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1.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431524

RESUMO

A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to 'think horses and not zebras', and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.


Assuntos
/diagnóstico , Dor no Peito/fisiopatologia , Dispneia/fisiopatologia , Comunicação Interatrial/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Hipertrofia Ventricular Direita/diagnóstico por imagem , Síndrome de Cimitarra/diagnóstico por imagem , Adulto , Cateterismo Cardíaco , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Diagnóstico Diferencial , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Dispneia/etiologia , Ecocardiografia , Eletrocardiografia , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Direita/complicações , Hipertrofia Ventricular Direita/fisiopatologia , Imagem por Ressonância Magnética , /fisiopatologia , Síndrome de Cimitarra/complicações , Síndrome de Cimitarra/fisiopatologia , Tomografia Computadorizada por Raios X , Pressão Ventricular
2.
Am J Cardiol ; 129: 87-94, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32593432

RESUMO

Several studies have reported aortic dilation and increased stiffness of the ascending aorta in patients after repair of congenital heart disease (CHD), which may be a predominant cardiovascular risk. However, the clinical significance has not been described in detail. In this retrospective study, 175 repaired patients with complex CHD achieving biventricular circulation and age-matched 39 control subjects were reviewed (median age: 14.9 and 15.7 years, respectively). We measured the diameters of the ascending aorta and descending aorta from catheterization angiograms to yield Z-scores and stiffness indexes (ß) using diameter fluctuations corresponding to pulsatile pressures. Clinical profile, peak oxygen uptake during the cardiopulmonary exercise test, and incidence of unscheduled hospitalization during follow-up was also reviewed. Compared with controls, patients with complex CHD, except for those with aortic coarctation, exhibited significant dilation and increased stiffness of the aortic root and ascending aorta, but not of the descending aorta. In this CHD population (n = 147, including 112 conotruncal anomalies), exercise capacities correlated independently with the diameter Z-score and stiffness index of the ascending aorta along with the history of repetitive thoracotomies, reduced forced vital capacity, and right ventricular hypertension. During a follow-up period (median 15.6 years), either dilation (Z-score >3.5) or increased stiffness (ß >6.0) of the ascending aorta stratified morbidity, but no synergistic impact was detected. In conclusion, in repaired patients with complex CHD, a stiffened and dilated ascending aorta was frequently found, exerting significant adverse impacts on diminished exercise capacity and morbidity.


Assuntos
Aorta/fisiopatologia , Doenças da Aorta/fisiopatologia , Tolerância ao Exercício/fisiologia , Cardiopatias Congênitas/fisiopatologia , Rigidez Vascular/fisiologia , Adolescente , Coartação Aórtica/fisiopatologia , Coartação Aórtica/cirurgia , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Transposição das Grandes Artérias , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Criança , Dilatação Patológica/fisiopatologia , Dupla Via de Saída do Ventrículo Direito/fisiopatologia , Dupla Via de Saída do Ventrículo Direito/cirurgia , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Transposição dos Grandes Vasos/fisiopatologia , Transposição dos Grandes Vasos/cirurgia , Persistência do Tronco Arterial/fisiopatologia , Persistência do Tronco Arterial/cirurgia
3.
Am J Cardiol ; 128: 210-215, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32534732

RESUMO

The clinical and imaging differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with medically managed asymptomatic moderate-to-severe aortic stenosis (AS) have not been studied previously. We aim to characterize these differences and their clinical outcomes in this study. A retrospective observational study was conducted on 836 consecutive cases of isolated asymptomatic moderate-to-severe AS, with median follow-up of 3.4 years. Clinical and echocardiographic characteristics were compared between BAV and TAV patients. Subgroup analysis stratified by AS severity were performed. Survival analysis of all-cause mortality was performed using Kaplan-Meier curves and Cox proportional hazards model. Compared to BAV patients, TAV patients were older (76 ± 11 vs 55 ± 16 years, p <0.001) and had more co-morbidities including hypertension (78% vs 56%; p <0.001), diabetes (41% vs 24%; p <0.001), and chronic kidney disease (20% vs 3%; p = 0.001). TAV patients had less severe aortic valve disease than BAV patients, with a higher aortic valve area index (0.71 ± 0.20 cm2/m2 vs 0.61 ± 0.18 cm2/m2, p <0.001) and less aortic dilation (sinotubular junction: 23.7 ± 4.0 mm vs 26.9 ± 4.8 mm, p <0.001; mid-ascending aorta: 31.4 ± 4.7 mm vs 36.3 ± 6.3 mm, p <0.001). TAV patients were more likely to have eccentric left ventricular hypertrophy and less likely to have a normal geometry (p = 0.003). Competing risk analysis identified increased age (hazard ratio 1.03, 95% confidence interval 1.02 to 1.05, p <0.001) and LVEF (hazard ratio 0.98, 95% confidence interval 0.97 to 0.99, p <0.001) as independent risk factors of all-cause mortality. Valve morphology was not a significant independent risk factor for aortic valve replacement or mortality. In conclusion, asymptomatic TAV patients had more cardiovascular risk factors, less severe aortic valve disease, less sinotubular and mid-ascending aortic dilation, more severe LV remodeling.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/anormalidades , Doenças Assintomáticas , Doenças das Valvas Cardíacas/diagnóstico por imagem , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/epidemiologia , Doenças da Aorta/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Estudos de Casos e Controles , Causas de Morte , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/epidemiologia , Dilatação Patológica/fisiopatologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico
4.
Curr Cardiol Rev ; 16(3): 164-172, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32164514

RESUMO

Lower extremity venous diseases or insufficiency include clinically deteriorating conditions with morphological and functional alterations of the venous system, including venous hypertension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruritis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.


Assuntos
Dilatação Patológica/fisiopatologia , Extremidade Inferior/patologia , Varizes/fisiopatologia , Veias/fisiopatologia , Feminino , Humanos , Masculino
5.
J Clin Hypertens (Greenwich) ; 21(12): 1863-1871, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31693279

RESUMO

Hypertension-mediated organ damage (HMOD) is frequently observed in hypertensive patients at different cardiovascular (CV) risk profile. This may have both diagnostic and therapeutic implications for the choice of the most appropriate therapies. Among different markers of HMOD, the most frequent functional and structural adaptations can be observed at cardiac level, including left ventricular hypertrophy (LVH), diastolic dysfunction, aortic root dilatation, and left atrial enlargement. In particular, LVH was shown to be a strong and independent risk factor for major CV events, namely myocardial infarction, stroke, congestive heart failure, CV death. Thus, early identification of LVH is a key element for preventing CV events in hypertension. Although echocardiographic assessment of LVH represents the gold standard technique, this is not cost-effective and cannot be adopted in routine clinical practice of hypertension. On the other hand, electrocardiographic (ECG) assessment of HMOD relative to the heart is a simple, reproducible, widely available and cost-effective method to assess the presence of LVH, and could be preferred in large scale screening tests. Several new indicators have been proposed and tested in observational studies and clinical trials of hypertension, in order to improve the relatively low sensitivity of the conventional ECG criteria for LVH, despite high specificity. This article reviews the differences in the use of the main conventional and the new 12 lead ECG criteria of LVH for early assessment of asymptomatic, subclinical cardiac HMOD in a setting of clinical practice of hypertension.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Eletrocardiografia/métodos , Coração/fisiopatologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Aorta/anatomia & histologia , Aorta/patologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Morte , Dilatação Patológica/fisiopatologia , Diagnóstico Precoce , Eletrocardiografia/normas , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Humanos , Hipertensão/complicações , Masculino , Programas de Rastreamento/métodos , Infarto do Miocárdio/epidemiologia , Narração , Padrões de Prática Médica/normas , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
7.
J Mol Cell Cardiol ; 135: 31-39, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31348923

RESUMO

BACKGROUND: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV). METHODS: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement. RESULTS: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 ±â€¯0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001). CONCLUSIONS: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.


Assuntos
Aorta , Estenose da Valva Aórtica , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas , Tomografia Computadorizada por Raios X , Valva Tricúspide , Idoso , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Dilatação Patológica/cirurgia , Dislipidemias/diagnóstico por imagem , Dislipidemias/fisiopatologia , Dislipidemias/cirurgia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Hipertensão/cirurgia , Masculino , Pessoa de Meia-Idade , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia
8.
J Am Heart Assoc ; 8(14): e012486, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31304837

RESUMO

Background Homoarginine ( hA rg) has been shown to be cardioprotective in a model of ischemic heart failure; however, the mechanism remains unknown. hA rg can inhibit tissue-nonspecific alkaline phosphatase ( TNAP ), an enzyme that promotes vascular calcification. We hypothesized that hA rg will exert beneficial effects by reducing calcification in a mouse model of coronary artery disease associated with TNAP overexpression and hypercholesterolemia. Methods and Results TNAP was overexpressed in the endothelium in mice homozygous for a low-density lipoprotein receptor mutation (wicked high cholesterol [ WHC ] allele). WHC and WHC -endothelial TNAP mice received placebo or hA rg supplementation (14 mg/L in drinking water) starting at 6 weeks of age simultaneously with an atherogenic diet. Outcomes were compared between the groups after 4 to 5 weeks on treatment. Experiments were performed in males, which presented a study limitation. As expected, WHC -endothelial TNAP mice on the placebo had increased mortality (median survival 27 days, P<0.0001), increased coronary calcium and lipids ( P<0.01), increased left ventricular end-diastolic diameter ( P<0.0001), reduced ejection fraction ( P<0.05), and increased myocardial fibrosis ( P<0.0001) compared with WHC mice. Contrary to our hypothesis, hA rg neither inhibited TNAP activity in vivo nor reduced coronary artery calcification and atherosclerosis in WHC -endothelial TNAP mice; however, compared with the placebo, hA rg prevented left ventricular dilatation ( P<0.01), preserved ejection fraction ( P<0.05), and reduced myocardial fibrosis ( P<0.001). Conclusions The beneficial effect of hA rg supplementation in the setting of calcified coronary artery disease is likely due to its direct protective actions on the myocardial response to the ischemic injury and not to the inhibition of TNAP activity and calcification.


Assuntos
Fosfatase Alcalina/efeitos dos fármacos , Doença da Artéria Coronariana/fisiopatologia , Endotélio/efeitos dos fármacos , Coração/efeitos dos fármacos , Homoarginina/farmacologia , Calcificação Vascular/patologia , Função Ventricular Esquerda/efeitos dos fármacos , Fosfatase Alcalina/genética , Animais , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/genética , Doença da Artéria Coronariana/patologia , Dieta Aterogênica , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/genética , Dilatação Patológica/fisiopatologia , Modelos Animais de Doenças , Ecocardiografia , Endotélio/metabolismo , Fibrose , Hipercolesterolemia/genética , Masculino , Camundongos , Camundongos Transgênicos , Mutação , Miocárdio/patologia , Receptores de LDL/genética , Volume Sistólico/efeitos dos fármacos , Volume Sistólico/genética , Taxa de Sobrevida , Sístole , Calcificação Vascular/genética , Função Ventricular Esquerda/genética
9.
Eur Heart J ; 40(30): 2534-2547, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31211361

RESUMO

Endothelial dysfunction is involved in the development of atherosclerosis, which precedes asymptomatic structural vascular alterations as well as clinical manifestations of cardiovascular disease (CVD). Endothelial function can be assessed non-invasively using the flow-mediated dilation (FMD) technique. Flow-mediated dilation represents an endothelium-dependent, largely nitric oxide (NO)-mediated dilatation of conduit arteries in response to an imposed increase in blood flow and shear stress. Flow-mediated dilation is affected by cardiovascular (CV) risk factors, relates to coronary artery endothelial function, and independently predicts CVD outcome. Accordingly, FMD is a tool for examining the pathophysiology of CVD and possibly identifying subjects at increased risk for future CV events. Moreover, it has merit in examining the acute and long-term impact of physiological and pharmacological interventions in humans. Despite concerns about its reproducibility, the available evidence shows that highly reliable FMD measurements can be achieved when specialized laboratories follow standardized protocols. For this purpose, updated expert consensus guidelines for the performance of FMD are presented, which are based on critical appraisal of novel technical approaches, development of analysis software, and studies exploring the physiological principles underlying the technique. Uniformity in FMD performance will (i) improve comparability between studies, (ii) contribute to construction of reference values, and (iii) offer an easy accessible and early marker of atherosclerosis that could complement clinical symptoms of structural arterial disease and facilitate early diagnosis and prediction of CVD outcomes.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Doenças Cardiovasculares/diagnóstico , Técnicas de Diagnóstico Cardiovascular , Idoso , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/fisiopatologia , Consenso , Dilatação Patológica/diagnóstico , Dilatação Patológica/patologia , Dilatação Patológica/fisiopatologia , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Humanos , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo
10.
Sci Rep ; 9(1): 7358, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31089154

