RESUMEN
BACKGROUND: Recently, there have been conflicting results reporting an increased risk of AR or MR associated with oral fluoroquinolones (FQs).This study investigated whether the use of FQs increases the risk of mitral regurgitation (MR) or aortic regurgitation (AR). METHODS: A retrospective cohort study was conducted by using the Taiwan National Health Insurance research database. A unidirectional case-crossover design without selecting controls from an external population was adopted in this study. A total of 26,650 adult patients with new onset of AR or MR between January 1, 2000, and December 31, 2012, were identified. The risk of outcomes was compared between the hazard period and one of the randomly selected referent periods of the same individuals. RESULTS: Before exclusion of pneumonia diagnosed within 2 months before the index date, patients who took FQs had a significantly greater risk of AR or MR (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI] 1.30-1.77), any AR (combined AR and MR) (aOR 1.50, 95% CI 1.10-2.04), and any MR (combined AR and MR) (aOR 1.37, 95% CI 1.16-1.62). After exclusion of pneumonia, FQs exposure remained significantly associated with a greater risk of MR (aOR 1.38, 95% CI 1.17-1.62) and any MR (aOR 1.25, 95% CI 1.05-1.48). CONCLUSIONS: The findings suggested that patients treated with FQs could be warned about the potential risk for MR even after considering the possibility of protopathic bias. Reducing unnecessary FQs prescriptions may be considered to reduce the risk of valvular heart disease.
Asunto(s)
Insuficiencia de la Válvula Aórtica , Estudios Cruzados , Fluoroquinolonas , Insuficiencia de la Válvula Mitral , Humanos , Fluoroquinolonas/efectos adversos , Masculino , Insuficiencia de la Válvula Mitral/inducido químicamente , Insuficiencia de la Válvula Mitral/epidemiología , Femenino , Persona de Mediana Edad , Anciano , Insuficiencia de la Válvula Aórtica/inducido químicamente , Insuficiencia de la Válvula Aórtica/epidemiología , Estudios Retrospectivos , Taiwán/epidemiología , Adulto , Antibacterianos/efectos adversos , Factores de RiesgoRESUMEN
BACKGROUND: Lithium remains the first line therapy for treatment of bipolar disorder and is widely used in psychiatry despite its narrow therapeutic window. Cardiac side effects are uncommon, but when they are present, they can vary from benign repolarization changes to life threatening tachyarrhythmias as well as conduction time abnormalities. In extremely rare cases complete atrioventricular block with cardiogenic shock can be seen. METHODS: We report the clinical course and outcome of a 79-year-old patient who presented with bradyarrhythmias and a complete atrioventricular block due to severe lithium intoxication. The patient was admitted to ICU where fluid resuscitation and intermittent haemodialysis were performed. Interestingly, the cardiac ultrasound on ICU showed a diastolic mitral regurgitation which was related to the underlying complete atrioventricular block. RESULTS: After two cycles of haemodialysis lithium blood levels were normalised and 24 h later sinus rhythm was restored without any signs of atrioventricular block. The patient recovered completely. CONCLUSION: Lithium is widely used for the treatment of bipolar disorder and it can rarely lead to complete atrioventricular block. If the physician encounters a patient with a history of lithium use, who also shows cardiac arrhythmias, then lithium intoxication should always be ruled out. Haemodialysis is the treatment of choice in severe lithium intoxication. Diastolic mitral regurgitation can hint towards underlying atrioventricular conduction disturbances.
