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1.
Rev Cardiovasc Med ; 22(4): 1577-1587, 2021 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-34957798

RESUMO

Intradialytic hypotension (IDH) is a sudden and often serious complication of chronic hemodialysis (HD). In this prospective study, we aimed at evaluating the clinical predictors of IDH in a homogeneous cohort of chronic HD patients, with a particular focus on marinobufagenin (MBG), an endogenous cardiotonic steroid which alterations have previously been involved in various cardiovascular disorders. MBG levels in HD patients were significantly higher than in controls (p = 0.03), remained unchanged throughout a single HD session and were not correlated with the absolute or partial fluid loss achieved. During a 30-day follow-up, 19 patients (65.5%) experienced at least one IDH (73 total episodes). An inverse correlation was found between baseline MBG and the number of IDH (R = -0.55; p = 0.001). HD patients experiencing IDH presented remarkably lower baseline MBG as compared to others (p = 0.008) with a statistically significant trend during HD (p = 0.02). At Kaplan-Meier analyses, HD patients with lower MBG manifested a four-to-six fold increased risk of IDH during follow-up (crude Hazard Ratio ranging from 4.37 to 6.68). At Cox regression analyses, MBG measurement at different time points resulted the strongest time-dependent predictors of IDH among all the variables considered (HR ranging from 0.068 to 0.155; p: 0.002 to <0.0001). Findings obtained suggest that differently altered MBG in chronic HD patients may reflect a diverse vascular and hemodynamic tolerance to HD stress, eventually leading to recurrent IDH episodes. Further studies are needed to confirm the prognostic capacity of MBG for identifying HD patients at high risk of IDH, particularly those with apparently optimal fluid status.

2.
G Ital Cardiol (Rome) ; 22(12): 1017-1023, 2021 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-34845404

RESUMO

The current COVID-19 pandemic has renewed interest in providing healthcare services based on the implementation of innovative technologies. Such strategy capillarizes the therapeutic opportunities for larger urban areas, mostly when people are living under extraordinarily difficult circumstances. Improving care delivery in cardiovascular diseases appears particularly feasible when telemedicine is pursued, especially with regard to baseline standard 12-lead electrocardiography, ambulatory electrocardiographic monitoring, and 24-hour ambulatory blood pressure monitoring. Nowadays, these first-line cardiovascular examinations are also available in health centers and pharmacies, and in recent months, there has been an increasing demand of such local services in the absence of specific rules and regulations regarding technical requirements and standards of interpretation that ensure a high quality clinical consultation.The purpose of this position paper is to provide critical requirements for the type/model of devices to be used, training dedicated to healthcare personnel, ensuring security of sensitive data, highlighting type of platforms to be used, as well as for maintaining high reporting quality and standards.

4.
Circulation ; 144(16): 1323-1343, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34662163

RESUMO

Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.

5.
G Ital Cardiol (Rome) ; 22(11): 894-899, 2021 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-34709228

RESUMO

The coronavirus disease (COVID-19) pandemic has caused 2.69 million deaths and 122 million infections. Great efforts have been made worldwide to promptly develop effective vaccines and reduce morbidity and mortality rates from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Available vaccines have proven highly effective at preventing symptomatic disease in clinical trials and real-world reports and are playing an essential role in flattening the epidemiology curve and, mostly, in reducing COVID-19 hospitalizations. Some concerns have been raised after very rare cases of myocarditis and pericarditis recently reported by the Centers for Disease Control and Prevention (CDC) as potentially associated with COVID-19 mRNA vaccinations, namely the Pfizer-BioNTech mRNA vaccine (BNT162b2) and the Moderna mRNA vaccine (mRNA-1273). Therefore, the aim of this document is to explore the possible link between COVID-19 mRNA vaccination and the development of myocarditis and/or pericarditis by performing a critical analysis of available data and to provide indications for specific subgroups of individuals.


