Left ventricular mass and cardiothoracic index in patients with chronic renal disease on hemodialysis.

INTRODUCTION: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk in patients with chronic renal disease (CRD) on hemodialysis (HD). OBJECTIVE: To show the usefulness of chest radiography in the diagnosis of LVH in CRD patients on HD. METHODS: Cross-sectional study including 100 patients (58 men and 42 women), mean age 46.2 ± 14.0 years, with CRD of all causes, for at least six months on HD. Were obtained echocardiogram and chest x-rays of patients, always up to one hour after the end of HD sessions. RESULTS: LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) with eccentric pattern of LVH. Cardiomegaly - defined by cardiothoracic index (CTI) > 0.5 - was present in 61 patients (61%). The following were the sensitivity, specificity and accuracy, respectively, for the variable ICT: 66.2%, 70.5% and 68.0%. The Pearson correlation between ICT and index of left ventricular mass (LVMI) was 0.552 (p < 0.05) and positive likelihood ratio of 2.2. CONCLUSION: Chest radiography is a safe and useful as a diagnostic tool of LVH in CKD patients on HD.

Correlação entre o índice de massa ventricular esquerda e a função endotelial em pacientes hipertensos / Correlation between left ventricular mass index and endothelial function in hypertensive patients

Fundamentos: Tanto a hipertrofia ventricular esquerda (HVE) como a disfunção endotelial representam importantes fatores de risco cardiovascular. No entanto, a correlação entre HVE e disfunção endotelial tem sido pouco explorada e ainda é motivo de controvérsias. Objetivo: Investigar a correlação entre o índice de massa do ventrículo esquerdo (IMVE) e a dilatação mediada por fluxo de artéria braquial (DMF), adotada como estimativa da função endotelial, em indivíduos hipertensos. Materiais e Métodos: Trata-se de estudo transversal envolvendo 94 hipertensos sem doença cardiovascular manifesta, com média de idade de 56,99 ± 11,89 anos, sendo 68,1% do sexo feminino. Todos os participantes foram submetidos a exame clínico, pesquisa de fatores de risco cardiovascular, dosagens bioquímicas, ecodopplercardiografia para determinação do IMVE e pesquisa da DMF por ultra-sonografia de alta resolução. Utilizouse a regressão linear múltipla para pesquisa da associação entre IMVE e DMF. Resultados: A média do IMVE foi de 104,4 ± 26,2 g/m2 e a da DMF, de 5,2 ± 5,7%. Na análise de regressão linear simples, observou-se uma correlação inversa significativa entre o IMVE e a DMF (ß = -0,389, p = 0,007). Após análise de regressão multivariada, a associação persistiu independentemente da pressão arterial, tanto sistólica quanto diastólica, proteína C reativa ultrassensível (PCR-US) e de outros fatores de risco cardiovascular. Conclusão: Observou-se correlação inversa significativa entre IMVE e DMF em hipertensos sem doença cardiovascular manifesta, independentemente da pressão arterial e do status inflamatório.

Background: Both left ventricular hypertrophy (LVH) and endothelial dysfunction represent important cardiovascular risk factors. However, the correlation between LVH and endothelial dysfunction has been little explored and is still a matter of controversies. Objective: To investigate the correlation between left ventricular mass index (LVMI) and flow-mediated dilation (FMD) of brachial artery , used as an estimative measure of endothelial dysfunction, in hypertensive patients. Materials and Methods: This is a cross-sectional study involving 94 middle-aged (56,99 ± 11,89 years) hypertensive outpatients without overt cardiovascular disease, being 68,1% female. All the participants underwent clinical examination, biochemical analyses, search for cardiovascular risk factors, transthoracic echocardiography for the determination of LVMI and assessment of FMD using a high-resolution Doppler B-mode ultrasound equipment. A multiple linear regression model was used to analyse the association between LVMI and DMF. Results: Mean LVMI was 104,4 ± 26,2 g/m2 and mean DMF, 5,2 ± 5,7%. Using simple linear regression, it was observed a significant inverse correlation between LVMI and FMD (ß = -0,389, p =0,007). This association remained significant even after adjustment for systolic and diastolic blood pressure, high sensitivity C-reactive protein (hs-CRP) and many other cardiovascular risk factors. Conclusions: In these hypertensive patients without overt cardiovascular disease, it was observed a significant inverse correlation between LVMI and FMD, which was independent of blood pressure and inflammatory status.

Percutaneous mechanical assistance for the failing heart.

One of the most challenging situations in contemporary medicine is, doubtlessly, the approach and treatment of patients presenting with severe left ventricle failure. Since its first clinical application in patients with cardiogenic shock in 1968, the intraaortic balloon pump (IABP) has been widely accepted by heart failure physicians. Although IABP therapy has been shown to be effective for the support and stabilization of hemodynamically compromised patients, it has failed to promote any improvements in patient outcomes. For this reason, much attention has been invested in the development of external devices that can collaborate with the treatment of this condition. In this context, the percutaneous left ventricle assist device (pLVAD), like TandemHeart (Cardiac Assist, Inc.; Pittsburgh, PA, USA), and, more recently, the Impella 2.5 (Abiomed Europe, Aachen, Germany) has emerged. The purpose of this review is to describe the history of pLVAD, from its beginning, to the other devices currently available, including those created for right ventricle and biventricular support.

Feasibility, safety and accuracy of dobutamine/atropine stress echocardiography for the detection of coronary artery disease in renal transplant candidates.

OBJECTIVE: To evaluate the feasibility, safety and accuracy of dobutamine/atropine stress echocardiography (DASE) for the detection of coronary artery disease (CAD) in renal transplant candidates. METHODS: Patients candidates to renal transplant were submitted consecutively to DASE and coronary angiography. The adopted angiographic criteria for CAD were an obstructive lesion of > or = 50% and > or = 70%. RESULTS: 148 patients underwent the DASE and the coronary angiography. Mean age was 52 +/- 9 years, 69% of the patients were males; 27% had diabetic nephropathy and 73% had LVH; 63% were asymptomatic; 36% and 22% presented coronary obstructions > or = 50% and 70%, respectively. The DASE performance was 91% and major complication rate was 2.7%. The sensibility, specificity and accuracy for the diagnosis of coronary obstruction > 50% were 53% (CI:45-61), 87% (CI:81-93), and 75% (CI:63-83) respectively. For coronary obstruction > or = 70% these values were, respectively, 71% (CI:64-92), 85% (CI:79-91) and 81% (CI:75-87). The sensibility to detect univessel and multivessel disease was 41% (CI:19-63) and 78% (CI:64-92), respectively. CONCLUSION: The DASE was practical and safe; however, it presented a poor result for the detection of CAD regarding obstructions > or = 50%. It can be a useful screening for the detection of CAD in candidates with obstructions > or = 70% and multivessel disease.