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1.
Biol Sex Differ ; 12(1): 29, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766130

RESUMO

BACKGROUND: Previous studies have described sex-based differences in the epidemiological and clinical patterns of non-alcoholic fatty liver disease (NAFLD); however, we understand relatively little regarding the underlying molecular mechanisms. Herein, we present the first systematic review and meta-analysis of NAFLD transcriptomic studies to identify sex-based differences in the molecular mechanisms involved during the steatosis (NAFL) and steatohepatitis (NASH) stages of the disease. METHODS: Transcriptomic studies in the Gene Expression Omnibus database were systematically reviewed following the PRISMA statement guidelines. For each study, NAFL and NASH in premenopausal women and men were compared using a dual strategy: gene-set analysis and pathway activity analysis. Finally, the functional results of all studies were integrated into a meta-analysis. RESULTS: We reviewed a total of 114 abstracts and analyzed seven studies that included 323 eligible patients. The meta-analyses identified significantly altered molecular mechanisms between premenopausal women and men, including the overrepresentation of genes associated with DNA regulation, vinculin binding, interleukin-2 responses, negative regulation of neuronal death, and the transport of ions and cations in premenopausal women. In men, we discovered the overrepresentation of genes associated with the negative regulation of interleukin-6 and the establishment of planar polarity involved in neural tube closure. CONCLUSIONS: Our meta-analysis of transcriptomic data provides a powerful approach to identify sex-based differences in NAFLD. We detected differences in relevant biological functions and molecular terms between premenopausal women and men. Differences in immune responsiveness between men and premenopausal women with NAFLD suggest that women possess a more immune tolerant milieu, while men display an impaired liver regenerative response.

2.
Medicina (B Aires) ; 80(5): 541-553, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33048800

RESUMO

Cardiovascular diseases are the leading cause of death in most regions of the world, usually followed by infectious diseases. For decades, infections in general, and particularly those involving the respiratory system, have been known to be associated with an increased risk of cardiovascular and cerebrovascular events, and their consequent morbidity and mortality. Although vaccines are an excellent strategy in the prevention of infectious diseases, the proportion of immunized adults in our country is frankly deficient. Multiple barriers contribute to perpetuating this problem, within which the lack of prescription of the same by professionals who care for vulnerable populations occupies a central place. Patients with cardiovascular disease represent a particularly risky subpopulation. The spectrum of pathologies that can trigger respiratory infections is wide: development or worsening of heart failure, arrhythmias, acute coronary syndromes and cerebrovascular diseases, among the main ones. The role of immunoprophylaxis with influenza, pneumococcal and tetanus vaccine in patients with different heart diseases is addressed here, evaluating the evidence supporting its use, and placing special emphasis on practical aspects of its use, such as adverse effects, contraindications and special care situations, such as congenital heart disease in adults, heart transplantation, anticoagulation or egg allergy. Thus, this document aims to assist in decision-making for any doctor involved in the care of patients with cardiovascular disease.


Assuntos
Doenças Cardiovasculares/epidemiologia , Imunização , Adulto , Cardiologia , Doenças Cardiovasculares/prevenção & controle , Consenso , Hipersensibilidade a Ovo , Humanos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33057991

RESUMO

An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12 years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = - 0.271, p < 0.001) and heart rate reserve (r = -.239, p < 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p < 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion.

4.
Genes (Basel) ; 11(9)2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32967293

RESUMO

The abuse of alcohol, one of the most popular psychoactive substances, can cause several pathological and psychological consequences, including alcohol use disorder (AUD). An impaired ability to stop or control alcohol intake despite adverse health or social consequences characterize AUD. While AUDs predominantly occur in men, growing evidence suggests the existence of distinct cognitive and biological consequences of alcohol dependence in women. The molecular and physiological mechanisms participating in these differential effects remain unknown. Transcriptomic technology permits the detection of the biological mechanisms responsible for such sex-based differences, which supports the subsequent development of novel personalized therapeutics to treat AUD. We conducted a systematic review and meta-analysis of transcriptomics studies regarding alcohol dependence in humans with representation from both sexes. For each study, we processed and analyzed transcriptomic data to obtain a functional profile of pathways and biological functions and then integrated the resulting data by meta-analysis to characterize any sex-based transcriptomic differences associated with AUD. Global results of the transcriptomic analysis revealed the association of decreased tissue regeneration, embryo malformations, altered intracellular transport, and increased rate of RNA and protein replacement with female AUD patients. Meanwhile, our analysis indicated that increased inflammatory response and blood pressure and a reduction in DNA repair capabilities are associated with male AUD patients. In summary, our functional meta-analysis of transcriptomic studies provides evidence for differential biological mechanisms of AUD patients of differing sex.

5.
JACC Cardiovasc Imaging ; 13(10): 2085-2095, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32682714

RESUMO

OBJECTIVES: The purpose of this study was to assess the functional and prognostic correlates of B-lines during stress echocardiography (SE). BACKGROUND: B-profile detected by lung ultrasound (LUS) is a sign of pulmonary congestion during SE. METHODS: The authors prospectively performed transthoracic echocardiography (TTE) and LUS in 2,145 patients referred for exercise (n = 1,012), vasodilator (n = 1,054), or dobutamine (n = 79) SE in 11 certified centers. B-lines were evaluated in a 4-site simplified scan (each site scored from 0: A-lines to 10: white lung for coalescing B-lines). During stress the following were also analyzed: stress-induced new regional wall motion abnormalities in 2 contiguous segments; reduced left ventricular contractile reserve (peak/rest based on force, ≤2.0 for exercise and dobutamine, ≤1.1 for vasodilators); and abnormal coronary flow velocity reserve ≤2.0, assessed by pulsed-wave Doppler sampling in left anterior descending coronary artery and abnormal heart rate reserve (peak/rest heart rate) ≤1.80 for exercise and dobutamine (≤1.22 for vasodilators). All patients completed follow-up. RESULTS: According to B-lines at peak stress patients were divided into 4 different groups: group I, absence of stress B-lines (score: 0 to 1; n = 1,389; 64.7%); group II, mild B-lines (score: 2 to 4; n = 428; 20%); group III, moderate B-lines (score: 5 to 9; n = 209; 9.7%) and group IV, severe B-lines (score: ≥10; n = 119; 5.4%). During median follow-up of 15.2 months (interquartile range: 12 to 20 months) there were 38 deaths and 28 nonfatal myocardial infarctions in 64 patients. At multivariable analysis, severe stress B-lines (hazard ratio [HR]: 3.544; 95% confidence interval [CI]: 1.466 to 8.687; p = 0.006), abnormal heart rate reserve (HR: 2.276; 95% CI: 1.215 to 4.262; p = 0.010), abnormal coronary flow velocity reserve (HR: 2.178; 95% CI: 1.059 to 4.479; p = 0.034), and age (HR: 1.031; 95% CI: 1.002 to 1.062; p = 0.037) were independent predictors of death and nonfatal myocardial infarction. CONCLUSIONS: Severe stress B-lines predict death and nonfatal myocardial infarction. (Stress Echo 2020-The International Stress Echo Study [SE2020]; NCT03049995).

7.
J Am Coll Cardiol ; 74(18): 2278-2291, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31672185

RESUMO

BACKGROUND: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). OBJECTIVES: The purpose of this study was to assess the feasibility and functional correlates of CFVR. METHODS: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. RESULTS: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. CONCLUSIONS: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia sob Estresse , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Idoso , Velocidade do Fluxo Sanguíneo , Doença da Artéria Coronariana/mortalidade , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
8.
Rev. argent. cardiol ; 87(6): 462-469, nov. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1250906

RESUMO

RESUMEN Introducción: Está poco estudiado el comportamiento del strain longitudinal regional y global en relación al valor de la reserva coronaria. Objetivos: Comparar el comportamiento del strain longitudinal apical y global con el valor de la reserva coronaria de la arteria descendente anterior y secundariamente comparar estas respuestas con el análisis visual de la motilidad parietal durante el eco-estrés con dipiridamol. Material y métodos: Estudio retrospectivo de 179 pacientes (edad 68,7 ± 7,8), 90 hombres (50,3%). En el pico del efecto de dipiridamol, se midió la reserva coronaria, simultáneamente al strain longitudinal y el análisis visual de la contractilidad. Se organizó a los pacientes en dos grupos: grupo 1: reserva coronaria ≥ 2 y grupo 2: < 2. Strain apical se definió como el promedio de 4 segmentos apicales y global de los 17 segmentos. Se consideró normal a todo incremento del strain. Resultados: Se incluyeron 113 pacientes (63,12%) en el grupo 1 y 66 (36,87%) en el grupo 2. Strain apical: el 96,77% del grupo 1 incrementaron su valor con el apremio, mientras que, en el grupo 2, el 95,31% presentaron una caída (p < 0,0001). Strain global: el 82,8% del grupo 1 presentaron incremento de sus valores, en cambio, en el grupo 2, el 78,8% empeoraron (p < 0,01). Análisis de la motilidad parietal posdipiridamol: el 96,46% del grupo 1 tenían motilidad parietal conservada y el 54,5% del grupo 2 (solo en 4 pacientes aumentó el strain apical). Conclusiones: Se comprobó una estrecha correlación entre la reserva coronaria y el strain longitudinal. El strain longitudinal apical resultó ser superior del global. El strain apical demostró tener una mejor correlación con la reserva coronaria que con el análisis visual de la contractilidad.


ABSTRACT Background: The behavior of regional and global longitudinal strain in relation to the value of the coronary reserve is poorly studied. Objectives: Compare the behavior of the Apical and global longitudinal Strain with the value of the coronary reserve of the anterior descending artery and as a secondary aim compare these responses with the visual analysis of parietal motility during Echo Stress with Dipyridamole. Materials and methods: Retrospective study of 179 patients (age 68.7±7.8), 90 patients (50.3%) were men. At the peak of the dipyridamole effect, the coronary reserve was measured, simultaneously with the Longitudinal Strain and the visual analisis of contractility. Two groups were divided: Group 1: Coronary reserve ≥2 and Group 2: <2. Apical Strain was defined as the average of 4 apical segments and global as the average of the 17 segments. It was considered normal any increased of deformation. Results: 113 patients (63.12%) were included in Group 1 and 66 (36.87%) in Group 2. Strain Apical: 96.77% of Group 1 increased their strain values with the stress, while in group 2, 95.31% presented a worsening strain values (p<0.0001). Global Strain: 82.8% of Group 1 had an increase in their values, while in Group 2, 78.8% showed worsening (p<0.01). Post Dipyridamole parietal Motility Analysis: 96.46% of Group 1 had preserved parietal motility and only 54.5% of Group 2 (4 patients had increased apical Strain in this group). Conclusions: There was a close correlation between the coronary reserve of the anterior descending artery and the contractile reserve evaluated by regional apical longitudinal strain of the 4 apical segments, which was superior to the use of global strain. The Apical Strain showed a better correlation with ADA coronary reserve than with the visual analysis of contractility.

10.
Rev. argent. cardiol ; 86(6): 20-26, dic. 2018. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1003233

RESUMO

RESUMEN Introducción: La fracción de eyección es un parámetro débil para evaluar la función ventricular en la hipertrofia ventricular. Es de fundamental importancia analizar aspectos de la mecánica ventricular que podrían diferenciar una amiloidosis cardiaca de una miocardiopatía hipertrófica. Objetivo: Comparar el comportamiento del strain longitudinal y otros parámetros de la mecánica ventricular entre pacientes con miocardiopatía hipertrófica y amiloidosis cardíaca ambos con fracción de eyección conservada. Material y métodos: Estudio comparativo, prospectivo realizado en 15 pacientes con amiloidosis cardíaca (Grupo G 1) y 15 pacientes con miocardiopatía hipertrófica (G 2), ambos con fracción de eyección conservada (> 50%). Fueron analizados con ecocardiografía por seguimiento de marcas (speckle tracking), parámetros de strain y rotacionales del VI. El strain longitudinal se obtuvo a partir de planos apicales de 4, 3 y 2 cámaras. El strain circunferencial y la rotación ventricular a partir de planos transversales del VI. Se calculó el giro: suma de rotación apical y basal (°), torsión (giro / distancia base-ápex del VI (°/cm)) y los nuevos parámetros: producto de deformación (multiplicación entre el strain longitudinal global y el strain circunferencial apical); índice de deformación (°/%): (giro / strain longitudinal) y el cociente fracción de eyección / strain longitudinal global Resultados: Los pacientes con amiloidosis cardíaca presentaron valores significativamente menores de fracción de eyección (58,08% ± 6,16 vs. 67,15% ± 8,09; p = 0,012) y de strain longitudinal global (-12,61% ± 4,32 vs. -17,15% ± 3,95; p = 0,008) a expensas de los segmentos basales. No se constataron diferencias significativas con el giro, la torsión, el strain circunferencial y el radial. El producto entre strain longitudinal y el circunferencial apical resultó disminuido mientras que el cociente fracción de eyección / strain longitudinal global se encontró aumentado de manera significativa en los pacientes con amiloidosis. Conclusiones: El producto strain longitudinal x strain circunferencial apical y el cociente fracción de eyección / strain longitudinal global son parámetros útiles que permiten diferenciar pacientes con amiloidosis cardíaca de pacientes con miocardiopatía hipertrófica.


ABSTRACT Background: Ejection fraction is a poor parameter to assess left ventricular function in ventricular hypertrophy. It is highly important to analyze aspectis of ventricular mechanics that could differentiate cardiac amyloidosis from hypertrophic car-diomyopathy. Objective: The aim of this study was to compare longitudinal strain and other ventricular mechanical parameters between patientis with hypertrophic cardiomyopathy and cardiac amyloidosis, both with preserved ejection fraction. Methods: A comparative, prospective study was conducted in 15 patientis with cardiac amyloidosis Group (G) 1 and 15 pa-tientis with hypertrophic cardiomyopathy (G2), both presenting preserved ejection fraction (>50%). Patientis were analyzed with speckle tracking echocardiography and strain and left ventricular (LV) rotational parameters. Longitudinal strain was obtained from apical 4-, 3- and 2-chamber planes. Circumferential strain and ventricular rotation were obtained from LV transverse planes. Twist: algebraic sum of apical and basal rotation (°), torsion [twist/LV base-apex distance (º/cm)] and the new parameters: deformation product (global longitudinal strain × apical circumferential strain); deformation index: twist/ longitudinal strain (°/%) and ejection fraction/global longitudinal strain ratio were calculated. Resultis: Patientis with cardiac amyloidosis presented significantly lower ejection fraction (58.08%±6.16 vs. 67.15%±8.09; p=0.012) and global longitudinal strain values (-12.61%±4.32 vs. -17.15%±3.95; p=0.008) at the expense of basal segmentis. No significant differences were found for twist, torsion, and circumferential and radial strain. The product between longitudinal strain and apical circumferential strain decreased, while the ejection fraction/global longitudinal strain ratio was significantly increased in patientis with cardiac amyloidosis. Conclusions: The product of longitudinal strain × apical circumferential strain and the ejection fraction/global longitudinal strain ratio are useful parameters that allow differentiating cardiac amyloidosis from hypertrophic cardiomyopathy patientis.

11.
Cardiovasc Ultrasound ; 16(1): 20, 2018 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-30249305

RESUMO

BACKGROUND: The effectiveness trial "Stress echo (SE) 2020" evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. PURPOSE: To provide web-based upstream quality control and harmonization of B-lines reading criteria. METHODS: 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each test clip was scored for B-lines from 0 (black lung, A-lines, no B-lines) to 10 (white lung, coalescing B-lines). The diagnostic gold standard was the concordant assessment of two experienced readers of the Pisa lab. The answer of the reader was considered correct if concordant with reference standard reading ±1 (for instance, reference standard reading of 5 B-lines; correct answer 4, 5, or 6). The a priori determined pass threshold was 18/20 (≥ 90%) with R value (intra-class correlation coefficient) between reference standard and recruiting center) > 0.90. Inter-observer agreement was assessed with intra-class correlation coefficient statistics. RESULTS: All 60 readers were successfully accredited: 26 (43%) on first, 24 (40%) on second, and 10 (17%) on third attempt. The average diagnostic accuracy of the 60 accredited readers was 95%, with R value of 0.95 compared to reference standard reading. The 53 B-lines naive scored similarly to the 7 B-lines expert on first attempt (90 versus 95%, p = NS). Compared to the step-1 of quality control for regional wall motion abnormalities, the mean reading time per attempt was shorter (17 ± 3 vs 29 ± 12 min, p < .01), the first attempt success rate was higher (43 vs 28%, p < 0.01), and the drop-out of readers smaller (0 vs 28%, p < .01). CONCLUSIONS: Web-based learning is highly effective for teaching and harmonizing B-lines reading. Echocardiographers without previous experience with B-lines learn quickly.


Assuntos
Ecocardiografia sob Estresse/normas , Pulmão/diagnóstico por imagem , Edema Pulmonar/diagnóstico , Controle de Qualidade , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade
12.
Rev. argent. cardiol ; 86(4): 32-42, ago. 2018.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1003209

RESUMO

RESUMEN Introducción: Existe evidencia de que la reperfusión subóptima tiene impacto pronóstico a corto plazo en los pacientes con síndromes coronarios agudos con elevación del segmento ST, pero hay poca información sobre los factores vinculados a esta. Objetivos: Analizar los factores asociados a la reperfusión subóptima en pacientes con infarto agudo de miocardio con elevación del segmento S T, tratados con angioplastia primaria. Material y métodos: Se analizaron los pacientes con diagnóstico de infarto agudo de miocardio con elevación del segmento ST que recibieron tratamiento de revascularización con angioplastia primaria en el registro SCAR (Síndromes Coronarios Agudos en Argentina). Se analizó la asociación entre las variables clínicas clásicas, de laboratorio y el índice leucoglucémico con la reperfusión subóptima. Se definió reperfusión subóptima como TIMI III angiográfico pos-ATC con descenso del segmento ST en el ECG menor del 50%. Resultados: Se analizaron 258 pacientes con infarto agudo de miocardio con elevación del segmento ST, de los cuales 197 (76,4%) cumplieron los criterios de inclusión. De estos, el 8,6% (n = 17) tuvieron reperfusión subóptima. La incidencia de muerte intrahospitalaria entre los pacientes con reperfusión subóptima fue del 17,6% (n = 3) versus 1,7% (n = 3) en aquellos sin reperfusión subóptima (p = 0,007). En el análisis univariado, las variables asociadas a reperfusión subóptima fueron: diabetes (OR: 3,2 [IC95% 1,09-9,43] p = 0,026), revascularización previa (OR: 5,8 [1,74-19,07] p = 0,008), índice leucoglucé-mico (> 2159) (OR 3,7 [1,32-10,22] p = 0,009), y el tiempo dolor/balón (> 159 min) (OR: 6,9 [0,88-53] p = 0,045). El Killip-Kimbal al ingreso 3-4; la edad, mayor de 70 años; el sexo masculino, la hipertensión arterial, el tabaquismo, el infarto previo 0 anterior y el flujo TIMI 0-1 al ingreso no fueron significativos. Se estableció por curva ROC el mejor punto de corte para el índice leucoglucémico asociado a RSO en 2159 puntos (VPN = 94%), y el de tiempo dolor/balón en 159 min (VPN = 96%). En la regresión logística, solo la revascularización previa (OR: 5,3 [1,53-18,55]) y el índice leucoglucémico (OR: 3,2 [1,11-9,28]) estuvieron asociadas a reperfusión subóptima. Conclusiones: La reperfusión subóptima se asoció significativamente con mayor incidencia de muerte intrahospitalaria; mientras que la revascularización previa y el índice leucoglucémico (>2159) se asociaron con reperfusión subóptima.


ABSTRACT Background: Although there is evidence that suboptimal reperfusion has short-term prognostic impact in patients with ST-segment elevation acute coronary syndromes, there is little information about its associated factors. Objectives: The aim of this study was to analyze the factors associated with suboptimal reperfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). Methods: Patients from the SCAR (Acute Coronary Syndromes in Argentina) registry diagnosed with acute STEMI undergo-ing PCI were included in the study. The association of classical clinical and laboratory variables and the leuko-glycemic index with suboptimal reperfusion was analyzed. Suboptimal reperfusion was defined as post-PCI angiography TIMI III flow with less than 50% ST-segment decrease in the ECG. Results: Overall, 197 patients (76.4%) out of 258 patients with acute STEMI met the inclusion criteria. Among them, 8.6% (n: 17) had suboptimal reperfusion, with an incidence of in-hospital death of 17.6% (n: 3) versus 1.7% (n: 3) in patients without suboptimal reperfusion (p=0.007). In the univariate analysis, variables associated with suboptimal reperfusion were: diabetes [OR: 3.2 (1.09-9.43) p=0.026], previous revascularization [OR: 5.8 (1.74-19.07) p=0.008], leuko-glycemic index (> 2,159) [OR 3.7 (1.32-10.22) p=0.009], and pain-to-balloon time (>159 minutes) [OR: 6.9 (0.88- 53) p=0.045]. Age >70 years, male sex, high blood pressure, smoking, previous or anterior-wall infarction, and Killip and Kimball 3-4 and TIMI 0-1 flow on admission were not significantly different between patients with or without suboptimal reperfusion. Prior to the analysis, the cutoff point for the leuko-glycemic index associated with suboptimal reperfusion was established at 2,159 points by ROC curve analysis (NPV: 94%), and the pain-to-balloon time at 159 min (NPV: 96%). In logistic regression analysis, only previous revascular-ization [OR: 5.3 (1.53 -18.55)] and leuko-glycemic index [OR: 3.2 (1.11-9.28)] were associated with suboptimal reperfusion. Conclusions: Suboptimal reperfusion was significantly associated with a higher incidence of in-hospital death, while previous revascularization and the leuko-glycemic index (>2,159) were factors independently associated with suboptimal reperfusion.

13.
Int J Cardiol ; 249: 479-485, 2017 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-28986062

RESUMO

BACKGROUND: The trial "Stress Echo (SE) 2020" evaluates novel applications of SE beyond coronary artery disease. The aim of the study was control quality and harmonize reading criteria. METHODS: One reader from 78 centers of the SE 2020 network asked for credentials to read a set of 20 SE video-clips selected by the core lab. All aspiring centers met the pre-requisite of high-volume and the years of experience in SE ranged from 5 to 31years (mean value 18years). The diagnostic gold standard was a reading by the core lab. The a priori determined pass threshold was 18/20 (≥90%). RESULTS: Of the initial 78 who started, 57 completed the first attempt: individual readers' score on first attempt ranged from 07/20 to 20/20 (accuracy from 35% to 100%, mean 78.7±13%) and 44 readers passed it. There was a very poor correlation between years of experience and the reader's score on first attempt (r=-0.161, p=0.231). Of the 13 readers who failed the first attempt, 12 took it again after the web-based session and their accuracy improved (74% vs. 96%, p<0.001). The kappa inter-observer agreement before and after web-based training was 0.59 on first attempt and rose to 0.91 on the last attempt. CONCLUSIONS: In SE reading, the volume of activity or years of experience is not synonymous with diagnostic quality. Qualitative analysis and operator-dependence can become a limiting weakness in clinical practice, in the absence of strict pathways of learning, credentialing and audit.


Assuntos
Cardiologistas/normas , Competência Clínica/normas , Doença das Coronárias/diagnóstico por imagem , Ecocardiografia sob Estresse/normas , Controle de Qualidade , Doença das Coronárias/epidemiologia , Ecocardiografia sob Estresse/métodos , Humanos , Internacionalidade , Reprodutibilidade dos Testes
14.
Rev. argent. cardiol ; 84(4): 1-10, ago. 2016. ilus
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-957744

RESUMO

Introducción: El eco estrés evidencia la isquemia miocárdica como un trastorno regional y transitorio de la motilidad. El análisis visual es subjetivo y depende de la experiencia del operador, lo que ha motivado la búsqueda de un método semiautomático que permita minimizar esta limitación y así mejorar la confiabilidad y reproducibilidad de la prueba. Esto ha generado creciente interés en la introducción de la medición del strain longitudinal bidimensional antes del eco estrés y durante y después de él. Su determinación en las diferentes fases de apremio, en caso de que sea útil, permitiría reducir otras limitaciones, como la imposibilidad de alcanzar la frecuencia cardíaca submáxima, la dificultad de visualizar trastornos muy sutiles y el retraso en la adquisición de las imágenes, lo que incrementa los falsos negativos. Objetivos: Evaluar si el análisis del strain longitudinal realizado en reposo, cuando no hay evidencias de trastornos contráctiles visuales, es capaz de predecir el resultado del eco estrés y si el strain longitudinal basal es diferente en los pacientes con enfermedad coronaria significativa en comparación con los que no la presentan (en su evaluación previa al comienzo de la prueba). Material y métodos: Se compararon los resultados del strain longitudinal en reposo en 62 pacientes con eco estrés positivo incorporados en forma consecutiva en un período de 12 meses, a la mitad de los cuales se les realizó una cinecoronariografía (Grupo A) y a la otra mitad no se le efectuó este estudio (Grupo B) versus un grupo control (Grupo C) con prueba negativa y sin cinecoronariografía. Resultados: El strain longitudinal entre el Grupo A y el Grupo B no mostró diferencia estadística significativa (-21,8% ± 2,4% vs. -21,5% ± 2,5%), como tampoco el de los pacientes con prueba positiva (Grupo A + B) versus los controles (-21,67% ± 2,4% vs. 21,9% ± 2,8%). Conclusión: El strain longitudinal bidimensional no permitió predecir el resultado del eco estrés ni tampoco la presencia de enfermedad coronaria significativa en los pacientes que fueron sometidos a cinecoronariografía invasiva.

15.
Rev. argent. cardiol ; 82(6): 500-505, dic. 2014. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-750558

RESUMO

Introducción: Se conoce que la leucocitosis y la hiperglucemia se correlacionan a corto plazo con peor pronóstico en pacientes con síndrome coronario agudo, pero su novel relación, denominada índice leucoglucémico (ILG), se ha evaluado escasamente. Objetivos: Analizar el valor pronóstico del ILG en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) y su valor agregado a los puntajes de riesgo clásicos. Material y métodos: Se analizaron los pacientes con diagnóstico de IAMCEST del Registro Multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). El punto final analizado fue la muerte o Killip Kimball 3-4 (KK 3-4) en el período hospitalario. Se analizó el ILG tanto como variable continua como en cuartiles según los valores de los percentiles 25, 50 y 75. Resultados: Se analizaron 405 de 476 pacientes con diagnóstico final de IAMCEST. La presencia del punto final fue significativamente creciente por cuartiles de ILG: 0%, 7,60%, 9,30% y 30,60% (p < 0,0001). El área bajo la curva ROC del ILG para el punto final combinado fue de 0,77 [(IC 95% 0,71-0,88); p = 0,0001]; el mejor valor de corte pronóstico fue de 1.000. La presencia de muerte o KK 3-4 fue del 0% y del 13% en los IAMCEST con ILG menor o mayor de 1.000, respectivamente. En un modelo de regresión logística multivariado, el ILG se asoció independientemente con muerte o KK 3-4. El área bajo la curva ROC del puntaje TIMI para IAMCEST fue de 0,58. El agregado del ILG incrementó su capacidad discriminatoria a 0,66 (p = 0,001). Conclusiones: El ILG demostró que es un predictor independiente de mala evolución en el IAMCEST (muerte o KK 3-4), con valor aditivo al puntaje TIMI.


Background: Leukocytosis and hyperglycemia correlate with worse short-term prognosis in patients with acute coronary syndrome, but their new relationship, called leuko-glycemic index (LGI), has been scarcely evaluated. Objectives: The aim of this study was to analyze the prognostic value of LGI in patients with ST-segment-elevation acute myocardial infarction (STEMI) and its added value to classical risk scores. Methods: Patients diagnosed with STEMI from the SCAR (Acute Coronary Syndromes in Argentina) Multicenter Registry were analyzed. The final endpoint was death or in-hospital Killip-Kimball 3-4 (KK 3-4). The LGI was analyzed as a continu-ous variable and in quartiles according to 25, 50 and 75 percentile values. Results: The study evaluated 405 out of 476 patients with final STEMI diagnosis. Presence of the primary endpoint significantly increased per LGI quartile: 0%, 7.60%, 9.30% and 30.60% (p < 0.0001). The LGI area under the ROC curve for the composite endpoint was 0.77 [(95% CI 0.71-0.88); p = 0.0001]; the best prognostic cut-off value was 1000. Presence of death or KK 3-4 was 0% and 13% in STEMI patients with LGI below or above 1000, respectively In a multivariate logistic regression model, LGI was independently associated with death or KK 3-4. The area under the ROC curve of the TIMI risk score for STEMI was 0.58. The addition of LGI increased its discriminatory capacity to 0.66 (p = 0.001). Conclusions: The LGI was an independent predictor of adverse outcome in STEMI patients (death or KK 3-4), adding prognostic value to the TIMI risk score.

16.
Rev. argent. cardiol ; 81(5): 408-414, oct. 2013. graf, tab
Artigo em Espanhol | BINACIS | ID: bin-130248

RESUMO

Introducción La relación entre los marcadores inflamatorios y los síndromes coronarios agudos se ha estudiado previamente. PACS (Prognosis in Acute Coronary Syndromes) fue un estudio prospectivo multicéntrico que se desarrolló entre enero de 2000 y mayo de 2002 en 11 unidades coronarias de la Argentina e incluyó pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) con el objetivo de determinar el valor pronóstico de los diferentes biomarcadores, solos o en combinación en la estratificación de riesgo. Sin embargo, la relación de la elevación de leucocitos con los hallazgos angiográficos y los eventos a mediano plazo se ha estudiado escasamente. Objetivo Determinar si el nivel de leucocitos al ingreso se relaciona con lesiones coronarias complejas y pronóstico adverso a los 6 meses en pacientes internados con SCASEST. Material y métodos El subestudio PACS angiográfico comprendió un subgrupo de 1.253 pacientes de la cohorte del estudio PACS central (cuya población total fue de 1.500 pacientes) e incluyó centros con disponibilidad de cinecoronariografía (CCG). De los 1.253 pacientes del subestudio, se realizó una CCG (media de tiempo 48 horas del ingreso, percentiles 25-75, 24-72 horas) en 633 (50,5%). Para el presente subanálisis se obtuvieron datos completos de 580 pacientes (46,2%). En estos, además de lo establecido en el protocolo PACS de biomarcadores, se analizó el recuento de leucocitos en sangre dentro de las 24 horas de la admisión. La población se dividió en percentiles según el recuento leucocitario al ingreso. En el percentil inferior se incluyeron los pacientes con un recuento inicial de glóbulos blancos < 7.700/mm³, en el percentil intermedio los pacientes con un recuento de entre 7.700 y 11.500/mm³ y en el percentil superior aquellos con > 11.500/mm³. Resultados De los 580 pacientes, la mayoría eran hombres (72,9%), edad media de 66 años (± 12). Tenían antecedentes de hipertensión el 64,4%, de diabetes el 17,9%, historia de infarto previo el 22,2%, riesgo clínico alto (ACC/AHA) el 60% y el electrocardiograma de ingreso mostró alteración del segmento ST o T en el 61,1%. El recuento de leucocitos superior a 11.500/mm³ se asoció con una tasa mayor de trombo visible, presencia de placa complicada y mayor extensión de enfermedad coronaria (p = 0,019, 0,033 y 0,07, respectivamente). En el seguimiento a 6 meses, los pacientes del percentil superior tuvieron mayor tendencia a muerte o infarto que los pacientes del percentil inferior (14,2% vs. 7,5%; p = 0,026). Conclusión En los pacientes con SCASEST, un recuento elevado de leucocitos al ingreso se asocia con lesiones coronarias complejas y peor pronóstico a los 6 meses.(AU)


Background Previous studies have analyzed the relationship between inflammatory markers and acute coronary syndromes. Prognosis in Acute Coronary Syndromes (PACS) is a prospective, multicentric study conducted between January 2000 and May 2002 in 11 coronary care units of Argentina. It determined the prognostic value of different biomarkers, alone or in combination, to stratify risk in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS). However, there are few studies on the relationship of increased leuko-cyte levels with angiographic findings and mid-term events. Objective The aim of the study was to establish whether leukocyte count at admission is associated with complex coronary disease and adverse prognosis at 6-month follow-up in patients with NSTEACS. Methods The angiographic PACS substudy was conducted in 1253 patients from the PACS study core group (with a population of 1500 patients) and it included centers with coronary angiography (CA). Out of the 1253 substudy patients, CA was performed in 633 (50.5%) (mean of 48 hours after admission, percentiles 25-75, 24-72 hours). To perform the sub-analysis, complete data were obtained from 580 patients (46.2%). In this group, leukocyte count within 24 hours of admission was analyzed in addition to tests performed in the biomarkers PACS protocol. The population was divided in percentiles according to admission leukocyte count. Patients with initial leukocytes < 7700/ mm³ were included in the lower percentile, patients with leukocyte count between 7700 and 11500/mm³ in the middle percentile and those with leukocyte count > 11500/mm³ in the higher percentile. Results Most of the 580 patients were men (72.9%), and mean age was 66±12 years. Among these patients, 64.4% had history of hypertension, 17.9% of diabetes, 22.2% of previous infarction, 60% presented high clinical risk (ACC/AHA) and 61.1% had ECG at admission with ST-segment or T wave alterations. Leukocyte count > 11500/mm³ was associated with higher rate of visible thrombus, presence of complicated plaque and more extensive coronary disease (p = 0.019, 0.033 and 0.07, respectively). At the 6-month follow-up, patients in the higher percentile had greater tendency of death or infarction than patients in the lower percentile (14.2% vs. 7.5%; p = 0.026). Conclusion In patients with NSTEACS, a high leukocyte count at admission is associated with complex coronary disease and worse prognosis at 6 month-follow-up.(AU)

17.
Rev. argent. cardiol ; 81(5): 408-414, oct. 2013. graf, tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: lil-708652

RESUMO

Introducción La relación entre los marcadores inflamatorios y los síndromes coronarios agudos se ha estudiado previamente. PACS (Prognosis in Acute Coronary Syndromes) fue un estudio prospectivo multicéntrico que se desarrolló entre enero de 2000 y mayo de 2002 en 11 unidades coronarias de la Argentina e incluyó pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) con el objetivo de determinar el valor pronóstico de los diferentes biomarcadores, solos o en combinación en la estratificación de riesgo. Sin embargo, la relación de la elevación de leucocitos con los hallazgos angiográficos y los eventos a mediano plazo se ha estudiado escasamente. Objetivo Determinar si el nivel de leucocitos al ingreso se relaciona con lesiones coronarias complejas y pronóstico adverso a los 6 meses en pacientes internados con SCASEST. Material y métodos El subestudio PACS angiográfico comprendió un subgrupo de 1.253 pacientes de la cohorte del estudio PACS central (cuya población total fue de 1.500 pacientes) e incluyó centros con disponibilidad de cinecoronariografía (CCG). De los 1.253 pacientes del subestudio, se realizó una CCG (media de tiempo 48 horas del ingreso, percentiles 25-75, 24-72 horas) en 633 (50,5%). Para el presente subanálisis se obtuvieron datos completos de 580 pacientes (46,2%). En estos, además de lo establecido en el protocolo PACS de biomarcadores, se analizó el recuento de leucocitos en sangre dentro de las 24 horas de la admisión. La población se dividió en percentiles según el recuento leucocitario al ingreso. En el percentil inferior se incluyeron los pacientes con un recuento inicial de glóbulos blancos < 7.700/mm³, en el percentil intermedio los pacientes con un recuento de entre 7.700 y 11.500/mm³ y en el percentil superior aquellos con > 11.500/mm³. Resultados De los 580 pacientes, la mayoría eran hombres (72,9%), edad media de 66 años (± 12). Tenían antecedentes de hipertensión el 64,4%, de diabetes el 17,9%, historia de infarto previo el 22,2%, riesgo clínico alto (ACC/AHA) el 60% y el electrocardiograma de ingreso mostró alteración del segmento ST o T en el 61,1%. El recuento de leucocitos superior a 11.500/mm³ se asoció con una tasa mayor de trombo visible, presencia de placa complicada y mayor extensión de enfermedad coronaria (p = 0,019, 0,033 y 0,07, respectivamente). En el seguimiento a 6 meses, los pacientes del percentil superior tuvieron mayor tendencia a muerte o infarto que los pacientes del percentil inferior (14,2% vs. 7,5%; p = 0,026). Conclusión En los pacientes con SCASEST, un recuento elevado de leucocitos al ingreso se asocia con lesiones coronarias complejas y peor pronóstico a los 6 meses.


Background Previous studies have analyzed the relationship between inflammatory markers and acute coronary syndromes. Prognosis in Acute Coronary Syndromes (PACS) is a prospective, multicentric study conducted between January 2000 and May 2002 in 11 coronary care units of Argentina. It determined the prognostic value of different biomarkers, alone or in combination, to stratify risk in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS). However, there are few studies on the relationship of increased leuko-cyte levels with angiographic findings and mid-term events. Objective The aim of the study was to establish whether leukocyte count at admission is associated with complex coronary disease and adverse prognosis at 6-month follow-up in patients with NSTEACS. Methods The angiographic PACS substudy was conducted in 1253 patients from the PACS study core group (with a population of 1500 patients) and it included centers with coronary angiography (CA). Out of the 1253 substudy patients, CA was performed in 633 (50.5%) (mean of 48 hours after admission, percentiles 25-75, 24-72 hours). To perform the sub-analysis, complete data were obtained from 580 patients (46.2%). In this group, leukocyte count within 24 hours of admission was analyzed in addition to tests performed in the biomarkers PACS protocol. The population was divided in percentiles according to admission leukocyte count. Patients with initial leukocytes < 7700/ mm³ were included in the lower percentile, patients with leukocyte count between 7700 and 11500/mm³ in the middle percentile and those with leukocyte count > 11500/mm³ in the higher percentile. Results Most of the 580 patients were men (72.9%), and mean age was 66±12 years. Among these patients, 64.4% had history of hypertension, 17.9% of diabetes, 22.2% of previous infarction, 60% presented high clinical risk (ACC/AHA) and 61.1% had ECG at admission with ST-segment or T wave alterations. Leukocyte count > 11500/mm³ was associated with higher rate of visible thrombus, presence of complicated plaque and more extensive coronary disease (p = 0.019, 0.033 and 0.07, respectively). At the 6-month follow-up, patients in the higher percentile had greater tendency of death or infarction than patients in the lower percentile (14.2% vs. 7.5%; p = 0.026). Conclusion In patients with NSTEACS, a high leukocyte count at admission is associated with complex coronary disease and worse prognosis at 6 month-follow-up.

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