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1.
Rev Port Cardiol ; 43(7): 399-414, 2024 Jul.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38583859

RESUMO

INTRODUCTION AND OBJECTIVES: Cardiovascular diseases (CVD) and cancer are some of the most recognized causes of mortality and morbidity worldwide. Cancer is the second leading cause of death in heart failure (HF) populations. Recent studies have hypothesized that HF might promote the development and progression of cancer. We aim to analyze and discuss the most recent evidence on the relationship between HF and cancer development. METHODS: From inception to November 2022, we searched PubMed, Web of Science and ClinicalTrials.gov for relevant articles on patients with HF and a subsequent cancer diagnosis that reported outcomes of overall and site-specific cancer incidence, or mortality. RESULTS: Of 2401 articles identified in our original search, 13 articles met our criteria. Studies reporting risk rate estimates were summarized qualitatively. Studies reporting hazard ratios (HRs), or relative risks were combined in a meta-analysis and revealed that HF was associated with an increased overall cancer incidence with a HR=1.30 (95% CI: 1.04-1.62) compared with individuals without HF. Subgroup analyses by cancer type revealed increased risk for lung cancer (HR=1.87; 95% CI: 1.28-2.73), gastrointestinal cancer (HR=1.22; 95% CI: 1.03-1.45), hematologic cancer (HR=1.60; 95% CI: 1.23-2.08) and female reproductive cancer (HR=1.67; 95% CI: 1.27-2.21). Mortality from cancer was higher in HF patients compared with non-HF subjects with a HR=2.17 (95% CI: 1.23-3.84). CONCLUSIONS: Our systematic review and meta-analysis revealed that HF may result in a subsequent increase in cancer incidence as well as in cancer-related mortality. The most common cancer subtypes in HF patients were lung, female reproductive system, and hematologic cancers. Further research is needed to understand this association better and to provide the best cardiological and oncological care.


Assuntos
Insuficiência Cardíaca , Neoplasias , Humanos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/complicações , Neoplasias/complicações , Neoplasias/epidemiologia , Incidência
2.
J Cardiovasc Imaging ; 31(4): 159-168, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37901993

RESUMO

BACKGROUND: The gold standard for diagnosis of cardiac tumours is histopathological examination. Cardiovascular magnetic resonance (CMR) is a valuable non-invasive, radiation-free tool for identifying and characterizing cardiac tumours. Our aim is to understand CMR diagnosis of cardiac tumours by distinguishing benign vs. malignant tumours compared to the gold standard. METHODS: A systematic search was performed in the PubMed, Web of Science, and Scopus databases up to December 2022, and the results were reviewed by 2 independent investigators. Studies reporting CMR diagnosis were included in a meta-analysis, and pooled measures were obtained. The risk of bias was assessed using the Quality Assessment Tools from the National Institutes of Health. RESULTS: A total of 2,321 results was obtained; 10 studies were eligible, including one identified by citation search. Eight studies were included in the meta-analysis, which presented a pooled sensitivity of 93% and specificity of 94%, a diagnostic odds ratio of 185, and an area under the curve of 0.98 for CMR diagnosis of benign vs. malignant tumours. Additionally, 4 studies evaluated whether CMR diagnosis of cardiac tumours matched specific histopathological subtypes, with 73.6% achieving the correct diagnosis. CONCLUSIONS: To the best of our knowledge, this is the first published systematic review on CMR diagnosis of cardiac tumours. Compared to histopathological results, the ability to discriminate benign from malignant tumours was good but not outstanding. However, significant heterogeneity may have had an impact on our findings.

3.
Scand Cardiovasc J ; 57(1): 2197183, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37029471

RESUMO

Objectives. Hereditary transthyretin amyloidosis caused by the (ATTRv) p. Val142Ile variant is a common cause of cardiac amyloidosis among Western African countries and Afro-Americans populations. However, in recent years, Caucasian patients have been identified in greater numbers, raising the question of whether this variant has been undeappreciated in this population. We now have new cases of cardiac amyloidosis caused by the p.Val142Ile from a center in northern Portugal. In addition, we reviewed and discussed the published data concerning p.Val142Ile in Caucasians. Design. Patients diagnosed with cardiac amyloidosis underwent genetic testing using TTR gene sequencing and their relatives were recommended for genetic counsellingand testing if a pathogenic TTR variant was found. In our center, we reviewed the clinical data of patients who had the p.Val142Ile variant. A review of published cases of p.Val142Ile in Caucasians was also performed, to which our data was compared. Results. We found three ATTRv patients with the p.Val142Ile variant (one homozygotic), all Caucasian males with a median age at diagnosis of 69 years old. All of them had heart failure and arrhythmias. During the follow-up period, two patients died. There were 47 unrelated unrelated Caucasian cases of ATTRv p.Val142Ile variant reported worldwide until May 2022. Conclusions. Our findings add to the mounting evidence that the global prevalence of p.Val142Ile is likely understated. This highlights the importance of the systematic screening of the TTR gene in amyloidosis and phenocopies, as well as larger epidemiologic studies to determine the true ATTRv p.Val142Ile prevalence in non-African communities.


