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Determinação do Tecido Cicatricial do Miocárdio no Fenômeno de Fluxo Coronário Lento e a Relação entre a Quantidade de Tecido Cicatricial e o Nt-ProBNP / Determination of Myocardial Scar Tissue in Coronary Slow Flow Phenomenon and The Relationship Between Amount of Scar Tissue and Nt-ProBNP
Candemir, Mustafa; Şahinarslan, Asife; Yazol, Merve; Öner, Yusuf Ali; Boyacı, Bülent.
  • Candemir, Mustafa; Yozgat City Hospital. Department of Cardiology. Yozgat. TR
  • Şahinarslan, Asife; Gazi University. Faculty of Medicine. Department of Cardiology. Ankara. TR
  • Yazol, Merve; Şanlıurfa Education and Research Hospital. Department of Radiology. Şanlıurfa. TR
  • Öner, Yusuf Ali; Gazi University. Faculty of Medicine. Department of Radiology. Ankara. TR
  • Boyacı, Bülent; Gazi University. Faculty of Medicine. Department of Cardiology. Ankara. TR
Arq. bras. cardiol ; 114(3): 540-551, mar. 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1088881
RESUMO
Resumo Fundamento A fisiopatologia e o prognóstico não estão claramente determinados nos pacientes com fenômeno do fluxo coronário lento (FCL). Esses pacientes apresentam várias condições clínicas, que variam desde quadro assintomático até internação hospitalar com morte cardíaca súbita. Objetivos Nosso objetivo foi avaliar os achados da ressonância magnética cardíaca (RMC) com o realce tardio pelo gadolínio (RTG), como um indicador de fibrose miocárdica. Também buscamos determinar a relação entre a presença de fibrose miocárdica e os níveis de NT-proBNP em pacientes com FCL na artéria coronária descendente anterior esquerda (DAE). Métodos Ao todo, 35 pacientes, entre 31 e 75 anos de idade, foram incluídos. Os pacientes estudados (n=19) apresentaram artérias coronárias epicárdicas normais na angiografia, mas tinham FCL na DAE. O grupo controle de pacientes (n=16) apresentou artérias coronárias epicárdicas normais e níveis de escore TIMI normais na angiografia. Em ambos os grupos, os pacientes foram examinados com RMC para a detecção de presença de fibrose miocárdica. Além disso, níveis plasmáticos de NT-proBNP foram medidos. Valores de p < 0,05 foram considerados significativos. Resultados A taxa de fibrose miocárdica foi significativamente maior na RMC para os pacientes com FCL (p=0.018). Uma quantidade variável de tecido cicatricial foi detectada no ápice ventricular esquerdo em 7 pacientes e nas regiões inferior e inferolateral em 3 pacientes. Não foram observadas diferenças nos níveis de NT-proBNP nos pacientes com FCL. Entretanto, os níveis de NT-proBNP foram maiores nos pacientes com FCL, que apresentaram fibrose miocárdica na RMC (p=0.022). Conclusões Em suma, o RTG na RMC mostrou que a cicatriz miocárdica isquêmica pode estar presente nos pacientes com FCL. Esses resultados indicam que o FCL pode nem sempre ser inofensivo. (Arq Bras Cardiol. 2020; 114(3)540-551)
ABSTRACT
Abstract Background Pathophysiology and prognosis are not clearly determined in patients with the coronary slow flow phenomenon (CSFP). These patients present with various clinical conditions ranging from being asymptomatic to being admitted with sudden cardiac death. Objectives We aimed at assessing the findings of late gadolinium enhancement (LGE) in cardiac magnetic resonance imaging (CMR) as an indicator of myocardial fibrosis. We also aimed at determining the relationship between the presence of myocardial fibrosis and NT-proBNP levels in patients with CSFP in the left anterior descending coronary artery (LAD). Methods A total of 35 patients were enrolled within an age range of 31-75. The study patients (n=19) had normal epicardial coronary arteries at angiography, but they presented with CSFP in the LAD. The control group patients (n=16) had normal epicardial coronary arteries and TIMI scores at normal levels in angiography. In both groups, the patients were examined with CMR for the presence of myocardial fibrosis. In addition, plasma NT-proBNP levels were measured. A p-value < 0.05 was considered significant. Results The rate of myocardial fibrosis was significantly higher in CMR in the patients with CSFP (p=0.018). A variable amount of myocardial scar tissue was detected at the left ventricular apex in 7 patients and at the inferior and inferolateral regions in 3 patients. There was no difference in the level of NT-proBNP in patients with CSFP. However, the NT-proBNP levels were higher in patients with CSFP, who had scar tissue in CMR (p=0.022). Conclusions In conclusion, LGE in CMR showed that ischemic myocardial scarring may exist in patients with CSFP. These results indicate that CSFP may not always be innocent. (Arq Bras Cardiol. 2020; 114(3)540-551)
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Full text: Available Index: LILACS (Americas) Main subject: Cicatrix / No-Reflow Phenomenon Type of study: Prognostic study Limits: Humans Language: Portuguese Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2020 Type: Article Affiliation country: Turkey Institution/Affiliation country: &#350;anl&#305;urfa Education and Research Hospital/TR / Gazi University/TR / Yozgat City Hospital/TR

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Full text: Available Index: LILACS (Americas) Main subject: Cicatrix / No-Reflow Phenomenon Type of study: Prognostic study Limits: Humans Language: Portuguese Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2020 Type: Article Affiliation country: Turkey Institution/Affiliation country: &#350;anl&#305;urfa Education and Research Hospital/TR / Gazi University/TR / Yozgat City Hospital/TR