RESUMEN
BACKGROUND: Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker. METHODS: Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model. RESULTS: 98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (-21.6 ± 6.6% vs -31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%. CONCLUSIONS: In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.
Asunto(s)
Cardiomiopatía Dilatada , Insuficiencia Cardíaca , Disfunción Ventricular Derecha , Humanos , Estudios Retrospectivos , Imagen por Resonancia Cinemagnética , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/etiología , Cardiomiopatía Dilatada/diagnóstico por imagen , Espectroscopía de Resonancia Magnética , Función Ventricular Derecha , Volumen SistólicoRESUMEN
Cardiovascular studies investigating therapeutic intervention with clinical endpoints are costly due to the need for considerable duration and large number of patients, or both. Therefore, for evaluation of novel cardiovascular drug efficacy, surrogate endpoints are used. Cardiovascular imaging endpoints have proven their worth. Sometimes the relevance of imaging is questioned and other methods are suggested instead. There is also some confusion about the strengths of imaging endpoints. The aim of the present paper is to review ultrasound and radiology imaging techniques as surrogate endpoints in pharmacological trials.
Asunto(s)
Biomarcadores , Enfermedades Cardiovasculares/diagnóstico por imagen , Determinación de Punto Final/métodos , Aterosclerosis/diagnóstico por imagen , Arteria Braquial/fisiopatología , Gasto Cardíaco , Enfermedades Cardiovasculares/tratamiento farmacológico , Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Dilatación Patológica , Ecocardiografía , Ventrículos Cardíacos/patología , Humanos , Imagen por Resonancia Magnética , RadiografíaRESUMEN
Given the growing evidence about the use of membrane-covered stents to treat coronary artery aneurysms, it is fundamental to know the exact anatomy of the aneurysm to enable patients to be selected correctly. Invasive heart catheterization has limitations for diagnostic purposes and can underestimate the size of the aneurysm. In this article, we review the noninvasive diagnostic imaging techniques for the study of coronary artery aneurysms, illustrating the usefulness of each technique.
Asunto(s)
Aneurisma Coronario/diagnóstico , Anciano , Aneurisma Coronario/diagnóstico por imagen , Angiografía Coronaria , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Ultrasonografía , Adulto JovenAsunto(s)
Ablación por Catéter/efectos adversos , Cardiopatías/etiología , Taquicardia Ventricular/cirugía , Trombosis/etiología , Anticoagulantes/uso terapéutico , Ecocardiografía , Aneurisma Cardíaco/diagnóstico por imagen , Aneurisma Cardíaco/etiología , Ventrículos Cardíacos , Humanos , Infarto del Miocardio/complicaciones , Trombosis/diagnóstico por imagen , Trombosis/prevención & controlRESUMEN
OBJECTIVES: The purpose of this study was to determine whether human neutrophils express an endothelial-type nitric oxide synthase (eNOS), and to study the effect of tumor necrosis factor-alpha (TNF-alpha) on its expression. BACKGROUND: Several studies have demonstrated the presence of a constitutively expressed nitric oxide svnthase (NOS) in neutrophils. Cardiovascular disease is characterized by increased levels of plasma TNF-alpha, a cytokine that has demonstrated eNOS messenger ribonucleic acid (mRNA) destabilization in cultured endothelial cells. METHODS: Neutrophils were obtained from healthy volunteers and from patients with acute myocardial infarction (AMI). RESULTS: Human neutrophils express eNOS mRNA and eNOS protein. Stimulation of neutrophils with TNF-alpha decreased eNOS protein expression by reducing eNOS mRNA stabilization. In the present study, we also show that the cytosol of human neutrophils contains proteins that bind to a specific region within the 3'-untranslated region (3'-UTR) of eNOS mRNA. Tumor necrosis factor-alpha increased the binding of the cytosolic proteins to the 3'-UTR of eNOS mRNA. Simvastatin reduced the TNF-alpha-related binding activity of neutrophil cytosolic proteins to eNOS mRNA, which was associated with its protective effect on eNOS protein expression. The in vivo reproduction of the in vitro findings was performed in neutrophils obtained from patients with AMI and showed a diminished expression of eNOS protein, which was associated with increased binding of the cytosolic proteins. CONCLUSIONS: These observations demonstrate that human neutrophils express eNOS, which is downregulated by TNF-alpha and during AMI. This effect is associated with increased binding of neutrophil cytosolic proteins to the 3'-UTR of eNOS mRNA.
Asunto(s)
Infarto del Miocardio/sangre , Neutrófilos/metabolismo , Óxido Nítrico Sintasa/metabolismo , Factor de Necrosis Tumoral alfa/fisiología , Adulto , Anciano , Northern Blotting , Regulación hacia Abajo/fisiología , Femenino , Humanos , Hipolipemiantes/farmacología , Masculino , Persona de Mediana Edad , Óxido Nítrico Sintasa de Tipo III , Simvastatina/farmacologíaRESUMEN
Aneurysm of the anterior mitral leaflet is a rare complication of infective aortic valve endocarditis, the natural evolution of which is generally its rupture, with subsequent acute and severe mitral regurgitation. Its presence cannot be recognized with transthoracic echocardiography and even in surgery. We describe a 78-year-old man with aortic valve endocarditis, in whom transesophageal echocardiography was essential for the diagnosis of this complication, its therapeutic management, and the postoperative follow-up after simple valve repair. In addition, the most appropriate surgical approach is discussed.