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1.
Arq. bras. cardiol ; 115(6): 1144-1151, dez. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1152951

ABSTRACT

Resumo Fundamento O acidente vascular encefálico isquêmico (AVEi) e a doença arterial coronariana (DAC) coexistem frequentemente e compartilham fatores de risco para doença aterosclerótica. Segundo a American Heart Association , os subtipos de AVEi podem ser considerados equivalentes de risco para DAC, mas a evidência para o AVEi não-aterosclerótico não está bem definida. Além disso, o escore de cálcio coronário (CAC) é um marcador preciso para estimar o risco de DAC. Entretanto, a distribuição do CAC pelos subtipos de AVEi ainda não foi bem caracterizada. Objetivos Comparar o CAC entre os grupos de AVEi ateroscleróticos e não ateroscleróticos, e determinar quais covariáveis estão associadas a CAC alto no AVEi Métodos Em um estudo transversal, incluímos todos os pacientes com AVEi, com idades entre 45 a 70 anos no momento do acidente vascular, consecutivamente admitidos em um hospital de reabilitação entre agosto de 2014 e dezembro de 2016, sem DAC prevalente. Todos os pacientes passaram por tomografia computadorizada (TC), para medir o CAC. CAC≥100 foi considerado alto risco de DAC. O nível de significância foi p<0,05. Resultados Dos 244 pacientes estudados (média de idade de 58,4±6,8 anos; 49% do sexo feminino), 164 (67%) apresentavam etiologia não-aterosclerótica. As proporções de CAC≥100 foram semelhantes entre os grupos ateroscleróticos e não-ateroscleróticos (33% [n=26] x 29% [n=47]; p= 0,54). Entre todos os pacientes com AVEi, apenas os de idade ≥60 anos foram associados independentemente a CAC≥100 (RC 3,5; 95% IC 1,7-7,1), ajustado para hipertensão, dislipidemia, diabetes, sedentarismo, e histórico familiar de DAC. Conclusão O AVEi aterosclerótico não apresentou risco maior de DAC quando comparado ao AVEi não-aterosclerótico de acordo com o CAC. Apenas a faixa etária ≥60 anos - mas não a etiologia - foi associada independentemente a CAC≥100. (Arq Bras Cardiol. 2020; 115(6):1144-1151)


Abstract Background Ischemic Stroke (IS) and Coronary Artery Disease (CAD) frequently coexist and share atherosclerotic disease risk factors. According to the American Heart Association, IS subtypes may be considered CAD risk equivalents, but the evidence for non-atherosclerotic IS is uncertain. Additionally, the Coronary Calcium Score (CCS) is an accurate marker to address CAD risk; however, CCS distribution between IS subtypes is not well characterized. Objectives To compare the CCS between atherosclerotic and non-atherosclerotic IS groups; and to determine which covariates were associated with high CCS in IS. Methods This cross-sectional design included all patients with IS, 45 to 70 years of age at the time of the stroke, consecutively admitted to a rehabilitation hospital between August 2014 and December 2016, without prevalent CAD. All patients underwent CT scanning for CCS measurement. CCS≥100 was considered a high risk for CAD, with a significance level of p<0.05. Results From the 244 studied patients (mean age 58.4±6.8 years; 49% female), 164 (67%) had non-atherosclerotic etiology. The proportions of CCS≥100 were similar between the atherosclerotic and the non-atherosclerotic groups (33% [n=26] x 29% [n=47]; p= 0.54). Among all IS patients, only age ≥60 years was independently associated with CCS≥100 (OR 3.5; 95%CI 1.7-7.1), accounting for hypertension, dyslipidemia, diabetes, sedentarism, and family history of CAD. Conclusion Atherosclerotic IS did not present a greater risk of CAD when compared to non-atherosclerotic IS according to CCS. Only age ≥60 years, but not etiology, was independently associated with CCS≥100.


Subject(s)
Humans , Male , Female , Aged , Coronary Artery Disease/etiology , Coronary Artery Disease/epidemiology , Coronary Artery Disease/diagnostic imaging , Brain Ischemia/etiology , Brain Ischemia/epidemiology , Stroke/etiology , Stroke/epidemiology , Ischemic Stroke , Calcium , Cross-Sectional Studies , Risk Factors , Coronary Angiography , Middle Aged
2.
Arq. bras. cardiol ; 115(6): 1094-1101, dez. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1152945

ABSTRACT

Resumo Fundamento A doença de Chagas (DC) constitui uma causa potencial negligenciada de doença microvascular coronariana (DMC). Objetivos Comparar pacientes com DMC relacionada à DC (DMC-DC) com pacientes com DMC ligada a outras etiologias (DMC-OE). Métodos De 1292 pacientes estáveis, encaminhados para angiografia coronária invasiva para elucidar o padrão hemodinâmico e a causa de angina, 247 apresentaram coronárias subepicárdicas normais, e 101 foram incluídos após aplicação dos critérios de exclusão. Desses, 15 compuseram o grupo de DMC-DC e suas características clínicas, hemodinâmicas, angiográficas, e cintilográficas foram comparadas às do grupo de 86 pacientes com DMC-OE. O nível de significância estatística para todas as comparações adotado foi de 0,05. Resultados Pacientes com suspeita de DMC-DC apresentaram características antropométricas, clínicas e angiográficas, além de alterações hemodinâmicas e de perfusão miocárdica estatisticamente comparáveis às detectadas nos 86 pacientes com DMC-OE. Disfunção ventricular diastólica, expressa por elevada pressão telediastólica do ventrículo esquerdo, foi igualmente encontrada nos dois grupos. Entretanto, em comparação a esse grupo com DMC-OE, o grupo com DMC-DC exibiu fração de ejeção ventricular esquerda mais baixa (61,1 ± 11,9 vs 54,8 ± 15,9; p= 0,049) e mais elevado escore de mobilidade da parede ventricular (1,77 ± 0,35 vs 1,18 ± 0,26; p= 0,02). Conclusão A cardiomiopatia crônica da doença de Chagas esteve associada à etiologia de possível doença microvascular coronariana em 15% de amostra de 101 pacientes estáveis, cujo sintoma principal era angina requerendo elucidação por angiografia invasiva. Embora os grupos DMC-DC e DMC-OE apresentassem características clínicas, hemodinâmicas, e de perfusão miocárdica em comum, a disfunção global e segmentar do ventrículo esquerdo foi mais grave nos pacientes com DMC associada à DC em comparação à DMC por outras etiologias. (Arq Bras Cardiol. 2020; 115(6):1094-1101)


