RESUMO
OBJECTIVES: To compare the effect of conjugated equine estrogens (CEE) and raloxifene on lipid profile and hemostasis. MATERIALS AND METHODS: A double-blind, randomized and parallel study was performed with 90 healthy postmenopausal women, aged 54 +/- 5 years, divided into three groups and submitted to daily therapy with either CEE 0.625 mg, raloxifene 60 mg or placebo for 4 months. The lipid profile, coagulation and fibrinolytic factors were analyzed. RESULTS: CEE increased the levels of high density lipoprotein cholesterol (HDL-C) from 49.0 to 56.8 mg/dl (p < 0.001), very low density lipoprotein cholesterol (VLDL-C) from 17.2 to 22.3 mg/dl (p < 0.001), and triglycerides from 86.0 to 111.7 mg/dl (p < 0.001), and decreased the levels of low density lipoprotein cholesterol (LDL-C) from 121.0 to 106.5 mg/dl (p < 0.001). The only significant effect of raloxifene was an increase in the levels of HDL-C from 46.0 to 47.8 mg/dl (p = 0.019). There was no significant reduction in LDL-C, from 115.5 to 110.2 mg/dl (p = 0.06), VLDL-C, from 21.7 to 20.0 mg/dl (p = 0.201), and triglycerides, from 108 to 100 mg/dl (p = 0.201). CEE decreased the levels of fibrinogen, from 370.5 to 326.8 g/l (p = 0.039) and the levels of antithrombin III, from 99.5 to 93.2% (p < 0.001). Raloxifene decreased the levels of fibrinogen, from 354.7 to 302.0 g/l (p = 0.009) and the levels of antithrombin III, from 102.4 to 98.5% (p = 0.039). CEE increased levels of protein C from 103.7 to 115.3 mg/l (p < 0.001) and raloxifene did not change the levels of protein C (107.9 to 105.1 mg/l; p = 0.158). CEE decreased the antigen levels of tissue plasminogen activator (t-PA) from 8.8 to 6.8 U/ml (p < 0.001), and of plasminogen activator inhibitor (PAI-1) from 30.8 to 21.6 U/ml (p < 0.010), whereas raloxifene had no significant effect on either t-PA, from 9.6 to 9.2 U/ml (p = 0.235) or PAI-1 antigen levels, from 32.1 to 30.4 U/ml (p = 0.538). CONCLUSION Both CEE and raloxifene exert significant effects on the lipid and coagulation profile. CEE had a more significant effect on fibrinolysis than raloxifene. These effects may have a significant impact on the cardiovascular risk that needs to be confirmed in larger studies.
Assuntos
Antagonistas de Estrogênios/farmacologia , Terapia de Reposição de Estrogênios/métodos , Estrogênios Conjugados (USP)/farmacologia , Estrogênios/agonistas , Cloridrato de Raloxifeno/farmacologia , Moduladores Seletivos de Receptor Estrogênico/farmacologia , Adulto , Idoso , Análise de Variância , Coagulação Sanguínea/efeitos dos fármacos , Fatores de Coagulação Sanguínea/análise , Fatores de Coagulação Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Método Duplo-Cego , Antagonistas de Estrogênios/administração & dosagem , Estrogênios Conjugados (USP)/administração & dosagem , Feminino , Fibrinólise/efeitos dos fármacos , Humanos , Lipídeos/sangue , Pessoa de Meia-Idade , Pós-Menopausa , Cloridrato de Raloxifeno/administração & dosagem , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: Left ventricular function changes in the postmenopausal state. However, there are conflicting reports about the effects of oestrogen on left ventricular diastolic function in postmenopausal women. OBJECTIVE: To evaluate the acute and chronic effects of oestradiol in physiological doses on diastolic heart function in hypertensive postmenopausal women with left ventricular diastolic dysfunction. METHODS: A prospective, randomised, double blind, placebo controlled study was used to evaluate the effects of oestradiol in 34 hypertensive women with left ventricular dysfunction. The acute effects of a single 1 mg oral dose of oestradiol or placebo were determined after 90 minutes. The chronic effects of 1 mg oestradiol orally/day or placebo were determined after 12 weeks. Diastolic functional indices (mitral flow and pulmonary venous flow) were assessed by Doppler echocardiography. RESULTS: Though an appropriate serum concentration was achieved, no acute effect of oestradiol administration on left ventricular diastolic function was identified. After 12 weeks of treatment the following changes (mean (SD)) were identified in the oestradiol group: a decrease in isovolumic relaxation time from 127 (23) to 106 (16) ms (p < 0.001), and in the deceleration time of the mitral E wave from 260 (42) to 238 (20) ms (p < 0.05); and an increase in the E/A ratio from 0.8 (0.2) (basal) to 1.0 (0.2) after 12 weeks (p < 0.001). CONCLUSIONS: Hypertensive postmenopausal women who had hormone replacement therapy over a period of 12 weeks had significant improvement in left ventricular diastolic function. No changes were identified following acute administration.
