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1.
J Environ Pathol Toxicol Oncol ; 39(2): 159-177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32749125

RESUMO

This review delineates the potential of naturally occurring substances for coronary artery disease (CAD), mainly coronary ischemia and its management, with their active constituents and probable mechanisms of action. As per the WHO, statistical incidence of CAD has increased in several countries. The number of coronary events worldwide has been increasing, and may increase even more in the near future. Meanwhile, increased sedentary behavior and poor diet will encourage the prevalence of CAD worldwide. As far as treatment is concerned, current conventional therapies have limitations due to their increased adverse events. The current approach to the management of CAD has certain lacunas that need to be overcome. Thus, new therapeutic options should be explored using traditional literature and current scientific data on natural products. The present review article deals with current knowledge associated with naturally occurring substances for the management of CAD.


Assuntos
Produtos Biológicos/farmacologia , Doença da Artéria Coronariana/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Medicina Herbária , Humanos
2.
Med Hypotheses ; 143: 110125, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32763657

RESUMO

The novel coronavirus (SARS-CoV-2) is primarily a respiratory pathogen and its clinical manifestations are dominated by respiratory symptoms, the most severe of which is acute respiratory distress syndrome (ARDS). However, COVID-19 is increasingly recognized to cause an overwhelming inflammatory response and cytokine storm leading to end organ damage. End organ damage to heart is one of the most severe complications of COVID-19 that increases the risk of death. We proposed a two-fold mechanism responsible for causing acute coronary events in patients with COVID-19 infection: Cytokine storm leading to rapid onset formation of new coronary plaques along with destabilization of pre-existing plaques and direct myocardial injury secondary to acute systemic viral infection. A well-coordinated immune response is the first line innate immunity against a viral infection. However, an uncoordinated response and hypersecretion of cytokines and chemokines lead to immune related damage to the human body. Human Coronavirus (HCoV) infection causes infiltration of inflammatory cells that cause excessive production of cytokines, proteases, coagulation factors, oxygen radicals and vasoactive molecules causing endothelial damage, disruption of fibrous cap and initiation of formation of thrombus. Systemic viral infections also cause vasoconstriction leading to narrowing of vascular lumen and stimulation of platelet activation via shear stress. The resultant cytokine storm causes secretion of hypercoagulable tissue factor without consequential increase in counter-regulatory pathways such as AT-III, activated protein C and plasminogen activator type 1. Lastly, influx of CD4+ T-cells in cardiac vasculature results in an increased production of cytokines that stimulate smooth muscle cells to migrate into the intima and generate collagen and other fibrous products leading to advancement of fatty streaks to advanced atherosclerotic lesions. Direct myocardial damage and cytokine storm leading to destabilization of pre-existing plaques and accelerated formation of new plaques are the two instigating mechanisms for acute coronary syndromes in COVID-19.


Assuntos
Síndrome Coronariana Aguda/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Modelos Cardiovasculares , Pandemias , Pneumonia Viral/complicações , Síndrome Coronariana Aguda/fisiopatologia , Linfócitos T CD4-Positivos/imunologia , Quimiocinas/fisiologia , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/metabolismo , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/fisiopatologia , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/fisiopatologia , Citocinas/fisiologia , Humanos , Imunidade Inata , Placa Aterosclerótica/etiologia , Placa Aterosclerótica/fisiopatologia , Ativação Plaquetária , Pneumonia Viral/imunologia , Pneumonia Viral/fisiopatologia , Vasoconstrição , Viroses/complicações , Viroses/imunologia
3.
Int J Cardiovasc Imaging ; 36(10): 1953-1962, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32757119

