RESUMO
One hundred thirty-three patients with biopsy-proven AL amyloidosis were studied with echocardiography, Holter recording, 12-lead electrocardiography, and signal-averaged electrocardiograms. Features from these tests were analyzed in relation to their effect on mortality. Late potentials were more frequent in patients with echocardiographic evidence of cardiac amyloidosis (31%) compared with patients with normal echocardiograms (9%, p < 0.003). One hundred six of the 133 patients died during follow-up, of which 34 were nonsudden cardiac deaths and 33 were sudden deaths. Abnormal echocardiograms and signal-averaged electrocardiograms were each predictive of all-cause cardiac death (p < 0.0001 ) and sudden cardiac death (p < 0.0001). Abnormal signal-averaged electrocardiograms were also independently predictive of sudden death in the subgroup of patients with an abnormal echocardiogram (p < 0.05). Thus late potentials are predictive of sudden death in patients with AL amyloidosis and provide independent prognostic information in patients with echocardiographic evidence of amyloid involvement.
Assuntos
Amiloidose/fisiopatologia , Cardiomiopatias/fisiopatologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Processamento de Sinais Assistido por Computador , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico por imagem , Amiloidose/mortalidade , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/mortalidade , Morte Súbita Cardíaca , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Potenciais da Membrana , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , UltrassonografiaRESUMO
We present a coronary anomaly of crossing obtuse marginal branches of the left circumflex coronary artery which has not been seen in our laboratory or previously reported. Recognition of anomalous intramyocardial branches of the circumflex artery was important to avoid confusion with branches of the left anterior descending artery in conventional angiographic views and was clinically important as well. Intramyocardial vessels may not be easily bypassed surgically, and therefore angioplasty may be a better therapeutic option.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , RadiografiaRESUMO
The increasing frequency of reoperation for coronary artery disease has led to the use of a variety of grafts. This report describes the catheter technique for selective opacification of a saphenous vein graft from the descending thoracic aorta to the posterior coronary circulation.
Assuntos
Angiografia/métodos , Cateterismo/métodos , Angiografia Coronária , Ponte de Artéria Coronária , Veia Safena/transplante , Angina Pectoris/cirurgia , Aorta Torácica , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva , Reoperação , Veia Safena/diagnóstico por imagemRESUMO
High-grade atrioventricular heart block (HGAVB) occurring as a manifestation of systemic lupus erythematosus is an exceedingly rare event. We describe a patient with HGAVB who had myositis and antibodies to nuclear RNP (previously associated with myocarditis). A review of the literature on HGAVB associated with systemic lupus erythematosus is also presented.
