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1.
Cardiovasc Drugs Ther ; 34(1): 89-94, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32096001

RESUMO

PURPOSE: The usefulness and mechanisms of antiarrhythmic drug (AAD) pre-treatment as a facilitator of the acute success of electrical cardioversion (ECV) in atrial fibrillation (AF) remain controversial. We sought to analyze the role of AAD treatment with this purpose, differentiating its possible utility either facilitating the restoration of sinus rhythm (SR) or reducing immediate AF recurrences (IAFR). METHODS: We analyzed 2962 consecutive patients with persistent AF undergoing ECV prospectively included in 3 national registries. The acute success of ECV was indicated by the reversion to SR without presenting an IAFR (< 2 h). RESULTS: A total of 1410 patients (48%) received AAD treatment prior to ECV (80% amiodarone, 15% class Ic AAD, 2% other AAD). The rate of restoration of SR was similar between the patients treated with amiodarone (92%), class Ic AAD (91%) and who did not receive AAD pre-treatment (91%) (p = 0.92). However, those treated with amiodarone had fewer IAFR than those in the other two groups (amiodarone 3% vs class Ic 7% vs without treatment 6%; p = 0.002), so the ECV success rate was higher in the amiodarone group than in the other groups (amiodarone 89% vs Ic 84% vs without treatment 86%; p = 0.04). After adjusting for multiple variables, amiodarone remained as an independent predictor of a lower occurrence of IAFR (OR = 0.57; p = 0.01) and of a successful ECV (OR 1.37; p = 0.01). CONCLUSIONS: For patients with persistent AF undergoing ECV, AAD has a neutral effect on the restoration of SR but amiodarone increases its effectiveness due to a lower incidence of IAFR.

4.
Clín. investig. arterioscler. (Ed. impr.) ; 31(3): 93-100, mayo-jun. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182702

RESUMO

Introducción y objetivos: El adecuado control lipídico tras un síndrome coronario agudo (SCA) es una estrategia de prevención secundaria crucial para disminuir el riesgo de reinfarto y muerte cardiovascular. Existen tablas que predicen la dosificación necesaria del tratamiento hipolipidemiante según el colesterol LDL (cLDL) inicial pero no han sido probadas en el SCA. Analizamos los factores asociados al control del cLDL tras un SCA y la utilidad de las tablas de Masana y Plana en este contexto. Métodos: Entre enero de 2015 y mayo de 2016 se incluyeron 326 pacientes con SCA. Se registraron las concentraciones basales de cLDL y el tratamiento hipolipidemiante al alta. Se analizaron las variables asociadas a un adecuado control del cLDL (< 70 mg/dL) en el seguimiento. Resultados: La edad media fue 66 ± 13 años, el 72% varones. El tratamiento hipolipidemiante al alta se ajustó a las recomendaciones de Masana en 196 (60%) pacientes. Tras 122 [66-184] días, en 148 (45%) se alcanzó el objetivo de cLDL, siendo este porcentaje mayor (109/196 -56%- vs. 39/130 -30%- pacientes) cuando el tratamiento fue planificado según las tablas de Masana y Plana (p < 0,001). En el análisis multivariante, el género masculino (p < 0,001), la ausencia de dislipidemia previa (p < 0,001) y la aplicación de las tablas de Masana y Plana (p = 0,007) fueron predictores independientes para alcanzar el cLDL objetivo. Conclusiones: El control lipídico adecuado tras un SCA se alcanza en menos de la mitad de casos. La dosificación de la terapia hipolipidemiante según las tablas de Masanay Plana mejora la consecución de este crucial objetivo terapéutico


Introduction and objectives: Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting. Methods: A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (< 70 mg/dL) control during follow-up. Results: Among our patient population (72% male, age 66 ± 13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P < .001). The male gender (P < .001), the absence of prior history of dyslipemia (P < .001) and the adherence to Masana's recommendations (P = .007) were independent predictors for the achievement of targeted LDLc levels during follow-up. Conclusions: In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , LDL-Colesterol/efeitos dos fármacos , Síndrome Coronariana Aguda/complicações , Prevenção Secundária , Fatores de Risco , Metabolismo dos Lipídeos/efeitos dos fármacos , LDL-Colesterol/metabolismo , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/prevenção & controle , Hipolipemiantes/administração & dosagem , Dislipidemias , Análise Multivariada , Lipídeos/sangue
5.
Ann Noninvasive Electrocardiol ; 24(6): e12662, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31141244

RESUMO

A 52-year-old man was admitted due to out-hospital cardiac arrest. Recurrent ventricular fibrillation (VF) occurred under therapeutic hypothermia thereafter. Previously inadverted full pre-excitation was documented exclusively and immediately prior to 4 out of the 5 VF relapses. Coronary vasospasm and early repolarization were also documented. An electrophysiological study demonstrated poor anterograde conduction over a left-sided accessory pathway. We theorize that maximum pre-excitation favored in-hospital VF by augmenting the repolarization vulnerability induced by therapeutic hypothermia, with coronary vasospasm accounting as the probable cause of out-hospital VF. A plausible VF mechanism in WPW syndrome unrelated to pre-excited atrial fibrillation is discussed.

6.
Clin Investig Arterioscler ; 31(3): 93-100, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30711338

RESUMO

INTRODUCTION AND OBJECTIVES: Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting. METHODS: A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (<70mg/dL) control during follow-up. RESULTS: Among our patient population (72% male, age 66±13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P<.001). The male gender (P<.001), the absence of prior history of dyslipemia (P<.001) and the adherence to Masana's recommendations (P=.007) were independent predictors for the achievement of targeted LDLc levels during follow-up. CONCLUSIONS: In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal.


Assuntos
Síndrome Coronariana Aguda/prevenção & controle , LDL-Colesterol/sangue , Hipolipemiantes/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária/métodos , Fatores Sexuais , Resultado do Tratamento
7.
J Cardiovasc Electrophysiol ; 30(3): 427-437, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30614100

RESUMO

Epicardial ablation may be required to eliminate ventricular tachycardia (VT) in patients with underlying structural heart disease. The decision to gain epicardial access is frequently based on the suspicion of an epicardial origin for the VT and/or presence of an arrhythmogenic substrate. Epicardial pathology and VT is frequently present in patients with nonischemic right and/or left cardiomyopathies even in the setting of modest or no endocardial bipolar voltage substrate. In this setting, unipolar voltage mapping from the endocardium serves to help identify midmyocardial and/or epicardial VT substrate. The additional value of endocardial unipolar mapping includes its usefulness to predict the clinical outcome after VT ablation, to determine the irreversibility of myocardial disease, and to guide endomyocardial biopsy procedures to specific areas of intramural scarring. In this review, we aim to provide a guide to the use of endocardial unipolar mapping and its appropriate interpretation in a variety of clinical situations.

10.
Rev Esp Cardiol (Engl Ed) ; 71(7): 578, 2018 Jul.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29958587
11.
Rev Esp Cardiol (Engl Ed) ; 71(8): 672, 2018 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30054056
14.
Europace ; 20(7): 1209-1216, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29016778

RESUMO

Aims: Pacing from the left ventricular (LV) endocardium might increase the likelihood of response to cardiac resynchronization therapy. However, experimental and clinical data supporting this assumption are limited and controversial. The aim of this study was to compare the acute response of biventricular pacing from the LV epicardium and endocardium in a swine non-ischaemic cardiomyopathy (NICM) model of dyssynchrony. Methods and results: A NICM was induced in six swine by 3 weeks of rapid ventricular pacing. Biventricular stimulation was performed from 16 paired locations in the LV (8 epicardial and 8 endocardial) with two different atrioventricular (80 and 110 ms) intervals and three interventricular (0, +30, -30 ms) delays. The acute response of the aortic blood flow, LV and right ventricular (RV) pressures, LVdP/dtmax and LVdP/dtmin and QRS complex width and QT duration induced by biventricular stimulation were analysed. The haemodynamic and electrical beneficial responses to either LV endocardial or epicardial biventricular pacing were similar (ΔLVdP/dtmax: +7.8 ± 2.2% ENDO vs. +7.3 ± 1.5% EPI, and ΔQRS width: -16.8 ± 1.3% ENDO vs. -17.1 ± 1.9% EPI; P = ns). Pacing from LV basal regions either from the epicardium or endocardium produced better haemodynamic responses as compared with mid or apical LV regions (P < 0.05). The LV regions producing the maximum QRS complex shortening did not correspond to those inducing the best haemodynamic responses (EPI: r2 = 0.013, P = ns; ENDO: r2 = 0.002, P = ns). Conclusion: Endocardial LV pacing induced similar haemodynamic changes than pacing from the epicardium. The response to endocardial LV pacing is region dependent as observed in epicardial pacing.


Assuntos
Arritmias Cardíacas/terapia , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatias/complicações , Endocárdio/fisiopatologia , Insuficiência Cardíaca/terapia , Pericárdio/fisiopatologia , Função Ventricular Esquerda , Função Ventricular Direita , Animais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Modelos Animais de Doenças , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Sus scrofa , Fatores de Tempo
15.
Artigo em Inglês | MEDLINE | ID: mdl-29133379

RESUMO

BACKGROUND: Chagasic cardiomyopathy (CC) is the most frequent nonischemic substrate causing left ventricular (LV) tachycardia in Latin America. Systematic characterization of the LV epicardial/endocardial scar distribution and density in CC has not been performed. Additionally, the usefulness of unipolar endocardial electroanatomic mapping to identify epicardial scar has not been assessed in this setting. METHODS AND RESULTS: Nineteen patients with CC undergoing detailed epicardial and endocardial LV tachycardia mapping and ablation were included. A total of 8494 epicardial and 6331 endocardial voltage signals and 314 epicardial/endocardial matched pairs of points were analyzed. Basal lateral LV scar involvement was observed in 18 of 19 patients. Bipolar voltage mapping demonstrated larger epicardial than endocardial scar and core-dense (≤0.5 mV) scar areas (28 [20-36] versus 19 [15-26] and 21 [2-49] versus 4 [0-7] cm2; P=0.049 and P=0.004, respectively). Bipolar epicardial and endocardial voltages within scar were low (0.4 [0.2-0.55] and 0.54 [0.33-0.87] mV, respectively) and confluent, indicating a dense/transmural scarring process in CC. The endocardial unipolar voltage value (with a newly proposed ≤4-mV cutoff) predicted the presence and extent of epicardial bipolar scar (P<0.001). CONCLUSIONS: CC causes a unique ventricular tachycardia substrate concentrated to the basal lateral LV, with marked epicardial predominance. The scar pattern is particularly dense and transmural as compared with the more erratic/patchy scar patterns seen in other nonischemic cardiomyopathies. Endocardial unipolar voltage mapping serves to characterize epicardial scar in this setting.


Assuntos
Potenciais de Ação , Cardiomiopatia Chagásica/complicações , Cicatriz/etiologia , Endocárdio/fisiopatologia , Mapeamento Epicárdico , Miocárdio/patologia , Pericárdio/fisiopatologia , Taquicardia Ventricular/diagnóstico , Idoso , Ablação por Cateter , Cardiomiopatia Chagásica/diagnóstico , Cicatriz/diagnóstico , Endocárdio/patologia , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgia
16.
Rev. esp. cardiol. (Ed. impr.) ; 70(5): 363-370, mayo 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-162914

RESUMO

Introducción y objetivos: El déficit de hierro (DH) es una condición frecuente en pacientes con cardiopatía isquémica o insuficiencia cardiaca. Pero se desconoce su impacto en la capacidad funcional y la calidad de vida (CdV) tras un síndrome coronario agudo (SCA). Métodos: Se evaluó prospectivamente el impacto del DH en la capacidad funcional y la CdV de 244 pacientes 30 días después de haber sufrido un SCA. La CdV se evaluó mediante el test EuroQol-5 dimensiones, la escala visual analógica y el Heart-QoL. La capacidad funcional se midió mediante ergometría en cinta sin fin o con la prueba de los 6 min de marcha. Se evaluó el impacto del DH en la morbimortalidad cardiovascular. Resultados: Se documentó DH en el 46% de los pacientes. Estos pacientes realizaban ejercicio menos tiempo (366 ± 162 frente a 462 ± 155 s; p < 0,001), presentaban peores tasas metabólicas de consumo (7,9 ± 2,9 frente a 9,3 ± 2,6 equivalentes metabólicos; p = 0,003) y peor CdV, con puntuaciones más bajas en el EuroQol-5 dimensiones (0,76 ± 0,25 frente a 0,84 ± 0,16), la escala visual analógica (66 ± 16 frente a 72 ± 17) y el Heart-QoL (1,9 ± 0,6 frente a 2,2 ± 0,6) (todas, p < 0,05). El DH fue un predictor independiente de peor capacidad funcional (OR = 2,9; IC95%, 1,1-7,6; p = 0,023) y peor CdV (OR = 1,9; IC95%, 1,1-3,3; p < 0,001). No se observó efecto en la morbimortalidad cardiovascular. Conclusiones: El DH implica peor capacidad funcional y peor calidad de vida a medio plazo tras un SCA (AU)


Background and objectives: Iron deficiency (ID) is a prevalent condition in patients with ischemic heart disease and heart failure. Little is known about the impact of ID on exercise capacity and quality of life (QoL) in the recovery phase after an acute coronary syndrome (ACS). Methods: Iron status and its impact on exercise capacity and QoL were prospectively evaluated in 244 patients 30 days after the ACS. QoL was assessed by the standard EuroQoL-5 dimensions, EuroQoL visual analogue scale, and Heart-QoL questionnaires. Exercise capacity was analyzed by treadmill/6-minute walk tests. The effect of ID on cardiovascular mortality and readmission rate was also investigated. Results: A total of 46% of the patients had ID. These patients had lower exercise times (366 ± 162 vs 462 ± 155 seconds; P < .001), metabolic consumption rates (7.9 ± 2.9 vs 9.3 ± 2.6 METS; P = .003), and EuroQoL-5 dimensions (0.76 ± 0.25 vs 0.84 ± 0.16), visual analogue scale (66 ± 16 vs 72 ± 17), and Heart-QoL (1.9 ± 0.6 vs 2.2 ± 0.6) scores (P < .05). ID independently predicted lower exercise times (OR, 2.9; 95%CI, 1.1-7.6; P = .023) and worse QoL (OR, 1.9; 95%CI, 1.1-3.3; P < .001) but had no effect on cardiovascular morbidity or mortality. Conclusions: ID, a prevalent condition in ACS patients, results in a poorer mid-term functional recovery, as measured by exercise capacity and QoL (AU)


Assuntos
Humanos , Deficiência de Ferro/diagnóstico , Síndrome Coronariana Aguda/reabilitação , Biomarcadores/análise , Qualidade de Vida , Perfil de Impacto da Doença , Esforço Físico/fisiologia , Tolerância ao Exercício/fisiologia , Inflamação/fisiopatologia
17.
BMC Cardiovasc Disord ; 17(1): 54, 2017 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-28173757

RESUMO

BACKGROUND: The AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry. DESIGN AND METHODS: Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors. RESULTS: A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11-30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates. CONCLUSIONS: Whereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.


Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Prevenção Secundária/métodos , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Prestação Integrada de Cuidados de Saúde , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Hipolipemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Recidiva , Sistema de Registros , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Fumar/efeitos adversos , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Fatores de Tempo , Resultado do Tratamento
18.
Rev Esp Cardiol (Engl Ed) ; 70(5): 363-370, 2017 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27838349

RESUMO

BACKGROUND AND OBJECTIVES: Iron deficiency (ID) is a prevalent condition in patients with ischemic heart disease and heart failure. Little is known about the impact of ID on exercise capacity and quality of life (QoL) in the recovery phase after an acute coronary syndrome (ACS). METHODS: Iron status and its impact on exercise capacity and QoL were prospectively evaluated in 244 patients 30 days after the ACS. QoL was assessed by the standard EuroQoL-5 dimensions, EuroQoL visual analogue scale, and Heart-QoL questionnaires. Exercise capacity was analyzed by treadmill/6-minute walk tests. The effect of ID on cardiovascular mortality and readmission rate was also investigated. RESULTS: A total of 46% of the patients had ID. These patients had lower exercise times (366±162 vs 462±155seconds; P<.001), metabolic consumption rates (7.9±2.9 vs 9.3±2.6 METS; P=.003), and EuroQoL-5 dimensions (0.76±0.25 vs 0.84±0.16), visual analogue scale (66±16 vs 72±17), and Heart-QoL (1.9±0.6 vs 2.2±0.6) scores (P<.05). ID independently predicted lower exercise times (OR, 2.9; 95%CI, 1.1-7.6; P=.023) and worse QoL (OR, 1.9; 95%CI, 1.1-3.3; P<.001) but had no effect on cardiovascular morbidity or mortality. CONCLUSIONS: ID, a prevalent condition in ACS patients, results in a poorer mid-term functional recovery, as measured by exercise capacity and QoL.


Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/fisiopatologia , Ferro/deficiência , Qualidade de Vida , Recuperação de Função Fisiológica , Síndrome Coronariana Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
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