RESUMO

Negative stress echocardiography (NSE) is associated with low cardiovascular morbidity and overall mortality. We aimed to determine the clinical and echocardiographic predictors of overall and cardiovascular outcomes following NSE. Patients who underwent SE between 2013 and 2017 were reviewed. Patients with a history of solid organ transplant or being evaluated for transplant, history of end-stage renal or liver disease, and positive SE were excluded. NSE results were divided into negative diagnostic if patient reached target heart rate (THR) and had no wall motion abnormality (WMA) at rest or stress; negative non-diagnostic if patient had no WMA but did not reach THR or if image quality was non-diagnostic; and abnormal non-ischemic if patient had a resting WMA not worsened at stress along with a personal history of coronary artery disease (CAD). New CAD lesion at 1 year was defined as ≥ 50% stenosis on cardiac catheterization. Of 4119 patients with SE, 2575 were included. All-cause mortality rate was 1.1%/year and CAD rate was 3.1%/year. Predictors of all-cause mortality were age, male gender, history of smoking and being selected for dobutamine SE. Predictors of a new CAD lesion at 1 year were male gender, diabetes, personal history of CAD and abnormal non-ischemic SE. We identified clinical and echocardiographic characteristics in a subset of NSE patients who are at higher risk for subsequent adverse events. These characteristics should be accounted for during the clinical interpretation of SE, and patients found at increased risk for morbidity and mortality warrant continued follow-up.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse , Teste de Esforço , Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Idoso , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Dobutamina/administração & dosagem , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
4.
Asian Cardiovasc Thorac Ann ; 28(6): 316-321, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32615773

RESUMO

BACKGROUND: The method of coronary-coronary bypass grafting was described in 1987 but has not been widely used, and there are only a few studies that report good short-term and mid-term results as well as some individual cases of long-term follow-up. In our medical institution, we carried out an analysis of the long-term results of coronary-coronary bypass grafting, which are presented in this study. METHODS: This was a retrospective single-center study on 95 patients who underwent coronary-coronary bypass grafting as a supplement to the standard coronary bypass grafting procedure. All patients underwent angiographic assessment of the coronary bypass grafts during the long-term follow-up period. The observation period was up to 123 months. Angiographic assessment of 109 coronary-coronary grafts was carried out. RESULTS: Twelve (7.6%) arterial and 11 (19.3%) venous conduits were found to be occluded, and 8 (10.3%) arterial and 10 (31.3%) venous coronary-coronary grafts were occluded during the observation period. CONCLUSION: Arterial coronary-coronary artery bypass grafting represents an alternative technique that allows complete myocardial revascularization.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Anastomose de Artéria Torácica Interna-Coronária , Artéria Torácica Interna/cirurgia , Veia Safena/transplante , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Humanos , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Masculino , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
Rev Cardiovasc Med ; 21(2): 157-162, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32706205

RESUMO

Cardiovascular disease, and in particular coronary artery disease (CAD), remains an important contributor of morbidity and mortality among patients with chronic kidney disease (CKD). Classic symptomatology of CAD and effectiveness of established therapeutic measures is less frequent in patients with CKD. This suggests unique characteristics of CAD among patients with CKD. Two important features of CAD in CKD include increased calcific density of atherosclerotic plaques and of the vessels themselves (coronary artery calcification -- CAC), as well as a decrease in microcirculatory function -- or coronary microcirculatory dysfunction. A multitude of pathophysiologic pathways have been identified that contribute to CAC in CKD; less is known about the pathophysiology of microcirculatory dysfunction. It is not well established if these two processes are directly related to each other, but the combination results in a greater severity of effect on overall myocardial function and may in part explain the greater preponderance of silent myocardial infarction. Further investigation is needed to better understand these unique aspects of CAD in CKD as well as the role they play in overall CVD in this group, and ultimately therapeutics that may lessen the burden of disease.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária , Vasos Coronários/fisiopatologia , Rim/fisiopatologia , Microcirculação , Insuficiência Renal Crônica/fisiopatologia , Calcificação Vascular/fisiopatologia , Animais , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/terapia , Vasos Coronários/diagnóstico por imagem , Progressão da Doença , Taxa de Filtração Glomerular , Hemodinâmica , Humanos , Placa Aterosclerótica , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Calcificação Vascular/terapia
6.
Methodist Debakey Cardiovasc J ; 16(2): 77-85, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670467

RESUMO

Cardiac computed tomography angiography (CCTA) has evolved into a versatile imaging modality that can depict atherosclerosis burden, determine functional significance of a stenotic lesion, and guide the management and treatment of stable coronary artery disease.1 With newer-generation scanners, diagnostic CCTA can be obtained in the majority of patients with a very acceptable radiation dose. We discuss the ability of CCTA to provide comprehensive assessment of a patient with suspected CAD, including functional techniques of stress-rest myocardial perfusion assessment using a vasodilator and a purely post-processing approach that assesses fractional flow reserve derived by CCTA. In addition, recent data validated the role of CCTA in managing stable patients with chest pain and suspected CAD, serving as a gatekeeper for invasive coronary angiogram as well as optimizing the preprocedural planning of percutaneous coronary revascularization and coronary artery bypass surgery.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Imagem de Perfusão do Miocárdio , Tomada de Decisão Clínica , Ponte de Artéria Coronária , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Humanos , Intervenção Coronária Percutânea , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
7.
Methodist Debakey Cardiovasc J ; 16(2): 114-121, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670471

RESUMO

Coronary artery disease (CAD), also known as ischemic heart disease, is a major cause of morbidity and mortality worldwide, and timely noninvasive diagnosis of clinical and subclinical CAD is imperative to mitigate its burden on individual patients and populations. Positron emission tomography (PET) is a versatile tool that can perform relative myocardial perfusion imaging (MPI) with high accuracy; furthermore, it provides valuable information about the coronary microvasculature using rest and stress myocardial blood flow (MBF) and coronary flow reserve (CFR) measurements. Several radiotracers are approved by the US Food and Drug Administration to help with MPI, MBF, and CFR evaluation. A large body of evidence indicates that evaluation of the coronary microcirculation using MBF and CFR provides strong diagnostic and prognostic data in a multitude of patient populations. This review describes the technical aspects of PET compared to other modalities and discusses its clinical uses for diagnosis and prognosis of coronary arterial epicardial and microcirculatory disease.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Microcirculação , Imagem de Perfusão do Miocárdio/métodos , Tomografia por Emissão de Pósitrons , Doença da Artéria Coronariana/fisiopatologia , Humanos , Valor Preditivo dos Testes
8.
Medicine (Baltimore) ; 99(28): e21086, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664128

RESUMO

The associations between the presence and severity of coronary artery disease (CAD) and measurements of the psoas major muscle (PMM) as assessed by multidetector row coronary computed tomography angiography (MDCT) are not known.We enrolled 793 patients who were clinically suspected to have CAD or had at least one cardiac risk factor and had undergone MDCT. The number of significantly stenosed coronary vessels (VD) and measurements of the PMM index (PMMI) were determined using MDCT.PMMI in the CAD group was significantly lower than that in the non-CAD group in males, but not females. In addition, the levels of PMMI tended to increase as the number of VD decreased in males. When male patients were divided into 2 groups according to median value of age, that is, relatively younger (53.4 ±â€Š9.2 years) and older (72.6 ±â€Š5.7 years) groups, the presence of CAD was independently associated with PMMI in the younger group by a multiple logistic regression analysis. The cut-off level of PMMI that gave the greatest sensitivity and specificity for the diagnosis of CAD in younger males was 8.3 cm/m (sensitivity 0.441, specificity 0.752).In conclusion, PMMI may be an imaging marker for evaluating the presence and/or severity of CAD in males, and particularly in the non-elderly.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/fisiopatologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
9.
Angiology ; 71(10): 909-915, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32720814

RESUMO

Recent studies have reported a relationship between the platelet to lymphocyte ratio (PLR) and acute coronary syndromes. The aim of the present study was to investigate the association between PLR and stable coronary artery disease (CAD). A systematic search was conducted based on electronic databases (Cochrane, PubMed, Elsevier, Medline, and Embase). A total of 14 studies (n = 4,871) were included in the meta-analysis. Compared with the non-CAD group, PLR was significantly higher in CAD group (P = .002). After further classification according to the Gensini score, the cases with atherosclerosis demonstrated a higher PLR than those without atherosclerosis (P < .001). Platelet to lymphocyte ratio was higher in the severe atherosclerosis group compared with the mild atherosclerosis group (P < .001). Compared with the poor coronary collateral circulation (CCC) group, PLR was significantly lower in the good CCC group (P < .001). The PLR was significantly higher in patients with coronary slow flow (CSF) than those with normal coronary flow (P = .01). On the basis of current evidence, an elevated PLR was associated with stable CAD, and it might be useful for predicting CAD severe stenosis, collateral circulation, and CSF. Future studies are needed to clarify the relationship between PLR and stable CAD.


Assuntos
Doença da Artéria Coronariana/sangue , Circulação Colateral/fisiologia , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária/fisiologia , Humanos , Contagem de Linfócitos , Contagem de Plaquetas
10.
Am J Physiol Heart Circ Physiol ; 319(2): H360-H369, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32678708

RESUMO

Proper inlet boundary conditions are essential for accurate computational fluid dynamics (CFD) modeling. We developed methodology to derive noninvasive FFRB using CFD and computed tomography coronary angiography (CTCA) images. This study aims to assess the influence of brachial mean blood pressure (MBP) and total coronary inflow on FFRB computation. Twenty-two patients underwent both CTCA and FFR measurements. Total coronary flow was computed from left ventricular mass (LVM) measured from CTCA. A total of 286 CFD simulations were run by varying MBP and LVM at 70, 80, 90, 100, 110, 120, and 130% of the measured values. FFRB increased with incrementally higher input values of MBP: 0.78 ± 0.12, 0.80 ± 0.11, 0.82 ± 0.10, 0.84 ± 0.09, 0.85 ± 0.08, 0.86 ± 0.08, and 0.87 ± 0.07, respectively. Conversely, FFRB decreased with incrementally higher inputs value of LVM: 0.86 ± 0.08, 0.85 ± 0.08, 0.84 ± 0.09, 0.84 ± 0.09, 0.83 ± 0.10, 0.83 ± 0.10, and 0.82 ± 0.10, respectively. Noninvasive FFRB calculated using measured MBP and LVM on a total of 30 vessels was 0.84 ± 0.09 and correlated well with invasive FFR (0.83 ± 0.09) (r = 0.92, P < 0.001). Positive association was observed between FFRB and MBP input values (mmHg) and negative association between FFRB and LVM values (g). Respective slopes were 0.0016 and -0.005, respectively, suggesting potential application of FFRB in a clinical setting. Inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions.NEW & NOTEWORTHY While brachial mean blood pressure (MBP) and left ventricular mass (LVM) measured from CTCA are the two CFD simulation input parameters, their effects on noninvasive fractional flow reserve (FFRB) have not been systematically investigated. We demonstrate that inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions. This is important in the clinical application of noninvasive FFR in coronary artery disease diagnosis.


Assuntos
Pressão Arterial , Artéria Braquial/fisiopatologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Ventrículos do Coração/diagnóstico por imagem , Modelos Cardiovasculares , Tomografia Computadorizada Multidetectores , Modelagem Computacional Específica para o Paciente , Interpretação de Imagem Radiográfica Assistida por Computador , Idoso , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Hidrodinâmica , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
11.
Herz ; 45(5): 453-457, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32494947

RESUMO

The International Study of Comparative Health Effectiveness With Medical And Invasive Approaches (ISCHEMIA) has the potential to be a game changer in terms of the diagnostic and management approach to patients presenting with chronic coronary syndrome, suggesting that coronary revascularization may become almost like a "bail-out" strategy in the treatment of these patients. However, invasive perfusion assessment as a means of detecting the source of myocardial ischaemia at a lesion level, such as fractional flow reserve (FFR), has been validated in the past and established beyond doubt as a key diagnostic tool. The complementary role of the two approaches will be discussed here.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Isquemia Miocárdica , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Humanos , Revascularização Miocárdica , Valor Preditivo dos Testes , Síndrome
12.
J Card Surg ; 35(8): 1824-1831, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32579770

RESUMO

OBJECTIVE: Revascularization via coronary artery bypass grafting (CABG) remains a common therapy for coronary artery disease. CABG-based revascularization is most commonly performed via either single arterial graft (SAG) or multiple arterial grafting (MAG) strategies. Echo-derived global and regional longitudinal strain was used to test where SAG or MAG results in immediate differences in left ventricular (LV) function after CABG. MATERIALS AND METHODS: Pre- and postprocedural intraoperative transesophageal echos were prospectively collected. Two-dimensional LV images were analyzed for global and regional longitudinal strain (GLS), LV ejection fraction, end-diastolic volume, end-systolic volume, and stroke volume (SV). RESULTS: Twenty patients underwent open, on-pump CABG (63.9 ± 10 years old, 85% male; 10 with SAG and 10 with MAG. Preprocedural GLS significantly differed between patients with SAG and MAG, with patients with MAG having greater GLS (mean [standard deviation, SD], 20.41 [5.54]) than patients with SAG (16.28 [3.48]). After CABG, in patients with MAG, LV strain decreased both globally (-1.13 [3.15]) and regionally in the anterior-lateral (-1.22 [3.84]) and inferior-lateral regions (-1.32 [5.69]), along with LVEF. In patients with SAG, LV strain increased after CABG globally (1.34 [2.73]) and regionally in the anterior-lateral (1.20 [6.49]) and inferior-lateral regions (0.39 [7.26]), as did LVEF and SV. Postprocedure, more patients with MAG were given vasopressor (100% vs 60%) and inotrope infusions (70% vs 40%) than patients with SAG. CONCLUSIONS: After CABG, LV function quantified through GLS changes both globally and regionally increased after SAG and decreased after MAG. This finding may have important clinical implications in terms of optimizing intraoperative management for patients with CABG and have the potential to guide the improvement of clinical outcomes.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Miocárdio , Período Pós-Operatório , Função Ventricular Esquerda
13.
PLoS One ; 15(6): e0234543, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555617

RESUMO

In comparison to male patients with coronary artery disease, female patients suffer from more comorbidities, experience symptoms of coronary artery disease differently and report poorer health-related quality of life (HRQoL) after coronary revascularization. However, there is limited data on the impact of comorbidity burden on the recovery in HRQoL in female and male patients. We investigated the impact of comorbidity burden on the change in HRQoL following coronary revascularization in female patients versus male patients. 230 patients (60 female) with coronary artery disease were assessed before, and two weeks, three months and six months after coronary revascularization. Disease-specific HRQoL was measured with the Short-Form Seattle Angina Questionnaire. Physical and mental health was measured with the Short-Form Health Survey. Comorbidity burden was assessed by the total number of identified comorbidity conditions and by the Charlson comorbidity score. Linear mixed models were used to estimate the effects of time, gender and comorbidity burden on HRQoL. Whereas HRQoL improved after coronary revascularization in all patients, female patients reported poorer physical health and disease-specific HRQoL and their physical health improved more slowly than male patients. A higher comorbidity burden was related with poorer physical health and disease-specific HRQoL in male patients, but not in female patients. A higher comorbidity burden was associated with slower improvement in HRQoL for both female and male patients. Female patients reported poorer HRQoL and their physical health improved more slowly after coronary revascularization, irrespective of comorbidity burden. Higher comorbidity burden was associated with poorer physical health and disease-specific HRQoL in male patients only. Our results indicate that female and male patients recover differently after coronary revascularization. These findings highlight the importance of comorbidity- and gender-specific approaches for evaluating coronary artery disease and coronary revascularization procedures.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/métodos , Qualidade de Vida , Idoso , Comorbidade , Doença da Artéria Coronariana/fisiopatologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Caracteres Sexuais , Inquéritos e Questionários
14.
J Allergy Clin Immunol ; 146(2): 307-314.e4, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32554082

RESUMO

BACKGROUND: The Centers for Disease Control and Prevention advises that patients with moderate to severe asthma belong to a high-risk group that is susceptible to severe coronavirus disease 2019 (COVID-19). However, the association between asthma and COVID-19 has not been well-established. OBJECTIVE: The primary objective was to determine the prevalence of asthma among patients with COVID-19 in a major US health system. We assessed the clinical characteristics and comorbidities in asthmatic and nonasthmatic patients with COVID-19. We also determined the risk of hospitalization associated with asthma and/or inhaled corticosteroid use. METHODS: Medical records of patients with COVID-19 were searched by a computer algorithm (March 1 to April 15, 2020), and chart review was used to validate the diagnosis of asthma and medications prescribed for asthma. All patients had PCR-confirmed COVID-19. Demographic and clinical features were characterized. Regression models were used to assess the associations between asthma and corticosteroid use and the risk of COVID-19-related hospitalization. RESULTS: Of 1526 patients identified with COVID-19, 220 (14%) were classified as having asthma. Asthma was not associated with an increased risk of hospitalization (relative risk, 0.96; 95% CI, 0.77-1.19) after adjusting for age, sex, and comorbidities. The ongoing use of inhaled corticosteroids did not increase the risk of hospitalization in a similar adjusted model (relative risk, 1.39; 95% CI, 0.90-2.15). CONCLUSIONS: Despite a substantial prevalence of asthma in our COVID-19 cohort, asthma was not associated with an increased risk of hospitalization. Similarly, the use of inhaled corticosteroids with or without systemic corticosteroids was not associated with COVID-19-related hospitalization.


Assuntos
Asma/epidemiologia , Betacoronavirus/patogenicidade , Doença da Artéria Coronariana/epidemiologia , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Pneumonia Viral/epidemiologia , Administração por Inalação , Corticosteroides/uso terapêutico , Adulto , Fatores Etários , Idoso , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/tratamento farmacológico , Asma/fisiopatologia , Técnicas de Laboratório Clínico/métodos , Comorbidade , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Illinois/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Obesidade/diagnóstico , Obesidade/fisiopatologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Prevalência , Estudos Retrospectivos , Fatores de Risco
15.
J Cardiovasc Magn Reson ; 22(1): 43, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32507107

RESUMO

BACKGROUND: Identifying coronary artery disease (CAD) in patients with end-stage renal disease (ESRD) is challenging. Adenosine stress native T1 mapping with cardiovascular magnetic resonance (CMR) may accurately detect obstructive CAD and microvascular dysfunction in the general population. This study assessed the feasibility and reliability of adenosine stress native T1 mapping in patients on haemodialysis. METHODS: The feasibility of undertaking rest and adenosine stress native T1 mapping using the single-shot Modified Look-Locker inversion recovery (MOLLI) sequence was assessed in 58 patients on maintenance haemodialysis using 3 T CMR. Ten patients underwent repeat stress CMR within 2 weeks for assessment of test-retest reliability of native T1, stress T1 and delta T1 (ΔT1). Interrater and intrarater agreement were assessed in 10 patients. Exploratory analyses were undertaken to assess associations between clinical variables and native T1 values in 51 patients on haemodialysis. RESULTS: Mean age of participants was 55 ± 15 years, 46 (79%) were male, and median dialysis vintage was 21 (8; 48) months. All patients completed the scan without complications. Mean native T1 rest, stress and ΔT1 were 1261 ± 57 ms, 1297 ± 50 ms and 2.9 ± 2.5%, respectively. Interrater and intrarater agreement of rest T1, stress T1 and ΔT1 were excellent, with intraclass correlation coefficients (ICC) > 0.9 for all. Test-retest reliability of rest and stress native T1 were excellent or good (CoV 1.2 and 1.5%; ICC, 0.79 and 0.69, respectively). Test-retest reliability of ΔT1 was moderate to poor (CoV 27.4%, ICC 0.55). On multivariate analysis, CAD, diabetes mellitus and resting native T1 time were independent determinants of ΔT1 (ß = - 0.275, p = 0.019; ß = - 0.297, p = 0.013; ß = - 0.455; p < 0.001, respectively). CONCLUSIONS: Rest and adenosine stress native T1 mapping is feasible and well-tolerated amongst patients with ESRD on haemodialysis. Although rater agreement of the technique is excellent, test-retest reliability of ΔT1 is moderate to poor. Prospective studies should evaluate the relationship between this technique and established methods of CAD assessment and association with outcomes.


Assuntos
Adenosina/administração & dosagem , Doença da Artéria Coronariana/diagnóstico por imagem , Falência Renal Crônica/terapia , Imagem por Ressonância Magnética , Diálise Renal , Vasodilatadores/administração & dosagem , Adulto , Idoso , Doença da Artéria Coronariana/fisiopatologia , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
16.
Ann Thorac Cardiovasc Surg ; 26(3): 125-132, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32475890

RESUMO

PURPOSE: Off-pump coronary arterial bypass grafting (OPCAB) has become a common practice for coronary artery bypass grafting (CABG) in Japan, with approximately 65% CABG procedures currently being performed using OPCAB. However, it is unclear whether OPCAB is superior in terms of associated mortality, incidence of complications, graft patency rate, and long-term outcomes compared with conventional CABG (CCABG). METHODS: Literature consideration was performed, mainly based on observational studies involving large samples and randomized controlled trials (RCTs). RESULTS: Many RCTs indicated that the acute-phase and long-term mortality rates were comparable between CCABG and OPCAB or that OPCAB was inferior to CCABG. In contrast, many observational studies indicated that OPCAB was superior to CCABG. CONCLUSION: CABG is a delicate procedure, the outcomes of which vary in accordance with the patient's condition as well as the level of expertise of the associated institution and surgeon. In the future, we hope that reports will emerge with excellent results, including long-term results, from Japanese institutions experienced in performing OPCAB.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Humanos , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
17.
Int J Cardiovasc Imaging ; 36(10): 2039-2050, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32488454

RESUMO

To explore the superiority of radiomics analysis in the diagnostic performance of coronary computed tomography angiography (CCTA) for identifying myocardial ischaemia and predicting major adverse cardiovascular events (MACE). A total of 105 lesions from 88 patients who underwent CCTA and invasive fractional flow reserve measurement were collected as the training set, and another 31 patients with CCTA and clinical outcome information were used as the validation set. Conventional CCTA features included the stenosis diameter, length, Agatston score and high-risk plaque characteristics. After extracting and selecting radiomics features, the robustness of the radiomics features was examined, and then conventional and radiomics models were established using logistic regressions. The area under the receiver operating characteristic (ROC) curve (AUC) and Net Reclassification Index (NRI) were analysed to compare the discrimination and classification abilities between the two models in both the training and validation sets. A total of 1409 radiomics features were extracted, and three wavelet features were finally screened out. The robustness test showed good stability for the refined radiomics features. Compared with the conventional model, the radiomics model displayed a significantly improved diagnostic performance in the training set (AUC 0.762 vs. 0.631, 95% confidence interval [CI] 0.671-0.853 vs. 0.519-0.742, P = 0.058) but a slightly improved diagnostic performance in the validation set (AUC 0.671 vs. 0.592, 95% CI 0.466-0.875 vs. 0.519-0.742, P = 0.448). The NRI of the radiomics model was increased in both the training and validation sets (NRI 0.198 and 0.238, respectively). Quantitative radiomics analysis was feasible and might help to improve the diagnostic performance of CCTA but is still controversial for predicting MACE.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Interpretação de Imagem Radiográfica Assistida por Computador , Idoso , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Análise de Ondaletas
18.
An Acad Bras Cienc ; 92(1): e20190658, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32428089

RESUMO

To investigated the role of HIF-1α in myocardial inflammatory injury in rats induced by CME and its possible mechanism. Forty SD rats were separated randomly and equally into four groups, i.e. CME+HIF-1α stabilizer dimethyloxalyl glycine (CME+DMOG) group, CME+HIF-1α inhibitor YC-1 (CME+YC-1) group, CME group, and Sham group. HBFP staining, myocardial enzyme assessment, and cardiac ultrasound were used to measure microinfarct, serum c-troponin I (cTnI) level, and Cardiac function. ELISA and western blot were applied for detecting NLRP3 inflammasome pathway and TLR4/MyD88/NF-κB signaling level.Pro-inflammatory factors of IL-18, IL-1ß and TNF-α increased their expression levels after CME, which indicated inflammatory responses in the myocardium. Additionally, in the inflammatory process, NLRP3 inflammasome and TLR4/MyD88/NF-κB signaling were involved. DMOG reverses these effects of CME, whereas YC-1 aggravates these effects. HIF-1α may attenuate myocardial inflammatory injury induced by CME and improve cardiac function, which can perhaps be explained by the fact that TLR4/MyD88/NF-κB signaling pathway activation is inhibited.


Assuntos
Doença da Artéria Coronariana/complicações , Circulação Coronária/fisiologia , Subunidade alfa do Fator 1 Induzível por Hipóxia/fisiologia , Isquemia Miocárdica/complicações , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Animais , Doença da Artéria Coronariana/fisiopatologia , Trombose Coronária , Modelos Animais de Doenças , Ensaio de Imunoadsorção Enzimática , Inflamassomos/metabolismo , Inflamação , Infarto do Miocárdio/complicações , Ratos , Ratos Sprague-Dawley , Troponina/sangue
19.
Health Qual Life Outcomes ; 18(1): 140, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32410687

RESUMO

BACKGROUND: Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. METHODS: From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. RESULTS: Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type. CONCLUSIONS: Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02400229.


Assuntos
Angina Pectoris/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Qualidade de Vida , Idoso , Angina Pectoris/classificação , Angina Pectoris/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Distribuição por Sexo , Inquéritos e Questionários
20.
Rev Assoc Med Bras (1992) ; 66(2): 160-165, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428150

RESUMO

OBJECTIVE: Coronary collateral development (CCD) predicts the severity of coronary heart disease. Hemogram parameters, such as mean platelet volume (MPV), eosinophil, red cell distribution width, and platelet distribution width (PDW), are supposed novel inflammatory markers. We aimed to compare hemogram parameter values in patients presenting with non-ST-elevation myocardial infarction (NSTEMI) with adequate or inadequate CCD. METHODS: A total of 177 patients with NSTEMI undergoing coronary arteriography were enrolled and divided into two groups based on the development of CCD: one group with adequate CCD (n=88) and the other with impaired CCD (n=89). RESULTS: Baseline demographics and clinical risk factors were similar between the groups. Hemogram parameters were not significantly different between the two groups. However, compared to the inadequate CCD group, the median PDW was significantly higher in the adequate CCD group, 17.6 (1.4) vs. 17.8 (1.6) p=0.004. In a multivariate analysis, PDW (p=0.001, 95% CI for OR: 0.489(0,319-0,750) was found to be significantly different in the adequate CCD group compared to the inadequate CCD group. Pearson's correlation analysis revealed that PDW was significantly correlated with the Rentrop score (r=0.26, p<0.001). CONCLUSIONS: We suggest that since PDW is an index that is inexpensive and easy to assess, it could serve as a marker of CCD in patients with NSTEMI.


Assuntos
Circulação Colateral/fisiologia , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária/fisiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Contagem de Células Sanguíneas , Plaquetas , Angiografia Coronária , Feminino , Humanos , Modelos Logísticos , Masculino , Volume Plaquetário Médio , Pessoa de Meia-Idade , Análise Multivariada , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas
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