Asunto(s)
Bloqueo Atrioventricular , Insuficiencia de la Válvula Mitral , Humanos , Anciano , Bloqueo Atrioventricular/inducido químicamente , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/terapia , Insuficiencia de la Válvula Mitral/inducido químicamente , Insuficiencia de la Válvula Mitral/diagnóstico , Litio , Arritmias Cardíacas/terapia , DiástoleRESUMEN
AIMS: Reports have suggested an increased risk of aortic and mitral regurgitation associated with oral fluoroquinolones (FQs) resulting in a safety warning published by the European Medicines Agency (EMA). However, these findings have not yet been replicated. METHODS AND RESULTS: Using Danish administrative registers, we conducted a nested case-control study in a nationwide cohort of individuals between 2005 and 2018. Cases were defined as the first occurrence of aortic or mitral regurgitation. Exposure of interest was the use of oral FQs. Hazard ratios (HRs) with 95% confidence intervals (95% CI) were obtained by fitting time-dependent Cox regression models, with penicillin V as comparator, to assess the association between FQ use and incident valvular regurgitation. We identified 38 370 cases of valvular regurgitation with 1 115 100 matched controls. FQ exposure was not significantly associated with increased rates of aortic or mitral regurgitation (HR 1.02, 95% CI 0.95-1.09) compared with penicillin V users. Investigating the cumulative defined daily doses (cDDD) of FQs yielded similar results with no significant association between increasing FQ use and valvular regurgitation (e.g. HR 1.08, 95% CI 0.95-1.23 for cDDD >10 compared with cDDD 1-5). These results were consistent across several analyses including a cohort of patients with hypertension and using a case definition based on valvular surgical interventions. CONCLUSIONS: In a nationwide nested case-control study, FQs were not significantly associated with increased rates of valvular regurgitation. Our findings do not support a possible causal connection between FQ exposure and incident valvular regurgitation.
Asunto(s)
Enfermedades de las Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Estudios de Casos y Controles , Estudios de Cohortes , Fluoroquinolonas , Humanos , Insuficiencia de la Válvula Mitral/inducido químicamente , Insuficiencia de la Válvula Mitral/epidemiologíaAsunto(s)
Cardiomiopatía Hipertrófica/tratamiento farmacológico , Insuficiencia de la Válvula Mitral/inducido químicamente , Válvula Mitral/efectos de los fármacos , Fenilefrina/efectos adversos , Cardiomiopatía Hipertrófica/fisiopatología , Cardiotónicos/efectos adversos , Ecocardiografía Transesofágica , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/fisiopatologíaRESUMEN
BACKGROUND: Recent studies have linked fluoroquinolones (FQs) to cardiac adverse events, including aortic dissection and aneurysm. To date, whether FQs can increase the risk of aortic or mitral regurgitation has not been studied. OBJECTIVES: This disproportionality analysis and case-control study examined whether FQs increase the risk of aortic and mitral regurgitation. METHODS: Data from the U.S. Food and Drug Administration's adverse reporting system database was used to undertake a disproportionality analysis, and a random sample of 9,053,240 patients from the U.S. PharMetrics Plus database (IQVIA) was used for the matched nested case-control study. Current FQ exposure implied an active prescription at the index date or 30 days prior to the event date. Recent FQ exposure was defined as FQ use within days 31 to 60 and past within days 61 to 365 prior to the event date. Rate ratios (RRs) were compared to users of amoxicillin and azithromycin. Conditional logistic regression was used to compute RRs adjusting for confounders. RESULTS: The reported odds ratio for the disproportionality analysis was 1.45 (95% confidence interval [CI]: 1.20 to 1.77). A total of 12,505 cases and 125,020 control subjects were identified in the case-control study. The adjusted RRs for current users of FQ compared with amoxicillin and azithromycin users were 2.40 (95% CI: 1.82 to 3.16) and 1.75 (95% CI: 1.34 to 2.29), respectively. The adjusted RRs for recent and past FQ users when compared with amoxicillin were 1.47 (95% CI: 1.03 to 2.09) and 1.06 (95% CI: 0.91 to 1.21), respectively. CONCLUSIONS: These results show that the risk of aortic and mitral regurgitation is highest with current use followed by recent use. No risk was observed with past use of FQs. Future studies are necessary to confirm or refute these associations.
