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1.
J Assoc Physicians India ; 68(11): 74-76, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33187045

RESUMO

Leiyomyosarcoma of vascular origin is rarely seen occurring in the Inferior Vena Cava. We report a rare case of a young male with giant retroperitoneal leiyomyosarcoma which extended into the right atrium.


Assuntos
Fibrilação Atrial , Leiomiossarcoma , Neoplasias Vasculares , Átrios do Coração/diagnóstico por imagem , Humanos , Leiomiossarcoma/diagnóstico por imagem , Masculino , Veia Cava Inferior/diagnóstico por imagem
2.
Pan Afr Med J ; 35(Suppl 2): 150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193965

RESUMO

The new coronavirus 2019 epidemic declared in China on December 31, 2019 soon spread to the rest of the world, becoming the subject of an unprecedented health pandemic according to the World Health Organization's declaration of March 11, 2020. It is a disease that has the potential to cause multiple systemic infections. We report here the case of an acute polyradiculoneuritis of the Guillain-Barré type (GBS) indicative of a COVID-19 infection. This is a 41 year old patient seen for ascending, symmetrical and bilateral, progressive and acute tetraparesis with in a context of influenza syndrome and digestive infections treated 2 weeks earlier. During a COVID-19 infection, certain inflammatory cells stimulated by the virus produce inflammatory cytokines creating immune-mediated processes. The same mechanism is observed in GBS being also an immune-mediated disorder. The management of this disease in COVID-19 positive patients does not differ from that of patients who do not carry the virus. The risk of respiratory distress in COVID-19 positive patients becomes twice as great in patients with GBS who test positive for COVID-19 at the same time. Monitoring for hemodynamic disorders and respiratory distress in a neuro-intensive care unit may be fruitful.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/etiologia , Pneumonia Viral/complicações , Adulto , Fibrilação Atrial/complicações , Azitromicina/uso terapêutico , Betacoronavirus/isolamento & purificação , Cloroquina/efeitos adversos , Cloroquina/uso terapêutico , Técnicas de Laboratório Clínico , Terapia Combinada , Contraindicações de Medicamentos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Diagnóstico Precoce , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/fisiopatologia , Síndrome de Guillain-Barré/terapia , Humanos , Masculino , Debilidade Muscular/etiologia , Nasofaringe/virologia , Transtornos do Olfato/etiologia , Oxigenoterapia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Quadriplegia/etiologia , Respiração Artificial , Incontinência Urinária/etiologia
3.
Eur Heart J ; 41(41): 4011-4020, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33205821

RESUMO

AIMS: The risk and burden of cardiovascular disease (CVD) are higher in homeless than in housed individuals but population-based analyses are lacking. The aim of this study was to investigate prevalence, incidence and outcomes across a range of specific CVDs among homeless individuals. METHODS AND RESULTS: Using linked UK primary care electronic health records (EHRs) and validated phenotypes, we identified homeless individuals aged ≥16 years between 1998 and 2019, and age- and sex-matched housed controls in a 1:5 ratio. For 12 CVDs (stable angina; unstable angina; myocardial infarction; sudden cardiac death or cardiac arrest; unheralded coronary death; heart failure; transient ischaemic attack; ischaemic stroke; subarachnoid haemorrhage; intracerebral haemorrhage; peripheral arterial disease; abdominal aortic aneurysm), we estimated prevalence, incidence, and 1-year mortality post-diagnosis, comparing homeless and housed groups. We identified 8492 homeless individuals (32 134 matched housed individuals). Comorbidities and risk factors were more prevalent in homeless people, e.g. smoking: 78.1% vs. 48.3% and atrial fibrillation: 9.9% vs. 8.6%, P < 0.001. CVD prevalence (11.6% vs. 6.5%), incidence (14.7 vs. 8.1 per 1000 person-years), and 1-year mortality risk [adjusted hazard ratio 1.64, 95% confidence interval (CI) 1.29-2.08, P < 0.001] were higher, and onset was earlier (difference 4.6, 95% CI 2.8-6.3 years, P < 0.001), in homeless, compared with housed people. Homeless individuals had higher CVD incidence in all three arterial territories than housed people. CONCLUSION: CVD in homeless individuals has high prevalence, incidence, and 1-year mortality risk post-diagnosis with earlier onset, and high burden of risk factors. Inclusion health and social care strategies should reflect this high preventable and treatable burden, which is increasingly important in the current COVID-19 context.


