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1.
High Blood Press Cardiovasc Prev ; 27(1): 9-17, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31975151

RESUMEN

The presence of hypertensive mediated organ damage is related to increased vascular risk and mortality and its prevention should be a therapeutic target and a surrogate marker of in/adequate blood pressure control. In old adult hypertensive patients the therapeutic target should be to prevent major cardiovascular events, but in young hypertensive subjects the focus should be pointed on preventing the development of hypertensive mediated organ damage, since most of the hard events are preceded by functional and structural tissues injury. Hypertension Guidelines of the European Society of Cardiology and European Society of Hypertension recognizes that some variables like electrocardiographic or echocardiographic left ventricle hypertrophy, chronic kidney disease or advance retinopathy, all considered as hypertensive mediated organ damage, may be modifiers of cardiovascular risk estimated by the SCORE system, and for that reason they should be screened in hypertensive patients. It is well known the problem of limited health systems financial resources in many low and even median income countries which precludes the possibilities of generalizing the search for hypertension mediated organ damage in all hypertensive patients. In these scenario the recommendation to perform a detailed screening should be critically evaluated. Some questions remained unanswered: the screening generalization of hypertensive mediated organ damage should modify the cardiovascular risk score of the patients, if its presence could modify the therapeutic approach, and as a consequence, if the treatment adjustment should prolong life expectancy and ameliorate the quality of life.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Cardiopatías/prevención & control , Hipertensión/tratamiento farmacológico , Enfermedades Renales/prevención & control , Enfermedades Vasculares/prevención & control , Antihipertensivos/efectos adversos , Diagnóstico Precoz , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Enfermedades Renales/diagnóstico , Enfermedades Renales/mortalidad , Enfermedades Renales/fisiopatología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/mortalidad , Enfermedades Vasculares/fisiopatología
2.
Br J Anaesth ; 124(1): 25-34, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31668348

RESUMEN

BACKGROUND: Iron deficiency is frequent in patients undergoing cardiac surgery. The relevance of iron deficiency, however, is ill defined. Therefore, our study aimed to investigate the impact of iron deficiency (ferritin <100 µg L-1) with or without concomitant anaemia on clinical outcome after cardiac surgery. METHODS: In this prospective observational study, 730 patients undergoing elective cardiac surgery were assigned into four groups according to their iron status and anaemia. Mortality, serious adverse events (SAEs), major cardiac and cerebrovascular events (MACCEs), allogenic blood transfusion requirements, and length of hospital stay were assessed during a 90-day follow-up period. The effect of iron deficiency on these outcomes was first calculated in models adjusting for anaemia only, followed by two multivariate models adjusting for anaemia and either the EuroSCORE II or any possible confounders. RESULTS: The presence of iron deficiency (ferritin <100 µg L-1) was associated with an increase in 90-day mortality from 2% to 5% in patients without anaemia, and from 4% to 14% in patients with anaemia. Logistic regression resulted in an odds ratio of 3.5 (95% confidence interval: 1.5-8.4); P=0.004. The effect persisted in both multivariate models. Moreover, iron deficiency was associated with an increased incidence of SAEs, MACCEs, transfusion, and prolonged hospital stay. CONCLUSIONS: Preoperative iron deficiency (ferritin <100 µg L-1) was independently associated with increased mortality, more SAEs, and prolonged hospital stay after cardiac surgery. These findings underline the importance of preoperative iron deficiency screening in the context of a comprehensive patient blood management programme, and highlight its importance as a research topic in cardiac surgery. CLINICAL TRIAL REGISTRATION: NCT02031289.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/mortalidad , Hierro/deficiencia , Adulto , Anciano , Anciano de 80 o más Años , Anemia Ferropénica/complicaciones , Anemia Ferropénica/mortalidad , Transfusión Sanguínea/estadística & datos numéricos , Trastornos Cerebrovasculares/mortalidad , Femenino , Ferritinas/sangre , Cardiopatías/mortalidad , Humanos , Incidencia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Resultado del Tratamiento
3.
J Stroke Cerebrovasc Dis ; 29(2): 104528, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31806451

RESUMEN

BACKGROUND: Elevated high-sensitivity cardiac troponin T (hs-cTnT) levels have been related to clinical outcome in stroke patients. However, the role of hs-cTnT and its potential as a biomarker in ischaemic stroke (IS) has not been well established. This study aims to determine whether basal hs-cTnT determination in the hyperacute phase of undetermined IS and transient ischaemic attack (TIA) can predict the cardioembolic aetiology and clinical outcome. METHODS: We prospectively studied 110 consecutive patients with undetermined acute IS and TIA. hs-cTnT levels were determined at hospital arrival. Large vessel stenosis/occlusion and previously known aetiologies at admission were exclusion criteria for this study. All patients were subjected to a complete aetiological evaluation. A 12-month follow-up was performed in all patients. The subtype of IS was evaluated following the SSS-TOAST criteria. We established two groups at admission: cardioembolic aetiology (group A) and noncardioembolic aetiologies (group B). RESULTS: The number of patients in each group was similar (group A: 52, 47.27%; group B, 58, 52.73%). Patients in group A had elevated hs-cTnT more frequently (61.54% versus 17.24%; P < .001). Group A patients had significantly higher mortality at 3 months (14.29% versus 1.82%, P = .025). In the multivariate analysis, elevated hs-cTnT was the only independent predictor of cardioembolic aetiology (odds ratio: 14.821; 95% confidence interval: 3.717-59.102, P < .001). CONCLUSION: Baseline hs-cTnT assessment in undetermined strokes and TIA during the hyperacute phase is independently associated with cardioembolic aetiology.


Asunto(s)
Isquemia Encefálica/etiología , Cardiopatías/sangre , Embolia Intracraneal/etiología , Ataque Isquémico Transitorio/etiología , Accidente Cerebrovascular/etiología , Troponina T/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidad , Femenino , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Humanos , Embolia Intracraneal/diagnóstico , Embolia Intracraneal/mortalidad , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/mortalidad , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Regulación hacia Arriba
4.
N Engl J Med ; 381(19): 1801-1808, 2019 11 07.
Artículo en Inglés | MEDLINE | ID: mdl-31633894

RESUMEN

BACKGROUND: Neurodegenerative disorders have been reported in elite athletes who participated in contact sports. The incidence of neurodegenerative disease among former professional soccer players has not been well characterized. METHODS: We conducted a retrospective cohort study to compare mortality from neurodegenerative disease among 7676 former professional soccer players (identified from databases of Scottish players) with that among 23,028 controls from the general population who were matched to the players on the basis of sex, age, and degree of social deprivation. Causes of death were determined from death certificates. Data on medications dispensed for the treatment of dementia in the two cohorts were also compared. Prescription information was obtained from the national Prescribing Information System. RESULTS: Over a median of 18 years, 1180 former soccer players (15.4%) and 3807 controls (16.5%) died. All-cause mortality was lower among former players than among controls up to the age of 70 years and was higher thereafter. Mortality from ischemic heart disease was lower among former players than among controls (hazard ratio, 0.80; 95% confidence interval [CI], 0.66 to 0.97; P = 0.02), as was mortality from lung cancer (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.001). Mortality with neurodegenerative disease listed as the primary cause was 1.7% among former soccer players and 0.5% among controls (subhazard ratio [the hazard ratio adjusted for competing risks of death from ischemic heart disease and death from any cancer], 3.45; 95% CI, 2.11 to 5.62; P<0.001). Among former players, mortality with neurodegenerative disease listed as the primary or a contributory cause on the death certificate varied according to disease subtype and was highest among those with Alzheimer's disease (hazard ratio [former players vs. controls], 5.07; 95% CI, 2.92 to 8.82; P<0.001) and lowest among those with Parkinson's disease (hazard ratio, 2.15; 95% CI, 1.17 to 3.96; P = 0.01). Dementia-related medications were prescribed more frequently to former players than to controls (odds ratio, 4.90; 95% CI, 3.81 to 6.31; P<0.001). Mortality with neurodegenerative disease listed as the primary or a contributory cause did not differ significantly between goalkeepers and outfield players (hazard ratio, 0.73; 95% CI, 0.43 to 1.24; P = 0.24), but dementia-related medications were prescribed less frequently to goalkeepers (odds ratio, 0.41; 95% CI, 0.19 to 0.89; P = 0.02). CONCLUSIONS: In this retrospective epidemiologic analysis, mortality from neurodegenerative disease was higher and mortality from other common diseases lower among former Scottish professional soccer players than among matched controls. Dementia-related medications were prescribed more frequently to former players than to controls. These observations need to be confirmed in prospective matched-cohort studies. (Funded by the Football Association and Professional Footballers' Association.).


