RESUMO
BACKGROUND: The relationship between renal dysfunction and mortality after myocardial infarction (MI) has been demonstrated in patients with reduced ejection fraction. The importance of diastolic dysfunction in this scenario is unknown. METHODS: We studied 749 patients with acute MI who were evaluated within 24 hours of symptom onset. The Modification of Diet in Renal Disease equation was used to calculate the estimated glomerular filtration rate (eGFR). Preserved and depressed renal functions were defined as eGFR >60 and <60 mL/min, respectively. Diastolic function was determined by echocardiography and classified as normal or mildly, moderately or severely reduced. The left ventricular systolic function (cutoff of 0.55) was assessed by echocardiography. RESULTS: The mean age of the cohort was 62 years (±13 years); 61.3% were male, 70.2% were hypertensive, 32% were diabetic and 34.8% had hyperlipidemia. Seventy-eight patients died in hospital (10.4%), and 319 (42.6%) had an eGFR <60 mL/min. Diastolic dysfunction was present in 520 (69.4%) patients. Renal function was independently associated with worse in-hospital mortality (adjusted odds ratio 3.12, 95% confidence interval 1.71-5.69, per 10 mL/min decrease in eGFR <60 mL/min). For patients with normal-to-moderate diastolic dysfunction, normal renal function was not associated with increased in-hospital mortality (p-interaction = 0.01). CONCLUSIONS: Impaired renal function and both systolic and diastolic dysfunctions were associated with worse in-hospital mortality. However, normal-to-moderate diastolic dysfunction in the presence of normal renal function was not associated with worse outcome. Efforts to preserve renal function in patients with acute myocardial infarction should be made, particularly in those with diastolic dysfunction.
Assuntos
Mortalidade Hospitalar , Infarto do Miocárdio/mortalidade , Insuficiência Renal Crônica/mortalidade , Disfunção Ventricular Esquerda/mortalidade , Idoso , Estudos de Coortes , Diástole , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Volume Sistólico , Sístole , Fatores de Tempo , Ultrassonografia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
Although opening an occluded infarct-related artery >24 hours after myocardial infarction in stable patients in the Occluded Artery Trial (OAT) did not reduce events over 7 years, there was a suggestion that the effect of treatment might differ by patient age. Baseline characteristics and outcomes by treatment with percutaneous coronary intervention (PCI) versus optimal medical therapy alone were compared by prespecified stratification at age 65 years. A p value <0.01 was prespecified as significant for OAT secondary analyses. The primary outcome was death, myocardial infarction, or New York Heart Association class IV heart failure. Patients aged >65 years (n = 641) were more likely to be female, to be nonsmokers, and to have hypertension, lower estimated glomerular filtration rates, and multivessel disease compared to younger patients (aged ≤65 years, n = 1,560) (p <0.001). There was no significant observed interaction between treatment assignment and age for the primary outcome after adjustment (p = 0.10), and there was no difference between PCI and optimal medical therapy observed in either age group. At 7-year follow-up, younger patients tended to have angina more often compared to the older group (hazard ratio 1.21, 99% confidence interval 1.00 to 1.46, p = 0.01). The 7-year composite primary outcome was more common in older patients (p <0.001), and age remained significant after covariate adjustment (hazard ratio 1.42, 99% confidence interval 1.09 to 1.84). The rate of early PCI complications was low in the 2 age groups. The trend toward a differential effect of PCI in the young versus the old for the primary outcome was likely driven by measured and unmeasured confounders and by chance. PCI reduces angina to a similar degree in the young and old. In conclusion, there is no indication for routine PCI to open a persistently occluded infarct-related artery in stable patients after myocardial infarction, regardless of age.
Assuntos
Angioplastia Coronária com Balão/métodos , Eletrocardiografia , Infarto do Miocárdio/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Feminino , Seguimentos , Saúde Global , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Prognóstico , Qualidade de Vida , Recidiva , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Adulto JovemRESUMO
A ecocardiografia em tempo real representa grande avanço para a análise ecocardiográfica das estruturas cardíacas. Atualmente há a possibilidade da análise estrutural a partir de batimento cardíaco único, o que traz maior realidade anatômica à investigação ultrassonográfica e representa potencial aplicação clínica em pacientes portadores de grande irregularidade de ritmo cardíaco.
Assuntos
Humanos , Ecocardiografia Tridimensional/tendências , Ecocardiografia TridimensionalRESUMO
Neste relato, é apresentado um caso de placa aterosclerótica complicada, com trombo móvel pedunculado ao nível da transição da aorta ascendente para o arco aórtico, demonstrando a importância da realização da investigação ecocardiográfica, com a inclusão da janela supraesternal, muitas vezes, negligenciada nos exames ecocardiograficos transtorácicos de rotina. O termo rato branco deve-se ao fato de a estrutura adquirir esse aspecto ao exame em tempo real.