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2.
Eur Heart J Cardiovasc Imaging ; 19(7): 768-776, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29237044

RESUMO

Aims: To determine the bioequivalence of several T1 mapping sequences in myocardial characterization of diffuse myocardial fibrosis. Methods and results: We performed an intra-individual sequence comparison of three types of T1 mapping sequences [MOdified Look-Locker Inversion recovery (MOLLI), Shortened MOdified Look-Locker Inversion recovery ((sh)MOLLI), and SAturation recovery single-SHot Acquisition (SASHA)]. We employed two model diseases of diffuse interstitial fibrosis [patients with non-ischaemic dilated cardiomyopathy (NIDCM), n = 32] and aortic stenosis [(AS), n = 25)]. Twenty-six healthy individuals served as controls. Relationship with collagen volume fraction (CVF) was assessed using endomyocardial biopsies (EMB) intraoperatively in 12 AS patients. T2 mapping (GraSE) was also performed. Myocardial native T1 with MOLLI and shMOLLI showed, firstly, an excellent discriminatory accuracy between health and disease [area under the curves (P-value): 0.94 (0.88-0.99); 0.87 (0.79-0.94); 0.61 (0.49-0.72)], secondly, relationship between histological CVF [native T1 MOLLI vs. shMOLLI vs. SASHA: r = 0.582 (P = 0.027), r = 0.524 (P = 0.046), r = 0.443 (P = 0.150)], and thirdly, with native T2 [r = 0.628(P < 0.001), r = 0.459 (P = 0.003), r = 0.211 (P = 0.083)]. The respective relationships for extracellular volume fraction with CVF [r = 0.489 (P = 0.044), r = 0.417 (0.071), r = 0.353 (P = 0.287)] were significant for MOLLI, but not other sequences. In AS patients, native T2 was significantly higher compared to controls, and associated with levels of C-reactive protein and troponin. Conclusion: T1 mapping sequences differ in their bioequivalence for discrimination between health and disease as well as associations with diffuse myocardial fibrosis.

3.
Medicine (Baltimore) ; 95(9): e2891, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26945378

RESUMO

The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ±â€Š12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P < 0.001), in younger individuals (P < 0.001), and in Hispanics (P = 0.03). Complete response to treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P < 0.001). Recurrences were associated with persistent lupus activity at the time of the last visit (P < 0.001) and with ESRD (P < 0.001). Thrombotic microangiopathy was a risk factor for ESRD (P = 0.04), as for the necessity of dialysis (P = 0.01) or renal transplantation (P = 0.03). LN itself was a poor prognostic risk factor of mortality (OR 2.4 [1.81-3.22], P < 0.001). Patients receiving antimalarials had a significantly lower risk of developing LN (P < 0.001) and ESRD (P < 0.001), and responded better to specific treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.


Assuntos
Nefrite Lúpica/epidemiologia , Sistema de Registros , Adolescente , Adulto , Feminino , Humanos , Nefrite Lúpica/terapia , Masculino , Recidiva , Estudos Retrospectivos , Reumatologia , Espanha/epidemiologia , Adulto Jovem
4.
Rev Port Cardiol ; 35(3): 133-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26919889

RESUMO

INTRODUCTION AND OBJECTIVES: To investigate the incidence and clinical relevance of the presence of mobile echogenic images (MEI) during transesophageal echocardiography (TEE) for monitoring of transcatheter aortic valve implantation (TAVI). METHODS: Consecutive patients referred to our center for transfemoral or transapical TAVI were included. The procedure was monitored by three-dimensional (3D) TEE and images were analyzed by two independent experts. In-hospital follow-up was carried out and correlated with imaging findings. RESULTS: A total of 104 patients were included. MEI were visualized in 11 patients during the procedure (11%) and in over 50% of cases were identified as thrombi, however no differences in periprocedural stroke were found in follow-up. CONCLUSIONS: Visualization of MEI during 3D TEE monitoring of TAVI is relatively common (11%) and in over 50% of cases they are identified as thrombi. The clinical implications of this finding are uncertain, as despite their frequency, the incidence of clinical stroke in this patient population was no higher. 3D TEE is a useful tool for diagnosis of MEI and can alert the operator to their presence.


