RESUMO
BACKGROUND: Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM: To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS: This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS: Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS: Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.
Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Humanos , Estudos Prospectivos , Função Ventricular Esquerda/fisiologia , Volume Sistólico/fisiologia , Resultado do Tratamento , Dispositivos de Terapia de Ressincronização CardíacaRESUMO
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Humanos , Pré-Escolar , Criança , Cardiopatias/congênito , Criança Adotada , Anormalidades Congênitas , Estudos RetrospectivosAssuntos
Criança Adotada , Cardiopatias Congênitas , Adoção , Criança , Cardiopatias Congênitas/epidemiologia , Humanos , PrevalênciaRESUMO
No disponible
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Humanos , Masculino , Feminino , Anisakis , Anisakis/isolamento & purificação , Diagnóstico Diferencial , Anamnese/métodos , Anamnese/normas , Urticária/complicações , Urticária/diagnóstico , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Atenção Primária à SaúdeRESUMO
No disponible
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Feminino , Humanos , Masculino , Prunus/efeitos adversos , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/prevenção & controle , Hipersensibilidade Alimentar/terapia , Testes Cutâneos/instrumentação , Testes Cutâneos/métodos , Testes Cutâneos , Aromatizantes/efeitos adversos , Causalidade , Prurido/complicações , Prurido/diagnóstico , Prurido/terapia , Fibromialgia/complicações , Fibromialgia/diagnóstico , Urticária/complicações , Urticária/diagnóstico , Urticária/terapiaRESUMO
BACKGROUND: Data on the cardiac characteristics of centenarians are scarce. Our aim was to describe electrocardiogram (ECG) and echocardiography in a cohort of centenarians and to correlate them with clinical data. METHODS: We used prospective multicenter registry of 118 centenarians (28 men) with a mean age of 101.5±1.7 years. Electrocardiogram was performed in 103 subjects (87.3%) and echocardiography in 100 (84.7%). All subjects underwent a follow-up for at least 6 months. RESULTS: Centenarians with abnormal ECG were less frequently females (72% vs 93%), had higher rates of previous consumption of tobacco (14% vs 0) and alcohol (24% vs 12%), and scored lower in the perception of health status (6.8±2.0 vs 8.3±6.8). Centenarians with significant abnormalities in echocardiography were less frequently able to walk 6 m (33% vs 54%). Atrial fibrillation/flutter was found in 27 subjects (26%). Mean left ventricular (LV) ejection fraction was 60.0±10.5%. Moderate or severe aortic valve stenosis was found in 16%, mitral valve regurgitation in 15%, and aortic valve regurgitation in 13%. Diastolic dysfunction was assessed in 79 subjects and was present in 55 (69.6%). Katz index and LV dilation were independently associated with the ability to walk 6 m. Age, Charlson and Katz indexes, and the presence of significant abnormalities in echocardiography were associated with mortality. CONCLUSIONS: Centenarians have frequent ECG alterations and abnormalities in echocardiography. More than one fifth has atrial fibrillation, and most have diastolic dysfunction. Left ventricular dilation was associated with the ability to walk 6 m. Significant abnormalities in echocardiography were associated with mortality.
Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Avaliação Geriátrica , Coração/fisiopatologia , Sistema de Registros , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico por imagem , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , UltrassonografiaRESUMO
Las histiocitosis son cuadros caracterizados por la proliferación de células del sistema mononuclear fagocítico. Incluyen la histiocitosis de células de Langerhans (HCL) y las histiocitosis de células no Langerhans (entre ellas la enfermedad de Chester-Erdheim [ECE]). Aunque la diabetes insípida (DI) es la alteración hipotálamo hipofisaria (HH) más frecuente, están menos estudiados los déficits hipofisarios anteriores. Se analiza la frecuencia y la progresión de los déficits hormonales hipofisarios y los hallazgos radiológicos de 9 pacientes (7 HCL y 2 ECE) con afectación de la región HH. El 89% de los pacientes presentaba DI (62% al diagnóstico) y el 78%, uno o más déficits anteriores (71% al diagnóstico). Dado que la afectación HH es relativamente frecuente en pacientes con diagnóstico de histiocitosis y que los déficits hormonales pueden estar presentes al diagnóstico o aparecer de forma paulatina durante el curso de la enfermedad, es recomendable monitorizar de manera regular a este tipo de pacientes
Histiocytosis is characterized by proliferation of cells from the mononuclear phagocyte system, and may be divided into Langerhans cell histiocytosis (LCH) and non-Langerhans cell histiocytosis (including Erdheim-Chester disease [ECD]). While diabetes insipidus (DI) is the most common hypothalamic-pituitary consequence, anterior pituitary deficiencies are less known. This study analyzed the frequency and progression of pituitary hormone deficiencies and the radiographic findings in 9 patients (7 with LCH and 2 with ECD) with hypothalamic-pituitary (HP) axis. Eighty-nine percent of patients had DI (62% at diagnosis), and 78% had one or more anterior pituitary deficiencies (71% at diagnosis). HP involvement is relatively common in patients diagnosed with histiocytosis and hormone deficiencies may be present at diagnosis or appear gradually during the course of disease. Regular monitoring of these patients is recommended
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Histiocitose de Células de Langerhans/complicações , Diabetes Insípido/epidemiologia , Doença de Erdheim-Chester/complicações , Adeno-Hipófise/fisiopatologia , Doenças da Hipófise/epidemiologia , Hipopituitarismo/epidemiologia , Estudos RetrospectivosRESUMO
Histiocytosis is characterized by proliferation of cells from the mononuclear phagocyte system, and may be divided into Langerhans cell histiocytosis (LCH) and non-Langerhans cell histiocytosis (including Erdheim-Chester disease [ECD]). While diabetes insipidus (DI) is the most common hypothalamic-pituitary consequence, anterior pituitary deficiencies are less known. This study analyzed the frequency and progression of pituitary hormone deficiencies and the radiographic findings in 9 patients (7 with LCH and 2 with ECD) with hypothalamic-pituitary (HP) axis. Eighty-nine percent of patients had DI (62% at diagnosis), and 78% had one or more anterior pituitary deficiencies (71% at diagnosis). HP involvement is relatively common in patients diagnosed with histiocytosis and hormone deficiencies may be present at diagnosis or appear gradually during the course of disease. Regular monitoring of these patients is recommended.
Assuntos
Diabetes Insípido/etiologia , Histiocitose/fisiopatologia , Hipopituitarismo/etiologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Adulto , Idoso , Diabetes Insípido/epidemiologia , Diabetes Insípido/fisiopatologia , Feminino , Doença de Graves/complicações , Histiocitose/complicações , Humanos , Hiperprolactinemia/etiologia , Hipopituitarismo/diagnóstico por imagem , Hipopituitarismo/epidemiologia , Hipopituitarismo/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hormônios Adeno-Hipofisários/sangue , Hormônios Adeno-Hipofisários/deficiência , Estudos Retrospectivos , Adulto JovemAssuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cavidade Peritoneal/patologia , Cavidade Peritoneal , Dor Abdominal/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Diagnóstico Diferencial , Fatores de Risco , Dipirona/uso terapêutico , Obesidade/complicações , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Atenção Primária à Saúde , Radiografia Torácica/métodosAssuntos
Átrios do Coração/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Cardiopatia Reumática/diagnóstico por imagem , Idoso , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/cirurgia , Humanos , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Radiografia , Cardiopatia Reumática/complicações , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
No disponible
No disponible
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Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Prognóstico , Ecocardiografia Doppler/métodos , Ecocardiografia Doppler/tendências , Estenose da Valva Aórtica , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva MitralRESUMO
No disponible
No disponible