Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 66
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Eur Heart J ; 2020 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-32385501
2.
Ann Noninvasive Electrocardiol ; : e12740, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31957119

RESUMO

BACKGROUND: Inserting an electrophysiological (EP) catheter into the coronary sinus (CS) via the femoral vein can be difficult and time-consuming in patients with variants of the CS orifice or lumen curve. Our experience with such patients inspired us to develop two new techniques: the Asclepius and Yellow Ribbon techniques. METHODS: Data from a 4-year period were retrieved from records of patients undergoing radiofrequency ablation for paroxysmal supraventricular tachycardia (PSVT) or Wolff-Parkinson-White (WPW) syndrome. Data were analyzed to determine the success and complication rates of conventional and alternative techniques for catheter placement. RESULTS: The success rate of the Asclepius technique was 96.7% (30/31) and that of the Yellow Ribbon technique was 100.0% (7/7). The overall success rate of these two techniques was 97.3% (37/38). CONCLUSIONS: With a high success rate, shorter procedure time, and no complications, the Asclepius and Yellow ribbon techniques may be safe, inexpensive, and effective alternative strategies for EP catheter placement in patients with difficult coronary sinus orifice access.

4.
IEEE Trans Biomed Circuits Syst ; 13(6): 1471-1482, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31634841

RESUMO

Heart-sound auscultation is a rapid and fundamental technique used for examining the cardiovascular system. The main components of heart sounds are the first and second heart sounds. Discriminating these heart sounds under the presence of additional heart sounds and murmurs will be difficult. To recognize these signals efficiently, this study proposes a monitoring system with phonocardiogram and electrocardiogram. This system has two key points. The first is chip implementation, including capacitor coupled amplifier, transimpedance amplifier, high-pass sigma-delta modulator, and digital signal processing block. The chip in the system is fabricated in 0.18 µm standard complementary metal-oxide-semiconductor process. The second is a software application on smartphones for heart-related physiological signal recording, display, and identification. A wavelet-based QRS complex detection algorithm verified by MIT/BIH Arrhythmia Database is also proposed. The overall measured positive prediction, sensitivity, and error rate of the proposed algorithm are 99.90%, 99.82%, and 0.28%, respectively. During auscultation, doctors may refer to these physiological signals displayed on the smartphone and simultaneously listen to the heart sounds to diagnose the potential heart disease. By taking advantage of signal visualization and keeping the original diagnosis procedure, the uncertainty existing in heart sounds can be eliminated, and the training period to acquire auscultation skills can be reduced.

5.
Sci Rep ; 9(1): 1426, 2019 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-30723238

RESUMO

Chronic hepatitis C (CHC) is strongly associated with risks of cardiovascular diseases. The impact of direct acting antiviral (DAA) therapy on central blood pressure remains unclear. This investigation evaluates changes in central blood pressure following DAA therapy. One hundred and two DAA-treated patients were prospectively enrolled. Lipid profiles and pulse wave analysis of brachial artery by cuff sphygmomanometry including augmentation index (AIx), a parameter of central artery stiffness, were evaluated. All of the 102 patients achieved sustained virological response (SVR12). Cholesterol and LDL significantly increased following SVR12. Along with lipid changes, significantly higher central diastolic pressure (78.2 ± 14.2 mm Hg at baseline vs. 83.3 ± 13.9 mm Hg at SVR12, p = 0.011) and AIx (33.0 ± 12.7% at baseline vs. 36.9 ± 12.9% at SVR12, p = 0.012) were only observed in the advanced fibrosis patients. Co-morbid diseases, including hypertension (33.4 ± 13.0% vs. 39.7 ± 12.6%, p = 0.003), abnormal waist circumference (33.8 ± 12.2% vs. 38.0 ± 13.2%, p = 0.027), and metabolic syndrome (34.5 ± 12.1% vs. 39.0 ± 11.2%, p = 0.043) were associated with augmented AIx upon SVR12. The augmented central artery stiffness following viral eradication by DAA therapy may raise the concern of short-term cardiovascular risk in CHC patients.

6.
Artigo em Inglês | MEDLINE | ID: mdl-29897627

RESUMO

BACKGROUND: Currently, several geographies around the world remain underrepresented in medical device trials. The PANORAMA 2 study was designed to assess contemporary region-specific differences in clinical practice patterns of patients with cardiac implantable electronic devices (CIEDs). METHODS: In this prospective, multicenter, observational, multinational study, baseline and implant data of 4,706 patients receiving Medtronic CIEDs (Medtronic plc, Minneapolis, MN, USA; either de novo device implants, replacements, or upgrades) were analyzed, consisting of: 54% implantable pulse generators (IPGs), 20.3% implantable cardiac defibrillators (ICDs), 15% cardiac resynchronization therapy -defibrillators, and 5.1% cardiac resynchronization therapy -pacemakers, from 117 hospitals in 23 countries across four geographical regions between 2012 and 2016. RESULTS: For all device types, in all regions, there were fewer females than males enrolled, and women were less likely to have ischemic cardiomyopathy. Implant procedure duration differed significantly across the geographies for all device types. Subjects from emerging countries, women, and older patients were less likely to receive a magnetic resonance imaging-compatible device. Defibrillation testing differed significantly between the regions. European patients had the highest rates of atrial fibrillation (AF), and the lowest number of implanted single-chamber IPGs. Evaluation of stroke history suggested that the general embolic risk is more strongly associated with stroke than AF. CONCLUSIONS: We provide comprehensive descriptive data on patients receiving Medtronic CIEDs from several geographies, some of which are understudied in randomized controlled trials. We found significant variations in patient characteristics. Several medical decisions appear to be affected by socioeconomic factors. Long-term follow-up data will help evaluate if these variations require adjustments to outcome expectations.

7.
Atherosclerosis ; 269: 166-171, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29366989

RESUMO

BAKGROUND AND AIMS: Obstructive sleep apnea (OSA) contributes to cardiovascular diseases, including arterial stiffness. The association between OSA and peripheral arterial stiffness indices remains controversial. METHODS: This study recruited 275 patients who were referred for sleep apnea study. Arterial stiffness was assessed by peripheral compliance index (CI) and central pulse wave velocity derived from digital volume pulse (PWVDVP) by photoplethysmography. Overnight polysomnography and autonomic nerve system function tests were also conducted. RESULTS: A total of 275 patients (170 men) were recruited. Most were middle-aged and overweight. Most patients (112/275, 40.7%) had rapid eye movement (REM)-predominant OSA. The CI was significantly correlated with the apnea-hypopnea index (AHI) (R = -0.132, p = 0.029) and AHI-REM (R = -0.170, p = 0.005) and AHI non-REM (R = -0.122, p = 0.043). Among models and variable used to predict CI, only male sex (B = -0.708, p = 0.007) and AHI-REM (B = -0.010, p = 0.033) were independent predictors of CI. An increase in the interquartile range of AHI-REM was associated with a 9.6% decrease in CI. CONCLUSIONS: AHI-REM was independently correlated with a peripheral arterial stiffness index, CI. AHI-REM may be a suitable surrogate marker for predicting peripheral arterial stiffness in OSA patients.


Assuntos
Pulmão/fisiopatologia , Doença Arterial Periférica/fisiopatologia , Respiração , Apneia Obstrutiva do Sono/fisiopatologia , Sono REM , Rigidez Vascular , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/etiologia , Fotopletismografia , Polissonografia , Estudos Prospectivos , Análise de Onda de Pulso/métodos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico
8.
Circ J ; 82(3): 747-756, 2018 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-29081474

RESUMO

BACKGROUND: There are few data on ticagrelor in Asian patients. This study evaluated clinical outcomes with ticagrelor and clopidogrel in Taiwanese patients with acute myocardial infarction (AMI).Methods and Results:We used the Taiwan National Health Insurance Research Database to identify 27,339 AMI patients aged ≥18 years between January 2012 and December 2014, and only patients who survived greater than or equal to 30 days after AMI and took dual antiplatelet therapy were included. Cohorts of ticagrelor and clopidogrel were matched 1:8, based on propensity score matching, to balance baseline covariates. The primary efficacy endpoints were death from any cause, AMI, or stroke. The safety endpoints consisted of major gastrointestinal bleeding or intracerebral hemorrhage. Following propensity matching, the primary efficacy endpoint rate was 22% lower in the ticagrelor group than in the clopidogrel group (10.6% and 16.2%, respectively; adjusted HR, 0.779; 95% CI: 0.684-0.887). The safety endpoint rate was similar between the ticagrelor and clopidogrel groups (3.2% and 4.1% respectively; adjusted HR, 0.731; 95% CI: 0.522-1.026). CONCLUSIONS: In real-world AMI Taiwanese patients, ticagrelor seemed to offer better anti-ischemic protection than clopidogrel, without an increase in the rate of major bleeding. A large-scale randomized trial is needed to assess the efficacy and safety of ticagrelor in East Asian AMI patients.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Clopidogrel/uso terapêutico , Hemorragia/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Ticagrelor/uso terapêutico , Idoso , Grupo com Ancestrais do Continente Asiático , Humanos , Isquemia/prevenção & controle , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Pontuação de Propensão , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Estudos Retrospectivos , Risco , Taiwan , Resultado do Tratamento
11.
J Am Soc Hypertens ; 11(11): 716-723, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28923555

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is associated with increased arterial stiffness. Although chronic hepatitis C virus (HCV) infection was shown to be associated with metabolic disorder and chronic inflammation, the effects of chronic HCV infection on arterial stiffness remain unclear. This study recruited 221 patients including 32 normal controls, 72 NAFLD patients, and 117 subjects with HCV infection. Arterial stiffness was assessed by peripheral arterial stiffness index, Compliance Index (CI), and central arterial stiffness index, Stiffness Index derived from digital volume pulse by photoplethysmography. Levels of oxidative stress marker and inflammatory markers were also measured. The HCV group had significantly lower CI (4.8 ± 3.1 units vs. 3.9 ± 2.1 units vs. 3.0 ± 1.7 units; P for trend <.001) and higher Stiffness Index (7.0 ± 1.6 m/s vs. 8.3 ± 2.3 m/s vs. 8.4 ± 2.3 m/s; P for trend = .001) compared with the normal controls and NAFLD groups. Multivariate linear regression analysis showed that CI was independently correlated with systolic blood pressure (beta = -0.202, P = .013) and HCV infection (beta = -0.216, P = .036). Chronic HCV infection was independently associated with peripheral arterial stiffness. Peripheral arterial stiffness in chronic HCV infection was not associated with a marker of general inflammation (high-sensitivity C-reactive protein); however, a role for more specific markers of inflammation cannot be ruled out.


Assuntos
Pressão Sanguínea/fisiologia , Hepatite C Crônica/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Rigidez Vascular/fisiologia , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/análise , Estudos Transversais , Feminino , Hepatite C Crônica/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Estresse Oxidativo/fisiologia , Fotopletismografia , Fatores de Risco
12.
Acta Cardiol Sin ; 33(5): 468-476, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28959098

RESUMO

BACKGROUND: The extension catheter was originally developed to facilitate stent delivery to challenging lesions. We evaluated the efficacy and safety of using an extension catheter in patients undergoing percutaneous coronary interventions (PCI). METHODS: Two interventional cardiologists reviewed the records of all consecutive patients who, between November 2011 and October 2015, had undergone PCI with a GuideLiner or Heartrail ST-01 extension catheter. Clinical demographics, vessel characteristics, procedural details, and outcomes were recorded. RESULTS: We identified 136 (3.7%) eligible patients (male: 81.6%; mean age: 66.2 ± 11.2 years) in 3665 PCI procedures. Seventy-two (52.9%) cases required increased support to cross severely calcified lesions. The remainder were coronary tortuosity [47 (34.6%)], chronic total occlusions [35 (25.7%)], previously deployed proximal stents [16 (11.8%)], and anomalous origin of coronary artery [9 (6.6%)]. There were 43 type B and 91 type C lesions. The success rate was 86.8% (118) and the complication rate was 6.6% (7 coronary dissections, 1 thrombus formation, and 1 stent dislodgement). All complications were successfully managed using endovascular interventions. The failure rate significantly (25.5%) increased if more than 3 of 6 peri-procedural factors coexisted: 1) long lesions (> 30 mm), 2) tortuosity, 3) calcification, 4) chronic total occlusion, 5) previous intervention history, and 6) previously deployed proximal stents. CONCLUSIONS: Using an extension catheter for challenging complex PCIs is safe and highly successful if the practitioner has adequate experience manipulating extension catheters.

13.
Clin Cardiol ; 40(8): 559-565, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28444977

RESUMO

BACKGROUND: Despite limited evidence, postoperative prophylactic antibiotics are often used in the setting of permanent pacemaker implantation or replacement. The aim of this study is to investigate the efficacy of postoperative antibiotics. HYPOTHESIS: Postoperative prophylactic antibiotics may be not clinically useful. METHODS: We recruited 367 consecutive patients undergoing permanent pacemaker implantation or generator replacement at a tertiary referral center. Baseline demographics, clinical characteristics, and procedure information were collected, and all patients received preoperative prophylactic antibiotics. Postoperative prophylactic antibiotics were administered at the discretion of the treating physician, and all patients were seen in follow-up every 3 to 6 months for an average follow-up period of 16 months. The primary endpoint was device-related infection. RESULTS: A total of 110 patients were treated with preoperative antibiotics only (group 1), whereas 257 patients received both preoperative and postoperative antibiotics (group 2). After a mean follow-up period of 16 months, 1 patient in group 1 (0.9%) and 4 patients in group 2 (1.5%) experienced a device-related infection. There was no significant difference in the rate of infection between the 2 groups (P = 0.624). In the univariate analysis, only the age (60 ± 11 vs 75 ± 12 years, P < 0.001) was significantly different between the infected and noninfected groups. In the multivariate analysis, younger age was an independent risk factor for infective complications (odds ratio = 1.08, P = 0.016). CONCLUSIONS: Patients treated with preoperative and postoperative antibiotics had a similar rate of infection as those treated with preoperative antibiotics alone. Further studies are needed to confirm these preliminary findings.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Infecções Bacterianas/prevenção & controle , Estimulação Cardíaca Artificial/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Esquema de Medicação , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
14.
J Cardiol Cases ; 16(1): 18-21, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30279788

RESUMO

Out-of-hospital cardiac arrest (OHCA) remains a challenge for physicians since effective management and definitive salvage depend upon correct determination of the etiology and the extent of injury. Definitive diagnosis of organophosphate poisoning (OP) requires physicians' clinical awareness of a typical toxidrome, that is, characteristic signs and symptoms of poisoning, and laboratory confirmation. Here we report a case of an OHCA patient with OP, which was initially misdiagnosed as an acute ST segment elevation myocardial infarction based on the patient's medical history and clinical manifestations. .

16.
Int Heart J ; 57(5): 541-6, 2016 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-27581671

RESUMO

It is unknown whether there has been any change in the causes of death for acute ST-segment elevation myocardial infarction (STEMI) in the era of aggressive reperfusion. We analyzed the direct causes of in-hospital death in patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a tertiary referral center over the past 10 years.We retrospectively analyzed 878 STEMI patients treated with primary PCI in our hospital between January 2005 and December 2014. There were no significant changes in the age and sex of patients, but the prevalence of hypertension and smoking decreased. STEMI severity increased with more patients in Killip classification > 2. The number of out-ofhospital cardiac arrest events also increased over the 10 years. Symptom onset-to-door time did not change in the 10year study period. The care quality was improved with shorter door-to-balloon time for primary PCI and increased use of dual antiplatelet therapy. The all-cause in-hospital mortality was 9.1%, which did not vary over the 10 years. Multivariable analysis showed that Killip classification > 2 was the most important determinant of death. Cardiogenic shock was the major cause of cardiovascular death. There was an increase in non-cardiovascular causes of death in the most recent 3 years, with infection being a major problem.Despite improvement in care quality for STEMI, the in-hospital mortality did not decrease in this tertiary referral center over these 10 years due to increased disease severity and non-cardiovascular causes of death.


Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Causas de Morte , Gerenciamento Clínico , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Taiwan , Centros de Atenção Terciária , Tempo para o Tratamento
17.
J Cardiovasc Electrophysiol ; 27(11): 1351-1352, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27433931
18.
Angiology ; 67(7): 638-46, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27401788

RESUMO

This is the first study to investigate the vasculoangiogenic effects of cilostazol on endothelial progenitor cells (EPCs) and flow-mediated dilatation (FMD) in patients at high risk of cardiovascular disease (CVD). This double-blind, placebo-controlled study included 71 patients (37 received 200 mg/d cilostazol and 34 received placebo for 12 weeks). Use of cilostazol, but not placebo, significantly increased circulating EPC (kinase insert domain receptor(+)CD34(+)) counts (percentage changes: 149.0% [67.9%-497.8%] vs 71.9% [-31.8% to 236.5%], P = .024) and improved triglyceride and high-density lipoprotein cholesterol levels (P = .002 and P = .003, respectively). Plasma levels of vascular endothelial growth factor (VEGF)-A165 and FMD significantly increased (72.5% [32.9%-120.4%] vs -5.8% [-46.0% to 57.6%], P = .001; 232.8% ± 83.1% vs -46.9% ± 21.5%, P = .003, respectively) in cilostazol-treated patients. Changes in the plasma triglyceride levels significantly inversely correlated with the changes in the VEGF-A165 levels and FMD. Cilostazol significantly enhanced the mobilization of EPCs and improved endothelium-dependent function by modifying some metabolic and angiogenic markers in patients at high risk of CVD.


Assuntos
Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/tratamento farmacológico , Células Progenitoras Endoteliais/efeitos dos fármacos , Endotélio Vascular/efeitos dos fármacos , Neovascularização Fisiológica/efeitos dos fármacos , Tetrazóis/farmacologia , Tetrazóis/uso terapêutico , Idoso , Antígenos CD34/sangue , Movimento Celular/efeitos dos fármacos , Cilostazol , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/farmacologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Fatores de Risco , Estatística como Assunto , Triglicerídeos/sangue , Fator A de Crescimento do Endotélio Vascular/sangue , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/sangue
19.
Hypertension ; 67(6): 1298-308, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27045031

RESUMO

Loss of integrity and massive disruption of elastic fibers are key features of abdominal aortic aneurysm (AAA). Peroxisome proliferator-activated receptor γ (PPARγ) has been shown to attenuate AAA through inhibition of inflammation and proteolytic degradation. However, its involvement in elastogenesis during AAA remains unclear. PPARγ was highly expressed in human AAA within all vascular cells, including inflammatory cells and fibroblasts. In the aortas of transgenic mice expressing PPARγ at 25% normal levels (Pparg(C) (/-) mice), we observed the fragmentation of elastic fibers and reduced expression of vital elastic fiber components of elastin and fibulin-5. These were not observed in mice with 50% normal PPARγ expression (Pparg(+/-) mice). Infusion of a moderate dose of angiotensin II (500 ng/kg per minute) did not induce AAA but Pparg(+/-) aorta developed flattened elastic lamellae, whereas Pparg(C/-) aorta showed severe destruction of elastic fibers. After infusion of angiotensin II at 1000 ng/kg per minute, 73% of Pparg(C/-) mice developed atypical suprarenal aortic aneurysms: superior mesenteric arteries were dilated with extensive collagen deposition in adventitia and infiltrations of inflammatory cells. Although matrix metalloproteinase inhibition by doxycycline somewhat attenuated the dilation of aneurysm, it did not reduce the incidence nor elastic lamella deterioration in angiotensin II-infused Pparg(C/-) mice. Furthermore, PPARγ antagonism downregulated elastin and fibulin-5 in fibroblasts, but not in vascular smooth muscle cells. Chromatin immunoprecipitation assay demonstrated PPARγ binding in the genomic sequence of fibulin-5 in fibroblasts. Our results underscore the importance of PPARγ in AAA development though orchestrating proper elastogenesis and preserving elastic fiber integrity.


Assuntos
Aorta Abdominal/efeitos dos fármacos , Aneurisma da Aorta Abdominal/genética , Regulação da Expressão Gênica , Metaloproteinases da Matriz/metabolismo , PPAR gama/genética , Análise de Variância , Angiotensina II/farmacologia , Animais , Aorta Abdominal/metabolismo , Aorta Abdominal/patologia , Células Cultivadas , Modelos Animais de Doenças , Elastina/metabolismo , Humanos , Inflamação/metabolismo , Masculino , Camundongos , Camundongos Knockout , Pessoa de Meia-Idade , Músculo Liso Vascular/metabolismo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA