Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 36
Filtrar
4.
5.
Wien Klin Wochenschr ; 133(15-16): 786-789, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34057577

RESUMO

The advent of transcatheter procedures for treatment of valvular heart disease has accelerated the pace of research in the diagnosis and treatment of heart valve disease. Rapid accumulation of novel knowledge in the field necessitates timely revisions of clinical guidelines. This paper comments on some important and novel issues addressed in the recently published American College of Cardiology/American Heart Association (ACC/AHA) guidelines.


Assuntos
Cardiologia , Doenças das Valvas Cardíacas , Substituição da Valva Aórtica Transcateter , American Heart Association , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/terapia , Humanos , Estados Unidos
6.
Wien Klin Wochenschr ; 133(15-16): 750-761, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33755758

RESUMO

This position statement is an update to the 2011 consensus statement of the Austrian Society of Cardiology (ÖKG) and the Austrian Society of Cardiac Surgery (ÖGTHG) for transfemoral transcatheter aortic valve implantation.Due to a number of recently published studies, broadening of indications and recommendations of medical societies and our own national developments, the ÖKG and the ÖGHTG wish to combine the 2017 ESC/EACTS guidelines for the management of valvular heart disease with a national position paper and to focus on certain details for the application in Austria. Thus, this position statement serves as a supplement and further interpretation of the international guidelines.


Assuntos
Estenose da Valva Aórtica , Cardiologia , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/cirurgia , Áustria , Humanos
8.
J Invasive Cardiol ; 31(12): E392-E393, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786532

RESUMO

Alport syndrome (AS) is a genetic disorder characterized by abnormal alpha chains of type IV collagen in multiple organs including the kidney, cochlea, cornea, lens, and retina. Aortic disease including dissection and aneurysm has been described with AS. We report the first case of multiple coronary aneurysms as a manifestation of AS.


Assuntos
Aneurisma Coronário , Angiografia Coronária/métodos , Rim/patologia , Nefrite Hereditária , Anti-Hipertensivos/uso terapêutico , Biópsia/métodos , Tratamento Conservador/métodos , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/etiologia , Aneurisma Coronário/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Nefrite Hereditária/diagnóstico , Nefrite Hereditária/fisiopatologia
9.
JACC Cardiovasc Interv ; 11(21): 2160-2167, 2018 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-30409272

RESUMO

OBJECTIVES: This study sought to investigate the outcome of high-risk and inoperable patients with severe symptomatic aortic stenosis undergoing transfemoral transcatheter aortic valve replacement (TAVR) in hospitals with (iOSCS) versus without institutional on-site cardiac surgery (no-iOSCS). BACKGROUND: Current guidelines recommend the use of TAVR only in institutions with a department for cardiac surgery on site. METHODS: In this analysis of the prospective multicenter Austrian TAVI registry, 1,822 consecutive high-risk patients with severe symptomatic aortic stenosis undergoing transfemoral TAVR were evaluated. A total of 290 (15.9%) underwent TAVR at no-iOSCS centers (no-iOSCS group), whereas the remaining 1,532 patients (84.1%) were treated in iOSCS centers (iOSCS group). RESULTS: Patients of the no-iOSCS group had a higher perioperative risk defined by the logistic EuroSCORE (20.9% vs. 14.2%; p < 0.001) compared with patients treated in hospitals with iOSCS. Procedural survival was 96.9% in no-iOSCS centers and 98.6% in iOSCS centers (p = 0.034), whereas 30-day survival was 93.1% versus 96.0% (p = 0.039) and 1-year survival was 80.9% versus 86.1% (p = 0.017), respectively. After propensity score matching for confounders procedural survival was 96.9% versus 98.6% (p = 0.162), 93.1% versus 93.8% (p = 0.719) at 30 days, and 80.9% versus 83.4% (p = 0.402) at 1 year. CONCLUSIONS: Patients undergoing transfemoral TAVR in hospitals without iOSCS had a significantly higher baseline risk profile. After propensity score matching short- and long-term mortality was similar between centers with and without iOSCS.


