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1.
JAMA ; 323(24): 2485-2492, June., 2020. tab., graf.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1123020

RESUMO

IMPORTANCE Corticosteroids are widely used in pediatric cardiac surgery to blunt systemic inflammatory response and to reduce complications; nevertheless, their clinical efficacy is uncertain. OBJECTIVE To determine whether intraoperative administration of dexamethasone is more effective than placebo for reducing major complications and mortality during pediatric cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS The Intraoperative Dexamethasone in Pediatric Cardiac Surgery was an investigator-initiated, double-blind, multicenter randomized trial that involved 4 centers in China, Brazil, and Russia. A total of 394 infants younger than 12 months, undergoing cardiac surgery with cardiopulmonary bypass were enrolled from December 2015 to October 2018, with follow-up completed in November 2018. INTERVENTIONS The dexamethasone group (n = 194) received 1mg/kg of dexamethasone; the control group (n = 200) received an equivolume of 0.9%sodium chloride intravenously after anesthesia induction. MAIN OUTCOMES AND MEASURES The primary end pointwas a composite of death, nonfatalmyocardial infarction, need for extracorporeal membrane oxygenation, need for cardiopulmonary resuscitation, acute kidney injury, prolonged mechanical ventilation, or neurological complications within 30 days after surgery. There were 17 secondary end points, including the individual components of the primary end point, and duration of mechanical ventilation, inotropic index, intensive care unit stay, readmission to intensive care unit, and length of hospitalization. RESULTS All of the 394 patients randomized (median age, 6 months; 47.2%boys) completed the trial. The primary end point occurred in 74 patients (38.1%) in the dexamethasone group vs 91 patients (45.5%) in the control group (absolute risk reduction, 7.4%; 95%CI, −0.8%to 15.3%; hazard ratio, 0.82; 95%CI, 0.60 to 1.10; P = .20). Of the 17 prespecified secondary end points, none showed a statistically significant difference between groups. Infections occurred in 4 patients (2.0%) in the dexamethasone group vs 3 patients (1.5%) in the control group. CONCLUSIONS AND RELEVANCE Among infants younger than 12 months undergoing cardiac surgery with cardiopulmonary bypass, intraoperative administration of dexamethasone, compared with placebo, did not significantly reduce major complications and mortality at 30 days. However, the study may have been underpowered to detect a clinically important difference.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Criança , Ponte Cardiopulmonar , Complicações Cognitivas Pós-Operatórias , Procedimentos Cirúrgicos Cardíacos/mortalidade , Cuidados Intraoperatórios , Dexametasona/efeitos adversos , Método Duplo-Cego , Glucocorticoides/efeitos adversos
3.
Opt Express ; 28(17): 25371-25382, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32907059

RESUMO

The lack of radiation sources in the frequency range of 7-10 THz is associated with strong absorption of the THz waves on optical phonons within the GaAs Reststrahlen band. To avoid such absorption, we propose to use HgCdTe as an alternative material for THz quantum cascade lasers thanks to a lower phonon energy than in III-V semiconductors. In this work, HgCdTe-based quantum cascade lasers operating in the GaAs phonon Reststrahlen band with a target frequency of 8.3 THz have been theoretically investigated using the balance equation method. The optimized active region designs, which are based on three and two quantum wells, exhibit the peak gain exceeding 100 cm-1 at 150 K. We have analyzed the temperature dependence of the peak gain and predicted the maximum operating temperatures of 170 K and 225 K for three- and two-well designs, respectively. At temperatures exceeding 120 K, the better temperature performance has been obtained for the two-well design, which is associated with a larger spatial overlap of weakly localized lasing wavefunctions, as well as, a higher population inversion. We believe that the findings of this work can open a pathway towards the development of THz quantum cascade lasers featuring a high level of optical gain due to the low electron effective mass in HgCdTe.

