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1.
Wiad Lek ; 74(3 cz 1): 395-398, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813439

RESUMEN

OBJECTIVE: The aim: The purpose of the present research was to study the results of coronary artery bypass graft (CABG) surgery depending on the degree of left ventricular ejection fraction (LVEF) reduction with the aim to identify additional echocardiographic predictors of the early postoperative period. PATIENTS AND METHODS: Materials and methods: Were fixed, the results of CABG in 97 patients operated on in the "Bikard" private clinic from March 2016 to December 2018 were the material of the research. All patients underwent CABG surgery under cardiopulmonary bypass and cardioplegia, and in the preoperative period underwent echocardiographic examination according to the standard technique on the Vivid 7 machine. Patients, in dependent of the LVEF, were divided into 3 groups: group 1 35 people (LVEF < 40%), group 2 32 people ( 40% < LVEF < 50%), group 3 30 people (LVEF > 50%). RESULTS: Results: Our studies showed that the most important echocardiographic predictors of a complicated development of the disease in the early postoperative period, in addition to LVEF of the heart, can be the size of the left ventricle and left atrial, the presence and severity of mitral regurgitation and diastolic dysfunction of the left ventricle of the heart. CONCLUSION: Conclusions: Comprehensive measurement of these echocardiographic parameters will allow more accurately predict the results of coronary artery bypass grafting in the early postoperative period.


Asunto(s)
Disfunción Ventricular Izquierda , Función Ventricular Izquierda , Puente de Arteria Coronaria , Ecocardiografía , Humanos , Periodo Posoperatorio , Volumen Sistólico , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico por imagen
2.
Kyobu Geka ; 74(3): 174-180, 2021 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-33831868

RESUMEN

We aimed to evaluate the results of transapical transcatheter aortic valve implantation (TAVI) for aortic stenosis. Thirty patients who had aortic stenosis and underwent transapical TAVI between 2016 and 2020 were enrolled. Medical records were reviewed, and the following data were retrieved and analyzed:basic demographic data, and intraoperative data and postoperative outcomes. Mean age was 85.8 years. There were 3 intraoperative complications (1 apex bleeding, 1 coronary stenosis and 1 mitral regurgitation). Extracorporeal membrane oxygenation was initiated due to unstable hemodynamics in two patients. One patient was converted to mitral valve replacement due to severe mitral regurgitation. There were 2 in-hospital complications (1 with sick sinus syndrome and 1 with cerebral infarction). One patient died of cerebral infarction and eventually, the 30-day mortality was 3%. Median observational period was 1.3 years. Three-year survival was 87.3%. Left ventricular ejection fraction increased by six months after the procedure and then, reached plateau. Left ventricular mass index decreased constantly throughout the observational period. Both parameters at one year after the procedure were significantly higher than preoperative ones. In conclusion, survival after transapical TAVI was favorable because of the low critical complication rate. Both left ventricular functional improvement and reverse remodeling were obtained.


Asunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Anciano de 80 o más Años , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Cateterismo Cardíaco , Humanos , Factores de Riesgo , Volumen Sistólico , Resultado del Tratamiento , Función Ventricular Izquierda
3.
Rev Med Liege ; 76(4): 248-255, 2021 Apr.
Artículo en Francés | MEDLINE | ID: mdl-33830688

RESUMEN

Gliflozins (sodium-glucose cotransporter type 2 inhibitors or SGLT2is) are the only glucose-lowering agents that have proven their ability to reduce major cardiovascular events, hospitalisations for heart failure and the progression to end-stage kidney disease in at risk patients with type 2 diabetes (T2D). One of the most marked and reproducible effects is the reduction in hospitalisations for heart failure. This protective effect was observed in all large prospective cardiovascular outcome trials, independently of the presence of heart failure at inclusion, and was confirmed in two dedicated trials that specifically targeted patients with heart failure and reduced left ventricular ejection fraction, with or without diabetes : DAPA-HF with dapagliflozin and EMPEROR-reduced with empagliflozin. The reduction in hospitalisations for heart failure appeared more marked when baseline renal function was impaired, including when estimated glomerular filtration rate (eGFR) was inferior to 45 ml/min/1.73 m². These favourable results contribute to give a privileged position to SGLT2is in more recent international guidelines produced by diabetologists, cardiologists and nephrologists. According to these guidelines, the prescription of SGLT2is should be extended to patients with an eGFR between 30 and 60 ml/min/1.73 m² as well to non-diabetic patients with heart failure and reduced ejection fraction. For other patients with preserved ejection fraction, one has to wait for further results from ongoing large prospective trials.


