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1.
Almeida, André Luiz Cerqueira; Melo, Marcelo Dantas Tavares de; Bihan, David Costa de Souza Le; Vieira, Marcelo Luiz Campos; Pena, José Luiz Barros; Del Castillo, José Maria; Abensur, Henry; Hortegal, Renato de Aguiar; Otto, Maria Estefania Bosco; Piveta, Rafael Bonafim; Dantas, Maria Rosa; Assef, Jorge Eduardo; Beck, Adenalva Lima de Souza; Santo, Thais Harada Campos Espirito; Silva, Tonnison de Oliveira; Salemi, Vera Maria Cury; Rocon, Camila; Lima, Márcio Silva Miguel; Barberato, Silvio Henrique; Rodrigues, Ana Clara; Rabschkowisky, Arnaldo; Frota, Daniela do Carmo Rassi; Gripp, Eliza de Almeida; Barretto, Rodrigo Bellio de Mattos; Silva, Sandra Marques e; Cauduro, Sanderson Antonio; Pinheiro, Aurélio Carvalho; Araujo, Salustiano Pereira de; Tressino, Cintia Galhardo; Silva, Carlos Eduardo Suaide; Monaco, Claudia Gianini; Paiva, Marcelo Goulart; Fisher, Cláudio Henrique; Alves, Marco Stephan Lofrano; Grau, Cláudia R. Pinheiro de Castro; Santos, Maria Veronica Camara dos; Guimarães, Isabel Cristina Britto; Morhy, Samira Saady; Leal, Gabriela Nunes; Soares, Andressa Mussi; Cruz, Cecilia Beatriz Bittencourt Viana; Guimarães Filho, Fabio Villaça; Assunção, Bruna Morhy Borges Leal; Fernandes, Rafael Modesto; Saraiva, Roberto Magalhães; Tsutsui, Jeane Mike; Soares, Fábio Luis de Jesus; Falcão, Sandra Nívea dos Reis Saraiva; Hotta, Viviane Tiemi; Armstrong, Anderson da Costa; Hygidio, Daniel de Andrade; Miglioranza, Marcelo Haertel; Camarozano, Ana Cristina; Lopes, Marly Maria Uellendahl; Cerci, Rodrigo Julio; Siqueira, Maria Eduarda Menezes de; Torreão, Jorge Andion; Rochitte, Carlos Eduardo; Felix, Alex.
Arq. bras. cardiol ; 120(12): e20230646, dez. 2023. tab, graf
Article in Portuguese | LILACS-Express | LILACS, SESSP-IDPCPROD, SES-SP | ID: biblio-1527794
4.
Arq. bras. cardiol ; 116(3): 371-380, Mar. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1248862

ABSTRACT

Resumo Fundamento Na pandemia pela COVID-19, o aumento da ocorrência e da mortalidade por doenças cardiovasculares (DCV) vem sendo reconhecido no mundo. No Brasil, é essencial que o impacto da COVID-19 na DCV seja analisado. Objetivos Avaliar o impacto desta pandemia nos números de internações hospitalares (IH), óbitos hospitalares (OH) e letalidade intra-hospitalar (LH) por DCV a partir de dados epidemiológicos do Sistema Único de Saúde (SUS). Métodos Estudo observacional de séries temporais por meio da análise comparativa das taxas de IH, OH e LH por DCV registrados entre janeiro e maio de 2020, usando como referência os valores obtidos no mesmo período entre 2016 e 2019 e os valores projetados por métodos de regressão linear para o ano de 2020. O nível significância estatística utilizado foi de 0,05. Resultados Em comparação com o mesmo período de 2019, houve um decréscimo de 15% na taxa de IH e de 9% no total de OH por DCV entre março e maio de 2020, acompanhado de um aumento de 9% na taxa de LH por esse grupo de doenças, sobretudo entre pacientes com idade de 20-59 anos. As taxas de IH e LH registradas em 2020 diferiram significativamente da tendência projetada para o corrente ano (p=0,0005 e 0,0318, respectivamente). Conclusões Durante os primeiros meses da pandemia, observou-se um declínio na IH associado a um aumento da LH por DCV no Brasil. Esses dados possivelmente são consequência do planejamento inadequado no manejo das DCV durante a pandemia, sendo necessária a implementação de ações imediatas para modificar esse cenário. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)


Abstract Background In the COVID-19 pandemic, the increase in the incidence of cardiovascular diseases (CVD) and mortality from them has been recognized worldwide. In Brazil, the impact of COVID-19 on CVD must be evaluated. Objectives To assess the impact of the current pandemic on the numbers of hospital admissions (HA), in-hospital deaths (ID), and in-hospital fatality (IF) from CVD by use of national epidemiological data from the Brazilian Unified Public Health System. Methods Time-series observational study using comparative analysis of the HA, ID, and IF due to CVD recorded from January to May 2020, having as reference the values registered in the same period from 2016 to 2019 and the values projected by linear regression methods for 2020. The statistical significance level applied was 0.05. Results Compared to the same period in 2019, there was a 15% decrease in the HA rate and a 9% decrease in the total ID due to CVD between March and May 2020, followed by a 9% increase in the IF rate due to CVD, especially among patients aged 20-59 years. The HA and IF rates registered in 2020 differed significantly from the projected trend for 2020 (p = 0.0005 and 0.0318, respectively). Conclusions During the first months of the pandemic, there were a decline in HA and an increase in IF due to CVD in Brazil. These data might have resulted from the inadequate planning of the CVD management during the pandemic. Thus, immediate actions are required to change this scenario. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)


Subject(s)
Humans , Adult , Cardiovascular Diseases , COVID-19 , Brazil/epidemiology , Pandemics , SARS-CoV-2 , Hospitalization , Middle Aged
5.
Clinics ; 76: e1958, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153932

ABSTRACT

OBJECTIVES: To evaluate the effects of sympathectomy on the myocardium in an experimental model. METHODS: The study evaluated three groups of male Wistar rats: control (CT; n=15), left unilateral sympathectomy (UNI; n=15), and bilateral sympathectomy (BIL; n=31). Sympathectomy was performed by injection of absolute alcohol into the space of the spinous process of the C7 vertebra. After 6 weeks, we assessed the chronotropic properties at rest and stress, cardiovascular autonomic modulation, myocardial and peripheral catecholamines, and beta-adrenergic receptors in the myocardium. The treadmill test consisted of an escalated protocol with a velocity increment until the maximal velocity tolerated by the animal was reached. RESULTS: The bilateral group had higher levels of peripheral catecholamines, and consequently, a higher heart rate (HR) and blood pressure levels. This suggests that the activation of a compensatory pathway in this group may have deleterious effects. The BIL group had basal tachycardia immediately before the exercise test and increased tachycardia at peak exercise (p<0.01); the blood pressure had the same pattern (p=0.0365). The variables related to autonomic modulation were not significantly different between groups, with the exception of the high frequency (HF) variable, which showed significant differences in CT vs UNI. There was no significant difference in beta receptor expression between groups. There was a higher concentration of peripheral norepinephrine in the BIL group (p=0.0001), and no significant difference in myocardial norepinephrine (p=0.09). CONCLUSION: These findings suggest that an extra cardiac compensatory pathway increases the sympathetic tonus and maintains a higher HR and higher levels of peripheral catecholamines in the procedure groups. The increase in HF activity can be interpreted as an attempt to increase the parasympathetic tonus to balance the greater sympathetic activity.


Subject(s)
Animals , Male , Rats , Sympathectomy , Myocardium , Blood Pressure , Rats, Wistar , Heart Rate
11.
Arq. bras. cardiol ; 109(6): 533-540, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-887973

ABSTRACT

Abstract Background: Endomyocardial fibrosis (EMF) is a rare disease, characterized by diastolic dysfunction which leads to reduced peak oxygen consumption (VO2). Cardiopulmonary exercise testing (CPET) has been proved to be a fundamental tool to identify central and peripheral alterations. However, most studies prioritize peak VO2 as the main variable, leaving aside other important CPET variables that can specify the severity of the disease and guide the clinical treatment. Objective: The aim of this study was to evaluate central and peripheral limitations in symptomatic patients with EMF by different CPET variables. Methods: Twenty-six EMF patients (functional class III, NYHA) were compared with 15 healthy subjects (HS). Functional capacity was evaluated using CPET and diastolic and systolic functions were evaluated by echocardiography. Results: Age and gender were similar between EMF patients and HS. Left ventricular ejection fraction was normal in EMF patients, but decreased compared to HS. Peak heart rate, peak workload, peak VO2, peak oxygen (O2) pulse and peak pulmonary ventilation (VE) were decreased in EMF compared to HS. Also, EMF patients showed increased Δ heart rate /Δ oxygen uptake and Δ oxygen uptake /Δ work rate compared to HS. Conclusion: Determination of the aerobic capacity by noninvasive respiratory gas exchange during incremental exercise provides additional information about the exercise tolerance in patients with EMF. The analysis of different CPET variables is necessary to help us understand more about the central and peripheral alterations cause by both diastolic dysfunction and restrictive pattern.


