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1.
Am J Cardiol ; 128: 202-209, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32534734

RESUMO

There are two commercially available transcatheter heart valve systems: balloon expandable valves (BEV) and self-expanding valves (SEV). However, there is a paucity of randomized trials comparing both systems. Electronic databases (Medline, the Cochrane Library, Web of Science, and clinicaltrials.gov) and major conference proceedings were searched for randomized trials of patients with symptomatic severe aortic stenosis and received transcatheter aortic valve implantation (TAVI) with a SEV or BEV or surgical aortic valve replacement. The main efficacy outcomes were all-cause mortality and stroke at the longest available follow-up. The main analysis was performed using a random-effects network meta-analysis complemented by several subgroup and sensitivity analyses. Ten trials with 9,439 patients (mostly undergoing transfemoral TAVI) were included. At a median of 27 months, there was no difference between BEV and SEV valves in terms of all-cause mortality (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.79 to 1.42). The incidence of any stroke was higher with BEV (OR 1.51, 95% CI 1.01 to 2.26), but there was no difference in the incidence of disabling stroke. At 30-days, BEV valves were associated with lower incidence of new permanent pacemaker placement (OR 0.50, 95% CI 0.32 to 0.79) and moderate/severe paravalvular regurgitation (OR 0.39, 95% CI 0.22 to 0.68). In conclusion, in patients with severe symptomatic aortic stenosis undergoing transfemoral TAVI, SEV and BEV were associated with similar all-cause mortality. BEV were associated with a higher incidence of any stroke driven by nondisabling strokes, but lower incidence of new permanent pacemaker placement and moderate/severe paravalvular regurgitation compared with SEV.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/cirurgia , Arritmias Cardíacas/epidemiologia , Estimulação Cardíaca Artificial/estatística & dados numéricos , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter/instrumentação , Arritmias Cardíacas/terapia , Causas de Morte , Humanos , Incidência , Mortalidade , Marca-Passo Artificial/estatística & dados numéricos
2.
PLoS One ; 15(6): e0233894, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479546

RESUMO

BACKGROUND: Transcatheter aortic valve-in-valve (VIV) procedure is a safe alternative to conventional reoperation for bioprosthetic dysfunction. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the 2 major types of devices used. Evidence regarding the comparison of the 2 valves remains scarce. METHODS: A systematic review and meta-analysis was conducted to compare the outcomes of BEV and SEV in transcatheter VIV for aortic bioprostheses dysfunction. A computerized search of Medline, PubMed, Embase, and Cochrane databases was performed. English-language journal articles reporting SEV or BEV outcomes of at least 10 patients were included. RESULTS: In total, 27 studies were included, with 2,269 and 1,671 patients in the BEV and SEV groups, respectively. Rates of 30-day mortality and stroke did not differ significantly between the 2 groups. However, BEV was associated with significantly lower rates of postprocedural permanent pacemaker implantation (3.8% vs. 12%; P < 0.001). Regarding echocardiographic parameters, SEV was associated with larger postprocedural effective orifice area at 30 days (1.53 cm2 vs. 1.23 cm2; P < 0.001) and 1 year (1.55 cm2 vs. 1.22 cm2; P < 0.001). CONCLUSIONS: For patients who underwent transcatheter aortic VIV, SEV was associated with larger postprocedural effective orifice area but higher rates of permanent pacemaker implantation. These findings provide valuable information for optimizing device selection for transcatheter aortic VIV.


Assuntos
Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Falha de Prótese , Substituição da Valva Aórtica Transcateter/instrumentação , Tomada de Decisão Clínica , Humanos , Marca-Passo Artificial/estatística & dados numéricos , Reoperação/instrumentação , Reoperação/métodos , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
4.
Am J Cardiol ; 126: 73-81, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32336533

RESUMO

Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (-4.0% vs -6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.


Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/tendências , Substituição da Valva Aórtica Transcateter/tendências , Lesão Renal Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/mortalidade , Bases de Dados Factuais , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/tendências , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter/mortalidade , Estados Unidos/epidemiologia
5.
PLoS One ; 15(1): e0226188, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995558

