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1.
Lima; Perú. ESSALUD. Instituto de Evaluación de Tecnologías en Salud e Investigación; 1 ed; May. 2022. 125 p. ilus.(GPC, 51).
Monography in Spanish | LILACS, LIPECS, MINSAPERU | ID: biblio-1373372

ABSTRACT

La presente publicación en versión extensa, describe las recomendaciones para el manejo infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) dentro de las primeras 12 horas de inicio de los síntomas, con el fin de contribuir a reducir la mortalidad, mejorar la calidad de vida, y reducir las complicaciones de los pacientes con esta condición, la población a la cual se aplicará la GPC:, o sea los pacientes con infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) dentro de las primeras 12 horas de inicio de los síntoma. El infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) es una emergencia médica, producto de la oclusión de las arterias coronarias, que conllevan a la isquemia miocárdica transmural, y que de persistir lleva a una lesión miocárdica o necrosis. Se ha reportado una mortalidad de la enfermedad del 23 % antes de llegar al hospital, 13% durante el ingreso hospitalario, y de 10% posterior al alta. Lo cual, inclusive, puede aumentar en ausencia de tratamiento entre un 5 a 10% (2). En el caso de Perú, se ha reportado una por IMCEST de aproximadamente 9%, pero con una incidencia de insuficiencia cardíaca posinfarto fue de 28% y de choque cardiogénico de 12% (3). Esta alta tasa de mortalidad y morbilidad hace hincapié en la necesidad de garantizar una evaluación y manejo adecuado de la enfermedad. Por ello, el Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) para establecer lineamientos basados en evidencia para gestionar de la mejor manera los procesos y procedimientos asistenciales de la presente condición


Subject(s)
Patients , Shock, Cardiogenic , Wounds and Injuries , Myocardial Ischemia , Coronary Vessels , Diagnostic Techniques and Procedures , ST Elevation Myocardial Infarction , Heart Failure , Myocardial Infarction
2.
Lima; Perú. ESSALUD. Instituto de Evaluación de Tecnologías en Salud e Investigación; 1 ed; May. 2022. 24 p. ilus.(GPC, 51).
Monography in Spanish | LILACS, LIPECS, MINSAPERU | ID: biblio-1373371

ABSTRACT

La presente publicación en versión corta, describe las recomendaciones para el manejo infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) dentro de las primeras 12 horas de inicio de los síntomas, con el fin de contribuir a reducir la mortalidad, mejorar la calidad de vida, y reducir las complicaciones de los pacientes con esta condición. El infarto agudo de miocardio con elevación persistente del segmento ST (IMCEST) es una emergencia médica, producto de la oclusión de las arterias coronarias, que conllevan a la isquemia miocárdica transmural, y que de persistir lleva a una lesión miocárdica o necrosis (1). Se ha reportado una mortalidad de la enfermedad del 23 % antes de llegar al hospital, 13% durante el ingreso hospitalario, y de 10% posterior al alta. Lo cual, inclusive, puede aumentar en ausencia de tratamiento entre un 5 a 10% (2). En el caso de Perú, se ha reportado una por IMCEST de aproximadamente 9%, pero con una incidencia de insuficiencia cardíaca postinfarto fue de 28% y de choque cardiogénico de 12% (3). Esta alta tasa de mortalidad y morbilidad hace hincapié en la necesidad de garantizar una evaluación y manejo adecuado de la enfermedad. Por ello, el Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) para establecer lineamientos basados en evidencia para gestionar de la mejor manera los procesos y procedimientos asistenciales de la presente condición


Subject(s)
Patients , Shock, Cardiogenic , Myocardial Ischemia , Coronary Vessels , Diagnostic Techniques and Procedures , Absenteeism , ST Elevation Myocardial Infarction , Heart Failure
4.
Medicina UPB ; 41(1): 75-79, mar. 2022. Ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1362712

ABSTRACT

Los aneurismas de las arterias coronarias (AAC) son poco comunes, con una incidencia de 0.3-5.3%. Se definen como una dilatación 1.5 veces mayor al diámetro interno de la arteria normal adyacente. La arteria coronaria derecha es la más comúnmente afectada. Su fisiopatología es poco clara, pero se cree que una de sus principales causas es la aterosclerosis. Los AAC son generalmente asintomáticos o pueden estar asociados a isquemia miocárdica. Su tratamiento aún no está bien establecido, debido al desconocimiento general sobre su historia natural, e incluye desde un manejo conservador hasta el tratamiento quirúrgico. A continuación, se reporta el caso de un paciente con infarto agudo de miocardio y elevación del segmento ST, llevado a coronariografía que evidenció aneurisma de la coronaria derecha, que requirió trombectomía, angioplastia y manejo médico vitalicio ambulatorio.


Coronary artery aneurysms (CAA) are a rare entity with an incidence of 0.3-5.3%. They are dilations of 1.5 times larger than normal adjacent artery, with the right coronary artery as the most affected vessel. Its pathophysiology is unclear but atherosclerosis is believed to be the main cause. CAA are generally asymptomatic but can cause coronary ischemia. Its treatment is yet to be established due to general ignorance about its nature. It ranges from conservative management to surgery. In the following text, we report a case of a patient with acute myocardial infarction presenting ST-segment elevation, who showed a right coronary artery aneurysm in coronary angiography. The patient required thrombectomy, angioplasty and subsequent lifetime outpatient medical management.


Os aneurismas das artérias coronárias (AAC) são pouco comuns, com uma incidência de 0.3-5.3%. Se definem como uma dilatação 1.5 vezes maior ao diâmetro interno da artéria normal adjacente. A artéria coronária direita é a mais comumente afetada. Sua fisiopatologia é pouco clara, mas se crê que uma das suas principais causas é a aterosclerose. Os AAC são geralmente assintomáticos ou podem estar associados a isquemia miocárdica. Seu tratamento ainda não está bem estabelecido, devido ao desconhecimento geral sobre sua história natural, e inclui desde um manejo conservador até o tratamento cirúrgico. A continuação, se reporta o caso de um paciente com infarto agudo de miocárdio e elevação do segmento ST, levado a coronariografia que evidenciou aneurisma da coronária direita, que requereu trombectomia, angioplastia e manejo médico vitalício ambulatório.


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Aneurysm , Coronary Angiography , Myocardial Ischemia , Angioplasty , Coronary Vessels , Myocardial Infarction
6.
Int. j. morphol ; 40(4): 1147-1151, 2022. ilus, tab
Article in English | LILACS-Express | LILACS | ID: biblio-1405244

ABSTRACT

SUMMARY: The ongoing advances in the technology of coronary artery angiograms have put high demands on the basic knowledge of coronary arteries. This study describes the angiographic morphology of the ostium (orifice) of the left coronary artery among Sudanese with respect to sex, age, length, and BMI. The study design is a cross-sectional retrospective hospital-based conducted from 2014 to 2016. The inclusion criterion of participants is adult males and females presented to the cardiac centers for elective angiograms. The exclusion criteria are age below 18 years, documented congenital heart disease, and previous coronary bypass. Angiograms were done using a digital radiographic system. Data was collected through a predesigned data collection sheet. The data were entered and analyzed using SPSS v27. A test of correlation was done between the different variables. The data were presented in the form of tables. A P-value of <0.05 was considered statistically significant. The total number of participants was 441; males and females represent 42.9 % and 57,1 %, respectively. The mean age of participants was 56.24±8.68 years. The left coronary artery originated from the left aortic sinus. The mean diameter and length of the left coronary artery were 3.8±0.70 mm and 8.1576±4.32 mm, respectively. A significant negative correlation was reported between the diameter of the orifice and both age and length of the left coronary artery. A non-significant difference between males and females in the diameter of the left coronary artery at ostium (P=0.058) and a significant difference in the length (P=0.00). Sudanese have the smallest diameter of the orifice of the left coronary artery among Africans. Sudanese males have a smaller diameter of orifice than females; females have the longest arteries. A wider orifice of the left coronary artery is associated with a short arterial length.


RESUMEN: Los avances en la tecnología de los angiogramas de las arterias coronarias constituyen importantes exigencias al conocimiento básico de las arterias coronarias. Este estudio describe la morfología angiográfica del ostio de la arteria coronaria izquierda (ACI) entre los sudaneses respecto al sexo, la edad, la longitud y el IMC. El estudio es un diseño hospitalario retrospectivo transversal realizado entre 2014 y 2016. El criterio de inclusión de los participantes, hombres y mujeres adultos, fue aquellos que se realizaron angiografías electivas en los centros cardiológicos Los criterios de exclusión fueron: edad menor de 18 años, cardiopatía congénita documentada y bypass coronario previo. Los angiogramas se realizaron utilizando un sistema radiográfico digital. Los datos se obtuvieron a través de una ficha de datos prediseñada. Estos fueron ingresados y analizados con SPSS v27. Se realizó una prueba de correlación entre las diferentes variables. Los datos se presentaron en forma de tablas. Un valor P de <0,05 se consideró estadísticamente significativo. El número total de participantes fue de 441; Hombres y mujeres representanron el 42,9 % y 57,1 %, respectivamente. La edad media de los participantes fue de 56,24±8,68 años. La arteria coronaria izquierda se originaba en el seno aórtico izquierdo. El diámetro medio y la longitud de la arteria coronaria izquierda fueron 3,8±0,70 mm y 8,1576±4,32 mm, respectivamente. Se encontró una correlación negativa significativa entre el diámetro del ostio, la edad y la ACI. Además se encontró una diferencia no significativa entre hombres y mujeres en el diámetro del ostio de la ACI (P=0,058) y una diferencia significativa en la longitud (P=0,00). Los sudaneses tienen el diámetro del ostio de la arteria coronaria izquierda más pequeño entre los africanos. Los hombres sudaneses tienen un diámetro del ostio de la arteria coronaria izquierda más pequeña y las mujeres tienen las arterias más largas. Un ostio más ancho de la arteria coronaria izquierda se asocia con una longitud arterial corta.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Coronary Vessels/diagnostic imaging , Sudan , Angiography , Cross-Sectional Studies , Retrospective Studies , Coronary Vessels/anatomy & histology
7.
Femina ; 50(1): 61-64, 2022. ilus
Article in Portuguese | LILACS | ID: biblio-1358222

