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Viviane Tiemi Hotta - One of the best experts on this subject based on the ideXlab platform.
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Effects of cardiac resynchronization therapy on left ventricular reverse remodeling in patients with non ischemic dilated myocardiopathy: evaluation by three dimensional echocardiography
Universidade de São Paulo, 2010Co-Authors: Viviane Tiemi HottaAbstract:Introdução: A terapia de ressincronização cardíaca (TRC) tem se mostrado como um tratamento eficaz no tratamento de pacientes com insuficiência cardíaca (IC) grave e distúrbio da condução ventricular. A ecocardiografia tridimensional (Eco 3D) consiste em uma nova modalidade diagnóstica com resultados promissores para a identificação da dissincronia cardíaca e avaliação dos resultados da TRC. Objetivos: Estudar os efeitos da TRC no remodelamento reverso do ventrículo esquerdo (VE), em pacientes com miocardiopatia não isquêmica, insuficiência cardíaca e distúrbio da condução intraventricular, por meio da ecocardiografia tridimensional em tempo real. Métodos: De janeiro de 2007 a junho de 2009, foram avaliados 24 pacientes com miocardiopatia dilatada não isquêmica, IC classe funcional (CF) III ou IV (NYHA), com tratamento medicamentoso otimizado, QRS > 120 ms ao eletrocardiograma, e fração de ejeção do ventrículo esquerdo (FEVE) < 0,35 submetidos à TRC. Os pacientes foram avaliados antes, três e seis meses após TRC pela CF (NYHA), qualidade de vida pelo escore de Minnesota (MLHFQ), eletrocardiograma (intervalo PR e duração do QRS), ecocardiograma bidimensional (volumes diastólico VDVE, e sistólico VSVE, do ventrículo esquerdo, fração de ejeção ventricular esquerda - FEVE), Doppler tecidual (TDI) (avaliação da dissincronia cardíaca) e análise tridimensional (VDVE, VSVE, FEVE e dissincronia pela análise do SDI systolic dyssynchrony index). Foi considerado remodelamento reverso redução > 15% do VSVE após a TRC. As diferenças das médias das variáveis contínuas foram analisadas com o teste T não pareado, entre os grupos respondedor e não respondedor, depois de satisfeita a condição de normalidade. Antes da TRC, foi realizada uma análise univariada das características clínicas, eletrocardiográficas e ecocardiográficas para a construção de um modelo de regressão logística. Resultados: 9/24(38%) dos pacientes analisados apresentaram remodelamento ventricular reverso após TRC. O grupo respondedor apresentou menores volumes ventriculares (VDVE: 230 + 35 ml vs 316 + 10 ml, p = 0,045; VSVE: 178 + 30 ml vs 238 + 10 ml, p = 0,047), avaliados pelo método de Simpson, além de maior dissincronia cardíaca, avaliada pelo Eco 3D (SDI:13 + 3% vs 9 + 3%, p = 0,005) e pelo TDI (138 + 31 ms vs 102 + 37 ms, p = 0,026). Após a análise de regressão logística, o SDI (SDI > 11%) foi o único fator independente na predição de remodelamento reverso, seis meses após a TRC (sensibilidade:0,78; especificidade:0,79). Conclusões: O Eco 3D foi eficaz na detecção do remodelamento reverso do VE após a TRC, por meio da detecção da redução dos volumes ventriculares esquerdos (VDVE, VSVE) e da melhora da FEVE. O SDI foi o único preditor independente de remodelamento reverso após a TRC. Apresentaram menor taxa de resposta seis meses após a TRC, os pacientes com maiores volumes ventriculares esquerdos e menor fração de ejeção ventricular esquerda. A TRC melhorou a CF (NYHA) de IC e a qualidade de vida pelo escore de MinnesotaIntroduction: Cardiac resynchronization therapy (CRT) consists of an effective treatment for patients with severe heart failure and ventricular conduction disturbance. Three dimensional echocardiography (3D Echo) is a new diagnostic modality with promising results in the identification of cardiac dyssynchrony and for the evaluation of CRT results. Objectives: To evaluate the effects of CRT in the left ventricular (LV) reverse remodeling in patients with non ischemic dilated myocardiopathy, heart failure and intraventricular conduction disturbance by using three dimensional echocardiography. Methods: From January, 2007 to June, 2009, twenty-four consecutive patients with heart failure, sinus rhythm, QRS > 120 ms, and Functional Class III or IV (NYHA), despite optimized medical treatment and left ventricular ejection fraction (LVEF) < 0,35, underwent CRT. All patients were assessed regarding Functional Class (NYHA), and the quality of life was evaluated using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). All patients were submitted to an electrocardiogram, two dimensional echocardiography (2D Echo) including the evaluation of cardiac dyssynchrony by Tissue Doppler Imaging (TDI) and 3D Echo (SDI - systolic dyssynchrony index), before, three and six months after CRT. Left ventricular reverse remodeling was defined as a reduction of at least 15% of the left ventricular systolic volume (LVSV) after CRT. The difference between the mean of the continuous variables were compared by students T test, after being tested for normality. Before CRT, it was performed a univariate analysis of clinical, electrocardiographic and echocardiographic baseline characteristics of the patients for the construction of a logistic regression model. Results: 9/24 (38%) of the patients presented with left ventricular reverse remodeling six months after CRT. Patients who presented LV reverse remodeling had smaller left ventricular volumes estimated by Simpsons Rule (LV diastolic volume (LVDV): 230 + 35 ml vs 316 + 10 ml, p = 0,045; LVSV: 178 + 30 ml vs 238 + 10 ml, p = 0,047) and greater cardiac dyssynchrony detected by 3D Echo (SDI: 13 + 3% vs 9 + 3%, p = 0,005) and by TDI (138 + 31 ms vs 102 + 37 ms, p = 0,026). After logistic regression analysis, the best predictors of left ventricular reverse remodeling after CRT were the cardiac dyssynchrony indexes evaluated by TDI (twelve segments) and SDI, but SDI (SDI > 11%) was the only independent factor in the prediction of left ventricular reverse remodeling six months after CRT (sensitivity of 0,78 and specificity of 0,79). Conclusions: 3D Echo was effective in the detection of left ventricular reverse remodeling after CRT, by detecting the reduction in left ventricular volumes (LVDV, LVSV) and the increase in LVEF. SDI was the only independent predictor of LV reverse remodeling after CRT. Patients with larger LV volumes, and smaller LVEF were more prone to not respond six months after CRT. CRT improved Functional Class (NYHA) and quality of life evaluated by MLHF
Γιαλέρνιος Θεόδωρος - One of the best experts on this subject based on the ideXlab platform.
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The significance of right and left atrial volume in atrial fibrillation occurrence
Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών (ΕΚΠΑ), 2013Co-Authors: Gialernios Theodoros, Γιαλέρνιος ΘεόδωροςAbstract:ObjectivesLeft atrial dimensions have been frequently considered as a surrogate index which reflect a specific organic and electrophysio-logical substrate of left atrial myocardium such as fibrosis or increased dispersion of refractoriness. Furthermore the impact of left atrial volume has been recognized in various forms of atrial fibrillation (AF) onset and maintenance. In contrast right atrial dimensions are frequently ignored. In this study we investigated the relative impact of right and/or left in postcardiac surgery atrial fibrillation induction. Methods149 patients (pts) mean age 64.12, 101 males and 48 females, in sinus rhythm referred in our institute for coronary bypass or valve surgery. The pts had undergone complete echocardiographic examination. Left (LAVmax), right (RAVmax) were measured using modified Simpsons Rule from the apical view. Demographic characteristics, clinical and angio-graphic data as well as also operative variables were registered. Pts were followed for 1 week postoperatively for the incidence of AF. All the registered data were inserted in a database and statistical analysis was performed. Results40/149 pts (27%) exhibit AF postoperatively (group AF) while 109/149 pts (73%) remained in sinus rhythm (group SR). RAVmax, LAV- max were greater in group AF than in group SR (RAV- max: 47.09± 20.21 vs. 32.81± 11.52ml p=0.001), LAVmax:, 85.83±36.18 vs 59.70±21.48 p
Styś Krystyna - One of the best experts on this subject based on the ideXlab platform.
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Lecture notes in numerical analysis with Mathematica
Bentham Science Publ., 2014Co-Authors: Styś Tadeusz, Styś KrystynaAbstract:The contents of this book include chapters on floating point computer arithmetic, natural and generalized interpolating polynomials, uniform approximation, numerical integration, polynomial splines and many more.This book is intended for undergraduate and graduate students in institutes, colleges, universities and academies who want to specialize in this field. The readers will develop a solid understanding of the concepts of numerical methods and their application. The inclusion of Lagrane and Hermite approximation by polynomials, Trapezian Rule, Simpsons Rule, Gauss methods and Romberg`s me
Gialernios Theodoros - One of the best experts on this subject based on the ideXlab platform.
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The significance of right and left atrial volume in atrial fibrillation occurrence
Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών (ΕΚΠΑ), 2013Co-Authors: Gialernios Theodoros, Γιαλέρνιος ΘεόδωροςAbstract:ObjectivesLeft atrial dimensions have been frequently considered as a surrogate index which reflect a specific organic and electrophysio-logical substrate of left atrial myocardium such as fibrosis or increased dispersion of refractoriness. Furthermore the impact of left atrial volume has been recognized in various forms of atrial fibrillation (AF) onset and maintenance. In contrast right atrial dimensions are frequently ignored. In this study we investigated the relative impact of right and/or left in postcardiac surgery atrial fibrillation induction. Methods149 patients (pts) mean age 64.12, 101 males and 48 females, in sinus rhythm referred in our institute for coronary bypass or valve surgery. The pts had undergone complete echocardiographic examination. Left (LAVmax), right (RAVmax) were measured using modified Simpsons Rule from the apical view. Demographic characteristics, clinical and angio-graphic data as well as also operative variables were registered. Pts were followed for 1 week postoperatively for the incidence of AF. All the registered data were inserted in a database and statistical analysis was performed. Results40/149 pts (27%) exhibit AF postoperatively (group AF) while 109/149 pts (73%) remained in sinus rhythm (group SR). RAVmax, LAV- max were greater in group AF than in group SR (RAV- max: 47.09± 20.21 vs. 32.81± 11.52ml p=0.001), LAVmax:, 85.83±36.18 vs 59.70±21.48 p
Styś Tadeusz - One of the best experts on this subject based on the ideXlab platform.
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Lecture notes in numerical analysis with Mathematica
Bentham Science Publ., 2014Co-Authors: Styś Tadeusz, Styś KrystynaAbstract:The contents of this book include chapters on floating point computer arithmetic, natural and generalized interpolating polynomials, uniform approximation, numerical integration, polynomial splines and many more.This book is intended for undergraduate and graduate students in institutes, colleges, universities and academies who want to specialize in this field. The readers will develop a solid understanding of the concepts of numerical methods and their application. The inclusion of Lagrane and Hermite approximation by polynomials, Trapezian Rule, Simpsons Rule, Gauss methods and Romberg`s me