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2.
Braz J Cardiovasc Surg ; 34(4): 451-457, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454199

RESUMO

OBJECTIVE: To evaluate the aortic wall elasticity using the maximal rate of systolic distension (MRSD) and maximal rate of diastolic recoil (MRDR) and their correlation with the aortic size index (ASI). METHODS: Forty-eight patients with thoracic aortic aneurysm were enrolled in this study. A standard magnetic resonance imaging (MRI) protocol was used to calculate MRSD and MRDR. Both MRSD and MRDR were expressed as percentile of maximal area/10-3 sec. ASI (maximal aortic diameter/body surface area) was calculated. A correlation between MRSD, MRDR, ASI, and the patient's age was performed using regression plot. RESULTS: A significant correlation between MRSD (t=-4,36; r2=0.29; P≤0.0001), MRDR (t=3.92; r2=0.25; P=0.0003), and ASI (25±4.33 mm/m2; range 15,48-35,14 mm/m2) is observed. As ASI increases, aortic MRSD and MRDR decrease. Such inverse correlation between MRSD, MRDR, and ASI indicates increased stiffness of the ascending aorta. A significant correlation between the patient's age and the decrease in MRSD and MRDR is observed. CONCLUSION: MRSD and MRDR are significantly correlated with ASI and the patient's age. They seem to describe properly the increasing stiffness of aortas. These two new indexes provide a promising, accessible, and reproducible approach to evaluate the biomechanical property of the aorta.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Aorta/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Imagem por Ressonância Magnética , Adulto , Idoso , Diástole/fisiologia , Dilatação Patológica , Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sístole/fisiologia
3.
Hypertension ; 74(4): 880-887, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31422691

RESUMO

Recent data suggest that visit-to-visit variability of blood pressure (BP) is associated with cardiovascular events. We evaluated the role of BP variability as a determinant of end-stage renal disease (ESRD). Using nationally representative data from the Korean National Health Insurance System, 8 199 089 subjects had been enrolled during 2009 to 2010 who were free of ESRD and underwent ≥3 health examinations during 2005 to 2010 were followed to the end of 2017. BP variability was measured using the coefficient of variation, SD, and variability independent of the mean. The primary outcome was the development of ESRD, defined as a combination of the relevant disease code and the initiation of renal replacement therapy. The χ2 test, t test, and log-rank test were used in the statistical analysis. There were 16 567 cases of ESRD during a median follow-up of 7.89±0.88 years. The highest quartile of systolic or diastolic BP showed a higher incident rate of ESRD compared with the other 3 quartiles. It was augmented in patients with the highest quartile of both systolic and diastolic BP variabilities. Among patients with the highest quartile of systolic and diastolic BP variabilities, the uncontrolled hypertension group (>140/90 mm Hg) taking antihypertensive medication showed the highest incidence rate of ESRD. These results were consistent when modeling variability of BP using coefficient of variation, SD, and variability independent of the mean and in various sensitivity analyses. Systolic and diastolic BP variabilities were independently associated with an increased incidence of ESRD, and it was augmented when both variabilities were present together.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Falência Renal Crônica/epidemiologia , Adulto , Determinação da Pressão Arterial , Diástole/fisiologia , Feminino , Taxa de Filtração Glomerular/fisiologia , Inquéritos Epidemiológicos , Humanos , Hipertensão/tratamento farmacológico , Incidência , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Risco , Sístole/fisiologia
4.
Hypertension ; 74(4): 767-775, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31422693

RESUMO

Concerns exist regarding the potential increased cardiovascular risk from lowering diastolic blood pressure (DBP) in hypertensive patients. We analyzed 30-year follow-up data of 10 355 hypertensive patients attending the Glasgow Blood Pressure Clinic. The association between blood pressure during the first 5 years of treatment and cause-specific hospital admissions or mortality was analyzed using multivariable adjusted Cox proportional hazard models. The primary outcome was a composite of cardiovascular admissions and deaths. DBP showed a U-shaped association (nadir, 92 mm Hg) for the primary cardiovascular outcome hazard and a reverse J-shaped association with all-cause mortality (nadir, 86 mm Hg) and noncardiovascular mortality (nadir, 92 mm Hg). The hazard ratio for the primary cardiovascular outcome after adjustment for systolic blood pressure was 1.38 (95% CI, 1.18-1.62) for DBP <80 compared with DBP of 80 to 89.9 mm Hg (referrant), and the subdistribution hazard ratio after accounting for competing risk was 1.33 (1.17-1.51) compared with DBP ≥80 mm Hg. Cause-specific nonfatal outcome analyses showed a reverse J-shaped relationship for myocardial infarction, ischemic heart disease, and heart failure admissions but a U-shaped relationship for stroke admissions. Age-stratified analyses showed DBP had no independent effect on stroke admissions among the older patient subgroup (≥60 years of age), but the younger subgroup showed a clear U-shaped relationship. Intensive blood pressure reduction may lead to unintended consequences of higher healthcare utilization because of increased cardiovascular morbidity, and this merits future prospective studies. Low on-treatment DBP is associated with increased risk of noncardiovascular mortality, the reasons for which are unclear.


Assuntos
Pressão Sanguínea/fisiologia , Diástole/fisiologia , Hipertensão/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Fatores de Risco , Taxa de Sobrevida , Atenção Terciária à Saúde
5.
Australas Phys Eng Sci Med ; 42(3): 733-743, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31313129

RESUMO

The problem addressed in this work is the detection of a heart murmur and the classification of the associated cardiovascular disorder based on the heart sound signal. For this purpose, a dataset of Phonocardiogram (PCG) signals is acquired using baseline conditions. The dataset is acquired from 283 volunteers using Littman 3200 electronic stethoscope for a normal and four different types of heart murmurs. The samples are labelled and validated through echocardiography test of each participating volunteer. For feature extraction, normalized average Shannon energy with time-domain characteristics of heart sound signal is exploited to segment the PCG signal into its components. To improve the quality of the features, in contrast to the previous methods, all systole and diastole intervals are utilized to extract 50 Mel-Frequency Cepstrum Coefficients (MFCC) based features. Then, the iterative backward elimination method is used to identify and remove the redundant features to reduce the complexity in order to conceive a computationally tractable system. An MFCC feature vector of dimension 26 is selected for training seven different types of Support Vector Machine (SVM) and K-Nearest Neighbors (KNN) based classifiers for detection and classification of cardiovascular disorders. Fivefold cross-validation and 20% data holdout validation schemes are used for testing the classifiers. Classification accuracy of 92.6% is achieved using selected features and medium Gaussian SVM classifier. The learning curves show a good bias-variance trade-off indicating a well-fitted and generalized model for making future predictions.


Assuntos
Algoritmos , Sopros Cardíacos/diagnóstico , Adulto , Diástole/fisiologia , Feminino , Sopros Cardíacos/fisiopatologia , Ruídos Cardíacos , Humanos , Masculino , Pessoa de Meia-Idade , Fonocardiografia , Processamento de Sinais Assistido por Computador , Máquina de Vetores de Suporte , Sístole/fisiologia
6.
J Vet Sci ; 20(3): e18, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31161736

RESUMO

This study aimed to assess the effects of dehydration on echocardiographic indices in healthy cats: specifically, it aimed to assess the effects of volume depletion on diastolic function. Nine experimental cats were subjected to both a dehydration and placebo protocol separated by a 21-day washout period. Echocardiography was performed at baseline and on completion of each protocol. Results were compared between the two protocols. Volume depletion was induced by intravenous administration of furosemide. Volume depletion showed a significant association with increased interventricular septal and left ventricular free wall thickness at end-diastole, decreased left ventricular internal diameter at end-diastole, and left atrial diameter at end-systole. The peak early (E) and late (A) diastolic filling velocities, and the peak early diastolic velocities (E') were significantly decreased by dehydration. Volume depletion did not affect peak longitudinal strain rate during early diastole, E/A, or E/E'. Volume depletion significantly affected the echocardiographic diastolic indices and conventional echocardiographic parameters in healthy cats.


