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1.
Am J Case Rep ; 21: e925771, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32699203

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) has been increasing all over the world. During the pandemic, a variety of presentations have been described. Nevertheless, some patients remain asymptomatic. Respiratory symptoms and gastrointestinal symptoms are often reported among these patients. CASE REPORT Here, we report a case with flank pain. Radiological images were significant for bilateral consolidation, which raised a high suspicion of COVID-19. Hence, on further investigation, he was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CONCLUSIONS In the time of the COVID-19 pandemic, patients with multiple comorbidities may present atypically. Flank pain, which is not a usual presentation, may raise the suspicion of COVID-19 infection.


Assuntos
Betacoronavirus , Pressão Sanguínea/fisiologia , Infecções por Coronavirus/complicações , Hipertensão/complicações , Isquemia Miocárdica/complicações , Dor/etiologia , Pneumonia Viral/complicações , Idoso , Comorbidade , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Humanos , Hipertensão/diagnóstico , Masculino , Isquemia Miocárdica/diagnóstico , Dor/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico
2.
JAMA ; 324(3): 279-290, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32692391

RESUMO

Importance: Perioperative cardiovascular complications occur in 3% of hospitalizations for noncardiac surgery in the US. This review summarizes evidence regarding cardiovascular risk assessment prior to noncardiac surgery. Observations: Preoperative cardiovascular risk assessment requires a focused history and physical examination to identify signs and symptoms of ischemic heart disease, heart failure, and severe valvular disease. Risk calculators, such as the Revised Cardiac Risk Index, identify individuals with low risk (<1%) and higher risk (≥1%) for perioperative major adverse cardiovascular events during the surgical hospital admission or within 30 days of surgery. Cardiovascular testing is rarely indicated in patients at low risk for major adverse cardiovascular events. Stress testing may be considered in patients at higher risk (determined by the inability to climb ≥2 flights of stairs, which is <4 metabolic equivalent tasks) if the results from the testing would change the perioperative medical, anesthesia, or surgical approaches. Routine coronary revascularization does not reduce perioperative risk and should not be performed without specific indications independent of planned surgery. Routine perioperative use of low-dose aspirin (100 mg/d) does not decrease cardiovascular events but does increase surgical bleeding. Statins are associated with fewer postoperative cardiovascular complications and lower mortality (1.8% vs 2.3% without statin use; P < .001) in observational studies, and should be considered preoperatively in patients with atherosclerotic cardiovascular disease undergoing vascular surgery. High-dose ß-blockers (eg, 100 mg of metoprolol succinate) administered 2 to 4 hours prior to surgery are associated with a higher risk of stroke (1.0% vs 0.5% without ß-blocker use; P = .005) and mortality (3.1% vs 2.3% without ß-blocker use; P = .03) and should not be routinely used. There is a greater risk of perioperative myocardial infarction and major adverse cardiovascular events in adults aged 75 years or older (9.5% vs 4.8% for younger adults; P < .001) and in patients with coronary stents (8.9% vs 1.5% for those without stents; P < .001) and these patients warrant careful preoperative consideration. Conclusions and Relevance: Comprehensive history, physical examination, and assessment of functional capacity during daily life should be performed prior to noncardiac surgery to assess cardiovascular risk. Cardiovascular testing is rarely indicated in patients with a low risk of major adverse cardiovascular events, but may be useful in patients with poor functional capacity (<4 metabolic equivalent tasks) undergoing high-risk surgery if test results would change therapy independent of the planned surgery. Perioperative medical therapy should be prescribed based on patient-specific risk.


Assuntos
Doenças Cardiovasculares/etiologia , Complicações Pós-Operatórias/etiologia , Medição de Risco/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Fatores Etários , Idoso , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Aspirina/administração & dosagem , Aspirina/efeitos adversos , Biomarcadores/sangue , Angiografia Coronária , Ecocardiografia Transesofagiana , Eletrocardiografia/métodos , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Insuficiência Cardíaca/diagnóstico , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Isquemia Miocárdica/diagnóstico , Revascularização Miocárdica , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Stents/efeitos adversos , Acidente Vascular Cerebral/induzido quimicamente , Fatores de Tempo , Estados Unidos/epidemiologia
3.
Angiology ; 71(8): 726-733, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32551954

RESUMO

Vascular function in dilated cardiomyopathy of different etiology has been poorly investigated. Moreover, reference values of flow-mediated dilation (FMD) in chronic heart failure (CHF) need to be updated according to the new standardized protocols. We characterized the vascular impairment in different stages of post-ischemic dilated cardiomyopathy (PI-DC) or idiopathic dilated cardiomyopathy (I-DC). Eighty consecutive outpatients with CHF in different New York Heart Association (NYHA) classes (45 PI-DC, 35 I-DC) and 50 control subjects underwent FMD and brachial distensibility coefficient measurement. Patients with CHF showed a marked impairment in FMD compared with controls that worsened from classes NYHA I-II to III-IV, independently of etiology (P < .05). New York Heart Association I-II PI-DC patients showed a worse FMD compared with NYHA I-II I-DC patients (P < .05). Brachial distensibility coefficient values were significantly lower in patients with CHF compared with controls (P < .001) without differences between PI-DC and I-DC. In conclusion, advanced CHF is characterized by vascular impairment that is independent of etiology. In the early stages of CHF, endothelial dysfunction is more severe in patients with PI-DC compared with I-DC probably due to the high cardiovascular risk profile. In I-DC, vascular function impairment is independent of cardiovascular risk factors and could participate in the pathogenesis of I-DC.


Assuntos
Artéria Braquial/fisiopatologia , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/fisiopatologia , Isquemia Miocárdica/complicações , Rigidez Vascular , Vasodilatação , Idoso , Artéria Braquial/diagnóstico por imagem , Cardiomiopatia Dilatada/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Prognóstico , Medição de Risco , Fatores de Risco
4.
Clin Res Hepatol Gastroenterol ; 44(4): e72-e76, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32505730

RESUMO

The COVID-19 outbreak has become a pandemic that is threatening global health. The typical clinical manifestations were fever, cough, dyspnea, and myalgia or fatigue. Digestive symptoms such as nausea, vomiting, diarrhea, abdominal pain usually accompany respiratory symptoms. However gastrointestinal bleeding as the first symptom is not reported. Here we reported a case of COVID-19 with gastrointestinal bleeding as the initial symptom to the emergency department with a real-time reverse transcriptase polymerase chain reaction test positive, and normal thorax tomography. The case demonstrate that; clinicians should be alerted to patients about COVID-19 when referring to atypical symptoms and every patient undergoing endoscopy should be considered potentially infected or can infect others.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Hemorragia Gastrointestinal/etiologia , Pneumonia Viral/complicações , Infecções por Coronavirus/diagnóstico , Diarreia/etiologia , Eletrocardiografia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Melena/diagnóstico , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real , Taquicardia Sinusal/diagnóstico
5.
Int J Cardiovasc Imaging ; 36(10): 2063-2071, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32495064

RESUMO

To compare the left ventricular (LV) phase dyssynchrony parameters obtained from Tc-99m Sestamibi SPECT (GSPECT) and F-18 FDG PET(GPET), as well as the prognostic values in patients with ischemic cardiomyopathy (ICM). Consecutive ICM patients referred for myocardial viability assessment were retrospectively evaluated and were followed-up for 21 ± 5 months. Phase parameter from both GSPECT and GPET were analyzed by QGS software, including histogram bandwidth (BW), standard deviation (SD) and entropy. Independent predictor for cardiac death was analyzed by Cox regression analysis. The estimated cardiac survival curve was analyzed by and was compared with the log-rank test. Eight-eight (mean age 56 ± 10, male 94%, LVEFSPECT23 ± 10%) ICM patients were included for analysis. Moderate correlations were observed for BW (r = 0.65; p < 0.001), SD (r = 0.63; p < 0.001) and entropy (r = 0.73; p < 0.001) between GSPECT and GPET. Among all covariates, the extent of myocardial scar was significantly associated with the differences of SD (r = 0.22; p < 0.05) and entropy (r = - 0.7; p < 0.05), whereas the extent of myocardial viability was not (all p > 0.05). Entropy measured by GSPECT was the predictor for cardiac death (p = 0.037) while QRS duration was not. The cardiac survival of patients with a high entropy (≥ 59%) was significantly lower than that of patients with low entropy (< 59%) (p < 0.05). GSPECT and GPET-derived phase parameters were not interchangeable in ICM patients. Patients with LV dyssynchrony measured by gated SPECT were associated with a worse outcome.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Isquemia Miocárdica/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Tecnécio Tc 99m Sestamibi/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Cardiomiopatias/etiologia , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia
6.
Cesk Patol ; 56(1): 13-17, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32393041

RESUMO

Several changes have occurred during last few years in diagnostics and treatment of the ischemic heart disease, especially due to introduction of so called high-sensitive troponins, implementation of new antiplatelet drugs, using of drug-eluting stents in percutaneous coronary interventions or novel definitions of acute myocardial infarction types. The European Society of Cardiology and Czech Society of Cardiology established new recommendations for management of both acute and chronic forms of the ischemic heart disease. Recently discovered inhibitors of the PCSK9 molecule that have been slowly introduced in the clinical practice represent a breakthrough in the treatment of dyslipidemia. Future research will certainly aim at detection of early forms of the atherosclerotic involvement of the coronary arteries.


Assuntos
Isquemia Miocárdica , Humanos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/genética , Pró-Proteína Convertase 9/efeitos dos fármacos
8.
J Stroke Cerebrovasc Dis ; 29(6): 104790, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32280001

RESUMO

BACKGROUND: Stroke awareness is known to influence treatment seeking and risk reduction behavior, but there is limited data from Sri Lanka and South Asia. AIM: To describe stroke awareness in incident stroke patients and to compare with patients without stroke and/or ischemic heart disease (IHD) in a Sri Lankan tertiary-care center. METHODS: We studied awareness of stroke in all incident stroke patients admitted to a tertiary-care center in Sri Lanka and compared with a group of age- and sex-matched patients without stroke and/or IHD, over 2 years. Knowledge on stroke mechanisms, risk factors, symptoms, prognosis, treatment, and prevention were evaluated using a 40-item interviewer-administered questionnaire and converted to a composite score of 100%. Total awareness was categorized as Very poor (<24%), Poor (25%-49%), Good (50%-74%), and Very good (>74%). RESULTS: One hundred and sixty four incident stroke patients (mean age 62.0 ± 11.5 years; 64.6% males) and 164 patients without stroke and/or IHD were studied. Mean stroke awareness was 47.79% ± 14.6 in stroke patients, and 47.73% ± 14.9 in the nonstroke and/or IHD patients (P = .95). Of the associations studied, better stroke awareness (>50%) was associated only with higher education levels (OR 1.90, 95%CI 1.33-2.72, P < .001) in stroke patients. CONCLUSIONS: Stroke awareness is not satisfactory in incident stroke patients and is no better than in patients without stroke and/or IHD. Better stroke awareness was associated with higher education levels.


Assuntos
Conscientização , Conhecimentos, Atitudes e Prática em Saúde , Isquemia Miocárdica , Educação de Pacientes como Assunto , Acidente Vascular Cerebral , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Sri Lanka/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Centros de Atenção Terciária
9.
Arq Bras Cardiol ; 114(2): 256-264, 2020 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32215494

RESUMO

BACKGROUND: The Instantaneous Wave-Free Ratio (iFR) is an invasive functional evaluation method that does not require vasoactive drugs to induce maximum hyperemia. OBJECTIVE: To evaluate the contribution of the iFR to the therapeutic decision-making of coronary lesions in the absence of non-invasive diagnostic methods for ischemia, or in case of discordance between these methods and coronary angiography. METHOD: We studied patients older than 18 years, of both sexes, consecutively referred for percutaneous treatment between May 2014 and March 2018. Coronary stenotic lesions were classified by visual estimation of the stenosis diameter into moderate (41-70% stenosis) or severe (71%-90%). An iFR ≤ 0.89 was considered positive for ischemia. Logistic regression was performed using the elastic net, with placement of stents as outcome variable, and age, sex, arterial hypertension, diabetes, dyslipidemia, smoking, family history, obesity and acute myocardial infarction (AMI) as independent variables. Classification trees, ROC curves, and Box Plot graphs were constructed using the R software. A p-value < 0.05 was considered statistically significant. RESULTS: Fifty-two patients with 96 stenotic lesions (56 moderate, 40 severe) were evaluated. The iFR cut-off point of 0.87 showed a sensitivity of 0.57 and 1-specificity of 0.88, demonstrating high accuracy in reclassifying the lesions. Diabetes mellitus, dyslipidemia, and presence of moderate lesions with an iFR < 0.87 were predictors of stent implantation. Stents were used in 32% of lesions in patients with stable coronary artery disease and AMI with or without ST elevation (non-culprit lesions). CONCLUSION: The iFR has an additional value to the therapeutic decision making in moderate and severe coronary stenotic lesions, by contributing to the reclassification of lesions and decreasing the need for stenting.


Assuntos
Cateterismo Cardíaco/métodos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Aterosclerose/fisiopatologia , Tomada de Decisão Clínica , Angiografia Coronária/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Stents
10.
Open Heart ; 7(1): e001155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32076562

RESUMO

Objective: Catheter ablation is an important treatment for ventricular tachycardia (VT) that reduces the frequency of episodes of VT. We sought to evaluate the cost-effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy. Methods: A decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy and an implantable cardioverter-defibrillator. The health states and input parameters of the model were informed by patient-reported health-related quality of life (HRQL) data using randomised clinical trial (RCT)-level evidence wherever possible. Costs were calculated from a 2018 UK perspective. Results: Catheter ablation versus AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144 150 (€161 448) per quality-adjusted life-year gained, over a 5-year time horizon. This ICER was driven by small differences in patient-reported HRQL between AAD therapy and catheter ablation. However, only three of six RCTs had measured patient-reported HRQL, and when this was done, it was assessed infrequently. Using probabilistic sensitivity analyses, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness-to-pay threshold of £30 000 used by the UK's National Institute for Health and Care Excellence. Conclusion: Catheter ablation of VT is unlikely to be cost-effective compared with AAD therapy based on the current randomised trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessments are needed to provide more robust and informed cost-effectiveness analyses.


Assuntos
Antiarrítmicos/economia , Antiarrítmicos/uso terapêutico , Cardiomiopatias/complicações , Ablação por Cateter/economia , Custos de Cuidados de Saúde , Isquemia Miocárdica/complicações , Taquicardia Ventricular/economia , Taquicardia Ventricular/terapia , Idoso , Antiarrítmicos/efeitos adversos , Cardiomiopatias/diagnóstico , Cardiomiopatias/economia , Cardiomiopatias/terapia , Ablação por Cateter/efeitos adversos , Análise Custo-Benefício , Desfibriladores Implantáveis/economia , Custos de Medicamentos , Cardioversão Elétrica/economia , Cardioversão Elétrica/instrumentação , Medicina Baseada em Evidências/economia , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/economia , Isquemia Miocárdica/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Resultado do Tratamento
11.
Cardiovasc Res ; 116(4): 741-755, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32034397

RESUMO

Although myocardial ischaemia usually manifests as a consequence of atherosclerosis-dependent obstructive epicardial coronary artery disease, a significant percentage of patients suffer ischaemic events in the absence of epicardial coronary artery obstruction. Experimental and clinical evidence highlight the abnormalities of the coronary microcirculation as a main cause of myocardial ischaemia in patients with 'normal or near normal' coronary arteries on angiography. Coronary microvascular disturbances have been associated with early stages of atherosclerosis even prior to any angiographic evidence of epicardial coronary stenosis, as well as to other cardiac pathologies such as myocardial hypertrophy and heart failure. The main objectives of the manuscript are (i) to provide updated evidence in our current understanding of the pathophysiological consequences of microvascular dysfunction in the heart; (ii) to report on the current knowledge on the relevance of cardiovascular risk factors and comorbid conditions for microcirculatory dysfunction; and (iii) to evidence the relevance of the clinical consequences of microvascular dysfunction. Highlighting the clinical importance of coronary microvascular dysfunction will open the field for research and the development of novel strategies for intervention will encourage early detection of subclinical disease and will help in the stratification of cardiovascular risk in agreement with the new concept of precision medicine.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Circulação Coronária , Vasos Coronários/fisiopatologia , Microcirculação , Microvasos/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Animais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Consenso , Feminino , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Prognóstico , Fatores de Risco , Fatores Sexuais
12.
Cardiovasc Res ; 116(4): 856-870, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32087007

RESUMO

Contemporary data indicate that patients with signs and symptoms of ischaemia and non-obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD) with elevated risk for adverse outcomes. Coronary endothelial (constriction with acetylcholine) and/or microvascular (limited coronary flow reserve with adenosine) dysfunction are well-documented, and extensive non-obstructive atherosclerosis is often present. Despite these data, patients with INOCA currently remain under-treated, in part, because existing management guidelines do not address this large, mostly female population due to the absence of evidence-based data. Relatively small sample-sized, short-term pilot studies of symptomatic mostly women, with INOCA, using intense medical therapies targeting endothelial, microvascular, and/or atherosclerosis mechanisms suggest symptom, ischaemia, and coronary vascular functional improvement, however, randomized, controlled outcome trials testing treatment strategies have not been completed. We review evidence regarding CMD pharmacotherapy. Potent statins in combination with angiotensin-converting enzyme inhibitor (ACE-I) or receptor blockers if intolerant, at maximally tolerated doses appear to improve angina, stress testing, myocardial perfusion, coronary endothelial function, and microvascular function. The Coronary Microvascular Angina trial supports invasive diagnostic testing with stratified therapy as an approach to improve symptoms and quality of life. The WARRIOR trial is testing intense medical therapy of high-intensity statin, maximally tolerated ACE-I plus aspirin on longer-term outcomes to provide evidence for guidelines. Novel treatments and those under development appear promising as the basis for future trial planning.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/efeitos dos fármacos , Microcirculação/efeitos dos fármacos , Microvasos/efeitos dos fármacos , Isquemia Miocárdica/tratamento farmacológico , Animais , Fármacos Cardiovasculares/efeitos adversos , Tomada de Decisão Clínica , Vasos Coronários/fisiopatologia , Sistemas de Apoio a Decisões Clínicas , Técnicas de Apoio para a Decisão , Humanos , Microvasos/fisiopatologia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Resultado do Tratamento
13.
BMC Cardiovasc Disord ; 20(1): 87, 2020 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-32087693

RESUMO

BACKGROUND: The purpose of this study was to confirm that inequalities in community-level social economic status (SES) do actually impact the incidence of ischemic heart disease (IHD) using the Korean population-based cohort study of the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database. METHODS: This study used the NHIS-NSC database, a population-based cohort database established by the NHIS in South Korea. Community-level SES was classified into three categories, i.e. low, moderate, and high, according to the rank. The outcome measure of interest was IHD, which was defined according to the International Classification of Disease, 10th Revision (ICD-10) codes. RESULTS: In the low community-level SES group, the incidence of IHD was 3.56 per 1000 person years (cumulative incidence rate, 1.78%), and in the high community level SES group, it was 3.13 per 1000 person years (cumulative incidence rate, 1.57%). Multivariate analysis showed that the incidence of IHD was higher in the low community-level SES group (p = 0.029). The log-rank test showed that the cumulative incidence of IHD was higher in the low community level SES group than the high community-level SES group (adjusted hazard ratio, 1.16; 95% CI, 1.01-1.32). CONCLUSIONS: People living in areas with low community-level SES show an increased incidence of IHD. Therefore, intervention in active, health-risk behavior corrections at the local level will be required to reduce the incidence of IHD.


Assuntos
Isquemia Miocárdica/epidemiologia , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Adulto Jovem
14.
Cardiovasc Drugs Ther ; 34(1): 133-137, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32034645

RESUMO

PURPOSE: Although physical inactivity (PI) is universally considered a major risk factor for cardiovascular disorders, no previous study has investigated its putative contribution on the societal and healthcare burden of ischemic heart disease (IHD). Therefore, we aimed to provide an objective assessment of the worldwide epidemiology of PI-related IHD. METHODS: An electronic search was performed in the Global Health Data Exchange (GHDx) registry, a large database of health-related data, for assessing the worldwide epidemiology of PI-related IHD. RESULTS: The current burden of PI-related disability-adjusted life years (DALYs) and deaths caused by IHD is 9.1% (15.42 out of 170.27 million DALYs) and 9.9% (5.46 out of 55.14 million deaths), respectively. Women have a ~ 14% higher risk of both PI-related DALYs and mortality. The impact of PI on IHD remains stable around 7% up to the middle age, then gradually increases in parallel with aging, up to over 11%. A ~ 20% higher risk of PI-related DALYs and mortality caused by IHD can be found in countries with middle-to-high socio-demographic index (SDI) compared with countries with lower SDIs. In multivariable analysis, PI-related DALYs and mortality caused by IHD were significantly predicted by female sex, advanced age, and higher SDI. CONCLUSIONS: The results of our analysis suggest that reinforced efforts shall be prioritized and scaled up for broadening and ameliorating the application of physical activity recommendations in populations more vulnerable to the risk of PI-related IHD.


Assuntos
Exercício Físico , Saúde Global , Isquemia Miocárdica/epidemiologia , Comportamento Sedentário , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Sistema de Registros , Fatores de Risco , Fatores Sexuais , Determinantes Sociais da Saúde , Fatores de Tempo
16.
Ann Intern Med ; 172(3): 175-185, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-31905377

RESUMO

Background: The optimal noninvasive method for surveillance in symptomatic patients with stable coronary artery disease (CAD) is unknown. Objective: To apply a novel approach using very low concentrations of high-sensitivity cardiac troponin I (hs-cTnI) for exclusion of inducible myocardial ischemia in symptomatic patients with CAD. Design: Prospective diagnostic cohort study. (ClinicalTrials.gov: NCT01838148). Setting: University hospital. Patients: 1896 consecutive patients with CAD referred with symptoms possibly related to inducible myocardial ischemia. Measurements: Presence of inducible myocardial ischemia was adjudicated using myocardial perfusion imaging with single-photon emission computed tomography, as well as coronary angiography and fractional flow reserve measurements where available. Staff blinded to adjudication measured circulating hs-cTn concentrations. An hs-cTnI cutoff of 2.5 ng/L, derived previously in mostly asymptomatic patients with CAD, was assessed. Predefined target performance criteria were at least 90% negative predictive value (NPV) and at least 90% sensitivity for exclusion of inducible myocardial ischemia. Sensitivity analyses were based on measurements with an hs-cTnT assay and an alternative hs-cTnI assay with even higher analytic sensitivity (limit of detection, 0.1 ng/L). Results: Overall, 865 patients (46%) had inducible myocardial ischemia. The hs-cTnI cutoff of 2.5 ng/L provided an NPV of 70% (95% CI, 64% to 75%) and a sensitivity of 90% (CI, 88% to 92%) for exclusion of inducible myocardial ischemia. No hs-cTnI cutoff reached both performance characteristics predefined as targets. Similarly, using the alternative assays for hs-cTnI or hs-cTnT, no cutoff achieved the target performance: hs-cTnT concentrations less than 5 ng/L yielded an NPV of 66% (CI, 59% to 72%), and hs-cTnI concentrations less than 2 ng/L yielded an NPV of 68% (CI, 62% to 74%). Limitation: Data were generated in a large single-center diagnostic study using central adjudication. Conclusion: In symptomatic patients with CAD, very low hs-cTn concentrations, including hs-cTnI concentrations less than 2.5 ng/L, do not generally allow users to safely exclude inducible myocardial ischemia. Primary Funding Source: European Union, Swiss National Science Foundation, Kommission für Technologie und Innovation (Innosuisse), Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University of Basel, University Hospital Basel, Roche, Abbott, and Singulex.


Assuntos
Doença da Artéria Coronariana/sangue , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Troponina I/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Estudos de Coortes , Angiografia Coronária , Feminino , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Valor Preditivo dos Testes , Tomografia Computadorizada de Emissão de Fóton Único
17.
Eur J Cancer ; 126: 65-73, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31923729

RESUMO

INTRODUCTION: T-DM1 has been approved for the treatment of HER2+ breast cancer. Cardiac dysfunction is a side effect of trastuzumab, a component of T-DM1. However, little is known about T-DM1-associated cardiotoxicity. METHODS: We have conducted a pooled analysis of T-DM1 trials in advanced HER2+ breast cancer cases to understand the incidence, clinical presentation as well as to establish possible risk factors for T-DM1-associated cardiotoxicity. The primary endpoint was the incidence of cardiac events (CEs). CEs were categorized as follows: (1) congestive heart failure (CHF) or grade 3/4 LVEF drop; (2) cardiac ischemia, (3) cardiac arrhythmia, (4) grade 1/2 LVEF drop. Secondary endpoints included CE recovery rate and impact of CEs on treatment discontinuation. Logistic regression was used to assess possible risk factors for CEs. RESULTS: Individual patient-level data from 1961 patients exposed to T-DM1 in seven trials were pooled. Of these, 1544 received T-DM1 and 417 T-DM1 + pertuzumab. CHF/LVEF drop grade 3/4 was reported in 0.71%, cardiac ischemia in 0.1%, cardiac arrhythmia in 0.71% and grade 1/2 LVEF drop in 2.04%. The total CE rate was 3.37% (95% confidence interval (CI), 2.6%-4.3%). Multivariate analysis showed patient's age ≥65 (OR 3.0; 95% CI, 1.77-5.14; P-value <0.001) and baseline LVEF<55% (OR 2.62; 95% CI, 1.29-5.32; P-value 0.008) as risk factors. CEs resolved in most (79%) patients after treatment discontinuation. CONCLUSION: The incidence of CEs in patients receiving T-DM1 was low. Older patients receiving T-DM1 should be carefully followed for cardiac safety during treatment.


Assuntos
Ado-Trastuzumab Emtansina/efeitos adversos , Arritmias Cardíacas/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Insuficiência Cardíaca/diagnóstico , Isquemia Miocárdica/diagnóstico , Ado-Trastuzumab Emtansina/uso terapêutico , Idoso , Antineoplásicos Imunológicos/efeitos adversos , Antineoplásicos Imunológicos/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Neoplasias da Mama/metabolismo , Cardiotoxicidade/diagnóstico , Cardiotoxicidade/etiologia , Cardiotoxicidade/fisiopatologia , Ensaios Clínicos Fase II como Assunto/métodos , Ensaios Clínicos Fase II como Assunto/estatística & dados numéricos , Ensaios Clínicos Fase III como Assunto/métodos , Ensaios Clínicos Fase III como Assunto/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/induzido quimicamente , Humanos , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto/métodos , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Isquemia Miocárdica/induzido quimicamente , Receptor ErbB-2/metabolismo
18.
Anesthesiology ; 132(2): 291-306, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31939844

RESUMO

BACKGROUND: Arterial pressure is a complex signal that can be characterized by systolic, mean, and diastolic components, along with pulse pressure (difference between systolic and diastolic pressures). The authors separately evaluated the strength of associations among intraoperative pressure components with myocardial and kidney injury after noncardiac surgery. METHODS: The authors included 23,140 noncardiac surgery patients at Cleveland Clinic who had blood pressure recorded at 1-min intervals from radial arterial catheters. The authors used univariable smoothing and multivariable logistic regression to estimate probabilities of each outcome as function of patients' lowest pressure for a cumulative 5 min for each component, comparing discriminative ability using C-statistics. The authors further assessed the association between outcomes and both area and minutes under derived thresholds corresponding to the beginning of increased risk for the average patient. RESULTS: Out of 23,140 patients analyzed, myocardial injury occurred in 6.1% and acute kidney injury in 8.2%. Based on the lowest patient blood pressure experienced for greater than or equal to 5 min, estimated thresholds below which the odds of myocardial or kidney injury progressively increased (slope P < 0.001) were 90 mmHg for systolic, 65 mmHg for mean, 50 mmHg for diastolic, and 35 mmHg for pulse pressure. Weak discriminative ability was noted between the pressure components, with univariable C-statistics ranging from 0.55 to 0.59. Area under the curve in the highest (deepest) quartile of exposure below the respective thresholds had significantly higher odds of myocardial injury after noncardiac surgery and acute kidney injury compared to no exposure for systolic, mean, and pulse pressure (all P < 0.001), but not diastolic, after adjusting for confounding. CONCLUSIONS: Systolic, mean, and pulse pressure hypotension were comparable in their strength of association with myocardial and renal injury. In contrast, the relationship with diastolic pressure was poor. Baseline factors were much more strongly associated with myocardial and renal injury than intraoperative blood pressure, but pressure differs in being modifiable.


Assuntos
Lesão Renal Aguda/fisiopatologia , Pressão Sanguínea/fisiologia , Monitorização Intraoperatória/métodos , Isquemia Miocárdica/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Arterial/fisiologia , Determinação da Pressão Arterial/métodos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
19.
Int J Clin Pract ; 74(5): e13473, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31909853

RESUMO

AIMS OF THE STUDY: Familial Mediterranean fever (FMF) is a hereditary, auto-inflammatory disease, characterised by recurrent, self-limiting attacks of fever with inflammation of the serosal membranes, joints, and skin. Chronic inflammation was previously associated with increased risk for ischaemic heart disease (IHD). However, the association between FMF and IHD remains unclear. The objective of this study is to determine whether this association exists. METHODS: Utilising the database of the largest health-care provider in Israel, a cross-sectional study was performed. The incidence of IHD was compared between patients diagnosed with FMF and age and sex-matched controls. Chi-square and t-test were used for categorial and continuous variables, and cox logistics regression model was used for multivariate analysis. Survival analysis was made using Kaplan-Meier plots and log-rank test. RESULTS: The study included 7670 patients diagnosed with FMF and an equal number of controls without FMF. In a univariate analysis FMF was found to be associated with higher prevalence of IHD (OR 1.33) and increased mortality (OR 1.29). In a multivariate analysis FMF was found to be independently associated with increased risk for IHD (OR 1.44). CONCLUSION: The study shows that FMF is associated with both increased risk for IHD and higher mortality rates. An early diagnosis and treatment of this disease can potentially improve patients' life expectancy and decrease cardiac comorbidities.


Assuntos
Bases de Dados Factuais , Febre Familiar do Mediterrâneo/mortalidade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/mortalidade , Adulto , Fatores Etários , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Febre Familiar do Mediterrâneo/diagnóstico , Feminino , Humanos , Incidência , Inflamação/mortalidade , Israel/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Prevalência
20.
Rev Esp Salud Publica ; 942020 Jan 07.
Artigo em Espanhol | MEDLINE | ID: mdl-31907346

RESUMO

OBJECTIVE: Cardiovascular disease is the first cause of death in Spain. There are a few studies about the incidence of ischemic heart disease and cerebrovascular disease in workers. The objectives of this study were to determine the incidence of coronary and cerebrovascular disease in a cohort of workers of a public administration in the south of Spain, to estimate the prevalence of CVRF and its contribution to it, as well as to evaluate the predictive behavior of the REGICOR function. METHODS: Longitudinal historical cohort study, not concurrent, consisting of 698 workers, recruited from occupational health examinations. The dependent variables were the appearance of CI or CVD while leading independent were glucose, cholesterol, triglycerides, BMI, blood pressure, waist circumference, physical activity, smoking and REGICOR score and Score. Is performed Cox regression and its calculated area AUC of the ROC curve area for the explanatory variables. RESULTS: According to the REGICOR function, 0.6% of the population was classified as high risk. The Incidence Density per 100,000 persons-year for ischemic heart disease in women was found to be 53.9 by 357.4 in men, without significant differences with respect to those expected from the REGICOR function. The combined DI for ischemic heart disease and stroke was 477.1 per 100,000 person-years (men). CONCLUSIONS: The REGICOR function adequately assesses cardiovascular risk globally, losing predictive capacity according to risk groups. Smoking and blood pressure are shown as modifiable risk factors with greater independent association in the onset of cardiovascular disease.


Assuntos
Isquemia Miocárdica/epidemiologia , Doenças Profissionais/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Regras de Decisão Clínica , Feminino , Seguimentos , Indicadores Básicos de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Doenças Profissionais/diagnóstico , Prevalência , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Acidente Vascular Cerebral/diagnóstico
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