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1.
J Nucl Cardiol ; 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31111450

RESUMO

OBJECTIVE: Myocardial positron emission tomography (PET) to detect cardiac sarcoidosis requires adequate patient preparation; however, in many cases physiologic myocardial 18F-fluorodeoxyglucose (18F-FDG) uptake may not be adequately suppressed. We sought to evaluate the efficacy of a structured patient preparation protocol as recommended by the joint SNMMI/ASNC expert consensus document on the role of 18F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring. The SNMMI/ASNC preparation protocol recommends at least two high-fat (> 35 g), low-carbohydrate (< 3 g) (HFLC) meals the day before testing followed by fasting for at least 4-12 hours. METHODS: All unique PET scans performed for cardiac sarcoidosis before (group 1) and after (group 2) application of the new preparation protocol were included in the study. In group 1, patients were given a preparation protocol of HFLC meals with suggested meals examples, while patients in group 2 received detailed diet instructions, together with accepted and non-accepted meal examples along. In group 2, reinforcement of instructions by nursing staff and review of dietary log were performed prior to testing. All PET images were evaluated for suppression of physiologic myocardial 18F-FDG uptake. RESULTS: Group 1 included 124 unique patients, and group 2 included 232 unique patients. There were no significant differences in baseline patient characteristics between the two groups. Suppression of physiologic myocardial 18F-FDG uptake was achieved in 91% of patients in group 2, compared to 78% of patients in group 1 (P < .001). A "diffuse" myocardial uptake pattern, indicating inadequate 18F-FDG suppression, was seen in 2% of studies in group 2 vs 12% in group 1 (P < .001). CONCLUSION: In this single-center study, application of a structured preparation protocol was highly successful in achieving suppression of physiologic myocardial 18F-FDG uptake in patients undergoing myocardial PET for cardiac sarcoidosis.

2.
J Am Heart Assoc ; 8(2): e008968, 2019 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-30638108

RESUMO

Background Myocarditis is an important cause of acute and chronic heart failure. Men with myocarditis have worse recovery and an increased need for transplantation compared with women, but the reason for the sex difference remains unclear. Elevated sera soluble (s) ST2 predicts mortality from acute and chronic heart failure, but has not been studied in myocarditis patients. Methods and Results Adults with a diagnosis of clinically suspected myocarditis (n=303, 78% male) were identified according to the 2013 European Society of Cardiology position statement. Sera sST2 levels were examined by ELISA in humans and mice and correlated with heart function according to sex and age. Sera sST2 levels were higher in healthy men ( P=8×10-6) and men with myocarditis ( P=0.004) compared with women. sST2 levels were elevated in patients with myocarditis and New York Heart Association class III - IV heart failure ( P=0.002), predominantly in men ( P=0.0003). Sera sST2 levels were associated with New York Heart Association class in men with myocarditis who were ≤50 years old ( r=0.231, P=0.0006), but not in women ( r=0.172, P=0.57). Sera sST2 levels were also significantly higher in male mice with myocarditis ( P=0.005) where levels were associated with cardiac inflammation. Gonadectomy with hormone replacement showed that testosterone ( P<0.001), but not estradiol ( P=0.32), increased sera sST2 levels in male mice with myocarditis. Conclusions We show in a well-characterized subset of heart failure patients with clinically suspected and biopsy-confirmed myocarditis that elevated sera sST2 is associated with an increased risk of heart failure based on New York Heart Association class in men ≤50 years old.

3.
Heart Fail Clin ; 15(1): 29-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30449378

RESUMO

Occurring in approximately 1 in 1000 live births in the United States, peripartum cardiomyopathy (PPCM) is characterized by left ventricular ejection fraction reduced to less than 45% near the end of pregnancy or within the first 5 months after delivery. Although the cause of PPCM remains unclear, increasing evidence supports a complex interaction of genetic and environmental factors contributing to angiogenic imbalance, which may lead to myocardial dysfunction in a susceptible woman. This article reviews the progress that has been made regarding understanding of the cause, management, and natural history of PPCM.


