ABSTRACT
Resumo Fundamento: A associação de supressão solúvel da tumorigênese-2 (sST2) com prognóstico em embolia pulmonar (EP) é desconhecida. Objetivo: Este estudo teve como objetivo investigar a relação entre os níveis de sST2 em pacientes com EP aguda e mortalidade em 6 meses e hospitalizações recorrentes. Métodos: Este estudo prospectivo incluiu 100 pacientes com EP aguda. Os pacientes foram classificados em dois grupos de acordo com a mortalidade em 6 meses e a presença de hospitalizações recorrentes relacionadas a doenças cardiovasculares. Dois grupos foram comparados. Um valor de p de 0,05 foi considerado estatisticamente significativo. Resultados: Os níveis de ST2 solúvel foram significativamente maiores no grupo com mortalidade e internações recorrentes. (138,6 ng/mL (56,7-236,8) vs. 38 ng/mL (26,3-75,4); p<0,001) O melhor limite de corte para níveis de sST2 na previsão de um desfecho composto de mortalidade em 6 meses e/ou a hospitalização recorrente relacionada a doenças cardiovasculares foi >89,9, com especificidade de 90,6% e sensibilidade de 65,2%, de acordo com a curva Receiver Operating Characteristic (área sob a curva = 0,798; IC 95%, 0,705-0,891; p <0,0001). Após ajuste para fatores de confusão que foram estatisticamente significativos na análise univariada ou para as variáveis correlacionadas com os níveis de sST2, nível de sST2 (OR = 1,019, IC 95%: 1,009-1,028, p 0,001) e proteína C reativa (PCR). (OR = 1,010, IC 95%: 1,001-1,021, p = 0,046) continuaram a ser preditores significativos de mortalidade em 6 meses e/ou hospitalização recorrente relacionada a doenças cardiovasculares no modelo de regressão logística múltipla através do método backward stepwise. Conclusões: O nível de ST2 solúvel parece ser um biomarcador para prever mortalidade em 6 meses e/ou hospitalização recorrente relacionada a doenças cardiovasculares em pacientes com EP aguda.
Abstract Background: The association of soluble suppression of tumorigenesis-2 (sST2) levels with prognosis in pulmonary embolism (PE) is unknown. Objective: This study aimed to investigate the relationship between sST2 levels in patients with acute PE and 6-month mortality and recurrent hospitalizations. Methods: This prospective study included 100 patients with acute PE. Patients were classified into two groups according to 6-month mortality and the presence of recurrent Cardiovascular-Related hospitalizations. Two groups were compared. A p-value of 0.05 was considered statistically significant. Results: Soluble ST2 levels were significantly higher in the group with mortality and recurrent hospitalizations. (138.6 ng/mL (56.7-236.8) vs. 38 ng/mL (26.3-75.4); p<0.001) The best cut-off threshold for sST2 levels in the prediction of a composite outcome of 6-month mortality and/or recurrent Cardiovascular-Related hospitalization was found to be >89.9 with a specificity of 90.6% and a sensitivity of 65.2%, according to the receiver operating characteristic curve (area under the curve = 0.798; 95% CI, 0.705-0.891; p <0.0001). After adjusting for confounding factors that were either statistically significant in the univariate analysis or for the variables correlated with the sST2 levels, sST2 level (OR = 1.019, 95% CI: 1.009-1.028, p 0.001) and C-reactive protein (CRP ) (OR = 1.010, 95% CI: 1.001-1.021, p = 0.046) continued to be significant predictors of 6-month mortality and/or recurrent Cardiovascular-Related hospitalization in the multiple logistic regression model via backward stepwise method. Conclusion: Soluble ST2 level seems to be a biomarker to predict 6-month mortality and/or recurrent Cardiovascular-Related hospitalization in patients with acute PE.
ABSTRACT
Abstract Objective: We aimed to investigate the protective effect of adrenomedullin (ADM) on cerebral tissue of rats with cerebral ischemia/reperfusion (I/R) injury. Methods: Thirty-two Wistar rats were randomized into four groups (n=8). In the I/R Group, bilateral common carotid arteries were clamped for 30 minutes and, subsequently, reperfused for 120 minutes. In the ADM Group, rats received 12 µg/kg of ADM. In the I/R+ADM Group, bilateral common carotid arteries were clamped for 30 minutes and, subsequently, the rats received 12 µg/ kg of ADM. Then, reperfusion was performed for 120 minutes. The Control Group underwent no procedure. Blood and brain tissue samples were collected for biochemical and histopathological analysis. Serum malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were analysed. Brain tissue was evaluated histopathologically and neuronal cells were counted in five different fields, at a magnification of ×400. Results: Brain MDA in I/R Group was significantly higher than in ADM Group. Brain GPx and SOD in I/R+ADM Group were significantly higher than in I/R Group. The number of neurons was decreased in I/R Group compared to the Control Group. The number of neurons in I/R+ADM Group was significantly higher than in I/R Group, and lower than in Control Group. Apoptotic changes decreased significantly in I/R+ADM Group and the cell structure was similar in morphology compared to the Control Group. Conclusion: We demonstrated the cerebral protective effect of ADM in the rat model of cerebral I/R injury after bilateral carotid artery occlusion.
Subject(s)
Animals , Rats , Carotid Artery, Common , Reperfusion , Reperfusion Injury/prevention & control , Rats, Wistar , AdrenomedullinABSTRACT
Resumo Fundamentos A resistência à insulina (RI) é um distúrbio importante em crianças obesas, pois está intimamente relacionado a doenças cardiovasculares. O tecido adiposo epicárdico (TAE) desempenha um papel no desenvolvimento da RI devido a moléculas bioativas secretadas, sendo que o processo inflamatório dessas moléculas pode causar atraso eletromecânico atrial (AEA). Objetivo O objetivo do nosso estudo foi determinar a relação entre o TAE e o AEA com a RI em crianças obesas. Métodos O estudo incluiu 94 pacientes obesos. A IR foi calculada usando o Modelo de Avaliação da Homeostase da Resistência à Insulina (HOMA-IR) e definida como HOMA-IR maior que o percentil 90 em uma curva de percentil específica para idade e sexo. Os pacientes foram divididos em dois grupos de acordo com sua RI. Todos os pacientes foram submetidos a exames ecocardiográficos. A significância estatística foi estabelecida como valor de < 0,05 bicaudal. Resultados A TAE encontrava-se significativamente maior no grupo RI (p < 0,001). O valor de corte ideal para que o TAE previsse a RI foi > 3,85 mm, com especificidade de 92,5% e sensibilidade de 68,5% (p = 0,002). No modelo de regressão logística multivariada, o TAE (OR = 1.256, IC de 95%: 1.016-1.53, p = 0.035) esteve associado à RI após o ajuste para as variáveis estatisticamente significativas na análise univariada. O AEA inter e intra-atrial mostrou-se significativamente prolongado no grupo RI em comparação com o grupo sem RI (p < 0,010; p = 0,032, respectivamente). Conclusão No nosso estudo, revelamos que o TAE esteve positivamente correlacionada com a RI e foi preditor independente de RI. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
Abstract Background Insulin resistance (IR) is an important disorder in obese children because it is closely related to cardiovascular diseases. Epicardial adipose tissue (EAT) plays a role in the development of IR due to secreted bioactive molecules, and the inflammatory process of these molecules may cause atrial electromechanical delay (EMD). Objective The objective of our study was to determine the relationship between EAT and EMD with IR in obese children. Methods Ninety-four obese patients were included in the study. IR was calculated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and defined as HOMA-IR greater than the 90thpercentile in an age- and sex-specific percentile curve. Patients were divided into two groups according to their IR. All patients underwent echocardiographic examinations. Statistical significance was set to a two-sided p-value < 0.05. Results EAT was significantly higher in the IR group (p < 0.001). The optimal cut-off value for EAT to predict IR was found to be > 3.85 mm, with 92.5% specificity and 68.5% sensitivity (p = 0.002). In the multivariate logistic regression model, EAT (OR = 1.256, 95% CI: 1.016-1.53, p = 0.035) was also associated with IR after adjustment for variables found to be statistically significant in univariate analysis. Inter- and intra-atrial EMD was significantly prolonged in the IR group compared to the group without IR (p < 0.010; p = 0.032 respectively). Conclusion: In our study, we revealed that EAT was positively correlated with IR and was an independent predictor of IR. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
Subject(s)
Insulin Resistance , Obesity , Pericardium , Echocardiography , Adipose Tissue , InsulinABSTRACT
ABSTRACT BACKGROUND: Right ventricular (RV) dysfunction may develop over the course of chronic obstructive pulmonary disease (COPD) and is an important predictor of morbidity and mortality. Polymorphism of the multidrug resistance-1 (MDR-1) gene has been correlated with worse clinical findings among patients with COPD. Our aim here was to investigate the relationship between MDR-1 C3435T gene polymorphism and RV dysfunction in COPD patients. DESIGN AND SETTING: This was a cross-sectional study investigating the relationship between RV dysfunction and genetic defects in COPD patients. METHODS: Forty-one consecutive patients diagnosed with COPD and hospitalized due to acute exacerbation were enrolled. Polymorphism was analyzed using the strip assay technique. RV parameters were evaluated, and RV dysfunction was identified via transthoracic echocardiography. Patients were categorized into three groups according to gene polymorphism: MDR-1 CC (wild type, n = 9), MDR-1 CT (heterozygote mutant, n = 21) or MDR-1 TT (homozygote mutant, n = 11). RESULTS: The study included 14 males and 27 females (mean age 65 ± 11 years). The mean systolic pulmonary artery pressure was 31.4 ± 8 mmHg in the wild-type group, 42.2 ± 12 mmHg in the heterozygote mutant group and 46.5±14 mmHg in the homozygote mutant group (P = 0.027). Presence of RV dilatation was significantly different among the three groups (33%, 71%, and 100%, respectively; P = 0.005). In multiple logistic regression analysis, MDR-1 C3435T gene polymorphism (OR = 9.000, P = 0.019) was an independent predictor of RV dysfunction after adjustment for potential confounders. CONCLUSION: MDR-1 C3435T gene polymorphism was associated with RV dysfunction in patients with COPD.