SLC26A4-AS1 Agrava a Hipertrofia Cardíaca Induzida por AngII Aumentando a Expressão de SLC26A4 / SLC26A4-AS1 Aggravates AngII-induced Cardiac Hypertrophy by Enhancing SLC26A4 Expression

Resumo Fundamento Foi relatado que o RNA 1 antisenso 1 (SLC26A4-AS1) do membro 4 da família de transportadores de soluto 26 está altamente relacionado à hipertrofia cardíaca. Objetivo Esta pesquisa visa investigar o papel e o mecanismo específicos de SLC26A4-AS1 na hipertrofia cardíaca, fornecendo um novo marcador para o tratamento da hipertrofia cardíaca. Métodos Angiotensina II (AngII) foi infundida em cardiomiócitos ventriculares (NMVCs) de camundongos neonatos para induzir hipertrofia cardíaca. A expressão gênica foi detectada por PCR quantitativo em tempo real (RT-qPCR). Os níveis de proteína foram avaliados por western blot. Ensaios funcionais analisaram o papel de SLC26A4-AS1. O mecanismo de SLC26A4-AS1 foi avaliado por imunoprecipitação de proteína de ligação a RNA (RIP), pull-down de RNA e ensaios de luciferase repórter. O valor de p < 0,05 foi identificado como significância estatística. O teste t de Student avaliou a comparação dos dois grupos. A diferença entre os diferentes grupos foi analisada por análise de variância (ANOVA) de uma via. Resultados SLC26A4-AS1 é regulado para cima em NMVCs tratados com AngII e promove hipertrofia cardíaca induzida por AngII. SLC26A4-AS1 regula o membro 4 da família de transportadores de soluto 26 (SLC26A4) por meio do funcionamento como um RNA endógeno competitivo (ceRNA) para modular o microRNA (miR)-301a-3p e o miR-301b-3p em NMVCs. SLC26A4-AS1 promove hipertrofia cardíaca induzida por AngII via regulação para cima de SLC26A4 ou absorção de miR-301a-3p/miR-301b-3p. Conclusão SLC26A4-AS1 agrava a hipertrofia cardíaca induzida por AngII via absorção de miR-301a-3p ou miR-301b-3p para aumentar a expressão de SLC26A4.

Abstract Background It has been reported that solute carrier family 26 members 4 antisense RNA 1 (SLC26A4-AS1) is highly related to cardiac hypertrophy. Objective This research aims to investigate the role and specific mechanism of SLC26A4-AS1 in cardiac hypertrophy, providing a novel marker for cardiac hypertrophy treatment. Methods Angiotensin II (AngII) was infused into neonatal mouse ventricular cardiomyocytes (NMVCs) to induce cardiac hypertrophy. Gene expression was detected by quantitative real-time PCR (RT-qPCR). Protein levels were evaluated via western blot. Functional assays analyzed the role of SLC26A4-AS1. The mechanism of SLC26A4-AS1 was assessed by RNA-binding protein immunoprecipitation (RIP), RNA pull-down, and luciferase reporter assays. The P value <0.05 was identified as statistical significance. Student's t-test evaluated the two-group comparison. The difference between different groups was analyzed by one-way analysis of variance (ANOVA). Results SLC26A4-AS1 is upregulated in AngII-treated NMVCs and promotes AngII-induced cardiac hypertrophy. SLC26A4-AS1 regulates its nearby gene solute carrier family 26 members 4 (SLC26A4) via functioning as a competing endogenous RNA (ceRNA) to modulate the microRNA (miR)-301a-3p and miR-301b-3p in NMVCs. SLC26A4-AS1 promotes AngII-induced cardiac hypertrophy via upregulating SLC26A4 or sponging miR-301a-3p/miR-301b-3p. Conclusion SLC26A4-AS1 aggravates AngII-induced cardiac hypertrophy via sponging miR-301a-3p or miR-301b-3p to enhance SLC26A4 expression.

Abernethy Malformation: Possible Diagnosis for Patients with Congenital Heart Disease and Persistent Cyanosis

ABSTRACT Clinical data: Infant, nine months of age, female, diagnosed with congenital heart disease, with signs of heart failure associated with cyanosis and difficulty in gaining weight. Chest radiography: Cardiomegaly with prevalence of pulmonary vascular network. Electrocardiogram: Ectopic atrial rhythm with right ventricular overload and left anterosuperior divisional block. Echocardiogram: Single atrium with absent interatrial septum, atrioventricular connection with a single valve and two orifices, with increased pulmonary pressure and high Qp/Qs. Computed tomography: Absence of portal vein and intrahepatic segment of the inferior vena cava. Infrahepatic portion continuing with the azygos system at the level of the thoracic cavity, presence of mesenteric-caval communication associated with signs suggestive of hepatic peribiliary fibrosis. Diagnosis: Abernethy malformation is a rare condition and represents an extrahepatic portosystemic shunt that develops between the mesenteric-portal vasculature and the systemic veins. It may be associated with cardiac malformations and advance with pulmonary hypertension and even the need for liver transplantation. Persistent cyanosis after corrective surgery led to a deeper investigation and correct diagnosis of this malformation. Operation: Sternotomy with 68 minutes of cardiopulmonary bypass and nine minutes of total circulatory arrest. In the postoperative period, persistence of cyanosis was evident, even though there were no immediate complications. Patient was discharged on the 10th postoperative day. An abdominal computed tomography angiography confirmed the diagnosis of Abernethy type I malformation, and the patient was transferred for liver transplantation after congenital heart disease treatment.

Insuficiência Cardíaca com Fração de Ejeção Ventricular Esquerda Supranormal - Estado da Arte / Heart Failure with Supra-normal Left Ventricular Ejection Fraction - State of the Art

Resumo Em 2019, um artigo publicado no European Heart Journal reconheceu pela primeira vez a insuficiência cardíaca (IC) com fração de ejeção do ventrículo esquerdo (FEVE) ≥ 65% como um novo fenótipo de IC, ou a insuficiência cardíaca com fração de ejeção supranormal (ICFEsn), com o objetivo principal de promover a investigação desta nova categoria. Eles analisaram a mortalidade em pessoas com IC e descobriram que havia uma relação em forma de U entre a mortalidade e a FEVE. Sendo assim, os pacientes com ICFEsn tinham uma mortalidade geral mais alta em comparação com outros pacientes diagnosticados com IC com fração de ejeção preservada (ICFEp). Este artigo descreve a situação atual da ICFEsn e discute as perspectivas futuras com base nos resultados preliminares de nosso grupo. Para melhor tratar os pacientes com ICFEsn, é fundamental que cardiologistas e médicos entendam as diferenças e semelhanças desse novo fenótipo.

Abstract In 2019, an article published in the European Heart Journal recognized for the first time heart failure (HF) with left ventricular ejection fraction (LVEF)≥ 65% as a new HF phenotype, heart failure with supra-normal left ventricular ejection fraction (HFsnEF), with the main purpose of promoting research on this new category. They analyzed mortality in people with HF and found that there was a u-shaped relationship between mortality and LVEF. Accordingly, HFsnEF patients had a higher all-cause mortality compared with other patients diagnosed with HF with preserved ejection fraction (HFpEF). This article describes the current situation of HFsnEF and discusses future perspectives based on the preliminary results of our group. To better treat patients with HFsnEF, it is fundamental that cardiologists and physicians understand the differences and similarities of this new phenotype.

Agenesia Pericárdica Completa. Presentación de una caso y revisión de la literatura / Complete pericardial agenesis. Presentation of a case and review of the literature

Resumen Paciente masculino de 18 años, quien es valorado en el Servicio de Cardiología del Hospital Víctor Manuel Sanabria Martínez referido del primer nivel de atención por cuadro crónico de dolor torácico atípico acompañado de pectus excavatum y desplazamiento izquierdo del latido de punta a la exploración física. La radiografía de tórax posteroanterior evidencia una cardiomegalia moderada con levocardia máxima. El ecocardiograma transtorácico con función sistólica biventricular conservada, dilatación moderada del ventrículo derecho, sin signos de hipertensión pulmonar e imagen cardiaca de "corazón en lágrima". Angiotomografía computarizada de tórax con contraste que documenta malformación de la caja torácica con hundimiento de la región esternal, en relación con pectus excavatum. Corazón aumentado de tamaño en relación con cardiomegalia grado I y desplazamiento hacia el hemitórax izquierdo. No se observa pericardio en ninguna región. Aurícula derecha levemente dilatada con un ventrículo derecho con diámetro aumentado en su porción media y deformidad de su tracto de salida debido a la forma de la caja torácica, de tal manera que se corrobora el diagnóstico de una agenesia pericárdica completa.

Abstract An 18-year-old male patient who is evaluated in the Cardiology Department of the Víctor Manuel Sanabria Martínez Hospital, referred to the first level of attention due to chronic symptoms of atypical chest pain accompanied by pectus excavatum and left displacement of the peak beat. Chest X-ray Posteroanterior with moderate cardiomegaly with maximum levocardia. Transthoracic echocardiogram with preserved biventricular systolic function, moderate dilatation of the right ventricle, without signs of pulmonary hypertension and cardiac image of "tear heart". Thoracic Computed Angiotomography with contrast documenting malformation of the rib cage with sinking of the external region, in relation to pectus excavatum. Heart enlarged in relation to grade I cardiomegaly and displacement towards the left hemithorax. No pericardium is observed in any region. Slightly dilated right atrium with a right ventricle with an increased diameter in its middle portion and deformity of its outflow tract due to the shape of the rib cage. Corroborating the diagnosis of complete pericardial agenesis.

Diferencias de sexo entre deportistas de ultramaratón preesfuerzo y posesfuerzo / Sex differences between pre and post effort ultra marathon athletes

RESUMEN Introducción: La presencia de mujeres en las competencias de ultramaratón se observa cada vez con más frecuencia. Las adaptaciones fisiológicas y la respuesta al máximo esfuerzo se diferencian influenciados por el sexo. Objetivos: Evaluar las diferencias observadas en los deportistas de ultramaratón o ultratrail (carreras de montaña de más de 42 km) en reposo (adaptaciones fisiológicas) y en el posesfuerzo (fatiga cardíaca inducida por el ejercicio [FCIE]), estratificado por parámetros de entrenamiento. Material y métodos: Se reclutaron veinticinco deportistas (mujeres n 6) que participaron de la carrera cruce Mendoza (55 km en montaña); fueron evaluados antes y después de la finalización de la carrera mediante ecocardiografía Doppler y técnicas de deformación miocárdica (posprocesamiento). Mediante relojes deportivos se documentaron parámetros durante el entrenamiento y la carrera. Se realizó extracción de sangre posesfuerzo inmediato para documentar variables asociadas con fatiga cardíaca. Resultados: Completaron la carrera 24 deportistas, 19 hombres (42 ± 12 años) y 5 mujeres (38 ± 4 años). Las mujeres presentaban parámetros similares de entrenamiento y completaron la prueba sin diferencia en tiempos respecto a los hombres. Se observó disminución de los parámetros de función miocárdica izquierda (fatiga cardíaca inducida por el ejercicio) en el 50% de los hombres y el 5% de las mujeres. Conclusiones: A pesar de no encontrar diferencias en las características del entrenamiento, se observó en las mujeres menos adaptación fisiológica basal y menor incidencia de fatiga cardíaca inducida por el ejercicio.

ABSTRACT Introduction: the presence of women in ultramarathon competitions is observed with increasing frequency. Physiological adaptations and response to maximum effort are differentiated influenced by sex. Objectives: to evaluate the differences observed in ultramarathon or ultratrail athletes (mountain races over 42 km) at rest (physiological adaptations) and at post-effort (exercise-induced cardiac fatigue-FCIE), stratified by training parameters. Material and methods: twenty-five athletes (women n 6) who participated in the Mendoza crossing race (55 km in the mountains) were recruited, being evaluated before and after the end of the race using Doppler echocardiography and myocardial deformation techniques (post-processing). Through sports watches, parameters during training and running are documented. Immediate post-effort blood collection was performed to document variables associated with cardiac fatigue. Results: 24 athletes completed the race, 19 men (42 ± 12 years) and 5 women (38 ± 4 years). The women presented similar training loads and completed the test with no difference in time compared to the men. Decreased left myocardial function parameters (exercise-induced cardiac fatigue) were observed in 50% of men and 5% of women. Conclusions: Despite not finding differences in training characteristics, less baseline physiological adaptation and a lower incidence of exercise-induced cardiac fatigue were observed in women.

Correlação entre Cardiomegalia pela Radiografia de Tórax e Diâmetro do Ventrículo Esquerdo pela Ecocardiografia em Pacientes com Doença de Chagas / Correlation between Cardiomegaly on Chest X-Ray and Left Ventricular Diameter on Echocardiography in Patients with Chagas Disease

Resumo Fundamento Cardiomegalia pela radiografia de tórax (RXT) é preditor independente de morte em indivíduos com cardiomiopatia crônica da doença de Chagas (CCDC). Contudo, a correlação entre o aumento do índice cardiotorácico (ICT) na RXT e do diâmetro telediastólico do ventrículo esquerdo (DDVE) pela ecocardiografia (ECO) nessa população não está bem definida. Objetivos Analisar a relação entre cardiomegalia pela RXT e DDVE pela ECO em pacientes com doença de Chagas (DC) e sua aplicabilidade ao escore de Rassi. Métodos Estudo retrospectivo incluiu 63 pacientes ambulatoriais com DC avaliados por RXT e ECO. Cardiomegalia na RXT foi definida como ICT > 0,5. DDVE foi avaliado como variável contínua. Curva ROC foi utilizada para avaliar o potencial do DDVE para identificação de cardiomegalia pela RXT, com ponto de corte definido pela maior somatória de sensibilidade e especificidade. Resultados Idade mediana = 61 anos [intervalo interquartil: 48-68], 56% mulheres. CCDC foi identificada em 58 pacientes; 5 tinham a forma indeterminada da DC. Cardiomegalia foi detectada em 28 indivíduos. A área sob a curva ROC do DDVE para identificação de cardiomegalia foi de 0,806 (IC 95%: 0,692-0,919). O ponto de corte ótimo para DDVE foi de 60 mm (sensibilidade = 64%, especificidade = 89%). O uso do DDVE pela ECO em substituição ao ICT pela RXT alterou o escore de Rassi em 14 pacientes, e em 10 deles houve redução do risco presumido. Conclusão DDVE pela ECO é parâmetro adequado e com alta especificidade para distinguir entre presença e ausência de cardiomegalia na RXT na DC. (Arq Bras Cardiol. 2021; 116(1):68-74)

Abstract Background Cardiomegaly on chest X-ray is an independent predictor of death in individuals with chronic Chagas cardiomyopathy (CCC). However, the correlation between increased cardiothoracic ratio (CTR) on chest X-ray and left ventricular end-diastolic diameter (LVEDD) on echocardiography is not well established in this population. Objectives To assess the relationship between chest X-ray and LVEDD on echocardiography in patients with Chagas disease and its applicability to the Rassi score. Methods Retrospective study on 63 Chagas disease outpatients who underwent chest X-ray and echocardiography. Cardiomegaly on chest X-ray was defined as a CTR>0.5. LVEDD was analyzed as a continuous variable. ROC curve was used to evaluate the ability of LVEDD in detecting cardiomegaly by chest X-ray, with a cut-off point defined by the highest sum of sensitivity and specificity. Results Median age 61 years [interquartile range 48-68], 56% were women. CCC was detected in 58 patients, five patients had the indeterminate form of Chagas disease. Cardiomegaly was detected in 28 patients. The area under the ROC curve for LVEDD was 0.806 (95%CI: 0.692-0.919). The optimal cut-off for LVEDD was 60 mm (sensitivity = 64%, specificity = 89%). The use of LVEDD on echocardiography as a surrogate for CTR on chest X-ray changed the Rassi score values of 14 patients, with a reduction in the presumed risk in 10 of them. Conclusion LVEDD on echocardiography is an appropriate, highly specific parameter to distinguish between the presence and absence of cardiomegaly on chest X-ray in Chagas disease. (Arq Bras Cardiol. 2021; 116(1):68-74)

Determination of the value of vertebral heart size regarding the weight and body area in canines / Determinação dos valores do vertebral heart size em relação ao peso e área corporal canina

The vertebral heart size is a method used to measure the cardiac dimension in order to identify the remodeling of the chambres in heart disease. This study aims to determinate the vertebral heart size values at right lateral and ventrodorsal radiographs views relating to canines weight and body area variations. For the purpose of the study 40 healthy dogs within the age of 1 to 6 years, males and females, with deep or intermediated thorax were selected, brachycephalic dogs were not included in the study; the dogs were separated in four groups: group 1(n=9) compound of dogs up to 5 kg; group 2 (n=8) with dogs from 5,1 to 10 kg; group 3 (n=12) with dogs from 10,1 to19 kg and group 4 (n=11) with dogs weighing more than 19,1 kg. The values of body score, body mass index and the thorax configuration where previously measured, as well as the vertebral heart size and the depth width ratio from the radiographs. The results demonstrated intervals of right lateral-lateral vertebral heart size 9.9 to 10.4v and ventro-dorsal vertebral heart size of 9.8-10.3v. The study results show that the vertebral heart size numbers did not correlate with weight or body area, regardless the type of radiography view. Therefore, it can be concluded that the vertebral heart size in right lateral and ventrodorsal radiography can be used to rate the cardiac area, not suffering influence by the dog's weight or body area.

O vertebral heart size é um método utilizado para mensurar a dimensão cardíaca visando identificar os remodelamentos das câmaras nas cardiopatias. O objetivo do estudo foi determinar os valores de vertebral heart size nas projeções radiográficas latero-lateral direita e ventro-dorsal conforme as variações do peso e área corporal. Para isso, foram selecionados 40 cães hígidos com idade entre 1 e 6 anos, machos e fêmeas, com padrão torácico intermediário e profundo, com exclusão dos braquicefálicos; os cães foram divididos em quatro grupos: grupo 1 (n=9) composto por cães de até 5 kg; grupo 2 (n=8) com cães de 5,1 a 10 kg; grupo 3 (n=12) com cães de 10,1 a 19 kg e grupo 4 (n=11) com cães acima de 19,1 kg. Os valores de escore corporal, índice de massa corporal e conformação torácica foram previamente mensurados, bem como os valores dos vertebral heart size a relação profundidade/largura torácica das radiografias. Os resultados demonstraram intervalos de vertebral heart size latero-lateral 9.9 a 10.4v e vertebral heart size ventro dorsal de 9.8-10.3v. Os valores não apresentaram correlação com o peso e área corporal nos grupos estudados, independente das projeções estudas. Assim, pode-se concluir que método vertebral heart size nas projeções estudadas é aplicável na avaliação da área cardíaca, não sofrendo influências do peso e área corporal canina.

Determination of the value of vertebral heart size regarding the weight and body area in canines / Determinação dos valores do vertebral heart size em relação ao peso e área corporal canina

The vertebral heart size is a method used to measure the cardiac dimension in order to identify the remodeling of the chambres in heart disease. This study aims to determinate the vertebral heart size values at right lateral and ventrodorsal radiographs views relating to canines weight and body area variations. For the purpose of the study 40 healthy dogs within the age of 1 to 6 years, males and females, with deep or intermediated thorax were selected, brachycephalic dogs were not included in the study; the dogs were separated in four groups: group 1(n=9) compound of dogs up to 5 kg; group 2 (n=8) with dogs from 5,1 to 10 kg; group 3 (n=12) with dogs from 10,1 to19 kg and group 4 (n=11) with dogs weighing more than 19,1 kg. The values of body score, body mass index and the thorax configuration where previously measured, as well as the VHS and the depth width ratio from the radiographs. The results demonstrated intervals of right lateral-lateral vertebral heart size 9.9 to 10.4v and ventro-dorsal vertebral heart size of 9.8-10.3v. The study results show that the vertebral heart size numbers did not correlate with weight or body area, regardless the type of radiography view. Therefore, it can be concluded that the vertebral heart size in right lateral and ventrodorsal radiography can be used to rate the cardiac area, not suffering influence by the dog's weight or body area.

O vertebral heart size é um método utilizado para mensurar a dimensão cardíaca visando identificar os remodelamentos das câmaras nas cardiopatias. O objetivo do estudo foi determinar os valores de vertebral heart size nas projeções radiográficas latero-lateral direita e ventro-dorsal conforme as variações do peso e área corporal. Para isso, foram selecionados 40 cães hígidos com idade entre 1 e 6 anos, machos e fêmeas, com padrão torácico intermediário e profundo, com exclusão dos braquicefálicos; os cães foram divididos em quatro grupos: grupo 1 (n=9) composto por cães de até 5 kg; grupo 2 (n=8) com cães de 5,1 a 10 kg; grupo 3 (n=12) com cães de 10,1 a 19 kg e grupo 4 (n=11) com cães acima de 19,1 kg. Os valores de escore corporal, índice de massa corporal e conformação torácica foram previamente mensurados, bem como os valores dos vertebral heart size a relação profundidade/largura torácica das radiografias. Os resultados demonstraram intervalos de vertebral heart size latero-lateral 9.9 a 10.4v e vertebral heart size ventro dorsal de 9.8-10.3v. Os valores não apresentaram correlação com o peso e área corporal nos grupos estudados, independente das projeções estudas. Assim, pode-se concluir que método vertebral heart size nas projeções estudadas é aplicável na avaliação da área cardíaca, não sofrendo influências do peso e área corporal canina.

