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1.
Clin Cardiol ; 41(6): 729-735, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29607528

RESUMO

Treatment with intravenous ferric carboxymaltose (FCM) has been shown to improve symptoms, functional capacity, and quality of life in patients with heart failure and iron deficiency. However, the underlying mechanisms for these beneficial effects remain undetermined. The aim of this study is to quantify cardiac magnetic resonance changes in myocardial iron content after administration of intravenous FCM in patients with heart failure and iron deficiency and contrast them with parameters of heart failure severity. This is a multicenter, double-blind, randomized study. Fifty patients with stable symptomatic heart failure, left ventricular ejection fraction <50%, and iron deficiency will be randomly assigned 1:1 to receive intravenous FCM or placebo. Intramyocardial iron will be evaluated by T2* and T1 mapping cardiac magnetic resonance sequences before and at 7 and 30 days after FCM. After 30 days, patients assigned to placebo will receive intravenous FCM in case of persistent iron deficiency. The main endpoint will be changes from baseline in myocardial iron content at 7 and 30 days. Secondary endpoints will include the correlation of these changes with left ventricular ejection fraction, functional capacity, quality of life, and cardiac biomarkers. The results of this study will add important knowledge about the effects of intravenous FCM on myocardial tissue and cardiac function. We hypothesize that short-term (7 and 30 days) myocardial iron content changes after intravenous FCM, evaluated by cardiac magnetic resonance, will correlate with simultaneous changes in parameters of heart failure severity. The study is registered at http://www.clinicaltrials.gov (NCT03398681).


Assuntos
Anemia Ferropriva/tratamento farmacológico , Compostos Férricos/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Hematínicos/administração & dosagem , Maltose/análogos & derivados , Miocárdio/metabolismo , Idoso , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/fisiopatologia , Protocolos Clínicos , Método Duplo-Cego , Feminino , Compostos Férricos/efeitos adversos , Compostos Férricos/metabolismo , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Hematínicos/efeitos adversos , Hematínicos/metabolismo , Humanos , Infusões Intravenosas , Imagem Cinética por Ressonância Magnética , Masculino , Maltose/administração & dosagem , Maltose/efeitos adversos , Maltose/metabolismo , Qualidade de Vida , Recuperação de Função Fisiológica , Projetos de Pesquisa , Índice de Gravidade de Doença , Espanha , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
2.
Rev. esp. cardiol. (Ed. impr.) ; 70(12): 1067-1073, dic. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-169305

RESUMO

Introducción y objetivos: El tratamiento óptimo de pacientes con insuficiencia cardiaca aguda (ICA) y síndrome cardiorrenal tipo 1 (SCR-1) no está bien definido. La hipoperfusión arterial y la congestión venosa tienen un papel fundamental en la fisiopatología del SCR-1. El antígeno carbohidrato 125 (CA125) ha emergido como marcador indirecto de sobrecarga de volumen en la ICA. El objetivo de este estudio es evaluar la utilidad del CA125 para el ajuste del tratamiento diurético de pacientes con SCR-1. Métodos: Ensayo clínico multicéntrico, abierto y paralelo, que incluye a pacientes con ICA y creatinina ≥ 1,4 mg/dl al ingreso, aleatorizados a: a) estrategia convencional: titulación basada en la evaluación clínica y bioquímica habitual, o b) estrategia basada en CA125: dosis altas de diuréticos si CA125 > 35 U/ml y bajas en caso contrario. El objetivo principal es el cambio en la función renal a las 24 y las 72 h tras el comienzo del tratamiento. Como objetivos secundarios: a) cambios clínicos y bioquímicos a las 24 y las 72 h, y b) cambios en la función renal y eventos clínicos mayores a 30 días. Resultados: Los resultados de este estudio aportarán datos relevantes sobre la utilidad del CA125 para guiar el tratamiento diurético en el SCR-1. Además, permitirá ampliar el conocimiento de la fisiopatología de esta compleja entidad clínica. Conclusiones: La hipótesis del presente estudio es que las concentraciones de CA125 aumentadas pueden identificar a una población de pacientes con SCR-1 para quienes una estrategia diurética más intensa puede ser beneficiosa. Por el contrario, las concentraciones bajas de esta glucoproteína seleccionarían a los pacientes para los que serían perjudiciales las dosis altas de diuréticos (AU)


Introduction and objectives: The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Methods: Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4 mg/dL on admission will be randomized to: a) standard diuretic strategy: titration-based on conventional clinical and biochemical evaluation, or b) diuretic strategy based on CA125: high dose if CA125 > 35 U/mL, and low doses otherwise. The main endpoint will be renal function changes at 24 and 72 hours after therapy initiation. Secondary endpoints will include: a) clinical and biochemical changes at 24 and 72 hours, and b) renal function changes and major clinical events at 30 days. Results: The results of this study will add important knowledge on the usefulness of CA125 for guiding diuretic treatment in CRS-1. In addition, it will pave the way toward a better knowledge of the pathophysiology of this challenging situation. Conclusions: We hypothesize that higher levels of CA125 will identify a patient population with CRS-1 who could benefit from the use of a more intense diuretic strategy. Conversely, low levels of this glycoprotein could select those patients who would be harmed by high diuretic doses (AU)


Assuntos
Humanos , Insuficiência Cardíaca/terapia , Nefropatias/complicações , Biomarcadores , Diuréticos/uso terapêutico , Insuficiência Cardíaca/complicações , Análise Estatística
4.
Rev Esp Cardiol (Engl Ed) ; 70(12): 1067-1073, 2017 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28341415

RESUMO

INTRODUCTION AND OBJECTIVES: The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. METHODS: Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4mg/dL on admission will be randomized to: a) standard diuretic strategy: titration-based on conventional clinical and biochemical evaluation, or b) diuretic strategy based on CA125: high dose if CA125 > 35 U/mL, and low doses otherwise. The main endpoint will be renal function changes at 24 and 72hours after therapy initiation. Secondary endpoints will include: a) clinical and biochemical changes at 24 and 72hours, and b) renal function changes and major clinical events at 30 days. RESULTS: The results of this study will add important knowledge on the usefulness of CA125 for guiding diuretic treatment in CRS-1. In addition, it will pave the way toward a better knowledge of the pathophysiology of this challenging situation. CONCLUSIONS: We hypothesize that higher levels of CA125 will identify a patient population with CRS-1 who could benefit from the use of a more intense diuretic strategy. Conversely, low levels of this glycoprotein could select those patients who would be harmed by high diuretic doses.


Assuntos
Acetazolamida/uso terapêutico , Antígeno Ca-125/sangue , Síndrome Cardiorrenal/tratamento farmacológico , Clortalidona/uso terapêutico , Diuréticos/uso terapêutico , Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Proteínas de Membrana/sangue , Desequilíbrio Hidroeletrolítico/tratamento farmacológico , Doença Aguda , Síndrome Cardiorrenal/sangue , Síndrome Cardiorrenal/complicações , Creatinina/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Humanos , Planejamento de Assistência ao Paciente , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/etiologia
6.
Eur J Heart Fail ; 18(7): 798-802, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27030541

RESUMO

AIMS: Early rehospitalization after an episode of acute heart failure (AHF) remains excessively high and its prediction a contemporary challenge. Iron deficiency (ID) is a frequent finding in AHF, but its prognostic implications remain unclear. We sought to evaluate the association between ID and risk of 30-day readmission in an unselected cohort of patients discharged for AHF. METHODS AND RESULTS: Serum ferritin and transferrin saturation (TSAT) were measured before discharge in 626 consecutive patients with AHF in a single teaching centre. ID was defined as serum ferritin <100 µg/L (absolute ID) or ferritin 100-299 µg/L with a TSAT <20% (functional ID). Cox regression adapted for competing events was used to determine the association between ID and the risk of 30-day readmissions. Mean age was 73.4 ± 10.4 years, 48% were females, and 52.1% showed an LVEF >50%. ID was identified in 463 patients (74%): 302 (48.2%) as absolute ID and 161 (25.7%) as functional ID. At 30-day post-discharge, 20 (3.2%) patients died and 103 (16.5%) were readmitted. Patients with absolute ID showed an increased rate of readmission compared with those with functional ID and no ID (19.9, 13, and 13.5%, respectively, P = 0.005). In a multivariate setting, absolute ID remained associated with higher risk of readmission [hazard ratio (HR) 1.72; 95% confidence interval (CI) 1.13-2.60, P = 0.011]. Compared with patients without ID, functional ID was not related to the risk of readmission (HR 0.87; 95% CI 0.46-1.62, P = 0.652). CONCLUSION: In patients with AHF, absolute ID, but not functional ID, was associated with an increased risk of early readmission.


Assuntos
Deficiências Nutricionais/epidemiologia , Insuficiência Cardíaca/epidemiologia , Hospitalização , Ferro/deficiência , Readmissão do Paciente/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Deficiências Nutricionais/metabolismo , Feminino , Ferritinas/sangue , Hemoglobinas/metabolismo , Humanos , Ferro/sangue , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Volume Sistólico , Transferrina/metabolismo
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