Isquemia miocárdica na síndrome cardíaca X investigada com ecocardiografia sob estresse físico / Myocardial ischemia in cardiac syndrome X evaluated by exercise echocardiography

Objetivo: Avaliar o significado da evidência da isquemia miocárdica e a ocorrência de eventos cardiovasculares na Síndrome Cardíca X (SCX), comparando com doença coronária obstrutiva inicial (DAC <- 50 por cento). Métodos: Estudo observacional de coorte, em, amostra de 605 pacientes (população fonte de 5.137 indivíduos), com ecocardiografia sob estresse físico (EEF) positiva para isquemia miocárdica, os quais foram submetidos à cineangiocoronariografia, e divididos, posteriormente, em 2 grupos: G1 (SCX, n=64) e G2 (DAC<- 50 por cento, n=84). Os pacientes foram comparados quanto às características clínicas, parâmetros ergométricos e ecocardiográficos, e seguidos po +- 43,8 meses (mínimo de 12 meses e máximo de 85 meses), quanto ao surgimento de ngina típica, infarto agudo do miocárdico...

Longevity in untreated congenital growth hormone deficiency due to a homozygous mutation in the GHRH receptor gene.

CONTEXT: Reduced longevity observed in hypopituitarism has been attributed to GH deficiency (GHD). It is, however, unclear whether GHD or other confounding factors cause this early mortality. OBJECTIVE: The aim was to study longevity in subjects from a large kindred with untreated, lifetime isolated GHD (IGHD) due to a homozygous mutation in the GHRH receptor gene and in heterozygous carriers of the mutation. DESIGN, SETTING, AND PARTICIPANTS: We carried out a retrospective cohort study on three groups. We first compared mortality risk of 65 IGHD individuals and their 128 unaffected siblings from 34 families. We then compared mean age of death of the IGHD to the general population. A transversal study was carried out to compare the rate of heterozygosity for the mutation in two groups of young (20-40 yr old) and old (60-80 yr old) normal-appearing subjects from the same county. MAIN OUTCOME MEASURE: We measured longevity. RESULTS: The risk of death of IGHD subjects was not different from their siblings. Life span in IGHD individuals was shorter than the general population. When stratified by sex, this difference persisted only in females, due to a high frequency of IGHD deaths in females aged 4-20. There was no significant difference in life span between IGHD subjects and siblings or the general population when analyzing subjects who reached age 20. The prevalence of heterozygosity did not differ in young and old groups, suggesting no survival advantage or disadvantage. CONCLUSIONS: In a selected genetic background, lifelong untreated IGHD does not affect longevity.

Adipokine profile and urinary albumin excretion in isolated growth hormone deficiency.

BACKGROUND: GH deficiency (GHD) is often associated with cardiovascular risk factors, including abdominal fat accumulation, hypercholesterolemia, and increased C-reactive protein. Despite the presence of these risk factors, adults with congenital lifetime isolated GHD (IGHD) due to an inactivating mutation in the GHRH receptor gene do not have premature atherosclerosis. OBJECTIVE: The aim was to study the serum levels of adiponectin and leptin (antiatherogenic and atherogenic adipokine, respectively), and the urinary albumin excretion (UAE) in these IGHD individuals. DESIGN AND PATIENTS: We conducted a cross-sectional study of 20 IGHD individuals (seven males; age, 50.8 +/- 14.6 yr) and 22 control subjects (eight males; age, 49.9 +/- 11.5 yr). MAIN OUTCOME MEASURES: Anthropometric factors, body composition, blood pressure, serum adiponectin, leptin, and UAE were measured. RESULTS: Adiponectin was higher [12.8 (7.1) vs. 9.7 (5) ng/ml; P = 0.041] in IGHD subjects, whereas no difference was observed in leptin [7.3 (6.3) vs. 9.3 (18.7 ng/ml] and UAE [8.6 (13.8) vs. 8.5 (11.1) microg/min]. CONCLUSIONS: Subjects with lifetime untreated IGHD have an adipokine profile with high adiponectin and normal leptin levels that may delay vascular damage and lesions of the renal endothelium.