Asunto(s)
Diabetes Mellitus Tipo 2 , Insuficiencia Cardíaca , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Compuestos de Bencidrilo , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Estudios Prospectivos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Volumen Sistólico , Función Ventricular Izquierda
4.
Georgian Med News ; (311): 85-88, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33814397

RESUMEN

The aim of our study was to study prevalence and clinical importance of Hyperuricemia (HU) in patients with heart failure (HF). 126 patients with HF were involved in a study. Main group included 75 patients with HF and HU. 51 patients with HF without HU were included in the control group. All patients underwent to a standardized clinical evaluation, including physical examination, determination of NYHA class and laboratory studies; namely, full blood count, serum uric acid, creatinine and ferritin. Assessment of exercise capacity was performed using a 6-min walk test. Echocardiographic assessment included interventricular septum thickness, left ventricular systolic and diastolic dimensions, left ventricular diastolic function, posterior wall thickness, left ventricular mass index and LVEF. Patients with HU had higher prevalence of diabetes mellitus than patients without HU. Patients with HU had significantly lower LVEF (38.2±7.0 and 44.5±5.1; respectively. P<0.05). No differences were recorded for body weight, diastolic blood pressure, platelets, serum creatinine, or presence of chronic obstructive pulmonary disease. Patients with HU had significantly thicker IVS, than those without it (10.49±2.9 vs 10.93 ±1.64mm; respectively. P<0.006). LV mass index was larger in patients with HU (P<0.001); There were no significant differences in LV end-systolic (LVESd) and end-diastolic (LVEDd) dimensions. Additionally, there were no differences in LV diastolic functional parameters. In both groups was decreased average distance walked and percentage of expected distance for healthy persons. Study results point out that female gender, higher NYHA class, low level of LVEF, the presence of hyperuricemia, lower than normal eGFR predict lower exercise capacity. Presented study demonstrates high prevalence of HU in patients with chronic heart failure. Despite high prevalence, historically the meaning of HU was underestimated in patients with HF. Taken into account the clinical relevance, treatability, and independent association with reduced exercise capacity, it is highly recommended to define HU level in all the patients with chronic heart failure to avoid future complications.


Asunto(s)
Insuficiencia Cardíaca , Hiperuricemia , Disfunción Ventricular Izquierda , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/epidemiología , Humanos , Hiperuricemia/complicaciones , Hiperuricemia/epidemiología , Prevalencia , Ácido Úrico , Función Ventricular Izquierda
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(3): 329-333, 2021 Mar.
Artículo en Chino | MEDLINE | ID: mdl-33834975

RESUMEN

OBJECTIVE: To explore the monitoring value of left ventricular functional parameters obtained by bedside ultrasound combined with clinically relevant indicators in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). METHODS: A retrospective study was conducted. A total of 24 patients receiving VA-ECMO adjuvant support in Renmin Hospital of Wuhan University from June 2018 to January 2020 were selected. The bedside ultrasound was performed on the first day of ECMO support, the day before weaning, the clinical indicators before weaning were obtained. The differences in clinical indicators and the left ventricular functional parameters between the two groups of whether weaning successfully were compared; univariate Logistic regression analysis was used to screen out the related factors affecting weaning. RESULTS: Sixteen patients were successful weaned and 8 patients failed. Compared with the weaning failure group, patients in the weaning success group required less continuous renal replacement therapy (CRRT, cases: 4 vs. 6, P < 0.05), mean arterial pressure (MAP) before weaning was higher [mmHg (1 mmHg = 0.133 kPa): 84.64±9.55 vs. 62.30±8.79, P < 0.05], and the pulse oxygen saturation (SpO2) was also higher (0.966±0.670 vs. 0.866±0.061, P < 0.05), while vasoactive-inotropic score (VIS), serum creatinine (SCr) and serum lactic acid (Lac) were lower [VIS score: 7.27±1.42 vs. 16.93±8.52, SCr (µmol/L): 123.60±83.64 vs. 213.10±117.39, Lac (mmol/L): 1.94±0.91 vs. 5.62±5.48, all P < 0.05]. Univariate Logistic regression analysis showed that the MAP, VIS, SCr, Lac, SpO2 before weaning were the related factors affecting weaning [odds ratio (OR) were 0.306, -0.740, -0.011, -0.632, -4.069; 95% confidence interval (95%CI) were 1.065-1.732, 0.235-0.899, 0.979-0.999, 0.285-0.992 and 0.001-0.208; P values were 0.014, 0.022, 0.038, 0.047, 0.002]. In the weaning success group, left ventricular ejection fraction (LVEF), velocity of mitralannulus in systolic (LatSa), maximum flow velocity of aortic valve (AV-Vmax), velocity-time integral (VTI), left ventricular global longitudinal strain (LVGLS), left ventricular global longitudinal strain rate (LVGLSr) were all increased on the day before ECMO weaning compared with the first day of ECMO support [LVEF: 0.40±0.05 vs. 0.28±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.62±1.02, AV-Vmax (cm/s): 104.81±33.98 vs. 64.44±16.85, VTI (cm): 14.56±3.11 vs. 7.96±1.98, LVGLS: (-8.95±2.59)% vs. (-5.26±1.28)%, LVGLSr (1/s): -0.48±0.11 vs. -0.29±0.09], whereas the ECMO flow was significantly reduced (L/min: 1.46±0.47 vs. 2.64±0.31), the differences were statistically significant (all P < 0.05). There was no significant difference in left ventricular functional parameters between the first day of ECMO support and the day before ECMO weaning in the weaning failure group. Compared with the weaning failure group, the weaning success group had higher LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr on the day before ECMO weaning [LVEF: 0.40±0.05 vs. 0.26±0.07, LatSa (cm/s): 6.81±0.91 vs. 4.31±1.03, AV-Vmax (cm/s): 104.81±33.98 vs. 67.67±18.46, VTI (cm): 14.56±3.11 vs. 7.75±2.77, LVGLS: (-8.95±2.59)% vs. (-4.81±1.81)%, LVGLSr (1/s): -0.48±0.11 vs. -0.30±0.10, all P < 0.05] and lower ECMO flow (L/min: 1.46±0.47 vs. 2.20±0.62, P < 0.05). CONCLUSIONS: Bedside echocardiographic left ventricular function parameters (LVEF, LatSa, AV-Vmax, VTI, LVGLS, LVGLSr) combined with clinical indicators (MAP, VIS, SCr, Lac, SpO2) were helpful to evaluate the therapeutic effect of patients receiving VA-ECMO support and can provide important guiding value in the selection of VA-ECMO weaning timing and the judgment of prognosis.


