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1.
Pol Arch Intern Med ; 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31517898

RESUMO

INTRODUCTION: Takotsubo syndrome (TTS) is an acute revesible left ventricular dysfunction which occurs mainly in postmenopausal women. OBJECTIVES: The goal of this study was to compare course of disease and prognoses in male and female patients with TTS in two large Polish academic hospitals. PATIENTS AND METHODS: The analysis included 232 patients (211 women and 21 men) hospitalized at the 1st Department of Cardiology, Warsaw and 1st Department of Cardiology, Gdansk. RESULTS: Men who developed TTS were more likely to live alone than women. Physical stress was trigger of TTS more often in men than women. There were no differences in the frequency of risk factors and comorbidities, with the exception of higher prevalence of smoking in men. Concerning the cardiac biomarkers, both at admission and peak NTproBNP levels were significantly more elevated in women.  ST depression was found more frequently in men than in women (6.2 vs. 25%). Ejection fraction was lower among male patients at discharge (50 vs. 60%), despite the same length of hospitalization. In-hospital outcome (arrhytmias, mechanical complications, cardiogenic shock, mortality) was similar in both groups. Beta-adrenolytics and statins were more frequently prescribed for women than for men (74.5 vs 52.4% and 68.3 vs 38.1%, respectively). Moreover, there was a tendency toward more frequent use of P2Y12 inhibitors for men (23.8 vs 10.4%). CONCLUSIONS: There are some differences in clinical course of male and female patients with TTS. However, in-hospital outcome was similar.

3.
J Am Heart Assoc ; 8(15): e010881, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31311438

RESUMO

Background Clinical characteristics and outcomes of takotsubo syndrome (TTS) patients with malignancy have not been fully elucidated. This study sought to explore differences in clinical characteristics and to investigate short- and long-term outcomes in TTS patients with or without malignancy. Methods and Results TTS patients were enrolled from the International Takotsubo Registry. The TTS cohort was divided into patients with and without malignancy to investigate differences in clinical characteristics and to assess short- and long-term mortality. A subanalysis was performed comparing long-term mortality between a subset of TTS patients with or without malignancy and acute coronary syndrome (ACS) patients with or without malignancy. Malignancy was observed in 16.6% of 1604 TTS patients. Patients with malignancy were older and more likely to have physical triggers, but less likely to have emotional triggers compared with those without malignancy. Long-term mortality was higher in patients with malignancy (P<0.001), while short-term outcome was comparable (P=0.17). In a subanalysis, long-term mortality was comparable between TTS patients with malignancies and ACS patients with malignancies (P=0.13). Malignancy emerged as an independent predictor of long-term mortality. Conclusions A substantial number of TTS patients show an association with malignancy. History of malignancy might increase the risk for TTS, and therefore, appropriate screening for malignancy should be considered in these patients. Clinical Trial Registration URL: http://www.clinicaltrial.gov. Unique identifier: NCT01947621.

4.
Cardiol J ; 26(4): 310-321, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31257567

RESUMO

BACKGROUND: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen-tial coronary stenosis without balloon inflation is hereby proposed. METHODS: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu-la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls' formula. FFR of the remaining lesion was finally recorded (measured FFR). RESULTS: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls' formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640-0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion. CONCLUSIONS: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.

6.
Eur Heart J ; 40(26): 2142-2151, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31098611

RESUMO

AIMS: We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS: We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS: Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

7.
Int J Cardiol ; 292: 56-61, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31003797

RESUMO

BACKGROUND: Data regarding the efficacy of the percutaneous coronary intervention (PCI) with new-designed drug-eluting stent (new-DES) vs. bare metal stent (BMS) of saphenous vein grafts (SVG) stenosis is scarce. The primary objective was to compare one-year clinical outcomes of PCI in stenosis of SVG using new-DES vs. BMS in a real-world population. METHODS AND RESULTS: We carried out a multi-center registry comparing new-DES with BMS in all consecutive patients undergoing PCI of SVG. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year. This observation included 792 consecutive patients (mean age 69 ±â€¯8.9y), treated with either new-DES (n = 379, 47.9%) or BMS (n = 413, 52.1%). Among patients treated with new-DES compared with BMS, there was a lower risk of MACCE (21.4% vs. 28.3%, HR = 0.69, 95% CI 0.50-0.95, p = 0.025) as well as myocardial infarction (MI) (6.3% vs. 12.1%; HR 0.49, 95% CI 0.30-0.82, p = 0.005) at 1 year. After propensity score adjustment, the similar, significant reduction in MACCE and MI was observed in favor of new-DES (HR 0.66, 95% CI 0.46-0.96, p = 0.030; and HR 0.53, 95% CI 0.31-0.92, p = 0.020, respectively). CONCLUSION: In patients undergoing PCI of SVG, the use of new-DES is associated with a reduced 1-year rate of MACCE and MI compared to BMS.

9.
Cardiol J ; 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30761515

RESUMO

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become a standard therapeutic option for patients with severe aortic stenosis (AS) at high cardiac surgical risk. The aim of the NAUTILUS study was to investigate the safety and performance of the New Valve Technology (NVT) Allegra bioprosthesis in high-risk patients undergoing TAVI. METHODS: 27 patients with severe, symptomatic AS at high surgical risk were prospectively enrolled, who underwent treatment using the novel self-expanding NVT Allegra bioprosthesis via transfemoral approach (TF-TAVI). The primary end-point was all-cause mortality at 30 days. RESULTS: Patients were elderly (83 years, range 75-89 years), and predominantly female (70.4%, n = 19). All patients were deemed to be at high surgical risk, with a mean logistic EuroSCORE of 12.4% (range, 2.8-31.8%). The bioprosthesis was successfully implanted in 96% of the cases (n = 25). The echocardiographic assessment confirmed good hemodynamic profile after implantation of the NVT Allegra bioprosthesis. Complications included cardiac tamponade (4%, n = 1) and the need for permanent pacemaker implantation (8%, n = 2). The analysis of procedural aspects showed a short learning effect related to the precise placement of the valve. A significant improvement in clinical symptoms were observed, and no patients died in-hospital or within 30 days of post-discharge observation. CONCLUSIONS: This prospective observation shows that the NVT Allegra bioprosthesis was associated with a satisfactory safety profile and a remarkable hemodynamic performance after implantation.

10.
Cardiovasc Revasc Med ; 20(2): 153-166, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30581088

RESUMO

In part 2 of this two-part manuscript on takotsubo syndrome (TTS), we discuss typical biomarkers (particularly excess catecholamines and what kinds of electrocardiographic information operators should look for) and numerous complications the syndrome can cause. This consensus paper is the result of a multinational effort aiming to summarize the current state of the art on TTS. Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support. New structured algorithms are also proposed to aid clinicians in the decision-making process as well as future directions for research given the current lack of evidence-based medical approaches.

12.
Cardiovasc Revasc Med ; 20(1): 70-79, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30528096

RESUMO

Takotsubo syndrome (TTS) is an acute cardiac condition independent of epicardial coronary obstruction that mimics acute coronary syndrome and is characterized by acute heart failure with reversible ventricular motion abnormalities. This consensus paper is the result of a multinational effort aiming to summarize the current state of the art on TTS. Experts in the field provide a thorough and detailed review of this syndrome. Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support. In part 1 of this two-part manuscript, we discuss how TTS came to be known, several patterns and forms it can take in patients, epidemiology and pathophysiology of the syndrome, and clinical presentation.

14.
Diabetes ; 2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30487264

RESUMO

The aim of this study was to compare endothelial permeability, which is considered a hallmark of CAD, between patients with different HbA1c-levels using an albumin-binding-MR-probe. This cross-sectional-study included 26 patients with clinical indication for x-ray-angiography, which were classified into 3 groups according to their HbA1c-levels (HbA1c<5.7%,<39mmol/mol; HbA1c=5.7-6.4%,39-47mmol/mol; HbA1c≥6.5%,48mmol/mol). Subjects underwent gadofosveset-enhanced-coronary-magnetic-resonance and x-ray-angiography including optical-coherence-tomography (OCT) within 24hours. Contrast-to-noise-ratios were assessed to measure the probe-uptake in the coronary-wall by coronary segment, excluding those with culprit lesions in x-ray-angiography. In the group of patients with HbA1c-levels between 5.7-6.4% 0.30 increased normalized CNR values were measured, compared to patients with HbA1c-levels <5.7% (0.30; 95% CI:[0.04, 0.57]). In patients with HbA1c levels ≥6.5%, we found 0.57 higher normalized CNR values as compared to patients with normal HbA1c-levels (0.57;95% CI:[0.28,0.85]) and 0.26 higher CNR values for patients with HbA1c-level≥6.5% as compared to patients with HbA1c-levels between 5.7-6.4% (0.26; 95% CI: [-0.04, 0.57]). Additionally late atherosclerotic lesions were more common in patients with high HbA1c-levels (HbA1c ≥6.5%:n=14 (74%); HbA1c 5.7-6.4%:n=6 (60%); HbA1c<5.7%:n=10 (53%)).In conclusion, coronary-magnetic-resonance imaging in combination with an albumin-binding probe suggests that both patients with intermediate and high HbA1c-levels are associated with a higher extent of endothelial damage of the coronary arteries as compared to patients with HbA1c-levels below 5.7.

15.
Catheter Cardiovasc Interv ; : e27876, 2018 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-30311397

RESUMO

BACKGROUND: There is a paucity of data on left main (LM) percutaneous coronary intervention (PCI) therapy with dedicated DES platforms. The LM-STENTYS is a multicenter registry aimed at evaluating clinical outcome after PCI of LM performed with a self-apposing Stentys DES implantation. METHODS: The registry consists of 175 consecutive patients treated with Stentys DES implanted to LM. The primary endpoint was the composite of major adverse cardiac and cerebral events (MACCE) defined as cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), and stroke assessed after 1 year. The secondary endpoint was stent thrombosis (ST) at 1 year. RESULTS: The median age was 69 years (IQR, 62-78 years). Acute coronary syndrome (ACS) was the presenting diagnosis in 117 (66.9%) patients [74 (63.2%) unstable angina, 31 (26.5%) NSTEMI, 12 (10.3%) STEMI] and stable angina (SA) was present in 58 (33.1%) patients. The median SYNTAX score was 23.0 (IQR, 18.7-32.2) in the SA group and 25.0 (IQR, 20.0-30.7) in the ACS group. During 1-year follow-up in the SA group two (3.4%) MACCE occurred, both of them were cardiac deaths. In ACS patients there were 19 (16.2%) MACCE [9 (7.7%) cardiac deaths, 11 (9.4%) MIs, 11(9.4%) TLR, 1(0.9%) stroke]. Altogether, three (1.7%) cases of acute ST were noted, all of them in ACS subset. CONCLUSION: LM PCI using self-apposing Stentys DES showed favorable clinical outcomes at 1-year in patients with SA. Events of ST in the ACS group warrant further research.

16.
Cardiol Res Pract ; 2018: 9762176, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30356345

RESUMO

Aims: To assess the incremental prognostic value of SYNTAX score II (SxSII) as compared to anatomical SYNTAX Score (SxS) and GRACE risk score in patients with acute coronary syndromes who underwent percutaneous coronary intervention. Methods and results: SxSII and SxS were determined in 734 ACS patients. Patients were enrolled in the prospective Special Program University Medicine ACS and the COMFORTABLE AMI cohorts and later on stratified according to tertiles of SxSII (SxSIILow ≤21.5 (n=245), SxSIIMid 21.5-30.6 (n=245), and SxSIIHigh ≥30.6 (n=244). The primary endpoint of adjudicated all-cause mortality and secondary endpoints of MACE (cardiac death, repeat revascularization, and myocardial infarction) and MACCE (all-cause mortality, cerebrovascular events, MI, and repeat revascularization) were determined at 1-year follow-up. SxSII provided incremental predictive information for risk stratification when compared to SxS and GRACE risk score (AUC 0.804, 95% CI 0.77-0.84, p < 0.001 versus 0.67, 95% CI 0.63-0.72, p=0.007 versus 0.69, 95% CI 0.6-0.8, p=0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96-1.07), p=0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06-1.11), p < 0.001). This was also true for the prediction of both secondary outcomes MACE (n=60) and MACCE (n=70) with an adjusted HR = 1.055, 95% CI (1.03-1.08), p < 0.001, and HR = 1.065, 95% CI (1.04-1.09), p < 0.001. Conclusion: In patients with ACS who underwent PCI, SxSII is an independent predictor of mortality during 1-year follow-up. SxSII shows superiority in discriminating risk compared to conventional SxS and GRACE for all-cause mortality.

17.
Cardiol J ; 25(5): 574-581, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30246237

RESUMO

BACKGROUND: Non-occlusive technique is universally accepted for acquisition of coronary optical coherence tomography (OCT), but the amount of contrast infused is still inconsistently calculated. Proposed herein, is an empirical formula for accurate contrast volume calculation. METHODS: In an observational prospective study, contrast volume of consecutive patients undergoing OCT was either calculated with formula, or eyeballed based on manufacturer recommendations. The quality of pullback, defined as % of high quality cross-sections (CS) in the segment of interest (SOI), was analyzed by two independent operators and compared between groups, together with the amount of contrast per pullback. RESULTS: Sixty patients (115 pullbacks, 4252 CS) were imaged using the formula, vs. 18 patients (22 pullbacks, 777 CS) eyeballing the contrast volume. The formula group used 18 mm/s as pullback speed more often (82.6% vs. 40.9%, p = 0.0001), but there were no significant differences between groups in SOI length or vessel imaged. The formula resulted in higher pullback quality than eyeballing (96.55% vs. 63.55%, p < 0.0001), interobserver agreement Kappa 0.903 (p < 0.0001), and tended to use less contrast per pullback than the eyeball group (13.03 mL vs. 14.55 mL, p = 0.057). After adjusting for pullback speed, SOI length and vessel in multivariate linear regression, the use of the formula significantly reduced the amount of contrast in 4.50 mL on average. CONCLUSIONS: Optical coherence tomography acquisition with the non-occlusive technique can be substantially eased with the use of a novel formula to calculate the contrast volume required. This method optimises the quality of the images whilst reducing the amount of contrast per pullback.

18.
Cardiol J ; 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30234904

RESUMO

BACKGROUND: Severe familial hypercholesterolemia (FH) individuals, refractory to conventional lipid-lowering medications are at exceptionally high risk of cardiovascular events. The established therapeutic option of last choice is lipoprotein apheresis (LA). Herein, it was sought to investigate the clinical usefulness of LA in a highly selected group of severe heterozygous FH (HeFH), as recently described by the International Atherosclerosis Society (IAS), for their efficacy in lipid reduction and safety. METHODS: Efficacy and safety of LA were investigated in 318 sessions of seven severe HeFH females with cardiovascular disease, over a mean period of 26.9 ± 6.5 months. Relative reduction of low density lipoprotein cholesterol (LDL-C) ≥ 60%, clinical complications and vascular access problems were evaluated and compared between the direct adsorption of lipoproteins (DALI) and lipoprotein filtration (Membrane Filtration Optimized Novel Extracorporeal Treatment [MONET]). Additionally, lipoprotein (a) [Lp(a)], total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) and fibrinogen concentrations were investigated. RESULTS: The relative reduction of LDL-C, TC, TG and Lp(a) were 69.4 ± 12.9%, 59.7 ± 9.1, 51.5 ± 14.2% and 71.3 ± 14.4%, respectively. A similar efficacy was found in both systems in LDL-C removal. DALI system led to larger depletions of Lp(a) (80.0 [76-83]% vs. 73.0 [64.7-78.8]%; p < 0.001). The frequency of clinical side effects and vascular access problems were low (8.5%). CONCLUSIONS: Long-term LA in severe HeFH individuals is safe and efficiently reduces LDL-C and Lp(a). Higher efficacy of the DALI system than MONET in Lp(a) removal may indicate the need for individualized application of the LA system in severe HeFH individuals.

20.
J Am Coll Cardiol ; 72(8): 874-882, 2018 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-30115226

RESUMO

BACKGROUND: Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. OBJECTIVES: This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. METHODS: Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. RESULTS: Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. CONCLUSIONS: Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).

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