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1.
Medicine (Baltimore) ; 99(15): e19817, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282747

RESUMO

RATIONALE: Two-dimensional echocardiography (2D echo) is a major tool for the diagnosis of Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). However 2D echo can skip regional localized anomalies of the right ventricular wall. We aimed to determine whether transesophageal and intracardiac ultrasound can provide additional information, on the right ventricular abnormalities compared to 2D echo. PATIENT CONCERNS: Case 1 is a 30-year-old patient that presented in the Emergency Department with multiple episodes of fast monomorphic ventricular tachycardia (VT) manifested by palpitations and diziness. Case 2 is a 65-year-old patient that also presented with episodes of ventircular tachycardia associated with low blood pressure. DIAGNOSIS: Both patients had a clear diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy confirmed by cardiac magnetic resonance imaging. INTERVENTION: In both patients transesophageal and intracardiac ultrasound was performed, which brought more information on the diagnosis of ARVD/C compared to transthoracic echocardiograpy. OUTCOMES: The first patient was implanted with an internal cardiac defibrillator and treated with Sotalol for VT recurrences. He presented episodes of VT during follow-up, treated with antitachycardia pacing. The second patient was implanted with an internal cardiac defibrillator and treated with Sotalol without any VT recurrence at 18 month-follow-up. LESSONS: Transesophageal echocardiography and intracardiac echocardiography can provide additional information on small, focal structural abnormalities in patients with ARVD/C: bulges, saculations, aneurysms with or without associated thrombus, partial or complete loss of trabeculations and hypertrophy of the moderator band. These changes are particularly important in cases with "concealed" form of the disease in which no morphological abnormalities are evident in transthoracic echocardiograpy.


Assuntos
Displasia Arritmogênica Ventricular Direita/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Trombose/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Antiarrítmicos/uso terapêutico , Displasia Arritmogênica Ventricular Direita/complicações , Displasia Arritmogênica Ventricular Direita/terapia , Técnicas de Imagem Cardíaca/instrumentação , Desfibriladores Implantáveis , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Recidiva , Trombose/patologia , Resultado do Tratamento , Ultrassonografia/tendências
2.
BMJ Case Rep ; 13(1)2020 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-32014988

RESUMO

We describe a case of 49-year-old man who presented with chest pain and was diagnosed with non-ST elevation myocardial infarction. Transthoracic echocardiogram (TTE) showed severe global hypokinesis of left ventricle with ejection fraction of 25%-30%. Left heart catheterisation showed severe right coronary stenosis and focal 60%-70% distal left anterior descending artery stenosis. Cardiac MRI (CMR) was done for evaluation of viability which showed a large pseudoaneurysm which was missed on TTE and left ventriculogram. Our case demonstrates the increasing importance of cardiac MRI in the diagnosis of left ventricular pseudoaneurysm. In our case left ventricular pseudoaneurysm was missed on TTE and left ventriculogram. It was diagnosed on CMR which was ordered for evaluation of myocardium viability.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Aneurisma Cardíaco/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Técnicas de Imagem Cardíaca , Dor no Peito/etiologia , Estenose Coronária/complicações , Estenose Coronária/cirurgia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Aneurisma Cardíaco/etiologia , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Resultado do Tratamento
3.
Rev. costarric. cardiol ; 21(2): 21-28, jul.-dic. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1042867

RESUMO

Resumen La ecocardiografía contrastada con solución salina agitada es una modalidad de imagen establecida. Este método es usualmente utilizado para el diagnóstico de foramen oval permeable, shunts intracardiacos, anomalías del drenaje venoso y shunts intrapulmonares. En este artículo se revisarán aspectos generales de la ecocardiografía contrastada con solución salina, así como métodos diagnósticos enfocados principalmente a la detección de la persistencia de vena cava superior izquierda y sus variantes.


