Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 58
Filtrar
1.
Diagnostics (Basel) ; 10(4)2020 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-32235380

RESUMEN

BACKGROUND: This study aimed to compare the diagnostic accuracy of stress single-photon emission computed tomography (SPECT) and stress cardiac magnetic resonance (CMR) for the assessment of coronary artery disease (CAD) in the same patients, using coronary angiography as the reference standard. METHODS: Thirty patients with known or suspected CAD who were referred for exercise SPECT myocardial perfusion imaging (MPI) for the evaluation of myocardial ischemia underwent stress CMR MPI and computed tomography coronary angiography (CTCA) or selective coronary angiography (SCA). The data from the two stress modalities were compared against the data from angiography. RESULTS: In our study population, 30% of the recruited subjects had significant CAD. The CMR sensitivity for the detection of significant CAD and/or myocardial ischemia was 89% and specificity was 76%. For SPECT, the corresponding sensitivity was 78% and specificity was 52%. The negative predictive value was 92% for CMR and 83% for SPECT. The receiver-operating characteristic (ROC) analysis evaluating the presence of significant CAD, CMR (area under the curve (AUC) 0.78) outperformed SPECT (AUC 0.59) (p < 0.01). The ROC analysis evaluating the presence of myocardial ischemia was also in favor of CMR (AUC 0.82) versus SPECT (AUC 0.67) (p < 0.01). CONCLUSIONS: CMR has high diagnostic accuracy for the detection of CAD and stress-induced ischemia and appears to outperform SPECT. CMR may thus be the preferred noninvasive imaging modality to assess patients with known or suspected CAD.

2.
World J Pediatr Congenit Heart Surg ; 7(3): 372-4, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27142407

RESUMEN

The unusual case of a thymic cyst emerging and rapidly expanding, mimicking hence a right atrial aneurysm in an asymptomatic patient with congenital heart disease is presented.


Asunto(s)
Aneurisma Cardíaco/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Quiste Mediastínico/diagnóstico por imagen , Adolescente , Diagnóstico Diferencial , Atrios Cardíacos/diagnóstico por imagen , Humanos , Masculino , Quiste Mediastínico/cirugía , Resultado del Tratamiento
4.
J Magn Reson Imaging ; 41(4): 1038-45, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24817313

RESUMEN

PURPOSE: To determine normative values for left ventricular (LV) volumes, mass, concentricity, and ejection fraction (EF) and investigate associations between sex, age, and body size with LV parameters in community-dwelling adults. MATERIALS AND METHODS: In all, 1794 Framingham Heart Study Offspring cohort members underwent LV short-axis oriented, contiguous multislice cine steady-state free precession MR of the left ventricle; from these a healthy referent group (n = 852, 61 ± 9 years, 40% men) free of clinical cardiac disease and hypertension (SBP < 140, DBP < 90 mmHg, never used antihypertensive medication ≥30 years prior to scanning) was identified. Referent participants were stratified by sex and age group (≤55, 56-65, >65 years); LV parameters were indexed to measures of body size. RESULTS: Men have greater LV volumes and mass than women both before and after indexation to height, powers of height, and body surface area (P < 0.01 all), but indexation to fat-free mass yielded greater LV volume and mass in women. In both sexes, LV volumes and mass decrease with advancing age, although indexation attenuates this association. LVEF is greater in women than men (68 ± 5% vs. 66 ± 5%, P < 0.01) and increases with age in both sexes (P < 0.05). CONCLUSION: Among nonhypertensive adults free of cardiac disease, men have greater LV volumes and mass with sex differences generally persisting after indexation to body size. LV volumes and mass tend to decrease with greater age in both sexes. Female sex and advanced age were both associated with greater LVEF. J. Magn. Reson. Imaging 2015;41:1038-1045. © 2014 Wiley Periodicals, Inc.


Asunto(s)
Envejecimiento/fisiología , Tamaño Corporal/fisiología , Ventrículos Cardíacos/anatomía & histología , Imagen por Resonancia Magnética/normas , Función Ventricular Izquierda/fisiología , Antropometría/métodos , Biometría/métodos , Estudios de Cohortes , Humanos , Tamaño de los Órganos/fisiología , Valores de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Caracteres Sexuales , Volumen Sistólico , Estados Unidos
5.
J Cardiovasc Med (Hagerstown) ; 13(7): 460-1, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21558872

RESUMEN

Little information exists regarding the prevalence of aberrant or ectopic aortic arch vessels in patients with different cardiovascular anomalies. We present a young patient with an aberrant right subclavian artery associated with an ectopic left vertebral artery and a bicuspid aortic valve.


Asunto(s)
Anomalías Múltiples/diagnóstico , Aorta Torácica/anomalías , Válvula Aórtica/anomalías , Aneurisma/diagnóstico , Anomalías Cardiovasculares/diagnóstico , Trastornos de Deglución/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Arteria Subclavia/anomalías , Arteria Vertebral/anomalías , Adulto Joven
6.
Am J Cardiol ; 109(1): 26-30, 2012 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-21943938

RESUMEN

Although stress gated technetium-99m single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) is useful in differentiating ischemic from nonischemic cardiomyopathy, its prognostic usefulness in this patient population is not well understood. Consecutive unique patients with suspected coronary artery disease who, for clinical indications, underwent technetium-99m rest and stress MPI demonstrating ejection fractions ≤40% by gated SPECT imaging were retrospectively identified. In addition to prescan variables, previously defined cutoffs for gated SPECT parameters using visual and standard 17-segment semiquantitative scoring were applied and related to the occurrence of cardiac death up to 5 years after MPI. Of the 475 patients fulfilling criteria for study inclusion, follow-up was complete in 444 (93%) over 3.7 ± 1.6 years. Of 393 patients without subsequent early (≤60 days) coronary revascularization, cardiac death occurred in 64 (16%). The summed stress score, an MPI measure of the extent and severity of coronary artery disease that also accounts for the ischemic burden, was the gated SPECT parameter most related to cardiac death with Kaplan-Meier 5-year cardiac death-free survival of 85.6% and 67.3% in patients with summed stress scores ≤8 and >8, respectively (p <0.001). In multivariate Cox regression analysis, a summed stress score >8 independently contributed to cardiac death (adjusted hazard ratio 2.20, 95% confidence interval 1.34 to 3.61), and its addition to the model significantly increased the global chi-square value over prescan variables (from 32.46 to 41.67, p = 0.002). In conclusion, stress MPI data from gated technetium-99m SPECT scans are useful for the prediction of cardiac death in patients with moderate to severe left ventricular systolic dysfunction in whom there is suspicion of underlying coronary artery disease.


Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Muerte Súbita Cardíaca/etiología , Contracción Miocárdica/fisiología , Imagen de Perfusión Miocárdica/métodos , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único/estadística & datos numéricos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Connecticut/epidemiología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/mortalidad , Muerte Súbita Cardíaca/epidemiología , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Volumen Sistólico , Encuestas y Cuestionarios , Tasa de Supervivencia/tendencias , Sístole , Tomografía Computarizada de Emisión de Fotón Único/métodos , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/mortalidad
8.
Vasc Med ; 16(4): 253-9, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21708875

