El péptido Pro-BNP como predictor de daño cardíaco en pacientes con esclerosis sistémica / Pro-BNP Peptide as a Predictor of Cardiac Damage in Systemic Sclerosis Patients

Introducción: La esclerosis sistémica es una enfermedad crónica del tejido conectivo de carácter autoinmune, de causa desconocida, que produce exceso de colágeno provocando fibrosis en la piel, con afectación de órganos internos. Los anticuerpos frecuentes son: antitopoisomerasa 1 y anticentrómero. Las formas clínicas son la cutánea difusa y cutánea limitada. La prevalencia de la afectación cardíaca varía entre un 8-28 por ciento y en fases tardías la presencia de signos y síntomas cardiovasculares es de mal pronóstico y una de las principales causas de mortalidad. Objetivo: Determinar la asociación entre afectación cardíaca y las formas clínicas, el pro-péptido natriurético cerebral N-terminal (NT-proBNP) y los autoanticuerpos en la esclerosis sistémica. Métodos: Se realizó un estudio descriptivo transversal de un universo de 140 pacientes, la muestra fue de 54 pacientes. Se le realizó ecocardiograma, niveles de NT-proBNP, anti-scl 70, anticentrómero y determinación de formas clínicas a todos los pacientes que cumplieron criterios de inclusión y que fueron atendidos en el Hospital: Hermanos Ameijeiras Habana-Cuba, entre julio de 2016 a diciembre de 2017. Resultados: La edad media fue 51,76 ± 12,82. Sexo femenino en un 96,3 por ciento. El 72,2 por ciento era piel blanca. La afectación cardíaca de la EScd fue de 77,5 por ciento, hormona NT-proBNP tuvo niveles elevados en un 55,0 por ciento. Los anti-scl-70 estuvieron negativos en el 70 por ciento (n = 28) de los pacientes con afectación cardíaca. El anti-centrómero estuvo negativo en el 95,0 por ciento (n = 38). Conclusiones: Se determinó que la afectación cardíaca en pacientes con esclerosis sistémica, es independiente de las formas clínicas y de la presencia de autoanticuerpos. Los pacientes que tuvieron los niveles séricos de NT-proBNP elevados presentaron afectación cardíaca(AU)

Introduction: Systemic sclerosis is a chronic autoimmune connective tissue disease of unknown cause, which produces excess collagen causing fibrosis in the skin, affecting internal organs. Common antibodies are antitopoisomerase 1 and anticentromere. The clinical forms are diffuse cutaneous and limited cutaneous. The prevalence of cardiac involvement varies between 8-28percent and in late stages the presence of cardiovascular signs and symptoms have poor prognosis and one of the main causes of mortality. Objective: To determine the association between cardiac involvement and clinical forms, N-terminal pro-brain natriuretic peptide (NT-proBNP) and autoantibodies in SSc. Methods: A cross-sectional descriptive study of a universe of 140 patients was carried out. Fifty four patients made up the sample. An echocardiogram, NT-proBNP, Anti-scl 70, anticentromere levels and determination of clinical forms were performed on all patients who met the inclusion criteria and who were treated at Hermanos Ameijeiras hospital in Havana, Cuba, from July 2016 to December 2017. Results: The mean age was 51.76 ± 12.82. Female sex accounted 96.3percent. 72.2percent were white skinned. Cardiac involvement of EScd was 77.5percent, NT-proBNP hormone had high levels in 55.0percent. Anti-scl-70 were negative in 70percent (n=28) of patients with cardiac involvement. Anti-centromere (ACT) was negative in 95.0percent (n=38). Conclusions: Cardiac involvement in patients with SS is independent of the clinical forms and the presence of autoantibodies. Patients with elevated NT-proBNP serum levels had cardiac involvement(AU)

Frecuencia de hipertensión pulmonar en pacientes con enfermedad pulmonar obstructiva crónica / Frequency of pulmonary hypertension in patients with chronic obstructive pulmonary disease

Introducción: La enfermedad pulmonar obstructiva crónica es uno de los padecimientos pulmonares más frecuente a nivel mundial. Tiene repercusión sobre la mortalidad, causa importante discapacidad y afecta un número considerable de sujetos en edad productiva. La hipertensión pulmonar es una complicación usual de las enfermedades respiratorias crónicas y en particular de la pulmonar obstructiva crónica. Objetivo: Caracterizar a pacientes con enfermedad pulmonar obstructiva crónica y sospecha de hipertensión pulmonar. Métodos: Se realizó un estudio descriptivo, prospectivo en 50 pacientes atendidos en el Hospital Neumológico Benéfico Jurídico desde noviembre 2016 a enero 2018. Se analizaron variables tales como la edad, el sexo, la prueba de función ventilatoria, la radiografía de tórax, el electrocardiograma y el ecocardiograma. Resultados: De 700 pacientes portadores de enfermedad pulmonar crónica, se sospechó hipertensión pulmonar en 7 por ciento y fue confirmada en 34. Las frecuencias por sexo fueron similares y primaron los mayores de 60 años. El 41,6 por ciento de los pacientes tuvo afectación respiratoria severa, 70,6 por ciento presentó hipertensión pulmonar ligera y 64,7 por ciento tenía disnea grado 3. Los índices kappa entre las técnicas utilizadas para el diagnóstico de la hipertensión pulmonar superaron la cifra de 0,74. Conclusiones: La frecuencia de hipertensión pulmonar en pacientes con enfermedad pulmonar obstructiva crónica fue elevada. Primaron pacientes con afectación severa de la función respiratoria e hipertensión pulmonar ligera. El grado de enfermedad pulmonar obstructiva crónica no determinó la severidad de hipertensión pulmonar. Los mayores valores de concordancia entre las técnicas diagnósticas se obtuvieron para la radiografía y el ecocardiograma(AU)

Introduction: Chronic obstructive pulmonary disease is one of the most frequent, worldwide. It has impact on mortality, causing significant disability and affecting a considerable number of subjects of productive age. Pulmonary hypertension is a common complication of chronic respiratory diseases, particularly chronic obstructive pulmonary disease. Objective: To describe patients with chronic obstructive pulmonary disease and suspected pulmonary hypertension. Methods: A descriptive, prospective study was carried out in 50 patients treated at Benéfico Jurídico Pneumological Hospital from November 2016 to January 2018. Variables such as age, sex, ventilatory function test, chest X-ray, electrocardiogram and the echocardiogram were analyzed. Results: Out of 700 patients with chronic lung disease, pulmonary hypertension was suspected in 7 por ciento and confirmed in 34. The frequencies by sex were similar and those older than 60 years prevailed. 41.6 por ciento of the patients had severe respiratory involvement, 70.6 por ciento had mild pulmonary hypertension and 64.7 por ciento had grade 3 dyspnea. The kappa indices between the techniques used for the diagnosis of pulmonary hypertension exceeded the figure of 0.74. Conclusions: The frequency of pulmonary hypertension in patients with chronic obstructive pulmonary disease was high. Patients with severe impairment of respiratory function and mild pulmonary hypertension predominated. The degree of chronic obstructive pulmonary disease did not determine the severity of pulmonary hypertension. The highest concordance values between diagnostic techniques were obtained for radiography and echocardiography(AU)

Hipertensión pulmonar. Definiendo la estructura y la función departamental a partir del riesgo / Pulmonary hypertension. Defining the structure and the departmental function based on risk

Se presenta un modelo departamental para la atención integral de pacientes con hipertensión pulmonar. Se resume el conocimiento actual de la hipertensión pulmonar, su mortalidad, pronóstico y la estratificación de su severidad que justifican la propuesta de la estructura y la función departamental.

A departmental model for the comprehensive care of patients with pulmonary hypertension is presented. The current knowledge of pulmonary hypertension, its mortality, prognosis and the stratification of its severity that justify the proposal of the departmental structure and function are summarized.

Relapsing polychondritis: prevalence of cardiovascular diseases and its risk factors, and general disease features according to gender / Policondrite recidivante: prevalência de doenças cardiovasculares e seus fatores de risco e características gerais da doença de acordo com o gênero

ABSTRACT The comorbidities in relapsing polychondritis have been scarcely described in the literature. Moreover, apart from a few relapsing polychondritis epidemiological studies, no studies specifically addressing relapsing polychondritis distribution according to gender are available. Therefore, the objectives of the present study were: (a) to analyze the prevalence of cardiovascular diseases and its risk factors in a series of patients with relapsing polychondritis; (b) to determine the influence of gender on relapsing polychondritis. A cross-sectional tertiary single center study evaluating 30 relapsing polychondritis cases from 1990 to 2016 was carried out. To compare comorbidities, 60 healthy individuals matched for age-, gender-, ethnicity- and body mass index were recruited. The mean age of relapsing polychondritis patients was 49.0 ± 12.4 years, the median disease duration 6.0 years, and 70% were women. A higher frequency of arterial hypertension (53.3% vs. 23.3%; p = 0.008) and diabetes mellitus (16.7% vs. 3.3%; p = 0.039) was found in the relapsing polychondritis group, compared to the control group. As an additional analysis, patients were compared according to gender distribution (9 men vs. 21 women). The clinical disease onset features were comparable in both genders. However, over the follow-up period, male patients had a greater prevalence of hearing loss, vestibular disorder and uveitis events, and also received more cyclophosphamide therapy (p < 0.05). There was a high prevalence of arterial hypertension and diabetes mellitus, and the male patients seemed to have worse prognosis than the female patients in the follow up.

RESUMO Há escassez de estudos na literatura sobre as comorbidades na policondrite recidivante (PR). Além disso, exceto por alguns estudos epidemiológicos sobre a PR, não existem trabalhos que analisem especificamente a distribuição da PR de acordo com o gênero. Portanto, os objetivos do presente estudo foram: (a) analisar a prevalência de doenças cardiovasculares e seus fatores de risco em uma série de pacientes com PR; (B) determinar a influência do gênero na PR. Fez-se um estudo transversal unicêntrico que avaliou 30 casos de PR entre 1990 e 2016. Para comparar as comorbidades, foram recrutados 60 indivíduos saudáveis pareados por idade, gênero, etnia e índice de massa corporal. A idade média dos pacientes com PR foi de 49,0 ± 12,4 anos. A duração média da doença foi de 6,0 anos e 70% eram mulheres. Foi observada uma maior frequência de hipertensão arterial (53,3% vs. 23,3%, p = 0,008) e diabetes mellitus (16,7% vs. 3,3%; p = 0,039) no grupo PR em comparação com o grupo controle. Em uma análise adicional, os pacientes foram comparados de acordo com a distribuição de gênero (nove homens versus 21 mulheres). As características clínicas iniciais da doença foram comparáveis em ambos os sexos. No entanto, durante o período de seguimento, os pacientes do sexo masculino tiveram maior prevalência de perda auditiva, envolvimento vestibular e eventos de uveíte e também receberam mais tratamento com ciclofosfamida (p < 0,05). Houve uma alta prevalência de hipertensão arterial e diabetes mellitus e os pacientes do sexo masculino apresentaram pior prognóstico do que as pacientes do sexo feminino no seguimento.

Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis

We investigated the risk factors for pulmonary hypertension (PH) in patients receiving maintenance peritoneal dialysis (MPD). A group of 180 end-stage renal disease patients (124 men and 56 women; mean age: 56.43±8.36) were enrolled in our study, which was conducted between January 2009 and June 2014. All of the patients received MPD treatment in the Dialysis Center of the Second Affiliated Hospital of Soochow University. Clinical data, laboratory indices, and echocardiographic data from these patients were collected, and follow-ups were scheduled bi-monthly. The incidence and relevant risk factors of PH were analyzed. The differences in measurement data were compared by t-test and enumeration data were compared with the χ2 test. Among the 180 patients receiving MPD, 60 were diagnosed with PH. The remaining 120 were regarded as the non-PH group. Significant differences were observed in the clinical data, laboratory indices, and echocardiographic data between the PH and non-PH patients (all P<0.05). Furthermore, hypertensive nephropathy patients on MPD showed a significantly higher incidence of PH compared with non-hypertensive nephropathy patients (P<0.05). Logistic regression analysis showed that the proportion of internal arteriovenous fistula, C-reactive protein levels, and ejection fraction were the highest risk factors for PH in patients receiving MPD. Our study shows that there is a high incidence of PH in patients receiving MPD and hypertensive nephropathy patients have an increased susceptibility to PH.

Hipertensão pulmonar associada à anemia falciforme / Sickle cell disease-associated pulmonary hypertension

A hipertensão pulmonar é uma complicação comum em pacientes com anemia falciforme. A despeito das elevações leves das pressões pulmonares, a morbimortalidade desses pacientes é alta e a hipertensão pulmonar é um fator de risco muito importante nestes pacientes. A patogênese da hipertensão pulmonar relacionada à anemia falciforme é multifatorial e inclui a hemólise, baixos níveis de óxido nítrico, hipóxia crônica, tromboembolismo, doença hepática crônica e asplenia. Na maioria dos pacientes, hipertensão arterial pulmonar é a causa principal para elevações na pressão arterial pulmonar, mas hipertensão pulmonar venosa também é um fator contribuinte em alguns pacientes. Existem poucos estudos específicos avaliando os efeitos de tratamento para a hipertensão pulmonar em pacientes com anemia falciforme. É provável que a intensificação da terapia para a anemia hemolítica em todos os pacientes e tratamento específico para a hipertensão pulmonar em pacientes com hipertensão pulmonar severa seja benéfica...

Pulmonary hypertension is a common complication of sickle cell disease. In spite of the mild elevations in pulmonary artery pressures in these patients, morbidity and mortality is high and in adult patients with sickle cell disease, pulmonary hypertension is emerging as a major risk factor for death. The pathogenesis of pulmonary hypertension is likely multifactorial, including hemolysis, impaired nitric oxide bioavailability, chronic hypoxemia, thromboembolism, chronic liver disease and asplenia. In the majority of patients with sickle cell disease, pulmonary arterial hypertension is the cause of elevated pulmonary artery pressures, but also that pulmonary venous hypertension does contribute to pulmonary hypertension in a subgroup of patients. There are currently limited specific data on the effects of any treatment modality for pulmonary hypertension in patients with sickle cell disease. It is likely that maximization of sickle cell disease therapy, in all patients, and treatment with selective pulmonary vasodilators and antiproliferative agents, in patients with severe disease, would be beneficial...

Frequência etiológica da hipertensão pulmonar em ambulatório de referência na Bahia / Etiological frequency of pulmonary hypertension in a reference outpatient clinic in Bahia, Brazil / Frecuencia etiológica de la hipertensión pulmonar en un ambulatorio de referencia en Bahia

Fundamento: A hipertensão pulmonar (HP) resulta de diversas etiologias com possíveis influências geográficas, porém poucos trabalhos descrevem a frequência etiológica da HP, especialmente em nosso meio. Não está claro se existe associação entre etiologia e nível de pressão pulmonar ou intensidade da sintomatologia. Objetivo: 1) descrever a prevalência etiológica da HP na Bahia; 2) avaliar se a etiologia é fator determinante no nível de pressão pulmonar; 3) avaliar se a etiologia é fator determinante na classe funcional; 4) identificar os demais preditores do nível de pressão pulmonar e da classe funcional. Métodos: Estudo observacional, de corte transversal, em portadores de HP atendidos no Ambulatório Magalhães Neto, entre junho de 2005 e dezembro de 2007. A HP foi definida como pressão sistólica da artéria pulmonar (PSAP) > 40 mmHg pelo ecocardiograma. Pacientes com doença pulmonar obstrutiva crônica ou doença ventricular esquerda não foram incluídos. Resultados: Foram estudados 48 pacientes com PSAP de 86 ± 24 mmHg. Quanto à etiologia, 42 por cento dos pacientes foram classificados como idiopáticos, seguidos de 25 por cento de esquistossomose, 19 por cento de cardiopatia congênita e 10 por cento de embolia pulmonar crônica. O maior tempo de doença prediz pressões mais elevadas em cardiopatas. Indivíduos com esquistossomose tiveram melhor desempenho funcional quando comparados aos demais (456 ± 58 vs. 299 ± 138 metros, p = 0,005). Etiologia esquistossomótica e idades menores apresentam melhor classe funcional. Conclusão: 1) Prevalece a classificação idiopática, sendo a esquistossomose a causa específica mais frequente em nosso meio; 2) pacientes com etiologia esquistossomótica e de idades menores apresentam melhor classe funcional; 3) cardiopatia congênita resulta em maior nível de pressão na artéria pulmonar, provavelmente devido ao maior tempo de doença.

Background: Pulmonary hypertension (PH) results from several etiologies, with possible geographic influences; however, few studies have described the etiological frequency of PH, especially in our country. It is not clear whether there is an association between etiology and pulmonary pressure level or symptom intensity. Objectives: 1) to describe the etiological prevalence of PH in the state of Bahia, Brazil; 2) to evaluate whether the etiology is a determinant factor for the pulmonary pressure level; 3) to evaluate whether the etiology is a determinant factor for functional class; 4) to identify the other predictors of pulmonary pressure level and functional class. Methods: The present was an observational, cross-sectional study that analyzed individuals with PH treated at the Magalhaes Neto Outpatient Clinic, between June 2005 and December 2007. PH was defined as pulmonary artery systolic pressure (PASP) > 40 mmHg measure at the echocardiogram. Patients with chronic obstructive pulmonary disease or ventricular disease were excluded from the study. RESULTS: A total of 48 patients with PASP = 86 ± 24 mmHg were studied. Regarding the etiology, 42 percent of the patients were classified as idiopathic, followed by 25 percent as schistosomatic, 19 percent as congenital cardiopathy and 10 percent of chronic pulmonary embolism. A longer time of disease predicted higher pressures in patients with cardiopathy. Individuals with schistosomiasis had the best functional performance when compared to the others (456 ± 58 vs. 299 ± 138 meters, p=0.005). The schistosomatic etiology and younger age presented better functional class. Conclusions: 1) the idiopathic classification is the most prevalent, with schistosomiasis being the most frequent specific cause in our country; 2) patients with schistosomatic etiology and of younger age present better functional class. 3) the congenital cardiopathy results in a higher pressure level in the pulmonary artery, ...

Fundamento: La hipertensión pulmonar (HP) es la resultante de diversas etiologías con posibles influencias geográficas, pero pocos trabajos describen la frecuencia etiológica de la HP, especialmente en nuestro medio. No está claro si existe asociación entre etiología y nivel de presión pulmonar o intensidad de la sintomatología. Objetivo: (1) Describir la prevalencia etiológica de la HP en Bahía; (2) evaluar si la etiología es factor determinante en el nivel de presión pulmonar; (3) evaluar si la etiología es factor determinante en la clase funcional; (4) identificar los demás predictores del nivel de presión pulmonar y de la clase funcional. Métodos: Estudio observacional, de corte transversal, en portadores de HP atendidos en el Ambulatorio Magalhães Neto, entre junio de 2005 y diciembre de 2007. La HP fue definida como presión sistólica de la arteria pulmonar (PSAP) > 40 mmHg por ecocardiograma. No se incluyó a los pacientes con enfermedad pulmonar obstructiva crónica o deterioro del ventrículo izquierdo. Resultados: Se estudiaron a 48 pacientes con PSAP de 86±24 mmHg. En cuanto a la etiología, el 42 por ciento de los pacientes fue clasificado como idiopático, seguido del 25 por ciento por esquistosomiasis, el 19 por ciento por cardiopatía congénita y el 10 por ciento por embolia pulmonar crónica. El mayor tiempo de enfermedad predice presiones más elevadas en cardiópatas. Los individuos con esquistosomiasis tuvieron mejor desempeño funcional cuando se los comparó con los demás (456±58 vs. 299±138 metros, P = 0,005). Pacientes con etiología esquistosomiásica y edades más jóvenes cursan con mejor capacidad funcional. Conclusión: (1) Prevalece la clasificación idiopática, y la esquistosomiasis constituye la causa específica más frecuente en nuestro medio; (2) pacientes con etiología esquistosomiásica y de edades menores presentan mejor clase funcional; (3) la cardiopatía congénita resulta en mayor nivel de presión en la arteria pulmonar, ...