4.
J Am Coll Cardiol ; 76(8): 916-926, 2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32819465

RESUMO

BACKGROUND: Pulmonary artery denervation (PADN) procedure has not been applied to patients with residual chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA). OBJECTIVES: This study sought to assess the safety and efficacy of PADN using remote magnetic navigation in patients with residual CTEPH after PEA. METHODS: Fifty patients with residual CTEPH despite medical therapy at least 6 months after PEA, who had mean pulmonary artery pressure ≥25 mm Hg or pulmonary vascular resistance (PVR) > 400 dyn‧s‧cm-5 based on right heart catheterization were randomized to treatment with PADN (PADN group; n = 25) using remote magnetic navigation for ablation or medical therapy with riociguat (MED group; n = 25). In the MED group, a sham procedure with mapping but no ablation was performed. The primary endpoint was PVR at 12 months after randomization. Key secondary endpoint included 6-min walk test. RESULTS: After PADN procedure, 2 patients (1 in each group) developed groin hematoma that resolved without any consequences. At 12 months, mean PVR reduction was 258 ± 135 dyn‧s‧cm-5 in the PADN group versus 149 ± 73 dyn‧s‧cm-5 in the MED group, mean between-group difference was 109 dyn‧s‧cm-5 (95% confidence interval: 45 to 171; p = 0.001). The 6-min walk test distance was significantly increased in the PADN group as compared to distance in the MED group (470 ± 84 m vs. 399 ± 116 m, respectively; p = 0.03). CONCLUSIONS: PADN in patients with residual CTEPH resulted in substantial reduction of PVR at 12 months of follow-up, accompanied by improved 6-min walk test.

5.
Opt Lett ; 45(13): 3418, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32630859

RESUMO

This publisher's note contains corrections to Opt. Lett.45, 3244 (2020)OPLEDP0146-959210.1364/OL.391861.

6.
Opt Lett ; 45(12): 3244-3247, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32538953

RESUMO

We propose and study a microstructure based on a dielectric cuboid placed on a thin metal film that can act as an efficient plasmonic lens allowing the focusing of surface plasmons at the subwavelength scale. Using numerical simulations of surface plasmon polariton (SPP) field intensity distributions, we observe high-intensity subwavelength spots and formation of the plasmonic nanojet (PJ) at the telecommunication wavelength of 1530 nm. The fabricated microstructure was characterized using amplitude and phase-resolved scattering-type scanning near-field optical microscopy. We show the first experimental observation of the PJ effect for the SPP waves. Such a novel, to the best of our knowledge, and simple platform can provide new pathways for plasmonics, high-resolution imaging, and biophotonics, as well as optical data storage.

7.
JAMA ; 323(24): 2485-2492, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32573670

RESUMO

Importance: Corticosteroids are widely used in pediatric cardiac surgery to blunt systemic inflammatory response and to reduce complications; nevertheless, their clinical efficacy is uncertain. Objective: To determine whether intraoperative administration of dexamethasone is more effective than placebo for reducing major complications and mortality during pediatric cardiac surgery. Design, Setting, and Participants: The Intraoperative Dexamethasone in Pediatric Cardiac Surgery was an investigator-initiated, double-blind, multicenter randomized trial that involved 4 centers in China, Brazil, and Russia. A total of 394 infants younger than 12 months, undergoing cardiac surgery with cardiopulmonary bypass were enrolled from December 2015 to October 2018, with follow-up completed in November 2018. Interventions: The dexamethasone group (n = 194) received 1 mg/kg of dexamethasone; the control group (n = 200) received an equivolume of 0.9% sodium chloride intravenously after anesthesia induction. Main Outcomes and Measures: The primary end point was a composite of death, nonfatal myocardial infarction, need for extracorporeal membrane oxygenation, need for cardiopulmonary resuscitation, acute kidney injury, prolonged mechanical ventilation, or neurological complications within 30 days after surgery. There were 17 secondary end points, including the individual components of the primary end point, and duration of mechanical ventilation, inotropic index, intensive care unit stay, readmission to intensive care unit, and length of hospitalization. Results: All of the 394 patients randomized (median age, 6 months; 47.2% boys) completed the trial. The primary end point occurred in 74 patients (38.1%) in the dexamethasone group vs 91 patients (45.5%) in the control group (absolute risk reduction, 7.4%; 95% CI, -0.8% to 15.3%; hazard ratio, 0.82; 95% CI, 0.60 to 1.10; P = .20). Of the 17 prespecified secondary end points, none showed a statistically significant difference between groups. Infections occurred in 4 patients (2.0%) in the dexamethasone group vs 3 patients (1.5%) in the control group. Conclusions and Relevance: Among infants younger than 12 months undergoing cardiac surgery with cardiopulmonary bypass, intraoperative administration of dexamethasone, compared with placebo, did not significantly reduce major complications and mortality at 30 days. However, the study may have been underpowered to detect a clinically important difference. Trial Registration: ClinicalTrials.gov Identifier: NCT02615262.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Cardiopatias Congênitas/cirurgia , Cuidados Intraoperatórios , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte Cardiopulmonar , Dexametasona/efeitos adversos , Método Duplo-Cego , Feminino , Glucocorticoides/efeitos adversos , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Cognitivas Pós-Operatórias/mortalidade
8.
J Cardiothorac Vasc Anesth ; 34(11): 3113-3124, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32144058

