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1.
Handb Exp Pharmacol ; 270: 47-71, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34467427

RESUMEN

Reduction of glucose is the hallmark of diabetes therapy proven to reduce micro- and macro-vascular risk in patients with type 1 diabetes. However glucose-lowering efficacy trials in type 2 diabetes didn't show major cardiovascular benefit. Then, a paradigm change in the treatment of patients with type 2 diabetes has emerged due to the introduction of new blood glucose-lowering agents. Cardiovascular endpoint studies have proven HbA1c-independent cardioprotective effects for GLP-1 receptor agonists and SGLT-2 inhibitors. Furthermore, SGLT-2 inhibitors reduce the risk for heart failure and chronic kidney disease. Mechanisms for these blood glucose independent drug target-related effects are still an enigma. Recent research has shown that GLP-1 receptor agonists might have anti-inflammatory and plaque stabilising effects whereas SGLT-2 inhibitors primarily reduce pre- and after-load of the heart and increase work load efficiency of the heart. In addition, reduction of intraglomerular pressure, improved energy supply chains and water regulation appear to be major mechanisms for renoprotection by SGLT-2 inhibitors. These studies and observations have led to recent changes in clinical recommendations and treatment guidelines for type 2 diabetes. In patients with high or very high cardio-renal risk, SGLT-2 inhibitors or GLP-1 receptor agonists have a preferred recommendation independent of baseline HbA1c levels due to cardioprotection. In patients with chronic heart failure, chronic kidney disease or at respective risks SGLT-2 inhibitors are the preferred choice. Therefore, the treatment paradigm of glucose control in diabetes has changed towards using diabetes drugs with evidence-based organ protection improving clinical prognosis.


Asunto(s)
Diabetes Mellitus Tipo 2 , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Control Glucémico , Humanos , Hipoglucemiantes/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico
2.
Herz ; 46(3): 217-220, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33564918

RESUMEN

Patients with chronic kidney disease (CKD) exhibit an increased risk to develop heart failure and the presence of heart failure in patients with CKD leads to a worse prognosis. The following overview article summarizes the current standard of medical heart failure therapy and discusses the treatment characteristics in patients with CKD.


Asunto(s)
Insuficiencia Cardíaca , Insuficiencia Renal Crónica , Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina , Progresión de la Enfermedad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Humanos , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia
3.
Pneumologie ; 74(1): 24-34, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31863422

RESUMEN

Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Symptomatic cardiac manifestations are found in less than 10 % of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with rhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany remains unclear and large prospective international observational studies.underline the importance of this disease entity. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society and the German Cardiac Society. The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.


Asunto(s)
Cardiología/normas , Guías de Práctica Clínica como Asunto , Sarcoidosis Pulmonar/diagnóstico , Sarcoidosis Pulmonar/terapia , Cardiomiopatías , Consenso , Alemania/epidemiología , Humanos , Comunicación Interdisciplinaria , Neumología/normas , Sociedades Médicas
4.
Herz ; 44(8): 684-687, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31686123

RESUMEN

At the last meeting of the European Society of Cardiology (ESC) in 2019 the new version of the ESC guidelines on "Diabetes, prediabetes and cardiovascular diseases", which were written in collaboration with the European Association for the Study of Diabetes (EASD), were presented. The recommendations of these guidelines included the novel evidence generated over the last 6 years in large cardiovascular outcome trials with novel antidiabetic drugs. This led to a completely novel positioning of medications for lowering blood glucose levels in the reduction of cardiovascular events for patients with diabetes mellitus. This overview article summarizes the most important recommendations of these new guidelines.


Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus , Estado Prediabético , Humanos , Guías de Práctica Clínica como Asunto , Factores de Riesgo
6.
Herz ; 44(3): 203-209, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30847507

RESUMEN

Diabetes mellitus is an important comorbidity in patients with heart failure. The presence of heart failure in diabetes worsens the prognosis of patients. Recent studies suggest that appropriate diagnostic approaches followed by differential medical treatment are of crucial importance to improve patient outcomes. This article summarizes important aspects of the association between diabetes mellitus and heart failure.


Asunto(s)
Complicaciones de la Diabetes , Diabetes Mellitus , Insuficiencia Cardíaca , Comorbilidad , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Humanos , Pronóstico
7.
Sci Rep ; 8(1): 17731, 2018 12 07.
Artículo en Inglés | MEDLINE | ID: mdl-30532026

RESUMEN

Efferocytosis, the clearing of dead or dying cells from living tissues, is a highly programmed, vital process to maintain the healthy functioning of every organism. Disorders of efferocytosis have been linked to several chronic diseases including atherosclerosis and auto-immune diseases. To date several different assays to determine phagocytosis, using microscopy or FACS analysis with labelled targets, have been developed. However, many of these are unable to differentiate between cells that have truly been phagocytosed and those still present on the surface of the macrophages hindering exact assessment of efferocytotic capacity. We herein describe AnxA5-pHrodo and its negative control M1234-pHrodo as new molecular probes to measure in vitro as well as ex-vivo efferocytotic capacity.


Asunto(s)
Anexina A5/metabolismo , Fagocitosis/fisiología , Animales , Apoptosis/fisiología , Aterosclerosis/metabolismo , Línea Celular , Humanos , Células Jurkat , Macrófagos/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Sondas Moleculares/metabolismo
8.
BMC Geriatr ; 18(1): 135, 2018 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-29898670

RESUMEN

BACKGROUND: Elderly patients are vulnerable to adverse drug reactions (ADRs). Drug-related readmissions (DRRs) can be a major consequence of ADR. Therefore, this study aimed to investigate the effects of a ward-based, comprehensive pharmaceutical care service on the occurrence of DRRs as the endpoint in dependent-living elderly patients. METHODS: A randomized, controlled trial was performed at a German University Hospital. Patients fulfilling the following criteria were eligible: admission to a cooperating ward, existing drug therapy at admission, 65 years of age and older, home-care or nursing home residents in ambulatory care, and a minimum hospital stay of three days. Patients received either standard care (control group) or pharmaceutical care (intervention group). Follow-up consultations were conducted for each patient at 1, 8, 26, and 52 weeks after discharge. The time to DRR was defined as the primary outcome measure and was analysed using the log-rank test. The Cox-proportional hazard model was used for risk factor analysis. RESULTS: Sixty patients (n = 31 intervention group, n = 29 control group) participated in the study. For patients in the intervention group, the median time to DRR was prolonged; however, the level of statistical significance was not reached (log-rank test P = 0.068; HR = 3.28, P = 0.086). When the risk factors 'age' or 'length of stay on the ward' were added to the Cox proportional hazard model, patients in the control group exhibited a significantly higher risk of experiencing a DRR than patients of the intervention group (HR = 4.62; P = 0.028 including age and HR = 5.76; P = 0.033 including length of stay on the ward). CONCLUSIONS: Our findings demonstrate the successful implementation of ward-based, comprehensive pharmaceutical care for dependent-living elderly. Despite a low participation rate, which led to an underpowered study, the results provide a preliminary efficacy signal and effect size estimates to power a definitive trial. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01578525 , prospectively registered April 13, 2012.


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Servicios de Atención de Salud a Domicilio/tendencias , Casas de Salud/tendencias , Readmisión del Paciente/tendencias , Servicios Farmacéuticos/tendencias , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/normas , Atención Ambulatoria/tendencias , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Femenino , Estudios de Seguimiento , Servicios de Atención de Salud a Domicilio/normas , Hospitalización/tendencias , Humanos , Tiempo de Internación/tendencias , Masculino , Casas de Salud/normas , Alta del Paciente/tendencias , Servicios Farmacéuticos/normas
9.
Herz ; 42(3): 329-340, 2017 May.
Artículo en Alemán | MEDLINE | ID: mdl-28396903

