RESUMO
BACKGROUND: Disparities between thermodilution (TD) and Fick measurements of cardiac index (CI) are common in real-world clinical practice. Published studies about the effect of tricuspid regurgitation (TR) on TD are small and describe conflicting results. We tested the correlation between TD and Fick across a wide range of TR severity, in a larger group of patients undergoing right heart catheterization (RHC). We aimed to determine if TD is an acceptable alternative to Fick in patients with TR in clinical practice. METHODS: We retrospectively evaluated patients undergoing RHC at a single center over a 10-month period, and included those with recent (<90 days) echocardiograms. TD was measured during RHC and Fick was calculated using estimated oxygen consumption. The primary outcome was the correlation between TD and Fick CIs. We performed regression modeling to evaluate predictors of the difference between TD and Fick. RESULTS: A total of 349 patients were included, 40% of whom had at least moderate TR. The correlation between TD and Fick was strong (r=0.765) and did not significantly differ in those with none to mild TR (r=0.73) and those with moderate to severe TR (r=0.80). Atrial fibrillation or atrial flutter was the only variable significantly associated with the difference between CI by Fick and TD (P=.04). CONCLUSION: The correlation between TD and Fick was strong and unaffected by TR severity.
Assuntos
Termodiluição , Insuficiência da Valva Tricúspide , Humanos , Termodiluição/métodos , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/diagnóstico , Débito Cardíaco , Cateterismo CardíacoRESUMO
A 65-year-old immunocompromised woman presented with progressive dyspnea and sacroiliac joint pain. Cardiac magnetic resonance showed abnormal right ventricular filling with septal bounce and abnormal pericardial enhancement, suggestive of constrictive pericarditis. Cultures from pericardium following pericardiectomy grew Coccidioides immitis. She was diagnosed with coccidioidomycosis and responded to pericardiectomy and amphotericin. (Level of Difficulty: Intermediate.).
Assuntos
Aminobutiratos/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Insuficiência Cardíaca/prevenção & controle , Infarto do Miocárdio/tratamento farmacológico , Inibidores de Proteases/uso terapêutico , Valsartana/uso terapêutico , Aminobutiratos/efeitos adversos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Animais , Compostos de Bifenilo/efeitos adversos , Tomada de Decisão Clínica , Modelos Animais de Doenças , Combinação de Medicamentos , Medicina Baseada em Evidências , Fatores de Risco de Doenças Cardíacas , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Neprilisina/antagonistas & inibidores , Inibidores de Proteases/efeitos adversos , Fatores de Proteção , Medição de Risco , Resultado do Tratamento , Valsartana/efeitos adversosRESUMO
Exercise testing represents the preferred stress modality for individuals undergoing evaluation of suspected myocardial ischemia. Patients with limited functional status may be unable to achieve an adequate exercise stress, thus influencing the diagnostic sensitivity of the results. The Duke Activity Status Index (DASI) is a clinically applicable tool to estimate exercise capacity. The purpose of the current study was to assess the utility of the DASI to identify patients unable to achieve an adequate exercise stress result. Patients referred for exercise stress testing were administered the DASI pre-exercise. Baseline characteristics and exercise variables were evaluated including DASI-metabolic equivalents (DASI-METs), peak METs, exercise time (ET), and %-predicted maximal heart rate (%PMHR). Criteria for determining adequate exercise stress was defined as ≥85%PMHR or ≥ 5-METs at peak exercise. In 608 cardiovascular stress tests performed during the study period; 314 were exercise stress. The median DASI-METs (8.4 [interquartile range; 6.7 to 9.9]) was associated with estimated peak exercise METs (R=0.50, p <0.001), ET (R=0.29, p <0.001), and %PMHR (R=0.19, pâ¯=â¯0.003). DASI-METs were different between those with < or ≥85%PMHR (7.9 [6.6-9.0] vs. 8.9 [7.1-9.9], P=0.025) and those with < or ≥5-METs (5.8 [4.6 to 6.6] versus 8.9 [7.3-9.9], p <0.001). Receiver operating characteristic curve analysis identified a DASI-MET threshold of ≤/>7.4 to optimally predict adequate exercise stress (sensitivity=93%, specificity=71%). In conclusion, the DASI correlates with peak METs, ET, and %PMHR among patients referred for exercise testing and can be used to identify patients with an increased likelihood of an inadequate stress test result.
Assuntos
Doenças Cardiovasculares/diagnóstico , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Indicadores Básicos de Saúde , Medição de Risco/métodos , Doenças Cardiovasculares/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Trombose Coronária/diagnóstico , Trombose Coronária/etiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Substituição da Valva Aórtica Transcateter , Idoso , Transplante de Coração , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
Although thought to be a rare event, permanent pacemakers and implantable cardioverter-defibrillators with right ventricular intracardiac leads have the potential to induce tricuspid valve dysfunction. Adverse lead-valve interactions can take place through a variety of mechanisms including damage at the time of implantation, leaflet pinning, or long-term fibrosis encapsulating the leaflet tissue. Clinical manifestations can display a wide range of severity, as well as a highly variable time span between implantation and hemodynamic deterioration. This review aims to describe the potential pathophysiologic effects of intracardiac device leads on the tricuspid valve, with a focus on ideal diagnostic strategies and treatment options once lead-induced valvular dysfunction is suspected.
Assuntos
Desfibriladores Implantáveis/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Complicações Pós-Operatórias/etiologia , Insuficiência da Valva Tricúspide/etiologia , Ventrículos do Coração , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Índice de Gravidade de Doença , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgiaAssuntos
Forame Oval Patente/complicações , Hipóxia/etiologia , Paralisia Respiratória/complicações , Biomarcadores/sangue , Cateterismo Cardíaco/instrumentação , Ecocardiografia Transesofagiana , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/fisiopatologia , Forame Oval Patente/terapia , Humanos , Hipóxia/sangue , Hipóxia/diagnóstico , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Paralisia Respiratória/diagnóstico por imagem , Paralisia Respiratória/fisiopatologia , Dispositivo para Oclusão Septal , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Patients with advanced liver disease have a high prevalence of cardiac risk factors. The stress of liver transplant surgery predisposes these patients to major cardiac events, such as myocardial infarction or ventricular arrhythmias in addition to heart failure exacerbation. Liver transplant patients who experience coronary events in the perioperative period have a decreased five-yr survival rate. Cardiovascular risk stratification prior to liver transplant can be accomplished by dobutamine stress echocardiography, stress myocardial perfusion imaging, cardiac computed tomography, and coronary angiography. Pre-liver transplant management of cardiovascular pathology includes cardiovascular intervention like percutaneous coronary intervention, coronary bypass graft surgery, or medical management. Thorough screening and optimal management of underlying cardiovascular pathology and cardiovascular risk factors should decrease the incidence of new cardiac events in liver transplant recipients.