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1.
Tuberk Toraks ; 67(2): 102-107, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414640

RESUMO

Introduction: Respiratory and cardiac functions in association with skeletal and neurophysiologic systems can be evaluated with cardiopulmonary exercise testing (CPET). Compared to treadmill exercise test, CPET provides more comprehensive data about the hemodynamic response to exercise. Materials and Methods: We aimed to evaluate the relationship with CPET findings and coronary lesions identified on angiography in patients with angina pectoris who underwent teradmill exercise, CPET and coronary angiography (CAG). By this way we sought to examine the CPET parameters that might be predictive for coronary artery disease (CAD) before diagnostic exercise test results and ischemia symptoms develop. Thirty patients in whom CAG was planned because of symptoms and exercise test results were enrolled in the study. Oxygen consumption (VO2), carbondioxide production (VCO2), minute ventilation (VE), maximum work rate (WR), DVO2/DWR and O2 pulse (VO2/HR) values were calculated. Significant CAD was defined as ≥ 50% narrowing in at least one of the coronary arteries. Result: The mean age was 60.4 ± 8.9 years ve 21 (65.6%) of subjects were male. On CAG, CAD was detected in 19 (59.4%) patients. Maximum heart rate, heart rate reserve (HRR), VE/VCO2 measured at anaerobic threshold (AT) and VO2(mL/kg/min) were significantly differed in patients with CAD than those without (p= 0.031; p= 0.041; p= 0.028; p= 0.03 respectively). Peak VO2, VO2/WR and O2 pulse values were higher in patients with normal angiographic results than those with CAD but the difference did not reach to statistical significance. Conclusions: The findings of our study indicate that among CPET parameters AT VE/VCO2, ATVO2 (mL/kg/dk) and HRR can have predictive value in the diagnosis of CAD. We think that these parameters might be used in the evaluation of patients with angina and dyspnea suspected of CAD. In conclusion parameters obtained during the test that are not influenced by patient's effort might increase the value of CPET in the diagnosis CAD.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Teste de Esforço , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/fisiopatologia , Dióxido de Carbono/metabolismo , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Teste de Esforço/métodos , Teste de Esforço/normas , Tolerância ao Exercício , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Testes de Função Respiratória
2.
Angiology ; 67(10): 961-969, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27069111

RESUMO

Impaired fasting glucose (IFG) and impaired glucose intolerance (IGT) are predictors of cardiovascular disease (CVD). We tested the hypothesis that epicardial fat thickness (EFT) and carotid intima-media thickness (cIMT), as markers of early atherosclerosis, are increased in patients with prediabetes. We prospectively enrolled 246 patients (162 with prediabetes and 84 controls). Prediabetes was defined according to American Diabetes Association criteria, and patients were divided into 3 groups: group 1-IFG, group 2-IGT, and group 3-IFG + IGT. Both cIMT and EFT were significantly greater in patients with prediabetes compared with controls (0.81 ± 0.20 mm vs 0.68 ± 0.16 mm, P < .001 and 7.0 ± 2.0 mm vs 5.6 ± 1.6 mm, P < .001, respectively). This difference was mainly attributed to patients with IGT. Age, waist circumference, and 2-hour glucose independently predicted cIMT, while 2-hour glucose was the only independent predictor of EFT in multivariate analysis among other relevant parameters for cIMT and EFT. The cIMT and EFT (measured noninvasively) could be useful indicators of CVD risk in these patients. In order to prove this hypothesis, long-term prospective studies with greater patient numbers are required.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Adiposidade , Doenças das Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Ecocardiografia Doppler , Estado Pré-Diabético/complicações , Tecido Adiposo/fisiopatologia , Fatores Etários , Idoso , Doenças Assintomáticas , Biomarcadores/sangue , Glicemia/metabolismo , Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pericárdio , Estado Pré-Diabético/sangue , Estado Pré-Diabético/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Circunferência da Cintura
3.
World J Gastroenterol ; 22(6): 2024-9, 2016 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-26877607

RESUMO

Pulmonary vascular disorders including portopulmonary hypertension (PoPHT) are among the common complications of liver disease and are prognostically significant. Survival is very low without medical treatment and liver transplantation. With advances in medical therapy for elevated pulmonary artery pressure (PAP) and liver transplant surgery, survival of patients with PoPHT and advanced liver disease is significantly improved. Because of the prognostic significance of PoPHT and the limited donor pool, a comprehensive preoperative cardio-pulmonary assessment is of great importance in cirrhotic patients prior to transplant surgery. Therefore, a detailed transthoracic Doppler echocardiographic examination must be an essential component of this evaluation. Patients with mild PoPHT can safely undergo liver transplant surgery. In cases of moderate to severe PoPHT, right heart catheterization (RHC) should be performed. In patients with moderate to severe PoPHT on RHC (mean PAP 35-45 mmHg), vasodilator therapy should be attempted. Liver transplantation should be encouraged in cases that demonstrate a positive response. Bridging therapy with specific pulmonary arterial hypertension treatment agents should be considered until the transplant surgery and should be continued during the peri- and post-operative periods as needed.


Assuntos
Doença Hepática Terminal/cirurgia , Hipertensão Portal/etiologia , Hipertensão Pulmonar/etiologia , Cirrose Hepática/complicações , Anti-Hipertensivos/uso terapêutico , Cateterismo Cardíaco , Ecocardiografia Doppler , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/mortalidade , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/tratamento farmacológico , Hipertensão Portal/mortalidade , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/mortalidade , Cirrose Hepática/diagnóstico , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
4.
Hellenic J Cardiol ; 56(3): 201-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26021241

RESUMO

INTRODUCTION: Reduced exercise capacity is of clinical importance. Sometimes no corresponding cardiovascular disease can be found to explain this condition. We hypothesized that coronary microvascular dysfunction may have an effect on exercise capacity in patients without apparent cardiovascular disease. METHODS: Fifty patients (33 female, mean age 46.8 ± 12.4 years) without coronary artery or other cardiac disease were enrolled. Coronary microvascular function was evaluated by measurement of coronary flow reserve (CFR) during transthoracic pulsed-wave Doppler echocardiography with pharmacological stress. CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities after dipyridamole infusion. Exercise capacity was determined by treadmill exercise testing. Exercise time, metabolic equivalent (MET), and Duke treadmill score (DTS) were recorded and compared with the CFR data. RESULTS: CFR was correlated with exercise time (r=0.376, p=0.007), MET (r=0.435, p=0.002) and DTS (r=0.458, p=0.001). Exercise time, MET, and DTS were lower in patients with impaired CFR (<2) than in those with normal CFR (2) (5.3 ± 1.8 min vs. 8.6 ± 2.7 min, p<0.001; 7.3 ± 3.1 vs. 11.4 ± 2.8, p=0.002; -1.75 (-5.9, 5.0) vs. 7.5 (5.2, 9.41), p<0.001; respectively). CFR was lower in patients with MET7 as compared to patients with MET>7 (2.0 ± 0.5 vs. 2.6 ± 0.6, p=0.015). CONCLUSIONS: CFR is associated with exercise capacity. Thus coronary microvascular dysfunction may be a reason for reduced exercise capacity in patients who have no apparent cardiovascular disease.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Exercício/fisiologia , Adulto , Idoso , Fenômenos Fisiológicos Cardiovasculares/efeitos dos fármacos , Circulação Coronária/efeitos dos fármacos , Circulação Coronária/fisiologia , Vasos Coronários/fisiopatologia , Diástole/efeitos dos fármacos , Diástole/fisiologia , Dipiridamol/administração & dosagem , Dipiridamol/efeitos adversos , Ecocardiografia Doppler/métodos , Ecocardiografia Doppler de Pulso , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Microvasos/fisiopatologia , Pessoa de Meia-Idade , Variações Dependentes do Observador
5.
Exp Clin Transplant ; 13 Suppl 1: 235-41, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25894162

RESUMO

OBJECTIVES: Velocity vector imaging allows quantitation of myocardial strain and strain rate from 2-dimensional images based on speckle tracking echocardiography. The aim of this study was to analyze the changes in myocardial strain and strain rate patterns in patients with end-stage renal disease and renal transplant recipients. MATERIALS AND METHODS: We studied 33 patients with end-stage renal disease on hemodialysis (19 men; mean age, 36 ± 8 y), 24 renal transplant recipients with functional grafts (21 men; mean age, 36 ± 7 y) and 26 age- and sex-matched control subjects. Longitudinal peak systolic strain and strain rate for basal, mid, and apical segments of the left ventricular wall were determined by velocity vector imaging from apical 4- and 2-chamber views. The average longitudinal strain and strain rate for the left ventricle were noted. From short-axis views at the level of papillary muscles, average circumferential, and radial strain, and strain rate were assessed. RESULTS: Mean heart rate and systolic and diastolic blood pressure during imaging were similar between the groups. Longitudinal peak systolic strain and strain rate at basal and mid-segments of the lateral wall were significantly higher in renal transplant recipients and control groups than endstage renal disease patients. Average longitudinal systolic strain from the 4-chamber view was highest in control subjects (-14.5% ± 2.9%) and was higher in renal transplant recipients (-12.5% ± 3.0%) than end-stage renal disease patients (-10.2% ± 1.6%; P ≤ .001). Radial and circumferential strain and strain rate at the level of the papillary muscle were lower in patients with end-stage renal disease than other groups. CONCLUSIONS: Differences in myocardial function in patients with end-stage renal disease, renal transplant recipients, and normal controls can be quantified by strain imaging. Myocardial function is improved in renal transplant recipients compared with end-stage renal disease patients.


Assuntos
Ecocardiografia Doppler , Falência Renal Crônica/cirurgia , Transplante de Rim , Contração Miocárdica , Diálise Renal , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Adulto , Fenômenos Biomecânicos , Pressão Sanguínea , Estudos de Casos e Controles , Estudos Transversais , Feminino , Frequência Cardíaca , Humanos , Interpretação de Imagem Assistida por Computador , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Masculino , Valor Preditivo dos Testes , Estresse Mecânico , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
6.
Am J Cardiol ; 112(10): 1540-4, 2013 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-23972351

RESUMO

Migraine is a common neurovascular disorder characterized by attacks of severe headache, autonomic and neurologic symptoms. Migraine can affect many systems in the body, yet its effects on cardiovascular system are unclear. We hypothesized that migraine and coronary microvascular angina may be manifestations of a common systemic microvascular dysfunction and clinically associated. Forty patients with migraine and 35 healthy volunteers were included into the study. Using transthoracic Doppler echocardiography, coronary flow was visualized in the middle or distal part of the left anterior descending artery. Coronary diastolic peak flow velocities were measured with pulse wave Doppler at baseline and after dipyridamole infusion (0.56 mg/kg/4 min). Coronary flow reserve of <2 was considered normal. In addition, thorough 2-dimensional and Doppler echocardiographic examinations were also performed. Fifty-two women and 23 men were included. Coronary flow reserve was significantly lesser in the migraine group than in the control group (1.99 ± 0.3 vs 2.90 ± 0.5, p <0.05). In addition, mitral annular velocities were lower and the ratio of early mitral inflow velocity to early mitral annular velocity (E/E' lateral and E/E' septal) was higher in migraineurs than in the control group (p <0.05 for all), indicating diastolic function abnormalities in the migraine group. In conclusion, these findings suggest that there is an association between coronary microvascular dysfunction and migraine independently of the metabolic state of the patients. A common pathophysiologic pathway of impaired endothelial vasodilatation, vasomotor dysfunction, and increased systemic inflammatory factors may play a role in these 2 clinical conditions and could be the underlying cause of subclinical systolic and diastolic left ventricular dysfunction in migraineurs.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Circulação Coronária/fisiologia , Vasos Coronários/fisiopatologia , Angina Microvascular/etiologia , Transtornos de Enxaqueca/fisiopatologia , Disfunção Ventricular Esquerda/complicações , Adolescente , Adulto , Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Ecocardiografia Doppler , Endotélio Vascular/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Angina Microvascular/diagnóstico por imagem , Angina Microvascular/fisiopatologia , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/etiologia , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Estudos Retrospectivos , Vasodilatação , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Adulto Jovem
8.
J Clin Hypertens (Greenwich) ; 14(12): 871-6, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23205754

RESUMO

Isolated systolic hypertension (ISH) is a common condition in the elderly that is associated with endothelial dysfunction. Concerning the effect of type of hypertension on coronary microvascular function, coronary flow reserve (CFR) in patients with ISH was evaluated and the results were compared with patients with combined systolic/diastolic hypertension (SDH). Seventy-six elderly patients (older than 60 years) who were free of coronary artery disease and diabetes mellitus were enrolled in the study (38 with ISH and 38 with combined SDH). Using transthoracic Doppler echocardiography, CFR was calculated as the ratio of hyperemic to baseline diastolic peak flow velocities. A CFR value of >2 was accepted as normal. The mean age was 68.6±6.3 years and the groups had similar features with regard to demographic and clinical characteristics. Patients with ISH had significantly lower CFR values compared with those with combined SDH (2.22±0.51 vs 2.49±0.56, respectively; P=.03). On multivariate regression analysis, ISH (ß=-0.40, P=.004) and dyslipidemia (ß=-0.29, P=.04) were the independent predictors of CFR. These findings indicate that CFR, an indicator of coronary microvascular/endothelial function, is impaired more profoundly in patients with ISH than in patients with combined SDH.


Assuntos
Pressão Sanguínea/fisiologia , Vasos Coronários , Ecocardiografia Doppler/métodos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Hipertensão , Idoso , Velocidade do Fluxo Sanguíneo , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Microcirculação , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Regressão
9.
Echocardiography ; 29(6): 634-40, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22404292

RESUMO

BACKGROUND: Abnormalities of coronary microcirculation have been reported in patients with diabetes mellitus (DM) even in the presence of normal coronary arteries. It is unknown when the microvascular effects on coronary arteries begin to appear in the DM disease course. Coronary flow reserve (CFR), determined by pharmacological stress transthoracic Doppler echocardiography, is a reliable indicator of coronary microvascular function. We sought to determine the coronary microvascular function of prediabetic patients compared to DM patients and normal population. METHODS: Seventy-four subjects with normal coronary arteries were enrolled. DM and prediabetes were diagnosed according to American Diabetes Association criteria. All subjects had Doppler recordings of the left anterior descending artery with adenosine infusion at a rate of 0.014 mg/kg per minute. RESULTS: The demographical characteristics and laboratory findings of the three groups were similar (DM group: n = 25, mean age 62 ± 7 years, 19 females; prediabetic group: n = 25, mean age 64 ± 12 years, 21 females; control group: n = 24, mean age 63 ± 7 years, 15 females) except fasting glucose levels. CFR values of the three groups were significantly different (DM group: CFR = 1.75 ± 0.50; prediabetic group: CFR = 2.24 ± 0.43; control group: CFR = 2.38 ± 0.32, P < 0.001). CFR values of DM group were lower than those of prediabetic and control groups (DM vs. prediabetic: P < 0.001, DM vs. control: P < 0.001). However, CFR levels of prediabetic group were not different from those of the control group (P = 0.481). DM was an independent factor predictive of CFR < 2 (OR, 22.69; 95% CI, 6.47-79.51; P < 0.001). CONCLUSION: Coronary microvascular function seems to be normal in the prediabetic state, but dysfunction appears after DM becomes overt.


Assuntos
Estenose Coronária/diagnóstico por imagem , Estenose Coronária/fisiopatologia , Complicações do Diabetes/diagnóstico por imagem , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/diagnóstico por imagem , Diabetes Mellitus/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico , Estenose Coronária/etiologia , Complicações do Diabetes/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia
10.
Acta Cardiol ; 66(2): 181-7, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21591576

RESUMO

OBJECTIVE: Patients with normal ejection fraction (EF) by conventional echocardiography may present with symptoms and findings of decreased cardiac functional capacity. We aimed to investigate the association between cardiac functional capacity determined by cardiopulmonary exercise test (CPET) and parameters of tissue Doppler (TD) imaging in patients with normal EF. METHODS: In all, 52 patients with normal EF were included. Conventional and TD imaging were performed. Peak systolic (S), early (E') and late (A') diastolic velocities were obtained from septal and lateral mitral annulus and tricuspid annulus by pulsed-wave TD. CPET was performed. Exercise time, peak oxygen consumption (peak VO2), anaerobic threshold (AT), metabolic equivalents (MET) values were determined and were compared with TD imaging parameters. RESULTS: We did not find any association between conventional echocardiographic measurements and cardiac functional capacity. However, peak S, E' and A velocity from the septal and tricuspid annulus and E' velocity from the lateral annulus correlated with exercise time, peak VO2, AT and MET (all P < 0.05). E/E' from the left ventricle correlated inversely with exercise time, peak VO2, AT and MET (all P < 0.05). S, E, A' velocities from septal and tricuspid annulus, E' velocity from lateral annulus were lower in patients with MET < or = 7 than in patients with MET > 7 (all P < 0.05). CONCLUSION: Systolic and diastolic velocities measured byTD imaging correlated with cardiac functional capacity as determined by CPET in patients with normal EF by conventional echocardiography. TD imaging could be more susceptible to determine cardiac functional capacity in these patients.


Assuntos
Ecocardiografia Doppler , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Volume Sistólico/fisiologia , Limiar Anaeróbio , Análise de Variância , Diástole/fisiologia , Teste de Esforço , Feminino , Testes de Função Cardíaca , Humanos , Modelos Lineares , Masculino , Equivalente Metabólico , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Sístole/fisiologia
11.
Circulation ; 123(15): 1622-32, 2011 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-21464051

RESUMO

BACKGROUND: Previous studies suggested that statin pretreatment reduces cardiac events in patients undergoing percutaneous coronary intervention. However, most data were observational, and single randomized trials included limited numbers of patients. METHODS AND RESULTS: We performed a collaborative meta-analysis using individual patient data from 13 randomized studies in which 3341 patients received either high-dose statin (n=1692) or no statin/low-dose statin (n=1649) before percutaneous coronary intervention, with all patients receiving statin therapy after intervention. Occurrence of periprocedural myocardial infarction, defined as postintervention creatine kinase-MB increase ≥3 times the upper limit of normal, and 30-day major adverse cardiac events (death, myocardial infarction, target-vessel revascularization) was evaluated. Incidence of periprocedural myocardial infarction was 7.0% in the high-dose statin versus 11.9% in the control group, which corresponds to a 44% risk reduction in the active-treatment arm (odds ratio by fixed-effects model 0.56, 95% confidence interval, 0.44 to 0.71, P<0.00001). The rate of major adverse cardiac events at 30 days was significantly lower in the high-dose statin group (7.4% versus 12.6%, a 44% risk reduction; P<0.00001), and 1-month major adverse cardiac events, excluding periprocedural events, were also reduced (0.6% versus 1.4%; P=0.05). The benefit of high-dose statins was realized irrespective of clinical presentation (P for interaction=0.43) and was maintained across various subgroups but appeared greater in the subgroup with elevated baseline C-reactive protein levels (n=734; 68% risk reduction for periprocedural myocardial infarction versus 31% in those 1861 patients with normal CRP; P for quantitative interaction=0.025). CONCLUSIONS: High-dose statin pretreatment leads to a significant reduction in periprocedural myocardial infarction and 30-day adverse events in patients undergoing percutaneous coronary intervention. This strategy should be considered in all patients with planned percutaneous coronary intervention.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Humanos , Complicações Pós-Operatórias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento
12.
Anadolu Kardiyol Derg ; 11(3): 207-12, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21421511

RESUMO

OBJECTIVE: Percutaneous coronary intervention (PCI) is known to induce both local and systemic inflammatory states. In addition to lowering lipid levels, statins exert well-proven anti-inflammatory effects. We investigated the effects of pravastatin on serum C-reactive protein (CRP) and neopterin levels in the short term after elective PCI. METHODS: In this randomized prospective study, 93 patients undergoing elective PCI were enrolled. Group 1 (n=30) received pravastatin at a dose of 10 mg/day, Group 2 (n=29) was given 40 mg/day, and Group 3 (n=34) served as the control group and received no lipid-lowering drugs. Blood samples were drawn before and after PCI to measure serum CRP and neopterin levels. Differences among the groups for continuous variables were evaluated by the ANOVA and the Kruskal-Wallis test as appropriate. The Chi-square test was used for comparison of categorical variables. RESULTS: Demographic features and the characteristics of the PCI, including the number of vessels and lesions and the duration and number of inflations, did not differ among groups (p>0.05). Serum CRP and neopterin levels were significantly increased after PCI (p<0.001). Mean serum neopterin levels before and after the PCI were as follows: Group 1: 13.3±5.9 vs 22.8±15.4 nmol/L, Group 2: 16.9±10.2 vs 22.0±14.9 nmol/L, controls: 15.2±11.9 and 18.8±11.5 nmol/L. Prior pravastatin therapy had no significant effect on these inflammatory markers (F=0.5, p=0.6). CONCLUSION: Percutaneous coronary intervention induces a pronounced inflammatory response. The pre-procedural administration of 2 different doses of pravastatin seems not enough to suppress this inflammation at the short-term follow-up. Further trials are needed to clarify this issue.


Assuntos
Angina Estável/terapia , Angioplastia Coronária com Balão/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/terapia , Pravastatina/uso terapêutico , Vasculite/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Estável/sangue , Angina Estável/complicações , Proteína C-Reativa/análise , Relação Dose-Resposta a Droga , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/complicações , Neopterina/sangue , Pravastatina/administração & dosagem , Pré-Medicação , Stents , Vasculite/etiologia
13.
Anadolu Kardiyol Derg ; 11(3): 201-6, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21421512

RESUMO

OBJECTIVE: We aimed to evaluate the relationship between postprandial triglyceride (PPTG) levels and coronary artery disease (CAD). METHODS: A total of 80 patients were included in this prospective cohort study. Oral lipid loading was used in order to measure PPTG levels. In the fasting state and after the high fat breakfast, triglyceride levels were measured by enzymatic methods at 2nd, 4th, 6th and 8th hours. We made subgroup analysis to show the effects of lipid loading on triglyceride levels in patients with and without fasting hypertriglyceridemia. We evaluated triglyceride levels and changes of triglyceride levels in percentages after lipid loading using a general linear model for repeated measures. Sample size analysis was performed. RESULTS: Baseline clinical, demographic and laboratory characteristics of both groups were similar. The peak triglyceride levels were seen at the 4th hour in both groups. Triglyceride levels were significantly increased after lipid-rich-breakfast loading compared to baseline levels in both groups (p<0.001) but these changes were not significant (p=0.279). In patients with elevated fasting triglyceride levels, the area under the plasma triglyceride concentration curve was significantly larger in CAD group than control group (334±103 vs. 233±58 mg/dl, p=0.02). CONCLUSION: Our data show that in patients who have a high fasting triglyceride level, high levels of PPTG may be related to CAD, however high PPTG levels are not related to CAD in patients with normal fasting levels of triglyceride.


Assuntos
Doença da Artéria Coronariana/etiologia , Hipertrigliceridemia/complicações , Período Pós-Prandial , Triglicerídeos/sangue , Idoso , Estudos de Coortes , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Hipertrigliceridemia/epidemiologia , Lipídeos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
14.
Turk Kardiyol Dern Ars ; 39(2): 122-8, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21430417

RESUMO

OBJECTIVES: Accumulating data indicate that serum gamma-glutamyltransferase (GGT) activity represents a true marker of atherosclerotic cardiovascular disease and has prognostic importance. In this study, we sought to evaluate serum GGT activity in patients with metabolic syndrome (MetS). STUDY DESIGN: We enrolled 232 patients (mean age 60.4 years) from our outpatient cardiology clinic, 117 with and 115 without MetS (control group) as defined by the ATP-III criteria. The results of serum liver function tests including serum GGT and C-reactive protein (CRP) levels were compared between the two groups. RESULTS: The two groups were similar with regard to age, sex, smoking, and family history of coronary artery disease (p>0.05). The prevalences of hypertension and dyslipidemia were significantly higher in patients with MetS. Compared with controls, patients with MetS had significantly higher serum GGT [(median 21, interquartile range (16-33) vs. 19 (14-26) U/l; p=0.008] and C-reactive protein levels [6.2 (3.6-9.4) vs. 5.0 (3.1-7.0) U/l; p=0.044]. A high GGT activity (>40 U/l) was determined in 14.5% of the patients with MetS and in 4.4% of the control subjects (p=0.012). Serum GGT level showed significant correlations with MetS (r=0.24, p=0.001), CRP (r=0.20, p=0.003), triglyceride (r=0.18, p=0.006), HDL cholesterol (r=-0.19, p=0.004), aspartate aminotransferase (r=0.15, p=0.02), alanine aminotransferase (r=0.32, p=0.001), and alkaline phosphatase (r=0.16, p=0.01). This significant association continued only for MetS (ß=-0.25, p=0.03), HDL cholesterol (ß=-0.18, p=0.03), and alkaline phosphatase (ß=0.17, p=0.01) in multivariate regression analysis. CONCLUSION: Our findings suggest that patients with MetS have higher serum GGT and CRP levels compared with controls. This increased GGT level might be a marker of increased oxidative stress and premature atherosclerosis.


Assuntos
Síndrome Metabólica/enzimologia , gama-Glutamiltransferase/sangue , Biomarcadores/sangue , Proteína C-Reativa/análise , Estudos de Casos e Controles , Colesterol/sangue , Dislipidemias/sangue , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/sangue , Hipertensão/epidemiologia , Modelos Lineares , Masculino , Síndrome Metabólica/sangue , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Prognóstico , Triglicerídeos/sangue
15.
Angiology ; 62(2): 107-10, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21220370

RESUMO

Serum gamma-glutamyltransferase (GGT) activity is a marker of oxidative stress and activity is associated with cardiovascular disease. Carotid intima-media thickness (IMT) is a noninvasive predictor of atherosclerosis. We investigated the association between serum GGT activity and carotid IMT. Fifty-five persons who had normal liver function tests were consecutively enrolled. Carotid IMT was evaluated in the right and left common carotid arteries. The averaged values of carotid IMT and serum GGT activity were compared. Serum GGT activity correlated with carotid IMT (r = .396, P = .003). Serum GGT activities were increased in patients with carotid intimal hyperplasia compared with those without intimal hyperplasia (20.3 ± 11.2 vs 34.3 ± 16.1 U/L; P = .001). Serum GGT activity is associated with carotid IMT. This finding supports the concept that elevated serum GGT activity is a marker of atherosclerosis.


Assuntos
Aterosclerose/enzimologia , Artérias Carótidas/patologia , Túnica Íntima/patologia , Túnica Média/patologia , gama-Glutamiltransferase/sangue , Adulto , Aterosclerose/diagnóstico , Aterosclerose/etiologia , Biomarcadores , Artérias Carótidas/diagnóstico por imagem , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Hiperplasia/diagnóstico , Hiperplasia/enzimologia , Hiperplasia/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Túnica Íntima/diagnóstico por imagem , Túnica Média/diagnóstico por imagem , Ultrassonografia
16.
Multidiscip Respir Med ; 6(3): 155-60, 2011 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-22959121

RESUMO

BACKGROUND: Pulmonary hypertension (PH) is present in a significant proportion of patients with end stage renal disease (ESRD) and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pulmonary artery pressure (SPAP) determined by Doppler echocardiography. METHODS: Analysis was performed on the records of 500 consecutive patients who underwent renal transplant at our center between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg. RESULTS: Pulmonary hypertension was detected in 85 of the 500 (17%) patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic examination was performed on 50 of the 85 patients. After exclusion of 8 cases (1 due to massive pulmonary thromboemboli; 7 due to graft failure requiring dialysis therapy) analyses were performed on 42 patients who had undergone both pre- and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3%) cases SPAP was above 50 mm Hg.Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p < 0.0001). CONCLUSION: These findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

17.
Turk Kardiyol Dern Ars ; 38(4): 239-43, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20935429

RESUMO

OBJECTIVES: We aimed to compare the level of platelet inhibition using the platelet function analyzer (PFA)-100 in patients receiving low and medium doses of aspirin. STUDY DESIGN: On a prospective basis, 159 cardiology outpatients (83 men, 76 women; mean age 60.9 ± 9.9 years) taking 100 mg/day or 300 mg/day aspirin at least for the previous 15 days were included. Of these, 79 patients (50%) were on 100 mg and 80 patients (50.3%) were on 300 mg aspirin treatment. Blood samples were collected between 09:30 and 11:00 hours in the morning. Platelet reactivity was measured with the PFA-100 system. Incomplete platelet inhibition was defined as a normal collagen/epinephrine closure time (< 165 sec) despite aspirin treatment. RESULTS: Baseline clinical and laboratory characteristics of the patient groups taking 100 mg or 300 mg aspirin were similar. The overall prevalence of incomplete platelet inhibition was 22% (35 patients). The prevalence of incomplete platelet inhibition was significantly higher in patients treated with 100 mg of aspirin (n = 24/79, 30.4%) compared with those treated with 300 mg of aspirin (n = 11/80, 13.8%) (p = 0.013). In univariate analysis, female sex (p = 0.002) and aspirin dose (p = 0.013) were significantly correlated with incomplete platelet inhibition. In multivariate analysis, female sex (OR: 0.99; 95% CI 0.9913-0.9994; p = 0.025) and aspirin dose (OR: 3.38; 95% CI 1.4774-7.7469; p = 0.003) were found as independent factors predictive of incomplete platelet inhibition. CONCLUSION: Our findings suggest that treatment with higher doses of aspirin can reduce incomplete platelet inhibition especially in female patients.


Assuntos
Aspirina/administração & dosagem , Cardiopatias/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Análise de Variância , Morte Súbita Cardíaca/prevenção & controle , Relação Dose-Resposta a Droga , Feminino , Cardiopatias/sangue , Cardiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Testes de Função Plaquetária , Prevenção Primária , Estudos Prospectivos , Prevenção Secundária , Fatores Sexuais , Acidente Vascular Cerebral/prevenção & controle
19.
Clin Cardiol ; 33(3): E1-7, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20155858

RESUMO

BACKGROUND: There are conflicting data in the literature about the clinical significance of aspirin resistance. HYPOTHESIS: We aimed to prospectively evaluate the prevalence of biochemical aspirin resistance in patients on aspirin therapy who were admitted to the emergency clinic with chest pain. We also aimed to evaluate the relation between acute coronary syndromes (ACS) and aspirin resistance. METHODS: A total of 338 patients were included in the study. Platelet reactivity was measured with the PFA-100 system (Dade Behring Inc, Deerfield, IL). Aspirin resistance determined by the PFA-100 was defined as a normal collagen and/or epinephrine closure time despite aspirin treatment (<165 s). RESULTS: Patients were divided into 4 groups: stable angina pectoris (SAP), unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI), ST-elevation myocardial infarction (STEMI), and rule out ACS. Aspirin resistance was found in 81 (24%) patients in all groups. Patients with ACS had significantly more aspirin resistance than patients with rule out ACS or patients with SAP (P < .001). In the SAP group, 31 (19.6%) patients; in the UA/NSTEMI group, 19 (35.8%) patients; in the STEMI group, 14 (50%) patients; and in the rule out ACS group, 17 (17.2%) patients had aspirin resistance (P < .001). In the multivariate analysis, cardiac biomarker elevation on admission to emergency department and platelet count appeared as independent factors predictive of aspirin resistance. CONCLUSIONS: We demonstrated that incidence of aspirin resistance was significantly higher in patients who were finally diagnosed as ACS, especially in aspirin-taking patients admitted to the emergency clinic with STEMI.


Assuntos
Síndrome Coronariana Aguda , Aspirina/farmacologia , Plaquetas/efeitos dos fármacos , Dor no Peito , Resistência a Medicamentos/efeitos dos fármacos , Inibidores da Agregação de Plaquetas/farmacologia , Idoso , Análise de Variância , Biomarcadores Farmacológicos , Colágeno/efeitos dos fármacos , Intervalos de Confiança , Estudos Transversais , Epinefrina , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Contagem de Plaquetas , Prevalência , Estudos Prospectivos , Fatores de Risco
20.
Anadolu Kardiyol Derg ; 10(1): 43-9, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20150004

RESUMO

OBJECTIVE: Pulmonary hypertension (PHT) is associated with high mortality and morbidity. Interest has increased in the use of drugs that, because of their neurohumoral inhibitory effects, inhibit the renin angiotensin system. In this study, we sought to examine whether losartan therapy is non-inferior to nifedipine in the treatment of secondary PHT. METHODS: This prospective randomized study consisted of 63 patients (mean age, 63.7+/- 9.1 years) with PHT who underwent Doppler echocardiographic examination. A baseline 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) were performed, and the endothelin-1 level of each patient was measured. Patients were assigned to two groups receiving treatment with nifedipine (n=30) and losartan (n=33). After 2 months of treatment, those measurements were repeated. The groups were compared with regard to effectiveness for the studied parameters using 2*2 factorial ANOVA design for repeated measurements. RESULTS: When posttreatment values were compared with baseline values in both groups, the following statistically significant changes were noted: the mean values of both mean and systolic pulmonary artery pressures (PAPs) were reduced (p<0.05) on Doppler echocardiography; exercise duration, work rate, and end-tidal carbon dioxide pressure (PETCO2) were higher (p<0.05 for all); and the minute ventilation (VE) and ventilatory equivalents for carbon dioxide (VE/VCO2) were lower (p<0.05 for both) according to the results of a CPET. No statistically significant change was noted in the mean levels of serum endothelin-1. With regard to the results cited above, no statistically significant difference was detected between the losartan and nifedipine groups (p>0.05). CONCLUSION: The findings of this study indicate that losartan is non-inferior to nifedipine for reducing PAP and improving exercise capacity. However, the short-term use of losartan or nifedipine had no statistically significant effect on endothelin-1 levels in patients with secondary PHT.


Assuntos
Hipertensão Pulmonar/tratamento farmacológico , Vasodilatadores/uso terapêutico , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/fisiopatologia , Diástole/efeitos dos fármacos , Ecocardiografia Doppler , Teste de Esforço/métodos , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Losartan , Pessoa de Meia-Idade , Nifedipino , Estudos Prospectivos
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