cardiac mortality were significantly higher in anemic vs. non-anemic patients, (31% vs. 6%, P<0.001, and 10% vs. 1%, P=0.016, respectively). Iron-deficiency anemia strongly predicted cardiac mortality (33% vs. 1% in non-anemic patients, P<0.001), while malignancy-associated anemia was the strongest predictor of non-cardiac death (57% vs. 4% in non-anemic patients, P<0.001). Anemia of chronic disease neither predicted cardiac nor non-cardiac death. CONCLUSIONS: To the authors' knowledge, this is the first study to show that iron-deficiency anemia is a strong predictor of cardiac death when compared to patients with other types of anemia or to non-anemic patients.


Asunto(s)
Anemia Ferropénica/complicaciones , Angioplastia Coronaria con Balón , Cardiopatías/complicaciones , Cardiopatías/mortalidad , Stents , Disfunción Ventricular Izquierda/complicaciones , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos
2.
Heart ; 94(6): 737-42, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17698556

RESUMEN

BACKGROUND: T-lymphocyte activation within atherosclerotic plaque, and widespread to the myocardium, has been shown in patients with acute coronary syndromes. OBJECTIVE: To investigate the presence of T-lymphocyte infiltrate at different stages of acute coronary syndromes by studying patients with sudden coronary death, acute myocardial infarction (AMI) and healed infarction, in comparison with patients with myocarditis and patients with non-ischaemic heart failure. METHODS: 72 cases were studied at autopsy: 12 dying of sudden coronary death (group 1), 12 dying <4 weeks (group 2) and 12 dying >4 months after AMI (group 3), 12 with active lymphocytic myocarditis (group 4), 12 with hypertensive heart disease (group 5), and 12 control subjects (group 6). Light microscopy was performed to measure the number of activated T-lymphocytes (CD3+/DR+) in the myocardium and coronary artery wall, and intercellular adhesion molecule-1 (ICAM-1) expression in the myocardium. RESULTS: Activated T-lymphocyte infiltrates and ICAM-1 myocardial expression in both remote and peri-infarction regions and activated T-lymphocytes within the epicardial coronary artery wall of both the infarct- and non-infarct-related arteries were found in groups 1, 2 and 3, whereas myocardial, but not coronary, infiltrates were found in groups 4 (p<0.001 vs groups 1, 2 and 3 for coronary infiltrates). Groups 5 and 6 had no evidence of myocardial or coronary inflammation (p<0.001 vs groups 1, 2 and 3). CONCLUSIONS: The study shows the presence of a lymphocytic infiltrate in both coronary arteries and myocardium and a proinflammatory phenotype shift in the myocardium associated with acute coronary thrombosis in patients dying suddenly, shortly, or even late after coronary thrombosis.


Asunto(s)
Arteritis/patología , Trombosis Coronaria/patología , Muerte Súbita Cardíaca/patología , Infarto del Miocardio/patología , Miocarditis/patología , Adulto , Anciano , Anciano de 80 o más Años , Autopsia , Muerte Súbita Cardíaca/etiología , Humanos , Masculino , Persona de Mediana Edad , Linfocitos T/patología
4.
Heart ; 92(2): 208-12, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15908482

RESUMEN

OBJECTIVE: To test the hypothesis that impaired coronary and myocardial blood flow are linked with increased myocyte apoptosis, thus establishing a link between pressure overload and left ventricular (LV) remodelling. METHODS AND RESULTS: Peak diastolic coronary blood flow velocity (CBFV) was evaluated at transthoracic Doppler echocardiography, and signal intensity (SI) and the rate of SI rise (beta) were measured at myocardial contrast echocardiography in 11 patients with severe aortic stenosis and LV hypertrophy. In the same patients, biopsies were obtained from the anterolateral LV free wall during surgery and analysed for cardiomyocyte apoptosis. LV mass corrected CBFV (CBFVI) was significantly lower in patients than in controls (median 0.100 cm.g/s (interquartile range 0.07-0.115) v 0.130 cm.g/s (0.130-0.160), p = 0.002). Similarly, SI*beta was significantly lower in patients than in controls (11 1/s (8-66) v 83 1/s (73-95), p = 0.001). Apoptotic rate was increased in aortic stenosis more than 100-fold versus controls (1.2% (0.8-1.4) v 0.01% (0.01-0.01), p < 0.001) and inversely correlated with lower CBFVI and SI*beta (r = -0.77, p = 0.001 for both). CONCLUSIONS: Patients with severe aortic stenosis and LV hypertrophy have impaired myocardial perfusion, which is associated with enhanced cardiomyocyte apoptosis. Impaired myocardial perfusion and the ensuing oxygen demand-supply imbalance may, at least partially, be responsible for increased apoptosis and possible transition to heart failure, thus establishing a link between pressure overload, LV remodelling, and heart failure.