Asunto(s)
Insuficiencia de la Válvula Aórtica/inducido químicamente , Fluoroquinolonas/efectos adversos , Insuficiencia de la Válvula Mitral/inducido químicamente , Administración Oral , Anciano , Estudios de Casos y Controles , Estudios Transversales , Femenino , Fluoroquinolonas/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Medición de RiesgoAsunto(s)
Fenfluramina/análogos & derivados , Implantación de Prótesis de Válvulas Cardíacas , Hipolipemiantes/efectos adversos , Insuficiencia de la Válvula Mitral/inducido químicamente , Insuficiencia de la Válvula Tricúspide/inducido químicamente , Fenfluramina/efectos adversos , Humanos , Insuficiencia de la Válvula Mitral/patología , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Tricúspide/patología , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
RATIONALE: Anthracyclines cardiotoxicity characterized by dilated myocardiopathy has been well described in the literature. However, anthracyclines-induced valvular diseases have been seldom reported. PATIENT CONCERNS: In this study, we present the case of a 62-year-old Chinese female patient with breast cancer developing severe mitral regurgitation after anthracycline exposure. DIAGNOSES: The patient was diagnosed with mitral regurgitation with preserved left ventricular ejection fraction and normal cardiac chamber dimensions in the sixth month after the last course of anthracycline-containing chemotherapy. However, continued decrease in LVEF with normal left ventricular wall thickness, and serial increases in left atrial and ventricular dimensions were observed in the follow-up echocardiography. INTERVENTIONS: Treatments with oral itraconazole at a dose of 75âmg/day and local wound care with ciclopirox olamine ointment were administered. OUTCOMES: The patient responded well to the treatment with perindopril, metoprolol succinate, spirolactone, and furosemide, and symptoms associated with heart failure were dramatically relieved. LESSONS: The incipient mitral regurgitation may serve as an early sign of myocardial dysfunction that can facilitate a timely recognition of cardiotoxicity, which is crucial to a timely change of chemotherapy regimen and an appropriate initiation of antiremodeling therapy that could limit anthracycline cardiotoxicity and improve overall outcome.
Asunto(s)
Antraciclinas/efectos adversos , Antibióticos Antineoplásicos/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Insuficiencia de la Válvula Mitral/inducido químicamente , Antraciclinas/uso terapéutico , Antibióticos Antineoplásicos/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
Ischemic mitral regurgitation (IMR) is a frequent complication after a myocardial infarction (MI), which doubles mortality. Transcatheter mitral repairs are emerging as alternative treatment options to open heart surgery for IMR, but animal models to test them are lacking. We report a percutaneous swine model of IMR. Seventeen swine were randomized to (group 1, n = 12) MI causing IMR, and (group 2, n = 5) controls. In group 1, MI was induced via percutaneous ethanol injection into the obtuse marginal branches of the left circumflex artery, resulting in ST elevating myocardial infarction. Nine animals were survived to 8-10 weeks with weekly echocardiograms and three swine were survived to 16-20 weeks with MRI at termination. In group 1 animals, average IMR fraction at termination was 26.6 ± 2.3% in the echo group, and 24.51 ± 0.41% in the MRI group. None of the animals in group 2 had IMR. Left ventricular dysfunction and significant dilatation were evident in group 1 animals, compared to the controls. In conclusion, a reproducible model of IMR is reported for use in pre-clinical testing of new mitral technologies.
Asunto(s)
Trombosis Coronaria/inducido químicamente , Etanol , Insuficiencia de la Válvula Mitral/inducido químicamente , Válvula Mitral/fisiopatología , Infarto del Miocardio con Elevación del ST/inducido químicamente , Animales , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/fisiopatología , Modelos Animales de Enfermedad , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Imagen por Resonancia Magnética , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/fisiopatología , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/fisiopatología , Sus scrofa , Factores de Tiempo , Disfunción Ventricular Izquierda/inducido químicamente , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular IzquierdaRESUMEN
We present a rare case of mitral regurgitation with anterior mitral leaflet perforation associated with gelatin-resorcinol-formaldehyde (GRF) glue. We performed mitral valve replacement for anterior mitral leaflet perforation occurred 7 years after aortic valve replacement and abscess cavity repair using GRF glue. Long-term follow-up is needed for patients who have undergone surgeries using GRF glue or BioGlue (CryoLife, Inc, Kennesaw, GA) because of the possibility of late complications. In particular, when an eccentric mitral regurgitation is observed after aortic root surgery using GRF glue or BioGlue, anterior mitral leaflet perforation should be considered.