Asunto(s)
Oxigenación por Membrana Extracorpórea , Humanos , Estudios Retrospectivos , Volumen Sistólico , Ultrasonografía , Función Ventricular Izquierda
6.
Int Heart J ; 62(2): 359-366, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33678800

RESUMEN

Dilated cardiomyopathy (DCM) is a common cause of heart failure. TTN, which encodes titin protein, is a representative causative gene of DCM, and is presented mainly as a truncation variant. However, TTN truncation variants are also found in healthy individuals, and it is therefore important to evaluate the pathogenicity of each variant. In this study, we analyzed 67 cardiomyopathy-associated genes in a male Japanese patient who was hospitalized for recurrent severe heart failure and identified a novel truncation variant, TTN Ser17456Arg fs*14. This TTN truncation variant was located in the A-band region. Moreover, the patient's mother with heart failure harbored the same variant, whereas the father and brother without heart failure did not harbor the variant. To examine the functional changes associated with the truncation variant, H9c2 cells were subjected to genome editing to generate cells with a homologous truncation variant. The cells were differentiated using all-trans-retinoic acid, and the mRNA expression of skeletal actin and cardiac actin were found to be increased and decreased, respectively, consistent with known changes in patients with DCM or heart failure. In contrast, another cell with the titin truncation variant used as a control showed no changes in heart failure-related genes. In summary, we found a novel TTN truncation variant in familial DCM patients and confirmed its functional changes using a relatively simple cell model. The novel truncation variant was identified as a pathogenic and disease-causing mutation.


Asunto(s)
Cardiomiopatía Dilatada/genética , Conectina/genética , ADN/genética , Mutación , Miocitos Cardíacos/metabolismo , Función Ventricular Izquierda/fisiología , Biopsia , Cardiomiopatía Dilatada/metabolismo , Cardiomiopatía Dilatada/patología , Conectina/metabolismo , ADN/metabolismo , Análisis Mutacional de ADN , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Miocitos Cardíacos/patología , Linaje
7.
Medicine (Baltimore) ; 100(10): e24944, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725857

RESUMEN

INTRODUCTION: The morbidity and mortality of acute myocardial infarction patients still remains high after percutaneous coronary intervention (PCI). Myocardial ischemia-reperfusion (MIR) injury is one of the important reasons. Although the phenomenon of MIR injury can paradoxically reduce the beneficial effects of myocardial reperfusion, there currently remains no effective therapeutic agent for preventing MIR. Previous studies have shown that Yiqi Liangxue Shengji prescription (YLS) is effective in improving clinical symptoms and ameliorating the major adverse cardiovascular events of coronary heart disease patients undergoing PCI. This study aims to evaluate the effectiveness and safety of YLS in patients with acute myocardial infarction (AMI) after PCI. METHODS: This study is a randomized, double-blinded, placebo-controlled, single-central clinical trial. A total of 140 participants are randomly allocated to 2 groups: the intervention group and the placebo group. Based on routine medications, the intervention group will be treated with YLS and the placebo group will be treated with YLS placebo. All participants will receive a 8-week treatment and then be followed up for another 12 months. The primary outcome measures are N terminal pro B type natriuretic peptide (NT-proBNP) and left ventricular ejection fraction. Secondary outcomes are plasma levels of microRNA-145, plasma cardiac enzyme, and Troponin I levels in blood samples, changes in ST-segment in ECG, Seattle Angina Questionnaire, the efficacy of angina symptoms, and occurrence of major adverse cardiac events. All the data will be recorded in case report forms and analyzed by SPSS V.17.0. DISCUSSION: The trial will investigate whether the postoperative administration of YLS in patients with AMI after PCI will improve cardiac function. And it explores microRNAs (miRNA)-145 as detection of blood-based biomarkers for AMI by evaluating the relation between miRNAs in plasma and cardiac function. TRIAL REGISTRATION: Chinese Clinical Trials Registry identifier ChiCTR2000038816. Registered on October 10, 2020.


