Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 158.339
Filtrar
1.
Medicine (Baltimore) ; 98(38): e16973, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567932

RESUMO

BACKGROUND: As the most important component of cardiovascular disease, coronary heart disease (CHD) is closely related to psychological factors such as anxiety. Anxiety, whether present before or after the onset of illness, can lead to many serious consequences. The aim of this systematic review and meta-analysis was to assess the prevalence of and potential risk factors for anxiety after coronary heart disease (post-CHD anxiety). METHOD: Systematic searches were performed in electronic databases including China National Knowledge Infrastructure (CNKI), Wanfang, Technology Journal database (VIP), PubMed, Web of Science, Embase and Medline. RESULT: Thirteen studies were included. With regard to cross-sectional studies, the prevalence of post-CHD anxiety was P = .37, 95% CI (0.26-0.49). The overall analysis among cohort studies revealed that the prevalence of post-CHD anxiety was P = .50, 95% CI (0.05-0.95). Among the 11 potential risk factors, low education level [OR = 1.46, 95% CI (1.05-2.02)] and long duration of disease [OR = 2.05, 95% CI (1.05-4.00)] were statistically significant. CONCLUSION: There is high heterogeneity between studies and many defects; thus, further research is required to support these results. Attention should be paid to post-CHD anxiety, and clinical caring should include psychological counselling and imparting disease-related knowledge to patients with a long disease duration and low educational background.


Assuntos
Transtornos de Ansiedade/epidemiologia , Infarto do Miocárdio/psicologia , Transtornos de Ansiedade/psicologia , China/epidemiologia , Humanos , Prevalência , Fatores de Risco
2.
Klin Lab Diagn ; 64(8): 463-468, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479600

RESUMO

To study the relationship between the blood concentration of superoxide dismutase in at the end of the hospital period of acute coronary syndrome without ST-segment elevation (nonST-ACS) and the development of adverse events in the long-term follow-up period. 415 patients with nonST-ACS are included in the local register study. The follow-up period was 60 months. The blood concentration of superoxide dismutase (SOD) determined in 200 patients on the 10-13th day of hospitalization in addition to clinical procedures. Within five years after discharge in 178 (47 %) patients reported the development of adverse events. Patients with poor outcome were older, had a history of myocardial infarction (PICS), stenoses of extracranial arteries more than 30% and decreased left ventricular ejection fraction (LVEF). There were significant differences in the concentration of SOD10-13 day, which was lower in the patients with development of adverse cardiovascular events (p = 0.0003). Multivariate analysis identified the factors that are most strongly associated with the development of the adverse events during a 5-year follow-up period in patients with nonST-ACS: SOD blood concentration ≤ 175,4 ng / ml (OR-3,85; р=0,0008), myocardial infarction in anamnesis (OR-3,26; р=0,006), LVEF ≤ 52% (OR-2,8; р=0,035). The incidence of adverse cardiovascular events during five years follow-up in patients with nonST-ACS was 47 % of cases. Adverse factors associated with the development of an unfavorable outcome in the long-term period follow are: SOD blood concentration ≤ 175,4 ng / ml, myocardial infarction in anamnesis, LVEF ≤ 52%.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Superóxido Dismutase/sangue , Síndrome Coronariana Aguda/complicações , Humanos , Infarto do Miocárdio/complicações , Fatores de Tempo , Função Ventricular Esquerda
3.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(9): 936-941, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31506157

RESUMO

In recent years, high-sensitivity cardiac troponin T (hs-cTnT) has been recognized as an effective marker for myocardial injury in adults and can be used to diagnose acute myocardial injury and predict major adverse cardiovascular events. It is the gold standard for the diagnosis of acute myocardial infarction in adults. Neonates are a special group, and due to the changes of various physiological processes during the perinatal period, many laboratory markers used in adults may have a low clinical value in neonates. So far, for example, there is still no suitable cardiac serum biomarker that can reflect the true condition of neonatal myocardial injury. In recent years, new breakthroughs have been made in the application of hs-cTnT in the field of neonates. In order to fully understand the role of hs-cTnT in neonatal diseases, this article reviews the research advances in the biological and physiological features of hs-cTnT and its application in neonates.


