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Background and objective: Orthostatic hypotension (OH) is a decrease in systolic blood pressure (BP) of 20 mm Hg and in diastolic BP of 10 mm Hg when changing the position from lying to standing. Arterial hypertension (AH), comorbidities and polypharmacy contribute to its development. The aim was to assess the presence of OH and its predictors in asymptomatic chronic kidney disease (CKD) patients. Material and methods: 45 CKD patients with estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m2 (CKD+) were examined for signs of OH and its predictors. The results were compared with the control group of 22 patients with eGFR > 60 mL/min/1.73 m2 (CKD-). Asymptomatic patients without ischemic heart disease and previous stroke were qualified. Total blood count, serum creatinine, eGFR, urea, phosphates, calcium, albumins, parathyroid hormone, uric acid, C reactive protein, N-terminal pro b-type natriuretic peptide, lipid profile, and urine protein to creatinine ratio were assessed. Simultaneously, patients underwent echocardiography. To detect OH, a modified Schellong test was performed. Results: OH was diagnosed in 17 out of 45 CKD+ patients (average age 69.12 ± 13.2) and in 8 out of 22 CKD- patients (average age 60.50 ± 14.99). The CKD+ group demonstrated significant differences on average values of systolic and diastolic BP between OH+ and OH- patients, lower when standing. In the eGFR range of 30-60 mL/min/1.73 m2 correlation was revealed between OH and ß-blockers (p = 0.04), in the entire CKD+ group between ß-blockers combined with diuretics (p = 0.007) and ACE-I (p = 0.033). Logistic regression test revealed that chronic heart failure (CHF, OR = 15.31), treatment with ß-blockers (OR = 13.86) were significant factors influencing the presence of OH. Conclusions: Predictors of OH in CKD may include: CHF, treatment with ß-blockers, combined with ACE-I and diuretics.
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Doenças Assintomáticas/epidemiologia , Hipotensão Ortostática/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Antagonistas Adrenérgicos beta/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Doença Crônica , Comorbidade , Diuréticos/efeitos adversos , Quimioterapia Combinada , Feminino , Insuficiência Cardíaca/complicações , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estatísticas não ParamétricasRESUMO
BACKGROUND: Mean platelet volume (MPV) was proved to be a reliable prognostic factor in cardiac patients. However, platelet distribution width (PDW) was disclosed to be more specific marker of platelet reactivity. The aim of study was to evaluate whether baseline PDW value can predict the outcome in patients undergoing percutaneous coronary interventions (PCI) with drug-eluting stent implantation within coronary bifurcation lesions. MATERIALS AND METHODS: It was a two-centre observational study, which included patients who underwent PCI within bifurcation lesions between January 2014 and December 2014. Thrombocytopenia below 100 000/µL and STEMI were the exclusion criteria. Analysed data came entirely from in-hospital records and information obtained from the 12-month telephone follow-up. RESULTS: We included 269 patients. Mean PDW value was 13·4 ± 2·5 fL, whereas median was 13 (Q1 < 11·6 fL, Q2 11·6-13 fL, Q3 13-14·8 fL and Q4 > 14·8 fL). We found strong correlation between PDW and MPV (r = 0·96, P < 0·001), but no correlation was revealed between red blood cell distribution width (RDW) and PDW (r = 0·003, P = 0·95) as well as RDW and MPV (r = 0·0018, P = 0·98). Receiver operating characteristics (ROC) curve showed that PDW for cutoff 15·8% can predict MACE rate with sensitivity of 79% and specificity of 47% (area under curve - AUC 0·654; P = 0·01). A ROC curve for PDW categorized by 1-year TLR rate was described by optimal cutoff 16·3%, with sensitivity 69% and specificity 54% (AUC 0·697; P = 0·0015). CONCLUSIONS: PDW is an affordable and reliable predictor of 1-year MACE and TLR rate after PCI within coronary bifurcation lesions.
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Doença da Artéria Coronariana/cirurgia , Volume Plaquetário Médio , Idoso , Aspirina/uso terapêutico , Plaquetas/fisiologia , Clopidogrel , Doença da Artéria Coronariana/mortalidade , Stents Farmacológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Intervenção Coronária Percutânea , Inibidores da Agregação Plaquetária/uso terapêutico , Recidiva , Ticlopidina/análogos & derivados , Ticlopidina/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: The increased value of the red cell distribution width (RDW) was reported to indicate poor prognosis in patients with chronic heart failure. We evaluated the value of the RDW in the diagnosis of left ventricular diastolic dysfunction (LVDD) in patients without diastolic heart failure among the chronic kidney disease (CKD) population. METHODS: The study group consisted of 73 ambulatory patients with CKD, stages 2-5. Standard echocardiography and tissue Doppler imaging (TDI) were performed, and the level of RDW was determined. Patients were divided into four groups according to the results of peak early diastolic velocity of mitral annulus (EmLV) and the stage of CKD: group with early stage CKD (eGFR > 30 ml/min/1.73 m(2)) without LVDD (EmLV ≥ 8 cm/s), early stage CKD with LVDD (EmLV < 8 cm/s), group with advanced stage CKD (eGFR ≤ 30 ml/min/1.73 m(2)) without LVDD, and group with advanced stage CKD with LVDD. RESULTS: Patients with advanced stage CKD with LVDD were characterized by higher RDW levels than patients with advanced stage CKD without LVDD and with early stage CKD groups with and without LVDD [14.5 (13.8-19.5) % vs. 13.7 (11.4-15,4) %, p = 0.049, vs. 13.8(13.1-14.9) %, p = 0.031, vs. 13.7(12.1-16.2) %, p = 0.0007], respectively. The area under the receiver operating characteristic (ROC) curve of RDW level for the detection of LVDD was 0.649, 95 % confidence interval (CI) 0.528-0.758, p = 0.021, whereas ROC derived RDW value of >13.5 % was characterized by a sensitivity of 83.3 % and specificity of 45.2 % for predicting LVDD. The only independent factor of LVDD was RDW level >13.5 % with odds ratio (OR) = 3.92 (95 % CI 1.05-14.56), p = 0.037. CONCLUSION: RDW can be used as an additional factor for the diagnosis of LVDD in patients with advanced stage of CKD.
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Índices de Eritrócitos , Insuficiência Renal Crônica/complicações , Disfunção Ventricular Esquerda/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Disfunção Ventricular Esquerda/complicaçõesRESUMO
INTRODUCTION: The introduction of the classification of chronic kidney disease (CKD) by NKF KDOQI guidelines in 2002, including the staging and risk assessment of this disease, was a landmark event. The division of CKD into stages 1-5 turned out to be very useful and sensitive tool in the hands of both scientists and clinical practitioners; it established common nomenclature pertaining to CKD all over the world. This stratification profoundly changed the approach to CKD, transforming it from a somewhat neglected clinical problem to the phenomenon named "the epidemic of CKD". However, after a short period if clinical experience a heated debate was initiated in the literature, indicating the shortcomings of the adopted classification. The most questionable areas included methodological issues as well as dissimilar prognoses for patients depending on the cause of kidney dysfunction, the presence of proteinuria and comorbidities. AIM: The aim of this study was to evaluate the prevalence of CKD and the risk factors based on NKF KDOQI classification of 2002 in the population of Ostróda administrative district. MATERIAL AND METHOD: In total 437 individuals (F 277, M 160) aged 52.7±18.0 were examined. The study was conducted in Ostróda among randomly selected inhabitants of Ostróda adminstrative district. Serum creatinine was determined by a modified Jaffe method and eGFR was calculated (MDRD formula) for each individual. The correlations between serum creatinine and eGFR, gender and age were studied. Additionally, 326 of the examined participants were interviewed to establish CKD risk factors: kidney disease in the family, being overweight and/or obese, arterial hypertension, diabetes, smoking, heart attack, stroke. RESULTS: 58.6% of the examined individuals demonstrated abnormal eGFR values (<90 ml/min/l.73 m2), whereas serum creatinine above the laboratory norm was found in 1.3% of patients. Significant CKD risk factors included an increased prevalence of obesity (78.3%), arterial hypertension (38.6%), and smoking (26.8%); 23.9% reported kidney disease in the family. CONCLUSIONS: Based on our study, it can be concluded that CKD prevalence evaluated according to the classification of 2002 seems to be overestimated, and the main factor contributing to a false CKD diagnosis is a physiological decline in eGFR values with aging. The modification of CKD classification carried out by NKF in 2012 requires further observation and evaluation of its usefulness in daily clinical practice.
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Guias de Prática Clínica como Assunto , Insuficiência Renal Crônica/classificação , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Causalidade , Comorbidade , Erros de Diagnóstico , Reações Falso-Positivas , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Polônia , Prevalência , Proteinúria/epidemiologia , Insuficiência Renal Crônica/diagnóstico , Fatores de Risco , Fumar/epidemiologia , Terminologia como AssuntoRESUMO
Renal artery thrombosis (RAT) is a rare condition, with a poor prognosis, which can lead to renal infarction (RI). RAT has both cardiogenic etiology (arrhythmia, endocarditis, valvular heart disease, coronary disease) and noncardiogenic etiology (renal artery injury and/or instrumentation, fibromuscular dysplasia, coagulation disorders, homocystinuria, cocaine intake). In 30% of cases RAT etiology remains undetermined and then it is labeled idiopathic RAT. Because of the absence of typical symptoms and abnormalities in laboratory tests as well as often ambiguous results of imaging scans, RAT frequently remains undiagnosed. Presently RAT treatment standards are lacking due to its being a rare disease, which renders making treatment decisions difficult. However, because of a high risk of developing its serious complication in the form of RI, it seems necessary to introduce patient-tailored treatment in each case. Two cases presented in this paper demonstrate diagnostic difficulties and the necessity to introduce personalized treatment. Case 1 concerns idiopathic RAT in which anticoagulation therapy was introduced. Case 2 describes cardiogenic RAT with renal artery stenosis treated interventionally, i.e., percutaneous transluminal angioplasty (PTA) combined with antiplatelet drugs. In both cases recanalization of the renal artery was successful and a stable renal function was achieved.
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Rim/irrigação sanguínea , Obstrução da Artéria Renal/diagnóstico , Obstrução da Artéria Renal/terapia , Trombose/diagnóstico , Trombose/terapia , Angioplastia , Anticoagulantes/uso terapêutico , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Resultado do TratamentoRESUMO
Despite an increasing number of hypotensive drugs available on the market, an unsatisfactory percentage of patients achieve expected therapeutic effects in the management of arterial hypertension (HTN). This issue is especially significant as regards patients with chronic kidney disease (CKD), due to a high HTN prevalence in this population of patients and because inappropriately controlled arterial blood pressure (ABP) constitutes an additional factor leading to the progression of this disease. Kidneys play a significant role in the pathophysiology of HTN. Some of the impaired mechanisms for controlling ABP in CKD can be corrected pharmacologically. However, in order to achieve therapeutic effectiveness, a simultaneous intervention at many pathophysiological levels is necessary, and this is associated with the necessity to administer more than one hypotensive drug. It is actually polytherapy that is the real challenge in managing HTN, as it disturbs the so-called compliance, i.e., cooperation and a proper adherence to the physician's orders by the patient. Combined drugs facilitate a multidirectional intervention on the impaired mechanisms for controlling ABP, while offering an uncomplicated treatment protocol. They are especially recommended in groups of patients with a high cardiovascular risk, diabetes and/or with CKD. However, despite a large body of evidence for the improved effectiveness of hypotensive treatment with the use of combination therapy in the general population, there are no multicenter studies performed on the population of CKD patients. Also there are only few reports referring to this issue in the literature. The authors of the present paper have overviewed literature concerning the distinctness of the pathogenesis of HTN in patients with CKD and have evaluated the usefulness of combination therapy in the correction mechanism of the impaired pathophysiological paths. On the basis of the conducted analysis, the combinations of drugs preferred in CKD have been presented. The usefulness of combination therapy in the early stages of CKD has been evidenced. Spe cial attention has been given to the limitations and risks associ ated with combination therapy in CKD, mainly in the advance stages and when the disease progresses rapidly. It has been pointed out that it is particularly important to monitor renal pa rameters, potassium concentrations and clinical situations that require the therapy to be changed into a standard one. It appean that despite the pros and cons of this type of HTN management in CKD, an increasing number of combined drugs available on the market and the chances for a more effective control of ABP in this group of patients with a high cardiovascular risk necessitate further studies.
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Anti-Hipertensivos/administração & dosagem , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Combinação de Medicamentos , Quimioterapia Combinada , HumanosRESUMO
Pericardial effusion is a relatively common clinical problem. It is, however, rarely the first symptom of cancer. Cardiac tamponade testifies to an advanced stage of cancer and is a negative prognostic factor. This paper presents a patient in whom cardiac tamponade was the first symptom of lung cancer. A 63-year-old male, habitual smoker, was admitted to hospital due to progressive symptoms of exertional dyspnoea lasting for a few days and chest pain. Echocardiographic examination revealed a large amount of fluid in the pericardium with echocardiographic signs of a life-threatening cardiac tamponade. The patient underwent pericardial puncture and additional imaging examinations. Lung adenocarcinoma was recognized as the underlying disease. Due to the recurrence of the life-threatening cardiac tamponade, video-assisted thoracoscopic pericardial fenestration was performed and systemic chemotherapy was introduced with good results.
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Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Tamponamento Cardíaco/patologia , Tamponamento Cardíaco/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Técnicas de Janela Pericárdica , Pericardiectomia/métodos , Resultado do Tratamento , UltrassonografiaRESUMO
Hepatorenal syndrome (HRS) was originally defined as a renal dysfunction caused by a decreased renal perfusion due to hemodynamic disturbances in the arterial circulation and an excessive activity of endogenous vasoactive systems in the course of cirrhosis. Considering the latest research, this syndrome may have a more complex pathomechanism. Equally often as in cirrhosis, HRS develops after orthotopic liver transplantation (OLTx) and worsens the prognosis significantly increasing mortality rates in this patient population. The prevalence of renal complications after OLTx and their negative prognostic impact on the survival of both the graft and the recipient prompted the authors of this work to analyze in detail 2 cases of HRS after OLTx to indicate the multiplicity of factors contributing to the pathophysiology of this syndrome. Attention was paid to risk factors for HRS found in the anamnesis before OLTx, especially a pre-existing renal dysfunction. In both cases early post-OLTx complications associated with the transplantation procedure were described: destabilization of the circulatory system, transfusions of blood products, prolonged stay at an intensive care unit, and necessity of introducing continuous renal replacement therapy. In the later period after the OLTx, infections (bacterial, fungal, viral) and drug nephrotoxicity, including the activity of immunosuppressants (tacrolimus), contributed primarily to the renal function impairment.
Assuntos
Síndrome Hepatorrenal , Transplante de Fígado , Síndrome Hepatorrenal/complicações , Síndrome Hepatorrenal/terapia , Humanos , Rim , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , TacrolimoRESUMO
BACKGROUND: This meta-analysis evaluates the overall effect of the non-pharmacological intervention, aerobic exercise, upon serum liver enzymes levels, glucose metabolism and anthropometric measures amongst patients with metabolic associated fatty liver disease (MAFLD). It also examines whether the effects on these outcomes are moderated by the aerobic training protocol when considered according to the American College of Sports Medicine (ACSM) recommended FITT (frequency, intensity, time, type) principles. Approach and Results: Fifteen randomized control trials were included in the meta-analysis. Compared with usual care, continuous and interval training showed significant efficacy in alanine aminotransferase (ALT) level improvement (MD = -2.4, 95% CI: -4.34 to -0.46 p = 0.015, I2 = 9.1%). Interventions based on all types of aerobic exercise protocols showed significant improvement of intrahepatic triglycerides (MD = -4.0557, 95% CI: -5.3711 to -2.7403, p < 0.0001, I2 = 0%) and BMI (MD = -0.9774, 95% CI: -1.4086 to -0.5462, p < 0.0001, I2 = 0). Meta-regression analysis demonstrated a significant correlation between total intervention time and ALT level (for all aerobic protocols: 6.0056, se = 2.6896, z = 2.2329, p = 0.02; as well as for continuous and interval aerobic protocols: 5.5069, se = 2.7315, z = 2.016, p = 0.04). CONCLUSIONS: All types of aerobic exercise protocols are effective at improving intrahepatic triglycerides and lead to a reduction in body mass index. In addition, continuous and interval aerobic exercise may be more effective at improving ALT ≤12 weeks intervention time benefits the management of MAFLD.
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Pulmonary embolism (PE), despite improvement of diagnostic methods often remains undiagnosed. Importantly, the lack of correct diagnosis is one of major factors negatively influencing the prognosis of PE for patients. Echocardiography is frequently performed on patients suspected of PE. However, the majority of signs reported by echocardiography only indirectly indicate PE. However, new parameters characteristic of pulmonary embolism by means of novel echo-cardiographic methods may increase the probability of a correct diagnosis, thus improving the prognosis in this group of patients. The aim of this study was to present a potential role of echo-cardiography with tissue Doppler imaging in diagnosing pulmonary embolism. Tissue Doppler echocardiography (TDE) is a based on the Doppler effect in order to assess movements of the heart structures. Due to a selective measurements of the velocities of selected fragments of myocardium, TDE allows for a fully quantitative and objective assessment of the regional myocardial function. One of the new parameters helpful in PE diagnosis is M-index, which is ratio of early diastolic mitral inflow velocity and right ventricular Tei index. M-index < 112, showed 92% sensitivity and 92% specificity for the PE diagnosis. Another parameter V-index, which is the ratio of right ventricular Tei index to left ventricular Tei index was assessed in PE diagnosis in patients with pulmonary hypertension (PH). The value of V-index > 1.2 confirmed PE with a sensitivity of 82% and a specificity of 83%. In our study, it was shown that patients with PE manifest hyperkinetic left ventricular function. Peak systolic velocity of the mitral annulus lateral portion (SmLV) = 5.5 cm/s had a sensitivity of 60% and a specificity of 86% in diagnosing PE in patients with congestive heart failure (CHF), whereas the ratio of peak systolic velocity of the tricuspid annulus to peak systolic velocity of the mitral annulus (SmRV/LV) = 1.2 showed a sensitivity of 76% and a specificity of 93% in diagnosing PE. The mentioned above date showing that echocardiography combined with tissue Doppler imaging may be useful in diagnosing PE.
Assuntos
Ecocardiografia Doppler , Embolia Pulmonar/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Humanos , Valva Mitral/diagnóstico por imagem , Prognóstico , Embolia Pulmonar/fisiopatologia , Sensibilidade e Especificidade , Sístole , Valva Tricúspide/diagnóstico por imagemRESUMO
BACKGROUND: The risk of cardiovascular (CV) complications is much greater in patients with chronic kidney disease (CKD). The aim of this study was to assess predictors of mortality, renal failure progression, and the need for dialysis in patients with CKD. METHODS: The study group consisted of 70 patients with stage 3-5 CKD, followed up on average for 33.4 ± 15.6 months. Laboratory tests and echocardiography were performed on all patients. Composite endpoints were defined as (1) all-cause mortality and (2) mortality or renal replacement therapy (RRT), defined as the initiation of dialysis therapy. RESULTS: During the observation period, 13 patients died and 11 began dialysis therapy. NT-proBNP was found to be a significant predictor in receiver operating characteristic curve analysis for all study endpoints. The optimal cutoff value for NT-proBNP as a predictor of mortality was 569.8 pg/mL, with a sensitivity of 53.8% and a specificity of 89.1%. For mortality or RRT, the cutoff value for NT-proBNP was 384.9 pg/mL, with a sensitivity and specificity of 70.8 and 72.7%, respectively. In a multivariate regression analysis, NT-proBNP was an independent predictor of mortality with an OR = 7.5 (95% CI: 1.05-53.87; p = 0.044) and of mortality or RRT with an OR = 4.7 (95% CI: 1.01-22.66; p = 0.048). CONCLUSIONS: NT-proBNP is an independent predictor of mortality in patients with CKD and can also be useful for CV risk stratification in this patient population.
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Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Insuficiência Renal Crônica/sangue , Terapia de Substituição Renal/métodos , Medição de Risco , Idoso , Biomarcadores/sangue , Causas de Morte/tendências , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Polônia/epidemiologia , Prognóstico , Precursores de Proteínas , Curva ROC , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Taxa de Sobrevida/tendências , Fatores de TempoRESUMO
The assessment of a patient's body fluid status is a challenging task for modern clinicians. Ultrasonography has numerous advantages, the most important being reproducibility and bedside monitoring of the patient. The examination is quick and has a significant diagnostic value. We reviewed the literature to assess the possibility of using ultrasound methods for evaluating body fluid status. The search of PubMed and Medline databases was performed up to February 2019. Data from published reports and clinical observations show that the quick and noninvasive ultrasound examination facilitates the assessment of intravascular volume status and that the results correlate with other modalities, including invasive methods. Ultrasound enables physicians to determine the baseline status of hydration and to monitor the patient during fluid therapy. Additionally, it allows an assessment of asymptomatic patients, patients who are well adapted to chronic oxygen deficiency, and those who develop pulmonary congestion secondary to congestive heart failure or chronic kidney disease. The development of a protocol for an ultrasound assessment of the volume status would significantly facilitate the everyday practice of internal medicine specialists.
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Líquidos Corporais/diagnóstico por imagem , Ultrassonografia/métodos , Insuficiência Cardíaca/complicações , Humanos , Testes Imediatos , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/etiologia , Insuficiência Renal Crônica/complicações , Reprodutibilidade dos TestesRESUMO
This paper presents an overview of published studies conducted on helminths - parasites of the human gastrointestinal tract. Making use of their ability for immunomodulation may lead to the introduction of effective therapies for autoimmune diseases. This paper presents chronologically attempts to treat autoimmune diseases not only of the gastrointestinal tract, but also of the nervous and endocrine systems, which have been undertaken for decades. The overview of analysed reports demonstrates that as medical knowledge on the cells and mediators participating actively in inflammatory processes accumulates, clinical trials focus on ever more specific areas concerning the pathomechanisms of autoimmune diseases. The outcomes of clinical trials conducted both on animals and humans give reasons to assume that the modification of the human intestinal microflora may be the key to fighting against these diseases.
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BACKGROUND: It has been reported that elevated serum uric acid (UA) levels is an independent factor of poor prognosis in patients with chronic heart failure and chronic kidney disease (CKD). OBJECTIVES: In our study, we assessed the potential impact of hyperuricemia on left ventricular (LV) diastolic dysfunction (DD) in patient with CKD. MATERIAL AND METHODS: The study group consisted of 50 patients with CKD, stages 2-5. Standard echocardiography and tissue Doppler imaging (TDI) were performed. The levels of UA and N-terminal prohormone brain natriuretic peptide (NT-proBNP) were determined. Patients were divided into two groups according to the results of peak mitral annular early diastolic velocity (EmLV): group with LV diastolic dysfunction (EmLV < 8 cm/s) DD (+) and group with normal LV diastolic function DD (-), when EmLV ≥ 8 cm/s. RESULTS: Patients DD (+) group, as compared to DD (-) patients were characterized by significantly higher serum UA levels [6.7 (4.4-14.3) mg/dL vs 5.8 (1.9-8.9) mg/dL, p = 0.004] respectively. The area under the receiver operating characteristic (ROC) curve was of serum UA levels for the detection of LV diastolic dysfunction was 0.734, 95% confidence interval (CI) 0.590-0.849, p = 0.001, whereas ROC derived UA value of > 6.0 mg/dL was characterized by a sensitivity of 76.9% and specificity of 62.5% for diagnosing LV diastolic dysfunction. The independent variable predicting LV diastolic dysfunction as measured by a multivariate logistic regression analysis was UA level > 6.0 mg/dL with odds ratio (OR) = 14.3 (95% CI 2.0-103.2), p = 0.006. CONCLUSIONS: Hyperuricemia is an independent predictive factor for LV diastolic dysfunction in patients with CKD.
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Hiperuricemia/sangue , Insuficiência Renal Crônica/sangue , Ácido Úrico/sangue , Disfunção Ventricular Esquerda/sangue , Idoso , Área Sob a Curva , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo , Diástole , Feminino , Humanos , Hiperuricemia/complicações , Hiperuricemia/diagnóstico por imagem , Hiperuricemia/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Prognóstico , Curva ROC , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico por imagem , Insuficiência Renal Crônica/patologia , Índice de Gravidade de Doença , Ultrassonografia , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/patologiaRESUMO
BACKGROUND: Left ventricular (LV) diastolic dysfunction in patients with chronic kidney disease (CKD) is of a complex nature and is the predominant cause of congestive heart failure in this group of patients. This work aimed to evaluate the potential effect of disturbances in calcium-phosphorus (Ca-P) metabolism in patients with CKD on LV diastolic function as assessed by echocardiography. MATERIALS AND METHODS: The study group consisted of 81 ambulatory patients with CKD, stages 2-5, with preserved LV systolic function-LV ejection fraction >50% and with sinus rhythm. Standard echocardiography was performed in all patients with tissue Doppler echocardiography for the evaluation of the systolic velocity and both diastolic velocities of LV (EmLV and AmLV). The following laboratory parameters were measured: serum creatinine concentration, estimated glomerular filtration rate, and the levels of urea, P, Ca, parathormone, platelet count, hemoglobin level, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Patients were divided into two groups according to the results of EmLV: group with LV diastolic dysfunction (EmLV<8cm/s) DF (+) and group with normal LV diastolic function DF (-), when EmLV was ≥8cm/s. RESULTS: Patients in DF (+) group, as compared to DF (-) patients, manifested a lower serum Ca level and an elevated NT-proBNP level [9.03±0.76mg/dL vs 9.44±0.78mg/dL, p=0.02, and 257.9 (32.6-12,633)pg/ml vs 149 (11.7-966)pg/ml, p=0.035, respectively]. The area under the receiver operating characteristics (ROC) curve of Ca for diastolic dysfunction was 0.627, 95% CI (0.511-0.734), p=0.04, whereas ROC derived Ca value of ≤9.82mg/dL was characterized by a sensitivity of 91.8% and specificity of 38.1% for diagnosing LV diastolic dysfunction. The only independent variable predicting LV diastolic dysfunction as measured by a multivariate logistic regression analysis was Ca level≤9.82mg/dL with odds ratio=8.81 (95% CI 1.49-51.82), p=0.014. CONCLUSIONS: Hypocalcemia is an independent predictive factor for LV diastolic dysfunction in patients with CKD.
Assuntos
Hipocalcemia/complicações , Insuficiência Renal Crônica/complicações , Disfunção Ventricular Esquerda/etiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Cálcio/sangue , Cálcio/metabolismo , Diástole , Ecocardiografia , Feminino , Previsões , Insuficiência Cardíaca/etiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fósforo/metabolismo , Curva ROC , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular EsquerdaRESUMO
INTRODUCTION: The diagnosis of acute pulmonary embolism (APE) in patients with chronic heart failure (CHF) remains a difficult task, despite the refinement of imaging techniques. The goal of this study was to assess the value of measuring tricuspid and mitral valve systolic annular velocities in CHF patients with suspected PE by tissue Doppler imaging (TDI). MATERIAL AND METHODS: The study included 75 patients with previously diagnosed CHF, admitted due to resting dyspnea, with a maximum tricuspid regurgitation pressure gradient (TRPG) of ≥ 35 mm Hg and positive D-dimer assay. Spiral computed tomography (sCT) was performed on all subjects to confirm APE. Acute pulmonary embolism was diagnosed in 35 patients (PE+), and excluded in 40 others (PE-). Tissue Doppler imaging was performed to measure maximum systolic lateral annular velocities in the mitral (SmLV) and tricuspid (SmRV) valves, as well as the SmRV/SmLV ratio. RESULTS: PE+ subjects were found to have higher SmLV than PE- subjects (6.0 cm/s (2.0-13.8 cm/s) vs. 4.2 cm/s (1.3-9.1 cm/s), p = 0.003). SmRV/SmLV ratios were 1.05 (0.50-2.50) and 1.56 (0.62-4.30), respectively (p < 0.0001). Areas under ROC curves for diagnosis of APE were 0.700 for SmLV and 0.789 for SmRV/SmLV. In multivariate logistic regression analysis, only SmRV/SmLV was statistically significant, with an odds ratio for APE of 6.26 (95% CI: 1.53-25.59; p = 0.009). CONCLUSIONS: Tissue Doppler imaging of the lateral tricuspid and mitral annuli is a useful clinical tool that can help identify PE in CHF patients. Those patients who fulfill these criteria should be considered for further diagnostic studies to confirm PE.
RESUMO
Exudative pericarditis, and in particular a purulent type, is a rare condition which requires emergency medical intervention. In our paper we present a case report concerning a patient with purulent pericarditis.
Assuntos
Pericardite/diagnóstico , Pericardite/terapia , Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Carbazóis/administração & dosagem , Carvedilol , Diuréticos/administração & dosagem , Drenagem , Ecocardiografia , Evolução Fatal , Furosemida/administração & dosagem , Humanos , Hidroclorotiazida/administração & dosagem , Infusões Intravenosas , Masculino , Mediastinite , Pessoa de Meia-Idade , Propanolaminas/administração & dosagem , Esclerose , Espironolactona/administração & dosagem , Supuração , Vitamina K/administração & dosagemRESUMO
BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). EPS almost exclusively occurs in patients treated longer than 3-5 years on PD. The more severe clinical features of EPS may develop if PD is discontinued (patient transferred to hemodialysis or transplanted). METHODS: All PD patients diagnosed with EPS after transplantation were identified, and their data were compared with those of non-EPS PD patients transplanted in our unit between 1994 and 2010. RESULTS: Four EPS cases were diagnosed among 157 transplanted PD patients. Mean renal replacement therapy and PD-only duration were 103.8 and 83.5 months in EPS and 26.5 and 22.2 months in non-EPS patients, respectively. All EPS patients (n = 4) required high-volume dialysis, 2 received icodextrin, 3 were high transporters, 1 had recurrent intraperitoneal bleeding, 4 received beta-blockers and 3 had peritonitis incidents. All required surgical intervention within 1-3 months after kidney transplantation (KT). Diagnosis of EPS was based on clinical symptoms, surgery, radiologic and histopathology findings. Treatment consisted of adhesiolysis (all), parenteral nutrition (PN) (3/4) and tamoxifen (all). One patient died 49 months after EPS diagnosis. CONCLUSIONS: First, bowel obstruction symptoms in long-term PD patients undergoing KT may suggest EPS. Second, long-term PD patients showing features of technique failure are at high risk of EPS after KT. Third, adhesiolysis, PN and tamoxifen are the available treatment options in EPS patients post KT. And finally, referral of eligible patients to a transplant waiting list early after starting PD may contribute significantly to EPS prevention in clinical practice.
Assuntos
Transplante de Rim/efeitos adversos , Diálise Peritoneal/efeitos adversos , Fibrose Peritoneal/etiologia , Adolescente , Adulto , Idoso , Criança , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Fibrose Peritoneal/diagnóstico , Fibrose Peritoneal/terapia , Reoperação , Fatores de Risco , Tamoxifeno/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Patients with acute pulmonary embolism (APE) with concomitant chronic heart failure (CHF) are characterized by higher mortality rates than APE patients without CHF. The aim of this study is to evaluate the potential impact of APE on early and long-term prognosis in patients with CHF. METHODS: This study included 87 patients with CHF with suspected APE. Patients were divided into two groups according to spiral computed tomography results: one group with confirmed APE and one with excluded APE. Total and cardiovascular mortality in patients of both groups during a 6- and 36-month follow up period was assessed. Potential risk factors for mortality in patients with CHF in short and long-term observations were identified. RESULTS: APE was diagnosed in 35 patients, and excluded in the remaining 52 patients. Total and cardiovascular 6-month mortality was higher in APE patients than in patients without APE: 34.3% and 28.5% vs. 13.4% and 11.5%, p = 0.02, p = 0.02, respectively. In 6-month follow-up the only independent risk factor for mortality was the presence of APE (HR = 2.7, 95% CI 1.1-24.4, p = 0.04). However, in the 36-month follow-up APE had no effect on mortality. CONCLUSIONS: Patients with CHF and acute episode of PE are characterized by a higher 6-month total and cardiovascular mortality rate following discharge from hospital compared to patients hospitalized due to acute CHF decompensation. Moreover, recent episode of PE in patients with CHF is an independent risk factor for early mortality in a 6-month follow-up.