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1.
Transplant Proc ; 51(6): 1684-1688, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31301859

RESUMO

BACKGROUND: Brazil's transplant network is a consolidated, worldwide-recognized program, with about 96% of heart transplantations (HTs) financed by its Unified Health System. It is known that the number of HTs has risen in the past few years, but it still does not meet the demand. This study aims to characterize the profile of the heart donors of a Brazilian center and ascertain the factors contributing to the increase in number of HTs. MATERIALS AND METHODS: This is a cross-sectional and analytical study, developed between 2012 and 2018 at a Brazilian transplant center. RESULTS: There were 210 donations for HT in this period. The median age of donors in years (range) was 33 (24-40), and the donors were 15.5 years younger than the recipients (P value < .001). One hundred forty-two donors (67.6%) were male, 98 (46.7%) were mullato, and 115 (54.8%) had cranioencephalic trauma as the cause of brain death. The distance from the transplant center to the organ procurement area was short in 183 (87.1%) cases, enabling a allograft ischemic time with a median of 125 minutes. There was a relevant association between donor age and cause of brain death (P < .001), sex and cause of brain death (P < .001), and organ procurement area and allograft ischemic time (P < .001). Hospitals that provide urgent and emergency care served as sources for a larger number of organ donations. CONCLUSIONS: This study concluded that the profile of most donors for HT include young adult mullato men who were victims of cranioencephalic trauma. In addition, these donors had few comorbidities and a median age of 33 years.


Assuntos
Seleção do Doador/estatística & dados numéricos , Transplante de Coração/estatística & dados numéricos , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
Arq Bras Cardiol ; 111(3): 436-539, 2018 Sep.
Artigo em Português | MEDLINE | ID: mdl-30379264
3.
Arq Bras Cardiol ; 111(2): 182-190, 2018 Aug.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30088556

RESUMO

BACKGROUND: Heart failure (HF) is a severe public health problem because of its high morbidity and mortality and elevated costs, thus requiring better understanding of its course. In its complex and multifactorial pathogenesis, sympathetic hyperactivity plays a relevant role. Considering that sympathetic dysfunction is already present in the initial phases of chronic Chagas cardiomyopathy (CCC) and frequently associated with a worse prognosis, we assumed it could be more severe in CCC than in cardiomyopathies of other etiologies (non-CCC). OBJECTIVES: To assess the cardiac sympathetic dysfunction 123I-MIBG) of HF, comparing individuals with CCC to those with non-CCC, using heart transplant (HT) patients as denervated heart parameters. METHODS: We assessed 76 patients with functional class II-VI HF, being 25 CCC (17 men), 25 non-CCC (14 men) and 26 HT (20 men), by use of cardiac 123I-metaiodobenzylguanidine 123I-MIBG) scintigraphy, estimating the early and late heart-to-mediastinum ratio (HMR) of 123I-MIBG uptake and cardiac washout (WO%). The 5% significance level was adopted in the statistical analysis. RESULTS: The early and late HMR values were 1.73 ± 0.24 and 1.58 ± 0.27, respectively, in CCC, and 1.62 ± 0.21 and 1.44 ± 0.16 in non-CCC (p = NS), being, however, higher in HT patients (p < 0.001). The WO% values were 41.65 ± 21.4 (CCC), 47.37 ± 14.19% (non-CCC) and 43.29 ± 23.02 (HT), p = 0.057. The late HMR values showed a positive weak correlation with left ventricular ejection fraction (LVEF) in CCC and non-CCC (r = 0.42 and p = 0.045; and r = 0.49 and p = 0.015, respectively). CONCLUSION: Sympathetic hyperactivity 123I-MIBG) was evidenced in patients with class II-IV HF, LVEF < 45%, independently of the HF etiology, as compared to HT patients.


Assuntos
3-Iodobenzilguanidina/administração & dosagem , Cardiomiopatia Chagásica/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Transplante de Coração , Disautonomias Primárias/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Adulto , Cardiomiopatia Chagásica/fisiopatologia , Estudos Transversais , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Disautonomias Primárias/etiologia , Disautonomias Primárias/fisiopatologia , Cintilografia
4.
Arq. bras. cardiol ; 111(2): 182-190, Aug. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-950212

RESUMO

Abstract Background: Heart failure (HF) is a severe public health problem because of its high morbidity and mortality and elevated costs, thus requiring better understanding of its course. In its complex and multifactorial pathogenesis, sympathetic hyperactivity plays a relevant role. Considering that sympathetic dysfunction is already present in the initial phases of chronic Chagas cardiomyopathy (CCC) and frequently associated with a worse prognosis, we assumed it could be more severe in CCC than in cardiomyopathies of other etiologies (non-CCC). Objectives: To assess the cardiac sympathetic dysfunction 123I-MIBG) of HF, comparing individuals with CCC to those with non-CCC, using heart transplant (HT) patients as denervated heart parameters. Methods: We assessed 76 patients with functional class II-VI HF, being 25 CCC (17 men), 25 non-CCC (14 men) and 26 HT (20 men), by use of cardiac 123I-metaiodobenzylguanidine 123I-MIBG) scintigraphy, estimating the early and late heart-to-mediastinum ratio (HMR) of 123I-MIBG uptake and cardiac washout (WO%). The 5% significance level was adopted in the statistical analysis. Results: The early and late HMR values were 1.73 ± 0.24 and 1.58 ± 0.27, respectively, in CCC, and 1.62 ± 0.21 and 1.44 ± 0.16 in non-CCC (p = NS), being, however, higher in HT patients (p < 0.001). The WO% values were 41.65 ± 21.4 (CCC), 47.37 ± 14.19% (non-CCC) and 43.29 ± 23.02 (HT), p = 0.057. The late HMR values showed a positive weak correlation with left ventricular ejection fraction (LVEF) in CCC and non-CCC (r = 0.42 and p = 0.045; and r = 0.49 and p = 0.015, respectively). Conclusion: Sympathetic hyperactivity 123I-MIBG) was evidenced in patients with class II-IV HF, LVEF < 45%, independently of the HF etiology, as compared to HT patients.


Resumo Fundamentos: A insuficiência cardíaca (IC) representa um grave problema de saúde pública pela alta morbimortalidade e custos envolvidos, exigindo uma melhor compreensão de sua evolução. Em sua patogênese, complexa e multifatorial, a hiperatividade simpática ocupa relevante papel. Considerando que a disfunção simpática está presente já nas fases iniciais da cardiopatia chagásica crônica (CCC), frequentemente associando-se a um pior prognóstico, supomos que pudesse ser mais grave na CCC que nas demais etiologias (não-CCC). Objetivos: Avaliar a disfunção simpática cardíaca (123I-MIBG) da IC, comparando-se os portadores de CCC aos não-CCC, utilizando os pacientes transplantados cardíacos (TC) como parâmetro de coração desnervado. Métodos: Estudamos 76 pacientes com IC classe funcional II-VI, sendo 25 CCC (17 homens), 25 não-CCC (14 homens) e 26 TC (20 homens), pela cintilografia cardíaca (123I-MIBG), estimando-se a captação (HMR) precoce e tardia e o washout cardíaco (Wc%). Nas análises estatísticas, o nível de significância foi de 5%. Resultados: Os valores da HMR precoce e da tardia foram 1,73 ± 0,24 e 1,58 ± 0,27, respectivamente, na CCC, e 1,62 ± 0,21 e 1,44 ± 0,16 na não-CCC (p = NS), sendo, porém, mais elevados nos TC (p < 0,001). Os valores de Wc% foram 41,65 ± 21,4 (CCC), 47,37 ± 14,19% (não-CCC) e 43,29 ± 23,02 (TC), p = 0,057. Os valores de HMR tardia apresentaram correlação positiva fraca com a fração de ejeção de ventrículo esquerdo (FEVE) na CCC e na não-CCC (r = 0,42 e p = 0,045; e r = 0,49 e p = 0,015, respectivamente). Conclusão: Evidenciou-se a presença de hiperatividade simpática (123I-MIBG) em pacientes com IC classe II-IV, FEVE < 45%, independentemente da etiologia da IC, quando comparados aos pacientes TC.

5.
Braz J Cardiovasc Surg ; 31(2): 89-97, 2016 04.
Artigo em Inglês | MEDLINE | ID: mdl-27556306

RESUMO

INTRODUCTION: Primary graft dysfunction is a major cause of mortality after heart transplantation. OBJECTIVE: To evaluate correlations between donor-related clinical/biochemical markers and the occurrence of primary graft dysfunction/clinical outcomes of recipients within 30 days of transplant. METHODS: The prospective study involved 43 donor/recipient pairs. Data collected from donors included demographic and echocardiographic information, noradrenaline administration rates and concentrations of soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data collected from recipients included operating, cardiopulmonary bypass, intensive care unit and hospitalization times, inotrope administration and left/right ventricular function through echocardiography. RESULTS: Recipients who developed moderate/severe left ventricular dysfunction had received organs from significantly older donors (P =0.020). Recipients from donors who required moderate/high doses of noradrenaline (>0.23 µg/kg/min) around harvesting time exhibited lower post-transplant ventricular ejection fractions (P =0.002) and required longer CPB times (P =0.039). Significantly higher concentrations of sTNFR1 (P =0.014) and sTNFR2 (P =0.030) in donors were associated with reduced intensive care unit times (≤5 days) in recipients, while higher donor IL-6 (P =0.029) and IL-10 (P =0.037) levels were correlated with reduced hospitalization times (≤25 days) in recipients. Recipients who required moderate/high levels of noradrenaline for weaning off cardiopulmonary bypass were associated with lower donor concentrations of sTNFR2 (P =0.028) and IL-6 (P =0.001). CONCLUSION: High levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with enhanced evolution in recipients. Allografts from older donors, or from those treated with noradrenaline doses >0.23 µg/kg/min, were more frequently affected by primary graft dysfunction within 30 days of surgery.


