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1.
Clin Res Cardiol ; 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31478072

RESUMO

BACKGROUND: The aim of this study was to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BiAV) stenosis using a mechanically expanded Lotus™ device. The prior experience with first-generation devices showed disappointing results mainly due to increased prevalence of aortic regurgitation (AR) that exceeded those observed in tricuspid stenosis. METHODS AND RESULTS: We collected baseline, in-hospital, 30-day and 2-year follow-up data from a prospective, multicentre registry of patients with BiAV undergoing TAVI using Lotus™ valve. Safety and efficacy endpoints were assessed according to VARC-2 criteria. The study group comprised 24 patients. The mean age was 73.5 years and the mean EuroSCORE 2 was 4.35 ± 2.56%. MDCT analysis revealed Type 1 BiAV in 75% of patients. The mean gradient decreased from 60.1 ± 18.3 to 15 ± 6.4 mm Hg, the AVA increased from 0.6 ± 0.19 to 1.7 ± 0.21 cm2. One in-hospital death was observed secondary to aortic perforation. There was no severe AR and the rate of moderate AR equalled 9% at 30 days (n = 2). Device success was achieved in 83% and the 30-day safety endpoint was 17%. In the 2-year follow-up, the overall mortality was 12.5% and the 2-year composite clinical efficacy endpoint was met in 25% of the patients (n = 6) CONCLUSIONS: The TAVI in selected BiAV patients using the Lotus™ is feasible and characterized by encouraging valve performance and mid-term clinical outcomes.

2.
N Engl J Med ; 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31475798

RESUMO

BACKGROUND: Patients with stable coronary artery disease and diabetes mellitus who have not had a myocardial infarction or stroke are at high risk for cardiovascular events. Whether adding ticagrelor to aspirin improves outcomes in this population is unclear. METHODS: In this randomized, double-blind trial, we assigned patients who were 50 years of age or older and who had stable coronary artery disease and type 2 diabetes mellitus to receive either ticagrelor plus aspirin or placebo plus aspirin. Patients with previous myocardial infarction or stroke were excluded. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was major bleeding as defined by the Thrombolysis in Myocardial Infarction (TIMI) criteria. RESULTS: A total of 19,220 patients underwent randomization. The median follow-up was 39.9 months. Permanent treatment discontinuation was more frequent with ticagrelor than placebo (34.5% vs. 25.4%). The incidence of ischemic cardiovascular events (the primary efficacy outcome) was lower in the ticagrelor group than in the placebo group (7.7% vs. 8.5%; hazard ratio, 0.90; 95% confidence interval [CI], 0.81 to 0.99; P = 0.04), whereas the incidence of TIMI major bleeding was higher (2.2% vs. 1.0%; hazard ratio, 2.32; 95% CI, 1.82 to 2.94; P<0.001), as was the incidence of intracranial hemorrhage (0.7% vs. 0.5%; hazard ratio, 1.71; 95% CI, 1.18 to 2.48; P = 0.005). There was no significant difference in the incidence of fatal bleeding (0.2% vs. 0.1%; hazard ratio, 1.90; 95% CI, 0.87 to 4.15; P = 0.11). The incidence of an exploratory composite outcome of irreversible harm (death from any cause, myocardial infarction, stroke, fatal bleeding, or intracranial hemorrhage) was similar in the ticagrelor group and the placebo group (10.1% vs. 10.8%; hazard ratio, 0.93; 95% CI, 0.86 to 1.02). CONCLUSIONS: In patients with stable coronary artery disease and diabetes without a history of myocardial infarction or stroke, those who received ticagrelor plus aspirin had a lower incidence of ischemic cardiovascular events but a higher incidence of major bleeding than those who received placebo plus aspirin. (Funded by AstraZeneca; THEMIS ClinicalTrials.gov number, NCT01991795.).

3.
Pol Arch Intern Med ; 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31517898

RESUMO

INTRODUCTION: Takotsubo syndrome (TTS) is an acute revesible left ventricular dysfunction which occurs mainly in postmenopausal women. OBJECTIVES: The goal of this study was to compare course of disease and prognoses in male and female patients with TTS in two large Polish academic hospitals. PATIENTS AND METHODS: The analysis included 232 patients (211 women and 21 men) hospitalized at the 1st Department of Cardiology, Warsaw and 1st Department of Cardiology, Gdansk. RESULTS: Men who developed TTS were more likely to live alone than women. Physical stress was trigger of TTS more often in men than women. There were no differences in the frequency of risk factors and comorbidities, with the exception of higher prevalence of smoking in men. Concerning the cardiac biomarkers, both at admission and peak NTproBNP levels were significantly more elevated in women.  ST depression was found more frequently in men than in women (6.2 vs. 25%). Ejection fraction was lower among male patients at discharge (50 vs. 60%), despite the same length of hospitalization. In-hospital outcome (arrhytmias, mechanical complications, cardiogenic shock, mortality) was similar in both groups. Beta-adrenolytics and statins were more frequently prescribed for women than for men (74.5 vs 52.4% and 68.3 vs 38.1%, respectively). Moreover, there was a tendency toward more frequent use of P2Y12 inhibitors for men (23.8 vs 10.4%). CONCLUSIONS: There are some differences in clinical course of male and female patients with TTS. However, in-hospital outcome was similar.

5.
Auton Neurosci ; 220: 102555, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331695

RESUMO

PURPOSE: Long-term ß-adrenolytics treatment in takotsubo syndrome (TTS) patients is based on the premise, that TTS is strongly associated with sympathetic nervous system overactivity. The aim of the study was to establish hemodynamic response to tilt, handgrip and Valsalva manoeuvre in patients with takotsubo syndrome compared to healthy subjects (CONTROL) and patients after ST Elevation Myocardial Infarction (STEMI). MATERIAL AND METHOD: Echocardiographic examination was performed at rest, ECG and continuously non-invasively measured arterial blood pressure were used for evaluation of hemodynamic responses to Valsalva manoeuvre, static handgrip (HG) followed by post-exercise ischemia, and tilt. Ten healthy women, 20 with TTS and 20 after STEMI, mean age 64 ±â€¯8.5 years, participated in the study. RESULTS: Pressor response to Valsalva manoeuvre and tilt in TTS group was diminished in comparison to CONTROL and close to that of STEMI. During HG, increase of SBP was the lowest in TTS group. Data indirectly suggest that it was due to deficient stroke volume in TTS and STEMI patients during these manoeuvres; though echocardiographic findings at rest did not reveal any significant differences between groups. CONCLUSIONS: Our data show that despite apparent resolution of the immediate effects of TTS, impaired response to cardiovascular challenge, similar to that in STEMI patients, persisted. As the manoeuvres applied mimic daily life situations, causes of impairment should be searched for and potential health risk evaluated.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31359325

RESUMO

Both transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) have been proven to effectively correct von Willebrand Factor (vWF) pathologies, however there is limited data simultaneously comparing outcomes of both approaches. We prospectively enrolled patients with severe aortic stenosis referred for TAVI (n = 52) or SAVR (n = 48). In each case, vWF antigen (vWF:Ag), vWF activity (vWF:Ac) and activity-to-antigen (vWF:Ac/Ag) ratio were assessed at baseline, 24 h and 72 h after procedure. VWF abnormalities were defined as reduced vWF:Ac/Ag ratio (< 0.8). Bleeding events in both arms were classified according to Valve Academic Research Consortium (VARC-2) definitions. Overall, there was no difference between patients referred for TAVI and SAVR in vWF:Ac (1.62 ± 0.52 vs 1.71 ± 0.64; p = 0.593), vWF:Ag (1.99 ± 0.81 vs 2.04 ± 0.81; p = 0.942) or vWF:Ac/Ag ratio (0.84 ± 0.16 vs 0.85 ± 0.12; p = 0.950). Pathological vWF:Ac/Ag ratio was found in 20 (38%) TAVI and 15 (31%) SAVR patients (p = 0.407). Normalization of vWF:Ac/Ag ratio at day 3 after procedure was achieved in 19 (95%) TAVI and 13 (87%) SAVR patients (p = 0.439). Similar prevalence of major or life-threatening bleedings (MLTB) after TAVI and SAVR in entire groups was observed (19% vs. 23%, p = 0.652). VWF abnormalities were associated with higher incidence of MLTB in SAVR (53% vs 9%, p < 0.001), but not TAVI (15% vs. 22%, p = 0.132). Accordingly, in receiver-operating characteristic curve analysis vWF:Ac/Ag ratio < 0.8 showed significant sensitivity and specificity for predicting MLTB in SAVR group (AUC 0.735, 95% CI 0.538-0.931, p = 0.019). We proved that abnormal function of vWF is corrected successfully after both TAVI and SAVR, but vWF abnormalities are predictive of MLTB only in surgical patients.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31343827

RESUMO

BACKGROUND: There is paucity of data on acute performance of Fantom (REVA Medical, CA), a second generation sirolimus-eluting bioresorbable scaffold (BRS), in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. The aim of this study was to evaluate safety and efficacy of the Fantom BRS in the acute setting of STEMI characterized by thrombogenic milieu. METHODOLOGY: Ten STEMI patients treated with a sirolimus-eluting Fantom BRS were enrolled into prospective, observational study. The scaffold sizing, positioning, and optimization were optical coherence tomography (OCT) guided. The primary end-point was the device-oriented composite endpoint (DOCE), additionally angiographic and OCT analysis were performed. RESULTS: The primary-end point, defined as DOCE, did not occur in any patient within the 30-day follow-up. The procedural and angiographic success rates were both 100%, there was no case of scaffold thrombosis, target lesion revascularization nor death. In QCA, an in-device minimum lumen diameter was 2.89 ± 0.24 mm and the residual diameter stenosis was 3.56 ± 3.17%. OCT revealed an incomplete scaffold apposition in five patients with an average of seven malapposed struts per scaffold and mean distance of 120 ± 30 µm. There was no proximal edge dissection, the distal edge dissection was recorded in one patient. CONCLUSIONS: This is the first pilot study evaluating safety and efficacy of the Fantom BRS, a second generation fully bioresorbable coronary scaffold, in STEMI patients undergoing primary PCI with OCT guidance. Fantom BRS showed adequate safety and efficacy in the acute 30-day angiographic, OCT, and clinical follow-up.

8.
Cardiol J ; 2019 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-31225634

RESUMO

BACKGROUND: The frequency of cardiac implantable electronic device (CIED) implantations is constantly increasing. Pericardial effusion (PE) and tricuspid regurgitation (TR) may occur after CIED implantation. The aim of the present study is to evaluate the prevalence and risk factors for new occurrences or progression of TR and PE early after CIED implantation. METHODS: This is an on-going, single-center, observational study of patients after their first CIED implantation, with an echocardiographic evaluation within 60 days before and 7 days after the procedure. Data are presented for first 110 consecutive patients who underwent CIED implantation from August 2015 to July 2016. RESULTS: Median age was 75 years, and 44% were women. In total, 87 (79%) pacemakers, 21 (19%) implantable cardioverter-defibrillators and 2 cardiac resynchronization therapy devices were implanted. After CIED implantation, there was TR progression in 17 (16%) patients: 5 patients developed moderate TR, none developed severe TR. An increase in TR was more often observed after implantations performed by operators in training than by certified operators (35% vs. 12%, p = 0.02). New PE after the procedure was observed in 8 (7%) patients and was trivial (< 5 mm) in all cases. Patients with new PE after implantation had lower baseline hemoglobin levels and tended to be women. CONCLUSIONS: New PE and an increase in TR severity are rare complications early after CIED implantation. Operator experience might be related to TR progression. Increasing the number of patients in the current on-going study will allow a more reliable assessment of the prevalence and risk factors of these complications.

9.
Pol Arch Intern Med ; 129(6): 386-391, 2019 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-31169258

RESUMO

INTRODUCTION: Previous studies demonstrated a possible positive effect of a smoking ban in public places on cardiovascular outcomes. However, little is known about the influence of such regulations in Poland, a country with a high cardiovascular risk. OBJECTIVES: We aimed to evaluate the association of hospitalization rates for acute myocardial infarction (AMI) in Poland before and after the introduction of the smoking ban in public places in November 2010. PATIENTS AND METHODS: The Nationwide Acute Myocardial Infarction Database (AMI­PL) was searched for the cases of AMI that occurred between 2009 and 2014. The analysis considered sex, age (20-64 years vs 65 years or older), and the place of residence (rural vs urban area). There were no specific exclusion criteria. RESULTS: The overall average number of AMI hospitalizations in the years 2009-2010, 2011-2012, and 2013-2014 was 79 323, 80 783, and 77 356, respectively. Age­standardized rates of AMI hospitalizations in both sexes and age groups decreased only slightly in the first 2 years and were more visible in the years following the implementation of the smoking ban. In men, the decrease was observed in both age groups and almost in the whole country. In younger women, the decrease was not observed in towns with more than 100 000 inhabitants. In large towns (over 500 000 inhabitants), mostly a nonsignificant decrease occurred. CONCLUSIONS: After the introduction of the smoking ban, a marked decrease in age­standardized AMI hospitalizations was observed in long­term follow­up both in men and women as well as both in younger and older patients, but with differences regarding the place of residence.

10.
Artigo em Inglês | MEDLINE | ID: mdl-31135569

RESUMO

PURPOSE: Clinical symptoms and electrocardiographic changes in patients with Takotsubo syndrome can be similar to patients with myocardial infarction. The aim of the study was to assess the impact of SPECT/CT imaging on the diagnosis and management of Takotsubo syndrome (TTS). METHODS: Gated single photon emission computed tomography (SPECT)/CT after injection 99Tc-MIBI in resting conditions was performed in 27 patients with TTS using dual-head Symbia T6SPECT/CT hybrid device. CT data were used for attenuation correction of SPECT images and to assess the risk of coronary artery disease on the basis of coronary artery calcium score. RESULTS: Abnormal myocardial perfusion was found in 20/27 patients. The mean defect size was 9.8 cm, the extent 11.7%, mean total perfusion defect was 10.36%, mean summed rest score (SRS) 6.71.Left ventricle ejection fraction was lower in patients with SRS at least 4 than in patients with SRS less than 4. Perfusion defect size, total perfusion defect, number of akinetic segments in echocardiography and number of segments with perfusion defect in SPECT were higher in the group with SRS at least 4. The applied attenuation correction algorithms did not change the result of our SPECT study. CONCLUSION: In the majority of patients with TTS perfusion in SPECT was normal or only minor perfusion defect was observed. Application of CT attenuation correction did not change the final result of myocardial perfusion imaging; therefore, the CT component of the SPECT/CT study performed for attenuation correction is not useful for TTS diagnosis.

11.
Heart ; 105(17): 1310-1315, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31040170

RESUMO

OBJECTIVE: We aimed to identify predictors of left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and to enhance the prognostic value of the CHA2DS2-VASc score. METHODS: Derivation cohort included 1033 consecutive AF patients referred for catheter ablation or direct current cardioversion, in whom transoesophageal echocardiography (TOE) was performed prior to the procedure. Logistic regression analysis was used to identify predictors of LAA thrombus on TOE. Receiver operating characteristic (ROC) curves were constructed to compare the newly developed score with the CHA2DS2 and CHA2DS2-VASc scores in the derivation and the validation (n=320) cohort. RESULTS: On TOE, LAA thrombus was present in 59 (5.7%) patients in the derivation cohort. Aside from variables encompassed by the CHA2DS2-VASc score, LAA thrombus predictors included AF type (persistent/'permanent' vs paroxysmal) and renal dysfunction. These predictors were incorporated into the CHA2DS2-VASc score. In ROC analysis, area under the curve (AUC) for the new score (CHA2DS2-VASc-RAF score) was significantly higher (0.81) than those for the CHA2DS2 and CHA2DS2-VASc scores (0.71 and 0.70, respectively). In the validation cohort, the CHA2DS2-VASc-RAF score also performed significantly better (AUC of 0.88) than the CHA2DS2 and CHA2DS2-VASc scores (AUC of 0.63 and 0.60, respectively). CONCLUSION: In real-world AF patients with majority on oral anticoagulation, LAA thrombus was found in approximately 6%. Two variables not included in the CHA2DS2-VASc score (AF type and renal dysfunction) proved strong, independent predictors of LAA thrombus and might improve thromboembolic risk stratification.

12.
Cardiol J ; 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30994183

RESUMO

BACKGROUND: Prompt reperfusion and post-resuscitation care, including targeted temperature management (TTM), improve survival in out-of-hospital cardiac arrest (OHCA) patients. To predict in-hospital mortality in OHCA patients treated with TTM, the Polish Hypothermia Registry Risk Score (PHR-RS) was developed. The use of dedicated risk stratification tools may support treatment decisions. METHODS: 376 OHCA patients who underwent TTM between 2012 and 2016 were retrospectively analysed and whose data were collected in the Polish Hypothermia Registry. A multivariate logistic regression model identified a set of predictors of in-hospital mortality that were used to develop a dedicated risk prediction model, which was tested for accuracy. RESULTS: The mean age of the studied population was 59.2 ± 12.9 years. 80% of patients were male, 73.8% had shockable rhythms, and mean time from cardiac arrest (CA) to cardiopulmonary resuscitation (CPR) was 7.2 ± 8.6 min. The inputs for PHR-RS were patient age and score according to the Mild Therapeutic Hypothermia (MTH) Scale. Criteria for the MTH score consisted of time from CA to CPR above 10 min, time from CA to the return of spontaneous circulation above 20 min, in-hospital CA, unwitnessed CA, and non-shockable rhythm, each counted as 1 point. The predictive value of PHR-RS was expressed as an area under the curve of 0.74. CONCLUSIONS: PHR-RS is one of the simplest and easiest models to use and enables a reliable prediction of in-hospital mortality in OHCA patients treated with TTM.

13.
Echocardiography ; 36(6): 1132-1138, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31012135

RESUMO

INTRODUCTION: Infective endocarditis (IE) may take different faces in patients after transcatheter aortic valve implantation (TAVI). OBJECTIVES: The primary aim of this study was to describe echocardiographic and clinical characteristics of TAVI's patients suffered from IE. METHODS: In a single-center, retrospective study we analyzed 311 consecutive patients treated with TAVI for severe aortic stenosis between 2010 and 2018. RESULTS: According to modified Duke criteria, we confirmed IE in 2.2% of the cohort, however PVE of TAVI's valve in 1.2% only; rest of the group suffered from CDRiE and IE of the mitral valve. In PVE's group vegetations were localized inside the frame with or without bioprosthesis moderate stenosis or regurgitation. Only 1 pts developed significant TAVI's bioprosthesis' paravalvular leak. We observed no native aortic anulus involvement. Mortality rate in the PVE-TAVI's group was 75% regardless of the type of treatment. CONCLUSIONS: The above findings show that IE following TAVI is a serious complication and various scenarios (also CDRiE and native valve IE) should be considered.

15.
Cardiol J ; 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30912577

RESUMO

BACKGROUND: Among patients with implanted cardiac implantable electronic device (CIED), ipsilateral upper extremity vein stenosis or occlusion (VSO) is observed more frequently than the in general population. However, there are no data available concerning relationship between hemostatic markers (and their dynamics) and occurrence of VSO. The aim of this study was to assess the predictive value of beta-thromboglobulin, von Wilebrand factor, fibrynogen and D-dimer for VSO development among first time CIED recipients. METHODS: We performed a single-center, prospective study of consecutive first time CIED recipients. In an ultrasound examination before CIED implantation the presence of upper extremity VSO was excluded. Biochemical data were collected from all the patients before CIED implantation (first measuring), up to seven days (second measuring) and six months after the operation (third measuring). Primary endpoint was defined as the presence of upper extremity VSO at the implantation site during the ultrasound examination six months after the operation. RESULTS: The study included 71 patients (mean age 73.1 + 10.5 years; 39 (55%) male). The incidence of VSO within 6-months follow up was 21.1%. Average concentrations of hemostatic markers increased significantly in all the patients immediately after CIED implantation. Serial hemostatic marker concentrations were similar in patients who met and did not meet the primary endpoint, apart from von Wilebrand factor. Its mean concentration was significantly elevated in a group who reached primary endpoint (p = 0.032). CONCLUSION: A significant increase in von Wilebrand factor concentration at six months post implantation may be a marker for VSO occurrence.

16.
Ann Transplant ; 24: 162-167, 2019 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-30898994

RESUMO

BACKGROUND The classical cardiovascular risk factors and changes in the circulatory system secondary to end-stage liver disease (ESLD) are associated with an increased risk of cardiac abnormalities (CAs) in patients waiting for liver transplantation (LTx). The aim of this study was to assess the relationship between the etiology of liver disease and the presence of CAs in patients qualified for LTx. MATERIAL AND METHODS The study enrolled patients qualified to LTx due to ESLD at the Clinical Hospital of the Medical University of Warsaw between 2013 and 2016. Out of 396 patients: 65, 157, 117, and 57 had ESLD due to the alcoholic liver disease (ALD), viral infections (VIR), autoimmune disorders (AUTO), and different etiologies (OTHER), respectively. RESULTS An increased frequency of hypertension and diabetes mellitus were observed in ALD and VIR groups, while for hyperlipidemia, the highest rates were observed in ALD and AUTO groups. Significant differences in CAs rates were observed for resting tachycardia, prolonged QT interval, bradycardia, and left ventricular diastolic dysfunction. After adjustment for age, MELD, and Child-Pugh scores, hyperlipidemia (26% vs. 7-15%, p<0.048) was most frequently observed in the AUTO group, while poor aerobic capacity (49% vs. 21-34%, p<0.009) dominated in the OTHER group. CONCLUSIONS The frequency of hyperlipidemia, and poor aerobic capacity were directly related to the etiology of liver disease, while the remaining associations resulted from effects of age, MELD, and Child-Pugh score.


Assuntos
Doenças Cardiovasculares/etiologia , Doença Hepática Terminal/complicações , Transplante de Fígado , Listas de Espera , Adulto , Doenças Autoimunes/complicações , Doenças Autoimunes/cirurgia , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/cirurgia , Feminino , Hepatite Viral Humana/complicações , Hepatite Viral Humana/cirurgia , Humanos , Hiperlipidemias/etiologia , Hepatopatias Alcoólicas/complicações , Hepatopatias Alcoólicas/cirurgia , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Período Perioperatório/efeitos adversos , Fatores de Risco
17.
Kardiol Pol ; 77(3): 380-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30835325

RESUMO

BACKGROUND: Heart failure (HF) has become an epidemic. A similar situation is also observed for atrial fibrillation (AF). The CHA2DS2-VASc score is one of the most useful tools for thromboembolic risk assessment. AIM: The aim of the study was to assess the prevalence of AF in patients with decompensated HF, who were divided into subgroups according to the CHA2DS2-VASc score. METHODS: We analysed the prevalence of AF in a group of 1108 patients (327 women) hospitalised due to HF decompensa- tion in medical centres of different referral levels. Twenty-one patients refused to participate in the registry. The data were collected from Polish centres included in the European Society of Cardiology Heart Failure Long-Term Registry. The recruit- ment period was from 2011 to 2014. The data were analysed retrospectively. Patients were divided into groups according to the CHA2DS2-VASC score. RESULTS: The study sample was characterised by a high occurrence of AF (44.3%), with the highest prevalence in patients with a CHA2DS2-VASC score ≥ 6 (61.3%, p = 0.01). CONCLUSIONS: The CHA2DS2-VASc score may be a useful tool for detecting patients with HF characterised by the highest risk of AF.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Índice de Gravidade de Doença , Adulto , Idoso , Fibrilação Atrial/complicações , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
18.
Cardiol J ; 26(2): 114-129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30761517

RESUMO

There is a great need for innovative technologies that will improve the health and quality of life (QoL) of Polish patients with cardiac problems. It is important that the safety and effectiveness of the technology are confirmed by scientific evidence on which guidelines and clinical recommendations are based. Scientific evidence for medical devices is also increasingly important for decision-making in finance approval from public funds. New technologies in cardiology and cardiac surgery contribute to improved patient QoL, increased treatment effectiveness and facilitated diagnosis. Hence, it is necessary to increase accessibility to such technologies, primarily through the development of clinical recommendations, and education of medical personnel in conjunction with public funding. The aim of this publication is to present the recommendations of leading experts in the field of cardiology and cardiosurgery, supported by clinical research results, regarding the use of the cited innovative medical technologies and solutions leading to their increased availability for Polish patients.

19.
Pol Arch Intern Med ; 129(2): 117-122, 2019 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-30758314

RESUMO

INTRODUCTION Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel remains a cornerstone of pharmacotherapy after percutaneous coronary intervention (PCI). It has been demonstrated that even up to 30% of patients receiving DAPT have inadequate response to clopidogrel, namely, high on­treatment platelet reactivity (HPR). The platelet to red cell distribution width (P­RDW) ratio represents an indicator of cardiovascular risk and may be related to HPR. OBJECTIVES The aim of the present study was to establish whether the P­RDW ratio predicts HPR in clopidogrel­treated patients undergoing elective PCI. PATIENTS AND METHODS This was a subanalysis of the prospective randomized­controlled ONSIDE TEST study. A total of 70 patients were included in the analysis, of whom 12 were identified with HPR. The HPR was defined as the values above the threshold of 208 platelet reactivity units (PRU >208) by the VerifyNowP2Y12 assay. RESULTS The P­RDW ratio was lower in patients with HPR than in those without HPR (mean [SD], 14.37 [4.13] vs 17.734 [4.96]; P = 0.03). A logistic regression analysis showed that the P­RDW ratio was associated with HPR (P = 0.03). Using a cut­off level of 15.23, the P­RDW ratio predicted HPR with a sensitivity of 69% and specificity of 75% (odds ratio, 6.67; 95% CI, 0.561-0.890; P = 0.02; are under the receiver operating characteristic curve, 0.723). CONCLUSIONS The P­RDW ratio may serve as a supplementary tool for identification of patients at risk of HPR. Further studies are warranted to assess its role in planning DAPT among patients undergoing PCI.

20.
Ann Biomed Eng ; 47(5): 1300-1313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30790099

RESUMO

Standard 12-lead ECG exercise testing is commonly used for screening of ischemic heart disease (IHD). We studied if high-resolution body surface potential mapping (HR-BSPM) during exercise offers advantages over current standards in noninvasive evaluation of IHD. This study was carried out on 90 IHD patients and 33 healthy controls. The 67-lead HR-BSPM was recorded at rest and during exercise. Twenty-one ECG parameters including classical ST criteria were compared. The effectiveness of methods was verified based on the results of SPECT and coronary angiography. The most effective parameters in the diagnosis of IHD were: amplitude parameter ΔST60 and δT parameter showing T-wave morphology changes during exercise. The sensitivities/specificities of ΔST60 and δT parameters for the HR-BSPM were 70/69 and 59/62%, while for the standard 12-lead ECG system they were: 63/62 and 59/56%. These results demonstrate the usefulness of HR-BSPM measurements during exercise. HR-BSPM resulted in higher sensitivities and specificities compared to the standard 12-lead exercise test. The advantage was partially associated with observed ischemic changes outside standard precordial leads position that were not visible when using the standard 12-lead exercise test. This justifies research into the optimization of the number and position of ECG leads in exercise testing.


Assuntos
Mapeamento Potencial de Superfície Corporal , Angiografia Coronária , Teste de Esforço , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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