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1.
Medicine (Baltimore) ; 99(2): e18717, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914085

RESUMO

BACKGROUND: Cardiac masses are rare, but lead to high risk of stroke and death. Because of the different treatment methods, it is significant for clinicians to differentiate the nature of masses. Cardiac magnetic resonance (CMR) imaging has high intrinsic soft-tissue contrast and high spatial and temporal resolution and can provide evidence for differential diagnosis of cardiac masses. However, there is no evidence-based conclusion as to its accuracy. Therefore, the purpose of our study is to perform a systematic review on this issue and provide useful information for clinical diagnosis and treatment. METHODS: We will perform a systematic search in EMBASE, Cochrane Library, PubMed and Web of Science for diagnostic studies using CMR to detect cardiac masses from inception to October, 2019. Two authors will independently screen titles and abstracts for relevance, review full texts for inclusion and conduct detail data extraction. The methodological quality will be assessed using the QUADAS-2 tool. If pooling is possible, we will use bivariate model for diagnostic meta-analysis to estimate summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CMR, as well as different sequences of CMR. Estimates of sensitivity and specificity from each study will be plotted in summary receive operating curve space and forest plots will be constructed for visual examination of variation in test accuracy. If enough studies are available, we will conduct sensitivity analysis and subgroup analysis. RESULTS: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION: To our knowledge, this will be the first systematic review on the accuracy of CMR in the differential diagnosis of cardiac masses. This study will provide evidence and data to form a comprehensive understanding of the clinical value of CMR for cardiac masses patients. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required, as this study is a systematic review. PROSPERO REGISTRATION NUMBER: CRD42019137800.


Assuntos
Trombose Coronária/diagnóstico , Neoplasias Cardíacas/diagnóstico , Imagem por Ressonância Magnética/métodos , Trombose Coronária/diagnóstico por imagem , Diagnóstico Diferencial , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Projetos de Pesquisa , Sensibilidade e Especificidade
2.
Int Heart J ; 60(5): 1061-1069, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484870

RESUMO

Plaque erosion (PE) is a significant substrate of acute coronary thrombosis. An improved ability to distinguish plaque phenotype in vivo among patients with ST-segment elevation myocardial infarction (STEMI) is of considerable interest because of the potential to formulate tailored treatment. This study assessed the plaque features and screened the circulating microRNAs (miRNAs) characteristically expressed in patients with PE compared with those with plaque rupture (PR). An miRNA microarray profile was generated in an initial cohort of eight STEMI patients with PE and eight clinically matched subjects with PR to select the circulating miRNAs with significant differences. miRNAs of interest were validated in a prospective cohort, and the plaque characteristics of enrolled patients were assessed by optical coherence tomography (OCT). Thirty culprit lesions were classified as PE (32.6%) and 46 as PR (50%). The main component of PE was fibrotic tissue, whereas the chief component of PR was lipids (P < 0.001). Thirty-four miRNAs were differentially expressed between the two groups; we validated five candidates and found that only the level of circulating miR-3667-3p exhibited significant discriminatory power in predicting the presence of PE (AUC = 0.767; P < 0.001). Our results show that high levels of circulating miR-3667-3p are closely related to PE in STEMI patients, which provides further evidence for PE pathophysiology and potential tailor treatment strategies.


Assuntos
MicroRNA Circulante/sangue , Trombose Coronária/diagnóstico por imagem , Placa Aterosclerótica/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Tomografia de Coerência Óptica/métodos , Idoso , Área Sob a Curva , Estudos de Casos e Controles , China , Angiografia Coronária/métodos , Trombose Coronária/mortalidade , Trombose Coronária/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/patologia , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Estatísticas não Paramétricas , Análise de Sobrevida , Resultado do Tratamento
3.
Khirurgiia (Mosk) ; (8): 36-40, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464272

RESUMO

Objective - analysis of coronary angiography data in long-term period after coronary artery bypass surgery. MATERIAL AND METHODS: There were 78 patients (75 (96.2%) men and 3 (3.8%) women) with recurrent angina pectoris after CABG. Postoperative follow-up period ranged from 1 month to 8 years. RESULTS: There were 104 and 39 local stenoses and occlusions de novo, respectively. New local stenoses appeared in 31 arteries with patent bypass grafts and in 18 arteries with closed graft. There were 143 (60.3%) patent and 94 (39.7%) occluded grafts. All grafts (n=4, 100%) were patent after bypass grafting of one coronary artery, 3 (13.7%) grafts were occluded after bypass grafting of 2 coronary arteries. Occlusion of 57 (45.2%) out of 126 grafts was noted after bypass grafting of 3 coronary arteries, in case of grafting of 4coronary arteries - 34 (40%) out of 85 grafts. CONCLUSION: Thus, the main causes of thrombosis of the grafts were poor distal vessels, technical errors in harvesting and implantation of the grafts, mediastinitis, overestimated indications for surgery (coronary stenoses <50%), progression of atherosclerotic process, usage of venous grafts. Also, there is a direct relationship between transplant thrombosis and the number of bypassed coronary arteries.


