56 research outputs found
Ischaemiás szívbetegség és tumoros betegségek együttes előfordulása. Kérdések és problémák | Ischaemic heart disease in cancer patients. Questions and problems
Európában a tumoros és cardiovascularis betegségek okozzák a halálozások több
mint felét, Magyarországon 2015-ben ez több mint 70% volt. Bizonyos onkológiai
kezelések 4–7-szeresére emelhetik az akut coronariaszindróma kialakulásának
lehetőségét, mindemellett az onkológiai betegségek önmagukban többszörösére
növelik szívinfarktus esetén a halálozást. A kezeléseket tovább nehezíti, hogy
nagyon kis esetszámú összesített klinikai adat áll rendelkezésre a tumoros
betegek kardiológiai ellátásának hatásairól, mivel ezeket a betegeket rendre
kizárták a klinikai vizsgálatokból. Onkológiai betegek esetében hiányosak a
protokollok az esetleges konzervatív vagy invazív beavatkozás szükségességének
eldöntésére, így egyéni tapasztalatokra, eseti közleményekre kell hagyatkoznunk.
Az onkokardiológia fontosságát kiemeli, hogy az onkológiai kezelések fejlődése
miatt egyre nő a daganatot túlélők aránya. Csak az Egyesült Államokban 2025-re
20 millió ilyen beteggel számolnak, így nem meglepő, hogy az American College of
Cardiology 2014-ben az onkokardiológiát kiemelt területnek minősítette, az
Európai Kardiológiai Társaság 2016-ban pedig kiadta első kardioonkológiai
ajánlását. Cikkünkben a tumoros ischaemiás szívbetegek ellátásának főbb
kérdéseit és javaslatait vesszük sorra a jelenleg használt ajánlásokat,
publikációkat és helyi protokollokat alapul véve. Orv Hetil. 2017; 158(43):
1691–1697.
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Abstract:
Cardiovascular and oncologic diseases are the causes of more than 50 percent of
mortality in Europe. In 2015 oncologic and cardiovascular mortality reached 70
percent in Hungary. Patients who receive anticancer therapies are at a 2- to
7-fold greater long-term risk of acute coronary syndrome; also concomittant
oncologic diseases further increase the mortality of myocardial infarction.
Unfortunately there is not enough data concerning cardiovascular treatment of
oncologic patients because they were excluded from most of the studies and
registries. Because there is no clear protocol to treat such patients, only
small studies and personal experiences could guide our medical therapies. The
role of cardio-oncology is even more important, because due to the new
treatments the number of tumor survivors rapidly increases. In the US more than
20 millions survivals are expected by 2025 who were treated by any kind of
malignant tumors. It is not surprising that in 2014 the American Society of
Cardiology declared cardio-oncology as a special and important field in
cardiology, and in 2016 European Society of Cardiology released the first
cardio-oncologic guideline. In this review we summarize questions and problems
concerning the treatment of oncologic patient with ischaemic heart disease based
on resent guidelines, published studies and local protocols. Orv Hetil. 2017;
158(43): 1691–1697
Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis
To investigate the correlations between the three-dimensional (3D) parameters of target coronary artery segments and restenosis after stent implantation. Sixty-four patients after single, cobalt chromium platform stent (27 BM stents and 37 DES) implantation were investigated retrospectively 12 ± 6 months after the index procedure. 3D coronary artery reconstruction was performed before and after the stent implantation using appropriate projections by a dedicated reconstruction software. The curve of the target segment was characterized by the ratio of the vessel length measured at midline (arc: A) and the distance between the edge points of the stent (chord: C): A/C ratio (ACr). Age, diabetes and hyperlipidaemia were taken into account for the statistical evaluation. 22 patients were diagnosed with ISR, while 42 patients without any restenosis served as controls. The two groups did not differ regarding major cardiovascular risk factors, proportion of the treated vessels or the type of stents. Higher initial ACr values were associated with greater straightening of the vessel curvature in all groups (p < 0.001). Significant negative correlations were found in cases of proximal or distal edge bending angles (p < 0.001). Pre-stent edge bending angles < 7° often showed an increase after the stent implantation, while in case of higher initial values, the bending angles generally decreased. Using multivariate logistic regression modelling we found that the pre-stent ACr was an independent predictor of in-stent restenosis (odds ratio for 1% increase of the ACr: 1.08; p = 0.012). Changes of angles at the stent edges following stent implantation correlate with the initial local bending angles. The ACr predispose to chronic shear stress in the vessel wall, which may contribute to the pathological intimal proliferation
Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis
To investigate the correlations between the three-dimensional (3D) parameters of target coronary artery segments and restenosis after stent implantation. Sixty-four patients after single, cobalt chromium platform stent (27 BM stents and 37 DES) implantation were investigated retrospectively 12 ± 6 months after the index procedure. 3D coronary artery reconstruction was performed before and after the stent implantation using appropriate projections by a dedicated reconstruction software. The curve of the target segment was characterized by the ratio of the vessel length measured at midline (arc: A) and the distance between the edge points of the stent (chord: C): A/C ratio (ACr). Age, diabetes and hyperlipidaemia were taken into account for the statistical evaluation. 22 patients were diagnosed with ISR, while 42 patients without any restenosis served as controls. The two groups did not differ regarding major cardiovascular risk factors, proportion of the treated vessels or the type of stents. Higher initial ACr values were associated with greater straightening of the vessel curvature in all groups (p < 0.001). Significant negative correlations were found in cases of proximal or distal edge bending angles (p < 0.001). Pre-stent edge bending angles < 7° often showed an increase after the stent implantation, while in case of higher initial values, the bending angles generally decreased. Using multivariate logistic regression modelling we found that the pre-stent ACr was an independent predictor of in-stent restenosis (odds ratio for 1% increase of the ACr: 1.08; p = 0.012). Changes of angles at the stent edges following stent implantation correlate with the initial local bending angles. The ACr predispose to chronic shear stress in the vessel wall, which may contribute to the pathological intimal proliferation
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