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1.
Mymensingh Med J ; 29(1): 1-4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915328

RESUMO

This cross sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College in collaboration with the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from January 2018 to December 2018. The aim of the study was to explore the relationship of serum NT-pro BNP in heart failure (HF) patients as a means to monitor the possibility of management of these patients. A total of 120 subjects were included in this study. Among them 60 were diagnosed HF patients denoted as case group and 60 were normal healthy individuals denoted as control group. Serum NT-pro BNP concentration was measured by Fluorescence Immunoassay (FIA) from each sample. Statistical analysis was performed by SPSS windows package, version 21. Among the study group the mean serum NT-pro BNP levels were 4931.93±7229.36 and 999.47±49.99 pg/ml in case and control group respectively. Analysis showed that the mean serum NT-pro BNP level was highly significant (p<0.001) increased in heart failure patients comparison to that of control group.


Assuntos
Insuficiência Cardíaca/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Bangladesh , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos Transversais , Insuficiência Cardíaca/sangue , Humanos
3.
Heart Fail Clin ; 16(1): 1-9, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735307

RESUMO

The effects of hyperthyroidism and hypothyroidism on the heart and cardiovascular system are well documented. It has also been shown that various forms of heart disease including but not limited to congenital, hypertensive, ischemic, cardiac surgery, and heart transplantation cause an alteration in thyroid function tests including a decrease in serum liothyronine (T3). This article discusses the basic science and clinical data that support the hypothesis that these changes pose pathophysiologic and potential novel therapeutic challenges.


Assuntos
Insuficiência Cardíaca/complicações , Doenças da Glândula Tireoide/etiologia , Hormônios Tireóideos/sangue , Biomarcadores/sangue , Ecocardiografia , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Lipoproteínas/sangue , Índice de Gravidade de Doença , Doenças da Glândula Tireoide/sangue
4.
Vasc Health Risk Manag ; 15: 533-538, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31824165

RESUMO

Purpose: Real-world data may provide insight into relationships between high triglycerides (TG), a modifiable cardiovascular (CV) risk factor, and increased heart failure (HF) risk. Patients and methods: This retrospective administrative claims analysis included statin-treated patients aged ≥45 years with diabetes and/or atherosclerotic CV disease enrolled in 2010 and followed for ≥6 months to March 2016. Patients with TG ≥150 mg/dL and a comparator cohort with TG <150 mg/dL and high-density lipoprotein cholesterol >40 mg/dL were included. A sub-analysis was conducted in patients with TG 200-499 mg/dL. Hazard ratios (HR) were calculated from multivariate analyses controlled for patient characteristics and comorbidities using Cox proportional hazard modeling. New diagnosis of HF required diagnosis in the follow-up period without prior evidence of HF. Results: Multivariate analyses revealed a 19% higher rate of new HF diagnosis in the TG ≥150 mg/dL cohort (HR=1.192; 95% confidence interval [CI]=1.134-1.252; P<0.001; n=24,043) and a 24% higher rate in the TG 200-499 mg/dL sub-cohort (HR=1.235; 95% CI=1.160-1.315; P<0.001; n=11,657), each versus the comparator cohort (n=30,218). Conclusion: In a real-world analysis of statin-treated patients with high CV risk, elevated and high TG were significant predictors of new HF diagnosis.


Assuntos
Dislipidemias/diagnóstico , Insuficiência Cardíaca/diagnóstico , Triglicerídeos/sangue , Demandas Administrativas em Assistência à Saúde , Idoso , Biomarcadores/sangue , Bases de Dados Factuais , Dislipidemias/sangue , Dislipidemias/tratamento farmacológico , Dislipidemias/epidemiologia , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Regulação para Cima
5.
Artigo em Inglês | MEDLINE | ID: mdl-31875779

RESUMO

BACKGROUND: Heart Failure (HF) is accompanied by a high cost of care and gloomy prognosis despite recent advances in its management. Therefore, efforts to minimize HF rehospitalizations is a major focus of several studies. METHODS: We conducted a retrospective cohort study of 140 patients 18 years and above who had baseline clinical parameters, echocardiography, NT-ProBNP, troponin I and other laboratory parameters following a 3-year electronic medical record review. Patients with coronary artery disease, preserved ejection fraction, pulmonary embolism, cancer, and end-stage renal disease were excluded. RESULTS: Of the 140 patients admitted with HF with reduced Ejection Fraction (HFrEF) secondary to non-ischemic cardiomyopathy, 15 were re-hospitalized within 30 days of discharge while 42 were rehospitalized within 6 months after discharge for decompensated HF. Receiver operating characteristic (ROC) cutoff points were obtained for NT-ProBNP at 5178 pg/ml and serum troponin I at 0.045 ng/ml. After Cox regression analysis, patients with HFrEF who had higher hemoglobin levels had reduced odds of re-hospitalization (p = 0.007) within 30 days after discharge. NT-ProBNP and troponin I were independent predictors of re-hospitalization at 6 months after discharge (p = 0.047 and p = 0.02), respectively, after Cox regression analysis. CONCLUSION: Troponin I and NT-ProBNP at admission are the best predictors of re-hospitalization 6 months after discharge among patients with HFrEF. Hemoglobin is the only predictor of 30 -day rehospitalization among HFrEF patients in this study. High-risk patients may require aggressive therapy to improve outcomes.


Assuntos
Cardiomiopatias/complicações , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina I/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Volume Sistólico
6.
Braz J Med Biol Res ; 52(12): e8658, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778438

RESUMO

Acute coronary syndromes are associated with a high prevalence of complications including heart failure (HF). The aim of this study was to investigate the association of novel biomarkers with the occurrence of post-acute myocardial infarction (AMI) HF. A prospective study was conducted with patients admitted to the emergency department with ST-segment elevation myocardial infarction (STEMI). Blood and urine samples were collected for analysis of traditional and novel biomarkers, including interleukin-6, vascular cell adhesion molecule 1 (VCAM-1), and intercellular adhesion molecule-1 (ICAM-1). We compared the levels of these biomarkers between patients with and without post-STEMI HF. A total of 48 patients were assessed, with a prevalence of males. Fifteen patients (31.2%) had post-STEMI HF. Patients with HF had higher mean values of IL-6, VCAM-1, and ICAM-1 compared to those who did not develop HF (57.06 vs 14.03 pg/mL, P=0.001; 1719.58 vs 1304.34 ng/mL, P=0.001; and 1594.20 vs 1158.74 ng/mL, P<0.001, respectively). The three biomarkers were shown to be good predictors of post-STEMI HF (IL-6: AUC 0.786, P=0.002; VCAM-1: AUC 0.797, P=0.001; and ICAM-1: AUC 0.825, P<0.0001), with the respective cutoff points being calculated based on the best sensitivity and specificity indexes (IL-6: 8.67 pg/mL; VCAM-1: 1501.42 ng/mL; and ICAM-1: 1262.38 ng/mL). Of the three biomarkers, only VCAM-1 and ICAM-1 had a direct linear association between them (r=0.470, P<0.0001). IL-6, VCAM-1, and ICAM-1 were associated with the development of new post-AMI HF symptoms, but only VCAM-1 and ICAM-1 correlated with each other, possibly because they have the same pathophysiological mechanism of action.


Assuntos
Insuficiência Cardíaca/sangue , Molécula 1 de Adesão Intercelular/sangue , Interleucina-6/sangue , Infarto do Miocárdio/sangue , Molécula 1 de Adesão de Célula Vascular/sangue , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade
7.
J Vet Cardiol ; 25: 41-51, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31568985

RESUMO

OBJECTIVES: Growth differentiation factor (GDF) 11 has been shown to reduce cardiac hypertrophy in mice. Low levels of GDF-11 are associated with cardiac hypertrophy in humans. The authors hypothesized that plasma GDF-11 level is decreased in cats with hypertrophic cardiomyopathy (HCM). Given the close homology between GDF-11 and myostatin/GDF-8, GDF-8 levels were also assessed. ANIMALS: Thirty-seven client-owned cats were enrolled, including cats with normal cardiac structure (n = 16), cats with HCM or hypertrophic obstructive cardiomyopathy (HOCM; n = 14), and cats with HCM and congestive heart failure (CHF; n = 7). METHODS: Plasma samples were analyzed for GDF-8 and GDF-11 using liquid chromatography tandem-mass spectrometry. Levels of GDF-8 and GDF-11 were compared between cats with normal cardiac structure, HCM or HOCM, and CHF. RESULTS: No differences in GDF-11 concentrations were found between cats with normal cardiac structure and cats with HCM/HOCM, with or without history of CHF. Decreased GDF-8 concentrations were detected in cats with CHF compared to cats with HCM/HOCM without history of CHF (p=0.031) and cats with normal cardiac structure (p=0.027). Growth differentiation factor 8 was higher in cats with HOCM compared to those with CHF (p=0.002). No statistical difference was noted in GDF-8 level as a function of age, weight, or body condition score. CONCLUSIONS: Plasma GDF-11 was not different between cats with HCM/HOCM and cats with normal cardiac structure regardless of age. Plasma GDF-8 was decreased in cats with CHF compared to cats with normal cardiac structure and cats with asymptomatic HCM/HOCM, suggesting a possible role in CHF development.


Assuntos
Cardiomiopatia Hipertrófica/veterinária , Doenças do Gato/sangue , Fatores de Diferenciação de Crescimento/sangue , Insuficiência Cardíaca/veterinária , Miostatina/sangue , Animais , Cardiomiopatia Hipertrófica/sangue , Cardiomiopatia Hipertrófica/complicações , Gatos , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Masculino
8.
Medicine (Baltimore) ; 98(38): e17069, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567942

RESUMO

Although serum magnesium (Mg) levels are closely associated with the prognosis of heart failure (HF) patients, the clinical significance of sMg levels on the cardiovascular outcomes of HF with preserved ejection fraction (HFpEF) patients is not fully understood. This study was a retrospective, single-center, observational study. We enrolled 452 consecutive HFpEF patients admitted to Kumamoto University Hospital. We defined lower sMg as <2.0 mg/dl (=0.8 mmol/L) based on recent clinical evidence and compared their clinical characteristics and prognosis. There were no significant differences between groups in the use of all medications (loop diuretics, mineralocorticoid receptor antagonists, renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, beta blockers, statins, and Mg preparations). The lower sMg group showed a significantly higher prevalence of diabetes mellitus (DM), uric acid levels, and BNP levels compared with the higher sMg group. Kaplan-Meier curve revealed a significantly higher probability of HF-related events in the lower sMg group compared with the higher sMg group (log-rank test, P = .012). Multivariate Cox-proportional-hazard analysis revealed that the lower sMg group had significantly and independently higher probabilities of HF-related events compared with the higher sMg group (hazard ratio = 2.37, 95% confidence intervals = 1.27-4.41, P = .007). We reclassified the risk of HF-related events after adding the lower sMg to the other prognostic factors (age, previous hospitalization for HF, DM, Ln-BNP); the continuous net reclassification improvement was 29.0% (P = .041). sMg levels might provide important prognostic information in regard to HFpEF.


Assuntos
Insuficiência Cardíaca/mortalidade , Magnésio/sangue , Volume Sistólico , Idoso , Ecocardiografia , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Japão , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
9.
Medicine (Baltimore) ; 98(38): e17108, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567947

RESUMO

Although some studies found that an increased monocyte count is a predictive, short-term marker of unfavorable outcomes for patients with acute heart failure (HF), others have reported that monocytosis predicts prolonged survival.The current follow-up study aimed to identify different monocyte count patterns and their prognostic association with HF outcomes.Baseline blood samples for complete blood counts, differential counts, renal function tests, and lipid profiles of 303 chronic HF patients (average NYHA classification 2.8) were prospectively obtained to evaluate whether there is an association between monocyte count and clinical outcomes.Mean follow-up was 11.3 years (range 1 month to 16 years) and 111 (36.6%) patients died during follow-up. Mean monocyte count was 10.6 ±â€Š5.5 and mean left ventricular ejection fraction (LVEF) was 36%. Patients with low monocyte counts (≤6%) had significantly lower survival rates than did those with monocyte counts 6.1% to 14%, or >14% (14.3% vs 70.2% vs. 88%, P < .001). Poorest survival was predicted for patients with NYHA class 3 to 4 and monocyte counts ≤6. Regression analysis showed that monocyte levels, NYHA class, and LVEF values were predictors of mortality, in decreasing importance.The total monocyte count was found to be an important prognostic factor that was inversely associated with predicted long-term mortality among patients with chronic HF. A low total monocyte count was strongly correlated with NYHA class and B-type natriuretic peptide levels, but no correlation was found with LVEF and oxidized low-density lipoproteins. It emerged as an independent risk factor for mortality in patients with chronic HF.


Assuntos
Insuficiência Cardíaca/mortalidade , Monócitos/citologia , Idoso , Biomarcadores/sangue , Doença Crônica , Estudos de Coortes , Feminino , Insuficiência Cardíaca/sangue , Humanos , Israel , Contagem de Leucócitos , Masculino , Prognóstico , Estudos Prospectivos , Análise de Sobrevida
10.
Adv Clin Chem ; 93: 63-113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31655733

RESUMO

The natural history of heart failure (HF) is not linear, because changes in the heart structure and function start long before the disease becomes clinically evident. Many different cytokines originating from intracardiac tissues (cardiomyocytes, cardiac endothelial cells, cardiac fibroblasts, and cardiac infiltrated immune cells) or extracardiac tissues (adipose tissue, gut, and lymphoid organs) have been identified in HF. Because the levels of circulating cytokines correlate with the development and severity of HF, these mediators may have both pathophysiological importance, through their ability to modulate inflammation, myocyte stress/stretch, myocyte injury and apoptosis, fibroblast activation and extracellular matrix remodeling, and utility as clinical predictive biomarkers. A greater understanding of the mechanisms mediated by the multifaceted network of cytokines, leading to distinct HF phenotypes (HF with reduced or preserved ejection fraction), is urgently needed for the development of new treatment strategies. In this chapter, all these issues were thoroughly discussed, pointing on the practical considerations concerning the clinical use of the cytokines as prognostic biomarkers and potential therapeutic targets in HF.


Assuntos
Citocinas/fisiologia , Insuficiência Cardíaca/fisiopatologia , Biomarcadores/sangue , Citocinas/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/classificação , Humanos , Mediadores da Inflamação/sangue
11.
Forensic Sci Med Pathol ; 15(4): 528-535, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31471870

RESUMO

Cardiac disease is the most common cause of sudden death in Western countries. It is known that high-sensitivity troponin I (hs-cTnI), widely used for detection of myocardial injury, is a sensitive biochemical marker. B-type natriuretic peptide (BNP) is a reliable tool for diagnosing heart failure, and for establishing prognosis or disease severity. We aimed to evaluate the diagnostic efficacy of the postmortem determination of BNP in serum alone or in addition to other biomarkers, such as hs-cTnI and MB isoenzyme of creatine kinase (CK-MB), to ascertain whether its determination improves the post-mortem diagnosis of heart failure-associated causes of death. This study involved 133 cadavers with a mean age of 58.2 (± 17.6) years and a mean postmortem interval of 12.8 (±6.6) h. Cases were assigned into two diagnostic groups, according to the cause of death: cardiac deaths (N = 62) and control (N = 71). In the cardiac group, two categories were established according to morphological features of the heart: 'ischemic deaths' (N = 39), and 'congestive heart' (n = 23). Both hs-cTnI and BNP were useful in diagnosing cardiac deaths, whereas CK-MB did not have any diagnostic relevance. hs-cTnI is higher in cases which acute ischemia as the principal pathology, while the presence of high BNP values is significantly related with chronic cardiac situations with significant ventricular overload. Our findings show that postmortem determination of hs-cTnI and BNP provides valuable information; hs-cTnI is useful for diagnosis of cardiac deaths, mainly with ischemic implications, and BNP gave better results for the diagnosis of congestive heart failure.


Assuntos
Morte Súbita Cardíaca/etiologia , Insuficiência Cardíaca/diagnóstico , Isquemia Miocárdica/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Troponina I/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Creatina Quinase Forma MB/sangue , Análise Discriminante , Feminino , Patologia Legal , Insuficiência Cardíaca/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Mudanças Depois da Morte
12.
Biosens Bioelectron ; 142: 111549, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31400725

RESUMO

C-reactive protein (CRP) is considered a promising biomarker for the rapid and high-throughput real-time monitoring of cardiovascular disease and inflammation in unprocessed clinical samples. Implementation of this monitoring would enable various transformative biomedical applications. We have fabricated a highly specific sensor chip to detect CRP with a detection limit of 2.25 fg/mL. The protein was immobilized on top of a gold (Au) wire/polycarbonate (PC) substrate using 1-ethyl-3-(3-dimethylamino-propyl) carbodiimide hydrochloride/N-hydroxy succinimide-activated 3-mercaptoproponic acid (MPA) as a self-assembled monolayer agent and bovine serum albumin (BSA) as a blocking agent. In contrast to the bare PC substrate, the CRP/BSA/anti-CRP/MPA/Au substrate exhibited a considerably high electrochemical signal toward CRP. The influence of the experimental parameters on CRP detection was assessed via various analysis methods, and these parameters were then optimized. The linear dynamic range of the CRP was 5-220 fg/mL for voltammetric and impedance analysis. Morever, the strategy exhibited high selectivity against various potential interfering species and was capable of directly probing trace amounts of the target CRP in human serum with excellent selectivity. The analytical assay based on the CRP/BSA/anti-CRP/MPA/Au substrate could be exploited as a potentially useful tool for detecting CRP in clinical samples.


Assuntos
Anticorpos Imobilizados/química , Técnicas Biossensoriais/instrumentação , Proteína C-Reativa/análise , Ouro/química , Cimento de Policarboxilato/química , Biomarcadores/análise , Biomarcadores/sangue , Técnicas Biossensoriais/métodos , Técnicas Eletroquímicas/instrumentação , Técnicas Eletroquímicas/métodos , Elétrons , Desenho de Equipamento , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Limite de Detecção
13.
Ther Adv Cardiovasc Dis ; 13: 1753944719868134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31401939

RESUMO

Since the launch of the first orally available angiotensin II (AngII) type 1 receptor (AT1R) blocker (ARB) losartan (Cozaar) in the late 1990s, the class of ARBs (or 'sartans', short for Angiotensin-RecepTor-ANtagonistS) quickly expanded to include candesartan, eprosartan, irbesartan, valsartan, telmisartan, and olmesartan. All ARBs have high affinity for the AT1 receptor, expressed in various tissues, including smooth muscle cells, heart, kidney, and brain. Since activation of AT1R, the target of these drugs, leads, among other effects, to vascular smooth muscle cell growth, proliferation and contraction, activation of fibroblasts, cardiac hypertrophy, aldosterone secretion from the adrenal cortex, thirst-fluid intake (hypervolemia), etc., the ARBs are nowadays one of the most useful cardiovascular drug classes used in clinical practice. However, significant differences in their pharmacological and clinical properties exist that may favor use of particular agents over others within the class, and, in fact, two of these drugs, candesartan and valsartan, continuously appear to distinguish themselves from the rest of the 'pack' in recent clinical trials. The reason(s) for the potential superiority of these two agents within the ARB class are currently unclear but under intense investigation. The present short review gives an overview of the clinical properties of the ARBs currently approved by the United States Food and Drug Administration, with a particular focus on candesartan and valsartan and the areas where these two drugs seem to have a therapeutic edge. In the second part of our review, we outline recent data from our laboratory (mainly) on the molecular effects of the ARB drugs on aldosterone production and on circulating aldosterone levels, which may underlie (at least in part) the apparent clinical superiority of candesartan (and valsartan) over most other ARBs currently in clinical use.


Assuntos
Aldosterona/sangue , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Benzimidazóis/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Sistema Renina-Angiotensina/efeitos dos fármacos , Tetrazóis/uso terapêutico , Valsartana/uso terapêutico , Animais , Biomarcadores/sangue , Regulação para Baixo , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Recuperação de Função Fisiológica , Resultado do Tratamento
14.
Ann Hematol ; 98(10): 2293-2297, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31402406

RESUMO

Heart failure (HF) is a chronic medical condition affecting an estimated 1-2% of the world's population, and as many as 10% of patients age 65 and above. Among patients with HF, iron deficiency (ID) has an estimated prevalence of 30-83%, often without concomitant anemia. Thus, ID in HF is often underdiagnosed unless actively sought after. ID in HF has been shown to be an independent contributor of increased mortality, hospitalization, and early readmission compared with HF patients without ID or HF patients with anemia without ID. Previous trials suggest that intravenous iron supplementation for patients with chronic HF and ID with or without anemia has resulted in improved functional outcomes and quality of life; however, the role of iron supplementation in patients hospitalized with HF has not been well characterized. In this retrospective analysis conducted in a large urban health system, we show that of the greater than 10,000 patients admitted for HF in 1 year, only 158 patients underwent screening for ID. Of these, 109 met criteria for ID. Despite intravenous iron being the standard of care for treatment of ID in HF patients, only 23 patients received this therapy. These data suggest that iron deficiency, despite having major implications in HF, is not being adequately evaluated during hospitalizations for HF. Further, if ID is identified, it is not being appropriately addressed, as per current treatment guidelines.


Assuntos
Insuficiência Cardíaca , Hospitalização , Ferro , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Humanos , Ferro/administração & dosagem , Ferro/deficiência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Int J Mol Sci ; 20(16)2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31404946

RESUMO

Heart failure (HF) patients frequently have elevated plasma renin activity. We examined the significance of elevated plasma renin activity in a translationally-relevant model of dilated cardiomyopathy (DCM), which replicates the progressive stages (A-D) of human HF. Female mice with DCM and elevated plasma renin activity concentrations were treated with a direct renin inhibitor (aliskiren) in a randomized, blinded fashion beginning at Stage B HF. By comparison to controls, aliskiren treatment normalized pathologically elevated plasma renin activity (p < 0.001) and neprilysin levels (p < 0.001), but did not significantly alter pathological changes in plasma aldosterone, angiotensin II, atrial natriuretic peptide, or corin levels. Aliskiren improved cardiac systolic function (ejection fraction, p < 0.05; cardiac output, p < 0.01) and significantly reduced the longitudinal development of edema (extracellular water, p < 0.0001), retarding the transition from Stage B to Stage C HF. The normalization of elevated plasma renin activity reduced the loss of body fat and lean mass (cachexia/sarcopenia), p < 0.001) and prolonged survival (p < 0.05). In summary, the normalization of plasma renin activity retards the progression of experimental HF by improving cardiac systolic function, reducing the development of systemic edema, cachexia/sarcopenia, and mortality. These data suggest that targeting pathologically elevated plasma renin activity may be beneficial in appropriately selected HF patients.


Assuntos
Amidas/uso terapêutico , Cardiomiopatia Dilatada/tratamento farmacológico , Fumaratos/uso terapêutico , Renina/antagonistas & inibidores , Renina/sangue , Animais , Caquexia/sangue , Caquexia/complicações , Caquexia/tratamento farmacológico , Cardiomiopatia Dilatada/sangue , Cardiomiopatia Dilatada/complicações , Modelos Animais de Doenças , Edema/sangue , Edema/complicações , Edema/tratamento farmacológico , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Camundongos , Camundongos Endogâmicos C57BL
16.
Clin Biochem ; 73: 62-69, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369736

RESUMO

BACKGROUND: Growth Differentiation Factor-15 (GDF-15) predicts death and cardiovascular events in acute coronary syndromes (ACS). We aimed to assess the long-term prognostic value of GDF-15 in ACS. METHODS: We included 358 patients with ACS who underwent coronary angiography. Plasma GDF-15 was measured and clinical data and long-term events were registered. Incremental value of GDF-15 for prognosing all-cause death above a clinical model including GRACE score, left ventricular ejection fraction <40%, prior myocardial infarction and age was assessed. RESULTS: GDF-15 concentrations >1800 ng/L were associated with an increased prevalence of cardiovascular risk factors. During 6.5 years of follow-up 56 patients died, 7 had values of GDF-15 < 1200 ng/L, 7 between 1200 and 1800 ng/L and 42 > 1800 ng/L. After adjustment for potential confounders, GDF-15 > 1800 ng/L were independently associated with all-cause death (HR 4.09; 95% CI 1.57-10.71; p = .004) and the composite of major adverse cardiovascular events (MACE) (HR 2.48; 95% CI 1.41-4.34; p = .001). For long-term all-cause death a significant increase of ROC curve was seen after addition of GDF-15 to a clinical model 0.876 (95% CI 0.823-0.928; p = .014). Same improvements were found for net reclassification improvement (0.776; 95% CI 0.494-1.037; p < .001) and integrated discrimination improvement (0.112; 95% CI 0.055-0.169; p < .001). Multivariate competing risk model showed a significant association between GDF-15 > 1800 ng/L and the incidence of heart failure but not of myocardial infarction. CONCLUSIONS: In the setting of ACS, GDF-15 is associated with long-term all-cause death, MACE and heart failure and provides incremental prognostic value beyond traditional risks factor.


Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/mortalidade , Fator 15 de Diferenciação de Crescimento/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Síndrome Coronariana Aguda/diagnóstico por imagem , Idoso , Angiografia Coronária , Intervalo Livre de Doença , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Taxa de Sobrevida
17.
Scand Cardiovasc J ; 53(5): 235-246, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31327253

RESUMO

Objective. To examine how liver function (LF) relates to invasive hemodynamics cross-sectionally and longitudinally, in advanced heart failure (AHF) patients treated with maximally tolerated medical HF therapy. Design. A retrospective study of 309 consecutive AHF patients with a left ventricular ejection fraction < 45% treated with maximally tolerated medical HF therapy who were referred for AHF therapies. All patients underwent right heart catheterization (RHC) using Swan-Ganz catheters. Cardiac output was measured using thermodilution. Measurements of pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP) were obtained. RHC and evaluation of LF were repeated (median (IQR) = 186.5 (150-208) days) in 33 patients. Results. Mean (SD) age was 50 (±13) years, and 239 (77%) were men. Only 22 (7%) were treated with inotropes, and none were receiving mechanical circulatory support. Median (IQR) plasma alanine transaminase (ALT) was 32 (22-53) U/l, alkaline phosphatase (ALP) 82 (63-122) U/l, bilirubin 14 (9-22) µmol/l, albumin 39 (35-43) g/l, lactate dehydrogenase 212 (175-275) U/l, and the prothrombin time/International Normalized Ratio (PT/INR) 1.1 (1.0-1.3). In multivariate analyses significant associations between LF tests and hemodynamics were seen for CVP: ALP (ß = 0.031, p = .0002), bilirubin (ß = 0.027, p = .004), and INR (ß = 0.013, p = .002). PCWP (ß = 0.020, p = .002) and CI (ß = -0.17, p = .005) were also associated with bilirubin. Over time, changes in bilirubin correlated positively with changes in CVP (ß = 1.496, p = .005). Conclusion. In optimally treated AHF patients, CVP was associated with both markers of biliary excretion and liver synthesis function, whereas changes in CVP were associated with changes in markers of biliary excretion. Decongestion may improve measures of LF in AHF.


Assuntos
Bilirrubina/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Fígado/metabolismo , Albumina Sérica Humana/metabolismo , Adulto , Pressão Arterial , Biomarcadores/sangue , Débito Cardíaco , Cateterismo de Swan-Ganz , Pressão Venosa Central , Estudos Transversais , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Coeficiente Internacional Normatizado , Testes de Função Hepática , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Pressão Propulsora Pulmonar , Estudos Retrospectivos , Fatores de Tempo
18.
Clin Ter ; 170(4): e267-e271, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31304514

RESUMO

OBJECTIVES: To evaluate the plasma galectin-3 concentration associated with the severity of HF and its use as a biomarker for clinical staging of heart failure (HF). METHODS: This was a cross-sectional study, in which 100 HF cases diagnosed by clinical parameters and echocardiography were included and subgrouped into NYHA classes (I-IV) based on clinical severity and functional limitations. Plasma galectin-3 was measured with respect to these subgroups. RESULTS: The median plasma galectin-3 concentration in pg/mL was 82.7 (95% confidence interval: 64.5-112.7), 267.2 (214.3-293.5), 694.8 (626.4-902.4), and 1530.4 (1443.1-2384.4) in NYHA class I, II, III, and IV subgroups, respectively (p <0.05). The proposed galectin-3 concentrations in mild, moderate, and severe HF were 100-460, 460-1170, and >1170 pg/mL, respectively. Galectin-3 was negatively correlated with LV Ejection fraction (EF) by Simpson's biplane method (r=-0.634, p<0.001). Pro BNP showed that the level of plasma galectin-3 was positively correlated with the level of plasma NT pro BNP (r = 0.878, p <0.001). CONCLUSIONS: The plasma galectin-3 concentration showed progressive increase with increasing severity of HF; therefore, it may be used in clinical staging of the disease.


Assuntos
Biomarcadores/sangue , Galectina 3/sangue , Insuficiência Cardíaca/sangue , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Biomed Res Int ; 2019: 8541402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317040

RESUMO

Objective: The underlying mechanisms by which cystatin C affects cardiovascular disease (CVD) are not very clear. Metabolic syndrome (MetS) is a cluster of risk factors that increase the risk of CVD. Here, we aimed to investigate the association of cystatin C with metabolic syndrome and cardiovascular outcomes in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with preserved renal function. Methods: In total, 422 NSTE-ACS patients with preserved renal function were enrolled to examine the association of cystatin C with MetS. MetS was defined based on the NCEP-ATP-III guidelines. Major adverse cardiovascular events (MACEs) were also evaluated, which included cardiac death, nonfatal myocardial infarction (MI), target vessel revascularization (TVR), heart failure, and nonfatal stroke. All patients underwent a 12-month follow-up for MACEs after admission. Results: Cystatin C was significantly correlated with metabolic risk factors and inflammation markers. The prevalence of MetS and MACEs correlated with cystatin C levels. Cystatin C showed a strong diagnostic performance for cardiovascular risk factors and outcomes in ROC analysis. After adjustment for multiple risk factors, cystatin C level was independently associated with MetS (OR 2.299, 95% CI 1.251-4.225, and P = 0.007). During a 12-month follow-up, the patients with high cystatin C level and MetS had higher incidence of MACEs (Log-rank = 24.586, P < 0.001) and cardiac death (Log-rank = 9.890, P = 0.020) compared to the others. Multivariate Cox analysis indicated that cystatin C level was an independent predictor of MACEs (HR 2.609, 95% CI 1.295-5.257, and P = 0.007). Conclusion: Cystatin C may be an independent predictor of metabolic syndrome and therefore valuable for management of NSTE-ACS patients. Further multicenter, large-scale studies are required to assess the implication of these results.


Assuntos
Cistatina C/sangue , Insuficiência Cardíaca/sangue , Síndrome Metabólica/sangue , Infarto do Miocárdio sem Supradesnível do Segmento ST/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Biomarcadores/sangue , Eletrocardiografia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Rim/metabolismo , Rim/fisiologia , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Prognóstico , Curva ROC , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
20.
Braz J Med Biol Res ; 52(7): e8416, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314851

RESUMO

Studies regarding the prognostic value of circulating adiponectin level in patients with heart failure are conflicting. The aim of this meta-analysis was to evaluate the association between elevated circulating adiponectin level and adverse outcomes in patients with heart failure. We searched PubMed and Embase databases from their inception to June 2018. Original observational studies that investigated the prognostic value of adiponectin in heart failure patients and reported all-cause mortality or combined endpoints of death/readmission as outcome measure were included. Pooled risk ratio (RR) with 95% confidence intervals (CI) were estimated by higher versus lower circulating adiponectin level. A total of 7 studies involving 862 heart failure patients were identified. Meta-analysis showed that heart failure patients with higher adiponectin level had significantly increased risk of all-cause mortality (RR 2.05; 95%CI 1.22-3.43) after adjustment for potential confounders. In addition, higher adiponectin level was associated with an increased risk of the combined endpoints of death/readmission (RR 2.22; 95%CI 1.38-3.57). Elevated baseline circulating adiponectin level is possibly associated with an increased risk of all-cause mortality and the combined endpoints of death/readmission in patients with heart failure. Determination of circulating adiponectin level has potential to improve risk stratification in heart failure patients.


Assuntos
Adiponectina/sangue , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Biomarcadores/sangue , Humanos , Prognóstico , Fatores de Risco
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