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1.
Joana Neiva Marisa Passos Silva Gustavo Pires-Morais Adelaide Dias Marta Ponte Daniel Caeiro José Pedro Braga Nuno Ferreira Vasco Ribeiro 《Revista portuguesa de cardiologia》2019,38(3):215-223
Introduction
Single coronary artery (SCA) with no associated congenital heart disease is a rare congenital anomaly. Most cases are asymptomatic and incidental findings, but SCA can cause ischemia, congestive heart failure, and sudden cardiac death (SCD).Case report
A 44-year-old woman presented with Takotsubo cardiomyopathy and cardiogenic shock. Selective cannulation of the left coronary artery (LCA) was not possible on coronary angiography (CA); an SCA was revealed arising from the right sinus, continuing distally as the circumflex artery and thereafter as the left anterior descending artery. Coronary computed tomography angiography (CCTA) confirmed left main atresia and no coronary stenosis. Cardiac magnetic resonance imaging (MRI) showed diffuse myocardial edema and no perfusion defects. The patient's clinical course was favorable under conservative management.Discussion
Our paper describes an incidental finding of right SCA. We report a Lipton type R-I, in which a dominant right SCA supplies the entire myocardium. It is the rarest SCA presentation, with an incidence of 0.0008%; only 15 cases have been reported in the literature, all of which were studied by CA. Of these 15, one had SCD, five angina, one ventricular arrhythmia and one complicated acute coronary syndrome. CCTA confirmed the diagnosis in seven patients, MRI in one and transesophageal echocardiography in another. Nine patients had coronary lesions. Two underwent coronary artery bypass grafting, one percutaneous intervention and 11 conservative treatment.Conclusion
Right SCA with congenital absence of the LCA is one of the rarest coronary artery anomalies. In a significant percentage of patients it is associated with ischemia and can be life-threatening. CCTA and MRI are the modalities of choice for diagnosis and risk stratification. 相似文献2.
Glória Abreu Carlos Galvão Braga João Costa Pedro Azevedo Jorge Marques 《Revista portuguesa de cardiologia》2018,37(8):707-713
Background
Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS). Better recognition and diagnosis has raised awareness of this condition. However, the pathophysiology of SCAD and its prognosis are still little understood. We aimed to investigate the characteristics and prognosis of patients with SCAD, and subsequently performed a review of literature.Methods
Single-center, retrospective study performed in patients hospitalized from January 2010 to December 2016 with suspected ACS (n=5002) whose final diagnosis was SCAD (n=27; 0.5%).Results
Patients with SCAD were mainly female (81.5%; n=22), with median age of 56. Predisposing factors were identified in 12 (44%) patients and precipitating factors in three (11.1%). Non-ST elevation myocardial infarction (NSTEMI) was the main form of presentation (51.9%). The left anterior descending artery (LAD) territory was the most commonly involved (n=12, 44.4%). Type 2 dissection was the most prevalent angiographic pattern (n=17, 63%). The majority of patients (n=15; 55.6%) were managed medically and the remaining patients underwent percutaneous coronary intervention (PCI) with drug-eluting stents. Seven patients re-infarcted while in the hospital. Over the median follow-up period of 20 months, 7.4% of patients (n=2) had symptoms of heart failure (HF) and 14.8% developed ACS (in three patients the event occurred in a coronary territory other than that of the index case, and in one patient it occurred in the previously affected territory). There were no deaths.Conclusion
In the studied population, SCAD was more prevalent in middle-aged women. Despite the high prevalence of in-hospital re-infarction or during follow-up, the prognosis was good overall. 相似文献3.
Rania Hammami Jihen Jdidi Fakher Mroua Rahma Kallel Mourad Hentati Leila Abid Samir Kammoun 《Revista portuguesa de cardiologia》2018,37(1):41-49
Introduction
The GRACE and TIMI scores have been well validated for assessment of prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, their value in predicting coronary artery disease (CAD) has been little studied. We aimed to assess the relationship between these scores and the extent of coronary disease.Methods
We analyzed 238 consecutive patients admitted for NSTE-ACS and undergoing a coronary angiogram during hospitalization. The severity of CAD was assessed using the SYNTAX score. Obstructive CAD was defined as ≥50% stenosis in the left main or ≥70% stenosis in other vessels. Severe CAD was defined as a SYNTAX score >32. The Pearson test was used to assess the correlation between scores.Results
The SYNTAX score was higher in patients at high risk (GRACE score: p<0.001 and TIMI score: p=0.001). Moreover, there was a significant positive correlation between the GRACE and SYNTAX scores (r=0.23, p<0.001) as well as between TIMI and SYNTAX (r=0.2, p=0.002). Both clinical scores can predict obstructive CAD moderately well (area under the curve [AUC] for GRACE score: 0.599, p=0.015; TIMI score: AUC 0.639, p=0.001) but not severe disease. A GRACE score of 120 and a TIMI score of 2 were predictive of obstructive CAD with, respectively, a sensitivity of 57% and 75.7% and a specificity of 61.8% and 47.9%.Conclusion
The GRACE and TIMI scores correlate moderately with the extent of coronary disease assessed by the SYNTAX score. They can predict obstructive CAD but not severe disease. 相似文献4.
João Filipe Carvalho Adriana Belo Kisa Congo David Neves Ana Rita Santos Bruno Piçarra Ana Filipa Damásio José Aguiar 《Revista portuguesa de cardiologia》2018,37(11):911-919
Introduction
A low-risk GRACE score identifies patients with a lower incidence of major cardiac events, however it can erroneously classify patients with severe coronary artery disease as low-risk. We assessed the prevalence, clinical outcomes and predictors of left main and/or three-vessel disease (LM/3VD) in non-ST-elevation acute myocardial infarction (NSTEMI) patients with a GRACE score of ≤108 at admission.Methods
Using data from the Portuguese Registry on Acute Coronary Syndromes, 1196 patients with NSTEMI and a GRACE score of ≤108 who underwent coronary angiography were studied. Independent predictors of LM/3VD and its impact on in-hospital complications and one-year mortality were retrospectively analyzed.Results
LM/3VD was present in 18.2% of patients. Its prevalence was higher in males and associated with hypertension, diabetes, previous myocardial infarction, heart failure and peripheral arterial disease (PAD). Although there were no differences in in-hospital complications, these patients had higher mortality (0.9 vs. 0.0%) and more major adverse cardiac and cerebrovascular events (MACCE) (4.1 vs. 2.5%, p=0.172), and higher one-year mortality (2.4 vs. 0.5%, p=0.005). Independent predictors of LM/3VD were age (OR 1.03; 95% CI 1.01-1.0, p=0.003), male gender (OR 2.56; 95% CI 1.56-4.17, p<0.001), heart rate (1.02; 95% CI 1.01-1.03, p<0.001), PAD (OR 3.21; 95% CI 1.47-7.00, p<0.001) and heart failure (OR 3.38; 95% CI 1.02-11.15, p=0.046).Conclusions
LM/3VD was found in one in five patients. These patients had a tendency for higher in-hospital mortality and more MACCE, and higher one-year mortality. Simple clinical variables could help predict this severe coronary anatomy. 相似文献5.
Filipa Cordeiro Pedro Silva Mateus Sílvia Leão Miguel Moz Joana Trigo Catarina Ferreira Sofia Silva Carvalho Alberto Ferreira José Ilídio Moreira 《Revista portuguesa de cardiologia》2018,37(10):799-807
Introduction
We sought to assess the prognostic impact of left atrial (LA) size on long-term outcomes of ST-segment elevation myocardial infarction (STEMI).Methods
We studied 200 consecutive patients admitted to a single center between January 2010 and December 2014 with non-fatal STEMI treated with primary percutaneous coronary intervention (pPCI) who underwent a comprehensive echocardiographic examination at discharge. LA volume was estimated by the area-length method. The left atrium was classified as normal, mildly, moderately or severely enlarged by LA volume index (LAVI). The endpoints were defined as all-cause mortality, a cardiac composite endpoint (all-cause mortality, reinfarction, unplanned revascularization and hospitalization for heart failure) and a cardiovascular composite endpoint (cardiac endpoint plus atrial fibrillation and ischemic stroke) during follow-up.Results
In this STEMI population, 58% had normal LA size, 22.5% had mild LA enlargement, 10% had moderate LA enlargement and 9.5% had severe LA enlargement. During a median follow-up of 28 (IQR 21-38) months, 14 (7.0%) patients died, 53 (26.5%) had the cardiac and 58 (29%) the cardiovascular composite endpoints. There was a stepwise increase in the incidence of all-cause mortality (p=0.020) and both cardiac (p<0.001) and cardiovascular (p<0.001) endpoints with each increment of LAVI class. In multivariate analysis, severe LA enlargement by LAVI was an independent predictor of all-cause mortality (HR: 11.153; 95% CI: 1.924-64.642, p=0.007) and the cardiac (HR: 4.351; 95% CI: 1.919-9.862, p<0.001) and cardiovascular (HR: 4.351; 95% CI: 1.919-9.862, p<0.001) endpoints during follow-up.Conclusions
This contemporary study confirms the prognostic effect of LA size at discharge, applying the most recent reference values in STEMI patients treated with pPCI. 相似文献6.
Madalena Coutinho Cruz Rita Ilhão Moreira Ana Abreu Ana Teresa Timóteo Ramiro Sá Carvalho Lurdes Ferreira Rui Cruz Ferreira 《Revista portuguesa de cardiologia》2018,37(10):847-855
Introduction
Smoking is associated with atherosclerotic disease, but there is controversy about its protective nature after acute coronary syndrome (ACS).Objective
To determine the impact of smoking on the presentation, treatment and outcome of ACS.Methods
We analyzed all consecutive patients with ACS in a single center between 2005 and 2014. Current smokers and never-smokers were compared. Independent predictors of in-hospital mortality and of a composite of all-cause mortality, rehospitalization for cardiovascular causes, angiography, percutaneous coronary intervention and coronary artery bypass grafting were assessed by multivariate logistic regression.Results
A total of 2727 patients were included, 41.7% current smokers and 58.3% never-smokers. Current smokers were younger, more often male, had fewer comorbidities, a typical clinical presentation, lower heart rate, systolic blood pressure, Killip class, BNP/NT-pro-BNP and creatinine, better left ventricular systolic function and less severe coronary anatomy. ST-segment elevation myocardial infarction was more common in current smokers. Current smokers received more evidence-based treatments and had less in-hospital complications, in-hospital mortality and adverse outcomes at one year. More frequent percutaneous coronary intervention at one year was noted in current smokers. Smoking was not an independent predictor of outcome when the multivariate model was fully adjusted for baseline characteristics.Conclusion
The smoker's paradox was not observed in this population, since all differences in outcome were explained by smokers’ more benign baseline characteristics. 相似文献7.
Eduardo Flores-Umanzor Victoria Martin-Yuste Guillem Caldentey Sara Vazquez Gustavo Jimenez-Britez Rodolfo San Antonio Pedro Cepas-Guillen Margarida Pujol-Lopez Marco Hernández Manel Sabaté 《Revista portuguesa de cardiologia》2018,37(10):865.e1-865.e4
Introduction
Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is an infrequent finding. Revascularization is recommended in the presence of demonstrated viability or ischemia. Coronary artery bypass grafting (CABG) has long been considered the preferred option. Patients with previous CABG due to LMCA disease with occlusion of one graft and progression of the LMCA to CTO constitute a special population, as just one ischemic artery remains. For these patients, there is no other option for revascularization other than cardiac surgery (requiring resternotomy) or percutaneous coronary intervention (PCI) of the LMCA.Methods and Results
Out of 620 patients with CTO diagnosed in our center, we identified five with previous CABG due to LMCA disease for a retrospective case series. They had occlusion of one graft and progression of the LMCA to CTO. All five underwent PCI. Each patient received a functional classification for angina, myocardial ischemic tests, and a follow-up coronary angiogram during a median follow-up of 63 months. Coronary angiogram showed CTO of the semi-protected LMCA lesions with two CABGs previously performed in all patients, one occluded and the other patent. Three patients had occluded saphenous vein grafts to the circumflex coronary artery, and the rest had left internal mammary artery-left anterior descending artery CABG failure. Ischemia and viability were demonstrated. Surgery was ruled out due to high surgical risk. PCI due to CTO of the LMCA with drug-eluting stents was performed. In a five-year follow-up period, four patients remained asymptomatic and event free. One post-PCI death occurred from non-cardiovascular cause.Conclusions
PCI due to CTO of the LMCA following CABG can be successful and safe and can provide sustained clinical improvements in selected cases. 相似文献8.
Daniel Bonhorst Sara Guerreiro Cândida Fonseca Nuno Cardim Filipe Macedo Pedro Adragão 《Revista portuguesa de cardiologia》2019,38(1):33-41
Introduction
The aim of this study was to document clinical practice in Portugal regarding the use of electronic cardiac devices in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF).Methods
The Síncrone study was an observational prospective multicenter registry conducted in 16 centers in Portugal between 2006 and 2014. It included adult patients with a diagnosis of HF, LVEF <35% and indication for implantable cardioverter‐defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) devices, according to the recommendations of the European Society of Cardiology at the beginning of the study. Patients were followed for one year according to the practice of each center.Results
A total of 486 patients were included in the registry, half of whom received an ICD and the other half a CRT pacemaker (CRT‐P) or CRT defibrillator (CRT‐D). Mean age was 65±12 years and the most frequent causes of HF were ischemic (47%) and idiopathic dilated cardiomyopathy (28%). Overall mortality at one year was 3.6% and the hospitalization rate was 11%, significantly higher in patients with CRT‐P/CRT‐D than with ICD (17% vs. 5.6%, p<0.001). Patients who received CRT‐P/CRT‐D experienced significant reductions in QRS duration (160±21 vs. 141±24 ms, p<0.001) as well as improvement in New York Heart Association functional class.Conclusion
The Síncrone study shows that the use of implantable devices in HF with reduced LVEF in Portugal is in accordance with international recommendations and that patients presented functional improvement and reduced one‐year mortality. 相似文献9.
César Correia Carlos Galvão Braga Juliana Martins Carina Arantes Glória Abreu Catarina Quina Alberto Salgado Miguel Álvares Pereira João Costa Jorge Marques 《Revista portuguesa de cardiologia》2018,37(2):143-154
Introduction
There have been no prospective randomized trials that enable the best strategy and timing to be determined for revascularization in patients with non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS) and multivessel coronary artery disease (CAD).Objectives
To compare short‐ and long‐term adverse events following multivessel vs. culprit‐only revascularization in patients with NSTE‐ACS and multivessel CAD.Methods
This was a retrospective observational study that included all patients diagnosed with NSTE‐ACS and multivessel CAD who underwent percutaneous coronary intervention (PCI) between January 2010 and June 2013 (n = 232). After exclusion of patients with previous coronary artery bypass grafting (n = 30), a multivessel revascularization strategy was adopted in 35.1% of patients (n = 71); in the others (n = 131, 64.9%), only the culprit artery was revascularized. After propensity score matching (PSM), two groups of 66 patients were obtained, matched according to revascularization strategy.Results
During follow‐up (1543 ± 545 days), after PSM, patients undergoing multivessel revascularization had lower rates of reinfarction (4.5% vs. 16.7%; log‐rank p = 0.018), unplanned revascularization (6.1% vs. 16.7%; log‐rank p = 0.048), unplanned PCI (3.0% vs. 13.6%; log‐rank p = 0.023) and the combined endpoint of death, reinfarction and unplanned revascularization (16.7 vs. 31.8%; log‐rank p = 0.046).Conclusions
In real‐world patients presenting with NSTE‐ACS and multivessel CAD, a multivessel revascularization strategy was associated with lower rates of reinfarction, unplanned revascularization and unplanned PCI, as well as a reduction in the combined endpoint of death, reinfarction and unplanned revascularization. 相似文献10.
Sergio Raposeiras-Roubin Emad Abu-Assi Berenice Caneiro-Queija Rafael Cobas-Paz Lucía Rioboo-Lestón Cristina García Rodríguez Cruz Giraldez Lemos María Blanco Vidal Beatriz Ogando Guillán Isabel Pérez Martínez Emilio Paredes-Galán Víctor Jimenez-Díaz Jose Antonio Baz-Alonso Francisco Calvo-Iglesias Andrés Íñiguez-Romo 《Revista portuguesa de cardiologia》2018,37(3):239-245
Introduction
Beta-blocker doses that have been shown to be effective in randomized clinical trials are not commonly used in daily clinical practice. The aim of this study was to analyze whether there is a prognostic benefit of high rather than low doses of beta-blockers after an acute coronary syndrome (ACS).Methods
In this retrospective cohort study, 2092 ACS patients discharged from hospital between June 2013 and January 2016 were classified according to the beta-blocker dose prescribed: high dose (≥50% of the target dose tested in clinical trials) and low dose (<50%). Two groups of 501 matched patients were obtained through propensity score matching according to treatment with high or low doses of beta-blockers. The prognostic impact (mortality) during follow-up of high vs. low dose was analyzed by Cox regression and represented by Kaplan-Meier curves.Results
Of the 2092 patients, 80.5% were discharged under beta-blockers, with lower mortality during follow-up (18.6±9.7 months). Of the 1685 patients discharged under beta-blockers, only 31.4% received high doses. There were no differences in mortality during follow-up between patients under high-dose vs. low-dose beta-blockers (HR 0.935, 95% CI 0.628-1.392, p=0.740), and the equivalence between the two doses remained after propensity score matching (HR 1.183, 95% CI 0.715-1.958, p=0.513).Conclusion
No prognostic benefit was found in terms of mortality for high-dose vs. low-dose beta-blockers after an ACS. 相似文献11.
Miguel Nobre Menezes Ana Rita G. Francisco Pedro Carrilho Ferreira Cláudia Jorge Diogo Torres Pedro Cardoso José António Duarte José Marques da Costa Eduardo Infante de Oliveira Fausto J. Pinto Pedro Canas da Silva 《Revista portuguesa de cardiologia》2018,37(6):511-520
Introduction and Objective
Assessment of coronary lesions by the instantaneous wave free ratio (iFR) has generated significant debate. We aimed to assess the diagnostic performance of iFR and its impact on the decision to use fractional flow reserve (FFR) and on procedural characteristics.Methods
In this single‐center registry of patients undergoing functional assessment of coronary lesions, FFR was used as a reference for assessing the diagnostic performance of iFR. An iFR value <0.86 was considered positive and a value >0.93 was considered negative.Results
Functional testing was undertaken of 402 lesions, of which 154 were assessed with both techniques, 222 with FFR only, and 26 with iFR only. Using a cut‐off of ≤0.80 for iFR, the area under the curve was 0.73 (95% CI 0.65‐0.81), with an optimal value of ≤0.91. FFR was undertaken in 93 out of 94 lesions with an inconclusive iFR and was performed in 69.1% of the remaining iFR‐tested lesions. Concordance between iFR and FFR was 87% (chi‐square=22.43; p<0.001). Notwithstanding, there were four out of 13 cases (30.7%) of positive iFR with negative FFR and three out of 42 (7.1%) cases of negative iFR and positive FFR. This difference was significant (p=0.026). iFR had no impact on procedure time, fluoroscopy time or radiation dose.Conclusion
iFR had a reasonable diagnostic performance. Operators often chose to perform FFR despite conclusive iFR results. iFR and FFR were highly concordant, but a non‐negligible proportion of lesions classified as ischemic by iFR were classified as non‐ischemic by FFR. iFR had no impact on procedural characteristics. 相似文献12.
Introduction
In patients with non‐ST‐elevation myocardial infarction (NSTEMI), the best timing for coronary angiography is not definitely established, although it is recognized that in high‐risk patients it should be performed within the first 24 hours. The aim of this work was to describe the evolution over time of the use of an invasive strategy in the treatment of NSTEMI and in‐hospital mortality.Methods
We performed a retrospective analysis of patients admitted with NSTEMI included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between 2002 and 2015. The annual proportion of patients undergoing coronary angiography and the time from admission to coronary angiography were assessed, as were changes in mortality and length of stay.Results
A total of 18 639 patients with NSTEMI were included in the ProACS registry between 2002 and 2015. Over this period there were significant increases in the proportion of patients undergoing coronary angiography (from 52.0 to 83.6%) and angioplasty (from 23.3 to 53.0%), as well as in the proportion of patients who underwent coronary angiography within 24 hours of admission (from 21.0 to 48.1%). In‐hospital mortality decreased in those aged over 74 years (from 9.5 to 3.7%) and in males.Conclusions
The progressive adoption of an invasive strategy, particularly an early one (within 24 hours), was accompanied by a reduction in in‐hospital mortality. Since coronary angiography is performed late (> 24 hours) in half of NSTEMI patients, these patients could benefit from initiatives similar to Stent for Life. 相似文献13.
Sílvia Aguiar Rosa Pedro Silva Cunha Ana Lousinha Bruno Valente Ana Sofia Delgado Ricardo Pimenta Manuel Brás Madalena Coutinho Cruz Guilherme Portugal André Viveiros Monteiro Mário Oliveira Rui Cruz Ferreira 《Revista portuguesa de cardiologia》2019,38(1):11-16
Introduction
Implantable cardioverter-defibrillator (ICD) monitoring zones (MZ) provide passive features that do not interfere with the functioning of active treatment zones. However, it is not known for certain whether programming an MZ affects arrhythmia detection by the ICD. The aim of the present study is to assess the clinical relevance of MZ in a population of patients with ICDs.Methods
In this retrospective analysis of patients with ICDs, with or without cardiac resynchronization therapy, for primary prevention under remote monitoring, the MZ was analyzed and recorded arrhythmias were assessed in detail.Results
A total of 221 patients were studied (77% men; age 64±12 years). Mean ejection fraction was 30±12%. The mean follow-up was 63±35 months. One hundred and seventy-four MZ events were documented in 139 patients (62.9%): 74 of non-sustained ventricular tachycardia (NSVT), 42 of supraventricular tachycardia, 44 of atrial fibrillation/atrial flutter, and five cases of noise. Among the 137 patients who presented with arrhythmias in the MZ (excluding two cases with noise detection only), 22 (16.1%) received appropriate shocks and/or antitachycardia pacing (ATP), while of the other 84 patients, 15.5% received appropriate ICD treatment (p=NS). In patients who presented with NSVT in the MZ, 15 (20.5%) received appropriate shocks and/or ATP. In accordance with the MZ findings, physicians decided to change outpatient medication in 41.7% of all patients in whom arrhythmic events were reported.Conclusion
Ventricular and supraventricular arrhythmias are common findings in the MZ of ICD patients. Programming an MZ is valuable in the diagnosis of arrhythmias and may be a useful tool in clinical practice. 相似文献14.
Juan Sanchis Albert Ariza-Solé Emad Abu-Assi Oriol Alegre Fernando Alfonso José Antonio Barrabés José Antonio Baz Antonio Carol Pablo Díez Villanueva Bruno García del Blanco Jaime Elízaga Eduard Fernandez Abel García del Egido Joan García Picard Iván Gómez Blázquez Joan Antoni Gómez Hospital Rosana Hernández-Antolín Cinta Llibre Héctor Bueno 《Revista espa?ola de cardiología》2019,72(2):154-159
Introduction and objectives
Although clinical guidelines recommend invasive management in non–ST-segment elevation myocardial infarction (NSTEMI), this strategy is underused in frail elderly patients in the real world. Furthermore, these patients are underrepresented in clinical trials and therefore the evidence is scarce. Our hypothesis is that an invasive strategy will improve prognosis in elderly frail patients with NSTEMI.Methods
This will be a prospective, multicenter, randomized trial, in which the conservative and invasive strategies will be compared in patients meeting all of the following inclusion criteria: NSTEMI diagnosis, age ≥ 70 years, and frailty defined by a category ≥ 4 in the Clinical Frailty Scale. Participants will be randomized to an invasive (coronary angiogram and revascularization if anatomically amenable) or conservative (medical treatment and coronary angiogram only if persistent clinical instability) strategy. The primary endpoint will be the number of days alive out of hospital during the first year. The coprimary endpoint will be the time until the first cardiac event (cardiac death, reinfarction or postdischarge revascularization). We estimate a sample size of 178 patients (89 per arm), considering an increase of 20% in the proportion of days alive out of hospital with the invasive management.Results
The results of this study will add important knowledge to inform the management of frail elderly patients hospitalized with NSTEMI.Conclusions
We hypothesize that the invasive strategy will improve outcomes in frail elderly patients with NSTEMI. If this is confirmed, frailty status should not dissuade physicians from implementing an invasive management strategy. Clinical trial registration: URL: http://www.clinicaltrials.gov.Identifier: NCT03208153. 相似文献15.
Nora Cazzagon Carlo Dal Lin Giulia Famoso Roberta Montisci Irene Franceschet Annarosa Floreani Francesco Tona 《Digestive and liver disease》2019,51(4):542-548
Background
It is still not clear whether primary biliary cholangitis (PBC) is associated with abnormalities of the cardiovascular system. We aimed to assess the relationship between PBC and coronary flow reserve (CFR).Methods
Our inclusion criterion was a diagnosis of PBC with no clinical evidence of heart disease or metabolic syndrome. Coronary flow velocity in the left anterior descending coronary artery was measured using transthoracic Doppler echocardiography at rest (DFVr), and during adenosine infusion (DFVh). The corrected CFR (cCFR) was defined as the ratio of DFVh to DFVr corrected for cardiac workload (cDFVr). Microvascular resistance was also assessed in baseline (BMR) and hyperemic conditions (HMR).Results
37 PBC patients and 37 sex- and age-matched controls were considered. The cCFR was significantly lower in PBC patients (2.8?±?0.7 vs. 3.7?±?0.7, p?<?0.0001), and abnormal (≤2.5) in 13 (35%) of them, but in none of the controls (p?<?0.0001). The cDFVr was higher in patients with abnormal cCFR (29.0?±?6.0 vs. 20.4?±?4.5?cm/sec, p?<?0.0001). The CFR and cCFR did not correlate with any characteristics of PBC, comorbidities or Framingham risk scores. The BMR and HMR correlated with time since PBC diagnosis and duration of symptoms.Conclusion
The CFR is reduced in PBC, apparently due to mechanisms correlating with the time since diagnosis. In particular, the higher cDFVr with a lower basal resistance in patients with cCFR?≤?2.5 suggests a compensatory mechanism against any cardiomyocyte bioenergetics impairment. 相似文献16.
Hasan Ata Bolayır Tarık Kıvrak Hakan Güneş Dursun Akaslan Ömer Şahin Aslı Bolayır 《Revista portuguesa de cardiologia》2018,37(5):375-381
Introduction and Aim
There is an important link between platelets and inflammation, thrombosis, and vascular and tissue repair mechanisms. SCUBE1 (signal peptide-CUB-EGF domain-containing protein 1) may function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Stent thrombosis (ST) following percutaneous coronary intervention is an uncommon and potentially catastrophic event that can manifest as myocardial infarction and sudden death. High platelet reactivity is a risk factor for thrombotic events, including late ST. For this reason, in the current study, we researched the role of SCUBE1 in the development of late coronary ST.Methods
We included 40 patients admitted to our hospital with a diagnosis of ST-elevation myocardial infarction (STEMI) and signs of late ST on a coronary angiogram. For the control group, we recruited 50 healthy gender- and age-matched individuals who were seen for health check-ups. We also randomly included 100 patients with a diagnosis of STEMI without ST.Results
There were no significant differences between the groups in terms of baseline and demographic characteristics. The mean SCUBE1 level in patients with STEMI with late ST at admission and the STEMI without ST group was significantly higher than in the control group (p<0.01). The mean SCUBE1 level in the STEMI with late ST group was significantly higher than in the STEMI without ST group (p=0.03). In multivariate regression analysis, serum SCUBE1 (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.011-1.033, p<0.001) remained an independent predictor for the presence of late ST. In addition, receiver operating characteristic curve analysis was used to determine the optimal SCUBE1 cut-off value for predicting late ST. The area under the curve was 0.972 (95% CI 0.95-0.98). The SCUBE1 cut-off value was 59.2 ng/ml, with a sensitivity of 95.4% and specificity of 82.9%.Conclusion
The present work is the first clinical study to demonstrate that serum SCUBE1 levels are significantly higher in patients with late ST and serum SCUBE1 was an independent predictor for the presence of late ST in our study population. 相似文献17.
Leonor Parreira Rita Marinheiro Pedro Carmo Pedro Amador Tiago Teixeira Diogo Cavaco Francisco Costa Katya Reis-Santos Pedro Adragão 《Revista portuguesa de cardiologia》2019,38(2):83-91
Introduction and Aims
Frequent premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT) are usually considered a benign entity and the ECG is typically normal. The aim of this study was to assess whether upward displacement of the ECG to the second intercostal space (ICS) would reveal any abnormal pattern.Methods
A total of 18 consecutive patients with apparently normal hearts were studied, mean age 44±16 years, 12 women, who underwent catheter ablation of the RVOT due to frequent PVCs. A 12-lead ECG was performed in the standard position and repeated in a higher position, at the level of the second ICS. Three-dimensional bipolar electroanatomical voltage mapping (EVM) was performed in all patients and low voltage areas (LVAs) were defined as areas with amplitude <1.5 mV.Results
The ECG in the second ICS was normal in eleven patients but in seven (39%) it revealed a pattern of ST-segment elevation in V1. EVM revealed the presence of LVAs in six patients (33%) which included the earliest activation site (EAS) in five. The ST elevation was associated with the presence of LVAs (p<0.0001) and with the LVAs at the EAS (p=0.002).Conclusion
In this group of patients with apparently normal hearts and with frequent PVCs of the RVOT, upward displacement of the ECG revealed the presence of ST elevation in more than one third of patients, and the ST elevation was associated with the presence of LVAs in the RVOT. 相似文献18.
Ismael Ballesta García Jacobo Ángel Rubio Arias Domingo Jesús Ramos Campo Ignacio Martínez González-Moro María Carrasco Poyatos 《Revista espa?ola de cardiología》2019,72(3):233-243
Introduction and objectives
High-interval intensity training (HIT) has been suggested to improve peak VO2 in cardiac rehabilitation programs. However, the optimal HIT protocol is unknown. The objective of this study was to identify the most effective doses of HIT to optimize peak VO2 in coronary artery disease (CAD) and heart failure (HF) patients.Methods
A search was conducted in 6 databases (MEDLINE, Web of Science, LILACS, CINAHL, Academic Search Complete, and SportDiscus). Studies using a HIT protocol in CAD or HF patients and measuring peak VO2 were included. The PEDro Scale and Cochrane Collaboration tools were used.Results
Analyses reported significant improvements in peak VO2 after HIT in both diseases (P = .000001), with a higher increase in HF patients (P = .03). Nevertheless, in HF patients, there were no improvements when the intensity recovery was ≤ 40% of peak VO2 (P = .19) and the frequency of training was ≤ 2 d/wk (P = .07). There were significant differences regarding duration in CAD patients, with greater improvements in peak VO2 when the duration was < 12 weeks (P = .05). In HF, programs lasting < 12 weeks did not significantly improve peak VO2 (P = .1).Conclusions
The HIT is an effective method for improving peak VO2 in HF and CAD, with a significantly greater increase in HF patients. The recovery intervals should be active and be between 40% and 60% of peak VO2 in HF patients. Training frequency should be ≥ 2 d/wk for CAD patients and ≥ 3 d/wk for HF patients. 相似文献19.
Catarina Perez‐Brandão Conceição Trigo Fátima F. Pinto 《Revista portuguesa de cardiologia》2019,38(2):97-101
Introduction
Pericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow‐up of children diagnosed with pericarditis at our center.Methods
We performed a retrospective analysis of all children admitted to our pediatric cardiology unit with pericarditis between 2003 and 2015. Patient characteristics were summarized using frequencies and percentages for categorical variables and medians with percentiles for continuous variables.Results
Fifty patients were analyzed (40 male, 10 female) with a median age of 14 years. The most common diagnosis was acute pericarditis (80%). Thirty‐five patients (70%) presented with chest pain and 26% reported fever. Cardiomegaly was identified on chest X‐ray in 11 patients (22%), 30 patients (60%) had an abnormal ECG and 44 patients (80%) had alterations on the transthoracic echocardiogram. In 17 cases (34%) there was myocardial involvement. Forty‐eight percent of patients presented with infectious pericarditis and the pathologic agent was identified in half of them. Postpericardiotomy syndrome was diagnosed in five cases. The first‐line therapy was aspirin in 50% of cases. Pericardiocentesis was performed in 12 patients. The median length of stay was nine days. There was symptom recurrence in seven children.Conclusions
In this study, acute infectious pericarditis was the most common presentation and about one third of patients also had myocarditis. The symptom recurrence rate was not negligible and is probably related to the type of therapy employed. 相似文献20.
Mariano Tomás Flórez García Loreto Carmona Raquel Almodóvar César Fernández de las Peñas Fernando García Pérez M. Ángeles Pérez Manzanero José Manuel García García Lidón Soriano Segarra José Fernando Jiménez Díaz Nuria Mendoza Laiz Eugenio de Miguel Mendieta Juan Carlos Torre Alonso Luis Francisco Linares Ferrando Eduardo Collantes Estévez Jesús Sanz Sanz Pedro Zarco Montejo 《Reumatología clinica》2019,15(2):77-83