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1.
J Infect Dev Ctries ; 15(2): 224-229, 2021 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-33690204

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has been associated with cardiac arrhythmias. Several electrocardiographic markers have been used to predict the risk of arrhythmia in patients with COVID-19. We aim to investigate the electrocardiographic (ECG) ventricular repolarization indices in patients with COVID-19. METHODOLOGY: We performed a comprehensive systematic literature search from PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and Google Scholar Preprint Servers. The primary endpoints of this search were: Tp-e (T-peak-to-T-end) interval, QTd (QT dispersion), and Tp-e/QTc ratio in patients with newly diagnosed COVID-19 from inception up until August 2020. RESULTS: There were a total of 241 patients from 2 studies. Meta-analysis showed that Tp-e/QTc ratio was higher in COVID-19 group (mean difference 0.02 [0.01, 0.02], p < 0.001; I2: 18%,). Tp-e interval was more prolonged in COVID-19 group (mean difference 7.76 [3.11, 12.41], p < 0.001; I2: 80%) compared to control group. QT dispersion (QTd) also was increased in COVID-19 group (mean difference 1.22 [0.61, 1.83], p < 0.001 ; I2:30%). CONCLUSIONS: Several electrocardiographic markers including Tp-e/QTc, Tp-e interval, and QTd are significantly increased in patients with COVID-19.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Eletrocardiografia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/virologia , Estudos de Casos e Controles , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Pessoa de Meia-Idade
2.
Ter Arkh ; 92(10): 70-77, 2020 Nov 24.
Artigo em Russo | MEDLINE | ID: mdl-33346482

RESUMO

Cardiovascular complications including arrhythmias and cardiac conduction disorders are one of the main reasons of high mortality rate in acromegaly, while they have not been well explored. AIM: To estimate arrhythmias frequency in acromegaly, identify risk factors leading to the development of arrhythmia and cardiac conduction disorder, to determine the role of cardiac MRI in detecting structural and functional changes. MATERIALS AND METHODS: A single-center prospective cohort study, which included 461 patients (151 men and 310 women) with acromegaly, was conducted. All the patients underwent a standard medical examination, including hormonal blood test, electrocardiogram, echocardiography, electrocardiogram daily monitoring. 18 patients with arrhythmias (11 men and 7 women) had cardiac MRI with gadolinium-based contrast. RESULTS: The results of our research show high frequency of arrhythmias and cardiac conduction disorders in patients with acromegaly 42%. Most frequent kinds of arrhythmias and cardiac conduction disorders were sinus bradycardia 19.1% of the cases and conduction disorders of bundle branch blocks 14.5%. Men were more likely to suffer from arrhythmias and cardiac conduction disorders than women (54.2% and 37.4%, respectively,p=0.0005). Not acromegaly activity but duration of the disease was a main risk factor of arrhythmias and cardiac conduction disorders. Patients with arrhythmias had a long anamnesis of acromegaly (10 and 7 years, respectively, p=0.04). Meanwhile, cardiac conduction disorders were commonly observed in the patients who were treated with somatostatin analogs comparing to the patients who didnt undergo this therapy (50% and 38.6% respectively,p=0.004). We showed that 61% of patients with acromegaly and cardiac conduction disorders who underwent magnetic resonance imaging (MRI) had the signs of myocardial fibrosis. The value of the ejection fraction of the left ventricle according to MRI was higher than with echocardiography (p=0.04). CONCLUSION: Arrhythmias and cardiac conduction disorders are often observed in patients with acromegaly even with remission of the disease. High risk group need careful diagnostic and monitoring approaches. Cardiac MRI is the gold standard for visualization of structural and morphological changes in the heart. Use of cardiac MRI in acromegalic patients expands our understanding of arrhythmias and cardiac conduction disorders in this disease. There are no specific laboratory markers of diffuse myocardial fibrosis, and the role of myocardial fibrosis in the occurrence of cardiac arrhythmias and conduction disorders needs further studying.


Assuntos
Acromegalia , Acromegalia/complicações , Acromegalia/diagnóstico por imagem , Acromegalia/epidemiologia , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/epidemiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Miocárdio , Estudos Prospectivos
4.
Mayo Clin Proc ; 95(10): 2099-2109, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33012341

RESUMO

OBJECTIVE: To study whether combining vital signs and electrocardiogram (ECG) analysis can improve early prognostication. METHODS: This study analyzed 1258 adults with coronavirus disease 2019 who were seen at three hospitals in New York in March and April 2020. Electrocardiograms at presentation to the emergency department were systematically read by electrophysiologists. The primary outcome was a composite of mechanical ventilation or death 48 hours from diagnosis. The prognostic value of ECG abnormalities was assessed in a model adjusted for demographics, comorbidities, and vital signs. RESULTS: At 48 hours, 73 of 1258 patients (5.8%) had died and 174 of 1258 (13.8%) were alive but receiving mechanical ventilation with 277 of 1258 (22.0%) patients dying by 30 days. Early development of respiratory failure was common, with 53% of all intubations occurring within 48 hours of presentation. In a multivariable logistic regression, atrial fibrillation/flutter (odds ratio [OR], 2.5; 95% CI, 1.1 to 6.2), right ventricular strain (OR, 2.7; 95% CI, 1.3 to 6.1), and ST segment abnormalities (OR, 2.4; 95% CI, 1.5 to 3.8) were associated with death or mechanical ventilation at 48 hours. In 108 patients without these ECG abnormalities and with normal respiratory vitals (rate <20 breaths/min and saturation >95%), only 5 (4.6%) died or required mechanical ventilation by 48 hours versus 68 of 216 patients (31.5%) having both ECG and respiratory vital sign abnormalities. CONCLUSION: The combination of abnormal respiratory vital signs and ECG findings of atrial fibrillation/flutter, right ventricular strain, or ST segment abnormalities accurately prognosticates early deterioration in patients with coronavirus disease 2019 and may assist with patient triage.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/fisiopatologia , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Betacoronavirus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico
5.
Int Heart J ; 61(5): 896-904, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999195

RESUMO

Identifying the optimal atrioventricular (AV) or interventricular (VV) delay is beneficial for patients using cardiac resynchronization therapy (CRT) devices. Ultrasonic echocardiography (UCG) has been the most commonly used method; however, it requires high technical knowledge. Impedance cardiography (ICG) can calculate stroke volume by measuring changes in transthoracic electric impedance. This study sought to assess the clinical utility of ICG in comparison with that of UCG for the optimization of CRT devices.Patients who underwent CRT device implantation were retrospectively analyzed. One week after implantation, optimization of AV delay (AVD) was performed in every patient with ICG (AVD-ICG) and UCG (AVD-UCG). VV delay (VVD) was then determined according to the optimal AVD using these two methods.Forty-two patients were enrolled. Average AVD-ICG was significantly shorter than AVD-UCG (128 ± 49 versus 146 ± 41 milliseconds, P = 0.018). Five patients (12%) had the same optimized AVD with two methods, and the difference between AVD-ICG and AVD-UCG was ≤ 20 milliseconds in 19 patients (45%). In the multivariate analysis, the presence of postoperative mitral regurgitation (MR) was an independent predictor of AVD-ICG/AVD-UCG mismatch, defined as a difference over 20 milliseconds (odds ratio = 10.71; 95% confidence interval = 1.72 to 66.72; P = 0.018). The results of optimized VVD were similar using both methods.ICG might be a promising tool for the rapid optimization of CRT devices. However, in patients with moderate-to-severe MR, ICG may not be able to optimize AVD.


Assuntos
Arritmias Cardíacas/terapia , Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Cardiografia de Impedância , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral , Complicações Pós-Operatórias , Estudos Retrospectivos
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2011-2014, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018398

RESUMO

Image registration represents one of the fundamental techniques in medical imaging and image-guided interventions. In this paper, we present a Convolutional Neural Network (CNN) framework for deformable transesophageal US/CT image registration, for the cardiac arrhythmias, and guidance therapy purposes. The framework consists of a CNN, a spatial transformer, and a resampler. The CNN expects concatenated pairs of moving and fixed images as its input, and estimates as output the parameters for the spatial transformer, which generates the displacement vector field that allows the resampler to wrap the moving image into the fixed image. In our method, we train the model to maximize standard image matching objective functions that are based on the image intensities. The network can be applied to perform non-rigid registration of a pair of CT/US images directly in one pass, avoiding so the time consuming computation of the classical iterative method.


Assuntos
Arritmias Cardíacas , Redes Neurais de Computação , Arritmias Cardíacas/diagnóstico por imagem , Humanos , Tomografia Computadorizada por Raios X
7.
Radiol Med ; 125(11): 1087-1101, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32978708

RESUMO

Over the past few years, the approach to the 'arrhythmic patient' has profoundly changed. An early clinical presentation of arrhythmia is often accompanied by non-specific symptoms and followed by inconclusive electrocardiographic findings. In this scenario, cardiac magnetic resonance (CMR) has been established as a clinical tool of fundamental importance for a correct prognostic stratification of the arrhythmic patient. This technique provides a high-spatial-resolution tomographic evaluation of the heart, which allows studying accurately the ventricular volumes, identifying even segmental kinetic anomalies and properly detecting diffuse or focal tissue alterations through an excellent tissue characterization, while depicting different patterns of fibrosis distribution, myocardial edema or fatty substitution. Through these capabilities, CMR has a pivotal role for the adequate management of the arrhythmic patient, allowing the identification of those phenotypic manifestations characteristic of structural heart diseases. Therefore, CMR provides valuable information to reclassify the patient within the wide spectrum of potentially arrhythmogenic heart diseases, the definition of which remains the major determinants for both an adequate treatment and a poor prognosis. The purpose of this review study was to focus on the role of CMR in the evaluation of the main cardiac clinical entities associated with arrhythmogenic phenomena and to present a brief debate on the main pathophysiological mechanisms involved in the arrhythmogenesis process.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Técnicas de Imagem Cardíaca/métodos , Cardiomiopatias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Cardiomegalia Induzida por Exercícios , Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia , Fibrose Endomiocárdica/complicações , Fibrose Endomiocárdica/diagnóstico por imagem , Humanos , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem
8.
Med. clín (Ed. impr.) ; 155(5): 207-214, sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195860

RESUMO

En 1979 Bayés de Luna describió los bloqueos interauriculares (BIA). Siguiendo el mismo principio de clasificación de los bloqueos en otras estructuras del corazón los dividió en primero (BIA parcial), segundo (aberrancia auricular) y tercer grado (BIA avanzado). Recientemente se describieron sus formas atípicas. Se cuenta con evidencias de que los retrasos o bloqueos de la conducción en el haz de Bachmann constituyen la base mecanística de dichos bloqueos. La asociación entre BIA, principalmente los de grado avanzado, y taquiarritmias auriculares ya es ciencia constituida, y es denominado por la comunidad médica como síndrome de Bayés. Los BIA también se asocian a la aparición de infarto cerebral isquémico y recurrencia de fibrilación auricular en varios escenarios. La presente revisión repasa aspectos clásicos y da luz sobre la interpretación de este patrón electrocardiográfico en la práctica clínica


In 1979 Bayés de Luna described interatrial blocks (IAB). Following the same principle of classification of blocks in other structures of the heart, he divided them into first (partial IAB), second (atrial aberrancy) and third degree (advanced IAB). Atypical forms of these blocks were recently described. There is evidence that delays or blocks of conduction in the Bachmann bundle constitute the mechanistic basis of these blocks. The association between IAB, mainly those of advanced grade, and atrial tachyarrhythmias is already constituted science, and is referred to by the medical community as Bayés syndrome. IABs are also associated with the occurrence of ischaemic stroke and recurrence of atrial fibrillation in several scenarios. This review presents classical aspects and sheds light on the interpretation of this electrocardiographic pattern in clinical practice


Assuntos
Humanos , Bloqueio Interatrial/diagnóstico por imagem , Bloqueio Interatrial/epidemiologia , Eletrocardiografia/métodos , Septo Interatrial/diagnóstico por imagem , Arritmias Cardíacas/diagnóstico por imagem , Sistema de Condução Cardíaco/diagnóstico por imagem
9.
Fisioterapia (Madr., Ed. impr.) ; 42(4): 170-176, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193504

RESUMO

INTRODUCCIÓN: Las tecnologías para la rehabilitación son instrumentos, equipos, sistemas o dispositivos, que aportan a los procesos de recuperación de las capacidades humanas. La 4.ª revolución industrial ha hecho que se utilice la realidad virtual en procesos de rehabilitación, por lo cual es necesario conocer sus efectos fisiológicos en las personas. OBJETIVO: Determinar el efecto de la exposición a la RV sobre los signos vitales en 7 adultos mayores aparentemente sanos. MÉTODO: Se presenta un estudio epidemiológico descriptivo de una serie de 7 casos que permitió evaluar el comportamiento de los signos vitales. Los participantes fueron adultos mayores con edades entre 50 a 75 años, sin ningún tipo de patología osteomuscular y neuromuscular que impidan la ejecución de programa. Se contó con 4 tipos de ambientes virtuales programados progresivamente desde un ambiente de adaptación hasta el ambiente virtual de demandas reales. RESULTADOS: En la recolección de los signos vitales se evidenció un aumento significativo en FC, FR, TAM y SaO2 (P < 0,05), no se encontraron diferencias significativas de los signos vitales tomados previos a la exposición y 10 minutos posterior (P < 0,05). CONCLUSIÓN: Los cambios hemodinámicos antes de la exposición a RV no son permanentes en el tiempo. Los signos vitales 10 minutos posterior a la exposición regresan a los valores iniciales; lo cual permite aplicar la RV en personas mayores aparentemente sanas como estrategia terapéutica sin riesgo de presentar cambios fisiológicos concurrentes y nocivos, de acuerdo a la muestra de este estudio


INTRODUCTION: The technologies for rehabilitation are instruments, equipment, systems or devices, which contribute to the processes of recovery of human capabilities. The 4.th industrial revolution has brought about the use of virtual reality in rehabilitation processes, and therefore it is necessary to be aware of its physiological effects on people. OBJECTIVE: To determine the effect of VR exposure on vital signs in 7 apparently healthy older adults. METHOD: We present a descriptive epidemiological study of a series of 7 cases that allowed us to evaluate the behaviour of vital signs. The participants were older adults aged between 50 and 75 years, without any musculoskeletal or neuromuscular pathology to prevent them undertaking the programme. There were 4 types of virtual environments programmed progressively from an adaptation environment to the virtual environment of real demands. RESULTS: In the collection of vital signs, a significant increase in HR, FR, TAM and SaO2 (P < .05) was evidenced, no significant differences were found in the vital signs taken before and 10minutes after exposure (P < .05). CONCLUSION: Haemodynamic changes before exposure to RV are not permanent over time. Vital signs 10minutes after exposure return to initial values, which allows the application of RV in apparently healthy older people as a therapeutic strategy without risk of presenting concurrent and harmful physiological changes, according to the sample of this study


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Realidade Virtual , Sinais Vitais/fisiologia , Terapia por Exercício , 24960 , Hemodinâmica , Técnicas de Exercício e de Movimento/instrumentação , Eletrocardiografia/métodos , Arritmias Cardíacas/diagnóstico por imagem
10.
J Surg Oncol ; 122(3): 407-411, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32483842

RESUMO

BACKGROUND AND OBJECTIVES: Irreversible electroporation (IRE) is a nonthermal electrical tumor ablative strategy for unresectable tumors. IRE is relatively safe around critical structures but may induce cardiac arrhythmia when its delivery is not synchronized to the cardiac cycle. We performed a systematic literature review to determine rates of arrhythmia when IRE was utilized with or without cardiac synchronization. METHODS: An online literature search was conducted with additional hand selection of articles. Data were extracted and pooled analyses were performed. RESULTS: Twelve articles were included in analysis. IRE was performed for 481 patients; 46% hepatic tumors (n = 223), 36% pancreatic lesions (n = 168), and multiple other locations including prostate. Synchronization was performed on 422 patients. Arrhythmias were noted in 3.7% of cases (n = 18/481); cardiac synchronization: 1.2% (n = 5/422) vs unsynchronized: 22.0% (n = 13/59), P < .0001. These events occurred in every organ except the prostate. CONCLUSIONS: IRE remains a potent technology for unresectable tumors, but arrhythmia is a clinical concern. This literature review confirms that cardiac gating should be used in all cases outside of prostate to prevent this potentially serious adverse event.


Assuntos
Técnicas de Ablação/estatística & dados numéricos , Arritmias Cardíacas/epidemiologia , Eletroporação/estatística & dados numéricos , Neoplasias Hepáticas/cirurgia , Neoplasias Pancreáticas/cirurgia , Técnicas de Ablação/efeitos adversos , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/etiologia , Técnicas de Imagem de Sincronização Cardíaca/métodos , Humanos
11.
Circ Arrhythm Electrophysiol ; 13(7): e008999, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32530306

RESUMO

Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted healthcare delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for patients with arrhythmia. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serological testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.


Assuntos
Arritmias Cardíacas/cirurgia , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Controle de Infecções/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , American Heart Association , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/epidemiologia , Eletrofisiologia Cardíaca , Técnicas de Imagem Cardíaca , Ablação por Cateter/métodos , Ablação por Cateter/estatística & dados numéricos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sociedades Médicas , Estados Unidos
12.
J Interv Card Electrophysiol ; 59(2): 329-336, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32494896

RESUMO

BACKGROUND: Cardiovascular and arrhythmic events have been reported in hospitalized COVID-19 patients. However, arrhythmia manifestations and treatment strategies used in these patients have not been well-described. We sought to better understand the cardiac arrhythmic manifestations and treatment strategies in hospitalized COVID-19 patients through a worldwide cross-sectional survey. METHODS: The Heart Rhythm Society (HRS) sent an online survey (via SurveyMonkey) to electrophysiology (EP) professionals (physicians, scientists, and allied professionals) across the globe. The survey was active from March 27 to April 13, 2020. RESULTS: A total of 1197 respondents completed the survey with 50% of respondents from outside the USA, representing 76 countries and 6 continents. Of respondents, 905 (76%) reported having COVID-19-positive patients in their hospital. Atrial fibrillation was the most commonly reported tachyarrhythmia whereas severe sinus bradycardia and complete heart block were the most common bradyarrhythmias. Ventricular tachycardia/ventricular fibrillation arrest and pulseless electrical activity were reported by 4.8% and 5.6% of respondents, respectively. There were 140 of 631 (22.2%) respondents who reported using anticoagulation therapy in all COVID-19-positive patients who did not otherwise have an indication. One hundred fifty-five of 498 (31%) reported regular use of hydroxychloroquine/chloroquine (HCQ) + azithromycin (AZM); concomitant use of AZM was more common in the USA. Sixty of 489 respondents (12.3%) reported having to discontinue therapy with HCQ + AZM due to significant QTc prolongation and 20 (4.1%) reported cases of Torsade de Pointes in patients on HCQ/chloroquine and AZM. Amiodarone was the most common antiarrhythmic drug used for ventricular arrhythmia management. CONCLUSIONS: In this global survey of > 1100 EP professionals regarding hospitalized COVID-19 patients, a variety of arrhythmic manifestations were observed, ranging from benign to potentially life-threatening. Observed adverse events related to use of HCQ + AZM included prolonged QTc requiring drug discontinuation as well as Torsade de Pointes. Large prospective studies to better define arrhythmic manifestations as well as the safety of treatment strategies in COVID-19 patients are warranted.


Assuntos
Antiarrítmicos/administração & dosagem , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Inquéritos e Questionários , Arritmias Cardíacas/tratamento farmacológico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Estudos Transversais , Eletrocardiografia/métodos , Feminino , Humanos , Incidência , Síndrome do QT Longo/diagnóstico por imagem , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/epidemiologia , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Prognóstico , Índice de Gravidade de Doença , Taxa de Sobrevida , Torsades de Pointes/diagnóstico por imagem , Torsades de Pointes/tratamento farmacológico , Torsades de Pointes/epidemiologia , Resultado do Tratamento
13.
Transplant Proc ; 52(6): 1784-1787, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32505505

RESUMO

OBJECTIVES: Five-lead electrocardiography (ECG) is commonly used during liver transplantation, while 3-lead ECG is used during most noncardiac operations. This study aimed to evaluate the incidence and clinical significance of ST segment abnormality during living donor liver transplantation (LDLT) with 5-lead ECG. METHODS: We retrospectively reviewed medical records of patients who received LDLT between May 2018 and May 2019. A total of 109 adult recipients underwent LDLT, and 108 recipients were divided into 2 groups according to whether or not significant ST segment abnormality had occurred at 8 predetermined time points during the operation. ST segment change by more than 1 mm was regarded as significant. RESULTS: Of the 108 recipients, 21 recipients (19.4%) had significant ST segment depression during the operation. No case of significant ST segment elevation was noted. The significant ST segment depression was detected mostly in lead II and V5, and with 2 in combination we could detect 95.2% of significant ST segment change. The significant ST segment depression was frequently observed 1 hour after anhepatic phase and 2 hours after reperfusion. Patient characteristics were not different between the 2 groups. Moreover, the cardiac enzyme (troponin I) measurements, measured immediately after the operation, were not different between the 2 groups. CONCLUSIONS: Although significant ST segment change was frequently observed during LDLT, more studies are required to determine the clinical significance of 5-lead ECG ST segment abnormality during LDLT.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Eletrocardiografia/métodos , Complicações Intraoperatórias/diagnóstico por imagem , Transplante de Fígado/efeitos adversos , Monitorização Intraoperatória/métodos , Adulto , Idoso , Arritmias Cardíacas/epidemiologia , Feminino , Humanos , Incidência , Complicações Intraoperatórias/epidemiologia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
14.
Transl Res ; 223: 25-39, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32438072

RESUMO

Chronic obstructive pulmonary disease (COPD) increases the risk of atrial fibrillation (AF), however, its arrhythmogenic mechanisms are unclear. This study investigated the effects of COPD on AF triggers (pulmonary veins, PVs) and substrates (atria), and their potential underlying mechanisms. Electrocardiographic, echocardiographic, and biochemical studies were conducted in control rabbits and rabbits with human leukocyte elastase (0.3 unit/kg)-induced COPD. Conventional microelectrode, Western blotting, and histological examinations were performed on PV, left atrium (LA), right atrium, and sinoatrial node (SAN) preparations from control rabbits and those with COPD. The rabbits with COPD had a higher incidence of atrial premature complexes, PV burst firing and delayed afterdepolarizations, higher sympathetic activity, larger LA, and faster PV spontaneous activity than did the control rabbits; but they exhibited a slower SAN beating rate. The LA of the rabbits with COPD had a shorter action potential duration and longer tachyarrhythmia induced by tachypacing (20 Hz) and isoproterenol (1 µM). Additionally, the rabbits with COPD had higher fibrosis in the PVs, LA, and SAN. H89 (10 µM), KN93 (1 µM), and KB-R7943 (10 µM) significantly suppressed burst firing and delayed afterdepolarizations in the PVs of the rabbits with COPD. Moreover, compared with the control rabbits, those with COPD had lower expression levels of the ß1 adrenergic receptor, Cav 1.2, and Na+/Ca2+ exchanger in the PVs; Cav 1.2 in the LA; and hyperpolarization-activated cyclic nucleotide-gated K+ channel 4 in the SAN. COPD increases atrial arrhythmogenesis by modulating the distinctive electrophysiological characteristics of the PVs, LA, and SAN.


Assuntos
Arritmias Cardíacas/complicações , Átrios do Coração/patologia , Doença Pulmonar Obstrutiva Crônica/complicações , Animais , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/fisiopatologia , Modelos Animais de Doenças , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Pulmão/fisiopatologia , Masculino , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Coelhos , Nó Sinoatrial/diagnóstico por imagem , Nó Sinoatrial/fisiopatologia
16.
Sci Rep ; 10(1): 6822, 2020 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321950

RESUMO

Equine athletes have a pattern of exercise which is analogous to human athletes and the cardiovascular risks in both species are similar. Both species have a propensity for atrial fibrillation (AF), which is challenging to detect by ECG analysis when in paroxysmal form. We hypothesised that the proarrhythmic background present between fibrillation episodes in paroxysmal AF (PAF) might be detectable by complexity analysis of apparently normal sinus-rhythm ECGs. In this retrospective study ECG recordings were obtained during routine clinical work from 82 healthy horses and from 10 horses with a diagnosis of PAF. Artefact-free 60-second strips of normal sinus-rhythm ECGs were converted to binary strings using threshold crossing, beat detection and a novel feature detection parsing algorithm. Complexity of the resulting binary strings was calculated using Lempel-Ziv ('76 & '78) and Titchener complexity estimators. Dependence of Lempel-Ziv '76 and Titchener T-complexity on the heart rate in ECG strips obtained at low heart rates (25-60 bpm) and processed by the feature detection method was found to be significantly different in control animals and those diagnosed with PAF. This allows identification of horses with PAF from sinus-rhythm ECGs with high accuracy.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/veterinária , Seio Coronário/diagnóstico por imagem , Seio Coronário/fisiopatologia , Eletrocardiografia/veterinária , Frequência Cardíaca/fisiologia , Cavalos/fisiologia , Animais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/fisiopatologia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia
17.
Sci Rep ; 10(1): 6878, 2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32327677

RESUMO

Alterations in connexins and specifically in 43 isoform (Cx43) in the heart have been associated with a high incidence of arrhythmogenesis and sudden death in several cardiac diseases. We propose to determine salutary effect of Cx43 mimetic peptide Gap27 in the progression of heart failure. High-output heart failure was induced by volume overload using the arterio-venous fistula model (AV-Shunt) in adult male rats. Four weeks after AV-Shunt surgery, the Cx43 mimetic peptide Gap27 or scrambled peptide, were administered via osmotic minipumps (AV-ShuntGap27 or AV-ShuntScr) for 4 weeks. Cardiac volumes, arrhythmias, function and remodeling were determined at 8 weeks after AV-Shunt surgeries. At 8th week, AV-ShuntGap27 showed a marked decrease in the progression of cardiac deterioration and showed a significant improvement in cardiac functions measured by intraventricular pressure-volume loops. Furthermore, AV-ShuntGap27 showed less cardiac arrhythmogenesis and cardiac hypertrophy index compared to AV-ShuntScr. Gap27 treatment results in no change Cx43 expression in the heart of AV-Shunt rats. Our results strongly suggest that Cx43 play a pivotal role in the progression of cardiac dysfunction and arrhythmogenesis in high-output heart failure; furthermore, support the use of Cx43 mimetic peptide Gap27 as an effective therapeutic tool to reduce the progression of cardiac dysfunction in high-output heart failure.


Assuntos
Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/fisiopatologia , Conexina 43/química , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Peptídeos/uso terapêutico , Remodelação Ventricular/efeitos dos fármacos , Animais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/diagnóstico por imagem , Derivação Arteriovenosa Cirúrgica , Cardiomegalia/complicações , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/fisiopatologia , Fibrose , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Ventrículos do Coração/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Masculino , Peptídeos/administração & dosagem , Ratos Sprague-Dawley , Vasodilatação/efeitos dos fármacos
18.
PLoS Med ; 17(3): e1003040, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32134952

RESUMO

BACKGROUND: Electrocardiographic QT interval prolongation is the most widely used risk marker for ventricular arrhythmia potential and thus an important component of drug cardiotoxicity assessments. Several antimalarial medicines are associated with QT interval prolongation. However, interpretation of electrocardiographic changes is confounded by the coincidence of peak antimalarial drug concentrations with recovery from malaria. We therefore reviewed all available data to characterise the effects of malaria disease and demographic factors on the QT interval in order to improve assessment of electrocardiographic changes in the treatment and prevention of malaria. METHODS AND FINDINGS: We conducted a systematic review and meta-analysis of individual patient data. We searched clinical bibliographic databases (last on August 21, 2017) for studies of the quinoline and structurally related antimalarials for malaria-related indications in human participants in which electrocardiograms were systematically recorded. Unpublished studies were identified by the World Health Organization (WHO) Evidence Review Group (ERG) on the Cardiotoxicity of Antimalarials. Risk of bias was assessed using the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European Consortium (PROTECT) checklist for adverse drug events. Bayesian hierarchical multivariable regression with generalised additive models was used to investigate the effects of malaria and demographic factors on the pretreatment QT interval. The meta-analysis included 10,452 individuals (9,778 malaria patients, including 343 with severe disease, and 674 healthy participants) from 43 studies. 7,170 (68.6%) had fever (body temperature ≥ 37.5°C), and none developed ventricular arrhythmia after antimalarial treatment. Compared to healthy participants, patients with uncomplicated falciparum malaria had shorter QT intervals (-61.77 milliseconds; 95% credible interval [CI]: -80.71 to -42.83) and increased sensitivity of the QT interval to heart rate changes. These effects were greater in severe malaria (-110.89 milliseconds; 95% CI: -140.38 to -81.25). Body temperature was associated independently with clinically significant QT shortening of 2.80 milliseconds (95% CI: -3.17 to -2.42) per 1°C increase. Study limitations include that it was not possible to assess the effect of other factors that may affect the QT interval but are not consistently collected in malaria clinical trials. CONCLUSIONS: Adjustment for malaria and fever-recovery-related QT lengthening is necessary to avoid misattributing malaria-disease-related QT changes to antimalarial drug effects. This would improve risk assessments of antimalarial-related cardiotoxicity in clinical research and practice. Similar adjustments may be indicated for other febrile illnesses for which QT-interval-prolonging medications are important therapeutic options.


Assuntos
Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Malária/fisiopatologia , Potenciais de Ação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antimaláricos/efeitos adversos , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/parasitologia , Regulação da Temperatura Corporal , Cardiotoxicidade , Criança , Pré-Escolar , Feminino , Sistema de Condução Cardíaco/efeitos dos fármacos , Sistema de Condução Cardíaco/parasitologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Lactente , Malária/diagnóstico , Malária/tratamento farmacológico , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
19.
Pediatr Cardiol ; 41(5): 862-868, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32095853

RESUMO

Sudden cardiac death (SCD) is the most common cause of late mortality in tetralogy of Fallot (TOF). Pulmonary regurgitation (PR) was previously found to be the most common hemodynamic abnormality associated with ventricular arrhythmias (VA), but cardiovascular magnetic resonance (CMR)-based studies did not show this association. The aim of this study is to investigate the risk factors for VA in TOF using CMR. Electronic records of TOF patients and their CMR studies between July 2006 and October 2018 in one center were retrospectively reviewed. Demographic, clinical and CMR data of patients were collected. Outcome was defined as sustained ventricular tachycardia (VT), aborted SCD and SCD. From a total of 434 TOF patients with complete CMR studies, 19 (4.4%) patients developed a positive outcome (12 sustained VT, 4 aborted SCD, 3 SCD) at a median age of 24 years. The number of surgical interventions was significantly greater in patients who developed VA. Right ventricular volumes were significantly larger in patients who suffered a positive outcome. Odds ratio for developing VA was 6.905 for RVEDVI ≥ 160 ml/m2 and 6.141 for RVESVI ≥ 80 ml/m2 (P = 0.0014 and 0.0012, respectively). Event-free survival was longer in patients with smaller right ventricular volumes. In conclusion, right ventricular dimensions are the most significant factors associated with the development of VA in TOF. The number of surgical interventions is also related to an increased risk.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/complicações , Arritmias Cardíacas/mortalidade , Procedimentos Cirúrgicos Cardíacos/métodos , Morte Súbita Cardíaca/etiologia , Feminino , Ventrículos do Coração/patologia , Hemodinâmica , Humanos , Masculino , Insuficiência da Valva Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Tetralogia de Fallot/complicações , Tetralogia de Fallot/diagnóstico , Tetralogia de Fallot/mortalidade , Adulto Jovem
20.
Sci Rep ; 10(1): 2898, 2020 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-32076033

RESUMO

Arrhythmia constitutes a problem with the rate or rhythm of the heartbeat, and an early diagnosis is essential for the timely inception of successful treatment. We have jointly optimized the entire multi-stage arrhythmia classification scheme based on 12-lead surface ECGs that attains the accuracy performance level of professional cardiologists. The new approach is comprised of a three-step noise reduction stage, a novel feature extraction method and an optimal classification model with finely tuned hyperparameters. We carried out an exhaustive study comparing thousands of competing classification algorithms that were trained on our proprietary, large and expertly labeled dataset consisting of 12-lead ECGs from 40,258 patients with four arrhythmia classes: atrial fibrillation, general supraventricular tachycardia, sinus bradycardia and sinus rhythm including sinus irregularity rhythm. Our results show that the optimal approach consisted of Low Band Pass filter, Robust LOESS, Non Local Means smoothing, a proprietary feature extraction method based on percentiles of the empirical distribution of ratios of interval lengths and magnitudes of peaks and valleys, and Extreme Gradient Boosting Tree classifier, achieved an F1-Score of 0.988 on patients without additional cardiac conditions. The same noise reduction and feature extraction methods combined with Gradient Boosting Tree classifier achieved an F1-Score of 0.97 on patients with additional cardiac conditions. Our method achieved the highest classification accuracy (average 10-fold cross-validation F1-Score of 0.992) using an external validation data, MIT-BIH arrhythmia database. The proposed optimal multi-stage arrhythmia classification approach can dramatically benefit automatic ECG data analysis by providing cardiologist level accuracy and robust compatibility with various ECG data sources.


Assuntos
Algoritmos , Arritmias Cardíacas/classificação , Idoso , Idoso de 80 Anos ou mais , Arritmia Sinusal/diagnóstico por imagem , Arritmias Cardíacas/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Bases de Dados como Assunto , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares
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