RESUMO
OBJECTIVE: The objective of this study was to describe heart rate turbulence (HRT) in advanced heart failure (HF) patients and in a group of patients who underwent heart transplantation (HT). MATERIALS AND METHODS: We performed 24-hour Holter recordings in 20 patients with advanced HF referred to our hospital for HT, including 16 males of overall mean age of 44 +/- 13 years and with a mean ejection fraction (EF) 21 +/- 7%. An additional set of recordings was obtained in a second group of 27 patients who had already undergone HT, including of 21 males of overall mean age of 47 +/- 14 years. We recorded the number of premature ventricular contractions (PVCs), mean heart rate (MHR), and 2 parameters of HRT-turbulence onset (TO) and turbulence slope (TS). RESULTS: Patients with HT showed a low density of premature ventricular complexes, in contrast to patients in the advanced HF group. For this reason, HRT could only be analyzed in 15 of the patients with advanced HF (66%) and in 10 of the patients who underwent HT (37%). MHR was 77 +/- 10 bpm in the advanced HF group and 90 +/- 10 bpm in the HT group. In both groups, TO and TS showed highly attenuated values. CONCLUSIONS: Patients with advanced HF showed a high number of PVCs with attenuated HRT parameters, reflecting increased circulating catecholamine levels and decreased response of the autonomic nervous system. Patients who underwent HT showed elevated MHRs, a small number of PVCs, and attenuated HRT values, as corresponds to a denervated heart.
Assuntos
Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/fisiologia , Transplante de Coração/fisiologia , Adulto , Eletrocardiografia Ambulatorial/métodos , Feminino , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In order to determine the relative significance of ventricular rate increase and AV delay on exercise cardiac output, we have studied 10 patients (8 male and 2 female, 16-59 years) with complete chronic heart block treated with AV sequential pacing. Cardiac output variations (delta CO) were estimated by pulsed Doppler comparisons of the aortic flow velocity in the supine position, at rest and during bicycle exercise. The following pacing programs were tested: DDD with AV intervals of 50, 100 and 150 ms (DDD50 o DDDD100, DDD150), VVI at 70 ppm (VVI70), and VVI at the maximal available rate in this pacing mode-113 or 130 ppm depending on the PM type (VVIM). Exercise measurements in DDD mode were taken when that rate was reached. The delta CO was calculated as a percent change of the product flow velocity integral x heart rate, from that obtained with VVI70 mode at rest. At rest, the delta CO obtained with DDD pacing was 20.4 +/- 14.7% and the optimal AV delay was 50 ms in 1 patient, 100 ms in 3 patients and 150 ms in six. During exercise, the delta CO was higher in DDD and VVIM modes (82.0 +/- 30.8% and 56.2 +/- 37.6%, respectively; p less than 0.01) than in VVI70 mode (20.4 +/- 10.4%; p less than 0.005), the greatest delta CO was reached at DDD mode in 8 out of 10 patients (p less than 0.03). The optimal AV delays were 50 ms in 5 patients, 100 ms in 4 patients and 150 ms in one. Thus, DDD pacing with the optimal AV delay seems to obtain greater haemodynamic benefits during exercise than does rate-responsive pacing; the optimal exercise AV delay varies from patient to patient and is usually less than 150 ms.
Assuntos
Nó Atrioventricular/fisiologia , Estimulação Cardíaca Artificial , Ecocardiografia Doppler , Exercício Físico , Frequência Cardíaca/fisiologia , Hemodinâmica/fisiologia , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We present an adult with echocardiographic diagnosis of cor triatriatum. Continuous wave Doppler echocardiography was able to assess correctly the severity of the left ventricular inflow obstruction caused by the intra-atrial membrane. Even though the diagnosis was confirmed by catheterization, the surgical decision was based in noninvasive data. Postoperative Doppler echocardiography proved the disappearance of the intra-atrial obstruction. The anatomical information obtained by echocardiography as well as the assessment of the intra-atrial obstruction by cardiac Doppler seem to be sufficient to make surgical decisions in patients suffering from this disease. Both are also suitable to test the result of the surgical intervention.
Assuntos
Coração Triatriado/diagnóstico por imagem , Ecocardiografia Doppler , Adulto , Cateterismo Cardíaco , Coração Triatriado/cirurgia , Humanos , MasculinoRESUMO
Doppler-echocardiography has proved useful in the assessment of mediastinal masses. We present the case of a young man with fever and new systolic murmur. Echocardiographic examination revealed a paracardiac mass compressing the right ventricular outflow tract and Doppler flow study detected marked acceleration in luminal narrowing. Complete remission of the tumour was obtained with subtotal resection and chemotherapy. Histological diagnosis was of embryonary carcinoma with areas of endodermic sinus. A new Doppler-echocardiography study showed disappearance of both the mass and the compression and showed normal right ventricular outflow tract flow.
Assuntos
Carcinoma Embrionário/complicações , Neoplasias do Mediastino/complicações , Obstrução do Fluxo Ventricular Externo/etiologia , Adulto , Carcinoma Embrionário/terapia , Ecocardiografia Doppler , Humanos , Masculino , Neoplasias do Mediastino/terapia , Indução de Remissão , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/terapiaRESUMO
Three adult patients presented with dysphagia due to vascular compression of the esophagus. In one case, a dysphagia aortica was diagnosed. In the remaining two cases a congenital vascular anomaly--aberrant right subclavian artery and right aortic arc, respectively--was proved by arteriography. The final diagnosis was suspected after the barium meal and confirmed by computarized tomography in each case.
Assuntos
Aorta Torácica/anormalidades , Aneurisma Aórtico/complicações , Transtornos de Deglutição/etiologia , Artéria Subclávia/anormalidades , Adulto , Idoso , Feminino , Humanos , MasculinoAssuntos
Aneurisma Cardíaco/diagnóstico por imagem , Átrios do Coração/anormalidades , Arritmias Cardíacas/etiologia , Criança , Feminino , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/congênito , Átrios do Coração/diagnóstico por imagem , Sopros Cardíacos , Humanos , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: It was aimed to compare urine B-type natriuretic peptide (BNP) according to left ventricular systolic dysfunction and to investigate its diagnostic value in heart failure (HF) patients. MATERIAL AND METHODS: A total of 90 HF outpatients (61 men, age 66 +/- 12) and 30 age- and gender-matched controls were studied. RESULTS: An increase in urine BNP was observed in patients with EF= 40% compared to EF> 40% (p < 0.0001), and controls (p < 0.0001). Significant correlations between urinary BNP and left ventricular functional parameters were obtained. A multivariate regression analysis was performed and the best model associated with urine BNP included plasma BNP (p < 0.0001), EF (p = 0.02) and LV volume indexes (p < 0.0001). The ROC for detection of EF = 40% using urine BNP levels showed an area under the curve of 0.74 +/- 0.05, (p < 0.0001). From the ROC curve, the optimal cut-off value (2.30 ng/l) had a 60% sensitivity and 90% specificity. Finally, we performed a binary logistic regression for detection of EF = 40%, and urine BNP was shown to be a strong predictor with an odds-ratio of 21. DISCUSSION: Urine BNP levels correlated with left ventricular functional parameters. This biomarker is a useful tool for detecting and diagnosing left ventricular systolic dysfunction in heart failure.