Asunto(s)
Enfermedad Coronaria/complicaciones , Medicamentos Herbarios Chinos/uso terapéutico , Infarto del Miocardio/tratamiento farmacológico , Daño por Reperfusión Miocárdica/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Coronaria/cirugía , Medicamentos Herbarios Chinos/farmacología , Electrocardiografía , Femenino , Humanos , Masculino , MicroARNs/sangre , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/etiología , Daño por Reperfusión Miocárdica/sangre , Daño por Reperfusión Miocárdica/diagnóstico , Daño por Reperfusión Miocárdica/etiología , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Intervención Coronaria Percutánea , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Troponina I/sangre , Función Ventricular Izquierda/efectos de los fármacos , Adulto Joven
8.
Int Heart J ; 62(2): 427-431, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731522

RESUMEN

In this study, we present a case of a 22-year-old female with a family history of syncope, suffering from recurrent syncope since childhood. She had an obvious prolonged QTc interval of up to 651 ms, a bifid T wave pattern on electrocardiogram, and torsade de pointes, corresponding to a syncope episode. Additionally, her echocardiogram showed left ventricular non-compaction in the apex. After treatment with mexiletine, the QTc interval has been observed to shorten immediately, and the T wave morphology recovered. A similar effect was also observed in her mother and young sister. Administration of propranolol prolonged her QTc interval. Target sequencing of candidate genes revealed a missense mutation in the pore area of the hERG protein, coded by KCNH2. We diagnosed this as a case of type 2 long QT syndrome in which mexiletine could be effective in shortening the QTc interval.


Asunto(s)
Electrocardiografía/efectos de los fármacos , Ventrículos Cardíacos/fisiopatología , Síndrome de QT Prolongado/tratamiento farmacológico , Mexiletine/farmacología , Taquicardia Ventricular/complicaciones , Función Ventricular Izquierda/fisiología , Antiarrítmicos/farmacología , Ecocardiografía , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Síndrome de QT Prolongado/etiología , Síndrome de QT Prolongado/genética , Linaje , Taquicardia Ventricular/fisiopatología , Adulto Joven
9.
Circ Heart Fail ; 14(3): e007048, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33663235

RESUMEN

BACKGROUND: Empagliflozin reduces the risk of hospitalization for heart failure in patients with type 2 diabetes and cardiovascular disease. We sought to elucidate the effect of empagliflozin as an add-on therapy on decongestion and renal function in patients with type 2 diabetes admitted for acute decompensated heart failure. METHODS: The study was terminated early due to COVID-19 pandemic. We enrolled 59 consecutive patients with type 2 diabetes admitted for acute decompensated heart failure. Patients were randomly assigned to receive either empagliflozin add-on (n=30) or conventional glucose-lowering therapy (n=29). We performed laboratory tests at baseline and 1, 2, 3, and 7 days after randomization. Percent change in plasma volume between admission and subsequent time points was calculated using the Strauss formula. RESULTS: There were no significant baseline differences in left ventricular ejection fraction and serum NT-proBNP (N-terminal pro-B-type natriuretic peptide), hematocrit, or serum creatinine levels between the 2 groups. Seven days after randomization, NT-proBNP level was significantly lower in the empagliflozin group than in the conventional group (P=0.040), and hemoconcentration (≥3% absolute increase in hematocrit) was more frequently observed in the empagliflozin group than in the conventional group (P=0.020). The decrease in percent change in plasma volume between baseline and subsequent time points was significantly larger in the empagliflozin group than in the conventional group 7 days after randomization (P=0.017). The incidence of worsening renal function (an increase in serum creatinine ≥0.3 mg/dL) did not significantly differ between the 2 groups. CONCLUSIONS: In this exploratory analysis, empagliflozin achieved effective decongestion without an increased risk of worsening renal function as an add-on therapy in patients with type 2 diabetes with acute decompensated heart failure. Registration: URL: https://www.umin.ac.jp/ctr/index.htm; Unique identifier: UMIN000026315.


