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1.
Cardiovasc Revasc Med ; 21(3): 422-431, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31302013

RESUMO

Paravalvular leak (PVL) is an important complication after surgical valve replacement and might lead to serious clinical results, including heart failure and/or hemolytic anemia. PVLs are the result of an incomplete seal between the sewing ring and annulus. It frequently affects surgical valves in the mitral position, occurring in 5% to 15% of valve replacements. For years, surgery has been considered the only treatment for symptomatic patients with PVLs. However, surgical re-intervention for PVLs is associated with a high risk of morbidity and mortality. Therefore, percutaneous treatment of PVL has become first-line therapy for most patients with symptomatic PVL. In this review, we will briefly summarize clinical findings, diagnostic modalities, laboratory assessment, surgical treatment, transcatheter approaches, device choice and outcomes of interventions in mitral PVLs.

2.
Acta Cardiol ; 75(1): 20-25, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30513267

RESUMO

Background: Angiotensin receptor neprilysin inhibitor (ARNI, sacubitril/valsartan) reduces sudden death in heart failure with reduced ejection fraction (HFrEF). Corrected QT (QTc), T-wave peak to T-wave end interval (Tp-e) and Tp-e/QTc are electrocardiographic indices of ventricular repolarization heterogeneity. We aimed to assess the effects of switching from ramipril to ARNI on electrocardiographic indices of ventricular repolarization.Methods: A total of 48 patients with HFrEF (mean age: 63.3 ± 11.7 years; 36 males, 77.1% ischaemic etiology) were enrolled. All patients had New York Heart Association functional class II-III, left ventricular ejection fraction ≤35% and previously switched from ramipril to ARNI treatment. The standard 12-lead electrocardiograms on ramipril treatment and 1 month after ARNI treatment were analysed; heart rate, QTc, Tp-e and Tp-e/QTc were calculated. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores and N-terminal pro-BNP (NT-proBNP) values were recorded.Results: QTc (415.2 ± 19.7 ms vs. 408.5 ± 20.8 ms, p = 0.022), Tp-e (100.7 ± 13.8 ms vs. 92.9 ± 12.1 ms, p < 0.001), Tp-e/QTc (0.242 ± 0.028 vs. 0.227 ± 0.029, p = 0.003) and heart rate (73.2 ± 4.7 bpm vs. 71.1 ± 4.9 bpm, p = 0.027) were reduced after ARNI. ARNI switch associated with improvement in MLWHFQ scores (32.4 ± 7.1 ms vs. 22.6 ± 7.0 ms, p < 0.001) and reduction of NT-proBNP (2457 ± 1879 pg/ml to 1377 ± 874 pg/ml, p < 0.001). Pearson's correlation analysis revealed moderate correlations of MLWHFQ score with Tp-e (r = 0.543, p = 0.001) and Tp-e/QTc (r = 0.556, p = 0.001).Conclusions: Switching from ramipril to ARNI favourably alters QTc, Tp-e and Tp-e/QTc in HFREF. ARNI reduces symptoms of HFREF assessed by MLWHFQ and lowers NT-proBNP levels. Reduction in Tp-e and Tp-e/QTc correlate with clinical improvement in patients with HFrEF.

4.
Herz ; 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796977

RESUMO

BACKGROUND: Angiotensin receptor neprilysin inhibitors (ARNI; sacubitril/valsartan combination) decrease morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). Increased P­wave duration and P­wave dispersion (Pd) reflect prolongation of atrial conduction and correlate with atrial fibrillation. Here, we aimed to assess the effects of switching from valsartan to ARNI treatment on the basis of P­wave indices. METHODS: A total of 28 patients with HFrEF (mean age, 64.8 ± 10.6 years; 18 males, 78.6% ischemic etiology) were included. All patients had New York Heart Association functional class II-III, left ventricular ejection fraction ≤35%, and had been switched from valsartan to ARNI treatment. Standard 12-lead electrocardiograms from patients on valsartan treatment and electrocardiograms 1 month after ARNI treatment were analyzed; heart rate, maximum P­wave duration (Pmax), minimum P­wave duration (Pmin), and Pd were calculated. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores and N­terminal pro-brain natriuretic peptide (NT-proBNP) values were recorded. RESULTS: The Pmax (135.6 ± 32.1 ms vs. 116.1 ± 14.1 ms, p = 0.041) and Pd (33.6 ± 7.9 vs. 28.6 ± 5.3, p = 0.006) values were significantly reduced after ARNI treatment. Furthermore, ARNI treatment was associated with an improvement in MLWHFQ scores (31.2 ± 6.2 ms vs. 23.2 ± 7.0 ms, p < 0.001) and with a reduction in NT-proBNP values (1827.3 ± 1287.3 pg/ml vs. 1074.4 ± 692.3 pg/ml, p < 0.001). There were moderately positive correlations between the reduction in Pd and the improvement in MLWHFQ scores (r = 0.408, p = 0.031) and the reduction in NT-proBNP values (r = 0.499, p = 0.007) CONCLUSION: Switching to ARNI treatment alters Pd and Pmax favorably in patients with HFrEF. The reduction in atrial inhomogeneous conduction assessed by Pd was correlated with clinical improvement and reduced NT-proBNP levels in patients with HFrEF.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31821482

RESUMO

BACKGROUND: Most clinical risk stratification models are based on measurement at a single time-point rather than serial measurements. Artificial intelligence (AI) is able to predict one-dimensional outcomes from multi-dimensional datasets. Using data from GARFIELD-AF registry, a new AI model was developed for predicting clinical outcomes in atrial fibrillation (AF) patients up to 1 year based on sequential measures of PT-INR within 30 days of enrolment. METHODS AND RESULTS: Patients with newly diagnosed AF who were treated with vitamin K antagonists (VKA) and had at least 3 measurements of PT-INR taken over the first 30 days after prescription were analyzed. The AI model was constructed with multilayer neural network including long short-term memory (LSTM) and one-dimensional convolution layers. The neural network was trained using PT-INR measurements within days 0-30 after starting treatment and clinical outcomes over days 31-365 in a derivation cohort (cohorts 1-3; n = 3185). Accuracy of the AI model at predicting major bleed, stroke/SE, and death was assessed in a validation cohort (cohorts 4-5; n = 1523). The model's c-statistic for predicting major bleed, stroke/SE, and all-cause death was 0.75, 0.70, and 0.61, respectively. CONCLUSIONS: Using serial PT-INR values collected within 1 month after starting VKA, the new AI model performed better than time in therapeutic range (TTR) at predicting clinical outcomes occurring up to 12 months thereafter. Serial PT-INR values contain important information that can be analyzed by computer to help predict adverse clinical outcomes.

6.
J Interv Card Electrophysiol ; 56(1): 99-115, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31482331

RESUMO

Energy drinks are increasingly used by young people and young athletes in order to improve their performance alone or in association of other substances, particularly alcohol. In recent years, a number of reports of reports have raised attention on the side-effects associated with the use or abuse of energy drinks particularly serious cardiovascular events. The European Cardiac Arrhythmia Society (ECAS) has undertaken a systematic and critical review of reported data on cardiovascular events including life-threatening arrhythmias with or without cardiac arrest and other cardiovascular events, and discussed in this review the possible causal effect of caffeine and other ingredients contained in energy drinks and the reported events. Twenty-two cardiovascular events were reported in association with the use or abuse of energy drinks. The European Cardiac Arrhythmia Society would like to draw attention on the possible cardiovascular complications that may occur with the consumption of these beverages and to emphasize the prevention measures to be taken particularly in the young population. Well-designed prospective studies are needed to clarify the possible role of energy drinks in inducing the cardiovascular events reported.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Bebidas Energéticas/efeitos adversos , Consenso , Europa (Continente) , Humanos , Fatores de Risco , Sociedades Médicas
7.
Anatol J Cardiol ; 21(5): 272-280, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31062761

RESUMO

The corner stone of atrial fibrillation therapy includes the prevention of stroke with less adverse effects. The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) study provided data to compare treatment strategies in Turkey with other populations and every-day practice of stroke prevention management with complications. METHODS: GARFIELD-AF is a large-scale registry that enrolled 52,014 patients in five sequential cohorts at >1,000 centers in 35 countries.This study initiated to track the evolution of global anticoagulation practice, and to study the impact of NOAC therapy in AF. 756 patients from 17 enrolling sites in Turkey were in cohort 4 and 5.Treatment strategies at diagnosis initiated by CHA2DS2-VASc score, baseline characteristics of patients, treatment according to stroke and bleeding risk profiles, INR values were analyzed in cohorts.Also event rates during the first year follow up were evaluated. RESULTS: AF patients in Turkey were mostly seen in young women.Stroke risk according to the CHADS2 score and CHA2DS2-VASc score compared with world data. The mean of risk score values including HAS-BLED score were lower in Turkey than world data.The percentage of patients receiving FXa inhibitor with or without an antiplatelet usage was more than the other drug groups. All-cause mortality was higher in Turkey. Different form world data when HAS-BLED score was above 3, the therapy was mostly changed to antiplatelet drugs in Turkey. CONCLUSION: The data of GARFIELD-AF provide data from Turkey about therapeutic strategies, best practices also deficiencies in available treatment options, patient care and clinical outcomes of patients with AF.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral/epidemiologia , Fatores Etários , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Estudos de Coortes , Feminino , Saúde Global , Humanos , Incidência , Masculino , Padrões de Prática Médica , Estudos Prospectivos , Sistema de Registros , Fatores Sexuais , Acidente Vascular Cerebral/prevenção & controle , Turquia/epidemiologia
8.
Eur J Heart Fail ; 21(5): 553-576, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30989768

RESUMO

Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies. In DCM, HF with reduced ejection fraction (HFrEF) has high incidence and prevalence and represents the most frequent cause of death, despite improvements in treatment. In addition, advanced HF in DCM is one of the leading indications for heart transplantation. In HCM, HF with preserved ejection (HFpEF) affects most patients with obstructive, and ∼10% of patients with non-obstructive HCM. A timely treatment is important, since development of advanced HF, although rare in HCM, portends a poor prognosis. In RCM, HFpEF is common, while HFrEF occurs later and more frequently in amyloidosis or iron overload/haemochromatosis. Irrespective of RCM aetiology, HF is a harbinger of a poor outcome. Recent advances in our understanding of the mechanisms underlying the development of HF in cardiomyopathies have significant implications for therapeutic decision-making. In addition, new aetiology-specific treatment options (e.g. enzyme replacement therapy, transthyretin stabilizers, immunoadsorption, immunotherapy, etc.) have shown a potential to improve outcomes. Still, causative therapies of many cardiomyopathies are lacking, highlighting the need for the development of effective strategies to prevent and treat HF in cardiomyopathies.

10.
Acta Cardiol Sin ; 35(1): 75-84, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30713402

RESUMO

Background: Lead exposure causes a wide range of vascular diseases through oxidative stress, sympathetic hyperactivity and impairment in nitric oxide bioavailability. In this study, the association between the effects of lead exposure on left ventricular diastolic indices and erectile function were assessed. Methods: A total of 94 lead-exposed workers without known cardiovascular diseases or risk factors and 30 healthy subjects were enrolled. Systolic and diastolic functions were measured using transthoracic echocardiography. All participants were non-smokers. The International Index of Erectile Function Questionnaire (IIEF-5) was used to diagnose and grade erectile dysfunction (ED). Echocardiographic parameters, IIEF-5 score and blood lead level (BLL) were analyzed. Results: The mean age and median BLL were 32.3 ± 6.4 years and 19 µg/dL in the workers, respectively. Sixty-five (69.1%) workers and 9 control subjects (30%) had ED. The IIEF-5 score was lower in the workers (17.0 ± 6.1) than in the controls (22.7 ± 2.1). In the workers, E and e' waves and E/A ratio were lower, and A wave, E/e' ratio, and left atrial volume index (LAVI) were higher than in the controls. Additionally, BLL was correlated with IIEF-5 score, e' wave, and E/e' ratio. IIEF-5 score was correlated with e' wave, E/e' ratio and LAVI. BLL was an independent risk factor for a decreased e' wave and IIEF-5 score and increased E/e' ratio in the lead-exposed workers. Conclusions: Impairment of diastolic and erectile functions, despite a younger age and in the absence of accompanying risk factors, was correlated with increased BLL.

12.
Acta Cardiol Sin ; 34(6): 488-495, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30449989

RESUMO

Purpose: The objectives of this study were to: (i) evaluate endothelial function via fingertip reactive hyperemia peripheral arterial tonometry (RH-PAT) among heart failure (HF) patients receiving cardiac resynchronization therapy (CRT), (ii) assess the effects of CRT on RH-PAT score, and (iii) investigate whether RH-PAT score can identify CRT response. Methods: A total of 63 patients (61.8 ± 10.3 years; 50 males; left ventricular (LV) ejection fraction 24.3 ± 3.9%) with HF who received CRT were enrolled. Endothelial function via RH-PAT was assessed 1 day before and 6 months after CRT. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used to assess clinical improvements. CRT response was defined as a reduction in LV end-systolic volume ≥ 15% at 6 months. Results: A RH-PAT score of < 1.7 signified a cut-off for endothelial dysfunction (ED). Baseline ED was observed among 43 (68.3%) patients and was more prevalent in responders (76.1% vs. 47.1%, p = 0.037). RH-PAT score improved 6 months after CRT (1.58 ± 0.35 vs. 1.71 ± 0.31, p = 0.012). A RH-PAT score of < 1.7 was a significant independent predictor of CRT response in multivariate logistic regression analysis (ß = 1.275, OR = 3.512, 95% CI = 1.231-11.477, p = 0.032). The severity of ED was an independent predictor of LV reverse remodeling (ß = -8.873, p = 0.015). Spearman's correlation analysis revealed moderate positive correlations between an improvement in RH-PAT (ΔRH-PAT) and LV reverse remodeling (r = 0.461, p = 0.001) and MLWHFQ score (r = 0.440, p = 0.001). Conclusions: ED detected via RH-PAT could predict the response to CRT. The RH-PAT score increased 6 months after CRT and was correlated with echocardiographic and clinical improvements.

15.
Blood Press Monit ; 23(4): 203-209, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29738357

RESUMO

OBJECTIVE: The aim of the present cross-sectional study was to evaluate the autonomic nervous system by dynamic pupillometry (DP) in normotensive and hypertensive individuals with either a non-dipper-type or a dipper-type circadian rhythm of blood pressure (BP). PATIENTS AND METHODS: A total of 80 patients were allocated into four groups: normotensive/dipper (n=23), normotensive/nondipper (n=19), hypertensive/dipper (n=18), and hypertensive/nondipper (n=20). Pupil diameters (R0, R1, R2, and R%): latency (Lc), amplitude (Ac), velocity (Vc), and duration (Tc) of pupil contraction: latency (Ld), velocity (Vd), and duration (Td) of pupil dilatation were measured by DP. Among the DP parameters, Vc and Ac were known parasympathetic indices and R% was the major sympathetic index. RESULTS: Vc and Ac were higher in the dipper normotensives with respect to nondipper normotensives (Vc=5.19±0.85 vs. 4.58±0.71, P=0.017; Ac=1.66±0.27 vs. 1.49±0.28, P=0.048). Vc and Ac were higher in dipper hypertensives with respect to the nondipper subgroup of hypertensive cases (Vc=4.44±0.81 vs. 3.94±0.45, P=0.024; Ac=1.47±0.26 vs. 1.27±0.11, P=0.004). R% was higher in the nondipper subgroup of hypertensives than the dipper subgroup of hypertensive cases (36.7±4.8 vs. 33.5±3.8, P=0.033). Correlation analyses showed moderate positive correlations of night-time decline in BP with Vc (r=0.460, P=0.001) and Ac (r=0.420, P=0.001). There was also a negative correlation between night-time decline in BP and R% (r=-0.259, P=0.001). CONCLUSION: Nondipping in BP is associated with lower parasympathetic activity both in normotensive and in hypertensives cases. Furthermore, in the nondipper subgroup of hypertensive cases, there is higher sympathetic activity than the dipper subgroup.


Assuntos
Pressão Arterial/fisiologia , Hipertensão/fisiopatologia , Sistema Nervoso Parassimpático/fisiopatologia , Pupila/fisiologia , Reflexo Pupilar , Adulto , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano/fisiologia , Estudos Transversais , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Turk Kardiyol Dern Ars ; 46(2): 84-91, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29512624

RESUMO

OBJECTIVE: Cardiac resynchronization therapy (CRT) induces structural and electrical reverse remodeling of the failing heart. However, the association between native QRS narrowing and cardiac fibrosis markers has not been investigated in patients with an implanted CRT device. METHODS: A total of 41 symptomatic patients diagnosed with systolic heart failure who underwent CRT implantation were included in this study. Electrocardiogram findings and cardiac fibrosis marker levels [galectin-3, growth-differentiation factor-15 (GDF-15) and procollagen III N-terminal propeptide (P3TD)] were collected before and 12 months after initiation of biventricular pacing. Reverse electrical remodeling was defined as a decrease in 12-month intrinsic QRS (iQRS) duration by ≥20 milliseconds after CRT implantation. RESULTS: The median QRS duration decreased from 155 milliseconds (interquartile range [IQR]: 142-178 milliseconds) before CRT to 142 milliseconds (IQR: 130-161 milliseconds) (p=0.001) after 12 months of CRT. According to the predefined criteria, electrical remodeling was detected in 16 (39.0%) patients. The median galectin-3, GDF-15, and P3TD levels were significantly decreased after CRT implantation in patients with electrical remodeling [27.65 ng/mL (IQR: 24.4-35.2 ng/mL) vs 23.00 ng/mL (IQR: 16.0-36.7 ng/mL), p=0.017; 3104 pg/mL (IQR: 2923-4825 pg/mL) vs 2276 pg/mL (IQR: 1294-3209 pg/mL), p=0.002; 0.43 ng/mL (IQR: 0.23-0.64) vs 0.15 ng/mL (IQR: 0.04-0.29 ng/mL), p=0.034, respectively]. The galectin-3, GDF-15, and P3TD levels were not significantly changed in patients without electrical remodeling [26.80 ng/mL (IQR: 23.9-31.5 ng/mL) vs 28.80 ng/mL (IQR: 23.0-34.8 ng/mL), p=0.211; 4221 pg/mL (IQR: 2709-4995 pg/mL) vs 3035 pg/mL (IQR: 2038-4872 pg/mL), p=0.143; and 0.34 ng/mL (IQR: 0.11-0.68 ng/mL) vs 0.21 ng/mL (IQR: 0.09-0.37 ng/mL), p=0.112, respectively]. CONCLUSION: The results from the small sample used in this study indicated that electrical reverse remodeling after CRT was associated with a decrease in cardiac fibrosis.


Assuntos
Remodelamento Atrial/fisiologia , Biomarcadores/sangue , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Cardiomiopatias/sangue , Idoso , Cardiomiopatias/epidemiologia , Estudos de Coortes , Ecocardiografia , Feminino , Fibrose , Galectina 3/sangue , Fator 15 de Diferenciação de Crescimento/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/sangue , Pró-Colágeno/sangue
18.
Turk Kardiyol Dern Ars ; 46(2): 92-102, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29512625

RESUMO

OBJECTIVE: The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patient quality of life. METHODS: A clinical surveillance study was conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recorded at baseline, the 6th month, and the 12th month in NVAF patients. RESULTS: Of 210 patients (57.1% male; mean age: 64.86±12.87 years), follow-up data were collected for 146 patients through phone interviews at the 6th month and 140 patients at the 12th month. At baseline, most patients had high CHADS2 score (≥2: 48.3%) and CHA2DS2-VASc (≥2: 78.7%) risk scores but a low HAS-BLED (0-2: 83.1%) score. Approximately two-thirds of the patients surveyed were using oral anticoagulants as an antithrombotic and one-third were using antiplatelet agents. The rate of persistence with initial treatment was approximately 86%. Bleeding was reported by 22.6% and 25.0% of patients at the 6th and 12th month, respectively. The proportion of patients with an INR of 2.0-3.0 was 41.8% at baseline, 65.7% at the 6th month, and 65.9% at the 12th month. The time in therapeutic range was 61.0% during 1 year of follow-up. The median EuroQol 5-dimensional health questionnaire (EQ-5D) score of the patients at baseline and the 12th month was 0.827 and 0.778, respectively (p<0.001). The results indicated that patient quality of life declined over time. CONCLUSION: In atrial fibrillation, despite a high rate of persistence with initial treatment, the outcomes of stroke prevention and patient quality of life are not at the desired level. National health policies should be developed and implemented to better integrate international guidelines for the management of NVAF into clinical practice.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Idoso , Feminino , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Estudos Prospectivos , Medição de Risco , Atenção Terciária à Saúde , Resultado do Tratamento , Turquia/epidemiologia
19.
Europace ; 20(3): 395-407, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29300976

RESUMO

There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Cardiologia/normas , Prestação Integrada de Cuidados de Saúde/normas , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Consenso , Difusão de Inovações , Humanos , Valor Preditivo dos Testes , Resultado do Tratamento
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