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1.
BMC Pulm Med ; 21(1): 96, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743654

RESUMO

BACKGROUND: Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. METHODS: Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. RESULTS: 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687). CONCLUSION: Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.


Assuntos
/epidemiologia , Idoso , Idoso de 80 Anos ou mais , /fisiopatologia , Comorbidade , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Hipóxia/epidemiologia , Hipóxia/fisiopatologia , Hipóxia/terapia , Itália/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Ventilação não Invasiva/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/epidemiologia
2.
Circ J ; 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33658444

RESUMO

BACKGROUND: Coronavirus Disease-2019 (COVID-19) may impair outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The extent of this phenomenon and its mechanisms are unclear.Methods and Results:This study prospectively included 50 consecutive STEMI patients admitted to our center for primary percutaneous coronary intervention (PCI) at the peak of the Italian COVID-19 outbreak. At admission, a COVID-19 test was positive in 24 patients (48%), negative in 26 (52%). The primary endpoint was in-hospital all-cause mortality. Upon admission, COVID-19 subjects had lower PO2/FiO2 (169 [100-425] vs. 390 [302-477], P<0.01), more need for oxygen support (62.5% vs. 26.9%, P=0.02) and a higher rate of myocardial dysfunction (ejection fraction <30% in 45.8% vs. 19.2%, P=0.04). All patients underwent emergency angiography. In 12.5% of COVID-19 patients, no culprit lesions were detected, thus PCI was performed in 87.5% and 100% of COVID-19 positive and negative patients, respectively (P=0.10). Despite a higher rate of obstinate thrombosis in the COVID-19 group (47.6% vs. 11.5%, P<0.01), the PCI result was similar (TIMI 2-3 in 90.5% vs. 100%, P=0.19). In-hospital mortality was 41.7% and 3.8% in COVID-19 positive and negative patients, respectively (P<0.01). Respiratory failure was the leading cause of death (80%) in the COVID-19 group, frequently associated with severe myocardial dysfunction. CONCLUSIONS: In-hospital mortality of COVID-19 patients with STEMI remains high despite successful PCI, mainly due to coexisting severe respiratory failure. This may be a critical factor in patient management and treatment selection.

3.
J Am Coll Cardiol ; 77(3): 314-325, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33478655

RESUMO

To investigate whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-induced myocarditis constitutes an important mechanism of cardiac injury, a review was conducted of the published data and the authors' experience was added from autopsy examination of 16 patients dying of SARS-CoV-2 infection. Myocarditis is an uncommon pathologic diagnosis occurring in 4.5% of highly selected cases undergoing autopsy or endomyocardial biopsy. Although polymerase chain reaction-detectable virus could be found in the lungs of most coronavirus disease-2019 (COVID-19)-infected subjects in our own autopsy registry, in only 2 cases was the virus detected in the heart. It should be appreciated that myocardial inflammation alone by macrophages and T cells can be seen in noninfectious deaths and COVID-19 cases, but the extent of each is different, and in neither case do such findings represent clinically relevant myocarditis. Given its extremely low frequency and unclear therapeutic implications, the authors do not advocate use of endomyocardial biopsy to diagnose myocarditis in the setting of COVID-19.


Assuntos
Miocardite/virologia , Biópsia , Humanos , Miocardite/patologia , Miocárdio/patologia
4.
Circulation ; 143(10): 1031-1042, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33480806

RESUMO

BACKGROUND: Cardiac injury is common in patients who are hospitalized with coronavirus disease 2019 (COVID-19) and portends poorer prognosis. However, the mechanism and the type of myocardial damage associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain uncertain. METHODS: We conducted a systematic pathological analysis of 40 hearts from hospitalized patients dying of COVID-19 in Bergamo, Italy, to determine the pathological mechanisms of cardiac injury. We divided the hearts according to presence or absence of acute myocyte necrosis and then determined the underlying mechanisms of cardiac injury. RESULTS: Of the 40 hearts examined, 14 (35%) had evidence of myocyte necrosis, predominantly of the left ventricle. Compared with subjects without necrosis, subjects with necrosis tended to be female, have chronic kidney disease, and have shorter symptom onset to admission. The incidence of severe coronary artery disease (ie, >75% cross-sectional narrowing) was not significantly different between those with and without necrosis. Three of 14 (21.4%) subjects with myocyte necrosis showed evidence of acute myocardial infarction, defined as ≥1 cm2 area of necrosis, whereas 11 of 14 (78.6%) showed evidence of focal (>20 necrotic myocytes with an area of ≥0.05 mm2 but <1 cm2) myocyte necrosis. Cardiac thrombi were present in 11 of 14 (78.6%) cases with necrosis, with 2 of 14 (14.2%) having epicardial coronary artery thrombi, whereas 9 of 14 (64.3%) had microthrombi in myocardial capillaries, arterioles, and small muscular arteries. We compared cardiac microthrombi from COVID-19-positive autopsy cases to intramyocardial thromboemboli from COVID-19 cases as well as to aspirated thrombi obtained during primary percutaneous coronary intervention from uninfected and COVID-19-infected patients presenting with ST-segment-elevation myocardial infarction. Microthrombi had significantly greater fibrin and terminal complement C5b-9 immunostaining compared with intramyocardial thromboemboli from COVID-19-negative subjects and with aspirated thrombi. There were no significant differences between the constituents of thrombi aspirated from COVID-19-positive and -negative patients with ST-segment-elevation myocardial infarction. CONCLUSIONS: The most common pathological cause of myocyte necrosis was microthrombi. Microthrombi were different in composition from intramyocardial thromboemboli from COVID-19-negative subjects and from coronary thrombi retrieved from COVID-19-positive and -negative patients with ST-segment-elevation myocardial infarction. Tailored antithrombotic strategies may be useful to counteract the cardiac effects of COVID-19 infection.


Assuntos
/virologia , Trombose Coronária/etiologia , Infarto do Miocárdio , Miocárdio/patologia , Idoso , Trombose Coronária/patologia , Trombose Coronária/virologia , Vasos Coronários/patologia , Vasos Coronários/virologia , Feminino , Coração/virologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/virologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/virologia
5.
Panminerva Med ; 2020 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-33244949

RESUMO

BACKGROUND: Findings from February, 2020, indicate that the clinical spectrum of Covid-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak. The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak. METHODS: Retrospective observational study of all Covid-19 patients admitted to the main hospital of Bergamo, from February 23 to March, 14, 2020. RESULTS: 508 patients were hospitalized , predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years. Most of patients presented with severe respiratory failure (median value [IQR] of PaO2/FiO2 233 [149-281]). Mortality rate at 28 days resulted of 33.7% (N=171). 39.0% of patients were treated with continuous positive airway pressure (CPAP), 9.5% with non-invasive ventilation (NIV) and 13.6% with endotracheal intubation. 9.5% were admitted to semi-intensive respiratory care unit, and 18.9% to ICU. Risk factors independently associated with 28-day mortality were advanced age (≥78 years: odds ratio, OR, 95% confidence interval [CI] 38.91 [10.67-141.93], p<0.001; 70-77 years: 17.30 [5.40-55.38], p<0.001; 60-69 years: 3.20 [1.00-10.20], p=0.049), PaO2/FiO2 <200 at presentation (3.50 [1.70-7.20], p=0.001), need for CPAP/NIV in the first 24 hours (8.38 [3.63-19.35], p <0.001), and blood urea value at admission (1.01 [1.00-1.02], p=0.015). CONCLUSIONS: At the peak of the outbreak, with a probable high infectious dose and viral load, older age, the severity of respiratory failure and renal impairment at presentation, but not comorbidities, are predictors of 28-day mortality in Covid-19.

6.
Int J Cardiol Heart Vasc ; 31: 100662, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33173807

RESUMO

Background: During the COVID-19 outbreak, healthcare Authorities of Lombardy modified the regional network concerning time-dependent emergencies. Specifically, 13 Macro-Hubs were identified to deliver timely optimal care to patients with acute coronary syndromes (ACS). Aim of this paper is to present the results of this experience. Methods and Results: This is a multicenter, observational study. A total of 953 patients were included, presenting with STEMI in 57.7% of the cases. About 98% of patients received coronary angiography with a median since first medical contact to angiography of 79 (IQR 45-124) minutes for STEMI and 1262 (IQR 643-2481) minutes for NSTEMI.A total of 107 patients (11.2%) had SARS-CoV2 infection, mostly with STEMI (74.8%). The time interval from first medical contact to cath-lab was significant shorter in patients with COVID-19, both in the overall population and in STEMI patients (87 (IQR 41-310) versus 160 (IQR 67-1220) minutes, P = 0.001, and 61 (IQR 23-98) versus 80 (IQR 47-126) minutes, P = 0.01, respectively). In-hospital mortality and cardiogenic shock rates were higher among patients with COVID-19 compared to patients without (32% vs 6%, P < 0.0001, and 16.8% vs 6.7%, P < 0.0003, respectively). Conclusions: During the COVID-19 outbreak in Lombardy, the redefinition of ACS network according to enlarged Macro-Hubs allowed to continue with timely ACS management, while reserving a high number of intensive care beds for the pandemic. Patients with ACS and COVID-19 presented a worst outcome, particularly in case of STEMI.

8.
EuroIntervention ; 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33106225

RESUMO

AIMS: Cardiogenic shock (CGS) occurs in 6-10% of patients with acute coronary syndromes (ACS). Mortality has fallen over time from 80% to approximately 50% consequent on acute revascularization but plateaued since the 1990s. Once established, patients with CGS develop adverse compensatory mechanisms that contribute to the downwards spiral towards death, which becomes difficult to reverse. METHODS AND RESULTS: The "EURO SHOCK' trial will test the benefit or otherwise of mechanical cardiac support using veno-arterial extra-corporeal membrane oxygenation (VA-ECMO), initiated early after acute percutaneous coronary intervention (PCI) for CGS. The trial sets out to randomize 428 patients with CGS complicating ACS, following primary PCI (P-PCI), to either very early ECMO plus standard pharmacotherapy, or to standard pharmacotherapy alone. It will be conducted in 39 European centers. The primary endpoint is 30-day all-cause mortality with key secondary endpoints: 1) 12-month all-cause mortality or admission for heart failure, 2) 12-month all-cause mortality, 3) 12-month admission for heart failure. Cost-effectiveness analysis (including quality of life measures) will be embedded. Mechanistic and hypothesis-generating sub-studies will be undertaken. CONCLUSIONS: The EURO SHOCK trial will determine whether early initiation of VA-ECMO in patients presenting with ACS-CGS persisting after PCI, improves mortality and morbidity.

9.
EuroIntervention ; 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32863246

RESUMO

AIMS: Randomized trials have demonstrated improvement in clinical outcomes with intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI. The ILUMIEN III trial demonstrated non-inferiority of an optical coherence tomography (OCT)- versus IVUS-guided PCI strategy in achieving similar post-PCI lumen dimensions. ILUMIEN IV is a large-scale, multicenter, randomized trial designed to demonstrate the superiority of OCT- versus angiography-guided stent implantation in patients with high-risk clinical characteristics (diabetes) and/or complex angiographic lesions in achieving larger post-PCI lumen dimensions and improving clinical outcomes. METHODS AND RESULTS: ILUMIEN IV is a prospective, single-blind clinical investigation that will randomize between 2490 and 3656 patients using an adaptive design to OCT-guided versus angiography-guided coronary stent implantation in a 1:1 ratio. The primary endpoints are: (1) Post-PCI minimal stent area assessed by OCT in each randomized arm, and (2) target vessel failure, the composite of cardiac death, target vessel myocardial infarction, or ischemia-driven target vessel revascularization. Clinical follow-up will continue for up to 2 years. The trial is currently enrolling, and the principal results are expected in 2022. CONCLUSIONS: The large-scale ILUMIEN IV randomized controlled trial will evaluate the effectiveness of OCT-guided versus angiography-guided PCI in improving post-PCI lumen dimensions and clinical outcomes in patients with diabetes and/or with complex coronary lesions.

12.
EuroIntervention ; 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32540793

RESUMO

AIMS: In the ILUMIEN III trial, among 450 randomised patients with non-complex lesions undergoing percutaneous coronary intervention (PCI), optical coherence tomography (OCT) guidance led to greater stent expansion than angiography guidance, similar minimal stent area compared to both intravascular ultrasound (IVUS) guidance and angiography guidance, and lower rates of uncorrected dissection and malapposition than both IVUS guidance and angiography guidance. Whether these differences impact clinical outcomes is unknown. METHODS AND RESULTS: OCT-guided PCI, using an external elastic lamina-based protocol, was compared to operator-directed IVUS-guided or angiography-guided PCI. Target lesion failure (TLF) and major adverse cardiovascular events (MACE) at 12 months were adjudicated by a blinded clinical events committee. There were no significant differences in the rates of TLF (2.0% OCT, 3.7% IVUS, 1.4% angiography), MACE (9.8% OCT, 9.1% IVUS, 7.9% angiography), or any of the individual components of these outcomes between groups. No independent predictors of 12-month stent-related clinical events were identified from final OCT. CONCLUSIONS: In this underpowered study, OCT-guided PCI of non-complex lesions did not show a statistical difference in clinical outcomes at 12-months compared with IVUS or angiography guidance. An appropriately powered trial, including only complex patients and lesions, is underway to substantiate the potential clinical benefit for OCT-guided PCI.

14.
Int J Cardiol ; 312: 24-26, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32339543
15.
EuroIntervention ; 16(9): e706-e714, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-32250248

RESUMO

Coronary bifurcation intervention is common but complex. Progress in this field has been made in recent years with considerable contribution from the Asia Pacific (APAC) region. However, the standard of practice varies across the APAC region due to differences in culture, socioeconomic state and healthcare set-up. Practice may also differ from the rest of the world. Hence, a panel of experts was invited to discuss topics relevant to bifurcation intervention in order to make a concerted effort to achieve consensus that is applicable within the region and in line with available evidence.


Assuntos
Doença das Coronárias , Ásia , Consenso , Doença das Coronárias/diagnóstico , Doença das Coronárias/terapia , Humanos
16.
G Ital Cardiol (Rome) ; 21(4 Suppl 2): 12S-21S, 2020 04.
Artigo em Italiano | MEDLINE | ID: mdl-32250365

RESUMO

Optical coherence tomography (OCT) is an innovative catheter-based imaging technology that uses light and fiberoptic to obtain unique details of the coronary arteries and stents on a microscope scale. OCT is an efficient method to rapidly map the extension and type of coronary artery disease with the potential to guide complex percutaneous coronary interventions (PCI). It can reliably detect and quantify atherosclerotic plaque characteristics, differentiate early from late stage of atherosclerotic disease and distinguish atherosclerotic (plaque rupture, erosion, calcified nodule) versus non atherosclerotic causes (spontaneous coronary dissection, intramural hematoma) of acute coronary syndromes. Further, it is very sensitive and accurate in detecting calcium and measuring the most relevant parameters (thickness, proximity to the lumen, circumferential extension) that may impact stent expansion. Based on automatic lumen measures and angiographic co-registration, OCT is used to plan and map the procedural strategy of stent implantation in complex lesion cohorts, with identification of the imaging features that require corrective actions to optimize stent results. OCT is a cardinal tool in patients presenting with stent failure (restenosis and thrombosis) to differentiate mechanical from biological causes with the potential of tailored treatment of the root mechanisms.

17.
Environ Mol Mutagen ; 61(3): 361-368, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31605552

RESUMO

Occupational radiation exposure may impact the reproductive outcome of male workers in the cardiac catheterization laboratory (cath Lab) who receive a dose of ~1-10 mSv/year. An increased copy number variation (CNV) in azoospermia factor region c (AZFc) of the Y chromosome is a marker of spermatogenic failure, previously associated with radiation exposure. This study sought to investigate the association between paternal exposure in the Cath Lab and adverse reproductive outcomes as well as to assess the induction of CNV in the AZFc region. In a case-control study, we enrolled 193 catheterization lab workers (Group I) and 164 age-matched unexposed controls (Group II). Reproductive outcomes were assessed through a structured questionnaire. Two sequence-tagged sites (SY1197 and SY579) in AZFc region were evaluated by qRT-PCR in 83 exposed and 47 unexposed subjects. Exposed workers had a higher prevalence of low birth weight in offspring (Group I = 13% vs. II = 5.3%, P = 0.02; ORadjusted = 2.7; 95% CI: 1.1-6.3; P = 0.02). The mean of CNV (microdeletion and microduplication) for SY1197 was significantly higher in the exposed workers (Group I = 1.53 ± 0.85 vs. Group II = 1.02 ± 0.41; P = 0.0005). Despite the study design limitations, our findings show that chronic occupational radiation exposure of male workers is correlated with higher prevalence of low birth weight in offspring and instability in the Y chromosome AZFc region. Environ. Mol. Mutagen. 61:361-368, 2020. © 2019 Wiley Periodicals, Inc.


Assuntos
Instabilidade Cromossômica/efeitos da radiação , Cromossomos Humanos Y/efeitos da radiação , Infertilidade Masculina/etiologia , Exposição Ocupacional/efeitos adversos , Exposição à Radiação/efeitos adversos , Adulto , Cateterismo Cardíaco , Estudos de Casos e Controles , Feminino , Pessoal de Saúde , Humanos , Laboratórios Hospitalares , Masculino , Saúde do Trabalhador , Doses de Radiação
18.
EuroIntervention ; 15(5): 434-451, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31258132

RESUMO

This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.


Assuntos
Síndrome Coronariana Aguda , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/cirurgia , Consenso , Angiografia Coronária , Vasos Coronários , Humanos , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção
20.
Eur Heart J ; 40(31): 2566-2584, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31112213

RESUMO

This consensus document is the second of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near infrared spectroscopy (NIRS)-IVUS. Beyond guidance of stent selection and optimization of deployment, invasive imaging facilitates angiographic interpretation and may guide treatment in acute coronary syndrome. Intravascular imaging can provide additional important diagnostic information when confronted with angiographically ambiguous lesions and allows assessment of plaque morphology enabling identification of vulnerability characteristics. This second document focuses on useful imaging features to identify culprit and vulnerable coronary plaque, which offers the interventional cardiologist guidance on when to adopt an intracoronary imaging-guided approach to the treatment of coronary artery disease and provides an appraisal of intravascular imaging-derived metrics to define the haemodynamic significance of coronary lesions.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Angiografia Coronária/tendências , Doença da Artéria Coronariana/terapia , Intervenção Coronária Percutânea/efeitos adversos , Síndrome Coronariana Aguda/terapia , Adulto , Idoso , Estudos de Casos e Controles , Ensaios Clínicos como Assunto , Consenso , Angiografia Coronária/métodos , Doença da Artéria Coronariana/patologia , Tomada de Decisões , União Europeia/organização & administração , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Placa Aterosclerótica/patologia , Valor Preditivo dos Testes , Ruptura/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Stents , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos
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