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1.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518185

RESUMO

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.


Assuntos
COVID-19 , Tamponamento Cardíaco , Derrame Pleural , Adulto , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Humanos , Masculino , Pericardiocentese , Pericárdio , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , SARS-CoV-2
2.
Front Endocrinol (Lausanne) ; 12: 726967, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484128

RESUMO

In March 2020, the WHO declared coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a global pandemic. Obesity was soon identified as a risk factor for poor prognosis, with an increased risk of intensive care admissions and mechanical ventilation, but also of adverse cardiovascular events. Obesity is associated with adipose tissue, chronic low-grade inflammation, and immune dysregulation with hypertrophy and hyperplasia of adipocytes and overexpression of pro-inflammatory cytokines. However, to implement appropriate therapeutic strategies, exact mechanisms must be clarified. The role of white visceral adipose tissue, increased in individuals with obesity, seems important, as a viral reservoir for SARS-CoV-2 via angiotensin-converting enzyme 2 (ACE2) receptors. After infection of host cells, the activation of pro-inflammatory cytokines creates a setting conducive to the "cytokine storm" and macrophage activation syndrome associated with progression to acute respiratory distress syndrome. In obesity, systemic viral spread, entry, and prolonged viral shedding in already inflamed adipose tissue may spur immune responses and subsequent amplification of a cytokine cascade, causing worse outcomes. More precisely, visceral adipose tissue, more than subcutaneous fat, could predict intensive care admission; and lower density of epicardial adipose tissue (EAT) could be associated with worse outcome. EAT, an ectopic adipose tissue that surrounds the myocardium, could fuel COVID-19-induced cardiac injury and myocarditis, and extensive pneumopathy, by strong expression of inflammatory mediators that could diffuse paracrinally through the vascular wall. The purpose of this review is to ascertain what mechanisms may be involved in unfavorable prognosis among COVID-19 patients with obesity, especially cardiovascular events, emphasizing the harmful role of excess ectopic adipose tissue, particularly EAT.


Assuntos
COVID-19/metabolismo , Cardiomiopatias/metabolismo , Gordura Intra-Abdominal/metabolismo , Obesidade/metabolismo , Tecido Adiposo/metabolismo , Tecido Adiposo/patologia , Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/complicações , COVID-19/imunologia , Cardiomiopatias/imunologia , Cardiomiopatias/patologia , Cardiopatias/imunologia , Cardiopatias/metabolismo , Cardiopatias/patologia , Humanos , Inflamação , Gordura Intra-Abdominal/patologia , Obesidade/complicações , Obesidade/imunologia , Obesidade/patologia , Pericárdio , Prognóstico , SARS-CoV-2/metabolismo , Serina Endopeptidases/metabolismo
3.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(4): 776-784, 2021 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-34393244

RESUMO

OBJECTIVE: To examine the morphology and biocompatibility of a native acellular porcine pericardium (APP) in vitro and to evaluate its barrier function and effects on osteogenesis when used in guided bone regeneration (GBR) in vivo. METHODS: First, the morphology of APP (BonanGenⓇ) was detected using a scanning electron microscope (SEM). Next, for biocompatibility test, proliferation of human bone marrow mesenchymal stem cells (hBMSCs) were determined using cell counting kit-8 (CCK-8) after being seeded 1, 3 and 7 days. Meanwhile, the cells stained with phalloidine and 4, 6-diamidino-2-phenylindole (DAPI) were observed using a confocal laser scanning microscopy (CLSM) to view the morphology of cell adhesion and pattern of cell proliferation on day 5. A 3-Beagle dog model with 18 teeth extraction sockets was used for the further research in vivo. These sites were randomly treated by 3 patterns below: filled with Bio-OssⓇand coverd by APP membrane (APP group), filled with Bio-OssⓇand covered by Bio-GideⓇmembrane (BG group) and natural healing (blank group). Micro-CT and hematoxylin-eosin (HE) were performed after 4 and 12 weeks. RESULTS: A bilayer and three-dimensional porous ultrastructure was identified for APP through SEM. In vitro, APP facilitated proliferation and adhesion of hBMSCs, especially after 7 days (P < 0.05). In vivo, for the analysis of the whole socket healing, no distinct difference of new bone ratio was found between all the three groups after 4 weeks (P>0.05), however significantly more new bone regeneration was detected in APP group and BG group in comparison to blank group after 12 weeks (P < 0.05). The radio of bone formation below the membrane was significantly higher in APP group and BG group than blank group after 4 and 12 weeks (P < 0.05), however, the difference between APP group and BG group was merely significant in 12 weeks (P < 0.05). Besides, less resorption of buccal crest after 4 weeks and 12 weeks was observed in APP group of a significant difference compared in blank group (P < 0.05). The resorption in BG group was slightly lower than blank group (P>0.05). CONCLUSION: APP showed considerable biocompatibility and three-dimentional structure. Performing well as a barrier membrane in the dog alveolar ridge preservation model, APP significantly promoted bone regeneration below it and reduced buccal crest resorption. On the basis of this study, APP is a potential osteoconductive and osteoinductive biomaterial.


Assuntos
Regeneração Óssea , Osteogênese , Animais , Materiais Biocompatíveis , Cães , Humanos , Pericárdio , Suínos , Extração Dentária , Alvéolo Dental
4.
Curr Cardiol Rep ; 23(10): 150, 2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34448954

RESUMO

PURPOSE OF REVIEW: To discuss the possible harmful effects and pathophysiology of exercise in cases of pericarditis, explore the role of multi-modality imaging to help guide exercise recommendations, and compare U.S. with European guideline recommendations on the safe resumption of physical activity following resolution of pericarditis. RECENT FINDINGS: Despite multiple postulated mechanisms by which exercise may be harmful during active inflammation of the myocardium or pericardium, the exact pathophysiology remains largely unknown. The inclusion of multi-modality cardiac imaging may play a role in further elucidating the relationship of exercise with outcomes in pericarditis. More recently, the prevalence of COVID-19 cardiac involvement in athletes prior to returning to play appears lower than previously reported; however, current recommendations are consistent with those for other etiologies of pericarditis. Further research is certainly needed to better understand the relationship between physical activity and pericarditis, the pathophysiology, and the prognostic role of multimodality imaging.


Assuntos
COVID-19 , Pericardite , Exercício Físico , Humanos , Pericardite/terapia , Pericárdio , SARS-CoV-2
5.
Chemosphere ; 282: 131124, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34374342

RESUMO

Environmental exposure to nanoplastics is inevitable as the application of nanoplastics in our daily life is more and more extensively. So, the adverse effects of nanoplastics on human health are also gaining greater concerns. However, the subsequent toxicological response to nanoplastics, especially on cardiovascular damage was still largely unknown. In this regard, the evaluation of cardiovascular effects of nanoplastics was performed in zebrafish embryos. The results indicated that the no observed adverse effect level (NOAEL) of nanoplastics is 50 µg/mL. The pericardial toxicity and hemodynamic changes were assessed by Albino (melanin allele) mutant zebrafish line. Severe pericardial edema was observed in zebrafish embryos after exposure to nanoplastics. At the concentration higher than NOAEL, nanoplastics significantly decreased the cardiac output (CO) and blood flow velocity. The fluorescence images manifested that the nanoplastics could inhibit the subintestinal angiogenesis of transgenic zebrafish embryos line Tg (fli-1: EGFP), which might disturb the cardiovascular formation and development. The resulting vascular endothelial dysfunction and hypercoagulable state of circulating blood further accelerated thrombosis. Reactive oxidative stress (ROS) and systemic inflammation were also found in Wild AB and Tg (mpo: GFP) zebrafish embryos, respectively. We also found many neutrophils recruiting in the tail vein where the zebrafish embryo thrombosis occurred. Our data suggested that nanoplastics could trigger the cardiovascular toxicity in zebrafish embryos, which could provide an essential clue for the safety assessment of nanoplastics.


Assuntos
Nanopartículas , Peixe-Zebra , Animais , Embrião não Mamífero , Humanos , Microplásticos , Pericárdio , Polietileno
6.
Tex Heart Inst J ; 48(3)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34379771

RESUMO

A 79-year-old man had an out-of-hospital acute ST-segment-elevation myocardial infarction with cardiac arrest. Cardiopulmonary resuscitation performed by a bystander resulted in traumatic hemopericardium. We discuss the patient's case, highlight the challenges of managing simultaneously life-threatening thrombosis and hemorrhage, and present our conclusions regarding the patient's eventual death.


Assuntos
Tamponamento Cardíaco/terapia , Derrame Pericárdico/terapia , Pericardiocentese/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Traumatismos Torácicos/complicações , Trombose/terapia , Idoso , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Angiografia Coronária , Ecocardiografia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/terapia , Humanos , Masculino , Derrame Pericárdico/complicações , Derrame Pericárdico/diagnóstico , Pericárdio , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Traumatismos Torácicos/diagnóstico , Trombose/etiologia
7.
Medicine (Baltimore) ; 100(34): e27043, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449489

RESUMO

ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is a risk factor for cardiac mortality. Pericoronary adipose tissue (PCAT) attenuation, expressed by the fat attenuation index on coronary computed tomography angiography, reflects pericoronary inflammation. We aimed to investigate the association between PCAT attenuation and NAFLD.This is a single-center cohort study comprising of patients who underwent coronary computed tomography angiography for suspected stable coronary artery disease between January and December 2020. Patient characteristics and coronary computed tomography angiography findings were analyzed between patients with NAFLD (n = 78) and a propensity score-matched cohort of patients without NAFLD (n = 78). PCAT attenuation was assessed in Hounsfield units (HU) of proximal 40-mm segments of the left anterior descending artery (LAD) and right coronary artery.The mean PCAT attenuation in LAD and right coronary artery were significantly higher in patients with NAFLD than those without NAFLD. When patients were divided into 2 groups using the median LAD-PCAT attenuation of -72.5 HU, the high PCAT attenuation group had more males (82% vs 67%, P = .028) and NAFLD patients (63% vs 37%, P = .001) compared to the low PCAT attenuation group. No differences in age, body mass index, conventional cardiovascular risk factors, or the presence of high-risk plaque were observed between the 2 groups. In the multivariate logistic analysis, NAFLD was independently associated with high PCAT attenuation (odds ratio 2.912, 95% confidence interval 1.386 to 6.118, P = .005).NAFLD is associated with high PCAT attenuation on coronary computed tomography angiography. This finding suggests that pericoronary inflammation is involved in the increased cardiac mortality in NAFLD patients.


Assuntos
Tecido Adiposo/patologia , Doença da Artéria Coronariana/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Tecido Adiposo/diagnóstico por imagem , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Comorbidade , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/patologia , Pericárdio , Fatores Sexuais
8.
Cardiovasc Diabetol ; 20(1): 147, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284784

RESUMO

BACKGROUND: Both visceral adipose tissue and epicardial adipose tissue (EAT) have pro-inflammatory properties. The former is associated with Coronavirus Disease 19 (COVID-19) severity. We aimed to investigate whether an association also exists for EAT. MATERIAL AND METHODS: We retrospectively measured EAT volume using computed tomography (CT) scans (semi-automatic software) of inpatients with COVID-19 and analyzed the correlation between EAT volume and anthropometric characteristics and comorbidities. We then analyzed the clinicobiological and radiological parameters associated with severe COVID-19 (O2 [Formula: see text] 6 l/min), intensive care unit (ICU) admission or death, and 25% or more CT lung involvement, which are three key indicators of COVID-19 severity. RESULTS: We included 100 consecutive patients; 63% were men, mean age was 61.8 ± 16.2 years, 47% were obese, 54% had hypertension, 42% diabetes, and 17.2% a cardiovascular event history. Severe COVID-19 (n = 35, 35%) was associated with EAT volume (132 ± 62 vs 104 ± 40 cm3, p = 0.02), age, ferritinemia, and 25% or more CT lung involvement. ICU admission or death (n = 14, 14%) was associated with EAT volume (153 ± 67 vs 108 ± 45 cm3, p = 0.015), hypertension and 25% or more CT lung involvement. The association between EAT volume and severe COVID-19 remained after adjustment for sex, BMI, ferritinemia and lung involvement, but not after adjustment for age. Instead, the association between EAT volume and ICU admission or death remained after adjustment for all five of these parameters. CONCLUSIONS: Our results suggest that measuring EAT volume on chest CT scans at hospital admission in patients diagnosed with COVID-19 might help to assess the risk of disease aggravation.


Assuntos
Tecido Adiposo/diagnóstico por imagem , COVID-19/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/terapia , Feminino , Humanos , Unidades de Terapia Intensiva , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
Kardiologiia ; 61(6): 59-68, 2021 Jul 01.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34311689

RESUMO

Aim      To study the effect of hypoxia on the activity of epithelial-mesenchymal transition (EMT) in epicardial cells, which provides formation of a specialized microenvironment.Material and methods   This study used a model of experimental myocardial infarction created by ligation of the anterior descendent coronary artery. The activity of epicardial cells after a hypoxic exposure was studied with the hypoxia marker, pimonidazole, bromodeoxyuridine, immunofluorescent staining of heart cryosections, and in vitro mesothelial cell culture.Results The undamaged heart maintained the quiescent condition of mesothelial cells and low levels of their proliferation, extracellular matrix protein production, and of the EMT activity. Acute ischemic injury induced moderate hypoxia in the epicardial/subepicardial region. This caused a global rearrangement of this region due to the initiation of EMT in cells, changes in the cell composition, and accumulation of extracellular matrix proteins. We found that the initiation of EMT in mesothelial cells may result in the formation of smooth muscle cell precursors, fibroblasts, and a population of Sca-1+ cardiac progenitor cells, which may both participate in construction of new blood vessels and serve as a mesenchymal link for the paracrine support of microenvironmental cells. In in vitro experiments, we showed that 72­h hypoxia facilitated activation of EMT regulatory genes, induced dissembling of intercellular contacts, cell uncoupling, and increased cell plasticity.Conclusion      The epicardium of an adult heart serves as a "reparative reserve" that can be reactivated by a hypoxic exposure. This creates a basis for an approach to influence the epicardium to modulate its activity for regulating reparative processes.


Assuntos
Infarto do Miocárdio , Pericárdio , Adulto , Vasos Coronários , Transição Epitelial-Mesenquimal , Humanos , Hipóxia
10.
Curr Cardiol Rep ; 23(9): 119, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34269901

RESUMO

PURPOSE OF REVIEW: Tumors of the pericardium are rare, but a wide variety of congenital, infectious, inflammatory, and neoplastic processes have been reported. Pericardial tumors can be categorized as non-neoplastic or neoplastic. Neoplastic lesions can be further divided into benign or malignant, with malignancies being either primary or secondary (metastatic). Clinical, radiographic, and pathologic features of the most common entities are discussed. RECENT FINDINGS: Metastatic neoplasms involving the heart and pericardium are far more common than primary pericardial neoplasms. Of primary pericardial malignancies, mesothelioma is the most common; notably, cytology of effusion fluid is relatively insensitive to the diagnosis. The prognosis for most malignancies of the pericardium, primary or secondary, is poor. Increasingly, clinically recognized diseases that involve the pericardium include Erdheim-Chester and IgG4-related disease. This article provides a comprehensive review of the most recent literature to develop a structured framework to the differential diagnosis of pericardial tumors.


Assuntos
Neoplasias Cardíacas , Mesotelioma Maligno , Mesotelioma , Diagnóstico Diferencial , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Mesotelioma/diagnóstico , Pericárdio/diagnóstico por imagem
11.
Int J Mol Sci ; 22(14)2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34299295

RESUMO

Nearly three decades ago, the Wilms' tumor suppressor Wt1 was identified as a crucial regulator of heart development. Wt1 is a zinc finger transcription factor with multiple biological functions, implicated in the development of several organ systems, among them cardiovascular structures. This review summarizes the results from many research groups which allowed to establish a relevant function for Wt1 in cardiac development and disease. During development, Wt1 is involved in fundamental processes as the formation of the epicardium, epicardial epithelial-mesenchymal transition, coronary vessel development, valve formation, organization of the cardiac autonomous nervous system, and formation of the cardiac ventricles. Wt1 is further implicated in cardiac disease and repair in adult life. We summarize here the current knowledge about expression and function of Wt1 in heart development and disease and point out controversies to further stimulate additional research in the areas of cardiac development and pathophysiology. As re-activation of developmental programs is considered as paradigm for regeneration in response to injury, understanding of these processes and the molecules involved therein is essential for the development of therapeutic strategies, which we discuss on the example of WT1.


Assuntos
Coração/crescimento & desenvolvimento , Miocárdio/metabolismo , Proteínas WT1/metabolismo , Animais , Transição Epitelial-Mesenquimal/fisiologia , Expressão Gênica/genética , Coração/embriologia , Cardiopatias/genética , Cardiopatias/metabolismo , Cardiopatias/fisiopatologia , Humanos , Pericárdio/embriologia , Pericárdio/patologia , Fatores de Transcrição/metabolismo , Proteínas WT1/genética , Proteínas WT1/fisiologia
12.
Nat Commun ; 12(1): 4155, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230480

RESUMO

The organization of an integrated coronary vasculature requires the specification of immature endothelial cells (ECs) into arterial and venous fates based on their localization within the heart. It remains unclear how spatial information controls EC identity and behavior. Here we use single-cell RNA sequencing at key developmental timepoints to interrogate cellular contributions to coronary vessel patterning and maturation. We perform transcriptional profiling to define a heterogenous population of epicardium-derived cells (EPDCs) that express unique chemokine signatures. We identify a population of Slit2+ EPDCs that emerge following epithelial-to-mesenchymal transition (EMT), which we term vascular guidepost cells. We show that the expression of guidepost-derived chemokines such as Slit2 are induced in epicardial cells undergoing EMT, while mesothelium-derived chemokines are silenced. We demonstrate that epicardium-specific deletion of myocardin-related transcription factors in mouse embryos disrupts the expression of key guidance cues and alters EPDC-EC signaling, leading to the persistence of an immature angiogenic EC identity and inappropriate accumulation of ECs on the epicardial surface. Our study suggests that EC pathfinding and fate specification is controlled by a common mechanism and guided by paracrine signaling from EPDCs linking epicardial EMT to EC localization and fate specification in the developing heart.


Assuntos
Células Endoteliais/citologia , Células Endoteliais/metabolismo , Pericárdio/citologia , Pericárdio/metabolismo , Animais , Quimiocinas , Vasos Coronários/metabolismo , Embrião de Mamíferos , Transição Epitelial-Mesenquimal , Expressão Gênica , Coração , Peptídeos e Proteínas de Sinalização Intercelular , Camundongos , Camundongos Endogâmicos C57BL , Proteínas do Tecido Nervoso , Proteínas Nucleares , Pericárdio/embriologia , Fator de Resposta Sérica , Transdução de Sinais , Transativadores , Fatores de Transcrição/metabolismo , Transcriptoma
13.
J Mech Behav Biomed Mater ; 121: 104588, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34091153

RESUMO

A primary cause of bioprosthetic heart valve failure is premature degeneration of the pericardial leaflets, owing specifically to mechanical fatigue. There remains a paucity of experimental data and understanding of the fatigue-damage behaviour of this collagenous tissue under complex loading regimes. To meet this knowledge gap, a novel pressure inflation system was designed and built, to cyclically load circular samples of glutaraldehyde fixed bovine pericardium, under equibiaxial bulge conditions. A study up to 60 million cycles revealed new insights into the fatigue behaviour of pericardial tissue, where a statistically significantly higher level of permanent set was found in samples with high collagen fibre dispersion, in comparison to those with highly aligned fibres. Whilst permanent set is known to occur in the non-collagenous matrix of pericardium, this study demonstrates that at physiological loads, which elicit a matrix dominant mechanical response, permanent set and thus tissue-level damage, is still mediated by the underlying collagen fibres.


Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Animais , Bovinos , Glutaral , Valvas Cardíacas , Pericárdio
14.
Med Phys ; 48(8): 4279-4290, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34062000

RESUMO

PURPOSE: Epicardial fat is the adipose tissue between the serosal pericardial wall layer and the visceral layer. It is distributed mainly around the atrioventricular groove, atrial septum, ventricular septum and coronary arteries. Studies have shown that the density, thickness, volume and other characteristics of epicardial adipose tissue (EAT) are independently correlated with a variety of cardiovascular diseases. Given this association, the accurate determination of EAT volume is an essential aim of future research. Therefore, the purpose of this study was to establish a framework for fully automatic EAT segmentation and quantification in coronary computed tomography angiography (CCTA) scans. METHODS: A set of 103 scans are randomly selected from our medical center. An automatic pipeline has been developed to segment and quantify the volume of EAT. First, a multi-slice deep neural network is used to simultaneously segment the pericardium in multiple adjacent slices. Then a deformable model is employed to reduce false positive and negative regions in the segmented binary pericardial images. Finally, the pericardium mask is used to define the region of interest (ROI) and the threshold method is utilized to extract the pixels ranging from -175 Hounsfield units (HU) to -15 HU for the segmentation of EAT. RESULTS: The Dice indices of the pericardial segmentation using the proposed method with respect to the manual delineation results of two radiology experts were 97.1%  ±  0.7% and 96.9%  ±  0.6%, respectively. The inter-observer variability was also assessed, resulting in a Dice index of 97.0%  ±  0.7%. For the EAT segmentation results, the Dice indices between the proposed method and the two radiology experts were 93.4%  ±  1.5% and 93.3%  ±  1.3%, respectively, and the same measurement between the experts themselves was 93.6%  ±  1.9%. The Pearson's correlation coefficients between the EAT volumes computed from the results of the proposed method and the manual delineation by the two experts were 1.00 and 0.99 and the same coefficients between the experts was 0.99. CONCLUSIONS: This work describes the development of a fully automatic EAT segmentation and quantification method from CCTA scans and the results compare favorably with the assessments of two independent experts. The proposed method is also packaged with a graphical user interface which can be found at https://github.com/MountainAndMorning/EATSeg.


Assuntos
Doença da Artéria Coronariana , Pericárdio , Tecido Adiposo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Variações Dependentes do Observador , Pericárdio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
ACS Appl Mater Interfaces ; 13(25): 29231-29246, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34137251

RESUMO

With the increasing volume of cardiovascular surgeries and the rising adoption rate of new methodologies that serve as a bridge to cardiac transplantation and that require multiple surgical interventions, the formation of postoperative intrapericardial adhesions has become a challenging problem that limits future surgical procedures, causes serious complications, and increases medical costs. To prevent this pathology, we developed a nanotechnology-based self-healing drug delivery hydrogel barrier composed of silicate nanodisks and polyethylene glycol with the ability to coat the epicardial surface of the heart without friction and locally deliver dexamethasone, an anti-inflammatory drug. After the fabrication of the hydrogel, mechanical characterization and responses to shear, strain, and recovery were analyzed, confirming its shear-thinning and self-healing properties. This behavior allowed its facile injection (5.75 ± 0.15 to 22.01 ± 0.95 N) and subsequent mechanical recovery. The encapsulation of dexamethasone within the hydrogel system was confirmed by 1H NMR, and controlled release for 5 days was observed. In vitro, limited cellular adhesion to the hydrogel surface was achieved, and its anti-inflammatory properties were confirmed, as downregulation of ICAM-1 and VCAM-1 was observed in TNF-α activated endothelial cells. In vivo, 1 week after administration of the hydrogel to a rabbit model of intrapericardial injury, superior efficacy was observed when compared to a commercial adhesion barrier, as histological and immunohistochemical examination revealed reduced adhesion formation and minimal immune infiltration of CD3+ lymphocytes and CD68+ macrophages, as well as NF-κß downregulation. We presented a novel nanostructured drug delivery hydrogel system with unique mechanical and biological properties that act synergistically to prevent cellular infiltration while providing local immunomodulation to protect the intrapericardial space after a surgical intervention.


Assuntos
Sistemas de Liberação de Medicamentos/métodos , Nanomedicina/métodos , Nanoestruturas , Pericárdio/cirurgia , Aderências Teciduais/prevenção & controle , Animais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Preparações de Ação Retardada/química , Preparações de Ação Retardada/farmacologia , Modelos Animais de Doenças , Hidrogéis/química , Hidrogéis/farmacologia , Masculino , Polietilenoglicóis/química , Polietilenoglicóis/farmacologia , Complicações Pós-Operatórias/prevenção & controle , Coelhos
16.
Int J Biol Macromol ; 184: 831-842, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34174314

RESUMO

Bovine pericardium(BP)is one of the biological membranes with extensive application in tissue engineering. To fully investigate the potential clinical applications of this natural biological material, a suitable cross-linking reagent is hopefully adopted for modification. Glutaraldehyde (GA) is a clinically most common synthetic cross-linking reagent. In the study, oxidized hyaluronic acid (AHA) was developed to substitute GA to fix acellular bovine pericardium (ABP) for lower cytotoxicity, aiming to evaluate the feasibility of AHA as a cross-linking reagent and develop AHA-fixed ABP as a biological patch for abdominal wall repair. The AHA with the feeding ratio (1.8:1.0) has an appropriate molecular weight and oxidation degree, almost no cytotoxicity and good cross-linking effect. The critical cross-linking characteristics and cytocompatibility of AHA-fixed ABP were also investigated. The results demonstrated that 2.0% AHA-fixed ABP had the most suitable mechanical properties, thermal stability, resistance to enzymatic degradation and hydrophilicity. Moreover, 2.0% AHA-fixed samples exhibited an excellent cytocompatibility with human peritoneal mesothelial cells (HPMC) and low antigenicity. It also showed a prominent anti-calcification ability required for abdominal wall repair. Our data provided experimental basis for future research on AHA as a new cross-linking reagent and AHA-fixed ABP for abdominal wall repair.


Assuntos
Parede Abdominal/fisiologia , Reagentes para Ligações Cruzadas/química , Ácido Hialurônico/química , Pericárdio/química , Animais , Curativos Biológicos , Bovinos , Linhagem Celular , Células Cultivadas , Estudos de Viabilidade , Humanos , Camundongos , Oxirredução , Engenharia Tecidual
17.
Int J Cardiol ; 338: 265-273, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34153414

RESUMO

BACKGROUND: Constrictive pericarditis represents a treatable cause of mainly right heart failure (RHF), characterized by increased filling pressures and congestive hepatopathy. We hypothesized assessment of T1 and T2 liver relaxation times enables to depict liver congestion, and thus to diagnose RHF. METHODS: Cardiovascular magnetic resonance imaging (CMR) was performed in 45 pericarditis patients i.e., 25 with constrictive physiology (CP+), 20 with normal physiology (CP-), and 30 control subjects. CMR included morphologic and functional assessment of the heart and pericardium. Liver relaxation times were measured on T1 and T2 cardiac maps. RESULTS: CP+ and CP- patients were predominantly male, but CP+ patients were on average 13 years older than CP- patients (p = 0.003). T1 and T2 Liver values were significantly higher in CP+ than in CP- patients and controls, i.e. T1: 765 ± 102 ms vs 581 ± 56 ms and 537 ± 30 ms (both p < 0.001); T2: 63 ± 13 ms vs 50 ± 4 ms and 46 ± 4 ms (both p < 0.001). Extracellular volume (ECV) liver values were also increased, i.e. 42 ± 7% CP+ vs 31 ± 3% CP- and 30 ± 3% control (both p < 0.001). Using a cut-off right atrial pressure of >5 mmHg to discriminate between normal and increased pressure, native T1 liver yielded the highest AUC (0.926) at ROC analysis with a sensitivity of 79.3% and specificity of 95.6%. Gamma-glutamyl transpeptidase correlated well withT1 liver (r2 = 0.43) and ECV liver (r2 = 0.30). Excellent intra- and inter-reader agreement was found for T1, T2 and ECV measurement of the liver. CONCLUSIONS: Assessment of liver relaxation times in pericarditis patients provide valuable information on the presence of concomitant congestive hepatopathy, reflecting RHF.


Assuntos
Hepatopatias , Pericardite Constritiva , Humanos , Hepatopatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Masculino , Pericardite Constritiva/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Valor Preditivo dos Testes
19.
J Cardiothorac Surg ; 16(1): 186, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174911

RESUMO

BACKGROUND: The debate on the best treatment strategy for atrial fibrillation (AF) has expanded following the introduction of the so-called "hybrid procedure" that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be established. METHODS: From June 2008 to December 2020, 609 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency (RF) device was used, whereas from 2011 to 2020 a bipolar RF device was used. In addition, between September 2016 and April 2017, 60 patients underwent endocardial completion of epicardial linear ablation. In 30 of these latter patients, surgical isolation of the Bachmann's bundle (BB) was also performed. Starting from 2021, surviving patients at follow-up were asked to undergo electrocardiographic evaluation and left ventricular function assessment and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF. RESULTS: The ablation procedure was completed in all patients. Upon discharge, 30 (4.9%) patients showed recurrence of AF, whereas the remaining patients (95.1%) were in sinus rhythm. All patients in whom a hybrid approach was used either with or without BB ablation were discharged in sinus rhythm. After a mean follow-up of 74 months, 122 (20%) patients developed recurrent AF, including 19.9% in whom a unipolar RF device was used, 21% in whom a bipolar RF device was used, 23% who had undergone a hybrid procedure without BB ablation and 3.3% who had undergone a hybrid procedure with BB ablation. On multivariate analysis, reduced left ventricular ejection fraction, worsening of European Heart Rhythm Association symptom class, and cognitive impairment or depression during follow-up were found to be significantly associated with AF recurrence. CONCLUSIONS: Surgical AF ablation through a right minithoracotomy is safe and may allow the creation of additional linear lesions, particularly in the BB. The placement of adjunctive linear lesions in the setting of a hybrid procedure can be more effective in reducing the risk for AF recurrence than isolated surgical ablation or hybrid ablation without the addition of further linear lesions, with no incremental risk to the patient.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Endocárdio/cirurgia , Pericárdio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Modelos de Riscos Proporcionais , Qualidade de Vida , Recidiva , Volume Sistólico
20.
Curr Cardiol Rep ; 23(7): 90, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34081219

RESUMO

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID19) involves the heart, including pericardium. This article reviews the possible pathophysiological mechanisms in pericardial involvement in COVID19 and pericardial manifestations of COVID19. It also summarizes the patients with pericarditis secondary to COVID19 and outlines the contemporary treatment strategies in this patient population. RECENT FINDINGS: A high degree of suspicion is required to identify the pericardial involvement in COVID19 patients. It is proposed that an underlying hyperinflammatory reaction in COVID19 leads to pericardial inflammation. Acute pericarditis with or without myocardial involvement is diagnosed on clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram. Multimodality imaging may also have an additional diagnostic value. Patients are usually managed medically, but some patients develop a life-threatening pericardial tamponade necessitating pericardial drainage. Pericardial involvement is an important clinical manifestation of COVID19 requiring a proper workup. Timely diagnosis and a specific management plan based on the presentation and concomitant organ involvement usually lead to a complete recovery.


Assuntos
COVID-19 , Tamponamento Cardíaco , Derrame Pericárdico , Pericardite , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Humanos , Pericardite/diagnóstico por imagem , Pericardite/terapia , Pericárdio/diagnóstico por imagem , SARS-CoV-2
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