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2.
Angiol Sosud Khir ; 26(3): 142-149, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063760

RESUMO

AIM: The study was aimed at comparatively assessing the immediate results of coronary artery bypass grafting operations without artificial circulation performed in non-ST-segment elevation acute myocardial infarction and chronic ischaemic heart disease. PATIENTS AND METHODS: The main group with non-ST-segment elevation acute myocardial infarction enrolled a total of 101 patients undergoing coronary artery bypass grafting without artificial circulation. The patients' age varied from 47 to 87 years, median 66.0 years (60.0; 71.0). The indication for the operation was persistent myocardial ischaemia on the background of carried out therapy with impossibility of performing percutaneous coronary intervention due to anatomy of coronary arteries and peculiarities of their pathology. The comparison group of chronic ischaemic heart disease was composed of 108 patients undergoing elective coronary artery bypass grafting without artificial circulation. The patients' age varied from 40 to 92 years, median - 60.0 years (58.0; 68.0). The patients with acute myocardial infarction had a significantly greater (p<0.05) number of coronary arteries measuring in diameter 2.5 mm and more, with significant occlusive and stenotic lesions, as well as a higher total SYNTAX score. The patients undergoing elective surgery were found to have an initially higher (p<0.05) left ventricular ejection fraction. RESULTS: In the group of acute myocardial infarction the waiting times for coronary artery bypass grafting varied from 2 to 8 days, median of waiting - 4.0 days (4.0; 5.0). The lethality rate (p<0.05) in the group of acute myocardial infarction amounted to 3.0% (3 cases) and in the group of chronic ischaemic heart disease to 0.9% (1 case). Twenty-one (20.8%) operations were carried out within the first 72 hours, with eighty surgical interventions (79.2%) performed after 72 hours from the onset of the disease. All 3 (3.8%) lethal outcomes were observed after coronary artery bypass grafting procedures performed later than 72 hours from the onset of acute myocardial infarction (p>0.05). The total number of complications (p>0.05) amounted to 18 (17.8%) and 10 (9.3%) in the group of acute myocardial infarction and in the group of chronic ischaemic heart disease, respectively. CONCLUSION: The immediate results of delayed coronary artery bypass grafting procedures without artificial circulation for acute myocardial infarction and chronic ischaemic heart disease were statistically comparable (p>0.05) by the lethality and complication rates. Lethality in the group of non-ST-segment elevation acute myocardial infarction din not depend on the time of operation after the onset of the disease.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Ponte de Artéria Coronária , Humanos , Infarto do Miocárdio/diagnóstico , Volume Sistólico , Função Ventricular Esquerda
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4067-4070, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018892

RESUMO

This paper presents a fully-automated end-to-end phonocardiogram(PCG)-based wearable system capable of providing echocardiography-like metrics for left ventricular (LV) diastolic function assessment. Proxy metrics for five echocardiographic parameters were calculated based on physiologically-motivated features extracted from PCG signals using noise-subtraction, heartbeat-segmentation, and quality-assurance algorithms. The clinical value of these proxy metrics was evaluated using the latest American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines for evaluation of LV diastolic function. When tested on a group of n=34 patients, proxy metrics successfully identified LV diastolic dysfunction in a n=29 subset with 87.5% accuracy, and elevated LV filling pressures in a n=17 subset with 75% accuracy.


Assuntos
Disfunção Ventricular Esquerda , Algoritmos , Diástole , Ecocardiografia , Humanos , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda
4.
Wiad Lek ; 73(8): 1765-1770, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055349

RESUMO

OBJECTIVE: The aim of the publication was to review available data on epidemiology, pathophysiological and clinical aspects of HFmrEF as a specific HF pattern. PATIENTS AND METHODS: Materials and methods: We carried out the analysis of the publications that appeared during last decade, related to the different aspects of HFmrEF. The literature search was conducted by use of Google Web Search and PubMed search engines by the following key words: heart failure, left ventricular ejection fraction, mid-range, as well as their combinations. CONCLUSION: Conclusions: Patients with specific HF pattern «HFmrEF¼ demonstrate multidirectional dynamic of systolic heart function with the possibility of transition to the category of reduced or preserved LVEF. Such patients need to be evaluated individually. Their management is based on neurohumoral modulators in order to prevent further LV dysfunction progression and repeated decompensation of HF.


Assuntos
Insuficiência Cardíaca , Função Ventricular Esquerda , Progressão da Doença , Humanos , Volume Sistólico , Sístole
5.
Asian Cardiovasc Thorac Ann ; 28(7): 427-430, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33023305

RESUMO

Based on current guidelines, 15% to 20% of patients undergoing mitral valve repair for regurgitation develop left ventricular dysfunction (ejection fraction < 50%-55%) despite a normal baseline. Two schools of thought have been debated: preexisting myocardial disease or suboptimal intraoperative myocardial protection. In our view, they could be reconciled. It is well recognized that left ventricular ejection fraction with a standard cut off at 50%-55% has limited sensitivity in detecting early systolic impairment in mitral regurgitation patients. Mitral regurgitation also leads to mitochondrial oxidative stress, thus rendering the myocardium more susceptible to ischemia-reperfusion injury and precipitating postoperative cardiac dysfunction. The fall in left ventricular ejection fraction early after mitral valve repair was shown to be caused by the reduction in both myocardial contractility and left ventricular stroke volume. To mitigate the risk to myocardial reperfusion injury, appropriate cardioplegia volume and distribution and well-defined surgical repair processes are equally important. We use transesophageal echocardiography-guided cardioplegia delivery, imaging the intramyocardial flow and ensuring adequate protection of the subendocardium during mitral valve repair. Mild aortic regurgitation on a beating heart often leads to left ventricular dilatation with diminished cardioplegia flow in the myocardium, thus requiring direct ostia cardioplegia. Systematic transesophageal echocardiography assessment before surgery is essential for establishing the mitral regurgitation mechanisms and translating them into precise surgical repair strategies. The benefits of transesophageal echocardiography-guided cardioplegia delivery warrant further clinical trials in order to evolve into part of a high surgical standard.


Assuntos
Ecocardiografia Transesofagiana , Parada Cardíaca Induzida , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Disfunção Ventricular Esquerda/prevenção & controle , Ecocardiografia Transesofagiana/efeitos adversos , Parada Cardíaca Induzida/efeitos adversos , Hemodinâmica , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
6.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 863-869, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047720

RESUMO

OBJECTIVE: To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery. METHODS: Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD). RESULTS: There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P < 0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up. CONCLUSION: The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.


Assuntos
Doença da Artéria Coronariana , Idoso , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 714-717, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018087

RESUMO

Early and noninvasive identification of heart failure progression is an important adjunct to successful and timely intervention. Severity of heart failure (HF) was assessed by Left Ventricular Ejection Fraction (LVEF). In this paper, we explore the circadian (24-hour) heart rate variability (HRV) features from ''normal" (EF >50%), "at-risk" (EF <40%), and "border-line" (40% ≤ EF ≤ 50%) patient data to determine whether HRV features can predict the stage of heart failure. All coronary artery disease (CAD) 24-hour circadian heart rate data were fitted by a cosinor analysis algorithm. Hourly HRV features from time- and frequency-domains were then extracted from all 24-hour patient data. A one-way ANOVA test was performed followed by a Tukey post-hoc multiple comparison test to investigate the differences among the three groups. The results showed a statistically significant difference between the three groups when using the normalized high frequency (HF Norm), low frequency peak (LF Peak), and the normalized very-low frequency (VLF Norm) for the 05:00-06:00 and 18:00-19:00 time periods. These results highlight a possible link between the circadian variation of sympathetic and parasympathetic nervous system activity and LVEF for CAD patients. The results could be useful in differentiating the various degrees of LVEF by using only noninvasive HRV features derived over a 24-hour period.Clinical relevance- The proposed method could be clinically useful to estimate the extent of LVEF associated with the severity of heart failure by recording the circadian variation of the heart rate in CAD patients. However, further clinical trials on a larger cohort of patients and controls are required.


Assuntos
Doença da Artéria Coronariana , Ritmo Circadiano , Frequência Cardíaca , Ventrículos do Coração , Humanos , Volume Sistólico , Função Ventricular Esquerda
8.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(10): 859-865, 2020 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-33076624

RESUMO

Objective: To analyze the electrophysiological characteristics and the therapeutic efficacy of irrigated-tip catheter radiofrequency ablation(RFA) without radiation for pregnant women with focal atrial tachycardia(AT) originating from the right atrial appendage (RAA). Methods: Data from 55 women with focal AT, who underwent radiofrequency ablation (RFA) in the First Affiliated Hospital of Zhengzhou University from October 2016 to March 2019, were screened. 2 non-pregnant women with right atrial appendage tachycardia (RAAT) and 4 pregnant women with non-RAAT were excluded. The remaining 49 cases were divided into RAAT during pregnancy group (n=6, including 4 cases of tachycardia-induced cardiomyopathy) and non-pregnant and non-RAAT group (control, n=43). Under the guidance of three-dimensional mapping system, the earliest activation site was identified, RFA with the irrigated catheter without x-ray fluoroscopy was performed in RAAT patients during pregnancy, all patients in control group underwent non-zero-ray ablation. Patients were followed up at 3, 6, 12 months post procedure, and yearly follow up thereafter in outpatient clinic. Electrocardiogram or Holter monitoring was performed during follow up. AT recurrence and surgical complications were recorded during follow up. At 6 months after RFA, echocardiography examination and laboratory examination including N-terminal B-type brain natriuretic peptide measurement were performed in the pregnant patients, delivery results were also recorded in the pregnant patients. The electrophysiological characteristics of RAAT during pregnancy were analyzed, the therapeutic efficacy of RFA was compared between the two groups. Results: This study is a retrospective study. Age ((30.7±6.2)years vs. (57.2±11.7)years), left ventricular ejection fraction ((46.0±12.8)% vs. (60.1±5.9)%), proportions of organic heart disease (0% vs. 58%) were significantly lower in the RAAT patients during pregnancy group than in control group (P<0.05), while proportions of patients with persistent tachycardia (100% vs. 7%), symptoms of chest distress and palpitation (6/6 vs. 49%) and left ventricular ejection farction≤50% (4/6 vs. 9%) were significantly higher in RAAT group than in control group (P<0.05), heart rate was similar between the two groups ((163.7±11.1)beats/minutes vs. (153.7±15.2)beats/minutes, P>0.05). The characteristic P-wave morphology was observed in RAAT patients during pregnancy, i.e, P wave was mostly upright (5/6) in inferior-leads (Ⅱ, Ⅲ, aVF) and in lead I and aVL, deep and wide negative P wave was found in V1 lead (5/6), and gradually became positive from V2-V6. The mean tachycardia cycle length was (361.7±38.5) ms. Three-dimensional mapping showed that the origin points of the 6 RAAT pregnant patients were all scattered in the local region, the local region was ablated accordingly, 2 patients (2/6) received extensive ablation of local areas. Immediate successful rate was similar between the two groups (6/6 vs. 93%). During follow up ((15.3±4.0) months), no complications were observed after RFA, postoperative recurrence rate was similar (1/6 vs. 12%). Uncomplicated delivery was reported in all 6 pregnant RAAT post ablation. Normal cardiac structure and function was observed in the 4 pregnant patients with tachycardia-induced cardiomyopathy post ablation. Compared to pre-ablation phase, reduced left atrial dimension ((30.3±1.3) mm vs. (36.8±6.7) mm, P>0.05), increased left ventricular ejection fraction ((64.0±2.9)% vs. (39.8±10.7)%), reduced left ventricular end-diastolic dimension ((44.8±4.0) mm vs. (60.0±2.9) mm) and reduced N-terminal B-type natriuretic peptide value ((136.2±47.5) ng/L vs. (3 408.4±901.3) ng/L) were observed at 6 months post ablation (P<0.05). Conclusion: The electrophysiological characteristics are suggestive for focal AT originating from RAA during pregnancy. Under the guidance of 3-dimension activation mapping, no fluoroscopic RFA with irrigated-tip catheter is a safe and effective strategy for the treatment of focal RAAT during pregnancy.


Assuntos
Apêndice Atrial , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Volume Sistólico , Taquicardia , Resultado do Tratamento , Função Ventricular Esquerda
9.
N Engl J Med ; 383(14): 1305-1316, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32865375

RESUMO

BACKGROUND: Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether early rhythm-control therapy can reduce this risk. METHODS: In this international, investigator-initiated, parallel-group, open, blinded-outcome-assessment trial, we randomly assigned patients who had early atrial fibrillation (diagnosed ≤1 year before enrollment) and cardiovascular conditions to receive either early rhythm control or usual care. Early rhythm control included treatment with antiarrhythmic drugs or atrial fibrillation ablation after randomization. Usual care limited rhythm control to the management of atrial fibrillation-related symptoms. The first primary outcome was a composite of death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome; the second primary outcome was the number of nights spent in the hospital per year. The primary safety outcome was a composite of death, stroke, or serious adverse events related to rhythm-control therapy. Secondary outcomes, including symptoms and left ventricular function, were also evaluated. RESULTS: In 135 centers, 2789 patients with early atrial fibrillation (median time since diagnosis, 36 days) underwent randomization. The trial was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient. A first-primary-outcome event occurred in 249 of the patients assigned to early rhythm control (3.9 per 100 person-years) and in 316 patients assigned to usual care (5.0 per 100 person-years) (hazard ratio, 0.79; 96% confidence interval, 0.66 to 0.94; P = 0.005). The mean (±SD) number of nights spent in the hospital did not differ significantly between the groups (5.8±21.9 and 5.1±15.5 days per year, respectively; P = 0.23). The percentage of patients with a primary safety outcome event did not differ significantly between the groups; serious adverse events related to rhythm-control therapy occurred in 4.9% of the patients assigned to early rhythm control and 1.4% of the patients assigned to usual care. Symptoms and left ventricular function at 2 years did not differ significantly between the groups. CONCLUSIONS: Early rhythm-control therapy was associated with a lower risk of adverse cardiovascular outcomes than usual care among patients with early atrial fibrillation and cardiovascular conditions. (Funded by the German Ministry of Education and Research and others; EAST-AFNET 4 ISRCTN number, ISRCTN04708680; ClinicalTrials.gov number, NCT01288352; EudraCT number, 2010-021258-20.).


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/cirurgia , Doenças Cardiovasculares/prevenção & controle , Ablação por Cateter , Síndrome Coronariana Aguda/epidemiologia , Idoso , Antiarrítmicos/efeitos adversos , Fibrilação Atrial/complicações , Doenças Cardiovasculares/mortalidade , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Tempo de Internação , Masculino , Risco , Prevenção Secundária , Método Simples-Cego , Função Ventricular Esquerda/efeitos dos fármacos
10.
J Cardiovasc Magn Reson ; 22(1): 62, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32878630

RESUMO

BACKGROUND: Intensive endurance exercise may induce a broad spectrum of right ventricular (RV) adaptation/remodelling patterns. Late gadolinium enhancement (LGE) has also been described in cardiovascular magnetic resonance (CMR) of some endurance athletes and its clinical meaning remains controversial. Our aim was to characterize the features of contrast CMR and the observed patterns of the LGE distribution in a cohort of highly trained endurance athletes. METHODS: Ninety-three highly trained endurance athletes (> 12 h training/week at least during the last 5 years; 36 ± 6 years old; 53% male) and 72 age and gender-matched controls underwent a resting contrast CMR. In a subgroup of 28 athletes, T1 mapping was also performed. RESULTS: High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and a slight reduction of biventricular ejection fraction, as compared to controls in both genders (p < 0.05). Focal LGE was significantly more prevalent in athletes than in healthy subjects (37.6% vs 2.8%; p < 0.001), with a typical pattern in the RV insertion points. In T1 mapping, those athletes who had focal LGE had higher extracellular volume (ECV) at the remote myocardium than those without (27 ± 2.2% vs 25.2 ± 2.1%; p < 0.05). CONCLUSIONS: Highly trained endurance athletes showed a ten-fold increase in the prevalence of focal LGE as compared to control subjects, always confined to the hinge points. Additionally, those athletes with focal LGE demonstrated globally higher myocardial ECV values. This matrix remodelling and potential presence of myocardial fibrosis may be another feature of the athlete's heart, of which the clinical and prognostic significance remains to be determined.


Assuntos
Atletas , Cardiomegalia Induzida por Exercícios , Meios de Contraste/administração & dosagem , Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Compostos Organometálicos/administração & dosagem , Resistência Física , Função Ventricular Direita , Remodelação Ventricular , Adaptação Fisiológica , Adulto , Estudos de Casos e Controles , Feminino , Fibrose , Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Valor Preditivo dos Testes , Volume Sistólico , Função Ventricular Esquerda , Adulto Jovem
11.
J Cardiovasc Magn Reson ; 22(1): 63, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32892751

RESUMO

BACKGROUND: Myocardial native T1 and T2 relaxation time mapping are sensitive to pathological increase of myocardial water content (e.g. myocardial edema). However, the influence of physiological hydration changes as a possible confounder of relaxation time assessment has not been studied. The purpose of this study was to evaluate, whether changes in myocardial water content due to dehydration and hydration might alter myocardial relaxation times in healthy subjects. METHODS: A total of 36 cardiovascular magnetic resonance (CMR) scans were performed in 12 healthy subjects (5 men, 25.8 ± 3.2 years). Subjects underwent three successive CMR scans: (1) baseline scan, (2) dehydration scan after 12 h of fasting (no food or water), (3) hydration scan after hydration. CMR scans were performed for the assessment of myocardial native T1 and T2 relaxation times and cardiac function. For multiple comparisons, repeated measures ANOVA or the Friedman test was used. RESULTS: There was no change in systolic blood pressure or left ventricular ejection fraction between CMR scans (P > 0.05, respectively). T1 relaxation times were significantly reduced with dehydration (987 ± 27 ms [baseline] vs. 968 ± 29 ms [dehydration] vs. 986 ± 28 ms [hydration]; P = 0.006). Similar results were observed for T2 relaxation times (52.9 ± 1.8 ms [baseline] vs. 51.5 ± 2.0 ms [dehydration] vs. 52.2 ± 1.9 ms [hydration]; P = 0.020). CONCLUSIONS: Dehydration may lead to significant alterations in relaxation times and thereby may influence precise, repeatable and comparable assessment of native T1 and T2 relaxation times. Hydration status should be recognized as new potential confounder of native T1 and T2 relaxation time assessment in clinical routine.


Assuntos
Composição Corporal , Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Estado de Hidratação do Organismo , Função Ventricular Esquerda , Equilíbrio Hidroeletrolítico , Adulto , Desidratação , Diástole , Feminino , Voluntários Saudáveis , Coração/fisiologia , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Adulto Jovem
12.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 953-959, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32912409

RESUMO

OBJECTIVE: To prepare primary cardiomyocyte (PCM) specific peptide-conjugated mesoporous silicon nanoparticles (MSN) with L-arginine (LA) as a core (PCM-MSN@LA), and evaluate its specific protective effect on septic myocardium. METHODS: PCM-MSN@LA was prepared by condensation reaction, the characterization of PCM-MSN@LA, the amount of LA modification and release was detected, and the phagocytosis of PCM-MSN@LA and its affinity to myocardial tissue was observed. (1) Experiment one: SD neonatal rat cardiomyocytes were divided into control group (Con group), lipopolysaccharide (LPS) group, MSN@LA/LPS group and PCM-MSN@LA/LPS group. The LPS group was stimulated with 5 mg/L LPS for 16 hours, while the MSN@LA/LPS group and PCM-MSN@LA/LPS group were treated with 5 mg/L LPS and 25 mg/L LA-containing nanoparticles (MSN@LA and PCM-MSN@LA) for 16 hours. Cell viability and reactive oxygen species (ROS) production levels were detected. Apoptosis was observed via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method (TUNEL). Western Blot was used to detect the changes in endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) proteins. (2) Experiment two: 64 healthy male C57BL/6 mice were divided into Sham group, LPS group, MSN@LA/LPS group and PCM-MSN@LA/LPS group by random number table method, 16 mice in each group. LPS group were injected 50 mg/kg LPS intraperitoneally. MSN@LA/LPS group and PCM-MSN@LA/LPS group were injected with 0.5 mg/kg MSN@LA and PCM-MSN@LA via tail vein immediately after intraperitoneal injection of LPS. Eight animals in each group were used to observe the 24-hour survival rate, and the other 8 mice were used to detect cardiac function by echocardiography at 12 hours after operation; mRNA expressions of interleukin (IL-1, IL-6) and tumor necrosis factor-α (TNF-α) were measured by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). RESULTS: PCM-MSN@LA was spherical, with particle size of about 180 nm, Zeta potential of about -21 mV, with LA loaded. The amount of LA modification and release rate were 12.3% and 24.3%, respectively. Cell phagocytosis experiments showed that PCM-MSN@LA had the targeting ability of cardiomyocytes and myocardial tissue. Experiment one: after LPS stimulation of myocardial cells, cell viability decreased, while ROS generation, apoptosis, eNOS and iNOS protein expressions increased. Compared with LPS group, MSN@LA/LPS group and PCM-MSN@LA/LPS group had higher cell viability, reduced ROS levels and apoptosis, increased expressions of eNOS and iNOS. PCM-MSN@LA/LPS group changed the above effect further than MSN@LA/LPS group [cell viability (A value): 0.51±0.08 vs. 0.41±0.03, ROS (relative fluorescence intensity): 28 450±1 941 vs. 35 628±2 551, TUNEL positive cells/total cells: 0.27±0.03 vs. 0.35±0.04, eNOS/ß-Tubulin: 1.467±0.046 vs. 1.201±0.131, iNOS/ß-Tubulin: 1.700±0.033 vs. 1.577±0.068, all P < 0.05]. Experiment two: the number of 24-hour survive in MSN@LA/LPS group and PCM-MSN@LA/LPS group were higher than LPS group (number: 2, 4 vs. 1, P values were 0.36 and 0.03 respectively). Compared with Sham group, the cardiac function of LPS group was significantly inhibited and the mRNA expression of inflammatory factors increased. The PCM-MSN@LA/LPS group had higher left ventricular ejection fraction (LVEF) and left ventricular short-axis shortening rate (LVFS) than LPS group, and lower mRNA expressions of IL-1, IL-6, and TNF-α mRNA [LVEF: 0.456±0.019 vs. 0.337±0.017, LVFS: (21.97±1.78)% vs. (15.53±1.67)%, IL-1 mRNA (2-ΔΔCT): 169.22±8.95 vs. 189.79±6.79, IL-6 mRNA (2-ΔΔCT): 19.90±1.60 vs. 23.74±1.45, TNF-α mRNA (2-ΔΔCT): 8.21±0.81 vs. 11.00±1.48, all P < 0.05]. There was no significant difference in each index between the MSN@LA/LPS group and LPS group. CONCLUSIONS: PCM-MSN@LA with myocardial targeting characteristic significantly increased the activity of myocardial cells, down-regulated the expression of inflammatory factors and the production of ROS, alleviated cardiac insufficiency in sepsis, and achieved the targeted treatment of myocardial injury in sepsis.


Assuntos
Nanopartículas , Substâncias Protetoras , Sepse , Animais , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Miocárdio , Ratos , Volume Sistólico , Função Ventricular Esquerda
13.
J Cardiovasc Magn Reson ; 22(1): 69, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32951605

RESUMO

PURPOSE: Common types of congenital heart disease exhibit a variety of structural and functional variations which may be accompanied by changes in the myocardial microstructure. We aimed to compare myocardial architecture from magnetic resonance diffusion tensor imaging (DTI) in preserved pathology specimens. MATERIALS AND METHODS: Pathology specimens (n = 24) formalin-fixed for 40.8 ± 7.9 years comprised tetralogy of Fallot (TOF, n = 10), dextro-transposition of great arteries (D-TGA, n = 8) five with ventricular septal defect (VSD), systemic right ventricle (n = 4), situs inversus totalis (SIT, n = 1) and levo-TGA (L-TGA, n = 1). Specimens were imaged using a custom spin-echo sequence and segmented automatically according to tissue volume fraction. In each specimen T1, T2, fractional anisotropy, mean diffusivity, helix angle (HA) and sheet angle (E2A) were quantified. Pathologies were compared according to their HA gradient, HA asymmetry and E2A mean value in each myocardial segment (anterior, posterior, septal and lateral walls). RESULTS: TOF and D-TGA with VSD had decreased helix angle gradient by - 0.34°/% and remained symmetric in the septum in comparison to D-TGA without VSD. Helix angle range was decreased by 45°. It was associated with a decreased HA gradient in the right ventricular (RV) wall, i.e. predominant circumferential myocytes. The sheet angle in the septum of TOF was opposing those of the left ventricular (LV) free wall. Univentricular systemic RV had the lowest HA gradient (- 0.43°/%) and the highest HA asymmetry (75%). HA in SIT was linear, asymmetric, and reversed with a sign change at about 70% of the depth at mid-ventricle. In L-TGA with VSD, HA was asymmetric (90%) and its gradients were decreased in the septum, anterior and lateral wall. CONCLUSION: The organization of the myocytes as determined by DTI differs between TOF, D-TGA, L-TGA, systemic RV and SIT specimens. These differences in cardiac structure may further enlighten our understanding of cardiac function in these diverse congenital heart diseases.


Assuntos
Imagem de Difusão por Ressonância Magnética , Ventrículos do Coração/diagnóstico por imagem , Miocárdio/patologia , Tetralogia de Fallot/diagnóstico por imagem , Adulto , Feminino , Ventrículos do Coração/anormalidades , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tetralogia de Fallot/patologia , Tetralogia de Fallot/fisiopatologia , Função Ventricular Esquerda , Função Ventricular Direita
14.
Zhonghua Bing Li Xue Za Zhi ; 49(10): 1046-1051, 2020 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-32992421

RESUMO

Objective: To investigate the protective effect of dihydromyricetin (DHM) on doxorubicin (DOX)-induced myocardial injury and its mechanism. Methods: Twenty-four healthy male SD rats were divided into 4 groups: control group, DOX group, DOX+DHM100 group and DOX+DHM200 group. Echocardiography was used to measure cardiac function. At the end of the 6th week, the rats were anesthetized and sacrificed, and the pathological changes of the cardiac tissues were observed by HE staining, Masson staining and WGA staining. Cardiomyocyte apoptosis was observed by TUNEL staining, and protein levels of NLRP3, caspase-1, IL-1ß, bax and bcl-2 were detected by Western blot and immunohistochemistry. Results: Compared with the control group, the left ventricular ejection fraction and left ventricular fractional shortening decreased significantly in DOX group, while left ventricular internal dimension at systole and left ventricular internal dimension at diastole increased. In DOX+DHM group, both left ventricular ejection fraction and left ventricular fractional shortening increased, while left ventricular internal dimension at systole and left ventricular internal dimension at diastole decreased (P<0.05). Furthermore, DOX group showed significant myocardial injury histologically, while DOX+DHM group significantly inhibited DOX-induced myocardial injury in rats. Meanwhile, cardiomyocyte hypertrophy was found in the DOX group, while the cardiomyocyte hypertrophy was notably inhibited in the DOX+DHM group. Compared with the control group, the apoptotic rates of cardiomyocytes and the levels of bax/bcl-2 ratio were significantly increased in DOX group, which were significantly alleviated in the DOX+DHM group (P<0.05). In addition, the levels of NLRP3, caspase-1 and IL-1ß were increased as compared with control group, while the levels of the above indicators were remarkably reversed in DOX+DHM group as compared with DOX group (P<0.05). Conclusion: DHM alleviates DOX-induced myocardial injury in rats by inhibiting NLRP3 inflammasome and reducing cardiomyocyte apoptosis.


Assuntos
Inflamassomos , Função Ventricular Esquerda , Animais , Doxorrubicina , Masculino , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Ratos , Ratos Sprague-Dawley , Volume Sistólico
15.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(9): 753-758, 2020 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-32957758

RESUMO

Objective: To investigate the clinical value of left ventricular function assessment in patients with cardiovascular disease by fully automatic quantified three-dimensional transthoracic echocardiography. Methods: One hundred and ninety-seven patients with cardiac diseases were examined by three-dimensional transthoracic echocardiography from September 2017 to May 2019. Data from 61 patients with grade 1 echocardiographic image quality were used to determine the default boundary values of endocardial end-diastolic and end-systolic phases. Clinical features were analyzed based on electronic medical records. The accuracy and repeatability of this strategy was evaluated by comparing left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) measured by automated quantitative three-dimensional echocardiography and those measured by conventional manual transthoracic echocardiography, the latter served as gold standard. Results: The levels of LVEDV, LVESV and LVEF measured by automatic three-dimensional echocardiography were positively correlated with values obtained by manual measurement(r=0.97,0.97, 0.98, 0.97, 0.97, 0.96;P<0.05). The levels of LVEDV and LVESV measured by full-automatic three-dimensional echocardiography were significantly higher than those obtained by manual three-dimensional echocardiography(all P<0.05). The classification and correlation of systolic dysfunction in patients with abnormal ventricular wall motion by automatic three-dimensional echocardiography were significantly improved after manual calibration (κ=0.74, P=0.00) as compared to without manual calibration (κ=0.63, P=0.00). The inter-observer and intra-observer variability of fully automated three-dimensional echocardiography were significantly smaller than manual three-dimensional echocardiography(both P<0.05). Conclusion: Fully automatic quantified three-dimensional transthoracic echocardiography possesses excellent accuracy and repeatability in measuring left ventricular volume and function, and it is feasible for clinical application.


Assuntos
Doenças Cardiovasculares , Ecocardiografia Tridimensional , Ecocardiografia , Estudos de Viabilidade , Humanos , Volume Sistólico , Função Ventricular Esquerda
16.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(9): 740-747, 2020 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-32957756

RESUMO

Objective: To explore the practice patterns and the related factors of oral antiarrhythmic drug (AAD) treatment in Chinese patients with atrial fibrillation (AF), and to evaluate the compliance of AAD application to atrial fibrillation management guidelines. Methods: From August 2011 to August 2016, medical records from 18 014 patients with AF were analyzed based on data from the Chinese Atrial Fibrillation Registry trial. Patients were divided into AAD group (7 788 cases, 43.23%) and non-AAD group (10 226 cases, 56.77%) according to whether AAD was used at baseline or at the time of first use during follow-up. Amiodarone (4 129 cases, 53.02%) and propafenone (3 211 cases, 41.23%) were the mostly prescribed AAD and subgroup analysis was performed accordingly. Medical records were analyzed by random forest regression to evaluate the use of AAD and related factors in patients with AF, and the rationality of AAD was analyzed according to the guidelines for the management of atrial fibrillation. Result: A total of 18 014 patients were included in this study, of which 60.48% (10 895/18 014) were male patients, 22.65% (4 081/18 014) were elderly patients(≥75 years old), there were 7 788 patients (43.23%) in AAD group, and 10 226 patients(56.77%) in non-AAD group. Compared with the non-AAD group, the elderly patients (≥75 years old, 13.74%(1 070/7 788) vs. 29.44%(3 011/10 226)), persistent AF (28.95% (2 250/7 788) 45.80% (4 683/10 226)), heart failure(8.29% (646/7 788) vs. 21.95% (2 245/10 226)), stroke and (or) TIA(12.15% (946/7 788) vs. 19.95% (2 040/10 226)), renal dysfunction(16.36%(1 274/7 788) vs. 29.37% (3 003/10 226)), and high thromboembolism risk(60.17% (4 748/7 788) vs. 76.40% (7 813/10 226)) were less prevalent in the AAD subgroup (P<0.001). Multivariate analysis showed that patients in tertiary hospitals (OR=3.72, 95%CI 3.17-4.37) were more likely to use AAD, elderly patients (≥75 years old, OR=0.47, 95%CI 0.39-0.55), persistent atrial fibrillation (OR=0.66, 95%CI 0.60-0.72), and patients with heart failure (OR=0.54, 95%CI 0.47-0.63), stroke and (or) TIA (OR=0.77, 95%CI 0.68-0.87), renal dysfunction (OR=0.75, 95%CI 0.59-0.95) and high thromboembolism risk(OR=0.7, 95%CI 0.58-0.84) were more likely not to use AAD(P<0.05). In the AAD group, amiodarone and propafenone were the most commonly used AAD, accounting for 53.02% (4 129/7 788) and 41.23% (3 211/7 788), respectively. Multivariate analysis showed that patients with persistent atrial fibrillation (OR=4.57, 95%CI 3.94-5.29) and coronary heart disease (OR=4.14, 95%CI 3.03-5.64), heart failure (OR=2.07, 95%CI 1.48-2.89), non-ischemic cardiomyopathy (OR=4.84, 95%CI 2.41-9.73) were more likely to use amiodarone, and those with normal left ventricular ejection fraction (OR=0.31, 95%CI 0.15-0.65) and low thromboembolism risk (OR=0.78, 95%CI 0.63-0.97) were more likely to use propafenone (P<0.001). The overall incidence of AAD treatment, which was not indicated by the guidelines was 6.5% (480/7 340); 5.1% (212/4 129) in the amiodarone group and 8.3% (268/3 211) in the propafenone group, respectively. Compared with the rational AAD use group, the proportion of irrational drug use was higher in the elderly (≥75 years old) (20.4% (98/480) vs. 12.9% (887/6 860)), patients of high thromboembolism risk (77.1% (379/480) vs. 59.0% (4 047/6 860)), and in non-tertiary hospitals (7.1% (34/480) vs. 3.3% (299/6 860)), but lower in men(50.8% (244/480) vs. 64.5% (4 427/6 860)), P<0.001. Conclusions: The patients with paroxysmal atrial fibrillation, who were treated with AAD, were mostly patients with fewer complications, and the patients who were treated with amiodarone were mostly patients with persistent atrial fibrillation, patients were more likely to complicate with organic heart disease. The incidence of AAD that do not comply with the guidelines was low, and it was more common in non-tertiary hospitals and the elder patients with high thromboembolism risk.


Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Padrões de Prática Médica , Sistema de Registros , Idoso , Ensaios Clínicos como Assunto , Humanos , Masculino , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
17.
Zhonghua Yi Xue Za Zhi ; 100(35): 2768-2773, 2020 Sep 22.
Artigo em Chinês | MEDLINE | ID: mdl-32972058

RESUMO

Objective: To evaluate the clinical impact of percutaneous coronary intervention (PCI) on left ventricular myocardial remodeling and main adverse cardiovascular and cerebrovascular events (MACE) in ischemic cardiomyopathy patients with different left ventricular ejection fraction and SYNTAX score≤22. Methods: A total of 191 ischemic cardiomyopathy patients who underwent PCI in Department of Cardiology from May 2017 to October 2018 were enrolled in this study, and they were divided into three groups according to preoperative left ventricular ejection fraction (≥50% group, 36%~49% group and ≤35% group). The main outcomes and left ventricular ejection fraction, left ventricular end-diastolic volume were analyzed at 12 months follow-up. The main outcomes were the recurrence of acute left ventricular failure, recurrent angina, restenosis, revascularization, non-fatal myocardial infarction, cardiovascular death and non-cardiovascular death. Results: The incidence of MACE was 32.6% (15 cases) in ≥50% group, 32.0% (31 cases) in 36%-49% group, 45.8% (22 cases) in ≤35% group, respectively, which was lower in the first two groups than in ≤35% group, but there was no statistically significant difference among the 3 groups (P=0.231). The incidence of acute left ventricular failure in the three groups was 2.2%, 12.4% and 22.9%, respectively, and there was statistically significant difference among the 3 groups (P= 0.01). Multivariate analysis indicated that preoperative left ventricular ejection fraction ≤35% was an independent predictor of acute left ventricular failure (OR=2.696, 95%CI: 1.099-6.612, P=0.030). Compared with baseline data, left ventricular end-diastolic volume ((62±4) mm vs (56±5) mm, P<0.001), left atrium ((42±6) mm vs (40±6) mm, P<0.001) decreased significantly 1 year after PCI. However, left ventricular ejection fraction ((43±10)% vs (51±13)%, P<0.001) increased significantly. At 1 year, left ventricular remodeling related parameters were detected in 3 groups, and there was statistically significant difference in left ventricular end-diastolic volume ((53.1±0.6) mm vs (55.1±0.5) mm vs (59.1±0.7) mm, P<0.001), left ventricular ejection fraction ((62.1±1.1)% vs (51.4±1.0)% vs (37.0±1.5)%, P<0.001) among the 3 groups. Conclusions: Coronary vascular reopening with PCI in patients with ischaemic cardiomyopathy and SYNTAX score≤22, can improve prognosis of patients with preoperative left ventricular ejection fraction>35% significantly, but not in those with preoperative left ventricular ejection fraction≤35%. Preoperative left ventricular ejection fraction may be an independent predictor of acute left ventricular failure in patients with ischemic cardiomyopathy and SYNTAX score≤22, postoperative left ventricular remodeling and left ventricular systolic function correlate with preoperative left ventricular ejection fraction.


Assuntos
Cardiomiopatias , Intervenção Coronária Percutânea , Humanos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
18.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 48-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965356

RESUMO

INTRODUCTION: In the current literature, there has been an upsurge of cases of COVID-19-induced acute myocarditis. In this case-based review, we aimed to describe the clinical characteristics, imaging findings, and in-hospital course of acute myocarditis. In addition, the limitations of the myocarditis diagnosis were discussed since only fulminant myocarditis cases have been mentioned in the current literature. METHODS: We performed a review of the literature of all patients who were diagnosed with COVID-19-induced acute myocarditis using the databases of PubMed, Embase, and the Cochrane. RESULTS: 16 case reports were found to be related to COVID-19-induced acute myocarditis. We observed that the ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads. Echocardiographic findings of COVID-19-induced acute myocarditis patients ranged from preserved left ventricular ejection fraction (LVEF) without segmental abnormalities to reduced LVEF with global hypokinesia. Interestingly, a few patients with COVID-19-induced acute fulminant myocarditis were steroid-responsive and had an amelioration with glucocorticoid and immunoglobulin therapy. CONCLUSION: Despite the COVID-19 pandemic worldwide, a limited number of cases has been shared in the current literature. There are a lot of difficulties in the differential diagnosis of acute myocarditis in the context of COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Miocardite/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Função Ventricular Esquerda/fisiologia , Doença Aguda , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Eletrocardiografia , Humanos , Miocardite/complicações , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Volume Sistólico
19.
Ann Hematol ; 99(10): 2289-2294, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32737633

RESUMO

Iron overload-induced cardiomyopathy is the leading cause of death in patients with transfusion-dependent thalassemia (TDT). The mortality is extremely high in these patients with severe cardiac complications, and how to rescue them remains a challenge. It is reasonable to use combined chelation with deferiprone (L1) and deferoxamine (DFO) because of their shuttle and synergistic effects on iron chelation. Here, seven consecutive patients with TDT who had severe cardiac complications between 2002 and 2019 and received combined chelation therapy with oral high-dose L1 (100 mg/kg/day) and continuous 24-h DFO infusion (50 mg/kg/day) in our hospital were reported. Survival for eight consecutive patients receiving DFO monotherapy for their severe cardiac complications between 1984 and 2001 was compared. We found that combined chelation therapy with high-dose L1 and DFO was efficient to improve survival and cardiac function in patients with TDT presenting severe cardiac complications. Reversal of arrhythmia to sinus rhythm was noted in all patients. Their 1-month follow-up left ventricular ejection fraction increased significantly (P < 0.001). There were no deaths, and all patients were discharged from hospital with good quality of life. In contrast, all the eight patients receiving DFO monotherapy died (P < 0.001). Accordingly, combined chelation therapy with high-dose L1 and DFO should be considered in patients with TDT presenting cardiac complications.


Assuntos
Arritmias Cardíacas/tratamento farmacológico , Terapia por Quelação/métodos , Deferiprona/uso terapêutico , Desferroxamina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Talassemia/terapia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Transfusão de Sangue , Deferiprona/administração & dosagem , Desferroxamina/administração & dosagem , Avaliação de Medicamentos , Quimioterapia Combinada , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Quelantes de Ferro/administração & dosagem , Sobrecarga de Ferro/etiologia , Masculino , Qualidade de Vida , Estudos Retrospectivos , Talassemia/complicações , Reação Transfusional , Resultado do Tratamento , Função Ventricular Esquerda
20.
J Am Soc Echocardiogr ; 33(10): 1278-1284, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32782131

RESUMO

BACKGROUND: Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease. METHODS: A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record. RESULTS: Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = -0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation. CONCLUSIONS: This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Ecocardiografia/métodos , Cardiopatias/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Pneumonia Viral/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Feminino , Seguimentos , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia , Adulto Jovem
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