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1.
Heart Lung Circ ; 28(9): 1436-1446, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266726

RESUMO

Multivalvular heart disease (MVD) is a highly prevalent condition causing significant morbidity and mortality. The complex haemodynamic interactions between coexisting valve lesions makes the diagnosis and treatment challenging. Current guidelines may not be adequate for managing the varying clinical scenarios of MVD and, therefore, the expertise of a multidisciplinary Heart Valve Team is of paramount importance. The indications for intervention should be based on a global assessment of the consequences of the multiple valve lesions after a careful estimation of the added surgical risk of combined procedures, the long-term risk of morbidity and mortality associated with multiple valve prostheses and the risk of reoperation if less-than-severe valve lesions are left untreated at the time of first evaluation. Echocardiography plays an important role in assessing patients and, as a general rule, an accurate echo diagnosis needs to combine different measurements. The emerging transcatheter valve therapies should be considered an option for high risk patients. More data on the natural history of MVD and the impact of intervention on outcome are required to better define the optimal management strategy.


Assuntos
Ecocardiografia , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valvas Cardíacas , Hemodinâmica , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Valvas Cardíacas/cirurgia , Humanos
2.
Lancet ; 393(10166): 61-73, 2019 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-30429050

RESUMO

BACKGROUND: Patients with dilated cardiomyopathy whose symptoms and cardiac function have recovered often ask whether their medications can be stopped. The safety of withdrawing treatment in this situation is unknown. METHODS: We did an open-label, pilot, randomised trial to examine the effect of phased withdrawal of heart failure medications in patients with previous dilated cardiomyopathy who were now asymptomatic, whose left ventricular ejection fraction (LVEF) had improved from less than 40% to 50% or greater, whose left ventricular end-diastolic volume (LVEDV) had normalised, and who had an N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) concentration less than 250 ng/L. Patients were recruited from a network of hospitals in the UK, assessed at one centre (Royal Brompton and Harefield NHS Foundation Trust, London, UK), and randomly assigned (1:1) to phased withdrawal or continuation of treatment. After 6 months, patients in the continued treatment group had treatment withdrawn by the same method. The primary endpoint was a relapse of dilated cardiomyopathy within 6 months, defined by a reduction in LVEF of more than 10% and to less than 50%, an increase in LVEDV by more than 10% and to higher than the normal range, a two-fold rise in NT-pro-BNP concentration and to more than 400 ng/L, or clinical evidence of heart failure, at which point treatments were re-established. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02859311. FINDINGS: Between April 21, 2016, and Aug 22, 2017, 51 patients were enrolled. 25 were randomly assigned to the treatment withdrawal group and 26 to continue treatment. Over the first 6 months, 11 (44%) patients randomly assigned to treatment withdrawal met the primary endpoint of relapse compared with none of those assigned to continue treatment (Kaplan-Meier estimate of event rate 45·7% [95% CI 28·5-67·2]; p=0·0001). After 6 months, 25 (96%) of 26 patients assigned initially to continue treatment attempted its withdrawal. During the following 6 months, nine patients met the primary endpoint of relapse (Kaplan-Meier estimate of event rate 36·0% [95% CI 20·6-57·8]). No deaths were reported in either group and three serious adverse events were reported in the treatment withdrawal group: hospital admissions for non-cardiac chest pain, sepsis, and an elective procedure. INTERPRETATION: Many patients deemed to have recovered from dilated cardiomyopathy will relapse following treatment withdrawal. Until robust predictors of relapse are defined, treatment should continue indefinitely. FUNDING: British Heart Foundation, Alexander Jansons Foundation, Royal Brompton Hospital and Imperial College London, Imperial College Biomedical Research Centre, Wellcome Trust, and Rosetrees Trust.


Assuntos
Cardiomiopatia Dilatada/tratamento farmacológico , Fármacos Cardiovasculares/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Suspensão de Tratamento , Biomarcadores/sangue , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/fisiopatologia , Fármacos Cardiovasculares/farmacologia , Esquema de Medicação , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Projetos Piloto , Prognóstico , Recidiva , Indução de Remissão , Volume Sistólico/efeitos dos fármacos , Resultado do Tratamento , Função Ventricular Esquerda/efeitos dos fármacos
3.
Expert Rev Cardiovasc Ther ; 16(4): 249-258, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29457984

RESUMO

INTRODUCTION: Cardio-oncology is a rapidly growing field aimed at improving the quality of care of cancer patients by preventing and monitoring cardiovascular complications resulting from cancer treatment. Cardiac imaging, and in particular, transthoracic echocardiography, plays an essentialrole in the baseline assessment and serial follow-up of cardio-oncology patients. Areas covered: This review article discusses the role of cardiac imaging with a focus on advanced echocardiography for the detection and management of cancer therapy related cardiovascular complications, in particular, left ventricular dysfunction and heart failure. Expert commentary: While traditional imaging based assessment of left ventricular ejection fraction still has its place in cardiac monitoring, more advanced echocardiographic modalities, in particular, myocardial deformation imaging with speckle tracking strain analysis, show great potential for detecting early signs of cardiotoxicity. Larger studies are needed to determine both the clinical role of strain measurement in influencing initiation of cardioprotective agents and its prognostic value in long term outcome.


Assuntos
Antineoplásicos/efeitos adversos , Cardiotoxicidade , Ecocardiografia/métodos , Cardiopatias , Neoplasias/tratamento farmacológico , Antineoplásicos/administração & dosagem , Cardiotoxicidade/diagnóstico , Cardiotoxicidade/etiologia , Detecção Precoce de Câncer/métodos , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico , Humanos
4.
Can J Cardiol ; 34(3): 281-287, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29395702

RESUMO

BACKGROUND: We sought to investigate left ventricular (LV) function and mechanics in patients with cancer before they received chemotherapy or radiotherapy, as well as the relationship between cancer and reduced LV multidirectional strain in the whole study population. METHODS: The retrospective study involved 122 chemotherapy- and radiotherapy-naive patients with cancer and 45 age- and sex-matched controls with a cardiovascular risk profile similar to that of the patients with cancer. All the patients underwent echocardiographic examination before introduction of chemotherapy or radiotherapy. RESULTS: LV longitudinal (-19.1% ± 2.1% vs -17.8% ± 3.5%; P = 0.022), circumferential (-22.9% ± 3.5% vs -20.1% ± 4.1%; P < 0.001), and radial (40.5% ± 8.8% vs 35.2% ± 10.7%; P = 0.004) strain was significantly lower in the patients with cancer than in the control group. Endocardial and midmyocardial longitudinal LV strain was significantly reduced in the patients with cancer compared with the controls, whereas epicardial longitudinal strain was similar between these groups. Endocardial, midmyocardial, and epicardial circumferential strain was significantly lower in the chemotherapy- or radiotherapy-naive patients with cancer than in the controls. Cancer was associated with reduced longitudinal (odds ratio [OR], 9.0; 95% confidence interval [CI], 2.20-23.50; P < 0.001), reduced circumferential (OR, 7.1; 95% CI, 3.80-20.40; P < 0.001), and reduced radial strain (OR, 7.2; 95% CI, 3.41-25.10; P < 0.001) independent of age, sex, body mass index, diabetes, and hypertension. CONCLUSIONS: LV mechanics was impaired in the patients with cancer compared with the controls even before initiation of chemotherapy and radiotherapy. Cancer and hypertension were associated with reduced LV multidirectional strain independent of other clinical parameters. The present results indicate that cancer itself potentially induces cardiac remodelling independent of chemotherapy and radiotherapy.


Assuntos
Ecocardiografia/métodos , Neoplasias/tratamento farmacológico , Neoplasias/radioterapia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Adulto , Cardiotoxicidade/diagnóstico por imagem , Cardiotoxicidade/fisiopatologia , Estudos de Casos e Controles , Quimioterapia Adjuvante , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/mortalidade , Neoplasias/patologia , Variações Dependentes do Observador , Prognóstico , Radioterapia Adjuvante , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Disfunção Ventricular Esquerda/mortalidade , Função Ventricular Esquerda/efeitos dos fármacos , Função Ventricular Esquerda/efeitos da radiação
5.
Clin Cardiol ; 40(7): 437-443, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28191909

RESUMO

BACKGROUND: A large number of chemotherapy-induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies was left ventricular (LV) remodeling. The aim of this article was to provide a comprehensive overview of potential mechanisms of chemotherapy-induced right ventricular (RV) remodeling and summarize clinical studies on this topic. HYPOTHESIS: Chemotherapy induces RV structural, functional, and mechanical changes. METHODS: We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 1990 up to September 2016 in the English language using the following keyword "chemotherapy," "heart," "right ventricle," "anthracyclines," and "trastuzumab." RESULTS: The existing research show that RV remodeling occurs simultaneously with LV remodeling, which is why RV remodeling should not be neglected in the overall cardiac assessment of patients treated with chemotherapy, and especially those protocols that involve anthracyclines and trastuzumab. Investigations showed that these agents could significantly impact RV structure, function, and mechanics. These medications induce fibrosis of the RV myocardium, RV dilatation, decline in RV systolic function, worsening of its diastolic function, and finally impairment of RV mechanics (strain). The mechanisms of chemotherapy-induced RV remodeling are still not entirely clear, but it is considered that direct destructive influence of chemotherapy on myocardium, oxidative stress, endothelial dysfunction, and negative impact on pulmonary circulation could significantly contribute to RV impairment. CONCLUSIONS: Chemotherapy induces the impairment of RV structure, function, and mechanics by different complex mechanisms.


Assuntos
Antineoplásicos/efeitos adversos , Insuficiência Cardíaca , Ventrículos do Coração , Neoplasias/tratamento farmacológico , Disfunção Ventricular Direita , Função Ventricular Direita/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos , Antineoplásicos/uso terapêutico , Diástole , Ecocardiografia/métodos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Humanos , Volume Sistólico , Sístole , Disfunção Ventricular Direita/induzido quimicamente , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/fisiopatologia
6.
Arch Cardiovasc Dis ; 110(2): 116-123, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28117246

RESUMO

The number of studies demonstrating that right ventricular structure, function and mechanics are valuable predictors of cardiovascular and total morbidity and mortality in patients with a wide range of cardiovascular conditions is constantly increasing. Most studies that evaluated the influence of radiotherapy on the heart focused on left ventricular remodelling, which is why current guidelines only recommend detailed assessment of the left ventricle. Data regarding right ventricular changes in cancer patients treated with radiotherapy are scarce. Given that radiotherapy more often induces late cardiac impairment - unlike chemotherapy-induced cardiotoxicity, which is usually acute - it is quite reasonable to follow these patients echocardiographically for a long time (even for 20years after initiation of radiotherapy). Investigations that have followed cancer survivors for at least 10years after radiotherapy agree that right ventricular structure, systolic/diastolic function and mechanics are significantly impaired. The mechanisms of radiation-induced right ventricular remodelling are still unclear, but it is thought that fibrosis is the dominant factor in myocardial remodelling and vascular changes. Many factors may contribute to right ventricular impairment during and after radiotherapy: cumulative radiation dose; dose per treatment; delivery technique; radiation target (chest and mediastinum); and co-morbidities. In this review, we aim to provide a comprehensive overview of the potential mechanisms of radiation-induced right ventricular remodelling, and to summarize clinical studies involving radiotherapy-treated cancer patients.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Neoplasias/radioterapia , Lesões por Radiação/complicações , Função Ventricular Esquerda/efeitos da radiação , Remodelação Ventricular/efeitos da radiação , Doenças Cardiovasculares/etiologia , Humanos
7.
Expert Rev Cardiovasc Ther ; 14(11): 1207-1209, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27538574
8.
Echocardiography ; 33(6): 889-95, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26833555

RESUMO

AIMS: Ultrasound contrast agents may be used for the assessment of regional wall motion and myocardial perfusion, but are generally considered not suitable for deformation analysis. The aim of our study was to assess the feasibility of deformation imaging on contrast-enhanced images using a novel methodology. METHODS AND RESULTS: We prospectively enrolled 40 patients who underwent stress echocardiography with continuous intravenous infusion of SonoVue for the assessment of myocardial perfusion imaging with flash replenishment technique. We compared longitudinal strain (Lε) values, assessed with a vendor-independent software (2D CPA), on 68 resting contrast-enhanced and 68 resting noncontrast recordings. Strain analysis on contrast recordings was evaluated in the first cardiac cycles after the flash. Tracking of contrast images was deemed feasible in all subjects and in all views. Contrast administration improved image quality and increased the number of segments used for deformation analysis. Lε of noncontrast and contrast-enhanced images were statistically different (-18.8 ± 4.5% and -22.8 ± 5.4%, respectively; P < 0.001), but their correlation was good (ICC 0.65, 95%CI 0.42-0.78). Patients with resting wall-motion abnormalities showed lower Lε values on contrast recordings (-18.6 ± 6.0% vs. -24.2 ± 5.5%, respectively; P < 0.01). Intra-operator and inter-operator reproducibility was good for both noncontrast and contrast images with no statistical differences. CONCLUSIONS: Our study shows that deformation analysis on postflash contrast-enhanced images is feasible and reproducible. Therefore, it would be possible to perform a simultaneous evaluation of wall-motion abnormalities, volumes, ejection fraction, perfusion defects, and cardiac deformation on the same contrast recording.


Assuntos
Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Fosfolipídeos , Hexafluoreto de Enxofre , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Velocidade do Fluxo Sanguíneo , Meios de Contraste , Circulação Coronária , Módulo de Elasticidade , Técnicas de Imagem por Elasticidade/métodos , Estudos de Viabilidade , Feminino , Testes de Função Cardíaca/métodos , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Contração Miocárdica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Volume Sistólico , Função Ventricular Esquerda
9.
Int J Cardiol ; 142(3): 288-95, 2010 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-19195722

RESUMO

OBJECTIVES: To estimate the correlation between the total heart calcification score index (CSI), assessed by echocardiography, left ventricle mass index (LVMI), Framingham risk score (FRS), and angiographically assessed coronary artery disease (CAD). BACKGROUND: Aortic valve and root sclerosis (AVS, ARS) and mitral annular calcium (MAC) detected by echocardiography have been associated with atherosclerosis. FRS is recommended for estimation of total coronary heart disease risk over the course of 10 years. The anatomic extent of CAD can be assessed with coronary angiography. Total and cardiovascular mortality risk increases with increasing LVMI. METHODS: 167 consecutive in-hospital patients (mean age 66.6+/-9.7 yrs, 119 men) underwent: 1) complete transthoracic echocardiography (TTE), with CSI assessment (from 0=normal to 10=diffuse calcification of aortic valve, mitral annulus and aortic root), 2) the FRS evaluation (FRSor=11 and or=21=high risk), and 3) coronary angiography (with Duke score evaluation, from 0=normal to 100=severe left main disease). RESULTS: The mean CSI of the entire population was 3.94+/-2.1, with a mean of 2.75+/-2 in patients at low risk, with a progressive increase in patients at average risk (4.11+/-2.2), at high risk (4.7+/-1.7), respectively. CSI was associated with the presence of CAD (p=0.003) and the presence of abnormal LVMI (p=0.002). CONCLUSIONS: Echocardiographically assessed CSI is correlated to FRS, Duke score and LVMI and can provide a simple, radiation-free index of cardiovascular risk.


Assuntos
Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Ecocardiografia/estatística & dados numéricos , Idoso , Aorta/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Angiografia Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Variações Dependentes do Observador , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco
10.
Recenti Prog Med ; 100(2): 80-3, 2009 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-19350799

RESUMO

A 52-year old female cardiologist with 16 year radiation exposure in Cath Lab as an interventional cardiologist developed a multifocal papillary thyroid carcinoma. Dosimetric (below apron) cumulative exposure totalled 56 mSv, corresponding to 2,800 chest radiographs. The patient also carried genetic polymorphisms of genes (XRCC1 and XRCC3) involved in DNA repair, increasing the cancer risk after ionizing radiation exposure. Dose optimization and diligent radioprotection are essential to minimize cancer risk in professionally exposed cardiologist. Good dosimetric practice is essential to establish a legally plausible cause-effect relationship between exposure and damage.


Assuntos
Carcinoma Papilar/etiologia , Reparo do DNA , Mutação , Neoplasias Induzidas por Radiação/etiologia , Exposição Ocupacional/efeitos adversos , Médicos , Radiologia Intervencionista , Neoplasias da Glândula Tireoide/etiologia , Carcinoma Papilar/genética , Proteínas de Ligação a DNA/genética , Feminino , Predisposição Genética para Doença , Humanos , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/genética , Polimorfismo Genético , Doses de Radiação , Fatores de Risco , Neoplasias da Glândula Tireoide/genética , Proteína 1 Complementadora Cruzada de Reparo de Raio-X
11.
Am Heart J ; 157(1): 118-24, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19081407

RESUMO

BACKGROUND: Occupational doses from fluoroscopy-guided interventional procedures are the highest ones registered among medical staff using x-rays. The aim of the present study was to evaluate the order of magnitude of cancer risk caused by professional radiation exposure in modern invasive cardiology practice. METHODS: From the dosimetric Tuscany Health Physics data bank of 2006, we selected dosimetric data of the 26 (7 women, 19 men; age 46 +/- 9 years) workers of the cardiovascular catheterization laboratory with effective dose >2 mSv. Effective dose (E) was expressed in milliSievert, calculated from personal dose equivalent registered by the thermoluminescent dosimeter, at waist or chest, under the apron, according to the recommendations of National Council of Radiation Protection. Lifetime attributable risk of cancer was estimated using the approach of Biological Effects of Ionizing Radiation 2006 report VII. RESULTS: Cardiac catheterization laboratory staff represented 67% of the 6 workers with yearly exposure >6 mSv. Of the 26 workers with 2006 exposure >2 mSv, 15 of them had complete records of at least 10 (up to 25) consecutive years. For these 15 subjects having a more complete lifetime dosimetric history, the median individual effective dose was 46 mSv (interquartile range = 24-64). The median risk of (fatal and nonfatal) cancer (Biological Effects of Ionizing Radiation 2006) was 1 in 192 (interquartile range = 1 in 137-1 in 370). CONCLUSIONS: Cumulative professional radiological exposure is associated with a non-negligible Lifetime attributable risk of cancer for the most exposed contemporary cardiac catheterization laboratory staff.


Assuntos
Cateterismo Cardíaco , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias Induzidas por Radiação/etiologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Cardiovasc Ultrasound ; 6: 41, 2008 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-18715514

RESUMO

BACKGROUND: Recently, a cutaneous force-frequency relation recording system based on first heart sound amplitude vibrations has been validated. A further application is the assessment of Second Heart Sound (S2) amplitude variations at increasing heart rates. The aim of this study was to assess the relationship between second heart sound amplitude variations at increasing heart rates and hemodynamic changes. METHODS: The transcutaneous force sensor was positioned in the precordial region in 146 consecutive patients referred for exercise (n = 99), dipyridamole (n = 41), or pacing stress (n = 6). The curve of S2 peak amplitude variation as a function of heart rate was computed as the increment with respect to the resting value. RESULTS: A consistent S2 signal was obtained in all patients. Baseline S2 was 7.2 +/- 3.3 mg, increasing to 12.7 +/- 7.7 mg at peak stress. S2 percentage increase was + 133 +/- 104% in the 99 exercise, + 2 +/- 22% in the 41 dipyridamole, and + 31 +/- 27% in the 6 pacing patients (p < 0.05). Significant determinants of S2 amplitude were blood pressure, heart rate, and cardiac index with best correlation (R = .57) for mean pressure. CONCLUSION: S2 recording quantitatively documents systemic pressure changes.


Assuntos
Monitores de Pressão Arterial , Pressão Sanguínea , Ecocardiografia sob Estresse , Ruídos Cardíacos , Idoso , Ciclismo , Estimulação Cardíaca Artificial , Dipiridamol , Eletrocardiografia , Feminino , Coração/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Decúbito Dorsal , Resistência Vascular
13.
Cardiovasc Ultrasound ; 6: 15, 2008 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-18426559

RESUMO

UNLABELLED: A cutaneous force-frequency relation recording system based on first heart sound amplitude vibrations has been recently validated. Second heart sound can be simultaneously recorded in order to quantify both systole and diastole duration. AIMS: 1- To assess the feasibility and extra-value of operator-independent, force sensor-based, diastolic time recording during stress. METHODS: We enrolled 161 patients referred for stress echocardiography (exercise 115, dipyridamole 40, pacing 6 patients).The sensor was fastened in the precordial region by a standard ECG electrode. The acceleration signal was converted into digital and recorded together with ECG signal. Both systolic and diastolic times were acquired continuously during stress and were displayed by plotting times vs. heart rate. Diastolic filling rate was calculated as echo-measured mitral filling volume/sensor-monitored diastolic time. RESULTS: Diastolic time decreased during stress more markedly than systolic time. At peak stress 62 of the 161 pts showed reversal of the systolic/diastolic ratio with the duration of systole longer than diastole. In the exercise group, at 100 bpm HR, systolic/diastolic time ratio was lower in the 17 controls (0.74 +/- 0.12) than in patients (0.86 +/- 0.10, p < 0.05 vs. controls). Diastolic filling rate increased from 101 +/- 36 (rest) to 219 +/- 92 ml/m2* s-1 at peak stress (p < 0.5 vs. rest). CONCLUSION: Cardiological systolic and diastolic duration can be monitored during stress by using an acceleration force sensor. Simultaneous calculation of stroke volume allows monitoring diastolic filling rate.Stress-induced "systolic-diastolic mismatch" can be easily quantified and is associated to several cardiac diseases, possibly expanding the spectrum of information obtainable during stress.


Assuntos
Circulação Coronária , Diástole , Auscultação Cardíaca/métodos , Modelos Cardiovasculares , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia , Simulação por Computador , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estatística como Assunto
14.
J Cardiovasc Med (Hagerstown) ; 8(12): 983-9, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18163008

RESUMO

Aortic valve stenosis (AVS), including a range of disorder severities, from mild leaflet thickening without valve obstruction, 'aortic sclerosis', to severe calcific aortic stenosis, is a progressive, active process of valve modification, mediating by chronic inflammation (similar to atherosclerosis for cardiovascular risk factors) and biological features. AVS is the expression of early tissue damage due to endothelial damage and oxidative, inflammatory processes, and appears as a surrogate marker for cardiovascular events associated with coronary artery disease (CAD). AVS progression correlates with coronary artery risk factors, such as hypertension, age and cholesterol, and a quantitative evaluation of valve and coronary calcium score comprises a useful marker for cardiovascular prognosis. The low concordance of AVS with CAD appears to be due to other genetic or metabolic factors more specific for calcification processes. Moreover, both pathologies appear to be included within atherosclerotic disease and may be the object of the same clinical therapy and prevention.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Doenças Cardiovasculares/etiologia , Doença da Artéria Coronariana/fisiopatologia , Estenose da Valva Aórtica/complicações , Calcinose/complicações , Calcinose/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Doença da Artéria Coronariana/complicações , Progressão da Doença , Humanos , Inflamação/complicações , Inflamação/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença
15.
Cardiovasc Ultrasound ; 5: 42, 2007 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-18031588

RESUMO

BACKGROUND: The inherent ability of ventricular myocardium to increase its force of contraction in response to an increase in contraction frequency is known as the cardiac force-frequency relation (FFR). This relation can be easily obtained in the stress echo lab, where the force is computed as the systolic pressure/end-systolic volume index ratio, and measured for increasing heart rates during stress. Ideally, the noninvasive, imaging independent, objective assessment of FFR would greatly enhance its practical appeal. OBJECTIVES: 1 - To evaluate the feasibility of the cardiac force measurement by a precordial cutaneous sensor. 2 - To build the curve of force variation as a function of the heart rate. 3 - To compare the standard stress echo results vs. this sensor operator-independent built FFR. METHODS: The transcutaneous force sensor was positioned in the precordial region in 88 consecutive patients referred for exercise, dipyridamole, or pacing stress. The force was measured as the myocardial vibrations amplitude in the isovolumic contraction period. FFR was computed as the curve of force variation as a function of heart rate. Standard echocardiographic FFR measurements were performed. RESULTS: A consistent FFR was obtained in all patients. Both the sensor built and the echo built FFR identifiy pts with normal or abnormal contractile reserve. The best cut-off value of the sensor built FFR was 15.5 g * 10-3 (Sensitivity = 0.85, Specificity = 0.77). Sensor built FFR slope and shape mirror pressure/volume relation during stress. This approach is extendable to daily physiological exercise and could be potentially attractive in home monitoring systems.


Assuntos
Ecocardiografia sob Estresse , Cardiopatias/fisiopatologia , Interpretação de Imagem Assistida por Computador/métodos , Contração Miocárdica/fisiologia , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Pressão Sanguínea/fisiologia , Estimulação Cardíaca Artificial , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Teste de Esforço/métodos , Estudos de Viabilidade , Feminino , Cardiopatias/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Frequência Cardíaca/fisiologia , Humanos , Interpretação de Imagem Assistida por Computador/instrumentação , Masculino , Pessoa de Meia-Idade , Volume Sistólico
16.
Int J Cardiol ; 119(1): 109-11, 2007 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-17045673

RESUMO

The prognostic value of systemic endothelial dysfunction still remains uncertain in ischemic heart disease. The aim of the study was to establish the prognostic value of ultrasonically assessed systemic endothelial dysfunction in patients with chest pain syndrome and to assess whether this information was incremental to that already provided by simple parameters derived from echocardiography, such as left ventricular mass index or ejection fraction. One hundred ninety-five in-hospital patients (age=60+/-10 years; 63 females) with known or suspected CAD have been enrolled. All of the patients underwent, on different days, coronary angiography, endothelium-dependent FMD testing of the brachial artery by high-resolution ultrasound and resting 2D-echocardiography evaluation. The result of the FMD has been defined as the percent change in the internal diameter of the brachial artery during reactive hyperemia related to baseline. All patients were followed-up for a median of 27 months. During follow-up there were 17 deaths (9 cardiac), 4 non-fatal myocardial infarction (MI), and 18 late clinically-driven revascularization procedures. By a multivariate analysis, echocardiographically assessed ejection fraction (odds ratio: 2.32; 95% confidence interval: 1.24-4.33; p=0.008) and angiographically assessed CAD (odds ratio: 2.82; 95% confidence interval: 1.40-5.67; p=0.003), were independent prognostic predictors of events. In patients with known or suspected CAD, systemic endothelial dysfunction did not show a significant prognostic value. Echocardiographic indices of structural left ventricular damage appear to have a stronger prognostic value than functional indices of peripheral vascular damage in risk stratifying ischemic patients.


Assuntos
Dor no Peito/diagnóstico por imagem , Dor no Peito/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Endotélio Vascular/fisiopatologia , Ecocardiografia , Humanos , Valor Preditivo dos Testes , Prognóstico
17.
Prog Biophys Mol Biol ; 93(1-3): 399-410, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-16934316

RESUMO

Diagnostic cardiac ultrasounds are an environment-friendly and non-ionising imaging technology. However, ultrasounds are not biologically inert, and their use might have profound clinical impact. This paper summarizes the known effects of cardiac ultrasound--compared to other major imaging techniques--to exposed patients and to clinically exposed physicians practising ultrasound imaging. Furthermore, this review also provides an overview of the evidences on the biological effects of diagnostic ultrasound--which suggest that ultrasound with frequency, intensity and duration fully in the diagnostic range have significant molecular, cellular and organ effects. A better understanding of these effects may improve our understanding of the complex interactions between ultrasound and biological tissues and may open new avenues to therapeutic applications based on the ultrasound-modulated cell functions, such as membrane transduction, apoptosis, cell permeability and thrombolysis.


Assuntos
Ecocardiografia/efeitos adversos , Exposição Ambiental/efeitos adversos , Corpo Clínico , Doenças Profissionais/etiologia , Doenças Profissionais/fisiopatologia , Lesões por Radiação/etiologia , Lesões por Radiação/fisiopatologia , Humanos , Medição de Risco
18.
Cardiovasc Ultrasound ; 4: 16, 2006 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-16563156

RESUMO

BACKGROUND: Carotid plaque severity and morphology can affect cardiovascular prognosis. We evaluate both the importance of echographically assessed carotid artery plaque geometry and morphology as predictors of death in hospitalised cardiological patients. METHODS: 541 hospitalised patients admitted in a cardiological division (age = 66 +/- 11 years, 411 men), have been studied through ultrasound Duplex carotid scan and successively followed-up for a median of 34 months. Echo evaluation assessed plaque severity and morphology (presence of heterogeneity and profile). RESULTS: 361 patients showed carotid stenosis (67% with < 50% stenosis, 18% with 50-69% stenosis, 9% with > 70% stenosis, 4% with near occlusion and 2% with total occlusion). During the follow-up period, there were 83 all-cause deaths (15% of the total population). Using Cox's proportional hazard model, age (RR 1.06, 95% CI 1.03-1.09, p = 0.000), ejection fraction > 50% (RR = 0.62, 95% CI 0.4-0.96, p = 0.03), treatment with statins (RR = 0.52, 95% CI 0.29-0.95, p = 0.34) and the presence of a heterogeneous plaque (RR 1.6; 95% CI, 1.2 to 2.14, p = 0.002) were independent predictors of death. Kaplan-Meier survival estimates have shown the best outcome in patients without plaque, intermediate in patients with homogeneous plaques and the worst outcome in patients with heterogeneous plaques (90% vs 79% vs 73%, p = 0.0001). CONCLUSION: In hospitalised cardiological patients, carotid plaque presence and morphology assessed by ultrasound are independent predictors of death.


Assuntos
Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Cardiopatias/complicações , Cardiopatias/mortalidade , Idoso , Envelhecimento , Estenose das Carótidas/tratamento farmacológico , Feminino , Cardiopatias/terapia , Hospitalização , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Índice de Gravidade de Doença , Volume Sistólico , Análise de Sobrevida , Ultrassonografia
19.
Eur Heart J ; 26(20): 2136-41, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16014645

RESUMO

AIMS: Patients with normal coronary arteries have a heterogeneous prognosis. Aim of this study was to assess whether dipyridamole stress echocardiography positivity identifies a prognostically less benign subset. METHODS AND RESULTS: We selected 457 patients (245 males; 56+/-10 years) who underwent stress high-dose dipyridamole echocardiography and had angiographically non-significant (<50% visually assessed) stenosis in any major vessel and preserved left ventricular function. All patients were followed up for a median of 7.1 years (first quartile 5 and third quartile 10.5). Dipyridamole echocardiography test (DET) positivity for regional dysfunction occurred in 43(9%) patients. Kaplan-Meier survival estimates showed a significant better outcome for those patients with negative dipyridamole echocardiography test compared with those with a positive test (90 vs. 75.7%, at 140 months of follow-up, P=0.0018). At multivariable analysis, mild or moderate irregularity on coronary arteriogram (HR=3.3, CI 95%=1.7-6.2), diabetes (HR=3.5, CI 95%=1.4-9.2), and wall motion score index at peak stress (HR=6.7, CI 95%=2.5-17.8) were independent predictors of all-cause death. CONCLUSION: DET adds incremental value to the prognostic stratification achieved with clinical and angiographic data in the subset of patients with normal or near-normal coronary arteries.


Assuntos
Vasos Coronários/diagnóstico por imagem , Dipiridamol , Angina Microvascular/mortalidade , Vasodilatadores , Angiografia Coronária/métodos , Ecocardiografia sob Estresse/métodos , Feminino , Humanos , Masculino , Angina Microvascular/diagnóstico por imagem , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Prognóstico , Fatores de Risco , Análise de Sobrevida
20.
J Mol Med (Berl) ; 83(4): 279-86, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15770499

RESUMO

Somatic DNA damage has been linked to coronary artery disease (CAD). However, whether genetic instability is linked to CAD per se or to concomitant potentially genotoxic metabolic and pharmacological factors remains still unclear. The aim of this study was to evaluate the determinants of somatic DNA damage in a large population of patients undergoing coronary angiography. A total of 278 in-hospital patients (215 men, age 61.8+/-0.7 years) were studied by using micronucleus assay (MN) in human lymphocytes, which is one of the most commonly used biomarker for somatic DNA damage. Significant CAD (>50% diameter stenosis) was present in 210 patients (179 men, age 62.3+/-0.7 years). Normal coronary arteries were observed in 68 patients (35 men, age 60.2+/-1.7 years). There were no significant differences between patients with and without CAD, but patients with multivessel disease had the highest MN levels (P=0.01). MN frequency was also found significantly higher in presence of type 2 diabetes (P<0.0001), dyslipidemia (P=0.048) and nitrate therapy (P=0.0002). A significant additive effect was also observed between diabetes and nitrate therapy (P=0.02). On multivariate logistic regression analysis, diabetes [odds ratio=6.8 (95% confidence interval, 3.2-14.5), P<0.0001] and nitrate therapy [odds ratio=2.4 (95% confidence interval, 1.3-4.7), P=0.01] remained the only significant determinants for the 50th percentile of MN (>12 per thousand). These results indicated that diabetes and, to a lesser extent, chronic nitrate therapy are major determinants of somatic DNA instability in patients with CAD. DNA damage might represent an additional pathogenetic dimension and a possible therapeutic target in the still challenging management of coronary artery disease concerning diabetics.


Assuntos
Doença da Artéria Coronariana/genética , Dano ao DNA , Complicações do Diabetes/genética , Diabetes Mellitus Tipo 2/tratamento farmacológico , Nitratos/uso terapêutico , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/genética , Masculino , Testes para Micronúcleos , Pessoa de Meia-Idade , Análise de Regressão
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