Abstract Echocardiography contrasted with agitated saline solution is an established imaging modality. This method is usually used for the diagnosis of patent foramen ovale, intracardiac shunts and venous drainage abnormalities. In this article, general aspects of the echocardiography contrasted with saline solution will be reviewed, as well as diagnostic methods focused mainly on the detection of the persistence of the left superior vena cava and its variants.


Assuntos
Humanos , Veia Cava Superior , Ecocardiografia , Ecocardiografia Transesofagiana , Costa Rica , Forame Oval Patente , Técnicas de Imagem Cardíaca
4.
Presse Med ; 48(12): 1406-1415, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31761606

RESUMO

Transthoracic echocardiography remains the first-line cardiac imaging for diagnosis, management and screening of heart failure, whatever its phenotype (heart failure with reduced, mid-range and preserved ejection fraction). It allows anatomic characterization, systolic and diastolic functions of left and right ventricles assessment, intracardiac hemodynamic evaluation and for the assessment of valve disease. Myocardial deformation imaging (strain) is indicated in patients with heart failure for the assessment of systolic ventricles function and the diagnosis of specific heart diseases. Strain is indicated for the screening of preclinical myocardial dysfunction in patients at risk or exposed to cardiotoxic treatment. Altered global longitudinal strain is associated with a poor prognosis in heart failure. Cardiac magnetic resonance is recommended for the assessment of myocardial structure and function in subjects with poor acoustic window and patients with complex congenital heart diseases, in order to distinguish between ischemic and non-ischemic myocardial damage in patients with dilated cardiopathy and to characterize myocardial tissue in case of suspected specific heart disease.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Insuficiência Cardíaca/diagnóstico , Diástole , Ecocardiografia/métodos , Humanos , Imagem por Ressonância Magnética/métodos , Seleção de Pacientes , Volume Sistólico , Função Ventricular Esquerda/fisiologia
5.
Rev Esp Cardiol (Engl Ed) ; 72(12): 1065-1075, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31611150

RESUMO

There is currently no other hot topic like the ability of current technology to develop capabilities similar to those of human beings, even in medicine. This ability to simulate the processes of human intelligence with computer systems is known as artificial intelligence (AI). This article aims to clarify the various terms that still sound foreign to us, such as AI, machine learning (ML), deep learning (DL), and big data. It also provides an in-depth description of the concept of AI and its types; the learning techniques and technology used by ML; cardiac imaging analysis with DL; and the contribution of this technological revolution to classical statistics, as well as its current limitations, legal aspects, and initial applications in cardiology. To do this, we conducted a detailed PubMed search on the evolution of original contributions on AI to the various areas of application in cardiology in the last 5 years and identified 673 research articles. We provide 19 detailed examples from distinct areas of cardiology that, by using AI, have shown diagnostic and therapeutic improvements, and which will aid understanding of ML and DL methodology.


Assuntos
Algoritmos , Inteligência Artificial , Técnicas de Imagem Cardíaca/métodos , Cardiologia/métodos , Aprendizado Profundo , Aprendizado de Máquina , Humanos
6.
J Cardiovasc Med (Hagerstown) ; 20(7): 414-418, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593558

RESUMO

: The 2015 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis recommend the use of a multidisciplinary team in the care of patients with infective endocarditis. A standardized collaborative approach should be implemented in centres with immediate access to different imaging techniques, cardiac surgery and health professionals from several specialties. This position paper has been produced by the Task Force for Management of Infective Endocarditis of Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) with the aim of providing recommendations for the implementation of the Endocarditis Team within the Italian hospital network. On the basis of the Italian hospital network with many cardiology facilities encompassing a total of 405 intensive cardiac care units (ICCUs) across the country, 224 (3.68 per million inhabitants) of which have on-site 24-h PCI capability, but with relatively few centres equipped with cardiac surgery and nuclear medicine, in the present article, the SIECVI Task Force for Management of Infective Endocarditis develops the idea of a network where 'functional' reference centres act as a link with the periphery and with 'structural' reference centres. A number of minimum characteristics are provided for these 'functional' reference centres. Outcome and cost analysis of implementing an Endocarditis Team with functional referral is expected to be derived from ongoing Italian and European registries.


Assuntos
Técnicas de Imagem Cardíaca/normas , Serviço Hospitalar de Cardiologia/normas , Prestação Integrada de Cuidados de Saúde/normas , Endocardite/diagnóstico por imagem , Endocardite/terapia , Equipe de Assistência ao Paciente/normas , Regionalização/normas , Consenso , Humanos , Comunicação Interdisciplinar , Valor Preditivo dos Testes , Resultado do Tratamento
7.
Arch Cardiovasc Dis ; 112(10): 630-641, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31494082

RESUMO

Myocarditis encompasses a wide range of myocardial inflammatory diseases, including acute myocarditis, chronic myocarditis and inflammatory cardiomyopathies, and myocardial inflammation associated with other cardiomyopathies. Because of this heterogeneity in clinical presentation, and the infrequent use of endomyocardial biopsy, cardiac imaging has gradually acquired a key role in the non-invasive detection of myocardial inflammation, the assessment of aetiology and the management of specific therapies. This article summarizes the issue of myocarditis and myocardial inflammation in clinical practice, and reviews the role of different non-invasive imaging techniques in the exploration of myocardial inflammation.


Assuntos
Técnicas de Imagem Cardíaca , Cardiomiopatias/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Humanos , Miocardite/fisiopatologia , Miocardite/terapia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes
10.
Methodist Debakey Cardiovasc J ; 15(2): 99-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384372

RESUMO

The population of patients with adult congenital heart disease has grown and is currently estimated to include approximately 1 million people in the United States. Cardiologists and imagers frequently encounter complex patients who have undergone multiple prior operations and interventions. A myriad of imaging tests are currently available, including echocardiography, cardiovascular magnetic resonance imaging, and computed tomography, all of which collectively provide invaluable information on cardiac anatomy and hemodynamics. Advanced imaging plays a role in diagnosis and preprocedural planning and also determines the need and frequency of follow-up. This article provides a contemporary review of the current role of cardiac imaging in patients with complex congenital heart disease.


Assuntos
Técnicas de Imagem Cardíaca , Cardiopatias Congênitas/diagnóstico por imagem , Adulto , Fatores Etários , Ecocardiografia , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Imagem por Ressonância Magnética , Valor Preditivo dos Testes , Prognóstico , Tomografia Computadorizada por Raios X
11.
Methodist Debakey Cardiovasc J ; 15(2): 111-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384374

RESUMO

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. The pathophysiology leading to sudden cardiac death, the specific risks associated with the different varieties of AAOCA, and the effects of different management strategies on the risk of sudden cardiac death are all unknown. This article describes the current knowledge of AAOCA, a proposed nomenclature for the different anatomic subtypes, the different modalities used to diagnose and characterize the disease, the available management strategies, and an algorithm used by the authors to diagnose and manage these patients.


Assuntos
Técnicas de Imagem Cardíaca , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/prevenção & controle , Algoritmos , Tomada de Decisão Clínica , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Morte Súbita Cardíaca/etiologia , Técnicas de Apoio para a Decisão , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
12.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466973

RESUMO

Takotsubo cardiomyopathy (TC), otherwise known as stress cardiomyopathy, is characterised by acute, transient left ventricular systolic dysfunction with apical ballooning in the absence of obstructive epicardial coronary stenosis. The presentation of TC mimics that of acute myocardial infarction. More recently there has been a shift towards thinking of TC as a 'microvascular acute coronary syndrome'. Our case is of an 82-year-old woman who presented with TC mimicking acute anterior ST elevation myocardial infarction in the context of sepsis. Slow flow noted in the left anterior descending artery prompted us to perform coronary physiology. Her fractional flow reserve was 0.91, with an index of myocardial resistance of 117 and a coronary flow reserve of 1.6. In combination these results are indicative of microvascular coronary dysfunction in the absence of significant epicardial stenosis.


Assuntos
Angina Microvascular/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Doença Aguda , Idoso de 80 Anos ou mais , Técnicas de Imagem Cardíaca , Angiografia Coronária , Ecocardiografia , Evolução Fatal , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Angina Microvascular/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Sepse/complicações , Cardiomiopatia de Takotsubo/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem
13.
BMC Health Serv Res ; 19(1): 446, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269933

RESUMO

BACKGROUND: Through the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. Despite growing interest in unnecessary care both within Canada and internationally, prior research has typically avoided taking a national or even multi-jurisdictional approach in measuring the extent of the issue. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions. METHODS: Two retrospective cohort studies were conducted using administrative health care data collected between fiscal years 2011/12 and 2012/13 to respectively quantify use of 1) diagnostic imaging (spinal X-ray, CT or MRI) among Albertan patients following a visit for lower back pain and 2) cardiac tests (electrocardiogram, chest X-ray, stress test, or transthoracic echocardiogram) prior to low-risk surgical procedures in Alberta, Saskatchewan, and Ontario. A cross-sectional study of the 2012 Canadian Community Health Survey was also conducted to estimate 3) the proportion of females aged 40-49 that reported having a routine mammogram in the past two years. RESULTS: Use of unnecessary care was relatively frequent across all three services and jurisdiction measured: 30.7% of Albertan patients had diagnostic imaging within six months of their initial visit for lower back pain; a cardiac test preceded 17.9 to 35.5% of low-risk surgical procedures across Alberta, Saskatchewan, and Ontario; and 22.2% of Canadian women aged 40-49 at average-risk for breast cancer reported having a routine screening mammogram in the past two years. CONCLUSIONS: The use of potentially unnecessary care appears to be common in Canada. This investigation provides methodology to facilitate future measurement efforts that may incorporate additional jurisdictions and/or unnecessary services.


Assuntos
Técnicas de Imagem Cardíaca/estatística & dados numéricos , Dor Lombar/diagnóstico por imagem , Mamografia/estatística & dados numéricos , Procedimentos Desnecessários , Canadá/epidemiologia , Estudos Transversais , Humanos , Sobremedicalização , Estudos Retrospectivos , Procedimentos Desnecessários/estatística & dados numéricos
14.
Medicine (Baltimore) ; 98(30): e16566, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348283

RESUMO

RATIONALE: Cardiac transthyretin amyloidosis is a progressive and fatal cardiomyopathy for which several promising therapies are in development. The diagnosis is frequently delayed or missed because of the limited specificity of clinical manifestations, routine electrocardiogram, echocardiography and the traditional requirement for endomyocardial biopsy confirmation. PATIENT CONCERNS: A 68-year-old female had suffered from lumbago for 5 years with progressive weakness, numbness in both lower limb. DIAGNOSIS: The patient's clinical signs were not specific, but cardiac amyloidosis was suspected based on relative left ventricular apical sparing of longitudinal strain on echocardiography and continuous elevated serum levels of cardiac biomarkers (ultrasensitive cardiac troponin I and NT-proBNP). She was finally diagnosed hereditary transthyretin-related cardiac amylodosis by specific findings of cardiovascular magnetic resonance imaging (CMR), -technetium pyrophosphate (Tc-PYP) scintigraphy and genetic testing. INTERVENTIONS: The patient received medications including diuretics, beta-blockers and angiotensin-converting enzyme inhibitors at the time of hospitalization. Ultimately, however, she refused further treatments and requested discharge from our hospital. OUTCOMES: A series of noninvasive technique enables the diagnosis of hereditary transthyretin-related cardiac amyloidosis. LESSONS: While endomyocardial biopsy is not able to performed, this case demonstrates that a combination of noninvasive techniques, especially CMR, nuclear imaging, and genetic testing, may help us to make a correct diagnosis of hereditary transthyretin-related cardiac amyloidosis.


Assuntos
Neuropatias Amiloides Familiares/diagnóstico , Técnicas de Imagem Cardíaca/métodos , Testes Genéticos/métodos , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina I/sangue , Idoso , Ecocardiografia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Cintilografia/métodos , Compostos Radiofarmacêuticos , Pirofosfato de Tecnécio Tc 99m
16.
Artigo em Inglês | MEDLINE | ID: mdl-31208148

RESUMO

There is no consensus as to whether the Coronary Artery Calcium Score (CACS) results can affect the therapeutic approach that is selected for coronary artery disease. The aim of this study was to follow patients' management over a period of ten years after application of the CACS. Methods: The research was conducted as a prospective, single-center, long-distance study. In 174 asymptomatic patients (78M; aged 58.9 ± 7.86), a CACS examination using 64-slice computed tomography was performed between 2008 and 2009. The patients were divided into three subgroups according to the CACS results using Agatston Units (AU)-G1: CACS = 0 AU (52 pts); G2: CACS = 1-399 AU (64 pts) and G3: CACS ≥ 400 AU (58 pts). During the ten years of follow-up, the classical cardiovascular risk factors, drugs, diseases, and information about the therapeutic approach that was used (PCI-Percutaneous Coronary Intervention; CABG-Coronary Artery Bypass Graft) were also analyzed. Results: The average time until a percutaneous intervention (PCI) was 825.2 ± 1111.7 and for CABG, it was 529.0 ± 833.6. PCI was performed in 5.8% (G1), 4.7% (G2) and 32.6% (G3) of the cases, respectively; p = 0.0000. CABG was performed in 0% (G1), 1.6% (G2) and 18.9% (G3) of the cases, respectively; 0.0035 Yates. The area under the curve in PCI was 0.783 (95% CI: 0.714-0.841); in CABG, it was 0.825 (95% CI: 0.760-0.878) and the average for both groups was 0.838 (95% CI: 0.774-0.889). Conclusions: The coronary artery calcium score can potentially help to predict the best therapeutic approach for coronary artery disease in a ten-year perspective.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/diagnóstico por imagem , Adulto , Idoso , Cálcio , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Feminino , Coração , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Estudos Prospectivos , Tempo
17.
Cardiology ; 142(3): 167-174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31189164

RESUMO

PURPOSE: The aim of this study was to quantify the value of various clinical, laboratory, and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. METHODS: In 100 patients (65 men, 44.7 ± 12.5 years old) with "idiopathic" arrhythmias (n = 20) and dilated cardiomyopathy (DCM; n = 80), we performed the following: 71 endomyocardial biopsies (EMB), 13 intraoperative biopsies, 5 studies of explanted hearts, and 11 autopsies with virus investigation (real-time PCR) of the blood and myocardium. Antiheart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), and coronary angiography (n = 47). The comparison group included 50 patients (25 men, 53.7 ± 11.7 years old) with noninflammatory heart diseases who underwent open heart surgery. RESULTS: Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients in the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients in the comparison group than in the study group (65.0 and 40.2%; p < 0.01). We evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of AHA had the greatest importance in the identification of myocarditis: sensitivity was 81.5%, and the positive and negative predictive values were 75.0 and 60.5%. This defined the diagnostic value of noninvasive markers of myocarditis and established a diagnostic algorithm providing an individual assessment of the likelihood of myocarditis development. CONCLUSION: AHA have the greatest significance in the diagnosis of latent myocarditis in patients with "idiopathic" arrhythmias and DCM. The use of a complex of noninvasive criteria allows the probability of myocarditis to be estimated and the indications for EMB to be determined.


Assuntos
Anticorpos/análise , Arritmias Cardíacas/diagnóstico , Cardiomiopatia Dilatada/diagnóstico , Miocardite/diagnóstico , Miocárdio/patologia , Adulto , Antiestreptolisina/sangue , Arritmias Cardíacas/sangue , Biópsia , Técnicas de Imagem Cardíaca , Cardiomiopatia Dilatada/sangue , Diagnóstico Diferencial , Feminino , Genoma Viral , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/sangue , Miocárdio/imunologia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Federação Russa
18.
J Vasc Surg ; 69(6S): 3S-125S.e40, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159978

RESUMO

Chronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.


Assuntos
Cardiologia/normas , Medicina Baseada em Evidências/normas , Isquemia/terapia , Doença Arterial Periférica/terapia , Técnicas de Imagem Cardíaca/normas , Doença Crônica , Consenso , Testes de Função Cardíaca/normas , Humanos , Isquemia/diagnóstico , Isquemia/mortalidade , Isquemia/fisiopatologia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Terminologia como Assunto , Resultado do Tratamento
19.
J Cardiovasc Med (Hagerstown) ; 20(8): 510-517, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31082987

RESUMO

: Type 2 myocardial infarction (MI) is commonly encountered in daily practice. Its incidence can range between 5 and 35% among all cases of MI. It is caused by disorders that result in supply-demand mismatch, which leads to myocardial ischemia and necrosis. Therefore, unsurprisingly, it is frequently diagnosed in critically ill patients and those with severe coronary artery disease (CAD) and multiple comorbidities. Though it can occur in the absence of CAD, the presence of coronary blood flow-limiting stenoses can allow even minor insults to disturb the already fine supply-demand balance. Generally, type 2 MI may be associated with higher mortality; however, some data suggest it may have different severities, and outcome is better in patients with type 2 MI of milder severity. Nonetheless, regardless of the causes (ischemic or nonischemic), troponin elevation is associated with worse outcome. Differentiating type 2 MI from other causes of myocardial necrosis, mainly type 1 MI and myocardial injury, remains a clinical challenge. Different diagnostic tools can be utilized to aid in reaching an accurate diagnosis. These can include contrast echocardiography, computed tomography, MRI, radionuclide imaging, coronary angiography, and intracoronary imaging. However, each comes with its own limitations and results should be interpreted with caution and in clinical context. Management of type 2 MI is uncertain because of paucity of data. Evidence-based therapies of type 1 MI are frequently used, though this may be harmful sometimes. Therefore, clinical judgment should be used, and management and therapies should be tailored to each individual case.


Assuntos
Técnicas de Imagem Cardíaca , Infarto do Miocárdio/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Infarto do Miocárdio/classificação , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco
20.
Curr Cardiol Rep ; 21(6): 53, 2019 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-31076948

RESUMO

PURPOSE OF REVIEW: Noninvasive hemodynamic assessments in patients with heart failure (HF) are essential for appropriate diagnosis and establishment of the best treatment strategies. Recently, the impact of pulmonary circulation and right ventricular function on prognosis in HF patients has drawn increasing attention. In this article, we explore the usefulness of cardiac imaging for hemodynamic assessments, mainly focusing on echocardiographic evaluation. RECENT FINDINGS: The reliability of Doppler echocardiography as a noninvasive alternative to Swan-Ganz catheterization has been well investigated with higher than 80% accuracy for estimating pulmonary artery pressure. Strain measurement and three-dimensional echocardiography are useful for evaluating right ventricular function together with pulmonary circulation. The accuracy of analyzing left and right ventricular functions by cardiac computed tomography and cardiac magnetic resonate imaging has also been established. These modalities can provide myocardial tissue information and allow calculation of the extracellular volume fraction as well. According to the rapid improvement of technologies, cardiac imaging has become an essential tool for hemodynamic evaluation in HF management.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Pneumopatias/fisiopatologia , Pulmão/fisiopatologia , Cateterismo Cardíaco , Hemodinâmica , Humanos , Reprodutibilidade dos Testes
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