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1.
Artigo em Inglês | MEDLINE | ID: mdl-32052224

RESUMO

In patients undergoing percutaneous closure of secundum atrial septal defect, the device selection is decided based on three-dimensional transesophageal echocardiography (3D TEE) measurements and two-dimensional balloon stretched diameter measurements; more importantly balloon sizing. The purpose of the study was to assess whether in patients with "halo-sign", defined as increased tissue thickness at the edge of the ASD rims, there is an agreement between 3D TEE and 2D balloon stretched diameter aiming to avoidance of balloon sizing. Forty consecutive patients who underwent closure of a single, without complex anatomy ASD were included. 3D and 2D TEE datasets were acquired and analyzed offline. Planimetry was used to calculate circumference derived diameter of ASD from 3D datasets. Patients were classified according to the presence of the "halo sign" and the agreement between circumference derived diameter and balloon stretched diameter was examined. Forty consecutive patients who underwent closure of a single, without complex anatomy ASD were included. 3D and 2D TEE datasets were acquired and analyzed offline. Planimetry was used to calculate circumference derived diameter of ASD from 3D datasets. Patients were classified according to the presence of the "halo sign" and the agreement between circumference derived diameter and balloon stretched diameter was examined. Higher correlation and lower median absolute difference between 3D TEE measurements and 2D stretched balloon diameter was found in patients with "halo sign". In patients with the "halo sign" mean diameter difference was non-significant. On the contrary statistically significant difference was found in patients without the "halo sign". Significant difference was also found when comparing mean difference in the two patient groups. ASD sizing by 3D echocardiography, is accurate in patients with halo sign and it correlates well with the balloon sizing method. This study justifies further investigation concerning the reliability of 3D imaging for the selection of the ASD device size with a view to avoid balloon sizing, decrease procedural time and thus simplify the procedure.

2.
J Clin Med ; 8(12)2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31817014

RESUMO

Cardiovascular dysfunction in cirrhotic patients is a recognized clinical entity commonly referred to as cirrhotic cardiomyopathy. Systematic inflammation, autonomic dysfunction, and activation of vasodilatory factors lead to hyperdynamic circulation with high cardiac output and low peripheral vascular resistance. Counter acting mechanisms as well as direct effects on cardiac cells led to systolic or diastolic dysfunction and electromechanical abnormalities, which are usually masked at rest but exposed at stress situations. While cardiovascular complications and mortality are common in patients undergoing liver transplantation, they cannot be adequately predicted by conventional cardiac examination including transthoracic echocardiography. Newer echocardiography indices and other imaging modalities such as cardiac magnetic resonance have shown increased diagnostic accuracy with predictive implications in cardiovascular diseases. The scope of this review was to describe the role of cardiac imaging in the preoperative assessment of liver transplantation candidates with comprehensive analysis of the future perspectives anticipated by the use of newer echocardiography indices and cardiac magnetic resonance applications.

3.
Diagnostics (Basel) ; 9(4)2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31835542

RESUMO

Ventricular arrhythmia (VA) in autoimmune rheumatic diseases (ARD) is an expression of autoimmune inflammatory cardiomyopathy (AIC), caused by structural, electrical, or inflammatory heart disease, and has a serious impact on a patient's outcome. Myocardial scar of ischemic or nonischemic origin through a re-entry mechanism facilitates the development of VA. Additionally, autoimmune myocardial inflammation, either isolated or as a part of the generalized inflammatory process, also facilitates the development of VA through arrhythmogenic autoantibodies and inflammatory channelopathies. The clinical presentation of AIC varies from oligo-asymptomatic presentation to severe VA and sudden cardiac death (SCD). Both positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) can diagnose AIC early and be useful tools for the assessment of therapies during follow-ups. The AIC treatment should be focused on the following: (1) early initiation of cardiac medication, including ACE-inhibitors, b-blockers, and aldosterone antagonists; (2) early initiation of antirheumatic medication, depending on the underlying disease; and (3) potentially implantable cardioverter-defibrillator (ICD) and/or ablation therapy in patients who are at high risk for SCD.

7.
J Cardiovasc Med (Hagerstown) ; 20(12): 825-830, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31592849

RESUMO

PURPOSE: In the current case series, we present our experience with the self-expanding CoreValve or Evolut R (Medtronic Inc.) in patients with severe symptomatic aortic valve stenosis and concomitant mitral valve prosthesis. METHODS: Twelve patients with previous mitral valve prosthesis underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and/or aortic valve regurgitation. All patients underwent evaluation with an echocardiogram, computed tomography and coronary angiogram. After the index intervention and before discharge all patients underwent transthoracic echocardiography. All outcomes were defined according to the Valve Academic Research Consortium-2 criteria. RESULTS: Eleven patients underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and one patient for severe aortic valve regurgitation. There was immediate improvement of patients' hemodynamic status; no cases of procedural death, stroke, myocardial infarction, or urgent cardiac surgery occurred. There was no 30-day mortality and all patients improved, with 91.6% in functional New York Heart Association class I-II. CONCLUSION: The current study demonstrates that in patients with severe aortic valve stenosis or regurgitation and mitral valve prosthesis, the implantation of a self-expanding aortic valve via the transfemoral route is safe and feasible, with maintained long-term results.

8.
J Invasive Cardiol ; 31(5): E76-E82, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034438

RESUMO

BACKGROUND: In transcatheter aortic valve implantation (TAVI), prosthesis over-sizing prevents paravalvular leak (PVL). Strategies of over-sizing for self-expanding bioprostheses are not well established at present. METHODS: Patients with aortic valve stenosis scheduled for TAVI underwent preprocedural multislice computed tomography. Based on the degree of over-sizing, a ROC curve was drawn to define the optimal value of valve sizing for reducing PVL after TAVI. RESULTS: A total of 152 consecutive patients were included in the study (mean age, 79.95 ± 7.71 years; log EuroScore: 23.87 ± 8.93%). Based on the ROC curve, sizing of 14% was the optimal that would lead to less moderate/severe PVL (P<.01). Group 1 was defined as sizing <14% (n = 49 patients) and group 2 was defined as sizing ≥14% (n = 103 patients). During a follow-up period of 36 ± 14 months, a total of 9 patients died from group 1 vs 4 patients from group 2 (P<.01). Two of the patients who died had moderate/severe PVL and 11 had no/mild PVL (P=.27). From the population, a total of 49 patients (32%) were found to be in the "borderline" zone. Patients who received the smaller valve had lower mean left ventricular outflow tract diameter (P=.048), higher rate of calcium load (mild: 10 [32%] vs 13 [72%]; moderate: 16 [52%] vs 3 [17%]; severe: 5 [16%] vs 2 [11%]; P=.02) and lower mean of sinus of Valsalva diameter (P=.046) compared with patients who received the bigger valve. CONCLUSIONS: In patients undergoing TAVI, over-sizing the prosthesis at least 14% reduces PVL. In borderline cases, taking into consideration additional anatomical parameters may result in low rates of PVL.


Assuntos
Insuficiência da Valva Aórtica , Valva Aórtica , Próteses Valvulares Cardíacas , Tomografia Computadorizada Multidetectores , Complicações Pós-Operatórias , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/prevenção & controle , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Feminino , Grécia , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/normas , Humanos , Masculino , Tomografia Computadorizada Multidetectores/métodos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Falha de Prótese/etiologia , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos
9.
Hellenic J Cardiol ; 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-31002876

RESUMO

BACKGROUND: It is reported that the mitral valve (MV) in hypertrophic cardiomyopathy (HCM) has structural abnormalities. PURPOSE: To assess the MV in HCM patients using Three-Dimensional Transesophageal Echocardiography (3DTEE). METHODS: Transthoracic and 3DTEE studies focused on the mitral valve were performed prospectively in 21 HCM patients with obstruction (Group I), 37 HCM patients without obstruction (Group II) and 28 controls (Group III). RESULTS: The aortomitral angle was less obtuse in groups I and II compared with group III (104.6 ± 6.7° vs 107.6 ± 8.5° vs 112.9 ± 3.2°, p < 0.001) and the annulus height was larger (11.6 ± 1.3 mm vs 11.6 ± 2 mm vs 9.3 ± 1.1 mm, p < 0.001). Patients in group I compared with groups II and III had increased ratio of anterior leaflet length to left ventricular outflow tract (LVOT) diameter (1.9 ± 0.1 vs 1.7 ± 0.3 vs 1.3 ± 0.1, p < 0.05) and anterior displacement of the coaptation line as showed by the reduced ratio of anterior to posterior leaflet length in the projection plane (1.7 ± 0.4 mm vs 2.2 ± 0.7 mm vs 2.4 ± 0.7 mm, p < 0.05). In groups I and II there was a positive correlation between the MV annulus height and the presence of non-sustained ventricular tachycardia (rs = 0.25, p < 0.05). CONCLUSION: The MV in HCM patients with or without obstruction shares some common anatomic features. Additionally, the MV in patients with obstruction has unique characteristics that appear to contribute to LVOT obstruction.

11.
Hellenic J Cardiol ; 2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30853607

RESUMO

We report the first case of real-time FFRangio™ application in Greece applied in a patient with tandem lesions in the proximal segment of the left anterior descendent artery.

12.
Int J Cardiovasc Imaging ; 35(2): 285-294, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30623352

RESUMO

Non-response cardiac resynchronization therapy (CRT) remains an issue, despite the refinement of selection criteria. The purpose of this study was to investigate the role of stress echocardiography along with dyssynchrony parameters for identification of CRT responders or late responders. 106 symptomatic heart failure patients were examined before, 6 months and 2-4 years after CRT implementation. Inotropic contractile reserve (ICR) and inferolateral (IL) wall viability were studied by stress echocardiography. Dyssynchrony was assessed by: (1) Septal to posterior wall motion delay (SPWMD) by m-mode. (2) Septal to lateral wall delay (SLD) by TDI. (3) Interventricular mechanical delay (IVMD) by pulsed wave Doppler for (4) difference in time to peak circumferential strain (TmaxCS) by speckle tracking. (5) Apical rocking (ApR) and septal flash (SF) by visual assessment. At 6 months there were 54 responders, with 12 additional late responders. TmaxCS had the greatest predictive value with an area under curve (AUC) of 0.835, followed by the presence of both ICR and viability of IL wall (AUC 0.799), m-mode (AUC = 0.775) and presence of either ApR or SF (AUC = 0.772). Predictive ability of ApR and of ICR is augmented if late responders are also included. Performance of dyssynchrony parameters is enhanced, in patients with both ICR and IL wall viability. Stress echocardiography and dyssynchrony parameters are simple and reliable predictors of 6-month and late CRT response. A stepwise approach with an initial assessment of ICR and viability and, if positive, further dyssynchrony analysis, could assist decision making.


Assuntos
Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Terapia de Ressincronização Cardíaca , Dobutamina/administração & dosagem , Ecocardiografia Doppler em Cores , Ecocardiografia sob Estresse/métodos , Insuficiência Cardíaca/terapia , Contração Miocárdica , Função Ventricular Esquerda , Função Ventricular Direita , Idoso , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
14.
Clin Cardiol ; 41(12): 1600-1610, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30315566

RESUMO

Stress echocardiography (SE) is a very useful method in clinical practice, because it offers important information of both the patient's functional status and hemodynamic changes during stress. Therefore, SE provides strong diagnostic and prognostic data in a wide spectrum of cardiovascular diseases. This review summarizes the clinical applications of SE in conditions beyond coronary artery disease (CAD) and highlights practical recommendations and key issues for each condition that need further investigation. SE is an established method for the evaluation of symptomatic and asymptomatic patients with valvular heart disease (VHD) and cardiomyopathies, and provides important information regarding prognosis and management of patients with congenital heart disease, pulmonary hypertension or diastolic dysfunction. Moreover, when one or multiple VHD and cardiomyopathy or CAD coexist in one patient, SE is a very useful clinical tool for the evaluation of etiology and symptomatology.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Ecocardiografia sob Estresse/métodos , Hemodinâmica/fisiologia , Doença da Artéria Coronariana/fisiopatologia , Humanos , Reprodutibilidade dos Testes
15.
Int J Cardiovasc Imaging ; 34(12): 1849-1861, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29956022

RESUMO

Patent foramen ovale (PFO) is a residual, oblique, slit or tunnel like communication in the atrial septum that persists into adulthood. It is usually an incidental finding with no clinical repercussions. Nevertheless, recent evidence supports the association between the presence of a PFO and a number of clinical conditions, most notably cryptogenic stroke (CS). There is enough evidence that paradoxical embolism is a mechanism which can explain this association. Patient characteristics and certain echocardiography-derived anatomical and hemodynamic features of PFO provide great assistance in estimating the probability of paradoxical embolism. In this review, we initially describe PFO embryology and anatomy. We extensively present the available data on clinical, anatomical and hemodynamic features of PFOs which have been correlated with increased likelihood of paradoxical embolism and recent evidence of therapeutic management.


Assuntos
Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Forame Oval Patente/diagnóstico por imagem , Forame Oval/diagnóstico por imagem , Embolia Paradoxal/etiologia , Embolia Paradoxal/fisiopatologia , Embolia Paradoxal/prevenção & controle , Forame Oval/embriologia , Forame Oval/fisiopatologia , Forame Oval Patente/complicações , Forame Oval Patente/fisiopatologia , Forame Oval Patente/terapia , Hemodinâmica , Humanos , Achados Incidentais , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
16.
Echocardiography ; 35(6): 804-808, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29490113

RESUMO

PURPOSE: Global longitudinal strain (GLS) is increasingly accepted as a predictor of mortality in various clinical settings. This study tested the hypothesis that GLS is associated with increased event rate in patients with extracardiac sarcoidosis, who have no overt symptoms of cardiovascular disease and preserved ejection fraction (EF). METHODS: We retrospectively studied 117 patients with extracardiac sarcoidosis and 45 age- and sex-matched controls, who underwent comprehensive echocardiographic study, while GLS was measured by an offline speckle tracking algorithm. Patients who had signs and symptoms of cardiovascular disease at the time of the examination were excluded from the study. Patients were followed for an average of 57.1 months. Primary endpoint was defined as a composite endpoint of heart failure-related hospitalizations, need for device therapy, arrhythmias, and all-cause mortality. RESULTS: The age of patients was 42 ± 6 years old (43 men). Events were recorded in 10 patients (8.5%). Tissue Doppler revealed E/Em 7.9 ± 3.5, while EF was 54.2 ± 3.5%. Global longitudinal strain was 14.4 ± 3%, and a cutoff value ≤-13.6% for GLS was considered more associated with adverse outcomes (AUC 0.84). After adjustment for multiple potential confounders (age, gender, hypertension, diabetes, E/Em, and EF), GLS remained strongly associated with adverse outcomes (HR 0.8, 0.63 to 0.98 95% C.I, P = .04). CONCLUSIONS: In conclusion, among patients with extracardiac sarcoidosis and no symptoms of cardiovascular disease, even when EF is preserved, GLS seems to be strongly associated with adverse future events.


Assuntos
Ecocardiografia Doppler/métodos , Ventrículos do Coração/diagnóstico por imagem , Sarcoidose/fisiopatologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Doenças Cardiovasculares , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Sarcoidose/diagnóstico
17.
Hellenic J Cardiol ; 59(6): 306-312, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29452309

RESUMO

Cardiac resynchronization therapy (CRT) is an established therapeutic option for the subset of patients with heart failure (HF), reduced ejection fraction (EF), and dyssynchrony evidenced by electrocardiography. Benefit from CRT has been proven in many clinical trials, yet a sizeable proportion of these patients with wide QRS do not respond to this intervention, despite the updated practice guidelines. Several echocardiographic indices, targeting mechanical rather than electrical dyssynchrony, have been suggested to address this issue, but research so far has not succeeded in providing a single and simple measurement with adequate sensitivity and specificity for identification of responders. While there is still ongoing research in this field, echocardiography proves helpful in other aspects of CRT implementation, such as site selection for left ventricular (LV) lead pacing and optimization of pacing parameters during follow-up visits.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Eletrocardiografia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Resultado do Tratamento
19.
J Clin Lipidol ; 12(1): 33-43, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29174439

RESUMO

BACKGROUND: Familial dyslipidemias of either heterozygous (heFH) or combined (FCH) type lead to accelerated atherogenesis and increased cardiovascular risk. OBJECTIVE: The aim of this study was to investigate in statin-naïve adult patients with familial dyslipidemias whether inflammatory activation and liver, spleen and bone marrow metabolic activity differ compared with normolipidemic subjects and between dyslipidemic groups. METHODS: Fourteen patients with FCH, 14 with heFH, and 14 normolipidemic individuals were enrolled. Serum lipids, high-sensitivity C-reactive protein, and fibrinogen levels were measured, followed by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Radiotracer uptake in the aortic wall, spleen, bone marrow, and liver was quantified as tissue-to-background ratio (TBR). RESULTS: Patients with heFH had significantly higher low-density lipoprotein levels compared with those with FCH and controls (P < .001). However, aortic TBRs were higher in FCH compared with heFH patients and controls (P = .02 and P < .001, respectively). FCH patients exhibited higher FDG uptake in the spleen compared with controls (P = .05). In addition, FCH exhibited higher bone marrow FDG uptake compared with heFH patients and controls (P = .03 and P = .02, respectively). FCH had higher liver uptake compared with heFH patients and controls (P < .001 for both). Significant correlations were observed between inflammatory biomarkers and imaging indices as well as between aortic TBR and FDG uptake of hematopoietic organs and liver. CONCLUSIONS: Systemic, as well as vascular inflammation and spleen, bone marrow, and hepatic metabolic activity are increased in patients with FCH despite lower levels of low-density lipoprotein.


Assuntos
Medula Óssea/metabolismo , Hiperlipidemia Familiar Combinada/patologia , Hiperlipoproteinemia Tipo II/patologia , Fígado/metabolismo , Baço/metabolismo , Adulto , Biomarcadores/sangue , Medula Óssea/diagnóstico por imagem , Proteína C-Reativa/análise , Estudos de Casos e Controles , Feminino , Heterozigoto , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipidemia Familiar Combinada/tratamento farmacológico , Hiperlipidemia Familiar Combinada/metabolismo , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Hiperlipoproteinemia Tipo II/metabolismo , Inflamação/metabolismo , Lipoproteínas LDL/sangue , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Baço/diagnóstico por imagem
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