Assuntos
Fibrilação Atrial , Isquemia Encefálica , Doenças Cardiovasculares , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Acidente Vascular Cerebral , Angiotensinas , Betacoronavirus , Doenças Cardiovasculares/epidemiologia , Registros Eletrônicos de Saúde , Humanos , Incidência , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
6.
BMJ Case Rep ; 13(11)2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148560

RESUMO

A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.


Assuntos
Aspirina/administração & dosagem , Fibrilação Atrial , Cegueira , Infartos do Tronco Encefálico , Infecções por Coronavirus , Diplopia , Endocardite Bacteriana , Oftalmoplegia , Pandemias , Pneumonia Viral , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Oclusão da Artéria Retiniana , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Betacoronavirus/isolamento & purificação , Cegueira/diagnóstico , Cegueira/etiologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/tratamento farmacológico , Infartos do Tronco Encefálico/fisiopatologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diplopia/diagnóstico , Diplopia/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/fisiopatologia , Inibidores do Fator Xa/administração & dosagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Oclusão da Artéria Retiniana/diagnóstico por imagem , Oclusão da Artéria Retiniana/tratamento farmacológico , Oclusão da Artéria Retiniana/etiologia , Oclusão da Artéria Retiniana/fisiopatologia , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
7.
Kardiologiia ; 60(8): 90-97, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155964

RESUMO

Aim To compare the efficacy of radiofrequency ablation (RFA) and antiarrhythmic therapy (AAT) in patients with atrial fibrillation (AF) and chronic heart failure (CHF) during 12-month observation.Materials and methods This prospective, nonrandomized comparative observational study included 130 patients with AF (men, 65 %; mean age, 62.8±11.8 years) and CHF with left ventricular ejection fraction (LV EF) <50 %. Paroxysmal AF was observed in 60 (46 %) patients and persistent AF was observed in 70 (54 %) patients. According to results of transthoracic echocardiography (EchoCG) 107 (82 %) patients had intermediate LV EF (40-49 %) and 23 (18 %) patients had reduced LV EF (<40 %). RFA of AF was performed for 65 patients whereas 65 patients received an optimal AAT. The 24-h electrocardiogram monitoring, EchoCG, and assessment of the quality of life (QoL) with the SF-36 questionnaire were performed for all patients on admission and at 12 months of observation. Stability of sinus rhythm, EchoCG, QoL, and exercise tolerance were evaluated at 12 months of observation.Results 49 (75%) of patients in the RFA group and 26 (40%) of patients in the AAT group had stable sinus rhythm (SR) at 12 months. Repeated RFA for relapse of AF was performed for 6 (12 %) of 49 patients; repeated cardioversion was performed for 16 (61.5 %) of 26 patients. In the AAT group, there were more interventions for maintaining SR than in the RFA group (p<0.001). In patients with SR of the RFA group at 12 months of observation, LV EF was increased (р<0.001), left ventricular dimension (р<0.001) and volume (р<0.001) were decreased, and mental (р<0.001) and physical (p<0.001) components of health were improved according to the SF-36 questionnaire. In patients with SR of the AAT group, only improvement of mental (р<0.001) and physical (р<0.001) components of health was observed according to the SF-36 questionnaire.Conclusion RFA provided a considerable decrease in the frequency of AF relapse and improvement of LV EF in patients with CHF. The effectiveness of RFA did not depend on the type of arrhythmia. For 12 months of observation, the number of hospitalizations for decompensated CHF and interventions to maintain SR decreased in the RFA group compared to the AAT group.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Cardioversão Elétrica , Insuficiência Cardíaca , Idoso , Fibrilação Atrial/cirurgia , Fibrilação Atrial/terapia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
8.
Kardiologiia ; 60(8): 124-129, 2020 Sep 17.
Artigo em Russo | MEDLINE | ID: mdl-33155968

