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1.
Medicine (Baltimore) ; 100(27): e26560, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232199

RESUMO

BACKGROUND: Right ventricular pacing (RVP) has been widely accepted as a traditional pacing strategy, but long-term RVP has detrimental impact on ventricular synchrony. However, left bundle branch pacing (LBBP) that evolved from His-bundle pacing could maintain ventricular synchrony and overcome its clinical deficiencies such as difficulty of lead implantation, His bundle damage, and high and unstable thresholds. This analysis aimed to appraise the clinical safety and efficacy of LBBP. METHODS: The Medline, PubMed, Embase, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing LBBP and RVP. RESULTS: Seven trials with 451 patients (221 patients underwent LBBP and 230 patients underwent RVP) were included in the analysis. Pooled analyses verified that the paced QRS duration (QRSd) and left ventricular mechanical synchronization parameters of the LBBP capture were similar with the native-conduction mode (P > .7),but LBBP showed shorter QRS duration (weighted mean difference [WMD]: -33.32; 95% confidence interval [CI], -40.44 to -26.19, P < .001), better left ventricular mechanical synchrony (standard mean differences: -1.5; 95% CI: -1.85 to -1.14, P < .001) compared with RVP. No significant differences in Pacing threshold (WMD: 0.01; 95% CI: -0.08 to 0.09, P < .001), R wave amplitude (WMD: 0.04; 95% CI: -1.12 to 1.19, P = .95) were noted between LBBP and RVP. Ventricular impedance of LBBP was higher than that of RVP originally (WMD: 19.34; 95% CI: 3.13-35.56, P = .02), and there was no difference between the 2 groups after follow-up (WMD: 11.78; 95% CI: -24.48 to 48.04, P = .52). And follow-up pacing threshold of LBBP kept stability (WMD: 0.08; 95% CI: -0.09 to 0.25, P = .36). However, no statistical difference existed in ejection fraction between the 2 groups (WMD: 1.41; 95% CI: -1.72 to 4.54, P = .38). CONCLUSIONS: The safety and efficacy of LBBP was firstly verified by meta-analysis to date. LBBP markedly preserve ventricular electrical and mechanical synchrony compared with RVP. Meanwhile, LBBP had stable and excellent pacing parameters. However, LBBP could not be significant difference in ejection fraction between RVP during short- term follow-up.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Frequência Cardíaca/fisiologia , Ventrículos do Coração/fisiopatologia , Função Ventricular Esquerda/fisiologia , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Humanos , Resultado do Tratamento
2.
Geriatr Gerontol Int ; 21(7): 577-583, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34008321

RESUMO

AIM: Heart failure is increasing in Japan, in particular that with preserved ejection fraction (HFpEF) prevalent in older-aged patients. The purpose of this study was to investigate the pathophysiology during the early stage of left ventricular (LV) diastolic dysfunction by the quantitative proteome analysis of human myocardium. METHODS: Among 331 post-mortem autopsy patients, we selected 23 patients (aged 79 ± 9.6 years) with echocardiographic data and without major comorbidities, except hypertension. Cryopreserved autopsy tissue of the LV myocardium was subjected to proteome analysis. LV diastolic function was evaluated by echocardiographic data. Thirteen patients were classified into the impaired diastolic function (IDF) group, and 10 the normal cardiac function group. We performed comparative proteome analysis between the IDF and normal groups by isobaric tags for relative and absolute quantitation (iTRAQ) using nano-liquid chromatography-tandem mass spectrometry. RESULTS: The iTRAQ-based proteome analysis revealed 57 differentially expressed proteins in the IDF group. Molecular network analysis of differentially expressed proteins indicated that endoplasmic reticulum (ER) stress was a potentially important event. Furthermore, the expressions of proteins associated with the ER stress response, such as glucose-regulated protein 78 kDa, inositol-requiring kinase 1α and spliced X-box binding protein 1, were significantly decreased in the IDF group. CONCLUSIONS: This study suggested that reduced ER stress responses were involved during the early stage of LV diastolic dysfunction. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2021; 21: 577-583.


