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1.
Medicina (B Aires) ; 80(2): 97-102, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32282313

RESUMO

Discrepancies between clinical suspicion and pathological findings in pulmonary embolism (PE) appear to be frequent. The aim of this study was to analyze the prevalence of PE in a necropsy series of patients who have died in an acute care hospital between 1998-2017, its relationship with previous clinical suspicion, and its importance as a cause of death. It is a retrospective observational study of 350 autopsies done at the Department of Pathology. We analyzed the demographic characteristics, main clinical diagnoses stated in the autopsy request form, incidence of PE diagnosed, main autopsy findings related with the cause of death, as well as the concordance between clinical suspicion and autopsy diagnosis. In only 8% of the cases (n = 28) the clinical diagnosis of autopsy request was PE. An autopsy diagnosis of PE was done in 127 cases (36.3%); in 33 cases (25.9%) affected large pulmonary vessels; medium caliber vessels were affected in 75 cases (59.1%), and in 19 cases small vessels. The PE was considered as a contributor or cause of death in 30.9% (n = 108). However, only 15.7% of the confirmed PE cases had previous clinical suspicion. This series of necropsies shows that PE is a high prevalence finding in autopsies at an acute care hospital, and an important cause of death in a 20 years period. The finding of a low concordance with clinical diagnosis should alert the medical community on the importance of clinical suspicion in order to achieve an early diagnosis and treatment of this disease.

2.
Rev Soc Bras Med Trop ; 53: e20190457, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130325

RESUMO

INTRODUCTION: Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls. METHODS: We compared 194 patients with the indeterminate form of Chagas disease to 72 age-matched healthy individuals. We considered p-values <0.05 to be statistically significant. RESULTS: TDI analysis of the right ventricular (RV) showed lengthened isovolumic relaxation time (IRT) and higher RV index of myocardial performance (RIMP) and left ventricle (LV) index of myocardial performance (LIMP) in the Chagas group than in the control group, indicating RV and LV systolic and diastolic myocardial damage. TDI analysis of the myocardial velocities of the interventricular septum and the lateral wall of the LV also showed a systolic and diastolic myocardial damage. CONCLUSIONS: The study results demonstrated early LV systolic and diastolic myocardial damage in the RV and LV in patients with the indeterminate form of Chagas disease by TDI. These early findings of RV and LV dysfunction may help identify patients who will progress to heart failure during the disease course. TDI should be included in initial patient evaluations because it allows adequate follow-up and treatment.


Assuntos
Doença de Chagas/fisiopatologia , Coração/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Adulto , Estudos de Casos e Controles , Doença de Chagas/diagnóstico por imagem , Diagnóstico Precoce , Ecocardiografia , Ecocardiografia Doppler , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Disfunção Ventricular Esquerda/diagnóstico por imagem
3.
Artigo em Inglês | MEDLINE | ID: mdl-31980416

RESUMO

BACKGROUND: Previous studies have shown a reduction in radiation dose and contrast volume using dual-axis rotational coronary angiography (DARCA), but this has not been replicated in a population with 100% coronary artery disease (CAD). OBJECTIVE: To find if DARCA dose reduction is achievable in this population, we sought to compare the radiation dose, contrast volume, and procedure time between DARCA and conventional coronary angiography (CCA) techniques in a setting characterized by a prevalence of 100% suspected coronary artery disease. METHODS: An all-comer, prospective, randomized, open-label trial was conducted. Cine acquisition dose-area product (DAP), cumulative air kerma (AK), effective dose (E), fluoroscopic time, contrast volume, AK, cine acquisition DAP (CADAP), fluoroscopic DAP (F-DAP), and total DAP were compared between DARCA and CCA groups. RESULTS: We included 503 consecutive patients with suspected CAD. 252 were assigned to DARCA and 251 to CCA. Stable coronary artery disease was reported in 465 cases and non-ST elevation acute coronary syndrome in 38. Mean age: 61.88 ± 11.2 years, male gender 70.2%. DARCA arm patients showed lower total E dose (6.85 [4.55-10.83] vs. 7.91 [5.58-11.94] Sv; P = .0023), and cine E (3.00 [2.00-4.00] vs. 4.00 [3.00-5.00] Sv; P < .0001). Total DAP was also lower (40.3 [26.8-63.7] vs. 46.5 [32.8-70.2] Gycm2; P = .0023), as a consequence of a lower CADAP (16.3 [10.5-22.9] vs. 23.4 [17.4-32.0] Gycm2; P < .0001), with lower AK (367 [248-1497] vs. 497 [381-1827] mGy; P < .0001), with less contrast medium used (90 [60.0-106.0] vs. 100 [75.0-120.0] mL; P = .014). CONCLUSION: In a population with 100% suspected coronary artery disease, DARCA provides accurate information required in CAD, is safe, and results in a significant decrease in contrast material volume and radiation dose compared with CCA. The required extra projections did not neutralize the DARCA radiation dose and contrast volume reduction achievements.

5.
Rev. Soc. Bras. Med. Trop ; 53: e20190457, 2020. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1092227

RESUMO

Abstract INTRODUCTION: Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls. METHODS: We compared 194 patients with the indeterminate form of Chagas disease to 72 age-matched healthy individuals. We considered p-values <0.05 to be statistically significant. RESULTS: TDI analysis of the right ventricular (RV) showed lengthened isovolumic relaxation time (IRT) and higher RV index of myocardial performance (RIMP) and left ventricle (LV) index of myocardial performance (LIMP) in the Chagas group than in the control group, indicating RV and LV systolic and diastolic myocardial damage. TDI analysis of the myocardial velocities of the interventricular septum and the lateral wall of the LV also showed a systolic and diastolic myocardial damage. CONCLUSIONS: The study results demonstrated early LV systolic and diastolic myocardial damage in the RV and LV in patients with the indeterminate form of Chagas disease by TDI. These early findings of RV and LV dysfunction may help identify patients who will progress to heart failure during the disease course. TDI should be included in initial patient evaluations because it allows adequate follow-up and treatment.

6.
Medicina (B Aires) ; 79(6): 461-467, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829948

RESUMO

Treatment of acute coronary syndrome (ACS) may differ according to the health system coverage. The objective of this study was to evaluate demographic characteristics of patients with ACS assisted in public sector institutions compared to the non-public sector of Argentina, as well as the therapeutic and its relationship with the resources of each sector. We analyzed patients hospitalized in institutions of a national, voluntary, prospective and multicenter registry. Between March 2006 and May 2016, 11 072 ACSs were registered in 64 institutions, 39% public (44% have hemodynamic laboratory) and 61% non-public (82% with hemodynamic). Public centers presented less structure and assisted a higher proportion of ST elevation acute coronary syndrome (STE-ACS). (52.5% vs. 36.1%, p < 0.001). Public sector patients were younger, more frequently men, smokers, and less dyslipemics. The proportion of patients reperfused in the STE-ACS was similar in both sectors. The use of coronary angiography in non-ST elevation acute coronary syndrome (NSTE-ACS) was higher in the public sector, whose patients presented more frequently electrocardiographic changes and biomarker elevation. Considering all ACS, 80.2% of patients in public and 90.1% in non-public institutions were incorporated by haemodynamic centers. The availability of hemodynamics was the variable most associated with reperfusion in NSTE-ACS, and invasive treatment in NSTE-ACS. This research demonstrates the complexity of a comparative analysis of health sectors, due to the relevance acquired by the level of resources installed and the demographic differences of the inpatient population, above the simple difference of belonging to the public or non-public system.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Síndrome Coronariana Aguda/diagnóstico por imagem , Distribuição por Idade , Idoso , Argentina/epidemiologia , Angiografia Coronária/métodos , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Hemodinâmica , Humanos , Hipertensão/epidemiologia , Laboratórios/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição por Sexo , Fumar/epidemiologia , Estatísticas não Paramétricas
7.
Medicina (B.Aires) ; 79(6): 461-467, dic. 2019. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1056754

RESUMO

El tratamiento del síndrome coronario agudo (SCA) puede diferir segó;ºn la cobertura de salud. El objetivo fue comparar características demográficas de pacientes con SCA atendidos en instituciones del sector pó;ºblico, o en el no-pó;ºblico de Argentina, las terapó;©uticas y su relació;n con los recursos de cada sector. Analizamos internaciones en instituciones de un registro nacional, voluntario, prospectivo y multicó;©ntrico. Entre marzo 2006 y mayo 2016 ingresaron 11 072 SCA en 64 instituciones, 39% pó;ºblicas (44% con laboratorio de hemodinamia) y 61% no pó;ºblicas (82% con hemodinamia). Los centros pó;ºblicos presentaron menos estructura y atendieron mayor proporció;n de SCA con elevació;n del segmento ST (SCACEST) (52.5% vs. 36.1%, p < 0.001). Los pacientes del sector pó;ºblico fueron más jó;venes, más frecuentemente hombres, fumadores, y menos dislipó;©micos. La proporció;n de reperfundidos entre SCA con elevació;n del ST (SCACEST) fue similar en ambos sectores. La utilizació;n de coronariografía en SCA sin elevació;n del ST (SCASEST) fue mayor en el sector pó;ºblico, cuyos pacientes presentaron más frecuentemente cambios electrocardiográficos y biomarcadores elevados. Un 80.2% de los SCA en instituciones pó;ºblicas y 90.1% en las no pó;ºblicas fueron incorporados por centros con hemodinamia. La disponibilidad de hemodinamia fue la variable más asociada a reperfusió;n entre SCACEST y al tratamiento invasivo entre SCASEST. Se demuestra la complejidad del análisis comparativo de sectores de salud, por la relevancia que adquieren los recursos instalados y las diferencias demográficas de la població;n, por encima de la simple diferencia de pertenecer al sistema pó;ºblico o al no pó;ºblico.


Treatment of acute coronary syndrome (ACS) may differ according to the health system coverage. The objective of this study was to evaluate demographic characteristics of patients with ACS assisted in public sector institutions compared to the non-public sector of Argentina, as well as the therapeutic and its relationship with the resources of each sector. We analyzed patients hospitalized in institutions of a national, voluntary, prospective and multicenter registry. Between March 2006 and May 2016, 11 072 ACSs were registered in 64 institutions, 39% public (44% have hemodynamic laboratory) and 61% non-public (82% with hemodynamic). Public centers presented less structure and assisted a higher proportion of ST elevation acute coronary syndrome (STE-ACS). (52.5% vs. 36.1%, p < 0.001). Public sector patients were younger, more frequently men, smokers, and less dyslipemics. The proportion of patients reperfused in the STE-ACS was similar in both sectors. The use of coronary angiography in non-ST elevation acute coronary syndrome (NSTE-ACS) was higher in the public sector, whose patients presented more frequently electrocardiographic changes and biomarker elevation. Considering all ACS, 80.2% of patients in public and 90.1% in non-public institutions were incorporated by haemodynamic centers. The availability of hemodynamics was the variable most associated with reperfusion in NSTE-ACS, and invasive treatment in NSTE-ACS. This research demonstrates the complexity of a comparative analysis of health sectors, due to the relevance acquired by the level of resources installed and the demographic differences of the inpatient population, above the simple difference of belonging to the public or non-public system.

8.
Medicina (B Aires) ; 79(4): 251-256, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487243

RESUMO

Our objective was to evaluate clinical characteristics, results and morbi-mortality in primary angioplasty (PA), of patients treated with PA within 36 hours of a myocardial infarction (MI), included in a prospective, transversal, multicenter and national survey (ARGEN-IAM-ST). A total of 1142 patients treated with PA were registered, 61.2 ± 12 years old, 88% male, 20% diabetics and 58% with hypertension; 77.6% in Killip Kimball I and 6.2% in cardiogenic shock. The time from the onset of pain until admission was 153 (75-316) minutes, and door-balloon of 91 (60-150) minutes. The transferred patients (17%) showed longer delay to admission, 200 minutes (195-420; p = 0.0001) and door-to-balloon 113.5 minutes (55-207); p = 0.099. In 47.6% of the cases, the PA was made in the anterior descending artery, in 36.4% in the right coronary artery, in 14.8% in the circumflex artery and in 1.2% in the left coronary artery; in 95% with stent (29% pharmacological); 95% was successful, 1.3% presented post-infarct angina (APIAM), 1.3% re-infarct, 8.8% shock and 3.2% bleeding. Age > 64 years (OR 6.2 (95% CI: 3.2-12), p <0.001), diabetes (OR 2.5, 95% CI 1.6-3.9, p < 0.001), re-infarction or APIAM (OR 3.3, 95% CI 1.3-8.3, p = 0.011) and shock (OR 29.2 (15.6-54.8), p < 0.001) were independently associated with higher mortality. In-hospital mortality of acute myocardial infarction with ST-segment elevation treated with PA was 7.6%. Transference from other center was associated with delay in the admission and treatment. Cardiogenic shock and post-infarct ischemia were associated with high mortality. There were no procedural variables associated with mortality.


Assuntos
Angioplastia Coronária com Balão , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Angioplastia Coronária com Balão/mortalidade , Argentina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Resultado do Tratamento
9.
Medicina (B.Aires) ; 79(4): 251-256, ago. 2019. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1040517

RESUMO

Se evaluaron las características clínicas, demoras, resultados y morbimortalidad de 1142 pacientes tratados con angioplastia primaria (AP) dentro de las 36 horas del infarto, incluidos en el registro ARGEN-IAM-ST, de carácter prospectivo, transversal, multicéntrico y de alcance nacional. Edades: 61.2 ± 12 años, 88% varones, 20% diabéticos y 58% hipertensos; 77.6% en Killip y Kimball I y 6.2% en shock cardiogénico. El tiempo desde el inicio del dolor hasta el ingreso fue de 153 (75-316) minutos, y puerta-balón de 91 (60-150) minutos. Los casos derivados (17%) tuvieron mayor demora de ingreso, 200 minutos (195-420; p = 0.0001) y mayor tiempo puerta-balón, 113 minutos (55-207); p = 0.099. En 47.6% de los casos la AP se hizo en arteria descendente anterior, en 36.4% a coronaria derecha, en 14.8% a circunfleja y en 1.2% al tronco de coronaria izquierda; en 95% con stent (29% farmacológico). El 95% fue exitoso. El 1.3% presentó angina post-infarto (APIAM), 1.3% re-infarto, 8.8% shock y 3.2% sangrado. Se asociaron a mayor mortalidad edad > 64 años (OR 6.2 (IC 95%: 3.2-12), p < 0.001), diabetes (OR 2.5, IC 95% 1.6-3.9, p < 0.001), re-infarto o APIAM (OR 3.3, IC 95% 1.3-8.3, p = 0.011) y shock (OR 29.2 (15.6-54.8), p < 0.001). La mortalidad hospitalaria del infarto agudo de miocardio con elevación del segmento ST tratado con AP fue de 7.6%. La derivación se asoció a demora de tratamiento. El shock cardiogénico y la isquemia post-infarto se asociaron a alta mortalidad. No hubo variables del procedimiento asociadas a mortalidad.


Our objective was to evaluate clinical characteristics, results and morbi-mortality in primary angioplasty (PA), of patients treated with PA within 36 hours of a myocardial infarction (MI), included in a prospective, transversal, multicenter and national survey (ARGEN-IAM-ST). A total of 1142 patients treated with PA were registered, 61.2 ± 12 years old, 88% male, 20% diabetics and 58% with hypertension; 77.6% in Killip Kimball I and 6.2% in cardiogenic shock. The time from the onset of pain until admission was 153 (75-316) minutes, and door-balloon of 91 (60-150) minutes. The transferred patients (17%) showed longer delay to admission, 200 minutes (195-420; p = 0.0001) and door-to-balloon 113.5 minutes (55-207); p = 0.099. In 47.6% of the cases, the PA was made in the anterior descending artery, in 36.4% in the right coronary artery, in 14.8% in the circumflex artery and in 1.2% in the left coronary artery; in 95% with stent (29% pharmacological); 95% was successful, 1.3% presented post-infarct angina (APIAM), 1.3% re-infarct, 8.8% shock and 3.2% bleeding. Age > 64 years (OR 6.2 (95% CI: 3.2-12), p <0.001), diabetes (OR 2.5, 95% CI 1.6-3.9, p < 0.001), re-infarction or APIAM (OR 3.3, 95% CI 1.3-8.3, p = 0.011) and shock (OR 29.2 (15.6-54.8), p < 0.001) were independently associated with higher mortality. In-hospital mortality of acute myocardial infarction with ST-segment elevation treated with PA was 7.6%. Transference from other center was associated with delay in the admission and treatment. Cardiogenic shock and post-infarct ischemia were associated with high mortality. There were no procedural variables associated with mortality.

10.
Rev. argent. cardiol ; 87(3): 234-237, mayo 2019. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1057348

RESUMO

RESUMEN Introducción: El paro cardiorrespiratorio (PCR) en el contexto de un síndrome coronario agudo es una causa importante de muerte, tanto extra como intrahospitalaria. Objetivo: El objetivo de nuestro trabajo fue describir la prevalencia, las características y la evolución intrahospitalaria de los pacientes que presentaron PCR durante las primeras 24 horas del ingreso (PCR 24 h) en la población del registro ARGEN-IAM-ST. Resultados: la prevalencia de PCR 24 horas fue del 7,8% (136/1754 pacientes). Los que presentaron PCR 24 h eran más añosos (mediana: 63 vs 61 años, p < 0,001), tuvieron más prevalencia de shock cardiogénico (42,6% vs 3%, p < 0,01) y mortalidad intrahospitalaria (66% vs 4%, p < 0,001). La mortalidad global del registro fue de 8,8% (154 muertes/1754 pacientes). Del total de las muertes intrahospitalarias (n:154), el 58% ocurrió en los pacientes que presentaron PCR 24 h . Conclusiones: El PCR 24 h en pacientes con un síndrome coronario agudo con elevación del ST es un evento grave y representa el 60% de las muertes intrahospitalarias.


ABSTRACT Background: Cardiac arrest (CA) in the setting of an acute coronary syndrome is an important cause of in-hospital and out-of hospital mortality. Objectives: The aim of this study was to describe the prevalence, clinical characteristics, and in-hospital outcome of patients from the ARGEN-IAM-ST registry with CA within the first 24 hours after hospital admission. Results: The prevalence of CA within the first 24 hours was 7.8% (136/1,754 patients). These patients were older (median age 63 vs. 61 years, p<0.001) and had higher prevalence of cardiogenic shock (42.6% vs., 3%, p<0.01) and of in-hospital mortality (66% vs. 4%, p<0.001). Overall mortality of the registry was 8.8% (154/1754) and 58% occurred in patients with CA within the first 24 hours after admission. Conclusions: Cardiac arrest within 24 hours in patients with ST- segment elevation acute coronary syndrome is a serious event representing 60% of in-hospital mortality.

11.
Respir Care ; 64(4): 473-483, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30944228

RESUMO

BACKGROUND: Previous studies that evaluated mortality in elderly subjects who received mechanical ventilation had conflicting results. The aim of this systematic review was to evaluate the effects of age on mortality. METHODS: A number of medical literature databases and the references listed (from 1974 to May 2015) were searched for studies that compared 2 different age groups. The primary outcome was mortality in subjects ages ≥ 65 y. The severity scores, ICU and hospital lengths of stay, and the presence of ventilator-associated pneumonia were secondary outcomes. Finally, mortality in the subjects with ARDS and of cutoff ages 70 and 80 y was assessed by subgroup analysis. Evidence quality was assessed by the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria score. RESULTS: Of the 5,182 articles identified, 21 were included. Subjects ages ≥ 65 y had higher mortalities (odds ratio [OR] 1.80, 95% CI 1.56-2.08; I2 = 71%). APACHE (Acute Physiology and Chronic Health Evaluation) II revealed intergroup differences (mean difference 3.07, 95% CI 2.52-3.61; I2 = 0%), whereas neither the ICU nor hospital length of stay (mean difference 1.27, 95% CI -0.82 to 3.36, I2 = 82%, and mean difference 1.29, 95% CI -0.71 to 3.29, I2 = 0%, respectively) nor the groups in the 2 studies that assessed ventilator-associated pneumonia exhibited any difference. Subgroup analysis revealed a higher mortality in the older subjects, in the subjects with ARDS (OR 1.76, 95% CI 1.30-2.36; I2 = 0%) and in the subjects ages 70 and 80 y (OR 1.78, 95% CI 1.51-2.10, I2 = 71%; and OR 1.96, 95% CI 1.81-2.13, I2 = 0%, respectively). The quality of associated evidence was low or very low. CONCLUSIONS: Although low-quality evidence was available, we conclude that age is associated with a greater mortality in critical subjects who were receiving mechanical ventilation.

12.
J Cardiovasc Imaging ; 27(1): 37-47, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30701715

RESUMO

BACKGROUND: Cardiac myxomas are the most frequent cardiac tumors. Although histologically benign, in some cases myxomas may be lethal, due to impairment of cardiac dynamics and their thromboembolic potential. The study aimed to assess the clinical presentation of cardiac myxomas and their correlation with echocardiographic features and to describe the perioperative results and long-term outcome of surgically treated patients. METHODS: A prospective study of 53 patients with cardiac myxomas who were operated the Hospital Argerich, followed clinically and with echocardiography from 1993 until 2013. All patients underwent echocardiographic studies. RESULTS: The patient's mean age was 53 ± 16 years (62.3% were women). The most common findings were dyspnea followed by embolic events. Most tumors were localized in the left atrium (77.4%), mainly in the fossa ovalis (63%). Mean size of the tumors was 4.76 x 3.50 cm. Tumors were generally mobile (88%) and went beyond the valve plane, causing mild mitral or tricuspid valve obstruction (58%) and dilation of the respective atrial chamber. Patients whose tumors were obstructive had higher pulmonary artery systolic pressures (50 vs 33 mmHg p < 0.01). According to the echocardiographic appearance 67% of tumors had a smooth surface and the remaining 32% had a villous surface. All patients with embolic manifestations had tumors with a villous surface. CONCLUSIONS: Clinical presentation relates to the ultrasound characteristics of myxomas. Smooth tumors are larger, occur with obstructive symptoms, and benefit from an elective surgery, whereas villous myxomas entailed a high embolic risk and require prompt surgical treatment.

13.
Rev. argent. cardiol ; 87(1): 16-20, feb. 2019. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1003244

RESUMO

RESUMEN Objetivos: Comparar pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) incluidos en centros participantes de dos registros argentinos. Material y métodos: Se compararon pacientes con IAMCEST incluidos en 54 centros que participaron tanto en el registro SCAR (2011) como en el ARGEN-IAM-ST (2015). Resultados: Se analizaron 676 pacientes con IAMCEST; 222 del SCAR y 454 del ARGEN-IAM-ST No hubo cambios significativos en la edad y el género. Se observó una reducción significativa en el uso de fibrinolíticos, con un incremento de la angioplastia primaria. El shock cardiogénico se redujo a la mitad. No hubo diferencias en la mortalidad y de reinfarto durante la hospitalización. Conclusiones: Se observó una mayor indicación de angioplastia primaria y una disminución en el uso de fibrinolíticos. El shock cardiogénico se redujo significativamente en los últimos 5 años, sin cambios significativos en la mortalidad hospitalaria.


ABSTRACT Objectives: The aim of this study was to compare patientis with ST-segment elevation myocardial infarction (STEMI) included in centers participating of two registries in Argentina. Methods: STEMI patientis included in the 54 centers participating in the SCAR (2011) registry and in the ARGEN-IAM-ST (2015) registry were compared. Resultis: A total of 676 STEMI patientis were analyzed: 222 in the SCAR registry and 454 in the ARGEN-IAM-ST registry. There were no significant differences in age and sex. The use of fibrinolytic agentis was significantly lower and the use of primary percutaneous coronary intervention was significantly increased. The incidence of cardiogenic shock was 50% lower. There were no differences in mortality and reinfarction during hospitalization. Conclusions: The indication of primary percutaneous coronary intervention increased and the use of fibrinolytic agentis decreased. Cardiogenic shock decreased significantly in the last 5 years without significant changes in in-hospital mortality.

14.
Rev. argent. cardiol ; 87(1): 41-50, feb. 2019. graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1003248

RESUMO

RESUMEN Introducción: Los adultos mayores representan una población cada vez más numerosa en la práctica clínica. Objetivos: Conocer las características clínicas y evolución de los adultos mayores que se internan por infarto en Argentina. Material y métodos: Se analizaron los pacientes de acuerdo con la edad mayor o menor de 75 años incluidos en el registro ARGEN-IAM-ST. Resultados: De 1714 pacientes ingresados, 233 (13,6%) tenían una edad ≥ 75 años. Se observó en estos una mayor prevalencia de sexo femenino, de hipertensión arterial, menor de tabaquismo y similar de diabetes, dislipidemia, infarto agudo de miocardio de localización anterior y tiempo de evolución al ingreso. Recibieron menos tratamiento de reperfusión y evolucionaron más frecuentemente con insuficiencia cardíaca (el 31% vs. a 14%; p < 0,01), reinfarto (3,9 vs. 1,4%; p = 0,009), sangrado no mayor (7,7% vs. 3,2%, p < 0,002) y muerte (21,5% vs. 6,7%, p < 0,001). Conclusiones: Los adultos mayores con infarto tienen una evolución más tórpida y una mortalidad que triplica la de los pacientes menores de 75 años.


ABSTRACT Background: Older adultis represent a growing population in clinical practice. Objectives: The aim of this study was to learn the clinical characteristics and outcome of older adultis hospitalized with myo-cardial infarction in Argentina. Methods: Patientis included in the ARGEN-IAM-ST registry were analyzed depending on whether they were older or younger than 75 years of age. Resultis: Among the 1,714 patientis included in the registry, 233 (13.6%) were aged 75 years or older. These patientis had greater prevalence of female sex and hypertension and lower incidence of smoking habitis, while the prevalence of diabetes, dyslipidemia, anterior myocardial infarction and time from onset of symptoms was similar. They were less likely to receive reperfusion therapy and progression to heart failure (31% vs. 14%; p <0.01), reinfarction (3.9 vs. 1.4%; p=0.009), minor bleeding (7.7% vs. 3.2%; p <0.002) and mortality (21.5% vs. 6.7%, p <0.001) were more common. Conclusions: Older adultis with myocardial infarction have a more unfavorable outcome and mortality is three times greater than that of patientis <75 years.

15.
Medicina (B Aires) ; 78(3): 163-170, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29940542

RESUMO

Congestion in heart failure patients with reduced ejection fraction (HFrEF) is relevant and closely linked to the clinical course. Bedside blood pressure measurement during the Valsalva maneuver (Val) added to clinical examination may improve the assessment of congestion when compared to NT-proBNP levels and left atrial pressure (LAP) estimation by Doppler echocardiography, as surrogate markers of congestion in HFrEF. A clinical examination, LAP and blood tests were performed in 69 HFrEF ambulatory patients with left ventricular ejection fraction ≤ 40% and sinus rhythm. Framingham Heart Failure Score (HFS) was used to evaluate clinical congestion; Val was classified as normal or abnormal, NT-proBNP was classified as low (< 1000 pg/ml) or high (≥ 1000 pg/ml) and the ratio between Doppler early mitral inflow and tissue diastolic velocity was used to estimate LAP and was classified as low (E/e'< 15) or high (E/e' ≥ 15). A total of 69 patients with HFrEF were included; 27 had a HFS ≥ 2 and 13 of them had high NT-proBNP. HFS ≥ 2 had a 62% sensitivity, 70% specificity and a positive likelihood ratio of 2.08 (p=0.01) to detect congestion. When Val was added to clinical examination, the presence of a HFS ≥ 2 and abnormal Val showed a 100% sensitivity, 64% specificity and a positive likelihood ratio of 2.8 (p = 0.0004). Compared with LAP, the presence of HFS = 2 and abnormal Val had 86% sensitivity, 54% specificity and a positive likelihood ratio of 1.86 (p = 0.03). In conclusion, an integrated clinical examination with the addition Valsalva maneuver may improve the assessment of congestion in patients with HFrEF.


Assuntos
Biomarcadores/análise , Insuficiência Cardíaca/diagnóstico , Peptídeo Natriurético Encefálico/análise , Fragmentos de Peptídeos/análise , Manobra de Valsalva , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença
16.
Medicina (B.Aires) ; 78(3): 163-170, jun. 2018. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-954972

RESUMO

La evaluación de la congestión en pacientes con insuficiencia cardíaca y fracción de eyección reducida (ICFEr) resulta relevante y estrechamente vinculada al curso clínico. El agregado del comportamiento de la presión arterial durante la maniobra de Valsalva en la cabecera del paciente (VAL) podría mejorar la evaluación clínica de congestión cuando la comparamos con los niveles de NT-proBNP y la estimación de la presión media en la aurícula izquierda por Doppler cardíaco, como subrogantes de congestión. Se realizó un examen clínico con el VAL, un examen de laboratorio y un Doppler cardíaco en 69 pacientes ambulatorios con insuficiencia cardíaca y fracción de eyección ≤ 40% en ritmo sinusal. El score de Framingham ≥ 2 (SFr ≥ 2) se empleó para evaluar congestión clínica. VAL fue clasificado como normal o anormal, el NT-proBNP como bajo (< 1000 pg/ml) o alto (≥ 1000 pg/ml) y la relación entre la velocidad del llenado ventricular rápido y la velocidad del Doppler tisular (E/e') como baja < 15 o alta ≥ 15. Se halló que 13/27 pacientes con SFr ≥ 2 tenían NT-proBNP alto (sensibilidad 62%, especificidad 70% y razón de verosimilitud positiva [LR+] de 2.08, p = 0.01). El agregado del VAL al SFr ≥ 2 mejoró la exactitud diagnóstica (sensibilidad 100%, especificidad 64% y LR+ 2.8 p = 0.0004). Comparado con la E/e', SFr ≥ 2 con VAL anormal mostró sensibilidad 86%, especificidad 56% y LR + 1.86 (p = 0.03). En conclusión, el agregado del comportamiento de la presión durante la maniobra de Valsalva podría mejorar la evaluación clínica de la congestión en la insuficiencia cardíaca.


Congestion in heart failure patients with reduced ejection fraction (HFrEF) is relevant and closely linked to the clinical course. Bedside blood pressure measurement during the Valsalva maneuver (Val) added to clinical examination may improve the assessment of congestion when compared to NT-proBNP levels and left atrial pressure (LAP) estimation by Doppler echocardiography, as surrogate markers of congestion in HFrEF. A clinical examination, LAP and blood tests were performed in 69 HFrEF ambulatory patients with left ventricular ejection fraction ≤ 40% and sinus rhythm. Framingham Heart Failure Score (HFS) was used to evaluate clinical congestion; Val was classified as normal or abnormal, NT-proBNP was classified as low (< 1000 pg/ml) or high (≥ 1000 pg/ml) and the ratio between Doppler early mitral inflow and tissue diastolic velocity was used to estimate LAP and was classified as low (E/e'< 15) or high (E/e' ≥ 15). A total of 69 patients with HFrEF were included; 27 had a HFS ≥ 2 and 13 of them had high NT-proBNP. HFS ≥ 2 had a 62% sensitivity, 70% specificity and a positive likelihood ratio of 2.08 (p=0.01) to detect congestion. When Val was added to clinical examination, the presence of a HFS ≥ 2 and abnormal Val showed a 100% sensitivity, 64% specificity and a positive likelihood ratio of 2.8 (p = 0.0004). Compared with LAP, the presence of HFS ≥ 2 and abnormal Val had 86% sensitivity, 54% specificity and a positive likelihood ratio of 1.86 (p = 0.03). In conclusion, an integrated clinical examination with the addition Valsalva maneuver may improve the assessment of congestion in patients with HFrEF.

17.
Echocardiography ; 35(5): 643-650, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29457264

RESUMO

BACKGROUND: Fabry disease (FD) and hypertrophic cardiomyopathy (HCM) are two diseases with a different pathophysiology, both cause left ventricular hypertrophy (LVH) and myocardial fibrosis. Although remodeling and systolic dysfunction of the left atrium (LA) are associated with atrial fibrillation and stroke in HCM, changes in the size and function of the LA have not been well studied in FD with LVH. METHODS: The following groups were studied prospectively, and their respective findings compared: 19 patients with non-obstructive HCM (Group I), 20 patients with a diagnosis of Fabry cardiomyopathy (Group II), and 20 normal subjects matched for sex and age (Group III). Left ventricular mass index was measured using Devereux' formula, left atrial volume with Simpson's biplane method and left atrial mechanical function, including strain and strain rate, was measured using the speckle tracking technique. Strain and strain rate of the reservoir were measured during the three phases: reservoir (SR S), passive conduit (SR E) and atrial contraction (SR A). RESULTS: Patients with HCM had a larger left atrial volume than patients with FD (48.16 ± 14.3 mL/m2 vs 38.9 ± 14.9 mL/m2 respectively, P < .001), but in both disorders there was a severe decrease in left atrial function: reservoir strain in the apical four-chamber view: 17.47% in HCM vs 22.5% in FD, P = .24), strain rate in the apical chamber view: SR A: -0.80/seconds in HCM vs -1.04/seconds in FD (P = .88), SR S: 0.69/seconds in HCM vs 0.93 in FD (P = .12), SR E: -0.80 seconds in HCM vs -0.97/seconds in FD (P = .18). CONCLUSIONS: In this echocardiographic study we used speckle tracking to assess left atrial mechanical function and showed that FD is associated to an atrial cardiomyopathy, affecting the three phasic functions of the LA. Although in patients with HCM left atrial volume is larger than in patients with FD, both disorders exhibit severe decrease in left atrial function. These findings should be considered, given the potentially serious complications that can occur with the two diseases.


Assuntos
Função do Átrio Esquerdo/fisiologia , Cardiomiopatia Hipertrófica/complicações , Ecocardiografia Doppler em Cores/métodos , Doença de Fabry/complicações , Átrios do Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/complicações , Função Ventricular Esquerda/fisiologia , Adulto , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/fisiopatologia , Doença de Fabry/diagnóstico , Feminino , Átrios do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes
18.
Rev. argent. cardiol ; 86(1): 21-29, Feb. 2018.
Artigo em Inglês | LILACS-Express | ID: biblio-990513

RESUMO

ABSTRACT: Background: The clinical and epidemiological characteristics of infective endocarditis (IE), a complex disease with high morbidity and mortality, have changed over time. Our country lacks updated information since the publication of the EIRA 1 and 2 studies (1992 and 2002). Objective: The aim of this study was to analyze the epidemiology, clinical and microbiological characteristics and hospital outcome of patients with IE. Methods: A prospective multicenter observational study of patients with definite IE was conducted according to the modified Duke criteria. results: A total of 502 patients were recruited from 48 centers (69.5% in the Buenos Aires Metropolitan Area). Mean age 60.7±19.3 years and 69.9% (n=351) were men]; 54.64% of patients (n=274) did not present underlying heart disease, 19.9% (n=100) had pros-thetic valves and 38.1% (n=191) had history of a healthcare-related procedure. The diagnosis was made within one month after the first clinical manifestation in 73.3% of cases (n=368) [76.5% (n=384) in the native valve]. The aortic valve was the most commonly affected valve (45.96%; n=230), followed by mitral valve involvement (33%; n=150). The most common germs were Staphylococcus spp in 46.3% of patients (n=232), Streptococcus spp in 28.2% (n=141) and Enterococcus in 12.8% (n=64). Blood cultures were nega-tive in 44 patients (8.76%). Complications: heart failure (30.9%; n=155), peripheral embolism (19.6%; n=98) and abscess (15.5%; n=78). Adequate empirical antibiotic treatment was administered to 62.4% (n=313) of the patients and 43.6% (n=219) underwent surgical treatment. Overall in-hospital mortality was 25.5% (n=128). Age, history of chronic kidney failure, mitral valve disease and heart failure were independent predictors of in-hospital mortality. Conclusions: A high percentage of patients with IE do not present known prior heart disease. Staphylococcus spp was the most com-mon microorganism. Mortality remains high and similar to the one observed in the EIRA 1 and 2 studies.


RESUMEN: introducción: La endocarditis infecciosa (EI) es una enfermedad compleja con elevada morbimortalidad, cuyas características clínicas y epidemiológicas han variado. Desde la realización de los Estudios EIRA 1 y 2 (1992 y 2002) no se dispone de información nacional actualizada. Objetivo: Analizar la epidemiología, características clínicas, microbiológicas y evolución hospitalaria de los pacientes con EI. Material y Métodos: Estudio observacional prospectivo multicéntrico de EI definidas según los criterios de Duke modificados. resultados: En 48 centros, (69.5% Área Metropolitana Buenos Aires), se registraron 502 pacientes; edad 60,7 ± 19,3 años, hombres 69,9% (N=351). El 54,64% de los pacientes (N= 274) no presentó cardiopatía subyacente. El 38,1% (N=191) tenía antecedentes de un procedimiento asociado al cuidado de la salud. En el 73,3% (N=368) se realizó el diagnóstico dentro del mes de la primera manifestación clínica. La localización más frecuente fue la aórtica, tanto en EI por válvulas nativas como protésicas (48,24%/N=233) seguida de mitral (25,88%/N=125). Los gérmenes más frecuentes fueron: Staphylococcus spp 46,3% (N=210), Streptococcus spp 28,2% (N=128) y Enterococcus spp 12,8% (N=58). En 9,56% (N=48) de los casos los hemocul-tivos fueron negativos. Complicaciones: insuficiencia cardíaca (30,9%/N=155), embolias periféricas (19,6%/N=98) y absceso (15,5%/ N=78). El 62,4% (N= 313) recibió tratamiento antibiótico empírico adecuado y el 43,4% tratamiento quirúrgico (N= 218). Mortalidad hospitalaria global: 25,5% (N=128). La edad, el antecedente de insuficiencia renal, la afección de la válvula mitral y la presencia de insuficiencia cardíaca fueron predictores de mortalidad hospitalaria. Conclusiones: Existe un elevado porcentaje de pacientes con EI sin enfermedad cardíaca previa conocida. El Staphylococcus spp fue el germen causal más frecuente. La mortalidad se mantiene elevada, y similar a la de los estudios EIRA 1 y 2.

19.
J Echocardiogr ; 16(3): 139-146, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29249067

RESUMO

BACKGROUND: Transesophageal Doppler echocardiography has shown that significant stenosis can be detected based on the presence of aliasing with color Doppler in the stenotic area. The study aimed to assess the detection of angiographically significant coronary stenosis (ASCS) by analyzing the characteristics and velocities of resting coronary artery flow (RCF) using transthoracic coronary Doppler echocardiography (TCDE). METHODS: TCDE was performed before diagnostic coronary angiography (CA). The following velocities were measured: peak systolic velocity (PSV), peak diastolic velocity (PDV), mean diastolic velocity (MDV), end-diastolic velocity (EDV), and distal to proximal velocity ratios. RESULTS: Twenty-five patients were included, and CA revealed ASCS in 14 patients. With TCDE, the proximal and distal portions of the left anterior descending artery (LAD) could be measured in 84% of cases. Among 12 patients with ASCS in the distal left main coronary artery (LMCA) or proximal or mid LAD, proximal and distal flow could be measured in ten patients. Proximal diastolic velocities were higher in patients with ASCS in the LAD, and a distal MDV/proximal MDV ratio < 0.5 had a 60% sensitivity and a 92% specificity for the detection of ASCS (AUC 0.77, 95% CI 0.56-0.92). For the detection of ASCS limited to the LMCA and/or proximal LAD, the distal MDV/proximal MDV ratio had a sensitivity of 100% and a specificity of 89% (AUC 0.98, 95% CI 0.81-0.99). CONCLUSIONS: Resting TCDE can detect ASCS in the LAD, particularly at the proximal level, analyzing the ratio between distal and proximal flow velocities. These results could not be demonstrated in the RCA and CX arteries.


Assuntos
Velocidade do Fluxo Sanguíneo , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Idoso , Diástole , Ecocardiografia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Sístole
20.
Curr Vasc Pharmacol ; 16(4): 355-360, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28595560

RESUMO

BACKGROUND: Vitamin D is a fat soluble vitamin involved in calcium and bone metabolism; recently its deficiency has been related to cardiovascular disease. In cardiac tissue, vitamin D suppresses metalloproteinases (MMPs) expression, enzymes directly associated with vulnerable plaque. OBJECTIVE: To investigate whether the association between vitamin D and leptin is related to markers of vulnerable plaque, such as MMPs in patients with acute myocardial infarction. METHODS: We studied 66 male patients with acute myocardial infarction, undergoing primary angioplasty. Blood samples were obtained at admission and 24hs after the surgery. Leptin and vitamin D concentrations in serum and MMP-2 and -9 activities in plasma were determined. RESULTS: MMP-2 activity was increased in Vitamin D deficient/insufficient patients at admission (p=0.04) and 24 hs later (p=0.05). In a linear regression model, vitamin D explained 24% of the variance of MMP-2 activity (F=2.839 p=0.04). At admission, vitamin D correlated with serum leptin (r=-0.302 p=0.033), and explained 39.5% of its variation (F=4.432 p=0.003). CONCLUSION: In the studied population, vitamin D was inversely related to MMP-2 and leptin which are involved in coronary artery disease and acute myocardial infarction. The decrease in this hormone levels would be associated with a worse metabolic profile in acute coronary syndrome patients.


Assuntos
Doença da Artéria Coronariana/sangue , Leptina/sangue , Metaloproteinase 2 da Matriz/sangue , Placa Aterosclerótica , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Adulto , Idoso , Biomarcadores/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Fatores de Tempo , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico
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