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- ItemEvaluation of myocardial contraction fraction in transcatheter aortic valve replacement(Heart, Vessels and Transplantation, 2024)Objective: Myocardial contraction fraction (MCF), a costless, easy-to-perform echocardiographic measure, which estimates cardiac function through the volumetric measurement of myocardial shortening, may be a useful prognostic indicator in patients undergoing transcatheter aortic valve replacement (TAVR). This study aimed to evaluate MCF in patients who underwent TAVR at a public hospital in Rio de Janeiro, Brazil. Methods: This was a retrospective cohort study. Clinical and echocardiographic data were obtained from medical records. MCF was calculated as FDV in mL/FSV in mL x100, where FDV= final diastolic volume and FSV= final systolic volume. These were derived from the dimensions of the left ventricle. The FDV was estimated as 4.5 x (final diastolic diameter of the left ventricle) and the FSV was estimated as 3.72 x (final systolic diameter of the left ventricle). Patients were followed for 66 months, and all-cause mortality was registered. Results: Overall, 78 patients were studied. Median age was 78 years. Mortality was 56.4% over 9 years, with 29% of deaths in the first year. Pre-TAVR median MCF (45.9%) was low, while mean left ventricular ejection fraction (LVEF) was normal (57.0%). In patients who survived after the procedure, MCF increased post-TAVR, but in those who died, it decreased (49.3% vs 45.1%). Conclusions: MCF may demonstrate left ventricular dysfunction unrecognized by LVEF measurement in patients undergoing TAVR, and may be a prognostic marker in this patient population.
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- ItemAerobic exercise simultaneous with non-invasive ventilation reduces the length of stay in intensive care in patients with heart failure: a randomised clinical trial(EUROPEAN JOURNAL OF PHYSIOTHERAPY, 2024)Introduction: Early cardiac rehabilitation using non-invasive ventilation (NIV) and aerobic exercise may reduce the length of hospital stay in patients with heart failure (HF), however, there is still no evidence of this effect on patients in the intensive care unit (ICU). Objectives: to investigate the effects of aerobic exercise (AE) performed simultaneously with non-inva- sive ventilation (NIV) on the length of intensive care stay (LICUS) in patients diagnosed with decom- pensated heart failure (HF) admitted to the intensive care units (ICU). Methods: Twenty-eight patients admitted to the intensive care unit (ICU) because of decompensation of HF were randomised into two groups: the intervention group (AE þ NIV), and a control group. The intervention group’s treatment strategy involved simultaneous AE with NIV daily. The control group performed non-simultaneous AE and NIV daily during their ICU stay. The primary outcome was LICUS. The secondary outcomes were the length of hospital stay, peripheral and respiratory muscle strength, functional status, functional classification, and exercise tolerance. Results: The mean LICUS was shorter in AE þ NIV than in the control group (6.3 ± 4.7 days vs 8.3 ± 3.6 days, respectively; p 1⁄4 0.015). Secondary outcomes were similar between groups, except for exercise hemodynamics, which was improved in AE þ NIV, as showed by the decreased diastolic blood pressure immediately after the exercise tolerance test. Conclusion: The use of AE simultaneous with NIV reduced the LICUS of patients admitted to the ICU because of decompensated HF. This innovative approach is a promising tool for accelerating ICU dis- charge during the in-hospital rehabilitation of patients with HF.
- ItemSEVERE AORTIC COARCTATION WITH OBSTRUCTION OF AN EXTRA-ANATOMIC TUBE(Journal of the American College of Cardiology, 2024)
- ItemThe Usefulness of Microcirculatory Assessment After Cardiac Surgery: Illustrative Case Report(Brazilian Journal of Cardiovascular Surgery, 2024)Cardiac surgery causes a series of disturbances in human physiology. The correction of systemic hemodynamic variables is frequently ineffective in improving microcirculatory perfusion and delivering oxygen to the tissues. We present the case of a 52-year-old male submitted to mitral valve replacement (metallic valve) and subaortic membrane resection. Sublingual microcirculatory density and perfusion were evaluated using a handheld CytoCam camera before surgery and in the early postoperative period. In this case, systemic hemodynamic variables were compromised despite an actual improvement in the microcirculatory parameters in comparison to the preoperative evaluation, possibly due to the correction of the structural cardiac defects.