RESUMO
BACKGROUND: In patients with symptomatic mitral PVL, successful transcatheter reduction of the PVL to less than mild is associated with significant improvement in short- and midterm survival. OBJECTIVES: In this study, we present our single-centre, same operators' experience on percutaneous paravalvular leak closure with techniques and outcomes. METHODS: In this retrospective observational designed study, we retrieved hospital records of patients with a surgical history of mechanical or biological prosthetic valve replacement and who subsequently underwent transcatheter mitral paravalvular leak closure (TMPLC). All procedures were performed by the same operators. RESULTS: A total of 45 patients with 58 PVDs underwent TMPLC using 60 devices. All patients had moderate or severe mitral paravalvular regurgitation associated with symptomatic HF (15.6%), clinically significant haemolytic anaemia (57.8%) or both (26.7%). The technical success rate was 91.4%, with 53 defects successfully occluded. The clinical success rate was 75.6%. Among the clinical success parameters, the preprocedural median ejection fraction increased from 45% (35-55) to 50% (40-55) (p = .04). Mitral gradients decreased from max/mean 18/8 mmHg to max/mean 16/7 mmHg; p = .02). Haemoglobin levels increased from 9.9 (8.5-11.1) to 11.1 (3-13); p = .003. LDH levels decreased from 875 (556-1125) to 435 (314-579); p: <.001. All-cause 30-day and in-hospital mortality rates were the same at 8.9%. CONCLUSION: This single-centre study with a limited number of patients confirmed that TMPLC is a safe and effective procedure to improve symptoms and severity of PVL.
Assuntos
Defeitos dos Septos Cardíacos/terapia , Complicações Pós-Operatórias/etiologia , Embolia Pulmonar/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Adulto , Angiografia Coronária , Remoção de Dispositivo/métodos , Diagnóstico Diferencial , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagemRESUMO
INTRODUCTION: Cilostazol is a PDE3 inhibitor and used to treat peripheral arterial disease. There are few reports on the influence of cilostazol on heart. AIMS: The aim of this study was to assess this effect on right ventricular function and pulmonary artery pressure. METHODS: Forty patients with normal left and right ventricular ejection fraction and mild or moderate pulmonary artery hypertension were enrolled in the study. Right ventricular function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tissue Doppler imaging (TDI), and two-dimensional speckle-tracking echocardiography (2D-STE) before and after oral administration of cilostazol. Also pulmonary artery pressure assessed before and after administration of cilostazol. RESULTS: After cilostazol administration, there were significant increases in the TAPSE (1.9 ± 0.3 cm vs. 2.2 ± 0.3 cm, P < 0.001). Peak longitudinal strain (-18.7 ± 4.5% vs. -21.3 ± 3.7%, P = 0.001), isovolumetric acceleration (IVA) (176.6 ± 62.7 cm/sec(2) vs. 200.6 ± 61.9 cm/sec(2) , P = 0.025), right ventricular FAC increased significantly (37.6 ± 8.0% vs. 41.5 ± 8.9%, P < 0.001). Pulmonary artery pressure decreased significantly (39.9 ± 7.9 vs. 36.6 ± 5.5 mmHg, P = 0.001) after cilostazol administration. CONCLUSION: Our study demonstrated that cilostazol improved right ventricular systolic function and reduced pulmonary artery pressure.
Assuntos
Hipertensão Pulmonar/tratamento farmacológico , Inibidores da Fosfodiesterase 3/farmacologia , Tetrazóis/farmacologia , Função Ventricular Direita/efeitos dos fármacos , Idoso , Cilostazol , Hipertensão Pulmonar Primária Familiar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/fisiologia , Tetrazóis/uso terapêuticoAssuntos
Miocárdio Ventricular não Compactado Isolado/complicações , Miopatias Congênitas Estruturais/complicações , Oftalmoplegia/complicações , Adolescente , Biópsia , Ecocardiografia , Eletrocardiografia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Miocárdio Ventricular não Compactado Isolado/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético/patologia , Miopatias Congênitas Estruturais/diagnóstico , Oftalmoplegia/diagnóstico , Valor Preditivo dos Testes , Canal de Liberação de Cálcio do Receptor de Rianodina/deficiênciaRESUMO
OBJECTIVES: Plasma brain natriuretic peptide (BNP) level increases with symptoms and severity of mitral regurgitation (MR). We aimed to determine the relationship between plasma BNP levels and echocardiographic parameters in patients with acute and chronic MR. STUDY DESIGN: The study included 55 patients (31 males, 24 females) with isolated moderate-to-severe MR. Of these, 31 patients had acute MR, and 24 patients had chronic MR. All the patients were assessed by transthoracic, transesophageal and Doppler echocardiography and plasma BNP levels were determined. RESULTS: Clinical characteristics and functional capacity were similar in the two groups. Patients with acute MR had significantly higher left ventricular (LV) ejection fraction (EF) (p=0.001), and significantly lower LV end-systolic diameter (p=0.016), end-systolic volume (p=0.027), end-diastolic diameter (p=0.011), left atrial volume (LAV) (p=0.003), and plasma BNP levels (p=0.036). Effective regurgitation orifice area was also significantly higher in patients with acute MR (p=0.038). In multiple linear regression analysis, the natural logarithm of BNP was significantly correlated with E/Ea ratio (ß=0.50, p=0.002) and LAV (ß=0.38, p=0.015) in patients with acute MR, and with systolic pulmonary artery pressure (ß=0.60, p=0.002) and EF (ß=-0.36, p=0.039) in patients with chronic MR. CONCLUSION: Although the echocardiographic degree of MR was more pronounced in patients with acute MR, serum BNP levels tended to be lower in this group. Correlation of serum BNP with E/Ea and LAV in this group may be an important finding.
Assuntos
Insuficiência da Valva Mitral/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Doença Aguda , Biomarcadores/sangue , Doença Crônica , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/sangue , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: We aimed to investigate the effects of preexisting left ventricular hypertrophy (LVH) on the circulating concentration of soluble Fas ligand (sFasL) and also the relationship of sFasL to ventricular remodeling in patients with acute myocardial infarction (MI). METHODS: Forty consecutive patients who presented with their first episode of acute MI were studied. These patients were then divided into two groups with regard to the presence of LVH. All the patients underwent complete transthoracic echocardiography with determination of end diastolic volume index and LV mass index within 24 h and at 6 months. sFasL levels were determined in serum on admission and at 24 h of admission. RESULTS: The serum sFasL concentration did not change significantly after acute MI at 24 h after admission in the study population (P=0.574), however, the serum level of sFasL concentration was significantly increased in the patients with preexisting LVH (P<0.001). There was a strong positive relationship between LV mass index and the serum level of sFasL concentration at 24 h after admission (r=0.611; P<0.001). Moreover, there was a stronger correlation between the change in end-diastolic volume index at 6 months and the serum level of sFasL in the LVH group compared with the group without LVH (r=0.499 and 0.181, respectively). CONCLUSION: In conclusion, we have shown that serum sFasL concentration at 24 h after admission was significantly higher in patients with LVH, and also, there is a close relationship between the serum level of sFasL and LV enlargement.
Assuntos
Proteína Ligante Fas/sangue , Hipertrofia Ventricular Esquerda/sangue , Infarto do Miocárdio/fisiopatologia , Remodelação Ventricular/fisiologia , Adulto , Idoso , Ecocardiografia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
The molecular basis and pathophysiology of pulmonary hypertension (PH) are rapidly evolving areas. Recently discovered angiopoietins (Ang) constitute a family of growth factors, and whether they play a causal or protective role in pulmonary hypertension has not been fully elucidated. Since left heart disease probably represents the most frequent cause of PH, we sought to determine whether there was a relationship between serum Ang-1 levels and pulmonary hypertension caused by mitral stenosis (MS). The study population was composed of 49 patients with isolated MS. These patients were then divided into group 1 [31 patients with severe MS: mitral valve area (MVA) ≤1.1 cm(2)] and group 2 (18 patients with mild-moderate MS: MVA 1.2-2.0 cm(2)). Twenty-one healthy volunteers comprised the control group (group 3). All of the subjects underwent complete transthoracic echocardiography with determination of systolic pulmonary artery pressure (PAPs). Ang-1 levels were determined in serum. Serum levels of Ang-1 were significantly higher in the control group compared to patients with severe (group 1) and mild-moderate (group 2) MS (p < 0.001). Ang-1 levels were found to have moderate inverse correlation with PAPs and left atrial (LA) diameter (r: -0.620, p < 0.001 and r: -0.489, p < 0.001, respectively). The AUC for the ROC curve for predicting PAPs <50 mmHg by serum Ang-1 level was 0.824 (95% CI 0.722-0.926, p < 0.001). A serum level of Ang-1 above 34,656 pg/ml has 74% sensitivity and 80% specificity for predicting that PH is not severe (PAPs <50 mmHg). In conclusion, the findings of this study are distinctive in the sense that they clearly demonstrate a negative correlation between serum Ang-1 levels and the degree of PH.
Assuntos
Angiopoietina-1/análise , Hipertensão Pulmonar/etiologia , Estenose da Valva Mitral/complicações , Adulto , Análise de Variância , Biomarcadores/sangue , Pressão Sanguínea , Regulação para Baixo , Ecocardiografia Doppler , Feminino , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/sangue , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Artéria Pulmonar/fisiopatologia , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença , TurquiaRESUMO
BACKGROUND: Increased serum uric acid (UA) has been shown to directly promote oxidative stress. Recent studies point toward a role for oxidative stress in the pathogenesis of ascending aortic aneurysms (AscAAs). This study was designed to examine the relationship between serum UA concentrations, total antioxidant reductive capacity, and AscAAs. METHODS: The serum UA concentrations, total antioxidant reductive capacity were compared in 60 patients with ascending aortic dilatation (ectasia group (3.8-4.3 cm), 34 patients; aneurysmal group (≥4.4 cm), 26 patients) vs. 30 control subjects. The patients were evaluated by a complete transthoracic echocardiographic examination including measurement of the aortic dimensions. RESULTS: The serum UA concentration and total antioxidant reductive capacity were significantly higher in patients with AscAAs. In multiple linear regression analysis, hypertension and serum UA concentration were significantly associated with aortic dilatation (ß = 0.3, P = 0.03; ß = 0.15, P < 0.001, respectively). CONCLUSIONS: In conclusion, we found that serum UA concentration and total antioxidant capacity (TAC) were significantly associated with aortic dilatation. The higher serum UA concentration may be responsible for the elevated serum antioxidant capacity that was observed among individuals with AscAA. Large-scale epidemiological studies conducted over several years are required to correlate the cross-sectional findings from this study with clinical outcome.
Assuntos
Aorta/patologia , Aneurisma Aórtico/sangue , Estresse Oxidativo , Ácido Úrico/sangue , Adulto , Idoso , Aorta/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Biomarcadores/sangue , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Dilatação Patológica , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Turquia , Ultrassonografia , Regulação para CimaRESUMO
BACKGROUND: Previous studies have demonstrated an increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However, biventricular heart function has yet to be investigated in these patients. Left ventricular (LV) myocardial performance index (LVMPI), which is an index of global ventricular function, incorporates ejection, isovolumic relaxation, and contraction times. In this study, pulmonary function and biventricular heart function were investigated in nonsmoking female patients with BFE. METHODS: Our study population consisted of 46 female patients with BFE (group 1) and 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular myocardial performance index (RVMPI) and LVMPI were obtained by tissue Doppler imaging echocardiography (TDI). RESULTS: BFE caused obstructive and restrictive spirometric impairments. RVMPI was higher in group 1 (0.55 ± 0.07) than group 2 (0.46 ± 0.06) (P = 0.042) and LVMPI was higher in group 1 (0.54 ± 0.08) than group 2 (0.47 ± 0.05) (P = 0.032). Also, pulmonary artery systolic pressure was higher in group 1 than group 2 (P = 0.02). CONCLUSIONS: BFE causes both obstructive and/or restrictive lung disease and systolic and diastolic biventricular dysfunction. Nonetheless, long-term studies are needed to understand on BFE-related ventricular dysfunctions and to document subsequent cardiovascular events.
Assuntos
Poluentes Atmosféricos/toxicidade , Biocombustíveis/toxicidade , Pneumopatias/complicações , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Direita/complicações , Idoso , Ecocardiografia Doppler , Exposição Ambiental , Feminino , Humanos , Pneumopatias/induzido quimicamente , Pneumopatias/diagnóstico por imagem , Fatores de Tempo , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagemRESUMO
AIMS: To define which echocardiographic parameters are related to the degree of functional mitral regurgitation (FMR) and to establish their relationship with clinical status, plasma B-type natriuretic peptide (BNP) levels, and prognosis in patients with non-ischaemic dilated cardiomyopathy (NICMP). METHODS AND RESULTS: Ninety patients (mean age: 50 ± 14, 31% females) with NICMP and FMR were prospectively analysed by echocardiography. Global and local left ventricular remodelling parameters such as ejection fraction and sphericity index, inter-papillary muscle distance, coaptation to septal distance, and mitral annular area, as well as mitral valve deformation indices such as tenting area (TA) and tenting distance, were measured as indicators of FMR. Patients were defined as having severe FMR [effective regurgitant orifice area (EROA) ≥ 0.2 cm(2), n = 41] or non-severe FMR (EROA < 0.2 cm(2), n = 49) and followed for 15 ± 3 months. Multivariate regression analysis revealed that TA had the greatest ability to predict severe FMR at a cut-off level of 3.4 cm(2) with 82% sensitivity and 77% specificity. Patients with higher TA values (>3.4 cm(2)) had statistically higher BNP levels, worse functional status, more hospitalizations, and higher death rates. The plasma BNP level (P: 0.012) and TA (P: 0.056) were predictors of all-cause mortality. New York Heart Association class (P < 0.001) and TA (P: 0.005) were predictors of combined death or hospitalization on multivariate Cox's regression analysis. CONCLUSION: Tenting area accurately reflects the degree of FMR at a cut-off value of 3.4 cm(2) and has a strong correlation with functional status, plasma BNP, mortality, and hospitalization rates. Tenting area is also an independent predictor of mortality and hospitalizations in patients with NICMP and FMR.
Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Peptídeo Natriurético Encefálico/sangue , Cardiomiopatia Dilatada/sangue , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/mortalidade , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/mortalidade , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , UltrassonografiaRESUMO
BACKGROUND: The aim of this study was to evaluate the prognostic value of different fractional flow reserve (FFR) cutoff values and corrected thrombolysis in myocardial infarction frame (TIMI) count (CTFC) measurements in a series of consecutive patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction, and/or positive noninvasive functional test findings. METHODS: We included 162 consecutive coronary patients in whom revascularization of a moderate coronary lesion was deferred based on a FFR value ≥0.75. Patients were divided according to the results of the intracoronary pressure and flow measurements into four groups: group A: 0.75 ≤ FFR ≤ 0.85 and CTFC > 28 (n=22), group B: 0.75 ≤ FFR ≤ 0.85 and CTFC ≤ 28 (n = 55), group C: 0.85 < FFR and CTFC > 28 (n = 19), and group D: 0.85 < FFR and CTFC ≤ 28 (n = 66). Adverse cardiac events and the presence of angina were evaluated at follow-up. RESULTS: At a mean follow-up of 18 ± 10 months, cardiac event rate in patients with 0.75 ≤ FFR ≤ 0.85 and FFR > 0.85 were 22% and 9%, respectively (P = 0.026) and also, a trend was observed toward a higher cardiac event rate in case of an abnormal CTFC (CTFC > 28) compared to a normal CTFC (24% vs 12%, P = 0.066). Furthermore, a significantly higher cardiac event rate was observed when group A was compared to group D (31.8% vs 7.6%, respectively, P = 0.004). CONCLUSION: Patients with potential microvascular dysfunction and borderline FFR values should be interpreted with caution, and management strategies should be guided not only by pressure measurement, but also by possibly supplementary clinical risk stratification and noninvasive tests.
Assuntos
Síndrome Coronariana Aguda/diagnóstico , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Síndrome Coronariana Aguda/tratamento farmacológico , Síndrome Coronariana Aguda/patologia , Angina Pectoris/diagnóstico , Angina Pectoris/tratamento farmacológico , Angina Pectoris/patologia , Velocidade do Fluxo Sanguíneo , Intervalos de Confiança , Reestenose Coronária/diagnóstico , Feminino , Hemodinâmica , Humanos , Modelos Logísticos , Masculino , Microvasos , Pessoa de Meia-Idade , Análise Multivariada , Revascularização Miocárdica , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The aim of this study was to investigate the electrocardiographic and echocardiographic predictors of ventricular tachycardia (VT) in patients with classical mitral valve prolapse (MVP). METHODS: Thirty patients (nine men and 21 women; mean age, 41.5 ± 15 years) in sinus rhythm with mitral valve prolapse who had VT in 24-hour Holter analysis and 30 patients with MVP without VT (eight men and 22 women; mean age, 43 ± 16 years) were included in this study. Transthoracic echocardiography, QT analyses from 12-lead electrocardiography, and 24-hour Holter electrocardiogram recordings were performed. RESULTS: Mitral posterior leaflet thickness (0.48 ± 0.03 cm vs 0.43 ± 0,08 cm, P = 0.025), mitral anterior leaflet length (3.2 ± 0.24 cm vs 2.9 ± 0.36, P < 0.001), mitral posterior leaflet length (2.2 ± 0.3 cm vs 1.9 ± 0.35 cm, P = 0.01), left atrium anteroposterior diameter (4.2 ± 0.8 cm vs 3.5 ± 0.5 cm, P = 0.001), and mitral annulus circumference (15.7 ± 1.3 cm vs 14.6 ± 1.6 cm, P = 0.004) were increased significantly in MVP cases with VT. No significant difference was found between the cases with and without VT in terms of frequency- and time-domain analysis. QT dispersion (72 ± 18 ms vs 55 ± 15 ms, P = 0.0002) and corrected QT dispersion (QTcD) (76 ± 18 ms vs 55 ± 15 ms, P = 0.0002) were significantly increased in cases with VT compared with those without VT. Based on logistic regression analysis for MVP cases, in the case of VT, an enhancement in QTcD (P = 0.01) and the mitral anterior leaflet length (P = 0.003) were the independent predictors of VT. CONCLUSION: Mitral anterior leaflet length and enhanced QTcD are closely related with VT in patients with classical MVP.
Assuntos
Prolapso da Valva Mitral/fisiopatologia , Valva Mitral/anatomia & histologia , Valva Mitral/fisiopatologia , Taquicardia Ventricular/fisiopatologia , Adulto , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia Ambulatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Prolapso da Valva Mitral/diagnóstico por imagem , Taquicardia Ventricular/diagnóstico por imagem , UltrassonografiaRESUMO
UNLABELLED: Previous studies have demonstrated a consistent increased risk for cardiovascular events and pulmonary disease in patients with biomass fuel exposure (BFE). However right ventricular (RV) function have not been investigated yet in these patients. In this study, pulmonary function, right ventricular function and their relations with Brain Natriuretic Peptide (BNP) were investigated in non-smoking female patients with BFE. METHODS: Our study population consisted of 39 female patients with BFE (group 1) and, 31 control subjects (group 2). Pulmonary function tests and transthoracic echocardiographic examination were performed. Right ventricular volumes, diameters and tissue velocities were obtained by tissue Doppler echocardiography. BNP levels were measured and correlated to right ventricular measurements and pulmonary artery pressure. RESULTS: In BFE group, obstructive and restrictive spirometric findings were found. RV diameters, volumes and pulmonary artery pressure were higher in group 1 than group 2. BNP levels were well correlated with right ventricular end diastolic diameter and pulmonary artery pressure. A suspicion is also arised that toxic chemicals in biomass fuel may play a role in RV dysfunction. CONCLUSION: Biomass fuel exposure not only cause obstructive and/or restrictive lung disease but also leads to systolic and diastolic right ventricular dysfunction. BNP levels may be used to monitor pulmonary artery pressure and right ventricular enlargement in these patients.
Assuntos
Poluição do Ar em Ambientes Fechados/efeitos adversos , Peptídeo Natriurético Encefálico/sangue , Fumaça/efeitos adversos , Disfunção Ventricular Direita/fisiopatologia , Idoso , Biomarcadores/sangue , Biomassa , Culinária , Estudos Transversais , Ecocardiografia Doppler , Feminino , Calefação , Humanos , Esterco , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Testes de Função Respiratória , Disfunção Ventricular Direita/sangue , Disfunção Ventricular Direita/etiologia , MadeiraRESUMO
The pathogenesis of ascending aortic aneurysm (AAA) involves many factors; elastin degradation could lead to initial dilation, and changes in the collagen structure predispose the aneurysm to rupture. Prolidase is an enzyme that catalyzes the final step of collagen breakdown by liberating free proline for collagen recycling. The enzyme activity may be a step-limiting factor in the regulation of collagen biosynthesis. Consequently, in this study we sought to determine serum prolidase activity in AAAs. Eighty consecutive patients with the diagnosis of hypertension or chest pain, referred for echocardiographic examination in the outpatient cardiology clinic, were included in the study. The subjects were grouped into three categories according to the aortic diameter; control group without aortic dilatation (
Assuntos
Aorta/patologia , Aneurisma Aórtico , Dipeptidases/sangue , Adulto , Idoso , Aneurisma Aórtico/sangue , Aneurisma Aórtico/patologia , Dilatação Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Heart rate recovery (HRR) and chronotropic incompetence (CI) in patients with subclinical hypothyroidism (SCH) has not been explored previously. The aim of the present study was to evaluate the HRR and CI in patients with SCH. METHODS: Twenty-five patients (11 men, 14 women with a mean age of 36 + or - 10 years) who were diagnosed SCH determined by an increased serum thyrothrophine (TSH) concentration (>4.0 ng/mL) and the normal free triiodothyronine (fT3) and free thyroxin (fT4) levels, were included in the study. The control group of healthy individuals with normal TSH (12 males, 15 females) with a mean age of 36 + or - 3 years was also included. Two groups were well matched for age, sex, and body mass index. Medical history, physical examination, electrocardiogram, treadmill exercise testing, and chest radiogram were performed for all participants. RESULTS: The characteristics of SCH patients and control cases were similar with regard to age, sex, and BMI except for TSH levels. Serum TSH levels were significantly higher in SCH patients than the controls (P < 0.001). No significant differences were observed in the changes of heart rate (HR), exercise tolerance (metabolic equivalents), or systolic and diastolic blood pressures at rest or during exercise between the groups, whereas HRR and CI were significantly lower during exercise testing in the SCH patients compared to controls (P < 0.003; P < 0.03, respectively). CONCLUSION: The results of the present study demonstrated that SCH can cause impaired cardiovascular autonomic function and attenuated HR response to exercise. (PACE 2010; 2-5).
Assuntos
Frequência Cardíaca/fisiologia , Hipotireoidismo/fisiopatologia , Adulto , Teste de Esforço , Feminino , Doença de Hashimoto/fisiopatologia , Humanos , Masculino , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangueRESUMO
BACKGROUND: Coronary artery anomalies have been reported to show various symptoms ranging from chest pain and dyspnea to cardio-respiratory arrest and sudden death. In this study, we attempted to assess the changes in QT interval duration and dispersion in anomalous origins of coronary arteries (AOCA). METHODS: Nineteen AOCA patients (mean age: 52 +/- 11 years) and 30 healthy control subjects (mean age: 50 +/- 12 years) were included in the study. Minimum and maximum corrected QT intervals, and corrected QT dispersion were calculated. The two groups were compared in terms of QT dispersion and QT duration. RESULTS: There was no difference between the two groups in terms of baseline demographic characteristics. Maximum corrected QT intervals (QTc max), minimum corrected QT intervals (QTc min), and corrected QT dispersion were higher in AOCA patients than controls (452 +/- 38 vs 411 +/- 25 ms [P = 0.0001], 402 +/- 31 vs 383 +/- 28 ms [P = 0.048], and 51 +/- 30 vs 28 +/- 12 ms [P = 0.001], respectively). CONCLUSION: In the patients with anomalous origins of coronary arteries, QT dispersion that is an indicator of sudden cardiac death and arrhythmias frequency increased. QTc max, QTc min, and corrected QT dispersion are higher in patients with anomalous origin of the coronary artery than in control subjects.
Assuntos
Arritmias Cardíacas/complicações , Arritmias Cardíacas/diagnóstico , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários , Eletrocardiografia/métodos , Frequência Cardíaca , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Response of systolic and diastolic velocities of mitral annulus to exercise in patients with subclinical hypothyroidism (SCH) has not been explored previously. We sought to investigate whether SCH is associated with abnormal left ventricular (LV) longitudinal function reserve to exercise. METHODS: Mitral annular systolic (S') and early diastolic (E') velocities were measured at rest and during supine bicycle exercise using tissue Doppler echocardiography (TDE) in 23 patients with newly diagnosed SCH and 25 controls. LV diastolic and systolic longitudinal function reserve indices were calculated. RESULTS: There were no significant differences in mitral inflow velocities at rest between groups except for LV end-diastolic dimension and LV end-systolic dimension, which were higher in the control group. E' and S' at rest were also similar between the groups. However, S' (9.8 +/- 1.5 vs. 11.3 +/- 1.5 cm/sec at 25 W, P = 0.001; and 11.3 +/- 1.8 vs. 13.1 +/- 1.8 cm/sec at 50 W, P = 0.001) and E' (13.8 +/- 1.4 vs. 15.7 +/- 1.6 cm/sec at 25 W, P < 0.001; and 15.6 +/- 1.6 vs. 18.2 +/- 1.5 cm/sec at 50 W, P < 0.001) during exercise were significantly lower in patients with SCH. Longitudinal systolic and diastolic function reserve indices were significantly lower in patients with SCH (systolic index, 1.4 +/- 0.9 vs. 2.5 +/- 0.9 cm/sec at 25 W, P = 0.001; and 2.7 +/- 1.3 vs. 4.1 +/- 1.2 cm/sec at 50 W, P = 0.001; diastolic index, 2.3 +/- 1.3 vs. 3.6 +/- 1.5 cm/sec at 25 W, P = 0.003; and 3.9 +/- 1.6 vs. 5.9 +/- 1.3 cm/sec at 50 W, P < 0.001). CONCLUSION: Assessment of LV longitudinal functional reserve with exercise using TDE appears to be helpful in identifying early myocardial dysfunction in SCH.
Assuntos
Ecocardiografia Doppler/métodos , Teste de Esforço , Hipotireoidismo/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Diástole , Feminino , Humanos , Masculino , Sístole , Tireotropina/sangue , Função Ventricular EsquerdaRESUMO
UNLABELLED: Coronary fractional flow reserve (FFR) as an invasive, and dobutamine stress echocardiography (DSE) as a noninvasive technique were used to detect critical coronary stenosis. This study was undertaken to assess correlation between these two techniques by using tissue Doppler, strain rate (SR), and strain imaging (S). METHODS: In 17 patients (aged 54.9+/-12.6, 4 F), a total of 22 vessels were studied. On dobutamine stress echocardiography, baseline and peak systolic (Sm), early (Em) and late (Am) diastolic myocardial velocities, SR and S were recorded from parasternal view (mid-posterior segment) for radial and apical view (mid-septum) for longitudinal deformation. Then coronary FFR was performed by using intracoronary adenosine infusion, and the value of < or = 0.75 was accepted as critical coronary stenosis. RESULTS: FFR was found to be significant in 10 vessels (FFR critical). Baseline Sm, Em/Am, SR, S values, and peak Em/Am, SR, S values were similar between critical or noncritical FFR groups. Baseline Sm and Em, and change between baseline and peak Sm and S were significantly higher in noncritical FFR group (p < 0.01, < 0.05, < 0.001, < 0.001, respectively). In all vessels, FFR after adenosine infusion showed a poor correlation with WMSI, Em, Am, Em/Am values, and the change in SR values (r = -0.22, 0.16, -0.14, 0.21, 18, respectively) showed a good correlation with the change in S (r = 0.51; p = 0.014), and a very good correlation with the change in Sm values (r = 0.77; p < 0.001) during DSE. When FFR values at left coronary system were analyzed for longitudinal SR and S values, it had a mild correlation with SR (r = 0.47, p = 0.044) and a good correlation with S (r = 0.66, p = 0.002). CONCLUSION: The quantification of regional myocardial deformation by using DSE rather than the motion would be more appropriate in detecting the ischemic dysfunctional segment supplied by the critical coronary stenosis. Strain measurement during the dobutamine infusion may provide an information on the FFR results of the culprit vessel.