Assuntos
COVID-19 , Cardiologia , Miocardite , Pericardite , Vacinas contra COVID-19 , Prova Pericial , Humanos , Itália/epidemiologia , Miocardite/etiologia , Pericardite/etiologia , RNA Mensageiro , SARS-CoV-2 , Vacinação
6.
Front Cardiovasc Med ; 8: 719603, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34504879

RESUMO

Background: Non-invasive prediction of critical coronary artery stenosis (CAST) in patients with coronary artery disease (CAD) is challenging. Strain parameters can often capture an impairment of regional longitudinal function; however, they are load dependent. A novel non-invasive method to estimate Myocardial Work (MW) has been recently proposed, showing a strong correlation with invasive work measurements. Our aim was to investigate the ability of non-invasive MW to predict the ischaemic risk area underlying a CAST. Methods and Results: The study population comprises 80 individuals: 50 patients with CAST and 30 controls (CTRL). Echocardiography recordings were obtained before coronary angiography to measure global longitudinal strain (GLS), Myocardial Work Index (MWI), Myocardial Constructive Work (MCW), Myocardial Wasted work (MWW), Myocardial Work Efficiency (MWE). Global MWI (p = 0.048), MWE (p < 0.001), and MCW (p = 0.048) at baseline were significantly reduced in patients with CAST compared to controls (p < 0.05). Regional MWE within the myocardial segments underlying the CAST, but not LS, was significantly reduced compared to non-target segments (p < 0.001). At ROC analysis, the diagnostic performance to predict CAST for regional MWE (AUC = 0.920, p < 0.001) was higher compared to both regional post-systolic shortening index (PSI) (AUC = 0.600, p = 0.129) and regional LS (AUC = 0.546, p = 0.469). Conclusions: Non-invasive estimation of MW work indices is able to predict a CAST before invasive angiography.

7.
Curr Vasc Pharmacol ; 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34370641

RESUMO

Patients at high bleeding risk (HBR) are a sizable part of the population undergoing percutaneous coronary intervention (PCI) and stent implantation. This population historically lacks standardized definition, thus limiting trial design, data generalizability, and clinical decision-making. To overcome this limitation the Academic Research Consortium (ARC) has recently released comprehensive guidelines defining HBR criteria for study design purpose and daily clinical practice. Furthermore, several risk scores have been developed aiming to discriminate HBR patients and support physicians for clinical decision making when faced with this complex subset of patients. Accordingly, the first part of this review article will explore guideline-recommended risk scoring as well as ARC-HBR criteria and their relative application for daily clinical practice. The second part of this review article will explore the complex interplay between risk of bleeding, and coronary thrombotic events in patients deemed at HBR. Indeed, several features that identify these patients, are also independent predictors of recurrent ischemic events, thus challenging revascularization strategies and optimal antithrombotic therapy. Accordingly, several clinical trials have been conducted to evaluate the safety and efficacy of the new generation of coronary platforms and different antithrombotic strategies for HBR patients to minimize both ischemic and bleeding events. Accordingly, in this part we discuss current guidelines, trials and observational data evaluating antithrombotic strategies and stent technologies for patients at HBR.

9.
Open Heart ; 8(2)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233914

RESUMO

AIMS: To investigate the changes in left atrial strain (LAS) after correction of severe aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR) and assess its prognostic impact. METHODS AND RESULTS: One hundred consecutive patients with severe symptomatic AS who underwent TAVR at the Magna Graecia University of Catanzaro underwent echocardiographic examination including assessment of LAS before and after TAVR. Independent investigators collected outcome data and information. The primary study outcome was the difference in ΔLAS (postTAVR-preTAVR) between patients those met the main clinical endpoint (a composite of cardiovascular mortality and heart failure hospitalisation) and those not meeting the endpoint.During a median follow-up of 31 months, 35 patients (35%) met the combined clinical endpoint. The difference between LAS post-TAVR and LAS pre-TAVR (ΔLAS) was significantly larger in patients who met the combined endpoint (HR=0.76 (0.67-0.86); p<0.001). Multivariate logistic regression analysis including ΔLAS, EuroSCORE II and left ventricular ejection fraction showed that ΔLAS (HR=0.80, p<0.001) was the only independent predictor of the combined clinical endpoint. Finally, a Kaplan-Maier analysis showed that patients with a ΔLAS above its median value had a significantly better event-free survival compared with those below the median (p<0.001). CONCLUSIONS: A lower reduction in ΔLAS after TAVR was an independent predictor of the primary composite outcome of cardiovascular death and hospitalisation for heart failure.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Função do Átrio Esquerdo/fisiologia , Diagnóstico Precoce , Ecocardiografia Doppler/métodos , Insuficiência Cardíaca/diagnóstico , Medição de Risco/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Progressão da Doença , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Humanos , Incidência , Itália/epidemiologia , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico/fisiologia , Resultado do Tratamento
10.
Heart Rhythm ; 18(10): 1698-1706, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34245912

