Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 18 de 18
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
JAMA Netw Open ; 4(4): e216842, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33890991

RESUMO

Importance: Critical illness, a marked inflammatory response, and viruses such as SARS-CoV-2 may prolong corrected QT interval (QTc). Objective: To evaluate baseline QTc interval on 12-lead electrocardiograms (ECGs) and ensuing changes among patients with and without COVID-19. Design, Setting, and Participants: This cohort study included 3050 patients aged 18 years and older who underwent SARS-CoV-2 testing and had ECGs at Columbia University Irving Medical Center from March 1 through May 1, 2020. Patients were analyzed by treatment group over 5 days, as follows: hydroxychloroquine with azithromycin, hydroxychloroquine alone, azithromycin alone, and neither hydroxychloroquine nor azithromycin. ECGs were manually analyzed by electrophysiologists masked to COVID-19 status. Multivariable modeling evaluated clinical associations with QTc prolongation from baseline. Exposures: COVID-19, hydroxychloroquine, azithromycin. Main Outcomes and Measures: Mean QTc prolongation, percentage of patients with QTc of 500 milliseconds or greater. Results: A total of 965 patients had more than 2 ECGs and were included in the study, with 561 (58.1%) men, 198 (26.2%) Black patients, and 191 (19.8%) aged 80 years and older. There were 733 patients (76.0%) with COVID-19 and 232 patients (24.0%) without COVID-19. COVID-19 infection was associated with significant mean QTc prolongation from baseline by both 5-day and 2-day multivariable models (5-day, patients with COVID-19: 20.81 [95% CI, 15.29 to 26.33] milliseconds; P < .001; patients without COVID-19: -2.01 [95% CI, -17.31 to 21.32] milliseconds; P = .93; 2-day, patients with COVID-19: 17.40 [95% CI, 12.65 to 22.16] milliseconds; P < .001; patients without COVID-19: 0.11 [95% CI, -12.60 to 12.81] milliseconds; P = .99). COVID-19 infection was independently associated with a modeled mean 27.32 (95% CI, 4.63-43.21) millisecond increase in QTc at 5 days compared with COVID-19-negative status (mean QTc, with COVID-19: 450.45 [95% CI, 441.6 to 459.3] milliseconds; without COVID-19: 423.13 [95% CI, 403.25 to 443.01] milliseconds; P = .01). More patients with COVID-19 not receiving hydroxychloroquine and azithromycin had QTc of 500 milliseconds or greater compared with patients without COVID-19 (34 of 136 [25.0%] vs 17 of 158 [10.8%], P = .002). Multivariable analysis revealed that age 80 years and older compared with those younger than 50 years (mean difference in QTc, 11.91 [SE, 4.69; 95% CI, 2.73 to 21.09]; P = .01), severe chronic kidney disease compared with no chronic kidney disease (mean difference in QTc, 12.20 [SE, 5.26; 95% CI, 1.89 to 22.51; P = .02]), elevated high-sensitivity troponin levels (mean difference in QTc, 5.05 [SE, 1.19; 95% CI, 2.72 to 7.38]; P < .001), and elevated lactate dehydrogenase levels (mean difference in QTc, 5.31 [SE, 2.68; 95% CI, 0.06 to 10.57]; P = .04) were associated with QTc prolongation. Torsades de pointes occurred in 1 patient (0.1%) with COVID-19. Conclusions and Relevance: In this cohort study, COVID-19 infection was independently associated with significant mean QTc prolongation at days 5 and 2 of hospitalization compared with day 0. More patients with COVID-19 had QTc of 500 milliseconds or greater compared with patients without COVID-19.


Assuntos
Azitromicina , Tratamento Farmacológico da COVID-19 , COVID-19 , Eletrocardiografia , Hidroxicloroquina , Síndrome do QT Longo , Idoso de 80 Anos ou mais , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Azitromicina/administração & dosagem , Azitromicina/efeitos adversos , COVID-19/diagnóstico , COVID-19/epidemiologia , Teste para COVID-19/métodos , Quimioterapia Combinada/métodos , Quimioterapia Combinada/estatística & dados numéricos , Eletrocardiografia/métodos , Eletrocardiografia/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/epidemiologia , Síndrome do QT Longo/virologia , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Fatores de Risco , SARS-CoV-2 , Fatores de Tempo
2.
Am J Cardiol ; 147: 52-57, 2021 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-33617812

RESUMO

There is growing evidence that COVID-19 can cause cardiovascular complications. However, there are limited data on the characteristics and importance of atrial arrhythmia (AA) in patients hospitalized with COVID-19. Data from 1,029 patients diagnosed with of COVID-19 and admitted to Columbia University Medical Center between March 1, 2020 and April 15, 2020 were analyzed. The diagnosis of AA was confirmed by 12 lead electrocardiographic recordings, 24-hour telemetry recordings and implantable device interrogations. Patients' history, biomarkers and hospital course were reviewed. Outcomes that were assessed were intubation, discharge and mortality. Of 1,029 patients reviewed, 82 (8%) were diagnosed with AA in whom 46 (56%) were new-onset AA 16 (20%) recurrent paroxysmal and 20 (24%) were chronic persistent AA. Sixty-five percent of the patients diagnosed with AA (n=53) died. Patients diagnosed with AA had significantly higher mortality compared with those without AA (65% vs 21%; p < 0.001). Predictors of mortality were older age (Odds Ratio (OR)=1.12, [95% Confidence Interval (CI), 1.04 to 1.22]); male gender (OR=6.4 [95% CI, 1.3 to 32]); azithromycin use (OR=13.4 [95% CI, 2.14 to 84]); and higher D-dimer levels (OR=2.8 [95% CI, 1.1 to 7.3]). In conclusion, patients diagnosed with AA had 3.1 times significant increase in mortality rate versus patients without diagnosis of AA in COVID-19 patients. Older age, male gender, azithromycin use and higher baseline D-dimer levels were predictors of mortality.


Assuntos
Fibrilação Atrial/epidemiologia , COVID-19/epidemiologia , Gerenciamento Clínico , Pandemias , Idoso , Idoso de 80 Anos ou mais , COVID-19/terapia , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença
4.
J Cardiovasc Electrophysiol ; 31(12): 3086-3096, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33022765

RESUMO

INTRODUCTION: Electrocardiographic characteristics in COVID-19-related mortality have not yet been reported, particularly in racial/ethnic minorities. METHODS AND RESULTS: We reviewed demographics, laboratory and cardiac tests, medications, and cardiac rhythm proximate to death or initiation of comfort care for patients hospitalized with a positive SARS-CoV-2 reverse-transcriptase polymerase chain reaction in three New York City hospitals between March 1 and April 3, 2020 who died. We described clinical characteristics and compared factors contributing toward arrhythmic versus nonarrhythmic death. Of 1258 patients screened, 133 died and were enrolled. Of these, 55.6% (74/133) were male, 69.9% (93/133) were racial/ethnic minorities, and 88.0% (117/133) had cardiovascular disease. The last cardiac rhythm recorded was VT or fibrillation in 5.3% (7/133), pulseless electrical activity in 7.5% (10/133), unspecified bradycardia in 0.8% (1/133), and asystole in 26.3% (35/133). Most 74.4% (99/133) died receiving comfort measures only. The most common abnormalities on admission electrocardiogram included abnormal QRS axis (25.8%), atrial fibrillation/flutter (14.3%), atrial ectopy (12.0%), and right bundle branch block (11.9%). During hospitalization, an additional 17.6% developed atrial ectopy, 14.7% ventricular ectopy, 10.1% atrial fibrillation/flutter, and 7.8% a right ventricular abnormality. Arrhythmic death was confirmed or suspected in 8.3% (11/133) associated with age, coronary artery disease, asthma, vasopressor use, longer admission corrected QT interval, and left bundle branch block (LBBB). CONCLUSIONS: Conduction, rhythm, and electrocardiographic abnormalities were common during COVID-19-related hospitalization. Arrhythmic death was associated with age, coronary artery disease, asthma, longer admission corrected QT interval, LBBB, ventricular ectopy, and usage of vasopressors. Most died receiving comfort measures.


Assuntos
Arritmias Cardíacas/mortalidade , COVID-19/mortalidade , Mortalidade Hospitalar , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etnologia , Arritmias Cardíacas/terapia , COVID-19/diagnóstico , COVID-19/etnologia , COVID-19/terapia , Causas de Morte , Comorbidade , Eletrocardiografia , Feminino , Fatores de Risco de Doenças Cardíacas , Mortalidade Hospitalar/etnologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prognóstico , Fatores Raciais , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo
6.
Indian Pacing Electrophysiol J ; 20(6): 250-256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32861812

RESUMO

BACKGROUND: The COVID-19 pandemic has greatly altered the practice of cardiac electrophysiology around the world for the foreseeable future. Professional organizations have provided guidance for practitioners, but real-world examples of the consults and responsibilities cardiac electrophysiologists face during a surge of COVID-19 patients is lacking. METHODS: In this observational case series we report on 29 consecutive inpatient electrophysiology consultations at a major academic medical center in New York City, the epicenter of the pandemic in the United States, during a 2 week period from March 30-April 12, 2020, when 80% of hospital beds were occupied by COVID-19 patients, and the New York City metropolitan area accounted for 10% of COVID-19 cases worldwide. RESULTS: Reasons for consultation included: Atrial tachyarrhythmia (31%), cardiac implantable electronic device management (28%), bradycardia (14%), QTc prolongation (10%), ventricular arrhythmia (7%), post-transcatheter aortic valve replacement conduction abnormality (3.5%), ventricular pre-excitation (3.5%), and paroxysmal supraventricular tachycardia (3.5%). Twenty-four patients (86%) were positive for COVID-19 by nasopharyngeal swab. All elective procedures were canceled, and only one urgent device implantation was performed. Thirteen patients (45%) required in-person evaluation and the remainder were managed remotely. CONCLUSION: Our experience shows that the application of a massive alteration in workflow and personnel forced by the pandemic allowed our team to efficiently address the intersection of COVID-19 with a range of electrophysiology issues. This experience will prove useful as guidance for emerging hot spots or areas affected by future waves of the pandemic.

7.
Crit Pathw Cardiol ; 19(3): 105-111, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32324622

RESUMO

The coronavirus disease 2019 crisis is a global pandemic of a novel infectious disease with far-ranging public health implications. With regard to cardiac electrophysiology (EP) services, we discuss the "real-world" challenges and solutions that have been essential for efficient and successful (1) ramping down of standard clinical practice patterns and (2) pivoting of workflow processes to meet the demands of this pandemic. The aims of these recommendations are to outline: (1) essential practical steps to approaching procedures, as well as outpatient and inpatient care of EP patients, with relevant examples, (2) successful strategies to minimize exposure risk to patients and clinical staff while also balancing resource utilization, (3) challenges related to redeployment and restructuring of clinical and support staff, and (4) considerations regarding continued collaboration with clinical and administrative colleagues to implement these changes. While process changes will vary across practices and hospital systems, we believe that these experiences from 4 different EP sections in a large New York City hospital network currently based in the global epicenter of the coronavirus disease 2019 pandemic will prove useful for other EP practices adapting their own practices in preparation for local surges.


Assuntos
Assistência Ambulatorial/tendências , Eletrofisiologia Cardíaca , Infecções por Coronavirus , Reestruturação Hospitalar , Controle de Infecções , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Telemedicina/tendências , Betacoronavirus/isolamento & purificação , COVID-19 , Eletrofisiologia Cardíaca/métodos , Eletrofisiologia Cardíaca/organização & administração , Eletrofisiologia Cardíaca/tendências , Gestão de Mudança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Procedimentos Clínicos/tendências , Reestruturação Hospitalar/métodos , Reestruturação Hospitalar/organização & administração , Hospitalização/tendências , Hospitais Urbanos/organização & administração , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Cidade de Nova Iorque , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2
8.
J Cardiovasc Electrophysiol ; 31(6): 1249-1254, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32281214

RESUMO

A global coronavirus (COVID-19) pandemic occurred at the start of 2020 and is already responsible for more than 74 000 deaths worldwide, just over 100 years after the influenza pandemic of 1918. At the center of the crisis is the highly infectious and deadly SARS-CoV-2, which has altered everything from individual daily lives to the global economy and our collective consciousness. Aside from the pulmonary manifestations of disease, there are likely to be several electrophysiologic (EP) sequelae of COVID-19 infection and its treatment, due to consequences of myocarditis and the use of QT-prolonging drugs. Most crucially, the surge in COVID-19 positive patients that have already overwhelmed the New York City hospital system requires conservation of hospital resources including personal protective equipment (PPE), reassignment of personnel, and reorganization of institutions, including the EP laboratory. In this proposal, we detail the specific protocol changes that our EP department has adopted during the COVID-19 pandemic, including performance of only urgent/emergent procedures, after hours/7-day per week laboratory operation, single attending-only cases to preserve PPE, appropriate use of PPE, telemedicine and video chat follow-up appointments, and daily conferences to collectively manage the clinical and ethical dilemmas to come. We discuss also discuss how we perform EP procedures on presumed COVID positive and COVID tested positive patients to highlight issues that others in the EP community may soon face in their own institution as the virus continues to spread nationally and internationally.


Assuntos
Centros Médicos Acadêmicos/provisão & distribuição , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Eletrofisiologia/métodos , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , COVID-19 , Humanos , Pandemias , SARS-CoV-2
10.
Clin Teach ; 15(3): 226-230, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28493398

RESUMO

BACKGROUND: Although there is much research about the prevalence of burnout among doctors and postgraduate doctor trainees, there is a paucity of evidence for effective preventive measures. METHODS: First-year postgraduate doctor trainees (PGY1s) in Internal Medicine at our institution were given protected time to participate in peer-facilitated monthly small group discussions on topics regarding humanism and professional development. The authors prompted participants before each session and followed a novel reflect, empathise, analyse and discuss in small groups (READ-SG) format. During the pilot period the authors administered a survey, approved by the Institutional Review Board, asking participants to rank the perceived effect of the sessions on their professional development and various symptoms of burnout, including levels of empathy, stress and motivation. RESULTS: Out of 20 PGY1s available to attend each session over the 3-month pilot period, there were an average of 9.6 attendees per session, with a 100 per cent survey completion rate, yielding 29 surveys. A total of 21 survey responses (72.4%) reported speaking during the sessions, and 29 (100%) reported that the sessions were important to have. Average scores on a Likert scale from 1 to 5 (ranging from negative to positive, respectively) for the perceived effect of the sessions on each measure were: 4.59 for professional development; 4.38 for empathy; 4.00 for stress; and 4.28 for motivation. There is a paucity of evidence for effective preventive measures [for burnout] CONCLUSIONS: Peer-facilitated monthly small group discussions using the READ-SG method seem to have positive effects on participants' sense of professional development and symptoms of burnout among postgraduate doctor trainees.


Assuntos
Esgotamento Profissional/prevenção & controle , Esgotamento Psicológico/prevenção & controle , Medicina Interna/educação , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/psicologia , Apoio Social , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Grupo Associado , Inquéritos e Questionários
12.
J Atr Fibrillation ; 10(1): 1494, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29250217