RESUMO

This review analyzes results of a large prospective, randomized, double-blind, placebo-controlled clinical study ENGAGE AF-TIMI 48 that compared efficacy and safety of warfarin, a vitamin K antagonist, and edoxaban, an oral inhibitor of activated coagulation factor X. The review addresses important practical aspects of using edoxaban in patients with nonvalvular atrial fibrillation.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Administração Oral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Método Duplo-Cego , Inibidores do Fator Xa/uso terapêutico , Humanos , Estudos Prospectivos , Piridinas , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/tratamento farmacológico , Tiazóis , Resultado do Tratamento , Varfarina/uso terapêutico
9.
Kardiologiia ; 60(7): 53-63, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155941

RESUMO

Aim To study efficacy and safety of a triple antithrombotic therapy with direct oral anticoagulants (DOAC) versus warfarin in patients with atrial fibrillation after acute coronary syndrome, for 12 months following discharge from the hospital.Materials and methods This single-site cohort, prospective, observational study performed at the Regional Vascular Center 2 of the N.A. Semashko Nizhniy Novgorod Regional Clinical Hospital included 402 patients. It was possible to maintain contacts with 206 patients for 12 months. These patients were divided into two groups, the DOAC treatment (n=105) and the warfarin treatment (n=101) as a part of triple antithrombotic therapy upon discharge. Clinical observation was performed at 1, 3, 6, and 12 months after the discharge by structured telephone interview. Predetermined efficacy endpoints included cardiovascular death, myocardial infarction, stent thrombosis, and ischemic stroke. Safety endpoints included bleeding defined as small, medium (clinically significant), and major in accordance with the TIMI classification.Results At 12 months of follow-up, 80 patients (76.19%) continued taking DOAC and 39 patients (38.61%, p<0.001) continued taking warfarin; in this process, only 25 patients (24.75%) monitored their INR on a regular basis. With a regular INR monitoring and TTR >70%, death rate did not differ in the warfarin and the DOAC treatment groups. However, there was a difference in reaching the composite efficacy endpoint (p=0.048): ischemic events occurred statistically significantly more frequently in the warfarin treatment group than in the DOAC treatment group.Conclusions In 12 months after discharge from the hospital, compliance with the DOAC treatment as a part of the antithrombotic therapy was significantly higher than compliance with the warfarin treatment. The triple antithrombotic therapy with DOAC was safer than the warfarin treatment by the number of hemorrhagic complications and more effective in prevention of ischemic events, primarily due to no need for monitoring of lab test values.


Assuntos
Síndrome Coronariana Aguda , Fibrilação Atrial , Acidente Vascular Cerebral , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/tratamento farmacológico , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Humanos , Estudos Prospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
10.
Kardiologiia ; 60(7): 108-114, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155949

RESUMO

Atrial fibrillation is one of the most common concomitant diseases in patients with diabetes mellitus (DM). Meta-analyses of multiple studies have shown that the risk of AF is higher for diabetic patients with impaired glucose homeostasis than for patients without DM. Patients with AF and DM were younger, more frequently had arterial hypertension, chronic kidney disease, heart failure, and ischemic heart disease, and stroke and were characterized with a more severe course of AF. The article discusses possible mechanisms of the mutually aggravating effects of DM and AF, scales for evaluating the risk of bleeding (CHADS2, CHA2DS2­VASc, HAS-BLED), and the role of anticoagulants. A meta-analysis of 16 randomized clinical studies, including 9 874 patients, has demonstrated the efficacy of oral anticoagulants in prevention of stroke with an overall decrease in the relative risk by 62 % compared to placebo (95% confidence interval, from 48 to 72 ). For prevention of complications in patients with AF and DM, current antithrombotic therapies can be used, specifically the oral factor Xa inhibitor, rivaroxaban, which is the best studied in patients with AF and DM and represents a possible alternative to warfarin in such patients.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Acidente Vascular Cerebral , Administração Oral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Diabetes Mellitus/tratamento farmacológico , Humanos , Fatores de Risco , Rivaroxabana/uso terapêutico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico
11.
Kardiologiia ; 60(8): 33-45, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-33155957

RESUMO

Aim      Searching for clinical, angiographic, and biochemical predictors of cardiovascular complications (CVC) and hemorrhagic complications in patients with atrial fibrillation (AF) receiving a multicomponent antithrombotic therapy (MAT) for an elective percutaneous coronary intervention (PCI). Patients with ischemic heart disease (IHD) and AF who require MAT for PCI are at a high risk of thrombotic complications (stroke, systemic embolism, coronary events) and hemorrhage. This warrants searching for new risk factors determining prediction of the outcome.Materials and methods This study included 207 patients (146 males aged 70.1±8.3 years) with IHD and AF who received direct oral anticoagulants (DOAC) as a part of their MAT therapy. Median duration of the follow-up was 12 [8.0; 12.0] months. The efficacy endpoint was a sum of CVCs combining cardiovascular death, ischemic stroke, venous thromboembolic complications, acute coronary syndrome (ACS), and requirement for an unscheduled PCI. "Coronary events", including ACS and requirement for an unscheduled PCI were analyzed separately. The safety endpoint was BARC type 2-5 bleeding. Upon admission, biomarkers (growth-differentiation factor 15 (GDF-15), D-dimer, thrombin-activated fibrinolysis inhibitor (TAFI), and plasminogen activator inhibitor-1 (PAI-1)) were measured for all patients. Searching for prognostically significant indexes was performed with the Cox proportional hazards regression.Results Incidence of all CVCs was 16.4 %. Independent predictors of CVC included the DOAC treatment at a reduced dose (odds ratio (OR) 2.5 at 95 % confidence interval (CI) 1.02-6.15; p=0.0454), GDF-15 >1191 pg /ml (OR 3.76 at 95 % CI, 1.26-11.18; p=0.0172), PAI-1 >13.2 U/ml (OR 2.67 at 95 % CI, 1.13-6,26; p=0.0245). Incidence of coronary complications was 9.2 %. Independent predictors of coronary complications included a SYNTAX index >26.5 (OR 4.5 at 95 % CI, 1.45-13.60; p=0.0090), PCI for chronic coronary occlusion (OR 3.21 at 95 % CI, 1.10-9.33; p=0.0326), a GDF-15 >1191 pg/ml (ОR 4.70 at 95 % CI, 1.32-16.81; p=0.0172). Incidence of BARC type 2-5 bleeding was 26.1 %. The only independent predictor for hemorrhage complications was the total PRECISE-DAPT score >30 (ОR 3.22; 95 % CI, 1.89-5.51; р<0.0001).Conclusion      Three independent predictors of CVC were identified for patients with IHD and AF treated with MAT following an elective PCI: treatment with a reduced dose of DOAC, GDF-15 >1191 pg /ml, and PAI-1>13.2 U/ml. Independent predictors of coronary complications included a SYNTAX index >26.5, PCI for chronic coronary occlusion, and GDF-15 >1191 pg/ml. The factor associated with a risk of bleeding was the total PRECISE-DAPT score >30.


Assuntos
Fibrilação Atrial , Intervenção Coronária Percutânea , Idoso , Anticoagulantes , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas , Fatores de Risco , Resultado do Tratamento
12.
Rev Med Liege ; 75(11): 706-710, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33155443

RESUMO

The 2020 recommendations of the European Society of Cardiology have been enriched on the basis of numerous data published over the past 4 years. They emphasize the importance of a comprehensive management of the arrhythmia and give an increasingly prominent place to treatment by ablation. In this article, we summarize all the new recommendations.


Assuntos
Fibrilação Atrial , Cardiologia , Fibrilação Atrial/terapia , Humanos
13.
Kyobu Geka ; 73(11): 905-909, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130711

RESUMO

A 48-year-old woman developed paralysis of the left upper limb and dysarthria. Two days later, she was admitted to a local hospital due to no improvement of symptoms. Brain magnetic resonance imaging showed acute hemorrhagic cerebral infarction in the left nucleus basalis. Echocardiography demonstrated a large left atrial mass in the left atrium, shuttling between the left atrium and the left ventricle and moderate mitral regurgitation. Then, she was transferred to our hospital for surgery. Five days after the initial symptoms, resection of the left atrial mass was performed under total cardiopulmonary bypass. First, heparin sodium, and then nafamostat mesilate were used as intraoperative anticoagulation treatment. The left mitral mass was removed via an atrial septal incision and the defect was repaired using a bovine pericardium. The mitral valve was intact and there was no regurgitation. The mass was immunohistologically diagnosed as myxoma. Postoperative brain computed tomography scans demonstrated no exacerbation of the cerebral infarction. She was discharged 13 days after surgery without neurological symptoms.


Assuntos
Fibrilação Atrial , Neoplasias Cardíacas , Insuficiência da Valva Mitral , Mixoma , Animais , Bovinos , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Infarto Cerebral/cirurgia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Mixoma/complicações , Mixoma/diagnóstico por imagem , Mixoma/cirurgia
14.
Kyobu Geka ; 73(10): 725-730, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130756

RESUMO

Stroke is an important cause of morbidity and mortality after cardiovascular surgery and its incidence has been reported as 1.5 to 8.7%. Preexisting cerebrovasuclar disease, stenotic lesions of the carotid artery and atherosclerosis of the ascending aorta are known to be significant anatomic risk factors. To prevent perioperative stroke, it is important to discuss the onset mechanisms. Intraoperative stroke is mainly caused by the embolization of scattered atheroscrelotic plaque. Carotid duplex scanning and magnetic resonance imaging (MRI) are useful methods for the preoperative screening of cerebrovascular stenosis and plaque. Enhanced computed tomography (CT) is a powerful tool to estimate the presence of severe atheroscrelotic plaque in the aorta. When severe plaque is present, the manipulation, cannulation or clamping of the diseased aortic segment should be prevented. Insufficient oxygenated brain blood flow is thought to be another mechanism of intraoperative stroke. Impaired cerebral autoregulation during caridopulmonary bypass has been reported. Thus, it is recommended to maintain a high mean arterial pressure during cardiopulmonary bypass, especially in patients with cerebrovasuclar occlusive diseases. Postoperative stroke is mainly caused by embolization of the thrombus. To prevent this, excessive hypovolemia and atrial fibrillation should be avoided. Preemptive usage of beta blockers is one option for preventing postoperative atrial fibrillation.


Assuntos
Doenças da Aorta , Aterosclerose , Fibrilação Atrial , Acidente Vascular Cerebral , Aorta , Ponte Cardiopulmonar , Humanos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
15.
Pol Merkur Lekarski ; 48(287): 361-364, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33130800

RESUMO

stroke or other thromboembolic complications in patients with atrial fibrillation (AF). On the other hand, dual antiplatelet therapy (aspirin plus P2Y12 inhibitor) represents a cornerstone in the treatment of acute coronary syndrome. Atrial fibrillation is relatively common in patients with coronary artery disease and patients who undergo primary percutaneous coronary interventions (PCI) with stent implantation. They should be on triple antithrombotic therapy (TAT): preferably direct oral anticoagulants (DOAC) plus aspirin plus clopidogrel as it prevents ischemic as well as thromboembolic events. Before introducing OAT in patients with AF we must assess the risk of future bleeding episodes as OAT can lead to some life-threatening bleeding events. The most common risk score used for that purpose is HASBLED score. HAS-BLED score is valuable, proven tool in assessing future bleeding events in patients with AF. Nevertheless, it does not make the difference between dual and triple antithrombotic therapy which can be of great importance in preventing bleeding events.


Assuntos
Fibrilação Atrial , Intervenção Coronária Percutânea , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Quimioterapia Combinada , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos
16.
Kardiologiia ; 60(9): 102-109, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33131481

RESUMO

Aim To compare efficacy and safety of direct oral anticoagulants (DOACs) for prevention of stroke in patients with nonvalvular atrial fibrillation and reduced creatinine clearance.Material and methods Systematic search for literature and indirect comparison of DOACs were performed.Results The indirect comparison included five randomized clinical trials. The DOACs were comparable by the efficacy of preventing stroke and systemic embolism. The safety profiles had differences. Apixaban significantly decreased the relative risk of major bleeding compared to rivaroxaban by 27 % (relative risk (RR) 0.73; 95 % confidence interval (CI): 0.55-0.98). The apixaban advantage was even greater in the group of patients with a creatinine clearance <50 ml/min: RR was reduced by 48 % compared to rivaroxaban (RR=0.52; 95 % CI: 0.32-0.84), by 50 % compared to dabigatran 300 mg/day (RR=0.50; 95 % CI: 0.31-0.81), and by 48 % compared to dabigatran 220 mg/day (RR=0.52; 95 % CI: 0.32-0.85)Conclusion The indirect comparison of DOACs showed that their efficacy was comparable. With respect of safety, apixaban is the preferrable DOAC for patients with atrial fibrillation and creatinine clearance below 50 ml/min.


Assuntos
Fibrilação Atrial , Insuficiência Renal Crônica , Acidente Vascular Cerebral , Administração Oral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/uso terapêutico , Humanos , Piridonas/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Rivaroxabana/efeitos adversos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
17.
Kardiologiia ; 60(9): 134-148, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33131484

RESUMO

This review focuses on the issue of atrial fibrillation (AF) following coronary bypass surgery in patients with ischemic heart disease. Risk factors of this complication are discussed in detail. The authors addressed the effect of diabetes mellitus on development of postoperative AF. Data on current methods for prevention and treatment of AF are provided.


Assuntos
Fibrilação Atrial , Isquemia Miocárdica , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Ponte de Artéria Coronária/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco
18.
Kardiologiia ; 60(9): 149-152, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33131485

RESUMO

The left three-atrial heart (LTH) is a rare congenital abnormality where the left auricle (LA) is divided into two chambers with an additional membrane. This article describes for the first time a clinical case of congenital heart defect with four atrial chambers. A 41-old man was hospitalized for newly diagnosed paroxysmal atrial fibrillation. On transthoracic echocardiogram (EchoCG), LA was considerably enlarged and divided into two equal interconnected parts with a membrane. Additional examination with contrast-enhanced EchoCG and computed tomography revealed two membranes dividing the LA into three chambers. Prediction for the patient was beneficial since there were no other developmental abnormalities of the heart, and the LA transmembrane pressure gradient (PG) was small. Data of literature on the incidence and prognosis of LTH are provided.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/diagnóstico , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Prognóstico , Tomografia Computadorizada por Raios X
19.
Kardiologiia ; 60(9): 22-29, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33131471

RESUMO

Aim To study the relationship between the serum level of growth differentiation factor 15 (GDF-15) and clinical and functional characteristics and severity of left atrial (LA) fibrosis in patients with nonvalvular atrial fibrillation (AF).Material and methods The study included 87 patients with nonvalvular AF (62 patients with paroxysmal AF and 25 patients with persistent AF) aged 27 to 72 years (mean age, 56.9±9.2 years, 32 women). 85 % of these patients had arterial hypertension (AH), 33 % had AH and ischemic heart disease, and 12.6 % had isolated AF and were hospitalized for primary catheter ablation. General clinical evaluation, echocardiography, laboratory tests including measurement of GDF-15 and NT-proBNP concentrations in blood were performed. As a surrogate substrate of LA fibrosis during the electroanatomical voltage mapping, the area of low-voltage (<0.5 mV) zones in LA was calculated, including the total LA fibrosis area (Sf, cm2) and a percentage of fibrosis of the total LA area (Sf%).Results Median concentration of GDF-15 was 767.5 [590.0; 951.0] pg /ml. The GDF-15 level positively correlated with age, presence and severity of AH and chronic heart failure, body mass index, and degree of obesity, CHA2DS2 VASc score, level of NT-proBNP, and LA fibrosis area (Sf and Sf%) and negatively correlated with the indexes of left ventricular diastolic function, e' septal and e' lateral. The area of fibrosis increased with increasing GDF-15 concentrations divided into quartiles; Sf% exceeded 20 % at GDF-15 levels higher than median. After a comparative analysis of patients with Sf% ≤20 % and >20 %, statistically significantly different variables were included into a stepwise logistic regression analysis. Two independent predictors of LA fibrosis >20% were identified: a concentration of GDF-15 higher than median (odd ratio (OR), 3.318, 95 % confidence interval (CI): 1.184-9.298) and LA volume index (OR, 1.079, 95 % CI: 1.014-1.147). According to results of the ROC analysis, the area under the curve (AUC) was 0.762 (p=0.000), the model specificity was 72.3 %, sensitivity was 72.4 %, and the prediction accuracy was 72.4 %.Conclusion Blood levels of GDF-15 were associated with the presence and severity of major risk factors for AF and the area of LA fibrosis. In this study, a level of GDF-15 above the median and the LA volume index were independent predictors of LA fibrosis > 20% of the LA area.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Ablação por Cateter , Fator 15 de Diferenciação de Crescimento , Adulto , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/patologia , Feminino , Fibrose , Fator 15 de Diferenciação de Crescimento/sangue , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Pessoa de Meia-Idade
20.
PLoS One ; 15(10): e0239339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002011

RESUMO

Open irrigation ablation catheters are now the standard in radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Among various irrigation catheters, laser-cut slit-based irrigation system (Cool Flex and FlexAbility) has a unique design to cool the catheter tip more efficiently. We aimed to assess the safety of slit-based irrigation catheters regarding prevention of procedure-related ischemic complication in AF patients undergoing RFCA. The analysis was performed with Korea University Medicine Anam Hospital RFCA registry. Procedure-related ischemic complication was defined as ischemic stroke or transient ischemic attack (TIA) occurring within 30 days after RFCA. Patients were divided into 3 groups: non-irrigation, hole-based irrigation, and slit-based irrigation catheter groups. A total of 3,120 AF patients underwent first RFCA. Non-irrigation, non-slit-based irrigation, and slit-based irrigation catheters were used in 290, 1,539, and 1,291 patients, respectively. As compared with non-irrigation and non-slit-based irrigation catheter groups, slit-based irrigation catheter group had significantly older age, higher prevalence of non-paroxysmal AF, large left atrial size, and decreased left atrial appendage flow velocity. The CHA2DS2-VASc score was not different among the 3 groups. Procedure-related ischemic complication occurred in 17 patients (0.54%) with 16 ischemic strokes and 1 TIA event: 5/290 (1.72%), 11/1,539 (0.71%), and 1/1,291 (0.08%) events in non-irrigation, non-slit-based irrigation, and slit-based irrigation catheter groups, respectively (p = 0.001). Slit-based irrigation catheter was superior in direct comparison with non-slit-based irrigation catheter (0.71% vs. 0.08%; p = 0.009). Slit-based irrigation catheters were highly effective in preventing procedure-related ischemic complications.


Assuntos
Fibrilação Atrial/terapia , Isquemia Encefálica/complicações , Ablação por Cateter/efeitos adversos , Cateteres , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/etiologia , Ablação por Cateter/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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