RESUMEN
BACKGROUND: Left atrial peak systolic strain (LA-PSS) imaging is an emerging index of left atrial function, and it was shown to be decreased in heart failure with preserved ejection fraction (EF). We aimed to determine whether LA-PSS could be used as an additional diagnostic parameter to current existing guidelines for the presence of left ventricle diastolic dysfunction (LVDD). MATERIALS AND METHODS: A total of 190 consecutive adult patients with cardiovascular risk factors and normal left ventricle EF with no prior history of heart failure were included in the study. Speckle tracking software was used to study ventricular parietal deformity, left ventricle global longitudinal systolic strain, and LA-PSS. RESULTS: The median left ventricle global longitudinal systolic strain was -19%, with a significant difference ( P < 0.001) between patients with normal diastolic function versus those with LVDD. The median LA-PSS was 33% (30% to 38%) ( P < 0.001). Most patients (61%) had grade 1 atrial dysfunction based on PSS (range 24%-35%). The analysis of the area under the receiver operating characteristic curve of the LA-PSS as a potential indicator pathway of LVDD was 67% [95% confidence interval (CI), 62-72], and 75% (95% CI, 70-80), when the indeterminate pattern was included. The decreased LA-PSS made it possible to reclassify patients with an indeterminate pattern of diastolic function in 96% of cases. CONCLUSIONS: These results support the potential role of LA-PSS as an additional parameter for the diagnosis of LVDD in patients with normal EF, and may be integrated into the guidelines for routine evaluation of patients.
Asunto(s)
Diástole , Volumen Sistólico , Sístole , Disfunción Ventricular Izquierda , Humanos , Femenino , Masculino , Persona de Mediana Edad , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/diagnóstico por imagen , Anciano , Volumen Sistólico/fisiología , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/diagnóstico por imagen , Función del Atrio Izquierdo/fisiología , Ecocardiografía/métodos , Curva ROC , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagenRESUMEN
During COVID-19 pandemic, several clinical manifestations have been described beyond respiratory compromise that characterizes the viral disease. Cardiovascular manifestations are one of the main complications. In this case, we report an unusual association between the novo diagnosis of pulmonary arterial hypertension in a pregnant patient with SARS Cov-2, with subsquent development of left ventricular dysfunction.
Durante la pandemia por COVID-19, se han descrito diferentes manifestaciones clínicas que van más allá del compromiso respiratorio que caracteriza a la enfermedad viral. Las manifestaciones cardiovasculares son una de las principales complicaciones. En este caso, nosotros reportamos la asociación poco usual entre el diagnóstico de novo de hipertensión pulmonar arterial en una paciente embarazada con SARS Cov-2 que posteriormente desarrolló disfunción ventricular izquierda.
Asunto(s)
COVID-19 , Hipertensión Pulmonar , Disfunción Ventricular Izquierda , Embarazo , Femenino , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Pandemias , COVID-19/complicaciones , Disfunción Ventricular Izquierda/diagnóstico , SARS-CoV-2RESUMEN
AIMS: Left ventricular diastolic dysfunction (LVDD) and LV systolic dysfunction (LVSD) are prevalent in CKD, but their prognostic relevance is debatable. We intent to verify whether LVDD and LVSD are independently predictive of all-cause mortality and if they have comparable or different effects on outcomes. METHODS: A retrospective analysis was conducted of the echocardiographic data of 1285 haemodialysis patients followed up until death or transplantation. LVDD was classified into 4 grades of severity. Endpoint was all-cause mortality. RESULTS: During a follow-up of 30 months, 419/1285 (33%) patients died, 224 (53%) due to CV events. LVDD occurred in 75% of patients, grade 1 DD was the prevalent diastolic abnormality, and pseudonormal pattern was the predominant form of moderate-severe DD. Moderate-severe LVDD (HR 1.379, CI% 1.074-1.770) and LVSD (HR 1.814, CI% 1.265-2.576) independently predicted death; a graded, progressive association was found between LVDD categories and the risk of death; and the impact of isolated severe-moderate LVDD on the risk of death was comparable to that exercised by isolated compromised LV systolic function. CONCLUSION: Moderate-severe LVDD and LVSD were independently associated with a higher probability of death and had a similar impact on survival. A progressive association was observed between LVDD grades and mortality.