Asunto(s)
Atletas , Enfermedades Neurodegenerativas/mortalidad , Fútbol , Adulto , Anciano , Anciano de 80 o más Años , Lesiones Encefálicas , Estudios de Casos y Controles , Causas de Muerte , Femenino , Cardiopatías/mortalidad , Humanos , Incidencia , Modelos Logísticos , Longevidad , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Nootrópicos/uso terapéutico , Estudios Retrospectivos , Escocia/epidemiología
5.
Artículo en Japonés | MEDLINE | ID: mdl-31534066

RESUMEN

OBJECTIVES: The purpose of this study was to confirm the association of the status of implementation of nonsmoking at eating and drinking establishments with the prevalence of persons with subjective symptoms, the prevalence of persons with diseases under treatment, medical expenses, and mortality rate using prefectural data. METHODS: The prefectural rate of eating and drinking establishments implementing nonsmoking (hereafter, nonsmoking rate) was calculated using the data from "Tabelog®". The variables of interest were the prevalence of persons with subjective symptoms, the prevalence of persons with diseases under treatment, medical expenses (total, hospitalization and nonhospitalization expenses), and the mortality rates of malignant neoplasms (lung cancer, stomach cancer, and colon cancer), heart disease, acute myocardial infarction, cerebrovascular disease, cerebral infarction, and pneumonia in each prefecture. The partial correlation coefficient was estimated between the nonsmoking rate and the variable of interest using the smoking rate by prefectural as the control variable. RESULTS: The nonsmoking rate showed a significantly negative correlation with the medical expenses. When eating and drinking establishments were divided into "restaurant", "café", and "bar", the nonsmoking rate also indicated a significantly negative correlation with the medical expenses in any category. It was negatively related to the mortality rates of cerebrovascular disease, cerebral infarction, and pneumonia. The negative correlation was stronger in females than in males. CONCLUSIONS: These results suggest that the implementation of nonsmoking at eating and drinking establishments may reduce the mortality rates of diseases, such as cerebrovascular disease, cerebral infarction, and pneumonia, and medical expenses. Thus, it is important to implement nonsmoking at eating and drinking establishments in line with the Revised Health Promotion Act.


Asunto(s)
Trastornos Cerebrovasculares/mortalidad , Gastos en Salud/estadística & datos numéricos , Promoción de la Salud/estadística & datos numéricos , Cardiopatías/mortalidad , Neoplasias/mortalidad , No-Fumadores/estadística & datos numéricos , Restaurantes/estadística & datos numéricos , Prevención del Hábito de Fumar/estadística & datos numéricos , Humanos , Japón/epidemiología , Infarto del Miocardio/mortalidad , Neumonía/mortalidad , Prevalencia
6.
Vasc Med ; 24(5): 431-438, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31543030

RESUMEN

Optimal management of patients with internal carotid artery (ICA) stenosis concurrent with severe cardiac disease remains undefined. The aim of this study is to evaluate the safety and feasibility of the one-day, sequential approach by carotid artery stenting (CAS) immediately followed by cardiac surgery. The study included 70 consecutive patients with symptomatic > 50% or ⩾ 80% asymptomatic ICA stenosis coexisting with severe coronary/valve disease, who underwent one-day, sequential CAS + cardiac surgery. The majority of patients (85.7%) had CSS class III or IV angina and 10% had non-ST elevation myocardial infarction. The EuroSCORE II risk was 2.4% (IQR 1.69-3.19%). All CAS procedures were performed according to the 'tailored' algorithm with a substantial use of proximal neuroprotection devices of 44.3%. Closed-cell (75.7%) and mesh-covered (18.6%) stents were implanted in most cases. The majority of patients underwent isolated coronary artery bypass grafting (88.6%) or isolated valve replacement (7.1%). No major adverse cardiac and cerebrovascular events (MACCE) occurred at the CAS stage. There were three (4.3%) perioperative MACCE: one myocardial infarction and two deaths. All MACCE were related to cardiac surgery and were due to the high surgical risk profile of the patients. Up to 30 days, no further MACCE were observed. No perioperative or 30-day neurological complications occurred. In this patient series, one-day, sequential CAS and cardiac surgery was relatively safe and did not result in neurological complications. Thus, a strategy of preoperative CAS could be considered for patients with severe or symptomatic ICA stenosis who require urgent cardiac surgery.


