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1.
Anticancer Res ; 41(10): 5241-5247, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593477

RESUMO

AIM: To clarify the clinical and radiological features of isolated tumor thrombi in the inferior vena cava (IVC)/right atrium in patients with hepatocellular carcinoma (HCC) without hepatic vein invasion. PATIENTS AND METHODS: In this retrospective study, from January 2007 to December 2019, a total of 35,163 chemoembolization sessions were performed in 7,704 patients with HCC. Among them, 10 (0.13%) patients had tumor thrombi in the IVC/right atrium without definitive hepatic vein invasion. Computed tomographic (CT) scans, digital subtraction angiograms, and cone-beam CT images were retrospectively reviewed and interpreted. RESULTS: The tumor thrombi were supplied by the right inferior phrenic artery (n=8) or the right internal mammary artery (n=2). Follow-up CT scans in eight patients showed linear accumulation of iodized oil along the diaphragm, which was presumed to be a thrombosis of the phrenic vein. Retrospective review of formal radiological reports of pre-procedural CT scans revealed that a correct diagnosis of tumor thrombi of the IVC/right atrium was made in only three cases. CONCLUSION: HCC invading the phrenic vein may have tumor thrombi in the IVC/right atrium without hepatic vein invasion.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/mortalidade , Átrios do Coração/patologia , Cardiopatias/terapia , Veias Hepáticas/patologia , Trombose/terapia , Veia Cava Inferior/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/métodos , Feminino , Seguimentos , Cardiopatias/etiologia , Cardiopatias/patologia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Trombose/etiologia , Trombose/patologia
2.
Nihon Ronen Igakkai Zasshi ; 58(3): 371-375, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34483160
3.
Viruses ; 13(9)2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34578462

RESUMO

Evidence is emerging that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect various organs of the body, including cardiomyocytes and cardiac endothelial cells in the heart. This review focuses on the effects of SARS-CoV-2 in the heart after direct infection that can lead to myocarditis and an outline of potential treatment options. The main points are: (1) Viral entry: SARS-CoV-2 uses specific receptors and proteases for docking and priming in cardiac cells. Thus, different receptors or protease inhibitors might be effective in SARS-CoV-2-infected cardiac cells. (2) Viral replication: SARS-CoV-2 uses RNA-dependent RNA polymerase for replication. Drugs acting against ssRNA(+) viral replication for cardiac cells can be effective. (3) Autophagy and double-membrane vesicles: SARS-CoV-2 manipulates autophagy to inhibit viral clearance and promote SARS-CoV-2 replication by creating double-membrane vesicles as replication sites. (4) Immune response: Host immune response is manipulated to evade host cell attacks against SARS-CoV-2 and increased inflammation by dysregulating immune cells. Efficiency of immunosuppressive therapy must be elucidated. (5) Programmed cell death: SARS-CoV-2 inhibits programmed cell death in early stages and induces apoptosis, necroptosis, and pyroptosis in later stages. (6) Energy metabolism: SARS-CoV-2 infection leads to disturbed energy metabolism that in turn leads to a decrease in ATP production and ROS production. (7) Viroporins: SARS-CoV-2 creates viroporins that lead to an imbalance of ion homeostasis. This causes apoptosis, altered action potential, and arrhythmia.


Assuntos
COVID-19/complicações , COVID-19/virologia , Cardiopatias/etiologia , SARS-CoV-2/fisiologia , Apoptose , Autofagia , Gerenciamento Clínico , Suscetibilidade a Doenças , Células Endoteliais/ultraestrutura , Células Endoteliais/virologia , Cardiopatias/diagnóstico , Cardiopatias/terapia , Interações Hospedeiro-Patógeno/imunologia , Humanos , Miocardite/diagnóstico , Miocardite/etiologia , Miocardite/terapia , Proteínas Viroporinas , Replicação Viral
5.
Best Pract Res Clin Anaesthesiol ; 35(3): 269-292, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34511219

RESUMO

Coronaviruses belong to the family Coronaviridae order Nidovirales and are known causes of respiratory and intestinal disease in various mammalian and avian species. Species of coronaviruses known to infect humans are referred to as human coronaviruses (HCoVs). While traditionally, HCoVs have been a significant cause of the common cold, more recently, emergent viruses, including severe acute respiratory syndrome coronavirus (SARS-CoV-2) has caused a global pandemic. Here, we discuss coronavirus disease (COVID-19) biology, pathology, epidemiology, signs and symptoms, diagnosis, treatment, and recent clinical trials involving promising treatments.


Assuntos
Antivirais/administração & dosagem , COVID-19/epidemiologia , COVID-19/terapia , SARS-CoV-2 , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/análogos & derivados , Corticosteroides/administração & dosagem , Alanina/administração & dosagem , Alanina/análogos & derivados , Animais , COVID-19/diagnóstico , COVID-19/imunologia , Coronavirus/efeitos dos fármacos , Coronavirus/imunologia , Tosse/epidemiologia , Tosse/terapia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Fadiga/epidemiologia , Fadiga/terapia , Febre , Cardiopatias/epidemiologia , Cardiopatias/terapia , Humanos , Respiração com Pressão Positiva/métodos , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , SARS-CoV-2/efeitos dos fármacos , SARS-CoV-2/imunologia , Resultado do Tratamento
6.
Open Heart ; 8(2)2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34376573

RESUMO

OBJECTIVES: To describe the use of echocardiography in patients hospitalised with suspected coronavirus infection and to assess its impact on clinical management. METHODS: We studied 79 adults from a prospective registry of inpatients with suspected coronavirus infection at a single academic centre. Echocardiographic indications included abnormal biomarkers, shock, cardiac symptoms, arrhythmia, worsening hypoxaemia or clinical deterioration. Study type (limited or complete) was assessed for each patient. The primary outcome measure was echocardiography-related change in clinical management, defined as intensive care transfer, medication changes, altered ventilation parameters or subsequent cardiac procedures within 24 hours of echocardiography. Coronavirus-positive versus coronavirus-negative patient groups were compared. The relationship between echocardiographic findings and coronavirus mortality was assessed. RESULTS: 56 patients were coronavirus-positive and 23 patients were coronavirus-negative with symptoms attributed to other diagnoses. Coronavirus-positive patients more often received limited echocardiograms (70% vs 26%, p=0.001). The echocardiographic indication for coronavirus-infected patients was frequently worsening hypoxaemia (43% vs 4%) versus chest pain, syncope or clinical heart failure (23% vs 44%). Echocardiography changed management less frequently in coronavirus-positive patients (18% vs 48%, p=0.01). Among coronavirus-positive patients, 14 of 56 (25.0%) died during hospitalisation. Those who died more often had echocardiography to evaluate clinical deterioration (71% vs 24%) and had elevated right ventricular systolic pressures (37 mm Hg vs 25 mm Hg), but other parameters were similar to survivors. CONCLUSIONS: Echocardiograms performed on hospitalised patients with coronavirus infection were often technically limited, and their findings altered patient management in a minority of patients.


Assuntos
COVID-19/diagnóstico por imagem , Ecocardiografia Doppler , Cardiopatias/diagnóstico por imagem , Coração/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , COVID-19/fisiopatologia , COVID-19/terapia , COVID-19/virologia , Tomada de Decisão Clínica , Feminino , Coração/fisiopatologia , Coração/virologia , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Cardiopatias/virologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos
7.
Theranostics ; 11(16): 7948-7969, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34335973

RESUMO

Heart disease is the main cause of death worldwide. Because death of the myocardium is irreversible, it remains a significant clinical challenge to rescue myocardial deficiency. Cardiac tissue engineering (CTE) is a promising strategy for repairing heart defects and offers platforms for studying cardiac tissue. Numerous achievements have been made in CTE in the past decades based on various advanced engineering approaches. 3D bioprinting has attracted much attention due to its ability to integrate multiple cells within printed scaffolds with complex 3D structures, and many advancements in bioprinted CTE have been reported recently. Herein, we review the recent progress in 3D bioprinting for CTE. After a brief overview of CTE with conventional methods, the current 3D printing strategies are discussed. Bioink formulations based on various biomaterials are introduced, and strategies utilizing composite bioinks are further discussed. Moreover, several applications including heart patches, tissue-engineered cardiac muscle, and other bionic structures created via 3D bioprinting are summarized. Finally, we discuss several crucial challenges and present our perspective on 3D bioprinting techniques in the field of CTE.


Assuntos
Bioimpressão/métodos , Miocárdio/metabolismo , Engenharia Tecidual/métodos , Materiais Biocompatíveis/química , Biônica/métodos , Bioimpressão/tendências , Procedimentos Cirúrgicos Cardíacos/métodos , Coração/fisiologia , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Humanos , Impressão Tridimensional/tendências , Tecidos Suporte/química
8.
Tex Heart Inst J ; 48(3)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34379771

RESUMO

A 79-year-old man had an out-of-hospital acute ST-segment-elevation myocardial infarction with cardiac arrest. Cardiopulmonary resuscitation performed by a bystander resulted in traumatic hemopericardium. We discuss the patient's case, highlight the challenges of managing simultaneously life-threatening thrombosis and hemorrhage, and present our conclusions regarding the patient's eventual death.


Assuntos
Tamponamento Cardíaco/terapia , Derrame Pericárdico/terapia , Pericardiocentese/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Traumatismos Torácicos/complicações , Trombose/terapia , Idoso , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Angiografia Coronária , Ecocardiografia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/terapia , Humanos , Masculino , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico , Pericárdio , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Traumatismos Torácicos/diagnóstico , Trombose/etiologia
9.
Circ Cardiovasc Imaging ; 14(8): e012943, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34387095

RESUMO

Imaging genomics is a rapidly evolving field that combines state-of-the-art bioimaging with genomic information to resolve phenotypic heterogeneity associated with genomic variation, improve risk prediction, discover prevention approaches, and enable precision diagnosis and treatment. Contemporary bioimaging methods provide exceptional resolution generating discrete and quantitative high-dimensional phenotypes for genomics investigation. Despite substantial progress in combining high-dimensional bioimaging and genomic data, methods for imaging genomics are evolving. Recognizing the potential impact of imaging genomics on the study of heart and lung disease, the National Heart, Lung, and Blood Institute convened a workshop to review cutting-edge approaches and methodologies in imaging genomics studies, and to establish research priorities for future investigation. This report summarizes the presentations and discussions at the workshop. In particular, we highlight the need for increased availability of imaging genomics data in diverse populations, dedicated focus on less common conditions, and centralization of efforts around specific disease areas.


Assuntos
Pesquisa Biomédica , Cardiopatias/diagnóstico por imagem , Genômica por Imageamento , Pneumopatias/diagnóstico por imagem , Animais , Inteligência Artificial , Difusão de Inovações , Predisposição Genética para Doença , Variação Genética , Cardiopatias/genética , Cardiopatias/terapia , Humanos , Pneumopatias/genética , Pneumopatias/terapia , National Heart, Lung, and Blood Institute (U.S.) , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Estados Unidos
10.
Arch Pediatr ; 28(7): 548-552, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34400053

