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2.
Rev Esp Cardiol (Engl Ed) ; 72(12): 1065-1075, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31611150

RESUMO

There is currently no other hot topic like the ability of current technology to develop capabilities similar to those of human beings, even in medicine. This ability to simulate the processes of human intelligence with computer systems is known as artificial intelligence (AI). This article aims to clarify the various terms that still sound foreign to us, such as AI, machine learning (ML), deep learning (DL), and big data. It also provides an in-depth description of the concept of AI and its types; the learning techniques and technology used by ML; cardiac imaging analysis with DL; and the contribution of this technological revolution to classical statistics, as well as its current limitations, legal aspects, and initial applications in cardiology. To do this, we conducted a detailed PubMed search on the evolution of original contributions on AI to the various areas of application in cardiology in the last 5 years and identified 673 research articles. We provide 19 detailed examples from distinct areas of cardiology that, by using AI, have shown diagnostic and therapeutic improvements, and which will aid understanding of ML and DL methodology.


Assuntos
Algoritmos , Inteligência Artificial , Técnicas de Imagem Cardíaca/métodos , Cardiologia/métodos , Aprendizado Profundo , Aprendizado de Máquina , Humanos
3.
Cardiol Clin ; 37(4): 469-486, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587788

RESUMO

Comorbidities specific to the cardio-oncology population contribute to the challenges in the interventional management of patients with cancer and cardiovascular disease (CVD). Patients with cancer have generally been excluded from cardiovascular randomized clinical trials. Endovascular procedures may represent a valid option in patients with cancer with a range of CVDs because of their minimally invasive nature. Patients with cancer are less likely to be treated according to societal guidelines because of perceived high risk. This article presents the specific challenges that interventional cardiologists face when caring for patients with cancer and the modern tools to optimize care.


Assuntos
Cardiologia/métodos , Doença da Artéria Coronariana/cirurgia , Oncologia/métodos , Revascularização Miocárdica/métodos , Neoplasias/epidemiologia , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Saúde Global , Humanos
5.
Presse Med ; 48(12): 1393-1400, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31471091

RESUMO

An ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (>4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1).


Assuntos
Atletas , Eletrocardiografia , Cardiopatias/diagnóstico , Esportes , Cardiologia/métodos , Cardiologia/normas , Diagnóstico Diferencial , Técnicas de Diagnóstico Cardiovascular/normas , Eletrocardiografia/métodos , Eletrocardiografia/normas , Exercício/fisiologia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Padrões de Referência , Esportes/normas
6.
BMC Health Serv Res ; 19(1): 681, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547824

RESUMO

BACKGROUND: Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. METHODS: This study aims at exploring the Pediatric Telecardiology Service's evolution, through a comprehensive assessment of the PCS's development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon's framework helped to understand the implementation and scale-up process and the role of policy-making. RESULTS: With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant "Clan" culture. The Momentum's critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals' engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. CONCLUSION: The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.


Assuntos
Cardiologia/métodos , Pediatria/métodos , Consulta Remota/organização & administração , Telemedicina/organização & administração , África , Criança , Comunicação , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Portugal , Consulta Remota/estatística & dados numéricos , Consulta Remota/tendências , Telemedicina/estatística & dados numéricos , Telemedicina/tendências
7.
Vet Clin North Am Exot Anim Pract ; 22(3): 349-366, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395319

RESUMO

This article reviews the use of the smartphone in exotic pet medicine. The mobile app is the most instinctive use of the smartphone; however, there are very limited software dedicated to the exotic pet specifically. With an adapter, the smartphone can be attached to a regular endoscope and acts as a small endoscopic unit. Additional devices, such as infrared thermography or ultrasound, can be connected to the smartphone through the micro-USB port. The medical use of the smartphone is still in its infancy in veterinary medicine but can bring several solutions to the exotic pet practitioner and improve point-of-care evaluation.


Assuntos
Animais Exóticos , Aplicativos Móveis , Smartphone , Medicina Veterinária/instrumentação , Animais , Cardiologia/instrumentação , Cardiologia/métodos , Cardiologia/tendências , Endoscopia/instrumentação , Endoscopia/veterinária , Humanos , Raios Infravermelhos , Microscopia/instrumentação , Microscopia/métodos , Microscopia/tendências , Microscopia/veterinária , Aplicativos Móveis/normas , Aplicativos Móveis/tendências , Oftalmologia/instrumentação , Oftalmologia/métodos , Oftalmologia/tendências , Smartphone/tendências , Termografia/instrumentação , Termografia/métodos , Termografia/tendências , Termografia/veterinária , Ultrassonografia/instrumentação , Ultrassonografia/métodos , Ultrassonografia/tendências , Ultrassonografia/veterinária , Medicina Veterinária/métodos , Medicina Veterinária/tendências
8.
Pediatr Cardiol ; 40(7): 1439-1444, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31367952

RESUMO

National management guidelines recommend that patients with moderate and complex congenital heart disease (CHD) receive life-long cardiac care (LLCC), guided in adulthood by an adult congenital heart disease (ACHD) specialist. However, the percentage of adult CHD patients who receive such care is quite low. Inadequate knowledge regarding LLCC may contribute to care interruption. We, therefore, sought to determine the knowledge of adolescents and young adults regarding LLCC. In this multi-center study, we administered a survey to patients 13-20 years of age with surgically repaired congenital heart disease. We assessed the understanding of both their need for LLCC and awareness of the type of recommended care providers. A total of 290/302 (96%) patients approached in the outpatient clinic setting (10 centers) agreed to study participation; mean age was 16.3 ± 2.3 years; patients were 62% male. While the need for LLCC was recognized by 78% of subjects, only 37% understood that an ACHD specialist in adulthood should guide this care. Only 37% of respondents stated that their current cardiology team had spoken to them about LLCC, but 90% wished to learn more. A substantial number of adolescents and young adults with moderate and complex CHD lack adequate knowledge about LLCC, but most have a desire to learn more about the type of care they will require in adulthood. Transition education/assessment ensuring successful transfer to adult-oriented care for this population should emphasize the importance of LLCC.


Assuntos
Cardiologia/métodos , Conhecimentos, Atitudes e Prática em Saúde , Cardiopatias Congênitas/psicologia , Pediatria/métodos , Transição para Assistência do Adulto/normas , Adolescente , Estudos Transversais , Feminino , Cardiopatias Congênitas/terapia , Humanos , Masculino , Educação de Pacientes como Assunto , Inquéritos e Questionários
9.
Gen Thorac Cardiovasc Surg ; 67(9): 736-741, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256329

RESUMO

Data on isolated coronary artery bypass grafting (CABG) performed in 2015 and 2016, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Isolated CABG was performed off-pump in 55.0% (n = 16,173) of all CABG cases (n = 29,392), and graft material for the LAD was positioned at the internal thoracic artery in 72.1% and at the right internal thoracic artery in 17.4% of patients. Operative mortality was 1.7% in elective cases, 8.8% in emergency cases, and 3.0% overall, which was similar to our previous report. In elective cases, operative mortality was 1.1% for off-pump CABG compared with 2.5% for on-pump CABG, and all morbidities except for "readmission < 30 days" were significantly better in OPCAB cases.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiologia/métodos , Cardiologia/tendências , Ponte de Artéria Coronária/tendências , Ponte de Artéria Coronária sem Circulação Extracorpórea/tendências , Vasos Coronários/cirurgia , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Tratamento de Emergência , Feminino , Humanos , Japão , Masculino , Artéria Torácica Interna/cirurgia , Pessoa de Meia-Idade , Morbidade , Estudos Retrospectivos , Resultado do Tratamento
10.
Rev Esp Cardiol (Engl Ed) ; 72(8): 658-663, 2019 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31262700

RESUMO

The percutaneous treatment of coronary artery disease and some structural cardiovascular diseases has undergone spectacular changes. More and more patients with different types of heart disease are being treated by percutaneous or transcatheter interventions, with no such increase in patients undergoing cardiac surgery. This situation has led to different types of approach, requiring an objective analysis that includes all the factors possibly influencing these changes. This document assesses the 2 scenarios where this problem is most evident: coronary revascularization and the treatment of aortic stenosis. The document analyzes the situation of coronary revascularization in Spain, and the causes that may explain the differences between the number of patients who currently undergo percutaneous revascularization and those who undergo coronary surgery. In contrast, treatment of aortic stenosis through transcatheter aortic valve implantation will lead to a foreseeable reduction in the number of candidates for surgical replacement. Several international scientific societies have published the requirements on training and experience and the necessary operator and center volumes to implement a transcatheter aortic valve implantation program, conditions that the Spanish Society of Cardiology, adopting a patient-centered approach, considers absolutely essential. Given that the 2 forms of intervention (percutaneous and surgical) are complementary, multidisciplinary patient assessment (Heart Team) remains crucial to offer the best treatment option. In this scenario of diverse approaches, a key figure is the clinical cardiologist. Finally, the changes currently occurring in the treatment of structural heart disease will, in future, lead to the performance of procedures requiring the participation of professionals from both specialties. This approach will require a redesign of current training programs.


Assuntos
Cardiologia/métodos , Consenso , Assistência Centrada no Paciente/métodos , Intervenção Coronária Percutânea/métodos , Sociedades Médicas , Substituição da Valva Aórtica Transcateter/métodos , Humanos , Espanha
11.
Gen Thorac Cardiovasc Surg ; 67(9): 742-749, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31270746

RESUMO

OBJECTIVES: Data related to valvular heart surgeries from the Japan Cardiovascular Surgery Database in 2015 and 2016 were analyzed to demonstrate the associated mortality and morbidity rates and choice of surgical procedures. METHODS: We used the Japan Cardiovascular Surgery Database to extract data related to cardiac valve replacement procedures performed in 2015 and 2016. The cases were further evaluated depending upon the type of procedure and prosthesis used at each site. The percentage of bio-prosthesis usage was calculated for each valve position and age group. The rates of operative mortality and morbidity were calculated for each valve position and type of procedure. RESULTS: Overall, 26,054 aortic valve replacements were performed in 2015 and 2016, showing a slightly larger number than the last report (2013-2014). A total of 3305 transcatheter aortic valve replacements, 5652 mitral valve replacements and 12,024 mitral valve repair procedures were performed. The percentage of bio-prosthesis usage in aortic valve replacement was 96.5, 92.7, and 63.5% for patients in their 80s, 70s, and 60s, respectively, demonstrating an increase in usage since 2013-2014. Mechanical valves were preferred in patients on chronic hemodialysis. The mortality rates of aortic valve replacement, mitral valve replacement, mitral valve repair, and tricuspid valve replacement procedures were 4.1, 7.1, 2.2, and 10.5%, respectively. CONCLUSION: We evaluated recent trends in valvular heart surgery in Japan with respect to the type of procedure and prosthesis preferred and the postoperative outcomes. We found that bio-prosthesis usage was becoming more common.


Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/tendências , Próteses Valvulares Cardíacas , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiologia/métodos , Cardiologia/tendências , Bases de Dados Factuais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Diálise Renal , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/tendências , Valva Tricúspide/cirurgia , Adulto Jovem
12.
Gen Thorac Cardiovasc Surg ; 67(9): 731-735, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31327137

RESUMO

OBJECTIVES: We analyzed the mortality and morbidity of congenital heart surgery in Japan by using Japan Cardiovascular Surgery Database (JCVSD). METHODS: The data on congenital heart surgery performed between January 2015 and December 2016 were obtained from JCVSD. From the data obtained, the most frequent 20 procedures were selected, and the mortalities and major morbidities were analyzed. In addition, the institutions were classified into three groups according to the number of cardiopulmonary cases for a year, and the distribution of the major operations was calculated. RESULTS: The mortality of ASD repair and VSD repair was under 1% and the mortality of TOF repair, complete AVSD repair, Rastelli operation, CoA complex repair, bidirectional Glenn and TCPC was 2-3%. The mortality of Norwood procedure and TAPVC repair were over 10%. These difficult operations were mainly performed at relatively high-volume institutions. CONCLUSION: Using the data from JCVSD, the national data of congenital heart surgery, including postoperative complications, were analyzed. Neonatal surgery still has considerable complication rates and further improvement is desired. In addition, it was shown that complicated operations tended to be performed at large volume institutions.


Assuntos
Transposição das Grandes Artérias , Cardiologia/normas , Cardiopatias Congênitas/cirurgia , Procedimentos de Norwood , Cardiologia/métodos , Cardiologia/tendências , Bases de Dados Factuais , Coração , Humanos , Lactente , Recém-Nascido , Japão , Morbidade , Complicações Pós-Operatórias
14.
Gen Thorac Cardiovasc Surg ; 67(9): 751-757, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312983

RESUMO

BACKGROUND: Thoracic and thoracoabdominal aortic diseases are treated using operative procedures like open aortic repair (OAR), thoracic endovascular aortic repair (TEVAR), or hybrid aortic repair (HAR), or a combination of OAR and TEVAR. The surgical approach to aortic repair has evolved over the decades. The purpose of this study was to examine the current trends in treatment. METHODS: We extracted nationwide data of aortic repair procedures performed in 2015 and 2016 from the Japan Cardiovascular Surgery Database (JCVSD). In addition to estimating the number of cases, we also reviewed the respective operative mortalities and associated major morbidities (e.g., stroke, spinal cord insufficiency, and renal failure) according to disease pathology (e.g., acute dissection, chronic dissection, ruptured aneurysm, and unruptured aneurysm), site of operative repair (i.e., aortic root, ascending aorta, aortic root to arch, aortic arch, descending aorta, and thoracoabdominal aorta), and the preferred surgical approach (i.e., OAR, HAR, or TEVAR). RESULTS: The total number of cases studied was 35,427, with an overall operative mortality rate of 7.3%. Among the 3 procedures, 64% of patients were treated with OAR. Compared to the data from our previous report (also derived from the JCVSD in 2013 and 2014), the total number of cases and number of OAR, HAR, and TEVAR procedures have increased by 17.0%, 2.4%, 126.1%, and 34.9%, respectively. While the overall stroke rates following aortic arch surgical repair with HAR, OAR, and TEVAR were 10.1%, 8.4%, and 7.3%, respectively, OAR was found to have the lowest stroke rate when limited to cases presenting with a non-dissected/unruptured aorta. The incidence rates of paraplegia following descending/thoracoabdominal aortic surgical repair using HAR, OAR, and TEVAR were 6.3%/10.4%, 4.3%/8.9%, and 3.4%/4.6%, respectively. TEVAR was found to be associated with the lowest incidence of postoperative renal failure. CONCLUSIONS: The number of operations for thoracic and thoracoabdominal aortic diseases has increased, though the rate of operations using an OAR approach has decreased. While TEVAR showed the lowest mortality and morbidity rates, OAR demonstrated the lowest postoperative stroke rate for non-dissecting aortic arch aneurysms.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Idoso , Aneurisma Dissecante , Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/tendências , Cardiologia/métodos , Cardiologia/tendências , Bases de Dados Factuais , Procedimentos Endovasculares/tendências , Feminino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Morbidade , Paraplegia/etiologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Med Hypotheses ; 128: 76-77, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31203914

RESUMO

Type A aortic dissection (TAAD) is a catastrophic condition with 24-48% mortality during the first day, if patients are not surgically treated. Due to old age and associated co-morbidities surgeons may be reluctant to operate and patients are administered medical therapy for the end of reducing systolic blood pressure and heart rate. Beta-blockers (BB) are the "medications of choice". Based on physical and physiological considerations, it was hypothesized that BB may actually exacerbate TAAD.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Aneurisma Dissecante/tratamento farmacológico , Contração Miocárdica/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Cardiologia/métodos , Comorbidade , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica , Humanos , Modelos Teóricos , Túnica Íntima/lesões
16.
J Invasive Cardiol ; 31(6): E98-E132, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158808

RESUMO

The International Andreas Gruentzig Society is an educational society of physicians and scientists interested in cardiovascular and related fields. Members cooperate in the advancement of knowledge and education through research, publication, study, and teaching in the fields of cardiovascular disease. This summary reflects the proceedings from the recent scientific meeting to assess current clinical problems and propose future directions and possible solutions.


Assuntos
Cardiologia/métodos , Doenças Cardiovasculares/terapia , Congressos como Assunto , Sociedades Médicas , Humanos
17.
Monaldi Arch Chest Dis ; 89(2)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31107036

RESUMO

We do not always accomplish what is best for our patients. Is "more procedures, more drugs" a real synonym of good and always useful medicine? Probably not. Indeed, it has been highlighted that many tests and treatments, widely used in medical practice, do not bring benefits to patients, but they can be harmful. So, why do we keep performing them? Many reasons, surely one of the main is the constant fear of malpractice legal-medical consequences; this led to the development of a defensive medicine, no longer focused on the health of the patient. For this reason, the Italian Association of Cardiac Prevention and Rehabilitation (GICR-IACPR) joined an international project "Choosing Wisely", supported by the Slow Medicine Initiative, a network which states that "Less is more". The purpose of "Choosing Wisely " project is to improve the quality and safety of health services through the reduction of practices that, according to available scientific knowledge, do not bring significant benefits to the patients, but can, on the contrary, expose them to risks. This GICR-IACPR paper proposes to avoid five widespread practices in cardiology, at risk for inappropriateness and lacking of clinical evidence of benefit: • Do not perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery • Do not perform Computed Tomography for coronary calcium score in patients at high cardiovascular risk • Do not perform Holter electrocardiographic monitoring in patients suffering from syncope, near syncope or dizziness, in whom a non-arrhythmic origin has been documented • Do not routinely prescribe proton pump inhibitors (PPI) for gastrointestinal bleeding prophylaxis in patient with single drug antiplatelet therapy in absence of additional risk factors. • Avoid routine use of infective endocarditis prophylaxis in mild to moderate native valve disease.


Assuntos
Cardiologia/métodos , Cardiologia/normas , Endocardite/prevenção & controle , Hemorragia Gastrointestinal/prevenção & controle , Melhoria de Qualidade , Procedimentos Desnecessários , Anti-Infecciosos/uso terapêutico , Reabilitação Cardíaca , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia Ambulatorial , Endocardite/etiologia , Hemorragia Gastrointestinal/induzido quimicamente , Doenças das Valvas Cardíacas/complicações , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Bomba de Prótons/uso terapêutico , Radiografia Torácica , Fatores de Risco , Síncope/etiologia , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagem
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