ABSTRACT
Background: Cardiotoxicity related to cancer treatment is an alarming source of significant morbidity and mortality, and may differ from subclinical myocardial dysfunction to irreversible heart failure or even death. DSE is a safe, feasible, and accurate modality for finding of myocardial ischemia and prognostication in patients with known or suspected coronary artery disease, particularly when they have limited exercise capacity.Materials& Methods:This study is a cross-sectional observational study which was conducted at the department of Cardiology, in BSMMU, Dhaka from June 2019- December 2019. The sample size for this study was 50.Results:The mean age was 56� where 17(34%) of the respondents were <65 years and 33(66%) were >65 years. The male respondent was 35(70%) where female was 15(30%). Diabetes was found in 3(6%) cases and followed by Acute ischemia, Hypertension 6(12%), Coronary Artery Disease (CAD) 4(8%), ACE-inhibitors 5(10%), Beta-blockers 3(6%), Nitrates 3(6%). Acute leukemia was found in 13(26%). in M12-18 was 45�and followed by mean of LVESD (mm) was 27� 29� 29� 30� 30� 31� Mean of IVSd (mm) was 9� 9� 9� 9� 8� 8� Mean of Peak E (cm/s) was 80�, 76�, 74�, 73�, 66� 63� and the p-value was seen <0.001 which denotes a significant improvement in treatment (p<0.005).Conclusions:The early discovery of cardiotoxicity may ensure the improved chemotherapeutic process and timely management of the treatment of cardiomyopathy, such as beta-blockers and ACE inhibitors.
ABSTRACT
Resumo Fundamento Em 2007, a Food and Drug Administration (FDA) determinou revisões sobre segurança dos agentes de contraste ecocardiográfico (ACE) disponíveis no mercado após relatos de mortes. Ao longo desses anos, diversos estudos comprovaram a segurança dos ACE, porém com poucos estudos relacionados ao SonoVue®. Objetivos Avaliar a segurança do SonoVue® durante o ecocardiograma sob estresse farmacológico (EEF) por meio da análise da incidência de reações alérgicas e da comparação entre os grupos quanto ao surgimento de arritmia, efeitos colaterais menores e eventos adversos. Métodos Estudo observacional, prospectivo, no qual 2.346 pacientes foram submetidos ao EEF e divididos em dois grupos: grupo 1 com ACE (n=1.099) e grupo 2 sem ACE (n=1.247). Os pacientes foram avaliados durante o EEF - 24 horas e 30 dias. Foi definido p significativo quando <0,05. Resultados O grupo 1 apresentou efeitos colaterais mais leves, como cefaleia (5/0,5% vs. 19/1,5%, p=0,012) e hipertensão reativa (3/0,3% vs . 19/1,5%, p=0,002), menos arritmias como extrassístoles ventriculares (180/16,4% vs . 247/19,8%, p=0,032) e taquicardia paroxística supraventricular (2/0,2% vs . 15/1,2%, p=0,003), assim como nenhum evento adverso como infarto agudo do miocárdio (IAM) e óbito. No grupo 2, um paciente apresentou IAM <24h (1/01%) e dois óbitos <30 dias (2/0,1%). Urticária relacionada ao SonoVue® foi observada em 3 (0,3%) pacientes sem reação anafilática. Conclusão SonoVue® demonstrou segurança durante o EEF, não sendo observados morte, IAM ou reação anafilática. Observou-se menor incidência de efeitos colaterais mais leves e arritmias no grupo que utilizou o ACE, assim como baixa incidência de reações alérgicas leves.
Abstract Background In 2007, the United States Food and Drug Administration mandated safety reviews of commercially available echocardiographic contrast agents (ECA), following reports of death. During the past years, different studies have proven the safety of ECA, but there have been few studies on SonoVue®. Objectives To evaluate the safety of SonoVue® during pharmacological stress echocardiography (PSE), by analyzing the incidence of allergic reactions and comparing groups regarding the appearance of arrhythmia, minor side effects and adverse events. Methods In this observational, prospective study, 2346 patients underwent PSE, and they were divided into the following 2 groups: group 1 with ECA (n = 1099) and group 2 without ECA (n = 1247). Patients were evaluated during PSE, at 24 hours, and at 30 days. Statistical significance was defined as p < 0.05. Results Group 1 had fewer minor side effects, such as headache (5/0.5% versus 19/1.5%, p = 0.012) and less reactive hypertension (3/0.3% versus 19/1.5%, p = 0.002); fewer arrhythmias, such as ventricular extrasystoles (180/16.4% versus 247/19.8%, p = 0.032) and paroxysmal supraventricular tachycardia (2/0.2% versus 15/1.2%, p = 0.003); and no adverse events, such as acute myocardial infarction (AMI) or death. In group 2, 1 patient had AMI in < 24 hours (1/01%), and there were 2 deaths in < 30 days (2/0.1%). SonoVue®-related urticaria was seen in 3 (0.3%) patients, without anaphylactic reaction. Conclusion SonoVue® demonstrated safety during PSE. No cases of death, AMI, or anaphylactic reaction were observed. There was a lower incidence of minor side effects and arrhythmias in the group that received ECA, as well as a low incidence of mild allergic reactions.
Subject(s)
Humans , Contrast Media/adverse effects , Echocardiography, Stress , Phospholipids , Sulfur Hexafluoride , United States , Echocardiography , Prospective StudiesABSTRACT
Objetivo. El objetivo del presente trabajo se dirige a revisar las indicaciones, protocolos y aplicaciones del ecocardiograma de estrés. materiales y métodos. Con las palabras clave "ecocardiograma de estrés", "ecocardiograma de esfuerzo" y "prueba de estres farmacológico" se hizo una búsqueda de información en la bases de datos de Pubmed/ Medline, Cochrane, SciELO, y en referencias de artículos de revistas y textos, principalmente de los últimos cinco años en inglés y en español. El resultado de esta búsqueda arrojó 203 referencias, de las cuales se tomaron las 46 más relevantes, teniendo en cuentra principalmente metanálisis, artículos de revision, actualizaciones, estudios aleatorios doble ciego y guías clínicas. Resultados. Los datos obtenidos de la función ventricular regional o global en el pico máximo de ejercicio son factores predictores importantes de eventos cardíacos, además de las variables clínicas, en el seguimiento de los pacientes. Un puntaje de motilidad parietal de esfuerzo mayor de 1,4 o una fracción de eyección de esfuerzo menor de 50%, implican un pronóstico significativamente adverso. Por otra parte, los indicadores de viabilidad miocárdica, mediante el estímulo farmacológico del miocardio, predicen la recuperación de la función cardiaca luego de los procedimientos de revascularización. Conclusión. El ecocardiograma de estrés es una técnica complementaria, útil para el diagnóstico y pronóstico del paciente con enfermedad coronaria. El fundamento de su uso consiste en que, al desencadenar isquemia, se produce una alteración de la motilidad parietal distal a la lesión coronaria obstructiva. Además, puede emplearse para evaluar la gravedad de una valvulopatía y para establecer el diagnóstico de la hipertensión pulmonar oculta.
Objective: the objective of this Project is to review the indications, protocols and applications of the stress echocardiogram. methods and materials: research on the following words was done in the PUBMED/Medline, Cochrane, SciELO databases, as well as in references in journal articles and texts mainly from texts from the last five years in English and in Spanish: stress echocardiogram, effort echocardiogram and phar-macological stress test. The result of this search returned 203 references, 46 of which were taken as the most relevant, taking into consideration mainly, meth analysis, revision articles, state of the art, random studies, DOBLE CIEGO, and clinical guides. Results: The data obtained from the regional ventricular function in the maximum peak of exercise, are important predictors of cardiac events; this, in addition to all of the clinical variables during patient follow up. A score of parietal motility, higher than 1.4, or a ejection fraction lower than 50%, imply a significant adverse forecast. On the other hand, the myocardiál an viábility indicators, through the pharmacologic stimulus of the myocardium, predict the recovery of the cardiac function after revascularization procedures. Conclusion: The stress echocardiogram (ECO) is a complementary technique, useful for the diagnose and forecast fo patients with coronary disease. The principles of its use consist on the basics that upon the creation of ischemia, an alteration in the distal parietal motility will be produced to the obstructive coronary injury. Furthermore, it can be used to evaluate the severity of a vulvopathy and to establish the diagnose of the hidden pulmonary hypertension.