Assuntos
Doenças do Recém-Nascido , Infarto do Miocárdio , Biomarcadores , Coração , Humanos , Recém-Nascido , Troponina T
5.
Arq. bras. cardiol ; 113(2 supl.1): 4-4, set., 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1016802

RESUMO

INTRODUÇÃO: A reperfusão precoce é recomendada universalmente para tratamento de pacientes com infarto agudo do miocárdico com supradesnivelamento do segmento ST (IAMCST). Entretanto, apesar de rápida reperfusão com angioplastia primária ou química, alguns pacientes ainda apresentam grandes massas de fibrose miocárdica e, portanto, queda significativa da função ventricular. OBJETIVO: avaliar o papel da resposta inflamatória mediada pelos linfócitos B na massa de infarto e na função ventricular após IAMCST. Métodos: amostras de sangue venoso foram coletadas no primeiro (D1) e trigésimo dia (D30) de pacientes com IAMCST(n=120), submetidos a estratégia fármacoinvasiva.A quantificação dos linfócitos B e T foi determinada por citometria de fluxo. A secreção espontânea de imunoglobulina M (IgM) pelos linfócitos B1, foi quantificada por ELISPOT. IgM total e níveis de interleucinas (IL) plasmáticas foram determinadas por ELISA. A massa de infarto e a fração de ejeção do ventrículo esquerdo (FEVE) foram estimadas por ressonância nuclear magnética cardíaca em D30. RESULTADOS: houve queda no número absoluto (cels/mL) das subpopulações de linfócitos B1 e B2 em D30...(AU)


Assuntos
Linfócitos B , Parâmetros , Infarto do Miocárdio
6.
Arq. bras. cardiol ; 113(2 supl.1): 87-87, set., 2019.
Artigo em Português | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1017167

RESUMO

Estudos recentes consideram a depressão como um fator de risco cardiovascular modificável independente para IAM. Nosso objetivo é relatar o caso de uma paciente jovem com IAM que apresentava depressão e ansiedade moderadas até então pouco valorizadas. Paciente do sexo feminino, 44 anos com HAS leve admitida com IAM com supra de ST no território da coronária direita. Recebeu terapia trombolítica, 2 horas após início da dor torácica, evoluindo com critérios de reperfusão miocárdica. Na investigação complementar apresentou CATE normal e ressonância cardíaca com infarto transmural. Medicada com antiagregante plaquetário, estatina e anti-hipertensivo. Durante as orientações de alta o neurologista levantou a hipótese de ansiedade e depressão como fatores de risco adicionais. Para confirmar essa hipótese foi solicitada avaliação psicológica. Na anamnese psíquica a paciente referiu situação familiar instável com marido esquizofrênico e filho usuário de drogas. Durante o exame psíquico pôde-se evidenciar tristeza e impotência frente à situação familiar prévia ao IAM. Aplicada Escala de Hamilton que foi compatível com ansiedade e depressão moderadas. A avaliação com os critérios de estresse crônico e depressão validados no estudo INTERHEART evidenciou aspectos depressivos relacionados com perda de interesse e prazer nas atividades, dificuldade de concentração, desmotivação e falta de energia. Recebeu alta com desvenlafaxina 50 mg e acompanhamento psicológico. Nas avaliações psicológicas de 30 e 60 dias apresentou sinais de melhora emocional. Depressão foi um dos 10 fatores de risco cardiovascular modificáveis mais importantes para IAM no estudo INTERHEART. Uma subanálise desse estudo sugeriu que fatores estressantes no lar foram 2.12 vezes mais comuns em pacientes com IAM, quando comparados ao grupo controle. Entretanto, a maioria dos pacientes com IAM não possuem avaliação psicológica durante a internação e médicos, geralmente, não são treinados para a investigação e manejo dos aspectos emocionais nos pacientes com doenças cardiovasculares. Nosso relato de caso visa despertar a importância do trabalho conjunto de médicos e psicólogos no atendimento dos pacientes com urgências e emergências cardiovasculares. (AU)


