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1.
Kardiologiia ; 61(5): 4-16, 2021 May 31.
Artigo em Russo | MEDLINE | ID: mdl-34112070

RESUMO

Heart failure (HF) is the ending of practically all cardiovascular diseases and the reason for hospitalization of 49% of patients in a cardiological hospital. Available instrumental diagnostic methods and biomarkers not always allow verification of HF, particularly in patients with preserved left ventricular ejection fraction. Prediction of chronic HF in patients with risk factors faces great difficulties. Currently, natriuretic peptides (NUP) are widely used for the diagnosis, prognosis and management of patients with HF and are included in clinical guidelines for diagnosis and treatment of HF. Following multiple studies, the understanding of NUP significance has changed. This resulted in a need for new biomarkers to improve the insight into the process of HF and to personalize the treatment by better individual phenotyping. In addition, current technologies, such as transcriptomic, proteomic and metabolomic analyses, provide identification of new biomarkers and better understanding of features of the HF pathogenesis. The aim of this study was to discuss recent reports on NUP and novel, most promising biomarkers in respect of their possible use in clinical practice.


Assuntos
Insuficiência Cardíaca , Proteômica , Biomarcadores , Insuficiência Cardíaca/diagnóstico , Humanos , Prognóstico , Volume Sistólico , Função Ventricular Esquerda
2.
Kardiologiia ; 61(5): 79-81, 2021 May 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34112079

RESUMO

On December 18, 2020, an expert council was held with the participation of members of the Russian Society of Cardiology, the Eurasian Association of Ther-apists, the National Society for Atherothrombosis, the National Society for Evi-dence-Based Pharmacotherapy, and the Russian Heart Failure Society. The event was devoted to the discussion of the correct use of research data of "real clinical practice" in decision making.


Assuntos
Cardiologia , Insuficiência Cardíaca , Insuficiência Cardíaca/diagnóstico , Humanos , Federação Russa , Sociedades Médicas
3.
J Med Case Rep ; 15(1): 316, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34099054

RESUMO

BACKGROUND: Left ventricular noncompaction is a rare cardiomyopathy characterized by a thin, compacted epicardial layer and a noncompacted endocardial layer, with trabeculations and recesses that communicate with the left ventricular cavity. In the advanced stage of the disease, the classical triad of heart failure, ventricular arrhythmia, and systemic embolization is common. Segments involved are the apex and mid inferior and lateral walls. The right ventricular apex may be affected as well. CASE PRESENTATION: A 29-year-old Caucasian male was hospitalized with dyspnea and fatigue at minimal exertion during the last months before admission. He also described a history of edema of the legs and abdominal pain in the last weeks. Physical examination revealed dyspnea, pulmonary rales, cardiomegaly, hepatomegaly, and splenomegaly. Electrocardiography showed sinus rhythm with nonspecific repolarization changes. Twenty-four-hour Holter monitoring identified ventricular tachycardia episodes with right bundle branch block morphology. Transthoracic echocardiography at admission revealed dilated left ventricle with trabeculations located predominantly at the apex but also in the apical and mid portion of lateral and inferior wall; end-systolic ratio of noncompacted to compacted layers > 2; moderate mitral regurgitation; and reduced left ventricular ejection fraction. Between apical trabeculations, multiple thrombi were found. The right ventricle had normal morphology and function. Speckle-tracking echocardiography also revealed systolic left ventricle dysfunction and solid body rotation. Abdominal echocardiography showed hepatomegaly and splenomegaly. Abdominal computed tomography was suggestive for hepatic and renal infarctions. Laboratory tests revealed high levels of N-terminal pro-brain natriuretic peptide and liver enzymes. Cardiac magnetic resonance evaluation at 1 month after discharge confirmed the diagnosis. The patient received anticoagulants, antiarrhythmics, and heart failure treatment. After 2 months, before device implantation, he presented clinical improvement, and echocardiographic evaluation did not detect thrombi in the left ventricle. Coronary angiography was within normal range. A cardioverter defibrillator was implanted for prevention of sudden cardiac death. CONCLUSIONS: Left ventricular noncompaction is rare cardiomyopathy, but it should always be considered as a possible diagnosis in a patient hospitalized with heart failure, ventricular arrhythmias, and systemic embolic events. Echocardiography and cardiac magnetic resonance are essential imaging tools for diagnosis and follow-up.


Assuntos
Insuficiência Cardíaca , Função Ventricular Esquerda , Adulto , Arritmias Cardíacas/etiologia , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Volume Sistólico
4.
Sensors (Basel) ; 21(11)2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34063825

RESUMO

With new advances in technology, remote monitoring of heart failure (HF) patients has become increasingly prevalent and has the potential to greatly enhance the outcome of care. Many studies have focused on implementing systems for the management of HF by analyzing physiological signals for the early detection of HF decompensation. This paper reviews recent literature exploring significant physiological variables, compares their reliability in predicting HF-related events, and examines the findings according to the monitored variables used such as body weight, bio-impedance, blood pressure, heart rate, and respiration rate. The reviewed studies identified correlations between the monitored variables and the number of alarms, HF-related events, and/or readmission rates. It was observed that the most promising results came from studies that used a combination of multiple parameters, compared to using an individual variable. The main challenges discussed include inaccurate data collection leading to contradictory outcomes from different studies, compliance with daily monitoring, and consideration of additional factors such as physical activity and diet. The findings demonstrate the need for a shared remote monitoring platform which can lead to a significant reduction of false alarms and help in collecting reliable data from the patients for clinical use especially for the prevention of cardiac events.


Assuntos
Insuficiência Cardíaca , Insuficiência Cardíaca/diagnóstico , Frequência Cardíaca , Humanos , Monitorização Fisiológica , Reprodutibilidade dos Testes , Taxa Respiratória
5.
Medicina (Kaunas) ; 57(5)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065174

RESUMO

In the management of atrial fibrillation in patients with heart failure, rate control is recommended, whereas the implication of rhythm control remains controversial. We experienced a 65-year-old man who had compensated heart failure due to hypertensive heart disease and atrial fibrillation with well-controlled heart rate (<100 bpm). At three months following the catheter ablation procedure, the left ventricular ejection fraction improved from 40% up to 65%. The implication of rhythm control using catheter ablation in improving cardiac reverse remodeling should be validated in large-scale clinical studies.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Insuficiência Cardíaca/complicações , Humanos , Masculino , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
6.
Medicina (Kaunas) ; 57(5)2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-34066321

RESUMO

Cardiac amyloidosis (CA) is a rare systemic disease determined by the extracellular deposition of amyloid protein in the heart. The protein can accumulate in any part of the heart: myocardium, vessels, endocardium, valves, epicardium and parietal pericardium. The types of CA include the following types: light chain (AL), amyloidosis AA (Amyloid A) and transthyretin (ATTR). The detection of specific subtypes remains of great importance to implement the targeted treatment. We present the case of a 65-year-old woman, who was admitted with severe deterioration of exercise capacity, a bilateral reduction of physiological vesicular murmur, ascites and edema of lower extremities. CA was suspected due to echocardiographic examination results, which led to further examination and final diagnosis. The aim of this study is to improve the disease awareness among clinicians and shorten the delay between the first symptoms and the diagnosis establishment resulting in a better outcome.


Assuntos
Amiloidose , Cardiomiopatias , Insuficiência Cardíaca , Idoso , Amiloidose/diagnóstico , Cardiomiopatias/diagnóstico por imagem , Feminino , Humanos , Miocárdio , Pré-Albumina
7.
Sensors (Basel) ; 21(11)2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34071624

RESUMO

The management of heart failure remains challenging despite evidence-based medical and pharmacological advances, especially in the ambulatory setting. There is an urgent need to develop strategies to reduce hospitalizations and readmission rates due to heart failure. Frequent monitoring of high-risk patients is imperative, and with the development of wireless and remote technology, frequent monitoring is now possible via remote monitoring. Nowadays, remote management of patients with cardiac implantable electronic devices is being increasingly adopted and integrated into clinical practice. Several clinical trials studied the impact of remote monitoring on clinical outcomes in patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization defibrillators (CRT-Ds). This point of view will focus on the remote monitoring of ICDs and CRT-Ds in patients with heart failure and discusses whether remote monitoring can be used as a potential instrument for the early identification of patients at risk of worsening heart failure.


Assuntos
Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Insuficiência Cardíaca , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Humanos
8.
Medicine (Baltimore) ; 100(22): e26180, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087882

RESUMO

BACKGROUND: Heart failure (HF) is one of the common and critical disease, and often accompanied by increased level of serum bilirubin, but the role of an indicator of bilirubin to monitor the prognosis of patients with heart failure is still unclear, so we implemented the study to systematically evaluate the predictive value of bilirubin in HF. METHODS: A comprehensive search and systematic review will be conducted on electronic databases such as Medline, Cochrane Library, Embase, Web of Science, Cochrane Clinical Trials Database of study on the relationship between bilirubin and prognosis of HF patients. Review Manager software (version 5.3.5) and STATA 14 software (version 14.0) will be used for data analysis and synthesis. RESULTS: The results will systematically and comprehensively reveal the evidence on the predictive value of bilirubin in HF. CONCLUSION: The study will display the effect of bilirubin level on the prognosis of patients with heart failure, and help clinicians to pay more attention to the level of bilirubin in patients with HF, and can take certain treatment measures as earlier as possible. INPLASY REGISTRATION NUMBER: INPLASY202140116.


Assuntos
Bilirrubina/sangue , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Ensaios Clínicos como Assunto , Gerenciamento de Dados , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico
9.
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
10.
Am J Case Rep ; 22: e930568, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34081681

RESUMO

BACKGROUND Refeeding syndrome is a complex metabolic disorder that develops following rapid nutritional administration after a long period of undernutrition. The onset mechanism involves intracellular transport of phosphorus, potassium, and water, in association with rapid glucose administration. The resulting hypophosphatemia is extremely dangerous and can cause severe heart failure and fatal arrhythmia. We successfully used extracorporeal cardiopulmonary support to manage a case of refeeding syndrome that occurred during the course of treatment of diabetic ketoacidosis. There are only a few reports of the use of cardiopulmonary support for the treatment of refeeding syndrome. CASE REPORT A 72-year-old man was admitted to the hospital for treatment of diabetic ketoacidosis. Despite receiving insulin and nutrition therapy, QT prolongation and ventricular fibrillation appeared on the electrocardiogram. Although coronary angiography was performed in consideration of the possibility of ischemic heart disease, no significant stenosis of the coronary arteries was identified. Due to persistent hypotension and recurrence of ventricular fibrillation, extracorporeal cardiopulmonary support was commenced in the ICU. His serum phosphorus level showed a marked decrease on his first day in the ICU, for which daily replacement therapy was administered during his ICU stay. No fatal arrhythmia developed thereafter. He was weaned off extracorporeal cardiopulmonary support on the fourth day of his ICU stay and was subsequently discharged from the hospital. CONCLUSIONS We suggest vigilant monitoring of electrolytes, including phosphate levels, in diabetic ketoacidosis patients, and active circulatory support, as required, in patients with refeeding syndrome.


Assuntos
Cetoacidose Diabética , Oxigenação por Membrana Extracorpórea , Insuficiência Cardíaca , Síndrome da Realimentação , Idoso , Arritmias Cardíacas , Cetoacidose Diabética/complicações , Cetoacidose Diabética/terapia , Humanos , Masculino , Síndrome da Realimentação/complicações , Síndrome da Realimentação/terapia
11.
Nat Commun ; 12(1): 2725, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33976166

RESUMO

Transthyretin amyloid cardiomyopathy, an often unrecognized cause of heart failure, is now treatable with a transthyretin stabilizer. It is therefore important to identify at-risk patients who can undergo targeted testing for earlier diagnosis and treatment, prior to the development of irreversible heart failure. Here we show that a random forest machine learning model can identify potential wild-type transthyretin amyloid cardiomyopathy using medical claims data. We derive a machine learning model in 1071 cases and 1071 non-amyloid heart failure controls and validate the model in three nationally representative cohorts (9412 cases, 9412 matched controls), and a large, single-center electronic health record-based cohort (261 cases, 39393 controls). We show that the machine learning model performs well in identifying patients with cardiac amyloidosis in the derivation cohort and all four validation cohorts, thereby providing a systematic framework to increase the suspicion of transthyretin cardiac amyloidosis in patients with heart failure.


Assuntos
Neuropatias Amiloides Familiares/metabolismo , Cardiomiopatias/metabolismo , Insuficiência Cardíaca/metabolismo , Aprendizado de Máquina , Pré-Albumina/metabolismo , Neuropatias Amiloides Familiares/genética , Cardiomiopatias/genética , Registros Eletrônicos de Saúde , Insuficiência Cardíaca/genética , Humanos , Pré-Albumina/genética
12.
Recenti Prog Med ; 112(5): 378-386, 2021 05.
Artigo em Italiano | MEDLINE | ID: mdl-34003190

RESUMO

High-flow nasal cannula (HFNC) are an oxygen therapy device developed in the last years for the treatment of patients with acute or acute on chronic hypoxemic respiratory failure with different etiology and severity (including covid-19 pneumonia). HFNC combine the possibility of delivering high flows of gases, actively humidified and heated, with the use of a comfortable nasal interface, resulting generally well tolerated by most patients. In light of these characteristics, together with the simplicity of use and versatility, they have spread not only in intensive and semi-intensive care units but also in general medical ward in which they can play an important role in the treatment of elderly, frail patients with comorbidity where other more aggressive and invasive methods of ventilations are not indicated or not practicable.


Assuntos
Cânula , Oxigenoterapia/instrumentação , Insuficiência Respiratória/terapia , Acidose Respiratória/complicações , Acidose Respiratória/terapia , /terapia , Cuidados Críticos/métodos , Desenho de Equipamento , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Hipóxia/complicações , Hipóxia/terapia , Medicina Interna , Oxigenoterapia/métodos , Cuidados Paliativos , Edema Pulmonar/complicações , Edema Pulmonar/terapia , Insuficiência Respiratória/complicações
13.
Nat Commun ; 12(1): 2942, 2021 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011988

RESUMO

The association between reduced myofilament force-generating capacity (Fmax) and heart failure (HF) is clear, however the underlying molecular mechanisms are poorly understood. Here, we show impaired Fmax arises from reduced BAG3-mediated sarcomere turnover. Myofilament BAG3 expression decreases in human HF and positively correlates with Fmax. We confirm this relationship using BAG3 haploinsufficient mice, which display reduced Fmax and increased myofilament ubiquitination, suggesting impaired protein turnover. We show cardiac BAG3 operates via chaperone-assisted selective autophagy (CASA), conserved from skeletal muscle, and confirm sarcomeric CASA complex localization is BAG3/proteotoxic stress-dependent. Using mass spectrometry, we characterize the myofilament CASA interactome in the human heart and identify eight clients of BAG3-mediated turnover. To determine if increasing BAG3 expression in HF can restore sarcomere proteostasis/Fmax, HF mice were treated with rAAV9-BAG3. Gene therapy fully rescued Fmax and CASA protein turnover after four weeks. Our findings indicate BAG3-mediated sarcomere turnover is fundamental for myofilament functional maintenance.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Proteínas Reguladoras de Apoptose/metabolismo , Insuficiência Cardíaca/fisiopatologia , Miócitos Cardíacos/fisiologia , Proteínas Adaptadoras de Transdução de Sinal/deficiência , Proteínas Adaptadoras de Transdução de Sinal/genética , Adulto , Idoso , Animais , Proteínas Reguladoras de Apoptose/deficiência , Proteínas Reguladoras de Apoptose/genética , Modelos Animais de Doenças , Feminino , Terapia Genética , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/terapia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pessoa de Meia-Idade , Proteínas Musculares/metabolismo , Contração Miocárdica/genética , Contração Miocárdica/fisiologia , Miócitos Cardíacos/metabolismo , Ratos , Ratos Sprague-Dawley , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Sarcômeros/metabolismo
14.
Eur Heart J ; 42(20): 1940-1958, 2021 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-33948637

RESUMO

Described as the 'single largest unmet need in cardiovascular medicine', heart failure with preserved ejection fraction (HFpEF) remains an untreatable disease currently representing 65% of new heart failure diagnoses. HFpEF is more frequent among women and associates with a poor prognosis and unsustainable healthcare costs. Moreover, the variability in HFpEF phenotypes amplifies complexity and difficulties in the approach. In this perspective, unveiling novel molecular targets is imperative. Epigenetic modifications-defined as changes of DNA, histones, and non-coding RNAs (ncRNAs)-represent a molecular framework through which the environment modulates gene expression. Epigenetic signals acquired over the lifetime lead to chromatin remodelling and affect transcriptional programmes underlying oxidative stress, inflammation, dysmetabolism, and maladaptive left ventricular remodelling, all conditions predisposing to HFpEF. The strong involvement of epigenetic signalling in this setting makes the epigenetic information relevant for diagnostic and therapeutic purposes in patients with HFpEF. The recent advances in high-throughput sequencing, computational epigenetics, and machine learning have enabled the identification of reliable epigenetic biomarkers in cardiovascular patients. Contrary to genetic tools, epigenetic biomarkers mirror the contribution of environmental cues and lifestyle changes and their reversible nature offers a promising opportunity to monitor disease states. The growing understanding of chromatin and ncRNAs biology has led to the development of several Food and Drug Administration approved 'epidrugs' (chromatin modifiers, mimics, anti-miRs) able to prevent transcriptional alterations underpinning left ventricular remodelling and HFpEF. In the present review, we discuss the importance of clinical epigenetics as a new tool to be employed for a personalized management of HFpEF.


Assuntos
Fármacos Cardiovasculares , Insuficiência Cardíaca , Fármacos Cardiovasculares/uso terapêutico , Epigênese Genética , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/genética , Humanos , Volume Sistólico , Função Ventricular Esquerda
15.
Curr Cardiol Rep ; 23(6): 55, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33959819

RESUMO

PURPOSE OF REVIEW: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is recommended as part of the individualized multidisciplinary follow-up of heart failure (HF) patients. Aim of this article is to critically review recent findings on RM, highlighting potential benefits and barriers to its implementation. RECENT FINDINGS: Device-based RM is useful in the early detection of CIEDs technical issues and cardiac arrhythmias. Moreover, RM allows the continuous monitoring of several patients' clinical parameters associated with impending HF decompensation, but there is still uncertainty regarding its effectiveness in reducing mortality and hospitalizations. Implementation of RM strategies, together with a proactive physicians' attitude towards clinical actions in response to RM data reception, will make RM a more valuable tool, potentially leading to better outcomes.


Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca , Telemedicina , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hospitalização , Humanos
16.
Curr Cardiol Rep ; 23(6): 59, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33961133

RESUMO

PURPOSE OF REVIEW: Heart failure is responsible for a significant part of diabetes-associated cardiovascular mortality and morbidity. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are novel agents approved for the treatment of diabetes mellitus; in recent clinical trials, these agents have shown a significant reduction in cardiovascular death and hospitalization secondary to heart failure. RECENT FINDINGS: Clinical trials with specific heart failure outcomes have shown the benefit of SGLT-2 inhibitors in reducing the mortality and morbidity associated with heart failure. The guidelines for the management of diabetes mellitus recommend the preferential use of SGLT-2 inhibitors in patients with a history of cardiovascular disease. SGLT-2 inhibitors are potential game changers in the treatment of heart failure. Guidelines for prescription of these agents help assess risk-benefit analysis and personalize treatment for maximal benefit.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Inibidores do Transportador 2 de Sódio-Glicose , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Hipoglicemiantes/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
17.
Eur J Radiol ; 140: 109743, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33971572

RESUMO

PURPOSE: To evaluate the relationship between myocardial extracellular volume (ECV) fraction measured using dual-energy computed tomography with late iodine enhancement (LIE-DECT) and risk of heart failure (HF) in patients without coronary artery disease (CAD), and to evaluate the relationship between ECV and left ventricular structure and function. MATERIALS AND METHODS: Sixty consecutive HF patients without CAD and 60 consecutive participants without heart disease who underwent coronary CT angiography (CCTA) following LIE-DECT were included. ECV of the left ventricle was calculated from the iodine maps and hematocrit levels using the American Heart Association (AHA) 16-segment model. Cardiac structural and functional parameters were collected including left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), left atrial volume (LAV), interventricular septal thickness (IVST), and N-terminal pro-brain natriuretic peptide (NT-pro-BNP). RESULTS: ECV in HF patients without CAD (31.3 ±â€¯4.0 %) was significantly higher than that in healthy subjects (27.1 ±â€¯3.7 %) (P < 0.001). Multivariate linear analysis revealed that ECV was associated with age (ß = 0.098, P = 0.010) and hypertension (ß = 2.093, P = 0.011) in all participants. Binary logistic regression analysis showed that after adjusting for age, sex, body mass index (BMI), smoking, and drinking, ECV was a risk factor affecting the occurrence of HF in those without CAD (OR = 1.356, 95 %CI:1.178-1.561, P < 0.001). A positive correlation was found between ECV and NT-pro-BNP, LVEDV, LVESV, and LAV (r = 0.629, 0.329, 0.346, and 0.338, respectively; all P < 0.001) in all participants. CONCLUSIONS: ECV could be measured using LIE-DECT iodine maps. ECV elevation was a risk factor for HF without CAD and correlated with cardiac structure and function.


Assuntos
Doença da Artéria Coronariana , Insuficiência Cardíaca , Iodo , Doença da Artéria Coronariana/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Miocárdio , Valor Preditivo dos Testes , Estudos Prospectivos , Volume Sistólico , Tomografia Computadorizada por Raios X , Função Ventricular Esquerda
18.
G Ital Cardiol (Rome) ; 22(5): 363-375, 2021 May.
Artigo em Italiano | MEDLINE | ID: mdl-33960979

RESUMO

In over a year, the COVID-19 pandemic caused 2.69 million deaths and 122 million infections. Social isolation and distancing measures have been the only prevention available for months. Scientific research has done a great deal of work, developing in a few months safe and effective vaccines against COVID-19. In the European Union, nowadays, four vaccines have been authorized for use: Pfizer-BioNTech, Moderna, ChAdOx1 (AstraZeneca/Oxford), Janssen (Johnson & Johnson), and three others are currently under rolling review.Vaccine allocation policy is crucial to optimize the advantage of treatment preferring people with the highest risk of contagion. These days the priority in the vaccination program is of particular importance since it has become clear that the number of vaccines is not sufficient for the entire Italian population in the short term. Cardiovascular diseases are frequently associated with severe COVID-19 infections, leading to the worst prognosis. The elderly population suffering from cardiovascular diseases is, therefore, to be considered a particularly vulnerable population. However, age cannot be considered the only discriminating factor because in the young-adult population suffering from severe forms of heart disease, the prognosis, if affected by COVID-19, is particularly ominous and these patients should have priority access to the vaccination program. The aim of this position paper is to establish a consensus on a priority in the vaccination of COVID-19 among subjects suffering from different cardiovascular diseases.


Assuntos
/administração & dosagem , Doenças Cardiovasculares/complicações , Consenso , Fatores Etários , Animais , /mortalidade , Cardiologia , Doença das Coronárias/complicações , Vetores de Doenças , Insuficiência Cardíaca/complicações , Transplante de Coração , Doenças das Valvas Cardíacas/complicações , Humanos , Hipertensão Pulmonar/complicações , Itália/epidemiologia , Prognóstico , Insuficiência Renal/complicações , Sociedades Médicas , Vacinas Sintéticas/administração & dosagem
19.
J Vis Exp ; (170)2021 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-33938885

RESUMO

The development of heart failure is the most powerful predictor of long-term mortality in patients surviving acute myocardial infarction (MI). There is an unmet clinical need for prevention and therapy of post-myocardial infarction heart failure (post-MI HF). Clinically relevant pig models of post-MI HF are prerequisites for final proof-of-concept studies before entering into clinical trials in drug and medical device development. Here we aimed to characterize a closed-chest porcine model of post-MI HF in adult Göttingen minipigs with long-term follow-up including serial cardiac magnetic resonance imaging (CMRI) and to compare it with the commonly used Landrace pig model. MI was induced by intraluminal balloon occlusion of the left anterior descending coronary artery for 120 min in Göttingen minipigs and for 90 min in Landrace pigs, followed by reperfusion. CMRI was performed to assess cardiac morphology and function at baseline in both breeds and at 3 and 6 months in Göttingen minipigs and at 2 months in Landrace pigs, respectively. Scar sizes were comparable in the two breeds, but MI resulted in a significant decrease of left ventricular ejection fraction (LVEF) only in Göttingen minipigs, while Landrace pigs did not show a reduction of LVEF. Right ventricular (RV) ejection fraction increased in both breeds despite the negligible RV scar sizes. In contrast to the significant increase of left ventricular end-diastolic (LVED) mass in Landrace pigs at 2 months, Göttingen minipigs showed a slight increase in LVED mass only at 6 months. In summary, this is the first characterization of post-MI HF in Göttingen minipigs in comparison to Landrace pigs, showing that the Göttingen minipig model reflects post-MI HF parameters comparable to the human pathology. We conclude that the Göttingen minipig model is superior to the Landrace pig model to study the development of post-MI HF.


Assuntos
Modelos Animais de Doenças , Insuficiência Cardíaca/etiologia , Infarto do Miocárdio/complicações , Animais , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/fisiopatologia , Feminino , Coração/diagnóstico por imagem , Coração/fisiopatologia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Reperfusão Miocárdica , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Suínos , Porco Miniatura , Função Ventricular Esquerda
20.
Clin Interv Aging ; 16: 707-719, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33953549

RESUMO

Purpose: We aimed to compare the rate of clinical outcomes among three age groups (<65, 65-74, and ≥75 years) of adult patients with non-valvular atrial fibrillation (NVAF). Patients and Methods: We prospectively enrolled NVAF patients from 27 Thailand medical centers. The following were collected at baseline: demographic data, risk factors, comorbid conditions, laboratory data, and medications. The clinical outcomes were ischemic stroke (IS) or transient ischemic attack (TIA), major bleeding (MB), intracerebral hemorrhage (ICH), heart failure (HF), and death. All events were adjudicated. Patients were categorized according to age group into three groups; age <65, 65-74, and ≥75 years. Results: Among the 3402 patients that were enrolled during 2014-2017, the mean age was 67.4±11.3 years, and 2073 (60.9%) were older. The average follow-up was 25.7±10.6 months. Oral anticoagulants were given in 75.4% of patients (91.1% of OAC was warfarin). The incidence rate of IS/TIA, MB, ICH, HF, and death was 1.43 (1.17-1.74), 2.11 (1.79-2.48), 0.70 (0.52-0.92), 3.03 (2.64-3.46), and 3.77 (3.33-4.24) per 100 person-years, respectively. The risk of IS/TIA, MB, ICH, HF, and death increased with age both before and after adjustment for potential confounders. Even though OAC reduced the risk of IS/TIA, it increased the risk of MB. Net clinical benefit (NCB) analysis favored oral anticoagulant (OAC) in the high-risk subset of older adults. Conclusion: Older adult NVAF patients had a significantly increased risk of IS/TIA, MB, ICH, HF, and death compared to younger NVAF before and after adjustment for potential confounders. Strategies to reduce overall risk, including OAC use and choice and integrated care, should be implemented.


Assuntos
Fibrilação Atrial/complicações , Hemorragia Cerebral/etiologia , Insuficiência Cardíaca/etiologia , Ataque Isquêmico Transitório/etiologia , Acidente Vascular Cerebral/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/mortalidade , Hemorragia Cerebral/mortalidade , Comorbidade , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Incidência , Ataque Isquêmico Transitório/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fatores Socioeconômicos , Acidente Vascular Cerebral/mortalidade , Tailândia/epidemiologia
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