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INTRODUCTION AND OBJECTIVES: Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. METHODS: We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. RESULTS: A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. CONCLUSIONS: This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.
Assuntos
Coartação Aórtica , Adulto , Criança , Humanos , Masculino , Feminino , Seguimentos , Coartação Aórtica/diagnóstico , Coartação Aórtica/epidemiologia , Coartação Aórtica/cirurgia , Resultado do Tratamento , Aortografia/métodos , Fatores de Tempo , Stents , Estudos RetrospectivosAssuntos
Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Inibidores do Transportador 2 de Sódio-Glicose , Canagliflozina/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Peptídeo Natriurético Encefálico , Peptídeos Natriuréticos , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêuticoRESUMO
BACKGROUND: Heart failure (HF) is one of the mayor contributors to cardiovascular morbidity and mortality in patients with diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for HF in patients with type 2 diabetes mellitus (T2D). We aimed to assess the risk for re-hospitalization in a cohort of patients hospitalized for HF according to whether or not they received canagliflozin at discharge, as well as changes in N-terminal pro-B-type natriuretic peptide (NT-ProBNP) concentration during follow-up. METHODS: We conducted a retrospective longitudinal study at a tertiary centre including 102 consecutive T2D patients discharged for acute HF without contraindication for SGLT2 inhibitors. We compared adverse clinical events (HF rehospitalization and cardiovascular death) and NT-ProBNP changes according to canagliflozin prescription at discharge. RESULTS: Among the 102 patients included, 45 patients (44.1%) were prescribed canagliflozin and the remaining 57 (55.9%) were not prescribed any SGLT2 inhibitors (control group). After a median follow-up of 22 months, 45 patients (44.1%) were hospitalized for HF. Most of the rehospitalizations occurred during the first year (37.3%). HF readmission at first year occurred in 10 patients (22.2%) in the canagliflozin group and 29 patients (49.1%) in the control group (hazard ratio (HR): 0.45; 95% confidence interval (CI): 0.21-0.96; p < 0.039). A composite outcome of hospitalization for HF or death from cardiovascular causes was lower in the canagliflozin group (37.8%) than in the control group (70.2%) (HR: 0.51; 95% CI: 0.27-0.95; p < 0.035). Analysis of NT-ProBNP concentration showed an interaction between canagliflozin therapy and follow-up time (p = 0.002). CONCLUSIONS: Canagliflozin therapy at discharge was associated with a lower risk of readmission for HF and a reduction in NT-ProBNP concentration in patients with diabetes after hospitalization for HF.
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El Consentimiento Informado, tanto para Prácticas Hospitalarias como para Investigación en Seres Humanos, tiene antecedentes Nacionales, Provinciales (Córdoba y otras provincias) e Internacionales. En lo que respecta a Córdoba, la existencia de: Un Sistema de Evaluación, Registro y Fiscalización de las Investigaciones en Salud creado por Resolución Nº 0022/2007 (de fecha 17-01-07) del Ministerio de Salud de la Provincia de Córdoba; una Comisión Provincial de Investigación en Seres Humanos, transformada en Consejo de Evaluación Ética de la Investigación en Salud (CoEIS) según Resolución Nº 118 del Ministerio de Salud de la Provincia de Córdoba, con designación de miembros integrantes, el 09-04-07; Comités Institucionales de Ética de la Investigación en Salud (CIEIS), a) Públicos: 1) del Niño y del Adulto, 2) Salud Sexual y Reproductiva humana, 3) del Adulto, 4) Salud Mental, según Resolución Nº 1.617 del Ministerio de Salud de la Provincia de Córdoba de fecha 28-12-07, b) Privados Acreditados: habilitados por el CoEIS, otorgan a los sujetos de investigación seguridad Legal, Bioética, Procedimental, de respeto por cada ser humano que interviene en un Protocolo de Investigación, preservando su dignidad y su integridad, condiciones esenciales que hacen a lo humano y, por tanto, ejes de los Derechos Humanos.
Informed Consent for both hospital and Practices for Research in Human Beings, has a history National, Provincial (Cordoba and other provinces) and International. With respect to Cordoba, the existence of: Evaluation System, Registration and Control of Health Research created by Resolution No. 00022/2007 (dated 17-01-07) from the Ministry of Health of the Province of Cordoba;a Commission Provincial Research Involving Human Subjects, transformed into Evaluation Board Research Ethics in Health (CoEIS) by Resolution No. 118 of Ministry of Health of the Province of Cordoba, with designation of membership, on 09-04-07; Institutional Ethics Committees of Health Research (ClEIS), a) Public: 1) Child and Adult, 2) Human Reproductive and Sexual Health, 3) Adult 4) Mental Health, by Resolution No. 1617 of the Ministry of Health of the Province of Cordoba, dated 28-12-07, b) Private Accredited: accredited by the CoEIS, accorded to research subjects Safety Legal, Bioethics, Procedural, respect for every human being involved in a research protocol, preserving their dignity and integrity, essential conditions that make human and therefore axis Rights Human. In a cross-sectional study (discussed CIEIS Informed Consent, 50 Public and 50 Private, accredited) as well as longitudinal (years 2006 and examines 2.007), assessing the presence or absence of significant differences in terms of...
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Humanos , Masculino , Feminino , Bioética , Ética em Pesquisa , Humanos , Consentimento Livre e Esclarecido , Pesquisa , ArgentinaRESUMO
En un estudio de corte transversal (se analizaron dos grupos de trabajo de una misma Empresa con distinto hábitat laboral, unos con ruidos y otros sin ruido, por Audiometrías de tonos puros en frecuencias 500, 1.000, 2.000 y 4.000Hz) y también de corte longitudinal simultáneamente (se analizaron durante cinco años, 1996-19997,1998,1999,2000, las variaciones audiométricas en realción con Oídos Izquierdos, Oídos Derechos, tarea que realiza, Años de trabajo y Edad), encontrándose que: El mayor porcentaje de Audiometría Normal se da entre el personal administrativo y vendedores, presentandose un menor porcentaje en Oficiales Playeros, Mantenimiento y Cortadores. Existe asociación entre el resultado de la audiometria del oído derecho y la tarea que realiza el empleado (p<0.003)....
RESUMO
En un estudio de corte transversal (se analizaron dos grupos de trabajo de una misma Empresa con distinto hábitat laboral, unos con ruidos y otros sin ruido, por Audiometrías de tonos puros en frecuencias 500, 1.000, 2.000 y 4.000Hz) y también de corte longitudinal simultáneamente (se analizaron durante cinco años, 1996-19997,1998,1999,2000, las variaciones audiométricas en realción con Oídos Izquierdos, Oídos Derechos, tarea que realiza, Años de trabajo y Edad), encontrándose que: El mayor porcentaje de Audiometría Normal se da entre el personal administrativo y vendedores, presentandose un menor porcentaje en Oficiales Playeros, Mantenimiento y Cortadores. Existe asociación entre el resultado de la audiometria del oído derecho y la tarea que realiza el empleado (p<0.003)....
RESUMO
En un estudio de corte transversal (se analizaron dos grupos de trabajo de una misma Empresa con distinto hábitat laboral, unos con ruidos y otros sin ruido, por Audiometrías de tonos puros en frecuencias 500, 1.000, 2.000 y 4.000Hz) y también de corte longitudinal simultáneamente (se analizaron durante cinco años, 1996-19997,1998,1999,2000, las variaciones audiométricas en realción con Oídos Izquierdos, Oídos Derechos, tarea que realiza, Años de trabajo y Edad), encontrándose que: El mayor porcentaje de Audiometría Normal se da entre el personal administrativo y vendedores, presentandose un menor porcentaje en Oficiales Playeros, Mantenimiento y Cortadores. Existe asociación entre el resultado de la audiometria del oído derecho y la tarea que realiza el empleado (p<0.003)....