Asunto(s)
Insuficiencia Cardíaca Diastólica , Insuficiencia Cardíaca Sistólica , Diálisis Renal , Insuficiencia Renal Crónica , Disfunción Ventricular Izquierda , Anciano , Brasil/epidemiología , Ecocardiografía Doppler/métodos , Femenino , Insuficiencia Cardíaca Diastólica/diagnóstico , Insuficiencia Cardíaca Diastólica/epidemiología , Insuficiencia Cardíaca Diastólica/fisiopatología , Insuficiencia Cardíaca Sistólica/diagnóstico , Insuficiencia Cardíaca Sistólica/epidemiología , Insuficiencia Cardíaca Sistólica/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Diálisis Renal/métodos , Diálisis Renal/estadística & datos numéricos , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/mortalidad , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: Left ventricular systolic dysfunction (LVSD) in Chagas disease (ChD) is relatively common and its treatment using low-cost drugs can improve symptoms and reduce mortality. Recently, an artificial intelligence (AI)-enabled ECG algorithm showed excellent accuracy to detect LVSD in a general population, but its accuracy in ChD has not been tested. OBJECTIVE: To analyze the ability of AI to recognize LVSD in patients with ChD, defined as a left ventricular ejection fraction determined by the Echocardiogram ≤ 40%. METHODOLOGY/PRINCIPAL FINDINGS: This is a cross-sectional study of ECG obtained from a large cohort of patients with ChD named São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) Study. The digital ECGs of the participants were submitted to the analysis of the trained machine to detect LVSD. The diagnostic performance of the AI-enabled ECG to detect LVSD was tested using an echocardiogram as the gold standard to detect LVSD, defined as an ejection fraction <40%. The model was enriched with NT-proBNP plasma levels, male sex, and QRS ≥ 120ms. Among the 1,304 participants of this study, 67% were women, median age of 60; there were 93 (7.1%) individuals with LVSD. Most patients had major ECG abnormalities (59.5%). The AI algorithm identified LVSD among ChD patients with an odds ratio of 63.3 (95% CI 32.3-128.9), a sensitivity of 73%, a specificity of 83%, an overall accuracy of 83%, and a negative predictive value of 97%; the AUC was 0.839. The model adjusted for the male sex and QRS ≥ 120ms improved the AUC to 0.859. The model adjusted for the male sex and elevated NT-proBNP had a higher accuracy of 0.89 and an AUC of 0.874. CONCLUSION: The AI analysis of the ECG of Chagas disease patients can be transformed into a powerful tool for the recognition of LVSD.
Asunto(s)
Inteligencia Artificial , Enfermedad de Chagas/complicaciones , Electrocardiografía/métodos , Disfunción Ventricular Izquierda/fisiopatología , Anciano , Algoritmos , Brasil , Enfermedad de Chagas/fisiopatología , Estudios Transversales , Electrocardiografía/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/etiología , Función Ventricular IzquierdaRESUMEN
BACKGROUND: Chagas disease remains a major cause of cardiovascular death in endemic areas. Focused echocardiography (FoCUS) is a point-of-care means of assessing cardiac function which can be useful for the diagnosis of cardiac involvement. OBJECTIVE: This study aims evaluating the characteristics of validity and reliability of FoCUS applied on Chagas disease patients. METHODS: Patients with Chagas disease coming from an endemic area were selected from a large cohort (SaMi-Trop). A simplified echocardiogram with only three images was extracted from the conventional echocardiogram performed in this cohort. The images were evaluated by an observer who was blinded to the clinical and echocardiographic data, to determine the accuracy and reliability of FoCUS for cardiac assessment. The analysis constituted of 5 prespecified variables, dichotomized in absence or presence: left ventricular (LV) size and systolic function, right ventricular (RV) size and systolic function, and LV aneurysm. RESULTS: We included 725 patients with a mean age of 63.4 ± 12.3 years, 483 (67%) female. Abnormal electrocardiogram was observed in 81.5% of the patients. Left and right ventricular dysfunctions were found in 103 (14%) and 49 (7%) of the patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 84%, 94%, 70% and 97% for LV enlargement and 81%, 93%, 68% and 97% for LV systolic dysfunction, respectively, and 46%, 99%, 60% and 98% for RV dilatation, and 37%, 100%, 100% and 96% for RV dysfunction, respectively. Inter and intraobserver agreement were 61% and 87% for LV enlargement and 63% and 92% for LV dysfunction, respectively, and 50% and 49% for RV size and 46% and 79% for RV dysfunction, respectively. LV apical aneurysm was found in 45 patients (6.2%) with the lowest sensitivity of FoCUS study (11%; 95% CI 2-28%). CONCLUSIONS: FoCUS showed satisfactory values of validity and reliability for assessment of cardiac chambers in patients with Chagas disease, except for apical aneurysm. This tool can identify heart disease with potential impact on patient management in the limited-resource setting.
Asunto(s)
Enfermedad de Chagas/diagnóstico , Ecocardiografía , Corazón/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Derecha/diagnóstico , Anciano , Cardiomiopatía Chagásica/diagnóstico , Cardiomiopatía Chagásica/diagnóstico por imagen , Cardiomiopatía Chagásica/fisiopatología , Enfermedad de Chagas/diagnóstico por imagen , Enfermedad de Chagas/fisiopatología , Femenino , Corazón/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Sístole/fisiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/fisiopatologíaRESUMEN
RESUMEN Introducción: la hipertensión pulmonar es un hallazgo frecuente en la insuficiencia cardíaca. El uso del sildenafilo en estos casos es una práctica habitual, pero aún controversial por lo limitado de los estudios realizados. Objetivo: comparar las variables ecocardiográficas de hemodinamia pulmonar, en pacientes con disfunción sistólica ventricular izquierda e hipertensión pulmonar secundaria severa, antes y después del uso del sildenafilo. Materiales y métodos: se realizó un estudio de cohorte, donde se incluyeron 19 pacientes; se realizó un seguimiento de dos años. Se analizaron variables clínicas, de laboratorio y ecocardiográficas. Se evaluaron las principales variables de hemodinamia pulmonar antes del uso del sildenafilo y a las doce semanas de su indicación. Se realizó una curva de supervivencia al concluir el seguimiento. El nivel de significación estadístico empleado fue de p < 0,05. Resultados: la edad promedio fue de 56,16 ± 15,77 años y predominó el sexo masculino, con un 73,7 %. La supervivencia al término del seguimiento fue de 78,9 %. Las principales variables ecocardiográficas de hemodinamia pulmonar mostraron una reducción significativa a las doce semanas del tratamiento con sildenafilo. La supervivencia de los pacientes con una reducción del 25 % de las presiones pulmonares en el ecocardiograma realizado a las doce semanas del tratamiento, fue mayor al terminar el estudio (100 % vs 33 %, log-rank test p = 0,001). Conclusiones: posterior al uso del sildenafilo se encontró una reducción significativa de las variables de hemodinamia pulmonar en el ecocardiograma evolutivo. La sobrevida fue mayor en los pacientes que presentaron dicha reducción (AU).
ABSTRACT Introduction: pulmonary hypertension is a common finding in heart failure. The use of sildenafil in these cases is a common practice, but still controversial due to the limited number of studies carried out. Objective: to compare echocardiographic variables of pulmonary hemodynamics, in patients with left ventricular systolic dysfunction and severe secondary pulmonary hypertension, before and after the use of sildenafil. Materials and methods: a cohort study was led, including 19 patients; a two-year follow-up was carried out. Clinical, laboratory and echocardiographic variables were analyzed. The main pulmonary hemodynamics variables were evaluated before the use of sildenafil and 12 weeks after its indication. A survival curve was performed at the end of the follow-up. The statistical significance level used was p < 0.05. Results: the average age was 56.16 ± 15.77 years, and male sex predominated with 73.3 %. Survival at the end of the follow up was 78.9 %. The main echocardiographic variables of pulmonary hemodinamics showed a significant reduction at 12 weeks of treatment with sildenafil. The survival of patients with a 25 % reduction in pulmonary pressures in the echocardiogram performed at 12 weeks of treatment was greater at the end of the study (100 % vs 33 %, log-rank test p = 0.001). Conclusions: after using sildenafil, a significant reduction of pulmonary hemodynamics variables was found in the evolutionary echocardiogram. Survival was higher in patients who had this reduction (AU).