Assuntos
Cardiomiopatias , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Cardiomiopatias/terapia , Gerenciamento Clínico , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Prognóstico , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/etiologia , Transtornos Puerperais/terapia , Disfunção Ventricular Esquerda/diagnóstico
5.
Obstet Gynecol ; 131(2): 322-327, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29324614

RESUMO

OBJECTIVE: To describe cardiac and obstetric outcomes in subsequent pregnancies of patients with peripartum cardiomyopathy and to report demographic and clinical characteristics of index pregnancies. METHODS: We conducted a retrospective cohort study of all pregnant patients with prior peripartum cardiomyopathy seen at the Mayo Clinic from January 2000 through March 2017. Maternal and neonatal outcome data of index and all subsequent pregnancies were abstracted, and all echocardiography examinations were individually reviewed. RESULTS: Twenty-five patients with prior peripartum cardiomyopathy were included; all except one had recovered left ventricular (LV) function (LV ejection fraction 50% or greater) before the subsequent pregnancy. Forty-three subsequent pregnancies were identified: six (14.0%) miscarriages, four (9.3%) terminations, and 33 (76.7%) live births. The rate of peripartum cardiomyopathy relapse was 20.9%; median LV ejection fraction nadir in patients with relapse was 43% (range 35-45%). None had LV ejection fraction decline to the level of their index pregnancy. No cardiac arrests or deaths were observed, and all patients with relapse recovered LV function. Median gestational age at delivery for all live births in subsequent pregnancies was 39.0 weeks (range 36 6/7-41 3/7 weeks). CONCLUSION: Patients with a history of peripartum cardiomyopathy who recover LV function are at risk for a transient minor decrease in LV ejection fraction during future pregnancies, but obstetric and neonatal outcomes are often favorable.


Assuntos
Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Complicações do Trabalho de Parto/epidemiologia , Transtornos Puerperais/fisiopatologia , Adolescente , Adulto , Cardiomiopatias/diagnóstico , Feminino , Humanos , Gravidez , Resultado da Gravidez , Transtornos Puerperais/diagnóstico , Recidiva , Estudos Retrospectivos , Função Ventricular Esquerda , Adulto Jovem
6.
Circ Res ; 121(7): 819-837, 2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-28912185

RESUMO

Restrictive cardiomyopathy (RCM) is characterized by nondilated left or right ventricle with diastolic dysfunction. The restrictive cardiomyopathies are a heterogenous group of myocardial diseases that vary according to pathogenesis, clinical presentation, diagnostic evaluation and criteria, treatment, and prognosis. In this review, an overview of RCMs will be presented followed by a detailed discussion on 3 major causes of RCM, for which tailored interventions are available: cardiac amyloidosis, cardiac sarcoidosis, and cardiac hemochromatosis. Each of these 3 RCMs is challenging to diagnose, and recognition of each disease entity is frequently delayed. Clinical clues to promote recognition of cardiac amyloidosis, cardiac sarcoidosis, and cardiac hemochromatosis and imaging techniques used to facilitate diagnosis are discussed. Disease-specific therapies are reviewed. Early recognition remains a key barrier to improving survival in all RCMs.


Assuntos
Técnicas de Imagem Cardíaca , Cardiomiopatia Restritiva , Técnicas de Diagnóstico Molecular , Mutação , Miocárdio/patologia , Disfunção Ventricular , Animais , Biópsia , Cardiomiopatia Restritiva/diagnóstico , Cardiomiopatia Restritiva/genética , Cardiomiopatia Restritiva/fisiopatologia , Cardiomiopatia Restritiva/terapia , Análise Mutacional de DNA , Marcadores Genéticos , Predisposição Genética para Doença , Humanos , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco
7.
Am J Cardiol ; 120(8): 1373-1380, 2017 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-28826894

RESUMO

This study aimed to investigate the utility of transthoracic echocardiographic (TTE) Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define optimal cut-off values for identification of such dysfunction by valve type. In total, 971 TTE studies (647 mechanical prostheses; 324 bioprostheses) were compared with transesophageal echocardiography for evaluation of mitral prosthesis function. Among all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral of MVP to that of left ventricular outflow tract; odds ratio [OR] 10.34, 95% confidence interval [95% CI] 6.43 to 16.61, p<0.001), E velocity (OR 3.23, 95% CI 1.61 to 6.47, p<0.001), and mean gradient (OR 1.13, 95% CI 1.02 to 1.25, p=0.02) provided good discrimination of clinically normal and clinically abnormal prostheses. Optimal cut-off values by receiver operating characteristic analysis for differentiating clinically normal and abnormal prostheses varied by prosthesis type. Combining MVP ratio and E velocity improved specificity (92%) and positive predictive value (65%) compared with either parameter alone, with minimal decline in negative predictive value (92%). Pressure halftime (OR 0.99, 95% CI 0.98 to 1.00, p=0.04) did not differentiate between clinically normal and clinically abnormal prostheses but was useful in discriminating obstructed from normal and regurgitant prostheses. In conclusion, cut-off values for TTE-derived Doppler parameters of MVP function were specific to prosthesis type and carried high sensitivity and specificity for identifying prosthetic valve dysfunction. MVP ratio was the best predictor of prosthetic dysfunction and, combined with E velocity, provided a useful parameter for determining likelihood of dysfunction and need for further assessment.


