Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 4.853
Filter
1.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1583323

ABSTRACT

Introducción: La warfarina es uno de los medicamentos más prescritos en el tratamiento y prevención de enfermedades tromboembólicas. El beneficio en la prevención de eventos trombóticos y en la reducción de la mortalidad está ampliamente documentado. Sin embargo, los aspectos relacionados con la seguridad han limitado su uso. El acompañamiento de pacientes, con especial atención en la información y educación sobre sus patologías, hábitos saludables, cumplimiento de tratamientos y comprensión de riesgos, es fundamental para conseguir buenos resultados, disminuyendo la morbi-mortalidad y las internaciones. La información respecto al perfil de seguridad y la calidad de la anticoagulación bajo un programa de intervención educativa es escasa en Uruguay. El objetivo de este estudio es analizar el efecto de un plan de intervención educativa potenciada con atención farmacéutica (IEPAF), sobre la calidad de anticoagulación con warfarina de pacientes ambulatorios de la unidad multidisciplinaria de insuficiencia cardíaca (UMIC), comparar la efectividad y seguridad del tratamiento, y evaluar la utilidad del score SAMeTT2R2. Metodología: Ensayo clínico randomizado. Se reclutaron pacientes en seguimiento en la UMIC tratados con warfarina y se randomizaron a control médico habitual vs control médico con ajustes de dosis según un protocolo establecido, más IEPAF. Resultados: Luego de 24 meses de seguimiento, ambos grupos mantuvieron buen nivel de anticoagulación, con tiempo en rango terapéutico (TTR) de 83,15% y 83,80% para grupo control e intervención respectivamente. La intervención educativa potenciada y el protocolo de ajuste de dosis de warfarina, aportó un resultado equiparable al seguimiento convencional de la anticoagulación. Conclusiones: La IEPAF promovió un resultado equiparable en seguridad, efectividad y adherencia con respecto al seguimiento convencional. Ambos grupos lograron un excelente nivel de anticoagulación evaluado por TTR. Del análisis post hoc surge una asociación estadísticamente significativa de los valores de SAMeTT2R2 4 y 6, con la aparición de eventos, con un riesgo relativo 5 veces mayor para el sexo femenino.


Introduction: Warfarin is one of the most prescribed drugs for the treatment and prevention of thromboembolic diseases. The benefit of the prevention of thrombotic events and the reduction of mortality is widely documented. However, security issues have limited its use. Monitoring patients, with special attention to information and education about their pathologies, healthy habits, compliance with treatment, and understanding of risks, is essential to achieve good results, reducing morbidity, mortality and hospitalizations. Information regarding anticoagulation's safety profile and quality under an educational intervention program is scarce in Uruguay. The objective of this study is to analyze the effect of an enhanced educational intervention plan with pharmaceutical care (IEPAF), on the quality of anticoagulation with warfarin in outpatients in the multidisciplinary heart failure unit (UMIC), and to compare the effectiveness and safety of treatment, and to evaluate the usefulness of the SAMeTT2R2 score. Methodology: Randomized clinical trial. Patients under follow-up in UMIC treated with warfarin were recruited and randomized to usual medical control vs medical control with dose adjustments according to an established protocol, plus enhanced educational intervention IEPAF. Results: After 24 months of follow-up, both groups maintained a good level of anticoagulation, with time in therapeutic range (TTR) of 83,15% and 83,80% for the control and intervention groups, respectively. The enhanced educational intervention and the warfarin dose adjustment protocol provided results comparable to conventional anticoagulation monitoring. Conclusions: The IEPAF with pharmaceutical care promoted a comparable result in safety, effectiveness, and adherence concerning conventional follow-up. Both groups achieved an excellent level of anticoagulation as assessed by TTR. From the post hoc analysis, a statistically significant association of SAMeTT2R2 values 4 and 6 emerges with events, with a relative risk 5 times greater for the female sex.


Introdução: A warfarina é um dos medicamentos mais prescritos para o tratamento e prevenção de doenças tromboembólicas. O benefício na prevenção de eventos trombóticos e na redução da mortalidade está amplamente documentado. No entanto, problemas de segurança limitaram seu uso. O acompanhamento dos pacientes, com atenção especial à informação e educação sobre suas patologias, hábitos saudáveis, adesão ao tratamento e compreensão dos riscos, é fundamental para o alcance de bons resultados, reduzindo a morbimortalidade e internações. Informações sobre o perfil de segurança e a qualidade da anticoagulação em um programa de intervenção educacional são escassas no Uruguai. O objetivo deste estudo é analisar o efeito de um plano de intervenção educacional aprimorado com assistência farmacêutica (IEPAF) , na qualidade da anticoagulação com warfarina em pacientes ambulatoriais na unidade multidisciplinar de insuficiência cardíaca (UMIC), e comparar a eficácia e segurança de tratamento e avaliar a utilidade do escore SAMeTT2R2. Metodologia: Ensaio clínico randomizado. Pacientes em acompanhamento em UMIC em tratamento com warfarina foram recrutados e randomizados para controle médico usual versus controle médico com ajustes de dose de acordo com protocolo estabelecido, além IEPAF. Resultados: Após 24 meses de seguimento, ambos os grupos mantiveram um bom nível de anticoagulação, com tempo na faixa terapêutica (TTR) de 83,15% e 83,80% para os grupos controle e intervenção, respectivamente. A intervenção educacional aprimorada e o protocolo de ajuste de dose de warfarina forneceram resultados comparáveis ​​ao monitoramento de anticoagulação convencional. Conclusões: O IEPAF com assistência farmacêutica promoveu resultado comparável em segurança, eficácia e adesão em relação ao acompanhamento convencional. Ambos os grupos alcançaram um excelente nível de anticoagulação avaliado pela TTR. Da análise post hoc emerge uma associação estatisticamente significativa dos valores 4 e 6 do SAMeTT2R2 com a ocorrência de eventos, com risco relativo 5 vezes maior para o sexo feminino.

2.
Article | IMSEAR | ID: sea-241300

ABSTRACT

Introduction: The cardiac manifestations of hypereosinophilia include mainly endomyocardial fibrosis, which is the most frequently observed form. However, eosinophilic cardiopathy can manifest itself in different ways, affecting the various layers of the heart and presenting a variety of clinical and echocardiographic presentations. Aim: The aim of our study is to describe the various aspects of cardiac involvement observed in hypereosinophilia, based on our case series and data from the literature. Methods: This is a retrospective, descriptive study of five observations illustrating the diversity of eosinophilic cardiopathy, from the cardiology department of the Mohammed VI University Hospital in Marrakech, over a period of 12 months. Results: Over the period of the study, five patients presented with cardiac damage in the context of hypereosinophilia. The mean age was 53.8 years, with a predominance of women (sex ratio 0.66). In the majority of cases, the discovery of cardiac involvement was incidental to a cardiovascular check-up requested during the course of their medical condition. All cases had high levels of hypereosinophilia, with an average of 5681. These observations illustrate the wide variety of aetiologies of hypereosinophilia, all of which were represented: 3 cases of Churg-Strauss syndrome, 1 case of idiopathic hypereosinophilia syndrome, and 1 case of DRESS syndrome. The cardiac disorders observed were hypokinetic cardiomyopathy at the dilated stage in 60% of cases, acute eosinophilic myocarditis in 20%, and acute pericarditis in the remaining cases. The outcome was marked by an improvement in the FE in 60% of cases, stabilisation in 20%, and a fatal outcome in the remainder. Treatment is based on symptomatic therapy of the CHF and treatment of the underlying aetiology. Discussion and Conclusion: Eosinophils are cytotoxic through the release of granular proteins that initially attack the endocardium, leading to thrombosis and embolic events. Subsequently, this aggression contributes to fibrosis and valvular complications. Cardiac damage can also manifest itself as potentially serious acute myocarditis or pericarditis, which can progress to cardiac tamponade. These cardiac disorders and the diversity of possible aetiologies serve as a reminder that vital prognosis may be at stake in the acute phase, and to emphasise that functional prognosis depends on early echocardiographic screening and rapid initiation of treatment to limit the risk of thrombo-embolic and fibrosing complications.

4.
Arq. bras. cardiol ; Arq. bras. cardiol;121(11): e20240155, 20240000. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1581708

ABSTRACT

Resumo Fundamento A glicogênio sintase quinase 3β (GSK3β) é uma enzima que tem papéis na patogênese da insuficiência cardíaca (IC). Tentamos revelar os níveis séricos de GSK3β em tipos de IC. Objetivos Neste estudo, avaliamos os níveis séricos de GSK3β em pacientes com IC. Além disso, tentamos elucidar qualquer possível relação entre os níveis séricos de GSK3β e a gravidade da doença entre três tipos diferentes de pacientes com IC. Métodos Realizamos um estudo prospectivo e inscrevemos 112 pacientes: 50 pacientes no grupo IC com fração de ejeção preservada (ICFEp), 30 pacientes no grupo IC com FE levemente reduzida (ICFEmr) e 32 pacientes no grupo IC com FE reduzida (ICFEr). Também avaliamos 50 controles saudáveis. Exames ecocardiográficos foram realizados. Medimos a GSK-3β sérica e o peptídeo natriurético tipo B N-terminal (NT-proBNP). Medimos os níveis de proteína C-reativa altamente sensível (PCR-as) e calculamos a razão neutrófilo-linfócito (NLR) e a razão plaquetas-linfócitos (PLR) a partir da contagem do hemograma. A significância estatística aceita foi p < 0,05. Resultados Os níveis séricos de GSK3β foram significativamente maiores entre pacientes com IC em comparação com controles saudáveis (níveis medianos de GSK3β; 117,26 (45,39 -223,85) vs 13,91 (5,6 -23,3) ng/mL, p < 0,001). Além disso, os níveis de GSK3β foram maiores entre pacientes com ICFEp e menores entre pacientes com ICFEr; 236,44 (132,89 -432) vs. 38,72 (23,15-67,31) ng/mL, respectivamente (p < 0,001). Os níveis medianos de NT-proBNP, como esperado, foram significativamente maiores entre pacientes com IC em comparação com controles saudáveis (660 (291 -1000) vs. 92 (78 -102) pg/mL, p<0,001). Como um marcador de inflamação sistêmica, os valores de hsCRP, NLR e PLR não diferiram significativamente entre pacientes com IC e controles. Conclusão: Os níveis de GSK3β foram significativamente maiores entre pacientes com IC. Além disso, à medida que a fração de ejeção diminui, os níveis de GSK3β também se reduzem, provavelmente como um mecanismo de proteção para evitar mais apoptose e morte de miócitos.


Abstract Background Glycogen synthase kinase 3β (GSK3β) is an enzyme that has roles in the pathogenesis of heart failure (HF). We try to reveal serum GSK3β levels in types of HF. Objectives In this study, we evaluated serum GSK3β levels in HF patients. Also, we tried to elucidate any possible relationship between serum GSK3β levels and disease severity among three different types of HF patients. Methods We performed a prospective study and enrolled 112 patients: 50 patients in heart failure with preserved ejection fraction (HFpEF) group, 30 patients in heart failure with mildly reduced ejection fraction (HFmrEF) group, and 32 patients in heart failure with reduced ejection fraction group (HFrEF). We also evaluated 50 healthy controls. Echocardiographic examinations were performed. We measured serum GSK-3β and N-terminal pro-B-type natriuretic peptide (NT-proBNP). We measured highly sensitive C-reactive protein (hs-CRP) levels and calculated neutrophil-lymphocyte ratio (NLR) platelets-to-lymphocyte ratio (PLR) from the hemogram count. Statistical significance was accepted p < 0.05. Results Serum GSK3β levels were significantly higher among patients with HF compared to healthy controls (median GSK3β levels; 117.26 (45.39 -223.85) vs 13.91 (5.6 -23.3) ng/mL, p<0.001). Also, GSK3β levels were highest among patients with HFpEF and lowest among patients with HFrEF; 236.44 (132.89 -432) vs. 38.72 (23.15-67.31) ng/mL respectively (p<0.001). Median NT-proBNP levels, as expected, were significantly higher among patients with HF compared to healthy controls (660 (291 -1000) vs. 92 (78 -102) pg/mL, p<0.001). As a marker of systemic inflammation, hsCRP values, NLR, and PLR did not differ significantly among HF patients and controls. Conclusion GSK3β levels were significantly higher among patients with HF. Also, as the ejection fraction declines, GSK3β levels also reduce, probably as a protective mechanism to prevent further apoptosis and myocyte death.

5.
Ann Card Anaesth ; 2024 Oct; 27(4): 357-360
Article | IMSEAR | ID: sea-240939

ABSTRACT

Heart failure poses significant challenges in perioperative settings, with an increasing prevalence in India. While much attention has been given to the management of symptomatic heart failure, there is a dearth of literature on asymptomatic left ventricular systolic dysfunction (ALVSD). In this case report, we present the successful perioperative management of a 35?year?old male with ALVSD and a low ejection fraction undergoing lower limb surgery under combined spinal epidural anesthesia. Our approach aimed to maintain hemodynamic stability, minimize myocardial overload, and mitigate the adverse effects of neuraxial blockade.

6.
Ann Card Anaesth ; 2024 Oct; 27(4): 352-356
Article | IMSEAR | ID: sea-240938

ABSTRACT

Bronchoscopy is a widely used technique for diagnostic and therapeutic purposes. Though it requires anesthesia, many options are available, depending on the patient’s health status, the purpose of the procedure, and the type of bronchoscope used. One such health status is heart failure, a leading cause of death, and a common challenge of anesthesiology. We report a 60?year?old male patient who is a known case of heart failure with an ejection fraction of 15%, and an implanted cardioverter defibrillator, along with concurrent ischemic heart disease, diabetes mellitus, and hypertension, who presented complaining of dysphagia. This highly morbid patient was able to successfully undergo a bronchoscopic biopsy with nerve block anesthesia considering his inadequacy for conventional methods. This report aims to shed light on these challenging cases and alert anesthesiologists on how to manage such situations in patients with cardiac morbidities.

7.
Rev. ANACEM (Impresa) ; 18(1)20240000.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1586406

ABSTRACT

La insuficiencia cardíaca (IC) es un síndrome clínico caracterizado por signos y síntomas secundarios a una función cardíaca deteriorada. La Insuficiencia cardiaca congestiva (ICC) es un mecanismo de compensación mediante remodelación excéntrica que provoca una descompensación hemodinámica desadaptativa. Materiales métodos: Estudio de tipo observacional, descriptivo y transversal. Un análisis descriptivo sobre la tasa de egreso hospitalario (TEH) por ICC entre los años 2019-2022 en Chile, según las variables sexo, grupo etario y estadía hospitalaria. Los datos fueron recolectados del Departamento de Estadísticas e Información de Salud y Censo 2017 y se procesaron en el programa Microsoft Excel 2019. No se requirió evaluación por un comité de ética. Resultados: Se estudiaron un total de 28,833 egresos hospitalarios, determinando una tasa del periodo de 41,02 casos por cada 100.000 habitantes. Con respecto a la variable sexo, se observó una mayor prevalencia en hombres y en mayores de 80 años. El promedio de estadía hospitalaria fue de 8,79 días, destacándose que el año 2022 la estadía hospitalaria disminuye abruptamente en los hombres con 5 días. Discusión: El estudio revela diferencias en la incidencia de egresos y días hospitalizados, con un aumento de egresos en hombres de edad avanzada, atribuible a la enfermedad que incrementa ingresos conforme aumenta la edad. La discrepancia de género puede explicarse por mayor cardiopatía isquémica en hombres y más comorbilidades en mujeres. En 2022, más personas estuvieron hospitalizadas menos días, posiblemente debido a la pandemia, en contraste con 2019.


Heart failure (HF) is a clinical syndrome characterized by signs and symptoms secondary to deteriorated cardiac function. Congestive heart failure (CHF) is a compensatory mechanism through eccentric remodeling that leads to maladaptive hemodynamic decompensation. Materials and Methods: Observational, descriptive, and cross-sectional study. A descriptive analysis of the hospital discharge rate (HDR) for CHF between the years 2019-2022 in Chile, according to the variables sex, age group, and length of hospital stay. Data were collected from the Department of Health Statistics and Information and the 2017 Census and processed using Microsoft Excel 2019. Evaluation by an ethics committee was not required. Results: A total of 28,833 hospital discharges were studied, determining a period rate of 41.02 cases per 100,000 inhabitants. Regarding the sex variable, a higher prevalence was observed in men and in those over 80 years of age. The average length of hospital stay was 8.79 days, with a notable decrease in hospital stay in men to 5 days in the year 2022. Discussion: The study reveals differences in discharge incidence and hospitalization days, with an increase in discharges in older men, attributable to the disease that increases admissions as age increases. Gender discrepancy may be explained by a higher incidence of ischemic heart disease in men and more comorbidities in women. In 2022, more people were hospitalized for fewer days, possibly due to the pandemic, contrasting with 2019.

8.
Medicina (B.Aires) ; Medicina (B.Aires);84(5): 823-830, Oct. 2024. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1582681

ABSTRACT

Resumen Introducción: La amiloidosis cardíaca por trans tiretina (TTR) se suele presentar como insuficiencia cardiaca (IC) con fracción de eyección preservada. Diagnosticarla tiene impacto clínico, ya que actual mente se dispone de tratamiento específico. El ob jetivo de este estudio fue evaluar la prevalencia en nuestro medio de TTR en pacientes hospitalizados por IC con función sistólica preservada e hipertrofia septal. Métodos: Estudio de corte transversal. Se incluyeron de forma prospectiva pacientes mayores a 18 años inter nados por IC con función sistólica conservada (fracción de eyección mayor a 50%) y espesor septal mayor o igual a 12 mm durante el periodo del 8/2019 a 1/2023. El com promiso cardiaco se evaluó mediante un centellograma óseo con pirofosfato (PYP) Se calculó la prevalencia de amiloidosis por TTR y su IC95%. Resultados: Se efectuó un centellograma en 59/82 pacientes. La edad fue de 85 [RIC 78-88] años, el 54% mujeres. Al ingreso, el 61% presentó ritmo de fibrilación/ aleteo auricular y una mediana de NT-Pro-Bnp de 3536 pg/ml [RIC 1700-7748 pg/nl]. La media de fracción de eyección fue de 57 (+/- 5) %. La prevalencia de amiloi dosis cardiaca por TTR diagnosticada por centellograma óseo con PYP fue del 19% (IC95% 9,7-30,1). No se detec taron diferencias con los 23 pacientes que no efectuaron centellograma. Conclusiones: En pacientes internados por IC con fracción de eyección preservada y engrosamiento sep tal el diagnóstico de amiloidosis cardiaca por TTR fue relativamente frecuente (1/5), por lo que consideramos que debería explorarse en forma rutinaria.


Abstract Introduction: Transthyretin cardiac amyloidosis (AT TR-CM) usually presents as heart failure with preserved ejection fraction. Its diagnosis has a significant clinical impact, as specific treatment is currently available. The aim of this study is to assess the prevalence of ATTR-CM in patients hospitalized for heart failure with preserved ejection fraction and septal thickness in our region. Methods: Cross-sectional study. Patients over 18 years old hospitalized for heart failure with preserved ejection fraction (greater than 50%) and septal thickness greater than or equal to 12 mm during the period from 8/2019 to 1/2023 were prospectively included. A pyrophosphate bone scintigraphy (PYP) was planned to assess cardiac involvement. The prevalence of ATTR-CM and its 95% confidence interval were calculated. Results: A PYP was performed in 59/82 patients. The median age was 85 [IQR 78-88] years old, 54% women. On admission, 61% had atrial fibrillation/flutter rhythm and the median NT-Pro-Bnp was 3536 [IQR 1700-7748] pg/nl. The mean ejection fraction was 57% (+/- 5). The prevalence of ATTR-CM diagnosed by bone scintigra phy with PYP was 19% (95%CI 9.7-30.1). No differences were found compared with those patients who did not perform a PYP. Conclusion: In patients admitted for heart failure with preserved ejection fraction and septal thickness, the diagnosis of ATTR-CM was relatively common (1/5). We believe that it should be routinely explored.

9.
Medicina (B.Aires) ; Medicina (B.Aires);84(5): 1011-1015, Oct. 2024. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1582705

ABSTRACT

Resumen Las fístulas arteriovenosas para hemodiálisis ge neran un cortocircuito de izquierda a derecha con un incremento promedio en el gasto cardíaco del 25%, asociado a remodelado de las cavidades cardíacas. Un porcentaje de estos pacientes desarrollan insuficiencia cardíaca con alto gasto cardíaco. Presentamos dos casos de insuficiencia cardíaca asociada a fístula arteriovenosa para hemodiálisis, con diferente evolución clínica luego de la oclusión o cerclaje de la misma. Basados en la literatura médica, se discuten las potenciales causas que pudieron justificar las diferencias en la evolución clínica entre ambos casos.


Abstract Arteriovenous fistulas for hemodialysis create a left-to-right shunt, resulting in an average 25% increase in cardiac output and subsequent remodeling of cardiac chambers. Some of these patients may develop high-output heart failure. In this report, we present two cases of heart failure associated with an arteriovenous fistula for hemodialysis, each showing distinct clinical outcomes following either its occlusion or cerclage. Drawing from existing medical literature, we explore potential causes that might account for the divergent clinical courses observed in these cases.

10.
Rev. colomb. cardiol ; 31(5): 275-281, sep.-oct. 2024. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1583543

ABSTRACT

Resumen Introducción: La insuficiencia cardíaca, enfermedad con alta prevalencia y mortalidad, presenta baja incorporación de cuidados paliativos (CP) a pesar de su necesidad. En Colombia, la falta de indicadores para monitorear la integración de CP en el tratamiento de la insuficiencia cardíaca dificulta la implementación de estrategias efectivas. Se propone utilizar un modelo de clasificación para monitorear la integración de CP en el sistema de salud colombiano. Objetivo: Consensuar un conjunto de indicadores evaluados por su relevancia y factibilidad para monitorear la integración de cuidados paliativos en insuficiencia cardíaca en el sistema de salud colombiano. Método: Se realizó un proceso de consenso Delphi en dos rondas, incluyendo expertos de las distintas regiones del país. Se utilizó una encuesta en línea sobre nueve indicadores relacionados con la integración de cuidados paliativos en insuficiencia cardíaca en el sistema de salud colombiano. Se valoró en cada indicador su relevancia y factibilidad. Resultados: Participaron 17 expertos de todas las regiones de Colombia, el 76% eran médicos y el 24% profesionales de enfermería; en su gran mayoría (65%) pertenecían a sociedades científicas como la Asociación Colombiana de Cuidados Paliativos. Todos los indicadores alcanzaron un puntaje > 7.0 con respecto a su relevancia y factibilidad. El indicador Voluntad anticipada en personas con insuficiencia cardíaca fue considerado el más relevante y factible, seguido de Cuidados paliativos domiciliarios para personas con insuficiencia cardíaca. Conclusiones: Se consensuaron ocho de los nueve indicadores propuestos para evaluar la integración de los cuidados paliativos en el tratamiento de insuficiencia cardíaca en Colombia.


Abstract Introduction: Heart failure, a disease with high prevalence and mortality, presents low incorporation of palliative care (PC) despite its necessity. In Colombia, the lack of indicators to monitor the integration of PC in the treatment of heart failure hinders the implementation of effective strategies. It is proposed to use a classification model to monitor the integration of palliative care in the Colombian health system. Objective: To reach a consensus on a set of indicators evaluated for their relevance and feasibility to monitor the integration of palliative care in heart failure in the Colombian health system. Method: A Delphi consensus process was carried out in two rounds, including experts from different regions of the country. An online survey was used on nine indicators related to the integration of palliative care in heart failure in the Colombian health system. Each indicator was evaluated for its relevance and feasibility. Results: Seventeen experts from all regions of Colombia participated, 76% were physicians and 24% nursing professionals; the vast majority (65%) belonged to scientific societies such as the Colombian Association of Palliative Care. All the indicators scored > 7.0 with respect to their relevance and feasibility. The Advance directives in people with heart failure indicator was considered the most relevant and feasible followed by home palliative care for people with heart failure. Conclusions: Based on feasibility and relevance there was consensus on eight of the nine indicators proposed to evaluate the integration of palliative care in the treatment of heart failure in Colombia.

11.
Article | IMSEAR | ID: sea-237150

ABSTRACT

Cardiac dysfunction or heart failure (HF) continues to be a leading cause of morbidity and mortality globally with more than 64 million affected people. Despite advancements in pharmacotherapy, patients with heart failure (HF) continue to face significant risks of mortality and hospitalization due to cardiovascular disease. Clinical trials in the last few years have demonstrated that SGLT2 inhibitors initially used for the treatment of Diabetes mellitus have been beneficial for the reduction of cardiovascular events in patients with HF regardless of their diabetes status. This systematic review and meta-analysis use data from RCTs and observational study to assess the effects of SGLT2 inhibitors on cardiovascular mortality and HF hospitalization. The study findings suggest a 16% decrease in cardiovascular mortality and a 24% decrease in HF related hospitalizations among the patients receiving SGLT2 inhibitors. The findings from the present study are suggestive of offering primacy to SGLT2 inhibitors in heart failure treatment as it has benefits more than the glycemic regulation. These outcomes have significant implications for the approach toward clinical treatments and establish a significant focus for further studies concerning the long-term outcomes of such therapies in different patient groups.

12.
Article | IMSEAR | ID: sea-237242

ABSTRACT

Cardiac failure (HF) is a multifaceted clinical center described by the incapacity of a heart to sufficiently pump blood leading to inefficient perfusion of tissues. It has two main categories that are represented by ejection fraction: Heart Failure with Reduced Ejection Fraction (HFrEF), or Heart Failure with Preserved Ejection Fraction (HFpEF). The following review is a summary of research on the diverse causes, symptoms as well as management approaches involved in heart failure. Heart disorder comes about as a result of the following factors: coronary artery disease, hypertension, cardiomyopathy, valvular heart diseases, arrhythmias, and congenital heart defects the main symptoms include shortness of breath, weariness/tiredness, and swelling of the feet among others. Management strategies cover lifestyle modifications, medicines using treatment (e.g. diuretics, ACE inhibitors, beta-blockers), and further treatments like cardiac resynchronization therapy (CRT) consisting of implantable cardioverter defibrillators (ICDs) along with mechanical circulatory support (MCS); however, there is also heart transplant aside them.’ Future progression in genetic treatment gene therapy, as well as stem cell study, sounds promising over improving results obtained from HF treatment.

13.
Article | IMSEAR | ID: sea-234168

ABSTRACT

Middle cerebral artery (MCA) stroke describes the sudden onset of a focal neurologic deficit resulting from hemorrhagic or ischemic disruption of the MCA's blood supply. Ischemic stroke is frequently divided into several etiological categories, including atherosclerotic, cardio embolic, lacunar, and cryptogenic. Chronic heart failure (CHF) is also common cause of ischemic stroke. A 66-year-old male patient came to the emergency room at Kasih Ibu Gianyar Hospital with complaints of suddenly not being able to talk since 8 hours before entering the hospital. There is weakness on the right side of the upper extremities, and weakness on the right and left lower extremities. The patient has a history of chronic heart failure since 3 years. A thorax X-ray showed atherosclerosis. Computed tomography (CT) scan showed acute thromboembolic ischemic infarction in the left temporoparietal lobe in the left MCA territory. The causal relation between CHF and ischemic stroke represent manifestations of similar underlying risk factors, such as hypertension and diabetes mellitus. The pathophysiological mechanism of chronic heart failure can be at risk of causing a stroke infarction in large blood vessels in the brain such as the MCA, and patient MCA Stroke with CHF has high risk of recurrent stroke.

