Artéria torácica interna enxertada: patência e estado funcional em repouso e após dobutamina

Abreu, Janessa Sampaio de; Diógenes, Tereza Cristina Pinheiro; Abreu, André Luís de Castro; Barreto, José Erirtônio Façanha; Morais, José Maria Bonfim de; Abreu, Marília Esther Benevides de; Pinto, Jorge Henrique Azevedo; Júnior, José Nogueira Paes

doi:10.1590/s0066-782x2008000100007

Cited by 3 publications

(6 citation statements)

References 28 publications

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“…On the other hand, the use of selective β-blocker increases myocardial perfusion and improves coronary flow reserve, thus reducing the possibility of ischemia 35,36 . In methodologies of studies related to stress echocardiography, some authors do not interfere in the use of β-blocker 5,8 , whereas others discontinue the drug for 24 to 48 hours prior to DSE 3,7,32 . In our study, patients were instructed to discontinue the drug for 72-hour with the purpose of reducing the occurrence of inconclusive DSE.…”

Section: Discussionmentioning

confidence: 99%

“…Ischemia was considered in the presence of a report of typical angina, new wall motion abnormality, or worsening of a pre-existing wall motion abnormality (except from akinesia to dyskinesia). Tests should be interrupted in the presence of intolerance to medication, hypertensive peak (blood pressure > 230 x 120 mmHg) or cardiac arrhythmia 3,32 .…”

Section: Methodsmentioning

confidence: 99%

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Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

Abreu¹,

Lima²,

Diógenes³

et al. 2013

Arquivos Brasileiros De Cardiologia

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Background A coronary flow velocity reserve (CFVR) ≥ 2 is adequate to infer a favorable prognosis or the absence of significant coronary artery disease. Objective To identify parameters which are relevant to obtain CFVR (adequate or inadequate) in the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE). Methods 100 patients referred for detection of myocardial ischemia by DSE were evaluated; they were instructed to discontinue the use of β-blockers 72 hours prior to the test. CFVR was calculated as a ratio of the diastolic peak velocity (cm/s) (DPV) on DSE (DPV-DSE) to baseline DPV at rest (DPV-Rest). In group I, CFVR was < 2 and, in group II, CFVR was ≥ 2. The Fisher's exact test and Student's t test were used for the statistical analyses. P values < 0.05 were considered statistically significant. Results At rest, the time (in seconds) to obtain Doppler in LAD in groups I and II was not different (53±31 vs. 45±32; p=0.23). During DSE, LAD was recorded in 92 patients. Group I patients were older (65.9±9.3 vs. 61.2±10.8 years; p=0.04), had lower ejection fraction (61±10 vs. 66±6%; p=0.005), higher DPV-Rest (36.81±08 vs. 25.63 ± 06cm/s; p<0.0001) and lower CFVR (1.67 ± 0.24 vs. 2.53 ± 0.57; p<0.0001), but no difference was observed regarding DPVDSE (61.40±16 vs. 64.23±16cm/s; p=0.42). β-blocker discontinuation was associated with a 4-fold higher chance of a CFVR < 2 (OR= 4; 95% CI [1.171-13.63], p=0.027). Conclusion DPV-Rest was the main parameter to determine an adequate CFVR. β-blocker discontinuation was significantly associated with inadequate CFVR. The high feasibility and the time to record the LAD corroborate the use of this methodology.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

Abreu¹,

Lima²,

Diógenes³

et al. 2013

Arquivos Brasileiros De Cardiologia

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“…The AITA Doppler assessment showed good functional status of this conduit as, during stress, it was observed that the flow became 100% diastolic with a coronary flow reserve index of 1.8. The two-dimensional Doppler study performed immediately after stent implantation in LSA showed that the flow direction in the LVA had normalized (anterograde) and that changes had occurred in the AITA flow, which demonstrated increased systolic component, while still remaining anterograde and with diastolic predominance (58%), which is the Doppler standard usually found in patent AITA 3 .…”

Section: Discussionmentioning

confidence: 91%

“…At peak stress, the flow in the AITA became exclusively diastolic, with coronary flow reserve index of 1.8 (Figure 2A and 2B), indicating good functional status 1,3 , while the LVA remained entirely with retrograde flow (Figure 2C and 2D). …”

Section: Case Reportmentioning

confidence: 99%

“…The two-dimensional and Doppler imaging allows anatomical assessment of arteries and the verification of normal and pathological flow patterns. Thus, the flow direction reversal of an artery can be compatible with steal of blood flow and an exacerbation of the diastolic component of the anastomosed internal thoracic artery (AITA) at Doppler may indicate good functional status of the vessel 1-3 .…”

Section: Introductionmentioning

confidence: 99%

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Steal of Blood Flow from the Vertebral Artery to the Internal Thoracic Artery Anastomosed to the Coronary Artery

Abreu

Pimentel²,

Siqueira³

et al. 2013

Arquivos Brasileiros De Cardiologia

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The analysis for time of referral to a medical center among patients with diabetic foot infection

et al. 2021

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Background Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking. Methods This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed. Results One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003–1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004–1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001–1.008, P=0.028). Conclusions The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested. Trial registration Not applicable.

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Artéria torácica interna enxertada: patência e estado funcional em repouso e após dobutamina

Abstract: SummaryBackground: The patent internal thoracic artery graft (ITAG) usually has a diastolic fraction (DF) > 50% of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI).

Cited by 3 publications

References 28 publications

Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

Coronary Flow Velocity Reserve during Dobutamine Stress Echocardiography

Steal of Blood Flow from the Vertebral Artery to the Internal Thoracic Artery Anastomosed to the Coronary Artery

The analysis for time of referral to a medical center among patients with diabetic foot infection

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