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1.
JACC Case Rep ; 4(22): 1515-1521, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36444176

RESUMO

Pericardial decompression syndrome (PDS) is a potentially fatal disorder of left ventricular function that sometimes occurs after drainage of a pericardial effusion for cardiac tamponade. Patients at risk for PDS are difficult to identify. Here, we report 2 cases where PDS developed after drainage of effusions that had been present for years, suggesting that patients with chronic effusions are at higher risk for PDS. (Level of Difficulty: Advanced.).

2.
Int J Cardiovasc Imaging ; 37(8): 2521-2527, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33956285

RESUMO

The shape of the left atrium (LA) and left atrial appendage (LAA) have been shown to predict stroke in patients with atrial fibrillation (AF). Prior studies rely on qualitative assessment of shape, which limits reproducibility and clinical utility. Statistical shape analysis (SSA) allows for quantitative assessment of shape. We use this method to assess the shape of the LA and LAA and predict stroke in patients with AF. From a database of AF patients who had previously undergone MRI of the LA, we identified 43 patients with AF who subsequently had an ischemic stroke. We also identified a cohort of 201 controls with AF who did not have a stroke after the MRI. We performed SSA of the LA and LAA shape to quantify the shape of these structures. We found three of the candidate LAA shape parameters to be predictive of stroke, while none of the LA shape parameters predicted stroke. When the three predictive LAA shape parameters were added to a logistic regression model that included the CHA2DS2-VASc score, the area under the ROC curve increased from 0.640 to 0.778 (p = .003). The shape of the LA and LAA can be assessed quantitatively using SSA. LAA shape predicts stroke in AF patients, while LA shape does not. Additionally, LAA shape predicts stroke independent of CHA2DS2-VASc score. SSA for assessment of LAA shape may improve stroke risk stratification and clinical decision making for AF patients.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Acidente Vascular Cerebral , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
3.
Fed Pract ; 36(Suppl 7): S32-S36, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31892787

RESUMO

A survey found that of cardiology services were widely available at facilities across the US Department of Veterans Affairs, but the types of services varied considerably based on facility complexity.

5.
Am J Cardiol ; 118(7): 991-7, 2016 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-27553101

RESUMO

Left ventricular (LV) scar identified by late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) is associated with adverse outcomes in coronary artery disease and cardiomyopathies. We sought to determine the prognostic significance of LV-LGE in atrial fibrillation (AF). We studied 778 consecutive patients referred for radiofrequency ablation of AF who underwent CMR. Patients with coronary artery disease, previous myocardial infarction, or hypertrophic or dilated cardiomyopathy were excluded. The end points of interest were major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of cardiovascular death, myocardial infarction, and ischemic stroke/transient ischemic attack. Of the 754 patients who met the inclusion criteria, 60% were men with an average age of 64 years. Most (87%) had a normal LV ejection fraction of ≥55%. LV-LGE was found in 46 patients (6%). There were 32 MACCE over the mean follow-up period of 55 months. The MACCE rate was higher for patients with LV-LGE (13.0% vs 3.7%; p = 0.002). In multivariate analysis, CHA2DS2-VASc score (hazard ratio [HR] 1.36, 95% CI 1.05 to 1.76), the presence of LV-LGE (HR 3.21, 95% CI 1.31 to 7.88), and the LV-LGE extent (HR 1.43, 95% CI 1.15 to 1.78) were independent predictors of MACCE. In addition, the presence of LV-LGE was an independent predictor for ischemic stroke/transient ischemic attack (HR 3.61, 95% CI 1.18 to 11.01) after adjusting for CHA2DS2-VASc score. In conclusion, the presence and extent of LV scar identified by LGE-CMR were independent predictors of MACCE in patients with AF.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Cicatriz/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Doenças Cardiovasculares/mortalidade , Ablação por Cateter , Cicatriz/epidemiologia , Meios de Contraste , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Seguimentos , Gadolínio , Insuficiência Cardíaca/epidemiologia , Humanos , Imageamento Tridimensional , Ataque Isquêmico Transitório/epidemiologia , Modelos Logísticos , Imageamento por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Razão de Chances , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
7.
JACC Cardiovasc Imaging ; 8(7): 793-800, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26093929

RESUMO

OBJECTIVES: This study sought to evaluate the prognostic significance of left ventricular late gadolinium enhancement (LV-LGE) incidentally found in atrial fibrillation (AF) patients who undergo ablation therapy. BACKGROUND: LV-LGE provides prognostic information in patients with ischemic and nonischemic cardiomyopathies. However, data on the clinical significance of incidental LV-LGE in the AF population are limited. METHODS: A total of 778 patients who were referred for radiofrequency ablation of AF underwent cardiac magnetic resonance examinations between June 2006 and January 2013. Patients with a history of myocardial infarction or ablation therapy were excluded. The presence of LV-LGE was assessed by experienced imaging physicians. Patients were followed for arrhythmia recurrence after the radiofrequency ablation procedure. RESULTS: Of 598 patients included in the study, 60% were men with a mean age of 64 years and a median AF duration of 25 months. LV-LGE was detected in 39 patients (6.5%). There were 240 arrhythmia recurrences observed involving 40% of patients over a median follow-up period of 52 months. On univariate analysis, age (hazard ratio [HR]: 1.02; 95% confidence interval [CI]: 1.00 to 1.03), male sex (HR: 0.63; 95% CI: 0.47 to 0.86), diabetes (HR: 1.53; 95% CI: 1.03 to 2.27), CHADS2 score (HR: 1.19; 95% CI: 1.04 to 1.36), CHA2DS2-VASc score (HR: 1.18; 95% CI: 1.08 to 1.30), left atrial (LA) fibrosis (HR: 1.66; 95% CI: 1.41 to 1.96), LV-LGE (HR: 1.83; 95% CI: 1.11 to 3.03), persistent AF (HR: 1.52; 95% CI: 1.11 to 2.09), and LA area (HR: 1.03; 95% CI: 1.01 to 1.05) were significantly associated with arrhythmia recurrence. The recurrence rate was 69% in patients with LV-LGE compared with 38% in patients without LV-LGE (p < 0.001). In a multivariate model, LA fibrosis and LV-LGE were independent predictors of arrhythmia recurrence. CONCLUSIONS: In AF patients without history of myocardial infarction, LV-LGE is a significant independent predictor of arrhythmia recurrence after ablation therapy.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Imageamento por Ressonância Magnética , Função Ventricular/fisiologia , Idoso , Fibrilação Atrial/patologia , Feminino , Previsões , Gadolínio , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva
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