RESUMEN
OBJECTIVES: Apical ballooning syndrome usually involves elderly women. We reported the profile of this syndrome in men. METHODS: We identified 54 consecutive patients with the syndrome: among them, seven were men (13%, group M) and 47 were women (87%, group F). RESULTS: Men were younger than women (group M 61.7 years vs. group F 72.8 years, median age, Pâ<â0.01) and emotional triggers predominated in women ( group M 14.3% vs. group F 44.7%, Pâ=â0.01) compared with physiological ones which were more frequent in men (group M 42.9% vs. group F 19.1%, Pâ=â0.02). At onset, men were more compromised than women (group M 42.9% vs. group F 6.4%, Pâ=â0.004). At the median follow-up of 18.5 months, more men died than women (group M 28.6% vs. group F 8.5%, Pâ=âNS), but only women had cardiac-related deaths (group M 0% vs. group F 6.4%, Pâ=âNS). Cardiac outcome was similar in both groups (group M 14.3% vs. group F 23.4%, Pâ=âNS). Left ventricular ejection fraction increased in both sexes from 41% to more than 56% (Pâ<â0.01). CONCLUSION: In this small case series, left ventricular apical ballooning syndrome showed similar features in both sexes. However, men seemed to be more affected at younger age, presented more physiological triggers and more compromised clinical status at admission. Despite this, cardiac outcome was good in both sexes.
Asunto(s)
Cardiomiopatía de Takotsubo , Factores de Edad , Anciano , Distribución de Chi-Cuadrado , Angiografía Coronaria , Ecocardiografía Doppler , Emociones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Estrés Fisiológico , Estrés Psicológico/complicaciones , Volumen Sistólico , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/mortalidad , Cardiomiopatía de Takotsubo/fisiopatología , Factores de Tiempo , Función Ventricular IzquierdaAsunto(s)
Angioplastia Coronaria con Balón/instrumentación , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Situs Inversus/complicaciones , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Electrocardiografía , Femenino , Humanos , Situs Inversus/diagnóstico , Resultado del TratamientoRESUMEN
We report a case of mitral valve repair complicated by iatrogenic coronary artery lesion. This rare coronary injury caused an acute ST-elevation myocardial infarction and it was treated successfully with a percutaneous coronary intervention.
Asunto(s)
Angioplastia Coronaria con Balón , Vasos Coronarios/lesiones , Lesiones Cardíacas/terapia , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Anuloplastia de la Válvula Mitral/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Infarto del Miocardio/terapia , Lesiones del Sistema Vascular/terapia , Angiografía Coronaria , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiología , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/etiología , Resultado del Tratamiento , Lesiones del Sistema Vascular/diagnóstico por imagen , Lesiones del Sistema Vascular/etiologíaRESUMEN
OBJECTIVE: Apical ballooning syndrome is a rare clinical entity that predominantly involves elderly women and is considered to be benign. We report our experience regarding this syndrome in terms of sex distribution and long-term outcome. METHODS: Between 1999 and 2006, we identified 28 consecutive patients affected by the apical ballooning syndrome. Inclusion criteria were an onset of mimicking acute myocardial infarction, transient akinesia/dyskinesia of the mid-apical left ventricular segments and no significant obstructive coronary artery disease. Patients with a recent brain disease, pheocromocytoma, hypertrophic cardiomyopathy and suspected myocarditis were excluded. Sex distribution was assessed across different ages according to quartiles: less than 61 years of age (group 1), 61-71 years (group 2), 72-77 years (group 3) and more than 77 years (group 4). In-hospital and follow-up events were observed. RESULTS: The apical ballooning syndrome represented 1.69% of ST-segment elevation acute coronary syndromes. There were more women than men in groups 2 (85.7 vs. 14.3%), 3 (85.7 vs. 14.3%) and 4 (100 vs. 0%), but there were fewer women than men in group 1 (42.9 vs. 57.1%), with an overall supremacy of women (78.6 vs. 21.4%) (P=0.02). In-hospital events were one (3.6%) cardiac death and five (17.9%) nonfatal events. At the median follow-up of 24 months, one patient was lost and two (7.7%) died of cardiac causes, thus, the total cardiac mortality was 10.7% (3/28 patients); no recurrence occurred and left ventricular ejection fraction increased from 40.4 to 58.6% (P<0.01). CONCLUSION: In our population, left ventricular apical ballooning syndrome included several typical features. However, a peculiar sex tendency across various age groups was observed and, although older women predominated, men seemed to be more affected than women at a younger age. The long-term prognosis seems to be favourable.
Asunto(s)
Cardiomiopatía de Takotsubo/diagnóstico , Distribución por Edad , Anciano , Electrocardiografía , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pronóstico , Distribución por Sexo , Cardiomiopatía de Takotsubo/terapiaRESUMEN
OBJECTIVE: The impact of vessel injury on the outcome of patients undergoing percutaneous coronary intervention combined with brachytherapy for in-stent restenosis is under investigation. We report our clinical experience adopting a low aggressive balloon angioplasty technique, to limit vessel trauma, associated with brachytherapy and short-term dual antiplatelet therapy. METHODS: Forty-nine consecutive patients, undergoing percutaneous coronary intervention with brachytherapy for symptomatic in-stent restenosis, were prospectively observed for a median time of 21 + or - 8 months. Clinical follow-up included anginal status, death, myocardial infarction and repeat revascularization; only patients with evidence of ischaemia repeated coronary angiography. Low aggressive angioplasty consisted in the use of a conventional balloon with a balloon to artery ratio < or = 1, avoiding high inflation pressures and the use of other devices. Dual antiplatelet therapy was continued for 3-6 months. RESULTS: Early angiographic result was good and the need for additional stent implantation was low (3.9%). At follow-up, we did not observe death, acute myocardial infarction or stent thrombosis, but 10 patients repeated coronary angiography for recurrence of ischaemia: disease progression was present in two cases (4.1%). Restenosis emerged in the remaining eight patients (16.3%): two cases showed restenosis within the target lesion segment, one case within the injured segment, one case within the radiated segment, and four cases at the edges. The consequent new revascularization was surgical in three patients and percutaneous in seven patients. CONCLUSIONS: Our data suggest that low aggressive angioplasty followed by brachytherapy and short-term dual antiplatelet therapy for in-stent restenosis is related to a good outcome, with a low restenosis rate and without stent thrombosis.