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2.
Angiol Sosud Khir ; 25(4): 7-26, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31855197

RESUMO

Ischemic cardiomyopathy is becoming a leading cause of morbidity and mortality in the whole world. Stem cell-based therapy is emerging as a promising option for treatment of ischemic cardiomyopathy. Several stem cell types, including cardiac-derived stem cells, bone marrow-derived stem cells, mesenchymal stem cells, skeletal myoblasts, CD34+ and CD133+ stem cells have been used in clinical trials. Clinical effects mostly depend on transdifferentiation and paracrine factors. One important issue is that a low survival and residential rate of transferred stem cells blocks the effective advances in cardiac improvement. Many other factors associated with the efficacy of cell replacement therapy for ischemic cardiomyopathy mainly including the route of delivery, the type and number of stem cell infusion, the timing of injection, patient's physical conditions, the particular microenvironment onto which the cells are delivered, and clinical conditions remain to be addressed. Here we provide an overview of modern methods of stem cell delivery, types of stem cells and discuss the current state of their therapeutic potential.


Assuntos
Cardiomiopatias/terapia , Isquemia Miocárdica/complicações , Transplante de Células-Tronco/métodos , Cardiomiopatias/etiologia , Humanos
3.
Int Heart J ; 60(6): 1268-1275, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666451

RESUMO

Few reports have focused on which patients with moderate ischemic mitral regurgitation (IMR) were not good candidates for coronary artery bypass grafting (CABG) alone. This single-center study aimed to assess risk factors for moderate or more residual regurgitation within two years after CABG alone for the treatment of moderate chronic IMR to optimize the operation strategy and prognosis.A total of 189 eligible patients were entered into a failure group (n = 108) or an improved group (n = 81) according to whether moderate or more residual regurgitation occurred within two years after surgery. Baseline and surgical characteristics were analyzed, and clinical outcomes were compared between groups.Prior myocardial infarction (MI)/chronic myocardial ischemia and region wall motion abnormality (anterior/inferior-posterior wall) were two independent risk factors for moderate or more residual regurgitation, following CABG alone, for the treatment of moderate chronic IMR (OR = 3.15, 95% CI 1.66-5.75, and OR = 2.45, 95% CI 1.36-4.84, respectively). During a median follow-up of 40 months, compared with the improved group, the failure group was more likely to present with New York Heart Association (NYHA) class III-IV and cardiac re-hospitalization (57.4% versus 11.1%, P < 0.001, and 13.9% versus 4.9%, P = 0.043, respectively) and had worse cumulative survival (χ2 = 4.259, log-rank P = 0.039).Patients suffering from moderate chronic IMR secondary to prior MI (rather than chronic ischemia) with anterior wall motion abnormalities (rather than inferior-posterior wall motion abnormalities) may not be good candidates for CABG alone, and may have a poor prognosis after CABG alone.


Assuntos
Ponte de Artéria Coronária , Insuficiência da Valva Mitral/etiologia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/cirurgia , Idoso , Doença Crônica , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/mortalidade , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Falha de Tratamento
4.
Hipertens. riesgo vasc ; 36(3): 162-164, jul.-sept. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-183955

RESUMO

En la actualidad son cada vez más los pacientes con hipertensión arterial refractaria (HTAR) que sufren insuficiencia cardiaca (IC) en fases avanzadas y que precisan dispositivos implantables para su tratamiento. Presentamos el caso de un paciente con un desfibrilador automático implantable (DAI) que precisó la colocación de un dispositivo de terapia de activación de barorreceptores (TAB) del seno carotídeo con la doble indicación de IC y HTAR. Hasta donde sabemos, se trata del primer caso realizado en nuestro país


The number of patients who suffer refractory arterial hypertension and chronic heart failure in advanced stages is currently increasing. The case is presented of a patient with an implantable cardioverter defibrillator, and with the dual indication of chronic heart failure and refractory arterial hypertension, who required the implanting of a baroreceptors activation therapy device of the carotid sinus. As far as it is known, it is the first case reported in Spain?


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Insuficiência Cardíaca/complicações , Pressorreceptores/efeitos dos fármacos , Fatores de Risco , Pressorreceptores/metabolismo , Hipercolesterolemia/complicações , Hipercolesterolemia/tratamento farmacológico , Isquemia Miocárdica/complicações
5.
Transplant Proc ; 51(8): 2755-2760, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31345598

RESUMO

BACKGROUND: Although electrocardiography (ECG) is routinely used as a preoperative cardiac assessment tool, impact of ECG-detected myocardial ischemia on postoperative outcomes remains unclear. We aimed to assess use of ECG as a predictor of postoperative mortality in patients undergoing liver transplant (LT). METHODS: Electronic medical records of patients who underwent LT were retrospectively analyzed. The primary end point was postoperative 1-year all-cause mortality. Electrocardiographic myocardial ischemia was diagnosed based on automated ECG interpretation suggesting ischemia or infarction. Cox proportional hazard analysis was performed to identify independent risk factors including Model for End-Stage Liver Disease score, revised cardiac risk index, echocardiographic wall motion abnormalities, and myocardial perfusion scan (MPS) abnormalities. RESULTS: Of the 1430 patients, 78 (5.5%) showed ischemic change on ECG. The 1-year mortality of patients with ischemic change on ECG was significantly higher than that of those without (11.5% vs 4.0%; P = .004). In the Cox proportional hazard model, ischemic change on ECG (hazard ratio [HR], 2.91; 95% CI, 1.43-5.92; P = .003), Model for End-Stage Liver Disease score (HR 1.06; 95% CI 1.04-1.09; P < .001), and revised cardiac risk index (HR, 2.84; 95% CI, 1.86-4.35; P < .001) were independent variables predicting 1-year mortality; however, MPS abnormalities and echocardiographic wall motion abnormalities were not. CONCLUSION: In patients undergoing LT, preoperative ischemic ECG findings should not be overlooked, as they are associated with increased mortality, while abnormalities on MPS and resting ECG are not. Thorough evaluations to detect underlying modifiable coronary artery disease are needed in patients with these findings.


Assuntos
Eletrocardiografia , Doença Hepática Terminal/complicações , Doença Hepática Terminal/cirurgia , Transplante de Fígado/mortalidade , Isquemia Miocárdica/complicações , Idoso , Doença Hepática Terminal/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
6.
Dis Markers ; 2019: 4823156, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31316680

RESUMO

Apelin plays important roles in cardiovascular homeostasis. However, its effects on the mechanoenergetics of heart failure (HF) are unavailable. We attempted to investigate the effects of apelin on the left ventricular-arterial coupling (VAC) and mechanical efficiency in rats with HF. HF was induced in rats by the ligation of the left coronary artery. The ischemic HF rats were treated with apelin or saline for 12 weeks. The sham-operated animals served as the control. The left ventricular (LV) afterload and the systolic and diastolic functions, as well as the mechanoenergetic indices were estimated from the pressure-volume loops. Myocardial fibrosis by Masson's trichrome staining, myocardial apoptosis by TUNEL, and collagen content in the aorta as well as media area in the aorta and the mesenteric arteries were determined. Our data indicated that HF rats manifested an increased arterial load (Ea), a declined systolic function (reduced ejection fraction, +dP/dtmax, end-systolic elastance, and stroke work), an abnormal diastolic function (elevated end-diastolic pressure, τ, and declined -dP/dtmax), and decreased mechanical efficiency. Apelin treatment improved those indices. Concomitantly, increased fibrosis in the LV myocardium and the aorta and enhanced apoptosis in the LV were partially restored by apelin treatment. A declined wall-to-lumen ratio in the mesenteric arteries of the untreated HF rats was further reduced in the apelin-treated group. We concluded that the rats with ischemic HF were characterized by deteriorated LV mechanoenergetics. Apelin improved mechanical efficiency, at least in part, due to the inhibiting cardiac fibrosis and apoptosis in the LV myocardium, reducing collagen deposition in the aorta and dilating the resistant artery.


Assuntos
Apelina/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Isquemia Miocárdica/tratamento farmacológico , Animais , Apoptose , Pressão Sanguínea , Colágeno/metabolismo , Insuficiência Cardíaca/etiologia , Masculino , Isquemia Miocárdica/complicações , Ratos , Ratos Wistar , Sístole , Função Ventricular Esquerda
7.
Int Heart J ; 60(4): 796-804, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308329

RESUMO

The benefits of concomitant mitral valve procedure (MVP) for treating moderate chronic ischemic mitral regurgitation (IMR) during coronary artery bypass grafting (CABG) have not been clearly established. This study aimed to determine the incidence of moderate or more residual mitral regurgitation (MR) following CABG plus MVP for moderate chronic IMR, and to evaluate the impacts of concomitant MVP vs. CABG alone on clinical outcomes based on propensity-matched data.All eligible patients were entered into either the MVP group (CABG plus MVP, n = 184) or CABG group (CABG alone, n = 162). Moderate or more residual MR rate was investigated, and in-hospital and follow-up outcomes between the groups were compared after matching.Moderate or more residual MR rate was 11.4% at 1 year and 22.9% at 2 years after CABG plus MVP, respectively. Patients in the MVP group as compared with the CABG group had significantly lower moderate or more residual MR rates at various postoperative time points (all P < 0.001). Grouping was not an independent risk factor for in-hospital adverse events in multivariate logistic regression analysis. Also, grouping was a significant variable related to moderate or more residual MR rate and NYHA class III-IV at the latest follow-up in Cox regression analysis (HR = 0.391, 95% CI 0.114-0.628; HR = 0.419, 95% CI 0.233-0.819, respectively).Concomitant MVP as compared with CABG alone for treating moderate chronic IMR was associated with a reduction in moderate or more residual MR rate and an improvement in NYHA functional status, with no increase in in-hospital adverse events or follow-up death.


Assuntos
Ponte de Artéria Coronária/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/complicações , Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , China/epidemiologia , Doença Crônica , Angiografia Coronária , Ecocardiografia Doppler , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
8.
Nutr. hosp ; 36(extr.3): 58-62, jul. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184437

RESUMO

Existe mucha evidencia que sugiere una relación en J entre el consumo moderado de alcohol y la salud cardiovascular. Se ha referido una reducción de alrededor del 20% en la mortalidad y de hasta el 40% en la cardiopatía isquémica en los bebedores moderados respecto a los abstemios absolutos. Las dosis consideradas saludables oscilan entre 10 y 20 g/día para mujeres y hombres, respectivamente, y parece que el patrón de bebida es igualmente relevante para obtener ese efecto saludable. Múltiples son los mecanismos que pueden explicar el retraso en la aterogénesis inducido por el consumo saludable de alcohol, pero probablemente los efectos sobre los lípidos y las plaquetas son los más importantes. Sin embargo, se mantiene la controversia sobre si las bebidas alcohólicas fermentadas con alto contenido en polifenoles como cerveza o vino tienen un mayor efecto de protección cardiovascular que los licores que no contienen apenas polifenoles


A large evidence-based reports a J-shaped association among moderate alcohol consumption and cardiovascular health. Low-moderate alcohol intake has been related to lower all-cause mortality (20%) and ischemic heart events (40%) compared to abstainers. The dose that is allegedly beneficial varies between 10-20 gr/day for women and men respectively. Moreover, the drinking pattern seems to be significant in order to get healthy effects. Moderate alcohol consumption hinders atherogenesis by several mechanisms mainly improving lipid profile and reducing thrombogenesis. Nevertheless, it is still unclear whether high-polyphenol alcoholic beverages, such as wine and beer, confer a greater cardiovascular protection than spirits, which have much less polyphenol content


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/prevenção & controle , Bebidas Alcoólicas/efeitos adversos , Isquemia Miocárdica/prevenção & controle , Arteriosclerose/fisiopatologia , Arteriosclerose/prevenção & controle , Isquemia Miocárdica/complicações , Aterosclerose/induzido quimicamente , Aterosclerose/complicações , Indicadores de Morbimortalidade , Polifenóis/efeitos adversos , Cerveja/efeitos adversos
9.
Scand Cardiovasc J ; 53(4): 213-219, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169417

RESUMO

Objectives. Exercise training has been proposed to have anti-inflammatory effects. We examined whether aerobic interval training (AIT) can attenuate the inflammatory response in ischemic heart failure (HF) as measured by serum biomarkers representing a broad spectrum of activated inflammatory pathways. Design. We conducted a controlled prospective trial recruiting 30 patients (19 in the AIT group and 11 in the control group) with ischemic HF and an implantable cardioverter defibrillator (ICD). This study is a sub study of the previously reported "Aerobic interval training in patients with heart failure and an ICD" (Eur J Prev Cardiol. 22 March 2015; 22:296-303). Patients in the AIT group exercised for 12-weeks completing a total of 36 AIT sessions. We analyzed serum levels of C-reactive protein, pentraxin-3, osteoprotegerin, brain natriuretic peptide, neopterin, and soluble tumor necrois factor type 1 and 2, all known to predict an adverse outcome in HF, at baseline and following the 12-week AIT intervention. Results. The AIT group significantly increased peak oxygen uptake and improved endothelial function compared to the sedentary control group. No statistically significant changes in serum levels of the biomarkers were detected from baseline following the AIT intervention and, there were no significant differences in changes of these mediators between the AIT and the control group. Conclusions. A 12-week AIT intervention, although improving exercise capacity and endothelial function, did not attenuate serum inflammatory biomarkers in stable ischemic HF patients with an ICD on optimal medical therapy.


Assuntos
Insuficiência Cardíaca/terapia , Treinamento Intervalado de Alta Intensidade , Mediadores da Inflamação/sangue , Isquemia Miocárdica/complicações , Idoso , Biomarcadores/sangue , Fármacos Cardiovasculares/uso terapêutico , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Tolerância ao Exercício , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
10.
Cells ; 8(6)2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31208058

RESUMO

Dilated cardiomyopathy (DCM) is one of the leading causes of heart failure and heart transplantation. A portion of familial DCM is due to mutations in the LMNA gene encoding the nuclear lamina proteins lamin A and C and without adequate treatment these patients have a poor prognosis. To get better insights into pathobiology behind this disease, we focused on modeling LMNA-related DCM using human induced pluripotent stem cell derived cardiomyocytes (hiPSC-CM). Primary skin fibroblasts from DCM patients carrying the most prevalent Finnish founder mutation (p.S143P) in LMNA were reprogrammed into hiPSCs and further differentiated into cardiomyocytes (CMs). The cellular structure, functionality as well as gene and protein expression were assessed in detail. While mutant hiPSC-CMs presented virtually normal sarcomere structure under normoxia, dramatic sarcomere damage and an increased sensitivity to cellular stress was observed after hypoxia. A detailed electrophysiological evaluation revealed bradyarrhythmia and increased occurrence of arrhythmias in mutant hiPSC-CMs on ß-adrenergic stimulation. Mutant hiPSC-CMs also showed increased sensitivity to hypoxia on microelectrode array and altered Ca2+ dynamics. Taken together, p.S143P hiPSC-CM model mimics hallmarks of LMNA-related DCM and provides a useful tool to study the underlying cellular mechanisms of accelerated cardiac degeneration in this disease.


Assuntos
Cardiomiopatia Dilatada/patologia , Células-Tronco Pluripotentes Induzidas/patologia , Lamina Tipo A/metabolismo , Modelos Biológicos , Adulto , Animais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/patologia , Cálcio/metabolismo , Cardiomiopatia Dilatada/complicações , Agregação Celular , Diferenciação Celular , Linhagem Celular , Feminino , Humanos , Hipóxia/patologia , Masculino , Camundongos , Microeletrodos , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/patologia , Miócitos Cardíacos/patologia , Miócitos Cardíacos/ultraestrutura , Sarcômeros/metabolismo , Estresse Fisiológico , Adulto Jovem
11.
Am J Case Rep ; 20: 810-815, 2019 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-31177265

RESUMO

BACKGROUND Response to cardiac resynchronization therapy (CRT) is variable among patients. Extensive scar tissue burden has been characterized as a negative predictor of significant response. Whereas mid-term and long-term response has been thoroughly investigated in randomized clinical trials; however, little is known about acute hemodynamic effects of biventricular pacing. CASE REPORT We report a case of an elderly female patient with severe ischemic cardiomyopathy and a large anterior wall aneurysm, who received right ventricular and biventricular pacing during ablation of incessant pleomorphic ventricular tachycardia. During the procedure, biventricular pacing was associated with a 20% acute increase in systolic blood pressure compared to right ventricular pacing, although there was no acute or long-term effect on left ventricular function. CONCLUSIONS The acute hemodynamic effect of CRT in our patient suggests an effect of CRT even in patients with negative predictors of CRT response such as severe ischemic cardiomyopathy with a large aneurysm. Although no marked increase in left ventricular function might be observed, the acute effect of CRT might contribute to stabilization of heart failure in these patients.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Ablação por Cateter/métodos , Aneurisma Cardíaco/complicações , Hemodinâmica/fisiologia , Isquemia Miocárdica/diagnóstico por imagem , Taquicardia Ventricular/cirurgia , Idoso de 80 Anos ou mais , Dispneia/diagnóstico , Dispneia/etiologia , Eletrocardiografia/métodos , Feminino , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Humanos , Imagem Tridimensional/métodos , Multimorbidade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/terapia , Prognóstico , Medição de Risco , Taquicardia Ventricular/diagnóstico por imagem , Resultado do Tratamento
12.
J Card Surg ; 34(8): 663-669, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31212371

RESUMO

BACKGROUND: In patients with end-stage renal disease requiring hemodialysis (HD patients), myocardial ischemia after coronary artery disease is a major cause of mortality. Coronary pathophysiology, namely myocardial microvascular dysfunction, appears to differ from patients not requiring HD (non-HD patients). OBJECTIVES: We compared functional improvement of myocardial ischemia after coronary artery bypass surgery (CABG) between HD and non-HD patients by transthoracic coronary flow velocity reserve (CFVR). METHODS: We retrospectively reviewed isolated CABG patients from between 2008 and 2017. Finally, 161 patients were enrolled; each underwent pre- and postoperative CFVR assessment, and left anterior descending (LAD) artery revascularization with "in-situ" internal mammary artery (IMA). Graft patency was confirmed, and after successful CABG, postoperative CFVR improvement between the two groups was compared. RESULTS: Preoperative CFVR value in group H was 1.81 ± 0.52, group N was 1.93 ± 0.66. There was no significant difference between the groups. IMA to LAD grafts were patent in postoperative evaluation in all patients. Postoperative CFVR in group H was 2.48 ± 0.72 and group N was 2.83 ± 0.73 (P = .042). Significant difference was observed. CONCLUSION: In both groups, CFVR values improved after successful CABG, but postoperative CFVR values were significant different. In younger populations CFVR values are generally higher. Our HD group was significantly younger than the non-HD group, but CFVR values were postoperatively significantly lower. CFVR values are reportedly affected by both epicardial and microcoronary circulation. In this study population, as all grafts to the LAD were patent, the lower CFVR value in the HD group was considered to have resulted in microvascular disorders.


Assuntos
Velocidade do Fluxo Sanguíneo , Ponte de Artéria Coronária , Vasos Coronários/fisiopatologia , Falência Renal Crônica/terapia , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Diálise Renal , Idoso , Circulação Coronária , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Estudos Retrospectivos , Resultado do Tratamento
13.
Bioelectrochemistry ; 129: 54-61, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31103847

RESUMO

OBJECTIVE: The aim of this research was to investigate if dielectric spectroscopy between 100 Hz and 1 MHz provides reliable information about water distribution in ischaemic heart tissue and to investigate the influence of temperature on oedema formation. METHODS: We examined hearts of landrace piglets (n = 13) during ischaemia at 35 °C, 25 °C, and 15 °C. The dielectric permittivity ε'(f) and conductivity σ'(f) were calculated from impedance spectra measured between 100Hz and 1MHz. Gap junction uncoupling (GJU) was identified in the sigmoidal time course of ε'(13 kHz). The extracellular space index (ECSI) was estimated by the ratio σ'(100 Hz)/σ'(1 MHz). Intercalated water was analysed in electron microscopy images of the myocardial samples and was used to calculate the extracellular space index ECSIhisto. The ECSI and ECSIhisto were compared during ischaemia. GJU and oedema formation were simulated with an electrical heart model. RESULTS: At the onset of ischaemia, the ECSI was significantly higher than the ECSIhisto (p < .01). GJU during ischaemia was temperature-dependent. After GJU, the values of the ECSI and ECSIhisto matched very well. The simulations confirmed the influence of GJU on the ECSI. SIGNIFICANCE: The estimation of cell oedema with the ECSI is reliable only after GJU. The development of oedema estimated by the ECSI was delayed at cooler temperatures.


Assuntos
Espectroscopia Dielétrica/instrumentação , Edema Cardíaco/patologia , Isquemia Miocárdica/patologia , Miocárdio/patologia , Animais , Espectroscopia Dielétrica/métodos , Edema Cardíaco/etiologia , Desenho de Equipamento , Junções Comunicantes/patologia , Isquemia Miocárdica/complicações , Suínos
14.
J Coll Physicians Surg Pak ; 29(5): 469-473, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036121

RESUMO

Myocardial infarction/ischemia can be an underlying etiology and a major causative risk factor of cardiovascular hiccups. The objective of this systematic review was to review the literature regarding clinical features and treatments of hiccups of cardiac ischemia origin. PRISMA guidelines were followed. In elderly patients with hiccups of uncertain causes, electrocardiography is necessary to ensure the cardiogenic etiology. Both symptomatic and etiologic treatments can be effective in terminating hiccups. Of the therapeutic regimens, gabapentin is a second-line agent alternative to baclofen in treating hiccups. It is especially helpful in patients undergoing stroke rehabilitation or palliative care when chlorpromazine is prohibited due to its adverse effects. Inferior myocardial infarction is the most common cause of hiccups in this patient setting. In addition to anti-myocardial ischemia agents and percutaneous coronary intervention, coronary artery bypass grafting could be an alternative to hiccups in such patients.


Assuntos
Baclofeno/uso terapêutico , Agonistas dos Receptores de GABA-B/uso terapêutico , Gabapentina/uso terapêutico , Soluço/tratamento farmacológico , Soluço/fisiopatologia , Infarto do Miocárdio/complicações , Isquemia Miocárdica/complicações , Eletrocardiografia , Soluço/diagnóstico , Soluço/etiologia , Humanos , Resultado do Tratamento
15.
Gac Med Mex ; 155(2): 196-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056601

RESUMO

The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Isquemia Miocárdica/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Isquemia Miocárdica/complicações , Implantação de Prótese/métodos
16.
Int J Mol Sci ; 20(9)2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31083399

RESUMO

Elevated pro-inflammatory biomarkers and cytokines are associated with morbidity and mortality in heart failure (HF). Preclinical and clinical studies have shown multiple inflammatory mechanisms causing cardiac remodeling, dysfunction and chronic failure. Therapeutics in trials targeting the immune response in heart failure and its effects did not result in evident benefits regarding clinical endpoints and mortality. This review elaborates pathways of immune cytokines in pathogenesis and worsening of heart failure in clinical and cellular settings. Besides the well-known mechanisms of immune activation and inflammation in atherosclerosis causing ischemic cardiomyopathy or myocarditis, attention is focused on other mechanisms leading to heart failure such as transthyretin (TTR) amyloidosis or heart failure with preserved ejection fraction. The knowledge of the pathogenesis in heart failure and amyloidosis on a molecular and cellular level might help to highlight new disease defining biomarkers and to lead the way to new therapeutic targets.


Assuntos
Amiloidose/complicações , Insuficiência Cardíaca/complicações , Inflamação/patologia , Isquemia Miocárdica/complicações , Pré-Albumina/metabolismo , Transdução de Sinais , Humanos
17.
Adv Exp Med Biol ; 1127: 117-130, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31140175

RESUMO

Ischemic heart disease is the main cause of morbidity and mortality in the developed world. Although reperfusion therapies are currently the best treatment for this entity, the restoration of blood flow leads, under certain circumstances, to a form of myocardial damage called reperfusion injury. Several studies have shown that age, sex, smoking, diabetes and dyslipidemia are risk factors for cardiovascular diseases. Among these risk factors, dyslipidemias are present in 40% of patients with ischemic heart disease and represent the clinical factor with the greatest impact on the prognosis of patients with cardiovascular diseases. It is known that during reperfusion the increase of the oxidative stress is perhaps one of the most important mechanisms implicated in cell damage. That is why several researchers have studied protective mechanisms against reperfusion injury, such as the ischemic pre- and post- conditioning, making emphasis mainly on the reduction of oxidative stress. However, few of these efforts have been successfully translated into the clinical setting. The controversial results in regards to the relation between cardioprotective mechanisms and dyslipidemia/hypercholesterolemia are mainly due to the difference among quality, composition and the time of administration of hypercholesterolemic diets, as well as the difference in the species used in each of the studies. Therefore, in order to compare results, it is crucial that all variables that could modify the obtained results are taken into consideration.


Assuntos
Dislipidemias/complicações , Isquemia Miocárdica/complicações , Traumatismo por Reperfusão Miocárdica/complicações , Estresse Oxidativo , Humanos , Pós-Condicionamento Isquêmico , Precondicionamento Isquêmico Miocárdico , Fatores de Risco
18.
Nucl Med Commun ; 40(7): 773-774, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31107409

RESUMO

Next to myocardial perfusion, single-photon emission computed tomography (SPECT) also allows for the assessment of nonperfusion parameters such as transient ischemic dilatation (TID) and a reduction of ejection fraction (EF) with stress imaging. This study aimed to evaluate the diagnostic value of TID and EF reserve for the detection of significant multivessel coronary artery disease (CAD). A total of 206 patients with suspected stable CAD prospectively underwent gated stress-rest Tc-tetrofosmin SPECT and invasive coronary angiography with routine fractional flow reserve (FFR) measurements, irrespective of imaging results. Left ventricular volumes, TID, and EF reserve were assessed and compared with FFR-defined severity of CAD. According to FFR, 92 (45%) patients had significant CAD, whereas 25 (12%) showed 2-vessel disease (VD) and 22 (11%) showed 3-VD. With an increasing extent of CAD, TID values and EF reserve did not change significantly (P=0.07 and 0.42 for trend, respectively). Conversely, absolute left ventricular volumes and EF differed significantly among groups of CAD severity (P<0.01 for all trends). SPECT-derived TID and EF reserve did not differ between patients with high-risk CAD (3-VD) and low risk or no significant CAD. Therefore, the present results advocate exerting caution when using these ancillary findings in clinical practice.


Assuntos
Adenosina , Doença da Artéria Coronariana/complicações , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Volume Sistólico , Tomografia Computadorizada de Emissão de Fóton Único , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Fatores de Tempo
19.
Scand Cardiovasc J ; 53(4): 183-191, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31117835

RESUMO

Background. Remote ischemic conditioning (RIC) protects against acute ischemia-reperfusion injury and may have beneficial effects in patients with stable cardiovascular disease. We investigated the effect of long-term RIC treatment in patients with chronic ischemic heart failure (CIHF). Methods. Prespecified post-hoc analysis of a prospective, exploratory and outcome-assessor blinded study. Twenty-one patients with compensated CIHF and 21 matched controls without heart failure or ischemic heart disease were treated with RIC once daily for 28 ± 4 days. RIC was conducted as 4 cycles of 5 minutes upper arm ischemia followed by 5 minutes of reperfusion. We evaluated circulating markers of inflammation and cardiac remodeling at baseline and following long-term RIC. Results. RIC reduced C-reactive protein from 1.5 (0.6-2.5) to 1.3 (0.6-2.1) mg/l following long-term RIC treatment (p = .02) and calprotectin from 477 (95% CI 380 to 600) to 434 (95% CI 354 to 533) ng/ml (p = .03) in patients with CIHF, but not in matched controls. Overall, RIC did not affect circulating markers related to adaptive or innate immunology or cardiac remodeling in patients with CIHF. Among patients with CIHF and N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels above the geometric mean of 372 ng/l, long-term RIC treatment reduced soluble ST2 (n = 9) from 22.0 ± 3.7 to 20.3 ± 3.9 ng/ml following long-term RIC treatment (p = .01). Conclusion. Our findings suggest that long-term RIC treatment has mild anti-inflammatory effects in patients with compensated CIHF and anti-remodeling effects in those with increased NT-proBNP levels. This should be further investigated in a randomized sham-controlled trial.


Assuntos
Insuficiência Cardíaca/terapia , Mediadores da Inflamação/sangue , Precondicionamento Isquêmico/métodos , Isquemia Miocárdica/complicações , Extremidade Superior/irrigação sanguínea , Remodelação Ventricular , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doença Crônica , Citocinas/sangue , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Precondicionamento Isquêmico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/sangue , Isquemia Miocárdica/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Fluxo Sanguíneo Regional , Fatores de Tempo , Resultado do Tratamento
20.
J Diabetes Res ; 2019: 9489826, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31089475

RESUMO

Ischemic heart disease (IHD) has several risk factors, among which diabetes mellitus represents one of the most important. In diabetic patients, the pathophysiology of myocardial ischemia remains unclear yet: some have atherosclerotic plaque which obstructs coronary blood flow, others show myocardial ischemia due to coronary microvascular dysfunction in the absence of plaques in epicardial vessels. In the cross-talk between myocardial metabolism and coronary blood flow (CBF), ion channels have a main role, and, in diabetic patients, they are involved in the pathophysiology of IHD. The exposition to the different cardiovascular risk factors and the ischemic condition determine an imbalance of the redox state, defined as oxidative stress, which shows itself with oxidant accumulation and antioxidant deficiency. In particular, several products of myocardial metabolism, belonging to oxidative stress, may influence ion channel function, altering their capacity to modulate CBF, in response to myocardial metabolism, and predisposing to myocardial ischemia. For this reason, considering the role of oxidative and ion channels in the pathophysiology of myocardial ischemia, it is allowed to consider new therapeutic perspectives in the treatment of IHD.


Assuntos
Complicações do Diabetes/metabolismo , Diabetes Mellitus/patologia , Coração/fisiologia , Isquemia Miocárdica/metabolismo , Estresse Oxidativo , Antioxidantes/metabolismo , Circulação Coronária , Diabetes Mellitus/metabolismo , Coração/fisiopatologia , Humanos , Canais Iônicos/metabolismo , Íons/metabolismo , MicroRNAs/metabolismo , Isquemia Miocárdica/complicações , Oxirredução , Ácido Peroxinitroso/metabolismo , Fatores de Risco
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