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1.
Enferm. foco (Brasília) ; 11(2): 139-145, jul. 2020. graf, tab
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1104395

ABSTRACT

Objetivos: identificar e analisar os principais desfechos secundários dos pacientes com insuficiência cardíaca, no período de 2009 a 2019, em Juiz de Fora, região da zona mata mineira. Metodologia: estudo epidemiológico a partir de dados coletados de julho a agosto de 2019 no site do Departamento de Informática do Sistema Único de Saúde (DATASUS), de domínio público no Brasil. Foram selecionados como principais desfechos secundários: taxa de hospitalização, mortalidade e custo econômico associado ao tratamento da insuficiência cardíaca. Resultados: no período houve 16.338 internações, 1.280 óbitos e custos com despesas hospitalares que ultrapassaram os 22 milhões de reais. Conclusão: os dados confirmam o impacto da insuficiência cardíaca como uma doença crônica de alta taxa de internação hospitalar, mortalidade e de elevado custo. (AU)


Objectives: To identify and analyze the main secondary outcomes of heart failure patients from 2009 to 2019 in Juiz de Fora, a Brazilian city of Minas Gerais. Methodology: Epidemiological study from data collected from July to August 2019 on the website of the Department of Informatics of the Unified Health System (DATASUS), in the public domain in Brazil. The main secondary outcomes were selected: hospitalization rate, mortality and economic cost associated with the treatment of heart failure. Results: In the period there were 16,338 hospitalizations, 1,280 deaths and costs with hospital expenses that exceeded 22 million reais. Conclusion: The data confirm the impact of heart failure as a chronic disease with high hospitalization rate, mortality and high cost. (AU)


Objetivos: Identificar y analizar los principales desfechos secundários dos pacientes con insuficiencia cardíaca en el período de 2009 a 2019 en Juiz de Fora, ciudad brasileña de la región de la zona minera. Metodología: Estudio epidemiológico basado en datos colectados de julio a agosto de 2019 en el sitio del Departamento de Informática del Sistema Único de Salud (DATASUS), del dominio público en Brasil. Se seleccionaron los principales resultados secundarios: tasa de hospitalización, mortalidad y costo económico asociado con el tratamiento de la insuficiencia cardíaca. Resultados: En el período hubo 16.338 hospitalizaciones, 1.280 muertes y costos con gastos hospitalarios que superaron los 22 millones de reales. Conclusión: Los datos confirman el impacto de la insuficiencia cardíaca como una enfermedad crónica con una alta tasa de hospitalización, mortalidad y alto costo. (AU)


Subject(s)
Epidemiology , Brazil , Mortality , Heart Failure , Hospitalization
2.
Enferm. actual Costa Rica (Online) ; (38): 163-178, Jan.-Jun. 2020. tab
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1090094

ABSTRACT

Resumo Analisar os fatores associados ao conhecimento de pessoas leigas acerca do suporte básico de vida. Estudo epidemiológico, descritivo, de corte transversal, desenvolvido com 65 funcionários de um Campus da Universidade do Estado da Bahia. Os dados foram coletados nos meses de fevereiro e março de 2019 e tabulados no software IBM SPSS versão 21.0. A análise foi realizada através de frequências descritivas, teste qui-quadrado de Pearson e Exato de Fisher, adotando um grau de significância de 95% e valor de p <0,05. Observou-se que 67,7% dos participantes não sabem o que é suporte básico de vida, 61,5% não se sentem preparadas para agir em emergência, 58,5% não saberia como facilitar a respiração de uma vítima, 64,7% não sabem a quantidade de compressões realizadas por minuto e 86,2% não sabem a função do desfibrilador externo automático. No que se refere aos fatores associados, o conhecimento sobre suporte básico está associado a ser docente, (p=0,005), sentirse preparado para atuar em situações de emergência (p=0,001), saber como facilitar a respiração da vítima (p=0,000), saber o local de realização das compressões torácicas (p=0,013). O estudo levanta a necessidade de maior capacitação de pessoas leigas acerca do suporte básico de vida para que possam assistir adequadamente as vítimas de parada cardíaca em ambiente extra-hospitalar.


Abstract To analyze the factors associated with the knowledge of lay people about basic life support. This is a descriptive cross-sectional epidemiological study, conducted with 65 employees from a Campus at the State University of Bahia. Data were collected in February and March 2019 and tabulated in IBM SPSS version 21.0 software. The analysis was performed using descriptive frequencies, Pearson's chi-square test and Fisher's exact test, adopting a significance level of 95% and p value <0.05. It was observed that 67.7% of participants do not know what is basic life support, 61.5% do not feel prepared to act in emergency, 58.5% would not know how to facilitate the breathing of a victim, 64.7% do not know the amount of compressions performed per minute and 86.2% do not know the function of the automatic external defibrillator. Regarding associated factors, knowledge about basic support is associated with being a teacher (p = 0.005), feeling prepared to act in emergency situations (p = 0.001), knowing how to facilitate the victim's breathing (p = 0.001). = 0.000), know the location of the chest compressions (p = 0.013). The study raises the need for greater training of lay people about basic life support so that they can adequately assist victims of cardiac arrest in an out-of-hospital setting.