Assuntos
Estenose da Valva Aórtica/diagnóstico , Ecocardiografia Transesofagiana , Implante de Prótese de Valva Cardíaca , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Imagem Tridimensional , Incidência
5.
JACC Cardiovasc Imaging ; 9(1): 40-50, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26762873

RESUMO

OBJECTIVES: The study sought to examine prognostic relevance of T1 mapping parameters (based on a T1 mapping method) in nonischemic dilated cardiomyopathy (NIDCM) and compare them with conventional markers of adverse outcome. BACKGROUND: NIDCM is a recognized cause of poor clinical outcome. NIDCM is characterized by intrinsic myocardial remodeling due to complex pathophysiological processes affecting myocardium diffusely. Lack of accurate and noninvasive characterization of diffuse myocardial disease limits recognition of early cardiomyopathy and effective clinical management in NIDCM. Cardiac magnetic resonance (CMR) supports detection of diffuse myocardial disease by T1 mapping. METHODS: This is a prospective observational multicenter longitudinal study in 637 consecutive patients with dilated NIDCM (mean age 50 years [interquartile range: 37 to 76 years]; 395 males [62%]) undergoing CMR with T1 mapping and late gadolinium enhancement (LGE) at 1.5-T and 3.0-T. The primary endpoint was all-cause mortality. A composite of heart failure (HF) mortality and hospitalization was a secondary endpoint. RESULTS: During a median follow-up period of 22 months (interquartile range: 19 to 25 months), we observed a total of 28 deaths (22 cardiac) and 68 composite HF events. T1 mapping indices (native T1 and extracellular volume fraction), as well as the presence and extent of LGE, were predictive of all-cause mortality and HF endpoint (p < 0.001 for all). In multivariable analyses, native T1 was the sole independent predictor of all-cause and HF composite endpoints (hazard ratio: 1.1; 95% confidence interval: 1.06 to 1.15; hazard ratio: 1.1; 95% confidence interval: 1.05 to 1.1; p < 0.001 for both), followed by the models including the extent of LGE and right ventricular ejection fraction, respectively. CONCLUSIONS: Noninvasive measures of diffuse myocardial disease by T1 mapping are significantly predictive of all-cause mortality and HF events in NIDCM. We provide a basis for a novel algorithm of risk stratification in NIDCM using a complementary assessment of diffuse and regional disease by T1 mapping and LGE, respectively.


Assuntos
Cardiomiopatia Dilatada/diagnóstico , Insuficiência Cardíaca/etiologia , Imagem por Ressonância Magnética , Miocárdio/patologia , Remodelação Ventricular , Adulto , Idoso , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/patologia , Cardiomiopatia Dilatada/fisiopatologia , Causas de Morte , Progressão da Doença , Europa (Continente) , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda , Função Ventricular Direita
6.
Circ Cardiovasc Imaging ; 8(12)2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26659373

RESUMO

BACKGROUND: The differential diagnosis of left ventricular (LV) hypertrophy remains challenging in clinical practice, in particular, between hypertrophic cardiomyopathy (HCM) and increased LV wall thickness because of systemic hypertension. Diffuse myocardial disease is a characteristic feature in HCM, and an early manifestation of sarcomere-gene mutations in subexpressed family members (G+P- subjects). This study aimed to investigate whether detecting diffuse myocardial disease by T1 mapping can discriminate between HCM versus hypertensive heart disease as well as to detect genetically driven interstitial changes in the G+P- subjects. METHODS AND RESULTS: Patients with diagnoses of HCM or hypertension (HCM, n=95; hypertension, n=69) and G+P- subjects (n=23) underwent a clinical cardiovascular magnetic resonance protocol (3 tesla) for cardiac volumes, function, and scar imaging. T1 mapping was performed before and >20 minutes after administration of 0.2 mmol/kg of gadobutrol. Native T1 and extracellular volume fraction were significantly higher in HCM compared with patients with hypertension (P<0.0001), including in subgroup comparisons of HCM subjects without evidence of late gadolinium enhancement, as well as of hypertensive patients LV wall thickness of >15 mm (P<0.0001). Compared with controls, native T1 was significantly higher in G+P- subjects (P<0.0001) and 65% of G+P- subjects had a native T1 value >2 SD above the mean of the normal range. Native T1 was an independent discriminator between HCM and hypertension, over and above extracellular volume fraction, LV wall thickness and indexed LV mass. Native T1 was also useful in separating G+P- subjects from controls. CONCLUSIONS: Native T1 may be applied to discriminate between HCM and hypertensive heart disease and detect early changes in G+P- subjects.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/diagnóstico , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Remodelação Ventricular , Adulto , Idoso , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/patologia , Meios de Contraste , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Fibrose , Humanos , Hipertensão/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/patologia , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos , Fenótipo , Valor Preditivo dos Testes
7.
Rev Port Cardiol ; 34(3): 193-9, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25686520

RESUMO

INTRODUCTION AND OBJECTIVES: The aim of this study was to analyze the incidence of drug-eluting stent thrombosis (sirolimus or everolimus) in patients with chronic total coronary occlusions (CTO) and to determine its clinical implications and related factors. METHODS: Data from the 12-month follow-up of the 207 patients included in the CIBELES trial with CTO were analyzed. RESULTS: Stent thrombosis occurred in three patients, two definite and one probable (overall thrombosis rate: 1.4%). However, there were no cases of death or Q-wave myocardial infarction. In univariate analysis, patients with a higher incidence of stent thrombosis were those in whom the target vessel was the left anterior descending, who had single-vessel disease, were assigned to treatment with sirolimus-eluting stents, and those with smaller minimum luminal diameter immediately after the procedure. In multivariate analysis, the only independent predictor of stent thrombosis was minimal luminal diameter immediately after the procedure. CONCLUSIONS: The rate of drug-eluting stent thrombosis in patients with CTO is relatively low (1.4%). The only independent predictor of stent thrombosis in this context was minimal luminal diameter after the procedure and the clinical presentation was in all cases relatively benign.


Assuntos
Oclusão Coronária/tratamento farmacológico , Stents Farmacológicos , Everolimo/administração & dosagem , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Sirolimo/administração & dosagem , Trombose/diagnóstico , Trombose/epidemiologia , Idoso , Doença Crônica , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade
8.
Rheumatology (Oxford) ; 54(7): 1236-43, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25573839

RESUMO

OBJECTIVE: The aim of this study was to develop a genetic prognostic tool to predict radiographic progression towards severe disease in primary knee OA (KOA) patients. METHODS: This investigation was a cross-sectional, retrospective, multicentric association study in 595 Spanish KOA patients. Caucasian patients aged ≥40 years at the time of diagnosis of primary KOA of Kellgren-Lawrence grade 2 or 3 were included. Patients who progressed to Kellgren-Lawrence score 4 or who were referred for total knee replacement within 8 years after diagnosis were classified as progressors to severe disease. Clinical variables of the initial stages of the disease (gender, BMI, age at diagnosis, OA in the contralateral knee, and OA in other joints) were registered as potential predictors. Single nucleotide polymorphisms and clinical variables with an association of P < 0.05 were included in the multivariate analysis using forward logistic regression. RESULTS: A total of 23 single nucleotide polymorphisms and the time of primary KOA diagnosis were significantly associated with KOA severe progression in the exploratory cohort (n = 220; P < 0.05). The predictive accuracy of the clinical variables was limited: area under the curve (AUC) = 0.66. When genetic variables were added to the clinical model (full model), the prediction of KOA progression was significantly improved (AUC = 0.82). Combining only genetic variables (rs2073508, rs10845493, rs2206593, rs10519263, rs874692, rs7342880, rs780094 and rs12009), a predictive model with good accuracy was also obtained (AUC = 0.78). The predictive ability for KOA progression of the full model was confirmed on the replication cohort (two-sample Z-test; n = 62; P = 0.190). CONCLUSION: An accurate prognostic tool to predict primary KOA progression has been developed based on genetic and clinical information from OA patients.


Assuntos
Progressão da Doença , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/genética , Polimorfismo de Nucleotídeo Único/genética , Índice de Gravidade de Doença , Idoso , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteoartrite do Joelho/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Radiografia , Estudos Retrospectivos , Espanha
9.
JACC Cardiovasc Imaging ; 8(1): 37-46, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25499131