Assuntos
Estradiol/farmacologia , Hipertensão/complicações , Pós-Menopausa/efeitos dos fármacos , Disfunção Ventricular Esquerda/tratamento farmacológico , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea/efeitos dos fármacos , Índice de Massa Corporal , Diástole , Método Duplo-Cego , Estradiol/administração & dosagem , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Ultrassonografia Doppler , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacosRESUMO
The objective of this study was to assess the acute and chronic effects of estradiol on the myocardial performance index (MPI) in hypertensive postmenopausal women. There are conflicting reports on the effects of estrogen on left ventricular function in postmenopausal women, and we are unaware of any study on the myocardial performance index in the postmenopausal state. We undertook a prospective, randomized, double-blind, placebo-controlled study in 34 women, distributed into an estradiol group or a placebo group. After 90 min and at 12 weeks of administration of 1 mg of oral estradiol we evaluated, by Doppler echocardiography, its effects on the MPI. The estradiol group showed no alteration in the MPI after 90 min of the administration of estradiol. On the other hand, after 12 weeks of treatment we observed a statistically significant decrease of isovolumic relaxation time, from 127+/-23 ms to 106+/-16 ms (p < 0.001 and of the MPI from 0.63+/-0.13 to 0.48+/-0.09 (p < 0.01) and an increase in ejection time, from 297+/-32 ms to 330+/-31 ms (p < 0.01). In conclusion, estrogen replacement therapy over a period of 12 weeks showed a significant improvement in the MPI in hypertensive postmenopausal women, whereas the acute administration did not have any effect.
Assuntos
Ecocardiografia Doppler , Estradiol/administração & dosagem , Terapia de Reposição de Estrogênios , Hipertensão/tratamento farmacológico , Miocárdio , Pós-Menopausa , Adulto , Idoso , Método Duplo-Cego , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Pessoa de Meia-Idade , Placebos , Estudos ProspectivosRESUMO
Hormone replacement therapy (HRT) reduces cardiovascular risks, although the initiation of therapy may be associated with transient adverse ischemic and thrombotic events. Antibodies against heat shock protein (Hsp) and oxidized low density lipoprotein (LDL) have been found in atherosclerotic lesions and plasma of patients with coronary artery disease and may play an important role in the pathogenesis of atherosclerosis. The aim of the present study was to assess the effects of HRT on the immune response by measuring plasma levels of antibodies against Hsp 65 and LDL with a low and high degree of copper-mediated oxidative modification of 20 postmenopausal women before and 90 days after receiving orally 0.625 mg equine conjugate estrogen plus 2.5 mg medroxyprogesterone acetate per day. HRT significantly increased antibodies against Hsp 65 (0.316 +/- 0.03 vs 0.558 +/- 0.11) and against LDL with a low degree of oxidative modification (0.100 +/- 0.01 vs 0.217 +/- 0.02) (P<0.05 and P<0.001, respectively, ANOVA). The hormone-mediated immune response may trigger an inflammatory response within the vessel wall and potentially increase plaque burden. Whether or not this immune response is temporary or sustained and deleterious requires further investigation.
