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1.
Cardiovasc Pathol ; 50: 107292, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32950709

RESUMO

OBJECTIVE: Endocarditis is increasing in incidence due to growing numbers of cardiac interventions, valve replacements and immunosuppressants. It can be difficult to diagnose clinically, has high mortality and can present as sudden cardiac death (SCD) with few/subtle preceding symptoms. True incidence of SCD related to endocarditis is unknown. METHODS: Retrospective analysis of UK national database of 6000 cases of SCD, 1994-2020, for "endocarditis" as cause of death. RESULTS: Of 30 cases (0.50%), 19(63%) were male and mean age was 36.2 ± 20.1 years. Postmortem examination showed the aortic valve was solely affected in 13 (43%), mitral in 9 (30%), tricuspid in 2(6.7%) and pulmonary in 1 (3.3%). Three cases (10%) had more than one valve affected and 2 (6.7%) were nonvalvular affecting the ascending aorta. Vegetations ranged from small easily missed irregularities to large fungating masses. Ten (33%) patients developed aortic abscesses, 2 of which had aneurysms, 13 (43%) had coronary artery septic emboli with micro-abscesses and myocardial microinfarction, and 2 (6.7%) were healed endocarditis with perforation and regurgitation with ventricular remodeling. Thirteen (43%) had an identifiable underlying valve abnormality or replacement, most common being a bicuspid aortic valve (7; 54%). CONCLUSIONS: This study highlights that although rare, endocarditis is an important cause of SCD in those with normal valves, valvular disease and valve replacement surgery. Absence of a premortem diagnosis in 70% of our cohort highlights the need for detailed analysis of the heart and cardiac valves at autopsy. Gross appearance of vegetations varies widely and can be missed. Awareness of associated cardiac complications is required for elucidation of the cause of death and will provide valuable lessons for clinicians.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/patologia , Endocardite/mortalidade , Endocardite/patologia , Valvas Cardíacas/patologia , Adolescente , Adulto , Autopsia , Causas de Morte , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Reino Unido/epidemiologia , Adulto Jovem
2.
Cardiovasc Pathol ; 50: 107267, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32818611

RESUMO

Congenitally corrected transposition of the great arteries (cc-TGA, also known as L-transposition) is a rare condition that represents approximately 0.5% of congenital heart disease. It is characterized by atrioventricular and ventriculoarterial discordance. Patients with cc-TGA are at risk for cardiac arrhythmias due to abnormalities of the conduction system. We present an autopsy case of a 49-year-old man with cc-TGA who died unexpectedly, likely as a result of a fatal arrhythmia. This case illustrates the cardiac pathology characteristic of cc-TGA and describes how to grossly identify inversion of the atrioventricular valves.


Assuntos
Transposição Congênita Corrigida de Grandes Artérias/patologia , Fibrilação Atrial/etiologia , Autopsia , Transposição Congênita Corrigida de Grandes Artérias/complicações , Morte Súbita Cardíaca/etiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/etiologia
4.
PLoS One ; 15(12): e0237292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33275630

RESUMO

AIM: Mouse models of sudden cardiac arrest are limited by challenges with surgical technique and obtaining reliable venous access. To overcome this limitation, we sought to develop a simplified method in the mouse that uses ultrasound-guided injection of potassium chloride directly into the heart. METHODS: Potassium chloride was delivered directly into the left ventricular cavity under ultrasound guidance in intubated mice, resulting in immediate asystole. Mice were resuscitated with injection of epinephrine and manual chest compressions and evaluated for survival, body temperature, cardiac function, kidney damage, and diffuse tissue injury. RESULTS: The direct injection sudden cardiac arrest model causes rapid asystole with high surgical survival rates and short surgical duration. Sudden cardiac arrest mice with 8-min of asystole have significant cardiac dysfunction at 24 hours and high lethality within the first seven days, where after cardiac function begins to improve. Sudden cardiac arrest mice have secondary organ damage, including significant kidney injury but no significant change to neurologic function. CONCLUSIONS: Ultrasound-guided direct injection of potassium chloride allows for rapid and reliable cardiac arrest in the mouse that mirrors human pathology without the need for intravenous access. This technique will improve investigators' ability to study the mechanisms underlying post-arrest changes in a mouse model.


