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1.
J Acoust Soc Am ; 142(4): EL401, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-29092550

RESUMO

This pilot study used acoustic speech analysis to monitor patients with heart failure (HF), which is characterized by increased intracardiac filling pressures and peripheral edema. HF-related edema in the vocal folds and lungs is hypothesized to affect phonation and speech respiration. Acoustic measures of vocal perturbation and speech breathing characteristics were computed from sustained vowels and speech passages recorded daily from ten patients with HF undergoing inpatient diuretic treatment. After treatment, patients displayed a higher proportion of automatically identified creaky voice, increased fundamental frequency, and decreased cepstral peak prominence variation, suggesting that speech biomarkers can be early indicators of HF.


Assuntos
Acústica , Edema/diagnóstico , Insuficiência Cardíaca/complicações , Fonação , Acústica da Fala , Medida da Produção da Fala , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Qualidade da Voz , Idoso , Idoso de 80 Anos ou mais , Diuréticos/uso terapêutico , Edema/tratamento farmacológico , Edema/etiologia , Edema/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fonação/efeitos dos fármacos , Projetos Piloto , Valor Preditivo dos Testes , Respiração , Resultado do Tratamento , Prega Vocal/efeitos dos fármacos , Distúrbios da Voz/tratamento farmacológico , Distúrbios da Voz/etiologia , Distúrbios da Voz/fisiopatologia , Qualidade da Voz/efeitos dos fármacos
2.
J Am Heart Assoc ; 5(3): e002712, 2016 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-27068627

RESUMO

BACKGROUND: Acute kidney injury (AKI) occurs commonly after transcatheter aortic valve replacement (TAVR) and is associated with markedly increased postoperative mortality. We previously identified plasma metabolites predictive of incident chronic kidney disease, but whether metabolite profiles can identify those at risk of AKI is unknown. METHODS AND RESULTS: We performed liquid chromatography-mass spectrometry-based metabolite profiling on plasma from patients undergoing TAVR and subjects from the community-based Framingham Heart Study (N=2164). AKI was defined by using the Valve Academic Research Consortium-2 criteria. Of 44 patients (mean age 82±9 years, 52% female) undergoing TAVR, 22 (50%) had chronic kidney disease and 9 (20%) developed AKI. Of 85 metabolites profiled, we detected markedly concordant cross-sectional metabolic changes associated with chronic kidney disease in the hospital-based TAVR and Framingham Heart Study cohorts. Baseline levels of 5-adenosylhomocysteine predicted AKI after TAVR, despite adjustment for baseline glomerular filtration rate (odds ratio per 1-SD increase 5.97, 95% CI 1.62-22.0; P=0.007). Of the patients who had AKI, 6 (66.7%) subsequently died, compared with 3 (8.6%) deaths among those patients who did not develop AKI (P=0.0008) over a median follow-up of 7.8 months. 5-adenosylhomocysteine was predictive of all-cause mortality after TAVR (hazard ratio per 1-SD increase 2.96, 95% CI 1.33-6.58; P=0.008), independent of baseline glomerular filtration rate. CONCLUSIONS: In an elderly population with severe aortic stenosis undergoing TAVR, metabolite profiling improves the prediction of AKI. Given the multifactorial nature of AKI after TAVR, metabolite profiles may identify those patients with reduced renal reserve.


Assuntos
Injúria Renal Aguda/mortalidade , Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco/mortalidade , Implante de Prótese de Valva Cardíaca/mortalidade , Metabolômica , S-Adenosil-Homocisteína/sangue , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Biomarcadores/sangue , Cateterismo Cardíaco/efeitos adversos , Cromatografia Líquida , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Modelos Lineares , Modelos Logísticos , Masculino , Espectrometria de Massas , Massachusetts/epidemiologia , Metabolômica/métodos , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco , Resultado do Tratamento
3.
Curr Treat Options Cardiovasc Med ; 17(7): 389, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26070587

RESUMO

OPINION STATEMENT: Surgical mitral valve (MV) repair remains the gold standard to treat patients with significant degenerative mitral regurgitation (DMR). Medical therapy was the only option for patients found to be not appropriate for MV surgery until the development of percutaneous/transcatheter MV repair options that now allow to reduce MR less invasively and safely. This article discusses the basic mechanisms of MR and the rationale for MR intervention and offers a detailed review on percutaneous/transcatheter MV repair with the MitraClip.

4.
Am Heart J ; 157(2): 383.e1-8, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19185649

RESUMO

BACKGROUND: Type 2 diabetics (DM2) are at increased risk for restenosis as well as nonculprit coronary artery lesion (NCCL) progression. Rosiglitazone (RSG) favorably modifies many of the altered biologic processes in DM2, although recent reports have questioned its safety. We conducted a double-blind randomized trial to assess the effects of RSG versus placebo on in-stent late lumen loss (LL) and angiographic progression of NCCL. METHODS: A total of 65 DM2 were randomized to RSG (4 mg/d) (n = 32) or placebo (n = 33) at the time of stenting and underwent clinical and laboratory analysis at 1 and 4 months and 8-month angiography (n = 46 patients). Rapid angiographic progression (RAP) was defined as > or =20% diameter reduction of preexisting NCCL by quantitative coronary angiography, or a new narrowing > or =30%. RESULTS: Mean LL in RSG (n = 33 lesions) was not different from that of placebo (0.62 +/- 0.59 vs 0.70 +/- 0.67, P = NS). Seven (13.5%) of 52 NCCLs have RAP in RSG versus 9 (16.1%) of 56 in placebo (P = NS). High-sensitivity C-reactive protein (hs-CRP) was the only predictor of RAP. Patients with a 120-day hs-CRP > or =75th percentile had an OR of 7.35 (95% CI 2.35-23) for RAP versus those below. Although RSG treatment also lowered log (hs-CRP) at 4 months (RSG 0.10 +/- 0.37 vs placebo 0.26 +/- 0.49, P = .06), it did not decrease the likelihood of plaque progression while also raising LDL and N-terminal brain naturetic peptide. CONCLUSIONS: Rosiglitazone appears not to lower LL or reduce angiographic progression of NCCL in DM2 and had complex effects on markers of cardiac risk.


Assuntos
Reestenose Coronária/etiologia , Diabetes Mellitus Tipo 2/complicações , Tiazolidinedionas/uso terapêutico , Vasodilatadores/uso terapêutico , Idoso , Angioplastia Coronária com Balão , Biomarcadores/sangue , Angiografia Coronária , Reestenose Coronária/sangue , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/prevenção & controle , Estenose Coronária/sangue , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/etiologia , Estenose Coronária/prevenção & controle , Angiopatias Diabéticas/complicações , Progressão da Doença , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Rosiglitazona , Stents
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