RESUMO
This study aimed to assess the predictive role of body mass index (BMI), waist circumference (WC) and the waist-to-hip ratio (WHR) for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients. We followed up 2266 essential hypertensive individuals (mean age, 57.8 years; males, 1083; office blood pressure (BP), 143/89 mm Hg) who were free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and, at baseline, underwent blood sampling and a complete echocardiographic study to determine the left ventricular (LV) mass index. CAD was defined as a history of myocardial infarction or significant coronary artery stenosis that was revealed by angiography or a coronary revascularization procedure. The incidence of CAD throughout the follow-up period was 2.33%. Hypertensive individuals who developed CAD (n=53) had a greater baseline WC (101.1±11.7 vs. 96.4±12 cm, P=0.005), WHR (0.94±0.07 vs. 0.89±0.08 cm, P<0.0001) and LV mass index (117±26.8 vs. 103.3±27 g m(-)(2), P<0.0001) compared with those without CAD at follow-up (n=2213), whereas no difference was observed compared with the baseline office BP and BMI values (P=NS for all). Using a multivariate Cox regression model, WC (hazard ratio (HR) 1.037, P=0.002) and LV mass index (HR 1.010, P=0.044) were found to be independent predictors of CAD. In essential hypertensive patients, WC could predict the future development of CAD, whereas BMI and WHR showed no independent prognostic value. These findings suggest that WC constitutes an easy clinical tool to assess risk in hypertension among individuals with obesity.
Assuntos
Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Doença da Artéria Coronariana/epidemiologia , Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Circunferência da Cintura/fisiologia , Adulto , Idoso , Comorbidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia , Hipertensão Essencial , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Fatores de Risco , Fatores SexuaisRESUMO
Lead perforation is a rare complication of device implantation, varying between 0.3% and 1%, although the prevalence may be higher. Late lead perforations (>1 month after implantation) are believed to be very rare. We describe the successful treatment of a 65-year-old man with late cardiac perforation due to the pacemaker active fixation lead after an uneventful implantation.
Assuntos
Apêndice Atrial/lesões , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial/efeitos adversos , Traumatismos Cardíacos/etiologia , Marca-Passo Artificial/efeitos adversos , Idoso , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Bloqueio Atrioventricular/diagnóstico , Procedimentos Cirúrgicos Cardíacos , Tamponamento Cardíaco/etiologia , Drenagem , Ecocardiografia Doppler , Desenho de Equipamento , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Humanos , Masculino , Derrame Pericárdico/etiologia , Radiografia , Reoperação , Esternotomia , Técnicas de Sutura , Resultado do TratamentoRESUMO
BACKGROUND: Albuminuria, arterial stiffening and left ventricular hypertrophy (LVH) constitute target organ damage. We estimated whether increased urinary albumin excretion, assessed by albumin-to-creatine ratio (ACR), and carotid to femoral pulse wave velocity (c-f PWV) were accompanied by augmented left ventricular (LV) mass index (LVMI) in hypertension. METHODS: In 428 non-diabetic untreated hypertensives (257 men, mean age = 52 years, office blood pressure (BP) = 146/93 mm Hg) the distributions of ACR and c-f PWV were split by the median (8 mg/g and 7.8 m/s, respectively). RESULTS: Age, male sex, 24 h systolic BP, ACR and c-f PWV were the independent predictors of LVMI (R(2) = 0.478, p < 0.0001). Among patients with low ACR (n = 198), those with high c-f PWV (n = 84) compared to those with low c-f PWV (n = 114) were characterized by increased LVMI (by 8.9 g/m(2), p = 0.012) and prevalence of LVH (30 vs. 14%, p = 0.015). Similarly among patients with high ACR (n = 230), those with high c-f PWV (n = 123) compared to those with low c-f PWV (n = 107) exhibited heightened LVMI (by 13.6 g/m(2), p = 0.001). CONCLUSIONS: Increased ACR in conjunction with pronounced arterial stiffness is accompanied by augmented LV mass and higher LVH rates. Furthermore, the interrelationships between albuminuria, c-f PWV and LVMI suggest parallel target organ damage progression.