Assuntos
Estenose da Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos , Serviço Hospitalar de Cardiologia , Cateterismo Periférico , Artéria Femoral , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Áustria , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/mortalidade , Feminino , Humanos , Masculino , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
10.
Eur Heart J Acute Cardiovasc Care ; 7(8): 739-742, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28849947

RESUMO

Acute kidney injury (AKI), mostly defined as a rise in serum creatinine concentration of more than 0.5 mg/dl, is a common, serious, and potentially preventable complication of percutaneous coronary intervention and is associated with adverse outcomes including an increased risk of inhospital mortality. Recent data from the National Cardiovascular Data Registry/Cath-PCI registry including 985,737 consecutive patients undergoing percutaneous coronary intervention suggest that approximately 7% experienced AKI with a reported incidence of 3-19%. In patients undergoing primary percutaneous coronary intervention for acute myocardial infarction (AMI), AKI occurs more frequently with rates up to 20% depending on patient and procedural characteristics. However, varying definitions of AKI limit comparisons of AKI rates across different studies. Recently, most studies have adopted the Acute Kidney Injury Network (AKIN) criteria for definition and classification of AKI. Beyond the AKIN criteria for AKI, other classifications such as the risk, injury, failure, loss and end-stage kidney disease (RIFLE) and kidney disease: improving global outcomes (KDIGO) criteria are used to define AKI. Notably, even small increases in serum creatinine beyond AKI may be associated with adverse outcomes including increased hospital length of stay and excess. Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary intervention (PCI). Worsening renal function is associated with adverse outcomes including a higher rate of in-hospital mortality. In patients undergoing primary PCI for acute myocardial infarction (AMI), AKI occurs up to 20% of such individuals. Varying definitions of AKI limit comparisons of AKI rates across different studies. Additionally, even small increases in serum creatinine beyond lavels meeting AKI definitions may be associated with adverse outcomes including increased hospital length of stay.


Assuntos
Injúria Renal Aguda/sangue , Creatinina/sangue , Infarto do Miocárdio/complicações , Intervenção Coronária Percutânea , Sistema de Registros , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Saúde Global , Humanos , Incidência , Infarto do Miocárdio/sangue , Infarto do Miocárdio/cirurgia , Fatores de Risco , Taxa de Sobrevida/tendências
13.
Atherosclerosis ; 210(2): 503-9, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20060973

RESUMO

BACKGROUND: Although drug-eluting stents (DES) reduce restenosis rates relative to bare-metal stents (BMS), recent reports have indicated that the use of DES may be associated with an increased risk of stent thrombosis. Our study focused on the effect of stent type on clinical outcomes in a "real world" setting. METHODS: 889 patients undergoing percutaneous coronary intervention (PCI) with either DES (Cypher or Taxus; n=490) or BMS (n=399) were enrolled in a prospective single center registry. The outcome analysis covered a period of up to 3.2 years (mean 2.7 years+/-0.5 years) and was based on 65 deaths, 27 myocardial infarctions, 76 clinically driven target lesion revascularizations (TLR), and 15 angiographically confirmed cases of definite stent thrombosis and was adjusted for differences in baseline characteristics. RESULTS: In total 1277 stents (613 BMS and 664 DES) were implanted in 1215 lesions. Despite a significantly different unadjusted death rate (10.1% and 5.1% in BMS and DES patients, respectively; p<0.05), the patient groups did not differ significantly in the risk of myocardial infarction during 2.7 years of follow-up. After adjustment for differences in baseline characteristics between groups, the difference in the cumulative incidence of death did not remain statistically significant (p=0.22). Target lesion revascularizations occurred significantly less frequently in patients with DES compared to individuals after BMS implantation (5.9% and 11.8% in patients with DES and BMS, respectively; p<0.05). The rate of angiographically confirmed stent thrombosis was 2.1% in patients with DES and 1.1% in BMS patients (p=0.31). There was a significantly lower unadjusted event rate (including deaths, myocardial infarction, target lesion revascularization, and stent thrombosis) in patients with drug-eluting stents than in those with bare-metal stents (16.4% and 25.8%, respectively), with 9.4 fewer such events per 100 patients (unadjusted hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.46 to 0.87). After adjustment, the relative risk for all outcome events in patients with drug-eluting stents was 0.79 (95% CI, 0.67 to 0.95). However, the adjusted relative risk for death and myocardial infarction did not differ significantly between groups (adjusted relative risk in patients with drug-eluting stents 0.94 (95% CI, 0.77 to 1.37)). CONCLUSIONS: In this real-world population, the beneficial effect of first generation DES in reducing the need for new revascularization compared with BMS extends to more than 2.5 years without evidence of a worse safety profile. The minor risk of stent thrombosis and myocardial infarction within this period after implantation of DES seems unlikely to outweigh the benefit of these stents.


