ABSTRACT
Development of ventricular failure and pulmonary edema is associated with a worse prognosis in ST-elevation myocardial infarction (STEMI). We aimed to evaluate the prognostic ability of a novel classification combining lung ultrasound (LUS) and left ventricular outflow tract (LVOT) velocity time integral (VTI) in patients with STEMI. LUS and LVOT-VTI were performed within 24 h of admission in STEMI patients. A LUS combined with LVOT-VTI (LUV) classification was developed based on LUS with < or ≥ 3 positive zone scans, combined with LVOT-VTI > or ≤ 14. Patients were classified as A (< 3zones/ > 14 cm VTI), B (≥ 3zones/ > 14 cm VTI), C (< 3zones/ ≤ 14 cm VTI) and D (≥ 3zones/ ≤ 14 cm VTI). Primary outcome was occurrence of in-hospital mortality. Development of cardiogenic shock (CS) within 24 h was also assessed. A total of 308 patients were included. Overall in-hospital mortality was 8.8%, while mortality for LUV A, B, C, and D was 0%, 3%, 12%, and 45%, respectively. The area under the curve (AUC) for predicting in-hospital mortality was 0.915. Moreover, after exclusion of patients admitted in Killip IV, at each increasing degree of LUV, a higher proportion of patients developed CS within 24 h: LUV A = 0.0%, LUV B 5%, LUV C = 12.5% and LUV D = 30.8% (p < 0.0001). The AUC for predicting CS was 0.908 (p < 0.001). In a cohort of STEMI patients, LUV provided to be an excellent method for prediction of in-hospital mortality and development of CS. LUV classification is a fast, non-invasive and very user-friendly ultrasonographic evaluation method to stratify the risk of mortality and CS.
ABSTRACT
Novos fármacos para o tratamento da hipercolesterolemia foram desenvolvidos, que poderão ser incorporadas nas diretrizes, resultantes de estudos clínicos robustos que demonstraram redução de desfechos cardiovasculares adicionais aos resultados obtidos com a otimização terapêutica disponível com as estatinas. O objetivo deste artigo é atualizar o conhecimento para o tratamento das dislipidemias baseado nas melhores evidências e as novas opções terapêuticas para reduzir o risco de eventos cardiovasculares em pacientes com dislipidemia refratária à otimização do tratamento atual.
New drugs for dyslipidemia treatment have been developed in solid clinical studies, which demonstrated an additional reduction of cardiovascular outcomes compared to therapeutic treatment with statins, and might be incorporated in new treatment guidelines. The aim of this article is to update the knowledge for the treatment of dyslipidemias based on the best evidences and the new therapeutic options incorporated to reduce the risk of cardiovascular events in patients with dyslipidemia refractory to treatment optimization.