Asunto(s)
Humanos , Masculino , Femenino , Disfunción Ventricular Izquierda/tratamiento farmacológico , Hipertensión Pulmonar/tratamiento farmacológico , Pacientes , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/terapia , Citrato de Sildenafil/provisión & distribución , Citrato de Sildenafil/uso terapéutico , Citrato de Sildenafil/farmacología , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/terapiaRESUMEN
Left ventricular false tendons are fibrous or fibromuscular bands that transverse the ventricular cavity and have no attachment to the mitral valve in many species. In cats it is considered a congenital defect that is rarely related to clinical disease and death in adult cats. A 45 days-old mixed breed cat had a history of inappetence since birth. At the physical exam the patient was lethargic and presented restrictive dyspnoea. At necropsy, there were marked ascites, hydrothorax, hepatomegaly with enhanced lobular pattern (nutmeg liver), and the lungs were markedly diminished (compressive pulmonary atelectasis). The heart was enlarged due to marked dilation of the cardiac chambers. Moreover, multiple slightly whitish and irregular cord-like structures were connecting the posterior papillary muscle to the interventricular septum (excessive moderator bands /left ventricular false tendons) at the left ventricle. Microscopically, these structures were characterized by a marked proliferation of fibrous connective tissue intermixed with Purkinje cells and well-differentiated cardiomyocytes lined by a single layer of endocardium. This study described a case of excessive moderator bands (left ventricular false tendons) in a young cat associated with congestive heart failure and death.(AU)
Falsos tendões são bandas fibrosas ou fibromusculares que atravessam a cavidade do ventrículo esquerdo, sem ligação com a valva mitral, em várias espécies. Nos gatos, a alteração é considerada um defeito congênito que raramente está relacionada com alterações clínicas e morte em gatos adultos. Um gato de 45 dias de idade, sem raça definida e com histórico de inapetência desde o nascimento foi encaminhado para atendimento veterinário. Ao exame físico apresentou letargia e dispneia restritiva. À necropsia, havia acentuada ascite, hidrotórax, hepatomegalia com evidenciação do padrão lobular (fígado noz-moscada) e os pulmões apresentavam-se acentuadamente diminuídos (atelectasia pulmonar compressiva). O coração apresentava acentuada dilatação das câmaras cardíacas. Em ventrículo esquerdo, havia numerosas estruturas brancacentas semelhantes a cordas conectando o músculo papilar ao septo interventricular (bandas moderadoras excessivas/falsos tendões). Microscopicamente, estas estruturas apresentavam acentuada proliferação de tecido conjuntivo fibroso, além de células de Purkinje e cardiomiócitos bem diferenciadas revestidas por uma única camada de endocárdio. O objetivo deste trabalho é descrever um caso de bandas moderadoras excessivas (falsos tendões) em ventrículo esquerdo de um gato jovem com insuficiência cardíaca congestiva e morte.(AU)
Asunto(s)
Animales , Femenino , Gatos , Enfermedades de los Gatos/congénito , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/veterinariaRESUMEN
Left ventricular false tendons are fibrous or fibromuscular bands that transverse the ventricular cavity and have no attachment to the mitral valve in many species. In cats it is considered a congenital defect that is rarely related to clinical disease and death in adult cats. A 45 days-old mixed breed cat had a history of inappetence since birth. At the physical exam the patient was lethargic and presented restrictive dyspnoea. At necropsy, there were marked ascites, hydrothorax, hepatomegaly with enhanced lobular pattern (nutmeg liver), and the lungs were markedly diminished (compressive pulmonary atelectasis). The heart was enlarged due to marked dilation of the cardiac chambers. Moreover, multiple slightly whitish and irregular cord-like structures were connecting the posterior papillary muscle to the interventricular septum (excessive moderator bands /left ventricular false tendons) at the left ventricle. Microscopically, these structures were characterized by a marked proliferation of fibrous connective tissue intermixed with Purkinje cells and well-differentiated cardiomyocytes lined by a single layer of endocardium. This study described a case of excessive moderator bands (left ventricular false tendons) in a young cat associated with congestive heart failure and death.
Falsos tendões são bandas fibrosas ou fibromusculares que atravessam a cavidade do ventrículo esquerdo, sem ligação com a valva mitral, em várias espécies. Nos gatos, a alteração é considerada um defeito congênito que raramente está relacionada com alterações clínicas e morte em gatos adultos. Um gato de 45 dias de idade, sem raça definida e com histórico de inapetência desde o nascimento foi encaminhado para atendimento veterinário. Ao exame físico apresentou letargia e dispneia restritiva. À necropsia, havia acentuada ascite, hidrotórax, hepatomegalia com evidenciação do padrão lobular (fígado noz-moscada) e os pulmões apresentavam-se acentuadamente diminuídos (atelectasia pulmonar compressiva). O coração apresentava acentuada dilatação das câmaras cardíacas. Em ventrículo esquerdo, havia numerosas estruturas brancacentas semelhantes a cordas conectando o músculo papilar ao septo interventricular (bandas moderadoras excessivas/falsos tendões). Microscopicamente, estas estruturas apresentavam acentuada proliferação de tecido conjuntivo fibroso, além de células de Purkinje e cardiomiócitos bem diferenciadas revestidas por uma única camada de endocárdio. O objetivo deste trabalho é descrever um caso de bandas moderadoras excessivas (falsos tendões) em ventrículo esquerdo de um gato jovem com insuficiência cardíaca congestiva e morte.
Asunto(s)
Femenino , Animales , Gatos , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/veterinaria , Enfermedades de los Gatos/congénitoRESUMEN
The severe acute respiratory syndrome (SARS-Cov-2) is a clinical entity generated by this new virus a Coronavirus (COVID-19). Disease called COVID-19 (CoronaVIrus Disease 2019) by the World Health Organization. Its presentation is acute respiratory failure characterized by hyperinflation of the lung that leads to an increase in capillaries and epithelial permeability, with loss of ventilation of lung tissue and increases lung stiffness. These disturbances lead to imbalances between ventilation and perfusion ratio, which ultimately result in hypoxemia and impaired carbon dioxide clearance. For this review, a search of PubMed and Trip Database was performed. Due to the scarcity of publications, a specific search algorithm was not used. The objective is to review, the evidence and the recommendations of national and international experts, of the hemodynamic and ventilatory management of these patients.
El coronavirus del síndrome respiratorio agudo grave 2 (SARS-CoV-2, conocido previamente como nCoV-2019) es el agente causal de una nueva enfermedad denominada COVID-19 (COronaVIrus Disease 2019) por la Organización Mundial de la Salud. Su presentación es la insuficiencia respiratoria aguda caracterizada por una hiperinflación del pulmón que conduce a un incremento de los capilares y permeabilidad epitelial, con pérdida de la aireación de tejido pulmonar e incremento de la rigidez pulmonar. Estas alteraciones conducen a desequilibrios entre la ventilación y la relación de perfusión, que finalmente resultan en hipoxemia y deterioro de la depuración de dióxido de carbono. Para la presente revisión se realizó una búsqueda en PubMed y Trip Database. Debido a la escasez de publicaciones no se utilizó un algoritmo de búsqueda específico. El objetivo es dar a conocer, de acuerdo con la evidencia y las recomendaciones de expertos nacionales e internacionales, el manejo hemodinámico y ventilatorio de estos pacientes.
Asunto(s)
COVID-19/terapia , Hemodinámica , Respiración , SARS-CoV-2 , COVID-19/sangre , COVID-19/complicaciones , COVID-19/fisiopatología , Oxigenación por Membrana Extracorpórea , Humanos , Hipoxia/etiología , Pulmón/patología , Fenotipo , Respiración de Presión Positiva Intrínseca , Posición Prona/fisiología , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria/etiología , Índice de Severidad de la Enfermedad , Posición Supina/fisiología , Factores de Tiempo , Ultrasonografía , Desconexión del Ventilador , Disfunción Ventricular Izquierda/diagnósticoRESUMEN
BACKGROUND: Heart failure with reduced ejection fraction (HFrEF) benefits from initiation and intensification of multiple pharmacotherapies. Unfortunately, there are major gaps in the routine use of these drugs. Without novel approaches to improve prescribing, the cumulative benefits of HFrEF treatment will be largely unrealized. Direct-to-consumer marketing and shared decision making reflect a culture where patients are increasingly involved in treatment choices, creating opportunities for prescribing interventions that engage patients. HYPOTHESIS: Encouraging patients to engage providers in HFrEF prescribing decisions will improve the use of guideline-directed medical therapies. DESIGN: The Electronically delivered, Patient-activation tool for Intensification of Chronic medications for Heart Failure with reduced ejection fraction (EPIC-HF) trial randomizes patients with HFrEF to usual care versus patient-activation tools-a 3-minute video and 1-page checklist-delivered prior to cardiology clinic visits that encourage patients to work collaboratively with their clinicians to intensify HFrEF prescribing. The study assesses the effectiveness of the EPIC-HF intervention to improve guideline-directed medical therapy in the month after its delivery while using an implementation design to also understand the reach, adoption, implementation, and maintenance of this approach within the context of real-world care delivery. Study enrollment was completed in January 2020, with a total 305 patients. Baseline data revealed significant opportunities, with <1% of patients on optimal HFrEF medical therapy. SUMMARY: The EPIC-HF trial assesses the implementation, effectiveness, and safety of patient engagement in HFrEF prescribing decisions. If successful, the tool can be easily disseminated and may inform similar interventions for other chronic conditions.
Asunto(s)
Toma de Decisiones Conjunta , Insuficiencia Cardíaca , Participación del Paciente , Pautas de la Práctica en Medicina , Volumen Sistólico , Adulto , Femenino , Mal Uso de los Servicios de Salud , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/psicología , Humanos , Intervención basada en la Internet , Masculino , Participación del Paciente/métodos , Participación del Paciente/psicología , Relaciones Médico-Paciente , Mejoramiento de la Calidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Disfunción Ventricular Izquierda/diagnósticoRESUMEN
BACKGROUND: Modern imaging plays a central role in the care of obese patients, and there is an integral focus on its use and accessibility in individuals who have alterations of various in various organs. The objective in this study was to perform an echographic analysis of musculoskeletal system disorders, endothelial dysfunction and the left ventricle (LV) in obese rats. METHODS: Sprague Dawley rats (250 ± 5 g) were obtained and divided into two groups: the control (C) group was fed with a standard diet, and the obese (Ob) group was fed hyper caloric diet with a high fructose-fat content for 4 months. Body weight, cholesterol, triglycerides, glucose, inflammatory cytokines and adhesion molecules (ICAM-1, VCAM-1) were measured. Additionally, two-dimensional echocardiography, abdominal ultrasound and musculoskeletal system studies were performed in the lower extremities. RESULTS: The body weight in the Ob group was increased compared to that in the control group, (p < 0.001); in addition, increased glucose, cholesterol and triglyceride concentrations (p < 0.05) as well as increased levels of the adhesion molecules ICAM-1 and, VCAM-1 (p < 0.01) were found in the Ob group vs the C group. On ultrasound, 75% of the Ob group presented fatty liver and distal joint abnormalities. CONCLUSION: Obese rats exhibit endothelial dysfunction and musculoskeletal changes, also, fatty liver and articular cysts in the posterior region of the distal lower- extremity joints.
Asunto(s)
Endotelio Vascular/diagnóstico por imagen , Corazón/diagnóstico por imagen , Hígado/diagnóstico por imagen , Sistema Musculoesquelético/diagnóstico por imagen , Obesidad/diagnóstico , Anatomía Transversal , Animales , Endotelio Vascular/patología , Endotelio Vascular/fisiopatología , Corazón/fisiopatología , Molécula 1 de Adhesión Intercelular/metabolismo , Hígado/fisiopatología , Masculino , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/patología , Enfermedades Musculoesqueléticas/fisiopatología , Sistema Musculoesquelético/patología , Sistema Musculoesquelético/fisiopatología , Miocardio/patología , Obesidad/complicaciones , Obesidad/fisiopatología , Ratas , Ratas Sprague-Dawley , Ultrasonografía , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/etiología , Enfermedades Vasculares/patología , Enfermedades Vasculares/fisiopatología , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/patología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
OBJECTIVE: The aim of this study was to examine echocardiographic parameters of left ventricle (LV) mechanics in obese patients before and after sleeve gastrectomy (SG). DESIGN AND METHODS: Twenty-five obese individuals submitted to laparoscopic SG were enrolled in this study. Echocardiography was performed before and after the procedure, and left ventricle mechanics were evaluated by speckle tracking imaging. RESULTS: Before surgery, altered global longitudinal strain (GLS) values were present in 56% of the patients. In a mean follow-up of 3.6 ± 0.5 months after surgery, there was an increase in GLS values (from 17.4 ± 3.2 to 19.3 ± 2.7%, P = 0.01). There was an inverse correlation between the absolute values of GLS in the preoperative period and the variation in the GLS at follow-up (r = 0.577, P = 0.002). Measurements of global circumferential strain (GCS), global radial strain (GRS), and LV twist were normal preoperatively and did not change after surgery. CONCLUSIONS: Altered global longitudinal strain values were common in young obese patients. Sleeve gastrectomy increased global longitudinal strain even in the early postoperative phase without promoting changes in global radial strain, global circumferential strain, and left ventricle twist measurements.
Asunto(s)
Gastrectomía/efectos adversos , Obesidad Mórbida/fisiopatología , Obesidad Mórbida/cirugía , Función Ventricular Izquierda/fisiología , Adulto , Estudios Controlados Antes y Después , Ecocardiografía/métodos , Femenino , Gastrectomía/métodos , Gastrectomía/rehabilitación , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Contracción Miocárdica/fisiología , Obesidad Mórbida/diagnóstico , Obesidad Mórbida/epidemiología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Abstract Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.
Resumo Fundamento: O aneurisma do ventrículo esquerdo (AVE) é uma importante complicação do infarto agudo do miocárdio (IAM). Objetivo: Investigar o papel da porção N-terminal do pró-hormônio do peptídeo natriurético do tipo B (NT-proBNP) para predizer o desenvolvimento de AVE após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Incluímos prospectivamente 1519 pacientes consecutivos com IAMCST. Os pacientes foram divididos em dois grupos de acordo com o desenvolvimento de AVE nos seis meses após o infarto do miocárdio. Os pacientes com ou sem AVE foram examinados para determinar se existia uma relação significativa entre os valores basais do NT-proBNP e as características clínicas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: O AVE foi detectado em 157 pacientes (10,3%). O nível basal do NT-proBNP foi significativamente maior em pacientes que desenvolveram AVE após IAM (523,5 ± 231,1 pg/mL vs. 192,3 ± 176,6 pg/mL, respectivamente, p < 0,001). Os preditores independentes da formação de AVE após IAM foram idade > 65 anos, tabagismo, classe Killip > 2, cirurgia de revascularização miocárdica anterior, insuficiência cardíaca pós-infarto do miocárdio, fração de ejeção do ventrículo esquerdo < 50%, falha de reperfusão, fenômeno de no-reflow, pico de troponina I e CK-MB e NT-proBNP > 400 pg/mL na internação. Conclusões: Nossos achados indicam que o nível plasmático do fragmento N-terminal do peptídeo natriurético tipo B na admissão, entre outras variáveis, fornece informações preditivas valiosas sobre o desenvolvimento de AVE após o IAMCST agudo.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Fragmentos de Péptidos/sangre , Disfunción Ventricular Izquierda/diagnóstico , Péptido Natriurético Encefálico/sangre , Infarto del Miocardio con Elevación del ST/complicaciones , Aneurisma Cardíaco/diagnóstico , Índice de Severidad de la Enfermedad , Biomarcadores/sangre , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Angiografía Coronaria , Disfunción Ventricular Izquierda/etiología , Aneurisma Cardíaco/etiologíaRESUMEN
BACKGROUND: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). METHODS: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. RESULTS: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. CONCLUSIONS: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.
Asunto(s)
Aneurisma Cardíaco/diagnóstico , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Infarto del Miocardio con Elevación del ST/complicaciones , Disfunción Ventricular Izquierda/diagnóstico , Adulto , Anciano , Biomarcadores/sangre , Angiografía Coronaria , Femenino , Aneurisma Cardíaco/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Disfunción Ventricular Izquierda/etiología , Adulto JovenRESUMEN
AIMS: The Doppler-derived myocardial performance index (MPI) has been considered as a diagnostic and prognostic Doppler marker for many different clinical conditions. The purpose of this study was to determine the diagnostic accuracy of traditional Pulsed-wave Doppler (PWD-MPI) and Pulsed-wave tissue Doppler imaging (TDI-MPI) and the degree of agreement between these methods in patients with grade-I diastolic dysfunction (DDI) and a normal ejection fraction. METHODS: Forty-seven consecutive ambulatory patients with DDI were compared to 51 healthy subjects with normal echocardiograms. All subjects underwent measurement of time intervals and MPI with PWD and pulsed TDI. RESULTS: TDI-MPI and PWD-MPI were significantly higher in patients with DDI than in control subjects: 0.49 ± 0.14 vs. 0.40 ± 0.09 (P < 0.001) and 0.45 ± 0.11 vs. 0.37 ± 0.08 (P < 0.001), respectively. Cutoff values of TDI-MPI > 0.42 and PWD-MPI > 0.40 identified DDI subjects, with sensitivities of 74 and 64%; specificities of 61 and 69%; positive likelihood ratios of 1.9 and 2.0; and negative likelihood ratios of 0.42 and 0.53, respectively; no significant difference was noted between the areas under the ROC curves of TDI-MPI and PWD-MPI (P = 0.77). Bland-Altman plots showed wide limits of agreement between these indices: - 0.17 to 0.23 in healthy subjects and - 0.24 to 0.32 in DDI patients. CONCLUSION: PWD-MPI and TDI-MPI showed poor clinical agreement and were not reliable parameters for the assessment of left ventricular diastolic function.
Asunto(s)
Ecocardiografía Doppler de Pulso/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Contracción Miocárdica/fisiología , Disfunción Ventricular Izquierda/fisiopatología , Función Ventricular Izquierda/fisiología , Adulto , Anciano , Diástole , Femenino , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Reproducibilidad de los Resultados , Volumen Sistólico/fisiología , Disfunción Ventricular Izquierda/diagnóstico , Adulto JovenAsunto(s)
Humanos , Masculino , Femenino , Fístula Arteriovenosa , Disfunción Ventricular Izquierda/diagnóstico , Intervención Coronaria Percutánea/métodos , Volumen Sistólico , Angiografía , Ecocardiografía Doppler/métodos , Anomalías de los Vasos Coronarios , Catéteres , Atrios Cardíacos , LactanteRESUMEN
BACKGROUND: There are limited options for percutaneous mechanical circulatory support (pMCS) in patients requiring high-risk percutaneous coronary intervention. OBJECTIVES: This first-in-human, single-center study aimed to evaluate the safety and feasibility of a novel pMCS device in high-risk percutaneous coronary intervention patients. METHODS: Aortix (Procyrion, Houston, Texas) is a pMCS device deployed in the descending aorta via the femoral artery that uses axial flow to provide cardiac unloading and augment renal and systemic perfusion. We assessed the use and effect of the Aortix device in six patients undergoing high-risk PCI. All patients had impaired left ventricular function, complex coronary disease, renal dysfunction, and suitable iliofemoral anatomy for Aortix placement via transfemoral approach. We recorded periprocedural events including hemodynamic effects of the device on cardiac output and urine output. We then followed patients up to 30 days following the PCI procedure for adverse events. RESULTS: Aortix delivery (18 Fr sheath) took 4-9 min, mean support time was 70 (range 47-95) min, and mean flow rate through the device was 3.5 L/min. During support, mean rate of urine output increased 10-fold (range 2.5-25.0x). Estimated GFR improved at discharge compared with baseline (mean increase 6.95 ± 8.09 mL/min). There were no device failures and PCI was successful in all patients. Aortix was removed and hemostasis was achieved with a vascular closure device and manual pressure. No patients experienced adverse events or hemodynamic compromise. No clinically significant hemolysis occurred (mean LDH 239.2 ± 73.6 mU/mL at baseline and 206.4 ± 82.2 mU/mL at discharge). No vascular access complications were observed. CONCLUSIONS: Aortix, a novel pMCS device, was successfully deployed and retrieved in all initial patients undergoing high-risk PCI. We noted no significant hemolysis with temporary use of this axial flow device. Improvement in eGFR suggests a potential renal protective effect and is an important area for future investigation in patients with impaired left ventricular function and renal dysfunction.