Assuntos
Stents Farmacológicos , Metais/química , Stents , Idoso , Angiografia/métodos , Stents Farmacológicos/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Modelos de Riscos Proporcionais , Risco , Stents/efeitos adversos , Trombose/etiologia , Resultado do Tratamento
14.
Can J Cardiol ; 23(11): 859-63, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17876375

RESUMO

BACKGROUND: Atrial fibrillation (AF) frequently occurs after cardiac surgery and is responsible for increased morbidity and resource use. The aim of the present study was to evaluate the association of impaired renal function and the development of postoperative AF. METHODS AND RESULTS: Patients undergoing elective cardiac surgery in the absence of significant left ventricular dysfunction (n=253; average age 65+/-11 years) were recruited to the present prospective study. Ninety-nine patients (39.1%) developed AF during the postoperative period. Creatinine clearance, estimated by the calculated glomerular filtration rate (GFR), was prospectively assessed to determine the association of baseline renal function and the development of postoperative AF. Baseline calculated GFR was assessed as a continuous and a categorical variable (normal: greater than 90 mL/min/1.73 m(2); mildly decreased: 60 mL/min/1.73 m(2) to 89 mL/min/1.73 m(2); and moderately to severely decreased: less than 60 mL/min/1.73 m(2)). Baseline creatinine clearance was 72+/-22.2 mL/min/1.73 m(2) and 78.8+/-23.5 mL/min/1.73 m(2) in patients with and without postoperative AF, respectively (P=0.02). There was an independent association between decreasing calculated GFR and the development of postoperative AF (OR for 10 mL decrease in calculated GFR: 1.21, 95% CI 1.02 to 1.39). In addition to calculated GFR, surgery for valvular heart disease (versus coronary artery bypass grafting [OR 2.23, 95% CI 1.09 to 3.14; P<0.01]), age (OR per 10-year increase in age 1.92, 1.18 to 2.59) and perioperative nonuse of beta-adrenergic blockers (OR 1.62, 95% CI 1.12 to 3.55; P<0.01) were identified as independent predictors of postoperative AF. CONCLUSIONS: In the setting of cardiac surgery, impaired calculated GFR is associated with an increased risk for the development of postoperative AF. These data provide additional evidence supporting the association between renal dysfunction and adverse cardiovascular outcomes.