Abstract Background Chagas disease (CD) as neglected secondary form of suspected coronary microvascular dysfunction (CMD). Objectives Comparison of patients with CMD related to CD (CMD-CE) versus patients with CMD caused by other etiologies (CMD-OE). Methods Of 1292 stable patients referred for invasive coronary angiography to elucidate the hemodynamic pattern and the cause of angina as a cardinal symptom in their medical history, 247 presented normal epicardial coronary arteries and 101 were included after strict exclusion criteria. Of those, 15 had suspected CMD-CE, and their clinical, hemodynamic, angiographic and scintigraphic characteristics were compared to those of the other 86 patients with suspected CDM-OE. Level of significance for all comparisons was p < 0.05. Results Patients with suspected CMD-CE showed most anthropometric, clinical, angiographic hemodynamic and myocardial perfusion abnormalities that were statistically similar to those detected in the remaining 86 patients with suspected CMD-OE. LV diastolic dysfunction, expressed by elevated LV end-diastolic pressure was equally found in both groups. However, as compared to the group of CMD-OE the group with CMD-CE exhibited lower left ventricular ejection fraction (54.8 ± 15.9 vs 61.1 ± 11.9, p= 0.049) and a more severely impaired index of regional wall motion abnormalities (1.77 ± 0.35 vs 1.18 ± 0.26, p= 0.02) respectively for the CMD-OE and CMD-CE groups. Conclusion Chronic Chagas cardiomyopathy was a secondary cause of suspected coronary microvascular disease in 15% of 101 stable patients whose cardinal symptom was anginal pain warranting coronary angiography. Although sharing several clinical, hemodynamic, and myocardial perfusion characteristics with patients whose suspected CMD was due to other etiologies, impairment of LV segmental and global systolic function was significantly more severe in the patients with suspected CMD related to Chagas cardiomyopathy. (Arq Bras Cardiol. 2020; 115(6):1094-1101)


Subject(s)
Humans , Coronary Artery Disease/etiology , Coronary Artery Disease/diagnostic imaging , Chagas Cardiomyopathy/diagnosis , Chagas Cardiomyopathy/diagnostic imaging , Stroke Volume , Ventricular Function, Left , Coronary Circulation , Microcirculation
3.
Arq. bras. cardiol ; 115(6): 1051-1060, dez. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1152934

ABSTRACT

Resumo Fundamento Em regiões endêmicas da doença de Chagas, por muitos anos, existe uma observação empírica recorrente de que a doença arterial coronariana (DAC) é incomum em pacientes com doença de Chagas. Estudos anteriores baseados em análise patológica ou angiografia coronária invasiva apresentam resultados controversos. Objetivo Investigar se a DAC é menos prevalente e menos grave em pacientes com doença de Chagas crônica em comparação a uma população pareada controle, com perfil de risco para DAC similar. Métodos Um total de 86 participantes, 43 pacientes com doença de Chagas crônica consecutivos e 43 indivíduos assintomáticos, sem qualquer história prévia de doença cardíaca ou doença DAC conhecida (grupo controle), foram incluídos no estudo. Pacientes e controles foram pareados quanto sexo, idade e escore de risco de Framingham. Todos os pacientes foram analisados quanto ao escore de cálcio coronário (ECC) e submetidos à angiotomografia coronária usando um tomógrafo de 320 detectores. O nível de significância estatística adotado foi de p < 0,05. Resultados O ECC foi significativamente mais baixo em pacientes com doença de Chagas em comparação aos controles (p<0,05). A presença de placas ateroscleróticas coronárias foi significativamente menos frequente em pacientes com doença de Chagas que nos controles (20,9% versus 41,9%, p=0,037). Após ajuste quanto ao escore de Framingham, o odds ratio para a presença de qualquer calcificação coronária foi de 0,26 (IC95%: 0,07-0,99, p=0,048). O padrão é similar para escore de cálcio coronário (ECC) > 10 (OR: 0,11, IC95%: 0,01-0,87, p=0,04), e para a presença de estenose (OR: 0,06, IC95%: 0,01-0,47, p=0,001). O pareamento por escore de propensão também mostrou um efeito da doença de Chagas no ECC (-21,6 pontos no escore absoluto e 25% menos pacientes com ECC > 10; p=0,015). Conclusões A prevalência e a gravidade da DAC são mais baixas nos pacientes com doença de Chagas crônica em comparação a uma população pareada e perfil de risco para DAC similar. (Arq Bras Cardiol. 2020; 115(6):1051-1060)


Abstract Background In Chagas' disease endemic regions, there has been for many years a recurrent empirical observation that coronary artery disease (CAD) is uncommon in patients with Chagas' disease. Previous pathological and invasive coronary angiography studies led to controversial results. Objective We sought to investigate whether CAD is less prevalent and less severe in patients with chronic Chagas' disease when compared with a matched population with a similar CAD risk profile. Methods A total of 86 participants, 43 consecutive patients with chronic Chagas' disease and 43 asymptomatic individuals, without any prior history of cardiac disease or known CAD (control group), were included. Patients and controls were matched according to gender, age, and Framingham risk score. All participants underwent coronary calcium scoring and coronary computed tomography angiography on a 320-row detector scanner. Statistical significance level adopted was p < 0.05. Results The coronary artery calcium score (CACS) was significantly lower in patients with Chagas' disease than in controls (p<0.05). The presence of coronary atherosclerotic plaques was significantly less frequent in patients with Chagas' disease than in controls (20.9% versus 41.9%, p=0.037). After adjustment for the Framingham score, the odds ratio for the presence of any coronary artery calcium (CAC) in Chagas patients was 0.26 (95%CI: 0.07-0.99, p=0.048). The pattern is similar for CACS > 10 (OR: 0.11, 95%CI: 0.01-0.87, p=0.04) and for the presence of any stenosis (OR: 0.06, 95%CI: 0.01-0.47, p=0.001). Propensity score matching also indicated an effect of Chagas disease on the CACS (-21.6 points in the absolute score and 25% less of patients with CACS >10, p=0.015). Conclusions CAD is less prevalent and less severe in patients with chronic Chagas' disease when compared with a matched population with a similar CAD risk profile. (Arq Bras Cardiol. 2020; 115(6):1051-1060)


Subject(s)
Humans , Coronary Artery Disease/etiology , Coronary Artery Disease/epidemiology , Coronary Artery Disease/diagnostic imaging , Chagas Disease/complications , Chagas Disease/epidemiology , Chagas Disease/diagnostic imaging , Prevalence , Predictive Value of Tests , Risk Factors , Coronary Angiography , Computed Tomography Angiography
4.
Arq. bras. cardiol ; 113(6): 1114-1118, Dec. 2019. tab
Article in English | LILACS | ID: biblio-1055056

ABSTRACT

Abstract Background: Coronary dilatation is the most important complication of Kawasaki disease (KD) and, in addition to some clinical characteristics, is common to KD and febrile exanthematous illnesses (FEIs). Objective: To assess whether children with FEI, who do not meet the criteria for KD, have changes in coronary arteries dimensions. Methods: Echocardiography was performed within the first two weeks of the disease in patients < 10 years with fever and exanthema without other KD criteria. To make a comparison with KD patients, we reviewed the echocardiograms and medical records of patients with a diagnosis of KD of the last five years. Coronary ectasia was assessed using Z scores of coronary arteries. The means of the dimensions of the coronary arteries were compared with a z test and a level of significance of 0.05 was adopted. Results: A total of 34 patients were included, 22 (64.7%) with FEI, and 12(35.2%) with a diagnosis of KD. Using the Z scores of coronary artery, a dilation of any of the coronary artery branches was observed in six (27.2%) patients with FEI. Conclusions: An important percentage of patients with FEI has coronary artery dilation.


