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2.
Medicine (Baltimore) ; 99(38): e22296, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957388

RESUMO

RATIONALE: The increasing incidence of cardiac comorbidities in the elderly population has led to an increasing demand for vigilance of cardiac dysfunction induced by surgery. Favorable outcomes can be ensured in such cases by an increased awareness of cardiogenic complications, early identification of the problem, and appropriate treatment. PATIENT CONCERNS: This study presents 2 cases of acute pulmonary edema (PE) that were likely caused by ischemic heart disease and diastolic dysfunction in postoperative patients, following vitrectomy, in the post-anesthetic care unit. DIAGNOSES: Chest x-ray and computed tomography indicated PE. INTERVENTIONS: Following the diagnosis of PE, patients were intubated and transferred to the intensive care unit where 20 mg furosemide was injected and 10 µg/kg/min dobutamine was infused intravenously. OUTCOMES: On postoperative day 2, the patients' vital signs were stable and there were no signs of respiratory disturbance. LESSONS: Physicians should be alert to the potential development of PE as a postoperative complication in patients with left ventricular (LV) diastolic dysfunction and ischemic heart disease, even if the patient has undergone a procedure with mild hemodynamic change and minimal surgical stimulation such as vitrectomy. We propose that physicians treating elderly patients with LV diastolic dysfunction and ischemic heart disease undergoing vitrectomy should consider the use of intraoperative transthoracic echocardiogram or transesophageal echocardiogram with continuous monitoring of blood pressure, using devices such as arterial catheter devices.


Assuntos
Complicações Pós-Operatórias/etiologia , Edema Pulmonar/etiologia , Vitrectomia/efeitos adversos , Idoso , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Edema Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem
3.
J Cardiovasc Magn Reson ; 22(1): 66, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32921308

RESUMO

BACKGROUND: Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) is a valuable technique for detecting myocardial disorders and fibrosis. However, we sometimes observe a linear, mid-wall high intensity signal in the basal septum in the short axis view, which often presents diagnostic difficulties in the clinical setting. The purpose of this study was to compare the linear, mid-wall high intensity in the basal septum identified by LGE with the anterior septal perforator arteries identified by coronary computed tomography angiography (CorCTA). METHODS: We retrospectively selected 148 patients who underwent both CorCTA and CMR LGE within 1 year. In the interpretation of LGE, we defined a positive linear high intensity (LHI+) as follows: ① LHI in the basal septum and ② observable for 1.5 cm or more. All other patients were defined as a negative LHI (LHI-). In LHI+ patients, we assessed the correlation between the LHI length and the septal perforator artery length on CorCTA. We also compared the length of the septal perforator artery on CorCTA between LHI+ patients and LHI- patients. RESULTS: A population of 111 patients were used for further analysis. Among these , there were 55 LHI+ patients and 56 LHI- patients. In LHI+ patients, linear regression analysis revealed that there was a good agreement between LGE LHI and septal perforator arteries by CorCTA in terms of length measurements. The measured length of the anterior septal perforator arteries was significantly shorter in LHI- patients than in LHI+ patients (10 ± 8 mm vs. 21 ± 8 mm; P < 0.05). CONCLUSIONS: The LHI observed in the basal septum on short axis LGE may reflect contrast enhancement of the anterior septal perforator arteries. It is important to interpret this septal LHI against knowledge of anatomic structure, to avoid misinterpretations of LGE and prevent misdiagnosis.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Meios de Contraste/administração & dosagem , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Gadolínio DTPA/administração & dosagem , Septos Cardíacos/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Isquemia Miocárdica/diagnóstico por imagem , Idoso , Artefatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
4.
Radiol Med ; 125(11): 1114-1123, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32936388

RESUMO

Cardiovascular magnetic resonance has always been more often used in the last 10 years in evaluation of heart disease. Role in diagnosis of ischemia and in evaluation of myocardial infarction is well established by many scientific papers and included in current guidelines. High accuracy in evaluation of stress-induced ischemia, tissue characterization and functional parameters are the pillars the make the method widely used. In this paper are described role and techniques in diagnosis of ischemia, myocardial infarction and its sequelae.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Imagem por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Gadolínio , Humanos , Microvasos/diagnóstico por imagem , Microvasos/lesões , Isquemia Miocárdica/diagnóstico por imagem
5.
Eur J Vasc Endovasc Surg ; 60(4): 594-601, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32753305

RESUMO

OBJECTIVE: Past studies have suggested a potential "J shaped" relationship between infrarenal aortic diameter and both cardiovascular disease (CVD) prevalence and all cause mortality. However, screening programmes have focused primarily on large (aneurysmal) aortas. In addition, aortic diameter is rarely adjusted for body size, which is particularly important for women. This study aimed to investigate specifically the relationship between body size adjusted infrarenal aortic diameter and baseline prevalence of CVD. METHODS: A retrospective analysis was performed on a total of 4882 elderly (>50 years) participants (mean age 69.4 ± 8.9 years) for whom duplex ultrasound to assess infrarenal abdominal aortic diameters had been performed. History of CVDs, including ischaemic heart disease (IHD), and associated risk factors were collected at the time of assessment. A derivation cohort of 1668 participants was used to select cut offs at the lower and upper 12.5% tails of the aortic size distributions (aortic size index of <0.84 and >1.2, respectively), which was then tested in a separate cohort. RESULTS: A significantly elevated prevalence of CVD, and specifically IHD, was observed in participants with both small and large aortas. These associations remained significant following adjustment for age, sex, diabetes, hypertension, dyslipidaemia, obesity (body mass index), and smoking. CONCLUSION: The largest and smallest infrarenal aortic sizes were both associated with prevalence of IHD. In addition to identifying those with aneurysmal disease, it is hypothesised that screening programmes examining infrarenal aortic size may also have the potential to improve global CVD risk prediction by identifying those with small aortas.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Isquemia Miocárdica/epidemiologia , Ultrassonografia Doppler Dupla , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Nova Zelândia/epidemiologia , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
6.
7.
Radiología (Madr., Ed. impr.) ; 62(3): 213-221, mayo-jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194219

RESUMO

OBJETIVO: Describir la seguridad del regadenosón como fármaco vasodilatador en estudios de resonancia magnética cardíaca (RMC) de estrés realizados para detectar isquemia miocárdica. MATERIAL Y MÉTODOS: Se analizaron de manera retrospectiva los estudios de 120 pacientes (88 varones, edad media 67 ±11,6 años) con sospecha de cardiopatía isquémica o con enfermedad coronaria conocida e indicación clínica para RMC de estrés. Los estudios se realizaron en un equipo de 1,5 Tesla (MAGNETOM Aera, Siemens Healthineers) empleando regadenosón (5ml, 0,4mg) como agente vasodilatador. En todos los pacientes se recogieron los factores de riesgo cardiovascular, fármacos que tomaban e indicación de la prueba, además de las constantes vitales en situación de reposo y bajo estrés y los síntomas y efectos adversos inducidos por el fármaco. RESULTADOS: El 52,6% de los pacientes permanecieron asintomáticos. Los síntomas más frecuentes fueron la opresión centrotorácica (25%) y la disnea (12%). Durante el pico de estrés, el incremento medio de la frecuencia cardíaca fue de 23,9±11,4 lpm y el descenso medio de la presión arterial sistólica y diastólica de 7,1±18,8mmHg y 5,3±9,2mmHg, respectivamente (p < 0,001). En pacientes obesos y diabéticos se objetivó menor respuesta hemodinámica al regadenosón, mientras que los pacientes sintomáticos presentaron mayor incremento de la frecuencia cardíaca (27,4±11,2 lpm frente a 20,6±10,7 lpm, p = 0,001). No se evidenció ningún efecto adverso grave. CONCLUSIÓN: El regadenosón es un fármaco bien tolerado que se puede utilizar con seguridad en RMC de estrés


OBJECTIVE: To determine the safety of regadenoson for vasodilation in cardiac MRI stress tests to detect myocardial ischemia. MATERIAL AND METHODS: We retrospectively analyzed cardiac MRI studies done in 120 patients (mean age, 67±11.6 years; 88 men) with suspected ischemic heart disease or known coronary disease who had clinical indications for cardiac MRI stress tests. All studies were done on a 1.5 T scanner (MAGNETOM Aera, Siemens Healthineers) using regadenoson (5ml, 0.4mg) for vasodilation. We recorded cardiovascular risk factors, medications, and indications for the test as well as vital signs at rest and under stress and the symptoms and adverse effects induced by the drug. RESULTS: No symptoms developed in 52.6% of patients. The most common symptoms were central chest pain (25%) and dyspnea (12%). At peak stress, the mean increase in heart rate was 23.9±11.4 beats per minute and the mean decreases in systolic and diastolic blood pressure were 7.1±18.8mmHg and 5.3±9.2mmHg, respectively (p <0.001). The response to regadenoson was less pronounced in obese and diabetic patients. The increase in heart rate was greater in symptomatic patients (27.4±11.2 bpm vs. 20.6±10.7 bpm in asymptomatic patients, p = 0.001). No severe adverse effects were observed. CONCLUSION: Regadenoson is well tolerated and can be safely used for cardiac MRI stress tests


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Vasodilatadores/administração & dosagem , Imagem por Ressonância Magnética , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/tratamento farmacológico , Estudos Retrospectivos , Doença das Coronárias/diagnóstico por imagem , Fatores de Risco , Gadolínio/administração & dosagem , Administração Intravenosa
8.
Medicina (B Aires) ; 80(3): 253-270, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32442940

RESUMO

One in every four coronarographies performed to study myocardial ischemia shows coronary angiographic stenosis less than 50%. This data triggered an increasing interest in the medical community. The American Society of Cardiology recently published a position paper about the pathophysiology, diagnosis and treatment of this entity. Our group performed a narrative review reflecting the opinion of cardiology experts from different centers in Argentina. It aims physiopatologic and diagnostic aspect to understand the current approach in patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) e INOCA (demonstrated angina and ischemia but without coronary lesions that justify this syndrome).


Assuntos
Tomada de Decisão Clínica , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Cineangiografia/métodos , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Prognóstico , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
9.
Artigo em Inglês | MEDLINE | ID: mdl-32357114

RESUMO

The survival rate of patients with ischemic heart disease (IHD) is increasing. However, survivors experience increased risk for neurological complications. The mechanisms for this increased risk are unknown. We tested the hypothesis that patients with IHD have greater carotid and cerebrovascular stiffness, and these indexes predict white matter small vessel disease. Fifty participants (age, 40-78 yr), 30 with IHD with preserved ejection fraction and 20 healthy age-matched controls, were studied using ultrasound imaging of the common carotid artery (CCA) and middle cerebral artery (MCA), as well as magnetic resonance imaging (T1, T2-FLAIR), to measure white matter lesion volume (WMLv). Carotid ß-stiffness provided the primary measure of peripheral vascular stiffness. Carotid-cerebral pulse wave transit time (ccPWTT) provided a marker of cerebrovascular stiffness. Pulsatility index (PI) and resistive index (RI) of the MCA were calculated as measures of downstream cerebrovascular resistance. When compared with controls, patients with IHD exhibited greater ß-stiffness [8.5 ± 3.3 vs. 6.8 ± 2.2 arbitrary units (AU); P = 0.04], MCA PI (1.1 ± 0.20 vs. 0.98 ± 0.18 AU; P = 0.02), and MCA RI (0.66 ± 0.06 vs. 0.62 ± 0.07 AU; P = 0.04). There was no difference in WMLv between IHD and control groups (0.95 ± 1.2 vs. 0.86 ± 1.4 mL; P = 0.81). In pooled patient data, WMLv correlated with both ß-stiffness (R = 0.34, P = 0.02) and cerebrovascular ccPWTT (R = -0.43, P = 0.02); however, ß-stiffness and ccPWTT were not associated (P = 0.13). In multivariate analysis, WMLv remained independently associated with ccPWTT (P = 0.02) and carotid ß-stiffness (P = 0.04). Patients with IHD expressed greater ß-stiffness and cerebral microvascular resistance. However, IHD did not increase risk of WMLv or cerebrovascular stiffness. Nonetheless, pooled data indicate that both carotid and cerebrovascular stiffness are independently associated with WMLv.NEW & NOTEWORTHY This study found that patients with ischemic heart disease (IHD) with preserved ejection fraction and normal blood pressures exhibit greater carotid ß-stiffness, as well as middle cerebral artery pulsatility and resistive indexes, than controls. White matter lesion volume (WMLv) was not different between vascular pathology groups. Cerebrovascular pulse wave transit time (ccPWTT) and carotid ß-stiffness independently associate with WMLv in pooled participant data, suggesting that regardless of heart disease history, ccPWTT and ß-stiffness are associated with structural white matter damage.


Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Rigidez Vascular/fisiologia , Substância Branca/diagnóstico por imagem , Adulto , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Pressão Sanguínea/fisiologia , Artéria Carótida Primitiva/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Volume Sistólico , Ultrassonografia , Substância Branca/fisiopatologia
10.
Int J Cardiovasc Imaging ; 36(9): 1725-1735, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32462451

RESUMO

Longitudinal myocardial strain is considered to deteriorate in the early ischemic stage compared to circumferential and radial strains because the subendocardial inner oblique fibers are generally directed along the longitudinal axis. However, it is unclear whether the decrease in longitudinal strain precedes a decrease in circumferential and radial strains during acute coronary flow reduction. The left anterior descending artery was gradually narrowed in 13 open-chest dogs. Whole-wall and subendocardial longitudinal, circumferential, and radial strains were analyzed at baseline and during flow reduction. Peak systolic and end-systolic strains, the postsystolic strain index (PSI), and the early systolic strain index (ESI) were measured in the risk area; the decreasing rate in each parameter and the diagnostic accuracy to detect flow reduction were evaluated. Absolute values of peak systolic and end-systolic strains gradually decreased with flow reduction. The decreasing rate and diagnostic accuracy of longitudinal systolic strain were not significantly different from those in other strains, although the diagnostic accuracy of radial systolic strain tended to be lower. PSI and ESI gradually increased with flow reduction. In these parameters, a lower diagnostic accuracy with respect to radial strain was not demonstrated. During acute coronary flow reduction, the decrease in longitudinal systolic strain did not precede that in circumferential systolic strain; however, the decrease in radial systolic strain may be smaller than that of other systolic strains. In contrast, there appeared to be no differences in the PSI and ESI values among the three strains.


Assuntos
Circulação Coronária , Ecocardiografia , Hemodinâmica , Contração Miocárdica , Isquemia Miocárdica/diagnóstico por imagem , Função Ventricular , Animais , Modelos Animais de Doenças , Cães , Diagnóstico Precoce , Isquemia Miocárdica/fisiopatologia , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo
11.
J Vis Exp ; (159)2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32449739

RESUMO

Ischemic heart disease is a significant cause of death worldwide. It has therefore been the subject of a tremendous amount of research, often with small-animal models such as rodents. However, the physiology of the human heart differs significantly from that of the rodent heart, underscoring the need for clinically relevant models to study heart disease. Here, we present a protocol to model ischemic heart disease using cardiomyocytes differentiated from human induced pluripotent stem cells (hiPS-CMs) and to quantify the damage and functional impairment of the ischemic cardiomyocytes. Exposure to 2% oxygen without glucose and serum increases the percentage of injured cells, which is indicated by staining of the nucleus with propidium iodide, and decreases cellular viability. These conditions also decrease the contractility of hiPS-CMs as confirmed by displacement vector field analysis of microscopic video images. This protocol may furthermore provide a convenient method for personalized drug screening by facilitating the use of hiPS cells from individual patients. Therefore, this model of ischemic heart disease, based on iPS-CMs of human origin, can provide a useful platform for drug screening and further research on ischemic heart disease.


Assuntos
Células-Tronco Pluripotentes Induzidas/citologia , Contração Miocárdica , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Miócitos Cardíacos/patologia , Animais , Diferenciação Celular , Sobrevivência Celular , Modelos Animais de Doenças , Humanos , Microscopia de Vídeo , Isquemia Miocárdica/diagnóstico por imagem
13.
Int Heart J ; 61(2): 301-307, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224602

RESUMO

Pulmonary hypertension (PH) caused by left-sided heart disease (LHD-PH) is classified into 2 types: isolated post-capillary PH (Ipc-PH) and combined pre- and post-capillary PH (Cpc-PH). However, the impact of pulmonary vascular resistance (PVR) or diastolic pressure gradient (DPG) on the prognosis of LHD-PH has varied among previous studies. Thus, we verified the significance of PVR or DPG on the prognosis of LHD-PH in our series.We analyzed 243 consecutive LHD-PH patients. The patients were divided into 3 groups: Group A, patients with PVR ≤ 3 Wood unit (WU) and DPG < 7 mmHg; Group B, patients with either PVR > 3 WU or DPG ≥ 7 mmHg; and Group C, patients with PVR > 3 WU and DPG ≥ 7 mmHg.The Kaplan-Meier curve demonstrated that Group B had lower cardiac death-free survival compared with Group A, whereas no significant differences were observed when compared with Group C. In the Cox hazard model, DPG was not associated with cardiac death in the LHD-PH patients. However, only in the ischemic heart disease group, patients with DPG ≥ 7 mmHg had worse prognosis compared with those with normal DPG.The cardiac death-free rate of patients with either increased PVR or DPG was close to that of patients with both increased PVR and DPG. It seems reasonable to define Cpc-PH only by PVR in the new criteria. However, the significance of DPG in LHD-PH might be dependent on the underlying cause of LHD-PH.


Assuntos
Pressão Sanguínea/fisiologia , Diástole/fisiologia , Insuficiência Cardíaca/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Taxa de Sobrevida , Resistência Vascular/fisiologia , Adulto , Idoso , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Morte , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Prognóstico , Modelos de Riscos Proporcionais
14.
Br J Radiol ; 93(1113): 20190764, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32302209

RESUMO

Stable ischemic heart disease remains a major cause of morbidity and mortality. Although there are multiple imaging modalities to diagnose and/or assist in the clinical management, the most cost-effective approach remains unclear. We reviewed the relevant and recent evidence-based clinical studies and trials to suggest the most cost-effective approach to stable ischemic heart disease. The limitations of these studies are discussed. Incorporating the results of recent multicenter trials, we suggest that for appropriate patients with coronary artery disease with any degree of stenosis or presence of coronary calcium, optimal medical therapy may be most cost-effective. Invasive coronary angiography and/or coronary revascularization would be primarily for non-responders or >/=50% left main stenosis. Stress cardiac magnetic imaging would be performed for those patients with non-diagnostic coronary CT angiography from motion and non-responders from optimal medical therapy in non-diagnostic coronary CT angiography group from high coronary calcium. These paths seem to be safe and cost-effective but requires modeling for confirmation.


Assuntos
Isquemia Miocárdica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/economia , Angiografia Coronária/economia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Análise Custo-Benefício , Humanos , Angiografia por Ressonância Magnética/economia , Angiografia por Ressonância Magnética/métodos , Estudos Multicêntricos como Assunto , Isquemia Miocárdica/terapia , Revascularização Miocárdica/economia , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/terapia
15.
Am J Cardiol ; 125(11): 1661-1665, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32273056

RESUMO

In patients in sinus rhythm, a blunted heart rate reserve (HRR) during dipyridamole stress echocardiography (SE) is a prognostically unfavorable sign of cardiac autonomic dysfunction. In this study we sought to assess the prognostic meaning of HRR in patients with permanent atrial fibrillation (AF). The study population was made by 301 patients (176 men, age 73 ± 8 years) with suspected (n = 200) or known (n = 101) coronary artery disease and permanent AF who underwent high-dose dipyridamole SE. HRR was calculated on an average of 5 consecutive beats as the peak/rest ratio of HR from 12-lead EKG. During a median follow-up time of 77 months (first quartile 44, third quartile 115 months), 111 (37%) patients died. Receiver operating characteristics analysis identified HRR ≤1.17 as the best predictor of mortality. At multivariable analysis, HRR ≤1.17 (HR 1.75, 95% CI 1.17 to 2.62; p = 0.006) independently predicted mortality together with age (HR 1.09, 95% CI 1.06 to 1.13; p <0.0001), rest wall motion score index (HR 1.69, 95% CI 1.01 to 2.83; p = 0.04), and systemic hypertension (HR 1.76, 95% CI 1.06 to 3.00; p = 0.04). The annual mortality was 5.1% in the overall population, 7.0% in the 140 (46%) patients with abnormal HRR and 3.5% in the 161 (54%) patients with normal HRR. The 8-year mortality was 48% in patients with abnormal HRR and 18% in those with normal HRR (p <0.0001). In conclusion, patients with suspected or known coronary artery disease with permanent AF with a blunted HRR have an increased mortality. HRR outweighs inducible ischemia for prediction of survival. The assessment of HRR should become an integral part of dipyridamole SE reading also in AF.


Assuntos
Fibrilação Atrial/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Dipiridamol , Frequência Cardíaca/fisiologia , Isquemia Miocárdica/fisiopatologia , Taxa de Sobrevida , Vasodilatadores , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Prognóstico
16.
Circ Cardiovasc Interv ; 13(4): e008565, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32279561

RESUMO

BACKGROUND: Whether revascularization improves prognosis in stable ischemic heart disease is controversial. METHODS: Individual patient-level data from 19 prospective, randomized stent trials were pooled. Rates of 5-year major adverse cardiovascular events (MACE; a composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) were assessed and compared after percutaneous coronary intervention with bare-metal stents (BMS) and first-generation and second-generation drug-eluting stents (DES1 and DES2, respectively). Poisson multivariable regression analysis was performed to identify predictors of adverse events. RESULTS: Among 10 987 patients treated with percutaneous coronary intervention for stable ischemic heart disease, 1550, 2776, and 6661 received BMS, DES1, and DES2, respectively. The 5-year rates of MACE progressively declined with evolution in stent technology (BMS: 24.1% versus DES1: 17.9% versus DES2: 13.4%, P<0.0001). However, MACE rates between 1 and 5 years increased from BMS to DES1, then declined with DES2 (BMS: 7.4% versus DES1: 10.2%, DES2: 8.5%, P=0.02). CONCLUSIONS: Patients with stable ischemic heart disease remain at substantial risk for long-term MACE after revascularization with percutaneous coronary intervention, even with contemporary DES. New approaches to reduce the ongoing risk of MACE beyond 1 year after stent implantation are necessary.


Assuntos
Stents Farmacológicos , Isquemia Miocárdica/terapia , Intervenção Coronária Percutânea/instrumentação , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Desenho de Prótese , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
18.
Rev Invest Clin ; 72(1): 32-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32132738

RESUMO

Background: The cost of performing a percutaneous coronary intervention is considerably high for the patient as well as for health systems, which have promoted the development of local technology to help meet the need for these devices. Methods: The INC-01 bare-metal stent was developed at the National Institute of Cardiology in Mexico City and was first implanted on porcine models with technical success in 100% of the evaluated parameters. Presentation of Cases: We present the first three cases of patients with ischemic heart disease, to whom the INC-01 bare-metal stent was implanted. Intracoronary ultrasonography was performed post-stent implantation, showing all the characteristics of implant success during evaluation and clinical follow-up. Conclusions: Angiography and intracoronary ultrasound were carried out demonstrating that the INC-01 bare-metal stent has physical, biological, and histological characteristics similar to those found in commercial metallic stents.


Assuntos
Isquemia Miocárdica/cirurgia , Desenho de Prótese , Stents , Adulto , Idoso , Seguimentos , Humanos , Masculino , México , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Projetos Piloto , Resultado do Tratamento , Ultrassonografia
20.
Circ Arrhythm Electrophysiol ; 13(4): e007975, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32188287

RESUMO

BACKGROUND: Transition zones between healthy myocardium and scar form a spatially complex substrate that may give rise to reentrant ventricular arrhythmias (VAs). We sought to assess the utility of a novel machine learning approach for quantifying 3-dimensional spatial complexity of grayscale patterns on late gadolinium enhanced cardiac magnetic resonance images to predict VAs in patients with ischemic cardiomyopathy. METHODS: One hundred twenty-two consecutive ischemic cardiomyopathy patients with left ventricular ejection fraction ≤35% without prior history of VAs underwent late gadolinium enhanced cardiac magnetic resonance images. From raw grayscale data, we generated graphs encoding the 3-dimensional geometry of the left ventricle. A novel technique, adapted to these graphs, assessed global regularity of signal intensity patterns using Fourier-like analysis and generated a substrate spatial complexity profile for each patient. A machine learning statistical algorithm was employed to discern which substrate spatial complexity profiles correlated with VA events (appropriate implantable cardioverter-defibrillator firings and arrhythmic sudden cardiac death) at 5 years of follow-up. From the statistical machine learning results, a complexity score ranging from 0 to 1 was calculated for each patient and tested using multivariable Cox regression models. RESULTS: At 5 years of follow-up, 40 patients had VA events. The machine learning algorithm classified with 81% overall accuracy and correctly classified 86% of those without VAs. Overall negative predictive value was 91%. Average complexity score was significantly higher in patients with VA events versus those without (0.5±0.5 versus 0.1±0.2; P<0.0001) and was independently associated with VA events in a multivariable model (hazard ratio, 1.5 [1.2-2.0]; P=0.002). CONCLUSIONS: Substrate spatial complexity analysis of late gadolinium enhanced cardiac magnetic resonance images may be helpful in refining VA risk in patients with ischemic cardiomyopathy, particularly to identify low-risk patients who may not benefit from prophylactic implantable cardioverter-defibrillator therapy. Visual Overview: A visual overview is available for this article.


Assuntos
Arritmias Cardíacas/etiologia , Cardiomiopatias/diagnóstico por imagem , Diagnóstico por Computador , Aprendizado de Máquina , Imagem por Ressonância Magnética , Isquemia Miocárdica/complicações , Potenciais de Ação , Idoso , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Meios de Contraste/administração & dosagem , Morte Súbita Cardíaca/etiologia , Feminino , Análise de Fourier , Gadolínio DTPA/administração & dosagem , Frequência Cardíaca , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Estados Unidos , Função Ventricular Esquerda
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