Asunto(s)
Estenosis de la Válvula Aórtica/fisiopatología , Apoptosis/fisiología , Circulación Coronaria/fisiología , Anciano , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/patología , Velocidad del Flujo Sanguíneo/fisiología , Ecocardiografía/métodos , Ecocardiografía Doppler/métodos , Femenino , Humanos , Masculino , Microcirculación/fisiología , Miocitos Cardíacos/patología
9.
Clin Anat ; 12(3): 153-8, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10340454

RESUMEN

A patient with dual left anterior descending (R. interventricularis anterior of the left coronary artery) coronary artery is presented. A normally arising left anterior descending was hypoplastic, and an anomalous left anterior descending, which arose from the right sinus aorticus had a normal caliber. The anomalous left anterior descending artery traversed between the aorta and the pulmonary artery supplying most of the anterior myocardial wall of the left ventricle. This rare coronary anomaly can potentially have implications on percutaneous coronary interventions or on surgical revascularization procedures.


Asunto(s)
Anomalías de los Vasos Coronarios/patología , Vasos Coronarios/patología , Angioplastia Coronaria con Balón/métodos , Arterias/anomalías , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad
10.
Catheter Cardiovasc Interv ; 46(2): 227-37, 1999 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-10348551

RESUMEN

Accelerated allograft vasculopathy significantly limits the survival of heart transplant recipients. The prevalence of allograft coronary artery disease is as high as 18% by 1 year and 50% by 5 years following heart transplant. Heart failure and sudden cardiac death are the two most common clinical presentations. In heart transplant recipients with severe, discrete focal allograft vascular disease, percutaneous balloon angioplasty is a viable palliative option. However, its application is limited by a significant restenosis rate and progression of allograft disease in nontreated segments. Diffuse disease with tapering of vessels may be approached by debulking devices. Emerging revascularization modalities for focal stenoses and some of the diffuse tapering vessels include coronary stents, rotational atherectomy, various wavelength lasers, and, to a lesser extent, directional atherectomy. Conceivably, stents will reduce restenosis rates related to focal, discrete plaques; yet it is unknown whether they will be efficacious in short- and long-term treatment of diffusely diseased segments affected by allograft disease. Accurate assessment of clinical outcomes and long-term evaluation is imperative prior to acceptance of these devices as fundamental interventional tools for treatment of allograft coronary artery disease.


Asunto(s)
Enfermedad Coronaria/cirugía , Trasplante de Corazón , Revascularización Miocárdica/métodos , Complicaciones Posoperatorias/cirugía , Adulto , Angioplastia Coronaria con Balón , Aterectomía Coronaria , Cardiomiopatía Dilatada/cirugía , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Trasplante Homólogo
11.
Catheter Cardiovasc Interv ; 46(4): 457-62, 1999 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-10216016

RESUMEN

Percutaneous therapeutic embolization may be an effective strategy to manage distal coronary perforations or inadvertent iatrogenic coronary arteriovenous fistula complicating revascularization procedures. We present two cases in which embolization techniques were used to manage these patients and avoid the need for surgical intervention.


Asunto(s)
Fístula Arteriovenosa/terapia , Puente de Arteria Coronaria , Enfermedad Coronaria/terapia , Embolización Terapéutica , Enfermedad Iatrogénica , Anciano , Fístula Arteriovenosa/etiología , Enfermedad Coronaria/etiología , Embolización Terapéutica/métodos , Femenino , Esponja de Gelatina Absorbible/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias
12.
Cathet Cardiovasc Diagn ; 44(1): 47-51, 1998 May.
Artículo en Inglés | MEDLINE | ID: mdl-9600523

RESUMEN

Left ventricular assist systems have become an important tool as a bridge to cardiac transplantation. Malfunction of these devices often leads to clinical and hemodynamic deterioration. One potential complication is the obstruction of the inflow cannula secondary to remodeling of the left ventricular cavity. We report two cases where fluoroscopy and selective angiography were used to visualize the orientation and obstruction of the inflow cannula when echocardiographic findings were indeterminant.


Asunto(s)
Angiografía/instrumentación , Fluoroscopía/instrumentación , Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Adulto , Gasto Cardíaco Bajo/diagnóstico por imagen , Gasto Cardíaco Bajo/terapia , Falla de Equipo , Insuficiencia Cardíaca/diagnóstico por imagen , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Función Ventricular Izquierda/fisiología
13.
Am J Cardiol ; 81(2): 163-9, 1998 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-9591899

RESUMEN

Issues raised recently concerning the safety of calcium channel blockers (CCBs) prompted an analysis of the occurrence of cardiovascular events and death in the Pfizer Inc. hypertension clinical trial databases for amlodipine (Norvasc) and nifedipine in the gastrointestinal therapeutic system (GITS) formulation (Procardia XL). Prospectively defined analyses of data from comparative and noncomparative trials of amlodipine and nifedipine GITS were conducted. Outcome measures included cardiovascular and noncardiovascular deaths, and adverse cardiovascular events including new/worsened angina, myocardial infarction (MI), serious arrhythmia, stroke, congestive heart failure, and bleeding. Among all amlodipine-treated patients (n = 32,920), the incidence rates for all-cause death, MI, and new/worsened angina were 3.0, 3.3, and 1.6/1,000 patient-years of exposure, respectively. Among those in comparative trials alone (n = 4,126), the all-cause death rate was 4.1/1,000 patient-years, which was comparable to that of other non-CCB agents and significantly less than that of other CCBs (23.8/1,000 patient-years, p = 0.015), although the difference in rates represents only 2 deaths. Among all nifedipine-GITS-treated patients (n = 2,645), the rate of all-cause death was 4.1/1,000 patient-years, of MI 6.5/1,000 patient-years, and of new/ worsened angina 5.7/1,000 patient-years. The incidence rates for MI and other cardiac events were low in these hypertension trials, and did not differ among treatment groups in either the amlodipine or nifedipine GITS comparative analyses. In the clinical trial databases analyzed, there is no signal suggesting excessive risk of death or cardiovascular events for hypertensive patients treated with amlodipine or nifedipine GITS.


Asunto(s)
Amlodipino/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Hipertensión/tratamiento farmacológico , Nifedipino/efectos adversos , Amlodipino/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Causas de Muerte , Trastornos Cerebrovasculares/inducido químicamente , Trastornos Cerebrovasculares/epidemiología , Ensayos Clínicos como Asunto , Preparaciones de Acción Retardada , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/inducido químicamente , Insuficiencia Cardíaca/epidemiología , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Humanos , Hipertensión/mortalidad , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/inducido químicamente , Infarto del Miocardio/epidemiología , Nifedipino/uso terapéutico , Estudios Prospectivos , Seguridad , Tasa de Supervivencia , Resultado del Tratamiento , Estados Unidos/epidemiología
14.
J Infect Dis ; 177(1): 209-12, 1998 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-9419190

RESUMEN

To determine if cytomegalovirus (CMV) infection is a risk factor for primary coronary artery disease (CAD), the association between CMV infection and CAD (>50% blockage in any coronary artery) was investigated in nearly 900 successive nontransplant patients undergoing coronary angiography. By use of logistic regression, older age (P <.001), white race (P <.001), gender (P <.001), hypercholesterolemia (P = .04), and other established cardiovascular risk factors (P = .003) were identified as significantly associated with CAD, but CMV seropositivity (P = .462), the level of IgG antibodies to CMV whole cell antigen (P = .98), or the levels of IgG antibodies to CMV glycoprotein B (P = .67) were not. These data suggest that CMV infection is not a major risk factor for the development of primary CAD in adults.


Asunto(s)
Angiografía Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/etiología , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/epidemiología , Adulto , Factores de Edad , Anciano , Anticuerpos Antivirales/análisis , Anticuerpos Antivirales/inmunología , Antígenos Virales/inmunología , Infecciones por Citomegalovirus/inmunología , Etnología , Glicoproteínas/inmunología , Humanos , Hipercolesterolemia , Inmunoglobulina G/análisis , Modelos Logísticos , Persona de Mediana Edad , Factores de Riesgo , Estudios Seroepidemiológicos , Factores Sexuales
17.
Clin Anat ; 10(5): 303-6, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9283726

RESUMEN

Acute thrombotic occlusion of an infarct-related artery is frequently found in patients presenting with myocardial infarction. In a patient with acute inferior wall myocardial infarction complicated by continuous chest pain and hemodynamic instability, emergency diagnostic coronary arteriography demonstrated a patent, infarct-related, "pseudo" right coronary artery while, in fact, this vessel was a rare anatomic variant of the posterior interventricular branch with very early origin from the right coronary artery and the true right coronary artery was completely occluded by a thrombotic obstruction. Accurate anatomic-angiographic interpretation of the angiogram was crucial for successful performance of emergency recanalization and revascularization of the true right coronary artery with laser and balloon angioplasty. Once antegrade flow was restored another rare coronary variant was discovered, i.e., a sinoatrial node artery arising from the middle portion of the newly patent right coronary artery.


Asunto(s)
Angioplastia de Balón , Anomalías de los Vasos Coronarios/complicaciones , Infarto del Miocardio/complicaciones , Infarto del Miocardio/terapia , Adulto , Angina de Pecho/etiología , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Supervivencia sin Enfermedad , Hemodinámica/fisiología , Humanos , Masculino
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