RESUMEN

Patients with diabetes mellitus exhibit an increased risk for the development of heart failure. The occurrence of heart failure in patients with diabetes is associated with a poor prognosis. Therapeutic strategies to reduce cardiovascular morbidity and mortality in diabetes have so far mainly focused on the prevention of coronary events but recent data suggest that an early diagnosis of heart failure in diabetes as well as specific therapies could have a major impact on the prognosis for these patients. This article aims to provide a comprehensive overview on the epidemiology, pathophysiology and prognosis of heart failure in diabetes patients and addresses current aspects of heart failure therapy in diabetes as well as diabetes therapy in heart failure patients.


Asunto(s)
Cardiomiopatías Diabéticas/mortalidad , Cardiomiopatías Diabéticas/terapia , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Hipoglucemiantes/uso terapéutico , Comorbilidad , Medicina Basada en la Evidencia , Humanos , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento
10.
Internist (Berl) ; 58(4): 329-335, 2017 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-28233014

RESUMEN

Type 2 diabetes mellitus is a growing chronic disease with a complex pathophysiology and multiple therapeutic options. Clinical prognosis is determined by multimorbidity and cardiovascular complications. For example, the prognosis of patients with diabetes hospitalized for heart failure is very poor with up to 50% mortality rate over the 3 years thereafter. Therefore, three levels have to be addressed in our approach to interdisciplinary diabetes care: screening and prevention, efficient patient-centered drug therapy, and a strategy for care including social environment of the patient suffering from complex diseases. Thus, we need diabetes specialists in out- and in-patient settings. Transsectoral interdisciplinary approaches to clinical care, as exemplary shown for the treatment of the diabetes foot syndrome, should be developed for other comorbidities, like renal and heart failure, respectively. The basis in the therapy of the cardiometabolic high-risk patient is prevention and multimodal treatment of cardiovascular risk factors. In this context, it is interesting to note that new cardiovascular outcome trials with a so-called safety design have shown that the GLP-1 receptor agonist liraglutide and the SGLT-2 inhibitor empagliflozin can reduce cardiovascular event rates. In addition, empagliflozin has significantly reduced the rate of hospitalization for heart failure. The latter has been included in the recent guidelines on heart failure by the European Society of Cardiology.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/prevención & control , Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Pie Diabético/terapia , Receptor del Péptido 1 Similar al Glucagón/agonistas , Humanos , Hipoglucemiantes/uso terapéutico , Pronóstico , Factores de Riesgo
11.
Acta Anaesthesiol Scand ; 60(9): 1270-80, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27492655

RESUMEN

BACKGROUND: It is not clear whether patients entering a specialized, interdisciplinary weaning unit from surgical or medical intensive care units (ICU) distinguish substantially. The purpose of the present study was to assess differences in patients with prolonged weaning being referred from surgical and medical ICU. METHODS: Data collected from April 2013 to April 2014 was conducted for retrospective analysis. Mortality rates, demographic data, clinical, and microbial differences in 150 patients with prolonged weaning were assessed (80 surgical and 70 medical). RESULTS: Surgical ICU referrals tended to be older (70.7 ± 11.3 vs. 67.3 ± 12.3, P = 0.051) and had fewer underlying pulmonary diseases (45% vs. 60%, P = 0.067). Sodium values at the time of referral to the weaning unit were significantly higher in surgical (147.1 ± 9.6) vs. medical (141.3 ± 6.7 mmol/l) patients (P < 0.001). Each 10-unit increase in sodium at the time of referral to the weaning unit was associated with a 2.5-day (95% CI -0.4, 5.4; P = 0.09) prolongation of stay in the weaning unit. Although significant differences in microbiological agents from tracheal aspiration were seen, the infection rate on the weaning unit was similar in both groups. There was no difference in weaning unit mortality between surgical and medical ICU patients (18% vs. 23%; P = 0.41). CONCLUSION: Few differences were found between patients being referred to a specialized weaning unit from surgical vs. medical ICUs. Besides differences in microbiological characteristics of tracheal secretions, there were also differences in sodium levels, which appear to influence on treatment duration.