Assuntos
Gatos/fisiologia , Desidratação/enzimologia , Desidratação/patologia , Ecocardiografia , Animais , Velocidade do Fluxo Sanguíneo/fisiologia , Desidratação/induzido quimicamente , Diástole/fisiologia , Furosemida , Peptidil Dipeptidase A/metabolismo , Função Ventricular Esquerda/fisiologia
7.
Can J Physiol Pharmacol ; 97(8): 786-795, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237455

RESUMO

Exercise enhances cardiac sarcoplasmic reticulum Ca2+-ATPase 2a (SERCA2a) function through unknown mechanisms. The present study tested the hypothesis that the positive effects of exercise on SERCA2a expression and function in the left ventricle is dependent on adenosine-monophosphate-activated protein kinase (AMPK) α2 function. AMPKα2 kinase-dead (KD) transgenic mice, which overexpress inactivated AMPKα2 subunit, and wild-type C57Bl/6 (WT) mice were randomized into sedentary groups or groups with access to running wheels. After 5 months, exercised KD mice exhibited shortened deceleration time compared with sedentary KD mice. In left ventricular tissue, the ratio of phosphorylated AMPKαThr172:total AMPKα was 65% lower (P < 0.05) in KD mice compared with WT mice. The left ventricle of KD mice had 37% lower levels of SERCA2a compared with WT mice. Although exercise increased SERCA2a protein levels in WT mice by 53%, this response of exercise was abolished in exercised KD mice. Exercise training reduced total phospholamban protein content by 23% in both the WT and KD mice but remained 20% higher overall in KD mice. Collectively, these data suggest that AMPKα influences SERCA2a and phospholamban protein content in the sedentary and exercised heart, and that exercise-induced changes in SERCA2a protein are dependent on AMPKα function.


Assuntos
Proteínas Quinases Ativadas por AMP/deficiência , Proteínas Quinases Ativadas por AMP/genética , Regulação Enzimológica da Expressão Gênica , Técnicas de Silenciamento de Genes , Condicionamento Físico Animal , ATPases Transportadoras de Cálcio do Retículo Sarcoplasmático/genética , ATPases Transportadoras de Cálcio do Retículo Sarcoplasmático/metabolismo , Proteínas Quinases Ativadas por AMP/metabolismo , Animais , Diástole/fisiologia , Masculino , Camundongos , Fosforilação , Comportamento Sedentário
8.
Pediatr Cardiol ; 40(5): 1017-1025, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041461

RESUMO

The timing and etiology of diastolic impairment in pediatric-onset systemic lupus erythematosus (SLE) are poorly understood. We compared echocardiographic metrics of left ventricular diastolic function in children at SLE diagnosis to controls and identified factors associated with diastolic indices. Echocardiograms of children aged 5-18 years within 1 year of SLE diagnosis and age-/sex-matched controls were retrospectively read by blinded cardiologists. Clinical characteristics were abstracted separately. Z-scores for diastolic indices (E/A, e', E/e', and isovolumetric relaxation time (IVRT)) were calculated using published normative data and study controls, and compared using linear mixed-effects models adjusted for blood pressure. Pericardial effusions and valvular disease were also evaluated. Linear regression was used to identify factors associated with diastolic measures. 85 children with incident SLE had echocardiograms performed a median of 6 days after diagnosis (interquartile range (IQR) 1-70). Prior cumulative prednisone exposure was minimal (median 60 mg, IQR 0-1652). SLE cases had lower E/A, lower e', higher E/e', and longer IVRT compared to controls. Though none met criteria for Grade I diastolic dysfunction, Z-scores for e', E/e', and IVRT were abnormal in 30%, 25%, and 6% of SLE cases, respectively. Greater disease activity was associated with lower septal e' (p < 0.01), higher E/e' (p = 0.02), and longer IVRT (p < 0.01). Children with incident SLE have worse diastolic indices at diagnosis compared to peers without SLE, independent of blood pressure and prior to significant prednisone exposure. Longitudinal studies will determine whether diastolic dysfunction develops in this population over time.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Adolescente , Estudos de Casos e Controles , Criança , Diástole/fisiologia , Ecocardiografia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda/fisiologia
9.
Sensors (Basel) ; 19(9)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31072052

RESUMO

Oscillometric blood pressure (BP) monitors currently estimate a single point but do not identify variations in response to physiological characteristics. In this paper, to analyze BP's normality based on oscillometric measurements, we use statistical approaches including kurtosis, skewness, Kolmogorov-Smirnov, and correlation tests. Then, to mitigate uncertainties, we use a deep learning method to determine the confidence limits (CLs) of BP measurements based on their normality. The proposed deep learning regression model decreases the standard deviation of error (SDE) of the mean error and the mean absolute error and reduces the uncertainties of the CLs and SDEs of the proposed technique. We validate the normality of the distribution of the BP estimation which fits the standard normal distribution very well. We use a rank test in the deep learning technique to demonstrate the independence of the artificial systolic BP and diastolic BP estimations. We perform statistical tests to verify the normality of the BP measurements for individual subjects. The proposed methodology provides accurate BP estimations and reduces the uncertainties associated with the CLs and SDEs using the deep learning algorithm.


Assuntos
Pressão Sanguínea/fisiologia , Aprendizado Profundo , Estatística como Assunto , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Diástole/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Reprodutibilidade dos Testes , Sístole/fisiologia , Adulto Jovem
11.
Med Sci Sports Exerc ; 51(9): 1838-1844, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30973478

RESUMO

PURPOSE: At the onset of physical exercise, oxygen (O2) transport adapts to meet the working muscle O2 demands. Cardiac output abruptly increases through the concomitant changes of HR and stroke volume (SV), which is conditioned by the left ventricular (LV) function. The purpose of this study was to investigate the contribution of many LV diastolic and systolic function parameters, including twist-untwist mechanics, to SV adaptation during the first minutes after exercise onset. METHODS: Diastolic and systolic myocardial strains and twist were monitored by two-dimensional speckle-tracking echocardiography with high temporal resolution in 28 young men (mean age, 23 ± 4 yr) who performed five similar constant work-load exercises on a cycloergometer (target HR: 125 bpm). Two-dimensional cine-loops were recorded every 15 s during the first minute of exercise, and then every 30 s for the next 3 min. RESULTS: During the first 60 s of exercise, SV (from 104 ± 15 mL to 126 ± 21 mL, P < 0.001) increased concomitantly with LV strain and strain rates. Early filling was the main SV determinant during this phase, probably linked to the increase of venous return (at the very beginning of exercise), LV relaxation (from 1.5 ± 0.3 s to 2.5 ± 0.4 s, P < 0.001) and untwisting (from -78 ± 34°·s to -165 ± 61°·s, P < 0.001). After the first minute, SV remained constant, whereas LV untwisting continued to increase (from -165 ± 61°·s to -187 ± 60°·s, P < 0.001) and the other systolic and diastolic parameters reached a plateau. CONCLUSIONS: This study gives new mechanical insights into LV kinetics to address the challenge of SV response at the onset of exercise.


Assuntos
Exercício/fisiologia , Descanso/fisiologia , Função Ventricular Esquerda/fisiologia , Adaptação Fisiológica , Adolescente , Adulto , Diástole/fisiologia , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Volume Sistólico/fisiologia , Sístole/fisiologia , Adulto Jovem
12.
PLoS One ; 14(4): e0214907, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947284

RESUMO

BACKGROUND: Women have a greater risk of heart failure with preserved ejection fraction (HFPEF) than men do, yet the basis for this disparity remains unclear. Greater arterial stiffness and afterload causes left ventricular (LV) diastolic dysfunction, a central mechanism of HFPEF. Because of smaller body habitus, previous reports have used body surface area as a surrogate of the size of the aorta. We performed a comprehensive hemodynamic evaluation of elderly patients with preserved EF and evaluated sex differences in the associations between LV function and afterload, before and after adjusting for the aortic sizes. METHODS AND RESULTS: Four hundred and forty-three patients (mean age: 73 years, 169 women) who underwent clinically indicated echocardiography and computed tomography (CT) were identified. Linear regression analyses were performed to assess the independent contributions of sex to and its interaction with LV function before and after adjusting for CT-derived aortic length and volume. Although blood pressures were similar between the sexes, women had greater arterial elastance, lower arterial compliance, and greater LV ejection fraction (all p<0.001). Sex differences were detected in the associations between LV afterload and relaxation (mitral e') as well as in the left atrial (LA) emptying fraction, but not in LA size. These differences remained significant after adjusting for the aortic length and volume. Sensitivity analyses in an age-matched subgroup (n = 324; 162 of each sex) confirmed the robustness of these sex disparities in LV diastolic function and afterload. CONCLUSION: Women had worse LV relaxation than men did against the same degree of afterload, before and even after adjusting for the aortic sizes.


Assuntos
Aorta/diagnóstico por imagem , Aorta/fisiologia , Diástole/fisiologia , Função Ventricular Esquerda/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Ecocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Estudos Retrospectivos , Caracteres Sexuais , Fatores Sexuais , Volume Sistólico/fisiologia , Tomografia Computadorizada por Raios X , Rigidez Vascular/fisiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
13.
Drug Discov Ther ; 13(1): 38-46, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30880321

RESUMO

Heart failure with preserved ejection fraction (HFpEF) is a leading cause of morbidity and mortality without an established treatment. Diastolic dysfunction, the hallmark of HFpEF, is associated with altered myocardial bioenergetics. No previous study has examined the effects of coenzyme Q10 (CoQ10) on left ventricle (LV) diastolic function in patients with HFpEF. We investigated whether CoQ10 could improve LV diastolic function in patients with HFpEF. We performed a randomized controlled trial (RCT) using pretest and posttest control groups of 30 patients with HFpEF. The patients received either CoQ10 100 mg three times a day or no CoQ10 in addition to routine treatment for 30 days. Echocardiographic study was performed at baseline and follow-up. LV diastolic function was evaluated by two dimensional and Doppler echocardiography as follows; average E/e׳, septal and lateral e׳velocity, and left atrium volume index (LAVI). A total of 28 patients completed the study. A statistically significant improvement was observed in the CoQ10 treatment group in terms between groups (∆E/e׳ ‒ 3.6 vs. ‒ 2.4; p = 0.28) and (∆LAVI ‒ 5.4 vs. ‒ 4.4; p = 0.83). Short term CoQ10 supplementation provided no additional benefits in improving LV diastolic function in patients with HFpEF.


Assuntos
Diástole/efeitos dos fármacos , Suplementos Nutricionais , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico/efeitos dos fármacos , Ubiquinona/análogos & derivados , Idoso , Diástole/fisiologia , Feminino , Seguimentos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico/fisiologia , Ubiquinona/administração & dosagem , Função Ventricular Esquerda/efeitos dos fármacos , Função Ventricular Esquerda/fisiologia
14.
Comput Methods Biomech Biomed Engin ; 22(7): 752-763, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30880461

RESUMO

OBJECTIVES: This study aims to examine the alteration in coronary haemodynamics with increasing the severity of vessel compression caused by myocardial bridging (MB). METHODS: Angiography and intravascular ultrasound were performed in 10 patients with MB with varying severities of systolic compression in the left anterior descending (LAD) artery. Computer models of MB were developed and transient computational fluid dynamics simulations were performed to derive distribution of blood residence time and shear stress. RESULTS: With increasing the severity of bridge compression, a decreasing trend was observed in the shear stress over proximal segment whereas an increasing trend was found in the shear stress over bridge segment. When patients were divided into 2 groups based on the average systolic vessel compression in the whole cohort (%CRave = 27.38), patients with bridges with major systolic compression (>%CRave) had smaller shear stress and higher residence time in the proximal segment compared to those with bridges with minor systolic compression (<%CRave) (0.37 ± 0.23 vs 0.69 ± 0.29 Pa and 0.0037 ± 0.0069 vs 0.022 ± 0.0094 s). In contrast, patients with bridges with major systolic compression had greater shear stress in the bridge segment compared to those with bridges with minor systolic compression (2.49 ± 2.06 vs 1.13 ± 0.89 Pa). No significant difference was found in the distal shear stress of patients with bridges with major and minor systolic compression. CONCLUSION: Our findings revealed a direct relationship between the severity of systolic compression of MB and haemodynamic perturbations in the proximal segment such that the increased systolic vessel compression was associated with decreased shear stress and increased blood residence time.


Assuntos
Hemodinâmica/fisiologia , Ponte Miocárdica/fisiopatologia , Pressão Sanguínea , Angiografia Coronária , Diástole/fisiologia , Feminino , Humanos , Hidrodinâmica , Masculino , Pessoa de Meia-Idade , Ponte Miocárdica/diagnóstico por imagem , Miocárdio/patologia , Sístole/fisiologia , Fatores de Tempo
15.
J Invasive Cardiol ; 31(4): E67-E68, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30927539

RESUMO

Crossing of a critically stenosed aortic valve is a pivotal step during diagnostic cardiac catheterization to measure the transvalvular gradient, especially in patients with discordant clinical and echocardiographic findings and also during transcatheter aortic valve replacement procedures. However, there are no data in the literature indicating whether aortic valve crossing typically occurs during systole or diastole. We hypothesize that aortic valve crossing is a diastolic phenomenon and describe our technique for crossing critically stenosed aortic valves.


Assuntos
Estenose da Valva Aórtica , Valva Aórtica , Velocidade do Fluxo Sanguíneo/fisiologia , Diástole/fisiologia , Reologia/métodos , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/patologia , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Cateterismo Cardíaco/métodos , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Estudos Retrospectivos
16.
Kaohsiung J Med Sci ; 35(2): 116-122, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30848023

RESUMO

Our hypothesis was that intubations with the McGRATH MAC videolaryngoscope in elderly patients would produce less hemodynamic responses and ECG changes than the Macintosh direct laryngoscope. The patients were divided into two groups: patients who were intubated using the McGRATH MAC (Group V, n = 45) and patients who were intubated using the Macintosh direct laryngoscope (Group L, n = 45). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR) were recorded before induction with anesthesia (baseline), immediately after induction and at 1 min, 3 min, and 5 min after intubation, with simultaneous ECG. When Group L was compared to Group V, there was an increase in the first, third and fitth minutes after intubation in terms of HR. SBP, MAP increased only at 1 min after intubation and DBP increased in the first and third minutes after intubation in Group L. In Group L, there was a significant difference in the HR values immediately after induction and the first minute after intubation compared with the baseline values. There was a difference in the SBP values immediately after induction and at 3 min and 5 min after intubation compared with the baseline values. There was a difference in DBP and MAP values immediately after induction and at 5 min after intubation. When the McGRATH MAC videolaryngoscope was compared with the Macintosh direct laryngoscope in elderly patients, the McGRATH MAC videolaryngoscope decreased the hemodynamic fluctuations due to tracheal intubation.


Assuntos
Eletrocardiografia , Hemodinâmica/fisiologia , Intubação Intratraqueal , Laringoscópios , Gravação em Vídeo , Idoso , Pressão Sanguínea/fisiologia , Diástole/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Sístole/fisiologia
17.
Cir Cir ; 87(2): 196-204, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768074

RESUMO

Introduction: Primary hyperparathyroidism (PHPT) is the leading cause of outpatient hypercalcemia associated with increased cardiovascular risk. The flow-mediated vasodilation (FMV) has been proposed as a non-invasive method for assessing endothelial function. Objective: To compare the endothelial dysfunction measured by FMV and diastolic dysfunction in patients with PHPT before and after parathyroidectomy. Method: We performed a quasi-experimental (before-after) study to evaluate diastolic function and FMV in patients with PHPT before and six months after parathyroidectomy. Results: Fifteen patients completed study: 12 women and 3 men; 73% presented lithiasis, 27% osteoporosis and 53% metabolic syndrome; 73% presented diastolic dysfunction before the surgery and 60% after the surgery (p = 0.09). Post-isquemia brachial diameter improved from 41 mm (before surgery) to 46 mm (after surgery; p = 0.020). After surgery, we also observed an increase in the brachial diameter pre vs. post-ischemia from 41 to 46 mm (p = 0.005). Before surgery, the change in the delta of brachial diameter pre and post-ischemia was 1 mm and up to 4 mm after surgery (p = 0.03). Conclusions: There is a minor endothelial dysfunction measured by FMV in patients who underwent surgery for PHPT at 6 months after surgery, as well as a trend towards improvement in diastolic dysfunction. Echocardiography can be useful in the preoperative evaluation in patients with asymptomatic PHPT.


Assuntos
Endotélio Vascular/fisiopatologia , Hiperparatireoidismo Primário/fisiopatologia , Hiperparatireoidismo Primário/cirurgia , Síndrome Metabólica/fisiopatologia , Paratireoidectomia , Vasodilatação/fisiologia , Idoso , Diástole/fisiologia , Ecocardiografia , Feminino , Humanos , Hiperparatireoidismo Primário/complicações , Masculino , Síndrome Metabólica/diagnóstico , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
18.
Int J Cardiol ; 281: 1-7, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30739803

RESUMO

BACKGROUND: We assessed whether the non-invasive measure of peak diastolic-systolic velocity ratio (rDSVR) at rest on the left anterior descending artery (LAD) using Doppler transthoracic echocardiography is associated with obstructive coronary artery disease (CAD) on the LAD and left main (LM) arteries. We compared rDSVR diagnostic accuracy with stress wall motion (WM) and coronary flow reserve (CFR-LAD), in a group of subjects who underwent contrast stress-echocardiography (cSE) and coronary angiography within 3 months. METHODS: 286 patients selected with a clinical indication to cSE, in which CFR-LAD was measured during the test who also underwent coronary angiography within 3 months were selected and diagnostic performance compared. RESULTS: Demographics and clinical variables were univariate predictors of LAD or LM >50% stenosis, but rDSVR < 1.7 outperformed other variables (OR 11.18, 95% CI 5.82-21.49, p < 0.001), comprising cSE variables such as reversible WM abnormalities (OR 1.53, 95% CI 0.94-2.49, p = 0.087) or CFR-LAD < 2 (OR 2.88, 95% CI 21.74-4.77, p < 0.001). The addition of rDSVR to multivariate logistic regression models (clinical or clinical + cSE variables) led to a marked increase in C-index (0.82, 95%CI 0.78-0.87) with significant improvement compared to all prior models (p < 0.001). CONCLUSIONS: Our data suggest a strict association of reduced rDSVR with >50% coronary artery stenosis on the LM/LAD, superior to other standard clinical or cSE related indexes, such as WM assessment or CFR-LAD, and builds incrementally to them and clinical variables in multivariable logistic models for the prediction of CAD on LM and LAD coronaries.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Diástole/fisiologia , Ecocardiografia Doppler/métodos , Sístole/fisiologia , Idoso , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Ecocardiografia sob Estresse/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
Yonsei Med J ; 60(3): 291-297, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30799592

RESUMO

PURPOSE: Cardiac changes in end-stage renal disease are the most common causes of death after kidney transplantation (KT). Chronic kidney disease presents a major risk factor for the development and progression of diastolic dysfunction. The purpose of this study was to identify the association between changes in left ventricular (LV) diastolic function and perioperative clinical factors in patients with preserved ejection fraction following KT. MATERIALS AND METHODS: We reviewed 115 patients who underwent KT between January 2011 and December 2015 with both preand post-transplant echocardiograms; patients with LV systolic dysfunction were excluded. LV diastolic function was measured using the ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e'). RESULTS: Patients with normal pre-operative LV systolic function (n=97) showed improvement in E/e' after KT (11.9±4.4 to 10.5±3.8, p=0.023). Additionally, post-KT estimated glomerular filtration ratio was associated with changes in E/e' (odds ratio, -0.056; 95% confidence interval, -0.014 to -0.007; p=0.026). Among patients with preexisting diastolic dysfunction (20/97 patients), the amount of intraoperative fluid administration was related to E/e' changes (odds ratio, 0.003; 95% confidence interval, 0.000 to 0.005; p=0.029). CONCLUSION: KT is associated with improved diastolic function. Post-KT renal function was significantly related to changes in LV diastolic function. The amount of intraoperative fluid was a risk factor for worsening diastolic function after KT in patients with preexisting diastolic dysfunction.


Assuntos
Diástole/fisiologia , Transplante de Rim/efeitos adversos , Assistência Perioperatória , Adulto , Feminino , Humanos , Modelos Lineares , Masculino , Valva Mitral/fisiopatologia , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia
20.
JAMA Cardiol ; 4(3): 287-294, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30810702

RESUMO

Importance: The cornerstones of imaging in heart failure (HF) are the measurement of systolic and diastolic function and left ventricular (LV) filling pressure. Observations: Ejection fraction and the assessment of LV filling pressure and diastolic dysfunction using the ratio of early transmitral flow and LV relaxation (E/e') are conventional imaging markers of LV function. Despite their extensive use in HF guidelines, both have significant detractions, especially in an era when HF with preserved ejection fraction is becoming the dominant presentation. In contrast, strain imaging has provided a new window into myocardial mechanics. Myocardial strain is now well validated, robust, and can easily be performed on most modern echocardiography machines. This Review summarizes the evidence in 9 situations across the stages of HF where LV global longitudinal strain and other strain parameters may provide information on risk prediction, diagnosis, assessment of treatment response, and follow-up. Conclusions and Relevance: The evolution of myocardial deformation imaging from research tool to clinical practice will provide clinicians with a useful additional imaging parameter to facilitate the assessment and risk evaluation of patients with HF.


Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Terapia de Ressincronização Cardíaca/métodos , Tomada de Decisões , Desfibriladores Implantáveis , Diástole/fisiologia , Ecocardiografia/métodos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Miocárdio/patologia , Medição de Risco , Sístole/fisiologia
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