[Invasive hemodynamic assessment and interventional therapy].
Cardiovascular diseases are the main reason for hospitalization and usually followed by a conservative therapeutic approach. Due to the improvement over the last few years in the results of surgery in the elderly, the number of hemodynamic studies has increased. Hemodynamic studies are generally performed in elderly patients with symptomatic valvular heart disease and acute myocardial infarction with complications. The incidence of complications in the elderly during catheterization and coronarography is higher than in younger but still low. Cardiovascular hemodynamics in the elderly is determined by a combination of lifestyle, the presence of cardiac diseases that increase in prevalence with advancing age (e.g., coronary artery disease) and age-related changes in cardiovascular hemodynamic per se. With age, the tunica media of major blood vessels stiffens. This produces a elevation of systolic blood pressure (afterload) in many elderly patients which in turn increases left ventricular (LV) wall stress and results in mild compensatory LV hypertrophy. This compensatory hypertrophy normalizes wall stress, but produces pertubations in diastolic function such as: a reduction in the rate of both diastolic and LV peak filling, a diminished diastolic compliance associated with LV hypertrophy and a greater dependence upon left atrial contraction to maintain cardiac output. Recently the proportion of these patients who have percutaneous transluminal coronary angioplasty (PTCA) is growing. PTCA can be performed with a high rate of clinical success. Complete revascularization is low, particularly in patients with trivessel disease. The most common reasons for incomplete revascularization were: vessels with chronic total occlusion and vessels with diffuse disease. The rate of major cardiac complications was high among patients at high-risk in the presence of trivessel disease and low left ejection fraction. Long-term results were encouraging. For 90% of patients who had clinical success after PTCA, the end results continued to be beneficial. In conclusion, PTCA is a valid therapeutic alternative in elderly patients with coronary artery disease. In subsets of patients with single and bivessel disease, the short- and long-term outcome is very favourable. In patients with triple vessel disease, early clinical success rate is low but the long-term success rate is, however, acceptable.
Gaglione
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A
Istituto di Malattie dell'Apparato Cardiovascolare, Università degli Studi, Bari.
Chiddo
A
A
Bortone
A
A
Maiello
L
L
Franchini
G
G
Biasco
G
G
Rizzon
P
P
D000368:Aged; D000375:Aging / Q000502:physiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D017023:Coronary Angiography / Q000009:adverse effects; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D012016:Reference Values
Valutazione emodinamica invasiva e terapia interventistica.