Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 22
Filtrar
1.
J Clin Med ; 10(24)2021 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-34945124

RESUMO

This study introduces the pulmonary vein isolation outcome degree (PVIOD) as a new semiquantitative measure for the efficacy of atrial fibrillation (AF) catheter ablation and reports the determination of predictors associated with PVIOD. The median follow-up periods of 117 patients after the first and last ablation were, respectively, 82 (IQR 15) and 72 (IQR 30) months. PVIOD 1 included 32.5% of patients, those with successful single pulmonary vein isolation (PVI); PVIOD 2 included 29.1% of subjects, those with success after multiple procedures; PVIOD 3 comprised 14.5% of patients, those with clinical success; and PVIOD 4 included 23.9% of cases, those with procedural and clinical failure. In the multivariate ordinal logistic regression analysis, PVIOD 1-4 were independently associated with longstanding persistent AF with paroxysmal AF as the referent category (odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.1-10.7 (p = 0.031)), left atrial (LA) diameter (OR, 1.2; 95% CI, 1.1-1.3 (p = 0.001)) and left ventricular ejection fraction (LVEF) (OR, 0.9; 95% CI, 0.86-1.0 (p = 0.038)). LA size > 41 mm, LVEF ≤ 50% and longstanding persistent AF are strong predictors of AF recurrence. PVIOD 1-4 offer the most exact long-term prognosis of PVI. The purpose of the present article is to expand the quantitative measure of procedural success in the medical and biological fields.

2.
J Am Heart Assoc ; 10(20): e021436, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34612059

RESUMO

Background We examined the association of long-term exposure to air pollution and road traffic noise with incident heart failure (HF). Methods And Results Using data on female nurses from the Danish Nurse Cohort (aged >44 years), we investigated associations between 3-year mean exposures to air pollution and road traffic noise and incident HF using Cox regression models, adjusting for relevant confounders. Incidence of HF was defined as the first hospital contact (inpatient, outpatient, or emergency) between cohort baseline (1993 or 1999) and December 31, 2014, based on the Danish National Patient Register. Annual mean levels of particulate matter with a diameter <2.5 µm since 1990 and NO2 and road traffic noise since 1970 were estimated at participants' residences. Of the 22 189 nurses, 484 developed HF. We detected associations with all 3 pollutants, with hazard ratios (HRs) of 1.17 (95% CI, 1.01-1.36), 1.10 (95% CI, 0.99-1.22), and 1.12 (95% CI, 0.99-1.26) per increase of 5.1 µg/m3 in particulate matter with a diameter <2.5 µm, 8.6 µg/m3 in NO2, and 9.3 dB in road traffic noise, respectively. We observed an enhanced risk of HF incidence for those exposed to high levels of the 3 pollutants; however, the effect modification of coexposure was not statistically significant. Former smokers and nurses with hypertension showed the strongest associations with particulate matter with a diameter <2.5 µm (Peffect modification<0.05). Conclusions We found that long-term exposures to air pollution and road traffic noise were independently associated with HF.

3.
Mol Cell Biochem ; 476(7): 2663-2673, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33666827

RESUMO

The aim of the study was to examine the effect of 4-week supplementation of Alixir 400 PROTECT® (Standardized Aronia L. Melanocarpa Extract Extract-SAE) on clinical and biochemical parameters in patients with confirmed metabolic syndrome (MetS). This study was designed as a prospective open-label clinical case-series study with 28 days of follow-up with cases selected and followed during the period from February 1, 2018 to November 2019. The study included 143 male and female patients with MetS who were subjected to SAE. SAE supplementation significantly altered SP, BP as well as HR values. After 2 weeks, CHOL levels significantly decreased in the fMetS-DM group compared to the baseline values in this group, while the LDL levels significantly decreased in the fMetS group. Triglycerides significantly decreased only after 4 weeks of SAE treatment in diabetic groups of patients (fMetS-DM and mMetS-DM) compared to the baseline, while in non-diabetic groups this marker was not significantly altered. Increased polyphenols or SAE consumption is correlated with a positive effect on body weight, total cholesterol, low and high-density lipoproteins, blood pressure and glycemia. Increasing consumption of polyphenol-rich foods could be a promising strategy to reduce cardiovascular risk.


