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1.
Medicine (Baltimore) ; 100(31): e26702, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397805

RESUMO

INTRODUCTION: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) catheter ablation. However, a PVI alone has been considered insufficient for persistent AF. This study aimed to evaluate the efficacy of persistent AF ablation targeting complex fractionated atrial electrogram (CFAE) areas within low voltage zones identified by high-resolution mapping in addition to the PVI. METHODS: We randomized 50 patients (mean age 58.4 ±â€Š9.5 years old, 86.0% males) with persistent AF to a PVI + CFAE group and PVI only group in a 1:1 ratio. CFAE and voltage mapping was performed simultaneously using a Pentaray Catheter with the CARTO3 CONFIDENSE module (Biosense Webster, CA, USA). The PVI + CFAE group, in addition to the PVI, underwent ablation targeting low voltage areas (<0.5 mV during AF) containing CFAEs. RESULTS: The mean persistent AF duration was 24.0 ±â€Š23.1 months and mean left atrial dimension 4.9 ±â€Š0.5 cm. In the PVI + CFAE group, AF converted to atrial tachycardia (AT) or sinus rhythm in 15 patients (60%) during the procedure. The PVI + CFAE group had a higher 1-year AF free survival (84.0% PVI + CFAE vs 44.0 PVI only, P = .006) without antiarrhythmic drugs. However, there was no difference in the AF/AT free survival (60.0% PVI + CFAE vs 40.0% PVI only, P = .329). CONCLUSION: Persistent AF ablation targeting CFAE areas within low voltage zones using high-density voltage mapping had a higher AF free survival than a PVI only. Although recurrence with AT was frequent in the PVI+CFAE group, the sinus rhythm maintenance rate after redo procedures was 76%.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas , Idoso , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Intervalo Livre de Doença , Técnicas Eletrofisiológicas Cardíacas/métodos , Feminino , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Recidiva , Cirurgia Assistida por Computador , Taquicardia/etiologia
2.
Heart Vessels ; 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34341876

RESUMO

The association of the soluble suppression of tumorigenicity 2 (sST2) and the prognosis of heart failure have been well evaluated. However, little is known about the prediction of sST2 for left ventricular (LV) remodeling in acute coronary syndrome (ACS). We investigated the ability of sST2 to predict LV remodeling following the revascularization of ACS. From May 2019 to December 2020, 95 patients with LV ejection fraction (EF) < 50% who underwent coronary revascularization for ACS (unstable angina, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction) were enrolled. Echocardiography and sST2 were performed at baseline and at a 3-month follow-up. The association between LV remodeling, using the end-diastolic volume index, and sST2 at baseline and at the 3-month follow-up, and the difference between each value was explored. During follow-up, 41 patients showed LV adverse remodeling. The baseline sST2 increased in patients without adverse remodeling (32.05 ng/mL vs. 23.5 ng/mL, p < 0.001), although clinical characteristics were similar between the two groups. During the mean follow-up of 3 months, a significant correlation was found in the changes between sST2 and LV end-diastolic/systolic volume index (r = 0.649; p < 0.001, r = 0.618; p < 0.001, respectively), but not in the changes of LVEF (r = - 0.132, p = 0.204). The use of angiotensin-converting enzyme 2 inhibitors/receptor blockers was higher (90.7% vs. 53.7%, p < 0.001) and sST2 decreased more predominantly in patients without adverse remodeling (23.18 ng/mL vs 26.40 ng/mL, p = 0.003). However, the changes in sST2 and LV volume were not different according to the ACS types (p > 0.05, for all). Estimates of the odds ratio (OR) for remodeling according to the sST2 difference increased substantially with a negative increase in the sST2 difference. Multivariable analysis found that, the difference between the baseline and 3-month sST2 was the most important determinant of LV remodeling following the revascularization of ACS (OR 1.24; 95% confidence interval: 1.09 to 1.41; p = 0.001). In conclusion, an increase in sST2 during follow-up was a useful predictor of LV remodeling.

3.
J Korean Med Sci ; 36(32): e229, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34402228

RESUMO

Increasing rates of coronavirus disease 2019 (COVID-19) vaccination coverage will result in more vaccine-related side effects, including acute myocarditis. In Korea, we present a 24-year-old male with acute myocarditis following COVID-19 vaccination (BNT162b2). His chest pain developed the day after vaccination and cardiac biomarkers were elevated. Echocardiography showed minimal pericardial effusion but normal myocardial contractility. Electrocardiography revealed diffuse ST elevation in lead II, and V2-5. Cardiac magnetic resonance images showed the high signal intensity of T2- short tau inversion recovery image, the high value of T2 mapping sequence, and late gadolinium enhancement in basal inferior and inferolateral wall. It was presumed that COVID-19 mRNA vaccination was probably responsible for acute myocarditis. Clinical course of the patient was favorable and he was discharged without any adverse event.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Coração/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Miocardite/patologia , Miocárdio/patologia , COVID-19/imunologia , COVID-19/prevenção & controle , Dor no Peito/patologia , Ecocardiografia , Eletrocardiografia , Humanos , Imageamento por Ressonância Magnética , Masculino , República da Coreia , Vacinação/efeitos adversos , Adulto Jovem
4.
Sci Rep ; 11(1): 16563, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400711

RESUMO

The muscular discontinuities at the pulmonary vein (PV)-left atrial (LA) junction are known. The high-density mapping may help to find the muscular discontinuity. This study evaluated the efficacy of a partial antral ablation for a pulmonary vein (PV) isolation using high density (HD) mapping. A total of 60 drug-refractory atrial fibrillation (AF) patients undergoing catheter ablation were enrolled. The detailed activation mapping of each PV and LA junction was performed using an HD mapping system, and each PV segment's activation pattern was classified into a "directly-activated from the LA" or "passively-activated from an adjacent PV segment" pattern. The antral ablations were performed at the directly-activated PV segments only when the PV had "passively-activated segments". If the PV did not contain passively-activated segments, a circumferential antral ablation was performed on those PVs. A "successful partial antral ablation" was designated if the electrical isolation of targeted PV was achieved by ablation at the directly-activated segments only. If the isolation was not achieved even though all directly-activated segments were ablated, a "failed partial antral ablation" was designated, and then a circumferential ablation was performed. Among 240 PVs, passively-activated segments were observed in 140 (58.3%) PVs. Both inferior PVs had more passively-activated segments than superior PVs, and the posteroinferior segments had the highest proportion of passive activation. The overall rate of successful partial antral ablation was 85%. The atrial tachyarrhythmia recurrence was observed in 10 patients (16.7%) at 1-year. HD mapping allowed the evaluation of the detailed activation patterns of the PVs, and passively-activated segments may represent muscular discontinuity. Partial antral ablation of directly-activated antral segments only was feasible and effective for a PVI.


Assuntos
Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/métodos , Ablação por Cateter/métodos , Veias Pulmonares/cirurgia , Cirurgia Assistida por Computador/métodos , Algoritmos , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco/instrumentação , Estimulação Cardíaca Artificial , Seio Coronário/fisiopatologia , Feminino , Fluoroscopia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Recidiva , Cirurgia Assistida por Computador/instrumentação
5.
J Cardiovasc Imaging ; 29(3): 265-278, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34080344

RESUMO

BACKGROUND: The annual incidence of venous thromboembolism (VTE) is increasing, and the treatment pattern of oral anticoagulants (OACs) has changed with introduction of new oral anticoagulants (NOACs). The aims of this study were to assess the annual incidence of VTE in a Korean population and the change of treatment pattern with availability of NOACs using a population-based database. METHODS: Using the Korean National Health Insurance Services database, we identified patients diagnosed with VTE between 2009 and 2016. The annual prevalence of VTE and clinical characteristics and treatment pattern were investigated. The annual incidence of VTE was calculated using direct and indirect methods using the estimated Korean population in 2009 as the reference. RESULTS: The annual incidence of VTE in Korean has increased yearly from 23.9 per 100,000 in 2009 to 42.2 in 2016. The overall rate of OAC prescription for VTE treatment increased from 55.9% to 68% in the same time period. The rate of initiation of NOAC treatment greatly increased, particularly from 2013 onwards, with a 20-fold increase from 2009 to 2016 (2.1% vs. 54.3%). CONCLUSIONS: The annual incidence of VTE in Korea increased by almost two-fold from 2009 to 2016. The rate of initiation of NOAC treatment has increased substantially since 2013, and these agents have surpassed VKAs as the anticoagulant of choice for VTE. This temporal pattern of OAC prescription is consistent with the current clinical guidelines, which indicate NOACs over the warfarin in patients with VTE.

