RESUMO
OBJECTIVES: Recent studies have shown that patients with syndromic thoracic aortic aneurysm, particularly patients with bicuspid aortic valve, have increased blood levels of transforming growth factor ß1 (TGF-ß1), indicating this molecule as a prognostic biomarker. However, it is not known whether TGF-ß1 is also elevated in the blood of patients with tricuspid aortic valve and aortic dilatation. METHODS: We analysed the plasma levels of TGF-ß1 in 52 patients with tricuspid or bicuspid aortic valve and with normal or dilated ascending aorta who underwent cardiac surgery in our hospital. RESULTS: TGF-ß1 blood level was significantly increased two-fold in patients with tricuspid aortic valve and dilated aorta compared to patients with tricuspid aortic valve and normal aorta. CONCLUSIONS: Our results suggest that TGF-ß1 blood levels may serve as a prognostic biomarker for patients with syndromic and non-syndromic thoracic aortic aneurysm. Further studies with larger cohorts of patients should be performed to confirm these results.
Assuntos
Aneurisma da Aorta Torácica/sangue , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/cirurgia , Fator de Crescimento Transformador beta1/sangue , Idoso , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica/cirurgia , Doença da Válvula Aórtica Bicúspide , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos , Feminino , Doenças das Valvas Cardíacas/sangue , Doenças das Valvas Cardíacas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoAssuntos
Doenças da Aorta/etiologia , Estenose da Valva Aórtica/terapia , Cateterismo Cardíaco , Cardiopatias/etiologia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Fístula Vascular/etiologia , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico , Aortografia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Ecocardiografia Doppler em Cores , Cardiopatias/diagnóstico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Desenho de Prótese , Fístula Vascular/diagnósticoRESUMO
Percutaneous coronary intervention with drug-eluting stents is an alternative for patients with high-risk unprotected left main coronary artery disease; those with diabetes mellitus are at even higher risk. Recent advances in percutaneous coronary intervention could lead to better results. The aim of this study was to evaluate medium-term results in a real-world sample of high-risk diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.From 3 tertiary hospitals, we retrospectively identified 334 high-risk patients, of whom 141 (42%) were diabetic and 193 (58%) were nondiabetic. The diabetes mellitus group showed a higher prevalence of peripheral vascular disease and left ventricular dysfunction. Angiographic and procedural characteristics did not differ significantly, with the exception of poor distal vessels in the diabetes mellitus group (44.5% vs 28.5%, P = 0.006). The use of intra-aortic balloon pumping and intravascular ultrasonography was low in both diabetic and nondiabetic patients. After a median follow-up of 22.4 months, cardiac death was higher in the diabetes mellitus group (16.2% vs 7.5%, P = 0.015), especially in insulin-dependent diabetic patients (25.8%). The incidence of major adverse cardiac events, including cardiac death, target-lesion revascularization, and myocardial infarction was similar in both groups (23.8% vs 18.3%, P = NS).High-risk diabetic patients who undergo percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease present with a worse clinical profile that carries a higher cardiac mortality rate in the medium term, especially in insulin-dependent diabetic patients.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Stents Farmacológicos , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/mortalidade , Doenças Cardiovasculares/etiologia , Distribuição de Qui-Quadrado , Comorbidade , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/mortalidade , Intervalo Livre de Doença , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do TratamentoRESUMO
The development of dynamic left ventricular outflow tract (LVOT) obstruction (DLVOTO) during effort in patients without hypertrophic cardiomyopathy has been described only a few times and its clinical significance has not been established. This study was undertaken to determine DLVOTO during exercise in patients with angina and normal coronary arteries, and to analyze the potential mechanism involved. The study included 23 patients (60.7 +/- 7.2 years), with effort angina and normal coronary arteries who underwent exercise echocardiography. DLVOTO during exercise appeared in 7 patients (30.4%), with gradients ranging from 31.1 to 67.2 mm Hg (mean 41.3 +/- 12.6). These patients showed more symptoms (effort angina) during testing than the remaining patients (100% vs 47.3%; P = .014). LVOT size was the only predictive factor of DLVOTO (9.1 +/- 0.5 vs 10.3 +/- 1.2 mm/m(2); P = .017). In patients with angina and no epicardical coronary artery disease DLVOTO is associated with a lower LVOT size.