Assuntos
Morte Súbita Cardíaca/patologia , Parada Cardíaca/tratamento farmacológico , Ventrículos do Coração/efeitos dos fármacos , Animais , Modelos Animais de Doenças , Feminino , Rim/efeitos dos fármacos , Nefropatias/induzido quimicamente , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Cloreto de Potássio/farmacologia , Taxa de Sobrevida , Ultrassonografia/métodos
5.
PLoS One ; 15(12): e0241816, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33259488

RESUMO

PURPOSE: This study aimed to determine if sequential deployment of a nurse-led Rapid Response Team (RRT) and an intensivist-led Medical Emergency Team (MET) for critically ill patients in the Emergency Department (ED) and acute care wards improved hospital-wide cardiac arrest rates. METHODS: In this single-center, retrospective observational cohort study, we compared the cardiac arrest rates per 1000 patient-days during two time periods. Our hospital instituted a nurse-led RRT in 2012 and added an intensivist-led MET in 2014. We compared the cardiac arrest rates during the nurse-led RRT period and the combined RRT-MET period. With the sequential approach, nurse-led RRT evaluated and managed rapid response calls in acute care wards and if required escalated care and co-managed with an intensivist-led MET. We specifically compared the rates of pulseless electrical activity (PEA) in the two periods. We also looked at the cardiac arrest rates in the ED as RRT-MET co-managed patients with the ED team. RESULTS: Hospital-wide cardiac arrests decreased from 2.2 events per 1000 patient-days in the nurse-led RRT period to 0.8 events per 1000 patient-days in the combined RRT and MET period (p-value = 0.001). Hospital-wide PEA arrests and shockable rhythms both decreased significantly. PEA rhythms significantly decreased in acute care wards and the ED. CONCLUSION: Implementing an intensivist-led MET-RRT significantly decreased the overall cardiac arrest rate relative to the rate under a nurse-led RRT model. Additional MET capabilities and early initiation of advanced, time-sensitive therapies likely had the most impact.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Parada Cardíaca/terapia , Equipe de Respostas Rápidas de Hospitais , Estudos de Coortes , Cuidados Críticos/métodos , Morte Súbita Cardíaca/epidemiologia , Serviço Hospitalar de Emergência , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/patologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade
6.
Med Hypotheses ; 144: 110177, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33254499

RESUMO

The mandatory use of facemasks is a public health measure implemented by various countries in response to the novel coronavirus disease 19 (COVID-19) pandemic. However, there have been case reports of sudden cardiac death (SCD) with the wearing of facemasks during exercise. In this paper, we hypothesize that exercise with facemasks may increase the risk of ventricular tachycardia/ventricular fibrillation (VT/VF) leading to SCD via the development of acute and/or intermittent hypoxia and hypercapnia. We discuss the potential underlying mechanisms including increases in adrenergic stimulation and oxidative stress leading to electrophysiological abnormalities that promote arrhythmias via non-reentrant and reentrant mechanisms. Given the interplay of multiple variables contributing to the increased arrhythmic risk, we advise avoidance of a facemask during high intensity exercise, or if wearing of a mask is mandatory, exercise intensity should remain low to avoid precipitation of lethal arrhythmias. However, we cannot exclude the possibility of an arrhythmic substrate even with low intensity exercise especially in those with established chronic cardiovascular disease in whom baseline electrophysiological abnormalities may be found.


Assuntos
/complicações , Morte Súbita Cardíaca , Fenômenos Eletrofisiológicos , Exercício Físico , Máscaras , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Humanos , Hipercapnia , Hipóxia , Modelos Teóricos , Estresse Oxidativo , Espécies Reativas de Oxigênio/metabolismo , Risco , Taquicardia Ventricular/fisiopatologia , Fibrilação Ventricular/fisiopatologia
7.
Med Hypotheses ; 144: 110198, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33254507

RESUMO

Chloroquine (CQ) and hydroxychloroquine (HCQ) were among the first drugs repurposed for the treatment of SARS-CoV-2 infection. A few in vitro studies confirmed that both drugs exhibited dose dependent anti-SARS-CoV-2 activities. These observations and the encouraging results from early poorly conducted observational studies created a major hype about the therapeutic potential of these drugs in the treatment of COVID-19 disease. This was further catalyzed by media and political influences leading to a widespread use of these agents. Subsequent randomized trials revealed lack of efficacy of these agents in improving the outcomes of COVID-19 or in preventing infection in post-exposure prophylaxis studies. Nevertheless, many ongoing trials continue to actively recruit tens of thousands of patients to receive HCQ worldwide. In this perspective, we address the possible mechanisms behind the lack of efficacy and the increased risk of cardiac toxicity of HCQ in COVID-19 disease. For the lack of efficacy, we discuss the fundamental differences of treatment initiation between in vitro and in vivo studies, the pitfalls of the pharmacological calculations of effective blood drug concentrations and related dosing regimens, and the possible negative effect of HCQ on the antiviral type-I interferon response. Although it has been repeatedly claimed that HCQ has a longstanding safety track record for many decades in use, we present counterarguments for this contention due to disease-drug and drug-drug interactions. We discuss the molecular mechanisms and the cumulative epidemiological evidence of HCQ cardiac toxicity.


Assuntos
/tratamento farmacológico , Hidroxicloroquina/efeitos adversos , Hidroxicloroquina/uso terapêutico , Animais , Antivirais , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/mortalidade , Azitromicina/farmacologia , Bradicardia/induzido quimicamente , Bradicardia/mortalidade , Morte Súbita Cardíaca , Interações Medicamentosas , Coração/efeitos dos fármacos , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/mortalidade , Humanos , Interferon Tipo I/metabolismo , Camundongos , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco
8.
Arq Bras Cardiol ; 115(5): 927-935, 2020 11.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33295458

RESUMO

Hypertrophic cardiomyopathy (HCM) is the most common heart disease with a genetic origin, and its main characteristic is left ventricular hypertrophy that occurs in the absence of other conditions that trigger this change. HCM may present from asymptomatic forms to manifestations of sudden cardiac death and severe heart failure. Contemporary high-resolution imaging methods and more accurate clinical scores have been used and developed to provide a prognostic assessment and adequate functional assessments, as well as to allow for the stratification of clinical severity. These aspects will be addressed in this review, along with other classic topics inherent to the study of this disease.


Assuntos
Cardiomiopatia Hipertrófica , Insuficiência Cardíaca , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Morte Súbita Cardíaca/etiologia , Humanos , Hipertrofia Ventricular Esquerda , Prognóstico
9.
Kardiologiia ; 60(10): 86-98, 2020 Nov 12.
Artigo em Russo | MEDLINE | ID: mdl-33228511

RESUMO

Aim Patients with heart failure with reduced left ventricular (LV) ejection fraction (HFrEF) who have had acute myocardial infarction have an unfavorable prognosis, largely due to ventricular arrhythmias (VA) and risk of sudden cardiac death (SCD). The optimal treatment (triple neurohormonal blockade plus implantable cardioverter defibrillator and cardiac resynchronization therapy) reduced the risk of SCD primarily due to reverse cardiac remodeling, but has not solved this problem completely. Efficacy of purified ω-3 polyunsaturated fatty acid esters (PUFA) in low doses (1 g/day) in reducing VA and risk of SCD in HFrEF patients was demonstrated in two large randomized clinical trials. The PUFA effects was suggested to be related also with increased heart rhythm variability (HRV) and chronotropic action, which might depend on the drug dose. The present open, prospective, randomized, comparative study in parallel groups evaluated the effect of Omacor in different doses on noninvasive markers of SCD risk in patients with ischemic HFrEF receiving the optimal drug therapy.Methods Patients (n=40) were randomized at a 1:1:2 ratio to the control group (n=10), the Omacor 1 g/day treatment group (n=10), and the Omacor 2 g/day treatment group (n=20) and were followed up for 12 months. Clinical evaluation included changes in the CHF functional class (FC) and Clinical Condition Scale (CCS) score; concentration of N-terminal pro-hormone brain natriuretic peptide (NT-proBNP); and peak oxygen consumption during exercise (peak VO2). The LV function was evaluated by LVEF. Holter ECG monitoring was used for evaluation of HRV (SDNN), average 24-h heart rate (HR), number of ventricular extrasystoles (VE) per hour and severity of VA, and presence of paired VE and VT runs.Results Improvement of CHF FC became significant only with the high-dose Omacor treatment (2 g/day). The CCS score showed a tendency towards decrease also with a lower dose (1 g/day) whereas the level of NT-proBNP significantly decreased with both Omacor doses. The increase in LV EF was significant only with the use of Omacor 2 g/day (+3 %, р=0.002). A negative chronotropic effect of ω-3 PUFA was observed. Average 24-h HR decreased by 8 bpm (р=0.05) and 11 bpm (р<0.001) with Omacor 1 g/day and 2 g/day, respectively. Either dose of ω-3 PUFA significantly improved VO2, which directly correlated with LV EF and inversely correlated with HR. The decrease in number of VE was associated not only with improved HRV (SDNN) but also with the decrease in 24-h HR, and thus Omacor 2 g/day significantly decreased the number of VE (by 16 per hour) and dangerous VA (paired VE and VT runs ceased to be detected in 40 % of patients).Conclusion Since HR, HRV, and VA are closely interrelated, the effect of ω-3 PUFA specifically on these noninvasive markers apparently determines its ability to decrease the risk of SCD in patients with ischemic HFrEF. The antiarrhythmic effect of Omacor was greater with higher doses of this drug.


