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1.
Intern Med ; 60(17): 2807-2809, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34470986

RESUMO

Sacubitril/valsartan has demonstrated its prognostic advantageousness over enalapril in patients with heart failure with a reduced ejection fraction. However, the optimal therapeutic strategy using sacubitril/valsartan in real-world practice, particularly among a Japanee cohort, remains uncertain. A 75-year-old man with systolic heart failure and chronic kidney disease was administered sacubitril/valsartan. Plasma B-type natriuretic peptide transiently increased, accompanied by an increase in the urine volume, which allowed us to terminate loop diuretics. The estimated glomerular filtration rate as well as heart failure symptom improved at the one-month follow-up. Sacubitril/valsartan might be a promising option to preserve the renal function and improve clinical outcomes when the dose of concomitant diuretics can be decreased, although further large-scale studies are warranted to validate our hypothesis.


Assuntos
Insuficiência Cardíaca Sistólica , Insuficiência Cardíaca , Insuficiência Renal Crônica , Idoso , Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Compostos de Bifenilo , Combinação de Medicamentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Humanos , Japão , Masculino , Neprilisina , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Volume Sistólico , Tetrazóis/uso terapêutico , Resultado do Tratamento , Valsartana/uso terapêutico
2.
Artigo em Chinês | MEDLINE | ID: mdl-34488266

RESUMO

Objective: To evaluate the changes of right ventricular function in patients with pneumoconiosis in different stages using three-dimensional speckle-tracking imaging (3D-STI) . Methods: In June 2020, 114 pneumoconiosis patients were selected as subjects, including 45 patients in stage Ⅰ pneumoconiosis group, 36 patients in stage Ⅱ pneumoconiosis group and 33 patients in stage Ⅲ pneumoconiosis group. Fifty healthy subjects were enrolled and served as control group. The longitudinal strain (LS) , radial strain (RS) and circumferential strain (CS) of free wall middle and basal segment of right ventricular were collected and compared. The right ventricular global longitudinal strain (GLS) , right ventricular global circumferential strain (GCS) , right ventricular ejection fraction (RVEF) , right ventricular global radial strain (GRS) , the rate of fractional area change (FAC) , the tricuspid valve systolic peak velocity (TVSPV) and the pulmonary artery systolic pressure (PASP) of each subject in the groups were collected and compared by 3D-STI. Results: The LS and RS of the right ventricular basal segment of patients in stage Ⅱ pneumoconiosis group were significantly lower than those of control group (P<0.0125) . The LS, CS, RS of the right ventricular basal segment and RS of right ventricular middle segment of patients in stage Ⅲ pneumoconiosis group were significantly lower than those of control group (P<0.0125) . The LS, CS and RS of the right ventricular basal segment of patients in stage Ⅰ pneumoconiosis group were significantly higher than those of stage Ⅲ pneumoconiosis group (P<0.0125) , and the RS of the right ventricular basal segment of patients in stage Ⅱ pneumoconiosis group was significantly higher than that of stage Ⅲ pneumoconiosis group (P<0.0125) . The levels of RVEF and GLS of patients in stage Ⅱ and stage Ⅲ pneumoconiosis group were significantly lower than those of control group (P<0.0125) , while the levels of PASP were significantly higher than that of control group (P<0.0125) . The levels of FAC and TVSPV of patients in stage Ⅲ pneumoconiosis group were significantly lower than those of control group (P<0.0125) . The levels of RVEF, GLS and FAC of patients in stage Ⅰ pneumoconiosis group were significantly higher those that of stage Ⅲ pneumoconiosis group (P<0.0125) , and the PASP level was significantly lower than that of stage Ⅲ pneumoconiosis group (P<0.0125) . The FAC level of patients in stage Ⅱ pneumoconiosis group was significantly higher than that of stage Ⅲ pneumoconiosis group (P<0.0125) . Conclusion: Patients with pneumoconiosis could experience a decline in right ventricular function at an early stage. The 3D-STI can accurately detect the GLS, GRS, GCS and hemodynamic changes of the right ventricular and evaluate the right ventricular function comprehensively and objectively. 3D-STI is of great significance for the early detection of right ventricular dysfunction in patients with pneumoconiosis.


Assuntos
Pneumoconiose , Disfunção Ventricular Direita , Humanos , Reprodutibilidade dos Testes , Volume Sistólico , Sístole , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita
3.
Ann Palliat Med ; 10(8): 8684-8691, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34488357

RESUMO

BACKGROUND: The aim of this study was to observe the effect of Sacubitril/Valsartan on cardiac function and remodeling in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: A total of 120 patients with HFrEF were selected and given standard heart failure treatment according to the 2017 ACC/AHA/HFSA guidelines. Regardless of whether patients had taken Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (ACEI/ARB) medications previously, after admission they were treated with the minimum effective dose of Sacubitril/Valsartan according to their blood pressure reading. Baseline clinical data were recorded and patients were followed up at 1, 3, 6, 9, and 12 months post discharge, during which time the dose of Sacubitril/Valsartan was gradually increased to the maximum tolerated dose (dose range 25-200 mg/twice daily). During follow-up, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), and left atrium diameter (LAD) were monitored; a 6-minute walking test and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores were recorded; and adverse reactions were collected. RESULTS: Over the course of the 12-month follow-up, the plasma concentrations of NT-proBNP were significantly reduced compared with the baseline, and the longer the follow-up time, the lower the NT-proBNP levels were (P<0.05). Similarly, LVEDD, LVESD and LAD were significantly smaller at 12 months than at baseline, and the longer the follow-up time, the smaller the internal diameter was (P<0.05). The LVEF, 6-minute walking distance and KCCQ scores increased significantly from baseline (P<0.05), whereas eGFR and serum potassium levels showed no significant change compared with the baseline. CONCLUSIONS: Sacubitril/Valsartan demonstrated a remarkable ability to improve cardiac function and to control cardiac remodeling with a high degree of safety in patients with HFrEF.


Assuntos
Insuficiência Cardíaca , Assistência ao Convalescente , Aminobutiratos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Compostos de Bifenilo , Combinação de Medicamentos , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Alta do Paciente , Volume Sistólico , Resultado do Tratamento , Valsartana , Função Ventricular Esquerda , Remodelação Ventricular
5.
Rev Soc Bras Med Trop ; 54: e03822021, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495258

RESUMO

INTRODUCTION: Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. METHODS: Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p<0.10 were put into multivariable models. RESULTS: Total 163 patients were enrolled, 59% were men, mean age 64±16 years, and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N=56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR=0.94), RV fractional area change (OR=0.96), tricuspid annular plane systolic excursion (TAPSE, OR=0.83) and RV dysfunction (OR=5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age≥63 years (OR=5.53, 95%CI 1.52-20.17), LVEF<64% (OR=7.37, 95%CI 2.10-25.94) and TAPSE<18.5 mm (OR=9.43, 95% CI 2.57-35.03), and the final model had good discrimination, with C-statistic=0.83 (95%CI 0.75-0.91). CONCLUSION: Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.


Assuntos
COVID-19 , Disfunção Ventricular Direita , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Volume Sistólico
6.
Arq Bras Cardiol ; 117(2): 300-306, 2021 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495223

RESUMO

BACKGROUND: The classification of heart failure (HF) by phenotypes has a great relevance in clinical practice. OBJECTIVE: The study aimed to analyze the prevalence, clinical characteristics, and outcomes between HF phenotypes in the primary care setting. METHODS: This is an analysis of a cohort study including 560 individuals, aged ≥ 45 years, who were randomly selected in a primary care program. All participants underwent clinical evaluations, b-type natriuretic peptide (BNP) measurements, electrocardiogram, and echocardiography in a single day. HF with left ventricular ejection fraction (LVEF) < 40% was classified as HF with reduced ejection fraction (HFrEF), LVEF 40% to 49% as HF with mid-range ejection fraction (HFmrEF) and LVEF ≥ 50% as HF with preserved ejection fraction (HFpEF). After 5 years, the patients were reassessed as to the occurrence of the composite outcome of death from any cause or hospitalization for cardiovascular disease. RESULTS: Of the 560 patients included, 51 patients had HF (9.1%), 11 of whom had HFrEF (21.6%), 10 had HFmrEF (19.6%) and 30 had HFpEF (58.8%). HFmrEF was similar to HFpEF in BNP levels (p < 0.001), left ventricular mass index (p = 0.037), and left atrial volume index (p < 0.001). The HFmrEF phenotype was similar to HFrEF regarding coronary artery disease (p = 0.009). After 5 years, patients with HFmrEF had a better prognosis when compared to patients with HFpEF and HFrEF (p < 0.001). CONCLUSION: The prevalence of ICFEI was similar to that observed in previous studies. ICFEI presented characteristics similar to ICFEP in this study. Our data show that ICFEi had a better prognosis compared to the other two phenotypes.


Assuntos
Insuficiência Cardíaca , Estudos de Coortes , Humanos , Fenótipo , Atenção Primária à Saúde , Prognóstico , Volume Sistólico , Função Ventricular Esquerda
9.
Kardiologiia ; 61(7): 4-13, 2021 Jul 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34397336

RESUMO

Aim    Optimal combination therapy for chronic heart failure (CHF) currently implies the mandatory use of at least four classes of drugs: renin-angiotensin-aldosterone (RAAS) system inhibitors or angiotensin receptor blocker neprilysin inhibitors (ARNI); beta-adrenoblockers (BAB); mineralocorticoid receptor antagonists; and sodium-glucose cotransporter 2 inhibitors. Furthermore, many of these drugs are able to decrease blood pressure even to hypotension and alleviate tachycardia. This study focused on the relationship of 24-h blood pressure (BP) and heart rate (HR) with the prognosis for CHF patients with sinus rhythm and left ventricular ejection fraction (LV EF) <50 % as well as on suggesting possible variants of safe therapy for CHF depending on the combination of studied factors.Material and methods    Effects of clinical data, echocardiographic parameters, 24-h BP, and heart rhythm (data from 24-h BP and ECG monitors) on the prognosis of 155 patients with clinically pronounced CHF, LV EF <50 %, and sinus rhythm who were followed up for 5 years after discharge from the hospital.Results    The one-factor analysis showed that the prognosis of CHF patients was statistically significantly influenced by the more severe functional class (FC) III CHF compared to FC II, reduced LV EF (<35 %), a lower 24-h systolic BP (SBP) (<103 mm Hg), the absence of hypotensive episodes in daytime, a low variability of nighttime BP (<7.5 mm Hg), a higher 24-h HR (>71 bpm vs. <60 bpm), the absence of therapy with RAAS inhibitors + BAB, and a lower body weight index. The multi-factor analysis showed that more severe CHF FC, lower LV EF, and the absence of RAAS inhibitors + BAB therapy retained the influence on the prognosis. After eliminating the influencing factor of drug therapy, also a low SBP variability significantly influenced the prognosis. An additional analysis determined the following four groups of CHF patients with reduced heart systolic function according to mean 24-h HR and SBP: the largest group (38.1 % of all patients) with controlled HR (≤69 bpm), preserved SBP (>103 mm Hg), and the lowest death rate of 15.3 %; the group with increased HR (>69 bpm) but preserved SBP (30.3 % of all patients) where the death rate was 44.7 %, which was significantly higher than in the first group; the group with normal HR (≤69 bpm) but reduced SBP (≤103 mm Hg) (16.1 % of patients) where the death rate was 40 %, which was comparable with the second group and significantly worse than in the first group; and the group with both increased HR (>69 bpm) and reduced SBP (≤103 mm Hg) (15.5 % of patients), which resulted in the maximal risk of death (70.8 % of patients with CHF and LV EF <50 %), which was significantly higher than in the three other groups.Conclusion    Low SBP (including 24-h SBP with reduced variability in day- and nighttime) in combination with high HR (including by data of Holter monitoring), low LV EF, more severe clinical course of CHF, and the absence of an adequate treatment with neurohormonal modulators (RAAS inhibitors and BAB) significantly increased the risk of death. Isolating four types of FC II-III CHF with sinus rhythm and EF <50% based on the combination of HR and BP identifies patients with an unfavorable prognosis, which will help developing differentiated therapeutic approaches taking into account clinical features.


Assuntos
Insuficiência Cardíaca , Função Ventricular Esquerda , Pressão Sanguínea , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca , Humanos , Prognóstico , Volume Sistólico
10.
Kardiologiia ; 61(7): 22-27, 2021 Jul 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34397338

RESUMO

Aim      Improvement of quality of life is one of the most important goals for the treatment of patients with chronic heart failure (CHF). This study searched for ways to increase the efficiency of CHF treatment based on parameters of quality of life in CHF patients during and after the treatment with exogenous phosphocreatine (EP).Material and methods  The effect of a single course of EP treatment on quality of life of patients with functional class (FC) II-IV CHF with reduced or mid-range left ventricular ejection fraction was studied as a part of the all-Russia prospective observational study BYHEART. The presence of FC II-IV CHF and a left ventricular ejection fraction <50 % were confirmed by results of 6-min walk test (6MWT) and findings of echocardiography after stabilization of the background therapy.Results An interim data analysis showed that the course of EP treatment was associated with a significant improvement of quality-of-life indexes as determined by the Minnesota Living with Heart Failure Questionnaire (LHFQ) total score. These indexes significantly increased and remained at a satisfactory level for 6 mos. following completion of the treatment course. Also, the treatment significantly beneficially influenced the clinical condition of patients (heart failure severity scale), results of 6MWT, and the increase in left ventricular ejection fraction.Conclusion      The conclusions based on results of the interim analysis should be confirmed by results of the completed study. Complete results are planned to be published in 2022.


Assuntos
Insuficiência Cardíaca , Qualidade de Vida , Doença Crônica , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Fosfocreatina , Volume Sistólico , Função Ventricular Esquerda
11.
J Pharm Biomed Anal ; 204: 114272, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34358813

RESUMO

Increased turnover of extracellular matrix proteins is seen in many different diseases and is an underlying and driving feature of pathogenesis. An increased ratio of formation over degradation of extracellular matrix proteins, such as collagens, leads to accumulation of proteins in the tissues, ultimately impairing organ function. Understanding how this balance is regulated is key to providing deeper insight into high extracellular matrix turnover diseases. Type XXVIII collagen is a novel collagen with limited information available in relation to expression, tissue prevalence and clinical implication. We generated a novel, technically robust ELISA to measure a C-terminal fragment of type XXVIII collagen in plasma and serum (PRO-C28). PRO-C28 was found to be significantly elevated in circulation in patients with heart failure with preserved ejection fraction (HFpEF) and in patients with lung cancer. Additionally, PRO-C28 correlated significantly to NT-proBNP levels in HFpEF patients. PRO-C28 levels were elevated in diseases characterized by high ECM-turnover. This suggests that type XXVIII collagen may play a role in fibroproliferative disorders in the heart and the lungs.


Assuntos
Insuficiência Cardíaca , Neoplasias , Biomarcadores , Insuficiência Cardíaca/diagnóstico , Humanos , Fragmentos de Peptídeos , Volume Sistólico
12.
Pan Afr Med J ; 38: 359, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367438

RESUMO

Introduction: obstructive sleep apnea (OSA) is a common chronic pulmonary disease, characterized by repetitive collapse of the upper respiratory airways, leading to oxygen desaturation. This condition is recognized to be associated with cardiovascular disease. Several studies have shown the effects of OSA on both geometry and cardiac function, with conflicting results. We aimed to investigate the relationship between echocardiographic abnormalities and the severity of OSA. Methods: this is a cross-sectional single center study including patients, without any cardiovascular or pulmonary comorbidities, with polygraphy proven OSA. All participants underwent a detailed transthoracic echocardiography (TTE). Results: a total of 93 patients were included in the study, with 62.2% (n=56) females. According to the apnea hypopnea index (AHI), patients were divided into two groups: mild to moderate OSA (5≤ AHI< 30/H) and severe OSA (AHI≥ 30/H). There were no differences in baseline characteristics between the two groups. The assessment of echocardiographic parameters demonstrated that severe OSA have a higher left ventricular end-systolic (LVES) (47.6±7.2 VS 46.2±4.7), left ventricular end-diastolic (LVED) (31.3±6.2 VS 28.9±4.5) diameters and interventricular septum (IVS) thickness (12.7±2.4 VS11.7±2.5) diameters rather than mild to moderate OSA without a significant difference between the two groups. Furthermore, severe OSA patients had lower mean value of left ventricular ejection fraction (LVEF) and fractional shortening (FS) equal to 62.1±9.7 and 32.5±6.3 respectively. The difference between the two groups was not statistically significant. However, a significant association was shown between severity of OSA and left ventricular (LV) diastolic dysfunction, right ventricular internal diameter (RVID) and systolic pulmonary artery pressure (sPAP), with p=0.05, p=0.05 and p= 0.03 respectively. The RVID was also independently associated to the severity of the OSA (aOR 1.33, 95%CI: 0.99-1.79; p=0.05). Conclusion: using bidimensional echocardiography showed a relationship between severe OSA and right ventricular parameters (diastolic dysfunction and RVID) and sPAP.


Assuntos
Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Apneia Obstrutiva do Sono/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/fisiopatologia , Volume Sistólico
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 809-814, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412749

RESUMO

OBJECTIVE: To analyze the prognostic risk factors of patients with sepsis and the clinical characteristics of patients with septic myocardial injury. METHODS: A retrospective study was conducted. The clinical data of 300 patients with sepsis admitted to emergency department of Zhongshan Hospital of Fudan University from September 2017 to June 2020 were enrolled, including basic information, blood test indicators and auxiliary inspection indicators. The patients were grouped according to myocardial injury and the clinical characteristics of patients with septic myocardial injury were analyzed. According to 28-day prognosis, they were divided into survival group and non-survival group. The differences in various indicators between the two groups were compared, and binary Logistic regression was used to explore independent risk factors for death in patients with sepsis. RESULTS: In 300 patients, 47 patients were excluded for previous heart disease or lack of the main inspections, and 253 patients were enrolled finally. (1) Myocardial injury occurred in 136 out of 253 patients (53.8%), and 117 without myocardial injury. Compared with the non-myocardial injury group, the myocardial injury group had higher blood white blood cell count [WBC (×109/L): 9.7 (6.7, 13.4) vs. 8.3 (5.4, 12.2)] and procalcitonin [PCT (µg/L): 0.61 (0.18, 4.63) vs. 0.23 (0.09, 0.99)] at admission, and more Staphylococcal infections (17.6% vs. 2.6%), more arrhythmia (sinus tachycardia: 30.9% vs. 23.1%), more ST-T changes (26.5% vs. 23.1%), lower left ventricular ejection fraction [LVEF: 0.60 (0.54, 0.65) vs. 0.62 (0.60, 0.66)], higher pulmonary artery systolic pressure [PASP (mmHg, 1 mmHg = 0.133 kPa): 38.0 (32.2, 46.0) vs. 33.0 (30.0, 40.2)], and worse prognosis (28-day mortality: 44.1% vs. 6.0%, all P < 0.05). Logistic regression analysis showed that PCT increased [odds ratio (OR) = 1.039, 95% confidence interval (95%CI) was 1.018-1.060, P < 0.01], LVEF decreased (OR = 0.828, 95%CI was 0.729-0.941, P < 0.01) and sinus tachycardia (OR = 3.512, 95%CI was 1.417-8.702, P < 0.01) were clinical characteristics of septic patients with myocardial injury. (2) A total of 186 of the 253 patients survived, and 67 died with 28-day mortality of 26.5%. Compared with the survival group, non-survival group had higher myocardial markers and inflammation markers at admission [cardiac troponin T (cTnT, µg/L): 0.06 (0.02, 0.17) vs. 0.02 (0.01, 0.05), N-terminal pro-brain natriuretic peptide (NT-proBNP, ng/L): 3 037.0 (1 308.7, 12 033.7) vs. 893.9 (272.8, 2 825.5), creatine kinase (CK, U/L): 144.5 (57.5, 660.8) vs. 89.5 (47.8, 201.0), WBC (×109/L): 10.5 (6.7, 14.6) vs. 8.6 (6.0, 12.0), C-reactive protein (CRP, mg/L): 89.2 (54.8, 128.5) vs. 63.8 (19.3, 105.6), PCT (µg/L): 2.13 (0.31, 11.79) vs. 0.28 (0.10, 1.25), all P < 0.05], and more sinus tachycardia and atrial arrhythmia (41.8% vs. 22.0%, 29.9% vs. 17.7%, both P < 0.05). Logistic regression analysis showed that cTnT increased (OR = 2.115, 95%CI was 1.189-5.459, P < 0.05), sinus tachycardia (OR = 2.557, 95%CI was 1.103-5.929, P < 0.05) and atrial arrhythmia (OR = 2.474, 95%CI was 1.025-5.969, P < 0.05) were independent risk factors for 28-day death in patients with sepsis. CONCLUSIONS: Myocardial injury is an independent risk factor for death in patients with sepsis. PCT elevation, LVEF decreased and sinus tachycardia are main characteristics of patients with septic myocardial injury, which should attract clinical attention.


Assuntos
Sepse , Função Ventricular Esquerda , Humanos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico
14.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 838-843, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412754

RESUMO

OBJECTIVE: To evaluate the dynamic changes of pulmonary arterial pressure (PAP) and cardiac function in neonates with pulmonary or extra-pulmonary acute respiratory distress syndrome (ARDSp/ARDSexp). METHODS: An observational study was conducted. A total of 128 neonates with ARDS admitted to neonatology department of the Affiliated Yancheng Hospital of Southeast University Medical College from January 2016 to December 2020 were enrolled, with 67 neonates in ARDSp group and 61 neonates in ARDSexp group. After starting mechanical ventilation, oxygenation index [OI, OI = mean airway pressure (Pmean)×fraction of inspired oxygen (FiO2)/arterial partial pressure of oxygen (PaO2)×100], PAP, cardiac function parameters [cardiac index (CI), left ventricular ejection fraction (LVEF), right ventricular Tei (RV-Tei)], and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) were compared between the two groups; the incidence of pulmonary arterial hypertension [PAH, pulmonary artery systolic pressure (PASP) was more than 35 mmHg (1 mmHg = 0.133 kPa) or more than 2/3 of the systolic blood pressure of the body circulation] of neonates was recorded. The correlation between PAP and NT-proBNP was analyzed by Pearson correlation method. The dynamically changes in PAP and RV-Tei before and after using Milrinone in neonates with ARDSp and ARDSexp combined with moderate-severe PAH (PASP 50-69 mmHg was moderate, and PASP ≥ 70 mmHg was severe) were observed. The duration of mechanical ventilation, total length of hospital stay and prognosis were recorded; Kaplan-Meier survival curve was drawn to analyze the 28-day survival of the two groups. RESULTS: The occurrence rate of PAH in ARDSp group was significantly higher than that in ARDSexp group (97.01% vs. 70.49%, P < 0.01). OI, PAP, NT-proBNP and RV-Tei were also higher [OI: 17.61±6.12 vs. 11.04±5.35, PAP (mmHg): 64.27±9.54 vs. 53.61±6.47, NT-proBNP (ng/L): 23 126.32±1 485.14 vs. 18 624.24±1 647.15, RV-Tei: 0.61±0.22 vs. 0.52±0.19, all P < 0.05], but there was no significant difference in CI or LVEF between the two groups. Pearson correlation analysis showed that PAP was significantly positively correlated with NT-proBNP (r = 0.918, P < 0.01). There were 97 ARDS neonates with moderate-severe PAH with 63 in ARDSp group and 34 in ARDSexp group. Both PAP and RV-Tei in the two group showed a decreasing trend with the prolongation of Milrinone treatment, the decrease was more significant in the ARDSexp group compared with ARDSp group, the difference was statistically significant at 72 hours of treatment [PAP (mmHg): 38.42±8.95 vs. 45.67±13.32, RV-Tei: 0.58±0.19 vs. 0.61±0.13, both P < 0.05]; there was no significant difference in PAP or RV-Tei before extubation between the two groups. The duration of mechanical ventilation and the total length of hospital stay in ARDSp group were significantly longer than those in ARDSexp group [duration of mechanical ventilation (days): 10.12±1.36 vs. 6.31±1.31, total length of hospital stay (days): 16.52±3.25 vs. 13.12±3.57, both P < 0.01]. Kaplan-Meier survival curve showed that neonate in ARDSp group had a significantly lower 28-day cumulative survival rate as compared with ARDSexp group (82.09% vs. 95.01%; Log-Rank test: χ2 = 5.062, P = 0.025). CONCLUSIONS: Both PAP and RV-Tei were significantly increased in neonates with ARDS, PAP in neonates with ARDSp were significantly higher than that in neonates with ARDSexp. Dynamic monitoring of PAP and RV-Tei can reflect the severity of ARDS in neonates, and targeted intervention of pulmonary surfactant combined with Milinone for improving oxygenation and reducing PAP is one of the effective methods for the treatment of PAH.


Assuntos
Síndrome do Desconforto Respiratório , Pressão Arterial , Humanos , Recém-Nascido , Pulmão , Volume Sistólico , Função Ventricular Esquerda
15.
Medicina (Kaunas) ; 57(8)2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34441004

RESUMO

Background and Objectives: Functional mitral regurgitation (F-MR) observed in patients with atrial fibrillation could affect the effectiveness of the sinus rhythm restoring procedures. The aim of the study was to evaluate the impact of F-MR on pulmonary vein isolation (PVI) efficacy in patient with preserved ejection fraction (EF). Materials and Methods: One hundred and thirty-six patients with EF ≥ 50% (65.4% males; mean age 56 ± 11 years) with symptomatic paroxysmal or persistent AF qualified for PVI were enrolled into the study. F-MR assessment was performed in transthoracic (TTE) and transesophageal (TEE) echocardiography before the PVI procedure. PVI efficacy was evaluated in three-month and long-term follow-up. Results: F-MR was diagnosed in 74.3% patient in transthoracic echocardiography (TTE) (trace: 26.5%, mild: 43.4%, moderate: 3.7%, severe 0.7%) and 94.9% in transesophageal echocardiography (TEE) (trace: 17.6%, mild: 59.6%, moderate: 16.2%, severe: 1.5%). The PVI three-month efficacy was 75.7% in the three-month and 64% in the long-term observation. Severe F-MR in TEE at baseline was associated with lower three-month PVI efficacy (p = 0.012), while moderate to severe F-MR in TEE was related to inefficient PVI assessed in long-term follow-up (p = 0.041). Conclusions: Significant F-MR confirmed by TEE predicts three-month as well as long-term PVI efficacy.


Assuntos
Ablação por Cateter , Insuficiência da Valva Mitral , Veias Pulmonares , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Prognóstico , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Volume Sistólico , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(32): e26892, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397913

RESUMO

ABSTRACT: There was no previous report on the prognostic impact of new-onset or improved anemia after discharge from acute decompensated heart failure (ADHF).We analyzed 771 patients with ADHF and who were followed in multicenters in Japan was divided into 4 groups based on the hemoglobin values at discharge and 6-month index visit: 373 patients (48.4%) with persistent anemia, 87 patients (11.3%) with new-onset anemia, 91 patients (11.8%) with improved anemia, and 220 patients (28.5%) without anemia.The primary outcome measure was a composite of all-cause death or HF hospitalization after index visit. The cumulative 6-month incidences of the primary outcome measure were 25.2% for persistent anemia, 18.5% for new onset anemia, 9.0% for improved anemia, and 9.2% for no anemia (log-rank P < .001). Compared with the no anemia group, the excess risk for the primary outcome measure remained significant in the persistent anemia group [hazard ratio (HR) 2.70, 95% confidence interval (95% CI), 1.45-5.44, P = .001] and in the new-onset anemia group (HR 2.73, 95% CI 1.19-6.25, P = .02), while it was not significant in the improved anemia group (HR 1.69, 95% CI 0.68-4.03, P = .25).Persistent and new-onset anemia at 6-month visit were associated with a subsequent higher risk for all-cause death or HF hospitalization in patients with ADHF, suggesting the importance of detecting anemia during follow-up.


Assuntos
Anemia/epidemiologia , Insuficiência Cardíaca/complicações , Volume Sistólico/fisiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Japão/epidemiologia , Masculino , Prognóstico , Estudos Prospectivos
17.
Medicine (Baltimore) ; 100(32): e26919, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397933

RESUMO

BACKGROUND: Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality and morbidity of patients with HF with preserved EF (HFpEF) are high. However, there is no established therapy to improve survival in these patients. HFpEF patients are often elderly and their primary chronic symptom is severe exercise intolerance. Thus, improvement of exercise capacity presents another important clinical outcome in HFpEF patients. Iron deficiency is common in HF patients, and the presence of iron deficiency, regardless of concomitant anemia, is associated with worse symptoms, impaired exercise capacity, and higher mortality and hospitalization in these patients. Several meta-analyses of randomized controlled trials reported that iron administration improved HF symptoms, exercise capacity, and clinical outcomes in iron-deficiency patients with HF with reduced EF. However, there is insufficient evidence as to the effect of iron administration in iron-deficiency HFpEF patients. METHODS AND RESULTS: This meta-analysis will include randomized controlled trials on the effects of iron administration on HF symptoms, exercise capacity, and health-related quality of life in iron-deficiency HFpEF patients. Information of studies will be collected from PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov. The primary outcome will be exercise capacity (6-minute walking distance). The secondary outcomes will be HF symptoms, health-related quality of life, and mortality and hospitalization rates. CONCLUSION: This meta-analysis will evaluate the effect of iron therapy in iron-deficiency HFpEF patients, providing evidence as to the iron administration in these patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020205297.


Assuntos
Anemia Ferropriva/terapia , Insuficiência Cardíaca/terapia , Ferro/uso terapêutico , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Anemia Ferropriva/complicações , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Qualidade de Vida
18.
Pol Merkur Lekarski ; 49(292): 295-302, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34464372

RESUMO

Cardiovascular complications of the COVID-19 comprise cardiac arrhythmias, including sinus bradycardia (SB). CASE REPORTS: The authors present clinical data of 19 hospitalized patients (12 males), aged 20-73 years, with marked (less than 45/min during daily hours) self-limiting SB. None of them had SB at admission or earlier, none had used cardiovascular medications potentially decreasing the heart rate. Pulmonary involvement was severe in 4, moderate in 13 and mild in 2 patients; 14 needed oxygen therapy (4 using high flow oxygen equipment), none required treatment in the intensive care unit. All patients were given low molecular weight heparin in a prophylactic dose, 13 intravenous ceftriaxone, 12 dexamethasone, 8 convalescent plasma. Before SB appearance, 12 patients were treated with remdesivir (3 patients did not receive a full planned dose) and 2 with tocilizumab. SB appeared suddenly on day 5-14 from the onset of the disease, with a minimal heart rate of 32-44/min and in 3 cases it was mildly symptomatic; 2 of those received ad-hoc atropine, one orciprenaline. Interleukin-6 (Il-6) and C-reactive protein (CRP) concentrations at SB onset were significantly lower than at admission (9.3 vs 70.0 pg/ml and 16.8 vs 98.5 mg/l, respectively). Cardiac troponin I was slightly elevated in 2 patients. ECG morphology abnormalities (transient negative T waves or ST depression) were found in 4 males. All subjects had normal left ventricular ejection fraction; in 5 echocardiography revealed small pericardial effusion; in 10 patients, longitudinal strain was also studied: reginal abnormalities were found in all of them, particularly in basal segments. SB lasted 3-11 days and was reversible in all patients; none required temporary stimulation. The COVID-19 course was favorable in all patients; they were stable at discharge. During 4-12 months of posthospital observation, including clinical features, control ECG and 24-hour Holter monitoring, none of the patients was qualified for pacemaker implantation.


Assuntos
COVID-19 , Arritmias Cardíacas , Bradicardia/terapia , COVID-19/terapia , Humanos , Imunização Passiva , Unidades de Terapia Intensiva , Masculino , SARS-CoV-2 , Volume Sistólico , Função Ventricular Esquerda
19.
Health Qual Life Outcomes ; 19(1): 197, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404411

RESUMO

BACKGROUND: The study aimed to evaluate the long-term change of health-related quality of life (HRQOL) and to identify predictors of HRQOL 5 years after cardiac surgery. METHODS: Consecutive adult patients, undergoing elective cardiac surgery were enrolled in the study. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) questionnaire before and 5-years after cardiac surgery. A multivariate latent change modeling approach was used for data analysis. RESULTS: 210 participants (30.5% female) were reached at 5-year follow-up and included in final data analysis. The study revealed, after controlling for gender effects, a significant long-term positive change, in physical functioning (PF, Mslope = 19.79, p < 0.001), social functioning (SF, Mslope = 17.27, p < 0.001), vitality (VT, Mslope = 6.309, p < 0.001) and mental health (MH, Mslope = 8.40, p < .001) in the total sample. Lower education was associated with an increase in PF (Mslope = 24.09, p < 0.001) and VT (Mslope = 8.39, p < 0.001), more complicated surgery (other than the coronary artery bypass graft (CABG) predicted increase in general health (GH, Mslope = 6.76, p = 0.005). Arrhythmia was a significant predictor for lower pre- and post-operative VT and SF. CONCLUSIONS: Overall HRQOL in our sample improved from baseline to five years postoperatively. Further studies including larger patient groups are needed to confirm these findings.


Assuntos
Procedimentos Cirúrgicos Cardíacos/psicologia , Qualidade de Vida/psicologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Saúde Mental , Volume Sistólico , Inquéritos e Questionários , Função Ventricular Esquerda
20.
Chin Med J (Engl) ; 134(16): 1977-1982, 2021 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-34387611

RESUMO

BACKGROUND: Postural tachycardia syndrome (POTS) is a common childhood disease that seriously affects the patient's physical and mental health. This study aimed to investigate whether pre-treatment baseline left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) values were associated with symptom improvement after metoprolol therapy for children and adolescents with POTS. METHODS: This retrospective study evaluated 51 children and adolescents with POTS who received metoprolol therapy at the Peking University First Hospital between November 2010 and July 2019. All patients had completed a standing test or basic head-up tilt test and cardiac echocardiography before treatment. Treatment response was evaluated 3 months after starting metoprolol therapy. The pre-treatment baseline LVEF and LVFS values were evaluated for correlations with decreases in the symptom score after treatment (ΔSS). Multivariable analysis was performed using factors with a P value of <0.100 in the univariate analyses and the demographic characteristics. RESULTS: A comparison of responders and non-responders revealed no significant differences in demographic, hemodynamic characteristics, and urine specific gravity (all P > 0.050). However, responders had significantly higher baseline LVEF (71.09% ±â€Š4.44% vs. 67.17% ±â€Š4.88%, t = -2.789, P = 0.008) and LVFS values (40.00 [38.00, 42.00]% vs. 36.79% ±â€Š4.11%, Z = -2.542, P = 0.010) than the non-responders. The baseline LVEF and LVFS were positively correlated with ΔSS (r = 0.378, P = 0.006; r = 0.363, P = 0.009), respectively. Logistic regression analysis revealed that LVEF was independently associated with the response to metoprolol therapy in children and adolescents with POTS (odds ratio: 1.201, 95% confidence interval: 1.039-1.387, P = 0.013). CONCLUSIONS: Pre-treatment baseline LVEF was associated with symptom improvement after metoprolol treatment for children and adolescents with POTS.


Assuntos
Metoprolol , Síndrome da Taquicardia Postural Ortostática , Adolescente , Criança , Humanos , Metoprolol/uso terapêutico , Síndrome da Taquicardia Postural Ortostática/tratamento farmacológico , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda
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