Asunto(s)
Compuestos de Bencidrilo/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Hospitalización , Riñón/efectos de los fármacos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Compuestos de Bencidrilo/efectos adversos , Biomarcadores/sangre , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Creatinina/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Terminación Anticipada de los Ensayos Clínicos , Femenino , Glucósidos/efectos adversos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Japón , Riñón/fisiopatología , Masculino , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Estudios Prospectivos , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
10.
Circ Heart Fail ; 14(3): e007767, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33724883

RESUMEN

BACKGROUND: The expense of clinical trials mandates new strategies to efficiently generate evidence and test novel therapies. In this context, we designed a decentralized, patient-centered randomized clinical trial leveraging mobile technologies, rather than in-person site visits, to test the efficacy of 12 weeks of canagliflozin for the treatment of heart failure, regardless of ejection fraction or diabetes status, on the reduction of heart failure symptoms. METHODS: One thousand nine hundred patients will be enrolled with a medical record-confirmed diagnosis of heart failure, stratified by reduced (≤40%) or preserved (>40%) ejection fraction and randomized 1:1 to 100 mg daily of canagliflozin or matching placebo. The primary outcome will be the 12-week change in the total symptom score of the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes will be daily step count and other scales of the Kansas City Cardiomyopathy Questionnaire. RESULTS: The trial is currently enrolling, even in the era of the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS: CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) is deploying a novel model of conducting a decentralized, patient-centered, randomized clinical trial for a new indication for canagliflozin to improve the symptoms of patients with heart failure. It can model a new method for more cost-effectively testing the efficacy of treatments using mobile technologies with patient-reported outcomes as the primary clinical end point of the trial. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04252287.


Asunto(s)
Canagliflozina/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Telemedicina , Actigrafía/instrumentación , Canagliflozina/efectos adversos , Método Doble Ciego , Tolerancia al Ejercicio/efectos de los fármacos , Monitores de Ejercicio , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Aplicaciones Móviles , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Volumen Sistólico/efectos de los fármacos , Telemedicina/instrumentación , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Función Ventricular Izquierda/efectos de los fármacos
11.
Arq Bras Cardiol ; 116(2): 248-256, 2021 02.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33656072

RESUMEN

BACKGROUND: The histopathological characteristics of Chagas disease (ChD) are: presence of myocarditis, destruction of heart fibers, and myocardial fibrosis. Galectin-3 (Gal-3) is a biomarker involved in the mechanism of fibrosis and inflammation that may be useful for risk stratification of individuals with ChD. OBJECTIVES: We sought to evaluate whether high Gal-3 levels are associated with severe forms of Chagas cardiomyopathy (CC) and whether they are predictive of mortality. METHODS: We studied anti-T. cruzi positive blood donors (BD): Non-CC-BD (187 BD without CC with normal electrocardiogram [ECG] and left ventricular ejection fraction [LVEF]); CC-Non-Dys-BD (46 BD with CC with abnormal ECG but normal LVEF); and 153 matched serum-negative controls. This cohort was composed of 97 patients with severe CC (CC-Dys). We used Kruskall-Wallis and Spearman's correlation to test hypothesis of associations, assuming a two-tailed p<0.05 as significant. RESULTS: The Gal-3 level was 12.3 ng/mL for Non-CC-BD, 12.0 ng/mL for CC-Non-Dys-BD, 13.8 ng/mL for controls, and 15.4 ng/mL for CC-Dys. LVEF<50 was associated with higher Gal-3 levels (p=0.0001). In our linear regression adjusted model, we found association between Gal-3 levels and echocardiogram parameters in T. cruzi-seropositive subjects. In CC-Dys patients, we found a significant association of higher Gal-3 levels (≥15.3 ng/mL) and subsequent death or heart transplantation in a 5-year follow-up (Hazard ratio - HR 3.11; 95%CI 1.21-8.04; p=0.019). CONCLUSIONS: In ChD patients, higher Gal-3 levels were significantly associated with severe forms of the disease and more long-term mortality, which means it may be a useful means to identify high-risk patients. (Arq Bras Cardiol. 2021; 116(2):248-256).


Asunto(s)
Cardiomiopatía Chagásica , Enfermedad de Chagas , Biomarcadores , Galectina 3 , Humanos , Volumen Sistólico , Función Ventricular Izquierda
12.
Pan Afr Med J ; 38: 29, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33777297

RESUMEN

Introduction: reduced exercise capacity, coronary artery abnormalities and reversible myocardial ischemia have been demonstrated after arterial switch operation (ASO) and coronary reimplantation. Despite this, indices of systolic function, assessed by standard and Doppler echocardiography, are within the normal range. The aim of this study was to highlight the long-term changes in myocardial function following coronary reimplantation using Doppler and speckle-tracking imaging (STI) echocardiography. Methods: this observational case control study included 36 patients and 20 gender and age-matched healthy controls. A group study was performed using patients who were followed for at least 6 months after the operation and who visited the pediatric cardiology outpatient between October 2015 and May 2016. Systolic and diastolic parameters, left ventricle (LV) and right ventricle (RV) myocardial performance were assessed in each group. Results: the LV global peak strain parameters revealed a significant decrease in the longitudinal and circumferential strain components. The LV global longitudinal strain (GLS) values were lower in both groups of operated patients than controls (-19.9 ± 2.2% (group 1) versus -20.9 ± 1.6% (group 2) versus -22.9 ± 2.3% (group 3), p<0.001). The patients with coronary reimplantation had the lowest values. The LV global circumferential strain was also decreased in the group 1 patients as compared with the 2 other groups (-16.6 ± 4.1% (group 1) versus -19.4 ± 3.9% (group 2) versus -19.8 ± 4.0% (group 3), p<0.001). Conclusion: although global LV function, assessed with conventional echocardiographic parameters, was normal, the 2D-STI analysis showed slight but significant decrease in the global and segmental longitudinal and circumferential LV strain during the long-term follow-up after coronary arteries reimplantation.


Asunto(s)
Vasos Coronarios/cirugía , Ecocardiografía Doppler/métodos , Ecocardiografía/métodos , Corazón/diagnóstico por imagen , Adolescente , Estudios de Casos y Controles , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Reimplantación/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Función Ventricular Izquierda
13.
Ther Adv Cardiovasc Dis ; 15: 17539447211002678, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33779401

RESUMEN

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors are a relatively new class of antihyperglycemic drug with salutary effects on glucose control, body weight, and blood pressure. Emerging evidence now indicates that these drugs may have a beneficial effect on outcomes in heart failure with reduced ejection fraction (HFrEF). Post-approval cardiovascular outcomes data for three of these agents (canagliflozin, empagliflozin, and dapagliflozin) showed an unexpected improvement in cardiovascular endpoints, including heart failure hospitalization and mortality, among patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease or risk factors. These studies were followed by a placebo controlled trial of dapagliflozin in patients with HFrEF both with and without T2DM, showing a reduction in all-cause mortality comparable to current guideline-directed HFrEF medical therapies such as angiotensin-converting enzyme inhibitors and beta-blockers. In this review, we discuss the current landscape of evidence, safety and adverse effects, and proposed mechanisms of action for use of these agents for patients with HFrEF. The United States (US) and European guidelines are reviewed, as are the current US federally approved indications for each SGLT2 inhibitor. Use of these agents in clinical practice may be limited by an uncertain insurance environment, especially in patients without T2DM. Finally, we discuss practical considerations for the cardiovascular clinician, including within-class differences of the SGLT2 inhibitors currently available on the US market (217/300).


Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Volumen Sistólico/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , Biomarcadores/sangre , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Progresión de la Enfermedad , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Hospitalización , Humanos , Recuperación de la Función , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Resultado del Tratamiento
14.
Zhongguo Zhong Yao Za Zhi ; 46(6): 1498-1510, 2021 Mar.
Artículo en Chino | MEDLINE | ID: mdl-33787149

RESUMEN

To systemically evaluate the effect of Qishen Yiqi Dripping Pills combined with Western medicine on adverse cardiovascular events and quality of life after percutaneous coronary intervention(PCI). A total of 7 Chinese and English databases including CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library and Web of Science were searched by computer to collect the randomized controlled trials(RCTs) on Qishen Yiqi Dripping Pills combined with Western medicine in the treatment of patients with coronary heart disease after PCI with the retrieval time from the database establishment to April 1, 2020. Two researchers independently conducted li-terature screening, data extraction and bias risk assessment. Then, Meta-analysis was performed by using RevMan 5.3 software. A total of 31 RCTs were included, involving 3 537 patients. The results of Meta-analysis showed that in terms of major adverse cardiovascular events(MACE) after PCI, the combination of Qishen Yiqi Dripping Pills could significantly reduce the recurrence of angina pectoris, incidence of arrhythmia, heart failure and re-revascularization, and the effect was better than that of Western medicine treatment alone. However, there was no significant difference between the two groups in the improvement of non-fatal myocardial infarction, cardiac death, stent restenosis, stroke and other adverse cardiovascular events. In terms of improving left ventricular ejection fraction(LVEF), 6 min walking test(6 MWT), high-sensitivity C-reactive protein(hs-CRP) and Seattle angina pectoris scale(SAQ), the combination of Qishen Yiqi Dripping Pills and Western medicine treatment had obvious advantages over Western medicine treatment alone in increasing LVEF, 6 MWT and SAQ, and reducing the level of hs-CRP, with statistically significant differences. There were few adverse reactions in both groups, and there was no significant difference between the two groups. The main manifestations were gastrointestinal reactions, rash, gingiva and other small bleeding, and no serious adverse reactions occurred. The above reactions could disappear after drug withdrawal or symptomatic treatment. The application of Qishen Yiqi Dripping Pills combined with Western medicine in the treatment of patients after PCI could reduce the occurrence of MACE, improve the clinical efficacy, quality of life and prognosis in a safe and reliable manner. However, due to the quantity and quality limitations of included studies, more standardized, rigo-rous and high-quality clinical studies are still needed to further verify the above conclusions.


Asunto(s)
Medicamentos Herbarios Chinos , Medicina , Intervención Coronaria Percutánea , Medicamentos Herbarios Chinos/efectos adversos , Humanos , Intervención Coronaria Percutánea/efectos adversos , Calidad de Vida , Volumen Sistólico , Función Ventricular Izquierda
15.
Zhonghua Yi Xue Za Zhi ; 101(11): 782-785, 2021 Mar 23.
Artículo en Chino | MEDLINE | ID: mdl-33765718

RESUMEN

Objective: To evaluate the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/shaft lesions in patients with unprotected left main coronary artery (ULMCA). Method: A total of 271 patients with isolated ostial/midshaft lesions in unprotected left main coronary artery who received drug-eluting stents (DES) implantation between January 2003 and July 2009 in Beijing An Zhen Hospital were consecutively enrolled . The endpoints of the study were all-cause death, repeat revascularization, myocardial infarction (MI) and stroke. Cox regression was carried out to analyze the all-cause mortality. Meanwhile, multivariate logistic regression analysis was performed to determine the independent risk factors of all-cause death. Results: The mean age of the patients was (62±10) years, and 201 of them (74.2%) were male. The median follow-up was 12.5 years (interquartile range: 10.1-14.5 years). During the follow-up, 46 patients (17.0%) died, of whom 20 (7.4%) died of a cardiovascular cause. A total of 38 (14.0%) cases suffered a MI, and 15 (5.5%) cases suffered a stroke. Repeat revascularization was performed in 63 (23.2%) cases. Multivariate logistic regression analysis showed that age (HR=1.041, 95%CI: 1.003-1.081, P=0.033), creatinine (HR=1.028, 95%CI:1.014-1.042, P<0.001) and diabetes mellitus (HR=1.924,95%CI: 1.053-3.514, P=0.033) were independent risk factors of all-cause death, whereas left ventricular ejection fraction (LVEF) (HR=0.972, 95%CI:0.953-0.992, P=0.007) was a protective factor. Conclusions: During a median follow-up of 12.5 years, the prognosis of PCI for left main ostium/shaft lesion was good. Age, creatinine and diabetes mellitus are independent risk factors of all-cause death.


Asunto(s)
Enfermedad de la Arteria Coronaria , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea , Anciano , Puente de Arteria Coronaria , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Volumen Sistólico , Resultado del Tratamiento , Función Ventricular Izquierda
16.
Sensors (Basel) ; 21(4)2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-33671930

RESUMEN

Heart failure (HF) hospitalisations due to decompensation are associated with shorter life expectancy and lower quality of life. These hospitalisations pose a significant burden on the patients, doctors and healthcare resources. Early detection of an upcoming episode of decompensation may facilitate timely optimisation of the ambulatory medical treatment and thereby prevent heart-failure-related hospitalisations. The HeartLogicTM algorithm combines data from five sensors of cardiac implantable electronic devices into a cumulative index value. It has been developed for early detection of fluid retention in heart failure patients. This review aims to provide an overview of the current literature and experience with the HeartLogicTM algorithm, illustrate how the index can be implemented in daily clinical practice and discuss ongoing studies and potential future developments of interest.


Asunto(s)
Desfibriladores Implantables , Insuficiencia Cardíaca , Algoritmos , Insuficiencia Cardíaca/diagnóstico , Humanos , Hidrodinámica , Masculino , Estudios Prospectivos , Calidad de Vida , Estudios Retrospectivos , Volumen Sistólico , Función Ventricular Izquierda
17.
Kardiologiia ; 61(1): 66-71, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33706689

RESUMEN

Goals Discrimination of the time course of functional recovery in early period following ST elevation myocardial infarction (STEMI) has prognostic importance. This study aims to establish the ability of the combined systolic-diastolic index (E / (Ea x Sa), for differentiating recoverable myocardium or persistent non-viability in subjects with STEMI.Material and methods 77 patients with first acute STEMI were enrolled to the study. Serial transthoracic echocardiography (TTE) examinations were performed at the time of the admission (immediately after reperfusion), hospital discharge (5±1 days) and control examination (30±2 days). To assess the association between E / (Ea×Sa) index and myocardial recovery, two categories (Transient stunning and persistent non-viability) were defined on basis of improvement of left ventricle ejection fraction (LV EF) (Improvement was defined as an increase more than 10 % in LV EF at day 30 compared to baseline).Results 55 patients (71.4 %) had improvement of LV EF and 24 patients (28.6 %) had no recovery of systolic function (30 days LV EF 48.78±6.1 vs. 39.31±8.1 %, p=0.01). The E / (Ea×Sa) index were significantly higher in the "non-viability" than in stunning group on predischarge and 1 month (1.61±0.64 vs 1.25±0.43, p=0.01 and 1.33±0.25 vs 1.14±0.21, p=0.01, respectively). The change in the E / (Ea×Sa) index in early period (within 5±1 days) was higher in the stunning group (26 %) compared to non-viability group (15 %) (p=0.033). E / (Ea×Sa) index was found to be a significant predictor of myocardial recovery in multivariable logistic regression (OR 0.91, 95 % CI 0.83-0.98, p=0.001). Roc curve showed that the cutoff value of E / (Ea×Sa) index is 1.29 with 73 % of sensitivity and 61 % of specificity (AUC: 0.71, p=0.01, CI: 0.54-0.89).Conclusions Our findings suggest that E / (Ea×Sa) index is a strong predictor of functional recovery; the odds of recovery decreases as E / (Ea×Sa) index value increases.


Asunto(s)
Infarto del Miocardio con Elevación del ST , Diástole , Ecocardiografía , Humanos , Miocardio , Valor Predictivo de las Pruebas , Infarto del Miocardio con Elevación del ST/diagnóstico , Función Ventricular Izquierda
18.
Heart Fail Clin ; 17(2): 245-254, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673948

RESUMEN

The heart and the arterial system are anatomically and functionally linked together. Noninvasive assessment of ventricular-arterial coupling (VAC) can be done using different methods that are promising tools to assess individual hemodynamics and tailor treatment in patients with heart failure (HF). Moreover, different methods available can be appropriately used in different settings such as acute and chronic HF. VAC parameters also can add incremental value over the conventional risk factors in predicting cardiac outcome.


Asunto(s)
Insuficiencia Cardíaca/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Medición de Riesgo/métodos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Pronóstico
19.
Heart Fail Clin ; 17(2): 289-301, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673953

RESUMEN

Cardiac resynchronization therapy (CRT) is an established treatment of patients with medically refractory, mild-to-severe systolic heart failure (HF), impaired left ventricular function, and wide QRS complex. The pathologic activation sequence observed in patients with abnormal QRS duration and morphology results in a dyssynchronous ventricular activation and contraction leading to cardiac remodeling, worsening systolic and diastolic function, and progressive HF. In this article, the authors aim to explore the current CRT literature, focusing their attentions on the promising innovation in this field.


Asunto(s)
Terapia de Resincronización Cardíaca/tendencias , Insuficiencia Cardíaca/terapia , Función Ventricular Izquierda/fisiología , Remodelación Ventricular/fisiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Resultado del Tratamiento
20.
Kardiologiia ; 61(2): 62-68, 2021 Mar 06.
Artículo en Ruso, Inglés | MEDLINE | ID: mdl-33734048

RESUMEN

Aim      To determine diagnostic capabilities of the expanded protocol for stress echocardiography (stress-EchoCG) with comprehensive evaluation of clinical and echocardiographic indexes in differential diagnosis of dyspnea.Material and methods This study included 243 patients (123 women and 120 men) who were referred to outpatient stress-EchoCG during one calendar month. For 80 patients complaining about shortness of breath, the expanded stress-EchoCG protocol with treadmill exercise was performed. During the exercise, E / e' and tricuspid regurgitation velocity were determined, and clinical features and possible nature of dyspnea were evaluated.Results Shortness of breath had an ischemic origin in 17.5 % of 80 patients; 13.8 % had criteria of elevated left ventricular end-diastolic pressure; 17.5 % of patients had clinical signs of bronco-pulmonary pathology; 5.0 % had moderate and severe mitral regurgitation; 20 % displayed signs of chronotropic insufficiency during exercise including on the background of beta-blocker therapy; 15.0 % of patients displayed a hypertensive response to exercise, which was associated with signs of chronotropic insufficiency in 50 % of them; and 1.3 % had signs of hyperventilation syndrome. In addition to diagnosis of transient ischemia, additional information about the nature of shortness of breath was obtained for 72.5 % of patients. Based on results of the test, objective causes for dyspnea were not identified for 10.0 % of patients.Conclusion      The expanded stress-EchoCG protocol with exercise allows obtaining information about the nature of dyspnea for most patients with shortness of breath of a non-ischemic origin. For this patient category, expanding the stress-EchoCG protocol does not increase duration of the study and is economically beneficial for diagnosis of chronic heart failure and other causes for shortness of breath.


Asunto(s)
Ecocardiografía de Estrés , Esfuerzo Físico , Diástole , Disnea/diagnóstico , Disnea/etiología , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Función Ventricular Izquierda
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