RESUMO

Atrial fibrillation (AF) is associated with worse outcomes in many cardiovascular diseases. There are few data examining pacemaker implantation rates and indications in patients with AF who undergo transcatheter aortic valve replacement (TAVR). To examine the impact of AF on the incidence of and indications for pacemakers in patients undergoing TAVR, we evaluated data of 1723 patients without pre-existing pacemakers who underwent TAVR in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. Permanent pacemaker implantation rates and indications were compared in groups based on baseline and discharge heart rhythm: sinus rhythm (SR) vs. AF. 1211 patients manifested SR at baseline/SR at discharge (SR/SR), 105 SR baseline/AF discharge (SR/AF), and 407 AF baseline/AF discharge (AF/AF). Patients who developed and were discharged with AF (SR/AF) had the highest rates of pacemaker implantation at 30 days (13.7% SR/AF vs. 5.4% SR/SR, p=0.0008 and 5.9% AF/AF, p=0.008) and 1 year (17.7% SR/AF vs. 7.1% SR/SR, p=0.0002 and 8.1% AF/AF, p=0.0034). Conversion from SR to AF by discharge was an independent predictor of increased pacemaker implantation at 30 days (HR 2.19 vs. SR/SR, 95% CI 1.23-3.93, p=0.008) and 1 year (HR 1.91 vs. SR/SR, 95% CI 1.33-3.80). Pacemaker indications differed between groups, with relatively more implanted in the AF groups for sick sinus syndrome (SSS) versus AV block. In conclusion, conversion to AF is an independent predictor of permanent pacemaker implantation in TAVR patients. Indications differ depending on heart rhythm, with patients in AF manifesting clinically significant tachy-brady syndrome versus AV block.

14.
J Atr Fibrillation ; 8(5): 1364, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27909480

RESUMO

This case report highlights the variety of wide complex tachycardias, and the need for their prompt management, in the growing population of patients with circulatory support devices. We present a case that demonstrates how a wide complex supraventricular tachycardia in a patient with a biventricular assist device can be safely and effectively targeted for treatment using percutaneous radiofrequency catheter ablation, allowing for clinical improvement, weaning of RVAD treatment, and discharge home with LVAD alone.

15.
JACC Clin Electrophysiol ; 2(7): 793-798, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-29759763

RESUMO

OBJECTIVES: This study sought to determine the prevalence of atrial fibrillation (AF) and its association with cardiac outcomes in patients with left ventricular assist devices (LVADs). BACKGROUND: LVADs are pivotal treatments for end-stage heart failure and a critical bridge to heart transplantation. METHODS: Medical records of 249 consecutive patients who received an LVAD at Columbia University Medical Center were reviewed. Patient demographics, clinical variables, medications, and outcomes were recorded. Descriptive statistics were generated, and multivariable logistic regression was performed to assess the independent association of clinical variables with the presence of AF. RESULTS: Overall, AF was documented in 80 patients (32%) following LVAD placement. Before LVAD placement, 182 patients had no history of AF, whereas 67 patients had documented AF. Among these 67 patients, 56 (84%) continued to have AF following LVAD placement; 24 patients without a history of AF (13%) developed AF after LVAD placement. Patients manifesting AF after LVAD placement were more likely to have had AF before LVAD insertion (p < 0.001). There were no significant differences in risk of stroke or death for patients with AF before or following LVAD insertion. CONCLUSIONS: AF is common in patients with LVADs, with 32% manifesting AF after placement of their LVAD, including 13% without a prior documented history of AF. The presence of AF was not associated with increased risk of death or stroke.


Assuntos
Fibrilação Atrial/epidemiologia , Coração Auxiliar/estatística & dados numéricos , Implantação de Prótese , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Implantação de Prótese/efeitos adversos , Implantação de Prótese/mortalidade , Implantação de Prótese/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
J Vasc Interv Radiol ; 23(8): 1031-5, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22739645

RESUMO

PURPOSE: To retrospectively evaluate the presence and distribution patterns of contrast agent retention in the liver on noncontrast computed tomography (CT) immediately following chemoembolization with drug-eluting beads (DEBs). MATERIALS AND METHODS: From 2008 to 2010, 95 patients with 224 liver lesions had chemoembolization performed with DEBs and a noncontrast CT examination of the liver performed immediately after embolization. Of these, 85 patients with 193 lesions were included. The postembolization CT scan was reviewed by a diagnostic radiologist, and the presence of contrast agent retention within the lesion was assessed. Varying patterns of contrast agent retention were defined. RESULTS: Of the 193 lesions included, 146 (76%) retained contrast medium. Aside from some contrast medium in vessels, very little if any contrast medium was seen in the surrounding liver. Various patterns of contrast agent retention were noted within lesions. In a single case, repeat imaging was obtained 6 hours later, which demonstrated washout of contrast agent in a lesion that had retained contrast agent on the postprocedure CT scan. Of significance, 13 additional foci of contrast agent retention were identified on postchemoembolization CT scans that, on retrospective review of preprocedure imaging, represented enhancing lesions not previously identified. CONCLUSIONS: Noncontrast CT after chemoembolization with DEBs demonstrates contrast agent retention in 76% of cases, without significant contrast medium seen in the adjacent liver parenchyma. The presence or absence of contrast agent retention may prove to be useful in evaluating accurate targeting of a lesion.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Meios de Contraste , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Tomografia Computadorizada por Raios X , Antibióticos Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/irrigação sanguínea , Doxorrubicina/administração & dosagem , Portadores de Fármacos , Óleo Etiodado/administração & dosagem , Humanos , Neoplasias Hepáticas/irrigação sanguínea , New York , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ácidos Tri-Iodobenzoicos
17.
Arthritis Res Ther ; 12(3): R105, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20509880

RESUMO

INTRODUCTION: Standard measurements used to assess murine models of rheumatoid arthritis, notably paw thickness and clinical score, do not align well with certain aspects of disease severity as assessed by histopathology. We tested the hypothesis that non-invasive optical tomographic imaging of molecular biomarkers of inflammation and bone turnover would provide a superior quantitative readout and would discriminate between a disease-modifying anti-rheumatic drug (DMARD) and a non-DMARD treatment. METHODS: Using two protease-activated near-infrared fluorescence imaging agents to detect inflammation-associated cathepsin and matrix metalloprotease activity, and a third agent to detect bone turnover, we quantified fluorescence in paws of mice with collagen antibody-induced arthritis. Fluorescence molecular tomographic (FMT) imaging results, which provided deep tissue detection and quantitative readouts in absolute picomoles of agent fluorescence per paw, were compared with paw swelling, clinical scores, a panel of plasma biomarkers, and histopathology to discriminate between steroid (prednisolone), DMARD (p38 mitogen-activated protein kinase (MAPK) inhibitor) and non-DMARD (celecoxib, cyclooxygenase-2 (COX-2) inhibitor) treatments. RESULTS: Paw thickness, clinical score, and plasma biomarkers failed to discriminate well between a p38 MAPK inhibitor and a COX-2 inhibitor. In contrast, FMT quantification using near-infrared agents to detect protease activity or bone resorption yielded a clear discrimination between the different classes of therapeutics. FMT results agreed well with inflammation scores, and both imaging and histopathology provided clearer discrimination between treatments as compared with paw swelling, clinical score, and serum biomarker readouts. CONCLUSIONS: Non-invasive optical tomographic imaging offers a unique approach to monitoring disease pathogenesis and correlates with histopathology assessment of joint inflammation and bone resorption. The specific use of optical tomography allowed accurate three-dimensional imaging, quantitation in picomoles rather than intensity or relative fluorescence, and, for the first time, showed that non-invasive imaging assessment can predict the pathologist's histology inflammation scoring and discriminate DMARD from non-DMARD activity.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Experimental/tratamento farmacológico , Artrite Experimental/patologia , Inibidores de Ciclo-Oxigenase/uso terapêutico , Pirazóis/uso terapêutico , Sulfonamidas/uso terapêutico , Tomografia Óptica , Animais , Artrite Experimental/metabolismo , Catepsinas/metabolismo , Celecoxib , Modelos Animais de Doenças , Progressão da Doença , Feminino , Glucocorticoides/uso terapêutico , Metaloproteinases da Matriz/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Prednisolona/uso terapêutico , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...