RESUMO
BACKGROUND: Survival rates after an out-of-hospital cardiac arrest (OHCA) remain low. Extracorporeal cardiopulmonary resuscitation (eCPR) has been introduced as an attempt to increase survival in selected patients and observational studies have shown promising results. Nevertheless, inclusion criteria and timing of eCPR remain undefined. OBJECTIVE: The current study analyzed a load and go strategy with respect to the golden hour of eCPR as a cut-off time for survival and favorable neurological outcome. MATERIAL AND METHODS: This retrospective cohort study included 32 patients who underwent eCPR treatment due to an OHCA between January 2017 and September 2019. Routinely taken patient demographic data (age, BMI, sex) were analyzed. The main focus was set on processing times in the preclinical and clinical setting. Time intervals including OHCA until ambulance arrival, time on scene, transportation times and door to eCPR were extracted from emergency medical service (EMS) and resuscitation protocols. Low-flow times, survival and neurological outcome were analyzed. RESULTS: The use of eCPR in OHCA was associated with survival to hospital discharge in 28% and a good neurological outcome in 19% of the cases. Both groups (survivor and nonsurvivor) did not differ in patient demographics except for age. Survivors were significantly younger (47 (30-60) vs. 59 (50-68) years, pâ¯= 0.035). Processing times as well as low-flow times were not significantly different (OHCA-eCPR survivor 64 (50-87) vs. non-survivor 74 (51-85) min; p-value 0.64); however, median low-flow times were outside the golden hour of eCPR (69 (52-86)). CONCLUSION: Despite low-flow times of more than 60â¯min, eCPR was associated with survival in 28% after OHCA. Hence, exceeding the golden hour of eCPR cannot act as a definitive exclusion criterion for eCPR.
Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Oxigenação por Membrana Extracorpórea , Parada Cardíaca Extra-Hospitalar , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Estudos RetrospectivosRESUMO
INTRODUCTION: Acute hemodynamic decompensation during catheter ablation of ventricular tachycardia is associated with increased mortality. We assessed the effectiveness of mechanical circulatory support using a micro-axial percutaneous assist device in preventing acute hemodynamic decompensation. METHODS AND RESULTS: Twenty-six consecutive patients with structural heart disease undergoing 28 ventricular tachycardia ablations between May 2013 and October 2017 were included. All patients presenting with left ventricular ejection fraction <25%, symptomatic heart failure and arrhythmia associated hemodynamic decompensation underwent catheter ablation with mechanical circulatory support (Impella 2.5; Impella CP, Abiomed, Danvers, MA). Electro-anatomic mapping was performed using Ensite NavX (Abbott, Chicago, IL) or Rhythmia (Boston Scientific, Marlborough, MA) mapping systems. Mapping/ablation strategy included a substrate and activation mapping/ablation. Of the 26 patients, 80% had ischemic cardiomyopathy, the mean age was 68 ± 9 years; mean left ventricular ejection fraction 19.6% ± 3%, mean PAAINESD score was 21 ± 3. Mean tachycardia cycle length was 348 ± 76 ms (range 280-500 ms). The assist device was used pre-emptively in 25 patients and as rescue therapy in one patient. All ventricular tachycardias occurring during substrate ablation were activation mapped and ablated. The ablation procedure was accomplished in 25 of 26 patients, acute decompensation occurred only in one patient receiving circulatory support as bail-out therapy. CONCLUSION: In patients with advanced heart failure and a high probability of acute hemodynamic decompensation during catheter ablation, mechanical circulatory support prevented acute decompensation in 25 of 26 patients. Thus, mechanical circulatory support facilitates catheter ablation of unstable ventricular tachycardia in a critically ill patient population.
Assuntos
Ablação por Cateter , Insuficiência Cardíaca/terapia , Coração Auxiliar , Hemodinâmica , Implantação de Prótese/instrumentação , Taquicardia Ventricular/cirurgia , Função Ventricular Esquerda , Idoso , Ablação por Cateter/efeitos adversos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Volume Sistólico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The long-QT syndromes (LQTS) are inherited electrical cardiomyopathies characterized by prolonged ventricular repolarization and ventricular arrhythmias. Several genetic reports have associated defects in LQTS-causing genes with atrial fibrillation (AF). We therefore studied whether atrial arrhythmias occur in patients with LQTS under daily-life conditions. METHODS: We systematically assessed atrial arrhythmias in LQTS patients and matched controls using implanted defibrillators or pacemakers as monitors of atrial rhythm in a nested case-control study. Twenty-one LQTS patients (3 male; 39 +/- 18 years old; 18 on beta blocker, ICD therapy duration 6.3 +/- 2.7 years; 4 LQT1, 6 LQT2, 2 LQT3) were matched to 21 control subjects (13 male; 50 +/- 19 years old; 3 on beta blocker; pacemaker therapy duration 8.5 +/- 5.5 years; 19 higher-degree AV block, 2 others). LQTS patients were identified by a systematic search of the LQTS patient databases in Münster and Munich. RESULTS: One-third (7 of 21) of the LQTS patients developed self-terminating atrial arrhythmias (atrial cycle lengths <250 ms). Only one control patient developed a single episode of postoperative AF (P < 0.05 vs LQTS). CONCLUSIONS: LQTS patients at high risk for ventricular arrhythmias may develop short-lasting atrial arrhythmias under daily-life conditions, suggesting that prolonged atrial repolarization may contribute to the initiation of AF.
Assuntos
Atividades Cotidianas , Antagonistas Adrenérgicos beta/uso terapêutico , Fibrilação Atrial/genética , Desfibriladores Implantáveis , Síndrome do QT Longo/genética , Marca-Passo Artificial , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/prevenção & controle , Estudos de Casos e Controles , Criança , Eletrocardiografia , Feminino , Alemanha , Humanos , Síndrome do QT Longo/complicações , Síndrome do QT Longo/tratamento farmacológico , Síndrome do QT Longo/terapia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
In patients with chronic heart failure (CHF), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) predicted poor outcome. Clinical predictors of NT-pro-BNP and its usefulness in the presence of chronic kidney disease (CKD) are largely unknown. A total of 341 patients with stable CHF were enrolled, of whom 183 (54%) had CKD. During a follow-up of 620 +/- 353 days, 57 patients (17%) experienced a cardiac event (cardiac death, need for extracorporeal assist device, or urgent cardiac transplantation), and 64 patients (20%) were rehospitalized because of worsening CHF. NT-pro-BNP was related to New York Heart Association functional class (R = 0.44, p <0.001) and inversely related to ejection fraction (R = -0.52, p <0.001) and glomerular filtration rate (R = -0.32, p <0.001). A cardiac event was independently predicted by NT-pro-BNP (hazard ratio [HR] 1.56, p <0.001), ejection fraction (HR 0.95, p = 0.018), and serum sodium (HR 0.89, p = 0.004). Using receiver-operator characteristic analysis, NT-pro-BNP > or =1,474 pg/ml best separated patients with or without cardiac events. In patients without CKD, outcome was significantly worse in patients with NT-pro-BNP >1,474 pg/ml in comparison to patients with NT-pro-BNP <1,474 pg/ml (event-free survival rate 0% vs 75%; p <0.001). In patients with CKD, outcome was also significantly worse in subjects with NT-pro-BNP >1,474 pg/ml in comparison to those with NT-pro-BNP <1,474 pg/ml (event-free survival rate 48% vs 93%; p <0.001). NT-pro-BNP independently predicted rehospitalization caused by worsening CHF (HR 1.26, p = 0.023), and a cut-off value of 1,474 pg/ml also separated patients with poor and intermediate prognosis in the CKD and non-CKD groups. In conclusion, NT-pro-BNP independently predicted morbidity and mortality in patients with CHF with and without CKD.
Assuntos
Insuficiência Cardíaca/sangue , Falência Renal Crônica/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Feminino , Taxa de Filtração Glomerular , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Hospitalização , Humanos , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Fatores de Risco , Volume Sistólico , Resultado do TratamentoRESUMO
In patients with chronic heart failure (CHF) and severe secondary mitral regurgitation (MR), the diagnostic usefulness and prognostic impact of tissue Doppler imaging (TDI) is unknown. This prospective study enrolled 370 patients with stable CHF. Severe secondary MR, defined as effective regurgitant orifice area >/=0.20 cm(2), was present in 92 patients (25%). Echo measurements comprised left ventricular volumes, ejection fraction, mitral E/A ratio, deceleration time, and TDI-derived mitral annular velocities (e.g., S', E', A', E/E'). During a follow-up of 790 +/- 450 days, all-cause mortality and rehospitalization data were analyzed. Patients with or without MR did not differ with respect to age or ejection fraction, but patients with MR were in a poorer New York Heart Association functional class and had a higher mitral E/E' ratio. During follow-up, 70 patients (18%) died and 134 patients (36%) were rehospitalized for worsening heart failure. Mortality rate was significantly higher in patients with versus without severe MR (33% vs 14%, p <0.001). In the MR group, the mitral E/E' ratio independently predicted all-cause mortality and was also significantly associated with rehospitalization for worsening heart failure. In patients with MR with an E/E' ratio >13.5, outcome was markedly worse compared with patients with an E/E' ratio =13.5 (event-free survival rate, 64% vs 31%, p <0.001). In conclusion, in patients with CHF and severe secondary MR, a higher mitral E/E' ratio is associated with increased morbidity and an adverse outcome. TDI appears to be a useful adjunct in the diagnostic workup and risk stratification of such patients.
Assuntos
Ecocardiografia Doppler em Cores , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Fatores Etários , Velocidade do Fluxo Sanguíneo/fisiologia , Volume Cardíaco/fisiologia , Causas de Morte , Progressão da Doença , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/fisiopatologia , Readmissão do Paciente , Prognóstico , Estudos Prospectivos , Volume Sistólico/fisiologia , Taxa de Sobrevida , Fatores de TempoRESUMO
OBJECTIVES: Implantation of an additional HV-P/S lead versus extraction of the defective HV-P/S lead and implantation of a new one is one possible therapeutic approach in cases of a defective high-voltage pace/sense lead (HV-P/S). No information is available on potential differences in clinical outcome in these different approaches. METHODS: Between January 2000 and February 2006, 86 patients with HV-P/S lead defect received either an additional transvenous HV-P/S lead (n = 33, group 1) or the HV-P/S lead was replaced (n = 53, group 2). The duration of the initially implanted leads was significantly different in the two groups (7.4 +/- 2.9; group 1 and 4.1 +/- 3.4 years; group 2). The outcome of these two groups of patients was retrospectively analyzed. RESULTS: Seventy-three patients [85%] survived until the end of follow-up of 29 +/- 15 (group 1) and 33 +/- 21 (group 2) months (P = ns), respectively. Thirteen patients died: six in group 1 and seven in group 2 (P = ns). Fourteen patients experienced perioperative complications (group 1: six; group 2: eight; P = ns). ICD system-related complications occurred in 22 patients (group 1: seven; group two: 15; P = ns). The event-free cumulative survival of patients with additional and replaced HV-P/S lead for postoperative events (including death) after 1, 2, and 3 years was 82%, 70%, 70%, and 86%, 81%, 66%, respectively (P = 0.93). CONCLUSIONS: Implantation of an additional HV-P/S lead or replacement of the HV-P/S lead in case of HV-P/S lead failure is statistically not different concerning mortality and morbidity. There are no predictors for further lead defects. Implantation of an additional HV-P/S lead should not be recommended in young patients or patients with greater likelihood of living many years. Predictors for death were an age over 70 years and renal insufficiency.
Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Cardiopatias/terapia , Implantação de Prótese/mortalidade , Implantação de Prótese/métodos , Eletrodos Implantados , Desenho de Equipamento , Falha de Equipamento , Feminino , Seguimentos , Cardiopatias/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
In patients with chronic heart failure and reduced systolic function, an implantable cardioverter-defibrillator (ICD) improves the prognosis, but morbidity and mortality remain high. We attempted to identify the prognostic impact of Doppler echocardiography and QRS duration in such patients. We prospectively enrolled 84 patients with chronic heart failure, an ICD, and impaired systolic function (mean ejection fraction 29 +/- 10%). Echocardiographic measurements included left ventricular dimensions/volumes, ejection fraction, mitral E/A ratio, deceleration time, and tissue Doppler analysis of mitral annular velocities (S', E', A'). A cardiac event (death from pump failure or appropriate ICD therapy, i.e., antitachycardia pacing/shock due to sustained ventricular tachycardia or ventricular fibrillation) was defined as the study end point. During a follow-up of 373 +/- 254 days, 22 patients (26%) had an event (death from pump failure, n = 7; patients who received an appropriate ICD therapy, n = 16). In patients with an event, the QRS duration was longer (169 +/- 41 vs 146 +/- 37 ms, p = 0.023), the mitral E/E' ratio was higher (16.0 +/- 6.5 vs 12.8 +/- 5.9, p = 0.044), and a restrictive filling pattern was more frequent (44% vs 9%, p = 0.017). Stepwise multivariate Cox regression analysis identified a restrictive filling pattern as the only independent predictor of an event (hazard ratio 3.65, 95% confidence interval 1.54 to 8.64, p = 0.003). For patients with a restrictive filling pattern, the outcome was markedly poorer than that for patients with a nonrestrictive pattern (event-free survival rate 38% vs 72%, p = 0.005). In conclusion, in patients with chronic heart failure, an ICD, and systolic dysfunction, a restrictive filling pattern is an independent predictor of adverse cardiac events.
Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Valva Mitral/fisiopatologia , Idoso , Doença Crônica , Ecocardiografia Doppler , Eletrocardiografia , Feminino , Seguimentos , Alemanha , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Volume Sistólico , Análise de Sobrevida , Sístole , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
Sudden death among implantable cardioverter defibrillator (ICD) recipients is well known. The underlying mechanism remains unclear in most cases. One possible mechanism is an accidentally induced arrhythmia by the ICD itself. This report describes for the first time a case of a life-threatening ventricular arrhythmia induced by a specific algorithm for ventricular arrhythmia reconfirmation before shock delivery in a fourth-generation ICD.
Assuntos
Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Desfibriladores Implantáveis/efeitos adversos , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/fisiopatologiaRESUMO
BACKGROUND: In left atrial appendage (LAA) closure, the correct sizing of the implantable devices is crucial. Data on the time-dependent changes in the shape and positioning of LAA occlusion devices are missing. We analyzed the results of 33 consecutive patients after implantation of an Amplatzer™ Cardiac Plug (ACP) LAA closure device to get more information on the optimal device sizing during implantation. METHODS AND RESULTS: Thirty-three consecutive patients were enrolled in this observational study. ACP implantation was guided by fluoroscopy and three dimensional transesophageal echocardiography (3-D TEE). Device sizing was based on the largest measured diameter of the intended landing zone adding 2-4 mm of device oversizing. Fluoroscopies were performed at 1 day after, and after 3 months, control 3-D TEE was performed 3 months after implantation. The stability of device positioning and shape was matched with the results of 3-D TEE. Patients' mean age was 70.2 ± 8 years; mean CHA2DS2VASc score was 3.8 ± 1.1. According to the manufacture's classification, the post-implant degree of compression of the device-lobe was classified in three categories 1) undercompression "square-like shape" (1 patient); 2) optimal compression "tire-like shape" (20 patients), 3) overcompression "strawberry-like shape" (12 patients). Changes in the degree of device compression by more than one classification class occurred in 18/33 of our patients. A complete loss of device compression ("square-like shape") was observed in 9 patients. Despite the changes in device compression, a complete closure of the LAA was achieved in 32/33 patients. CONCLUSIONS: There is a temporal change in shape and positioning of the ACP within 3 months after implantation. A late decompression of the ACP lobe was observed in 61% of our patients, leading to a complete loss in device compression in 27%. This observation may be the rationale for a higher degree of ACP oversizing during implantation.
Assuntos
Apêndice Atrial , Cateterismo Cardíaco/instrumentação , Dispositivo para Oclusão Septal , Idoso , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Cateterismo Cardíaco/efeitos adversos , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Feminino , Fluoroscopia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Desenho de Prótese , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Mitral annular velocities derived from tissue Doppler imaging (TDI) provide information about left ventricular (LV) long-axis function and allow for the assessment of LV filling pressures in selected subsets of patients. It was the aim of this study to assess the usefulness of TDI in patients with moderate to severe aortic valve stenosis (AS). METHODS: Twenty-three patients with moderate to severe AS (mean aortic valve area 0.8 +/- 0.4 cm2), in whom coronary artery disease had been ruled out, and 36 asymptomatic age-matched control subjects underwent assessment of ejection fraction, fractional shortening, and mitral inflow (E, A, E/A ratio). TDI velocities (S', E', A') were derived from the septal mitral annulus. In patients with AS, LV pressure before atrial contraction (LV pre-A pressure), LV end-diastolic pressure, and cardiac index were measured during cardiac catheterization. RESULTS: In patients with AS, systolic (S') and early diastolic mitral annular velocities (E') were significantly reduced in comparison to control subjects (systolic, 5.5 +/- 1.2 vs 8.3 +/- 1.3 cm/s; early diastolic, 5.6 +/- 1.6 vs 10.2 +/- 3.0 cm/s, P <.001 for both comparisons), but ejection fraction, fractional shortening, and cardiac index were normal. In patients with AS, LV pre-A pressures (14 +/- 4 mm Hg) and end-diastolic pressures were high (19 +/- 7 mm Hg). In such patients, the mitral E/E' ratio was significantly related to LV pre-A pressure (r = 0.75, P <.001) and to LV end-diastolic pressure (r = 0.78, P <.001). In patients with AS, an E/E' ratio > or =13 identified an LV end-diastolic pressure >15 mm Hg, with a sensitivity of 93% and a specificity of 88%. CONCLUSIONS: In patients with moderate to severe AS, TDI allows for a reliable, noninvasive estimation of filling pressures. In such patients, systolic long-axis function is impaired even in the presence of normal ejection fraction and cardiac index. Thus, TDI integrates information about systolic and diastolic performance and may be a useful addition in the echocardiographic workup and care of patients with AS.
Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia Doppler , Pressão Ventricular , Idoso , Estenose da Valva Aórtica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Volume SistólicoRESUMO
Mitral annular velocities derived from tissue Doppler (S', E', A') and left ventricular (LV) end-diastolic pressures were obtained in 11 patients with significant primary mitral regurgitation (MR), 26 patients with significant MR secondary to ischemic or dilated cardiomyopathy, and in 29 asymptomatic controls. The mitral E/E' ratio was related significantly to LV end-diastolic pressure in patients with secondary, but not in patients with primary MR. In patients with secondary MR, a mitral E/E' ratio >15 predicted an elevated LV end-diastolic pressure with a sensitivity of 80% and a specificity of 100%. Thus, the mitral E/E' ratio is a reliable estimate of filling pressures only in subjects with significant secondary, but not with significant, primary MR.
Assuntos
Ecocardiografia Doppler , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Função Ventricular Esquerda/fisiologia , Pressão Ventricular , Adulto , Idoso , Diástole/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Sístole/fisiologiaRESUMO
BACKGROUND: the incidence and prevalence of patients with advanced heart failure is increasing worldwide and the number of cardiac transplantations remains limited. AIMS: it was the aim of the study to describe our experience with the increasing number of available medical, interventional and cardiac surgery options, and to assess heart failure survival score predictability in an academic heart failure center within a 1-year follow-up. METHODS AND RESULTS: in all patients who were referred for cardiac transplant evaluation within a 12-month period between April 1998 and March 1999 at our Interdisciplinary Heart Failure and Transplant Program, our team assessed all medical interventions as well as interventional and surgical treatment options that were available, based on the clinical profile on initial presentation. In 92% of the 120 patients referred for cardiac transplantation evaluation, drug therapy could be optimized. A considerable number of patients could be subjected to an organ-preserving intervention or surgery, either PTCA (n=11), CABG (n=4), valve repair (n=7), multisite pacing (n=7), or partial ventricular resection (n=5). Only a small group of patients with the worst heart failure survival score were listed for heart transplantation (n=17) or received a ventricular assist device (n=3). CONCLUSIONS: within a contemporary cohort of advanced heart failure patients, only a small number of patients will undergo cardiac transplantation, which is predictable by the heart failure survival score. Most patients will undergo optimized medical therapy and a considerable number will be subjected to interventional or surgical treatment options.
Assuntos
Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Angioplastia Coronária com Balão , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Ponte de Artéria Coronária , Tomada de Decisões , Feminino , Seguimentos , Alemanha/epidemiologia , Transplante de Coração , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Análise de SobrevidaRESUMO
BACKGROUND: Vasoactive peptides are accepted indicators of the degree of heart failure and its progression or improvement following medical therapy. Normalization of cardiac hemodynamics by cardiac transplantation (HTx) may lead to normalization of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) plasma levels shortly after the procedure. METHODS: Long-term follow-up was done for 14 consecutive patients, 12 men and 2 women, 49 years of age (range 24 to 64 years). ANP and BNP were measured by radioimmunoassay (RIA) in central venous plasma samples (before breakfast, at steady state) at the following intervals after HTx: 7 to 30 (1), 31 to 60 (2), 61 to 90 (3), 120 to 180 (4) and 210 to 365 (5) days. RESULTS: During follow-up, ANP decreased significantly within 2 months after HTx and continued of this level, whereas BNP decreased continuously without reaching normal values. The mean ratio of ANP:BNP increased from 3.23 to 8.01 during follow-up. Whereas right atrial pressure (RAP), right ventricular pressure (RVP), right ventricular end-diastolic pressure (RVEDP) and pulmonary capillary wedge pressure (PCWP) did not change during follow-up, cardiac output (CO) improved slightly, but significantly from 5.21 liters/min to 5.9 liters/min (p = 0.035). CONCLUSIONS: Normalization of left ventricular function after orthotopic HTx does not induce an early diminution of ANP and BNP plasma levels to normal concentrations. Although elevated ANP concentrations showed only minimal changes within 1 year, BNP decreased significantly as early as 2 months after HTx, without reaching normal values during the year of follow-up. Also, the ratio of ANP and BNP increased significantly from 3.23 to 8.01. These results demonstrate the contribution of other factors beyond cardiac function that determine the levels of these peptides.
Assuntos
Fator Natriurético Atrial/sangue , Transplante de Coração , Peptídeo Natriurético Encefálico/sangue , Feminino , Seguimentos , Transplante de Coração/fisiologia , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Radioimunoensaio , Valores de Referência , Fatores de Tempo , Função Ventricular Esquerda/fisiologiaRESUMO
BACKGROUND: The presence of signs and symptoms of heart failure (HF), abnormal diastolic function and an ejection fraction > 45%, have been defined as diastolic HF (DHF). However, a cut-off value of 45% for ejection fraction seems arbitrary as mild systolic dysfunction may be overlooked. It was the goal of this study to assess the additive information derived from Doppler tissue imaging for patients with DHF. METHODS: As a measure of left ventricular (LV) long-axis function, systolic and diastolic velocities of the mitral annulus (peak, peak early, and peak late) derived from pulsed Doppler tissue imaging were assessed in 36 asymptomatic control subjects, 36 patients with DHF, and 35 patients with systolic HF (SHF). As a measure of overall LV performance, the Tei index (isovolumic contraction time and isovolumic relaxation time divided by ejection time) was assessed. RESULTS: In the DHF group, peak systolic annular velocity was reduced (7.1 +/- 1.2 cm/s) as compared with the control group (9.0 +/- 1.2 cm/s, P <.05), and was even lower in the SHF group (5.0 +/- 0.7 cm/s, P <.01 SHF group vs DHF/control groups). The Tei index was increased in the DHF group (0.53 +/- 0.14) in comparison with the control group (0.39 +/- 0.07, P <.05), and was highest in the SHF group (0.94 +/- 0.43, P <.01 SHF group vs control/DHF groups). Using peak systolic annular velocity < 7.95 cm/s as a cut-off value (derived from receiver operating characteristic curve analysis), patients with DHF were separated from control subjects with a sensitivity of 83% and a specificity of 83%. A Tei index > 0.43 separated patients with DHF and control subjects with a sensitivity of 79% and a specificity of 72%. CONCLUSION: Systolic long-axis LV function is also impaired in patients with DHF, resulting in feasible diagnosis of DHF by Doppler tissue imaging analysis of LV long-axis function and overall LV function with the Tei index.
Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Ecocardiografia Doppler , Insuficiência Cardíaca/fisiopatologia , Valva Mitral/diagnóstico por imagem , Idoso , Pressão Sanguínea/fisiologia , Superfície Corporal , Cateterismo Cardíaco , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/fisiopatologia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/fisiopatologia , Diástole/fisiologia , Feminino , Alemanha , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Volume Sistólico/fisiologia , Sístole/fisiologia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Acute pulmonary embolism is a leading cause of death during pregnancy and delivery in the United States. We describe the case of a 25-year-old woman who presented in cardiogenic shock in week 38 of her first pregnancy. After the emergent cesarean delivery of a healthy male neonate, the mother underwent immediate surgical pulmonary embolectomy. We confirmed the diagnosis of pulmonary embolism intraoperatively by means of transesophageal echocardiography and removed large clots from the patient's pulmonary arteries. Mother and child were doing well, 27 months later. In addition to presenting our patient's case, we discuss the other relevant reports and the options for treating massive pulmonary embolism during pregnancy.