RESUMO
BACKGROUND: Even though atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG), its etiology remains poorly understood. Several factors are linked to postoperative AF (POAF), including advanced age and systemic inflammation. However, left atrial (LA) contractile dysfunction has not been evaluated in the perioperative scenario. AIM: To evaluate LA function through strain and strain rate in patients with coronary artery disease undergoing CABG and its correlation with POAF. METHODS: We studied 70 patients undergoing CABG in sinus rhythm at the time of surgery. Preoperative echocardiography with evaluation of LA strain and strain rate by speckle tracking was performed. The occurrence of POAF was evaluated by continuous monitoring. Baseline and postoperative C-reactive protein (CRP) levels were measured to evaluate systemic inflammation. RESULTS: After 1-week follow-up 26% of subjects developed AF. LA strain s wave (LASs) and LA strain rate s (LASRs) and a wave (LASRa) were significantly decreased in patients who developed POAF: LASs (10 ± 1% vs. 24 ± 1%, P < 0.001), LASRs (0.6 ± 0.1 sec(-1) vs. 1.2 ± 0.1 sec(-1) , P < 0.001), LASRa (-0.6 ± 0.1 sec(-1) vs. -1.8 ± 0.1 sec(-1) , P < 0.001). LASRs, LASRa, age, and LA volume were independent predictors of POAF. CRP at baseline was similar irrespective of POAF development. CONCLUSIONS: LA dysfunction, evaluated by strain and strain rate is an independent predictor of POAF and contributes to classic risk factors like age and atrial volume.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/etiologia , Ponte de Artéria Coronária/efeitos adversos , Ecocardiografia/métodos , Técnicas de Imagem por Elasticidade/métodos , Átrios do Coração/diagnóstico por imagem , Idoso , Fibrilação Atrial/fisiopatologia , Módulo de Elasticidade , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Estatística como Assunto , Resultado do TratamentoRESUMO
Introducción: La fibrilación auricular (FA) es la arritmia más común post cirugía de revascularización miocárdica (CRM) y está asociada a dilatación y disfunción auricular izquierda (AI). El strain y strain rate global longitudinal AI determinado por speckle tracking constituyen herramientas novedosas en la evaluación de la función AI. Objetivo: evaluar el strain y strain rate global longitudinal AI en pacientes con enfermedad coronaria con indicación de CRM y su relación con el desarrollo de FA post operatoria. Métodos: se incluyeron pacientes consecutivos con indicación de CRM, en ritmo sinusal con fracción de eyección > 50 por ciento. Se registraron características clínicas y ecocardiográficas con evaluación del strain AI: onda s (LASs) y strain rate: onda a (LASRa), onda s (LASRs) por speckle tracking (pre-cirugía). Se evaluó la ocurrencia de FA en el período post operatorio (una semana) mediante monitorización electrocardiografía continua. Se utilizó t-Student, chi-cuadrado y regresión logística múltiple. Resultados: Se incluyeron 70 pacientes, 26 por ciento presentaron FA. LASs, LASRr y LASRa estaban significativamente disminuidos en los pacientes que desarrollaron FA post CRM, LASs (10 +/- 1,1 vs 24 +/- 1,2 por ciento, p < 0,001), LASRa (- 0,6 +/- 0,1 vs - 1,8 +/- 0,12, p < 0,001) LASRs (0,6 +/- 0,007 vs 1,2 +/- 0,008, p < 0,001). Los pre-dictores independientes de FA fueron: LASRs OR: 6,1 IC 95 por ciento (1,3-15,2); LASRa OR: 2,4 IC 95 por ciento (1,1-19,6); volumen AI OR: 4,67 IC 95 por ciento (1,5-19,2) y edad > 65 años OR: 2,31 IC 95 por ciento (1,1-15,8). Conclusiones: LASs, LASRs y LASRa están disminudos en pacientes que desarrollan FA post CRM y LASRs, LASRa fueron predictores independientes de ésta.
Background: Atrial fibrillation (AF) is the commonest arrhythmia post coronary artery bypass grafting (CABG); it is associated to left atrial (LA) dilatation and dysfunction. Speckle tracking derived longitudinal strain and strain rate are novel techniques to evaluate LA function. Aim: to evaluate the relation of global longitudinal LA strain and strain rate with the development of AF in patients undergoing CABG. Methods: Consecutive patients undergoing CABG with LV ejection > 50 percent and sinus rhythm were included. Clinical characteristics were tabulated and LA echocar-diographic speckle tracking measurements, LASs, LAS-Ra, LARs, were used to determine LA strain and LA strain rate. Continuous ECG monitoring for 1 week was performed to assess the occurrence of AF. Student's t, chi square and multiple logistic regression were used for statistical analysis. Results. 70 patients were studied; 26 percent developed post-operative AF. Compared to patients remaining in sinus rhythm, patients developing post-operative AF had lower LASs (10 +/- 1,1 vs 24 +/- 1,2 percent, p < 0,001), LASRa (- 0,6 +/- 0,1 vs - 1,8 +/- 0,12, p < 0,001) and LASRs (0.6 +/- 0.007 vs 1.2 +/- 0.008, p < 0,001). Independent predictors of AF were LASRs (OR: 6.1, 95 percent CI 1.3-15.2); LASRa (OR: 2.4, 95 percent CI 1.1-19.6); LA volume (OR: 4,67, 95 percent CI 1.5-19.2) and age>65 years (OR: 2.31, 95 percent CI 1.1-15.8). Conclusion.: LASs , LASRs and LASRa are lower in patients who develop AF after CABG and LASRs and LASRa were independent predictors of post-operative AF. Thus, LA strain rate assessed by speckle tracking is useful for predicting AF after CABG in addition to classic risk factors such as age and LA volume.
Assuntos
Humanos , Pessoa de Meia-Idade , Ecocardiografia , Fibrilação AtrialRESUMO
Background: Chest pain (CT) constitutes an important cause of consultation and diagnostic dilemma in the emergency room, especially due to the possible presence of coronary disease. Its presentation, diagnosis and prognosis are different between men and women. Aim: To report a follow-up of patients attended at a Chest Pain Unit (CPU), evaluating gender differences. Material and Methods: Prospective evaluation of patients that consulted for chest pain in a period of 4 years. Baseline characteristics and the final diagnosis from CPU or hospitalization were registered. Telephonic follow-up was performed for at least one year. Mortality was determined using the national mortality registry. Results: A total of 1,168 patients aged 62 ± 23 years, 69 percent men, were followed for a mean of 28 ± 20 months. A definitive diagnosis of coronary disease (CD) was done in 32 percent. Mortality among women and men with CD was 28 and 14 percent respectively (p = 0,02). Predictor variables for mortality were the presence of a complete left branch block in the initial electrocardiogram, with an odds ratio (OR) of 12,5 (95 percent confi dence intervals (CI): 1,98-25,8), the presence of coronary disease with an OR of 3,98 (95 percent CI: 1,45-13,8) and elevated troponin I with an OR 2,12 (95 percent CI: 1,05-7,89). Female gender lost significance in the adjusted model. Conclusions: Complete left branch block, elevated troponin I and coronary etiology of CP are indicators of bad prognosis among patients that consult for CP. Women have twice the mortality of men after 28 months of follow-up.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor no Peito/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Distribuição por Idade , Dor no Peito/etiologia , Chile/epidemiologia , Doença da Artéria Coronariana/mortalidade , Eletrocardiografia , Métodos Epidemiológicos , Hospitais Universitários/estatística & dados numéricos , Encaminhamento e Consulta , Distribuição por Sexo , Fatores Sexuais , Troponina I/análiseRESUMO
BACKGROUND: chest pain (CT) constitutes an important cause of consultation and diagnostic dilemma in the emergency room, especially due to the possible presence of coronary disease. Its presentation, diagnosis and prognosis are different between men and women. AIM: to report a follow-up of patients attended at a Chest Pain Unit (CPU), evaluating gender differences. MATERIAL AND METHODS: prospective evaluation of patients that consulted for chest pain in a period of 4 years. Baseline characteristics and the final diagnosis from CPU or hospitalization were registered. Telephonic follow-up was performed for at least one year. Mortality was determined using the national mortality registry. RESULTS: a total of 1,168 patients aged 62 ± 23 years, 69 % men, were followed for a mean of 28 ± 20 months. A definitive diagnosis of coronary disease (CD) was done in 32 %. Mortality among women and men with CD was 28 and 14% respectively (p = 0,02). Predictor variables for mortality were the presence of a complete left branch block in the initial electrocardiogram, with an odds ratio (OR) of 12,5 (95% confi dence intervals (CI): 1,98-25,8), the presence of coronary disease with an OR of 3,98 (95% CI: 1,45-13,8) and elevated troponin I with an OR 2,12 (95% CI: 1,05-7,89). Female gender lost significance in the adjusted model. CONCLUSIONS: complete left branch block, elevated troponin I and coronary etiology of CP are indicators of bad prognosis among patients that consult for CP. Women have twice the mortality of men after 28 months of follow-up.
Assuntos
Dor no Peito/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Distribuição por Idade , Dor no Peito/etiologia , Chile/epidemiologia , Doença da Artéria Coronariana/mortalidade , Eletrocardiografia , Métodos Epidemiológicos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Distribuição por Sexo , Fatores Sexuais , Troponina I/análiseRESUMO
Despite advances in medical treatment, the prognosis of advanced heart failure remains poor. The number of hospitalizations for heart failure exacerbations continues to increase and most patients will ultimately die of complications related to heart failure. Implantable left ventricular assist devices (LVAD) are currently in use throughout the world with increasing frequency. This paper is a comprehensive review about mechanical support, focusing on a general description of the different LVAD, complications and mortality.
Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar/normas , Insuficiência Cardíaca/mortalidade , Transplante de Coração , Coração Auxiliar/efeitos adversos , Coração Auxiliar/economia , Humanos , Seleção de Pacientes , Choque Cardiogênico/mortalidade , Choque Cardiogênico/cirurgia , Análise de Sobrevida , Fatores de Tempo , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/cirurgiaRESUMO
Hospitalization and death due to heart failure and cardiogenic shock is frequent and currently is increasing among the adult population. Although cardiac transplantation is the most effective treatment in patients with end-stage heart failure, its availability is limited. While waiting for transplantation, some patients become refractory to treatment and deteriorate progressively. Secondary multi-organ damage could highly compromise the transplant success and also could contraindicate it. Mechanical ventricular assist devices allow reestablishing normal cardiac output and they have been used as a bridge to recovery and transplantation. We report four patients that underwent mechanical ventricular support using the ABIOMED BVS 5000 system as a bridge for transplantation. Two patients were connected to biventricular assistance; a third patient was connected to a left ventricular support and the fourth to a right ventricular support. Three were successfully transplanted and one died of refractory non-cardiogenic shock. There were no complications related to the support system, such as infection, hemorrhage or stroke. In our experience, the ABIOMED BVS 5000 was an effective strategy as a bridge to heart transplant in patients in cardiogenic shock.
Assuntos
Insuficiência Cardíaca/terapia , Transplante de Coração , Coração Auxiliar , Choque Cardiogênico/terapia , Adulto , Chile , Desenho de Equipamento , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Radionuclide isotopic ventriculography with phase analysis was performed in 30 patients with stable heart failure (HF), determining left ventricular (LV) and interventricular contraction synchrony at baseline and after 6 months of treatment with maximal tolerated doses of carvedilol. Patients with HF had significant ventricular dyssynchrony compared with a normal population. The 50th percentile of patients with the greatest dyssynchrony at baseline showed significant improvement in ventricular synchrony after receiving carvedilol, and this was correlated positively with a reduction in end-diastolic LV volumes.
Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Carbazóis/administração & dosagem , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Propanolaminas/administração & dosagem , Remodelação Ventricular/efeitos dos fármacos , Carvedilol , Doença Crônica , Relação Dose-Resposta a Droga , Esquema de Medicação , Eletrocardiografia , Feminino , Insuficiência Cardíaca/mortalidade , Testes de Função Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Função Ventricular Esquerda/efeitos dos fármacosRESUMO
Introducción: Carvedilol es un bloqueador adrenérgico que mejora el remodelamiento ventricular izquierdo y reduce la morbi-mortalidad de los pacientes con insuficiencia cardíaca congestiva (ICC). Esto podría estar relacionado con una corrección de la sincronía ventricular. Objetivo: Evaluar el efecto de Carvedilol sobre la sincronía en la contracción ventricular en pacientes con ICC. Métodos: Se estudiaron 30 pacientes con ICC estable, capacidad funcional NYHA (CF) II-III, fracción de eyección (FE) < 40 por ciento, los cuales estaban tratados en forma habitual. Se excluyeron pacientes usuarios de betabloqueadores o de marcapaso. Se realizó ventriculografía radioisotópica de equilibrio, al inicio y posterior a la terapia con Carvedilol por 6 meses, para evaluar la función sistólica y la sincronía ventricular. La sincronía interventricular fue calculada mediante la diferencia de promedio de fase de ambos ventrículos y la intraventricular usando la desviación estándar del análisis de fase. Resultados: La edad fue 55 ± 13 años, 71 por ciento hombres, 35 por ciento de etiología isquémica y 29 por ciento con bloqueo completo de rama izquierda (BCRI). Posterior a la terapia con Carvedilol (dosis promedio de 22 mg, rango de 6.25 50 mg/día) hubo una mejoría en la CF y en la distancia recorrida en 6 min (499 ± 18 m a 534 ± 17 m ). La FE mejoró de 24 ± 8.3 por ciento a 31 ± 11. 3 por ciento (p<0.001). En los pacientes con peor sincronía, bajo el percentil 50, mejoró la sincronía intraventricular (113 ± ms vs. 94 ± 38 ms, p=0.02) e interventricular (62.8 ± 7 ms vs. 39.4 ± 9 ms, p=0.02). Los pacientes con etiología no isquémica tuvieron una mejoría en la sincronía intraventricular (103.8 ± 7 ms vs 78.3 ± 12 ms, p=0.04) e interventricular (68.1 ± 9 ms vs. 35.3 ± 12 ms, p=0.02). En aquellos sin BCRI mejoró la sincronía intraventricular (112.1 ± 8 ms vs. 88.5 ± 11.2 ms, p=0.01). No hubo cambios significativos en pacientes con causa isquémica o con BCRI. Conclusiones: En pacientes con IC y disfunción ventricular izquierda, Carvedilol mejora la sincronía intra e interventricular. Estos efectos podrían estar relacionados a una acción favorable sobre el remodelamiento cardíaco.