Assuntos
Estresse do Retículo Endoplasmático , Insuficiência Cardíaca , Coração/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Idoso , Ecocardiografia , Feminino , Humanos , Japão , Masculino , Miocárdio , Proteoma , Volume Sistólico
3.
Heart Fail Clin ; 17(3): 369-376, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051969

RESUMO

It is generally considered that obstructive sleep apnea is a potential cause of heart failure (HF), and insomnia and central sleep apnea are results of HF. However, the number of reports describing the bidirectional relationship between sleep disorder and HF has increased. Sleep disorder may contribute to left ventricular diastolic dysfunction via left atrial overload, left ventricular remodeling, pulmonary hypertension, and atrial fibrillation, which lead to HF with preserved left ventricular ejection fraction. Overnight rostral fluid shift and lung congestion may lead to airflow obstruction in the upper pharynx and stimulate pulmonary irritant receptors, which induce hyperventilation and sleep disorder.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Insuficiência Cardíaca/complicações , Humanos , Apneia Obstrutiva do Sono/etiologia
4.
Heart Fail Clin ; 17(3): 423-434, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051974

RESUMO

Noninvasive cardiac imaging by transthoracic echocardiography is among the first-line assessments in evaluation of heart failure patients with preserved ejection fraction (HFpEF). Although systolic function seems preserved by conventional measurers, important information is found through examination of the heart's hemodynamic profile through Doppler and novel echocardiographic measures. These measures aid in establishing the diagnosis of HFpEF and provide valuable prognostic information. Targets of interest include the left ventricle diastolic function, atrial structure and function, and right ventricular function including pulmonary pressures. Contemporary assessments of the hemodynamic profile attainable through echocardiography in HFpEF at rest are reviewed and future directions outlined.


Assuntos
Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Hemodinâmica/fisiologia , Humanos , Prognóstico
5.
Heart Fail Clin ; 17(3): 447-462, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051976

RESUMO

Heart failure with preserved ejection fraction (HFpEF) burden is increasing. Its diagnostic process is challenging and imprecise due to absence of a single diagnostic marker, and the multiparametric echocardiography evaluation needed. Left ventricular (LV) ejection fraction (LVEF) is a limited marker of LV function; thus, allocating HF phenotypes based on LVEF can be misleading. HFpEF encompasses a broad spectrum of causes, and its diagnostic criteria give a central role to echocardiography, a first-line technique with inherent limitations related to ultrasound capabilities. Conversely, cardiac magnetic resonance provides superior anatomic and functional assessment, enabling tissue characterization, offering unprecedented diagnostic precision.


Assuntos
Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos
6.
Diabetes Res Clin Pract ; 176: 108851, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33957142

RESUMO

Patients with diabetes have an increased risk of developing heart failure and those with heart failure are at higher risk of developing diabetes. In patients with diabetes antidiabetic medications and the metabolic alterations of diabetes increase the risk of developing heart failure. In diabetic patients with heart failure and in those with an increased likelihood of developing the disease a stepwise approach based on the use of natriuretic peptides and echocardiography to rule out the presence of heart failure should be used. Once the diagnosis of heart failure is established it will be important to define the phenotype according to the left ventricular function and, where appropriate, use additional tests to identify possible additional underlying causes of heart failure like coronary artery disease. A multidisciplinary heart failure management programs is recommended in all patients with diabetes mellitus and heart failure to enable appropriate investigations, accurate diagnosis, and appropriate agreed evidence-based therapy and care plan. The implementation of a multidisciplinary heart failure management program requires a multidisciplinary team that will have to follow the patients throughout the whole heart failure trajectory and that should consider a holistic approach to the diabetic patient with heart failure rather than focussing merely on either heart failure or diabetes.


Assuntos
Algoritmos , Cardiologistas , Angiopatias Diabéticas/diagnóstico , Insuficiência Cardíaca/diagnóstico , Papel do Médico , Angiopatias Diabéticas/tratamento farmacológico , Angiopatias Diabéticas/fisiopatologia , Técnicas de Diagnóstico Cardiovascular , Técnicas de Diagnóstico Endócrino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipoglicemiantes/uso terapêutico , Equipe de Assistência ao Paciente , Prognóstico , Função Ventricular Esquerda/fisiologia
7.
Nutrients ; 13(4)2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33924572

RESUMO

Subclinical effects of coffee consumption (CC) with regard to metabolic, cardiac, and neurological complications were evaluated using a whole-body magnetic resonance imaging (MRI) protocol. A blended approach was used to estimate habitual CC in a population-based study cohort without a history of cardiovascular disease. Associations of CC with MRI markers of gray matter volume, white matter hyperintensities, cerebral microhemorrhages, total and visceral adipose tissue (VAT), hepatic proton density fat fraction, early/late diastolic filling rate, end-diastolic/-systolic and stroke volume, ejection fraction, peak ejection rate, and myocardial mass were evaluated by linear regression. In our analysis with 132 women and 168 men, CC was positively associated with MR-based cardiac function parameters including late diastolic filling rate, stroke volume (p < 0.01 each), and ejection fraction (p < 0.05) when adjusting for age, sex, smoking, hypertension, diabetes, Low-density lipoprotein (LDL), triglycerides, cholesterol, and alcohol consumption. CC was inversely associated with VAT independent of demographic variables and cardiovascular risk factors (p < 0.05), but this association did not remain significant after additional adjustment for alcohol consumption. CC was not significantly associated with potential neurodegeneration. We found a significant positive and independent association between CC and MRI-based systolic and diastolic cardiac function. CC was also inversely associated with VAT but not independent of alcohol consumption.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Ingestão de Líquidos/fisiologia , Doenças Neurodegenerativas/epidemiologia , Adiposidade/fisiologia , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Café , Feminino , Seguimentos , Alemanha/epidemiologia , Coração/diagnóstico por imagem , Coração/fisiologia , Fatores de Risco de Doenças Cardíacas , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/fisiologia , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/diagnóstico , Doenças Neurodegenerativas/fisiopatologia , Doenças Neurodegenerativas/prevenção & controle , Fatores de Proteção , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Imagem Corporal Total/métodos
8.
Metabolism ; 119: 154773, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33838144

RESUMO

AIMS: We explored the early effects of bariatric surgery on subclinical myocardial function in individuals with severe obesity and preserved left ventricular (LV) ejection fraction. METHODS: Thirty-eight patients with severe obesity [body mass index (BMI) ≥35 kg/m2] and preserved LV ejection fraction (≥50%) who underwent bariatric surgery (biliopancreatic diversion with duodenal switch [BPD-DS]) (Surgery group), 19 patients with severe obesity managed with usual care (Medical group), and 18 age and sex-matched non-obese controls (non-obese group) were included. Left ventricular global longitudinal strain (LV GLS) was evaluated with echocardiography speckle tracking imaging. Abnormal myocardial function was defined as LV GLS <18%. RESULTS: Age of the participants was 42 ±â€¯11 years with a BMI of 48 ±â€¯8 kg/m2 (mean ±â€¯standard deviation); 82% were female. The percentage of total weight loss at 6 months after bariatric surgery was 26.3 ±â€¯5.2%. Proportions of hypertension (61 vs. 30%, P = 0.0005), dyslipidemia (42 vs. 5%, P = 0.0001) and type 2 diabetes (40 vs. 13%, P = 0.002) were reduced postoperatively. Before surgery, patients with obesity displayed abnormal subclinical myocardial function vs. non-obese controls (LV GLS, 16.3 ±â€¯2.5 vs. 19.6 ±â€¯1.7%, P < 0.001). Six months after bariatric surgery, the subclinical myocardial function was comparable to non-obese (LV GLS, 18.2 ±â€¯1.9 vs. 19.6 ±â€¯1.7%, surgery vs. non-obese, P = NS). On the contrary, half of individuals with obesity managed medically worsened their myocardial function during the follow-up (P = 0.002). Improvement in subclinical myocardial function following bariatric surgery was associated with changes in abdominal visceral fat (r = 0.43, P < 0.05) and inflammatory markers (r = 0.45, P < 0.01), whereas no significant association was found with weight loss or change in insulin sensitivity (HOMA-IR) (P > 0.05). In a multivariate model, losing visceral fat mass was independently associated with improved subclinical myocardial function. CONCLUSIONS: Bariatric surgery was associated with significant improvement in the metabolic profile and in subclinical myocardial function. Early improvement in subclinical myocardial function following bariatric surgery was related to a greater mobilization of visceral fat depot, linked to global fat dysfunction and cardiometabolic morbidity.


Assuntos
Cirurgia Bariátrica , Mobilização Lipídica/fisiologia , Obesidade Mórbida/cirurgia , Função Ventricular Esquerda/fisiologia , Adulto , Doenças Assintomáticas , Estudos de Casos e Controles , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Gordura Intra-Abdominal/metabolismo , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/metabolismo , Obesidade Mórbida/fisiopatologia , Período Pós-Operatório , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
9.
Medicine (Baltimore) ; 100(15): e25050, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847613