The Rare Congenital Anomaly of Scimitar Syndrome: An Unusual Presentation in Symptomatic Adult

@#Scimitar syndrome is a rare congenital heart defect occurring in 1 to 3 per 100,000 live births. This is a case of a 26 years old lady presenting with episodic fainting spells since the age of 18 years old. She was initially diagnosed with epilepsy until a referral to our centre found a soft splitting of the second heart sound and multiple premature ventricular complexes on ECG. The computed tomography of the pulmonary artery confirmed the diagnosis if Scimitar syndrome in the presence of anomalous single right pulmonary vein draining into infra-diaphragmatic systemic venous circulation. A corrective open-heart surgery to re-implant the pulmonary vein was performed with excellent clinical outcomes. Therefore, it is crucial for clinicians to embody high index of suspicion of congenital anomaly even in adults presenting with indefinite clinical symptoms. This report also represents the first published case of adult Scimitar syndrome from Malaysia.

Correlação entre os achados radiográficos e ecocardiográficos sugestivos de aumento cardíaco em cães: 104 casos / Correlation between radiographic and ecocardiographic findings suggestive of cardiomegaly in 104 dogs

Radiografias torácicas e ecocardiogramas de 104 caninos foram avaliados e correlacionados quanto ao aumento das câmaras cardíacas. Os achados radiográficos foram correlacionados estatisticamente a fim de se estabelecer a acurácia do exame radiográfico na detecção do aumento cardíaco em comparação ao ecocardiográfico - padrão-ouro não invasivo. A correlação entre os achados radiográficos indicativos de aumento cardíaco e os índices ecocardiográficos mostrou-se fraca, significativa somente para VHS versus relação átrio esquerdo/aorta (r=0,3136), eixo curto versus relação átrio esquerdo/aorta (r=0,3813) e eixo curto versus velocidade da onda E (r=0,2021). A acurácia da radiografia na determinação subjetiva de aumento das câmaras cardíacas foi razoável, variando entre 72,1% e 80,8%. Em contrapartida, o VHS apresentou baixa acurácia (50,9%) na detecção de cardiomegalia.(AU)

Thoracic radiographs and echocardiograms of 104 canines were evaluated and correlated regarding cardiac chambers enlargement. The radiographic findings were statistically correlated in order to establish the accuracy of the radiographic examination in the detection of cardiac enlargement in comparison with the echocardiogram - non-invasive gold standard. The correlation between the radiographic findings indicative of cardiac enlargement and echocardiographic indexes was weak, significant only for VHS versus left atrium to aorta ratio (r= 0.3136), short axis versus left atrium to aorta ratio (r= 0, 3813) and short axis versus E wave velocity (r= 0.2021). The radiographic accuracy in the subjective determination of cardiac chamber enlargement was reasonable, ranging from 72.1% to 80.8%. On the other hand, VHS presented low accuracy (50.9%) in the detection of cardiomegaly.(AU)

Serum Sirtuin 1, 3 and 6 Levels in Acute Myocardial Infarction Patients / Níveis de Sirtuína 1, 3 e 6 em Pacientes com Infarto Agudo do Miocárdio

Abstract Background: Sirtuins may act in many cellular processes like apoptosis, DNA repair and lipid/glucose metabolism. Experimental studies suggested some sirtuin types may have protective effects against endothelial dysfunction, atherosclerosis, cardiac hypertrophy and reperfusion injury. Data about sirtuins in acute myocardial infarction (AMI) patients are scarce. Objectives: To investigate temporal changes of serum sirtuin 1,3 and 6 levels in AMI patients; to compare the serum sirtuin 1,3 and 6 levels between AMI patients and control subjects; and to investigate the association of serum sirtuin 1,3 and 6 levels with prognostic markers of AMI. Methods: Forty patients with AMI and 40 patients with normal coronary arteries were included. Left ventricular ejection fraction (LVEF), serum proBNP, CRP, sirtuin1, sirtuin 3 and sirtuin 6 levels were processed. Peak troponin T levels, GRACE score, first day / second day sirtuin levels were recorded of AMI patients. A p value < 0.05 was considered statistically significant. Results: Serum sirtuin 1,3 and 6 levels in AMI patients were similar to those in normal coronary patients. No temporal change in serum sirtuin 1,3 and 6 levels were found in AMI course. No correlation was evident between the sirtuin levels and the following parameters: proBNP, CRP, peak troponin and LVEF. Baseline sirtuin 1 and 6 levels were positively correlated with reperfusion duration. Baseline sirtuin 3 levels were negatively correlated with GRACE score. Conclusion: Serum sirtuin 1,3 and 6 levels in AMI patients were similar to those in normal coronary patients. This study does not represent evidence of the possible protective effects of sirtuin1, 3 and 6 in AMI patients.

Resumo Fundamento: As sirtuínas podem atuar em muitos processos celulares, como a apoptose, reparo de DNA e metabolismo de lipídios e de glicose. Estudos experimentais sugeriram que alguns tipos de sirtuínas possam ter efeitos protetores contra disfunção endotelial, aterosclerose, hipertrofia cardíaca e lesão decorrente de reperfusão. Dados sobre as sirtuínas em pacientes com infarto agudo do miocárdio (IAM) são escassos. Objetivos: Avaliar as mudanças temporais dos níveis de sirtuína 1, 3 e 6 entre pacientes com IAM e indivíduos controles; investigar a associação entre os níveis de sirtuína 1, 3 e 6 e marcadores prognósticos de IAM. Métodos: Quarenta pacientes com IAM e 40 pacientes com artérias coronárias normais foram incluídos. Foram avaliados fração de ejeção do ventrículo esquerdo (FEVE), concentrações séricas de pró-BNP, proteína C-reativa, sirtuína 1, sirtuína 3 e de sirtuína 6. Pico de troponina T, escore GRACE, concentrações de sirtuínas no primeiro e no segundo dia foram registrados dos pacientes com IAM. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados: Os níveis de sirtuína 1, 3 e 6 em pacientes com IAM foram similares aos de pacientes com coronária normal. Não foram observadas mudanças temporais nos níveis de sirtuína 1, 3 e 6 no curso do IAM. Nenhuma correlação evidente foi observada dos níveis de sirtuína com os seguintes parâmetros: pró-BNP, proteína C-reativa, pico de troponina e FEVE. Níveis basais de sirtuína 1 e 6 apresentaram correlação positiva com a duração da reperfusão. Os níveis basais de sirtuína 3 correlacionaram-se negativamente com o escore GRACE. Conclusão: Os níveis de sirtuína 1, 3 e 6 em pacientes com IAM foram similares aos de pacientes com artérias coronárias normais. Este estudo não apresenta evidência de possíveis efeitos protetores da sirtuína 1, 3 e 6 em pacientes com IAM.

Most common cause of cardiomegaly without significant murmur in pediatric age group at tertiary care hospital, Hyderabad, India: a prospective observational study

Background: Following the invention of monaural stethoscope by Laennec and X ray by Roentgen in 18th century there was spectacular advancements in cardiology. The myocardium can be affected by various disease process unrelated to abnormal pressure or volume loads. These processes may be inflammatory, metabolic, infiltrative, ischemic or primary with significant overlap. These diseases usually present as cardiomegaly. In pediatric age group cardiac diseases will present early, sometimes without any signs and symptoms like sudden death due to less cardiac reserve. Few cases of sudden death also showed huge cardiomegaly in postmortem X rays. authors want to carry out this study to find out most common cause of cardiomegaly with silent chest as authors usually miss the diagnosis and these cases may present as sudden death without giving much time to intervene. The aim of the study is to know the most common cause of cardiomegaly without significant murmur in pediatric age group above one year.Methods: Prospective observational study done at a tertiary care hospital Hyderabad over a period of one year from January 2018 to January2019.Results: Most common cause of cardiomegaly without significant murmur was cardiac beriberi. It is mostly prevalent in rural areas of Telangana, mostly occurring in breastfed babies and below six years. All cases were recovered after proper treatment. Fortunately, it is associated with nil mortality, if timely treatment was initiated.Conclusions: Cardiac beriberi which is easily preventable and if treated in proper time it will associated with nil mortality. As it was occurring commonly breastfed babies supplementation of Thiamine to mothers was very useful as a preventive strategy.

The Effects of Trimetazidine on QT-interval Prolongation and Cardiac Hypertrophy in Diabetic Rats / Os Efeitos da Trimetazidina no Prolongamento do Intervalo QT e na Hipertrofia Cardíaca em Ratos Diabéticos

Abstract Background: Trimetazidine (TMZ) is an anti-ischemic drug. In spite of its protective effects on cardiovascular system, there is no scientific study on the usefulness of TMZ treatment for prolonged QT interval and cardiac hypertrophy induced by diabetes. Objectives: To evaluate the effects of TMZ on QT interval prolongation and cardiac hypertrophy in the diabetic rats. Methods: Twenty-four male Sprague-Dawley rats (200-250 g) were randomly assigned into three groups (n = 8) by simple random sampling method. Control (C), diabetic (D), and diabetic administrated with TMZ at 10 mg/kg (T10). TMZ was administrated for 8 weeks. The echocardiogram was recorded before isolating the hearts and transfer to a Langendorff apparatus. Hemodynamic parameters, QT and corrected QT interval (QTc) intervals, heart rate and antioxidant enzymes were measured. The hypertrophy index was calculated. The results were evaluated by one-way ANOVA and paired t-test using SPSS (version 16) and p < 0.05 was regarded as significant. Results: The diabetic rats significantly indicated increased hypertrophy, QT and QTc intervals and decreased Left ventricular systolic pressure (LVSP), Left ventricular developed pressure (LVDP), rate pressure product (RPP), Max dp/dt, and min dp/dt (±dp/dt max), heart rate, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase in the heart. Treatment with TMZ in the diabetic animals was significantly improved these parameters in comparison to the untreated diabetic group. Conclusions: TMZ improves QTc interval prolongation and cardiac hypertrophy in diabetes.

Resumo Fundamento: A trimetazidina (TMZ) é uma droga anti-isquêmica. Apesar de seus efeitos protetores sobre o sistema cardiovascular, não há estudos científicos sobre a utilidade do tratamento com TMZ para o intervalo QT prolongado e a hipertrofia cardíaca induzida pelo diabetes. Objetivo: Avaliar os efeitos da TMZ no prolongamento do intervalo QT e na hipertrofia cardíaca em ratos diabéticos. Métodos: Vinte e quatro ratos machos Sprague-Dawley (200-250 g) foram distribuídos aleatoriamente em três grupos (n = 8) pelo método de amostragem aleatória simples. Controle (C), diabético (D) e diabético administrado com TMZ a 10 mg/kg (T10). A TMZ foi administrada por 8 semanas. O ecocardiograma foi registrado antes de isolar os corações e transferir para um aparelho de Langendorff. Foram medidos os parâmetros hemodinâmicos, intervalo QT e intervalo QT corrigido (QTc), frequência cardíaca e enzimas antioxidantes. O índice de hipertrofia foi calculado. Os resultados foram avaliados pelo one-way ANOVA e pelo teste t pareado pelo SPSS (versão 16) e p < 0,05 foi considerado significativo. Resultados: Os ratos diabéticos indicaram hipertrofia aumentada, intervalos QT e QTc e diminuição da pressão sistólica no ventrículo esquerdo (PSVE), pressão desenvolvida no ventrículo esquerdo (PDVE), duplo produto (DP), Max dp/dt e min dp/dt (± dp/dt max), frequência cardíaca, superóxido dismutase (SOD), glutationa peroxidase (GPx) e catalase no coração. O tratamento com TMZ nos animais diabéticos melhorou significativamente esses parâmetros em comparação com o grupo diabético não tratado. Conclusões: A TMZ melhora o prolongamento do intervalo QTc e a hipertrofia cardíaca no diabetes.

Hypotensive response to continuous aerobic and high-intensity interval exercise matched by volume in sedentary subjects / Resposta hipotensiva ao exercício aeróbio contínuo e intervalado de alta intensidade pareados por volume em indivíduos sedentários

Background: Systemic arterial hypertension (SAH) is one of the main risk factors for heart disease. Among the benefits linked to different modalities of physical exercise, post-exercise hypotension (PEH) is a key point for exercise prescription in this condition. Objective: To investigate and compare PEH in response to continuous aerobic exercise (CONT) and high-intensity interval exercise (HIIE), matched by volume, in sedentary individuals. Methods: A randomized cross-over study, composed of sedentary, healthy male subjects submitted to two acute physical exercise protocols matched by volume, HIIE and CONT, on a treadmill. Hemodynamic measures for the evaluation of PEH were performed pre, immediately after exercise and every five minutes thereafter, during one hour of recovery. Two-way ANOVA with repeated measurements was used for comparisons between groups and Bonferroni post hoc test as appropriate. P < 0.05 was considered significant. Results: Both exercise protocols promoted significant PEH, with reductions in systolic blood pressure (SBP) and mean arterial pressure (MAP). HIIE promoted a reduction of SBP and MAP at the 15th minute, whereas the same effect was observed at the 30th following CONT. Conclusion: Both HIIE and CONT, matched by volume, promote PEH of similar magnitude. However, PEH occurs earlier following HIIE, suggesting a better time /effectiveness ratio, and an additional beneficial effect of this modality