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2.
N Engl J Med ; 382(1): 20-28, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31893513

RESUMO

BACKGROUND: Excessive alcohol consumption is associated with incident atrial fibrillation and adverse atrial remodeling; however, the effect of abstinence from alcohol on secondary prevention of atrial fibrillation is unclear. METHODS: We conducted a multicenter, prospective, open-label, randomized, controlled trial at six hospitals in Australia. Adults who consumed 10 or more standard drinks (with 1 standard drink containing approximately 12 g of pure alcohol) per week and who had paroxysmal or persistent atrial fibrillation in sinus rhythm at baseline were randomly assigned in a 1:1 ratio to either abstain from alcohol or continue their usual alcohol consumption. The two primary end points were freedom from recurrence of atrial fibrillation (after a 2-week "blanking period") and total atrial fibrillation burden (proportion of time in atrial fibrillation) during 6 months of follow-up. RESULTS: Of 140 patients who underwent randomization (85% men; mean [±SD] age, 62±9 years), 70 were assigned to the abstinence group and 70 to the control group. Patients in the abstinence group reduced their alcohol intake from 16.8±7.7 to 2.1±3.7 standard drinks per week (a reduction of 87.5%), and patients in the control group reduced their alcohol intake from 16.4±6.9 to 13.2±6.5 drinks per week (a reduction of 19.5%). After a 2-week blanking period, atrial fibrillation recurred in 37 of 70 patients (53%) in the abstinence group and in 51 of 70 patients (73%) in the control group. The abstinence group had a longer period before recurrence of atrial fibrillation than the control group (hazard ratio, 0.55; 95% confidence interval, 0.36 to 0.84; P = 0.005). The atrial fibrillation burden over 6 months of follow-up was significantly lower in the abstinence group than in the control group (median percentage of time in atrial fibrillation, 0.5% [interquartile range, 0.0 to 3.0] vs. 1.2% [interquartile range, 0.0 to 10.3]; P = 0.01). CONCLUSIONS: Abstinence from alcohol reduced arrhythmia recurrences in regular drinkers with atrial fibrillation. (Funded by the Government of Victoria Operational Infrastructure Support Program and others; Australian New Zealand Clinical Trials Registry number, ACTRN12616000256471.).


Assuntos
Abstinência de Álcool , Consumo de Bebidas Alcoólicas/efeitos adversos , Fibrilação Atrial/prevenção & controle , Idoso , Fibrilação Atrial/etiologia , Austrália , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Prevenção Secundária
3.
Medicine (Baltimore) ; 99(2): e18675, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914059

RESUMO

BACKGROUND: The efficacy of patent foramen ovale (PFO) closure remains controversial, and it is unclear which patient groups are best benefited. We performed this meta-analysis to clarify the efficacy of PFO closure of younger patients for prevention of recurrent ischemic neurological events. METHODS: We systematically searched for studies of PFO closure for younger patients under the age of 55, and pooled available data on PFO closure of younger vs older patients and on PFO closure of younger patients vs medical therapy. The primary endpoints were the composite outcome of recurrent ischemic neurological events [stroke and/or transient ischemic attack (TIA)]. The secondary endpoints included recurrent stroke, TIA, atrial fibrillation (AF) and bleeding events. We calculated the odds ratios (OR) and 95% confidence interval (CI) using fixed-effect and random-effect models. RESULTS: Three randomized controlled trials (RCT) and 13 observational studies were eligible. Compared with older patients undergoing PFO closure, younger patients undergoing closure had a lower risk of composite outcome (OR: 0.40, 95% CI: 0.28 to .56; P < .001) and AF (OR: 0.25, 95% CI: 0.10-0.61; P = .003). Compared with medical therapy, PFO closure of younger patients reduced the risk of composite outcome (OR: 0.50, 95% CI: 0.33-0.75; P<.001); there was no statistical difference in total complications of AF and bleeding events (OR: 2.15, 95% CI: 0.15-30.37; P = .57). Separate analysis of stroke and TIA showed that PFO closure in younger patients was more effective in preventing stroke (OR: 0.45, 95% CI: 0.28-0.72; P < .001) and TIA (OR: 0.35, 95% CI: 0.21-0.58); P < .001) compared with older patients. Compared with medical therapy, PFO closure of younger patients reduced the risk of stroke (OR: 0.26, 95% CI: 0.13-0.51; P < .001); but there was no difference in the risk of TIA (OR: 1.07, 95% CI: 0.16-7.01; P = .94). CONCLUSIONS: Compared with PFO closure of older patients and medical therapy, PFO closure of younger patients can benefit more for the prevention of recurrent ischemic neurological events. Our results indicate that PFO closure is the best treatment strategy for younger patients under the age of 55.


Assuntos
Forame Oval Patente/cirurgia , Ataque Isquêmico Transitório/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Adulto , Fatores Etários , Fibrilação Atrial/etiologia , Fibrilação Atrial/prevenção & controle , Feminino , Forame Oval Patente/complicações , Humanos , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia , Fatores de Tempo
4.
Einstein (Sao Paulo) ; 18: eAO4409, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31618286

RESUMO

OBJECTIVE: To compare the chest tube drainage by the same thoracotomy intercostal space with the traditional approach in patients undergoing muscle-sparing thoracotomy. METHODS: We evaluated 40 patients aged ≥18 years who underwent elective muscle sparing thoracotomies. Patients were divided into two groups of 20 patients. One group underwent thoracic drainage by the same intercostal space of thoracotomy and the other by traditional chest drainage approach. RESULTS: The mean length of hospital stay for the intercostal drainage group in the intensive care unit was 1.5 day (1.0 to 2.0 days) and 2.0 days (25.1 to 3.0 days) for the traditional chest drainage group (p=0.060). The intercostal drainage group had mean length of hospital stay (p=0.527) and drainage (p=0.547) of 4 days, and the traditional chest drainage group and 2 and 5.5 days, respectively. Dipirona and tramadol doses did not differ between groups (p=0.201 and p=0.341). The mean pain scale values on first postoperative was 4.24 in the drainage by the same intercostal group and 3.95 in the traditional chest drainage (p=0.733). In third postoperative day, mean was 3.18 for the first group and 3.11 for the traditional group (p=0.937). In the 15th day after surgery, drainage by the incision was 1.53 and the traditional chest drainage was 2.11 (p=0.440), 30th days after drainage by incision was 0.71 and traditional chest drainage was 0.84 (p=0.787). Complications, for both groups were similar with 30% in proposed drainage and 25% in traditional approach (p=0.723). CONCLUSION: Drainage by the same thoracotomy intercostal space was feasible and results 30 days after surgery were not inferior to those of the traditional chest drainage approach.


Assuntos
Tubos Torácicos , Drenagem/métodos , Toracotomia/métodos , Analgesia Epidural , Analgésicos/uso terapêutico , Fibrilação Atrial/etiologia , Dipirona/uso terapêutico , Drenagem/estatística & dados numéricos , Dispneia/etiologia , Humanos , Tempo de Internação , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Período Pós-Operatório , Estudos Prospectivos , Toracotomia/efeitos adversos , Tramadol/uso terapêutico
5.
Artigo em Inglês | MEDLINE | ID: mdl-31859840

RESUMO

Leptospirosis is a globally distributed zoonosis with a broad clinical spectrum. This disease mostly affects liver and kidney tissues. Other organs such as the pancreas, can be affected by leptospirosis-induced vasculitis. In addition, cardiac manifestations are common, and the presence of transient ECG abnormalities can be found in 70% of the patients. We report a male patient who presented with an atypical leptospirosis that progressed with severe acute pancreatitis, acute kidney injury and atrial fibrillation. Early diagnosis and adequate supportive therapy are crucial for the appropriated management of symptoms.


Assuntos
Lesão Renal Aguda/etiologia , Fibrilação Atrial/etiologia , Leptospirose/complicações , Pancreatite/etiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
6.
Int Heart J ; 60(6): 1308-1314, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666450

RESUMO

Although atrial ischemic damage is an atrial fibrillation (AF) risk factor, the impact of atrial branches' occlusion on AF development after acute myocardial infarction (AMI) is unclear. Therefore, this study's purpose was to identify predictors of new-onset AF with regard to atrial branches' occlusion. We retrospectively analyzed the AMI database at our single center. Consecutive patients with AMI from June 2011 to May 2017 were enrolled. Exclusion criteria were prior AF before AMI, hemodialysis, and follow-up of < 30 days. The study enrolled 204 consecutive patients (follow-up, 543 ± 469 days; age, 66 ± 12 years; male sex, 77%). All patients underwent primary percutaneous coronary intervention. Thirty-six patients (18%) had new-onset AF in the hospital after AMI. The Killip classification ≥ 3 (41% versus 7%, P < 0.001), ejection fraction ≤ 35% (19% versus 5%, P = 0.014), ischemic occlusion of atrial branches (58% versus 28%, P < 0.001), and ischemic occlusion of atrial branches originating from the right coronary artery (52% versus 18%, P < 0.001) were more frequent in patients with new-onset AF. Multivariable logistic regression analysis showed that Killip classification ≥ 3 (odds ratio, 6.97; 95% confidence interval [CI], 2.77-17.52; P < 0.001), and ischemic occlusion of the atrial branch of the right coronary artery (odds ratio, 4.35; 95% confidence interval, 1.91-9.93; P < 0.001) were independent predictors of new-onset AF. Altogether, proximal occlusion in the right coronary artery involving the atrial branch is a strong predictor of new-onset AF after AMI.


Assuntos
Fibrilação Atrial/etiologia , Doença da Artéria Coronariana/complicações , Oclusão Coronária/complicações , Infarto do Miocárdio/complicações , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Oclusão Coronária/diagnóstico por imagem , Feminino , Hospitalização , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Razão de Chances , Estudos Retrospectivos , Fatores de Risco
7.
Int Heart J ; 60(6): 1398-1406, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666455

RESUMO

Atrial inflammation and fibrosis are the critical processes involved in atrial fibrillation (AF) after myocardial infarction (MI). Fisetin is a dietary flavonoid that has shown forceful anti-inflammatory and anti-proliferative properties in diverse models of disease. However, fisetin's role in atrial inflammation, fibrosis, and AF vulnerability post-MI remains completely unknown.Rats were subjected to MI surgery, by left anterior descending coronary artery ligation or sham operation, and treated with DMSO or fisetin via intraperitoneal injection. After 28 days, echocardiographic parameters were performed, and AF inducibility was tested. We further evaluated the inflammation, fibrosis of left atria (LA), and related signal pathways by RT-PCR, Western blot, and staining analysis.Compared to the MI group, fisetin treatment improved cardiac function, inhibited macrophage recruitment into the LA and production of IL-1ß and TNF-α, and attenuated adverse atrial fibrosis following acute myocardial infarction (AMI). Electrophysiological recordings, using an isolated perfused heart, showed that MI-induced higher inducibility of AF and prolonged AF duration, interatrial conduction time (IACT), atrial effective refractory period (AERP) were significantly alleviated by fisetin. Mechanistically, fisetin markedly increased phosphorylated AMPK (p-AMPK) levels and suppressed NF-κB p65, p38MAPK, and smad3 phosphorylation in the LA post-MI.We demonstrate that fisetin improves LA expansion, cardiac function, atrial inflammation, fibrosis, and vulnerability to AF following MI by possibly regulating AMPK/NF-κB p65 and p38MAPK/smad3 signaling pathways.


Assuntos
Fibrilação Atrial/etiologia , Remodelamento Atrial/efeitos dos fármacos , Flavonoides/uso terapêutico , Infarto do Miocárdio/complicações , Proteínas Quinases Ativadas por AMP/metabolismo , Animais , Fibrilação Atrial/metabolismo , Fibrilação Atrial/patologia , Modelos Animais de Doenças , Masculino , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Proteína Smad3/metabolismo , Fator de Transcrição RelA/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
8.
Braz J Cardiovasc Surg ; 34(5): 605-609, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719011

RESUMO

Atrial fibrillation is a common type of arrhythmia and is an important cause of stroke and heart failure. vitamin D is an emerging risk factor of AF, and is implicated in the pathophysiology of atrial fibrillation. It has been established that this vitamin is extensively involved in the regulation of both the renin angiotensin aldosterone system and the immune system. Epidemiological studies have not yet reached a consensus on the possible association between vitamin D deficiency and atrial fibrillation. Better research designs and methods can further clarify the relationship between the two.


Assuntos
Fibrilação Atrial/etiologia , Fibrilação Atrial/metabolismo , Deficiência de Vitamina D/complicações , Humanos , Sistema Renina-Angiotensina/fisiologia , Fatores de Risco
10.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1136-1140, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683401

RESUMO

Objective: To explore gender-specific factors and their contributions to ischemic stroke among atrial fibrillation (AF) patients. Methods: A case-control study was conducted. The relevant data were obtained from the database of China National Stroke Screening Survey. The cases were first-ever ischemic stroke cases diagnosed from September 2013 to September 2015. Frequency-matched for the age and distribution of city and country, controls were randomly selected by 1∶3 ratio from individuals with AF but without stroke in the program. Altogether, there were 85 male cases (320 controls) and 147 female cases (484 controls). Unconditional logistic regression model was applied for the analysis of relevant factors of the onset of ischemic stroke, and their population-attributable risk proportion [PARP, (95%CI)] was calculated. Results: The age of male subjects in the case group and control group were (65.26±11.20) and (64.83±11.08) years old, and that of females in two groups were (63.63±10.40) and (63.93±10.35) years old. According to the PARP (95%CI), relevant factors of the onset of ischemic stroke in a descending sequence were hypertension history [35.63 (18.64-47.73)], family history of stroke [28.70 (23.63-32.30)]and physical inactivity [15.73 [5.62-23.06)] among male AF patients, and family history of stroke (29.39 (24.21-33.08)), dyslipidemia (22.17 (2.26-36.45)) and smoking [2.09 (0.76-3.24)] among female AF patients. Conclusion: The relevant factors of ischemic stroke were different between male and female AF patients.


Assuntos
Fibrilação Atrial/epidemiologia , Isquemia Encefálica/epidemiologia , Fatores Sexuais , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Isquemia Encefálica/complicações , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/complicações
11.
Heart Surg Forum ; 22(5): E317-E318, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31596704

RESUMO

Cardiac myxoma typically is thought to be a slow-growing, benign primary. Atrial myxomas can lead to many complications and can also mimic mitral stenosis, infective endocarditis, and other vascular diseases associated with systemic embolization. A 75-year-old woman with a history of lung cancer (pT1cN1, adenocarcinoma), atrial fibrillation, and a cerebral infarction presented with dysarthria and visual disturbances. In our case, we had to consider some questionable issues with the left atrial mass, and whether the recurrence of cerebral events was due to the thrombotic material in the left atrium or from locally recurrent lung cancer from the stump margin of the previously resected left superior pulmonary vein. We present a case with a rapidly-growing left atrial myxoma with a growth rate of 12.60 mm/month, rather than a thrombus or local recurrence of tumor under a medication of non-VKA oral antagonists.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Cardíacas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Mixoma/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Fibrilação Atrial/etiologia , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiologia , Diagnóstico Diferencial , Progressão da Doença , Endocardite/diagnóstico , Feminino , Átrios do Coração , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Estenose da Valva Mitral/diagnóstico , Mixoma/patologia , Mixoma/cirurgia
12.
Heart Surg Forum ; 22(5): E319-E324, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31596705

RESUMO

BACKGROUND: Atrial fibrillation is a frequent cause of morbidity following coronary artery bypass grafting (CABG). SYNTAX score II (SSII) is associated with outcomes in patients undergoing coronary revascularization. We investigated the relationship between SSII and postoperative atrial fibrillation (POAF) in patients undergoing CABG. METHODS: Records of 461 consecutive patients who underwent elective isolated CABG were retrospectively reviewed. Characteristics of patients with and without POAF were compared. RESULTS: POAF developed in 51 (11.1%) patients. Patients with POAF were older (61.8 ± 7.8 versus 58.4±7.7; P = .003). Chronic obstructive pulmonary disease (COPD) and history of coronary artery disease (CAD) were more frequent in patients with POAF whereas the frequency of hypertension (HT), diabetes mellitus (DM), and smoking did not differ. CRP was significantly higher in patients with POAF. Left atrial diameter (LAD),  EuroSCORE II, SSI and SSII were greater in patients with POAF (P < .001 for all). Age, history of CAD, LAD, SSI, and SSII were independent predictors of POAF in multivariate regression analysis. In ROC analysis, SSII was more accurate than SSI for predicting POAF, albeit statistically insignificant [difference between AUC: 0.0483, 95% CI (-0.0411) - (0.138); z statistic:1.059, P = .29)]. In-hospital MACE (3.2% versus 9.8%, P = .038) and one-year mortality (4.6% versus 13.5%, P = .008) of patients with POAF were significantly higher. CONCLUSION: POAF occurred in more than one-tenth of patients undergoing CABG, and it is associated with in-hospital MACE and one-year mortality. Age, history of CAD, LAD, SSI, and SSII are independent predictors of POAF. SSII seems to be more accurate than SSI for predicting POAF.


Assuntos
Fibrilação Atrial/etiologia , Ponte de Artéria Coronária/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fatores Etários , Área Sob a Curva , Fibrilação Atrial/mortalidade , Proteína C-Reativa/análise , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Átrios do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Complicações Pós-Operatórias/mortalidade , Doença Pulmonar Obstrutiva Crônica/complicações , Análise de Regressão , Estudos Retrospectivos , Resultado do Tratamento
13.
Heart Surg Forum ; 22(5): E331-E339, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31596707

RESUMO

BACKGROUND: Although the use of transcatheter aortic valve replacement (TAVR) has recently become an attractive strategy in prohibitive surgical high-risk patients undergoing aortic valve replacement (AVR), the most appropriate treatment option in patients with an intermediate- to high-risk profile- whether conventional surgery (SAVR) or TAVR-has been widely debated. METHODS: One hundred and forty-three consecutive patients with intermediate to high risk were prospectively enrolled and selected to undergo SAVR (Group 1 [G1], n = 63) or TAVR (Group 2 [G2], n = 80) following a multidisciplinary evaluation including frailty, anatomy, and degree of atherosclerotic disease of the aorta/peripheral vessels. The mean logistic EuroSCORE (G1 = 20.11 ± 7.144 versus G2 = 23.33 ± 8.97; P = .022), STS score (G1 = 5.722 ± 1.309 versus G2 = 5.958 ± 1.689; P = .347), and preoperative demographics such as sex, left ventricular ejection fraction (LVEF),  body mass index (BMI), peripheral vascular disease, diabetes, atrial fibrillation, renal impairment and syncope were similar. Of note, chronic obstructive pulmonary disease was more frequent in TAVR patients (G2 [46.2%] versus G1 [19.0%]; P = .001), whereas pulmonary hypertension was more frequent in SAVR group (G1 [47.6%] versus G2 [17.5%]; P = .000). The SAVR was performed with either a mechanical or tissue valve; meanwhile, TAVR was performed with either Core valve prosthesis or Edwards-Sapiens XT valve. RESULTS: SAVR group showed higher incidence of some postoperative complications compared to TAVR, namely, postoperative bleeding (4.8% versus 0.0%; P = .048), tamponade (4.8% versus 0.0%; P = .048) and postoperative atrial fibrillation (34.9% versus 10.0%; P = .000), whereas TAVR group had a higher incidence of other sets of postoperative complications, namely, left bundle branch block (58.8% versus 4.8%; P = .000), need for permanent pacemaker implantation (25.0% versus 1.6%; P = .000) and peripheral vascular complications (15.0% versus 0.0%; P = .001). On the contrary, when the two groups were compared they did not show any significant difference regarding anemia requiring more than two units of blood transfusion, postoperative renal failure, stroke, myocardial infarction, and hospital mortality. P = .534, .873, .258, .373 and .072 respectively. Hospital mortality was similar among the two groups (G1 = 0% versus G2 = 5%; P = .072). At the 24-month follow-up, overall mortality, major adverse cardiac and cerebrovascular events were comparable between the two groups but prosthetic regurgitation was better in SAVR group (G2 = 8 patients [10.0%] versus G1 = 1 patient [1.6%] in SAVR group; P = .040). CONCLUSION: In this study, we could not detect an advantage in survival when SAVR or TAVR were utilized in intermediate to high surgical risk patients needing aortic valve replacement for severe aortic stenosis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Bloqueio de Ramo/etiologia , Tamponamento Cardíaco/etiologia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Hipertensão Pulmonar/complicações , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Hemorragia Pós-Operatória/etiologia , Desenho de Prótese , Doença Pulmonar Obstrutiva Crônica/complicações , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
14.
Heart Surg Forum ; 22(5): E375-E379, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31596715

RESUMO

BACKGROUND: Coronary collateral circulation (CCC) is a small vascular formation that allows the connection between the different parts of an epicardial vessel or other vessels. The presence of collateral circulation contributes positively to the course of coronary artery disease (CAD). The aim of this study was to investigate the effect of collateral circulation on myocardial injury and clinical outcomes during coronary artery bypass grafting (CABG) in a high-risk patient group. METHODS: 386 patients who underwent isolated CABG under cardiopulmonary bypass (CPB) were included in the study. Patients were divided into two groups according to the Rentrop scores (n = 225 poor CCC group; and n = 161 good CCC group). Myocardial injury and postoperative clinical results were evaluated as endpoints. RESULTS: The mean age was 62.9 ± 7.5 years, and 61.6% of all patients were male. Postoperative 30-day mortality rate was significantly higher in poor CCC group (4 [1.7%] and 1 [0.6%], P < .001). The frequency of postoperative intraaortic balloon pump (IABP) use (5 [2.2%] and 1 [0.6%], P < .001), low cardiac output syndrome (LCOS) (28 [12.4%] and 10 [6.2%], P < .001) and postoperative atrial fibrillation (35 [15.6%] and 16 [9.9%], P = .038) were significantly higher in poor CCC group. 12th and 24th hour CK-MB and cTn-I values were found to be significantly lower in the good CCC group. CONCLUSION: It is inevitable that the CPB circuit and operation have devastating effects on myocardium in CABG operations. The presence of CCC reduces postoperative myocardial injury, low cardiac output syndrome, and mortality rates.


Assuntos
Ponte Cardiopulmonar/efeitos adversos , Circulação Colateral , Ponte de Artéria Coronária/efeitos adversos , Circulação Coronária , Traumatismos Cardíacos/etiologia , Complicações Pós-Operatórias/etiologia , Fibrilação Atrial/etiologia , Baixo Débito Cardíaco/etiologia , Ponte Cardiopulmonar/mortalidade , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/cirurgia , Feminino , Parada Cardíaca Induzida , Humanos , Balão Intra-Aórtico/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos
15.
Life Sci ; 237: 116949, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31605712

RESUMO

AIMS: New-onset atrial fibrillation (AF) is frequently observed following acute stroke. The aim of this study was to investigate the effects of the brain-stellate ganglion-atrium network on AF vulnerability in a canine model with acute middle cerebral artery occlusion (MCAO). MATERIALS AND METHODS: Twenty-six dogs were randomly divided into the sham-operated group (n = 6), acute stroke (AS) group (n = 7), stellate ganglion ablation (SGA) group (n = 6) and clodronate liposome (CL) group (n = 7). In the sham-operated group, dogs received craniotomy without MCAO. Cerebral ischemic model was established in AS dogs by right MCAO. Right MCAO along with SGA and CL injection into the atrium was performed in SGA and CL dogs, respectively. After 3 days, atrial electrophysiology, neural activity, and the phenotype and function of macrophages in the atrium were studied in all the dogs. KEY FINDINGS: Higher AF inducibility (24.4 ±â€¯4.4% versus 4.4 ±â€¯2.2%, P < 0.05) and AF duration (15.7 ±â€¯3.8 s versus 2.6 ±â€¯1.1 s, P < 0.05) were observed in the AS group compared with the sham-operated group, and were associated with increased left stellate ganglion activity, higher macrophage infiltration and higher levels of inflammatory cytokines in the atrium. SGA or CL injection sharply suppressed AF inducibility (5.5 ±â€¯2.7% versus 24.4 ±â€¯4.4%; 5.3 ±â€¯3.2% versus 24.4 ±â€¯4.4%, both P < 0.05) and AF duration (2.9 ±â€¯1.2 s versus 15.7 ±â€¯3.8 s; 3.6 ±â€¯1.0 s versus 15.7 ±â€¯3.8 s, both P < 0.05) in canines with acute stroke. SIGNIFICANCE: A brain-stellate ganglion-atrium network may increase AF vulnerability through macrophage activation after acute stroke.


Assuntos
Fibrilação Atrial/patologia , Modelos Animais de Doenças , Átrios do Coração/fisiopatologia , Infarto da Artéria Cerebral Média/fisiopatologia , Macrófagos/patologia , Gânglio Estrelado/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Animais , Fibrilação Atrial/etiologia , Cães
17.
Braz J Med Biol Res ; 52(9): e8446, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482999

RESUMO

Left atrial diameter (LAD) has been considered an independent risk factor for atrial fibrillation (AF) relapse after pulmonary vein isolation (PVI). However, whether LAD or other factors are more predictive of late recurrence in patients with paroxysmal AF remains unclear. We aimed to evaluate the value of pulmonary vein (PV) parameters for predicting AF relapse 1 year after patients underwent cryoablation for paroxysmal AF. Ninety-seven patients with paroxysmal AF who underwent PVI successfully were included. PV parameters were measured through computed tomography scans prior to PVI. A total of 28 patients had recurrence of AF at one-year follow-up. The impact of several variables on recurrence was evaluated in multivariate analyses. LAD and the time from first diagnosis of AF to ablation maintained its significance in predicting the relapse of AF after relevant adjustments in multivariate analysis. When major diameter of right inferior pulmonary vein (RIPV) (net reclassification improvement (NRI) 0.179, CI=0.031-0.326, P<0.05) and cross-sectional area (CSA) of RIPV (NRI: 0.122, CI=0.004-0.240, P<0.05) entered the AF risk model separately, the added predictive capacity was large. The accuracy of the two parameters in predicting recurrence of AF were not inferior (AUC: 0.665 and 0.659, respectively) to echocardiographic LAD (AUC: 0.663). The inclusion of either RIPV major diameter or CSA of RIPV in the model increased the C-index (0.766 and 0.758, respectively). We concluded that major diameter of RIPV had predictive capacity similar to or even better than that of LAD for predicting AF relapse after cryoablation PVI.


Assuntos
Fibrilação Atrial/etiologia , Átrios do Coração/anatomia & histologia , Veias Pulmonares/anatomia & histologia , Idoso , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/diagnóstico por imagem , Recidiva , Fatores de Risco , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Clin Nephrol ; 92(5): 226-232, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31496513

RESUMO

BACKGROUND: Antithrombotic therapy for stroke prevention in atrial fibrillation (AF) is considered a standard of care, but for hemodialysis (HD) patients the benefits are unclear, and bleeding risks are high. Our study objective was to compare cardiologists' and nephrologists' stroke prevention practices in different patient risk scenarios. MATERIALS AND METHODS: A cross-sectional, online survey was distributed to members of three Canadian physician societies (Nephrology, Cardiovascular, Heart Rhythm), and to cardiologists affiliated with three Canadian Universities. The questionnaire included four AF scenarios in HD patients with varying stroke and bleeding risks. Physicians selected one of six antithrombotic therapy options for each scenario. RESULTS: Cardiologists were 3 times more likely than nephro-logists to choose anticoagulant therapy over both antiplatelet and no drug therapy, regardless of stroke or bleeding risk (p < 0.001). Physicians' drug therapy choices in regards to level of stroke and bleeding risk reflected the expected pattern based on current evidence. CONCLUSION: Cardiologists were more likely to prescribe anticoagulant therapy for AF in the HD population compared to nephrologists, regardless of patient stroke or bleeding risk.


Assuntos
Fibrilação Atrial , Cardiologistas/estatística & dados numéricos , Nefrologistas/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Diálise Renal/efeitos adversos , Anticoagulantes/uso terapêutico , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Canadá , Estudos Transversais , Humanos
19.
J Vet Cardiol ; 24: 78-84, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31405558

RESUMO

This report describes a rare case of an aorto-cardiac fistula in a six-year-old French Warmblood mare presented with atrial fibrillation, decreased performance, ventral oedema, bounding arterial pulsation and pathological jugular venous pulse. A 2.7-cm-diameter fistula connected the right aortic sinus of Valsalva to the right atrium. Atrial fibrillation was likely due to volume overload of the right heart due to left-to-right shunting. The horse was treated by percutaneous transcatheter closure of the fistula delivered under general anaesthesia using a transarterial approach. The operation was initially successful, and clinical signs of congestive heart failure improved immediately. However, the device dislodged six days after procedure, and the general condition of the horse deteriorated quickly. A second closure attempt to deliver the occluder using a transvenous approach in the standing horse failed, and the horse was eventually euthanized. Procedural aspects and several possible risk factors for device dislodgement are discussed.


Assuntos
Átrios do Coração , Doenças dos Cavalos/cirurgia , Seio Aórtico , Fístula Vascular/veterinária , Animais , Fibrilação Atrial/etiologia , Fibrilação Atrial/veterinária , Cateterismo Cardíaco , Feminino , Cavalos , Fístula Vascular/complicações , Fístula Vascular/cirurgia
20.
J Stroke Cerebrovasc Dis ; 28(11): 104325, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31427189

RESUMO

We report a case of atrial fibrillation with rheumatic heart disease (RHD) who had intracardiac thrombus and cardiogenic cerebral embolism with rivaroxaban therapy. Intracardiac thrombus disappeared after switching from rivaroxaban to warfarin. Patients of RHD have the possibility of gradual progression of valvular disease even if they are old, so we need to distinguish nonvalvular atrial fibrillation from RHD before starting direct oral anticoagulants.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Inibidores do Fator Xa/administração & dosagem , Cardiopatia Reumática/complicações , Rivaroxabana/administração & dosagem , Trombose/etiologia , Varfarina/administração & dosagem , Administração Oral , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Infarto Encefálico/etiologia , Substituição de Medicamentos , Inibidores do Fator Xa/efeitos adversos , Humanos , Embolia Intracraniana/etiologia , Masculino , Cardiopatia Reumática/diagnóstico , Rivaroxabana/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Resultado do Tratamento , Varfarina/efeitos adversos
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