Asunto(s)
Humanos , Isquemia Miocárdica/diagnóstico por imagen , Técnicas de Imagen Cardíaca/métodos , Angina de Pecho/complicaciones , Espectroscopía de Resonancia Magnética/métodos , Tomografía Computarizada de Emisión de Fotón Único/métodos , Adenosina/efectos de la radiación , Isquemia Miocárdica/complicaciones , Tomografía de Emisión de Positrones/métodos , Gadolinio/efectos de la radiaciónRESUMEN
Extracorporeal shockwave myocardial revascularization (ESMR) is a therapy for refractory angina pectoris. Our aim was to assess the efficacy and safety of ESMR in the management of patients with stable coronary artery disease (CAD) and heart failure as well as its effects on inflammation and angiogenesis. In this single-arm prospective trial, we included 48 patients with CAD, myocardial ischemia assessed by radionuclide imaging, echocardiographic evidence of left ventricular systolic dysfunction and without revascularization options. Changes in angina grading score, myocardial perfusion, left ventricular ejection fraction, and six-minute walk test after ESMR therapy were used for efficacy assessment. Changes of inflammation and angiogenesis biomarkers were also evaluated. ESMR therapy was performed using a commercially available cardiac shockwave generator system (Cardiospec; Medispec). After 9 weeks of ESMR therapy, a significant improvement was found regarding the initial angina class, severity of ischemia, left ventricular ejection fraction, and six-minute walk test in most patients. No deleterious side effects after treatment were detected. Regarding biomarkers, endothelial progenitor cells and angiopoietin-3 were significantly increased whereas IL-18 and TGF-ß were significantly decreased after ESMR in the total group. Notably, VEGF, IL-1ß, and lipoxin A4 levels were significantly increased only in patients with myocardial ischemia improvement. In conclusion, ESMR therapy is safe and effective in most but not all patients with CAD and heart failure. ESMR is associated with increased markers of angiogenesis and decreased markers of inflammation. Myocardial ischemia improvement after ESMR is associated with increased markers of angiogenesis and pro-resolving mediators.
Asunto(s)
Angina de Pecho/terapia , Enfermedad de la Arteria Coronaria/terapia , Tratamiento con Ondas de Choque Extracorpóreas/métodos , Insuficiencia Cardíaca/fisiopatología , Revascularización Miocárdica/métodos , Disfunción Ventricular Izquierda/fisiopatología , Anciano , Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/metabolismo , Proteína 1 Similar a la Angiopoyetina , Proteínas Similares a la Angiopoyetina/metabolismo , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/metabolismo , Citocinas/metabolismo , Células Progenitoras Endoteliales , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/metabolismo , Humanos , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Lipoxinas/metabolismo , Masculino , Persona de Mediana Edad , Imagen de Perfusión Miocárdica , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Volumen Sistólico , Factor de Crecimiento Transformador beta/metabolismo , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/metabolismo , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/metabolismo , Prueba de PasoRESUMEN
BACKGROUND: Cardiac shockwave therapy (CSWT) is a new potential option for the treatment of patients with chronic coronary disease and refractory angina (RA). We aimed to study the effects of CSWT on left ventricular myocardial perfusion and mechanics in patients with RA. METHOD: We prospectively studied 19 patients who underwent CSWT. Left ventricular mechanics were evaluated by speckle tracking echocardiography (STE), and myocardial perfusion by single-photon emission computed tomography, using stress/rest-Technetium-99 m Sestamibi, for determination of summed stress score (SSS). Canadian Cardiac Society (CCS), New York Heart Association (NYHA), and quality of life by Seattle Angina Questionnaire (SAQ) were assessed at baseline and 6 months after therapy. RESULTS: CSWT therapy was applied without major side effects. At baseline, 18 patients (94.7%) had CCS class III or IV, and after CSWT there was reduction to 3 (15.8%), P = .0001, associated with improvement in SAQ (38.5%; P < .001). Thirteen (68.4%) had class NYHA III or IV before treatment, with significant reduction to 7 (36.8%); P = .014. No change was observed in the global SSS from baseline to 6-month follow-up (15.33 ± 8.60 vs 16.60 ± 8.06; P = .157). However, there was a significant reduction in the average SSS of the treated ischemic segments (2.1 ± 0.87 pre vs 1.6 ± 1.19 post CSWT; P = .024). Global longitudinal strain by STE remained unaltered (-13.03 ± 8.96 pre vs -15.88 ± 3.43 6-month post CSWT; P = .256). CONCLUSION: CSWT is a safe procedure for the treatment of patients with RA that results in better quality of life, improvement in myocardial perfusion of the treated segments with preservation of left ventricular mechanics.
Asunto(s)
Angina de Pecho/terapia , Ecocardiografía/métodos , Tratamiento con Ondas de Choque Extracorpóreas/métodos , Corazón/fisiología , Disfunción Ventricular Izquierda/terapia , Angina de Pecho/complicaciones , Angina de Pecho/fisiopatología , Femenino , Corazón/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiofármacos , Tecnecio Tc 99m Sestamibi , Tomografía Computarizada de Emisión de Fotón Único , Resultado del Tratamiento , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Background: Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital
Fundamentos: O infarto agudo do miocárdio se configura como uma das principais causas de morbimortalidade no mundo, e um dos fatores de maior impacto prognóstico é o atendimento especializado precoce, porém ainda existem inúmeros fatores que retardam a chegada do paciente até o hospital. Objetivo: Correlacionar fatores sociais, educacionais, cognitivos e clínicos com o tempo para a chegada no hospital após os primeiros sintomas de infarto agudo do miocárdio. Métodos: O tempo para a busca de atendimento médico foi mensurado entre o início dos primeiros sintomas de infarto relatado pelo paciente e o registro da admissão hospitalar em prontuário eletrônico do serviço de emergência. A correlação entre o delta T e outras variáveis foi verificada por meio da correlação de Kendall. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Não houve correlação entre delta T e escolaridade, e nem entre delta T e desempenho no Mini-Exame do Estado Mental, assim como não houve associação entre a presença de hipertensão arterial sistêmica, diabetes melito, dislipidemia, sedentarismo, história familiar ou tabagismo com o tempo de chegada no hospital. Comparações entre delta T e estado civil também não foram estatisticamente significativas. A transferência de outro serviço de saúde e a região de procedência foram os fatores que mais determinaram atraso no atendimento especializado de nossa população. Conclusão: Fatores educacionais, sociais e cognitivos não estiveram diretamente relacionados ao atraso na chegada ao hospital
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Servicios Médicos de Urgencia/métodos , Infarto del Miocardio/complicaciones , Factores de Riesgo , Angina de Pecho/complicaciones , Dolor en el Pecho/complicaciones , Diabetes Mellitus/diagnóstico , Mortalidad Hospitalaria , Hipertensión/complicaciones , Indicadores de Morbimortalidad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/mortalidad , Estudios Prospectivos , Conducta Sedentaria , Interpretación Estadística de DatosRESUMEN
Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital
Asunto(s)
Factores de Riesgo , Servicios Médicos de Urgencia/métodos , Infarto del Miocardio/complicaciones , Dolor en el Pecho/complicaciones , Indicadores de Morbimortalidad , Interpretación Estadística de Datos , Estudios Prospectivos , Mortalidad Hospitalaria , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/mortalidad , Diabetes Mellitus , Conducta Sedentaria , Hipertensión/complicaciones , Angina de Pecho/complicacionesRESUMEN
OBJECTIVE: To investigate the association between obstructive sleep apnoea (OSA) severity with markers of overnight myocardial injury in patients with refractory angina. METHODS: Patients with refractory angina were characterised clinically and they underwent ischaemia imaging stress tests by single-photon emission computed tomography (SPECT) and/or cardiac MRI. The patients were admitted to the hospital, remained under resting conditions for blood determination of high-sensitivity cardiac troponin T (hs-cTnT) at 14:00, 22:00 and after overnight polysomnography at 7:00. RESULTS: We studied 80 consecutive patients (age: 62±10â years; male: 66%; body mass index (BMI): 29.5±4â kg/m(2)) with well-established diagnosis of refractory angina. The mean apnoea-hypopnoea index (AHI) was 37±29 events/h and OSA (AHI >15 events/h) was present in 75% of the population. Morning detectable hs-cTnT and above 99th percentile was present in 88% and 36% of the population, respectively. Patients in the first to third quartiles of OSA severity did not have circadian variation of hs-cTnT. In contrast, patients in the fourth quartile (AHI ≥51 events/h) had a circadian variation of hs-cTnT with a morning peak of hs-cTnT that was two times higher than that in the remaining population (p=0.02). The highest quartile of OSA severity remained associated with the highest quartile of hs-cTnT (p=0.028) in multivariate analysis. CONCLUSION: Very severe OSA is common and independently associated with overnight myocardial injury in patients with refractory angina.
Asunto(s)
Angina de Pecho/complicaciones , Miocardio/patología , Apnea Obstructiva del Sueño/complicaciones , Anciano , Angina de Pecho/sangre , Angina de Pecho/diagnóstico por imagen , Biomarcadores/sangre , Ritmo Circadiano , Estudios Transversales , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Imagen de Perfusión Miocárdica/métodos , Miocardio/metabolismo , Polisomnografía , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/diagnóstico , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único , Troponina T/sangreRESUMEN
Relatamos o caso de um paciente portador de hipertensão pulmonar de origem esquistossomótica, que procurou pronto atendimento por apresentar quadro de dor torácica em repouso. A apresentação clínica e os demais dados referentes ao caso levantaram a suspeita de insuficiência coronariana aguda, e foi diagnosticada uma obstrução grave do tronco da coronária esquerda. O relato do caso teve por objetivo destacar a necessidade do diagnóstico diferencial da queixa de dor torácica nestes pacientes e ressaltar a opção da intervenção coronariana percutânea como tratamento eficaz e seguro neste cenário.
This report describes a patient with pulmonary hypertension secondary to schistosomiasis, who sought emergency care due to chest pain at rest. The clinical presentation and other information related to the case raised the suspicion of acute coronary failure, and a severe obstruction was identified in the left main coronary artery. The case report aimed to highlight the need for a differential diagnosis of chest pain complaints in these patients, and emphasizes the choice of percutaneous coronary intervention as an effective and safe treatment in this scenario.
Asunto(s)
Humanos , Masculino , Anciano , Angina de Pecho/complicaciones , Arteria Pulmonar/cirugía , Esquistosomiasis/complicaciones , Esquistosomiasis/terapia , Angiografía/métodos , Bloqueo de Rama/complicaciones , Dolor en el Pecho/complicaciones , Ecocardiografía/métodos , Hipertensión Pulmonar , Stents , Ultrasonografía/métodosRESUMEN
BACKGROUND: Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC) is a priority. OBJECTIVE: To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS) as a predictor of cardiovascular complications during hospitalization. METHODS: Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1), point of minimum circumference (2); immediately above the iliac crest (3), umbilicus (4), one inch above the umbilicus (5), one centimeter above the umbilicus (6), smallest rib and (7) the point of greatest circumference around the waist (8). Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. RESULTS: A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67%) patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. CONCLUSION: The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes.
Asunto(s)
Síndrome Coronario Agudo/complicaciones , Antropometría/métodos , Obesidad Abdominal/complicaciones , Circunferencia de la Cintura , Pared Abdominal/anatomía & histología , Anciano , Angina de Pecho/complicaciones , Femenino , Insuficiencia Cardíaca/complicaciones , Hospitalización , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
Background: Abdominal obesity is an important cardiovascular risk factor. Therefore, identifying the best method for measuring waist circumference (WC) is a priority. Objective: To evaluate the eight methods of measuring WC in patients with acute coronary syndrome (ACS) as a predictor of cardiovascular complications during hospitalization. Methods: Prospective study of patients with ACS. The measurement of WC was performed by eight known methods: midpoint between the last rib and the iliac crest (1), point of minimum circumference (2); immediately above the iliac crest (3), umbilicus (4), one inch above the umbilicus (5), one centimeter above the umbilicus (6), smallest rib and (7) the point of greatest circumference around the waist (8). Complications included: angina, arrhythmia, heart failure, cardiogenic shock, hypotension, pericarditis and death. Logistic regression tests were used for predictive factors. Results: A total of 55 patients were evaluated. During the hospitalization period, which corresponded on average to seven days, 37 (67%) patients had complications, with the exception of death, which was not observed in any of the cases. Of these complications, the only one that was associated with WC was angina, and with every cm of WC increase, the risk for angina increased from 7.5 to 9.9%, depending on the measurement site. It is noteworthy the fact that there was no difference between the different methods of measuring WC as a predictor of angina. Conclusion: The eight methods of measuring WC are also predictors of recurrent angina after acute coronary syndromes. .
Fundamento: A obesidade abdominal é relevante fator de risco cardiovascular. Portanto, a identificação do melhor método para medição da circunferência abdominal (CA) é prioritária. Objetivo: Avaliar os oito métodos de medição da CA, em pacientes com síndrome coronariana aguda, como preditor de complicações cardiovasculares durante o período de internação. Métodos: Estudo prospectivo com pacientes com síndrome coronariana aguda. A medição da CA foi realizada pelos oito métodos conhecidos: ponto médio entre a última costela e a crista ilíaca (1), ponto da circunferência mínima (2); imediatamente acima da crista ilíaca (3), cicatriz umbilical (4), uma polegada acima do umbigo (5), um centímetro acima do umbigo (6), menor costela (7), no ponto de maior circunferência em torno da cintura (8). As complicações observadas foram: angina, arritmia, insuficiência cardíaca, choque cardiogênico, hipotensão, pericardite e óbito. Para os fatores de predição foram utilizados os testes de regressão logística. Resultados: Foram avaliados 55 pacientes. Durante o período de internação, que correspondeu, em média, a sete dias, 37 (67%) pacientes apresentaram complicações, com exceção do óbito, que não foi verificado em nenhum dos casos. Destas complicações, a única que apresentou associação com a CA foi a angina, sendo que a cada centímetro de elevação da CA, o risco de apresentar angina aumentou de 7,5 a 9,9%, conforme o local de medição. É importante destacar que não houve diferença entre os diferentes métodos de medição da CA como preditor de angina. Conclusão: Os oito métodos de medição da ...
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome Coronario Agudo/complicaciones , Antropometría/métodos , Obesidad Abdominal/complicaciones , Circunferencia de la Cintura , Pared Abdominal/anatomía & histología , Angina de Pecho/complicaciones , Hospitalización , Insuficiencia Cardíaca/complicaciones , Modelos Logísticos , Estudios Prospectivos , Factores de RiesgoRESUMEN
Cardiac involvement in Churg-Strauss syndrome is common and represents the main cause of mortality. We report the case of a patient with Churg-Strauss vasculitis, mitral regurgitation with left ventricular dysfunction, paroxysmal atrial fibrillation and refractory angina with non-significant coronary lesions. Cardiac denervation was proposed as an associated procedure to treat angina. The total removal of peri-adventitial and adventitial tissue around the superior vena cava, ascending aorta and main pulmonary trunk was performed. After 3 months of follow-up, the patient was angina-free and could resume his normal lifestyle.
Asunto(s)
Angina de Pecho/cirugía , Desnervación Autonómica , Síndrome de Churg-Strauss/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Corazón/inervación , Adulto , Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/fisiopatología , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/etiología , Enfermedad de la Arteria Coronaria/fisiopatología , Humanos , Masculino , Resultado del TratamientoRESUMEN
Objetivo: Avaliar pelo ecocardiograma, o efeito da intervenção coronária percutânea (ICP) nos índices de função diastólica do ventrículo esquerdo (VE), obtidos por meio do Doppler tissular e da medida do volume atrial esquerdo (VAE), três meses após a realizaçãodo procedimento. Métodos: Estudo longitudinal e prospectivo, incluindo 66 (40 homens) pacientes consecutivos, com estenose crítica em uma artéria coronária. Ecocardiograma transtorácico foi realizado 24 horas antes da ICP e três meses após o procedimento. Com o Doppler tissular foi determinado o pico de velocidade das ondas E e A, da região septal e lateral do anel mitral e a relação E/A, considerando-se a média de tais medidas. Com o Doppler de fluxo foi determinada a velocidade de pico da onda E do fluxograma mitral e, a partir desta, a relação E/E. O VAE foi determinado pelo método de Simpson. As medidas ecodopplercardiográficas seguiram as recomendações da American Society of Echocardiography. Resultados: A idade média dos pacientes estudados foi de 61 + 14 anos e a ICP foi realizada em apenas um vaso. Determinando-se a média dos valores da onda E, da relação E/A, E/E e VAEde todos os pacientes, observamos que não houve variação, estatisticamente significante desses índices, após a ICP. Conclusão: O presente estudo mostrou que a ICP de um vaso, com lesão grave, não é suficiente para causar melhora da função diastólica do VE em pacientes com angina estável, quando avaliada pelo Doppler tissular e VAE.
Objective: The aim of this study was to evaluate by echocardiogram, the effect of percutaneous coronary intervention (PCI) in left ventricular (LV) diastolic function indices, obtained by tissue Doppler imaging and measurement of left atrial volume (LAV), three months after the procedure. Methods: This was a longitudinal and prospective study including 66 (40 men) consecutive patients with critical stenosis in one coronary vessel. Transthoracic echocardiography was performed 24 hours before and three months after PCI.Medial and lateral mitral annulus peak velocity of the waves E and A, and the averaged ratio E/A were obtained. Early transmitral flow velocity was measured, E wave and the ratio E/E was calculated. The LAV was determined by the Simpsons method. Dopplerechocardiography measurements followed the recommendations of the American Society of Echocardiography. Results: Mean age was 61 + years. PCI was performed in a single vessel. By determining the average value of the wave E of E/A, E/E and LAV of allpatients, we found no statistically significant variations in these indices after PCI. Conclusion: This study showed that PCI of a single vessel with a severe lesion, is not sufficient to improve of LV diastolic function in patients with stable angina, evaluated by tissue Doppler and LAV.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Angina de Pecho/complicaciones , Angioplastia Coronaria con Balón/métodos , Angioplastia Coronaria con Balón , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico , Ecocardiografía/métodos , Ecocardiografía , Estudios Longitudinales , Estudios ProspectivosRESUMEN
OBJECTIVE: The aim of this study is to evaluate the applicability of a new score for predicting mediastinitis - MagedanzSCORE - in patients undergoing coronary artery bypass graft (CABG) surgery in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. METHODS: Retrospective study involving 500 patients operated between May/2007 and April/2010. The registers contained all the information used to calculate the MagedanzSCORE. The outcome of interest was mediastinitis. We calculated sensitivity, specificity, positive predictive value, negative predictive value, concordance and accuracy. The accuracy of the model was evaluated by ROC (receiver operating characteristic) curve. RESULTS: The incidence of mediastinitis was 5.6%, with a lethality rate of 32.1%. In univariate analysis, the five variables of the MagedanzSCORE were predictors of postoperative mediastinitis: chronic obstructive pulmonary disease (OR 6.42; 95.0% CI 2.76-14.96; P<0.001), obesity (OR 3.06; 95.0% CI 1.32-7.09; P=0.009), surgical reintervention (OR 82.40; 95.0% CI 30.40-223.30; P<0.001), multiple transfusion (OR 3.33; 95.0% CI 1.52-7.29; P=0.003) and stable angina class IV or unstable (OR 2.59; 95.0% CI 1.19-7.64; P=0.016) according to Canadian Cardiovascular Society. The score had a sensitivity of 96.4%, specificity of 90.0%, positive predictive value of 36.5%, negative predictive value of 99.8% and 90.4% concordance. The accuracy measured by the area under the ROC curve was 96.2% (95.0% CI 94.5%-97.9%). CONCLUSIONS: The MagedanzSCORE proved to be a simple and objective index, revealing a satisfactory predictor of development of postoperative mediastinitis in patients undergoing CABG surgery at our institution.
Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Mediastinitis/diagnóstico , Angina de Pecho/complicaciones , Transfusión Sanguínea/estadística & datos numéricos , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Mediastinitis/epidemiología , Persona de Mediana Edad , Obesidad/complicaciones , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Reoperación/estadística & datos numéricos , Medición de Riesgo/métodos , Medición de Riesgo/normasRESUMEN
OBJECTIVE: The aim of this study is to evaluate the applicability of a new score for predicting mediastinitis - MagedanzSCORE - in patients undergoing coronary artery bypass graft (CABG) surgery in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. METHODS: Retrospective study involving 500 patients operated between May/2007 and April/2010. The registers contained all the information used to calculate the MagedanzSCORE. The outcome of interest was mediastinitis. We calculated sensitivity, specificity, positive predictive value, negative predictive value, concordance and accuracy. The accuracy of the model was evaluated by ROC (receiver operating characteristic) curve. RESULTS: The incidence of mediastinitis was 5.6%, with a lethality rate of 32.1%. In univariate analysis, the five variables of the MagedanzSCORE were predictors of postoperative mediastinitis: chronic obstructive pulmonary disease (OR 6.42; 95.0% CI 2.76-14.96; P<0.001), obesity (OR 3.06; 95.0% CI 1.32-7.09; P=0.009), surgical reintervention (OR 82.40; 95.0% CI 30.40-223.30; P<0.001), multiple transfusion (OR 3.33; 95.0% CI 1.52-7.29; P=0.003) and stable angina class IV or unstable (OR 2.59; 95.0% CI 1.19-7.64; P=0.016) according to Canadian Cardiovascular Society. The score had a sensitivity of 96.4%, specificity of 90.0%, positive predictive value of 36.5%, negative predictive value of 99.8% and 90.4% concordance. The accuracy measured by the area under the ROC curve was 96.2% (95.0% CI 94.5%-97.9%). CONCLUSIONS: The MagedanzSCORE proved to be a simple and objective index, revealing a satisfactory predictor of development of postoperative mediastinitis in patients undergoing CABG surgery at our institution.
OBJETIVO: O objetivo deste estudo é avaliar a aplicabilidade de um novo escore de predição de mediastinite - MagedanzSCORE - em pacientes submetidos à cirurgia de revascularização miocárdica (CRM) na Divisão de Cirurgia Cardiovascular do Pronto Socorro Cardiológico de Pernambuco - PROCAPE. MÉTODOS: Estudo retrospectivo envolvendo 500 pacientes operados entre maio/2007 e abril/2010. Os registros continham todas as informações utilizadas para calcular o MagedanzSCORE. O desfecho de interesse foi mediastinite. Foram calculados sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo, concordância e acurácia. A acurácia do modelo foi avaliada pelo ROC (receiver operating characteristic curve). RESULTADOS: A incidência de mediastinite foi de 5,6%, com uma taxa de letalidade de 32,1%. Na análise univariada, as cinco variáveis do MagedanzSCORE foram preditoras de mediastinite no pós-operatório: doença pulmonar obstrutiva crônica (OR 6,42; IC 95,0% 2,76-14,96; P<0,001), obesidade (OR 3,06; IC 95,0% 1,32-7,09; P=0,009), reintervenção cirúrgica (OR 82,40; IC 95,0% 30,40-223,30; p<0,001), transfusões múltiplas (OR 3,33; IC 95,0% 1,52-7,29; P=0,003) e angina estável classe IV ou instável (OR 2,59; IC 95,0% 1,19-7,64; P=0,016) de acordo com a Sociedade Canadense de Cardiologia. O escore teve uma sensibilidade de 96,4%, especificidade de 90,0%, valor preditivo positivo de 36,5%, valor preditivo negativo de 99,8% e 90,4% de concordância. A acurácia medida pela área sob a curva ROC foi 96,2% (IC 95,0% 94,5%-97,9%). CONCLUSÕES: O MagedanzSCORE provou ser um índice simples e objetivo, revelando-se um preditor satisfatório de desenvolvimento de mediastinite no pós-operatório de pacientes submetidos à CRM em nossa instituição.
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Puente de Arteria Coronaria/efectos adversos , Mediastinitis/diagnóstico , Angina de Pecho/complicaciones , Transfusión Sanguínea/estadística & datos numéricos , Métodos Epidemiológicos , Mediastinitis/epidemiología , Obesidad/complicaciones , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Reoperación/estadística & datos numéricos , Medición de Riesgo/métodos , Medición de Riesgo/normasRESUMEN
A angioplastia transluminal coronária é um tratamento adequado para prevenção de morte ou infarto em doentes instáveis, porém seu efeito em pacientes estáveis ou assintomáticos tem sido objeto de discussão há vários anos, uma vez que muitos trabalhos antigos não incorporaram os mais novos recursos clínicos ou novos dispositivos em suas populações. A tese de que a aplicação generalizada de stents e tratamento médico intensivo resultaria no desejado efeito de redução de eventos maiores (morte ou infarto) motivou o desenho de novos estudos, de excelente qualidade, que, todavia, continuaram demonstrando similaridade estatística entre o tratamento médico e a intervenção percutânea para esse subgrupo. Entretanto, a dificuldade de obtenção dos objetivos metabólicos alcançados nos grandes estudos, a alta taxa de cruzamento precoces do tratamento médico para angioplastia, a baixa representação de subgrupos de alto risco e a ainda limitada aplicação de stents farmacológicos em pacientes multiarteriais e diabéticos acabam limitando...
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Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico , Angioplastia Coronaria con Balón/métodos , Angioplastia Coronaria con Balón , Revascularización Miocárdica/métodos , Revascularización Miocárdica , Diabetes Mellitus/diagnósticoRESUMEN
A realização do cateterismo cardíaco diagnóstico e da intervenção coronária percutânea (ICP) no mesmo procedimento (ICP ad hoc) tem sido uma prática crescente. Estudos têm apontado como vantagens dessa estratégia a redução dos custos hospitalares, a maior comodidade para o paciente e a diminuição das complicações vasculares. Neste estudo, 651 pacientes com angina estável foram randomizados para ICP ad hoc ou ICP estagiada. O desfecho primário foi a composição de: morte cardíaca de urgência, acidente vascular cerebral (AVC) ou complicações hemorrágicas...
Introduction: Performing diagnostic cardiac catheterization and percutaneous coronary intervention (PCI) in the same procedure (ad hoc PCI) has been an increasing practice. Studies have indicated a reduction in hospital costs, greater patient commodity and less vascular complications as advantages of this strategy. Methods: Six hundred and fifty-one patients with stable angina were randomized to ad hoc PCI or staged PCI. Primary endpoint was the composition of cardiac death, acute myocardial infarction (AMI), urgent cardiac surgery, stroke, or hemorrhagic complications...
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Humanos , Masculino , Femenino , Anciano , Stents , Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico , Angioplastia Coronaria con Balón/métodos , Angioplastia Coronaria con Balón , Enfermedad Coronaria , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Microvascular disease is proposed as a cause of segmental myocardial blood flow abnormalities and heterogeneous myocardial perfusion in cardiac syndrome X. OBJECTIVE: To assess if myocardial ischemia can be evidenced through both perfusion abnormalities and poststress left ventricular ejection fraction (LVEF) reduction by gated single photon emission tomography (SPECT) myocardial scintigraphy in women with syndrome X in a similar way to those with epicardial coronary lesions. METHODS: Three groups of postmenopausal women were studied: group I, 20 women with angina, perfusion defects, and normal coronary angiography; group II, 20 women with epicardial coronary lesions (> or =50% of coronary lumen reduction); group III, 15 volunteers without signs or symptoms of ischemia (control group). Each underwent technetium-99m ((99m)TC) methoxyisobutylisonitrile gated SPECT myocardial scintigraphy (protocol: exercise-stress-rest), brachial artery endothelial function measured by ultrasonography, and lipidogram. RESULTS: Groups I and III patients had a higher body mass index (BMI). There were more smokers in groups I and II. Very low density lipoprotein cholesterol (VLDL-C) and triglycerides were higher in group II patients. The brachial artery vasodilator responsiveness after 5 minutes of ischemia was similarly lower in patients of groups I and II compared with those of group III (3% vs. 6.5%, respectively; p = 0.03 group III vs. group I and group II). Mean DeltaLVEF (LVEF poststress minus LVEF at rest) was -3.86%, -2.90%, and 4.18% in groups I, II, and III, respectively (p = NS between I and II, p = 0.005 between II and III, and p = 0.003 between I and III). In 43% of group I patients and in 10 of 18 group III patients with perfusion defects, there was a poststress LVEF reduction >5%. CONCLUSIONS: Stress-induced ischemia is associated with poststress LVEF reduction as a probable manifestation of myocardial stunning in postmenopausal women with typical angina and normal coronary angiography.
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Isquemia Miocárdica/complicaciones , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/etiología , Adulto , Distribución por Edad , Angina de Pecho/complicaciones , Índice de Masa Corporal , Angiografía Coronaria , Prueba de Esfuerzo , Femenino , Humanos , Angina Microvascular , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Imagen de Perfusión Miocárdica , Posmenopausia , Factores de Riesgo , Fumar/epidemiología , Volumen Sistólico/fisiología , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
O entendimento do funcionamento da circulação coronariana, desde as artérias de condutância até a microcirculação é abordado nesse artigo. Aprofunda-se no entendimento biovascular com ênfase na importância do óxido nítrico para o correto funcionamento da musculatura lisa arterial, a partir de um endotélio íntegro. As consequências da perda dessa regulação, principalmente pela aterosclerose, são avaliadas e os consequêntes quadros clínicos são definidos. A partir da isquemia decorrente da obstrução do leito vascular coronariano, aspectos de fisiopatologia embasam o entendimento da clínica.
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Humanos , Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico , Endotelio/fisiopatología , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Factores de RiesgoRESUMEN
AIMS: We sought to evaluate the effects of trimetazidine on ischemia induced by dobutamine-atropine stress echocardiography in patients with class I or class II angina. METHODS: In a randomized, double-blind, placebo-controlled study, 66 patients with proved coronary disease were subjected to dobutamine-atropine stress echocardiography. Ischemia was proved in 56 patients who were included in the study and who had been on standard maintenance medications (propranolol, aspirin and statin). They were randomized to placebo or trimetazidine, 20 mg three times daily for a 12-week period, when dobutamine-atropine stress echocardiography was repeated. RESULTS: Fifty-two patients (56.53+/-8.9 years old) completed the study. No differences were seen between groups at entry. Thirty patients had class I and 26 class II angina. At the end of the study, 42 had class I and 14 class II angina (P=0.01), owing to patients being in the trimetazidine arm. We did not observe any differences between groups either for onset time of ventricular ischemic dysfunction, or for wall-motion score index. Comparing variation at peak using the delta wall-motion score index, we observed no differences, but only a trend toward reduction favoring trimetazidine (P=0.09). CONCLUSION: We did not detect a significant anti-ischemic effect of trimetazidine in patients with mild angina, but there was a clear improvement in angina class.
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Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/tratamiento farmacológico , Trimetazidina/uso terapéutico , Vasodilatadores/uso terapéutico , Anciano , Atropina/administración & dosificación , Dobutamina/administración & dosificación , Método Doble Ciego , Ecocardiografía de Estrés , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/etiología , Resultado del TratamientoRESUMEN
OBJECTIVE: Ischemic preconditioning is an increased tolerance to myocardial ischemia during the second of two consecutive exercise tests. ATP-sensitive K(+) channel blockers, such as glinides and sulfonylurea drugs, can induce loss of ischemic preconditioning. This study aimed to investigate the effects of repaglinide, a hypoglycemic agent with an affinity for myocardial ATP-sensitive K (+)channels, on the results of consecutive exercise tests in patients with diabetes and multivessel coronary artery disease. METHODS: Forty-two patients with type 2 diabetes and chronic stable angina pectoris, and two-vessel or three-vessel disease participated in this study. The patients underwent two consecutive treadmill exercise tests (phase 1). On the day after these exercise tests, 2 mg of oral repaglinide was given to the patients. One week later, two exercise tests were repeated consecutively (phase 2). RESULTS: All patients achieved 1.0-mm ST-segment depression during the four exercise tests (T1, T2, T3, and T4). In phase 2, seven patients improved in time to onset of 1.0-mm ST-segment depression. The worsening of the time to onset of 1.0-mm ST-segment depression in phase 2 demonstrated ischemic preconditioning block in 83.3% of patients (P=0.0001). Even the postexercise electrocardiographic parameters (ST-segment depression morphology and magnitude and arrhythmias) were significantly different between the groups with and without pharmacologic ischemic preconditioning block (P=0.031). CONCLUSIONS: Repaglinide, an oral hypoglycemic agent with ATP-sensitive K(+) channel-blocker activity, eliminated the myocardial ischemic preconditioning in patients with coronary disease and diabetes.