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2.
Am J Cardiol ; 156: 85-92, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34344513

RESUMO

Two widely used methods for left ventricular (LV) ejection fraction (EF) determination, echocardiography (echo) and gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), often have wide limits of agreement. Factors influencing discrepancies between core laboratory echo and MPI LVEF determinations were examined in a large series of heart failure (HF) subjects and normal controls. 879 HF and 101 control subjects had core lab analyses of echo and MPI (mean time between procedures 7-8 days). LVEF differences were analyzed using one-way analysis of variance and Bland-Altman plots. Relationships between LVEF differences and patient characteristics and outcome endpoints (mortality and arrhythmias) were explored with logistic regression, Cox proportional hazards models, and Kaplan-Meier survival analyses. There was a systematic difference between the 2 modalities; echo LVEF was higher with more severe LV dysfunction, MPI LVEF higher when systolic function was normal. LVEF results were within ±5% in only 37% of HF and 23% of control subjects. Considering discordance around the LVEF threshold 35%, there was disagreement between the 2 methods in 305 HF subjects (35%). Male gender (odds ratio (OR) = 0.200), atrial fibrillation (OR = 2.314), higher body mass index (OR = 1.051) and lower LV end-diastolic volume (OR = 0.985) were the strongest predictors of methodologic discordance. Cardiac event rates were highest if both LVEF values were ≤35% and lowest when both LVEF values were >35%. In conclusion, substantial disagreements between LVEF results by echo and MPI are common. HF patients with LVEF ≤35% by both techniques have the highest 2-year event risk.


Assuntos
Ecocardiografia/métodos , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Feminino , Seguimentos , Imagem do Acúmulo Cardíaco de Comporta/métodos , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia Computadorizada de Emissão de Fóton Único/métodos
3.
Mayo Clin Proc ; 96(8): 2145-2156, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353469

RESUMO

OBJECTIVE: To examine contemporary clinical differences between men and women with hemodynamically significant chronic aortic regurgitation (AR). PATIENTS AND METHODS: We retrospectively identified 1072 consecutive patients with moderate to severe or severe AR diagnosed between February 21, 2004, and April 29, 2019. Echocardiographic data, aortic valve surgical intervention (AVS), and all-cause death were analyzed. RESULTS: At baseline, the 189 women in the study group were older than the 883 men (mean ± SD age, 64±18 years vs 58±17 years), had more advanced symptoms, and had larger left ventricular end-systolic dimension index (LVESDi) (all P<.001) despite similar AR severity. An LVESDi of greater than 20 mm/m2 was noted in 60 of 92 asymptomatic women (65%) vs 225 of 559 asymptomatic men (40%) (P<.001). Median follow-up was 5.6 years (interquartile range, 2.5 to 10.0 years). Female sex was associated with less AVS (P=.009), and overall 10-year survival was better in men (76%±2%) than in women (64%±5%) (P=.004). However, 10-year post-AVS survival was similar between the sexes (P=.86), and women had better left ventricular reverse remodeling than men regarding end-diastolic dimension (P=.02). Multivariable independent predictors of death were age, advanced symptoms, LVESDi, ejection fraction, and AVS (all P≤.03) but not female sex. When compared with the age-matched US population, women exhibited a 1.3-fold increased relative risk of death (P=.0383) while men had similar survival (P=.11). CONCLUSION: In contemporary practice, women with AR continue to exhibit an overall survival penalty not related to female sex but to late referral markers, including more advanced symptoms, larger LVESDi, and less AVS. Nonetheless, women in our study exhibited outstanding post-AVS left ventricular remodeling and had good post-AVS survival, a step forward toward closing the sex-related mortality gap. The high percentage of LVESDi of 20 mm/m2 or greater in asymptomatic women represents a window of opportunity for advanced-symptom prevention and timely AR surgical correction that may close the mortality gap.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Valva Aórtica/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Doença Crônica , Ecocardiografia , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
4.
Tex Heart Inst J ; 48(3)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34388240

RESUMO

Takotsubo cardiomyopathy (TTC), a persistently obscure dysfunctional condition of the left ventricle, is uniquely transient but nevertheless dangerous. It features variable ventricular patterns and is predominant in women. For 30 years, pathophysiologic investigations have progressed only slowly and with inadequate focus. It was initially proposed that sudden-onset spastic obliteration of coronary flow induced myocardial ischemia with residual stunning and thus TTC. Later, it was generally accepted without proof that, in the presence of pain or emotional stress, the dominant mechanism for TTC onset was a catecholamine surge that had a direct, toxic myocardial effect. We think that the manifestations of TTC are more dynamic and complex than can be assumed from catecholamine effects alone. In addition, after reviewing the recent medical literature and considering our own clinical observations, especially on spasm, we theorize that atherosclerotic coronary artery disease modulates and physically opposes obstruction during spasm. This phenomenon may explain the midventricular variant of TTC and the lower incidence of TTC in men. We continue to recommend and perform acetylcholine testing to reproduce TTC and to confirm our theory that coronary spasm is its initial pathophysiologic factor. An improved understanding of TTC is especially important because of the condition's markedly increased incidence during the ongoing COVID-19 pandemic.


Assuntos
COVID-19/epidemiologia , Vasoespasmo Coronário , Ventrículos do Coração/fisiopatologia , Isquemia Miocárdica , Cardiomiopatia de Takotsubo , Catecolaminas/metabolismo , Vasoespasmo Coronário/fisiopatologia , Humanos , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/fisiopatologia , SARS-CoV-2 , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/metabolismo , Cardiomiopatia de Takotsubo/fisiopatologia
5.
Am J Cardiol ; 155: 96-102, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34315571

RESUMO

In patients with moderate aortic stenosis (AS), heart failure (HF) symptoms are often unrelated to the AS severity, and the causes of HF symptoms are often unclear. Hypertension is known as one of the most common comorbidities in degenerative AS. Therefore, we assessed the impact of systolic blood pressure (BP) on HF symptoms in patients with moderate AS. We retrospectively analyzed 317 patients with moderate AS (mean transaortic pressure gradient 20 to 39 mm Hg) and preserved left ventricular ejection fraction (left ventricular ejection fraction ≥50%). We classified patients according to the presence or absence of HF symptoms. One hundred patients (32%) had HF symptoms. Symptomatic patients had higher systolic BP (141±21 versus 129±21 mm Hg; p<0.001) and mean transaortic pressure gradient, and lower aortic valve area than asymptomatic patients. In the multivariable analysis after adjustment for age, atrial fibrillation, Charlson comorbidity index, brain natriuretic peptide, and the use of diuretics, HF symptoms in patients with moderate AS were independently associated with systolic BP (odds ratio, 1.43 per 10 mm Hg increase in systolic BP; 95% confidence interval, 1.14-1.78; p=0.001) and left atrial volume index (odds ratio, 1.04 per 1 mL/m2 increase in left atrial volume index; 95% confidence interval, 1.00-1.08; p=0.026). Receiver operating characteristics curve analysis identified systolic BP 133 mm Hg as the cutoff value associated with HF symptoms. In conclusion, systolic BP as well as left atrial volume index were independent correlates of HF symptoms in patients with moderate AS.


Assuntos
Estenose da Valva Aórtica/complicações , Pressão Sanguínea/fisiologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Hipertensão/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Humanos , Hipertensão/etiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico/fisiologia
6.
Tex Heart Inst J ; 48(3)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34243189

RESUMO

Aortic insufficiency with recirculation can be difficult to diagnose echocardiographically in patients who have continuous-flow left ventricular assist devices. Transthoracic and transesophageal echocardiography can underestimate its severity; moreover, transesophageal echocardiography necessitates general anesthesia. We report the case of a 58-year-old man with obesity and end-stage nonischemic cardiomyopathy who, after 3 months of support with a continuous-flow left ventricular assist device, underwent intracardiac echocardiography to evaluate complications potentially associated with the device. The findings ruled out aortic insufficiency, preventing an unnecessary valvular intervention.


Assuntos
Ecocardiografia/métodos , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração/diagnóstico por imagem , Coração Auxiliar , Obesidade/complicações , Função Ventricular Esquerda/fisiologia , Progressão da Doença , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Índice de Gravidade de Doença
7.
Mayo Clin Proc ; 96(8): 2133-2144, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34226024

RESUMO

OBJECTIVE: To evaluate outcomes of elective surgical management of tricuspid regurgitation (TR) in patients with transvenous right ventricular leads, and compare results between non-lead-induced and lead-induced TR patients. PATIENTS AND METHODS: We studied patients with right ventricular leads who underwent tricuspid valve surgery from January 1, 1993, through December 31, 2015, and categorized them as non-lead-induced and lead-induced TR. Propensity score (PS) for the tendency to have lead-induced TR was estimated from logistic regression and was used to adjust for group differences. RESULTS: From the initial cohort of 470 patients, 444 were included in PS-adjustment analyses (174 non-lead-induced TRs [123 repairs, 51 replacements], 270 lead-induced TRs [129 repairs, 141 replacements]). In PS-adjusted multivariable analysis, lead-induced TR was not associated with mortality (P=.73), but tricuspid valve replacement was (hazard ratio, 1.59; 95% CI, 1.13 to 2.25; P=.008). Five-year freedom from tricuspid valve re-intervention was 100% for non-lead-induced TR and 92.3% for lead-induced TR; rates adjusted for PS differed between groups (P=.005). There was significant improvement in TR postoperatively in each group (P<.001). In patients having tricuspid valve repair, TR grades tended to worsen over time, but the difference in trends was not significantly different between groups. CONCLUSION: Lead-induced TR did not affect long-term survival after elective tricuspid valve surgery. In patients with lead-induced TR, tricuspid valve re-intervention was more common. Improvement in TR was achieved in both groups after surgery; however, severity of TR tended to increase over follow-up after tricuspid valve repair.


Assuntos
Fibrilação Atrial/terapia , Anuloplastia da Valva Cardíaca/métodos , Ecocardiografia/métodos , Marca-Passo Artificial , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Função Ventricular Direita/fisiologia , Idoso , Fibrilação Atrial/complicações , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico
8.
Medicine (Baltimore) ; 100(27): e25915, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232164

RESUMO

ABSTRACT: Early right ventricular dysfunction in patients with non-advanced idiopathic pulmonary fibrosis (IPF) has not been fully elucidated. Thus, we aimed to assess right ventricular functions in IPF patients and controls by speckle-tracking strain echocardiography at rest and peak exercise.We screened 116 IPF patients from February to August 2019 to include 20 patients with no history of oxygen therapy, peripheral saturation levels ≥92% at rest, Gender-Age-Physiology Index score ≤5, and modified Medical Research Council score ≤3. Additionally, we enrolled 10 matched controls. Transthoracic echocardiography images were acquired at rest and during a cardiopulmonary exercise test. We analyzed 2-dimensional echocardiographic parameters and right ventricular function using the global longitudinal strain assessed by the 2-dimensional speckle-tracking technique.In the control group, we found normal values of right ventricle longitudinal strain (RVLS) at rest and at peak exercise, the latter being much more negative (-23.6 ±â€Š2.2% and -26.8 ±â€Š3.1%, respectively; P < .001). By contrast, RVLS values in the IPF group increased from -21.1 ±â€Š3.8% at rest to -17.0 ±â€Š4.5% at peak exercise (P < .001). The exercise revealed a difference between the 2 groups as the mean RVLS values moved during peak exercise in opposite directions. Patients with IPF got worse, whereas control patients presented improved right ventricular contractility.Right ventricular dysfunction was unveiled by speckle-tracking echocardiography during exercise in non-advanced IPF patients. We suggest that this reflects an inadequate right ventricular-arterial coupling decreasing the right ventricular longitudinal contraction during exercise in these patients. This parameter may be useful as an early index of suspected pulmonary hypertension.


Assuntos
Terapia por Exercício/métodos , Exercício Físico/fisiologia , Ventrículos do Coração/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Fibrose Pulmonar Idiopática/fisiopatologia , Contração Miocárdica/fisiologia , Função Ventricular Direita/fisiologia , Idoso , Estudos Transversais , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/terapia , Fibrose Pulmonar Idiopática/complicações , Masculino
9.
Medicine (Baltimore) ; 100(27): e26560, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232199

RESUMO

BACKGROUND: Right ventricular pacing (RVP) has been widely accepted as a traditional pacing strategy, but long-term RVP has detrimental impact on ventricular synchrony. However, left bundle branch pacing (LBBP) that evolved from His-bundle pacing could maintain ventricular synchrony and overcome its clinical deficiencies such as difficulty of lead implantation, His bundle damage, and high and unstable thresholds. This analysis aimed to appraise the clinical safety and efficacy of LBBP. METHODS: The Medline, PubMed, Embase, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing LBBP and RVP. RESULTS: Seven trials with 451 patients (221 patients underwent LBBP and 230 patients underwent RVP) were included in the analysis. Pooled analyses verified that the paced QRS duration (QRSd) and left ventricular mechanical synchronization parameters of the LBBP capture were similar with the native-conduction mode (P > .7),but LBBP showed shorter QRS duration (weighted mean difference [WMD]: -33.32; 95% confidence interval [CI], -40.44 to -26.19, P < .001), better left ventricular mechanical synchrony (standard mean differences: -1.5; 95% CI: -1.85 to -1.14, P < .001) compared with RVP. No significant differences in Pacing threshold (WMD: 0.01; 95% CI: -0.08 to 0.09, P < .001), R wave amplitude (WMD: 0.04; 95% CI: -1.12 to 1.19, P = .95) were noted between LBBP and RVP. Ventricular impedance of LBBP was higher than that of RVP originally (WMD: 19.34; 95% CI: 3.13-35.56, P = .02), and there was no difference between the 2 groups after follow-up (WMD: 11.78; 95% CI: -24.48 to 48.04, P = .52). And follow-up pacing threshold of LBBP kept stability (WMD: 0.08; 95% CI: -0.09 to 0.25, P = .36). However, no statistical difference existed in ejection fraction between the 2 groups (WMD: 1.41; 95% CI: -1.72 to 4.54, P = .38). CONCLUSIONS: The safety and efficacy of LBBP was firstly verified by meta-analysis to date. LBBP markedly preserve ventricular electrical and mechanical synchrony compared with RVP. Meanwhile, LBBP had stable and excellent pacing parameters. However, LBBP could not be significant difference in ejection fraction between RVP during short- term follow-up.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Frequência Cardíaca/fisiologia , Ventrículos do Coração/fisiopatologia , Função Ventricular Esquerda/fisiologia , Bloqueio de Ramo/fisiopatologia , Eletrocardiografia , Humanos , Resultado do Tratamento
10.
Arch Cardiovasc Dis ; 114(5): 407-414, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34088625

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been a fast-growing worldwide pandemic. AIMS: We aimed to investigate the incidence of cardiac arrhythmias among a large French cohort of implantable cardioverter defibrillator recipients over the first 5 months of 2020. METHODS: Five thousand nine hundred and fifty-four implantable cardioverter defibrillator recipients were followed by remote monitoring during the COVID-19 period (from 01 January to 31 May 2020). Data were obtained from automated remote follow-up of implantable cardioverter defibrillators utilizing the Implicity® platform. For all patients, the type of arrhythmia (atrial fibrillation, ventricular tachycardia or ventricular fibrillation), the number of ventricular arrhythmia episodes and the type of implantable cardioverter defibrillator-delivered therapy were recorded. RESULTS: A total of 472 (7.9%) patients presented 4917 ventricular arrhythmia events. An increase in ventricular arrhythmia incidence was observed after the first COVID-19 case in France, and especially during weeks #10 and #11, at the time of major governmental measures, with an increase in the incidence of antitachycardia pacing delivered therapy. During the 11 weeks before the lockdown order, the curve of the percentage of live-stream television coverage of COVID-19 information matched the ventricular arrhythmia incidence. During the lockdown, the incidence of ventricular arrhythmia decreased significantly compared with baseline (0.05±0.7 vs. 0.09±1.2 episodes per patient per week, respectively; P<0.001). Importantly, no correlation was observed between ventricular arrhythmia incidence and the curve of COVID-19 incidence. No changes were observed regarding atrial fibrillation/atrial tachycardia episodes over time. CONCLUSIONS: An increase in ventricular arrhythmia incidence was observed in the 2 weeks before the lockdown order, at the time of major governmental measures. Ventricular arrhythmia incidence decreased dramatically during the lockdown.


Assuntos
Arritmias Cardíacas/epidemiologia , COVID-19/epidemiologia , Desfibriladores Implantáveis , Monitorização Ambulatorial/métodos , Tecnologia de Sensoriamento Remoto/métodos , SARS-CoV-2 , Idoso , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Feminino , Seguimentos , França/epidemiologia , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/estatística & dados numéricos , Estudos Prospectivos , Quarentena , Tecnologia de Sensoriamento Remoto/instrumentação , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/epidemiologia
11.
Medicine (Baltimore) ; 100(25): e26372, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160410

RESUMO

RATIONALE: Idiopathic ventricular tachycardia (VT) occurs in individuals without structural abnormalities in the heart, accounts for approximately 10% of total VTs. Furthermore, approximately 70% of idiopathic VTs originate from Right ventricular outflow tract (RVOT). However, among perioperative arrhythmias, incidence of VT after surgery is extremely rare and most arrhythmias are atrial origin. PATIENT CONCERNS: A 69-year-old man with permanent pacemaker underwent colon surgery. DIAGNOSES: Patient suffered from low blood pressure and dizziness, sweating at post anesthetic care unit (PACU) and heart rate (HR) increased suddenly to 200 beats/min with monomorphic VT after bolus ephedrine administration and continuous dopamine infusion. INTERVENTIONS: Pacemaker interrogation followed by DC cardioversion was done. OUTCOMES: Patient's vital signs became normal and symptoms are subsided. LESSONS: RVOT VT can be caused by triggering activities, such as ephedrine, dopamine, and inadequate fluid management. These triggering activities are initiated by acceleration of HR from ventricles with infusion of catecholamine which lead monomorphic VT originating from RVOT.RVOT origin PVCs can be precipitated into monomorphic VT by administrating catecholamines such as ephedrine and dopamine even in patient with pacemaker. The mechanism of these VTs includes catecholamine induced acceleration of HR. Since RVOT PVCs can be recognize by 12 EKGs, we should be pay more attentions to the pre-operation EKG and be cautious using catecholamines.


Assuntos
Colectomia/efeitos adversos , Ventrículos do Coração/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Taquicardia Ventricular/diagnóstico , Idoso , Neoplasias do Colo/cirurgia , Ecocardiografia , Cardioversão Elétrica , Eletrocardiografia , Bloqueio Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Marca-Passo Artificial , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapia , Resultado do Tratamento
12.
Am J Physiol Heart Circ Physiol ; 321(2): H382-H389, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34142888

RESUMO

Pulmonary hypertension (PH) is associated with structural remodeling of pulmonary arteries (PAs) because of excessive proliferation of fibroblasts, endothelial cells, and smooth muscle cells (SMCs). The peptide hormone angiotensin II (ANG II) contributes to pulmonary vascular remodeling, in part, through its ability to trigger extracellular signal-regulated kinase (ERK1/2) activation. Here, we demonstrate that the ERK1/2 phosphatase, dual-specificity phosphatase 5 (DUSP5), functions as a negative regulator of ANG II-mediated SMC proliferation and PH. In contrast to wild-type controls, Dusp5 null mice infused with ANG II developed PH and right ventricular (RV) hypertrophy. PH in Dusp5 null mice was associated with thickening of the medial layer of small PAs, suggesting an in vivo role for DUSP5 as a negative regulator of ANG II-dependent SMC proliferation. Consistent with this, overexpression of DUSP5 blocked ANG II-mediated proliferation of cultured human pulmonary artery SMCs (hPASMCs) derived from patients with idiopathic PH or from failed donor controls. Collectively, the data support a role for DUSP5 as a feedback inhibitor of ANG II-mediated ERK signaling and PASMC proliferation and suggest that disruption of this circuit leads to adverse cardiopulmonary remodeling.NEW & NOTEWORTHY Dual-specificity phosphatases (DUSPs) serve critical roles in the regulation of mitogen-activated protein kinases, but their functions in the cardiovascular system remain poorly defined. Here, we provide evidence that DUSP5, which resides in the nucleus and specifically dephosphorylates extracellular signal-regulated kinase (ERK1/2), blocks pulmonary vascular smooth muscle cell proliferation. In response to angiotensin II infusion, mice lacking DUSP5 develop pulmonary hypertension and right ventricular cardiac hypertrophy. These findings illustrate DUSP5-mediated suppression of ERK signaling in the lungs as a protective mechanism.


Assuntos
Proliferação de Células/genética , Fosfatases de Especificidade Dupla/genética , Ventrículos do Coração/metabolismo , Hipertensão Pulmonar/genética , Hipertrofia Ventricular Direita/genética , Miócitos de Músculo Liso/metabolismo , Artéria Pulmonar/metabolismo , Remodelação Vascular/genética , Angiotensina II/farmacologia , Animais , Estudos de Casos e Controles , Células Cultivadas , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão Pulmonar/induzido quimicamente , Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Direita/induzido quimicamente , Hipertrofia Ventricular Direita/fisiopatologia , Sistema de Sinalização das MAP Quinases , Camundongos , Camundongos Knockout , Músculo Liso Vascular/citologia , Miócitos de Músculo Liso/efeitos dos fármacos , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/patologia , Artéria Pulmonar/fisiopatologia , Vasoconstritores/farmacologia
13.
Sci Rep ; 11(1): 11648, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078942

RESUMO

Cardiovascular magnetic resonance (CMR) imaging provides reliable assessments of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards novel artificial intelligence-based fully automated analyses. Hence, we sought to investigate the impact of artificial intelligence-based fully automated assessments on the inter-study variability of biventricular volumes and function. Eighteen participants (11 with normal, 3 with heart failure and preserved and 4 with reduced ejection fraction (EF)) underwent serial CMR imaging at in median 63 days (range 49-87) interval. Short axis cine stacks were acquired for the evaluation of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic, end-systolic and stroke volumes as well as EF. Assessments were performed manually (QMass, Medis Medical Imaging Systems, Leiden, Netherlands) by an experienced (3 years) and inexperienced reader (no active reporting, 45 min of training with five cases from the SCMR consensus data) as well as fully automated (suiteHEART, Neosoft, Pewaukee, WI, USA) without any manual corrections. Inter-study reproducibility was overall excellent with respect to LV volumetric indices, best for the experienced observer (intraclass correlation coefficient (ICC) > 0.98, coefficient of variation (CoV, < 9.6%) closely followed by automated analyses (ICC > 0.93, CoV < 12.4%) and lowest for the inexperienced observer (ICC > 0.86, CoV < 18.8%). Inter-study reproducibility of RV volumes was excellent for the experienced observer (ICC > 0.88, CoV < 10.7%) but considerably lower for automated and inexperienced manual analyses (ICC > 0.69 and > 0.46, CoV < 22.8% and < 28.7% respectively). In this cohort, fully automated analyses allowed reliable serial investigations of LV volumes with comparable inter-study reproducibility to manual analyses performed by an experienced CMR observer. In contrast, RV automated quantification with current algorithms still relied on manual post-processing for reliability.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Algoritmos , Eletrocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia
14.
Int J Mol Sci ; 22(9)2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-34066865

RESUMO

Hypertension is one of the most prevalent and powerful contributors of cardiovascular diseases. Malignant hypertension is a relatively rare but extremely severe form of hypertension accompanied with heart, brain, and renal impairment. Resveratrol, a recently described grape-derived, polyphenolic antioxidant molecule, has been proposed as an effective agent in the prevention of cardiovascular diseases. This study was designed to examine chronic resveratrol administration on blood pressure, oxidative stress, and inflammation, with special emphasis on cardiac structure and function in two models of experimental hypertension. The experiments were performed in spontaneously (SHRs) and malignantly hypertensive rats (MHRs). The chronic administration of resveratrol significantly decreased blood pressure in both spontaneously and malignant hypertensive animals. The resveratrol treatment ameliorated morphological changes in the heart tissue. The immunohistochemistry of the heart tissue after resveratrol treatment showed that both TGF-ß and Bax were not present in the myocytes of SHRs and were present mainly in the myocytes of MHRs. Resveratrol suppressed lipid peroxidation and significantly improved oxidative status and release of NO. These results suggest that resveratrol prevents hypertrophic and apoptotic consequences induced by high blood pressure with more pronounced effects in malignant hypertension.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Apoptose , Cardiotônicos/uso terapêutico , Hipertensão Maligna/tratamento farmacológico , Resveratrol/uso terapêutico , Animais , Anti-Inflamatórios/farmacologia , Apoptose/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Cardiotônicos/farmacologia , Feminino , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/patologia , Ventrículos do Coração/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Hipertensão Maligna/enzimologia , Hipertensão Maligna/patologia , Hipertensão Maligna/fisiopatologia , Inflamação/complicações , Inflamação/tratamento farmacológico , Miocárdio/patologia , NG-Nitroarginina Metil Éster/química , NG-Nitroarginina Metil Éster/farmacologia , Tamanho do Órgão/efeitos dos fármacos , Oxirredução , Ratos Endogâmicos SHR , Resveratrol/química , Resveratrol/farmacologia , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo , Proteína X Associada a bcl-2/metabolismo
15.
Biomed Res Int ; 2021: 5551325, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33997005

RESUMO

Background: The study was aimed at exploring the electrophysiological characteristics (EPS) of the optimal ablation site and its relationship with electroanatomic voltage mapping (EVM) in idiopathic premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT). Methods: A total of 28 patients with idiopathic RVOT PVCs underwent successful ablation and EVM using a 3D electroanatomical mapping (CARTO) system. Results: Both bipolar and unipolar EVM showed a similar band-like lower-voltage area (LVA) under the pulmonary valve in all the patients; 21.4% of the targets were located in the band-like LVA. 42.9% of the targets were at the border of the band-like LVA on the bipolar voltage map, but unipolar mapping showed that 53.6% of the targets were located in the band-like LVA, and 35.7% of the targets at the border of the band-like LVA. A significant difference was found in both unipolar and bipolar voltage values between the regions within 0-5 mm above the optimal ablation site and the other regions. A similar difference was observed only in unipolar voltage values below the optimal ablation site. At the ablation site, there were frequent occurrences of a fragmented wave and voltage reversion in the bipolar electrograms, frustrated falling limbs, W bottom, and a QS configuration width > 150 ms in the unipolar electrograms. Conclusions: EVM showed that the band-like LVA was an interesting area for the search of the optimal ablation sites of idiopathic RVOT-PVCs, especially the border area. There was focal microscarring around the ablation targets; some characteristics of EPS proved significant for successful ablation.


Assuntos
Técnicas Eletrofisiológicas Cardíacas , Ventrículos do Coração , Complexos Ventriculares Prematuros , Adulto , Ablação por Cateter , Eletrocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complexos Ventriculares Prematuros/diagnóstico por imagem , Complexos Ventriculares Prematuros/fisiopatologia , Complexos Ventriculares Prematuros/cirurgia
16.
Am J Physiol Heart Circ Physiol ; 320(6): H2385-H2400, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33989079

RESUMO

Cell-free hemoglobin (CFH) levels are elevated in septic shock and are higher in nonsurvivors. Whether CFH is only a marker of sepsis severity or is involved in pathogenesis is unknown. This study aimed to investigate whether CFH worsens sepsis-associated injuries and to determine potential mechanisms of harm. Fifty-one, 10-12 kg purpose-bred beagles were randomized to receive Staphylococcus aureus intrapulmonary challenges or saline followed by CFH infusions (oxyhemoglobin >80%) or placebo. Animals received antibiotics and intensive care support for 96 h. CFH significantly increased mean pulmonary arterial pressures and right ventricular afterload in both septic and nonseptic animals, effects that were significantly greater in nonsurvivors. These findings are consistent with CFH-associated nitric oxide (NO) scavenging and were associated with significantly depressed cardiac function, and worsened shock, lactate levels, metabolic acidosis, and multiorgan failure. In septic animals only, CFH administration significantly increased mean alveolar-arterial oxygenation gradients, also to a significantly greater degree in nonsurvivors. CFH-associated iron levels were significantly suppressed in infected animals, suggesting that bacterial iron uptake worsened pneumonia. Notably, cytokine levels were similar in survivors and nonsurvivors and were not predictive of outcome. In the absence and presence of infection, CFH infusions resulted in pulmonary hypertension, cardiogenic shock, and multiorgan failure, likely through NO scavenging. In the presence of infection alone, CFH infusions worsened oxygen exchange and lung injury, presumably by supplying iron that promoted bacterial growth. CFH elevation, a known consequence of clinical septic shock, adversely impacts sepsis outcomes through more than one mechanism, and is a biologically plausible, nonantibiotic, noncytokine target for therapeutic intervention.NEW & NOTEWORTHY Cell-free hemoglobin (CFH) elevations are a known consequence of clinical sepsis. Using a two-by-two factorial design and extensive physiological and biochemical evidence, we found a direct mechanism of injury related to nitric oxide scavenging leading to pulmonary hypertension increasing right heart afterload, depressed cardiac function, worsening circulatory failure, and death, as well as an indirect mechanism related to iron toxicity. These discoveries alter conventional thinking about septic shock pathogenesis and provide novel therapeutic approaches.


Assuntos
Hemoglobinas/metabolismo , Pneumonia/metabolismo , Artéria Pulmonar/fisiopatologia , Choque Séptico/metabolismo , Infecções Estafilocócicas/metabolismo , Acidose/metabolismo , Acidose/fisiopatologia , Lesão Pulmonar Aguda/metabolismo , Lesão Pulmonar Aguda/fisiopatologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Cães , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Hemoglobinas/farmacologia , Ferro/metabolismo , Ácido Láctico/metabolismo , Insuficiência de Múltiplos Órgãos/metabolismo , Insuficiência de Múltiplos Órgãos/fisiopatologia , Óxido Nítrico/metabolismo , Pneumonia/fisiopatologia , Troca Gasosa Pulmonar , Distribuição Aleatória , Choque Séptico/fisiopatologia , Staphylococcus aureus/crescimento & desenvolvimento
18.
Crit Care ; 25(1): 172, 2021 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-34020703

RESUMO

BACKGROUND: Previous studies have found various incidences of right ventricular (RV) injury and its association with clinical outcome in patients with acute respiratory distress syndrome (ARDS). In this systematic review and meta-analysis, we aimed to investigate the impact of the presence of RV injury on mortality in patients with ARDS. METHOD: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies investigating the association between RV injury and mortality. Two authors independently evaluated whether studies meet eligibility criteria and extracted the selected patients' and studies' characteristics and outcomes. RV injury was diagnosed by trans-thoracic echocardiogram (TTE), trans-esophageal echocardiogram (TEE) and PAC (pulmonary artery catheter) in the included studies. The primary outcome was the association between mortality and the presence of RV injury in patients with ARDS. The overall reported mortality was defined as either the intensive care unit (ICU) mortality, in-hospital mortality, or mortality within 90 days, and short-term mortality was defined as ICU-mortality, in-hospital mortality, or mortality within 30 days. RESULTS: We included 9 studies (N = 1861 patients) in this meta-analysis. RV injury that included RV dysfunction, RV dysfunction with hemodynamic compromise, RV failure, or acute cor-pulmonale was present in 21.0% (391/1,861). In the pooled meta-analysis, the presence of RV injury in patients with ARDS was associated with significantly higher overall mortality (OR 1.45, 95% CI 1.13-1.86, p-value = 0.003, I2 = 0%), as well as short-term mortality (OR 1.48, 95% CI 1.14-1.93, p-value = 0.003, I2 = 0%). CONCLUSION: In this systematic review and meta-analysis including 1861 patients with ARDS, the presence of RV injury was significantly associated with increased overall and short-term mortality. TRIAL REGISTRATION: The protocol was registered at PROSPERO (CRD42020206521).


Assuntos
Ventrículos do Coração/lesões , Síndrome do Desconforto Respiratório/mortalidade , Ventrículos do Coração/fisiopatologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Razão de Chances
19.
Pediatr Cardiol ; 42(6): 1416-1424, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33963894

RESUMO

Vein of Galen aneurysmal malformation (VGAM) is a rare anomaly associated with poor outcomes from high output cardiac failure and neurologic complications. Studies addressing fetal cardiovascular status and outcomes in this population are limited. A single-center retrospective review was conducted on patients with a prenatal diagnosis of VGAM who underwent a fetal echocardiogram between January 2015 and July 2019. Fetal echocardiographic data, brain magnetic resonance imaging (MRI) findings and outcomes were collected. Nine fetuses [median gestational age at echocardiogram 34 (1.1) weeks] were included. All patients had superior vena cava dilation and reversal of diastolic flow in the transverse aortic arch. Median cardiothoracic (CT) ratio was 0.39 (0.09). Right ventricular (RV) and left ventricular (LV) dysfunction was present in 66% and 11% fetuses, respectively. Four out of five patients that underwent postnatal endovascular neurosurgical interventions at our center were alive at follow-up (mean 2.7 years). Of the non-survivors (n = 5), 3 received comfort care because of severe brain damage and died in the neonatal period. Non-survivors more commonly had > mild tricuspid regurgitation (TR) (40% vs. 25%) and > mild RV dilation (60% vs. 25%). Combined cardiac index (CCI) was higher in non-survivors when compared to survivors (672.7 vs. 530.2 ml/kg/min, p = 0.016). Fetuses with significant parenchymal damage on brain MRI tended to have a higher CCI than those without (979.8 vs. 605.0 ml/kg/min, p = 0.047). RV dysfunction, TR and elevated CCI are more commonly seen in non-survivors with VGAM. A higher CCI is seen in those deemed untreatable due to significant parenchymal volume loss. Future multicenter studies are needed to assess for prenatal prediction of outcomes in this high-risk population.


Assuntos
Ecocardiografia/métodos , Imagem Cinética por Ressonância Magnética/métodos , Ultrassonografia Pré-Natal/métodos , Malformações da Veia de Galeno/fisiopatologia , Veia Cava Superior/fisiopatologia , Feminino , Idade Gestacional , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Malformações da Veia de Galeno/diagnóstico , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagem
20.
Pediatr Cardiol ; 42(6): 1324-1333, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33934202

RESUMO

INTRODUCTION: Right ventricular (RV) dilatation is the determining prognostic factor in the long-term follow up of patients with repaired Tetralogy of Fallot (TOF). The objective of this study is to analyze whether the results vary depending on the timing of the complete repair and on the surgical technique applied. MATERIAL-METHODS: This is a retrospective longitudinal study in which patients with standard TOF were divided into 3 groups depending on their age at surgical repair: group 1 = Early repair (n = 12,1-8 months), group 2 = Late repair (n = 26, > 8 months), and group 3 = Late repair with previous palliative surgery (n = 17, > 8 months). Clinical, echocardiographic and cardiac magnetic resonance (CMR) data from patients that had received complete reparative surgery in our institution from January 2000 to March 2014 were analyzed and compared. RESULTS: 55 patients with echocardiogram and CMR studies (13.39 ± 3.59 years) were reviewed. All patients had at least moderate pulmonary regurgitation (PR). We observed a positive correlation between PR and right ventricular end-diastolic volume (r2 = 0.418; p = 0,004). Group 3 had more severe right ventricular dilatation than patients in groups 1 and 2 (p = 0.001). No differences in right ventricular end-diastolic volume, PR, and pulmonary trunk dimensions were observed between groups 1 and 2. Patients in group 3 had a longer hospital stay. CONCLUSIONS: Although all patients from our cohort had significant PR, age at surgery was not related to RV or pulmonary trunk dilatation. Previous palliative surgery was associated with more severe right ventricular dilatation and longer hospital stays. No differences were observed between early and late repair groups. Our study suggests that postponing TOF repair to a late stage does not improve the degree of PR or long-term morbidity from RV dilatation. Palliative surgery should be avoided if possible.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Tetralogia de Fallot/diagnóstico , Estudos de Coortes , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Lactente , Estudos Longitudinais , Masculino , Circulação Pulmonar/fisiologia , Estudos Retrospectivos , Tetralogia de Fallot/fisiopatologia , Tetralogia de Fallot/cirurgia , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento
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