Asunto(s)
Cardiomiopatía Hipertrófica , Anomalías de los Vasos Coronarios , Puente Miocárdico , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/cirugía , Humanos , Puente Miocárdico/diagnóstico , Puente Miocárdico/diagnóstico por imagenRESUMEN
BACKGROUND: Right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation is a major cause of postoperative morbidity and mortality. Despite the availability of multiple imaging parameters, none of these parameters had adequate predictive accuracy for post-LVAD RVF. AIM: To study whether right ventricular pressure-dimension index (PDI), which is a novel echocardiographic index that combines both morphologic and functional aspects of the right ventricle, is predictive of post-LVAD RVF and survival. METHODS: 49 cases that underwent elective LVAD implantation were retrospectively analyzed using data from an institutional registry. PDI was calculated by dividing systolic pulmonary artery pressure to the square of the right ventricular minor diameter. Cases were categorized according to tertiles. RESULTS: Patients within the highest PDI tertile (PDI>3.62 mmHg/cm2 ) had significantly higher short-term mortality (42.8%) and combined short-term mortality and severe RVF (50%) compared to other tertiles (P < .05 for both, log-rank p for survival to 15th day 0.014), but mortality was similar across tertiles in the long-term follow-up. PDI was an independent predictor of short-term mortality (HR:1.05-26.49, P = .031) and short-term composite of mortality and severe RVF (HR:1.37-38.87, P = .027). CONCLUSIONS: Increased PDI is a marker of an overburdened right ventricle. Heart failure patients with a high PDI are at risk for short-term mortality following LVAD implantation.
Asunto(s)
Insuficiencia Cardíaca , Corazón Auxiliar , Disfunción Ventricular Derecha , Insuficiencia Cardíaca/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Estudios Retrospectivos , Disfunción Ventricular Derecha/diagnóstico por imagenAsunto(s)
Aneurisma/diagnóstico por imagen , Tabique Interatrial/patología , Aneurisma Cardíaco/patología , Cardiopatía Reumática/complicaciones , Aneurisma/etiología , Ecocardiografía Doppler en Color/métodos , Ecocardiografía Transesofágica/métodos , Femenino , Humanos , Persona de Mediana Edad , Cardiopatía Reumática/cirugíaAsunto(s)
Antibacterianos/administración & dosificación , Desfibriladores Implantables/efectos adversos , Marcapaso Artificial/efectos adversos , Infecciones Relacionadas con Prótesis/prevención & control , Antiinfecciosos Locales/administración & dosificación , Dispositivos de Terapia de Resincronización Cardíaca/efectos adversos , Desinfección/métodos , Humanos , Piel , Procedimientos Quirúrgicos Operativos/métodosAsunto(s)
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatología , Ecocardiografía/métodos , Atrios Cardíacos/fisiopatología , Ventrículos Cardíacos/fisiopatología , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etiología , Velocidad del Flujo Sanguíneo/fisiología , Diástole , Electrocardiografía , Femenino , Estudios de Seguimiento , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Prevalencia , Volumen Sistólico , Sístole , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologíaRESUMEN
Background: Development of contrast-induced acute kidney injury (CI-AKI) in patients with ST-elevation myocardial infarction (STEMI) treated via primary percutaneous coronary intervention (PCI) is a major cause of morbidity and mortality worldwide. The neutrophil-to-lymphocyte ratio (NLR), which is a marker of inflammation, has been demonstrated to be associated with the development of major adverse cardiovascular outcomes in many studies. From this point of view, in this study, we aimed to evaluate the predictive value of the NLR as regards the occurrence of CI-AKI in patients with STEMI undergoing primary PCI. Methods: This study was conducted at Dr. Siyami Ersek Training and Research Hospital from May 2008 to June 2016. A total of 2000 patients with STEMI treated via primary PCI were enrolled in the study. The NLR was calculated as the ratio of the number of neutrophils to the number of lymphocytes. All venous blood samples were obtained within 8 hours after admission. CI-AKI was the primary end point of the study. Then, the relationship between CI-AKI and the NLR was assessed. Results: CI-AKI was detected in 148 (7.4%) patients. The patients who developed CI-AKI had a significantly higher NLR than those who did not (7.08±4.43 vs. 6.18±3.98; P=0.011). In the multivariate logistic regression analyses, the NLR remained a significant independent predictor of CI-AKI (OR: 1.78, 95% CI: 1.21-2.61, and P=0.003). Conclusion: The NLR may be a significant independent predictor of CI-AKI in patients with STEMI treated via primary PCI and higher NLR values could be independently associated with a greater risk for CI-AKI.