Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28.712
Filtrar
1.
Trials ; 22(1): 582, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34470656

RESUMO

BACKGROUND: Nut consumption has been related to improvements on cardiometabolic parameters and reduction in the severity of atherosclerosis mainly in primary cardiovascular prevention. The objective of this trial is to evaluate the effects of the Brazilian Cardioprotective Diet (DIeta CArdioprotetora Brasileira, DICA Br) based on consumption of inexpensive locally accessible foods supplemented or not with mixed nuts on cardiometabolic features in patients with previous myocardial infarction (MI). METHODS: DICA-NUTS study is a national, multicenter, randomized 16-week follow-up clinical trial. Patients over 40 years old with diagnosis of previous MI in the last 2 to 6 months will be recruited (n = 388). A standardized questionnaire will be applied to data collection and blood samples will be obtained. Patients will be allocated in two groups: Group 1: DICA Br supplemented with 30 g/day of mixed nuts (10 g of peanuts, 10 g of cashew, 10 g of Brazil nuts); and Group 2: only DICA Br. The primary outcome will consist of LDL cholesterol means (in mg/dL) after 16 weeks of intervention. Secondary outcomes will consist of other markers of lipid profile, glycemic profile, and anthropometric data. DISCUSSION: It is expected that DICA Br supplemented with mixed nuts have superior beneficial effects on cardiometabolic parameters in patients after a MI, when compared to DICA Br. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03728127 . First register: November 1, 2018; Last update: June 16, 2021. World Health Organization Universal Trial Number (WHO-UTN): U1111-1259-8105.


Assuntos
Dieta , Infarto do Miocárdio , Adulto , Biomarcadores , Glicemia , LDL-Colesterol , Humanos , Estudos Multicêntricos como Assunto , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
BMJ Open ; 11(8): e048356, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408048

RESUMO

BACKGROUND: The study aimed to compare the predictive values of the thrombolysis in myocardial infarction (TIMI); History, Electrocardiography, Age, Risk factors and Troponin (HEART) and Global Registry in Acute Coronary Events (GRACE) scoring systems for major adverse cardiovascular events (MACEs) in acute chest pain (ACP) patients admitted to the emergency department (ED). METHODS: We systematically searched PubMed, Embase and the Cochrane Library from their inception to June 2020; we compared the following parameters: sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curves (AUC). RESULTS: The pooled sensitivity and specificity for TIMI, HEART and GRACE were 0.95 and 0.36, 0.96 and 0.50, and 0.78 and 0.56, respectively. The pooled PLR and NLR for TIMI, HEART and GRACE were 1.49 and 0.13, 1.94 and 0.08, and 1.77 and 0.40, respectively. The pooled DOR for TIMI, HEART and GRACE was 9.18, 17.92 and 4.00, respectively. The AUC for TIMI, HEART and GRACE was 0.80, 0.80 and 0.70, respectively. Finally, the results of indirect comparison suggested the superiority of values of TIMI and HEART to those of GRACE for predicting MACEs, while there were no significant differences between TIMI and HEART for predicting MACEs. CONCLUSIONS: TIMI and HEART were superior to GRACE for predicting MACE risk in ACP patients admitted to the ED.


Assuntos
Infarto do Miocárdio , Troponina , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Infarto do Miocárdio/diagnóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Fatores de Risco , Triagem
3.
S D Med ; 74(6): 248-249, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34449162

RESUMO

Coronary vasospasm is an underdiagnosed cause of myocardial infarction in the absence of obstructive coronary artery disease. Systemic inflammation is one of several triggers associated with coronary vasospasm. We report the case of a 47-year woman incidentally found to be COVID-positive (RT-PCR) during evaluation of constitutional symptoms and breast cellulitis. Later in the hospitalization, she developed sudden-onset typical angina at rest; 12 lead EKG showed inferolateral ST-elevations. Urgent coronary angiogram showed nitrate-responsive subtotal focal occlusions in the right coronary and circumflex arteries. In the absence of sepsis, it is difficult to attribute coronary vasospasm solely to cellulitis. Focal coronary artery spasm mimicking ST-elevation myocardial infarction successfully managed solely with intracoronary nitroglycerine in an incidentally COVID-positive patient adds to the diverse manifestations of COVID infection. The exact mechanism of focal, as opposed to diffuse coronary vasospasm is unclear.


Assuntos
COVID-19 , Vasoespasmo Coronário , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/diagnóstico , Feminino , Humanos , Infarto do Miocárdio/diagnóstico , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
4.
PLoS One ; 16(8): e0256116, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34383840

RESUMO

INTRODUCTION: The coronavirus disease (COVID-19) pandemic has delayed the management of other serious medical conditions. This study presents an efficient method to prevent the degradation of the quality of diagnosis and treatment of other critical diseases during the pandemic. METHODS: We performed a retrospective observational study. The primary outcome was ED length of stay (ED LOS). The secondary outcomes were the door-to-balloon time in patients with suspected ST-segment elevation myocardial infarction and door-to-brain computed tomography time for patients with suspected stroke. The outcome measures were compared between patients who were treated in the red and orange zones designated as the changeable isolation unit and those who were treated in the non-isolation care unit. To control confounding factors, we performed propensity score matching, following which, outcomes were analyzed for non-inferiority. RESULTS: The mean ED LOS for hospitalized patients in the isolation and non-isolation care units were 406.5 min (standard deviation [SD], 237.9) and 360.2 min (SD, 226.4), respectively. The mean difference between the groups indicated non-inferiority of the isolation care unit (p = 0.037) but not in the patients discharged from the ED (p>0.999). The mean difference in the ED LOS for patients admitted to the ICU between the isolation and non-isolation care units was -22.0 min (p = 0.009). The mean difference in the door-to-brain computed tomography time between patients with suspected stroke in the isolation and non-isolation care units was 7.4 min for those with confirmed stroke (p = 0.013), and -20.1 min for those who were discharged (p = 0.012). The mean difference in the door-to-balloon time between patients who underwent coronary angiography in the isolation and non-isolation care units was -2.1 min (p<0.001). CONCLUSIONS: Appropriate and efficient handling of a properly planned ED plays a key role in improving the quality of medical care for other critical diseases during the COVID-19 outbreak.


Assuntos
COVID-19 , Serviço Hospitalar de Emergência/organização & administração , Tempo de Internação , Infarto do Miocárdio/diagnóstico , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia
5.
Kardiologiia ; 61(7): 36-43, 2021 Jul 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34397340

RESUMO

Aim      To study the effect of residual coronary injury after a percutaneous coronary intervention (PCI), as evaluated with the SYNTAX scale (residual SYNTAX score, RSS), on the mid-term prognosis for patients with non-ST elevation acute myocardial infarction (NSTEMI) and also to determine threshold RSS values for patients at high and low risk of adverse cardiac events.Material and methods  A single-center, retrospective study was performed. From 421 patients with NSTEMI after PCI with stenting, 169 patients were selected who originally had multivessel coronary disease and who had undergone a repeated inpatient examination, including mid-term (11.7±3.0 mos.) coronary angiography. The endpoints were recurrent clinical manifestations of angina, repeat revascularization (RR), unstable angina (UA), recurrent acute myocardial infarction (AMI), cardiac death, and also a composite endpoint (major adverse cardiac events, MACE) that included UA, recurrent AMI, and cardiac death. After revealing a significant direct correlation between RSS and the probability of recurrent AMI, UA, MACE, or RR (p <0.05) using the ROC analysis, we have established threshold RSS values that divided patients into groups with high and low risk of the cardiac events listed above.Results For a significantly high risk of recurrent AMI (area under the curve, AUC 0.79±0.05; 95 % confidence interval, CI 0.68-0.89; р=0.048), the threshold RSS score was 8 (sensitivity 100 %, specificity 70.9 %). For UA and MACE, the RSS scores were both 3 (AUC 0.68±0.5; 95 % CI 0.58-0.79; p=0.005 and AUC 0.71±0.05; 95 % CI 0.61-0.8; p=0.001, respectively). The probability of UA during the observation period with RSS >3 was 4.07 times higher and that of MACE was 5.23 times higher than with RSS<3 (95 % CI 1.44-11.49; р=0.01 and 95 % CI 1.88-14.53; р=0.001, respectively).Conclusion      The study demonstrated a significant, direct correlation between the RSS and the risk of adverse cardiac events in patients with NSTEMI during one year of observation. Specific threshold values were obtained, which may help in choosing both the extent of revascularization and the tactics for postoperative management of patients.


Assuntos
Doença da Artéria Coronariana , Infarto do Miocárdio , Intervenção Coronária Percutânea , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Humanos , Infarto do Miocárdio/diagnóstico , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
6.
Scand J Trauma Resusc Emerg Med ; 29(1): 106, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332603

RESUMO

BACKGROUND: There exists a therapeutic conflict between haemorrhage control and prevention of thromboembolic events following polytrauma and complications are not uncommon. Such opposing therapies can result in unexpected pathophysiology and there is a real risk of misdiagnosis resulting in harm. This case presents a previously unreported complication of prevention and management of thromboembolism- STEMI (ST elevation myocardial infarction) and tamponade mimic secondary to retroperitoneal haematoma. CASE PRESENTATION: We present a 50-year-old male polytrauma patient who following treatment for presumed pulmonary embolus demonstrated classical clinical findings of myocardial infarction and pericardial tamponade secondary to a retroperitoneal haematoma. This is an event not previously reported in the literature. The risk of adverse outcome by management along the standard lines of STEMI (ST elevation myocardial infarction) was averted through awareness for alternative aetiology via a multi-team approach which resulted in percutaneous drainage of the haematoma and complete resolution of symptoms. CONCLUSIONS: This manuscript highlights the therapeutic conflict between haemorrhage control and prevention of thromboembolic events in critically injured, the importance of high index of suspicion in this patient cohort and the benefits of multidisciplinary decision making in the complex patient through a not previously published pathophysiologic phenomenon.


Assuntos
Traumatismo Múltiplo , Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Estômago , Resultado do Tratamento
7.
Intern Med J ; 51(8): 1328-1331, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34213031

RESUMO

During the first months of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, Google Trends data in the United States showed a strong increase in search query frequency for chest pain symptoms despite a concurrent decrease in search interest for myocardial infarction. This suggests a reduced attention to acute coronary syndrome (ACS) and chest pain as its main symptom during this time period. These observations could help explain why cardiovascular mortality rose dramatically despite a strong decrease in hospitalisation rates for ACS.


Assuntos
COVID-19 , Infarto do Miocárdio , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Pandemias , SARS-CoV-2 , Ferramenta de Busca , Estados Unidos/epidemiologia
8.
Kardiologiia ; 61(6): 41-51, 2021 Jul 01.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34311687

RESUMO

Aim      To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods  The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion      REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.


Assuntos
Infarto do Miocárdio , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Federação Russa/epidemiologia , Fatores de Tempo , Resultado do Tratamento
9.
Medicina (Kaunas) ; 57(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34208003

RESUMO

Background and Objectives: Serum cortisol has been extensively studied for its role during acute myocardial infarction (AMI). Reports have been inconsistent, with high and low serum cortisol associated with various clinical outcomes. Several publications claim to have developed methods to evaluate cortisol activity by using elements of complete blood count with its differential. This study aims to compare the prognostic value of the cortisol index of Endobiogeny with serum cortisol in AMI patients, and to identify if the risk of mortality in AMI patients can be more precisely assessed by using both troponin I and cortisol index than troponin I alone. Materials and methods: This prospective study included 123 consecutive patients diagnosed with AMI. Diagnostic coronary angiography and revascularization was performed for all patients. Cortisol index was measured on admission, on discharge, and after 6 months. Two year follow-up for all patients was obtained. Results: Our study shows cortisol index peaks at 7-12 h after the onset of AMI, while serum cortisol peaked within 3 h from the onset of AMI. The cortisol index is elevated at admission, then significantly decreases at discharge; furthermore, the decline to its bottom most at 6 months is observed with mean values being constantly elevated. The cortisol index on admission correlated with 24-month mortality. We established combined cut-off values of cortisol index on admission > 100 and troponin I > 1.56 µg/las a prognosticator of poor outcomes for the 24-month period. Conclusions: The cortisol index derived from the global living systems theory of Endobiogeny is more predictive of mortality than serum cortisol. Moreover, a combined assessment of cortisol index and Troponin I during AMI offers more accurate risk stratification of mortality risk than troponin alone.


Assuntos
Hidrocortisona , Infarto do Miocárdio , Biomarcadores , Humanos , Infarto do Miocárdio/diagnóstico , Prognóstico , Estudos Prospectivos , Troponina I
10.
Arch Iran Med ; 24(4): 339-340, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196196

RESUMO

Since the emergence of novel coronavirus and the disease named as COVID-19 in late December of 2019 in Wuhan, Hubei province, China, many aspects of this disease have been reported in the literature (mainly pulmonary manifestations). In patients with COVID-19, rheumatic and cardiovascular manifestations and interactions were reported separately, but they were all very rare. This is the report of a 14-year-old teenager with GPA (previously known as Wegner's granulomatosis) who was in remission with immunosuppressive therapy. Post COVID-19 infection, she developed exacerbation of her disease. Besides the rheumatologic manifestations, she developed epigastric pain found to be acute myocardial infarction (MI) that needed primary percutaneous coronary intervention (PCI).


Assuntos
COVID-19/complicações , COVID-19/diagnóstico , Granulomatose com Poliangiite/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Adolescente , COVID-19/terapia , Feminino , Humanos , Infarto do Miocárdio/terapia
11.
Biomed Pharmacother ; 139: 111621, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34243599

RESUMO

Alterations in xanthine oxidase activity are known to be pathologically influential on coronary artery disease (CAD), but the association between purine-related blood metabolites and CAD has only been partially elucidated. We performed global metabolomics profiling and network analysis on blood samples from the Wonju and Pyeongchang (WP) cohort study (n = 2055) to elucidate the importance of purine related metabolites associated with potential CAD risk. Then, 5 selected serum metabolites were quantified from the WP cohort, Shinchon cohort (n = 259), and Shinchon case control (n = 424) groups to develop machine learning models for 10-year risk prediction, relapse within 10 years and diagnosis of the disease via 100 repeated 5-fold cross-validations of logistic models. The combination of purine metabolite levels or only xanthine levels in blood could be applied for machine learning model development for major adverse cardiac and cerebrovascular event (MACCE, cerebrovascular death, nonfatal myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, and stroke) risk prediction, relapse of MACCEs among patients with myocardial infarction history and diagnosis of stable CAD. In particular, our research provided initial evidence that blood xanthine and uric acid levels play different roles in the development of machine learning models for primary/secondary prevention or diagnosis of CAD. In this research, we determined that purine-related metabolites in blood are applicable to machine learning model development for CAD risk prediction and diagnosis. Also, our work advances current CAD biomarker discovery strategies mainly relying on clinical features; emphasizes the differential biomarkers in first/secondary prevention or diagnosis studies.


Assuntos
Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/patologia , Purinas/metabolismo , Idoso , Biomarcadores/metabolismo , Estudos de Casos e Controles , Estudos de Coortes , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Intervenção Coronária Percutânea/métodos , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/metabolismo , Acidente Vascular Cerebral/patologia
12.
Mayo Clin Proc ; 96(7): 1746-1757, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34218855

RESUMO

OBJECTIVE: To examine the associations of muscle strength and genetic risk for stroke with stroke incidence. PARTICIPANTS AND METHODS: We included 284,767 white British participants of UK Biobank without genetic relatedness and stroke or myocardial infarction at baseline between March 13, 2006, and October 1, 2010. Genetic risk was assessed with polygenic risk scores, calculated by summing the risk-increasing alleles, weighted by the effect estimates. Muscle strength was assessed through grip strength tests by hand dynamometers. Incidence of overall (n= 4008), ischemic (n= 3031), and hemorrhagic (n=1073) stroke was adjudicated during 11.5-year follow-up. RESULTS: Compared with the bottom muscle strength tertile, hazard ratios (95% CI) of stroke were 0.81 (0.75 to 0.87) and 0.76 (0.71 to 0.82) for the middle and top muscle strength tertiles, respectively, after adjustment for confounders and genetic risk; higher genetic risk was independently associated with higher stroke incidence. Stroke hazards for the top muscle strength tertile were consistently lower across genetic risk strata, with no evidence of interaction. Compared with individuals with high muscle strength and low genetic risk, stroke hazards were higher for individuals who had medium or high genetic risk combined with low or medium muscle strength but not for those who had medium genetic risk but high muscle strength. Associations were similar for ischemic and hemorrhagic stroke (although CIs were inconclusive for some of the associations). CONCLUSION: Higher muscle strength was associated with lower stroke incidence in all individuals, including those with high genetic susceptibility. The increased genetic risk of overall and ischemic stroke was partly attenuated through increased muscle strength.


Assuntos
AVC Hemorrágico , AVC Isquêmico , Força Muscular , Infarto do Miocárdio , Bancos de Espécimes Biológicos/estatística & dados numéricos , Correlação de Dados , Feminino , Predisposição Genética para Doença , Fatores de Risco de Doenças Cardíacas , AVC Hemorrágico/diagnóstico , AVC Hemorrágico/epidemiologia , Humanos , Incidência , AVC Isquêmico/diagnóstico , AVC Isquêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Fatores de Risco , Reino Unido/epidemiologia
13.
Medicine (Baltimore) ; 100(27): e26604, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232213

RESUMO

RATIONALE: Congenital agenesis of the right coronary artery (CARCA) initially presenting as acute myocardial infarction (AMI) due to total occlusion is a rare clinical condition that can lead to severe complications, including death. We report a case of successful percutaneous coronary intervention (PCI) in a patient with this condition. PATIENT CONCERNS: A 57-year-old man was admitted to our center with chest pain that had occurred several hours prior. Since he was initially diagnosed with AMI with ST-segment elevation, we promptly commenced coronary angiography (CAG). DIAGNOSIS: CAG revealed the absence of a right coronary artery (RCA). In the left coronary cusp area, the left circumflex coronary artery (LCX) was occluded totally. INTERVENTIONS: We performed PCI for total occlusion of the proximal part of the LCX. Follow-up CAG showed a superdominant branch of the LCX, sprouting into the RCA territory. OUTCOMES: The patient was discharged uneventfully after successful PCI. LESSONS: CARCA with AMI, which is an extremely unusual case, can be fatal; however, PCI seems to be an effective treatment option.


Assuntos
Oclusão Coronária/complicações , Anomalias dos Vasos Coronários/complicações , Vasos Coronários/cirurgia , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/métodos , Angiografia Coronária , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia
15.
Am Heart J ; 239: 100-109, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34077743

RESUMO

BACKGROUND: Stable chest pain is a common indication for cardiac catheterization. We assessed the prognostic value of the Prospective Multicenter Imaging Study for Evaluation (PROMISE) Minimal-Risk Tool in identifying patients who are at very low risk of obstructive coronary artery disease (CAD) or downstream cardiovascular adverse outcomes. METHODS: We applied the PROMISE Minimal-Risk Tool to consecutive patients without known CAD who underwent elective cardiac catheterization for stable angina from January 1, 2000 to December 31, 2014 in the Duke Databank for Cardiovascular Disease (DDCD). Patients with scores >0.46 (top decile of lowest-risk from the PROMISE cohort) were classified as low-risk. Logistic regression modeling compared likelihood of freedom from obstructive coronary artery disease on index angiography, 2-year survival, and 2-year survival free of myocardial infarction (MI) and MI/revascularization between low- and non low-risk patients. Alternative cut points to define low- risk patients were also explored. RESULTS: Among 6251 patients undergoing cardiac catheterization for stable chest pain, 1082 (17.3%) were low-risk per the PROMISE minimal-risk tool. Among low risk patients, obstructive coronary artery disease was observed in 14.9% and left main disease (≥ 50% Stenosis) was rare (0.9%). Compared with other patients, low risk patients had a higher likelihood of freedom from obstructive coronary disease on index catheterization (85.1% vs. 44.2%, OR 4.84, 95% CI 4.06-5.77). Low risk patients had significantly higher survival (98.2% vs. 94.4%, OR 3.18, 95% CI 1.99-5.08), MI-free survival (97.2% vs. 91.9%, OR 3.03, 95% CI 2.07-4.45), and MI/revascularization-free survival (86.2 vs. 59.9%, OR 4.19, 95% CI 3.48-5.05) at 2 years than non-low risk patients. Operating characteristics for predicting the outcomes of interest varied modestly depending on the low-risk cut-point used but the positive predictive value for 2 year freedom from death was >98% regardless. CONCLUSION: The PROMISE minimal-risk tool identifies 17% of stable chest pain patients referred to cardiac catheterization as low risk. These patients have a low prevalence of obstructive CAD and better survival than non-low risk patients. While this suggests that these patients are unlikely to benefit from catheterization, further research is needed to confirm a favorable downstream prognosis with medical management alone.


Assuntos
Angina Estável , Estenose Coronária , Vasos Coronários/diagnóstico por imagem , Fatores de Risco de Doenças Cardíacas , Sobremedicalização , Infarto do Miocárdio , Medição de Risco/métodos , Angina Estável/complicações , Angina Estável/diagnóstico , Angina Estável/etiologia , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico , Estenose Coronária/epidemiologia , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Feminino , Humanos , Masculino , Sobremedicalização/prevenção & controle , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Revascularização Miocárdica/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Estados Unidos/epidemiologia
17.
Exp Gerontol ; 152: 111453, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34144190

RESUMO

BACKGROUND: Acute myocardial infarction (AMI) is a cardiovascular disease with high morbidity and mortality, and microRNA-139-5p (miR-139-5p) has been reported to be closely related with myocardial viability. This study aimed to investigate the effects of miR-139-5p on vascular endothelial cells, detect miR-139-5p expression in AMI patients and evaluate its diagnostic value. METHODS: A dual-luciferase reporter assay was utilized to confirm the interaction of miR-139-5p with vascular endothelial growth factor receptor-1 (VEGFR-1). Quantitative real-time PCR was used to detect the levels of miR-139-5p and VEGFR-1 in serum and cells. The viability of human umbilical vein endothelial cells (HUVECs) was measured using a cell counting kit-8 assay. The correlation between miR-139-5p and VEGFR-1 was analyzed by Pearson correlation analysis. The diagnostic value of miR-139-5p, cardiac troponin I (cTnI) and creatine kinase isoenzymes (CK-MB) was identified by receiver operating characteristic analysis. RESULTS: miR-139-5p suppressed cell viability by directly targeting VEGFR-1 in HUVECs. Increased miR-139-5p and decreased VEGFR-1 levels were found in AMI patients and hypoxia-treated HUVECs, and miR-139-5p and VEGFR-1 were shown to be negatively correlated. The diagnostic value of miR-139-5p for AMI screening was high, and the combination of cTnI, CK-MB and miR-139-5p had the highest diagnostic accuracy. miR-139-5p inhibited cell viability by inhibiting VEGFR-1 in hypoxia-treated HUVECs. CONCLUSION: miR-139-5p inhibits endothelial cell viability of AMI by inhibiting VEGFR-1, and increased miR-139-5p expression in AMI patients has high diagnostic value for AMI screening, indicating that miR-139-5p may serve as a diagnostic biomarker and molecular therapeutic target for AMI.


Assuntos
MicroRNAs , Infarto do Miocárdio , Biomarcadores , Células Endoteliais da Veia Umbilical Humana , Humanos , MicroRNAs/genética , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/genética , Fator A de Crescimento do Endotélio Vascular
18.
DNA Cell Biol ; 40(8): 1064-1075, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34115526

RESUMO

This study aimed to explore the potential diagnostic biomarkers and mechanisms underlying acute myocardial infarction (AMI). We downloaded four datasets (GSE19339, GSE48060, GSE66360, and GSE97320) from the Gene Expression Omnibus database and combined them as an integrated dataset. A total of 153 differentially expressed genes (DEGs) were analyzed by the linear models for microarray analysis (LIMMA) package. Weighted gene co-expression network analysis was used to screen for the significant gene modules. The intersection of DEGs and genes in the most significant module was termed "common genes" (CGs). CGs were mainly enriched in "inflammatory response," "neutrophil chemotaxis," and "IL-17 signaling pathway" through functional enrichment analyses. Subsequently, 15 genes were identified as the hub genes in the protein-protein interaction network. The Fc fragment of IgE receptor Ig (FCER1G) and prostaglandin-endoperoxide synthase 2 (PTGS2) showed significantly increased expression in AMI patients and mice at the 12-h time point in our experiments. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of FCER1G and PTGS2. The area under ROC curve of FCER1G and PTGS2 was 77.6% and 80.7%, respectively. Moreover, the micro (mi)RNA-messenger (m)RNA network was also visualized; the results showed that miRNA-143, miRNA-144, and miRNA-26 could target PTGS2 in AMI progression.


Assuntos
Ciclo-Oxigenase 2/genética , Infarto do Miocárdio/genética , Receptores Fc/genética , Animais , Biomarcadores/metabolismo , Ciclo-Oxigenase 2/metabolismo , Redes Reguladoras de Genes , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , MicroRNAs/genética , MicroRNAs/metabolismo , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/metabolismo , Mapas de Interação de Proteínas , Receptores Fc/metabolismo
19.
Ann Biol Clin (Paris) ; 79(3): 219-231, 2021 06 01.
Artigo em Francês | MEDLINE | ID: mdl-34165431

RESUMO

Covid-19 is responsible for myocardial injury in many infected patients, which is associated with severe disease and critical illness. The mechanisms by which SARS-CoV-2 may cause myocardial damage involve direct effect of the virus in cardiac cells and indirect effect due to the clinical consequences of Covid-19. Cardiomyocytes are well known to express Angiotensin-Converting Enzyme-2 receptors (ACE-2) to facilitate the virus cell entry, which could explain the occurrence of myocarditis, functional alterations in the myocardium, and more rarely, myocardial infarction. Myocardial injury may also be secondary to systemic inflammation or coagulopathy due to complicated Covid-19. The existence of a cardio-intestinal axis with alteration of tryptophan metabolism in the small bowel leading first to colitis and then to systemic inflammation has also been evoked to explain the myocardial injury. Morphological and metabolic disturbances of the heart during the Covid-19 are associated with elevated concentrations of cardiac blood biomarkers, mainly troponins and natriuretic peptides. The determination of these biomarkers has proven to be very useful for diagnosis, prognosis, and risk stratification. Indeed, recent data demonstrated that about 20% of infected patients admitted to the hospital have elevated troponin or BNP levels, and Covid-19 patients with elevated troponin concentrations beyond the diagnostic threshold (99th percentile) were associated with a higher risk of in-hospital mortality. In conclusion, after more than a year of a unique global pandemic, it is now clearly established that myocardial injury during Covid-19 is frequent and strongly contributes to the severity of the disease. Cardiac alterations secondary to direct infection of cardiac cells by SARS-CoV-2 or to the clinical consequences of Covid-19 are associated with elevated levels of cardiac biomarkers in blood, whose measurement is crucial in clinical decision making.


Assuntos
Biomarcadores/metabolismo , COVID-19/complicações , Endocardite/diagnóstico , Miocárdio/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , COVID-19/diagnóstico , COVID-19/epidemiologia , Endocardite/epidemiologia , Endocardite/virologia , Feminino , França/epidemiologia , Coração/virologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/virologia , Pandemias , Valor Preditivo dos Testes , Prognóstico , SARS-CoV-2/fisiologia
20.
Kardiologiia ; 61(5): 59-64, 2021 May 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34112076

RESUMO

Aim    To analyze associations between levels of the inflammatory marker, growth differentiation factor 15 (GDF-15), and echocardiographic indexes in CHF patients with mid-range and preserved left ventricular ejection fraction (LV EF) depending on the history of myocardial infarction (MI).Material and methods    This study included 34 CHF patients with preserved and mid-range LV EF after MI (group 1, n=19) and without a history of MI (group 2, n=15). Serum concentration of GDF-15 was measured with enzyme immunoassay (BioVendor, Czech Republic). Statistical analysis was performed with STATISTICA 10.0.Results    Patients of the study groups were age-matched [62 (58;67) and 64 (60;70) years, p=0.2] but differed in the gender; group 1 consisted of men only (100 %) whereas in group 2, the proportion of men was 53.3 % (p=0.001). Median concentration of GDF-15 was 2385 (2274; 2632.5) and 1997 (1534;2691) pg/ml in groups 1 and 2, respectively (p=0.09). Patients without MI showed a moderate negative correlation between LV EF and GDF-15 concentration (r= - 0.51, p=0.050) and a pronounced correlation between GDF-15 and LV stroke volume (r= -0.722, p=0.002). For patients after MI, a correlation between the level of GDF-15 and the degree of systolic dysfunction was not found (р>0.05).Conclusion    Blood concentration of the inflammatory marker, GDF-15, correlates with LV EF and stroke volume in CHF patients with preserved or mid-range LV EF and without a history of MI while no such correlations were observed for patients with a history of MI.


Assuntos
Fator 15 de Diferenciação de Crescimento/sangue , Insuficiência Cardíaca , Infarto do Miocárdio , Idoso , República Tcheca , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Volume Sistólico , Função Ventricular Esquerda
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...