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J Thromb Thrombolysis ; 47(3): 454-461, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30560487


Mechanical heart valves (MHV) require life-long anticoagulation with vitamin K antagonists (VKA), but anticoagulation management is complex in patients with cancer due to a high risk of thrombosis and bleeding. This is a retrospective, single-center study to assess anticoagulation management and thrombotic (stroke/valve thrombosis) and bleeding events in patients with active cancer and MHV. The incidence of thrombotic complications was compared to a control group (matched 1:1) of patients with MHV but without cancer. We included 48 patients, 60% of whom had aortic prostheses, 23% mitral prostheses and 17% both types. All patients received VKA as anticoagulant. With a median follow-up of 5.12 years, we observed two arterial thrombotic events (two strokes and no heart valve thrombosis). The 5-year incidence (95% confidence interval [CI]) of stroke/valve thrombosis was 5.7% (0.9-17.9%). The control group had a similar incidence of stroke/valve thrombosis (5-year incidence 7.9% [95%CI 2-19.8], p = 0.16). There were also 15 major bleeding episodes in the cancer group, 11 of which were related to a surgical procedure. The 5-year incidence (95% CI) of major bleeding was 32.9% (18.5-48%), and that of major bleeding unrelated to any procedure was 10.3% (3-23%). We found a low incidence of thrombotic events in this series of patients with active cancer and MHV who were anticoagulated with VKA. However, the incidence of bleeding was high, particularly in relation to invasive procedures.

Próteses Valvulares Cardíacas/efeitos adversos , Hemorragia/etiologia , Neoplasias/complicações , Tromboembolia/etiologia , Idoso , Anticoagulantes/efeitos adversos , Estudos de Casos e Controles , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Vitamina K/antagonistas & inibidores
Echocardiography ; 35(11): 1736-1745, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30136745


BACKGROUND: Pulmonary hypertension (PH) is a common cause of right ventricular (RV) remodeling and functional tricuspid regurgitation (FTR), but incremental pulmonary artery systolic pressure (PASP) does not always correlate with anatomic and functional RV changes. This study aimed to evaluate a noninvasive measure of pulmonary vascular resistance (PVR) for predicting RV dilatation, RV dysfunction, and severity of FTR. METHODS: We prospectively analyzed consecutive stable patients with PASP ≥ 35 mm Hg or any degree of RV dilatation or dysfunction secondary to PH. Noninvasive PVR was calculated based on FTR peak velocity and flow in RV outflow tract. RESULTS: We included 251 patients, aged 72.1 ± 11.4 years, 53% women, 74.9% with type 2 pulmonary hypertension. The mean PASP was 48.3 ± 12.2 mm Hg. Both PASP and PVR significantly correlated with FTR, RV dilatation, and RV systolic dysfunction. After dichotomizing FTR and RV dilatation and systolic dysfunction as nonsignificant vs significant, FTR and RV dilatation were similarly predicted by PASP and PVR, but RV dysfunction was better predicted by PVR (AUC = 0.78 [0.72-0.84] vs 0.66 [0.60-0.73] for PASP, P < 0.001). Patients with low PASP but high PVR showed worse RV and left ventricular function but lower rates of right heart failure and smaller inferior vena cava, compared to patients with high PASP but low PVR. CONCLUSIONS: Noninvasive PVR was superior to PASP for predicting RV systolic dysfunction, but both were similarly associated with RV dilatation or FTR grade. PASP and PVR complement each other to define the echocardiographic findings and clinical status of the patient.

Pressão Arterial/fisiologia , Ecocardiografia/métodos , Artéria Pulmonar/fisiopatologia , Insuficiência da Valva Tricúspide/fisiopatologia , Resistência Vascular/fisiologia , Remodelação Ventricular/fisiologia , Idoso , Feminino , Ventrículos do Coração , Humanos , Masculino , Estudos Prospectivos , Artéria Pulmonar/diagnóstico por imagem , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico por imagem
Ann Hematol ; 97(9): 1633-1640, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29728734


Atrial fibrillation (AF) and cancer are common disorders in the general population but there are few studies in patients with both diseases. More specifically, there are scarce data on AF in patients with non-Hodgkin lymphoma (NHL). We assessed the incidence, predictive factors, management, and survival impact of AF in a cohort of patients with NHL from a single institution between 2002 and 2016 (n = 747). Twenty-three patients were diagnosed with AF before and 40 after the diagnosis of NHL (of the later, 16 were secondary to an extracardiac comorbidity and 24 unrelated to any triggering event [primary AF]). The 5-year cumulative incidence of new-onset AF was 4% (95% confidence interval [CI] 3-6%). Age and hypertension were the only predictive factors for the development of AF. Management of AF was heterogeneous, primarily with anti-vitamin K agents but also antiplatelet therapy in a significant proportion of patients. Among the 63 patients, there were six episodes of ischemic stroke/transient ischemic attack and four venous thromboembolic events, with four major bleeding episodes. Overall survival (OS) was inferior in patients with AF (HR 0.1, 95% CI 0.01-0.7, p = 0.02), largely due to secondary AF. We conclude that the incidence of new-onset AF in NHL patients seemed somewhat higher than in the general population, although with similar predictive factors. The management was heterogeneous, and the risk of ischemic and hemorrhagic events did not seem higher than in cancer-free patients. Survival was particularly poor for patients with secondary AF.

Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Linfoma não Hodgkin/epidemiologia , Linfoma não Hodgkin/terapia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Comorbidade , Feminino , Humanos , Incidência , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
Echocardiography ; 35(7): 1042-1044, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29800501


Doppler echocardiogram provides not only structural information about heart chambers, valves and pericardium but also contributes to functional assessment. A unique feature of this assessment is its variability, not only due to heart disease course but also related to extracardiac conditions. We present a case of primary amyloidosis with two atypical characteristics: left ventricular outflow obstruction and low-grade diastolic dysfunction. Nevertheless, a more typical picture of cardiac amyloidosis was observed in the evolution of the disease coinciding with a second cardiac stressor, emphasizing the necessity of not focusing our attention exclusively to the heart.

Amiloidose/diagnóstico , Cardiomiopatias/diagnóstico , Ecocardiografia Doppler/métodos , Função Ventricular Esquerda/fisiologia , Obstrução do Fluxo Ventricular Externo/diagnóstico , Amiloidose/complicações , Amiloidose/fisiopatologia , Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia
J Clin Ultrasound ; 41(5): 321-2, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22457267


Assessment of possible cardiac sources of cerebral embolism is a frequent indication for transesophageal echocardiography. We report the case of a patient with a previous left upper pulmonary lobe resection who presented with an ischemic stroke suggestive of cardioembolic origin. A dense spontaneous echo contrast was found in the left upper pulmonary vein stump, which, in the absence of other potential causes of stroke, was considered to be related to the embolic event. We discuss the clinical significance of this finding as a possibly underappreciated source of systemic embolization.

Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Ecocardiografia Transesofagiana , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Pneumonectomia , Veias Pulmonares/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Idoso , Humanos , Masculino
Eur J Echocardiogr ; 11(5): E18, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20008328


Left atrial wall haematoma is a very uncommon entity, associated mainly to cardiac surgery, interventional procedures, or trauma. Spontaneous cases are supposed to be associated with left atrial wall pathology. We present a case of a 53-year-old male who was admitted for prolonged chest pain, with transthoracic and transesophagic echocardiography documentation of a left atrial mass in close proximity to a mitral annular calcification. Tissue characterization with cardiac magnetic resonance suggested the aetiology of the mass, which was confirmed histologically.

Calcinose/patologia , Átrios do Coração/patologia , Hematoma/patologia , Valva Mitral/patologia , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Dor no Peito , Ecocardiografia , Ecocardiografia Transesofagiana , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Fatores de Tempo