Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24
Filtrar
Mais filtros










Intervalo de ano de publicação
2.
J Am Soc Echocardiogr ; 29(7): 679-88, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27086044

RESUMO

BACKGROUND: Chagas heart disease has a high socioeconomic burden, and any strategy to detect early myocardial damage is welcome. Speckle-tracking echocardiography assesses global and segmental left ventricular (LV) systolic function, yielding values of two-dimensional strain (ε). The aim of this study was to determine if patients with chronic Chagas disease and normal LV ejection fractions present abnormalities in global and segmental LV ε. METHODS: In this prospective study, patients with Chagas disease with no evidence of cardiac involvement (group I; n = 83) or at stage A of the cardiac form (i.e., with changes limited to the electrocardiogram) (group A; n = 42) and 43 control subjects (group C) underwent evaluation of global and segmental LV ε by speckle-tracking echocardiography. A subset of randomly selected patients in group A underwent cardiac magnetic resonance imaging and repeated echocardiography 3.5 ± 0.8 years after the first evaluation. RESULTS: Mean age, chamber dimensions, and LV ejection fraction were similar among the groups. Global longitudinal (group C, -19 ± 2%; group I, -19 ± 2%; group A, -19 ± 2%), circumferential (group C, -19 ± 3%; group I, -20 ± 3%; group A, -19 ± 3%), and radial (group C, 46 ± 10%; group I, 45 ± 13%; group A, 42 ± 14%) LV ε were similar among the groups. Segmental longitudinal, circumferential, and radial LV ε were similar across the studied groups. Seven of 14 patients had areas of fibrosis on cardiac magnetic resonance imaging. Patients with fibrosis had lower global longitudinal (-15 ± 2% vs -18 ± 2%, P = .004), circumferential (-14 ± 2% vs -19 ± 2%, P = .002), and radial LV ε (36 ± 13% vs 54 ± 12%, P = .02) than those without cardiac fibrosis despite similar LV ejection fractions. Patients with fibrosis had lower radial LV ε in the basal inferoseptal wall than patients without cardiac fibrosis (27 ± 17% vs 60 ± 15%, P = .04). CONCLUSIONS: Patients with chronic Chagas disease and normal global and segmental LV systolic function on two-dimensional echocardiography had global and segmental LV ε similar to that of control subjects. However, those in the early stages of the cardiac form and cardiac fibrosis had lower global longitudinal, circumferential, and radial LV ε.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/epidemiologia , Ecocardiografia/estatística & dados numéricos , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/epidemiologia , Adulto , Brasil/epidemiologia , Comorbidade , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/estatística & dados numéricos , Masculino , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade
3.
Arq. bras. cardiol ; 104(2): 159-168, 02/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-741144

RESUMO

Background: Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. Objective: To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. Methods: A total of 1959 reports of “infarct size” were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors – left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named “MET-AMI”. The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. Results: The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). Conclusion: The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently ...


Fundamento: A ressonância magnética cardíaca fornece informações anatômicas detalhadas do infarto, porém poucos estudos investigaram a associação desses dados com mortalidade pós-infarto agudo do miocárdio. Objetivo: Verificar a associação entre os dados de anatomia e magnitude do infarto, obtidos da ressonância magnética cardíaca pós-infarto agudo do miocárdio, e mortalidade em longo prazo. Métodos: Foram identificados 1.959 laudos com “massa infartada” em 7.119 exames de ressonância magnética cardíaca, dos quais 420 possuíam documentação clínica e laboratorial de infarto agudo do miocárdio prévio. As variáveis estudadas foram os fatores de risco clássicos, fração de ejeção do ventrículo esquerdo, função ventricular categorizada e localização do infarto agudo do miocárdio. Massa infartada, extensão e transmuralidade do infarto agudo do miocárdio foram analisadas de maneira isolada e conjuntamente, pela variável denominada “MET-IAM”. A análise estatística foi feita pelo elastic net regularization, pelo modelo de Cox e por árvores de sobrevida. Resultados: A idade média foi 62,3 ± 12 anos, sendo 77,3% de homens. Durante o seguimento de 6,4 ± 2,9 anos, foram identificados 76 óbitos (18,1%). Creatinina sérica, diabetes melito e infarto agudo do miocárdio prévio demonstraram associação independente com mortalidade. A idade foi o principal fator explicativo. As variáveis da ressonância magnética cardíaca que se associaram de forma independente com a mortalidade foram: transmuralidade do infarto agudo do miocárdio (p = 0,047), disfunção ventricular (p = 0,0005) e massa infartada (p = 0,0005) − sendo essa última a principal variável explicativa para morte por doença isquêmica cardíaca. A variável MET-IAM exibiu a maior associação de risco para morte por doença isquêmica cardíaca (HR: 16,04; IC95%: 2,64-97,5; p = 0,003). Conclusão: Os dados anatômicos do infarto obtidos da ressonância magnética cardíaca pós-infarto ...


Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Causas de Morte , Determinação de Ponto Final , Métodos Epidemiológicos , Infarto do Miocárdio/fisiopatologia , Índice de Gravidade de Doença , Fatores de Tempo , Doenças Vasculares/mortalidade , Doenças Vasculares/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia
4.
Arq Bras Cardiol ; 104(2): 159-68, 2015 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25424161

RESUMO

BACKGROUND: Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. OBJECTIVE: To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. METHODS: A total of 1959 reports of "infarct size" were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors - left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named "MET-AMI". The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. RESULTS: The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%). Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047), ventricular dysfunction (p = 0.0005) and infarcted size (p = 0.0005); the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003). CONCLUSION: The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long-term mortality, especially for ischemic heart disease death.


Assuntos
Imagem por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Determinação de Ponto Final , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Índice de Gravidade de Doença , Fatores de Tempo , Doenças Vasculares/mortalidade , Doenças Vasculares/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia
5.
Arq. bras. cardiol ; 103(6,supl.3): 1-86, 12/2014. tab
Artigo em Português | LILACS | ID: lil-732178
6.
Arq Bras Cardiol ; 103(6 Suppl 3): 1-86, 2014 Dec.
Artigo em Português | MEDLINE | ID: mdl-25594284
9.
Arq. bras. cardiol ; 99(6): 1149-1155, dez. 2012. graf, tab
Artigo em Português | LILACS | ID: lil-662369

RESUMO

FUNDAMENTO: A ressonância magnética cardíaca é considerada o método padrão-ouro para o cálculo de volumes cardíacos. A bioimpedância transtorácica cardíaca avalia o débito cardíaco. Não há trabalhos que validem essa medida comparada à ressonância. OBJETIVO: Avaliar o desempenho da bioimpedância transtorácica cardíaca no cálculo do débito cardíaco, índice cardíaco e volume sistólico, utilizando a ressonância como padrão-ouro. MÉTODOS: Avaliados 31 pacientes, com média de idade de 56,7 ± 18 anos, sendo 18 (58%) do sexo masculino. Foram excluídos os pacientes cuja indicação para a ressonância magnética cardíaca incluía avaliação sob estresse farmacológico. A correlação entre os métodos foi avaliada pelo coeficiente de Pearson, e a dispersão das diferenças absolutas em relação à média foi demonstrada pelo método de Bland-Altman. A concordância entre os métodos foi realizada pelo coeficiente de correlação intraclasses. RESULTADOS: A média do débito cardíaco pela bioimpedância transtorácica cardíaca e pela ressonância foi, respectivamente, 5,16 ± 0,9 e 5,13 ± 0,9 L/min. Observou-se boa correlação entre os métodos para o débito cardíaco (r = 0,79; p = 0,0001), índice cardíaco (r = 0,74; p = 0,0001) e volume sistólico (r = 0,88; p = 0,0001). A avaliação pelo gráfico de Bland-Altman mostrou pequena dispersão das diferenças em relação à média, com baixa amplitude dos intervalos de concordância. Houve boa concordância entre os dois métodos quando avaliados pelo coeficiente de correlação intraclasses, com coeficientes para débito cardíaco, índice cardíaco e volume sistólico de 0,78, 0,73 e 0,88, respectivamente (p < 0,0001 para todas as comparações). CONCLUSÃO: A bioimpedância transtorácica cardíaca mostrou-se acurada no cálculo do débito cardíaco quando comparada à ressonância magnética cardíaca.


