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1.
Vasc Health Risk Manag ; 17: 431-443, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34366667

RESUMO

In modern laboratory diagnostics of cardiovascular diseases (CVD), there is a clear tendency toward an increase in the sensitivity of methods for determining key CVD biomarkers, among which highly sensitive cardiac troponins (hs-Tn) deserve special attention. The introduction of the latter into clinical practice made it possible not only to improve the early diagnosis of acute myocardial infarction but also to open up a number of additional valuable opportunities for the use of hs-Tn, including the assessment of the risk of developing CVD in a healthy population, detection and monitoring of early myocardial injuries in the early stages of CVD development (for example, with ischemic heart disease and arterial hypertension), with noncardiac pathologies (for example, sepsis, chronic obstructive pulmonary disease, chronic renal failure, stroke, cancer, etc), and diagnostics of CVD by using biological fluids that can be obtained by noninvasive methods. This article discusses in detail the diagnostic value of hs-Tn in serum and urine in cases of arterial hypertension. Also, the paper pays considerable attention to the consideration of the mechanisms underlying the increase in hs-Tn in serum and urine in cases of arterial hypertension.


Assuntos
Pressão Arterial , Cardiopatias/diagnóstico , Hipertensão/diagnóstico , Troponina/sangue , Troponina/urina , Biomarcadores/sangue , Biomarcadores/urina , Cardiopatias/etiologia , Cardiopatias/metabolismo , Cardiopatias/fisiopatologia , Humanos , Hipertensão/complicações , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Regulação para Cima
2.
Eur J Med Res ; 26(1): 90, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376255

RESUMO

BACKGROUND: The goal of this study was to investigate the diagnostic value of miR-29c-3p in sepsis and its role in sepsis-induced inflammatory response and cardiac dysfunction. METHODS: Serum level of miR-29c-3p was detected by qRT-PCR. The ROC curve was used to evaluate the diagnostic value of miR-29c-3p for Sepsis. The cecal ligation and puncture method (CLP) was used to establish a rat sepsis model. To assess cardiac function, left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP) and maximum rate of rise/fall of left ventricle pressure (± dp/dtmax) in different experimental groups were detected, and the serum cardiac troponin I (cTnI), creative kinase isoenzyme MB (CK-MB) were measured by ELISA. Meanwhile, TNF-α, IL-1ß, and IL-6 were detected by ELISA to assess the level of inflammatory response in animals. RESULTS: miR-29c-3p level was upregulated in sepsis patients. ROC curve revealed that miR-29c-3p had the ability to distinguish sepsis patients from healthy controls. Cardiac dysfunction and inflammation were observed in sepsis rat, which were characterized by the decrease of LVSP and + dp/dtmax, the increase of LVEDP, - dp/dtmax, cTnI, CK-MB, TNF-α, IL-1ß, IL-6. All effects were reversed by the injection of miR-29c-3p antagomir. Logistics regression analysis manifested miR-29c-3p is an independent factor in the occurrence of cardiac dysfunction in sepsis patients. CONCLUSIONS: miR-29c-3p has potential as a biomarker for the diagnosis of sepsis, and inhibition of miR-29c-3p expression in animal models reduced sepsis-induced cardiac dysfunction and inflammatory response.


Assuntos
Cardiopatias/sangue , MicroRNAs/sangue , Sepse/sangue , Idoso , Animais , Biomarcadores/sangue , Pressão Sanguínea , Citocinas/sangue , Feminino , Cardiopatias/etiologia , Cardiopatias/patologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Ratos , Ratos Sprague-Dawley , Sepse/complicações , Sepse/patologia , Troponina I/sangue
3.
Tex Heart Inst J ; 48(3)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34379771

RESUMO

A 79-year-old man had an out-of-hospital acute ST-segment-elevation myocardial infarction with cardiac arrest. Cardiopulmonary resuscitation performed by a bystander resulted in traumatic hemopericardium. We discuss the patient's case, highlight the challenges of managing simultaneously life-threatening thrombosis and hemorrhage, and present our conclusions regarding the patient's eventual death.


Assuntos
Tamponamento Cardíaco/terapia , Derrame Pericárdico/terapia , Pericardiocentese/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Traumatismos Torácicos/complicações , Trombose/terapia , Idoso , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Angiografia Coronária , Ecocardiografia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/terapia , Humanos , Masculino , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico , Pericárdio , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Traumatismos Torácicos/diagnóstico , Trombose/etiologia
4.
J Am Heart Assoc ; 10(16): e021428, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34365798

RESUMO

Background Cardiac dysfunction is a prominent feature of multisystem inflammatory syndrome in children (MIS-C), yet the etiology is poorly understood. We determined whether dysfunction is global or regional, and whether it is associated with the cytokine milieu, microangiopathy, or severity of shock. Methods and Results We analyzed echocardiographic parameters of myocardial deformation and compared global and segmental left ventricular strain between 43 cases with MIS-C ≤18 years old and 40 controls. Primary outcomes included left ventricular global longitudinal strain, right ventricular free wall strain), and left atrial strain. We evaluated relationships between strain and profiles of 10 proinflammatory cytokines, microangiopathic features (soluble C5b9), and vasoactive-inotropic requirements. Compared with controls, cases with MIS-C had significant impairments in all parameters of systolic and diastolic function. 65% of cases with MIS-C had abnormal left ventricular function (|global longitudinal strain|<17%), although elevations of cytokines were modest. All left ventricular segments were involved, without apical or basal dominance to suggest acute stress cardiomyopathy. Worse global longitudinal strain correlated with higher ratios of interleukin-6 (ρ -0.43) and interleukin-8 (ρ -0.43) to total hypercytokinemia, but not absolute levels of interleukin-6 or interleukin-8, or total hypercytokinemia. Similarly, worse right ventricular free wall strain correlated with higher relative interleukin-8 expression (ρ -0.59). There were no significant associations between function and microangiopathy or vasoactive-inotropic requirements. Conclusions Myocardial function is globally decreased in MIS-C and not explained by acute stress cardiomyopathy. Cardiac dysfunction may be driven by the relative skew of the immune response toward interleukin-6 and interleukin-8 pathways, more so than degree of hyperinflammation, refining the current paradigm of myocardial involvement in MIS-C.


Assuntos
Função do Átrio Esquerdo , COVID-19/complicações , Síndrome da Liberação de Citocina/etiologia , Citocinas/sangue , Cardiopatias/etiologia , Mediadores da Inflamação/sangue , Síndrome de Resposta Inflamatória Sistêmica/complicações , Função Ventricular Esquerda , Função Ventricular Direita , Adolescente , Fatores Etários , Biomarcadores/sangue , COVID-19/diagnóstico , COVID-19/imunologia , Criança , Estudos Transversais , Síndrome da Liberação de Citocina/diagnóstico , Síndrome da Liberação de Citocina/imunologia , Ecocardiografia , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/imunologia , Cardiopatias/fisiopatologia , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/imunologia
5.
Medicine (Baltimore) ; 100(30): e26687, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397695

RESUMO

RATIONALE: Escobar syndrome (ES) is an autosomal recessive disorder. It is highly characterized by facial abnormalities, congenital diaphragmatic muscle weakness, myasthenic-like features, and skin pterygiums on multiple body legions. ES is a rare condition associated with many external and internal abnormalities. The internal malformations described in ES affect many organs including the heart, lungs, esophagus, liver, spleen, and intestine. The purpose of this paper is to explore the cardiac manifestations associated with ES. PATIENT CONCERNS: A 3.5-year-old girl, who was born for double first cousins, was admitted to the hospital for neuromuscular evaluation of multiple congenital contractures. DIAGNOSIS: The girl was diagnosed with ES and isolated dextrocardia which is a rare cardiac manifestation. However, to the best of our knowledge, no similar cases have been reported to date, and this case is thus believed to be very rare. INTERVENTIONS: The patient underwent an operative intervention to correct the bilateral fixed flexion deformity at her knees which was related to the posterior bilateral fibrotic bands/pterygia. OUTCOMES: Post-operatively, complete knee extension was obtained, the patient was fitted with a cast and extension night splint. She was discharged alive and had no complications. The patient was followed regularly in the orthopedic clinic and had periodic physiotherapy sessions. CONCLUSIONS: ES and isolated dextrocardia concurrence in the presented case resulted from different pathogenic mechanisms. Our findings suggest that ES might be caused by dysfunction in the acetylcholine receptor throughout fetal life, which may have affected muscle strength and movement. Other cardiac conditions include hypoplastic left-sided heart, Hypertrophic cardiomyopathy, patent ductus arteriosus, and heterotaxia.


Assuntos
Cardiopatias/etiologia , Hipertermia Maligna/complicações , Anormalidades da Pele/complicações , Anormalidades Múltiplas/genética , Anormalidades Múltiplas/fisiopatologia , Pré-Escolar , Contratura/etiologia , Permeabilidade do Canal Arterial/etiologia , Feminino , Cardiopatias/fisiopatologia , Humanos , Hipertermia Maligna/genética , Hipertermia Maligna/fisiopatologia , Arábia Saudita , Anormalidades da Pele/genética , Anormalidades da Pele/fisiopatologia
6.
J Card Surg ; 36(10): 3939-3943, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34309906

RESUMO

Inflammation and thrombogenic effects of coronavirus disease 2019 (COVID-19) can lead to cardiovascular complications in patients even after recovery from COVID-19. Intracardiac thrombus is life-threatening and can cause sudden death. Our study describes two patients who recovered from COVID-19 and presented with chronic intracardiac thrombus.


Assuntos
COVID-19 , Cardiopatias , Trombose , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , SARS-CoV-2 , Trombose/diagnóstico por imagem , Trombose/etiologia
7.
CMAJ Open ; 9(3): E777-E787, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285057

RESUMO

BACKGROUND: The identification of frailty before complex and invasive procedures may have relevance for prognostic and recovery purposes, to optimally inform patients, caregivers and clinicians about perioperative risk and postoperative care needs. The aim of this study was to estimate the prevalence of frailty and describe the associated clinical course and outcomes of patients referred for nonemergent cardiac surgery. METHODS: A prospective cohort of patients aged 50 years and older referred for nonemergent cardiac surgery in Alberta, Canada, from November 2011 to March 2014 were screened preoperatively for frailty, defined as a Clinical Frailty Scale (CFS) score of 5 or greater. Postoperatively, patients were followed by telephone to assess CFS score, health services use and vital status. The primary outcome was all-cause hospital mortality. Secondary outcomes included health services use, hospital discharge disposition, 1-year health-related quality of life and all-cause 5-year mortality. RESULTS: The cohort (n = 529) had a mean age of 67 (standard deviation [SD] 9) years; 25.9% were female, and the prevalence of frailty was 9.6% (n = 51; 95% confidence interval [CI] 7.3%-12.5%). Frail patients were older (median age 75, interquartile range [IQR] 65-80 v. 67, IQR 60-73, yr; p < 0.001), were more likely to be female (51.0% v. 23.2%; p < 0.001), had a higher mean EuroSCORE II (8, SD 3 v. 5, SD 3; p < 0.001) and received combined coronary artery bypass grafting and valve procedures more frequently (29.4% v. 15.9%; p = 0.02) than nonfrail patients. Postoperatively, frail patients had a longer median duration of stay in the cardiovascular intensive care unit (median difference 2.2, 95% CI 1.60-2.79) and hospital (median difference 9.3, 95% CI 8.2-10.3). Hospital mortality was 9.8% among frail patients and 1.0% among nonfrail patients (adjusted hazard ratio 3.84, 95% CI 0.90-16.34). INTERPRETATION: Preoperative frailty was present in 10% of patients and was associated with a higher risk of morbidity and greater health services use. Preoperative frailty has important implications for the postoperative clinical course and resource utilization of patients undergoing cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fragilidade/epidemiologia , Cardiopatias/epidemiologia , Cardiopatias/cirurgia , Período Pré-Operatório , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Eletivos , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Cardiopatias/etiologia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
8.
Br J Anaesth ; 127(3): 376-385, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34330416

RESUMO

BACKGROUND: European Society of Cardiology/European Society of Anaesthesiology (ESC/ESA) guidelines inform cardiac workup before noncardiac surgery based on an algorithm. Our primary hypotheses were that there would be associations between (i) the groups stratified according to the algorithms and major adverse cardiac events (MACE), and (ii) over- and underuse of cardiac testing and MACE. METHODS: This is a secondary analysis of a multicentre prospective cohort. Major adverse cardiac events were a composite of cardiac death, myocardial infarction, acute heart failure, and life-threatening arrhythmia at 30 days. For each cardiac test, pathological findings were defined a priori. We used multivariable logistic regression to measure associations. RESULTS: We registered 359 MACE at 30 days amongst 6976 patients; classification in a higher-risk group using the ESC/ESA algorithm was associated with 30-day MACE; however, discrimination of the ESC/ESA algorithms for 30-day MACE was modest; area under the curve 0.64 (95% confidence interval: 0.61-0.67). After adjustment for sex, age, and ASA physical status, discrimination was 0.72 (0.70-0.75). Overuse or underuse of cardiac tests were not consistently associated with MACE. There was no independent association between test recommendation class and pathological findings (P=0.14 for stress imaging; P=0.35 for transthoracic echocardiography; P=0.52 for coronary angiography). CONCLUSIONS: Discrimination for MACE using the ESC/ESA guidelines algorithms was limited. Overuse or underuse of cardiac tests was not consistently associated with cardiovascular events. The recommendation class of preoperative cardiac tests did not influence their yield. CLINICAL TRIAL REGISTRATION: NCT02573532.


Assuntos
Anestesiologia/normas , Técnicas de Diagnóstico Cardiovascular/normas , Fidelidade a Diretrizes/normas , Cardiopatias/diagnóstico , Guias de Prática Clínica como Assunto/normas , Cuidados Pré-Operatórios/normas , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Algoritmos , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Cardiopatias/etiologia , Cardiopatias/mortalidade , Cardiopatias/prevenção & controle , Humanos , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/mortalidade , Resultado do Tratamento
9.
EBioMedicine ; 69: 103456, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34233258

RESUMO

BACKGROUND: Doxorubicin, an anthracycline chemotherapeutic agent, is widely used in the treatment of many cancers. However, doxorubicin posts a great risk of adverse cardiovascular events, which are thought to be caused by oxidative stress. We recently reported that the ubiquitin E3 ligase TRIM21 interacts and ubiquitylates p62 and negatively regulates the p62-Keap1-Nrf2 antioxidant pathway. Therefore, we sought to determine the role TRIM21 in cardiotoxicity induced by oxidative damage. METHODS: Using TRIM21 knockout mice, we examined the effects of TRIM21 on cardiotoxicity induced by two oxidative damage models: the doxorubicin treatment model and the Left Anterior Descending (LAD) model. We also explored the underlying mechanism by RNA-sequencing of the heart tissues, and by treating the mouse embryonic fibroblasts (MEFs), immortalized rat cardiomyocyte line H9c2, and immortalized human cardiomyocyte line AC16 with doxorubicin. FINDINGS: TRIM21 knockout mice are protected from heart failure and fatality in both the doxorubicin and LAD models. Hearts of doxorubicin-treated wild-type mice exhibit deformed mitochondria and elevated level of lipid peroxidation reminiscent of ferroptosis, which is alleviated in TRIM21 knockout hearts. Mechanistically, TRIM21-deficient heart tissues and cultured MEFs and H9c2 cells display enhanced p62 sequestration of Keap1 and are protected from doxorubicin-induced ferroptosis. Reconstitution of wild-type but not the E3 ligase-dead and the p62 binding-deficient TRIM21 mutants impedes the protection from doxorubicin-induced cell death. INTERPRETATION: Our study demonstrates that TRIM21 ablation protects doxorubicin-induced cardiotoxicity and illustrates a new function of TRIM21 in ferroptosis, and suggests TRIM21 as a therapeutic target for reducing chemotherapy-related cardiotoxicity. FUNDING: NIH (CA129536; DK108989): data collection, analysis. Shanghai Pujiang Program (19PJ1401900): data collection. National Natural Science Foundation (31971161): data collection. Department of Veteran Affairs (BX004083): data collection. Tianjin Science and Technology Plan Project (17ZXMFSY00020): data collection.


Assuntos
Antineoplásicos/toxicidade , Doxorrubicina/toxicidade , Ferroptose , Cardiopatias/genética , Miócitos Cardíacos/efeitos dos fármacos , Ribonucleoproteínas/genética , Animais , Cardiotoxicidade/genética , Linhagem Celular , Células Cultivadas , Cardiopatias/etiologia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Miócitos Cardíacos/metabolismo , Ratos
10.
Medicina (Kaunas) ; 57(5)2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-34064539

RESUMO

When the pandemic started in February, about 5 million women were running businesses. Just 2 months later, 25% of those businesses closed. Approximately 2.5 million women have lost their jobs or dropped out of the workforce since the pandemic, but that is just the start of the impact on women. Women have been disproportionately affected by the pandemic, as the brunt of homelife has fallen on them, and the psychosocial impact will inevitably have a physical impact. The pandemic has revealed the gender inequality that exists from the socioeconomic perspective, but soon we will see the impact from the medical perspective. Predictably, we know that the impact of stress and lack of self-care that women have had to endure heightens heart disease, already the number one killer of all women. Heart disease is 80% preventable based on the major risk factors: high cholesterol, high blood pressure, elevated sugar, obesity, smoking, sedentary lifestyle, and poor diet. But the psychological risk factors drive up biomarkers and the root causes of manifesting disease. Historically, women have been less diagnosed and treated, and less likely to receive lifesaving care in a timely fashion. The pandemic is sure to amplify these issues. Without mitigation and prevention, women's hearts will suffer. We need to be aware of this now to prepare for the future potential of a significant increase in the incidence of women and heart disease.


Assuntos
Cardiopatias , Pandemias , Ansiedade , Feminino , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Obesidade , Comportamento Sedentário
11.
Int J Mol Sci ; 22(11)2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-34072423

RESUMO

Tenascin-C (TNC) is a large extracellular matrix (ECM) glycoprotein and an original member of the matricellular protein family. TNC is transiently expressed in the heart during embryonic development, but is rarely detected in normal adults; however, its expression is strongly up-regulated with inflammation. Although neither TNC-knockout nor -overexpressing mice show a distinct phenotype, disease models using genetically engineered mice combined with in vitro experiments have revealed multiple significant roles for TNC in responses to injury and myocardial repair, particularly in the regulation of inflammation. In most cases, TNC appears to deteriorate adverse ventricular remodeling by aggravating inflammation/fibrosis. Furthermore, accumulating clinical evidence has shown that high TNC levels predict adverse ventricular remodeling and a poor prognosis in patients with various heart diseases. Since the importance of inflammation has attracted attention in the pathophysiology of heart diseases, this review will focus on the roles of TNC in various types of inflammatory reactions, such as myocardial infarction, hypertensive fibrosis, myocarditis caused by viral infection or autoimmunity, and dilated cardiomyopathy. The utility of TNC as a biomarker for the stratification of myocardial disease conditions and the selection of appropriate therapies will also be discussed from a clinical viewpoint.


Assuntos
Suscetibilidade a Doenças , Cardiopatias/etiologia , Cardiopatias/metabolismo , Tenascina/genética , Tenascina/metabolismo , Animais , Biomarcadores , Biópsia , Gerenciamento Clínico , Fibrose , Expressão Gênica , Regulação da Expressão Gênica , Cardiopatias/diagnóstico , Humanos , Miocardite/diagnóstico , Miocardite/etiologia , Miocardite/metabolismo , Organogênese/genética , Prognóstico , Transdução de Sinais , Remodelação Ventricular/genética
12.
G Ital Cardiol (Rome) ; 22(7): 529-534, 2021 Jul.
Artigo em Italiano | MEDLINE | ID: mdl-34175907

RESUMO

Growing evidence about COVID-19 and its possible cardiopulmonary complications have raised concerns about a potential subclinical heart damage even in asymptomatic patients. Many countries worldwide provided recommendations for a safe return to play and sports activity for athletes with previous COVID-19 disease. Italy was among the first nations to deal with the problem of protecting athletes' health. In this regard, after an initial version released on April 2020, on December 11, 2020 the Italian Sports Medicine Federation (FMSI) updated the recommendations for the return play of non-professional athletes. The purpose of this article is to analyze and deepen the contents of the new FMSI recommendations, integrating and comparing them with the previous ones. Further updates may occur if new scientific and epidemiological evidence will rise regarding COVID-19.


Assuntos
COVID-19 , Volta ao Esporte/normas , COVID-19/complicações , Cardiopatias/etiologia , Humanos , Itália , Pneumopatias/etiologia , Guias de Prática Clínica como Assunto
13.
J Cardiothorac Surg ; 16(1): 173, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127023

RESUMO

BACKGROUND: Despite the steady improvements in survival and operative safety, postoperative complications still remain a significant cause of morbidity and mortality after coronary artery bypass grafting (CABG). However, less is known on the impact of postoperative complications on health-related quality of life (QoL). The main objective of our study was to investigate the impact of postoperative complications on long-term QoL and survival after CABG surgery. METHODS: Data of 508 patients, who underwent isolated CABG was prospectively collected. The RAND-36 Health Survey (RAND-36) was used to evaluate patients' QoL status preoperatively, 1 year and 12 years after the surgery. Predefined postoperative complications were reported during primary and secondary hospital stay. QoL and survival analysis were performed primarily on three patient groups: patients with and without complications and patients with major adverse cardiac and cerebrovascular events (MACCE). RESULTS: In total 205(40%) of 508 patients had at least one postoperative complication and 73 (14%) experienced MACCE. Patients' thirty-day, 1-year and 10-year survival rates were, 99, 98, 84% without complications, 97, 95, 72% with complications, and 90, 89, 64% with MACCE, respectively (log-rank p < 0.001). Patients without complications showed significant(p < 0.05) improvements in seven and patients with complications in five out of eight RAND-36 QoL dimensions. All patient groups showed significant improvements in RAND-36 summary scores compared with preoperative values. Patients with complications and especially with MACCE had more profound decline in their RAND-36 summary scores while patients without complications maintained their health status best. CONCLUSIONS: Despite the constant deterioration, both patients with and without complications showed improvements even 12 years after CABG compared with preoperative state. Postoperative complications and especially MACCE were associated with impaired long-term QoL.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Complicações Pós-Operatórias , Qualidade de Vida , Idoso , Transtornos Cerebrovasculares/etiologia , Cardiopatias/etiologia , Cardiopatias/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos
14.
Life Sci ; 281: 119718, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34147483

RESUMO

AIMS: Hypoxia, a pathophysiological condition, is profound in several cardiopulmonary diseases (CPD). Every individual's lethality to a hypoxia state differs in terms of hypoxia exposure time, dosage units and dependent on the individual's genetic makeup. Most of the proposed markers for CPD were generally aim to distinguish disease samples from normal samples. Although, as per the 2018 GOLD guidelines, clinically useful biomarkers for several cardio pulmonary disease patients in stable condition have yet to be identified. We attempt to address these key issues through the identification of Dynamic Network Biomarkers (DNB) to detect hypoxia induced early warning signals of CPD before the catastrophic deterioration. MATERIALS AND METHODS: The human microvascular endothelial tissues microarray datasets (GSE11341) of lung and cardiac expose to hypoxia (1% O2) for 3, 24 and 48 h were retrieved from the public repository. The time dependent differentially expressed genes were subjected to tissue specificity and promoter analysis to filtrate the noise levels in the networks and to dissect the tissue specific hypoxia induced genes. These filtered out genes were used to construct the dynamic segmentation networks. The hypoxia induced dynamic differentially expressed genes were validated in the lung and heart tissues of male rats. These rats were exposed to hypobaric hypoxia (simulated altitude of 25,000 or PO2 - 282 mm of Hg) progressively for 3, 24 and 48 h. KEY FINDINGS: To identify the temporal key genes regulated in hypoxia, we ranked the dominant genes based on their consolidated topological features from tissue specific networks, time dependent networks and dynamic networks. Overall topological ranking described VEGFA as a single node dynamic hub and strongly communicated with tissue specific genes to carry forward their tissue specific information. We named this type of VEGFAcentric dynamic networks as "V-DNBs". As a proof of principle, our methodology helped us to identify the V-DNBs specific for lung and cardiac tissues namely V-DNBL and V-DNBC respectively. SIGNIFICANCE: Our experimental studies identified VEGFA, SLC2A3, ADM and ENO2 as the minimum and sufficient candidates of V-DNBL. The dynamic expression patterns could be readily exploited to capture the pre disease state of hypoxia induced pulmonary vascular remodelling. Whereas in V-DNBC the minimum and sufficient candidates are VEGFA, SCL2A3, ADM, NDRG1, ENO2 and BHLHE40. The time dependent single node expansion indicates V-DNBC could also be the pre disease state pathological hallmark for hypoxia-associated cardiovascular remodelling. The network cross-talk and expression pattern between V-DNBL and V-DNBC are completely distinct. On the other hand, the great clinical advantage of V-DNBs for pre disease predictions, a set of samples during the healthy condition should suffice. Future clinical studies might further shed light on the predictive power of V-DNBs as prognostic and diagnostic biomarkers for CPD.


Assuntos
Cardiopatias/metabolismo , Hipóxia/metabolismo , Pneumopatias/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Biomarcadores/metabolismo , Deterioração Clínica , Regulação da Expressão Gênica , Cardiopatias/etiologia , Cardiopatias/patologia , Humanos , Hipóxia/complicações , Hipóxia/genética , Pneumopatias/etiologia , Pneumopatias/patologia , Masculino , Ratos , Ratos Sprague-Dawley
15.
Clin Microbiol Infect ; 27(9): 1250-1261, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34171458

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been implicated in a wide spectrum of cardiac manifestations following the acute phase of the disease. OBJECTIVES: To assess the range of cardiac sequelae after COVID-19 recovery. DATA SOURCES: PubMed, Embase, Scopus (inception through 17 February 2021) and Google scholar (2019 through 17 February 2021). STUDY ELIGIBILITY CRITERIA: Prospective and retrospective studies, case reports and case series. PARTICIPANTS: Adult patients assessed for cardiac manifestations after COVID-19 recovery. EXPOSURE: Severe acute respiratory syndrome coronavirus 2 infection diagnosed by PCR. METHODS: Systematic review. RESULTS: Thirty-five studies (fifteen prospective cohort, seven case reports, five cross-sectional, four case series, three retrospective cohort and one ambidirectional cohort) evaluating cardiac sequelae in 52 609 patients were included. Twenty-nine studies used objective cardiac assessments, mostly cardiac magnetic resonance imaging (CMR) in 16 studies, echocardiography in 15, electrocardiography (ECG) in 16 and cardiac biomarkers in 18. Most studies had a fair risk of bias. The median time from diagnosis/recovery to cardiac assessment was 48 days (1-180 days). Common short-term cardiac abnormalities (<3 months) included increased T1 (proportion: 30%), T2 (16%), pericardial effusion (15%) and late gadolinium enhancement (11%) on CMR, with symptoms such as chest pain (25%) and dyspnoea (36%). In the medium term (3-6 months), common changes included reduced left ventricular global longitudinal strain (30%) and late gadolinium enhancement (10%) on CMR, diastolic dysfunction (40%) on echocardiography and elevated N-terminal proB-type natriuretic peptide (18%). In addition, COVID-19 survivors had higher risk (risk ratio 3; 95% CI 2.7-3.2) of developing heart failure, arrythmias and myocardial infarction. CONCLUSIONS: COVID-19 appears to be associated with persistent/de novo cardiac injury after recovery, particularly subclinical myocardial injury in the earlier phase and diastolic dysfunction later. Larger well-designed and controlled studies with baseline assessments are needed to better measure the extent of cardiac injury and its clinical impact.


Assuntos
COVID-19/diagnóstico , Cardiopatias/epidemiologia , SARS-CoV-2/isolamento & purificação , Adulto , COVID-19/complicações , Teste de Ácido Nucleico para COVID-19 , Ecocardiografia , Eletrocardiografia , Cardiopatias/etiologia , Humanos , Imagem Cinética por Ressonância Magnética , SARS-CoV-2/genética
16.
Medicine (Baltimore) ; 100(19): e25780, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106611

RESUMO

RATIONALE: Hepatocellular with tumor thrombi extending into 3 hepatic veins (HVs) and right atrium presents as a real clinical challenge. We report the first documented case of surgical resection of an advanced hepatocellular carcinoma (HCC) with extensive invasion to distal stomach, atrium and hepatic vasculatures. PATIENT CONCERNS: We present a case of 48-years old man with abdominal mass accompanying shortness of breath after activities. DIAGNOSES: Preoperative examination revealed giant HCC with tumor thrombi extending into portal vein, HVs, inferior vena cava, and atrium. INTERVENTIONS: Distal stomach involvement was confirmed at surgery and, distal gastrectomy, atrial reconstruction and ante-situm liver resection and autotransplantation under cardio-pulmonary bypass were performed. OUTCOMES: The operation time was 490 minutes, extracorporeal circulation time 124 minutes, and anhepatic time 40 minutes. Postoperative follow-up revealed normal hepatic and cardiac function with no sign of recurrence. LESSONS: This case illustrates that the extensive invasion of HCC to major vasculature and adjacent organs may not necessarily preclude the liver autotransplantation with multi-visceral resection as the treatment option of extremely advanced HCC patients.


Assuntos
Carcinoma Hepatocelular/secundário , Gastrectomia/métodos , Átrios do Coração/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/patologia , Transplante de Fígado/métodos , Trombose/etiologia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/cirurgia , Átrios do Coração/patologia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/cirurgia , Veias Hepáticas/patologia , Veias Hepáticas/cirurgia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Veia Porta/patologia , Veia Porta/cirurgia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/secundário , Neoplasias Gástricas/cirurgia , Trombose/diagnóstico , Trombose/cirurgia , Transplante Autólogo
17.
Int Heart J ; 62(3): 687-694, 2021 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-33994503

RESUMO

A 58-year-old man with non-ischemic cardiomyopathy visited a hospital once a month after his first hospitalization for heart failure. Three months later, he presented with consciousness impairment and heat stroke. Blood tests showed multiple organ failure, and echocardiography revealed biventricular thrombi. After admission, intensive care was provided, and anticoagulation therapy was initiated. The echocardiographic findings in the third week confirmed the complete disappearance of thrombi. Biventricular thrombi associated with disseminated intravascular coagulation from heat stroke is rare. We report the case of a patient who was treated with anticoagulation therapy only, without surgical intervention.


Assuntos
Anticoagulantes/uso terapêutico , Coagulação Intravascular Disseminada/complicações , Cardiopatias/etiologia , Golpe de Calor/complicações , Trombose/etiologia , Cardiopatias/tratamento farmacológico , Cardiopatias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Trombose/tratamento farmacológico , Trombose/fisiopatologia
18.
High Blood Press Cardiovasc Prev ; 28(4): 383-391, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33950510

RESUMO

INTRODUCTION: Hypertensive mediated heart disease is the consequence of anatomical and functional changes in cardiovascular system. The benefits on left ventricular (LV) diastolic impairment and remodeling of hypertension treatment are well established. AIM: To evaluate LV structure, systolic and diastolic function of treated hypertensive patients on a medium to long term follow-up. METHODS: Prospectively observational cohort study. Hypertensive patients over 18 years, ultrasound evaluation of LV structure and diastolic and systolic function, follow-up at least once a year. Diastolic function assessed following recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. RESULTS: 285 patients, mean follow up of 1731 ± 952 days. Sample mean age 56.3 ± 12.5 years, 166 patients (58.3%) were males. Baseline blood pressure 147.8 ± 19/86.8 ± 11 mm Hg, 5 years blood pressure 134.4 ± 15.7/79 ± 9 mm Hg (p < 0.005 SBP and p < 0.01 DBP). Baseline fixed dose combinations 115 patients (40.4%), follow-up 53.1% (p < 0.05). LV remodeling was detected in 88 patients (30.9%) vs. 30.1% at 5 years (p = NS). The frequency of an E/e' ratio > 14 was reduced from 38 patients (13.3%) to 3.6% (p < 0.001), e' septal velocity < 7 cm/sec or e' lateral velocity < 10 cm/sec was reduced from 38.6% (110 patients) to 19.3% (p < 0.001). Baseline normal diastolic function was detected in 85.6% (244 patients) and 94% at the end of the follow-up (p < 0.02). CONCLUSIONS: In this observational cohort followed by a mean of 5 years, the main benefit of hypertension treatment was the prevention or regression of diastolic dysfunction.


Assuntos
Anti-Hipertensivos/uso terapêutico , Cardiopatias/etiologia , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Diástole/efeitos dos fármacos , Feminino , Seguimentos , Cardiopatias/fisiopatologia , Cardiopatias/prevenção & controle , Humanos , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Esquerda/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sístole/efeitos dos fármacos , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/prevenção & controle
19.
Radiologia ; 63(4): 370-383, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33931205

RESUMO

In March 2020, the World Health Organization declared a global pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); epidemic conditions continue in nearly all countries today. Although the symptoms and imaging manifestations of COVID-19 predominantly involve the respiratory system, it is fundamental to know the manifestations of the disease and its possible complications in other organs to help in diagnosis and orient the prognosis. To improve the diagnostic process without increasing the risk of contagion unnecessarily, it is crucial to know when extrathoracic imaging tests are indicated and which tests are best in each situation. This paper aims to provide answers to these questions. To this end, we describe and illustrate the extrathoracic imaging manifestations of COVID-19 in adults as well as the entire spectrum of imaging findings in children.


Assuntos
COVID-19/complicações , COVID-19/diagnóstico por imagem , Adulto , Idoso , COVID-19/etiologia , Criança , Doenças do Sistema Digestório/etiologia , Feminino , Cardiopatias/etiologia , Humanos , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/etiologia , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/etiologia , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Trombose/diagnóstico por imagem , Trombose/etiologia , Tomografia Computadorizada por Raios X , Doenças Urológicas/etiologia
20.
Pediatr Ann ; 50(3): e128-e135, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34038652

RESUMO

Coronavirus disease 2019 (COVID-19) has a predilection to cardiac involvement. The early clinical phase, during viremia, may manifest as pericarditis, acute myocarditis, and sepsis-related cardiomyopathy. Delayed presentations, such as multisystem inflammatory syndrome in children, coronary artery dilation/aneurysms, and late myocarditis, may occur in the weeks after the acute infection. These delayed presentations commonly test negative for severe acute respiratory syndrome coronavirus 2 via polymerase chain reaction testing and are thought to be primarily postviral hyperinflammatory sequelae. The long-term consequences of cardiac involvement in COVID-19 are unknown. Most recommendations for cardiac management are based on known conditions that are similar. For example, coronary aneurysms can be managed under Kawasaki disease guidelines. Similarly, for patients with COVID-19 myocarditis, they can be cleared for sports under protocols for other types of myocarditis. There is concern for cardiac involvement as a subclinical entity even in more minor presentations. Several expert algorithms have been developed for clearing competition athletes to return to exercise. Sports clearance should be individualized considering the severity of disease, age of patient, and performance level of the sport. [Pediatr Ann. 2021;50(3):e128-e135.].


Assuntos
COVID-19/complicações , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Adolescente , Fatores Etários , COVID-19/patologia , Criança , Cardiopatias/patologia , Humanos , SARS-CoV-2 , Adulto Jovem
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