Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 82
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Rev Port Cardiol ; 35(10): 543.e1-5, 2016 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-27609554

RESUMO

A 64-year-old woman was admitted for non-ST elevation myocardial infarction. The coronary angiogram showed a severe stenosis in the left anterior descending artery (LAD) ostium. A 3.5 mm×18 mm everolimus-eluting stent was directly deployed in the left main and proximal LAD, with significant jailing of the circumflex (Cx) ostium. A 3.25 mm×11 mm everolimus-eluting stent was therefore deployed in the Cx using the T-stenting and small protrusion technique. One year later, the patient was readmitted for non-ST elevation myocardial infarction, and the coronary angiogram showed ostial restenosis of the Cx stent. Optical coherence tomography imaging confirmed the severity of ostial restenosis. Percutaneous coronary intervention by a radial approach was performed using a sheathless guide catheter.


Assuntos
Reestenose Coronária/cirurgia , Intervenção Coronária Percutânea/instrumentação , Idoso , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Vasos Coronários , Stents Farmacológicos , Feminino , Humanos , Retratamento/instrumentação , Resultado do Tratamento
2.
Eur Heart J Acute Cardiovasc Care ; 5(5): 399-406, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26136512

RESUMO

BACKGROUND: The additional diagnostic and prognostic information provided by delta high-sensitivity troponin T (hs-cTnT) in patients with acute chest pain and hs-cTnT elevation remains unclear. METHODS: The study group consisted of 601 patients presenting at the emergency department with non-ST-segment elevation acute chest pain and hs-cTnT elevation after two determinations (admission and within the first six hours). Maximum hs-cTnT and delta hs-cTnT (absolute or percentage change between the two measurements) were considered. Cutoff values were optimized using the quartile distribution for the endpoints. The endpoints were diagnostic (significant stenosis in the coronary angiogram) and prognostic (death or recurrent myocardial infarction at one year). RESULTS: Regarding the diagnostic endpoint, 114 patients showed a normal angiogram. Both maximum hs-cTnT ⩾80 ng/ml (OR 2.5, 95% CI 1.3-4.8, P=0.005) and delta hs-cTnT ⩾20 ng/l (OR 2.1, 95% CI 1.1-4.0, P=0.02) median value cutoffs were related to significant coronary stenosis. Furthermore, the combination of hs-cTn <80 ng/l and delta hs-cTn <20 ng/l showed the lowest probability of significant coronary stenosis (OR 0.3, 95% CI 0.1-0.4, P=0.001). During follow-up, 86 patients experienced the prognostic endpoint. After full adjustment for clinical data, maximum hs-cTnT ⩾30 ng/l, first quartile cutoff, was related to the outcome (HR 1.8, 95% CI 1.0-3.4, P=0.05), while delta hs-cTnT, either absolute or percentage change, lacked prognostic value. CONCLUSIONS: Maximum hs-cTnT captures all the prognostic information provided by hs-cTnT in non-ST-segment elevation acute chest pain. Low maximum and low delta hs-cTnT are associated with a normal coronary angiogram, which could make the final diagnosis challenging in some cases.


Assuntos
Dor no Peito/diagnóstico , Dor no Peito/metabolismo , Troponina T/metabolismo , Idoso , Dor no Peito/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
3.
Can J Cardiol ; 31(12): 1462-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26514748

RESUMO

BACKGROUND: Frailty predicts mortality after acute coronary syndrome (ACS). The standard frailty scales, such as the Fried score, consist of a variety of questionnaires and physical tests. Our aim was to investigate easily available clinical data and blood markers to predict frailty at discharge, in elderly patients after ACS. METHODS: A total of 342 patients older than 65 years, survivors after ACS, were included. A high number of clinical variables were collected. In addition, blood markers potentially linked to frailty and related to the processes of inflammation, coagulation, hormonal dysregulation, nutrition, renal dysfunction, and heart dysfunction were determined. Frailty was evaluated using the Fried score at discharge. The main outcome was frailty defined by a Fried score ≥ 3 points. Secondary endpoints were mortality and myocardial infarction at 30-month median follow-up. RESULTS: A total of 116 patients were frail. Seven clinical variables or biomarkers predicted frailty: age ≥ 75 years, female, prior ischemic heart disease, admission heart failure, haemoglobin ≤ 12.5 g/dL, vitamin D ≤ 9 ng/mL, and cystatin-C ≥ 1.2 mg/L. This model based on clinical data and biomarkers showed an excellent discrimination accuracy for frailty (C-statistic = 0.818). During the follow-up, 105 patients died and 137 died or suffered myocardial infarction. The clinical data and biomarker model (C-statistics = 0.730 and 0.691) performed better than the Fried score (C-statistics = 0.676 and 0.650) for death and death or myocardial infarction, respectively. CONCLUSIONS: Easy available clinical data and biomarkers can identify frail patients at discharge after ACS and predict outcomes better than the standard Fried's frailty scale.


Assuntos
Síndrome Coronariana Aguda/sangue , Biomarcadores/sangue , Idoso Fragilizado , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Cistatina C/sangue , Feminino , Seguimentos , Hemoglobinometria , Humanos , Masculino , Infarto do Miocárdio/sangue , Infarto do Miocárdio/mortalidade , Alta do Paciente , Avaliação de Resultados da Assistência ao Paciente , Prognóstico , Fatores de Risco , Vitamina D/sangue
5.
PLoS One ; 10(4): e0122360, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25875367

RESUMO

AIMS: Galectin-3 (Gal-3) and carbohydrate antigen 125 (CA125) have emerged as robust prognostic biomarkers in heart failure. Experimental data have also suggested a potential molecular interaction between CA125 and Gal-3; however, the biological and clinical relevance of this interaction is still uncertain. We sought to evaluate, in patients admitted for acute heart failure, the association between plasma Gal-3 with all-cause mortality and the risk for rehospitalizations among high and low levels of CA125. METHODS AND RESULTS: We included 264 consecutive patients admitted for acute heart failure to the Cardiology Department in a third-level center. Both biomarkers were measured on admission. Negative binomial and Cox regression models were used to evaluate the prognostic effect of the interaction between Gal-3 and CA125 (dichotomized by its median) with hospital readmission and all-cause mortality, respectively. During a median follow-up of 2 years (IQR = 1-2.8), 108 (40.9%) patients deaths and 365 rehospitalizations in 171 (69.5%) patients were registered. In a multivariable setting, the effect of Gal-3 on mortality and rehospitalization was differentially mediated by CA125 (p = 0.007 and p<0.001, respectively). Indeed, in patients with CA125 above median (>67 U/ml), values across the continuum of Gal-3 showed a positive and almost linear relationship with either the risk of death or rehospitalization. Conversely, when CA125 was below median (≤67 U/ml), Gal-3 lacked any prognostic effect on both endpoints. CONCLUSION: In patients with acute heart failure, Gal-3 was strongly associated with higher risk of long-term mortality and repeated rehospitalizations, but only in those patients exhibiting higher values of CA125 (above 67 U/ml).


Assuntos
Biomarcadores/sangue , Antígeno Ca-125/sangue , Galectina 3/sangue , Insuficiência Cardíaca/sangue , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco
6.
Med Princ Pract ; 24(2): 171-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25531292

RESUMO

OBJECTIVE: The aim of this study was to describe our initial experience with the GuideLiner® catheter (Vascular Solutions Inc.) in the transradial treatment of complex lesions. MATERIALS AND METHODS: The clinical, angiographic and procedural data of percutaneous coronary interventions where GuideLiner was used during 2013 were collected. The transradial approach was used in all cases. The indication for its use, efficacy and periprocedural complications were determined. Sixteen consecutive procedures (in 15 patients; 12 males and 3 females) were evaluated. The indication for the use of GuideLiner was a difficulty to advance and properly position a stent through a tortuous and/or calcified artery despite using high-support guide catheters or other useful techniques. RESULTS: Of the 16 angiographic procedures, 14 (87.5%) were successful (stent deployment in 13 cases and a drug-eluting balloon in 1 case). Unsuccessful cases were a chronic total occlusion and a diffusely diseased left anterior descendant artery. A type B dissection of a proximal left circumflex artery was the only periprocedural complication. CONCLUSION: Use of the GuideLiner was an effective and safe technique for the percutaneous treatment of complex coronary lesions in which the adequate progress of angioplasty devices had failed. GuideLiner was particularly helpful when using the transradial approach. Only one minor complication was recorded.


Assuntos
Angiografia Coronária/instrumentação , Angiografia Coronária/métodos , Intervenção Coronária Percutânea/métodos , Idoso , Idoso de 80 Anos ou mais , Angina Estável/cirurgia , Cateteres Cardíacos , Oclusão Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/instrumentação , Artéria Radial/cirurgia , Resultado do Tratamento
7.
Am Heart J ; 168(5): 784-91, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25440808

