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Infecções Relacionadas a Cateter , Cardiopatias , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Diálise Renal/efeitos adversos , Trombose , Ultrassonografia/métodos , Trombose Venosa , Adulto , Encéfalo/diagnóstico por imagem , Procedimentos Cirúrgicos Cardiovasculares/métodos , Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Infarto Cerebral/diagnóstico por imagem , Drenagem/métodos , Feminino , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Humanos , Falência Renal Crônica/terapia , Testes Imediatos , Diálise Renal/instrumentação , Supuração , Trombose/complicações , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Trombose/cirurgia , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/etiologiaRESUMO
Purpose: Mouthwash is used by a large population. Short-term clinical trials have shown that antibacterial mouthwash deplete oral nitrate-reducing bacteria, and decrease systemic nitric oxide bioavailability. Our previous publication from the San Juan Overweight Adults Longitudinal Study (SOALS) was the first to show frequent over-the-counter mouthwash use was independently associated with increased risk of prediabetes/diabetes. This manuscript evaluates whether over-the-counter mouthwash was associated with increased risk of hypertension.Materials and methods: SOALS recruited 40-65 year old overweight/obese individuals; baseline evaluations started in 2011 and the 3-year follow-up exam was completed by 2016. From the 1028 participants (76%) who completed follow-up, we excluded people with reported physician diagnosis of hypertension or systolic or diastolic BP at or above the hypertension cut-offs (n = 481), missing smoking (n = 1), missing physical activity (n = 1) and missing alcohol intake (n = 5) at baseline; 540 participants were included. The primary exposure was mouthwash use twice daily or more. The primary outcome for this manuscript is self-reported physician-diagnosed hypertension over the follow-up. We used Poisson regression controlling for age, sex, smoking, physical activity, waist circumference, alcohol intake, systolic blood pressure, pre-diabetes/diabetes status and cardiac medication use. We additionally evaluated other mouthwash use categorizations.Results: Twelve percent (66/540) developed hypertension over follow-up. People who used mouthwash twice/day or more had higher incidence of hypertension compared to less frequent users (Incidence Rate Ratio = 1.85; 95% Confidence Interval: 1.17, 2.94), and compared to non-users (IRR = 2.17; 95% CI: 1.27, 3.71). Several additional potential confounders evaluated did not impact these associations. Associations persisted among never smokers. Additional outcomes including BP assessed at a single study visit did not show associations.Conclusion: In this study, frequent regular use of over-the-counter mouthwash was associated with increased risk of hypertension, independent of major risk factors for hypertension and several other potential confounders.
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Bactérias/efeitos dos fármacos , Pressão Sanguínea , Hipertensão/epidemiologia , Boca/microbiologia , Antissépticos Bucais/efeitos adversos , Óxido Nítrico/metabolismo , Adulto , Idoso , Bactérias/metabolismo , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Porto Rico , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
The scope of hypertension (HTN) even for those involved in the field is staggering with numbers close to 60 million Americans and more than 1 billion individuals across the globe. It is the most common reason to seek medical attention and according to the World Health Organization, the number one cause of mortality in the world. Yet, we still don't know what is normal or abnormal. Even though the most recent 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults has created quite a commotion, new questions could be raised. The purpose of this Editorial not only to fuel more interest on this topic but also to create the notion that HTN needs to be considered a dynamic clinical entity rather than a static blood pressure reading.
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Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Hipertensão/tratamento farmacológico , Humanos , Fenótipo , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
BACKGROUND: Even though left atrial (LA) size and function are intimately related to left ventricular (LV) diastolic dysfunction, the role of LA with regard to LV systolic function is less clear. Consequently, we examined the potential association that might exist between measures of longitudinal LV systolic shortening and LA dilation using LA volume index (LAVI). METHODS: In this retrospective analysis, data from 75 echocardiograms (mean age 53 ± 14; range 24 - 89 years; mean body surface area (BSA) 2.0 ± 0.3) were analyzed. RESULTS: Peak global longitudinal (PGLS) correlated best with LV mass index (LVMI) followed by mitral annular systolic excursion (MAPSE), and age. Similar results were obtained when analyzing the best variables that correlated with LAVI. Finally, MAPSE correlated best with PGLS, then with MA tissue Doppler systolic velocity, BSA, and LAVI in that order. All patients had normal LV ejection fraction (LVEF) and normal sinus rhythm when studied. CONCLUSIONS: LAVI does not directly affect LV systolic function and longitudinal measures of LV shortening are mainly dependent on LV mass. Additional studies are now required to determine how these associations vary when different degrees of LV dilatation and systolic dysfunction are included in the analysis.
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BACKGROUND: Antiplatelet therapy with clopidogrel is recommended to reduce cardiovascular events in patients with peripheral artery disease (PAD); however, clopidogrel efficacy has not been adequately studied in this patient population. Therefore, we aimed to determine the effects of cilostazol therapy on platelet reactivity among PAD patients on clopidogrel. METHODS: We performed a cross-sectional pilot study of 46 Puerto Rican patients diagnosed with PAD. The cohort was divided based on use of clopidogrel and cilostazol (n=24) or clopidogrel alone (n=22). Platelet function was measured ex vivo using the VerifyNow P2Y12 assay. Genomic DNA was extracted from peripheral blood samples using the QIAamp DNA Blood Midi Kit, which was subjected to candidate variant genotyping (CYP2C19, ABCB1, PON1 and P2RY12) using TaqMan quantitative polymerase chain reaction assays. All analyses were performed using SAS version 9.4 (SAS Institute). RESULTS: Among all enrolled patients, 18 (39%) had high on-treatment platelet reactivity (HTPR). The mean platelet reactivity was 207±53 (range, 78-325) with higher P2Y12 reaction units in the non-cilostazol group, 224±45 vs. 191±55 on the cilostazol group (p=0.03). No significant differences were observed in the clinical or genetic variables between the two groups. A multiple regression analysis determined that history of diabetes mellitus (p=0.03), use of cilostazol (p=0.03) and hematocrit (p=0.02) were independent predictors of platelet reactivity. CONCLUSIONS: In Puerto Rican PAD patients on clopidogrel therapy, history of diabetes mellitus, use of cilostazol and hematocrit are independent predictors of platelet reactivity. Adjunctive cilostazol therapy may enhance clopidogrel efficacy among PAD patients with HTPR.
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Plaquetas/efeitos dos fármacos , Doença Arterial Periférica/complicações , Doença Arterial Periférica/tratamento farmacológico , Inibidores da Agregação Plaquetária/farmacologia , Inibidores da Agregação Plaquetária/uso terapêutico , Tetrazóis/farmacologia , Ticlopidina/análogos & derivados , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Idoso , Arildialquilfosfatase/genética , Cilostazol , Clopidogrel , Estudos Transversais , Citocromo P-450 CYP2C19 , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Projetos Piloto , Testes de Função Plaquetária , Receptores Purinérgicos P2Y12/genética , Tetrazóis/uso terapêutico , Ticlopidina/farmacologia , Ticlopidina/uso terapêuticoRESUMO
The destruction in Puerto Rico following Hurricane Maria brought an increased demand for health care services while severely limiting the health care system's ability to provide patient care. Immediately following the hurricane, countless patients found themselves in a situation without their medications for both acute and chronic conditions. Many of these patients turned first to community pharmacies for access to their medications. In this letter, we describe the response of pharmacists to the needs of their communities following the natural disaster, Hurricane Maria, and summarize some lessons learned from the experience that may be useful in future disaster planning.
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Tempestades Ciclônicas , Planejamento em Desastres , Farmacêuticos , Acessibilidade aos Serviços de Saúde , Humanos , Assistência ao Paciente , Farmácias , Papel Profissional , Porto RicoRESUMO
BACKGROUND: Though diastolic interrogation of the mitral annulus (MA) using tissue Doppler imaging (TDI) has been quite useful in assessing left ventricular (LV) diastolic function, the relative contribution of the previous cycle MA systolic displacement or velocity components to subsequent LV diastole has not been previously investigated. We therefore sought to determine the association between MA systolic dynamics and LV diastolic function parameters. METHODS: For this retrospective study, only complete echocardiograms having good endocardial border resolution of both left atrial (LA) and LV chambers with M-mode (MAPSE) and tissue Doppler of the lateral MA (MA TDI S') as well as complete Doppler data to perform assessment of LV diastole were included in our analysis. RESULTS: Data from 100 patients (mean age 54 ± 14) showed that both MA systolic displacement and velocity correlate with LV ejection fraction (P < 0.05). Only MA displacement was associated with age and LV mass. Most importantly no correlation was found between MAPSE and LV diastole. However, in sharp contrast MA TDI S' correlated with MA relaxation velocities during both early and late LV diastole. CONCLUSION: Even though MAPSE and MA TDI S' are surrogate measures of LV ejection fraction, only MA TDI S' correlates with diastolic MA velocities as no correlation was identified between MAPSE and measures of LV diastole. Additional studies are now warranted to explore whether a reduced MA TDI S' may affect the symptomatic profile or the overall prognosis of patients with LV diastolic dysfunction.
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BACKGROUND: Clopidogrel is by far the most prescribed platelet adenosine diphosphate (ADP) antagonist in Puerto Rico despite the advent of newer agents (prasugrel and ticagrelor). Given the paucity of data on clopidogrel responsiveness in Hispanics, we sought to determine the association between clinical characteristics and platelet reactivity in Puerto Rican patients on clopidogrel therapy. STUDY POPULATION: A total of 100 Puerto Rican patients on clopidogrel therapy were enrolled and allocated into two groups: Group I, without high on-treatment platelet reactivity (HTPR); and Group II, with HTPR. Platelet function was measured ex vivo using the VerifyNow® P2Y12 assay. RESULTS: The cohort was comprised of Hispanic patients with coronary artery disease (57%), peripheral artery disease (32%), carotid artery stenosis (7%), cerebral artery aneurysm (2%), and stroke (2%). Mean platelet reactivity was 200 ± 61 P2Y12 reaction units (PRUs) (range: 8-324), and 35% of patients had HTPR (PRUs ⩾ 230). Multivariable logistic regression analysis determined that diabetes mellitus (DM) [odds ratio (OR) = 3.27; 95% confidence interval (CI): 1.20-8.96], use of proton-pump inhibitors (PPIs) (OR = 3.60; 95% CI: 1.09-11.82), and calcium channel blockers (CCBs) (OR = 3.10; 95% CI: 1.09-8.83) were independent predictors of HTPR ( p < 0.05) after adjusting for other clinical variables. CONCLUSIONS: In a sample of 100 Puerto Rican Hispanic patients on clopidogrel, 35% had HTPR. Furthermore, DM, PPIs and CCBs predicted HTPR. Clinical outcome data are needed to identify appropriate PRU thresholds for risk prediction in the Puerto Rican population.
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Plaquetas/efeitos dos fármacos , Doenças Cardiovasculares/tratamento farmacológico , Resistência a Medicamentos , Hispânico ou Latino , Inibidores da Agregação Plaquetária/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Ticlopidina/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Plaquetas/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etnologia , Distribuição de Qui-Quadrado , Clopidogrel , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Inibidores da Agregação Plaquetária/efeitos adversos , Testes de Função Plaquetária , Valor Preditivo dos Testes , Porto Rico/epidemiologia , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Receptores Purinérgicos P2Y12/sangue , Receptores Purinérgicos P2Y12/efeitos dos fármacos , Medição de Risco , Fatores de Risco , Ticlopidina/efeitos adversos , Ticlopidina/uso terapêutico , Resultado do TratamentoRESUMO
The metabolic syndrome (MetS) is a cluster of clinical disorders including an unhealthy body habitus with a large waistline, dyslipidemia, glucose intolerance and hypertension. It is known that these disorders not only increase the chances of developing type 2 diabetes mellitus (T2DM), but also cardiovascular disease (CVD). Furthermore, the co-occurrence of all these risk factors known as the MetS is linked to pathways sharing common underlying mediators and mechanisms. Though insulin resistance has been considered as the root of the problem to explain the conglomerate of metabolic abnormalities within this syndrome; new evidence points to several pro-inflammatory cytokines, reactive oxygen species and free fatty acid intermediates might play an even greater role in regulating a series of intracellular signaling pathways sustain as well as perpetuate the development of the MetS and its CVD complications. Since having a diagnosis of MetS confers not only a 5-fold increase in the risk of T2DM, but also a 2-fold risk of developing CVD over a period of 5 to 10 years; it is vital to better recognize the mechanisms by which the MetS is associated with such adverse outcomes. Therefore, it is the purpose of this review to address (1) how inflammation modifies insulin sensitivity, (2) known factors believed to contribute to this process, and (3) new concepts of inflammatory markers in regulating the development of MetS and its individual components.
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BACKGROUND: Left ventricular (LV) velocity of propagation (Vp) has been shown to be inversely related to the LV relaxation time constant. We sought to examine Vp from a group of chronic pulmonary hypertension (cPH) patients and compare these values to Vp obtained in normal individuals and patients with known LV diastolic dysfunction (LVDD). METHODS: Echo-Doppler data and Vp measurements were retrospectively collected from all patients. The studied population was divided into four groups. Group I comprised of 15 patients with normal LV diastole, group II included 27 patients with stage 1 LVDD, group III was made up of 27 patients with stage 2 LVDD, and group IV included 66 patients with cPH. RESULTS: In the cPH population studied, patients had smaller end-diastolic LV cavities with the highest Vp values but their early mitral inflow to Vp ratios were not different from healthy controls. In addition, Vp values and pulmonary wedge capillary pressures were significantly associated in patients with LV dysfunction or pulmonary hypertension (P < 0.01). CONCLUSIONS: LVVp might be a useful non-invasive measurement to be routinely obtained in cPH patients as it probably not only reflects the compressive forces being exerted on the LV, known to increase Vp, but also might be quite useful for the non-invasive assessment of pulmonary capillary wedge pressures in these patients.
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BACKGROUND: Even though the tricuspid annulus (TA) is anatomically and functionally related to right atrioventricular dependence and tricuspid annular plane systolic excursion (TAPSE) is a well-known measure of right ventricular (RV) systolic function, there is paucity of data regarding the potential impact that right atrial (RA) size and function have on TAPSE. Hence, we sought to determine whether RA volumetric and longitudinal measures affect TAPSE in patients with chronic pulmonary hypertension (cPH). METHODS: In this retrospective study, echocardiographic data from 110 patients were reviewed and the studied population was divided into Group I consisting of 50 patients (50±11 years) without PH and Group II that included 60 patients (55±14 years) with cPH. RESULTS: Even though RA areas, RA fractional area change, and maximal long-axis length measurements were abnormal in cPH patients, TA tissue Doppler imaging systolic velocity and RV fractional area change were the only useful variables in identifying patients with abnormal TAPSE (P<.0001 and P=.018, respectively). Additionally, TAPSE was independent of all RA measures, left ventricular ejection fraction, and age (P>.05). CONCLUSIONS: Based on these results, TAPSE does not appear to be influenced by either RA size or function. Additional studies using strain echocardiography to interrogate RA mechanics might now be very useful to advance our understanding of TA motion in cPH patients given recent data showing that RA function accounts for a significantly greater proportion of total right heart function in patients with cPH than in normal subjects.
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Hipertensão Pulmonar/fisiopatologia , Valva Tricúspide/fisiologia , Disfunção Ventricular Direita/fisiopatologia , Doença Crônica , Ecocardiografia Doppler , Feminino , Átrios do Coração/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/patologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Sístole , Disfunção Ventricular Direita/complicaçõesAssuntos
Pesquisa Biomédica/educação , Internato e Residência , Pesquisa Translacional Biomédica/educação , Pesquisa Biomédica/organização & administração , Humanos , Médicos/organização & administração , Pesquisadores/educação , Pesquisadores/organização & administração , Pesquisa Translacional Biomédica/organização & administraçãoRESUMO
BACKGROUND: Pulmonary arterial hypertension (PAH) is known to trigger right ventricular (RV) remodeling that might compromise left ventricular (LV) filling due to inter-ventricular interdependence. In this study, we aimed to examine standard echocardiographic measurements of LV diastolic function in PAH patients. METHODS: In this retrospective study, we identified clinical as well as complete echocardiographic data from 128 chronic PAH patients to fully assess LV diastolic dysfunction (LVDD) using standard recommended Doppler guidelines. Accordingly, patients were divided into three groups: LVDD 0, LVDD 1 and LVDD 2. RESULTS: The mean age of the studied population was 57 ± 14 years with a mean pulmonary artery systolic pressure (PASP) of 55 ± 21 mm Hg. A total of 36% of the study patients had normal LV diastolic function. However, 64% had LVDD with LVDD stage 1 being the most common (48%). In terms of echocardiographic data, significant differences were found among the three LVDD groups in regards to PASP, LV end systolic and diastolic volumes, tricuspid annular plane systolic excursion, right ventricular fractional area change as well as many other tissue Doppler imaging parameters. Finally, just age and PASP were predictors of abnormal LV diastolic function (P < 0.05). CONCLUSIONS: Impaired relaxation is a common abnormality in PAH patients. Additional studies are warranted to determine whether LVDD alters prognosis or is related to changes in the symptomatic profile of this group of patients.
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Over the past decades, chemotherapy has significantly increased the overall prognosis and survival of several patients diagnosed with cancer. However, the usefulness of some chemotherapeutic agents has been hindered by a collateral dose-dependent cardiotoxicity. To date, although extensive efforts have been directed to the early detection of subclinical toxicity in patients treated with these drugs, it remains unclear which approach would be best in order to prevent chemotherapy-induced cardiotoxicity (CIC). For many years, conventional echocardiography has been among preferred noninvasive imaging modality to monitor left ventricular ejection fraction (LVEF) in patients undergoing chemotherapy. Unfortunately, a significant reduction in LVEF is not recognized early on after chemotherapy-induced myocardial damage. Moreover, delayed recognition has been associated with poor recovery potential and poor clinical outcome. Thus, there is a critical need to identify early, reliable parameters of subclinical injury. Myocardial deformation imaging, also known as strain imaging echocardiography (SIE), is becoming readily available for advanced routine echocardiography and has shown value in detecting subclinical ventricular dysfunction in several clinical scenarios. Abnormalities in systolic deformation parameters have been identified as early manifestation but left ventricular diastolic properties remain less well defined. We hypothesize that onset as well as progression of cardiotoxicity not only should disturb deformation curves of myocardial contraction, but also relaxation. Hence, SIE may detect subtle myocardial changes in diastole that could be of potential benefit in the early prediction of CIC. If this premise is proven correct, the use of a standardized advanced echocardiographic imaging protocol using both, systolic and diastolic strain imaging, will prove to be a powerful noninvasive tool as baseline and follow-up of these patients. Furthermore, it will foster the developing of more effective screening strategies in at risk cancer survivor populations, or identify the best time to start cardioprotective therapy to prevent CIC. Also, this experience might be extrapolated to other non-oncologic patient population in need of a surveillance tool to early recognize cardiac injury secondary to the use of cardiotoxic medications.
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Antineoplásicos/uso terapêutico , Cardiotoxicidade/diagnóstico , Diástole , Ecocardiografia , Neoplasias/tratamento farmacológico , Cardiopatias/induzido quimicamente , Ventrículos do Coração/efeitos dos fármacos , Humanos , Neoplasias/complicações , Sístole , Disfunção Ventricular Esquerda , Função Ventricular Esquerda/efeitos dos fármacosRESUMO
INTRODUCTION: There is scarce information about right ventricle (RV) function in patients with secondary pulmonary hypertension (PH) undergoing transcatheter aortic valve implantation (TAVI). We aim to identify possible RV abnormalities in patients referred for TAVI with severe aortic stenosis (sAS) and secondary PH. METHODS: Objective measures of RV function, as well as noninvasive estimates of pulmonary artery systolic pressures (PASP) were obtained from 30 sAS patients undergoing percutaneous valve intervention. RESULTS: Sixteen (53%) evaluated patients had some degree of PH. As expected, left ventricular mass index (281 ± 75 g/m2) and left atrial volume index (89 ± 23 mL/m2) values were significantly elevated. Even though RV end-systolic (8 ± 4 cm2) and end-diastolic (17 ± 4 cm2) areas were normal as well as RV fractional area change values (57 ± 16%); both longitudinal measures of RV systolic function such as tricuspid annular plane systolic excursion (1.9 ± 0.5 cm) and systolic velocity (10 ± 2 cm/s) were clearly reduced with just mild elevations in PASP (54 ± 7 mmHg). CONCLUSIONS: Subclinical RV dysfunction is present in patients with sAS and secondary PH undergoing TAVI. Whether longitudinal measures of RV systolic function could predict clinical outcomes in these patients needs to be further explored.