RESUMO

The nociceptive and autonomic nervous systems (ANS) are significantly intertwined. Decoupling of these systems may occur in pathological pain conditions, including irritable bowel syndrome (IBS). We investigated ANS activity and its association with visceral perception and brain activity during rectal distention in 27 patients with non-constipated IBS and 33 controls by assessing heart rate variability (HRV) using electrocardiography at rest, before, and during colorectal distention. Brain responses to colorectal distention were measured using functional magnetic resonance imaging and correlated with individual ANS function parameters. The IBS group displayed blunted sympathovagal balance [low/high-frequency ratio (LF:HF) of HRV] in response to colorectal distention compared with controls (P = 0.003). In controls, basal parasympathetic tone (HF component of HRV) was significantly negatively correlated with toleration threshold to the rectal distention, but not in patients with IBS (group comparison P = 0.04). Further, a positive correlation between baseline HF values and neural responses to rectal distension was found in the right caudate, bilateral dorsolateral anterior cingulate cortex, and pregenual anterior cingulate cortex in the control group but not in the IBS group. The results indicate abnormal interactions between ANS activity and the brain mechanisms underlying visceral perception in patients with IBS.


Assuntos
Núcleo Caudado/fisiopatologia , Giro do Cíngulo/fisiopatologia , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/fisiopatologia , Nervo Vago/fisiologia , Dor Visceral/fisiopatologia , Adulto , Núcleo Caudado/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Eletrocardiografia , Feminino , Voluntários Saudáveis , Frequência Cardíaca/fisiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Vias Neurais/fisiopatologia , Nociceptividade/fisiologia , Reto/inervação , Reto/fisiopatologia , Dor Visceral/etiologia , Adulto Jovem
11.
Angiology ; 70(10): 969-977, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31064194

RESUMO

Aortic diameter and progression to thoracic aortic aneurysm are influenced by several factors. In this study, we investigated the association of alcohol consumption with aortic root and ascending aorta dilatation. In the context of the Corinthia study, we examined 1751 patients with echocardiography. Several demographic and clinical characteristics were recorded. Alcohol consumption was assessed based on a questionnaire of frequency, type, and quantity. Accordingly, patients were categorized as everyday alcohol consumers (EDACs) and as social drinkers (SoD). Everyday alcohol consumers were further categorized to group 1: 0 to 1 drink/d; group 2: 1 to 2 drinks/d; and group 3: ≥3 drinks/d. From the study population, 40% were categorized as EDAC and had an increased aortic root diameter (AoRD) and an elevated AoRD index compared with SoD. Interestingly, there was a stepwise increase in aortic root and ascending aorta diameter according to daily alcohol consumption. Specifically, patients consuming ≥3 drinks of alcohol/d had increased indexed aortic by 1.4 mm/m2 compared with SoD even after adjustment for possible confounders. Daily alcohol consumption is associated with increased aortic root diameter. These findings may have important clinical implications, especially in patients with borderline or dilated aortic root, and merit further investigation.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Aorta Torácica/patologia , Doenças da Aorta/patologia , Cardiopatias Congênitas/patologia , Doenças das Valvas Cardíacas/patologia , Adulto , Idoso , Consumo de Bebidas Alcoólicas/metabolismo , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Dilatação Patológica/patologia , Dilatação Patológica/fisiopatologia , Ecocardiografia Transesofagiana/métodos , Feminino , Cardiopatias Congênitas/fisiopatologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco
12.
J Mol Cell Cardiol ; 130: 205-215, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30998978

RESUMO

Ascending thoracic aortic aneurysm (ATAA) in patients with bicuspid aortic valve (BAV) can present an asymmetrical aortic dilatation compared with patients with tricuspid aortic valve (TAV). This pattern of aneurysm dilatation led us to hypothesize that biomechanical differences likely induced by regional heterogeneity of material properties can underlie the observed asymmetric enlargement discrepancies between BAV ATAA and TAV ATAA. This study aimed to characterize the mechanical properties and associated aortic tissue stiffness changes along the circumferential direction of aortic rings collected from surgically-repaired patients with ATAA. Biaxial material testing was performed on tissue specimens extrapolated from all aortic quadrants (i.e. anterior, posterior, major and minor curvature of the aorta), and then the tissue stiffness was quantified at both physiological and supra-physiological stress levels (i.e. 142 kPa and 242 kPa, respectively). Tissue stiffness revealed that the major curvature of BAV ATAA is statistically less stiff than the anterior quadrant (276.6 ±â€¯137.1 kPa for BAV ATAA and 830.1 ±â€¯557.1 kPa for BAV ATAA, p = .024, at 142 kPa) and to that of major curvature of TAV ATAA (276.6 ±â€¯137.0 kPa for BAV ATAA and 733.2 ±â€¯391.1 kPa for TAV ATAA, p = .001, at 142 kPa), suggesting local weakening of bicuspid aortic wall. Multiphoton imaging revealed local changes on elastic fiber networks. The recovered material parameters for the Fung-type constitutive model are crucial for reliable stress predictions while the information on regional tissue stiffness changes are fundamental to develop risk stratification strategies not based on aortic size.


Assuntos
Aorta Torácica , Aneurisma da Aorta Torácica , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas , Rigidez Vascular , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/patologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Dilatação Patológica/patologia , Dilatação Patológica/fisiopatologia , Dilatação Patológica/cirurgia , Feminino , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Refract Surg ; 35(4): 261-267, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30984984

RESUMO

PURPOSE: To analyze the outcomes of a new technique (corneal remodeling) to treat corneal ectasia. METHODS: Sixty-nine cases that underwent corneal remodeling were analyzed. Anesthetic drops were instilled and a femtosecond laser platform was used to perform an 8-mm diameter keratectomy (180°, 270°, or 360°). Once ablation was completed, the edges of the resection were sutured with 8 to 12 interrupted stitches. RESULTS: Three-year follow-up data are presented. The age of the population was 30.83 ± 12.65 years (range: 16 to 48 years). At 36 months postoperatively, 57.2% presented with uncorrected distance visual acuity (UDVA) of 20/100 or worse and 42.8% achieved between 20/80 and 20/40. After performing photorefractive keratectomy in 3 cases, 14.3% presented with UDVA of 20/100 or worse, 57.2% achieved between 20/80 and 20/40, and 28.5% achieved 20/30 or better in 180° arc length keratectomy. Most parameters compared were moderately to statistically significant (P < .05 to < .0000001). CONCLUSIONS: Corneal remodeling is a safe technique that produces corneal flattening, reduction of anterior chamber depth, and decreased optical aberrations. It also offers a possibility to perform complementary refractive procedures. [J Refract Surg. 2019;35(4):261-267.].


Assuntos
Córnea/fisiologia , Cirurgia da Córnea a Laser/métodos , Ceratocone/cirurgia , Lasers de Excimer/uso terapêutico , Adolescente , Adulto , Córnea/cirurgia , Topografia da Córnea , Dilatação Patológica/fisiopatologia , Feminino , Seguimentos , Humanos , Ceratocone/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fenômenos Fisiológicos Oculares , Refração Ocular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
14.
Pediatr Crit Care Med ; 20(7): 595-602, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30925571

RESUMO

OBJECTIVES: To determine if the presence of cardiac dysfunction in anthracycline-exposed pediatric oncology patients is associated with an increased frequency of PICU admission or mortality. DESIGN: Retrospective parallel cohort study. SETTING: PICU at an academic freestanding children's hospital. SUBJECTS: Children with oncologic diagnoses who received anthracyclines between January 2006 and December 2014 and were admitted to the hospital within 1 year of completion of therapy. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Charts of 734 patients were reviewed and 545 were included in analysis. Anthracycline-exposed pediatric oncology patients with cardiac dysfunction were more likely to be admitted to the PICU than those without cardiac dysfunction (87% vs 37% rate of PICU admission). PICU admission was also associated with identified infection and higher cumulative anthracycline dose. Once admitted to the PICU, those anthracycline-exposed patients with cardiac dysfunction had significantly higher mortality (26% vs 6%) and longer length of stay (7 vs 2 d) than children without cardiac dysfunction. Patients with cardiac dysfunction were more likely to require mechanical ventilation (59% vs 18%), required more vasoactive medications for longer, and were more likely to develop fluid overload. Death within 1 year of ICU admission was associated with higher cumulative anthracycline dose. CONCLUSIONS: Children with cancer who received anthracyclines, especially at higher doses, and who develop cardiac dysfunction are at higher risk of critical illness, have higher rates of multiple organ dysfunction and higher rates of mortality than anthracycline-exposed patients without cardiac dysfunction.


Assuntos
Antraciclinas/efeitos adversos , Estado Terminal/mortalidade , Cardiopatias/fisiopatologia , Neoplasias/tratamento farmacológico , Admissão do Paciente , Adolescente , Antraciclinas/administração & dosagem , Criança , Pré-Escolar , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Ecocardiografia , Feminino , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico por imagem , Cardiopatias/mortalidade , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Masculino , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico
15.
Am J Cardiol ; 123(3): 523-531, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30477802

RESUMO

Many studies have explored the hypothesis that epicardial adipose tissue (EAT) accumulation adversely affects cardiac remodeling. We assessed, through a systematic review and meta-analysis, whether EAT is linked to left atrial (LA) and left ventricular (LV) structure and function, irrespective of global or abdominal visceral adiposity. We searched MEDLINE, Scopus, and Web of Science for studies evaluating the association of EAT volume quantified by computed tomography with cardiac morphology and function. We used DerSimonian and Laird random-effects models to summarize the adjusted-effect of 10 ml variation of EAT on LA size, LV mass, LV diastolic and systolic functions parameters, and presence of diastolic dysfunction. We quantified heterogeneity using I2 statistic. We included 19 studies. Quantitative analysis by cardiac parameters, including LA dimension (n = 2,719), LV mass (n = 2,519), diastolic function (n = 3,741), and systolic function (n = 2,037) showed that EAT was associated with LA dilation (pooled B-coefficient: 0.12 mm; 95% confidence interval [CI] 0.08 to 0.17; I2: 97%), LV hypertrophy (pooled B-coefficient: 1.21 g; 95% CI 0.63 to 1.79; I2: 77%), diastolic dysfunction (odds ratio: 1.35; 95% CI 1.16 to 1.57; I2: 0%), higher E/E' ratio (pooled B-coefficient: 0.28 cm/s; 95% CI 0.08 to 0.49; I2: 67%), lower E' velocity (pooled B-coefficient: -0.16 cm/s; 95% CI -0.22 to -0.09; I2: 43%), and E/A ratio (pooled B-coefficient: -0.01; 95% CI -0.02 to -0.001; I2: 70%), independently of body mass index. There was no association between EAT and LV systolic function. In conclusion, EAT volume measured by computed tomography was independently associated with LA dilation, LV hypertrophy, and diastolic dysfunction.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Átrios do Coração/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Pericárdio/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Diástole/fisiologia , Humanos , Tomografia Computadorizada por Raios X
16.
Heart ; 105(8): 603-608, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30322846

RESUMO

OBJECTIVE: Bicuspid aortic valve (BAV) is the most common congenital heart disease. This study aimed to determine the prevalence rate of BAV in first-degree relatives (FDR) and the inheritance pattern according to different morphotypes and aortic dilation. METHODS: BAV probands were consecutively studied at eight tertiary referral centres. After sequential screening, FDR were included in the study. The BAV morphotype, aortic dilation and aortic phenotype were assessed by transthoracic echocardiography. RESULTS: Seven hundred and twenty-four FDR of 256 BAV probands agreed to undergo family screening. The prevalence of BAV was 6.4% in FDR (9.2% in men, 3.5% in women, p=0.002). Aortic dilation was diagnosed in 9.6% of FRD with tricuspid aortic valves (TAV), with a root phenotype in 2.7% and tubular in 6.9% and more frequently in the presence of arterial hypertension (OR 4.48; CI 95% 2.51 to 7.99; p=0.0001) and valvular regurgitation (OR 5.87, CI 95% 1.37 to 25.16; p=0.025). The heritability (h2 ) of BAV was highly significant (0.47; p=0.002); however, no concordance was observed among valve morphotypes. Aortic dilation heritability was not significant. CONCLUSIONS: The BAV prevalence rate in FDR was low (6.4%) but aortic dilation was observed in 9.6% of FDR with TAV. The heritability of BAV was high without concordance in valve morphotypes, and aortic dilation heritability was not observed. Patients with BAV should be made aware of its familial pattern.


Assuntos
Aorta , Doenças da Aorta , Valva Aórtica/anormalidades , Família , Doenças das Valvas Cardíacas , Adulto , Aorta/anormalidades , Aorta/diagnóstico por imagem , Aorta/patologia , Doenças da Aorta/diagnóstico , Doenças da Aorta/etiologia , Doenças da Aorta/fisiopatologia , Valva Aórtica/fisiopatologia , Variação Biológica da População , Análise por Conglomerados , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/etiologia , Dilatação Patológica/fisiopatologia , Ecocardiografia/métodos , Saúde da Família/estatística & dados numéricos , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Padrões de Herança , Masculino , Pessoa de Meia-Idade , Linhagem , Prevalência , Análise de Sequência/métodos , Espanha/epidemiologia
17.
Heart ; 105(5): 405-413, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30242138

RESUMO

CLINICAL INTRODUCTION: A 14-year-old boy presented with history of decreased appetite and bilateral swelling of feet for 6 months. He did not give any associated history of orthopnoea or paroxysmal nocturnal dyspnoea. He was born by a normal delivery after a non-consanguineous marriage. He had an unremarkable birth and childhood health history. There was no family history of significant cardiovascular illness or sudden death. Clinical examination showed an average built boy with elevated jugular venous pressure with prominent v wave and bilateral pitting pedal oedema. Cardiovascular examination showed normal first (S1) and second (S2) heart sounds and a short early systolic murmur over tricuspid region. Other systems examination was remarkable for soft tender hepatomegaly.ECG showed sinus rhythm with tall, peaked p waves. Chest X-ray revealed enlargement along the right cardiac border. Transthoracic echocardiographic images are shown in figure 1A (apical four-chamber view) and figure 1B (tricuspid inflow Doppler). There was no colour Doppler evidence of interatrial shunt.heartjnl;105/5/405/F1F1F1Figure 1(A) Transthoracic echocardiographic apical four-chamber view. (B) Tricuspid inflow continuous wave Doppler image. QUESTION: What is the most likely diagnosis of his condition? Endomyocardial fibrosis (EMF)Ebstein's anomalyArrhythmogenic right ventricular dysplasia (ARVD)Idiopathic dilatation of right atriumRestrictive cardiomyopathy.


Assuntos
Ecocardiografia Doppler em Cores/métodos , Eletrocardiografia/métodos , Átrios do Coração , Imagem Cinética por Ressonância Magnética/métodos , Adolescente , Diagnóstico Diferencial , Dilatação Patológica/diagnóstico , Dilatação Patológica/fisiopatologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Masculino , Administração dos Cuidados ao Paciente/métodos
18.
Phlebology ; 34(2): 128-136, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29793400

RESUMO

OBJECTIVE: The aim of this study is to evaluate chronic venous disease symptoms by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire in varicocele patients. MATERIAL AND METHODS: The study was designed as a prospective, case controlled study and conducted in four hospitals from Turkey. A total of 600 patients who admitted to urology outpatient clinic were enrolled to the study. After the exclusion of 44 patients who do not match the inclusion criteria, the remaining 556 patients were examined for the presence and grade of varicocele and subsequently examined clinically for the presence of chronic venous disease findings. Finally, patients were asked to answer the VEINES-Sym questionnaire consisting of 10 items. All patients' demographic parameters, cardiovascular risk factors, other co-morbid diseases and drug usage were noted. RESULTS: Patients were classified into two groups: varicocele (+) group ( n = 269) and varicocele (-) group ( n = 287). VEINES-Sym scores of varicocele patients were lower compared to patients without varicocele (41.41 ± 5.21, 43.19 ± 3.22, respectively, p < 0.001). Grades of varicocele significantly but inversely correlated with VEINES-Sym score ( r = 0, -206, p = 0.001). Logistic regression analysis revealed that presence of varicocele irrespective of grading significantly and independently associated with the presence of aching (odds ratio: 2.054, 95% confidence interval: 1.265-3.338, p = 0.004) and throbbing (odds ratio: 2.586, 95% confidence interval: 1.353-4.943, p = 0.004). CONCLUSION: Varicocele patients have lower VEINES-Sym scores compared to patients without varicocele and this finding is inversely correlated with the degree of the varicocele. This association supports the hypothesis that there may be a systemic vessel wall abnormality in venous disease patients. Patients with symptoms related to vascular dilatation in any territory may deserve to be assessed systematically with the support of further clinical studies.


Assuntos
Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiopatologia , Varicocele/patologia , Varicocele/fisiopatologia , Adulto , Doença Crônica , Dilatação Patológica/patologia , Dilatação Patológica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Turquia/epidemiologia
19.
Neuropharmacology ; 140: 193-200, 2018 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-30059662

RESUMO

BACKGROUND: Cerebral evoked potentials (CEP) induced by colorectal distension (CRD) in conscious rats provides a novel method in studies of visceral sensitivity. The aim of this study was to explore the pharmacological effect on CEP of compounds known to reduce the visceromotor response to CRD. METHODS: Epidural electrodes were chronically implanted in eight female Sprague-Dawley rats. Evoked potentials were elicited by colorectal rapid balloon distensions (100 ms, 80 mmHg) and the effect of WIN55 (cannabinoid CB receptor agonist), clonidine (adrenergic α2 receptor agonist), MPEP (mGluR5 receptor antagonist), pregabalin (ligand of α2δ subunits in voltage-gated calcium channels) and baclofen (GABA-B receptor agonist) on amplitudes and latency of CEP were determined. RESULTS: WIN55 (0.1 µmol kg-1), clonidine (0.05 µmol kg-1), MPEP (10 µmol kg-1) and pregabalin (200 µmol kg-1) caused a significant, p < 0.05, reduction of the N2 to P2 peak-to-peak amplitude by 23 ±â€¯8%, 25 ±â€¯8%, 39 ±â€¯5%, and 47 ±â€¯6% respectively. Baclofen (9 µmol kg-1) induced a prolongation of the N2 peak latency of 18 ±â€¯4% but had no significant effect on the amplitudes. CONCLUSION: The obtained results suggest that MPEP, WIN55, clonidine, and pregabalin reduce visceral nociceptive input to the brain, whereas the lack of effect of baclofen on CRD evoked CEP amplitudes suggest that the effect on VMR is not due to a direct analgesic effect. Brain responses to colorectal distension provide a useful tool to evaluate pharmacological effects in rats and may serve as a valuable preclinical model for understanding pharmacological mechanisms related to visceral sensitivity.


Assuntos
Baclofeno/farmacologia , Benzoxazinas/farmacologia , Córtex Cerebral/fisiologia , Clonidina/farmacologia , Colo/efeitos dos fármacos , Dilatação Patológica/fisiopatologia , Potenciais Evocados/fisiologia , Morfolinas/farmacologia , Naftalenos/farmacologia , Pregabalina/farmacologia , Piridinas/farmacologia , Animais , Feminino , Ratos
20.
Turk Kardiyol Dern Ars ; 46(5): 366-374, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30024393

RESUMO

OBJECTIVE: The aim of this study was to investigate the oscillometric measurements of the elastic properties of the aorta in patients with isolated coronary artery ectasia (CAE). METHODS: This study included 137 patients (92 men and 45 women; mean age: 60.8±11.7 years) who underwent coronary angiography to investigate ischemic heart disease. The patients were divided into 3 groups; the first group consisted of 51 patients with CAE, the second group comprised 36 patients with coronary artery disease (CAD), and the third group was made up of 50 patients with normal coronary arteries. Aortic stiffness (AS) measurements, including pulse wave velocity (PWV) and augmentation index (AIx), were measured using the oscillometric method. RESULTS: The mean PWV was significantly higher in the CAE group compared with the CAD and control groups (9.1±2.3 vs. 8.2±1.3 and 8.0±1.6; p=0.008), whereas the median AIx was significantly lower in the CAE group compared with the CAD and control groups (10.0% [-3.0-63.0] vs. 15.5% [-2.0-57.0] and 21.5% [-1.0-45.0]; p=0.010). Multinomial logistic regression analysis demonstrated that gender, hypertension, highdensity lipoprotein cholesterol level, PWV, and AIx were independently associated with CAE. CONCLUSION: The oscillometric elastic properties of the aorta, including PWV and AIx, are impaired in patients with CAE.


Assuntos
Aorta/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Vasos Coronários/fisiopatologia , Aorta/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Pulsátil , Rigidez Vascular
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