Asunto(s)
Arteria Carótida Interna , Estenosis Carotídea/terapia , Puente de Arteria Coronaria , Procedimientos Endovasculares/instrumentación , Cardiopatías/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Stents , Anciano , Anciano de 80 o más Años , Arteria Carótida Interna/diagnóstico por imagen , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/mortalidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Estudios de Factibilidad , Femenino , Cardiopatías/complicaciones , Cardiopatías/diagnóstico por imagen , Cardiopatías/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
7.
Cardiovasc Pathol ; 43: 107147, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31494524

RESUMEN

BACKGROUND: We evaluated the risk of cardiac death in patients with prior cancer diagnoses and compared risk by cancer type and ethnicity in a large US population. METHOD: Utilizing the Surveillance, Epidemiology, and End Results database, data on patients with a cancer diagnosis between 2000 and 2014 were obtained. We calculated the standardized mortality ratio (SMR) of cardiac death after a cancer diagnosis and the excess risk per 10,000 person-years. We stratified the analysis according to the time interval between cancer and cardiac events, cancer site, cancer stage, and race. RESULTS: A total of 4,671,989 patients with a cancer diagnosis were included, of which 163,255 died due to cardiac causes within 10 years of diagnosis. We found a significantly higher rate of cardiac death for cancer patients [SMR=1.16, 95% confidence interval (CI) 1.15-1.16] compared to the general population. When observed for each cancer site, the highest SMR was after a diagnosis of hepatocellular carcinoma (SMR=2.58, 95% CI 2.45-2.72), pancreatic cancer (SMR=2.36, 95% CI 2.25-2.47), and lung cancer (SMR=2.30, 95% CI 2.27-2.34). Patients with metastatic disease had a higher rate of cardiac death (SMR=2.16, 95% CI 2.13-2.19). When stratified by ethnicity, SMR for cardiac death was 1.76, 2.28, 3.68, 2.65, and 1.84 for whites, blacks, American Indians/Alaska Natives, Asians/Pacific Islanders, and Hispanics, respectively. CONCLUSIONS: Cancer patients are more vulnerable to cardiac death than the general population, especially those with nonwhite ethnicity; liver, lung, and pancreatic cancers; and history of metastasis. Healthcare providers should be aware of this risk and pay particular attention to the highest-risk groups.


Asunto(s)
Grupos de Población Continentales , Grupos Étnicos , Cardiopatías/etnología , Cardiopatías/mortalidad , Neoplasias/etnología , Neoplasias/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias/patología , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Programa de VERF , Factores de Tiempo , Estados Unidos/epidemiología , Adulto Joven
8.
Transplant Proc ; 51(7): 2478-2481, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474300

RESUMEN

BACKGROUND: Preoperative cardiac troponin-I (cTnI) elevation has been shown to be a predictor of mortality after liver transplantation. Myocardial injury after non-cardiac surgery (MINS) has been defined as elevation of serum cardiac troponin levels in the perioperative period that does not fulfill the criteria for myocardial infarction. MINS has been shown to be a prognostic factor for in-hospital and long-term mortality, but there is limited data in patients undergoing living-donor liver transplantation (LDLT). In this study, we aimed to evaluate the relationship between MINS and postoperative mortality. MATERIAL AND METHODS: Patients who had undergone adult LDLT at Florence Nightingale Hospital Liver Transplantation Unit between December 2012 and December 2015 were retrospectively analyzed for 30-day in-hospital and 1-year mortality. Myocardial injury was defined as cTnI level above 0.04 ng/mL. Patients (N = 214) were divided into 2 groups according to postoperative cTnI levels. The following were the exclusion criteria: 1. patients under 18 years old, 2. patients undergoing deceased-donor liver transplantation or dual liver-kidney transplantation, 3. cTnI elevation due to other causes (sepsis, renal failure, pulmonary embolism, myocardial infarction), and 4. patients without postoperative troponin levels. RESULTS: MINS occurred in 123 (57.4%) patients after LDLT. There was no difference between the groups according to age, sex, creatinine levels, presence of ischemic heart disease, hypertension, diabetes mellitus, and tobacco use. The presence of MINS did not predict 30-day and 1-year mortality in the study population. CONCLUSION: Myocardial injury detected by serum cTnI elevation was frequent after LDLT; however, it was not associated with 30-day in-hospital and 1-year mortality.