RESUMO

ABSTRACT: Myocardial strain analysis by 2D speckle tracking echocardiography could determine the left ventricular function. Our purpose is to investigate the global longitudinal strain (GLS) changes during the course of fulminant myocarditis (FM) and evaluate their correlation with cardiac magnetic resonance (CMR).Patients with clinical diagnosis of FM from June 30, 2017 to June 30, 2019 were screened prospectively. 18 survived patients (mean age 34 ±â€Š18 years) who had two scans of transthoracic echocardiography and underwent CMR were included.All patients had severely impaired left ventricular ejection fraction and GLS value at admission that improved significantly before discharge. The patients in the healed stage revealed elevated global native T1 and T2 relaxation time and extracellular volume fraction as well, which were 1408.3 ±â€Š88.3ms, 46.56 ±â€Š5.23ms, and 0.35 ±â€Š0.09, respectively. GLS from the second transthoracic echocardiography in the healed stage correlated significantly with global native T1 relaxation time (r =-0.574, P = .013) and with extracellular volume fraction (r = -0.582, P = .011), but not global native T2 relaxation time (r = -0.31, P = .211) and not with late gadolinium enhancement mass (r = 0.084, P = .743). In comparison, GLS at admission were not correlated with CMR parameters of fibrosis and oedema in the healed stage.GLS by 2D-STE may emerge as a new tool to monitor inflammatory myocardial injuries during the course of FM. FM in the acute healed stage has the presence of both chronic fibrosis and oedema which are correlated with GLS, but GLS at admission can't predict the early recovery of myocardial inflammation.


Assuntos
Ecocardiografia/métodos , Miocardite/fisiopatologia , Adulto , Débito Cardíaco/fisiologia , Feminino , Gadolínio/farmacocinética , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Função Ventricular Esquerda/fisiologia
10.
Medicine (Baltimore) ; 100(14): e25370, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832121

RESUMO

RATIONALE: Dual atrioventricular node non-reentrant tachycardia (DAVNNRT) is a rare arrhythmia. We present a case of inappropriate implantable cardioverter defibrillator (ICD) therapy caused by DAVNNRT. DAVNNRT is easily misdiagnosed as atrial fibrillation and is often identified as ventricular tachycardia (VT) by the supraventricular tachycardia-ventricular tachycardia (SVT-VT) discriminator of the ICD. PATIENT CONCERNS: A 73-year-old man with ischemic heart disease (IHD) presented with palpitations accompanied by dyspnea and syncope. Frequent multifocal premature ventricular beats and non-sustained ventricular tachycardia were observed on ambulatory electrocardiography. The left ventricular ejection fraction decreased to 32%. DIAGNOSIS: He was diagnosed with IHD, heart failure with reduced ejection fraction (HFrEF), and VT. INTERVENTIONS: : Initially, the patient received a single-chamber ICD implantation for secondary prevention of sudden death. He then suffered from inappropriate anti-tachycardia pacing (ATP)/shock therapy many times after the procedure. DAVNNRT was confirmed in an electrophysiology study (EPS), and radiofrequency ablation of the slow pathway successfully terminated this tachycardia. OUTCOMES: No episode of inappropriate ICD therapy or tachycardia occurred during the follow-up. LESSONS: In conclusion, it is essential to have a full understanding of DAVNNRT and eliminate slow pathways for patients with DAVNNRT and be prepared to implant an ICD.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Insuficiência Cardíaca/diagnóstico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Idoso , Eletrofisiologia Cardíaca/métodos , Desfibriladores Implantáveis/efeitos adversos , Erros de Diagnóstico , Eletrocardiografia Ambulatorial/métodos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Isquemia Miocárdica/complicações , Ablação por Radiofrequência/métodos , Volume Sistólico/fisiologia , Taquicardia Supraventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
11.
Pan Afr Med J ; 38: 45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33854674

RESUMO

Introduction: our aim was to investigate the value of conventional echocardiography, pulsed Doppler and speckle tracking imaging (STI) analysis in the assessment of the left ventricular (LV) myocardial function in hemodialysis (HD) patients with preserved LV ejection fraction and to evaluate the effect of a single HD session on the LV systolic and diastolic functions. Methods: the study population consisted of 30 chronic HD patients. Echocardiography and Doppler studies were performed before and after HD. The LV global longitudinal, circumferential and radial strains were measured with two and three-dimensional STI. Results: after HD, LV dimensions, left atrium (LA) area, systolic pulmonary arterial pressure and inferior vena cava diameter decreased significantly. The peak mitral E velocity, the E/A ratio of the mitral inflow and the lateral E/E´ ratio decreased also significantly. The LV and LA volumes index and LV mass index (LVMi) decreased remarkably after HD. The 3D- LV and LA ejection fractions were unchanged after HD. Although, 3D-estimated LVEF seemed to be preserved in the HD patients, the 2D and 3D- strain rates were decreased in all directions. The global strain values improved in all directions after a single HD session. Inverse correlations were found between the LVMi, serum BNP and LV global longitudinal strain. Conclusion: in HD patients with preserved LV ejection fraction, the STI analysis may add important information concerning the subclinical LV dysfunction.


Assuntos
Ecocardiografia/métodos , Diálise Renal , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Adulto , Ecocardiografia Doppler , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/terapia , Volume Sistólico
12.
Medicine (Baltimore) ; 100(13): e25128, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787595

RESUMO

BACKGROUND AND OBJECTIVE: Systematically review the current published literature on the impact of exercise training (ET) in chronic heart failure (CHF) patients who were conducted cardiac resynchronization therapy (CRT). METHODS: PubMed, EMBASE, and the Cochrane Library of Controlled Trails databases were searched for trials comparing the additional effects of ET in CHF patients after CRT implantation with no exercise or usual care control up until 2020.03.07. We independently screened the literature, extracted data, employed the tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX) to evaluate study quality and risk of bias, and performed meta-analysis with Revman 5.3 software. RESULTS: Eight trials were identified for qualitative analysis and 7 randomized controlled trails (RCTs) included 235 participants (120 ET; 115 controls) for quantitative analysis. The results showed that the maximal workload (mean difference [MD] 26.32 W, 95% CI 19.41-33.23; P < .00001, I2 = 0%) and the exercise duration (MD 68.95 seconds, 95% CI 15.41-122.48; P = .01, I2 = 76%) had significant improvement in the ET group versus control. Subgroup analysis showed that compared with control, the change in peak oxygen uptake (VO2) (MD 3.05 ml/kg/minute, 95% CI 2.53-3.56; P < .00001, I2 = 0%), left ventricular ejection fraction (LVEF) (MD 4.97%, 95% CI 1.44-8.49; P = .006, I2 = 59%), and health related quality of life (HRQoL) (the change in Minnesota living with heart failure questionnaire [MLHFQ]: MD -19.96, 95% CI -21.57 to -18.34; P < .00001, I2 = 0%) were significantly improved in the light to moderate intensity training (non-HIT) group, while there seemed no statistical difference of above endpoints in the high intensity training (HIT) group. CONCLUSION: During the short term (up to 6 months), non-HIT could improve exercise capacity, cardiac function, and HRQoL in CHF patients with CRT. However, due to the small number of participants, a high-quality large-sample multicenter trial is demanded.


Assuntos
Reabilitação Cardíaca/métodos , Terapia de Ressincronização Cardíaca/métodos , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Insuficiência Cardíaca/reabilitação , Idoso , Doença Crônica , Tolerância ao Exercício , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Volume Sistólico/fisiologia , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
13.
Am J Cardiol ; 147: 101-108, 2021 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-33647268

RESUMO

Optimal patient selection for transcatheter mitral valve repair (TMVR) remains challenging. The aim of the study was to assess the impact of left and right ventricular stroke work index (LVSWi, RVSWi) on mortality in patients with chronic heart failure (CHF) undergoing TMVR. One hundred-forty patients (median age 74 ± 9.9 years, 67.9% male) with CHF who underwent successful TMVR were included. Primary end point was defined as all-cause mortality after 16 ± 9 months of follow-up. LVSWi was calculated as: Stroke volume index (SVi) * (mean arterial pressure - postcapillary wedge pressure) * 0.0136 = g/m-1/m2. RVSWi was calculated as: SVi * (mean pulmonary artery pressure - right atrial pressure) * 0.0136 = g/m-1/m2. Receiver operating characteristic (ROC) analysis determined an optimal threshold of 24.8 g/m-1/m2 for LVSWi (sensitivity 80.4%, specificity 40.2%, area under the curve (AUC) 0.71 [0.60 to 0.81]; p = 0.001) and 8.3 g/m-1/m2 for RVSWi (sensitivity 67.4%, specificity 57.0%, AUC 0.67 [0.56 to 0.78]; p = 0.006), respectively. Kaplan-Meier analysis showed significantly lower survival in patients with LVSWi ≤24.8 g/m-1/m2 (20.0% vs 39.4%; log-rank p = 0.038) and in patients with RVSWi ≤8.3 g/m-1/m2 (22.1% vs 43.7%; log-rank p = 0.026), respectively. LVSWi of ≤24.8 g/m-1/m2 and RVSWi of ≤8.3 g/m-1/m2 were independent predictors for all-cause mortality (hazard ratio (HR) 2.83; 95% confidence interval (CI) 1.1 to 7.6; p = 0.04; HR 2.52; 95% CI 1.04 to 6.1; p = 0.041). A risk-score incorporating LVSWi and RVSWi cut-off values from ROC analysis powerfully predicts long-term survival after successful TMVR (log-rank p = 0.02). In conclusion, LVSWi and RVSWi independently predict mortality in patients with CHF undergoing TMVR and might be useful in risk stratification of TMVR candidates.


Assuntos
Cateterismo Cardíaco , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral/cirurgia , Volume Sistólico/fisiologia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/fisiopatologia , Seleção de Pacientes , Valor Preditivo dos Testes , Curva ROC , Taxa de Sobrevida , Função Ventricular Esquerda/fisiologia , Função Ventricular Direita/fisiologia
14.
Int Heart J ; 62(2): 359-366, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33678800

RESUMO

Dilated cardiomyopathy (DCM) is a common cause of heart failure. TTN, which encodes titin protein, is a representative causative gene of DCM, and is presented mainly as a truncation variant. However, TTN truncation variants are also found in healthy individuals, and it is therefore important to evaluate the pathogenicity of each variant. In this study, we analyzed 67 cardiomyopathy-associated genes in a male Japanese patient who was hospitalized for recurrent severe heart failure and identified a novel truncation variant, TTN Ser17456Arg fs*14. This TTN truncation variant was located in the A-band region. Moreover, the patient's mother with heart failure harbored the same variant, whereas the father and brother without heart failure did not harbor the variant. To examine the functional changes associated with the truncation variant, H9c2 cells were subjected to genome editing to generate cells with a homologous truncation variant. The cells were differentiated using all-trans-retinoic acid, and the mRNA expression of skeletal actin and cardiac actin were found to be increased and decreased, respectively, consistent with known changes in patients with DCM or heart failure. In contrast, another cell with the titin truncation variant used as a control showed no changes in heart failure-related genes. In summary, we found a novel TTN truncation variant in familial DCM patients and confirmed its functional changes using a relatively simple cell model. The novel truncation variant was identified as a pathogenic and disease-causing mutation.


Assuntos
Cardiomiopatia Dilatada/genética , Conectina/genética , DNA/genética , Mutação , Miócitos Cardíacos/metabolismo , Função Ventricular Esquerda/fisiologia , Biópsia , Cardiomiopatia Dilatada/metabolismo , Cardiomiopatia Dilatada/patologia , Conectina/metabolismo , DNA/metabolismo , Análise Mutacional de DNA , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Miócitos Cardíacos/patologia , Linhagem
15.
Int Heart J ; 62(2): 427-431, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731522

RESUMO

In this study, we present a case of a 22-year-old female with a family history of syncope, suffering from recurrent syncope since childhood. She had an obvious prolonged QTc interval of up to 651 ms, a bifid T wave pattern on electrocardiogram, and torsade de pointes, corresponding to a syncope episode. Additionally, her echocardiogram showed left ventricular non-compaction in the apex. After treatment with mexiletine, the QTc interval has been observed to shorten immediately, and the T wave morphology recovered. A similar effect was also observed in her mother and young sister. Administration of propranolol prolonged her QTc interval. Target sequencing of candidate genes revealed a missense mutation in the pore area of the hERG protein, coded by KCNH2. We diagnosed this as a case of type 2 long QT syndrome in which mexiletine could be effective in shortening the QTc interval.


Assuntos
Eletrocardiografia/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Síndrome do QT Longo/tratamento farmacológico , Mexiletina/farmacologia , Taquicardia Ventricular/complicações , Função Ventricular Esquerda/fisiologia , Antiarrítmicos/farmacologia , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/genética , Linhagem , Taquicardia Ventricular/fisiopatologia , Adulto Jovem
16.
Heart Fail Clin ; 17(2): 245-254, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673948

RESUMO

The heart and the arterial system are anatomically and functionally linked together. Noninvasive assessment of ventricular-arterial coupling (VAC) can be done using different methods that are promising tools to assess individual hemodynamics and tailor treatment in patients with heart failure (HF). Moreover, different methods available can be appropriately used in different settings such as acute and chronic HF. VAC parameters also can add incremental value over the conventional risk factors in predicting cardiac outcome.


Assuntos
Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Medição de Risco/métodos , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Prognóstico
17.
Heart Fail Clin ; 17(2): 289-301, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33673953

RESUMO

Cardiac resynchronization therapy (CRT) is an established treatment of patients with medically refractory, mild-to-severe systolic heart failure (HF), impaired left ventricular function, and wide QRS complex. The pathologic activation sequence observed in patients with abnormal QRS duration and morphology results in a dyssynchronous ventricular activation and contraction leading to cardiac remodeling, worsening systolic and diastolic function, and progressive HF. In this article, the authors aim to explore the current CRT literature, focusing their attentions on the promising innovation in this field.


Assuntos
Terapia de Ressincronização Cardíaca/tendências , Insuficiência Cardíaca/terapia , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular/fisiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Resultado do Tratamento
18.
Heart Surg Forum ; 24(1): E038-E047, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33635267

RESUMO

BACKGROUND: One of the main sources of ischemia/reperfusion injury (IRI) and release of free oxygen radicals (FORs) during extracorporeal circulation (ECC) during cardiac surgery is neutrophils. In this study, we investigated the potential effects of our modification of del Nido cardioplegia (mDNC) (amino acids enriched del Nido cardioplegia) on myocardial polymorphonuclear leucocyte (PMNL) accumulation. We also compared the effects of our mDND and classical del Nido cardiplegia (cDNC) on ventricular contractile functions in coronary artery bypass grafting (CABG) surgery. PATIENTS AND METHODS: Our study included 100 isolated CABG patients with similar characteristics, including age, gender, preoperative medications, diabetes, hypertension, and left ventricular ejection fraction (LVEF). The patients were divided into two groups. Amino acids supplemented del Nido cardioplegia (L-aspartate and L-glutamate at a dose of 13 milimol/L) in 50 patients (study group, G1). In the remaining 50 patients, we used a classical del Nido cardioplegic solution (cDNC) (control group, G2). Myocardial Tru-Cut biopsy from the right ventricle was taken before the institution of ECC and after weaning from ECC in all patients. Cardiac troponine-I (cTn-I), tumor necrosis factor-alpha (TNF-Alpha), Pro-Brain Natriuretic Peptide (Pro-BNP), and lactate levels were measured pre- and postoperatively. Invasive monitoring was performed to provide the left ventricular functions in both groups in the operating room and noted by a blinded anaesthesiologist. RESULTS: Five patients died post-surgery (5%) (two from SG and three from CG (P = .67), due to low cardiac output syndrome or multiorgan failure. At the postoperative period, cardiac output (CO) and stroke volume index (SVI) was higher in mDNC (mean ± SDS; 32.1 ± 7 versus 22.2 ± 6.9 mL/min/m² (P < .001). CI was significantly higher in mDNC after surgery (3.10 ± 0.76 versus 2.40 ± 0.30L/min/m² (P = .002). Ten patients (20%) in mDNC and 16 patients (32%) in cDNC required inotropic support (P < .001). The postoperative inotropic requirement was less in mDNC (6.1 ± 1.8 mg/kg versus 9.2 ± 1.9 mg/kg, P < .004). Blood gas analyses from the coronary sinus showed that myocardial acidosis was more severe in the control group [pH (0.10 ± 0.09 versus 0.054 ± 0.001; P = .34)]. Blood lactate levels were significantly high in the control group (1.01 ± 0.007 mmol/L versus 1.92 ± 0.35 mmol/L) (P = .22). No difference was found when compared with cardioplegia volume in the mDNC and cDNC groups (mDNC= 990.00 ± 385 mL in DNC = 960 ± 240 mL, P = .070). An aortic cross-clamp time in the mDNC and cDNC groups were 88.4 ± 8.9 min, and 93 ± 11 min, (P = .76), but cardiopulmonary bypass time was significantly low in mDNC (mDNC = 98.3 ± 22.5 min, DNC = 126 ± 19.5 min, P = .0020). TNF-Alpha and Pro-BNP levels in patients received mDNC were significantly low (P = .022). Postoperative cardiac enzyme levels (creatine kinase-MB and high sensitive troponin-I) were significantly low in the mDNC group (P = .0034). Myocardial biopsy results showed that myocardial PMNL accumulation was significantly high in the control group (P = .001). The amount of inotropic agent use was significantly high in the control group (P = .003). After weaning from ECC, the left ventricular stroke work index (LVSWI), cardiac index (CI), and heart rate (HR) were significantly high in the study group (P = .032; P = .002; P = .01). Postoperative blood and blood products requirements were significantly low in the mDNC group (P = .002). At pre-discharge echocardiography, the mDNC group demonstrated significantly higher ventricular ejection fraction (37.9 ± 4.3% and 29.7 ± 3.8%, respectively (P = .003). CONCLUSION: Our study findings show that glutamate-aspartate supplemented del Nido cardioplegia significantly decrease myocardial PMNL accumulation with reduced release of biochemical markers, including cardiac troponin-I, TNF-alpha, and Pro-Bnp. Our study results demonstrated that amino acids supplementation in del Nido cardioplegia has some advantages in CABG patients, including the decrease of perioperative myocardial infarction and increase significantly the left ventricular functions including ventricular SVI and CI.


Assuntos
Aminoácidos/farmacologia , Soluções Cardioplégicas/farmacologia , Ponte de Artéria Coronária/métodos , Parada Cardíaca Induzida/métodos , Leucócitos/patologia , Miocárdio/patologia , Função Ventricular Esquerda/fisiologia , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos
19.
J Am Soc Echocardiogr ; 34(6): 642-652, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1071272

RESUMO

BACKGROUND: The aim of this study was to evaluate sonographic features that may aid in risk stratification and to propose a focused cardiac and lung ultrasound (LUS) algorithm in patients with coronavirus disease 2019. METHODS: Two hundred consecutive hospitalized patients with coronavirus disease 2019 underwent comprehensive clinical and echocardiographic examination, as well as LUS, irrespective of clinical indication, within 24 hours of admission as part of a prospective predefined protocol. Assessment included calculation of the modified early warning score (MEWS), left ventricular systolic and diastolic function, hemodynamic and right ventricular assessment, and a calculated LUS score. Outcome analysis was performed to identify echocardiographic and LUS predictors of mortality or the composite event of mortality or need for invasive mechanical ventilation and to assess their adjunctive value on top of clinical parameters and MEWS. RESULTS: A simplified echocardiographic risk score composed of left ventricular ejection fraction < 50% combined with tricuspid annular plane systolic excursion < 18 mm was associated with mortality (P = .0002) and with the composite event (P = .0001). Stepwise analyses evaluating echocardiographic and LUS parameters on top of existing clinical risk scores showed that addition of tricuspid annular plane systolic excursion and stroke volume index improved prediction of mortality when added to clinical variables but not when added to MEWS. Once echocardiography was added, and patients were recategorized as high risk only if having both high-risk MEWS and high-risk cardiac features, specificity increased from 63% to 87%, positive predictive value from 28% to 48%, and accuracy from 66% to 85%. Although LUS was not associated with incremental risk prediction for mortality above clinical and echocardiographic criteria, it improved prediction of need for invasive mechanical ventilation. CONCLUSIONS: In hospitalized patients with coronavirus disease 2019, a very limited echocardiographic examination is sufficient for outcome prediction. The addition of echocardiography in patients with high-risk MEWS decreases the rate of falsely identifying patients as high risk to die and may improve resource allocation in case of high patient load.


Assuntos
COVID-19/epidemiologia , Ventrículos do Coração/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Volume Sistólico/fisiologia , Ultrassonografia/métodos , Função Ventricular Esquerda/fisiologia , COVID-19/diagnóstico , Ecocardiografia/métodos , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , SARS-CoV-2 , Sístole
20.
Transplant Proc ; 53(3): 1014-1018, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33602526

RESUMO

BACKGROUND: End-stage renal disease is a major risk factor for cardiovascular disease. Kidney transplantation (KT) may lead to reversal of these cardiac changes. METHODS: Echocardiographic changes in cardiac structure and function were recorded in 30 patients with end-stage renal disease before KT, and 3 months and 6 months after KT. Patients with ischemic heart disease and valvular heart disease were not included. RESULTS: Thirty patients with a mean age of 34±12 years were studied, and 28 (93%) were male. Mean duration of hemodialysis (none on peritoneal dialysis) was 9.18±8.39 months. There was significant improvement in echocardiographic parameter of cardiac morphology and the cardiac systolic and diastolic functions after KT. CONCLUSIONS: This longitudinal prospective study found significant regression of left ventricular hypertrophy within 6 months after renal transplant. There was also an improvement in ventricular functions on echocardiography. The improvement in hemoglobin shows linear correlation with reduction in left ventricular dimension and improvement in left ventricular functions.


Assuntos
Hipertrofia Ventricular Esquerda/patologia , Transplante de Rim , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia , Adulto , Ecocardiografia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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