Assuntos
Autoanticorpos/sangue , Proteínas de Bactérias , Chaperoninas/imunologia , Terapia de Reposição Hormonal , Lipoproteínas LDL/imunologia , Acetato de Medroxiprogesterona/uso terapêutico , Pós-Menopausa/imunologia , Congêneres da Progesterona/uso terapêutico , Idoso , Análise de Variância , Autoanticorpos/efeitos dos fármacos , Chaperonina 60 , Feminino , Humanos , Pessoa de Meia-Idade , Pós-Menopausa/efeitos dos fármacosRESUMO
Hormone replacement therapy (HRT) reduces cardiovascular risks, although the initiation of therapy may be associated with transient adverse ischemic and thrombotic events. Antibodies against heat shock protein (Hsp) and oxidized low density lipoprotein (LDL) have been found in atherosclerotic lesions and plasma of patients with coronary artery disease and may play an important role in the pathogenesis of atherosclerosis. The aim of the present study was to assess the effects of HRT on the immune response by measuring plasma levels of antibodies against Hsp 65 and LDL with a low and high degree of copper-mediated oxidative modification of 20 postmenopausal women before and 90 days after receiving orally 0.625 mg equine conjugate estrogen plus 2.5 mg medroxyprogesterone acetate per day. HRT significantly increased antibodies against Hsp 65 (0.316 ± 0.03 vs 0.558 ± 0.11) and against LDL with a low degree of oxidative modification (0.100 ± 0.01 vs 0.217 ± 0.02) (P<0.05 and P<0.001, respectively, ANOVA). The hormone-mediated immune response may trigger an inflammatory response within the vessel wall and potentially increase plaque burden. Whether or not this immune response is temporary or sustained and deleterious requires further investigation
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Autoanticorpos , Proteínas de Choque Térmico , Terapia de Reposição Hormonal , Lipoproteínas LDL , Acetato de Medroxiprogesterona , Pós-Menopausa , Análise de Variância , Autoanticorpos , Pós-MenopausaRESUMO
OBJETIVO - Verificar como são tratados pacientes com insuficiência cardíaca (IC) em hospital terciário de Säo Paulo. MÉTODOS - Analisados 100 pacientes com IC, em tratamento ambulatorial, com idade média de 56,8 anos, sendo 76 homens. Todos realizaram estudo ecocardiográfico, que identificou diâmetros ventriculares entre 48 e 89mm (média 65,9) e fraçäo de ejeçäo (FE) entre 0,22 e 0,59 (média 0,43). A etiologia da disfunçäo ventricular (DV) foi isquêmica em 42 casos, cardiomiopatia dilatada em 28, secundária à valvopatia em 12, doença de Chagas em 10 e cardiomiopatia hipertensiva em 8. Analisou-se a terapêutica prescrita, se continha inibidores da enzima conversora de angiotensina (IECA) e qual a sua dosagem. Foi analisado, também, se a etiologia ou o grau de DV tinha influência na prescrita. RESULTADOS - Oitenta e sete pacientes receberam IECA, sendo que em 31 a dose foi inferior à preconizada nos grandes estudos. Digoxina foi prescrita em 69 casos, diuréticos em 85 e ácido acetilsalicílico em 33. Dividindo os pacientes os pacientes em dois grupos, com FE maior e menor que 0,45, observamos que, no último, foi maior a prescrição de IECA (91,5 'por cento' vs 80,4 'por cento') e maior o uso de doses adequadas (61 'por cento' vs 48,7 'por cento'). CONCLUSÄO - A maioria dos pacientes foi tratada conforme recomendaçöes atuais, apresentando boa tolerabilidade para IECA, contudo 1/3 deles não usou IECA em dose considerada adequada. Esquemas terapêuticos com betabloqueadores e inibidores da angiotensina II não fizeram parte da prática clínica rotineira.