RESUMO

INTRODUCTION: The aim of our study was to perform an economic assessment in order to check whether or not telemonitoring of users with pacemakers offers a cost-effective alternative to traditional follow-up in outpatient clinics. METHODS: We used effectiveness and cost data from the NORDLAND trial, which is a controlled, randomized, non-masked clinical trial. Fifty patients were assigned to receive either telemonitoring (TM; n = 25) or conventional monitoring (CM; n = 25) and were followed up for 12 months after the implantation. A cost-utility analysis was performed in terms of additional costs per additional Quality-Adjusted Life Year (QALY) attained from the perspectives of the Norwegian National Healthcare System and patients and their caregivers. RESULTS: Effectiveness was similar between alternatives (TM: 0.7804 [CI: 0.6864 to 0.8745] vs. CM: 0.7465 [CI: 0.6543 to 0.8387]), while cost per patient was higher in the RM group, both from the Norwegian NHS perspective (TM: €2,079.84 [CI: 0.00 to 4,610.58] vs. €271.97 [CI: 158.18 to 385.76]; p = 0.147) and including the patient/family perspective (TM: €2,295.91 [CI: 0.00 to 4,843.28] vs. CM: €430.39 [CI: 0.00 to 4,841.48]), although these large differences-mainly due to a few patients being hospitalized in the TM group, as opposed to none in the CM group-did not reach statistical significance. The Incremental Cost-Effectiveness Ratio (ICER) from the Norwegian NHS perspective (€53,345.27/QALY) and including the patient/caregiver perspective (€55,046.40/QALY), as well as the Incremental Net Benefit (INB), favors the CM alternative, albeit with very broad 95%CIs. The probabilistic analysis confirmed inconclusive results due to the wide CIs even suggesting that TM was not cost-effective in this study. Supplemental analysis excluding the hospitalization costs shows positive INBs, whereby suggesting a discrete superiority of the RM alternative if hospitalization costs were not considered, albeit also with broad CIs. CONCLUSIONS: Cost-utility analysis of TM vs. CM shows inconclusive results because of broad confidence intervals with ICER and INB figures ranging from potential savings to high costs for an additional QALY, with the majority of ICERs being above the usual NHS thresholds for coverage decisions. TRIAL REGISTRATION: ClinicalTrials.gov NCT02237404.


Assuntos
Análise Custo-Benefício , Hospitais/estatística & dados numéricos , Marca-Passo Artificial/economia , Marca-Passo Artificial/estatística & dados numéricos , Qualidade de Vida , Telemedicina/economia , Telemedicina/estatística & dados numéricos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida
6.
Radiol Med ; 125(3): 329-335, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31832987

RESUMO

INTRODUCTION: The management of patients bearing a cardiac implantable electronic device and needing a radiotherapy treatment is an important clinical scenario. The aim of this survey was to evaluate the level of awareness within the Italian Radiation Oncologist community on this topic. MATERIALS AND METHODS: A survey was promoted by the Young Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) with a questionnaire made up of 22 questions allowing for multiple answers, which was administered, both online and on paper version. It was addressed to Radiation Oncologists, AIRO members, participating in the National Congress held in 2015. RESULTS: A total of 113 questionnaires were collected back and analyzed (survey online: 50 respondents; paper version: 63). The answers showed a good level of awareness on the issue, but with a nonhomogeneous adherence to the different published guidelines (GL). There is a general low rate of referral for a preliminary cardiological evaluation in patients bearing PM/ICDs, in line with some published surveys; nevertheless, a focused attention to certain specific treatment factors and patient-centered point of view emerged. CONCLUSIONS: A generally good awareness of this topic was shown but homogeneous application of GL was not observed, possibly due to the multiplicity of available GL. A prospective data collection could help to better clarify the shadows on this topics.


Assuntos
Desfibriladores Implantáveis , Fidelidade a Diretrizes , Marca-Passo Artificial , Radioterapia (Especialidade) , Radioterapia , Adulto , Desfibriladores Implantáveis/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Itália , Marca-Passo Artificial/estatística & dados numéricos , Doses de Radiação , Radioterapia (Especialidade)/estatística & dados numéricos , Sociedades Médicas
7.
Am Heart J ; 218: 128-132, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806088

RESUMO

New-onset left bundle branch block (N-LBBB) after transcatheter aortic valve replacement (TAVR) is a challenging clinical dilemma. In our single-center study, 60 out of 172 patients who underwent permanent pacemaker implantation (PPM) after TAVR had N-LBBB (34.9%). At a median follow-up duration of 357 days (IQR, 178; 560 days), two patients (3.5%) were completely pacemaker-dependent, and four others (7%) were partially dependent. Twelve patients (24%) recovered conduction in their left bundle at a median follow-up duration of 5 weeks (IQR, 4; 14 weeks). Due to the lack of clinical predictors of pacemaker dependency, active surveillance is warranted and may be an alternative to permanent pacemaker implantation.


Assuntos
Bloqueio de Ramo/terapia , Marca-Passo Artificial , Complicações Pós-Operatórias/terapia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Implantação de Prótese/estatística & dados numéricos , Recuperação de Função Fisiológica , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Resultado do Tratamento
8.
J Interv Cardiol ; 2019: 1906814, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772515

RESUMO

Objectives: The purpose of this study was to compare the efficacy and safety of the Evolut PRO to the Evolut R valve in a real-world setting. Background: The next-generation self-expanding transcatheter aortic valve replacement (TAVR) system, the CoreValve Evolut PRO was designed with an outer pericardial skirt to improve valve-sealing performance. Safety and efficacy of this valve have not previously been compared to its predecessor, the Evolut R valve. Methods: We retrospectively studied 134 patients who underwent TAVR with the Evolut PRO or Evolut R valve over one year at a tertiary center. Endpoints, defined by the Valve Academic Research Consortium-2 criteria, included device success, paravalvular leak (PVL), and a composite safety endpoint including mortality, stroke, major vascular complications, life-threatening bleeding, acute kidney injury, coronary artery obstruction, and repeat procedure for valve-related dysfunction. Results: 60 Evolut PRO and 56 Evolut R patients met the study criteria. Both groups had similar device success rates (90 vs. 89%, p=0.44). Incidence of moderate PVL was similar on discharge (5 vs. 11%, p=0.68) and at 30 days (11 vs. 13%, p=0.79), with nil incidence of severe PVL. There were no mortalities, and the VARC-2 safety endpoint at 30 days was comparable. Conclusion: Despite the additional pericardial skirt and larger sheath size of Evolut PRO, outcomes were comparable between the two Evolut systems, supporting adoption of the newest generation valve in the management of severe aortic stenosis as well as continued use of the Evolut R in patients with smaller vasculature warranting a lower profile device.


Assuntos
Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/instrumentação , Lesão Renal Aguda/epidemiologia , Idoso de 80 Anos ou mais , Valvuloplastia com Balão/estatística & dados numéricos , Feminino , Hemorragia/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias , Desenho de Prótese , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos
9.
J Am Coll Cardiol ; 74(21): 2607-2620, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31753204

RESUMO

BACKGROUND: Risk factors for post-operative conduction disturbances after cardiac valve surgery requiring a permanent pacemaker (PPM) are poorly characterized. OBJECTIVES: The aim of this study was to investigate the timing and risk factors for PPM implantation after mitral or aortic valve surgery. METHODS: All patients who underwent open aortic or mitral valve surgery between January 1996 and December 2014 were reviewed using New York State's mandatory hospital discharge database. Patients with prior cardiac surgery or pre-existing PPM were excluded. The primary endpoint was PPM implantation within 1 year. RESULTS: Among 77,882 patients, 63.8% (n = 49,706) underwent aortic valve replacement (AVR), 18.9% (n = 14,686) underwent mitral valve replacement (MVR), 10.5% (n = 8,219) underwent mitral valve repair (MVr), 5.4% (n = 4,202) underwent AVR plus MVR, and 1.4% (n = 1,069) underwent AVR plus MVr. The 1-year PPM implantation rate was 4.5% after MVr, 6.6% after AVR, 9.3% after AVR plus MVr, 10.5% after MVR, and 13.3% after AVR plus MVR (p < 0.001). Across all groups, the majority of PPMs were implanted during the index hospitalization (79.9%). MVr was associated with the lowest risk for PPM and AVR plus MVR with the highest risk. Older age, history of arrhythmias, pre-operative conduction disturbances, and concomitant index procedures were associated with increased risk for PPM during the index hospitalization. Conversely, beyond 30 days, chronic comorbidities were associated with increased risk for PPM. CONCLUSIONS: Conduction disturbances requiring PPM remain a common adverse event after valve surgery. Identifying patients at risk for PPM will help facilitate perioperative planning and inform clinical decision making regarding post-operative rhythm surveillance.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Valva Mitral/cirurgia , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Estudos Retrospectivos , Fatores de Risco
10.
Rev. esp. cardiol. (Ed. impr.) ; 72(11): 944-953, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190746

RESUMO

Introducción y objetivos: Se describe el resultado del análisis de los dispositivos de estimulación implantados y remitidos al Registro Español de Marcapasos en 2018. Métodos: Información que aporta la Tarjeta Europea del Paciente Portador de Marcapasos, así como los datos proporcionados por la industria sobre el número total de dispositivos implantados. Resultados: Se recibió información de 90 centros hospitalarios, con un total de 12.148 tarjetas, lo cual supone un 31% de la actividad total estimada. El consumo de generadores convencionales y de dispositivos de resincronización fue de 825 y 77 unidades por millón de habitantes respectivamente. La media de edad de los pacientes que recibieron un implante fue 78,3 años y un 54% de los dispositivos se implantaron en pacientes mayores de 80 años. El 77,1% de los procedimientos fueron primoimplantes y el 21,6%, recambios de generador. Aunque la estimulación secuencial bicameral sigue siendo mayoritaria, se utiliza menos en pacientes mayores de 80 años y en mujeres. Además, al 28% de los pacientes con enfermedad del nódulo sinusal y el 24,7% de aquellos con bloqueo auriculoventricular se los estimula en modo VVI/R pese a estar en ritmo sinusal. Conclusiones: El consumo total de generadores de marcapasos en España ha aumentado en un 1,2% con respecto al año 2017, fundamentalmente a expensas del aumento del consumo de generadores de terapia de resincronización cardiaca con marcapasos (8,7%). Los factores directamente relacionados con la elección del modo de estimulación son la edad y el sexo


Introduction and objectives: This report describes the result of the analysis of the implanted pacemakers reported to the Spanish Pacemaker Registry in 2018. Methods: The analysis is based on the information provided by the European Pacemaker Identification Card and supplier-reported data on the overall number of implanted pacemakers. Results: Information was received from 90 hospitals, with a total of 12 148 cards, representing 31% of the estimated activity. Use of conventional and resynchronization pacemakers was 825 and 77 units per million people, respectively. The mean age of the patients receiving an implant was 78.3 years, and 54% of the devices were implanted in people aged> 80 years. A total of 77.1% were first implants and 21.6% corresponded to generator exchanges. Bicameral sequential pacing was the most frequent pacing mode but was less frequently used in patients aged> 80 years and in women. Single chamber VVI/R pacing was used in 28% of patients with sick sinus syndrome and in 24.7% of those with atrioventricular block, despite being in sinus rhythm. Conclusions: The total consumption of pacemaker generators in Spain increased by 1.2% compared with 2017, mainly due to an 8.7% increase in cardiac resynchronization therapy with pacemaker generators. Selection of pacing mode was directly influenced by age and sex


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Marca-Passo Artificial/estatística & dados numéricos , Estimulação Cardíaca Artificial/métodos , Bloqueio Atrioventricular/cirurgia , Fibrilação Atrial/cirurgia , Síndrome do Nó Sinusal/cirurgia , Espanha/epidemiologia , Registros de Doenças/estatística & dados numéricos , Marca-Passo Artificial/classificação , Seleção de Pacientes , Fibrilação Atrial/epidemiologia , Bloqueio Atrioventricular/epidemiologia , Síndrome do Nó Sinusal/epidemiologia , Tecnologia sem Fio/tendências
11.
Lupus ; 28(13): 1589-1593, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31615326

RESUMO

Conduction abnormalities are uncommon in adult patients with lupus. We present a young woman with recurrent syncope caused by third-degree atrio-ventricular block as the initial manifestation of lupus and review 31 additional cases of systemic lupus erythematosus patients that have been described previously with complete heart block. Heart blocks occurred almost exclusively in females. The median age was 37 years. In 24 cases heart blocks were diagnosed in patients with established lupus. In only five patients, including the patient presented here, heart blocks were diagnosed before the lupus diagnosis. Syncope was the most common presenting symptom of heart block. Electrocardiographic findings prior to heart block episodes were reported in 17 cases: eight had normal findings, but nine had already variant forms of atrioventricular or intraventricular conduction defects. Anti-nuclear antibody tests were reported in 25 cases and were all positive. Anti-DNA antibodies were also common and were positive in 16 of 19 cases (84%). Anti-La and anti-Ro antibodies were less common (13% and 35%, respectively). Three patients died, all prior to 1975. Heart block resolved in 10 cases. Follow-up was reported in four of these cases and heart block recurred in three of them. A permanent pacemaker was the eventual treatment in 22 cases. The etiology of lupus-associated complete heart block is not clear. It is probably variable, possibly related to effects of autoantibodies reacting with the conduction system, myocardial disease and adverse effects of antimalarials. Insertion of a permanent pacemaker seems to be the preferable method of treatment.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Síncope/etiologia , Adulto , Anticorpos Antinucleares/imunologia , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Marca-Passo Artificial/estatística & dados numéricos , Recidiva , Adulto Jovem
12.
Am J Cardiol ; 124(11): 1720-1724, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31606190

RESUMO

Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (2) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up. We conducted a single-center prospective study. Consecutive patients with SAM pacemakers were comprehensively assessed. SAM automatically computes a respiratory disturbance index (RDI, apneas/hypopneas per hour - AH/h) in the previous night and the percentage of nights with RDI >20 AH/h in the previous 6 months. Thirty-seven patients were included (79.3 ± 11.2 years, 46% males). A high RDI in the previous night and a higher %nights with increased RDI were associated with increased NT-proBNP values (p = 0.008 and p = 0.013, respectively) and were the sole predictors of increased noninvasive pulmonary capillary wedge pressures (PCWP) in the morning of assessment (p = 0.031 and p = 0.044, respectively). Receiver operating characteristic curve analysis revealed an area under the curve of 0.804 (95% confidence interval 0.656 to 0.953, p = 0.002) for %nights with RDI >20 AH/h in the prediction of high PCWP. Patients with >12.5% of nights with RDI >20AH/h tended to have more ADHF during follow-up (log-rank p = 0.067). In conclusion, a high burden of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values and an increased risk of ADHF over 1 year. These patients might benefit from early tailored clinical management.


Assuntos
Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Marca-Passo Artificial/estatística & dados numéricos , Polissonografia/estatística & dados numéricos , Síndromes da Apneia do Sono/diagnóstico , Função Ventricular Esquerda/fisiologia , Doença Aguda , Idoso , Ecocardiografia , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Incidência , Masculino , Polissonografia/instrumentação , Portugal/epidemiologia , Prognóstico , Estudos Prospectivos , Curva ROC , Síndromes da Apneia do Sono/complicações , Síndromes da Apneia do Sono/fisiopatologia , Volume Sistólico/fisiologia
13.
Rev Esp Cardiol (Engl Ed) ; 72(11): 944-953, 2019 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31631049

RESUMO

INTRODUCTION AND OBJECTIVES: This report describes the result of the analysis of the implanted pacemakers reported to the Spanish Pacemaker Registry in 2018. METHODS: The analysis is based on the information provided by the European Pacemaker Identification Card and supplier-reported data on the overall number of implanted pacemakers. RESULTS: Information was received from 90 hospitals, with a total of 12 148 cards, representing 31% of the estimated activity. Use of conventional and resynchronization pacemakers was 825 and 77 units per million people, respectively. The mean age of the patients receiving an implant was 78.3 years, and 54% of the devices were implanted in people aged> 80 years. A total of 77.1% were first implants and 21.6% corresponded to generator exchanges. Bicameral sequential pacing was the most frequent pacing mode but was less frequently used in patients aged> 80 years and in women. Single chamber VVI/R pacing was used in 28% of patients with sick sinus syndrome and in 24.7% of those with atrioventricular block, despite being in sinus rhythm. CONCLUSIONS: The total consumption of pacemaker generators in Spain increased by 1.2% compared with 2017, mainly due to an 8.7% increase in cardiac resynchronization therapy with pacemaker generators. Selection of pacing mode was directly influenced by age and sex.


Assuntos
Arritmias Cardíacas/terapia , Cardiologia , Marca-Passo Artificial/estatística & dados numéricos , Sistema de Registros , Sociedades Médicas , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Espanha/epidemiologia
14.
Rev. clín. esp. (Ed. impr.) ; 219(7): 351-359, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186639

RESUMO

Antecedentes: La información sobre el autocuidado en la insuficiencia cardiaca (IC) en España es escasa. En concreto, existe la necesidad de fijar el nivel de comprensión de los pacientes sobre la IC, así como su capacidad para reconocer los signos y los síntomas de la descompensación. Pacientes y métodos: Estudio transversal para determinar el nivel de autocuidado en una población de pacientes españoles ingresados en el hospital con un diagnóstico primario de IC descompensada. Para el estudio, se reclutó una muestra de conveniencia integrada por 108 pacientes (50 mujeres y 58 hombres) con una edad de 83+/-8 años. Resultados: Para cuantificar el autocuidado en nuestra muestra se empleó el Índice de Autocuidado en Insuficiencia Cardiaca versión 6.2. La media y la desviación estándar de la subescala de mantenimiento de autocuidado del Índice de Autocuidado en Insuficiencia Cardiaca fueron: a) «ejercicio durante 30 minutos», 1+/-1; b) «olvida tomar una de sus medicinas», 2+/-2; c) «pedir productos bajos en sal cuando sale a comer o de visita», 2+/-1. En el mes previo, el 67,6% experimentó dificultad para respirar o inflamación del tobillo. Sin embargo, era improbable que la gran mayoría de nuestros pacientes implementaran de forma independiente un remedio: a) reducir sal, 2+/-1; b) reducir la ingesta de líquidos, 1+/-1; c) tomar un diurético extra, 1+/-1. Más del 50% de los pacientes de nuestra muestra se sintieron confiados o muy confiados siguiendo los consejos profesionales (3+/-1), manteniéndose libres de síntomas (3+/-1), reconociendo los cambios en su enfermedad (3+/-1) y valorando la importancia de dichos cambios (3+/-1). Conclusiones: Al comparar a nuestros pacientes con IC con los de otros países el nivel de autocuidado es significativamente bajo, especialmente en lo que se refiere a la gestión de su enfermedad. La promoción del autocuidado debería ser una prioridad para todos los profesionales de la salud involucrados en la gestión de los pacientes con IC


Background: There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients' level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. Patients and methods: Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83+/-8 were recruited to participate in this study. Results: The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) "exercise for 30 minutes", 1+/-1; b) "forget to take one of your medicines", 2+/-2; c) "ask for low-salt items when eating out or visiting others", 2+/-1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2+/-1; b) reduce fluid intake, 1+/-1; c) take an extra diuretic, 1+/-1. Over 50% of our sample felt confident or very confident at following professional advice (3+/-1), keeping themselves free of symptoms (3+/-1), recognizing changes in their condition (3+/-1) and evaluating the significance of such changes (3+/-1). Conclusions: HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Autocuidado/métodos , Insuficiência Cardíaca/complicações , Psicometria/métodos , Estudos Transversais , Exacerbação dos Sintomas , Autogestão/métodos , Hospitalização/estatística & dados numéricos , Comorbidade , Inquéritos e Questionários/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos
15.
N Z Med J ; 132(1500): 40-49, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415498

RESUMO

AIMS: The ANZACS-QI Cardiac Implanted Device Registry (ANZACS-QI DEVICE) collects data on cardiac implantable electronic devices inserted in New Zealand. We evaluated completeness of data capture and quality of ANZACS-QI DEVICE in 2016. METHODS: Complete datasets within ANZACS-QI DEVICE, comprising DEVICE-PPM (permanent pacemakers) and DEVICE-ICD (implantable cardioverter defibrillators), from 1 January 2016 to 31 December 2016 were linked with the National Hospitalisation dataset (all New Zealand public hospital admissions). The total number of implants included procedures captured in either dataset. Variables assessed included age, gender, ethnicity, procedure type, implanting centre, admission and procedure date. RESULTS: DEVICE-PPM captured 85.9% of all PPM procedures (n=2,512). This was similar regardless of age, sex and ethnicity. In the 84.4% of procedures captured in both datasets, agreement was >97% for all variables except admission date (90.1%). DEVICE-ICD captured 81.3% of all ICD procedures (n=690). Capture was similar across age, sex and ethnicity groups. In the 76.8% of procedures captured in both datasets, agreement was >96% for all variables except admission date (90.6%). CONCLUSION: The ANZACS-QI DEVICE registry had a good capture rate and excellent agreement with the national dataset. This high concordance supports the use of both datasets for future research.


Assuntos
Bases de Dados Factuais/normas , Desfibriladores Implantáveis/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Sistema de Registros/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Pesquisa Biomédica , Coleta de Dados , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia
16.
Rev. esp. cardiol. (Ed. impr.) ; 72(8): 641-648, ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-189035

RESUMO

Introducción y objetivos: Para lograr el éxito del dispositivo, se recomienda cierto sobredimensionamiento de la prótesis (SP) SAPIEN 3. Sin embargo, un aumento en el SP puede incrementar las tasas de implante de marcapasos definitivo (IMD). Por lo tanto, se investiga la influencia del SP en el fallo del dispositivo y el IMD. Métodos: Se trató con SAPIEN 3 a 804 pacientes en 3 centros. El SP, determinado mediante tomografía computarizada multicorte, se calculó y analizó como variable continua y categorizada en incrementos del 5%, con -4% a 0 como referencia. Resultados: Se produjo fallo del dispositivo en el 8,8% de los pacientes. La mediana de SP fue menor en los pacientes con fallo del dispositivo que en aquellos con éxito (el +4 frente al +8%; p=0,038). El SP mostró un patrón de riesgo no lineal, con una tasa de fallo del dispositivo significativamente reducida para valores entre el +4 y el +22%. No hubo ningún caso de fuga paravalvular II+ entre un +10 y un +20% de SP. La tasa general de IMD fue del 16,2% y la mediana de SP fue significativamente mayor en los pacientes con IMD (IMD, el +9% frente a no IMD, el +7%; p=0,025), mientras que la profundidad del implante no varió entre pacientes con y sin IMD (6,9+/-1,7 frente a 6,6+/-1,9mm; p=0,101). El riesgo de IMD aumentó con el aumento del SP y fue mayor en las 2 categorías más altas. Conclusiones: El incremento en el SP reduce el riesgo de fallo del dispositivo, pero aumenta el de IMD. No se halló un intervalo de SP ideal para minimizar los riesgos de fallo del dispositivo e IMD


Introduction and objectives: A certain degree of prosthesis oversizing (OS) is recommended for the SAPIEN 3 to achieve device success. However, an increase in OS may increase permanent pacemaker implantation (PPI) rates. We therefore investigated the influence of OS on device failure and PPI. Methods: A total of 804 patients were treated with SAPIEN 3 at 3 centers. Multislice computed tomography-derived OS was calculated and analyzed both as a continuous variable and categorized in 5% increments with −4% to 0% as reference. Results: Device failure occurred in 8.8% of patients. Median OS was lower in patients with device failure vs those with device success (+4% vs +8%; P=.038). A nonlinear risk pattern was shown for OS with a significantly reduced device failure rate within 4% to +22% of OS. There was no case of paravalvular leakage II+ between +10% to +20% of OS. The overall PPI rate was 16.2% and the median OS was significantly larger in patients with PPI (PPI: +9% vs no PPI: +7%; P = .025), while implantation depth did not vary in patients with vs without PPI (6.9+/-1.7 mm vs 6.6+/-1.9 mm; P=.101). The risk of PPI increased with increasing OS and was highest in the 2 highest categories. Conclusions: An increase in OS reduces the risk for device failure but increases the risk for PPI. There was no ideal range of OS to minimize both device failure and PPI


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Falha de Prótese/efeitos adversos , Estenose da Valva Aórtica/cirurgia , Tomografia Computadorizada Multidetectores/métodos , Fatores de Risco , Estudos Retrospectivos , Desenho de Prótese/estatística & dados numéricos
17.
Can J Cardiol ; 35(7): 866-874, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31292085

RESUMO

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is the gold standard for severe valvular aortic stenosis in patients at high/prohibitive surgical risk. This procedure has also been used in patients with previous mitral valve (MV) prostheses, with contrasting outcomes reported. The aim of this study is to describe procedural and early outcomes of patients with previous MV prostheses undergoing TAVR. METHODS: This is a retrospective registry of 154 patients with previous MV prostheses who underwent TAVR across high-volume medical centres at a mean of 11.7 ± 8.4 years after mitral surgery. RESULTS: Mean mitroaortic distance at computed tomography was 9.7 ± 4.8 mm. Procedural success was achieved in 150 (97.4%) patients, with reduction of aortic gradients (42.6 ± 14.2 to 10.0 ± 7.0 mm Hg; P < 0.001). Device success was achieved in 133 (86.3%) patients. MV prosthesis interference by the TAVR device was observed in 2 patients; in both, the mitroaortic distance was <5 mm, with 1 complicated by TAVR prosthesis embolization. Periprocedural complications included 4 (2.6%) cerebrovascular accidents, 10 (6.6%) major vascular complications, 22 (14.4%) severe bleedings, 1 (0.7%) myocardial infarction, and 5 (3.2%) in-hospital deaths (all cases cardiovascular or procedure related). At a median follow-up of 13.5 (interquartile range 1.0 to 36.0) months, 26 (16.9%) deaths occurred; 15 (9.7%) were cardiac related. Late fatal mitral prosthesis thromboses occurred in 2 patients. We recorded a case of fatal hemorrhagic stroke; hospital readmission was observed in 25 (16.2%) patients due to worsening heart failure. CONCLUSIONS: TAVR in patients with previous mitral prostheses appears to be safe and feasible, with good hemodynamic results at 30-day and at longer-term follow-up.


Assuntos
Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/cirurgia , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Marca-Passo Artificial/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Estudos Retrospectivos
18.
EuroIntervention ; 15(10): 875-883, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31217147

RESUMO

AIMS: The aims of this study were to determine the appropriateness of permanent pacemaker implantation (PPI) after TAVI through an analysis of PM dependency at follow-up, and to assess long-term outcomes of patients undergoing PPI after TAVI. METHODS AND RESULTS: From June 2007 to February 2018, 1,116 consecutive patients without prior PM underwent TAVI in our institution. We assessed the incidence and predictors of PM dependency of patients who underwent PPI within 30 days, and also the six-year outcomes among patients who did not undergo PPI at 30 days. At 30 days, PPI was reported in 145 patients (13.0%). Rates of PM dependency were 35.7%, 35.8% and 33.3% at 1, 6 and 12 months, respectively. Analysing PPI timing, implantation on day 1 was found to be a predictor of PM dependency at six months (OR 20.7 [95% CI: 3.4-126.7]; p=0.001) and 12 months (OR 7.5 [95% CI: 1.4-40.2]; p=0.019). An interaction between PM dependency and the presence of baseline right bundle branch block (RBBB) at six months (pinteraction=0.024) and 12 months (pinteraction=0.028) was reported when PPI was performed on the same day as TAVI. At six years, patients who received a PM at 30 days showed a higher all-cause death rate (KM estimate 41.7% vs 57%; plog-rank=0.034). CONCLUSIONS: Among patients receiving PPI after TAVI, PM dependency rates were about 33-36% at one year. Patients with a baseline RBBB undergoing PPI at day 0 or at day 1 when severe CDs persisted for 24 hours after TAVI, irrespective of baseline CDs, had a higher chance of being PM-dependent at follow-ups. Finally, PPI after TAVI was associated with increased six-year mortality.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter , Valva Aórtica , Humanos , Incidência , Marca-Passo Artificial/estatística & dados numéricos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos , Resultado do Tratamento
19.
Am J Cardiol ; 124(3): 416-422, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31174835

RESUMO

Peripheral vascular disease (PVD) is common in patients referred for transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of PVD on patients who underwent TAVI. Using data from the National Inpatient Sample database 2011 and 2014, we identified patients who had undergone TAVI. We studied the clinical characteristics and procedural outcomes in patients with PVD who underwent TAVI compared with those patients without PVD using propensity score matching score matching. Results: A total of 42,215 patients underwent TAVI; of which 1,388 patients were matched using propensity score matched scores to 694 in each (PVD vs no PVD) patients. The population had a mean age of 81 years old and 55.8% were of female gender. African-Americans constituted 4.3%. PVD patients who underwent TAVI were found to have higher rates of vascular complications (11.8% vs 5.9 % p <0.001) compared with non-PVD patients and tended to have higher mortality (5.5% vs 3.6%, p = 0.121) and post-TAVI bleeding (13.5% vs 12% p = 0.143). In conclusion, PVD patients have higher in-hospital mortality and higher incidence of in-hospital overall complications compared with patients who have no PVD.


Assuntos
Estenose da Valva Aórtica/cirurgia , Doenças Vasculares Periféricas/epidemiologia , Substituição da Valva Aórtica Transcateter , Lesão Renal Aguda/epidemiologia , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Análise por Pareamento , Marca-Passo Artificial/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
20.
Kardiol Pol ; 77(5): 561-567, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31066721

RESUMO

BACKGROUND: The rate of cardiac device-related infective endocarditis (CDRIE) is increasing worldwide, but no detailed data are available for Poland. AIMS: We aimed to evaluate clinical, diagnostic, and therapeutic data of patients hospitalized due to CDRIE in 22 Polish referential cardiology centers from May 1, 2016 to May 1, 2017. METHODS: Participating cardiology departments were asked to fill in a questionnaire that included data on the number of hospitalized patients, number and types of implanted cardiac electrotherapy devices, and number of infective endocarditis cases. We also collected clinical data and data regarding the management of patients with CDRIE. RESULTS: Overall, 99 621 hospitalizations were reported. Infective endocarditis unrelated to cardiac device was the cause of 596 admissions (0.6%), and CDRIE, of 195 (0.2%). Pacemaker was implanted in 91 patients with CDRIE (47%); cardioverter­defibrillator, in 51 (26%); cardiac resynchronization therapy­defibrillator, in 48 (25%); and cardiac resynchronization therapy­pacemaker, in 5 (2.5%). The most common symptoms were malaise (62%), fever/chills (61%), cough (21%), chest pain (19.5%), and inflammation of the device pocket (5.6%). Cultures were positive in 77.5% of patients. The cardiac device was removed in 91% of patients. The percutaneous approach was most common for cardiac device removal. All patients received antibiotic therapy, and 3 patients underwent a heart valve procedure. Transesophageal echocardiography was performed in 80% of patients. The most common complication was heart failure (25% of patients). CONCLUSIONS: The clinical profile, pathogen types, and management strategies in Polish patients with CDRIE are consistent with similar data from other European countries. Transesophageal echocardiography was performed less frequently than recommended. The removal rate in the Polish population is consistent with the general rates observed for interventional treatment in patients with CDRIE.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Endocardite/etiologia , Marca-Passo Artificial/efeitos adversos , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Serviço Hospitalar de Cardiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Ecocardiografia Transesofagiana/estatística & dados numéricos , Endocardite/diagnóstico por imagem , Endocardite/epidemiologia , Endocardite/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/estatística & dados numéricos , Polônia/epidemiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia
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