RESUMEN

We aimed to determine the relationships between resting left ventricular (LV) wall motion abnormalities (WMAs), aortic plaque, and peripheral artery disease (PAD) in a community cohort. A total of 1726 Framingham Heart Study Offspring Cohort participants (806 males, 65 ± 9 years) underwent cardiovascular magnetic resonance with quantification of aortic plaque volume and assessment of regional left ventricular systolic function. Claudication, lower extremity revascularization, and ankle-brachial index (ABI) were recorded at the most contemporaneous examination visit. WMAs were associated with greater aortic plaque burden, decreased ABI, and claudication in age- and sex-adjusted analyses (all p < 0.001), which were not significant after adjustment for cardiovascular risk factors. In age- and sex-adjusted analyses, both the presence (p < 0.001) and volume of aortic plaque were associated with decreased ABI (p < 0.001). After multivariable adjustment, an ABI ≤ 0.9 or prior revascularization was associated with a threefold odds of aortic plaque (p = 0.0083). Plaque volume significantly increased with decreasing ABI in multivariable-adjusted analyses (p < 0.0001). In this free-living population, associations of WMAs with aortic plaque burden and clinical measures of PAD were attenuated after adjustment for coronary heart disease risk factors. Aortic plaque volume and ABI remained strongly negatively correlated after multivariable adjustment. Our findings suggest that the association between coronary heart disease and non-coronary atherosclerosis is explained by cardiovascular risk factors. Aortic atherosclerosis and PAD remain strongly associated after multivariable adjustment, suggesting shared mechanisms beyond those captured by traditional risk factors.


Asunto(s)
Enfermedades de la Aorta/epidemiología , Aterosclerosis/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad Arterial Periférica/epidemiología , Disfunción Ventricular Izquierda/epidemiología , Anciano , Análisis de Varianza , Índice Tobillo Braquial , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/fisiopatología , Aterosclerosis/diagnóstico , Aterosclerosis/fisiopatología , Distribución de Chi-Cuadrado , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Humanos , Modelos Lineales , Modelos Logísticos , Imagen por Resonancia Magnética , Masculino , Massachusetts/epidemiología , Persona de Mediana Edad , Oportunidad Relativa , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Prevalencia , Medición de Riesgo , Factores de Riesgo , Volumen Sistólico , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda
9.
Hellenic J Cardiol ; 52(1): 75-8, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21292610

RESUMEN

Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes be totally asymptomatic and can be found incidentally during coronary arteriography later in adult life. We report the case of a 75-year-old man with such a fistula and describe our diagnostic approach. In addition, we review the literature on the etiology, epidemiology, the diagnostic modalities and treatment of coronary fistulas.


Asunto(s)
Anomalías de los Vasos Coronarios/diagnóstico , Fístula Vascular/diagnóstico , Anciano , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/terapia , Humanos , Hallazgos Incidentales , Imagen por Resonancia Magnética , Masculino , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/terapia
10.
Am J Cardiol ; 107(6): 949-55, 2011 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-21247548

RESUMEN

The prevalence and clinical correlates of left ventricular (LV) wall motion abnormalities (WMAs), associated with morbidity and mortality, have not been well-characterized in the population. Framingham Heart Study Offspring Cohort participants (n = 1,794, 844 men, age 65 ± 9 years) underwent cine cardiovascular magnetic resonance for evaluation of LV function. A subset (n = 1,009, 460 men) underwent cardiac multidetector computed tomography for analysis of coronary artery calcium. The presence of coronary heart disease and heart failure (CHD-HF) were assessed in relation to the presence of WMAs. WMAs were present in 117 participants (6.5%) and were associated with male gender, elevated hemoglobin A1c, LV mass, LV end-diastolic volume, and lower LV ejection fraction. Of the 1,637 participants without CHD-HF, 68 (4.2%) had WMAs. In this group, WMAs were associated with obesity, hypertension, and Framingham coronary heart disease risk score in the age- and gender-adjusted analyses and were associated with male gender and hypertension on multivariate analysis. Most subjects with WMAs were in the greatest coronary artery calcium groups. The presence of coronary artery calcium greater than the seventy-fifth percentile and Agatston score >100 were associated with a greater than twofold risk of WMAs in the age- and gender-adjusted analysis but were no longer significant when additionally adjusted for CHD-HF. Previous Q-wave myocardial infarction was present in 29% of the 117 participants with WMAs. In conclusion, in the present longitudinally followed free-living population, 4.2% of the participants without CHD-HF had WMAs. WMAs were associated with the clinical parameters associated with cardiovascular disease risk. Aggressive risk factor modification may be prudent for subjects with WMAs, particularly those free of clinical CHD-HF.


Asunto(s)
Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/fisiopatología , Anciano , Calcinosis/epidemiología , Calcinosis/fisiopatología , Comorbilidad , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Ecocardiografía , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Estudios Longitudinales , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Factores Sexuales , Tomografía Computarizada por Rayos X , Estados Unidos/epidemiología , Disfunción Ventricular Izquierda/diagnóstico
12.
Hellenic J Cardiol ; 51(5): 463-6, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20876061

RESUMEN

We report the case of a 62-year-old man who presented with shortness of breath, lower extremity edema and clinical signs of congestive heart failure. Transthoracic echocardiography demonstrated concentric left ventricular hypertrophy with severe diastolic dysfunction and biatrial enlargement. After aggressive diuresis and clinical improvement, a cardiac magnetic resonance imaging (CMR) examination was performed. The study confirmed the presence of concentric left ventricular hypertrophy with borderline systolic function and impaired diastolic function. Delayed contrast-enhanced imaging indicated diffuse enhancement and lack of adequate signal suppression of the left ventricular myocardium, suggesting the diagnosis of infiltrative heart disease. Rectal biopsy confirmed the diagnosis of amyloidosis. This report presents the typical noninvasive imaging findings of cardiac amyloidosis.


Asunto(s)
Amiloidosis/diagnóstico , Cardiopatías/diagnóstico , Amiloidosis/complicaciones , Amiloidosis/fisiopatología , Cardiopatías/complicaciones , Cardiopatías/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/complicaciones , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Ultrasonografía
13.
J Cardiovasc Magn Reson ; 11: 54, 2009 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-20015374

RESUMEN

We present an unusual case of cardiomyopathy in a two month old male infant with a grade-I systolic murmur. Echocardiographic examination disclosed left ventricular (LV), dysplasia with saw-tooth like inwards myocardial projections extending from the lateral walls towards the LV cavity. There was mild LV systolic dysfunction with apical hypokinesia. Cardiovascular magnetic resonance demonstrated in detail these cross bridging muscular projections originating from the inferior interventricular septum and lateral LV wall, along with areas of hypokinesis at the LV septum and apex in a noncoronary distribution, without any late gadolinium enhancement. We have termed this condition saw-tooth cardiomyopathy because of the very characteristic appearance.


Asunto(s)
Cardiomiopatías/diagnóstico , Imagen por Resonancia Magnética , Miocardio/patología , Tabique Interventricular/patología , Cardiomiopatías/complicaciones , Cardiomiopatías/tratamiento farmacológico , Fármacos Cardiovasculares/uso terapéutico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/patología , Soplos Cardíacos/etiología , Soplos Cardíacos/patología , Humanos , Lactante , Masculino , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/patología
14.
Pediatr Cardiol ; 30(4): 536-9, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19365666

RESUMEN

Fibroma, the second most common tumor in childhood, usually is a large solitary mass involving the ventricular septum or the left and rarely the right free ventricular wall. An unusual case of a 5.2-year-old boy with a large mass originating from the pulmonary valve is reported. The patient presented for evaluation of a murmur. Echocardiography and cardiac magnetic resonance imaging showed a large tumor extending from the distal right ventricular outflow tract through the pulmonary valve and into the main pulmonary artery causing moderate obstruction. The patient had a fatal cardiac arrest while awaiting surgery. The postmortem examination proved the tumor to be a fibroma.


Asunto(s)
Fibroma/patología , Paro Cardíaco/etiología , Neoplasias Cardíacas/patología , Enfermedades de las Válvulas Cardíacas/patología , Válvula Pulmonar , Niño , Resultado Fatal , Fibroma/complicaciones , Neoplasias Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Masculino
15.
Metabolism ; 58(5): 682-8, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19375592

RESUMEN

The objective of the study was to examine the effect of a 6-month daily treatment with 160 mg valsartan, an angiotensin II receptor blocker, on the left ventricular systolic function and aortic elasticity of patients with type 2 diabetes mellitus (T2DM) and healthy subjects. This was a prospective, randomized, double-blind, placebo-controlled crossover study. Thirteen healthy control subjects and 11 patients with T2DM were enrolled in the study. Eight control subjects and 4 T2DM patients completed the study. Cardiovascular magnetic resonance was used to evaluate the effect of valsartan on the left ventricular function and aortic elasticity. At baseline, T2DM patients had increased left ventricular mass (P = .006) when compared with the healthy controls. In the T2DM patients, treatment with valsartan, in comparison with receiving placebo, resulted in a reduction of aortic radius (P = .026) and wall thickness (P = .032) of the ascending aorta. In the abdominal aorta, valsartan treatment, when compared with placebo treatment, reduced the arterial compliance (P = .014) in the T2DM patients. Valsartan treatment for 6 months decreased the diameter and wall thickness of the ascending aorta in patients with T2DM, but may decrease AC of the abdominal aorta.


Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Aorta/efectos de los fármacos , Diabetes Mellitus Tipo 2/complicaciones , Angiopatías Diabéticas/tratamiento farmacológico , Tetrazoles/uso terapéutico , Valina/análogos & derivados , Función Ventricular Izquierda/efectos de los fármacos , Adulto , Anciano , Anciano de 80 o más Años , Aorta/fisiología , Glucemia/metabolismo , Presión Sanguínea/fisiología , Estudios Cruzados , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Método Doble Ciego , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Valina/uso terapéutico , Valsartán , Adulto Joven
16.
Stud Health Technol Inform ; 142: 386-8, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19377189

RESUMEN

Following fixation and MRI imaging a post-mortem human heart was sliced at the sagittal plane. Each anatomical section was then cut into smaller segments and each one was objected to classical histology process. The resulting microscopy slides were digitalized with a scanner. The histological section reconstruction was achieved using Adobe Photoshop CS2(R). Using specific software, called FiberCad, the user can define and draw (with the assistance of optical microscope) those fibers that are parallel and those fibers that are vertical to the slides plane. To better align the histological 3D reconstruction, the software is equipped with an option that allows the user to make best possible fit between histological and MRI slices. We present the consequent sagittal sections of LV free wall (from epicardial to endocardial surface), whereby the clockwise rotation of the mean orientation of the fibers that are on the plane of sectioning is clearly evident. We present a post mortem analysis of the complete LV free wall of a human heart.


Asunto(s)
Tejido Conectivo/anatomía & histología , Tecnología de Fibra Óptica , Ventrículos Cardíacos , Cadáver , Endocardio/anatomía & histología , Corazón/fisiología , Humanos , Imagen por Resonancia Magnética
17.
Stud Health Technol Inform ; 142: 389-91, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19377190

RESUMEN

In cardiac transplantation has been recognized some "abnormalities" in recipient ECG. We investigated the influence of heart geometrical position within the chest cavity as well as somatometric parameters on body surface torso potentials. Two control patients with different Body Mass Index (BMI) were undergone a chest MRI scan. Using specific software we created two tetrahedral meshes that could be applied in our study. A post-mortem human heart was undergone a MRI scan and we also created its tetrahedral mesh. Using second software we extracted the heart mesh of control's torsos and we replaced them with the mesh of the post-mortem heart. The last program also assessed the influence of heart (re)positioning within the thorax, on the body surface potentials. The Finite Elements Method (FEM) was used to solve the forward electrocardiographic problem for both torsos, under the assumption that all the ventricular myocardium of the one post-mortem heart was excited. FEM was also applied in simulating Body Surface Potential Mapping (BSPM) on the first thorax torso for nine different heart positions. For BSPM, FEM has been applied on Poison equation. The results show higher BSPM in patient with lower BMI and significant changes in BSPM when heart was rotated round its long axis. Conversely, the heart shifts (long x- or y- axis) didn't cause significant changes on simulated BSPM.


Asunto(s)
Superficie Corporal , Simulación por Computador , Trasplante de Corazón , Donantes de Tejidos , Trasplante , Análisis de Elementos Finitos , Humanos , Imagen por Resonancia Magnética
18.
Hellenic J Cardiol ; 50(2): 151-4, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19329419

RESUMEN

We report the case of a 58-year-old man with a recent anterior myocardial infarction, for which he did not receive prompt reperfusion therapy. The patient underwent cardiac magnetic resonance (CMR) imaging, for the assessment of left ventricular function and myocardial viability, and coronary angiography, two weeks after the acute cardiac event. The CMR study demonstrated a moderately dilated left ventricle, with impaired systolic function and wall motion abnormalities in the anterior, apical and inferior left ventricular walls. The T1-weighted images obtained early after contrast administration demonstrated a dark rim in the endocardial region of the interventricular septum and apex. The delayed-enhanced images demonstrated complete absence of signal at the same rim, adjacent to a hyper-enhanced region that corresponded to the wall motion abnormalities. These findings are suggestive of microvascular obstruction in the distribution of the left anterior descending coronary artery. Microvascular obstruction has been reported to correlate positively with the size of the infarction and the left ventricular end-diastolic volume, and inversely with the left ventricular ejection fraction. Furthermore, it has been reported as an independent predictor of future major cardiovascular events. Microvascular obstruction should be routinely checked for in patients presenting in the peri-myocardial infarction period for CMR assessment of myocardial viability.


Asunto(s)
Estenosis Coronaria/diagnóstico , Vasos Coronarios/patología , Imagen por Resonancia Magnética/métodos , Infarto del Miocardio/etiología , Angiografía Coronaria , Circulación Coronaria , Estenosis Coronaria/complicaciones , Diagnóstico Diferencial , Humanos , Masculino , Microcirculación , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico
20.
Endocr Pract ; 14(1): 40-9, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18238740

RESUMEN

OBJECTIVE: To examine the efficacy and safety of recombinant human growth hormone (rhGH) therapy in congestive heart failure (CHF) by conducting a meta-analysis of clinical studies. METHODS: We searched 3 literature databases (MEDLINE, EMBASE, and the Cochrane Register) for clinical studies of rhGH therapy in CHF due to systolic dysfunction and conducted a meta-analysis. RESULTS: Therapy with rhGH appears to have beneficial clinical effects (weighted mean difference [95% confidence interval]) in CHF including improved exercise duration (1.9 min [1.1-2.7]), maximum oxygen consumption (2.1 mL x kg(-1) x min(-1) [1.2-3.0]), and New York Heart Association class (-0.9 [-1.5 to -0.3]). There were salutary hemodynamic effects of rhGH therapy, including increased cardiac output (0.4 L x min(-1) [0.1-0.6]) and decreased systemic vascular resistance (-177 dyn x s x cm(-5) [-279 to -74]). Among rhGH-treated patients, left ventricular (LV) ejection fraction improved (4.3% [2.2-6.4]). Despite increases in LV mass and wall thickness, there were no adverse effects on diastolic function. Subgroup analyses suggest that study design and treatment duration may influence some of the treatment effects. Most of the beneficial effects were driven by either uncontrolled or longer duration studies. Administration of rhGH therapy slightly increased the risk for ventricular arrhythmia; however, this finding was driven by a single small study. CONCLUSION: rhGH therapy may have beneficial cardiovascular effects in CHF caused by LV systolic dysfunction. The possibility of proarrhythmia associated with rhGH therapy requires further study. Larger randomized trials with longer treatment duration are needed to fully elucidate the efficacy and safety of rhGH therapy in this patient population.


Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/etiología , Hormona de Crecimiento Humana/uso terapéutico , Disfunción Ventricular Izquierda/complicaciones , Adulto , Anciano , Gasto Cardíaco/efectos de los fármacos , Gasto Cardíaco/fisiología , Ensayos Clínicos Controlados como Asunto , Ejercicio Físico/fisiología , Femenino , Insuficiencia Cardíaca Sistólica/tratamiento farmacológico , Hormona de Crecimiento Humana/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/efectos de los fármacos , Ensayos Clínicos Controlados Aleatorios como Asunto , Volumen Sistólico/efectos de los fármacos , Resultado del Tratamiento , Resistencia Vascular/efectos de los fármacos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA