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1.
Int Heart J ; 61(1): 83-88, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956134

RESUMO

Percutaneous occlusion of atrial septal defect (ASD) has recently become a standard therapeutic strategy, but little is known about left atrial (LA) function thereafter. The present study aimed to determine LA function in 43 children with ASD and 13 controls based on LA strain measured by two-dimensional echocardiographic speckle tracking (2DE-ST). Among these children, 12 underwent surgery (ASD-S), 31 had device closure (ASD-D), and 13 were included as controls. LA strain was significantly decreased after ASD-D but was not significantly altered after ASD-S, indicating that percutaneous occlusion of an ASD might decrease LA function. Furthermore, the size of the ASD device negatively correlated with LA strain. These results imply that ASD occlusion devices negatively influence LA function and might be important when decided therapeutic strategies for ASD. LA strain measured by 2DE-ST should become a good indicator of LA function after ASD treatment in children.


Assuntos
Átrios do Coração/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Função do Átrio Esquerdo , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Criança , Ecocardiografia , Feminino , Átrios do Coração/fisiopatologia , Comunicação Interatrial/fisiopatologia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(48): e18146, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770253

RESUMO

Left atrial (LA) remodeling has been identified to predict atrial fibrillation (AF) and heart failure. However, the role of LA diameter (LAD) in patients with heart failure (HF) with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF) remains poorly understood.A total of 142 patients including 71 subjects with AF (21 of HFpEF, 22 of HFmrEF, and 28 of HFrEF) and 71 ejection fraction (EF)-matched subjects with sinus rhythm (SR) were included in the study. Baseline characteristics and echocardiographic parameters including LAD were compared between both groups as well as among HFpEF, HFmrEF, and HFrEF.In receiver-operating characteristic (ROC) analyses, LAD predicted AF in HFpEF, HFmrEF, and HFrEF [area under the curve (AUC): 0.646; P = .03]. LAD was negatively association with left ventricular ejection fraction while positively with Nt-proNP and left ventricular end-diastolic diameter (regression coefficient: -0.239, P = .004; regression coefficient: 0.191, P = .023; regression coefficient: 0.357, P < .001). In ROC analyses, LAD predicted HFrEF among the 3 categories (AUC: 0.629, P = .01).In the setting of HF, LAD was higher in AF than in and SR, and predicted AF. Furthermore, LAD was associated with severity of HF in HFpEF, HFmrEF, and HFrEF, and also predicted HFrEF.


Assuntos
Átrios do Coração , Insuficiência Cardíaca , Volume Sistólico , Disfunção Ventricular Esquerda , Função Ventricular Esquerda/fisiologia , Idoso , Idoso de 80 Anos ou mais , China , Ecocardiografia/métodos , Ecocardiografia/estatística & dados numéricos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Tamanho do Órgão , Prognóstico , Estudos Retrospectivos , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
4.
Life Sci ; 237: 116949, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31605712

RESUMO

AIMS: New-onset atrial fibrillation (AF) is frequently observed following acute stroke. The aim of this study was to investigate the effects of the brain-stellate ganglion-atrium network on AF vulnerability in a canine model with acute middle cerebral artery occlusion (MCAO). MATERIALS AND METHODS: Twenty-six dogs were randomly divided into the sham-operated group (n = 6), acute stroke (AS) group (n = 7), stellate ganglion ablation (SGA) group (n = 6) and clodronate liposome (CL) group (n = 7). In the sham-operated group, dogs received craniotomy without MCAO. Cerebral ischemic model was established in AS dogs by right MCAO. Right MCAO along with SGA and CL injection into the atrium was performed in SGA and CL dogs, respectively. After 3 days, atrial electrophysiology, neural activity, and the phenotype and function of macrophages in the atrium were studied in all the dogs. KEY FINDINGS: Higher AF inducibility (24.4 ±â€¯4.4% versus 4.4 ±â€¯2.2%, P < 0.05) and AF duration (15.7 ±â€¯3.8 s versus 2.6 ±â€¯1.1 s, P < 0.05) were observed in the AS group compared with the sham-operated group, and were associated with increased left stellate ganglion activity, higher macrophage infiltration and higher levels of inflammatory cytokines in the atrium. SGA or CL injection sharply suppressed AF inducibility (5.5 ±â€¯2.7% versus 24.4 ±â€¯4.4%; 5.3 ±â€¯3.2% versus 24.4 ±â€¯4.4%, both P < 0.05) and AF duration (2.9 ±â€¯1.2 s versus 15.7 ±â€¯3.8 s; 3.6 ±â€¯1.0 s versus 15.7 ±â€¯3.8 s, both P < 0.05) in canines with acute stroke. SIGNIFICANCE: A brain-stellate ganglion-atrium network may increase AF vulnerability through macrophage activation after acute stroke.


Assuntos
Fibrilação Atrial/patologia , Modelos Animais de Doenças , Átrios do Coração/fisiopatologia , Infarto da Artéria Cerebral Média/fisiopatologia , Macrófagos/patologia , Gânglio Estrelado/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Animais , Fibrilação Atrial/etiologia , Cães
5.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(4): 521-530, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31441251

RESUMO

Atrial fibrillation (AF) is one of the most common arrhythmias, which does great harm to patients. Effective methods were urgently required to prevent the recurrence of AF. Four methods were used to analyze RR sequence in this paper, and differences between Pre-AF (preceding an episode of AF) and Normal period (far away from episodes of AF) were analyzed to find discriminative criterion. These methods are: power spectral analysis, approximate entropy (ApEn) and sample entropy (SpEn) analysis, recurrence analysis and time series symbolization. The RR sequence data used in this research were downloaded from the Paroxysmal Atrial Fibrillation Prediction Database. Supporting vector machine (SVM) classification was used to evaluate the methods by calculating sensitivity, specificity and accuracy rate. The results showed that the comprehensive utilization of recurrence analysis parameters reached the highest accuracy rate (95%); power spectrum analysis took second place (90%); while the results of entropy analyses and time sequence symbolization were not satisfactory, whose accuracy were both only 70%. In conclusion, the recurrence analysis and power spectrum could be adopted to evaluate the atrial chaotic state effectively, thus having certain reference value for prediction of AF recurrence.


Assuntos
Fibrilação Atrial/diagnóstico , Entropia , Átrios do Coração/fisiopatologia , Humanos , Recidiva , Sensibilidade e Especificidade , Máquina de Vetores de Suporte
6.
Int Heart J ; 60(4): 788-795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31353344

RESUMO

Severe ventricular arrhythmias such as high-grade atrioventricular block and ventricular tachycardia may cause lethal conditions or sudden death in patients with cardiac sarcoidosis (CS). Physicians should examine patients carefully for these conditions and treat them appropriately. As arrhythmias are being better diagnosed and treated, physicians are increasingly aware of atrial arrhythmias, which have not been focused upon as CS-related conditions, in patients with CS. This article reports a case of atrial flutter in sarcoidosis, and discusses literature findings on atrial arrhythmias and atrial involvement of CS. It is highly likely that atrial arrhythmia and supraventricular conduction disorder associated with or caused by CS are more common than previously thought. Physicians should pay careful attention for these conditions in the diagnosis and treatment of CS.


Assuntos
Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Cardiomiopatias/complicações , Átrios do Coração/fisiopatologia , Sarcoidose/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Flutter Atrial/diagnóstico , Flutter Atrial/cirurgia , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Ablação por Cateter , Ecocardiografia , Eletrocardiografia Ambulatorial , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico , Sarcoidose/fisiopatologia
7.
Biomed Res Int ; 2019: 2983752, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31341894

RESUMO

Background: Response to cardiac resynchronization therapy (CRT) varies significantly among patients. This study aimed to identify baseline characteristics that could predict super-response to CRT and to evaluate the long-term prognosis in super-responders. Methods: We retrospectively reviewed the data of 73 consecutive patients who received CRT. Patients were considered as super-responders after 6-month follow-up when NYHA class reduction to I or II combined with left ventricular ejection fraction (LVEF) ≥ 50% was observed. Patients were divided into super-responders group and non-super-responders group. All-cause mortality or hospitalization for heart failure (HF) was referred to the combined end point. Results: 17 (23.3%) patients were super-responders. HF duration, left atrial dimension (LAD), and left bundle branch block (LBBB) were independent predictors of super-response to CRT. The combination of HF duration and LAD could provide more robust prediction of super-response than standalone HF duration (0.899 versus 0.789, Z = 2.207, P = 0.027) or standalone LAD (0.899 versus 0.775, Z = 2.487, P = 0.013). super-responders had excellent LV reverse remodeling. The cumulative incidences of combined end point were significantly lower in the super-responders group, LAD ≤ 42mm group, and combination of HF duration ≤ 48 months and LAD ≤ 42mm group. LBBB remained associated with a lowered risk of the combined end point (HR: 0.19, 95% CI: 0.07-0.57, P = 0.003), whereas LAD was associated with a raised risk of the combined end point (HR: 1.09, 95% CI: 1.02-1.17, P = 0.014). Conclusions: HF duration, LAD, and LBBB independently predicted super-response. The combination of HF duration and LAD makes more robust prediction of CRT super-response. Super-responders had excellent LV reverse remodeling and decreased the incidences of the combined end point. LBBB and LAD were independently associated with the combined end point.


Assuntos
Fibrilação Atrial , Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Insuficiência Cardíaca , Idoso , Fibrilação Atrial/mortalidade , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Intervalo Livre de Doença , Feminino , Seguimentos , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
8.
Curr Med Sci ; 39(4): 541-545, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31346988

RESUMO

The difference in the atrial organizational structure between patients with atrial fibrillation (AF) and those with sinus rhythm was investigated. In order to analyze the rationality in explaining the electrocardiogram (ECG) characteristics of AF with statistics data or tissue remodeling model, and the logical relationship between the hypothesis of pulmonary veins (PV) muscle sleeves and that of multi wavelets in mechanism of AF, we examined the expression of collagen volume fraction of type I (CVF-I) with picrosirius red staining, connexin 40 (Cx40) by immunohistochemistry, and intercalated disc (ID) using transmission electron microscope in atrial tissue. The results showed that there was significant difference in the expression of CVF-I (t=3.827, P<0.01), Cx40 (t=4.21, P<0.01), and groups of the ID that keeping the electrical transmission and atrial electrical coupling synchronization (t=15.116, P<0.001), but no significant difference was found in total IDs (t=0.611, P=0.543) between patients with AF and those with sinus rhythm. The quantitative differences in the tissue remodeling could not explain the ECG characteristics of AF. The number of normal IDs and abnormal distribution are the structural basis to trigger and maintain atrial electrical remodeling, and induce and maintain AF. Such histological reconstruction supports the hypothesis of multi wavelets and can also explain ECG features.


Assuntos
Fibrilação Atrial/metabolismo , Remodelamento Atrial/fisiologia , Conexinas/genética , Átrios do Coração/fisiopatologia , Adulto , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Remodelamento Atrial/genética , Eletrocardiografia , Feminino , Coração/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Miocárdio/metabolismo , Miocárdio/patologia , Veias Pulmonares/metabolismo , Veias Pulmonares/patologia , Adulto Jovem
9.
Scand Cardiovasc J ; 53(6): 317-322, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31321990

RESUMO

Objectives. Left atrial fibrosis represents a substrate for atrial fibrillation (AF) and cardioembolic events. White matter hyperintensities (WMH) are commonly found on magnetic resonance imaging (MRI) and are regarded, at least partly as ischemic brain lesions. Aortic excess pressure (excessPTI) represents an extra work performed by the left ventricle and is a new risk metric associated with cardiovascular complications. The aim of our study was to assessed whether there is a correlation between the degree of LA fibrosis, aortic excess pressure, and WMH in patients without a history of atrial fibrillation but the presence of risk factors for cardiovascular complications. Design. Thirty-eight subjects (10, females, 28 males, median age 64 years) with risk factors (hypertension, diabetes, heart failure, vascular disease) but no history of AF were recruited. Left atrial fibrosis and brain WMH were estimated by MRI. Aortic excess pressure was obtained non-invasively. Results. Atrial fibrosis correlated significantly with aortic excess pressure (r = 0.65, p < .0001) and was significantly associated with periventricular white matter lesion volume (r = 0.34, p = .036). In multiple regression analysis, atrial fibrosis and age were positively associated with periventricular white matter lesions, while aortic excess pressure was not quite significant associated with WMH. This model explains the 30% variance in white matter lesions volume observed in the study. Left atrial fibrosis was independently associated with excessPTI but not with age and mean BP. This model explained 42% of the variance in an area of atrial fibrosis. Conclusions. Atrial fibrosis in subjects with cardiovascular risk factors and no history of AF is associated with white matter hyperintensities and aortic excess pressure.


Assuntos
Aorta/fisiopatologia , Pressão Arterial , Função do Átrio Esquerdo , Remodelamento Atrial , Doenças Cardiovasculares/complicações , Átrios do Coração/fisiopatologia , Leucoencefalopatias/etiologia , Idoso , Aorta/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Feminino , Fibrose , Átrios do Coração/diagnóstico por imagem , Humanos , Leucoencefalopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Função Ventricular Esquerda
10.
High Blood Press Cardiovasc Prev ; 26(4): 331-337, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31309456

RESUMO

INTRODUCTION: We aimed to find new predictive parameters for atrial fibrillation (AF) onset in hypertensive patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA). METHODS: One hundred and eight patients with essential hypertension (HTN) were prospectively enrolled, from which 67 patients had no other important comorbidities (HTN group), while 41 patients had a recent AF episode, but were in sinus rhythm at the moment of enrollment (HTN and AF group). LA diameters and maximal volume, LV mass, LV ejection fraction and diastolic function were assessed through 2D conventional echocardiography. Moreover, peak longitudinal and contractile strain of LA walls (PALS and PACS, respectively) were analyzed by speckle tracking technique. Patients were followed up for 1 year and recurrent 24-h rhythm monitoring was done, in order to identify atrial fibrillation. RESULTS: Age and time from diagnosis of HTN were higher in HTN and AF group than in HTN group (68.02 ± 19 years versus 57.2 ± 1.52 years, p = 0.001 and 62.2 ± 9.2 months versus 40.4 ± 6.4 months, p = 0.04). All LA diameters and LA maximal volume were significantly larger in HTN and AF group (for LA antero-posterior diameter p = 0.02, for all the rest p < 0.0001). LV ejection fraction was preserved in both groups, being significantly lower in HTN and AF patients (58.44 ± 0.79 versus 60.75 ± 0.57, p = 0.02). LV mass was higher in HTN and AF group and these patients had also a more severe diastolic dysfunction, (E/A ratio 1.8 ± 0.51 versus 0.9 ± 0.02, p = 0.04) and lower septal and lateral A' velocities (p < 0.0001 and p = 0.002). The peak LA longitudinal and contractile strain values were also significantly lower in HTN and AF group versus HTN group (for all p < 0.0001). Among the echocardiographic parameters, we identified PALS and PACS as predictors for AF, with a good discriminating capacity (AUC = 0.88 for PALS and AUC = 0.86 for PACS). CONCLUSIONS: Compared to patients with isolated hypertension, patients with hypertension and AF display several echocardiographic differences. Among them, LA strain parameters could be useful predictors of AF occurrence in hypertensive patients.


Assuntos
Fibrilação Atrial/etiologia , Função do Átrio Esquerdo , Ecocardiografia Doppler de Pulso , Hipertensão Essencial/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Fenômenos Biomecânicos , Eletrocardiografia Ambulatorial , Hipertensão Essencial/complicações , Hipertensão Essencial/fisiopatologia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
11.
Medicina (Kaunas) ; 55(6)2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31151287

RESUMO

Background and Objective: Childhood obesity is one of the worldwide health problems with an increasing prevalence and accompanied by severe morbidity and mortality. It is a serious predisposing risk factor especially for the development of cardiovascular diseases and arrhythmias. Electromechanical delay (EMD) is known to be a predictor for the development of atrial fibrillation (AF). Our study aims to investigate whether EMD, which is a predictor of AF, prolongs in obese children or not. MATERIAL AND METHODS: The study included 59 obese patients aged between 8-18 years and 38 healthy patients as the control group with a similar age and gender. All the individuals underwent transthoracic echo and tissue Doppler echocardiography. Systolic and diastolic left ventricular (LV) functions, inter- and intra-atrial electromechanical delay were measured by tissue Doppler imaging (TDI) and conventional echocardiography. RESULTS: Obese patients had significantly lengthened P-wave on surface ECG to the beginning of the late diastolic wave (PA) lateral, PA septum, intra- and inter-atrial electromechanical delays when compared with the control group (p < 0.001, p = 0.001, p < 0.001 and p < 0.001, respectively) Inter-atrial EMD and intra-atrial EMD correlated positively with body mass index (BMI) values (r = 0.484, p < 0.001 and r = 0.376, p = 0.001; respectively) BMI was significantly related with inter-atrial EMD (ß = 0.473, p < 0.001) However, there was no relationship between inter-atrial EMD and serum glucose and platelet count. CONCLUSION: In our study, we declared that electromechanical delay was increased in obese children when compared to the control group and intra- and inter-atrial electromechanical delay was in correlation with body mass index. Furthermore, we discovered that BMI is an independent predictor of the inter-atrial EMD in obese children.


Assuntos
Condutividade Elétrica/classificação , Átrios do Coração/fisiopatologia , Obesidade/fisiopatologia , Adolescente , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Índice de Massa Corporal , Criança , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Obesidade/complicações , Estudos Prospectivos , Fatores de Tempo
12.
Amyloid ; 26(3): 128-138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172799

RESUMO

Background: Atrial fibrillation (AF) commonly affects patients with cardiac amyloidosis (CA). Amyloid deposition within the left atrium may be responsible for the subtype of AF in either permanent or non-permanent form. The prognostic implications of AF and its clinical subtype according to the type of CA are still controversial in this population. This study sought to investigate the prevalence, incidence and prognostic implications of AF and the clinical subtype of AF (permanent or non-permanent) in patients with CA. Methods: Two hundred and thirty-eight patients with CA and full medical records were retrospectively enrolled in the study: About 115 (48%) with light chain (AL) amyloidosis and 123 (52%) with transthyretin amyloidosis (ATTR). Patient's medical records were reviewed to establish baseline prevalence, incidence and impact on all-cause and cardiovascular mortality during follow-up of AF. Results: One hundred and four (44%) patients had history of AF at the time of diagnosis: 62 (60%) permanent and 42 (40%) non-permanent. There were 30 (26%) and 74 (60%) patients with history of AF among patients with AL and ATTR (including 5 hereditary and 69 wild-type), respectively (p<.0001). During the follow-up, 48 new patients developed AF (29, 12 and 7 among patients with AL, wild-type ATTR and hereditary ATTR). After adjustment for age, survival was similar in patients with or without history of AF (HR 0.87 (95% CI, 0.60 to 1.27; p = .467). AF had no impact on cardiovascular mortality. Among the 152 patients with history of AF included in the whole study, there were 75 (49%) patients with permanent AF. After adjustment for age, survival was similar in patients with permanent and non-permanent AF: HR 1.29 (95% CI, 0.84 to 1.99; p = .251). The results were the same among patients with AL or wild-type amyloidosis. Subtype of AF had no impact on cardiovascular mortality. Conclusions: AF is common in patients with CA. However, AF and clinical subtype of AF have no impact on all-cause mortality, whatever the type of amyloidosis.


Assuntos
Neuropatias Amiloides Familiares/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Neuropatias Amiloides Familiares/sangue , Neuropatias Amiloides Familiares/complicações , Neuropatias Amiloides Familiares/mortalidade , Fibrilação Atrial/sangue , Fibrilação Atrial/complicações , Fibrilação Atrial/mortalidade , Ecocardiografia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/sangue , Amiloidose de Cadeia Leve de Imunoglobulina/complicações , Amiloidose de Cadeia Leve de Imunoglobulina/mortalidade , Masculino , Pessoa de Meia-Idade , Pré-Albumina/metabolismo , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
13.
Echocardiography ; 36(6): 1045-1053, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31148237

RESUMO

BACKGROUND AND AIM: Predictors of exercise capacity in heart failure (HF) with preserved ejection fraction (HFpEF) remain of difficult determination. The aim of this study was to identify predictors of exercise capacity in a group of patients with HFpEF and right ventricle (RV) dysfunction METHODS: In 143 consecutive patients with HFpEF (age 62 ± 9 years, LV EF ≥45) and 41 controls, a complete echocardiographic study was performed. In addition to conventional measurements, LA compliance was calculated using the formula: [LAV max - LAV min/LAV min × 100]. Exercise capacity was assessed using the six-minute walking test (6-MWT). Tricuspid annular plane systolic excursion (TAPSE) < 1.7 cm was utilized to categorize patients with RV dysfunction (n = 40) from those with maintained RV function (n = 103). RESULTS: Patients with RV dysfunction were older (P = 0.002), had higher NYHA class (P = 0.001), higher LV mass index (P = 0.01), reduced septal and lateral MAPSE (all P < 0.001), enlarged LA (P = 0.001) impaired LA compliance index (P < 0.001) and exhibited a more compromised 6-MWT (P = 0.001). LA compliance index correlated more closely with 6-MWT (r = 0.51, P < 0.001) compared with the other LA indices (AP diameter, transverse diameter and volume indexed; r = -0.30, r = -0.35 and r = -0.38, respectively). In multivariate analysis, LA compliance index <60% was 88% sensitive and 61% specific (AUC 0.80, CI = 0.67-0.92 P = 0.001) in predicting exercise capacity. CONCLUSION: An impairment in LA compliance was profound in patients with HFpEF and RV dysfunction and seems to be most powerful independent predictor of limited exercise capacity.


Assuntos
Ecocardiografia/métodos , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Disfunção Ventricular Direita/fisiopatologia , Teste de Esforço , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade
14.
Oxid Med Cell Longev ; 2019: 5703764, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31178968

RESUMO

MicroRNAs (miRNAs) are regarded as a potential method for the treatment of atrial fibrillation (AF) although its molecular mechanism remains unknown. We found in our previous study that the level of peripheral blood miR-27b-3p and the expression of atrial tissue CX43 were both significantly downregulated in AF patients. In the present study, we propose and test this hypothesis that overexpression of miR-27b-3p attenuates atrial fibrosis, increases CX43 expression, and regulates the signaling pathway of Wnt/ß-Catenin by targeting Wnt3a. miR-27b-3p overexpression was induced by rat tail vein injection of adeno-associated virus. Two weeks after transfection of adeno-associated virus, the rat AF model was established by tail vein injection of acetylcholine- (ACh-) CaCl2 for 7 days, and 1 ml/kg was injected daily. The incidence and duration of AF were recorded with an electrocardiogram. Cardiac function was monitored by cardiac ultrasound. Serum cardiac enzyme was detected by ELISA. The expression of atrial miR-27b-3 and Wnt3a was assayed by quantitative RT-PCR. Atrial fibrosis was determined by Masson's trichrome staining. Expression of atrial Collagen-I and Collagen-III was tested by the immunohistochemical method. Expression of CX43 was measured by immunofluorescence. The expression of Collagen-I, a-SMA, Collagen-III, TGF-ß1, CX43, Wnt3a, ß-Catenin, and p-ß-Catenin was assayed by western blot. Our results showed that miR-27b-3p overexpression could reduce the incidence and duration of AF, alleviate atrial fibrosis, increase atrial CX43 expression, and decrease the expression of Collagen-I, a-SMA, Collagen-III, TGF-ß1, Wnt3a, and p-ß-Catenin. In addition, the results of luciferase activity assay showed that Wnt3a is a validated miR-27b-3p target in HEK 293T cells. Our results provide a new evidence that miR-27b-3p regulates the signaling pathway of Wnt/ß-Catenin by targeting Wnt3a, which may play an important role in the development of atrial fibrosis and AF.


Assuntos
Fibrilação Atrial/metabolismo , MicroRNAs/metabolismo , Via de Sinalização Wnt , Proteína Wnt3A/metabolismo , beta Catenina/metabolismo , Animais , Fibrilação Atrial/genética , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Conexina 43/biossíntese , Conexina 43/genética , Fibrose , Células HEK293 , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Humanos , Masculino , MicroRNAs/biossíntese , MicroRNAs/genética , Ratos , Ratos Sprague-Dawley , Proteína Wnt3A/genética , beta Catenina/genética
15.
Clin Interv Aging ; 14: 969-975, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31239651

RESUMO

Purpose: Left ventricle (LV)-only pacing is non-inferior to biventricular pacing but permanent fusion pacing is needed to ensure cardiac resynchronization therapy (CRT) responsiveness. The role of systematic exercise testing (ET) in these patients has not been established. This study was designed to assess clinical and therapeutic implications (device programming/drugs) of systematic ET in patients requiring fusion-pacing CRT without an right ventricle (RV) lead. Methods: Consecutive patients with a right atrium/LV-only dual-chamber (DDD) pacing system were included. Prospective data were obtained: device interrogation, ET, and echocardiography at every 6-month follow-up visit. CRT assessment during ET included maximal heart rate, beat-to-beat echocardiography analysis of LV fusion pacing, LV loss of capture, and improvement in exercise capacity. If LV loss of capture or unsatisfactory LV fusion pacing occurred, reprogramming was individualized for each patient and ET redone. Results: A total of 55 patients (29 male) aged 62±11 years were included. During follow-up (39±18 months), a total of 235 ETs were performed, with mean exercise load 6.4±1.3 metabolic equivalents of task (118±35 W, maximal heart rate 119±17 beats/min). Twenty patients (36%) had inadequate pacing or loss of LV capture during ET, due to exceeding the maximum tracking rate (11%), chronotropic incompetence (7%), and LV pacing outside the fusion-pacing band (18%), caused by physiological shortening of the PR interval or exagerated LV preexcitation during maximum exercise. Post-ET CRT-device optimization included reprogramming of rate-adaptive atrioventricular interval (total decrease 23±8 ms), individualized programming of maximum tracking rate, or rate-response function. Drug optimization was performed in 32% of patients, and ET redone in 36%. Conclusion: In one of three ETs, an intervention in device and medication optimization was done to ensure a better outcome. Routine ET should be a standard approach to maximize fusion-pacing CRT response during follow-up.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Doenças Cardiovasculares/terapia , Teste de Esforço/métodos , Exercício/fisiologia , Átrios do Coração/fisiopatologia , Ventrículos do Coração/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
16.
Int J Cardiovasc Imaging ; 35(9): 1637-1649, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31037473

RESUMO

Pulmonary arterial hypertension (PAH) is a serious and often fatal complication of connective tissue disease (CTD). Right atrial (RA) function is essential to maintaining adequate total right heart function in PAH. However, little is known about prognostic utility of RA function in CTD-PAH. RA longitudinal strain (LS) and strain rate (LSR) were evaluated in 53 consecutive patients (51 female, mean age 42 ± 15 years) with CTD-PAH, including systemic lupus erythematosus (SLE) (33.7%), mixed connective tissue disease (MCTD) (32.1%), primary Sjögren's syndrome (pSS) (26.4%), and systemic sclerosis (SSc) (3.8%). At a mean follow-up of 19.3 ± 10.9 months, 20 patients (37.7%) were clinically worse. The group with clinical events had worse clinical conditions and poorer RA function at baseline compared with the group that had no clinical events. RA LS independently reflected World Health Organization functional class (WHO FC) after adjusting for RA area (RAA), tricuspid regurgitation (TR) grade, right ventricular (RV) global longitudinal strain (GLS), and pulmonary vascular resistance (PVR) (P = 0.006). Receiver operator characteristic (ROC) curve analysis indicated that RA LS < 22.9% was predictive of clinical worsening during follow-up (sensitivity = 80%; specificity = 87.9%; area under the curve (AUC) = 0.858), and the Kaplan-Meier curve confirmed that RA LS ≥ 22.9% was associated with more favorable long-term outcomes compared to RA LS < 22.9% (log-rank P < 0.01). On univariate Cox proportional hazards analysis, PVR, RVGLS, RAA, and RA LS were associated with long-term outcome, while RA LS was the only independent predictor in the multivariate analysis. Our findings suggest that RA LS measurements by speckle-tracking echocardiography (STE) can independently reflect the extent of right heart failure and predict clinical outcomes in patients with CTD-PAH. RA LS < 22.9% is associated with a higher risk of clinical worsening.


Assuntos
Pressão Arterial , Função do Átrio Direito , Doenças do Tecido Conjuntivo/complicações , Ecocardiografia Doppler/métodos , Átrios do Coração/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Interpretação de Imagem Assistida por Computador/métodos , Artéria Pulmonar/fisiopatologia , Adulto , Idoso , Doenças do Tecido Conjuntivo/diagnóstico , Progressão da Doença , Feminino , Átrios do Coração/fisiopatologia , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Fatores de Tempo , Função Ventricular Direita , Remodelação Ventricular
17.
Int J Cardiovasc Imaging ; 35(9): 1619-1626, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31037476

RESUMO

There are few data on the effects of low hemoglobine levels on the left atrium (LA) in anemic patients. Our aim was to evaluate left atrial (LA) volume and functions in anemic patients using real time three-dimensional echocardiography (RT3DE) and also to investigate changes in variables of LA after the correction of anemia. In total, 55 iron-deficiency anemia patients without traditional cardiovascular (CV) risk factors and 30 age- and gender-matched controls were studied. Assessments included history, physical examination and echocardiography. Of the 55 patients with anemia enrolled, 50 (39 females and 11 males 40.3 years) were followed and underwent echocardiography after correction of the anemia. LA maximum volume (LAVmax), LA minimal volume (LAVmin), LAVmax index (LAVI), before atrial contraction volume (LAVpreA), LA total emptying fraction, LA active emptying volume were higher in anemic patients. LA passive emptying fraction was significantly lower in anemic patients. Following correction of anemia, LA volume and function parameters were observed to be significantly reduced. Moreover, significant increase was noted in LA passive emptying fraction. Correlation analysis was performed and a significant negative correlation was noted between the percentage change in hemoglobin level and percentage change in LAVI (r = - 0.382, p = 0.003). It was shown that volume and functions of LA are impaired in anemic patients. However impaired parameters were improved after correction of anemia. It may be thought that RT3DE LA parameters can be used as an important preclinical marker of disease pathogenesis before developing heart failure or atrial arrhythmia.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Função do Átrio Esquerdo , Ecocardiografia Tridimensional , Átrios do Coração/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Hematínicos/uso terapêutico , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Anemia Ferropriva/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Átrios do Coração/fisiopatologia , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Resultado do Tratamento
18.
Clin Cardiol ; 42(6): 644-652, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31038759

RESUMO

The cardiac autonomic nerve system (CANS) is a potentially potent modulator of the initiation and perpetuation of atrial fibrillation (AF). In this review, we focus on the relationship between the autonomic nervous system (ANS) and the pathophysiology of AF and the potential benefit and limitations of neuromodulation in the management of this arrhythmia from eight aspects. We conclude that Activation and Remodeling of CANS involved in the initiation and maintenance of AF. The network control mechanism, innervation regions, and sympathetic/parasympathetic balance play an important role in AF substrate. And the formation of Complex Fractional Atrial Electrograms also related to CANS activity. In addition, modulating CANS function by potential therapeutic applications include ganglionated plexus ablation, renal sympathetic denervation, and low-level vagal nerve stimulation, may enable AF to be controlled. Although the role of the ANS has long been recognized, a better understanding of the complex interrelationships of the various components of the CANS will lead to improvement of treatments for this common arrhythmia.


Assuntos
Fibrilação Atrial/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Ablação por Cateter/métodos , Átrios do Coração/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Sistema Nervoso Autônomo/cirurgia , Técnicas Eletrofisiológicas Cardíacas , Sistema de Condução Cardíaco/cirurgia , Humanos
19.
PLoS One ; 14(5): e0216928, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31083689

RESUMO

BACKGROUND: Heart failure (HF) is a leading cause of mortality and is associated with cardiac remodeling. Vulnerability to atrial fibrillation (AF) has been shown to be greater in the early stages of HF, whereas ventricular tachycardia/fibrillation develop during late stages. Here, we explore changes in gene expression that underlie the differential development of fibrosis and structural alterations that predispose to atrial and ventricular arrhythmias. OBJECTIVE: To study transcriptomic changes associated with the development of cardiac arrhythmias in early and late stages of heart failure. METHODS: Dogs were tachy-paced from right ventricle (RV) for 2-3 or 5-6 weeks (early and late HF). We performed transcriptomic analysis of right atria (RA) and RV isolated from control dogs and those in early and late HF. Transcripts with mean relative log2-fold change ≥2 were included in the differential analysis with significance threshold adjusted to p<0.05. RESULTS: Early HF remodeling was more prominent in RA with enrichment of extracellular matrix, circulatory system, wound healing and immune response pathways; many of these processes were not present in RA in late HF. RV showed no signs of remodeling in early HF but enrichment of extracellular matrix and wound healing in late HF. CONCLUSION: Our transcriptomic data indicate significant fibrosis-associated transcriptional changes in RA in early HF and in RV in late HF, with strong atrial predominance. These alterations in gene expression are consistent with the development of arrhythmogenesis in atria in early but not late HF and in the ventricle in late but not early HF.


Assuntos
Fibrilação Atrial/genética , Proteínas da Matriz Extracelular/genética , Insuficiência Cardíaca/genética , Marca-Passo Artificial/veterinária , Taquicardia Ventricular/genética , Transcriptoma , Animais , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/metabolismo , Fibrilação Atrial/fisiopatologia , Modelos Animais de Doenças , Cães , Ecocardiografia , Proteínas da Matriz Extracelular/metabolismo , Fibrose , Perfilação da Expressão Gênica , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/metabolismo , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/metabolismo , Ventrículos do Coração/fisiopatologia , Hemodinâmica/genética , Imunidade Inata/genética , Análise em Microsséries , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/metabolismo , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Cicatrização/genética
20.
Cardiovasc Ultrasound ; 17(1): 9, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092263

RESUMO

BACKGROUND: Two-dimensional speckle-tracking echocardiography (2D-STE) enables objective assessment of left atrial (LA) deformation through the analysis of myocardial strain, which can be measured by different speckle-tracking software. The aim of this study was to compare the consistency of 3 different commercially available software, which include vendor-specific software for measuring left ventricle (VSSLV), vendor-independent software packages for measuring LV strain (VISLV) and vendor-independent software packages for measuring LA strain (VISLA). METHODS: Sixty-four subjects (mean age: 44 ± 16 years, 50% males) underwent conventional echocardiograms using a GE Vivid 9 (GE Ultrasound, Horten, Norway) cardiac ultrasound system. Standard apical 4 and 2 chamber views of the left atrium were obtained in each subject with a frame-rate range of 40-71 frames/s. LA strain during the contraction phase (Sct), conduit phase (Scd), reservoir phase (Sr = Sct + Scd) were analyzed by 2 independent observers and 3 different software. RESULTS: Sct, Scd, Sr were, respectively, - 11.26 ± 2.45%, - 16.77 ± 7.06%, and 28.03 ± 7.58% with VSSLV, - 14.77 ± 3.59%, - 23.17 ± 10.33%, and 38.23 ± 10.99% with VISLV, and - 14.80 ± 3.88%, - 23.94 ± 10.48%, and 38.73 ± 11.56% when VISLA was used. A comparison of strain measurements between VSSLV and VIS (VISLV and VISLA) showed VIS had significantly smaller mean differences and narrower limits of agreement. Similar results were observed in the coefficient of variation (CV) for measurements between VSSLV and VIS (VISLV and VISLA). Comparison of the intra-class correlation coefficients (ICCs) indicated that measurement reliability was weaker with VSSLV (ICC < 0.6) than with VIS (VISLV and VISLA) (ICC > 0.9). For intra-observer ICCs, VISLA > VSSLV = VISLV. For inter-observer ICCs, VSSLV > VISLA > VISLV. CONCLUSIONS: Software measurement results of LA strain vary considerably. We recommended not measuring LA strain across vendor platforms.


Assuntos
Fibrilação Atrial/diagnóstico , Função do Átrio Esquerdo/fisiologia , Comércio , Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Software , Adulto , Fibrilação Atrial/fisiopatologia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
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