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1.
Can J Cardiol ; 36(4): 518-526, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32007348

RESUMO

BACKGROUND: The clinical significance of left ventricular (LV) trabeculation remains unknown in cardiomyopathies. B-Type natriuretic peptide (BNP) strongly reflects LV end-diastolic wall stress and is a useful prognostic marker of cardiovascular diseases. The enhanced identification of LV trabeculae (T) with the use of cardiac magnetic resonance and the evaluation of its relationship with BNP may elucidate the biologic significance and clinical impact of trabeculation in patients with nonischemic cardiomyopathy (NICM). METHODS: The LV volume and mass of 515 patients with NICM and 36 control subjects were analyzed with the use of a steady-state free precession sequence, and individual T mass was planimetred. Major adverse cardiac events (MACE) were assessed. RESULTS: T mass index correlated with LV end-diastolic volume index (EDVI), LV mass index, and papillary muscle mass index (all P < 0.001). Also, T mass index was positively correlated with BNP level (R = 0.381; P < 0.001) and was an independent determinant of BNP after adjusting for age, sex, body mass index (BMI), etiology, LV ejection fraction, and LV EDVI (P < 0.001). Kaplan-Meier analysis during a median follow-up of 17.3 months showed that higher T mass index and increased BNP level correlated with MACE. On multivariate analysis, T mass index (P = 0.031) and BNP (P < 0.001) remained associated with poor outcomes when combined with age, sex, BMI, and etiology. CONCLUSIONS: Increased LV trabeculation was associated with LV dysfunction/remodelling and impaired outcomes in NICM of various etiologies. This may support the biologic significance of LV trabeculation and could be attributed to its association with BNP through LV wall stress.

2.
Coron Artery Dis ; 31(1): 73-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31609758

RESUMO

BACKGROUND: Visual-functional mismatch between coronary angiography and fractional flow reserve (FFR) has been reported, and the underlying reason remains poorly understood. Therefore, the relationship between angiographic measurements and FFR was evaluated, and predictors for FFR in intermediate coronary artery stenosis were determined. METHODS: Consecutive 314 patients (405 lesions) with a lesion of 30-80% angiographic diameter stenosis who underwent invasive FFR were recruited. The myocardial area supplied by the coronary artery distal to the stenosis was evaluated using a modified version of the Bypass Angioplasty Revascularization Investigation (BARI) score. Participants underwent follow-up, and major cardiovascular events (MACE), including all-cause death, myocardial infarction (MI), and unplanned revascularization were recorded. RESULTS: Although % diameter stenosis was correlated with FFR (R = 0.279, P < 0.001), diameter stenosis-FFR mismatch was observed in 37.8% of the lesions. Although FFR values were not associated with clinical factors, such as age, sex, and comorbidities, it was correlated with minimal lumen diameter (MLD), diffuse lesion, presence of proximal lesion, and BARI score. In addition, the lesions in left anterior descending (LAD) coronary artery showed low FFR values compared with those in the left circumflex coronary artery or right coronary artery. In multivariate logistic analysis, MLD (ß coefficient = 0.330), diffuse lesion (ß coefficient = -0.266), proximal lesion (ß coefficient = -0.144), BARI score (ß coefficient = -0.219), and LAD lesion (ß coefficient = -0.293) were all independent predictors for FFR value. The estimated FFR value based on these factors showed smaller mismatch and higher sensitivity. No difference was observed in the event rates for MACE and MI or revascularization between the FFR-guided and estimated FFR-guided strategies. CONCLUSIONS: MLD, diffuse lesion, proximal lesion, BARI score, and lesion vessel were independent predictors for FFR in intermediate coronary stenosis. Not only the extent of local lesion stenosis but also the amount of myocardial supply and the lesion location may determine the physiological significance and explain the visual-functional mismatch. The estimation of FFR by these factors may be useful in clinical practice.

3.
Clin Res Cardiol ; 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31872264

RESUMO

BACKGROUND: Late gadolinium enhancement imaging (LGE) of the left ventricle (LV) by cardiac magnetic resonance (CMR) has prognostic value for patients with cardiac sarcoidosis (CS). Right ventricle (RV) dysfunction is also associated with adverse outcomes in patients with heart failure. Therefore, we sought to determine if RV LGE and dysfunction predicted adverse events in patients with suspected CS. METHODS: In 103 consecutive patients with suspected CS who underwent CMR, functional and remodeling indexes of both the LV and RV were measured and the extent and localization of LGE were also analyzed. Major adverse cardiac events (MACE) were defined as cardiovascular mortality, severe ventricular tachyarrhythmia, hospitalization with heart failure, and advanced atrioventricular block. RESULTS: During a median follow-up of 20.6 months, Kaplan-Meier analysis showed that decreased RV ejection fraction (EF) was associated with MACE (P < 0.001) and receiver operating characteristics curve (ROC) analysis indicated good predictive performance of RV EF for MACE (area under the ROC = 0.834). RV EF operated independently of LV EF or LGE extent for predicting MACE. In addition, the presence of LGE in RV was independently associated with MACE (P = 0.011), and a combined analysis of RV EF and RV LGE showed better risk stratification for MACE (P < 0.001). CONCLUSIONS: Both RV EF and LGE were independently associated with MACE and enhanced risk stratification in patients with suspected CS. CMR may be a useful tool for detecting myocardial function and fibrosis in both the LV and RV.

4.
Kidney Blood Press Res ; 44(5): 1050-1062, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487705

RESUMO

BACKGROUND: An increased cardiac troponin T (cTnT) level identifies a high-risk group in patients with end-stage renal disease; however, the mechanism of cTnT elevation remains unclear in such patients without acute coronary syndrome (ACS). Therefore, we explored the relationship between cTnT levels and the hemodynamic parameters and the prognostic potential of cTnT in stable patients with chronic hemodialysis (HD). METHODS: We included consecutive 174 patients with HD who were referred for coronary angiography due to stable coronary artery disease (CAD), peripheral artery disease (PAD), or heart failure (HF). Hemodynamic measurement was performed, and plasma cTnT, B-type natriuretic peptide (BNP), and A-type natriuretic peptide (ANP) were measured at the same time. The potential of 3 biomarkers to predict all-cause mortality, cardiac death or hospitalized HF, and vascular event was assessed. RESULTS: Increased log cTnT levels were correlated with increased log BNP and log ANP levels (r = 0.531, p < 0.001 and r = 0.411, p < 0.001, respectively). Not increased log cTnT, but increased log BNP and log ANP were associated with the presence of CAD and the extent of CAD. In contrast, they were all associated with the New York Heart Association functional classification and the presence of PAD and significantly correlated with left ventricular end-diastolic pressure (LVEDP) in an independent manner. Increased cTnT and BNP levels were associated with the mortality and hospitalized HF. However, increased cTnT was not associated with vascular events, unlike increased BNP. CONCLUSIONS: In patients with chronic HD without ACS, increased cTnT reflected increased LVEDP and the presence of HF or PAD independently, and it did not reflect the presence of CAD in contrast to increased BNP. cTnT and BNP were significant prognostic predictors; however, increased cTnT was associated with HF-related events, not with arteriosclerotic events.

5.
J Cardiol Cases ; 19(2): 66-69, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31193704

RESUMO

Catheter ablation (CA) targeting premature ventricular contraction (PVC) from Purkinje fibers can be an effective therapy for refractory ventricular fibrillation (VF) after myocardial infarction (MI). We experienced two cases in which catheter ablation targeting PVC initiating VF after percutaneous coronary intervention (PCI) in post-MI patients was effective despite transient early recurrences of VF. The first patient (a 68-year-old woman with MI) developed drug-refractory VF 3 days after PCI to the left anterior descending artery (LAD) and left circumflex artery. CA targeting Purkinje potential preceding PVC at the infarcted area eliminated both the PVCs and VF. Three days after the procedure, the VF attacks relapsed by a different type of PVC. However, the VF responded to conventional treatments and disappeared thereafter. In the second patient (an 83-year-old woman with old MI), refractory VF attacks occurred after PCI to the LAD. CA targeting Purkinje potential preceding two distinct types of PVC successfully suppressed the VF. Although the VF relapsed 2 days after CA, it was suppressed by conventional treatment and disappeared the next day. .

6.
J Am Coll Cardiol ; 73(24): 3228-3229, 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31221265
7.
Methods Cell Biol ; 151: 13-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30948005

RESUMO

This is a personal essay starting from the early study on fertilization signals in echinoderm and mammalian oocytes. It presents actual examples showing that a unexpected discovery leads to unimaginable development of the research in diverse directions in later years and yields a common concept after long years' effort and accumulation. Those outcomes are the happiest gift for researchers. We also learn many precepts in our own research life.


Assuntos
Potenciais de Ação/genética , Biologia Celular/história , Oócitos/crescimento & desenvolvimento , Espermatozoides/crescimento & desenvolvimento , Potenciais de Ação/fisiologia , Animais , Cálcio/metabolismo , Sinalização do Cálcio/genética , Equinodermos/genética , Equinodermos/crescimento & desenvolvimento , Feminino , Fertilização , História do Século XX , História do Século XXI , Humanos , Masculino , Mamíferos/crescimento & desenvolvimento
9.
Intern Med ; 58(14): 2041-2044, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30918200

RESUMO

An 84-year-old man presented with syncope. Prior to admission, ambulatory electrocardiogram had demonstrated non-sustained ventricular tachycardia. Echocardiography showed severe aortic stenosis. He was also diagnosed with hypertrophic cardiomyopathy (HCM) by cardiac magnetic resonance (CMR) showing remarkable inhomogeneous left ventricular hypertrophy and extensive late gadolinium enhancement (LGE) in the lesions at the upper border and right-ventricular side of the basal-mid septal wall. Finally, he showed complete atrioventricular (AV) block followed by a long pause and syncope several times after admission. In this case with several possible causes of syncope, the CMR findings suggested a clue concerning the etiology of his syncope: complete AV block in HCM.


Assuntos
Bloqueio Atrioventricular/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Fibrose/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/complicações , Imagem Cinética por Ressonância Magnética/métodos , Marca-Passo Artificial , Síncope/complicações , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica , Bloqueio Atrioventricular/cirurgia , Meios de Contraste , Eletrocardiografia Ambulatorial/métodos , Fibrose/cirurgia , Gadolínio DTPA , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Miocárdio/patologia , Síncope/cirurgia , Resultado do Tratamento
10.
Int J Cardiol ; 285: 65-71, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876665

RESUMO

AIMS: To compare the effects of metoprolol and carvedilol on baroreflex-mediated sympathetic circulatory regulation. METHODS: In anesthetized Wistar-Kyoto rats, carotid sinus baroreceptor regions were isolated. Changes in sympathetic nerve activity (SNA), arterial pressure (AP), heart rate (HR), and aortic flow (AoF) in response to a staircase-wise pressure input were examined before (control) and after intravenous injection of low-dose metoprolol (2 mg/kg), high-dose metoprolol (10 mg/kg), or carvedilol (0.67 mg/kg) (n = 6 each). Peripheral vascular resistance (PVR) was calculated from mean AP divided by mean AoF. RESULTS: Low-dose metoprolol had limited effect on sympathetic AP regulation compared to control [operating-point AP (drug vs. control): 88.7 ±â€¯7.1 vs. 98.3 ±â€¯3.3 mm Hg, not significant] despite a significant bradycardic effect. Although high-dose metoprolol showed central sympathoinhibition, it increased PVR at a given SNA as a peripheral effect. Consequently, high-dose metoprolol decreased the operating-point AP slightly (96.1 ±â€¯2.7 vs. 101.9 ±â€¯2.7 mm Hg, P < 0.01). Carvedilol showed no significant central sympathoinhibition at the dose examined in this study, but significantly reduced PVR at a given SNA, leading to a marked reduction in the operating-point AP (71.9 ±â€¯8.2 vs. 112.6 ±â€¯7.6 mm Hg, P < 0.05). CONCLUSION: Low-dose metoprolol has limited hypotensive effect despite blockade of sympathetic HR regulation. Although high-dose metoprolol induces central sympathoinhibition, it also induces peripheral vasoconstriction that antagonizes the hypotensive effect. In contrast, carvedilol exhibits hypotensive effect mainly through peripheral vasodilation. Although carvedilol is frequently classified as a ß-blocker, its vasodilatory effect via α1-adrenergic blockade plays an important role in AP reduction or heart failure treatment.


Assuntos
Barorreflexo/efeitos dos fármacos , Carvedilol/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Metoprolol/administração & dosagem , Sistema Nervoso Simpático/efeitos dos fármacos , Antagonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Animais , Barorreflexo/fisiologia , Pressão Sanguínea/efeitos dos fármacos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Eletrocardiografia , Insuficiência Cardíaca/fisiopatologia , Injeções Intravenosas , Masculino , Ratos , Ratos Endogâmicos WKY , Sistema Nervoso Simpático/fisiopatologia , Resultado do Tratamento
11.
J Cardiovasc Pharmacol Ther ; 24(4): 387-396, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30786751

RESUMO

BACKGROUND: Whether the reduction of heart rate with ivabradine (IVA) could affect sympathetic activation and cardiac innervation in heart failure (HF) remains unknown. PURPOSE: The present study assessed the chronic effects of IVA and ß-blocker on the systemic and local sympathetic nervous systems of hypertensive animals with HF. METHODS AND RESULTS: The Dahl salt-sensitive rats received chronic IVA, bisoprolol (BIS), or placebo (CTL) therapy. The survival of the animal models with IVA and BIS significantly improved (median; 19.7 in IVA and 19.7 in BIS vs 17.0 weeks in CTL, P < .001). A similar decrease in 24-hour heart rate (mean; 305 in IVA and 329 in BIS vs 388 beats/min in CTL, P < .001) without effect on blood pressure, and an improvement in the left ventricular dysfunction (mean fractional shortening; 56.7% in IVA and 47.8% in BIS vs 39.0% in CTL, P < .001) were observed in the animals with IVA and BIS. However, a negative inotropic effect was only observed in the animals with BIS. Excessive urinary noradrenaline excretion in animals with CTL was only suppressed with the use of IVA (mean; 1.35 µg/d in IVA and 1.95 µg/d in BIS vs 2.27 µg/d in CTL, P = .002). In contrast, atrial noradrenaline and acetylcholine depletion in the animals with CTL improved and the tyrosine hydroxylase expression in the both atria were restored with the use of both IVA and BIS. CONCLUSIONS: IVA therapy improved the survival of hypertensive animals with HF. Furthermore, it was associated with the amelioration of systemic sympathetic activation and cardiac sympathetic and parasympathetic nerve innervations. Chronic ß-blocker therapy with negative inotropic effects had beneficial effects only on cardiac innervations.

12.
Heart Vessels ; 34(8): 1317-1324, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30796565

RESUMO

The relationship between activation of the sympathetic nervous system (SNS) and improvement of left ventricular (LV) function and how this correlates with clinical outcomes are not fully explored in Takotsubo syndrome (TS). The purpose of this study is to evaluate the relationship between activation of the SNS and LV function improvement and how this correlates with clinical outcomes in TS. Patients with TS were retrospectively identified. Patients were divided into two groups according to the timing of LV function improvement: < 1 month (S group) and ≥ 1 month (L group). Activation of the SNS was assessed by plasma catecholamine measurement and Iodine-123 meta-iodobenzylguanidine (I123-MIBG) scintigraphy. In-hospital complications included heart failure, cardiogenic shock, the use of invasive or noninvasive ventilation, life-threatening arrhythmia, cerebrovascular event and all-cause death. A total of 90 patients with TS were enrolled. Of these, 39 patients were in the S group and 51 in the L group. There were no significant differences between the two groups in clinical demographics. The L group was characterized by enhanced SNS activation, including higher levels of catecholamines and lower late heart-mediastinum ratio followed by higher washout rate in I123-MIBG scintigraphy, compared with the S group. In-hospital complications were increased in the L group (56% vs. 33.3%, p = 0.03), including higher rates of heart failure (45% vs. 23%, p = 0.03) and in-hospital death (8.0% vs. 0%, p = 0.03). In patients with TS, high activity of the SNS was observed in patients with delayed LV function recovery, which was associated with in-hospital adverse outcomes.


Assuntos
3-Iodobenzilguanidina/administração & dosagem , Coração/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Sistema Nervoso Simpático/fisiopatologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Coração/inervação , Insuficiência Cardíaca/epidemiologia , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Cintilografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Volume Sistólico , Cardiomiopatia de Takotsubo/mortalidade , Cardiomiopatia de Takotsubo/fisiopatologia , Função Ventricular Esquerda
14.
Cardiovasc Interv Ther ; 34(1): 47-58, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29508236

RESUMO

It is unknown whether there is a threshold of creatine kinase (CK) or CK-MB affecting the subsequent mortality for post-discharge myocardial infarction (PDMI) after percutaneous coronary intervention. Current study sought to evaluate the impact of PDMI. The study population included 30,051 patients with successful coronary stenting and discharged alive in the pooled patient-level database of 4 Japanese studies (j-Cypher registry, CREDO-Kyoto PCI/CABG registry cohort-2, RESET, and NEXT). During 4.4 ± 1.4 year follow-up, 915 patients experienced PDMI (cumulative 5-year incidence of 3.6%). Among 466 patients with available peak CK ratio (peak CK/upper limit of normal), peak CK ratio (< 3) was present in 21% of patients, while peak CK ratios (≥ 3 and < 5), (≥ 5 and < 10), (≥ 10 and < 30), and (≥ 30) were present in 17, 25, 30, and 7.3% of patients, respectively. The excess mortality risk of patients with relative to those without PDMI for subsequent mortality was significant (adjusted HR 5.12, 95% CI 4.52-5.80, P < 0.001) by the Cox model with PDMI incorporated as the time-updated covariate. However, the mortality risk of patients in the smallest peak CK ratio category (< 3) was insignificant (HR 0.85, 95% CI 0.43-1.71, P = 0.65). In conclusion, despite significant overall mortality risk of PDMI, the mortality risk of small PDMI was similar to that of no PDMI, suggesting the presence of some threshold about infarct size influencing mortality.Trial registrations The Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial (RESET); NCT01035450 and NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial (NEXT); NCT01303640. J-Cypher and CREDO-Kyoto PCI/CABG registry cohort 2 were not registered into clinical trial database.


Assuntos
Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Creatina Quinase/análise , Feminino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Alta do Paciente/estatística & dados numéricos , Sistema de Registros , Medição de Risco/métodos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
15.
Medicine (Baltimore) ; 97(35): e11938, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30170386

RESUMO

RATIONALE: Diagnostic difficulty due to overlapped clinical findings exists in cardiac sarcoidosis (CS) patients who also have coronary artery disease. Since cardiac magnetic resonance (CMR) and fluorodeoxyglucose-positron emission tomography (FDG-PET) evaluate different pathological processes, that is, fibrosis and inflammation respectively, the combination may be useful in such a case. PATIENT CONCERNS: A 77-year-old man was admitted due to heart failure and advanced atrioventricular block who was previously diagnosed with cutaneous sarcoidosis and old myocardial infarction (MI) with angiographical evidence. DIAGNOSIS: He was finally diagnosed with CS using CMR and FDG-PET by specifying the myocardial lesion of sarcoidosis. INTERVENTIONS: He was treated with corticosteroids based on the diagnosis. OUTCOMES: The focal high uptake on FDG-PET was improved and he had a better clinical course without further cardiac events. LESSONS: Our case suggests that CMR and FDG-PET are complimentary, and the combination is useful for diagnosis of CS, particularly in cases that have previous MI.


Assuntos
Angiografia por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Infarto do Miocárdio/complicações , Tomografia por Emissão de Pósitrons/métodos , Sarcoidose/diagnóstico por imagem , Idoso , Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/etiologia , Fluordesoxiglucose F18 , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Compostos Radiofarmacêuticos , Sarcoidose/etiologia
16.
J Cardiovasc Comput Tomogr ; 12(5): 436-443, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30017608

RESUMO

BACKGROUND: Coronary computed tomography angiography (CCTA) not only provides information regarding luminal stenoses but also allows for visualization of mural atheromatous changes (coronary plaques). OBJECTIVE: We sought to elucidate whether plaques seen on CCTA enable prediction of 2-year outcomes in patients with suspected and known coronary artery disease (CAD). METHODS: Of 3015 patients who underwent CCTA, the images and 2-year clinical courses of 2802 patients were independently analyzed. The primary endpoint was the composite of all-cause death and acute coronary syndrome. RESULTS: During the 2-year observation period, 49 (1.7%) patients developed the primary outcome. The 2-year rates of the primary outcome in the normal (n = 515, no mural lesions), calcium (n = 654, calcified lesion alone), and plaque groups (n = 1633, presence of noncalcified or partially calcified plaques) were 0.2%, 2.0%, and 2.1%, respectively (P = 0.0028). Adverse plaque features such as low attenuation, positive remodeling, spotty calcification, and the napkin-ring sign (low-attenuation core with a higher-attenuation rim) were assessed by an independent core laboratory. Stepwise multivariate Cox proportional hazard analysis showed that a plaque with two or more characteristics (adjusted hazard ratio, 1.98; 95% confidence interval, 1.09-3.60; P = 0.0254), age of ≥67 years (mean), statin treatment after CCTA, and obstructive stenosis remained independent predictors of the primary outcome. CONCLUSIONS: Plaque imaging in CCTA has predictive value for the 2-year outcome and is a useful identifier for high-risk patients among those with known and suspected CAD.


Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Placa Aterosclerótica , Calcificação Vascular/diagnóstico por imagem , Idoso , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Calcificação Vascular/mortalidade , Calcificação Vascular/patologia
17.
Int J Cardiol ; 257: 255-261, 2018 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-29506704

RESUMO

AIMS: To assess the acute effects of intravenous ivabradine, a selective bradycardic agent, on carotid sinus baroreflex-mediated sympathetic arterial pressure (AP) and heart rate (HR) responses. METHODS AND RESULTS: In anesthetized and vagotomized Wistar-Kyoto rats (n=6), carotid sinus baroreceptor regions were isolated. Changes in splanchnic sympathetic nerve activity (SNA), AP, and HR in response to a step-wise pressure input were examined before and after intravenous ivabradine (2mg/kg). Ivabradine did not affect the response range of SNA (91.8±6.5 vs. 93.5±9.8%) or AP (89.6±10.6 vs. 91.0±9.7mmHg). Ivabradine significantly reduced the minimum HR from 369.4±8.4 to 223.3±13.2 (P<0.001) but did not attenuate the HR response range (69.1±7.0 vs. 82.5±9.6beats/min). CONCLUSIONS: Ivabradine does not acutely affect baroreflex-mediated sympathetic AP regulation and also spares the magnitude of the sympathetic HR response, despite significant bradycardia. The preserved sympathetic HR response, which could not be afforded by beta-blockers, may contribute to some beneficial clinical effects of ivabradine.


Assuntos
Barorreflexo/efeitos dos fármacos , Benzazepinas/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Fármacos Cardiovasculares/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Pressorreceptores/efeitos dos fármacos , Animais , Barorreflexo/fisiologia , Pressão Sanguínea/fisiologia , Relação Dose-Resposta a Droga , Frequência Cardíaca/fisiologia , Ivabradina , Pressorreceptores/fisiologia , Ratos , Ratos Endogâmicos WKY , Sistema Nervoso Simpático/efeitos dos fármacos , Sistema Nervoso Simpático/fisiologia
18.
Front Cardiovasc Med ; 4: 10, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28321399

RESUMO

Mortality among the patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) remains high because of the very high incidence of cardiovascular disease (CVD) such as coronary artery disease, cardiac hypertrophy, and heart failure. Identifying CVD in patients with CKD/ESRD remains a significant hurdle and the early diagnosis and therapy for CVD is crucial in these patients. Therefore, it is necessary for the better management to identify and utilize cardiovascular (CV) biomarkers in profiling CVD risk and enabling stratification of early mortality. This review summarizes current evidence about renocardiovascular biomarkers: CV biomarkers in patients with CKD as well as with ESRD, emphasizing on the emerging biomarkers: B-type natriuretic peptide, cardiac troponins, copeptin, the biomarker of renal injury (neutrophil gelatinase-associated lipocalin), and the mineral and bone disorder hormone/marker (fibroblast growth factor-23). Furthermore, it discusses their potential roles especially in ESRD and in future diagnostic and therapeutic strategies for CVD in the context of managing cardiorenal syndrome.

19.
Circ J ; 81(5): 668-674, 2017 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-28216515

RESUMO

BACKGROUND: The CRYO-Japan PMS study indicated that cryoballoon ablation (Cryo-Abl) has a lower acute success rate of pulmonary vein isolation (PVI) for the right and left inferior PVs (RIPV and LIPV, respectively) than for the superior PVs. This study aimed to determine if the orientation and position of the inferior PVs are related to the difficulty of acute success of PVI.Methods and Results:We investigated 30 consecutive patients who underwent Cryo-Abl. A "difficult PV" was defined as the requirement for >2 cooling applications and/or touch-up ablation to achieve PVI. We measured the ventral angle between the vertical line and the direction of each PV trunk (PV angle) on the transverse plane of enhanced CT images. PV position was defined as the difference in the levels between the bottom of the RIPVs and the non-coronary cusp of the aorta. PV angle <105° and PV position <1.250 mm were independent factors of difficult RIPV isolation (PV angle: odds ratio (OR)=23.80, confidence interval (CI) -3.15528 to -0.53622, P=0.002; PV position: OR=12.14, CI -2.77301 to -0.23160, P=0.014). PV position <16.875 mm was also related to the difficulty of LIPV isolation (OR=5.78, CI -1.77095 to -0.09474, P=0.027). CONCLUSIONS: RIPV with ventral orientation may require difficult maneuvers to advance an ablation system towards it. Low take-off of the inferior PVs may cause non-coaxial configuration of balloon catheters towards the direction of these veins.


Assuntos
Fibrilação Atrial , Criocirurgia/métodos , Veias Pulmonares/patologia , Idoso , Angioplastia com Balão/métodos , Fibrilação Atrial/cirurgia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/anatomia & histologia , Veias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Heart Vessels ; 32(7): 893-901, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28130587

RESUMO

Low blood flow velocity in the left atrial appendage (LAA) indicates a high risk of thromboembolism. Although transesophageal echocardiography (TEE) has been the standard method with which to evaluate the LAA blood flow velocity, a clinically noninvasive method is desired. We hypothesized that the ratio of the Hounsfield unit (HU) density at two distinct points within the LAA represents the blood flow velocity in the LAA. We retrospectively investigated 60 consecutive patients with atrial fibrillation (paroxysmal type, n = 29) who underwent enhanced computed tomography (CT) and TEE. The peak emptying flow velocity in the LAA (LAAPV) was evaluated using TEE. HU density was measured at proximal and distal sites of the LAA (LAAp and LAAd) on CT images. The LAAd/LAAp ratio was correlated with the LAAPV (P < 0.01, r = 0.69). Among several indices, the HU ratio was the most significant parameter associated with the LAAPV (ß = 0.469, CI 28.602-68.286, P < 0.001). Receiver-operating characteristic analysis (area under the curve, 0.91) demonstrated that an HU density ratio cutoff of 0.32 discriminated a low LAAPV (<25 cm/s) with sensitivity of 90% and specificity of 84%. Flow velocity of the LAA can be estimated by the HU density ratio at distal and proximal sites within the LAA. Our method might be a feasible substitution for TEE to discriminate patients with a reduced LAAPV.


Assuntos
Apêndice Atrial/fisiopatologia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Velocidade do Fluxo Sanguíneo , Idoso , Ecocardiografia Transesofagiana , Feminino , Humanos , Japão , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
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