BACKGROUND: Cardiac magnetic resonance imaging is considered the gold-standard method for the calculation of cardiac volumes. Transthoracic impedance cardiography assesses the cardiac output. No studies validating this measurement, in comparison to that obtained by magnetic resonance imaging, are available. OBJECTIVE: To evaluate the performance of transthoracic impedance cardiography in the calculation of the cardiac output, cardiac index and stroke volume using magnetic resonance imaging as the gold-standard. METHODS: 31 patients with a mean age of 56.7 ± 18 years were assessed; of these, 18 (58%) were males. Patients whose indication for magnetic resonance imaging required pharmacologic stress test were excluded. Correlation between methods was assessed using the Pearson's coefficient, and dispersion of absolute differences in relation to the mean was demonstrated using the Bland-Altman's method. Agreement between methods was analyzed using the intraclass correlation coefficient. RESULTS: The mean cardiac output by transthoracic impedance cardiography and by magnetic resonance imaging was 5.16 ± 0.9 and 5.13 ± 0.9 L/min, respectively. Good agreement between methods was observed for cardiac output (r = 0.79; p = 0.0001), cardiac index (r = 0.74; p = 0.0001) and stroke volume (r = 0.88; p = 0.0001). The analysis by the Bland-Altman plot showed low dispersion of differences in relation to the mean, with a low amplitude of agreement intervals. Good agreement between the two methods was observed when analyzed by the intraclass correlation coefficient, with coefficients for cardiac output, cardiac index and stroke volume of 0.78, 0.73 and 0.88, respectively (p < 0.0001 for all comparisons). CONCLUSION: Transthoracic impedance cardiography proved accurate in the calculation of the cardiac output in comparison to cardiac magnetic resonance imaging.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Débito Cardíaco/fisiologia , Cardiografia de Impedância/normas , Imagem por Ressonância Magnética/normas , Insuficiência Cardíaca/diagnóstico , Hemodinâmica/fisiologia , Volume Sistólico
10.
Arq Bras Cardiol ; 99(6): 1149-55, 2012 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23152290

RESUMO

BACKGROUND: Cardiac magnetic resonance imaging is considered the gold-standard method for the calculation of cardiac volumes. Transthoracic impedance cardiography assesses the cardiac output. No studies validating this measurement, in comparison to that obtained by magnetic resonance imaging, are available. OBJECTIVE: To evaluate the performance of transthoracic impedance cardiography in the calculation of the cardiac output, cardiac index and stroke volume using magnetic resonance imaging as the gold-standard. METHODS: 31 patients with a mean age of 56.7 ± 18 years were assessed; of these, 18 (58%) were males. Patients whose indication for magnetic resonance imaging required pharmacologic stress test were excluded. Correlation between methods was assessed using the Pearson's coefficient, and dispersion of absolute differences in relation to the mean was demonstrated using the Bland-Altman's method. Agreement between methods was analyzed using the intraclass correlation coefficient. RESULTS: The mean cardiac output by transthoracic impedance cardiography and by magnetic resonance imaging was 5.16 ± 0.9 and 5.13 ± 0.9 L/min, respectively. Good agreement between methods was observed for cardiac output (r = 0.79; p = 0.0001), cardiac index (r = 0.74; p = 0.0001) and stroke volume (r = 0.88; p = 0.0001). The analysis by the Bland-Altman plot showed low dispersion of differences in relation to the mean, with a low amplitude of agreement intervals. Good agreement between the two methods was observed when analyzed by the intraclass correlation coefficient, with coefficients for cardiac output, cardiac index and stroke volume of 0.78, 0.73 and 0.88, respectively (p < 0.0001 for all comparisons). CONCLUSION: Transthoracic impedance cardiography proved accurate in the calculation of the cardiac output in comparison to cardiac magnetic resonance imaging.