Assuntos
Angina Pectoris/etiologia , Angiografia Coronária , Ponte de Artéria Coronária/efeitos adversos , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Oclusão de Enxerto Vascular/diagnóstico por imagem , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/etiologia , Estenose Coronária/etiologia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Vasos Coronários/cirurgia , Feminino , Seguimentos , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Recidiva , Grau de Desobstrução Vascular
4.
Echocardiography ; 36(6): 1103-1109, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31116460

RESUMO

OBJECTIVE: The correlation between the echocardiographic Doppler flow parameters of microvascular obstruction (MVO) and coronary wedge pressure (CWP) measured as a marker of severe compressive microvascular dysfunction and a predictor of adverse left ventricular remodeling was evaluated in a group of high-risk acute anterior myocardial infarction survivors. METHODS: Twenty-four patients with mechanically reperfused anterior STEMI were divided into two groups based on the 38 mm Hg CWP cutoff for adverse left ventricular remodeling. Diastolic deceleration time (DDT), coronary flow reserve (CFR), systolic retrograde flow, peak systolic and peak diastolic velocities in the infarct-related artery were determined 3-5 days after revascularization. An echocardiographic 20% increase in left ventricular volumes defined adverse remodeling. RESULTS: No significant differences were recorded between groups with regard to the echocardiographic parameters of MVO. No significant correlation was identified between CWP on one side and DDT (P = 0.30) and CFR (P = 0.39) on the other, irrespective of total ischemic time and extracted thrombus length. No difference in 5 years of follow-up left ventricular remodeling was detected in patients with DDT<900 msec as compared to those with DDT≥900 msec. The medium increase in left ventricular end-systolic volume in patients with low CWP was 24.78%, while it reached 127.27% (P = 0.03) in patients with CWP>38 mm Hg. CONCLUSIONS: Coronary wedge pressure did not correlate with the surrogate parameters for MVO, but it was a predictor of left ventricular remodeling. None of the echocardiographic MVO parameters was associated with adverse remodeling at 5 years of follow-up.


Assuntos
Circulação Coronária/fisiologia , Trombose Coronária/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Microcirculação/fisiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Remodelação Ventricular/fisiologia , Trombose Coronária/complicações , Trombose Coronária/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pressão Propulsora Pulmonar , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
5.
Echocardiography ; 36(5): 975-979, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30957272

RESUMO

Takotsubo Cardiomyopathy (TC) is an uncommon, transient, reversible cardiomyopathy, with a classic pattern of wall-motion abnormalities, usually seen in women after an emotional stressor. Despite its increased recognition, there remain gaps in the exact mechanisms, predisposing factors, and predictors of recovery; this is particularly true for males where the condition occurs far less frequently than in females. TC typically resolves within weeks, and the prognosis is favorable compared to acute coronary syndromes. Nonetheless, about 1% of cases may be complicated by left ventricular (LV) thrombus and embolism. Herein we describe an atypical case of a man with no obvious trigger, who developed TC with left ventricular thrombus and multiple embolic complications, but subsequently showed complete and full resolution. Multimodality imaging including echocardiography, cardiac CT and cardiac MRI was instrumental in this diagnostic dilemma, as well as useful in guiding treatment options and informing prognosis.


