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1.
Hormones (Athens) ; 2024 Apr 18.
Artículo en Inglés | MEDLINE | ID: mdl-38632216

RESUMEN

PURPOSE: In patients with acromegaly, the long-term presence of elevated GH and IGF-1 levels is associated with an unfavorable cardiovascular risk profile. We aimed to assess the relationship of four-dimensional speckle tracking echocardiographic (4DSTE) measurements with growth differentiation factor-15 (GDF-15) levels and the Framingham Cardiovascular Risk Score (FRS) in patients with acromegaly. METHODS: A single-center, cross-sectional study was conducted. The study included 40 acromegaly and 32 age- and gender-matched controls. Anthropometric, biochemical, and echocardiographic assessments were performed. GDF-15 levels were measured using ELISA. RESULTS: In the controlled acromegaly group, global longitudinal (GLS), circumferential (GCS), area (GAS), and radial (GRS) strain measurements identified by 4DSTE were lower than those of the controls (p < 0.05). Moreover, strain parameters were lower in active acromegaly patients than in controls, but the difference was not statistically significant. The GLS was negatively correlated with age, the estimated disease duration, and FRS. Serum GDF-15 levels showed no significant difference between the acromegaly and control groups. In patients with acromegaly, serum GDF-15 levels were positively correlated with age, waist-to-hip ratio, systolic and diastolic blood pressure, FRS, fasting plasma glucose, and HbA1c, but not with strain parameters. The multiple regression analysis revealed that FRS was an independent factor associated with serum GDF-15 levels in patients with acromegaly and the overall cohort (p < 0.001). CONCLUSION: Our study demonstrates that while LVEF was within normal limits, global strain parameters (GLS, GCS, GAS, and GRS) measured by using a novel imaging technique, 4DSTE, were lower in patients with acromegaly, suggesting the presence of subclinical systolic dysfunction in patients with acromegaly. GDF-15 can be a potential predictor of cardiovascular risk in patients with acromegaly.

2.
Pacing Clin Electrophysiol ; 47(4): 583-590, 2024 04.
Artículo en Inglés | MEDLINE | ID: mdl-38477017

RESUMEN

BACKGROUND: The study explores left atrial appendage closure (LAAC) as a safe and effective alternative to anticoagulation for atrial fibrillation (AF) patients at high bleeding risk. Complications, such as cardioembolic events due to left atrial appendage thrombus (LAAT), highlight the need for alternative stroke prevention strategies. AIMS: This research assesses LAAC's safety and efficacy in patients with LAAT, aiming to offer valuable insights into its potential as a viable option for stroke prevention in such cases. METHODS: The study included 205 patients who underwent LAAC using specific devices between September 2015 and February 2023. Among them, 32 patients had persistent LAAT. Baseline characteristics, antithrombotic medications, risk scores, and LAAC indications were documented. Patients were followed to monitor significant clinical events like stroke, cardiovascular mortality, and all-cause mortality. RESULTS: The mean age was 71.9 and mostly female. Indications for LAAC were ischemic cerebrovascular events (CVE) despite anticoagulation (25%), bleeding complications (major/minor, 37.5% each), or both. Successful LAA closure was achieved in all cases, with minimal pericardial effusion in one. One-month follow-up showed no major events or device-related issues. Median follow-up of 16.5 months saw 21.9% non-cardiac deaths. The study underscores LAAC's efficacy for stroke prevention in patients with persistent LAAT. CONCLUSIONS: The LAAC in cases of LAAT, whether pursued initially or as a deferred approach, demonstrates feasibility and safety, exhibiting notable procedural success and minimal incidence of periprocedural complications.


Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Derrame Pericárdico , Accidente Cerebrovascular , Trombosis , Humanos , Femenino , Anciano , Masculino , Apéndice Atrial/cirugía , Cierre del Apéndice Auricular Izquierdo , Resultado del Tratamiento , Trombosis/etiología , Fibrilación Atrial/complicaciones , Fibrilación Atrial/cirugía , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/complicaciones , Hemorragia/inducido químicamente , Anticoagulantes/efectos adversos
3.
Cardiovasc Toxicol ; 24(1): 41-48, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38108958

RESUMEN

Cardiac magnetic resonance imaging is the gold standard to detect cardiac iron overload in patients with beta-thalassemia. The aim of this study was to evaluate cardiac iron overload using four-dimensional transthoracic echocardiography in thalassemia patients with and without cardiac involvement detected by T2* value and to compare the two techniques. This cross-sectional and observational study was conducted in 44 patients diagnosed with thalassemia major. Left ventricular systolic function was assessed using four-dimensional speckle tracking echocardiography-derived global longitudinal (GLS), circumferential, radial, and area strain indices. Left ventricular ejection fraction, volumes, and mass index were similar between the patients with T2* values less than 20 ms as compared to those with T2* values greater than 20 ms. However, patients with lower T2* values had significantly higher GLS values (- 17.0% vs. - 19.8%, p < 0.001) compared with those with higher T2* values. GLS demonstrated a sensitivity of 91.7% and a specificity of 71.9% at a cut-off value of - 18.5%; however, sensitivity was 75%, and the specificity was 84.4% at a cut-off value of - 17.5%. For - 18.5%, the positive predictive value was 55%, and the negative predictive value was 95.8%; for - 17.5%, these values were 64.2 and 90%, respectively. This novel echocardiographic method, tested for the first time in our study in comparison with cardiac MRI in an adult patient group, has been shown to predict cardiac iron overload in thalassemia patients in the subclinical period without LVEF decline. Four-dimensional GLS is a marker with high sensitivity and negative predictive value.


Asunto(s)
Sobrecarga de Hierro , Talasemia , Disfunción Ventricular Izquierda , Talasemia beta , Adulto , Humanos , Talasemia beta/complicaciones , Talasemia beta/diagnóstico por imagen , Volumen Sistólico , Estudios Transversales , Función Ventricular Izquierda , Sobrecarga de Hierro/diagnóstico por imagen , Sobrecarga de Hierro/etiología , Imagen por Resonancia Magnética/métodos , Ecocardiografía Tetradimensional , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología
6.
Anatol J Cardiol ; 27(3): 176-177, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36856596
7.
Acta Cardiol Sin ; 38(1): 13-20, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35068878

RESUMEN

The renin-angiotensin system (RAS) has both important systemic circulatory and local effects. The effects of local cardiac RAS on the cardiovascular system have been increasingly researched. In this study, we review the relationship between local bone marrow and local cardiac RAS and their impacts on atherosclerosis.

9.
Anatol J Cardiol ; 25(4): 274, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33830050
10.
Anatol J Cardiol ; 25(4): 282, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33830054

Asunto(s)
Corazón , Humanos
12.
Acta Cardiol Sin ; 37(1): 86-96, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33488031

RESUMEN

OBJECTIVES: Exposure to arsenic is associated with various cardiovascular diseases. The imbalance between antioxidant and oxidant homeostasis plays a crucial role in the cardiovascular effects of arsenic. The aim of this study was to investigate the effect of arsenic exposure on diastolic function by measuring thiol and disulphide in arsenic-exposed workers. METHODS AND RESULTS: A total of 107 male arsenic-exposed workers and 36 healthy subjects were enrolled. Mitral inflow velocity and parameters of diastolic function were measured. As oxidative stress indicators, total thiol, native thiol, disulphide, and their percent ratios were determined. The mean age was 39.1 ± 9.5 years in the arsenic-exposed group and 37.4 ± 9.6 years in the controls. The median blood arsenic level was 42 µg/dL in the arsenic-exposed group and 3.75 µg/dL in the controls. E-wave, E/A ratio, and e' wave were lower and left atrial diameter, A-wave, average E/e' ratio, and tricuspid regurgitation velocity were higher in the arsenic-exposed group. Native and total thiol concentrations were lower, and disulphide/native and disulphide/total thiol ratios were higher in the arsenic-exposed group. Fourteen (13.1%) workers had diastolic dysfunction, 26 (24.3%) had indeterminate, and 67 (62.6%) had normal diastolic function, compared to 1 (2.8%), 2 (5.6%), and 33 (97.7%) in the control group, respectively. In regression analysis, disulphide/native thiol ratio (p < 0.001) and blood arsenic level (p < 0.001) predicted increased average E/e' ratio in the arsenic-exposed group. CONCLUSIONS: This study showed strong associations among arsenic exposure, oxidative stress, and diastolic function, and revealed the influence of arsenic exposure on diastolic dysfunction through oxidative stress.

13.
Cardiovasc Toxicol ; 21(3): 216-223, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33068232

RESUMEN

Tyrosine kinase inhibitors (TKIs) are established treatment for haematological malignancies. However, cardiac adverse effects, including the reduction in left ventricular ejection fraction and symptomatic heart failure remain clinical problems. The purpose of this study was to evaluate the left ventricular systolic functions in patients with chronic myeloid leukaemia receiving TKIs. A cross-sectional and observational study was conducted of 37 patients with chronic myeloid leukaemia receiving dasatinib or nilotinib after imatinib failure. Left ventricular systolic functions were evaluated using four-dimensional speckle tracking echocardiography derived global longitudinal (GLS), circumferential (GCS), radial (GRS), and area (GAS) strain indices. Mean ejection fraction, stroke volume, cardiac output and left ventricular mass index were similar between control and patient groups and within normal limits. GLS (- 16.7% vs - 20.8%, p < 0.001), GCS (- 13.0% vs - 15.6%, p = 0.002), and GAS (- 26.2% vs - 31.0, p < 0.001) values were significantly higher in the patient population than those of the controls. Dasatinib and nilotinib groups did not show differences regarding strain indices. In multivariate regression analysis, only the usage of dasatinib or nilotinib was found to be an independent risk factor for diminished GAS (ß = 4.406, p = 0.016), GLS (ß = 3.797, p = 0.001), and GCS (ß = 2.404, p = 0.040). Although imatinib, nilotinib, and dasatinib seem to be clinically safe in terms of cardiac function, monitoring of systolic functions using strain imaging, and long-term observation of patients may provide early detection of the possible cardiac toxicity.


Asunto(s)
Antineoplásicos/efectos adversos , Ecocardiografía Tetradimensional , Leucemia Mielógena Crónica BCR-ABL Positiva/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Disfunción Ventricular Izquierda/diagnóstico por imagen , Función Ventricular Izquierda/efectos de los fármacos , Adulto , Anciano , Cardiotoxicidad , Estudios Transversales , Dasatinib/efectos adversos , Diagnóstico Precoz , Femenino , Humanos , Mesilato de Imatinib/efectos adversos , Leucemia Mielógena Crónica BCR-ABL Positiva/diagnóstico , Leucemia Mielógena Crónica BCR-ABL Positiva/enzimología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Proteínas Tirosina Quinasas/metabolismo , Pirimidinas/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Sístole , Factores de Tiempo , Resultado del Tratamiento , Disfunción Ventricular Izquierda/inducido químicamente , Disfunción Ventricular Izquierda/fisiopatología
14.
JACC Case Rep ; 2(13): 2101-2106, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34317116

RESUMEN

All-trans retinoic acid (ATRA) is the mainstay of treatment in patients with acute promyelocytic leukemia. Despite being effective, it can lead to cardiac complications either as a component of ATRA syndrome or an isolated form denominated as ATRA-induced isolated perimyocarditis. We present a case of this complication and review the literature. (Level of Difficulty: Intermediate.).

15.
Turk J Med Sci ; 49(1): 66-73, 2019 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-30761860

RESUMEN

Background/aim: Lead can cause morphological and functional changes in heart, and inflammation and endothelial dysfunction in vasculature. Endocan, as a novel indicator of endothelial dysfunction, has been used for cardiovascular diseases. This study investigated the relationship between lead exposure, endocan levels, and diastolic functions. Materials and methods: A total of 51 lead-exposed workers without a known cardiovascular disease or risk factors and 54 healthy controls were enrolled. All participants underwent transthoracic echocardiography. Blood lead and serum endocan levels were analyzed. Results: Baseline demographic and clinical characteristics were found to be similar between groups. Median blood lead (32 vs 1.5 µg/dL, P < 0.001) and serum endocan levels (67 vs 57.1 pg/mL, P = 0.02) were significantly higher in the lead-exposed group. Serum endocan level showed a positive correlation with blood lead levels (r = 0.404, P = 0.003) in lead-exposed workers. Serum endocan level was an independent risk factor for increased E/E' ratio (ß = 0.704, P = 0.002) and left atrial volume index (ß = 1.158, P = 0.011) and higher level of lead in blood was an independent risk factor for increased E wave (ß = 8.004, P = 0.022) in lead-exposed workers. Conclusion: Worsened diastolic functions may be seen in the course of lead exposure. Due to sharing a similar mechanism, a higher serum level of endocan may be a valuable laboratory clue for impaired diastolic function in this population.


Asunto(s)
Plomo/toxicidad , Proteínas de Neoplasias/sangre , Exposición Profesional/estadística & datos numéricos , Proteoglicanos/sangre , Adulto , Biomarcadores/sangre , Presión Sanguínea/efectos de los fármacos , Estudios Transversales , Humanos , Masculino , Factores de Riesgo
18.
Anatol J Cardiol ; 18(1): 10-14, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28554985

RESUMEN

OBJECTIVE: Lead exposure has been associated with various cardiovascular disorders. It may also cause increased inflammation and fibrosis in the arterial system resulting in an increase in arterial stiffness. In this study, the ambulatory arterial stiffness index (AASI), which is a technique that measures arterial stiffness, was evaluated in occupationally lead-exposed workers. METHODS: In this cross-sectional study, 68 lead-exposed workers without known cardiovascular risk factors and 68 healthy subjects were evaluated according to the 24-hour ambulatory blood pressure monitorization (ABPM) profiles and blood and 24-hour urine lead levels. A regression slope of diastolic over systolic blood pressure (BP) was computed in each participant. AASI was defined as 1 minus the regression slope. RESULTS: There were no significant differences in terms of baseline demographic, clinical, echocardiographic characteristics, and ABPM profiles between the groups. In lead-exposed workers, the mean age was 34.7±8.1 years, and the median blood and urine lead levels were 40.5 µg/dL and 34.9 µg/L, respectively. AASI was 0.42±0.10 in lead-exposed workers and 0.37±0.10 in control subjects (p=0.007). In correlation analysis, AASI was correlated with both blood (r=0.417, p<0.001) and urine lead (r=0.242, p=0.047) levels. In regression analysis, blood lead level was found to be associated with AASI (ß=0.086, p<0.001). CONCLUSION: AASI, which is an indicator of arterial stiffness, was found to be higher in lead-exposed workers than in healthy individuals. Increased AASI may be considered an early sign of arterial involvement in case of lead exposure.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Plomo/efectos adversos , Metalurgia , Exposición Profesional/efectos adversos , Rigidez Vascular , Adolescente , Adulto , Anciano , Monitoreo Ambulatorio de la Presión Arterial , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/fisiopatología , Estudios de Casos y Controles , Estudios Transversales , Ecocardiografía , Femenino , Humanos , Japón , Plomo/sangre , Plomo/orina , Masculino , Persona de Mediana Edad , Análisis de Regresión , Factores de Riesgo , Adulto Joven
19.
Artículo en Inglés | MEDLINE | ID: mdl-28247524

RESUMEN

BACKGROUND: Arsenic exposure is associated with various cardiovascular diseases. The aim of the present study was to assess cardiac autonomic function via heart rate response to exercise and recovery period of treadmill testing in arsenic-exposed workers. METHODS: Sixty-five (65) occupationally arsenic-exposed workers and 35 healthy controls were enrolled. Blood and urinary arsenic levels were analyzed and symptom limited maximal treadmill exercise test were performed. Chronotropic response to exercise including age-predicted maximal heart rate (APMHR), heart rate reserve (HRreserve ), age-predicted HRreserve (APHRreserve ) and adjusted HRreserve and 1st-, 2nd-and 3rd-min heart rate recovery (HRR) indices were calculated. RESULTS: Baseline clinical and echocardiographic parameters, exercise test duration, resting and maximal heart rate, peak exercise capacity, HRreserve , APMHR, APHRreserve , and adjusted HRreserve were found to be similar between groups. HRR1 (22.0 ± 4.3 vs. 24.3 ± 3.1 bpm, p = .003) and HRR2 (43.2 ± 6.2 vs. 46.7 ± 6.4 bpm, p = .012) were significantly lower in arsenic-exposed workers compared to controls. Blood and urinary arsenic levels negatively correlated with HRR1 (r = -.477, p < .001 and r = -.438, p < .001, respectively) and HRR2 (r = -.507, p < .001 and r = -.412, p < .001 respectively). CONCLUSIONS: Arsenic-exposed workers had lower HRR indices than normal subjects but chronotropic response were similar. Cardiac autonomic dysregulation may be one of the cardiovascular consequences of arsenic exposure.


Asunto(s)
Intoxicación por Arsénico/fisiopatología , Enfermedades Cardiovasculares/inducido químicamente , Electrocardiografía/métodos , Prueba de Esfuerzo/métodos , Frecuencia Cardíaca/fisiología , Adulto , Arsénico , Estudios Transversales , Electrocardiografía/estadística & datos numéricos , Ejercicio Físico , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Recuperación de la Función
20.
Turk Kardiyol Dern Ars ; 44(5): 371-9, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27439922

RESUMEN

OBJECTIVE: The aim of the present study was to assess cardiac autonomic function via indices of exercise heart rate recovery (HRR) in workers occupationally exposed to lead. METHODS: A total of 98 lead-exposed workers and 98 healthy controls were enrolled. All underwent exercise testing and transthoracic echocardiography. HRR indices were calculated by subtracting 1st- (HRR1), 2nd- (HRR2), and 3rd-minute (HRR3) heart rates from maximal heart rate (HR). Exercise test parameters- HRR in particular- were compared between groups, and correlation analysis of blood, 24-hour urine lead levels, and test parameters was performed. RESULTS: Baseline demographic and clinical characteristics were found to be similar between groups. Mean HRR1 (26.2±3.6 vs 29.0±4.1 bpm, p<0.001), HRR2 (42.6±3.9 vs 46.9±3.7 bpm, p<0.001), and HRR3 (56.6±4.5 vs 61.8±4.3 bpm, p<0.001) values were significantly lower in the lead-exposed group than in the healthy controls. HRR1 was found to be significantly correlated with blood (r:-0.415; p<0.001) and 24-hour urine lead levels (r:-0.446; p<0.001). HRR2 and HRR3 were significantly correlated with 24-hour urine lead level (r:-0.396; p<0.001 and r:-0.233; p=0.021, respectively). CONCLUSION: Lead-exposed workers had lower HRR indices than normal subjects. Blood and 24-hour urine lead levels were significantly associated with HRR indices. Cardiac autonomic functions may be affected by exposure to lead, and those occupationally exposed should be closely followed for adverse cardiovascular outcome.


Asunto(s)
Ejercicio Físico/fisiología , Frecuencia Cardíaca/fisiología , Plomo/sangre , Plomo/orina , Exposición Profesional/análisis , Adulto , Estudios Transversales , Humanos , Plomo/toxicidad , Masculino , Persona de Mediana Edad , Exposición Profesional/estadística & datos numéricos
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