Assuntos
Débito Cardíaco/fisiologia , Cardiografia de Impedância/normas , Imagem por Ressonância Magnética/normas , Adulto , Idoso , Feminino , Insuficiência Cardíaca/diagnóstico , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico
11.
Arq Bras Cardiol ; 99(4): 944-51, 2012 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23033110

RESUMO

BACKGROUND: The standardization of images used in Medicine in 1993 was performed using the DICOM (Digital Imaging and Communications in Medicine) standard. Several tests use this standard and it is increasingly necessary to design software applications capable of handling this type of image; however, these software applications are not usually free and open-source, and this fact hinders their adjustment to most diverse interests. OBJECTIVE: To develop and validate a free and open-source software application capable of handling DICOM coronary computed tomography angiography images. METHODS: We developed and tested the ImageLab software in the evaluation of 100 tests randomly selected from a database. We carried out 600 tests divided between two observers using ImageLab and another software sold with Philips Brilliance computed tomography appliances in the evaluation of coronary lesions and plaques around the left main coronary artery (LMCA) and the anterior descending artery (ADA). To evaluate intraobserver, interobserver and intersoftware agreements, we used simple and kappa statistics agreements. RESULTS: The agreements observed between software applications were generally classified as substantial or almost perfect in most comparisons. CONCLUSION: The ImageLab software agreed with the Philips software in the evaluation of coronary computed tomography angiography tests, especially in patients without lesions, with lesions < 50% in the LMCA and < 70% in the ADA. The agreement for lesions > 70% in the ADA was lower, but this is also observed when the anatomical reference standard is used.


Assuntos
Angiografia Coronária/métodos , Processamento de Imagem Assistida por Computador/métodos , Software , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária/instrumentação , Angiografia Coronária/normas , Feminino , Humanos , Processamento de Imagem Assistida por Computador/instrumentação , Processamento de Imagem Assistida por Computador/normas , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/normas , Adulto Jovem
12.
Arq. bras. cardiol ; 99(4): 944-951, out. 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-654261

RESUMO

FUNDAMENTO: A estandardização do padrão de imagens utilizada dentro da medicina foi realizada em 1993 por meio do padrão DICOM (Digital Imaging and Communications in Medicine). Diversos exames utilizam esse padrão e cada vez mais são necessários softwares capazes de manipular esse tipo de imagem, porém esses softwares geralmente não têm o formato livre e de código aberto, e isso dificulta o seu ajuste para os mais diferentes interesses. OBJETIVO: Desenvolver e validar um software livre e de código aberto capaz de manipular imagens DICOM de exames de angiotomografia de coronárias. MÉTODOS: Desenvolvemos e testamos o software intitulado ImageLab na avaliação de 100 exames selecionados de forma randômica por meio de um banco de dados. Foram realizadas 600 análises divididas por dois observadores utilizando o ImageLab e um outro software comercializado junto a aparelhos de tomografia computadorizada Philips Brilliance, na avaliação da presença de lesões e placas coronarianas nos territórios do Tronco da Coronária Esquerda (TCE) e na Artéria Descendente Anterior (ADA). Para avaliar as concordâncias intraobservador, interobservadores e intersoftware, utilizamos concordância simples e estatística Kappa. RESULTADOS: As concordâncias observadas entre os softwares foram em geral classificadas como substancial ou quase perfeitas na maioria das comparações. CONCLUSÃO: O software ImageLab concordou com o software Philips na avaliação de exames de angiotomografia de coronárias especialmente em pacientes sem lesões, com lesões inferiores a 50% no TCE e inferiores a 70% na ADA. A concordância para lesão >70% na ADA foi menor, porém isso também é observado quando se utiliza o padrão de referência anatômico.