Asunto(s)
Formaldehído/efectos adversos , Insuficiencia de la Válvula Mitral/inducido químicamente , Válvula Mitral/patología , Adhesivos Tisulares/efectos adversos , Adulto , Aorta/cirugía , Válvula Aórtica/cirugía , Endocarditis/cirugía , Gelatina/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/patología , Necrosis/inducido químicamente , Complicaciones Posoperatorias , Resorcinoles/efectos adversosAsunto(s)
Ecocardiografía Doppler en Color/métodos , Ecocardiografía de Estrés/métodos , Ergotamina/efectos adversos , Insuficiencia de la Válvula Mitral/inducido químicamente , Función Ventricular Izquierda/fisiología , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/fisiopatología , Agonistas de Receptores de Serotonina/efectos adversosAsunto(s)
Fenfluramina/análogos & derivados , Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Mitral , Válvula Mitral , Disfunción Ventricular Izquierda , Anciano , Depresores del Apetito/uso terapéutico , Depresores del Apetito/toxicidad , Autopsia , Ecocardiografía/métodos , Resultado Fatal , Fenfluramina/uso terapéutico , Fenfluramina/toxicidad , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Válvula Mitral/efectos de los fármacos , Válvula Mitral/patología , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/inducido químicamente , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/fisiopatología , Obesidad/tratamiento farmacológico , Volumen Sistólico , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatologíaAsunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Lobular/tratamiento farmacológico , Insuficiencia de la Válvula Mitral/inducido químicamente , Trastuzumab/efectos adversos , Función Ventricular Izquierda/efectos de los fármacos , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Ecocardiografía , Femenino , Humanos , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Trastuzumab/uso terapéuticoRESUMEN
We present a series of echocardiography images to demonstrate the myocardial response to a high dose of prednisone. A young woman with systemic lupus erythematosus (SLE) associated with interventricular septal hypertrophy exhibited a high pressure gradient between the ascending aorta and left ventricular outflow tract as well as significant systolic anterior motion (SAM) and mitral regurgitation (MR) during high-dose prednisone treatment. However, the pressure gradient decreased dramatically and the MR disappeared rapidly when the dose of prednisone was reduced. To the best of our knowledge, this is the only adult case of myocardial hypertrophy that is assumed to be related to prednisone use.
Asunto(s)
Cardiomiopatía Hipertrófica/inducido químicamente , Lupus Eritematoso Sistémico/tratamiento farmacológico , Insuficiencia de la Válvula Mitral/inducido químicamente , Prednisona/uso terapéutico , Obstrucción del Flujo Ventricular Externo/inducido químicamente , Adulto , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Ecocardiografía Doppler en Color/métodos , Femenino , Estudios de Seguimiento , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Enfermedades Raras , Medición de Riesgo , Índice de Severidad de la Enfermedad , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagenAsunto(s)
Insuficiencia de la Válvula Aórtica/inducido químicamente , Bromocriptina/efectos adversos , Ecocardiografía Doppler en Color/métodos , Insuficiencia de la Válvula Mitral/inducido químicamente , Anciano , Insuficiencia de la Válvula Aórtica/diagnóstico , Bromocriptina/uso terapéutico , Agonistas de Dopamina/efectos adversos , Agonistas de Dopamina/uso terapéutico , Humanos , Masculino , Insuficiencia de la Válvula Mitral/diagnóstico , Enfermedad de Parkinson/tratamiento farmacológicoAsunto(s)
Ergotamina/efectos adversos , Enfermedades de las Válvulas Cardíacas/inducido químicamente , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/inducido químicamente , Insuficiencia de la Válvula Aórtica/cirugía , Ergotamina/uso terapéutico , Femenino , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Persona de Mediana Edad , Trastornos Migrañosos/tratamiento farmacológico , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/inducido químicamente , Insuficiencia de la Válvula Mitral/cirugía , Estenosis de la Válvula Mitral/inducido químicamente , Estenosis de la Válvula Mitral/cirugía , UltrasonografíaAsunto(s)
