Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.707
Filtrar
1.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372015

RESUMO

We describe the case of an 86-year-old man with a background of severe left ventricular dysfunction and ischaemic cardiomyopathy who, having been optimised for heart failure therapy in hospital, unexpectedly deteriorated again with hypotension and progressive renal failure over the course of 2 days. Common causes of decompensation were ruled out and a bedside echocardiogram unexpectedly diagnosed new pericardial effusion with tamponade physiology. The patient underwent urgent pericardiocentesis and 890 mL of haemorrhagic fluid was drained. Common causes for haemopericardium were ruled out, and the spontaneous haemopericardium was thought to be related to introduction of rivaroxaban anticoagulation. The patient made a full recovery and was well 2 months following discharge. This case highlights the challenges of diagnosing cardiac tamponade in the presence of more common disorders that share similar non-specific clinical features. In addition, this case adds to growing evidence that therapy with direct oral anticoagulants can be complicated by spontaneous haemopericardium, especially when coadministered with other agents that affect clotting, renal dysfunction and cytochrome P3A5 inhibitors.


Assuntos
Anticoagulantes/efeitos adversos , Tamponamento Cardíaco/etiologia , Insuficiência Cardíaca/complicações , Isquemia Miocárdica/complicações , Derrame Pericárdico/complicações , Rivaroxabana/efeitos adversos , Lesão Renal Aguda/etiologia , Idoso de 80 Anos ou mais , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/terapia , Inibidores do Citocromo P-450 CYP3A/efeitos adversos , Diagnóstico Diferencial , Drenagem , Ecocardiografia , Humanos , Hipotensão/etiologia , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/terapia , Disfunção Ventricular Esquerda/complicações
2.
Heart Surg Forum ; 23(5): E574-E578, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32990580

RESUMO

OBJECTIVE: To explore the effect of atrial septal defect (ASD) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the treatment of ARDS combined with left ventricular dysfunction (LVD) to find a new effective method for treating severe COVID-19 patients. MATERIALS AND METHODS: Five large animal ARDS models of sheep were established by intravenous injection of Lipopolysaccharide. ASD was made under general anesthesia and VA-ECMO was simulated by extracorporeal circulation machine. The oxygenation of peripheral blood, systemic circulation, and cardiac function were observed under conditions of closed and opened ASD, and the significance of ASD shunt in improving cardiopulmonary function was evaluated. RESULTS: With ASD closed, the atrial shunts disappeared, the peripheral artery pressure of oxygen(PaO2): 141.2±21.4mmHg, the oxygenation index (PaO2/FiO2): 353.0±53.5, the mean blood pressure (MAP): 49.3±13.5 mmHg, the heart was full; with ASD opened, the left-to-right shunt was observed, PaO2: 169.3±18.9mmHg, PaO2/FiO2: 423.3±47.3, MAP: 68.2±16.1 mmHg, the range of cardiac motion significantly increased, heart beat was powerful, and systemic circulation significantly improved. Statistical analysis showed that there were significant differences between opened and closed ASD (P < .01). CONCLUSION: ASD plus VA-ECMO is an effective method for the treatment of ARDS combined with LVD, which is the main cause of death in severe COVID-19 patients. However, further clinical validation is needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Oxigenação por Membrana Extracorpórea , Comunicação Interatrial/complicações , Pneumonia Viral/complicações , Disfunção Ventricular Esquerda/complicações , Animais , Diagnóstico Diferencial , Modelos Animais de Doenças , Pandemias , Ovinos
3.
Medicine (Baltimore) ; 99(38): e22296, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957388