BACKGROUND: The standardization of images used in Medicine in 1993 was performed using the DICOM (Digital Imaging and Communications in Medicine) standard. Several tests use this standard and it is increasingly necessary to design software applications capable of handling this type of image; however, these software applications are not usually free and open-source, and this fact hinders their adjustment to most diverse interests. OBJECTIVE: To develop and validate a free and open-source software application capable of handling DICOM coronary computed tomography angiography images. METHODS: We developed and tested the ImageLab software in the evaluation of 100 tests randomly selected from a database. We carried out 600 tests divided between two observers using ImageLab and another software sold with Philips Brilliance computed tomography appliances in the evaluation of coronary lesions and plaques around the left main coronary artery (LMCA) and the anterior descending artery (ADA). To evaluate intraobserver, interobserver and intersoftware agreements, we used simple and kappa statistics agreements. RESULTS: The agreements observed between software applications were generally classified as substantial or almost perfect in most comparisons. CONCLUSION: The ImageLab software agreed with the Philips software in the evaluation of coronary computed tomography angiography tests, especially in patients without lesions, with lesions < 50% in the LMCA and < 70% in the ADA. The agreement for lesions > 70% in the ADA was lower, but this is also observed when the anatomical reference standard is used.


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Angiografia Coronária/métodos , Processamento de Imagem Assistida por Computador/métodos , Software , Tomografia Computadorizada por Raios X/métodos , Angiografia Coronária/instrumentação , Angiografia Coronária/normas , Processamento de Imagem Assistida por Computador/instrumentação , Processamento de Imagem Assistida por Computador/normas , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/normas
13.
Braz. j. infect. dis ; 15(6): 521-527, Nov.-Dec. 2011. tab
Artigo em Inglês | LILACS | ID: lil-610521

RESUMO

Current treatment for human immunodeficiency virus (HIV) infection has improved survival and allowed infected patients to develop atherosclerotic coronary artery disease (CAD). Specific strategies to reduce cardiovascular risk in the infected population have not been developed. It is necessary to know the magnitude of cardiovascular risk in this population. OBJECTIVES: This study aimed to assess cardiovascular risk using a well-known clinical score and to investigate coronary artery calcium scoring (CACS) in this population. METHODS: This was a cross-sectional study. Adults with HIV infection were studied. Demographic, clinical and anthropometric data, serum glucose and lipids were obtained. Cardiovascular risk was calculated through Framingham risk score (FRS) and CACS. Categorical variables were compared by Chi-square or Fisher's exact test, and continuous variables were analyzed by Student t test or Mann-Whitney test. An analysis of concordance between FRS and CACS was performed using kappa statistic. RESULTS: Forty patients, aged 45.9 ± 8.1 years, were studied. Age of risk for CAD were found in 30.0 percent, hypertension in 55.0 percent, diabetes in 10.0 percent, smoking in 35.0 percent, dyslipidemia in 67.5 percent and family history of CAD in 57.5 percent. Altered levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were found in 30.0 percent, 25.0 percent and 82.5 percent, respectively. HDL-cholesterol and triglycerides were altered more frequently among protease inhibitors users. The FRS classified the risk as low for 72.5 percent, moderate for 25.0 percent, and high for 2.5 percent. CACS > 0 was found in 32.5 percent of the patients, in 67.5 percent the score was low, in 17.5 percent moderate, and in 15.0 percent high. Concordance between FRS and CACS showed a kappa = 0.435. CONCLUSIONS: There is a high prevalence of risk factors for CAD in the studied population, with dyslipidemia being the most frequent. HDL-cholesterol and triglycerides were the most frequently altered factors and were associated with the use of protease inhibitors. Risk assessed by the FRS was low in most cases. CACS > 0 was found in 32.5 percent, demonstrating the need to re-evaluate the strategies for assessing cardiovascular risk in the HIV-infected population.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença da Artéria Coronariana/etiologia , Infecções por HIV/complicações , Terapia Antirretroviral de Alta Atividade , Fármacos Anti-HIV/uso terapêutico , Cálcio , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Prevalência , Fatores de Risco
14.
JACC Cardiovasc Imaging ; 4(7): 740-51, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21757164

RESUMO

OBJECTIVES: We attempted to determine the prognostic value of coronary computed tomographic angiography (CTA) in patients with inconclusive functional stress tests. BACKGROUND: Patients with suspected coronary artery disease (CAD) and inconclusive noninvasive cardiac stress tests represent a frequent management challenge. METHODS: We examined 529 consecutive patients with suspected CAD and prior inconclusive functional stress tests. All patients underwent a coronary CTA scan using a 64-slice multidetector row scanner. CAD severity by coronary CTA was categorized as: 1) no evidence of CAD; 2) nonobstructive coronary plaques (< 30%); 3) mild stenosis (30% to 49%); 4) moderate stenosis (50% to 69%); and 5) severe stenosis (≥ 70%). Patients were also categorized according to a modified Duke prognostic CAD index. Survival analyses were performed using Cox proportional hazards models adjusted for baseline risk factors and coronary artery calcium score. The primary outcome of the study was the combined endpoint of all-cause mortality and nonfatal myocardial infarction. RESULTS: Among patients with inconclusive stress tests, the large majority (69%) did not demonstrate significant CAD by coronary CTA. During a mean follow-up of 30.1 ± 11.1 months, there were 20 (3.8%) deaths and 17 (3.2%) nonfatal myocardial infarctions. Multivariable Cox regression analysis revealed that the presence of increasing degrees of obstructive CAD by CTA was an independent predictor of adverse events (hazard ratio [HR]: 1.66 [95% confidence interval (CI): 1.23 to 2.23], p = 0.001). Indeed, the presence of ≥ 50% coronary stenosis was associated with an increased risk of events (HR: 3.15 [95% CI: 1.26 to 7.89], p = 0.01). Likewise, the Duke prognostic CAD index was also found to be an independent predictor of events (HR: 1.54 [95% CI: 1.20 to 1.97], p = 0.001). CONCLUSIONS: Among patients with inconclusive functional stress tests, the noninvasive assessment of CAD severity by coronary CTA has been shown to provide incremental prognostic information beyond the evaluation of traditional risk factors and coronary artery calcium score.


Assuntos
Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Teste de Esforço , Tomografia Computadorizada por Raios X , Adulto , Idoso , Brasil , Calcinose/diagnóstico , Calcinose/diagnóstico por imagem , Distribuição de Qui-Quadrado , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Intervalo Livre de Doença , Ecocardiografia sob Estresse , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Imagem de Perfusão do Miocárdio , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo
15.
Braz J Infect Dis ; 15(6): 521-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22218509

RESUMO

UNLABELLED: Current treatment for human immunodeficiency virus (HIV) infection has improved survival and allowed infected patients to develop atherosclerotic coronary artery disease (CAD). Specific strategies to reduce cardiovascular risk in the infected population have not been developed. It is necessary to know the magnitude of cardiovascular risk in this population. OBJECTIVES: This study aimed to assess cardiovascular risk using a well-known clinical score and to investigate coronary artery calcium scoring (CACS) in this population. METHODS: This was a cross-sectional study. Adults with HIV infection were studied. Demographic, clinical and anthropometric data, serum glucose and lipids were obtained. Cardiovascular risk was calculated through Framingham risk score (FRS) and CACS. Categorical variables were compared by Chi-square or Fisher's exact test, and continuous variables were analyzed by Student t test or Mann-Whitney test. An analysis of concordance between FRS and CACS was performed using kappa statistic. RESULTS: Forty patients, aged 45.9 ± 8.1 years, were studied. Age of risk for CAD were found in 30.0%, hypertension in 55.0%, diabetes in 10.0%, smoking in 35.0%, dyslipidemia in 67.5% and family history of CAD in 57.5%. Altered levels of total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were found in 30.0%, 25.0% and 82.5%, respectively. HDL-cholesterol and triglycerides were altered more frequently among protease inhibitors users. The FRS classified the risk as low for 72.5%, moderate for 25.0%, and high for 2.5%. CACS > 0 was found in 32.5% of the patients, in 67.5% the score was low, in 17.5% moderate, and in 15.0% high. Concordance between FRS and CACS showed a kappa = 0.435. CONCLUSIONS: There is a high prevalence of risk factors for CAD in the studied population, with dyslipidemia being the most frequent. HDL-cholesterol and triglycerides were the most frequently altered factors and were associated with the use of protease inhibitors. Risk assessed by the FRS was low in most cases. CACS > 0 was found in 32.5%, demonstrating the need to re-evaluate the strategies for assessing cardiovascular risk in the HIV-infected population.


Assuntos
Doença da Artéria Coronariana/etiologia , Infecções por HIV/complicações , Adulto , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Cálcio , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
16.
Rev. bras. cardiol. (Impr.) ; 23(5): 292-295, set.-out. 2010. ilus
Artigo em Português | LILACS | ID: lil-568758

RESUMO

O aneurisma de artéria coronaria é uma doença geralmente descoberta de forma acidental já que a maioria dos pacientes permanece assintomática. Não obstante, raros pacientes podem apresentar complicações locais do aneurisma. Relata-se um caso de trombose de aneurisma de coronária seguido de infarto agudo do miocárdio em um adolescente. São revisadas, também, as modalidades diagnósticas na avaliação desta doença.


Coronary artery aneurysm is a disease usually diagnosed accidentally since most patients remain asymptomatic. Nonetheless, rare patients may havelocal aneurysm complications. We describe a case of coronary artery aneurysm thrombosis followed by acute myocardial infarction in an adolescent. We also review the imaging diagnosis of this disease.


Assuntos
Humanos , Masculino , Adolescente , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Tomografia , Ecocardiografia/métodos , Ecocardiografia , Eletrocardiografia/métodos , Eletrocardiografia
17.
Rev. SOCERJ ; 20(3): 205-211, mai.-jun. 2007. tab, ilus
Artigo em Português | LILACS | ID: lil-458341

RESUMO

Objetivo: Avaliar a segurança do uso do dipiridamol (dipi) em dose máxima com a técnica combinada para a pesquisa de isquemia miocárdica(TCPI). Métodos: Foram avaliados, prospectivamente, 110 pacientes, encaminhados no período de junho 2006 a abril 2007, com indicação de pesquisa de isquemia miocárdica, associada ou não à pesquisa de viabilidade miocárdica, que não apresentassem alguma contra-indicação ao exame. Resultados: Todos os pacientes conseguiram realizar o exame completo, sem interrupção por sintomas. O tempo médio de aquisição das imagens durante os exames foi de 39,6min, com o tempo de estresse de 11,8min. Conclusão: É possível realizar o exame completo de TCPI pela RMC, com dose máxima do dipi, com boa tolerabilidade e segurança, e com tempo de aquisição de imagem em média inferior a 40 minutos.


Objective: To assess the safety of using a maximum dose of dipyridamole through the combined technique forinvestigating myocardial ischemia.Methods: A prospective assessment of 110 patients from June 2006 to April 2007, recommended for myocardialischemia investigation and associated or not with myocardial feasibility studies, presenting no counterindicationsfor this examination. Results: All the patients managed to complete the fullexamination with no interruptions caused by symptoms. The average time of image acquisition was 39.6 minutes,with a stress time of 11.8 minutes.Conclusion: It is possible to use the combined technique for investigating myocardial ischemia through magneticresonance imaging (MRI) with a maximum dose of dipyridamole, without causing hemodynamic effects orsymptoms that interrupt the examination. This procedure may be performed in less than forty minutes, providing important clinical information.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dipiridamol/administração & dosagem , Dipiridamol/efeitos adversos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Isquemia/complicações , Isquemia/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA