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1.
Med Sci Monit ; 25: 4149-4158, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31160548

RESUMO

BACKGROUND The aim of this study was to determine the role of AMP-activated protein kinase (AMPK) in myocardial insulin resistance after myocardial ischemia-reperfusion during cardiopulmonary bypass surgery in dogs. MATERIAL AND METHODS Twenty-four mongrel dogs were randomly assigned to 4 groups. The control group did not undergo aortic cross-clamping; the model group underwent 60 mins of aortic cross-clamping with 150 ml cardioplegic solution. The treatment group, the inhibition group respectively with 0.11mg/kg AICAR (AMPK agonist) in 150 ml cardioplegic solution and 0.11mg/kg Compound C (AMPK inhibitor) in 150 ml cardioplegic solution. The blood flow was determined and left ventricular myocardial tissue were taken at pre-bypass, 15, 60, and 90 min after aorta declamping, respectively. Expression of AMPK mRNA, p-AMPK and GLUT-4 proteins was determined by RT-PCR, IHC and WB. RESULTS Compared with the control group, receiving 60 min ischemia at 15 min after reperfusion, Myocardial Glucose Extraction Ratio were significantly decreased in the other 3 groups, it was significantly decreased from 20.0% to 1.2% at 60 min of reperfusion, and recovered to 6.1% after 90 min reperfusion in model group, while recovered to 4.1%, 12.0% after 90 min reperfusion respectively exposed to Compound C and AICAR. The expressions of p-AMPK, GLUT-4 protein and AMPK mRNA in myocardium were decreased in different experiment groups, but these changes occurred to a lesser extent in the treatment group. CONCLUSIONS The inability of GLUT-4 expression induced by the decreases in p-AMPK protein expression that may be one of the reasons for myocardial insulin resistance.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Resistência à Insulina/fisiologia , Traumatismo por Reperfusão Miocárdica/metabolismo , Aminoimidazol Carboxamida/análogos & derivados , Aminoimidazol Carboxamida/farmacologia , Animais , Soluções Cardioplégicas , Ponte Cardiopulmonar/métodos , Ponte Cardiopulmonar/veterinária , China , Doença da Artéria Coronariana/metabolismo , Doença da Artéria Coronariana/cirurgia , Cães , Feminino , Glucose/metabolismo , Transportador de Glucose Tipo 4/metabolismo , Ventrículos do Coração/fisiopatologia , Isquemia/metabolismo , Masculino , Isquemia Miocárdica/metabolismo , Reperfusão Miocárdica/métodos , Miocárdio/metabolismo , Fosforilação , Pirazóis/farmacologia , Pirimidinas/farmacologia , Ribonucleotídeos/farmacologia
2.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 227-237, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002219

RESUMO

The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model, with evidence of impact on performance


Assuntos
Humanos , Masculino , Feminino , Indicadores de Qualidade em Assistência à Saúde , Serviço Hospitalar de Emergência/tendências , Síndrome Coronariana Aguda/mortalidade , Prescrições de Medicamentos , Heparina/uso terapêutico , Reperfusão Miocárdica/métodos , Análise Estatística , Telemedicina/métodos , Assistência Centrada no Paciente/métodos , Educação Médica Continuada/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência , Infarto do Miocárdio
3.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 227-237, may.-june. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1005940

RESUMO

Background: The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model , with evidence of impact on performance


Assuntos
Humanos , Masculino , Feminino , Indicadores de Qualidade em Assistência à Saúde , Serviço Hospitalar de Emergência/tendências , Síndrome Coronariana Aguda/mortalidade , Prescrições de Medicamentos , Heparina/uso terapêutico , Reperfusão Miocárdica/métodos , Análise Estatística , Telemedicina/métodos , Assistência Centrada no Paciente/métodos , Educação Médica Continuada/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência/métodos , Infarto do Miocárdio
4.
J Clin Nurs ; 28(17-18): 3233-3241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31017336

RESUMO

AIMS AND OBJECTIVES: To establish and report cross-sectional data of reperfusion times for emergency primary percutaneous coronary interventions (PPCI) and to examine factors associated with times to reperfusion. BACKGROUND: Rapid coronary reperfusion can salvage myocardial tissue, preserve left ventricular function and reduce mortality. PPCI is the gold standard of management. Researchers have reported on international median reperfusion times, but this is the first Irish study to do so. METHODS: This observational, prospective, cross-sectional study included patients diagnosed with ST-segment elevation myocardial infarction (STEMI) and admitted for emergency PPCI. Descriptive and inferential statistics were used. The study was ethically approved. We adopted the STROBE guidelines. RESULTS: All patients (N = 133) who met the inclusion criteria were included initially. Of these, 105 (79%) were diagnosed with STEMI and received emergency PPCI. The majority of STEMIs were diagnosed by paramedics and most (67%) were reperfused within 120 min, with a median time of 96 min. The results suggested that younger patients achieved timelier PPCI and source of referral was also significant in that more of those transferred directly to the coronary catheterisation laboratory achieved reperfusion within 120 min, compared with those who presented to the emergency department. CONCLUSION: A timely reperfusion service is achieved for the majority. Attention is needed in respect of the ageing and those admitted directly to the emergency departments with STEMI. RELEVANCE TO CLINICAL PRACTICE: Further international research is recommended to compare current reperfusion times against guidelines and to identify areas for improvement. Clinicians should be mindful of the importance of rapid reperfusion and the implications of its delay for patients with STEMI. Those presenting to emergency departments with chest pain should be prioritised.


Assuntos
Reperfusão Miocárdica/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Med Sci Monit ; 25: 3100-3107, 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31028241

RESUMO

BACKGROUND The aim of this study was to investigate the effects of sevoflurane (SEV) on myocardial ischemia/reperfusion (I/R) injury in rats and its mechanism. MATERIAL AND METHODS Sixty male Sprague-Dawley rats were randomly divided into 3 groups: Sham group (n=20), I/R group (n=20) and I/R+SEV group (n=20). The I/R model was established by ligating and recanalizing the left anterior descending coronary artery (LAD). Triphenyl tetrazolium chloride (TTC) test and echocardiography (ECG) were used for analysis. Hematoxylin and eosin (H&E) staining was applied to detect the morphological changes. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was conducted to detect the apoptosis levels. The expression level of superoxide dismutase 2 (SOD2) was measured. Finally, the effect of SEV on the protein kinase B (Akt)/hypoxia-inducible factor 1-alpha (HIF-1alpha)/vascular endothelial growth factor (VEGF) signaling pathway was detected via western blotting. RESULTS SEV could significantly improve I/R-induced cardiac insufficiency, inhibit cardiac infarction, and as well as reduce the infarction area from 53.21±2.11% to 32.33±3.49% (P<0.05). Compared with rats in I/R group, the cardiac myofilament was better in alignment, degradation and necrosis were milder, and cell edema was notably reduced in the I/R+SEV group. Thus, SEV could significantly reverse the decreased expression of SOD2 caused by I/R and reduce oxidative stress in the heart (P<0.05). According to the western blotting results, SEV was capable of obviously activating the expressions of phosphorylated-Akt (p-Akt), HIF-1alpha, and VEGF. CONCLUSIONS SEV can significantly improve myocardial injury caused by I/R in rats, and its mechanism might be related to the activation of the Akt/HIF-1alpha/VEGF signaling pathway.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Proteínas Proto-Oncogênicas c-akt/metabolismo , Sevoflurano/farmacologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Apoptose/efeitos dos fármacos , Masculino , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/metabolismo , Reperfusão Miocárdica/métodos , Traumatismo por Reperfusão Miocárdica/metabolismo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
6.
Rev. chil. cardiol ; 38(1): 46-53, abr. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1003637

RESUMO

Resumen En Chile, se han logrado avances importantes en el manejo del Infarto Agudo de Miocardio (IAM) con elevación del segmento ST (IAMCEST). Debido a la mejoría en el diagnóstico precoz y tratamiento, particularmente, con el incremento de la Angioplastía Primaria (APP), hoy están dadas las condiciones para seguir progresando por la vía de la combinación de estrategias de reperfusión y la creación de Redes de Manejo del IAM. El siguiente artículo revisa la evidencia que justifica impulsar dicho avance y se esbozan posibles caminos para lograrlo.


Abstract In Chile, important advances have been made in the management of Acute Myocardial Infarction (MI) with ST segment elevation (STEMI). Due to the progress in early diagnosis and treatment, particularly with the increase in Primary Angioplasty (Primary PCI), nowadays there are conditions to improve early management through the combination of reperfusion strategies and the implementation of MI reperfusion networks. The present article reviews the evidence justifying the promotion of this strategy and outlines possible actions to achieve it.


Assuntos
Humanos , Reperfusão Miocárdica/métodos , Terapia Trombolítica/métodos , Angioplastia/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Chile , Procedimentos Endovasculares , Fibrinolíticos/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
7.
Int J Cardiol ; 280: 80-83, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30661844

RESUMO

AIM: Ventricular fibrillation (VF) during reperfusion in ST-elevation myocardial infarction (STEMI) is associated with increased in-hospital mortality. Dispersion of ventricular repolarization contributes to ventricular vulnerability during ischemia. Tpeak-Tend interval was proposed as a ventricular repolarization dispersion marker, however its value for prediction of reperfusion VF remains uncertain. We aimed to assess whether Tpeak-Tend before PCI in STEMI is associated with reperfusion VF. METHODS: STEMI patients admitted for primary PCI were retrospectively assessed for VF during reperfusion. Pre-PCI ECGs recorded in 40 patients with reperfusion VF (rVF group; age 65 ±â€¯13 years, 80% male) were compared with 374 consecutive patients without reperfusion arrhythmias (No-rVF group; age 67 ±â€¯12 years; 68% male). Digital ECGs were automatically processed and Tpeak-Tend interval computed on a per-lead basis. The global Tpeak-Tend was calculated between the earliest Tpeak and the latest Tend in any lead, and tested for association with reperfusion VF using logistic regression analysis. RESULTS: The leftward shift of Tpeak toward QRS complex in ischemic leads resulted in Tpeak-Tend prolongation. Global Tpeak-Tend in rVF group was higher than in No-rVF group (142 ±â€¯24 vs 130 ±â€¯27 ms; p = 0.007). Global Tpeak-Tend ≥ 131 ms predicted reperfusion VF (OR = 3.41; 95% CI 1.66-7.04; p = 0.001) and remained a significant predictor of reperfusion VF in multivariable analysis. CONCLUSION: Tpeak-Tend interval before PCI in STEMI was an independent predictor of reperfusion VF. Our findings warrants further research aimed at prospective validation of Tpeak-Tend as a marker of periprocedural arrhythmic risk.


Assuntos
Frequência Cardíaca/fisiologia , Reperfusão Miocárdica/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/cirurgia , Idoso , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/métodos , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/efeitos adversos , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Suécia/epidemiologia , Fibrilação Ventricular/epidemiologia
8.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(1 (Supl)): 94-96, jan.-mar. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1015189

RESUMO

O eletrocardiograma (ECG) é fundamental na avaliação dos pacientes com síndrome coronariana aguda (SCA), pois possibilita a identificação precoce dos pacientes com sinais de oclusão coronariana (infarto agudo do miocárdio com supradesnivelamento do segmento ST - IAMCSSST), que se beneficiam com estratégias de reperfusão miocárdica de emergência. Os casos de SCA sem supradesnivelamento de segmento ST pressupõem ausência de oclusão coronariana, e o ECG pode mostrar sinais de isquemia como inversão simétrica de ondas T, infradesnivelamento de segmento ST, ou mesmo ser normal em até 15% dos casos. No entanto, recentemente foi descrito um padrão eletrocardiográfico raro, conhecido como padrão "De Winter", relacionado à oclusão coronariana aguda da artéria descendente anterior (ADA) em seu terço proximal, na ausência de supradesnivelamento de segmento ST. Este é o relato de um paciente jovem, do sexo masculino, com quadro clínico anginoso típico, menos de uma hora depois de angioplastia eletiva da ADA, que apresentou padrão "De Winter" no ECG e teve confirmada trombose aguda de stent. O reconhecimento desse padrão eletrocardiográfico incomum é fundamental para garantir terapia de reperfusão coronariana emergencial em casos de síndrome coronariana aguda


he electrocardiogram (ECG) is a crucial tool in the evaluation of patients with acute coronary syndrome (ACS), since it allows the early identification of patients with signs of coronary occlusion (ST-elevation myocardial infarction ­ STEMI), who benefit from emergency myocardial reperfusion strategies. On the other hand, cases of non-ST-elevation ACS presumably have no coronary occlusion, and the ECG may show signs of ischemia such as symmetrical T-wave inversion, ST-segment depression, or even be normal in up to 15% of cases. However, a rare ECG pattern, known as the "De Winter" pattern, related to an acute occlusion of the Left Anterior Descending (LAD) coronary artery in its proximal third segment, has been recently described without ST-segment elevation. This is a case report of a young male patient with typical chest pain symptoms less than one hour after an elective LAD angioplasty, who presented with "De Winter" pattern on the ECG and had confirmed acute stent thrombosis. The recognition of this unusual electrocardiographic pattern is essential to guarantee emergency coronary reperfusion therapy in cases of acute coronary syndrome


Assuntos
Humanos , Masculino , Adulto , Eletrocardiografia/métodos , Síndrome Coronariana Aguda , Oclusão Coronária , Trombose , Reperfusão Miocárdica/métodos , Stents , Angioplastia/métodos , Infarto do Miocárdio
9.
Clin Cardiol ; 42(1): 5-12, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30421441

RESUMO

BACKGROUND: In ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI), current oral P2Y12 platelet inhibitors do not provide maximal platelet inhibition at the time of reperfusion. Furthermore, administration of cangrelor prior to reperfusion has been shown in pre-clinical studies to reduce myocardial infarct (MI) size. Therefore, we hypothesize that cangrelor administered prior to reperfusion in STEMI patients will reduce the incidence of microvascular obstruction (MVO) and limit MI size in STEMI patients treated with PPCI. METHODS: The platelet inhibition to target reperfusion injury (PITRI) trial, is a phase 2A, multi-center, double-blinded, randomized controlled trial, in which 210 STEMI patients will be randomized to receive either an intravenous (IV) bolus of cangrelor (30 µg/kg) followed by a 120-minute infusion (4 µg/kg/min) or matching saline placebo, initiated prior to reperfusion (NCT03102723). RESULTS: The study started in October 2017 and the anticipated end date would be July 2020. The primary end-point will be MI size quantified by cardiovascular magnetic resonance (CMR) on day 3 post-PPCI. Secondary endpoints will include markers of reperfusion, incidence of MVO, MI size, and adverse left ventricular remodeling at 6 months, and major adverse cardiac and cerebrovascular events. SUMMARY: The aim of the PITRI trial is to assess whether cangrelor administered prior to reperfusion would reduce acute MI size and MVO, as assessed by CMR.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Circulação Coronária/fisiologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Reperfusão Miocárdica/métodos , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Remodelação Ventricular/fisiologia , Monofosfato de Adenosina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão Miocárdica/diagnóstico , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Miocárdio/patologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Resultado do Tratamento , Adulto Jovem
10.
J Cardiothorac Vasc Anesth ; 33(5): 1205-1213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30416026

RESUMO

OBJECTIVE: To investigate whether prophylactic amiodarone infusion prevents ventricular fibrillation after aortic cross-clamp release and attenuates cytokine production in patients with left ventricular hypertrophy undergoing cardiac surgery. DESIGN: Prospective, randomized controlled trial. SETTING: A public hospital. PARTICIPANTS: The study comprised 68 patients undergoing aortic valve replacement for severe aortic stenosis. INTERVENTIONS: Patients were randomly assigned to receive a 150mg bolus then 30mg/h continuous infusion of amiodarone (amiodarone group) or a 1 mg/kg bolus then 1 mg/kg/h continuous infusion of lidocaine (lidocaine group). The primary outcome was the ventricular fibrillation incidence rate after aortic cross-clamp release. Secondary outcomes included perioperative serum interleukin-6 and tumor necrosis factor-alpha levels. MEASUREMENTS AND MAIN RESULTS: The ventricular fibrillation incidence rate was significantly lower in the amiodarone than in the lidocaine group (20.6% v 50%, relative risk 0.41; 95% confidence interval [CI] 0.20-0.86; p = 0.021). Interleukin-6 levels 1hour after aortic cross-clamp release and at intensive care unit admission were significantly lower in the amiodarone than in the lidocaine group (geometric mean [95% CI] 117.4pg/mL [87.1-158.4] v 339.5pg/mL [210.6-547.2]; p < 0.01 and 211.1pg/mL [162.8-73.6] v 434.1pg/mL [293.7-641.5]; p < 0.01, respectively). Tumor necrosis factor-alpha levels 1hour after aortic cross-clamp release were significantly lower in the amiodarone than in the lidocaine group (geometric mean [95% CI] 1.624pg/mL [1.359-1.940] v 2.283pg/mL [1.910-2.731]; p = 0.02). CONCLUSIONS: Amiodarone prevented reperfusion ventricular fibrillation in patients with left ventricular hypertrophy undergoing aortic valve replacement to a greater extent than did lidocaine. Furthermore, amiodarone inhibited postoperative interleukin-6 and tumor necrosis factor-alpha production.


Assuntos
Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Estenose da Valva Aórtica/terapia , Implante de Prótese de Valva Cardíaca/tendências , Hipertrofia Ventricular Esquerda/terapia , Reperfusão Miocárdica/métodos , Fibrilação Ventricular/terapia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Método Duplo-Cego , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/tendências , Profilaxia Pós-Exposição/métodos , Profilaxia Pós-Exposição/tendências , Estudos Prospectivos , Resultado do Tratamento , Fibrilação Ventricular/fisiopatologia
11.
Semin Thorac Cardiovasc Surg ; 31(2): 188-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30278268

RESUMO

The objectives were to investigate if after hypoxia or ischemia, normoxic reperfusion is associated with less oxidant stress (OS), inflammation, and myocardial injury than hyperoxic reperfusion. In this study, cardiomyocytes (H9c2 cells) were cultured in hypoxia, followed by reoxygenation in normoxia or hyperoxia. Cardiomyocyte OS, inflammation, and apoptosis were measured. In parallel experiments, rabbits were cannulated for cardiopulmonary bypass (CPB). Following cardioplegic arrest and aortic cross-clamp removal, hearts were reperfused under normoxic or hyperoxic conditions. Left ventricular developed pressure and contractility (LV +dP/dt) were recorded, and blood samples and heart tissues were collected for measurement of OS, inflammation, and cardiac injury. Results showed that H9c2 cells exposed to hyperoxic reoxygenation showed significant increases in OS, inflammation, and apoptosis compared to normoxic reoxygenation. Following CPB and 2-hour hyperoxic reperfusion, LV +dP/dt and left ventricular developed pressure were significantly decreased compared with pre-CPB values (to 36 ± 21%, P = 0.002; and 53 ± 20%, P = 0.02, respectively), associated with significant increases in all plasma and tissue biomarkers for OS, inflammation, and myocardial injury. In contrast, LV +dP/dt was relatively well preserved under normoxic reperfusion conditions (to 70 ± 14% after 2-hour reperfusion), and was associated with an attenuated myocardial OS, inflammatory, apoptotic, and injury response compared to the hyperoxia group (eg, cTn-I: 5.9 ± 1.5 vs 20.2 ± 7.6 ng/mL, respectively, P < 0.0001). Overall, in both in vitro and in vivo experiments, normoxic reperfusion/reoxygenation was associated with less robust OS, inflammation, apoptosis, and myocardial injury compared with hyperoxic reperfusion/reoxygenation. These results suggest that hyperoxia should be avoided to minimize myocardial OS, inflammation, and ventricular dysfunction after CPB.


Assuntos
Apoptose , Hiperóxia/prevenção & controle , Mediadores da Inflamação/metabolismo , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Reperfusão Miocárdica/métodos , Miócitos Cardíacos/patologia , Estresse Oxidativo , Oxigênio/administração & dosagem , Animais , Apoptose/efeitos dos fármacos , Biomarcadores/sangue , Ponte Cardiopulmonar , Linhagem Celular , Hiperóxia/metabolismo , Hiperóxia/patologia , Hiperóxia/fisiopatologia , Masculino , Reperfusão Miocárdica/efeitos adversos , Traumatismo por Reperfusão Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Oxigênio/toxicidade , Coelhos , Ratos , Disfunção Ventricular Esquerda/metabolismo , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/prevenção & controle , Função Ventricular Esquerda , Pressão Ventricular
12.
Biomed Pharmacother ; 109: 1346-1350, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30551385

RESUMO

Interleukin 8 (IL-8) is an important pro-inflammatory cytokine that recruits neutrophil to the areas of inflammation and has been implicated in myocardial ischemia reperfusion injury (MIRI). This study aimed to apply IL-8 targeted myocardial contrast echocardiography (MCE) to evaluate MIRI in rabbits. MCE imaging with IL-8 targeted microbubbles (MBIL-8) and control microbubbles (MBc) was performed in 40 Japanese white rabbits after brief proximal left anterior descending (LAD) partial occlusion for 30 min and subsequent reperfusion for 30 min, 60 min, 120 min and 180 min. Electrocardiogram and regional wall motion were assessed during occlusion and reperfusion. MCE demonstrated that IL-8 level rapidly increased in reperfused myocardial tissue and reached the peak after 120 min of reperfusion and lasted to 180 min of reperfusion. ELISA showed that the tendency of MCE data to change with reperfusion time was the same as that of IL-8 content. Taken together, these results suggest that targeted MCE with IL-8 antibody provides a new approach to noninvasive evaluation of MIRI using ultrasound imaging techniques.


Assuntos
Interleucina-8/metabolismo , Isquemia Miocárdica/metabolismo , Traumatismo por Reperfusão Miocárdica/metabolismo , Miocárdio/metabolismo , Animais , Meios de Contraste/metabolismo , Ecocardiografia/métodos , Masculino , Microbolhas , Infarto do Miocárdio/metabolismo , Reperfusão Miocárdica/métodos , Coelhos
13.
Circulation ; 139(3): 337-346, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30586728

RESUMO

BACKGROUND: In ST-segment-elevation myocardial infarction (STEMI), infarct size correlates directly with heart failure and mortality. Preclinical testing has shown that, in comparison with reperfusion alone, mechanically unloading the left ventricle (LV) before reperfusion reduces infarct size and that 30 minutes of unloading activates a cardioprotective program that limits reperfusion injury. The DTU-STEMI pilot trial (Door-To-Unload in STEMI Pilot Trial) represents the first exploratory study testing whether LV unloading and delayed reperfusion in patients with STEMI without cardiogenic shock is safe and feasible. METHODS: In a multicenter, prospective, randomized exploratory safety and feasibility trial, we assigned 50 patients with anterior STEMI to LV unloading by using the Impella CP followed by immediate reperfusion (U-IR) versus delayed reperfusion after 30 minutes of unloading (U-DR). The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events at 30 days. Efficacy parameters included the assessment of infarct size by using cardiac magnetic resonance imaging. RESULTS: All patients completed the U-IR (n=25) or U-DR (n=25) protocols with respective mean door-to-balloon times of 72 versus 97 minutes. Major adverse cardiovascular and cerebrovascular event rates were not statistically different between the U-IR versus U-DR groups (8% versus 12%, respectively, P=0.99). In comparison with the U-IR group, delaying reperfusion in the U-DR group did not affect 30-day mean infarct size measured as a percentage of LV mass (15±12% versus 13±11%, U-IR versus U-DR, P=0.53). CONCLUSIONS: We report that LV unloading using the Impella CP device with a 30-minute delay before reperfusion is feasible within a relatively short time period in anterior STEMI. The DTU-STEMI pilot trial did not identify prohibitive safety signals that would preclude proceeding to a larger pivotal study of LV unloading before reperfusion. An appropriately powered pivotal trial comparing LV unloading before reperfusion to the current standard of care is required. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03000270.


Assuntos
Infarto Miocárdico de Parede Anterior/terapia , Coração Auxiliar , Reperfusão Miocárdica/métodos , Implantação de Prótese/instrumentação , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Função Ventricular Esquerda , Adulto , Idoso , Idoso de 80 Anos ou mais , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Infarto Miocárdico de Parede Anterior/fisiopatologia , Transtornos Cerebrovasculares/etiologia , Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/prevenção & controle , Estudos de Viabilidade , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/efeitos adversos , Traumatismo por Reperfusão Miocárdica/etiologia , Traumatismo por Reperfusão Miocárdica/fisiopatologia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Projetos Piloto , Estudos Prospectivos , Implantação de Prótese/efeitos adversos , Recuperação de Função Fisiológica , Recidiva , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
14.
Arq Bras Cardiol ; 112(1): 20-29, 2019 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30570061

RESUMO

BACKGROUND: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. OBJECTIVE: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. METHODS: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. RESULTS: We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. CONCLUSION: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis.


Assuntos
Fibrinolíticos/uso terapêutico , Reperfusão Miocárdica/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Tenecteplase/uso terapêutico , Terapia Trombolítica/métodos , Adulto , Idoso , Angiografia Coronária/métodos , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Estudos Prospectivos , Curva ROC , Valores de Referência , Reprodutibilidade dos Testes , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Estatísticas não Paramétricas , Tenecteplase/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
15.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.156-164.
Monografia em Português | LILACS | ID: biblio-1009286
19.
Int. j. cardiovasc. sci. (Impr.) ; 31(5)set.-out. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-914765

RESUMO

Background: To reduce mortality of acute myocardial infarction, medical care must be provided within the first hours of the event. Objective: To identify the "front door" to medical care of acute coronary patients and the time elapsed between patients'admission and performance of myocardial reperfusion in the public health system of the city of Joinville, Brazil. Methods: The study was a retrospective analysis of the medical records of 112 consecutive patients diagnosed with acute myocardial infarction by coronary angiography. We identified the place of the first medical contact and calculated the time between admission to this place and admission to the referral hospital, as well as the time until coronary angiography, with or without percutaneous transluminal angioplasty. A descriptive analysis of data was made using mean and standard deviation, and a p < 0.05 was set as statistically significant. Results: Only 16 (14.3%) patients were admitted through the cardiology referral unit. Door-to-angiography time was shorter than 90 minutes in 50 (44.2%) patients and longer than 270 minutes in 39 (34.5%) patients. No statistically significant difference was observed in door-to-angiography time between patients transported directly to the referral hospital and those transferred from other health units (p < 0.240). Considering the time between pain onset and angiography, only 3 (2.9%) patients may have benefited from myocardial reperfusion performed within less than 240 minutes. Conclusion: Management of patients with acute myocardial infarction is not in conformity with current guidelines for the treatment of this condition. The structure of the healthcare system should be urgently modified so that users in need of emergency services receive adequate care in accordance with local conditions


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Assistência à Saúde/métodos , Falha da Terapia de Resgate , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Terapêutica/métodos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Angioplastia/métodos , Angiografia Coronária/métodos , Procedimentos Clínicos/tendências , Morte Súbita/prevenção & controle , Diagnóstico por Imagem/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência/métodos , Assistência Hospitalar/métodos , Reperfusão Miocárdica/métodos , Estudos Retrospectivos , Análise Estatística , Terapia Trombolítica/métodos , Sistema Único de Saúde
20.
G Ital Cardiol (Rome) ; 19(9): 514-518, 2018 Sep.
Artigo em Italiano | MEDLINE | ID: mdl-30087513

RESUMO

The recommended treatment for ST-segment elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (pPCI). However, in a non-negligible proportion of patients, pPCI is ineffective and the cardiologist must face the decision of how to achieve optimal myocardial reperfusion. Although the possibility of a rescue fibrinolytic strategy has not been evaluated yet in this clinical setting, it is a viable alternative to emergency cardiac surgery. We here report the case of a 60-year-old STEMI patient presenting with a coronary anatomy unsuitable for percutaneous mechanical revascularization, characterized by marked dilation and tortuosity of the proximal and middle epicardial segments. After pPCI failure, the administration of recombinant tissue-type plasminogen activator allowed us to obtain reperfusion as shown by clinical outcome, ST-segment resolution and subsequent angiographic study. No indication was given to further percutaneous or surgical revascularization. The long-term pharmacological management of these patients represents a challenge for the clinician, also considering the available data on the use of new antiplatelet and anticoagulant molecules and their possible associations.


Assuntos
Aneurisma Coronário/terapia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica/métodos , Angiografia Coronária/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento
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