Assuntos
Transplante de Coração/normas , Norepinefrina/administração & dosagem , Disfunção Primária do Enxerto/sangue , Doadores de Tecidos , Adolescente , Adulto , Fatores Etários , Aloenxertos/fisiopatologia , Biomarcadores/sangue , Seleção do Doador/normas , Feminino , Transplante de Coração/mortalidade , Humanos , Interleucinas/análise , Masculino , Pessoa de Meia-Idade , Norepinefrina/efeitos adversos , Período Pós-Operatório , Disfunção Primária do Enxerto/etiologia , Estudos Prospectivos , Receptores do Fator de Necrose Tumoral/análise , Adulto Jovem
6.
Rev. bras. cir. cardiovasc ; 31(2): 89-97, Mar.-Apr. 2016. tab, graf
Artigo em Inglês | LILACS-Express | ID: lil-792643

RESUMO

Abstract Introduction: Primary graft dysfunction is a major cause of mortality after heart transplantation. Objective: To evaluate correlations between donor-related clinical/biochemical markers and the occurrence of primary graft dysfunction/clinical outcomes of recipients within 30 days of transplant. Methods: The prospective study involved 43 donor/recipient pairs. Data collected from donors included demographic and echocardiographic information, noradrenaline administration rates and concentrations of soluble tumor necrosis factor receptors (sTNFR1 and sTNFR2), interleukins (IL-6 and IL-10), monocyte chemoattractant protein-1, C-reactive protein and cardiac troponin I. Data collected from recipients included operating, cardiopulmonary bypass, intensive care unit and hospitalization times, inotrope administration and left/right ventricular function through echocardiography. Results: Recipients who developed moderate/severe left ventricular dysfunction had received organs from significantly older donors (P =0.020). Recipients from donors who required moderate/high doses of noradrenaline (>0.23 µg/kg/min) around harvesting time exhibited lower post-transplant ventricular ejection fractions (P =0.002) and required longer CPB times (P =0.039). Significantly higher concentrations of sTNFR1 (P =0.014) and sTNFR2 (P =0.030) in donors were associated with reduced intensive care unit times (≤5 days) in recipients, while higher donor IL-6 (P =0.029) and IL-10 (P =0.037) levels were correlated with reduced hospitalization times (≤25 days) in recipients. Recipients who required moderate/high levels of noradrenaline for weaning off cardiopulmonary bypass were associated with lower donor concentrations of sTNFR2 (P =0.028) and IL-6 (P =0.001). Conclusion: High levels of sTNFR1, sTNFR2, IL-6 and IL-10 in donors were associated with enhanced evolution in recipients. Allografts from older donors, or from those treated with noradrenaline doses >0.23 µg/kg/min, were more frequently affected by primary graft dysfunction within 30 days of surgery.

7.
Autops Case Rep ; 5(4): 53-63, 2015 Oct-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26894046

RESUMO

We present the case of a patient who underwent cardiac transplantation with the diagnosis of idiopathic dilated cardiomyopathy. Once the explanted heart was examined, a type of granulomatous myocarditis compatible with cardiac sarcoidosis was observed. However, there was severe involvement of the right ventricle, with markedly reduced width of the muscular layer and extensive fibrofatty replacement, findings similar to the ones encountered in cases of arrhythmogenic right ventricular cardiomyopathy (ARVC). Confocal immunofluorescence analysis revealed a reduced signal for plakoglobin and desmoplakin at the cardiac intercalated disks. The immunoreactive signal for desmin showed the typical sarcomeric distribution but not a concentrated signal at the intercalated disks, a pattern previously seen in an 11-year-old girl with Carvajal syndrome bearing a C-terminal truncating mutation in the desmoplakin gene. This case illustrates the difficult and challenging work involved in performing a differential diagnosis among idiopathic dilated cardiomyopathy, isolated cardiac sarcoidosis, and ARVC, all of which are clinical entities known to masquerade as one another.

8.
Arq. bras. cardiol ; 103(2): 138-145, 08/2014. tab
Artigo em Inglês | LILACS | ID: lil-720819

RESUMO

Background: The autonomic nervous system plays a central role in cardiovascular regulation; sympathetic activation occurs during myocardial ischemia. Objective: To assess the spectral analysis of heart rate variability during stent implantation, comparing the types of stent. Methods: This study assessed 61 patients (mean age, 64.0 years; 35 men) with ischemic heart disease and indication for stenting. Stent implantation was performed under Holter monitoring to record the spectral analysis of heart rate variability (Fourier transform), measuring the low-frequency (LF) and high-frequency (HF) components, and the LF/HF ratio before and during the procedure. Results: Bare-metal stent was implanted in 34 patients, while the others received drug-eluting stents. The right coronary artery was approached in 21 patients, the left anterior descending, in 28, and the circumflex, in 9. As compared with the pre-stenting period, all patients showed an increase in LF and HF during stent implantation (658 versus 185 ms2, p = 0.00; 322 versus 121, p = 0.00, respectively), with no change in LF/HF. During stent implantation, LF was 864 ms2 in patients with bare-metal stents, and 398 ms2 in those with drug-eluting stents (p = 0.00). The spectral analysis of heart rate variability showed no association with diabetes mellitus, family history, clinical presentation, beta-blockers, age, and vessel or its segment. Conclusions: Stent implantation resulted in concomitant sympathetic and vagal activations. Diabetes mellitus, use of beta-blockers, and the vessel approached showed no influence on the spectral analysis of heart rate variability. Sympathetic activation was lower during the implantation of drug-eluting stents. .


Fundamento: O sistema nervoso autônomo tem papel central na regulação cardiovascular, ocorrendo uma ativação simpática durante a isquemia miocárdica. Objetivo: Avaliar a análise espectral da frequência cardíaca (AE) durante o implante de stent, comparando os tipos de stent. Métodos: Foram estudados 61 pacientes (idade média de 64 anos), 35 homens, com cardiopatia isquêmica e indicação de implante de stent. O implante foi feito sob monitoramento pelo Holter para o registro da AE (transformação de Fourier), com medidas dos componentes LF (baixa frequência), HF (alta frequência) e relação LF/HF, antes e durante o procedimento. Resultados: Implante de stent convencional feito em 34 pacientes; nos demais, farmacológico. A coronária abordada foi a direita em 21 pacientes, a descendente anterior em 28, a circunflexa em nove. Houve aumento do LF e do HF durante o implante em todos os pacientes, comparando-se com o período antes do implante (658 versus 185 ms2, p = 0,00, para LF; 322 versus 121 ms2, p = 0,00, para HF, respectivamente), sem alteração da LF/HF. LF durante o implante foi de 864 ms2 nos pacientes com stent convencional e de 398 com farmacológico (p = 0,00). Não houve associação entre a AE e a presença de diabetes, história familiar, apresentação clínica, uso de betabloqueador (BB), idade, vaso ou seu segmento. Conclusões: O implante de stent resultou em ativação simpática e concomitante ativação vagal. Não houve influência do quadro de diabetes, uso de BB e vaso sobre a AE. Houve menor ativação simpática durante o implante de stent farmacológico. .


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Frequência Cardíaca/fisiologia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/métodos , Stents , Análise de Fourier , Estudos Longitudinais , Estudos Prospectivos , Valores de Referência , Estatísticas não Paramétricas , Sistema Nervoso Simpático/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
9.
Arq Bras Cardiol ; 103(2): 138-45, 2014 Aug.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25029473

RESUMO

BACKGROUND: The autonomic nervous system plays a central role in cardiovascular regulation; sympathetic activation occurs during myocardial ischemia. OBJECTIVE: To assess the spectral analysis of heart rate variability during stent implantation, comparing the types of stent. METHODS: This study assessed 61 patients (mean age, 64.0 years; 35 men) with ischemic heart disease and indication for stenting. Stent implantation was performed under Holter monitoring to record the spectral analysis of heart rate variability (Fourier transform), measuring the low-frequency (LF) and high-frequency (HF) components, and the LF/HF ratio before and during the procedure. RESULTS: Bare-metal stent was implanted in 34 patients, while the others received drug-eluting stents. The right coronary artery was approached in 21 patients, the left anterior descending, in 28, and the circumflex, in 9. As compared with the pre-stenting period, all patients showed an increase in LF and HF during stent implantation (658 versus 185 ms2, p = 0.00; 322 versus 121, p = 0.00, respectively), with no change in LF/HF. During stent implantation, LF was 864 ms2 in patients with bare-metal stents, and 398 ms2 in those with drug-eluting stents (p = 0.00). The spectral analysis of heart rate variability showed no association with diabetes mellitus, family history, clinical presentation, beta-blockers, age, and vessel or its segment. CONCLUSIONS: Stent implantation resulted in concomitant sympathetic and vagal activations. Diabetes mellitus, use of beta-blockers, and the vessel approached showed no influence on the spectral analysis of heart rate variability. Sympathetic activation was lower during the implantation of drug-eluting stents.