ABSTRACT

O infarto agudo do miocárdio no período gravídico-puerperal é uma condição rara em que a principal causa é a dissecção espontânea da artéria coronária. É um evento comumente subdiagnosticado, com pouca literatura disponível e elevado índice de morbimortalidade. Esse relato descreve o caso de uma gestante de 36 semanas de gravidez gemelar, monocoriônica-diamniótica, com infarto agudo do miocárdio secundário à dissecção espontânea da artéria coronária. As equipes de cirurgia cardíaca e obstetrícia optaram pela realização de parto cesariano e histerectomia subtotal, seguido da revascularização da artéria mamária descendente anterior. Discutem-se as orientações adotadas na dissecção espontânea da artéria coronária, bem como a abordagem terapêutica e a conduta obstétrica, quando essa condição ocorre durante a gravidez.(AU)


Acute myocardial infarction in the pregnancy-puerperal period is a rare condition the main cause of which is the spontaneous coronary artery dissection. A commonly underdiagnosed event with little available literature and a high rate of morbidity and mortality. This case reports a 36-week pregnant woman of mono-chorionic-diamniotic pregnancy who had a myocardial infarction secondary to a spontaneous coronary artery dissection. In a joint discussion between the team of cardiac surgery and obstetrics, it was decided to perform a cesarean delivery and subtotal hysterectomy followed by revascularization of the mammary anterior descendant. It discusses the conducts to be adopted in a case of spontaneous coronary artery dissection as well as therapeutic approaches and obstetric conducts to be taken in a case of dissection during pregnancy.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/surgery , Coronary Vessels/pathology , Dissection/adverse effects , Acute Coronary Syndrome/pathology , Myocardial Infarction/complications , Cesarean Section , Pregnancy, High-Risk , Pregnancy, Twin , Heart Disease Risk Factors , Hysterectomy , Myocardial Infarction/etiology
8.
Article in Chinese | WPRIM | ID: wpr-939648

ABSTRACT

OBJECTIVES@#To summarize the clinical features of liver damage in children in the acute stage of Kawasaki disease (KD), and to investigate the clinical value of liver damage in predicting coronary artery lesion and no response to intravenous immunoglobulin (IVIG) in children with KD.@*METHODS@#The medical data were collected from 925 children who were diagnosed with KD for the first time in Beijing Children's Hospital from January 1, 2016 to December 31, 2017. According to the presence or absence of abnormal alanine aminotransferase (ALT) level on admission, the children were divided into a liver damage group (n=284) and a non-liver damage group (n=641). A logistic regression analysis was used to investigate the clinical value of the indicators including liver damage in predicting coronary artery lesion and no response to IVIG in children with KD.@*RESULTS@#Compared with the non-liver damage group, the liver damage group had a significantly earlier admission time and significantly higher serum levels of inflammatory indicators (P<0.05). The liver damage group had a significantly higher incidence rate of coronary artery lesion on admission than the non-liver damage group (P=0.034). After initial IVIG therapy, the liver damage group had a significantly higher proportion of children with no response to IVIG than the non-liver damage group (P<0.001). In children with KD, coronary artery lesion was associated with the reduction in the hemoglobin level and the increases in platelet count, C-reactive protein, and ALT (P<0.05), and no response to IVIG was associated with limb changes, the reduction in the hemoglobin level, the increases in platelet count, C-reactive protein, and ALT, and coronary artery lesion (P<0.05).@*CONCLUSIONS@#Compared with those without liver damage, the children in the early stage of KD with liver damage tend to develop clinical symptoms early and have higher levels of inflammatory indicators, and they are more likely to have coronary artery lesion and show no response to IVIG treatment.


Subject(s)
C-Reactive Protein/analysis , Child , Coronary Vessels/pathology , Hemoglobins/analysis , Humans , Immunoglobulins, Intravenous/therapeutic use , Liver Diseases , Mucocutaneous Lymph Node Syndrome/drug therapy , Retrospective Studies
9.
Article in Chinese | WPRIM | ID: wpr-939636

ABSTRACT

Kawasaki disease (KD) is one of the common acquired heart diseases in children aged <5 years and is an acute systemic vasculitis. After nearly 60 years of research, intravenous immunoglobulin combined with oral aspirin has become the first-line treatment for the prevention of coronary artery lesion in acute KD; however, there are still controversies over the role and optimal dose of aspirin. The consensus was formulated based on the latest research findings of KD treatment in China and overseas and comprehensive discussion of pediatric experts in China and put forward recommendations on the dose, usage, and course of aspirin treatment in the first-line treatment of KD.


Subject(s)
Aspirin/therapeutic use , Child , Consensus , Coronary Vessels/pathology , Humans , Immunoglobulins, Intravenous/therapeutic use , Mucocutaneous Lymph Node Syndrome/pathology
10.
Article in Chinese | WPRIM | ID: wpr-928230

ABSTRACT

To explore the influence of bionic texture coronary stents on hemodynamics, a type of bioabsorbable polylactic acid coronary stents was designed, for which a finite element analysis method was used to carry out simulation analysis on blood flow field after the implantation of bionic texture stents with three different shapes (rectangle, triangle and trapezoid), thus revealing the influence of groove shape and size on hemodynamics, and identifying the optimal solution of bionic texture groove. The results showed that the influence of bionic texture grooves of different shapes and sizes on the lower wall shear stress region had a certain regularity. Specifically, the improvement effect of grooves above 0.06 mm on blood flow characteristics was poor, and the effect of grooves below 0.06 mm was good. Furthermore, the smaller the size is, the better the improvement effect is, and the 0.02 mm triangular groove had the best improvement effect. Based on the results of this study, it is expected that bionic texture stents have provided a new method for reducing in-stent restenosis.


Subject(s)
Bionics , Computer Simulation , Coronary Vessels , Hemodynamics/physiology , Models, Cardiovascular , Stents , Stress, Mechanical
11.
Repert. med. cir ; 31(2): 161-169, 2022. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1382276

ABSTRACT

Introducción: un evento de muerte súbita supone un gran impacto para la sociedad, siendo importante su estudio para aportar conocimiento y fortalecer estrategias de promoción y prevención. Objetivo: determinar la prevalencia de los diagnósticos anatomopatológicos cardiacos definitivos y los hallazgos histopatológicos asociados con la muerte súbita de origen cardíaco en los pacientes sometidos a autopsias clínicas realizadas en el Hospital de San José de Bogotá DC, Colombia, durante el período 2015 a 2018. Métodos: estudio descriptivo de corte transversal retrospectivo en pacientes a quienes se les realizó autopsia con diagnóstico de muerte súbita de origen cardiovascular en el servicio de patología del Hospital de SanJosé, Bogotá DC, Colombia. Resultados: se incluyeron 178 autopsias con diagnóstico de muerte súbita cardíaca. El promedio global de edad fue 56.1 años (DE: 15.06) con una relación hombre-mujer de 3:1. El hallazgo macroscópico más frecuente fue cardiomegalia (promedio 428.1 g (DE 112.8), acompañado de la presencia de coronariopatía esclerótica (p=0.000) con obstrucción de la luz de las arterias coronarias mayores de 80% (p=0.037). Conclusiones: los diagnósticos anatomopatológicos definitivos prevalentes en la muerte súbita cardiaca fueron cardiopatía isquémica crónica complicada (65%) e infarto agudo de miocardio (16%), datos similares a los reportados a nivel mundial. La cardiomegalia es un hallazgo frecuente que debe valorarse en forma cuidadosa.


Introduction: a sudden death incident has a great impact on society and its study is important to provide understanding for strengthening promotion and prevention strategies. Objective: to determine the prevalence of definitive anatomopathological cardiac diagnoses and histopathological findings associated with sudden death due to a cardiovascular cause based on autopsies performed at Hospital de San José in Bogotá DC, Colombia, during the period between 2015 and 2018. Methods: retrospective descriptive cross-sectional study of cases of sudden cardiac death of cardiovascular origin diagnosed in autopsies performed at the pathology service of Hospital de San José, Bogotá DC, Colombia. Results: 178 autopsies with a diagnosis of sudden cardiac death were included. The overall mean age was 56.1 years (SD: 15.06). Male/female ratio was 3:1. The most frequent macroscopic finding was cardiomegaly (average 428.1 g (SD 112.8), with the presence of sclerotic coronary artery disease (p=0.000) with a blockage greater than 80% (p=0.037) in the major coronary arteries. Conclusions: the prevalent definitive anatomopathological diagnoses in SCD were complicated chronic ischemic heart disease (65%) and acute myocardial infarction (16%). Data obtained in this study is similar to that reported worldwide. Cardiomegaly is a frequent finding that should be carefully evaluated.


Subject(s)
Humans , Male , Female , Middle Aged , Death, Sudden, Cardiac , Coronary Vessels , Autopsy , Heart
12.
Ibom Medical Journal ; 15(2): 159-165, 2022. tables, figures
Article in English | AIM | ID: biblio-1379854

ABSTRACT

Background: Peripheral artery disease (PAD) is a progressive disorder characterized by stenosis and/or occlusion of large and medium-sized arteries, other than those that supply the heart (coronary artery disease, CAD) or the brain (cerebrovascular disease). It is increasingly becoming a challenge in developing countries owing to poverty and ignorance. Objective: To review the scourge of peripheral artery diseases in our institution in a low-income setting with a view to determining the role of a vascular surgeon. Materials and method: Over a period of 15 years (2006 to 2021), patients with documented PAD were reviewed. Data of the patients were retrieved from the record department and such data included demography, aetiology/risk factors, clinical features and investigative parameters as well as modes of treatment especially vascular surgery. Results: There were 35 patients which comprised 20 males and 15 females with male to female ratio of 4:3. Age range affected most was 71-80 years. Aetiologically, artherosclerosis was dominant. Leriche Fontaine classification used in clinical evaluation showed that type III was dominant. 6 Ps (pain, pulselessness, paralysis, paraesthesie, pallor and poikilothermia) of vascular ischemia were evident. Doppler/duplex ultrasound and computer angiography were used in diagnosis. Medical and or surgical treatments were used in patients' management. Vascular and or orthopedic surgery played significant role. Conclusion: PAD affects the lower extremities more commonly than the upper extremity vessels especially in the elderly leading to intermittent claudicationn which is the most recognized symptomatic subset of lower extremity PAD. Morbidity and mortality emanating from inadequate revascularization are burden to emerging economy like ours.


Subject(s)
Humans , Male , Female , Angioplasty, Laser , Coronary Vessels , Vascular Surgical Procedures , Cerebrovascular Disorders , Endarterectomy, Carotid , Cardiovascular Nursing
13.
Ann. afr. méd. (En ligne) ; 16(1): 4931-4938, 2022. tales, figures
Article in French | AIM | ID: biblio-1410559

ABSTRACT

Contexte et objectif. La maladie athéromateuse dont la coronaropathie étant une pathologie diffuse peut être prévenue par le contrôle des facteurs de risqué cardiovasculaire. Le but de cette étude était de décrire les caractéristiques pharmaco doppler pénien des patients coronariens souffrant de dysfonction érectile. Méthodes. Il s'agissait d'une série analytique des cas suivie entre juin 2020 et février 2021. Elle concernait des patients ayant des lésions athéromateuses significatives à la coronographie et souffrant de dysfonction érectile. Nous avons évalué les caractéristiques pharmaco doppler pénien. La qualité d'érection était appréciée par le score de rigidité Erectile Hardness Score (EHS). Résultats. Trente-six patients étaient inclus. L'âge moyen était de 56 ± 8,4 ans. le pic de Vitesse systolique au repos (PSVr) moyen des patients était de 13,7 cm/s ± 5,9. Le pic de vitesse systolique post injection (PSV pi) moyen des patients était de 23,9 cm/s ± 5,4. Les causes étaient principalement artérielles de 75%. La qualité d'érection était appréciée selon le score EHS : E1 (83%), E2 (22%), E3 (5%) et E4 (3%). Conclusion. La dysfunction érectile est associée aux facteurs de risque cardiovasculaire selon plusieurs études. L'echodoppler pénien avait occupé une place importante dans le diagnostic étiologique. Les causes retrouvées étaient principalement artérielles avec une baisse de PSVpi<25 cm/s.


Subject(s)
Humans , Coronary Artery Disease , Heart Disease Risk Factors , Blood Pressure , Coronary Vessels , Erectile Dysfunction
14.
Rev. Nac. (Itauguá) ; 13(2): 29-39, DICIEMBRE, 2021.
Article in Spanish | LILACS-Express | LILACS, BDNPAR | ID: biblio-1348675

ABSTRACT

RESUMEN Introducción: la cardiopatía dilatada definida como la dilatación de cavidades cardiacas de múltiples etiologías tiene una prevalencia en adultos de alrededor de 1/2.500 individuos. La ecocardiografía transtorácica determina la dilatación de cavidades y evalúa la función ventricular mientras que la cinecoronariografía permite identificar la etiología principalmente isquémica por afección de arterias coronarias epicárdicas. La utilización de la cinecoronariografía como primera línea para el diagnóstico etiológico, implica riesgos propios de un método invasivo con un alto costo en recursos económicos, por lo cual es imperioso determinar el posible resultado de dicho procedimiento. Objetivo: determinar la frecuencia de lesiones coronarias epicárdicas en pacientes con Cardiopatía Dilatada en un Departamento de Cardiología en el periodo del 2015 ­ 2021. Metodología: estudio observacional, descriptivo, retrospectivo y de corte transversal con muestreo no probabilístico por conveniencia, mediante la revisión en la base de datos en un Departamento de Cardiología. Resultados: este estudio incluyó a 88 pacientes, con disnea en clase funcional II-IV de la NYHA y cardiopatía dilatada por ecocardiografía, de etiología no filiada. De éste grupo, 66 % eran varones y 34 % mujeres, la media de edad fue de 56 ± 11,19 años. Al ser sometidos a cinecoronariografía diagnostica, se constató que el 23 % presentó lesiones coronarias epicárdicas, siendo la más frecuente la lesión de un vaso (55 %), predominando el sexo masculino en aquellos con o sin lesiones coronarias epicárdicas. Conclusiones: la frecuencia de lesiones coronarias epicárdicas en pacientes con cardiopatía dilatada, es baja.


ABSTRACT Introduction: dilated heart disease defined as the dilation of cardiac cavities of multiple etiologies has a prevalence in adults of around 1/2.500 individuals. Transthoracic echocardiography determines chamber dilation and evaluates ventricular function, while coronary angiography can identify the mainly ischemic etiology due to involvement of the epicardial coronary arteries. The use of coronary angiography as the first line for the etiological diagnosis implies risks of an invasive method with a high cost in economic resources, for which it is imperative to determine the possible result of said procedure. Objective: to determine the frequency of epicardial coronary lesions in patients with Dilated Heart Disease in a Departmento de Cardiología in the period 2015-2021. Methodology: observational, descriptive, retrospective and cross-sectional study with non-probabilistic convenience sampling, by reviewing the database in a Departmento de Cardiología. Results: this study included 88 patients, with dyspnea in NYHA functional class II-IV and dilated heart disease by echocardiography, of unknown etiology. Out of this group, 66% were men and 34 % women, the mean age was 56 ± 11.19 years. When undergoing diagnostic cinecoronariography, it was found that 23 % had epicardial coronary lesions, the most frequent being a lesion of a vessel (55 %), with the male sex predominating in those with or without epicardial coronary lesions. Conclusions: the frequency of epicardial coronary lesions in patients with dilated heart disease is low.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Coronary Vessels , Heart Diseases , Echocardiography , Dyspnea
16.
Arq. bras. cardiol ; 117(3): 503-510, Sept. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1339182

ABSTRACT

Resumo Fundamento: Os efeitos benéficos do elabela no sistema cardiovascular foram demonstrados em estudos. Objetivo: Comparar os níveis séricos de elabela de pacientes com oclusão total crônica (OTC) com pacientes controle com artérias coronárias normais e investigar se há correlação com o desenvolvimento colateral. Métodos: Estudo transversal e prospectivo. O estudo incluiu cinquenta pacientes (28,0% mulheres, idade média 61,6±7,3 anos) com OTC em pelo menos um vaso coronário e 50 pacientes (38% mulheres, idade média 60,7±6,38 anos) com artérias coronárias normais. Os pacientes do grupo OTC foram divididos em dois grupos: Rentrop 0-1, composto por pacientes com fraco desenvolvimento colateral e Rentrop 2-3, composto por pacientes com bom desenvolvimento colateral. Além da idade, sexo, características demográficas e exames laboratoriais de rotina dos pacientes, foram medidos os níveis de elabela. Resultados: As características demográficas e os valores laboratoriais mostraram-se semelhantes em ambos os grupos. Ao passo que o nível médio de NT-proBNP e troponina estava maior no grupo OTC, o nível médio de elabela estava menor (p<0,05 para todos). Na análise de regressão multivariada, os níveis de NT-proBNP e elabela foram considerados preditores independentes para OTC. Além disso, o nível de elabela apresentou-se estatisticamente maior em pacientes do grupo Rentrop 2-3 em comparação com os pacientes do grupo Rentrop 0-1 (p<0,05). Conclusões: Em nosso estudo, mostramos que o nível médio de elabela estava baixo em pacientes com OTC em comparação com pacientes normais. Além disso, constatamos que o nível de elabela é inferior em pacientes com desenvolvimento colateral fraco em comparação com pacientes com bom desenvolvimento colateral. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)


Abstract Background: The beneficial effects of Elabela on the cardiovascular system have been shown in studies. Objective: To compare serum Elabela levels of chronic total occlusion (CTO) patients with control patients with normal coronary arteries, and to investigate whether there is a correlation with collateral development. Methods: The study was planned cross-sectionally and prospectively. Fifty patients (28.0% female, mean age 61.6±7.3years) with CTO in at least one coronary vessel and 50 patients (38% female, mean age 60,7±6.38 years) with normal coronary arteries were included in the study. Patients in the CTO group were divided into two groups as Rentrop 0-1, those with weak collateral development, and Rentrop 2-3 with good collateral development. In addition to the age, sex, demographic characteristics and routine laboratory tests of the patients, Elabela levels were measured. Results: Demographic characteristics and laboratory values were similar in both groups. While the mean NT-proBNP and troponin were higher in the CTO group, the Elabela mean was lower (p <0.05 for all). In the multivariate regression analysis, NT-proBNP and Elabela levels were found to be independent predictors for CTO. Also, Elabela level was found to be statistically higher in Rentrop class 2-3 patients compared to Rentrop class 0-1 patients (p<0.05). Conclusion: In our study, we showed that the average Elabela level was low in CTO patients compared to normal patients. In addition, we found the level of Elabela to be lower in patients with weak collateral development compared to patients with good collateral development. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)


Subject(s)
Humans , Male , Female , Aged , Coronary Occlusion , Angina, Stable , Chronic Disease , Multivariate Analysis , Coronary Angiography , Collateral Circulation , Coronary Vessels , Middle Aged
18.
Medicina (B.Aires) ; 81(3): 375-381, jun. 2021. graf
Article in Spanish | LILACS | ID: biblio-1346472

ABSTRACT

Los síndromes coronarios agudos sin lesiones coronarias han cobrado relevancia en los últimos años, pero aún no se dispone de datos locales. Analizamos un registro de pacientes con infarto agudo de miocardio, en 45 centros del país con residencias de cardiología. Se analizaron 1182 participantes de los cuales 33 (2.8%) no presentaron lesiones coronarias en angiografía, mientras que 89.5% tenían lesiones graves y 7.7% lesiones intermedias. La edad promedio de los pacientes sin lesiones coronarias fue 64.5 ± 13.0 años, 69.7% eran varones, sin diferencias respecto a aquellos con enfermedad epicárdica. La presentación electrocardiográfica más frecuente fue la desviación del segmento ST (13 supradesnivel y 10 infradesnivel del segmento). Además, este subgrupo presentó biomarcadores más bajos (CPK pico 203.5 UI/l, rango [RIC] 102- 422.5 vs. 895.5 UI/l RIC 350-1891, p < 0.0001). La mediana de días de internación fue 4.0 (RIC 3-5.5), siendo menor que la del grupo con enfermedad coronaria intermedia y grave (5.5 días, RIC 4-7, y 6 RIC 4-7, p = 0.003). Al alta, aquellos sin lesiones coronarias recibieron menor prescripción de IECA/ARA II (54.6% vs. 78.0% y 79.7%, p = 0.002) y estatinas (78.8% vs. 87.9% y 91.9%, p = 0.017). Ninguno de este subgrupo falleció durante la inter nación. Nuestros datos sugieren que los infartos sin lesiones coronarias significativas son frecuentes en nuestro medio, aunque probablemente se encuentren subdiagnosticados. Si bien su pronóstico parece más favorable, resulta importante señalar que recibieron menos fármacos para prevenir su recurrencia. Nuevos estudios son necesarios para profundizar el conocimiento de esta enfermedad.


Abstract Acute coronary syndromes without coronary lesions have gained relevance in recent years. However, local data on this condition is scarce. We aimed to explore this entity in a National registry of acute myocardial infarction that was carried out prospectively in hospitals with cardiology residence programs from Ar gentina. We included 1182 patients from 45 centers, where 33 did not present coronary lesions on angiography. The mean age was 64.5 ±13.0 and 69.7% were male, without differences compared to participants with epicardial disease. The most common electrocardiographic presentation was ST segment deviation. In addition, presented lower biomarkers (peak CPK 203.5 IU / l, range [IQR] 102-422.5 vs. 895.5 IU / l IQR 350-1891, p < 0.0001). The median hospitalization was 4.0 days (IQR 3-5.5), lower than the group with intermediate and severe coronary disease (5.5 days, RIC 4-7, and 6, RIC 4-7, p = 0.003). At discharge, less use of ACE/ARB (54.6% vs.78.0% y 79.7%, p = 0.002) and statins (78.8% vs. 87.9% y 91.9%, p = 0.017). No deaths during hospitalization were reported. Our data suggested that infarcts without significant coronary lesions are frequent, although they are probably underdiagnosed. Their prognosis seems to be more favorable, but they receive fewer drugs to prevent recurrence. New studies are necessary to deepen the knowledge of the disease.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Vessels/diagnostic imaging , Myocardial Infarction/epidemiology , Myocardial Infarction/diagnostic imaging , Argentina/epidemiology , Angiotensin-Converting Enzyme Inhibitors , Registries , Risk Factors , Coronary Angiography , Angiotensin Receptor Antagonists
19.
Rev. bras. cir. cardiovasc ; 36(3): 433-435, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1288244

ABSTRACT

Abstract A 32-year-old man diagnosed with Kawasaki disease at the age of three years presented with coronary artery aneurysm (CAA). The aneurysm increased in size, and the patient was referred to our hospital for surgery. Preoperative computed tomography scan showed a super-giant right CAA and giant left CAAs; surgery was performed. The super-giant right CAA was resected, and the ostium of the right coronary artery was closed; then, coronary artery bypass grafting was performed. The left CAAs were not treated surgically because the risk of rupture was low. Here, we describe the successful surgical treatment of a right super-giant CAA.


Subject(s)
Humans , Male , Child, Preschool , Adult , Coronary Aneurysm/surgery , Coronary Aneurysm/etiology , Coronary Aneurysm/diagnostic imaging , Mucocutaneous Lymph Node Syndrome/complications , Tomography, X-Ray Computed , Coronary Artery Bypass , Coronary Vessels/surgery , Coronary Vessels/diagnostic imaging
20.
Arq. bras. cardiol ; 116(6): 1091-1098, Jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1278330

ABSTRACT

Resumo Fundamento A quantificação não invasiva da reserva fracionada de fluxo miocárdico (FFR TC ) através de software baseado em inteligência artificial em versão mais atualizada e tomógrafo de última geração (384 cortes) apresenta elevada performance na detecção de isquemia coronariana. Objetivos Avaliar o desempenho diagnóstico da FFR TC na detecção de doença arterial coronariana (DAC) significativa em relação ao FFRi, em tomógrafos de gerações anteriores (128 e 256 cortes). Métodos Estudo retrospectivo com pacientes encaminhados à angiotomografia de artérias coronárias (TCC) e cateterismo (FFRi). Foram utilizados os tomógrafos Siemens Somatom Definition Flash (256 cortes) e AS+ (128 cortes). A FFR TC e a área luminal mínima (ALM) foram avaliadas em software (cFFR versão 3.0.0, Siemens Healthineers, Forchheim, Alemanha). DAC obstrutiva foi definida como TCC com redução luminal ≥50% e DAC funcionalmente obstrutiva como FFRi ≤0,8. Todos os valores de p reportados são bicaudais; e quando <0,05, foram considerados estatisticamente significativos. Resultados Noventa e três pacientes consecutivos (152 vasos) foram incluídos. Houve boa concordância entre FFR TC e FFRi, com mínima superestimação da FFR TC (viés: -0,02; limites de concordância: 0,14 a 0,09). Diferentes tomógrafos não modificaram a relação entre FFR TC e FFRi (p para interação = 0,73). A FFR TC demonstrou performance significativamente superior à classificação visual de estenose coronariana (AUC 0,93 vs. 0,61, p <0,001) e à ALM (AUC 0,93 vs. 0,75, p <0,001) reduzindo o número de casos falso-positivos. O melhor ponto de corte para a FFR TC utilizando um índice de Youden foi de 0,85 (sensiblidade, 87%; especificidade, 86%; VPP, 73%; NPV, 94%), com redução de falso-positivos. Conclusão FFR TC baseada em inteligência artificial, em tomógrafos de gerações anteriores (128 e 256 cortes), apresenta boa performance diagnóstica na detecção de DAC, podendo ser utilizada para reduzir procedimentos invasivos.


Abstract Background The non-invasive quantification of the fractional flow reserve (FFRCT) using a more recent version of an artificial intelligence-based software and latest generation CT scanner (384 slices) may show high performance to detect coronary ischemia. Objectives To evaluate the diagnostic performance of FFRCT for the detection of significant coronary artery disease (CAD) in contrast to invasive FFR (iFFR) using previous generation CT scanners (128 and 256- detector rows). Methods Retrospective study with patients referred to coronary artery CT angiography (CTA) and catheterization (iFFR) procedures. Siemens Somatom Definition Flash (256-detector rows) and AS+ (128-detector rows) CT scanners were used to acquire the images. The FFRCT and the minimal lumen area (MLA) were evaluated using a dedicated software (cFFR version 3.0.0, Siemens Healthineers, Forchheim, Germany). Obstructive CAD was defined as CTA lumen reduction ≥ 50%, and flow-limiting stenosis as iFFR ≤0.8. All reported P values are two-tailed, and when <0.05, they were considered statistically significant. Results Ninety-three consecutive patients (152 vessels) were included. There was good agreement between FFRCT and iFFR, with minimal FFRCT overestimation (bias: -0.02; limits of agreement:0.14-0.09). Different CT scanners did not modify the association between FFRCT and FFRi (p for interaction=0.73). The performance of FFRCT was significantly superior compared to the visual classification of coronary stenosis (AUC 0.93vs.0.61, p<0.001) and to MLA (AUC 0.93vs.0.75, p<0.001), reducing the number of false-positive cases. The optimal cut-off point for FFRCT using a Youden index was 0.85 (87% Sensitivity, 86% Specificity, 73% PPV, 94% NPV), with a reduction of false-positives. Conclusion Machine learning-based FFRCT using previous generation CT scanners (128 and 256-detector rows) shows good diagnostic performance for the detection of CAD, and can be used to reduce the number of invasive procedures.


Subject(s)
Humans , Coronary Artery Disease , Coronary Stenosis , Fractional Flow Reserve, Myocardial , Severity of Illness Index , Artificial Intelligence , Tomography, X-Ray Computed , Predictive Value of Tests , Retrospective Studies , Coronary Angiography , Constriction, Pathologic , Coronary Vessels , Machine Learning , Computed Tomography Angiography
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