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[PMID]:28468926
[Au] Autor:Lubitz SA; Parsons OE; Anderson CD; Benjamin EJ; Malik R; Weng LC; Dichgans M; Sudlow CL; Rothwell PM; Rosand J; Ellinor PT; Markus HS; Traylor M; WTCCC2, International Stroke Genetics Consortium, and AFGen Consortia
[Ad] Endereço:From the Stroke Research Center (C.D.A., J.R.), Center for Human Genetic Research (C.D.A., J.R.), and Cardiovascular Research Center (S.A.L., L.-C.W., P.T.E.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, The Broad Insitute of Harvard and MIT, Cambridge, MA (S.
[Ti] Título:Atrial Fibrillation Genetic Risk and Ischemic Stroke Mechanisms.
[So] Source:Stroke;48(6):1451-1456, 2017 06.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Atrial fibrillation (AF) is a leading cause of cardioembolic stroke, but the relationship between AF and noncardioembolic stroke subtypes are unclear. Because AF may be unrecognized, and because AF has a substantial genetic basis, we assessed for predisposition to AF across ischemic stroke subtypes. METHODS: We examined associations between AF genetic risk and Trial of Org 10172 in Acute Stroke Treatment stroke subtypes in 2374 ambulatory individuals with ischemic stroke and 5175 without from the Wellcome Trust Case-Control Consortium 2 using logistic regression. We calculated AF genetic risk scores using single-nucleotide polymorphisms associated with AF in a previous independent analysis across a range of preselected significance thresholds. RESULTS: There were 460 (19.4%) individuals with cardioembolic stroke, 498 (21.0%) with large vessel, 474 (20.0%) with small vessel, and 814 (32.3%) individuals with strokes of undetermined cause. Most AF genetic risk scores were associated with stroke, with the strongest association ( =6×10 ) attributed to scores of 944 single-nucleotide polymorphisms (each associated with AF at <1×10 in a previous analysis). Associations between AF genetic risk and stroke were enriched in the cardioembolic stroke subset (strongest =1.2×10 , 944 single-nucleotide polymorphism score). In contrast, AF genetic risk was not significantly associated with noncardioembolic stroke subtypes. CONCLUSIONS: Comprehensive AF genetic risk scores were specific for cardioembolic stroke. Incomplete workups and subtype misclassification may have limited the power to detect associations with strokes of undetermined pathogenesis. Future studies are warranted to determine whether AF genetic risk is a useful biomarker to enhance clinical discrimination of stroke pathogeneses.
[Mh] Termos MeSH primário: Fibrilação Atrial/genética
Isquemia Encefálica/genética
Embolia/genética
Estudos de Associação Genética
Predisposição Genética para Doença
Acidente Vascular Cerebral/genética
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Genótipo
Seres Humanos
Polimorfismo de Nucleotídeo Único
Fatores de Risco
Acidente Vascular Cerebral/etiologia
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016198


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[PMID]:29279534
[Au] Autor:Her AY; Lim KH; Shin ES
[Ad] Endereço:Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine.
[Ti] Título:Transcatheter Retrieval of Embolized Atrial Septal Defect Occluder Device by Waist Capture Technique.
[So] Source:Int Heart J;59(1):226-228, 2018 Jan 27.
[Is] ISSN:1349-3299
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:This case study describes the successful percutaneous transcatheter retrieval of an embolized Amplatzer occluder device using the "waist capture technique" in a patient with an atrial septal defect. This technique allowed for stability of the Amplatzer device, compression of the atrial discs for easier removal, prevention of further embolization, and minimal injury to vasculature during device retrieval. This novel and effective technique can be used safely for the retrieval of Amplatzer devices in the venous system.
[Mh] Termos MeSH primário: Cateterismo Cardíaco/métodos
Remoção de Dispositivo/métodos
Embolia/cirurgia
Comunicação Interatrial/cirurgia
Dispositivo para Oclusão Septal/efeitos adversos
[Mh] Termos MeSH secundário: Angiografia
Ecocardiografia Transesofagiana
Embolia/diagnóstico
Embolia/etiologia
Comunicação Interatrial/diagnóstico
Seres Humanos
Masculino
Meia-Idade
Falha de Prótese
Reoperação
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE
[do] DOI:10.1536/ihj.17-227


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[PMID]:28456697
[Au] Autor:Satogami K; Ino Y; Kubo T; Tanimoto T; Orii M; Matsuo Y; Ota S; Yamaguchi T; Shiono Y; Shimamura K; Katayama Y; Aoki H; Nishiguchi T; Ozaki Y; Yamano T; Kameyama T; Kuroi A; Kitabata H; Tanaka A; Hozumi T; Akasaka T
[Ad] Endereço:Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
[Ti] Título:Impact of Plaque Rupture Detected by Optical Coherence Tomography on Transmural Extent of Infarction After Successful Stenting in ST-Segment Elevation Acute Myocardial Infarction.
[So] Source:JACC Cardiovasc Interv;10(10):1025-1033, 2017 May 22.
[Is] ISSN:1876-7605
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The aim of the present study was to investigate the association between plaque rupture (PR) assessed by optical coherence tomography (OCT), and the transmural extent of infarction (TEI) assessed by contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI). BACKGROUND: PR is associated with larger infarct size as assessed by cardiac enzymes in STEMI patients. CE-CMR is a favorable method to assess TEI, which can predict the prognosis of STEMI patients. METHODS: First, STEMI patients with primary PCI within 12 h after onset were enrolled and divided into 2 groups according to presence (n = 71) or absence (n = 32) of PR at the culprit lesion as assessed by pre-intervention OCT. CE-CMR was performed at 1 week after primary PCI. RESULTS: The frequency of no-reflow phenomenon (37% vs. 16%; p = 0.032) and distal embolization (24% vs. 6%; p = 0.032) was significantly higher in the rupture group compared with the non-rupture group. TEI grade was significantly greater in the rupture group (28% vs. 15% in grade 3 and 45% vs. 13% in grade 4; p < 0.001). Microvascular obstruction was more frequently seen in the rupture group (39% vs. 19%; p = 0.039). Multivariate analysis identified PR (odds ratio: 6.60, 95% confidence interval: 2.19 to 21.69; p < 0.001) and no statin use before admission (odds ratio: 3.37, 95% confidence interval: 1.06 to 11.19; p = 0.039) as independent predictors of TEI grade 3 or 4. CONCLUSIONS: PR as assessed by OCT is associated with greater TEI as assessed by CE-CMR in STEMI patients after primary PCI.
[Mh] Termos MeSH primário: Doença da Artéria Coronariana/terapia
Vasos Coronários/diagnóstico por imagem
Imagem por Ressonância Magnética
Miocárdio/patologia
Intervenção Coronária Percutânea/instrumentação
Placa Aterosclerótica
Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
Stents
Tomografia de Coerência Óptica
[Mh] Termos MeSH secundário: Idoso
Distribuição de Qui-Quadrado
Meios de Contraste/administração & dosagem
Angiografia Coronária
Doença da Artéria Coronariana/diagnóstico por imagem
Eletrocardiografia
Embolia/diagnóstico por imagem
Embolia/etiologia
Feminino
Gadolínio DTPA/administração & dosagem
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Fenômeno de não Refluxo/diagnóstico por imagem
Fenômeno de não Refluxo/etiologia
Razão de Chances
Intervenção Coronária Percutânea/efeitos adversos
Valor Preditivo dos Testes
Estudos Retrospectivos
Fatores de Risco
Ruptura Espontânea
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media); K2I13DR72L (Gadolinium DTPA)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE


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[PMID]:28941605
[Au] Autor:Bastiany A; Grenier ME; Matteau A; Mansour S; Daneault B; Potter BJ
[Ad] Endereço:Cardiology Service, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
[Ti] Título:Prevention of Left Ventricular Thrombus Formation and Systemic Embolism After Anterior Myocardial Infarction: A Systematic Literature Review.
[So] Source:Can J Cardiol;33(10):1229-1236, 2017 Oct.
[Is] ISSN:1916-7075
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Anterior myocardial infarction (MI) with apical dysfunction is associated with an increased risk of left ventricular thrombus (LVT) formation and systemic embolism (SE). However, the role for prophylactic anticoagulation in current practice is a matter of debate. METHODS: We conducted a systematic review of peer-reviewed original articles in either English or French on the benefit of combining anticoagulation with standard therapy for the prevention of LVT/SE after MI by searching PubMed, Ovid/MedLine/Embase, the Cochrane Library, and Google Scholar. RESULTS: Of 7382 identified records, 14 were retained for analysis. Nine articles addressed anticoagulation for patients not treated with percutaneous coronary intervention (PCI). Another 5 included at least some patients treated with PCI. Only 1 study specifically addressed exclusively a primary PCI population. Some studies showed a benefit for combining anticoagulation with standard therapy in patients not treated with PCI, but results were inconsistent. No evidence of benefit was reported when PCI patients were included and 1 study reported a signal for net harm. There was important interstudy heterogeneity and methodological limitations. Studies were likely individually underpowered. CONCLUSIONS: The available studies of LVT/SE prevention after MI lacked statistical power and are heterogeneous in terms of treatments, revascularization methods, background medical therapy, and study design. We conclude that there is presently no compelling evidence for or against combining anticoagulation with standard therapy for post-MI patients with apical dysfunction after primary PCI, and inconsistent evidence supporting prophylaxis after thrombolysis. An appropriately powered randomized trial is required to answer this clinically relevant question.
[Mh] Termos MeSH primário: Infarto Miocárdico de Parede Anterior/complicações
Embolia/etiologia
Cardiopatias/etiologia
Terapia Trombolítica/métodos
Trombose/etiologia
[Mh] Termos MeSH secundário: Embolia/prevenção & controle
Cardiopatias/prevenção & controle
Ventrículos do Coração
Seres Humanos
Fatores de Risco
Trombose/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170925
[St] Status:MEDLINE


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[PMID]:28935324
[Au] Autor:Tourmousoglou C; Karkos C; Fidanis T; Theofilogiannakos EK; Hytiroglou P; Pitsis A
[Ad] Endereço:Thessaloniki Heart Institute, St. Luke's Hospital, Thessaloniki, Greece. Electronic address: christostourmousoglou@gmail.com.
[Ti] Título:An Unusual Case of Arterial Embolism in an Adolescent With a Mitral Valve Repair With a Ring.
[So] Source:Ann Thorac Surg;104(4):e315-e317, 2017 Oct.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:We report a case of an adolescent young man who presented with embolism of both lower legs. The patient had undergone mitral valve repair with a Kalangos biodegradable ring (Bioring SA, Lonay, Switzerland) 9 months earlier. Bilateral embolectomy was performed. Histopathologic examination revealed minute fragments of synthetic material within the embolus, which otherwise consisted of recent thrombus.
[Mh] Termos MeSH primário: Bioprótese/efeitos adversos
Embolia/etiologia
Implante de Prótese de Valva Cardíaca/efeitos adversos
Insuficiência da Valva Mitral/cirurgia
Falha de Prótese
[Mh] Termos MeSH secundário: Adolescente
Ecocardiografia Transesofagiana/métodos
Embolectomia/métodos
Embolia/diagnóstico por imagem
Embolia/cirurgia
Seguimentos
Próteses Valvulares Cardíacas
Implante de Prótese de Valva Cardíaca/métodos
Seres Humanos
Extremidade Inferior/cirurgia
Masculino
Insuficiência da Valva Mitral/diagnóstico por imagem
Doenças Raras
Medição de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE


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[PMID]:28886856
[Au] Autor:Chen ST; Hellkamp AS; Becker RC; Berkowitz SD; Breithardt G; Fox KAA; Hacke W; Halperin JL; Hankey GJ; Mahaffey KW; Nessel CC; Piccini JP; Singer DE; Patel MR
[Ad] Endereço:Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
[Ti] Título:Outcome of Patients Receiving Thrombolytic Therapy While on Rivaroxaban for Nonvalvular Atrial Fibrillation (from Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation).
[So] Source:Am J Cardiol;120(10):1837-1840, 2017 Nov 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The safety of intravenous thrombolysis in patients taking rivaroxaban has not been well established. We retrospectively analyzed the outcomes of all patients who received thrombolytic therapy in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). A review of medical and adverse event records for patients receiving thrombolytic therapy while enrolled in ROCKET AF was performed to determine their baseline characteristics, indications for thrombolysis, and type of agent used. Safety end points were 30-day post-thrombolytic rates of stroke, bleeding, and mortality. A total of 28 patients in ROCKET AF received thrombolytic therapy, with 19 patients on rivaroxaban and 9 patients on warfarin. Ischemic stroke was the most common indication for thrombolysis (n = 10), and alteplase was the most commonly used fibrinolytic agent (n = 14). Of the 19 patients in the rivaroxaban group, there were 2 nonfatal bleeding events and 2 deaths, mostly occurring when thrombolytic therapy was administered within 48 hours of the last rivaroxaban dose. Of the 9 patients in the warfarin group, there was 1 nonfatal bleeding event and 3 deaths, most occurring when thrombolytic therapy was administered outside of 48 hours from the last warfarin dose. In conclusion, these observations suggest that careful assessment of the time since the last dose may be of clinical significance in patients on novel oral anticoagulants who require emergent thrombolysis.
[Mh] Termos MeSH primário: Fibrilação Atrial/tratamento farmacológico
Embolia/prevenção & controle
Rivaroxabana/administração & dosagem
Acidente Vascular Cerebral/prevenção & controle
Terapia Trombolítica/métodos
Vitamina K/antagonistas & inibidores
Varfarina/administração & dosagem
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Fibrilação Atrial/complicações
Fibrilação Atrial/mortalidade
Relação Dose-Resposta a Droga
Método Duplo-Cego
Esquema de Medicação
Embolia/epidemiologia
Embolia/etiologia
Inibidores do Fator Xa/administração & dosagem
Feminino
Seguimentos
Seres Humanos
Incidência
Masculino
Estudos Retrospectivos
Acidente Vascular Cerebral/epidemiologia
Acidente Vascular Cerebral/etiologia
Taxa de Sobrevida/tendências
Fatores de Tempo
Resultado do Tratamento
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Factor Xa Inhibitors); 12001-79-5 (Vitamin K); 5Q7ZVV76EI (Warfarin); 9NDF7JZ4M3 (Rivaroxaban)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170910
[St] Status:MEDLINE


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[PMID]:28864318
[Au] Autor:Hernandez I; Zhang Y; Saba S
[Ad] Endereço:Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: inh3@pitt.edu.
[Ti] Título:Comparison of the Effectiveness and Safety of Apixaban, Dabigatran, Rivaroxaban, and Warfarin in Newly Diagnosed Atrial Fibrillation.
[So] Source:Am J Cardiol;120(10):1813-1819, 2017 Nov 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:No studies have performed direct pairwise comparisons of the effectiveness and safety of warfarin and the new oral anticoagulants (NOACs) apixaban, dabigatran, and rivaroxaban. Using 2013 to 2014 claims from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with atrial fibrillation who initiated apixaban, dabigatran, rivaroxaban, warfarin, or no oral anticoagulation therapy in 2013 to 2014. Outcomes included the composite of ischemic stroke, systemic embolism (SE) and death, any bleeding event, gastrointestinal bleeding, intracranial bleeding, and treatment persistence. We constructed Cox proportional hazard models to compare outcomes between each pair of treatment groups. The composite risk of ischemic stroke, SE, and death was lower for NOACs than for warfarin: hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76 to 0.98 for apixaban; 0.73, 95% CI 0.63 to 0.86 for dabigatran; and 0.82, 95% CI 0.75 to 0.89 for rivaroxaban, all compared with warfarin. There were no differences in effectiveness across NOACs. The risk of any bleeding was lower with apixaban than with warfarin, but higher with rivaroxaban than with warfarin. Apixaban (HR 0.69, 95% CI 0.60 to 0.79) and dabigatran (HR 0.79, 95% CI 0.69 to 0.92) were associated with lower bleeding risk than rivaroxaban. Treatment persistence was highest for apixaban (82%), and lowest for dabigatran and warfarin (64%) (p value <0.001). Compared with warfarin, NOACs are more effective in preventing stroke but their risk of bleeding varies, with rivaroxaban having higher risk than warfarin. Altogether, apixaban had the most favorable effectiveness, safety, and persistence profile.
[Mh] Termos MeSH primário: Fibrilação Atrial/complicações
Dabigatrana/administração & dosagem
Pirazóis/administração & dosagem
Piridonas/administração & dosagem
Rivaroxabana/administração & dosagem
Acidente Vascular Cerebral/prevenção & controle
Varfarina/administração & dosagem
[Mh] Termos MeSH secundário: Administração Oral
Idoso
Anticoagulantes/administração & dosagem
Antitrombinas/administração & dosagem
Fibrilação Atrial/diagnóstico
Fibrilação Atrial/tratamento farmacológico
Relação Dose-Resposta a Droga
Embolia/epidemiologia
Embolia/prevenção & controle
Inibidores do Fator Xa/administração & dosagem
Feminino
Seguimentos
Seres Humanos
Incidência
Masculino
Pennsylvania/epidemiologia
Estudos Retrospectivos
Acidente Vascular Cerebral/epidemiologia
Acidente Vascular Cerebral/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Antithrombins); 0 (Factor Xa Inhibitors); 0 (Pyrazoles); 0 (Pyridones); 3Z9Y7UWC1J (apixaban); 5Q7ZVV76EI (Warfarin); 9NDF7JZ4M3 (Rivaroxaban); I0VM4M70GC (Dabigatran)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170903
[St] Status:MEDLINE


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[PMID]:28837736
[Au] Autor:Cheung N; Teo K; Zhao W; Wang JJ; Neelam K; Tan NYQ; Mitchell P; Cheng CY; Wong TY
[Ad] Endereço:Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
[Ti] Título:Prevalence and Associations of Retinal Emboli With Ethnicity, Stroke, and Renal Disease in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Disease Study.
[So] Source:JAMA Ophthalmol;135(10):1023-1028, 2017 Oct 01.
[Is] ISSN:2168-6173
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: To our knowledge, population-based data on retinal emboli are limited in Asia. Besides its associations with traditional cardiovascular risk factors and stroke, associations between retinal emboli and renal disease and function remain unclear. Objective: To examine the prevalence of and risk factors for retinal emboli in a large, contemporary, multiethnic Asian population. Design, Setting, and Participants: This population-based cross-sectional study was conducted from 2004 to 2011 and included a total of 10 033 Chinese, Malay, and Indian persons aged 40 to 80 years residing in the general communities of Singapore. Analyses were performed from November 2016 to February 2017. Interventions or Exposures: Retinal emboli were ascertained from retinal photographs obtained from both eyes of all participants according to a standardized protocol. Age-standardized prevalence of retinal emboli was calculated using the 2010 Singapore adult population. Risk factors were assessed from comprehensive systemic and ophthalmic examinations, interviews, and laboratory investigations. Main Outcomes and Measures: Retinal emboli. Results: Of the 10 033 participants, 9978 (99.5%) had gradable retinal photographs. Of these, 5057 (50.7%) were female, and 3375 (33.8%) were Indian. We identified 88 individuals (0.9%) with retinal emboli; the overall person-specific, age-standardized prevalence of retinal emboli was 0.75% (95% CI, 0.60-0.95), with the highest prevalence seen in the Indian cohort (0.98%), followed by the Chinese (0.73%) and Malay (0.44%) cohorts (P = .03). In multivariable-adjusted analysis, factors associated with prevalent retinal emboli included older age (per 5-year increase; odds ratio [OR], 1.22; 95% CI, 1.05-1.41), Indian ethnicity (compared with Malay ethnicity; OR, 3.58; 95% CI, 1.95-6.60), hypertension (OR, 1.95; 95% CI, 1.03-3.70), chronic kidney disease (OR, 2.05; 95% CI, 1.15-3.64), creatinine level (per SD increase; OR, 1.13; 95% CI, 1.05-1.21), glomerular filtration rate (per SD increase; OR, 0.67; 95% CI, 0.51-0.86), and history of stroke (OR, 3.45; 95% CI, 1.70-6.99). Conclusions and Relevance: Based on 88 individuals among 9978 participants of 3 major Asian ethnic populations, retinal emboli were most commonly seen in Indian persons and associated with conventional cardiovascular risk factors, stroke, and chronic kidney disease. Therefore, its presence may signal vascular embolic event and damage not only in the brain but also in the kidneys. If these data are confirmed in longitudinal studies, they would suggest that persons with retinal emboli may require both general cardiovascular and renal assessment.
[Mh] Termos MeSH primário: Grupo com Ancestrais do Continente Asiático/etnologia
Embolia/etnologia
Grupos Étnicos
Nefropatias/etnologia
Artéria Retiniana
Doenças Retinianas/etnologia
Acidente Vascular Cerebral/etnologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Estudos Transversais
Embolia/patologia
Estudos Epidemiológicos
Feminino
Seres Humanos
Masculino
Meia-Idade
Fotografia
Prevalência
Doenças Retinianas/patologia
Fatores de Risco
Singapura/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170825
[St] Status:MEDLINE
[do] DOI:10.1001/jamaophthalmol.2017.2972


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[PMID]:28784693
[Au] Autor:Mari L; Behr S; Shea A; Dominguez E; Johnson PJ; Ekiri A; De Risio L
[Ad] Endereço:Department of Neurology/Neurosurgery, Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK.
[Ti] Título:Outcome comparison in dogs with a presumptive diagnosis of thoracolumbar fibrocartilaginous embolic myelopathy and acute non-compressive nucleus pulposus extrusion.
[So] Source:Vet Rec;181(11):293, 2017 Sep 16.
[Is] ISSN:2042-7670
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Dogs with fibrocartilaginous embolic myelopathy (FCEM) or acute non-compressive nucleus pulposus extrusion (ANNPE) are reported to have a fair prognosis; however, persistent motor/autonomic deficits are possible. Specific MRI patterns have been suggested to differentiate these diseases although never been validated with histopathology in large studies. The aim of this retrospective study was to evaluate if these MRI patterns are associated with different clinical outcomes in dogs with peracute non-progressive T3-L3 myelopathy. Two hundred and one dogs were included. Outcome data were obtained via medical records and telephone questionnaires. MRIs were blindly reviewed by three board-certified observers, obtaining substantial to almost perfect interobserver agreement on diagnoses (κ=0.635-0.828). Presumptive ANNPE and FCEM were diagnosed in 157 and 44 dogs , respectively. Ambulatory function was regained in 99 per cent of cases, with persistent motor deficits in 83.6 per cent and 92.5 per cent of dogs with presumptive ANNPE and FCEM, respectively. The presumptive diagnosis was not associated with motor function recovery, recovery times or urinary continence. Faecal incontinence was five times more likely in dogs with presumptive ANNPE (23 per cent) compared with presumptive FCEM (7.5 per cent).Distinguishing between MRI patterns of presumptive ANNPE or FCEM in dogs with peracute non-progressive T3-L3 myelopathy may help predict the risk of developing faecal incontinence.
[Mh] Termos MeSH primário: Doenças das Cartilagens/veterinária
Doenças do Cão/diagnóstico
Embolia/veterinária
Degeneração do Disco Intervertebral/veterinária
Imagem por Ressonância Magnética/veterinária
Núcleo Pulposo/patologia
Doenças da Medula Espinal/veterinária
[Mh] Termos MeSH secundário: Doença Aguda
Animais
Doenças das Cartilagens/diagnóstico
Diagnóstico Diferencial
Cães
Embolia/diagnóstico
Degeneração do Disco Intervertebral/diagnóstico
Vértebras Lombares
Prognóstico
Reprodutibilidade dos Testes
Estudos Retrospectivos
Doenças da Medula Espinal/diagnóstico
Vértebras Torácicas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE
[do] DOI:10.1136/vr.104090


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[PMID]:28754361
[Au] Autor:Meyermann K; Trani J; Caputo FJ; Lombardi JV
[Ad] Endereço:Division of Vascular and Endovascular Surgery, Department of Surgery, Cooper University Hospital, Camden, NJ.
[Ti] Título:Descending thoracic aortic mural thrombus presentation and treatment strategies.
[So] Source:J Vasc Surg;66(3):931-936, 2017 Sep.
[Is] ISSN:1097-6809
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Thoracic aortic mural thrombus (TAMT) of the descending aorta is rare but can result in dramatic embolic events. Early treatment is therefore crucial; however, there is not a consensus on ideal initial treatment. METHODS: A review of the literature using PubMed was conducted, and all relevant publications describing descending TAMT of the past 15 years were reviewed. Variables included for this analysis were presentation, initial treatment strategy employed, outcome measures of thrombus resolution or regression, recurrence of symptomatic emboli, and mortality. RESULTS: Seventy-four patients were included in this analysis. Women were significantly more likely to be described with descending TAMT. The majority (82.4%) of cases reported were diagnosed after an embolic event. Patients were equally likely to receive medical, open surgical, or endovascular therapy as the initial treatment modality. However, there is a trend within the past 5 years to report cases describing successful thoracic endovascular aortic repair for initial management. Of patients who initially underwent medical management, nine patients (34.6%) had persistent thrombus. Of the patients who initially underwent open surgical repair, six patients (31.6%) had persistent thrombus; of these patients, four underwent endovascular repair. Twenty-nine patients (39.2%) with descending TAMT initially underwent thoracic endovascular aortic repair. Twenty-seven (93.1%) had fully excluded thrombus at the time of the procedure, with no recurrence or evidence of repeated embolic phenomena at follow-up. CONCLUSIONS: Whereas mural thrombus of the thoracic aorta is uncommon, it must be considered in the differential diagnosis of embolic events. Although endovascular therapy may be a useful first-line option for TAMT with reports of positive outcomes in select literature, further study of this treatment option is required.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Aorta Torácica/cirurgia
Doenças da Aorta/terapia
Implante de Prótese Vascular
Procedimentos Endovasculares
Trombectomia
Trombose/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Anticoagulantes/efeitos adversos
Aorta Torácica/diagnóstico por imagem
Doenças da Aorta/complicações
Doenças da Aorta/diagnóstico por imagem
Doenças da Aorta/mortalidade
Implante de Prótese Vascular/efeitos adversos
Implante de Prótese Vascular/mortalidade
Embolia/etiologia
Procedimentos Endovasculares/efeitos adversos
Procedimentos Endovasculares/mortalidade
Feminino
Seres Humanos
Masculino
Meia-Idade
Recidiva
Fatores de Risco
Trombectomia/efeitos adversos
Trombectomia/mortalidade
Trombose/complicações
Trombose/diagnóstico por imagem
Trombose/mortalidade
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170730
[St] Status:MEDLINE



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