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1.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 36(12): 1167-1170, 2019 Dec 10.
Artigo em Chinês | MEDLINE | ID: mdl-31813139

RESUMO

OBJECTIVE: To study the prevalence, clinical and genetic characteristics of primary carnitine deficiency (PCD). METHODS: From January 2013 to December 2017, 720 667 newborns and their mothers were tested for PCD by tandem mass spectrometry. Potential mutations of carnitine transporter gene SLC22A5 among suspected PCD patients were analyzed. Dietary guidance and L-carnitine supplementation were provided to the parents. Growth and intelligence development were surveyed during follow-up. RESULTS: In total 21 neonates and 6 mothers were diagnosed with PCD, which yielded an incidence of 1 in 34 317. Eighteen SLC22A5 mutations were detected, which included 4 novel mutations, namely c.1484T>C, c.394-1G>T, c.431T>C and c.265-266insGGCTCGCCACC. Eighteen patients were found to carry compound heterozygous mutations and 3 have carried homozygous SLC22A5 mutations. Three mothers carried compound heterozygous mutations and 2 carried homozygous mutations. Common mutations included c.1400C>G (42.3%), c.760C>T (11.5%) and c.51C>G (7.7%). During the 8-42 month follow-up, neonates with PCD showed no clinical symptoms but normal growth. Blood level of free carnitine was raised in all mothers after the treatment. CONCLUSION: The incidence of neonatal PCD in Henan is 1 in 34 317, with the most common mutation being c.1400C>G. Above finding has enriched the spectrum of SLC22A5 gene mutations.


Assuntos
Cardiomiopatias/genética , Carnitina/deficiência , Hiperamonemia/genética , Doenças Musculares/genética , Membro 5 da Família 22 de Carreadores de Soluto/genética , Cardiomiopatias/epidemiologia , Carnitina/administração & dosagem , Carnitina/genética , China , Feminino , Humanos , Hiperamonemia/epidemiologia , Recém-Nascido , Doenças Musculares/epidemiologia , Mutação , Triagem Neonatal
2.
Medicine (Baltimore) ; 98(44): e17548, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689756

RESUMO

BACKGROUND: The incidence of atrial fibrillation (AF) varies from 5.4% to 47.1% in patients with mitral annulus calcification (MAC). We conducted a systematic review and meta-analysis on the association between MAC and AF, as well as the relation between MAC and major cardiac adverse events (MACEs) in AF patients. METHODS: We conducted comprehensive search for literature on associations between MAC and AF using the following databases: MEDLINE, PubMed, Embase, and the Web of Science. The pooled odds ratio (OR) or relative risk and the corresponding 95% confidence intervals (CIs) were calculated to assess the relationship between MAC and AF, as well as the rates of MACEs in AF patients with or without MAC. RESULTS: Thirteen studies met our eligibility criteria on associations between MAC and AF, including 6232 patients with MAC and 15,199 patients without MAC. Moreover, 5 studies met our eligibility criteria on the rates of MACEs in AF patients with or without MAC. The pooled analysis demonstrated a statistically significant increased risk of development of incident AF in patients with MAC than those without MAC (random effects OR: 2.34; 95% CI: 1.91, 2.85; P = .000). And the pooled analysis demonstrated a statistically significant increased risk of development of MACEs in AF patients with MAC (random effects OR: 2.34; 95% CI: 1.24, 4.41; P = .009). CONCLUSION: MAC was independently associated with AF and AF patients with MAC were at greater risk for cardiovascular and cerebrovascular events.


Assuntos
Fibrilação Atrial/epidemiologia , Calcinose/epidemiologia , Cardiomiopatias/epidemiologia , Valva Mitral/patologia , Fatores Etários , Doenças Cardiovasculares/epidemiologia , Humanos , Razão de Chances , Fatores de Risco , Fatores Sexuais
3.
Cardiol Clin ; 37(4): 407-418, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587782

RESUMO

Trastuzumab targets the human epidermal growth factor receptor 2 (HER2). Its overexpression occurs in 25% of breast cancers and is associated with aggressive tumor characteristics and poor prognosis in absence of targeted therapy. Trastuzumab dramatically improves HER2-positive breast cancer outcomes; however, its clinical use is associated with left ventricular dysfunction and heart failure. Patients receiving trastuzumab or other HER2-targeted therapies undergo routine cardiac function assessment. Holding and/or stopping trastuzumab treatment in the setting of left ventricular dysfunction is recommended. This article summarizes the role of trastuzumab in cancer treatment, the mechanisms of trastuzumab-induced cardiotoxicity, recent clinical investigations, and current controversies.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Cardiomiopatias/induzido quimicamente , Trastuzumab/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Cardiomiopatias/epidemiologia , Cardiotoxicidade , Feminino , Saúde Global , Humanos , Incidência
4.
Arch Cardiovasc Dis ; 112(10): 615-629, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607558

RESUMO

Multimodality imaging plays an important role in the initial evaluation, diagnosis and management of patients suspected of having a cardiomyopathy. Beyond functional and anatomical information, multimodality imaging provides important variables that facilitate risk stratification and prognosis evaluation. Whatever the underlying suspected cardiomyopathy, echocardiography is the most common initial imaging test used to establish the presence of cardiomyopathy, by depicting structural and functional abnormalities. However, echocardiographic findings are non-specific, and therefore have a limited role in identifying the underlying aetiology. Cardiac magnetic resonance imaging allows characterization of myocardial tissue, which can be of great help in identifying the aetiology of the cardiomyopathy. When a specific aetiology is suspected, particularly inflammation, 18F-fluorodeoxyglucose positron emission tomography is recommended. The clinician should be capable of selecting the appropriate imaging techniques for each clinical scenario. Each technique has strengths and weaknesses, which should be known. In order to improve diagnostic performance, and as proposed by the European Association for Cardiovascular Imaging, cardiovascular imaging groups must be composed of experts from all modalities. The future of multimodality imaging in the diagnosis and management of cardiomyopathies will also involve evolution of its use in care, teaching and research. Training goals for future cardiac imaging experts must be defined; academic and industry partnerships should enable the connection to be made between imaging data and clinical data on the one hand and outcomes on the other hand, using big-data analysis and artificial intelligence.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Imagem Multimodal/métodos , Cardiomiopatias/epidemiologia , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Humanos , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco
5.
Pregnancy Hypertens ; 17: 82-88, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487662

RESUMO

BACKGROUND: Peripartum cardiomyopathy (PPCM) and preeclampsia are strongly associated, yet a description of risk factors for PPCM among women with preeclampsia is currently lacking. Additionally, the effect of preeclampsia on PPCM-related outcomes is not well known. METHODS: We constructed a cohort of delivery admissions from 2011 to 2014 using a large US administrative database (Marketscan). We assessed risk factors for the development of PPCM among women with preeclampsia. We compared the risks of major adverse cardiovascular events (MACE) at 6 months between PPCM with co-incident preeclampsia (pePPCM) and PPCM without preeclampsia (npePPCM). RESULTS: We included 1,024,035 pregnancies, of which 64,503 (6.3%) had preeclampsia. A total of 874 had PPCM (283 with preeclampsia and 591 without preeclampsia). Among women with preeclampsia, clinical risk factors for PPCM consisted in chronic kidney disease (OR 3.18, 95% CI [1.51, 6.69]), multiple pregnancy (OR 2.11, 95% CI [1.49, 2.98]), chronic hypertension (OR 1.88, 95% CI [1.43, 2.47]), advanced maternal age (OR 1.82, 95% CI [1.42, 2.33]), and type 2 diabetes (OR 1.58, 95% CI [1.00, 2.48]). Women with pePPCM had a higher risk of MACE than women with npePPCM (adjusted RR 1.29, 95% CI [1.06, 1.57]) due to increased rates of clinical heart failure and pulmonary embolism in the pePPCM group. Mortality did not differ between groups. CONCLUSION: Preeclamptic women with risk factors for PPCM and women with pePPCM at increased risk of MACE should be followed closely. Further studies are required to determine whether preeclampsia affects the long-term prognosis of women with PPCM.


Assuntos
Cardiomiopatias/epidemiologia , Seguro Saúde , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Cuidado Pré-Natal , Adulto , Cardiomiopatias/complicações , Cardiomiopatias/economia , Estudos de Coortes , Bases de Dados Factuais , Parto Obstétrico , Feminino , Humanos , Período Periparto , Pré-Eclâmpsia/economia , Gravidez , Complicações Cardiovasculares na Gravidez/economia , Fatores de Risco , Estados Unidos/epidemiologia
6.
BMC Res Notes ; 12(1): 491, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391105

RESUMO

OBJECTIVES: The purpose of this study to determine the clinical pattern and prevalence of heart disease in pregnancy at the first established cardio-maternal unit in Iraq over the last 4 years; since January 2015 till May 2019. Data are presented as number and percentage. RESULTS: A total of 252 pregnant women presented to cardio-maternal unit included in this study. According to the collected data, among the main diagnosis of heart disease during pregnancy was valvular heart disease 34.1%, followed by congenital heart disease 30.5%, cardiomyopathy 29.8%, pulmonary hypertension 4%, and ischemic heart disease 1.6%. Among subtypes of the main heart diseases in pregnant women, the most clinical pattern was: the prosthetic heart valve (26.7%) in valvular heart disease, both atrial septal defect and ventricular septal defect (35%) in congenital heart disease, and peripartum cardiomyopathy (76%) among cardiomyopathies.


Assuntos
Cardiomiopatias/epidemiologia , Comunicação Interatrial/epidemiologia , Comunicação Interventricular/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Hipertensão Pulmonar/epidemiologia , Isquemia Miocárdica/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Cardiomiopatias/diagnóstico , Feminino , Comunicação Interatrial/diagnóstico , Comunicação Interatrial/cirurgia , Comunicação Interventricular/diagnóstico , Comunicação Interventricular/cirurgia , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/estatística & dados numéricos , Unidades Hospitalares , Humanos , Hipertensão Pulmonar/diagnóstico , Iraque/epidemiologia , Isquemia Miocárdica/diagnóstico , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/cirurgia , Prevalência
8.
Environ Pollut ; 252(Pt B): 1412-1422, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31260941

RESUMO

Concerning PM2.5 concentrations, rapid industrialization, along with increase in cardiovascular disease (CVD) were recorded in Pakistan, especially in urban areas. The degree to which air pollution contributes to the increase in the burden of CVD in Pakistan has not been assessed due to lack of data. This study aims to describe the characteristics of PM2.5 constituents and investigate the impact of individual PM2.5 constituent on cardiovascular morbidity in Karachi, a mega city in Pakistan. Daily levels of twenty-one constituents of PM2.5 were analyzed using samples collected at two sites from fall 2008 to summer 2009 in Karachi. Hospital admission and emergency room visits due to CVD were collected from two large hospitals. Negative Binominal Regression was used to estimate associations between pollutants and the risk of CVD. All PM2.5 constituents were assessed in single-pollutant models and selected constituents were assessed in multi-pollutant models adjusting for PM2.5 mass and gaseous pollutants. The most common CVD subtypes among our participants were ischemic heart disease, hypertension, heart failure, and cardiomyopathy. Extremely high levels of PM2.5 constituents from fossil-fuels combustion and industrial emissions were observed, with notable peaks in winter. The most consistent associations were found between exposure to nickel (5-14% increase per interquartile range) and cardiovascular hospital admissions. Suggestive evidence was also observed for associations between cardiovascular hospital admissions and Al, Fe, Ti, and nitrate. Our findings suggested that PM2.5 generated from fossil-fuels combustion and road dust resuspension were associated with the increased risk of CVD in Pakistan.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Material Particulado/análise , Adulto , Cardiomiopatias/epidemiologia , Cidades/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Indústrias/estatística & dados numéricos , Isquemia Miocárdica/epidemiologia , Níquel/toxicidade , Paquistão/epidemiologia , Estações do Ano
10.
Neurology ; 93(4): e381-e387, 2019 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31239359

RESUMO

OBJECTIVE: To examine the hypothesis that atrial fibrosis and associated atrial cardiopathy may be in the causal pathway of cardioembolic stroke independently of atrial fibrillation (AF) by comparing atrial fibrosis burden between patients with embolic stroke of undetermined source (ESUS), patients with AF, and healthy controls. METHODS: We used late-gadolinium-enhancement MRI to compare atrial fibrosis in 10 patients with ESUS against 10 controls (no stroke, no AF) and 10 patients with AF. Fibrosis was compared between groups, controlling for stroke risk factors. RESULTS: Mean age was 51 ± 15 years, and 43% of participants were female. Patients with ESUS had more atrial fibrosis than controls (16.8 ± 5.7% vs 10.6 ± 5.7%, p = 0.019) and similar fibrosis compared to patients with AF (17.8 ± 4.8%, p = 0.65). Odds ratios of ESUS per quartile of fibrosis were 3.22 (95% CI [CI] 1.11-9.32, p = 0.031, unadjusted) and 3.17 (95% CI 1.05-9.52, p = 0.041, CHA2DVASc score adjusted). Patients with >12% fibrosis had a higher percentage of ESUS (77.8% vs 27.3%, p = 0.02), and patients with >20% fibrosis had the highest proportion of ESUS (4 of 5). CONCLUSIONS: Patients with ESUS exhibit similar atrial fibrosis compared to patients with AF and more fibrosis than healthy controls. Fibrosis is associated with ESUS after controlling for stroke risk factors, supporting the hypothesis that fibrosis is in the causal pathway of cardioembolic stroke independently of AF. Prospective studies are needed to assess the role of anticoagulation in primary and secondary stroke prevention in patients with high atrial fibrosis.


Assuntos
Fibrilação Atrial/epidemiologia , Cardiomiopatias/epidemiologia , Átrios do Coração/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Miocárdio/patologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Cardiomiopatias/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Fibrose , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
11.
Cardiovasc Pathol ; 42: 30-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31226597

RESUMO

Cardiac amyloidosis in the setting of systemic amyloidosis due to ß2-microglobulin can occur in the setting of long-term dialysis. It has been suggested that newer dialysis techniques may prevent or at least reduce the likelihood of this disorder occurring. Currently, the prevalence and incidence of dialysis-related cardiac ß2-microglobulin amyloidosis are unclear. The published literature regarding dialysis-related cardiac ß2-microglobulin amyloidosis (Aß2M) was reviewed, and a new case of this disorder is reported. The cumulative available data were analyzed for changing patient characteristics over time. Cardiac Aß2M was previously a common condition in patients who had undergone dialysis for 9 or more years with traditional low-flow dialysis membranes. Newer dialysis technologies reduce, but do not normalize, serum ß2-microglobulin levels in chronic dialysis patients. Newer dialysis technologies appear to reduce the risk of developing Aß2M compared with traditional low-flow dialysis membranes. New cases of documented dialysis-related cardiac Aß2M are uncommon. Analysis of the cases of dialysis-related cardiac Aß2M published over the last 3 decades reveals increasing dialysis intervals over time. Thus, new cases of this disorder are typically associated with remote prior dialysis with low-flow membranes. While initially, the majority of cases of dialysis-related cardiac Aß2M were reported from Europe and the United States, more recently, the majority of cases were reported from Japan, where there is a relatively large population of patients on very long-term dialysis. In addition, low-flow dialysis membranes continue to be used in many parts of the world, raising the potential for dialysis-related cardiac Aß2M to be more common in those countries. Dialysis-related osteoarticular Aß2M appears to continue to occur in the setting of chronic dialysis with the use of high-flow membranes. Dialysis-related cardiac Aß2M is currently uncommon and typically associated with the use of low-flow dialysis membranes. However, the condition could potentially occur in the setting of long-term dialysis even with the use of high-flow membranes. SUMMARY: Dialysis-related cardiac ß2-microglobulin amyloidosis frequently occurred in the past in patients who had undergone dialysis for nine or more years. Currently, the condition is uncommon and typically associated with remote prior dialysis with low-flow membranes. There is potential for this condition to continue to afflict patients receiving chronic dialysis with newer dialysis technologies.


Assuntos
Amiloidose/epidemiologia , Amiloidose/patologia , Cardiomiopatias/epidemiologia , Cardiomiopatias/patologia , Miocárdio/patologia , Diálise Renal/efeitos adversos , Microglobulina beta-2/sangue , Idoso , Amiloidose/sangue , Cardiomiopatias/sangue , Humanos , Masculino , Miocárdio/metabolismo , Prognóstico , Fatores de Risco
12.
Am J Cardiol ; 124(2): 262-269, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31109634

RESUMO

Patients with cardiomyopathy are at risk of developing atrial fibrillation (AF) which is a strong risk factor for thromboembolic events, progression to heart failure, and mortality or heart transplantation. This systematic review and meta-analysis sought to estimate the prevalence of AF in a global population with cardiomyopathy. PubMed and EMBASE were searched from inception until June 30, 2017 for published articles on AF and major cardiomyopathies without language restrictions. Eligible papers were independently assessed for methodological qualities. The prevalence of AF in patients with cardiomyopathy was estimated using a random-effect model. The chi-square test on Cochrane's Q statistics was used to evaluate heterogeneity across studies. In total 220 full texts representing a population of 118,668 participants were included in the meta-analysis. The ages of the participants ranged from a median of 31 to 72 years. The proportion of males ranged from 3% to 97%. Considering only cardiomyopathies with more than one contributing study, the prevalence of AF was highest in participants with dilated (24% [95% confidence interval: 21 to 28]), ischemic (20% [8 to 35]), and hypertrophic (19% [17 to 21]) cardiomyopathies, and lowest in patients with peripartum cardiomyopathies (5% [1 to 11]). In conclusion, with the exception of peripartum cardiomyopathy, an average of 1 to 2 in every 10 patients with a cardiomyopathy had AF, with no gender difference. Future guidelines need to take into consideration the management of AF in all the forms of cardiomyopathy.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Cardiomiopatias/complicações , Cardiomiopatias/epidemiologia , Progressão da Doença , Humanos , Incidência , Prevalência , Fatores de Risco
13.
Indian J Gastroenterol ; 38(2): 150-157, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31115783

RESUMO

BACKGROUND: There are scanty data from India on the prevalence and clinical profile of cirrhotic cardiomyopathy (CCM). AIM: To identify the prevalence and clinical presentation of CCM in patients with liver cirrhosis. METHODS: Five hundred and eighty-six patients with liver cirrhosis were recruited based on inclusion criteria and evaluated for cardiac parameters using electrocardiography, 2-dimensional echocardiography, dobutamine stress test and coronary angiography as needed. Baseline demographic data, liver biochemistry, endoscopic and radiological findings were recorded in all the patients. Appropriate statistical analyses were performed.  RESULTS: Four thousand eight hundred and seventy-seven patients with liver disease were registered during the study period. Five hundred and eighty-six cirrhotic patients had cardiac evaluation as per the study protocol. One hundred fifty-nine had coronary artery disease and were excluded. One hundred and ninety-eight of 427 remaining patients (46.4%) had CCM. The median age of patients with CCM was higher compared with those without CCM (52 years vs. 46 years; p-value < 0.00001). Likewise, cirrhosis-related complications ([isolated or in combination], lower pulse rate [< 60/min] and prolonged corrected QT interval [QTc]; p<0.00001) were more frequent in patients with CCM. After excluding known risk factors for CCM such as alcohol, diabetes, hypothyroidism, hypertension, the true prevalence of CCM was 8.2% (48 out of 586). Hepatotropic viral infections (p 0.03) and prolonged QTc (p 0.0004) were commoner in CCM. CONCLUSION: Prevalence of CCM in our setting is 33.8%. CCM is commoner in males and is independent of the etiology of cirrhosis, comorbidity and severity of liver disease. Diastolic dysfunction and prolonged QTc interval are common in CCM.


Assuntos
Cardiomiopatias/epidemiologia , Cirrose Hepática/epidemiologia , Adulto , Fatores Etários , Idoso , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Comorbidade , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Volume Sistólico , Função Ventricular Esquerda , Adulto Jovem
14.
J Cardiovasc Magn Reson ; 21(1): 26, 2019 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046780

RESUMO

BACKGROUND: Conduction disease and arrhythmias represent a major cause of mortality in myotonic muscular dystrophy type 1 (MMD1). Permanent pacemaker (PPM) implantation is the cornerstone of therapy to reduce cardiovascular mortality in MMD1. Cardiovascular magnetic resonance (CMR) studies demonstrate a high prevalence of myocardial fibrosis in MMD1, however the association between CMR myocardial fibrosis with late gadolinium enhancement (CMR-LGE) and surface conduction abnormality is not well established in MMD1. We investigated whether myocardial fibrosis by CMR-LGE is associated with surface conduction abnormalities meeting criteria for PPM implantation according to current guidelines in a cohort of patients with genetically confirmed MMD1. METHODS: Patients with genetically confirmed MMD1 were retrospectively evaluated. 12-lead electrocardiography (ECG) performed within 6 months of CMR was necessary for inclusion. The severity and extent of MMD1 was quantified using a validated Muscular Impairment Rating Scale (MIRS). Based on current guidelines for device-based therapy of cardiac rhythm abnormalities, we defined surface conduction abnormality as the presence of ECG alterations meeting criteria for PPM implant (class I or II indications): PR interval > 200 ms (type I atrioventricular (AV) block) and/or mono or bifascicular block (QRS > 120 ms), or evidence of advanced AV block. Balanced steady-state free precession sequences (bSSFP) were used for assessment of left ventricular (LV) volumes and ejection fraction. MOdified Look-Locker Inversion Recovery (MOLLI) acquisition schemes were used to acquire T1 maps. Patients' charts were reviewed up to 12 months post-CMR for occurrence of PPM implantation. RESULTS: Fifty-two patients (38% male, 41 ± 14 years) were included. Overall, 31 (60%) patients had a surface conduction abnormality and 22 (42%) demonstrated midwall myocardial fibrosis by CMR-LGE. After a median of 57 days from CMR exam, 15 patients (29%) underwent PPM implantation. Subjects with vs. without surface conduction abnormality had significantly longer disease length (15.5 vs. 7.8 years, p = 0.015) and higher disease severity on the MIRS scale (p = 0.041). High prevalence of myocardial fibrosis by CMR-LGE was detected in subjects with and without surface conduction abnormality with no significant difference between the two cohorts (42% vs. 43%, p = 0.999). By multivariate logistic regression analysis, disease length was the only independent variable associated with surface conduction abnormality (OR 1.071, 95%CI 1.003-1.144, p = 0.040); while CMR-LGE was not associated with conduction abnormality (ρ = - 0.009, p = 0.949). CONCLUSIONS: Myocardial fibrosis by CMR-LGE is highly prevalent in MMD1 but not related to surface conduction abnormality meeting current guideline criteria for PPM implantation .


Assuntos
Arritmias Cardíacas/epidemiologia , Cardiomiopatias/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Distrofia Miotônica/epidemiologia , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Cardiomiopatias/epidemiologia , Cardiomiopatias/patologia , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Distrofia Miotônica/diagnóstico , Distrofia Miotônica/genética , Ohio/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco
16.
Am J Cardiol ; 123(12): 2006-2014, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30967289

RESUMO

There is limited data on postpartum maternal postpartum major adverse cardiovascular and cerebrovascular events (MACCE) among women with heart disease (HD) in the US. Therefore, we aimed to determine the prevalence and predictors of MACCE in the US. The Nationwide Readmissions Databases (2010 to 2014) were screened for patients with and without HD undergoing delivery. HD subtypes included cardiomyopathy (CDM), congenital heart disease, valvular heart disease, and pulmonary hypertension. Rates and reasons of 42-day readmission were determined using weighted national estimates. Independent predictors of postpartum MACCE were determined using multivariable logistic regression for complex survey data. We found among 15,273,247 patients hospitalized for delivery, 33,827 had HD (CDM 22.78%, congenital heart disease 45.98%, valvular heart disease 24.81%, and pulmonary hypertension 6.41%). Of these, 5.2% of HD patients and 1.4% of No HD were readmitted. MACCE was higher in HD vs No HD (2.68% vs 0.17%, p <0.0001). Median time to MACCE was 5.6 days (interquartile range 3 to 15 days). CDM had >10% readmission at 42 days. Among HD patients, cardiovascular, infectious, hypertensive syndromes, and complications of pregnancy were the most common reasons for 42-day readmission. MACCE predictors in women with HD included HD subtype, age, insurance status, obesity, eclampsia, postpartum hemorrhage, MACCE during delivery, preterm delivery, and thrombotic complications. In conclusion, among a nationwide analysis, postpartum MACCE was more common among patients with HD especially within 1 week of discharge from delivery. Predictors can be easily screened for by clinicians, including presence of any HD, hypertensive syndromes, age, obesity, and obstetrical events during index hospitalization.


Assuntos
Cardiomiopatias/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Transtornos Puerperais/epidemiologia , Adulto , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Modelos Logísticos , Gravidez , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
17.
Int Heart J ; 60(3): 503-511, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31019181

RESUMO

Peripartum cardiomyopathy (PPCM) is a specific cardiomyopathy in which heart failure develops due to reduced myocardial contraction during pregnancy or in the postpartum period in women without a previous history of heart disease. The epidemiology of PPCM has been reported in various countries and areas, and the incidence of PPCM differed among these reports. The incidence was highest (1 in 102 deliveries) in Nigeria and lowest (1 in 15,533 births) in Japan. The incidence was higher in African-Americans than in other races in several reports from the United States, and was also high in African countries and Haiti, indicating that the risk for PPCM is highest in the black race. However, the study design and definition of PPCM differ among studies, and these differences may influence the incidence. Moreover, the incidence of PPCM and the maternal mortality rate were well correlated. Since maternal mortality reflects the level of perinatal health care and hygiene, this finding suggests that the extent of perinatal care is partly related to the incidence of PPCM, which reflects heart failure and cardiomyopathy of unknown cause in women.


Assuntos
Cardiomiopatias/etiologia , Mortalidade Materna/tendências , Complicações Cardiovasculares na Gravidez/epidemiologia , Cardiomiopatias/epidemiologia , Cardiomiopatias/mortalidade , Feminino , Humanos , Incidência , Japão/epidemiologia , Mortalidade Materna/etnologia , Nigéria/epidemiologia , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/mortalidade , Projetos de Pesquisa , Estados Unidos/etnologia
18.
JAMA Cardiol ; 4(4): 342-352, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30865215

RESUMO

Importance: Cardiovascular disease (CVD) remains the top cause of death in China. To our knowledge, no consistent and comparable assessments of CVD burden have been produced at subnational levels, and little is understood about the spatial patterns and temporal trends of CVD in China. Objective: To determine the national and province-level burden of CVD from 1990 to 2016 in China. Design, Setting, and Participants: Following the methodology framework and analytical strategies used in the 2016 Global Burden of Disease study, the mortality, prevalence, and disability-adjusted life-years (DALYs) of CVD in the Chinese population were examined by age, sex, and year and according to 10 subcategories. Estimates were produced for all province-level administrative units of mainland China, Hong Kong, and Macao. Exposures: Residence in China. Main Outcomes and Measures: Mortality, prevalence, and DALYs of CVD. Results: The annual number of deaths owing to CVD increased from 2.51 million to 3.97 million between 1990 and 2016; the age-standardized mortality rate fell by 28.7%, from 431.6 per 100 000 persons in 1990 to 307.9 per 100 000 in 2016. Prevalent cases of CVD doubled since 1990, reaching nearly 94 million in 2016. The age-standardized prevalence rate of CVD overall increased significantly from 1990 to 2016 by 14.7%, as did rates for ischemic heart disease (19.1%), ischemic stroke (36.6%), cardiomyopathy and myocarditis (23.1%), and endocarditis (26.7%). Substantial reduction in the CVD burden, as measured by age-standardized DALY rate, was observed from 1990 to 2016 nationally, with a greater reduction in women (43.7%) than men (24.7%). There were marked differences in the spatial patterns of mortality, prevalence, and DALYs of CVD overall as well as its main subcategories, including ischemic heart disease, hemorrhagic stroke, and ischemic stroke. The CVD burden appeared to be lower in coastal provinces with higher economic development. The between-province gap in relative burden of CVD increased from 1990 to 2016, with faster decline in economically developed provinces. Conclusions and Relevance: Substantial discrepancies in the total CVD burden and burdens of CVD subcategories have persisted between provinces in China despite a relative decrease in the CVD burden. Geographically targeted considerations are needed to tailor future strategies to enhance CVD health throughout China and in specific provinces.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Carga Global da Doença/métodos , Mortalidade/tendências , Cardiomiopatias/epidemiologia , Cardiomiopatias/mortalidade , China/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Endocardite/epidemiologia , Endocardite/mortalidade , Feminino , Geografia/tendências , Carga Global da Doença/tendências , Humanos , Masculino , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/mortalidade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade
19.
J Cardiovasc Magn Reson ; 21(1): 21, 2019 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-30917836

RESUMO

BACKGROUND: The measurement of native T1 through cardiovascular magnetic resonance (CMR) is a noninvasive method of assessing myocardial fibrosis without gadolinium contrast. No studies so far have evaluated native T1 after renal transplantation. The primary aim of the current study is to assess changes in the myocardium native T1 6 months after renal transplantation. METHODS: We prospectively evaluated 44 renal transplant patients with 3 T CMR exams: baseline at the beginning of transplantation and at 6 months after transplantation. RESULTS: The native T1 time was measured in the midventricular septum and decreased significantly from 1331 ± 52 ms at the baseline to 1298 ± 42 ms 6 months after transplantation (p = 0.001). The patients were split into two groups through a two-step cluster algorithm: In cluster-1 (n = 30) the left ventricular (LV) mass index and the prevalence of diabetes were lower. In cluster-2 (n = 14) the LV mass index and diabetes prevalence were higher. Decrease in native T1 values was significant only in the patients in cluster-1 (p = 0.001). CONCLUSIONS: The native myocardial T1 time decreased significantly 6 months after renal transplant, which may be associated with the regression of the reactive fibrosis. The patients with greater baseline LV mass index and the diabetic group did not reach a significant decrease in T1.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Transplante de Rim , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Insuficiência Renal Crônica/cirurgia , Adulto , Brasil/epidemiologia , Cardiomiopatias/epidemiologia , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Diabetes Mellitus/epidemiologia , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Remodelação Ventricular
20.
Pediatr Blood Cancer ; 66(6): e27703, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30848046

RESUMO

PURPOSE: Sickle cell anemia (SCA) patients frequently have many comorbidities, including diastolic dysfunction (DD) and exercise intolerance. SCA patients often cannot reach maximal effort on exercise testing; little is known regarding whether submaximal exercise parameters can predict abnormal maximal exercise results in SCA patients and if there are any possible associations with DD. METHODS: A prospective longitudinal study was performed in SCA patients. All patients had a resting cardiac MRI (CMR), cardiopulmonary exercise test (CPET) with cycle ergometry using a ramp protocol, and an echocardiogram. Exercise data were compared with age-, gender-, and size-matched normal controls. RESULTS: Compared with normal controls, the SCA group (n = 19) had lower mean max oxygen consumption (VO2 ; 1378 ± 412 mL/min vs 2237 ± 580, P < 0.01) and workload (117 ± 37.6 watts vs 175 ± 50.5 watts, P = 0.0003). When evaluating the submaximal exercise parameters, there was lower VO2 at the anaerobic threshold (AT; 950 ± 311.7 vs 1460 ± 409.9, P < 0.01) and oxygen uptake efficiency slope (OUES) at AT (1512 ± 426.2 vs 2080 ± 339, P < 0.01). The max VO2 strongly correlated with VO2 at AT (r = 0.9, P < 0.01) and OUES (r = 0.83, P < 0.01) at AT. The VO2 at AT correlated with hematocrit (r = 0.77, P < 0.05). The OUES correlated with left ventricular ejection fraction by CMR (r = 0.55, P = 0.01), hematocrit (r = 0.52, P = 0.02), and lateral E/e' (r = -0.54, P = 0.01). CONCLUSIONS: SCA patients have abnormal submaximal exercise measures compared with controls, which is strongly associated with abnormal maximal exercise results. The degree of submaximal abnormality correlates with DD abnormalities by echocardiography. These data expand the scope of functional cardiovascular abnormalities in SCA.


Assuntos
Anemia Falciforme/fisiopatologia , Cardiomiopatias/epidemiologia , Teste de Esforço , Exercício , Consumo de Oxigênio , Oxigênio/metabolismo , Adolescente , Adulto , Cardiomiopatias/diagnóstico , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Ohio/epidemiologia , Prognóstico , Estudos Prospectivos , Testes de Função Respiratória , Adulto Jovem
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