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1.
Int. j. cardiovasc. sci. (Impr.) ; 35(4): 530-536, July-Aug. 2022. tab, graf
Article in English | LILACS | ID: biblio-1385261

ABSTRACT

Abstract Background: Although electrical and structural remodeling has been recognized to be important in the pathophysiology of atrial fibrillation, the mechanisms underlying remodeling process are unknown. There has been increasing interest in the involvement of inflammatory molecules and adipokines released from the epicardial fat tissue in the pathophysiology of atrial fibrillation. Objectives: In our study, we aimed to investigate the relationship of atrial fibrillation with increased epicardial adipose tissue, inflammatory molecules released from this tissue and omentin. Methods: Thirty-six patients who were followed up with a diagnosis of permanent AF at the cardiology outpatient clinic 33 individuals without atrial fibrillation (controls) were included in the study. Epicardial adipose tissue thickness of patients was measured by echocardiography. Serum omentin, IL 6, IL 1 beta, TNF alpha and CRP levels were measured. Man-Whitney U test was performed for comparisons and significance was established at 5% (p<0.05). Results: Epicardial adipose tissue thickness was significantly greater in the patient group (6mm [4-5.5]) than controls (4mm [3-5.5]) (p <0.001). No significant difference was found in the concentrations of omentin or inflammatory molecules between the groups. Conclusion: No relationship was found between atrial fibrillation and serum levels or omentin or inflammatory markers. A relationship between epicardial adipose tissue thickness measured by echocardiography and atrial fibrillation was determined.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Pericardium/anatomy & histology , Atrial Fibrillation/physiopathology , Adipose Tissue , Echocardiography , Biomarkers , Adipokines/physiology
2.
Säo Paulo med. j ; 140(3): 384-389, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377397

ABSTRACT

ABSTRACT BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. OBJECTIVE: To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. DESIGN AND SETTING: Prospective study in a tertiary-care university hospital in Antalya, Turkey. METHODS: Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. RESULTS: IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. CONCLUSIONS: IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.


Subject(s)
Humans , Ischemic Stroke , Echocardiography , Adipose Tissue/pathology , Adipose Tissue/diagnostic imaging , Prospective Studies , Risk Factors , Granulocytes , Inflammation
3.
Int. j. cardiovasc. sci. (Impr.) ; 35(3): 423-429, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1375648

ABSTRACT

Abstract Pericardial agenesis is a rare congenital anomaly found predominantly in men, and its complete form is extremely rare and difficult to diagnose. This report describes the case of a pregnant patient with complete pericardial agenesis in which mode of delivery and sterilization raised debate among specialists.


Subject(s)
Humans , Female , Pregnancy , Adult , Pericardium/abnormalities , Delivery, Obstetric , Pericardium/diagnostic imaging , Sterilization, Reproductive , Echocardiography
4.
Arq. bras. cardiol ; 118(3): 634-645, mar. 2022. tab, graf
Article in Portuguese | LILACS | ID: biblio-1364356

ABSTRACT

Resumo Fundamento Embora se saiba que a fração de ejeção (FE) do ventrículo esquerdo (VE) medida por eletrocardiograma seja preservada em pacientes com acromegalia, não há informação suficiente sobre deformação longitudinal global e deformação do átrio esquerdo (SLG-VE e SAE). Objetivo O objetivo deste estudo foi avaliar as funções do ventrículo esquerdo (VE) e do átrio esquerdo (AE) por ecocardiograma strain (ES) em pacientes com acromegalia. Métodos Este estudo incluiu 50 pacientes com acromegalia na forma ativa da doença e 50 controles saudáveis com idade, sexo e área de superfície corporal similares. Além dos ecocardiogramas de rotina, medições de SLG-VE e SAE foram realizadas com o ES. Resultados Os valores dos SAE e SLG-VE foram significativamente mais baixos em pacientes com acromegalia (p<0,05 para todos). Na análise bivariada, a pressão arterial sistólica, o pró-hormônio N-terminal do peptídeo natriurético cerebral, o fator de crescimento semelhante à insulina tipo 1, e detectou-se que os níveis de IMVE tinham correlação positiva com SAE e SLG-VE (p<0,05). O nível de IGF-1 tinha forte correlação com SAE e SLG-VE (p<0,001 e β=0,5 vs. p<0,001 e β=0,626, respectivamente); 48% dos pacientes com acromegalia têm SLG-VE reduzido (<20%). O índice de massa do ventrículo esquerdo (IMVE) determina independentemente a presença de SLG-VE reduzido, e cada 1g/m2 de aumento no nível de IMVE aumenta a probabilidade de redução de SLG-VE em 6%. Conclusão Embora a fração de ejeção de VE seja normal em pacientes com acromegalia, os valores de SAE e SLG-VE são significativamente mais baixos. Além do aumento em IMVE, outro achado do envolvimento cardíaco pode ser a redução de SAE e SLG-VE. Portanto, além do ecocardiograma de rotina, SAE e SLG-VE podem ser úteis para avaliar os sinais iniciais de envolvimento cardíaco antes da ocorrência de alterações cardíacas irreversíveis.


Abstract Background Although it is known that the left ventricular (LV) ejection fraction (EF) measured by echocardiography is preserved in patients with acromegaly, there is not enough information about the LV and left atrial strain (LV-GLS and LAS). Objective This study aimed to evaluate the left ventricular (LV) and left atrial (LA) functions with strain echocardiography (SE) in patients with acromegaly. Methods This study included 50 acromegaly patients with active disease and 50 healthy controls with similar age, gender, and body surface area. In addition to routine echocardiography examinations, LV-GLS and LAS measurements were performed with SE. Results LAS and LV-GLS values were significantly lower in patients with acromegaly (p<0.05 for all). In bivariate analysis, systolic blood pressure, N-terminal prohormone of brain natriuretic peptide, Insulin-like growth factor-1, LA diastolic diameter, and LVMI levels were found to be positively correlated with both LAS and LV-GLS (p <0.05). IGF-1 level was strongly correlated with LAS and LV-GLS (p<0.001 and β=0.5 vs. p<0.001 and β=0.626, respectively); 48% of patients with acromegaly have reduced LV-GLS (<20%). Left ventricular mass-index (LVMI) independently determines the presence of reduced LV-GLS and each 1g/m2increase in LVMI level increases the likelihood of reduced LV-GLS by 6%. Conclusion Although LV ejection fraction is normal in patients with acromegaly, LAS and LV-GLS values were significantly reduced. Apart from LVMI increase, another finding of cardiac involvement may be LAS and LV-GLS decrease. Therefore, in addition to routine echocardiography, LAS and LV-GLS may be useful to evaluate early signs of cardiac involvement before the occurrence of irreversible cardiac changes.


Subject(s)
Humans , Acromegaly/complications , Acromegaly/diagnostic imaging , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/diagnostic imaging , Stroke Volume/physiology , Echocardiography , Ventricular Function, Left/physiology
5.
Arq. bras. cardiol ; 118(3): 565-575, mar. 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364343

ABSTRACT

Resumo Fundamento Pacientes com anemia falciforme (AF) têm risco aumentado de complicações cardiovasculares. O teste ergométrico é usado como marcador de prognóstico em uma série de doenças cardiovasculares. Entretanto, há uma escassez de evidências sobre exercícios em pacientes com AF, especialmente em relação à sua segurança, viabilidade e possível função prognóstica. Objetivos Usamos o teste em esteira máximo para determinar a segurança e a viabilidade do teste ergométrico em pacientes com AF. Além disso, os fatores associados à duração do exercício, bem como o impacto das alterações causadas pelo exercício em resultados clínicos, também foram avaliados. Métodos 113 pacientes com AF que passaram pelo teste ergométrico e por uma avaliação cardiovascular abrangente incluindo um ecocardiograma e os níveis do peptídeo natriurético do tipo B (BNP). O desfecho de longo prazo foi uma combinação de eventos incluindo morte, crises álgicas graves, síndrome torácica aguda ou internações hospitalares por outras complicações associadas â doença falciforme. A análise de regressão de Cox foi realizada para identificar as variáveis associadas ao resultado. Um p valor <0,05 foi considerado estatisticamente significativo. Resultados A média de idade foi de 36 ± 12 anos (intervalo, 18-65 anos), e 62 pacientes eram do sexo feminino (52%). A presença de alterações isquêmicas ao esforço e resposta pressórica anormal ao exercício foram detectadas em 17% e 9 % da´população estudada respectivamente. Dois pacientes apresentaram crise álgica com necessidade de internação hospitalar no período de 48 horas da realização do exame. Fatores associados à duração do exercício foram idade, sexo, velocidade máxima de regurgitação tricúspide (RT), e relação E/e', após a padronização quanto aos marcadores da gravidade da doença. Durante o período médio de acompanhamento de 10,1 meses (variando de 1,2 a 26), 27 pacientes (23%) apresentaram desfechos clínicos adversos. Preditores independentes de eventos adversos foram a concentração de hemoglobina, velocidade do fluxo transmitral tardio (onda A), e a resposta da PA ao exercício. Conclusões A realização de testes ergométricos em pacientes com AF, clinicamente estáveis, é viável. A duração do exercício estava associada à função diastólica e a pressão arterial pulmonar. A resposta anormal da PA foi um preditor independente de eventos adversos.


Abstract Background Patients with sickle cell disease (SCD) are at increased risk for cardiovascular complications. Exercise testing is used as a prognostic marker in a variety of cardiovascular diseases. However, there is a lack of evidence on exercise in SCD patients, particularly regarding its safety, feasibility, and possible prognostic role. Objectives We used the maximal treadmill test to determine safety and feasibility of the exercise testing in SCD patients. Additionally, the factors associated with exercise duration, as well as the impact of exercise-induced changes on clinical outcome, were also assessed. Methods One-hundred thirteen patients with SCD, who underwent exercise testing, were prospectively enrolled. A comprehensive cardiovascular evaluation, including echocardiography and B-type natriuretic peptide (BNP) levels, were obtained. The long-term outcome was a composite endpoint of death, severe acute painful episodes, acute chest syndrome, or hospitalization for other SCD-related complications. Cox regression analysis was performed to identify the variables associated with the outcome. A p-value<0.05 was considered to be statistically significant. Results The mean age was 36 ± 12 years (range, 18-65 years), and 62 patients were women (52%). Ischemic electrocardiogram and abnormal blood pressure (BP) response to exercise were detected in 17% and 9%, respectively. Two patients experienced pain crises within 48 hours that required hospitalization. Factors associated with exercise duration were age, sex, tricuspid regurgitation (TR) maximal velocity, and E/e' ratio, after adjustment for markers of disease severity. During the mean follow-up of 10.1 months (ranging from 1.2 to 26), the endpoint was reached in 27 patients (23%). Independent predictors of adverse events were hemoglobin concentration, late transmitral flow velocity (A wave), and BP response to exercise. Conclusions Exercise testing in SCD patients who were clinically stable is feasible. Exercise duration was associated with diastolic function and pulmonary artery pressure. Abnormal BP response was an independent predictor of adverse events.


Subject(s)
Humans , Female , Adult , Young Adult , Exercise Test , Anemia, Sickle Cell/complications , Prognosis , Echocardiography , Feasibility Studies , Middle Aged
6.
Int. j. cardiovasc. sci. (Impr.) ; 35(2): 161-171, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364975

ABSTRACT

Abstract Background: There are divergences in the literature regarding the experimental model (Wistar-WIS or Wistar Kyoto-WKY) to be used as a Spontaneously Hypertensive Rat (SHR) control. The characterization of these models in terms of cardiovascular parameters provides researchers with important tools at the time of selection and application in scientific research. Objective: The aim of this study was to evaluate the use of WIS and WKY as a Spontaneously Hypertensive Rat (SHR) control by assessing the long-term behavior of blood pressure and cardiac structure and function in these strains. Methods: To this end, WIS, WKY, and SHR underwent longitudinal experiments. Blood pressure and body mass were measured every two weeks from the 8th to the 72nd. Echocardiographic analysis was performed in all groups with 16, 48, and 72 weeks of life. After having applied the normality test, the Two-Way ANOVA of repeated measures followed by the Tukey post hoc test was used. A significance level of 5% was established. Results: The WIS group showed higher body mass (p<0.05), while the WKY and SHR presented higher body mass variation over time (p<0.05). SHR exhibited increased values of systolic, diastolic, and mean blood pressure when compared to WKY and WIS, whereas the WKY generally showed higher values than WIS (p<0.05). Regarding the cardiac function, SHR showed reduced values, while the WKY presented an early decrease when compared to WIS with aging (p<0.05). Conclusion: WIS is a more suitable normotensive control for SHR than WKY in experiments to test blood pressure and cardiac structure and function.


Subject(s)
Animals , Male , Rats , Arterial Pressure/physiology , Heart/anatomy & histology , Heart/physiology , Hypertension/physiopathology , Rats, Inbred SHR , Rats, Inbred WKY , Body Weight , Echocardiography , Longitudinal Studies , Rats, Wistar , Disease Models, Animal
7.
Rev. Assoc. Med. Bras. (1992) ; 68(2): 250-255, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365337

ABSTRACT

SUMMARY OBJECTIVE: The metabolic syndrome involves both metabolic and cardiovascular risk factors and is associated with cardiovascular mortality. Epicardial fat tissue plays a crucial role in deleterious effects of metabolic syndrome on the heart, including myocardial fibrosis. The fragmented QRS reflects heterogeneous depolarization of the myocardium and occurs as a result of fibrosis. Thus, we aimed to investigate whether there is an association between fragmented QRS and epicardial fat tissue in patients with metabolic syndrome. METHODS: This study enrolled 140 metabolic syndrome patients, of whom 35 patients with fragmented QRS (+) and 105 patients with fragmented QRS (−). The two groups were compared with respect to clinical, laboratory, electrocardiographic, and echocardiographic indexes. RESULTS: Fragmented QRS (+) patients had higher waist circumference, red cell distribution width, creatinine, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, QRS duration, and epicardial fat tissue compared with fragmented QRS (−) patients. Waist circumference, red cell distribution width, QRS duration, left ventricular end-systolic diameter, left atrium diameter, septal a velocity, and epicardial fat tissue were significantly associated with the presence of fragmented QRS. The QRS duration and epicardial fat tissue were independently associated with the presence of fragmented QRS on surface electrocardiographic in metabolic syndrome patients. CONCLUSIONS: Epicardial fat tissue and QRS duration were independently associated with the presence of fragmented QRS. Basic echocardiographic and electrocardiographic parameters might be used for the risk stratification in metabolic syndrome patients.


Subject(s)
Humans , Metabolic Syndrome/complications , Echocardiography , Adipose Tissue/diagnostic imaging , Electrocardiography/methods , Waist Circumference
8.
Arq. bras. cardiol ; 118(1): 52-58, jan. 2022. tab, graf
Article in Portuguese | LILACS | ID: biblio-1360111

ABSTRACT

Resumo Fundamento Os níveis de Proteína 3 relacionada ao fator de necrose tumoral/complemento sérico C1q (CTRP3) e a relação com a fibrilação atrial (FA) na doença arterial coronária estável (DAC) não estão claros atualmente. Objetivos O objetivo deste estudo foi investigar a mudança nos níveis séricos de CTRP3 e sua relação com a FA paroxística em DAC estável. Método O estudo incluiu 252 pacientes com DAC e 50 controles saudáveis com idade/sexo compatíveis. Os níveis séricos de CTRP3 foram medidos, além da anamnese de rotina, exame físico, exames laboratoriais e ecocardiograma. Os pacientes foram divididos em grupos com e sem DAC e indivíduos com DAC com e sem FA paroxística. Os valores eram estatisticamente significativos quando p<0,05. Resultados Os níveis séricos de CTRP3 foram significativamente menores em pacientes com DAC do que no grupo controle (p<0,001). A FA foi detectada em 28 pacientes (15,08%) no grupo DAC. A frequência de hipertensão e do sexo feminino, a proteína C reativa de alta sensibilidade (PCR-as), o nitrogênio ureico no sangue, os níveis de creatinina e o diâmetro diastólico do átrio esquerdo foram maiores (p<0,05 para cada um), e os níveis de CTRP3 foram mais baixos em pacientes com FA (p<0,001). Na análise de regressão logística, os níveis séricos de CTRP3 e os diâmetros diastólicos do átrio esquerdo foram independentemente determinados pelos pacientes com FA (p<0,01 para cada um). Nesta análise, observamos que cada 1 ng/mL de redução nos níveis de CTRP3 aumentou o risco de FA em 10,7%. Na análise ROC dos valores de CTRP3 para detectar pacientes com FA, a área da curva ROC para CTRP3 foi 0,971 (0,951-991) e considerada estatisticamente significativa (p<0,001). Quando o ponto de corte de CTRP3 foi considerado em 300 ng/mL, demonstrava a presença de FA com 87,9% de sensibilidade e 86,8% de especificidade. Conclusão Os níveis séricos de CTRP3 caíram significativamente em pacientes com DAC estável, e níveis reduzidos de CTRP3 estiveram relacionados à presença de FA paroxística nesses pacientes.


Abstract Background Serum Complement C1q/tumor necrosis factor-related protein-3 (CTRP3) levels and the relationship with atrial fibrillation (AF) in stable coronary artery disease (CAD) are not clearly known. Objective The aim of this study was to investigate the change in serum CTRP3 levels and its relationship with paroxysmal AF in stable CAD. Method The study included 252 patients with CAD and 50 age-sex matched healthy control subjects. Serum CTRP3 levels were measured in addition to routine anamnesis, physical examination, laboratory and echocardiography examinations. The patients were divided into groups with and without CAD and CAD patients with and without paroxysmal AF. Statistical significance was accepted as p<0.05. Results Serum CTRP3 levels were found to be significantly lower in patients with CAD than in the control group (p<0.001). AF was detected in 38 patients (15.08%) in the CAD group. The frequency of hypertension and female gender, hs-CRP, blood urea nitrogen, creatinine levels and left atrial end-diastolic (LAd) diameter were higher (p<0.05 for each one), and CTRP3 levels were lower in patients with AF (p <0.001). In the logistic regression analysis, serum CTRP3 levels and LAd diameters were independently determined the patients with AF (p<0.01 for each one). In this analysis, we found that every 1 ng/mL reduction in CTRP3 levels increased the risk of AF by 10.7%. In the ROC analysis of CTRP3 values for detecting patients with AF, the area under the ROC curve for CTRP3 was 0.971 (0.951-991) and was statistically significant (p<0.001). When the CTRP3 cut-off value was taken as 300 ng/mL, it was found to predict the presence of AF with 87.9% sensitivity and 86.8% specificity. Conclusion Serum CTRP3 levels were significantly reduced in patients with stable CAD and decreased CTRP3 levels were closely related to the presence of paroxysmal AF in these patients.


Subject(s)
Humans , Female , Atrial Fibrillation , Coronary Artery Disease/diagnostic imaging , Echocardiography , ROC Curve , Heart Atria
9.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.436-441, tab, ilus.
Monography in Portuguese | LILACS | ID: biblio-1352663
10.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.987-990.
Monography in Portuguese | LILACS | ID: biblio-1354094
12.
Annals of Medical Research and Practice ; 3(4)2022. tables, figures
Article in English | AIM | ID: biblio-1379217

ABSTRACT

OBJECTIVE: Systemic hypertension remains an important risk factors for cardiovascular diseases and a major global public health problem. Left ventricular hypertrophy (LVH) is a recognized complication of hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies evaluated the role of echocardiography in the diagnosis of LVHs among hypertensives. This study sets out to determine the prevalence of LVH among hypertensives as determined by echocardiography.MATERIAL AND METHODS: One hundred and seventy-eight hypertensives and eighty-nine age and sex-matched controls were recruited consecutively into the study. They all had echocardiography done to determine which among had LVH. The partition value for LVH for hypertensives was determined using the 97th percentile of the left ventricular mass for controls as a cutoff point. RESULTS:Echocardiographic determined the prevalence of LVH among hypertensives was 32.4%.CONCLUSION:The echocardiographic prevalence of LVH was 32.4% in the study population. This is a significant proportion among the study population considering the clinical impact of LVH among patients with hypertension.


Subject(s)
Echocardiography , Tertiary Healthcare , Caribbean Public Health Agency , Hypertrophy, Left Ventricular , Hypertension
13.
Med. lab ; 26(1): 35-46, 2022. Grafs
Article in Spanish | LILACS | ID: biblio-1370947

ABSTRACT

COVID-19 es una enfermedad infecciosa respiratoria aguda, causada por el SARS-CoV-2, un nuevo coronavirus, que se extendió rápidamente por todo el mundo, dando como resultado una pandemia. Los pacientes presentan un amplio espectro de manifestaciones clínicas, entre ellas, la miocarditis, y de manera alterna, algunos pacientes sin síntomas de enfermedad cardíaca, tienen anomalías en las pruebas, como elevación de la troponina y arritmias cardíacas en el electrocardiograma, o anomalías en las imágenes cardíacas. La patogenia del compromiso miocárdico no es clara, pero las dos principales teorías prevén un papel directo de la enzima convertidora de angiotensina 2, que funciona como el receptor viral, y una respuesta hiperinmune, que también puede conducir a una presentación aislada. El estándar de oro del diagnóstico es la biopsia endomiocárdica, la cual no está disponible en la mayoría de los escenarios. En esta revisión, se pretende brindar al lector pautas para identificar las manifestaciones clínicas, ayudas diagnósticas y manejo de los pacientes con sospecha de miocarditis por COVID-19


COVID-19 is an acute respiratory infectious disease caused by a new coronavirus, SARS-CoV-2 virus, that spread rapidly around the world, resulting in a pandemic. Patients present with a wide spectrum of clinical manifestations, including myocarditis, and alternately, some patients without symptoms of heart disease have abnormalities in tests, such as elevated troponin, arrhythmias in the ECG orabnormalities in cardiac imaging testing. The pathogenesis of myocardial involvement is not completely clear, but the two main theories suggest a direct role of the angiotensin-converting enzyme, which functions as the virus receptor, and a hyperimmune response, which can also lead to an isolated presentation. The gold standard for the diagnosis is the endomyocardial biopsy, which is not available in most settings. In this review, we intend to provide the reader with guidelines to identify the clinical manifestations, diagnostic tools, and management of patients with suspected COVID-19 myocarditis


Subject(s)
COVID-19 , Biopsy , Echocardiography , SARS-CoV-2 , Myocarditis , Myocardium
14.
Arq. bras. cardiol ; 118(2): 422-432, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364337

ABSTRACT

Resumo Fundamento Amiloidose sistêmica é uma doença com manifestações clínicas diversas. O diagnóstico envolve suspeita clínica, aliada a métodos complementares. Objetivo Descrever o perfil clínico, laboratorial, eletrocardiográfico e de imagem no acometimento cardíaco da amiloidose sistêmica. Métodos Estudo de uma amostra de conveniência, analisando dados clínicos, laboratoriais, eletrocardiográficos, ecocardiográficos, medicina nuclear e ressonância magnética. Considerou-se significância estatística quando p < 0,05. Resultados Avaliaram-se 105 pacientes (com mediana de idade de 66 anos), sendo 62 homens, dos quais 83 indivíduos apresentavam amiloidose por transtirretina (ATTR) e 22 amiloidose por cadeia leve (AL). Na ATTR, 68,7% eram de caráter hereditário (ATTRh) e 31,3% do tipo selvagem (ATTRw). As mutações mais prevalentes foram Val142Ile (45,6%) e Val50Met (40,3%). O tempo de início dos sintomas ao diagnóstico foi 0,54 e 2,15 anos nas formas AL e ATTR (p < 0,001), respectivamente. O acometimento cardíaco foi observado em 77,9% dos ATTR e 90,9% dos AL. Observaram-se alterações de condução atrioventricular em 20% e intraventricular em 27,6% dos pacientes, sendo 33,7 % na ATTR e 4,5% das AL (p = 0,006). A forma ATTRw apresentou mais arritmias atriais que os ATTRh (61,5% x 22,8%; p = 0,001). Ao ecocardiograma a mediana da espessura do septo na ATTRw x ATTRh x AL foi de 15 mm x 12 mm x 11 mm (p = 0,193). Observou-se BNP elevado em 89,5% dos indivíduos (mediana 249 ng/mL, IQR 597,7) e elevação da troponina em 43,2%. Conclusão Foi possível caracterizar, em nosso meio, o acometimento cardíaco na amiloidose sistêmica, em seus diferentes subtipos, através da história clínica e dos métodos diagnósticos descritos.


Abstract Background Systemic amyloidosis is a disease with heterogeneous clinical manifestations. Diagnosis depends on clinical suspicion combined with specific complementary methods. Objective To describe the clinical, laboratory, electrocardiographic, and imaging profile in patients with systemic amyloidosis with cardiac involvement. Methods This study was conducted with a convenience sample, analyzing clinical, laboratory, electrocardiographic, echocardiographic, nuclear medicine, and magnetic resonance data. Statistical significance was set at p < 0.05. Results A total of 105 patients were evaluated (median age of 66 years), 62 of whom were male. Of all patients, 83 had transthyretin (ATTR) amyloidosis, and 22 had light chain (AL) amyloidosis. With respect to ATTR cases, 68.7% were the hereditary form (ATTRh), and 31.3% were wild type (ATTRw). The most prevalent mutations were Val142Ile (45.6%) and Val50Met (40.3%). Time from onset of symptoms to diagnosis was 0.54 and 2.15 years, in the AL and ATTR forms, respectively (p < 0.001). Cardiac involvement was observed in 77.9% of patients with ATTR and in 90.9% of those with AL. Alterations were observed in atrioventricular and intraventricular conduction in 20% and 27.6% of patients, respectively, with 33.7% in ATTR and 4.5% in AL (p = 0.006). In the ATTRw form, there were more atrial arrhythmias than in ATTRh (61.5% versus 22.8%; p = 0.001). On echocardiogram, median septum thickness in ATTRw, ATTRh, and AL was 15 mm, 12 mm, and 11 mm, respectively (p = 0.193). Elevated BNP was observed in 89.5% of patients (median 249, ICR 597.7), and elevated troponin was observed in 43.2%. Conclusion In this setting, it was possible to characterize cardiac involvement in systemic amyloidosis in its different subtypes by means of clinical history and the diagnostic methods described.


Subject(s)
Humans , Male , Female , Adult , Cardiology , Amyloid Neuropathies, Familial/diagnostic imaging , Amyloidosis/diagnostic imaging , Cardiomyopathies/diagnostic imaging , Referral and Consultation , Brazil , Prealbumin/genetics , Echocardiography
15.
Einstein (Säo Paulo) ; 20: eRC6478, 2022. tab, graf
Article in English | LILACS | ID: biblio-1364801

ABSTRACT

ABSTRACT Primary cardiac tumors are rare, with an incidence between 0.0017 and 0.19%, and are asymptomatic in up to 72% of cases. Approximately 75% of tumors are benign, and nearly 50% of these are myxomas. Concerning location, 75% of myxomas are in the left atrium, 15 to 20% in the right atrium, and more rarely in the ventricles. The finding of cardiac myxomas usually implies immediate surgical excision to prevent embolic events and sudden cardiac death. Reports with documented growth rate are rare, and the actual growth rate remains a controversial issue. We report the rapid growth rate of a right atrial myxoma in an oligosymptomatic 69-year-old patient, with negative previous echocardiographic history in the last two years, who refused surgery upon diagnosis, enabling monitoring of myxoma growth.


Subject(s)
Humans , Aged , Heart Neoplasms/surgery , Heart Neoplasms/diagnostic imaging , Myxoma/surgery , Myxoma/diagnostic imaging , Echocardiography , Incidence , Heart Atria/pathology , Heart Atria/diagnostic imaging
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