Cintilografia sincronizada com hemácias marcadas e ressincronizaçao cardíaca: relatos de casos

A Terapia de Ressincronizaçao Cardíaca (TRC) representa uma terapêutica adjuvante para insuficiência cardíaca, com eficácia em torno de 70%, no que diz respeito à melhora clínica. Vários métodos de imagem têm sido propostos para avaliar a dissincronia cardíaca e os efeitos da TRC. O estudo PROSPECT concluiu que nenhum critério ecocardiográfico seria capaz de correlacionar a porçao dissincrônica com o local de implante do eletrodo. Assim, relatamos casos de pacientes que foram submetidos à TRC, utilizando a cintilografia com hemácias marcadas (CSHM) como principal exame complementar para indicar a TRC com a possibilidade de diminuir o número de pacientes nao respondedores. Os dois casos sao apresentados, sendo um deles classificado como respondedor a terapia e o segundo como nao respondedor a TRC. A CSHM de ambos apresentou, também, dissincronia intraventricular em parede lateral e indicou nessa regiao a melhor porçao para implante do eletrodo. Na paciente do caso 1, ocorreu: implante de eletrodo ventricular endocárdico na veia cardíaca lateral. Já no paciente do caso 2: implante de eletrodo epicárdico na parede anterior por toracotomia, devido fibrose da veia cava superior (complicaçao de quimioterapia). Este paciente, entao, nao recebeu o implante no local indicado pela CSHM

Cintilografia sincronizada com hemácias marcadas e ressincronizaçao cardíaca: relatos de casos

A Terapia de Ressincronizaçao Cardíaca (TRC) representa uma terapêutica adjuvante para insuficiência cardíaca, com eficácia em torno de 70%, no que diz respeito à melhora clínica. Vários métodos de imagem têm sido propostos para avaliar a dissincronia cardíaca e os efeitos da TRC. O estudo PROSPECT concluiu que nenhum critério ecocardiográfico seria capaz de correlacionar a porçao dissincrônica com o local de implante do eletrodo. Assim, relatamos casos de pacientes que foram submetidos à TRC, utilizando a cintilografia com hemácias marcadas (CSHM) como principal exame complementar para indicar a TRC com a possibilidade de diminuir o número de pacientes nao respondedores. Os dois casos sao apresentados, sendo um deles classificado como respondedor a terapia e o segundo como nao respondedor a TRC. A CSHM de ambos apresentou, também, dissincronia intraventricular em parede lateral e indicou nessa regiao a melhor porçao para implante do eletrodo. Na paciente do caso 1, ocorreu: implante de eletrodo ventricular endocárdico na veia cardíaca lateral. Já no paciente do caso 2: implante de eletrodo epicárdico na parede anterior por toracotomia, devido fibrose da veia cava superior (complicaçao de quimioterapia). Este paciente, entao, nao recebeu o implante no local indicado pela CSHM

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Early Blood Pressure Normalization Independent Of The Class Of Antihypertensive Agent Prevents Augmented Renal Fibronectin And Albuminuria In Experimental Diabetic Nephropathy.

This study tested the hypothesis that prevention of the development of hypertension, and not the class of antihypertensive agent, inhibits the increase in renal fibronectin and albuminuria in experimental diabetes. Four-week-old spontaneously hypertensive rats (SHR), with diabetes induced by streptozotocin, were randomized for no treatment, or treatment with captopril, amlodipine, an association of captopril and amlodipine (Cap+A) or an association of captopril and verapamil (Cap+V) for 12 weeks. Systolic blood pressure increased similarly in control (187 +/- 5 mm Hg, mean +/- SE) and diabetic (186 +/- 4) SHR and was kept within the normal range by amlodipine (131 +/- 3), captopril (127 +/- 3), Cap+A (134 +/- 4) and Cap+V (134 +/- 9, p < 0.0001). In diabetic rats, albuminuria was higher than in control SHR [geometric mean (variance), 1,213 (953-1,708) vs. 512 (213-850), p < 0.0001] and was reduced to a similar extent by amlodipine [573 (353-744), p < 0.0001], captopril [562 (238-771), p < 0.0001], Cap+A [679 (442-971), p < 0.0001] and Cap+V [748 (581-848) microg/24 h, p = 0.0002]. Renal fibronectin increased in diabetic rats (24.0 +/- 3.3 densitometric units, mean +/- SE) compared to control rats (9.6 +/- 1.8, p = 0.0005) and was normalized by amlodipine (9.9 +/- 1.0, p = 0.0001), captopril (11.2 +/- 0.4, p = 0.0016), Cap+A (9.9 +/- 2.0, p = 0.0004) and Cap+V (14.7 +/- 4.9, p = 0.0159). In this model, tight blood pressure control rather than the class of antihypertensive agent was the main determinant factor in attenuating of nephropathy.27114-2

Effects of carbohydrate counting on glycaemic control on patients with type I diabetes with glargine in a basal/bolus multiple daily insulin regimen

Carbohydrate counting improves glycaemic control in patients with type I diabetes treated with glargine in a basal/bolus multiple daily insulin regime