SUMMARY Twenty-eight patients with cardiac amyloidosis were studied by echocardiography -26 by Mmode and 13 by two-dimensional (2D) studies. All had heart failure and biopsy-proved amyloidosis. M-mode features included (1) normal left ventricular (LV) dimension in all; (2) thickened ventricular septum (88%), LV posterior wall (77%), and right ventricular (RV) anterior wall (79%); (3) decreased thickening of ventricular septum (96%) and of LV posterior wall (65%) and reduced LV global function (62%); (4) left atrial enlargement (50%); and (5) pericardial effusion (58%). Two-dimensional echocardiography provided additional features: (1) thickened papillary muscles (five of 13); (2) thickened valves (four of 13); (3) better appreciation of thickened RV wall; and (4) a characteristic "granular sparkling" appearance of thickened cardiac wallspresumably secondary to the amyloid deposit which was noted in 12 of 13 patients. Thus, M-mode echocardiography is helpful in the recognition of cardiac amyloidosis. However, the better appreciation with 2D echocardiography of thickened cardiac walls with a "granular sparkling" appearance in patients with unexplained cardiac failure is virtually diagnostic of cardiac amyloidosis.
BackgroundThere is growing concern about the economic impact of cardiovascular diseases
(CVD) in Brazil and worldwide.ObjectiveTo estimate the economic impact of CVD in Brazil in the last five years.MethodsThe information to estimate CVD costs was taken from national databases,
adding the direct costs with hospitalizations, outpatient visits and
benefits granted by social security. Indirect costs were added to the
calculation, such as loss of income caused by CVD morbidity or
mortality.ResultsCVD mortality accounts for 28% of all deaths in Brazil in the last five years
and for 38% of deaths in the productive age range (18 to 65 years). The
estimated costs of CVD were R$ 37.1 billion in 2015, a 17% increase in the
period from 2010 to 2015. The estimated costs of premature death due to CVD
represent 61% of the total cost of CVD, Direct costs with hospitalizations
and consultations were 22%, and costs related to the loss of productivity
related to the disease were 15% of the total. Health expenditures in Brazil
are estimated at 9.5% of GDP and the average cost of CVD was estimated at
0.7% of GDP.ConclusionCVD costs have increased significantly in the last five years. It is
estimated that CVD costs increase as the Brazilian population ages and the
prevalence of CVD increases.
BackgroundDue to the nature of the percutaneous prosthesis deployment process, a
variation in its final position is expected. Prosthetic valve placement will
define the spatial location of its effective orifice in relation to the
aortic annulus. The blood flow pattern in the ascending aorta is related to
the aortic remodeling process, and depends on the spatial location of the
effective orifice. The hemodynamic effect of small variations in the angle
of inclination of the effective orifice has not been studied in detail.ObjectiveTo implement an in vitro simulation to characterize the
hydrodynamic blood flow pattern associated with small variations in the
effective orifice inclination.MethodsA three-dimensional aortic phantom was constructed, reproducing the anatomy
of one patient submitted to percutaneous aortic valve implantation. Flow
analysis was performed by use of the Particle Image Velocimetry technique.
The flow pattern in the ascending aorta was characterized for six flow rate
levels. In addition, six angles of inclination of the effective orifice were
assessed.ResultsThe effective orifice at the -4º and -2º angles directed the main flow
towards the anterior wall of the aortic model, inducing asymmetric and high
shear stress in that region. However, the effective orifice at the +3º and
+5º angles mimics the physiological pattern, centralizing the main flow and
promoting a symmetric distribution of shear stress.ConclusionThe measurements performed suggest that small changes in the angle of
inclination of the percutaneous prosthesis aid in the generation of a
physiological hemodynamic pattern, and can contribute to reduce aortic
remodeling.
SummaryObjective: To analyze the long term evolution of patients undergoing percutaneous balloon mitral valvoplasty comparing the Inoue and Balt single balloon methods, and to identify predictors of death and major events (death, repeat balloon mitral valvoplasty or mitral valve surgery).
Methods
SummaryBackground: Cardioinhibitory response (CIR) is defined as asystole ≥3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). Pacemaker implantation is indicated for patients with unexplained syncope episodes and CIR.
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