Assuntos
Bioprótese/efeitos adversos , Velocidade do Fluxo Sanguíneo/fisiologia , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Mitral/fisiopatologia , Valva Mitral/fisiopatologia , Função Ventricular Esquerda/fisiologia , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos , Fatores de Tempo
8.
Case Rep Obstet Gynecol ; 2017: 3670520, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28255481

RESUMO

Peripartum cardiomyopathy (PPCM) is a disease that typically affects young otherwise healthy women. As PPCM is associated with significant mortality, timely diagnosis is necessary to ensure appropriate care. To our knowledge, this represents the first reported case of PPCM presenting as symptomatic bradycardia. We describe the patient's clinical presentation and relevant findings and review the potential etiology and ramifications of bradycardia in patients with PPCM.

9.
Circ Heart Fail ; 9(5)2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27166247

RESUMO

BACKGROUND: Peripartum cardiomyopathy has variable disease progression and left ventricular (LV) recovery. We hypothesized that baseline right ventricular (RV) size and function are associated with LV recovery and outcome. METHODS AND RESULTS: Investigations of Pregnancy-Associated Cardiomyopathy was a prospective 30-center study of 100 peripartum cardiomyopathy women with LV ejection fraction (LVEF) <45% within 13 weeks after delivery. Baseline RV function was assessed by echocardiographic end-diastolic area, end-systolic area, fractional area change, tricuspid annular plane excursion, and RV speckle-tracking longitudinal strain. LV recovery was defined as LVEF of ≥50% at 1 year, persistent severe LV dysfunction as LVEF of ≤35%, and major events as death, transplant, or LV assist device implantation. RV measurements were feasible for 90 of the 96 patients (94%) with echocardiograms available. Mean baseline LVEF was 36±9%. RV fractional area change was <35% in 38% of patients. Of 84 patients with 1-year follow-up data, 63 (75%) had LV recovery and 11 (13%) had LVEF of ≤35% or a major event (4 LV assist devices and 2 deaths). Tricuspid annular plane excursion and RV strain did not predict outcome. Baseline RV fractional area change by multivariable analysis was independently associated with subsequent LV recovery and clinical outcome. CONCLUSIONS: Peripartum cardiomyopathy patients had a high incidence of LV recovery, but a significant minority had persistent LV dysfunction or a major clinical event by 1 year. RV function per echocardiographic fractional area change at presentation was associated with subsequent LV recovery and clinical outcomes and thus is prognostically important.


Assuntos
Cardiomiopatias/fisiopatologia , Período Periparto , Complicações Cardiovasculares na Gravidez/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , Função Ventricular Direita , Área Sob a Curva , Canadá , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/mortalidade , Cardiomiopatias/terapia , Ecocardiografia , Feminino , Humanos , Estimativa de Kaplan-Meier , Valor Preditivo dos Testes , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/mortalidade , Complicações Cardiovasculares na Gravidez/terapia , Prognóstico , Estudos Prospectivos , Curva ROC , Recuperação de Função Fisiológica , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Estados Unidos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/terapia
10.
PLoS One ; 11(4): e0153479, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27073856