Asunto(s)
Unidades de Cuidados Intensivos , Desconexión del Ventilador , Anciano , Anciano de 80 o más Años , Farmacorresistencia Bacteriana , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neumonía Asociada al Ventilador/etiología , Derivación y Consulta , Estudios Retrospectivos , Factores de Tiempo
12.
Diabetes Obes Metab ; 18(11): 1147-1151, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27350651

RESUMEN

Recently, glucagon-like peptide-1 (GLP-1) levels have been found to be increased in response to inflammatory stimuli, leading to insulin secretion and prevention of hyperglycaemia during endotoxemia in mice. In the present study, we assess the relevance of the other incretin hormone, glucose-dependent insulinotropic peptide (GIP), as a regulator of glucose metabolism under inflammatory conditions. We found that lipopolysaccharide (LPS) increased GIP secretion in a time- and dose-dependent manner in C57BL/6J mice. To elucidate the underlying mechanisms, mice were injected with inflammatory cytokines known to be released by LPS. Circulating GIP levels significantly increased in response to interleukin (IL)-1ß but not IL-6 or tumour necrosis factor (TNF)-α administration. Using respective knockout mice we found that LPS-mediated GIP secretion was selectively dependent on IL-1 signalling. To evaluate the functional relevance of inflammatory GIP secretion we pretreated mice with the GIP-receptor antagonist (Pro3)GIP. This blunted LPS-induced TNF-α and IL-6 secretion but did not affect LPS-induced insulin secretion or blood glucose-lowering. In conclusion, GIP provides a novel link between the immune system and the gut, with proinflammatory-immune modulatory function but minor glucose regulatory relevance in the context of acute endotoxemia.


Asunto(s)
Glucemia/metabolismo , Polipéptido Inhibidor Gástrico/metabolismo , Inflamación/inducido químicamente , Interleucina-1beta/fisiología , Lipopolisacáridos/farmacología , Receptores Tipo I de Interleucina-1/fisiología , Animales , Glucemia/efectos de los fármacos , Inflamación/metabolismo , Interleucina-6/genética , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Receptores Tipo I de Interleucina-1/genética , Regulación hacia Arriba/efectos de los fármacos
13.
Herz ; 41(4): 290-5, 2016 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-27215418

RESUMEN

Proprotein convertase subtilisin/kexin type 9 (PCSK9) binds to low-density lipoprotein (LDL) receptors leading to their degradation in the liver. Inhibition of PCSK9 leads to an increase in LDL receptors and as a result to a reduction of LDL cholesterol in blood. Currently, two antibodies against PCSK9 are available for clinical treatment in Germany, evolocumab (Repatha®) and alirocumab (Praluent®). Clinical studies have shown that treatment with these antibodies, which must be subcutaneously injected by patients every 2 or 4 weeks, in addition to an already existing lipid therapy can lower the LDL cholesterol level in blood by an average of 50-60 %. Data from previous study programs show that this treatment is safe although long-term data are still lacking. The results of currently running cardiovascular endpoint studies are not yet available, whereby a beneficial effect is to be expected after the preliminary analyses. These novel effective therapy approaches open up new perspectives for the treatment of patients whose LDL cholesterol values are still in excess of the corresponding target values despite previous maximum lipid-reducing therapy and suffer from a preexisting cardiovascular disease, statin intolerance, genetic forms of familiar hypercholesterolemia and patients on LDL apheresis.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Anticolesterolemiantes/uso terapéutico , Hipercolesterolemia/tratamiento farmacológico , Hipercolesterolemia/metabolismo , Inhibidores de PCSK9 , Proproteína Convertasa 9/metabolismo , LDL-Colesterol/sangre , Medicina Basada en la Evidencia , Humanos , Metabolismo de los Lípidos/efectos de los fármacos , Terapia Molecular Dirigida/métodos , Receptores de LDL/metabolismo , Resultado del Tratamiento
15.
PPAR Res ; 2016: 2756781, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28115923

RESUMEN

Tissue factor (TF) is the initiator of the blood coagulation cascade after interaction with the activated factor VII (FVIIa). Moreover, the TF/FVIIa complex also activates intracellular signalling pathways leading to the production of inflammatory cytokines. The TF/FVIIa complex is inhibited by the tissue factor pathway inhibitor-1 (TFPI-1). Peroxisome proliferator-activated receptor gamma (PPARγ) is a transcription factor that, together with PPARα and PPARß/δ, controls macrophage functions. However, whether PPARγ activation modulates the expression of TFP1-1 in human macrophages is not known. Here we report that PPARγ activation increases the expression of TFPI-1 in human macrophages in vitro as well as in vivo in circulating peripheral blood mononuclear cells. The induction of TFPI-1 expression by PPARγ ligands, an effect shared by the activation of PPARα and PPARß/δ, occurs also in proinflammatory M1 and in anti-inflammatory M2 polarized macrophages. As a functional consequence, treatment with PPARγ ligands significantly reduces the inflammatory response induced by FVIIa, as measured by variations in the IL-8, MMP-2, and MCP-1 expression. These data identify a novel role for PPARγ in the control of TF the pathway.

17.
Nutr Metab Cardiovasc Dis ; 25(8): 697-705, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26164634

RESUMEN

AIM: Type 2 diabetes is not only an independent risk factor for cardiovascular (CV) disease but is also associated with a greater incidence of heart failure (HF). The aim of this review is to examine the effects of oral antidiabetic drugs on CV disease and HF. DATA SYNTHESIS: Trials of anti-diabetic agents are now designed to assess CV safety, but frequently HF is not included as a primary endpoint. However, HF in patients with diabetes is more frequent than other CV events and seems to be underestimated. A burning question is therefore if the most used trial design to monitor CV safety, i.e. non-inferiority, allows clinical translation of trial findings. Available data further suggest that the CV effects of anti-diabetic drugs may be rather class-specific and are only partly due to their glucose-lowering actions. Metformin, recommended as first line in most guidelines, shows positive CV effects while other classes like thiazolidinediones may precipitate HF. Experimental results on the relatively novel dipeptidyl peptidase IV (DPP IV) inhibitors imply CV protective effects, but the non-inferiority trials published to date show an overall neutral CV outcome and a potential increase in HF by saxagliptin. However, results on sitagliptin of the recently released TECOS indicate that HF is not a class-dependent effect of DPP IV inhibitors. CONCLUSION: Further basic research and long-term outcome studies to clarify the effects of antidiabetic agents on CV and HF are required so that we can select the optimal antidiabetic therapy for our patients.


Asunto(s)
Glucemia/efectos de los fármacos , Enfermedades Cardiovasculares/inducido químicamente , Ensayos Clínicos como Asunto , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/inducido químicamente , Hipoglucemiantes/efectos adversos , Adamantano/efectos adversos , Adamantano/análogos & derivados , Administración Oral , Dipéptidos/efectos adversos , Inhibidores de la Dipeptidil-Peptidasa IV/efectos adversos , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Metformina/efectos adversos , Factores de Riesgo , Fosfato de Sitagliptina/efectos adversos , Tiazolidinedionas/efectos adversos
18.
FEBS Lett ; 589(4): 461-6, 2015 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-25595457

RESUMEN

Coronary artery disease (CAD) is a major cause of morbidity and mortality. Mutations in C6ORF105, associated with decreased gene expression, positively correlate with the risk of CAD in Chinese populations. Moreover, the C6ORF105-encoded protein may play a role in coagulation. Here, we report that C6ORF105 gene expression is lower in circulating mononuclear cells from obese diabetic than lean subjects. Moreover, C6ORF105 is expressed in human macrophages and atherosclerotic lesions, where its expression positively correlates with expression of the transcription factor Peroxisome Proliferator-Activated Receptor (PPAR)γ. Activation of PPARγ increases, in a PPARγ-dependent manner, the expression of C6ORF105 in human macrophages and atherosclerotic lesions.


Asunto(s)
Enfermedad de la Arteria Coronaria/genética , Macrófagos/metabolismo , Proteínas de la Membrana/genética , PPAR gamma/fisiología , Aterosclerosis/metabolismo , Células Cultivadas , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Expresión Génica , Humanos , Proteínas de la Membrana/biosíntesis , Obesidad/metabolismo , Activación Transcripcional
19.
Herz ; 39(5): 586-92, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23793836

RESUMEN

Seismocardiography (SCG) is a noninvasive technique for recording cardiac vibrations. Changes in these waves have been correlated with chronic and acute alterations in myocardial function. This analysis is complex and clinical integration limited. The current study aimed to simplify the utilization of SCG by fast Fourier transformation for a reliable discrimination between different intra- and postoperative causes of hypotension (i.e., myocardial ischemia or hypovolemia). We operated on nine pigs and recorded SCG at baseline, at hypovolemia (occlusion of the inferior vena cava), and at ischemia (occlusion of the right coronary artery). In conclusion, SCG enables detection and differentiation of ischemia and hypovolemia as important causes of altered myocardial function during and after surgery. Thus, this simple and noninvasive diagnostic tool may be used intra- and postoperatively to identify patients at risk.


Asunto(s)
Balistocardiografía/métodos , Electrocardiografía/métodos , Contracción Miocárdica/fisiología , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatología , Animales , Diagnóstico Diferencial , Modelos Animales de Enfermedad , Análisis de Fourier , Frecuencia Cardíaca/fisiología , Hemodinámica/fisiología , Isquemia Miocárdica/etiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Porcinos , Disfunción Ventricular Izquierda/etiología
20.
Minerva Med ; 104(2): 119-30, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23514988

RESUMEN

Atrial fibrillation is the most common clinically relevant heart rhythm disorder and is associated with increased morbidity and mortality. Most important risk factors for atrial fibrillation are high age, arterial hypertension, diabetes mellitus, heart failure and rheumatic heart disease. Chronic atrial fibrillation is classified as paroxysmal, persistent, long-standing persistent and permanent atrial fibrillation. Spontaneous conversion to sinus rhythm is observed in paroxysmal atrial fibrillation, whereas in persistent atrial fibrillation, pharmacological or electrical cardioversion is required in order to restore sinus rhythm. In permanent atrial fibrillation, the arrythmia is accepted by patient and physician and cardioversion is not attempted. Rate control only is thus applied in permanent atrial fibrillation, whereas in paroxysmal and persistent atrial fibrillation, addition rhythm control with anti-arrhythmic drugs and/or ablation is attempted if symptoms persist and age and co-morbidities do not pose contra-indications. Besides rhythm management, oral anticoagulation is the mainstay of therapy for most patients with atrial fibrillation. Risk scores such as the CHA2DS2-VASc score help to identify patients with a high risk of stroke and need for oral anticoagulation. The underuse of vitamin K antagonists in clinical practise is partly due to considerable disadvantages: an increased bleeding risk, a narrow therapeutic window and multiple drug interactions prompting frequent laboratory controls to assess an individual dosage. New oral anticoagulants targeting thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban and edoxaban) may replace warfarin in many patients with atrial fibrillation due to convincing data both on efficacy and safety as well as convenience. However, challenges remain with respect to lack of specific antidotes and high costs.


Asunto(s)
Fibrilación Atrial/terapia , Antiarrítmicos/uso terapéutico , Anticoagulantes/uso terapéutico , Fibrilación Atrial/clasificación , Fibrilación Atrial/complicaciones , Ablación por Catéter/métodos , Cardioversión Eléctrica/métodos , Frecuencia Cardíaca , Humanos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Factores de Riesgo , Stents , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Vitamina K/antagonistas & inhibidores
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