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2.
Cardiol Rev ; 27(6): 308-313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31584472

RESUMO

The management of ventricular arrhythmias (VA) has evolved over time to an advanced discipline, incorporating many technologies in the diagnosis and treatment of the myriad types of VA. The first application of imaging is in the assessment for structural heart disease, as this has the greatest impact on prognosis. Advanced imaging has its greatest utility in the planning and execution of ablation for VA. The following review outlines the application of different imaging modalities, such as ultrasonography, magnetic resonance imaging, computed tomography, and positron emission tomography, for the treatment of VA.


Assuntos
Técnicas de Ablação/métodos , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/cirurgia , Gerenciamento Clínico , Humanos , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Ultrassonografia
4.
Amyloid ; 26(3): 156-163, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31210553

RESUMO

Objective: Cardiac amyloid infiltration can lead to systolic heart failure (HF) or to conduction disorders (CD). Patients with transthyretin (ATTR) amyloidosis are particularly exposed. We sought to determine the prevalence of ATTR and AL among patients >60 years admitted with CD or unexplained systolic HF and increased wall thickness. Materials and Methods: We studied 143 patients (57% males, 79 ± 9 years) with HF (N = 28) or CD requiring pacemaker implantation (N = 115). In total, 139 (97%) patients (28 with HF and 111 with CD) underwent 99mTc-DPD scintigraphy to detect ATTR, and 105 (73%; 19 HF and 86 CD) underwent AL screening. Results: Five patients (4%; 95%CI:0-7%) exhibited wild-type ATTR (ATTRwt) amyloidosis, 2 (2%; 95%CI:0-4%) had CD and 3 (11%; 95%CI:0-23%) HF. No patient showed AL. The 2 ATTRwt patients with CD were previously asymptomatic, did not show classical ECG signs and exhibited mild LV hypertrophy with preserved LVEF. By contrast, all ATTRwt patients with HF had ECG and echocardiographic signs of amyloid. During a mean follow-up of 18 ± 11 months, 3(60%) patients with ATTRwt amyloidosis (1 CD and 2 HF) and 14(10.4%) without died. Conclusion: Prevalence of ATTRwt amyloidosis in patients with CD requiring pacemaker is low. Although, additional studies are needed, prevalence seems to be higher in elderly patients with systolic HF.


Assuntos
Neuropatias Amiloides Familiares/diagnóstico por imagem , Arritmias Cardíacas/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Insuficiência Cardíaca Sistólica/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/mortalidade , Neuropatias Amiloides Familiares/cirurgia , Arritmias Cardíacas/complicações , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/cirurgia , Biomarcadores/metabolismo , Cardiomiopatias/complicações , Cardiomiopatias/mortalidade , Cardiomiopatias/cirurgia , Estudos Transversais , Ecocardiografia , Feminino , Insuficiência Cardíaca Sistólica/complicações , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/cirurgia , Humanos , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/mortalidade , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Marca-Passo Artificial , Pré-Albumina/metabolismo , Estudos Prospectivos , Cintilografia , Análise de Sobrevida
5.
Anatol J Cardiol ; 21(5): 253-258, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31062754

RESUMO

OBJECTIVE: In a subgroup of patients with the anterior wall myocardial infarction (MI), the electrocardiogram (ECG) records a concomitant inferior ST-segment elevation (STE), which is generally explained by a 'wrap-around' left anterior descending (LAD) artery occlusion. However, recent evidence indicates that this may be due to a distal LAD occlusion, which may be irrelevant to the LAD length. We investigated the relationship between inferior ST-T changes in anterior MI and the presence of a wrap-around LAD. METHODS: Consecutive patients diagnosed with anterior MI due to an acute LAD occlusion were enrolled into the study. All ECGs were measured manually by a cardiologist, who was blinded to the angiographic outcomes. The site of the LAD occlusion was determined using multiple angiographic views. A wrap-around LAD was defined as a LAD artery from a post-reperfusion coronary angiogram that perfused at least one-fourth of the inferior wall of the left ventricle in the right anterior oblique projection. RESULTS: A total of 379 anterior MI cases were enrolled, and the final study population consisted of 259 patients. The presence of a wrap-around LAD was more frequent in patients presenting with inferior STE compared with patients without inferior STE (62.1% vs. 30.4%, p=0.001), however, this relationship was weak (φ=0.211). Inferior STE was more frequent in distal occlusions (22.9% vs. 4.3%, p<0.001), which showed a stronger relationship (φ=0.285). The polarity of the T-wave in lead III did not give any clues about the LAD anatomy. CONCLUSION: Contrary to the popular acceptance, our results indicate that a wrap-around LAD cannot be reliably diagnosed by ECG.


Assuntos
Infarto Miocárdico de Parede Anterior/fisiopatologia , Arritmias Cardíacas/fisiopatologia , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Infarto Miocárdico de Parede Anterior/complicações , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Arritmias Cardíacas/complicações , Arritmias Cardíacas/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
6.
Prog Cardiovasc Dis ; 62(3): 205-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31054859

RESUMO

Sudden cardiac death (SCD) accounts for one fifth of global deaths, and occurs when a trigger (e.g. myocardial ischemia, premature ventricular contraction) interacts with an arrhythmic substrate (e.g. myocardial scar, dilated cardiomyopathy). Multimodality imaging (echocardiographic, cardiac magnetic resonance and nuclear techniques) can potentially visualize many predisposing substrates and triggers. Implantable cardioverter-defibrillator (ICD) is the most effective approach to primary prevention of SCD, and current guidelines regarding ICD implantation are based on a left ventricular ejection fraction (LVEF) ≤35%. This practice is limited by a low sensitivity and specificity, and has limited value when applied to different etiologies. In this review, the role of multimodality imaging in SCD risk-stratification and the limitations of an LVEF-based approach, are discussed. Additional randomized, prospective data are eagerly awaited to inform on the role of imaging in SCD risk-stratification, and ongoing/ planned trials are subsequently discussed.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Morte Súbita Cardíaca , Arritmias Cardíacas/complicações , Arritmias Cardíacas/patologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Ecocardiografia , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Função Ventricular Esquerda
7.
Biomed Res Int ; 2019: 4217076, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984780

RESUMO

Purpose: 3D nonfluoroscopic mapping systems (NMSs) are generally used in the catheter ablation (CA) of complex ventricular and atrial arrhythmias. The aim of this study was to evaluate the efficacy, safety, and long-term effect of the extended, routine use of NMSs for CA. Methods: Our study involved 1028 patients who underwent CA procedures from 2007 to 2016. Initially, CA procedures were performed mainly with the aid of fluoroscopy. From October 2008, NMSs were used for all procedures. Results: The median fluoroscopy time of the overall CA procedures fell by 71%: from 29.2 min in 2007 to 8.4 min in 2016. Over the same period, total X-ray exposure decreased by 65%: from 58.18 Gy⁎cm2 to 20.19 Gy⁎cm2. This reduction was achieved without prolonging the total procedure time. In AF CA procedures, the median fluoroscopy time fell by 85%, with an 86% reduction in total X-ray exposure. In SVT CA procedures, the median fluoroscopy time fell by 93%, with a 92% reduction in total X-ray exposure. At the end of the follow-up period, the estimated probability of disease-free survival was 67.7% at 12 months for AF CA procedures and 97.2% at 3 months for SVT CA, without any statistically significant difference between years. Conclusions: Our study shows the feasibility of using NMSs as the main imaging modality to guide CA. The extended, routine use of NMSs dramatically reduces radiation exposure, with only slight fluctuations due to the process of acquiring experience on the part of untrained operators, without affecting disease-free survival.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Fibrilação Atrial/radioterapia , Ablação por Cateter/efeitos adversos , Neoplasias Induzidas por Radiação/diagnóstico por imagem , Idoso , Arritmias Cardíacas/complicações , Arritmias Cardíacas/patologia , Arritmias Cardíacas/radioterapia , Fibrilação Atrial/complicações , Fibrilação Atrial/patologia , Feminino , Humanos , Imagem Tridimensional/métodos , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/prevenção & controle , Exposição à Radiação/efeitos adversos , Cirurgia Assistida por Computador , Raios X/efeitos adversos
8.
Circ Arrhythm Electrophysiol ; 12(5): e007175, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31006313

RESUMO

BACKGROUND: Conduction velocity (CV) is an important property that contributes to the arrhythmogenicity of the tissue substrate. The aim of this study was to investigate the association between local CV versus late gadolinium enhancement (LGE) and myocardial wall thickness in a swine model of healed left ventricular infarction. METHODS: Six swine with healed myocardial infarction underwent cardiovascular magnetic resonance imaging and electroanatomic mapping. Two healthy controls (one treated with amiodarone and one unmedicated) underwent electroanatomic mapping with identical protocols to establish the baseline CV. CV was estimated using a triangulation technique. LGE+ regions were defined as signal intensity >2 SD than the mean of remote regions, wall thinning+ as those with wall thickness <2 SD than the mean of remote regions. LGE heterogeneity was defined as SD of LGE in the local neighborhood of 5 mm and wall thickness gradient as SD within 5 mm. Cardiovascular magnetic resonance and electroanatomic mapping data were registered, and hierarchical modeling was performed to estimate the mean difference of CV (LGE+/-, wall thinning+/-), or the change of the mean of CV per unit change (LGE heterogeneity, wall thickness gradient). RESULTS: Significantly slower CV was observed in LGE+ (0.33±0.25 versus 0.54±0.36 m/s; P<0.001) and wall thinning+ regions (0.38±0.28 versus 0.55±0.37 m/s; P<0.001). Areas with greater LGE heterogeneity ( P<0.001) and wall thickness gradient ( P<0.001) exhibited slower CV. CONCLUSIONS: Slower CV is observed in the presence of LGE, myocardial wall thinning, high LGE heterogeneity, and a high wall thickness gradient. Cardiovascular magnetic resonance may offer a valuable imaging surrogate for estimating CV, which may support noninvasive identification of the arrhythmogenic substrate.


Assuntos
Potenciais de Ação , Arritmias Cardíacas/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Imagem por Ressonância Magnética , Meglumina/análogos & derivados , Infarto do Miocárdio/complicações , Miocárdio/patologia , Compostos Organometálicos/administração & dosagem , Animais , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Modelos Animais de Doenças , Técnicas Eletrofisiológicas Cardíacas , Feminino , Masculino , Meglumina/administração & dosagem , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Sus scrofa , Fatores de Tempo , Função Ventricular Esquerda , Remodelação Ventricular
9.
Eur J Radiol ; 113: 140-147, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927938

RESUMO

PURPOSE: To develop institutional diagnostic reference levels (IDRL) for coronary CT angiography (CCTA) according to patient size by analyzing radiation dose changes over the past 10 years. MATERIALS AND METHODS: This IRB approved retrospective investigation analyzed radiation dose data from CCTA between 2007 and 2016 at our institution. Annual trends in radiation dose were described for each scanner type and scanning mode. Radiation levels were analyzed for normorhythmic patients, patients with prior coronary artery bypass grafting (CABG), arrhythmia, and according to patient size and tube voltage. Median, and quartile values for volume CT dose index (CTDIvol), dose-length product (DLP), and size-specific dose estimate (SSDE) were calculated. Wilcoxon rank-sum test and Kruskal Wallis test were performed to assess the significance of quantitative data. RESULTS: 35,375 examinations from 33,317 patients (median age, 58 [50-66] years; male patients, 21,087 [58.7%]) were analyzed. CTDIvol, DLP, and SSDE significantly decreased by 9.0%, 30.8%, and 40.1% (all P < 0.05) for all examinations, respectively. All radiation dose metrics progressively decreased across scanning modes (especially retrospectively ECG-gated spiral and prospectively ECG-triggered high-pitch spiral acquisition mode), but did not significantly change across scanners in the last 6 years. CTDIvol and DLP increased with patient size when water-equivalent diameters were >19 cm for normorhythmic and CABG patients. In arrhythmic patients, CTDIvol increased progressively with water-equivalent diameters across all groups. CONCLUSION: CCTA radiation dose has progressively decreased in the past decade except in patients with prior CABG and arrhythmia. Size-specific IDRLs may optimize radiation utilization in these patients going forward.


Assuntos
Angiografia por Tomografia Computadorizada/tendências , Angiografia Coronária/tendências , Idoso , Arritmias Cardíacas/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/normas , Tomografia Computadorizada de Feixe Cônico/normas , Tomografia Computadorizada de Feixe Cônico/tendências , Angiografia Coronária/normas , Ponte de Artéria Coronária/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Valores de Referência , Estudos Retrospectivos , Estatísticas não Paramétricas
10.
J Cardiovasc Med (Hagerstown) ; 20(7): 450-458, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30985353

RESUMO

OBJECTIVE: The objective was to provide an exhaustive characterization of ECG features in a large cohort of dilated cardiomyopathies (DCMs) and then investigate their possible prognostic role in the long term. BACKGROUND: ECG is an accessible, reproducible, low-cost diagnostic and prognostic tool. However, an extensive description of ECG features and their long-term prognostic role in a large cohort of DCM is lacking. METHODS: All available baseline ECGs of DCM patients enrolled from 1992 to 2013 were systematically analysed. Patients underwent to a complete clinical-laboratory evaluation. The study outcome measures were death or heart transplant (D/HT) and sudden death or malignant ventricular arrhythmias (SD/MVA). RESULTS: Four hundred and fourteen DCM patients were enrolled. During a median follow-up of 125 months, 55 and 57 patients experienced D/HT and SD/MVA, respectively. At multivariate analysis, left ventricular hypertrophy (P = 0.017), heart rate (HR, P = 0.005) and anterolateral T-wave inversion (P = 0.041) predicted D/HT. Regarding SD/MVA, S wave amplitude in V2 (P = 0.008), R wave amplitude in DIII (P = 0.007), anterolateral T-wave inversion (P = 0.017) emerged as predictors. At receiver-operating curve analyses, the addition of ECG models to the clinical-laboratory evaluation significantly increased the area under the curve both for D/HT (from 0.68 to 0.74, P = 0.042) and SD/MVA (from 0.70 to 0.77, P = 0.048). CONCLUSION: The exhaustive systematic evaluation of ECG has an incremental impact in the prognostication of a large cohort of DCM patients, also regarding the arrhythmic stratification.


Assuntos
Cardiomiopatia Dilatada/diagnóstico , Eletrocardiografia , Frequência Cardíaca , Adulto , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/fisiopatologia , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/cirurgia , Morte Súbita Cardíaca/epidemiologia , Feminino , Transplante de Coração , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
11.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(2): 86-89, 2019 Mar 30.
Artigo em Chinês | MEDLINE | ID: mdl-30977601

RESUMO

OBJECTIVE: To classify Right Bundle Branch Block (RBBB),Left Bundle Branch Block (LBBB) and normal ECG signals automatically. METHODS: The MIT-BIH database was used as experimental data sources.The training set and test set were extracted for training and testing network models.Based on convolutional neural network,this paper proposed the core algorithm:sparse connection residual network.Compared the sparse connected residual network with classic network models,then evaluated the recognition effect of the model. RESULTS: The accuracy of the test set the MIT-BIH database was 95.2%,the result is better than classic network models. CONCLUSIONS: The algorithm proposed in this paper can assist doctors in the diagnosis of heart block related disease and place a high value on clinical application.


Assuntos
Arritmias Cardíacas , Bloqueio de Ramo , Eletrocardiografia , Algoritmos , Arritmias Cardíacas/diagnóstico por imagem , Bloqueio de Ramo/diagnóstico por imagem , Humanos
12.
Australas Phys Eng Sci Med ; 42(2): 511-528, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30941635

RESUMO

In this paper, synthetic electrocardiogram signals (SECG) of eight cardiac arrhythmias (sinus bradycardia, junctional bradycardia, tachycardia, flutter, atrial extrasystole, ventricular extrasystole, left branch block and right branch block) are obtained numerically by solving the McSharry mathematical model (2003) based on three coupled ordinary differential equations with the fourth-order Runge-Kutta method. They are compared with normal electrocardiogram signal. Indeed, visual analysis of a section of electrocardiogram (ECG) signals of these arrhythmias was used to suggest suitable values for the parameters in the McSharry mathematical model. Results from numerical simulation showed a good agreement between the simulation results and the real cardiac arrhythmias ECG signals.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Eletrocardiografia , Modelos Teóricos , Processamento de Sinais Assistido por Computador , Simulação por Computador , Bases de Dados como Assunto , Humanos
13.
PLoS One ; 14(3): e0214087, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893383

RESUMO

Pediatric myocarditis symptoms can be mild or as extreme as sudden cardiac arrest. Early identification of the severity of illness and timely provision of critical care is helpful; however, the risk factors associated with mortality remain unclear and controversial. We undertook a retrospective review of the medical records of pediatric patients with myocarditis in a tertiary care referral hospital for over 12 years to identify the predictive factors of mortality. Demographics, presentation, laboratory test results, echocardiography findings, and treatment outcomes were obtained. Regression analyses revealed the clinical parameters for predicting mortality. During the 12-year period, 94 patients with myocarditis were included. Of these, 16 (17%) patients died, with 12 succumbing in the first 72 hours after admission. Fatal cases more commonly presented with arrhythmia, hypotension, acidosis, gastrointestinal symptoms, decreased left ventricular ejection fraction, and elevated isoenzyme of creatine kinase and troponin I levels than nonfatal cases. In multivariate analysis, troponin I > 45 ng/mL and left ventricular ejection fraction < 42% were significantly associated with mortality. Pediatric myocarditis had a high mortality rate, much of which was concentrated in the first 72 hours after hospitalization. Children with very high troponin levels or reduced ejection fraction in the first 24 hours were at higher risk of mortality, and targeting these individuals for more intensive therapies may be warranted.


Assuntos
Ecocardiografia , Mortalidade Hospitalar , Miocardite/diagnóstico por imagem , Miocardite/mortalidade , Adolescente , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Criança , Pré-Escolar , Feminino , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Hospitalização , Humanos , Hipotensão/diagnóstico por imagem , Hipotensão/etiologia , Hipotensão/mortalidade , Masculino , Miocardite/complicações , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de Tempo
14.
PET Clin ; 14(2): 281-291, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826025

RESUMO

Ventricular arrhythmias (VAs) are a major cause of morbidity and mortality, especially in patients with structural heart disease. In the last decade, advanced imaging modalities, such as cardiac MR and nuclear imaging, have progressively demonstrated to play a central role in the diagnosis and management of patients presenting with VAs. PET is acquiring a growing role thanks to its capability to assess different pathophysiologic aspects of the arrhythmogenic substrate by evaluating abnormal myocardial perfusion, presence of inflammation, myocardial viability, and sympathetic innervation. This review describes the principles and main clinical applications of PET imaging in the setting of VAs.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Cardiomiopatia Chagásica/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Miocardite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Recidiva , Sarcoidose/diagnóstico por imagem
15.
Vet Clin North Am Equine Pract ; 35(1): 43-64, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826106

RESUMO

This article provides an overview on the principles of transthoracic echocardiography in horses. Indications for echocardiography, equipment, and technical considerations are discussed and a systematic approach for a complete echocardiographic examination in horses is described. Methods for assessment of chamber dimensions, allometric scaling of measurements, assessment of systolic and diastolic ventricular function, assessment of atrial function, hemodynamic assessment, and evaluation of valvular regurgitation are explained, focusing on traditional 2-dimensional (2D), motion-mode, and Doppler echocardiographic methods. Selected applications of newer echocardiographic methods, such as tissue Doppler imaging and 2D speckle tracking are also described.


Assuntos
Arritmias Cardíacas/veterinária , Ecocardiografia/veterinária , Doenças dos Cavalos/diagnóstico por imagem , Animais , Arritmias Cardíacas/diagnóstico por imagem , Ecocardiografia/métodos , Cavalos
16.
Int. j. cardiovasc. sci. (Impr.) ; 32(2): 152-157, mar.-abr. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-989994

RESUMO

Galectin-3 is the designation given to the protein that binds to ß-galactosides, expressed by activated macrophages and described as a cardiac fibrosis mediator. In hypertrophic cardiomyopathy (HCM), myocardial fibrosis is an independent predictor of adverse outcome; however, the association between Galectin-3 and myocardial fibrosis has not been studied in this cardiopathy. Objective: To evaluate the association of Galectin-3 and the presence of myocardial fibrosis in a patient with hypertrophic cardiomyopathy. Methods: Galectin-3 was measured in automated equipment using the Elisa technique in 100 participants divided into two groups: 50 patients with hypertrophic cardiomyopathy and 50 healthy control subjects. All patients with hypertrophic cardiomyopathy underwent magnetic nuclear resonance with the late enhancement technique to investigate myocardial fibrosis. For the statistical analysis, p values < 0.05 were considered statistically significant. Results: Galectin-3 levels were low and did not show significant differences between patients with hypertrophic cardiomyopathy and the control group, 10.3 ± 3.1 ng/dL and 11.3 ± 2.6 ng/dL (p = 0.12) respectively. Myocardial fibrosis was a common finding and was identified in 84% (42/50) of patients with HCM, but no differences were observed between Galectin-3 levels when comparing patients with and without fibrosis, 10.3 ± 2.4 ng/dL and 10.1 ± 2.1 ng/dL (p = 0.59). Conclusion: The results did not show an association between Galectin-3 and myocardial fibrosis in patients with hypertrophic cardiomyopathy, suggesting that non-inflammatory mechanisms of myocardial fibrosis formation and cardiac remodeling are involved in this cardiopathy


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Galectina 3 , Fibrose Endomiocárdica , Arritmias Cardíacas/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Espectroscopia de Ressonância Magnética/métodos , Biomarcadores , Doenças Cardiovasculares/diagnóstico , Ecocardiografia Doppler/métodos , Análise Estatística
18.
Eur J Obstet Gynecol Reprod Biol ; 234: 213-217, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30731334

RESUMO

OBJECTIVES: Randomized studies have obtained conflicting results regarding the usefulness of fetal electrocardiographic (ECG) ST-segment analysis, possibly because these studies included non-homogeneous populations. We designed a study to determine whether this monitoring technique is potentially useful for populations at risk for fetal heart rate alterations during labor, i.e. groups of women who share late-term pregnancy as a risk factor. STUDY DESIGN: This randomized clinical trial recruited women whose pregnancy had lasted more than 290 days. The participants were randomly assigned to continuous fetal cardiotocographic monitoring alone (CTG group) or with fetal ECG ST-segment analysis (ECG-F group). In the CTG group fetal heart rate was interpreted according to guidelines from the National Institute of Child Health and Human Development, whereas in the ECG-F group the tracings were interpreted according the original International Federation of Gynecology and Obstetrics (FIGO) guidelines. The primary outcome measure was neonatal outcome, evaluated as arterial blood pH in neonates after abdominal or vaginal operative delivery indicated because of nonreassuring fetal status. RESULTS: A total of 237 women were randomized, of whom 200 were included in the final analysis (100 in each group). The rate of cesarean delivery was the same in both groups (26%), and the rate of operative delivery due to nonreassuring fetal status did not differ significantly (38% in the CTG group vs. 39% in the ECG-F group). Regarding neonatal outcomes, there was no significant difference between groups in neonatal pH (7.27 [7.23-7.29] and 7.25 [7.21-7.27]). CONCLUSIONS: In a population comprising only late-term pregnancies, fetal ECG monitoring had no benefits for the mother or fetus. Additional studies are needed of protocols for using ST waveform analysis in selected population groups.


Assuntos
Cardiotocografia/métodos , Sofrimento Fetal/diagnóstico por imagem , Monitorização Fetal/métodos , Sistema de Condução Cardíaco/diagnóstico por imagem , Gravidez Prolongada/diagnóstico por imagem , Adulto , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/embriologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Frequência Cardíaca Fetal , Humanos , Trabalho de Parto , Gravidez
19.
Am J Trop Med Hyg ; 100(2): 399-404, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30734694

RESUMO

This study compared the frequency of abnormal electrocardiogram (ECG) types between scrub typhus patient group and age- and gender-matched health checkup group and their associations with disease severity in scrub typhus patient. Demographic characteristics and ECG and laboratory findings of patients with scrub typhus admitted to Chosun University Hospital, and normal subjects visiting the hospital for health checkup from January 2008 to December 2012 were retrospectively studied. Electrocardiogram abnormalities at admission were observed in 72 of 165 (43.6%) scrub typhus confirmed patients. The following ECG abnormalities were observed: arrhythmic group (31 cases, 18.8%), ischemic change group (25 cases, 15.1%), prolonged QT group (32 cases, 19.4%).Compared with the age and gender-matched health checkup group, ECG abnormalities were more commonly observed in scrub typhus patient group (13.9% versus 43.6%, P < 0.001). In addition, when compared with the normal ECG group, scrub typhus in the abnormal ECG group showed greater disease severity and this phenomenon was particularly prominent in the prolonged QT group. Based on our study prolonged QT observed in approximately 20% of patients with scrub typhus, clinicians should pay additional attention to drugs that affect QT interval.


Assuntos
Arritmias Cardíacas/fisiopatologia , Síndrome do QT Longo/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Tifo por Ácaros/fisiopatologia , Idoso , Arritmias Cardíacas/complicações , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/microbiologia , Análise Química do Sangue , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Humanos , Síndrome do QT Longo/complicações , Síndrome do QT Longo/diagnóstico por imagem , Síndrome do QT Longo/microbiologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/microbiologia , Orientia tsutsugamushi/patogenicidade , Orientia tsutsugamushi/fisiologia , Estudos Retrospectivos , Tifo por Ácaros/complicações , Tifo por Ácaros/diagnóstico por imagem , Tifo por Ácaros/microbiologia , Índice de Gravidade de Doença
20.
Circ Arrhythm Electrophysiol ; 12(1): e007004, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30636476

RESUMO

BACKGROUND: Papillary muscles (PM) ventricular arrhythmias (VAs) exhibit QRS variability, attributed to anisotropy. ECG inconsistencies such as late precordial transition (TZ) and discordant QRS axis may not be solely explained by anisotropic conduction. We sought to determine the presence of anatomic connections of the PM and correlate them with ECG inconsistencies and ablation results. METHODS: Patients with prior PM VAs catheter ablation (N=33/66 PMs) were prospectively evaluated with cardiac resonance for the presence of muscular connection (PMCs) away from the PM base. Specific ECG characteristics including early (consistent TZ) and late (inconsistent-ITZ) TZ or inconsistent (IQA) or consistent QA QRS axis were correlated with PMCs. RESULTS: Thirty-five PMs exhibited clinical VAs (N=29 posteromedial PM and N=6 anterolateral PM). PM VAs with ITZ and IQA were observed in 11 and 9 PMs, respectively. In total, 41 PMs (62%) exhibited 90 PMCs. Arrhythmogenic PMs (N=35) exhibited higher number of PMCs (72 versus 18; P=0.01). Patients with ITZ and IQA exhibited 100% prevalence of PMCs. Those with consistent TZ and consistent QA showed 40% and 26% prevalence of PMCs, respectively. ITZ and IQA predicted the presence of PMCs with 59% of 28% sensitivity; and 100% of 100% specificity, respectively. Type-specific PMCs were more prevalent in patients with ECG inconsistencies. Those PMs are exhibiting clinical recurrence after ablation presented higher prevalence of PMCs (91% versus 60%; P=0.04). CONCLUSIONS: PMCs are highly prevalent in patients with PM VAs. A direct correlation exists between PM VAs ECG inconsistencies and type-specific PMCs. Patients with ITZ or IQA exhibited PMC 100% prevalence. Recurrence was higher among patients with PMCs.


Assuntos
Arritmias Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Imagem por Ressonância Magnética , Miocárdio/patologia , Músculos Papilares/diagnóstico por imagem , Potenciais de Ação , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/cirurgia , Ablação por Cateter , Eletrocardiografia , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Músculos Papilares/fisiopatologia , Músculos Papilares/cirurgia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Recidiva , Fatores de Tempo , Resultado do Tratamento
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