Assuntos
Morte Súbita Cardíaca , Ácidos Graxos Ômega-3 , Insuficiência Cardíaca , Arritmias Cardíacas/etiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Ésteres , Ácidos Graxos Ômega-3/uso terapêutico , Insuficiência Cardíaca/complicações , Humanos , Estudos Prospectivos , Volume Sistólico
12.
PLoS One ; 15(11): e0242799, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237971

RESUMO

The incidence of sudden cardiac arrest (SCA) in Asians is lower than that seen in Western populations, but there are few available data on the incidence and associated cardiac etiology of SCA in Asians. From 2002 to 2013, patients with SCA were analyzed using a cohort from the South Korean National Health Insurance Service (NHIS) coded database. Sudden unexplained death syndrome (SUDS) was defined as cryptogenic arrest, excluding that of non-cardiac origin, coronary artery disease (CAD), cardiomyopathy (CM), and valvular heart disease. During the 12-year study period, 5,973 patients (0.53%) from the total cohort of 1,125,691 had a cardiac arrest code. The overall incidence of arrest was 48.7 per 100,000 person-years (95% CI 16.6-18.0). The incidence of primary SCA excluding those of non-cardiac origin was 16.1 per 100,000 person-years (95% CI 15.4-16.8). It was higher in males than in females (18.1 vs. 14.1 per 100,000 person-years). CAD was the most common cause of SCA (59.4%), and followed by CM (13.9%). SUDS accounted for 14.7% of SCA events. The risk of SCA had increased gradually from over 25 years old. Heart failure, atrial fibrillation and hypertension are major factors associated with SCA incidence. Our findings outline epidemiologic data for SCA and the proportion of associated cardiac etiology leads SCA in a large population.


Assuntos
Síndrome de Brugada/epidemiologia , Cardiomiopatias/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Morte Súbita Cardíaca/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome de Brugada/patologia , Cardiomiopatias/patologia , Criança , Pré-Escolar , Doença da Artéria Coronariana/patologia , Morte Súbita Cardíaca/patologia , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/patologia , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/patologia , Humanos , Hipertensão/epidemiologia , Hipertensão/patologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Adulto Jovem
13.
PLoS One ; 15(10): e0235101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002020

RESUMO

Implantable cardioverter defibrillators (ICD) are the most effective therapy to terminate malignant ventricular arrhythmias (VA) and therefore to prevent sudden cardiac death. Until today, there is no way to predict the onset of such VA. Our aim was to develop a mathematical model that could predict VA in a timely fashion. We analyzed the time series of R-R intervals from 3 groups. Two groups from the Spontaneous Ventricular Tachyarrhythmia Database (v 1.0) were analyzed from a set of 81 pairs of R-R interval time series records from patients, each pair containing one record before the VT episode (Dataset 1A) and one control record which was obtained during the follow up visit (Dataset 1B). A third data set was composed of the R-R interval time series of 54 subjects without a significant arrhythmia heart disease (Dataset 2). We developed a new method to transform a time series into a network for its analysis, the ε-regular graphs. This novel approach transforms a time series into a network which is sensitive to the quantitative properties of the time series, it has a single parameter (ε) to be adjusted, and it can trace long-range correlations. This procedure allows to use graph theory to extract the dynamics of any time series. The average of the difference between the VT and the control record graph degree of each patient, at each time window, reached a global minimum value of -2.12 followed by a drastic increase of the average graph until reaching a local maximum of 5.59. The global minimum and the following local maxima occur at the windows 276 and 393, respectively. This change in the connectivity of the graphs distinguishes two distinct dynamics occurring during the VA, while the states in between the 276 and 393, determine a transitional state. We propose this change in the dynamic of the R-R intervals as a measurable and detectable "early warning" of the VT event, occurring an average of 514.625 seconds (8:30 minutes) before the onset of the VT episode. It is feasible to detect retrospectively early warnings of the VA episode using their corresponding ε-regular graphs, with an average of 8:30 minutes before the ICD terminates the VA event.


Assuntos
Desfibriladores Implantáveis , Modelos Teóricos , Fibrilação Ventricular/prevenção & controle , Gerenciamento de Dados , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Masculino , Estudos Retrospectivos , Taquicardia Ventricular/fisiopatologia
14.
Rev Cardiovasc Med ; 21(3): 321-338, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33070538

RESUMO

Sarcoidosis is a chronic inflammatory disease of unknown etiology characterized by multi-organ involvement. End-organ disease consists of granulomatous inflammation, which if left untreated or not resolved spontaneously, leads to permanent fibrosis and end-organ dysfunction. Cardiac involvement and fibrosis in sarcoidosis occur in 5-10% of cases and is becoming increasingly diagnosed. This is due to increased clinical awareness among clinicians and new diagnostic modalities, since magnetic resonance imaging and positron-emission tomography are emerging as "gold standard" tools replacing endomyocardial biopsy. Despite this progress, isolated cardiac sarcoidosis is difficult to differentiate from other causes of arrhythmogenic cardiomyopathy. Cardiac fibrosis leads to congestive heart failure, arrhythmias and sudden cardiac death. Immunosuppressives (mostly corticosteroids) are used for the treatment of cardiac sarcoidosis. Implantable devices like a cardioverter-defibrillator may be warranted in order to prevent sudden cardiac death. In this article current trends in the pathophysiology, diagnosis and management of cardiac sarcoidosis will be reviewed focusing on published research and latest guidelines. Lastly, a management algorithm is proposed.


Assuntos
Corticosteroides/uso terapêutico , Cardiomiopatias/diagnóstico , Cardiomiopatias/terapia , Cardioversão Elétrica , Imunossupressores/uso terapêutico , Sarcoidose/diagnóstico , Sarcoidose/terapia , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Morte Súbita Cardíaca/patologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Fibrose , Humanos , Miocárdio/patologia , Fatores de Risco , Sarcoidose/patologia , Sarcoidose/fisiopatologia , Resultado do Tratamento
15.
Rev Prat ; 70(5): 555-560, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058647

RESUMO

How to reduce the sudden nontraumatic death related to sport risk? Sport's related sudden cardiac death (SCD) is still dramatically perceived and often widely publicized. In case of SCD sport's practice reveals a heart disease that is mainly overlooked. In a society under the influence of the precautionary principle, preventing SCD seems essential. However, implementing effective SCD prevention is not easy. Among the three most often preventive actions proposed, the pre-participation screening evaluation, the athlete's education, and the population education for resuscitation maneuvers, the pre-participation evaluation currently seems to have the most difficulty in proving its effectiveness.


Assuntos
Cardiopatias , Esportes , Atletas , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Humanos , Programas de Rastreamento
16.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(10): 837-841, 2020 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-33076620

RESUMO

Objective: To investigate the clinical characteristics of inpatients with the indication of cardiac implantable electronic devices (CIED) therapy and combined acute pulmonary thromboembolism (APTE). Methods: We retrospectively screened 8 641 inpatients who admitted with the indication of CIED implantation in Fuwai Hospital from January 2014 to May 2019. The clinical characteristics, management strategies and clinical outcome were analyzed for patients diagnosed as APTE. Results: APTE were identified in 45 (5‰) patients in this cohort, there were 18(40%) male patients, the average age was (73±8) years old and body mass index was (27±10) kg/m2.Thirty-two (70%) patients were at intermediate-risk and 13 (30%) at low-risk. Anti-coagulation therapy was initiated in 38(84%) patients, and 30 patients underwent CIED implantation (27 pacemaker, 2 CRT and 1 ICD). No postoperative bleeding or pocket hematoma were detected in the 23 patients taking anticoagulation medication before implantation. During an average of (30±7) months' follow up, thrombus was dissolved in 20 patients, hemorrhage complications were observed in 2 patients (1 cerebral hemorrhage and 1 hematuria), anticoagulation therapy was discontinued in these 2 patients. Among 15 patients without immediate CIED implantation and treated with anticoagulation therapy during hospitalization, 2 patients developed complete paroxysmal Ⅲ° atrioventricular block, and recovered after therapy during hospitalization. Seven patients were re-hospitalized for CIED implantation due to bradycardia. Five patients died during follow-up (3 sudden cardiac death, 1 APTE combined with cerebral infarction, and 1 pulmonary infection). Conclusion: APTE is not rare in patients with the indication of CIED implantation, CIED implantation and anti-coagulation therapy are safe for these patients, and transient atrioventricular block could be detected in APTE patients.


Assuntos
Desfibriladores Implantáveis , Marca-Passo Artificial , Embolia Pulmonar , Idoso , Idoso de 80 Anos ou mais , Morte Súbita Cardíaca , Feminino , Humanos , Masculino , Embolia Pulmonar/complicações , Estudos Retrospectivos
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5567-5570, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019239

RESUMO

Malignant ventricular arrhythmia (especially ventricular fibrillation (VF)) is the main reason which causes sudden cardiac death (SCD). This paper presents an automatic SCD-patient classifier we developed to identify patients with unexpected VF using 60-minutes continuous single-lead electrocardiograms (ECG) signals before that. Patients are classified as having SCD if the majority of their recorded ventricular repolarization (VR) is recognized as characteristic of unexpected VF. Thus, the classifier's underlying task is to recognize individual VR delineated from single-lead ECG signals as SCD VR, where VR from non-SCD patients are used as controls. With the reported clinical practices of SCD, we extracted five morphological and temporal features (both commonly used and newly developed ones) from ECG signals for VR classification. To evaluate classification performance, we trained and tested k nearest neighbor classifier, a decision tree classifier, and a Naïve Bayes classifier using five-fold cross validation on 36 one-hour ECG signals (18 from patients at risk of SCD and 18 from control people). We compared the performance of these three classifiers, and the patient-classification sensitivity is approximately 98.02-99.51%. Moreover, the k nearest neighbor with a higher accuracy (98.89%) and specificity (98.27%) performed better than the other two. Importantly, the results show obvious superiorities of performance over that in the same duration and of usefulness over several minutes given by related works.Clinical Relevance- This could be integrated into a real-time, long-term out-of-hospital SCD predictor to improve the warning veracity and bring forward the warning time, especially for patients with implantable cardiac defibrillators or pacemakers, etc..


Assuntos
Arritmias Cardíacas , Fibrilação Ventricular , Teorema de Bayes , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Humanos , Fibrilação Ventricular/diagnóstico
18.
Artigo em Inglês | MEDLINE | ID: mdl-33093765

RESUMO

Background: Patients with cardiac sarcoidosis (CS) are at increased risk of atrioventricular blocks, ventricular arrhythmias, and sudden cardiac death. Objectives We aimed to investigate the characteristics associated with appropriate therapy in implantable cardiac defibrillator (ICD) -implanted CS patients. Methods: We performed a PubMed and Web of Science search for studies reporting patients with CS who underwent an ICD implantation. The primary criterion was an appropriate therapy. Results: We screened 705 studies, of which 5 were included in the final analysis. We conducted a meta-analysis including 464 patients (mean age 55 years, 282 males (60%)). The mean follow-up was 3.5 years. Among the 464 patients, 180 received an appropriate therapy (39%). Patients who received an appropriate therapy were younger (-3.33, 95% confidence interval (CI) -6.42 to -0.23, p=0.004), were more likely to be male (OR 2.06, 95% CI 1.37-3.09, p=0.0005), had a lower left ventricular ejection fraction (LVEF) (-10.5, 95% CI -18.23 to -2.78, p=0.008), had a higher rate of complete heart block (OR 2.19, 95% CI 1.20 to 3.99, p=0.01), and more frequently had ventricular pacing (OR 6.44 95% CI 2.57 to 16.16, p<0.0001). Conclusions: Appropriate ICD therapy during CS is associated with young age, male sex, low LVEF, history of complete heart block, and ventricular pacing. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 17-23).


Assuntos
Cardiomiopatias/terapia , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Bloqueio Cardíaco/terapia , Sarcoidose/terapia , Adulto , Fatores Etários , Idoso , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Morte Súbita Cardíaca/prevenção & controle , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/mortalidade , Feminino , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/mortalidade , Bloqueio Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Sarcoidose/diagnóstico por imagem , Sarcoidose/mortalidade , Sarcoidose/fisiopatologia , Fatores Sexuais , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
19.
Fa Yi Xue Za Zhi ; 36(4): 497-501, 2020 Aug.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33047533

RESUMO

Abstract: Objective To explore the association of cardiac disease associated genetic variants and the high incidence of Yunnan sudden unexplained death (YNSUD) in Yi nationality. Methods The genomic DNA was extracted from peripheral blood samples collected from 205 Yi villagers from YNSUD aggregative villages (inpatient group) and 197 healthy Yi villagers from neighboring villages (control group). Fifty-two single nucleotide variants (SNVs) of 25 cardiac disease associated genes were genotyped using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS). The SPSS 17.0 was used to analyze data. The pathogenicities of variants with differences between the two groups that have statistical significance were predicted by protein function prediction software PolyPhen-2 and SIFT. All villagers from inpatient group were given electrocardiogram (ECG) examination using a 12-lead electrocardiograph. Results The allele frequency and the genotype frequency of missense mutation DSG2 (rs2278792, c.2318G>A, p.R773K) of pathogenic genes of arrhythmogenic right ventricular cardiomyopathy (ARVC) in inpatient group was higher than that in control group (P<0.05). Abnormal ECG changes were detected in 71 individuals (34.6%) in the inpatient group, among which 54 individuals carried R773K mutation, including clockwise (counterclockwise) rotation, left (right) axis deviation, ST segment and T wave alteration and heart-blocking. Conclusion Definite pathogenic mutations have not been found in the 52 cardiac disease genes associated SNVs detected in Yi nationality in regions with high incidence of YNSUD. The cause of high incidence of YNSUD in Yi nationality needs further study.


Assuntos
Displasia Arritmogênica Ventricular Direita , Grupos Étnicos , China/epidemiologia , Morte Súbita/epidemiologia , Morte Súbita/etiologia , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Grupos Étnicos/genética , Humanos , Incidência , Mutação
20.
Yonsei Med J ; 61(11): 942-950, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107237

RESUMO

PURPOSE: Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemic cardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM. MATERIALS AND METHODS: In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who were eligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital and clinical factors, were investigated. RESULTS: Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0-78.0) years], only 76 (5.2%) patients underwent ICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and total hospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospital system score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10-1.50] was an independent factor for predicting ICD implantation, along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97-17.87) and younger age (<70 years: OR, 2.14; 95% CI, 1.30-3.53). CONCLUSION: PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICD implantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantation rate (Clinical trial registration No. NCT03590925).


Assuntos
Cardiomiopatias/prevenção & controle , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/instrumentação , Insuficiência Cardíaca/terapia , Isquemia Miocárdica/prevenção & controle , Prevenção Primária/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/epidemiologia , Cardiomiopatias/terapia , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Prevenção Primária/métodos , Estudos Prospectivos , Sistema de Registros , República da Coreia/epidemiologia , Fatores de Risco , Resultado do Tratamento
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