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Ïðåäëîæåíà íîâàÿ ìåòîäèêà äèàãíîñòèêè èíôåêöèîííîãî ýíäîêàðäèòà
Íîâûé ìåòîä ñöèíòèîãðàôèè îêàçàëñÿ î÷åíü ýôôåêòèâíûì â äèàãíîñòèêå ñëîæíûõ ñëó÷àåâ èíôåêöèîííîãî ýíäîêàðäèòà. Ñîãëàñíî ñòàòüå, îïóáëèêîâàííîé â The Journal of Nuclear Medicine, ðàíåå íå ïðèìåíÿâøàÿñÿ â äàííîé îáëàñòè ñöèíòèãðàôèÿ ñ ëåéêîöèòàìè, ìå÷åííûìè ãåêñàìåòèëïðîïëåàìèíîêñèìîì òåõíåöèÿ 99m (99m Tc-HMPAO), ïîçâîëÿåò äîñòîâåðíî âåðèôèöèðîâàòü èëè îïðîâåðãíóòü èíôåêöèîííûé ýíäîêàðäèò äàæå â ñëîæíûõ ñëó÷àÿõ. Ýôôåêòèâíîñòü äàííîé ìåòîäèêè äèàãíîñòèêè áûëà îöåíåíà ïóòåì ñåðèéíîãî îáñëåäîâàíèÿ 131 ïàöèåíòà ñ ïîäîçðåíèåì íà èíôåêöèîííûé ýíäîêàðäèò è ñðàâíåíèÿ ïîëó÷åííûõ ðåçóëüòàòîâ ñ ðåçóëüòàòàìè ñòàíäàðòíûõ ìåòîäîâ îáñëåäîâàíèÿ, òàêèõ êàê òðàíñòîðàêàëüíàÿ èëè ÷ðåñïèùåâîäíàÿ ýõîêàðäèîãðàôèÿ, è äèàãíîñòè÷åñêèå êðèòåðèè Äþêà. ×óâñòâèòåëüíîñòü è ñïåöèôè÷íîñòü íîâûõ ìåòîäîâ ñîñòàâèëè 90% è 94% äëÿ èñêëþ÷åíèÿ äèàãíîçà ñîîòâåòñòâåííî, à äëÿ ïîäòâåðæäåíèÿ äèàãíîçà – 100%.  õîäå èñïûòàíèé íîâîé ìåòîäèêè íå áûëî çàôèêñèðîâàíî íè îäíîãî ëîæíîïîëîæèòåëüíîãî ðåçóëüòàòà. Ó 21 èç 24 áîëüíûõ ìåòîä îáíàðóæèë íàëè÷èå ñåïòè÷åñêèõ î÷àãîâ èíôåêöèè, èç êîòîðûõ ïðîèñõîäèë îòñåâ âîçáóäèòåëåé èíôåêöèè. Ñåïòè÷åñêèå ýìáîëèè æå áûëè îáíàðóæåíû òîëüêî â 11 èç 18 ñëó÷àåâ ýíäîêàðäèòà, âûñòàâëåííûõ ïî êðèòåðèÿì Äþêà. Ïðîâåäåíèå ñöèíòèãðàôèè îêàçàëîñü îñîáåííî ýôôåêòèâíûì â ñëó÷àÿõ îòðèöàòåëüíûõ èëè òðóäíûõ äëÿ èíòåðïðåòàöèè ðåçóëüòàòîâ ýõîêàðäèîãðàôèè è ïîäòâåðäèëî äèàãíîç ó 11 èç 88 ïàöèåíòîâ, à ó 3 îáñëåäóåìûõ ïîçâîëèëî èñêëþ÷èòü ïîñòàâëåííûé ïî äàííûì ÓÇÈ äèàãíîç: íàëîæåíèÿ íà êëàïàíàõ, âûÿâëåííûå ïî äàííûì ÓÇÈ, áûëè ðàñöåíåíû êàê ñòàð÷åñêèå. Ñîãëàñíî àâòîðàì èññëåäîâàíèÿ, íîâàÿ ìåòîäèêà äèàãíîñòèêè îñîáåííî ýôôåêòèâíà â ñèòóàöèÿõ, êîãäà äàííûå êëèíè÷åñêîé êàðòèíû óêàçûâàþò íà èíôåêöèîííûé ýíäîêàðäèò, íî ýõîêàðäèîãðàôè÷åñêàÿ êàðòèíà íå ïîêàçûâàåò õàðàêòåðíûõ èçìåíåíèé; ïðè íåîáõîäèìîñòè äèôôåðåíöèàëüíîé äèàãíîñòèêè ìåæäó èíôèöèðîâàííûìè è ñòåðèëüíûìè âåãåòàöèÿìè, à òàê æå êîãäà êëèíè÷åñêàÿ êàðòèíà, ëàáîðàòîðíàÿ äèàãíîñòèêà è ÓÇÈ ñåðäöà ïðîòèâîðå÷àò äðóã äðóãó. Òàê æå ìåòîäèêà ìîæåò îêàçàòüñÿ ïîëåçíà äëÿ èñêëþ÷åíèÿ âîâëå÷åíèÿ â ïðîöåññ êëàïàíîâ, â òîì ÷èñëå ïðîòåçèðîâàííûõ. Àáñòðàêò òóò [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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AHA/ASA Science Advisory Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation A Science Advisory for Healthcare Professionals From the American Heart Association/American Stroke Association
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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Indirect Comparison Finds No Significant Differences Between New OACs - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Cochrane Database Syst Rev. 2012 Aug 15;8:CD008893.
Effect of cocoa on blood pressure. --- Flavanol-rich chocolate and cocoa products may have a small but statistically significant effect in lowering blood pressure by 2-3 mm Hg in the short term. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#548
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ESC Guidelines for the management of acute myocardial infarction in patients presenting
with ST-segment elevation [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 2012 focused update of the ESC Guidelines for the management of atrial fibrillation [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Guidelines on the management of valvular heart disease (version 2012) [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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Äëÿ òåõ, êòî íå äîåõàë äî ESC:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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2012 EACPR/AHA Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events: A Systematic Review and Meta-Analysis - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#555
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Meta-Analysis Suggests No Net Clinical Benefit With New Generation of Oral Anticoagulants Following ACS - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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