Assuntos
Ablação por Cateter , Taquicardia Supraventricular/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Few works have evaluated the effect of statins on left ventricular dysfunction in patients with chronic heart failure (CHF), by using tissue Doppler imaging (TDI). We therefore aimed to investigate whether atorvastatin treatment may influence prognosis and myocardial performance evaluated by TDI in subjects with CHF. METHODS: Five hundred thirty-two consecutive CHF outpatients enrolled in a local registry, the Daunia Heart Failure Registry, were prospectively analysed. 195 patients with CHF and left ventricular ejection fraction (LVEF) ≤40 %, either in treatment with atorvastatin (N: 114) or without statins (N: 81), underwent TDI examination. Adverse events were evaluated during follow-up. RESULTS: The atorvastatin group showed a lower incidence of adverse events (cardiac death: 0 % vs 7 %, p < 0.01), and better TDI performance (E/E' 15 ± 5.7 vs 18 ± 8.3, p < 001) than controls. Ischaemic CHF patients in treatment with atorvastatin also showed a lower incidence of adverse events (death: 10 % vs 26 %, p < 0.05; sustained ventricular arrhythmias: 5 % vs 19 %, p < 0.05, cardiac death: 0 vs 8 %, p < 0.05) and better TDI performance (E/E' ratio: 15.00 ± 5.68 vs 19.72 ± 9.14, p < 0.01; St: 353.70 ± 48.96 vs 303.33 ± 68.52 msec, p < 0.01) than controls. The association between atorvastatin and lower rates of cardiac death remained statistically significant even after correction in a multivariable analysis (RR 0.83, 95 % CI 0.71-0.96, p < 0.05 in CHF with LVEF ≤40 %; RR 0.77, 95 % CI 0.62-0.95, p < 0.05 in ischaemic CHF with LVEF ≤40 %). CONCLUSIONS: Treatment with atorvastatin in outpatients with systolic CHF is associated with fewer cardiac deaths, and a better left ventricular performance, as assessed by TDI.
RESUMO
Background: The aim was to investigate prognostic relevance of history of allergy in subjects with unstable angina treated with coronary angioplasty. Methods: Fifty-seven consecutive patients with unstable angina who underwent coronary angioplasty were enrolled in the study and were divided into two groups: those with a history of allergy (Group A, N=15); and controls (Group C, N=42). Major adverse cardiac events were recorded over a six-month follow-up period. Patients with primary or unsuccessful angioplasty and patients treated with drug eluting stent were excluded from the study. Results: Group A patients (history of allergy) showed a 46.67% incidence of major adverse cardiac events at six-month follow-up (vs. 9.52% Group C, p<0.01): results remained significant even in a multiple Cox regression analysis (hazard ratio 7.17, 95% CI 1.7129.98, p<0.01). Conclusion: History of allergy is an independent predictor of major adverse cardiac events after coronary angioplasty in a six-month follow-up period in unstable angina(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Angina Instável/complicações , Angina Instável/prevenção & controle , Angina Instável , Angioplastia/métodos , Angioplastia/normas , Angioplastia , Prognóstico , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/imunologia , Doença da Artéria Coronariana/prevenção & controle , Angiografia Coronária/métodos , Angiografia Coronária/tendências , Anafilaxia/imunologia , Anafilaxia/prevenção & controle , Estimativa de Kaplan-Meier , Aterosclerose/epidemiologia , Aterosclerose/imunologia , Aterosclerose/prevenção & controleRESUMO
BACKGROUND: The aim was to investigate prognostic relevance of history of allergy in subjects with unstable angina treated with coronary angioplasty. METHODS: Fifty-seven consecutive patients with unstable angina who underwent coronary angioplasty were enrolled in the study and were divided into two groups: those with a history of allergy (Group A, N = 15); and controls (Group C, N =42). Major adverse cardiac events were recorded over a six-month follow-up period. Patients with primary or unsuccessful angioplasty and patients treated with drug eluting stent were excluded from the study. RESULTS: Group A patients (history of allergy) showed a 46.67% incidence of major adverse cardiac events at six-month follow-up (vs. 9.52% Group C, p < 0.01): results remained significant even in a multiple Cox regression analysis (hazard ratio 7.17, 95% CI 1.71-29.98, p < 0.01). CONCLUSION: History of allergy is an independent predictor of major adverse cardiac events after coronary angioplasty in a six-month follow-up period in unstable angina.
Assuntos
Angina Instável/cirurgia , Angioplastia Coronária com Balão/efeitos adversos , Hipersensibilidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Morte Súbita , Feminino , Seguimentos , Humanos , Incidência , Masculino , Anamnese , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Recidiva , Resultado do TratamentoRESUMO
BACKGROUND: The cardiopulmonary exercise test (CPX) is an affordable tool for risk prediction in patients with chronic heart failure (CHF). We aimed to determine the role of CPX parameters in predicting the risk of incidence of sustained ventricular arrhythmias (SVA) in CHF. METHODS: Sixty-one consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent CPX and were followed for 327 ± 247 days. Clinical follow-up was performed every month and anticipated in case of re-hospitalisation for cardiac disease. Incidence of SVA was evaluated by direct clinical examination (ECG, ambulatory ECG). RESULTS: Patients with episodes of SVA (N 14) showed lower values of pVO2 and PetCO2, and higher values of VE/VCO2, VE/VCO2 slope, and VE%. After correction for age, gender, diabetes, ischaemic heart disease and left ventricular ejection fraction, peak VO2 (hazard ratio (HR) 0.68, 95 % confidence interval (CI) 0.51-0.91, p < 0.05), VE% (HR 1.38, 95 % CI 1.04-1.84, p < 0.05), VE/VCO2 (HR 1.38, 95 % CI 1.04-1.82, p < 0.05), VE/VCO2 slope (HR 1.77, 95 % CI 1.31-2.39, p < 0.01), PetCO2 (HR 0.66, 95 % CI 0.50-0.88, p < 0.01) were found as predictors of SVA. At Kaplan-Meier analysis, lower event-free rates were found in subjects with peak VO2 values below median (log rank p < 0.05), values of VE/VCO2 above mean (p < 0.05), higher VE/VCO2 slope tertiles (p <0.05), and values of PetCO2 below median (p < 0.05). CONCLUSIONS: CPX provides prognostic independent information for risk of SVA in subjects with CHF.
RESUMO
BACKGROUND: Coronary flow is influenced by several determinants and may change according to external stimuli. In patients with dilated cardiomyopathy (DC), adaptive mechanisms could induce alterations in coronary flow, possibly related to oxygen consumption. METHODS: In 67 consecutive patients with DC (mean age 52.06+/-13.84, 52 male gender, left ventricle ejection fraction (LVEF) 29.49%+/-8.68) and normal coronary angiography findings, coronary flow in left anterior descending (LAD), right coronary artery (RC) and left circumflex (LCx) was reported as TIMI frame count (TFC). All patients underwent a cardiopulmonary test with VO2 peak and anaerobic threshold (AT) measurement, New York Heart Association (NYHA) class stratification, two-dimensional echocardiographic evaluation including LVEF and left ventricle end-diastolic diameter (LVEDD) assessment. All patients were receiving optimal medical treatment. RESULTS: In a multivariate analysis, a statistically significant correlation was found between VO2 peak and TFC (B 7.61, p<0.001, R2 0.61 for LAD; B 3.42, p<0.001, R2 0.33 for RC); an inverse correlation was found between AT and TFC (B -9.77, p<0.001, R2 0.61 for LAD; B -4.26, p<0.001, R2 0.33 for RC). CONCLUSIONS: Coronary flow is related to VO2 peak and AT in patients with DC, suggesting a "compensatory" mechanism.