Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.863
Filtrar
1.
REME rev. min. enferm ; 24: e-1275, fev.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1051265

RESUMO

Objetivo: identificar os fatores de riscos modificáveis de pacientes com hipertensão arterial sistêmica e relacioná-los às características sociodemográficas e clínicas. Métodos: estudo transversal e correlacional realizado em pacientes com hipertensão arterial sistêmica. Os fatores de risco analisados foram obesidade, consumo excessivo de sal, sedentarismo, consumo de bebida alcoólica, tabagismo, estresse e apneia do sono. A obesidade foi analisada pelo índice de massa corporal e medida da circunferência abdominal, o consumo de sal e o sedentarismo pelo relato dos pacientes, as desordens relacionadas ao consumo de álcool pelo Alcohol Use Disorders Indentification Test, o tabagismo pelo relato dos pacientes e pelo Questionário de Fagerström, o estresse pela Escala de Estresse Percebido e a apneia do sono pelo Questionário de Berlim. As variáveis sociodemográficas e clínicas analisadas foram idade, sexo, raça, escolaridade, estado civil, renda familiar, moradia, número de filhos e de conviventes e ocupação profissional. Resultados: foram avaliados 106 pacientes; 85 eram obesos, 73 sedentários, 71 apresentavam alto risco para apneia obstrutiva do sono e 25 faziam uso de álcool. A média do escore de desordens devido ao álcool foi de 0,83+2,8 pontos, do consumo de sal foi de 3,95 gramas, do estresse foi de 14,2+7,6 pontos e da dependência de nicotina foi de 3,00+1,7 pontos. Obesidade, sedentarismo, uso de bebida alcoólica, consumo de sal e estresse relacionaram-se a algumas variáveis sociodemográficas. Conclusão: ações preventivas devem ser adotadas para que haja mudança no estilo de vida desses pacientes e, consequentemente, redução de complicações e de outras doenças cardiovasculares.(AU)


Objective: to identify the modifiable risk factors of patients with systemic arterial hypertension and to relate them to sociodemographic and clinical characteristics. Methods: cross-sectional and correlational study carried out in patients with systemic arterial hypertension. The risk factors analyzed were obesity, excessive salt consumption, physical inactivity, alcohol consumption, smoking, stress and sleep apnea. Obesity was analyzed by body mass index and measurement of waist circumference, salt consumption and physical inactivity by patients' reports, disorders related to alcohol consumption by the Alcohol Use Disorders Identification Test, smoking by patients' reports and Fagerström Questionnaire, stress by the Perceived Stress Scale and sleep apnea by the Berlin Questionnaire. The sociodemographic and clinical variables analyzed were age, sex, race, education, marital status, family income, housing, number of children and cohabitants and professional occupation. Results: 106 patients were evaluated; 85 were obese, 73 were sedentary, 71 were at high risk for obstructive sleep apnea and 25 were using alcohol. The average score of disorders due to alcohol was...(AU)


Objetivo: identificar los factores de riesgo modificables de pacientes con hipertensión arterial sistémica y relacionarlos con características sociodemográficas y clínicas. Métodos: estudio transversal y correlacional realizado en pacientes con hipertensión arterial sistémica. Los factores de riesgo analizados fueron obesidad, consumo excesivo de sal, inactividad física, consumo de alcohol, tabaquismo, estrés y apnea del sueño. La obesidad se analizó mediante el índice de masa corporal y la medición de la circunferencia de la cintura, el consumo de sal y la inactividad física según los informes de los pacientes, los trastornos relacionados con el consumo de alcohol mediante el test para la identificación de trastornos por uso de alcohol (AUDIT), el tabaquismo según los informes de los pacientes y el cuestionario de Fagerström, estrés por la escala de estrés percibido y apnea del sueño por el cuestionario de Berlín. Las variables sociodemográficas y clínicas analizadas fueron edad, sexo, raza, educación, estado civil, ingresos familiares, vivienda, número de hijos y convivientes y ocupación profesional. Resultados: se evaluaron 106 pacientes; 85 eran obesos, 73 eran sedentarios, 71 tenían un alto riesgo de apnea obstructiva del sueño y 25 usaban alcohol. El puntaje promedio de los trastornos debidos al alcohol fue de 0,83 + 2,8 puntos, el consumo de sal fue de 3,95 gramos, el estrés fue de 14,2 + 7, 6 puntos y la dependencia de la nicotina fue 3,00 + 1,7 puntos. La obesidad, la inactividad física, el uso de alcohol, el consumo de sal y el estrés se relacionaron con algunas variables sociodemográficas. Conclusión: deben tomarse medidas preventivas para cambiar el estilo de vida de estos pacientes y, en consecuencia, reducir las complicaciones y demás enfermedades cardiovasculares. (AU)


Assuntos
Humanos , Masculino , Feminino , Fatores de Risco , Enfermagem Cardiovascular , Hipertensão , Hipertensão/prevenção & controle , Fatores Socioeconômicos , Técnicas de Diagnóstico Cardiovascular
2.
Presse Med ; 48(12): 1387-1392, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31679896

RESUMO

The GERS-P (Exercise Rehabilitation Sports Prevention Group of the French Society of Cardiology) has decided to update current guidelines regarding the practice of EKG stress tests. Since the last update dates from 1997, the GERS judged it necessary to integrate data from new works and advancements made in the last 20 years. Good clinical practices and safety conditions are better defined regarding the structure, location, material, staff competency, as well as convention with hospital structures. The diagnosis of coronary artery disease remains the principal indication for a stress test. Interpretation of the results is crucial - it must be multivariate and provide either a low, intermediate or strong probability of the existence of coronary lesions, taking into account the studied population (risk factors, age, sex and symptoms). We no longer have to talk about a "positive, negative or litigious" test. Several new indications for a stress test have been defined for the assessment of cardiac pathologies. With such indications, the use of gas expiration measurements is highly recommended in order to provide a precise prognosis for all the various cardiac pathologies : congenital, ischemic, valvular, cardiomyopathy, congestive heart failure, rhythm and conduction disorders, pacemaker fine-tuning, or pulmonary hypertension. Indications for stress tests and contraindications are defined according to different population subgroups, for instance : athletes, women, children, the elderly, asymptomatic patients, diabetics, hypertensive patients, peripheral arteritis disease patients, or in the context of a non-cardiac surgery pre-op visit. The new guidelines are considerably different from those dating from 1997 and further pinpoint the relevance and importance of an EKG stress test within the arsenal of complementary cardiologic exams. With the improvements made in providing diagnostic value in CAD, as well as better prognostic value for any underlying pathology, the indication for an EKG stress test has extended to all cardiovascular disease.


Assuntos
Cardiologia/normas , Teste de Esforço/normas , Cardiologia/organização & administração , Doença da Artéria Coronariana/diagnóstico , Técnicas de Diagnóstico Cardiovascular/normas , Exercício/fisiologia , Teste de Esforço/métodos , Humanos , Prognóstico , Sociedades Médicas/normas
3.
Arq. bras. med. vet. zootec. (Online) ; 71(5): 1506-1512, set.-out. 2019. tab
Artigo em Português | LILACS, VETINDEX | ID: biblio-1038670

RESUMO

A degeneração mixomatosa valvar mitral (DMVM) costuma ser diagnosticada pelo ecocardiograma, porém o eletrocardiograma (ECG) pode sugerir alterações específicas e auxiliar no diagnóstico e no tratamento. A deflexão intrinsecóide (DI) é uma medida simples do ECG, que representa o início da despolarização ventricular e pode indicar a presença de sobrecargas e hipertrofia no ventrículo esquerdo. O objetivo deste trabalho é comparar dados prévios sobre condição clínica e ecocardiograma de cães com endocardiose de mitral e o valor da deflexão intrinsecóide do ECG, para buscar uma relação de concordância. Foram selecionados os arquivos de 45 cães anteriormente atendidos na rotina clínica do HV-UPFR. A estatística mostrou diferença relevante nos grupos B1, B2 e C nas derivações D2, D3, aVF, rV, V2 e V4 (P<0,05), o que permitiu classificá-los de acordo com o tamanho da DI, e esse resultado correspondeu à classificação do consenso de endocardiose de mitral em cães nesses estágios. Concluiu-se que há um aumento gradativo no valor da DI à medida que a DMVM avança, principalmente nos estágios B1, B2 e C, associado à sobrecarga e à hipertrofia ventricular esquerda, portanto esse parâmetro pode ser usado na classificação da doença.(AU)


The mitral valve myxomatous degeneration (DMVM) is usually diagnosed by echocardiography, however, electrocardiogram (ECG) may suggest specific alterations and aid diagnosis and treatment. Intrinsicoid deflection (DI) is a simple ECG measure that represents the onset of ventricular depolarization and may indicate the presence of overload and hypertrophy in the left ventricle. The objective of this study is to compare previous data on clinical condition and echocardiogram of dogs with mitral endocardiosis and the value of the intrinsicoid deflection from ECG to obtain a concordance relation. The archives of 45 previously examined dogs in the clinical routine of HV-UFPR were selected. The statistic showed a significant difference in groups B1, B2 and C in leads D2, D3, aVF, rV, V2 and V4 (P< 0,05), which allowed to classify them according to the DI size, and this result corresponded to the consensus classification of mitral endocardiosis in dogs at these stages. It was concluded that there is a gradual increase in the value of DI as DMVM progresses, especially in stages B1, B2 and C, associated with left ventricular overload and hypertrophy, so this parameter can be used to classify the disease.(AU)


Assuntos
Animais , Cães , Técnicas de Diagnóstico Cardiovascular/veterinária , Eletrocardiografia/veterinária , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/veterinária , Valva Mitral
4.
Presse Med ; 48(12): 1393-1400, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31471091

RESUMO

An ECG is recommended by the French Society of Cardiology in the screening of a competitive athlete. An intense and prolonged physical activity (>4 hours of intense sport/week) can lead to a physiological electric remodeling. In addition to physical activity (type, intensity, duration), the ECG should be interpreted according to the athlete's ethnicity and age. It is necessary to know the physiological modifications related to sport practice to avoid either false reassurances or the realization of unjustified additional examinations because of a wrong interpretation. The latest athlete ECG classification published in 2017 can be used to identify in which athlete additional tests are recommended (figure 1).


Assuntos
Atletas , Eletrocardiografia , Cardiopatias/diagnóstico , Esportes , Cardiologia/métodos , Cardiologia/normas , Diagnóstico Diferencial , Técnicas de Diagnóstico Cardiovascular/normas , Eletrocardiografia/métodos , Eletrocardiografia/normas , Exercício/fisiologia , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Padrões de Referência , Esportes/normas
5.
Presse Med ; 48(12): 1439-1444, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31471092

RESUMO

Malignant hypertension has not disappeared, it has been forgotten. Its incidence is increasing again. It considerably worsens the prognosis of young patients (35 to 55 years old on average). There might be susceptibility factors, several hypotheses are under study. New diagnostic criteria and therapeutic options have been proposed and will have to be validated. Faced with these important challenges for patients, the first prospective multicentric register on this pathology will be set up in France in September 2019.


Assuntos
Hipertensão Maligna , Técnicas de Diagnóstico Cardiovascular/tendências , Suscetibilidade a Doenças/epidemiologia , França/epidemiologia , Humanos , Hipertensão Maligna/diagnóstico , Hipertensão Maligna/epidemiologia , Hipertensão Maligna/terapia , Incidência , Prognóstico , Sistema de Registros
6.
Semin Vasc Surg ; 32(1-2): 41-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540656

RESUMO

Diagnostic testing performed in the noninvasive vascular laboratory is a cornerstone of care for patients with suspected or known vascular disease. The Society for Vascular Surgery has mandated that vascular surgery resident training include mentored experience in performing vascular laboratory testing and interpreting its results. The trainee should be experienced with vascular laboratory instrumentation and testing protocols, be knowledgeable in ultrasound imaging of vascular anatomy, and be competent to classify disease severity relevant to the study indication. The scope of test interpretation should include peripheral arterial, peripheral venous, cerebrovascular, and visceral abdominal testing using duplex ultrasound supplemented by indirect physiologic testing for peripheral arterial and venous disease. The emergence of endovascular therapy has expanded duplex ultrasound applications in the areas of screening, procedural imaging, and surveillance following intervention. Pre-procedure testing to assess disease location and severity, and vein mapping for dialysis access or extremity bypass grafting provide important patient-specific information that can reduce the need for more invasive vascular imaging. It is recommended that trainees acquire the hand-on skills to perform duplex testing in vascular clinic and inpatient sites, such as the emergency department and operating room. Training programs should have a structured vascular laboratory curriculum that documents annual educational milestones that encompass both test interpretation aptitude and hands-on duplex scanning skills. Before completion of training, the resident should acquire documented experience in test interpretation sufficient to take the Physician Vascular Interpretation examination, which is required for American Board of Surgery certification as a vascular surgeon.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/cirurgia , Técnicas de Diagnóstico Cardiovascular , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Tomada de Decisão Clínica , Currículo , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
7.
Int J Comput Assist Radiol Surg ; 14(10): 1775-1784, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31367806

RESUMO

PURPOSE: Digital subtraction angiography (DSA) is a powerful technique for diagnosing cardiovascular disease. In order to avoid image artifacts caused by patient movement during imaging, we take deep learning-based methods to generate DSA image from single live image without the mask image. METHODS: Conventional clinical DSA datasets are acquired with a standard injection protocol. More than 600 sequences obtained from more than 100 subjects were used for head and leg experiments. Here, the residual dense block (RDB) is adopted to generate DSA image from single live image directly, and RDBs can extract high-level features by dense connected layers. To obtain better vessel details, a supervised generative adversarial network strategy is also used in the training stage. RESULTS: The human head and leg experiments show that the deep learning methods can generate DSA image from single live image, and our method can do better than other models. Specifically, the DSA image generating with our method contains less artifact and is suitable for diagnosis. We use metrics including PSNR, SSIM and FSIM, which can reach 23.731, 0.877 and 0.8946 on the head dataset and 26.555, 0.870 and 0.9284 on the leg dataset. CONCLUSIONS: The experiment results show the model can extract the vessels from the single live image, thus avoiding the image artifacts obtained by subtracting the live image and the mask image. And our method has a better performance than other methods we have tried on this task.


Assuntos
Angiografia Digital/métodos , Aprendizado Profundo , Técnicas de Diagnóstico Cardiovascular , Processamento de Imagem Assistida por Computador/métodos , Artefatos , Humanos
9.
Int J Comput Assist Radiol Surg ; 14(10): 1785-1794, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31286396

RESUMO

PURPOSE: We aim to perform generation of angiograms for various vascular structures as a mean of data augmentation in learning tasks. The task is to enhance the realism of vessels images generated from an anatomically realistic cardiorespiratory simulator to make them look like real angiographies. METHODS: The enhancement is performed by applying the CycleGAN deep network for transferring the style of real angiograms acquired during percutaneous interventions into a data set composed of realistically simulated arteries. RESULTS: The cycle consistency was evaluated by comparing an input simulated image with the one obtained after two cycles of image translation. An average structural similarity (SSIM) of 0.948 on our data sets has been obtained. The vessel preservation was measured by comparing segmentations of an input image and its corresponding enhanced image using Dice coefficient. CONCLUSIONS: We proposed an application of the CycleGAN deep network for enhancing the artificial data as an alternative to classical data augmentation techniques for medical applications, particularly focused on angiogram generation. We discussed success and failure cases, explaining conditions for the realistic data augmentation which respects both the complex physiology of arteries and the various patterns and textures generated by X-ray angiography.


Assuntos
Angiografia/métodos , Técnicas de Diagnóstico Cardiovascular , Processamento de Imagem Assistida por Computador/métodos , Humanos
10.
PLoS One ; 14(7): e0218874, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276508

RESUMO

INTRODUCTION: Tissue Phase Mapping (TPM) MRI can accurately measure regional myocardial velocities and strain. The lengthy data acquisition, however, renders TPM prone to errors due to variations in physiological parameters, and reduces data yield and experimental throughput. The purpose of the present study is to examine the quality of functional measures (velocity and strain) obtained by highly undersampled TPM data using compressed sensing reconstruction in infarcted and non-infarcted rat hearts. METHODS: Three fully sampled left-ventricular short-axis TPM slices were acquired from 5 non-infarcted rat hearts and 12 infarcted rat hearts in vivo. The datasets were used to generate retrospectively (simulated) undersampled TPM datasets, with undersampling factors of 2, 4, 8 and 16. Myocardial velocities and circumferential strain were calculated from all datasets. The error introduced from undersampling was then measured and compared to the fully sampled data in order to validate the method. Finally, prospectively undersampled data were acquired and compared to the fully sampled datasets. RESULTS: Bland Altman analysis of the retrospectively undersampled and fully sampled data revealed narrow limits of agreement and little bias (global radial velocity: median bias = -0.01 cm/s, 95% limits of agreement = [-0.16, 0.20] cm/s, global circumferential strain: median bias = -0.01%strain, 95% limits of agreement = [-0.43, 0.51] %strain, all for 4x undersampled data at the mid-ventricular level). The prospectively undersampled TPM datasets successfully demonstrated the feasibility of method implementation. CONCLUSION: Through compressed sensing reconstruction, highly undersampled TPM data can be used to accurately measure the velocity and strain of the infarcted and non-infarcted rat myocardium in vivo, thereby increasing experimental throughput and simultaneously reducing error introduced by physiological variations over time.


Assuntos
Coração/diagnóstico por imagem , Coração/fisiologia , Imagem Cinética por Ressonância Magnética/métodos , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Algoritmos , Animais , Simulação por Computador , Técnicas de Diagnóstico Cardiovascular/estatística & dados numéricos , Testes de Função Cardíaca/instrumentação , Testes de Função Cardíaca/métodos , Imagem Cinética por Ressonância Magnética/estatística & dados numéricos , Masculino , Miocárdio/patologia , Ratos Wistar , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
11.
Med. infant ; 26(2): 197-204, Junio 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1021613

RESUMO

Los innegables progresos en la supervivencia de los pacientes con cardiopatía congénita en los últimos años fue acompañado de los avances en todas las áreas concurrentes a la cirugía cardiovascular, incluyendo la recuperación y los métodos diagnósticos que permiten una mejor comprensión de la patología cardíaca congénita o adquirida. La velocidad con que se desarrollan estas herramientas en el arsenal médico, exige una mejor comprensión a la hora de definir la estrategia diagnóstica para cada paciente en particular. Tradicionalmente, las imágenes diagnósticas de las cardiopatías congénitas eran dominio de la ecocardiografía y el cateterismo. En los últimos 10 años, la Resonancia y la Tomografía Computada fueron ganando terreno. La principal ventaja de la Resonancia es que no utiliza Rayos X para obtener las imágenes, diferencia de la angiografía por cateterismo y la tomografía axial computada. La resonancia magnética cardíaca se ha convertido en una herramienta importante para evaluar la enfermedad cardíaca congénita y también la adquirida en niños y adultos. La variedad y complejidad de la patología y sus posibilidades quirúrgicas hace indispensable la presencia del cardiólogo infantil durante la adquisición de las imágenes y su post procesamiento. En esta sección se presentarán algunas de las herramientas o secuencias que utiliza la Resonancia Magnética Cardíaca y su utilización práctica en el diagnóstico de las cardiopatías más frecuentes (AU)


The undeniable progress in survival of patients with congenital heart defects in recent years has been accompanied by advances in all areas related to cardiovascular surgery, including recovery and diagnostic methods that allow for a better understanding of congenital or acquired heart disease. The speed with which these tools are developed in the medical arsenal requires a better understanding when defining the diagnostic strategy for each individual patient. Traditionally, diagnostic images of choice for congenital heart disease were echocardiography and catheterization. Over the last 10 years, MRI. and CT scan have become more important. The main advantage of MRI is that it does not use X-rays to obtain the images, unlike catheterization and computed tomography angiogram. Cardiac MRI has become an important tool for assessing congenital and acquired heart disease in children and adults. The variety and complexity of the disease and its surgical possibilities warrant the presence of the child cardiologist during imaging acquisition and processing. This section will present some of the MRI tools and sequences and their practical use in the diagnosis of the most common heart diseases (AU)


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Imagem por Ressonância Magnética/instrumentação , Imagem por Ressonância Magnética/tendências , Cardiopatias Congênitas/diagnóstico por imagem , Cardiomiopatias/diagnóstico por imagem , Técnicas de Diagnóstico Cardiovascular
12.
PLoS Med ; 16(5): e1002805, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31112552

RESUMO

BACKGROUND: Effective management of heart failure is complex, and ensuring evidence-based practice presents a major challenge to health services worldwide. Over the past decade, the United Kingdom introduced a series of national initiatives to improve evidence-based heart failure management, including a landmark pay-for-performance scheme in primary care and a national audit in secondary care started in 2004 and 2007, respectively. Quality improvement efforts have been evaluated within individual clinical settings, but patterns of care across its continuum, although a critical component of chronic disease management, have not been studied. We have designed this study to investigate patients' trajectories of care around the time of diagnosis and their variation over time by age, sex, and socioeconomic status. METHODS AND FINDINGS: For this retrospective population-based study, we used linked primary and secondary health records from a representative sample of the UK population provided by the Clinical Practice Research Datalink (CPRD). We identified 93,074 individuals newly diagnosed with heart failure between 2002 and 2014, with a mean age of 76.7 years and of which 49% were women. We examined five indicators of care: (i) diagnosis care setting (inpatient or outpatient), (ii) posthospitalisation follow-up in primary care, (iii) diagnostic investigations, (iv) prescription of essential drugs, and (v) drug treatment dose. We used Poisson and linear regression models to calculate category-specific risk ratios (RRs) or adjusted differences and 95% confidence intervals (CIs), adjusting for year of diagnosis, age, sex, region, and socioeconomic status. From 2002 to 2014, indicators of care presented diverging trends. Outpatient diagnoses and follow-up after hospital discharge in primary care declined substantially (ranging from 56% in 2002 to 36% in 2014, RR 0.64 [0.62, 0.67] and 20% to 14%, RR 0.73 [0.65, 0.82], respectively). Primary care referral for diagnostic investigations and appropriate initiation of beta blockers and angiotensin-converting-enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) both increased significantly (37% versus 82%, RR 2.24 [2.15, 2.34] and 18% versus 63%, RR 3.48 [2.72, 4.43], respectively). Yet, the average daily dose prescribed remained below guideline recommendations (42% for ACE-Is or ARBs, 29% for beta blockers in 2014) and was largely unchanged beyond the first 30 days after diagnosis. Despite increasing rates of treatment initiation, the overall dose prescribed to patients in the 12 months following diagnosis improved little over the period of study (adjusted difference for the combined dose of beta blocker and ACE-I or ARB: +6% [+2%, +10%]). Women and patients aged over 75 years presented significant gaps across all five indicators of care. Our study was limited by the available clinical information, which did not include exact left ventricular ejection fraction values, investigations performed during hospital admissions, or information about follow-up in community heart failure clinics. CONCLUSIONS: Management of heart failure patients in the UK presents important shortcomings that affect screening, continuity of care, and medication titration and disproportionally impact women and older people. National reporting and incentive schemes confined to individual clinical settings have been insufficient to identify these gaps and address patients' long-term care needs.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Técnicas de Diagnóstico Cardiovascular/tendências , Disparidades em Assistência à Saúde/tendências , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Padrões de Prática Médica/tendências , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos , Feminino , Pesquisas sobre Serviços de Saúde , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Lacunas da Prática Profissional/tendências , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Classe Social , Fatores de Tempo , Resultado do Tratamento , Reino Unido/epidemiologia
13.
Turk J Med Sci ; 49(3): 844-853, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31121997

RESUMO

Background/aim: Evaluating the relationship of patellar chondromalacia with obesity, infrapatellar fat pad (IFP) volume and popliteal artery intima-media thickness (IMT). Materials and methods: A total of203 patients with different degree of patellar chondromalacia (103 male, 100 female) and 52 control subjects (19 male, 33 female) were included and grouped according to sex, age, body surface area (BSA), body mass index (BMI) and patellar chondromalacia classification. All measurements were completed with 3T magnetic resonance imaging (MRI). Articular cartilage and IFP volume were measured in saggital plane using double echo steady state (DESS) and DIXON sequences, respectively. Patellar cartilage damage was graded using modified outerbridge classification, and the relations among cartilage volume and BMI, BSA, IFP, IMT were statistically assessed. Results: Popliteal artery IMT showed an independent association with the prevalence of cartilage defects and IFP volumes (P ˂ 0.001). There was an association between BMI and IFP volumes (P ˂ 0.001). However, no differences were observed between IFP volume and different chondromalacia groups. When IFP measurements were corrected using individual BMI and BSA values, a positive correlation was found between control and advanced chondromalacia groups (P ˂ 0.001). Conclusion: This study demonstrates the relationship among obesity, IMT and chondromalacia and highlights this potential circle to develop effective treatments and inhibit the progression of chondromalacia.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Índice de Massa Corporal , Doenças das Cartilagens , Patela , Artéria Poplítea/diagnóstico por imagem , Adulto , Idoso , Doenças das Cartilagens/complicações , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/fisiopatologia , Técnicas de Diagnóstico Cardiovascular , Feminino , Humanos , Joelho/diagnóstico por imagem , Joelho/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico por imagem , Patela/diagnóstico por imagem , Patela/fisiopatologia , Artéria Poplítea/fisiologia , Adulto Jovem
15.
Can J Cardiol ; 35(3): 260-269, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30825948

RESUMO

Antiretroviral therapy (ART) has been pivotal in prolonging the lifespan of people living with HIV (PLWH). However, this also simultaneously increases their risk of cardiovascular disease (CVD) either related to ART, aging, hypertension, immunosenescence, inflammation, immune activation, or other comorbidities. Although the use of risk markers has greatly enhanced the field of cardiovascular (CV) medicine and improved the prognosis and early diagnosis in the general population, this strategy has not been clearly elucidated in PLWH. Developing accurate risk algorithms for PLWH requires an innate understanding of mechanistic factors influencing their risks. Early identification of CV risk will significantly enhance the prospects of PLWH living longer and relatively healthily. Herein, we discuss the use of multimodality noninvasive CV imaging as robust markers for ameliorating CV risk. The ability to prognosticate CV risk and hence prevent CV events in PLWH would represent an important advance in CV medicine, allowing precise detection and early institution of preventative strategies. Using novel CV imaging modalities and strategies would have a positive impact on precision medicine in this patient cohort.


Assuntos
Doenças Cardiovasculares , Técnicas de Diagnóstico Cardiovascular , Infecções por HIV/complicações , Medição de Risco , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Diagnóstico Precoce , Infecções por HIV/tratamento farmacológico , Humanos , Prognóstico , Medição de Risco/métodos , Medição de Risco/tendências
17.
Expert Rev Cardiovasc Ther ; 17(4): 305-318, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30916592

RESUMO

INTRODUCTION: The cold pressor test (CPT) is a common and extensively validated test, which induces systemic stress involving immersion of an individual's hand in ice water (normally temperature between 0 and 5 degrees Celsius) for a period of time. CPT has been used in various fields, like examining effects of stress on memory, decision-making, pain and cardiovascular health. Areas covered: In terms of cardiovascular health, current research is mainly interested in predicting the occurrence of cardiovascular (CV) events. The objective of this review is to give an overview of the history and methodology of the CPT, and clinical utility in possibly predicting CV events in CAD and other atherosclerotic diseases. Secondly, we will discuss possible future applications of the CPT in clinical care. Expert opinion: An important issue to address is the fact that the physiology of the CPT is not fully understood at this moment. As pointed out multiple mechanisms might be responsible for contributing to either coronary vasodilatation or coronary vasoconstriction. Regarding the physiological mechanism of the CPT and its effect on the measurements of the carotid artery reactivity even less is known.


Assuntos
Doenças Cardiovasculares/diagnóstico , Temperatura Baixa , Sistema Cardiovascular/fisiopatologia , Técnicas de Diagnóstico Cardiovascular , Previsões , Humanos , Valor Preditivo dos Testes , Estresse Fisiológico
18.
Diabetes Metab Res Rev ; 35(5): e3145, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30790434

RESUMO

BACKGROUND: Risk factors included in the cardiovascular (CHA2 DS2 -VASc) score, currently used for atrial fibrillation (AF), may predispose to cardiovascular events whether or not AF is present. The aim was to explore the predictive role of CHA2 DS2 -VASc score on cardiovascular outcomes in diabetic patients without AF. METHODS: We accessed individual data from 610 diabetic patients without AF at baseline included in the prospective cohort of the Malmö Diet and Cancer study. Main outcome measure was the occurrence of cardiovascular events (stroke, coronary events) and death. Mean follow-up was 14.5 ± 5 years (8845 person/years). RESULTS: The CHA2 DS2 -VASc score significantly predicted the risk of all outcome measures. There was a significant increase in stroke, coronary events, and death risk by each point of CHA2 DS2 -VASc score elevation [stroke: adjusted hazard ratio (aHR) 1.43, 95% CI 1.14-1.79, P = 0.001; coronary events: aHR 1.55, 95% CI 1.34-1.80, P < 0.0001; death: aHR 1.94, 95% CI 1.71-2.21, P < 0.0001]. A CHA2 DS2 -VASc score ≥4 was associated with higher incidence of ischemic stroke (aHR 1.47, 95% CI 1.18-1.82; P = 0.001), coronary events (aHR 1.32; 95% CI 1.11-1.58; P = 0.002), and death (aHR 1.36; 95% CI 1.20-1.54; P < 0.001). CONCLUSIONS: In this population-based study on diabetic patients without AF, the CHA2 DS2 -VASc score was an independent predictor of ischemic stroke, coronary events, and overall mortality. Regardless of the AF status, the CHA2 DS2 -VASc score might represent a rapid and user-friendly tool for clinical assessment of diabetic patients at higher cardiovascular risk.


Assuntos
Doenças Cardiovasculares/diagnóstico , Sistema Cardiovascular/fisiopatologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Técnicas de Diagnóstico Cardiovascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/fisiopatologia , Técnicas de Diagnóstico Endócrino , Feminino , Seguimentos , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Projetos de Pesquisa , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Suécia/epidemiologia
19.
JAMA Netw Open ; 2(2): e188023, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30768193

RESUMO

Importance: The interplay of self-rated health (SRH), coronary artery calcium (CAC) scores, and cardiovascular risk is poorly described. Objectives: To assess the degree of correlation between SRH and CAC, to determine whether these measures are complementary for risk prediction, and to assess the incremental value of the addition of SRH to established risk tools. Design, Setting, and Participants: The Multi-Ethnic Study of Atherosclerosis (MESA) is a large population-based prospective cohort study of adults aged 45 to 84 years who were recruited from 6 US communities. A total of 6764 participants without baseline cardiovascular disease (CVD) were included in the analysis. Data were collected from July 2000 through August 2002. Follow-up was completed by December 2013, and data were analyzed from October 2018 to December 2018. Exposures: The EVGGFP (excellent, very good, good, fair, and poor) self-assessment of overall health (assessed before the baseline study examination) and CAC score. The EVGGFP rating was categorized as poor/fair, good, very good, or excellent. Main Outcomes and Measures: Hard coronary heart disease (CHD) events, hard CVD events, and all-cause mortality during a median follow-up of 13.2 years (interquartile range, 12.7-13.7 years). Results: Among the study population of 6764 participants, the mean (SD) age was 62.1 (10.2) years, and 52.9% were women. The EVGGFP rating was strongly associated with age, sex, race/ethnicity, educational and income levels, healthy diet and physical activity, and cardiovascular risk factors. Despite encapsulating many risk variables, no correlation (r = -0.007; P = .57) or association between EVGGFP and the presence (χ2 = 0.84; P = .84) or severity (χ2 = 4.64; P = .86) of CAC was found. During follow-up, 1161 deaths, 637 hard CVD events, and 405 hard CHD events were recorded. In models adjusted for age, sex, race/ethnicity, and CAC, participants who reported excellent health had a 45% lower risk of CVD (hazard ratio [HR], 0.55; 95% CI, 0.39-0.77) and a 42% lower risk of CHD (HR, 0.58; 95% CI, 0.37-0.90) compared with those who reported poor/fair health. Participants in the excellent SRH category who had any CAC had markedly elevated risk of hard CHD (HR, 6.19; 95% CI, 2.1-18.3) and CVD (HR, 6.50; 95% CI, 2.7-15.6) events compared with those with a CAC score of 0. The addition of the EVGGFP rating to CAC improved the area under the curve (C statistic) for CHD events (0.725 vs 0.734; P = .007), CVD events (0.693 vs 0.706; P < .001), and all-cause mortality (0.685 vs 0.707; P < .001). However, the addition of the EVGGFP rating to the combination of CAC and atherosclerotic CVD risk score did not significantly improve C statistics for CHD events (0.751 vs 0.753; P = .39), CVD events (0.739 vs 0.741; P = .18), or all-cause mortality (0.779 vs 0.781; P = .13). Conclusions and Relevance: Although SRH and CAC integrate many risk variables, this study suggests that they are poorly correlated and have complementary predictive utility. A perception of excellent health does not obviate the need for definitive assessment of CVD risk, whereas fair/poor perceived health may serve as a risk enhancer, arguing for advanced risk assessment in selected clinical scenarios.


Assuntos
Aterosclerose/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Nível de Saúde , Calcificação Vascular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Técnicas de Diagnóstico Cardiovascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Calcificação Vascular/diagnóstico
20.
Ann Vasc Surg ; 59: 12-15, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30769059

RESUMO

BACKGROUND: Routine laboratory testing to rule out myocardial infarction (MI) after carotid endarterectomy (CEA) is common in many centers. Its use in this patient population has not been thoroughly investigated. We hypothesize that routine testing for MI in post-CEA patients is of low yield and not cost-effective. METHODS: A retrospective review of 291 consecutive CEAs from February 2011 to July 2015 was performed. Two patients were excluded: one for postoperative noncardiac death and one for preoperative MI. Patient demographics, medications, medical history, type of anesthesia, and postoperative laboratory results were reviewed. All patients had troponin-I and creatine kinase-MB levels taken postoperatively. A patient was judged to have an MI if troponin-I was greater than or equal to 0.6 ng/mL or CK-MB is >6.3 ng/mL. The incidence of postoperative MI was recorded, and a cost analysis was performed. RESULTS: The mean age was 70.2 years (range: 42-92). Of all, 59.5% were male, and 92.4% had a history of hypertension. Preoperatively, 57.4% were on beta-blocker therapy, 86.5% on aspirin, and 52.2% on both. Most (80.6%) were on preoperative statin therapy, 26.9% had a prior history of MI (37.2% within 5 years of surgery), and 56.4% of patients had a prior coronary intervention (27.6% percutaneous, 28.7% coronary artery bypass grafting, and 11% both). All patients received general anesthesia. The mean procedure time was 121.5 min (range: 62-258). The mean postoperative length of stay was 2.6 days. Eight patients (2.7%) were judged to have acute MI, one of which was symptomatic. Three of the 8 (38%) had a prior history of MI. In asymptomatic patients, the peak level of troponin-I ranges from 0.52 to 3.64 ng/mL and that of CK-MB from 11.8 to 24 ng/mL. The symptomatic patient had chest pain and bradycardia. The patient had a peak troponin-I level of 1.59 ng/mL, with a CK-MB level of 11.5 ng/mL. All patients were treated medically. The cost per troponin-I and CK-MB is $27.78 and $31.44, respectively, in our institution. We estimate that eliminating routine postoperative troponin-I and CK-MB testing in patients who underwent CEA would have saved an estimated $51,343 over the course of treatment of the studied population. CONCLUSIONS: Routine postoperative cardiac laboratory testing in asymptomatic patients after CEA increases the hospital cost. The low overall rate of postoperative MI suggests that cardiac testing is best reserved for symptomatic patients or those with clinical suspicion for MI.


Assuntos
Creatina Quinase Forma MB/sangue , Técnicas de Diagnóstico Cardiovascular , Endarterectomia das Carótidas/efeitos adversos , Infarto do Miocárdio/diagnóstico , Troponina I/sangue , Procedimentos Desnecessários , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Análise Custo-Benefício , Técnicas de Diagnóstico Cardiovascular/economia , Endarterectomia das Carótidas/economia , Feminino , Custos Hospitalares , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/economia , Infarto do Miocárdio/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Procedimentos Desnecessários/economia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA