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1.
J Am Coll Cardiol ; 77(2): 173-185, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33446311

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. OBJECTIVES: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. METHODS: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. RESULTS: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. CONCLUSIONS: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted.


Assuntos
Cardiopatias/diagnóstico , Técnicas de Diagnóstico Cardiovascular/estatística & dados numéricos , Saúde Global , Pesquisas sobre Serviços de Saúde , Humanos , Agências Internacionais
2.
PLoS One ; 15(12): e0243737, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362252

RESUMO

BACKGROUND: The glycocalyx is an extracellular layer lining the lumen of the vascular endothelium, protecting the endothelium from shear stress and atherosclerosis and contributes to coagulation, immune response and microvascular perfusion. The GlycoCheck system estimates glycocalyx' thickness in vessels under the tongue from perfused boundary region (PBR) and microvascular perfusion (red blood cell (RBC) filling) via a camera and dedicated software. OBJECTIVES: Evaluating reproducibility and influence of examination conditions on measurements with the GlycoCheck system. METHODS: Open, randomised, controlled study including 42 healthy smokers investigating day-to-day, side-of-tongue, inter-investigator variance, intraclass-correlation (ICC) and influence of examination conditions at intervals from 0-180 minutes on PBR and RBC filling. RESULTS: Mean (SD) age was 24.9 (6.1) years, 52% were male. There was no significant intra- or inter-investigator variation for PBR or RBC filling nor for PBR for side-of-tongue. A small day-to-day variance was found for PBR (0.012µm, p = 0.007) and RBC filling (0.003%, p = 0.005) and side-of-tongue, RBC filling (0.025%, p = 0.009). ICC was modest but highly improved by increasing measurements. Small significant influence of cigarette smoking (from 40-180 minutes), high calorie meal intake and coffee consumption was found. The latter two peaking immediately and tapering off but remained significant up to 180 minutes, highest PBR changes for the three being 0.042µm (p<0.05), 0.183µm (p<0.001) and 0.160µm (p<0.05) respectively. CONCLUSIONS: Measurements with the GlycoCheck system have a moderate reproducibility, but highly increases with multiple measurements and a small day-to-day variability. Smoking, meal and coffee intake had effects up to 180 minutes, abstinence is recommended at least 180 minutes before GlycoCheck measurements. Future studies should standardise conditions during measurements.


Assuntos
Doenças Cardiovasculares/diagnóstico , Técnicas de Diagnóstico Cardiovascular/instrumentação , Endotélio Vascular/diagnóstico por imagem , Microvasos/diagnóstico por imagem , Soalho Bucal/irrigação sanguínea , Adolescente , Adulto , Doenças Cardiovasculares/fisiopatologia , Endotélio Vascular/citologia , Endotélio Vascular/fisiopatologia , Eritrócitos/fisiologia , Feminino , Glicocálix/fisiologia , Humanos , Masculino , Microcirculação/fisiologia , Microvasos/citologia , Microvasos/fisiopatologia , Soalho Bucal/diagnóstico por imagem , Reprodutibilidade dos Testes , Fumantes , Software , Adulto Jovem
3.
Eur. j. anat ; 24(6): 519-521, nov. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-198393

RESUMO

Coarctation of the cervical aortic arch (CAA), though rare, is a clinical entity of embryological significance. Based on Rathke's aortic arch diagrams and Edward's concept of functioning double aortic arch, we are postulating that the coarctation in a CAA occurs due to partial involution of the dorsal aorta developed from the "ductus caroticus". Hence coarctation in CAA should be classified as a "clinically significant aortic arch anomaly of ductus caroticus origin". Conversely, location of coarctation in CAA substantiates the theory that embryogenesis of CAA is due to aortic arch development from the third or second branchial arch vessel, rather than the usual fourth arch vessel


No disponible


Assuntos
Humanos , Masculino , Criança , Coartação Aórtica/diagnóstico por imagem , Aorta Torácica/anatomia & histologia , Aorta Torácica/diagnóstico por imagem , Ecocardiografia , Tomografia Computadorizada por Raios X , Técnicas de Diagnóstico Cardiovascular
7.
Revista Digital de Postgrado ; 9(2): 208, ago. 2020. tab, graf
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1103357

RESUMO

La diabetes mellitus tipo 2 (DM2) representa un problema de salud pública, debido a su alta incidencia y prevalencia en el mundo. Un método para evaluar el riesgo de desarrollar DM2 es la escala Latin American Finnish Diabetes Risk Score (LA FINDRISC). La DM2 es un factor de riesgo de enfermedad arterial periférica (EAP) la cual puede ser diagnosticada mediante el índice tobillo-brazo (ITB). Objetivo: evaluar la presencia y severidad de enfermedad arterial periférica mediante ITB y relacionarlo con el riesgo de desarrollar DM2 según LA FINDRISC. Métodos: estudio descriptivo, correlacional, de corte transversal. Se evaluaron 134 personas y se les midió glicemia capilar para descartar diabetes. Posteriormente, se realizó el LA FINDRISC y el ITB. Resultados: El puntaje LA FINDRISC y la glicemia alteradas en ayunas aumentaron proporcionalmente (R2=0,5). Esta relación no se observó entre LA FINDRISC y el ITB arrojado por la población general. Sin embargo, al seleccionar los pacientes con vasos no comprimibles aparece una correlación positiva (R2=0,36) entre los dos instrumentos diagnósticos. Conclusión: LA FINDRISC y el ITB son instrumentos de diagnósticos no invasivo, sencillos y válidos para detectar riesgo de desarrollar DM2, y detectar presencia y severidad de enfermedad arterial periférica, respectivamente(AU)


Type 2 diabetes mellitus (DM2) represents a public health problem, due to its high incidence and prevalence in the world. One method to assess the risk of developing DM2 is the Latin American Finnish Diabetes Risk Score (LA FINDRISC) scale. DM2 is a risk factor for peripheral arterial disease (PAD) which can be diagnosed using the ankle-brachial index (ABI). Objective: to evaluate the presence and severity of peripheral arterial disease using ABI and to relate it to the risk of developing DM2 according to LA FINDRISC. Methods: descriptive, correlational, cross-sectional study. 134 people were evaluated, and capillary glycemia was measured to rule out diabetes. Subsequently, the LA FINDRISC and the ITB were held. Results: The LA FINDRISC score and impaired fasting blood glucose increased proportionally (R2 = 0.5). This relationship was not observed between LA FINDRISC and the ITB showed by the general population. However, when selecting patients with non-compressible vessels, a positive correlation (R2 = 0.36) appears between the two diagnostic instruments. Conclusion: FINDRISC and ITB are simple and valid non-invasive diagnostic instruments to detect the risk of developing DM2, and detect the presence and severity of peripheral arterial disease, respectively(AU)


Assuntos
Humanos , Masculino , Feminino , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/fisiopatologia , Técnicas de Diagnóstico Cardiovascular , Doença Arterial Periférica/complicações , Pesos e Medidas Corporais , Antropometria , Circunferência Abdominal
8.
Clin Auton Res ; 30(4): 325-330, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32661775

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has changed the way most medical procedures are performed. Autonomic units, as well as other healthcare sectors, are required to undergo a thorough reorganization of the protocols in order to guarantee the safety of patients and healthcare staff. Cardiovascular autonomic function testing (CAFT) is necessary in certain situations; however, it poses several concerns which need to be addressed. Here, we provide some practical advice based on current national and international health authorities' recommendations and our experience about how to perform CAFT during the COVID-19 emergency. We examine aspects regarding patients, healthcare staff, laboratory preparation, and test performance.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Técnicas de Diagnóstico Cardiovascular/normas , Pessoal de Saúde/normas , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Humanos , Itália/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia
9.
J Med Vasc ; 45(3): 114-124, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32402425

RESUMO

BACKGROUND: The precise epidemiological evaluation of amputations is difficult. It is a serious public health and economic problem with a high death rate. The proportion of amputees with pre-amputation vascular status remains unknown. The main objective of our study was to evaluate the proportion of patients with lower limb amputation who had a pre-procedural vascular assessment. The secondary objectives were to evaluate the risk of amputation at the admission of these patients, estimate the incidence of amputations in Martinique, and to collect epidemiological data on this category of patients. MATERIAL AND METHODS: We conducted an epidemiological, retrospective, and observational study, over the year 2018 between January 01 and December 31, including all adults' patients who underwent an amputation of the lower limb at the university hospital center of Martinique. RESULTS: Among the 170 included patients, 79 (46%) patients had a major lower limb amputation. The incidence of amputations in 2018 was estimated at 48.9/100,000 inhabitants. The vascular assessment was performed for 110 (65%) patients. For the other 60 (35%) patients who did not have a vascular assessment, 53 (88%) had a severe infection. This assessment was significantly related to the amputation level: a vascular assessment was performed in 97 (70%) patients with below the knee amputation versus 13 (41%) patients with above the knee amputation (P<0.01). The WIfI classification system found a high risk of amputation for 152 (89%) of patients but also a benefit of revascularization ranked high for 138 (81%) of them. The origin of amputation was limb ischemia for 125 (68%) patients. CONCLUSION: A significant number of patients who underwent lower limb amputation did not have a pre-procedural vascular assessment. Many improvements in the health care are therefore to be implemented. The upcoming M@diCICAT project in Martinique will contribute in the improvement of patient management. The incidence of amputation in Martinique is considered high compared to other countries (French national incidence in 2003=24.8/100,000 inhabitants), and it seems to have remained stable since 2008. Our population is considered to be at high risk of amputation by the SVS-WIfI classification. This score seems adapted to anticipate the evolution of these patients and could be useful in daily practice.


Assuntos
Amputação/tendências , Amputados , Técnicas de Diagnóstico Cardiovascular/tendências , Hospitais Universitários , Extremidade Inferior/cirurgia , Doenças Vasculares/diagnóstico , Doenças Vasculares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Doenças Vasculares/epidemiologia
11.
Tunis Med ; 98(1): 70-79, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32395780

RESUMO

BACKGROUND: Strain has shown a promising diagnostic and prognostic value in acute coronary syndromes. With, however, less data in non-ST elevation myocardial infarction (NSEMI). AIM: to evaluate in NSTEMI patients, the ability of strain to predict the severity of the disease, by assessing correlations to established prognostic parameters, and to predict culprit and occluded coronary arteries (CA). Secondary, to determine factors associated to strain changes during follow-up. METHODS: The study was prospective, NSTEMI patients with significant coronary lesion and without significant non-ischaemic disease were included. Angiographic and echocardiographic investigation including global (GLS) and territorial (TLS) longitudinal strain were performed within 24h from admission. Syntax I score was calculated. Severe coronary artery disease (CAD) was defined by left main of three-vessel disease. RESULTS: Seventy NSTEMI patients aged 60.2±10.1 years were enrolled; 61% were smokers, 54% diabetics and 46% hypertensive. 34% had a severe CAD, 7% had an acute coronary occlusion (ACO) and 14% a chronic coronary total occlusion (CTO). GLS >-15.3% predicted a left ventricular ejection fraction (LVEF) <50% with 80% Sensitivity (Se) and 78% Specificity (Sp). GLS was associated to CAD complexity and severity. GLS > -14.1% detected severe CAD with 83% Se and 80%Sp. TLS determined the culprit artery in 74% of cases and TLS > -9.2% predicted ACO with 85% Se and 85% Sp. TLS was also associated to CTO. At a 10 months median follow-up [3-12months], GLS significantly improved, baseline LVEF, GLS, wall motion score index and revascularization were the predictors of this improvement. CONCLUSION: In NSTEMI patients, GLS detected severe CAD and poor myocardial function. TLS predicted the culprit vessel and its occlusion. GLS improvement at midterm was predicted by baseline systolic LV function parameters and myocardial revascularization.


Assuntos
Técnicas de Diagnóstico Cardiovascular , Eletrocardiografia/métodos , Teste de Esforço , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Idoso , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/patologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia
12.
Kardiol Pol ; 78(5): 498-507, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32415767

RESUMO

The ongoing pandemic of coronavirus disease 2019 (COVID­19), caused by severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2), represents a major challenge for healthcare. The involvement of cardiovascular system in COVID­19 has been proven and increased healthcare system resources are redirected towards handling infected patients, which induces major changes in access to services and prioritization in the management of patients with chronic cardiovascular disease unrelated to COVID­19. In this expert opinion, conceived by the task force involving the Working Groups on Valvular Heart Diseases and Cardiac Surgery as well as the Association of Cardiovascular Intervention of the Polish Cardiac Society, modification of diagnostic pathways, principles of healthcare personnel protection, and treatment guidelines regarding triage and prioritization are suggested. Heart Teams responsible for the treatment of valvular heart disease should continue their work using telemedicine and digital technology. Diagnostic tests must be simplified or deferred to minimize the number of potentially dangerous aerosol­generating procedures, such as transesophageal echocardiography or exercise imaging. The treatment of aortic stenosis and mitral regurgitation has to be offered particularly due to urgent indications and in patients with advanced disease and poor prognosis. Expert risk stratification is essential for triage and setting the priority lists. In each case, an appropriate level of personal protection must be ensured for the healthcare personnel to prevent spreading infection and preserve specialized manpower, who will supply the continuing need for handling serious chronic cardiovascular disease. Importantly, as soon as the local epidemic situation improves, efforts must be made to restore standard opportunities for elective treatment of valvular heart disease and occluder­based therapies according to existing guidelines, thus rebuilding the state ­of ­the ­art cardiovascular services.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/normas , Infecções por Coronavirus/prevenção & controle , Técnicas de Diagnóstico Cardiovascular/normas , Cardiopatias/diagnóstico , Cardiopatias/terapia , Controle de Infecções/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Humanos , Polônia , Guias de Prática Clínica como Assunto
13.
J Thromb Haemost ; 18(8): 1859-1865, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32459046
14.
Artigo em Inglês | MEDLINE | ID: mdl-32280412

RESUMO

Cardiogenic shock (CGS) is common and highly morbid. According to the National Inpatient Sample, there are more than 100,000 cases per year, and 30-day mortality approaches 50% despite improvements in critical care practices and novel mechanical therapies targeted at restoring normal hemodynamics. This issue aims to enhance clinicians' understanding of CGS, and this review specifically focuses on the underlying pathophysiology. We examine the definition and etiologies of CGS, approaches to risk assessment, and the pressure-volume loop framework that is the foundation for conceptualizing ventricular mechanics, ventricular-vascular interactions, and the derangements observed in CGS. This overview will also contextualize subsequent chapters that discuss nuances of CGS encountered in particular scenarios (ie, post-myocardial infraction, acutely decompensated chronic heart failure, post-cardiac surgery), address pharmacological and mechanical treatments for CGS, and review CGS in a case-based format.


Assuntos
Técnicas de Diagnóstico Cardiovascular , Hemodinâmica , Choque Cardiogênico/diagnóstico , Função Ventricular Esquerda , Função Ventricular Direita , Humanos , Modelos Cardiovasculares , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia
15.
Am Heart J ; 223: 106-109, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32240829

RESUMO

BACKGROUND: The diagnosis of cardiac sarcoidosis (CS) is challenging. Because of the current limitations of endomyocardial biopsy as a reference standard, physicians rely on advanced cardiac imaging, multidisciplinary evaluation, and diagnostic criteria to diagnose CS. AIMS: To compare the 3 main available diagnostic criteria in patients clinically judged to have CS. METHODS: We prospectively included patients clinically judged to have CS by a multidisciplinary sarcoidosis team from November 2016 to October 2017. We included only incident cases (diagnosis of CS within 1 year of inclusion). We applied retrospectively the following diagnostic criteria: the World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG), the Heart Rhythm Society (HRS), and the Japanese Circulation Society (JCS) 2016 criteria. RESULTS: We identified 69 patients. Diagnostic criteria classified patients as follows: WASOG as highly probable (1.4%), probable (52.2%), possible (0%), some criteria (40.6%), and no criteria (5.8%); HRS as histological diagnosis (1.4%), probable (52.2%), some criteria (40.6%), and no criteria (5.8%); JCS as histological diagnosis (1.4%), clinical diagnosis (58%), some criteria (39.1%), and no criteria (1.4%). Concordance was high between WASOG and HRS (κ = 1) but low between JCS and the others (κ = 0.326). CONCLUSIONS: A high proportion of patients clinically judged to have CS are unable to be classified according to the 3 main diagnostic criteria. There is low concordance between JCS criteria and the other 2 criteria (WASOG and HRS).


Assuntos
Cardiomiopatias/diagnóstico , Sarcoidose/diagnóstico , Adulto , Técnicas de Diagnóstico Cardiovascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
JACC Cardiovasc Interv ; 13(8): 976-985, 2020 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-32113927

RESUMO

OBJECTIVES: This study investigated the correlation between vascular flow reserve (VFR) values and wound healing rate in patients with critical limb ischemia. BACKGROUND: Peripheral VFR may be useful for predicting complete wound healing after endovascular therapy (EVT). However, published reports included small numbers of patients from single centers and long-term outcomes remain unknown. METHODS: This was a prospective multicenter study that consecutively enrolled 104 patients (115 limbs) who received EVT for ischemic ulcerations. All lesions were treated with conventional balloon angioplasty. After EVT, VFR was measured using a pressure/temperature guidewire. The study endpoints were correlation between VFR values and wound healing rate at 3 months and 1 year. RESULTS: The median VFR was 2.9. A total of 110 and 104 limbs completed the 3-month and 1-year follow-up, respectively. The 3-month and 1-year wound healing rates were 49% and 76%, respectively. VFR was significantly associated with the 3-month and 1-year wound healing (p < 0.001 for both). The crude hazard ratios of VFR (per 2-fold increase) for the 3-month and 1-year wound healing were 2.6 (1.7 to 3.9) and 2.9 (2.0 to 4.2), respectively. The estimated median time to wound healing was 5.0 (3.2 to 7.2) months, 3.3 (2.8 to 4.9) months, and 2.5 (2.0 to 3.0) months, when the VFR value was 2.4, 2.9, and 3.9, respectively. CONCLUSIONS: Post-procedure VFR is significantly associated with wound healing. VFR, measured in the catheterization laboratory, is useful in clinical risk stratification for patients with critical limb ischemia after EVT. (Predictor of Wound Healing in Patients with Critical Limb Ischemia-Multicenter Prospective Study; UMIN000012746).


Assuntos
Angioplastia com Balão , Técnicas de Diagnóstico Cardiovascular , Isquemia/terapia , Microcirculação , Doença Arterial Periférica/terapia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão/efeitos adversos , Estado Terminal , Feminino , Humanos , Isquemia/diagnóstico , Isquemia/fisiopatologia , Japão , Masculino , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de Tempo , Resultado do Tratamento
17.
Open Heart ; 7(1): e001157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32206315

RESUMO

Background: The aim of this study was to assess by a census supported by the Italian Society of Cardiology (Società Italiana di Cardiologia, SIC) the present implementation of telemedicine in the field of cardiovascular disease in Italy. Methods: A dedicated questionnaire was sent by email to all the members of the SIC: data on telemedicine providers, service provided, reimbursement, funding and organisational solutions were collected and analysed. Results: Reported telemedicine activities were mostly stable and public hospital based, focused on acute cardiovascular disease and prehospital triage of suspected acute myocardial infarction (prehospital ECG, always interpreted by a cardiologist and not automatically reported by computerised algorithms). Private companies delivering telemedicine services in cardiology (ECGs, ambulatory ECG monitoring) were also present. In 16% of cases, ECGs were also delivered through pharmacies or general practitioners. ICD/CRT-D remote control was performed in 42% of cases, heart failure patient remote monitoring in 37% (21% vital parameters monitoring, 32% nurse telephone monitoring). Telemedicine service was public in 74% of cases, paid by the patient in 26%. About half of telemedicine service received no funding, 17% received State and/or European Union funding. Conclusions: Several telemedicine activities have been reported for the management of acute and chronic cardiovascular disease in Italy. The whole continuum of cardiovascular disease is covered by telemedicine solutions. A periodic census may be useful to assess the implementation of guidelines recommendations on telemedicine.


Assuntos
Cardiologistas/normas , Cardiologia/normas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Técnicas de Diagnóstico Cardiovascular/normas , Telemedicina/normas , Censos , Feminino , Pesquisas sobre Serviços de Saúde , Disparidades em Assistência à Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/normas , Valor Preditivo dos Testes , Indicadores de Qualidade em Assistência à Saúde/normas
18.
Circ Heart Fail ; 13(4): e006963, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32207996

RESUMO

BACKGROUND: Current guidelines recommend evaluation for underlying heart disease and reversible conditions for patients with new-onset heart failure (HF). There are limited data on contemporary testing for coronary artery disease (CAD) in patients with new-onset HF. METHODS: We performed an observational cohort study using the Get With The Guidelines-Heart Failure registry linked to Medicare claims. All patients were aged ≥65 and hospitalized for new-onset HF from 2009 to 2015. We collected left ventricular ejection fraction (LVEF), prior HF history, and in-hospital CAD testing from the registry, as well as testing for CAD using claims from 90 days before to 90 days after index HF hospitalization. RESULTS: Among 17 185 patients with new-onset HF, 6672 (39%) received testing for CAD, including 3997 (23%) during the index hospitalization. Testing for CAD differed by LVEF: 53% in HF with reduced EF (LVEF ≤40%), 42% in HF with borderline EF (LVEF, 41%-49%), and 31% in HF with preserved EF (LVEF ≥50%). After multivariable adjustment, patients who received testing for CAD, compared with those who did not, were younger and more likely to be male, have a smoking history, have hyperlipidemia, and have HF with reduced ejection fraction or HF with borderline ejection fraction (all P<0.05). CONCLUSIONS: The majority of patients hospitalized for new-onset HF did not receive testing for CAD either during the hospitalization or in the 90 days before and after. The rates of testing for CAD were higher in patients with LVEF ≤40% though remained low. These data highlight an opportunity to improve care by identifying appropriate candidates for optimal CAD medical therapy and revascularization.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Técnicas de Diagnóstico Cardiovascular/normas , Fidelidade a Diretrizes/normas , Insuficiência Cardíaca/diagnóstico , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/fisiopatologia , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Masculino , Medicare , Valor Preditivo dos Testes , Sistema de Registros , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Estados Unidos/epidemiologia , Função Ventricular Esquerda
20.
Circ Cardiovasc Interv ; 13(2): e008445, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32069111

RESUMO

BACKGROUND: Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and longitudinal follow-up data are sparse. We aim to evaluate outcomes in a prospective study of anomalous aortic origin of CA patients following a standardized algorithm. METHODS: Patients with anomalous aortic origin of a CA were followed prospectively from December 2012 to April 2017. All patients were evaluated following a standardized algorithm, and data were reviewed by a dedicated multidisciplinary team. Assessment of myocardial perfusion was performed using stress imaging. High-risk patients (high-risk anatomy-anomalous left CA from the opposite sinus, presence of intramurality, abnormal ostium-and symptoms or evidence of myocardial ischemia) were offered surgery or exercise restriction (if deemed high risk for surgical intervention). Univariate and multivariable analyses were used to determine predictors of high risk. RESULTS: Of 201 patients evaluated, 163 met inclusion criteria: 116 anomalous right CA (71%), 25 anomalous left CA (15%), 17 single CA (10%), and 5 anomalous circumflex CA (3%). Patients presented as an incidental finding (n=80, 49%), with exertional (n=31, 21%) and nonexertional (n=32, 20%) symptoms and following sudden cardiac arrest/shock (n=5, 3%). Eighty-two patients (50.3%) were considered high risk. Predictors of high risk were older age at diagnosis, black race, intramural course, and exertional syncope. Most patients (82%) are allowed unrestrictive sports activities. Forty-seven patients had surgery (11 anomalous left CA and 36 anomalous right CA), 3 (6.4%) remained restricted from sports activities. All patients are alive at a median follow-up of 1.6 (interquartile range, 0.7-2.8) years. CONCLUSIONS: In this prospective cohort of patients with anomalous aortic origin of a CA, most have remained free of exercise restrictions. Development of a multidisciplinary team has allowed a consistent approach and may have implications in risk stratification and long-term prognosis.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/prevenção & controle , Técnicas de Diagnóstico Cardiovascular , Exercício Físico , Adolescente , Algoritmos , Cateterismo Cardíaco , Criança , Pré-Escolar , Tomada de Decisão Clínica , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Morte Súbita Cardíaca/etiologia , Técnicas de Apoio para a Decisão , Teste de Esforço , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Imagem de Perfusão do Miocárdio , Equipe de Assistência ao Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
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