Assuntos
Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
6.
Echocardiography ; 36(6): 1110-1117, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31012159

RESUMO

BACKGROUND: Coronary microvascular dysfunction (CMD) may cause angina in the absence of obstructive coronary artery disease (CAD) and increases the risk of future adverse cardiovascular events. Transthoracic Doppler echocardiography (TTDE) with pharmacological stress can assess coronary flow velocity reserve (CFVR), a measure of coronary microvascular function. However, simpler methods would be preferable for diagnosing CMD. Therefore, we examined the relationship between CFVR and cardiac time intervals measured by TTDE in a cohort of women with angina and no obstructive CAD. METHODS: In a prospective cohort study, we included 389 women with angina, left ventricular ejection fraction > 45%, and no obstructive CAD. CMD was defined as CFVR < 2.0. The study population was divided into three groups according to cutoff values of CFVR < 2, 2 ≤ CFVR ≤ 2.5, and CFVR > 2.5. Isovolumic contraction time (IVCT), ejection time (ET), and isovolumic relaxation time (IVRT) were measured by tissue Doppler M-mode, and the myocardial performance index (MPI = (IVCT + IVRT)/ET) was calculated. RESULTS: Coronary microvascular dysfunction was associated with increasing age, hypertension, higher resting heart rate, and lower diastolic blood pressure. Moreover, CMD was associated with higher E/e' ratio (P = 0.002) and longer IVCT (P < 0.001), higher MPI (P < 0.001) and shorter ET (P = 0.002), but not with IVRT or conventional measures of left ventricular geometry, mass, and function. In multivariable analysis, longer IVCT (P < 0.001) and higher MPI (P = 0.002) remained associated with CMD. CONCLUSION: In women with angina and no obstructive CAD, CMD is associated with longer IVCT and higher MPI indicating a link between CMD and subtle alternations of systolic and combined measures of cardiac time intervals.


Assuntos
Angina Pectoris/etiologia , Doença da Artéria Coronariana , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Microcirculação/fisiologia , Angina Pectoris/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos de Coortes , Circulação Coronária , Trombose Coronária/fisiopatologia , Ecocardiografia sob Estresse , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
8.
Int J Cardiovasc Imaging ; 35(7): 1189-1198, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30911857

RESUMO

Due to expansion limits of the Absorb bioresorbable scaffold a meticulous implantation with correct sizing is required. We sought to investigate the clinical outcomes based on the sizing of the device related to the maximal lumen diameter measured by quantitative coronary angiography in Absorb BVS and Xience EES treated lesions in the AIDA trial. Sizing of Absorb bioresorbable vascular scaffold (BVS) and Xience everolimus eluting stent (EES) was graded according to the definitions of device non-oversize and device oversize on pre-procedural angiography. Lesion-oriented outcomes (LOCE) (device thrombosis, TLR and TVMI) that occurred during 2 years follow-up were related to device non-oversized or oversized status. In the Absorb BVS group, LOCE occurred in 48 (7.4%) lesions in the oversized group and in 32 (8.2%) lesions in the non-oversized group (HR 0.91; 95% CI 0.58-1.42; p = 0.681), whereas TLR occurred in 34 (5.3%) lesions and in 23 lesions (5.9%), respectively (HR 0.89; 95% CI 0.52-1.51; p = 0.666). Definite scaffold thrombosis occurred in 11 (1.7%) device oversized treated lesions against 16 (4.1%) device non-oversized treated lesions (HR 0.41; 95% CI 0.19-0.89; p = 0.020). There were no differences in event rates between oversized and non-oversized groups in lesions treated with Xience EES. There was no significant difference in LOCE between oversized and non-oversized treated Absorb BVS and Xience EES treated lesions. Non-oversized Absorb BVS implantation was associated with a higher risk of scaffold thrombosis at complete 2 years follow-up. The majority of very late scaffold thrombosis occurred in properly sized devices.


Assuntos
Implantes Absorvíveis , Fármacos Cardiovasculares/administração & dosagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Stents Farmacológicos , Everolimo/administração & dosagem , Intervenção Coronária Percutânea/instrumentação , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Humanos , Países Baixos , Intervenção Coronária Percutânea/efeitos adversos , Valor Preditivo dos Testes , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
Echocardiography ; 36(4): 794-796, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30735269

RESUMO

Chronic myeloid leukaemia (CML) is a neoplastic disorder of myeloid cell lines and is a less aggressive disease compared to acute myeloid leukemia (AML). Although cardiovascular complications are not uncommon, intracardiac thrombosis in CML is rarely reported. Herein, we report a case of CML presenting with an intracardiac thrombus attached to the posterior mitral leaflet, and subsequently resulting in peripheral embolization.


Assuntos
Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Ecocardiografia/métodos , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Humanos , Masculino , Pessoa de Meia-Idade
11.
Angiology ; 70(7): 642-648, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30621429

RESUMO

The incidence of contrast-induced nephropathy (CIN) increases in the range from patients with unstable angina to ST-segment elevation myocardial infarction (STEMI). Platelet activation has been associated with pathophysiology of nephropathy and thrombus burden in the infarct-related arteries. We investigated the impact of thrombus burden on CIN in patients with STEMI. We enrolled 883 patients with STEMI who received primary percutaneous coronary intervention. Patients were divided into groups according to thrombus burden and CIN development. Thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades (TGs). Thrombus grade 4 was defined as large thrombus burden (LTB), while thrombus burden

Assuntos
Lesão Renal Aguda/induzido quimicamente , Angiografia Coronária/efeitos adversos , Trombose Coronária/complicações , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Trombose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Índice de Gravidade de Doença , Resultado do Tratamento
12.
J Cardiovasc Med (Hagerstown) ; 20(3): 122-130, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30601191

RESUMO

AIMS: Stent implantation in ST-segment elevation myocardial infarction (STEMI) patients can be challenging and sometimes associated with immediate and long-term suboptimal results. Stent malapposition and strut uncoverage, predictors of stent thrombosis, are frequently detected in STEMI patients at medium/long-term follow-up. Nevertheless, data at a short follow-up are missing. We aimed to assess the extent of stent malapposition and struts coverage in the subacute phase of STEMI after stent implantation in primary or rescue percutaneous coronary intervention (PCI). METHODS: STEMI patients undergone primary or rescue PCI and scheduled for a second coronary angiography after 2-7 days were enrolled. During the second procedure, frequency domain optical coherence tomography (FD-OCT) was performed to assess percentage of malapposed struts (MS%), percentage area of malapposition (MA%), percentage of uncovered struts (US%), percentage area of atherothrombotic prolapse (PA%) and optical coherence tomography thrombus score (OCT-TS). RESULTS: Twenty patients were included and 21 stents (19 865 struts) were evaluated. Strut uncoverage was relatively limited [US% = 11.1 (8.1-13.6) %]. Stent malapposition was observed frequently, even if at low degree [MS% = 6.4 (3.3-13.3) %, MA% = 1.80 (0.46-2.76) %] as well as atherothrombotic prolapse [PA% = 0.09 (0.00-1.06) %]. Both MA% and PA% were significantly related to residual OCT-TS (R = -0.52, P = 0.02 and R = 0.71, P < 0.001, respectively), use of thrombolysis (P = 0.001 and P = 0.004, respectively) and time elapsed from PCI to FD-OCT analysis (P = 0.001). CONCLUSION: In the subacute phase after stenting in STEMI patients, strut uncoverage is relatively limited, while stent malapposition and atherothrombotic prolapse are common albeit limited features. Residual thrombus burden influences the degree of both stent malapposition and atherothrombotic prolapse.


Assuntos
Doença da Artéria Coronariana/cirurgia , Trombose Coronária/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Stents , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Fatores de Tempo , Tomografia de Coerência Óptica , Resultado do Tratamento
13.
Nat Rev Cardiol ; 16(4): 243-256, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30518952

RESUMO

Stent thrombosis (ST) is a rare but severe complication of coronary procedures with high mortality, high relapse rate and a very complex pathophysiology. An individual's susceptibility to ST is multifactorial and results from interactions between clinical factors, endothelial biology, hypersensitivity and/or inflammatory reactions, blood rheology, platelet reactivity, clotting factors, physical and mechanical properties of the stent and from the effects of these different factors on the fluid dynamics of blood flow. Since the introduction of stents 32 years ago, continuous improvements in our understanding of the pathophysiology of ST have triggered important advances, including new therapies, new technologies and an increased awareness of the implications of implantation techniques. Furthermore, advances in medical imaging and in the mathematical processing of this information have allowed a more detailed assessment of the mechanisms of ST at the time of its onset. Evidence shows that addressing the risk factors for ST leads to a substantial reduction in its incidence, both early and late after stent implantation. A better knowledge of the mechanisms of this complication is, however, necessary to direct the choice of the most appropriate strategy for its prevention and treatment.


Assuntos
Doença da Artéria Coronariana/terapia , Trombose Coronária/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Stents , Implantes Absorvíveis , Doença da Artéria Coronariana/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Stents Farmacológicos , Humanos , Desenho de Prótese , Medição de Risco , Fatores de Risco , Stents Metálicos Autoexpansíveis , Resultado do Tratamento
15.
Radiol Clin North Am ; 57(1): 75-84, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30454819

RESUMO

Although not considered a first-line modality for assessing cardiac masses, computed tomography (CT) can provide clinically useful information and is underused for this purpose. In addition to characterizing masses with insights about presence of fat or calcification and the perfusion characteristics of a mass, CT produces high-resolution four-dimensional images depicting the mass and its relationship to chambers, valves, and coronaries. This is combined with imaging of the chest, abdomen, or coronaries. Advances in CT technology, such as dual-energy CT, dynamic perfusion imaging, and three-dimensional printing for preoperative planning, will increase the role of CT in assessment of cardiac masses.


Assuntos
Trombose Coronária/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Lipomatose/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste , Diagnóstico Diferencial , Humanos
16.
Ann Thorac Surg ; 107(5): e307-e308, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30403982

RESUMO

An 8-year-old girl presenting with fulminant myocarditis and cardiogenic shock underwent peripheral extracorporeal membrane oxygenation. She was switched to central extracorporeal membrane oxygenation because of inadequate venous drainage, and an echocardiogram showed left ventricular (LV) thrombus. She underwent removal of the LV thrombus with LV venting. An echocardiogram showed LV thrombus again 2 days later. The LV thrombus was again removed, and a biventricular assist device support was initiated to avoid further thrombus formation. The patient was completely weaned from mechanical circulatory support after 7 days. She recovered fully without any neurologic deficit.


Assuntos
Trombose Coronária/terapia , Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Miocardite/terapia , Choque Cardiogênico/terapia , Criança , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Feminino , Humanos , Miocardite/complicações , Miocardite/diagnóstico por imagem , Choque Cardiogênico/etiologia
17.
Am J Cardiol ; 123(1): 63-68, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30360887

RESUMO

Left atrial appendage (LAA) thrombus in nonvalvular atrial fibrillation or flutter (AF) is a major cause of stroke and presents a therapeutic dilemma in a rhythm-control strategy. The prevalence and resolution of LAA thrombus has not been studied well in the era of non-vitamin K antagonist oral anticoagulant use. This study sought to establish (1) the prevalence of LAA thrombus (2) the prevalence of LAA thrombus despite antithrombotic therapy, (3) the rate of persistence of LAA thrombus despite appropriate anticoagulant prescriptions, and (4) determinants of LAA thrombus persistence. Consecutive transesophageal echocardiograms (TEE) performed in patients with AF were reviewed to estimate the overall prevalence of LAA thrombus and the resolution rate in those with repeat studies. Multivariable logistic regression was used to identify clinical and echocardiographic predictors of thrombus resolution. Of 1,485 patients with AF, 117 (8%) had LAA thrombus. Of those, 62 had repeat TEE within 1 year and 58 (94%) were prescribed adequate anticoagulation in TEE studies (mean interval 96 ± 72 days). Thirty-seven patients (60%) had LAA thrombus resolution. Thrombus resolution rate was only 79% in patients considered on appropriate anticoagulation. Patients with persistent LAA thrombus were more likely to have diabetes; no other clinical or echocardiographic variable was independently associated with thrombus resolution. There was no significant difference in LAA thrombus resolution between non-vitamin K antagonist oral anticoagulants and warfarin. LAA thrombus persistence despite adequate anticoagulation is relatively common and difficult to predict clinically; TEE before electrical cardioversion should be considered regardless of anticoagulation status.


Assuntos
Anticoagulantes/administração & dosagem , Apêndice Atrial , Fibrilação Atrial/tratamento farmacológico , Trombose Coronária/tratamento farmacológico , Administração Oral , Idoso , Fibrilação Atrial/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/epidemiologia , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Prevalência , Resultado do Tratamento
18.
Am J Cardiol ; 123(1): 57-62, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30376957

RESUMO

Direct acting oral anticoagulants (DOACs) are increasingly used for thromboembolic prophylaxis in patients with atrial fibrillation (AF). However, there is limited data to evaluate the use of DOACs for the treatment of pre-existing left atrial appendage thrombus. We aimed to determine the efficacy of DOACs in treatment of left atrial appendage (LAA) thrombus utilizing transesophageal echocardiographic (TEE) and clinical outcomes. In this single-center study, we identified 33 patients that were treated for LAA thrombus with DOAC. Eighteen were treated with apixaban, 10 with dabigatran, and 5 with rivaroxaban. The primary endpoint was defined as resolution of LAA thrombus (in patients undergoing TEE), or death, major bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke, or peripheral embolization. In this study, 15 of the 16 patients treated with DOACs who underwent follow-up TEE had resolution of LAA thrombus, with a mean duration of 112 days. Of the 15 patients who achieved resolution of the LAA thrombus, 14 had resolution by their first follow-up TEE. In the 17 patients without a follow-up TEE, 1 died of a retroperitoneal bleed (28 days after DOAC initiation), and 1 suffered an ischemic stroke (484 days after DOAC initiation). In general, patients without a follow-up TEE were older and had more co-morbidities. Although these results are descriptive and limited in number of patients, we believe this is ample evidence that DOACs are relatively safe and efficacious in treatment of patients with AF and concomitant LAA thrombus.


Assuntos
Anticoagulantes/administração & dosagem , Apêndice Atrial , Fibrilação Atrial/tratamento farmacológico , Trombose Coronária/tratamento farmacológico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Dabigatrana/administração & dosagem , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Estudos Retrospectivos , Rivaroxabana/administração & dosagem , Resultado do Tratamento
19.
J Thromb Thrombolysis ; 47(1): 157-161, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30269287

RESUMO

The incidence of acute myocardial infarction in the setting of acute pancreatitis is very rare. The recognition of such complex diagnosis may be clinically challenging, as the symptoms of both conditions are often indistinguishable. We report a case in which we encountered both conditions concurrently, and hypothesize that the ambient inflammatory and pro-thrombotic milieu of acute pancreatitis resulted in acute coronary thrombosis despite the absence of significant coronary atherosclerosis. Among multiple coronary imaging modalities currently in use, optimal cohesion tomography provided a unique capability for direct visualization of the coronary thrombus. (1) Inflammatory processes such as acute pancreatitis promote a thrombogenic state. (2) Presentation of acute myocardial infarction is variable and can mimic a variety of medical conditions. (3) Intravascular imaging is emerging as a useful tool in delineating details of intra-coronary pathology not clear on standard fluoroscopy. (4) The above case highlights the likely concurrence of pathologies that follow common pathways such as system-wide inflammation and coagulation. Clinicians must be aware of this uncommon yet very likely possibility and keep a low threshold to perform ECG and cardiac biomarker testing if symptoms are suggestive of a myocardial infarction, even in the presence of a clear alternative diagnosis.


Assuntos
Trombose Coronária/etiologia , Pancreatite/complicações , Coagulação Sanguínea , Trombose Coronária/diagnóstico por imagem , Procedimentos Endovasculares , Humanos , Inflamação , Infarto do Miocárdio/diagnóstico , Tomografia de Coerência Óptica
20.
Cardiovasc Interv Ther ; 34(2): 155-163, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30046978

RESUMO

Although stent implantation may be associated with tissue protrusion (TP), especially in patients with acute coronary syndrome (ACS), its long-term clinical outcomes remain unknown. The aim of the current study was to evaluate the long-term clinical outcomes of ACS patients with TP after the implantation of newer-generation drug-eluting stents (DESs). We retrospectively evaluated 366 consecutive ACS patients who underwent primary percutaneous coronary intervention (PCI) with newer-generation DESs. All culprit lesions underwent pre- and post-PCI intravascular ultrasound (IVUS) examinations and were classified according to the presence or absence of post-stent TP. After primary PCI, 198 lesions (54.1%) displayed TP on IVUS examination. At the 12-month follow-up, the incidence of target lesion revascularization did not differ between patients with (n = 198) and without (n = 168) TP (3.5 vs. 4.2%, p = 0.790). The incidence of recurrent ACS (r-ACS) was higher in patients with versus those without TP (7.1 vs. 2.4%; log-rank test p = 0.043). Cox proportional hazard analysis showed that triple-vessel disease (HR = 9.258, p = 0.001), TP (HR = 3.149, p = 0.008), and low-density lipoprotein cholesterol reduction rate ≥ 50% (HR = 0.184, p = 0.008) were the independent predictors of r-ACS. TP detected using IVUS after DES implantation may be associated with the occurrence of r-ACS after the 12-month follow-up, although short-term clinical outcomes were not worse during the 12-month follow-up.


Assuntos
Síndrome Coronariana Aguda/terapia , Trombose Coronária/diagnóstico por imagem , Stents Farmacológicos/efeitos adversos , Placa Aterosclerótica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Recidiva , Estudos Retrospectivos , Ultrassonografia de Intervenção
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