RESUMO
Shear forces play a key role in thrombus formation and shear-based tests may better reflect physiological conditions in vivo compared with agonist-based tests. We evaluated the PlaCor PRT®, a novel platelet reactivity test based on shear-induced platelet aggregation, in patients with stable coronary artery disease (CAD) treated with single (SAPT) and dual antiplatelet therapy (DAPT). We examined 100 patients with multiple risk factors for CAD and/or documented stable CAD: 38 treated with SAPT, aspirin 100 mg qd, 62 treated with DAPT, aspirin 100 mg + clopidogrel 75 mg qd, compared with age- and sex-matched healthy volunteers without antiplatelet therapy (HV, n = 35). Measures of shear-induced platelet aggregation were performed with the PlaCor PRT®. In 25 patients in SAPT, the PlaCor test was also performed before and after a 12-hour-loading dose of clopidogrel 600 mg. The mean ± SD PRT time (seconds) in HV was 78 ± 13 and was significantly lower compared with SAPT (118 ± 16, p = 0.030) and to DAPT patients (242 ± 11, p < 0.0001). A statistically significant difference was also reported between SAPT and DAPT patients (p < 0.0001). After a loading dose of clopidogrel, the PRT time of SAPT patients increased significantly from 112 ± 20 to 254 ± 17, p < 0.0001. 2.7 and 26% of patients were considered as "poor responders" to single and dual antiplatelet therapy, respectively. This study shows that in patients with multiple risk factors for CAD and/or documented stable CAD, SAPT and DAPT play an important role in reducing platelet aggregation mediated by shear forces as evaluated with the novel PlaCor PRT®. Further studies will be required to confirm and assess the extent of these findings in patients with acute coronary syndromes.
Assuntos
Aspirina/uso terapêutico , Plaquetas/efeitos dos fármacos , Coleta de Amostras Sanguíneas/métodos , Inibidores da Agregação Plaquetária/farmacologia , Testes de Função Plaquetária/métodos , Ticlopidina/análogos & derivados , Aspirina/administração & dosagem , Aspirina/farmacologia , Plaquetas/citologia , Clopidogrel , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agregação Plaquetária/efeitos dos fármacos , Testes de Função Plaquetária/instrumentação , Fatores de Risco , Resistência ao Cisalhamento , Ticlopidina/administração & dosagem , Ticlopidina/uso terapêuticoRESUMO
We describe the case of a young pregnant woman with moderate mitral regurgitation who was admitted to our department for dyspnea. The patient was treated with low-dose diuretic therapy and ventilatory support. At follow-up echocardiographic evaluation, a progressive improvement of mitral regurgitation and pulmonary artery pressure was observed. The most significant hemodynamic changes occurring during pregnancy are reviewed and discussed in the setting of associated mitral regurgitation.
Assuntos
Hemodinâmica , Insuficiência da Valva Mitral/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Feminino , Humanos , Gravidez , Adulto JovemAssuntos
Angiodisplasia , Estenose da Valva Aórtica , Valva Aórtica/cirurgia , Calcinose , Hemorragia Gastrointestinal , Implante de Prótese de Valva Cardíaca , Doenças de von Willebrand , Idoso , Idoso de 80 Anos ou mais , Angiodisplasia/diagnóstico , Angiodisplasia/epidemiologia , Angiodisplasia/fisiopatologia , Anticoagulantes/uso terapêutico , Valva Aórtica/patologia , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/patologia , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Calcinose/epidemiologia , Calcinose/patologia , Calcinose/fisiopatologia , Gerenciamento Clínico , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/fisiopatologia , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Incidência , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Índice de Gravidade de Doença , Síndrome , Procedimentos Cirúrgicos Vasculares/métodos , Doenças de von Willebrand/diagnóstico , Doenças de von Willebrand/epidemiologia , Doenças de von Willebrand/fisiopatologiaRESUMO
BACKGROUND: Limited data are available on clinical outcome of patients with previously failed or not attempted chronic total occlusion (CTO) recanalization by percutaneous coronary intervention (PCI). The aim of the study is to determine prevalence and predictors of cardiac death in patients with CTO not revascularized by PCI. METHODS: Double-center study analyzing data of 1.345 consecutive patients with at least one CTO between 1998 and 2008. Of these, 847 patients were successfully revascularized (Revascularized group) and 498 patients were not revascularized (Not revascularized group) either due to failure of CTO-PCI (n=337) or because no attempt was made (n=161). RESULTS: At 4-year clinical follow-up, Not revascularized patients had a significantly higher rate of cardiac mortality (8.5% vs. 2.5%, p<0.0001) and sudden cardiac death (2.7% vs. 0.5%, p=0.001) compared to those Revascularized. The separate adjusted Cox-model analysis made for Not revascularized patients showed the most significant independent predictors of cardiac death were: chronic renal failure [HR (CI), 6.0 (2.66-13.80)], low-LVEF [5.7 (2.84-11.58)], insulin-dependent diabetes mellitus (IDDM) 4.6 [(1.96-10.97)]. In the Revascularized group, the presence of 3-vessel disease was the only significant independent predictor of cardiac death [4.4 (1.40-13.70)]. CONCLUSIONS: CTO patients Not revascularized had a significant higher rate of cardiac mortality and sudden cardiac death compared to those Revascularized. Within Not revascularized patients, the presence of low-LVEF, or CRF or IDDM was associated with an incidence of cardiac death at least 4 times higher than those without the same risk factors.
