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- ItemAcesso aberto (Open Access)Avaliação das pressões sistólica, diastólica e pressão de pulso como fator de risco para doença aterosclerótica coronariana grave em mulheres com angina instável ou infarto agudo do miocárdio sem supradesnivelamento do segmento ST(Sociedade Brasileira de Cardiologia - SBC, 2004-05-01) Sousa, José Marconi Almeida de [UNIFESP]; Hermann, João L. V. [UNIFESP]; Guimarães, João B. [UNIFESP]; Menezes, Pedro Paulo O. [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Santa MarcelinaOBJECTIVE: To evaluate pressures assessed at the aortic root as risk factors for severe atherosclerotic coronary heart disease in women with unstable angina/compatible clinical history associated with increase in cardiac enzymes (total CPK and CK-MB) 2 times greater than the standard value used in the hospital, with the absence of new Q waves on the electrocardiogram (UA/NSTEMI). METHODS: Five hundred and ninety-three female patients with clinical diagnosis of UA/NSTEMI underwent cinecoronariography from March 1993 to August 2001, and the risk factors for CHD were studied. During examination the pressures, at the aortic root, and coronary obstructions were visually assessed by 2 interventional cardiologists, and those stenosis over 70% were considered severe. RESULTS: Eight-one per cent of the population was white and 18.3% was black. Mean age was 59.2±11.2 years, and it was significantly higher in patients with severe coronary lesions: 61.9 ± 10.8 years versus 56.4 ± 10.8 years; smoking, diabetes mellitus and climacteric were more frequent in patients with CHD. The average mean arterial pressure and mean systolic blood pressure was the same in both groups, however, average left ventricle diastolic pressure (17.6 ± 8.7 x 15.1 ± 8.1, p=0.001), and aortic pulse pressure were significantly greater in patients with CHD (75.5 ± 22 x 70 ± 19, p=0.002), while average aortic diastolic pressure was significantly greater in patients without CHD (79.8 ± 16 x 75.3 ± 17.5, p=0.003). In the multivariated analysis, pulse pressure > 80 mmHg and systolic blood pressure > 165 were independently associated with severe CHD with odds ratio of 2.12 and 2.09, p<0.05, respectively. CONCLUSION: CHD is associated with increased pulse pressure and lower diastolic blood pressure in women with UA/NSTEMI. Although average systolic blood pressure has not been associated with CHD in this population, dichotomized values of pulse pressure > 80 mmHg and systolic blood pressure > 165 mmHG determined risk two times greater of severe coronary disease.
- ItemSomente MetadadadosCardiovascular changes resulting from sexual activity and sexual dysfunction after myocardial infarction: integrative review(Wiley-Blackwell, 2013-12-01) Bispo, Gisele S.; Lopes, Juliana de Lima [UNIFESP]; Barros, Alba L. B. L. de [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Aims and objectivesTo identify studies on cardiovascular changes resulting from sexual activity, as well as the occurrence of sexual dysfunction after acute myocardial infarction.BackgroundMany patients with acute myocardial infarction experience sexual dysfunction, mainly due to fear of dying and/or of having another heart attack.DesignThe research was an integrative literature review.MethodsSearched databases included Lilacs, Medline and PubMed, and the following were inclusion criteria: national and international articles published from 2000-2011, written in Portuguese, Spanish or English.ResultsThe results indicate that many patients with coronary heart disease experience sexual dysfunction whether from fear of experiencing another acute myocardial infarction or due to the side effects of medication. Studies show there are few cardiovascular changes during sexual activity.ConclusionsBecause sexual dysfunction negatively affects the lives of people, providing guidance to individuals with cardiovascular disease, especially after an acute myocardial infarction, may be a crucial factor in determining quality of life and should be incorporated into clinical practice.Relevance to clinical practiceDespite the subject's importance, there are few studies on nursing guidance concerning sexual activity; moreover, addressing sexuality with patients is still a challenge for nurses.
- ItemSomente MetadadadosChoque cardiogênico no infarto agudo do miocárdio tratado com estratégia fármaco-invasiva: características clínicas e análise angiográfica(Universidade Federal de São Paulo (UNIFESP), 2016-09-28) Souza, Marco Tulio de [UNIFESP]; Alves, Claudia Maria Rodrigues Alves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Primary PCI is the recommended treatment in acute myocardial infarction with ST elevation (STEMI) complicated by cardiogenic shock (CS), fibrinolytic therapy with tenecteplase (TNK) in pharmaco invasive therapy (PIT) strategy is used in many patients. Clinical and angiographic findings in this scenario are unknown. Our goal is to present angiographic characteristics and clinical outcomes in a large population submitted to PIT, identifying predictors of in-hospital mortality in the group with CS. Methods: Patients were included in a referral cardiology hub as part of a PIT strategy (STEMI network) of the public health system in Sao Paulo. Descriptive statistical analysis and multivariate logistic regression was used to identify predictors of in-hospital death in the CS group. A total of 1094 consecutive STEMI patients were treated between 2010-2014. Cardiogenic shock rate was 10% and all of them were due to ventricular failure. A significant difference in age (61 ± 13.1 vs 57 ± 11.3, p = 0.011), diabetes (43% vs. 30% p = 0.006) and chronic kidney disease (24% vs 10%, p<0.001) were observed in CS group. Angiographic findings of CS group were 30% single-vessel, 35% two-vessel, 32% three-vessel. The culprit artery was the left main in 3% and similar incidence of lesions in LAD, LCX and RCA. There was a low rate of successful reperfusion after TNK (46% vs 70% without CH, p<0.0001) and although TIMI flow grade 2/3 post PCI was achieved in 83% only 44% achieved BLUSH 2/3. Major complications related to catheterization were more frequent in group CS: stroke (ischemic or hemorrhagic): 7.6% vs 1.2%, p <0.001; death in the catheterization (6.6% vs 0.5%, p <0.001) and major bleeding (11.8% vs. 7.6%, p <0.001). In-hospital mortality was 40%. Predictors of mortality were: obesity (OR = 5.5 p = 0.009), peripheral arterial disease (PAD) (OR = 20.1 p = 0.003), pain-to-needle> 12 hours (OR 7.64 p = 0.022), time pain-shock> 6 hours (OR 14.1 p = 0.001), no-reflow (OR 7.094 p = 0.029), TNK in CS duration (OR=12.2, p=0.021). This unique population was characterized by predominance of multiarterial lesion, absence of mechanical complications, low rates of successful microvascular reperfusion. PIT is a suboptimal treatment for this high risk population and understanding its role and limitations is fundamental for its appropriate use when primary PCI is unavailable.
- ItemAcesso aberto (Open Access)Dissecção espontânea de artéria coronária no ciclo gravídico-puerperal: análise de uma série de 13 casos e revisão da literatura(Universidade Federal de São Paulo (UNIFESP), 2016-11-29) Cade, Jamil Ribeiro [UNIFESP]; Caixeta, Adriano Mendes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: This study aims a descriptive analysis of 13 cases of SCAD in the peripartum period, based on the emphatic observation of clinical and epidemiological data, previous pregnancy history, clinical and angiographic presentation on admission, treatment in acute phase and in-hospital follow-up. Additionally to the study a review of all published cases of this disease, from 1952 to 2015, with evaluation using the same data cited above. Methods: A retrospective and observational study including patients with peripartum SCAD, using database of 15 tertiary hospitals. The diagnosis of SCAD was given through the agreement of two interventional cardiologists, using angiographic existing diagnosis criteria. The assessment of all cases from 1952 to 2015 was research through Pubmed, Web of Science, Embase and Cochrane Library. Age, risk factors for CAD, gestational history, clinical presentation, angiographic data and treatment as well as maternal and fetal outcomes at hospital discharge, were stored for later analysis. Results: All 13 cases of SCAD were reported descriptively. The mean age was 33.8 ± 3.7 years, mean of pregnancies were 1.8 ± 0.7 and births 1.7 ± 0.8. Twelve SCAD patients occurred in postpartum period and only one in the 37th week of pregnancy. The clinical presentation was myocardial infarction in 92.3%. Most were kept in clinical treatment alone (53.8%), followed by coronary angioplasty in 30.7%. There was one maternal death (7.7%) due to cardiogenic shock. In the review of all cases of peripartum SCAD from 1952 to 2015 were identified 133 more cases. Of this total an average age was 33.4 ± 5 years, mean 2.5 ± 1.5 pregnancies and 1.9 ± 1.3 deliveries. The postpartum period accounted for 75.3% of SCAD, with a median of 10 days after delivery. In pregnant women with SCAD (21.2%) the median was 34 weeks. The majority (65.1%) had no risk factors for CAD. Of the total cases, STEMI represented 61%, Non-STEMI 19.8%, angina 4.1% and sudden death in 13.7% of cases. LAD isolated was the most affected (35%), but the involvement of LM occurred in 29.4%, and two or more arteries compromises 44% patients. The isolated clinical treatment occurred in 33%, PCI in 20% and CABG in 21% of cases. Heart transplant occurred in 2%. The hospital mortality rate was 18.5% on 146 analyzed patients. Conclusions: Although it is a rare, underdiagnosed, and potentially fatal disease, the peripartum SCAD is often presented as STEMI on young patients with few or no risk factors for CAD. Mainly affects the LAD, but the involvement of multiple vessels occurs in about a half of cases and LM in almost one-third cases. Compared to historical cases, we observed a favorable maternal and fetal survival over the years, probably with the advancement in the management of acute STEMI and better understanding of SCAD, manly in the last decade.
- ItemAcesso aberto (Open Access)Echocardiographic predictors of early in-hospital heart failure during first ST-elevation acute myocardial infarction: does myocardial performance index and left atrial volume improve diagnosis over conventional parameters of left ventricular function?(Biomed Central Ltd, 2011-06-03) Souza, Lilian P. [UNIFESP]; Campos, Orlando [UNIFESP]; Peres, Clovis A. [UNIFESP]; Machado, Cristiano V. [UNIFESP]; Carvalho, Antonio C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Left ventricular ejection fraction (LVEF) has been considered a major determinant of early outcome in acute myocardial infarction (AMI). Myocardial performance index (MPI) has been associated to early evolution in AMI in a heterogeneous population, including non ST-elevation or previous AMI. Left atrial volume has been related with late evolution after AMI. We evaluated the independent role of clinical and echocardiographic variables including LVEF, MPI and left atrial volume in predicting early in-hospital congestive heart failure (CHF) specifically in patients with a first isolated ST-elevation AMI.Methods: Echocardiography was performed within 30 hours of chest pain in 95 patients with a first ST-elevation AMI followed during the first week of hospitalization. Several clinical and echocardiographic variables were analyzed. CHF was defined as Killip class >= II. Multivariate regression analysis was used to select independent predictor of in-hospital CHF.Results: Early in-hospital CHF occurred in 29 (31%) of patients. LVEF <= 0.45 was the single independent and highly significant predictor of early CHF among other clinical and echocardiographic variables (odds ratio 17.0; [ 95% CI 4.1 - 70.8]; p < 0.0001). MPI alone could not predict CHF in first ST-elevation AMI patients. Left atrial volume was not associated with early CHF in such patients.Conclusion: for patients with first, isolated ST-elevation AMI, LVEF assessed by echocardiography still constitutes a strong and accurate independent predictor of early in-hospital CHF, superior to isolated MPI and left atrial volume in this particular subset of patients.
- ItemSomente MetadadadosFatores preditores e impacto do fenômeno de no reflow em pacientes com infarto agudo do miocárdio com supra de segmento st submetidos à estratégia fármaco-invasiva(Universidade Federal de São Paulo (UNIFESP), 2016-09-28) Moraes, Pedro Ivo de Marqui [UNIFESP]; Carvalho, Antonio Carlos de Camargo Carvalho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The reflow phenomenon is a complication of percutaneous coronary intervention (PCI), characterized by a weakened blood flow despite the restoration of patency in the epicardial coronary artery. We sought to evaluate the incidence, predictors and impact of the reflow phenomenon in patients with acute myocardial infarction (STEMI) treated with the drug-invasive strategy (EFI). For this, we analyzed 1012 patients with IAMCSST, who received fibrinolytic therapy in the initial care and were systematically transferred to the tertiary hospital for cardiac catheterization and PCI, when indicated. This study stands out for originality, since there is scarce knowledge about the phenomenon of no reflow in the specific EFI scenario. The results showed that the incidence of the phenomenon was 9.2%. After applying a multivariate logistic regression model, the independent predictors related to the phenomenon were: TIMI coronary flow pre-PCI ? 2 (OR 3.38 CI 95% 2.80-5.92), higher values ??in the TIMI (OR 2.09 95% CI 1.69-3.12) and GRACE (OR 1.02 95% CI 1.01-1.04), advanced age (OR 1.05 95% CI 1.02-1.08 ) And greater amplitude of supra ST pre fibrinolysis (OR 1.02 95% CI 1.002-1.043). The reflow phenomenon was also related to higher mortality rates (22.6% versus 4% p <0.001) and in-hospital complications. It is concluded that the phenomenon of no reflow in patients with IAMCSST treated according to EFI has an incidence of 9.2%. Its predictors were prenormal PCI, advanced age, higher pre-fibrinolysis ST, and higher values ??of TIMI and GRACE scores. The phenomenon represented a negative impact due to higher mortality rates and in-hospital complications.
- ItemSomente MetadadadosPregnancy-associated spontaneous coronary artery dissection: insights from a case series of 13 patients(Oxford Univ Press, 2017) Cade, Jamil Ribeiro [UNIFESP]; Szarf, Gilberto [UNIFESP]; Siqueira, Maria Eduarda Menezes de [UNIFESP]; Chaves, Aurea; Andrea, Julio C. M.; Figueira, Helio R.; Gomes Junior, Manuel Pereira Marques [UNIFESP]; Freitas, Barbara P.; Medeiros, Juliana Filgueiras [UNIFESP]; dos Santos, Marcio Ricardo; Fiorotto, Walter B.; Daige, Augusto; Goncalves, Rosaly; Cantarelli, Marcelo; Alves, Claudia Maria Rodrigues [UNIFESP]; Echenique, Leandro [UNIFESP]; Fabio, S. de Brito; Perin, Marco A.; Born, Daniel [UNIFESP]; Hecht, Harvey; Caixeta, Adriano [UNIFESP]Aims We sought to present a series of 13 pregnancy-associated spontaneous coronary artery dissection (P-SCAD), their angiographic and multimodal imaging findings, acute phase treatment, and outcomes. Methods and results Between 2005 and 2015, 13 cases of P-SCAD were collected from a database of 11 tertiary hospitals. The mean age was 33.8 3.7 years
- ItemSomente MetadadadosTissue characterization and phenotype classification in patients presenting with acute myocardial infarction: Insights from the iWonder study(Wiley, 2017) Souza, Cristiano F. [UNIFESP]; Maehara, Akiko; Mintz, Gary S.; Matsumura, Mitsuaki; Alves, Claudia M. R. [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Caixeta, Adriano [UNIFESP]ObjectivesWe sought to assess a new modality of radiofrequency intravascular ultrasound (IVUS) called iMAP-IVUS (Boston Scientific, Santa Clara, California) during the evaluation of patients presenting with high-risk acute coronary syndromes. BackgroundThere are limited data on plaque tissue characterization and phenotype classification using iMAP-IVUS. MethodsIn the iWonder study patients presenting with ST-elevation myocardial infarction (STEMI) or non-STEMI underwent three-vessel grayscale IVUS and iMAP-IVUS tissue characterization prior to percutaneous intervention. In total 385 lesions from 100 patients were divided into culprit (n=100) and nonculprit (n=285) lesions. Lesion phenotype was classified as (i) thin-cap fibroatheroma (iMAP-derived TCFA); (ii) thick-cap fibroatheroma; (iii) pathological intimal thickening; (iv) fibrotic plaque; and (v) fibrocalcific plaque. ResultsCulprit lesions had smaller minimum lumen cross-sectional area (MLA) with greater plaque burden compared to non-culprit lesions. Volumetric analysis showed that culprit lesions had longer length and larger vessel and plaque volumes compared to non-culprit lesions. iMAP-IVUS revealed that culprit lesions presented more NC and fibrofatty volume, both at lesion level and at the MLA site (all P<0.001). Any fibroatheroma was more frequently identified in culprit lesions compared with non-culprit lesions (93% vs. 78.9%, P=0.001), anywhere within the lesion 19.0%, P<0.001) as well as at the MLA site (18.0% vs. 9.5%, P=0.07). ConclusionsThree-vessel radiofrequency iMAP-IVUS demonstrated a greater plaque burden and higher prevalence of any fibroatheroma as well as iMAP-derived TCFAs in culprit versus non-culprit lesions in patients presenting with STEMI or non-STEMI undergoing percutaneous coronary intervention. (c) 2017 Wiley Periodicals, Inc.