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5.
Br J Radiol ; 93(1114): 20200540, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32706985

RESUMO

OBJECTIVE: This study sought to investigate the association between volume and attenuation of epicardial fat and presence of obstructive coronary artery disease (CAD) and high-risk plaque features (HRPF) on CT angiography (CTA) in patients with atypical chest pain and whether the association, if any, is independent of conventional cardiovascular risk factors and coronary artery calcium score (CACS). METHODS: Patients referred for coronary CTA with atypical chest pain and clinical suspicion of CAD were included in the study. Quantification of CACS, epicardial fat volume (EFV) and epicardial fat attenuation (EFat) was performed on non-contrast images. CTA was evaluated for presence of obstructive CAD and presence of HRPF. RESULTS: 255 patients (median age [interquartile range; IQR]: 51[41-60] years, 51.8% males) were included. On CTA, CAD, obstructive CAD (≥50% stenosis) and CTA-derived HRPFs was present in 133 (52.2%), 37 (14.5%) and 82 (32.2%) patients respectively. A significantly lower EFat was seen in patients with obstructive CAD than in those without (-86HU [IQR:-88 to -82 HU] vs -84 [IQR:-87 HU to -82 HU]; p = 0.0486) and in patients with HRPF compared to those without (-86 HU [IQR:-88 to -83 HU] vs -83 HU [-86 HU to -81.750 HU]; p < 0.0001). EFat showed significant association with obstructive CAD (unadjusted Odd's ratio (OR) [95% CI]: 0.90 [0.81-0.99];p = 0.0248) and HRPF (unadjusted OR [95% CI]: 0.83 [0.76-0.90];p < 0.0001) in univariate analysis, which remained significant in multivariate analysis. However, EFV did not show any significant association with neither obstructive CAD nor HRPF in multivariate analysis. Adding EFat to conventional coronary risk factors and CACS in the pre-test probability models increased the area-under curve (AUC) for prediction of both obstructive CAD (AUC[95% CI]: 0.76 [0.70-0.81] vs 0.71 [0.65-0.77)) and HRPF (AUC [95% CI]: 0.92 [0.88-0.95] vs 0.89 [0.85-0.93]), although not reaching statistical significance. CONCLUSION: EFat, but not EFV, is an independent predictor of obstructive CAD and HRPF. Addition of EFat to traditional cardiovascular risk factors and CACS improves estimation for pretest probability of obstructive CAD and HRPF. ADVANCES IN KNOWLEDGE: EFat is an important attribute of epicardial fat as it reflects the "quality" of fat, taking into account the effects of brown-white fat transformation and fibrosis, as opposed to mere evaluation of "quantity" of fat by EFV. Our study shows that EFat is a better predictor of obstructive CAD and HRPF than EFV and can thus explain the inconsistent association of increased EFV alone with CAD.


Assuntos
Tecido Adiposo/patologia , Dor no Peito , Doença da Artéria Coronariana/patologia , Pericárdio/patologia , Placa Aterosclerótica/patologia , Tecido Adiposo/diagnóstico por imagem , Adulto , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Pericárdio/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco
6.
Rev. cir. (Impr.) ; 72(3): 236-240, jun. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1115548

RESUMO

Resumen Introducción: La pericarditis es la enfermedad del pericardio más presente en la práctica médica. La pericarditis purulenta representa el 5% de ellas, con una mortalidad de hasta el 40%. Caso Clínico: Se presenta un paciente masculino, de 27 años de edad, con antecedentes de hipotiroidismo que ingresa con tos y expectoración amarillenta, asociado a fiebre, que resolvió con tratamiento antibiótico. Un mes después, reingresa con dolor abdominal, astenia y disnea intensa que no tolera el decúbito. Se indica ecocardiograma, que diagnostica derrame pericárdico severo, con colapso de cavidades derechas. Se procedió a pericardiocentesis de emergencia, donde se extrajeron 450 mililitros de líquido purulento. En el seguimiento ecocardiográfico a las 48 h, se observa aumento del derrame, por lo que se decide tratamiento quirúrgico, mediante toracotomía anterolateral izquierda, encontrando derrame purulento y engrosamiento pericárdico de 6 mm, con múltiples adherencias. Se indica pericardiectomía parcial. El paciente evolucionó favorablemente, egresándose 7 días posteriores a la cirugía.


Introduction: Pericarditis is frecuent pericardial disease in medical practice. The purulent pericarditis represents 5%, with a mortality of up to 40%. Case Report: We present a male patient, 27 years old, with a history of hypothyroidism that enters with cough and yellowish expectoration, associated with fever, resolved with antibiotic treatment. One month later, he reenters with abdominal pain, asthenia and intense dyspnea that does not tolerate decubitus. Echocardiogram diagnosed severe pericardial effusion, with collapse of right cavities. Emergency pericardiocentesis was performed and 450 milliliters of purulent fluid were extracted. In the echocardiographic follow-up at 48 hours, an increase in the effusion was observed, was decided surgical treatment by left anterolateral thoracotomy, finding purulent effusion and pericardial thickening of 6 mm, with multiple adhesions. Partial pericardiectomy is indicated. The patient evolved favorably, leaving 7 days after surgery.


Assuntos
Humanos , Masculino , Adulto , Pericardite/cirurgia , Pericardite/complicações , Pericardiectomia/métodos , Pericardiocentese/métodos , Pericardite/etiologia , Pericardite/tratamento farmacológico , Pericárdio/patologia , Prognóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Antibacterianos/uso terapêutico
8.
Khirurgiia (Mosk) ; (5): 93-95, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500696

RESUMO

Long-term outcome of surgical treatment of a patient with severe aortic insufficiency and ascending aortic aneurysm is reported. The patient underwent Bentall-DeBono procedure with xenopericardial valved conduit. This technique is associated with no complications specific for Dacron conduits and ensures clinical compensation of heart failure, improves prognosis and quality of life.


Assuntos
Aneurisma Aórtico/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Pericárdio/transplante , Prótese Vascular , Implante de Prótese Vascular , Seguimentos , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca , Humanos , Qualidade de Vida , Transplante Heterólogo
9.
Bull Cancer ; 107(7-8): 756-762, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32513434

RESUMO

INTRODUCTION: Malignant pericardial effusion is a severe complication of lung and breast cancer. The median survival is less than 4 months and recurrences occurs in about 40% of cases. Systemic chemotherapy and/or local treatments are necessary, even if there is no consensus. METHODS: We collected data from patients in our center from 1997 to 2016 who received at least one intrapericardial instillation of bleomycin (60mg). At the same time, we conducted a review of the relevant literature on the subject. RESULTS: We included 46 patients in the analysis. Median survival was 2.6 months [95% CI: 1.7; 4.7]. Overall survival was 49% [33%; 63%] at 3 months and 28% [15%; 42%] at 6 months. In the lung cancer subgroup, overall survival was 18% [3%; 44%] at 3 months. In the breast cancer subgroup, overall survival was 73% [44%; 89%] at 3 months and 46% [21%; 69%] at 6 months. DISCUSSION: The best response rates in the literature are obtained with local instillation of bleomycin or cisplatin. Malignant pericardial effusions in breast cancer patients had a better prognosis. This is certainly related to the prognosis of the underlying disease. We have not found an increase in overall survival with intrapericardial chemotherapy injections, but preventing recurrence of malignant pericardial effusions is a benefit in itself, thus avoiding a lethal complication.


Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Bleomicina/administração & dosagem , Neoplasias da Mama/complicações , Neoplasias Pulmonares/complicações , Derrame Pericárdico/prevenção & controle , Adulto , Idoso , Neoplasias da Mama/mortalidade , Cisplatino/administração & dosagem , Feminino , Humanos , Instilação de Medicamentos , Neoplasias Pulmonares/mortalidade , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/mortalidade , Derrame Pericárdico/etiologia , Derrame Pericárdico/mortalidade , Pericárdio , Estudos Retrospectivos , Prevenção Secundária , Fatores de Tempo , Adulto Jovem
10.
N Z Med J ; 133(1516): 22-32, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32525859

RESUMO

AIM: We aimed to investigate the correlation between epicardial adipose tissue (EAT) and body mass index (BMI) in different ethnic groups in New Zealand. METHODS: The study included 205 individuals undergoing open heart surgery. Maori and Pacific groups were combined to increase statistical power. EAT was measured using 2D echocardiography. RESULTS: There were 164 New Zealand Europeans (NZE) and 41 Maori/Pacific participants. The mean (SD) age of the study group was 67.9 (10.1) years, 69.1 (9.5) for NZE and 63.5 (11.4) for Maori/Pacific. BMI was 29.6 (5.5) kg/m2 for NZE and 31.8 (6.2) for Maori/Pacific. EAT thickness was 6.2 (2.2) mm and 6.0 (1.8) mm for NZE and Maori/Pacific, respectively. Using univariate linear regression, BMI showed moderate correlation with EAT in NZE (R2=0.26, p<0.001); however, there was no significant correlation between BMI and EAT in Maori/Pacific patients (R2=0.05, p=0.17). Using multivariate analysis, BMI remained a significant predictor of EAT thickness in NZE (R2 =0.27, p<0.001). CONCLUSIONS: BMI was associated with EAT thickness in NZE patients, but not in Maori/Pacific patients. The same level of BMI can carry different connotations of risk in different ethnic groups, with BMI likely being an inconsistent measure of obesity in in Maori/Pacific patients.


Assuntos
Tecido Adiposo , Índice de Massa Corporal , Obesidade/etnologia , Pericárdio , Tecido Adiposo/diagnóstico por imagem , Idoso , Ecocardiografia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Grupo com Ancestrais Oceânicos , Pericárdio/diagnóstico por imagem
11.
Ter Arkh ; 92(4): 23-29, 2020 May 19.
Artigo em Russo | MEDLINE | ID: mdl-32598694

RESUMO

AIM: To determine the dependence of adiponectin gene expression by subcutaneous, epicardial and perivascular adipocytes on the degree of coronary lesion in coronary heart disease. MATERIALS AND METHODS: 84 patients with coronary artery disease were examined. Of these, 39 people showed a moderate degree of atherosclerotic lesion of the coronary bed (less than or equal to 22 points) on the SYNTAX Score scale, 20 severe (2231 points), and 25 extremely severe (more than 32 points). Upon admission to the hospital, all patients underwent an echocardiographic study (Echocardiography, Acuson, Germany) with the calculation of the ejection fraction (EF) of the left ventricle (LV) to assess its systolic function. During a planned surgical intervention (coronary bypass surgery, CABG), adipocytes of subcutaneous, epicardial (EAT) and perivascular adipose tissue (PVAT) were taken. Adiponectin gene expression was evaluated by polymerase chain reaction (real-time PCR) using TaqMan probes. Statistical analysis was performed using Statistica 9.0. RESULTS: The maximum level of adiponectin expression was detected in adipocytes of PVAT, and the minimum EAT. With an increase in the degree of atherosclerotic lesion of the coronary bed, the expression of the adiponectin gene in adipocytes of local depots significantly decreases r=-0.82; p=0.023. Moreover, the low level of gene expression in EAT correlated with a decrease in LV EF by r=0.73; p=0.03. In adipocytes of subcutaneous and especially PVAT, gene expression was the highest in patients with a moderate degree of coronary lesion. CONCLUSIONS: Low adiponectin gene expression in EAT is associated with an increase in the degree of atherosclerotic lesion of the coronary bed and a decrease in LV EF.


Assuntos
Adiponectina , Doença da Artéria Coronariana , Adipócitos , Tecido Adiposo , Ponte de Artéria Coronária , Humanos , Pericárdio
12.
Clín. investig. arterioscler. (Ed. impr.) ; 32(3): 129-134, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193359

RESUMO

La enfermedad renal crónica representa un verdadero estado inflamatorio y está relacionada con múltiples factores de riesgo cardiovascular. La enfermedad arterial coronaria es una de sus principales complicaciones y usualmente ha sido asociada con factores de riesgo cardiovascular no clásicos o propios de pacientes urémicos como las alteraciones del metabolismo del calcio y el fósforo, entre otros. Evidencia clínica reciente muestra que el depósito de grasa órgano específico, como el tejido adiposo epicárdico, es un factor de riesgo adicional a tener en cuenta en el momento de la evaluación de riesgo cardiovascular en la población general y en los pacientes renales. La interacción directa de este tejido con los vasos coronarios y la consecuente mediación de sustancias proaterogénicas generan un proceso local que termina en la producción de daño endotelial. Aunque la población de enfermos renales ha sido evaluada escasamente, estudios futuros determinarán con precisión si un incremento en la adiposidad epicárdica está verdaderamente asociado a la morbimortalidad cardiovascular en este grupo de riesgo


Chronic kidney disease represents a true inflammatory state, and is related to multiple cardiovascular risk factors. Coronary artery disease is the major complication, and has usually been associated with non-classical or uraemic related factors that include the disturbance of calcium and phosphorus metabolism, among others. Recent clinical evidence shows that specific body fat deposition like epicardial adipose tissue is an additional factor to consider when evaluating cardiovascular risk in the general population and kidney patients. Direct interaction of this tissue and coronary vessels with consequent mediation of pro-atherogenic substances have a local process ending in endothelial damage. Although the population of renal patients has been poorly evaluated, future studies should determine precisely whether an increase in epicardial fat is truly associated with cardiovascular morbidity and mortality in this risk group


Assuntos
Humanos , Tecido Adiposo , Tecido Adiposo/metabolismo , Síndrome Metabólica/complicações , Insuficiência Renal Crônica/complicações , Doença da Artéria Coronariana/complicações , Gordura Subcutânea , Fatores de Risco , Cálcio/metabolismo , Fósforo/metabolismo , Pericárdio/fisiopatologia , Pericárdio/diagnóstico por imagem , Obesidade/fisiopatologia
13.
Z Geburtshilfe Neonatol ; 224(4): 187-193, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32575128

RESUMO

Fetal intrapericardial teratomas are rare and benign cardiac tumors. By comprehensive literature retrieval of the pertinent articles published since 2000, 49 articles with 61 cases of intrapericadial teratomas were recruited into this study. The intrapericardial teratomas were found during pregnancy in 55 cases (fetal group), while the tumors were detected until neonatal period in 6 cases (neonatal group). In the fetal group, 15 cases were critical with fetal/neonatal respiratory distress or cardiac tamponade. Antenatal treatments including centesis, shunt placement, open fetal surgery and the ex utero intrapartum treatment were required in 24 (43.6%) fetal cases. Postnatal intubation was required in 19 cases with 18 of them having immediate intubation after birth. Postnatal tumor resection was performed in 41 (95.3%) cases. In neonatal group, 4 neonates had respiratory distress and/or cardiac tamponade. Neonatal intubation was required in 1 (16.7%) patient. Surgical tumor resection was performed in all 6 patients. A comparison between the fetal and neonatal groups revealed that the fetal group was associated with higher refractory effusions while the neonatal group had a higher incidence of respiratory distress. Although the all cause death rate was higher in the fetal group than in the neonatal (25.5 vs. 0%), but lack of a statistical significance. Antenatal treatments for fetal intrapericardial teratomas are feasible but carry higher risks in comparison to neonatal cases.


Assuntos
Tamponamento Cardíaco/etiologia , Neoplasias Cardíacas/cirurgia , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Teratoma/cirurgia , Feminino , Feto , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido , Triagem Neonatal , Pericárdio , Gravidez , Cuidado Pré-Natal , Teratoma/diagnóstico por imagem , Teratoma/patologia , Ultrassonografia Pré-Natal
14.
Asian Cardiovasc Thorac Ann ; 28(6): 336-338, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32539424

RESUMO

Rapidly progressive epicardial hemorrhagic blebs during weaning from cardiopulmonary bypass after perimembranous ventricular septal defect closure has not been reported previously. Here, we describe the case of a 3-month-old baby with life-threatening epicardial hemorrhagic blebs and an interventricular septal hematoma after perimembranous ventricular septal defect patch closure.


Assuntos
Vesícula/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Comunicação Interventricular/cirurgia , Hematoma/etiologia , Pericárdio/transplante , Vesícula/diagnóstico por imagem , Evolução Fatal , Comunicação Interventricular/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Humanos , Lactente , Masculino
19.
Kardiologiia ; 60(4): 62-69, 2020 Mar 27.
Artigo em Russo | MEDLINE | ID: mdl-32394859

RESUMO

Aim To determine the expression of adiponectin gene (ADIPOQ) and the content of high-molecular-weight adiponectin (HMWA) in epicardial (EAT) and subcutaneous adipose tissue (SCAT) in patients with ischemic heart disease (IHD).Material and methods Paired samples of EAT and SCAT and blood serum were withdrawn from patients with IHD after bypass surgery and 16 subjects without IHD (comparison group). Matrix RNA (mRNA) level was measured using real-time polymerase chain reaction. HMWA levels in EAT and SCAT were evaluated by Western blotting. Serum adiponectin concentration was measured immunoenzymatically. For all patients, echocardiography was performed to measure the EAT thickness; coronarography was performed to determine severity of coronary atherosclerosis.Results Serum adiponectin concentration was lower in IHD patients than in the comparison group (p<0.001). Levels of ADIPOO gene mRNA and HMWA in SCAT were lower in IHD patients than in the comparison group (р=0.020 and p=0.003, respectively). The HMWA level in EAT was lower with the EAT thickness of 8 mm compared to the HMWA level in IHD patients with EAT ≤8 mm (p=0.034).Conclusion The decreased serum concentration of antiatherogenic adiponectin and the reduced expression of ADIPOQ gene in SCAT (mRNA, HMWA) are associated with IHD.


Assuntos
Doença da Artéria Coronariana , Adiponectina , Tecido Adiposo , Humanos , Pericárdio
20.
Life Sci ; 253: 117732, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32360570

RESUMO

AIMS: Recently, the zebrafish has gained attention as an innovative experimental model to decipher molecular and cellular mechanisms involved in cardiovascular development and diseases. Nevertheless, the use of zebrafish models has been challenged because the transparency of these fish, which allows for accurate cardiac evaluation, disappears in adulthood. In this study, the epicardial outline method was performed to investigate the feasibility of echocardiography in assessing cardiac function in pathological adult zebrafish. MATERIALS AND METHODS: We attempted to estimate heart failure in adult zebrafish treated with three distinct regulators of cardiac function: phenylhydrazine hydrochloride (PHZ), doxorubicin (DOX), and ethanol. B-mode and Doppler images were evaluated at frequencies of up to 50 MHz and 40 MHz, respectively. The correlation between alterations in cardiac function, haemoglobin concentration, and myocardial histopathology were assessed. KEY FINDINGS: Cardiac output (CO) in PHZ-treated zebrafish was significantly higher than that in control zebrafish (151 ± 67 vs. 84 ± 37 µl/min, P = 0.004), whereas ejection fraction (EF) was lower (36.3 ± 10.9 vs. 50.9 ± 8.7%, P < 0.001), indicating typical high output heart failure derived from anaemia. Additionally, ventricular dysfunction in DOX-treated zebrafish was characterised by low CO (57 ± 38 µl/min) and EF (28.8 ± 10.4%), accompanied by an enlarged ventricle in diastole and systole, representing low output heart failure. For ethanol-treated zebrafish, EF was markedly reduced (39.6 ± 7.2%) indicating a dilated heart, while CO remained unchanged (90 ± 40 µl/min). SIGNIFICANCE: The epicardial outline method is an effective way of using echocardiography to assess cardiac dysfunction in pathological adult zebrafish, unlocking a major bottleneck in this research field with limited cardiac functional assays.


Assuntos
Ecocardiografia/métodos , Cardiopatias/diagnóstico por imagem , Insuficiência Cardíaca/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Animais , Débito Cardíaco/fisiologia , Modelos Animais de Doenças , Doxorrubicina/toxicidade , Etanol/toxicidade , Estudos de Viabilidade , Feminino , Cardiopatias/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Fenil-Hidrazinas/toxicidade , Disfunção Ventricular/diagnóstico por imagem , Disfunção Ventricular/fisiopatologia , Peixe-Zebra
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