Resumen Analizar los factores asociados con el conocimiento de los laicos sobre el soporte vital básico. Este es un estudio epidemiológico descriptivo de corte transversal, realizado con 65 empleados de un campus de la Universidad Estatal de Bahía. Los datos se recopilaron en febrero y marzo de 2019 y se tabularon en el software IBM SPSS versión 21.0. El análisis se realizó utilizando frecuencias descriptivas, la prueba de chi-cuadrado de Pearson y la prueba exacta de Fisher, adoptando un nivel de significación del 95% y un valor de p <0,05. Se observó que el 67.7% de los participantes no sabe qué es el soporte vital básico, el 61.5% no se siente preparado para actuar en caso de emergencia, el 58.5% no sabe cómo facilitar la respiración de una víctima, el 64,7% desconoce la cantidad de compresiones realizadas por minuto y el 86,2% desconoce la función del desfibrilador externo automático. Con respecto a los factores asociados, el conocimiento sobre el apoyo básico se asocia con ser un maestro (p = 0.005), sentirse preparado para actuar en situaciones de emergencia (p = 0.001), saber cómo facilitar la respiración de la víctima (p = 0.001). = 0.000), conoce la ubicación de las compresiones torácicas (p = 0.013). El estudio plantea la necesidad de una mayor capacitación de los laicos sobre el soporte vital básico para que puedan ayudar adecuadamente a las víctimas de un paro cardíaco en un entorno fuera del hospital.


Subject(s)
Humans , Brazil , Health Education , Cardiopulmonary Resuscitation , Health Promotion , Heart Arrest , Heart Failure
3.
Av. enferm ; 38(1): 9-17, ene.-abr. 2020. tab
Article in Spanish | LILACS (Americas), BDENF, COLNAL | ID: biblio-1089005

ABSTRACT

Resumen Objetivo: Dar a conocer el diseño, implementación y evaluación de una intervención de enfermería: "Toma de decisiones para el manejo de los síntomas en adultos con falla cardíaca". Métodos: Se realizó un proceso sistemático propuesto por Sidani y Braden que contempla cuatro fases: diseño de la intervención, operacionalización de la intervención en un manual de intervención, estudio de aceptabilidad, viabilidad y efectividad de la intervención y traducción de la intervención. Resultados: Se diseñó la intervención según los postulados de la teoría de situación específica autocuidado en falla cardíaca, centrada en la toma de decisiones para el manejo de los síntomas en adultos con falla cardíaca. Los expertos (n = 5) evaluaron satisfactoriamente el nivel teórico del protocolo (índice de cumplimiento 90 %). La tasa de reclutamiento de los participantes fue exitosa (91,6 %). En una muestra final para el análisis (n = 105) se halló una mejora significativa en el grupo de intervención (n = 53) en el mantenimiento del autocuidado [F (1,103) = 719,6; p = 0,000; η 2 p = 0,88 (f de Cohen's = 2,65)] y en la gestión del autocuidado [F (174) = 23501,07; p = 0,000; η 2 p = 0,97 (f de Cohen's = 5,6)] comparado con el grupo de control (n = 52) que recibió la atención habitual. Conclusiones: Se demuestra la fidelidad teórica y operacional, la factibilidad y efectividad del protocolo de una intervención de enfermería para mejorar el autocuidado en adultos con falla cardíaca con un tamaño de efecto grande.


Resumo Objetivo: Apresentar a criação, a implementação e a avaliação de uma intervenção de enfermagem: "Tomada de decisões para o gerenciamento dos sintomas em adultos com insuficiência cardíaca". Métodos: Realizou-se um processo sistemático proposto por Sidani e Braden que contempla quatro fases: criação da intervenção, operacionalização da intervenção em um manual de intervenção, estudo de aceitabilidade, viabilidade e efetividade da intervenção e tradução da intervenção. Resultados: Criou-se a intervenção segundo os postulados da teoria de situação específica autocuidado em insuficiência cardíaca, centrada na tomada de decisões para o gerenciamento dos sintomas em adultos com insuficiência cardíaca. Os especialistas (n = 5) avaliaram satisfatoriamente o nível teórico do protocolo (índice de cumprimento 90 %). A taxa de recrutamento dos participantes foi bem-sucedida (91,6 %). Em uma amostra final para a análise (n = 105), descobriu-se uma melhora significativa no grupo de intervenção (n = 53) na manutenção do autocuidado [F (1,103) = 719,6; p = 0,000; η 2 p =0,88 (f de Cohen's = 2,65)] e na gestão do auto-cuidado [F (1,74) = 23501,07; p = 0,000; η 2 p =0,97 (f de Cohen's = 5,6)] comparado com o grupo de controle (n = 52) que recebeu atendimento habitual. Conclusões: Demonstra-se a fidelidade teórica e operacional, a facti-bilidade e a efetividade do protocolo de uma intervenção de enfermagem para melhorar o autocuidado em adultos com insuficiência cardíaca com um tamanho de efeito grande.


Abstract Objective: To expose the design, implementation, and evaluation of a nursing intervention: "Decision-making for the management of symptoms in adults with heart failure". Methods: We realized a systematic process proposed by Sidani and Braden that contemplates four phases: design of the intervention, operationalization of the intervention in an intervention manual, study of acceptability, feasibility, and effectiveness of the intervention and translation of the intervention. Results: The intervention was designed according to the postulates of the specific situation theory self-care in heart failure, focused on decision-making for the management of symptoms in adults with heart failure. Experts (n = 5) successfully assessed the theoretical level of the protocol (compliance rate 90 %). The recruitment rate of the participants was successful (91.6 %). In a final sample for the analysis (n = 105), a significant improvement was found in the intervention group (n = 53) in the maintenance of self-care [F (1.103) = 719.6; p = 0.000; η 2 p = 0.88 (Cohen's f = 2.65)] and in the management of self-care [F (174) = 23501.07; p = 0.000; η 2 p = 0.97 (Cohen's f = 5.6)] compared to the control group (n = 52) that received the usual attention. Conclusions: It demonstrates the theoretical and operational fidelity, feasibility, and effectiveness of the protocol of a nursing intervention to improve self-care in adults with heart failure with a large effect size.


Subject(s)
Humans , Self Care , Cardiovascular Diseases , Health Education , Heart Failure , Attention , Nursing
4.
Rev. salud pública Parag ; 10(1): [P74-P79], mar. 2020.
Article in Spanish | LILACS (Americas), BDNPAR | ID: biblio-1087935

ABSTRACT

Las enfermedades cardiovasculares constituyen la principal causa de mortalidad y morbilidad en el mundo actualmente, lo que obliga a la realización de los continuos avances en las estrategias diagnóstico precoz y tratamiento con el fin de mejorar el pronóstico y disminuir la mortalidad. Sin duda esto abre las puertas al campo de la investigación y en los últimos años aparecen los llamados biomarcadores séricos y entre ellos los microARN (miARN) que juegan un papel fundamental tanto en el desarrollo y como en la regulación del sistema cardiovascular. Los microARN tienen un tamaño de 19-25 nucleótidos, son el grupo de ARN de pequeño tamaño que ha atraído mayor atención durante los últimos años. Hasta la fecha, se han identificado aproximadamente unos 2500 miARN en el genoma humano. Los miARN desempeñan un papel en la regulación de diversos procesos biológicos, como la embriogénesis, la proliferación y diferenciación celular, la apoptosis o la tumorogénesis. En el sistema cardiovascular, los miARN controlan el crecimiento y la contractilidad de los cardiomiocitos, el desarrollo y mantenimiento del ritmo cardíaco, la formación de la placa arterioesclerótica, el metabolismo de los lípidos y la angiogénesis. Además están vinculados en la fisiopatología de varias enfermedades cardiovasculares, fundamentalmente la insuficiencia cardiaca, el infarto de miocardio, la enfermedad coronaria, la ateroesclerosis, y las cardiomiopatías de diversas etiologías, de allí que su determinación en la circulación podría ser de utilidad en la práctica clínica como potencial biomarcador diagnóstico y pronóstico de las enfermedades cardiovasculares. Palabras clave: Micro RNA; Enfermedades cardiovasculares; Biomarcadores séricos.


Cardiovascular diseases are the main cause of mortality and morbidity in the world today, which forces the continuous progress in early diagnosis and treatment strategies in order to improve the prognosis and decrease mortality. Undoubtedly this opens the doors to the field of research and in recent years there are the so-called serum biomarkers and among them microRNAs (miRNAs) that play a fundamental role both in the development and in the regulation of the cardiovascular system. The microRNAs are 19 to 25 nucleotides in size, they are the small group of RNA that has attracted the most attention in recent years. To date, approximately 2,500 miRNAs have been identified in the human genome. The miRNAs play a role in the regulation of various biological processes, such as embryogenesis, cell proliferation and differentiation, apoptosis or oncogenesis. In the cardiovascular system, miRNAs control the growth and contractility of cardiomyocytes, the development and maintenance of heart rhythm, the formation of atherosclerotic plaque, lipid metabolism and angiogenesis. They are also linked in the pathophysiology of several cardiovascular diseases, mainly heart failure, myocardial infarction, coronary heart disease, atherosclerosis, and cardiomyopathies of various etiologies, hence their determination in circulation could be useful in clinical practice as a potential biomarker in the diagnosis and prognosis of cardiovascular diseases. Keywords: Micro RNA; Cardiovascular diseases; Serum biomarkers.


Subject(s)
Humans , Biomarkers , Cardiovascular Abnormalities , MicroRNAs , RNA , Cardiovascular Abnormalities/etiology , Heart Failure , Myocardial Infarction
5.
REME rev. min. enferm ; 24: e-1301, fev.2020.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1096591

ABSTRACT

Introdução: a insuficiência cardíaca (IC) é um grave problema de saúde. Pacientes com IC em estágio avançado apresentam, além de baixa expectativa de vida, alteração no nível de qualidade de vida (QV). Objetivo: analisar o nível de QV de pacientes com IC avançada, candidatos ou não ao transplante cardíaco (TC). Método: estudo transversal realizado em um hospital universitário brasileiro, em que os pacientes foram submetidos à avaliação da QV pelo Minnesota Living With Heart Failure Questionnaire (MLHFQ). Resultados: participaram do estudo 76 pacientes. A principal etiologia da IC foi a chagásica (25 pacientes). As classes funcionais mais frequentes foram NYHA II (26 pacientes) e III (33 pacientes). Pacientes em avaliação para TC e aqueles em fila para TC não apresentaram diferença estatisticamente significativa na avaliação do nível de QV. A pontuação dos pacientes segundo as dimensões avaliadas no MLHFQ foram: dimensão física com mediana 28,5; emocional, 13; outras questões, 21; e, no escore total, 61. O modelo final na análise multivariada demonstrou que a QV está associada a variáveis como classe funcional da IC, número de medicações em uso, número de comorbidades e a ocupação do lar. Discussão e Conclusão: a IC é doença grave, que impacta negativamente na sobrevida e na QV. Neste estudo, o nível de QV dos pacientes esteve associado à classe funcional da IC - NYHA, ao número de medicações em uso e à ocupação do lar. Ações que estimulem e favoreçam a adesão ao tratamento otimizado devem ser incentivadas.(AU)


Introduction: heart Failure (HF) is a serious health problem. Patients with an advanced stage of HF present, besides low life expectancy, a change in the Quality of Life (QoL) level. Objective: to analyze the QoL level of advanced HF patients, candidates or not for Heart Transplantation (HT). Method: a cross-sectional study carried out in a Brazilian university hospital, in which patients were submitted to QoL evaluation by the Minnesota Living With Heart Failure Questionnaire (MLHFQ). Results: 76 patients participated in the study. The main etiology of HF was chagasic (25 patients). The most frequent functional classes were NYHA II (26 patients) and III (33 patients). Patients under evaluation for HT and those in the queue for HT did not show a statistically significant difference in the evaluation of the QoL level. The score of the patients according to the dimensions assessed in the MLHFQ were the following: physical dimension with a median of 28.5; emotional, 13; other questions, 21; and, in the total score, 61. The final model in the multivariate analysis showed that QoL is associated with variables such as HF functional class, number of using medications, number of comorbidities and household occupation. Discussion and Conclusion: HF is a serious disease that ...(AU)


Introducción: la insuficiencia cardíaca (IC) es un problema de salud grave. Los pacientes con IC avanzada tienen, además de baja esperanza de vida, alteraciones en su calidad de vida (CV). Objetivo: analizar la calidad de vida de pacientes con IC avanzada, candidatos o no para trasplante de corazón (TC). Método: estudio transversal realizado en un hospital universitario brasileño, en el que los pacientes se sometieron a una evaluación de calidad de vida mediante el cuestionario Minnesota Living With Heart Failure Questionnaire (MLHFQ). Resultados: 76 pacientes participaron en el estudio. La etiología principal de la insuficiencia cardíaca fue mal de Chagas (25 pacientes). Las clases funcionales más frecuentes fueron NYHA II (26 pacientes) y III (33 pacientes). Los pacientes bajo evaluación para TC y aquellos en fila de espera para TC no mostraron diferencias estadísticamente significativas en la evaluación del nivel de calidad de vida. Las puntuaciones de los pacientes según las dimensiones evaluadas en el MLHFQ fueron: dimensión física con promedio de 28,5; emocional, 13; otros asuntos, 21; y, en el puntaje total, 61. El modelo final en el análisis multivariado demostró que la calidad de vida está asociada con variables como la clase funcional de IC, la cantidad de medicamentos en uso, la cantidad de comorbilidades y la ocupación dueña de casa. Discusión y conclusión: la insuficiencia cardíaca es una enfermedad grave que afecta negativamente la supervivencia y la calidad de vida. En este estudio, el nivel de calidad de vida de los pacientes se asoció con la clase funcional de IC - NYHA, la cantidad de medicamentos en uso y la ocupación dueña de casa. Deben fomentarse acciones que estimulen y favorezcan la adherencia al tratamiento optimizado.(AU)


