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1.
Microvasc Res ; 76(3): 224-32, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18721820

RESUMO

Laser Doppler flowmetry (LDF) of forearm skin blood flow, combined with iontophoretically-administered acetylcholine and sodium nitroprusside and wavelet spectral analysis, was used for noninvasive evaluation of endothelial function in 17 patients newly diagnosed with New York Heart Association class II-III congestive heart failure (CHF). After 20+/-10 weeks' treatment with a beta(1)-blocker (Bisoprolol), the measurements were repeated. Measurements were also made on an age- and sex-matched group of healthy controls (HC). In each case data were recorded for 30 min. In HC, the difference in absolute spectral amplitude of LDF oscillations between the two vasodilators manifests in the frequency interval 0.005-0.0095 Hz (p<0.01); this difference is initially absent in patients with CHF, but appears following the beta(1)-blocker treatment (p<0.01). For HC, the difference between the two vasodilators also manifests in normalised spectral amplitude in 0.0095-0.021 Hz (p<0.05). This latter difference is absent in CHF patients and is unchanged by treatment with beta(1)-blockers. It is concluded that there are two oscillatory skin blood flow components associated with endothelial function. Both are reduced in CHF. Activity in the lower frequency interval is restored by beta(1)-blocker treatment, confirming the association between CHF and endothelial dysfunction but suggesting the involvement of two distinct mechanisms.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Bisoprolol/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Acetilcolina/farmacologia , Idoso , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Velocidade do Fluxo Sanguíneo/fisiologia , Estudos de Casos e Controles , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Fluxometria por Laser-Doppler , Masculino , Pessoa de Meia-Idade , Nitroprussiato/farmacologia , Oscilometria , Pele/irrigação sanguínea , Vasodilatadores/farmacologia
2.
J Hypertens ; 15(9): 995-1000, 1997 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9321747

RESUMO

BACKGROUND: An insertion/deletion (I/D) polymorphism in the angiotensin converting enzyme (ACE) gene accounts for 50% of the variance in serum ACE activity. ACE is responsible for the generation of angiotensin II, which not only has pressor and mitogenic activities but also exerts effects on left ventricular diastolic performance. OBJECTIVE: To investigate the contribution of genetic polymorphisms at the ACE gene to the development of diastolic functional abnormalities in 100 patients with essential hypertension. METHODS AND RESULTS: The left ventricular mass (LVMI) of each patient was assessed echocardiographically. We calculated peak and integral early:late left ventricular diastolic filling ratios (E:AP, and E:AI, respectively) and determined the ACE genotype from leukocyte DNA. There was no significant difference in age, sex, blood pressure and LVMI among genotype groups. Analysis of covariance modelled for indices of diastolic function, adjusted for age, sex, heart rate and LVMI, demonstrated that the E:AP interacted with age (P < 0.0001), heart rate (P < 0.001) and ACE genotype (P = 0.018). Similarly, the E:AI interacted with age (P < 0.001), heart rate (P = 0.025) and ACE genotype (P = 0.047). There was a strong correlation between the E:AP and the LVMI for the DD group (r = -0.81, P < 0.0001) but not for the ID (r = -0.03, P = 0.83) and II (r = -0.23, P = 0.23) groups. CONCLUSIONS: These findings suggest that that the I/D polymorphism of the ACE gene influences the relationship between left ventricular mass and echocardiographic left ventricular diastolic filling abnormalities in patients with essential hypertension.


Assuntos
Diástole/genética , Hipertensão/genética , Peptidil Dipeptidase A/genética , Adulto , Pressão Sanguínea/genética , Elementos de DNA Transponíveis , Ecocardiografia Doppler de Pulso , Feminino , Humanos , Hipertrofia Ventricular Esquerda/genética , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético , Função Ventricular Esquerda/genética
3.
QJM ; 88(5): 327-32, 1995 May.
Artigo em Inglês | MEDLINE | ID: mdl-7796087

