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1.
G Ital Cardiol (Rome) ; 21(1): 34-88, 2020 Jan.
Artigo em Italiano | MEDLINE | ID: mdl-31960833

RESUMO

The complexity of cardiovascular diseases has led to an extensive use of technological instruments and the development of multimodality imaging. This extensive use of different cardiovascular imaging tests in the same patient has increased costs and waiting times.The concept of appropriateness has changed over time. Appropriateness criteria address the need for specific cardiovascular imaging tests in well-defined clinical scenarios, and define the kind of cardiovascular imaging that is appropriated for each clinical scenario in different stages of the disease. The concept of appropriateness criteria has replaced the old idea of appropriate use criteria and reflects the increasing effort of the international Scientific Societies to create and review in a critical way the management of diagnostic tests used by clinicians.The aim of this Italian consensus document is to address the use of multimodality imaging in the diagnosis and management of the major cardiovascular clinical scenarios, taking into consideration not only the international guidelines and scientific documents already published, but also the reality of Italian laws as well as the various professional profiles involved in patient management and availability of technological diagnostic instruments.

2.
G Ital Cardiol (Rome) ; 20(12): 746-761, 2019 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-31834298

RESUMO

Sarcomeric hypertrophic cardiomyopathy is the most common cardiovascular genetic disease. Clinical evaluation and comprehensive echocardiography are crucial for the diagnosis and early evaluation of the hypertrophic phenotype, but multimodality imaging approach is often required to better define diagnosis and differential diagnosis from phenocopies. This review aims to assess the role of multimodality imaging and, in particular, advanced echocardiography and cardiac magnetic resonance in relation to differential diagnosis and preclinical diagnosis, identification of different phenotypes, and assessment of disease progression and risk of sudden cardiac death. A multimodality imaging approach is also crucial for the selection of patients amenable to surgical or percutaneous septal myectomy and for guiding both procedures.

3.
G Ital Cardiol (Rome) ; 20(11): 627-631, 2019 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-31697269

RESUMO

Echocardiographic quantification is crucial for the diagnosis and management of patients with acquired and congenital heart disease (CHD). In neonatal and pediatric age, the echocardiogram begins with subxiphoid, or subcostal, imaging instead of left parasternal views. This allows for the determination of visceral situs (site or location) at the beginning of an examination. Regardless of where the examination starts, the segmental approach is used to describe all of the major cardiovascular structures in sequence. Patent foramen ovale is a normal interatrial communication during fetal life. Complete anatomic closure of the foramen ovale occurs in 70-75% of adults, which means that almost 25% of the population has a patent foramen ovale. Atrial septal defects are a common congenital disorder with a prevalence of approximately 2 per 1000 live births. The reported rate of spontaneous atrial septal defect closure in the first year of life ranges from 4% to 96%. The most important predictor for spontaneous closure is the size of the defect, with smaller defects more likely to close. Systemic-to-pulmonary collateral arteries can occur in premature infants without chronic lung disease and may represent a transient phenomenon. They may be present normally after birth and then gradually disappear. Physiological valvular regurgitation is most commonly observed in the tricuspid valve among children (32.8%), followed by pulmonary regurgitation (17.2%). The ductus arteriosus usually is functionally closed within 48 h of birth, although some authors consider the patent ductus to be abnormal only after 3 months of age. Prematurity clearly increases the incidence of patent ductus arteriosus.

4.
J Cardiovasc Med (Hagerstown) ; 20(7): 414-418, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593558

RESUMO

: The 2015 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis recommend the use of a multidisciplinary team in the care of patients with infective endocarditis. A standardized collaborative approach should be implemented in centres with immediate access to different imaging techniques, cardiac surgery and health professionals from several specialties. This position paper has been produced by the Task Force for Management of Infective Endocarditis of Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) with the aim of providing recommendations for the implementation of the Endocarditis Team within the Italian hospital network. On the basis of the Italian hospital network with many cardiology facilities encompassing a total of 405 intensive cardiac care units (ICCUs) across the country, 224 (3.68 per million inhabitants) of which have on-site 24-h PCI capability, but with relatively few centres equipped with cardiac surgery and nuclear medicine, in the present article, the SIECVI Task Force for Management of Infective Endocarditis develops the idea of a network where 'functional' reference centres act as a link with the periphery and with 'structural' reference centres. A number of minimum characteristics are provided for these 'functional' reference centres. Outcome and cost analysis of implementing an Endocarditis Team with functional referral is expected to be derived from ongoing Italian and European registries.


Assuntos
Técnicas de Imagem Cardíaca/normas , Serviço Hospitalar de Cardiologia/normas , Prestação Integrada de Cuidados de Saúde/normas , Endocardite/diagnóstico por imagem , Endocardite/terapia , Equipe de Assistência ao Paciente/normas , Regionalização/normas , Consenso , Humanos , Comunicação Interdisciplinar , Valor Preditivo dos Testes , Resultado do Tratamento
5.
G Ital Cardiol (Rome) ; 20(9): 481-490, 2019 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-31530949

RESUMO

Mechanical or bioprosthetic aortic valve replacement has traditionally been the treatment of choice for patients with aortic valve insufficiency. However, prosthetic valve replacement has significant limitations being associated with a substantial cumulative risk of thromboembolism, anticoagulation-related hemorrhage, prosthetic valve endocarditis, and structural or non-structural valve dysfunction requiring reoperation. In this setting, aortic valve repair, by avoiding the long-term risks associated with prosthetic valve implantation, has emerged as a valid alternative treatment to conventional aortic valve replacement. In the last decade, improvements in the understanding of the mechanisms of valve disease, development of a classification system for aortic insufficiency and advances in surgical procedures have allowed for more effective and reproducible techniques for aortic valve repair. The aim of the present review is to assess the principles, the surgical techniques, and the role of echocardiographic imaging in the setting of aortic valve repair surgery.

7.
Int J Cardiovasc Imaging ; 35(12): 2167-2175, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31321652

RESUMO

Treatment of overt form of hypertrophic cardiomyopathy (HCM) is often unsuccessful. Efforts are focused on a possible early identification in order to prevent or delaying the development of hypertrophy. Our aim was to find an echocardiographic marker able to distinguish mutation carriers without left ventricular hypertrophy (LVH) from healthy subjects. We evaluated 28 patients, members of eight families. Three types of mutation were recognized: MYBPC3 (five families), MYH7 (two families) and TNNT2 (one family). According to genetic (G) and phenotypic (Ph) features, patients were divided in three groups: Group A (10 patients), mutation carriers with LVH (G+/Ph+); Group B (9 patients), mutation carriers without LVH (G+/Ph-); Group C (9 patients), healthy subjects (G-/Ph-). Echocardiography examination was performed acquiring standard 2D, DTI and 2D-strain imaging. Global longitudinal strain (GLS) and global radial strain (GRS) at basal and mid-level were measured. GRS was significantly different between group B and C at basal level (32.18% ± 9.6 vs. 44.59% ± 12.67 respectively; p-value < 0.0001). In basal posterior and basal inferior segments this difference was particularly evident. ROC curves showed for both the involved segments good AUCs (0.931 and 0.861 for basal posterior and inferior GRS respectively) with the best predictive cut-off for basal posterior GRS at 43.65%, while it was 38.4% for basal inferior GRS. Conversely, GLS values were similar in the three group. 2D longitudinal strain is a valid technique to study HCM. Radial strain and particularly basal posterior and inferior segmental reduction could be able to identify mutation carriers in a pre-clinical phase of disease.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia , Função Ventricular Esquerda , Adolescente , Adulto , Idoso , Miosinas Cardíacas/genética , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/fisiopatologia , Proteínas de Transporte/genética , Estudos de Casos e Controles , Análise Mutacional de DNA , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Cadeias Pesadas de Miosina/genética , Fenótipo , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Troponina T/genética , Adulto Jovem
8.
Gene ; 715: 143970, 2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31330235

RESUMO

BACKGROUND: Bicuspid aortic valve (BAV) formation is genetically determined, with reduced penetrance and variable expressivity. NOTCH1 is a proven candidate gene and its mutations have been found in familial and sporadic cases of BAV. METHODS: 66 BAV patients from the GISSI VAR study were genotyped for the NOTCH1 gene. RESULTS: We identified 63 variants, in heterozygous and homozygous states. Fifty-two are common polymorphisms present in almost all patients. Eleven variants are new and never yet reported: two are non-synonymous substitutions, Gly540Asp in exon 10 and Glu851Gln in exon 16; one is in the 3'UTR region and seven in introns, one corresponds to a T allele insertion in intron 27. We selected four statistically noteworthy and seven new variants identified in six BAV patients and correlated them with clinical and demographic variables and with imaging and histological parameters. Preliminary data show that four were BAV patients with isolated stenosis in patients over 60 aged. These variants may correlate with a later need for surgery for the presence of stenosis and not aortic valve regurgitation or ascending aortic aneurysm. CONCLUSIONS: Completing the genotyping of 62 BAV patients we found 11 new variants in the NOTCH1 gene never yet reported. These findings confirm that the identification of new, clinically remarkable biomarkers for BAV requires a deeper genetic understanding of the NOTCH1 gene variants, which could be targeted by future diagnostic and therapeutic strategies.


Assuntos
Estenose da Valva Aórtica/genética , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas , Mutação de Sentido Incorreto , Penetrância , Receptor Notch1/genética , Adulto , Alelos , Substituição de Aminoácidos , Éxons , Feminino , Heterozigoto , Homozigoto , Humanos , Íntrons , Itália , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sequência de DNA
9.
J Hypertens ; 37(6): 1183-1190, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30882598

RESUMO

BACKGROUND: Vascular structural (intima-media thickness) and functional (carotid pulse wave velocity, cPWV) alterations are related to different patterns of left ventricular (LV) geometry in general population samples and in hypertensive patients. The relationship between vascular damage, evaluated by both echotracking ultrasound and coronary angiography, and LV geometry has not been prospectively analyzed. METHODS: In eight Italian centers, 399 consecutive patients, without history of prior coronary artery disease and with clinical indication to coronary angiography, prospectively underwent cardiac standard ultrasound examination for the evaluation of LV mass, indexed by height to 2.7 power (LVMi g/m) and relative wall thickness (RWT), the measurement of Doppler flow in the left anterior descending artery (LAD) and the echocardiographic calcium score (eCS). In all patients measurement of common carotid intima-media thickness (cIMT) and cPWV by carotid ultrasound, with the realtime echotracking system was performed. The noninvasive evaluations were performed blindly to clinical information, before coronary angiography. RESULTS: cIMT and cPWV were higher in patients with concentric LV hypertrophy (LVH) (LVMi ≥ 49 g/m in men and ≥47 g/m in women and RWT ≥ 0.42) as compared with those with normal LVMi and geometry (N: LVMi < 49 g/m in men and <47 g/m in women and RWT < 0.42) and to those with concentric remodeling (normal LVMi and RWT ≥ 0.42). Distal LAD velocity and eCS were greater in patients with concentric LVH than in others groups. At coronary angiography the prevalence of coronary stenosis (>50%) was greater in patients with concentric LVH and concentric remodeling, as compared with N. Patients with both concentric LVH and concentric remodeling showed higher values of cIMT and cPWV and distal LAD velocity and a greater prevalence of coronary stenosis (>50%) than patients with RWT less than 0.42. CONCLUSION: Our results further reinforced the observation that in patients undergoing elective coronary angiography, concentric geometry is associated with structural and functional carotid alterations, with higher distal LAD flow velocity and eCS. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography. These results might contribute to explain the greater cardiovascular risk associated with concentric remodeling and LVH.

10.
Int J Cardiol ; 283: 131-133, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30833105

RESUMO

INTRODUCTION: No data regarding the safety of continuous-flow left ventricular assist device (CF-LVAD) implantation in patients with previous MitraClip have been reported. Thus, it remains unknown whether an initial treatment strategy with MitraClip therapy might complicate future heart failure management in patients who are also considered for CF-LVAD. METHODS: We retrospectively identified 6 patients (median age of 62 years; 2 women) who had been treated with MitraClip, that were eventually implanted with a CF-LVAD (all Heartware HVAD) in 3 hospitals between 2013 and 2018. RESULTS: Patients were treated in 4 cases with 2 clips, and in 2 cases with 1 clip. Median time from MitraClip implantation to CF-LVAD implant was 282 days (interquartile range 67 to 493), and median time on CF-LVAD support was 401 days (interquartile range 105 to 492 days). Two patients underwent a heart transplant, 3 patients died on support, and 1 is alive on support. In all cases, there was a reduction of functional mitral regurgitation without MitraClip-related complications. CONCLUSIONS: Based on this small case series, implantation of a CF-LVAD appears safe in patients with a previously positioned MitraClip system, at least, with 1 or 2 clips in place, with no need for additional mitral valve surgery.


Assuntos
Insuficiência Cardíaca/terapia , Ventrículos do Coração/diagnóstico por imagem , Coração Auxiliar , Insuficiência da Valva Mitral/terapia , Função Ventricular Esquerda/fisiologia , Idoso , Ecocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico , Desenho de Prótese , Estudos Retrospectivos
11.
J Hypertens ; 37(1): 57-64, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30036270

RESUMO

AIM: The aim of this study was to assess the prevalence of ascending aortic dilatation and to evaluate the possible association between proximal aorta dilatation and structural or functional markers of cardiac organ damage in hypertensive patients. BACKGROUND: Dilatation of the sinus of valsalva (SoV) is a common finding in clinical practice and it is associated with an increased cardiovascular risk in hypertensive patients: less is known about the dilatation prevalence of the subsequent portion, the proper ascending aorta and its relationship with cardiovascular organ damage. METHODS: This multicentric study included 582 hypertensive and 104 normotensive control individuals. All individuals underwent clinical evaluation and two-dimensional transthoracic echocardiography focused on the evaluation of the aorta. Aortic diameters at three levels were measured: SoV, sinotubular junction and ascending aorta. RESULTS: The prevalence of ascending aorta dilatation was 13%. Patients with ascending aorta dilatation were on average 10 years older than hypertensive patients without aortic dilatation and control individuals.Left ventricular mass was significantly increased (P < 0.0001) in patients with ascending aorta dilatation with (113.29 ±â€Š3 g/m) or without (109.16 ±â€Š3 g/m) SoV dilatation compared with patients with isolated SoV dilatation (98.80 ±â€Š21.8 g/m) or normal aorta (96.04 ±â€Š26.5 g/m), with left ventricular hypertrophy (LVH) being twice as common in this group compared with the latter (60 vs. 28%, P < 0.0001). CONCLUSION: Prevalence of ascending aorta dilatation in hypertensive patients reaches 13%. Hypertensive individuals with enlarged ascending aorta showed significantly increased left ventricular mass, a well known sign of hypertension related cardiac damage and could thus represent a subset of hypertensive patients at an increased cardiovascular risk.


Assuntos
Doenças da Aorta , Hipertensão , Aorta/fisiopatologia , Doenças da Aorta/complicações , Doenças da Aorta/epidemiologia , Ecocardiografia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Prevalência
12.
J Cardiovasc Med (Hagerstown) ; 20(1): 10-15, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30418268

RESUMO

: Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma Coronário/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/mortalidade , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/mortalidade , Aneurisma Coronário/terapia , Endocardite/microbiologia , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/mortalidade , Infecções Relacionadas à Prótese/terapia , Fatores de Risco , Stents/efeitos adversos , Resultado do Tratamento
13.
Heart Fail Clin ; 14(3): 271-281, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29966626

RESUMO

Involvement of the right heart-pulmonary circulation system in systemic sclerosis is a typical feature, with critical prognostic implications. Pulmonary hypertension may occur in association with interstitial lung disease or as a result of an isolated pulmonary vascular disease that may affect both the precapillary arterioles and the postcapillary venules, as well as a consequence of left heart involvement. These apparently different phenotypes often underlie a significant pathophysiologic overlap, which makes the diagnosis and management of these patients highly complex and uncertain.


Assuntos
Coração/fisiopatologia , Hipertensão Pulmonar/etiologia , Programas de Rastreamento/métodos , Circulação Pulmonar/fisiologia , Escleroderma Sistêmico/complicações , Cardiologistas , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Reumatologistas , Escleroderma Sistêmico/terapia
14.
Heart Fail Clin ; 14(3): 443-465, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29966641

RESUMO

The Right Heart International Network is a multicenter international study aiming to prospectively collect exercise Doppler echocardiography tests of the right heart pulmonary circulation unit (RHPCU) in large cohorts of healthy subjects, elite athletes, and individuals at risk of or with overt pulmonary hypertension. It is going to provide standardization of exercise stress echocardiography of RHPCU and explore the full physiopathologic response.


Assuntos
Ecocardiografia Doppler/métodos , Ecocardiografia sob Estresse/métodos , Hipertensão Pulmonar/fisiopatologia , Circulação Pulmonar/fisiologia , Função Ventricular Direita/fisiologia , Exercício/fisiologia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Masculino , Estudos Prospectivos , Projetos de Pesquisa
16.
Echocardiography ; 35(9): 1258-1265, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29797430

RESUMO

BACKGROUND: Left ventricular hypertrophy (LVH) may reflect a wide variety of physiologic and pathologic conditions. Thus, it can be misleading to consider all LVH to be homogenous or similar. Refined 4-group classification of LVH based on ventricular concentricity and dilatation may be identified. To determine whether the 4-group classification of LVH identified distinct phenotypes, we compared their association with various noninvasive markers of cardiac stress. METHODS: Cohort of unselected adult outpatients referred to a seven tertiary care echocardiographic laboratory for any indication in a 2-week period. We evaluated the LV geometric patterns using validated echocardiographic indexation methods and partition values. RESULTS: Standard echocardiography was performed in 1137 consecutive subjects, and LVH was found in 42%. The newly proposed 4-group classification of LVH was applicable in 88% of patients. The most common pattern resulted in concentric LVH (19%). The worst functional and hemodynamic profile was associated with eccentric LVH and those with mixed LVH had a higher prevalence of reduced EF than those with concentric LVH (P < .001 for all). CONCLUSIONS: The new 4-group classification of LVH system showed distinct differences in cardiac function and noninvasive hemodynamics allowing clinicians to distinguish different LV hemodynamic stress adaptations in patients with LVH.


Assuntos
Ecocardiografia/métodos , Hemodinâmica/fisiologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Idoso , Estudos Transversais , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
17.
Eur Heart J Case Rep ; 2(4): yty127, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31020203

RESUMO

Background: The presence of a persistent fibrous sheath in right-sided heart chambers after transvenous lead extraction has already been described in some studies as echocardiographic tubular mobile masses called 'ghosts'. Their presence has been associated with cardiac device-related infective endocarditis or local device infection, but to the best of our knowledge, this is the first case where 'ghosts' have been reported among non-infected patients. Case summary: We present a case of a 73-year-old woman hospitalized due to worsening dyspnoea and a significant pericardial effusion, relapsed after pericardiocentesis with removal of about 1500 mL of non-haemorrhagic fluid. The patient's history revealed a previous dual-chamber pacemaker implantation due to symptomatic sick sinus syndrome. Transoesophageal echocardiography (TOE), essential to exclude endocarditis vegetations suggested an etiopathogenesis of mechanical irritation caused by the distal end of the passive fixation atrial lead on the right atrial appendage wall. Considering the echocardiographic report and the condition of reactive pericarditis with the early relapse of the significant pericardial effusion after pericardiocentesis, we opted for a lead removal procedure to eliminate the stimulus causing the irritation, with transoesophageal echocardiographic monitoring, thus the early detection of a 'ghost' was possible. Discussion: This is the first clinical case describing the presence of fibrin 'ghosts' sometime after the implantation of a pacemaker, highlighting a non-exclusively infectious genesis, and emphasizing the importance of TOE for the early detection of this post-extraction complication and its monitoring.

18.
Interact Cardiovasc Thorac Surg ; 26(4): 602-609, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29272391

RESUMO

OBJECTIVES: Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2 weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis. METHODS: This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases. RESULTS: Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio = 0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70). CONCLUSIONS: Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Endocardite/cirurgia , Sistema de Registros , Medição de Risco , Idoso , Idoso de 80 Anos ou mais , Endocardite/mortalidade , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Taxa de Sobrevida/tendências , Fatores de Tempo
19.
Circulation ; 136(6): 529-545, 2017 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-28576783

RESUMO

BACKGROUND: Previous reports have suggested that despite their dramatic presentation, patients with fulminant myocarditis (FM) might have better outcome than those with acute nonfulminant myocarditis (NFM). In this retrospective study, we report outcome and changes in left ventricular ejection fraction (LVEF) in a large cohort of patients with FM compared with patients with NFM. METHODS: The study population consists of 187 consecutive patients admitted between May 2001 and November 2016 with a diagnosis of acute myocarditis (onset of symptoms <1 month) of whom 55 required inotropes and/or mechanical circulatory support (FM) and the remaining 132 were hemodynamically stable (NFM). We also performed a subanalysis in 130 adult patients with acute viral myocarditis and viral prodrome within 2 weeks from the onset, which includes 34 with FM and 96 with NFM. Patients with giant-cell myocarditis, eosinophilic myocarditis, or cardiac sarcoidosis and those <15 years of age were excluded from the subanalysis. RESULTS: In the whole population (n=187), the rate of in-hospital death or heart transplantation was 25.5% versus 0% in FM versus NFM, respectively (P<0.0001). Long-term heart transplantation-free survival at 9 years was lower in FM than NFM (64.5% versus 100%, log-rank P<0.0001). Despite greater improvement in LVEF during hospitalization in FM versus NFM forms (median, 32% [interquartile range, 20%-40%] versus 3% [0%-10%], respectively; P<0.0001), the proportion of patients with LVEF <55% at last follow-up was higher in FM versus NFM (29% versus 9%; relative risk, 3.32; 95% confidence interval, 1.45-7.64, P=0.003). Similar results for survival and changes in LVEF in FM versus NFM were observed in the subgroup (n=130) with viral myocarditis. None of the patients with NFM and LVEF ≥55% at discharge had a significant decrease in LVEF at follow-up. CONCLUSIONS: Patients with FM have an increased mortality and need for heart transplantation compared with those with NFM. From a functional viewpoint, patients with FM have a more severely impaired LVEF at admission that, despite steep improvement during hospitalization, remains lower than that in patients with NFM at long-term follow-up. These findings also hold true when only the viral forms are considered and are different from previous studies showing better prognosis in FM.


Assuntos
Miocardite/diagnóstico , Função Ventricular Esquerda/fisiologia , Doença Aguda , Adolescente , Adulto , Ecocardiografia , Feminino , Seguimentos , Coração/diagnóstico por imagem , Transplante de Coração , Coração Auxiliar , Hemodinâmica , Mortalidade Hospitalar , Humanos , Imunossupressores/uso terapêutico , Estimativa de Kaplan-Meier , Imagem Cinética por Ressonância Magnética , Masculino , Miocardite/mortalidade , Miocardite/terapia , Miocárdio/patologia , Adulto Jovem
20.
Minerva Cardioangiol ; 65(6): 629-637, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28471149

RESUMO

Echocardiography remains the cornerstone of the diagnostic of anatomic lesions and consequences on cardiac function caused by infective endocarditis (IE). There is now evidence that other imaging techniques are useful in reducing the number of non-conclusive diagnoses, in particular when IE is suspected on prosthetic material or devices. Besides diagnosis, cardiac imaging strongly contributes to prognostic assessment, indications for early surgery and patient follow-up. It is required a specific expertise for implementing and interpreting all imaging techniques and the complexity of decision-making highlights the need for a multidisciplinary management of difficult cases in specialized endocarditis teams.


Assuntos
Ecocardiografia/métodos , Endocardite/diagnóstico por imagem , Febre/etiologia , Tomada de Decisões , Humanos , Comunicação Interdisciplinar , Prognóstico , Infecções Relacionadas à Prótese/diagnóstico por imagem
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