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4.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(10): 859-865, 2020 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-33076624

RESUMO

Objective: To analyze the electrophysiological characteristics and the therapeutic efficacy of irrigated-tip catheter radiofrequency ablation(RFA) without radiation for pregnant women with focal atrial tachycardia(AT) originating from the right atrial appendage (RAA). Methods: Data from 55 women with focal AT, who underwent radiofrequency ablation (RFA) in the First Affiliated Hospital of Zhengzhou University from October 2016 to March 2019, were screened. 2 non-pregnant women with right atrial appendage tachycardia (RAAT) and 4 pregnant women with non-RAAT were excluded. The remaining 49 cases were divided into RAAT during pregnancy group (n=6, including 4 cases of tachycardia-induced cardiomyopathy) and non-pregnant and non-RAAT group (control, n=43). Under the guidance of three-dimensional mapping system, the earliest activation site was identified, RFA with the irrigated catheter without x-ray fluoroscopy was performed in RAAT patients during pregnancy, all patients in control group underwent non-zero-ray ablation. Patients were followed up at 3, 6, 12 months post procedure, and yearly follow up thereafter in outpatient clinic. Electrocardiogram or Holter monitoring was performed during follow up. AT recurrence and surgical complications were recorded during follow up. At 6 months after RFA, echocardiography examination and laboratory examination including N-terminal B-type brain natriuretic peptide measurement were performed in the pregnant patients, delivery results were also recorded in the pregnant patients. The electrophysiological characteristics of RAAT during pregnancy were analyzed, the therapeutic efficacy of RFA was compared between the two groups. Results: This study is a retrospective study. Age ((30.7±6.2)years vs. (57.2±11.7)years), left ventricular ejection fraction ((46.0±12.8)% vs. (60.1±5.9)%), proportions of organic heart disease (0% vs. 58%) were significantly lower in the RAAT patients during pregnancy group than in control group (P<0.05), while proportions of patients with persistent tachycardia (100% vs. 7%), symptoms of chest distress and palpitation (6/6 vs. 49%) and left ventricular ejection farction≤50% (4/6 vs. 9%) were significantly higher in RAAT group than in control group (P<0.05), heart rate was similar between the two groups ((163.7±11.1)beats/minutes vs. (153.7±15.2)beats/minutes, P>0.05). The characteristic P-wave morphology was observed in RAAT patients during pregnancy, i.e, P wave was mostly upright (5/6) in inferior-leads (Ⅱ, Ⅲ, aVF) and in lead I and aVL, deep and wide negative P wave was found in V1 lead (5/6), and gradually became positive from V2-V6. The mean tachycardia cycle length was (361.7±38.5) ms. Three-dimensional mapping showed that the origin points of the 6 RAAT pregnant patients were all scattered in the local region, the local region was ablated accordingly, 2 patients (2/6) received extensive ablation of local areas. Immediate successful rate was similar between the two groups (6/6 vs. 93%). During follow up ((15.3±4.0) months), no complications were observed after RFA, postoperative recurrence rate was similar (1/6 vs. 12%). Uncomplicated delivery was reported in all 6 pregnant RAAT post ablation. Normal cardiac structure and function was observed in the 4 pregnant patients with tachycardia-induced cardiomyopathy post ablation. Compared to pre-ablation phase, reduced left atrial dimension ((30.3±1.3) mm vs. (36.8±6.7) mm, P>0.05), increased left ventricular ejection fraction ((64.0±2.9)% vs. (39.8±10.7)%), reduced left ventricular end-diastolic dimension ((44.8±4.0) mm vs. (60.0±2.9) mm) and reduced N-terminal B-type natriuretic peptide value ((136.2±47.5) ng/L vs. (3 408.4±901.3) ng/L) were observed at 6 months post ablation (P<0.05). Conclusion: The electrophysiological characteristics are suggestive for focal AT originating from RAA during pregnancy. Under the guidance of 3-dimension activation mapping, no fluoroscopic RFA with irrigated-tip catheter is a safe and effective strategy for the treatment of focal RAAT during pregnancy.


Assuntos
Apêndice Atrial , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Volume Sistólico , Taquicardia , Resultado do Tratamento , Função Ventricular Esquerda
5.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 863-869, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047720

RESUMO

OBJECTIVE: To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery. METHODS: Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD). RESULTS: There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P < 0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up. CONCLUSION: The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.


Assuntos
Doença da Artéria Coronariana , Idoso , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
6.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 714-717, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018087

RESUMO

Early and noninvasive identification of heart failure progression is an important adjunct to successful and timely intervention. Severity of heart failure (HF) was assessed by Left Ventricular Ejection Fraction (LVEF). In this paper, we explore the circadian (24-hour) heart rate variability (HRV) features from ''normal" (EF >50%), "at-risk" (EF <40%), and "border-line" (40% ≤ EF ≤ 50%) patient data to determine whether HRV features can predict the stage of heart failure. All coronary artery disease (CAD) 24-hour circadian heart rate data were fitted by a cosinor analysis algorithm. Hourly HRV features from time- and frequency-domains were then extracted from all 24-hour patient data. A one-way ANOVA test was performed followed by a Tukey post-hoc multiple comparison test to investigate the differences among the three groups. The results showed a statistically significant difference between the three groups when using the normalized high frequency (HF Norm), low frequency peak (LF Peak), and the normalized very-low frequency (VLF Norm) for the 05:00-06:00 and 18:00-19:00 time periods. These results highlight a possible link between the circadian variation of sympathetic and parasympathetic nervous system activity and LVEF for CAD patients. The results could be useful in differentiating the various degrees of LVEF by using only noninvasive HRV features derived over a 24-hour period.Clinical relevance- The proposed method could be clinically useful to estimate the extent of LVEF associated with the severity of heart failure by recording the circadian variation of the heart rate in CAD patients. However, further clinical trials on a larger cohort of patients and controls are required.


Assuntos
Doença da Artéria Coronariana , Ritmo Circadiano , Frequência Cardíaca , Ventrículos do Coração , Humanos , Volume Sistólico , Função Ventricular Esquerda
7.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1182-1185, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018198

RESUMO

Atrial fibrillation (AF) is a global common disease which 33.5 million individuals suffer from. Conventional cardiac magnetic resonance and 4D flow magnetic resonance imaging have been used to study AF patients. We propose a left ventricular flow component analysis from 4D flow for AF detection. This method was applied to healthy controls and AF patients before catheter ablation. Retained inflow, delayed ejection, and residual volume had a significant difference between controls and the AF group as well as a conventional LV stroke volume parameter, and among them, residual volume was the strongest parameter to detect AF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Volume Sistólico
8.
Angiol Sosud Khir ; 26(3): 142-149, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063760

RESUMO

AIM: The study was aimed at comparatively assessing the immediate results of coronary artery bypass grafting operations without artificial circulation performed in non-ST-segment elevation acute myocardial infarction and chronic ischaemic heart disease. PATIENTS AND METHODS: The main group with non-ST-segment elevation acute myocardial infarction enrolled a total of 101 patients undergoing coronary artery bypass grafting without artificial circulation. The patients' age varied from 47 to 87 years, median 66.0 years (60.0; 71.0). The indication for the operation was persistent myocardial ischaemia on the background of carried out therapy with impossibility of performing percutaneous coronary intervention due to anatomy of coronary arteries and peculiarities of their pathology. The comparison group of chronic ischaemic heart disease was composed of 108 patients undergoing elective coronary artery bypass grafting without artificial circulation. The patients' age varied from 40 to 92 years, median - 60.0 years (58.0; 68.0). The patients with acute myocardial infarction had a significantly greater (p<0.05) number of coronary arteries measuring in diameter 2.5 mm and more, with significant occlusive and stenotic lesions, as well as a higher total SYNTAX score. The patients undergoing elective surgery were found to have an initially higher (p<0.05) left ventricular ejection fraction. RESULTS: In the group of acute myocardial infarction the waiting times for coronary artery bypass grafting varied from 2 to 8 days, median of waiting - 4.0 days (4.0; 5.0). The lethality rate (p<0.05) in the group of acute myocardial infarction amounted to 3.0% (3 cases) and in the group of chronic ischaemic heart disease to 0.9% (1 case). Twenty-one (20.8%) operations were carried out within the first 72 hours, with eighty surgical interventions (79.2%) performed after 72 hours from the onset of the disease. All 3 (3.8%) lethal outcomes were observed after coronary artery bypass grafting procedures performed later than 72 hours from the onset of acute myocardial infarction (p>0.05). The total number of complications (p>0.05) amounted to 18 (17.8%) and 10 (9.3%) in the group of acute myocardial infarction and in the group of chronic ischaemic heart disease, respectively. CONCLUSION: The immediate results of delayed coronary artery bypass grafting procedures without artificial circulation for acute myocardial infarction and chronic ischaemic heart disease were statistically comparable (p>0.05) by the lethality and complication rates. Lethality in the group of non-ST-segment elevation acute myocardial infarction din not depend on the time of operation after the onset of the disease.


Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Ponte de Artéria Coronária , Humanos , Infarto do Miocárdio/diagnóstico , Volume Sistólico , Função Ventricular Esquerda
9.
Wiad Lek ; 73(8): 1765-1770, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055349

RESUMO

OBJECTIVE: The aim of the publication was to review available data on epidemiology, pathophysiological and clinical aspects of HFmrEF as a specific HF pattern. PATIENTS AND METHODS: Materials and methods: We carried out the analysis of the publications that appeared during last decade, related to the different aspects of HFmrEF. The literature search was conducted by use of Google Web Search and PubMed search engines by the following key words: heart failure, left ventricular ejection fraction, mid-range, as well as their combinations. CONCLUSION: Conclusions: Patients with specific HF pattern «HFmrEF¼ demonstrate multidirectional dynamic of systolic heart function with the possibility of transition to the category of reduced or preserved LVEF. Such patients need to be evaluated individually. Their management is based on neurohumoral modulators in order to prevent further LV dysfunction progression and repeated decompensation of HF.


Assuntos
Insuficiência Cardíaca , Função Ventricular Esquerda , Progressão da Doença , Humanos , Volume Sistólico , Sístole
13.
Lancet ; 396(10254): 819-829, 2020 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-32877652

RESUMO

BACKGROUND: Both DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin) trials showed that sodium-glucose co-transporter-2 (SGLT2) inhibition reduced the combined risk of cardiovascular death or hospitalisation for heart failure in patients with heart failure with reduced ejection fraction (HFrEF) with or without diabetes. However, neither trial was powered to assess effects on cardiovascular death or all-cause death or to characterise effects in clinically important subgroups. Using study-level published data from DAPA-HF and patient-level data from EMPEROR-Reduced, we aimed to estimate the effect of SGLT2 inhibition on fatal and non-fatal heart failure events and renal outcomes in all randomly assigned patients with HFrEF and in relevant subgroups from DAPA-HF and EMPEROR-Reduced trials. METHODS: We did a prespecified meta-analysis of the two single large-scale trials assessing the effects of SGLT2 inhibitors on cardiovascular outcomes in patients with HFrEF with or without diabetes: DAPA-HF (assessing dapagliflozin) and EMPEROR-Reduced (assessing empagliflozin). The primary endpoint was time to all-cause death. Additionally, we assessed the effects of treatment in prespecified subgroups on the combined risk of cardiovascular death or hospitalisation for heart failure. These subgroups were based on type 2 diabetes status, age, sex, angiotensin receptor neprilysin inhibitor (ARNI) treatment, New York Heart Association (NYHA) functional class, race, history of hospitalisation for heart failure, estimated glomerular filtration rate (eGFR), body-mass index, and region (post-hoc). We used hazard ratios (HRs) derived from Cox proportional hazard models for time-to-first event endpoints and Cochran's Q test for treatment interactions; the analysis of recurrent events was based on rate ratios derived from the Lin-Wei-Yang-Ying model. FINDINGS: Among 8474 patients combined from both trials, the estimated treatment effect was a 13% reduction in all-cause death (pooled HR 0·87, 95% CI 0·77-0·98; p=0·018) and 14% reduction in cardiovascular death (0·86, 0·76-0·98; p=0·027). SGLT2 inhibition was accompanied by a 26% relative reduction in the combined risk of cardiovascular death or first hospitalisation for heart failure (0·74, 0·68-0·82; p<0·0001), and by a 25% decrease in the composite of recurrent hospitalisations for heart failure or cardiovascular death (0·75, 0·68-0·84; p<0·0001). The risk of the composite renal endpoint was also reduced (0·62, 0·43-0·90; p=0·013). All tests for heterogeneity of effect size between trials were not significant. The pooled treatment effects showed consistent benefits for subgroups based on age, sex, diabetes, treatment with an ARNI and baseline eGFR, but suggested treatment-by-subgroup interactions for subgroups based on NYHA functional class and race. INTERPRETATION: The effects of empagliflozin and dapagliflozin on hospitalisations for heart failure were consistent in the two independent trials and suggest that these agents also improve renal outcomes and reduce all-cause and cardiovascular death in patients with HFrEF. FUNDING: Boehringer Ingelheim.


Assuntos
Compostos Benzidrílicos/efeitos adversos , Glucosídeos/efeitos adversos , Insuficiência Cardíaca/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Volume Sistólico/efeitos dos fármacos , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Compostos Benzidrílicos/uso terapêutico , Índice de Massa Corporal , Estudos de Casos e Controles , Causas de Morte/tendências , Ensaios Clínicos como Assunto , Morte , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Taxa de Filtração Glomerular/fisiologia , Glucosídeos/uso terapêutico , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neprilisina/antagonistas & inibidores , Avaliação de Resultados da Assistência ao Paciente , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico
14.
J Am Heart Assoc ; 9(19): e017126, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901560

RESUMO

Background After the coronavirus disease 2019 outbreak, social isolation measures were introduced to contain infection. Although there is currently a slowing down of the infection, a reduction of hospitalizations, especially for myocardial infarction, was observed. The aim of our study is to evaluate the impact of the infectious disease on ST-segment-elevation myocardial infarction (STEMI) care during the coronavirus disease 2019 pandemic, through the analysis of recent cases of patients who underwent percutaneous coronary intervention. Methods and Results Consecutive patients affected by STEMI from March 1 to 31, 2020, during social restrictions of Italian government, were collected and compared with patients with STEMI treated during March 2019. During March 2020, we observed a 63% reduction of patients with STEMI who were admitted to our catheterization laboratory, when compared with the same period of 2019 (13 versus 35 patients). Changes in all time components of STEMI care were notably observed, particularly for longer median time in symptom-to-first medical contact, spoke-to-hub, and the cumulative symptom-to-wire delay. Procedural data and in-hospital outcomes were similar between the 2 groups, whereas the length of hospitalization was longer in patients of 2020. In this group, we also observed higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline and discharge. Conclusions The coronavirus disease 2019 outbreak induced a reduction of hospital access for STEMI with an increase in treatment delay, longer hospitalization, higher levels of cardiac biomarkers, and worse left ventricular function.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Ventrículos do Coração/fisiopatologia , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Idoso , Comorbidade , Ecocardiografia Doppler em Cores , Eletrocardiografia , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Intervenção Coronária Percutânea/métodos , Prognóstico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Volume Sistólico/fisiologia , Taxa de Sobrevida/tendências
15.
G Ital Cardiol (Rome) ; 21(10): 739-749, 2020 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-32968306

RESUMO

Coronavirus 2019 disease (COVID-19), caused by SARS-CoV-2, can lead to cardiac impairment with various types of clinical manifestations, including heart failure and cardiogenic shock. A possible expression of cardiac impairment is non-ischemic ventricular dysfunction, which can be related to different pathological conditions, such as myocarditis, stress and cytokine-related ventricular dysfunction. The diagnosis of these pathological conditions can be challenging during COVID-19; furthermore, their prevalence and prognostic significance have not been elucidated yet. The purpose of this review is to take stock of the various aspects of non-ischemic ventricular dysfunction that may occur during COVID-19 and of the diagnostic implications related to the use of cardiac imaging techniques.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Miocardite/diagnóstico por imagem , Pneumonia Viral/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Doença Aguda , Infecções Assintomáticas , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico por imagem , Síndrome da Liberação de Citocina/complicações , Ecocardiografia , Eletrocardiografia , Insuficiência Cardíaca/etiologia , Humanos , Miocardite/sangue , Miocardite/etiologia , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico por imagem , Volume Sistólico/fisiologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/etiologia , Troponina/sangue , Disfunção Ventricular Esquerda/sangue , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/etiologia
16.
G Ital Cardiol (Rome) ; 21(10): 750-756, 2020 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-32968307

RESUMO

BACKGROUND: During the COVID-19 pandemic, non-urgent outpatient activities were temporarily suspended. The aim of this study was to assess the impact of this measure on the management of the heart failure outpatient clinic at our institution. METHODS: We analyzed the clinical outcome of 110 chronic heart failure patients (mean age 73 ± 9 years) whose follow-up visit had been delayed. RESULTS: At their last visit before the lockdown, 80.9% was in NYHA class II, had an ejection fraction of 37 ± 7%, and B-type natriuretic peptide level was moderately elevated (266 ± 138 pg/ml). All patients received loop diuretics, 97.2% beta-blockers, 64.9% an aldosterone antagonist, 60.9% sacubitril/valsartan (S/V), and 72.2% of the remaining patients were on angiotensin-converting enzyme inhibitor or valsartan therapy. Patients were contacted by phone during and at the end of the lockdown period to fix a new appointment and underwent a structured interview to assess their clinical conditions and ongoing therapy and to verify whether they had contracted SARS-CoV-2 infection. Twelve patients (13.2%) contracted COVID-19. None was hospitalized for worsening heart failure or reported defibrillator shocks and none changed autonomously the prescribed therapy. Overall, 75% of patients reported stable or improved general well-being from the last in-person visit, while 25% described subjective worsening due to the social effect of the pandemic. Unchanged body weight and blood pressure values were reported by 86% and 78.4% of patients, respectively. Lower blood pressure values compared to baseline were recorded in 15.2% of patients on conventional renin-angiotensin system inhibition vs 21% of those on S/V, one of whom had to down-titrate S/V for persistent but asymptomatic hypotension; 4 patients up-titrated S/V to 200 mg/day following phone indications. CONCLUSIONS: Cancellation of scheduled follow-up visits during 3 months did not have significant negative effects in a cohort of stable patients with chronic heart failure on optimized medical therapy. Telephone support was effective in keeping connections with the patients during the lockdown, allowing appropriate management and implementation of drug therapy. In particular, patients who received S/V were not affected by delays in scheduled visits, confirming the tolerability and safety of this novel therapy in terms of both clinical and biohumoral parameters.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Insuficiência Cardíaca/tratamento farmacológico , Pneumonia Viral/epidemiologia , Quarentena , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Instituições de Assistência Ambulatorial , Aminobutiratos/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Doença Crônica , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/psicologia , Assistência à Saúde , Progressão da Doença , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/psicologia , Humanos , Itália/epidemiologia , Masculino , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Peptídeo Natriurético Encefálico/sangue , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/psicologia , Recidiva , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Volume Sistólico , Telefone , Tetrazóis/uso terapêutico , Suspensão de Tratamento
17.
Medicine (Baltimore) ; 99(37): e21663, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925713

RESUMO

BACKGROUND: The incidence of heart failure with normal ejection fraction (HFNEF) is increasing yearly, accounting for approximately half of all heart failure cases. Even after standardized treatment, the patient's prognosis is not good. Therefore, it is necessary to explore new treatment methods for HFNEF. Yangyin Shuxin Decoction, a traditional Chinese medicine prescription from our clinical experience in the treatment of HFNEF, has a potential cardioprotective effect. Preliminary clinical trials have shown that this prescription can improve the quality of life of HFNEF. This prompted us to use more objective indicators to further evaluate whether Yangyin Shuxin Decoction can improve the exercise capacity in HENEF patients. METHODS: This is a single-center parallel randomized controlled trial. The 64 patients who met the inclusion criteria were from the Cardiovascular Clinic. They will be randomly assigned to the treatment group (Yangying Shuxin Decoction combined with standard treatment) or the control group (standard treatment) according to the ratio of 1:1. The course of treatment will be 2 weeks. Both groups were interviewed at the following time points: of at enrollment (V1), and week 2 (V2), week 4 (V3), week 8 (V4), and week 12 (V5) after enrollment. The primary indicator is the peak oxygen consumption (Peak VO2) of the cardiopulmonary exercise test (CPET). Secondary indicators include CPET indicators such as anaerobic threshold oxygen consumption, carbon dioxide ventilation equivalent slope, echocardiographic indicators such as the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity(E/e'), left atrial volume index (LAVI), left ventricular mass index (LVMI), the peak velocity of tricuspid regurgitation (TR), B-type natriuretic peptide (BNP), New York Heart Association (NYHA) cardiac function grading, and so on. These indicators will be used to evaluate the effect of Yangyin Shuxin Decoction on exercise capacity in patients with HFNEF. DISCUSSION: At present, it is unclear whether the exercise capacity can be maintained after long-term use of Yangyin Shuxin Decoction. In this study, we will evaluate whether Yangyin Shuxin Decoction can improve the exercise capacity and quality of life of patients with HFNEF. This will provide an objective basis for the therapeutic effect of traditional Chinese medicine on HFNEF. TRIAL REGISTRATION: This study protocol has been listed in the Chinese Clinical Trial Registry (registration number: ChiCTR-IOR-17014206, http://www.chictr.org.cn/showproj.aspx?proj=24304) on December 28, 2017.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico/fisiologia , Adulto , Idoso , Ecocardiografia , Teste de Esforço , Tolerância ao Exercício , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/efeitos dos fármacos , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome , Resultado do Tratamento
18.
Int Heart J ; 61(5): 1014-1021, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879261

RESUMO

Impaired fatty acid metabolism is associated with heart failure (HF) prognosis. However, specific changes in acylcarnitine profiles and their potential clinical value have not been well explored in patients recovering from acute decompensation.This study recruited 79 HF patients hospitalized because of acute decompensation with a left ventricular ejection fraction (LVEF) of < 40% and 51 normal controls. Patients were dichotomized into two groups, namely, the "improved (IMP) " and the "non-improved (NIMP) " groups, as defined by the changes in LVEF from baseline to 12 months after discharge. Mass spectrometry was used to quantify the acylcarnitine concentrations at baseline and 6 and 12 months after discharge. The IMP and NIMP groups contained 42 and 37 patients, respectively. At baseline, HF patients had higher plasma concentrations of specific long-, medium-, and short-chain acylcarnitines compared to normal controls. From baseline to 12 months post-discharge, the IMP group showed significant decreases in long- and short-chain acylcarnitine concentrations, but significant increases in medium-chain acylcarnitines. In the NIMP group, none of the acylcarnitines significantly decreased, and significant increases were noted in long-, medium-, and short-chain acylcarnitines. Generalized estimating equations demonstrated that nine acylcarnitines could discriminate the IMP group from the NIMP group, including three long-chain (C18:1, C16, and C16:1) and six short-chain acylcarnitines (C5, C5-OH, C4, C4:1-DC, C3, and C2). After adjusting for age, the six short-chain acylcarnitines remained significant. Changes in short-chain acylcarnitine profiles are independently associated with the improvement in cardiac systolic function after acute decompensation.


Assuntos
Carnitina/análogos & derivados , Ácidos Graxos/metabolismo , Insuficiência Cardíaca/metabolismo , Metabolômica , Idoso , Carnitina/metabolismo , Estudos de Casos e Controles , Ésteres/metabolismo , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Prognóstico , Volume Sistólico , Sístole
19.
Zhonghua Bing Li Xue Za Zhi ; 49(10): 1046-1051, 2020 Oct 08.
Artigo em Chinês | MEDLINE | ID: mdl-32992421

RESUMO

Objective: To investigate the protective effect of dihydromyricetin (DHM) on doxorubicin (DOX)-induced myocardial injury and its mechanism. Methods: Twenty-four healthy male SD rats were divided into 4 groups: control group, DOX group, DOX+DHM100 group and DOX+DHM200 group. Echocardiography was used to measure cardiac function. At the end of the 6th week, the rats were anesthetized and sacrificed, and the pathological changes of the cardiac tissues were observed by HE staining, Masson staining and WGA staining. Cardiomyocyte apoptosis was observed by TUNEL staining, and protein levels of NLRP3, caspase-1, IL-1ß, bax and bcl-2 were detected by Western blot and immunohistochemistry. Results: Compared with the control group, the left ventricular ejection fraction and left ventricular fractional shortening decreased significantly in DOX group, while left ventricular internal dimension at systole and left ventricular internal dimension at diastole increased. In DOX+DHM group, both left ventricular ejection fraction and left ventricular fractional shortening increased, while left ventricular internal dimension at systole and left ventricular internal dimension at diastole decreased (P<0.05). Furthermore, DOX group showed significant myocardial injury histologically, while DOX+DHM group significantly inhibited DOX-induced myocardial injury in rats. Meanwhile, cardiomyocyte hypertrophy was found in the DOX group, while the cardiomyocyte hypertrophy was notably inhibited in the DOX+DHM group. Compared with the control group, the apoptotic rates of cardiomyocytes and the levels of bax/bcl-2 ratio were significantly increased in DOX group, which were significantly alleviated in the DOX+DHM group (P<0.05). In addition, the levels of NLRP3, caspase-1 and IL-1ß were increased as compared with control group, while the levels of the above indicators were remarkably reversed in DOX+DHM group as compared with DOX group (P<0.05). Conclusion: DHM alleviates DOX-induced myocardial injury in rats by inhibiting NLRP3 inflammasome and reducing cardiomyocyte apoptosis.


Assuntos
Inflamassomos , Função Ventricular Esquerda , Animais , Doxorrubicina , Masculino , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Ratos , Ratos Sprague-Dawley , Volume Sistólico
20.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 48-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965356

RESUMO

INTRODUCTION: In the current literature, there has been an upsurge of cases of COVID-19-induced acute myocarditis. In this case-based review, we aimed to describe the clinical characteristics, imaging findings, and in-hospital course of acute myocarditis. In addition, the limitations of the myocarditis diagnosis were discussed since only fulminant myocarditis cases have been mentioned in the current literature. METHODS: We performed a review of the literature of all patients who were diagnosed with COVID-19-induced acute myocarditis using the databases of PubMed, Embase, and the Cochrane. RESULTS: 16 case reports were found to be related to COVID-19-induced acute myocarditis. We observed that the ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads. Echocardiographic findings of COVID-19-induced acute myocarditis patients ranged from preserved left ventricular ejection fraction (LVEF) without segmental abnormalities to reduced LVEF with global hypokinesia. Interestingly, a few patients with COVID-19-induced acute fulminant myocarditis were steroid-responsive and had an amelioration with glucocorticoid and immunoglobulin therapy. CONCLUSION: Despite the COVID-19 pandemic worldwide, a limited number of cases has been shared in the current literature. There are a lot of difficulties in the differential diagnosis of acute myocarditis in the context of COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Miocardite/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Função Ventricular Esquerda/fisiologia , Doença Aguda , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Eletrocardiografia , Humanos , Miocardite/complicações , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Volume Sistólico
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