RESUMO

BACKGROUND: Geriatric conditions may predict outcomes beyond age and standard risk factors. Our aim was to investigate a wide spectrum of geriatric conditions in survivors after an acute coronary syndrome. METHODS: A total of 342 patients older than 65 years were included. At hospital discharge, 5 geriatric conditions were evaluated: frailty (Fried and Green scores), physical disability (Barthel index), instrumental disability (Lawton-Brody scale), cognitive impairment (Pfeiffer questionnaire), and comorbidity (Charlson and simple comorbidity indexes). The outcomes were postdischarge mortality and the composite of death/myocardial infarction during a 30-month median follow-up. RESULTS: Seventy-four (22%) patients died and 105 (31%) suffered from the composite end point. Through univariable analysis, all individual geriatric indexes were associated with outcomes, mainly mortality. Of all of them, frailty using the Green score had the strongest discriminative accuracy (area under the receiver operating characteristic curve 0.76 for mortality). After full adjustment including clinical and geriatric data, the Green score was the only independent predictive geriatric condition (per point; mortality: hazard ratio 1.25, 95% CI 1.15-1.36, P = .0001; composite end point: hazard ratio 1.16, 95% CI 1.09-1.24, P = .0001). A Green score ≥ 5 points was the strongest mortality predictor. The addition of the Green score to the clinical model improved discrimination (area under the receiver operating characteristic curve 0.823 vs 0.846) and significantly reclassified mortality risk (net reclassification improvement 26.3, 95% CI 1.4-43.5; integrated discrimination improvement 4.0, 95% CI 0.8-9.0). The incremental predictive information was even greater over the GRACE score. CONCLUSIONS: Frailty captures most of the prognostic information provided by geriatric conditions after acute coronary syndromes. The Green score performed better than the other geriatric indexes.


Assuntos
Atividades Cotidianas , Síndrome Coronariana Aguda/epidemiologia , Transtornos Cognitivos/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Medição de Risco , Síndrome Coronariana Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Estudos de Coortes , Comorbidade , Teste de Esforço , Feminino , Avaliação Geriátrica , Força da Mão , Humanos , Masculino , Análise Multivariada , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Curva ROC , Fatores de Risco
8.
Heart ; 100(20): 1591-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24947318

RESUMO

OBJECTIVES: High-sensitivity troponin (hs-cTn) is substituting conventional cTn for evaluation of chest pain. Our aim was to assess the impact on patient management and outcome. METHODS: A total of 1372 consecutive patients presenting at the emergency department with non-ST-elevation acute chest pain were divided into two periods according to the cTn assay used, conventional (n=699, March 2008 to July 2010) or hs-cTn (n=673, November 2010 to March 2013). Management policies were similar and according to guidelines. The primary endpoint was major adverse cardiac events (MACE) at 6 months (death, myocardial infarction, readmission by unstable angina or postdischarge revascularisation). RESULTS: There were minor differences in baseline characteristics. In the hs-cTn period, more patients elevated cTn (73% vs 37%, p=0.0001) leading to more coronary angiograms (77% vs 55%, p=0.0001) and revascularisations (45% vs 31%, p=0.0001); conversely, fewer patients were initially assigned to exercise testing (14% vs 36%, p=0.0001) and, therefore, discharged early after a negative result (7% vs 22%, p=0.0001). At 6 months, 135 patients suffered MACE, including 54 deaths. After adjusting for a Propensity Score, hs-cTn use was not significantly associated with MACE (HR=0.99; 95% CI 0.70 to 1.41; p=0.98) or mortality (HR=1.02; 95% CI 0.59 to 1.77; p=0.95), though the risk of longer hospitalisation stay increased at the index episode (OR=1.35, 95% CI 1.07 to 1.71, p=0.02). CONCLUSIONS: hs-cTn simplified chest pain triage on avoiding a more complex evaluation with non-invasive tests in the chest pain unit, but prompted longer hospitalisations and more invasive procedures without impacting on the 6-month outcomes.


Assuntos
Dor no Peito/sangue , Dor no Peito/terapia , Troponina/sangue , Doença Aguda , Idoso , Feminino , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade
9.
Int J Cardiol ; 175(1): 138-46, 2014 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-24856802

RESUMO

BACKGROUND: Ischemic postconditioning (PCON) appears as a potentially beneficial tool in ST-segment elevation myocardial infarction (STEMI). We evaluated the effect of PCON on microvascular obstruction (MVO) in STEMI patients and in an experimental swine model. METHODS: A prospective randomized study in patients and an experimental study in swine were carried out in two university hospitals in Spain. 101 consecutive STEMI patients were randomized to undergo primary angioplasty followed by PCON or primary angioplasty alone (non-PCON). Using late gadolinium enhancement cardiovascular magnetic resonance, infarct size and MVO were quantified (% of left ventricular mass). In swine, using an angioplasty balloon-induced anterior STEMI model, MVO was defined as the % of area at risk without thioflavin-S staining. RESULTS: In patients, PCON (n=49) in comparison with non-PCON (n=52) did not significantly reduce MVO (0 [0-1.02]% vs. 0 [0-2.1]% p=0.2) or IS (18 ± 13% vs. 21 ± 14%, p=0.2). MVO (>1 segment in the 17-segment model) occurred in 12/49 (25%) PCON and in 18/52 (35%) non-PCON patients, p=0.3. No significant differences were observed between PCON and non-PCON patients in left ventricular volumes, ejection fraction or the extent of hemorrhage. In the swine model, MVO occurred in 4/6 (67%) PCON and in 4/6 (67%) non-PCON pigs, p=0.9. The extent of MVO (10 ± 7% vs. 10 ± 8%, p=0.9) and infarct size (23 ± 14% vs. 24 ± 10%, p=0.8) was not reduced in PCON compared with non-PCON pigs. CONCLUSIONS: Ischemic postconditioning does not significantly reduce microvascular obstruction in ST-segment elevation myocardial infarction. Clinical Trial Registration http://www.clinicaltrials.gov. Unique identifier: NCT01898546.


Assuntos
Modelos Animais de Doenças , Pós-Condicionamento Isquêmico/tendências , Microcirculação/fisiologia , Infarto do Miocárdio/terapia , Reperfusão Miocárdica/tendências , Idoso , Animais , Feminino , Humanos , Pós-Condicionamento Isquêmico/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Reperfusão Miocárdica/métodos , Estudos Prospectivos , Suínos , Resultado do Tratamento
10.
Thromb Res ; 132(5): 592-8, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24007796

RESUMO

INTRODUCTION: Data on right ventricular (RV) involvement in anterior myocardial infarction are scarce. The presence of RV microvascular obstruction (MVO) in this context has not been analyzed yet. The aim of the present study was to characterize the presence of MVO in the RV in a controlled experimental swine model of reperfused anterior myocardial infarction. MATERIALS AND METHODS: Left anterior descending (LAD) artery-perfused area (thioflavin-S staining after selective infusion in LAD artery), infarct size (lack of triphenyltetrazolium-chloride staining) and MVO (lack of thioflavin-S staining in the core of the infarcted area) in the RV were studied. A quantitative (% of the ventricular volume) and semiquantitative (number of segments involved) analysis was carried out both in the RV and LV in a 90-min left anterior descending balloon occlusion and 3-day reperfusion model in swine (n=15). RESULTS: RV infarction and RV MVO (>1 segment) were detected in 9 (60%) and 6 (40%) cases respectively. Mean LAD-perfused area, infarct size and MVO in the RV were 33.8 ± 13%, 13.53 ± 11.7% and 3.4 ± 4.5%. Haematoxylin and eosin stains and electron microscopy of the RV-MVO areas demonstrated generalized cardiomyocyte necrosis and inflammatory infiltration along with patched hemorrhagic areas. Ex-vivo nuclear magnetic resonance (T2 sequences) microimaging of RV-MVO showed, in comparison with remote non-infarcted territories, marked hypointense zones (corresponding to necrosis, inflammation and hemorrhage) in the core of hyperintense regions (corresponding to edema). CONCLUSIONS: In reperfused anterior myocardial infarction, MVO is frequently present in the RV. It is associated with severe histologic repercussion on the RV wall. Nuclear magnetic resonance appears as a promising technique for the noninvasive detection of this phenomenon. Further studies are warranted to evaluate the pathophysiological and clinical implications.


Assuntos
Vasos Coronários/patologia , Ventrículos do Coração/patologia , Microvasos/patologia , Infarto do Miocárdio/patologia , Animais , Feminino , Imagem por Ressonância Magnética , Suínos
11.
Int J Cardiovasc Imaging ; 29(7): 1499-509, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23733237

RESUMO

Infarct size (IS) at 1 week after ST-elevation myocardial infarction (MI) diminishes during the first months. The incremental prognostic value of IS regression and of scar size (SS) at 6 months is unknown. We compared cardiovascular magnetic resonance (CMR)-derived IS at 1 week and SS at 6 months after MI for predicting late major adverse cardiac events (MACE). 250 patients underwent CMR at 1 week and 6 months after MI. IS and SS were determined as the extent of transmural late enhancement (in >50 % of wall thickness, ETLE). During 163 weeks, 23 late MACE (cardiac death, MI or readmission for heart failure after the 6 months CMR) occurred. Patients with MACE had a larger IS at 1 week (6 [4-9] vs. 3 [1-5], p < .0001) and a larger SS at 6 months (5 [2-6] vs. 3 [1-5], p = .005) than those without MACE. Late MACE rates in IS >median were higher at 1 week (14 vs. 4 %, p = .007) and in SS >median at 6 months (12 vs. 5 %, p = .053). The C-statistic for predicting late MACE of CMR at 1 week and 6 months was comparable (.720 vs. .746, p = .1). Only ETLE at 1 week (HR 1.31 95 % CI [1.14-1.52], p < .0001, per segment) independently predicted late MACE. CMR-derived SS at 6 months does not offer prognostic value beyond IS at 1 week after MI. The strongest predictor of late MACE is ETLE at 1 week.


Assuntos
Imagem Cinética por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Miocárdio/patologia , Idoso , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Readmissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fatores de Tempo
12.
Pacing Clin Electrophysiol ; 36(3): 286-98, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23240900

RESUMO

BACKGROUND: Selective local acceleration of myocardial activation during ventricular fibrillation (VF) contributes information on the interactions between neighboring zones during the arrhythmia. This study analyzes these interactions, centering the observations on an isthmus of myocardium between two radiofrequency (RF) lesions. METHODS: In nine isolated rabbit hearts, a gap of preserved myocardium was established between two RF lesions in the anterolateral left ventricle (LV) wall. Before, during, and after increasing the spatial heterogeneity of VF by local myocardial stretching, VF epicardial recordings were obtained. RESULTS: Local stretch in the anterior LV wall decreased the excitable window (17 ± 7 ms vs 26 ± 7 ms; P < 0.05) and increased the dominant frequency (DFr; 18.9 ± 5.0 Hz vs 15.2 ± 3.6 Hz; P < 0.05) in this zone, without changes in the non-stretched posterolateral zone (25 ± 4 ms vs 27 ± 6 ms, ns and 14.1 ± 2.7 Hz vs 14.3 ± 3.0 Hz, ns). The DFr ratio at both sides of the gap was inversely correlated to the excitable window ratio (R = -0.57; P = 0.002). Before (31% vs 26%), during (29% vs 22%), and after stretch suppression (35% vs 25%), the wavefronts passing through the gap from the posterolateral to the anterior LV wall were seen to predominate. The number of wavefronts that passed from the anterior to the posterolateral LV wall was related to the excitable window in this zone (R = 0.41; P = 0.03). CONCLUSIONS: The VF acceleration induced in the stretched zone does not increase the flow of wavefronts toward the non-stretched zone in the adjacent gap of preserved myocardium. The absence of significant changes in the electrophysiological parameters of the non-stretched myocardium limits the arrival of wavefronts in this zone.


Assuntos
Sistema de Condução Cardíaco/fisiopatologia , Fibrilação Ventricular/fisiopatologia , Animais , Fenômenos Fisiológicos Cardiovasculares , Ablação por Cateter , Técnicas In Vitro , Coelhos , Fibrilação Ventricular/cirurgia
13.
J Am Coll Cardiol ; 59(18): 1629-41, 2012 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-22538333

RESUMO

OBJECTIVES: The aim of this study was to investigate the metabolomic profile of acute myocardial ischemia (MIS) using nuclear magnetic resonance spectroscopy of peripheral blood serum of swine and patients undergoing angioplasty balloon-induced transient coronary occlusion. BACKGROUND: Biochemical detection of MIS is a major challenge. The validation of novel biosignatures is of utmost importance. METHODS: High-resolution nuclear magnetic resonance spectroscopy was used to profile 32 blood serum metabolites obtained (before and after controlled ischemia) from swine (n = 9) and patients (n = 20) undergoing transitory MIS in the setting of planned coronary angioplasty. Additionally, blood serum of control patients (n = 10) was sequentially profiled. Preliminary clinical validation of the developed metabolomic biosignature was undertaken in patients with spontaneous acute chest pain (n = 30). RESULTS: Striking differences were detected in the blood profiles of swine and patients immediately after MIS. MIS induced early increases (10 min) of circulating glucose, lactate, glutamine, glycine, glycerol, phenylalanine, tyrosine, and phosphoethanolamine; decreases in choline-containing compounds and triacylglycerols; and a change in the pattern of total, esterified, and nonesterified fatty acids. Creatine increased 2 h after ischemia. Using multivariate analyses, a biosignature was developed that accurately detected patients with MIS both in the setting of angioplasty-related MIS (area under the curve 0.94) and in patients with acute chest pain (negative predictive value 95%). CONCLUSIONS: This study reports, to the authors' knowledge, the first metabolic biosignature of acute MIS developed under highly controlled coronary flow restriction. Metabolic profiling of blood plasma appears to be a promising approach for the early detection of MIS in patients.


Assuntos
Biomarcadores/sangue , Metabolismo Energético , Espectroscopia de Ressonância Magnética/métodos , Isquemia Miocárdica/sangue , Miocárdio/metabolismo , Adulto , Idoso , Animais , Biomarcadores/análise , Oclusão Coronária/sangue , Oclusão Coronária/diagnóstico , Diagnóstico Diferencial , Modelos Animais de Doenças , Feminino , Humanos , Masculino , Metabolômica/métodos , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Reprodutibilidade dos Testes , Suínos
14.
Rev Esp Cardiol (Engl Ed) ; 65(2): 143-51, 2012 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-22177961

RESUMO

INTRODUCTION AND OBJECTIVES: An analysis was made of the effects of a radiofrequency-induced linear lesion during ventricular fibrillation and the capacity to capture myocardium through high-frequency pacing. METHODS: Using multiple epicardial electrodes, ventricular fibrillation was recorded in 22 isolated perfused rabbit hearts, analyzing the activation maps upon applying trains of stimuli at 3 different frequencies close to that of the arrhythmia: a) at baseline; b) after radio-frequency ablation to induce a lesion of the left ventricular free wall (length=10 [1] mm), and c) after lengthening the lesion (length=23 [2] mm). RESULTS: Following lesion induction, the regularity of the recorded signals decreased and significant variations in the direction of the activation fronts were observed. On lengthening the lesion, there was a slight increase in the episodes with at least 3 consecutive captures when pacing at cycles 10% longer than the arrhythmia (baseline: 0.6 [0.7]; initial lesion: 1 [1], no significant differences; lengthened lesion: 3 [2.8]; P<.001), while a decrease was observed in those obtained upon pacing at cycles 10% shorter than the arrhythmia. CONCLUSIONS: The radio-frequency -induced lesion increases the heterogeneity of myocardial activation during ventricular fibrillation and modifies arrival of the activation fronts in the adjacent zones. High-frequency pacing during ventricular fibrillation produces occasional captures during at least 3 consecutive stimuli. The lengthened lesion in turn slightly increases capture capacity when using cycles slightly longer than the arrhythmia.


Assuntos
Ablação por Cateter/efeitos adversos , Ondas de Rádio/efeitos adversos , Fibrilação Ventricular/etiologia , Animais , Estimulação Cardíaca Artificial , Eletrocardiografia , Eletrodos , Técnicas In Vitro , Miocárdio/patologia , Coelhos , Fibrilação Ventricular/patologia
15.
Int J Cardiol ; 159(1): 21-8, 2012 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-21367474

RESUMO

BACKGROUND: The prognostic utility of combining serial measurements of brain natriuretic peptide (BNP) and antigen carbohydrate 125 (CA125) is largely unknown. The aim of this work is to assess the prognostic utility of serial measurements of BNP, CA125, and their optimal combination for predicting long-term mortality, following a hospitalization for acute heart failure (AHF). METHODS AND RESULTS: We analyzed 293 consecutive patients admitted with AHF where CA125 and BNP were measured at discharge (T1) and at the first ambulatory visit (T2: median 31 days after discharge). Biomarkers were evaluated as snapshot determinations or as serial changes in absolute, relative or categorical changes and related to subsequent mortality with Cox regression analysis. The incremental prognostic value added by each biomarker was evaluated by the integrated discrimination improvement (IDI) index. During a median follow-up of 18 months, 91 deaths (31.1%) were identified. From the different metrics tested, the categorical changes in CA125 (Normalization: decreasing to≤35 U/ml at T2; Decreasing but not normalization: decreasing but T2>35 U/ml; small-increase: increasing but T2≤35 U/ml and; high-increase: increasing and T2>35 U/ml) showed the best discriminative accuracy. For BNP none of the serial changes metrics tested were superior to a single determination at T2 (BNP≥100 pg/ml). Adding these two biomarkers characterization to the clinical model, resulted in a 9.21% (p<0.001) gain in IDI index. CONCLUSIONS: In patients discharged for AHF, CA125 modeled as a pre-post categorical change, and BNP as a single determination at T2, resulted in the best marker combination for predicting all-cause mortality.


Assuntos
Antígeno Ca-125/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Coortes , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
16.
Am J Cardiol ; 107(7): 1034-9, 2011 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-21296316

RESUMO

Several works have endorsed a significant role of the immune system and inflammation in the pathogenesis of heart failure. As indirect evidence, an association between a low relative lymphocyte count (RLC%) and worse outcomes found in this population has been suggested. Nevertheless, the role of RLC% for risk stratification in a large and nonselected population of patients with acute heart failure (AHF) has not yet been determined. Thus, the aim of this study was to determine the association between low RLC% and 1-year mortality in patients with AHF and consequently to define whether it has any role for early risk stratification. A total of 1,192 consecutive patients admitted for AHF were analyzed. Total white blood cell and differential counts were measured on admission. RLC% (calculated as absolute lymphocyte count/total white blood cell count) was categorized in quintiles and its association with all-cause mortality at 1 year assessed using Cox regression. At 1 year, 286 deaths (24%) were identified. A negative trend was observed between 1-year mortality rates and quintiles of RLC%: 31.5%, 27.2%, 23.1%, 23%, and 15.5% in quintiles 1 to 5, respectively (p for trend <0.001). After thorough covariate adjustment, only patients in the lowest quintile (<9.7%) showed an increased risk for mortality (hazard ratio 1.76, 95% confidence interval 1.17 to 2.65, p = 0.006). When RLC% was modeled with restricted cubic splines, a stepped increase in risk was observed patients in quintile 1: those with RLC% values <7.5% and <5% showed 1.95- and 2.66-fold increased risk for death compared to those in the top quintile. In conclusion, in patients with AHF, RLC% is a simple, widely available, and inexpensive biomarker, with potential for identifying patients at increased risk for 1-year mortality.


Assuntos
Insuficiência Cardíaca/imunologia , Insuficiência Cardíaca/mortalidade , Contagem de Linfócitos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Espanha , Taxa de Sobrevida
17.
Inflammation ; 34(2): 73-84, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20419392

RESUMO

The evolution of white blood cells after ST elevation myocardial infarction (STEMI) and their association with infarct size and major adverse cardiac events (MACE) remains unclear. Two hundred eleven patients underwent CMR after STEMI. Infarct mass (grams) was determined. Neutrophil, lymphocyte, and monocyte counts (×1,000 cells/ml) were measured upon arrival and at 12, 24, 48, 72, and 96 h. Patients with large infarctions (3rd tertile ≥ 28.5 g vs. 1st and 2nd tertiles < 28.5 g) showed a larger neutrophil count at 12 h (14.8 ± 4.8 vs. 11.4 ± 3.3, p < 0.0001) and an increased monocyte count (maximum at 24 h (0.65[0.50-0.91] vs. 0.55[0.42-0.71], p = 0.004)) but no difference in lymphocyte count. Neutrophil count at 12 h independently predicted large infarctions (OR 1.14, 95%CI [1.04-1.26], p = 0.008). During follow-up (median 504 days), 25 MACE occurred. Neutrophil count at 96 h independently predicted MACE (HR 1.2, 95%CI [1.1-1.4], p = 0.003). Large infarctions show a marked neutrophil peak and an increasing monocyte count. Neutrophil count independently predicts large infarctions and MACE.


Assuntos
Infarto do Miocárdio/sangue , Infarto do Miocárdio/patologia , Neutrófilos/fisiologia , Adulto , Idoso , Angioplastia , Biomarcadores , Cateterismo Cardíaco , Eletrocardiografia , Feminino , Humanos , Contagem de Leucócitos , Contagem de Linfócitos , Linfócitos/fisiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Monócitos/fisiologia , Infarto do Miocárdio/fisiopatologia , Miocárdio/patologia , Stents , Resultado do Tratamento
18.
J Gene Med ; 12(11): 920-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20967894

RESUMO

BACKGROUND: Hydrodynamic injection has demonstrated to be very efficient in the liver of small animals, although this procedure must be translated to the clinical practice in a milder but no less efficient way. The present study evaluates the capacity of non-invasive interventional catheterization as a procedure for naked DNA delivery to the heart in large animals. METHODS: Two catheters were placed in the coronary sinus: one of them to block blood circulation and the other to retrogradely inject 50 ml of a saline solution of DNA (20 µg/ml) containing the enhanced green fluorescent protein (EGFP) gene, at a flow rate of 5 ml/s. RESULTS: The results obtained show that EGFP protein, identified by immunohistochemistry, was present and widely distributed throughout the atrial and ventricular cardiac tissue. This observation agrees with the efficiency of EGFP gene delivery resulting in 1-200 EGFP gene copies per endogenous haploid genome. However, the transcription efficiency of the exogenous EGFP gene was at a ratio of 0.2-10 copies with respect to the endogenous GAPDH gene, suggesting that optimized gene constructs for expression in cardiac tissue could increase the final efficacy of gene transfer. CONCLUSIONS: We conclude that the retrovenous injection of naked DNA in the coronary sinus employing the catheterization technique is an easy and probably safe method for whole cardiac gene transfer.


Assuntos
Cateterismo , Seio Coronário , DNA/administração & dosagem , Proteínas de Fluorescência Verde/metabolismo , Coração , Sus scrofa/genética , Animais , Cateteres , DNA/metabolismo , Feminino , Corantes Fluorescentes/metabolismo , Expressão Gênica , Técnicas de Transferência de Genes , Terapia Genética , Hidrodinâmica , Injeções , Sus scrofa/metabolismo
19.
Rev. esp. cardiol. (Ed. impr.) ; 63(10): 1145-1154, oct. 2010. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-82085

RESUMO

Introducción y objetivos. La utilidad de la resolución del segmento ST (RST) para la predicción de la reperfusión epicárdica está bien establecida. La asociación de los cambios del segmento ST con la obstrucción microvascular (OMV) observada en la resonancia magnética cardiovascular (RMC) tras una intervención coronaria percutánea primaria (ICPp) en el infarto de miocardio con elevación del ST (IMEST) no se ha aclarado todavía. Métodos. Estudiamos a 85 pacientes consecutivos ingresados por un primer IMEST y tratados con una ICPp que tenían una arteria relacionada con el infarto permeable. Se registró un ECG al ingreso, tras 90 min y tras 6, 24, 48 y 96 h de la ICPp. Se calculó la RST y la suma de la elevación del ST (sumEST) en todas las derivaciones. Resultados. La RMC reveló una OMV en 37 pacientes. En los infartos con OMV, el valor de la sumEST antes y después de la revascularización fue mayor que en los infartos sin OMV (p <= 0,001 en todos los casos). En cambio, no hubo diferencias significativas en la cantidad de RST entre los infartos con y sin OMV a los 90 min de la revascularización (p = 0,1), sino sólo a partir de las 6 h (p < 0,05 en todos los casos). El área bajo la curva de características operativas del receptor para la detección de la OMV fue mayor para la sumEST que para la RST (p < 0,05 en todas las determinaciones). En el análisis multivariable, ajustado respecto a las características clínicas, angiográficas y electrocardiográficas, una sumEST > 3 mm a los 90 min de la ICPp, pero no una RST >= 70%, predijo de manera independiente la OMV observada en la RMC (odds ratio = 3,1; intervalo de confianza del 95%, 1,2-8,4; p = 0,02). Conclusiones. La OMV se asoció a un valor significativamente superior de la sumEST en todos los momentos de valoración tras la revascularización. La diferencia en la cantidad de RST entre los infartos con OMV y sin OMV sólo fue significativa a partir de las 6 h tras la revascularización. La OMV se predijo mejor con una sumEST > 3 mm a los 90 min de la ICPp (AU)


Introduction and objectives. The usefulness of STsegment elevation resolution (STR) for predicting epicardial reperfusion is well established. However, it is still not clear how ST-segment changes are related to microvascular obstruction (MVO) observed by cardiovascular magnetic resonance (CMR) after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). Methods. The study involved 85 consecutive patients admitted for a first STEMI and treated by pPCI who had a patent infarct-related artery. An ECG was recorded on admission and 90 min and 6, 24, 48 and 96 h after pPCI. Thereafter, STR and the sum of ST-segment elevation (sumSTE) in all leads were determined. Results. Overall, CMR revealed MVO in 37 patients. In infarcts with MVO, sumSTE was greater both before and after revascularization than in infarcts without MVO (P<=.001 at all times). In contrast, there was no significant difference in the magnitude of STR between infarcts with and without MVO 90 min after revascularization (P=.1), though there was after 6 h (P<.05 at all times). The area under the receiver operating characteristic curve for detecting MVO was greater for sumSTE than STR (P<.05 for all measurements). On multivariate analysis, after adjusting for clinical, angiographic and ECG characteristics, a sumSTE >3 mm 90 min after pPCI was an independent predictor of MVO on CMR, while an STR >=70% was not (odds ratio=3.1; 95% confidence interval, 1.2-8.4; P=.02). Conclusions. MVO was associated with a significantly increased sumSTE at all times after revascularization. The difference in the magnitude of STR between infarcts with and without MVO was significant only >6 h after revascularization. The best predictor of MVO was a sumSTE >3 mm 90 min after pPCI. Key words: Cardiovascular magnetic resonance. Microvascular obstruction. ST-segment resolution. Sum of ST-segment elevation. ST-segment elevation myocardial infarction (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico , Imagem por Ressonância Magnética/instrumentação , Imagem por Ressonância Magnética/métodos , Angiografia/métodos , Intervalos de Confiança , Análise Multivariada , Eletrocardiografia/métodos , Eletrocardiografia/tendências , Estudos Prospectivos
20.
Rev Esp Cardiol ; 63(10): 1145-54, 2010 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-20875354

RESUMO

INTRODUCTION AND OBJECTIVES: The usefulness of ST-segment elevation resolution (STR) for predicting epicardial reperfusion is well established. However, it is still not clear how ST-segment changes are related to microvascular obstruction (MVO) observed by cardiovascular magnetic resonance (CMR) after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). METHODS: The study involved 85 consecutive patients admitted for a first STEMI and treated by pPCI who had a patent infarct-related artery. An ECG was recorded on admission and 90 min and 6, 24, 48 and 96 h after pPCI. Thereafter, STR and the sum of ST-segment elevation (sumSTE) in all leads were determined. RESULTS: Overall, CMR revealed MVO in 37 patients. In infarcts with MVO, sumSTE was greater both before and after revascularization than in infarcts without MVO (P≤.001 at all times). In contrast, there was no significant difference in the magnitude of STR between infarcts with and without MVO 90 min after revascularization (P=.1), though there was after 6 h (P< .05 at all times). The area under the receiver operating characteristic curve for detecting MVO was greater for sumSTE than STR (P< .05 for all measurements). On multivariate analysis, after adjusting for clinical, angiographic and ECG characteristics, a sumSTE >3 mm 90 min after pPCI was an independent predictor of MVO on CMR, while an STR ≥70% was not (odds ratio=3.1; 95% confidence interval, 1.2-8.4; P=.02). CONCLUSIONS: MVO was associated with a significantly increased sumSTE at all times after revascularization. The difference in the magnitude of STR between infarcts with and without MVO was significant only >6 h after revascularization. The best predictor of MVO was a sumSTE >3 mm 90 min after pPCI.


Assuntos
Angioplastia , Sistema Cardiovascular/patologia , Eletrocardiografia , Microcirculação/fisiologia , Infarto do Miocárdio/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Feminino , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA