Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.478
Filtrar
1.
Int Heart J ; 62(2): 407-415, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33678798

RESUMO

Exercise preconditioning (EP) provides protective effects for acute cardiovascular stress; however, its mechanisms need to be further investigated. Autophagy is a degradation pathway essential for myocardium health. Therefore, we investigated whether intermittent myocardial ischemia-hypoxia affected Beclin1 and whether the changes in autophagy levels contribute to EP-induced early myocardial protective effects. Rats were trained on a treadmill using an EP model (four cycles of 10 minutes of running/10 minutes of rest). Exhaustive exercise (EE) was performed to induce myocardial injury. Cardiac troponin I (cTnI) and ischemia-hypoxia staining were used to evaluate myocardial injury and protection. Double-labeled immunofluorescence staining and western blot analysis were employed to examine related markers. EP attenuated the myocardial ischemic-hypoxic injury induced by EE. Compared with the control (C) group, the dissociations of Beclin1/Bcl-2 ratio and Beclin1 expression were both higher in all other groups. Compared with the C group, PI3KC3 and the LC3-II/LC3-I ratio were higher in all other groups, whereas LC3-II was higher in the EE and EEP + EE groups. p62 was higher in the EE group than in the C group but lower in the EEP + EE group than in the EE group. We concluded that EP increases Beclin1 via intermittent myocardial ischemia-hypoxia and induces autophagy, which exerts early myocardial protective effects and reduces the myocardial ischemic-hypoxic injury induced by exhaustive exercise.


Assuntos
Proteína Beclina-1/metabolismo , Isquemia Miocárdica/prevenção & controle , Miocárdio/metabolismo , Condicionamento Físico Animal/métodos , Animais , Autofagia , Western Blotting , Modelos Animais de Doenças , Masculino , Isquemia Miocárdica/fisiopatologia , Miocárdio/patologia , Ratos , Ratos Sprague-Dawley
2.
Eur J Clin Invest ; 51(4): e13509, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33548060

RESUMO

BACKGROUND: No data are available about whether Coronavirus disease 2019 (COVID-19) pandemic have led to changes in clinical profiles or results of exercise testing once the usual activity was reassumed, as well as if wearing a facemask has any impact on the tests. The aim of this study is to evaluate differences in the patients referred to exercise stress testing in the context of COVID-19 pandemic and analyse the feasibility and results of these tests wearing a facemask. METHODS: We included all patients referred for an exercise test from 1 June to 30 September 2020 and compared them with the patients attended within the same period in 2019 before and after propensity score matching. All patients referred in 2020 wore a facemask. RESULTS: A total of 854 patients were included: 398 in the 2020 group and 456 in 2019. No significant differences in baseline characteristics of the patients were observed, with the exception of dyspnoea, which was nearly twice as high in 2020 as compared with 2019. Regarding the results of the tests, no differences were observed, with almost 80% of maximal tests, similar functional capacity and over a 20% of positive exercise tests in both groups. These results remained after propensity score matching. CONCLUSION: COVID-19 pandemic has not changed the clinical profile of patients referred to exercise testing. In addition, performing exercise testing wearing a facemask is feasible, with no influence in functional capacity and clinical results.


Assuntos
/prevenção & controle , Ecocardiografia sob Estresse/métodos , Eletrocardiografia , Teste de Esforço/métodos , Máscaras , Isquemia Miocárdica/diagnóstico , Idoso , Tolerância ao Exercício , Feminino , Humanos , Masculino , Equivalente Metabólico , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Desempenho Físico Funcional , Pontuação de Propensão , Encaminhamento e Consulta , Espanha
4.
Am J Cardiol ; 144: 37-45, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33383008

RESUMO

Early diastolic tissue velocity (e') by tissue Doppler imaging represents an early marker of left ventricular (LV) dysfunction in ischemic heart disease. We assessed the value of e' for predicting mortality in patients undergoing coronary artery bypass grafting (CABG). We retrospectively investigated patients treated with CABG between 2006-2011. Before surgery, all patients underwent an echocardiogram with tissue Doppler imaging to measure tissue velocities: systolic (s'), e', and late diastolic (a'). The primary outcome was all-cause mortality. Survival analysis was applied. Improvement of EuroSCORE-II was assessed by net reclassification index. Of 660 patients, 72 (11%) died during a median follow-up time of 3.8 years. Mean age was 68 years, LVEF 50%, and 84% were men. All tissue velocities showed a significant negative association with outcome and e' provided highest Harrell's C-statistics (c-stat=0.68). After multivariable adjustment for EuroSCORE-II, LV hypertrophy, LV internal diameter, and global longitudinal strain, declining e' was associated with a higher risk of mortality (HR=1.35 (1.12 to 1.61), p = 0.001, per 1cm/s absolute decrease). LVEF≤40% modified the relationship between both s' and e' and outcome (p for interaction=0.021 and 0.024, respectively), such that neither predicted mortality when LVEF was ≤40%. In patients with LVEF>40%, only e' remained a predictor after multivariable adjustments (HR=1.36 (1.10 to 1.69), p = 0.005, per 1cm/s absolute decrease). A net reclassification index improvement of 0.14 was observed when adding global e' to the EuroSCORE-II. In conclusion, e' is an independent predictor of all-cause mortality in patients undergoing CABG, especially in patients with LVEF>40%, and improves the predictive value of EuroSCORE-II.


Assuntos
Ponte de Artéria Coronária , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/cirurgia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Doenças Cardiovasculares/mortalidade , Diástole , Ecocardiografia Doppler em Cores , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Isquemia Miocárdica/fisiopatologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Volume Sistólico , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia
5.
Bol. méd. postgrado ; 36(2): 31-36, dic.2020. graf
Artigo em Espanhol | LILACS, LIVECS | ID: biblio-1117897

RESUMO

La cardiopatía isquémica es la causa más frecuente de morbimortalidad a nivel mundial. La artritis reumatoide (AR) se asocia con el desarrollo prematuro de enfermedades cardiovasculares y la esperanza de vida se reduce principalmente debido a un incremento en la muerte cardiovascular. Se realizó un estudio retrospectivo de revisión de historias médicas con el objetivo de describir el perfil clínico de los pacientes con cardiopatía isquémica y AR que acudieron a la Unidad de Prevención Secundaria y Rehabilitación Cardiovascular del Centro Cardiovascular Regional Centro Occidental desde enero 2013 hasta diciembre 2018. Se incluyeron 37 pacientes con diagnóstico de AR que presentaron algún evento coronario. Ell 62% de los pacientes eran del sexo femenino con una edad media de 59 ± 11 años; el 65% tenían menos de 10 años de diagnóstico de AR. El sedentarismo representó el factor más frecuente (92%), seguido de HTA (76%), tabaquismo (73%), DM (43%), antecedentes familiares de cardiopatía isquémica (24%), obesidad (22%), dislipidemia (16%) y ERC (11%); el tipo de evento coronario más frecuente fue el IMsEST (43%). El análisis multivariado no mostró relación estadísticamente significativa entre número de factores de riesgo y tiempo de duración de la AR con la presencia de lesiones coronarias. El sedentarismo fue el factor de riesgo más frecuente en esta población especial sin embargo el comportamiento de los factores de riesgo tradicionales para cardiopatía isquémica en los pacientes con AR no difiere del de la población general...(AU)


Ischemic heart disease is the most frequent cause of morbidity and mortality worldwide. Rheumatoid arthritis (RA) is associated with premature development of cardiovascular disease and life expectancy is mainly reduced due to an increase in cardiovascular death. A descriptive and retrospective review of medical charts was conducted with the objective of describing the clinical profile of patients with ischemic heart disease and RA who attended the Unidad de Prevención Secundaria y Rehabilitación Cardiovascular del Centro Cardiovascular Regional Centro Occidental from January 2013 to December 2018. 37 patients with RA diagnosis who presented a coronary event were included. The results show that 62% of patients were female with a mean age of 59 ± 11 years; 65% had less than 10 years of diagnosis of RA. Sedentary lifestyle represented the most frequent factor (92%), followed by HTA (76%), smoking (73%), DM (43%), family history of ischemic heart disease (24%), obesity (22%), dyslipidemia (16%) and finally CKD (11%); the most frequent type of coronary event was the IMsEST (43%). The multivariate analysis showed no statistically significant relationship between the number of risk factors and the duration of RA with the presence of coronary lesions. Sedentary lifestyle was the most frequent risk factor in this population however the behavior of traditional risk factors for ischemic heart disease in patients with RA does not differ from the general population...(AU)


Assuntos
Humanos , Masculino , Feminino , Artrite Reumatoide , Fatores de Risco , Isquemia Miocárdica/fisiopatologia , Técnicas de Laboratório Clínico , Doenças Cardiovasculares , Reabilitação Cardíaca
6.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33169595

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Assuntos
Cardiomegalia/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Coração/diagnóstico por imagem , Isquemia Miocárdica/diagnóstico por imagem , Miocardite/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Betacoronavirus , Cardiomegalia/fisiopatologia , Angiografia Coronária , Infecções por Coronavirus/fisiopatologia , Ecocardiografia , Edema/diagnóstico por imagem , Edema/fisiopatologia , Coração/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Isquemia Miocárdica/fisiopatologia , Miocardite/fisiopatologia , Pandemias , Derrame Pericárdico/fisiopatologia , Pneumonia Viral/fisiopatologia , Radiografia Torácica , Recuperação de Função Fisiológica , Tomografia Computadorizada por Raios X , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia
7.
PLoS One ; 15(10): e0239416, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002014

RESUMO

Predicting the electrical behavior of the heart, from the cellular scale to the tissue level, relies on the numerical approximation of coupled nonlinear dynamical systems. These systems describe the cardiac action potential, that is the polarization/depolarization cycle occurring at every heart beat that models the time evolution of the electrical potential across the cell membrane, as well as a set of ionic variables. Multiple solutions of these systems, corresponding to different model inputs, are required to evaluate outputs of clinical interest, such as activation maps and action potential duration. More importantly, these models feature coherent structures that propagate over time, such as wavefronts. These systems can hardly be reduced to lower dimensional problems by conventional reduced order models (ROMs) such as, e.g., the reduced basis method. This is primarily due to the low regularity of the solution manifold (with respect to the problem parameters), as well as to the nonlinear nature of the input-output maps that we intend to reconstruct numerically. To overcome this difficulty, in this paper we propose a new, nonlinear approach relying on deep learning (DL) algorithms-such as deep feedforward neural networks and convolutional autoencoders-to obtain accurate and efficient ROMs, whose dimensionality matches the number of system parameters. We show that the proposed DL-ROM framework can efficiently provide solutions to parametrized electrophysiology problems, thus enabling multi-scenario analysis in pathological cases. We investigate four challenging test cases in cardiac electrophysiology, thus demonstrating that DL-ROM outperforms classical projection-based ROMs.


Assuntos
Aprendizado Profundo , Fenômenos Eletrofisiológicos , Coração/fisiologia , Modelos Cardiovasculares , Isquemia Miocárdica/fisiopatologia , Dinâmica não Linear
8.
Vasc Health Risk Manag ; 16: 353-365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982263

RESUMO

Among the vast number of noncommunicable diseases encountered worldwide, cardiovascular diseases accounted for about 17.8 million deaths in 2017 and ischemic heart disease (IHD) remains the single-largest cause of death in countries across all income groups. Because conventional medications are not without shortcomings and patients still refractory to these medications, scientific investigation is ongoing to advance the management of IHD, and shows a great promise for better treatment modalities, but additional research can warrant improvement in terms of the quality of life of patients. Metabolic modulation is one promising strategy for the treatment of IHD, because alterations in energy metabolism are involved in progression of the disease. Therefore, the purpose of this review was to strengthen attention toward the use of metabolic modulators and to review the current level of knowledge on cardiac energy metabolic pathways.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Metabolismo Energético/efeitos dos fármacos , Mitocôndrias Cardíacas/efeitos dos fármacos , Isquemia Miocárdica/tratamento farmacológico , Miócitos Cardíacos/efeitos dos fármacos , Animais , Humanos , Mitocôndrias Cardíacas/metabolismo , Terapia de Alvo Molecular , Isquemia Miocárdica/metabolismo , Isquemia Miocárdica/fisiopatologia , Miócitos Cardíacos/metabolismo
9.
Int Heart J ; 61(5): 927-935, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879263

RESUMO

We prospectively collected device and heart rate data through remote monitoring (RM) of patients with an implantable cardioverter defibrillator (ICD). The objective was to identify the predictors of lethal arrhythmic events (VT/VF).Thirty-three patients (mean age: 50 years) with ICDs [with functionality of heart rate variability (HRV) analysis] were divided into two groups [VT/VF (+), VT/VF (-) ]. Clinical, device (ventricular lead impedance; amplitude of ventricular electrogram), and HRV data were compared between the two groups. The NN interval-index (SDNNi) was calculated for every 5 minutes, and the mean, maximum, minimum, and standard deviation of SDNNi during the 24-hour period were used.During the observation period of 13 ± 10 months, 10 patients experienced VT/VF events. Total mean, max, and min SDNNi were higher in the VT/VF (+) than the VT/VF (-) group (132.9 ± 9.3 versus 93.5 ± 6.1, P = 0.0013; 214.6 ± 10.6 versus 167.0 ± 7.0, P = 0.0007; 71.2 ± 7.5 versus 43.9 ± 4.9, P = 0.0047). On logistic regression analysis, a total mean SDNNi of 100.1, max SDNNi of 185.0 and min SDNNi of 52.0 as cut-off values for prediction of a VT/VF event demonstrated significant receiver operating characteristic (ROC) curves (AUC = 0.86, P = 0.0007; AUC = 0.84, P = 0.0005; AUC = 0.78, P = 0.0030). The max ΔSDNNi, i.e., difference from baseline SDNNi, and min ΔSDNNi in 7 and 28 days preceding VT/VF events were significant predictors of VT/VF events.Time-domain HRV analysis through a RM system may help identify patients at high risk of lethal arrhythmic events; in addition, it may help predict the occurrence of lethal arrhythmic events in specific cases.


Assuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Frequência Cardíaca , Taquicardia Ventricular/epidemiologia , Fibrilação Ventricular/epidemiologia , Adulto , Idoso , Síndrome de Brugada/fisiopatologia , Cardiomiopatias/fisiopatologia , Feminino , Humanos , Síndrome do QT Longo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Tecnologia de Sensoriamento Remoto , Taquicardia Ventricular/fisiopatologia , Fibrilação Ventricular/fisiopatologia
10.
Asian Cardiovasc Thorac Ann ; 28(9): 633-637, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32870026

RESUMO

Optimal treatment for patients with ischemic heart disease and severe left ventricular dysfunction is a debatable subject in the literature. The largest and only trial on the subject so far is the Surgical Treatment for Ischemic Heart Failure trial. This trial compared coronary artery bypass grafting with optimal medical treatment in one arm versus coronary artery bypass grafting with surgical ventricular restoration in the second arm. Recently, the 10-year follow-up data of various subsets of the trial have been published. This study reviews various pertinent clinical issues related to the trial and its sub-studies and their relevance in routine modern-day clinical practice.


Assuntos
Ponte de Artéria Coronária , Insuficiência Cardíaca/cirurgia , Isquemia Miocárdica/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Disfunção Ventricular Esquerda/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
11.
Am J Physiol Heart Circ Physiol ; 319(3): H682-H693, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32795177

RESUMO

An ischemic insult is accompanied by an acute increase in circulating fatty acid (FA) levels, which can induce adverse changes related to cardiac metabolism/energetics. Although chronic hyperlipidemia contributes to the pathogenesis of obesity-/diabetes-related cardiomyopathy, it is unclear how these hearts are affected by an acute high FA-load. We hypothesize that adaptation to chronic FA exposure enhances the obese hearts' ability to handle an acute high FA-load. Diet-induced obese (DIO) and age-matched control (CON) mouse hearts were perfused in the presence of low- or high FA-load (0.4 and 1.8 mM, respectively). Left ventricular (LV) function, FA oxidation rate, myocardial oxygen consumption, and mechanical efficiency were assessed, followed by analysis of myocardial oxidative stress, mitochondrial respiration, protein acetylation, and gene expression. Finally, ischemic tolerance was determined by examining LV functional recovery and infarct size. Under low-FA conditions, DIO hearts showed mild LV dysfunction, oxygen wasting, mechanical inefficiency, and reduced mitochondrial OxPhos. High FA-load increased FA oxidation rates in both groups, but this did not alter any of the above parameters in DIO hearts. In contrast, CON hearts showed FA-induced mechanical inefficiency, oxidative stress, and reduced OxPhos, as well as enhanced acetylation and activation of PPARα-dependent gene expression. While high FA-load did not alter functional recovery and infarct size in CON hearts, it increased ischemic tolerance in DIO hearts. Thus, this study demonstrates that acute FA-load affects normal and obese hearts differently and that chronically elevated circulating FA levels render the DIO heart less vulnerable to the disadvantageous effects of an acute FA-load.NEW & NOTEWORTHY An acute myocardial fat-load leads to oxidative stress, oxygen wasting, mechanical inefficiency, hyperacetylation, and impaired mitochondrial function, which can contribute to reduced ischemic tolerance. Following obesity/insulin resistance, hearts were less affected by a high fat-load, which subsequently also improved ischemic tolerance. This study highlights that an acute fat-load affects normal and obese hearts differently and that obesity renders hearts less vulnerable to the disadvantageous effects of an acute fat-load.


Assuntos
Cardiomiopatias/metabolismo , Dieta Hiperlipídica , Metabolismo Energético , Ácidos Graxos/metabolismo , Isquemia Miocárdica/metabolismo , Miocárdio/metabolismo , Obesidade/metabolismo , Adaptação Fisiológica , Animais , Cardiomiopatias/etiologia , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Modelos Animais de Doenças , Masculino , Camundongos Endogâmicos C57BL , Mitocôndrias Cardíacas/metabolismo , Mitocôndrias Cardíacas/patologia , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Miocárdio/patologia , Obesidade/etiologia , Obesidade/patologia , Obesidade/fisiopatologia , Consumo de Oxigênio , Espécies Reativas de Oxigênio/metabolismo , Função Ventricular Esquerda
12.
PLoS One ; 15(8): e0236457, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790682

RESUMO

Transgenic mice with selective induction of calreticulin transgene expression in cardiomyocytes (CardiacCRT+) were analyzed. CardiacCRT+ cardiomyocytes showed increased contractility and Ca2+ transients. Yet, in vivo assessment of cardiac performance, and ischemic tolerance of CardiacCRT+ mice demonstrated right ventricle dilation and reduced cardiac output, increased QT interval and decreased P amplitude. Paradoxically, ex vivo working hearts from CardiacCRT+ mice showed enhanced ischemic cardio-protection and cardiac efficiency. Under aerobic conditions, CardiacCRT+ hearts showed less efficient cardiac function than sham control hearts due to an increased ATP production from glycolysis relative to glucose oxidation. During reperfusion, this inefficiency was reversed, with CardiacCRT+ hearts exhibiting better functional recovery and increased cardiac efficiency compared to sham control hearts. On the other hand, mechanical stretching of isolated cardiac fibroblasts activated the IRE1α branch of the unfolded protein response pathway as well as induction of Col1A2 and TGFß gene expression ex vivo, which were all suppressed by tauroursodeoxycholic acid.


Assuntos
Calreticulina/metabolismo , Contração Miocárdica , Isquemia Miocárdica/metabolismo , Miócitos Cardíacos/metabolismo , Animais , Calreticulina/genética , Células Cultivadas , Metabolismo Energético , Frequência Cardíaca , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Isquemia Miocárdica/genética , Isquemia Miocárdica/fisiopatologia , Miócitos Cardíacos/patologia , Regulação para Cima
13.
Am J Physiol Regul Integr Comp Physiol ; 319(3): R347-R357, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32755463

RESUMO

How low-level psychological stress and overnutrition interact in influencing cardiometabolic disease is unclear. Mechanistic overlaps suggest potential synergies; however, findings are contradictory. We test whether low-level stress and Western diet (WD) feeding synergistically influence homeostasis, mood, and myocardial ischemic tolerance. Male C57BL6/J mice were fed a control diet or WD (32%/57%/11% calories from fat/carbohydrates/protein) for 12 wk, with subgroups restrained for 30 min/day over the final 3 wk. Metabolism, behavior, tolerance of perfused hearts to ischemia-reperfusion (I/R), and cardiac "death proteins" were assessed. The WD resulted in insignificant trends toward increased body weight (+5%), glucose (+40%), insulin (+40%), triglycerides (+15%), and cholesterol (+20%) and reduced leptin (-20%) while significantly reducing insulin sensitivity [100% rise in homeostasis model assessment of insulin resistance (HOMA-IR), P < 0.05]. Restraint did not independently influence metabolism while increasing HOMA-IR a further 50% (and resulting in significant elevations in insulin and glucose to 60-90% above control) in WD mice (P < 0.05), despite blunting weight gain in control and WD mice. Anxiogenesis with restraint or WD was nonadditive, whereas anhedonia (reduced sucrose consumption) only arose with their combination. Neuroinflammation markers (hippocampal TNF-α, Il-1b) were unchanged. Myocardial I/R tolerance was unaltered with stress or WD alone, whereas the combination worsened dysfunction and oncosis [lactate dehydrogenase (LDH) efflux]. Apoptosis (nucleosome accumulation) and death protein expression (BAK, BAX, BCL-2, RIP-1, TNF-α, cleaved caspase-3, and PARP) were unchanged. We conclude that mild, anxiogenic yet cardio-metabolically "benign" stress interacts synergistically with a WD to disrupt homeostasis, promote anhedonia (independently of neuroinflammation), and impair myocardial ischemic tolerance (independently of apoptosis and death protein levels).


Assuntos
Dieta Hiperlipídica , Ingestão de Energia/fisiologia , Homeostase/fisiologia , Isquemia Miocárdica/fisiopatologia , Miocárdio/metabolismo , Animais , Coração/fisiopatologia , Resistência à Insulina/fisiologia , Camundongos Endogâmicos C57BL , Isquemia Miocárdica/metabolismo , Obesidade/fisiopatologia
14.
Medicine (Baltimore) ; 99(34): e21794, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846812

RESUMO

Patients with cardiovascular diseases frequently experience exertional dyspnea. However, the relationship between respiratory muscle strength including its fatigue and cardiovascular dysfunctions remains to be clarified.The maximal inspiratory pressure/maximal expiratory pressure (MIP/MEP) before and after cardiopulmonary exercise testing (CPX) in 44 patients with heart failure and ischemic heart disease were measured. Respiratory muscle fatigue was evaluated by calculating MIP (MIPpost/MIPpre) and MEP (MEPpost/MEPpre) changes.The mean MIPpre and MEPpre values were 67.5 ±â€Š29.0 and 61.6 ±â€Š23.8 cm H2O, respectively. After CPX, MIP decreased in 25 patients, and MEP decreased in 22 patients. We evaluated the correlation relationship between respiratory muscle function including respiratory muscle fatigue and exercise capacity evaluated by CPX such as peak VO2 and VE/VCO2 slope. Among MIP, MEP, change in MIP, and change in MEP, only the value of change in MIP had an association with the value of VE/VCO2 slope (R = -0.36, P = .017). In addition, multivariate analysis for determining factor of change in MIP revealed that the association between the change in MIP and eGFR was independent from other confounding parameters (beta, 0.40, P = .017). The patients were divided into 2 groups, with (MIP change < 0.9) and without respiratory muscle fatigue (MIP change > 0.9), and a significant difference in peak VO2 (14.2 ±â€Š3.4 [with fatigue] vs 17.4 ±â€Š4.7 [without fatigue] mL/kg/min; P = .020) was observed between the groups.Respiratory muscle fatigue demonstrated by the change of MIP before and after CPX significantly correlated with exercise capacity and renal function in patients with cardiovascular disease.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Fadiga Muscular , Isquemia Miocárdica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Idoso , Exercício Físico/fisiologia , Teste de Esforço , Tolerância ao Exercício , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/fisiopatologia , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade
15.
Anesth Analg ; 131(3): 792-807, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32665471

RESUMO

Intraaortic balloon pump (IABP) counterpulsation, introduced more than 50 years ago, remains the most commonly utilized mechanical circulatory support device for patients with cardiogenic shock and myocardial ischemia, despite lack of definitive proof regarding its outcome in these patients. Part I of this review focused on the history of counterpulsation, physiologic principles, technical considerations, and evidence for its use in cardiogenic shock; Part II will discuss periprocedural uses for IABP counterpulsation and review advances in technology, including the emergence of alternative mechanical circulatory support devices that have influenced IABP utilization.


Assuntos
Coração Auxiliar/tendências , Hemodinâmica , Balão Intra-Aórtico/tendências , Isquemia Miocárdica/terapia , Revascularização Miocárdica , Choque Cardiogênico/terapia , Difusão de Inovações , Humanos , Balão Intra-Aórtico/efeitos adversos , Balão Intra-Aórtico/instrumentação , Balão Intra-Aórtico/mortalidade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/mortalidade , Recuperação de Função Fisiológica , Fatores de Risco , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Resultado do Tratamento , Função Ventricular
16.
Am J Physiol Heart Circ Physiol ; 319(2): H396-H409, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32678707

RESUMO

Myocardial ischemia leads to conduction slowing, cell-to-cell uncoupling, and arrhythmias. We previously demonstrated that varying perfusate sodium (Na+) and calcium (Ca2+) attenuates conduction slowing and arrhythmias during simulated ischemia with continuous perfusion. Cardioprotection was selectively associated with widening of the perinexus, a gap junction adjacent nanodomain important to ephaptic coupling. It is unknown whether perfusate composition affects the perinexus or ischemic conduction during nonsimulated ischemia, when coronary flow is reduced or halted. We hypothesized that altering preischemic perfusate composition could facilitate perinexal expansion and attenuate conduction slowing during global ischemia. To test this hypothesis, ex vivo guinea pig hearts (n = 49) were Langendorff perfused with 145 or 153 mM Na+ and 1.25 or 2.0 mM Ca2+ and optically mapped during 30 min of no-flow ischemia. Altering Na+ and Ca2+ did not substantially affect baseline conduction. Increasing Na+ and decreasing Ca2+ both lowered pacing thresholds, whereas increasing Ca2+ narrowed perinexal width (Wp). A least squares mean estimate revealed that reduced perfusate Na+ and Ca2+ resulted in the most severe conduction slowing during ischemia. Increasing Na+ alone modestly attenuated conduction slowing, yet significantly delayed the median time to conduction block (10 to 16 min). Increasing both Na+ and Ca2+ selectively widened Wp during ischemia (22.7 vs. 15.7 nm) and attenuated conduction slowing to the greatest extent. Neither repolarization nor levels of total or phosphorylated connexin43 correlated with conduction slowing or block. Thus, perfusate-dependent widening of the perinexus preserved ischemic conduction and may be an adaptive response to ischemic stress.NEW & NOTEWORTHY Conduction slowing during acute ischemia creates an arrhythmogenic substrate. We have shown that extracellular ionic concentrations can alter conduction by modulating ephaptic coupling. Here, we demonstrate increased extracellular sodium and calcium significantly attenuate conduction slowing during no-flow ischemia. This effect was associated with selective widening of the perinexus, an intercalated disc nanodomain and putative cardiac ephapse. These findings suggest that acute changes in ephaptic coupling may serve as an adaptive response to ischemic stress.


Assuntos
Bradicardia/prevenção & controle , Cálcio/metabolismo , Bloqueio Cardíaco/prevenção & controle , Sistema de Condução Cardíaco/metabolismo , Frequência Cardíaca , Isquemia Miocárdica/metabolismo , Sódio/metabolismo , Potenciais de Ação , Animais , Bradicardia/etiologia , Bradicardia/metabolismo , Bradicardia/fisiopatologia , Circulação Coronária , Modelos Animais de Doenças , Cobaias , Bloqueio Cardíaco/etiologia , Bloqueio Cardíaco/metabolismo , Bloqueio Cardíaco/fisiopatologia , Preparação de Coração Isolado , Masculino , Isquemia Miocárdica/complicações , Isquemia Miocárdica/fisiopatologia , Transdução de Sinais , Fatores de Tempo
17.
Cardiovasc Ther ; 2020: 3480276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32565909

RESUMO

Wenxin Keli (WXKL) is a traditional Chinese medicine drug approved for the treatment of cardiovascular diseases. This study aimed to identify WXKL-targeting genes involved in antiarrhythmic efficacy of WXKL. The Traditional Chinese Medicine Systems Pharmacology (TCMSP) technology platform was used to screen active compounds of WXKL and WXKL-targeting arrhythmia-related genes. A pig model of myocardial ischemia (MI) was established by balloon-expanding the endothelium of the left coronary artery. Pigs were divided into the model group and WXKL group (n = 6). MI, QT interval, heart rate, and arrhythmia were recorded, and the mRNA expression of target genes in myocardial tissues was detected by PCR. Eleven active ingredients of WXKL and eight WXKL-targeting arrhythmia-related genes were screened. Five pathways were enriched, and an "ingredient-gene-path" network was constructed. WXKL markedly decreased the incidence of arrhythmia in the MI pig model (P < 0.05). The QT interval was significantly shortened, and the heart rate was slowed down in the WXKL group compared with the model group (P < 0.05). In addition, the expression of sodium channel protein type 5 subunit alpha (SCN5A) and beta-2 adrenergic receptor (ADRB2) was downregulated, while muscarinic acetylcholine receptor M2 (CHRM2) was upregulated in the WXKL group (P < 0.05). In conclusion, WXKL may shorten the QT interval and slow down the heart rate by downregulating SCN5A and ADRB2 and upregulating CHRM2 during MI. These findings provide novel insight into molecular mechanisms of WXKL in reducing the incidence of ventricular arrhythmia.


Assuntos
Potenciais de Ação/efeitos dos fármacos , Antiarrítmicos/farmacologia , Arritmias Cardíacas/prevenção & controle , Medicamentos de Ervas Chinesas/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Isquemia Miocárdica/tratamento farmacológico , Potenciais de Ação/genética , Animais , Arritmias Cardíacas/genética , Arritmias Cardíacas/metabolismo , Arritmias Cardíacas/fisiopatologia , Modelos Animais de Doenças , Regulação da Expressão Gênica , Redes Reguladoras de Genes , Frequência Cardíaca/genética , Masculino , Medicina Tradicional Chinesa , Isquemia Miocárdica/genética , Isquemia Miocárdica/metabolismo , Isquemia Miocárdica/fisiopatologia , Canal de Sódio Disparado por Voltagem NAV1.5/genética , Canal de Sódio Disparado por Voltagem NAV1.5/metabolismo , Mapas de Interação de Proteínas , Receptor Muscarínico M2/genética , Receptor Muscarínico M2/metabolismo , Receptores Adrenérgicos beta 2/genética , Receptores Adrenérgicos beta 2/metabolismo , Suínos , Porco Miniatura , Fatores de Tempo
18.
Angiology ; 71(8): 726-733, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32551954

RESUMO

Vascular function in dilated cardiomyopathy of different etiology has been poorly investigated. Moreover, reference values of flow-mediated dilation (FMD) in chronic heart failure (CHF) need to be updated according to the new standardized protocols. We characterized the vascular impairment in different stages of post-ischemic dilated cardiomyopathy (PI-DC) or idiopathic dilated cardiomyopathy (I-DC). Eighty consecutive outpatients with CHF in different New York Heart Association (NYHA) classes (45 PI-DC, 35 I-DC) and 50 control subjects underwent FMD and brachial distensibility coefficient measurement. Patients with CHF showed a marked impairment in FMD compared with controls that worsened from classes NYHA I-II to III-IV, independently of etiology (P < .05). New York Heart Association I-II PI-DC patients showed a worse FMD compared with NYHA I-II I-DC patients (P < .05). Brachial distensibility coefficient values were significantly lower in patients with CHF compared with controls (P < .001) without differences between PI-DC and I-DC. In conclusion, advanced CHF is characterized by vascular impairment that is independent of etiology. In the early stages of CHF, endothelial dysfunction is more severe in patients with PI-DC compared with I-DC probably due to the high cardiovascular risk profile. In I-DC, vascular function impairment is independent of cardiovascular risk factors and could participate in the pathogenesis of I-DC.


Assuntos
Artéria Braquial/fisiopatologia , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/fisiopatologia , Isquemia Miocárdica/complicações , Rigidez Vascular , Vasodilatação , Idoso , Artéria Braquial/diagnóstico por imagem , Cardiomiopatia Dilatada/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/fisiopatologia , Prognóstico , Medição de Risco , Fatores de Risco
19.
Int J Cardiovasc Imaging ; 36(10): 2063-2071, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32495064

RESUMO

To compare the left ventricular (LV) phase dyssynchrony parameters obtained from Tc-99m Sestamibi SPECT (GSPECT) and F-18 FDG PET(GPET), as well as the prognostic values in patients with ischemic cardiomyopathy (ICM). Consecutive ICM patients referred for myocardial viability assessment were retrospectively evaluated and were followed-up for 21 ± 5 months. Phase parameter from both GSPECT and GPET were analyzed by QGS software, including histogram bandwidth (BW), standard deviation (SD) and entropy. Independent predictor for cardiac death was analyzed by Cox regression analysis. The estimated cardiac survival curve was analyzed by and was compared with the log-rank test. Eight-eight (mean age 56 ± 10, male 94%, LVEFSPECT23 ± 10%) ICM patients were included for analysis. Moderate correlations were observed for BW (r = 0.65; p < 0.001), SD (r = 0.63; p < 0.001) and entropy (r = 0.73; p < 0.001) between GSPECT and GPET. Among all covariates, the extent of myocardial scar was significantly associated with the differences of SD (r = 0.22; p < 0.05) and entropy (r = - 0.7; p < 0.05), whereas the extent of myocardial viability was not (all p > 0.05). Entropy measured by GSPECT was the predictor for cardiac death (p = 0.037) while QRS duration was not. The cardiac survival of patients with a high entropy (≥ 59%) was significantly lower than that of patients with low entropy (< 59%) (p < 0.05). GSPECT and GPET-derived phase parameters were not interchangeable in ICM patients. Patients with LV dyssynchrony measured by gated SPECT were associated with a worse outcome.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Isquemia Miocárdica/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Tecnécio Tc 99m Sestamibi/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Cardiomiopatias/etiologia , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia
20.
Inflamm Res ; 69(7): 667-681, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32350569

RESUMO

OBJECTIVES: Ischemic heart failure (IHF) is the most common cause of death globally. Growing evidence shows abnormal expression of long non-coding RNAs in heart failure patients. This study aims to investigate the effect of sex-determining region Y-box 2 (SOX2) overlapping transcript (SOX2-OT) on the regulation of the inflammatory response in ischemic heart failure. METHODS: IHF rat and oxygen and glucose deprivation (OGD) cell models were established. qRT-PCR was employed to investigate the expression of SOX2-OT. ELISA, western blot and cell viability/apoptosis assays were performed to assess the effects of SOX2-OT. Online software program was used to identify miRNAs that target SOX2-OT, followed by validation using RNA pull-down. Potential targets of miRNAs were searched, and examined by immunoblotting, qRT-PCR and luciferase reporter assay. RESULTS: SOX2-OT was up-regulated in IHF and OGD. Knockdown of SOX2-OT promoted cell proliferation, decreased apoptosis rate and cell oxidative damage, and ameliorated inflammatory response. SOX2-OT contains binding sites for miR-455-3p, miR-5586-3p and miR-1252-5p. RNA pull-down confirmed the binding ability between SOX2-OT and miR-455-3p. TRAF6 is a direct target of miR-455-3p. Moreover, the regulatory activity of SOX2-OT on inflammatory response was partially through its negative regulation of miR-455-3p, which directly regulates TRAF6. Down-regulation of SOX2-OT improved myocardial dysfunction in IHF rat. CONCLUSIONS: Our results reveal that SOX2-OT may be a driver of IHF through repression of miR-455-3p, and miR-455-3p alleviates IHF by targeting TRAF6. Therefore, SOX2-OT/miR-455-3p/TRAF6 may be a potential target for advanced therapeutic strategy for IHF.


Assuntos
Inflamação/fisiopatologia , MicroRNAs/fisiologia , Isquemia Miocárdica/fisiopatologia , RNA Longo não Codificante/fisiologia , Fator 6 Associado a Receptor de TNF/fisiologia , Animais , Sítios de Ligação , Linhagem Celular , Regulação da Expressão Gênica , Técnicas de Silenciamento de Genes , Insuficiência Cardíaca/fisiopatologia , Inflamação/genética , Masculino , MicroRNAs/metabolismo , Isquemia Miocárdica/genética , Miócitos Cardíacos , RNA Longo não Codificante/genética , RNA Longo não Codificante/metabolismo , Ratos , Ratos Sprague-Dawley , Transfecção
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...