RESUMO

OBJECTIVES: This study investigated whether T1 mapping by cardiac magnetic resonance (CMR) reflects the clinical evolution of disease in myocarditis and supports its diagnosis independently of the disease stages. BACKGROUND: Acute viral myocarditis is characterized by a range of intracellular changes due to viral replication and extracellular spill of debris within days of viral infection. Convalescence may be characterized by a chronic low-grade inflammation leading to ventricular remodelling, but also a complete resolution of myocardial changes. METHODS: Patients with clinical diagnosis of viral myocarditis (N = 165) underwent routine clinical CMR protocol (1.5- and 3.0-T) for assessment of cardiac function and structure, and tissue characterization with T2-weighted imaging and late gadolinium enhancement. T1 mapping was obtained in a mid-ventricular short-axis slice before and >20 min after administration of 0.2 mmol/kg of gadobutrol. RESULTS: Compared with control subjects (n = 40), T1 indexes were increased in patients with myocarditis. Patients with acute symptoms (n = 61) had higher values of T1 indexes compared with patients in clinical convalescence (n = 67). Native T1 is an independent discriminator between health and disease, as well as a discriminator between acute and convalescent stage of the disease. Native T1- was superior to T2-weighted imaging and late gadolinium enhancement with high diagnostic accuracy and positive and negative predictive values. Using pre-defined cutoff values for normal ranges, we demonstrated that acute myocarditis can be independently identified by native T1 of >5 SD above the mean of normal range, whereas convalescence is best defined by either abnormal native T1 (>2 SD) or presence of late gadolinium enhancement. We prospectively tested a new diagnostic algorithm in an independent dataset of patients with clinical diagnosis of myocarditis and achieved similar diagnostic performance. CONCLUSIONS: The new diagnostic algorithm using native T1 can reliably discriminate between health and disease and determine the clinical disease stage in patients with a clinical diagnosis of myocarditis.


Assuntos
Algoritmos , Imagem por Ressonância Magnética , Miocardite/diagnóstico , Humanos , Miocárdio , Estudos Prospectivos , Viroses/diagnóstico
10.
J Cardiovasc Magn Reson ; 16: 66, 2014 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-25231729

RESUMO

BACKGROUND: Myocardial crypts are discrete clefts or fissures in otherwise compacted myocardium of the left ventricle (LV). Recent reports suggest a higher prevalence of crypts in patients with hypertrophic cardiomyopathy (HCM) and also within small samples of genotype positive but phenotype negative relatives. The presence of a crypt has been suggested to be a predictor of gene carrier status. However, the prevalence and clinical significance of crypts in the general population is unclear. We aimed to determine the prevalence of myocardial crypts in a large cohort of subjects using clinical cardiovascular magnetic resonance (CMR). METHODS: Consecutive subjects referred for clinical CMR during a 12-month period (n = 1020, age 52.6 ± 17, males: 61%) were included. Crypts were defined as >50% invagination into normal myocardium and their overall prevalence, location and shape was investigated and compared between different patient groups. RESULTS: The overall prevalence of crypts was 64/1020 (6.3%). In a predefined 'normal' control group the prevalence was lower (11/306, 3.6%, p = 0.031), but were equally prevalent in ischemic heart disease (12/236, 5.1%, p = n/s) and the combined non-ischemic cardiomyopathy (NICM) groups (24/373; 6.4%, p = n/s). Within the NICM group, crypts were significantly more common in HCM (9/76, 11.7%, p = 0.04) and hypertensive CM subjects (3/11, 27%, p = 0.03). In patients referred for CMR for family screening of inherited forms of CM, crypts were significantly more prevalent (10/41, 23%, p < 0.001), including a smaller group with a first degree relative with HCM (3/9, 33%, p = 0.01). CONCLUSION: Myocardial crypts are relatively common in the normal population, and increasingly common in HCM and hypertensive cardiomyopathy. Crypts are also more frequently seen in normal phenotype subjects referred because of a family history of an inherited cardiomyopathy and HCM specifically. It is uncertain what the significance of crypts are in this group, and because of variability in the imaging protocols used and their relative frequency within the normal population, should not be used to clinically stratify these patients. Prospective studies are required to confirm the clinical significance of myocardial crypts, as their significance remains unclear.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Adulto , Idoso , Cardiomiopatia Hipertrófica/epidemiologia , Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda , Função Ventricular Direita
11.
Rev. esp. cardiol. (Ed. impr.) ; 67(8): 615-623, ago. 2014. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181851