Assuntos
Fibrilação Atrial/etiologia , Nefropatias/complicações , Rim/patologia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Idoso , Fibrilação Atrial/fisiopatologia , Creatinina/urina , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Cuidados Pré-Operatórios , Estudos Prospectivos , Fatores de Risco
15.
J Card Fail ; 13(5): 353-9, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17602981

RESUMO

BACKGROUND: In general, pulse pressure (PP), augmentation index (AIx), and pulse wave velocity (PWV) are directly and positively associated with cardiovascular risk. However, in patients with systolic heart failure, the opposite (ie, an association between a lower PP and a worse outcome) has been reported as well. METHODS AND RESULTS: We assessed central PP and AIx, using applanation tonometry (SphygmoCor, AtCor Medical) in 63 patients with cardiomyopathy (CMP) and 126 controls, matched for age, gender, and brachial blood pressure (BP). All patients underwent coronary angiography for suspected coronary artery disease. In a subgroup (21 patients, 42 controls), we additionally measured aortic PWV invasively during catheter pullback. Mean age was 63.9 versus 64.1 years and ejection fraction (EF) was 29.9 versus 72.2% in patients versus controls, respectively. Calculated aortic systolic BP as well as invasively measured systolic BP was lower in patients versus controls. Central (but not peripheral) PP (33.8 versus 37.8 mm Hg, P = .01) and AIx (17.5 versus 23.3, P = .002) were lower and ejection duration was shorter (265 versus 314 ms, P < .00001) in patients as compared with controls. When we subdivided the CMP patients with respect to AIx, those with values below and equal to the median (median AIx = 17) had more advanced systolic dysfunction. In multiple regression analysis, EF was an independent predictor of AIx. PVW did not differ between CMP patients and controls (8.6 versus 8.2 m/s in patients versus controls, P = .43). Within the group of CMP patients, however, we observed a strong, positive correlation (r = 0.62, P = .003) between PWV and EF. CONCLUSIONS: Central PP, AIx, but also aortic PWV, key measures of arterial function, are susceptible to left ventricular performance.


Assuntos
Cardiomiopatias/fisiopatologia , Idoso , Artérias/patologia , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Artéria Braquial , Angiografia Coronária , Angiopatias Diabéticas/fisiopatologia , Elasticidade , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Análise Multivariada , Isquemia Miocárdica/fisiopatologia , Fluxo Pulsátil/fisiologia , Medição de Risco , Resistência Vascular/fisiologia , Função Ventricular Esquerda
16.
Am J Hypertens ; 20(3): 256-62, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17324736

RESUMO

BACKGROUND: Pulse waveform analysis (PWA) for determination of augmentation index (AIx), a measure of arterial wave reflections, has been used to assess endothelial function, but only in combination with provocative pharmacologic testing. We hypothesized that AIx under basal conditions would be related to endothelial function as well. METHODS: We quantified arterial wave reflections as aortic AIx, using applanation tonometry of the radial artery, and PWA in 424 patients (mean age 64.6 years) undergoing coronary angiography. Plasma levels of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of endothelial nitric oxide (NO) synthase, were determined with a validated ELISA assay. In a group of the patients (n = 160), pulse wave velocity (PWV) was measured invasively during catheter pullback. Statistics were Spearman's correlation coefficient and multiple linear regression models. RESULTS: We observed a positive, statistically significant correlation between AIx and ADMA (R = 0.11, P = .03), that was closer in 134 patients up to 60 years of age (R = 0.28, P = .001). In the latter group, the correlation was independent of age, gender, smoking, lipids, heart rate, diastolic blood pressure (BP), the presence of hypertension or diabetes, and the extent of coronary artery disease. In contrast, we observed a significant (R = 0.19, P = .02) correlation between PWV and ADMA that disappeared after correction for age and BP. CONCLUSIONS: Our cross-sectional data indicate that ADMA levels are associated with increased arterial wave reflections, most likely due to decreased NO activity in small arteries and arterioles. This relationship is more pronounced in patients up to 60 years of age.


