Navegando por Palavras-chave "Myocardial ischemia"
Agora exibindo 1 - 6 de 6
Resultados por página
Opções de Ordenação
- ItemAcesso aberto (Open Access)Doenças isquêmicas do coração: mortalidade em nativos e migrantes, São Paulo, 1979-1998(Faculdade de Saúde Pública da Universidade de São Paulo, 2003-12-01) Marcopito, Luiz Francisco [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The State of São Paulo has been a major center of attraction for foreign and Brazilian migrants since the 19th century. The pattern of mortality due to ischemic heart disease according to place of birth is, however, unknown. Thus, the objective of the study was to identify differences in mortality due to ischemic heart disease among residents of the State of São Paulo according to their place of birth. METHODS: Analytical time series study based on secondary data. Rates were not calculated due to lack of denominators. Instead, non-census indicators (proportional mortality and standardized mortality ratio weighted for years of potential life lost before the age of 100 years) and medians were utilized. Temporal trends were analyzed by means of simple linear regression. RESULTS: In the State of São Paulo, about 40% of deaths due to ischemic heart disease occurred among migrants. The trend was negative for foreigners and positive for Brazilian migrants. Those born in northeastern Brazil, who presented the highest percentage of deaths in hospitals, had the worst performance: their proportional mortality due to ischemic heart disease remained unchanged throughout the study period (while this clearly declined for all other groups) and they died at younger ages. CONCLUSIONS: Migrants' share of total deaths due to ischemic heart disease in the State of São Paulo is very high. While there is a declining trend for foreigners, it is growing among Brazilian migrants. Among the compared groups, mortality due to ischemic heart disease in the State of São Paulo is most prominent for those born in northeastern Brazil.
- ItemAcesso aberto (Open Access)Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs(Associação Brasileira de Divulgação Científica, 2009-03-01) Fuchs, Angela Rúbia Cavalcanti Neves [UNIFESP]; Meneghelo, Romeu Sergio; Stefanini, Edson [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Smanio, Paola Emanuela Poggio; Mastrocolla, Luiz Eduardo; Ferraz, Almir Sergio; Buglia, Susimeire; Piegas, Leopoldo Soares; Carvalho, Antonio Carlos [UNIFESP]; Instituto Dante Pazzanese de Cardiologia Serviço de Reabilitação Cardiovascular; Instituto Dante Pazzanese de Cardiologia Seção Médica de Medicina Nuclear; Instituto Dante Pazzanese de Cardiologia Departamento de Saúde; Universidade Federal de São Paulo (UNIFESP)Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P < 0.05). The presence of myocardial ischemia during exercise was defined as a difference ≥2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.
- ItemAcesso aberto (Open Access)Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda(Universidade Federal de São Paulo (UNIFESP), 2017-06-29) Altino, Denise Meira [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; Barros, Alba Lucia Bottura Leite de [UNIFESP]; http://lattes.cnpq.br/3089430786971948; http://lattes.cnpq.br/1478157388713375; http://lattes.cnpq.br/0009905887482691; Universidade Federal de São Paulo (UNIFESP)Objective. Assess the impact of an anxious profile and symptoms of depression on the morbidity and mortality of patients with acute coronary syndrome (ACS) and identify predictive factors for anxiety and depression among these patients. Method. This retrospective cohort study was conducted in two phases in a coronary care unit. The first phase assessed predictive factors for anxiety and depression in 120 patients with ACS. Data were obtained from a previous study’s database. The second phase assessed the morbidity and mortality of 94 patients over a two-year period following hospital discharge. Data were collected from the patients’ electronic medical files and through telephone contact established at three points in time: immediately after hospital discharge; one year after discharge; and two years after discharge. The need to be readmitted due to a cardiovascular disease or the need for myocardial revascularization (MR) was considered for morbidity. Depression and anxiety were assessed using the Beck’s Depression Inventory and the Beck Anxiety Inventory-Trait. The variables collected to identify predictive factors were obtained using an instrument addressing sociodemographic and clinical data. Pearson’s chi-square test, Fisher’s exact test, Likelihood Ratio, the Mann-Whitney, Student’s t-test, and Spearman’s correlation coefficient were used to assess the relationship between anxiety and depression with the study’s variables. Variables associated with p<0.10 in the univariate analysis were used in the fitting of the logistic regression model. To describe the behavior of morbidity and mortality over time in the second phase, the Kaplan-Meier curve was used and the association of survival curves per category of depression and anxiety were compared using the log-rank test. The level of significance adopted was 0.05. The study was submitted to and approved by the Institutional Review Board. Results. Sex, diabetes mellitus, stress, anxiety, obesity, and number of years of education were related to depression. Sex, stress, depression and years of education were related to anxiety. Obesity increased the likelihood of depression by approximately 4.5 times (p-value=0.037) and each added unit in the anxiety score increased the likelihood of depression by 1.2 times (p-value<0.001). Depression, in turn, increased the likelihood of anxiety by 7.9 times (p-value<0.001), while one extra year of education is a protective factor from anxiety (OR=0.874, p-value=0.036). The two-year follow-up showed that 23.4% of the patients had been readmitted after the first year and 12.8% after the second. During hospitalization, 17% underwent a MR, 4.2% of which had one after the first year and none of the patients after the second year. Only 9.6% died in the follow-up period. Depression and anxiety were not related to morbidity or mortality. Conclusion. No significant relationship was found between anxiety and depression and morbidity or mortality. Obesity and anxiety were predictive factors for depression, while depression and fewer years of education were predictive factors for anxiety.
- ItemAcesso aberto (Open Access)No limiar anaeróbico ventilatório exercício pode causar isquemia miocárdica em programa de reabilitação cardiovascular(Universidade Federal de São Paulo (UNIFESP), 2009-01-28) Fuchs, Angela Rúbia Cavalcanti Neves [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Objectives: To assess the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Methods: Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99msestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise testing determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise testing at the prescribed workload and heart rate. Results: Myocardial perfusion images, analyzed using a score system: 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (p<0.05). The presence of myocardial ischemia during exercise was defined as a difference ³ 2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. Conclusion: MIBI-SPECT has shown myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise program. The changes in patient care and exercise program were implemented as a result of our findings (ischemia during the prescribed exercise).
- ItemAcesso aberto (Open Access)Revascularização do miocárdio sem circulação extracorpória: análise dos resultados em 15 anos de experiência(Sociedade Brasileira de Cirurgia Cardiovascular, 1996-12-01) Buffolo, Enio [UNIFESP]; Andrade, José Carlos S [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Teles, Carlos Alberto [UNIFESP]; Gomes, Walter José [UNIFESP]; Aguiar, Luciano F [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Myocardial revascularization without cardiopulmonary bypass is now a subject of increasing interest. The purpose of this paper is to present the results obtained during 15 years of experience. From September 1981 till March 1996,1549 patients we operated on without the use of cardiopulmonary bypass with an applicability of this alternative around 18% of the total revascularized patients in this period. The ages varied from 28 to 86 years (medium 57) with 1126 males and 423 females. The number of grafts varied from 1 to 5 (medium 1.7 grafts/patient). The technique did not constitute special limitation to use arterial grafts. The thoracic internal arteries were used 1140 times. In 1515 patients the revascularization was achieved through medsternotomy and in 34 through a minor left anterior thoracotomy. The mortality rate was 2.4% (38/1549) the main primary cause of death, low cardiac output in patients operated under acute ischemia after failed angioplasty or evolving mycardial infarction. In 8 patients the revascularization was performed under intraaortic balloon pump. The results of this 15 years experience permit the conclusion that myocardial revascularization without extracorporeal circulation is an excelent alternative of surgical treatment of coronary artery disease for a subset of patients with lower mortality and morbidity being specially indicated in high risk patients.
- ItemAcesso aberto (Open Access)Terapia gênica com VEGF para angiogênese na angina refratária: ensaio clínico fase I/II(Sociedade Brasileira de Cirurgia Cardiovascular, 2010-09-01) Kalil, Renato A. K.; Salles, Felipe Borsu De; Giusti, Imarilde Inês; Rodrigues, Clarissa Garcia; Han, Sang Won [UNIFESP]; Sant'anna, Roberto Tofani; Ludwig, Eduardo; Grossman, Gabriel; Prates, Paulo Roberto Lunardi; Sant'anna, João Ricardo Michelin; Teixeira Filho, Guaracy Fernandes; Nardi, Nance Beyer; Nesralla, Ivo Abrahão; Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia; UFCSPA; Universidade Federal de São Paulo (UNIFESP); Instituto de Cardiologia do RS/Fundação Universitária de Cardiologia Laboratório de Cardiologia Molecular e CelularOBJECTIVE: Safety, feasibility and early myocardial angiogenic effects evaluation of transthoracic intramyocardial phVEGF165 administration for refractory angina in no option patients. METHODS: Cohort study, in which 13 patients with refractory angina under optimized clinical treatment where included, after cineangiograms had been evaluated and found unfeasible by surgeon and interventional cardiologist. Intramyocardial injections of 5mL solution containing plasmidial VEGF165 where done over the ischemic area of myocardium identified by previous SPECT/Sestamibi scan. Evaluations included a SPECT scan, stress test, Minnesotta QOL questionnaire and NYHA functional class and CCS angina class determinations. RESULTS: There were no deaths or new interventions during the study period. There were no significant variations in SPECT scans, QOL scores and stress tests results during medical treatment in the included patients. After the 3rd post operative month, there was improvement in SPECT segmental scores, SSS (18.38±7.51 vs. 15.31±7.29, P=0.003) and SRS (11.92±7.49 vs. 8.53±6.68, P=0.002). The ischemic area extension, however, had non-significant variation (23.38±13.12% vs. 20.08±13.88%, P=0.1). Stress tests METs varied from 7.66±4.47 pre to 10.29±4.36 METs post-op (P=0.08). QOL score improved from 48.23±18.35 pre to 30.15±20.13 post-op points (P=0.02). NYHA class was 3.15±0.38 pre vs. 1.77±0.83 post-op (P=0.001) and angina CCS class, 3.08±0.64 vs. 1.77±0.83 (P=0.001). CONCLUSIONS: Intramyocardial VEGF165 therapy for refractory angina, in this small trial of no option patients, resulted feasible and safe. Early clinical and scintilographic data showed improvements in symptoms and myocardial perfusion, with regression of ischemia severity in treated areas.