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1.
Orv Hetil ; 161(5): 169-176, 2020 02.
Artigo em Húngaro | MEDLINE | ID: mdl-31984773

RESUMO

Introduction: Hypereosinophilic syndrome (HES) and immunoglobulin light-chain amyloidosis (ALA) are two, rare haematological disorders associated with cardiac alterations. Aim: The goal of the present study was a comparative assessment of left ventricular (LV) deformational parameters in HES and ALA patients using three-dimensional speckle-tracking echocardiography (3DSTE). Method: In the present study, results of 10 HES patients (mean age: 60.9 ± 14.7 years) and 19 ALA patients (mean age: 63.4 ± 7.8 years, 13 males) were analysed. The control group contained 13 age- and gender-matched healthy adults (mean age: 59.2 ± 4.3 years, 5 males). All patients underwent a complete two-dimensional Doppler echocardiography followed by 3DSTE. Results: All basal segmental LV strains were significantly reduced in ALA patients as compared to the control group. Global and mean segmental LV longitudinal strain (LS) values of ALA patients proved to be significantly decreased as compared to those of the healthy control group. During comparison of HES patients and healthy controls, significant difference could be detected in global LV-LS, while segmental basal LV-LS was also significantly reduced in HES patients. Basal LV radial and 3D strains showed significant differences when parameters of HES and ALA patient groups were compared. Conclusion: 3DSTE is a feasible tool for the detailed assessment of LV deformation in HES and ALA patients. Significant LV deformational abnormalities could be detected in both groups. In the case of ALA, these abnormalities are more prominent. Orv Hetil. 2020; 161(5): 169-176.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ventrículos do Coração/diagnóstico por imagem , Síndrome Hipereosinofílica , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatias/imunologia , Cardiomiopatias/fisiopatologia , Estudos de Casos e Controles , Ecocardiografia Doppler , Feminino , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/imunologia , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/imunologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
2.
Vasc Health Risk Manag ; 15: 375-384, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695398

RESUMO

Background: Survivors of myocardial infarction (MI) are at high risk of new major adverse cardiovascular events (MACE). Coronary flow reserve (CFR) is a strong and independent predictor of MACE. Understanding the prevalence of impaired CFR in this patient group and identifying risk markers for impaired CFR are important steps in the development of personalized and targeted treatment for high-risk individuals with prior MI. Methods: PROFLOW is a prospective, exploratory, cross-sectional open study. We used information from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) to identify high-risk patients with a history of type-1 MI. We measured CFR non-invasively in a left anterior descending artery (LAD) using transthoracic Doppler echocardiography. Coronary flow velocity was measured at rest and at maximal flow after induction of hyperemia by intravenous infusion of adenosine (140 µg/kg/min). Independent predictors of CFR were assessed with multiple linear regression. Results: We included 619 patients. The median age was 69 (IQR 65-73), and 114 (18.4%) were women. Almost one-half of the patients, 285 (46.0%) had the multi-vessel disease, and 147 (23.7%) were incompletely revascularized. The majority were on optimal standard treatment eg ASA (93.1%), statins (90.0%), ACEI/ARB (82.6%) and beta-blockers (80.8%). The majority, 547 (88.4%) had no angina pectoris, and 572 (92.2%) were in NYHA class I. Evaluation of CFR was possible in 611 (98.7%) patients. Mean CFR was 2.74 (±0.79 (mean ± SD)). A substantial number of patients (39.7%) had CFR ≤2.5. In a multiple linear regression model age, dyslipidemia, smoking, hypertension, body mass index, incomplete revascularization, and treatment with angiotensin receptor blockers were independent predictors of CFR. Conclusion: In this high-risk group of patients with prior MI, the prevalence of impaired CFR was high. Further risk stratification with CFR in addition to traditional cardiovascular risk factors may improve predictive accuracy for future MACE in this patient population.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler , Reserva Fracionada de Fluxo Miocárdico , Infarto do Miocárdio/diagnóstico por imagem , Adenosina/administração & dosagem , Idoso , Velocidade do Fluxo Sanguíneo , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/terapia , Vasos Coronários/fisiopatologia , Estudos Transversais , Feminino , Humanos , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Prevenção Secundária , Suécia/epidemiologia , Vasodilatadores/administração & dosagem
3.
Tex Heart Inst J ; 46(3): 219-221, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708708

RESUMO

Bioprosthetic valve thrombosis was previously considered to be a relatively rare complication of surgical or transcatheter bioprosthetic valve replacement. Although echocardiograms can reliably show the characteristic findings of prosthetic valve stenosis, differentiating between thrombus formation and pannus overgrowth as the underlying cause of prosthetic valve dysfunction can be challenging. We present the case of a 75-year-old man who underwent transthoracic Doppler echocardiography in the presence of an elevated valvular gradient 2 years after his aortic valve had been surgically replaced with a bioprosthesis. The echocardiographic findings suggested prosthetic valve stenosis. Cardiac computed tomography, performed to distinguish between thrombus formation and pannus overgrowth, revealed hypoattenuated leaflet thickening and reduced leaflet mobility, which suggested thrombus. After the patient took oral anticoagulants for 3 months, images showed complete resolution of the previous abnormalities, thus confirming the diagnosis of bioprosthetic valve thrombosis. We found cardiac computed tomography valuable when evaluating our patient who had an elevated prosthetic valve gradient.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Bioprótese/efeitos adversos , Cardiopatias/diagnóstico , Trombose/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Diagnóstico Diferencial , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Cardiopatias/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Desenho de Prótese
4.
ABC., imagem cardiovasc ; 32(4): 303-308, out.-dez. 2019. tab, ilus, graf
Artigo em Português | LILACS | ID: biblio-1023931

RESUMO

A cardiomiopatia hipertrófica é uma doença de origem genética, que afeta milhares de pessoas em todo o mundo.Objetivos: Avaliar a presença de regurgitação mitral em pacientes com cardiomiopatia hipertrófica, bem como sua relação com variáveis ecodopplercardiográficas do ventrículo esquerdo. A disfunção de valva mitral encontradas nesses pacientes mostra-se um dado de extrema relevância, visto que é capaz de predizer a sobrevida e a taxa de mortalidade dos enfermos acometidos pela cardiomiopatia hipertrófica.Métodos: Foram avaliados todos os ecocardiogramas realizados no período de 2006 a 2016 no serviço de ecocardiografia do Hospital de Base de São José do Rio Preto, sendo o total de 112.930 exames. Foram selecionados aqueles com diagnóstico de cardiomiopatia hipertrófica ou espessura parietal > 15 mm, e incluídos na análise 132 pacientes.Resultados: Regurgitação valvar mitral de grau moderado e importante esteve presente em 25% e 5,3% dos pacientes, respectivamente, sendo que a regurgitação mitral esteve independentemente correlacionada com a forma obstrutiva de cardiomiopatia hipertrófica.Conclusão: A regurgitação mitral é achado frequente em pacientes com cardiomiopatia hipertrófica, no entanto, a insuficiência mitral importante é extremamente incomum e está correlacionada com a forma obstrutiva da doença


Hypertrophic Cardiomyopathy (HCM) is a genetic disease that affects thousands of people around the world.Objectives:The present study aims to evaluate the presence of mitral regurgitation in patients with HCM, as well as its relationship with left ventricular Doppler echocardiographic variables. The mitral valve failure found in these patients is an extremely important finding, since it is able to predict the survival and mortality rate of the patients affected by HCM.Materials and Methods: All echocardiograms performed from 2006 to 2016 in the echocardiographic service of Hospital de Base de São José do Rio Preto were evaluated. A total of 112,930 tests were gathered, of which those with HCM diagnosis or wall thickness >15 mm were selected and 132 patients were included in the analysis.Results: Moderate and major mitral valve regurgitation is present in 25% and 5.3% of the patients, respectively, and MRI is independently correlated with the obstructive form of HCM.Conclusion: Mitral regurgitation is a frequent finding in patients with CMP, however, significant MI is extremely uncommon and is correlated with the obstructive form of the disease


Assuntos
Humanos , Masculino , Feminino , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/genética , Ecocardiografia/métodos , Insuficiência da Valva Mitral , Volume Sistólico , Ecocardiografia Doppler/métodos , Análise Estatística , Estudos Retrospectivos , Ventrículos do Coração , Hipertensão , Valva Mitral
5.
ABC., imagem cardiovasc ; 32(4): 318-30, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1024061

RESUMO

A doença pulmonar hipertensiva pode ser definida como um conjunto de alterações fisiopatológicas pulmonares que resultam em uma patologia grave, progressiva e com alta morbimortalidade. O ecocardiograma transtorácico é um método de imagem de fácil acesso e essencial para avaliação desta doença, principalmente na faixa pediátrica, na qual há limitações para realização frequente e de rotina do cateterismo direito. Nesta revisão, abordaremos as principais técnicas ecocardiográficas para o diagnóstico e a avaliação hemodinâmica da hipertensão pulmonar na população pediátrica. O diagnóstico precoce e o adequado estadiamento no acompanhamento das intervenções clínicas são fundamentais para escolha assertiva da abordagem terapêutica e, consequentemente, melhora do desfecho clínico


Assuntos
Humanos , Masculino , Feminino , Pediatria , Ecocardiografia/métodos , Criança , Hipertensão Pulmonar/mortalidade , Artéria Pulmonar , Valva Tricúspide , Veia Cava Inferior , Cateterismo Cardíaco , Ecocardiografia Doppler/métodos , Disfunção Ventricular Direita , Disfunção Ventricular Esquerda , Átrios do Coração , Ventrículos do Coração
6.
Int J Med Sci ; 16(8): 1171-1179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31523180

RESUMO

AIM: To investigate the association between plasma S100A1 level and ST-segment elevation myocardial infarction (STEMI) and potential significance of S100A1 in post-infarction cardiac function. METHODS: We examined the plasma S100A1 level in 207 STEMI patients (STEMI group) and 217 clinically healthy subjects for routine physical examination without a history of coronary artery disease (Control group). Baseline characteristics and concentrations of relevant biomarkers were compared. The relationship between S100A1 and other plasma biomarkers was detected using correlation analysis. The predictive role of S100A1 on occurrence of STEMI was then assessed using multivariate ordinal regression model analysis after adjusting for other covariates. RESULTS: The plasma S100A1 level was found to be significantly higher (P<0.001) in STEMI group (3197.7±1576.0 pg/mL) than in Control (1423.5±1315.5 pg/mL) group. Furthermore, the correlation analysis demonstrated plasma S100A1 level was significantly associated correlated with hypersensitive cardiac troponin T (hs-cTnT) (r = 0.32; P < 0.001), creatine kinase MB (CK-MB) (r = 0.42, P < 0.001), left ventricular eject fraction (LVEF) (r = -0.12, P = 0.01), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (r = 0.61; P < 0.001) and hypersensitive C reactive protein (hs-CRP) (r = 0.38; P < 0.001). Moreover, the enrolled subjects who with a S100A1 concentration ≤ 1965.9 pg/mL presented significantly better cardiac function than the rest population. Multivariate Logistic regression analysis revealed that S100A1 was an independent predictor for STEMI patients (OR: 0.671, 95% CI 0.500-0.891, P<0.001). In addition, higher S100A1 concentration (> 1965.9 pg/mL) significantly increased the risk of STEMI as compared with the lower level (OR: 6.925; 95% CI: 4.15-11.375; P<0.001). CONCLUSION: These results indicated that the elevated plasma S100A1 level is an important predictor of STEMI in combination with several biomarkers and also potentially reflects the cardiac function following the acute coronary ischemia.


Assuntos
Proteínas S100/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Creatina Quinase Forma MB/sangue , Ecocardiografia Doppler , Feminino , Testes de Função Cardíaca , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Troponina T/sangue
7.
J Radiol Case Rep ; 13(7): 1-13, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31558962

RESUMO

Uterine intravenous leiomyomatosis is an uncommon tumor, usually arising from the uterus, with nodular masses which extend intravascularly over variable distances and may reach the inferior vena cava, right atrium, and pulmonary arteries. Early diagnosis and surgical intervention are crucial as intracardiac leiomyomatosis not only causes cardiac symptoms but may result in pulmonary embolism and sudden death. Complete tumor resection is key in disease management, thus rendering cardiac-extending uterine intravenous leiomyomatosis one of the most challenging conditions for surgical treatment. The use of interventional radiology procedures can facilitate the surgical approach. We report the case of a massive pelvic recurrence of uterine leiomyomatosis with intracardiac extension and pulmonary embolism, analyzing management and surgical outcomes, highlighting the role of interventional radiology during the therapeutic pathway. Nonetheless, there are currently very few data available concerning the use of interventional radiology procedures in the therapeutic strategy of uterine intravenous leiomyomatosis with intracardiac extension.


Assuntos
Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Leiomiomatose/complicações , Leiomiomatose/diagnóstico por imagem , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico por imagem , Ecocardiografia Doppler , Feminino , Coração/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Leiomiomatose/patologia , Leiomiomatose/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Neoplasias Uterinas/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgia
8.
Pan Afr Med J ; 33: 97, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489075

RESUMO

Libman-Sacks endocarditis is a rare cardiac manifestation systemic lupus erythematosus, in which there is a sterile vegetation in the heart valves. There is a significant risk of infective endocarditis. Our patient was a 38 year old woman with persistent fever from two months with inflammatory polyarthralgia, fixed at the wrists and ankles. She was febrile at 39 ° C, had a mitral systolic murmur 2/6 and painful swelling of the wrists and ankles. We have objectified an inflammatory syndrome, blood cultures were negative. The dosage of anti-nuclear antibody was positive with a mottled appearance, as well as anti-DNA antibodies. The Doppler echocardiography had objectified vegetations in the mitral and aortic valves. Clinical, biological and morphological improvements were obtained after antibiotic and corticosteroid combination. We can conclude that Libman-Sacks endocarditis evolution is favorable in the absence of an associated antiphospholipid syndrome (APS). Always fear in all cases a surinfection. The treatment is based on the combination antibiotic-corticosteroid-synthetic antimalarial.


Assuntos
Anticorpos Antinucleares/imunologia , Endocardite/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Corticosteroides/administração & dosagem , Adulto , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Ecocardiografia Doppler/métodos , Endocardite/etiologia , Endocardite/imunologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Superinfecção/diagnóstico
9.
Int Heart J ; 60(5): 1211-1218, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484857

RESUMO

Extra- and/or intracorporeal renal replacement therapy can improve the cardiorenal hemodynamics in patients with advanced heart failure (HF) refractory to medical therapy and renal failure. Here, we report the case of a 51-year-old woman with inotrope-dependent end-stage HF and chronic renal failure due to anthracycline-induced cardiomyopathy, in whom the induction of hemodiafiltration and subsequent chronic peritoneal dialysis (PD) provided a dramatic improvement of her cardiac hemodynamics from restrictive to almost normal physiology assessed by echocardiography and cardiac catheterization. The patient returned to office work with New York Heart Association functional class I-II symptoms for at least 3 years with continuous ambulatory PD after hospital discharge.


Assuntos
Síndrome Cardiorrenal/terapia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Peritoneal/métodos , Antraciclinas/efeitos adversos , Antraciclinas/uso terapêutico , Biópsia por Agulha , Síndrome Cardiorrenal/diagnóstico por imagem , Doença Crônica , Progressão da Doença , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Insuficiência Cardíaca/terapia , Hemodiafiltração/métodos , Hemodinâmica/fisiologia , Humanos , Imuno-Histoquímica , Falência Renal Crônica/diagnóstico , Pessoa de Meia-Idade , Prognóstico , Retorno ao Trabalho , Resultado do Tratamento
10.
Int Heart J ; 60(5): 1201-1205, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484869

RESUMO

Right-sided accessary pathways in patients with Wolff-Parkinson-White (WPW) syndrome may cause cardiac dyssynchrony and dilated cardiomyopathy, with a characteristic septal shape, irrespective of any supraventricular tachycardia episodes. We report on two infants (13 and 5 months), whose right-sided accessary pathway-induced dilated cardiomyopathy was successfully treated by flecainide for the first time. After the flecainide administration, an abnormal aneurysmal dilation of the basal interventricular septum was almost restored to normal, and the decreased ejection fraction recovered. Flecainide use may be an important therapeutic option for this entity to avoid catheter ablation during infancy.


Assuntos
Feixe Acessório Atrioventricular/diagnóstico por imagem , Feixe Acessório Atrioventricular/tratamento farmacológico , Cardiomiopatia Dilatada/diagnóstico por imagem , Flecainida/uso terapêutico , Síndrome de Wolff-Parkinson-White/diagnóstico por imagem , Feixe Acessório Atrioventricular/complicações , Cardiomiopatia Dilatada/tratamento farmacológico , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/terapia , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Lactente , Injeções Intravenosas , Masculino , Medição de Risco , Amostragem , Resultado do Tratamento , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/fisiopatologia
11.
Int Heart J ; 60(5): 1106-1112, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484874

RESUMO

A useful biomarker for detecting cardiac amyloidosis (CA) has not been fully established. We aimed to investigate the utility of several biomarkers to detect CA in patients with amyloid light-chain (AL) amyloidosis.We examined the plasma levels of B-type natriuretic peptide (BNP), N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), serum amyloid A, and the difference between kappa and lambda free light chain (dFLC) between CA patients (n = 30, 47.6%) and non-CA patients (n = 33, 52.4%). Levels of BNP were significantly higher in the CA group compared to the non-CA group (1200.0 versus 224.0 pg/mL, P = 0.001). From the ROC analysis, the sensitivity and specificity of BNP for detecting CA (with a cut-off value of 412 pg/mL) were 83% and 70%, respectively, and the area under the receiver operating curve was 0.75 (95% CI 0.61-0.90, P < 0.001) in all AL amyloidosis patients (n = 63). In contrast, other markers such as NT-proBNP, hs-cTnT, serum amyloid A, and dFLC were not useful for detecting CA in AL amyloidosis patients. Additionally, in the Cox proportional hazard analysis, BNP was a predictor of all-cause mortality (hazard ratio 3.266, 95% confidence interval 1.498-7.119, P = 0.003).BNP is a useful biomarker for detecting cardiac involvement and predicting prognosis in AL amyloidosis patients.


Assuntos
Cardiopatias/sangue , Cardiopatias/epidemiologia , Amiloidose de Cadeia Leve de Imunoglobulina/sangue , Peptídeo Natriurético Encefálico/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Causas de Morte , Estudos de Coortes , Progressão da Doença , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Feminino , Cardiopatias/diagnóstico por imagem , Hospitais Universitários , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
12.
J Vet Cardiol ; 24: 85-94, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405559

RESUMO

INTRODUCTION: Non-invasive diagnosis of pulmonary hypertension (PH) relies on estimation of pulmonary arterial pressure (PAP) via Doppler echocardiographic measurement of tricuspid regurgitation pressure gradient (TRPG). The pulmonary vein-to-right pulmonary artery ratio (PV/PA) recently has been described for the detection of pulmonary venous congestion. Whether this variable could be used to detect the presence of precapillary PH is unknown. The objective of the present study was to investigate the diagnostic value of PV/PA for prediction of TRPG, as a surrogate of PAP, in dogs with PH of precapillary origin. ANIMALS: Sixty-seven client-owned dogs were included in the study. METHODS: This was a retrospective study. Dogs with a measurable TRPG were included and classified into group 1 (TRPG < 30 mmHg), group 2 (TRPG 30-49 mmHg), group 3 (TRPG 50-80 mmHg), or group 4 (TRPG > 80 mmHg). The PV/PA, acceleration time-to-ejection time ratio of pulmonary artery flow, main pulmonary artery diameter-to-aortic diameter ratio, and right pulmonary artery distensibility index were measured retrospectively from cineloops in each dog. RESULTS: The PV/PA measured by both two-dimensional (2D) and time-motion mode(MM) echocardiography decreased proportionally with PH severity. Using regression analysis, PV/PA (2D) was identified as the strongest predictor for TRPG (R2 = 0.70, p < 0.0001) among other variables studied, with a good diagnostic accuracy (area under the curve = 0.94) for moderate PH (TRPG > 50 mmHg) using a cutoff value of < 0.70 (sensitivity = 96%, specificity = 82%). CONCLUSIONS: Results of the present study suggest that PV/PA can be useful as an additional, non-invasive, and indirect variable to identify precapillary PH in dogs.


Assuntos
Doenças do Cão/diagnóstico , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar/diagnóstico por imagem , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia Doppler/veterinária , Feminino , Hipertensão Pulmonar/diagnóstico por imagem , Masculino , Sensibilidade e Especificidade
13.
Congenit Heart Dis ; 14(4): 671-677, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31368237

RESUMO

BACKGROUND: Since routine clinical use of antibiotics as well as surgical and catheter-based closure of a patent arterial duct (PDA), PDA-associated infective endarteritis (PDA-IE) is rare but can still occur when the ductus is still open or as it closes. Thus, clinicians should maintain a high index of concern for patients with unexplained fever. METHODS: We report on a PDA-IE in a young infant shortly after potentially delayed obliteration of a PDA. We discuss this case report by reviewing the literature in regard to the pathogenesis (infection primary or secondary to PDA thrombus formation), clinical (new heart murmur) and diagnostic findings (transthoracic echocardiography, total body MRI, laboratory findings), and clinical outcome during mid-term follow-up after successful antibiotic treatment. RESULTS: A 7-week-old term infant with Staphylococcus aureus sepsis and a new heart murmur was diagnosed with PDA-IE by transthoracic echocardiography at the pulmonary artery end of an obliterated PDA. Broad diagnostic workup excluded other reasons for sepsis. After 4 weeks of antibiotic treatment the vegetation reduced in size and the infant recovered completely. A review of all cases of PDA-IE (in pediatric and adult patients) previously published was performed. CONCLUSION: Nowadays, a PDA-IE is an extremely rare, but still life-threating condition that may even affect patients with a nonpatent ductus arteriosus shortly after its obliteration and should be considered as infective complication in preterms, neonates, and small infants. Therefore, in septic neonates with bacteremia, transthoracic echocardiography may be integrated in the diagnostic workup, especially by fever without source and clinical signs of IE such as a new heart murmur.


Assuntos
Permeabilidade do Canal Arterial/complicações , Endocardite Bacteriana/etiologia , Infecções Estafilocócicas/etiologia , Permeabilidade do Canal Arterial/diagnóstico , Ecocardiografia Doppler , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Seguimentos , Humanos , Lactente , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação
14.
Rev Assoc Med Bras (1992) ; 65(7): 946-950, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389502

RESUMO

OBJECTIVE: A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. METHODS: A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. RESULTS: Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. CONCLUSION: PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Hipertensão Pulmonar/complicações , Trombose Venosa/etiologia , Idoso , Ecocardiografia Doppler , Feminino , Quadril/irrigação sanguínea , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Joelho/irrigação sanguínea , Masculino , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/diagnóstico por imagem
18.
Int J Cardiovasc Imaging ; 35(11): 2037-2047, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31297672

RESUMO

Left ventricular (LV) adaptation to aging is currently poorly understood. We aimed to characterize age related changes in LV structure and function by studying a large group of healthy subjects across a wide age range. Prospectively enrolled healthy volunteers (n = 778, 327 females; age 18 to 100 years, mean age 49.8 ± 18.1 years), were divided into 4 age groups: 18 to 34 years (n = 165); 35 to 49 years (n = 242), 50 to 79 years (n = 334) and ≥ 80 years (n = 40). All subjects underwent clinical examination, as well as comprehensive transthoracic echocardiogram [TTE]. Body mass index, systolic blood pressure (BP), and left atrial volume (p < 0.0001) increased with age while diastolic BP (p < 0.0001) decreased over time. LV mass/body surface area (BSA) and relative wall thickness increased with age (p < 0.0001) coincident with worsening parameters of diastolic function (E/A and E/Em, p < 0.0001). The ejection fraction and Sm did not change significantly. Stroke volume, ejection time index, flow rate and stroke work significantly increased with age (p < 0.01). The arterial elastance (Ea), a measure of ventricular afterload, and ventricular elastance (Ees), an index of LV systolic stiffness did not change with age nor did their ratio (Ees/Ea) the latter being an expression of ventricular-arterial coupling. Age, gender and LVM were the main independent variables associated with LV systolic function. In conclusion, LV adaptation to aging in a healthy cohort is characterized by concentric LV remodeling, increased contractility and preserved ventricular-arterial coupling.


Assuntos
Envelhecimento , Ecocardiografia Doppler , Ventrículos do Coração/diagnóstico por imagem , Contração Miocárdica , Função Ventricular Esquerda , Remodelação Ventricular , Adaptação Fisiológica , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores Sexuais , Adulto Jovem
19.
Rev Port Cardiol ; 38(6): 419-423, 2019 06.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31324408

RESUMO

INTRODUCTION: Imbalance between pro- and anti-inflammatory cytokines secreted from visceral adipose tissue (VAT) contributes to the pathogenesis of certain cardiovascular and metabolic disorders, including insulin resistance. Epicardial adipose tissue (EAT) is a form of VAT mainly concentrated along the coronary arteries. It has been shown in various studies that EAT thickness is positively correlated with cardiovascular disease. Due to its high worldwide prevalence, prevention and management of type 2 diabetes (T2D) has become a major public health challenge. Metformin, the most widely prescribed drug to treat T2D, has favorable effects on VAT and body weight. As metformin decreases VAT mass, in this prospective study we analyzed the possible positive effect of metformin on EAT mass, which is organ-specific VAT, and body mass index (BMI). METHODS: Subjects were selected from patients admitted to the internal medicine outpatient clinic. Newly diagnosed T2D patients treated with metformin monotherapy were analyzed and 40 patients were included. EAT thickness in the included patients was measured echocardiographically. BMI and EAT thickness were analyzed at the beginning (BMI0 and EAT0) and after three months of metformin monotherapy (BMI3 and EAT3). RESULTS: There was a statistically significant decrease in EAT thickness after three months of metformin monotherapy (EAT0=5.07±1.33 mm vs. EAT3=4.76±1.32 mm; p<0.001). Furthermore, BMI was also significantly decreased (BMI0=28.27±2.71 vs. BMI3=27.29±2.10; p<0.0001). CONCLUSIONS: In this study we show that metformin monotherapy significantly decreases EAT thickness and BMI in T2D patients. This suggests that metformin could reduce the frequency of coronary atherosclerosis.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Metformina/uso terapêutico , Pericárdio/diagnóstico por imagem , Índice de Massa Corporal , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
20.
Pediatr Cardiol ; 40(7): 1460-1467, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324952

RESUMO

This study was aimed at determining if the myocardial performance index (MPI) is altered in well-controlled gestational diabetics and if so whether it is predictive of adverse perinatal outcome. In a prospective cross-sectional study, 54 consecutive women with well-controlled gestational diabetes controlled on insulin or metformin in the third trimester were recruited and matched with 54 women with normal pregnancies (control group). Using Doppler echocardiography, the MPI was calculated. Sonographic biophysical and placental resistance Doppler markers in both groups were also determined. An abnormal outcome was defined as any of the following: stillbirth; neonatal death; neonatal intensive care admissions; tachypnea with pulmonary edema; neonatal cord pH < 7.15; 5-min Apgar score < 7, polycythemia; and nucleated red blood cells > 10/100 white blood cell counts, hypoglycemia. The MPI was significantly higher in the diabetic group compared to controls (p < 0.0001). Rate of adverse outcome was 22% in the diabetic group. The diabetic group with adverse outcomes had significantly elevated MPI values compared to the diabetic group with normal outcomes. There were 26 diabetics controlled on metformin and 28 controlled on insulin. The adverse outcome rate was slightly higher in the IDDM group compared to the non-insulin-dependent group but was not statistically significant. The main adverse outcomes were low Apgars (18%), hypoglycemia (22%), polycythemia (13%) and low pH in 7%. All control births had normal outcomes. MPI served as an independent predictor of adverse outcome. The MPI z-score had a good diagnostic accuracy as evidenced by the area under the ROC curve of 0.83. An MPI z-score exceeding 4.55 conferred a 90% sensitivity and 74% specificity, with 77% of outcomes correctly classified with a likelihood ratio of 3.5. The MPI is impaired in fetuses in well-controlled gestational diabetes, with fetuses with an adverse outcome having significantly higher MPI values compared to the fetuses with normal outcome in the diabetic group. MPI has the potential to improve fetal surveillance in gestational diabetes.


Assuntos
Diabetes Gestacional/fisiopatologia , Coração Fetal/fisiopatologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia Doppler , Feminino , Coração Fetal/diagnóstico por imagem , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal
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