Assuntos
Frequência Cardíaca/fisiologia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/métodos , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Análise de Fourier , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Estatísticas não Paramétricas , Sistema Nervoso Simpático/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
10.
Case Rep Transplant ; 2013: 606481, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24066253

RESUMO

Cardiac allograft vasculopathy is still a major issue, with significative mortality in heart transplant patients, and the best therapeutic options are not yet established. The progressively higher survival rates after transplantation have made it a major concern. This is a case report about a patient who underwent cardiac transplantation due to chagasic cardiomiopathy. During an endomyocardial biopsy more than 2 years after the transplant, the patient arrested in ventricular fibrillation, with ST-elevation in anterior leads after defibrillation. The angiography showed total occlusion of proximal left anterior descending artery, promptly treated with primary angioplasty, with excellent angiographic and clinical results.

12.
Arq. bras. cardiol ; 100(1): 67-74, jan. 2013. graf, tab
Artigo em Português | LILACS | ID: lil-662386

RESUMO

FUNDAMENTO: Estudos demonstram que a dispersão da onda P (DP) e o índice de volume do átrio esquerdo (Aesc) são preditores de eventos cardiovasculares (EC). OBJETIVO: Verificar o valor prognóstico da dispersão da onda P e do Aesc para a ocorrência de EC em pacientes com insuficiência cardíaca. MÉTODOS: Estudo longitudinal e prospectivo com 78 pacientes consecutivos com idade média de 47,2 anos, sendo 52 homens, estáveis com insuficiência cardíaca, submetidos à avaliação clínica, aos exames de eletrocardiograma e ao ecocardiograma, com seguimento de 26,5 meses. RESULTADOS: As médias das variáveis foram: 50 ms DP e 35,5 ml/m² Aesc. Considerando-se DP > 40 ms e como referência Aesc > 28 ml/m², o valor preditivo positivo da DP foi de 87,5% e o negativo de 76,9%. Durante o seguimento, 21 pacientes apresentaram EC. Houve associação entre as medidas do átrio esquerdo, os volumes do ventrículo esquerdo e a fração de ejeção e EC. Não houve associação entre a DP e EC. Pela análise multivariada, o átrio esquerdo e o Aesc foram preditores de eventos (p = 0,00 e 0,02). Pela curva de operação característica para a variável estável EC, foram obtidas as áreas de 0,80 e 0,69 para Aesc (p = 0,00) e Aesc > 28 ml/m² (p = 0,01). As curvas de sobrevida (Kaplan-Meier) livre daqueles eventos para Aesc > 28 ml/m² e para a etiologia chagásica demonstraram razão de chance de 14,4 (p = 0,00) e de 3,2 (p = 0,03). Não houve diferença de evolução entre pacientes com insuficiência cardíaca isquêmica e não isquêmica. CONCLUSÃO: DP não esteve correlacionada a EC. Aesc foi um preditor independente de EC e os chagásicos apresentaram pior evolução.


BACKGROUND: Studies have shown that P-wave dispersion (PWD) and left atrial volume index (LAVi) are predictors of cardiovascular events (CE). OBJECTIVE: To verify the prognostic value of PWD and LAVi for the occurrence of CE in patients with heart failure (HF). METHODS: This was a longitudinal prospective study of 78 consecutive patients with a mean age of 47.2 years, of which 52 were males. Patients had stable HF and underwent clinical evaluation, electrocardiogram and echocardiogram assessments, with a follow-up of 26.5 months. RESULTS: The means of the variables were: 50 ms for PWD and 35.5 mL/m² for LAVi. Considering PWD > 40 ms and, as reference, LAVi > 28 mL/m², the positive predictive value of PWD was 87.5% and the negative predictive value was 76.9%. During follow-up, 21 patients had CE. There was an association between left atrial measurements, left ventricular volumes, ejection fraction and CE. There was no association between PWD and CE. At the multivariate analysis, the left atrium and LAVi were predictors of events (p = 0.00 and 0.02). Through the operating characteristic curve for the variable stable CE, areas of 0.80 and 0.69 were obtained for LAVi (p = 0.00) and LAVi > 28 mL/m² (p = 0.01). Survival curves (Kaplan-Meier) free of those events for LAVi > 28 mL/m² and for Chagas disease etiology showed an odds ratio of 14.4 (p = 0.00) and 3.2 (p = 0.03). There was no difference in outcome between patients with ischemic and nonischemic heart failure. CONCLUSION: PWD was not correlated to CE. LAVi was an independent predictor of CE, and chagasic patients showed worse outcomes.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Insuficiência Cardíaca/complicações , Função do Átrio Esquerdo , Ecocardiografia , Eletrocardiografia , Métodos Epidemiológicos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca , Tamanho do Órgão , Prognóstico , Valores de Referência , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo
13.
Arq Bras Cardiol ; 100(1): 67-74, 2013 Jan.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23224351

RESUMO

BACKGROUND: Studies have shown that P-wave dispersion (PWD) and left atrial volume index (LAVi) are predictors of cardiovascular events (CE). OBJECTIVE: To verify the prognostic value of PWD and LAVi for the occurrence of CE in patients with heart failure (HF). METHODS: This was a longitudinal prospective study of 78 consecutive patients with a mean age of 47.2 years, of which 52 were males. Patients had stable HF and underwent clinical evaluation, electrocardiogram and echocardiogram assessments, with a follow-up of 26.5 months. RESULTS: The means of the variables were: 50 ms for PWD and 35.5 mL/m² for LAVi. Considering PWD > 40 ms and, as reference, LAVi > 28 mL/m², the positive predictive value of PWD was 87.5% and the negative predictive value was 76.9%. During follow-up, 21 patients had CE. There was an association between left atrial measurements, left ventricular volumes, ejection fraction and CE. There was no association between PWD and CE. At the multivariate analysis, the left atrium and LAVi were predictors of events (p = 0.00 and 0.02). Through the operating characteristic curve for the variable stable CE, areas of 0.80 and 0.69 were obtained for LAVi (p = 0.00) and LAVi > 28 mL/m² (p = 0.01). Survival curves (Kaplan-Meier) free of those events for LAVi > 28 mL/m² and for Chagas disease etiology showed an odds ratio of 14.4 (p = 0.00) and 3.2 (p = 0.03). There was no difference in outcome between patients with ischemic and nonischemic heart failure. CONCLUSION: PWD was not correlated to CE. LAVi was an independent predictor of CE, and chagasic patients showed worse outcomes.


Assuntos
Insuficiência Cardíaca/complicações , Adulto , Idoso , Função do Átrio Esquerdo , Ecocardiografia , Eletrocardiografia , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prognóstico , Valores de Referência , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Adulto Jovem
14.
Rev. bras. med. esporte ; 18(6): 369-372, nov.-dez. 2012. tab
Artigo em Português | LILACS-Express | ID: lil-666197

RESUMO

INTRODUÇÃO E OBJETIVO: O teste de esforço com protocolo de rampa é descrito como o que mais se adéqua à condição física de indivíduos com insuficiência cardíaca (IC). Porém, não há padronização descrita sobre incrementos de velocidade e inclinação. Este estudo teve como objetivo descrever resultados encontrados a partir da aplicação de um teste de esforço com protocolo de rampa adaptado para indivíduos com IC, classes II e III da New York Heart Association (NYHA). MÉTODOS: 41 indivíduos com média de idade de 46,37 ± 8,98 anos e fração de ejeção de 31,51 ± 9,45% fizeram o teste de esforço com análise de gases expirados em esteira, com protocolo de rampa desenvolvido a partir de critérios definidos pelo estudo de Barbosa e Silva e Sobral. Análise estatística: Foi realizada análise descritiva com distribuição de frequência e o tempo de teste foi apresentado como média ± desvio padrão. Foi realizado o modelo de regressão linear incluindo classe da NYHA, idade e fração de ejeção como variáveis explicativas para tempo de teste. Foi considerado significativo p < 0,05. RESULTADOS: O tempo médio do teste foi 8,89 ± 3,57 minutos e o R alcançado foi 1,12 ± 0,11. Sessenta e um porcento da amostra apresentou duração do teste entre seis e 12 minutos, considerando intervalo de média ± 1 desvio padrão, e 73,2% da amostra apresentou duração entre seis e 15 minutos. CONCLUSÃO: Os achados deste estudo demonstraram que a maioria dos indivíduos com IC finalizou o teste com o protocolo de rampa adaptado dentro da duração considerada adequada pela literatura.


INTRODUCTION AND OBJECTIVE: The exercise test with ramp protocol is described as the one which best adapts to physical condition of subjects with heart failure (HF). However, velocity and inclination standard increments have not been described yet. This study aimed to describe the results found after application of an exercise test with ramp protocol adjusted for subjects with HF, New York Heart Association (NYHA) class II and III. METHODS: 41 subjects with mean age 46.37 ± 8.98 years and ejection fraction of 31.51 ± 9.45% performed the exercise test with expired gas analysis on treadmill with ramp protocol developed from criteria defined in a study by Barbosa and Silva et al. Statistical Analysis: descriptive analysis was performed with frequency distribution and the test time was presented as mean ± standard deviation. Linear regression model was used and NYHA class, age and ejection fraction were included as explanation variables for the test time. A p value of < 0.05 was considered statistically significant. RESULTS: Mean test time was 8.89 ± 3.57 minutes and the R was 1.12 ± 0.11. Sixty-one percent of the sample presented test duration between 6 and 12 minutes - mean ± 1 standard deviation interval - and 73.2% presented duration between 6 and 15 minutes. CONCLUSION: This study demonstrated that the majority of the subjects with HF concluded the test with ramp protocol adjusted in time considered adequate in the literature.

15.
Clin Ther ; 34(7): 1511-20, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22717417

RESUMO

BACKGROUND: The efficacy and risks of oral anticoagulation are largely associated with maintaining the quality of anticoagulation control. Nevertheless, few studies have addressed which factors, if any, are associated with this control. OBJECTIVE: This study aimed to identify predictors of high-quality oral anticoagulation. METHODS: A prospective observational study enrolled all adult patients on intended long-term oral anticoagulation attending a public anticoagulation clinic. Patients with high-quality anticoagulation, defined as percentage of time in therapeutic international normalized ratio (INR) range (TTR) ≥66%, were compared with those with poor anticoagulation control (TTR <66%). Measures included cognitive, psychological, and relevant behavioral factors, in addition to traditionally implicated ones, such as age, comorbidity, and concurrent medications. RESULTS: Participation was requested from all 233 patients followed up at the anticoagulation clinic. Eighty-six did not meet the inclusion criteria (49 due to intended anticoagulation duration <90 days, 37 due to the need for a caregiver responsible for medications). A total of 147 patients were enrolled, of whom 13 (8.8%) were lost to follow-up. Therefore, data were analyzed from 134 patients (mean [SD] age, 55 [14.2] years [range, 19-87 years]), who were followed up for a mean (SD) duration of 272 (87) days. The total mean TTR was 64.7%, which is comparable to values achieved in clinical trials. The good-control group had 61 patients (45.5%) (mean TTR, 77.7% [8.5%]) and the poor-control group had 73 patients (54.5%) (mean TTR, 50.4 [11.7%]). On multivariate logistic regression analysis, high-quality anticoagulation was independently associated with regular vitamin K intake, expressed by its variability in daily dosage (odds ratio [OR] = 0.79; 95% CI, 0.64-0.98); male sex (OR = 2.41; 95% CI, 1.06-5.49); duration of anticoagulation treatment >2 months (OR = 3.23; 95% CI, 1.25-8.36); presence of family support (OR = 3.32; 95% CI, 1.16-9.48); functional and cognitive ability to take medications as prescribed, defined as good medication management capacity (MMC; as assed using the Drug Regimen Unassisted Grading Scale) (OR = 4.18; 95% CI, 1.63-10.68); and no regular use of alcohol (OR = 8.59; 95% CI, 1.45-51.09). CONCLUSIONS: The data suggest that independent predictors of high-quality oral anticoagulation included regular vitamin K intake, male sex, duration of anticoagulation treatment >2 months, presence of family support, good MMC, and no regular alcohol use. These findings may help clinicians to decide whether to start anticoagulation in intermediate-risk patients, to identify patients who will require closer attention on their anticoagulation management, and to direct their efforts to improve the quality of oral anticoagulation.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Anticoagulantes/farmacologia , Vitamina K/administração & dosagem , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Relação Dose-Resposta a Droga , Família/psicologia , Feminino , Seguimentos , Humanos , Coeficiente Internacional Normatizado , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Apoio Social , Fatores de Tempo , Adulto Jovem
16.
Inflammation ; 35(2): 509-15, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21556736

RESUMO

The aim of this study is to compare the response of interleukin-6 (IL-6) and soluble tumor necrosis factor alpha receptor 1 (s-TNFr1) to two submaximal intensities of exercise in individuals with heart failure (HF). Thirty-two HF individuals aged 45.53 ± 9.41 years, classes II and III of the New York Heart Association (NYHA) classification underwent two sessions of exercise at low and moderate intensities with blood analysis at baseline, exercise and after exercise. The differences were evaluated by Friedman test and factorial ANOVA. Alpha = 5% was considered. No difference in IL-6 was detected for low intensity. At moderate intensity, there was a significant increase after exercise. The s-TNFr1 increased in moderate-intensity exercise and went back to baseline levels after it. A session of moderate-intensity exercise is better than low-intensity exercise at promoting positive immediate inflammatory responses in individuals with HF class II and III of the NYHA.


Assuntos
Exercício , Insuficiência Cardíaca/imunologia , Interleucina-6/sangue , Receptores Tipo I de Fatores de Necrose Tumoral/sangue , Adulto , Teste de Esforço , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade
17.
Rev. méd. Minas Gerais ; 21(4)out.-dez. 2011.
Artigo em Português | LILACS-Express | ID: lil-673879

RESUMO

Fundamento: gestações em fases mais adiantadas da vida podem associar-se a hipertensão arterial sistêmica crônica e hipertrofia ventricular esquerda, ocasionando aumentos nas taxas de morbimortalidade cardiovascular. Objetivos: avaliar a eficácia do eletrocardiograma na identificação de gestantes hipertensas crônicas portadoras de hipertrofia ventricular esquerda. Métodos: foram estudadas 80 gestantes no 3º trimestre de gestação. Utilizou-se a quantificação ecocardiográfica da massa ventricular esquerda como padrão-ouro para o diagnóstico de hipertrofia miocárdica, sendo considerado o ponto de corte de 122 g/m² como limite superior normal para massa ventricular esquerda no 3º trimestre de gestação. Foram utilizados os critérios de Sokolow-Lyon, Lewis, Sokolow-Lyon-Rappaport, Gubner, Cornell, escore de pontos de Romhilt e Estes, Grant, onda ?R? de aVL > 11 mm, razão RV6 / RV5 > 1. Resultados: todos os critérios eletrocardiográficos analisados apresentaram baixa eficácia para o reconhecimento da hipertrofia ventricular esquerda em gestantes hipertensas crônicas. Conclusões: apesar da ampla difusão do eletrocardiograma como recurso propedêutico, ao utilizá-lo para a pesquisa de hipertrofia ventricular esquerda em gestantes hipertensas crônicas, deve-se considerar suas importantes limitações para essa finalidade.


