RESUMO
The implantable cardioverter defibrillator is today an indisputable evidence-based treatment for cardiac sudden death both in primary and secondary prevention. However, trans-venous cardioverter defibrillator implantation still carries a not negligible risk of complications both acutely and during follow-up. Trans-venous endocardial lead is the weak link of implantable cardioverter defibrillator (ICD) technology being the source of most mechanical complications on vessels and heart structures and exposed to infection, malfunction and recalls. A totally subcutaneous defibrillation lead has recently been introduced in clinical practice. With the subcutaneous pulse generator forms a defibrillation system that leaves the vessels and the heart completely "untouched." Subcutaneous ICD has proven to be safe and effective in many clinical trials. Patients without pacing indications and at higher risk of complications from trans-venous lead implantation represent the perfect candidates to S-ICD technology. However, with technical improvement, it is reasonable to expect a further expansion of indications.
Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Arritmias Cardíacas/complicações , Arritmias Cardíacas/terapia , Ensaios Clínicos como Assunto , Morte Súbita Cardíaca/etiologia , Desfibriladores Implantáveis/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Humanos , Desenho de Prótese , Falha de PróteseRESUMO
BACKGROUND: Functional mitral regurgitation (MR) is a factor affecting prognosis of patients with chronic left ventricular (LV) dysfunction. The aim of the study was to investigate whether the evaluation of plasma N-terminal protype-B natriuretic peptide (NT-proBNP) concentrations is useful for prognostic assessment of patients with functional MR due to either ischemic or nonischemic chronic LV dysfunction. METHODS: Echocardiograms were obtained in 207 patients with chronic LV dysfunction (ejection fraction
Assuntos
Cardiomiopatia Dilatada/sangue , Insuficiência da Valva Mitral/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Idoso , Cardiomiopatia Dilatada/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/etiologia , Medição de Risco , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/sangueRESUMO
Prognostication of patients with chronic heart failure (HF) stabilized by therapy may be difficult. Therefore, the aim was to evaluate whether combined assessment of plasma N-terminal pro-B natriuretic peptide (NT-pro-BNP) and Doppler left ventricular (LV) diastolic variables was relevant to the prognosis of patients with stable HF. Outpatients with LV systolic HF (ejection fraction < or =45%), classified using clinical criteria as decompensated (n = 94) and stable HF (n = 219), underwent a complete Doppler echocardiographic study. NT-pro-BNP was measured together with mitral wave velocities, E wave deceleration time, and tissue Doppler early septal annular velocity. Median follow-up was 22 months. Freedom from all-cause mortality or HF hospitalization at 24 months was worst (44%) in patients with decompensated HF, intermediate (58%) in patients with stable HF with NT-pro-BNP higher than the median (>1,129 pg/ml), and best (92%) in patients with lower NT-pro-BNP (log-rank p <0.0001). In patients with stable HF, NT-pro-BNP >1,129 pg/ml (hazard ratio [HR] 2.84, p = 0.003), E wave deceleration time <150 ms (HR 2.31, p = 0.004), and tissue Doppler early septal annular velocity <8 cm/s (HR 2.18, p = 0.01) were predictors of the end point at multivariate analysis. The addition of Doppler LV diastolic variables and NT-pro-BNP significantly improved the chi-square test for outcome prediction (from 14.4 to 46.4). In conclusion, NT-pro-BNP and spectral and tissue Doppler variables of LV diastolic dysfunction added independent and incremental contributions to prognostic stratification of patients with stable HF.
Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Ultrassonografia Doppler , Idoso , Doença Crônica , Diástole , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Septos Cardíacos/patologia , Humanos , Masculino , Valva Mitral/patologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , Medição de Risco , Sensibilidade e Especificidade , Volume Sistólico , Sístole , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
BACKGROUND: The role of the right ventricle has been relatively neglected proportionate to its importance. We sought to evaluate the impact of right ventricular (RV) and NT-proBNP on the outcome of patients with heart failure (HF) and functional mitral regurgitation (MR). METHODS AND PATIENTS: Outpatients with left ventricular (LV) systolic HF (ejection fraction [EF] < or =45%) and moderate-to-severe MR measured by a vena contracta width > or =0.5 cm were prospectively enrolled (n=142). Indexes of LV and RV function, including tricuspid annular plane systolic excursion (TAPSE), RV fractional area change and tissue Doppler RV acceleration at isovolumic contraction and NT-proBNP plasma levels were measured at the time of the index echocardiogram. RESULTS: Multivariate predictors of all-cause mortality included TAPSE<16 mm (hazards ratio [HR]: 2.64; p=0.009) and plasma NT-proBNP> or =3283 pg/ml (HR: 2.58; p=0.011). TAPSE<16 mm and plasma NT-proBNP> or =3283 pg/ml added incremental prognostic information to LV EF< or =25%, NYHA classes 3-4, coronary artery disease, elderly age and male sex. The 36-month Kaplan-Meier curve showed that survival was worst in the group with TAPSE<16 mm and NT-proBNP> or =3283 pg/ml (p<0.0001). CONCLUSION: This study demonstrates the significance of TAPSE and plasma NT-proBNP in predicting all-cause mortality in patients with systolic HF and moderate-to-severe functional MR.
Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Insuficiência da Valva Mitral/sangue , Insuficiência da Valva Mitral/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Disfunção Ventricular Direita/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Volume Sistólico , Análise de Sobrevida , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/fisiopatologiaRESUMO
BACKGROUND: This study aimed to assess the prognostic value of right ventricular (RV) dysfunction in patients with secondary mitral regurgitation (MR) by simple methods of echocardiographic measurement. Although both RV dysfunction and functional MR may affect prognosis of patients with heart failure (HF) due to left ventricular (LV) dysfunction, information is lacking regarding the impact of RV dysfunction in patients with functional MR. METHODS: Among 356 consecutive patients with chronic HF due to LV dysfunction (ejection fraction < or = 45%), 107 met the entry criteria of moderate to severe MR as assessed by a vena contracta width > or = 0.5 cm. Tricuspid annular plane systolic excursion (TAPSE) was acquired to evaluate RV function. Median follow-up duration was 21 months. RESULTS: Among patients with a vena contracta width > or = 0.5 cm, 30 (28%) died and 28 (26%) were hospitalized for worsening HF. By multivariate analysis, TAPSE < or = 14 mm (hazard ratio [HR] 2.83, P = .027) and LV ejection fraction (HR 2.17, P = .099) were predictive of death from all causes. Independent predictors of freedom from all-cause mortality or hospitalization for worsening HF were New York Heart Association class (HR 2.15, P = .027), age (HR 1.98, P = .021) and TAPSE < or = 14 mm (HR 1.96, P = .031). At 24 months, survival was 45% in those with the worse TAPSE, whereas it was 82% in those with TAPSE > 14 mm (log-rank statistic = 0.0002). Aminoterminal pro-type B natriuretic peptide plasma levels were higher in patients with vena contracta width of > or = 0.5 cm and TAPSE < or = 14 mm. CONCLUSIONS: This study shows that RV function, assessed by TAPSE, plays a major role in the outcome of patients with functional moderate to severe MR.
Assuntos
Insuficiência da Valva Mitral/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Comorbidade , Intervalo Livre de Doença , Ecocardiografia , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Análise Multivariada , Peptídeo Natriurético Encefálico/metabolismo , Fragmentos de Peptídeos/metabolismo , Valor Preditivo dos Testes , Taxa de Sobrevida , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagemAssuntos
Acromegalia/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Hormônio do Crescimento Humano/metabolismo , Complicações Cardiovasculares na Gravidez/prevenção & controle , Prevenção Secundária/métodos , Acromegalia/complicações , Acromegalia/diagnóstico por imagem , Adulto , Desfibriladores Implantáveis/tendências , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Prevenção Secundária/tendênciasAssuntos
Ritmo Idioventricular Acelerado/diagnóstico , Ritmo Idioventricular Acelerado/fisiopatologia , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/fisiopatologia , Adulto , Eletrocardiografia/tendências , Feminino , Frequência Cardíaca/fisiologia , Humanos , Gravidez , Fatores de TempoRESUMO
BACKGROUND: In systolic heart failure (HF), preventing the development of severe symptoms, before patients are in advanced NYHA functional classes, is a worthwhile target of therapy. Early recognition of left ventricular (LV) diastolic dysfunction and neuroendocrine activation may have an important impact on patient's outcome. AIM: To investigate whether N-terminal proBNP (NT-proBNP) and mitral flow and tissue Doppler (TD) diastolic parameters are incremental for risk stratification of systolic HF patients in NYHA class I and II. METHODS: The study consisted of 232 consecutive outpatients with systolic HF (ejection fraction [EF] Assuntos
Ecocardiografia Doppler
, Insuficiência Cardíaca Sistólica
, Peptídeo Natriurético Encefálico/sangue
, Fragmentos de Peptídeos/sangue
, Idoso
, Idoso de 80 Anos ou mais
, Diástole
, Diagnóstico Precoce
, Feminino
, Seguimentos
, Insuficiência Cardíaca Sistólica/sangue
, Insuficiência Cardíaca Sistólica/diagnóstico por imagem
, Insuficiência Cardíaca Sistólica/mortalidade
, Hospitalização/estatística & dados numéricos
, Humanos
, Estimativa de Kaplan-Meier
, Masculino
, Pessoa de Meia-Idade
, Valva Mitral/diagnóstico por imagem
, Valor Preditivo dos Testes
, Prognóstico
, Fatores de Risco
, Sístole