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2.
Sleep Breath ; 23(3): 747-752, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30552556

RESUMO

PURPOSE: Obstructive sleep apnea (OSA) is highly prevalent among patients with coronary artery disease (CAD). The relationship between the severity of OSA and the severity of CAD has not been entirely established. The objective was to explore the type of correlation existent between the apnea-hypopnea index and the Gensini score, which provides granularity in terms of CAD extension and severity, in search of a dose-response relationship. METHODS: A cross-sectional study was conducted among patients that underwent cardiac catheterization due to the suspicion of CAD. Coronary lesions were classified according to one's Gensini score. The severity of OSA was determined by the apnea-hypopnea index (AHI), obtainable through a respiratory polysomnography. RESULTS: Eighty patients were eligible for the study. The mean age was 55 years, and 37% had AHI ≥ 15. Forty-four subjects (55%) had a Gensini score of 0, and five had a score < 2, indicating a 25% obstruction in a non-proximal artery; these individuals were considered non-CAD controls; and clinical characteristics were similar between them and CAD cases. Attempts to correlate the AHI with the Gensini score either converting both variables to square root (r = 0.08) or using Spearman's rho (rho = 0.13) obtained small, non-significant coefficients. AHI ≥ 15 was a predictor of a Gensini score ≥ 2 with a large effect size (OR 4.46) when adjusted for age ≥ 55 years, BMI ≥ 25 kg/m2, uric acid, and hypertension. CONCLUSIONS: In patients undergoing coronary angiography due to suspected CAD, moderate-severe OSA was associated with the presence of CAD but no significant correlation was found between the lesion severity and the AHI. Our results suggest that OSA influences CAD pathogenesis but a dose-response relationship is unlikely.

3.
Coron Artery Dis ; 2018 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-30334819

RESUMO

BACKGROUND: Elevated neutrophil-to-lymphocyte ratio (NLR) is an indirect marker of inflammation, and is associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the usefulness of NLR to predict procedural adverse events is patients who underwent primary percutaneous coronary intervention (PCI). PATIENTS AND METHODS: Consecutive patients with STEMI who underwent primary PCI were divided into low and high NLR, whereas high was defined as an NLR value above 75° percentile (≥9.45). The occurrence of procedural complications, in-hospital, and 30-day major adverse cardiovascular events and 1-year all-cause mortality were evaluated. RESULTS: We included 664 patients with a mean age of 60.5 (±12.1) years and 66.3% were male. In multivariate analysis, NLR remained an independent predictor of in-hospital death [relative risk (RR)=1.03; 95% confidence interval (CI)=1.00-1.08; P=0.04], contrast-induced nephropathy (RR=2.35; 95% CI=1.11-4.71; P=0.02), distal embolization (RR=2.72; 95% CI=1.55-4.75; P<0.001), and no-reflow (RR=2.31; 95% CI=2.31-4.68; P=0.01). The area under the curve for distal embolization was 0.67, 0.64 for no-reflow and 0.62 for procedural complications. A low value of NLR had an excellent negative predictive value of 97.8, 96.9, and 92.1 for distal embolization, no-reflow, and procedural complications, respectively. CONCLUSION: High NLR is an independent predictor of distal embolization, no-reflow, and procedural complications in patients with STEMI who underwent primary PCI. A low NLR value has an excellent negative predictive value for these procedural outcomes. NLR may be a useful and inexpensive tool that may be used at bedside.

4.
Cardiovasc Interv Ther ; 33(3): 224-231, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28540634

RESUMO

Contrast-induced acute kidney injury (CI-AKI) is a common event after percutaneous coronary intervention (PCI). Presently, the main strategy to avoid CI-AKI lies in saline hydration, since to date none pharmacologic prophylaxis proved beneficial. Our aim was to determine if a low complexity mortality risk model is able to predict CI-AKI in patients undergoing PCI after ST elevation myocardial infarction (STEMI). We have included patients with STEMI submitted to primary PCI in a tertiary hospital. The definition of CI-AKI was a raise of 0.3 mg/dL or 50% in post procedure (24-72 h) serum creatinine compared to baseline. Age, glomerular filtration and ejection fraction were used to calculate ACEF-MDRD score. We have included 347 patients with mean age of 60 years. In univariate analysis, age, diabetes, previous ASA use, Killip 3 or 4 at admission, ACEF-MDRD and Mehran scores were predictors of CI-AKI. After multivariate adjustment, only ACEF-MDRD score and diabetes remained CI-AKI predictors. Areas under the ROC curve of ACEF-MDRD and Mehran scores were 0.733 (0.68-0.78) and 0.649 (0.59-0.70), respectively. When we compared both scores with DeLong test ACEF-MDRDs AUC was greater than Mehran's (P = 0.03). An ACEF-MDRD score of 2.33 or lower has a negative predictive value of 92.6% for development of CI-AKI. ACEF-MDRD score is a user-friendly tool that has an excellent CI-AKI predictive accuracy in patients undergoing primary percutaneous coronary intervention. Moreover, a low ACEF-MDRD score has a very good negative predictive value for CI-AKI, which makes this complication unlikely in patients with an ACEF-MDRD score of <2.33.