Subject(s)
Humans , Quality of Life , Heart Transplantation , Heart Failure , Treatment Adherence and Compliance , Heart Diseases
6.
Arch. argent. pediatr ; 118(1): e67-e71, 2020-02-00. ilus
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-1096158

ABSTRACT

La coartación de aorta en neonatos se puede manifestar como insuficiencia cardíaca según el grado de obstrucción. Hay situaciones que pueden simular una coartación de aorta en los recién nacidos. Limitarse a la imagen típica de muesca aórtica en la ecocardiografía para diagnosticar una coartación de aorta puede inducir a error y demorar el diagnóstico adecuado. Se presenta el caso de un recién nacido con insuficiencia cardíaca con diagnóstico inicial de coartación de aorta y, posteriormente, de malformación arteriovenosa cerebral. Se debe considerar la malformación arteriovenosa en el diagnóstico diferencial de un recién nacido con insuficiencia cardíaca.


Coarctation of the aorta in neonates can manifest as heart failure when there is a certain degree of obstruction. There are some situations that can simulate a coarctation of the aorta in newborns. Diagnosis of coarctation of the aorta based solely on the typical aortic arch image on echocardiography can be misleading and delay an accurate diagnosis. We describe an unusual case of a newborn with heart failure who was initially diagnosed with coarctation of the aorta and then with cerebral arteriovenous malformation. We must consider the cerebral arteriovenous malformation in the differential diagnosis of a newborn with heart failure.


Subject(s)
Humans , Male , Infant, Newborn , Intracranial Arteriovenous Malformations/diagnostic imaging , Heart Failure , Embolization, Therapeutic , Hypertension, Pulmonary
8.
Korean Circulation Journal ; : 395-405, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-816678

ABSTRACT

Despite considerable efforts to prevent and treat cardiovascular disease (CVD), it has become the leading cause of death worldwide. Cardiac mitochondria are crucial cell organelles responsible for creating energy-rich ATP and mitochondrial dysfunction is the root cause for developing heart failure. Therefore, maintenance of mitochondrial quality control (MQC) is an essential process for cardiovascular homeostasis and cardiac health. In this review, we describe the major mechanisms of MQC system, such as mitochondrial unfolded protein response and mitophagy. Moreover, we describe the results of MQC failure in cardiac mitochondria. Furthermore, we discuss the prospects of 2 drug candidates, urolithin A and spermidine, for restoring mitochondrial homeostasis to treat CVD.


Subject(s)
Adenosine Triphosphate , Cardiovascular Diseases , Cause of Death , Heart Failure , Heart , Homeostasis , Mitochondria , Mitophagy , Organelles , Quality Control , Spermidine , Unfolded Protein Response
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-782287

ABSTRACT

The receptor of vitamin D is expressed in almost all body cells, including vascular endothelial cells and cardiomyocytes. Vitamin D deficiency has been observed widespread amongst heart failure (HF) patients, which could have harmful effects on their health condition. This study aims to investigate the effect of vitamin D supplements on blood pressure (BP) and physical activity of HF patients. Thirty-nine systolic HF patients with low ejection fraction (EF) < 50% and class III of New York Heart Association functional classification were randomly divided into 2 groups including intervention and placebo to enroll in an 8 weeks double-blind clinical trial. During the trial 6-minute walk test (6MWT), 25-hydroxyvitamin D (25[OH]D) level, BP, sodium and potassium intakes were assessed. The mean 25(OH)D level increased to 28.9 ± 11.7 ng/mL (p < 0.001) in the intervention group. There was a poor but non-significant reduction in systolic BP (−0.033 ± 4.71 mmHg, p = 0.531) in the intervention group. The BP also did not change in the placebo group at the end of the trial. A negligible decrease of 6MWT was observed in the intervention group (−6.6 ± 29.2 m) compared to the placebo (−14.1 ± 40.5 m). However, differences between the 2 groups were not statistically significant (p = 0.325). The results solely showed a slight positive correlation between 25(OH)D level and 6MWT. No significant improvements in BP and 6MWT were observed after vitamin D3 supplementation.TRIAL REGISTRATION: Iranian Registry of Clinical Trials Identifier: IRCT2016102113678N13


Subject(s)
Blood Pressure , Cholecalciferol , Classification , Endothelial Cells , Exercise Test , Exercise Tolerance , Heart Failure , Heart , Humans , Motor Activity , Myocytes, Cardiac , Potassium , Sodium , Vitamin D , Vitamin D Deficiency , Vitamins
10.
Article in English | WPRIM (Western Pacific) | ID: wprim-782183

ABSTRACT

Infantile hepatic hemangioma, the most common vascular tumor of the liver in infancy, can occur with acute postnatal liver and congestive heart failure. Nevertheless, its course is often benign, and many children can be diagnosed and treated without surgical intervention. The distinction from malignant diseases is not always easy and it not clear whether invasive procedures for diagnosis and therapy should be performed. Here we report our experiences in our Center for Pediatric Liver Disease and postulate that large studies are needed to avoid unnecessary invasive procedures for these patients in the future.


