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

S. Voicu, G. Sergey, D. Yannopoulos

Supriya Rai, MD (Hons), Nikita B. Jolapara, MD, BSc (Hons), Patrick Savage, MB, BCh, BAO, BSc (Hons) et al.

Daniel Becker, MD, Ahmed Ali, MD, Anja Lehmann, MD et al.

Objective: Juxtarenal abdominal aortic aneurysms (AAAs), pose a greater surgical challenge than infrarenal AAAs and often require suprarenal aortic clamping during open repair. This study aims to assess the impact of suprarenal vs infrarenal clamping on short- and long-term renal outcomes, mortality, and reintervention rates. Methods: A retrospective cohort analysis was conducted on 1250 patients undergoing open AAA repair between 2000 and 2020 at a tertiary vascular center. Patients were stratified into suprarenal and infrarenal clamping groups. Outcomes included 30-day mortality, major adverse events, acute kidney injury, new-onset dialysis, chronic kidney disease (CKD), long-term mortality, and reintervention. Propensity score matching and multivariate analysis were used to adjust for confounders. Results: Of the cohort, 492 underwent suprarenal and 758 infrarenal clamping. The suprarenal group experienced higher 30-day major adverse events (20.9% vs 16.2%; P = .036), acute kidney injury (37.6% vs 22.0%; P < .001), and new-onset dialysis (4.5% vs 1.8%; P = .009). At a median follow-up of 8.6 years, CKD incidence was significantly higher in the suprarenal group (28.5% vs 21.1%; P = .004), as was all-cause mortality (41.3% vs 32.4%; P < .001). We found no difference in reintervention rates between groups. In the propensity-matched cohort, CKD remained significantly more common with suprarenal clamping (P < .001), whereas differences in mortality were not statistically significant. Conclusions: Suprarenal clamping during open AAA repair is associated with increased postoperative renal complications and long-term CKD and mortality, despite similar reintervention and short-term mortality rates. These findings support the need for individualized surgical planning.

Zaid Al Jebaje, Ahmad Jabri, Tushar Mishra et al.

Windy W. Alonso, Sara E. Bills, Scott W. Lundgren et al.

Abstract Aims Most adults with stable heart failure are safe to exercise at a moderate intensity for 150 min/week. Regular participation in exercise may improve outcomes in adults with heart failure with preserved ejection fraction (HFpEF). Few adults with HFpEF initiate and sustain long‐term exercise. To promote exercise adherence in adults with HFpEF, we developed the Heart Failure Exercise and Resistance Training (HEART) Camp Connect intervention that is tested in this clinical trial. This trial tests our central hypothesis that theory‐informed coaching strategies delivered virtually will promote long‐term adherence to exercise in adults with HFpEF and drive clinically meaningful, and cost‐effective improvements in physiological and patient‐reported outcomes. Our aims are to (a) evaluate the effects of virtual and in‐person exercise and coaching on long‐term adherence, (b) determine a benchmark of minutes of moderate intensity exercise associated with health status as related to key biobehavioural outcomes, (c) examine behaviour change theory‐defined constructs as mediators of exercise adherence and (d) evaluate intervention costs. Methods This 18 month, three‐group, repeated measures randomized controlled trial is enrolling 300 adults with HFpEF. Participants are randomized to enhanced usual care (EUC), virtual coaching, or in‐person coaching. Our intervention applies coaching strategies, informed by behaviour change theories, in one‐on‐one and group settings weekly for 12 months. Our objective is to compare the effects of each delivery method to the other and EUC on exercise adherence (defined as ≥ 120 min of moderate intensity exercise/week) at 12 months (primary endpoint) and 18 months (sustainability endpoint). Secondary outcomes include minutes of moderate intensity exercise needed to drive minimal clinically important differences in health status, biomarkers, patient‐reported symptoms and cost. Behaviour change theory‐defined constructs (e.g., self‐efficacy and outcome expectations) will be tested as mediators of exercise adherence. Results We expect that virtual coaching is equally as efficacious and more cost effective at promoting exercise adherence as in‐person coaching. Effects on exercise adherence may be mediated by theory‐defined constructs. We also expect to identify a threshold for minutes of moderate intensity exercise to potentially serve as an adherence benchmark in adults with HFpEF, one that may differ from the 120 min of exercise in our current definition. Conclusions These findings could shift the paradigm of exercise coaching in HF towards virtual delivery and increase the generalizability and reach of exercise training. This is especially important for adults with HFpEF as they are excluded from Medicare reimbursement for traditional cardiopulmonary rehabilitation.

Jisun Lee, Seung-Kee Min

Adventitial cystic disease (ACD), a rare vascular disease characterized by mucus accumulation in the adventitia of blood vessels, typically affects the popliteal artery. We present the case of a 61-year-old female diagnosed with ACD in 2018 who was initially treated with endovascular stenting and percutaneous aspiration of the cyst. The patient, who had been asymptomatic for 5 years, developed a stent fracture and pseudoaneurysm requiring surgical intervention. Despite initial successful treatment, complications such as stent fracture and recurrence can occur; therefore, surgical treatment is recommended to optimize outcomes in patients with ACD. Endovascular treatment and cyst aspiration should only be considered in cases with high surgical risk. After treatment, long-term follow-up and individualized management strategies are important to monitor ACD recurrence.

Takashi Nagase, MD, Shinichiro Oda, MD, PhD, Yoshinobu Maeda, MD et al.

The conventional Damus-Kaye-Stansel procedure may cause coronary artery compression when the coronary arteries are situated between the great arteries. We have performed a modified Damus-Kaye-Stansel procedure utilizing a “flap-bridging technique,” in which an inverted U-shaped flap incised from the aorta is bridged to the main pulmonary trunk, creating sufficient space between the great arteries, in an 8-month-old boy who was a Fontan candidate with congenitally corrected transposition of the great arteries. This modified approach yielded favorable outcomes without coronary events and can effectively prevent coronary obstruction in cases where the coronary arteries run between the great arteries.

Mai T. H. Nguyen, Yuki Sakamoto, Toshiki Maeda et al.

Background This review aimed to quantify the impact of socioeconomic status on functional outcomes from stroke and identify the socioeconomic status indicators that exhibit the highest magnitude of association. Methods and Results We performed a systematic literature search across Medline and Embase from inception to May 2022, to identify observational studies (n≥100, and in English). Risk of bias was assessed using the modified Newcastle Ottawa Scale. Random effects meta‐analysis was used to pool data. We included 19 studies (157 715 patients, 47.7% women) reporting functional outcomes measured with modified Rankin Scale or Barthel index, with 10 assessed as low risk of bias. Measures of socioeconomic status reported were education (11 studies), income (8), occupation (4), health insurance status (3), and neighborhood socioeconomic deprivation (3). Pooled data suggested that low socioeconomic status was significantly associated with poor functional outcomes, including incomplete education or below high school level versus high school attainment and above (odds ratio [OR], 1.66 [95% CI, 1.40–1.95]), lowest income versus highest income (OR, 1.36 [95% CI, 1.02–1.83]), a manual job/being unemployed versus a nonmanual job/working (OR, 1.62 [95% CI, 1.29–2.02]), and living in the most disadvantaged socioeconomic neighborhood versus the least disadvantaged (OR, 1.55 [95% CI, 1.25–1.92]). Low health insurance status was also associated with an increased risk of poor functional outcomes (OR, 1.32 [95% CI, 0.95–1.84]), although this was association was not statistically significant. Conclusions Despite great strides in stroke treatment in the past decades, social disadvantage remains a risk factor for poor functional outcome after an acute stroke. Further research is needed to better understand causal mechanisms and disparities.

Dasheng Lu, Dasheng Lu, Xinyue Zou et al.

Atrial fibrillation (AF) is characterized by high morbidity and disability rate. The incidence of AF has rapidly increased due to increased aging population, causing a serious burden on society and patients. Therefore, it is necessary to determine the prevention and treatment of AF. Several studies have assessed the occurrence, development mechanism, and intervention measures of AF. The human gut has several non-pathogenic microorganisms forming the gut flora. The human gut microbiota plays a crucial role in the construction and operation of the metabolic system and immune system. Emerging clinical studies and basic experiments have confirmed that intestinal flora and its metabolites have a role in some metabolic disorders and chronic inflammatory diseases. Moreover, the gut microbiota has a role in cardiovascular diseases, such as hypertension and heart failure. However, the relationship between AF and gut microbiota is unclear. This review summarizes the relevant literature on the relationship between AF and intestinal flora with its metabolites, including Trimethylamine N-Oxide, short-chain fatty acids, lipopolysaccharide and bile acids. Therefore, this review may enhance further development of related research.

Belén Díaz‐Antón, Rodrigo Madurga, Blanca Zorita et al.

Abstract Aims To evaluate echocardiographic and biomarker changes during chemotherapy, assess their ability to early detect and predict cardiotoxicity and to define the best time for their evaluation. Methods and results Seventy‐two women with breast cancer (52 ± 9.8 years) treated with anthracyclines (26 also with trastuzumab), were evaluated for 14 months (6 echocardiograms/12 laboratory tests). We analysed: high‐sensitivity cardiac troponin T, NT‐proBNP, global longitudinal strain (GLS), left ventricle end‐systolic volume (LVESV), left ventricle end‐diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF). Cardiotoxicity was defined as a reduction in LVEF>10% compared with baseline with LVEF<53%. High‐sensitivity troponin T levels rose gradually reaching a maximum peak at 96 ± 13 days after starting chemotherapy (P < 0.001) and 62.5% of patients presented increased values during treatment. NT‐proBNP augmented after each anthracycline cycle (mean pre‐cycle levels of 72 ± 68 pg/mL and post‐cycle levels of 260 ± 187 pg/mL; P < 0.0001). Cardiotoxicity was detected in 9.7% of patients (mean onset at 5.2 months). In the group with cardiotoxicity, the LVESV was higher compared with those without cardiotoxicity (40 mL vs. 29.5 mL; P = 0.045) at 1 month post‐anthracycline treatment and the decline in GLS was more pronounced (−17.6% vs. −21.4%; P = 0.03). Trastuzumab did not alter serum biomarkers, but it was associated with an increase in LVESV and LVEDV (P < 0.05). While baseline LVEF was an independent predictor of later cardiotoxicity (P = 0.039), LVESV and GLS resulted to be early detectors of cardiotoxicity [odds ratio = 1.12 (1.02–1.24), odds ratio = 0.66 (0.44–0.92), P < 0.05] at 1 month post‐anthracycline treatment. Neither high‐sensitivity troponin T nor NT‐proBNP was capable of predicting subsequent cardiotoxicity. Conclusions One month after completion of anthracycline treatment is the optimal time to detect cardiotoxicity by means of imaging parameters (LVESV and GSL) and to determine maximal troponin rise. Baseline LVEF was a predictor of later cardiotoxicity. Trastuzumab therapy does not affect troponin values hence imaging techniques are recommended to detect trastuzumab‐induced cardiotoxicity.

Ahmet Belce, Beyza Nur Ozkan, Fatma Sena Dumlu et al.

Atherosclerosis is a chronic vascular inflammatory disease associated to oxidative stress and endothelial dysfunction. It is characterized by lipid accumulation in the arterial wall, increased hyperlipidemia, oxidative stress, lipid peroxidation, and protein oxidation. Our study included 45 patients ages of 40–60 and 45 healthy volunteers with similar demographic characteristics without any chronic disease as well. Fasting plasma glucose, BUN, creatinine, LDL-cholesterol, HDL-cholesterol, triglyceride, total cholesterol, HbA1c, and C-reactive protein (CRP) levels were measured using commercial kits by autoanalyzer. The oxidative stress biomarkers total oxidant status (TOS), total antioxidant status (TAS), total thiol (TT), native thiol (NT), catalase (CAT), paraoxonase (PON1), and arylesterase (ARES) enzyme activities were measured using photometric methods. The inflammatory biomarkers interleukin 1 beta (IL-1β), tumor necrosis factor-α (TNF-α), presepsin (PSPN), and raftlin (RFTN1) levels were measured with ELISA Kits. Oxidative stress index (OSI) and disulfide (DIS) were calculated. The clinical, biochemical biomarkers such as BUN, creatinine, HDL, LDL, total cholesterol, triglyceride, and CRP levels were found to be higher than the control group and lower post-treatment compared to the pre-treatment group (p <0.001). The oxidative stress parameters, TOS, OSI, and DIS levels were found to be higher than the control group, and the levels before the treatment were statistically significantly higher than after the treatment (p < 0.001). Antioxidant biomarkers TAS, TT, and NT levels were low in the patient group. Inflammatory biomarkers were highest before treatment and decreased with treatment. Oxidative stress and inflammation, which increased in atherosclerosis patients may guide disease prognosis and treatment strategies.

Sanjay Dixit, Aung Lin

Robin Jacob, MD, Paolo Strati, MD, Nicolas Palaskas, MD et al.

A 66-year-old woman with follicular lymphoma on lenalidomide and rituximab presented with chest pain. High-sensitivity troponin T peaked at 7,566 ng/l. Cardiac biopsy revealed extensive inflammation consistent with medication-induced myocarditis. Lenalidomide was stopped with improvement in troponins and patient was initiated on high-dose corticosteroid therapy. (Level of Difficulty: Intermediate.)

Ana Santurtún, Ana García Blanco, Pablo Fdez-Arroyabe et al.

Adenauer Marinho de Oliveira Góes Junior, Carolina Pinheiro de Oliveira, Camilla Castilho Maia et al.

Resumo A fístula arteriovenosa (FAV) é uma comunicação anormal e permanente entre uma artéria e uma veia devido a traumas penetrantes e lesões iatrogênicas. O trauma penetrante na parede arterial pode levar à formação de pseudoaneurismas (PSA) e, se houver lesão venosa concomitante, à formação de uma FAV. Os autores apresentam o caso de um paciente portador de FAV complexa de vasos poplíteos associada a pseudoaneurisma de artéria poplítea, sugeridos a partir de exames clínicos e exames de imagem, e tratados por cirurgia convencional devido à indisponibilidade de um stent graft com diâmetro apropriado, além de a cirurgia endovascular não estar disponível no serviço em que o paciente foi operado.

Marylou Para, L. Bocquillon, Clément Delmas et al.

Igor Alexandre Côrtes de Menezes, Márcio Roberto Viana Santos, Cláudio Leinig Pereira da Cunha

Fundamento: A disfunção endotelial se caracteriza por um fenômeno vascular, com importância evidente em todos os processos da aterogênese. Interessa, assim, a busca por métodos de avaliação da disfunção endotelial mais acurados, práticos e menos dispendiosos, objetivando melhoria na prevenção e tratamento das doenças ateroscleróticas. Objetivo: Verificar o potencial do índice de perfusão derivado da oximetria de pulso (IPP) como método de avaliação da disfunção endotelial em pacientes portadores de aterosclerose Métodos: Foram selecionados 18 pacientes controles e 24 pacientes portadores de doenças ateroscleróticas, em tratamento otimizado, selecionados em Unidades Básicas de Saúde. Foram avaliados os valores do IPP antes a após a aplicação de um estímulo vasodilatador dependente do endotélio - a hiperemia reativa. Também foram analisados os valores do IPP especificamente no período que possui a maior contribuição do óxido nítrico para a vasodilatação (IPP90-120). Os resultados do IPP foram discutidos, por meio da literatura, estimando o seu potencial diagnóstico e prognóstico. Resultados: A resposta vasodilatadora dependente do endotélio mensurada pelo IPP foi significantemente menor em indivíduos com aterosclerose em comparação aos controles a partir de 45 segundos após a hiperemia reativa. Foram observados, do mesmo modo, valores menores do IPP90-120 em pacientes com aterosclerose [35% (4% - 53%) vs. 73% (55% - 169%); p < 0,001]. Tais valores se mantiveram menores tanto em indivíduos masculinos quanto femininos. Conclusões: Os resultados do IPP, demonstrados na avaliação de pacientes ateroscleróticos, associados ao baixo custo da aparelhagem, tornam esse método atraente para futuros ensaios e possível contribuição na prevenção e tratamento das doenças ateroscleróticas.

A.P. Farrell

Renato Braulio, Cláudio Léo Gelape, Geraldo Brasileiro Filho et al.

Uma complicação grave, como a dissecção do tronco de coronária esquerda, com redução relevante do fluxo sanguíneo coronário pela luz verdadeira, requer ação rápida. Diante disso, a escolha imediata do stent no comprimento e calibre adequados para tratar a complicação se faz necessária.<br>A serious complication such as dissection of the left main coronary artery, with significant reduction in coronary blood flow by the true light, requires quick action. Therefore, the immediate choice of stent with appropriate length and size to treat the complication is necessary.

V. A. Kokorin, N. V. Sytnik, A. V. Dudareva et al.

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