Background: Pregnancy at late stages of life may be associated with chronic systemic arterial hypertension and left ventricular hypertrophy, causing increased cardiovascular morbimortality rates. Objectives: To assess electrocardiograph efficiency to identify chronic hypertensive pregnant women with left ventricular hypertrophy. Methods: Eighty women in the third trimester of pregnancy were investigated. Echocardiographic quantification of left ventricular mass was used as gold standard to diagnose myocardial hypertrophy, the 122g/m2 cut-off being assumed as the maximal limit for normal left ventricular mass in the third trimester of pregnancy. The following criteria were used:Sokolow-Lyon, Lewis, Sokolow-Lyon-Rappaport, Gubner, Cornell, Grant, Romhilt and Estes point scores, ?R? wave of aVL > 11 mm, ratio RV5 / RV5 > 1. Results: All the electrocardiograph criteria analyzed showed low efficacy to recognize left ventricular hypertrophy in chronic hypertensive pregnant women. Conclusions: Despite wide use of electrocardiograph as a propaedeutic resource, studies on left ventricular hypertrophy in chronic hypertensive pregnant women should consider the limitation of this resource

18.
Rev Bras Cir Cardiovasc ; 26(3): 481-4, 2011 Jul-Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22086588

RESUMO

A serious complication such as dissection of the left main coronary artery, with significant reduction in coronary blood flow by the true light, requires quick action. Therefore, the immediate choice of stent with appropriate length and size to treat the complication is necessary.


Assuntos
Infarto do Miocárdio/terapia , Isquemia Miocárdica/etiologia , Stents/efeitos adversos , Doença Aguda , Feminino , Transplante de Coração , Humanos , Pessoa de Meia-Idade , Miocárdio/patologia
20.
Rev Bras Cir Cardiovasc ; 26(1): 54-60, 2011 Jan-Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21881712

RESUMO

INTRODUCTION: The patients suffering heart failure develop an increase in pulmonary pressure because of a retrograde mechanism. The pulmonary hypertension is a prognostic marker. OBJECTIVE: The aim of this study is to correlate pulmonary hypertension measured by echocardiogram versus catheterization in pre-heart transplant patients on waiting list. METHODS: Data from 90 patients of the Clinical Hospital UFMG were collected between 2004 and 2009. All the patients took an echo and catheterization as an integral part of pre-heart transplant. Mean age was 45.5 years old, 68 (75.6%) male. Fourty-two (46.7%) were Chagas' disease patients, 32 (35.6%) presented idiopathic dilated cardiomyopathy, 10 (11.1%) had ischemic cardyomiopathy. RESULTS: The mean eco-PASP was 45 ± 12mmHg). The mean cat-PASP was 47 ±14mmHg. The eco-PASP-Chagas was 41.7 ±12,5 mmHg and non-Chagas 47.6 ±12.8 mmHg P=0.04. The cat-PASP-Chagas was 46 ±12.1 mmHg and non-Chagas 48.7 ±12.8 mmHg P=0.43. Eight patients had cat-PASP>60. The correlation between eco-PASP and cat-PASP in Chagas' patients was r=0.45; P=0.008 and in the non-Chagas was r=0.66; P<0.001. The eco-PASP-Chagas>32,5mmHg has a sensitivity of 79% and specificity of 75% to diagnose PH, with an area under the curve of 0.819. The eco-PASP-non-Chagas>35.5 mmHg has a sensitivity of 82% and a specificity of 70% to diagnose PH, with an area under the curve of 0.776. CONCLUSIONS: There is a good correlation between eco-PASP and cat-PASP (r=0.54) in pre-heart transplant patients. The eco-PASP was lower in the Chagas' group. The echocardiogram is an important method to diagnosis and control pulmonary pressure in pre-heart transplant, specifically in Chagas' patients. The catheterization is still important to evaluate pulmonary reactivity during vasodilation test.


Assuntos
Cateterismo Cardíaco/métodos , Doença de Chagas/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Transplante de Coração , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar/diagnóstico por imagem , Listas de Espera , Adolescente , Adulto , Idoso , Métodos Epidemiológicos , Feminino , Hemodinâmica/fisiologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Artéria Pulmonar/fisiopatologia , Adulto Jovem
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