Assuntos
Neuropatias Amiloides Familiares , Insuficiência Cardíaca , Masculino , Humanos , Idoso , Portugal/epidemiologia , Neuropatias Amiloides Familiares/diagnóstico , Neuropatias Amiloides Familiares/epidemiologia , Neuropatias Amiloides Familiares/genética
4.
Rev Port Cardiol ; 41(8): 693-703, 2022 Aug.
Artigo em Inglês, Português | MEDLINE | ID: mdl-36073269

RESUMO

Hypertrophic cardiomyopathy (HCM) is one of the most common inherited cardiac diseases, defined as a left ventricular wall thickness of ≥15 mm, in the absence of other causes of abnormal ventricular loading. A major hallmark of this disease is the presence of left ventricular outflow tract obstruction, which develops in up to three quarters of patients, referred to as obstructive hypertrophic cardiomyopathy. Current treatment is offered to symptomatic patients, based on the presence of documented left ventricular obstruction, aimed at reducing symptoms and disease progression. This is achieved through pharmacological empirical therapy, surgery, alcohol ablation and/or pacing. Mavacamten is a first-in-class allosteric inhibitor of cardiac myosin that promises to provide clinicians with targeted therapy for these patients. The aim of this review is to provide a general overview of the modern approach to the diagnosis and management of HCM, as well as to integrate all the current knowledge on mavacamten, in anticipation of a future change in the treatment algorithm of patients with HCM.

5.
Eur J Case Rep Intern Med ; 6(12): 001237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31893197

RESUMO

Amyloidosis is a group of disorders characterised by the accumulation of extracellular deposits of insoluble protein aggregates. Clinical management depends on the accurate identification of the amyloid precursor and underlying cause. We describe a rare case of apolipoprotein A-IV cardiac amyloidosis, the diagnosis of which required mass spectrometry-based proteomic analysis. LEARNING POINTS: To be able to perform the differential diagnosis of cardiac amyloidosis subtypes using imaging methods, analytical results and tissue analysis.To recognise the added value of mass spectrometry (MS)-based proteomic analysis.

6.
Pediatr Infect Dis J ; 38(6): 620-624, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30299423

RESUMO

BACKGROUND: Despite a risk-based peripartum chemoprophylaxis approach in Iceland since 1996, Streptococcus agalactiae [group B streptococci (GBS)] remains an important cause of early-onset [<7 days, early-onset disease (EOD)] and late-onset disease (LOD; 7 days to 3 months). METHODS: We studied GBS invasive disease in children <1 year in Iceland in 1976-2015. Bacteria (n = 98) were characterized by susceptibility to a panel of antimicrobials, capsular serotyping, resistance genes, surface protein and pilus-locus profiling and multilocus sequence typing. RESULTS: Both EOD and LOD increased during the early years, but while EOD subsequently decreased from 0.7/1000 live births in 1991-1995 to 0.2/1000 in 2011-2015, LOD showed a nonsignificant decrease from its peak value of 0.6/1000 in 2001-2005 to 0.4/1000 in 2006-2015. Serotype III was the most frequently found (n = 48), represented mostly by the hypervirulent lineage CC17/III/rib/PI-1+PI-2b (62%), but also by CC19/III/rib/PI-1+PI-2a (35%) frequently associated with colonization. Serotype Ia (n = 22) was represented by CC23/Ia/eps/PI-2a (68%) and CC7/Ia/bca/PI-1+PI-2b (23%) of possible zoonotic origin. Resistance to erythromycin and clindamycin was increasingly detected in the last years of the study (5 of the 9 cases were isolated after 2013), including representatives of a multiresistant CC17/III/rib/PI-2b sublineage described recently in other countries and expressing resistance to erythromycin, clindamycin and streptomycin. CONCLUSIONS: The risk-based chemoprophylaxis adopted in Iceland possibly contributed to the decline of EOD but has had limited effect on LOD. GBS causing neonatal and early infancy invasive infections in Iceland are genetically diverse, and the recent emergence of antimicrobial resistant lineages may reduce the choices for prophylaxis and therapy of these infections.


Assuntos
Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/classificação , Streptococcus agalactiae/efeitos dos fármacos , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Quimioprevenção , Farmacorresistência Bacteriana Múltipla , Genótipo , Humanos , Islândia/epidemiologia , Lactente , Recém-Nascido , Tipagem de Sequências Multilocus , Pesquisa Qualitativa , Estudos Retrospectivos , Sorogrupo , Infecções Estreptocócicas/microbiologia
7.
Acta Reumatol Port ; 43(4): 309-313, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30641540

RESUMO

Eosinophilic granulomatosis with polyangiitis is a rare multisystemic disorder, characterized by necrotizing vasculitis affecting small to medium-sized vessels, associated with asthma and eosinophilia. Cardiac involvement is the most important predictor of mortality and it seems to be more frequent in anti-neutrophil cytoplasmic antibodies-negative patients. Cardiomyopathy and congestive heart failure can occur but a significant proportion of patients are asymptomatic. We present a case of this condition in a 65-year-old woman with a past medical history of rhinosinusitis and recent episodes of asthma, that developed palpable purpura, sensory deficiency and excruciating pain mainly in the lower limbs. A significant hypereosinophilia and elevated troponin level were found, although she had not cardiac symptomatology. Cardiovascular magnetic resonance revealed late gadolinium enhancement and a severe reduction of the left ventricular ejection fraction. Mononeuritis multiplex was documented and diagnosis was confirmed by biopsy. Complementary cardiac investigation is mandatory in any patient with suspicion of Eosinophilic granulomatosis with polyangiitis. Early detection and the appropriate treatment are crucial due to the possible life-threatening manifestations.


Assuntos
Doenças Assintomáticas , Granulomatose com Poliangiite/complicações , Miocardite/diagnóstico , Miocardite/etiologia , Doença Aguda , Idoso , Feminino , Humanos
8.
Rev Port Cardiol ; 36(10): 709-716, 2017 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-28989069

RESUMO

INTRODUCTION: Biomarkers in dilated cardiomyopathy (DCM) reflect various pathobiological processes, including neurohormonal activation, oxidative stress, matrix remodeling, myocyte injury and myocyte stretch. We assessed the role of biomarkers in clinical and echocardiographic parameters and in left ventricular (LV) reverse remodeling (LVRR). METHODS: In this prospective study of 50 DCM patients (28 men, aged 59±10 years) with LV ejection fraction (LVEF) <40%, LVRR was defined as an increase of >10 U in LVEF after optimal medical therapy. RESULTS: Baseline LVEF was 25.4±9.8% and LV end-diastolic diameter (LVEDD)/body surface area (BSA) was 34.2±4.5 mm/m2. LVRR occurred in 34% of patients within 17.6±15.6 months. No correlation was found between B-type natriuretic peptide (BNP), 25-hydroxyvitamin D (25(OH)D), CA-125, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) [Lp(a)], noradrenaline, adrenaline, renin or aldosterone and LVRR. Patients in NYHA class III or IV, with pulmonary congestion or ankle edema, had higher CA-125, cystatin C, BNP and hs-CRP levels (p<0.05). CA-125 was correlated with BNP (r=0.61), hs-CRP (r=0.56) and uric acid (r=0.52) (all p=0.01). BNP correlated directly with LVEDD (r=0.49), LV volumes (r=0.51), pulmonary artery systolic pressure (PASP) (r=0.43) and E/e' (r=0.31), and was inversely correlated with LVEF (r=-0.50) and e' velocity (r=-0.32) (p<0.05). CA-125 was positively correlated with left atrial volume/BSA (r=0.46), E/A ratio (r=0.60) and PASP (r=0.49) (p<0.05). CONCLUSIONS: No correlation was found between biomarkers and LVRR, but CA-125, BNP and hs-CRP were predictors of clinical severity and congestion. BNP correlated with parameters of systolic and diastolic dysfunction, while CA-125 correlated with measures of diastolic dysfunction.


Assuntos
Cardiomiopatia Dilatada/sangue , Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia , Remodelação Ventricular , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença
9.
Biomed Res Int ; 2017: 6509754, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28553649

RESUMO

Introduction. Cardiovascular (CV) diseases are a major cause of death in rheumatoid arthritis (RA) patients. Novel biomarkers [B-type natriuretic peptide (BNP); osteoprotegerin (OPG)/receptor activator of nuclear factor-kappa B ligand (RANKL) ratio; and dickkopf-1 (DKK-1)] have been used in CV risk assessment. We analysed, in established RA patients, the presence of silent myocardial ischemia and its association with clinical variables, BNP, and bone and atheroma biomarkers. Methods. From a single-center tertiary referral hospital, RA patients asymptomatic for CV disease were submitted to myocardial perfusion scintigraphy (MPS) under adenosine stress and biomarkers measurements. Logistic regression was used to estimate crude odds ratios (OR) and 95% confidence intervals (CI). Results. In 189 patients, perfusion defects were frequent (25%) and associated with BNP ≥ 100 pg/mL (OR = 5.68; 95% CI: 2.038-15.830), fourth log OPG/RANKL ratio quartile (OR = 2.88; 95% CI: 1.091-7.622), and DKK-1 ≥ 133 pmol/L (OR = 2.69; 95% CI: 1.058-6.840). Similar associations were confirmed in those with C-reactive protein > or ≤ 3 mg/L. No relationship was found with the majority of traditional CV factors nor with disease variables. Conclusions. Our results corroborated the hypothesis that MPS could reveal subclinical CV dysfunction, supported the utility of BNP measurements as a screening tool, and put in perspective the potential usefulness of complementary approaches in CV risk assessment in RA patients.


Assuntos
Artrite Reumatoide , Isquemia Miocárdica , Imagem de Perfusão do Miocárdio , Peptídeo Natriurético Encefálico/sangue , Placa Aterosclerótica , Adulto , Idoso , Artrite Reumatoide/sangue , Artrite Reumatoide/diagnóstico por imagem , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico por imagem , Placa Aterosclerótica/sangue , Placa Aterosclerótica/diagnóstico por imagem , Fatores de Risco
10.
Motriz rev. educ. fís. (Impr.) ; 21(3): 230-236, July-Sept. 2015. tab
Artigo em Inglês | LILACS | ID: lil-761648

RESUMO

The analysis of the movement patterns of children with spastic diplegia (SD) during the process of standing up can contribute to a better understanding of postural control. The purpose of this study was to describe the movement patterns during this task in children with SD and typical development and to analyze the differences according to their age group. Participated 40 children (38-154 months), 20 children with SD and 20 children with typical development. The participants were instructed to lie down in a supine position and quickly stand up (10 trials). Motor task sessions were videotaped and subsequently analyzed. Children with SD had more asymmetrical and less efficient movement patterns in the Upper Limbs (UL), Axial Region (AR) and Lower Limbs (LL). The oldest group of children with SD did not have more mature and efficient movement patterns, and the oldest children with typical development have more mature and efficient movement patterns in the UL and AR.


A análise dos padrões de movimento de crianças com diplegia espástica (DE) durante o movimento de levantar pode contribuir para uma melhor compreensão do controle postural. O objetivo do estudo foi descrever os padrões de movimento durante esta tarefa em crianças com DE e com desenvolvimento típico e analisar as diferenças de acordo com a idade. Participaram 40 crianças (38-154 meses), 20 crianças com DE e 20 crianças com desenvolvimento típico. Os participantes foram instruídos para se deitarem em posição de decúbito dorsal e levantarem-se rapidamente (10 tentativas). As sessões foram gravadas e analisadas posteriormente. As crianças com DE apresentaram padrões de movimentos mais assimétricos e menos eficientes nos Membros Superiores (MS), Região Axial (RA) e Membros Inferiores (MI). As crianças mais velhas com DE não apresentaram padrões de movimento mais maduros e eficientes, e as mais velhas com desenvolvimento típico apresentaram padrões movimentos mais eficientes e maduros nos MS e RA.


El análisis de los patrones de movimiento de los niños con diplejía espástica (DE) durante el movimiento de levantar puede contribuir para una mejor comprensión del control postural. El objetivo del estudio fue describir los patrones de movimiento durante esta tarea en niños con DE y con desarrollo típico y analizar las diferencias en función de la edad. Participaron 40 niños (38-154 meses), 20 niños con DE y 20 niños con desarrollo típico. Los participantes fueron instruidos para que se echaran en decúbito dorsal y se levantaran rápidamente (10 intentos). Las sesiones fueron gravadas y analizadas posteriormente. Los niños con DE presentaron patrones de movimientos más asimétricos y menos eficientes en los miembros superiores (MS), región axial (RA) y miembros inferiores (MI). Los niños más viejos con DE no mostraron patrones de movimiento más eficientes y maduros, y los más viejos con desarrollo típico mostraron patrones de movimientos más eficientes y maduros en los MS y RA.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Paralisia Cerebral , Equilíbrio Postural
11.
Clin Chim Acta ; 447: 96-104, 2015 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-26070511

RESUMO

Recent data have shown that lyso-Gb3, the deacylated derivative of globotriaosylceramide (Gb3), is possibly involved in the pathogenesis of Fabry disease (FD) and might be a clinically useful biomarker of its metabolic load. To test this hypothesis, we assayed Gb3 and lyso-Gb3 and related analogs in plasma and/or urine samples of 12 clinically well-characterized subjects carrying several different GLA variant alleles associated with a wide range of residual α-galactosidase A activities. Urinary Gb3 was measured by HPLC-MS/MS; plasma and urinary lyso-Gb3 and related analogs were measured by UPLC-MS/MS. Individual profiles of Gb3 and lyso-Gb3 and related analogs closely correlated with the phenotypic data for each subject, discerning the classical FD patient from the two patients carrying cardiac variants as well as those from all the others without FD. The lyso-Gb3 analog at m/z 836 was found at increased levels only in patients manifesting clinically severe heart disease, irrespective of the pathogenicity of the GLA variant they carried. This finding suggests that this lyso-Gb3 analog might be an earlier biomarker of progressive heart disease, non-specific of the FD cardiomyopathy. The possibility that urinary Gb3 is a specific marker of kidney involvement in FD deserves further study.


Assuntos
Glicolipídeos/sangue , Glicolipídeos/urina , Mutação , Esfingolipídeos/sangue , Esfingolipídeos/urina , Triexosilceramidas/sangue , Triexosilceramidas/urina , alfa-Galactosidase/genética , Adulto , Idoso , Alelos , Doença de Fabry/sangue , Doença de Fabry/enzimologia , Doença de Fabry/genética , Doença de Fabry/urina , Glicolipídeos/química , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Moleculares , Conformação Proteica , Esfingolipídeos/química , Triexosilceramidas/química , Adulto Jovem , alfa-Galactosidase/química
13.
Rev Port Cardiol ; 33(9): 563.e1-4, 2014 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25242677

RESUMO

The authors present the case of a 68-year-old man with predominantly right heart failure in the context of severe aortic stenosis associated with pulmonary hypertension. Anemia was diagnosed which, after endoscopic study, was considered to be secondary to angiodysplasia and a diagnosis of Heyde syndrome was made. After valve replacement surgery the patient's heart failure improved and hemoglobin levels stabilized. We present this case to show the need to recognize less common associations of severe aortic stenosis, in order to provide immediate and appropriate treatment.


Assuntos
Anemia/etiologia , Angiodisplasia/complicações , Estenose da Valva Aórtica/complicações , Insuficiência Cardíaca/complicações , Hipertensão Pulmonar/complicações , Intestinos/irrigação sanguínea , Idoso , Anemia/diagnóstico , Humanos , Masculino , Síndrome
14.
Rev Port Cardiol ; 33(9): 565.e1-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25246064

RESUMO

Fabry disease is a rare X-linked lysosomal storage disorder caused by mutations in the alpha-galactosidase gene. The most frequent cardiac presentation of Fabry disease is cardiomyopathy characterized by left ventricular (LV) hypertrophy, usually concentric. Heart disease in affected females tends to be clinically recognized later than in males and cardiac complications are the most frequently reported cause of death in females with Fabry disease. There are few data regarding the association between Fabry disease and LV noncompaction. We report a case of a 30-year-old asymptomatic woman, heterozygous for a nonsense alpha-galactosidase gene mutation (p.R220X), who presented LV noncompaction on cardiac magnetic resonance imaging, without LV wall hypertrophy. Histopathological examination of myocardial fragments showed marked deposition of glycosphingolipids in cardiomyocytes, confirming the diagnosis of Fabry cardiomyopathy. Based on this finding, the patient was proposed for enzyme replacement therapy. This case illustrates the role of endomyocardial biopsy in the clarification of doubtful or atypical findings related to cardiac Fabry disease, even in heterozygous women, and corroborates the contention that Fabry disease should be included in the differential diagnosis of LV hypertrabeculation/noncompaction.


Assuntos
Doença de Fabry/patologia , Miocárdio Ventricular não Compactado Isolado/patologia , Adulto , Códon sem Sentido , Feminino , Humanos , alfa-Galactosidase/genética
15.
Rev Port Cardiol ; 33(5): 307.e1-4, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24931181

RESUMO

Post-cardiac injury syndrome (PCIS) is an inflammatory process involving the pericardium secondary to cardiac injury. It can develop after cardiac trauma, cardiac surgery, myocardial infarction, and, rarely, after certain intravascular procedures. We report a rare case of an iatrogenic cardiac rupture followed by PCIS with delayed inflammatory pericardial effusion after pacemaker implantation. A comprehensive literature review on this topic is provided.


Assuntos
Traumatismos Cardíacos/etiologia , Marca-Passo Artificial/efeitos adversos , Idoso de 80 Anos ou mais , Feminino , Veia Femoral , Humanos , Implantação de Prótese , Síndrome
16.
Cardiology ; 128(4): 320-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24924145

RESUMO

OBJECTIVE: To assess the prognostic significance of iron deficiency (ID) in a chronic heart failure (CHF) outpatient population. METHODS AND RESULTS: We prospectively evaluated 127 patients with stable CHF and left ventricular ejection fraction ≤45%. Clinical and analytical data as well as information regarding the occurrence of the composite endpoint of overall mortality and nonfatal cardiovascular events were assessed. Among the 127 patients enrolled [81% men, median age: 62 years (25th-75th percentile: 53-68)], 46 (36%) patients had ID. Women, patients with higher plasma brain natriuretic peptide levels (>400 pg/ml) and with right ventricular systolic dysfunction presented ID more frequently (p < 0.05 for all). At 225 ± 139 days of follow-up, the composite endpoint occurred in 15 (12%) patients. It was more frequent in ID (24 vs. 5%, p = 0.001) and anemic patients (25 vs. 8%, p = 0.014). In a Cox regression analysis, ID was associated with a higher likelihood of composite endpoint occurrence (HR 5.00, 95% CI 1.59-15.78, p = 0.006). In a multivariable analysis adjusted for clinical variables, including the presence of anemia, ID remained a significant predictor of the composite endpoint (HR 5.38, 95% CI 1.54-18.87, p = 0.009). CONCLUSION: In a CHF outpatient population, ID carried a higher risk of unfavorable outcome, irrespectively of the presence of anemia.


Assuntos
Anemia/complicações , Insuficiência Cardíaca/sangue , Deficiências de Ferro , Idoso , Anemia/epidemiologia , Doença Crônica , Intervalo Livre de Doença , Feminino , Insuficiência Cardíaca/complicações , Humanos , Ferro/sangue , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Transferrina/análise
17.
Rev Port Cardiol ; 31(3): 247-50, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22336571

RESUMO

Left ventricular noncompaction is an unusual but increasingly recognized cardiomyopathy, the etiology of which is still not definitely established. Clinical presentation includes a wide spectrum of scenarios, including heart failure, thromboembolism and malignant arrhythmias, with half of deaths occurring suddenly. Early detection of LVNC is therefore essential to prevent sudden cardiac death. To our knowledge, this is the first report of the presence of cardiac sympathetic nervous dysfunction, assessed by 123iodine-metaiodobenzylguanidine myocardial scintigraphy, in a patient with LVNC, preserved left ventricular systolic function and exercise-induced nonsustained ventricular tachycardia. This finding may be related to the increased arrhythmic risk observed in this cardiomyopathy, giving a new insight into the pathophysiology of LVNC.


Assuntos
3-Iodobenzilguanidina , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/etiologia , Radioisótopos do Iodo , Miocárdio Ventricular não Compactado Isolado/complicações , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Compostos Radiofarmacêuticos , Adulto , Humanos , Masculino , Cintilografia , Fatores de Risco
18.
Rev Port Cir Cardiotorac Vasc ; 19(3): 133-5, 2012.
Artigo em Português | MEDLINE | ID: mdl-23894736

RESUMO

Atrial myxoma is the most prevalent primary heart tumor. Although it is considered histologically benign, it may course with serious complications. We report the clinical case of a 35 years old man, previously asymptomatic, admitted due to an acute ischemia of the lower limbs, consequence of an embolic complication of a left atrial myxoma. We conclude with a brief review of the literature on the topic.


Assuntos
Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Mixoma/patologia , Adulto , Embolia/etiologia , Embolia/patologia , Neoplasias Cardíacas/complicações , Humanos , Isquemia/etiologia , Isquemia/patologia , Extremidade Inferior , Masculino , Mixoma/complicações
19.
Rev Port Cardiol ; 30(7-8): 649-54, 2011 Jul.
Artigo em Português | MEDLINE | ID: mdl-22005308

RESUMO

INTRODUCTION: The diagnosis of Marfan syndrome (MFS) depends on a multidisciplinary clinical evaluation. Molecular study to identify mutations in the FBN1 gene can establish a definitive diagnosis even with atypical or «incomplete¼ phenotypes and enable earlier diagnosis in asymptomatic patients. OBJECTIVES: The aim of the present work was to evaluate the frequency and type of FBN1 gene mutations in a population of Marfan syndrome patients referred to a tertiary care center with cardiothoracic surgery. METHODS: Our sample included 30 individuals with MFS (from 14 families), evaluated in cardiology, rheumatology and ophthalmology consultations. In all patients, DNA was extracted from a peripheral blood sample and mutation screening of the entire coding sequence of the FBN1 gene was then performed, using the polymerase chain reaction. RESULTS: We identified 12 different mutations in the 14 families studied. Of these, only two had been previously described in the literature, while the other 10 were found to be new mutations; 36% of patients carried a missense mutation and 50% carried a mutation leading to a premature termination codon. CONCLUSIONS: To the best of our knowledge this is the first genotypic description of Portuguese patients with MFS. In this study, we highlight the need for comprehensive clinical evaluation of these patients and the value of FBN1 mutation analysis in selected cases. By describing 10 new mutations, we have also helped broaden the spectrum of known FBN1 mutations associated with MFS.


Assuntos
Síndrome de Marfan/genética , Proteínas dos Microfilamentos/genética , Mutação , Adulto , Feminino , Fibrilina-1 , Fibrilinas , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Adulto Jovem
20.
São Paulo; s.n; 2009. 60 p. tab.
Tese em Português | LILACS | ID: lil-520496

RESUMO

A preferência por produtos prontos para o consumo pode implicar em aumento do risco de doenças transmitidas por alimentos (DTAs) e uma grande preocupação, nesse caso, é a presença da Listeria monocytogenes. A infecção por essa bactéria apresenta baixa taxa de morbidade, porém alta de mortalidade, representando maior risco para gestantes, idosos, crianças e indivíduos imunodeprimidos. Os produtos considerados de maior risco são aqueles prontos para o consumo, mantidos sob refrigeração e com longa vida útil. Face ao exposto, foi pesquisada a ocorrência de L. monocytogenes em dois grupos de produtos cárneos fatiados: presunto cozido e salame. Cento e trinta amostras de cada tipo de produto, adquiridas no comércio varejista do Município de São Paulo, foram submetidas a análises laboratoriais. Tais análises foram conduzidas em dois momentos: no terço inicial e no final de vida útil dos produtos. Nos casos de positividade, foram realizadas a quantificação e a sorotipagem da bactéria em cada um dos produtos, a fim de avaliar se os resultados obtidos poderiam oferecer risco à saúde. O salame apresentou prevalência significativamente maior para a L. monocytogenes, 6,2 por cento (8/130), enquanto no presunto a prevalência foi de 0,8 por cento (1/130). As contagens nas amostras de salame apresentaram valores entre<10 a 1900UFC/g. Os sorotipos identificados, considerando os dois tipos de produtos, apresentaram as seguintes freqüências: 4b=37,5 por cento (3/8), 1/2b=25 por cento (2/8), 3b=25 por cento (2/8) e 1/2c=12,5 por cento (1/8). Os resultados encontrados permitem inferir que, para os produtos analisados, o risco de listeriose decorrente do consumo de salame é maior do que o associado ao consumo de presunto cozido.


Assuntos
Bactérias , Alimentos , Ingestão de Alimentos , Listeria monocytogenes , Refrigeração
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