Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 199
Filtrar
2.
Artigo em Inglês | MEDLINE | ID: mdl-33011773

RESUMO

Since its clinical implementation in the late nineties, thoracic endovascular aortic repair (TEVAR) has become the standard treatment of several acute and chronic diseases of the thoracic aorta. While TEVAR has been embraced by many, this disruptive technology has also stimulated the continuing evolution of open surgery, which became even more important as late TEVAR failures do need open surgical correction justifying the need to unite both treatment options under one umbrella. This fact shows the importance of-in analogy to the heart team-aortic centre formation and centralization of care, which stimulates continuing development and improves outcome . The next frontier to be explored is the most proximal component of the aorta-the aortic root, in particular in acute type A aortic dissection-which remains the main challenge for the years to come. The aim of this document is to provide the reader with a synopsis of current evidence regarding the use or non-use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and for reporting standards and finally to provide a glimpse into future developments.

4.
JAMA Cardiol ; 2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-32997098

RESUMO

Importance: Patients with symptomatic lower extremity peripheral artery disease (LE-PAD) experience an increased risk of major vascular events. There is limited information on what clinical features of symptomatic LE-PAD prognosticate major vascular events and whether patients at high risk have a greater absolute benefit from low-dose rivaroxaban and aspirin. Objective: To quantify the risk of major vascular events and investigate the response to treatment with low-dose rivaroxaban and aspirin among patients with symptomatic LE-PAD based on clinical presentation and comorbidities. Design, Setting, and Participants: This is a subanalysis of a previously reported subgroup of patients with symptomatic LE-PAD who were enrolled in a large, double-blind, placebo-controlled randomized clinical trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies [COMPASS]) in 602 centers in 33 countries from March 2013 to January 2020. Data analysis was completed from May 2016 to June 2020. Interventions: A combination of low-dose rivaroxaban and aspirin compared with aspirin alone. Main Outcomes and Measures: Thirty-month incidence risk of myocardial infarction, stroke and cardiovascular death (MACE), major adverse limb events (MALE) including major vascular amputation, and bleeding. Results: The COMPASS trial enrolled 4129 patients with symptomatic LE-PAD (mean [SD] age, 66.8 [8.8] years; 2932 men [71.0%]). The 30-month Kaplan-Meier incidence risk of MACE or MALE, including major amputation, was 22.6% in those with prior amputation (this outcome was observed in 54 patients), 17.6% (n = 15) in those with Fontaine III or IV symptoms, and 11.8% (n = 142) in those with previous peripheral artery revascularization, classifying these features as high-risk limb presentations. The 30-month incidence risk of MACE or MALE, including major amputation, was 14.1% (n = 118) in those with kidney dysfunction, 13.5% (n = 67) in those with heart failure, 13.4% (n = 199) in those with diabetes, and 12.8% (n = 222) in those with polyvascular disease, classifying these features as high-risk comorbidities. Among patients with either high-risk limb presentations or high-risk comorbidities, treatment with rivaroxaban and aspirin compared with aspirin alone was associated with an estimated 4.2% (95% CI, 1.9%-6.2%) absolute risk reduction for MACE or MALE, including major amputation, at 30 months. Although the estimated absolute risk increase of major bleeding was higher with rivaroxaban and aspirin in combination than aspirin alone (2.0% [95% CI, 0.5%-3.9%]) for patients with either high-risk limb presentation or high-risk comorbidity, the estimated absolute risk increase of fatal or critical organ bleeding was low in this high-risk group (0.4% [95% CI, 0.2%-1.8%]), such that the net clinical benefit was estimated to be 3.2% (95% CI, 0.6%-5.3%). Conclusions and Relevance: Patients with LE-PAD with high-risk limb presentations or high-risk comorbidities had a high incidence of major vascular events. For these patients, treatment with rivaroxaban and aspirin in combination compared with aspirin alone led to a large absolute reduction in vascular risk.

