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1.
Arq Bras Cardiol ; 111(3): 436-539, 2018 Sep.
Artigo em Português | MEDLINE | ID: mdl-30379264
3.
Arch Med Res ; 49(4): 278-281, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-30268703

RESUMO

The heart has an intense aerobic metabolism and is among the most metabolically active organs in the body. Its tissue stores fatty acid, the main energetic substrate, and requires high concentrations of plasma L-carnitine. This nutrient is essential in the transport of fatty acids to the mitochondria to generate energy and maintain the proper concentration of coenzyme A free. In decompensated chronic heart failure metabolic changes, associated with inflammation, alter the metabolism of L-carnitine and compromise cardiac energy metabolism. The aim of this study was to evaluate plasma L-carnitine in chronic heart failure patients during cardiac decompensation. A cross-sectional study was conducted with 109 volunteers with chronic heart failure. Participants were stratified in the compensated (HF compensated) and decompensated (decompensated HF) groups. Plasma L-carnitine was evaluated by the spectrophotometric enzymatic method. Low plasma L-carnitine was found in the decompensated HF group (p = 0.0001). In this group it was also observed that 29.1% of the participants presented plasma L-carnitine below the reference range (<20 mmol). Reduced plasma L-carnitine in patients with decompensated chronic systolic heart failure was founded. These findings suggest that plasma L-carnitine assessment may be helpful in clinical practice for the treatment of patients with cardiac decompensation.

4.
J Nucl Cardiol ; 2018 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-29948896

RESUMO

BACKGROUND: 18F-fluorodeoxyglucose (FDG) has been useful in the evaluation of myocardial inflammatory processes. However, it is challenging to identify them due to physiological 18F-FDG uptake. There are no publications demonstrating the application of FDG in post-transplant rejection in humans yet. The aim of this study is to determine the feasibility of suppression of myocardial FDG uptake in post-transplant patients, comparing three different protocols of preparation. METHODS: Ten patients after heart transplantation were imaged by FDG associated with three endomyocardial biopsies (EMB), scheduled in the first year after the procedure. Before each imaging, patients were randomized to one of three preparations: (1) hyperlipidic-hypoglycemic diet; (2) fasting longer than 12 hours; and (3) fasting associated with intravenous heparin. All patients would undergo the three methods. FDG images were analyzed using visual analysis scores and relative radiotracer cardiac uptake (RRCU). RESULTS: The suppression rate of radiotracer activity ranged from 55% to 62%. Visual analysis showed that preparation 3 presented less efficacy in the suppression compared to the others. However, RRCU did not show difference between the preparations. CONCLUSIONS: Suppression of physiological myocardial FDG uptake after cardiac transplantation is feasible. The usefulness of heparin in the suppression is unclear.

5.
Braz J Cardiovasc Surg ; 33(1): 1-7, 2018 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29617494

RESUMO

OBJECTIVE: Transcatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period. METHODS: This prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included. RESULTS: Fifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%). CONCLUSION: Mortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up.

6.
Rev. bras. cir. cardiovasc ; 33(1): 1-7, Jan.-Feb. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-897979

RESUMO

Abstract Objective: Transcatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period. Methods: This prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included. Results: Fifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%). Conclusion: Mortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up.

8.
Braz J Cardiovasc Surg ; 32(3): 202-209, 2017 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28832799

RESUMO

Objective:: To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated. Methods:: Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated. Results:: After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%. Conclusion:: Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.


Assuntos
Fibrilação Atrial/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Cardiopatia Reumática/cirurgia , Adulto , Fatores Etários , Idoso , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Ponte Cardiopulmonar , Ablação por Cateter/métodos , Ablação por Cateter/mortalidade , Feminino , Frequência Cardíaca/fisiologia , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Análise Multivariada , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cardiopatia Reumática/mortalidade , Cardiopatia Reumática/fisiopatologia , Medição de Risco/métodos , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
9.
Rev. bras. cir. cardiovasc ; 32(3): 202-209, May-June 2017. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-897907

RESUMO

Abstract Objective: To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated. Methods: Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated. Results: After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%. Conclusion: Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.

11.
Clin Transplant ; 30(9): 1178-81, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27411082

RESUMO

The notable evolution of heart transplant (HTX) has paralleled the capacity of diagnosing rejection and, consequently, initiating timely treatment. Acute cellular rejection, diagnosed by endomyocardial biopsy, is the most frequent in the first 6 months after HTX. HLA matching is not routinely performed in HTX due to the absence of consensus regarding its usefulness. However, the use of HLA typing might be underscored if it could predict an increased risk of rejection. Therefore, the aim of this study was to evaluate, at a public cardiology center in Brazil, the association between HLA mismatches and the incidence of acute cellular rejection in the first 6 months after HTX. Data were obtained from hospital records and from the National Transplant System. Overall, there was no association between the number of HLA mismatches and the frequency of acute cellular rejection, but there was a tendency toward a higher incidence of rejection with HLA-DR incompatibility.


Assuntos
Países em Desenvolvimento , Rejeição de Enxerto/imunologia , Transplante de Coração/efeitos adversos , Histocompatibilidade/imunologia , Doença Aguda , Biópsia , Brasil/epidemiologia , Feminino , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto , Teste de Histocompatibilidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Arq. bras. cardiol ; 106(6): 519-527, tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-787321

RESUMO

Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.


Resumo Fundamento: O implante de válvula aórtica por cateter tornou-se uma opção para pacientes com doença valvar aórtica de elevado risco cirúrgico. Objetivo: Avaliar os resultados dos seguimentos intra-hospitalar e de até 1 ano do implante de válvula aórtica por cateter. Métodos: Estudo de coorte prospectiva de casos de implante de válvula aórtica por cateter entre julho de 2009 e fevereiro de 2015. Análise de variáveis clínicas e do procedimento, correlacionando com mortalidade intra-hospitalar e de 1 ano. Resultados: Foram submetidos ao implante 136 pacientes, com média de idade de 83 (80-87) anos, sendo 49% mulheres, 131 (96,3%) deles com estenose aórtica, um (0,7%) com insuficiência aórtica e quatro (2,9%) com disfunção de prótese. A classe funcional da NYHA foi III ou IV em 129 (94,8%) casos. A área valvar inicial foi 0,67 ± 0,17 cm2 e o gradiente ventrículo esquerdo-aorta médio de 47,3 ± 18,2 mmHg, com STS de 9,3% (4,8%-22,3%). As próteses implantadas eram autoexpansíveis em 97% dos casos. A mortalidade peroperatória em 1,5% dos casos; em 30 dias em 5,9%; intra-hospitalar em 8,1%; e após 1 ano em 15,5% dos casos. A hemotransfusão (risco relativo de 54; p = 0,0003) e a hipertensão arterial pulmonar (risco relativo de 5,3; p = 0,036) foram preditoras de mortalidade hospitalar; e a proteína C-reativa pico (risco relativo de 1,8; p = 0,013) e a hemotransfusão (risco relativo de 8,3; p = 0,0009) de mortalidade em 1 ano. Aos 30 dias, 97% dos pacientes estavam em classe NYHA I/II e, em 1 ano, o número chegou a 96%. Conclusão: O implante de válvula aórtica por cateter foi realizado com alto índice de sucesso e baixa mortalidade. A hemotransfusão associou-se com maior mortalidade hospitalar e de 1 ano. Proteína C-reativa pico se associou com a mortalidade de 1 ano.

13.
Arq Bras Cardiol ; 106(6): 519-27, 2016 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27192383

RESUMO

BACKGROUND: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. OBJECTIVE: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. METHODS: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. RESULTS: A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. CONCLUSION: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Mortalidade Hospitalar , Substituição da Valva Aórtica Transcateter/mortalidade , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Brasil/epidemiologia , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Fatores de Tempo
14.
Int. j. cardiovasc. sci. (Impr.) ; 28(6): 440-450, nov.-dez. 2015.
Artigo em Português | LILACS | ID: lil-788761

RESUMO

Fundamentos: A insuficiência cardíaca de etiologia chagásica (ICCh) parece ter maior mortalidade que a de outrascom disfunção sistólica. O teste cardiopulmonar de exercício (TCPE) é uma ferramenta de avaliação prognósticaainda pouco estudada na cardiopatia chagásica.Objetivo: Avaliar se o TCPE pode discriminar as diferenças prognósticas da ICCh em comparação às de etiologianão chagásica (ICNCh) e verificar quais das suas variáveis são preditoras independentes de mau prognóstico.Métodos: Análise retrospectiva de 21 pacientes com ICCh e 76 pacientes com ICNCh encaminhados ao TCPE, eseguidos quanto à sua mortalidade em dois anos.Resultados: No seguimento, houve óbito de 5 pacientes no grupo chagásico (GC) e 25 no grupo não chagásico(GNC). A curva de Kaplan-Meier não mostrou diferença na curva de sobrevida entre os grupos (p=0,43). Aregressão logística encontrou a potência circulatória como uma variável preditora independente para óbito paraambos os grupos, com uma razão de risco para o GC de 17,3 (IC95% 1,39-217,0; p=0,027) e no GNC de 4,8(IC95% 1,59-14,6; p=0,005). A curva ROC para esta variável encontrou uma área de 0,91 (IC95% 0,78-1,00; p=0,006)com um valor de corte ≤1 280 mmHg.mL.kg-1.min-1 no GC e uma área de 0,75 (IC95% 0,64-0,86; p<0,0001) com umvalor de corte de ≤1 245 mmHg.mL.kg-1.min-1 no GNC.Conclusão: A potência circulatória foi a variável associada à morte em ambos os grupos, e deve ser mais amplamenteutilizada como indicador de prognóstico na insuficiência cardíaca.


Background: Chagas heart failure (CHF) seems to have higher mortality than other systolic dysfunction conditions. Cardiopulmonaryexercise testing (CPET) is a prognostic assessment tool that is still little studied in Chagas heart disease.Objective: To assess whether CPET can discriminate the prognostic differences of CHF compared to non-Chagas heart failures(NCHF) and determine which of its variables are independent predictors of poor prognosis.Methods: Retrospective analysis of 21 patients with CHF and 76 patients with NCHF referred to CPET and followed up formortality in two years.Results: During follow-up, 5 patients died in the Chagas group (CG) and 25 in the non-Chagas group (NCG). The Kaplan-Meiercurve showed no difference in the survival curve between groups (p=0.43). Logistic regression found the circulatory power as anindependent predictor of death for both groups, with a hazard ratio for the CG of 17.3 (95% CI 1.39-217.0; p=0.027) and for theNCG of 4.8 (95% CI 1.59-14.6; p=0.005). The ROC curve for this variable found an area of 0.91 (95% CI 0.78-1.00; p=0.006) witha cutoff value ≤1280 mmHg.mL.kg-1.min-1 in the CG and an area of 0.75 (95% CI 0.64-0.86; p<0.0001) with a cutoff value of≤1245 mmHg.mL.kg-1.min-1 in the NCG.Conclusion: Circulatory power was the variable associated with death in both groups and should be more widely used as an indicatorof prognosis in heart failure.


Assuntos
Humanos , Masculino , Adulto Jovem , Pessoa de Meia-Idade , Cardiomiopatia Chagásica/prevenção & controle , Teste de Esforço , Insuficiência Cardíaca/etiologia , Ecocardiografia , Seguimentos , Estudos Retrospectivos , Tomada de Decisão Clínica/métodos
15.
Eur Heart J Cardiovasc Imaging ; 16(9): 919-48, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26139361

RESUMO

The cohort of long-term survivors of heart transplant is expanding, and the assessment of these patients requires specific knowledge of the surgical techniques employed to implant the donor heart, the physiology of the transplanted heart, complications of invasive tests routinely performed to detect graft rejection (GR), and the specific pathologies that may affect the transplanted heart. A joint EACVI/Brazilian cardiovascular imaging writing group committee has prepared these recommendations to provide a practical guide to echocardiographers involved in the follow-up of heart transplant patients and a framework for standardized and efficient use of cardiovascular imaging after heart transplant. Since the transplanted heart is smaller than the recipient's dilated heart, the former is usually located more medially in the mediastinum and tends to be rotated clockwise. Therefore, standard views with conventional two-dimensional (2D) echocardiography are often difficult to obtain generating a large variability from patient to patient. Therefore, in echocardiography laboratories equipped with three-dimensional echocardiography (3DE) scanners and specific expertise with the technique, 3DE may be a suitable alternative to conventional 2D echocardiography to assess the size and the function of cardiac chambers. 3DE measurement of left (LV) and right ventricular (RV) size and function are more accurate and reproducible than conventional 2D calculations. However, clinicians should be aware that cardiac chamber volumes obtained with 3DE cannot be compared with those obtained with 2D echocardiography. To assess cardiac chamber morphology and function during follow-up studies, it is recommended to obtain a comprehensive echocardiographic study at 6 months from the cardiac transplantation as a baseline and make a careful quantitation of cardiac chamber size, RV systolic function, both systolic and diastolic parameters of LV function, and pulmonary artery pressure. Subsequent echocardiographic studies should be interpreted in comparison with the data obtained from the 6-month study. An echocardiographic study, which shows no change from the baseline study, has a high negative predictive value for GR. There is no single systolic or diastolic parameter that can be reliably used to diagnose GR. However, in case several parameters are abnormal, the likelihood of GR increases. When an abnormality is detected, careful revision of images of the present and baseline study (side-by-side) is highly recommended. Global longitudinal strain (GLS) is a suitable parameter to diagnose subclinical allograft dysfunction, regardless of aetiology, by comparing the changes occurring during serial evaluations. Evaluation of GLS could be used in association with endomyocardial biopsy (EMB) to characterize and monitor an acute GR or global dysfunction episode. RV size and function at baseline should be assessed using several parameters, which do not exclusively evaluate longitudinal function. At follow-up echocardiogram, all these parameters should be compared with the baseline values. 3DE may provide a more accurate and comprehensive assessment of RV size and function. Moreover, due to the unpredictable shape of the atria in transplanted patients, atrial volume should be measured using the discs' summation algorithm (biplane algorithm for the left atrium) or 3DE. Tricuspid regurgitation should be looked for and properly assessed in all echocardiographic studies. In case of significant changes in severity of tricuspid regurgitation during follow-up, a 2D/3D and colour Doppler assessment of its severity and mechanisms should be performed. Aortic and mitral valves should be evaluated according to current recommendations. Pericardial effusion should be serially evaluated regarding extent, location, and haemodynamic impact. In case of newly detected pericardial effusion, GR should be considered taking into account the overall echocardiographic assessment and patient evaluation. Dobutamine stress echocardiography might be a suitable alternative to routine coronary angiography to assess cardiac allograft vasculopathy (CAV) at centres with adequate experience with the methodology. Coronary flow reserve and/or contrast infusion to assess myocardial perfusion might be combined with stress echocardiography to improve the accuracy of the test. In addition to its role in monitoring cardiac chamber function and in diagnosis the occurrence of GR and/or CAV, in experienced centres, echocardiography might be an alternative to fluoroscopy to guide EMB, particularly in children and young women, since echocardiography avoids repeated X-ray exposure, permits visualization of soft tissues and safer performance of biopsies of different RV regions. Finally, in addition to the indications about when and how to use echocardiography, the document also addresses the role of the other cardiovascular imaging modalities during follow-up of heart transplant patients. In patients with inadequate acoustic window and contraindication to contrast agents, pharmacological SPECT is an alternative imaging modality to detect CAV in heart transplant patients. However, in centres with adequate expertise, intravascular ultrasound (IVUS) in conjunction with coronary angiography with a baseline study at 4-6 weeks and at 1 year after heart transplant should be performed to exclude donor coronary artery disease, to detect rapidly progressive CAV, and to provide prognostic information. Despite the fact that coronary angiography is the current gold-standard method for the detection of CAV, the use of IVUS should also be considered when there is a discrepancy between non-invasive imaging tests and coronary angiography concerning the presence of CAV. In experienced centres, computerized tomography coronary angiography is a good alternative to coronary angiography to detect CAV. In patients with a persistently high heart rate, scanners that provide high temporal resolution, such as dual-source systems, provide better image quality. Finally, in patients with insufficient acoustic window, cardiac magnetic resonance is an alternative to echocardiography to assess cardiac chamber volumes and function and to exclude acute GR and CAV in a surveillance protocol.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Transplante de Coração/métodos , Interpretação de Imagem Assistida por Computador , Complicações Pós-Operatórias/diagnóstico , Guias de Prática Clínica como Assunto , Brasil , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/tendências , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia , Ecocardiografia sob Estresse/métodos , Ecocardiografia Tridimensional/métodos , Feminino , Seguimentos , Rejeição de Enxerto , Transplante de Coração/efeitos adversos , Transplante de Coração/mortalidade , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Monitorização Fisiológica/métodos , Complicações Pós-Operatórias/mortalidade , Medição de Risco , Sociedades Médicas/normas , Análise de Sobrevida , Sobreviventes , Fatores de Tempo
16.
Interact Cardiovasc Thorac Surg ; 20(6): 844-7, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25757475

RESUMO

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is robotic mitral valve surgery more expensive than its conventional counterpart?' Altogether 19 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is a general impression in the surgical community that robotic operations might incur prohibitive additional costs. There is a paucity of data in the literature regarding cost analysis in cardiac robotic surgery. From the five studies, four were single institution experiences and one was a database inquiry study. These four studies showed that operational costs are higher for robotic cases but this was partially (one study) or completely (three studies) offset by lower postoperative costs. Overall hospital costs were similar between the two approaches in three studies and one study showed higher costs in the robotic group. Higher operating theatre (OT) costs were driven mainly by use of robotic instruments (approximately US$1500 per case) and longer OT times. Savings in postoperative care were driven by shorter length of hospital stay (on average 2 days fewer in robotic cases) and lower morbidity. If amortization cost, that is, the value of the initial capital investment on the robotic system divided by all operations performed, is included in this analysis, robotic approach becomes significantly more expensive by approximately US$3400 per case. The fifth study was a large national database inquiry in which robotic approach was found to be more expensive by US$600 per case excluding amortization cost and by US$3700 if amortization is included. We conclude that the total hospital cost of robotic mitral valve surgery is slightly higher than conventional sternotomy surgery. If amortization is taken into consideration, robotic cases are considerably more expensive.


Assuntos
Implante de Prótese de Valva Cardíaca/economia , Custos Hospitalares , Anuloplastia da Valva Mitral/economia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/economia , Benchmarking , Redução de Custos , Análise Custo-Benefício , Medicina Baseada em Evidências , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Tempo de Internação/economia , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Instrumentos Cirúrgicos/economia , Fatores de Tempo , Resultado do Tratamento
18.
Arq Bras Cardiol ; 98(5): 375-83, 2012 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22858653

RESUMO

In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.


Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Doença Aguda , Brasil , Insuficiência Cardíaca/mortalidade , Humanos
19.
Rev Bras Cir Cardiovasc ; 27(1): 45-51, 2012 Jan-Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22729300

RESUMO

OBJECTIVE: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients >70 years-old in comparison to patients <70 years-old. METHODS: Patients undergoing isolated CABG were selected for the study. The patients were grouped in G1 (age > 70 years-old) and G2 (age <70 years-old). The endpoints were in-hospital mortality, acute myocardial infarction (AMI), stroke, reexploration for bleeding, intra-aortic balloon for circulatory shock, respiratory complications, acute renal failure, mediastinitis, sepsis, atrial fibrillation, and complete atrioventricular block (CAVB). RESULTS: 1,033 patients were included, 257 (24.8%) in G1 and 776 (75.2%) in G2. Patients in G1 were more likely to have in-hospital mortality than G2 (8.9% vs. 3.6%, respectively; P=0.001), while the incidence of AMI was similar (5.8% vs. 5.5%; P=0.87) than G2. More patients in G1 had re-exploration for bleeding (12.1% vs. 6.1%; P=0.003). G1 had more incidence of respiratory complications (21.4% vs. 9.1%; P<0.001), mediastinitis (5.1% vs. 1.9%; P=0.013), stroke (3.9% vs. 1.3%; P=0.016), acute renal failure (7.8% vs. 1.3%; P<0.001), sepsis (3.9% vs. 1.9%;P=0.003), atrial fibrillation (15.6% vs. 9.8%; P=0.016), and CAVB (3.5% vs. 1.2%; P=0.023) than G2. There was no significant difference in the use of intra-aortic balloon. In the forward stepwise multivariate logistic regression analysis age > 70-year-old was an independent predictive factor for higher in-hospital mortality (P=0.004), reexploration for bleeding (P=0.002), sepsis (P=0.002), respiratory complications (P<0.001), mediastinitis (P=0.016), stroke (P=0.029), acute renal failure (P<0.001), atrial fibrillation (P=0.021) and CAVB (P=0.031). CONCLUSION: This study suggests that patients > 70 years-old were at increased risk of death and other complications in the CABG's postoperative period in comparison to younger patients.


Assuntos
Fatores Etários , Ponte de Artéria Coronária/mortalidade , Mortalidade Hospitalar , Idoso , Ponte de Artéria Coronária/efeitos adversos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Resultado do Tratamento
20.
Arq. bras. cardiol ; 98(5): 375-383, maio 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-643631

RESUMO

Nos últimos dois anos, observamos diversas modificações na abordagem diagnóstica e terapêutica dos pacientes com Insuficiência Cardíaca aguda (IC aguda), o que nos motivou quanto à necessidade da realização de um sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda de 2009. Na avaliação diagnóstica, o fluxograma diagnóstico foi simplificado e foi fortalecido o papel da avaliação clínica e ecocardiograma. Na avaliação clínico-hemodinâmica admissional, o ecocardiograma hemodinâmico ganhou destaque no auxilio da definição dessa condição no paciente com IC aguda na sala de emergência. Na avaliação prognóstica, os biomarcadores tiveram seu papel mais bem estabelecido, e a síndrome cardiorrenal teve seus critérios e valor prognóstico mais bem definidos. Os fluxogramas de abordagem terapêutica foram revistos, tornando-se mais simples e objetivos. Dentre os avanços na terapêutica medicamentosa destacam-se a segurança e a importância da manutenção ou introdução dos betabloqueadores na terapêutica admissional. A anticoagulação, de acordo com as novas evidências, ganha um espectro maior de indicações. O edema agudo de pulmão tem bem estabelecido os seus modelos hemodinâmicos de apresentação com suas distintas formas de abordagens terapêuticas, com novos níveis de indicação e evidência. No tratamento cirúrgico da IC aguda, a revascularização miocárdica, a abordagem das lesões mecânicas e o transplante cardíaco foram revistos e atualizados. Este sumário de atualização fortalece a II Diretriz Brasileira de Insuficiência Cardíaca Aguda por mantê-la atualizada e rejuvenescida. Todos os clínicos cardiologistas que lidam com pacientes com IC aguda encontrarão na diretriz e em seu sumário de atualização importantes instrumentos no auxílio da prática clínica para o melhor diagnóstico e tratamento de seus pacientes.


In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.


Assuntos
Humanos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Doença Aguda , Brasil , Insuficiência Cardíaca/mortalidade
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