Asunto(s)
Cardiopatías/etiología , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/mortalidad , Complicaciones Posoperatorias/etiología , Adolescente , Anciano , Femenino , Cardiopatías/mortalidad , Humanos , Donadores Vivos , Masculino , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Troponina I/sangre
10.
Med Arch ; 73(2): 76-80, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31391691

RESUMEN

Introduction: Platelets play a crucial role in thrombotic episodes. Mean Platelet Volume (MPV) is the primary indicator of platelet's activation; its measurement is easy and time-effective. Aim: We tested the hypothesis that MPV is correlated with SYNTAX score in patients that suffered from an Acute Coronary Syndrome (ACS). Material and Methods: One hundred and four (104) patients (79 male-25 female, mean age 64.2±11.1 years), who were hospitalized for an ACS and underwent coronary angiography, were included in the study. Syntax score, as an indicator of the severity of coronary artery disease (CAD), was calculated. We tried to investigate the correlation between the first measured MPV, CRP, Creatinine and high sensitivity Troponin with the Syntax score of the patient and the association of MPV and a possible Major Advanced Cardiac Event (MACE) during hospitalization. Results: The patients were divided into four groups according to the SYNTAX score: Group A (SYNTAX score: 0, n=12), group B: Mild CAD (SYNTAX score: 1-22, n=68), group C: Moderate CAD (SYNTAX score: 23-32, n=12), and group D: Severe CAD (SYNTAX score: ≥ 33, n=12). Four patients (3.8%) developed a MACE during their hospitalization. MPV was significantly correlated to Syntax score (r=0.658, p<0.001) and was found to be an independent predictor factor of MACE with HR=6.8 (95% Confidence Interval 1.46-33.36). The cut-off value of MPV was 7.5 with a sensitivity of 98% and a specificity of 30.8%. Conclusion: We determined a positive correlation between MPV and Syntax score, transforming this simple test in a possible factor of risk stratification in ACS.


Asunto(s)
Síndrome Coronario Agudo/sangre , Enfermedad de la Arteria Coronaria/sangre , Infarto del Miocardio/sangre , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/metabolismo , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Creatinina/sangre , Femenino , Cardiopatías/mortalidad , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Volúmen Plaquetario Medio , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Pronóstico , Recurrencia , Índice de Severidad de la Enfermedad , Troponina T/sangre
11.
Int J Mol Med ; 44(4): 1255-1266, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31432099

RESUMEN

The primary mechanism underlying sepsis­induced cardiac dysfunction is loss of endothelial barrier function. Neuregulin­1 (NRG­1) exerts its functions on multiple targets. The present study aimed to identify the protective effects of NRG­1 in myocardial cells, including endothelial, anti­inflammatory and anti­apoptotic effects. Subsequent to lipopolysaccharide (LPS)­induced sepsis, rats were administered with either a vehicle or recombinant human NRG­1 (rhNRG­1; 10 µg/kg/day) for one or two days. H9c2 cardiomyoblasts were subjected to LPS (10 µg/ml) treatment for 12 and 24 h with or without rhNRG­1 (1 µg/ml). Survival rates were recorded at 48 h following sepsis induction. The hemodynamic method was performed to evaluate cardiac function, and myocardial morphology was observed. Von Willebrand Factor levels were detected using an immunofluorescence assay. Serum levels of tumor necrosis factor α, interleukin­6, intercellular cell adhesion molecule­1 and vascular endothelial growth factor were detected using an enzyme­linked immunosorbent assay; the reductase method was performed to detect serum nitric oxide levels. Apoptosis rates were determined using terminal deoxynucleotidyl transferase dUTP nick end labeling staining. Ras homolog family member A (RhoA) and Rho­associated protein kinase 1 (ROCK1) protein levels were assessed using western blotting. Transmission electron microscopy was used to observe endothelial cells and myocardial ultrastructure changes. Results revealed that NRG­1­treated rats displayed less myocardial damage compared with sham rats. NRG­1 administration strengthened the barrier function of the vasculature, reduced the secretion of endothelial­associated biomarkers and exerted anti­inflammatory and anti­apoptotic effects. In addition, NRG­1 inhibited RhoA and ROCK1 signaling. The results revealed that NRG­1 improves cardiac function, increases the survival rate of septic rats and exerts protective effects via multiple targets throughout the body. The present results contribute to the development of a novel approach to reverse damage to myocardial and endothelial cells during sepsis.


Asunto(s)
Cardiotónicos/farmacología , Células Endoteliales/efectos de los fármacos , Células Endoteliales/metabolismo , Cardiopatías/etiología , Cardiopatías/fisiopatología , Neurregulina-1/farmacología , Sepsis/complicaciones , Animales , Apoptosis/efectos de los fármacos , Biomarcadores , Permeabilidad Capilar/efectos de los fármacos , Citocinas/metabolismo , Cardiopatías/tratamiento farmacológico , Cardiopatías/mortalidad , Pruebas de Función Cardíaca , Humanos , Mediadores de Inflamación , Miocardio/metabolismo , Miocardio/patología , Miocardio/ultraestructura , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/ultraestructura , Estrés Oxidativo/efectos de los fármacos , Unión Proteica , Ratas , Especies Reactivas de Oxígeno/metabolismo , Proteínas Recombinantes/farmacología
13.
Intern Med J ; 49(7): 826-833, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31295785

RESUMEN

Sudden cardiac death (SCD) is a devastating and all too common result of both acquired and genetic heart diseases. The profound sadness endured by families is compounded by the risk many of these deaths confer upon surviving relatives. For those with known cardiac disease, disease-specific therapy and risk stratification are key to reducing sudden death. For families of a SCD victim, uncovering a definitive cause of death can help relieve the agonising uncertainty and is a vital first step in screening surviving relatives and instituting therapy to reduce SCD risk. Increasing knowledge about the molecular mechanisms and genetic drivers of malignant arrhythmias in the diverse clinical entities that can cause SCD is vital if we are to optimise risk stratification and personalise patient care. Advances in diagnostic tools, disease-specific therapy and defibrillator technology are improving outcomes for patients and their families but there is still much progress to be made.


Asunto(s)
Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/prevención & control , Cardiopatías/mortalidad , Cardiopatías/prevención & control , Cardiopatías/diagnóstico , Humanos , Factores de Riesgo
14.
J Orthop Surg Res ; 14(1): 203, 2019 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-31272470

RESUMEN

BACKGROUND: It is known that mortality after hip fracture increases compared to the general population; the trend in mortality is a controversial issue. The objective of this study is to examine incidence, trends, and factors associated with mortality in patients with osteoporotic hip fractures. METHODS: This is a retrospective cohort study that uses the Registry for Hospital Discharges of the National Health System of our hospital. Patients older than 45 having an osteoporotic hip fracture between 1999 and 2015 were identified. Demographic data and comorbidities were obtained. A survival analysis was performed (Cox regression and Kaplan-Meier). Incidence rate, standardized death rate (SDR), trend (Poisson regression), and risk (hazard ratio) were calculated. RESULTS: During 1999-2015, in our hospital, there were a total of 3992 patients admitted due to osteoporotic hip fracture. Out of these 3992 patients, 3109 patients (77.9%) were women with an average age of 84.47 years (SD 8.45) and 803 (22.1%) were men with an average age of 81.64 years (SD 10.08). The cumulative incidence of mortality was 69.38%. The cumulative mortality rate for 12 months was 33%. The annual mortality was 144.9/1000 patients/year. The 1-year mortality rate increased significantly by 2% per year (IRR 1.020, CI95% 1.008-1.033). The median overall survival was 886 days (CI95% 836-951). The probability of mortality density for a period of 10 years following a hip fracture was 16% for women and 25% for men (first 90 days). The SDR was 8.3 (CI95% 7.98-8.59). Variables that showed statistically significant association with mortality were aged over 75, masculine, institutionalization, mild to severe liver disease, chronic kidney disease, COPD, dementia, heart failure, diabetes, the Charlson Index > 2 , presence of vision disorders and hearing impairment, incontinence, and Downton scale. CONCLUSIONS: For the last 17 years, an increase of mortality for patients with hip fracture and a higher mortality rate in men than in women were observed. Institutionalization combined with comorbidities is associated with a higher mortality.


Asunto(s)
Fracturas de Cadera/diagnóstico , Fracturas de Cadera/mortalidad , Fracturas Osteoporóticas/diagnóstico , Fracturas Osteoporóticas/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Humanos , Incidencia , Enfermedades Renales/diagnóstico , Enfermedades Renales/mortalidad , Masculino , Mortalidad/tendencias , Estudios Retrospectivos , Factores Sexuales
15.
J Card Surg ; 34(10): 927-932, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31269296

RESUMEN

BACKGROUND: Patients undergoing heart transplantation (HT) frequently receive perioperative red blood cell (RBC) transfusions, but the impact of perioperative transfusion on clinical outcomes after HT remains unclear. METHODS: All adult HTs performed in Korea between 2007 and 2016 were analyzed using data from the National Health Insurance Service. Patients were classified into four groups based on the number of RBC units transfused during hospital admission for HT: 0, 1 to 2, 3 to 5, and greater than or equal to 6 units. In-hospital and long-term mortality rates were compared among the groups. RESULTS: In total, 833 adults HTs were included in the study. The overall in-hospital mortality rate was 8.4% (70 of 833), with no mortality occurring in patients who received no transfusion. The in-hospital mortality rate was higher in patients requiring greater than or equal to 6 units (25.1%) than in patients who received 1 to 2 units (0.3%) and 3 to 5 units (2.7%; P < .001). Patients who received greater than or equal to 6 units of RBCs had a significantly higher risk of all-cause mortality after HT compared to patients who received no transfusion (hazard ratio [95% confidence interval], 5.99 [1.46-24.56]; P = .012). Long-term survival rate was also lower in patients who received transfusions of greater than or equal to 6 units of RBCs than in patients who received no transfusion (P < .001). CONCLUSIONS: Perioperative transfusion of greater than or equal to 6 units of RBCs may be associated with an increased risk of in-hospital and long-term mortality after HT.


Asunto(s)
Transfusión de Eritrocitos/métodos , Cardiopatías/cirugía , Trasplante de Corazón/mortalidad , Atención Perioperativa/métodos , Vigilancia de la Población , Adulto , Femenino , Estudios de Seguimiento , Cardiopatías/mortalidad , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , República de Corea/epidemiología , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Adulto Joven
16.
Thorac Cardiovasc Surg ; 67(5): 331-344, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31311036

RESUMEN

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), well-defined data of all cardiac, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during the year 2018 are analyzed. For this period, a total of 174,902 procedures were submitted to the registry, 98,707 summarized as heart surgery procedures in the classical meaning. The unadjusted in-hospital survival rate for 33,999 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.8:1) was 97.1% and for 34,915 isolated heart valve procedures, 14,396 transcatheter interventions included, it was 96.0%. Concerning short- and long-term circulatory supports, a total of 2,871 extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) implants, respectively, 942 assist device implantations (L-/R-/BVAD, TAH) were registered. In 2018, the number of isolated heart transplantations increased to 312, a growth of 23% compared with the previous year. The isolated lung transplantations reached 340, a rise of nearly 19%. This annual updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and is a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is appropriate and nationwide patient treatment is guaranteed all the time.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/tendencias , Cardiopatías/cirugía , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/instrumentación , Procedimientos Quirúrgicos Cardíacos/mortalidad , Alemania/epidemiología , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Mortalidad Hospitalaria/tendencias , Humanos , Complicaciones Posoperatorias/mortalidad , Pautas de la Práctica en Medicina/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Sistema de Registros , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
17.
Nutrients ; 11(6)2019 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-31238536

RESUMEN

BACKGROUND: A poor nutritional status has been gathering intense clinical interest recently as it has been suggested to associate with adverse outcomes in patients in the intensive care unit (ICU). However, there is still no established nutritional index dominantly used in clinical practice. We have previously proposed a novel nutritional index, which can be calculated using serum levels of triglycerides, total cholesterol, and body weight (TCBI). In this study, to expand the application of TCBI for critical patients, we investigated the usefulness of TCBI to predict prognosis in hemodynamically unstable patients with percutaneously implantable mechanical circulatory support (MCS) devices in the ICU. PATIENTS AND METHODS: This is a retrospective analysis of a multicenter registry consisting of three Juntendo University hospitals in Japan involving patients who received MCS devices, including intra-aortic balloon pumping (IABP) with or without veno-arterial extracorporeal membrane oxygenation (VA-ECMO), between 2012 and 2016 (n = 439). The median follow-up period was 298 days. RESULTS: Spearman's correlation coefficient between TCBI and the geriatric nutritional risk index (GNRI) was 0.44 (p < 0.0001), indicating a moderate positive correlation for these two variables. Unadjusted Kaplan-Meier analysis demonstrated reduced risks of all-cause and cardiovascular mortalities in patients with higher tertiles of TCBI. Furthermore, adjusted multivariate Cox proportional hazard analyses revealed that the highest tertile TCBI was an independent predictor for the reduced risk of all-cause mortality (hazard ratio (HR): 0.22, 95% confidence interval: 0.10-0.48, p < 0.0001) and cardiovascular mortality (0.20, 0.09-0.45, p < 0.0001). CONCLUSION: A novel and simple to calculate nutritional index, TCBI, can be applicable as a prognostic indicator in hemodynamically unstable patients requiring MCS devices.


Asunto(s)
Oxigenación por Membrana Extracorpórea , Cardiopatías/terapia , Corazón Auxiliar , Hemodinámica , Contrapulsador Intraaórtico , Evaluación Nutricional , Estado Nutricional , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Peso Corporal , Colesterol/sangre , Enfermedad Crítica , Oxigenación por Membrana Extracorpórea/efectos adversos , Oxigenación por Membrana Extracorpórea/mortalidad , Femenino , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Humanos , Contrapulsador Intraaórtico/efectos adversos , Contrapulsador Intraaórtico/mortalidad , Japón , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recuperación de la Función , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Triglicéridos/sangre
18.
Nagoya J Med Sci ; 81(2): 303-312, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31239598

RESUMEN

The Kaifukuki-Rehabilitation Ward (KRW) is a type of inpatient rehabilitation facility in Japan. In the KRW of our institute, mortality and frequency of emergency referrals in 2013 were rather high, 2.6% and 4.3%, respectively. We aimed to investigate the usefulness of an original gatekeeping system to reduce mortality and morbidity from cardiac complications, and to improve the quality of medical care in the KRW. A total of 370 consecutive patients admitted to the KRW of Kobayashi Memorial Hospital between 1 May 2015 and 31 March 2016 were enrolled in this prospective observational study. All patients underwent a screening evaluation in which we defined patients as being screen positive (SC-positive) if they had at least one of 20 diagnostic ECG codes and/or BNP level over 140 pg/dL at admission. A cardiologist provided weekly interventions to those among SC-positive patients who needed cardiac disease treatment during hospitalization. In all, 129 patients were classified as SC-positive (mean age 80 years, 124 [32%] male), and weekly intervention was needed in 28 patients, including start of cardiac medication in 17 cases. Mortality and frequency of emergency transfer due to cardiac disease during hospital stay were 0.3% and 0.3%, respectively. Our gatekeeping system involving a screening evaluation at admission and weekly intervention in selected patients by a cardiologist may be useful in reducing mortality and rate of transfer due to cardiac disease and may improve quality of medical care in KRWs.


Asunto(s)
Cardiopatías/rehabilitación , Anciano , Anciano de 80 o más Años , Electrocardiografía , Femenino , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Humanos , Masculino , Péptido Natriurético Encefálico/análisis , Estudios Prospectivos
19.
PLoS One ; 14(6): e0218548, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31211810

RESUMEN

Use of cardiopulmonary bypass in cardiac surgery triggers systemic inflammation by neutrophil activation leading to neutrophil extracellular traps (NETs) release. Hence, nuclear DNA released by necrotic and apoptotic cells might contribute to an increase in circulating cell-free DNA (cfDNA). cfDNA/NETs might induce endothelial damage and organ dysfunction. This study focuses on the accuracy of cfDNA to predict acute kidney injury (AKI) after on-pump surgery. 58 cardiac patients undergoing on-pump surgery were prospectively enrolled. Blood samples were taken preoperatively, immediately after surgery, at day 1, 2, 3 and 5 from patients with (n = 21) or without (n = 37) postoperative AKI development. Levels of cfDNA, neutrophil gelatinase-associated lipocalin (NGAL) and creatinine in patients' plasma were quantified. ROC curves were used to assess the predictive value of the biomarkers for AKI. Further baseline characteristics and perioperative variables were analyzed.cfDNA and NGAL levels highly increased in AKI patients and significant intergroup differences (vs. non-AKI) were found until day 3 and day 5 after surgery, respectively. cfDNA levels were significantly elevated in patients who developed late AKI (>24 hours), but not in those with AKI development during the first 24 hours (early AKI). NGAL and creatinine, which were highest in patients with early AKI, accurately predicted during the first 24 postoperative hours (early AKI). At day 3, at a threshold of 260.53 ng/ml cfDNA was the best predictor for AKI (AUC = 0.804) compared to NGAL (AUC = 0.699) and creatinine (AUC = 0.688). NGAL, but not cfDNA, was strongly associated with AKI stages and mortality. Monitoring of cfDNA levels from the first postoperative day might represent a valuable tool to predict late AKI after on-pump surgery.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ácidos Nucleicos Libres de Células , Cardiopatías/sangre , Cardiopatías/complicaciones , Enfermedades Renales/diagnóstico , Enfermedades Renales/etiología , Complicaciones Posoperatorias , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Anciano , Biomarcadores , Procedimientos Quirúrgicos Cardíacos/métodos , Creatinina/sangre , Femenino , Cardiopatías/mortalidad , Cardiopatías/cirugía , Humanos , Enfermedades Renales/mortalidad , Lipocalina 2/sangre , Masculino , Oportunidad Relativa , Periodo Posoperatorio , Pronóstico , Curva ROC , Índice de Severidad de la Enfermedad
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