RESUMO
BACKGROUND: Cirrhosis is associated with structural and functional abnormalities of the heart. We examined the evolution of these abnormalities after liver transplantation (LT). METHODS: Sixty cirrhotic patients, without cardiovascular disease, were included. Clinical data, echocardiography, and aminoterminal pro-brain natriuretic peptide (NT-proBNP) levels were analyzed before and after transplantation. Healthy controls (n = 25) were included for reference. RESULTS: Before transplantation, cirrhotic patients had higher left atrium diameter, left ventricular (LV) mass index, and ejection fraction than controls. After transplantation, LV mass index increased (105 ± 31 vs. 119 ± 35 g/m(2) ; p < 0.05), diastolic cardiac function deteriorated, expressed as a reduction in E/A wave ratio (1.105 ± 0.295 vs. 0.798 ± 0.248; p < 0.001), and NT-proBNP levels decreased significantly in patients compared to pre-transplantation values (1759 ± 1154 vs. 1117 ± 600 pg/mL; p < 0.001), although they were still above levels found in controls (1117 ± 600 vs. 856 ± 123 pg/mL; p < 0.05). NT-proBNP levels above 2000 pg/mL before transplantation were significantly associated with risk for cardiovascular events after procedure (37% vs. 9%, p = 0.008). CONCLUSIONS: In cirrhotic patients, diastolic function and cardiac structure deteriorate after LT. Compared to controls, NT-proBNP levels tend to be higher before and after transplantation. The mechanisms and consequences of these results require further study.
Assuntos
Biomarcadores/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Cirrose Hepática/complicações , Transplante de Fígado/efeitos adversos , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Adulto , Idoso , Ecocardiografia Doppler , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosAssuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Forame Oval Patente/complicações , Forame Oval Patente/cirurgia , Complicações Intraoperatórias/terapia , Trombose/etiologia , Ecocardiografia , Feminino , Humanos , Embolia Intracraniana/complicações , Complicações Intraoperatórias/tratamento farmacológico , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Acidente Vascular Cerebral/etiologia , Trombose/diagnóstico por imagem , Trombose/terapiaRESUMO
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Assuntos
Humanos , Masculino , Adulto , Mixoma/diagnóstico , Neoplasias Cardíacas/diagnóstico , Febre de Causa Desconhecida/etiologia , Eletrocardiografia , EcocardiografiaRESUMO
Atrial pacing with floating electrodes primarily designed for single lead VDD systems has disadvantages attributable to the floatability of the electrodes. Body and breathing movements cause changes in the position of the atrial dipole that can lead to failure of atrial capture and sensing, and even alternation of the stimulated chamber. We report the induction of typical intranodal tachycardia episodes related to intermittent failure of atrial capture in a patient with an implanted single lead DDD pacing system. Such systems pose a substantial risk of potentially arrhythmogenic asynchronous pacing.
Assuntos
Arritmias Cardíacas/etiologia , Eletrodos/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/terapia , Função do Átrio Direito/fisiologia , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia , Eletrodos Implantados , Técnicas Eletrofisiológicas Cardíacas/métodos , Humanos , MasculinoRESUMO
INTRODUCTION AND OBJECTIVES: The objective of this study was to compare heart abnormalities in young women with anorexia nervosa and in a control group of the same age and sex. Patients and method. We report a matched case-control study of 30 adolescents with anorexia nervosa and 30 healthy women of the same age with normal weight. An electrocardiogram and echocardiogram were done. Heart parameters were measured on the electrocardiographic tracings, and QT dispersion was defined as the difference between maximum QT and minimum QT in any of the 12 leads. Diameter, mass and left ventricular mass index were measured. RESULTS: QT and corrected QT intervals were significantly greater in patients with anorexia nervosa than in the control group. QT dispersion and corrected QT dispersion were significantly greater in anorexia nervosa than in the control group (QTd, 59.3 23.0 vs 38.4 8.0 ms; p = 0.000; QTcd, 56.5 24.2 vs. 40.3 21.8 ms; p = 0.011). Left ventricular mass was significantly lower in young women with anorexia nervosa. We found a significant relationship between body mass index and left ventricular mass index, and between the former and corrected QT dispersion. CONCLUSIONS: Adolescents with anorexia nervosa show significant cardiac disorders in comparison to healthy women of the same age. This finding may be a useful indicator of the risk of arrhythmia and sudden death in patients with anorexia nervosa.
Assuntos
Anorexia Nervosa/complicações , Cardiopatias/etiologia , Adolescente , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Humanos , UltrassonografiaRESUMO
Introducción y objetivos. El objetivo de este estudio es comparar las alteraciones cardiológicas de mujeres adolescentes con anorexia nerviosa con un grupo control de la misma edad y sexo. Pacientes y método. Se trata de un estudio de casos y controles apareado en 30 mujeres adolescentes con anorexia nerviosa y 30 controles sanas de la misma edad y peso normal. Se les realizó electrocardiograma y ecocardiograma. Los parámetros cardiológicos fueron medidos sobre la superficie de los electrocardiogramas y la dispersión de QT fue definida como la diferencia entre el máximo y el mínimo QT de las 12 derivaciones. Se cuantificó el diámetro y la masa y el índice masa del ventrículo izquierdo. Resultados. Los intervalos QT y QT corregidos fueron significativamente mayores en pacientes con anorexia nerviosa que en el grupo control. Las dispersiones del intervalo QT y del intervalo QT corregido fueron significativamente mayores en la anorexia nerviosa que en el grupo control (QTd, 59,3 ñ 23,0 frente a 38,4 ñ 8,0 ms; p = 0,000; QTcd, 56,5 ñ 24,2 frente a 40,3 ñ 21,8 ms; p = 0,011). La masa del ventrículo izquierdo fue significativamente menor en las mujeres con anorexia nerviosa. Existe una correlación significativa entre el índice de masa corporal y el índice de masa del ventrículo izquierdo y la dispersión del intervalo QT corregido. Conclusiones. Las adolescentes con anorexia nerviosa presentan alteraciones cardiológicas significativas en relación con mujeres sanas de la misma edad. Dichos parámetros pueden ser indicadores útiles de riesgo de arritmia y muerte súbita en pacientes con anorexia nerviosa (AU)
