RESUMO
AIMS: The aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival. METHODS: We included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available. RESULTS: Mean age was 80.1 ± 7.1 years and aortic valve area (AVA) index 0.4 ± 0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50 ± 13% and mean LVGLS was - 14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS > - 18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS > - 14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient > 30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS > - 14% (HR 1.79 [1.02-3.14], p = 0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS > - 14% in the total population (p < 0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p = 0.006). CONCLUSIONS: In patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS > - 14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS > - 14%.
Assuntos
Estenose da Valva Aórtica/cirurgia , Volume Sistólico , Substituição da Valva Aórtica Transcateter , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Dinamarca , Feminino , Humanos , Masculino , Prevalência , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidadeRESUMO
More than half of patients with carcinoid syndrome develop carcinoid valve disease. Both the tricuspid and pulmonary valve are often involved. Symptoms of carcinoid syndrome with flushing, diarrhea, and bronchospasm often precedes cardiac symptoms. We report a case of carcinoid initially presenting with rapid development of right heart failure due to severe pulmonary valve stenosis. In untreated carcinoid, there is a risk of carcinoid crisis with anesthesia and surgery. In local anesthesia, we performed a sub-acute balloon pulmonary valvuloplasty. The procedure was successful without any residual pulmonary valve stenosis and with immediately relief of dyspnea. The final diagnostic workup for the underlying malignancy continued the day after valvuloplasty. © 2015 Wiley Periodicals, Inc.
Assuntos
Valvuloplastia com Balão , Doença Cardíaca Carcinoide/terapia , Estenose da Valva Pulmonar/terapia , Valva Pulmonar , Anestesia Local , Angiografia , Doença Cardíaca Carcinoide/diagnóstico por imagem , Doença Cardíaca Carcinoide/etiologia , Doença Cardíaca Carcinoide/fisiopatologia , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Pessoa de Meia-Idade , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/etiologia , Estenose da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
The impact of left ventricle (LV) hypertrophy (LVH) regression on contractility-associated measures, the extent of residual cardiac dysfunction and prognostic implications after the initial remodeling process after transcatheter aortic valve replacement (TAVR) has not been investigated. We aimed to assess whether greater LV mass regression from pre-TAVR to 12-months after TAVR was associated with increased systolic function; and assess the prognostic value of residual LVH, systolic function and contractility-associated measures 12-months after TAVR. A total of 439 symptomatic patients were included and examined by echocardiography. LVH regression was assessed as percentage change in LV mass index (LVMi) from baseline to 12-months after TAVR. Midwall fractional shortening (mFS) and stress-corrected (SC-mFS) were used as contractility-associated measures. Primary outcome was all-cause mortality. SC-mFS increased from 0.94 (0.7) at baseline (BS) to 1.22 (0.7) (p < 0.05) 12-months after TAVR for patients with the most LVH regression, compared to patients with no LV regression (BS 1.06 (0.7) to 1.04 (0.5), NS). At 12-months after TAVR, multivariate analysis showed independent prognostic value of LVEF < 50% or GLS < 15% (HR 1.59, p = 0.049) and mFS < 14% (HR 1.99, p = 0.002) for future all cause death. LVH regression in AS after TAVR is associated with significant improvements of LV systolic function in contrast to patients without LV regression. Residual LVH and subsequent LV systolic dysfunction is substantial 12 months after TAVR and are associated with reduced survival. Impaired mFS and the combination of abnormal LVEF or GLS independently predicted all-cause mortality beyond 12 months after TAVR.
Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etiologia , Prognóstico , Valor Preditivo dos Testes , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Função Ventricular Esquerda , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Resultado do Tratamento , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: Several observational studies suggest an association between treatment with ergoline-derived dopamine agonists and valvular regurgitation. In this article, we present an overview of the literature and conduct a meta-analysis. METHODS: Observational studies addressing the frequency of moderate or severe valvular regurgitation among ergoline-treated patients with Parkinson's disease were considered for a meta-analysis. Pooled risk estimates and the risk of increased pulmonary artery pressure were calculated. RESULTS: The pooling of data from well-designed observational studies documented that both pergolide (RR = 3.05 [1.71-5.44]) and cabergoline (RR = 6.38 [3.17-12.81]) represent a substantially increased risk of developing moderate to severe valvular regurgitation. In addition, pergolide, but not cabergoline, was associated with an increase in pulmonary artery pressure. CONCLUSIONS: The present meta-analysis confirmed a statistically significant association between pergolide and cabergoline treatment and the risk of moderate to severe valvular regurgitation. An association between bromocriptine and valvular regurgitation cannot be entirely ruled out.
Assuntos
Agonistas de Dopamina/efeitos adversos , Doenças das Valvas Cardíacas/induzido quimicamente , Doença de Parkinson/tratamento farmacológico , Bases de Dados Factuais/estatística & dados numéricos , Humanos , Modelos Estatísticos , Observação , Fatores de RiscoRESUMO
AIMS: Ergot-derived dopamine agonists (EDDA) induce fibrotic heart valve disease. We aimed to investigate whether EDDA treatment also affects left ventricular (LV) function. METHODS AND RESULTS: Myocardial function was evaluated in 110 Parkinson patients [mean age (63.4 +/- 9.0 years)] treated for at least 6 months with either EDDA (n = 71) or non-EDDA (n = 39). LV ejection fraction did not differ between EDDA and non-EDDA patients [63 +/- 4% vs. 65 +/- 4% (ns)]. There was no difference in prevalence of diastolic dysfunction between EDDA and non-EDDA patients [7% vs. 8% (ns)]. Finally, averaged LV systolic myocardial strain and longitudinal displacement analysed by means of two-dimensional speckle tracking showed no difference between EDDA and non-EDDA patients [strain: 19 +/- 3% vs. 19 +/- 2% (ns) and longitudinal displacement: 12 +/- 2 mm vs. 12 +/- 2 mm (ns)]. Elevated p-NT-proBNP was found in 38% of EDDA patients and in 59% of non-EDDA patients (ns). CONCLUSION: In contrast to the well-established association between EDDA treatment and valvular fibrosis, EDDA did not have a detectable adverse impact on myocardial systolic and diastolic function.
Assuntos
Agonistas de Dopamina/efeitos adversos , Ecocardiografia/métodos , Ergotamina/efeitos adversos , Interpretação de Imagem Assistida por Computador/métodos , Doença de Parkinson/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Análise de Variância , Biomarcadores/sangue , Diástole , Agonistas de Dopamina/uso terapêutico , Ecocardiografia Doppler de Pulso , Ergotamina/uso terapêutico , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peptídeo Natriurético Encefálico/sangue , Doença de Parkinson/sangue , Doença de Parkinson/tratamento farmacológico , Estudos Retrospectivos , Sístole , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda/efeitos dos fármacosAssuntos
Valva Aórtica/cirurgia , Parada Cardíaca/cirurgia , Massagem Cardíaca/instrumentação , Massagem Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/métodos , Adulto , Valva Aórtica/patologia , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Tratamento de Emergência/métodos , Feminino , Parada Cardíaca/diagnóstico , Humanos , Fatores de TempoRESUMO
Cardiovascular complications following thoracic radiotherapy in patients with cancer are well described. Advancements in surgery, radiotherapy and systemic treatments have led to an increasing number of cancer survivors and thus an increasing number of patients with long-term side effects of their cancer treatments. This article describes the short- and long-term cardiovascular morbidity and mortality following thoracic radiotherapy and further, optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients.
Assuntos
Doenças Cardiovasculares/etiologia , Neoplasias/radioterapia , Lesões por Radiação/complicações , Biomarcadores/análise , Cardiomiopatias/etiologia , Doença das Coronárias/etiologia , Coração/efeitos da radiação , Doenças das Valvas Cardíacas/etiologia , Humanos , Miocardite/etiologia , Pericardite/etiologia , Doenças Vasculares/etiologiaRESUMO
Ergot derivatives (EDs) are used in the treatment of Parkinson's disease, but recent reports indicate induction of valvular heart disease. This survey reviews the documentation and reports on the design of a blinded study of 160 Parkinson's patients treated with either EDs or non-EDs. The present recommendations regarding monitoring of patients treated with ED are also described.