RESUMO

Pulmonary complications are common after cardiac surgery and are closely related to postoperative heart failure and adverse outcomes. Lung ultrasonography (LUS) is currently a widely accepted diagnostic approach with well-established methodology, nomenclature, accuracy, and prognostic value in numerous clinical conditions. The advantages of LUS are universally recognized and include bedside applicability, high diagnostic sensitivity and reproducibility, no radiation exposure, and low cost. However, routine perioperative ultrasonography during cardiac surgery generally is limited to echocardiography, diagnosis of pleural effusion, and as a diagnostic tool for postoperative complications in different organs, and few studies have explored the clinical outcomes in relation to LUS among cardiac patients. This narrative review presents the clinical evidence regarding LUS application in intensive care and during the perioperative period for cardiac surgery. Furthermore, this review describes the methodology and the diagnostic and prognostic accuracies of LUS. A summary of ongoing clinical trials evaluating the clinical outcomes related to LUS also is provided. Finally, this review discusses the rationale for upcoming clinical research regarding whether routine use of LUS can modify current intensive care practice and potentially affect the clinical outcomes after cardiac surgery.

9.
JAMA ; 323(3): 248-255, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31961420

RESUMO

Importance: Renal denervation can reduce cardiac sympathetic activity that may result in an antiarrhythmic effect on atrial fibrillation. Objective: To determine whether renal denervation when added to pulmonary vein isolation enhances long-term antiarrhythmic efficacy. Design, Setting, and Participants: The Evaluate Renal Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial was an investigator-initiated, multicenter, single-blind, randomized clinical trial conducted at 5 referral centers for catheter ablation of atrial fibrillation in the Russian Federation, Poland, and Germany. A total of 302 patients with hypertension despite taking at least 1 antihypertensive medication, paroxysmal atrial fibrillation, and plans for ablation were enrolled from April 2013 to March 2018. Follow-up concluded in March 2019. Interventions: Patients were randomized to either pulmonary vein isolation alone (n = 148) or pulmonary vein isolation plus renal denervation (n = 154). Complete pulmonary vein isolation to v an end point of elimination of all pulmonary vein potentials; renal denervation using an irrigated-tip ablation catheter delivering radiofrequency energy to discrete sites in a spiral pattern from distal to proximal in both renal arteries. Main Outcomes and Measures: The primary end point was freedom from atrial fibrillation, atrial flutter, or atrial tachycardia at 12 months. Secondary end points included procedural complications within 30 days and blood pressure control at 6 and 12 months. Results: Of the 302 randomized patients (median age, 60 years [interquartile range, 55-65 years]; 182 men [60.3%]), 283 (93.7%) completed the trial. All successfully underwent their assigned procedures. Freedom from atrial fibrillation, flutter, or tachycardia at 12 months was observed in 84 of 148 (56.5%) of those undergoing pulmonary vein isolation alone and in 111 of 154 (72.1%) of those undergoing pulmonary vein isolation plus renal denervation (hazard ratio, 0.57; 95% CI, 0.38 to 0.85; P = .006). Of 5 prespecified secondary end points, 4 are reported and 3 differed between groups. Mean systolic blood pressure from baseline to 12 months decreased from 151 mm Hg to 147 mm Hg in the isolation-only group and from 150 mm Hg to 135 mm Hg in the renal denervation group (between-group difference, -13 mm Hg; 95% CI, -15 to -11 mm Hg; P < .001). Procedural complications occurred in 7 patients (4.7%) in the isolation-only group and 7 (4.5%) of the renal denervation group. Conclusions and Relevance: Among patients with paroxysmal atrial fibrillation and hypertension, renal denervation added to catheter ablation, compared with catheter ablation alone, significantly increased the likelihood of freedom from atrial fibrillation at 12 months. The lack of a formal sham-control renal denervation procedure should be considered in interpreting the results of this trial. Trial Registration: ClinicalTrials.gov Identifier: NCT01873352.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Hipertensão/cirurgia , Rim/inervação , Veias Pulmonares/cirurgia , Simpatectomia , Idoso , Anti-Hipertensivos/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/prevenção & controle , Terapia Combinada , Resistência a Medicamentos , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Método Simples-Cego
10.
Phys Rev Lett ; 122(10): 101602, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30932631

RESUMO

In this Letter, we suggest a natural spinor-helicity formalism for massless fields in four-dimensional anti-de Sitter space (AdS_{4}). It is based on the standard realization of the AdS_{4} isometry algebra so(3,2) in terms of differential operators acting on sl(2,C) spinor variables. We start by deriving the anti-de Sitter counterpart of plane waves in flat space and then use them to evaluate simple scattering amplitudes. Finally, based on symmetry arguments, we classify all three-point amplitudes involving massless spinning fields. As in flat space, we find that the spinor-helicity formalism allows us to construct additional consistent interactions as compared to approaches employing Lorentz tensors.

11.
N Engl J Med ; 380(13): 1214-1225, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30888743

RESUMO

BACKGROUND: Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). METHODS: We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia. The primary outcome was death from any cause at 1 year. RESULTS: A total of 5400 patients were randomly assigned: 2709 to the volatile anesthetics group and 2691 to the total intravenous anesthesia group. On-pump CABG was performed in 64% of patients, with a mean duration of cardiopulmonary bypass of 79 minutes. The two groups were similar with respect to demographic and clinical characteristics at baseline, the duration of cardiopulmonary bypass, and the number of grafts. At the time of the second interim analysis, the data and safety monitoring board advised that the trial should be stopped for futility. No significant difference between the groups with respect to deaths from any cause was seen at 1 year (2.8% in the volatile anesthetics group and 3.0% in the total intravenous anesthesia group; relative risk, 0.94; 95% confidence interval [CI], 0.69 to 1.29; P = 0.71), with data available for 5353 patients (99.1%), or at 30 days (1.4% and 1.3%, respectively; relative risk, 1.11; 95% CI, 0.70 to 1.76), with data available for 5398 patients (99.9%). There were no significant differences between the groups in any of the secondary outcomes or in the incidence of prespecified adverse events, including myocardial infarction. CONCLUSIONS: Among patients undergoing elective CABG, anesthesia with a volatile agent did not result in significantly fewer deaths at 1 year than total intravenous anesthesia. (Funded by the Italian Ministry of Health; MYRIAD ClinicalTrials.gov number, NCT02105610.).


Assuntos
Anestesia Intravenosa , Anestésicos Gerais/farmacologia , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Administração por Inalação , Idoso , Anestesia Geral , Anestésicos Intravenosos , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Método Simples-Cego , Volume Sistólico
12.
Angew Chem Int Ed Engl ; 58(24): 7914-7920, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-30614618

RESUMO

Named reactions are key points in the development of chemistry. Any competent chemist easily identifies the reaction named after Wittig, or Grignard, Diels-Alder, or Friedel-Crafts, Michael, or Favorsky. But how much do we can say about scientist who discovered it? This Essay is devoted to the transition-metal-catalyzed hydration of acetylenic hydrocarbons discovered by Russian chemist Mikhail Kucherov. This reaction is one of the most straightforward methods for the synthesis of carbonyl compounds. With it, in industry for a long time acetaldehyde was essentially manufactured from accessible unsaturated raw material-acetylene. This reaction is one of the first steps in the establishment of homogenous metal complex catalysis in organic synthesis. Herein, we described the history of this discovery and the role of many scientists in the development of research in this field. We would also like to show the life of Russian scientists in the latter half of the 19th century.

13.
Heart Rhythm ; 16(2): 172-177, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30414841

RESUMO

BACKGROUND: Botulinum toxin (BTX) injections into epicardial fat pads in patients undergoing coronary artery bypass grafting (CABG) has resulted in suppression of atrial fibrillation (AF) during the early postoperative period through 1-year of follow-up in a pilot program. OBJECTIVE: The purpose of this study was to report 3-year AF patterns by the use of implantable cardiac monitors (ICMs). METHODS: Sixty patients with a history of paroxysmal AF and indications for CABG were randomized 1:1 to either BTX or placebo injections into 4 posterior epicardial fat pads. All patients received an ICM with regular follow-up for 3 years after surgery. The primary end point of the extended follow-up period was incidence of any atrial tachyarrhythmia after 30 days of procedure until 36 months on no antiarrhythmic drugs. The secondary end points included clinical events and AF burden. RESULTS: At the end of 36 months, the incidence of any atrial tachyarrhythmia was 23.3% in the BTX group vs 50% in the placebo group (hazard ratio 0.36; 95% confidence interval 0.14-0.88; P = .02). AF burden at 12, 24, and 36 months was significantly lower in the BTX group than in the placebo group: 0.22% vs 1.88% (P = .003), 1.6% vs 9.5% (P < .001), and 1.3% vs 6.9% (P = .007), respectively. In the BTX group, 2 patients (7%) were hospitalized during follow-up compared with 10 (33%) in the placebo group (P = .02). CONCLUSION: Injection of BTX into epicardial fat pads in patients undergoing CABG resulted in a sustained and substantial reduction in atrial tachyarrhythmia incidence and burden during 3-year follow-up, accompanied by reduction in hospitalizations.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Toxinas Botulínicas/administração & dosagem , Procedimentos Cirúrgicos Cardíacos , Frequência Cardíaca/efeitos dos fármacos , Cuidados Pré-Operatórios/métodos , Tecido Adiposo , Fibrilação Atrial/fisiopatologia , Método Duplo-Cego , Eletrocardiografia , Feminino , Seguimentos , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Neurotoxinas/administração & dosagem , Pericárdio , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
16.
J Cardiovasc Electrophysiol ; 29(6): 872-878, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29570894

RESUMO

INTRODUCTION: The PREVENT AF I study demonstrated that prophylactic pulmonary vein isolation (PVI) in patients with pure typical atrial flutter (AFL) resulted in substantial reduction of new-onset atrial fibrillation (AF) during 1-year follow-up as assessed by continuous implantable cardiac monitor (ICM). The objective of this study was to assess 3-year outcomes. METHODS AND RESULTS: Fifty patients with documented AFL were randomized to either cavotricuspid isthmus (CTI) ablation alone (n = 25) or CTI with concomitant PVI (n = 25). The primary endpoint of the study was the occurrence of any atrial tachyarrhythmia with the monthly burden exceeding 0.5% on the ICM. At the end of 3 years, freedom from any atrial tachyarrhythmia was 48% (95% confidence interval [CI]: 32-72%) in the CTI plus PVI group as compared to 20% (95% CI: 9-44%) in the CTI-only group (P = 0.01). Freedom from redo procedures was also higher: 92% (95% CI: 82-100%) versus 68% (95% CI: 52-89%), respectively (P = 0.027). The 3-year AF burden favored the combined ablation group: 6.2% versus 16.8% (P = 0.03). In the CTI-only group, 12 (48%) patients were hospitalized compared to 4 (16%) in the PVI + CTI group (P = 0.03). Two patients in the CTI-only group developed stroke with no serious adverse events in the PVI + CTI group. CONCLUSION: Prophylactic PVI in patients with only typical AFL resulted in a significant reduction of new-onset AF and burden during long-term follow-up as assessed by ICM, with consequent reduction in hospitalizations and need to perform repeat ablation for AF.


Assuntos
Fibrilação Atrial/prevenção & controle , Flutter Atrial/cirurgia , Ablação por Cateter , Veias Pulmonares/cirurgia , Valva Tricúspide/cirurgia , Veia Cava Superior/cirurgia , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Projetos Piloto , Intervalo Livre de Progressão , Estudos Prospectivos , Veias Pulmonares/fisiopatologia , Recidiva , Reoperação , Fatores de Risco , Fatores de Tempo , Valva Tricúspide/fisiopatologia , Veia Cava Superior/fisiopatologia
17.
J Cardiothorac Vasc Anesth ; 32(5): 2241-2245, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29336961

RESUMO

OBJECTIVE: To investigate the 1-year survival in cardiac surgical patients with lung disease, including previously undiagnosed cases. DESIGN: Prospective cohort study. SETTING: Tertiary hospital. PARTICIPANTS: Patients scheduled for elective coronary artery bypass graft (CABG) surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pulmonary function tests (PFTs) were performed in 454 patients before surgery. Abnormal respiratory patterns were defined as follows: obstructive (forced expiratory volume in 1 second/forced vital capacity <0.70), restrictive (forced expiratory volume in 1 second/forced vital capacity ≥0.70 and forced vital capacity <80% of predicted), and mixed. Overall 1-year mortality was 3.3%. Among 31 patients with documented chronic obstructive pulmonary disease (COPD), mortality was 9.6%, hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.02-12.80, p = 0.04. Of 423 patients without history of COPD, 57 obstructive, 46 restrictive, and 4 mixed abnormal patterns were identified. Of a total of 72 with obstructive lung disease confirmed by PFT (ie, 15 of COPD patients and 57 newly identified cases), 6.9% died, HR 2.75, 95% CI 0.98-8.07, p = 0.06. When combined with cases of COPD where a respiratory abnormality was confirmed (26 patients), newly diagnosed obstructive lung disease (57 patients) was significantly associated with 1-year mortality, HR 4.13, 95% CI 1.50-11.42, p = 0.006. The adjustment for EuroSCORE II did not change the results. CONCLUSIONS: Combination of confirmed preexisting lung disease and newly diagnosed cases provides a clear link to mid-term mortality.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Doença da Artéria Coronariana/cirurgia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Comorbidade/tendências , Doença da Artéria Coronariana/epidemiologia , Seguimentos , Humanos , Incidência , Estudos Prospectivos , Fatores de Risco , Federação Russa/epidemiologia , Taxa de Sobrevida/tendências , Fatores de Tempo
18.
Europace ; 20(2): 263-270, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28069838

RESUMO

Aims: Cardiac arrhythmias following acute myocardial infarction (AMI) can be associated with major adverse cardiovascular events. Data on the "real incidence" of post-MI arrhythmias are limited. We aimed to determine the rate and burden of cardiac arrhythmias by the use of insertable cardiac monitors (ICM) in patients with preserved left ventricular ejection fraction (LVEF) after AMI. Methods and results: In this prospective observational study, patients with LVEF ≥40% who underwent PCI within 7 days following AMI were enrolled to receive an ICM. Primary outcome was the incidence of new-onset atrial fibrillation (AF) measured by the ICM during a follow-up of 2 years; results: Of 165 consecutive patients with AMI, 50 (30.3%) eligible patients were recruited (mean age 57.8 ± 8.3, 88% male). During follow-up, AF was the most frequently detected arrhythmia. Twenty-nine (58%, 95% CI: 42-70%) patients developed new-onset AF, with a cumulative rate of all detected arrhythmias of 65%. Median time to the first detected AF episode was 4.8 months and the peak cumulative AF burden was detected between 3 and 6 months. Twenty-seven (93%) out of 29 patients with AF were asymptomatic. Cox regression analysis found that baseline troponin level (hazard ratio [HR] for 1 ng/mL increment: 1.03, 95% CI: 1.01-1.06, P = 0.01) and CHA2DS2-VASc score of 4 (HR: 11.42, 95% CI: 1.01-129.06, P = 0.04) were independent risk factors of new-onset AF post-AMI. Conclusion: AF is a frequent but largely underestimated cardiac arrhythmia after AMI. More rigorous monitoring strategies resulting in crucial medical interventions (e.g. implementation of oral anti-coagulation) are needed. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT02492243.


Assuntos
Fibrilação Atrial/diagnóstico , Eletrocardiografia Ambulatorial , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Volume Sistólico , Função Ventricular Esquerda , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Eletrocardiografia Ambulatorial/instrumentação , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Fatores de Tempo
19.
JPEN J Parenter Enteral Nutr ; 42(4): 702-708, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28575581

RESUMO

BACKGROUND: This study tested the accuracy of resting energy expenditure (REE) equations among patients who underwent cardiopulmonary bypass and developed/validated a more accurate cardio-specific equation (CSE). MATERIALS AND METHODS: Prospective observational cohort of 240 adults (derivation data set, 170 patients; validation data set, 70 patients). REEs were calculated with 6 equations-Penn State 2003a, Penn State 2003b, Ireton-Jones, Swinamer, Faisy, and American College of Chest Physicians-and results were compared with indirect calorimetry (IC). Multivariable linear regression analysis was used to develop the CSE. Agreement between measured and calculated REEs was assessed with Lin's concordance correlation coefficient (LCCC), Bland-Altman plot, and regression analysis. RESULTS: LCCCs present poor agreement between measured and calculated REEs: 0.24 (95% CI, 0.19-0.29), for the Faisy equation; 0.15 (95% CI, 0.1-0.19), Ireton-Jones; 0.31 (95% CI, 0.25-0.37), Swinamer; 0.17 (95% CI, 0.13-0.21), Penn State 2003a; 0.19 (95% CI, 0.14-0.23), Penn State 2003b; and 0.11 (95% CI, 0.07-0.15), American College of Chest Physicians. Based on the derivation data set, REEs are explained by the following equation: CSE = 616 - 8 × age in years + 13 × weight in kilograms + 450 if on ventilator + 159 × MV in liters + 145 if on inotropes. Based on the validation study results, the LCCC between IC and the CSE was 0.82 (95% CI, 0.73-0.88). CONCLUSION: The CSE has adequate precision and could be used for REE estimation for patients undergoing cardiopulmonary bypass if IC is unavailable.


Assuntos
Metabolismo Basal , Ponte Cardiopulmonar , Modelos Biológicos , Idoso , Calorimetria Indireta/métodos , Cardiologia/métodos , Cardiotônicos , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/cirurgia , Cuidados Críticos , Metabolismo Energético , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necessidades Nutricionais , Estudos Prospectivos , Reprodutibilidade dos Testes , Descanso , Ventiladores Mecânicos
20.
Cardiovasc Ther ; 35(4)2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28423234

RESUMO

BACKGROUND: Renal artery denervation (RDN) has provided incremental atrial fibrillation (AF) suppression after pulmonary vein isolation (PVI) in patients with AF in the setting of drug-resistant hypertension. OBJECTIVE: To assess the relationship between changes of mean blood pressure (BP) and AF recurrences/AF burden after PVI combined with RDN. METHODS: All patients from two randomized studies with symptomatic paroxysmal AF and/or persistent AF and resistant hypertension who underwent PVI-only (n=37) or PVI with RDN (n=39), and implantable cardiac monitor (ICM) implantation were eligible for this study. Mixed-effects linear models were used to investigate the effect of RDN on mean BP and mean AF burden and associations between the two during the 12-month follow-up. RESULTS: Concomitant RDN was associated with a significant reduction in both mean AF burden (2.43 [95% CI: 1.76-3.09] % vs 6.95 [95% CI: 5.44-8.45] %) and mean BP (104 [95% CI: 103-106] mm Hg vs 112 [95% CI: 110-113] mm Hg). Decrease in mean BP was positively correlated with decline in mean AF burden: reduction of 5-10 mm Hg was accompanied by a 7.0% decreased mean AF burden, with greater reduction (up to 20 mm Hg) associated with on average 17.7% lower mean AF burden. CONCLUSIONS: Renal artery denervation when added to PVI decreases AF recurrences, AF burden, and mean BP. Reduction in mean BP is associated with both AF burden and recurrences. Further large-scale studies are needed to define the mechanistic pathway(s) of the antiarrhythmic effects of RDN.


Assuntos
Pressão Arterial , Fibrilação Atrial/prevenção & controle , Fibrilação Atrial/fisiopatologia , Veias Pulmonares/cirurgia , Artéria Renal/cirurgia , Pressão Sanguínea , Ablação por Cateter , Efeitos Psicossociais da Doença , Denervação , Feminino , Humanos , Hipertensão/cirurgia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Próteses e Implantes , Veias Pulmonares/fisiopatologia , Recidiva , Artéria Renal/fisiopatologia , Análise de Sobrevida
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