5.
Clin Cardiol ; 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32735030

RESUMO

BACKGROUND: Acute aortic dissection (AAD) is a life-threatening medical emergency that requires immediate diagnosis and rapid treatment. There is a paucity of data on the role of biomarkers in risk stratification of patients with AAD. HYPOTHESIS: N-terminal pro-brain natriuretic peptide (NT-proBNP) is associated with short-term mortality in AAD patients. METHODS: We systematically searched Medline and Scopus to identify all observational cohort studies published before January 2020 that compared outcome (short-term mortality) in patients with AAD with high vs low levels of baseline NT-proBNP combining terms "brain natriuretic peptide" and "aortic dissection." A meta-analysis was conducted using the generic inverse variance method. Heterogeneity between studies was investigated using the Cochrane's Q test and I2 statistic. RESULTS: Four studies were included in final analysis including a total of 950 patients, and 105 (11%) patients died. Baseline NT-proBNP concentrations were significantly higher in nonsurvivors (median 2240 pg/mL, range 1678-16 347 pg/mL) when compared to survivors (665 pg/mL, 328-1252 pg/mL). Elevated NT-proBNP values were significantly associated with an increased risk of short-term mortality (odds ratio 4.13, 95% CI [confidence interval] 2.33-7.33), with low heterogeneity (I2 = 8.77%, Cochran Q = 2.19, P = .33), and no publication bias. The pooled standardized mean difference between groups was 1.28 (95% CI 0.99-1.56), with low heterogeneity (I2 = 38.73%, Cochran Q = 3.26, P = .19). CONCLUSION: Elevated NT-proBNP levels on admission are associated with an increased risk of short-term mortality in AAD.

6.
Eur J Vasc Endovasc Surg ; 60(3): 462-468, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32763120

RESUMO

OBJECTIVE: Ankle brachial index (ABI) is widely used for the diagnosis of lower extremity artery disease (LEAD). The purpose of this prospective study was to validate the diagnostic ability and reproducibility of a four cuff automated oscillometric device vs. the Doppler method. METHODS: Patients with suspected LEAD or asymptomatic individuals at risk because of the presence two or more cardiovascular risk factors were enrolled. For each patient, Doppler and oscillometric ABI measurements were repeated by two observers to address intra- and interobserver reproducibility. RESULTS: In total, 118 patients were evaluated. The prevalence of Doppler ABI (Dop-ABI) ≤ 0.90 was 45.8%. Taking the Dop-ABI as the reference, the sensitivity, specificity, accuracy, positive and negative predictive values of oscillometric ABI (Osc-ABI) during the first measurement by the first observer were 89.1%, 94.4%, 94.1%, 91.8%, and 92.4%, respectively. The concordance for diagnosing ABI ≤0.90 between methods was excellent (kappa coefficients ranging from 0.80 to 0.88 with different observers). Intra-observer reproducibility assessed by intraclass correlation coefficient (ICC) between methods were 0.94 for observer 1 and 0.96 for observer 2. The intra-observer reproducibility using the same method was also excellent (ICC 0.94, 95% confidence interval [CI] 0.91-0.95) for Dop-ABI and 0.95 (95% CI 0.93-0.97) for Osc-ABI). The ICC for interobserver reproducibility using the same method was 0.95 (95% CI 0.92-0.96) for Dop-ABI and 0.96 (95% CI 0.94-0.97) for Osc-ABI. CONCLUSION: This study validates the excellent diagnostic performances of a four cuff oscillometric device specifically designed for screening for LEAD. The simple measurement method could therefore be advocated in primary care where fast, easy, and reliable methods are suitable.


Assuntos
Índice Tornozelo-Braço/instrumentação , Extremidade Inferior/irrigação sanguínea , Oscilometria/instrumentação , Doença Arterial Periférica/diagnóstico , Ultrassonografia Doppler , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , França , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes
7.
Eur. j. prev. cardiol ; 27(3): 1-12, Ago. 2020. gráfico, tabela
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1050001

RESUMO

Abstract Aims: Secondary prevention in patients with coronary artery disease and peripheral artery disease involves antithrombotic therapy and optimal control of cardiovascular risk factors. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) study, adding low-dose rivaroxaban on top of aspirin lowered cardiovascular events, but there is limited data about risk factor control in secondary prevention. We studied the association between risk factor status and outcomes, and the impact of risk factor status on the treatment effect of rivaroxaban, in a large contemporary population of patients with coronary artery disease or peripheral artery disease. Methods and results: We reported ischemic events (cardiovascular death, stroke, or myocardial infarction) in participants from the randomized, double-blind COMPASS study by individual risk factor (blood pressure, smoking status, cholesterol level, presence of diabetes, body mass index, and level of physical activity), and by number of risk factors. We compared rates and hazard ratios of patients treated with rivaroxaban plus aspirin vs aspirin alone within each risk factor category and tested for interaction between risk factor status and antithrombotic regimen. Complete baseline risk factor status was available in 27,117 (99%) patients. Status and number of risk factors were both associated with increased risk of ischemic events. Rates of ischemic events (hazard ratio 2.2; 95% confidence interval 1.8­2.6) and cardiovascular death (hazard ratio 2.0; 1.5­2.7) were more than twofold higher in patients with 4­6 compared with 0­1 risk factors (p<0.0001 for both). Rivaroxaban reduced event rates independently of the number of risk factors (p interaction 0.93), with the largest absolute benefit in patients with the highest number of risk factors. Conclusion: More favorable risk factor status and low-dose rivaroxaban were independently associated with lower risk of cardiovascular events. (AU)


Assuntos
Doença da Artéria Coronariana , Prevenção Secundária
9.
Vasa ; 49(4): 323-329, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32452724

RESUMO

Background: Peripheral artery disease (PAD) is one of the most common manifestations of atherosclerosis affecting more than 200 million people globally but little is known about its epidemiology in Middle East populations, particularly in Arab countries. The present study was undertaken to assess the prevalence of PAD in the general population aged 40 years and more in Gaza-Palestine, and to determine the prevalence of its associated risk factors. Patients and methods: The study design was a cross-sectional with a stratified proportional sampling, involving the five governorates in Gaza Strip. We selected 1490 individuals aged age ≥ 40 years living in the area for more than 3 years. The questionnaire on lifestyle and cardiovascular risk factors was applied and the ankle-brachial index (ABI) was measured by Doppler examination in both legs in all participants. PAD was defined as an ABI ≤ 0.90. We excluded 92 participants (6 %) because of missing ABI or ABI > 1.40. Results: One-half of the 1398 participants had at least two associated cardiovascular risk factors, one-third were on aspirin and 15 % on statins. Overall, we found PAD in 191 (13.7 %) cases. This prevalence increased with age, and 18.7 % of adults older than 65 years had PAD. The prevalence was higher in females than in males (respectively 15.6 % vs 11.6 % p = 0.031). In the multivariate logistic regression model, significant associated factors with PAD in males were CAD (OR: 3.5; 95 % CI: 1.4-8.6), hypertension (OR: 2.8; 95 % CI: 1.3-6.1), and current smoking (OR: 2.7; 95 % CI: 1.1-6.6). In women, hypertension remains the main associated risk factor. Conclusions: Our study highlights the high prevalence of PAD in the Gazan community, mostly related to the high prevalence of cardiovascular risk factors and other cardiovascular conditions.


Assuntos
Doença Arterial Periférica , Adulto , Idoso , Índice Tornozelo-Braço , Estudos Transversais , Feminino , Humanos , Hipertensão , Masculino , Prevalência , Fatores de Risco
10.
Circulation ; 141(21): 1670-1680, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32223336

RESUMO

BACKGROUND: Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence, and disability-adjusted life-years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease, and other nonrheumatic valvular diseases were estimated for 195 countries and territories from 1990 to 2017. METHODS: Vital registration data, epidemiologic survey data, and administrative hospital data were used to estimate disease burden using the Global Burden of Disease Study modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimate disease for all countries, because data on nonrheumatic valvular diseases are extremely limited for some regions of the world, such as Sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for both sexes and each 5-year age group, location, and year from 1990 to 2017. RESULTS: Globally, CAVD and degenerative mitral valve disease caused 102 700 (95% uncertainty interval [UI], 82 700-107 900) and 35 700 (95% UI, 30 500-42 500) deaths, and 12.6 million (95% UI, 11.4 million-13.8 million) and 18.1 million (95% UI, 17.6 million-18.6 million) prevalent cases existed in 2017, respectively. A total of 2.5 million (95% UI, 2.3 million-2.8 million) DALYs were estimated as caused by nonrheumatic valvular diseases globally, representing 0.10% (95% UI, 0.09%-0.11%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and degenerative mitral valve disease between 1990 and 2017 by 101% (95% UI, 79%-117%) and 35% (95% UI, 23%-47%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries. CONCLUSIONS: These global and national estimates demonstrate that CAVD and degenerative mitral valve disease are important causes of disease burden among older adults. Efforts to clarify modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.

11.
Cardiovasc Res ; 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32282914

RESUMO

Endothelial cells (EC) are sentinels of cardiovascular health. Their function is reduced by the presence of cardiovascular risk factors, and is regained once pathological stimuli are removed. In this European Society for Cardiology Position Paper we describe endothelial dysfunction as a spectrum of phenotypic states and advocate further studies to determine the role of EC subtypes in cardiovascular disease. We conclude that there is no single ideal method for measurement of endothelial function. Techniques to measure coronary epicardial and microvascular function are well established but they are invasive, time-consuming and expensive. Flow-mediated dilatation (FMD) of the brachial arteries provides a non-invasive alternative but is technically challenging and requires extensive training and standardization. We therefore propose that a consensus methodology for FMD is universally adopted to minimize technical variation between studies, and that reference FMD values are established for different populations of healthy individuals and patient groups. Newer techniques to measure endothelial function that are relatively easy to perform, such as finger plethysmography and the retinal flicker test, have the potential for increased clinical use provided a consensus is achieved on the measurement protocol used. We recommend further clinical studies to establish reference values for these techniques and to assess their ability to improve cardiovascular risk stratification. We advocate future studies to determine whether integration of endothelial function measurements with patient-specific epigenetic data and other biomarkers can enhance the stratification of patients for differential diagnosis, disease progression and responses to therapy.

12.
Artigo em Inglês | MEDLINE | ID: mdl-32271868

RESUMO

AIMS: The objective was to assess the association between angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) prescription at discharge in patients hospitalized for symptomatic lower extremity artery disease (LEAD) and one-year mortality. METHODS AND RESULTS: The COPART registry is a multicentre, prospective, observational, cohort study which includes consecutive patients hospitalized for symptomatic LEAD in 4 French academic centres. All-cause mortality during a one-year follow-up after hospital discharge was compared between patients with ARB, patients with ACEI and patients without ARB or ACEI. Analyses were performed using Cox models. As a sensitivity analysis, a propensity score (PS)-matching analysis was carried out. Among 1,981 patients, 421 had ARB (21.3%), 766 ACEI (38.7%), and 794 no ACEI/ARB (40.1%) at discharge. During the one-year follow-up, incidence rates for mortality were 12.6/100 person-years (95% confidence interval, 9.7-16.1) for patients with ARB, 15.8/100 person-years (95%CI, 13.4-18.6) for patients with ACEI and 19.8/100 person-years for patients without ACEI/ARB (95%CI, 17.2-22.8). In a multivariate Cox model, ARB at discharge was associated with decreased mortality compared with no ACEI/ARB, hazard ratio (HR) 0.68 (95%CI, 0.49-0.95), and with ACEI, HR 0.69 (95%CI, 0.49-0.97). These results are consistent with those obtained by the Cox analyses in the PS-matched sample: HR 0.68 (95%CI, 0.47-0.98) for patients with ARB compared with no ARB. CONCLUSION: ARB at discharge after hospitalization for symptomatic LEAD is associated with a better survival compared with ACEI or no ACEI/ARB.

13.
Am Heart J ; 222: 166-173, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32092505

RESUMO

Patients with coronary artery disease (CAD), peripheral artery disease (PAD), or both remain at risk of cardiovascular events (including peripheral ischemic events), even when they receive the current guideline-recommended treatment. The phase III COMPASS trial demonstrated that treatment with rivaroxaban vascular dose 2.5 mg twice daily plus aspirin (dual pathway inhibition [DPI] regimen) significantly reduced the risk of major adverse cardiovascular events (including peripheral ischemic events) and increased the risk of major bleeding, but not fatal bleeding or intracranial hemorrhage, versus aspirin alone in patients with CAD, PAD, or both. The results of the COMPASS trial supported the regulatory approval of the DPI regimen in several geographic regions. However, it is unclear whether the patients selected for treatment with the DPI regimen in clinical practice will have a similar risk profile and event rates compared with the COMPASS trial population. The prospective post-approval XATOA registry study aims to assess treatment patterns, as well as ischemic and bleeding outcomes in patients with CAD, PAD, or both, who receive DPI therapy in routine clinical practice. Up to 10,000 patients from at least 400 centers in 22 countries will be enrolled and followed up for a minimum of 12 months, and all treatment will be at the discretion of the prescribing physician. The primary objective of the XATOA study will be to describe early treatment patterns, while ischemic and bleeding outcomes will be described as a secondary objective. TRIAL REGISTRATION NUMBER: NCT03746275.