RESUMO

Introducción y objetivos: El cierre percutáneo de dehiscencias paravalvulares es una alternativa a la cirugía en pacientes de alto riesgo, pero la falta de dispositivos específicos ha limitado su uso. Recientemente se han desarrollado dispositivos más adecuados, como el Amplatzer Vascular Plug III, pero actualmente hay poca información de su eficacia y su seguridad. El objetivo es estudiar el resultado a medio plazo del cierre de dehiscencias paravalvulares con este dispositivo. Métodos: Se analizó la evolución clínica y ecocardiográfica tanto hospitalaria como a medio plazo (13±9 meses) de una serie de 20 pacientes consecutivos (edad, 68 años; EuroSCORE logístico, 29) con dehiscencias paravalvulares e intento de cierre percutáneo. Resultados: Se intentó el cierre de 23 dehiscencias (17 mitrales y 6 aórticas) durante 22 procedimientos en 20 pacientes. Se logró el éxito del implante en el 87% de las dehiscencias y el éxito del procedimiento con una reducción de ≥ 1 grado de la insuficiencia en el 83%. La supervivencia al año fue del 64,7% y la supervivencia libre de muerte/cirugía, del 58,8%. El grado de insuficiencia valvular residual no se relacionó con la mortalidad, pero sí con el grado funcional. Entre los supervivientes se observó una mejora significativa en la clase funcional. Conclusiones: El cierre percutáneo de dehiscencias con el Amplatzer Vascular Plug III es seguro y eficaz a medio plazo, aunque la mortalidad de los pacientes de alto riesgo es alta independientemente del grado de insuficiencia residual, lo que indica que se realiza en un estadio avanzado de la cardiopatía


Introduction and objectives: Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. Methods: We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. Results: Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. Conclusions: Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dispositivos de Oclusão Vascular/tendências , Técnicas Hemostáticas , Deiscência da Ferida Operatória/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Deiscência da Ferida Operatória/complicações , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento
12.
Hypertension ; 64(4): 762-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25024285

RESUMO

Increased aortic stiffness is related to increased ventricular stiffness and remodeling. Myocardial fibrosis is the pathophysiological hallmark of failing heart. We investigated the relationship between noninvasive imaging markers of myocardial fibrosis, native T1, and late gadolinium enhancement, respectively, and aortic stiffness in ventricular remodeling. Consecutive patients with known dilated cardiomyopathy (n=173) underwent assessment of cardiac volumes and function, T1 mapping, scar imaging, and pulse wave velocity, a measure of aortic stiffness. Asymptomatic healthy volunteers served as controls (n=47). Controls and patients showed an increase in pulse wave velocity with age, which was accelerated in the presence of cardiovascular disease. On the contrary, native T1 increased with age in patients, but not in controls. Pulse wave velocity was associated with native T1 in the presence of disease, but not in health. Native T1 showed a strong relationship with markers of structural and functional left ventricular remodeling and diastolic impairment. Ischemic and nonischemic pathophysiology of ventricular remodeling showed a similar slope of relationship between pulse wave velocity and native T1. However, in nonischemic patients, increase in pulse wave velocity was associated with greater increase in native T1. Aortic stiffness is related to age, and this process is accelerated in the presence of disease. On the contrary, increase in interstitial myocardial fibrosis is associated with age in the presence of disease. Patients with ischemic and nonischemic dilated cardiomyopathy have a similar relationship between native T1 and pulse wave velocity, which is stronger in the latter group.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Miocárdio/patologia , Rigidez Vascular , Remodelação Ventricular , Adulto , Idoso , Pressão Sanguínea , Cardiomiopatia Dilatada/patologia , Feminino , Fibrose , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Onda de Pulso , Disfunção Ventricular Esquerda/fisiopatologia
13.
Rev Esp Cardiol (Engl Ed) ; 67(8): 615-23, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25037540

RESUMO

INTRODUCTION AND OBJECTIVES: Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. METHODS: We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. RESULTS: Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. CONCLUSIONS: Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Idoso , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Falha de Prótese , Reoperação , Fatores de Tempo , Resultado do Tratamento
14.
JACC Cardiovasc Imaging ; 7(8): 762-70, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25051945

RESUMO

OBJECTIVES: This study investigated the feasibility of visual and quantitative assessment of coronary vessel wall contrast enhancement (CE) for detection of symptomatic atherosclerotic coronary artery disease (CAD) and subclinical coronary vasculitis in autoimmune inflammatory disease (systemic lupus erythematosus [SLE]), as well as the association with aortic stiffness, an established marker of risk. BACKGROUND: Coronary CE by cardiac magnetic resonance (CMR) is a novel noninvasive approach to visualize gadolinium contrast uptake within the coronary artery vessel wall. METHODS: A total of 75 subjects (CAD: n = 25; SLE: n = 27; control: n = 23) underwent CMR imaging using a 3-T clinical scanner. Coronary arteries were visualized by a T2-prepared steady state free precession technique. Coronary wall CE was visualized using inversion-recovery T1 weighted gradient echo sequence 40 min after administration of 0.2 mmol/kg gadobutrol. Proximal coronary segments were visually examined for distribution of CE and quantified for contrast-to-noise ratio (CNR) and total CE area. RESULTS: Coronary CE was prevalent in patients (93%, n = 42) with a diffuse pattern for SLE and a patchy/regional distribution in CAD patients. Compared with control subjects, CNR values and total CE area in patients with CAD and SLE were significantly higher (mean CNR: 3.9 ± 2.5 vs. 6.9 ± 2.5 vs. 6.8 ± 2.0, respectively; p < 0.001; total CE area: median 0.8 [interquartile range (IQR): 0.6 to 1.2] vs. 3.2 [IQR: 2.6 to 4.0] vs. 3.3 [IQR: 1.9 to 4.5], respectively; p < 0.001). Both measures were positively associated with aortic stiffness (CNR: r = 0.61, p < 0.01; total CE area: 0.36, p = 0.03), hypercholesterolemia (r = 0.68, p < 0.001; r = 0.61, p < 0.001) and hypertension (r = 0.40, p < 0.01; r = 0.32, p < 0.05). CONCLUSIONS: We demonstrate that quantification of coronary CE by CNR and total CE area is feasible for detection of subclinical and clinical uptake of gadolinium within the coronary vessel wall. Coronary vessel wall CE may become an instrumental novel direct marker of vessel wall injury and remodeling in subpopulations at risk.


Assuntos
Aterosclerose/patologia , Meios de Contraste , Angiografia Coronária/métodos , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Lúpus Eritematoso Sistêmico/complicações , Angiografia por Ressonância Magnética , Compostos Organometálicos , Vasculite/patologia , Adulto , Aterosclerose/etiologia , Aterosclerose/fisiopatologia , Estudos de Casos e Controles , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Hipercolesterolemia , Interpretação de Imagem Assistida por Computador , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Placa Aterosclerótica , Valor Preditivo dos Testes , Remodelação Vascular , Rigidez Vascular , Vasculite/etiologia , Vasculite/fisiopatologia
16.
Med. clín (Ed. impr.) ; 140(12): 537-541, jun. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-114455

RESUMO

Fundamentos y objetivo: Los contaminantes del aire urbano están constituidos por una mezcla heterogénea de sustancias presentes en estado gaseoso y aerosoles. El objetivo del presente estudio fue comparar los efectos causados por la exposición a contaminantes en fase gas y partículas atmosféricas en aire ambiente en pacientes que ingresan por un síndrome coronario agudo (SCA), en relación con la presencia o no de lesiones obstructivas significativas (LOS) en arterias coronarias epicárdicas. Pacientes y método: Analizamos de forma prospectiva a un total de 2.110 pacientes con el diagnóstico de SCA. Se determinaron las concentraciones medias de contaminantes en fase gas y partículas atmosféricas desde el día anterior hasta 7 días previos al ingreso. Se dividió la población de estudio en aquellos con presencia o no de LOS. Resultados: De los 2.110 pacientes con SCA, 1.892 presentaban LOS y 218 no. Cuando se compararon las concentraciones de los contaminantes en fase gas, se observó que, en los pacientes con LOS, el dióxido de azufre tenía una tendencia a tener valores más altos (media [DE] de 10,93 [9,31] frente a 8,33 [6,77] ¿g/m; p=0,004). El análisis multivariable muestra que por cada 10¿g/m3 de aumento del dióxido de azufre, aumenta el riesgo de ingreso por SCA con LOS frente a sin LOS un 41% (odds ratio 1,41; intervalo de confianza del 95% 1,039-1,931; p=0,028). Conclusiones: En nuestra población de estudio, la exposición a concentraciones elevadas de dióxido de azufre constituyen un factor precipitante de ingreso para pacientes con SCA y LOS (AU)