Assuntos
Humanos , Masculino , Feminino , Adulto , Insuficiência Cardíaca/etnologia , Insuficiência Cardíaca/terapia , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Epidemiologia Descritiva , Disfunção VentricularRESUMO
PURPOSE: To identify the principal forms of cardiac amiloydosis presentation in a terciary hospital. METHODS: Eight cases with cardiac amyloidosis were identified. Five were women, their ages ranged from 23 to 83 years (mean 62). After a medical history and clinical examination the patients were submitted to complementary tests: electrocardiogram (EKG), echocardiogram (ECHO), scintigraphy with technecium pirophosphate and cardiac biopsy these results allowed the identification of their clinical situation. RESULTS: Seven patients referred dyspnea, 6 were in heart failure, 1 patient had syncope. The EKG identified complete atrioventricular (AV) block in 4 patients, and antero septal inactive area in the other 4. The ECHO showed normal cardiac diameter in all (mean left ventricular diastolic diameter of 46.8) and slight reduction of left ventricular ejection fraction; hypertrophy of the left ventricular septal and posterior walls in all cases, in 7 cases there was a hyper refractile granular sparkling ECHO. Two different groups were identified: one with complete AV block and the second with restrictive cardiomyopathy. The prognosis was different in these two groups. Those with complete AV block evolved better after pacemaker implantation and those with restrictive cardiomyopathy had refractory heart failure and 3 of them died. CONCLUSION: The increased free wall and septal thickness, the slight systolic dysfunction and the infiltration aspect at ECHO allow us to identify the great majority of the cases. Those patients with restrictive cardiomyopathy evolve with refractory heart failure and most of them die in a few months.
Assuntos
Amiloidose/diagnóstico , Cardiopatias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Dispneia , Eletrocardiografia , Feminino , Bloqueio Cardíaco , Insuficiência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
OBJETIVO - Avaliar as formas de apresentaçäo da amilóidose cardíaca em hospital terciário. MÉTODOS - Nos últimos 15 anos, foram identificados 8 pacientes com amilóidose, sendo 5 mulheres, com idades entre 23 e 83 (média 62) anos. Após anamnese e exame físico foram submetidos a eletrocardiograma (ECG), ecocardiograma (ECO), estudo com pirosfofato de tecnécio e biópsia endomiocárdica, cujos resultados permitiram caracterizar suas formas clínicas. RESULTADOS - Sete pacientes apresentavam dispnéia aos esforços, 6 quadro de insuficiência cardíaca congestiva (ICC), 1 síncopes. O ECG identificou bloqueio atrioventricular total (BAVT) em 4 casos e área eletricamente inativa ântero-septal em outros 4. O ECG mostrou diâmetros normais em todos e fraçäo de ejeçÝo discretamente reduzida em 6. Hipertrofia do septo e parede posterior em todos, sendo em 7 com aspecto sugestivo de doença de depósito (aspecto granuloso). Os dados clínicos caracterizam dois grupos. um com BAVT e outro com cardiomiopatia restritiva. A evoluçäo foi difrente com melhora clínica após o implante de marcapasso no primeiro grupo e má evoluçäo no grupo com cardiomiopatia restritiva que evoluiu de maneira refratária, 3 falecendo em menos de 6 meses após diagnóstico. CONCLUSÄO - A presença de aumento da espessura das paredes ao ECO, discreta disfunçäo sistólica e aspecto de doença de depósito identifiram a quase totalidade dos casos. Cardiomiopatia restritiva e distúrbio de conduçÝo foram as formas de apresentaçäo, sendo o prognóstico muito reservado nos pacientes com forma restritiva, evoluindo para ICC refratária
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Pessoa de Meia-Idade , Amiloidose/complicações , Cardiomiopatias/complicações , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico , Avaliação de Programas e Projetos de Saúde/métodos , Biópsia , Cardiomiopatias/diagnóstico , Ecocardiografia , Eletrocardiografia , PrognósticoRESUMO
We reported two cases of patients that underwent left internal mammary (LIMA)-coronary bypass graft and developed recurrent myocardial ischemia in the follow-up period caused by stenosis in the subclavian artery. The angiography showed retrograde flow from the left anterior descending artery to subclavian artery. After initial dilatation with a conventional angioplasty balloon catheter, we implanted Palmaz-Schatz Stents, achieving an excellent final result. Our finding suggest that Stent implantation is a safe and effective procedure, and provides an alternative to other forms of revascularization for the treatment of this disorder.
Assuntos
Arteriopatias Oclusivas/terapia , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Stents , Artéria Subclávia , Idoso , Angioplastia Coronária com Balão , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/terapia , Angiografia Coronária , Feminino , Humanos , Masculino , Artéria Subclávia/diagnóstico por imagemRESUMO
Descrevemos dois casos de pacientes que haviam sido submetidos a revascularizaçäo do miocárdio com a utilizaçäo da artéria mamária interna esquerda e que desenvolveram na evoluçäo, quadro de insuficiência coronária por estenose da artéria subclávia esquerda. A cinecoronariografia evidenciou fluxo retrógrado da artéria descendente anterior para artéria mamária com enchimento da artéria subclávia distal à estenose que se localizava na sua origem. Após dilataçäo inicial com catater baläo de angioplastia coronária, foram implantados stents de Palmaz-Schantz, obtendo-se excelente aspecto angiográfico, sem complicaçöes e regressäo dos sintomas. Nossos resultados demonstram que a implantaçäo de stents nestes pacientes pode ser realizada com eficácia e segurança, mostrando ser um tratamento alternativo a outras formas de revascularizaçäo cirúrgica ou percutânea para esta doença.
We reported two cases of patients that underwent leftinternal mammary (LIMA) - coronary bypass graft and developed recurrent myocardial ischemia in the follow-up period caused by stenosis in the subclavian artery. The angiography showed retrograde flow from the left anterior descending artery to subclavian artery. After initial dilatation with a conventional angioplasty balloon catheter, we implanted Palmaz-Schatz Stents, achieving an excellent final result. Our finding suggest that Stent implantation is a safe and effective procedure, and provides an alternative to other forms of revascularization for the treatment of this disorder
Assuntos
Humanos , Masculino , Idoso , Arteriopatias Oclusivas/cirurgia , Artéria Subclávia/cirurgia , Stents , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversos , Arteriopatias Oclusivas/etiologiaRESUMO
PURPOSE: To study how patients with heart failure (HF) are treated in a tertiary hospital in São Paulo. METHODS: One hundred patients with HF during ambulatory care were analyzed. Seventy-six were men, and the average population age was 56.8 years old. All patients were submitted to echocardiogram, which identified ventricular diameters ranging between 48 and 89 mm (average 65.9) and ejection fraction (EF) between 0.22 and 0.59 (average 0.43). The cause of HF was ischemic in 42 cases, dilated cardiomyopathy in 28, valvular heart disease in 12, Chagas' disease in 10 and systemic hypertension in 8 patients. The prescribed treatment was analyzed, with attention to the prescription and dosage of angiotensin converting enzyme (ACE) inhibitors. We also analyzed whether the cause and/or the degree of HF influenced the treatment chosen. RESULTS: Eighty-seven patients received ACE inhibitors, 31 received doses below those recommended in the large trials. Digoxin was prescribed in 69 cases, diuretics in 85, and aspirin in 33. When dividing the patients according to EF, the group with EF below 0.45 was prescribed more often ACE inhibitors (91.5% vs 80.4%) and had more often usage of adequate doses (61% vs 48.7%). CONCLUSION: In this sample the majority of the patients were treated according to modern recommendations and tolerated well ACE inhibitors, however 1/3 did not receive ACE inhibitors in the recommended doses. Treatment based on betablockers or angiotensin II inhibitors were not routinely employed.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Baixo Débito Cardíaco/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Baixo Débito Cardíaco/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/etiologiaRESUMO
PURPOSE: To evaluate the influence of age on response to pravastatin treatment in patients treated by community physicians. METHODS: According to age, 873 patients were divided in three groups: group A with ages ranging from 45 to 59 years (n = 55), group B with ages from 60 to 64 years (n = 182) and group C with ages from 65 to 70 years (n = 143). After four weeks only with diet orientation, patients received 10 mg/day of pravastatin for 12 weeks. RESULTS: There was a greater prevalence of risk factors in elderly patients: hypertension (45.7%, 54.4% and 57.1% in groups A, B and C respectively p = 0.0165), diabetes mellitus (9.3%, 17.6% and 25.8% respectively in groups A, B and C p < 0.0001), and previous heart disease (23.1%, 34.3% and 34.7% in groups A, B and C respectively p < 0.001). During the period of diet orientation there was a similar total cholesterol reduction in the three groups (about 10.5%), the reduction reached 30.0% with the introduction of pravastatin for 12 weeks. Low density cholesterol level decreased during the diet period in the three groups (about 10.5%), pravastatin prescription induced further reduction (about 31.7%). The high density cholesterol level (HDL) increased significantly with pravastatin treatment (12.7%). After pravastatin treatment the increase in HDL levels was more significantly among those patients with initial low levels of HDL (< 35 mg/dL) in the three groups. CONCLUSION: In patients selected by community physicians to receive lipid lowering therapy, increased age was associated with greater prevalence of risk factors and heart disease. Regardless of age, there was a good response to pravastatin treatment, however less than half of patients had received treatment prior to the protocol.
Assuntos
Anticolesterolemiantes/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Pravastatina/uso terapêutico , Fatores Etários , Idoso , Colesterol/sangue , Feminino , Humanos , Hiperlipidemias/sangue , Hiperlipidemias/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Triglicerídeos/sangueAssuntos
Doença das Coronárias/prevenção & controle , Terapia de Reposição de Estrogênios/efeitos adversos , Menopausa/efeitos dos fármacos , Fatores Etários , Idoso , Neoplasias da Mama/induzido quimicamente , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/epidemiologia , Neoplasias do Endométrio/induzido quimicamente , Feminino , Humanos , Incidência , Menopausa/fisiologia , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Left ventricular (LV) diastolic function changes after myocardial infarction. It has been suggested that beta blockers may improve diastolic function in hypertensive and heart failure patients. Doppler echocardiographic filling patterns and invasive hemodynamic indices have been used to analyze LV diastolic function. To determine the effect of beta blockers on LV diastolic function, we studied 32 patients with anterior wall myocardial infarction with a mean age of 53 years. Peak early and late flow velocities, peak early-to-late flow velocities ratio, pressure half time, diastolic filling period, isovolumic relaxation time, cardiac index, mean arterial pressure, wedge pressure, and systemic and pulmonary vascular resistance indices were obtained simultaneously before and after an intravenous infusion of 10 mg of atenolol. Cardiac index decreased from 4.27 +/- 0.97 to 3.19 +/- 0.91 l/min/m2 (p = 0.0001); mean arterial pressure decreased from 85 +/- 10 to 80 +/- 11 mmHg (p = 0.004); wedge pressure increased from 11 +/- 5 to 13 +/- 4 mmHg (p = 0.002); systemic vascular resistance index increased from 1586 +/- 409 to 1980 +/- 634 dyn.m2.s/cm5 (p = 0.0002); pulmonary vascular resistance index increased from 115 +/- 58 to 163 +/- 72 dyn.m2.s/cm5 (p = 0.0004); peak late flow velocity decreased from 64 +/- 15 to 49 +/- 14 cm/s (p = 0.0001); early-to-late ratio increased from 0.95 +/- 0.35 to 1.29 +/- 0.36 (p = 0.0001); diastolic filling period increased from 300 +/- 108 to 400 +/- 110 ms (p = 0.0001) and isovolumic relaxation time increased from 133 +/- 29 to 143 +/- 29 ms (p = 0.009). No significant changes were observed for peak early flow velocity and pressure half-time.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Atenolol/farmacologia , Diástole/efeitos dos fármacos , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos , Adulto , Atenolol/administração & dosagem , Cateterismo Cardíaco , Ecocardiografia Doppler , Feminino , Hemodinâmica , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Função Ventricular Esquerda/fisiologiaRESUMO
PURPOSE: To evaluate the feasibility of bedside Technetium99-methoxy-isobutyl-isonitrile (99mTc-MIBI) cardiac imaging to assess perfusion after thrombolytic therapy (TT) for myocardial infarction (MI). METHODS: We studied 9 patients (mean age 59 +/- 9 years) submitted to TT with 100 mg of rt-PA in 90 minutes within the 6 hours of the onset of MI with subsequent angiography. 99mTc-MIBI was injected intravenously in a doses of 740 MBq immediately before TT start. Imaging was performed in three moments: study 1--as soon as the TT finished, study 2--3-18 hours after TT; study 3--7-10 days after TT. A perfusion score was established in each study and then compared to determine the perfusion patterns after TT. We compared through linear regression, the perfusion score with left ventricle ejection fraction, and with CKMB enzymatic peak. RESULTS: All patients had a patent infarct related artery. The perfusion score of study 1 varied from 12 to 22, mean 15.8 +/- 3.7, and correlated with ejection fraction (r = 0.9, p < 0.01) and peak CKMB (r = 0.78, p = 0.03). Four (44%) patients presented perfusion score improvement in study 2 (varied from 12 to 23, mean 16.8 +/- 4.3) and 8 (88%) in study 3 (varied from 12 to 28, mean 19.0 +/- 4.3). CONCLUSION: Bedside 99mTc-MIBI cardiac imaging is useful to quantify myocardial area under risk before TT, and to identify the late (7 to 10 days) benefit of TT.
Assuntos
Infarto do Miocárdio/diagnóstico por imagem , Nitrilas , Compostos de Organotecnécio , Terapia Trombolítica , Adulto , Heparina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Nitroglicerina/uso terapêutico , Prognóstico , Cintilografia , Tecnécio Tc 99m Sestamibi , Ativador de Plasminogênio Tecidual/uso terapêuticoRESUMO
A 32-year-old male patient with clinical and electrocardiographic evidence of acute myocardial infarction underwent coronary angiographic study. We observed nonocclusive thrombosis simultaneously in right and left anterior descending coronary arteries, without confirmation of spasm or obstructive artery disease in other coronary branches. Documentation of coronary thrombosis in more than one artery is rare, and its pathophysiology is still unknown. With the advent of thrombolytic therapy and immediate coronary angiographic studies in patients with evolving myocardial infarction, it has been possible to confirm the presence of thrombus and the type of coronary disease. In this case, we observed total lysis of both thrombi and the final aspect of "normal" angiographically reperfused coronary arteries.
Assuntos
Trombose Coronária/complicações , Infarto do Miocárdio/etiologia , Terapia Trombolítica , Adulto , Angiografia , Trombose Coronária/diagnóstico , Trombose Coronária/tratamento farmacológico , Eletrocardiografia , Humanos , MasculinoRESUMO
PURPOSE: Evaluate the lytic state (LS) expressed by the level of plasmatic fibrinogen (PF) after rt-PA "in bolus" infusion for acute myocardial infarction (MI) and its relation to coronary reperfusion. PATIENTS AND METHODS: Fifty-one patients (38 men, mean age of 53.0 +/- 9.8 years) with demonstrated occlusion of the infarct related artery (IRA) received an intravenous bolus infusion of 70 mg of rt-PA, PF was assessed before and 90 minutes after the treatment and the levels were compared in patients with (group 1) and without (group 2) reperfusion of the IRA. RESULTS: Basal levels of PF were within the normal range in all patients. There was a decrement of 35.1% in the PF dosed at 90 minutes, from 276.8 +/- 55.5 mg/dl to 168.0 +/- 68.2 mg/dl. Both groups were similar in the levels of PF 90 after treatment (145.1 +/- 95.7 mg/dl in group 1 versus 187.0 +/- 53.7 mg/dl in group 2). CONCLUSION: "In bolus" rt-PA treatment for MI significantly reduces the PF, but the LS obtained was similar in patients with or without reperfusion of the IRA.
Assuntos
Fibrinogênio/análise , Infarto do Miocárdio/tratamento farmacológico , Ativadores de Plasminogênio/uso terapêutico , Terapia Trombolítica , Adulto , Idoso , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Ativadores de Plasminogênio/administração & dosagem , Estreptoquinase/uso terapêuticoRESUMO
The incidence of late potentials on the signal-averaged electrocardiogram before and after coronary thrombolysis was studied in 54 patients with an acute myocardial infarction of less than or equal to 5 hours' duration and with an angiographically documented total occlusion of the infarct-related coronary artery on admission. A significant (p = 0.038) 50% relative reduction in the incidence of late potentials was observed in the group of 35 patients who underwent reperfusion: from 16 of 35 (46%) before to 8 of 35 (23%) at 120 minutes after the start of thrombolytic treatment. No significant reduction was seen in the 19 patients in whom thrombolysis was unsuccessful: from 8 of 19 (42%) before to 7 of 19 (37%) afterward. Despite successful recanalization, late potentials persisted or newly developed after thrombolytic therapy in 8 of 54 patients (15%). It is concluded that successful thrombolysis reduces the incidence of late potentials on the signal-averaged electrocardiogram but that the sensitivity and specificity of this finding are not high enough to allow reliable monitoring of coronary reperfusion at the bedside.
Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia/métodos , Infarto do Miocárdio/tratamento farmacológico , Reperfusão Miocárdica , Processamento de Sinais Assistido por Computador , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Proteínas Recombinantes/uso terapêutico , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To evaluate the importance of the segment ST in the identification of coronary recanalization in patients submitted to intravenous thrombolysis during acute myocardial infarction (MI). PATIENTS AND METHODS: Seventy four patients with MI, 62 male with mean age of 52.6 +/- 10 years. All patients had angiographically demonstrated occlusion of the infarct-related artery (IRA) before the thrombolytic treatment with intravenous "in bolus" infusion of 50 mg, 60 mg and 70 mg of rt-PA. The recanalization of the IRA was assessed 90 minutes later. The real status of the IRA in the angiograms was compared with the ST segment changes between the ECGs obtained before and after the thrombolytic therapy. RESULTS: Fifty six (75.6%) patients presented a significant reduction in the ST segment elevation (groups I and II). Of these, 47 possessed an opened IRA. From the 18 patients who did not show ST segment decrement (group III), 13 had an occluded IRA, and 5 an opened one. The method presented sensitivity of 90.3% and a specificity of 59.1%, positive predictive value of 83.9% and negative predictive value of 72.2%. CONCLUSIONS: The ST segment is an important marker of coronary recanalization or not following intravenous thrombolytic therapy.
Assuntos
Eletrocardiografia , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica , Adulto , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologiaRESUMO
A 74 year-old man with acute myocardial infarction submitted to thrombolytic therapy had the diagnosis of atherosclerotic aneurysm of the coronary artery attained with Doppler echocardiography. Subsequently diagnosis was confirmed by angiography and the atherosclerotic etiology identified in pathology.