5.
Diabetol Metab Syndr ; 9: 67, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28878828

RESUMO

BACKGROUND: Interleukin-6 (IL-6) plays a central role in atherosclerosis and inflammation. It may improve risk prediction in patients at intermediate cardiovascular risk. OBJECTIVE: To analyze the impact of serum IL-6 in predicting early angiographic coronary artery disease in patients at intermediate cardiovascular risk with chest pain. METHODS: In a cross-sectional study, patients referred for coronary angiography due to suspected coronary artery disease (CAD) were included. Coronary artery disease was defined as the presence of at least 30% stenosis in one or more coronary artery. Severity of CAD was classified by the anatomic burden score. Performance of serum IL-6 assay was compared with ACC/AHA atherosclerotic cardiovascular disease (ASCVD) risk score and hs-CRP through receiver operating characteristic (ROC) curves. RESULTS: We have included 48 patients with a mean 10-year ASCVD risk of 10.0 ± 6.8%. The prevalence of CAD was 72.9%. The presence of CAD was associated with higher mean levels of IL-6 (p = 0.025). Patients with CAD had significantly more overweight than subjects without CAD. In 27% of patients, IL-6 was >1.0 pg/mL and 100% of these patients had CAD, while only 64% in those with IL-6 <1.0 pg/mL, corresponding to a positive predictive value of 100% (p = 0.015). The area under the receiver operating characteristic (ROC) curve of IL-6, hs-CRP and ASCVD were respectively 0.72, 0.60 and 0.54. Intermediate risk patients with IL-6 >1.0 pg/mL were further reclassified into ASCVD high risk due to the presence of coronary lesions. CONCLUSION: In intermediate risk patients referred for coronary angiography, a serum IL-6 level above 1 pg/mL is predictive of significant CAD. IL-6 determination may be useful to reclassify ASCVD intermediate risk patients into higher risk categories.

6.
J Invasive Cardiol ; 29(7): E79-E80, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28667809

RESUMO

The clinical course of coronary artery aneurysms after drug-eluting stent implantation is variable. Some aneurysms naturally resolve, but some can lead to complications such as stent thrombosis. In order to avoid such complications, it is important to reduce as much as possible the chance of exposing causal factors, and intravascular imaging may be needed in order to accurately assess the results of stent deployment and apposition. In the presented case, intravascular imaging was shown to be useful in accurately assessing the results of bioresorbable stent deployment and apposition.


Assuntos
Implantes Absorvíveis/efeitos adversos , Aneurisma Coronário/etiologia , Estenose Coronária/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias , Tecidos Suporte/efeitos adversos , Aneurisma Coronário/diagnóstico , Estenose Coronária/diagnóstico , Vasos Coronários , Humanos , Masculino , Pessoa de Meia-Idade
7.
J Bras Nefrol ; 39(1): 91-94, 2017 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-28355402

RESUMO

INTRODUCTION: Patients with chronic kidney disease (CKD) are at increased risk for thrombotic complications. The use of central venous catheters as dialysis vascular access additionally increases this risk. We describe the first case of Budd-Chiari syndrome (BCS) secondary to central venous catheter misplacement in a patient with CKD. CASE REPORT: A 30-year-old female patient with HIV/AIDS and CKD on hemodialysis was admitted to the emergency room for complaints of fever, prostration, and headache in the last six days. She had a tunneled dialysis catheter placed at the left jugular vein. The diagnosis of BCS was established by abdominal computed tomography that showed a partial thrombus within the inferior vena cava which extended from the right atrium to medium hepatic vein, and continuing along the left hepatic vein. Patient was treated with anticoagulants and discharged asymptomatic. DISCUSSION: Budd-Chiari syndrome is a rare medical condition caused by hepatic veins thrombosis. It can involve one, two, or all three of the major hepatic veins. It is usually related to myeloproliferative disorders, malignancy and hypercoagulable states. This case calls attention for inadvertent catheter tip placement into hepatic vein leading to this rare complication. CONCLUSION: Assessment of catheter dialysis tip location with radiological image seems to be a prudent measure after each procedure even if the tunneled dialysis catheter has been introduced with fluoroscopy image.


Assuntos
Síndrome de Budd-Chiari/etiologia , Cateteres Venosos Centrais/efeitos adversos , Trombose/complicações , Trombose/etiologia , Veia Cava Inferior , Adulto , Feminino , Humanos
8.
J. bras. nefrol ; 39(1): 91-94, Jan.-Mar. 2017. graf
Artigo em Inglês | LILACS-Express | ID: biblio-841197

RESUMO

Abstract Introduction: Patients with chronic kidney disease (CKD) are at increased risk for thrombotic complications. The use of central venous catheters as dialysis vascular access additionally increases this risk. We describe the first case of Budd-Chiari syndrome (BCS) secondary to central venous catheter misplacement in a patient with CKD. Case report: A 30-year-old female patient with HIV/AIDS and CKD on hemodialysis was admitted to the emergency room for complaints of fever, prostration, and headache in the last six days. She had a tunneled dialysis catheter placed at the left jugular vein. The diagnosis of BCS was established by abdominal computed tomography that showed a partial thrombus within the inferior vena cava which extended from the right atrium to medium hepatic vein, and continuing along the left hepatic vein. Patient was treated with anticoagulants and discharged asymptomatic. Discussion: Budd-Chiari syndrome is a rare medical condition caused by hepatic veins thrombosis. It can involve one, two, or all three of the major hepatic veins. It is usually related to myeloproliferative disorders, malignancy and hypercoagulable states. This case calls attention for inadvertent catheter tip placement into hepatic vein leading to this rare complication. Conclusion: Assessment of catheter dialysis tip location with radiological image seems to be a prudent measure after each procedure even if the tunneled dialysis catheter has been introduced with fluoroscopy image.


Resumo Introdução: Pacientes com doença renal crônica (DRC) apresentam risco aumentado de complicações trombóticas e o uso de cateter venoso central para realização de hemodiálise aumenta este risco. Nós descrevemos um caso de síndrome de Budd-Chiari (SBC) causado pelo mal posicionamento de um cateter de diálise em um paciente com DRC e, para nosso conhecimento, este é o primeiro caso relatado na literatura. Caso clínico: Paciente feminina, 30 anos, com diagnóstico de HIV/SIDA e DRC em hemodiálise foi admitida na emergência com queixas de febre, prostração e cefaleia há 6 dias. Ela apresentava um cateter de diálise tunelizado implantado 7 dias antes na veia jugular esquerda. O diagnóstico de SBC foi realizado por tomografia computadorizada abdominal que mostrava um trombo no interior da veia cava inferior o qual estendia-se desde o átrio direito até a veia hepática esquerda. O cateter foi removido e a paciente foi anticoagulada. A paciente estava assintomática no momento da alta hospitalar. Discussão: SBC é uma condição clínica rara causada por trombose das veias hepáticas, podendo envolver desde uma até todas as três principais veias. Esta síndrome é em geral associada a desordens mieloproliferativas, a malignidades e a situações de hipercoagulabilidade. Este caso demonstra que o mal posicionamento da ponta do cateter no interior da veia hepática causou esta rara complicação. Conclusão: Realização de exame radiológico para avaliar localização da ponta do cateter de diálise é uma medida prudente após cada procedimento, mesmo nos casos de implante de cateter de diálise tunelizados com fluoroscopia.

9.
J Interv Cardiol ; 29(5): 447-453, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27377243

RESUMO

OBJECTIVES: We sought to compare 2 contrast-induced nephropathy (CIN) risk prediction models in a validation cohort using a consensus definition. BACKGROUND: Contrast-induced nephropathy (CIN) is independently associated with mortality following percutaneous coronary intervention (PCI). Multiple prediction models for the development of CIN have been published using heterogeneous outcome definitions. METHODS: We analyzed 5,540 patients who underwent PCI from January 2005 to June 2012 at a single academic medical center. The primary outcome was development of CIN, defined as an increase in serum creatinine of ≥0.5 mg/dl or a relative increase of ≥25% from baseline. Receiver operator characteristic (ROC) curves were used to evaluate the discriminatory power of Mehran and WBH prediction models. RESULTS: The mean age of our cohort was 68 ± 12 years. The mean baseline creatinine was 1.2 ± 0.53 mg/dl (eGFR 73 ± 27 ml/min). The mean contrast volume used was 212 ± 92 ml. CIN occurred in 436 patients (7.9%). The Mehran risk score demonstrated better discrimination than the William Beaumont Hospital (WBH) risk score to predict the occurrence of CIN (c statistic: 0.82 vs. 0.73, respectively). Mortality at 30 days was approximately 8 times higher among patients with CIN as compared to those without (14.7% vs. 1.8% P < 0.01). CONCLUSIONS: In an independent validation cohort, the Mehran risk model demonstrates greater discriminatory power than the WBH model in predicting the incidence of CIN. Mortality was significantly higher in patients who developed CIN after PCI.


Assuntos
Meios de Contraste/efeitos adversos , Doença das Coronárias , Nefropatias , Intervenção Coronária Percutânea , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Doença das Coronárias/terapia , Creatinina/análise , Feminino , Humanos , Nefropatias/induzido quimicamente , Nefropatias/diagnóstico , Nefropatias/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Avaliação de Processos e Resultados (Cuidados de Saúde) , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Fatores de Risco , Estados Unidos/epidemiologia
10.
Diabetes Care ; 34(11): 2353-5, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21926286

RESUMO

OBJECTIVE To evaluate the performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate glomerular filtration rate (GFR) in type 2 diabetic patients with GFR >60 mL/min/1.73 m(2). RESEARCH DESIGN AND METHODS This was a cross-sectional study including 105 type 2 diabetic patients. GFR was measured by (51)Cr-EDTA method and estimated by the MDRD and CKD-EPI equations. Serum creatinine was measured by the traceable Jaffe method. Bland-Altman plots were used. Bias, accuracy (P30), and precision were evaluated. RESULTS The mean age of patients was 57 ± 8 years; 53 (50%) were men and 90 (86%) were white. Forty-six (44%) patients had microalbuminuria, and 14 (13%) had macroalbuminuria. (51)Cr-EDTA GFR was 103 ± 23, CKD-EPI GFR was 83 ± 15, and MDRD-GFR was 78 ± 17 mL/min/1.73 m² (P < 0.001). Accuracy (95% CI) was 67% (58-74) for CKD-EPI and 64% (56-75) for MDRD. Precision was 21 and 22, respectively. CONCLUSIONS The CKD-EPI and MDRD equations pronouncedly underestimated GFR in type 2 diabetic patients.


Assuntos
Creatinina/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Taxa de Filtração Glomerular , Falência Renal Crônica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminúria/sangue , Glicemia , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
11.
Inflamm Res ; 60(2): 137-42, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20848159

RESUMO

OBJECTIVE: To evaluate the association between plasma myeloperoxidase (MPO) levels and angiographic severity of coronary atherosclerotic lesions in patients with non-ST elevation acute coronary syndrome (ACS). DESIGN AND METHODS: This cross-sectional study examined high-risk ACS patients who underwent coronary angiography within 72 h of the onset of symptoms by measuring their plasma MPO levels after sheath insertion. Gensini score was used to evaluate angiographic severity of coronary artery disease. RESULTS: A total of 48 patients were included in the study. Median MPO levels and Gensini scores were 6.9 ng/mL (4.4-73.5 ng/mL) and 10 (0-87.5), respectively. Spearman's correlation coefficient did not show a significant association between MPO levels and Gensini scores (r (s) = 0.2; p = 0.177). There was no correlation between MPO and age, hypertension, diabetes, leukocyte count, troponin I, CK-MB ≥ 2 × ULN (upper limit of normal), TIMI risk score ≥ 4 and Gensini score in the multivariate analysis. CONCLUSION: Our findings indicate that MPO expression is not associated with anatomical severity of coronary lesions in ACS.


Assuntos
Síndrome Coronariana Aguda/patologia , Doença da Artéria Coronariana/enzimologia , Doença da Artéria Coronariana/patologia , Peroxidase/sangue , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
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