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1.
Gynecol Oncol ; 155(2): 301-304, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31575390

RESUMO

OBJECTIVE: Pegylated liposomal doxorubicin (PLD) has similar reported clinical efficacy compared with conventional doxorubicin with less cardiotoxicity. The manufacturer of PLD advises that cardiac function should be evaluated with endomyocardial biopsy, echocardiography or multigated radionucleotide scan (MUGA) pre-treatment and during therapy. This study was designed to assess the necessity of pre-treatment cardiac evaluation in patients receiving PLD. METHODS: After IRB approval, a retrospective study of all women with gynecologic cancer who received PLD from 2006 to 2018 was performed. Demographic information, treatment records, cardiac risk factors, and cardiac surveillance testing were examined. Wilcoxon signed rank sum test and logistic regression were used to evaluate the association of cumulative PLD exposure with cardiotoxicity. RESULTS: A total of 235 patients received PLD for gynecologic cancer. Patients received a median of 3 cycles of PLD with a cumulative dosage of 237 mg over a median follow-up time of 24 months. Sixteen patients in the cohort (7%) had no cardiac surveillance at all. Of the remaining patients who underwent cardiac testing, 183 (84%) received MUGA scans and 36 (16%) had echocardiography. Of the 56 patients who had both pre- and post-treatment cardiac testing, there was no significant difference in median ejection fraction (p = 0.17). Three patients developed PLD-associated cardiac toxicity but only one patient had severe manifestations requiring discontinuation of PLD therapy. CONCLUSIONS: Routine cardiac testing before, during or after treatment with PLD may be unnecessary. Cardiac testing may be more appropriate for individual patients for whom the clinical suspicion of PLD-related cardiac toxicity is high.


Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Doxorrubicina/análogos & derivados , Neoplasias dos Genitais Femininos/tratamento farmacológico , Cardiopatias/induzido quimicamente , Doxorrubicina/efeitos adversos , Substituição de Medicamentos , Ecocardiografia/métodos , Feminino , Cardiopatias/fisiopatologia , Cardiopatias/prevenção & controle , Humanos , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Polietilenoglicóis/efeitos adversos , Angiografia Cintilográfica/métodos , Estudos Retrospectivos , Volume Sistólico/efeitos dos fármacos
2.
Adv Exp Med Biol ; 1161: 37-44, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31562620

RESUMO

The term cardiovascular diseases (CVD) refers to disorders of heart and blood vessels, and include coronary heart disease, cerebrovascular disease, peripheral vascular disease, and heart failure, among others. Atherosclerosis is a common background of these diseases. It is not infrequent that some acute diseases, such as coronary syndromes, appear superimposed on a chronic arterial disease. Acute coronary syndromes (ACS), found worldwide among the leading causes of death, can be the origin of disabling chronic CVD such as heart failure [46]. Clinical and experimental evidence associates this group of alterations with an inflammatory process that takes part in its pathophysiology. In fact, inflammation is one of the most important factors for its initiation, progression, and consolidation [6].


Assuntos
Biomarcadores , Cardiopatias , Inflamação , Síndrome Coronariana Aguda , Animais , Aterosclerose , Biomarcadores/sangue , Doença Crônica , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Humanos
3.
Physiol Rev ; 99(4): 1765-1817, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31364924

RESUMO

Twelve regulated cell death programs have been described. We review in detail the basic biology of nine including death receptor-mediated apoptosis, death receptor-mediated necrosis (necroptosis), mitochondrial-mediated apoptosis, mitochondrial-mediated necrosis, autophagy-dependent cell death, ferroptosis, pyroptosis, parthanatos, and immunogenic cell death. This is followed by a dissection of the roles of these cell death programs in the major cardiac syndromes: myocardial infarction and heart failure. The most important conclusion relevant to heart disease is that regulated forms of cardiomyocyte death play important roles in both myocardial infarction with reperfusion (ischemia/reperfusion) and heart failure. While a role for apoptosis in ischemia/reperfusion cannot be excluded, regulated forms of necrosis, through both death receptor and mitochondrial pathways, are critical. Ferroptosis and parthanatos are also likely important in ischemia/reperfusion, although it is unclear if these entities are functioning as independent death programs or as amplification mechanisms for necrotic cell death. Pyroptosis may also contribute to ischemia/reperfusion injury, but potentially through effects in non-cardiomyocytes. Cardiomyocyte loss through apoptosis and necrosis is also an important component in the pathogenesis of heart failure and is mediated by both death receptor and mitochondrial signaling. Roles for immunogenic cell death in cardiac disease remain to be defined but merit study in this era of immune checkpoint cancer therapy. Biology-based approaches to inhibit cell death in the various cardiac syndromes are also discussed.


Assuntos
Morte Celular , Citotoxicidade Imunológica , Cardiopatias/patologia , Mitocôndrias Cardíacas/patologia , Miocárdio/patologia , Animais , Apoptose , Proteínas Reguladoras de Apoptose/metabolismo , Autofagia , Proteínas Relacionadas à Autofagia/metabolismo , Cardiopatias/imunologia , Cardiopatias/metabolismo , Cardiopatias/fisiopatologia , Humanos , Mitocôndrias Cardíacas/imunologia , Mitocôndrias Cardíacas/metabolismo , Miocárdio/imunologia , Miocárdio/metabolismo , Necrose , Piroptose , Transdução de Sinais
4.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(2): 214-218, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31309761

RESUMO

Pathological processes such as myocardial apoptosis, cardiac hypertrophy, myocardial fibrosis, and cardiac electrical remodeling are involved in the development and progression of most cardiac diseases. MicroRNA-21 (miR-21) has been found to play an important role in heart diseases as a novel type of endogenous regulators, which can inhibit cardiomyocyte apoptosis, improve hypertension and cardiac hypertrophy, promote myocardial fibrosis and atrial electrical remodeling. In this review, we summarize the research progress on the function of miR-21 in heart diseases and its mechanism, and discuss its potential application in diagnosis and treatment of heart diseases.


Assuntos
Cardiopatias , MicroRNAs , Cardiomegalia/genética , Cardiomegalia/fisiopatologia , Cardiopatias/genética , Cardiopatias/fisiopatologia , Humanos , MicroRNAs/genética , MicroRNAs/metabolismo , Miocárdio/patologia
6.
Sensors (Basel) ; 19(12)2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31226869

RESUMO

One of the major causes of death all over the world is heart disease or cardiac dysfunction. These diseases could be identified easily with the variations in the sound produced due to the heart activity. These sophisticated auscultations need important clinical experience and concentrated listening skills. Therefore, there is an unmet need for a portable system for the early detection of cardiac illnesses. This paper proposes a prototype model of a smart digital-stethoscope system to monitor patient's heart sounds and diagnose any abnormality in a real-time manner. This system consists of two subsystems that communicate wirelessly using Bluetooth low energy technology: A portable digital stethoscope subsystem, and a computer-based decision-making subsystem. The portable subsystem captures the heart sounds of the patient, filters and digitizes, and sends the captured heart sounds to a personal computer wirelessly to visualize the heart sounds and for further processing to make a decision if the heart sounds are normal or abnormal. Twenty-seven t-domain, f-domain, and Mel frequency cepstral coefficients (MFCC) features were used to train a public database to identify the best-performing algorithm for classifying abnormal and normal heart sound (HS). The hyper parameter optimization, along with and without a feature reduction method, was tested to improve accuracy. The cost-adjusted optimized ensemble algorithm can produce 97% and 88% accuracy of classifying abnormal and normal HS, respectively.


Assuntos
Cardiopatias/diagnóstico , Monitorização Fisiológica , Estetoscópios , Algoritmos , Auscultação , Cardiopatias/fisiopatologia , Ruídos Cardíacos/fisiologia , Humanos , Processamento de Sinais Assistido por Computador
7.
Medicina (Kaunas) ; 55(5)2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31075882

RESUMO

Cardiovascular diseases (CVDs) account for the majority of deaths worldwide. Radiation-induced heart diseases (RIHD) is one of the side effects following exposure to ionizing radiation (IR). Exposure could be from various forms such as diagnostic imaging, radiotherapy for cancer treatment, as well as nuclear disasters and nuclear accidents. RIHD is mostly observed after radiotherapy for thoracic malignancies, especially left breast cancer. RIHD may affect the supply of blood to heart muscles, leading to an increase in the risk of heart attacks to irradiated persons. Due to its dose-limiting consequence, RIHD has a negative effect on the therapeutic efficacy of radiotherapy. Several methods have been proposed for protection against RIHD. In this paper, we review the use of natural products, which have shown promising results for protection against RIHD.


Assuntos
Produtos Biológicos/uso terapêutico , Cardiopatias/etiologia , Fatores de Proteção , Lesões por Radiação/complicações , Ácidos Cafeicos/farmacologia , Ácidos Cafeicos/uso terapêutico , Curcumina/farmacologia , Curcumina/uso terapêutico , Combinação de Medicamentos , Medicamentos de Ervas Chinesas/farmacologia , Medicamentos de Ervas Chinesas/uso terapêutico , Guaiacol/análogos & derivados , Guaiacol/farmacologia , Guaiacol/uso terapêutico , Cardiopatias/fisiopatologia , Hesperidina/farmacologia , Hesperidina/uso terapêutico , Humanos , Melatonina/farmacologia , Melatonina/uso terapêutico , Álcool Feniletílico/análogos & derivados , Álcool Feniletílico/farmacologia , Álcool Feniletílico/uso terapêutico , Lesões por Radiação/fisiopatologia , Selênio/farmacologia , Selênio/uso terapêutico , Vitis
8.
Biomed Res Int ; 2019: 2605323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31093497

RESUMO

Background: Pheochromocytoma is a rare neuroendocrine tumor, clinically characterized by high blood pressure, palpitations, and headache. It is often associated with abnormalities of the ventricular repolarization phase; the dispersion of ventricular repolarization is the basis for ventricular arrhythmias (torsion de point, ventricular tachycardia or ventricular fibrillation). Objectives: Analysis of abnormal ventricular repolarization focused on the presence and amount of U wave in patients affected by pheochromocytoma and its modification after surgery. Materials and Methods: We reviewed pathology records of 722 patients admitted for adrenal nodule or suspected chromaffin-cell tumor and identified 39 patients affected by pheochromocytoma. Metanephrine, normetanephrine, and 3-methoxytyramine have been assessed by determining concentrations in 24-hour urine collection. Standard 12-lead electrocardiogram records have been reviewed with analysis of heart rate, P wave, PR interval, QRS duration, QTc, and U wave. Then we selected and compared 22 patients of 39 affected by pheochromocytoma, with both clinical and electrocardiographic data before and after surgery. Results: In our cohort of 39 patients affected by pheochromocytoma, we found U wave in ECG, before treatment, in 82.8 percent of patients, while only 37.0 percent after treatment (p<0.001) and we observed a statistically significant correlation between this wave and the urinary metanephrine. After surgery, in the selected 22 patients, we observed a clear significant reduction in systemic blood pressure, fasting glucose, metanephrine, normetanephrine, and 3-methoxytyramine. We found a significant reduction of U wave presence and leads involved in these patients after surgery (90.9% versus 9%). We observed a linear correlation between the amount of U waves in 12-lead electrocardiogram and metanephrine (r2=0.333, p=0.015), 3-methoxytyramine levels (r2=0.458, p=0.006), and tumor size (r2=0.429, p=0.003). Conclusions: In our retrospective analysis, patients affected by pheochromocytoma presented U wave in electrocardiogram. The presence and amount of U wave were associated with the metanephrine levels and the tumor size with significant reduction after surgical removal.


Assuntos
Neoplasias das Glândulas Suprarrenais/fisiopatologia , Eletrocardiografia , Cardiopatias/fisiopatologia , Feocromocitoma/fisiopatologia , Feocromocitoma/terapia , Remodelação Ventricular , Neoplasias das Glândulas Suprarrenais/cirurgia , Neoplasias das Glândulas Suprarrenais/urina , Adulto , Dopamina/análogos & derivados , Dopamina/urina , Feminino , Humanos , Masculino , Metanefrina/urina , Feocromocitoma/cirurgia , Feocromocitoma/urina , Estudos Retrospectivos , Carga Tumoral
9.
Hemoglobin ; 43(1): 34-37, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31084365

RESUMO

ß-Thalassemia major (ß-TM) patients are at increased risk for cardiovascular diseases. Determination of subclinical cardiac involvement is essential for preventive measures. Thus, we aimed to evaluate the role of stress echocardiography for identification of subclinical cardiac dysfunction in ß-TM patients. In this prospective study, 45 ß-TM patients who were referred for cardiac evaluation, were enrolled. Exclusion criteria included non sinus rhythm and overt cardiac disease. Stress echocardiography levels and cardiac magnetic resonance imaging (MRI) results were obtained from ß-TM patients. Patients were divided into two groups of normal vs. iron overload from cardiac T2* greater or less than 20 msec, respectively. Resting and peak exercise right ventricular stroke volume (RVSV) and left ventricular SV (LVSV) were significantly lower in iron overload vs. normal ß-TM patients, respectively (p value <0.05). At peak LV global longitudinal strain (GLS) and myocardial performance index (MPI) were significantly decreased and increased compared with resting in iron overload vs. normal ß-TM patients, respectively (p value <0.05). There was a significant relationship between inappropriate hemodynamic response to exercise and lower age (p value = 0.032). Resting LVSV and RVSV seemed better prognosticators for iron overload than LV ejection fraction (LVEF). Decreased GLS and increased MPI at peak exercise could also predict the presence of cardiac iron overload. These measurements by stress echocardiography could be evaluated when cardiac T2* could not be determined.


Assuntos
Ecocardiografia sob Estresse , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Talassemia beta/complicações , Adolescente , Adulto , Ecocardiografia sob Estresse/métodos , Feminino , Cardiopatias/fisiopatologia , Testes de Função Cardíaca , Humanos , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/diagnóstico , Sobrecarga de Ferro/tratamento farmacológico , Sobrecarga de Ferro/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda , Adulto Jovem , Talassemia beta/diagnóstico , Talassemia beta/terapia
11.
J Vet Intern Med ; 33(4): 1695-1706, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31119786

RESUMO

BACKGROUND: Chagas disease, caused by the protozoan parasite Trypanosoma cruzi, causes sudden death and chronic heart disease with no currently approved treatment. OBJECTIVE: To report epidemiologic and select cardiac characteristics associated with T. cruzi infection in dogs presenting to a teaching hospital in Texas. ANIMALS: Three hundred seventy-five client-owned dogs. METHODS: A retrospective search of medical records identified dogs tested for T. cruzi antibodies or with histologic T. cruzi parasites. Data retrieved included signalment, location of residence, reported reason for testing, cardiac troponin I (cTnI) concentration, and ECG abnormalities. RESULTS: Trypanosoma cruzi-infected dogs (N = 63, 16.8%) were significantly younger than negative dogs (N = 312) (mean, 5.9 ± 3.8 versus 7.4 ± 4.0 years; P = .007) with no difference by sex or breed. Ninety-one breeds were tested; the highest percent infected were non-sporting (10/35; 29%) and toy breed (10/42; 24%) groups. The odds of infection were 13 times greater among dogs with an infected housemate or littermate (95% confidence interval [CI], 3.94-50.45; P < .001). Infected dogs were more likely to have ventricular arrhythmias (odds ratio [OR], 2.19; 95% CI, 1.15-4.33, P = .02), combinations of ECG abnormalities (OR, 2.91; 95% CI, 1.37-5.99; P = .004), and cTnI >0.129 ng/mL (ADVIA; OR, 10.71; 95% CI, 1.60-212.21; P = .035). CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs infected with T. cruzi were identified in Texas in many breed groups including breeds affected by well-described heart diseases that mimic Chagas disease suggesting a need for increased awareness, including knowledge of when to consider testing.


Assuntos
Doença de Chagas/veterinária , Doenças do Cão/parasitologia , Cardiopatias/veterinária , Animais , Arritmias Cardíacas/veterinária , Doença de Chagas/complicações , Doença de Chagas/epidemiologia , Doenças do Cão/epidemiologia , Cães , Eletrocardiografia/veterinária , Feminino , Cardiopatias/fisiopatologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Texas/epidemiologia , Troponina I/sangue , Trypanosoma cruzi/isolamento & purificação
12.
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
13.
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
14.
Int J Cardiovasc Imaging ; 35(10): 1893-1901, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31104178

RESUMO

Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) sequences have evolved. Free-breathing motion-corrected (MOCO) LGE has potential advantages over breath-held (bh) LGE including minimal user input for the short axis (SAX) stack without breath-holds. It has previously been shown that MOCO-LGE delivers high image quality compared to bh-LGE. We sought to conduct an independent validation study to investigate real-world performance of bh-LGE versus MOCO-LGE in a high-throughput CMR center immediately after the introduction of the MOCO-LGE sequence and with elementary staff induction in its use. Four-hundred consecutive patients, referred for CMR and graded by clinical complexity, underwent CMR on either of two scanners (1.5 T, both Siemens) in a UK tertiary cardiac center. Scar imaging was by bh-LGE or MOCO-LGE (both with phase sensitive inversion recovery). Image quality, scan time, reader confidence and report reproducibility were compared between those scanned by bh-LGE versus MOCO-LGE. Readers had > 3 years CMR experience. Categorical variables were compared by χ2 or Fisher's exact tests and continuous variables by unpaired Student's t-test. Inter-rater agreement of LGE reports was by Cohen's kappa. Image quality (low score = better) was better for MOCO-LGE (median, interquartile range [Q1-Q3]: 0 [0-0] vs. 2 [0-3], P < 0.0001). This persisted when just clinically complex patients were assessed (0 [0-1] vs. 2 [1-4] P < 0.0001). Readers were more confident in their MOCO-LGE rulings (P < 0.001) and reports more reproducible [bh-LGE vs. MOCO-LGE: kappa 0.76, confidence interval (CI) 0.7-0.9 vs. 0.82, CI 0.7-0.9]. MOCO-LGE significantly shortened LGE acquisition times compared to bh-LGE (for left ventricle SAX stack: 03:22 ± 01:14 vs 06:09 ± 01:47 min respectively, P < 0.0001). In a busy clinical service, immediately after its introduction and with elementary staff training, MOCO-LGE is demonstrably faster to bh-LGE, providing better images that are easier to interpret, even in the sickest of patients.


Assuntos
Meios de Contraste/administração & dosagem , Cardiopatias/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Meglumina/administração & dosagem , Miocárdio/patologia , Compostos Organometálicos/administração & dosagem , Função Ventricular Esquerda , Adulto , Idoso , Eficiência Organizacional , Feminino , Fibrose , Cardiopatias/patologia , Cardiopatias/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Centros de Atenção Terciária , Fatores de Tempo , Fluxo de Trabalho
15.
Life Sci ; 228: 121-127, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31039364

RESUMO

AIMS: B1- and B2-kinin receptors play a major role in several cardiovascular diseases. Therefore, we aimed to evaluate cardiac functional consequences of B1- and B2-kinin receptors ablation, focusing on the cardiac ROS and NO generation. MAIN METHODS: Cardiac contractility, ROS, and NO generation, and protein expression were evaluated in male wild-type (WT), B1- (B1-/-) and B2-kinin (B2-/-) knockout mice. KEY FINDINGS: Impaired contractility in B1-/- and B2-/- hearts was associated with oxidative stress through upregulation of NADPH oxidase p22phox subunit. B1-/- and B2-/- hearts presented higher NO and peroxynitrite levels than WT. Despite decreased sarcoplasmic reticulum Ca2+ ATPase pump (SERCA2) expression, nitration at tyrosine residues of SERCA2 was markedly higher in B1-/- and B2-/- hearts. SIGNIFICANCE: B1- and B2-kinin receptors govern ROS generation, while disruption of B1- and B2-kinin receptors leads to impaired cardiac dysfunction through excessive tyrosine nitration on the SERCA2 structure.


Assuntos
Cardiopatias/genética , Coração/fisiopatologia , Receptor B1 da Bradicinina/genética , Receptor B2 da Bradicinina/genética , Animais , Deleção de Genes , Cardiopatias/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Contração Miocárdica , NADPH Oxidases/metabolismo , Óxido Nítrico/metabolismo , Oxirredução , Espécies Reativas de Oxigênio/metabolismo , Receptor B1 da Bradicinina/metabolismo , Receptor B2 da Bradicinina/metabolismo
16.
Expert Opin Drug Saf ; 18(4): 321-332, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30998433

RESUMO

INTRODUCTION: The cardiovascular (CV) safety of testosterone replacement therapy (TRT) remains a crucial issue in the management of subjects with late-onset hypogonadism. The authors systematically reviewed and discussed the available evidence focusing our analysis on heart-related issues. AREAS COVERED: All the available data from prospective observational studies evaluating the role endogenous T levels on the risk of acute myocardial infarction (AMI) were collected and analyzed. In addition, the impact of TRT on heart-related diseases, as derived from pharmaco-epidemiological studies as well as from randomized placebo-controlled trials (RCTs), was also investigated. EXPERT OPINION: Available evidence indicates that endogenous low T represents a risk factor of AMI incidence and its related mortality. TRT in hypogonadal patients is able to improve angina symptoms in subjects with ischemic heart diseases and exercise ability in patients with heart failure (HF). In addition, when prescribed according to the recommended dosage, TRT does not increase the risk of heart-related events.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Cardiopatias/induzido quimicamente , Testosterona/administração & dosagem , Animais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Relação Dose-Resposta a Droga , Cardiopatias/epidemiologia , Cardiopatias/fisiopatologia , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Humanos , Incidência , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Testosterona/efeitos adversos , Testosterona/metabolismo
17.
Anticancer Res ; 39(4): 1667-1673, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30952705

RESUMO

Breast cancer radiotherapy has a clear benefit for both long-term survival and local recurrence rate. However, there is still much concern about the early radiation-induced heart toxicity. This article aimed to clarify the impact of certain cardiac biomarkers and strain echocardiographic imaging on the detection of early cardiac dysfunction. Several studies that reported changes in either echocardiographic and/or serum levels measurements after breast radiotherapy were searched. Despite the established role of cardiac biomarkers to predict late cardiotoxicity after radiotherapy, data concerning early cardiac damage are still lacking. Furthermore, although strain echocardiography represents a specific tool for the detection of cardiac morbidity in certain diseases, much interest concerns its role in the prediction of early heart failure after radiotherapy. Identification of new tools for the detection of early cardiotoxicity after breast radiotherapy may minimize the side-effects of therapeutic modalities in the clinical setting.


Assuntos
Neoplasias da Mama/radioterapia , Ecocardiografia/métodos , Cardiopatias/sangue , Cardiopatias/diagnóstico por imagem , Coração/efeitos da radiação , Lesões por Radiação/sangue , Lesões por Radiação/diagnóstico por imagem , Animais , Biomarcadores/sangue , Cardiotoxicidade , Feminino , Coração/fisiopatologia , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Valor Preditivo dos Testes , Lesões por Radiação/etiologia , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Fatores de Risco
18.
J Stroke Cerebrovasc Dis ; 28(7): 1891-1896, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31031144

RESUMO

BACKGROUND: Cryptogenic stroke, now defined as embolic stroke of undetermined source (ESUS), represents about a quarter of all ischemic strokes and the reoccurrence is high. Understanding this stroke subtype better would likely guide treatment recommendations. In this study, we tested the hypothesis that left atrial (LA) shape and function at rest, as well as with exercise, are abnormal compared to matched normal controls. METHODS: The study design was prospective enrollment of ESUS subjects who underwent measurement of LA function at rest and exercise by 2D and 3D echocardiograms. The exercise portion of the study was conducted using a ramped supine bicycle protocol during which LA function was measured. Stroke subjects were matched with normal subjects by age, gender, and body surface area. RESULTS: Over a 1-year enrollment period, 18 ESUS patients met inclusionary criteria and were studied. Their average age was 58 years old and 44% were female. ESUS subjects have larger LA end-diastolic volume at rest (14 versus 11 mL/m2, P = .04) and with exercise (11 versus 6 mL/m2, P = .001) compared to normal controls. In ESUS, there was a lack of response to maximal exercise of LA function as measured by the LA ejection fraction (61% versus 73% P = .001) and the LA function index (.68 versus .82, P = .02). The 3D analysis showed spherical remodeling of the LA in ESUS. This remodeling was documented by the sphericity index, which was increased in both diastole (.40 versus .32, P = .02) and systole (.63 versus .71 P = .03). CONCLUSIONS: In support of our hypothesis, we found that ESUS subjects have LA dysfunction and remodeling at rest and exercise in comparison to healthy, matched controls. Evaluation of the left atrium in this high-risk stroke subtype has potential to inform stroke prevention strategies and to suggest pathways for research.


Assuntos
Função do Átrio Esquerdo , Remodelamento Atrial , Átrios do Coração/fisiopatologia , Cardiopatias/complicações , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Estudos de Casos e Controles , Ecocardiografia sob Estresse/métodos , Ecocardiografia Tridimensional , Teste de Esforço , Feminino , Átrios do Coração/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Humanos , Embolia Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem
19.
J Vasc Surg ; 69(5): 1538-1544, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010518

RESUMO

OBJECTIVE: This study aimed to examine the relationship between dynamic changes in aortic diameter and corresponding measurement methods. METHODS: Consecutive adult (nonaneurysmal) patients being surgically treated for heart disease (mean age, 51 ± 11 years; range, 29-76 years; N = 25) were included in this study. All patients underwent transthoracic echocardiography (TTE), computed tomography angiography (CTA), and intraoperative ultrasound (IOUS). Anteroposterior diameters were measured at 1 cm above the junction of the aortic sinus, the proximal 1 cm of the innominate artery, and the midpoint of the two. RESULTS: The average diameter of the proximal ascending aorta in systole/diastole measured by IOUS was 32.07 ± 2.03/30.27 ± 2.05 mm (paired t-test: difference, 1.80 ± 0.46 mm; P < .001). The average diameters of the proximal ascending aorta measured by nonelectrocardiography-gated CTA and TTE were 31.45 ± 1.97 mm and 29.7 ± 1.84 mm, respectively. The average diameter of the mid and distal ascending aorta in systole/diastole measured by IOUS was 32.35 ± 1.95/30.57 ± 1.94 mm (paired t-test: difference, 1.78 ± 0.44 mm; P < .001) and 32.32 ± 1.92/30.67 ± 1.90 mm (paired t-test: difference, 1.65 ± 0.42 mm; P < .001), respectively. The average diameter of the mid and distal ascending aorta measured by CTA was 31.74 ± 1.92 mm and 31.59 ± 1.96 mm, respectively. At each location, the difference in the aortic diameter between systole and diastole was statistically significant (all P values <.001; paired t-test). The minimum and maximum changes in the diameter between systole and diastole were 0.90 mm and 2.70 mm. In all, 96% (24/25) of the average diameters derived from IOUS and CTA at the three locations were within the concordance limit in systole, and 92% to 100% (23/25 to 25/25) were within the concordance limit in diastole. The average diameters derived from IOUS and TTE images of the proximal ascending aorta were within the bounds of the concordance limit 92% (23/25) of the time in systole and 100% (25/25) of the time in diastole. The average diameters derived from CTA and TTE images of the proximal ascending aorta were within the bounds of the concordance limit 88% (22/25) of the time. Pearson correlation coefficients between these groups ranged from 0.905 to 0.982 (all P values <.01). CONCLUSIONS: The ascending aorta diameters measured by nonelectrocardiography-gated CTA and TTE were consistent with the IOUS measurements.


Assuntos
Aorta/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Hemodinâmica , Tomografia Computadorizada Multidetectores , Ultrassonografia de Intervenção , Adulto , Idoso , Pontos de Referência Anatômicos , Aorta/fisiopatologia , Técnicas de Imagem de Sincronização Cardíaca , Feminino , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
20.
Vet Clin North Am Equine Pract ; 35(1): 1-22, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30871827

RESUMO

Equine heart diseases can be categorized with morphologic, etiologic, and physiologic diagnoses and classified anatomically as diseases of the pericardium, myocardium, valves (endocardium), and great vessels. An appreciation of normal and pathologic physiology is a key to understanding diagnosis and therapy of heart disease. Pathophysiologic diagnoses include arrhythmias, congestive heart failure, and pulmonary hypertension. Heart rhythm disturbances can occur in isolation or with structural disease. Heart failure stems from arterial filling owing to insufficient cardiac output. Pulmonary hypertension is associated with strenuous exercise, left heart failure, bronchopulmonary diseases, and pulmonary arteriopathies. The etiopathogenesis of these disorders are incompletely understood.


Assuntos
Cardiopatias/veterinária , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/terapia , Animais , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Cardiopatias/terapia , Doenças dos Cavalos/fisiopatologia , Cavalos
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