Alteração precoce da matriz extracelular e parâmetros diastólicos na síndrome metabólica / Early change of extracellular matrix and diastolic parameters in metabolic syndrome

FUNDAMENTOS: Síndrome Metabólica (SM) está associada com maior risco cardiovascular, porém não está claro se as alterações miocárdicas presentes nessa condição, como a disfunção diastólica, são consequência de mecanismos sistêmicos ou de efeitos diretos no miocárdio. OBJETIVOS: Comparar função diastólica, biomarcadores de atividade da Matriz Extracelular (MEC), inflamação e estresse hemodinâmico, em pacientes com SM e controles saudáveis. MÉTODOS: Pacientes com SM (n = 76) e controles saudáveis (n = 30) foram avaliados clinicamente e submetidos a exame ecocardiográfico e mensuração dos níveis plasmáticos de metaloproteinase-9 (MMP9), inibidor tecidual da metaloproteinase-1 (TIMP1), proteína C reativa ultrassensível (PCR-us), resistência insulínica (HOMA-RI) e NT-proBNP. RESULTADOS: O grupo SM apresentou menor onda E' (10,1 ± 3,0 cm/s vs. 11,9 ± 2,6 cm/s, p = 0,005), maiores valores para onda A (63,4 ± 14,1 vs. 53,1 ± 8,9 cm/s, p < 0,001), razão E/E'(8,0 ± 2,2 vs. 6,3 ± 1,2; p < 0,001), MMP9 (502,9 ± 237,1 vs. 330,4 ± 162,7 ng/mL, p < 0,001), PCR-us (p = 0,001) e HOMA-RI (p < 0,001), sem diferença nos níveis de TIMP1 e NT-proBNP. Na análise multivariada, apenas MMP9 foi independentemente associada a SM. CONCLUSÃO: Pacientes com SM apresentaram diferenças em medidas ecocardiográficas de função diastólica, na atividade da MEC, PCR-us e HOMA-RI em relação aos controles. Porém, somente MMP9 foi independentemente associada com SM. Esses achados sugerem que os efeitos precoces da SM sobre a atividade da MEC podem não ser detectados nas medidas ecocardiográficas de função diastólica usuais.

BACKGROUND: Metabolic syndrome (MS) is associated with increased cardiovascular risk. It is not clear whether myocardial changes showed in this syndrome, such as diastolic dysfunction, are due to the systemic effects of the syndrome, or to specific myocardial effects. OBJECTIVES: Compare diastolic function, biomarkers representing extracellular matrix activity (ECM), inflammation and cardiac hemodynamic stress in patients with the MS and healthy controls. METHODS: MS patients (n=76) and healthy controls (n=30) were submitted to a clinical assessment, echocardiographic study, and measurement of plasma levels of metalloproteinase-9 (MMP9), tissue inhibitor of metalloproteinase-1 (TIMP1), ultrasensitive-reactive-C-Protein (us-CRP), insulin resistance (HOMA-IR) and natriuretic peptide (NT-proBNP). RESULTS: MS group showed lower E' wave (10.1 ± 3.0 cm/s vs 11.9 ± 2.6 cm/s, p = 0.005), increased A wave (63.4 ± 14.1 cm/s vs. 53.1 ± 8.9 cm/s; p < 0.001), E/E' ratio (8.0 ± 2.2 vs. 6.3 ± 1.2; p < 0.001), MMP9 (502.9 ± 237.1 ng/mL vs. 330.4±162.7 ng/mL; p < 0.001), us-CRP (p = 0.001) and HOMA-IR (p < 0.001), but no difference for TIMP1 or NT-proBNP levels. In a multivariable analysis, only MMP9 was independently associated with MS. CONCLUSION: MS patients showed differences for echocardiographic measures of diastolic function, ECM activity, us-CRP and HOMA-IR when compared to controls. However, only MMP9 was independently associated with the MS. These findings suggest that there are early effects on ECM activity, which cannot be tracked by routine echocardiographic measures of diastolic function.

Early change of extracellular matrix and diastolic parameters in metabolic syndrome.

BACKGROUND: Metabolic syndrome (MS) is associated with increased cardiovascular risk. It is not clear whether myocardial changes showed in this syndrome, such as diastolic dysfunction, are due to the systemic effects of the syndrome, or to specific myocardial effects. OBJECTIVES: Compare diastolic function, biomarkers representing extracellular matrix activity (ECM), inflammation and cardiac hemodynamic stress in patients with the MS and healthy controls. METHODS: MS patients (n = 76) and healthy controls (n=30) were submitted to a clinical assessment, echocardiographic study, and measurement of plasma levels of metalloproteinase-9 (MMP9), tissue inhibitor of metalloproteinase-1 (TIMP1), ultrasensitive-reactive-C-Protein (us-CRP), insulin resistance (HOMA-IR) and natriuretic peptide (NT-proBNP). RESULTS: MS group showed lower E' wave (10.1 ± 3.0 cm/s vs 11.9 ± 2.6 cm/s, p = 0.005), increased A wave (63.4 ± 14.1 cm/s vs. 53.1 ± 8.9 cm/s; p < 0.001), E/E' ratio (8.0 ± 2.2 vs. 6.3 ± 1.2; p < 0.001), MMP9 (502.9 ± 237.1 ng/mL vs. 330.4 ± 162.7 ng/mL; p < 0.001), us-CRP (p = 0.001) and HOMA-IR (p < 0.001), but no difference for TIMP1 or NT-proBNP levels. In a multivariable analysis, only MMP9 was independently associated with MS. CONCLUSION: MS patients showed differences for echocardiographic measures of diastolic function, ECM activity, us-CRP and HOMA-IR when compared to controls. However, only MMP9 was independently associated with the MS. These findings suggest that there are early effects on ECM activity, which cannot be tracked by routine echocardiographic measures of diastolic function.

Intensive practical lifestyle intervention improves endothelial function in metabolic syndrome independent of weight loss: a randomized controlled trial.

The objective was to evaluate the metabolic and vascular effects of lifestyle interventions involving a healthy diet and either a moderate- or a high-intensity exercise regimen in nondiabetic subjects with metabolic syndrome. The effects of these interventions on flow-mediated vasodilation (FMD) and risk profiles were compared with a standard low-fat diet and engaging in daily walking (standard of care). Seventy-five healthy adults with metabolic syndrome (30-55 years old) were randomized to a 10,000-steps-a-day exercise program, a 3-times-a-week fitness (>75% peak VO(2)) program, or a 1-hour-walking-a-day program for 12 weeks. The first 2 interventions were combined with an accessible healthy, no-sugar diet; and the third was combined with a tailored low-fat diet. The outcomes, including FMD and risk factors, were examined at 12 weeks and at 1-year reassessment. Significant increase in FMD (mean difference = 1.51%, 95% confidence interval = 1.05%-3.017%, P = .0007) and decrease in arterial pressure (mean difference = 19.3 ± 2.3/-12.6 ± 1.8 mm Hg, P = .0001) were observed in all groups. However, the FMD changed most favorably in the high-intensity, low-sugar group (mean difference = 1.56%, 95% confidence interval = 0.1%-3.02%, P = .036). Significant improvements in body mass index, waist, insulin-like growth factor-1, homeostasis model assessment of insulin resistance, insulin, glucose, urinary albumin excretion, and lipid profiles occurred in all groups. Metabolic syndrome was resolved in 64%. One year later, weight loss (-9.1 ± 2.3 kg, P = .0001) and arterial pressure decrease (-18.5 ± 2.3/-12.3 ± 2.1 mm Hg, P = .0001) were maintained. Practical, health-centered diet combined with high-intensity exercise is associated with enhanced vascular protection. These data suggest that more intense exercise combined with a low-sugar diet modulates endothelium-dependent vasodilation.

Análise do perfil de solicitações para transfusão de hemocomponentes no Hospital de Clínicas de Porto Alegre no ano de 2005 / Blood-based products request profile analysis in Hospital de Clínicas de Porto Alegre in 2005

O uso de hemocomponentes em hospitais de alta complexidade é elevado, sendo necessário controle e racionalização de sua utilização, dada sua escassez e alto custo. Para tal, muitos hospitais desenvolveram protocolos para uso de hemocomponentes. O objetivo deste trabalho foi descrever as características epidemiológicas das solicitações de hemoderivados e sua adequação em conformidade ao protocolo vigente no Hospital de Clínicas de Porto Alegre. Por meio de estudo retrospectivo transversal, foram avaliadas a freqüência de transfusões e suas indicações no ano de 2005 em três áreas (Internação Clínica, Cirúrgica e Centro de Terapia Intensiva). Analisaram-se as justificativas de cada solicitação em conformidade com o protocolo vigente. Foram identificadas 12.175 solicitações de hemoderivados no ano de 2005. O hemocomponente mais solicitado foi o concentrado de hemácias (6.578 solicitações), seguido do concentrado de plaquetas (4.133), plasma fresco (1.296) e do crioprecipitado (168). As perdas representaram 2,96 por cento dos eventos. As três áreas foram responsáveis por 59,77 por cento das solicitações de hemocomponentes. A internação clínica apresentou 85,57 por cento de solicitações em conformidade com o protocolo, seguida da CTI com 81,4 por cento e da cirurgia com 71,42 por cento. A maioria das solicitações de hemocomponentes esteve de acordo com o protocolo da instituição no ano de 2005. A internação clínica teve o perfil mais adequado de solicitações no ano de 2005, seguida do CTI e, por fim, da internação cirúrgica.

The use of blood-based products in a tertiary hospital is elevated so control and rational use is necessary. Many hospitals have protocols for the use of blood components. The aim of this work was to describe the epidemiological characteristics of blood-based product requests and their adjustment to the protocol of Hospital de Clínicas in Porto Alegre. Using a cross-sectional retrospective study, we analyzed the frequencies and indications of transfusion requests in 2005 in three different sectors (Clinical, Surgical and Intensive Care Unit). Each transfusion request was analyzed according to the current protocol. A total of 12,175 transfusion requests were analyzed. Requests for blood (6,578) were the commonest, followed by platelets (4,133), fresh frozen plasma (1296) and cryoprecipitate (168). Lost data represented 2.96 percent of the total events. The three sectors were responsible for 59.77 percent of blood-based product requests. The Clinical Sector requested 85.57 percent of its transfusions satisfactorily, followed by the ICU (81.4 percent) and finally the Surgical Sector (71.42 percent). The majority of transfusion requests in HCPA in 2005 were adequate according to the protocol. The Clinical Sector had the best request profile, followed by the ICU and the Surgical Sectort.

Disfunção endotelial no diabetes melito / Endotelial dysfunction and diabetes mellitus

O diabetes melito está associado a elevado risco cardiovascular, sendo sugerido que a expressão da doença aterosclerótica apresenta características próprias nessa situação, com evolução mais grave e acelerada da doença aterosclerótica. A disfunção endotelial é considerada condição "sine qua non" para o desenvolvimento da aterogênese, uma vez que ocorra dano ao endotélio vascular por um ou mais fatores de risco cardiovascular. Nesse sentido, o diabetes melito tipo 1 e tipo 2 e a síndrome de resistência à insulina têm sido associados à disfunção endotelial. Nesta revisão são abordados os modelos experimentais e clínicos que associam o diabetes e a hiperglicemia à disfunção endotelial, bem como o papel da insulina nesse processo. São revisados também aspectos distintos presentes na disfunção endotelial no diabetes tipo 1 e tipo 2, a relação entre insulina e endotélio, e os diferentes marcadores biológicos associados à disfunção endotelial.