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1.
Bratisl Lek Listy ; 120(9): 676-679, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31475553

RESUMO

OBJECTIVES: Medial arterial calcification (MAC) is a nonobstructive condition leading to reduced arterial compliance. The disease most commonly occurs in diabetes mellitus. Decreased ankle-brachial pressure index (ABI) is a well-known marker of increased cardiovascular mortality. However, also the values of ABI above 1.3, typical in MAC, are associated with increased mortality. METHODS: By means of Holter ECG monitoring, we investigated 41 patients (25 men, 16 women) with mean age of 59±8 years, suffering of type 2 diabetes mellitus and identified as having MAC, and Holter ECG monitoring with an average duration of recording 22.36 hours, was carried out by GE-Marquette MARS ECG Holter system. RESULTS: We found frequent incidence of cardiac arrhythmias and myocardial ischemia in 22 patients (53.7 %). Only 19 patients (46.3 %) had normal Holter ECG recordings. ABI values were significantly higher in patients with abnormal ECG Holter recordings. CONCLUSION: Our results confirm the importance of ABI estimation in clinical practice. As the central goal of therapy for patients with myocardial ischemia and/or complex forms of cardiac arrhythmias is the reduction or elimination of these episodes. Ambulatory Holter ECG monitoring plays an important role in the management of these patients (Tab. 7, Ref. 16).


Assuntos
Arritmias Cardíacas/diagnóstico , Calcinose/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Eletrocardiografia Ambulatorial , Isquemia Miocárdica/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Int Heart J ; 60(4): 796-804, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308329

RESUMO

The benefits of concomitant mitral valve procedure (MVP) for treating moderate chronic ischemic mitral regurgitation (IMR) during coronary artery bypass grafting (CABG) have not been clearly established. This study aimed to determine the incidence of moderate or more residual mitral regurgitation (MR) following CABG plus MVP for moderate chronic IMR, and to evaluate the impacts of concomitant MVP vs. CABG alone on clinical outcomes based on propensity-matched data.All eligible patients were entered into either the MVP group (CABG plus MVP, n = 184) or CABG group (CABG alone, n = 162). Moderate or more residual MR rate was investigated, and in-hospital and follow-up outcomes between the groups were compared after matching.Moderate or more residual MR rate was 11.4% at 1 year and 22.9% at 2 years after CABG plus MVP, respectively. Patients in the MVP group as compared with the CABG group had significantly lower moderate or more residual MR rates at various postoperative time points (all P < 0.001). Grouping was not an independent risk factor for in-hospital adverse events in multivariate logistic regression analysis. Also, grouping was a significant variable related to moderate or more residual MR rate and NYHA class III-IV at the latest follow-up in Cox regression analysis (HR = 0.391, 95% CI 0.114-0.628; HR = 0.419, 95% CI 0.233-0.819, respectively).Concomitant MVP as compared with CABG alone for treating moderate chronic IMR was associated with a reduction in moderate or more residual MR rate and an improvement in NYHA functional status, with no increase in in-hospital adverse events or follow-up death.


Assuntos
Ponte de Artéria Coronária/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/complicações , Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , China/epidemiologia , Doença Crônica , Angiografia Coronária , Ecocardiografia Doppler , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
3.
Rev Med Suisse ; 15(652): 1087-1090, 2019 May 22.
Artigo em Francês | MEDLINE | ID: mdl-31116524

RESUMO

The interpretation of troponin elevation whitout a typical myocardial infarction symptomatology is a daily challenge in the acute care setting. Using current investigative techniques, doctors navigate between the five types of myocardial infarction established by the Fourth Universal Definition. However, due to the development of ultrasensitive troponin assays, the myocardial injury without ischemia, acute or chronic, is became a more common entity. The purpose of this article is to describe the situations without typical symptoms of myocardial ischemia and their mechanisms to better differentiate them.


Assuntos
Infarto do Miocárdio , Isquemia Miocárdica , Troponina , Biomarcadores , Eletrocardiografia , Humanos , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Troponina/sangue
4.
Medicine (Baltimore) ; 98(20): e15618, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096471

RESUMO

To explore the prevalence and risk factors of silent myocardial ischemia (SMI) detected by using single photon emission computed tomography (SPECT) in Chinese asymptomatic patients with type 2 diabetes (T2D).In this hospital-based retrospective study, 821 T2D patients who were screened for SMI detected by stress myocardial perfusion imaging using SPECT between June 2014 and July 2016 were investigated. Clinical indicators were compared between the patients with SMI and controls without SMI. Risk factors for SMI were evaluated by univariate and multivariate analysis.In this study, there were 131 patients with SMI in asymptomatic diabetes and the prevalence of SMI was 21.3% of 614 individuals. Logistic regression analysis indicated that diabetic retinopathy (OR = 1.474, 95%CI: 1.113-1.951, P = .007), male gender (OR = 1.805, 95%CI: 1.183-2.747, P = .006), and low-density lipoprotein (LDL) cholesterol (OR = 1.298, 95%CI: 1.042-1.615, P = .02) were risk factors associated with SMI. Besides, the prevalence of SMI increased in associated with the progression of retinopathy (P = .041). The percentage of SMI diagnosed in patients with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) were 18.5% (75/405), 25.2% (37/147), and 30.6% (19/62), respectively. The percentage of SMI in male (24.5%, 85/347) was higher than that in female (17.2%, 46/267), P = .029.Physicians should be aware of these conditions when examining male patients with type 2 diabetes, especially with DR and/or high level of low-density lipoprotein cholesterol (LDL cholesterol), even if otherwise asymptomatic. A routine screening for SMI may thus be considered advisable in these patients.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Adulto , Fatores Etários , Idoso , China/epidemiologia , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Lipídeos/sangue , Masculino , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Razão de Chances , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Tomografia Computadorizada de Emissão de Fóton Único
5.
South Med J ; 112(3): 143-146, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30830226

RESUMO

OBJECTIVES: Previous work suggests that hospitals' teaching status is correlated with readmission rates, cost of care, and mortality. The degree to which teaching status is associated with the management of syncope has not been studied extensively. We sought to characterize the relation between teaching status and inpatient syncope management. METHODS: We created regression models to characterize the relation between teaching status and cardiac ischemic evaluations (cardiac catheterization and/or stress test) during syncope admissions. Admissions with a primary diagnosis of syncope in Maryland and Kentucky between 2007 and 2014 were included. RESULTS: The dataset included 71,341 syncope admissions at 151 hospitals. Overall, 15% of patients had an ischemic evaluation. There was a significantly lower likelihood of an ischemic evaluation at major teaching hospitals relative to nonteaching hospitals (adjusted odds ratio 0.75, 95% confidence interval 0.71-0.79), but a higher likelihood of an ischemic evaluation at minor teaching hospitals (adjusted odds ratio 1.21, 95% confidence interval 1.16-1.25). CONCLUSIONS: By definition, the syncope admissions included were unexplained or idiopathic cases, and thus likely to be lower-risk syncope cases. Those with a known etiology are coded by the cause of syncope, as dictated by coding guidelines. It is likely that many of these ischemic evaluations represent low-value care. Financial incentives and processes of care at major teaching hospitals may be driving this trend, and efforts should be made to better understand and replicate these at minor teaching and nonteaching hospitals.


Assuntos
Cateterismo Cardíaco/estatística & dados numéricos , Teste de Esforço/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Isquemia Miocárdica/diagnóstico , Síncope/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Feminino , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Síncope/terapia
6.
J Cardiovasc Med (Hagerstown) ; 20(5): 313-320, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30921269

RESUMO

AIMS: To systematically review literature comparing bare metal stent (BMS) to drug-eluting stent (DES) in end-stage renal disease (ESRD) patients on dialysis. ESRD patients on dialysis often suffer from accelerated atherosclerosis and higher rate of stent-related complications including major adverse cardiovascular events. Because dialysis usually qualifies ineligibility for randomized clinical trials, an evidenced-based stent choice for these patients is scarce. METHODS: PUBMED, CINHAL, COCHRANE, EMBASE and WEB OF SCIENCE were searched for studies comparing BMS vs. DES outcome in ESRD patients on dialysis. RESULTS: Twenty studies including 64 232 patients were considered. The use of DES was significantly associated with a reduction in all-cause mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.76-0.89], death from a cardiovascular cause (OR 0.80, 95% CI 0.76-0.84) and target lesion revascularization/target vessel revascularization (OR 0.73, 95% CI 0.53-1.00). No significant difference was found in stent thrombosis (OR 1.08, 95% CI 0.50-2.33) and myocardial infarction incidence (OR 0.91, 95% CI 0.69-1.20). CONCLUSIONS: Our meta-analysis shows a significant reduction in all-cause and cardiovascular mortality with the use of DES over BMS in dialyzed patients. Despite the lack of randomized studies, systematic use of DES in these high-risk patients should thus reasonably be considered as a first option in percutaneous coronary intervention candidates.


Assuntos
Stents Farmacológicos , Falência Renal Crônica/terapia , Metais , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/instrumentação , Diálise Renal , Stents , Idoso , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Desenho de Prótese , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Pediatr Cardiol ; 40(5): 901-908, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30852629

RESUMO

The incidence of late coronary complications is reported around 8% after arterial switch operation (ASO) for d-transposition of the great arteries, but the affected patients are usually asymptomatic. Exercise stress test (EST) and myocardial perfusion imaging (MPI) are common non-invasive modalities to screen for silent myocardial ischemia, but their diagnostic reliability in children after ASO is unclear. We retrospectively reviewed asymptomatic patients following ASO with EST, MPI, and coronary imaging studies (CIS) and examined the reliability of each test in identifying abnormal coronary lesions responsible for myocardial ischemia. Thirty-seven asymptomatic patients (24 males; ages 12.7 ± 3.7 years) had EST, in which 27 and 33 patients also underwent MPI and CIS, respectively. Exercise capacity was comparable to the age- and sex-matched 37 controls. In seven patients with angiographically proven moderate to severe coronary abnormalities, only two patients had positive EST and/or MPI, and five patients were negative including one patient who later developed exercise-induced cardiac arrest due to severe proximal left coronary artery stenosis. Two patients with positive EST or MPI showed no corresponding coronary abnormalities by CIS. Occurrence of acquired late coronary abnormalities did not correlate with the original coronary anatomy or initial surgical procedures. There is no single reliable method to identify the risk of myocardial ischemia after ASO. Although CIS are regarded as a gold standard, multidisciplinary studies are essential to risk-stratify the potential life-threatening coronary lesions after ASO in children.


Assuntos
Transposição das Grandes Artérias/efeitos adversos , Isquemia Miocárdica/diagnóstico , Transposição dos Grandes Vasos/cirurgia , Adolescente , Doenças Assintomáticas , Estudos de Casos e Controles , Criança , Angiografia Coronária , Teste de Esforço , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Imagem de Perfusão do Miocárdio , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
8.
Eur Radiol ; 29(7): 3647-3657, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30903334

RESUMO

OBJECTIVES: The present study aimed to compare the diagnostic performance of a machine learning (ML)-based FFRCT algorithm, quantified subtended myocardial volume, and high-risk plaque features for predicting if a coronary stenosis is hemodynamically significant, with reference to FFRICA. METHODS: Patients who underwent both CCTA and FFRICA measurement within 2 weeks were retrospectively included. ML-based FFRCT, volume of subtended myocardium (Vsub), percentage of subtended myocardium volume versus total myocardium volume (Vratio), high-risk plaque features, minimal lumen diameter (MLD), and minimal lumen area (MLA) along with other parameters were recorded. Lesions with FFRICA ≤ 0.8 were considered to be functionally significant. RESULTS: One hundred eighty patients with 208 lesions were included. The lesion length (LL), diameter stenosis, area stenosis, plaque burden, Vsub, Vratio, Vratio/MLD, Vratio/MLA, and LL/MLD4 were all significantly longer or larger in the group of FFRICA ≤ 0.8 while smaller minimal lumen area, MLD, and FFRCT value were noted. The AUC of FFRCT + Vratio/MLD was significantly better than that of FFRCT alone (0.935 versus 0.873, p < 0.001). High-risk plaque features failed to show difference between functionally significant and insignificant groups. Vratio/MLD-complemented ML-based FFRCT for "gray zone" lesions with FFRCT value ranged from 0.7 to 0.8 and the combined use of these two parameters yielded the best diagnostic performance (86.5%, 180/208). CONCLUSIONS: ML-based FFRCT simulation and Vratio/MLD both provide incremental value over CCTA-derived diameter stenosis and high-risk plaque features for predicting hemodynamically significant lesions. Vratio/MLD is more accurate than ML-based FFRCT for lesions with simulated FFRCT value from 0.7 to 0.8. KEY POINTS: • Machine learning-based FFR CT and subtended myocardium volume both performed well for predicting hemodynamically significant coronary stenosis. • Subtended myocardium volume was more accurate than machine learning-based FFR CT for "gray zone" lesions with simulated FFR value from 0.7 to 0.8. • CT-derived high-risk plaque features failed to correctly identify hemodynamically significant stenosis.


Assuntos
Estenose Coronária/diagnóstico , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Aprendizado de Máquina , Isquemia Miocárdica/diagnóstico , Placa Aterosclerótica/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Angiografia Coronária/métodos , Estenose Coronária/complicações , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/fisiopatologia , Estudos Retrospectivos
9.
Medisan ; 23(1)ene.-feb. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-990178

RESUMO

Se realizó una investigación descriptiva, longitudinal y prospectiva de 41 pacientes con antecedentes de infarto agudo del miocardio, que formaron parte de un programa de rehabilitación cardiovascular en el Servicio de Terapia Física y Rehabilitación del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde mayo de 2017 hasta igual mes de 2018, con vistas a evaluar el efecto del entrenamiento físico sobre la función cardiovascular de estos. Se examinó la función cardiovascular a través del ecocardiograma y el electrocardiograma, antes y después de aplicado el programa, y al final del estudio se obtuvo una modificación positiva de las variables eco- y electrocardiográficas, con un mayor grado de recuperación de la contractilidad segmentaria. Pudo concluirse que el programa tuvo un papel importante en la restauración de la función cardíaca y, con ello, se mejoró la capacidad física y psicológica de los pacientes, de manera que fue beneficioso para estos y para la sociedad.


A descriptive, longitudinal and prospective investigation of 41 patients with a history of acute myocardial infarction who were part of a program of cardiovascular rehabilitation in the Service of Physical Therapy and Rehabilitation from Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out from May, 2017 to the same month in 2018, with the aim of evaluating the effect of the physical training on their cardiovascular function. The cardiovascular function was examined through the echocardiogram and the electrocardiogram, before and after the program was applied, and at the end of the study a positive modification of the echocardiographical and electrocardiographical variables was obtained with a higher degree of recovery of the segmental contractility. It could be concluded that the program had an important role in the restoration of the heart function and, with it, the physical and psychological capacity of the patients improved, so that it was beneficial for them and for the society.


Assuntos
Humanos , Masculino , Feminino , Isquemia Miocárdica/diagnóstico , Eletrocardiografia , Terapia por Exercício , Infarto do Miocárdio/terapia , Exercício , Estudos Prospectivos , Estudos Longitudinais , Contração Miocárdica
10.
Eur J Radiol ; 112: 136-143, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30777202

RESUMO

BACKGROUND: The aim of this study was to assess the potential of rest-stress DECT iodine quantification to discriminate between normal, ischemic, and infarcted myocardium. METHODS: Patients who underwent rest-stress DECT on a 2nd generation dual-source system and cardiac magnetic resonance (CMR) were retrospectively included from a prospective study cohort. CMR was performed to identify ischemic and infarcted myocardium and categorize patients into ischemic, infarcted, and control groups. Controls were analyzed on a per-slice and per-segment basis. Regions of interest (ROIs) were placed in ischemic and infarcted areas based on CMR. Additionally, ROIs were placed in the septal area to assess normal and remote myocardium. RESULTS: We included 42 patients: 10 ischemic, 17 infarcted, and 15 controls. Iodine concentrations showed no significant between segments in controls. Iodine concentrations for normal myocardium increased significantly from rest to stress (median 3.7 mg/mL (interquartile range 3.5-3.9) vs. 4.5 mg/mL (4.3-4.9)) (p < 0.001). Iodine concentrations in diseased myocardium were significantly lower than in normal myocardium; 1.3 mg/mL (0.9-1.8) and 0.6 mg/mL (0.4-0.8) at rest and stress in ischemic myocardium, and 0.3 mg/mL (0.3-0.5) and 0.5 mg/mL (0.5-0.7) at rest and stress in infarcted myocardium (p < 0.005 and p < 0.001). At rest only, iodine concentrations were significantly lower in infarcted vs. ischemic myocardium (p < 0.001). The optimal threshold for differentiating diseased from normal myocardium was 2.5 mg/mL and 2.1 mg/mL for rest and stress (AUC 1.00). To discriminate ischemic from infarcted myocardium, the optimal threshold was 1.0 mg/ml (AUC 0.944) at rest. CONCLUSION: DECT iodine concentration from rest-stress imaging can potentially differentiate between normal, ischemic, and infarcted myocardium.


Assuntos
Meios de Contraste/farmacocinética , Iodo/farmacocinética , Isquemia Miocárdica/diagnóstico , Idoso , Estudos de Casos e Controles , Teste de Esforço/métodos , Feminino , Coração/fisiologia , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Imagem de Perfusão do Miocárdio/métodos , Miocárdio/química , Estudos Prospectivos , Descanso , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
11.
Eur Radiol ; 29(7): 3658-3668, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30770973

RESUMO

OBJECTIVES: To validate deformable registration algorithms (DRAs) for cine balanced steady-state free precession (bSSFP) assessment of global longitudinal strain (GLS) and global circumferential strain (GCS) using harmonic phase (HARP) cardiovascular magnetic resonance as standard of reference (SoR). METHODS: Seventeen patients and 17 volunteers underwent short axis stack and 2-/4-chamber cine bSSFP imaging with matching slice long-axis and mid-ventricular spatial modulation of magnetization (SPAMM) myocardial tagging. Inverse DRA was applied on bSSFP data for assessment of GLS and GCS while myocardial tagging was processed using HARP. Intra- and inter-observer variability assessment was based on repeated analysis by a single observer and analysis by a second observer, respectively. Standard semi-automated short axis stack segmentation was performed for analysis of left ventricular (LV) volumes and ejection fraction (EF). RESULTS: DRA demonstrated strong relationships to HARP for myocardial GLS (R2 = 0.75; p < 0.0001) and endocardial GLS (R2 = 0.61; p < 0.0001). GCS result comparison also demonstrated significant relationships between DRA and HARP for myocardial strain (R2 = 0.61; p < 0.0001) and endocardial strain (R2 = 0.51; p < 0.0001). Both methods demonstrated small systematic errors for intra- and inter-observer variability but DRA demonstrated consistently lower CV. Global LVEF was significantly lower (p = 0.0099) in patients (53.7%; IQR 43.9/64.0%) than in healthy volunteers (62.6%; IQR 61.1/66.2%). DRA and HARP strain data demonstrated significant relationships to LVEF. CONCLUSIONS: Non-rigid deformation method-based DRA provides a reliable measure of peak systolic GCS and GLS based on cine bSSFP with superior intra- and inter-observer reproducibility compared to HARP. KEY POINT: • Myocardial strain can be reliably analyzed using inverse deformable registration algorithms (DRAs) on cine CMR. • Inverse DRA-derived strain shows higher reproducibility than tagged CMR. • DRA and tagged CMR-based myocardial strain demonstrate strong relationships to global left ventricular function.


Assuntos
Algoritmos , Ventrículos do Coração/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Imagem Cinética por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico , Miocárdio/patologia , Função Ventricular Esquerda/fisiologia , Adulto , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Estudos Prospectivos , Reprodutibilidade dos Testes
12.
ABC., imagem cardiovasc ; 32(1): 19-28, jan.-mar. 2019. ilus, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-969863

RESUMO

A miocardiopatia hipertrófica é a cardiopatia hereditária mais comum e acomete cerca de 1:500 indivíduos na população geral. O diagnóstico, que nem sempre é simples pela variação fenotípica e pela concomitância de outras patologias, baseia-se, inicialmente, em critérios eletrocardiográficos e ecocardiográficos, e na ausência de outras doenças que cursem com hipertrofia ventricular. Tendo como base celular o desarranjo miofibrilar e a fibrose com alterações hemodinâmicas decorrentes, a miocardiopatia hipertrófica pode revelar isquemia miocárdica (não relacionada à aterosclerose) e morte súbita. Assim, a avaliação da repercussão funcional por meio da cintilografia de perfusão miocárdica pela técnica Single Photon Emission Computed Tomography (SPECT) tem ganhado espaço, uma vez que 25% dos pacientes com miocardiopatia hipertrófica demonstram defeitos de perfusão fixos ou isquêmicos. Neste âmbito, notam-se alterações perfusionais que não estão necessariamente associadas ao tipo de miocardiopatia hipertrófica, mas conseguem predizer morbimortalidade nestes indivíduos. Outra técnica cintilográfica mais recente é a tomografia por emissão de pósitrons (PET), que se destaca na avaliação da microcirculação, na reserva de fluxo coronário e no metabolismo miocárdico. Em pacientes com miocardiopatia hipertrófica, estudos têm demonstrado resultados desfavoráveis quanto menores o fluxo sanguíneo miocárdico e a reserva de fluxo coronário. A avaliação miocárdica metabólica pela PET parece útil no entendimento fisiopatológico desta doença e na avaliação prognóstica da ablação alcoólica, procedimento realizado em formas obstrutivas graves. Assim, esta revisão aborda o papel da cardiologia nuclear pelas técnicas SPECT e PET miocárdico na avaliação diagnóstica, prognóstica e terapêutica da miocardiopatia hipertrófica


Assuntos
Humanos , Masculino , Feminino , Cintilografia/métodos , Cardiomiopatia Hipertrófica Familiar/genética , Cardiomiopatia Hipertrófica Familiar/terapia , Tomografia por Emissão de Pósitrons/métodos , Imagem de Perfusão do Miocárdio/métodos , Prognóstico , Volume Sistólico , Diagnóstico por Imagem/métodos , Ecocardiografia/métodos , Isquemia Miocárdica/diagnóstico , Morte Súbita , Diagnóstico Diferencial , Eletrocardiografia/métodos , Insuficiência Cardíaca/diagnóstico
13.
Clin Imaging ; 54: 148-152, 2019 Mar - Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30654226

RESUMO

We report the case of a 49-year-old man with a history of diabetes and hypertension who presented to the emergency room with intermittent chest pain radiating to the back for one day. An electrocardiogram-gated CT aortogram excluded the emergency department's primary consideration of aortic dissection, but incidentally revealed a myocardial perfusion defect and corresponding coronary artery stenosis. Cardiac catheterization performed the following day confirmed the CT findings and the patient underwent angioplasty and stent placement. We show that despite a different protocol than coronary CTA or myocardial perfusion CT, a gated CTA for dissection (CT aortogram) is capable of detecting resting perfusion abnormalities in patients presenting to the emergency room with chest pain.


Assuntos
Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Aortografia/métodos , Estenose Coronária/complicações , Eletrocardiografia , Isquemia Miocárdica/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Aneurisma Dissecante/complicações , Aneurisma da Aorta Torácica/complicações , Angiografia Coronária , Estenose Coronária/diagnóstico , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia
14.
Herz ; 44(1): 4-9, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30680412

RESUMO

Elevation of cardiac troponins above the 99th percentile of a healthy reference population is established as a marker for myocardial cell damage and is crucial for the diagnosis of myocardial infarction. In addition, corresponding clinical evidence of acute myocardial ischemia i.e. symptoms, changes in the electrocardiogram (ECG), wall motion abnormalities or suggestive angiographic findings are required for the diagnosis of myocardial infarction. Using modern highly sensitive assays myocardial infarction can be detected more frequently and earlier. On the other hand myocardial infarction can be ruled out with a higher diagnostic accuracy. Cardiac troponins are specific for myocardial cell damage but not for myocardial infarction and can be elevated in numerous other disease states. In these cases myocardial injury can be diagnosed independently of myocardial ischemia. Typical dynamics with rise and fall of troponin levels can distinguish acute myocardial injury (e. g. pericarditis/myocarditis and pulmonary embolism) from chronic myocardial injury (e. g. cardiomyopathy). Clinically, highly sensitive troponin assays are currently recommended in addition to the 0/3 h and 0/1 h algorithms for rapid inclusion or exclusion of myocardial infarction.


Assuntos
Infarto do Miocárdio , Isquemia Miocárdica , Troponina , Biomarcadores/sangue , Eletrocardiografia , Humanos , Infarto do Miocárdio/diagnóstico , Isquemia Miocárdica/diagnóstico , Troponina/sangue
15.
Clin Cardiol ; 42(3): 379-384, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30597592

RESUMO

BACKGROUND: A fragmented QRS complex (fQRS) is caused by conduction abnormalities of the ventricle secondary to myocardial ischemia and/or scar in patients with myocardial infarction. However, the implications of the fQRS in the development of coronary artery disease with myocardial ischemia in those without a scar remain unknown. METHODS: We studied electrocardiograms (ECGs) obtained from 150 patients (60.5 ± 8.5 years, 102 men) with myocardial ischemia, which was confirmed by performing both, a nuclear exercise stress test and coronary angiography. We also studied ECGs obtained from 601 patients (58.5 ± 10.0 years, 315 men) who showed a negative nuclear exercise stress test (control group). Patients in whom the nuclear exercise stress test showed a myocardial scar were excluded. RESULTS: An fQRS was more commonly observed in patients with myocardial ischemia (n = 48, 32.0%) than in the control group (n = 133, 22.1%) (P = 0.011). The sensitivity, specificity, positive, and negative predictive values of fQRS in diagnosing myocardial ischemia were 32.0, 77.9, 26.5, and 82.1%, respectively. The fQRS (odds ratio 1.580, 95% confidence interval 1.020-2.446, P = 0.040) was an independent predictor of myocardial ischemia after adjusting for age, sex, current smoking habits, ST-T changes on ECG, as well as histories of hypertension, diabetes, and dyslipidemia. Moreover, the fQRS showed an incremental prognostic value over conventional risk factors (χ2 = 5, P = 0.032) and over a combination of conventional factors and ST-T changes (χ2 = 9, P = 0.014). CONCLUSIONS: The fQRS is a moderately sensitive and independent predictor of myocardial ischemia.


Assuntos
Angiografia Coronária/métodos , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Isquemia Miocárdica/diagnóstico , Medição de Risco/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco
17.
Angiol Sosud Khir ; 24(4): 55-61, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30531770

RESUMO

Despite obvious progress of cardiac surgery, a low left ventricular ejection fraction is an important independent predictor of a high rate of complications and increased in-hospital lethality in open surgical interventions. On this ground, promising seems to be a method of endovascular myocardial revascularization, which is associated with a minimal number of intraoperative and postoperative complications. However, by means of transcutaneous coronary intervention (TCI) it is not always possible to perform complete anatomical myocardial revascularization. The subject concerning the necessity of complete myocardial revascularization, changes of anatomy and physiology of the heart, clinical state of patients with a low left ventricular ejection fraction after endovascular intervention has not been sufficiently explored. In order to clear up these problems we carried out a prospective single-centre study including a total of 151 patients suffering from ischaemic heart diseases with a left ventricular ejection fraction of less than 35%, who were subjected to endovascular myocardial revascularization. The patients were divided into two groups: with complete (n=87) and incomplete (n=64) revascularization. All patients before and 6 months after the intervention underwent echocardiographic examination with the measurement of the left ventricular ejection fraction, stroke volume, end-diastolic volume and assessment of the functional class of angina pectoris. The obtained findings are indicative of efficacy of both complete and incomplete endovascular myocardial revascularization in patients with a low left ventricular fraction. No statistically significant difference by the examined parameters between the patients of both groups was revealed.


Assuntos
Angina Pectoris , Procedimentos Endovasculares , Isquemia Miocárdica , Complicações Pós-Operatórias , Disfunção Ventricular Esquerda , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Angina Pectoris/fisiopatologia , Ecocardiografia/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Período Perioperatório , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Federação Russa , Volume Sistólico , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia
19.
Vasc Health Risk Manag ; 14: 265-278, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30349279

RESUMO

Background: The EPHES trial (Evaluation of influence of fixed dose combination Perindo-pril/amlodipine on target organ damage in patients with arterial HypErtension with or without iSchemic heart disease) compared the dynamics of target organ damage (TOD) in hypertensive patients with and without ischemic heart disease (IHD) treated with the fixed-dose combination (FDC) perindopril + amlodipine. Methods: The analysis included 60 hypertensive patients (aged >30 years): 30 without IHD and 30 with IHD. At randomization, FDC was administered at a daily baseline dose of 5/5 mg with uptitration to 10/10 mg every two weeks. If target blood pressure (BP<140/90 mmHg) was not achieved after six weeks, indapamide 1.5 mg was added to the regimen. All patients underwent body mass index measurements, office and ambulatory BP measurements, pulse wave velocity (PWVe) and central systolic BP evaluation, augmentation index adjusted to heart rate 75 (Aix@75) evaluation, biochemical analysis, ECG, echocardiography with Doppler, ankle-brachial index measurement, and intima-media thickness measurement. The follow-up period was 12 months. Results: Therapy based on FDC perindopril/amlodipine was effective in lowering BP (office, ambulatory, central) in both groups. We noted significant decrease in Aix@75 with the therapy in both groups, but ΔAix@75 was lesser in the group with IHD than the group without IHD. FDC provided significant improvement in PWVe and left ventricular diastolic function, and decrease in albuminuria, left ventricular hypertrophy (LVH), and left atrium size. ΔPWVe was significantly (P<0.005) less in patients without IHD than those with IHD (2.5±0.2 vs 4.4±0.5 m/s, respectively). In spite of almost equal LVH regression, the positive dynamics of ΔE/A and ΔE/E´ were more in patients with IHD than those without IHD (64.4% and 54.1% vs 39.8 and 23.2%, respectively; P<0.05 for both comparisons). Adverse reactions were in 2 (6.5%) patients without IHD and 3 (10%) with IHD (P=NS). In the group with IHD, we noted significant decrease in angina episode rate - from 2.5±0.4 to 1.2±0.2 (P<0.01) per week. Conclusion: Thus, treatment based on FDC was effective in decreasing BP and TOD regression in both patients with and without IHD. However, the dynamics of changes in TOD were different between the two groups, which should be taken into consideration during management of patients with and without IHD.


Assuntos
Anlodipino/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Hipertensão/tratamento farmacológico , Isquemia Miocárdica/complicações , Perindopril/uso terapêutico , Adulto , Anlodipino/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Bloqueadores dos Canais de Cálcio/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Perindopril/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ucrânia
20.
Cardiol Young ; 28(10): 1160-1161, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30081969

RESUMO

Hydatid disease is a zoonotic parasitic infection endemic in livestock-raising countries. Isolated cardiac hydatid cyst is a very rare disease, and chest pain, palpitations, cough, and dyspnoea are the most common presenting symptoms. Here a case of isolated cardiac hydatid cyst in a female patient with chest pain and electrocardiographic changes mimicking myocardial ischaemia is presented.


Assuntos
Anticorpos Anti-Helmínticos/análise , Procedimentos Cirúrgicos Cardíacos/métodos , Equinococose/diagnóstico , Echinococcus granulosus/imunologia , Cardiopatias/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico , Animais , Criança , Diagnóstico Diferencial , Equinococose/cirurgia , Ecocardiografia , Eletrocardiografia , Feminino , Cardiopatias/parasitologia , Cardiopatias/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Tomografia Computadorizada por Raios X
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