RESUMO

RATIONALE: The increasing incidence of cardiac comorbidities in the elderly population has led to an increasing demand for vigilance of cardiac dysfunction induced by surgery. Favorable outcomes can be ensured in such cases by an increased awareness of cardiogenic complications, early identification of the problem, and appropriate treatment. PATIENT CONCERNS: This study presents 2 cases of acute pulmonary edema (PE) that were likely caused by ischemic heart disease and diastolic dysfunction in postoperative patients, following vitrectomy, in the post-anesthetic care unit. DIAGNOSES: Chest x-ray and computed tomography indicated PE. INTERVENTIONS: Following the diagnosis of PE, patients were intubated and transferred to the intensive care unit where 20 mg furosemide was injected and 10 µg/kg/min dobutamine was infused intravenously. OUTCOMES: On postoperative day 2, the patients' vital signs were stable and there were no signs of respiratory disturbance. LESSONS: Physicians should be alert to the potential development of PE as a postoperative complication in patients with left ventricular (LV) diastolic dysfunction and ischemic heart disease, even if the patient has undergone a procedure with mild hemodynamic change and minimal surgical stimulation such as vitrectomy. We propose that physicians treating elderly patients with LV diastolic dysfunction and ischemic heart disease undergoing vitrectomy should consider the use of intraoperative transthoracic echocardiogram or transesophageal echocardiogram with continuous monitoring of blood pressure, using devices such as arterial catheter devices.


Assuntos
Complicações Pós-Operatórias/etiologia , Edema Pulmonar/etiologia , Vitrectomia/efeitos adversos , Idoso , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem
4.
Int Heart J ; 61(5): 944-950, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921677

RESUMO

Clinical experience with landiolol use in patients with atrial fibrillation (AF) and a severely depressed left ventricular (LV) function is limited. We compared the efficacy and safety of landiolol with that of digoxin as an intravenous drug in controlling the heart rate (HR) during AF associated with a very low LV ejection fraction (LVEF).We retrospectively analyzed 53 patients treated with landiolol (n = 34) or digoxin (n = 19) for AF tachycardias with an LVEF ≤ 25. The landiolol dose was adjusted between 0.5 and 10 µg/kg/minute according to the patient's condition. The response to treatment was defined as a decrease in the HR of ≤ 110/minute, and that decreased by ≥ 20% from baseline.There were no significant differences between the two groups regarding the clinical characteristics. The responder rate to landiolol at 24 hours was significantly higher than that to digoxin (71.0% versus 41.2%; odds ratio: 4.65, 95% confidence interval: 1.47-31.0, P = 0.048). The percent decrease in the HR from baseline at 1, 2, 12, and 24 hours was greater in the landiolol group than in the digoxin group (P < 0.01, P = 0.071, P = 0.036, and P = 0.016, respectively). The systolic blood pressure (SBP) from baseline within 24 hours after administering landiolol was significantly reduced, whereas digoxin did not decrease the SBP over time. Hypotension (< 80 mmHg) occurred in two patients in the landiolol group and 0 in the digoxin group (P = 0.53).Landiolol could be more effective in controlling the AF HR than digoxin even in patients with severely depressed LV function. However, careful hemodynamic monitoring is necessary when administering landiolol.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Digoxina/uso terapêutico , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Morfolinas/uso terapêutico , Taquicardia/tratamento farmacológico , Ureia/análogos & derivados , Disfunção Ventricular Esquerda/fisiopatologia , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Pressão Sanguínea , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Volume Sistólico , Taquicardia/etiologia , Taquicardia/fisiopatologia , Resultado do Tratamento , Ureia/uso terapêutico , Disfunção Ventricular Esquerda/complicações
5.
PLoS One ; 15(9): e0235824, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881898

RESUMO

Pulmonary hypertension due to left heart disease (PH-LHD) is a momentous pulmonary hypertension disease, and left heart disease is the most familiar cause. Mechanical stretching may be a crucial cause of vascular remodeling. While, the underlining mechanism of mechanical stretching-induced in remodeling of pulmonary vein in the early stage of PH-LHD has not been completely elucidated. In our study, the PH-LHD model rats were successfully constructed. After 25 days, doppler echocardiography and hemodynamic examination were performed. In addition, after treatment, the levels of matrix metalloproteinase-9 (MMP-9) and transforming growth factor-ß1 (TGF-ß1) were determined by ELISA, immunohistochemistry and western blot assays in the pulmonary veins. Moreover, the pathological change of pulmonary tissues was evaluated by H&E staining. Our results uncovered that left ventricular insufficiency and interventricular septal shift could be observed in PH-LHD model rats, and the right ventricular systolic pressure (RVSP) and mean left atrial pressure (mLAP) were also elevated in PH-LHD model rats. Meanwhile, we found that MMP-9 and TGF-ß1 could be highly expressed in PH-LHD model rats. Besides, we revealed that stretch-activated channel (SAC)/mitogen-activated protein kinases (MAPKs) signaling pathway could be involved in the upregulations of MMP-9 and TGF-ß1 mediated by mechanical stretching in pulmonary vein. Therefore, current research revealed that mechanical stretching induced the increasing expressions of MMP-9 and TGF-ß1 in pulmonary vein, which could be mediated by activation of SAC/MAPKs signaling pathway in the early stage of PH-LHD.


Assuntos
Hipertensão Pulmonar/fisiopatologia , Sistema de Sinalização das MAP Quinases , Metaloproteinase 9 da Matriz/metabolismo , Veias Pulmonares/fisiopatologia , Fator de Crescimento Transformador beta1/metabolismo , Disfunção Ventricular Esquerda/fisiopatologia , Animais , Fenômenos Biomecânicos , Modelos Animais de Doenças , Ativação Enzimática , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/metabolismo , Masculino , Veias Pulmonares/metabolismo , Ratos , Ratos Sprague-Dawley , Estresse Mecânico , Remodelação Vascular , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/metabolismo
6.
Circ Arrhythm Electrophysiol ; 13(8): e008437, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32986471

RESUMO

BACKGROUND: Identification of systolic heart failure among patients presenting to the emergency department (ED) with acute dyspnea is challenging. The reasons for dyspnea are often multifactorial. A focused physical evaluation and diagnostic testing can lack sensitivity and specificity. The objective of this study was to assess the accuracy of an artificial intelligence-enabled ECG to identify patients presenting with dyspnea who have left ventricular systolic dysfunction (LVSD). METHODS: We retrospectively applied a validated artificial intelligence-enabled ECG algorithm for the identification of LVSD (defined as LV ejection fraction ≤35%) to a cohort of patients aged ≥18 years who were evaluated in the ED at a Mayo Clinic site with dyspnea. Patients were included if they had at least one standard 12-lead ECG acquired on the date of the ED visit and an echocardiogram performed within 30 days of presentation. Patients with prior LVSD were excluded. We assessed the model performance using area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity. RESULTS: A total of 1606 patients were included. Median time from ECG to echocardiogram was 1 day (Q1: 1, Q3: 2). The artificial intelligence-enabled ECG algorithm identified LVSD with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.86-0.91) and accuracy of 85.9%. Sensitivity, specificity, negative predictive value, and positive predictive value were 74%, 87%, 97%, and 40%, respectively. To identify an ejection fraction <50%, the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were 0.85 (95% CI, 0.83-0.88), 86%, 63%, and 91%, respectively. NT-proBNP (N-terminal pro-B-type natriuretic peptide) alone at a cutoff of >800 identified LVSD with an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.76-0.84). CONCLUSIONS: The ECG is an inexpensive, ubiquitous, painless test which can be quickly obtained in the ED. It effectively identifies LVSD in selected patients presenting to the ED with dyspnea when analyzed with artificial intelligence and outperforms NT-proBNP. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Inteligência Artificial , Serviço Hospitalar de Cardiologia , Diagnóstico por Computador , Dispneia/etiologia , Eletrocardiografia , Serviços Médicos de Emergência , Insuficiência Cardíaca Sistólica/diagnóstico , Processamento de Sinais Assistido por Computador , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda , Idoso , Dispneia/fisiopatologia , Feminino , Insuficiência Cardíaca Sistólica/complicações , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume Sistólico , Sístole , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia
8.
J Card Surg ; 35(10): 2866-2868, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720320

RESUMO

BACKGROUND AND AIMS: Fracture and retention of a guidewire after cardiac resynchronization therapy device implantation has not been reported in the literature so far, although it is an uncommon but known complication during cardiac interventions like percutaneous coronary interventions and other cardiac catheterization procedures. METHODS: A 53 years old female patient presented with severe pain over the left arm and shoulder for a period of 1 to 2 days. The patient had a history of dilated cardiomyopathy with severe left ventricular dysfunction and underwent cardiac resynchronization therapy device implant 3 years back with subsequent lead replacement 6 months back due to lead dysfunction. On evaluation, a coronary guidewire which might have fractured and been retained inadvertently during previous surgical procedure, was discovered in her deltoid muscle. Her symptoms were attributed to the guide wire which may have been aggravated by the movements of her arm. Emergency surgical exploration was done and the guidewire was removed. RESULTS AND CONCLUSION: We are reporting a case of unlikely and unusual delayed presentation of retained intervention guide-wire post cardiac resynchronization therapy, which was retrieved from the left deltoid muscle.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/efeitos adversos , Cardiomiopatia Dilatada/terapia , Músculo Deltoide/cirurgia , Remoção de Dispositivo/métodos , Falha de Equipamento , Intervenção Coronária Percutânea/efeitos adversos , Disfunção Ventricular Esquerda/terapia , Cardiomiopatia Dilatada/complicações , Emergências , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
9.
J Card Surg ; 35(8): 1958-1978, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32643847

RESUMO

BACKGROUND: Operative technique for surgical myocardial revascularization in high-risk patients remains an argument of debate. On-pump coronary artery bypass graft (CABG) with cardioplegic arrest and off-pump CABG have intrinsic limitations. The hybrid approach of on-pump beating-heart CABG (OPBHC) has been proposed over the years with conflicting results. This systematic review and meta-analysis intends to summarize the contemporary literature. METHODS: A literature search was conducted through major electronic databases. The systematic review provided a total of 279 articles, of those 17 studies were included in the present study. RESULTS: Compared with on-pump CABG, OPBHC patients showed a preoperative higher risk profile but had reduced early mortality (risk ratio [RR], 0.59, 95% CI, 0.36-0.97) and reduced postoperative stroke (RR, 0.60, 95% CI, 0.39-0.91). Also, interesting trends towards reduced postoperative intra-aortic balloon pump use (RR, 0.56, 95% CI, 0.31-1.01) and myocardial infarction (RR, 0.48, 95% CI, 0.22-1.07) were observed. Baseline characteristics and postoperative complications were similar between OPBHC and off-pump CABG, but limited data are available. The risk of incomplete revascularization in OPBHC is lower than off-pump CABG (RR, 0.53, 95% CI, 0.33-0.87) but higher than conventional on-pump CABG (RR, 1.71, 95% CI, 1.23-2.39). CONCLUSION: OPBHC is an effective technique to perform surgical revascularization in high-risk patients as preventing haemodynamic deterioration and guaranteeing adequate end-organ perfusion. OPBHC represents an alternative technique to on-pump and off-pump CABG, in those cases in which complications deriving from cardioplegic arrest or manipulation of the heart are more likely. For these reasons, OPBHC might be useful in patients with recent myocardial infarction or with left ventricular dysfunction.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/complicações , Humanos , Balão Intra-Aórtico/estatística & dados numéricos , Infarto do Miocárdio/complicações , Complicações Pós-Operatórias/prevenção & controle , Risco , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
10.
Int Heart J ; 61(4): 685-694, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684598

RESUMO

Left ventricular (LV) mechanical dyssynchrony assessed with phase analysis of electrocardiogram (ECG) -gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is useful for predicting major cardiac events (MCEs) in patients with cardiac dysfunction. However, there is no report on its usefulness in Japanese patients with known or suspected stable coronary artery disease (CAD) with preserved LV ejection fraction (LVEF).We retrospectively investigated 3,374 consecutive patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin ECG-gated SPECT MPI and had preserved LVEF (≥ 45%), and followed them up to confirm their prognosis for three years. The composite endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction (MI), unstable angina pectoris, and severe heart failure requiring hospitalization. LV mechanical dyssynchrony was evaluated with phase analysis with the Heart Risk View-F software to obtain the phase bandwidth and standard deviation.During the follow-up, 179 patients experienced MCEs: cardiac death (n = 42); non-fatal MI (n = 34); unstable angina pectoris (n = 54); and severe heart failure (n = 49). Results of the multivariate analysis showed age, a history of MI, diabetes mellitus, summed stress score, and stress phase bandwidth to be independent predictors for MCEs. In Kaplan-Meier analysis, prognoses were significantly stratified with the tertiles of stress phase bandwidth.LV mechanical dyssynchrony assessed with ECG-gated SPECT MPI is useful for predicting a prognosis and stratifying the risk of MCEs in Japanese patients with known or suspected stable CAD with preserved LVEF.


Assuntos
Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Doença da Artéria Coronariana/complicações , Imagem de Perfusão do Miocárdio , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Volume Sistólico , Disfunção Ventricular Esquerda/complicações
12.
Transplant Proc ; 52(6): 1919-1923, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32482444

RESUMO

It is well known that correction of uremia by kidney transplantation alone (KTA) improves left ventricular systolic dysfunction (LVSD). However, for kidney transplant candidates with extremely severe LVSD, KTA is considered to be contraindicated because of the high risk of peri-operative management. We report a case of successful kidney transplantation with severe LVSD with an ejection fraction (EF) of 14% and low systolic blood pressure (SBP) of approximately 65 to 80 mm Hg. In this case, in spite of an extremely low EF and SBP, functional capacity was assessed using metabolic equivalents (METs) and showed a level of almost 4. The operation was performed carefully, considering the cardiac, operative, and anesthetic risks. No surgical complications occurred, and the patient received intensive care during the peri-operative period. His postoperative course was almost favorable, and he was discharged on postoperative day 29. The present report concludes that evaluation of METs may expand the indication for KTA in patients with extremely severe LVSD.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Disfunção Ventricular Esquerda/complicações , Adulto , Humanos , Falência Renal Crônica/etiologia , Masculino , Púrpura de Schoenlein-Henoch/complicações , Volume Sistólico
14.
J Pediatr ; 224: 141-145, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32553873

RESUMO

We report on the presentation and course of 33 children with multisystem inflammatory syndrome in children and confirmed severe acute respiratory syndrome coronavirus 2 infection. Hemodynamic instability and cardiac dysfunction were prominent findings, with most patients exhibiting rapid resolution following anti-inflammatory therapy.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Adolescente , Anti-Inflamatórios/uso terapêutico , Betacoronavirus , Criança , Pré-Escolar , Aneurisma Coronário , Infecções por Coronavirus/tratamento farmacológico , Feminino , Febre , Humanos , Inflamação , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Cidade de Nova Iorque , Pandemias , Estudos Retrospectivos , Choque/complicações , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
16.
J Cardiothorac Surg ; 15(1): 84, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393284

RESUMO

OBJECTIVES: Does the manipulation of the off-pump CABG (OPCAB) in patient with depressed left ventricular function is better than on-pump CABG (ONCAB) approach in in-hospital mortality and morbidities? Here we undertook a meta-analysis of the best evidence available on the comparison of primary and second clinical outcomes of the off-pump and on-pump CABG. DESIGN: Systematic literature reviewer and meta-analysis. DATA SOURCES: PubMed, EMBASE, Web of science and Cochrane Center Registry of Controlled Trials were searched the studies which comparing the use of the off-pump CABG(OPCAB) and on-pump CABG (ONCAB) for patients with LVD during January 1990.1 to January 2018. ELIGIBILITY CRITERIA: All observation studies and randomized controlled trials comparing on-pump and off-pump as main technique for multi-vessel coronary artery disease (defined as severe stenosis (>70%) in at least 2 major diseased coronary arteries) with left ventricular dysfunction(defined as ejection fraction (EF) 40% or less) were included. DATA EXTRACTION AND SYNTHESIS: Authors will screen and select the studies extract the following data, first author, year of publication, trial characters, study design, inclusion and exclusion criteria, graft type, clinical outcome, assess the risk of bias and heterogeneity. Study-specific estimates will pool through the modification of the Newcastle-Ottawa scale for the quality of study and while leave-one-out analysis will be used to detect the impact of individual studies on the robustness of outcomes. RESULTS: Among the 987 screened articles, a total of 16 studies (32,354 patients) were included. A significant relationship between patient risk profile and benefits from OPCAB was found in terms of the 30-day mortality (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73-0.97; P = 0.02), stroke (OR, 0.69; 95% CI, 0.55-0.86; P = 0.00), myocardial infarction (MI) (OR, 0.71; 95% CI, 0.53-0.96; P = 0.02), renal failure (OR, 0.71; 95% CI, 0.55-0.93; P = 0.01), pulmonary complication (OR, 0.68; 95% CI, 0.52-0.90; P = 0.01), infection (OR, 0.67; 95% CI, 0.49-0.91; P = 0.00),postoperative transfusion (OR, 0.25; 95% CI, 0.08-0.84; P = 0.02) and reoperation for bleeding (OR, 0.56; 95% CI, 0.41-0.75; P = 0.00). There was no significant difference in atrial fibrillation (AF) (OR, 0.96;95%; CI, 0.78-1.41; P = 0.56) and neurological dysfunction (OR, 0.88; 95% CI, 0.49-1.57; P = 0.65). CONCLUSIONS: Compared with the on-pump CABG with LVD, using the off-pump CABG is a better choice for patients with lower mortality, stroke, MI, RF, pulmonary complication, infection, postoperative transfusion and reoperation for bleeding. Further randomized studies are warranted to corroborate these observational data.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Disfunção Ventricular Esquerda/cirurgia , Fibrilação Atrial/cirurgia , Doença da Artéria Coronariana/complicações , Mortalidade Hospitalar , Humanos , Infarto do Miocárdio/complicações , Razão de Chances , Reoperação , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações , Função Ventricular Esquerda
17.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-32225996

RESUMO

Exercise oscillatory ventilation (EOV) is an ominous sign in heart failure due to reduced left ventricular ejection fraction (HFrEF) whatever it is represented. But EOV is detected also in normal healthy individuals and in other cardiovascular disease (CVD) patients, however, its prevalence in these is not completed clear. The aim was to describe the occurrence of EOV in healthy subjects and the overall population all CVD patients who performing symptom limited cardiopulmonary exercise testing (CPET). Healthy subjects were divided in athletes and normal subjects, while, CVD patients were subdivided into: i) t hose with preserved left ventricular ejection fraction (LVEF); ii) those with mild to moderate impairment of LVEF (41-49%); iii) those with severe impairment of LVEF (≤40%); iv) HFrEF or with preserved LVEF (HFpEF); and iv) patients after heart transplantation (HXT). EOV was observed only in CVD patients and in those with depressed LVEF; the prevalence of EOV was observed 1.9% (3/55) those with mild to moderate impairment of LVEF (41-49%), 3.4% (56/1613) those with severe impairment of LVEF (≤40%), and 7.3% (214/2903) in HFrEF); no EOV was observed in CVD with preserved LVEF. Kremser's EOV was observed in patients, and, particularly, in those with systolic function impairment. Moreover, as EOV impacts prognosis in HFrEF, its occurrence can modify prognostic-decision models. Even though, EOV prevalence was derived from largest single center population, more studies are needed to tackle the EOV prevalence in different CVD conditions and in normal subjects.


Assuntos
Doenças Cardiovasculares , Respiração de Cheyne-Stokes/etiologia , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Atletas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos de Casos e Controles , Técnicas de Apoio para a Decisão , Teste de Esforço , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Consumo de Oxigênio , Prognóstico , Volume Sistólico , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda
18.
Adv Exp Med Biol ; 1177: 269-295, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32246448

RESUMO

Heart failure (HF) is defined as a clinical syndrome resulting from structural or functional impairment of ventricular fillings or ejections of blood. Currently, HF is divided into three groups which include HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF) and HF with midrange EF (HFmrEF). Even though major advances have been made in treating HFrEF during the past decades, heart failure is a fatal disease. In this review, we briefly summarize the current advances in pharmaceutical managements for heart failure, which includes drugs used in acute heart failure as well as those that prevent heart failure progression, in each category major clinical trials are also described. In addition, information about some of potential new drugs are also mentioned. Traditional Chinese medicine also shows its potential in treating HF, and we are still lack of medicine to treat HFpEF.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Progressão da Doença , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Volume Sistólico/efeitos dos fármacos , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/fisiopatologia
19.
Circ Cardiovasc Imaging ; 13(4): e009939, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32312116

RESUMO

BACKGROUND: Although in clinical practice heart failure (HF) patients are classified using left ventricular ejection fraction (LVEF), this categorization is insufficient for prognosis, especially when LVEF is preserved or there is a concomitant right ventricular (RV) dysfunction. We hypothesized that a combined noninvasive evaluation of LV forward flow, filling pressure, and RV function would be better than LVEF in predicting all-cause mortality of hospitalized patients with HF. METHODS: Transthoracic echocardiographic examinations of 603 patients hospitalized with HF were analyzed. In a subsample of 200 patients with HF, LV stroke volume index, LV filling pressure estimation, tricuspid annular plane systolic excursion, and systolic pulmonary artery pressure were combined to determine 4 hemodynamic profiles: normal flow-normal pressure, normal flow-high pressure, low flow without RV dysfunction, and low flow with RV dysfunction profile. This model was then applied in a validation cohort (n=403). RESULTS: Prognosis worsened from the normal flow-normal pressure profile to the low flow with right ventricular dysfunction profile. At the multivariate survival analysis, the model showed independent high risk-stratification capability (P<0.001), even in subgroups of patients with LVEF < or ≥50% (P=0.011 and P<0.001, respectively) and < or ≥40% (P=0.044 and P<0.001, respectively). LVEF and HF classification based on LVEF did not predict outcome. CONCLUSIONS: Echocardiographic-derived profiling of LV forward flow, filling pressure, and RV function allowed categorization of patients hospitalized with HF and predicted all-cause mortality independently of LVEF. This model is based on conventional echocardiography, is easy to apply, and is, therefore, suggested for clinical practice.


Assuntos
Ecocardiografia/métodos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica/fisiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Insuficiência Cardíaca/complicações , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Hospitalização , Humanos , Pacientes Internados , Masculino , Fenótipo , Prognóstico , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/fisiopatologia
20.
Rev Med Liege ; 75(4): 233-239, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32267111

RESUMO

The strategy for the management of type 2 diabetes (T2D) has been updated late 2019-2020 by a group of experts of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). The indications of two pharmacological classes that have demonstrated a cardiovascular and renal protection, i.e. sodium-glucose cotransporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1AR), are now extended because of the favourable results of recent clinical trials. In patients with T2D at high cardiovascular risk (even without previous event, but with indicators of atherosclerotic disease), the addition of these antidiabetic agents to metformin background therapy is now recommended independently of the glycated haemo¬globin (HbA1c) level. For SGLT2i, the prescription may be extended to patients with an estimated glomerular filtration rate down to 30 (instead of 60) ml/min/1.73 m², in particular in patients with progressive renal disease and albuminuria and in patients at risk of heart failure, especially if left ventricular ejection fraction is reduced. However, these new proposals could not be applied stricto sensu because of strict reimbursement criteria based upon HbA1c currently applied in our country.


Assuntos
Diabetes Mellitus Tipo 2 , Hipoglicemiantes , Disfunção Ventricular Esquerda/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipoglicemiantes/uso terapêutico , Rim , Nefropatias/complicações , Volume Sistólico , Função Ventricular Esquerda
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA