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1.
Korean Circ J ; 50(2): 163-175, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31642215

RESUMO

BACKGROUND AND OBJECTIVES: Although anticoagulation with warfarin is recommended as an international normalized ratio (INR) of prothrombin time between 2.0 and 3.0 and mean time in the therapeutic range (TTR) ≥70%, little has been proven that universal criteria might be suitable in Korean atrial fibrillation (AF) patients. METHODS: We analyzed 710 patients with non-valvular AF who took warfarin. INR value and clinical outcomes were assessed during 2-year follow-up. Intensity of anticoagulation was assessed as mean INR value and TTR according to target INR range. Primary net-clinical outcome was defined as the composite of new-onset stroke and major bleeding. Secondary net-clinical outcome was defined as the composite of new-onset stroke, major bleeding and death. RESULTS: Thromboembolism was significantly decreased when mean INR was over 1.6. Major bleeding was significantly decreased when TTR was over 70% and mean INR was less than 2.6. Mean INR 1.6-2.6 significantly reduced thromboembolism (adjusted hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.19-0.85), major bleeding (HR, 0.43; 95% CI, 0.23-0.81), primary (HR, 0.50; 95% CI, 0.29-0.84) and secondary (HR, 0.45; 95% CI, 0.28-0.74) net-clinical outcomes, whereas mean INR 2.0-3.0 did not. Simultaneous satisfaction of mean INR 1.6-2.6 and TTR ≥70% was associated with significant risk reduction of major bleeding, primary and secondary net-clinical outcomes. CONCLUSIONS: Mean INR 1.6-2.6 was better than mean INR 2.0-3.0 for the prevention of thromboembolism and major bleeding. However, INR 1.6-2.6 and TTR ≥70% had similar clinical outcomes to INR 2.0-3.0 and TTR ≥70% in Korean patients with non-valvular AF.

2.
J Cardiothorac Surg ; 14(1): 196, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718656

RESUMO

BACKGROUND: Primary thrombosis of the pulmonary vasculatures without extra-pulmonary sources of embolism are uncommon. Here, we report 2 cases of thrombosis of the stump of the remnant pulmonary vasculatures after lung resection complicated by embolic events with review of the literature. CASE PRESENTATION: A 75-year-old female was consulted to evaluate cardiac source of embolism for acute cerebral infarction. The patient underwent left upper lobectomy because of lung cancer 2 years ago. Cardiovascular imaging revealed about 1.6 cm × 1.4 cm sized thrombus within the remnant stump of the left superior pulmonary vein. The patient was treated by anticoagulation with warfarin, because the patients refused surgical removal of thrombus. A 57-year-old female who had a history of right pneumonectomy 10 years ago presented with dyspnea. Cardiovascular imaging revealed 1.7 × 1.5 cm sized thrombus in the right pulmonary artery stump and small pulmonary embolism in the left lower segmental pulmonary artery. The patient was treated by long-term anticoagulation with warfarin, and the thrombus and pulmonary embolism were resolved. CONCLUSION: The present cases demonstrated that very late thrombosis of the remnant pulmonary vascular structures and subsequent fatal embolic complications can develope even several years later after lung resection. Therefore, the dead space of the remnant vascular structures should be minimized during lung resection surgery, and the developement of delayed thromboembolic complications associated with vascular stump thrombosis should be carefully monitored.


Assuntos
Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Embolia Pulmonar/etiologia , Veias Pulmonares/diagnóstico por imagem , Trombose Venosa/etiologia , Idoso , Infarto Encefálico/etiologia , Dispneia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Embolia Pulmonar/diagnóstico por imagem , Veias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
3.
Cardiol J ; 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31478557

RESUMO

Various imaging modalities include chest computed tomography pulmonary angiography (CTPA), echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessment of varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step in the diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chest CTPA. Nuclear imaging is useful in discriminating CTEPH from APE. Better perspectives on diagnosis, risk stratification and decision making in PE can be provided by combining multimodality cardiovascular imaging. Here, the advantages or pitfalls of each imaging modality in diagnosis, risk stratification, or management of PE will be discussed.

4.
Korean J Radiol ; 20(7): 1216-1225, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31270985

RESUMO

OBJECTIVE: The absence of collateral ventilation (CV) is crucial for effective bronchoscopic lung volume reduction (BLVR) with an endobronchial valve. Here, we assessed whether CT can predict the Chartis™ results. MATERIALS AND METHODS: This study included 69 patients (mean age: 70.9 ± 6.6 years; 66 [95.7%] males) who had undergone CT to assess BLVR eligibility. The Chartis™ system (Pulmonox Inc.) was used to check CV. Experienced thoracic radiologists independently determined the completeness of fissures on volumetric CT images. RESULTS: The comparison between the visual and quantitative analyses revealed that 5% defect criterion showed good agreement. The Chartis™ assessment was performed for 129 lobes; 11 (19.6%) of 56 lobes with complete fissures on CT showed positive CV, while this rate was significantly higher (40 of 49 lobes, i.e., 81.6%) for lobes with incomplete fissures. The size of the fissure defect did not affect the rate of CV. Of the patients who underwent BLVR, 22 of 24 patients (91.7%) with complete fissures and three of four patients with incomplete fissures (75%) achieved target lobe volume reduction (TLVR). CONCLUSION: The quantitative analysis of fissure shows that incomplete fissures increased the probability of CV on Chartis™, while the defect size did not affect the overall rates. TLVR could be achieved even in some patients with relatively large fissure defect, if they showed negative CV on Chartis™.

5.
J Cardiol ; 74(3): 267-272, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30955998

RESUMO

BACKGROUND: Although many studies showed the predictive factors of stent thrombosis (ST) occurrence, there are few data about clinical outcomes and recurrent ST after percutaneous coronary intervention (PCI) for ST. Furthermore, it is uncertain which factors can cause adverse clinical events including recurrent ST. METHODS: This study examined the clinical outcomes after treatment for definite ST. Among 18,739 patients between June 2003 and December 2016 who underwent PCI using a drug-eluting stent (DES) or bare-metal stent (BMS), 243 consecutive patients who suffered definite ST were enrolled in this study. The overall incidence of ST was 1.3% (DES 1.4% and BMS 0.8%). The study endpoint was 1-year cardiac death or recurrent definite ST after the initial ST. RESULTS: Study endpoint occurred in 57 patients (23.5%) during the 1-year follow-up after the initial ST. In multivariate analysis, the factors predicting 1-year endpoint were early ST [adjusted hazard ratio (HR): 2.23, 95% confidence interval (CI): 1.26-4.08, p=0.006], BMS ST (HR: 2.42, 95% CI: 1.27-4.81, p=0.045), serum level of glucose (HR: 1.03, 95% CI: 1.01-1.05, p=0.048), and ST-segment elevation myocardial infarction (STEMI) at the initial ST (HR: 3.73, 95% CI: 1.82-7.65, p<0.001). CONCLUSIONS: Recurrent ST or cardiac death during the first year after the initial ST event occurred in ∼25% of patients treated for definite ST. BMS ST, serum level of glucose, STEMI, and early ST at the initial ST were associated with adverse cardiac events.

6.
Chonnam Med J ; 55(1): 54-61, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30740341

RESUMO

Rivaroxaban has emerged as a potential alternative to warfarin for the prevention of thromboembolism in patients with atrial fibrillation (AF). However, there has been concern for the risk of major bleeding, especially in Asian patients. We investigated the efficacy and safety of rivaroxaban compared to warfarin in Korean real world practice. A total of 2,208 consecutive non-valvular AF patients were divided into the Warfarin group (n=990) and the Rivaroxaban group (n=1218). Propensity matched 1-year clinical outcomes were compared (Warfarin, n=804; Rivaroxaban, n=804). The efficacy outcome was defined as stroke/systemic embolism (SE). The safety outcome was major bleeding. The primary net clinical benefit (NCB) was defined as the composite of stroke/SE, major bleeding, and all-cause mortality. Secondary, NCB was defined as the composite of stroke, SE, and major bleeding. Rivaroxaban had the similar efficacy in terms of thromboembolic event prevention [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.37-1.32, p=0.266] compared to warfarin. Rivaroxaban significantly lowered the risk of major bleeding [HR 0.41, 95% CI 0.22-0.76, p=0.004]. Primary NCB was significantly low in the rivaroxaban group [HR 0.54, 95% CI 0.36-0.81, p=0.003]. Secondary NCB was also low in the rivaroxaban group [HR 0.62, 95% CI 0.40-0.99, p=0.041]. Both rivaroxaban 15 mg and 20 mg groups had similar efficacy and significantly lower risks of major bleeding as well as primary and secondary NCB compared to the warfarin group. In patients with non-valvular AF, rivaroxaban had a similar efficacy to warfarin in Korean real world practice. However, rivaroxaban had better safety and net clinical outcomes compared to warfarin.

7.
Clin Res Cardiol ; 108(8): 892-900, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30737527

RESUMO

OBJECTIVES: The impacts of non-recovery of trastuzumab-induced left ventricular dysfunction (LVD) on clinical outcomes in breast cancer have been poorly studied. We investigated the predictors of LV-functional non-recovery and its impacts on clinical outcomes in breast cancer patients with trastuzumab-induced LVD. METHODS AND RESULTS: A total of 243 patients with trastuzumab-induced LVD were divided into the recovered LVD group (n = 195) and non-recovered LVD group (n = 48). Major adverse clinical events (MACEs) including death, symptomatic heart failure (HF), and HF hospitalization (HHF) were compared. Hemoglobin and albumin levels were significantly lower in non-recovered LVD than in recovered LVD group. Non-recovered LVD group showed significantly larger LV end-diastolic and systolic dimension, higher pulmonary artery systolic pressure, lower LV ejection fraction (EF), and decreased global longitudinal strain than in recovered LVD group. Decreased LVEF, enlarged LV size, pulmonary hypertension, and anemia were independent predictors of LV-functional non-recovery. During 45.9 ± 23.5 months of follow-up, MACEs were developed in 32 patients: 15 deaths, 28 symptomatic HF, and 22 HHF. In Kaplan-Meier survival analysis, MACE free survival was significantly lower in non-recovered LVD group than in recovered LVD group (log rank p = 0.002). CONCLUSION: LV-functional non-recovery was not uncommon in breast cancer patients with trastuzumab-induced cardiomyopathy, and non-recovered LVD was significantly associated with MACEs. Decreased LVEF, enlarged LV size, pulmonary hypertension, and anemia were independent predictors of LV-functional non-recovery. Careful monitoring for MACEs and intensive medical management should be considered in trastuzumab-induced cardiomyopathy with these characteristics.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Ventrículos do Coração/fisiopatologia , Recuperação de Função Fisiológica/efeitos dos fármacos , Volume Sistólico/fisiologia , Trastuzumab/efeitos adversos , Disfunção Ventricular Esquerda/induzido quimicamente , Função Ventricular Esquerda/fisiologia , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Diástole , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Trastuzumab/uso terapêutico , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia
8.
J Korean Med Sci ; 34(7): e63, 2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30804731

RESUMO

Background: Fabry disease is an X-linked recessive disorder caused by deficiency of the lysosomal enzyme α-galactosidase A (α-Gal A). Previous studies identified many cases of Fabry disease among men with left ventricular hypertrophy (LVH). The purpose of this study was to define the frequency of Fabry disease among Korean men with LVH. Methods: In this national prospective multicenter study, we screened Fabry disease in men with LVH on echocardiography. The criterion for LVH diagnosis was a maximum LV wall thickness 13 mm or greater. We screened 988 men with LVH for plasma α-Gal A activity. In patients with low α-Gal A activity (< 3 nmol/hr/mL), we searched for mutations in the α-galactosidase gene. Results: In seven men, α-Gal A activity was low. Three had previously identified mutations; Gly328Arg, Arg301Gln, and His46Arg. Two unrelated men had the E66Q variant associated with functional polymorphism. In two patients, we did not detect GLA mutations, although α-Gal A activity was low on repeated assessment. Conclusion: We identified three patients (0.3%) with Fabry disease among unselected Korean men with LVH. Although the prevalence of Fabry disease was low in our study, early treatment of Fabry disease can result in a good prognosis. Therefore, in men with unexplained LVH, differential diagnosis of Fabry disease should be considered.


Assuntos
Doença de Fabry/diagnóstico , Hipertrofia Ventricular Esquerda/diagnóstico , Adulto , Idoso , Análise Mutacional de DNA , Ecocardiografia , Doença de Fabry/complicações , Doença de Fabry/epidemiologia , Genótipo , Humanos , Hipertrofia Ventricular Esquerda/complicações , Rim/patologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , República da Coreia/epidemiologia , Adulto Jovem , alfa-Galactosidase/sangue , alfa-Galactosidase/genética
9.
Korean Circ J ; 49(5): 419-433, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30808084

RESUMO

BACKGROUND AND OBJECTIVES: Although current guidelines recommend early initiation of statin in patients with acute myocardial infarction (AMI), there is no consensus for optimal timing of statin initiation. METHODS: A total of 3,921 statin-naïve patients undergoing percutaneous coronary intervention were analyzed, and divided into 3 groups according to statin initiation time: group 1 (statin initiation <24 hours after admission), group 2 (24-48 hours) and group 3 (≥48 hours). We also made 3 stratified models to reduce bias: model 1 (<24 hours vs. ≥24 hours), model 2 (<48 hours vs. ≥48 hours) and model 3 (<24 hours vs. 24-48 hours). The endpoint was major adverse cardiac events (MACE; composite of cardiac death, myocardial infarction and target-vessel revascularization) during median 3.8 years. RESULTS: During follow-up, incidence of MACE was lower in early statin group in both model 1 (14.3% vs. 18.4%, hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.91; p=0.002) and model 2 (14.6% vs. 19.7%, HR, 0.81; 95% CI, 0.67-0.97; p=0.022). After propensity-score matching, results remained unaltered. Statin initiation <24 hours reduced MACE compared to statin initiation ≥24 hours in model 1. Statin initiation <48 hours also reduced MACE compared to statin initiation later in model 2. However, there was no difference in incidence of MACE between statin initiation <24 hours and 24-48 hours) in model 3. CONCLUSIONS: Early statin therapy within 48 hours after admission in statin-naïve patients with AMI reduced long-term clinical outcomes compared with statin initiation later. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02385682.

10.
Korean J Intern Med ; 34(6): 1263-1271, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30685960

RESUMO

BACKGROUND/AIMS: The aim of this study was to investigate useful cardiac biomarkers in the differential diagnosis of acute pulmonary embolism (APE) with troponin elevation from acute non-ST elevation myocardial infarction (NSTEMI). METHODS: A total of 771 consecutive NSTEMI patients with D-dimer measurements and 90 patients with troponin-I (TnI) elevation out of 233 APE patients were enrolled, and cardiac biomarkers were compared. RESULTS: D-dimer elevation was noted in 382 patients with NSTEMI (49.5%), and TnI elevation was noted 90 out of 233 APE patients (38.6%). Unnecessary coronary angiography was performed in 10 patients (11.1%) among 90 APE patients with TnI elevation. D-dimer was significantly elevated in APE than in NSTEMI (9.9 ± 11.6 mg/L vs. 1.8 ± 4.3 mg/L, p < 0.001), whereas TnI was significantly elevated in NSTEMI (22.4 ± 41.5 ng/mL vs. 0.7 ± 1.4 ng/mL, p < 0.001). D-dimer/TnI ratio was significantly higher in APE than in NSTEMI (50.6 ± 85.3 vs. 1.6 ± 5.7, p < 0.001). On receiver operation characteristic curve analysis, the optimal cut-off value for differentiating APE from NSTEMI was 1.12 mg/L for D-dimer (sensitivity 81.1%, specificity 70.2%), 0.72 ng/mL for TnI (sensitivity 80.6%, specificity 78.9%), and 1.82 for D-dimer/TnI ratio (sensitivity 93.3%, specificity 86.6%). CONCLUSION: D-dimer/TnI ratio would be a simple and useful parameter for differentiating APE with cardiac troponin elevation from NSTEMI. Optimal cardiovascular imaging to identify APE should be considered in patients with D-dimer/ TnI ratio > 1.82 before performing coronary angiography to avoid unnecessary invasive procedure.

11.
Korean J Intern Med ; 34(3): 549-558, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29562736

RESUMO

BACKGROUND/AIMS: The impact of the timing of anemia during hospitalization on future clinical outcomes after surviving discharge from an index heart failure (HF) has been poorly studied in patients with acute decompensated heart failure (ADHF). METHODS: A total of 384 surviving patients with acute ADHF were divided into two groups: an anemia group (n = 270, 199 anemia at admission and 71 pre-discharge anemia) and a no anemia group (n = 114). All-cause mortality and HF re-hospitalization were compared between groups. RESULTS: During the follow-up period (median, 528 days), death occurred in 60 patients (15.6%) and HF re-hospitalization occurred in 131 patients (34.1%). Overall anemia was associated with increased mortality (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.03 to 3.01; p = 0.039), but not HF re-hospitalization (HR, 0.92; 95% CI, 0.59 to 1.42; p = 0.707). Pre-discharge anemia was significantly associated with increased mortality (HR, 1.68; 95% CI, 1.01 to 2.82; p = 0.048), but anemia at admission did not predict increased mortality or re-hospitalization. CONCLUSION: Pre-discharge anemia, rather than anemia at admission, was identified as an independent predictor of mortality in patients with ADHF after surviving discharge. The results of the present study suggest that the identification and optimal management of anemia during hospitalization are important in patients with ADHF.


Assuntos
Anemia/complicações , Insuficiência Cardíaca/complicações , Idoso , Idoso de 80 Anos ou mais , Anemia/sangue , Anemia/mortalidade , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , República da Coreia/epidemiologia , Estudos Retrospectivos
13.
Eur Heart J Cardiovasc Imaging ; 20(4): 407-416, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30541113

RESUMO

AIMS: There is a paucity of data regarding the changes of cardiac geometry in highly trained international and multiracial university athletes. We aimed to investigate the incidence of structural cardiac abnormalities and changes of cardiac geometry in highly trained university athletes. METHODS AND RESULTS: Comprehensive echocardiographic studies were performed in 1185 university athletes through the Check-up Your Heart Program during the 2015 Gwangju Summer Universiade. Participants were divided into two groups: normal vs. abnormal left ventricular (LV) geometry (concentric remodelling, concentric hypertrophy, or eccentric hypertrophy). Structural heart diseases associated with sudden cardiac death were not identified, but minor structural cardiac abnormalities were common in university athletes. One hundred and fifty-six athletes (13.2%) had abnormal LV geometry; concentric remodelling (n = 73, 6.2%), concentric hypertrophy (n = 25, 2.1%), and eccentric hypertrophy (n = 58, 4.9%). Abnormal LV geometry was significantly more common in athletes of African descent and in endurance, mixed, or power disciplines. In multivariate logistic regression analysis, athletes of African descent [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.34-3.46; P = 0.001], endurance disciplines (OR 1.79, 95% CI 1.26-2.54; P = 0.001), and training time (OR 1.01, 95% CI 1.00-1.02; P = 0.045) were independent predictors of abnormal LV geometry. CONCLUSION: A large scale cardiovascular screening programme of the 2015 Summer Universiade demonstrated that abnormal LV geometry is not uncommon (13.2%) and concentric remodelling is the most common pattern of LV geometric change in young trained university athletes. Race, type of sport, and training time are significant predictors of abnormal LV geometry. Structural cardiac abnormalities are common in university athletes even though they are minor abnormalities.


Assuntos
Atletas/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Ventrículos do Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Remodelação Ventricular/fisiologia , Adolescente , Adulto , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/patologia , Humanos , Hipertrofia Ventricular Esquerda/etnologia , Internacionalidade , Masculino , Programas de Rastreamento , Fatores de Risco , Esportes/estatística & dados numéricos , Universidades , Adulto Jovem
14.
Chonnam Med J ; 54(3): 190-196, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30288376

RESUMO

We investigated predictors of major adverse cardiac events (MACE) with two years after medical treatment for lesions with angiographically intermediate lesions with intravascular ultrasound (IVUS) minimum lumen area (MLA) <4 mm2 in non-proximal epicardial coronary artery. We retrospectively enrolled 104 patients (57 males, 62±10 years) with angiographically intermediate lesions (diameter stenosis 30-70%) with IVUS MLA <4 mm2 in the non-proximal epicardial coronary artery with a reference lumen diameter between 2.25 and 3.0 mm. We evaluated the incidences of major adverse cardiovascular events (MACE including death, myocardial infarction, target lesion and target vessel revascularizations, and cerebrovascular accident) two years after medical therapy. During the two-year follow-up, 15 MACEs (14.4%) (including 1 death, 2 myocardial infarctions, 10 target vessel revascularizations, and 2 cerebrovascular accidents) occurred. Diabetes mellitus was more prevalent (46.7% vs. 18.0%, p=0.013) and statins were used less frequently in patients with MACE compared with those without MACE (40.0% vs. 71.9%, p=0.015). Independent predictors of MACEs with two years included diabetes mellitus (odds ratio [OR]=3.41; 95% CI=1.43-8.39, p=0.020) and non-statin therapy (OR=3.11; 95% CI=1.14-6.50, p=0.027). Long-term event rates are relatively low with only medical therapy without any intervention, so the cut-off of IVUS MLA 4 mm2 might be too large to be applied for defining significant stenosis. The predictors of long-term MACE were diabetes mellitus and statin therapy in patients with angiographically intermediate lesions in non-proximal epicardial coronary artery.

15.
BMC Cardiovasc Disord ; 18(1): 142, 2018 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-29986652

RESUMO

BACKGROUND: Intracardiac invasion of head and neck cancer is extremely rare. Here, we report a case of recurred oral cavity cancer presenting with complete atrioventricular (AV) block caused by cardiac metastasis. CASE PRESENTATION: A 70-year-old male presented with dizziness for 2 days. He had a history of oral cavity cancer a year ago, and the tumor was treated by surgical excision after induction chemotherapy and concurrent chemoradiation therapy. Electrocardiography showed complete AV block with ventricular escape rate of 43 beats per minute. Cardiac imaging revealed about 4.0 × 2.0 cm-sized mass invading interventricular septum and AV nodes and protruding into the right ventricle. Magenetic resonance imaging of head and neck demonstrated recurred mass in oral cavity and maxillary sinus. Fluorodeoxyglucose-positron emission tomography showed hypermetabolic lesion in both oral cavity and the heart around interventricular septum and atrioventricular node indicating recurred oral cavity cancer with cardiac metastasis. Permament pacemaker of DDD type was implanted for the symptomatic complete AV block, and palliative chemotherapy was initiated. CONCLUSION: The present case demonstrated that oral cavity cancer can metastasize to the heart, and complete AV block may be an initial manifestation of the recurrence of extracardiac cancer with intracardiac invasion.


Assuntos
Bloqueio Atrioventricular/etiologia , Neoplasias Cardíacas/secundário , Frequência Cardíaca , Neoplasias Bucais/patologia , Recidiva Local de Neoplasia , Carcinoma de Células Escamosas de Cabeça e Pescoço/secundário , Potenciais de Ação , Idoso , Antineoplásicos/uso terapêutico , Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Ecocardiografia , Eletrocardiografia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/terapia , Marca-Passo Artificial , Cuidados Paliativos , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento
16.
Am J Cardiol ; 122(2): 192-198, 2018 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-29729896

RESUMO

The presence of metabolic syndrome (MS) is associated with an increased risk of cardiovascular disease morbidity and mortality. Moreover, data are lacking on the association of MS with clinical outcomes in young adults with acute myocardial infarction (AMI). This study was a retrospective analysis of 2,082 patients with AMI who underwent percutaneous coronary intervention. The term young was defined as age <50 years. The prevalence of patients aged <50 years was 18.4%. Among those patients, 43.4% had MS. The highest incidence of long-term major adverse cardiac and cerebral events was in old patients without MS (30.7% in young patients with MS, 22.2% in young patients without MS, 38.4% in old patients with MS, and 40.4% in old patients without MS, p <0.001). However, recurrent AMI (re-AMI) was the highest in young AMI patients with MS (4.8%, 1.4%, 2.1%, and 1.5%, p = 0.035, respectively). In Kaplan-Meier curve, young AMI patients with MS tend to have highest incidence of re-AMI (p = 0.050). The presence of MS in young AMI patients was an independent predictor of 6-year major adverse cardiac and cerebral events (hazard ratio 3.320, 95% confidence interval 1.073 to 10.283, p = 0.038) and re-AMI (hazard ratio 7.782, 95% confidence interval 1.290 to 45.298, p = 0.022). In conclusion, almost half of young patients with AMI had MS. The young AMI patients with MS had the highest incidence of re-AMI compared with the other groups. Aggressive pharmacological intervention and lifestyle modification are needed for the management of AMI in young patients with MS.


Assuntos
Síndrome Metabólica/complicações , Infarto do Miocárdio/etiologia , Vigilância da População , Adulto , Idoso , Causas de Morte/tendências , Angiografia Coronária , Eletrocardiografia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Prevalência , Prognóstico , Estudos Prospectivos , República da Coreia/epidemiologia , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo
18.
Circ J ; 82(6): 1651-1658, 2018 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-29607893

RESUMO

BACKGROUND: Diastolic function is an independent predictor of death in heart failure (HF), but the effect of a change in diastolic function during hospitalization on clinical outcomes in patients with hypertensive HF (HHF) has been poorly studied. Therefore, the aim of this study was to investigate the effect of predischarge diastolic functional recovery (DFR) on future clinical outcomes in hospitalized patients with a first diagnosis of HHF.Methods and Results:A total of 175 hospitalized patients with HHF were divided into 2 groups according to the change in diastolic function on predischarge echocardiography in comparison with baseline echocardiography: DFR group (n=74, 54.2±17.1 years, 55 males) vs. no DFR group (n=101, 59.1±16.8 years, 72 males). During 66.5±37 months of clinical follow-up, major adverse cardiac events (MACE) occurred in 89 patients: 85 HF rehospitalizations, 4 deaths, no MI. The number of MACE were significantly higher in the no DFR group than in the DFR group (61.6% vs. 32.4%, P<0.001). Predischarge systolic functional recovery was not a predictor of MACE, but impaired DFR was an independent predictor of MACE (RR=2.952, P=0.010, confidence interval, 1.878-6.955). CONCLUSIONS: Impaired predischarge DFR, regardless of the type of HF or predischarge systolic functional recovery, is an independent predictor of future MACE in HHF. Changes in diastolic function should be carefully monitored and would be useful in risk stratification of HHF.


Assuntos
Diástole/fisiologia , Insuficiência Cardíaca/fisiopatologia , Hipertensão/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Ecocardiografia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento
20.
Am J Cardiol ; 121(5): 544-551, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29325904

RESUMO

It remains unclear whether complete revascularization (CR) reduces the incidences of acute decompensated heart failure (ADHF) and adverse cardiac outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD). A total of 453 hemodynamically stable patients with STEMI and MVD were retrospectively evaluated; the patients were divided into 2 groups according to interventional strategy: CR (n = 240) and incomplete revascularization (IR) (n = 213). We analyzed the incidences of ADHF and major adverse cardiac events (MACE; a composite of all-cause mortality, myocardial infarction, and any revascularization) over a long follow-up period (median 6.3 years). MACE developed in 158 patients (34.9%), and 40 patients (8.8%) were re-admitted because of ADHF developing during follow-up. Results after propensity matching showed that CR did not reduce the incidence of ADHF (hazard ratio [HR] for IR 1.63, 95% confidence interval [CI] 0.63 to 4.22, p = 0.311). However, IR increased the risk of MACE (HR 1.73, 95% CI 1.09 to 2.74, p = 0.021), attributable principally to an increased risk of nontarget vessel revascularization (HR 3.12, 95% CI 1.23 to 7.92, p = 0.039). Although CR did not reduce the incidence of ADHF, CR might reduce repeat revascularization to treat non-infarct-related arteries in hemodynamically stable patients with STEMI and MVD.


Assuntos
Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/cirurgia , Insuficiência Cardíaca/etiologia , Revascularização Miocárdica , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Doença Aguda , Idoso , Causas de Morte , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Resultado do Tratamento
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