Unusual origins of cardiac insufficiency: a case of iliac arteriovenous fistula post-spinal disc surgery.

In this case report, we present the unique and intriguing case of a 57-year-old man who experienced exertional palpitations and shortness of breath for 5 years. He was diagnosed with idiopathic heart failure three years ago, leading to diuretic treatment. Physical examination revealed notable left lower extremity swelling, severe varicose veins, and cardiac murmurs. Echocardiography showed significant cardiac enlargement and severe functional mitral and tricuspid valve regurgitation. Computed tomography (CT) imaging uncovered a 10 mm left common iliac arteriovenous fistula, causing abnormal early filling of the inferior vena cava (IVC) and marked IVC dilation. Open surgical repair of the arteriovenous fistula resulted in symptom relief and improved cardiac function. This case underscores the importance of considering unusual causes in heart failure patients and highlights the value of early diagnosis and intervention in complex cardiac-vascular interactions.

α-Ketoglutarate improves cardiac insufficiency through NAD+-SIRT1 signaling-mediated mitophagy and ferroptosis in pressure overload-induced mice.

BACKGROUND: In heart failure (HF), mitochondrial dysfunction and metabolic remodeling lead to a reduction in energy productivity and aggravate cardiomyocyte injury. Supplementation with α-ketoglutarate (AKG) alleviated myocardial hypertrophy and fibrosis in mice with HF and improved cardiac insufficiency. However, the myocardial protective mechanism of AKG remains unclear. We verified the hypothesis that AKG improves mitochondrial function by upregulating NAD+ levels and activating silent information regulator 2 homolog 1 (SIRT1) in cardiomyocytes. METHODS: In vivo, 2% AKG was added to the drinking water of mice undergoing transverse aortic constriction (TAC) surgery. Echocardiography and biopsy were performed to evaluate cardiac function and pathological changes. Myocardial metabolomics was analyzed by liquid chromatography‒mass spectrometry (LC‒MS/MS) at 8 weeks after surgery. In vitro, the expression of SIRT1 or PINK1 proteins was inhibited by selective inhibitors and siRNA in cardiomyocytes stimulated with angiotensin II (AngII) and AKG. NAD+ levels were detected using an NAD test kit. Mitophagy and ferroptosis levels were evaluated by Western blotting, qPCR, JC-1 staining and lipid peroxidation analysis. RESULTS: AKG supplementation after TAC surgery could alleviate myocardial hypertrophy and fibrosis and improve cardiac function in mice. Metabolites of the malate-aspartate shuttle (MAS) were increased, but the TCA cycle and fatty acid metabolism pathway could be inhibited in the myocardium of TAC mice after AKG supplementation. Decreased NAD+ levels and SIRT1 protein expression were observed in heart of mice and AngII-treated cardiomyocytes. After AKG treatment, these changes were reversed, and increased mitophagy, inhibited ferroptosis, and alleviated damage in cardiomyocytes were observed. When the expression of SIRT1 was inhibited by a selective inhibitor and siRNA, the protective effect of AKG was suppressed. CONCLUSION: Supplementation with AKG can improve myocardial hypertrophy, fibrosis and chronic cardiac insufficiency caused by pressure overload. By increasing the level of NAD+, the SIRT-PINK1 and SIRT1-GPX4 signaling pathways are activated to promote mitophagy and inhibit ferroptosis in cardiomyocytes, which ultimately alleviates cardiomyocyte damage.

Right congestive heart failure in domestic kitten (Felis domesticus) by dilation of the pulmonary veins and cardiomegali.

Background: Congestive heart failure (CHF) is a pathological state characterized by the incapability of the heart to properly perform its essential function of delivering blood to meet the metabolic demands of the body. Case Description: The present case report concerns a 3-month-old male domestic kitten, displaying symptoms including an enlarged abdomen, emaciation, dehydration, dyspnea, rhinorrhea, and infestation with scabies. This animal, weighing 0.7 kg displays a tabby bicolor pattern. The findings gleaned from the clinical evaluation revealed the presence of a murmur upon auscultation of the cardiac region. Upon conducting an ultrasound examination, it was determined that the abdominal cavity contained a fluid accumulation known as ascites. Conclusion: The findings from the radiographic evaluation indicate that feline Hiro exhibits ascites alongside cardiomegaly, in conjunction with discernible vascular modifications characterized by both enlargements of the pulmonary arteries and veins.

Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery.

This study aims to analyze the effect of cardiac rehabilitation therapy on cardiac autonomic nervous function in patients with cardiac insufficiency complicated with anxiety depression after cardiac operation to provide a reference for clinical practice. A total of 109 patients subject to cardiac operation in our hospital from January 2020 to March 2023 were enrolled as study subjects, including 50 patients who received conventional rehabilitation therapy (control group) and 69 patients who received cardiac rehabilitation therapy (research group). Before and after treatment, the left ventricular ejection fraction (LVEF) and central venous pressure (CVP) were determined, and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) was measured. Low frequency/high frequency (LF/HF), standard deviation of normal to normal (SDNN), and root mean of successive square differences (RMSSD) were measured by a multi-lead ECG system. Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Activity of daily living (ADL), and Barthel Index (BI) were applied for corresponding investigations, as well as the 6-min walk test (6MWT). After treatment, the research group showed higher LVEF, CVP, LF/HF, SDNN, and RMSSD, and lower NT-proBNP, SAS, and SDS than the control group (P < 0.05). Significantly elevated ADL score, BI, and 6MWT and reduced PSQI were observed in both groups after treatment, with more remarkable changes in the research group (P < 0.05). In conclusion, cardiac rehabilitation therapy effectively improved the cardiac function of patients with cardiac insufficiency complicated with anxiety and depression after the cardiac operation and alleviated their negative emotions.

[Mechanisms of action and clinical application of diuretics in intensive care medicine]. / Wirkmechanismen und klinische Anwendung von Diuretika in der Intensivmedizin.

The paired kidneys play a significant role in the human body due to the multitude of physiological tasks. Complex biochemical processes keep the sensitive electrolyte and water balance stable and thus ensure the organism's ability to adapt to exogenous and endogenous factors, which is essential for survival. The drug class of diuretics includes substances with very differing pharmacological characteristics. The functioning of the nephron is therefore indispensable for a deeper understanding of the pharmacodynamics, pharmacokinetics and side effect profile of diuretics. In the treatment of acute heart failure with pulmonary congestion, certain diuretics represent an important therapeutic option to counteract hypervolemia and thus an increase in preload. According to current data, diuretics have no proven benefits in the treatment or prevention of acute kidney injury but they can counteract hypervolemia and under certain conditions even reduce the use of renal replacement procedures.

Effects of Sodium-Glucose Cotransporter Inhibitor Use in Type 2 Diabetes Mellitus Patients With Heart Failure.

The advances in the development of sodium-glucose cotransporter 2 inhibitors (SGLT2i) have expanded the variety of favorable approaches to treating diabetes mellitus. It is possible to have an improvement in insulin resistance and natriuresis by inhibiting the reabsorption of sodium and glucose at the proximal tubules in the kidney, and a decrease in cardiovascular mortality in patients with diabetes mellitus (DM). In addition, SGLT2i provides renoprotection by reducing intraglomerular higher blood pressure. The usage of SGLT2i also provides hemodynamic and metabolic benefits. SGLT2i demonstrates large cardiovascular benefits in patients both with and without diabetes, as well as in existing heart failure patients. These SGLT2i have direct and indirect effects on the kidney, likely contributing to stated cardiovascular benefits. Here we review the literature on the direct effects of SGLT2 inhibitors in diabetic patients with heart failure (HF). We assume that the benefit in cardiac cells modulated by SGLT2i is due to the inhibition of sodium transporters affecting intracellular sodium homeostasis. In conclusion, the sodium transporters in cardiac cells provide, at least partly, an example of the clinical benefits of SGLT2i observed in HF patients.

One-step impedimetric NT-proBNP aptasensor targeting cardiac insufficiency in artificial saliva.

Currently, sensitive and accurate approaches for diagnosis, rapid assessment, and cardiac biomarker monitoring in patients with heart failure are needed. In this context, the advantages of aptamers over traditional antibodies have been employed to fabricate a single-step impedimetric N-terminal pro b-type natriuretic peptide (NT-proBNP)-modified gold microelectrode array. The development of an electrochemical aptasensing platform was based on the coimmobilization of alkanethiol self-assembled monolayers and amine-terminated aptamer that specifically recognized cardiac NT-proBNP protein resulting in charge electron transfer. Electroimpedimetric signals of the sensor were observed to be linear to the NT-proBNP concentrations in the range of 5.0 × 10-3 to 1.0 pg mL-1 (R2 = 0.9624), while achieving a low detection limit of 5.0 × 10-3 pg mL-1. Clinically relevant detection levels for NT-proBNP were achieved in a simple, rapid, and label-free measurement using artificial saliva, which was highlighted to be specific, regenerative, and selective over potential interferers occurring during the processes of cardiac insufficiency, Therefore, the novel NT-proBNP aptasensor is a promising point-of-care tool exhibiting safe, non-invasive, affordable, and non-prescription home use accessible to overcome the limitations associated with conventional ELISA and previous aptasensing.

Tissue-specific metabolomic profiling after cardiopulmonary bypass in fetal sheep.

Objective: Fetal cardiopulmonary bypass (CPB) is essential to fetal heart surgery, while its development is limited by vital organ dysfunction after CPB. Studying organ metabolism may help to solve this problem. The objective of this study was to describe the tissue-specific metabolic fingerprints of fetal sheep under CPB and to associate them with organ functions. Methods: Ten pregnant ewes at 90-120 days of gestation were randomly divided into two groups. The bypass group underwent a 1-h fetal CPB, whereas the control group underwent only a fetal sternotomy. During bypass, echocardiography, blood gases, and blood biochemistry were measured. After bypass, lambs were sacrificed, and tissues of the heart, liver, brain, kidney, and placenta were harvested. The metabolites extracted from these tissues were analyzed using non-targeted metabolomics based on liquid chromatography-mass spectrometry techniques. Results: All tissues except the placenta displayed significant metabolic changes, and the fetal heart displayed obvious functional changes. Fetal sheep that underwent CPB had common and tissue-specific metabolic signatures. These changes can be attributed to dysregulated lipid metabolism, altered amino acid metabolism, and the accumulation of plasticizer metabolism. Conclusion: Fetal CPB causes tissue-specific metabolic changes in fetal sheep. Studying these metabolic changes, especially cardiac metabolism, is of great significance for the study of fetal CPB.

The ex-utero intrapartum treatment (EXIT) strategy for fetal giant sacrococcygeal teratoma with cardiac insufficiency: A case report and review of the literature.

Background: Antenatally diagnosed sacrococcygeal teratoma has been associated with risks of perinatal complications and death, especially when the foetus has symptoms of cardiac insufficiency, hydrops or anemia in utero; however, the method of intervention remains controversial. Case: A 25-year-old pregnant woman was found to have a cystic and solid tumor in the fetal sacrococcygeal region at 16 weeks of gestation. As the tumour grew, the mother developed polyhydramnios accompanied with gestational diabetes. Fetal and tumorous hemodynamics were closely monitored by ultrasound. Abnormal cardiac function was detected at 31 weeks' gestation, and we creatively performed pre-emptive delivery through the ex-utero intrapartum treatment with debulking. The teratoma was removed with utero-placental circulation support. The operation proceeded smoothly with favourable prognosis for both mother and newborn. Conclusion: The ex-utero intrapartum treatment may improve the prognosis for fetuses with heart failure when they reach viable gestation.

Systemic Lupus Erythematosus Patients With Related Organic Damage Are at High Risk of Hypothyroidism.

Purpose: The aim of this study included determining the prevalence of hypothyroidism in patients with systemic lupus erythematosus (SLE), clarifying the clinical characteristics of SLE patients with hypothyroidism, and identifying the relationship between hypothyroidism and SLE-related organic damage. Another purpose was to analyze the relationship between SLE and thyroid autoantibody. We also intended to discuss the pathogenesis of hypothyroidism in SLE patients, which would provide clues for further investigation. Methods: This study recruited 856 SLE patients and 856 age- and sex-matched healthy population and compared the prevalence of hypothyroidism between the cases and controls. Univariate and multivariate logistic analyses were applied to identify risk factors for hypothyroidism in SLE patients. Results: SLE patients had higher prevalence of clinical hypothyroidism (9.10%) and TgAb+TPOAb- (10.40%) than controls. The prevalence of hypothyroidism was the highest in SLE patients aged 16-26 years (18.9%) and decreased with age. The prevalence of autoimmune hypothyroidism in SLE group was higher than that in the control group (64.4% vs. 51.5%, P=0.042), which was mainly due to TgAb; the prevalence of non-autoimmune hypothyroidism in SLE group was also significantly higher than that in the control group (67.3% vs. 47.8%, P<0.001). Based on multivariate analysis, the use of glucocorticoids/immunosuppressants, liver abnormality, lupus nephritis (LN), and cardiac insufficiency were independently associated with hypothyroidism in SLE patients. Conclusion: The prevalence of hypothyroidism in SLE patients was higher than that in controls and decreased with age. The results suggested that young SLE patients combined with LN, liver abnormality and cardiac insufficiency were at higher risk of hypothyroidism. According to the results of this study, we speculated that SLE might have impact on thyroid, and SLE might be one of the causes of hypothyroidism.

Pooled Analysis of Central Venous Pressure and Brain Natriuretic Peptide Levels in Patients With Extubation Failure.

Purpose: Cardiac insufficiency has been considered to be a common cause of extubation failure. Some studies have shown that central venous pressure (CVP) and brain natriuretic peptide (BNP) are able to predict extubation outcomes. Therefore, we conducted a pooled analysis to evaluate the potential of CVP and BNP levels as predictors of extubation outcomes, using a cohort of critically ill patients who were on mechanical ventilation (MV). Methods: We searched three online electronic databases up to October 2021. All data were analyzed using Review Manager 5.4. For each study, the analysis was performed using standardized mean differences (SMD) with 95% confidence intervals (CI). Results: The pooled analysis of seven studies on CVP levels and extubation outcomes showed that elevated CVP levels were significantly associated with extubation failure (SMD:0.47, 95% CI: 0. 43-0.51, p < 0.00001). This association also appeared before extubation (SMD:0.47, 95% CI: 0. 43-0.51, p < 0.00001), but it did not appear after extubation (SMD: 0.63, 95% CI: -0.05-1.31, p=0.07). Similarly, pooled analysis of eight studies on BNP levels and extubation outcomes showed that increased BNP levels are closely related to extubation failure (SMD:0.68, 95% CI: 0.49-0.86, p < 0.00001). This relationship also occurs before (SMD: 0.57, 95% CI: 0.35-0.79, p < 0.00001) and after (SMD: 0.91, 95% CI: 0.59-1.23, p < 0.00001) extubation. Conclusions: This study showed that elevated CVP and BNP levels are associated with extubation failure in critically ill patients. However, BNP levels are more valuable than CVP levels in predicting extubation outcomes.

Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services.

Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.

Application and evaluation of sacubitril/valsartan in patients with cardiac insufficiency during perioperative period of cardiac surgery.

Sacubitril/valsartan is the first angiotensin II receptor blocker neprilysin inhibitor, which inhibits both angiotensin II receptor and neprilysin. In recent years, a series of clinical studies have shown that sacubitril/valsartan has a good therapeutic effect on heart failure. The present study was conducted to investigate the therapeutic effect and safety of sacubitril/valsartan in patients with cardiac insufficiency during the perioperative period of cardiac surgery. A total of 59 patients were divided into two groups: Heart failure with reduced ejection fraction (HFrEF) group and heart failure with preserved ejection fraction (HFpEF) group. The therapeutic effect on patients with sacubitril/valsartan was assessed by the values of left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVED). The renal safety of patients was assessed by serum creatinine (Cr) and blood urea nitrogen (BUN). Sacubitril/valsartan decreased LVED in HFrEF group and HFpEF group. And it showed a significant increase of LVEF in the HFrEF group. There was no significant change in Cr and BUN. Sacubitril/valsartan showed a good therapeutic effect on cardiac function for the perioperative period of cardiac surgery.

[Dihydromyricetin improves cardiac insufficiency by inhibiting HMGB1 in diabetic rats].

OBJECTIVE: To investigate the effect of dihydromyricetin (DHM) on cardiac insufficiency in diabetic rats and explore the underlying mechanism. METHOD: Twenty-four male SD rats were randomized equally into normal control group, type 2 diabetes (T2DM) group fed on a high-glucose and high-fat diet for 6 weeks with low-dose streptozotocin (STZ) injection, metformin (MET) group with daily intragastric administration of MET (150 mg/kg) for 8 weeks after T2DM modeling, and dihydromyricetin (DHM) group with daily intragastric administration of DHM (250 mg/kg) for 8 weeks after modeling. The levels of fasting blood glucose, low density lipoprotein (LDL-C), triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL-C) and glycosylated hemoglobin (HbA1c) of the rats were measured, and plasma levels of insulin and high mobility group protein-1 (HMGB1) were detected with ELISA. The cardiac function of the rats was assessed using color echocardiography, ECG was measured using a biological signal acquisition system, and myocardial pathology was observed with HE staining. The protein expressions of HMGB1, nuclear factor-κB (NF-κB) p65 and phospho-NF-κB p65 (p-NF-κB p65) in the myocardial tissue were detected using Western blotting. RESULTS: Compared with the control group, the rats in T2DM group showed significant anomalies in cardiac function after modeling with significantly increased plasma HMGB1 level and expressions of HMGB1, NF-κB p65 and p-NF-κB p65 proteins in the myocardial tissue (P < 0.05 or 0.01). Treatment with DHM significantly improved the indexes of cardiac function of the diabetic rats (P < 0.05 or 0.01), decreased plasma HMGB1 level and down-regulated the protein expressions of HMGB1 and p-NF-κB p65 in the myocardial tissue (P < 0.05 or 0.01). CONCLUSION: DHM treatment can improve cardiac function in diabetic rats possibly by down-regulation of HMGB1 and phospho-NF-κB p65 expressions in the myocardium.

BALANCE Dietary Index in Patients with Heart Failure, and Its Adherence in Sergipe, Brazil.

BACKGROUND: "The effective treatment of Heart Failure (HF) involves care with food intake. Recently, the Ministry of Health created the Brazilian Cardioprotective Diet and its dietary index, BALANCE, which assesses adherence to the standard's recommendations". METHODS: This observational prospective study is part of the Congestive Heart Failure Registry (VICTIM-CHF) of Aracaju/SE. Observations and data collection took place from April 2018 to February 2021. Sociodemographic and clinical aspects and food consumption were evaluated. Food intake was determined using the food frequency questionnaire. Foods were categorized using the BALANCE dietary index into green, yellow, blue and red food groups. The BALANCE dietary index was obtained using median and interquartile ranges, scores of the Mann-Whitney U test, and associations between clinical variables and the index, through linear regression. RESULTS: Participants included 240 patients with HF (61.12 ± 1.06 years), who were assisted by the Unified Health System (67.5%). Individuals with a partner showed greater adherence to the green food group recommendations (0.09; 0.00-0.17). The lowest adherence to recommendations regarding the blue food group was observed in individuals with excess weight, who had a higher consumption of foods rich in animal protein (0.54; 0.38-0.78). As for the red food group (ultra-processed foods) the highest adherence was observed by patients with diabetes mellitus (0.41; 0.05-0.77). The greatest adherence to the yellow food group, and a higher score, was observed in patients with the smallest left ventricular systolic diameter (LVSD). CONCLUSIONS: Being married was directly associated with the consumption of foods in the green group, while being overweight and having diabetes were inversely associated with adherence to the blue and red food groups, respectively. Greater adherence to the yellow food group recommendations was inversely associated with less change in the DSFVE.

Endovascular Repair of an Iliac Arteriovenous Fistula in a 30-Year-Old Female Patient with Suspected Severe Cardiac Insufficiency: A Case Report.

A 30-year-old female was initially diagnosed with cardiac insufficiency and severe claudication. Additional imaging revealed a large iliac arteriovenous fistula, which was treated with an endovascular technique. A custom-made, self-expanding, polytetrafluorethylene-covered stent was implanted to restore the physiologic hemodynamic environment. The patient was asymptomatic at the 12-month clinical follow-up.

Systematic assessment of heart valves and cardiac function by echocardiography in axial spondyloarthritis: A systematic review and meta-analysis.

OBJECTIVES: Axial Spondyloarthritis (ax-SpA) is associated with increased risk of cardiovascular disease (CVD)-specific deaths. We aimed to assess the prevalence of left ventricular (LV) systolic and diastolic dysfunction and valvular heart disease (VHD) by transthoracic echocardiography (TTE) in ax-SpA patients without history of CVD. METHODS: A systematic literature review was performed in PUBMED, Embase, Cochrane Library databases published before April 2020. We included all controlled studies assessing myocardial function and heart valve by TTE in ax-SpA without history of CVD. A meta-analysis was performed with random or fixed effects model estimating mean differences (MD) and odds ratio (OR). RESULTS: Literature search selected 189 abstracts and 28 articles were included (1471 ax-SpA and 1115 controls). ax-SpA had a statistically slight alteration of LV ejection fraction (MD=0.64%, 95%CI: 0.14-1.14). ax-SpA had more frequently LV diastolic dysfunction (OR=3.43, 95%CI: 1.78-6.59) and an alteration of E/A ratio (MD=0.15, 95%CI: 0.08-0.21), deceleration time (MD=13.07ms, 95%CI: 7.75-18.40), isovolumetric relaxation time (MD=7.90ms, 95%CI: 4.50-11.30), left-ventricular end diastolic (MD=0.57mm, 95%CI: 0.19-0.95) and systolic (MD=0.77mm, 95%CI: 0.36-1.17) diameters. Three studies (15%) used a combination of TTE parameters to diagnose LV diastolic dysfunction. Prevalence of mitral regurgitation and aortic regurgitation were similar in ax-SpA patients and healthy individuals. CONCLUSION: ax-SpA have a non-clinically relevant alteration of LV ejection fraction and similar prevalence of VHD compared to healthy individuals. LV diastolic TTE parameters are altered in ax-SpA. However, most studies do not combine set of parameters to recognize diastolic dysfunction. The clinical relevance of diastolic dysfunction observed by TTE remains to be determined in future longitudinal studies.

Food Patterns of Hospitalized Patients with Heart Failure and Their Relationship with Demographic, Economic and Clinical Factors in Sergipe, Brazil.

Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)" of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System­SUS (67.5%). Three dietary patterns were identified, labeled "traditional" (typical foods of the Brazilian northeastern population added to ultra-processed foods), "Mediterranean" (foods recommended by the Mediterranean diet) and "dual" (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the "traditional" pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The "Mediterranean" was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The "dual" diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the "traditional" pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the "dual" pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.

Acute left ventricular insufficiency in a Burkitt Lymphoma patient with myocardial involvement and extensive local tumor cell lysis: a case report.

BACKGROUND: Burkitt lymphoma (BL) is a rare disease with the sporadic variant accounting for less than 1% of adult non-Hodgkin lymphomas. BL usually presents with an abdominal bulk, but extranodal disease affecting the bone marrow and central nervous system is common. Cardiac manifestations, however, are exceedingly rare, with less than 30 cases reported in the literature. CASE PRESENTATION: We report on a 54-year-old male patient with a six week-long history of paranasal sinus swelling, fatigue and dyspnea on exertion. Stage IV sporadic BL with extensive lymphonodal and cardiovascular involvement was diagnosed. Manifestations included supra- and infradiaphragmatic lymphadenopathy as well as infiltration of the aortic root, the pericardium, the right atrium and the right ventricle. EBV-reactivation was detected, which is uncommon in the sporadic subtype. After initial full-dose chemotherapy with very good BL control, the patient developed acute, but fully reversible cardiac insufficiency. Myocardial lymphoma involvement receded completely during the following two therapy cycles, while cardiac function periodically deteriorated shortly after chemotherapy administration and quickly recovered thereafter. Interestingly, the decline in cardiac function lessened with decreasing myocardial lymphoma manifestation. Once the cardiovascular BL infiltration was resolved, cardiac function remained stable throughout further treatment. Following seven cycles of chemotherapy and mediastinal radiation, the patient is now in continued complete remission. CONCLUSIONS: Although rare, cardiac involvement in BL can quickly become life-threatening due to rapid lymphoma doubling time and should therefore be considered at initial diagnosis. This case suggests an association between myocardial infiltration, chemotherapy associated tumor cell lysis and transient deterioration of cardiac function until the damage caused by the underlying lymphoma could be restored. While additional studies are needed to further elucidate the mechanisms of acute cardiac insufficiency due to lymphoma lysis in the infiltrated structures, prompt BL control and full recovery of the patient supports courageous treatment start despite extensive cardiovascular involvement.

[Diagnosis and treatment of cardiac transthyretin amyloidosis. Innovative therapy with tafamidis.] / Le médicament du mois. Diagnostic et traitement d'une amyloïdose cardiaque à transthyrétine. Thérapeutique innovante avec le tafamidis.

Cardiac amyloidosis is a rare and severe disease with worse prognosis than classic cardiac insufficiency. Transthyretin amyloïdosis is an underdiagnosed cause of amyloidosis. Technetium scintigraphy allows to confirm diagnosis of transthyretin amyloidosis with great specificity. A new hope is brought by tafamidis, a novel therapeutic option for this specific condition. This medication is the first one that proved a risk reduction in mortality among patients with cardiac amyloidosis in class NYHA I and II. In this article, we review across a clinical case the modalities for the diagnosis and treatment of transthyretin amyloidosis.

L'amyloïdose cardiaque est une maladie rare et sévère. En cas d'insuffisance cardiaque, le pronostic est pire que pour les autres étiologies. L'amyloïdose à transthyrétine est une des formes d'amyloïdose dont le diagnostic peut être posé avec une grande spécificité grâce à la scintigraphie au technétium. Une lueur d'espoir est apportée par l'arrivée du tafamidis, une nouvelle classe thérapeutique. Ce médicament est le premier à avoir démontré une réduction de mortalité parmi les patients en classe NYHA I et II. Dans cet article, nous décrivons, à partir d'un cas clinique, les démarches diagnostiques et thérapeutiques nécessaires à la prise en charge d'un patient présentant une insuffisance cardiaque sur amyloïdose à transthyrétine.