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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(4): 483-488, 2019 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-31642223

RESUMO

OBJECTIVE: To study the application value of motion-correction phase sensitive inversion recovery (MOCO-PSIR) to evaluate myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy (DCM). METHODS: A prospective study included 60 patients who underwent cardiac MRI enhanced scan from June 2017 to November 2018, including 38 patients who were clinically diagnosed with DCM and 22 patients in the normal control group. All patients were scanned with three late gadolinium enhancement (LGE) sequences: segmented-PSIR, single-shot-PSIR, MOCO-PSIR at the same time. The subjective quality score (level 4) and image signal-to-noise ratio (objective evaluation) of normal and abnormal myocardium were analyzed and compared in three scanning technique groups. The detection rate of myocardial fibrosis and image acquisition time of the three scanning techniques were recorded. RESULTS: In the normal control group (sinus rhythm), subjective score showed no statistical significance. Subjective scoring results in the patients with DCM: MOCO-PSIR>single-shot-PSIR> segmented-PSIR (P < 0.05). SNR results PSIR-LGE images in DCM patients as well as control group: segmented-PSIR>MOCO-PSIR> single-shot-PSIR (P < 0.05). In the whole 646 segments analysis of DCM patients, the ratio unable to judge in segmented-PSIR was up to 25.5%, but only 1.4% in MOCO-PSIR. Significant difference was found in the three groups. While in the 374 segments of control group, no statistical difference was found in comparison of incapability to judge. Acquisition time covered left ventricular: (5.6±1.7) min in segmented-PSIR, (0.4±0.2) min in single-shot-PSIR and (4.5±1.1) min in MOCO-PSIR. Pairwise comparison of acquisition time among three scanning techniques was statistically significant (P < 0.001). CONCLUSION: MOCO-PSIR-LGE has better clinical significance than conventional delayed enhanced scan sequences in the diagnosis of myocardial fibrosis in the patients with heart failure caused by dilated cardiomyopathy.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Imagem por Ressonância Magnética , Miocárdio/patologia , Estudos de Casos e Controles , Meios de Contraste , Fibrose , Gadolínio , Humanos , Aumento da Imagem , Estudos Prospectivos
2.
Int Heart J ; 60(5): 1201-1205, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484869

RESUMO

Right-sided accessary pathways in patients with Wolff-Parkinson-White (WPW) syndrome may cause cardiac dyssynchrony and dilated cardiomyopathy, with a characteristic septal shape, irrespective of any supraventricular tachycardia episodes. We report on two infants (13 and 5 months), whose right-sided accessary pathway-induced dilated cardiomyopathy was successfully treated by flecainide for the first time. After the flecainide administration, an abnormal aneurysmal dilation of the basal interventricular septum was almost restored to normal, and the decreased ejection fraction recovered. Flecainide use may be an important therapeutic option for this entity to avoid catheter ablation during infancy.


Assuntos
Feixe Acessório Atrioventricular/diagnóstico por imagem , Feixe Acessório Atrioventricular/tratamento farmacológico , Cardiomiopatia Dilatada/diagnóstico por imagem , Flecainida/uso terapêutico , Síndrome de Wolff-Parkinson-White/diagnóstico por imagem , Feixe Acessório Atrioventricular/complicações , Cardiomiopatia Dilatada/tratamento farmacológico , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/terapia , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Lactente , Injeções Intravenosas , Masculino , Medição de Risco , Amostragem , Resultado do Tratamento , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/fisiopatologia
3.
Pediatr Cardiol ; 40(6): 1317-1319, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240369

RESUMO

Pulmonary artery banding may benefit infants with dilated cardiomyopathy. We present the case of an infant with end-stage dilated cardiomyopathy and intractable heart failure who received pulmonary artery banding. Serial follow-up through two-dimensional and three-dimensional echocardiography revealed gradual improvement in the left ventricular ejection fraction and favorable remodeling. The result of three-dimensional speckle tracking suggested that this benefit is associated with improvements in global strain and intraventricular dyssynchrony.


Assuntos
Ecocardiografia Tridimensional/métodos , Artéria Pulmonar/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Feminino , Insuficiência Cardíaca/complicações , Humanos , Lactente , Cuidados Paliativos/métodos , Artéria Pulmonar/cirurgia , Disfunção Ventricular Esquerda/diagnóstico por imagem
4.
JNMA J Nepal Med Assoc ; 57(215): 33-36, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080243

RESUMO

INTRODUCTION: Cardiomyopathies are diseases of heart muscle that may originate from genetic defects, cardiac myocyte injury or infiltration of myocardial tissues. Dilated cardiomyopathy is the most common phenotype and is often a final common pathway of numerous cardiac insults. Mostly it remains unknown in the absence of echocardiography, histopathology and genetic evaluation. Though common it is underdiagnosed with not much of data available in our setup. METHODS: This study was analytical cross-sectional study of hospital data on Echocardiographic findings in 65 patients of DCM visiting cardiology unit for Echocardiographic evaluation from 1st of February to 31st July 2018 for the period of six months in Shree Birendra Hospital, a tertiary care military hospital at Chhauni, Kathmandu. Pediatric age group patients and those who refused to give consent were excluded. Data obtained were entered in Microsoft Excel 2010 and analyzed by IBM SPSS 21. RESULTS: Among 65 patients enrolled 40 (61%) were male and 25 (39%) female with male to female ratio of 1.6:1. Elderly people (61-75 years) with an average age of 65 were commonly involved and they presented mostly with congestive heart failure, 32 (49%). Echocardiographic evaluation showed 36 (55%) with mildly dilated Left Ventricle (5.6-6.0cm). Majority had reduced Left ventricular systolic function with an average Ejection fraction (EF) of 39.6%. No significant difference between male and female with the average EF% (P=0.990) and there was no significant relation between age and average EF% (P=0.091). CONCLUSIONS: Dilated Cardiomyopathy is the commonest cardiomyopathy phenotype mostly presenting with congestive heart failure. It is often underdiagnosed in our part of the world, however echocardiography will easily detect the condition.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia/métodos , Insuficiência Cardíaca/epidemiologia , Volume Sistólico/fisiologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal , Centros de Atenção Terciária , Disfunção Ventricular Esquerda/epidemiologia
5.
Ter Arkh ; 91(4): 28-36, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31094473

RESUMO

AIM: to assess the diagnostic meaning of cardiac magnetic resonance imaging (CMR) in various clinical forms of myocarditis. MATERIALS AND METHODS: 11 (8 men, mean age 32.8±11.1 years) patients (pts), hospitalized with suspected acute coronary syndrome, while an acute myocardial infarction was excluded during the examination (group I); 48 pts (31 men, 43.1±12.7 years), with clinical and instrumental signs of dilated cardiomyopathy (DCM) - group II; and 20 patients (12 men, 39.5±14 years), with episodes of ventricular tachycardia (group III) underwent cardiac magnetic resonance imaging (CMRI). In 38 patients endomyocardial biopsy (EMB) was performed. RESULTS: According to EMB, signs of active myocarditis were revealed in 10 (34.5%) group II pts and in 3 (37.5%) group III pts; signs of resolved myocarditis - in 8 (27.6%) patients in group II and in 3 (37.5%); minimal morphological changes - in 11 (37.9%) patients of group II and in 2 (25%) patients of group III. In 9 (81.9%) patients of group I MRI data allowed to establish the diagnosis of acute myocarditis. Signs of active inflammation from MRI data were detected in myocardium 5 (10.4%) in group II pts and 7 (35%) in group III pts. In 22 (45.8%) pts in group II and 10 (50%), CMR data corresponded to the picture of resolved myocarditis. In 21 (43.8%) cases of group II and 3 (15%) of group III, MRI revealed minimal structural changes. In pts with clinical and instrumental signs of DCM and/or ventricular tachycardia MRI allows to identify signs of "active myocarditis" with a sensitivity of 37.5% with a specificity of 83.4%. At the same time, in cases of resolved myocarditis and minimal morphological changes MRI has high sensitivity (70 and 71.5%) and specificity (71.5 and 75%, respectively). CONCLUSION: CMR has high diagnostic significance in patients with infarct-like course of myocarditis. In patients with clinical syndrome of dilated cardiomyopathy or arrhythmias, the sensitivity of MRI in detecting active myocarditis is low (37.5%) with high specificity (83.4%). In cases of minimal structural changes in the myocardium and resolved inflammation, CMR is a good alternative to EMB.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Adulto , Biópsia , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Miocárdio , Adulto Jovem
6.
Minerva Cardioangiol ; 67(4): 261-271, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31115242

RESUMO

BACKGROUND: Since left ventricular reverse remodeling (LVRR) and sphericity index (SI) are correlated with DCM patients' survival, we attempted to establish the relationship between LVRR, SI and left ventricle (LV) dimensions. METHODS: In 70 DCM patients, we measured EF, LV transverse (sLVd) and longitudinal (lLVd) diameters at hospital admission, then after 3 and 12 months. SI was assessed thus: SI=sLVd/lLVd. RESULTS: LVRR was present in 32 patients (52%). SI measurements were similar in LVRR-present and -absent groups at baseline (0.71 vs. 0.70) and differed after 3 and 12 months (0.61 vs. 0.72, P<0.005; 0.59 vs. 0.73, P<0.001; respectively). During 12 months, SI and sLVd decreased in the LVRR-present (0.71 vs. 0.61 vs. 0.59, P<0.05; 5.75 vs. 5.00 vs. 4.82 cm, P<0.001; respectively) and increased in the LVRR-absent cohort (0.70 vs. 0.72 vs. 0.73, P<0.001; 6.01 vs. 6.15 vs. 6.67, P<0.001; respectively). lLVd remained stable (8.23 vs. 8.16 vs. 8.38cm; 8.66 vs. 8.85 vs. 9.13 cm; respectively). SI was significantly correlated with sLVd but not with lLVd. At 3-month follow-up, SI (P<0.005, OR=14000 [95% CI: 5 - 3.9*107]) was found to be a significant LVRR predictor via univariate logistic regression. CONCLUSIONS: To summarize, changes in sLVd are crucial for changes in LV geometry, whereas lLVd has a negligible effect on this process. The presence of LVRR was not always associated with an improvement in SI and its absence with increase in SI. Since the assessment of SI is less complex than LVRR, SI as a significant LVRR predictor can be useful part of a regular echocardiography examination.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular/fisiologia , Adulto , Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/diagnóstico por imagem
7.
Prog Cardiovasc Dis ; 62(3): 249-255, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31004606

RESUMO

The implantable cardioverter-defibrillator (ICD) has been successfully treating patients with lethal ventricular arrhythmias for decades. The main acute and chronic complications of this therapy modality are related to the use of a transvenous lead. An entirely extravascular ICD concept was developed over the last 20 years, with emergence of the subcutaneous ICD (S-ICD). This device was approved for clinical use seven years ago, and accumulating real-life experience confirms its safety and efficacy. The main limitations related to this system include the lack of pacing capabilities for bradycardia, tachycardia or resynchronization therapy, a large size, and relatively high energy requirements for effective defibrillation. This review article summarizes current knowledge and potential future developments of the extravascular ICD technologies.


Assuntos
Desfibriladores Implantáveis , Algoritmos , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/terapia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Masculino , Desenho de Prótese , Radiografia
9.
Echocardiography ; 36(4): 702-706, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30868655

RESUMO

BACKGROUND: The differentiation between dilated cardiomyopathy (DCM) and systolic dysfunction caused by coronary artery disease (CAD) based on clinical and echocardiographic presentation can be difficult in some cases. AIM: Our study aimed to define differences in myocardial function between patients with ischemic and nonischemic etiology of reduced left ventricular ejection fraction using 2D speckle tracking echocardiography (STE). MATERIAL AND METHODS: We retrospectively analyzed 90 patients (mean age 65 ± 11 years, 70% male) with de novo diagnosed reduced left ventricular ejection fraction (≤45% as determined by the transthoracic echocardiography), who were referred for coronary angiography to determine the presence of significant CAD. On the basis of coronary angiography results, patients were divided into two subgroups as follows: 45 subjects with significant CAD (group A) and 45 subjects without CAD (group B). Acquired transthoracic echocardiographic images were assessed off-line using 2DSTE. In each patient, we calculated arithmetic mean, median value, and standard deviation of regional longitudinal strain and strain rate of 18 left ventricular segments. RESULTS: Standard deviation of the regional peak early diastolic strain rate was significantly higher in group A than in group B (P = 0.01). The cutoff value with the highest diagnostic value was >0.37/s-its sensitivity and specificity for the diagnosis of CAD were 73% and 53%, respectively. The remaining parameters did not differ significantly between the study groups. CONCLUSIONS: Patients with systolic dysfunction resulting from CAD have significantly more heterogeneous regional longitudinal early diastolic strain rate assessed by 2DSTE than patients with DCM.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/fisiopatologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Diagnóstico Diferencial , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
10.
Molecules ; 24(6)2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30917606

RESUMO

The genetic modification of the mouse genome using the cre-lox system has been an invaluable tool in deciphering gene and protein function in a temporal and/or spatial manner. However, it has its pitfalls, as researchers have shown that the unregulated expression of cre recombinase can cause DNA damage, the consequences of which can be very detrimental to mouse health. Previously published literature on the most utilized cardiac-specific cre, αMHC-cre, mouse model exhibited a nonlethal hypertrophic cardiomyopathy (HCM) with aging. However, using the same αMHC-cre mice, we observed a cardiac pathology, resulting in complete lethality by 11 months of age. Echocardiography and histology revealed that the αMHC-cre mice were displaying symptoms of dilated cardiomyopathy (DCM) by seven months of age, which ultimately led to their demise in the absence of any HCM at any age. Molecular analysis showed that this phenotype was associated with the DNA damage response through the downregulation of activated p38 and increased expression of JNK, p53, and Bax, known inducers of myocyte death resulting in fibrosis. Our data urges strong caution when interpreting the phenotypic impact of gene responses using αMHC-cre mice, since a lethal DCM was induced by the cre driver in an age-dependent manner in this commonly utilized model system.


Assuntos
Envelhecimento/genética , Cardiomiopatia Dilatada/diagnóstico por imagem , Integrases/metabolismo , Cadeias Pesadas de Miosina/genética , Envelhecimento/metabolismo , Animais , Cardiomiopatia Dilatada/genética , Cardiomiopatia Dilatada/metabolismo , Dano ao DNA , Modelos Animais de Doenças , Ecocardiografia , Regulação da Expressão Gênica , Genes Letais , Integrases/genética , Camundongos , Cadeias Pesadas de Miosina/metabolismo , Fenótipo
11.
Ann Thorac Surg ; 108(3): e149-e151, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30853589

RESUMO

Implantation of the HeartMate 3 (HM3) left ventricular assist device (Abbott Laboratories, Lake Bluff, IL) continues to increase as the results of European and U.S. clinical trials become available. Although the large trials adequately capture the more common and expected outcomes, rare and unexpected clinical complications will continue to appear with higher volumes of implantation. This report describes a rare complication of severe refractory postural dizziness and syncope after successful implantation of an HM3 in a patient who ultimately required pump exchange to a HeartWare HVAD (HeartWare, Framingham, MA) for resolution of symptoms.


Assuntos
Cardiomiopatia Dilatada/complicações , Angiografia por Tomografia Computadorizada , Coração Auxiliar/efeitos adversos , Reoperação/métodos , Disfunção Ventricular Esquerda/cirurgia , Baixo Débito Cardíaco/diagnóstico , Cardiomiopatia Dilatada/diagnóstico por imagem , Remoção de Dispositivo , Tontura/diagnóstico , Tontura/etiologia , Ecocardiografia/métodos , Falha de Equipamento , Seguimentos , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Índice de Gravidade de Doença , Síncope/diagnóstico , Síncope/etiologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia
12.
Ann Thorac Surg ; 108(3): e153-e155, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30853593

RESUMO

A 58-year-old woman had medically refractory heart failure due to idiopathic dilated cardiomyopathy. She underwent tricuspid repair and left ventricular assist device implantation for inotropic-dependent heart failure. Because of severe right ventricular dysfunction, she experienced progressive bradycardia and ventricular asystole with electrocardiographic and echocardiographic standstill. Despite the lack of native cardiac activity, she maintained end-organ perfusion with inotropic support until she underwent successful transplantation. This report highlights a case of mechanical circulatory support with an isolated left ventricular assist device implantation even in the absence of native right ventricular function.


Assuntos
Cardiotônicos/uso terapêutico , Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Coração Auxiliar , Implantação de Prótese/efeitos adversos , Disfunção Ventricular Direita/diagnóstico por imagem , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/tratamento farmacológico , Progressão da Doença , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Sobrevivência de Enxerto , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Pessoa de Meia-Idade , Prognóstico , Implantação de Prótese/métodos , Medição de Risco , Falha de Tratamento , Resultado do Tratamento , Disfunção Ventricular Direita/cirurgia
13.
Circ Heart Fail ; 12(3): e005700, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30871348

RESUMO

Background As pathogenic variants in the gene for RBM20 appear with a frequency of 6% among Danish patients with dilated cardiomyopathy (DCM), it was the aim to investigate the associated disease expression in affected families. Methods and Results Clinical investigations were routinely performed in DCM index-patients and their relatives. In addition, ≥76 recognized and likely DCM-genes were investigated. DNA-sequence-variants within RBM20 were considered suitable for genetic testing when they fulfilled the criteria of (1) being pathogenic according to the American College of Medical Genetics and Genomics-classification, (2) appeared with an allele frequency of <1:10.000, and (3) segregated with DCM in ≥7 affected individuals. A total of 80 individuals from 15 families carried 5 different pathogenic RBM20-variants considered suitable for genetic testing. The penetrance was 66% (53/80) and age-dependent. Males were both significantly younger and had lower ejection fraction at diagnosis than females (age, 29±11 versus 48±12 years; P<0.01; ejection fraction, 29±13% versus 38±9%; P<0.01). Furthermore, 11 of 31 affected males needed a cardiac transplant while none of 22 affected females required this treatment ( P<0.001). Thirty percent of RBM20-carriers with DCM died suddenly or experienced severe ventricular arrhythmias although no adverse events were identified among healthy RBM20-carriers with a normal cardiac investigation. The event-free survival of male RBM20-carriers was significantly shorter compared with female carriers ( P<0.001). Conclusions The disease expression associated with pathogenic RBM20-variants was severe especially in males. The findings of the current study suggested that close clinical follow-up of RBM20-carriers is important which may ensure early detection of disease development and thereby improve management.


Assuntos
Cardiomiopatia Dilatada/genética , Proteínas de Ligação a RNA/genética , Adolescente , Adulto , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Mutação de Sentido Incorreto , Fenótipo , Fatores Sexuais , Adulto Jovem
15.
Echocardiography ; 36(3): 558-566, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30726568

RESUMO

OBJECTIVES: The purpose of this study was to investigate the relationship between the vortex in left ventricle (LV) during the isovolumic contraction (IVC) period and the preejectional flow velocity in LV outflow tract (VLVOT ). METHODS: Color Doppler loops were acquired for vector flow mapping in apical long-axis view in 76 patients with dilated cardiomyopathy, 61 patients with coronary artery disease and 36 healthy controls. RESULTS: All normals exhibited an IVC vortex reaching the LV base. VLVOT was significantly related to IVC vortex area flux, transmitral A velocity, mitral annular a' velocity and E/e' ratio, respectively. Transmitral A velocity was the only independent predictor of VLVOT (R2  = 0.292, P = 0.001). In patients the IVC vortex could reach the LV base, middle, or apex. VLVOT was significantly related to range, area and area flux of the IVC vortex, LV size, LVEF, mitral annular velocities, E/e' ratio, transmitral A velocity, and IVC time, respectively. Range and corrected area flux of the IVC vortex, LV end-systolic short diameter, and IVC time were independent predictors of VLVOT (R2  = 0.608, P < 0.001). CONCLUSIONS: In normals, the transmitral A velocity (momentum) is efficiently transferred from mitral orifice to LV outflow tract by a normally formed IVC vortex, and transmitral A velocity is the only independent predictor of VLVOT . However, in patients with a wide range of LV enlargement and dysfunction, the momentum transfer is associated with not only the LV dimension and function, but also the range and volume of the IVC vortex.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia Doppler em Cores/métodos , Contração Miocárdica/fisiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo/fisiologia , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/fisiopatologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Adulto Jovem
16.
Pediatr Emerg Care ; 35(7): 516-518, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30702648

RESUMO

Anomalous left coronary artery from the pulmonary artery is a rare cause of dilated cardiomyopathy. We present the first reported case of anomalous left coronary artery from the pulmonary artery diagnosed by point-of-care ultrasound, leading to expedited management, stabilization, and eventual treatment.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Artéria Pulmonar/anormalidades , Ultrassonografia , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/fisiopatologia , Feminino , Humanos , Lactente , Contração Miocárdica , Sistemas Automatizados de Assistência Junto ao Leito , Insuficiência Respiratória/etiologia
17.
J Vet Cardiol ; 21: 1-9, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30797439

RESUMO

INTRODUCTION: Canine dilated cardiomyopathy (DCM) can result from numerous etiologies including genetic mutations, infections, toxins, and nutritional imbalances. This study sought to characterize differences in echocardiographic findings between dogs with DCM fed grain-free (GF) diets and grain-based (GB) diets. ANIMALS: Forty-eight dogs with DCM and known diet history. METHODS: This was a retrospective analysis of dogs with DCM from January 1, 2015 to May 1, 2018 with a known diet history. Dogs were grouped by diet (GF and GB), and the GF group was further divided into dogs eating the most common grain-free diet (GF-1) and other grain-free diets (GF-o). Demographics, diet history, echocardiographic parameters, taurine concentrations, and vertebral heart scale were compared between GB, all GF, GF-1, and GF-o groups at diagnosis and recheck. RESULTS: Dogs eating GF-1 weighed less than GB and GF-o dogs, but age and sex were not different between groups. Left ventricular size in diastole and systole was greater, and sphericity index was less for GF-1 compared with GB dogs. Diastolic left ventricular size was greater for all GF compared with that of GB dogs. Fractional shortening, left atrial size, and vertebral heart scale were not different between groups. Taurine deficiency was not identified in GF dogs, and presence of congestive heart failure was not different between groups. Seven dogs that were reevaluated after diet change (6 received taurine supplementation) had clinical and echocardiographic improvement. CONCLUSIONS: Dietary-associated DCM occurs with some GF diets and can improve with nutritional management, including diet change. The role of taurine supplementation, even without deficiency, is uncertain.


Assuntos
Cardiomiopatia Dilatada/veterinária , Dieta/veterinária , Doenças do Cão/diagnóstico por imagem , Animais , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/patologia , Dieta/efeitos adversos , Doenças do Cão/patologia , Cães , Ecocardiografia/veterinária , Grão Comestível/efeitos adversos , Feminino , Masculino , Fenótipo
18.
J Vet Cardiol ; 21: 28-33, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30797442

RESUMO

A two-month-old Red Angus heifer calf presented to the University of Wisconsin Veterinary Care for evaluation of suspected severe bronchopneumonia. Pertinent physical exam findings included tachycardia, tachypnea, dyspnea with a significant abdominal component, and cyanotic mucous membranes. On thoracic auscultation, wheezes were present bilaterally, as well as a grade 2/6 right apical systolic murmur. Thoracic radiographs revealed cardiomegaly, most severely affecting the right side. Echocardiography showed tricuspid valve dysplasia, resulting in severe tricuspid regurgitation and right-heart dilation, as well as a patent foramen ovale. A postmortem examination confirmed the presence of the aforementioned cardiac abnormalities and revealed only mild pulmonary changes. This case report is the first to describe tricuspid dysplasia in the absence of multiple, complex congenital cardiac abnormalities in a calf, and it highlights the value of echocardiography for an antemortem diagnosis.


Assuntos
Cardiomiopatia Dilatada/veterinária , Doenças dos Bovinos/patologia , Forame Oval Patente/veterinária , Insuficiência da Valva Tricúspide/veterinária , Animais , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/etiologia , Bovinos , Doenças dos Bovinos/diagnóstico , Doenças dos Bovinos/diagnóstico por imagem , Ecocardiografia/veterinária , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Radiografia Torácica/veterinária , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
19.
Int J Cardiol ; 280: 124-129, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30679073

RESUMO

BACKGROUND: Presence of myocardial fibrosis in well-established non-ischaemic dilated cardiomyopathy (NIDCM) is associated with adverse clinical outcomes. However, the impact of myocardial fibrosis at first presentation in NIDCM, and its long-term association with left ventricular (LV) dysfunction, heart failure (HF) and ventricular arrhythmia (VA) remains unclear. We investigated whether the presence of myocardial fibrosis quantified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) at presentation, is independently associated with long-term major adverse cardiovascular events (MACE) in patients with first presentation NIDCM. METHODS: Consecutive patients with a first diagnosis of NIDCM were recruited. Patients underwent LGE-CMR at baseline. Replacement myocardial fibrosis by LGE-CMR was quantified by experienced observers blinded to patient outcome. MACE was defined as a composite end-point including cardiac death, HF rehospitalisation and the occurrence of sustained VA. RESULTS: Fifty-one patients with first presentation NIDCM were included, of which 49 (96%) had follow up and outcome data. Median follow up was 8.2 years. Both the LGE positive and LGE negative groups had similar clinical characteristics at follow up. In univariate Cox regression analysis, positive LGE was associated with MACE (HR:3.44; 95% CI:1.89 to 6.24, p-value < 0.001) and HF rehospitalisation (HR:2.89; 95% CI:1.42 to 5.85, p-value = 0.003). In multivariate Cox regression, positive LGE-CMR was independently associated with MACE (HR:3.53; 95% CI:1.51 to 8.27, p-value = 0.004) and HF rehospitalisation (HR:3.07; 95% CI:1.24 to 7.59, p-value = 0.015). CONCLUSIONS: The presence of myocardial fibrosis in first presentation NIDCM is independently associated with an increased risk of HF rehospitalisation, at long term follow-up.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/terapia , Gadolínio , Imagem Cinética por Ressonância Magnética/métodos , Idoso , Cardiomiopatia Dilatada/fisiopatologia , Feminino , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/tendências , Prognóstico , Fatores de Tempo
20.
J Vet Diagn Invest ; 31(2): 289-293, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30694111

RESUMO

Dilated cardiomyopathy (DCM) is a myocardial disease characterized by ventricular chamber dilation associated with systolic myocardial dysfunction in the absence of other cardiac lesions. DCM occasionally develops in conjunction with proliferation of fibroelastic fibers in the endocardium, producing endocardial fibroelastosis (EFE). Although early reports describe EFE as a primary disease, evidence now suggests that EFE may develop as a response to myocardial dysfunction. Echocardiographic evaluation of a 4-wk-old Pallas cat ( Otocolobus manul) with respiratory distress revealed enlargement of both atria, enlarged end-systolic left ventricular dimension, and left ventricular dilation. DCM was diagnosed, and the cat was euthanized, given the poor prognosis. Postmortem examination revealed pericardial effusion and biventricular and biatrial enlargement. The interventricular septum and free walls of ventricles were thin. Histologically, the endocardium of the left and right ventricles was diffusely thickened; Verhoeff-Van Gieson staining of the left ventricular endocardium revealed a moderate amount of endocardial accumulation of elastin and collagen. These fibers were more prominent in papillary muscles and around coronary blood vessels. Based on these findings, we diagnosed DCM with EFE. Cardiac diseases are rarely diagnosed in wild felids.


Assuntos
Cardiomiopatia Dilatada/veterinária , Fibroelastose Endocárdica/veterinária , Felidae , Animais , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/etiologia , Ecocardiografia/veterinária , Fibroelastose Endocárdica/diagnóstico , Fibroelastose Endocárdica/diagnóstico por imagem , Fibroelastose Endocárdica/etiologia , Feminino
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