RESUMO

INTRODUCTION: Pediatric palliative care (PPC) teams address unmet needs and improve the quality of life of patients with life-limiting conditions across pediatric subspecialties. However, little is known about the timing, reasons, and nature of PPC team interventions in advanced heart diseases (AHD). OBJECTIVES: Here we describe how, when, and why PPC teams interact with referred teams of children suffering from AHD. METHODS: We conducted a retrospective nationwide survey among PPC teams in France. All patients referred to participating PPC teams for a cardiologic disease in 2019 were studied. RESULTS: Among six PPC teams, 18 patients with AHD had a PPC consultation in 2019. Six of these patients had cardiomyopathy and 12 had congenital heart disease (CHD). The median age at referral was 0.9 months for CHD and 72 months for cardiomyopathy. An antenatal diagnosis had been made for six families with CHD, and two of them were referred to PPC before birth allowing for a prenatal palliative care plan. The main reason for referral was ethical considerations (50%) followed by organization for home-based palliative care (28%). PPC teams participated in ethical discussions when asked to but also provided family support (12/18), home-based PPC (9/18), coordination of care (5/18), support of the referred team (4/18), and symptoms management (3/18) CONCLUSION: The main reason for referral to PPC was ethical considerations, but PPC interventions followed a holistic model of care. Prospective outcomes measurement and partnerships should be further developed.


Assuntos
Cardiopatias/terapia , Cuidados Paliativos/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , França/epidemiologia , Cardiopatias/epidemiologia , Humanos , Lactente , Masculino , Cuidados Paliativos/métodos , Pediatria/métodos , Pediatria/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos , Inquéritos e Questionários
11.
Rev Cardiovasc Med ; 22(2): 365-371, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34258904

RESUMO

COVID-19 is a novel viral infection caused by severe acute respiratory syndrome (SARS) beta-coronavirus. Epidemiological status changes dynamically as the pandemy is far from ending. Several complications of presented virus may be similar to those observed in other viral infections. Despite lacking data, the heart involvement may be comparable to cardiac complications observed previously in those with SARS as well as Middle East Respiratory Syndrome (MERS). In COVID-19 we observe elevated levels of cardiac biomarkers, such as natriuretic peptides, troponins, myoglobin, C-reactive protein (CRP), interleukin-2 (IL-2), interleukin-6 (IL-6) and ferritin, which is likely the result of myocardial injury. The possible mechanisms of cardiovascular injury include direct toxicity through the viral invasion of cardiac myocytes, ACE-2 receptor-mediated CV (cardiac and endothelial) injury, microvascular dysfunction and thrombosis and cytokine release syndrome (mainly IL-6 mediated). Cardiac manifestations of COVID-19 are focal or global myocardial inflammation, necrosis, ventricular dysfunction, heart failure and arrhythmia.


Assuntos
COVID-19/virologia , Cardiopatias/virologia , Coração/virologia , SARS-CoV-2/patogenicidade , COVID-19/mortalidade , COVID-19/fisiopatologia , COVID-19/terapia , Coração/fisiopatologia , Cardiopatias/mortalidade , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Interações Hospedeiro-Patógeno , Humanos , Prognóstico , Fatores de Risco , SARS-CoV-2/efeitos dos fármacos
12.
Nutrients ; 13(7)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34201625

RESUMO

Omega-3 (n-3) polyunsaturated fatty acids (PUFA) and their metabolites have long been recognized to protect against inflammation-related diseases including heart disease. Recent reports present conflicting evidence on the effects of n-3 PUFAs on major cardiovascular events including death. While some studies document that n-3 PUFA supplementation reduces the risk for heart disease, others report no beneficial effects on heart disease composite primary outcomes. Much of this heterogeneity may be related to the genetic variation in different individuals/populations that alters their capacity to synthesize biologically active n-3 and omega 6 (n-6) PUFAs and metabolites from their 18 carbon dietary precursors, linoleic acid (LA, 18:2 n-6) and alpha-linolenic (ALA, 18:3, n-3). Here, we discuss the role of a FADS gene-by-dietary PUFA interaction model that takes into consideration dietary exposure, including the intake of LA and ALA, n-3 PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in determining the efficacy of n-3 PUFA supplementation. We also review recent clinical trials with n-3 PUFA supplementation and coronary heart disease in the context of what is known about fatty acid desaturase (FADS) gene-by-dietary PUFA interactions. Given the dramatic differences in the frequencies of FADS variants that impact the efficiency of n-3 and n-6 PUFA biosynthesis, and their downstream signaling products among global and admixture populations, we conclude that large clinical trials utilizing "one size fits all" n-3 PUFA supplementation approaches are unlikely to show effectiveness. However, evidence discussed in this review suggests that n-3 PUFA supplementation may represent an important opportunity where precision interventions can be focused on those populations that will benefit the most from n-3 PUFA supplementation.


Assuntos
Ensaios Clínicos como Assunto , Dieta , Suplementos Nutricionais , Ácidos Graxos Ômega-3/farmacologia , Cardiopatias/genética , Cardiopatias/terapia , Variação Genética , Humanos
13.
Int J Mol Sci ; 22(14)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34299066

RESUMO

Stem cell therapy is a promising alternative approach to heart diseases. The most prevalent source of multipotent stem cells, usually called somatic or adult stem cells (mesenchymal stromal/stem cells, MSCs) used in clinical trials is bone marrow (BM-MSCs), adipose tissue (AT-MSCs), umbilical cord (UC-MSCs) and placenta. Therapeutic use of MSCs in cardiovascular diseases is based on the benefits in reducing cardiac fibrosis and inflammation that compose the cardiac remodeling responsible for the maintenance of normal function, something which may end up causing progressive and irreversible dysfunction. Many factors lead to cardiac fibrosis and failure, and an effective therapy is lacking to reverse or attenuate this condition. Different approaches have been shown to be promising in surpassing the poor survival of transplanted cells in cardiac tissue to provide cardioprotection and prevent cardiac remodeling. This review includes the description of pre-clinical and clinical investigation of the therapeutic potential of MSCs in improving ventricular dysfunction consequent to diverse cardiac diseases.


Assuntos
Fibrose/terapia , Cardiopatias/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/citologia , Animais , Humanos
14.
Trials ; 22(1): 455, 2021 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-34271952

RESUMO

BACKGROUND: Many patients with coronary artery disease (CAD) and valvular heart disease (VHD) suffer from psychological distress. Such stress is associated with increased morbidity, reduced quality of life and delayed return to work. European guidelines emphasize recognition and intervention, but evidence-based treatment options are limited and perceived as costly. The present study will test the effect of brief, group-based cognitive therapy as an adjunct to usual cardiac rehabilitation in a randomized design. METHODS: A total of 148 patients with CAD and/or VHD after surgical intervention and concomitant psychological distress (defined as HADS anxiety (A) or depression (D) score ≥8) will be randomized to either usual out-patient cardiac rehabilitation (CR) comprising an 8-week multidisciplinary programme or usual care supplemented by five group-based cognitive therapy sessions performed by trained CR nurses. A structured, standardized treatment manual will be used. Patients will be randomized 1:1 at three different sites. Additionally, a non-randomized sub-group of 40 matched patients without signs of psychological distress will be followed to investigate spontaneous variation in HADS. The primary outcome is Hospital Anxiety and Depression Score (HADS). Secondary outcomes are adherence to cardiac rehabilitation (CR), health-related quality of life measured by HeartQoL, time to return to work, adherence to lifestyle interventions and cardiovascular readmissions. Patients are followed up for 12 months. DISCUSSION: To our knowledge, this is the first randomized controlled trial (RCT) on patients with cardiac disease with an intensive group-based programme of cognitive therapy performed by CR nurses, which makes it affordable and widely implementable. The outcome will elucidate the feasibility and effect of cognitive therapy as an adjunct to CR in patients with post-surgery CAD and/or VHD and psychological distress and could possibly benefit patients with other heart conditions as well. The clinical trial complies with the Declaration of Helsinki. The trial has been approved by The Regional Research Ethics Committee (file number H-16042832) and The Danish Data Protection Agency. The results will be disseminated as original research in peer-reviewed manuscripts. TRIAL REGISTRATION: www.clinicaltrials.gov NCT04254315 . Retrospectively registered on 30 January 2020.


Assuntos
Reabilitação Cardíaca , Terapia Cognitivo-Comportamental , Cardiopatias , Angústia Psicológica , Psicoterapia de Grupo , Cardiopatias/diagnóstico , Cardiopatias/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Estresse Psicológico/diagnóstico , Estresse Psicológico/terapia , Resultado do Tratamento
15.
Methods Mol Biol ; 2320: 3-7, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34302642

RESUMO

The ability to differentiate pluripotent stem cells to cardiomyocyte lineages (PSC-CMs) has opened the door to new disease models and innovative drug and cell therapies for the heart. Nevertheless, further advances in the differentiation protocols are needed to fulfill the promise of PSC-CMs. Obstacles that remain include deriving PSC-CMs with proper electromechanical properties, coalescing them into functional tissue structures, and manipulating the genome to test the impact mutations have on arrhythmias and other heart disorders. This chapter gives a brief consideration of these challenges and outlines current methodologies that offer partial solutions.


Assuntos
Miócitos Cardíacos/citologia , Células-Tronco Pluripotentes/citologia , Diferenciação Celular/fisiologia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Cardiopatias/terapia , Humanos , Mutação/genética
16.
Methods Mol Biol ; 2320: 91-100, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34302651

RESUMO

Induced pluripotent stem cells (iPSCs) have been utilized to study physiological development and also the pathogenesis of heart diseases. iPS-derived cardiomyocytes and engineered cardiac tissues provide a promising capacity for investigating cardiac development and disease modeling. In addition to protocols for cardiac differentiation and 3D cardiac tissue construction, the establishment of protocols for the comprehensive evaluation of the physiological and/or pathophysiological properties for the iPS-derived cells/tissues are indispensable.


Assuntos
Células-Tronco Pluripotentes Induzidas/citologia , Miócitos Cardíacos/citologia , Diferenciação Celular/fisiologia , Células Cultivadas , Cardiopatias/terapia , Humanos , Fenótipo , Engenharia Tecidual/métodos
17.
Biomed Res Int ; 2021: 7302165, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34222484

RESUMO

Infective endocarditis is a sinister condition with considerable morbidity and mortality. Its relevance in the current era is compounded by the increased use of implanted devices such as replacement valves or cardiac implantable electronic devices. These infections are caused by multiple different bacteria with different virulence, pathogenicity, and antimicrobial resistance. Unlike in native endocarditis, the presence of foreign tissue permits sustenance by inflammatory and thrombotic processes as the artificial surfaces promote inflammatory responses and hypercoagulability. Prevention of these infections has been suggested with the use of homografts in combination with antibiotics. Others have attempted to use "low fouling coats" with little clinical success thus far. The use of antibiotic prophylaxis plays a pivotal part in reducing the incidence of prosthesis-related endocarditis. This remains especially crucial with the increasing use of transcatheter heart valve therapies. The widespread use of cardiac implantable electronic devices such as permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices has also heralded a noticeable increase in cases of infectious endocarditis affecting complex equipment which can be difficult to treat. Multimodality strategies are needed with input from surgeons and cardiologists to ensure treatment is both prompt and successful, tailored to the individual needs of the patients.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Endocardite/terapia , Cardiopatias/cirurgia , Próteses Valvulares Cardíacas , Marca-Passo Artificial/efeitos adversos , Desenho de Prótese , Infecções Relacionadas à Prótese/etiologia , Animais , Materiais Biocompatíveis , Cardiopatias/terapia , Valvas Cardíacas , Humanos , Inflamação , Implantação de Prótese , Fatores de Risco , Suínos
18.
PLoS One ; 16(7): e0255070, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297761

RESUMO

BACKGROUND/AIMS: Maternal and infant morbidities associated with pregnant women with cardiac conditions are a global issue contingent upon appropriate care. This study aimed to describe the clinical variables and their association with the adherence scores to perinatal guidelines for pregnant women with cardiac conditions. The clinical variables included cardiac, perinatal, and neonatal outcomes and complications. METHODS: Using a retrospective cross-sectional medical record audit, data were abstracted and categorised as cardiac, obstetric, and neonatal predictors. Linear regression modelling was used to find the mean difference (MD) in adherence scores for each predictor, including a 95% confidence interval (CI) and a significance value for all the three categories' clinical outcomes. RESULTS: This maternal cohort's (n = 261) cardiac complications were primarily arrhythmias requiring treatment (29.9%), particularly SVT (28%), a new diagnosis of valvular heart disease and congenital heart disease (24%) and decompensated heart failure (HF) (16%). Women with HF had associated increased adherence scores (MD = 3.546, 95% CI: 1.689, 5.403) compared to those without HF. Elective LSCS mode of delivery was associated with a higher adherence score (MD = 5.197, 95% CI: 3.584, 6.811) than non-elective LSCS subgroups. Babies admitted to intensive /special care had greater adherence to the guidelines (MD = 3.581, 95% CI: 1.822, 5.340) than those not requiring the same care. CONCLUSIONS: Some pregnancy associated complications and morbidities were associated with higher adherence scores, reflecting that a diagnosis, identification of morbidities or risk factors, initiation of appropriate multidisciplinary involvement and adherence to guidelines were associated. Conversely, potentially avoidable major complications such as sepsis were associated with a low adherence score. TRIAL REGISTRATION: ACTRN12617000417381.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Cardiopatias/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Feminino , Cardiopatias/terapia , Humanos , Morbidade , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Resultado do Tratamento
20.
BMC Cardiovasc Disord ; 21(1): 287, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112101

RESUMO

BACKGROUND: Despite the increasing availability of clinical data due to the digitalisation of healthcare systems, data often remain inaccessible due to the diversity of data collection systems. In the Netherlands, Cardiology Centers of the Netherlands (CCN) introduced "one-stop shop" diagnostic clinics for patients suspected of cardiac disease by their general practitioner. All CCN clinics use the same data collection system and standardised protocol, creating a large regular care database. This database can be used to describe referral practices, evaluate risk factors for cardiovascular disease (CVD) in important patient subgroups, and develop prediction models for use in daily care. CONSTRUCTION AND CONTENT: The current database contains data on all patients who underwent a cardiac workup in one of the 13 CCN clinics between 2007 and February 2018 (n = 109,151, 51.9% women). Data were pseudonymised and contain information on anthropometrics, cardiac symptoms, risk factors, comorbidities, cardiovascular and family history, standard blood laboratory measurements, transthoracic echocardiography, electrocardiography in rest and during exercise, and medication use. Clinical follow-up is based on medical need and consisted of either a repeat visit at CCN (43.8%) or referral for an external procedure in a hospital (16.5%). Passive follow-up via linkage to national mortality registers is available for 95% of the database. UTILITY AND DISCUSSION: The CCN database provides a strong base for research into historically underrepresented patient groups due to the large number of patients and the lack of in- and exclusion criteria. It also enables the development of artificial intelligence-based decision support tools. Its contemporary nature allows for comparison of daily care with the current guidelines and protocols. Missing data is an inherent limitation, as the cardiologist could deviate from standardised protocols when clinically indicated. CONCLUSION: The CCN database offers the opportunity to conduct research in a unique population referred from the general practitioner to the cardiologist for diagnostic workup. This, in combination with its large size, the representation of historically underrepresented patient groups and contemporary nature makes it a valuable tool for expanding our knowledge of cardiovascular diseases. TRIAL REGISTRATION: Not applicable.


Assuntos
Assistência Ambulatorial , Serviço Hospitalar de Cardiologia , Bases de Dados Factuais , Cardiopatias/terapia , Ambulatório Hospitalar , Projetos de Pesquisa , Idoso , Mineração de Dados , Feminino , Pesquisa sobre Serviços de Saúde , Fatores de Risco de Doenças Cardíacas , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Padrões de Prática Médica , Prevalência , Prognóstico , Encaminhamento e Consulta , Medição de Risco , Fatores de Tempo
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