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1.
Medicine (Baltimore) ; 98(48): e17994, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770210

RESUMO

STUDY OBJECTIVE: Computed tomography (CT) is an important imaging modality in diagnosing a variety of disorders. Although systolic heart failure is a well-known risk factor for postcontrast acute kidney injury (PC-AKI), few studies have evaluated the association between diastolic dysfunction and PC-AKI. Therefore, the aim of our study was to investigate whether PC-AKI occurs more likely in patients with diastolic dysfuction. METHODS: This retrospective study was conducted by collecting the data of patients who visited an emergency medical center between January 2008 and December 2014. Patients who underwent contrast-enhanced CT (CECT) in the emergency department and had undergone echocardiography within 1 month of CECT were included. We defined PC-AKI as an elevation in the serum creatinine level of ≥0.5 mg/dL or ≥25% within 72 hours after CECT. RESULTS: We included 327 patients, aged 18 years and older, who had a CECT scan and underwent an echocardiography within 1 month of the CECT scan at our institute over 20 years. The mean value of estimated glomerular filtration rate and E/E (early left ventricular filling velocity to early diastolic mitral annular velocity ratio) was 51.55 ±â€Š7.66 mL·min·1.73 m and 11.56 ±â€Š5.33, respectively. A total of 32 patients (9.79%) developed PC-AKI. The prevalence of diabetes mellitus and chronic kidney disease was significantly higher in the PC-AKI group than in the non-PC-AKI group. Echocardiographic findings revealed that E/E was significantly increased in patients with PC-AKI. The logistic regression analysis showed that a higher E/E value (odds ratio [OR] 5.39, 95% confidence interval [CI] 1.51-25.23, P = .015) was a significant risk factor for PC-AKI. CONCLUSION: This study demonstrated that, among the echocardiographic variables, E/E was an independent predictor of PC- AKI. This, in turn, suggests that diastolic dysfunction may be a useful parameter in PC-AKI risk stratification.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Insuficiência Cardíaca Diastólica/complicações , Tomografia Computadorizada por Raios X/efeitos adversos , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca Diastólica/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
2.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(4 (Supl)): 393-399, out.-dez. 2019. tab
Artigo em Português | LILACS | ID: biblio-1047325

RESUMO

A testosterona, hormônio masculino com efeitos androgênicos e anabólicos, também exerce efeito sobre o leito vascular. Este hormônio promove vasodilatação através da liberação de óxido nítrico e modulação dos canais de cálcio que impacta a função endotelial. Em pacientes com doença arterial coronariana (DAC) e insuficiência cardíaca (IC), reduções nas concentrações de testosterona total (<300 ng/dL) estão relacionadas com maior mortalidade e severidade dessas doenças. Em pacientes com DAC, a reposição de testosterona (RT) tem relação com melhora do tônus vascular coronário e melhora do limiar de isquemia. Em pacientes com IC, os efeitos parecem estar mais relacionados à melhora da capacidade funcional, aumento na distância percorrida em testes funcionais, maior VO2máx, menor razão VE/VCO2, e melhora adicional da sensibilidade barorreflexa. No entanto, embora os efeitos da testosterona sobre o aumento de massa muscular e força muscular estejam bem estabelecidos na literatura, os efeitos dessa substância no sistema cardiovascular precisam ser elucidados. O aumento das concentrações de antígeno prostático específico da próstata tem sido constantemente discutido quando a RT é proposta no tratamento de pacientes com doenças cardiovasculares. Por se tratar de um hormônio com grande potencial anabólico, os efeitos do uso de quantidades suprafisiológicas de testosterona e seus análogos sobre as alterações cardiovasculares em jovens atletas têm sido estudados. Portanto, o objetivo dessa revisão é abordar os efeitos benéficos da RT em homens com hipogonadismo com DAC e IC, e mostrar os riscos relacionados com a prática indiscriminada do uso de anabolizantes em jovens sem deficiência de testosterona


Testosterone, the male hormone with androgenic and anabolic effects, also has an effect on the vascular bed. This hormone promotes vasodilation by releasing nitric oxide and calcium channel modulation that impacts endothelial function. In patients with coronary artery disease (CAD) and heart failure (HF), reductions in total testosterone concentrations (<300 ng/dL) are related to higher mortality and severity of these diseases. In patients with CAD, testosterone replacement (TR) is related to improved coronary vascular tone and improved ischemia threshold. In HF patients, the effects seem be more related to improved functional capacity, increased distance covered in functional tests, higher VO2max, lower LV/VCO2 ratio, and further improvement of baroreflex sensitivity. However, although the effects of testosterone on muscle mass gain and muscle strength are well established in the literature, the effects of testosterone on the cardiovascular system need to be elucidated. Increased prostate-specific prostate antigen concentrations have been constantly discussed when TR is proposed in the treatment of patients with cardiovascular disease. Because it is a hormone with great anabolic potential, the effects of supraphysiological amounts of testosterone and its analogues on cardiovascular disorders in young athletes have been studied. Therefore, the objective of this review is to address the beneficial effects of TR in men with hypogonadism with CAD and HF, and to show the risks related to anabolic steroids abuse in young people without testosterone deficiency


Assuntos
Testosterona , Doenças Cardiovasculares/terapia , Doença da Artéria Coronariana , Sistema Cardiovascular , Exercício , Vasos Coronários , Insuficiência Cardíaca Diastólica , Hormônios , Hipogonadismo
3.
Kardiologiia ; 59(8): 88-96, 2019 Aug 08.
Artigo em Russo | MEDLINE | ID: mdl-31397234

RESUMO

Chronic heart failure is the cause of hospitalization of every fifth cardiological patient. Number of patients with heart failure symptoms that have preserved or intermediate left ventricle ejection fraction increases, i.e. grows portion of diastolic heart failure grows. Gray scale myocardial strain techniques provide an opportunity to detect myocardial dysfunction on early stages when absence of clinically significant symptoms are absent and conventional echocardiography is not informative. The goal of this study is to review parameters of myocardial strain and its clinical applicability in patients with chronic heart failure.


Assuntos
Insuficiência Cardíaca Diastólica , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Doença Crônica , Ecocardiografia , Humanos , Volume Sistólico , Função Ventricular Esquerda
4.
Echocardiography ; 36(7): 1263-1272, Jul. 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1009243

RESUMO

BACKGROUND: A weak correlation has been reported between left ventricular filling pressures and the traditional echocardiographic tools for the evaluation of diastolic function in patients with coronary artery disease (CAD) and preserved left ventricular ejection fraction (LVEF). On the other hand, studies that compared invasive measurements with speckle tracking echocardiography have shown promising results, but they were not exclusively targeted on this specific population. METHODS AND RESULTS: Immediately before the left heart catheterization, a comprehensive two-dimensional Doppler echocardiography and speckle tracking analysis was prospectively performed in outpatients referred for coronary angiography. Left ventricular end-diastolic pressure (LVEDP) was measured before any contrast exposure. Eighty-one patients with coronary artery disease were studied, and the group with high LVEDP (n = 40) showed increased left atrial volume index (22 +/- 6 mL/m(2) vs 26 +/- 8.26 mL/m(2) , P = 0.04), E-wave velocity (65 +/- 15 cm/s vs 78 +/- 20 cm/s, P = 0.02), E/e` (average) ratio (8.14 +/- 2.0 vs 11.54 +/- 2.7, P = 0.03), and E/global circumferential strain rate E peak ratio (E/GCSRE ) (39 cm vs 46 cm, P < 0.01). There was a positive correlation between LVEDP and E/e` (rho = 0.56; P = 0.03), and between LVEDP and E/GCSRE ratio (rho = 0.43; P < 0.01). The area under the receiver operating characteristics (ROC) curve was 0.83 and 0.73, respectively (P < 0.05). E/e` and E/GCSRE were both independent predictors of elevated LVEDP (P < 0.05, with a higher C-statistic for the model including E/e` (0.89 vs 0.85). CONCLUSION: The E/e` ratio was able to identify elevated LVEDP in CAD patients with preserved LVEF with more accuracy than the E/GCSRE ratio.(AU)


Assuntos
Humanos , Ecocardiografia , Doença das Coronárias , Insuficiência Cardíaca Diastólica , Disfunção Ventricular Direita
7.
Dtsch Med Wochenschr ; 144(8): 561-567, 2019 04.
Artigo em Alemão | MEDLINE | ID: mdl-30822805

RESUMO

The term "ventricular-arterial coupling" (va-coupling) describes the close interaction of the left ventricle with the arterial system during systole. Increased arterial stiffness in conditions such as isolated systolic hypertension (ISH) or increases in pulse wave reflection may lead to disturbed va-coupling. Pathological pulse wave reflection is closely related to increased left ventricular late systolic load, diastolic dysfunction and, in the long-term, the risk of new-onset HFpEF. Non-invasive technologies for pulse wave analysis may identify patients at increased risk for the development of diastolic dysfunction or HFpEF. Women are approximately two times more likely than men to develop HFpEF which may be explained by sex differences in cardiovascular pathophysiology. Elderly women with ISH show sex-specific alterations of pulse wave reflection, LV remodelling and va-coupling which may increase the risk of HFpEF.


Assuntos
Insuficiência Cardíaca Diastólica/complicações , Insuficiência Cardíaca Sistólica/complicações , Hipertensão/complicações , Feminino , Humanos , Masculino , Fluxo Pulsátil , Análise de Onda de Pulso , Fatores de Risco
8.
Int J Mol Sci ; 20(4)2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30823517

RESUMO

BACKGROUND: Here we examined myocardial microRNA (miRNA) expression profile in a sensory neuropathy model with cardiac diastolic dysfunction and aimed to identify key mRNA molecular targets of the differentially expressed miRNAs that may contribute to cardiac dysfunction. METHODS: Male Wistar rats were treated with vehicle or capsaicin for 3 days to induce systemic sensory neuropathy. Seven days later, diastolic dysfunction was detected by echocardiography, and miRNAs were isolated from the whole ventricles. RESULTS: Out of 711 known miRNAs measured by miRNA microarray, the expression of 257 miRNAs was detected in the heart. As compared to vehicle-treated hearts, miR-344b, miR-466b, miR-98, let-7a, miR-1, miR-206, and miR-34b were downregulated, while miR-181a was upregulated as validated also by quantitative real time polymerase chain reaction (qRT-PCR). By an in silico network analysis, we identified common mRNA targets (insulin-like growth factor 1 (IGF-1), solute carrier family 2 facilitated glucose transporter member 12 (SLC2a-12), eukaryotic translation initiation factor 4e (EIF-4e), and Unc-51 like autophagy activating kinase 2 (ULK-2)) targeted by at least three altered miRNAs. Predicted upregulation of these mRNA targets were validated by qRT-PCR. CONCLUSION: This is the first demonstration that sensory neuropathy affects cardiac miRNA expression network targeting IGF-1, SLC2a-12, EIF-4e, and ULK-2, which may contribute to cardiac diastolic dysfunction. These results further support the need for unbiased omics approach followed by in silico prediction and validation of molecular targets to reveal novel pathomechanisms.


Assuntos
Insuficiência Cardíaca Diastólica/etiologia , MicroRNAs/genética , Polineuropatias/complicações , Animais , Capsaicina/toxicidade , Modelos Animais de Doenças , Fator de Iniciação 4E em Eucariotos/genética , Perfilação da Expressão Gênica , Redes Reguladoras de Genes , Proteínas Facilitadoras de Transporte de Glucose/genética , Insuficiência Cardíaca Diastólica/genética , Fator de Crescimento Insulin-Like I/genética , Masculino , Polineuropatias/induzido quimicamente , Proteínas Serina-Treonina Quinases/genética , Ratos , Ratos Wistar
9.
Molecules ; 24(3)2019 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-30736394

RESUMO

Background and Aims: Diabetic cardiomyopathy (DCM) is an emerging problem worldwide due to an increase in the incidence of type 2 diabetes. Animal studies have indicated that metformin and pioglitazone can prevent DCM partly by normalizing insulin resistance, and partly by other, pleiotropic mechanisms. One clinical study has evidenced the insulin-senzitizing effect of the drug candidate BGP-15, along with additional animal studies that have confirmed its beneficial effects in models of diabetes, muscular dystrophy and heart failure, with the drug affecting chaperones, contractile proteins and mitochondria. Our aim was to investigate whether the inzulin-senzitizer BGP-15 exert any additive cardiovascular effects compared to metformin or pioglitazone, using Goto-Kakizaki (GotoK) rats. Methods: Rats were divided into five groups: (I) healthy control (Wistar), (II) diseased (GotoK), and GotoK rats treated with: (III) BGP-15, (IV) metformin, and (V) pioglitazone, respectively, for 12 weeks. Metabolic parameters and insulin levels were determined at the endpoint. Doppler echocardiography was carried out to estimate diabetes-associated cardiac dysfunction. Thoracotomy was performed after the vascular status of rats was evaluated using an isolated aortic ring method. Furthermore, western blot assays were carried out to determine expression or phosphorylation levels of selected proteins that take part in myocyte relaxation. Results: BGP-15 restored diastolic parameters (e'/a', E/e', LAP, E and A wave) and improved Tei-index compared to untreated GotoK rats. Vascular status was unaffected by BGP-15. Expression of sarco/endoplasmic reticulum Ca2+-ATPase (SERCA2a) and phosphodiesterase 9A (PDE9A) were unchanged by the treatments, but the phosphorylation level of vasodilator-stimulated phosphoprotein (VASP) and phospholamban (PLB) increased in BGP-15-treated rats, in comparison to GotoK. Conclusions: Even though the BGP-15-treatment did not interfere significantly with glucose homeostasis and vascular status, it considerably enhanced diastolic function, by affecting the SERCA/phospholamban pathway in GotoK rats. Although it requires further investigation, BGP-15 may offer a new therapeutic approach in DCM.


Assuntos
Cardiomiopatias Diabéticas/fisiopatologia , Diástole/efeitos dos fármacos , Insuficiência Cardíaca Diastólica/etiologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Oximas/farmacologia , Piperidinas/farmacologia , Animais , Biomarcadores , Cardiomiopatias Diabéticas/diagnóstico , Cardiomiopatias Diabéticas/tratamento farmacológico , Modelos Animais de Doenças , Ecocardiografia/métodos , Insuficiência Cardíaca Diastólica/diagnóstico , Insuficiência Cardíaca Diastólica/tratamento farmacológico , Testes de Função Cardíaca , Hipoglicemiantes/farmacologia , Metformina/farmacologia , Ratos
10.
ESC Heart Fail ; 6(2): 262-270, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30784226

RESUMO

AIMS: Vitamin D deficiency is prevalent in heart failure (HF), but its relevance in early stages of heart failure with preserved ejection fraction (HFpEF) is unknown. We tested the association of 25-hydroxyvitamin D [25(OH)D] serum levels with mortality, hospitalizations, cardiovascular risk factors, and echocardiographic parameters in patients with asymptomatic diastolic dysfunction (DD) or newly diagnosed HFpEF. METHODS AND RESULTS: We measured 25(OH)D serum levels in outpatients with risk factors for DD or history of HF derived from the DIAST-CHF study. Participants were comprehensively phenotyped including physical examination, echocardiography, and 6 min walk test and were followed up to 5 years. Quality of life was evaluated by the Short Form 36 (SF-36) questionnaire. We included 787 patients with available 25(OH)D levels. Median 25(OH)D levels were 13.1 ng/mL, mean E/e' medial was 13.2, and mean left ventricular ejection fraction was 59.1%. Only 9% (n = 73) showed a left ventricular ejection fraction <50%. Fifteen per cent (n = 119) of the recruited participants had symptomatic HFpEF. At baseline, participants with 25(OH)D levels in the lowest tertile (≤10.9 ng/L; n = 263) were older, more often symptomatic (oedema and fatigue, all P ≤ 0.002) and had worse cardiac [higher N-terminal pro-brain natriuretic peptide (NT-proBNP) and left atrial volume index, both P ≤ 0.023], renal (lower glomerular filtration rate, P = 0.012), metabolic (higher uric acid levels, P < 0.001), and functional (reduced exercise capacity, 6 min walk distance, and SF-36 physical functioning score, all P < 0.001) parameters. Increased NT-proBNP, uric acid, and left atrial volume index and decreased SF-36 physical functioning scores were independently associated with lower 25(OH)D levels. There was a higher risk for lower 25(OH)D levels in association with HF, DD, and atrial fibrillation (all P ≤ 0.004), which remained significant after adjusting for age. Lower 25(OH)D levels (per 10 ng/mL decrease) tended to be associated with higher 5 year mortality, P = 0.05, hazard ratio (HR) 1.55 [1.00; 2.42]. Furthermore, lower 25(OH)D levels (per 10 ng/mL decrease) were related to an increased rate of cardiovascular hospitalizations, P = 0.023, HR = 1.74 [1.08; 2.80], and remained significant after adjusting for age, P = 0.046, HR = 1.63 [1.01; 2.64], baseline NT-proBNP, P = 0.048, HR = 1.62 [1.01; 2.61], and other selected baseline characteristics and co-morbidities, P = 0.043, HR = 3.60 [1.04; 12.43]. CONCLUSIONS: Lower 25(OH)D levels were associated with reduced functional capacity in patients with DD or HFpEF and were significantly predictive for an increased rate of cardiovascular hospitalizations, also after adjusting for age, NT-proBNP, and selected baseline characteristics and co-morbidities.


Assuntos
Insuficiência Cardíaca Diastólica/complicações , Qualidade de Vida , Volume Sistólico/fisiologia , Deficiência de Vitamina D/etiologia , Vitamina D/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Áustria/epidemiologia , Biomarcadores/sangue , Ecocardiografia , Feminino , Seguimentos , Alemanha/epidemiologia , Insuficiência Cardíaca Diastólica/diagnóstico , Insuficiência Cardíaca Diastólica/fisiopatologia , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Prevalência , Prognóstico , Estudos Prospectivos , Precursores de Proteínas , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Função Ventricular Esquerda , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia
11.
Gene ; 697: 11-18, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-30763670

RESUMO

OBJECTIVE: To explore the effect of adeno-associated virus 9-mediated RNA interference targeting SOCS3 (AAV9-SOCS3 siRNA) on the treatment of diastolic heart failure (DHF). METHOD: A rat DHF model was established, and cardiac function and hemodynamic changes were measured. HE, Sirius red and TUNEL staining were applied to observe the pathological changes in the myocardium. Immunoblotting and immunohistochemical staining were utilized to detect SOCS3 expression. The expression levels of various factors, including fibrosis-related factors (collagen I, collagen II, α-SMA and TGF-ß), inflammatory-related factors (IL-1ß, IL-6, TNF-α, p-p65 and ICAM-1) and factors related to the JAK/STAT signal pathway were analyzed by immunoblotting and/or qPCR. The serum levels of IL-1ß, IL-6, and TNF-α were measured using ELISA. RESULTS: SOCS3 expression was significantly downregulated in the DHF rat model by SOCS3 siRNA delivery. In the successfully established DHF rat model, cardiac function was clearly decreased, and cardiomyocyte apoptosis and myocardial fibrosis were significantly increased. These changes were ameliorated by treatment with AAV9-SOCS3 siRNA. The expression levels of p-JAK2 and p-STAT3 were significantly upregulated in the AAV9-SOCS3 siRNA group compared with the sham and AAV9-siRNA control groups, indicating that SOCS3 is a negative regulator of this signaling pathway. The expression levels of collagen I/III, α-SMA and TGF-ß were also decreased at both the mRNA and protein levels. In addition, the serum and myocardial tissue expression levels of inflammatory-related factors, such as IL-6, IL-1ß, and TNF-α, were also reduced by the administration of AAV9-SOCS3 siRNA compared with the AAV9-siRNA control. CONCLUSIONS: SOCS3 gene silencing by AAV9-SOCS3 siRNA administration in a DHF rat model significantly reduced myocardial fibrosis and the inflammatory response and improved heart function. Therefore, this treatment is a potential therapeutic method for treating DHF.


Assuntos
Insuficiência Cardíaca Diastólica/genética , Proteína 3 Supressora da Sinalização de Citocinas/genética , Proteína 3 Supressora da Sinalização de Citocinas/metabolismo , Actinas/metabolismo , Animais , Apoptose/fisiologia , Dependovirus/genética , Modelos Animais de Doenças , Inativação Gênica , Insuficiência Cardíaca Diastólica/metabolismo , Insuficiência Cardíaca Diastólica/patologia , Hemodinâmica , Interleucina-1beta/sangue , Interleucina-6/sangue , Janus Quinase 2/metabolismo , Masculino , Interferência de RNA , RNA Interferente Pequeno/genética , Ratos , Ratos Wistar , Fator de Transcrição STAT3/metabolismo , Transdução de Sinais , Fator de Necrose Tumoral alfa/sangue
12.
Proteomics Clin Appl ; 13(2): e1800174, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30632674

RESUMO

Diastolic heart failure (DHF) is characterized by slow left ventricular (LV) relaxation, increased LV stiffness, interstitial deposition of collagen, and a modified extracellular matrix proteins. Among Europeans, the frequency of asymptomatic diastolic LV dysfunction (DD) is 25%. This constitutes a large pool of people at high risk of DHF. The goal of this review was to describe the discovery and the initial validation of new multidimensional urinary peptidomic biomarkers (UPB) indicative of DD, mainly consisting of collagen fragments, and to describe a roadmap for their introduction into clinical practice. The availability of new drugs creates a window of opportunity for mounting a randomized clinical trial consolidating the clinical applicability of UPB to screen for DD. If successfully completed, such trial will benefit ≈25% of all people older than 50 years and open a large market for a UPB diagnostic tool and the drug tested. Moreover, sequenced peptides making up UPB will generate novel insights in the pathophysiology of DD and facilitate personalized treatment of patients with DHF for whom prevention came too late. If proven cost-effective, the clinical application of UPB will contribute to the sustainability of health care in aging population in epidemiologic transition.


Assuntos
Insuficiência Cardíaca Diastólica/prevenção & controle , Insuficiência Cardíaca Diastólica/terapia , Peptídeos/urina , Medicina de Precisão/métodos , Proteômica/métodos , Disfunção Ventricular Esquerda/urina , Biomarcadores/urina , Insuficiência Cardíaca Diastólica/fisiopatologia , Insuficiência Cardíaca Diastólica/urina , Humanos
13.
Heart Fail Clin ; 15(1): 55-64, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30449380

RESUMO

Atrial fibrillation often occurs as a cause or consequence of heart failure. Clinical outcomes are worse when atrial fibrillation and heart failure coexist. There are important sex-related differences in the incidence, prevalence, pathophysiology, treatment, and outcomes of these patients. Women with heart failure are at greater risk of developing atrial fibrillation than men, and more women with atrial fibrillation develop heart failure. More women die of atrial fibrillation-related strokes. Despite significant morbidity and mortality, current treatments for women are inadequate. This review explores sex differences in atrial fibrillation and heart failure, emphasizing risk stratification and treatments to improve clinical outcomes.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca Diastólica , Administração dos Cuidados ao Paciente/métodos , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Feminino , Insuficiência Cardíaca Diastólica/epidemiologia , Insuficiência Cardíaca Diastólica/etiologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Insuficiência Cardíaca Diastólica/terapia , Humanos , Masculino , Prevalência , Medição de Risco , Fatores Sexuais , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
14.
Int J Cardiol ; 274: 202-207, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30049496

RESUMO

AIMS: To study prevalence and prognostic importance of diagnostic echocardiographic variables in patients with suspected heart failure with preserved ejection fraction (HFpEF) in the prospective KaRen register study. METHODS AND RESULTS: KaRen patients were included following an acute HF-presentation, using Framingham criteria, B-type natriuretic peptide (BNP) >100 ng/L or N-terminal pro-BNP (NT-pro-BNP) >300 ng/L, and left ventricular (LV) ejection fraction ≥45%. Echocardiography was performed after 4-8 weeks and analyzed at a core laboratory. In this substudy HFpEF was diagnosed according to the ESC guidelines for heart failure 2016. A total of 539 patients were included with a follow-up after 4-8 weeks in 438 patients. Complete echocardiography and ECG were available in 356 patients. At least two abnormal echocardiographic criteria for HFpEF were found in 94% (n = 333). Echocardiographic signs of structural heart disease and diastolic dysfunction according to 4 criteria by ESC were found in 76% (n = 270). Diastolic dysfunction was graded as mild in 30% (n = 107), moderate in 27% (n = 97) or severe in 35% (n = 124). After multivariate analyses with adjustment for age, gender, EF and natriuretic peptides we found two independent predictors of worse prognosis: presence of moderate and severe diastolic dysfunction (HR 1.8, CI 1.2-2.7, p = 0.0037) and presence of a high number (≥4) of abnormal diastolic parameters (HR 2.0, CI 1.3-3.1, p = 0.0033). CONCLUSION: The majority of KaRen patients with suspected HFpEF had diagnostic echocardiographic criteria for HFpEF according to ESC Guidelines. Our findings support using 2016 ESC HF guidelines for risk prediction in HFpEF.


Assuntos
Cardiomiopatias/diagnóstico , Ecocardiografia Doppler/métodos , Insuficiência Cardíaca Diastólica/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Doença Aguda , Idoso , Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Europa (Continente) , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Insuficiência Cardíaca Diastólica/complicações , Insuficiência Cardíaca Diastólica/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Sistema de Registros , Sociedades Médicas , Fatores de Tempo
15.
Clin Res Cardiol ; 108(3): 225-233, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30091084

RESUMO

The prevalence of subclinical hypothyroidism (SCH) ranges from 5 to 15% of the general population. However, it remains controversial if SCH warrants life-long thyroxine replacement therapy. Patients with a thyroid-stimulating hormone (TSH) level > 10 mIU/L have a higher risk of developing heart failure with reduced ejection fraction as compared to subjects with normal thyroid function. However, abnormally high TSH levels could also be connected with an overall lower metabolic rate and better survival in elderly subjects. The potential mechanisms responsible for diastolic dysfunction of the left ventricle (LV) in SCH are connected with endothelial dysfunction and arterial stiffness, inflammatory state and are driven by TSH apoptosis-derived microparticles. The impact of SCH on LV systolic function is more controversial, and it is connected not only with cardiac remodelling but also with predisposition of patients with SCH to the conditions leading to heart failure. This review presents an overview of processes in the context of potential benefits of thyroxine supplementation therapy.


Assuntos
Insuficiência Cardíaca Diastólica/etiologia , Ventrículos do Coração/fisiopatologia , Hipotireoidismo , Tiroxina/sangue , Função Ventricular Esquerda/fisiologia , Progressão da Doença , Saúde Global , Insuficiência Cardíaca Diastólica/epidemiologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Hipotireoidismo/epidemiologia , Incidência , Fatores de Risco , Volume Sistólico
16.
Turk Kardiyol Dern Ars ; 46(8): 651-658, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30516522

RESUMO

OBJECTIVE: Body mass index (BMI) and waist circumference (WC) as measures of obesity have some limitations. The aim of this study was to evaluate whether one measure could predict the presence of diastolic dysfunction (DD) more accurately than the other measures. METHODS: A total of 91 obese patients without any other risk factors for DD were prospectively enrolled. Echocardiographic examination was performed. DD was defined and categorized according to recent guidelines. The study participants were divided into 2 groups according to the presence of DD. Weight, height, and WC were measured; BMI and waist-to-hip ratio (WHR) were calculated; and a body shape index (ABSI) was calculated as WC/(BMI2/3height1/2). The associations between ABSI, BMI, WHR, and WC and the presence of DD were examined using logistic regression analyses. Analysis of covariance was used to examine the differences. RESULTS: WC and BMI were significantly greater in subjects with DD (p=0.049 and 0.051, respectively). A greater BMI, WC, and WHR increased the risk of the presence of DD (BMIDD: odds ratio [OR]=1.096, p=0.024; WC-DD: OR=1.059, p=0.007; WHR-DD: OR=2.363, p=0.007). After adjustment for age and sex, only BMI continued to be significantly associated with DD (p=0.031). ABSI was not associated with DD. CONCLUSION: After adjustment for age and sex, BMI was the only predictor of DD in obesity. Despite its limitations, BMI may still be a potentially more accurate measure of DD compared with other obesity measures.


Assuntos
Insuficiência Cardíaca Diastólica , Obesidade , Adulto , Índice de Massa Corporal , Feminino , Insuficiência Cardíaca Diastólica/complicações , Insuficiência Cardíaca Diastólica/epidemiologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/fisiopatologia , Estudos Prospectivos , Relação Cintura-Quadril
17.
Hipertens. riesgo vasc ; 35(4): 160-168, oct.-dic. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-180575

RESUMO

Introduction: The progression of hypertensive heart disease leads to the left ventricular diastolic dysfunction (LVDD), which is associated with increased cardiovascular morbidity and mortality. The purpose of this analysis is to explore the determinants for LVDD in patients with hypertension. Methods: This is a secondary analysis of data of Impedance Cardiography in the Evaluation of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension (IMPEDDANS) Study. Mann-Whitney and Chi-square tests were used for univariable analysis. Multiple logistic regression was used to model for LVDD occurrence and discriminative capacity of the model assessed by the value of the area under the curve given by the receiver-operating characteristic curve. Results: Older age (65 vs. 58 years, p < 0.001), longer duration of hypertension (160 vs. 48 months, p < 0.001), uncontrolled hypertension (59.8 vs. 15.9%, p < 0.001), tobacco smoking (17.8 vs. 3.8%, p = 0.016), higher systolic blood pressure (133 vs. 124 mmHg, p = 0.001) and slower heart rate (62 vs. 66 bpm, p = 0.023) were associated with LVDD. Multivariate model identified uncontrolled hypertension (AdjOR 36.90; 95% CI 7.94-171.58; p < 0.001), smoking (AdjOR 6.66; 95% CI 1.63-27.26; p = 0.008), eccentric hypertrophy (AdjOR 3.59; 95% CI 0.89-14.39; p = 0.072), duration of hypertension (AdjOR 1.03; 95% CI 1.02-1.05; p < 0.001) and concentric remodeling (AdjOR 0.19; 95% CI 0.04-0.93; p = 0.041) as the more determinant for occurrence of LVDD. The discriminative capacity of the model was AUC = 0.95 (95% CI 0.91-0.98). Conclusion: The occurrence of LVDD in hypertensive patients was strongly associated to long-lasting, uncontrolled hypertension, tobacco smoking, concentric remodeling and eccentric hypertrophy


Introducción: La progresión de la enfermedad cardiaca hipertensiva produce disfunción diastólica del ventrículo izquierdo (DDVI) y aumento de morbilidad y mortalidad. El objetivo de este estudio es evaluar los factores que se asocian a la DDVI en pacientes con hipertensión arterial. Métodos: Se trata de un análisis secundario del estudio IMPEDDANS. Se utilizaron las pruebas de la U de Mann-Whitney y la Chi-cuadrado para el análisis univariado, y posteriormente se realizó un análisis de regresión logística multivariado. La capacidad discriminativa del modelo fue evaluada por el valor del área bajo la curva (ABC) dada por la curva característica de funcionamiento del receptor. Resultados: Los pacientes con DDVI eran mayores (65 vs. 58 años; p < 0,001), tenían historia previa de hipertensión arterial más larga (160 vs. 48 meses; p < 0,001), presentaban frecuentemente hipertensión arterial no controlada (59,8 vs. 15,9%; p < 0,001), fumaban más (17,8 vs 3,8%; p = 0,016), presentaban presión arterial sistólica más alta (133 vs. 124 mmHg; p = 0,001) y frecuencia cardiaca más lenta (62 vs. 66 pm; p = 0,023). En el modelo multivariado se objetivó hipertensión no controlada (OR 36,90; IC 95% 7,94-171,58; p < 0,001), hábito tabáquico (OR 6,66; IC 95% 1,63-27,26; p = 0,008), hipertrofia excéntrica (OR 3,59; IC 95% 0,89-14,39; p = 0,072), la duración de la hipertensión (OR 1,03; IC 95% 1,02-1,05; p < 0,001) y remodelado concéntrico (OR 0,19; IC 95% 0,04-0,93; p = 0,041) eran factores asociados a la DDVI. La capacidad discriminativa del modelo se correspondió con un ABC = 0,95 (IC 95% 0,91-0,98). Conclusión: El desarrollo de la DDVI en pacientes con hipertensión arterial se asoció a la duración de la hipertensión, la hipertensión no controlada, el hábito tabáquico, el remodelado concéntrico y la hipertrofia excéntrica


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Insuficiência Cardíaca Diastólica/complicações , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Fatores de Risco , Indicadores de Morbimortalidade , Estatísticas não Paramétricas , Frequência Cardíaca
18.
BMC Med Imaging ; 18(1): 47, 2018 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-30477437

RESUMO

BACKGROUND: Spontaneous T2DM in rhesus monkeys manifests as isolated diastolic dysfunction in the early stage of diabetic cardiomyopathy, similar to humans. Myocardial deformation measurements have emerged as a superior way to measure left ventricular (LV) function in the early stage of cardiac dysfunction, making it possible to further evaluate early-stage LV dysfunction in spontaneous T2DM rhesus monkeys. METHODS: Spontaneous T2DM rhesus monkeys with isolated diastolic dysfunction (T2DM-DD, n = 10) and corresponding nondiabetic healthy animals (ND, n = 9) were prospectively scanned for a CMR study. Circumferential and longitudinal peak systolic strain (Ecc, Ell), time to peak strain (tEcc, tEll) and peak diastolic strain rate (CSR, LSR) obtained from 2D/3D CMR-TT were compared with those obtained from CMR tagging separately. In addition, all CMR imaging protocols were performed twice in 9 ND animals to assess test-retest reproducibility. RESULTS: Compared with the ND group, the T2DM-DD monkeys demonstrated significantly impaired LV Ecc (- 10.63 ± 3.23 vs - 14.18 ± 3.19, p < 0.05), CSR (65.50 ± 14.48 vs 65.50 ± 14.48, p < 0.01), Ell (- 9.11 ± 2.59 vs - 14.17 ± 1.68, p < 0.05), and LSR (59.43 ± 19.17 vs 108.46 ± 22.33, p < 0.01) with the tagging. Only Ecc (- 13.10 ± 2.47 vs - 19.03 ± 3.69, p < 0.01) and CSR (148.90 ± 31.27 vs 202.00 ± 51.88, p < 0.01) were significantly reduced with 2D CMR-TT, and only Ecc (- 13.77 ± 1.98 vs - 17.26 ± 3.78, p < 0.05) was significantly reduced with 3D CMR-TT. Moreover, 2D/3D CMR-TT-derived Ecc and CSR correlated with the corresponding tagging values collectively, with a statistically significant ICC value (p < 0.05). Test-retest repeatability analysis showed that most tagging-derived biomarkers had acceptable repeatability (p < 0.01). In addition, 2D CMR-TT-derived indicators were poorer than those derived from the tagging method but better than those obtained using the 3D method, with larger ICCs except for tEcc (p < 0.05). CONCLUSIONS: LV systolic and diastolic deformations were impaired in spontaneous T2DM rhesus monkeys previously diagnosed with isolated diastolic dysfunction by echocardiography. The 2D CMR-TT-derived Ecc and CSR were effective in the evaluation of the myocardial systolic and diastolic functions of early-diabetic cardiomyopathy, with relatively higher test-retest reproducibility and acceptable correlation with the tagging method compared with the 3D CMR-TT method.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Insuficiência Cardíaca Diastólica/diagnóstico por imagem , Insuficiência Cardíaca Diastólica/fisiopatologia , Imagem Cinética por Ressonância Magnética/métodos , Animais , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/fisiopatologia , Modelos Animais de Doenças , Humanos , Macaca mulatta , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
19.
Rev. esp. cardiol. (Ed. impr.) ; 71(11): 926-934, nov. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-178947

RESUMO

Introducción y objetivos: La hipertensión causa cambios subclínicos en la estructura y la función del ventrículo izquierdo, es decir, disfunción diastólica. La disfunción diastólica es un predictor de insuficiencia cardiaca, pues participa en la asociación entre hipertensión e insuficiencia cardiaca con fracción de eyección conservada. El objetivo es evaluar en una gran cohorte poblacional de adultos asintomáticos si los pacientes con prehipertensión tienen cambios precoces en la función diastólica. Métodos: Se evaluó de manera transversal una cohorte poblacional consistente en 925 adultos de 45 años o más sin enfermedad cardiovascular conocida. Todos los participantes se sometieron a un examen clínico y ecocardiográfico detallado. Se clasificó a los participantes, según las guías europeas para la clasificación de la presión arterial (PA) en la consulta, como óptima, prehipertensión (normal y normal-alta) e hipertensión. La función diastólica se evaluó mediante ecocardiografía usando las velocidades de e' y la razón E/e'. La disfunción diastólica se definió utilizando las recomendaciones conjuntas de ASE/EACVI de 2016 y un algoritmo de orientación clínica de 2017. Resultados: En esta cohorte (61,5 ± 10,5 años; el 37% varones), tenía prehipertensión el 30,4% e hipertensión el 51,0%. Se utilizó la PA óptima como referencia, y se observó una disminución progresiva de la velocidad e' en los individuos prehipertensos e hipertensos (12,2 ± 3,5 frente a 11,3 ± 3,1 frente a 9,6 ± 2,9 cm/s respectivamente; p de tendencia < 0,001). Después del ajuste multivariable, ambas categorías de PA fueron predictoras independientes de una menor velocidad e' (prehipertensión, ß = -0,56; p = 0,035; hipertensión, ß = -1,08; p < 0,001). Conclusiones: En esta cohorte poblacional, los adultos con prehipertensión mostraron una relajación cardiaca alterada antes del inicio de la hipertensión


Introduction and objectives: Hypertension causes subclinical changes in left ventricular structure and function, namely diastolic dysfunction. Diastolic dysfunction is a predictor of heart failure, being involved in the association between hypertension and heart failure with preserved ejection fraction. We aimed to determine whether patients with prehypertension have early changes in diastolic function in a large community-based cohort of asymptomatic adults. Methods: A cross-sectional evaluation was performed of a community-based cohort consisting of 925 adults, aged 45 years or older, without known cardiovascular disease. All participants underwent detailed clinical and echocardiographic examination. The participants were categorized according to the European guidelines for the classification of office blood pressure (BP) levels as optimal, prehypertensive (normal and high-normal categories), and hypertensive. Diastolic function was evaluated by echocardiography using e' velocities and E/e' ratio. Diastolic dysfunction was defined using the 2016 ASE/EACVI Joint Recommendations and a 2017 clinically-oriented algorithm. Results: In this cohort (61.5 ± 10.5 years; 37% men), prehypertension was present in 30.4% and hypertension in 51.0%. Using optimal BP as the reference, there was a progressive decrease of e' velocity in prehypertensive and hypertensive individuals (12.2 ± 3.5 vs 11.3 ± 3.1 vs 9.6 ± 2.9 cm/s, respectively; P for trend < .001). After multivariable adjustment, both BP categories were independent predictors of a lower e' velocity (ß = -0.56, P = .035 for prehypertension and ß = -1.08, P < .001 for hypertension). Conclusions: In this large community-based cohort, adults with prehypertension already showed impaired cardiac relaxation before the onset of hypertension


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diástole/fisiologia , Pré-Hipertensão/fisiopatologia , Hipertensão/fisiopatologia , Insuficiência Cardíaca Diastólica/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Estudos Transversais , Pressão Arterial/fisiologia , Pressão Sanguínea/fisiologia , Pulso Arterial , Progressão da Doença
20.
Rev. esp. cardiol. (Ed. impr.) ; 71(11): 935-940, nov. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-178948

RESUMO

En el presente documento se sintetizan el concepto de ecocardioscopia, los aspectos técnicos fundamentales relacionados con esta técnica y sus objetivos diagnósticos. Además, se define cómo deben ser la formación y la capacitación en ecocardioscopia. Todo ello, avalado por la Sociedad Española de Medicina Interna (SEMI), la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), la Sociedad Española de Neurología (SEN) y la Sociedad Española de Cardiología (SEC)


This document summarizes the concept of focused cardiac ultrasound, the basic technical aspects related to this technique, and its diagnostic objectives. It also defines training requisites in focused cardiac ultrasound. This consensus document has been endorsed by the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of Neurology (SEN), and the Spanish Society of Cardiology (SEC)


Assuntos
Humanos , Endossonografia/métodos , Ecocardiografia/métodos , Cardiopatias/diagnóstico por imagem , Insuficiência Cardíaca Diastólica/diagnóstico por imagem , Capacitação Profissional , Diagnóstico Diferencial , Disfunção Ventricular Esquerda/diagnóstico por imagem
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