Assuntos
Humanos , Feminino , Adulto , Mulheres , Fatores de Risco , Depressão , Infarto do Miocárdio
7.
Artigo em Japonês | MEDLINE | ID: mdl-31534066

RESUMO

OBJECTIVES: The purpose of this study was to confirm the association of the status of implementation of nonsmoking at eating and drinking establishments with the prevalence of persons with subjective symptoms, the prevalence of persons with diseases under treatment, medical expenses, and mortality rate using prefectural data. METHODS: The prefectural rate of eating and drinking establishments implementing nonsmoking (hereafter, nonsmoking rate) was calculated using the data from "Tabelog®". The variables of interest were the prevalence of persons with subjective symptoms, the prevalence of persons with diseases under treatment, medical expenses (total, hospitalization and nonhospitalization expenses), and the mortality rates of malignant neoplasms (lung cancer, stomach cancer, and colon cancer), heart disease, acute myocardial infarction, cerebrovascular disease, cerebral infarction, and pneumonia in each prefecture. The partial correlation coefficient was estimated between the nonsmoking rate and the variable of interest using the smoking rate by prefectural as the control variable. RESULTS: The nonsmoking rate showed a significantly negative correlation with the medical expenses. When eating and drinking establishments were divided into "restaurant", "café", and "bar", the nonsmoking rate also indicated a significantly negative correlation with the medical expenses in any category. It was negatively related to the mortality rates of cerebrovascular disease, cerebral infarction, and pneumonia. The negative correlation was stronger in females than in males. CONCLUSIONS: These results suggest that the implementation of nonsmoking at eating and drinking establishments may reduce the mortality rates of diseases, such as cerebrovascular disease, cerebral infarction, and pneumonia, and medical expenses. Thus, it is important to implement nonsmoking at eating and drinking establishments in line with the Revised Health Promotion Act.


Assuntos
Transtornos Cerebrovasculares/mortalidade , Gastos em Saúde/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Cardiopatias/mortalidade , Neoplasias/mortalidade , não Fumantes/estatística & dados numéricos , Restaurantes/estatística & dados numéricos , Prevenção do Hábito de Fumar/estatística & dados numéricos , Humanos , Japão/epidemiologia , Infarto do Miocárdio/mortalidade , Pneumonia/mortalidade , Prevalência
8.
Adv Exp Med Biol ; 1161: 45-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562621

RESUMO

After myocardial infarction, splenic leukocytes direct biosynthesis of specialized pro-resolving mediators (SPMs) that are essential for the resolution of inflammation and tissue repair. In a laboratory environment, after coronary ligation of healthy risk free rodents (young adult mice) leukocytes biosynthesize SPMs with induced activity of lipoxygenases and cyclooxygenases, which facilitate cardiac repair. Activated monocytes/macrophages drive the biosynthesis of SPMs following experimental myocardial infarction in mice during the acute heart failure. In the presented review, we provided the recent updates on SPMs (resolvins, lipoxins and maresins) in cardiac repair that may serve as novel therapeutics for future heart failure therapy/management. We incorporated the underlying causes of non-resolving inflammation following cardiac injury if superimposed with obesity, hypertension, diabetes, disrupted circadian rhythm, co-medication (painkillers or oncological therapeutics), and/or aging that may delay or impair the biosynthesis of SPMs, intensifying pathological remodeling in heart failure.