Assuntos
Aspirina/administração & dosagem , Aterosclerose/prevenção & controle , Trombose Coronária/prevenção & controle , Doença Arterial Periférica/prevenção & controle , Rivaroxabana/administração & dosagem , Aterosclerose/complicações , Trombose Coronária/etiologia , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Inibidores do Fator Xa/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/etiologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento
18.
Eur Heart J Cardiovasc Pharmacother ; 6(2): 86-93, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31392312

RESUMO

AIMS: The role and selection of antithrombotic therapy to improve limb outcomes in chronic lower extremity artery disease (LEAD) is still debated. We conducted a meta-analysis to examine the efficacy and safety of antithrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic LEAD. METHODS AND RESULTS: Study inclusion criteria were: enrolment of patients with LEAD, randomized allocation to more vs. less intense antithrombotic therapy [more vs. less intense single-antiplatelet therapy (SAPT); dual-antiplatelet therapy vs. SAPT; dual antithrombotic therapy vs. SAPT or oral anticoagulant]; enrolment of ≥200 patients; reporting of at least one of following outcomes: limb amputation or revascularization. Seven randomized studies enrolling 30 447 patients were included. Over a median follow-up of 24 months, more vs. less intense antithrombotic therapy or placebo significantly reduced the risk of limb revascularization [relative risk (RR) 0.89, 95% confidence interval (CI) 0.83-0.94] and limb amputation (RR 0.63, 95% CI 0.46-0.86), as well as stroke (RR 0.82, 95% CI 0.70-0.97). There was no statistically significant effect on the risk of myocardial infarction (RR 0.98, 95% CI 0.87-1.11), all-cause (RR 0.93, 95% CI 0.86-1.01), and cardiovascular death (RR 0.97, 95% CI 0.86-1.08). Risk of major bleeding increased (RR 1.23, 95% CI 1.04-1.44). CONCLUSION: In patients with LEAD, more intense antithrombotic therapy reduces the risk of limb amputation and revascularization as well as stroke with an increase in the risk of bleeding events.

19.
Eur J Prev Cardiol ; 27(3): 296-307, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31615291

RESUMO

AIMS: Secondary prevention in patients with coronary artery disease and peripheral artery disease involves antithrombotic therapy and optimal control of cardiovascular risk factors. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) study, adding low-dose rivaroxaban on top of aspirin lowered cardiovascular events, but there is limited data about risk factor control in secondary prevention. We studied the association between risk factor status and outcomes, and the impact of risk factor status on the treatment effect of rivaroxaban, in a large contemporary population of patients with coronary artery disease or peripheral artery disease. METHODS AND RESULTS: We reported ischemic events (cardiovascular death, stroke, or myocardial infarction) in participants from the randomized, double-blind COMPASS study by individual risk factor (blood pressure, smoking status, cholesterol level, presence of diabetes, body mass index, and level of physical activity), and by number of risk factors. We compared rates and hazard ratios of patients treated with rivaroxaban plus aspirin vs aspirin alone within each risk factor category and tested for interaction between risk factor status and antithrombotic regimen. Complete baseline risk factor status was available in 27,117 (99%) patients. Status and number of risk factors were both associated with increased risk of ischemic events. Rates of ischemic events (hazard ratio 2.2; 95% confidence interval 1.8-2.6) and cardiovascular death (hazard ratio 2.0; 1.5-2.7) were more than twofold higher in patients with 4-6 compared with 0-1 risk factors (p < 0.0001 for both). Rivaroxaban reduced event rates independently of the number of risk factors (p interaction 0.93), with the largest absolute benefit in patients with the highest number of risk factors. CONCLUSION: More favorable risk factor status and low-dose rivaroxaban were independently associated with lower risk of cardiovascular events.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA