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1.
Francesco Fici Elif Ali Bakir Sengul Beyaz Wim Makel Nicolas Roberto Robles 《Primary Care Diabetes》2018,12(6):558-564
Background
Albuminuria is an early marker of kidney disease in patients with diabetes and/or hypertension undetected or untreated albuminuria is a leading cause of chronic kidney disease and cardiovascular events, The purpose of the present survey was to assess the prevalence of albuminuria in patients with diabetes and hypertension, treated with a combinations of renin angiotensin aldosterone system inhibitors and dihydropyridine calcium channel blockers.Methods
The survey was performed in 105 Primary Care Units in Turkey and involved outpatients, routinely visited by either a specialist or a non-specialist physician.Albuminuria was evaluated in a spot morning urine sample, as albumin–creatinine ratio, using the Multistic-Clinitek-device analyzer (Siemens), that has a strong correlation with 24-h urinary albumin excretion. Microalbuminuria was defined as a loss of 3.4–33.9 mg albumin/mmol creatinine and macroalbuminuria as a loss of >33.9 mg albumin/mmol creatinine. Diabetes was assessed through documented blood glucose concentration or use antidiabetic drugs, whereas hypertension through blood pressure measurement and current antihypertensive treatment.Results
The survey enrolled 1708 subjects with a prevalence of type 2 diabetes (87.6%). Albuminuria was detected in 52.0% of patients. Blood pressure was controlled in 37.0% and diabetes in 56.7%. The risk of albuminuria was significantly high in patients with uncontrolled diabetes (p < 0.001) and blood pressure (p = 0.009).Conclusions
In a large cohort of treated hypertensive patients with diabetes, albuminuria was present in about 50% and was correlated with poor diabetes and blood pressure control. Systematic screening of albuminuria, particularly in Primary Care, is an important tool for the early diagnosis of nephropathy. 相似文献2.
Paulo Dinis Rogério Teixeira Hélder Dores Pedro Correia Hanna Lekedal Marie Bergman Maria Carmo Cachulo Joaquim Cardoso Lino Gonçalves 《Revista portuguesa de cardiologia》2018,37(3):249-256
Introduction
Exercise‐induced cardiac remodeling is frequent in athletes. This adaptation is structurally manifested by an increase in cardiac dimensions and mass. Soldiers are also subject to intense physical exercise, although with different characteristics.Objective
To compare exercise‐induced cardiac remodeling in competitive athletes and in soldiers on a special forces training course.Methods
We studied 17 soldiers (all male and Caucasian, mean age 21 ± 3 years) who completed a special forces course and 17 basketball players (47.3% male, 64.7% Caucasian, mean age 21 ± 3 years). Assessment included a transthoracic echocardiogram and analysis of myocardial mechanics. This assessment was performed at the beginning and end of the military course and the sports season, respectively.Results
Cardiac remodeling was observed in both groups. The soldiers presented a predominantly eccentric pattern, with increased left ventricular (LV) size (49.7 ± 3.2 vs. 52.8 ± 3.4 mm; p < 0.01), increased LV mass (93.1 ± 7.7 vs. 100.2 ± 11.4 g/m2; p < 0.01) and decreased relative wall thickness (0.40 ± 0.1 vs. 0.36 ± 0.1; p = 0.05). The basketball players showed a concentric pattern, with decreased LV size (52.0 ± 4.7 vs. 50.4 ± 4.7 mm; p = 0.05), and increased relative wall thickness (0.33 ± 0.1 vs. 0.36 ± 0.1; p = 0.05). Although there was no significant difference in LV myocardial strain in the groups separately, when compared there was a significant decrease (‐20.2 ± 1.6% vs. ‐19.4 ± 2.1%; p = 0.03).Conclusion
Cardiac remodeling was frequent, with an eccentric pattern in soldiers and a concentric pattern in basketball players. Myocardial deformation may represent a physiological adaptation to physical exercise. 相似文献3.
Rufeng Shi Kai Liu Di Shi Qi Liu Xiaoping Chen 《The American journal of the medical sciences》2017,353(1):6-11
Objectives
Antihypertensive therapy is effective to control blood pressure (BP) and to prevent cardiovascular events, but the further treatment strategies for patients who cannot achieve goal BP with low-dose monotherapy is still under dispute. Our study investigates the effects of high-dose amlodipine and valsartan and their low-dose combination on blood pressure variability (BPV) and pulse wave velocity (PWV) to provide references for clinical medication.Materials and Methods
This study was a prospective, randomized, parallel, case-controlled trial performed in a medical center. A total of 134 outpatients newly diagnosed with essential hypertension or receiving low-dose monotherapy were enrolled and 119 completed the trial. They were randomized into amlodipine 10 mg group (n = 40), valsartan 160 mg group (n = 38) and amlodipine 5 mg + valsartan 80 mg (n = 41) in a 1:1:1 allocation ratio for a 10-week treatment. Demographic data and laboratory indicators were collected at the randomization and 10 weeks after the treatment. The 24-hour ambulatory BP and brachial-ankle PWV were also monitored.Results
All therapies reduced systolic and diastolic BP (P < 0.05). The 24-hour systolic BPV was significantly decreased in amlodipine and combination groups (3.55 ± 2.57, 4.11 ± 2.20 versus 2.23 ± 2.54 mm Hg, P < 0.05). The effects on diastolic BPV differed between different treatments. PWV was lowered by 3 antihypertensive schemes; the degree of which from strongest to weakest were valsartan, combination and amlodipine (228.87 ± 60.41 versus 152.49 ± 49.25 versus 99.35 ± 35.57 cm/second, P < 0.01).Conclusions
All further strategies can effectively control BP. The combination treatment reduces both BPV and PWV noticeably, whereas double-dose amlodipine achieves the greatest BPV decrease and valsartan is best in controlling PWV. 相似文献4.
Virginia Pascual-Ramos Ana Guilaisne Bernard-Medina Diana Elsa Flores-Alvarado Margarita Portela-Hernández María del Rocío Maldonado-Velázquez Luis Javier Jara-Quezada Luis Manuel Amezcua-Guerra Nadina E. Rubio-Judith López-Zepeda Everardo Álvarez-Hernandez Miguel Ángel Saavedra César Alejandro Arce-Salinas 《Reumatología clinica》2018,14(3):137-141
Background
The Mexican Accreditation Council for Rheumatology certifies trainees (TR) on an annual basis using both a multiple-choice question (MCQ) test and an objective structured clinical examination (OSCE). For 2013 and 2014, the OSCE pass mark (PM) was set by criterion referencing as ≥6 (CPM), whereas overall rating of borderline performance method (BPM) was added for 2015 and 2016 accreditations. We compared OSCE TR performance according to CPM and BPM, and examined whether correlations between MCQ and OSCE were affected by PM.Methods
Forty-three (2015) and 37 (2016) candidates underwent both tests. Altogether, OSCE were integrated by 15 validated stations; one evaluator per station scored TR performance according to a station-tailored check-list and a Likert scale (fail, borderline, above range) of overall performance. A composite OSCE score was derived for each candidate. Appropriate statistics were used.Results
Mean (±standard derivation [SD]) MCQ test scores were 6.6 ± 0.6 (2015) and 6.4 ± 0.6 (2016) with 5 candidates receiving a failing score each year. Mean (±SD) OSCE scores were 7.4 ± 0.6 (2015) and 7.3 ± 0.6 (2016); no candidate received a failing CPM score in either 2015 or 2016 OSCE, although 21 (49%) and 19 (51%) TR, respectively, received a failing BPM score (calculated as 7.3 and 7.4, respectively). Stations for BPM ranged from 4.5 to 9.5; overall, candidates showed better performance in CPM.In all, MCQ correlated with composite OSCE, r = 0.67 (2015) and r = 0.53 (2016); P≤.001. Trainees with a passing BPM score in OSCE had higher MCQ scores than those with a failing score.Conclusions
Overall, OSCE-PM selection impacted candidates’ performance but had a limited affect on correlation between clinical and practical examinations. 相似文献5.
Sílvia Aguiar Rosa Ana Agapito Rui M. Soares Lídia Sousa José Alberto Oliveira Ana Abreu Ana Sofia Silva Sandra Alves Helena Aidos Fátima F. Pinto Rui Cruz Ferreira 《Revista portuguesa de cardiologia》2018,37(5):399-405
Aim
The aim of the study was to compare functional capacity in different types of congenital heart disease (CHD), as assessed by cardiopulmonary exercise testing (CPET).Methods
A retrospective analysis was performed of adult patients with CHD who had undergone CPET in a single tertiary center. Diagnoses were divided into repaired tetralogy of Fallot, transposition of the great arteries (TGA) after Senning or Mustard procedures or congenitally corrected TGA, complex defects, shunts, left heart valve disease and right ventricular outflow tract obstruction.Results
We analyzed 154 CPET cases. There were significant differences between groups, with the lowest peak oxygen consumption (VO2) values seen in patients with cardiac shunts (39% with Eisenmenger physiology) (17.2±7.1 ml/kg/min, compared to 26.2±7.0 ml/kg/min in tetralogy of Fallot patients; p<0.001), the lowest percentage of predicted peak VO2 in complex heart defects (50.1±13.0%) and the highest minute ventilation/carbon dioxide production slope in cardiac shunts (38.4±13.4). Chronotropism was impaired in patients with complex defects. Eisenmenger syndrome (n=17) was associated with the lowest peak VO2 (16.9±4.8 vs. 23.6±7.8 ml/kg/min; p=0.001) and the highest minute ventilation/carbon dioxide production slope (44.8±14.7 vs. 31.0± 8.5; p=0.002). Age, cyanosis, CPET duration, peak systolic blood pressure, time to anaerobic threshold and heart rate at anaerobic threshold were predictors of the combined outcome of all-cause mortality and hospitalization for cardiac cause.Conclusion
Across the spectrum of CHD, cardiac shunts (particularly in those with Eisenmenger syndrome) and complex defects were associated with lower functional capacity and attenuated chronotropic response to exercise. 相似文献6.
J. Antonio García-Bello Joel Ortiz-Flores Francisco E. Torres de la Riva G. Karina Mendoza-Moreno Circe Gómez-Tenorio 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(4):414-419
Introduction
Left ventricular diastolic dysfunction (LVDD) is an independent predictor of mortality in Chronic Kidney Disease (CKD). The increase in the E/e’ ratio is an indicator of LVDD. The association between cardiovascular risk factors (CVRFs) and E/e’ in children with automated peritoneal dialysis (APD) has not been widely studied.Objective
To measure the association between CVRFs and E/e’ in children with CKD on APD.Methods
Cross-sectional, prolective, observational, analytical study of children aged 6–16 years on APD. We recorded age, gender, time since onset, time on dialysis, and measured weight, height, blood pressure, hemoglobin, albumin, calcium, phosphorus, parathyroid hormone, and C-reactive protein. E/e’ ratio was measured and considered to have increased when it was higher than 15.Results
Twenty-nine children were studied, (19 females). Age was 14.0 ± 2.5 years, and 16.9 ± 11.2 months with substitutive therapy. One patient had reduced left ventricular ejection fraction, and 21 (72.4%) had increased E/e’. E/e’ correlated significantly with hemoglobin (r = –0.53, P = .003). Hemoglobin and albumin were significantly lower (9.72 ± 1.9 vs. 12.2 ± 1.8; P = .004 and 3.6 ± 0.5 vs. 4.0 ± 0.3; P = .035) and the proportion of patients with anemia and hypoalbuminemia was significantly higher (85.7% vs. 37.5%; P = .019 and 61.9% vs. 12.5%; P = .035) in patients with increased E/e’. Hemoglobin was the only independent predictor of E/e’ (β = –0.66; P = .020) and patients with anemia were 10 times more likely to have increased E/e’ (95% CI 1.5-65.6, P = .016).Conclusions
75% of the children had increased E/e’. Anemia and hypoalbuminemia were significantly related with an increased E/e’. 相似文献7.
Miguel Liern Anabella Collazo Maylin Valencia Alejandro Fainboin Lorena Isse Cristian Costales-Collaguazo Federico Ochoa Graciela Vallejo Elsa Zotta 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2019,39(2):177-183
Introduction
Fabry disease (FD) is a hereditary disorder caused by a deficiency of α-galactosidase A enzyme activity. The transmission of the disorder is linked to the X chromosome.Objectives
The objectives of the study were: 1. To quantify the presence of podocytes in paediatric patients with FD and compare them with the value of the measured podocyturia in healthy controls. 2. To determine whether a greater podocyturia is related to the onset of pathological albuminuria in patients with FD. 3. To determine the risk factors associated with pathological albuminuria.Methods
We performed an analytical, observational study of Fabry and control subjects, which were separated into 2 groups in accordance with the absence of the disease (control group) or the presence of the disease (Fabry group).Results
We studied 31 patients, 11 with FD and 20 controls, with a mean age of 11.6 years.The difference between the mean time elapsed from the diagnosis of FD to the measurement of podocyturia (40 months) and the onset of pathological albuminuria (34 months) was not significant (p = 0.09). Podocytes were identified by staining for the presence of synaptopodin and the mean quantitative differences between both podocyturias were statistically significant (p = 0.001). Albuminuria was physiological in 4 of the patients with FD and the relative risk to develop pathological albuminuria according to podocyturia was 1.1 in the control group and 3.9 in the Fabry group, with a coefficient of correlation between podocyturia and albuminuria in the Fabry group of 0.8354. Finally, the 2 risk factors associated with the development of pathological albuminuria were podocyturia (OR: 14) and being aged over 10 years (OR: 18). We found no significant risk with regard to glomerular filtrate renal (GFR) (OR: 0.5) or gender (OR: 1.3). The mean GFR remained within normal values.Conclusion
The detection of podocyturia in paediatric patients with FD could be used as an early marker of renal damage, preceding and proportional to the occurrence of pathological albuminuria. 相似文献8.
Almudena Pérez-Torres M. Elena González Garcia Belén San José-Valiente M. Auxiliadora Bajo Rubio Olga Celadilla Diez Ana M. López-Sobaler Rafael Selgas 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(2):141-151
Introduction
Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%.Objective
To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA).Patients and methods
Cross-sectional study of 186 patients (101 men) with a mean age of 66.1 ± 16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis.Results
The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p < 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2 methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio.The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084–1.457, p = 0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893–0.983, p = 0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998–0.999, p = 0.001) and cell mass index (OR: 0.995; 95% CI: 0.992–0.998).Conclusion
Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria. 相似文献9.
Hugo Marques Pedro de Araújo Gonçalves António Miguel Ferreira Rita Cruz João Lopes Rosana dos Santos Lucian Radu Francisco Costa João Mesquita Pedro Carmo Diogo Cavaco Leonor Parreira João Pisco João Goyri O’Neill Pedro Adragão 《Revista portuguesa de cardiologia》2018,37(11):873-883
Background
Cardiac computed tomography (CT) can provide a precise tridimentional anatomic map and exclude intra‐cardiac thrombus. We aimed to access the impact of CT protocol optimization and technological evolution on the contrast and radiation dose as well as on image quality previous to atrial fibrillation (AF) ablation.Methods
From a prospective registry of consecutive patients who underwent cardiac CT in a single center, we selected 270 patients in whom the CT was done for evaluation prior to AF ablation and they were distributed in 3 groups: Group1: the first 150 patients included; Group2: the last 60 patients performed with the same CT scanner; Group3: the first 60 exams performed with the new CT scanner. Quality of the protocol was access based on radiation dose, contrast volume used, the use of a second (delayed) acquisition, and on quantitative image quality analisis (signal to noise and contrast to noise ratios; density homogeneity racio between LA and LAA).Results
We found a significant radiation dose as well as contrast dose reduction between the first and last subgroups (G1: 5,6 mSv and 100 ml; G2: 1,3 mSv and 90 ml; G3: 0,6 mSv and 65 ml). Even though group 3 had less radiation and contrast used it still had better quantitative image quality (signal/noise of 13,5; contrast/noise 14,8; density homogeneity racio of 0,92).Conclusion
Protocol optimization and technology both contributed to significant lower radiation dose and contrast volume used on cardiac CTs prior to AF ablation, without compromising image quality. 相似文献10.
Ruth María Sánchez Soriano María Dolores Albero Molina Carlos Israel Chamorro Fernández Rocío Juliá-Sanchís Ramón López Menchero Carlos del Pozo Fernández Guillermo Grau Jornet Julio Núñez Villota 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(4):394-400
Introduction and objectives
Evidence for the efficacy and safety of oral anticoagulation with dicumarines in patients with atrial fibrillation (AF) on hemodialysis is controversial. The aim of our study is to evaluate the long-term prognostic implications of anticoagulation with dicumarines in a cohort of patients with non-valvular AF on a hemodialysis program due to end-stage renal disease.Methods
Retrospective, observational study with consecutive inclusion of 74 patients with AF on hemodialysis. The inclusion period was from January 2005 to October 2016. The primary variables were all-cause mortality, non-scheduled readmissions and bleeding during follow-up.Results
Mean age was 75 ± 10 years; 66.2% were men and 43 patients (58.1%) received acenocoumarol. During a median follow-up of 2.40 years (IQR = 0.88-4.15), acenocoumarol showed no survival benefit [HR = 0.76, 95% CI (0.35-1.66), p = 0.494]. However, anticoagulated patients were at increased risk of recurrent cardiovascular hospitalizations [IRR = 3.94, 95% CI (1.06-14.69), p = 0.041]. There was a trend towards an increase in repeated hospitalizations of ischemic cause in anticoagulated patients [IRR = 5.80, 95% CI (0.86-39.0), p = 0.071]. There was a statistical trend towards a higher risk of recurrent total bleeding in patients treated with acenocoumarol [IRR = 4.43, 95% CI (0.94-20.81), p = 0.059].Conclusions
In this study, oral anticoagulation with acenocoumarol in patients with AF on hemodialysis did not increase survival. However, it was associated with an increased risk of hospitalizations of cardiovascular causes and a tendency to an increased risk of total bleeding. 相似文献11.
Carlos Labata Teresa Oliveras Elisabet Berastegui Xavier Ruyra Bernat Romero Maria-Luisa Camara Maria-Soledad Just Jordi Serra Ferran Rueda Marc Ferrer Cosme García-García Antoni Bayes-Genis 《Revista espa?ola de cardiología》2018,71(8):638-642
Introduction and objectives
Current postoperative management of adult cardiac surgery often comprises transfer from the intensive care unit (ICU) to a conventional ward. Intermediate care units (IMCU) permit hospital resource optimization. We analyzed the impact of an IMCU on length of stay (both ICU and in-hospital) and outcomes (in-hospital mortality and 30-day readmissions) after adult cardiac surgery (IMCU-CS).Methods
From November 2012 to April 2015, 1324 consecutive patients were admitted to a university hospital for cardiac surgery. In May 2014, an IMCU-CS was established for postoperative care. For the purposes of this study, patients were classified into 2 groups, depending on the admission period: pre-IMCU-CS (November 2012-April 2014, n = 674) and post-IMCU-CS (May 2014-April 2015, n = 650).Results
There were no statistically significant differences in age, sex, risk factors, comorbidities, EuroSCORE 2, left ventricular ejection fraction, or the types of surgery (valvular in 53%, coronary in 26%, valvular plus coronary in 11.5%, and aorta in 1.8%). The ICU length of stay decreased from 4.9 ± 11 to 2.9 ± 6 days (mean ± standard deviation; P < .001); 2 [1-4] to 1 [0-3] (median [Q1-Q3]); in-hospital length of stay decreased from 13.5 ± 15 to 12.7 ± 11 days (mean ± standard deviation; P = .01); 9 [7-13] to 9 [7-11] (median [Q1-Q3]), in pre-IMCU-CS to post-IMCU-CS, respectively. There were no statistically significant differences in in-hospital mortality (4.9% vs 3.5%; P = .28) or 30-day readmission rate (4.3% vs 4.2%; P = .89).Conclusions
After the establishment of an IMCU-CS for postoperative cardiac surgery, there was a reduction in ICU and in-hospital mean lengths of stay with no increase in in-hospital mortality or 30-day readmissions.Full English text available from: www.revespcardiol.org/en 相似文献12.
Natalia Morales Mestre Andrea Papaleo Vicente Morales Hidalgo Gilles Caty Gregory Reychler 《Archivos de bronconeumología》2018,54(12):607-613
Introduction
Bronchopulmonary dysplasia (BPD) is the most common complication of extreme preterm delivery, and is associated with reduced exercise tolerance and exercise capacity. The aim of this study was to assess the effects of a physical activity programme on exercise tolerance, exercise capacity, flexibility, and lung function in prematurely born children with BPD.Methods
This was a randomized controlled trial. Preterm children with BPD (4–6 years) were randomized to intervention (IG) and control (CG) groups. The CG did not participate in any physical activity during the study period. The IG performed a 4-week exercise programme based on aerobic interval and resistance training. Outcomes were based on the 6-minute walk test (6MWT), incremental shuttle walk test (ISWT), modified sit and reach test (MSRT) and spirometry results.Results
Twenty individuals were recruited. In the IG (n = 10), statistical and clinical improvement was observed in the 6MWT (316.3 ± 31.4 m vs 376.2 ± 39.5 m; P = .002). Significant improvements were also seen in the IG in the ISWT (248.0 ± 45.2 m vs 465.3 ± 58.2 m; P = .013), MSRT (14.5 ± 7.7 cm vs 22.8 ± 6.9 cm; P = .003), and FEV1 (102% ± 16% pred vs 104% ± 17% pred; P = .004). No significant differences between pre- and post-intervention were observed in the CG for all outcomes (n = 10).Conclusion
This 4-week programme resulted in statistical and clinical improvements in exercise tolerance, exercise capacity and flexibility in preterm children with BPD. 相似文献13.
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14.
Eduardo Enríquez-Rodríguez Ignacio J. Amat-Santos Pilar Jiménez-Quevedo Irene Martín-Morquecho Gabriela Tirado-Conte María José Pérez-Vizcayno José Juan Gómez de Diego Roman Arnold Andrés Aldazábal Paol Rojas Alberto de Agustín María Del Trigo Hipólito Gutiérrez José A. San Román Carlos Macaya Luis Nombela-Franco 《Revista espa?ola de cardiología》2018,71(9):735-742
Introduction and objectives
The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis.Methods
Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed.Results
The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10 mmHg; P < .001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6 mmHg; P < .001), and Doppler velocity index (EVR 0.65 ± 0.15 vs S3 0.51 ± 0.16; P < .001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P < .05, respectively), with a larger number of paravalvular jets (P < .001).Conclusions
In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system.Full English text available from: www.revespcardiol.org/en 相似文献15.
Paulo Rogério Melo Rodrigues Rosangela Alves Pereira Augusta Gama Isabel Mourão Carvalhal Helena Nogueira Vitor Rosado-Marques Cristina Padez 《Revista portuguesa de cardiologia》2018,37(4):285-292
Objective
The aim of the study was to estimate the prevalence of high blood pressure (HBP) and its association with anthropometric indicators of adiposity in Portuguese schoolchildren.Methods
In this cross-sectional study, a nationally representative sample of 6-9-year-old children was analyzed. Weight and height (used to calculate body mass index [BMI]), blood pressure (BP), waist circumference (WC) and skinfold thickness (used to estimate body fat percentage [BFP]) were measured using standard techniques. BP was classified as high-normal BP or hypertension for values between the 90th and 95th percentiles or above the 95th percentile, respectively. A body adiposity index was calculated with principal component analysis using BMI, WC and BFP. Multinomial logistic regression models were used to estimate the strength of the association between anthropometric indicators and HBP.Results
The prevalence of high-normal BP and hypertension was 4.5% and 3.7%, respectively. BP was positively correlated with all anthropometric indicators (p < 0.01 for all). HBP was significantly more prevalent in females than in males and was positively associated with higher values of the assessed anthropometric indicators of adiposity, especially among females.Conclusion
Increased body fat predicted HBP. The use of anthropometric indicators may thus be useful in screening for HBP among Portuguese schoolchildren. 相似文献16.
Ji-won Hwang Eun Kyoung Kim Shin Yi Jang Tae-Young Chung Chang-Seok Ki Kiick Sung Sung Mok Kim Joonghyun Ahn Keumhee Carriere Yeon Hyeon Choe Sung-A. Chang Duk-Kyung Kim 《Revista espa?ola de cardiología》2018,71(9):743-749
Introduction and objectives
The aim of this study was to evaluate the effect of aliskiren on aortic stiffness in patients with Marfan syndrome (MS).Methods
Twenty-eight MS patients (mean age ± standard deviation: 32.6 ± 10.6 years) were recruited from November 2009 to October 2014. All patients were receiving atenolol as standard beta-blocker therapy. A prospective randomization process was performed to assign participants to either aliskiren treatment (150-300 mg orally per day) or no aliskiren treatment (negative control) in an open-label design. Central aortic distensibility and central pulsed wave velocity (PWV) by magnetic resonance imaging (MRI), peripheral PWV, central aortic blood pressure and augmentation index by peripheral tonometry, and aortic dilatation by echocardiography were examined initially and after 24 weeks. The primary endpoint was central aortic distensibility by MRI.Results
In analyses of differences between baseline and 24 weeks for the aliskiren treatment group vs the negative control group, central distensibility (overall; P = .26) and central PWV (0.2 ± 0.9 vs 0.03 ± 0.7 [m/s]; P = .79) by MRI were not significantly different. Central systolic aortic blood pressure tended to be lower by 14 mmHg in patients in the aliskiren treatment group than in the control group (P = .09). A significant decrease in peripheral PWV (brachial-ankle PWV) in the aliskiren treatment group (–1.6 m/s) compared with the control group (+0.28 m/s) was noted (P = .005).Conclusions
Among patients with MS, the addition of aliskiren to beta-blocker treatment did not significantly improve central aortic stiffness during a 24-week period.Full English text available from: www.revespcardiol.org/en 相似文献17.
Mário B.G. Nunes Antônio C. Filho Valéria R.C. Alvares Rafael Meneguz-Moreno Edgar Lamas Vitor Loures Daniel Chamié Alexandre Abizaid 《Revista portuguesa de cardiologia》2018,37(1):25-33
Introduction
Individuals with glomerular filtration rate (GFR) ≥ 60 ml/min/1.73 m2 estimated by the Cockcroft‐Gault formula (CG) who undergo percutaneous coronary intervention (PCI) frequently develop contrast‐induced nephropathy (CIN). This study aimed to assess whether individuals with significant renal impairment assessed by the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) formula, but not by CG, more often develop CIN following PCI than those without renal impairment by either formula.Methods
In this cross‐sectional study analyzing patients with baseline CG GFR ≥ 60 ml/min/1.73 m2 before PCI, subjects were divided into two groups according to CIN occurrence. Baseline CKD‐EPI GFR was calculated for all patients.Results
We analyzed 140 patients. Baseline GFR was 87.5 ± 21.3 and 77.1 ± 15.0 ml/min/1.73 m2 for CG and CKD‐EPI, respectively. CIN occurred in 84.6% of individuals with baseline CKD‐EPI GFR < 60 ml/min/1.73 m2 vs. 51.1% of those without. Males and those with higher body mass index were more likely to present baseline CKD‐EPI GFR < 60 ml/min/1.73 m2 (p = 0.021). Non‐ionic contrast agent use and baseline CKD‐EPI GFR ≥ 60 ml/min/1.73 m2 were protective factors against CIN. Greater amounts of contrast agent and acute coronary syndrome were associated with higher CIN risk. In subjects with serum creatinine < 1.0 mg/dl, GFR was more likely to be overestimated by CG, but not by CKD‐EPI (sensitivity 100.0%; specificity 52.0%).Conclusion
In patients undergoing PCI without renal dysfunction by CG, a finding of CKD‐EPI GFR < 60 ml/ min/1.73 m2 was associated with a higher probability of CIN, especially among men and those with higher body mass index. 相似文献18.
Soledad Ojeda Lorenzo Azzalini Jorge Chavarría Antonio Serra Francisco Hidalgo Susanna Benincasa Livia L. Gheorghe Roberto Diletti Miguel Romero Barbara Bellini Alejandro Gutiérrez Javier Suárez de Lezo Francisco Mazuelos José Segura Mauro Carlino Antonio Colombo Manuel Pan 《Revista espa?ola de cardiología》2018,71(6):432-439
Introduction and objectives
There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry.Methods
Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2 mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n = 201) or complex strategy (n = 37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization.Results
Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P = .48 and 85.6% vs 81.1%; P = .49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P = .58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P = .08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results.Conclusions
Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies.Full English text available from: www.revespcardiol.org/en 相似文献19.
Luis Pérez de Llano Borja G. Cosío Marc Miravitlles Vicente Plaza 《Archivos de bronconeumología》2018,54(4):198-204
Objectives
We aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD).Methods
ACO was diagnosed in a cohort of COAD patients in those patients with COPD who were either diagnosed with current asthma or showed significant blood eosinophilia (≥300 cells/μl) and/or a very positive bronchodilator response (>400 ml and >15% in FEV1).Results
Eighty-seven (29.8%) out of 292 patients fulfilled the ACO diagnostic criteria (12.8% asthmatics who smoked <20 pack-years, 100% of asthmatics who smoked ≥20 pack-years, 47.7% of COPD with >200 eosinophils/μl in blood and none with non-eosinophilic COPD). ACO, asthma and COPD patients showed no differences in symptoms or exacerbation rate. Mean pre-bronchodilator FEV1 in ACO and asthma were similar (1741 vs 1771 ml), higher than in COPD (1431 ml, p < 0.05). DLCO was lower in ACO than in asthma (68.1 vs 84.1%) and similar to COPD (64.5%). Mean blood eosinophil count was similar in ACO and asthma (360 vs 305 cells/μl) and higher than in COPD (170 cells/μl). Periostin levels were similar in ACO to COPD (36.6 and 36.5 IU/ml) and lower than in asthma (41.5 IU/ml, p < 0.05), whereas FeNO levels in ACO were intermediate.Conclusion
This algorithm classifies as ACO all smoking asthmatics with non-fully reversible airway obstruction and a considerable proportion of e-COPD patients, highlighting those who can benefit from inhaled corticosteroids. 相似文献20.
Nicola Ryan Luis Nombela-Franco Pilar Jiménez-Quevedo Corina Biagioni Pablo Salinas Andrés Aldazábal Enrico Cerrato Nieves Gonzalo María del Trigo Iván Núñez-Gil Antonio Fernández-Ortiz Carlos Macaya Javier Escaned 《Revista espa?ola de cardiología》2018,71(8):628-637