Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges.
- 作者列表："Costa HS","Lima MMO","Figueiredo PHS","Lima VP","Ávila MR","Menezes KKP","Mendonça VA","Lacerda ACR","Nunes MCP","Mediano MFF","Rocha MODC
:Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.
: Chagas心肌病 (ChC) 患者通常进展乏力和呼吸困难。运动试验对于这些患者的功能评估是有价值的。然而，有关运动试验适用性的信息是分散的，并且没有研究系统地审查结果。因此，本综述探讨了运动试验在ChC患者中的一般方面和预后价值。对MEDLINE、Web of Science、CINAHL、Scopus和LILACS数据库进行文献检索，以确定相关研究。没有数据限制，并选择符合研究目的的文章。考虑了用英语、葡萄牙语和西班牙语写的文章，最终纳入了25篇文章。峰值摄氧量 (VO2peak) 与人口统计学和超声心动图变量相关。除年龄和性别外，左心室舒张功能和右心室收缩功能的超声心动图特征似乎是功能能力的决定因素。VO2peak与较高的死亡率相关，特别是在扩张的ChC患者中。分钟通气量/二氧化碳产生斜率 (VE/VCO2斜率) 是生存的强预测因子; 然而，需要更多的研究来验证这一观察结果。现场试验显示与VO2peak有中度到强烈的相关性，因此可能是用于ChC患者功能评估的廉价工具。然而，很少有研究证实其预后意义。虽然运动测试是功能评估的有用工具，但是关于进一步考虑的信息很少，并且许多标准是基于其他心脏疾病的指南。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.