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1.
Artigo em Inglês | MEDLINE | ID: mdl-30519544

RESUMO

Background: Archaeal genes present in Trypanosoma cruzi may represent symbionts that would explain development of heart failure in 30% of Chagas disease patients. Extracellular vesicles in peripheral blood, called exosomes (< 0.1 µm) or microvesicles (>0.1 µm), present in larger numbers in heart failure, were analyzed to determine whether they are derived from archaea in heart failure Chagas disease. Methods: Exosomes and microvesicles in serum supernatant from 3 groups were analyzed: heart failure Chagas disease (N = 26), asymptomatic indeterminate form (N = 21) and healthy non-chagasic control (N = 16). Samples were quantified with transmission electron microscopy, flow cytometer immunolabeled with anti-archaemetzincin-1 antibody (AMZ 1, archaea collagenase) and probe anti-archaeal DNA and zymography to determine AMZ1 (Archaeal metalloproteinase) activity. Results: Indeterminate form patients had higher median numbers of exosomes/case vs. heart failure patients (58.5 vs. 25.5, P < 0.001), higher exosome content of AMZ1 antigens (2.0 vs. 0.0; P < 0.001), and lower archaeal DNA content (0.2 vs. 1.5, P = 0.02). A positive correlation between exosomes and AMZ1 content was seen in indeterminate form (r = 0.5, P < 0.001), but not in heart failure patients (r = 0.002, P = 0.98). Higher free archaeal DNA (63.0 vs. 11.1, P < 0.001) in correlation with exosome numbers (r = 0.66, P = 0.01) was seen in heart failure but not in indeterminate form (r = 0.29, P = 0.10). Flow cytometer showed higher numbers of AMZ1 microvesicles in indeterminate form (64 vs. 36, P = 0.02) and higher archaeal DNA microvesicles in heart failure (8.1 vs. 0.9, P < 0.001). Zymography showed strong% collagenase activity in HF group, mild activity in IF compared to non-chagasic healthy group (121 ± 14, 106 ± 13 and 100; P < 0.001). Conclusions: Numerous exosomes, possibly removing and degrading abnormal AMZ1 collagenase, are associated with indeterminate form. Archaeal microvesicles and their exosomes, possibly associated with release of archaeal AMZ1 in heart failure, are future candidates of heart failure biomarkers if confirmed in larger series, and the therapeutic focus in the treatment of Chagas disease.


Assuntos
Archaea/fisiologia , Doença de Chagas/imunologia , Insuficiência Cardíaca/imunologia , Trypanosoma cruzi/imunologia , Trypanosoma cruzi/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos de Bactérias/sangue , Biomarcadores , Doença de Chagas/sangue , Colagenases , Exossomos , Feminino , Citometria de Fluxo , Insuficiência Cardíaca/sangue , Humanos , Masculino , Metaloproteases , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade
2.
J Am Coll Cardiol ; 72(21): 2577-2587, 2018 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-30466515

RESUMO

BACKGROUND: Myocardial fibrosis (MF) according to cardiac magnetic resonance (CMR) is a frequent finding in Chagas cardiomyopathy and has been associated with risk factors of poor outcome. OBJECTIVES: The goal of this study was to determine the prognostic value of MF in predicting combined hard events or all-cause mortality. METHODS: Patients with Chagas cardiomyopathy who had a previous CMR evaluation were included, and clinical follow-up was retrospectively obtained. The primary outcome was a combination of all-cause mortality, heart transplantation, antitachycardia pacing or appropriate shock from an implantable cardioverter-defibrillator, and aborted sudden cardiac death; the secondary outcome was all-cause mortality. RESULTS: A total of 130 patients were included; mean age was 53.6 ± 11.5 years, and 53.9% were female. The majority of patients reported no symptoms of heart failure or arrhythmia, but electrocardiographic and echocardiographic abnormalities were common. On CMR, left ventricular dilatation and dysfunction were frequent, and MF was found in 76.1%, with a mean mass of 15.2 ± 16.5 g. Over a median follow-up of 5.05 years, 58 (44.6%) patients reached the combined endpoint, and 45 (34.6%) patients died. MF was associated with the primary outcome as a continuous variable (adjusted hazard ratio: 1.031; 95% CI: 1.013 to 1.049; p = 0.001) and as a categorical variable (MF ≥12.3 g) (adjusted hazard ratio: 2.107; 95% CI: 1.111 to 3.994; p = 0.022), independently from the Rassi risk score. MF expressed as a continuous variable was also associated with all-cause mortality (adjusted hazard ratio: 1.028; 95% CI: 1.005 to 1.051; p = 0.017) independently from the Rassi risk score. CONCLUSIONS: MF is an independent predictor of adverse outcome in Chagas cardiomyopathy. Our data may support the use of CMR in better risk-stratifying this population and possibly guiding therapy.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Cardiomiopatia Chagásica/mortalidade , Miocárdio/patologia , Adulto , Idoso , Estudos de Coortes , Ecocardiografia/tendências , Feminino , Fibrose/diagnóstico por imagem , Fibrose/mortalidade , Seguimentos , Humanos , Imagem Cinética por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo
3.
J Cardiovasc Magn Reson ; 18(1): 88, 2016 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-27890014

RESUMO

BACKGROUND: Since a male-related higher cardiovascular morbidity and mortality in patients with Chagas' heart disease has been reported, we aimed to investigate gender differences in myocardial damage assessed by cardiovascular magnetic resonance (CMR). METHODS AND RESULTS: Retrospectively, 62 seropositive Chagas' heart disease patients referred to CMR (1.5 T) and with low probability of having significant coronary artery disease were included in this analysis. Amongst both sexes, there was a strong negative correlation between LV ejection fraction and myocardial fibrosis (male r = 0.64, female r = 0.73, both P < 0.001), with males showing significantly greater myocardial fibrosis (P = 0.002) and lower LV ejection fraction (P < 0.001) than females. After adjustment for potential confounders, gender remained associated with myocardial dysfunction, and 53% of the effect was mediated by myocardial fibrosis (P for mediation = 0.004). Also, the transmural pattern was more prevalent among male patients (23.7 vs. 9.9%, P < 0.001) as well as the myocardial heterogeneity or gray zone (2.2 vs. 1.3 g, P = 0.003). CONCLUSIONS: We observed gender-related differences in myocardial damage assessed by CMR in patients with Chagas' heart disease. As myocardial fibrosis and myocardial dysfunction are associated to cardiovascular outcomes, our findings might help to understand the poorer prognosis observed in males in Chagas' disease.


Assuntos
Cardiomiopatia Chagásica/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Adulto , Idoso , Cardiomiopatia Chagásica/patologia , Cardiomiopatia Chagásica/fisiopatologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Feminino , Fibrose , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Volume Sistólico , Função Ventricular Esquerda , Remodelação Ventricular
4.
J Cardiovasc Magn Reson ; 17: 97, 2015 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-26581396

RESUMO

BACKGROUND: Chagas' heart disease is an important public health problem in South America. Several aspects of the pathogenesis are not fully understood, especially in its subclinical phases. On pathology Chagas' heart disease is characterized by chronic myocardial inflammation and extensive myocardial fibrosis. The latter has also been demonstrated by late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR). In three clinical phases of this disease, we sought to investigate the presence of LGE, myocardial increase in signal intensity in T2-weighted images (T2W) and in T1-weighted myocardial early gadolinium enhancement (MEGE), previously described CMR surrogates for myocardial fibrosis, myocardial edema and hyperemia, respectively. METHODS: Fifty-four patients were analyzed. Sixteen patients with the indeterminate phase (IND), seventeen patients with the cardiac phase with no left ventricular systolic dysfunction (CPND), and twenty-one patients with the cardiac phase with left ventricular systolic dysfunction (CPD). All patients underwent 1.5 T CMR scan including LGE, T2W and MEGE image sequences to evaluate myocardial abnormalities. RESULTS: Late gadolinium enhancement was present in 72.2 % of all patients, in 12.5 % of IND, 94.1 % of the CPND and 100 % of the CPD patients (p < 0.0001). Myocardial increase in signal intensity in T2-weighted images (T2W) was present in 77.8 % of all patients, in 31.3 % of the IND, 94.1 % of the CPND and 100 % of the CPD patients (p < 0.0001). T1-weighted myocardial early gadolinium enhancement (MEGE) was present in 73.8 % of all patients, in 25.0 % of the IND, 92.3 % of the CPND and 94.1 % of the CPD (p < 0.0001). A good correlation between LGE and T2W was observed (r = 0.72, and p < 0.001). CONCLUSIONS: Increase in T2-weighted (T2W) myocardial signal intensity and T1-weighted myocardial early gadolinium enhancement (MEGE) can be detected by CMR in patients throughout all phases of Chagas' heart disease, including its subclinical presentation (IND). Moreover, those findings were parallel to myocardial fibrosis (LGE) in extent and location and also correlated with the degree of Chagas' heart disease clinical severity. These findings contribute to further the knowledge on pathophysiology of Chagas' heart disease, and might have therapeutic and prognostic usefulness in the future.


Assuntos
Cardiomiopatia Chagásica/patologia , Edema Cardíaco/patologia , Imagem por Ressonância Magnética , Miocárdio/patologia , Disfunção Ventricular Esquerda/patologia , Adulto , Idoso , Cardiomiopatia Chagásica/parasitologia , Cardiomiopatia Chagásica/fisiopatologia , Meios de Contraste , Estudos Transversais , Edema Cardíaco/parasitologia , Edema Cardíaco/fisiopatologia , Feminino , Fibrose , Compostos Heterocíclicos , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Sístole , Disfunção Ventricular Esquerda/parasitologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
7.
PLoS Negl Trop Dis ; 7(2): e2078, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23469305

RESUMO

BACKGROUND: Blood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease. OBJECTIVES: To assess the frequency of ECG abnormalities in T.cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction. METHODS: The study retrospectively enrolled 499 seropositive blood donors in São Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF)<0.50%. RESULTS: Right bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients -0.159,p<0.0003, and -0.142,p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction. CONCLUSIONS: ECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.


Assuntos
Anticorpos Antiprotozoários/sangue , Cardiomiopatia Chagásica/epidemiologia , Eletrocardiografia , Coração/fisiopatologia , Trypanosoma cruzi/imunologia , Adulto , Doadores de Sangue , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Circulation ; 127(10): 1105-15, 2013 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-23393012

RESUMO

BACKGROUND: Very few studies have measured disease penetrance and prognostic factors of Chagas cardiomyopathy among asymptomatic Trypanosoma cruzi-infected persons. METHODS AND RESULTS: We performed a retrospective cohort study among initially healthy blood donors with an index T cruzi-seropositive donation and age-, sex-, and period-matched seronegatives in 1996 to 2002 in the Brazilian cities of São Paulo and Montes Claros. In 2008 to 2010, all subjects underwent medical history, physical examination, ECGs, and echocardiograms. ECG and echocardiogram results were classified by blinded core laboratories, and records with abnormal results were reviewed by a blinded panel of 3 cardiologists who adjudicated the outcome of Chagas cardiomyopathy. Associations with Chagas cardiomyopathy were tested with multivariate logistic regression. Mean follow-up time between index donation and outcome assessment was 10.5 years for the seropositives and 11.1 years for the seronegatives. Among 499 T cruzi seropositives, 120 (24%) had definite Chagas cardiomyopathy, and among 488 T cruzi seronegatives, 24 (5%) had cardiomyopathy, for an incidence difference of 1.85 per 100 person-years attributable to T cruzi infection. Of the 120 seropositives classified as having Chagas cardiomyopathy, only 31 (26%) presented with ejection fraction <50%, and only 11 (9%) were classified as New York Heart Association class II or higher. Chagas cardiomyopathy was associated (P<0.01) with male sex, a history of abnormal ECG, and the presence of an S3 heart sound. CONCLUSIONS: There is a substantial annual incidence of Chagas cardiomyopathy among initially asymptomatic T cruzi-seropositive blood donors, although disease was mild at diagnosis.


Assuntos
Doenças Assintomáticas/epidemiologia , Doadores de Sangue , Cardiomiopatia Chagásica/sangue , Cardiomiopatia Chagásica/epidemiologia , Trypanosoma cruzi/isolamento & purificação , Adulto , Brasil/epidemiologia , Cardiomiopatia Chagásica/parasitologia , Estudos de Coortes , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
9.
Heart Surg Forum ; 11(1): E62-5, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18270145

RESUMO

BACKGROUND: The pericardial biopsy has opened a new perspective for the etiologic diagnosis of pericardial effusions, because adequate pericardial visualization via the use of a video camera can provide more accurate results. We assessed the usefulness of videopericardioscopy for the diagnosis and treatment of pericardial effusion of indeterminate origin. METHODS: We conducted a retrospective study of clinical data from patients who underwent videopericardioscopy examination for pericardial effusion without an established diagnosis. The video-assisted pericardioscopy procedure was performed through a small incision in the xiphoid area. RESULTS: From January 1998 to January 2007, 101 consecutive patients underwent videopericardioscopy evaluation for pericardial effusion. Ten patients were excluded because of lack of data. Fifty men and 41 women were included (mean age, 50 years; range, 14-76 years). All of the patients had moderate or significant pericardial effusion as demonstrated by echocardiography or computed tomography. The following diagnoses for the pericardial effusions were established: nonspecific inflammation, 50 cases (54.94%); neoplastic disorders, 22 cases (24.17%); tuberculous, 11 cases (12.08%); bacterial inflammatory process, 3 cases (3.29%); chylopericardial, 2 cases (2.19%); fungal infection, 2 cases (2.19%); and viral infection, 1 case (1.09%). Pericardioscopy evaluation provided the definitive diagnosis via the pericardial biopsy in 36.26% of the cases and via the results of fluid analyses in 13.18% of the cases; the use of both methods established the definitive diagnosis in 45.05% of the cases in this group of patients. The overall morbidity rate was 4.3%, and the most common complication was arrhythmia due to intraoperative manipulation, which ceased with the removal of the instruments from the pericardial cavity. We had 1 death, by cardiac tamponade, in the perioperative period. CONCLUSION: Videopericardioscopy is a safe and efficient method for obtaining a better diagnosis of and satisfactory therapeutic results for pericardial effusions of indeterminate cause, and such results are obtained via an improved exploration of the pericardial cavity.


Assuntos
Derrame Pericárdico/diagnóstico , Pericárdio/cirurgia , Adolescente , Adulto , Idoso , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/fisiopatologia , Derrame Pericárdico/cirurgia , Estudos Retrospectivos , Televisão , Procedimentos Cirúrgicos Torácicos
10.
Artigo em Inglês | MEDLINE | ID: mdl-17094053

RESUMO

INTRODUCTION: Chagas' disease is one of the most important causes of dilated cardiomyopathy in South and Central America. It is an inflammatory cardiomyopathy. We wanted to investigate whether it could have the same response to aldosterone antagonism as demonstrated before in other dilated cardiomyopathies. OBJECTIVE: To evaluate the role of spironolactone in myocardial remodelling in a Chagas cardiomyopathy model. MATERIAL AND METHODS: We studied 60 Sirius Hamsters divided into: control (C) infected (Inf) and Inf plus spironolactone (Infsp, 40 mg/kg/day) groups, for 11 months. Echocardiography with colour doppler was performed. Left ventricular end diastolic diameter (LVEDD), fractional shortening (FS) and corrected isovolumic relaxation time (IRT) were evaluated, as well as interstitial collagen volume fraction (ICVF) and myocardial inflammation. RESULT: The results demonstrated that survival was improved by use of spironolactone in the chronic phase (p<0.04). Body weight (BW) was C:190 g, Inf:167 g*, Infsp:198 g (*p<0.05, compared to C and Infsp), LVEDD/BW was C:0.31, Inf: 0.35*, Infsp: 0.29 (*p<0.05, compared to C and Infsp), FS was C:38, Inf: 35.5, Infsp: 38 (with no statistical difference) and IRT was C: 23 msec, Inf: 26 msec*, Infsp: 22 msec (p<0.05, compared to C and Infsp). ICVF (%) was attenuated at LV (C: 0.34+/-0.1, Inf: 1.75+/-0.7*, Infsp: 0.95+/-0.2*; *p<0.05, p<0.05). CONCLUSION: Spironolactone attenuated the myocardial remodelling in Chagas cardiomyopathy, reduced mortality during the chronic phase and reduced inflammatory infiltration.


Assuntos
Cardiotônicos/farmacologia , Cardiomiopatia Chagásica/patologia , Antagonistas de Receptores de Mineralocorticoides/farmacologia , Espironolactona/farmacologia , Trypanosoma cruzi , Remodelação Ventricular/efeitos dos fármacos , Aldosterona/metabolismo , Animais , Cardiomiopatia Chagásica/diagnóstico por imagem , Colágeno/análise , Cricetinae , Modelos Animais de Doenças , Ecocardiografia Doppler em Cores , Feminino , Mesocricetus , Miocárdio/química
11.
Echocardiography ; 23(9): 734-40, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16999691

RESUMO

Left ventricular outflow tract (LVOT) obstruction is predictive of a worse outcome in hypertrophic cardiomyopathy (HCM). In a detailed Doppler echocardiographic study of 178 selected HCM patients, the group of patients (n = 73) with the obstructive form (resting peak gradient > or = 30 mmHg) presented more hypertrophy and poorer systolic and diastolic left ventricular (LV) functions than the HCM group (n = 105) without obstruction. LVOT peak gradient was positively correlated with hypertrophy (P < 0.0001) and negatively to tissue Doppler mitral annulus systolic (P = 0.0001) and early diastolic (P < 0.0001) velocities. The gradient significantly correlated with E/Ea ratio (r = 0.67; P < 0.0001). By multiple regression, LVOT gradient was related to E/Ea, LV maximal thickness and left atrial size. In comparison with patients without obstruction, patients with obstruction presented greater hypertrophy (P < 0.0001), lower systolic and early diastolic mitral annulus velocities (both P < 0.0001), higher E/Ea ratio (P < 0.0001) and higher global function index (P < 0.0001). In HCM, beyond the effects on hypertrophy, LVOT obstruction is an independent determinant of LV functional abnormalities.


Assuntos
Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/fisiopatologia , Ecocardiografia Doppler , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Obstrução do Fluxo Ventricular Externo/etiologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Adolescente , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Brasil , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Análise Multivariada , Contração Miocárdica , Valor Preditivo dos Testes , Projetos de Pesquisa , Índice de Gravidade de Doença , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem
12.
Arq Bras Cardiol ; 86(3): 175-80, 2006 Mar.
Artigo em Português | MEDLINE | ID: mdl-16612443

RESUMO

OBJECTIVE: To determine whether NT pro-BNP levels are high in patients reporting pericardial diseases, as well as to investigate how they relate to diastolic dysfunction echocardiographic measures. METHODS: Twenty-five patients were split into two groups: 1) pericardial effusion (PE): 15 patients; 2) constrictive pericarditis (CP): 10 patients. A control group was made up with 30 individuals reporting no heart disease. Pericardial effusion was evaluated by bidimensional echocardiogram, with restriction evaluated by pulsed Doppler of mitral flow. CP diagnosis was confirmed by MRI. NT pro-BNP levels were measured by immunoassay and detected by electrochemiluminescence. RESULTS: From the 15 PD patients, 14 reported relevant PD, and only 1, moderate PD. Log NT pro-BNP was shown to be higher in PD (p < 0.05), with log mean of 2.31 pg/ml and CP (p < 0.05), with log mean of 2.67 pg/ml, when compared to control group, log mean of 1.32 pg/ml. No difference was reported between PD and CP (p = 0.149). The NT pro-BNP log showed to be correlated to peak velocity of the E wave (r = 0.845; p = 0.001) and with E/A (r = 0.717; p = 0.003). CONCLUSION: NT pro-BNP is shown to have increased in pericardial diseases, and is associated to diastolic dysfunction. It may serve as an additional method in quantifying restriction.


Assuntos
Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Derrame Pericárdico/diagnóstico , Pericardite Constritiva/diagnóstico , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Diástole/fisiologia , Ecocardiografia Doppler em Cores , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Pericardite Constritiva/diagnóstico por imagem
13.
Echocardiography ; 23(3): 197-201, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16524389

RESUMO

BACKGROUND: A global function index (GFI) derived from tissue Doppler imaging (TDI) has been proposed to improve the diagnosis of hypertrophic cardiomyopathy (HCM). We aimed to evaluate the usefulness of this index in a large selected HCM population. METHODS: GFI =[E/Ea]/Sa, was calculated at mitral annulus lateral and septal borders in 164 HCM patients and in 40 healthy volunteers. Group comparisons and correlations between GFI and other variables were performed. RESULTS: Of the 164 patients, 69 (42%) had a peak gradient >30 mmHg in the left ventricle outflow tract (LVOT). GFI (lateral or septal) was not normally distributed. There were differences among controls, obstructive HCM, and nonobstructive HCM (P < 0.0001), but significant overlap of GFI values were observed between groups. GFI was correlated to septal thickness (r = 0.44; P < 0.0001), left atrial diameter (r = 0.52; P < 0.0001), and LVOT gradient (r = 0.58; P < 0.0001). CONCLUSION: In a selected HCM population, GFI was limited by its asymmetrical distribution and significant overlap of values between groups. Further studies are necessary to verify the reliability of GFI in the clinical practice and its position among other tissue Doppler indices.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia Doppler , Adolescente , Adulto , Cardiomiopatia Hipertrófica/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatísticas não Paramétricas
14.
Arq. bras. cardiol ; 86(3): 175-180, mar. 2006. tab, graf
Artigo em Português | LILACS | ID: lil-424259

RESUMO

OBJETIVO: Determinar se os níveis de NT pro-BNP encontram-se elevados em pacientes com afecções pericárdicas e avaliar a sua relação com medidas ecocardiográficas de disfunção diastólica. MÉTODOS: Vinte e cinco pacientes foram divididos em dois grupos: 1) derrame pericárdico (DP), 15 pacientes; 2) pericardite constritiva (PC), 10 pacientes. Foi constituído um grupo controle de 30 indivíduos sem doença cardíaca. O grau de derrame pericárdico foi avaliado pelo ecocardiograma bidimensional e a restrição avaliada pelo Doppler pulsátil do fluxo mitral. O diagnóstico de PC foi confirmado por meio da ressonância magnética. Os níveis de NT pro-BNP foram medidos por imunoensaio com detecção por eletroquimioluminescência. RESULTADOS: Dos 15 pacientes com DP, 14 apresentavam DP importante e apenas 1, moderado. Log NT pro-BNP esteve aumentado no DP (p <0,05), com média de log 2,31 pg/ml e PC (p <0,05), com média de log 2,67 pg/ml, quando comparados ao grupo controle, média de log 1,32 pg/ml. Não houve diferença entre DP e PC (p = 0,149). O log NT pro-BNP correlacionou-se com o pico de velocidade da onda E (r = 0,845; p = 0,001) e com a relação E/A (r=0,717; p= 0,003). CONCLUSÃO: O NT pro-BNP encontra-se aumentado nas afecções pericárdicas e apresenta relação com o grau de disfunção diastólica, podendo servir como método adicional na quantificação de restrição.


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Derrame Pericárdico/diagnóstico , Pericardite Constritiva/diagnóstico , Biomarcadores/sangue , Diástole/fisiologia , Ecocardiografia Doppler em Cores , Métodos Epidemiológicos , Derrame Pericárdico , Pericardite Constritiva
15.
J Am Coll Cardiol ; 46(8): 1553-8, 2005 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-16226184

RESUMO

OBJECTIVES: We sought to investigate whether myocardial delayed enhancement (MDE) by magnetic resonance imaging (MRI) could quantify myocardial fibrosis (MF) in patients with Chagas' heart disease (CHD), thus defining the severity of the disease. BACKGROUND: Myocardial fibrosis secondary to ischemic disease can be imaged using MDE. Advanced CHD is characterized by progressive MF. METHODS: Fifty-one patients with CHD were enrolled: 15 seropositive asymptomatic participants in the indeterminate phase (IND); 26 patients with known clinical CHD; and 10 patients with known CHD and ventricular tachycardia (VT). Using a 1.5-T MRI system, we acquired left ventricular (LV) short-axis slices using cine-MRI (LV function) and inversion-recovery gradient-echo (MDE). RESULTS: Myocardial fibrosis by MRI was present in 68.6% of all patients, in 20% of IND, 84.6% of CHD, and 100% of VT (p < 0.001). Quantified MF increased progressively across disease severity subgroups (0.9 +/- 2.3% in IND; 16.0 +/- 12.3% in CHD; and 25.4 +/- 9.8% in VT, p < 0.001) and New York Heart Association functional classes (I: 7.5 +/- 9.5%; II: 21.9 +/- 13.8%; and III: 25.3 +/- 9.9% of LV mass, p < 0.001). Left ventricular ejection fraction and MF had significant negative correlation (r = -0.78, p < 0.001), similar to the segmental MF and function: 4.9 +/- 15.1% of MF in normal function, 32.5 +/- 32.5% in mildly hypokinetic, 57.8 +/- 31.4% in severely hypokinetic, and 72.3 +/- 36.2% in akinetic and dyskinetic segments, respectively (p < 0.001). CONCLUSIONS: In CHD, MDE by MRI quantifies MF that not only can be detected in the early asymptomatic stages but parallels well-established prognostic factors and provides unique information for clinical disease staging.


Assuntos
Cardiomiopatia Chagásica/patologia , Imagem por Ressonância Magnética , Cardiomiopatia Chagásica/complicações , Feminino , Fibrose , Humanos , Masculino , Miocárdio/patologia , Índice de Gravidade de Doença
16.
Am Heart J ; 150(1): 144-9, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16084161

RESUMO

AIM: The aim of this study was to analyze the relationships among exercise capacity (EC), hypertrophy, and diastolic function in nonobstructive hypertrophic cardiomyopathy (NOHCM). METHODS AND RESULTS: Twenty-seven patients with NOHCM were studied. Left ventricular hypertrophy (LVH) was determined by appropriate echocardiographic indexes. For diastolic function evaluation, the following were measured: the early (E) and late (A) waves, E/A, and deceleration time of E of the mitral flow; the systolic (S), diastolic (D), and atrial reversal (AR) waves, S/D, and the atrial systolic filling fraction of the pulmonary vein flow; and the early (Ea), late (Aa) waves, Ea/Aa, and E/Ea by tissue Doppler imaging. The difference between the duration of AR and A waves (DurAR - DurA), the peak VO2, and anaerobic threshold (AT) were also determined. In these patients, the E/Ea ratio was 8.9 +/- 3.2 and DurAR - DurA was 22.6 +/- 32.6 milliseconds. The peak VO2 and AT correlated with D (r = 0.55, P = .003 and .51, P = .007, respectively) and Ea/Aa (r = 0.56, P = .007 and .45, P = .03, respectively). There was no correlation between EC and LVH. CONCLUSIONS: Patients with NOHCM demonstrated evidences of elevated left ventricular (LV) end-diastolic pressure with normal filling pressure. EC compromise may be attributed to relaxation changes with inadequate filling of the left ventricle.


Assuntos
Cardiomegalia/complicações , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/fisiopatologia , Tolerância ao Exercício , Função Ventricular Esquerda , Adolescente , Adulto , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
Arq Bras Cardiol ; 82(3): 281-3, 2004 Mar.
Artigo em Português | MEDLINE | ID: mdl-15073654

RESUMO

The patient was a 70-year-old female with antecedents of diabetes mellitus and hypertension, being followed up in the outpatient care clinic due to chronic anemia after corrective surgery for angiodysplasia of the proximal jejunum, in whom an image suggestive of left atrial myxoma was found on routine transthoracic echocardiography. Then multiplanar transesophageal echocardiography and 3-dimensional echocardiography were performed, showing the latter better anatomical details of the tumor. The patient underwent exeresis of the mass with anatomicopathological confirmation of the tumor. Three-dimensional echocardiography proved to be a technique that can provide additional contributions to the diagnostic investigation of structural heart diseases.


Assuntos
Ecocardiografia Tridimensional , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Idoso , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos
18.
Arq. bras. cardiol ; 82(3): 281-286, mar. 2004. ilus
Artigo em Inglês, Português | LILACS | ID: lil-356899

RESUMO

Mulher de 70 anos, com antecedentes de diabetes mellitus e hipertensão arterial sistêmica, em acompanhamento ambulatorial por anemia crônica após cirurgia corretiva de angiodisplasia de jejuno proximal, apresentou imagem de mixoma em átrio esquerdo em exame ecocardiográfico transtorácico de rotina. Foi submetida a investigação ecocardiográfica transesofágica multiplanar e a estudo ecocardiográfico tridimensional. O ecocardiograma tridimensional propiciou melhor detalhamento anatômico da tumoração. A paciente foi submetida a exérese da massa, com confirmação anatomopatológica. O ecocardiograma tridimensional mostrou ser técnica que apresenta contribuição adicional à investigação diagnóstica das cardiopatias estruturais.


Assuntos
Humanos , Feminino , Idoso , Ecocardiografia Tridimensional , Neoplasias Cardíacas , Mixoma , Átrios do Coração
19.
Mem Inst Oswaldo Cruz ; 98(3): 407-11, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12886425

RESUMO

We compared plasma tumor necrosis factor-alpha (TNF-alpha) levels among asymptomatic/"indeterminate" Chagas disease patients (ASY) and patients across the clinical spectrum of chronic Chagas disease cardiomyopathy (CCC). Idiopathic dilated cardiomyopathy (DCM) patients and normal controls (NC) were included as controls. ASY Chagas disease patients had significantly higher plasma TNF-alpha levels than NC. TNF-alpha levels among severe CCC patients with significant left ventricular (LV) dysfunction were similar to those of DCM patients, showing average 2-fold higher levels than CCC patients without LV dysfunction and ASY patients, and 8-fold higher levels than NC. In Chagas disease, chronic TNF-a production prior to heart failure may play a role in CCC progression.


Assuntos
Cardiomiopatia Dilatada/sangue , Doença de Chagas/sangue , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cardiomiopatia Chagásica/sangue , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Disfunção Ventricular Esquerda/sangue
20.
Mem. Inst. Oswaldo Cruz ; 98(3): 407-412, Apr. 2003. tab, graf
Artigo em Inglês | LILACS | ID: lil-340124

RESUMO

We compared plasma tumor necrosis factor-alpha (TNF-alpha) levels among asymptomatic/"indeterminate" Chagas disease patients (ASY) and patients across the clinical spectrum of chronic Chagas disease cardiomyopathy (CCC). Idiopathic dilated cardiomyopathy (DCM) patients and normal controls (NC) were included as controls. ASY Chagas disease patients had significantly higher plasma TNF-alpha levels than NC. TNF-alpha levels among severe CCC patients with significant left ventricular (LV) dysfunction were similar to those of DCM patients, showing average 2-fold higher levels than CCC patients without LV dysfunction and ASY patients, and 8-fold higher levels than NC. In Chagas disease, chronic TNF-a production prior to heart failure may play a role in CCC progression


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Cardiomiopatia Dilatada , Doença de Chagas , Fator de Necrose Tumoral alfa , Idoso de 80 Anos ou mais , Cardiomiopatia Chagásica , Doença Crônica , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Disfunção Ventricular Esquerda
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