Resumo Fundamento: A endomiocardiofibrose (EMF) é uma doença rara, caracterizada por disfunção diastólica que leva à redução consumo de oxigênio (VO2) pico. O teste de esforço cardiopulmonar (TECP) tem se mostrado uma ferramenta fundamental na identificação de alterações centrais e periféricas. No entanto, a maioria dos estudos prioriza o VO2 pico como a variável principal, em detrimento de outras importantes variáveis do TECP que poderiam identificar a gravidade da doença e direcionar o tratamento clínico. Objetivo: O objetivo deste estudo foi avaliar limitações centrais e periféricas em pacientes com EMF sintomáticos por meio de variáveis do TECP. Métodos: Vinte e seis pacientes com EMF (classe funcional III, NYHA) foram comparados com 15 indivíduos controle saudáveis (CS). A capacidade funcional foi avaliada por TECP e funções sistólicas e diastólicas por ecocardiografia. Resultados: A idade e o gênero foram similares entre pacientes com EMF e CS. A fração de ejeção do ventrículo esquerdo foi normal em pacientes com EMF, porém diminuída em comparação aos CS. Os picos de frequência cardíaca, carga de trabalho, VO2, pulso de oxigênio (O2) e da ventilação pulmonar (VE) estavam diminuídos em pacientes com EMF em comparação aos CS. Ainda, os pacientes com EMF apresentaram Δ frequência cardíaca /Δ consumo de oxigênio e Δ consumo de oxigênio /Δ taxa de trabalho aumentados em comparação aos CS. Conclusão: A determinação da capacidade aeróbica por troca respiratória não invasiva durante exercício progressivo fornece informações sobre a tolerância ao exercício em pacientes com EMF. É necessária uma análise das diferentes variáveis do TECP para nos ajudar a compreender mais acerca das alterações centrais e periféricas causadas tanto pela disfunção diastólica como pelo padrão restritivo.


Subject(s)
Humans , Male , Female , Middle Aged , Respiratory Function Tests , Endocardium/surgery , Endomyocardial Fibrosis/etiology , Exercise Test , Heart Failure/surgery , Cardiac Surgical Procedures/adverse effects , Oxygen Consumption , Echocardiography , Case-Control Studies , Exercise Tolerance , Endomyocardial Fibrosis/physiopathology
12.
Clin. biomed. res ; 37(2): 73-80, 2017. graf, tab
Article in English | LILACS | ID: biblio-847904

ABSTRACT

Introduction: The purpose of this study was to investigate the effects of isolated vitamin B6 (VB6 ) supplementation on experimental hyperhomocysteinemia (Hhe) induced by homocysteine thiolactone (HcyT). Methods: Fifteen male Wistar rats were divided into three groups according to their treatment. Animals received water and food ad libitum and an intragastric probe was used to administer water for 60 days (groups: CB6, HcyT, and HB6 ). On the 30th day of treatment, two groups were supplemented with VB6 in the drinking water (groups: CB6 and HB6 ). After 60 days of treatment, homocysteine (Hcy), cysteine, and hydrogen peroxide concentration, nuclear factor (erythroid-derived 2)-like 2 (NRF2) and glutathione S-transferase (GST) immunocontent, and superoxide dismutase (SOD), catalase (CAT), and GST activities were measured. Results: The HcyT group showed an increase in Hcy concentration (62%) in relation to the CB6 group. Additionally, GST immunocontent was enhanced (51%) in the HB6 group compared to the HcyT group. Also, SOD activity was lower (17%) in the HB6 group compared to the CB6 group, and CAT activity was higher in the HcyT group (53%) compared to the CB6 group. Ejection fraction (EF) was improved in the HB6 group compared to the HcyT group. E/A ratio was enhanced in the HB6 group compared to the CB6 group. Correlations were found between CAT activity with myocardial performance index (MPI) (r = 0.71; P = 0.06) and E/A ratio (r = 0.6; P = 0.01), and between EF and GST activity (r = 0.62; P = 0.02). Conclusions: These findings indicate that isolated VB6 supplementation may lead to the reduction of Hcy concentration and promotes additional benefits to oxidative stress and heart function parameters (AU)


Subject(s)
Animals , Rats , Heart/drug effects , Hyperhomocysteinemia/drug therapy , Oxidative Stress/drug effects , Vitamin B 6/therapeutic use , Cardiovascular Diseases/etiology , Models, Animal , Rats, Wistar
13.
Arq. bras. cardiol ; 105(1): 28-36, July 2015. tab
Article in English | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-755004

ABSTRACT

Background:

Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks.

Objective:

To assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions.

Methods:

10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging.

Results:

Reservoir function (Total Emptying Fraction: TEF): (p <0.0001), lower in GIII as compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p<0.0001) and GII (p = 0.002). There was a negative correlation of E/e’average with the reservoir and pump functions (TEF and AEF), and a positive correlation of e’average with s’ wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions.

Conclusion:

An impairment of LA functions in Chagas cardiomyopathy was observed.

.

Fundamento:

A doença de Chagas é uma causa de miocardiopatia dilatada, sendo ainda pouco conhecida a função do átrio esquerdo (AE) nessa doença.

Objetivo:

Avaliar as diferenças nas funções do AE (reservatório, conduto e bomba) e sua correlação com os parâmetros ecocardiográficos das funções sistólica e diastólica do ventrículo esquerdo (VE).

Método:

10 controles (GC) e os seguintes pacientes com doença de Chagas: 26 com a forma indeterminada (GI); 30 com alterações eletrocardiográficas (GII); e 19 com disfunção de VE (GIII). Todos os pacientes foram submetidos a ecocardiografia bidimensional e em modo M, Doppler pulsado e Doppler tecidual.

Resultados:

Função de reservatório (fração de esvaziamento total: FET) (p < 0,0001), mais baixa no GIII do que no GC (p = 0,003), GI (p < 0,001) e GII (p < 0,001). Função de conduto (fração de esvaziamento passivo: FEP) (p = 0,004), mais baixa no GIII (GIII e GC, p = 0.06; GI e GII, p = 0.06; e GII e GIII, p = 0,07). Função de bomba (fração de esvaziamento ativo: FEA) (p = 0,0001), mais baixa no GIII do que no CG (p = 0,05), GI (p<0,0001) e GII (p = 0,002). Observou-se uma correlação negativa entre E/e’média e as funções de reservatório e de bomba (FET e FEA), e uma correlação positiva entre as ondas e’média e s’ (paredes septal e lateral) e as funções de reservatório, conduto e bomba.

Conclusão:

Observou-se comprometimento das funções do AE na miocardiopatia chagásica.

.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Atrial Function, Left/physiology , Chagas Cardiomyopathy/physiopathology , Ventricular Dysfunction, Left/physiopathology , Cardiomyopathy, Dilated/physiopathology , Case-Control Studies , Chagas Cardiomyopathy , Echocardiography, Doppler , Myocardial Contraction/physiology , Reference Values , Statistics, Nonparametric , Stroke Volume/physiology , Ventricular Dysfunction, Left
14.
Rev. bras. ecocardiogr. imagem cardiovasc ; 25(4): 267-277, out.-dez. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-653984

ABSTRACT

Introdução: O Doppler tecidual (DT) evoluiu para a determinação da deformação miocárdica regional pela medida do strain rate (SR) e strain (ε) longitudinal (L) e radial (R) unidimensionais. Objetivos: Determinar padrões de normalidade em neonatos nas primeiras 24 horas de vida e estabelecer valores de referência. Casuística e Método: Foram selecionados 55 neonatos, com idade média de 20,14 ± 14,0 horas. Por meio dos cortes apical e paraesternal, em três ciclos cardíacos consecutivos, digitalmente obtidos com taxas de 300 ± 50 ciclos/s, foram realizadas medidas dos componentes sistólico, diastólico inicial e final das curvas de SR/ε, utilizando programa específico. Comparações múltiplas entre paredes e segmentos foram feitas. Resultados: Verificou-se diferença significativa na deformação longitudinal entre as medidas do SR/ε sistólicos do segmento basal da parede septal, em relação à apical (-1,89 ± 0,60, -25,86 ± 4,83 versus -1,66 ± 0,22, -24,23 ± 3,48), P= 0,04 e P= 0,02. A deformação longitudinal regional do VD também não foi homogênea, com diferenças significantes entre os segmentos basal e apical. Os valores absolutos de SR/ε e todos os seus componentes foram maiores na direção R, quando comparados com a L (SR sistólico 2,98 ± 0,78 s-1 versus (-)1,89 ± 0,60 s-1ε sistólico 53,8% ± 19% versus (-) 24,8% ± 3% P< 0,01). A variabilidade interobservador da medida do SR/ε foi de 0,7% e 1,2%, respectivamente. Conclusão: Os índices regionais de deformação miocárdica baseados no Doppler (SR/ε) constituem técnica clínica reproduzível em neonatos, permitindo a análise da função regional em diferentes segmentos do VE e VD. Representam parâmetros novos, não invasivos e independentes da interpretação visual, podendo ser utilizados no diagnóstico de acometimento cardíaco do neonato.


Subject(s)
Humans , Infant, Newborn , Heart Defects, Congenital/complications , Echocardiography, Doppler/methods , Echocardiography, Doppler , Infant, Newborn , Foramen Ovale/abnormalities
15.
Clinics ; 67(9): 1063-1069, Sept. 2012. ilus, tab
Article in English | LILACS | ID: lil-649387

ABSTRACT

OBJECTIVE: Chagas' disease has spread throughout Latin America because of the high rate of migration among these countries. Approximately 30% of Chagas' patients will develop cardiomyopathy, and 10% of these will develop severe cardiac damage leading to heart failure. Beta-blockade improves symptoms and survival in heart failure patients; however, its efficacy has not been well established in Chagas' disease. We evaluated the role of carvedilol in cardiac remodeling and mortality in a Chagas' cardiomyopathy animal model. METHODS: We studied Trypanosoma cruzi infection in 55 Syrian hamsters that were divided into three groups: control (15), infected (20), and infected + carvedilol (20). Animals underwent echocardiography, electrocardiography, and morphometry for collagen evaluation in ventricles stained with picrosirius red. RESULTS: The left ventricular diastolic diameter did not change between groups, although it was slightly larger in infected groups, as was left ventricular systolic diameter. Fractional shortening also did not change between groups, although it was slightly lower in infected groups. Collagen accumulation in the interstitial myocardial space was significantly higher in infected groups and was not attenuated by carvedilol. The same response was observed in the perivascular space. The survival curve showed significantly better survival in the control group compared with the infected groups; but no benefit of carvedilol was observed during the study. However, in the acute phase (up to 100 days of infection), carvedilol did reduce mortality. CONCLUSION: Carvedilol did not attenuate cardiac remodeling or mortality in this model of Chagas' cardiomyopathy. The treatment did improve survival in the acute phase of the disease.


Subject(s)
Animals , Cricetinae , Female , Adrenergic beta-Antagonists/therapeutic use , Carbazoles/therapeutic use , Chagas Cardiomyopathy/drug therapy , Propanolamines/therapeutic use , Ventricular Remodeling/drug effects , Chagas Cardiomyopathy/mortality , Chagas Cardiomyopathy/pathology , Collagen/analysis , Disease Models, Animal , Echocardiography , Heart Rate/drug effects , Heart Ventricles/physiopathology , Kaplan-Meier Estimate , Mesocricetus , Survival Rate , Time Factors , Treatment Outcome
16.
Clinics ; 67(7): 815-820, July 2012. graf, tab
Article in English | LILACS | ID: lil-645456

ABSTRACT

OBJECTIVE: High fructose consumption contributes to the incidence of metabolic syndrome and, consequently, to cardiovascular outcomes. We investigated whether exercise training prevents high fructose diet-induced metabolic and cardiac morphofunctional alterations. METHODS: Wistar rats receiving fructose overload (F) in drinking water (100 g/l) were concomitantly trained on a treadmill (FT) for 10 weeks or kept sedentary. These rats were compared with a control group (C). Obesity was evaluated by the Lee index, and glycemia and insulin tolerance tests constituted the metabolic evaluation. Blood pressure was measured directly (Windaq, 2 kHz), and echocardiography was performed to determine left ventricular morphology and function. Statistical significance was determined by one-way ANOVA, with significance set at p<0.05. RESULTS: Fructose overload induced a metabolic syndrome state, as confirmed by insulin resistance (F: 3.6 ± 0.2 vs. C: 4.5 ± 0.2 mg/dl/min), hypertension (mean blood pressure, F: 118 ± 3 vs. C: 104 ± 4 mmHg) and obesity (F: 0.31±0.001 vs. C: 0.29 ± 0.001 g/mm). Interestingly, fructose overload rats also exhibited diastolic dysfunction. Exercise training performed during the period of high fructose intake eliminated all of these derangements. The improvements in metabolic parameters were correlated with the maintenance of diastolic function. CONCLUSION: The role of exercise training in the prevention of metabolic and hemodynamic parameter alterations is of great importance in decreasing the cardiac morbidity and mortality related to metabolic syndrome.


Subject(s)
Animals , Male , Rats , Metabolic Syndrome/complications , Physical Conditioning, Animal/physiology , Ventricular Dysfunction, Left/prevention & control , Disease Models, Animal , Diastole/physiology , Fructose/adverse effects , Metabolic Syndrome/physiopathology , Rats, Wistar , Sweetening Agents/adverse effects , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology
17.
Arq. bras. cardiol ; 97(3): e53-e55, set. 2011. ilus
Article in Portuguese | LILACS | ID: lil-601798

ABSTRACT

A prevenção de complicações cardiovasculares tardias após radioterapia (RT) para tratamento de um tumor maligno é um desafio. Relatamos o caso de um jovem paciente com linfoma de Hodgkin submetido a tratamento com RT que desenvolveu doença cardíaca isquêmica no seguimento, embora não apresentasse fatores de risco cardiovasculares. Concluímos que pacientes submetidos a RT que apresentam dor torácica deveriam ser criteriosamente avaliados em relação à doença arterial coronariana.


Prevention of late cardiovascular complications after radiation therapy (RT) for treatment of a malignant tumor is challenging. We report the case of a young male patient with Hodgkin's lymphoma treated with RT, who developed ischemic heart disease during follow-up, although he had no cardiovascular risk factors. We conclude that patients undergoing RT who experience chest pain should be fully investigated for coronary artery disease.


Subject(s)
Humans , Male , Young Adult , Coronary Artery Disease/etiology , Coronary Vessels/radiation effects , Hodgkin Disease/radiotherapy , Radiation Injuries/complications , Coronary Artery Disease/surgery , Radiation Injuries/surgery
19.
Arq. bras. cardiol ; 97(1): e13-e19, jul. 2011. ilus, tab
Article in Portuguese | LILACS | ID: lil-597676

ABSTRACT

A miocardiopatia não compactada isolada é uma doença rara, que provavelmente surge no período embrionário, com a parada intrauterina da compactação miocárdica no início do desenvolvimento fetal, e que determina trabeculações miocárdicas proeminentes com recessos intertrabeculares profundos e espessamento do miocárdio em duas camadas distintas (compactado e não compactado). Embora descrita inicialmente na população pediátrica ou em conjunto com cardiopatia congênita, pode-se compreender que essa doença ocorre de forma isolada, porque o diagnóstico é cada vez mais comum em pacientes adultos que não apresentam outra doença cardíaca. As manifestações clínicas são altamente variáveis, porque partem da ausência de sintomas à insuficiência cardíaca congestiva, arritmias e tromboembolismo sistêmico. A ecocardiografia é o procedimento diagnóstico mais utilizado, porém o pouco conhecimento sobre essa doença, sua semelhança com outras afecções miocárdicas e a limitação da técnica ecocardiográfica empregada fazem com que o diagnóstico seja postergado. Esta revisão objetiva mostrar que outras modalidades de imagem como ressonância magnética, tomografia computadorizada e ventriculografia esquerda são alternativas diagnósticas.


Isolated non-compaction cardiomyopathy is a rare disease that is likely to develop in the embryonic period. It is caused by the intrauterine arrest of the myocardial compaction process in the beginning of the fetal development. It is characterized by prominent myocardial trabeculations and deep intertrabecular recesses, as well as the thickening of the myocardium into two distinct layers (compacted and not compacted). Even though this disease is said to be prevalent in the pediatric population or together with congenital heart disease, one can understand that this disease occurs in isolation, because the diagnosis is becoming more common in adult patients that have no other heart disease. The clinical manifestations vary greatly, because they range from absence of symptoms to congestive heart failure, arrhythmias and systemic thromboembolism. Echocardiography is the most widely used diagnostic procedure, but the little knowledge about this disease, its similarity to other myocardial diseases and the limitation of the echocardiographic technique used delay the diagnosis. The purpose of this review is to show that that other imaging techniques, such as MRI, CT and left ventriculography have emerged as diagnostic alternatives.


La miocardiopatía no compactada aislada es una enfermedad rara, que probablemente surge en el período embrionario, con la parada intrauterina de la compactación miocárdica en el comienzo del desarrollo fetal, y que determina trabeculaciones miocárdicas prominentes con recesos intertrabeculares profundos y espesamiento del miocardio en dos capas distintas (compactado y no compactado). Aunque descripta inicialmente en la población pediátrica o en conjunto con cardiopatía congénita, se puede comprender que esa enfermedad ocurre de forma aislada, porque el diagnóstico es cada vez más común en pacientes adultos que no presentan otra enfermedad cardíaca. Las manifestaciones clínicas son altamente variables, porque parten de la ausencia de síntomas a la insuficiencia cardíaca congestiva, arritmias y tromboembolismo sistémico. La ecocardiografía es el procedimiento diagnóstico más utilizado, sin embargo el poco conocimiento sobre esa enfermedad, su semejanza con otras afecciones miocárdicas y la limitación de la técnica ecocardiográfica empleada hacen que el diagnóstico sea postergado. Esta revisión pretende mostrar que otras modalidades de imagen como resonancia magnética, tomografía computarizada y ventriculografía izquierda son alternativas diagnósticas.


Subject(s)
Humans , Isolated Noncompaction of the Ventricular Myocardium/diagnosis , Diagnosis, Differential , Echocardiography , Isolated Noncompaction of the Ventricular Myocardium/etiology , Isolated Noncompaction of the Ventricular Myocardium/therapy , Magnetic Resonance Imaging
20.
Arq. bras. cardiol ; 96(2): 99-106, fev. 2011. graf
Article in Portuguese | LILACS | ID: lil-579616

ABSTRACT

FUNDAMENTO: A norepinefrina miocárdica está alterada na disfunção ventricular esquerda. Em pacientes com cardiomiopatia chagásica (CC), essa questão ainda não foi discutida. OBJETIVO: Determinar o nível de norepinefrina (NE) miocárdica em pacientes com CC e compará-la em pacientes com doença arterial coronariana (DAC) e relacionar NE miocárdica com a fração de ejeção do ventrículo esquerdo (FEVE). MÉTODOS: Estudamos 39 pacientes com CC, divididos em grupo 1: 21 indivíduos com FEVE normal e grupo 2: 18 com FEVE diminuída. Dezessete pacientes com DAC foram divididos em grupo 3: 12 indivíduos com FEVE normal e grupo 4: 5 indivíduos com FEVE diminuída. Ecocardiografia bidimensional foi usada para medir a FEVE. A NE miocárdica foi determinada através de Cromatografia Líquida de Alta Eficiência (HPLC). RESULTADOS: A NE miocárdica na CC com e sem disfunção ventricular foi 1,3±1,3 e 6,1±4,2 pg/μg de proteína não-colagenosa, respectivamente (p<0,0001); na DAC com e sem disfunção ventricular, foi 3,3±3,0 e 9,8±4,2 pg/μg de proteína não-colagenosa, respectivamente (p<0,0001). Uma correlação positive foi observada entre a FEVE e a concentração de NE miocárdica em pacientes com CC (p<0,01; r = 0,57) e também naqueles com DAC (p<0,01; r=0,69). Uma diferença significante foi demonstrada entre as concentrações de NE em pacientes com FEVE normal (grupos 1 e 3; p = 0,0182), mas nenhuma diferença foi observada em pacientes com FEVE diminuída (grupos 2 e 4; p = 0,1467). CONCLUSÃO: Pacientes com CC e fração de ejeção global normal apresentam uma denervação cardíaca precoce, quando comparados à pacientes com doença arterial coronariana.


BACKGROUND: Myocardial norepinephrine is altered in left ventricular impairment. In patients with Chagas' cardiomyopathy (CC), this issue has not been addressed. OBJECTIVE: To determine the level of myocardial norepinephrine in patients with CC and compare it in patients with coronary artery disease, and to relate myocardial norepinephrine to left ventricular ejection fraction (LVEF). METHODS: We studied 39 patients with CC, divided into group 1: 21 individuals with normal LVEF and group 2: 18 individuals with decreased LVEF. Seventeen patients with coronary artery disease were divided into group 3: 12 individuals with normal LVEF and group 4: 5 individuals with decreased LVEF. Two-dimensional echocardiography was used to measure LVEF. Myocardial norepinephrine was determined by high-performance liquid chromatography. RESULTS: Myocardial norepinephrine in CC with and without ventricular dysfunction was 1.3±1.3 and 6.1±4.2 pg/μg noncollagen protein, respectively (p<0.0001); in coronary artery disease with and without ventricular dysfunction, it was 3.3±3.0 and 9.8±4.2 pgμg noncollagen protein, respectively (p<0.0001). A positive correlation was found between LVEF and myocardial norepinephrine concentration in the patients with Chagas' cardiomyopathy (p<0.01, r = 0.57) and also in those with coronary artery disease (p<0.01, r=0.69). A significant difference was demonstrated between norepinephrine concentrations in patients with normal LVEF (groups 1 and 3; p = 0.0182), but no difference was found in patients with decreased LVEF (groups 2 and 4; p = 0.1467). CONCLUSION: In patients with Chagas' cardiomyopathy and normal global ejection fraction there is an early cardiac denervation, when compared to coronary artery disease patients.


FUNDAMENTO: La norepinefrina miocárdica está alterada en la disfunción ventricular izquierda. En pacientes con cardiomiopatía chagásica (CC), esa cuestión aun no fue discutida. OBJETIVO: Determinar el nivel de norepinefrina (NE) miocárdica en pacientes con CC y compararla en pacientes con enfermedad arterial coronaria (EAC) y relacionar NE miocárdica con la fracción de eyección del ventrículo izquierdo (FEVI). MÉTODOS: 39 pacientes con CC, divididos en grupo 1: 21 individuos con FEVI normal y grupo 2: 18 con FEVI disminuida. Diecisiete pacientes con EAC fueron divididos en grupo 3: 12 individuos con FEVI normal y grupo 4: 5 individuos con FEVI disminuida. Ecocardiografía bidimensional fue usada para medir la FEVI. La NE miocárdica fue determinada a través de Cromatografía Líquida de Alta Eficiencia (HPLC). RESULTADOS: La NE miocárdica en la CC con y sin disfunción ventricular fue 1,3±1,3 y 6,1±4,2 pg/µg de proteína no colagenosa, respectivamente (p<0,0001); en la EAC con y sin disfunción ventricular, fue 3,3±3,0 y 9,8±4,2 pg/µg de proteína no colagenosa, respectivamente (p<0,0001). Una correlación positiva fue observada entre la FEVI y la concentración de NE miocárdica en pacientes con CC (p<0,01; r=0,57) y también en aquellos con EAC (p<0,01; r=0,69). Una diferencia significativa fue demostrada entre las concentraciones de NE en pacientes con FEVI normal (grupos 1 y 3; p = 0,0182), pero ninguna diferencia fue observada en pacientes con FEVI disminuida (grupos 2 y 4; p = 0,1467). CONCLUSIONES: Pacientes con CC y fracción de eyección global normal presentan una denervación cardíaca precoz, cuando son comparados a pacientes con enfermedad arterial coronaria.


Subject(s)
Female , Humans , Male , Middle Aged , Chagas Cardiomyopathy/metabolism , Coronary Artery Disease/metabolism , Myocardium/chemistry , Norepinephrine/analysis , Stroke Volume/physiology , Chagas Cardiomyopathy/physiopathology , Chromatography, High Pressure Liquid/methods , Coronary Artery Disease/physiopathology , Epidemiologic Methods , Heart/innervation
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