Resumo Fundamento: A dilatação das artérias coronárias é a principal complicação da Doença de Kawasaki (DK) e, além de algumas características clínicas, é comum à DK e a doenças exantemáticas febris (DEFs). Objetivo: Avaliar se crianças com DEF e que não têm critério para DK apresentam alterações nas dimensões das artérias coronárias. Métodos: Foi realizada ecocardiografia nas primeiras duas semanas da doença em crianças com idade inferior a 10 anos, que apresentaram febre e exantema e nenhum outro critério de DK. Para comparar com pacientes com DK, fizemos a revisão de ecocardiogramas e prontuários médicos de pacientes com diagnóstico de DK dos últimos cinco anos. Ectasia coronária foi avaliada usando escore Z das artérias coronárias. As médias das dimensões das artérias coronárias foram comparadas pelo teste z, e um nível de significância de 0,05 foi adotado. Resultados: Foram incluídos no estudo 34 pacientes, 22 (64,7%) com diagnóstico de DEF e 12 (35,2%) com diagnóstico de DK. Usando o escore Z das artérias coronárias, observou-se dilatação em algum dos ramos da artéria coronária em seis (27,2%) pacientes com DEF. Conclusão: Uma porcentagem importante dos pacientes com DEFs apresenta dilatação das artérias coronárias.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Coronary Artery Disease/etiology , Coronary Vessels/physiopathology , Dilatation, Pathologic/etiology , Fever/complications , Coronary Artery Disease/diagnostic imaging , Echocardiography , Coronary Vessels/diagnostic imaging , Dilatation, Pathologic/diagnostic imaging , Exanthema , Mexico
5.
Rev. méd. Chile ; 147(12): 1626-1629, dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1094196

ABSTRACT

The anomalous origin of the coronary arteries is uncommon and the origin of the right coronary artery from the middle third of the anterior descending artery is a finding of extreme rarity. We report two patients with coronary atherosclerotic disease and with an acute coronary syndrome, in whom a single left coronary artery was found. The clinical and angiographic characteristics and the treatment of these patients are described.


Subject(s)
Humans , Male , Middle Aged , Aged , Coronary Artery Disease/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Coronary Artery Disease/surgery , Coronary Artery Disease/etiology , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Vessel Anomalies/surgery , Coronary Vessel Anomalies/complications
6.
Rev. bras. cir. cardiovasc ; 34(6): 749-758, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057489

ABSTRACT

Abstract Objective: In our clinic, we aimed to investigate the effect of preoperative risk factors and postoperative complications on reoperation and mortality in cases with Behçet's disease which presents very rare coronary artery involvement. Methods: Thirteen patients with Behçet's Disease who had undergone coronary artery bypass grafting in our center between 2003 and 2015 were analyzed. We evaluated the clinical and laboratory findings, complications and mortality rates of our patients in light of the literature. Results: The mean age was 38.5 (30-55; 3 women). The mean time from onset of Behçet's disease to coronary artery disease was 4,7 (3-11) years. Fifty-four percent of the patients were asymptomatic. Coronary artery disease of these was exposed while peripheral vascular surgery was planned due to complications of Behçet's disease. Symptomatic patients presented angina pectoris (31%), acute coronary syndrome (8%) and arrhythmia (8%). In coronary pathology of patients, distal type obstruction (31%), aneurysm and pseudoaneurysm (31%), proximal segment thrombus (15%), chronic type stenosis and occlusions (31%) were present. Early mortality (15%) was due to acute myocardial infarction while the late mortality (15%) was due to cerebral and gastrointestinal bleeding. Reoperation was due to bleeding in one case on the 1st postoperative day and due to acute pulmonary embolism in another case in the 3rdpostoperative year. Conclusion: In Behçet's disease, coronary artery bypass grafting is a procedure with high mortality, especially in the acute period. The on-pump surgery technique in these cases can be safely performed for multiple bypasses and in patients above 40 years old.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Coronary Artery Disease/etiology , Coronary Artery Bypass/adverse effects , Behcet Syndrome/complications , Postoperative Complications , Prognosis , Behcet Syndrome/surgery , Behcet Syndrome/mortality , Risk Factors , Aneurysm, False/etiology , Coronary Vessels/surgery , Rare Diseases , Preoperative Period
7.
Rev. bras. cir. cardiovasc ; 34(5): 560-564, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042042

ABSTRACT

Abstract Introduction: Angiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts. Methods: Bypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I - 0-4 months (22 grafts), II - 5-8 months (23 grafts), III - 9-12 months (19 grafts) and IV - 13-16 months (13 grafts) after CABG. Student's t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study. Results: In period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038). Conclusion: IVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.


Subject(s)
Humans , Male , Female , Middle Aged , Saphenous Vein/transplantation , Coronary Artery Disease/etiology , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/adverse effects , Atherosclerosis/etiology , Atherosclerosis/diagnostic imaging , Time Factors , Retrospective Studies , Coronary Angiography/methods , Ultrasonography, Interventional/methods , Early Diagnosis
8.
Rev. Assoc. Med. Bras. (1992) ; 65(6): 923-929, June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012981

ABSTRACT

SUMMARY OBJECTIVE: To investigate the association between genotype insertion or deletion polymorphism of the angiotensin-converting enzyme gene (ACE) and susceptibility to coronary artery disease (CAD) in Chinese Han population. METHODS: We conducted a comprehensive search for the OR value of contrast between the group of genotype insertion or deletion polymorphism of the ACE and the group of CAD as an effective index. A meta-analysis (Stata 12.0) was used to test the heterogeneity of the results, combine the values for effect, conduct sensitivity analysis, and basic evaluation. RESULTS: A total of 638 studies were found on the association between polymorphisms of the angiotensin-converting enzyme gene and CAD, of which 44 studies met the inclusion criteria. In total, our study included 5619 cases and 4865 controls. The heterogeneity test of each study (P < 0.001) was carried out using a random effect model. The OR value of DD/ID+II was 1.95, 95% confidence interval (95%CI) (1.66-2.29). The OR value of II/DI+DD was 0.63, 95%CI (0.55-0.72). The funnel figure is basically symmetrical and the results of the sensitivity analysis were stable. CONCLUSION: The DD genotype of the angiotensin converting enzyme gene may be a weaker risk factor for CAD in the Chinese Han population.


RESUMO OBJETIVO: Investigar a associação entre o polimorfismo de inserção ou deleção do genótipo do gene da enzima conversora da angiotensina (ACE) e a susceptibilidade da etnia Han chinesa para a doença arterial coronariana (DAC). Métodos: Foi realizada uma pesquisa abrangente para o valor de OR (Odds Ratio) de contraste entre o grupo de polimorfismo de inserção ou deleção do genótipo do gene da enzima conversora da angiotensina (ACE) e o grupo de doença arterial coronariana (DAC) como um índice de eficácia. Uma meta-análise (Stata 12,0) foi utilizada para testar a heterogeneidade dos resultados, combinar os valores de eficácia, realizar análises de sensibilidade e de avaliação básica. RESULTADOS: Um total de 638 estudos foram encontrados sobre a associação entre polimorfismos do gene da enzima conversora da angiotensina e doença arterial coronariana, dos quais 44 satisfaziam os critérios de inclusão. Nosso estudo incluiu 6246 casos e 5713 controles. O teste de heterogeneidade de cada estudo (p < 0,001) foi realizado seguindo o modelo de efeito randômico. O valor de OR para DD/ID+II foi 1,95, com 95% de intervalo de confiança de (95%CI) (1,66-2,29). O valor de OR para II/DI+DD foi 0,63, com 95% IC (0,55-0,72). A figura do funil é basicamente simétrica e os resultados da análise de sensibilidade foram estáveis. CONCLUSÃO: O genótipo DD do gene da enzima conversora da angiotensina podem ser um fator de risco mais fraco para doença coronariana na população chinesa Han.


Subject(s)
Humans , Polymorphism, Genetic , Coronary Artery Disease/genetics , Peptidyl-Dipeptidase A/genetics , Genetic Association Studies , Coronary Artery Disease/etiology , China/ethnology , Risk Factors
9.
Rev. bras. cir. cardiovasc ; 34(3): 297-304, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013476

ABSTRACT

Abstract Objectives: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. Methods: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. Results: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). Conclusion: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Saphenous Vein/transplantation , Blood Platelets/physiology , Vascular Patency/physiology , Coronary Artery Bypass/adverse effects , Platelet Count , Reference Values , Saphenous Vein/physiopathology , Coronary Artery Disease/etiology , Echocardiography , Logistic Models , Coronary Artery Bypass/methods , Predictive Value of Tests , Retrospective Studies , Risk Factors , ROC Curve , Age Factors , Coronary Angiography/methods , Treatment Failure , Statistics, Nonparametric , Hematologic Tests
10.
Rev. bras. cir. cardiovasc ; 34(1): 57-61, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985249

ABSTRACT

Abstract Objective: To evaluate the association between serum vitamin D (vitD) level and SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) score (SS). Methods: The medical records of consecutive patients, who underwent coronary artery bypass graft surgery, were retrospectively reviewed. The study group consisted of 158 patients. Biochemical, clinical, and echocardiographic parameters and SS were evaluated in all patients. The patients were divided into 2 groups according to SS (≥23= high, <23= low). Results: The high SYNTAX score (HSS) group was older and had higher body mass index, C-reactive protein (CRP), low-density lipoprotein, and fasting plasma glucose level than the low SYNTAX score (LSS) group. The HSS group had lower high-density lipoprotein and vitD level than the LSS group. The HSS group had a higher prevalence of diabetes mellitus (DM), hypertension (HT), hyperlipidemia (HL), and current smoking patients than the LSS group. On univariate analysis, age, HT, DM, HL, smoking, CRP, and serum vitD level were associated with HSS. On multivariate analysis, HT, DM, and HL were independent predictors of HSS (odds ratio [OR]: 2.137, 95% confidence interval [CI]: 1.468-2.935, P<0.001; OR: 3.559, 95% CI: 2.763-5.927, P<0.001; OR: 2.631, 95% CI: 1.529-3.438, P<0.001; respectively). Conclusion: In our study, we have found out that HT, DM, and HL were independent predictors of HSS. Serum vitD level was not found to be an independent predictor of HSS.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Vitamin D/blood , Coronary Artery Disease/blood , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/methods , Coronary Angiography/methods , Risk Assessment/methods , Reference Values , Vitamin D Deficiency/blood , Coronary Artery Disease/etiology , Cross-Sectional Studies , Multivariate Analysis , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Diabetes Complications , Percutaneous Coronary Intervention/methods , Hyperlipidemias/complications , Hypertension/complications
11.
Rev. bras. cir. cardiovasc ; 34(1): 114-117, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985245

ABSTRACT

Abstract Buerger's disease, vasculitis of small and medium-sized blood vessels, is a non-atherosclerotic and progressive occlusive condition which frequently involves the distal part of the limbs. The occlusion of coronary arteries in Buerger's disease is a rare condition; however, coronary artery dissection has not been reported previously. Therefore, this paper presents a 45-year-old man who developed coronary artery dissection associated with Buerger's disease. The patient was treated successfully with coronary artery bypass grafting with the left internal mammary artery to the left anterior descending artery, and saphenous vein graft to the right coronary artery.


Subject(s)
Humans , Male , Middle Aged , Thromboangiitis Obliterans/complications , Coronary Artery Disease/etiology , Coronary Occlusion/etiology , Saphenous Vein/transplantation , Thromboangiitis Obliterans/surgery , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Coronary Artery Bypass/methods , Coronary Angiography/methods , Coronary Occlusion/surgery , Coronary Occlusion/diagnostic imaging , Computed Tomography Angiography/methods , Mammary Arteries/surgery
12.
Rev. Col. Bras. Cir ; 46(3): e20192170, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1013167

ABSTRACT

RESUMO Objetivo: investigar o impacto da cirurgia bariátrica no escore de cálcio coronariano (ECC) e estabelecer fatores preditivos de progressão desse escore em pacientes obesos. Métodos: estudo prospectivo de 18 pacientes obesos antes e depois da cirurgia bariátrica. Todos os pacientes foram submetidos à tomografia computadorizada e a exames laboratoriais com dosagens sanguíneas de colesterol total, LDL, HDL, triglicerídeos, glicose de jejum, A1C, insulina, cálcio sérico, peptídeo C e proteína C-reativa, para determinar o ECC e o escore de risco de Framingham (ERF). Resultados: o ERF reduziu 50% entre as avaliações pré e pós-operatórias. O ECC médio aumentou significativamente no período pós-operatório, aumentando de 8,5 para 33,1. Os níveis de HDL também aumentaram no pós-operatório. Todas as outras variáveis quantitativas reduziram significativamente no pós-operatório. Ao estratificar o ECC em quatro categorias, foi observado que 22,2% da amostra apresentou ECC=0 no pós-operatório. A prevalência de ECC leve reduziu de 77,8% para 50%, enquanto que ECC moderado permaneceu igual no pré e no pós-operatório (11,1%). ECC grave aumentou de 11,1% para 16,7%. Idade avançada foi associada à progressão do ECC, e essa foi a única variável que apresentou correlação estatística com a progressão do ECC. Conclusão: cirurgia bariátrica produz desfechos cardiovasculares positivos, que, aparentemente, ocorrem de forma independente do ECC.


ABSTRACT Objective: to investigate the impact of bariatric surgery on the coronary artery calcium score (CACS), and to establish predictors of progression of this score in patients with obesity. Methods: prospective study that evaluated 18 obese patients before and after bariatric surgery. All patients were submitted to computed tomography scans and blood tests (total cholesterol, LDL, HDL, triglycerides, fasting plasma glucose, A1C, insulin, serum calcium, C-peptide and C-Reactive Protein) in order to determine CACS and Framingham risk score (FRS). Results: the FRS decreased 50% between the pre and postoperative evaluations. The mean CACS increased significantly at the late postoperative period, going from 8.5 to 33.1. HDL levels had also increased between the pre and postoperative periods. All of the other quantitative variables reduced significantly at the postoperative evaluation. When dividing CACS into four degrees, it was observed that 22.2% presented CACS=0 at the postoperative evaluation. The prevalence of mild CACS decreased from 77.8% to 50%, while moderate CACS remained the same (11.1%). Severe CACS increased from 11.1% to 16.7%. Older ages were linked to CACS progression, and this was the only variable that presented statistical association with progression. Conclusion: bariatric surgery leads to positive cardiovascular outcomes, apparently regardless of CACS.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Coronary Artery Disease/etiology , Bariatric Surgery , Vascular Calcification/etiology , Obesity/surgery , Coronary Artery Disease/diagnostic imaging , Tomography, X-Ray Computed , Prospective Studies , Risk Assessment , Disease Progression , Vascular Calcification/diagnostic imaging , Middle Aged , Obesity/complications
14.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3): 302-311, jul.-ago. 2018. tab, ilus, graf
Article in English, Portuguese | LILACS | ID: biblio-916547

ABSTRACT

A incidência exata de parada cardiorrespiratória (PCR) mesmo em países com registros clínicos bem estruturados ainda é desconhecida, mas as estimativas variam de 180.000 a mais de 450.000 mortes anuais. A etiologia mais comum da PCR é a doença cardiovascular isquêmica que ocasiona no desenvolvimento de arritmias letais. A sobrevivência decorrente da PCR apresenta desfechos divergentes. No cenário extra-hospitalar, os estudos relataram taxas de sobrevida de 1% a 6%. Três revisões sistemáticas de alta hospitalar sobre a PCR extra-hospitalar mostraram 5% a 10% de sobrevida entre aqueles tratados através de serviços médicos de emergência e 15% quando o distúrbio do ritmo era a fibrilação ventricular (FV). O suporte básico de vida consiste em ressuscitação cardiopulmonar (RCP) e, quando disponível, desfibrilação com desfibrilador externo automático (DEA). As chaves para a sobrevivência após a PCR são reconhecimento e tratamento precoces, especificamente, início imediato de excelente RCP e desfibrilação precoce. O presente artigo discutirá os princípios do suporte básico de vida em adultos do pré-hospitalar à sala de emergência, conforme descritos nas Diretrizes de Ressuscitação Cardiopulmonar e Atendimento Cardiovascular de Emergência do ILCOR e AHA, atualizadas em novembro de 2017


The exact incidence of cardiorespiratory arrest (CRA) even in countries with well-structured clinical records is still unknown, but estimates range from 180,000 to over 450,000 annual deaths. The most common etiology of CRA is ischemic cardiovascular disease, resulting in the development of lethal arrhythmias. Survival of CRA shows divergent outcomes. In the out-of-hospital setting, studies have reported survival rates of 1% to 6%. Three systematic reviews of hospital discharge on extra-hospital CRA showed 5% to 10% survival between those treated by emergency medical services and 15% when the rhythm disorder was ventricular fibrillation (VF). Basic life support consists of cardiopulmonary resuscitation (CPR) and, when available, defibrillation with an automatic external defibrillator (AED). The keys to survival of CRA are early recognition and treatment, specifically, immediate onset of excellent CPR and early defibrillation. This article will discuss the basics of adult life support from prehospital to emergency room, as outlined in the ILCOR and AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, updated in November 2017


Subject(s)
Humans , Male , Female , Cardiopulmonary Resuscitation/methods , Guidelines as Topic/standards , Emergency Treatment/methods , Prehospital Care/methods , Arrhythmias, Cardiac , Ventricular Fibrillation/therapy , Coronary Artery Disease/complications , Coronary Artery Disease/etiology , Electric Countershock/methods , Cardiovascular Diseases/etiology , Epinephrine/therapeutic use , Defibrillators, Implantable , Defibrillators , Electrodes , Heart Arrest/etiology , Amiodarone/therapeutic use
15.
Arch. endocrinol. metab. (Online) ; 62(3): 303-308, May-June 2018. tab
Article in English | LILACS | ID: biblio-950061

ABSTRACT

ABSTRACT Objective: Cardiovascular diseases are the leading cause of death in Brazil, imposing substantial economic burden on the health care system. Familial hypercholesterolemia (FH) is known to greatly increase the risk of premature coronary artery disease (CAD). This study aimed to estimate the economic impact of hospitalizations due to CAD attributable to FH in the Brazilian Unified Health Care System (SUS). Subjects and methods: Retrospective, cross-sectional study of data obtained from the Hospital Information System of the SUS (SIHSUS). We selected all adults (≥ 20 years of age) hospitalized from 2012­-2014 with primary diagnoses related to CAD (ICD-10 I20 to I25). Attributable risk methodology estimated the contribution of FH in the outcomes of interest, using international data for prevalence (0.4% and 0.73%) and relative risk for events (RR = 8.56). Results: Assuming an international prevalence of FH of 0.4% and 0.73%, of the 245,981 CAD admissions/year in Brazil, approximately 7,249 and 12,915, respectively, would be attributable to an underlying diagnosis ­­of FH. The total cost due to CAD per year, considering both sexes and all adults, was R$ 985,919,064, of which R$ 29,053,500 and R$ 51,764,175, respectively, were estimated to be attributable to FH. The average cost per FH-related CAD event was R$ 4,008. Conclusion: Based on estimated costs of hospitalization for CAD, we estimated that 2.9-5.3% are directed to FH patients. FH can require early specific therapies to lower risk in families. It is mandatory to determine the prevalence of FH and institute appropriate treatment to minimize the clinical and economic impact of this disease in Brazil.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Coronary Artery Disease/economics , Public Health/economics , Health Care Costs/statistics & numerical data , Hospitalization/economics , Hypercholesterolemia/economics , Coronary Artery Disease/etiology , Coronary Artery Disease/therapy , Brazil , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Hospitalization/statistics & numerical data , Hypercholesterolemia/complications , Hypercholesterolemia/therapy
16.
Arq. bras. cardiol ; 110(3): 211-216, Mar. 2018. tab
Article in English | LILACS | ID: biblio-888027

ABSTRACT

Abstract Background: Coronary artery disease (CAD) and osteoporosis (OP) are common diseases in postmenopausal women. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CAD. However, available data on the relationship between bone mineral density (BMD) and severity of coronary lesions is limited. Objective: To investigate association between the BMD and severity of coronary lesions assessed by Gensini score in postmenopausal women. Methods: This study included 122 postmenopausal women who were diagnosed with CAD. These patients were divided into two groups according to the severity of coronary lesions assessed by the Gensini score - patients with mild coronary lesions (Gensini score < 25) and patients with severe coronary lesions (Gensini score ≥ 25). Femoral neck mineral density was measured with dual energy X-ray absorptiometry (DXA). Results: The study included postmenopausal women aged 64.31 ± 4.71 years, 85 of whom (69.7%) exhibited severe coronary lesions. Participants with severe coronary lesions had a significantly higher T score than did those with mild coronary lesions at the femoral neck (p < 0.05). The mean T-score was −0.84 ± 1.01 in mild coronary lesions group, −1.42 ± 1.39 in severe coronary lesions group (p < 0.05). Multivariable logistic regression analysis showed that osteopenia-osteoporosis at the Femoral neck (odds ratio 2.73; 95% confidence interval 1.06 to 6.13) was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores (b = −0.407, SE = 0.151, p=0.007) were the independent predictors of Gensini score. Conclusion: The relationship between severity of coronary lesions and BMD was significant in postmenopausal women. BMD, a low-cost technique involving minimal radiation exposure, widely used for osteoporosis screening, is a promising marker of severity of coronary lesions.


Resumo Fundamento: A doença arterial coronariana (DAC) e a osteoporose são doenças comuns em mulheres pós-menopausa. Tanto em estudos transversais como em estudos epidemiológicos longitudinais, a massa óssea diminuída foi relacionada à frequência aumentada de DAC. No entanto, dados disponíveis sobre a relação entre densidade mineral óssea (DMO) e gravidade das lesões coronarianas são limitados. Objetivo: Investigar a associação entre DMO e gravidade das lesões coronarianas avaliadas pelo escore de Gensini em mulheres pós-menopausa. Métodos: Este estudo incluiu 122 mulheres pós-menopausa diagnosticadas com DAC. As pacientes foram divididas em dois grupos de acordo com a gravidade das lesões coronarianas avaliada pelo escore de Gensini - pacientes com lesões coronarianas leves (escore de Gensini < 25) e pacientes com lesões coronarianas graves (escore de Gensini ≥ 25). A densidade mineral do colo femoral foi medida por absorção de raios-X de dupla energia (DXA). Resultados: O estudo incluiu mulheres pós-menopausa com idade de 64,31 ± 4,71 anos, 85 delas (69,7%) com lesões coronarianas graves. Pacientes com lesões coronarianas graves apresentaram um escore T mais elevado que aquelas com lesões coronarianas leves no colo femoral (p < 0,05). O escore T médio foi -0,84 ± 1,01 no grupo com lesões leves, e -1,42 ± 1,39 no grupo com lesões graves (p < 0,05). A análise de regressão logística multivariada mostrou que a osteopenia-osteoporose no colo femoral (odds ratio 2,73; intervalo de confiança de 95% 1,06 - 6,13) esteve associada com um risco aumentado de se desenvolver lesões coronarianas graves. O modelo de regressão múltipla mostrou que os escores T (b = -0,407; EP= 0,151; p = 0,007) foram preditores independentes do escore de Gensini. Conclusão: Encontrou-se uma relação significativa entre a gravidade das lesões coronarianas e a DMO em mulheres pós-menopausa. DMO, uma técnica de baixo custo que envolve mínima exposição à radiação, e amplamente utilizada no rastreamento de osteoporose, é um marcador promissor da gravidade de lesões coronarianas graves.


Subject(s)
Humans , Female , Middle Aged , Aged , Coronary Artery Disease/physiopathology , Bone Density/physiology , Osteoporosis, Postmenopausal/physiopathology , Postmenopause/physiology , Bone Demineralization, Pathologic/physiopathology , Reference Values , Severity of Illness Index , Coronary Artery Disease/etiology , Absorptiometry, Photon/methods , Logistic Models , Osteoporosis, Postmenopausal/complications , Cross-Sectional Studies , Risk Factors , Age Factors , Statistics, Nonparametric , Risk Assessment , Bone Demineralization, Pathologic/complications , Femur Neck/diagnostic imaging , Hyperlipidemias/complications
17.
Int. j. cardiovasc. sci. (Impr.) ; 31(2): f:133-l:142, mar.-abr. 2018. tab, graf
Article in English | LILACS | ID: biblio-881967

ABSTRACT

Background: Cardiogenic Acute Pulmonary Edema (APE) is considered one of the main medical emergencies, and it is the extreme manifestation of acute heart failure. The main etiology of heart failure is ischemic heart disease. To date, the definition of ischemic etiology in acute pulmonary edema was based on criteria such as: clinical history of ischemic heart disease, noninvasive examinations and, in other patients, coronary angiography. Classified as such, ischemic heart disease has been shown to be its main etiology. The high prevalence between these two diseases was evaluated, but not by the exclusive angiographic criterion, the gold standard of this pathology and the reason of this study. Objective: To evaluate the predictors of obstructive coronary artery disease in patients with acute pulmonary edema of unclear origin. Method: Patients admitted to a cardiovascular disease referral emergency unit were recruited to undergo coronary angiography if the acute pulmonary edema etiology was not adequately elucidated. Obstructive coronary disease was considered if at least one epicardial vessel had 70% of occlusion. Results: Obstructive coronary disease was classified by coronary angiography in 149 consecutively evaluated patients, and coronary artery obstruction was the outcome variable of the predictor model. Among the variables related to coronary disease, the predictor variables were the history of coronary artery disease (p < 0.001) and myocardium segmental deficit at the echocardiogram (p < 0.02). Conclusion: The antecedent of coronary disease and the myocardium segmental deficit at the echocardiogram were able to discriminate patients with acute pulmonary edema associated with obstructive coronary disease. Troponin values classified by two cardiologists as secondary to an acute non-ST-segment elevation myocardial infarction, and chest pain preceding the clinical picture were not able to discriminate patients with or without coronary obstruction and thus, the diagnosis of obstructive coronary disease should not be pursued based on the troponin value and/or chest pain preceding the clinical picture


Fundamento: O Edema Agudo de Pulmão cardiogênico é considerado uma das maiores emergências médicas, é a manifestação extrema da insuficiência cardíaca aguda. A principal etiologia da insuficiência cardíaca é a cardiopatia isquêmica. Até o momento, a definição da etiologia isquêmica no edema agudo de pulmão foi baseada em critérios como: história clínica de doença cardíaca isquêmica, exames não invasivos e, em outros pacientes, na cinecoronariografia. Desta forma classificada, a doença isquêmica do coração demonstrou ser sua principal etiologia. A alta prevalência entre estas duas doenças foi avaliada, mas não pelo critério angiográfico exclusivo, o padrão-ouro desta patologia, a razão deste estudo. Objetivo: Avaliar os preditores da doença arterial coronária obstrutiva nos portadores de Edema Agudo de Pulmão de origem claramente não definida. Método: Pacientes admitidos em um pronto-socorro de referência no tratamento das doenças cardiovasculares foram recrutados a realizar a coronariografia se a etiologia do edema agudo de pulmão não era devidamente esclarecida. A doença coronária obstrutiva foi considerada se ao menos um vaso epicádico tivesse oclusão = 70%. Resultados: A doença coronária obstrutiva foi classificada pela cinecoronariografia em 149 pacientes consecutivamente avaliados, a obstrução da artéria coronária foi a variável desfecho do modelo preditor. Dentre as variáveis relacionadas a doença coronária, as variáveis preditoras foram a história de doença da artéria coronária (p < 0,001) e o déficit segmentar do miocárdio ao ecocardiograma (p < 0,02). Conclusão: O antecedente de doença coronariana e o déficit segmentar do miocárdio ao ecocardiograma foram capazes de discriminar pacientes com edema agudo de pulmão associado a doença coronária obstrutiva. Valores da troponina classificados por dois cardiologistas como secundário a um infarto agudo do miocárdio sem elevação do segmento ST a e a dor torácica antecedendo o quadro não foram capazes de discriminar doentes com ou sem obstrução coronária, logo, o diagnóstico de doença coronária obstrutiva não deve ser perseguido baseado no valor da troponina e ou dor torácica antecedendo o quadro


Subject(s)
Humans , Male , Female , Middle Aged , Coronary Artery Disease/diagnosis , Coronary Artery Disease/etiology , Predictive Value of Tests , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/etiology , Pulmonary Edema , Chest Pain , Diabetes Mellitus , Echocardiography/methods , Electrocardiography/methods , Heart Failure , Hypertension , Myocardial Ischemia/etiology , Observational Study , Statistical Analysis , Stroke , Troponin
18.
Arch. cardiol. Méx ; 88(5): 441-446, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-1142154

ABSTRACT

Resumen Objetivo: Describir las manifestaciones cardiacas en la etapa aguda de la enfermedad de Kawasaki en pacientes atendidos en un hospital de tercer nivel de la Ciudad de México, México. Métodos: Estudio retrospectivo, descriptivo en pacientes con diagnóstico de enfermedad de Kawasaki de agosto de 1995 a diciembre del 2016 en el Instituto Nacional de Pediatría, México. Se estudio la demografía de los pacientes, características clínicas, tratamiento empleado y desarrollo de complicaciones cardiacas en la etapa aguda de la enfermedad. Resultados: Se estudiaron 508 casos de enfermedad de Kawasaki. La edad media al diagnóstico fue de 37.64 ± 35.56 meses. Predominio de pacientes masculinos del 65.4%, con una relación masculino/femenino de 1.88:1. La mayoría de los casos (79.2%) tuvo una presentación completa. La gammaglobulina intravenosa fue administrada en 92.4% de los casos. Veintiocho pacientes (5.5%) desarrollaron arritmias, se presentaron cambios en el segmento ST en 29 pacientes (5.6%) y 5 pacientes desarrollaron isquemia miocárdica. En el ecocardiograma inicial, 51 pacientes (9.9%) presentaron datos de miocarditis, 72 pacien- tes (14%) datos de pericarditis y 77 casos tuvieron derrame pericárdico (15%). Se detectaron alteraciones en las arterias coronarias en 169 casos (32.9%). Cuatro pacientes fallecieron en la etapa aguda de la enfermedad por complicaciones cardiacas de la enfermedad de Kawasaki. Conclusiones: En México cada vez existen más casos de enfermedad de Kawasaki con un alto porcentaje de manifestaciones cardiacas al diagnóstico. Se requiere de un mayor conocimiento de la enfermedad en México, para poder establecer cuál es la evolución cardiológica de los pacientes en el país.


Abstract Objectives: To describe the cardiac manifestations in the acute phase of patients with Kawasaki disease treated in a third level Children's hospital in Mexico City, Mexico. Methods: A cross-sectional study was conducted in patients with a diagnosis of Kawasaki disease treated in this hospital from August 1995 to December 2016. Information included patient demographics, clinical features, treatment used, electrocardiographic findings, extra-coronary echocardiographic findings, and the development of coronary artery aneurysms in the acute phase of the disease. Results: The study included 508 cases of Kawasaki disease, with a mean age at diagnosis of 37.64 ± 35.56 months (range from 2 to 200 months). Almost two-thirds (65.4%) of the patients were male, with a male/female ratio of 1.88:1. Complete Kawasaki disease was diagnosed in 79.2% of cases. Almost all cases (92.4%) received intravenous immunoglobulin. Twenty-eight patients (5.5%) developed arrhythmias, ST changes developed in 29 patients (5.6%), and 5 patients presented with ischaemic changes. In the initial echocardiographic evaluation, 51 patients (9.9%) were diagnosed with myocar- ditis, 72 patients (14.0%) with pericarditis and 77 cases (15.0%) developed pericardial effusion. Coronary artery anomalies were detected in 169 cases (32.9%). 32 cases were diagnosed as giant coronary aneurysms. Four patients died from cardiac complications in the acute phase of the disease. Conclusions: There has been an increase in the diagnosis of Kawasaki disease in Mexico. They presented with more cardiac complications than reported in literature. An increased knowledge of Kawasaki disease is required in Mexico in order to establish the cardiac outcomes of this group of patients.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Coronary Aneurysm/etiology , Coronary Artery Disease/etiology , Heart Diseases/etiology , Mucocutaneous Lymph Node Syndrome/complications , Coronary Aneurysm/epidemiology , Coronary Artery Disease/epidemiology , Echocardiography , Cross-Sectional Studies , Retrospective Studies , Immunoglobulins, Intravenous/administration & dosage , Heart Diseases/epidemiology , Hospitals, Pediatric , Mexico/epidemiology , Mucocutaneous Lymph Node Syndrome/drug therapy
19.
Arch. cardiol. Méx ; 88(5): 423-431, dic. 2018. graf
Article in English | LILACS | ID: biblio-1142152

ABSTRACT

Abstract Introduction: Three-vessel coronary artery disease is an advanced manifestation of atherosclerosis, with high prevalence in Mexico. Objective: The aim of this study was to describe coronary risk factors in a group of patients with three-vessel coronary artery disease in Northwest Mexico. Methods: A cross sectional study was conducted on a population with three-vessel coronary artery disease from May 2015 to February 2016. The disease was defined when ≥70% stenosis was present in each major epicardial coronary artery. Anthropometric and biochemical parameters were measured in each patient. Ankle-Brachial Index was measured with vascular ultrasound, and Syntax score calculation with an on-line application. Statistical analysis for qualitative differences was performed using Pearson X2 test, with p < 0.05 being considered as significant. Results: The study included 100 patients, of whom 75 were male (mean age 63 ± 9 years) and 25 female (mean age 69 ± 9 years). The coronary risk factors observed were diabetes (58%), hypertension (86%), smoking (68%), dyslipidaemia (100%), metabolic syndrome (71%), and obesity/overweight (75%). Diabetes and metabolic syndrome prevalence was higher in women (p = 0.03), but smoking was higher in men (76%, p = 0.003). Ankle-Brachial Index was abnormal in 58% of patients, the mean Syntax score was in 36.9 ± 11.5, and the prevalence of left main coronary heart disease was 36%. Conclusions: This group of patients with complex coronary lesions has a high prevalence of coronary risk factors, which could represent a worse prognosis.


Resumen Introducción: La enfermedad coronaria de tres vasos (ECTV) es una manifestación avanzada de aterosclerosis, con alta prevalencia en el noroeste de México. Objetivo: Describir los factores de riesgo coronario (FRC) en un grupo de enfermos con ECTV en el noroeste de México. Métodos: De mayo de 2015 a febrero de 2016 se realizó un estudio transversal en una población del noroeste de México diagnosticada con ECTV. Se definió ECTV cuando existía estenosis ≥70% en cada una de las arterias coronarias epicárdicas mayores. Se midieron parámetros antropométricos y bioquímicos en cada paciente. Los parámetros para el índice tobillo-brazo (ITB) se obtuvieron con ultrasonido vascular (Edan SonoTrax 8 Hz) y un cálculo de puntaje Syntax con una aplicación en línea. Análisis estadístico con 32 de Pearson para diferencias cualitativas Se consideró significativo cuando p ≤ 0.05. Resultados: Se estudiaron 25 mujeres (edad 69 ± 9 años) y 75 varones (edad 63 ± 9 años). Los FRC observados fueron diabetes (58%), hipertensión (86%), antecedente de tabaquismo (68%), dislipidemia (100%), síndrome metabólico (71%) y sobrepeso/obesidad (75%). En las mujeres la prevalencia de diabetes y síndrome metabólico fue mayor que en los varones (p = 0.03), pero el tabaquismo fue más prevalente en los varones (76%, p = 0.003). El ITB se encontró anormal en el 58% de los pacientes, el puntaje Syntax promedio fue de 36.9 ± 11.5 y la prevalencia de la enfermedad del tronco de la arteria coronaria izquierda fue del 36%. Conclusión: En este grupo de estudio con lesiones coronarias complejas existe alta prevalencia de FRC que se refleja en y posiblemente un peor pronóstico.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Disease/epidemiology , Smoking/epidemiology , Metabolic Syndrome/epidemiology , Diabetes Mellitus/epidemiology , Prognosis , Coronary Artery Disease/etiology , Coronary Artery Disease/pathology , Smoking/adverse effects , Sex Factors , Cross-Sectional Studies , Risk Factors , Ankle Brachial Index , Mexico/epidemiology
20.
Arch. cardiol. Méx ; 87(4): 292-301, oct.-dic. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-887539

ABSTRACT

Resumen: Objetivo: La prevalencia de calcificación arterial coronaria (CAC), marcador específico de aterosclerosis, no es conocida en México. Nuestro objetivo fue investigar la prevalencia y extensión de CAC y su asociación con factores de riesgo cardiovascular en población mexicana. Métodos: La CAC fue medida por tomografía computarizada multidetector en individuos asintomáticos que participaron en el estudio Genética de la Enfermedad Aterosclerosa. Los factores de riesgo cardiovascular y los medicamentos fueron registrados. Resultados: La muestra incluyó 1,423 individuos (49.5% hombres), con una edad de 53.7 ± 8.4 años. Los portadores de CAC mostraron prevalencias más altas de dislipidemia, diabetes, hipertensión y otros factores de riesgo. La prevalencia de CAC > 0 unidades Agatston fue de 27%, significativamente más alta en hombres (40%) que en mujeres (13%). Los valores medios del puntaje de CAC aumentaron consistentemente con la edad y fueron más altos en hombres que en mujeres en todos los grupos etarios. La edad y el c-LDL elevado se asociaron de manera independiente con la prevalencia de CAC > 0 en hombres y mujeres, mientras que la presión arterial sistólica en las mujeres, y el incremento de la edad en ambos géneros mostró una asociación independiente con la severidad de CAC. Conclusiones: En población mexicana la prevalencia y la extensión de CAC fueron mucho más altas en hombres que en mujeres y aumentaron consistentemente con la edad. Los predictores independientes de la prevalencia de CAC fueron la edad y el c-LDL.


Abstract: Objective: The prevalence of coronary artery calcification (CAC), a specific marker of atherosclerosis, is unknown in Mexico. Our aim was to investigate the prevalence and quantity of CAC and their association with cardiovascular risk factors in a Mexican population. Methods: CAC was measured by multidetector computed tomography in asymptomatic subjects who participated in the Genetics of Atherosclerotic Disease study. Cardiovascular risk factors and medication were recorded. Results: The sample included 1,423 individuals (49.5% men), aged 53.7 ± 8.4 years. Those with CAC showed a higher prevalence of dyslipidaemia, diabetes, hypertension, and other risk factors. The prevalence of CAC > 0 Agatston units was significantly higher among men (40%) than among women (13%). Mean values of CAC score increased consistently with increasing age and were higher in men than women in each age group. Age and high low density lipoprotein cholesterol were independently associated with prevalence of CAC > 0 in men and women, while increasing systolic blood pressure in women and age in both genders showed an independent association with CAC extension. Conclusions: In the Mexican population the prevalence and extent of CAC were much higher in men than in women, and strongly increased with age. Independent predictors of CAC prevalence were age and low density lipoprotein cholesterol (LDL-C).


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Coronary Artery Disease/epidemiology , Vascular Calcification/epidemiology , Coronary Artery Disease/etiology , Cardiovascular Diseases/complications , Prevalence , Cross-Sectional Studies , Risk Factors , Asymptomatic Diseases , Vascular Calcification/etiology , Mexico/epidemiology
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