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1.
J Card Surg ; 35(10): 2759-2767, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32939829

RESUMO

OBJECTIVES: Hyperglycemia is associated with an increased risk of adverse cardiovascular outcomes, such as heart failure, coronary heart disease, stroke, and in-hospital mortality. For those receiving cardiac surgery, up to half develop hyperglycemia while 30% have a diagnosis of diabetes, which is defined by chronic hyperglycemia. Due to a prothrombic state and endovascular damage, patients with diabetes have a twofold increased risk of cardiovascular events. METHODS: Electronic literature search was done to identify articles that have discussed antidiabetic medications and how it is impacting the glycemia status as well as cardiovascular outcomes. No limits were placed on timing of the publication or type of the article. Key words and MeSH terms were used to conduct the search and the results are summarized in a narrative manner within each relevant section. RESULTS: Antidiabetic medications play a key role in lowering blood glucose levels to reduce adverse cardiovascular outcomes. However, it is a challenge to assess their cardiovascular safety due to confounding factors, such as age, obesity, smoking, hyperlipidemia, and high blood pressure. Further research in this field is required to understand this correlation closely. CONCLUSION: Optimizing blood glucose level during the perioperative period with correct medication and dose have a significant role in reducing morbidities. Measures should be taken to provide a safe blood glucose level for optimum outcomes.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/cirurgia , Complicações do Diabetes/complicações , Diabetes Mellitus/tratamento farmacológico , Hiperglicemia/complicações , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Assistência Perioperatória , Complicações Pós-Operatórias/prevenção & controle , Humanos , Risco , Resultado do Tratamento
2.
Am J Cardiol ; 132: 36-43, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32773223

RESUMO

Triglyceride (TG) levels encompass several lipoproteins that have been implicated in atherogenic pathways. Whether TG levels independently associate with cardiovascular disease both overall and, in particular among patients with established coronary artery disease (CAD) and type 2 diabetes (T2DM), remains controversial. Data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial was used to evaluate patients with T2DM and CAD. Cox proportional hazards models were used to determine the association between TG levels and outcomes. Stepwise adjustment was performed for demographics, clinical factors, lipid profile and statin treatment. The primary composite outcome was time to CV death, myocardial infarction (MI), or stroke and secondary outcome was CV death. Among 2,307 patients with T2DM and CAD, the mean (±SD) TG levels were 181 (±136) with a median (Q1-Q3) 148mg/dL (104-219). Overall, 51% of patients had TG <150 mg/dL, 18% 150-199 mg/dL, 28% 200-499 mg/dL and 3% ≥500 mg/dL. Participants with elevated TG levels (≥150 mg/dL) were younger (61 vs 63 years, p <0.001), had higher BMI (32 vs 30 kg/m2, p <0.001), more likely to have had prior MI (34.2 vs 30.1%, p = 0.033) and revascularization (25.8 vs 21.4%, p = 0.013), had lower HDL-C (34 vs 39 mg/dL, p <0.001) and higher HbA1c (8 vs 7%, p <0.001). In unadjusted analyses, baseline TG levels were linearly associated with both the primary composite and secondary outcomes. In fully adjusted analyses, every 50 mg/dL increase in TG level was associated with a 3.8% (HR 1.038, 95%CI 1.004-1.072, p <0.001) increase in the primary composite outcome and a 6.4% (HR 1.064 95%CI 1.018-1.113, p <0.001) increase in the secondary outcome. There was no interaction between TG and outcomes within key subgroups including female sex, additional non-coronary atherosclerotic disease, CKD or low LDL (<100 mg/dL). In conclusion, among patients with T2DM and CAD, elevated TG were independently associated with adverse cardiovascular outcomes, even after adjustment for clinical and simple biochemical covariates.


Assuntos
Doenças Cardiovasculares/epidemiologia , Angiografia Coronária , Diabetes Mellitus Tipo 2/complicações , Medição de Risco/métodos , Triglicerídeos/sangue , Idoso , Biomarcadores/sangue , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/cirurgia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
3.
JACC Cardiovasc Interv ; 13(16): 1949-1950, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32819484

RESUMO

The coronavirus disease-19 (COVID-19) period have dictated a different approach to cardiac interventions at our medical institution. We prioritize emergent care geared toward lesser invasive approaches while minimizing hospitalization duration. This reflects upon coronary and structural/valvular cases altogether. Despite potential criticism of this approach, we believe it is the most appropriate therapeutic strategy for this unique period. Further investigation is needed to examine the external validity of our approach in other medical centers worldwide.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/normas , Doenças Cardiovasculares/cirurgia , Infecções por Coronavirus/complicações , Gerenciamento Clínico , Fidelidade a Diretrizes , Pandemias , Pneumonia Viral/complicações , Doenças Cardiovasculares/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
4.
Arq Bras Cardiol ; 115(1): 111-126, 2020 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32813825

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures.


Assuntos
Betacoronavirus , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/estatística & dados numéricos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/epidemiologia , Ecocardiografia , Humanos , Pandemias , Pneumonia Viral/epidemiologia
5.
J Invasive Cardiol ; 32(7): E178-E181, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32610270

RESUMO

BACKGROUND: COVID-19 has led to major changes in hospital systems across the world. In an effort to reduce viral transmission, conserve resources, and in accordance with institutional and state mandates, all elective procedures and surgeries were postponed during the initial outbreak. Guidelines for case selection are limited and management for pediatric catheterization laboratories during this crisis is unprecedented. OBJECTIVES: To report the protocols and case selection of a high-volume pediatric cardiac catheterization laboratory in the epicenter of the novel coronavirus (COVID-19) pandemic. METHODS: All pediatric cardiac catheterization procedures from March 16, 2020 through May 10, 2020 were reviewed. Changes to case selection and periprocedural workflow are described. Data were collected on COVID-19 testing status and primary procedure type, and all procedures were classified by urgency. RESULTS: There were 52 catheterizations performed on 50 patients. Endomyocardial biopsies were the most common procedure (n = 27; 52%). Interventional and diagnostic procedures represented 27% (n = 14) and 21% (n = 11) of cases, respectively. Two emergent procedures (3.8%) were performed on patients with positive COVID-19 testing. Most cases were performed on patients with negative COVID-19 testing (n = 33; 94%). CONCLUSIONS: Adjusting to the COVID-19 pandemic in a high-volume pediatric cardiac catheterization laboratory can be safely and effectively managed by prioritizing emergent and urgent cases and modifying workflow operations. The experience of this center may assist other pediatric cardiac catheterization laboratories in adapting to similar practice changes as the pandemic continues to evolve.


Assuntos
Cateterismo Cardíaco , Doenças Cardiovasculares , Infecções por Coronavirus , Procedimentos Clínicos , Controle de Infecções , Pandemias , Seleção de Pacientes , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/cirurgia , Criança , Protocolos Clínicos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/tendências , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , New York/epidemiologia , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
6.
Pediatr Clin North Am ; 67(4): 635-639, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650860

RESUMO

Telehealth is a promising new tool in medicine that has changed the landscape of medical care. The benefits of telehealth technology are immense, including improved access to care and potential savings in monetary and opportunity costs. Current challenges of incorporating telehealth services into regular clinical care include licensure and regulatory barriers, difficulty obtaining insurance reimbursements, and high costs of setting up successful telehealth infrastructures. These challenges threaten telehealth's future scalability and expansion to reach all patients in need.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Exercício Físico , Transplante de Coração , Estado Nutricional , Telemedicina/métodos , Adolescente , Doenças Cardiovasculares/cirurgia , Doenças Cardiovasculares/terapia , Criança , Dietoterapia , Ecocardiografia/métodos , Humanos , Reembolso de Seguro de Saúde , Pais , Telemedicina/economia , Telemedicina/legislação & jurisprudência , Função Ventricular Esquerda , Comunicação por Videoconferência
7.
J Card Surg ; 35(10): 2768-2772, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32668048

RESUMO

BACKGROUND: The coronavirus disease (COVID-19) has affected a large population across the world. Patients with cardiovascular disease have increased morbidity and mortality due to coronavirus disease. The burden over the health care system has to be reduced in this global pandemic to provide optimal care of patients with COVID-19, as well not compromising those who are in need of emergent cardiovascular care. METHODS: There is a very limited data published defining which cardiovascular procedures are to be performed or to be deferred in the COVID-19 pandemic. In this article, we have reviewed a few published guidelines regarding cardiovascular surgery in COVID-19 pandemics. CONCLUSION: After reviewing a few available guidelines regarding cardiovascular surgery in COVID-19, we conclude to perform only those surgeries which cannot be deferred to a certain period of time, to reduce the burden of the health care system of the country, provide optimal care to patients with COVID-19, and to protect health care workers and cardiovascular patients from COVID-19.


Assuntos
Betacoronavirus , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/normas , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Pandemias , Pneumonia Viral/epidemiologia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/transmissão
8.
Eur J Endocrinol ; 183(3): R57-R73, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32508312

RESUMO

Non-alcoholic fatty liver disease (NAFLD) is a growing health problem with a global prevalence of over 25% and prevalence rates of over 60% in high-risk populations. It is considered the hepatic component of the metabolic syndrome and is associated with an increased risk of the development of various liver-associated and cardiometabolic complications. Given the complexity of NAFLD and associated comorbidities and complications, treatment requires interventions from a variety of different healthcare specialties. However, many clinicians are currently insufficiently aware of the potential harm and severity of NAFLD and associated comorbidities, complications and the steps that should be taken when NAFLD is suspected. Recognizing which patients suffer from non-progressive simple steatosis, metabolically active NASH with high risk of developing cardiovascular disease and which patients have a high risk of developing cirrhosis and hepatocellular carcinoma is important. Unfortunately, this can be difficult and guidelines towards the optimal diagnostic and therapeutic approach are ambivalent. Here we review the pathogenesis, diagnostics and treatment of NAFLD and discuss how multidisciplinary care path development could move forward.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/patologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/patologia , Animais , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/cirurgia , Humanos , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/cirurgia
10.
Ann Thorac Surg ; 110(4): 1108-1118, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32591132

RESUMO

BACKGROUND: The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery program and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care, and enable support for the hospital in terms of physical resources, providers, and resident training. METHODS: In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our program, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. RESULTS: We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. CONCLUSIONS: We recognize that individual programs around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programs to plan for the future.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Doenças Cardiovasculares/cirurgia , Infecções por Coronavirus/epidemiologia , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/métodos , Doenças Cardiovasculares/epidemiologia , Comorbidade , Saúde Global , Humanos
11.
Eur J Cardiothorac Surg ; 58(4): 667-675, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32573737

RESUMO

OBJECTIVES: The onset of the coronavirus disease 2019 (COVID-19) pandemic has forced our cardiac surgery programme and hospital to enact drastic measures that has forced us to change how we care for cardiac surgery patients, assist with COVID-19 care and enable support for the hospital in terms of physical resources, providers and resident training. METHODS: In this review, we review the cardiovascular manifestations of COVID-19 and describe our system-wide adaptations to the pandemic, including the use of telemedicine, how a severe reduction in operative volume affected our programme, the process of redeployment of staff, repurposing of residents into specific task teams, the creation of operation room intensive care units, and the challenges that we faced in this process. RESULTS: We offer a revised set of definitions of surgical priority during this pandemic and how this was applied to our system, followed by specific considerations in coronary/valve, aortic, heart failure and transplant surgery. Finally, we outline a path forward for cardiac surgery for the near future. CONCLUSIONS: We recognize that individual programmes around the world will eventually face COVID-19 with varying levels of infection burden and different resources, and we hope this document can assist programmes to plan for the future.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Betacoronavirus , Procedimentos Cirúrgicos Cardíacos , Doenças Cardiovasculares/cirurgia , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde/organização & administração , Pandemias , Pneumonia Viral , Telemedicina/tendências , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Acesso aos Serviços de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Cidade de Nova Iorque/epidemiologia , Salas Cirúrgicas/organização & administração , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Telemedicina/métodos , Telemedicina/organização & administração
13.
Expert Rev Cardiovasc Ther ; 18(6): 343-353, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32400225

RESUMO

INTRODUCTION: Due to the lifestyle changes and the on-going urbanization waves there is obesity pandemic. The visceral fatty tissue of patients with obesity, in comparison with subcutaneous fat, has more gene expression related to inflammation, oxidative stress, cytokine production, and angiogenesis. The abovementioned leads to a decrease in arteriolar function and also an impaired endothelial vasodilatation and eventually endothelial dysfunction. AREAS COVERED: This review aims to provide an overview of the pathophysiology of obesity and endothelial dysfunction and the effects after bariatric and metabolic surgery and the consequences of surgery for the endothelial function. In this review, we focussed and searched for literature in Pubmed and The Cochrane library (from the earliest date of each database until February 2020) regarding endothelial function, obesity, and effects of bariatric and metabolic surgery. EXPERT OPINION: Within cardiovascular research, the endothelium and its function have a prominent role and it is the responsibility of the researchers to unravel the pathophysiological mechanisms and potential new targets for treatment of cardiovascular diseases.


Assuntos
Cirurgia Bariátrica , Endotélio Vascular/fisiopatologia , Obesidade/fisiopatologia , Doenças Cardiovasculares/cirurgia , Humanos , Obesidade/cirurgia
14.
Curr Cardiol Rep ; 22(7): 37, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32430786

RESUMO

PURPOSE OF THE REVIEW: Low- and middle-income countries (LMICs) have long-battled communicable diseases, and now, a rise in non-communicable diseases (NCD) is conferring tremendous burden in these areas. Cardiovascular disease (CVD) remains the number one cause of death among NCDs across the globe. The current review provides insight regarding this disease burden and highlights challenges as well as strategies for establishing functional cardiac surgery centers and sustainable access to comprehensive cardiovascular care within LMICs. RECENT FINDINGS: Without effective prevention and treatment strategies, estimates suggest that deaths from CVDs will reach 24 million by the year 2030. Surgery exists as a limited option for selected patients with advanced cardiac disease in LMICs in comparison with its availability in developed countries. Multi-lateral or public-private initiatives, government investment, philanthropic efforts, innovative financing systems to strengthen Universal Health Coverage, and expansion of training options through centers of excellence appear to be the way forward to broadening the availability of cardiovascular services, inclusive of surgery, to LMICs.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças Cardiovasculares/cirurgia , Acesso aos Serviços de Saúde , Países em Desenvolvimento , Humanos
17.
J Cardiothorac Vasc Anesth ; 34(6): 1397-1401, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-19627

RESUMO

The outbreak of a new coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) in China in December 2019 has brought serious challenges to disease prevention and public health. Patients with severe coronavirus disease 2019 (COVID-19) who undergo cardiovascular surgery necessitate extremely high demands from anesthesia personnel, and face high risks of mortality and morbidity. Based on the current understanding of COVID-19 and the clinical characteristics of cardiovascular surgical patients, the authors provide anesthesia management guidelines for cardiovascular surgery along with the prevention and control of COVID-19.


Assuntos
Anestésicos/uso terapêutico , Consenso , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Anestesiologia/métodos , Doenças Cardiovasculares/cirurgia , Doenças Cardiovasculares/virologia , Procedimentos Cirúrgicos Cardiovasculares , Sistema Cardiovascular/virologia , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Sistema Renina-Angiotensina/fisiologia
20.
J Cardiothorac Vasc Anesth ; 34(6): 1397-1401, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32268984

RESUMO

The outbreak of a new coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) in China in December 2019 has brought serious challenges to disease prevention and public health. Patients with severe coronavirus disease 2019 (COVID-19) who undergo cardiovascular surgery necessitate extremely high demands from anesthesia personnel, and face high risks of mortality and morbidity. Based on the current understanding of COVID-19 and the clinical characteristics of cardiovascular surgical patients, the authors provide anesthesia management guidelines for cardiovascular surgery along with the prevention and control of COVID-19.


Assuntos
Anestésicos/uso terapêutico , Consenso , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Anestesiologia/métodos , Doenças Cardiovasculares/cirurgia , Doenças Cardiovasculares/virologia , Procedimentos Cirúrgicos Cardiovasculares , Sistema Cardiovascular/virologia , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Sistema Renina-Angiotensina/fisiologia
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