Subject(s)
Child , Diagnosis , Heart Failure , Hemangioma , Humans , Infant , Liver , Liver Diseases , Vascular Malformations , Vascular Neoplasms
11.
Chonnam Medical Journal ; : 55-61, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-787273

ABSTRACT

The optimal dose of beta blockers after acute myocardial infarction (MI) remains uncertain. We evaluated the effectiveness of low-dose nebivolol, a beta1 blocker and a vasodilator, in patients with acute MI. A total of 625 patients with acute MI from 14 teaching hospitals in Korea were divided into 2 groups according to the dose of nebivolol (nebistol®, Elyson Pharmaceutical Co., Ltd., Seoul, Korea): low-dose group (1.25 mg daily, n=219) and usual- to high-dose group (≥2.5 mg daily, n=406). The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE, composite of death from any cause, non-fatal MI, stroke, repeat revascularization, rehospitalization for unstable angina or heart failure) at 12 months. After adjustment using inverse probability of treatment weighting, the rates of MACCE were not different between the low-dose and the usual- to high-dose groups (2.8% and 3.1%, respectively; hazard ratio: 0.92, 95% confidence interval: 0.38 to 2.24, p=0.860). The low-dose nebivolol group showed higher rates of MI than the usual- to high-dose group (1.2% and 0%, p=0.008). The 2 groups had similar rates of death from any cause (1.1% and 0.3%, p=0.273), stroke (0.4% and 1.1%, p=0.384), repeat PCI (1.2% and 0.8%, p=0.428), rehospitalization for unstable angina (1.2% and 1.0%, p=0.743) and for heart failure (0.6% and 0.7%, p=0.832). In patients with acute MI, the rates of MACCE for low-dose and usual- to high-dose nebivolol were not significantly different at 12-month follow-up.


Subject(s)
Angina, Unstable , Follow-Up Studies , Heart , Heart Failure , Hospitals, Teaching , Humans , Hypertension , Korea , Myocardial Infarction , Nebivolol , Observational Study , Receptors, Adrenergic, beta , Seoul , Stroke
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-787133

ABSTRACT

In vascular smooth muscle, K⁺ channels, such as voltage-gated K⁺ channels (Kv), inward-rectifier K⁺ channels (Kir), and big-conductance Ca²⁺-activated K⁺ channels (BK(Ca)), establish a hyperpolarized membrane potential and counterbalance the depolarizing vasoactive stimuli. Additionally, Kir mediates endothelium-dependent hyperpolarization and the active hyperemia response in various vessels, including the coronary artery. Pulmonary arterial hypertension (PAH) induces right ventricular hypertrophy (RVH), thereby elevating the risk of ischemia and right heart failure. Here, using the whole-cell patch-clamp technique, we compared Kv and Kir current densities (I(Kv) and I(Kir)) in the left (LCSMCs), right (RCSMCs), and septal branches of coronary smooth muscle cells (SCSMCs) from control and monocrotaline (MCT)-induced PAH rats exhibiting RVH. In control rats, (1) I(Kv) was larger in RCSMCs than that in SCSMCs and LCSMCs, (2) I(Kv) inactivation occurred at more negative voltages in SCSMCs than those in RCSMCs and LCSMCs, (3) I(Kir) was smaller in SCSMCs than that in RCSMCs and LCSMCs, and (4) I(BKCa) did not differ between branches. Moreover, in PAH rats, I(Kir) and I(Kv) decreased in SCSMCs, but not in RCSMCs or LCSMCs, and I(BKCa) did not change in any of the branches. These results demonstrated that SCSMC-specific decreases in I(Kv) and I(Kir) occur in an MCT-induced PAH model, thereby offering insights into the potential pathophysiological implications of coronary blood flow regulation in right heart disease. Furthermore, the relatively smaller I(Kir) in SCSMCs suggested a less effective vasodilatory response in the septal region to the moderate increase in extracellular K⁺ concentration under increased activity of the myocardium.


Subject(s)
Animals , Coronary Vessels , Heart Diseases , Heart Failure , Hyperemia , Hypertension , Hypertrophy, Right Ventricular , Ischemia , Membrane Potentials , Monocrotaline , Muscle, Smooth , Muscle, Smooth, Vascular , Myocardium , Myocytes, Smooth Muscle , Patch-Clamp Techniques , Potassium Channels , Rats , Septum of Brain
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-811150

ABSTRACT

Mitochondrial medicine is increasingly discussed as a promising therapeutic approach, given that mitochondrial defects are thought to contribute to many prevalent diseases and their complications. In individuals with diabetes mellitus (DM), defects in mitochondrial structure and function occur in many organs throughout the body, contributing both to the pathogenesis of DM and complications of DM. Diabetic cardiomyopathy (DbCM) is increasingly recognized as an underlying cause of increased heart failure in DM, and several mitochondrial mechanisms have been proposed to contribute to the development of DbCM. Well established mechanisms include myocardial energy depletion due to impaired adenosine triphosphate (ATP) synthesis and mitochondrial uncoupling, and increased mitochondrial oxidative stress. A variety of upstream mechanisms of impaired ATP regeneration and increased mitochondrial reactive oxygen species have been proposed, and recent studies now also suggest alterations in mitochondrial dynamics and autophagy, impaired mitochondrial Ca²⁺ uptake, decreased cardiac adiponectin action, increased O-GlcNAcylation, and impaired activity of sirtuins to contribute to mitochondrial defects in DbCM, among others. In the current review, we present and discuss the evidence that underlies both established and recently proposed mechanisms that are thought to contribute to mitochondrial dysfunction in DbCM.


Subject(s)
Adenosine Triphosphate , Adiponectin , Autophagy , Diabetes Mellitus , Diabetic Cardiomyopathies , Heart Failure , Mitochondria , Mitochondrial Dynamics , Oxidative Stress , Reactive Oxygen Species , Regeneration , Sirtuins
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-810987

ABSTRACT

OBJECTIVE: To determine the most valuable cardiac magnetic resonance feature tracking (CMR-FT) parameters for evaluating aortic stenosis (AS) and determine whether they can predict the prognosis in asymptomatic AS patients with preserved ejection fraction (pEF).MATERIALS AND METHODS: A prospective cohort of 123 moderate to severe AS patients (60 males, 68.6 ± 9.2 years) and 32 control subjects (14 males, 67.9 ± 4.4 years) underwent echocardiography and 3T CMR imaging from 2011–2015. CMR cine images were analyzed using CMR-FT to assess the left ventricular radial, circumferential, and longitudinal peak strain (PS) in 2- and 3-dimensions. The primary endpoints were clinical cardiac events (CCEs), including cardiac death, heart failure, and AS-associated symptom development. For statistical analysis, logistic regression and log-rank tests were used.RESULTS: Global PSs differed between AS patients and controls and between severe and moderate AS patients (p < 0.05). Two-dimensional (2D) global radial and longitudinal PSs changed gradually with the severity of AS groups (p < 0.001). Twenty-two of 67 asymptomatic AS patients with pEF experienced CCEs during the follow-up (median: 31.1 months). 2D global longitudinal PS (GLPS) was the single risk factor for CCE (p = 0.017). The relative risk for CCE was 3.9 (p = 0.016, 95% confidence interval: 1.2–11.9) based on 2D GLPS with a cutoff of −17.9% according to receiver operating characteristic curve analysis. Survival analysis demonstrated that asymptomatic AS patients with pEF having impaired 2D GLPS experienced worse event-free survival than the others (p = 0.041).CONCLUSION: 2D global longitudinal and radial PSs may reflect cardiac dysfunction according to the degree of AS. 2D GLPS might be a prognostic predictor of CCEs in asymptomatic AS patients with pEF.


Subject(s)
Aortic Valve Stenosis , Cohort Studies , Death , Disease-Free Survival , Echocardiography , Follow-Up Studies , Heart Failure , Humans , Logistic Models , Male , Prognosis , Prospective Studies , Risk Factors , ROC Curve
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-810971

ABSTRACT

BACKGROUND: Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.METHODS: Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).RESULTS: During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001).CONCLUSION: In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.


Subject(s)
Asian Continental Ancestry Group , Body Mass Index , Defibrillators, Implantable , Filtration , Follow-Up Studies , Heart , Heart Failure , Humans , Korea , Mortality , Primary Prevention , Risk Assessment , Secondary Prevention , Shock
17.
ABC., imagem cardiovasc ; 33(3): [rev01], 2020.
Article in Portuguese | LILACS (Americas) | ID: biblio-1117806

ABSTRACT

Nas últimas décadas, o aumento das indicações para dispositivos cardíacos eletrônicos implantáveis tem sido acompanhado pela elevação dos casos de complicações relacionadas ao seu uso, dentre elas a endocardite infecciosa. Apesar dos avanços diagnósticos e terapêuticos da doença, esta mantém elevada morbimortalidade. Os casos relacionados aos dispositivos apresentam importantes limitações referentes aos critérios e aos métodos diagnósticos que implicam na tomada de decisão terapêutica sobre retirada do dispositivo, com risco de morte e outras complicações. Ainda assim, o ecocardiograma mantém um grande valor no diagnóstico da endocardite infecciosa relacionada a dispositivos cardíacos e de suas complicações. O entendimento das limitações e dos desafios acerca do diagnóstico reforça a necessidade de mais estudos sobre do tema. O presente artigo visa descrever a epidemiologia, a microbiologia, os fatores de risco, a patogenia, o diagnóstico e o tratamento da endocardite infecciosa associada aos dispositivos cardíacos eletrônicos implantáveis, visando demonstrar, principalmente, o valor dos exames de imagem na abordagem dessa condição clínica, com ênfase nos achados ao ecocardiograma.


In recent decades, the increase in indications for implantable electronic cardiac devices has been accompanied by an increase in cases of complications related to their use, including infectious endocarditis. Despite the diagnostic and therapeutic advances of the disease, it maintains high morbidity and mortality. The cases related to the devices have important limitations regarding the criteria and diagnostic methods that imply in making a therapeutic decision about removing the device, with risk of death and other complications. Still, echocardiography remains of great value in the diagnosis of infective endocarditis related to cardiac devices and their complications. Understanding the limitations and challenges regarding diagnosis reinforces the need for further studies on the topic. This article aims to describe the epidemiology, microbiology, risk factors, pathogenesis, diagnosis and treatment of infective endocarditis associated with implantable electronic cardiac devices, aiming to demonstrate, mainly, the value of imaging tests in addressing this clinical condition , with emphasis on echocardiogram findings.


Subject(s)
Humans , Male , Middle Aged , Arrhythmias, Cardiac/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/epidemiology , Heart Failure/drug therapy , Infections/therapy , Pacemaker, Artificial , Staphylococcus aureus/pathogenicity , Magnetic Resonance Imaging/methods , Vancomycin/administration & dosage , Comorbidity , Risk Factors , Defibrillators, Implantable , Echocardiography, Transesophageal/methods , Cardiac Resynchronization Therapy Devices , Floxacillin/administration & dosage , Positron Emission Tomography Computed Tomography/methods
18.
Rev. gaúch. enferm ; 41(spe): e20190095, 2020. graf
Article in English | LILACS (Americas) | ID: biblio-1093864

ABSTRACT

ABSTRACT Aim: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. Methods: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. Results: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. Conclusions: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.


RESUMEN Objetivo: Analizar el comportamiento del péptido natriurético tipo B (BNP) en presencia de características definitorias (CD) del diagnóstico de enfermería Exceso de volumen de líquidos (00026) en pacientes hospitalizados por insuficiencia cardíaca aguda descompensada (ICAD). Métodos: Estudio de cohorte de pacientes ingresados ​​con ICAD (septiembre/2015 a septiembre/2016).Se incluyeron pacientes hospitalizados hasta 36 h con valores de BNP ≥ 100 pg / ml; Los valores de BNP en la evaluación inicial basal se compararon mediante la prueba de Wilcoxon, el número de CD en la evaluación inicial basal se comparó mediante el Test-T apareado. Resultados: Se incluyeron 64 pacientes; hubo una correlación positiva significativa entre el delta del BNP y las CD presentes en la evaluación clínica inicial. Conclusiones: El comportamiento del BNP se correlacionó con las CD que indican congestión. Con compensación clínica, las CD y el BNP disminuyeron. El uso del BNP puede proporcionar precisión adicional a la evaluación de enfermería.


RESUMO Objetivo: Analisar o comportamento do peptídeo natriurético tipo B (BNP) na presença de características definidoras (CDs) do diagnóstico de enfermagem Excesso de volume de líquidos (00026) em pacientes hospitalizados por insuficiência cardíaca descompensada. Métodos: Estudo de coorte com pacientes internados com insuficiência cardíaca descompensada (setembro-2015 a setembro-2016), definida pelos Critérios de Boston. Pacientes hospitalizados por mais de 36 horas, valor de BNP ≥ 100 pg/ml foram incluídos; valores de BNP basal-final foram comparados pelo teste Wilcoxon; as CDs no basal-final foram comparadas pelo teste t pareado. Resultados: Sessenta e quatro pacientes foram incluídos; houve correlação positiva significativa entre o delta de BNP com o número de CDs presentes na avaliação clínica inicial. Conclusões: O comportamento do BNP foi correlacionado com as CDs, indicando congestão. Com a compensação clínica, as CDs e a concentração de BNP diminuíram. O uso deste biomarcador pode fornecer precisão adicional à avaliação de enfermagem.


Subject(s)
Humans , Male , Female , Aged , Water-Electrolyte Imbalance/diagnosis , Nursing Diagnosis , Natriuretic Peptide, Brain/blood , Heart Failure/blood , Stroke Volume , Water-Electrolyte Imbalance/blood , Biomarkers/blood , Cohort Studies , Sample Size , Emergency Medical Services , Heart Failure/nursing , Heart Failure/physiopathology
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