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1.
Rev. clín. esp. (Ed. impr.) ; 220(2): 100-108, mar. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186419

RESUMO

Objetivo: La hipertrofia ventricular izquierda es el marcador de daño de órgano diana más frecuente en la hipertensión arterial. Habitualmente se realiza un ECG para su identificación. El objetivo de este trabajo es analizar la utilidad pronóstica de otras alteraciones electrocardiográficas en pacientes hipertensos, más allá de la hipertrofia ventricular. Materiales y métodos: Se incluyeron 1.003 pacientes hipertensos mayores de65años. Se recogieron factores de riesgo, historia cardiovascular previa y tratamiento médico. Se analizaron diferentes alteraciones electrocardiográficas, incluyendo índice de Sokolow-Lyon, índice de Cornell, presencia de sobrecarga ventricular y bloqueos de rama, entre otros. Se llevó a cabo un seguimiento de 2años con recogida de eventos cardiovasculares mayores (mortalidad, infarto de miocardio, accidentes cerebrovascular o ingreso por insuficiencia cardiaca). Resultados: La edad media de la población era de 72,9+/-5,8años, con un 47,5% de varones. Durante el seguimiento el 13,9% sufrieron un evento cardiovascular mayor. Estos pacientes eran de mayor edad, más fumadores y practicaban menos ejercicio físico, sin presentar diferencias en el tratamiento antihipertensivo empleado ni en el control tensional. El patrón de sobrecarga ventricular (HR: 1,93; IC95%: 1,160-3,196; p=0,011) y el bloqueo completo de rama izquierda (HR: 2,27; IC95%: 1,040-4,956; p=0,040) se comportaron como factores electrocardiográficos predictores independientes de eventos cardiovasculares mayores, no así la hipertrofia ventricular izquierda por Sokolow y/o Cornell. Conclusiones: En pacientes hipertensos, la existencia en el ECG basal de un bloqueo completo de rama izquierda o un patrón de sobrecarga ventricular identifica a una población de mayor riesgo cardiovascular


Objective: Left ventricular hypertrophy is the most common marker of target organ damage in arterial hypertension. Electrocardiograms are typically performed to identify left ventricular hypertrophy. The aim of this study was to analyse the prognostic utility of other electrocardiographic abnormalities in patients with arterial hypertension, beyond ventricular hypertrophy. Materials and methods: The study included 1003 patients older than 65years with arterial hypertension. We recorded risk factors, previous cardiovascular history and medical treatment and analysed various electrocardiographic abnormalities including the Sokolow-Lyon index, the Cornell index, ventricular overload and branch blocks. The study conducted a 2-year follow-up, recording the major cardiovascular events (mortality, myocardial infarction, stroke and hospitalisation for heart failure). Results: The study population's mean age was 72.9+/-5.8years, 47.5% of whom were men. During the follow-up, 13.9% of the patients experienced a major cardiovascular event. These patients were older, more often smokers and engaged in less physical exercise, without presenting differences in the antihypertensive therapy or blood pressure control. The ventricular overload pattern (HR: 1.93; 95%CI: 1.160-3.196; P=.011) and the complete left bundle branch block (HR: 2.27; 95%CI: 1.040-4.956; P=.040) behaved as independent electrocardiographic predictors of major cardiovascular events; however, left ventricular hypertrophy using the Sokolow and/or Cornell index did not behave as such. Conclusions: For patients with hypertension, the presence in the baseline electrocardiogram of complete left bundle branch block or a pattern of ventricular overload identifies a population at increased cardiovascular risk


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Hipertensão/fisiopatologia , Eletrocardiografia/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Valor Preditivo dos Testes , Fatores de Risco , Seguimentos , Comportamento Sedentário , Tabagismo/epidemiologia , Fatores Etários , Bloqueio de Ramo/epidemiologia
2.
Am J Cardiol ; 125(5): 795-802, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31889524

RESUMO

This study sought to determine, in patients with new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve implantation (TAVI), the incidence and factors associated with (i) LBBB recovery and (ii) permanent pacemaker implantation (PPI) at 1-year follow-up. This was a multicenter study including 153 patients (mean age: 81 ± 5 years, 56% of women) with NOP-LBBB post-TAVI (balloon-expandable valve in 112 patients). Delta PR (ΔPR) and delta QRS (ΔQRS) were defined as the difference in PR and QRS length between baseline and hospital discharge ECG, and the relative ΔPR and ΔQRS as absolute ΔPR and ΔQRS divided by baseline PR and QRS length, respectively. The patients had a clinical visit and 12-lead ECG at 1-year follow-up. LBBB recovery was observed in 50 patients (33%), and 14 patients (9%) had advanced conduction disturbances requiring PPI during the follow-up period. No clinical or ECG variables were associated with LBBB recovery, including prosthesis type (self- or balloon-expandable valve, p = 0.563), QRS width at baseline/discharge or absolute/relative ΔQRS (p >0.10 for all). The presence of atrial fibrillation at baseline (0.026), a longer PR interval at discharge (0.009), and a longer absolute and relative ΔPR (p = 0.002 and p = 0.004, respectively) were associated with an increased risk of PPI at 1-year follow-up. In conclusion, NOP-LBBB post-TAVI resolved in one-third of patients at 1-year follow-up, but no clinical or ECG variables were associated with LBBB recovery. Conversely, a nonsinus rhythm at baseline and a longer ΔPR were associated with an increased risk of PPI within the year after TAVI.


Assuntos
Valva Aórtica/cirurgia , Bloqueio de Ramo/fisiopatologia , Estimulação Cardíaca Artificial , Eletrocardiografia , Complicações Pós-Operatórias/fisiopatologia , Recuperação de Função Fisiológica , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/terapia , Comorbidade , Feminino , Humanos , Incidência , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia
3.
Am J Cardiol ; 125(5): 783-787, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31898969

RESUMO

The ACURATE neo transcatheter heart valve has been associated with very low rates of new conduction disorders (CDs). We assessed the clinical relevance of new CDs in patients undergoing transcatheter aortic valve replacement (TAVR) with this valve. Data of consecutive patients without a pre-existing left bundle branch block (LBBB) or a permanent pacemaker (PPM) undergoing TAVR with the ACURATE neo were analyzed from the prospective SwissTAVI registry. Patients with new CDs were compared with patients with an unchanged electrocardiogram (ECG). ACURATE neo was implanted in 203 patients (mean age 82 ± 6 years, 63% women), CDs occurred in 28 patients (22 [11%] developed a LBBB, 6 [3%] required a PPM). New CDs resulted in a longer median duration of hospitalization (7 vs 5 days, interquartile range 4 to 13 vs 3 to 8 days, p = 0.04). At 1-year follow-up, left ventricular ejection fraction was significantly lower in patients with new CDs comparedwith patients with an unchanged ECG (54% ± 13% vs 61% ± 9%, p <0.01). Kaplan-Meier estimates of survival at 1-year were 89% in patients with new CDs and 95% in patients with an unchanged ECG (hazard ratio 2.0, 95% confidence interval 0.7 to 6.2, p = 0.22). After TAVR with the self-expanding ACURATE neo valve, the rate of new CDs, including complete LBBB was low and very few patients required a new PPM. However, new CDs prolonged initial hospitalization and increased the risk for left ventricular-dysfunction at 1-year follow-up. Patients without new CDs had excellent outcomes with a very high survival rate at 1-year follow-up.


Assuntos
Valva Aórtica/cirurgia , Doença do Sistema de Condução Cardíaco/epidemiologia , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Bioprótese , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/terapia , Doença do Sistema de Condução Cardíaco/terapia , Estimulação Cardíaca Artificial , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/terapia , Modelos de Riscos Proporcionais , Desenho de Prótese , Volume Sistólico , Taxa de Sobrevida
4.
J Am Coll Cardiol ; 74(5): 645-655, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31370956

RESUMO

BACKGROUND: Conduction abnormalities including bundle branch block are recognized sequelae following septal myectomy in patients with hypertrophic cardiomyopathy, but their incidence and effect on long-term mortality have not been well studied. OBJECTIVES: This study was conducted to determine the impact of conduction abnormalities on mortality in patients with obstructive hypertrophic cardiomyopathy following myectomy. METHODS: The outcomes of 2,482 patients with obstructive hypertrophic cardiomyopathy who underwent transaortic septal myectomy from 1961 to 2016 were analyzed. Pre-operative and early post-operative electrocardiograms were reviewed to determine conduction status. The study endpoint was all-cause mortality. RESULTS: Mean age at operation was 54.2 ± 14.6 years, and 1,370 patients (55.2%) were men. Pre-operatively, 2,159 patients (87.0%) had normal conduction, of whom 38.8% developed left bundle branch block, 1.1% developed right bundle branch block (RBBB), and 0.6% had complete heart block (CHB) after myectomy. Among 112 patients with baseline RBBB, 34.8% developed CHB post-operatively. Overall, only 2.3% of patients developed CHB. Over a median follow-up period of 8.6 years, overall mortality differed among post-operative conduction groups after adjustment for age, sex, and concomitant procedures (p = 0.015). Specifically, mortality in those with paced rhythm after myectomy was significantly increased relative to those with normal conduction (hazard ratio: 1.57; 95% confidence interval: 1.15 to 2.14; p = 0.005), although no significant difference was observed in left bundle branch block and RBBB (vs. normal) groups. CONCLUSIONS: Left bundle branch block is a common sequela after septal myectomy but does not influence post-operative mortality. Myectomy-related CHB is rare in patients with baseline normal conduction, while pre-existing RBBB greatly increases the risk for CHB. Persistent paced rhythm after operation is an independent predictor of mortality.


Assuntos
Bloqueio de Ramo/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiomiopatia Hipertrófica/cirurgia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Septos Cardíacos/cirurgia , Complicações Pós-Operatórias , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Cardiomiopatia Hipertrófica/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Taxa de Sobrevida/tendências
5.
Eur J Gen Pract ; 25(3): 109-115, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31339387

RESUMO

Background: Right bundle branch block (RBBB) is among the most common electrocardiographic abnormalities. Objectives: To establish the prevalence and incidence of RBBB in the general population without cardiovascular events (CVE) and whether RBBB increases cardiovascular morbidity and mortality compared with patients with a normal electrocardiogram (ECG). Methods: A historical study of two cohorts including 2981 patients from 29 primary health centres without baseline CVE. Cox (for CVE) and logistic (for cardiovascular factors) regression was used to assess their association with RBBB. Results: Of the patients (58% women; mean age 65.9), 92.2% had a normal ECG, 4.6% incomplete RBBB (iRBBB) and 3.2% complete RBBB (cRBBB). Mean follow-up was five years. Factors associated with appearance of cRBBB were male sex (HR = 3.8; 95%CI: 2.4-6.1) and age (HR = 1.05 per year; 95%CI: 1.03-1.08). In a univariate analysis, cRBBB was associated with an increase in all-cause mortality but only bifascicular block (BFB) was significant after adjusting for confounders. cRBBB tended to increase CVE but the results were not statistically significant. Presence of iRBBB was not associated with adverse outcomes. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease. Conclusion: In this general population cohort with no CV disease, 8% had RBBB, with a higher prevalence among men and elderly patients. Although all-cause mortality and CVE tended to increase in the presence of cRBBB, only BFB showed a statistically significant association with cRBBB. Patients with iRBBB who progressed to cRBBB had a higher incidence of CVE. We detected no effect of iRBBB on morbidity and mortality.


Assuntos
Bloqueio de Ramo/epidemiologia , Doenças Cardiovasculares/epidemiologia , Eletrocardiografia , Fatores Etários , Idoso , Bloqueio de Ramo/diagnóstico , Estudos de Coortes , Progressão da Doença , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Prevalência , Insuficiência Renal Crônica/epidemiologia , Fatores Sexuais
6.
J Am Coll Cardiol ; 73(24): 3082-3099, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31221257

RESUMO

BACKGROUND: The benefits of cardiac resynchronization therapy (CRT) in patients with non-left bundle branch block (LBBB) conduction abnormality have not been fully explored. OBJECTIVES: This study sought to evaluate clinical outcomes among Medicare-aged patients with nonspecific intraventricular conduction delay (NICD) versus right bundle branch block (RBBB) in patients eligible for implantation with a CRT with defibrillator (CRT-D). METHODS: Using the National Cardiovascular Data Registry implantable cardioverter-defibrillator (ICD) registry data between 2010 and 2013, the authors compared outcomes in CRT-eligible patients implanted with CRT-D versus ICD-only therapy among patients with NICD and RBBB. Also, among all CRT-D-implanted patients, the authors compared outcomes in those with NICD versus RBBB. Survival curves and multivariable adjusted hazard ratios (HRs) were used to assess outcomes including hospitalization and death. RESULTS: In 11,505 non-LBBB CRT-eligible patients, after multivariable adjustment, among patients with RBBB, CRT-D was not associated with better outcomes, compared with ICD alone, regardless of QRS duration. Among patients with NICD and a QRS ≥150 ms, CRT-D was associated with decreased mortality at 3 years compared with ICD alone (HR: 0.602; 95% confidence interval [CI]: 0.416 to 0.871; p = 0.0071). Among 5,954 CRT-D-implanted patients, after multivariable adjustment NICD compared with RBBB was associated with lower mortality at 3 years in those with a QRS duration of ≥150 ms (HR: 0.757; 95% CI: 0.625 to 0.917; p = 0.0044). CONCLUSIONS: Among non-LBBB CRT-D-eligible patients, CRT-D implantation was associated with better outcomes compared with ICD alone specifically in NICD patients with a QRS duration of ≥150 ms. Careful patient selection should be considered for CRT-D implantation in patients with non-LBBB conduction.


Assuntos
Bloqueio de Ramo , Doença do Sistema de Condução Cardíaco , Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis/estatística & dados numéricos , Ventrículos do Coração/fisiopatologia , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Doença do Sistema de Condução Cardíaco/diagnóstico , Doença do Sistema de Condução Cardíaco/epidemiologia , Doença do Sistema de Condução Cardíaco/fisiopatologia , Doença do Sistema de Condução Cardíaco/terapia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/métodos , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Seleção de Pacientes , Sistema de Registros , Estados Unidos/epidemiologia
7.
Gerontology ; 65(5): 485-494, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112977

RESUMO

OBJECTIVES: We investigated the clinical, electrocardiographic, and echocardiographic determinants of the cardiac status in nonagenarian patients. METHODS: We consecutively examined 654 Caucasian patients (232 males and 422 females) aged ≥90 years. All patients underwent clinical examination, ECG, and transthoracic echocardiography. RESULTS: Their average age was 92.5 ± 2.5 years. Patients were predominately female of older age (p < 0.0001 and p = 0.02, respectively). A history of cardiovascular disease was present in 78.4% of the participants. One third of the patients was hospitalized for cardiovascular causes, with females being twice as many (p < 0.0001). Females showed higher levels of serum cholesterol, triglycerides, and glycemia (p < 0.0001, p< 0.0001, and p = 0.04 respectively). Sinus rhythm was detected in 65%, and atrial fibrillation in 31% of the overall population. Heart rate, PR and corrected QT (QTc) intervals, right bundle branch block (RBBB) and RBBB associated with left anterior fascicular block (LAFB) were higher in males (p < 0.0001, p = 0.036, p = 0.009, p = 0.001, and p = 0.004, respectively). Aortic root dimension, left ventricular (LV) mass index, and indexed LV systolic-diastolic volumes were higher in males (p < 0.001, p < 0.0001, p < 0.001, and p < 0.0001, respectively). Women showed fewer LV segmental kinetic disorders (p = 0009) and higher LV ejection fraction (LVEF; p< 0.0001). Hyperuricemia was positively associated with a history of cardiovascular disease (r = 0.15), glycemia (r = 19), creatininemia (r = 0.50), uremia (r = 0.51), triglycerides (r = 0.19), PR interval (r = 0.14), and left bundle branch block (r = 0.11), and inversely associated with sinus rhythm (r = -0.14) and LVEF (r = -0.17). Diabetes was positively correlated with PR and QTc intervals (r = 0.14 and r = 0.10, respectively), and RBBB with LFAB (r = 0.10), and inversely correlated with LVEF (r = -0.10). CONCLUSIONS: We found a remarkable presence of cardiovascular risk factors, ECG, and structural alterations in hospitalized nonagenarians, which presents more commonly in males.


Assuntos
Fibrilação Atrial/epidemiologia , Bloqueio de Ramo/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Hiperuricemia/epidemiologia , Volume Sistólico , Idoso de 80 Anos ou mais , Glicemia/metabolismo , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/epidemiologia , Colesterol/sangue , Diabetes Mellitus/epidemiologia , Ecocardiografia , Eletrocardiografia , Feminino , Hospitalização , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Distribuição por Sexo , Triglicerídeos/sangue , Uremia/epidemiologia
8.
Einstein (Sao Paulo) ; 17(2): eAO4539, 2019 Apr 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942280

RESUMO

OBJECTIVE: To investigate the prevalence of electrocardiographic changes in patients with spondyloarthritis and to correlate these changes with use of anti-tumor necrosis factor-alpha (TNF-α) drugs and HLA-B27 positivity. METHODS: Retrospective study including 100 patients diagnosed with spondyloarthritis according to Assessment of SpondyloArthritis International Society (ASAS) criteria and 50 controls. Epidemiological and clinical features, results of inflammatory activity tests, HLA-B27 positivity, and medication use data were extracted from medical records. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). All participants were submitted to electrocardiogram performed using a 12-lead device; rhythm, heart rate, conduction disorders and QT interval corrected using the Bazett formula were analyzed. RESULTS: Of 100 patients with spondyloarthritis, 51 were on anti-TNF-α drugs and 49 were not. HLA-B27 was detected in 53.1% of patients in the sample. Patients with spondyloarthritis had lower heart rate (p=0.06), longer QT interval (p<0.0001) and higher prevalence of right bundle branch block (p=0.014) compared to controls. Duration of disease was weakly correlated with heart rate (Rho=0.26; 95%CI: 0.06-0.44; p=0.008). The prevalence of right bundle branch block was positively correlated with HLA-B27 positivity. Use of Anti-TNF-α drugs did not interfere with electrocardiographic parameters. CONCLUSION: Patients with spondyloarthritis had lower heart rate, longer QT interval and a higher prevalence of right bundle branch block compared to controls. HLA-B27 positivity was associated with the prevalence of right bundle branch block. Anti-TNF-α drugs had no impact on electrocardiographic findings.


Assuntos
Eletrocardiografia , Espondilartrite/tratamento farmacológico , Espondilartrite/fisiopatologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/fisiopatologia , Estudos de Casos e Controles , Feminino , Antígeno HLA-B27/análise , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Estudos Retrospectivos , Espondilartrite/epidemiologia , Espondilartrite/imunologia , Estatísticas não Paramétricas , Fatores de Tempo , Adulto Jovem
9.
J Hypertens ; 37(3): 629-635, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30676480

RESUMO

BACKGROUND: Previous work has demonstrated that treatment of hypertensive patients with the angiotensin-converting enzyme inhibitor lisinopril was associated with a reduced incidence of a composite conduction system disease endpoint and also left bundle branch block (LBBB) compared with chlorthalidone therapy. The relationship of incident conduction system disease to angiotensin receptor blocker therapy has not been examined. METHODS: Risk of new right (RBBB) or LBBB in relation to losartan-based vs. atenolol-based treatment was assessed in 8342 hypertensive patients without baseline RBBB or LBBB. Risk of incident intraventricular conduction delay (IVCD), defined as new QRS duration at least 110 ms was assessed in the 7110 patient subset who also had baseline QRS duration less than 110 ms. QRS duration and BBB were determined on in-study ECGs done at 6 months, 1 year and then yearly. RESULTS: During 4.8 ±â€Š1.0 years follow-up, 459 patients developed new LBBB (5.5%), 184 (2.2) new RBBB and 1173 (16.5%) a new IVCD. In univariate Cox analyses, losartan-based treatment was not associated with a significantly reduced risk of either new LBBB (hazard ratio 0.95, 95% CI 0.79-1.14, P = 0.583) or RBBB (hazard ratio 1.02, 95% CI 0.76-1.36, P = 0.903), but resulted in a 15% lower risk of new IVCD (hazard ratio 0.85, 95% CI 0.76-0.95, P = 0.005). In a multivariable Cox model that adjusted for other statistically significant predictors of incident IVCD in this population (age, sex, race, history of ischemic heart disease, MI, heart failure, diabetes or atrial fibrillation, prior antihypertensive treatment, baseline total and HDL cholesterol, serum glucose and creatinine and baseline QRS duration as standard covariates and incident MI and on-treatment systolic and diastolic pressure, BMI and Cornell voltage as time-dependent covariates), losartan treatment remained associated with a 13% lower risk of new IVCD (hazard ratio 0.87, 95% CI 0.77-0.98, P = 0.021). CONCLUSION: Incident IVCD, but not BBB, is significantly reduced by losartan-based treatment. Further study is warranted to assess the potential differential impact of this therapy on QRS prolongation vs. development of more discrete conduction system block. CLINICAL TRIALS REGISTRATION: .


Assuntos
Anti-Hipertensivos/uso terapêutico , Bloqueio de Ramo , Clortalidona/uso terapêutico , Hipertensão , Lisinopril/uso terapêutico , Bloqueio de Ramo/complicações , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/prevenção & controle , Eletrocardiografia , Sistema de Condução Cardíaco/fisiologia , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia
10.
Eur Heart J Acute Cardiovasc Care ; 8(2): 161-166, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30362813

RESUMO

AIMS:: The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. We aimed to evaluate this novel recommendation in two prospective studies of patients with suspected myocardial infarction. METHODS AND RESULTS:: We included 4067 patients presenting to the emergency department with suspected myocardial infarction. All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB), bifascicular block (BFB) or no bundle branch block. All patients were followed for up to two years to assess mortality. In the overall population 125 (3.1%) patients had RBBB, 281 (6.9%) LBBB and 60 (1.5%) BFB. The final diagnosis of myocardial infarction was adjudicated in 20.8% (RBBB), 28.5% (LBBB), 23.3% (BFB) and 21.6% (no complete block) of patients. The mortality rate after one year was 10.7% (RBBB), 7% (LBBB), 17.5% (BFB) and 3.2% (no complete block). The adjusted hazard ratios were 1.29 (95% confidence interval (CI) 0.71-2.34; P=0.40) for RBBB, 1.71 (95% CI 1.17-2.50; P=0.006) for LBBB and 2.27 (95% CI 1.28-4.05; P=0.005) for BFB. CONCLUSION:: Our results support the new European Society of Cardiology ST-segment elevation myocardial infarction guideline describing RBBB as a high risk for mortality in patients with suspected myocardial infarction. However, the data challenge the concept of RBBB as a trigger of acute angiography because the likelihood of myocardial infarction in a chest pain unit setting is equally frequent in patients without bundle branch block.


Assuntos
Bloqueio de Ramo/etiologia , Eletrocardiografia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/epidemiologia , Causas de Morte/tendências , Angiografia Coronária , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Taxa de Sobrevida/tendências
11.
J Electrocardiol ; 52: 39-45, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30476637

RESUMO

BACKGROUND: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. METHODS: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. RESULTS: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71-3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19-1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26-4.02) within 30 days and a HR of 1.67 (95%CI 1.25-2.23) after 30 days. CONCLUSION: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.


Assuntos
Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Idoso , Algoritmos , Bloqueio de Ramo/epidemiologia , Dinamarca/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Sensibilidade e Especificidade
12.
Ann Noninvasive Electrocardiol ; 24(2): e12603, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30267454

RESUMO

BACKGROUND: Baseline predictors of myocardial recovery after cardiac resynchronization therapy (CRT) in left bundle branch block (LBBB)-associated idiopathic nonischemic cardiomyopathy (NICM) are unknown. METHODS: A retrospective study included subjects with idiopathic NICM, left ventricular ejection fraction (LVEF) ≤35%, and LBBB. Myocardial recovery was defined as post-CRT LVEF ≥50%. Logistic regression analyses described associations between baseline characteristics and myocardial recovery. Cox regression analyses estimated the hazard ratio (HR) between myocardial recovery status and adverse clinical events. RESULTS: In 105 subjects (mean age 61 years, 44% male, mean initial LVEF 22.6% ± 6.6%, 81% New York Heart Association class III, and 98% CRT-defibrillators), myocardial recovery after CRT was observed in 56 (54%) subjects. Hypertension, heart rate, and serum blood urea nitrogen (BUN) had negative associations with myocardial recovery in univariable analyses. These associations persisted in multivariable analysis: hypertension (odds ratio (OR), 0.40; 95% confidence interval (CI), 0.17-0.95; p = 0.04), heart rate (OR per 10 bpm, 0.69; 95% CI, 0.48-0.997; p = 0.048), and serum BUN (OR per 1 mg/dl, 0.94; 95% CI, 0.88-0.99; p = 0.04). Subjects with post-CRT LVEF ≥50%, when compared to <50%, had lower risk for adverse clinical events (heart failure hospitalization, appropriate implantable cardioverter-defibrillator shock, appropriate anti-tachycardia pacing therapy, ventricular assist device implantation, heart transplantation, and death) over a median follow-up of 75.9 months (HR, 0.38; 95% CI, 0.16-0.88; p = 0.02). CONCLUSION: In LBBB-associated idiopathic NICM, myocardial recovery after CRT was associated with absence of hypertension, lower heart rate, and lower serum BUN. Those with myocardial recovery had fewer adverse clinical events.


Assuntos
Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatias/epidemiologia , Cardiomiopatias/terapia , Remodelação Ventricular/fisiologia , Centros Médicos Acadêmicos , Idoso , Análise de Variância , Bloqueio de Ramo/diagnóstico por imagem , Terapia de Ressincronização Cardíaca/mortalidade , Cardiomiopatias/diagnóstico , Causas de Morte , Estudos de Coortes , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica , Pennsylvania , Prognóstico , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Volume Sistólico/fisiologia , Taxa de Sobrevida , Resultado do Tratamento
13.
J Formos Med Assoc ; 118(3): 686-691, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30193834

RESUMO

BACKGROUND/PURPOSE: A deleterious effect of complete left bundle-branch block (cLBBB) on left ventricular (LV) function has been established. The underutilization of cardiac resynchronization therapy has been noted in Taiwan and the Asian-Pacific area, but the reasons remain unclear. This study aimed to evaluate the prevalence and association of cLBBB and impaired LV ejection fraction (LVEF) in patients at the National Taiwan University Hospital (NTUH). METHODS: We enrolled 164,049 patients who underwent standard 12-lead electrocardiography (ECG) between January 2010 and December 2013 at NTUH. Echocardiographic examinations within one year of the index ECG were analyzed. Baseline clinical characteristics, electrocardiography and ECG parameters, in patients with cLBBB were compared among those with three different LVEFs (EF <35%, 35%≤ EF<50%, and EF ≥50%). Multivariable logistic regression analysis were conducted to identify independent predictors of impaired LVEF in patient with cLBBB. RESULTS: The prevalence of cLBBB was 0.4% (648 patients), and it increased with age. The estimated prevalence of cLBBB and LVEF <35% was about 0.1%. The effects of age on the distributions of patients with cLBBB by three different EF statuses were significantly disparate. In patients with cLBBB aged >80 years, 64% had a normal EF. However, in those aged between 40 and 60 years, the risk of EF <35% was as high as 45%, and the risk of EF <50% was even higher at 60%. CONCLUSION: Patients in Taiwan had a low prevalence of LVEF<35% and cLBBB. About three-fourth of patients with cLBBB did not experience HF events, and 56% of them had a normal LVEF. The development of an effective triage strategy for these patients is warranted.


Assuntos
Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Volume Sistólico , Taiwan/epidemiologia , Resultado do Tratamento , Adulto Jovem
14.
Ann Noninvasive Electrocardiol ; 24(2): e12572, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29932265

RESUMO

In left bundle branch block (LBBB), the ventricles are activated in a sequential manner with alterations in left ventricular mechanics, perfusion, and workload resulting in cardiac remodeling. Underlying molecular, cellular, and interstitial changes manifest clinically as changes in size, mass, geometry, and function of the heart. Cardiac remodeling is associated with progressive ventricular dysfunction, arrhythmias, and impaired prognosis. Clinical and diagnostic notions about LBBB have evolved from a simple electrocardiographic alteration to a critically important finding affecting diagnostic and clinical management of many patients. Advances in cardiac magnetic resonance imaging have significantly improved the assessment of patients with LBBB and provided additional insights into pathophysiological mechanisms of left ventricular remodeling. In this review, we will discuss the epidemiology, etiologies, and electrovectorcardiographic features of LBBB and propose a classification of the conduction disturbance.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/epidemiologia , Eletrocardiografia/métodos , Idoso , Bloqueio de Ramo/classificação , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Feminino , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Vetorcardiografia/métodos
15.
Med. clín (Ed. impr.) ; 151(10): 402-411, nov. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174029

RESUMO

La significación clínica que tiene un bloqueo de rama derecha (BRD) en los pacientes asintomáticos sin evidencia de patología cardiovascular conocida es fuente de controversia. Para establecer la relación entre la aparición del BRD y el aumento de morbimortalidad cardiovascular en pacientes sanos se realizó una revisión bibliográfica de los artículos existentes hasta septiembre de 2017, a través de la búsqueda sistemática en PubMed, Cochrane y búsqueda manual de la bibliografía citada y artículos relacionados. De las 29 publicaciones que cumplían los criterios de inclusión, 8 mostraron resultados de mortalidad y 16 de morbilidad. En 8 artículos se observó un aumento de riesgo de muerte y en 11 de eventos cardiovasculares. Las publicaciones revisadas sugieren que la presencia de BRD en pacientes sanos no es irrelevante. Se necesitan más estudios que analicen qué tipo de seguimiento se debería realizar en estos pacientes


The clinical significance of a right bundle branch block (RBBB) in an asymptomatic adult without evidence of cardiovascular disease is controversial. To establish the relationship between the appearance of the RBBB and the increase of cardiovascular morbidity and mortality in healthy patients, we have carried out a literature review of documents available until September 2017 through a systematic search on the Pubmed database, Cochrane library and a manual search of the mentioned literature and related articles. From the 29 articles included in the study sample, eight showed mortality and 16 morbidity outcomes. An increase of risk of death is observed is eight articles and an increase of cardiovascular events is observed in 11 articles. The most recent publications suggest that the appearance of an RBBB in healthy individuals should not be underestimated, thus further studies are needed to analyse the type of follow-up that should be carried out in these patients


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/epidemiologia , Função Ventricular Direita/fisiologia , Indicadores de Morbimortalidade , Bloqueio de Ramo/mortalidade , Bloqueio de Ramo/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Fatores de Risco , Eletrocardiografia/métodos
16.
JACC Cardiovasc Interv ; 11(15): 1495-1505, 2018 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-30031719

RESUMO

OBJECTIVES: The authors sought to determine: 1) the global arrhythmic burden; 2) the rate of arrhythmias leading to a treatment change; and 3) the incidence of high-degree atrioventricular block (HAVB) at 12-month follow-up in patients with new-onset persistent left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). BACKGROUND: Controversial data exist on the occurrence of significant arrhythmias in patients with LBBB post-TAVR. METHODS: This was a multicenter prospective study including 103 consecutive patients with new-onset persistent LBBB post-TAVR with the balloon-expandable SAPIEN XT/3 valve (n = 53), or the self-expanding CoreValve/Evolut R system (n = 50). An implantable cardiac monitor (Reveal XT, Reveal Linq) was implanted at 4 (3 to 6) days post-TAVR, and patients had continuous electrocardiogram monitoring for 12 months. All arrhythmic events were adjudicated in a central electrocardiography core lab. Primary endpoints were the incidence of arrhythmias leading to a treatment change, and the incidence of HAVB at 12-month follow-up. RESULTS: A total of 1,553 new arrhythmic events were detected in 44 patients (1,443 episodes of tachyarrhythmia in 26 patients [atrial fibrillation/flutter/atrial tachycardia: 1,427, ventricular tachycardia 16]; 110 episodes of bradyarrhythmia in 21 patients [HAVB 54, severe bradycardia 56]). All arrhythmic events were silent in 34 patients (77%), the arrhythmic event led to a treatment change in 19 patients (18%), and 11 patients (11%) required pacemaker or implantable cardioverter-defibrillator implantation (due to HAVB, severe bradycardia, or ventricular tachycardia episodes in 9, 1, and 1 patient, respectively). A total of 12 patients died at 1-year follow-up, 1 from sudden death. CONCLUSIONS: A high incidence of arrhythmic events was observed at 1-year follow-up in close to one-half of the patients with LBBB post-TAVR. Significant bradyarrhythmias occurred in one-fifth of the patients, and PPM was required in nearly one-half of them. These data support the use of a cardiac monitoring device for close follow-up and expediting the initiation of treatment in this challenging group of patients. (Ambulatory Electrocardiographic Monitoring for the Detection of High-Degree Atrio-Ventricular Block in Patients With New-onset PeRsistent LEft Bundle Branch Block After Transcatheter Aortic Valve Implantation [MARE study]: NCT02153307).


Assuntos
Estenose da Valva Aórtica/cirurgia , Arritmias Cardíacas/diagnóstico , Bloqueio de Ramo/diagnóstico , Eletrocardiografia Ambulatorial , Substituição da Valva Aórtica Transcateter/efeitos adversos , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Canadá/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Frequência Cardíaca , Humanos , Incidência , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
17.
Am J Cardiol ; 122(2): 199-205, 2018 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-29778237

RESUMO

Changes in QRS duration and pattern are regarded to reflect severe ischemia in acute coronary syndromes (ACS), and ventricular conduction blocks (VCBs) are recognized high-risk markers in both ACS and acute heart failure. Our aim was to evaluate the prevalence, temporal evolution, association with clinical and angiographic parameters, and impact on mortality of VCBs in ACS-related cardiogenic shock (CS). Data of 199 patients with ACS-related CS from a prospective multinational cohort were evaluated with electrocardiogram data from baseline and day 3. VCBs including left or right bundle branch block, right bundle branch block and hemiblock, isolated hemiblocks, and unspecified intraventricular conduction delay were assessed. Fifty percent of patients had a VCB at baseline; these patients were older, had poorer left ventricular function and had more often left main disease compared with those without VCB. One-year mortality was over 2-fold in patients with VCB compared with those without VCB (68% vs 32%, p<0.001). All types of VCBs at baseline were associated with increased mortality, and the predictive value of a VCB was independent of baseline variables and coronary angiography findings. Interestingly, 37% of the VCBs were transient, i.e., disappeared before day 3. However, 1-year mortality was much higher in these patients (69%) compared to patients with persistent (38%) or no VCB (15%, p<0.001). Indeed, a transient VCB was a strong independent predictor of 1-year mortality. In conclusion, our findings propose that any VCB in baseline electrocardiogram, even if transient, identifies very early patients at particularly high mortality risk in ACS-related CS.


Assuntos
Síndrome Coronariana Aguda/complicações , Bloqueio de Ramo/epidemiologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Choque Cardiogênico/complicações , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Angiografia Coronária , República Tcheca/epidemiologia , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Taxa de Sobrevida/tendências
18.
Rev Esp Med Nucl Imagen Mol ; 37(5): 273-276, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29680771

RESUMO

INTRODUCTION: Exercise-induced left bundle branch block (EI-LBBB) is a rare circumstance of unknown significance. The purpose of this paper is to describe the scintigraphic features and the prognostic value of this finding. MATERIAL AND METHODS: We reviewed the features of 1,885 patients who had visited our department to undergo GATED-SPECT ergometry to diagnose ischaemic heart disease. Seven patients showed EI-LBBB throughout the exercise testing. Coronary angiography was performed in 4 of them. Patients were followed-up over an average period of time of 30±8 months. The onset of major cardiovascular events was recorded during the follow-up period. RESULTS: The prevalence of EI-LBBB was 0.37%. Six out of 7 patients were women. Myocardial function and perfusion were normal in 3 patients. Three patients had fixed perfusion defects and one patient had a reversible defect. Two out of the 4 patients showing perfusion defects presented a moderate-severe decrease of the left ventricular ejection fraction. None of the 4 patients with perfusion defects were found to have coronary disease on coronary angiography. CONCLUSIONS: The prevalence of EI-LBBB among the patients that came to undergo GATED-SPECT ergometry was very low. The finding was more frequent in women. In our series, 2 patients presented non-ischaemic structural heart disease, but no patient was diagnosed with coronary artery disease. In our patients the presence of EI-LBBB did not relate to a greater risk of experiencing a major cardiovascular event.


Assuntos
Bloqueio de Ramo/etiologia , Teste de Esforço/efeitos adversos , Idoso , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Prevalência , Prognóstico
19.
Int J Cardiol ; 261: 119-129, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29657035

RESUMO

Cardiac resynchronization therapy (CRT) was proposed around 20 years ago, and its clinical use rapidly moved from pioneering experiences to randomized controlled trials (RCT). Since 2002 recommendations for CRT have been included in international consensus guidelines that even in an early phase recommended CRT as an effective treatment for improving symptoms, reducing hospitalizations and mortality in well-selected patients with wide QRS, left ventricular dysfunction and moderate to severe heart failure (NYHA classes III-IV), on optimal medical therapy. Subsequently the indications were extended to mild (NYHA class II) heart failure (associated with left ventricular dysfunction and wide QRS) and more recently also to appropriately selected patients with conventional indications for pacing having a left ventricular ejection fraction of 50% or less and NYHA class I-III. While all the guidelines strongly recommend CRT in case of LBBB with QRS duration >150 ms, lower strength of recommendations, with some heterogeneity, appears when QRS duration is 130-150 ms, especially if not associated with LBBB. Of note, according to recent guidelines, CRT is not recommended in case of QRS duration <130 ms, which is now the lower limit for candidacy to CRT, differently from the 120 ms limit used before. Despite consensus guidelines, many data indicate that CRT is still underused, with great heterogeneity in its implementation, both in North America and Europe, thus requiring a more organized patient referral.


Assuntos
Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/normas , Terapia de Ressincronização Cardíaca/tendências , Consenso , Guias de Prática Clínica como Assunto/normas , Bloqueio de Ramo/fisiopatologia , Europa (Continente)/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Fatores de Tempo , Estados Unidos/epidemiologia
20.
Am J Cardiol ; 121(11): 1358-1364, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29680171

RESUMO

The impact of predilatation (Pre-Dil) on prosthesis hemodynamics and clinical outcomes of subjects who underwent transcatheter aortic valve implantation (TAVI) with a self-expanding prosthesis remains unclear. Two thousand seven hundred twenty-one subjects from the extreme- and high-risk CoreValve Continued Access Study (CAS) were included in the analysis. Subjects who underwent Pre-Dil before TAVI were compared with subjects who underwent TAVI without Pre-Dil. Clinical outcomes included death, stroke, myocardial infarction, acute kidney injury, and new permanent pacemaker implantation. Serial echocardiograms were analyzed to evaluate prosthesis hemodynamics, specifically paravalvular regurgitation, effective orifice area, and mean gradient. Two thousand one hundred eighteen and 603 subjects underwent TAVI with and without Pre-Dil, respectively. Subjects in the Pre-Dil cohort were more commonly male, while subjects in the no Pre-Dil cohort had higher rates of previous stroke and lower mean aortic valve gradients. Outcomes at 30 days were comparable between Pre-Dil and no Pre-Dil subjects, with no significant difference in mortality (5.5% vs 4.3%, p = 0.27), major stroke (2.6% vs 2.2%, p = 0.54), major vascular complications (6.9% vs 8.0%, p = 0.37), major bleeding (24.4% vs 26.1%, p = 0.40), and permanent pacemaker implantation (21.3% vs 23.4%, p = 0.36). There were no significant differences in the same outcomes at 12 months. Effective orifice area and mean gradient were comparable between Pre-Dil and no-Pre-Dil subjects at discharge, at 30 days, and at 12 months. In conclusion, when performing TAVI with the self-expanding CoreValve device, performing direct implantation without Pre-Dil maintains an acceptable safety profile and still achieves desired and consistent prosthesis hemodynamics.


Assuntos
Estenose da Valva Aórtica/cirurgia , Dilatação/métodos , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/métodos , Lesão Renal Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial , Ecocardiografia , Feminino , Hemodinâmica , Humanos , Masculino , Mortalidade , Infarto do Miocárdio/epidemiologia , Marca-Passo Artificial , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
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