RESUMO

Increased QT dispersion is associated with sudden cardiac death in congestive heart failure, hypertrophic cardiomyopathy, and following acute myocardial infarction. Patients with hypertension, in particular those with left ventricular hypertrophy, are also at greater risk of sudden cardiac death. We examined whether QT dispersion, which is easily obtained from a routine ECG, correlates with echo LVH. Sixty-nine untreated patients with essential hypertension had QT dispersion measured from a surface 12-lead electrocardiogram, and two-dimensional echocardiography performed to measure interventricular septal thickness, posterior wall thickness, and left ventricular internal diameter. Office blood pressure was recorded, and in 56 patients, 24 h ambulatory blood pressure monitoring was also done. Multivariate analysis demonstrated significant relationships between QT dispersion and office systolic blood pressure, and left ventricular mass index. Similar findings were obtained when QT dispersion was corrected for heart rate (QTc dispersion). After patients with electrocardiographic left ventricular hypertrophy (n = 5) were excluded from the analysis, the above relationships persisted. Increased QT dispersion is thus found in those essential hypertensives at greatest risk of sudden death. Since this relationship persists even in the absence of electrocardiographic left ventricular hypertrophy, measurement of QT dispersion might be a simple, non-invasive screening procedure to identify those hypertensives at greatest risk of sudden death.


Assuntos
Eletrocardiografia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Fatores de Risco
4.
Heart ; 81(4): 393-7, 1999 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10092566

RESUMO

OBJECTIVE: To compare early complication rates in unselected cases of coronary artery stenting in patients with stable v unstable angina. SETTING: Tertiary referral centre. PATIENTS: 390 patients with stable angina pectoris (SAP) and 306 with unstable angina (UAP). Patients treated for acute myocardial infarction (primary angioplasty) or cardiogenic shock were excluded. INTERVENTIONS: 268 coronary stents were attempted in 211 patients (30.3%). Stents used included AVE (63%), Freedom (14%), NIR (7%), Palmaz-Schatz (5%), JO (5%), and Multilink (4%). Intravascular ultrasound was not used in any of the cases. All stented patients were treated with ticlopidine and aspirin together with periprocedural unfractionated heparin. RESULTS: 123 stents were successfully deployed in 99 SAP patients v 132 stents in 103 UAP patients. Failed deployment occurred with nine stents in SAP patients, v four in UAP patients (NS). Stent thrombosis occurred in four SAP patients and 11 UAP patients. Multivariate analysis showed no relation between stent thrombosis and clinical presentation (SAP v UAP), age, sex, target vessel, stent length, or make of stent. Stent thrombosis was associated with small vessel size (p < 0.001) and bailout stenting (p = 0.01) compared with elective stenting and stenting for suboptimal PTCA, with strong trends toward smaller stent diameter (p = 0.052) and number of stents deployed (p = 0.06). Most stent thromboses occurred in vessels < 3 mm diameter. CONCLUSIONS: Coronary artery stenting in unstable angina is safe in vessels >/= 3 mm diameter, with comparable initial success and stent thrombosis rates to stenting in stable angina.


Assuntos
Angina Instável/cirurgia , Angioplastia Coronária com Balão , Stents , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/mortalidade , Angina Pectoris/cirurgia , Angina Instável/diagnóstico por imagem , Angina Instável/mortalidade , Angiografia Coronária , Feminino , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Trombose/etiologia , Falha de Tratamento
5.
Pharmacoeconomics ; 16(4): 399-407, 1999 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10623367

RESUMO

OBJECTIVE: To investigate whether the extent of systolic dysfunction is a useful predictor of the costs of healthcare and social support for patients with heart failure. DESIGN: Cross-sectional study with collection of cost data attributed to management of heart failure in the previous year. SETTING: Four primary-care practices in Scotland. PATIENTS: Patients receiving long term therapy with loop diuretics for suspected heart failure. INTERVENTIONS: Two-dimensional and Doppler echocardiography. MAIN OUTCOME MEASURES AND RESULTS: Two hypotheses were tested: (i) the proportion of patients incurring costs is higher in patients with abnormal left ventricular (LV) function; and (ii) the median cost per patient that incurs costs is higher in patients with abnormal LV function. Of the 226 patients in the study, 67 (30%) had abnormal systolic function. In comparison with the remaining 159 patients, they had higher healthcare costs [560 Pounds vs 440 Pounds per patient year (1994/1995 values)], were more likely to incur hospital inpatient or outpatient costs [Odds ratio (OR): 2.02; 95% confidence interval (CI): 1.06 to 3.84] and had significantly higher primary-care costs (mean 292 Pounds vs 231 Pounds per patient year; p = 0.02, Mann Whitney test). In contrast, they were no more likely to incur social support costs (OR: 1.22; 95% CI: 0.52 to 2.86) and the mean cost of social support per patient year was lower (234 Pounds vs 373 Pounds). CONCLUSIONS: Patients with objectively measured systolic dysfunction incurred significantly higher healthcare costs in the year before diagnosis. This suggests that treatment that improves systolic function will reduce healthcare costs, even in a primary-care population with relatively mild congestive heart failure.