6.
J Hum Hypertens ; 35(11): 994-1002, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33408327

RESUMO

Peripheral blood pressure (PBP) is usually higher than central blood pressure (CBP) due to pulse amplification; however, it is not well understood why cuff-measured PBP can be lower than CBP estimated by the late systolic pressure of radial pulse waves. We explored the implications of systolic PBP-CBP (P-CBP) differences for cardiovascular (CV) prognosis. In total, 335 patients at very high risk of atherosclerotic cardiovascular disease (ASCVD) underwent automated applanation tonometry and brachial-ankle pulse wave velocity (baPWV), and they were classified into groups according to positive or negative systolic P-CBP differences. Between-group characteristics and clinical outcomes (the composite of coronary revascularization, stroke, heart failure hospitalization, and CV death) were evaluated. Patients with negative differences had significantly higher frequency of hypertension, coronary artery disease, higher ASCVD risk burden, and elevated N-terminal pro b-type natriuretic peptide. They had higher left atrial volume index (LAVI) and lower systolic mitral septal tissue velocity (TVI-s') than those with a positive difference. These patients showed higher systolic PBP and CBP, and a higher baPWV. Multivariable analysis indicated that TVI-s', LAVI, and ASCVD risk burden were independent determinants of such systolic P-CBP differences. During a median follow-up of 12.6 months, clinical outcomes were significantly related to a negative difference (11.5% vs. 3.4%, p = 0.014), and a systolic P-CBP difference ≤ -8 mmHg was associated with a threefold higher likelihood of poor prognosis. In patients at very high risk of ASCVD, systolic P-CBP difference was associated with cardiac dysfunction and ASCVD risk burden, allowing further risk stratification.

7.
Int J Cardiovasc Imaging ; 37(2): 467-477, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32901347

RESUMO

Trabeculation exhibits highly varied presentations, whereas noncompaction (NC) is a specific disease entity based arithmetically on wall thickness. We aimed to evaluate the clinical implications of trabeculation and its relevance to outcomes. A total of 296 patients (age 63 ± 12 years; 64% men) with trabeculation who underwent echocardiography were retrospectively identified between January 2011 and December 2012. Analyses were conducted on distinguished trabeculation which was divided into NC (maximum noncompacted/compacted ratio ≥ 2.0) or hypertrabeculation (HT) (ratio < 2.0). We evaluated features of trabeculation and explored cardiovascular (CV) outcome events (coronary revascularization, hospitalization for worsening heart failure (HF), stroke, nonsustained ventricular tachycardia (VT), implantation of an implantable cardioverter defibrillator (ICD), and CV death). Over a mean of 4.2 years, CV outcome events occurred in 122 (41%) patients who were older and exhibited an increased frequency of diabetes mellitus, stroke, implantation of ICD, HF and dilated cardiomyopathy. The frequencies of NC or HT, the trabeculation ratio and its manifestation were similar among patients with and without events. NC/HT with concomitant apical hypocontractility and worsening systolic function were univariable predictors of adverse events. On multivariable analysis, concomitant apical hypocontractility on NC/HT remained significant (hazard ratio 8.94, 95% confidence interval 2.9-27.2, p < 0.001) together with old age, HF and increased E/e' ratio. NC/HT with concomitant apical hypocontractility provided clues about the current medical illness and aided in risk stratification.


Assuntos
Miocárdio Ventricular não Compactado Isolado , Idoso , Progressão da Doença , Ecocardiografia , Feminino , Humanos , Miocárdio Ventricular não Compactado Isolado/complicações , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Miocárdio Ventricular não Compactado Isolado/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Função Ventricular Esquerda
8.
J Korean Med Sci ; 35(39): e349, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33045772

RESUMO

BACKGROUNDS: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes. METHODS: This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed. RESULTS: A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, P = 0.026), and were more male (59.1% vs. 18.8%, P = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, P = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, P = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis (P = 0.008). CONCLUSION: The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Miocárdio/metabolismo , Pneumonia Viral/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , COVID-19 , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Creatina Quinase Forma MB/metabolismo , Eletrocardiografia , Feminino , Traumatismos Cardíacos/metabolismo , Traumatismos Cardíacos/patologia , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Peptídeo Natriurético Encefálico/metabolismo , Pandemias , Fragmentos de Peptídeos/metabolismo , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , SARS-CoV-2 , Fatores Sexuais , Centros de Atenção Terciária , Troponina I/metabolismo
9.
J Clin Hypertens (Greenwich) ; 22(10): 1835-1845, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32937023

RESUMO

Single risk factors, such as hypertension and dyslipidemia, can combine to exacerbate the development and severity of cardiovascular disease. Treatment goals may be more effectively achieved if multiple disease factors are targeted with combination treatment. We enrolled 202 patients who were randomly divided into the following three groups: telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg, telmisartan 80 mg + rosuvastatin 20 mg, and telmisartan/amlodipine 80/5 mg. The primary efficacy variables were changes from baseline in mean sitting systolic blood pressure (MSSBP) between telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan 80 mg + rosuvastatin 20 mg at 8 weeks, and the percent changes from baseline in low-density lipoprotein (LDL) cholesterol between telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan/amlodipine 80/5 mg at 8 weeks. The secondary efficacy variables were changes in MSSBP, mean sitting diastolic blood pressure (MSDBP), LDL cholesterol and other lipid levels at 4 weeks and 8 weeks, as well as observed adverse events during follow-up. There were no significant differences between the three groups in demographic characteristics and no significant difference among the three groups in terms of baseline characteristics for the validity evaluation variables. The mean overall treatment compliance in the three groups was, respectively, 98.42%, 96.68%, and 98.12%, indicating strong compliance for all patients. The Least-Square (LS) mean (SE) for changes in MSSBP in the two (telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan 80 mg + rosuvastatin 20 mg) groups were -19.3 (2.68) mm Hg and -6.69 (2.76) mm Hg. The difference between the two groups was significant (-12.60 (2.77) mm Hg, 95% CI -18.06 to -7.14, P < .0001). The LS Mean for the percent changes from baseline in LDL cholesterol in the two (telmisartan/amlodipine 80/5 mg + rosuvastatin 20 mg and telmisartan/amlodipine 80/5 mg) groups were -52.45 (3.23) % and 2.68 (3.15) %. The difference between the two groups was significant (-55.13 (3.20) %, 95% CI -61.45 to -48.81, P < .0001). There were no adverse events leading to discontinuation or death. Combined administration of telmisartan/amlodipine 80/5 mg and rosuvastatin 20 mg for the treatment of hypertensive patients with dyslipidemia significantly reduces blood pressure and improves lipid control. ClinicalTrials.gov identifier: NCT03067688.


Assuntos
Anlodipino/administração & dosagem , Dislipidemias , Hipertensão , Rosuvastatina Cálcica/administração & dosagem , Telmisartan/administração & dosagem , Idoso , Anlodipino/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Combinação de Medicamentos , Quimioterapia Combinada , Dislipidemias/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Rosuvastatina Cálcica/uso terapêutico , Telmisartan/uso terapêutico
10.
JACC Cardiovasc Interv ; 13(16): 1907-1916, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32819479

RESUMO

OBJECTIVES: The aim of this study was to evaluate the clinical and anatomical features to predict the long-term outcomes in patients with fractional flow reserve (FFR)-guided deferred lesions, verified by intravascular ultrasound (IVUS). BACKGROUND: Deferral of nonsignificant lesion by FFR is associated with a low risk of clinical events. However, the impact of combined information on clinical and anatomical factors is not well known. METHODS: The study included 459 patients with 552 intermediate lesions who had deferred revascularization on the basis of a nonischemic FFR (>0.80). Grayscale IVUS was examined simultaneously. The primary endpoint was patient-oriented composite outcome (POCO) (a composite of all-cause death, myocardial infarction, and any revascularization) during 5-year follow-up. RESULTS: The rate of 5-year POCO was 9.8%. Diabetes mellitus (hazard ratio: 3.50; 95% confidence interval [CI]: 1.86 to 6.57; p < 0.001), left ventricular ejection fraction ≤40% (hazard ratio: 4.80; 95% CI: 1.57 to 14.63; p = 0.006), and positive remodeling (hazard ratio: 2.04; 95% CI: 1.03 to 4.03; p = 0.041) were independent predictors for POCO. When the lesions were classified according to the presence of the adverse clinical characteristics (diabetes, left ventricular ejection fraction ≤40%) or adverse plaque characteristics (positive remodeling, plaque burden ≥70%), the risk of POCO was incrementally increased (4.3%, 13.6%, and 21.3%, respectively; p < 0.001). CONCLUSIONS: In patients with FFR-guided deferred lesions, 5-year clinical outcomes were excellent. Lesion-related anatomical factors from intravascular imaging as well as patient-related clinical factors could provide incremental information about future clinical risks.


Assuntos
Cateterismo Cardíaco , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Revascularização Miocárdica , Tempo para o Tratamento , Ultrassonografia de Intervenção , Idoso , Tomada de Decisão Clínica , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Vasos Coronários/fisiopatologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Seul , Fatores de Tempo , Resultado do Tratamento
11.
Heart Surg Forum ; 23(3): E358-E365, 2020 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-32524973

RESUMO

BACKGROUND: While the surgical correction of moderate aortic stenosis (AS) can be deferred with a watchful waiting according to the present guideline, the clinical outcomes for moderate AS with comorbidity have not extensively been studied. We aimed to explore the factors that would contribute to the outcomes of moderate AS with at least five years of follow-up duration. METHODS: Medical records review identified patients with moderate aortic valve (AV) stenosis from January 2008 and December 2012. Echocardiographic data were gathered, and the final 5-year clinical outcomes, defined as the composite of cardiovascular (CV) death, admission for heart failure (HF) aggravation, and AV replacement, were evaluated. RESULTS: Among 148 patients (mean age, 69.3 years; mean AV area, 1.24 cm2), 79 had adverse outcomes (16 CV deaths, 32 AV replacements, and 31 HF cases), during a mean follow-up of 5.6 years. The event group showed worse dyspnea of NYHA III-IV and a higher frequency of diabetes mellitus (DM). They had a higher frequency of moderate or moderate-to-severe functional mitral regurgitation (MR) and smaller AV area. In the multivariate analysis, DM (HR 2.29, 95% CI 1.03-5.10), moderate or moderate-to-severe MR (HR 4.84, 95% CI 1.66-10.07), and NYHA III-IV (HR 3.84, 95% CI 1.72-8.56) independently were associated with adverse outcomes. CONCLUSIONS: The symptomatic patients with moderate AS had higher events than expected, and early intervention should be considered in case of concomitant MR and DM.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Conduta Expectante/métodos
12.
PLoS One ; 15(6): e0234362, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520973

RESUMO

BACKGROUND: Patients with diabetes mellitus are at an increased risk for adverse clinical events following percutaneous coronary interventions (PCI). However, the clinical impact of diabetes mellitus (DM) on second-generation drug-eluting stent (DES) implantation is not well-known. The aim of the current analysis was to examine the clinical impact of DM on clinical outcomes and the time sequence of associated risks in patients treated with second-generation DES. METHODS: Using patient-level data from two stent-specific, all-comer, prospective DES registries, we evaluated 1,913 patients who underwent PCI with second-generation DES between Feb 2009 and Dec 2013. The primary outcomes assessed were two-year major cardiac adverse events (MACE), composite endpoints of death from any cause, myocardial infarction (MI), and any repeat revascularization. We classified 0-1 year as the early period and 1-2 years as the late period. Landmark analyses were performed according to diabetes mellitus status. RESULTS: There were 1,913 patients with 2,614 lesions included in the pooled dataset. The median duration of clinical follow-up in the overall population was 2.0 years (interquartile range 1.9-2.1). Patients with DM had more cardiovascular risk factors than patients without DM. In multivariate analyses, the presence of DM and renal failure were strong predictors of MACE and target-vessel revascularization (TVR). After inverse probability of treatment weighting (IPTW) analyses, patients with DM had significantly increased rates of 2-year MACE (HR 2.07, 95% CI; 1.50-2.86; P <0.001). In landmark analyses, patients with DM had significantly higher rates of MACE in the early period (0-1 year) (HR 3.04, 95% CI; 1.97-4.68; P < 0.001) after IPTW adjustment, but these findings or trends were not observed in the late period (1-2 year) (HR 1.24, 95% CI; 0.74-2.07; P = 0.41). CONCLUSIONS: In the second-generation DES era, the clinical impact of DM significantly increased the 2-year event rate of MACE, mainly caused by clinical events in the early period (0-1 year). Careful observation of patients with DM is advised in the early period following PCI with second-generation DES.


Assuntos
Complicações do Diabetes/metabolismo , Stents Farmacológicos/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Doença da Artéria Coronariana/complicações , Complicações do Diabetes/terapia , Diabetes Mellitus/etiologia , Diabetes Mellitus/metabolismo , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Sistema de Registros , República da Coreia/epidemiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
J Cardiovasc Imaging ; 28(3): 186-198, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32583635

RESUMO

BACKGROUND: Left atrial (LA) strain is a novel parameter of LA function. However, its reference value has not been established, and the determining factors for LA strain remain elusive. We aimed to present LA strain with reservoir, conduit, and contractile components and associated parameters in a large-sized group of healthy individuals. METHODS: The present study was from a prospective multicenter registry in South Korea. Subjects who had no history of cardiovascular disease with adequate images were eligible for inclusion. LA reservoir, conduit, and contractile strains (LASRES, LASCD and LASCT, respectively) were measured. Left ventricular global longitudinal strain (LV GLS) and early and late diastolic strain rates (DSRe and DSRa, respectively) were also evaluated. RESULTS: Among a total of 324 subjects (mean age: 49 ± 16 years, 167 females), the mean LASRES, LASCD, and LASCT values were 35.9% ± 10.6%, 21.9% ± 9.3%, and 13.9% ± 3.6%, respectively. Mean LV GLS was -20.4% ± 2.2%, and mean DSRe and DSRa were 1.6 ± 0.4 s-1 and 0.8 ± 0.3 s-1, respectively. With aging, LASRES and LASCD showed significant decreases. Factors showing independent associations with LASRES were age (B = -0.425, p < 0.001), DSRe (B = 4.706, p = 0.001), and LV GLS (B = -1.081, p < 0.001). Age (B = -0.319, p < 0.001), DSRe (B = 4.140, p = 0.002), DSRa (B = -3.409, p = 0.018), and LV GLS (B = -0.783, p < 0.001) showed associations with LASCD. With LASCT, only DSRa showed a correlation (R = 0.277, p < 0.001). CONCLUSIONS: We presented LA strain in a large-sized group of healthy subjects. Age is a significant determinant of LA function. Associations of LA strain with diastolic strain rates and LV GLS reflect cardiac mechanics.

15.
Ultrasound Med Biol ; 46(8): 1880-1888, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32439357

RESUMO

During left ventricular opacification (LVO), myocardial contrast uptake (MCU) is frequently observed, but its clinical implication is uncertain. We aimed to investigate the diagnostic performance of MCU and its prognostic value in known or suspected coronary artery disease (CAD). Contrast echocardiography was retrospectively analyzed in 457 patients who had previous coronary angiography <12 mo before LVO. MCU was classified into replacement or interstitial patterns. Subendocardial patterns were further inspected. Events were defined as a primary composite of the occurrence of acute coronary syndrome, heart failure hospitalization, sustained ventricular tachycardia and all-cause mortality. MCU had an 87.6% sensitivity, 75.5% specificity, 73.0% positive predictive value and 87.7% negative predictive value in detecting CAD. After a median follow-up of 17.3 mo, 52 events occurred. Replacement, interstitial and subendocardial MCU patterns were associated with events. In conclusion, the presence of MCU was useful in identifying CAD and provided incremental prognostic value for clinical outcomes.


Assuntos
Meios de Contraste/farmacocinética , Doença da Artéria Coronariana/diagnóstico , Ecocardiografia , Miocárdio/metabolismo , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/metabolismo , Ecocardiografia/métodos , Feminino , Coração/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade
17.
J Interv Card Electrophysiol ; 57(1): 87-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31889225

RESUMO

PURPOSE: The exact correlation between the baseline left atrial (LA) volume (LAV) and atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) outcomes and changes to the LA after AF RFCA has not yet been fully understood. We sought to evaluate the serial changes in the LAV and LA function after RFCA using 3D echocardiography. METHODS: Consecutive patients who received RFCA of paroxysmal (PAF) or persistent AF (PeAF) at our center between January 2013 and March 2016 were included. Real-time 3D apical full-volume images were acquired, and a 3D volumetric assessment was performed using an automated three-beat averaging method. The LAV index (LAVI) was calculated and the LA ejection fraction (LAEF) was calculated as [LAVmax - LAVmin]/LAVmax. RESULTS: Ninety-nine total patients were enrolled, and the mean age was 58.0 ± 8.2 years and 75 (74.7%) were male. There were 59 (59.6%) PAF patients and the remaining 40 (40.4%) had PeAF. AF recurred in 5 of 59 (8.5%) PAF and in 10 of 40 (25%) PeAF patients. The LAVImax increased on 1 day, decreased at 3 months, and then increased again at 1 year but was lower than that at baseline. The LAEF changes were similar to the volume changes but were more prominent in PeAF than PAF patients. The baseline 3D LAVImax was an independent predictor of AF recurrence after RFCA and the cut-off value was 44.13 ml/m2. CONCLUSION: In our study, even after 3 months of scar formation due to ablation, structural remodeling of the LA continued. The changes were more prominent in the non-recurrent, PeAF patients.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo , Ablação por Cateter/métodos , Ecocardiografia Tridimensional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Korean J Intern Med ; 35(2): 342-350, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31422649

RESUMO

BACKGROUND/AIMS: To date, prospective data are limited on efficacy and safety profiles of statin therapy in Korean hypercholesterolemic patients. Hence, the aim of this study was to evaluate the practice patterns of statin therapy and its efficacy and safety through the prospective Daegu and Gyeongbuk statin registry. METHODS: Statin naïve patients who were prescribed statins according to the criteria of Korean Guidelines for Management of Dyslipidemia were enrolled. Clinical and laboratory evaluations were performed at baseline and at week 8, where the efficacy was assessed with the same guidelines. RESULTS: Of 908 patients, atorvastatin and rosuvastatin were most frequently prescribed statins (63.1% and 29.3%, respectively). High intensity statins (atorvastatin 40 mg or rosuvastatin 20 mg) were prescribed in 24.7% of all patients and in 79.5% of high and very high risk groups. The total and low density lipoprotein (LDL) cholesterol levels decreased from 203.7 ± 43.0 to 140.6 ± 28.6 mg/dL and 134.4 ± 35.7 to 79.5 ± 21.3 mg/dL, respectively. The achievement rate of the LDL target goal was 98.6% in low risk, 95.0% in moderate risk, 88.1% in high risk, and 42.1% in very high risk patients (59.7% in overall). There was no significant difference in the efficacy between atorvastatin and rosuvastatin. Adverse events were observed in 12.0% of patients and led to 1.4% of treatment cessation. CONCLUSION: The efficacy of the usual starting dose of statins in daily practice was relatively insufficient for Korean hypercholesterolemic patients with high or very high risks. Short-term adverse events of statin therapy were not common in Korean patients with a low discontinuation rate.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia , LDL-Colesterol , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/tratamento farmacológico , Estudos Prospectivos , Sistema de Registros , República da Coreia , Resultado do Tratamento
20.
J Clin Ultrasound ; 48(3): 160-167, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31675137

RESUMO

PURPOSE: We explored the potential of tissue velocity imaging (TVI) for prognosis of nonischemic left ventricular (LV) dysfunction (LVD). METHODS: We reviewed 138 nonischemic LVD patients (58 ± 14 years) who underwent both cardiac magnetic resonance (CMR) and echocardiography. Septal and lateral mitral annular TVI data were compared with late gadolinium enhancement (LGE) on CMR. During a mean follow-up of 24 months, recovery (>15%) of LV ejection fraction and clinical outcomes (cardiovascular death and heart failure hospitalization) were assessed. RESULTS: LGE was commonly observed in the basal anteroseptal, inferoseptal, and inferior segments, but infrequently observed in the anterolateral segment. LGE was associated with lower early diastolic, septal (Sep-e' = 5.2 ± 2.0 vs 6.9 ± 2.0 cm/s, P = .031) and lateral (Lat-e' = 7.3 ± 3.0 vs 9.5 ± 2.0 cm/s, P < .001) TVI. The relationship between Lat-e' and anterolateral LGE (area under the curve, AUC 0.834) was much better than that between Sep-e' and inferoseptal LGE (AUC 0.699). The 60 patients with LVD reversibility revealed higher Lat-e' (9.8 ± 2.0 vs 6.7 ± 2.2 cm/s, P < .001) and lower LGE burden (7.3 ± 9.0 vs 22 ± 10%, P < .001), while Lat-e' ≤ 7.8 cm/s appeared unfavorable for 31 events patients. On multivariate analyses, Lat-e' (HR 0.79, 95% CI 0.63-0.99, P = .044) and LVD reversibility (HR 0.53, 95% CI 0.16-0.90, P = .018) were still meaningful together with LGE segments and burden. CONCLUSION: Lat-e' was related with LVD reversibility and a significant predictor of clinical outcomes.


Assuntos
Diástole , Ecocardiografia/métodos , Imageamento por Ressonância Magnética/métodos , Valva Mitral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Meios de Contraste , Feminino , Seguimentos , Gadolínio , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
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