RESUMO

BACKGROUND: The genetic architecture of Brugada syndrome (BrS) is emerging as an increasingly complex area of investigation. The identification of genetically homogeneous populations can provide mechanistic insights and improve genotype-phenotype correlation. OBJECTIVE: To characterize and define the clinical implications of a novel BrS founder mutation. Using a haplotype-based approach we investigated whether 2 SCN5A genetic variants could derive from founder events. METHODS: Single nucleotide polymorphisms were genotyped in 201 subjects, haplotypes reconstructed, and mutational age estimated. Clinical phenotypes and historical records were collected. RESULTS: A SCN5A variant (c.3352C>T; p.Gln1118Ter) was identified in 3 probands with BrS originating from south Italy. The same mutation was identified in a proband from central Italy and in 1 U.S. resident subject with Italian ancestry. The 5 individuals carried a common core haplotype, whose frequency was extremely low in local noncarrier probands and in population controls (0%-6.06%). The clinical presentation included multigenerational dominant transmission of Brugada electrocardiographic pattern, high incidence of sudden cardiac death (SCD), and cardiac conduction defects (CCD). We reconstructed 7-generation pedigrees with common geographic origin. Variant's age estimates suggested that origin of the p.Gln1118Ter dates back 76 generations (95% confidence interval: 28-200). A second SCN5A variant (c.5350G>A; p.Glu1784Lys) identified in the region did not show similar founder signal. CONCLUSION: p.Gln1118Ter is a novel BrS/CCD/SCD founder mutation. We illustrate how these findings provide insights on the inheritance patterns and phenotypes associated with SCN5A mutation.

11.
J Cardiovasc Med (Hagerstown) ; 22(7): 515-529, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34076599

RESUMO

Cardiovascular magnetic resonance (CMR) has emerged as an accurate diagnostic technique for the evaluation of patients with cardiac disease in the majority of clinical settings, thanks to an established additional diagnostic and prognostic value. This document has been developed by a joined group of experts of the Italian Society of Cardiology (SIC) and Italian Society of Radiology (SIRM) to provide a summary about the current state of technology and clinical applications of CMR, to improve the clinical diagnostic pathways and to promote its inclusion in clinical practice. The writing committee consisted of members and experts of both societies in order to develop a more integrated approach in the field of cardiac imaging. This section 2 will cover myocarditis, pericardial disease, cardiomyopathies and valvular heart disease.

12.
Radiol Med ; 126(9): 1236-1248, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34160775

RESUMO

In the past 20 years, Cardiac Computed Tomography (CCT) has become a pivotal technique for the noninvasive diagnostic work-up of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Recent large multicenter randomized clinical trials documented the high prognostic value of CCT and its capability to increase the cost-effectiveness of the management of patients with suspected CAD. In the meantime, CCT, initially perceived as a simple non-invasive technique for studying coronary anatomy, has transformed into a multiparametric "one-stop-shop" approach able to investigate the heart in a comprehensive way, including functional, structural and pathophysiological biomarkers. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) and by the Italian Society of Cardiology (SIC), represents the first of two consensus documents collecting the expert opinion of Radiologists and Cardiologists about current appropriate use of CCT.


Assuntos
Técnicas de Imagem Cardíaca , Angiografia por Tomografia Computadorizada , Doença das Coronárias/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Coração/diagnóstico por imagem , Cuidados Pré-Operatórios , Calcinose/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Humanos , Prevenção Primária
13.
Sci Rep ; 11(1): 10464, 2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001992

RESUMO

Coronavirus disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019 and spread rapidly around the world. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH criteria for disseminated intravascular coagulopathy (DIC) with fulminant activation of coagulation, resulting in widespread microvascular thrombosis and consumption of coagulation factors. We conducted a meta-analysis in order to explore differences in coagulopathy indices in patients with severe and non-severe COVID-19. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases between December 2019 (first confirmed Covid-19 case) up to April 6th, 2020. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. Furthermore, results on additional coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time) were also analyzed. The primary analysis showed that mean d-dimer was significantly lower in COVID-19 patients with non-severe disease than in those with severe (SMD - 2.15 [- 2.73 to - 1.56], I2 98%, P < 0.0001). Similarly, we found a lower mean d-dimer in Survivors compared to Non-Survivors (SMD - 2.91 [- 3.87 to - 1.96], I2 98%, P < 0.0001). Additional analysis of platelet count showed higher levels of mean PLT in Non-Severe patients than those observed in the Severe group (SMD 0.77 [0.32 to 1.22], I2 96%, P < 0.001). Of note, a similar result was observed even when Survivors were compared to Non-Survivors (SMD 1.84 [1.16 to 2.53], I2 97%, P < 0.0001). Interestingly, shorter mean PT was found in both Non-Severe (SMD - 1.34 [- 2.06 to - 0.62], I2 98%, P < 0.0002) and Survivors groups (SMD - 1.61 [- 2.69 to - 0.54], I2 98%, P < 0.003) compared to Severe and Non-Survivor patients. In conclusion, the results of the present meta-analysis demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT. This data suggests a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.


Assuntos
COVID-19 , Coagulação Intravascular Disseminada/sangue , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/sangue , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Artigo em Inglês | MEDLINE | ID: mdl-33944535

RESUMO

The tricuspid valve (TV) has been neglected for many years. Only recently, new studies demonstrated the prognostic role of the tricuspid valve lesions. In addition to that, new interventional approaches offer the possibility to non-invasively treat tricuspid valve disease. In this review, our aim is to summarize the role of different imaging techniques in the assessment of tricuspid valve with particular regards to congenital heart diseases. Finally, we analyze the importance of the TV and its adjacent regions from an electrophysiological point of view, both in structurally normal hearts and in congenital heart diseases. The most relevant transthoracic echocardiography (TTE) views to visualize the TV are the "modified" parasternal long axis, the apical views and subcostal projections, such as right oblique or left oblique views. However, simultaneous visualization of the three leaflets is possible only with three-dimensional TTE, or, sometimes, in parasternal short axis and subcostal short axis views in children. 3D echocardiography (3DE) is promising in this field. Indeed, its unique projections, such as en face views from the right ventricular and atrial perspectives, are able to define the spatial relationship of the tricuspid leaflets with the surrounding structures. Moreover, multimodality imaging assessment has been recently proposed for the diagnostic assessment of the TV, especially before percutaneous intervention. Cardiac Computed Tomography (CCT) provides valuable anatomic spatial information of the TV apparatus. Cardiac Magnetic Resonance (CMR) is able to provide, non-invasively, detailed morphological and functional information of the valve.

16.
G Ital Cardiol (Rome) ; 22(5): 363-375, 2021 May.
Artigo em Italiano | MEDLINE | ID: mdl-33960979

RESUMO

In over a year, the COVID-19 pandemic caused 2.69 million deaths and 122 million infections. Social isolation and distancing measures have been the only prevention available for months. Scientific research has done a great deal of work, developing in a few months safe and effective vaccines against COVID-19. In the European Union, nowadays, four vaccines have been authorized for use: Pfizer-BioNTech, Moderna, ChAdOx1 (AstraZeneca/Oxford), Janssen (Johnson & Johnson), and three others are currently under rolling review.Vaccine allocation policy is crucial to optimize the advantage of treatment preferring people with the highest risk of contagion. These days the priority in the vaccination program is of particular importance since it has become clear that the number of vaccines is not sufficient for the entire Italian population in the short term. Cardiovascular diseases are frequently associated with severe COVID-19 infections, leading to the worst prognosis. The elderly population suffering from cardiovascular diseases is, therefore, to be considered a particularly vulnerable population. However, age cannot be considered the only discriminating factor because in the young-adult population suffering from severe forms of heart disease, the prognosis, if affected by COVID-19, is particularly ominous and these patients should have priority access to the vaccination program. The aim of this position paper is to establish a consensus on a priority in the vaccination of COVID-19 among subjects suffering from different cardiovascular diseases.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Doenças Cardiovasculares/complicações , Consenso , Fatores Etários , Animais , COVID-19/epidemiologia , COVID-19/mortalidade , Cardiologia , Doença das Coronárias/complicações , Vetores de Doenças , Insuficiência Cardíaca/complicações , Transplante de Coração , Doenças das Valvas Cardíacas/complicações , Humanos , Hipertensão Pulmonar/complicações , Itália/epidemiologia , Prognóstico , Insuficiência Renal/complicações , SARS-CoV-2/imunologia , Sociedades Médicas , Vacinas Sintéticas/administração & dosagem
17.
Nutr Metab Cardiovasc Dis ; 31(6): 1671-1690, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-33994263

RESUMO

AIM: This review represents a joint effort of the Italian Societies of Cardiology (SIC) and Diabetes (SID) to define the state of the art in a field of great clinical and scientific interest which is experiencing a moment of major cultural advancements, the cardiovascular risk management in type 2 diabetes mellitus. DATA SYNTHESIS: Consists of six chapters that examine various aspects of pathophysiology, diagnosis and therapy which in recent months have seen numerous scientific innovations and several clinical studies that require extensive sharing. CONCLUSIONS: The continuous evolution of our knowledge in this field confirms the great cultural vitality of these two cultural spheres, which requires, under the leadership of the scientific Societies, an ever greater and effective collaboration.


Assuntos
Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dislipidemias/tratamento farmacológico , Hipertensão/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Hipolipemiantes/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Dislipidemias/fisiopatologia , Fatores de Risco de Doenças Cardíacas , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipoglicemiantes/efeitos adversos , Hipolipemiantes/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Prevalência , Medição de Risco , Resultado do Tratamento
18.
J Cardiovasc Med (Hagerstown) ; 22(9): 711-715, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34009835

RESUMO

CoronaVIrus Disease-19 (COVID-19) had a huge impact on human health and economy. However, to this date, the effects of the pandemic on the training of young cardiologists are only partially known. To assess the consequences of the pandemic on the education of the cardiologists in training, we performed a 23-item national survey that has been delivered to 1443 Italian cardiologists in training, registered in the database of the Italian Society of Cardiology (SIC). Six hundred and thirty-three cardiologists in training participated in the survey. Ninety-five percent of the respondents affirmed that the training programme has been somewhat stopped or greatly jeopardized by the pandemic. For 61% of the fellows in training (FITs), the pandemic had a negative effect on their education. Moreover, 59% of the respondents believe that they would not be able to fill the gap gained during that period over the rest of their training. A negative impact on the psycho-physical well being has been reported by 86% of the FITs. The COVID-19 pandemic had an unparalleled impact on the education, formation and mental state of the cardiologists in training. Regulatory agencies, universities and politicians should make a great effort in the organization and reorganization of the teaching programs of the cardiologists of tomorrow.


Assuntos
COVID-19 , Cardiologistas , Cardiologia/educação , Controle de Doenças Transmissíveis , Educação , Internato e Residência , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cardiologistas/educação , Cardiologistas/psicologia , Cardiologistas/normas , Competência Clínica/normas , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Educação/organização & administração , Educação/normas , Bolsas de Estudo/métodos , Bolsas de Estudo/estatística & dados numéricos , Humanos , Internato e Residência/métodos , Internato e Residência/organização & administração , Internato e Residência/normas , Itália/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , SARS-CoV-2 , Sociedades Médicas/estatística & dados numéricos , Inquéritos e Questionários
19.
G Ital Cardiol (Rome) ; 22(6): 480-489, 2021 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-34037592

RESUMO

Patients with severely calcified coronary lesions undergoing percutaneous revascularization have a substantial risk of adverse outcomes, both during the procedure and in the long term. Over the last decade, a renewed interest has been observed about devices for plaque modification and lesion preparation, new technologies have been introduced in clinical practice and well-known devices have undergone technical and procedural improvements. The available tools for intravascular imaging allow a detailed evaluation of the calcific plaques within all the layers of the vessel wall. The complementary use of all these tools is ultimately aimed at optimizing the mechanics of balloon angioplasty and the delivery and expansion of drug-eluting stents. It has been fully demonstrated that rotational atherectomy improves procedural success when treating heavily calcified lesions. Intravascular lithotripsy, techniques and materials used during complex procedures such as chronic total occlusions, increasing operators' experience, as well as new drug-eluting stents with excellent mechanical characteristics, have further contributed to the feasibility and the safety of treating most fibrotic and heavily calcified vessels. We finally propose an algorithm for evaluation and treatment of severely calcific coronary lesions to demonstrate how such percutaneous revascularization procedures are planned and performed.


Assuntos
Aterectomia Coronária , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Calcificação Vascular , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Índice de Gravidade de Doença , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia
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