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BACKGROUND: There is little information about vitamin D (Vit D) deficiency in patients with pulmonary hypertension (PH). The objective of this study was: 1) compare Vit D levels between patients with PH, left ventricular failure (LVF) and healthy subjects (HS); 2) correlate, in patients with PH, Vit D levels with prognosis-related variables, such as the 6-min walk test (6MWT). METHODS: Vitamin D levels were measured in a cross-sectional study in 126 patients from one of three groups: patients with PH (n = 53), patients with LVF (n = 42) and healthy subjects (n = 31). In all groups, 8-h fasting blood samples were obtained in the morning. In the PH and the LVF group, functional class (WHO criteria), metres covered in the 6MWT and echocardiographic parameters were analysed. In the PH group, plasma N terminal pro B type natriuretic peptide (NT-proBNP) level was analysed and a complete haemodynamic evaluation by right heart catheterisation was made. RESULTS: Mean Vit D levels were lower in PH than in both other groups (ng/ml, mean ± SD): PH 19.25 ± 10, LVF 25.68 ± 12, HS 28.8 ± 12 (PH vs LVF p = 0.017, PH vs HS p = 0.001 and HS vs LVF p = 0.46). Vit D deficiency prevalence was higher in PH as compared to the other groups (PH 53.8%, LVF 45.2%, HS 25%, p = 0.01). Patients with PH in functional class (FC; WHO criteria) III-IV had higher Vit D deficiency prevalence than those in FC I-II (86.7% vs 40.5%, p = 0.003). There was a significant linear correlation between the 6MWT and Vit D levels in PH (p < 0.01), but not in LVF (p = 0.69). CONCLUSIONS: Vit D levels were lower in patients with PH as compared to patients with LVF and HS and correlated directly with 6-min walk distance.
Assuntos
Hipertensão Pulmonar/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Prevalência , Prognóstico , Disfunção Ventricular Esquerda/epidemiologia , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Teste de Caminhada , Adulto JovemRESUMO
RESUMEN Objetivos: Evaluar la prevalencia del déficit de hierro en hipertensión pulmonar y compararlo con otras poblaciones de pacientes. Establecer su valor pronóstico. Material y métodos: Estudio prospectivo, observacional. Se midieron parámetros de hierro sérico en pacientes consecutivos con diagnóstico de hipertensión pulmonar. Se compararon con pacientes con insuficiencia cardíaca y con controles sanos. Se buscó correlación entre los valores séricos de hierro y la clase funcional, la distancia recorrida en TC6M y el NT-proBNP. Resultados: Participaron 107 pacientes: 60 con hipertensión pulmonar, 26 con insuficiencia cardíaca y 21 controles sanos. El déficit de hierro fue del 78,3% en los pacientes con hipertensión pulmonar; del 45,8%, en aquellos que presentaban insuficiencia cardíaca; y del 23,8% (p < 0,001) en los controles sanos. La prevalencia de anemia resultó del 25% en los pacientes con hipertensión pulmonar; del 26,9% en los que padecían insuficiencia cardíaca; y del 19% (p < 0,8) en los controles sanos. En el subgrupo de pacientes en clase funcional I-II, la prevalencia de DFe fue del 78% en los pacientes con hipertensión pulmonar vs. el 43,5% (p < 0,005) en los que tenían insuficiencia cardíaca, y la anemia resultó del 17,1%% vs. el 28%% (p < 0,2). Se halló correlación significativa entre ferremia y saturación de transferrina con distancia caminada en TC6M (r: 0,35; p < 0,01 y r: 0,34; p < 0,01) y no hubo correlación para ferritina y transferrina. No se encontró significancia estadística entre déficit de hierro y clase funcional o NT-proBNP. Conclusiones: El déficit de hierro en la hipertensión arterial es altamente prevalente y superior al observado en la insuficiencia cardíaca y en los sujetos control, y no se establece relación con prevalencia de anemia, la cual fue similar en los tres grupos. El hierro sérico tiene una clara relación con la distancia caminada, no así con clase funcional, lo que, tal vez, obedezca al bajo número de pacientes.
ABSTRACT Objective: The aim of this study was to assess the prevalence of iron deficiency in pulmonary hypertension, to compare it with other patient populations and to establish its prognostic value. Methods: This was a prospective, observational study. Serum iron parameters were measured in consecutive patients diagnosed with pulmonary hypertension and compared with heart failure patients and healthy controls. A correlation was sought between serum iron levels and functional class, distance walked in the 6-minute walk test and NT-proBNP. Results: A total of 107 patients were included in the study: 60 with pulmonary hypertension, 26 with heart failure and 21 healthy controls. Iron deficiency was 78.3% in patients with pulmonary hypertension, 45.8% in those with heart failure and 23.8% in healthy controls (p<0.001). The prevalence of anemia was 25% in pulmonary hypertension, 26.9% in heart failure and 19% in healthy controls (p<0.8). In patients with functional class I-II, iron deficiency was: 78% in pulmonary hypertension vs. 43.5% in heart failure (p<0.005), and anemia was 17.1% vs. 28%, respectively (p<0.2). A significant correlation was found between serum iron and transferrin saturation with the distance walked in the 6-minute walk test (r: 0.35; p<0.01 and r: 0.34; p<0.01, respectively) and no correlation was found for transferrin and ferritin. Also, no significant correlation was found between iron deficiency and functional class or NT-proBNP. Conclusions: Iron deficiency is highly prevalent in pulmonary hypertension, and superior to that found in heart failure patients and healthy controls. No relationship was established with anemia, which was similar in the three groups. Serum iron is clearly related with the distance walked, but not with functional class, a result which may be attributed to the limited number of patients.
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INTRODUCTION: Transcatheter aortic valve implantation (TAVI) is currently reserved for patients with symptomatic aortic stenosis and high surgical risk. One major limiting factor related to TAVI procedural complications is conduction abnormalities and the need for permanent pacemaker implantation. OBJECTIVES: Evaluate the incidence of new conduction disturbances and pacemaker indications in patients with TAVI CoreValve® prosthesis (Medtronic Inc. Minneapolis, Minnesota, United States). METHODS: We included 28 patients, mean age 80 years. ECG parameters were evaluated previous and after implantation. All patients were monitorized during TAVI. Follow up Holter monitoring was performed at one, 6 and 12 months after the procedure and we also evaluated telemetry of implanted pacemaker. RESULTS: In previous ECG we found 7 patients had right bundle branch block and 7 patients had left bundle brunch block (LBBB). The post implant ECG showed 7 new LBBB: 3 during valvuloplasty and 4 on the end of it. Six patients required pacemaker implantation for permanent or paroxysmal complete AV block (CAVB). At one year follow up, 3 patients with LBBB during valvuloplasty had a normal ECG, one still had LBBB and one an asymptomatic CAVB found in Holter monitoring. CONCLUSIONS: Conduction abnormalities are frequent after CoreValve® aortic valve prosthesis implantation. The incidence of new LBBB was 25%. CAVB during or post TAVI require PM implantation. New LBBB may need a closer follow up because in a 3% of the cases it may progress to CAVB.
Assuntos
Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Humanos , Incidência , Masculino , Estudos Prospectivos , Desenho de PróteseRESUMO
BACKGROUND: The occurrence of contrast-induced acute kidney injury (CIAKI) has paralleled the increased number of diagnostic interventions requiring radiographic contrast media (CM). Several strategies aimed at preventing renal injury following iodine have been carried out over the last several years. The aim of this study was to evaluate the impact of three different strategies aimed at preventing CIAKI in patients with renal dysfunction (serum creatinine >1.25 mg/dl or estimated creatinine clearance <45 ml/min) receiving low osmolar CM for diagnostic-therapeutic procedures. METHODS: Candidates received 154 mmol NaHCO3 solution (B0) at a rate of 3 ml/kg/h from at least 2 h before the procedure and at 1 ml/kg/h during and for the next 6-12 h; the same schedule plus N-acethyl-cysteine (NAC) 600 mg twice daily the day before and the day of the procedure (BN) or NAC as above plus 154 mmol NaCl solution at a rate of 3 ml/kg/h from at least 2 h before the procedure and at 1 ml/kg/h during and for the next 6-12 h (SN). Serum creatinine (SCr) was measured at baseline and on days 2 or occasionally 3 after CM. The main outcome measure was the occurrence of CIAKI, defined as a ≥25% increase in SCr within 2-3 days of CM. RESULTS: The three groups were similar with regard to age, gender distribution, weight, baseline serum levels of creatinine, sodium, potassium, urate and estimated creatinine clearance. A larger proportion of individuals received ACEIs/ARAs in the BN group (p < 0.05), but in the SN group, more patients declared a past history of acute myocardial infarction or had high blood pressure, and few displayed mild-moderate left ventricular dysfunction (p < 0.05). CIAKI occurred in 24/123 (19.5%) assessable patients (15/42 in the B0 group, 3/43 in the BN group and 6/38 in the SN group; p < 0.01). Thus, 15/42 patients who did not receive NAC developed CIAKI in contrast to 9/81 who did (p < 0.01). Multivariate logistic regression models showed that the use of NAC was the unique factor associated with a statistically significant influence for the occurrence of CIAKI (OR: 0.18; 95% CI: 0.04-0.72; p = 0.016). CONCLUSIONS: The results from this study show that: (1) the occurrence of CIAKI after low-osmolar CM administration is similar to that reported worldwide. (2) NAC-based renoprotective measures are superior for the prevention of CIAKI in patients with previous renal dysfunction. (3) They also demonstrate that bicarbonate expansion alone has limited value in preventing CIAKI. For those individuals at risk, combination prophylaxis including volume expansion plus NAC should be recommended to reduce the chance of overt kidney injury following CM administration.
Assuntos
Acetilcisteína/uso terapêutico , Injúria Renal Aguda/prevenção & controle , Meios de Contraste/efeitos adversos , Bicarbonato de Sódio/administração & dosagem , Injúria Renal Aguda/induzido quimicamente , Adulto , Idoso , Creatinina/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Substitutos do Plasma/administração & dosagem , Insuficiência Renal/diagnóstico , Cloreto de Sódio/administração & dosagem , Ácidos Tri-Iodobenzoicos/efeitos adversosRESUMO
La tromboembolia coronaria es una causa infrecuente y poco documentada de síndrome coronario agudo. En la bibliografía sólo se encuentran comunicaciones aisladas con escasa fundamentación angiográfica. En esta presentación se describe el caso de un varón de 32 años sin antecedentes cardiovasculares, que debuta con un cuadro de infarto agudo de miocardio con evidencia angiográfica de múltiples tromboembolias coronarias y evoluciona a shock cardiogénico y muerte. Se realiza, asimismo, una revisión de las causas y de las formas de presentación clínica de la tromboembolia coronaria.
Acute Myocardial Infarction Caused by Multiple Coronary Artery Embolisms Coronary artery embolism is a rare cause of acute coronary syndrome that is scarcely documented. Only a few case reports have been published but lack of solid angiographic evidence. We describe a 32-year old man without history of cardiovascular disease with a first episode of acute myocardial infarction with angiographic evidence of multiple thromboembolisms of the coronary arteries who developed cardiogenic shock and died. We review the causes and the clinical presentations of coronary artery embolism.