Hasil untuk "Diseases of the circulatory (Cardiovascular) system"

N. A. Mashkina, A. I. Ershova, O. V. Kopylova et al.

The accumulation of biospecimens associated with large-scale clinical data (data from electronic medical records, epidemiological and other large-scale studies) has made it possible to conduct studies aimed at studying associations between genetic variants and phenotypes, in particular, phenome-wide association studies (PheWAS). It was originally designed to test one or more genetic variants associated with a disease or clinical symptom for associations with other phenotypes. PheWAS can identify novel genetic and phenotypic associations, differentiate true pleiotropy and clinical comorbidity, identify new disease subtypes, and identify new drug targets. Future efforts to integrate broad and robust phenotypic data collection and improve PheWAS tools will provide a valuable resource for more efficient genome-phenome analysis, leading to new discoveries in personalized medicine.

N. Elias, N. Parast, Z. Koopman et al.

Carlos Eduardo Rochitte, MD, PhD, Andre Vaz, MD, Luciana Sacilotto et al.

César D. Niño, Orlando Castaño, Jorge E. Marín et al.

El uso de dispositivos cardiacos implantables ha aumentado en los últimos años, lo que ha generado un aumento en el número de procedimientos de extracción de electrodos a medida que se intervienen pacientes con un mayor número de comorbilidades. En la actualidad, la técnica percutánea de extracción es de elección en la mayoría de los pacientes debido a los excelentes resultados alcanzados y a una morbi-mortalidad asociada inferior a la de la extracción quirúrgica. No obstante, algunos pacientes pueden presentar retos que aumentan el grado de dificultad técnica del procedimiento, entre los que se encuentran variantes anatómicas, calcificaciones extensas o la necesidad de extraer electrodos de fijación pasiva. Se expone el caso de la extracción de un electrodo disfuncionante en una paciente portadora de marcapasos por bloqueo auriculoventricular completo, con estimulación diafragmática por electrodo ventricular de fijación pasiva implantado a través de una vena cava superior izquierda persistente en una vena posterolateral del seno coronario.

Bambang Dwiputra, Ade Meidian Ambari, Kevin Triangto et al.

Abstract Background Beyond the acute phase, a considerable proportion of patients recovering from the coronavirus disease 2019 (COVID-19) experience long-term sequelae that profoundly impact their quality of life, particularly their physical fitness. This study aims to assess the effect of home-based breathing and chest mobility exercise on the cardiorespiratory functional capacity of long COVID with cardiovascular comorbidity. Methods In this randomized, controlled, single-blind clinical trial, 46 long COVID with cardiovascular comorbidities were randomly assigned to either intervention or control group. The intervention group (n = 23) received additional home-based breathing and chest mobility exercise 3x/week for 12 weeks supervised by attending physicians, whereas the control group only received a home-based cardiac rehabilitation program. Baseline and post-intervention assessments consisted of laboratory (D-Dimer and CRP levels) and functional capacity, assessed through 6-minute walking test (6-MWT), exercise stress test’s metabolic equivalents (METS), and predicted peak oxygen consumption (VO2 peak), peak expiratory flow rate (PEFR), peak cough flow (PCF), chest expansion, and EuroQoL’s quality of life. Intention to treat analysis was performed. Results At the 12th week, intervention subjects had significantly greater functional capacity with higher mean PEFR (p = .031) and PCF (p = .016). Similarly, 6-MWT was higher in the group receiving home-based breathing and chest mobility training (p = .032). The bottom part of the chest circumference was statistically different between the two groups (p = .01). METS and predicted VO2 peak were also higher in the intervention group. However, laboratory parameters and quality of life did not differ markedly (p > .05). Conclusions Home-based respiratory and chest mobility exercise could be an adjunct to cardiac rehabilitation in long COVID with cardiovascular comorbidities for improving cardiorespiratory functional capacity. Trial registration The study protocol was registered at http://ClinicalTrial.gov.id NCT05077943 (14/10/2021).

Georgina Pappas, Michael Stoner, Craig Narins et al.

In the United States, current endovascular repair of proximal arch pathology is limited by patient anatomy, and the availability of Food and Drug Administration (FDA) approved devices. Through the first FDA-authorized Compassionate Use (CU) of a modified scalloped Terumo RelayPro Plus, we describe an endovascular repair of a type Ia endoleak, in a patient with bovine arch anatomy, with distal arch aneurysmal degeneration after an open type A dissection repair and failed conventional TEVAR. Further investigation is warranted to determine whether the increased effective seal zone provided by a scalloped thoracic endograft decreased the risk of type Ia endoleak and subsequent dissection-related aneurysmal degeneration in the aortic arch.

T. A. Lelyavina, M. Yu. Sitnikova, V. L. Galenko et al.

Aim. To assess the change in ergoreflex activity in heart failure patients with reduced left ventricular systolic function in the study of the effectiveness of physical training (PT) with original regimen, compared with PT with conventionally estimated regimen.Material and methods. Single-center open-label study of 297 patients with class III HF. The patients were divided into two groups: main group (MG) — patients, in whom the PT intensity was estimated based on lactate threshold (LT); comparison group (CG), in whom the PT intensity was estimated based on 60% VO2peak. We analyzed ergoreflex activity, the relationship of ergoreflex with exercise tolerance (ET), routine systemic inflammation markers, clinical manifestations of HF, and ET based on VO2peak.Results. An increase in gait velocity at the LT level after 3 months of PT was registered in 94% (n=210) of the MG patients. After 3 months, the PT regimen was recalculated according to 60% VO2реак; an increase in gait velocity at this level after 3 months of PT was registered in 70% of CG patients (n=35). The severity of HF decreased in both groups, but the dynamics was more pronounced in the MG, where class II was achieved by 75% of patients (in CG — 44%, p=0,003). In the MG, to a greater extent than in the CG, the ET increased. Ergoreflex activity (according to ΔVE) decreased by ≥15% in 230 (97%) MG patients and in 31 (63%) patients with CG. After the completion of the PT period, when in some patients the HF severity decreased to class II, we revealed a direct association of the ergoreflex value (according to ΔVE) with a greater severity of HF (r=-0,57, p=0,01) and the relationship between the decrease in ergoreflex activity (according to ΔVE), an increase in VO2LT (r=-0,55, p=0,001), VO2peak (r=0,49, p=0,001), a decrease in monocyte count (r=0,63, p=0,01).Conclusion. In stable patients with class III HF receiving the proper disease-modifying therapy, ergoreflex activity is increased and is associated with functional class, ET, and systemic inflammation activity. In the course of physical rehabilitation, a decrease in ergoreflex activity is accompanied by a decrease in functional class, an increase in EF, which is more pronounced with personalized aerobic exercise using LT regimen assessment.

Naomie Jutras-Beaudoin, BSc, Victoria Toro, MSc, Annie Christine Lajoie, MD et al.

Background: The blood neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a powerful predictor of adverse outcomes in some cardiovascular and lung diseases. Pulmonary arterial hypertension (PAH) is a lethal vasculopathy associated with increased inflammation. Although PAH exhibits a higher prevalence among women, men have a poorer prognosis. We investigated the NLR as an independent predictor of transplant-free survival in PAH. Methods: We performed a retrospective analysis of 78 PAH patients from the Quebec PAHBiobank (71% female). We used univariate and multivariate (adjusted for age, sex, renal function, and disease severity) Cox regression analyses to assess the relationship between the NLR and transplant-free survival, in the whole sample, and according to sex. The NLR was categorized as high (≥ 4.8) or low (< 4.8) using receiver operating characteristic analysis. Unadjusted Kaplan-Meier analysis estimated survival per NLR category. Results: The NLR was higher in patients who died, compared to that in patients who had transplant-free survival (P < 0.05). The NLR was an independent predictor of event-free survival in PAH (unadjusted hazard ratio: 1.11, 95% confidence interval: 1.04-1.18, which remained significant after adjustment for covariates). The high-NLR group had lower 1-, 3-, and 5-year survival compared to those with a low NLR (P < 0.001). The NLR remains a predictor of survival in women. Conclusions: The NLR is an independent predictor of transplant-free survival in PAH. We report a potential sexual dimorphism in the ability of the NLR to predict mortality in PAH, emphasizing the importance of considering sex-related differences in the development of biomarkers in PAH. Résumé: Contexte: Le rapport neutrophiles/lymphocytes (RNL) s’est récemment imposé comme un puissant facteur prédictif de l’issue défavorable de certaines maladies cardiovasculaires et pulmonaires. L’hypertension artérielle pulmonaire (HTAP) est une vasculopathie mortelle associée à une inflammation accrue. Bien que sa prévalence soit plus élevée chez les femmes, son pronostic est plus défavorable chez les hommes. Nous avons étudié le RNL en tant que prédicteur indépendant de la survie sans greffe chez des sujets atteints d’HTAP. Méthodologie: Nous avons effectué une analyse rétrospective du matériel sur l’HTAP de la Biobanque du Québec se rapportant à 78 patients (71 % de femmes). Des analyses de régression de Cox univariées et multivariées (ajustées en fonction de l’âge, du sexe, de la fonction rénale et de la gravité de la maladie) nous ont permis d’évaluer la relation entre le RNL et la survie sans greffe dans l’ensemble de l’échantillon et selon le sexe. Le RNL a été classé comme élevé (≥ 4,8) ou faible (< 4,8) au terme d’une analyse des caractéristiques de fonctionnement du récepteur. Une analyse non ajustée effectuée selon la méthode de Kaplan-Meier a servi à estimer la survie par catégorie de RNL. Résultats: Le RNL était plus élevé chez les patients décédés que chez les patients ayant survécu sans greffe (p < 0,05). Le RNL était un prédicteur indépendant de la survie sans événement chez les patients atteints d’HTAP (rapport des risques instantanés non ajusté : 1,11, intervalle de confiance à 95 % : 1,04-1,18, demeuré significatif après ajustement en fonction des covariables). La survie à 1, 3 et 5 ans a été inférieure au sein du groupe présentant un RNL élevé comparativement au groupe présentant un RNL faible (p < 0,001). Le RNL demeure un prédicteur de la survie chez les femmes. Conclusions: Le RNL est un facteur prédictif indépendant de la survie sans greffe chez les sujets atteints d’HTAP. Selon nos observations, un dimorphisme sexuel potentiel le caractérise en tant que prédicteur de la mortalité chez les sujets atteints d’HTAP. Il importe donc de tenir compte des différences liées au sexe dans le développement des biomarqueurs de l’HTAP.

Nakul Kumar, MD, Mariya Geube, MD, FASE

Antoine H G Driessen, Jan H N Lindeman, Robert J M Klautz et al.

Objective Bicuspid aortic valve (BAV) has been associated with less atherosclerosis as compared with tricuspid aortic valve (TAV) patients. It, however, remains unclear whether this reflects the older age of TAV patients and/or accumulation of atherosclerotic risk factors or that the BAV phenotype is atheroprotective. Therefore, we compared the atherosclerotic disease burden of BAV and TAV patients, with that of the general (age-matched) population.Methods The prevalence of coronary artery disease (CAD) and CAD risk factors in BAV and TAV patients who underwent aortic valve surgery were compared with the Dutch general practitioners registry data. BAV (n=454) and TAV (n=1101) patients were divided into four groups: BAV with aortic valve stenosis (BAV-AoS), BAV with aortic valve regurgitation (BAV-AR), TAV with AoS (TAV-AoS) and TAV with AR (TAV-AR). The atherosclerotic disease burden of each group was compared with that of the corresponding age cohort for the general population.Results CAD risk factors hypertension and hypercholesterolaemia were more prevalent in the surgery groups than the age-matched general population (all p&lt;0.001). All BAVs (BAV-AoS and BAV-AR) and TAV-AR had a similar incidence of CAD history as compared to the age-matched general populations (p=0.689, p=0.325 and p=0.617 respectively), whereas TAV-AoS had a higher incidence (21.6% versus 14.9% in the age-matched general population, p&lt;0.001).Conclusions Stenotic TAV disease is part of the atherosclerotic disease spectrum, while regurgitant TAV and all BAVs are not. Although the prevalence of cardiovascular risk factors is higher in all BAV patients, the prevalence of CAD is similar to the general population.

Stefan Toggweiler, Matthias Bossard, Florim Cuculi et al.

Objectives Report predictors and the natural course of paravalvular leak (PVL) following implantation of the ACURATE neo transcatheter heart valve (THV).Background Understanding the mechanisms of PVL may help to improve patient selection, patient outcomes and the design of next-generation THVs.Methods A total of 30 patients (mean age 81±5 years, 47% women) undergoing transcatheter aortic valve replacement with the ACURATE neo were enrolled in the PREDICT PVL study. The effective regurgitant orifice area (EROA, in mm2) of PVL was assessed by transthoracic and transoesophageal echocardiography before discharge and at 6 months follow-up.Results PVL was none/trace in 10 (33%), mild in 18 (60%) and moderate in 2 (7%) patients and occurred in distinct locations with largest EROAs in the area of the left coronary cusp and its adjacent commissures. Independent predictors for EROA were implantation depth (r coefficient −1.9 mm2 per mm implantation depth, p=0.01), leaflet calcification (6.2 mm2 per calcification grade, p=0.03) and THV size L (7.6 mm2 more than size S or M, p=0.01). At 6 months follow-up, EROA decreased by 29% from 13.7±9.7 mm2 to 9.5±7.9 mm2 (p&lt;0.01). Patients with smaller EROAs were more likely to be in New York Heart Association class 1 than patients with larger EROAs (p&lt;0.01).Conclusions PVL occurred predominantly in the region of the left coronary cusp and decreased by 29% during 6 months of follow-up. Our results underscore the importance of adequate patient selection and optimal implantation depth.

Alberto Caggiati, MD, PhD

Verrucous hyperplasia of the skin rarely occurs in legs with severe venous stasis. In these cases, ultrasound demonstrated thickening and hyperechogenicity of the skin layers. The core of the verrucous-like protrusions consisted of a fibrous lump of the reticular dermis, surrounded by an anechogenic layer and covered by a thickened epidermal shell. Compression treatment provokes the progressive disappearance of the dermal plications, accompanied by reduction of the cutaneous and subcutaneous edema and infiltration. Ultrasound easily demonstrates the histologic changes of verrucous hyperplasia of the skin and allows evaluation of the evolution of the disease and the efficacy of treatments. Keywords: Skin ultrasound, Verrucous skin hyperplasia, Venous stasis, Compression treatment

O. V. Tsygankova, T. I. Batluk, L. D. Latyntseva et al.

The current state of the Russian and foreign regulatory framework for off-label prescription of medicines is presented in the article. The existing problems of this specific drug therapy and possible solutions are described. Unfortunately, there are some gaps in the Russian legislation regarding the off-label medication use. Based on the clinical reality, in some cases, the “off-label” drugs prescription can be justified by the clinical condition of the patient, the lack of alternative approved drugs, and the availability of published scientific data that create the prerequisites for the effectiveness of this approach. When off-label drug prescribing as a forced measure, the doctor must provide a rationale for this prescription in the medical documentation, the conclusion of the consultation (with the participation of relevant specialists and the clinical pharmacologist) or the medical commission (with the participation of the administration representative), and the written informed consent of the patient or his legal representative. This information should be actively communicated to doctors in order to increase their legal literacy and prevent possible negative and legal consequences.

Alok Kumar Singh

Mohsin Ansari, Ameya Udyavar

A 72 yr male came for routine follow up of his pacemaker status and clinical condition. 2D Echo showed multiple clots attached to ventricular pacemaker lead. He was put on warfarin and therapeutic anticoagulation maintained for 3 months. We describe a case wherein complete resolution of the clots on the pacemaker lead were seen following treatment with warfarin therapy.

O. Yu. Shaydyuk, M. A. Kudinova, E. O. Taratukhin

The article is on some contemporary data about genetic specifics of patients with sleep apnea syndrome. The data discussed is concerned on either adult and newborn subjects with the syndrome.

Simone Nascimento dos Santos, Benhur Davi Henz, André Rodrigues Zanatta et al.

Background: Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. Objective: To evaluate the impact of AF ablation on estimated LV filling pressure. Methods: A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. Results: One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001) compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Conclusion: Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.

Luiz Felipe P. Moreira

ANIJAR Alberto Mauro, MALUF Miguel Angel, BUFFOLO Ênio

Os autores revisam as técnicas cirúrgicas utilizadas para a reconstrução da continuidade ventrículo direito (VD) e o tronco pulmonar (TP), dando ênfase às diferentes técnicas e associação, dependendo das formas anatômicas de cada lesão. Apresentam, para ilustração, 2 casos, operados com o uso de um novo conceito de prótese biológica produzida com a valva pulmonar e o tronco pulmonar suíno, preservados em glutaraldeído mediante dois modelos: retalho bivalvulado e tubo valvulado na experiência atual. No período de maio/91 e junho/95, foram operados 48 pacientes, em 43 foi usado retalho bivalvulado e, em 5 casos, prótese tubular valvulada. Houve 5 (10,4%) óbitos imediatos e 2 (4,6%) tardios. Este novo conceito de reconstrução da valva pulmonar e via de saída do ventrículo direito, usando heteroenxertos valvulados evita a insuficiência pulmonar significativa e apresenta baixa incidência de calcificação. É uma técnica facilmente reprodutível.