Assuntos
Custos de Cuidados de Saúde , Insuficiência Cardíaca/economia , Sístole/fisiologia , Estudos Transversais , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/economia
6.
Philos Trans A Math Phys Eng Sci ; 371(1997): 20110622, 2013 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-23858485

RESUMO

We describe an analysis of cardiac and respiratory time series recorded from 189 subjects of both genders aged 16-90. By application of the synchrosqueezed wavelet transform, we extract the respiratory and cardiac frequencies and phases with better time resolution than is possible with the marked events procedure. By treating the heart and respiration as coupled oscillators, we then apply a method based on Bayesian inference to find the underlying coupling parameters and their time dependence, deriving from them measures such as synchronization, coupling directionality and the relative contributions of different mechanisms. We report a detailed analysis of the reconstructed cardiorespiratory coupling function, its time evolution and age dependence. We show that the direct and indirect respiratory modulations of the heart rate both decrease with age, and that the cardiorespiratory coupling becomes less stable and more time-variable.


Assuntos
Envelhecimento/fisiologia , Relógios Biológicos/fisiologia , Frequência Cardíaca/fisiologia , Modelos Biológicos , Taxa Respiratória/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Simulação por Computador , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Int J Clin Pract ; 54(7): 475-7, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11070576

RESUMO

We describe a 30-year-old Afro-Caribbean woman with a history of secondary amenorrhoea, who had been treated with HRT because of a presumed diagnosis of premature ovarian failure, and subsequently presented with an acute infero-lateral myocardial infarction. Subsequent coronary angiography demonstrated normal coronary arteries.


Assuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Infarto do Miocárdio/etiologia , Insuficiência Ovariana Primária/terapia , Adulto , Angiografia Coronária , Vasos Coronários/efeitos dos fármacos , Congêneres do Estradiol/farmacologia , Feminino , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia
10.
Br J Clin Pharmacol ; 40(4): 299-305, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8554930

RESUMO

1. Nitric oxide is recognised as an important biological mediator, which is thought to be involved in cardiovascular homeostasis. The purpose of this study was to investigate the effects of basal nitric oxide synthesis on cardiac function in man, by blocking nitric oxide synthesis with NG-monomethyl-L-arginine (L-NMMA). 2. Eight normal volunteers were studied on two separate occasions. Measurements of heart rate, blood pressure and echocardiographic indices of left ventricular systolic and diastolic function were made at baseline on each day and every 20 min during incremental infusion of L-NMMA (0.1, 0.2, 0.5, 1.0 and 2.0 mg kg-1 h-1) or placebo. 3. A trend towards reduction in heart rate was observed with L-NMMA infusion although this did not reach statistical significance, whereas significant increases in both systolic blood pressure (at 2.0 mg kg-1 h-1) and systemic vascular resistance index (at 0.5 mg kg-1 h-1) were seen. 4. L-NMMA infusion caused significant reductions in stroke distance and cardiac index, although there was no change in the ratio of end systolic wall stress/end systolic volume index (an afterload independent index of left ventricular systolic performance). 5. The isovolumic relaxation time significantly increased with L-NMMA infusion, together with a significant reduction in the 'E' wave flow velocity integral. Reductions in both peak E/A ratio and E/A flow velocity integral ratio were also seen, although these failed to reach statistical significance. 6. In conclusion, the basal generation of nitric oxide in man appears to maintain a vasodilated state, and modifies left ventricular diastolic filling parameters.


Assuntos
Coração/fisiologia , Óxido Nítrico/fisiologia , Adulto , Arginina/análogos & derivados , Arginina/farmacologia , Método Duplo-Cego , Endotelinas/sangue , Inibidores Enzimáticos/farmacologia , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Óxido Nítrico/biossíntese , Óxido Nítrico Sintase/antagonistas & inibidores , Placebos , Valores de Referência , ômega-N-Metilarginina
11.
Clin Sci (Lond) ; 87(4): 397-401, 1994 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7834990

RESUMO

1. Doppler echocardiographic indices of diastolic function and systemic haemodynamics were studied in response to infusions of angiotensin II (1, 2, 5 and 10 ng min-1 kg-1), D-aldosterone (2, 4, 10 and 20 ng min-1 kg-1) and placebo [0.9% (w/v) NaCl] in ten normal male subjects. 2. Dose-related increases in systolic and diastolic blood pressure were observed with angiotensin II infusion at rates of 2 ng min-1 kg-1 and above, whereas no changes in blood pressure occurred with D-aldosterone. No changes in aortic stroke distance or heart rate were seen with either angiotensin II or aldosterone infusion. 3. Compared with placebo, angiotensin II infusion produced a dose-related prolongation of the isovolumic relaxation time [mean and 95% confidence intervals 12.0 (8.2-15.8) ms, P < 0.001] at 10 ng min-1 kg-1, and a significant reduction in the ratio between early and late transmitral flow velocity integrals at 2 ng min-1 kg-1, [-0.84 (-1.63 to -0.05), P < 0.05] and 5 ng min-1 kg-1 [-0.76 (-1.47 to -0.05), P < 0.05]. No changes in Doppler echocardiographic indices of diastolic function were observed with D-aldosterone infusion. 4. These data suggest that angiotensin II, even at a sub-pressor concentration, produces an impairment of left ventricular diastolic filling, which occurs independently of its effect on aldosterone release.


Assuntos
Aldosterona/farmacologia , Angiotensina II/farmacologia , Diástole/efeitos dos fármacos , Adulto , Aldosterona/sangue , Angiotensina II/sangue , Pressão Sanguínea/efeitos dos fármacos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Ecocardiografia Doppler , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino
12.
Clin Sci (Lond) ; 88(2): 159-64, 1995 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-7720339

RESUMO

1. Elevated plasma concentrations of brain natriuretic peptide are found in conditions associated with impaired left ventricular diastolic function. The purpose of this study was to determine whether this peptide actually plays a physiological role in improving myocardial performance in diastole. 2. Nine normal subjects received infusions of brain natriuretic peptide or placebo in a randomized, double-blind, crossover study. Brain natriuretic peptide infusion produced a significant reduction in isovolumic relaxation time (means and 95% confidence interval for difference -10.8 ms, -14.5 to -7.0 ms) (P < 0.01) and significantly increased both the peak E/A velocity (0.54, 0.14-0.94) (P < 0.05) and the E/A time velocity integral (1.09, 0.20-1.98) (P < 0.05). 3. These responses were evident at concentrations of brain natriuretic peptide that produced no associated effects on blood pressure, heart rate or stroke distance. 4. Brain natriuretic peptide infusion in normal subjects significantly reduces isovolumic relaxation time and improves transmitral Doppler flow profiles, suggesting that this peptide may be important in the control of left ventricular diastolic relaxation in man.


Assuntos
Proteínas do Tecido Nervoso/farmacologia , Função Ventricular Esquerda/efeitos dos fármacos , Estudos Cross-Over , Diástole , Método Duplo-Cego , Ecocardiografia , Humanos , Masculino , Peptídeo Natriurético Encefálico
13.
Eur Heart J ; 16(11): 1710-15, 1995 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8881869

RESUMO

Doppler echocardiographic indices of diastolic function and systemic haemodynamics were studied in response to infusions of atrial natriuretic peptide (0.5, 1, 2, 5 pmol.kg-1.min-1) and placebo (0.9% (w/v) saline) in ten normal male subjects. Compared with placebo, atrial natriuretic peptide infusion produced a significant and dose-related reduction in the isovolumic relaxation time [(mean and 95% CI) -5.9 (-9.2 to -2.6) ms (P < 0.01) at 5 pg.kg-1 min-1] and a significant increase in the ratio between early and late transmitral peak velocities [0.46 (0.02 to 0.89) (P < 0.05) at 5 pg.kg-1 min-1]. No significant changes in heart rate, blood pressure or aortic stroke distance were observed with infusion of atrial natriuretic peptide compared with placebo. These data suggest that pathophysiological plasma concentrations of atrial natriuretic peptide improve diastolic function by increasing the rate of myocardial relaxation.


Assuntos
Fator Natriurético Atrial/farmacologia , Função Ventricular Esquerda/efeitos dos fármacos , Adolescente , Adulto , Fator Natriurético Atrial/sangue , Diástole , Ecocardiografia , Hemodinâmica/efeitos dos fármacos , Humanos , Masculino , Valores de Referência , Fatores de Tempo
14.
Ann Intern Med ; 124(1 Pt 1): 41-55, 1996 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-7503477

RESUMO

PURPOSE: To review information on exercise testing in hypertensive patients and persons at risk for developing hypertension and to determine whether this type of investigation is valuable for diagnosis, prognosis, or assessment of the effect of therapy. DATA SOURCES: A MEDLINE search of English-language articles published between 1985 and 1995 and reviews of the bibliographies of textbooks. STUDY SELECTION: Primary research articles on exercise testing in patients with hypertension, with an emphasis on methods, diagnosis, prognosis, and assessment of drug therapy. DATA EXTRACTION: Study design and quality were assessed, with particular attention paid to methods and aims. Relevant data on hemodynamic responses in hypertensive patients and persons at risk for developing hypertension and correlations to end-organ damage, mortality, and exercise tolerance were analyzed. DATA SYNTHESIS: The exercise capacity of hypertensive patients was found to be reduced by as much as 30% compared with age-matched controls. This exercise impairment increases with age and end-organ damage, and its origin can be traced back to adolescence. Total peripheral resistance also progressively increases. These changes are caused by functional and structural involvement of the cardiovascular system. Diastolic dysfunction of the heart is a prominent factor in this exercise limitation. The blood pressure responses to exercise have prognostic value for the future development of hypertension, end-organ damage, and death. The adequacy of antihypertensive treatment should therefore be evaluated in terms of normalizing these stress-related blood pressure responses. CONCLUSION: Exercise testing is a simple procedure that has great potential for assessing hypertensive patients. More research is necessary, however, to determine whether controlling blood pressure during exercise is beneficial.


Assuntos
Tolerância ao Exercício , Hipertensão/fisiopatologia , Fatores Etários , Anti-Hipertensivos/farmacologia , Teste de Esforço , Cardiopatias/complicações , Hemodinâmica/efeitos dos fármacos , Humanos , Hipertensão/complicações , Análise por Pareamento , Fatores de Risco
15.
Br Heart J ; 74(6): 664-70, 1995 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8541175

RESUMO

OBJECTIVE: To evaluate the waveforms of left atrial area changes obtained by automated boundary detection with newly developed acoustic quantification technology. DESIGN: All subjects had measurements of left atrial areas taken in the apical four chamber, parasternal long axis, and parasternal short axis views using both conventional echocardiographic methods and automatic boundary detection on two occasions separated by at least a week. On the second visit measurements were also repeated in healthy volunteers after acute intravenous volume loading with 1 litre of saline over 2-5 minutes. SETTING: A university medical school echocardiographic laboratory. SUBJECTS: 12 healthy male volunteers and 8 patients with cardiac disease (5 with congestive heart failure, 1 with mitral stenosis, and 2 with hypertensive left ventricular hypertrophy, and dilated left atria). RESULTS: There was close correlation between conventionally derived left atrial areas and those obtained by automatic boundary detection, particularly in the apical four chamber view (r = 0.98). Both inter and intra observer variabilities (coefficient of variation) for left atrial areas measured by automatic boundary detection were good (4.7-14.2% and 8.1-18.6% respectively). The reproducibility (coefficient of variation) for derived indices of left atrial function, however, was much poorer (10.4-104.8% and 12.5-88% respectively). After acute volume loading significant increases in left atrial area were observed at all stages in the cardiac cycle. CONCLUSIONS: These data demonstrate that although the reproducibility of left atrial functional indices is poor, instantaneous left atrial cavity measurements with automatic boundary detection are reproducible. This suggests that automatic boundary detection may assist in serial non-invasive measurement of left atrial size to assess disease states and treatments.


Assuntos
Função do Átrio Esquerdo , Ecocardiografia , Adulto , Humanos , Masculino , Variações Dependentes do Observador
16.
Diabet Med ; 15(8): 678-82, 1998 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9702472

RESUMO

Raised plasma concentrations of atrial natriuretic peptide (ANP) have been reported in patients with Type 1 (insulin dependent) diabetes mellitus (DM) who have poor glycaemic control and are associated with the presence of microalbuminuria. To test the hypothesis that elevations in plasma ANP concentration increase urinary albumin excretion in Type 1 DM, we have studied the effects of intravenous infusions of ANP in eight such subjects with established microalbuminuria. Blood glucose was maintained between 4 and 7 mmol l-1 in all subjects for the duration of studies; after euglycaemia had been established, a standard oral water load (20 ml kg-1 plus replacement of urinary losses) was given. Once steady state diuresis was attained, subjects received intravenous infusion of either placebo (0.9% saline), low dose (2.5 pmol kg-1 min-1) or high dose (5.0 pmol kg-1 kg min-1) ANP solution in a randomized, double-blind protocol. Infusion of ANP caused a dose-dependent increase in urinary albumin excretion rate (placebo, 11.3 (SD 8.9) to 8.7 (SD 6.8) micrograms min-1; low dose ANP, 12.4 (SD 9.9) to 26.5 (SD 27.5) micrograms min-1, p < 0.01; high dose ANP 10.3 (SD 7.3) to 36.6 (SD 28.5) micrograms min-1, p < 0.001, ANOVA). Only high dose ANP caused an increase in urine flow. Blood glucose remained unchanged in all studies. We conclude that intravenous infusions of ANP cause a dose-dependent increase in urinary albumin excretion rate in Type 1 DM subjects with microalbuminuria. These data support the hypothesis that ANP has albuminuric actions which may contribute to microalbuminuria in Type 1 DM.


Assuntos
Albuminúria , Fator Natriurético Atrial/farmacologia , Diabetes Mellitus Tipo 1/urina , Adulto , Albuminúria/fisiopatologia , Fator Natriurético Atrial/administração & dosagem , Fator Natriurético Atrial/sangue , Pressão Sanguínea/efeitos dos fármacos , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/fisiopatologia , Diurese/efeitos dos fármacos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Hemoglobinas Glicadas/análise , Frequência Cardíaca/efeitos dos fármacos , Humanos , Infusões Intravenosas , Masculino
17.
Circulation ; 93(11): 2037-42, 1996 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-8640980

RESUMO

BACKGROUND: Experimental models suggest that brain natriuretic peptide (BNP) can modify left ventricular diastolic performance. The aim of this study was to evaluate the effects of BNP on resting and exercise hemodynamics and neurohormones in patients with isolated diastolic heart failure. METHODS AND RESULTS: Six patients with isolated diastolic heart failure were studied. After baseline hemodynamic measurements were obtained with use of thermistor-tipped pulmonary artery catheters, patients were randomized to receive infusion of BNP or placebo in a single-blind, crossover study. Hemodynamic and neurohormonal parameters were measured at rest after 30 minutes of infusion and during incremental supine bicycle exercise. BNP did not significantly affect resting hemodynamics but attenuated the rise in both pulmonary capillary wedge pressure (placebo, 23 +/- 2 mm Hg; BNP, 16 +/- 2 mm Hg; P < .01) and mean pulmonary artery pressure (placebo, 34 +/- 3 mm Hg; BNP, 29 +/- 3 mm Hg; P < .05) during exercise without affecting changes in heart rate, systemic blood pressure, or stroke volume. In response to BNP, there was significant suppression of plasma aldosterone concentration (placebo, 551 +/- 107 pmol/L; BNP, 381 +/- 56 pmol/L; P < .05). CONCLUSIONS: BNP infusion causes beneficial hemodynamic and neurohormonal effects during exercise in patients with isolated diastolic heart failure.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Proteínas do Tecido Nervoso/farmacologia , Idoso , Aldosterona/sangue , Angiotensina II/sangue , Fator Natriurético Atrial/sangue , Pressão Sanguínea , Estudos Cross-Over , Diástole , Teste de Esforço , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico , Proteínas do Tecido Nervoso/sangue , Proteínas do Tecido Nervoso/uso terapêutico , Artéria Pulmonar , Pressão Propulsora Pulmonar , Método Simples-Cego
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