16.
Arq. bras. cardiol ; Arq. bras. cardiol;121(8): e20230670, ago. 2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1568810

ABSTRACT

Resumo Fundamento A insuficiência cardíaca é uma das principais causas de hospitalização e mortalidade em todo o mundo e representa um grande fardo económico para os sistemas de saúde. A identificação de fatores prognósticos em pacientes com IC é de grande importância para estabelecer estratégias de manejo ideais e evitar procedimentos invasivos e dispendiosos desnecessários em pacientes em estágio terminal. Objetivos No presente estudo, nosso objetivo foi investigar a associação entre parâmetros de strain diastólico, incluindo E/e' SR, e resultados de curto prazo em pacientes com IC avançada. Métodos O estudo populacional incluiu 116 pacientes com insuficiência cardíaca avançada com fração de ejeção reduzida (ICFEr) avançada. Avaliações clínicas, laboratoriais e ecocardiográficas dos pacientes foram realizadas nas primeiras 24 horas de internação. Os pacientes foram acompanhados por um mês e qualquer reinternação por piora dos sintomas de IC e qualquer mortalidade foi registrada. O nível de significância adotado na análise estatística foi de 5%. Resultados A E/e' SR foi significativamente maior no grupo de pacientes em comparação ao grupo controle (p=0,001). Durante o acompanhamento de um mês, 13,8% dos pacientes morreram e 37,1% dos pacientes foram reinternados. NT-ProBNP sérico (p=0,034) e E/e' SR (p=0,033) foram considerados preditores independentes de mortalidade e o uso de IECA (p=0,027) e strain 3C apical (p=0,011) foram considerados independentes preditores de reinternação no grupo de pacientes. Conclusão Os resultados do presente estudo prospectivo demonstram que a E/e' SR medida pela ecocardiografia com speckle tracking é um preditor independente e sensível de mortalidade em curto prazo em pacientes com ICFEr avançada e pode ter um papel na identificação de pacientes com ICFEr em estágio terminal.


Abstract Background Heart failure (HF) is a leading cause of hospitalization and mortality worldwide and places a great economic burden on healthcare systems. Identification of prognostic factors in HF patients is of great importance to establish optimal management strategies and to avoid unnecessary invasive and costly procedures in end-stage patients. Objectives In the current study, we aimed to investigate the association between diastolic strain parameters including E/e' SR, and short-term outcomes in advanced HF patients. Methods The population study included 116 advanced HF with reduced ejection fraction (HFrEF) patients. Clinical, laboratory, and echocardiographic evaluations of the patients were performed within the first 24 hours of hospital admission. Patients were followed for one month and any re-hospitalization due to worsening of HF symptoms and any mortality was recorded. The level of significance adopted in the statistical analysis was 5%. Results E/e' SR was significantly higher in the patient group compared to the control group (p=0.001). During one-month follow-up, 13.8% of patients died and 37.1% of patients were rehospitalized. Serum NT-ProBNP (p=0.034) and E/e' SR (p=0.033) were found to be independent predictors of mortality and ACEİ use (p=0.027) and apical 3C strain (p=0.011) were found to be independent predictors of rehospitalization in the patient group. Conclusion Findings of the current prospective study demonstrate that E/e' SR measured by speckle tracking echocardiography is an independent and sensitive predictor of short-term mortality in advanced HFrEF patients and may have a role in the identification of end-stage HFrEF patients.

18.
Arq. bras. cardiol ; Arq. bras. cardiol;121(8): e20230771, ago. 2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1568816

ABSTRACT

Resumo Fundamento A frequência cardíaca (FC) na insuficiência cardíaca com fração de ejeção reduzida (ICFEr) e ritmo sinusal apresenta valor prognóstico. Entretanto, o método de mensuração é debatido na literatura. Objetivos Comparar em pacientes com ICFEr e ritmo sinusal a FC no Holter com três eletrocardiogramas de repouso: ECG1, ECG2 e ECG3. Metodologia Estudo transversal com 135 pacientes portadores de insuficiência cardíaca com fração de ejeção ≤ 40% e ritmo sinusal. A FC foi avaliada por ECG e Holter. Análises incluíram o coeficiente de correlação intraclasse (CCI), regressão robusta, raiz do erro quadrático médio, Bland-Altman e a área sobre a curva ROC. Adotou-se nível de significância de 0,05 e o ajuste de Bonferroni-Holm para minimizar erros tipo I. Resultados As medianas [intervalo interquartil] de idade e fração de ejeção foram de 65 anos [16] e 30% [11], respectivamente. O CCI dos 3 ECG foi de 0,922 (intervalo de confiança de 95%: 0,892; 0,942). Os coeficientes de regressão robusta para ECG1 e ECG3 foram 0,20 (intervalo de confiança de 95%: 0,12; 0,29) e 0,21 (intervalo de confiança de 95%: 0,06; 0,36). O R2 robusto foi de 0,711 (intervalo de confiança de 95%: 0,628; 0,76). Na análise de concordância de Bland-Altman, os limites de concordância foram de −17,0 (intervalo de confiança de 95%: −19,0; −15,0) e 32,0 (intervalo de confiança de 95%: 30,0; 34,0). A área sob a curva ROC foi de 0,896 (intervalo de confiança de 95%: 0,865; 0,923). Conclusão A FC do ECG mostrou alta concordância com a FC do Holter, validando seu uso clínico em pacientes com ICFEr e ritmo sinusal. Contudo, a concordância foi subótima em um terço dos pacientes com FC inferior a 70 bpm pelo ECG, devendo ser considerada a realização de Holter neste contexto.


Abstract Background Heart rate (HR) has shown prognostic value in patients with heart failure with reduced ejection fraction (HFrEF) and sinus rhythm. However, the method of measurement is debated in the literature. Objectives To compare HR on Holter with 3 resting electrocardiograms (ECG1, ECG2, and ECG3) in patients with HFrEF and sinus rhythm. Methods This was a cross-sectional study with 135 patients with heart failure with ejection fraction ≤ 40% and sinus rhythm. HR was assessed by ECG and Holter. Analyses included intraclass correlation coefficient (ICC), robust regression, root mean squared error, Bland-Altman, and area under the receiver operating characteristic (ROC) curve. A significance level of 0.05 and Bonferroni-Holm adjustment were adopted to minimize type I errors. Results The median [interquartile range] age and ejection fraction were 65 years [16] and 30% [11], respectively. The ICC of the 3 ECGs was 0.922 (95% confidence interval: 0.892; 0.942). The robust regression coefficients for ECG1 and ECG3 were 0.20 (95% confidence interval: 0.12; 0.29) and 0.21 (95% confidence interval: 0.06; 0.36). The robust R2 was 0.711 (95% confidence interval: 0.628; 0.76). In the Bland-Altman agreement analysis, the limits of agreement were −17.0 (95% confidence interval: −19.0; −15.0) and 32.0 (95% confidence interval: 30.0; 34.0). The area under the ROC curve was 0.896 (95% confidence interval: 0.865; 0.923). Conclusion The HR on ECG showed high agreement with the HR on Holter, validating its clinical use in patients with HFrEF and sinus rhythm. However, agreement was suboptimal in one third of patients with HR below 70 bpm on ECG; thus, 24-hour Holter monitoring should be considered in this context.

19.
Article | IMSEAR | ID: sea-238695

ABSTRACT

Acute decompensated heart failure (HF) is the most common form of acute HF (AHF) and presents with systemic congestion due to left ventricular dysfunction with sodium and water retention. Diuretics are the mainstay of treatment for AHF, with loop diuretics being the first?line therapy. However, in some studies, patients who were given high doses of loop diuretics were discharged from the hospital with residual signs of volume overload. Combining acetazolamide, a carbonic anhydrase inhibitor, with loop diuretics has been shown to be beneficial as it increases the efficacy of loop diuretics and reduces the signs and symptoms of congestion. Further, it can be used for the prevention or treatment of diuretic resistance (DR). Sequential nephron blockade with acetazolamide has emerged as a novel strategy for the treatment of AHF to enhance the efficacy of loop diuretics and prevent DR. This review highlights the combination of acetazolamide with loop diuretics as an alternative and possibly more effective decongestive strategy option in AHF patients. Nevertheless, there is limited evidence to support this combination therapy, and further research is necessary to substantiate its use in AHF patients.

20.
Rev. Fac. Med. Hum ; 24(3): 148-153, jul.-set. 2024. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1583224

ABSTRACT

RESUMEN La insuficiencia cardíaca con fracción de eyección recuperada se define como la mejoría de la función sistólica del ventrículo izquierdo (FEVI) hasta valores ≥ 40%, después de haber presentado una FEVI reducida (< 40%) en un momento previo y con un incremento absoluto de la FEVI ≥10%. Es una condición crónica y dinámica con alto riesgo de recaída y deterioro, por lo que, el seguimiento estrecho y la terapia médica óptima son fundamentales para su manejo. Se presenta el caso de un paciente varón joven con cardiopatía dilatada con grave disfunción sistólica del ventrículo izquierdo, que con terapia neurohormonal de falla cardiaca, presenta una rápida recuperación clínica y mejoría de la fracción de eyección y remodelado ventricular izquierdo. Se requieren más estudios para comprender mejor esta condición y su tratamiento a largo plazo.


ABSTRACT Heart failure with recovered ejection fraction is defined as the improvement of left ventricular systolic function (LVEF) to values ≥ 40%, after having presented a reduced LVEF (< 40%) at a previous time and ≥10% absolute improvement in LVEF. It is a chronic and dynamic condition with a high risk of relapse and deterioration, so close monitoring and optimal medical therapy are essential for its management. A case is presented of a young male patient with dilated cardiomyopathy with severe left ventricular systolic dysfunction, who with neurohormonal therapy for heart failure, showed rapid clinical recovery and improvement of ejection fraction and left ventricular remodeling. Further studies are needed to better understand this condition and its long-term treatment.

SELECTION OF CITATIONS
SEARCH DETAIL