Background and objectives: Urban air pollutants are composed of a heterogeneous mixture of substances in gas and aerosol states. The aim of this study was to compare the effects caused by exposure to contaminants in the gas phase and atmospheric particles in ambient air in patients hospitalized for acute coronary syndrome (ACS) regarding the presence or absence of significant obstructive lesions (SOL) in epicardial coronary arteries. Patients and methods: Prospectively analyzed a total of 2,110 patients with a diagnosis of ACS. We determined the mean concentrations of contaminants in the gas phase and atmospheric particles from the day before until 7 days prior to admission (1 to 7 days lag time). We divided the study population into those with presence or absence of SOL. Results: Of the 2,110 patients with ACS, 1,892 presented SOL and 218 without SOL. When comparing the concentrations of contaminants in the gas phase, we observed that the sulfur dioxide in patients with SOL had a trend toward higher values (10.93±8.33 versus 9.31±6.77¿g/m3; P=.004). Multivariate analysis shows that for every 10¿g/m3 increase of sulfur dioxide, there is an increase in the risk of hospitalization for ACS with SOL a 41% (odds ratio 1.41; 95% confidence interval 1.039-1.931; P=.028). Conclusions: In our study population, exposure to high concentrations of sulfur dioxide is a precipitating factor for admission of patients with ACS and SOL (AU)


Assuntos
Humanos , Dióxido de Enxofre/efeitos adversos , Exposição Ambiental/efeitos adversos , Síndrome Coronariana Aguda/complicações , Oclusão Coronária/induzido quimicamente , Infarto do Miocárdio/complicações , Angina Instável/complicações , Fatores de Risco
17.
Biomarkers ; 18(4): 310-3, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23566002

RESUMO

Low circulating melatonin levels predict poor outcome in patients with ST-segment elevation myocardial infarction (STEMI). In the present study, we investigated whether a relationship between myocardial deformation in parameters measured by echocardiography and circulating melatonin level exists. We prospectively included 112 patients with STEMI who performed echocardiography and simultaneous measurement of serum melatonin, during the light period within 72 h of admission. We found a negative correlation between circulating melatonin levels and global longitudinal strain (p = 0.006, r = -0.33). In conclusion, melatonin levels have a correlation with two-dimensional speckle tracking in patients with STEMI.


Assuntos
Biomarcadores/sangue , Ventrículos do Coração/fisiopatologia , Melatonina/sangue , Infarto do Miocárdio/sangue , Infarto do Miocárdio/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
World J Cardiol ; 5(3): 49-53, 2013 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-23538391

RESUMO

AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction. METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 µm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission. RESULTS: The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 µg/m(3) vs 4.50 ± 2.34 µg/m(3), P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03). CONCLUSION: This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.

19.
Med Clin (Barc) ; 140(12): 537-41, 2013 Jun 18.
Artigo em Espanhol | MEDLINE | ID: mdl-23122610

RESUMO

BACKGROUND AND OBJECTIVES: Urban air pollutants are composed of a heterogeneous mixture of substances in gas and aerosol states. The aim of this study was to compare the effects caused by exposure to contaminants in the gas phase and atmospheric particles in ambient air in patients hospitalized for acute coronary syndrome (ACS) regarding the presence or absence of significant obstructive lesions (SOL) in epicardial coronary arteries. PATIENTS AND METHODS: Prospectively analyzed a total of 2,110 patients with a diagnosis of ACS. We determined the mean concentrations of contaminants in the gas phase and atmospheric particles from the day before until 7 days prior to admission (1 to 7 days lag time). We divided the study population into those with presence or absence of SOL. RESULTS: Of the 2,110 patients with ACS, 1,892 presented SOL and 218 without SOL. When comparing the concentrations of contaminants in the gas phase, we observed that the sulfur dioxide in patients with SOL had a trend toward higher values (10.93 ± 8.33 versus 9.31 ± 6.77 µg/m(3); P = .004). Multivariate analysis shows that for every 10 µg/m(3) increase of sulfur dioxide, there is an increase in the risk of hospitalization for ACS with SOL a 41% (odds ratio 1.41; 95% confidence interval 1.039-1.931; P = .028). CONCLUSIONS: In our study population, exposure to high concentrations of sulfur dioxide is a precipitating factor for admission of patients with ACS and SOL.


Assuntos
Síndrome Coronariana Aguda/etiologia , Poluentes Atmosféricos/toxicidade , Estenose Coronária/etiologia , Exposição Ambiental , Material Particulado/toxicidade , Dióxido de Enxofre/toxicidade , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/patologia , Idoso , Poluentes Atmosféricos/análise , Área Programática (Saúde) , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/epidemiologia , Relação Dose-Resposta a Droga , Monitoramento Ambiental , Feminino , Gases/toxicidade , Hospitalização , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Conceitos Meteorológicos , Pessoa de Meia-Idade , Material Particulado/análise , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Dióxido de Enxofre/análise , Fatores de Tempo , População Urbana
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