Assuntos
Insuficiência Cardíaca , Mediadores da Inflamação , Animais , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Inflamação/fisiopatologia , Mediadores da Inflamação/metabolismo , Mediadores da Inflamação/uso terapêutico , Leucócitos , Infarto do Miocárdio
9.
Zhonghua Yi Xue Za Zhi ; 99(35): 2750-2755, 2019 Sep 17.
Artigo em Chinês | MEDLINE | ID: mdl-31550797

RESUMO

Objective: To assess whether acute-phase plasma PCSK9 levels predict recurrent cardiovascular (CV) events in acute myocardial infarction (AMI) patients without receiving reperfusion therapy. Methods: Plasma PCSK9 levels were measured during the acute phase (≤24 hours) in 882 patients who did not undergo reperfusion therapy from the China PEACE-Prospective AMI Study (2012-2014). Associations of acute-phase PCSK9 tertiles with patient characteristics and recurrent CV events at 1 year were assessed using multivariable logistic and Cox proportional hazards regression models. Results: Female gender (odds ratio [OR] 2.86, 95% confidence interval [CI] 1.36-5.98), premature coronary heart disease (CHD) (OR 2.82, 95%CI 1.43-5.53), higher high-sensitivity C-reactive protein (OR 1.69, 95%CI 1.35-2.13), and higher triglycerides (OR 1.93, 95%CI 1.10-3.38) were associated with higher baseline PCSK9 levels. Patients with PCSK9 levels in the highest tertile (versus lowest) did not have an increased risk of 1-year recurrent CV events (HR 0.77, 95%CI 0.44-1.34). Conclusion: Acute-phase plasma PCSK9 levels are associated with levels of inflammation and triglycerides, premature CHD, and gender in AMI patients without reperfusion therapy, however it do not predict recurrent CV events at 1 year.


Assuntos
Infarto do Miocárdio/sangue , Pró-Proteína Convertase 9/sangue , China , Doença das Coronárias/epidemiologia , Feminino , Humanos , Inflamação , Masculino , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Recidiva , Fatores Sexuais , Triglicerídeos/sangue
10.
Kardiologiia ; 59(8S): 15-23, 2019 Sep 16.
Artigo em Russo | MEDLINE | ID: mdl-31526358

RESUMO

Theory of atherogenesis and its complications underwent numerous changes. Today we observe that inflammation is a universal pathogenetic link between various processes such as atherosclerosis, rupture of atherosclerotic plaques and following myocardial infarction, post-infarction cardiac repair and heart failure. This review discusses examples, difficulties, and prospects of implementation of anti-inflammatory therapies in management of acute coronary syndrome and its complications.


Assuntos
Síndrome Coronariana Aguda , Humanos , Inflamação , Infarto do Miocárdio , Placa Aterosclerótica , Regeneração
11.
Niger J Clin Pract ; 22(9): 1201-1207, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489854

RESUMO

Background: The presence of vitamin D, and parathyroid hormone receptors has been demonstrated in the vascular endothelium. Variations in vitamin D, and parathyroid hormone levels may affect coronary flow and cause the coronary slow-flow phenomenon (CSF). Methods: We enrolled 93 patients who had undergone coronary angiography and had near-normal coronary arteries. Blood samples were taken to determine the calcium, phosphorus, 25-hydroxy vitamin D, and parathyroid hormone levels. Vitamin D deficiency was defined as a serum 25-hydroxy vitamin D level of less than 20 ng/mL. We divided the study population into two groups according to thrombolysis in myocardial infarction frame count (TFC) levels. Results: Patients with TFC ≤27 were in the control group (n = 39), and those with TFC >27 were in the CSF group (n = 54). 25-Hydroxy vitamin D levels were similar in both groups: 17.5 [3.3-36.1] ng/ml in the CSF group and 15.2 [5.3-34] ng/ml in the control group (P = 0.129). When we analyzed TFC for each of the coronary arteries, we found a weak negative correlation between vitamin D level and TFC of the right coronary artery in the CSF group (r = -0.314, P = 0.021). Parathyroid hormone levels were similar in both groups: 48 [16-140] pg/ml in the CSF group and 52 [25-125] pg/ml in the control group (P = 0.297). Conclusion: The study failed to demonstrate a relationship between serum parathyroid hormone level and CSF. However, a weak negative correlation was found between vitamin D level and TFC of the right coronary artery.


Assuntos
Circulação Coronária/fisiologia , Vasos Coronários/diagnóstico por imagem , Fenômeno de não Refluxo , Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/diagnóstico , Vitamina D/análogos & derivados , Idoso , Calcifediol/sangue , Cálcio/sangue , Angiografia Coronária , Vasos Coronários/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Fósforo/sangue , Vitamina D/sangue , Deficiência de Vitamina D/sangue
12.
BMJ ; 366: l4563, 2019 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-31405902

RESUMO

OBJECTIVE: To determine any changes in total hospital revisits within 30 days of discharge after a hospital stay for medical conditions targeted by the Hospital Readmissions Reduction Program (HRRP). DESIGN: Retrospective cohort study. SETTING: Hospital stays among Medicare patients for heart failure, acute myocardial infarction, or pneumonia between 1 January 2012 and 1 October 2015. PARTICIPANTS: Medicare fee-for-service patients aged 65 or over. MAIN OUTCOMES: Total hospital revisits within 30 days of discharge after hospital stays for medical conditions targeted by the HRRP, and by type of revisit: treat-and-discharge visit to an emergency department, observation stay (not leading to inpatient readmission), and inpatient readmission. Patient subgroups (age, sex, race) were also evaluated for each type of revisit. RESULTS: Our study cohort included 3 038 740 total index hospital stays from January 2012 to September 2015: 1 357 620 for heart failure, 634 795 for acute myocardial infarction, and 1 046 325 for pneumonia. Counting all revisits after discharge, the total number of hospital revisits per 100 patient discharges for target conditions increased across the study period (monthly increase 0.023 visits per 100 patient discharges (95% confidence interval 0.010 to 0.035)). This change was due to monthly increases in treat-and-discharge visits to an emergency department (0.023 (0.015 to 0.032) and observation stays (0.022 (0.020 to 0.025)), which were only partly offset by declines in readmissions (-0.023 (-0.035 to -0.012)). Increases in observation stay use were more pronounced among non-white patients than white patients. No significant change was seen in mortality within 30 days of discharge for target conditions (-0.0034 (-0.012 to 0.0054)). CONCLUSIONS: In the United States, total hospital revisits within 30 days of discharge for conditions targeted by the HRRP increased across the study period. This increase was due to a rise in post-discharge emergency department visits and observation stays, which exceeded the decline in readmissions. Although reductions in readmissions have been attributed to improvements in discharge planning and care transitions, our findings suggest that these declines could instead be because hospitals and clinicians have intensified efforts to treat patients who return to a hospital within 30 days of discharge in emergency departments and as observation stays.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Unidades de Observação Clínica/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pesquisa sobre Serviços de Saúde/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Medicare/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Alta do Paciente , Readmissão do Paciente/tendências , Pneumonia/epidemiologia , Pneumonia/terapia , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Estados Unidos/epidemiologia
13.
Vasc Health Risk Manag ; 15: 221-227, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31410012

RESUMO

Background: High sensitivity C-reactive protein (hsCRP) predicts myocardial dysfunction after acute coronary syndromes. We aimed to study the association of hsCRP estimation at first acute myocardial infarction (AMI) with myocardial dysfunction and heart failure. Methods: This research was carried out at the Department of Physiology and Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. In this prospective study, 227 patients were studied. hsCRP levels were estimated when patients came to the emergency department at AMI, 7 days post AMI, and at 12 weeks of follow up after AMI. The outcome was change in myocardial functions, especially heart failure, 12 months after the attack. Results: Based on a cutoff mean value of hsCRP levels at admission (10.05±12.68 mg/L), patients were grouped into high and low C-reactive protein (CRP.) The ejection fraction was significantly lower at follow up in the high CRP group (37.29±12.97) compared to the low CRP group (43.85±11.77, p<0.0198). hsCRP had significant inverse correlation with left ventricular ejection fraction (r=-0.283, p<0.01). About 38.1% patients showed heart failure, with 23.6% in the high CRP group and 14.5% in the low CRP group (OR 2.4, p=0.028). Receiver operating characteristic curve analysis showed that CRP levels at AMI had a specificity of 79% and sensitivity of 83% to predict heart failure. Conclusion: A high hsCRP level measured at first AMI predicts myocardial dysfunction and heart failure. It is suggested that hsCRP plays an important role in the development of heart failure after myocardial infarction.


Assuntos
Proteína C-Reativa/análise , Insuficiência Cardíaca/etiologia , Infarto do Miocárdio/sangue , Adulto , Idoso , Biomarcadores/sangue , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Arábia Saudita , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda
14.
Kardiologiia ; 59(7S): 40-46, 2019 Aug 23.
Artigo em Russo | MEDLINE | ID: mdl-31441740

RESUMO

AIM: To study clinical prognostic value of residual platelet activity in patients with acute coronary syndrome without ST segment elevation. MATERIAL AND METHODS: The study included 120 patients with acute coronary syndrome without ST segment elevation (NSTE ACS) with coronary artery stenting. Testing of residual reactivity of platelets in the subjects was carried out after loading doses of  aspirin and P2Y12-inhibitors.Patients were divided into two groups comparable in gender and age: with low residual reactivity of platelets (LRR), n=90 and with high residual reactivity of platelets (HRR), n=30. Between the groups a comparative assessment of clinical-laboratory and instrumental indicators, development of a combined end point (ischemic events) and bleeding during follow-up (16 ± 6 months). RESULTS: The group with HRR was initially heavier: patients with angina pectoris of functional class III, atrial fibrillation, myocardial infarction, was a higher risk on the GRACE (202,6±11 vs. 148,6±7, р=0,03),increased levels of Troponin T (70,0 vs. 45,5%, р=0,02), acute occlusion in the coronary arteries (66,6 vs. 42,4%, р=0,02).The combined endpoint was more often reported in patients with HRR (40 vs. 20,7%, р=0,04). Patients with ADP-aggregation of platelets in the range 0-1 Om had a greater risk of developing hemorrhagic events (17,1 vs. 2,1%, RR 8,05 CI: 1,1-59,9, р=0,01). CONCLUSION: In patients with NSTE ACSHRR after loading doses of aspirin and P2Y12-inhibitor was associated with the development of repeated atherothrombotic events. Very low LRR was associated with the development of bleeding.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Aspirina , Plaquetas , Humanos , Inibidores da Agregação de Plaquetas , Prognóstico
15.
S D Med ; 72(4): 174-177, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31436931

RESUMO

The effect of pre-existing collateral circulation on presentation of acute coronary syndrome (ACS) is not well known. We present a case of a 54-year-old male with a known history of chronic total occlusion of left circumflex artery and well-developed collaterals, who presented to the emergency department with non-STsegment elevation myocardial infarction. He underwent urgent coronary angiogram which showed an acute total thrombotic occlusion in proximal large right coronary artery with collaterals from left to right. After percutaneous coronary intervention, the collaterals reversed to a right to left direction. We postulate that the well-developed collateral circulation protected the patient from larger transmural ischemia and ST elevation myocardial infarction.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Circulação Colateral , Angiografia Coronária , Circulação Coronária , Humanos , Masculino , Pessoa de Meia-Idade
16.
Medicine (Baltimore) ; 98(35): e17020, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464961

RESUMO

The aim of this retrospective national cohort study is to assess the association between various radiation heart dosimetric parameters (RHDPs), acute myocardial infarct (AMI) and overall survival (OS) outcomes in non-small cell lung cancer (NSCLC) patients treated with post-operative thoracic radiotherapy (PORT) using contemporary radiation techniques.We identified patients with stage I to III NSCLC treated with PORT at the 2 national cancer institutions from 2007 to 2014. We linked their electronic medical records to the national AMI and death registries. Univariable Cox regression was performed to assess the association between various RHDPs, AMI, and OS.We included 43 eligible patients with median follow-up of 36.6 months. Median age was 64 years. Majority of the patients had pathological stage III disease (72%). Median prescription dose was 60Gy. Median mean heart dose (MHD) was 9.4Gy. There were no AMI events. The 5-year OS was 34%. Univariable Cox regression showed that age was significantly associated with OS (hazard ratio, 1.06; 95% confidence interval, 1.01 to 1.10; P = .008). Radiation heart doses, including MHD, volume of heart receiving at least 5, 25, 30, 40, 50Gy and dose to 30% of heart volume, were not significantly associated with OS.There is insufficient evidence to conclude that RHDPs are associated with OS for patients with NSCLC treated with PORT in this study. Studies with larger sample size and longer term follow-up are needed to assess AMI outcome.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/radioterapia , Dosagem Radioterapêutica , Fatores Etários , Idoso , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Estudos Retrospectivos
17.
Kardiologiia ; 59(8): 15-24, 2019 Aug 08.
Artigo em Russo | MEDLINE | ID: mdl-31397226

RESUMO

OBJECTIVE: to assess the clinical status, comorbidities, complications, in-hospital mortality and its structure in dependence of age and type of acute coronary syndrome (ACS) in case of early invasive strategy of ACS management. MATERIALS AND METHODS: we included in this retrospective study data of all patients (n=1353) with ACS subjected to emergency and urgent myocardial revascularization in High Medical Technologies Center (Kaliningrad, Russia) in 2014-2016. Age of 984 patients was <75 (group 1) and of 369 >75 years (group 2). RESULTS: Mean age was 60±8.6 and 80.1±4.2 years, in groups 1 and 2, respectively. Anamnesis of group 2 patients was substantially burdened by myocardial infarction and stroke, they significantly more often had reduced left ventricular ejection fraction (EF), congestive heart failure, valve disorders, and atrial fibrillation. Patients of group 2 more frequently had severe manifestations of acute heart failure (AHF) and cardiogenic shock. Portions of patients with Killip class III were 5.9 and 11.4%, IV -2.1% and 9.1% in 1 and 2, respectively. Group 2 patients compared with those of group 1 had higher GRACE score and higher bleeding risk. In-hospital all-cause mortality was 3.1 and 10%, ST elevation myocardial infarction mortality - 2.6 and 9.5% in groups 1 and 2, respectively. Non-ST elevation myocardial infarction + unstable angina mortality (0.5%) did not differ between groups. Mortality from AHF (2 and 6.5%) and percutaneous coronary intervention complications (stent thrombosis and no-reflow) (0.5 and 2.4%) was significantly higher in group 2. AHF mortality was similar in patients with preserved and mid-range EF of both groups, but among those with reduced EF it was significantly higher in group 2 compared with group 1 (7.3 vs. 18.6%, respectively). There were no significant differences between groups in rates of gastro-intestinal and major bleedings. CONCLUSIONS: Clinical course of ACS was more severe in patients aged >75 years compared with patients aged <75 years. Early invasive strategy was effective irrespective of patient's age and ACS type. Rate of fatal outcomes due to complications of stenting and AHF were higher among very elderly patients. AHF more often caused death in very elderly patients with reduced EF. The rest of the structure of complications and mortality was similar in patients of different ages.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Idoso , Idoso de 80 Anos ou mais , Angina Instável , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Federação Russa
18.
Kardiologiia ; 59(8): 25-38, 2019 Aug 08.
Artigo em Russo | MEDLINE | ID: mdl-31397227

RESUMO

PURPOSE: to assess the clinical course of ischemic mitral regurgitation (IMR) in patients with myocardial infarction of different localizations and reveal its mechanisms and predictors. MATERIALS AND METHODS: We enrolled in this study patients with first inferoposterior myocardial infarction (IPMI) (n=77), and anteroseptal MI (ASMI) (n=79) revascularized within 12 hours after symptoms onset, as well as age, sex and weight matched healthy control subjects (n=50). Parameters of mitral structures and mitral annulus areas (MAA), left ventricular (LV) volumes (LVV) and sphericity index (SI), global (G) and segmental (S) longitudinal LV strain (GLS, SLS), papillary muscles (PM) LS (PMLS) and PM systolic dyssynchrony (PMSD) were measured by echocardiography on the 7th and 180th days of follow up. RESULTS: On the 7th day of follow up IMR was diagnosed more frequently in IPMI vs. ASMI (42 vs. 28%, р<0.001). In both groups patients with TIMI 0 flow before angioplasty had highest, while those with TIMI 3 flow - lowest incidence of IMR. Presence of IMR depended on collateral flow availability in vascular bed of infarct related artery. Wall motion abnormalities (WMA) of infarcted segments, MAA, posteromedial PM posterior displacement (PPMPD), SLS, PMLS, PMSD correlated with IMR in patients with IPMI on the 7th day of follow up. VLV, GLS and MAA correlated with IMR in patients with ASMI on the 7th day follow up. Patients with IPMI without IMR in 7th day did not develop IMR for 180 days of follow up while IMR developed in 19.3% of patients with ASMI without IMR at initial examination. Among patients with IPMI and ASMI 37.5% and 45.5%, respectively, of those with IMR at initial examination had no IMR after 180 days of follow up. Patients with IPMI more frequently had eccentric IMR than patients with ASMI (78 and 24%, respectively, p<0.002). At examination after 6 months WMA, MAA, PMSD, PPMPD, SLS, PMLS, PMSD correlated with IMR in patients with IPMI, while VLV, AMA, PM apical displacement (PMAD), GLS and PMSD correlated with IMR in patients with ASMI. AMA, PMAD and PMSD were predictors of IMR in patients with MI of both localizations. In addition, in patients with ASMI VLV and SI were also predictors of IMR.


Assuntos
Insuficiência da Valva Mitral , Infarto do Miocárdio , Ecocardiografia , Ventrículos do Coração , Humanos , Valva Mitral
19.
Kardiologiia ; 59(8): 64-71, 2019 Aug 08.
Artigo em Russo | MEDLINE | ID: mdl-31397231

RESUMO

This review article contains presentation of modern diagnostic criteria and prognostic scales for cardiogenic shock in patients with myocardial infarction as well as analysis of current clinical guidelines. Main results of clinical trials underlying recommendations of these guidelines are discussed. The article focuses on controversial and unfounded recommendations and issues requiring further research.


Assuntos
Infarto do Miocárdio , Choque Cardiogênico , Humanos , Prognóstico
20.
Medicine (Baltimore) ; 98(33): e16657, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415359

RESUMO

RATIONALE: Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal hematopoietic stem cell disease. Patients with PNH often experience a high incidence (14%-40%) of thrombotic events, which are mainly venous and rarely arterial thrombotic events. Because it is very rare, delay in diagnosis is common in patients with PNH, imposing a remarkable impact on patient's management and prognosis. PATIENT CONCERNS: We presented a 33-year-old female case with no medical history of any systemic illnesses who complained of approximately 1-month progressively worsening constant heartburn, and was also hospitalized twice due to acute myocardial infarction (AMI). DIAGNOSES: In our case, AMI occurred twice, whereas there were no cardiovascular risk factors and abnormalities based on the angiography of the coronary artery. Flow cytometry analysis showed that 25% of CD55 and CD59 were lost on the surface of neutrophils, and 30% of CD55 and CD59 were lost on the surface of the blood cells. Thus, our diagnosis of this patient was AMI secondary to PNH. INTERVENTIONS AND OUTCOMES: For the first myocardial infarction, local hospitals used thrombolytic therapy to alleviate symptoms. After the patient's second myocardial infarction was treated in our hospital, we adopted coronary interventional therapy. Considering the patient's situation, eculizumab was given for treatment. The patient was gradually restored to achieve stability, and the follow-up observation showed that there was no arterial thrombosis. LESSONS: This case report aimed to provide a reliable reference for the rare cause of AMI. In addition, PNH should be highly taken into consideration in young patients who have a rare cause of AMI.


Assuntos
Hemoglobinúria Paroxística/complicações , Infarto do Miocárdio/etiologia , Doença Aguda , Adulto , China , Feminino , Humanos , Infarto do Miocárdio/urina , Recidiva
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA