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1.
Int Heart J ; 61(6): 1311-1314, 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-33191338

RESUMO

Although some researches proved the influence of radiation therapy (RT) on pacemakers and implantable cardioverter defibrillators, little has been reported on cardiac resynchronization therapy defibrillators (CRTDs). We experienced a case of RT on CRTD and had a new finding.A patient with CRTD implanted for dilated cardiomyopathy was diagnosed with lung squamous cell carcinoma and started receiving RT. All the implanted devices, including the main body of CRTD, left ventricular lead (LV), right ventricular lead with high-voltage conductor, and right atrial lead, were from the same manufacturer. The radiation targeted the tumor of 67 mm in diameter in the right superior lobe for 5 min per session. The CRTD was outside the radiation field, which is 65 mm, but the leads were inside. Plan 1 used 2 Gy/fr with 8 megavolt photons, and Plan 1 was irradiated at 0° and 180° for 16 RT sessions. The dosage was increased to 3 Gy for Plan 2 for 4 sessions. Plan 3 used 2 Gy with 6 and 8 megavolt photons, and Plan 3 was irradiated at 27.7° and 200.7° for 11 RT sessions. Changes in measured parameters were assessed before and after RT.Changes in impedance of LV and high-voltage lead exceeded prespecified threshold. However, no significant errors were detected in the CRTD on the dosages and energy we used.We hypothesize that the lead insulator could have been affected by radiation.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Dispositivos de Terapia de Ressincronização Cardíaca , Cardiomiopatia Dilatada/terapia , Desfibriladores Implantáveis , Neoplasias Pulmonares/radioterapia , Radioterapia/métodos , Idoso , Carcinoma de Células Escamosas/complicações , Terapia de Ressincronização Cardíaca , Cardiomiopatia Dilatada/complicações , Impedância Elétrica , Eletrodos Implantados , Humanos , Neoplasias Pulmonares/complicações , Masculino
2.
Artigo em Russo | MEDLINE | ID: mdl-33054004

RESUMO

The search for new methods of symptomatic therapy of dilated cardiomyopathy (DCM) remains a relevant objective of modern cardiology. This is due to the low and short-term existing methods effectiveness of conservative and surgical treatment, including drug therapy. PURPOSE OF THE STUDY: Efficacy evaluation of the combined use of kinesio- and laser therapy for the correction of regional hemodynamics in patients with DCM against the background of maintenance drug therapy. MATERIAL AND METHODS: 100 patients with DCM were examined. All patients received differential maintenance drug therapy (beta-blockers, ACE inhibitors, with intolerance to the latter - angiotensin II receptor blockers, aldosterone receptor antagonists, diuretics, cardiac glycosides, antiarrhythmic drugs). Patients were divided into 2 groups at least 3 months after the selection of drug therapy. Intravenous laser blood irradiation (ILBI) and the selection of unloading therapeutic exercises were performed for patients of the main group during therapy. Patients in the control group received only drug therapy. The main research method was venous occlusion plethysmography. It was used to assess regional hemodynamics with the determination of recirculating blood flow (Qr) and regional vascular resistance (Rr) at rest, venous tone (Vt), reserve blood flow (QH) and regional vascular resistance (RH) against a functional stress test. RESULTS: Data obtained in the dynamic observation process (after 1, 3, 6, 9 and 12 months) in the main group indicate a significant increase in Qr and QH, a decrease in Rr and RH, Vt. Significant positive dynamics in the control group was not observed. The regional hemodynamics indices after 9 and 12 months of observation significantly worsened. CONCLUSION: Thus, according to venous-occlusal plethysmography, the use of unloading therapeutic exercises in combination with ILBI against the background of rationally selected differentiated drug therapy in patients with DCM significantly improves the regional hemodynamics. The developed symptomatic therapy methods can be applied in the practice of cardiologists, general practitioners, therapeutists, rehabilitation physicians to optimize the treatment of patients with DCM.


Assuntos
Cardiomiopatia Dilatada , Terapia a Laser , Terapia com Luz de Baixa Intensidade , Antagonistas Adrenérgicos beta , Cardiomiopatia Dilatada/terapia , Hemodinâmica , Humanos
3.
Pediatr Cardiol ; 41(8): 1559-1568, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32856126

RESUMO

Though ventricular assist devices (VADs) are an important treatment option for acute heart failure, an extracorporeal membrane oxygenator (ECMO) is usually used in pediatric patients for several reasons. However, a temporary centrifugal pump-based Bi-VAD might have clinical advantages versus ECMO or implantable VADs. From January 2000 to July 2018, we retrospectively reviewed 36 pediatric patients who required mechanical circulatory support (MCS) for acute heart failure. Cases with postoperative MCS were excluded. Since 2016, we have tried to immediately add a right VAD rather than ECMO, when the patients begin to present features of right heart failure after left VAD support started in cases that the patients' respiratory function did not require an oxygenator. Original diagnoses included dilated cardiomyopathy (n = 18), myocarditis (n = 11), and others (n = 7). Eleven patients were supported by Bi-VAD, and 25 patients were supported by ECMO; of these. Four patients were successfully weaned from VAD, and 10 patients were weaned from ECMO. Eleven patients underwent heart transplantation. Overall, we have 15 (41.7%) early mortalities. There were no significant differences in early mortality, morbidity, and weaning rate between the Bi-VAD group and the ECMO group. During the support, patients with Bi-VADs significantly required fewer platelets and showed less hemolysis than ECMO patients. Patients with myocarditis were successfully weaned from Bi-VAD support and bridged to transplantation thereafter. A temporary centrifugal pump-based Bi-VAD was clinically comparable to ECMO for pediatric patients with acceptable pulmonary function.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/terapia , Coração Auxiliar , Cardiomiopatia Dilatada/terapia , Criança , Pré-Escolar , Feminino , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Humanos , Lactente , Masculino , Miocardite/terapia , Estudos Retrospectivos , Resultado do Tratamento
4.
BMC Cardiovasc Disord ; 20(1): 352, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727396

RESUMO

BACKGROUND: Cardiac manifestations of neonatal lupus include an array of structural and conduction abnormalities due to placental transference of maternal anti-SSA/Ro and anti-SSB/La autoantibodies. Late-onset neonatal lupus cardiomyopathies, occurring outside the neonatal period, is an infrequently reported manifestation with unknown pathophysiology and poorly defined treatment regimens. Due to the rarity of this condition, additional studies and case reports are required to better understand and manage late-onset neonatal lupus cardiomyopathies. CASE PRESENTATION: A 4-week-old female, born to a mother with known anti-SSA/Ro and anti-SSB/La autoantibodies, presents with classic cutaneous manifestations for neonatal lupus and is found to have left bundle branch block, severely dilated cardiomyopathy with an ejection fraction of 25%, and a thin echogenic dyskinetic ventricular septum. Weekly second trimester and 30-week fetal echocardiograms showed no signs of structural or conduction abnormalities. There were no histologic signs of inflammation on cardiac tissue biopsy. After a complicated hospital course, she was successfully treated with biventricular pacemaker, intravenous immunoglobulin, and plasmapheresis. CONCLUSIONS: We present a case of late-onset neonatal lupus with severe dilated cardiomyopathy, a dyskinetic ventricular septum, and left bundle branch block. To our knowledge, the dyskinetic ventricular septum has never been reported and left bundle branch block is rarely reported in NL. This case further validates the need for long term cardiac follow up for patients born with NL, even if lacking cardiac manifestations in the peripartum period. We characterize a unique presentation of a rare clinical entity, highlighting the diagnostic challenges, and describe a successful treatment course.


Assuntos
Bloqueio de Ramo/etiologia , Cardiomiopatia Dilatada/etiologia , Lúpus Eritematoso Sistêmico/congênito , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Dispositivos de Terapia de Ressincronização Cardíaca , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/terapia , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Recém-Nascido , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Plasmaferese , Resultado do Tratamento
6.
J Card Surg ; 35(10): 2866-2868, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720320

RESUMO

BACKGROUND AND AIMS: Fracture and retention of a guidewire after cardiac resynchronization therapy device implantation has not been reported in the literature so far, although it is an uncommon but known complication during cardiac interventions like percutaneous coronary interventions and other cardiac catheterization procedures. METHODS: A 53 years old female patient presented with severe pain over the left arm and shoulder for a period of 1 to 2 days. The patient had a history of dilated cardiomyopathy with severe left ventricular dysfunction and underwent cardiac resynchronization therapy device implant 3 years back with subsequent lead replacement 6 months back due to lead dysfunction. On evaluation, a coronary guidewire which might have fractured and been retained inadvertently during previous surgical procedure, was discovered in her deltoid muscle. Her symptoms were attributed to the guide wire which may have been aggravated by the movements of her arm. Emergency surgical exploration was done and the guidewire was removed. RESULTS AND CONCLUSION: We are reporting a case of unlikely and unusual delayed presentation of retained intervention guide-wire post cardiac resynchronization therapy, which was retrieved from the left deltoid muscle.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca/efeitos adversos , Cardiomiopatia Dilatada/terapia , Músculo Deltoide/cirurgia , Remoção de Dispositivo/métodos , Falha de Equipamento , Intervenção Coronária Percutânea/efeitos adversos , Disfunção Ventricular Esquerda/terapia , Cardiomiopatia Dilatada/complicações , Emergências , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações
7.
J Cardiothorac Surg ; 15(1): 123, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493377

RESUMO

BACKGROUND: Heart failure complicated by pulmonary embolism is an extremely rare condition described in the literature. We report a case of very young patient with advanced heart failure against the background of dilated cardiomyopathy of unknown etiology with the presence of blood clots in both ventricles. CASE PRESENTATION: The course of treatment was complicated by acute pulmonary embolism. In emergency setting the patient was qualified for combine surgery pulmonary embolization and implantation of a continuous flow pump as a bridge for heart transplantation. The post-operative course is described in detail as well as reimplantation of the pump due to early thrombosis. CONCLUSIONS: Performed surgical procedures combined with alteration in anticoagulant drugs was sufficient to stabilize the clinical condition.


Assuntos
Anticoagulantes/uso terapêutico , Cardiomiopatia Dilatada/terapia , Embolectomia/métodos , Insuficiência Cardíaca/terapia , Coração Auxiliar , Embolia Pulmonar/terapia , Trombectomia/métodos , Trombose/terapia , Adolescente , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia , Cardiopatias/complicações , Cardiopatias/terapia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Transplante de Coração , Ventrículos do Coração , Humanos , Masculino , Implantação de Prótese , Artéria Pulmonar , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico por imagem , Trombose/complicações
8.
Herz ; 45(3): 221-229, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32123933

RESUMO

Inflammatory dilated cardiomyopathy (DCMi) is a syndrome, not an etiological disease entity. The infective etiology and the immunopathology can be best determined through endomyocardial biopsy with a complete work-up by light microscopy, immunohistology, and polymerase chain reaction for microbial agents. This review focuses on the methodological advances in diagnosis in the past few years and exemplifies the importance of an etiology-orientated treatment in different case scenarios. In fulminant nonviral myocarditis, immunosuppressive treatment together with hemodynamic stabilization of the patient via mechanical circulatory support (e.g., microaxial pumps, extracorporeal membrane oxygenation, left ventricular assist device) can be life-saving. For viral inflammatory cardiomyopathy, intravenous immunoglobulin treatment can resolve inflammation and often eradicate the virus.


Assuntos
Cardiomiopatias , Cardiomiopatia Dilatada , Inflamação , Miocardite , Biópsia , Cardiomiopatias/etiologia , Cardiomiopatias/terapia , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/terapia , Humanos , Imunoglobulinas Intravenosas , Miocardite/etiologia , Miocardite/terapia , Miocárdio
9.
G Ital Cardiol (Rome) ; 21(3): 195-208, 2020 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-32100732

RESUMO

Cardiomyopathies are a heterogeneous group of cardiac diseases for which diagnosis and treatment are not always simple. The diagnosis of cardiomyopathy, in particular the etiology, comes from an integration between symptoms and results collected by several instrumental exams. The brain storming for the diagnosis includes also the identification of the "red flags", i.e. the pathognomonic features for each etiology that can drive the choice of appropriate diagnostic tests and therapy. In this review, we provide a step by step approach in order to help cardiologists, not specifically dedicated to cardiomyopathies, to draw the diagnosis, therapy and follow-up. This approach will be accompanied by the consultation of other specialists to discuss together the results of the exams performed and to deepen extracardiac signs and symptoms.


Assuntos
Cardiomiopatias/diagnóstico , Cardiomiopatias/genética , Fenótipo , Avaliação de Sintomas , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/genética , Displasia Arritmogênica Ventricular Direita/terapia , Cardiomiopatias/terapia , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/genética , Cardiomiopatia Dilatada/terapia , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/terapia , Cardiomiopatia Restritiva/diagnóstico , Cardiomiopatia Restritiva/etiologia , Cardiomiopatia Restritiva/terapia , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Humanos , Imagem Cinética por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Encaminhamento e Consulta , Sarcoidose/diagnóstico
10.
Mol Ther ; 28(3): 845-854, 2020 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-31981493

RESUMO

Loss of dystrophin leads to Duchenne muscular dystrophy (DMD). A pathogenic feature of DMD is the significant elevation of cytosolic calcium. Supraphysiological calcium triggers protein degradation, membrane damage, and eventually muscle death and dysfunction. Sarcoplasmic/endoplasmic reticulum (SR) calcium ATPase (SERCA) is a calcium pump that transports cytosolic calcium to the SR during excitation-contraction coupling. We hypothesize that a single systemic delivery of SERCA2a with adeno-associated virus (AAV) may improve calcium recycling and provide long-lasting benefits in DMD. To test this, we injected an AAV9 human SERCA2a vector (6 × 1012 viral genome particles/mouse) intravenously to 3-month-old mdx mice, the most commonly used DMD model. Immunostaining and western blot showed robust human SERCA2a expression in the heart and skeletal muscle for 18 months. Concomitantly, SR calcium uptake was significantly improved in these tissues. SERCA2a therapy significantly enhanced grip force and treadmill performance, completely prevented myocardial fibrosis, and normalized electrocardiograms (ECGs). Cardiac catheterization showed normalization of multiple systolic and diastolic hemodynamic parameters in treated mice. Importantly, chamber dilation was completely prevented, and ejection fraction was restored to the wild-type level. Our results suggest that a single systemic AAV9 SERCA2a therapy has the potential to provide long-lasting benefits for DMD.


Assuntos
Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/terapia , Expressão Gênica , Terapia Genética , Distrofia Muscular de Duchenne/complicações , ATPases Transportadoras de Cálcio do Retículo Sarcoplasmático/genética , Administração Intravenosa , Animais , Dependovirus/genética , Modelos Animais de Doenças , Técnicas de Transferência de Genes , Terapia Genética/efeitos adversos , Terapia Genética/métodos , Vetores Genéticos/administração & dosagem , Vetores Genéticos/genética , Camundongos , Camundongos Endogâmicos mdx , Músculo Esquelético/metabolismo , Distrofia Muscular de Duchenne/genética , Distrofia Muscular de Duchenne/terapia , Retículo Sarcoplasmático/metabolismo , Fatores de Tempo , Transdução Genética
11.
Heart Lung Circ ; 29(4): 566-574, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31974027

RESUMO

Advances in human genome sequencing have re-invigorated genetics studies of dilated cardiomyopathy (DCM), facilitating genetic testing and clinical applications. With a range of genetic testing options now available, new challenges arise for data interpretation and identifying single pathogenic variants from the many thousands of rare variants present in every individual. There is accumulating evidence that genetic factors have an important role in the pathogenesis of DCM. However, although more than 100 genes have been implicated to date, the sensitivity of genetic testing, even in familial disease, is only ∼25-40%. As more patients are genotyped, nuanced information about disease phenotypes is emerging including variability in age of onset and penetrance of DCM, as well as additional cardiac and extra-cardiac features. Genotype-phenotype correlations have also identified a subset of genes that can be highly arrhythmogenic or show frequent progression to heart failure. Recognition of variants in these genes is important as this may impact on the timing of implantable cardioverter-defibrillators or heart transplantation. Finding a causative variant in a patient with DCM allows predictive testing of family members and provides an opportunity for preventative intervention. Diagnostic imaging modalities such as speckle-tracking echocardiography and cardiac magnetic resonance imaging are increasingly being used to detect and monitor pre-clinical ventricular dysfunction in asymptomatic variant carriers. Although there are several examples of successful genotype-based therapy, optimal strategies for implementation of precision medicine in familial DCM remain to be determined. Identification of modifiable co-morbidities and lifestyle factors that exacerbate or protect against DCM development in genetically-predisposed individuals remains a key component of family management.


Assuntos
Arritmias Cardíacas , Cardiomiopatia Dilatada , Predisposição Genética para Doença , Testes Genéticos , Mutação , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/genética , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/genética , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/terapia , Humanos
12.
J Cardiovasc Med (Hagerstown) ; 21(2): 134-143, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923053

RESUMO

BACKGROUND: The right ventriculoarterial coupling (R-V/A), a measure of right ventricular systolic dysfunction (RVSD) adaptation/maladaptation to chronic overload, and consequent pulmonary hypertension, has been little investigated in nonischemic dilated cardiomyopathy (NIDCM). We examined the correlates of R-V/A and traditional echocardiographic indices of RVSD, over the spectrum of pulmonary hypertension and tertiles of mean pulmonary artery pressures (PAPm). METHODS: In 2016-2017, we studied 81 consecutive patients for heart transplant/advanced heart failure. Inclusion criteria were NIDCM, reduced ejection fraction (≤40%) and sinus rhythm. R-V/A was computed as the RV/pulmonary elastances ratio (R-Elv/P-Ea), derived from a combined right heart catheterization/transthoracic- echocardiographic assessment [right heart catheterization/transthoracic-echocardiographic (RHC/TTE)]. RESULTS: A total of 68 patients (mean age 64 ±â€Š7 years, 82% men) were eligible. After adjustments, R-Elv and P-Ea were higher in isolated postcapillary-pulmonary hypertension (Ipc-PH) than combined-pulmonary hypertension (Cpc-PH) (P = 0.004 and P = 0.002, respectively), whereas R-V/A progressively decreased over Ipc-PH and Cpc-PH (P = 0.006). According to PAPm increment, P-Ea congruently increased (P-Trend = 0.028), R-Elv progressively decreased (P-Trend<0.00)1, whereas R-V/A significantly worsened (P-Trend = 0.045). At the multivariable analysis, a reduced RV longitudinal function (TAPSE<17 mm) was positively associated with R-V/A impairment (<0.8) [odds ratio 1.41, 95% confidence interval (CI) (1.07--1.87), P = 0.015]. R-Elv and P-Ea showed good interobserver reliability [interclass correlation (ICC) 0.84, 95% CI (0.32--0.99), P = 0.012 and ICC 0.98, 95% CI (0.93--99), P < 0.001, respectively]. CONCLUSION: Among NIDCM HF patients, in a small cohort study, RHC/TTE-derived R-V/A assessment demonstrated good correlations with pulmonary hypertension types and RV functional status. These data suggest that R-V/A encloses comprehensive information of the whole cardiopulmonary efficiency, better clarifying the amount of RVSD, with good reliability.


Assuntos
Pressão Arterial , Cardiomiopatia Dilatada/diagnóstico por imagem , Ecocardiografia Doppler , Insuficiência Cardíaca/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Idoso , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/terapia , Estudos Transversais , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Artéria Pulmonar/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume Sistólico , Disfunção Ventricular Direita/fisiopatologia , Disfunção Ventricular Direita/terapia
13.
Can J Cardiol ; 36(2): 317.e5-317.e7, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31932114

RESUMO

Exposure to synthetic drugs such as amphetamines may lead to significant consequences on the cardiovascular system. The prognosis of young adults with amphetamine-induced cardiomyopathy remains poor. We present 2 young patients (aged <40 years) who developed severe dilated cardiomyopathy after chronic amphetamine use. Thorough psychological evaluations demonstrated favorable features with patients being reliable and committed to their health problems. A left ventricular assist device (HeartMate II; Abbott, Chicago, IL) was implanted in the patients shortly after admission to optimize hemodynamic support and evaluate the potential for recovery. Within less than 1 year, significant improvement was achieved and successful explantation of left ventricular assist device was performed in both patients.


Assuntos
Anfetamina/efeitos adversos , Cardiomiopatia Dilatada/induzido quimicamente , Cardiomiopatia Dilatada/terapia , Estimulantes do Sistema Nervoso Central/efeitos adversos , Coração Auxiliar , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Humanos , Masculino , Índice de Gravidade de Doença , Adulto Jovem
14.
Analyst ; 145(2): 486-496, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31781708

RESUMO

Dilated cardiomyopathy (DCM) is a leading cardiomyopathy condition and is the leading reason for heart transplantation. Due to high etiologic and genetic heterogeneity of the pathologies, different therapeutic treatment strategies are available and have been successful for different treatments. Immunoadsorption (IA) therapy removes the circulating anticardiac antibodies and improves the left ventricular function in substantial proportion of DCM patients. Powerful, non-invasive analytical tools are highly desired to investigate the efficiency and success of IA therapy. In this contribution, we followed the changes of a female DCM patient undergoing IA therapy at different treatment time points in a label-free, non-invasive manner from blood samples (plasma and serum) on the basis of vibrational spectroscopy (Raman scattering and IR absorption). Chemometric methods, including dimension reduction and statistical modeling, were used to interpret spectral data. The impact of different time points of the IA treatment can be identified in both the plasma and serum, using both techniques, with high accuracy. The removal of antibodies of immunoglobulin G (IgG) group during IA therapy and their restoration was reflected in both Raman and FTIR spectra. Relative changes in the spectral bands assigned to IgG agreed well with the immunoturbidimetry measurement of total IgG. Successful clinical treatment was accompanied by spectral differences between vibrational spectra obtained at initial disease state and 11 months after the IA treatment. The long-term follow-up of the patient reveals the stabilization of the health state after therapy. It is noteworthy that the treatment time points were distinguished with a better accuracy using spectra from plasma compared to those from serum samples, which might indicate the involvement of corresponding proteins in the coagulation. Vibrational spectroscopy is a powerful tool for personalized medicine to follow-up the treatment success of IA therapy for the DCM disorder.


Assuntos
Cardiomiopatia Dilatada/terapia , Imunoglobulina G/sangue , Plasmaferese , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medicina de Precisão/métodos , Análise de Componente Principal , Análise Espectral/métodos , Fatores de Tempo , Vibração
15.
EuroIntervention ; 16(4): e293-e300, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31763984

RESUMO

AIMS: The DYNAMIC trial assessed the safety and explored the efficacy of multivessel intracoronary infusion of allogeneic cardiosphere-derived cells (CDCs) in patients with heart failure and reduced ejection fraction (HFrEF). Here we report the results of the DYNAMIC trial. METHODS AND RESULTS: We enrolled 14 patients with EF ≤35% and NYHA Class III-IV despite maximal medical and device-based therapy in this single-centre, open-label trial. Intracoronary catheterisation delivered four escalating doses (totalling 37.5-75 million cells) by sequential non-occlusive technique to all three major coronary arteries. The primary safety endpoint was a composite of post-infusion TIMI flow, ventricular tachycardia/fibrillation, sudden death, major adverse cardiac events or acute myocarditis within 72 hours. Twelve patients were male and EF averaged 23.0% (±4.5%). No primary safety endpoints were observed. Two patients died of HFrEF progression nine and 12 months following infusion. Compared to baseline, there was an improvement in EF (26.8% vs 22.9%, p=0.023) and left ventricular end-systolic volume (139.5 vs 177.8 cm3, p=0.03) at six months. Quality of life (QoL) scores and NYHA class (p=0.006) improved at six months. At 12 months, the improvement in EF and QoL remained significant. CONCLUSIONS: Global intracoronary infusion of allogeneic CDCs is safe and feasible. The efficacy of allogeneic CDCs in HFrEF needs to be tested in larger randomised trials.


Assuntos
Cardiomiopatia Dilatada/terapia , Insuficiência Cardíaca/terapia , Transplante de Células-Tronco Hematopoéticas , Transplante de Células-Tronco/métodos , Humanos , Masculino , Qualidade de Vida , Volume Sistólico , Transplante Autólogo , Resultado do Tratamento
16.
Clin Res Cardiol ; 109(1): 115-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31236690

RESUMO

INTRODUCTION: The DANISH trial raised doubts about the effectiveness of primary prevention of sudden cardiac death by ICD implantation among patients with non-ischemic heart failure. We sought to analyse data from the EVITA-HF registry to give an answer from real-world registry data to the DANISH trial. METHODS: 1804 patients were identified from the EVITA-HF registry with chronic heart failure (CHF) due to ischemic or dilated heart disease and reduced left ventricular ejection fraction of ≤ 35%. The patients were divided into two groups: Patients with newly implanted cardioverter-defibrillator (ICD group; mean age 66 ± 12 years, 77% male) and without ICD (no-ICD group; mean age 66 ± 14 years, 77% male). The subgroups were compared with regard to mortality and predictive parameters affecting survival. RESULTS: Cardiovascular risk factors were similar among patients in the non-ICD group (n = 1473) compared to ICD group (n = 331). After 1-year follow-up patients with ischemic heart disease showed a significant improved survival in the ICD group compared to non-ICD group [92.1% vs. 80.6%, HR 0.37 (0.22-0.62)]. Patients with non-ischemic cardiomyopathy did not show a difference with regard to survival between the ICD and the non-ICD group [93.7% vs. 93.1%, HR 0.92 (0.43-1.97)]. The data were stable in a Cox-regression model. CONCLUSION: In a real-world setting, no benefit was evident for patients with non-ischemic cardiomyopathy and reduced left ventricular ejection fraction by adding ICD therapy in a short-term follow-up of 12 months in contrast to patients with ischemic cardiomyopathy.


Assuntos
Cardiomiopatia Dilatada/terapia , Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Isquemia Miocárdica/terapia , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/fisiopatologia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Sistema de Registros , Fatores de Risco , Volume Sistólico/fisiologia , Taxa de Sobrevida , Função Ventricular Esquerda/fisiologia
17.
Int J Cardiol ; 298: 85-92, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31668660

RESUMO

AIMS: To recapitulate progressive human dilated cardiomyopathy (DCM) and heart block in the Lmna R225X mutant mice model and investigate the molecular basis of LMNA mutation induced cardiac conduction disorders (CD); To investigate the potential interventional impact of exercise endurance. METHODS AND RESULTS: A Lmna R225X knock-in mice model in either heterozygous or homozygous genotype was generated. Electrical remodeling was observed with higher occurrence of AV block from neonatal and aged mutant mice as measured by surface electrocardiogram and atrio-ventricular Wenckebach point detection. Histological and molecular profiles revealed an increase in apoptotic cells and activation of caspase-3 activities in heart tissue. Upon aging, extracellular cellular matrix (ECM) remodeling appeared with accumulation of collagen in Lmna R225X mutant hearts as visualized by Masson's trichrome stain. This could be explained by the upregulated ECM gene expression, such as Fibronectin: Fn1, collagen: Col12a1, intergrin: Itgb2 and 3, as detected by microarray gene chip. Also, endurance exercise for 3 month improved the ventricular ejection fraction, attenuated fibrosis and cardiomyocytes apoptosis in the aged mutant mice. CONCLUSIONS: The mechanism of LMNA nonsense mutation induced cardiac conduction defects through AV node fibrosis is due to upregulated ECM gene expression upon activation of cardiac apoptosis. Lmna R225X mutant mice hold the potential for serving as in vivo models to explore the mechanism and therapeutic methods for AV block or myopathy associated with the aging process.


Assuntos
Doença do Sistema de Condução Cardíaco/genética , Cardiomiopatia Dilatada/genética , Códon sem Sentido/genética , Lamina Tipo A/genética , Condicionamento Físico Animal/fisiologia , Animais , Animais Recém-Nascidos , Doença do Sistema de Condução Cardíaco/metabolismo , Doença do Sistema de Condução Cardíaco/terapia , Cardiomiopatia Dilatada/metabolismo , Cardiomiopatia Dilatada/terapia , Expressão Gênica , Técnicas de Introdução de Genes/métodos , Frequência Cardíaca/fisiologia , Lamina Tipo A/biossíntese , Camundongos , Condicionamento Físico Animal/métodos
18.
Nutr Metab Cardiovasc Dis ; 30(3): 393-399, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-31791635

RESUMO

BACKGROUND AND AIMS: The prognostic nutritional index (PNI) had been associated with adverse outcomes in numerous clinical conditions. However, its influence on idiopathic dilated cardiomyopathy (DCM) was not determined. This aim of this study was to determine the predictive ability of PNI in patients with idiopathic DCM. METHODS AND RESULTS: A total of 1021 consecutive patients with idiopathic DCM were retrospectively included and divided into three groups based on admission PNI tertiles: <41.7 (n = 339), 41.7-47.3 (n = 342), >47.3 (n = 340). The association of PNI with in-hospital major adverse clinical events (MACEs) and death during follow-up was evaluated. In-hospital mortality (2.9% vs. 1.5% vs. 0.0%, respectively; p = 0.006) and MACEs (13.6% vs. 6.7% vs. 3.5%, respectively; p < 0.001) decreased from the lowest to the highest PNI tertile. The optimal cut-off value of PNI to predict in-hospital MACEs was 44.0 (area under the curve: 0.689; 95% confidence interval [CI]: 0.626-0.753; p < 0.001). Multivariate analysis showed that a PNI≤44.0 was an independent risk factor of in-hospital MACEs (odd ratio: 2.86; 95% CI: 1.64-4.98; p < 0.001) and all-cause mortality at a median follow-up of 27 months (hazard ratio: 1.67; 95% CI: 1.11-2.49; p = 0.013). In addition, patients with a PNI≤44.0 had a lower cumulative survival rate during follow-up (log-rank: 35.62; p < 0.001). CONCLUSION: The PNI was an independent risk factor for in-hospital MACEs and all-cause mortality at a median follow-up of 27 months in patients with idiopathic DCM; hence, it may be considered a tool for risk assessment.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Dieta , Estado Nutricional , Valor Nutritivo , Adulto , Idoso , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/terapia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
20.
Can J Cardiol ; 36(2): 317.e1-317.e3, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31837890

RESUMO

The deleterious effect of energy drinks is increasingly recognized. We present a 26-year-old woman with inotrope-dependent severe dilated cardiomyopathy, potentially caused by chronic ingestion of energy drinks. The results of extensive investigation-consisting of cardiac magnetic resonance, F-18-fluorodesoxyglucose-positron emission tomography, coronary angiography, and endomyocardial biopsy-were normal. A left ventricular assist device (LVAD) was implanted as a potential bridge to recovery. After 10 months of mechanical support and pharmacological treatment, cardiac function was recovered, and the LVAD was successfully explanted. This is the first case report of energy drink abuse leading to severe heart failure requiring mechanical support for recovery.


Assuntos
Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/terapia , Bebidas Energéticas/efeitos adversos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Coração Auxiliar , Adulto , Feminino , Humanos
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