Cardiomiopatia Hipertrófica Obstrutiva Médio-Ventricular / Mid-Ventricular Hypertrophic Obstructive Cardiomyopathy

A cardiomiopatia hipertrófica obstrutiva médio-ventricular é uma variante rara (1%) da cardiomiopatia hipertrófica obstrutiva. Neste relato de caso, apresentamos uma paciente encaminhada para realização de cateterismo cardíaco eletivo por angina e dispneia aos moderados esforços, sem obstrução coronariana significativa e com ventriculografia esquerda, demostrando cardiomiopatia hipertrófica obstrutiva médio-ventricular com um gradiente pressórico intraventricular de 130 mmHg...

Mid-ventricular hypertrophic obstructive cardiomyopathy is a rare variant form (1%) of hypertrophic obstructive cardiomyopathy. In this case, we report a patient referred for elective cardiac catheterization due to angina and dyspnea on moderate exertion, with no significant coronary obstruction, and left ventriculography indicating the presence of mid-ventricular hypertrophic obstructive cardiomyopathy with an intraventricular pressure gradient of 130 mmHg...

Perfil da intervenção coronária percutânea no infarto agudo do miocárdio com supradesnivelamento do segmento ST no Brasil de 2006 a 2010: Registro CENIC / National profile of percutaneous coronary intervention in acute ST elevation myocardial infarction in Brazil from 2006 to 2010: the CENIC Registry

Introdução: O infarto agudo do miocárdio (IAM) persiste comoimportante causa de morbidade e mortalidade. Este estudo visa a delinear o panorama nacional da intervenção coronária percutânea (ICP) no cenário do IAM, analisando diferentes períodos e regiões do Brasil, com enfoque na ICP primária e nos tratamentos adjuntos farmacológicos e mecânicos.Métodos: Foram analisados dados de 20.004 pacientes com diagnóstico de IAM com supradesnivelamento dosegmento ST (IAMCSST) e submetidos a ICP, provenientes do Registro CENIC (Central Nacional de Intervenções Cardiovasculares), de janeiro de 2006 a dezembro de 2010. Esses dados são oriundos de 252 centros localizados em22 Estados das cinco regiões do País. Resultados: A ICP primária correspondeu a 57,8% das ICPs realizadas no contexto do IAM, seguida de ICP eletiva pós-IAMCSST (35,7%), ICP de resgate (6,1%) e ICP facilitada (0,4%). A evolução ao longo dos anos evidencia aumento progressivo do número de ICPs primárias no Brasil, partindo de 56,7% do total em 2006 para 71,6% em 2010. O tempo médio porta-balão da ICP primária no Brasil nesse período foi de 2 horas. A aspiração de trombos aumentou de 0,4%em 2006 para 8,2% dos casos em 2010. A taxa média de sucesso do procedimento foi de 93,8%, enquanto a de óbito hospitalar foi de apenas 2,8%. Conclusões: A ICP no cenário do IAMCSST vem apresentando avanços de 2006 a 2010, embora de maneira heterogênea nas diferentes regiões doBrasil, mediante aumento das taxas de ICP primária e maior utilização de dispositivos de aspiração de trombo, osquais ainda não foram incorporados na rotina. Investimentos em recursos humanos e implementação de protocolos de atendimento constituem elementos essenciais para a otimização do tempo porta-balão e para a melhora dos resultados clínicos.

Background: Acute myocardial infarction (AMI) remains a major cause of morbidity and mortality. This study aims to outline the national profile of percutaneous coronary intervention(PCI) in the setting of AMI, analyzing different time periods and geographic regions, with focus on primary PCI and adjunctive pharmacological and mechanical treatments. Methods: Data from 20,004 patients with ST elevationmyocardial infarction (STEMI) undergoing PCI and included in the CENIC Registry (National Center of Cardiovascular Interventions) from January 2006 to December 2010 wereincluded in this study. Data were obtained from 252 centers located in 22 states from five different geographic regions in the country. Results: Primary PCI accounted for 57.8% of PCI performed in the setting of AMI, followed by elective PCI after STEMI (35.7%), rescue PCI (6.1%) and facilitated PCI (0.4%). The evolution over time showed a progressiveincrease in the number of primary PCIs in Brazil, from 56.7% in 2006 to 71.6% in 2010. The mean door-to-balloon timeof primary PCI in Brazil during this period was 2 hours. Thrombus aspiration increased from 0.4% in 2006 to 8.2%of cases in 2010. Procedural success rate was 93.8%, while in-hospital mortality was only 2.8%. Conclusions: PCI in the setting of STEMI has improved from 2006 to 2010, althoughheterogeneously in the different regions of Brazil, due to increased primary PCI rates and higher use of thrombusaspiration devices, which have not been incorporated in the routine practice. Investments in staff training and implementation of clinical protocols are essential to optimize the door-to-balloon time and improve clinical outcomes.

Modelo experimental de reestenose intrastent em artérias coronárias de suínos: efeito do implante de stent sobredimensionado / Experimental model of in-stent restenosis in swine coronary arteries: effect of oversized stent deployment

INTRODUÇÃO: Há múltiplos modelos experimentais em animais, entretanto o modelo suíno é o que apresenta características anatômicas e funcionais mais próximas às humanas. Assim sendo, esse trabalho foi realizado com o objetivo de desenvolverr e implementar um protocolo experimental de indução de hiperproliferação neointimal em suínos, visando à criação de técnicasw de lesão vascular simulando a reestenose. Método: De agosto de 2006 a março de 2009, 69 suínos jovens da raça Large White foram submetidos a cinecoronariografia seguida de lesão vascular com implante de 102 stents sobredimensionados, guiados por ultrassom intracoronário. Em 28 dias foi realizado reestudo com nova cinecoronariografia e ultrassom intracoronário. Resultados: O diâmetro luminal mínimo e a área luminal mínima imediatamente após o implante de stent no grupo stent sobredimensionado foram maiores em comparação ao grupo controle...

BACKGROUND: There are several experimental animal models, but, the swine model is the most similar to human anatomic and physiologic characteristics. Therefore, this study was carried out to develop and implement an experimental protocol of vascular neointimal hyperplasia induction in swine, aiming at creating vascular injury techniques simulating restenosis. METHOD: From August 2006 to March 2009, 69 young Large White swine underwent coronary angiography followed by vascular injury and implantation of 102 oversized stents guided by intravascular ultrasound. After 28 days a new coronary angiography and intravascular ultrasound was performed. RESULTS: The minimal luminal diameter and the minimal luminal area immediately after the stent deployment in the group treated with an oversized stent were significantly higher when compared to the control group (3.5 ± 0.3 mm vs. 3 ± 0.2 mm, P < 0.0001 and 40.7 ± 0.3 mm² vs. 30.2 ± 0.2 mm², P < 0.0001). The binary restenosis rate in the group treated with an oversized stent was 92% (69/75 stents), whereas it was 12% (3/25 stents) in the control group, with a statistically significant difference (P < 0.0001). The neointimal hyperplasia volume was significantly higher in the group treated with an oversized stent in comparison to the control group (5.9 ± 0.8 mm³/stent mm vs. 1.8 ± 0.7 mm³/stent mm, P < 0.0001). CONCLUSION: The proposed experimental model of neointimal proliferation induction in swine is effective in inducing instent hyperplasia, and therefore it may be used for the study of the pathophysiologic mechanisms of in-stent restenosis as well as for therapeutic purposes, such as the evaluations of new drugs, new devices and new drug-eluting stents for the prevention and treatment of in-stent restenosis.

Importância da interação entre a integrina Mac-1 leucócitos e a glicoproteína Ib alfa das plaquetas para o recrutamento de leucócitos pelas plaquetas e para a resposta inflamatória à lesão vascular / The importance of the leukocyte integrin Mac-1 and platelet glycoprotein Ib? interaction for the leukocyte recruitment by platelets and for the inflammatory response to vascular injury

INTRODUÇÃO: A interação entre leucócitos e plaquetas é fundamental para o início e a progressão da reestenose e da aterosclerose. Recentemente foi evidenciado em estudos in vitro que a integrina Mac-1 dos leucócitos se liga à glicoproteína Ibalfa (GP Ibalfa) das plaquetas e que esta interação possui uma função central na firme adesão e transmigração de leucócitos em locais de deposição de plaquetas. Entretanto, não há estudos in vivo que avaliam a importância da interação entre a integrina Mac-1 dos leucócitos e a GP Ibalfa das plaquetas (alfaMbeta2-GP Ibalfa) em modelo experimental de lesão vascular. MÉTODO: Um peptídeo denominado M2 ou anticorpo anti-M2 foi desenvolvido para bloquear a interação da integrina Mac-1 dos leucócitos com a GP Ibalfa das plaquetas, visando, deste modo, inibir a adesão de leucócitos na superfície do vaso coberta por plaquetas, a proliferação celular e a hiperplasia neointimal. Este peptídeo foi injetado e comparado com anticorpo-controle em camundongos C57B1/6J submetidos à lesão vascular da artéria femoral com corda-guia. Um dia (controle: n= 6; anti-M2: n= 6), 5 dias (controle: n= 9; anti-M2: n= 9) ou 28 dias (controle: n= 9; anti-M2: n= 9) após a lesão vascular, as artérias femorais foram retiradas para a realização de morfometria e imunohistoquímica. RESULTADOS: O bloqueio da interação alfaMbeta2-GP Ibalfa promoveu redução estatisticamente significativa de 75% do número de leucócitos na camada média no primeiro dia após a lesão vascular...

INTRODUCTION: The interaction between leukocytes and platelets is fundamental for the beginning and the progression of restenosis and atherosclerosis. Recent in vitro studies have shown that the leukocyte integrin Mac-1 binds to the platelet glycoprotein (GP) Ibalfa, and this interaction plays a central role in the leukocyte firm adhesion and transmigration at sites of platelet deposition. However, there is no in vivo study evaluating the importance of the integrin Mac-1 and GP Ibalfa (alfaMbeta2-GP Ibalfa) interaction in experimental models of vascular injury. METHODS: A peptide termed M2 or anti-M2 antibody was developed to block the leukocyte Mac-1 and platelet GP Ibalfa interaction, aiming to inhibit the adhesion of leukocytes to the platelet-coated surface of vessels as well as the cellular proliferation and the neointimal hyperplasia. The peptide was injected and compared with a control-antibody in C57B1/6J mice subjected to wire-induced femoral artery injury. One day (control: n= 6; anti-M2: n= 6), 5 days (control: n= 9; anti-M2: n= 9) or 28 days (control: n= 9; anti-M2: n= 9) after vascular injury, the femoral arteries were harvested for morphometry and immunohistochemistry. RESULTS: The alfaMbeta2-GP Ibalfa interaction blockade promoted a statistically significant 75% reduction in leukocytes in the medial layer on the first day after vascular injury (control: 7.9 ± 5.0% out of the total cells in the medial layer versus anti-M2: 2.0 ± 1.6%; p=0.021), as well as determined a statistically significant 42% decrease 5 days later (control: 42.3 ± 12.9% out of the total cells in the neointima versus anti-M2: 24.6 ± 10.8%; p=0.047), and a 58% decrease in leukocyte accumulation in the developing neointima 28 days later (control: 7.9 ± 3.0% versus anti-M2: 3.3 ± 1.3%; p=0.012). The cellular proliferation in the vessel medial layer 5 days after vascular injury presented a statistically significant 64% reduction by the alfaMbeta2-GP Ibalfa interaction blockade...

Estudo comparativo do uso do diltiazem como droga antiespástica em cinecoronariografia por via transradial / Comparative study of the use of diltiazem as an antispasmodic drug in coronary angiography via the transradial approach

OBJECTIVE: To evaluate the impact of the use, prior to the procedure, of injectable diltiazem to prevent complications. METHODS: Between September 2000 and July 2001, 50 patients underwent transradial coronary angiography and were randomized to receive placebo (GI) or diltiazem (GII) through a catheter inserted into the radial artery. All patients received isosorbide mononitrate. Ultrasound analyses of the radial artery were performed before examination, 30 minutes afterwards, and 7 days afterwards to evaluate the flow, the diameter, and the artery output. RESULTS: The radial artery diameter of GI was 2.4± 0.5 mm before the procedure and 2.3±0.5 mm after 30 minutes (NS), whereas in GII the diameter was 2.2±0.3 mm before the examination and 2.5±0.4 mm 30 minutes after it (P<0.001). Radial artery output in group 1 was 7.3±5.l2 mL/min before the examination and 6.1±3.5 mL/min 30 minutes after the examination (NS), and GII had an increase of 5.9±2.5 mL/min before examination to 9.05± 7.78 mL/min after the examination (P=0.04). Complications (spasm, occlusion, and partial obstruction) occurred in 4 patients (17.4 percent) in GI and did not occur in GII (P=0.04). CONCLUSION: The study suggests a decrease in vascular complications through the transradial access for coronary angiography with the use of diltiazem as an antispasmodic drug, resulting in the significant increase in the diameter of the radial artery and radial artery output