Assuntos
Glicemia/metabolismo , Pressão Sanguínea/efeitos dos fármacos , Lipídeos/sangue , Síndrome Metabólica , Photinia/química , Extratos Vegetais/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/tratamento farmacológico , Pessoa de Meia-Idade , Extratos Vegetais/química , Estudos Prospectivos
4.
J Hypertens ; 37(9): 1832-1837, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31246893

RESUMO

BACKGROUND: Electronic devices for blood pressure (BP) measurements need to go through independent clinical validation as recommended by different authorities, both in general and special populations. Reproducibility of such validation protocols is unknown. OBJECTIVE: The aim of this study was to assess the inter-centre reproducibility of the European Society of Hypertension-International protocol (ESH-IP) in patients with large arm circumference at least 32 cm or obesity. METHODS: Two independent validation studies were performed in parallel according to the ESH-IP protocol in two centres (Serbia and Armenia). The two studies were performed blindly and independently. The ESH-IP criteria were applied for the analysis. The OMRON RS7 wrist oscillometric devices were used in both studies. RESULTS: The distribution of the mean differences values of 5 or less, 10 or less and 15 mmHg or less between the observers and the device were for the Serbia team: 74, 95 and 98 for SBP and 78, 95 and 99 for DBP; and for the Armenia team: 86, 95 and 99 for SBP and 90, 99 and 99 for DBP. The mean differences (SD) of BP values between the observers and the device were for the Serbia team of 1.7 ±â€Š4.8 mmHg for SBP and 1.2 ±â€Š4.6 mmHg for DBP and for the Armenia team of -1.1 ±â€Š4.2 mmHg for SBP and -0.3 ±â€Š3.5 mmHg for DBP. CONCLUSION: This study showed that the ESH-IP validation protocol presents a good inter-centre reproducibility. The OMRON RS7 device showed similar results, fulfilling the validation criteria in two independent studies in patients with arm circumference at least 32 cm.


Assuntos
Determinação da Pressão Arterial/estatística & dados numéricos , Hipertensão/diagnóstico , Obesidade , Adulto , Idoso , Armênia , Pressão Sanguínea , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria , Reprodutibilidade dos Testes , Sérvia , Esfigmomanômetros , Estudos de Validação como Assunto , Punho
5.
J Hypertens ; 36(4): 824-833, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29324585

RESUMO

OBJECTIVE: The aim of the Advanced Approach to Arterial Stiffness study was to compare arterial stiffness measured simultaneously with two different methods in different age groups of middle-aged and older adults with or without metabolic syndrome (MetS). The specific effects of the different MetS components on arterial stiffness were also studied. METHODS: This prospective, multicentre, international study included 2224 patients aged 40 years and older, 1664 with and 560 without MetS. Patients were enrolled in 32 centres from 18 European countries affiliated to the International Society of Vascular Health & Aging. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI) and the carotid-femoral pulse wave velocity (CF-PWV) in four prespecified age groups: 40-49, 50-59, 60-74, 75-90 years. In this report, we present the baseline data of this study. RESULTS: Both CF-PWV and CAVI increased with age, with a higher correlation coefficient for CAVI (comparison of coefficients P < 0.001). Age-adjusted and sex-adjusted values of CF-PWV and CAVI were weakly intercorrelated (r = 0.06, P < 0.001). Age-adjusted and sex-adjusted values for CF-PWV but not CAVI were higher in presence of MetS (CF-PWV: 9.57 ±â€Š0.06 vs. 8.65 ±â€Š0.10, P < 0.001; CAVI: 8.34 ±â€Š0.03 vs. 8.29 ±â€Š0.04, P = 0.40; mean ±â€ŠSEM; MetS vs. no MetS). The absence of an overall effect of MetS on CAVI was related to the heterogeneous effects of the components of MetS on this parameter: CAVI was positively associated with the high glycaemia and high blood pressure components, whereas lacked significant associations with the HDL and triglycerides components while exhibiting a negative association with the overweight component. In contrast, all five MetS components showed positive associations with CF-PWV. CONCLUSION: This large European multicentre study reveals a differential impact of MetS and age on CAVI and CF-PWV and suggests that age may have a more pronounced effect on CAVI, whereas MetS increases CF-PWV but not CAVI. This important finding may be due to heterogeneous effects of MetS components on CAVI. The clinical significance of these original results will be assessed during the longitudinal phase of the study.


Assuntos
Artérias/fisiopatologia , Hiperglicemia/fisiopatologia , Hipertensão/fisiopatologia , Síndrome Metabólica/fisiopatologia , Rigidez Vascular , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Glicemia/metabolismo , Pressão Sanguínea , Estudos de Casos e Controles , Dislipidemias/fisiopatologia , Feminino , Humanos , Lipoproteínas HDL/sangue , Masculino , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Estudos Prospectivos , Análise de Onda de Pulso , Triglicerídeos/sangue
6.
Vnitr Lek ; 63(1): 25-30, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28225288

RESUMO

INTRODUCTION: Despite great recent progress, familial hypercholesterolemia (FH) is still underestimated, under-diagnosed and thus undertreated worldwide. We have very little information on exact prevalence of patients with FH in the Central, Eastern and Southern Europe (CESE) region. The aim of the study was to describe the epidemiological situation in the CESE region from data available. METHODS: All local leaders of the ScreenPro FH project were asked to provide local data on (a) expert guess of FH prevalence (b) the medical facilities focused on FH already in place (c) the diagnostic criteria used (d) the number of patients already evidenced in local database and (e) the availability of therapeutic options (especially plasma apheresis). RESULTS: With the guess prevalence of FH around 1 : 500, we estimate the overall population of 588 363 FH heterozygotes in the CESE region. Only 14 108 persons (2.4 %) were depicted in local databases; but the depiction rate varied between 0.1 % and 31.6 %. Only four out of 17 participating countries reported the the LDL apheresis availability. CONCLUSION: Our data point to the large population of heterozygous FH patients in the CESE region but low diagnostic rate. However structures through the ScreenPro FH project are being created and we can hope that the results will appear soon.Key words: diagnosis - epidemiology - familial hypercholesterolemia - screening.


Assuntos
Hiperlipoproteinemia Tipo II/epidemiologia , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Europa Oriental/epidemiologia , Heterozigoto , Humanos , Hiperlipoproteinemia Tipo II/diagnóstico , Programas de Rastreamento , Prevalência
7.
Vnitr Lek ; 63(1): 43-48, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28225290

RESUMO

Familial hypercholesterolemia (FH) is a genetic disorder with well-known genetic transmission and clinical course. Despite great recent progress, FH is still underestimated, under-diagnosed and thus undertreated. Furthermore it represents a significant healthcare challenge as a common risk factor for the premature development of coronary heart disease. The ScreenPro FH Project is an international network project aiming at improving complex care - from timely screening, through diagnosis to up-to-date treatment of familial hypercholesterolemia in Central, Eastern and Southern Europe. An important task for the project is to harmonise and unify diagnostic and therapeutic approaches in participating countries, where the situation differs from country to country. Countries with more experience should serve as a model for countries developing the FH network.Key words: diagnosis - familial hypercholesterolemia - screening - treatment optimization.


Assuntos
Hiperlipoproteinemia Tipo II/diagnóstico , Anticolesterolemiantes/uso terapêutico , Remoção de Componentes Sanguíneos , Doença das Coronárias/epidemiologia , Europa (Continente)/epidemiologia , Europa Oriental/epidemiologia , Humanos , Hiperlipoproteinemia Tipo II/epidemiologia , Hiperlipoproteinemia Tipo II/terapia , Programas de Rastreamento , Fatores de Risco
8.
Vojnosanit Pregl ; 72(9): 801-6, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26554112

RESUMO

BACKGROUND/AIM: Some oligoelements are now investigated as possibly having a role in atherosclerosis. The aim of this study was to compare the concentrations of copper and zinc in the serum and carotid plaque and parameters of lipid metabolism in patients with different morphology of carotid atherosclerotic plaque. METHODS: Carotid endarterectomy due to the significant atherosclerotic stenosis was performed in 91 patients (mean age 64 ± 7). The control group consisted of 27 patients (mean age 58 ± 9), without carotid atherosclerosis. Atheroscletoric plaques were divided into four morphological groups, according to ultrasonic and intraoperative characteristics. Copper and zinc concentrations in the plaque, carotid artery and serum were measured by atomic absorption spectrophotometry. RESULTS: Serum copper concentrations were statistically significantly higher in the patients with hemorrhagic in comparison to those with calcified plaque (1.2 ± 0.9 µmol/L vs 0.7 ± 0.2 µmol/L, respectively; p = 0.021). Zinc concentrations were statistically significantly lower in plaques of the patients with fibrolipid in comparison to those with calcified plaques (22.1 ± 16.3 g/g vs 38.4 ± 25.8 µg/g, respectively; p = 0.024). A negative significant correlation was found for zinc and triglycerides in the serum in all the patients (r = -0.52, p = 0.025). In the control group we also demonstrated a positive significant correlation for low-density lipoprotein cholesterol and copper in the serum (r = 0.54, p = 0.04). CONCLUSION: The data obtained in the current study are consistent with the hypothesis that high copper and lower zinc levels may contribute to atherosclerosis and its sequelae as factors in a multifactorial disease. Further studies are necessary in order to conclude whether high concentration of copper and zinc in the serum could be risk factors for atherosclesrosis.


Assuntos
Doenças das Artérias Carótidas/metabolismo , Cobre/metabolismo , Endarterectomia das Carótidas/métodos , Placa Aterosclerótica , Zinco/metabolismo , Idoso , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/cirurgia , LDL-Colesterol/sangue , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Metabolismo dos Lipídeos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/metabolismo , Placa Aterosclerótica/patologia , Reprodutibilidade dos Testes , Fatores de Risco , Estatística como Assunto , Ultrassonografia/métodos
9.
J Cardiothorac Surg ; 10: 127, 2015 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-26466996

RESUMO

BACKGROUND: There is ongoing debate regarding the efficacy of the radial artery (RA) as an aortocoronary conduit, with few solid data regarding long-term clinical results. We sought to determine if the use of the RA as the second arterial conduit, beside left internal thoracic artery (LITA), would improve long-term clinical outcome after CABG as compared to saphenous vein graft (SVG). METHODS: Between March 2001 and November 2003, 200 patients underwent isolated CABG and were randomized in 1:1 fashion to receive either LITA and RA grafts or LITA and SVGs. The primary end point was composite of cardiovascular mortality, non-fatal myocardial infarction and need for repeat myocardial revascularization (either surgical or percutaneous). RESULTS: There was no significant difference in absolute survival, with 12 deaths in each group during the study period (log rank = 0.01, p = 0.979). There were 3 and 2 cardiac deaths in RA and SVG groups, respectively. There was no difference in long-term clinical outcome between the groups (log rank = 0.450, p = 0.509). Eleven patients in RA group had one or more non-fatal events; 7 patients suffered a myocardial infarction, 9 patients underwent percutaneous coronary angioplasty, and 1 patient required redo coronary surgery. Likewise, 13 patients in SVG group had non-fatal event; 7 patients had myocardial infarction, 13 patients had percutaneous coronary intervention and 3 patients required redo coronary surgery. Angiograms were performed in 23 patients in RA group (patency rate 92 %) and 24 in SVG group (patency rate 86 %) (p = 0.67). CONCLUSION: In this small randomised study our data indicate that there is no difference in the 8 year clinical outcomes in relatively young patients between those having a RA or a saphenous vein graft used as a second conduit, beside LITA, for surgical myocardial revascularisation.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/métodos , Artéria Radial/transplante , Veia Safena/transplante , Idoso , Doença da Artéria Coronariana/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Artéria Torácica Interna/cirurgia , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento
10.
Acta Physiol Hung ; 102(2): 143-50, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26100304

RESUMO

The aim of this study was to investigate the iron concentrations in serum and carotid plaque in patients with different morphology of carotid atherosclerotic plaque and compared with other metal ions. Carotid endarterectomy due to the significant atherosclerotic stenosis was performed in 91 patients. Control group consisted of 27 patients, without carotid atherosclerosis. Atherosclerotic plaques were divided into four morphological groups, according to ultrasonic and intraoperative characteristics. Iron, copper and zinc concentration in plaque, carotid artery and serum were measured by spectrophotometry. Serum iron concentrations were higher in patients with hemorrhagic plaques in comparison to the control group (4.7 µmol/l ± 1.2 vs. 2.1 µmol/l ± 0.8, p < 0.05). Iron concentrations were higher in patients with hemorrhagic plaques in comparison to fibrolipid plaques (72.1 ± 14.3 µg/g vs. 39.3 ± 22.9 µg/g; p < 0.05). Negative significant correlation was found for zinc in serum and plaque iron concentration in patients (p < 0.05). We also demonstrated positive significant correlation for copper and iron in serum (p < 0.05). The data obtained in the current study are consistent with the hypothesis that high iron levels may contribute to atherosclerosis and its complications as factors in a multifactorial disease.


Assuntos
Artérias Carótidas/química , Doenças das Artérias Carótidas/sangue , Ferro/sangue , Placa Aterosclerótica , Idoso , Biomarcadores/sangue , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/cirurgia , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/cirurgia , Estudos de Casos e Controles , Cobre/sangue , Endarterectomia das Carótidas , Feminino , Fibrose , Hemorragia/sangue , Hemorragia/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Regulação para Cima , Zinco/sangue
11.
Vasa ; 41(5): 343-51, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22915531

RESUMO

BACKGROUND: Cardiovascular (CV) morbidity and mortality are increased in patients with rheumatoid arthritis (RA). Our study aim was to determine the relationship between carotid artery intima-media wall thickness (IMT) and flow-mediated endothelium-dependent vasodilatation (FMD) in a patients with RA, in context with clinical and laboratory measurements. PATIENTS AND METHODS: Fifty-two patients with RA and 30 matched healthy controls without clinically evident CV disease were studied. Brachial and carotid ultrasonography was performed to determine FMD and IMT, respectively. We also assayed immunological, inflammatory and metabolic laboratory markers. RESULTS: IMT was significantly higher in RA patients (1.00 ± 0.16 mm) patients than in controls (0.89 ± 0.13 mm) (P = 0.001). FMD was significantly lower in RA (9.16 ± 7.03) as compared to controls (12.60 ± 5.49) (p = 0.005). RA patients had significant positive correlations between erythrocyte sedimentation rate (ESR) (r=0.395 p = 0.021) and IMT and negative correlation between visual analog scale (VAS) (r= -0.311, p= 0.025) and IMT. RA patients who used low doses of corticosteroids have, statistically, significantly better FMD, than those who do not use corticosteroids. Linear regression analysis revealed that IMT was related to tender joint count (p = 0.008), VAS (p < 0.001), ESR (p = 0.048) and total cholesterol/high density lipoprotein cholesterol ratio (p = 0.039). CONCLUSIONS: In patients with RA, FMD was impaired and IMT was increased, indicating early endothelial dysfunction and accelerated atherosclerosis. Early treatment of disease may reduce the risk of atherosclerosis in RA.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Hiperemia/diagnóstico por imagem , Hiperemia/fisiopatologia , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/fisiopatologia , Túnica Média/diagnóstico por imagem , Túnica Média/fisiopatologia , Vasodilatação/fisiologia , Adulto , Diagnóstico Precoce , Endotélio Vascular/diagnóstico por imagem , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Ultrassonografia
12.
J Clin Ultrasound ; 40(7): 405-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22407437

RESUMO

BACKGROUND: We and others have shown previously that left ventricular (LV) contractile reserve assessed quantitatively by high-dose dobutamine stress-echocardiography (DSE) has prognostic implications in patients with dilated cardiomyopathy. PURPOSE: To assess the feasibility of semi-quantitative assessment of LV contractile reserve by differently skilled operators in patients with dilated cardiomyopathy. METHODS: High-dose DSE was performed in 63 consecutive patients, mean age 50 ± 10 years and ejection fraction (EF) 19 ± 8%. LVEF was calculated 1) using Simpson's biplane formula, and 2) semi-quantitatively (5% increments) by novice and experienced echocardiographers, and by a DSE expert. Patients were considered to have preserved LV contractile reserve if LVEF dobutamine-induced change was ≥5%. RESULTS: Twenty-seven (45.8%) patients died during the 5-year follow-up. The feasibility of the assessment was 89%, 94%, and 98% for novice and experienced readers and DSE expert, respectively. Kaplan-Meier analysis showed that LV contractile reserve assessed semi-quantitatively by DSE expert and experienced reader achieved the best prognostic separation (log rank 19.63 and 18.99, respectively, p < 0.001 for both), followed by quantitative assessment (log rank 9.76, p = 0.0018) and assessment by novice reader (log rank 8.76, p = 0.012). Areas under the curves were similar for quantitative and semi-quantitative assessment of LV contractile reserve. CONCLUSIONS: Our data indicate that semi-quantitative assessment of LV contractile reserve is feasible by differently skilled operators.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia sob Estresse , Ventrículos do Coração/diagnóstico por imagem , Contração Miocárdica , Função Ventricular Esquerda , Adulto , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/fisiopatologia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC
13.
J Cardiothorac Surg ; 6: 51, 2011 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-21489286

RESUMO

BACKGROUND: Prognostic value of concomitant aprtic regurgitation (AR) in patients operated for severe aortic stenosis (AS) is not clarified. The aim of this study was to prospectively examine the impact of presence and severity of concomitant AR in patients operated for severe AS on long-term functional capacity, left ventricular (LV) function and mortality. METHODS: Study group consisted of 110 consecutive patients operated due to severe AS. The patients were divided into AS group (56 patients with AS without AR or with mild AR) and AS+AR group (54 patients with AS and moderate, severe or very severe AR). Follow-up included clinical examination, six minutes walk test (6MWT) and echocardiography 12 and 104 months after AVR. RESULTS: Patients in AS group had lower LV volume indices throughout the study than patients in AS+AR group. Patients in AS group did not have postoperative decrease in LV volume indices, whereas patients in AS+AR group experienced decrease in LV volume indices at 12 and 104 months. Unlike LV volume indices, LV mass index was significantly lower in both groups after 12 and 104 months as compared to preoperative values. Mean LVEF remained unchanged in both groups throughout the study. NYHA class was improved in both groups at 12 months, but at 104 months remained improved only in patients with AS. On the other hand, distance covered during 6MWT was longer at 104 months as compared to 12 months only in AS+AR group (p = 0,013), but patients in AS group walked longer at 12 months than patients in AS+AR group (p = 0,002). There were 30 deaths during study period, of which 13 (10 due to cardiovascular causes) in AS group and 17 (12 due to cardiovascular causes) in AS+AR group. Kaplan-Meier analysis showed that the survival probability was similar between the groups. Multivariate analysis identified diabetes mellitus (beta 1.78, p = 0.038) and LVEF < 45% (beta 1.92, p = 0.049) as the only independent predictor of long-term mortality. CONCLUSION: Our data indicate that the preoperative presence and severity of concomitant AR has no influence on long-term postoperative outcome, LV function and functional capacity in patients undergoing AVR for severe AS.


Assuntos
Insuficiência da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Ecocardiografia , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
14.
Srp Arh Celok Lek ; 137(5-6): 275-7, 2009.
Artigo em Sérvio | MEDLINE | ID: mdl-19594070

RESUMO

INTRODUCTION: Moderate ischemic mitral regurgitation (MR) is characterized by significant, symptomatic multivessel coronary disease and mitral regurgitation 2-3+. CASE OUTLINE: A 60-year-old patient was admitted at the Cardiovascular Institute "Dedinje" due to the symptoms of unstable angina pectoris. He survived a myocardial infarction (inferoposterolateral localization) 8 years ago. On admission echocardiogram revealed regional disturbances of the left ventricle wall with ejection fraction of 25% and mitral regurgitation 2+. The patient underwent a triple coronary bypass with surgical correction of mitral regurgitation. Postoperative course was normal. CONCLUSION: Several authors are against surgical correction of MR in moderate ischemic MR due to several reasons: revascularization of ischemic areas will improve regional wall motion and correct MR, while mitral valve surgery adds significantly to the operative risk of coronary surgery. Other authors, however, favour combined operation emphasizing that in many patients coronary surgery alone will not correct a moderate ischemic MR. Today there is no consensus whether to operate the moderate ischemic MR or to ignore it. Some novel studies underscore significant predictors of a long-term survival of these patients: NYHA (New York Heart Association) class and left ventricle ejection fraction. In that respect a combined operation should be recommended in patients with heart failure and NYHA class III and IV.


Assuntos
Doença das Coronárias/complicações , Insuficiência da Valva Mitral/cirurgia , Ponte de Artéria Coronária , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações
15.
Heart Surg Forum ; 11(6): E340-5, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19073530

RESUMO

OBJECTIVE: Mitral incompetence is a chronic sequela of myocardial infarction. It is caused by apical displacement and tethering of the mitral valve leaflets after myocardial infarction, resulting in incomplete coaptation. The consensus is for mitral valve surgery in the presence of significant ischemic mitral regurgitation (IMR). Previously, the only option was mitral valve replacement (MVR) with a mechanical or tissue valve. The suboptimal results obtained prompted the development of several methods of mitral valve repair. Today, the most commonly used repair is undersized annuloplasty. METHODS: We conducted a retrospective nonrandomized study of all patients who underwent operation for coronary artery disease and IMR between 2000 and 2006. The surgeon chose the surgical method used for the mitral valve procedure. The most commonly used procedures were restrictive mitral valve annuloplasty (MVP) and MVR with a mechanical prosthesis. We collected all pertinent preoperative, intraoperative, and early-postoperative data. We followed up with phone interviews of the patients and their relatives and with complete clinical and echocardiography examinations. RESULTS: We carried out operations on 138 patients during the study period (MVR, 52 patients; MVP, 86 patients). The 2 groups had comparable demographic data and risk factors. The 2 groups were significantly different with respect to mean (+/-SD) New York Heart Association (NYHA) class (MVP, 2.72 +/- 0.62; MVR, 2.48 +/- 0.70; P < .01) and ejection fraction (MVP, 29.01% +/- 11.00%; MVR, 35.87% +/- 11.00%; P

Assuntos
Procedimentos Cirúrgicos Cardiovasculares/mortalidade , Próteses Valvulares Cardíacas/estatística & dados numéricos , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/cirurgia , Medição de Risco/métodos , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sérvia/epidemiologia , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
16.
Vascular ; 16(5): 291-4, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19238873

RESUMO

Jugular vein aneurysm is a rare morphologic entity. This report describes a case of an asymptomatic internal jugular vein aneurysm that presented as an enlarging mass in the neck. Diagnosis was established with duplex ultrasonography and venography. No thrombus was diagnosed in the aneurysm, but since the patient was uncomfortable with having a tumor in his neck, surgery was performed with resection of the aneurysm and lateral venorrhaphy of the jugular vein.


Assuntos
Aneurisma/diagnóstico por imagem , Veias Jugulares/diagnóstico por imagem , Aneurisma/cirurgia , Humanos , Veias Jugulares/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Ultrassonografia Doppler Dupla
17.
Srp Arh Celok Lek ; 135(7-8): 407-13, 2007.
Artigo em Sérvio | MEDLINE | ID: mdl-17929532

RESUMO

INTRODUCTION: Transplantation is the method of choice in the treatment of terminal liver diseases with acute and structural damage of liver tissue and congenital liver diseases. OBJECTIVE: The aim of our study was to determine specificity and significance of vascular anastomosis in liver transplantation by postoperative evaluation of vascular anastomosis function. METHOD: The study included 16 patients with 16 liver transplantations and one re-do liver transplantation. In all patients, preoperative angiography and postoperative duplex sonographic and angiographic evaluation of vascular anastomosis were performed. RESULTS: Preoperative angiographic evaluation did not reveal anomalies in liver blood vessels of transplant candidates. In one patient, we identified and angiographically confirmed stenosis on anastomosis of the hepatic artery on the 7th postoperative day. In another patient, we had artificial thrombosis of the hepatic artery branch due to the liver biopsy. CONCLUSION: The successful performance of vascular anastomosis in liver transplantation is significant for adequate liver graft perfusion, good postoperative graft function and overall outcome of the liver transplantation.


Assuntos
Transplante de Fígado/métodos , Fígado/irrigação sanguínea , Anastomose Cirúrgica/métodos , Angiografia , Humanos , Reoperação , Ultrassonografia Doppler Dupla
18.
Int J Cardiol ; 117(1): e24-6, 2007 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-17258329

RESUMO

Patient was admitted for endarterectomy of the left internal carotid artery. Echocardiography showed mitral stenosis with mitral valve area of 1.4 cm2. Since the patient's functional capacity could not be determined due to left-sided hemiplegia, it was decided to perform high-dose dobutamine stress-echocardiography in order to assess the patient's hemodynamics during stress. Gradients over mitral valve increased from 32/10 mmHg at baseline to 43/16 mmHg at 40 mcg/kg/min dobutamine infusion. Preoperative and 24 hour perioperative hemodynamic variables were monitored by Swan-Ganz catheter, and their values did not change significantly as compared to baseline. Postoperative course was uneventful, and the patient was discharged on the fifth postoperative day.


Assuntos
Estenose das Carótidas/cirurgia , Ecocardiografia sob Estresse/métodos , Estenose da Valva Mitral/diagnóstico por imagem , Assistência Perioperatória/métodos , Idoso , Pressão Sanguínea , Débito Cardíaco , Artéria Carótida Interna , Estenose das Carótidas/complicações , Estenose das Carótidas/fisiopatologia , Endarterectomia das Carótidas , Frequência Cardíaca , Humanos , Masculino , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/fisiopatologia , Resultado do Tratamento , Resistência Vascular
19.
Srp Arh Celok Lek ; 132(3-4): 80-4, 2004.
Artigo em Sérvio | MEDLINE | ID: mdl-15307308

RESUMO

INTRODUCTION: Copper and zinc have significant antiatherogenic effect influencing activity of antioxidant enzymes (glutathione-peroxidase and superoxide-dismutase), mechanism of apoptosis and other mechanisms. Few studies showed increased copper and zinc concentration in atherosclerotic plaque in comparison to normal vascular tissue. AIM: The aim of the study was to compare copper and zinc concentrations in carotid artery tissue without significant atherosclerotic changes and human ulcered atherosclerotic plaque. MATERIAL AND METHODS: Study was conducted on 66 patients. Carotid endarterectomy due to the significant carotid atherosclerotic changes with cerebrovascular disorders was performed in 54 patients (81.8%). Control group consisted of 12 patients (18.2%) without carotid atherosclerotic changes operated due to the symptomatic kinking and coiling of carotid artery. Operated group consisted of 38 men (62.96%) and 16 women (37.04%). Control group had the same number of patients: six men (50%) and six women (50%). Preoperatively, all patients were examined by vascular surgeon, neurologist and cardiologist. Duplex sonography of carotid and vertebral arteries was performed by Aloca DSD 630 ultrasound with mechanical and linear transducer 7.7 MHz. Indication for surgical treatment was obtained according to non-invasive diagnostic protocol and neurological symptoms. Copper and zinc concentration in human ulcered atherosclerotic plaque and carotid artery segment were estimated by spectrophotometry (Varian AA-5). RESULTS: Average age of our patients was 59.8+/-8.1 years. For males average age was 76.1+/-9.8 years. And for females 42.4+/-5.8 years. In group with carotid endarterectomy female patients were significantly younger than male patients (p<0.01). In group with carotid endarterectomy clinically determined neurological disorders were found in 47 patients (87.03%)--35 male (74.47%) and 12 female patients (25.53%). Regarding risk factors for cardiovascular diseases, no significant difference among groups was found for blood pressure and smoking. However, patients with carotid endarterectomy had significantly more diabetes mellitus (p<0.05), obesity (p<0.01) and hypercholesterolemia (p<0.01). DISCUSSION: Our study showed significantly lower total copper value in the group with human ulcered atherosclerotic plaque in comparison with the control group (p<0.05). We also found significantly lower total zinc value in the group with human ulcered atherosclerotic plaque in comparison with the control group (p<0.05). CONCLUSION: Our study revealed significant difference in copper and zinc content between human ulcered atherosclerotic plaque and normal carotid tissue. Closer correlation of these oligoelements and endothelial dysfunction will be established in future investigations.


Assuntos
Arteriosclerose/metabolismo , Artérias Carótidas/metabolismo , Doenças das Artérias Carótidas/metabolismo , Cobre/análise , Zinco/análise , Idoso , Arteriosclerose/patologia , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/cirurgia , Estenose das Carótidas/metabolismo , Estenose das Carótidas/patologia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...