Insuficiencia de la Válvula Aórtica/inducido químicamente , Depresores del Apetito/efectos adversos , Fenfluramina/análogos & derivados , Hipolipemiantes/efectos adversos , Insuficiencia de la Válvula Mitral/inducido químicamente , Femenino , Fenfluramina/efectos adversos , Humanos , MasculinoRESUMEN
AIMS: The epidemiologic link between benfluorex use and an increased global frequency of left heart valve regurgitation has been well documented. However, no data linking previous drug exposure to the frequency of diagnosis of drug-induced valvular heart disease (DI-VHD) are available. The present study was conducted to address this issue. METHODS AND RESULTS: This echocardiography reader-blinded, controlled study conducted in 10 centres between February 2010 and February 2012 prospectively included 835 subjects previously exposed to benfluorex referred by primary care physicians for echocardiography. Based on blinded off-line analysis, echocardiography findings were classified as: (i) DI-VHD⺠for patients with an echocardiographic diagnosis of DI-VHD, (ii) inconclusive, and (iii) DI-VHDâ» for patients without signs of DI-VHD. Fifty-seven (6.8%) patients exposed to benfluorex were classified as DI-VHDâº, 733 (87.8%) patients were classified as DI-VHDâ», and 45 (5.4%) were classified as inconclusive. Mitral and aortic DI-VHD were reported in 43 patients (5.1%) and 30 (3.6%) patients, respectively. Longer duration of exposure, female gender, smoking, and lower BMI were independently associated with a diagnosis of DI-VHD. Good inter-observer reproducibility was observed for the echocardiography classification (Kappa = 0.83, P < 0.00001). CONCLUSIONS: About 7% of patients without a history of heart valve disease previously exposed to benfluorex present echocardiography features of DI-VHD. Further studies are needed to study the natural history of DI-VHD and to identify risk factors for the development of drug-induced valve lesions.
Asunto(s)
Insuficiencia de la Válvula Aórtica/inducido químicamente , Depresores del Apetito/efectos adversos , Fenfluramina/análogos & derivados , Hipolipemiantes/efectos adversos , Insuficiencia de la Válvula Mitral/inducido químicamente , Análisis de Varianza , Estudios de Casos y Controles , Diabetes Mellitus/tratamiento farmacológico , Dislipidemias/tratamiento farmacológico , Ecocardiografía , Femenino , Fenfluramina/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Obesidad/tratamiento farmacológico , Estudios Prospectivos , Factores de RiesgoRESUMEN
La evaluación de la competencia de la válvula mitral puede ser imposible en el escenario de un mixoma auricular gigante. Presentamos el caso de una paciente de 50 años, que sufrió insuficiencia mitral severa en el período posderivación cardiopulmonar, tras resección de un mixoma auricular izquierdo, que precisó recambio valvular. La ausencia de insuficiencia mitral en el examen ecocardiográfico preoperatorio no debe ser tomada como un predictor fiable de una función valvular adecuada. Discutimos el papel del ecocardiograma intraoperatorio, los mecanismos fisiopatológicos y el tratamiento propuesto de la insuficiencia mitral severa, después de la resección del mixoma(AU)
Evaluation of the competence of a mitral valve can often be impossible in the clinical setting of a giant atrial myxoma. A 50-year-old woman with severe mitral regurgitation in the post-bypass period following a myxoma resection was managed with a mitral valve replacement. The absence of mitral insufficiency in the preoperative examination should not be taken as a reliable predictor of normal valve function. So herein, we discuss the role of the intraoperative echocardiographic examination, the underlying mechanisms, and the proposed management of severe mitral regurgitation following the resection of an atrial myxoma(AU)