Assuntos
Aorta/fisiopatologia , Arginina/análogos & derivados , Doença da Artéria Coronariana/fisiopatologia , Endotélio Vascular/fisiopatologia , Artéria Radial/fisiopatologia , Fatores Etários , Idoso , Arginina/sangue , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Doença da Artéria Coronariana/sangue , Estudos Transversais , Elasticidade , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Modelos Lineares , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fluxo Pulsátil
17.
Int J Cardiol ; 119(3): 395-7, 2007 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-17079039

RESUMO

The syndrome of "apical ballooning" is characterized by an acute onset of transient akinesia of the apical portion of the left ventricle accompanied by electrocardiographic changes and minimal myocardial enzymatic release mimicking acute myocardial infarction without significant stenosis on the coronary angiogram. Emotional or physical stress might trigger this reversible form of cardiomyopathy. We describe a case of a 70-year old woman presenting with an atypical form of ventricular ballooning after a violent attack.


Assuntos
Estresse Psicológico/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Violência/psicologia , Idoso , Feminino , Humanos , Radiografia
18.
CJEM ; 8(1): 13-8, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17175624

RESUMO

BACKGROUND: Accurate prediction of survival to hospital discharge in patients who achieve return of spontaneous circulation after cardiopulmonary resuscitation (CPR) has significant ethical and socioeconomic implications. We investigated the prognostic performance of serum neuron-specific enolase (NSE), a biochemical marker of ischemic brain injury, after successful CPR. METHODS: In-hospital or out-of-hospital patients with nontraumatic normothermic cardiac arrest who achieved return of spontaneous circulation (ROSC) following at least 5 minutes of CPR were eligible. Neuron-specific enolase levels were assessed immediately, 6 hours, 12 hours and 2 days after ROSC. Subjects were followed to death or hospital discharge. RESULTS: Seventeen patients (7 men, 10 women) were enrolled during a 1-year period. Median (range) NSE levels in survivors and non-survivors respectively were as follows: immediately after ROSC: 14.0 microg/L (9.1-51.4 microg/L) versus 25.9 microg/L (10.2-57.5 microg/L); 6 hours after ROSC: 15.2 microg/L (9.7-30.8 microg/L) versus 25.6 microg/L (12.7-38.2 microg/L); 12 hours after ROSC: 14.0 microg/L (8.6-32.4 microg/L) versus 28.5 microg/L (11.0-50.7 microg/L); and 48 hours after ROSC: 13.1 microg/L (7.8-29.5 microg/L) versus 52.0 microg/L (29.1-254.0 microg/L). Non-survivors had significantly higher NSE levels 48 hours after ROSC than surivors (p = 0.04) and showed a trend toward higher values during the entire time course following ROSC. An NSE concentration of >30 microg/L 48 hours after ROSC predicted death with a high specificity (100%: 95% confidence interval [CI] 85%-100%), and a level of 29 microg/L or less at 48 hours predicted survival with a high specificity (100%: 95% CI 83%-100%). CONCLUSIONS: Serum NSE levels may have clinical utility for the prediction of survival to hospital discharge in patients after ROSC following CPR over 5 minutes in duration. This study is small, and our results are limited by wide confidence intervals. Further research on ability of NSE to facilitate prediction and clinical decision-making after cardiac arrest is warranted.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca/enzimologia , Parada Cardíaca/mortalidade , Alta do Paciente , Fosfopiruvato Hidratase/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Áustria , Biomarcadores/sangue , Feminino , Parada Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Sensibilidade e Especificidade , Fatores de Tempo
20.
Int J Cardiol ; 112(3): e85-6, 2006 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-16887218

RESUMO

We report a case of air embolism detected by transesophageal echocardiography in a patient undergoing open heart surgery for acute mitral regurgitation. Intraoperative transesophageal echocardiography revealed an increased brightness of the apical wall and a severely compromised left ventricular myocardium with severe diffuse hypokinesis after removal of the aortic cross clamps and spontaneous resolution in the control echocardiography.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Vasos Coronários , Embolia Aérea/etiologia , Isquemia Miocárdica/etiologia , Ecocardiografia Transesofagiana , Eletrocardiografia , Embolia Aérea/complicações , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/fisiopatologia , Enterocolite Necrosante/complicações , Evolução Fatal , Hemodinâmica , Humanos , Balão Intra-Aórtico , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...