RESUMO

INTRODUCTION: Right ventricular (RV) systolic dysfunction is now recognized widely as a strong and independent predictor of adverse outcomes in patients with heart failure (HF). Reduction of RV systolic function more closely predicts impaired exercise tolerance and poor survival than does left ventricular (LV) systolic function. In spite of this, there is a dearth of data on RV function in hypertensive HF which is the commonest form of HF in sub-Saharan Africa. We therefore conducted a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, Nigeria over an 8 year period. METHODS: Each subject had transthoracic echocardiography performed on them according to the guidelines of American Society of Echocardiography. RV systolic function was defined as a tricuspid annular plane systolic excursion (TAPSE) <15 mm using M-mode echocardiography. RESULTS: RV systolic dysfunction was identified in 272 (44.5%) of the 611 subjects that were studied. Subjects with TAPSE less than 15 mm had worse prognosis compared to those with TAPSE ≥15 mm.There was a significant correlation between TAPSE and other adverse prognostic markers including left and right atrial area, LV size, LV mass, LV ejection fraction, restrictive mitral inflow and RV systolic pressure (RVSP). However, LV ejection fraction and right atrial area were the only independent determinants of RV systolic dysfunction. CONCLUSIONS: Hypertensive HF is a major cause of RV systolic dysfunction even in a population with a low prevalence of coronary artery disease, and RV systolic dysfunction is associated with poor prognosis in hypertensive HF. Detailed assessment of RV function should therefore be part of the echocardiography evaluation of patients with hypertensive HF.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Hipertensão/fisiopatologia , Sístole/fisiologia , Disfunção Ventricular Direita/fisiopatologia , Adulto , África ao Sul do Saara , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Nigéria , Prognóstico , Estudos Prospectivos , Função Ventricular Direita
11.
A A Case Rep ; 6(1): 6-9, 2016 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-26462164

RESUMO

The diagnosis of heart failure during pregnancy has important management implications for the parturient and her fetus. A 19-year-old primigravida developed eclampsia at 29 weeks' gestation. Echocardiography demonstrated normal left ventricular size and ejection fraction of 35% with reverse apical ballooning (reverse takotsubo pattern). Under general anesthesia with invasive monitoring, she underwent urgent cesarean delivery of a preterm infant. Follow-up echocardiography 4 weeks after delivery showed complete normalization of her ejection fraction (56%). This case of eclampsia-related stress-induced cardiomyopathy is a distinct entity from peripartum cardiomyopathy. Using echocardiography, the diagnoses should be differentiated with appropriate management and counseling.


Assuntos
Eclampsia/fisiopatologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Anestesia Geral , Anticonvulsivantes/uso terapêutico , Cesárea , Diagnóstico Diferencial , Ecocardiografia , Eclampsia/tratamento farmacológico , Feminino , Humanos , Recém-Nascido Prematuro , Unidades de Terapia Intensiva , Sulfato de Magnésio/uso terapêutico , Gravidez , Convulsões/terapia , Volume Sistólico , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/etiologia , Adulto Jovem
12.
Avicenna J Med ; 5(1): 21-3, 2015 Jan-Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25625086

RESUMO

A 63-year-old man presented with generalized fatigue, chills, malaise, dyspnea, intermittent fevers, and 50-pound weight loss of 4 months' duration. Blood cultures were positive for pan-sensitive Streptococcus anginosus. Transesophageal echocardiography showed an 11 mm × 3 mm mobile mass attached to the mitral valve, a 16 mm × 16 mm mobile mass attached to the pulmonary valve, and a small membranous ventricular septal defect. The patient received 12 weeks of intravenous (IV) antibiotics with eventual resolution of the masses. Multi-valve endocarditis involving both the left and right chambers is rarely reported without prior history of IV drug use or infective endocarditis. Our case emphasizes the importance of careful assessment for ventricular septal defects or extra-cardiac shunts in individuals who present with simultaneous right and left-sided endocarditis.

14.
Prog Cardiovasc Dis ; 57(1): 100-10, 2014 Jul-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25081405

RESUMO

Valvular heart disease is a global health problem. It is estimated that more than 280,000 prosthetic heart valves are implanted worldwide each year. As the world's population is aging, the incidence of prosthetic heart valve implantation and the prevalence of prosthetic heart valves continue to increase. Assessing heart valve prosthesis function remains challenging, as prosthesis malfunction is unpredictable but not uncommon. Transthoracic two-dimensional and Doppler echocardiography is the preferred method for assessing prosthetic valve function. Clinically useful Doppler-derived measures for assessing prosthetic valve hemodynamic profiles have been reported for aortic, mitral, and tricuspid valve prostheses, but echocardiographic data regarding pulmonary valve prostheses remain limited. Complete prosthetic valve evaluation by transthoracic echocardiography (TTE) is sometimes challenging due to acoustic shadowing and artifacts. In these cases, further imaging with transesophageal echocardiography, fluoroscopy and/or gated CT may be warranted, particularly if prosthetic valve dysfunction is suspected. Being able to differentiate pathologic versus functional obstruction of an individual prosthesis is extremely important, as this distinction affects management decisions. Transprosthetic and periprosthetic regurgitation may be difficult to visualize on TTE, so careful review of Doppler-derived data combined with a high index of suspicion is warranted, particularly in symptomatic patients. A baseline TTE soon after valve implantation is indicated in order to "fingerprint" the prosthesis hemodynamic profile. It remains unclear how frequently serial imaging should be performed in order to assess prosthetic valve function, as this issue has not been systematically studied.


Assuntos
Ecocardiografia/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Humanos
15.
Mayo Clin Proc ; 89(6): 790-8, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24684783

RESUMO

OBJECTIVE: To assess the diagnostic capability of handheld echocardiography (HHE) compared with transthoracic echocardiography (TTE) performed and evaluated by experienced sonographers and expert echocardiographers. PATIENTS AND METHODS: We conducted a prospective study of adult outpatients undergoing comprehensive TTE between July 9, 2012, and April 3, 2013. Experienced sonographers performed a detailed, standardized examination using a handheld ultrasound device that included 2-dimensional and color Doppler images from standard imaging windows. Images from TTE and HHE were independently interpreted by expert echocardiographers to whom the other study was masked. Agreement between the standard TTE and the HHE reports was analyzed. RESULTS: The study group contained 190 patients (mean ± SD age, 62 ± 17 years; 49% male [n=93]). The κ values were 0.52 for left ventricular (LV) enlargement, 0.52 for right ventricular enlargement, 0.62 for regional wall motion abnormalities, 0.73 for aortic stenosis, and 0.61 for mitral regurgitation. Lin concordance correlation coefficients ranged from 0.89 for LV end-systolic diameter to 0.78 for LV end-diastolic diameter. In 51 patients (27%), echocardiographic findings were discordant between HHE and standard TTE. The most common discordant finding was the presence vs absence of any regional wall motion abnormalities. In discordant cases, HHE tended to underestimate, rather than overestimate, the severity of abnormal findings. CONCLUSION: In experienced hands, HHE shows moderate correlation with standard TTE, but discordant findings were present in 27% of patients. Even when performed and interpreted by experienced operators, HHE should not be used as a surrogate for standard TTE. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01558518.


Assuntos
Ecocardiografia/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Ecocardiografia Doppler/métodos , Ecocardiografia Doppler em Cores , Feminino , Cardiopatias/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos
16.
J Am Soc Echocardiogr ; 26(4): 381-9, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23484437

RESUMO

BACKGROUND: Two-dimensional and Doppler-derived echocardiographic data on normal St. Jude Medical mechanical mitral valve prosthesis function have been reported but remain limited. METHODS: Comprehensive retrospective two-dimensional and Doppler echocardiographic assessment of 368 normal St. Jude Medical mechanical mitral valve prostheses was performed early after implantation. The early postimplantation hemodynamic profiles of 98 patients were compared with profiles obtained by follow-up transthoracic echocardiography performed <13 months after implantation. RESULTS: Using mean ± 2 SDs to define the normal distribution of values for Doppler-derived hemodynamic variables, the calculated normal ranges of values were as follows: mean gradient, 2 to 7 mm Hg; peak early mitral diastolic velocity (E velocity), 1.1 to 2.4 m/sec; time-velocity integral of the mitral valve prosthesis (TVIMVP) 20 to 50 cm; ratio of the TVIMVP to the time-velocity integral of the left ventricular outflow tract (TVILVOT), 0.9 to 2.5; pressure half-time, 35 to 99 msec; and effective orifice area, 1.12 to 3.24 cm(2). Patients with severe prosthesis-patient mismatch (ie, indexed effective orifice area ≤ 0.9 cm(2)/m(2)) had significantly higher mean gradients, E velocity, TVIMVP, and TVIMVP/TVILVOT. There was a trend for longer pressure half-times for patients with severe prosthesis-patient mismatch than for patients without severe prosthesis-patient mismatch, but none of these patients had pressure half-times > 130 msec. Among the 98 patients with follow-up transthoracic echocardiography <1 year after implantation, no significant differences were observed between early postimplantation findings and follow-up hemodynamic profiles. CONCLUSIONS: This study establishes parameters (mean ± 2 SDs) defining the distribution of values for Doppler-derived hemodynamic data with normal St. Jude Medical mechanical mitral valve prostheses. Prostheses with hemodynamic values outside these parameters are likely dysfunctional; however, prosthesis dysfunction may be present even when hemodynamic values are within these ranges.


Assuntos
Ecocardiografia Doppler , Próteses Valvulares Cardíacas , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Idoso , Feminino , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Período Pós-Operatório , Desenho de Prótese , Falha de Prótese , Recuperação de Função Fisiológica , Estudos Retrospectivos , Cardiopatia Reumática/cirurgia , Resultado do Tratamento
17.
Heart Fail Rev ; 18(6): 733-46, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23111533

RESUMO

Idiopathic giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare disorders that cause cardiomyopathy, often with ventricular arrhythmias or heart block. Infection, autoimmune processes, and genetics have all been implicated in the pathogenesis of these diseases, but the etiology for both diseases is likely a complex multifactorial process. Both GCM and CS are generally progressive despite treatment with standard heart failure and arrhythmia therapies. Making the diagnosis of GCM or CS on initial clinical presentation is possible in only a small percentage of patients, so myocardial tissue diagnosis is required. The use of multiple noninvasive imaging modalities may aid in diagnosis and assessment of response to treatment. Establishing the diagnosis of GCM or CS early is crucial, as tailored immunosuppressive treatment may significantly alter the clinical course of these patients. The prognosis of patients with GCM is poor, while the prognosis for patients with CS varies according to degree of left ventricular dysfunction.


Assuntos
Cardiomiopatias/patologia , Células Gigantes/patologia , Imagem Multimodal/métodos , Miocardite/patologia , Sarcoidose/patologia , Arritmias Cardíacas/diagnóstico , Biópsia por Agulha , Síndrome de Brugada , Doença do Sistema de Condução Cardíaco , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Meios de Contraste , Ecocardiografia Doppler/métodos , Feminino , Sistema de Condução Cardíaco/anormalidades , Humanos , Imuno-Histoquímica , Imunoterapia/métodos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Miocardite/diagnóstico , Miocardite/terapia , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Intensificação de Imagem Radiográfica/métodos , Doenças Raras , Sarcoidose/diagnóstico , Sarcoidose/terapia , Tomografia Computadorizada por Raios X/métodos
18.
Heart ; 99(5): 308-13, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23118348

RESUMO

OBJECTIVE: Identify novel prognostic factors for patients with peripartum cardiomyopathy (PPCM). DESIGN AND SETTING: Prospective cohort study conducted in a single tertiary care centre in South Africa. PATIENTS: 176 African women with newly diagnosed PPCM were studied. INTERVENTIONS: Clinical assessment, echocardiography and laboratory results were obtained at baseline and at 6 months. MAIN OUTCOME MEASURES: Poor outcome was defined as the combined end point of death, left ventricular (LV) ejection fraction (LVEF) < 35%, or remaining in New York Heart Association (NYHA) functional class III/IV at 6 months. Complete LV recovery was defined as LVEF ≥55% at 6 months. RESULTS: Forty-five (26%) patients had a poor outcome. Multiple logistic regression analysis revealed that, after adjustment for age, NYHA functional class, LVEF and systolic blood pressure, increased left ventricular end systolic dimension (LVESD), lower body mass index (BMI) and lower total cholesterol at baseline were independent predictors of poor outcome (adjusted OR 1.09, 95% CI 1.04 to 1.15, p=0.001; OR 0.89, 95% CI 0.83 to 0.96, p=0.004, and OR 0.50, 95% CI 0.34 to 0.73, p=0.0004, respectively). Thirty (21%) of the 141 surviving patients with echocardiographic follow-up recovered LV function at 6 months. Multiple logistic regression analysis revealed that, after adjustment for NYHA functional class, LVEF and left ventricular end diastolic dimension, older age and smaller LVESD at baseline were predictors of LV recovery (OR 1.08, 95% CI 1.01 to 1.17, p=0.02 and OR 0.92, 95% CI 0.86 to 0.98, p=0.007, respectively). CONCLUSIONS: This study suggests that increased LVESD, lower BMI and lower serum cholesterol at baseline may be independent predictors of poor outcome in patients with PPCM, while older age and smaller LVESD at baseline appear to be independently associated with a higher chance of LV recovery.


Assuntos
Cardiomiopatias/epidemiologia , Ecocardiografia , Período Periparto , Função Ventricular Esquerda/fisiologia , Adolescente , Adulto , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Feminino , Seguimentos , Humanos , Morbidade/tendências , Prognóstico , Estudos Prospectivos , África do Sul/epidemiologia , Adulto Jovem
19.
Curr Probl Cardiol ; 38(1): 7-46, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23158412

RESUMO

Heart failure due to nonischemic dilated cardiomyopathy (DCM) contributes significantly to the global burden of cardiovascular disease. Myocarditis is, in turn, a major cause of acute DCM in both men and women. However, recent clinical and experimental evidence suggests that the pathogenesis and prognosis of DCM differ between the sexes. This seminar provides a contemporary perspective on the immune mediators of myocarditis, including interdependent elements of the innate and adaptive immune response. The heart's acute response to injury is influenced by sex hormones that appear to determine the subsequent risk of chronic DCM. Preliminary data suggest additional genetic variations may account for some of the differences in epidemiology, left ventricular recovery, and survival between men and women. We highlight the gaps in our knowledge regarding the management of women with acute DCM and discuss emerging therapies, including bromocriptine for the treatment of peripartum cardiomyopathy.


Assuntos
Cardiomiopatia Dilatada , Miocardite , Miocárdio , Animais , Cardiomiopatia Dilatada/genética , Cardiomiopatia Dilatada/imunologia , Cardiomiopatia Dilatada/metabolismo , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/patologia , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/terapia , Feminino , Predisposição Genética para Doença , Hormônios Esteroides Gonadais/metabolismo , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Miocardite/genética , Miocardite/imunologia , Miocardite/metabolismo , Miocardite/mortalidade , Miocardite/patologia , Miocardite/fisiopatologia , Miocardite/terapia , Miocárdio/imunologia , Miocárdio/metabolismo , Miocárdio/patologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Função Ventricular Esquerda
20.
J Am Coll Cardiol ; 59(9): 813-8, 2012 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-22361401

RESUMO

OBJECTIVES: The goal of this study was to determine the impact of transvenous pacemaker and defibrillator leads on the incidence of bioprosthetic tricuspid valve (BTV) regurgitation compared with BTV patients without a transvalvular lead. BACKGROUND: Although concern has been raised regarding the potential deleterious effect of permanent transvenous device leads on BTV function, little is known about the incidence of prosthetic tricuspid regurgitation (TR) after lead placement. METHODS: A retrospective review of 58 patients who underwent BTV implantation and subsequently required endocardial pacemaker (n = 52) or defibrillator (n = 6) lead implantation across the BTV was conducted. Patient and prosthesis characteristics, lead type, and clinical events were collected. The incidence and severity of prosthetic TR, determined by Doppler echocardiography, was compared with 265 consecutive patients who underwent BTV implantation without undergoing subsequent transvalvular device lead implantation. RESULTS: Over a mean follow-up of 25 months, in 5 patients (9%) with a transvalvular lead significant (moderate or greater) prosthetic TR developed compared with 12 patients (5%) in the control group (p = 0.20). Kaplan-Meier analysis revealed no significant difference in the incidence of TR in BTV patients with and without transvalvular leads (p = 0.45). Significant prosthetic TR in patients with and without a transvalvular lead more commonly occurred 2 years or later after lead or BTV implantation (4 of 5, 80% and 10 of 12, 83%, respectively). CONCLUSIONS: Transvalvular device lead implantation in BTV patients was not associated with an increased incidence of significant prosthetic TR (p = 0.45). Based on these data, transvalvular lead implantation appears to be an acceptable approach for patients with a BTV who require permanent pacemaker or defibrillator placement.


Assuntos
Eletrodos Implantados/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Taquicardia Ventricular/terapia , Insuficiência da Valva Tricúspide/etiologia , Idoso , Bioprótese , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Prognóstico , Falha de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Insuficiência da Valva Tricúspide/diagnóstico , Insuficiência da Valva Tricúspide/epidemiologia
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