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1.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1410068

ABSTRACT

RESUMEN Introducción: la hipertensión arterial constituye el principal factor de riesgo para el desarrollo de enfermedades cardiovasculares. Su detección en adultos jóvenes obliga a buscar una causa secundaria y potencialmente corregible. Objetivo: determinar las características clínicas de la hipertensión arterial en adultos menores de 30 años de edad que acuden al Hospital Nacional, Itauguá, Paraguay, en el periodo 2019-2021. Sujetos y métodos: estudio descriptivo observacional retrospectivo de corte transversal donde se incluyó 50 pacientes entre 18 y 30 años de edad con hipertensión arterial. La investigación fue aprobada por el Comité de Ética de la Universidad Nacional de Itapúa, Paraguay. Resultados: la edad media fue 23 ± 4 años, en su mayoría eran provenientes de la zona urbana, siendo 58% del sexo masculino y con un bajo nivel educativo. La media de índice de masa corporal fue 23,5 ± 5 k/m2 y 58% no tenía antecedente familiar de hipertensión arterial. La media de cifras de presión arterial fueron 150 mmHg para la sistólica y 100 mmHg para la diastólica. La hipertensión arterial secundaria se detectó en 86% de la muestra. La etiología más frecuente fue la enfermedad renal parenquimatosa (86%), de los cuales 89% padecía enfermedad renal crónica y nefritis lúpica. La frecuencia de daño de órgano blanco fue de 86%, el fondo de ojo era anormal en 8%, 46% tenía hipertrofia ventricular izquierda por electrocardiograma y 58% por ecocardiograma, 78% tenía alteración de la arquitectura normal renal por ecografía, 57% presentaba creatininemia elevada, 76% trazas de proteínas en orina tomada al azar y 80% proteinuria de 24 hs elevada. Conclusión: la forma prevalente de hipertensión arterial en los adultos jóvenes estudiados fue la secundaria, con leve predominio del sexo masculino, con normopeso y sin antecedente familiar. La principal causa fue la enfermedad renal parenquimatosa. Más de la mitad de los casos presentó hipertrofia ventricular izquierda y proteinuria elevada.


ABSTRACT Introduction: High blood pressure is the main risk factor for the development of cardiovascular diseases. Its detection in young adults makes necessary to look for a secondary and potentially correctable cause. Objective: To determine the clinical characteristics of arterial hypertension in adults under 30 years of age who attended the Hospital Nacional of Itauguá, Paraguay, in the period 2019-2021. Subjects and methods: Retrospective observational cross-sectional descriptive study which included 50 patients between 18 and 30 years of age with arterial hypertension. The research was approved by the Ethics Committee of the National University of Itapúa, Paraguay. Results: The mean age was 23±4 years, most patients were from urban areas, 58% was male and had a low educational level. The mean body mass index was 23.5±5 k/m2 and 58% had no family history of arterial hypertension. The mean blood pressure values were 150 mmHg for systolic and 100 mmHg for diastolic. Secondary arterial hypertension was detected in 86% of the sample. The most frequent etiology was parenchymal kidney disease (86%), of which 89% had chronic kidney disease and lupus nephritis. The frequency of target organ damage was 86%, the eye fundus was abnormal in 8%, 46% had left ventricular hypertrophy by electrocardiogram and 58% by echocardiogram, 78% had abnormal renal architecture by ultrasound, 57% had elevated creatininemia, 76% trace protein in randomly collected urine, and 80% elevated 24-hour proteinuria. Conclusion: The prevalent form of arterial hypertension in the young adults studied was secondary, with a slight predominance of males, with normal weight and without family history. The main cause was renal parenchymal disease. More than half of the cases presented left ventricular hypertrophy and high proteinuria.

2.
Rev. bras. hipertens ; 29(1): 6-9, 10 març. 2022. tab, ilus
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1367435

ABSTRACT

Fundamento: A Hipertensão Arterial Sistêmica (HAS) acomete mais de 35% da população brasileira e tende a trazer repercussões cardíacas, entre elas a hipertrofia ventricular esquerda (HVE). O eletrocardiograma (ECG) é um exame indicado na investigação de possíveis repercussões cardiológicas em pacientes hipertensos, podendo apresentar alterações sugestivas de HVE. Objetivo: Avaliar sinais da presença de HVE em indivíduos hipertensos através do ECG e comparar com achados de ecocardiograma transtorácico (ETT). Método: Estudo transversal retrospectivo. Foram revisados prontuários eletrônicos de 159 pacientes (65,2±9,8 anos) diagnosticados com HAS, com e sem HVE ao ETT. Os resultados dos exames ECG e ETT foram comparados para avaliar a sensibilidade e especificidade do ECG em relação ao ETT. Nesta análise, foram utilizados os critérios de Sokolow-Lyon e Cornell no ECG e a relação de massa indexada do ventrículo esquerdo (VE) e espessura relativa de parede ao ETT, para avaliação do padrão geométrico do VE (PGV). Resultados: Identificamos 128 pacientes hipertensos com HVE e 31 sem alterações geométricas. A sensibilidade e especificidade para identificar HVE ao ECG foram de 31% e 90%, respectivamente, quando considerado o critério de Sokolow-Lyon conjuntamente com o critério de Cornell. Conclusão: A melhor análise de HVE ao ECG deve considerar a associação dos critérios de Sokolow-Lyon e Cornell. Apesar de apresentar uma sensibilidade menor que o ETT, o ECG possui alta especificidade e continua sendo uma alternativa importante inicial para o diagnóstico de HVE em indivíduos hipertensos


Introduction: Hipertension is a condition that affects more than 35% of the brazilian population and can lead to cardiac repercussions such as left ventricle hypertrophy (LVH). The electrocardiogram (ECG) is used in the investigation of possible cardiac repercussions in hypertensive patients, as it may indicate alterations that suggest LVH. Objective: To evaluate signs of LVH in hypertensive patients through ECG and comparing with findings from transthoracic echocardiogram (TTE). Methods: Transversal retrospective study. One hundred fifty nine electronic medical records of hypertensive patients (65,2 ± 9,8 years), with and without LVH at the TTE, were selected. Results of the ECG and TTE were compared to assess the sensitivity and specificity of the ECG in relation to TTE. Sokolow-Lyon and Cornell criteria were applied on ECG and left ventricular mass index and relative wall thickness on TTE to assess left ventricular geometry. Results: We identified 128 hypertensive patients with abnormal left ventricular geometry and 31 hypertensive patients without geometric abnormalities. The sensitivity and specificity for LVH on ECG were 31% and 90%, respectively, when considering both the Sokolow-Lyon and the Cornell criteria. Conclusion: the best way to evaluate LVH on the ECG is by using both Sokolow-yon and Cornell criteria. Despite having a lower sensitivity than TTE, ECG has high specificity and continues to be an important initial alternative to be used in the assessment of LVH in hypertensive patients

3.
Arq. bras. cardiol ; 118(1): 77-87, jan. 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1360119

ABSTRACT

Resumo Fundamento A cardiomiopatia hipertrófica (CMH) e a hipertrofia ventricular esquerda (HVE) secundária à hipertensão arterial sistêmica (HAS) podem estar associadas a anormalidades funcionais do átrio esquerdo (AE). Objetivos Caracterizar a mecânica do AE na CMH e na HAS e avaliar qualquer correlação com a extensão da fibrose ventricular esquerda medida por ressonância magnética cardíaca (RMC) em pacientes com CMH. Métodos A função longitudinal do AE derivada do ecocardiograma bidimensional com speckle tracking foi adquirida a partir de cortes apicais de 60 pacientes com CMH e 34 indivíduos controles, pareados por idade. Pacientes com CMH também foram submetidos à RMC, com medida da extensão do realce tardio por gadolínio. A associação com parâmetros de strain do AE foi analisada. Valores p < 0,05 foram definidos como estatisticamente significativos. Resultados A média da fração de ejeção do ventrículo esquerdo não foi diferente entre os grupos. A razão E/e' estava comprometida no grupo CMH e preservada no grupo controle. A mecânica do AE estava significativamente reduzida na CMH em comparação aos pacientes com HAS. O strain rate do AE nas fases de reservatório (SRrAE) e na fase contrátil (SRctAE) foram os melhores parâmetros de discriminação de CMH com uma área sob a curva (AUC) de 0,8, seguido do strain do AE na fase de reservatório (SrAE) (AUC 0,76). O SRrAE e o SRctAE apresentaram elevada especificidade (89% e 91%, respectivamente), e o SrAE apresentou sensibilidade de 80%. Um decréscimo de 2,79% no strain rate do AE na fase de condução (SRcdAE) foi preditor de um aumento de 1 cm na extensão do RT pelo gadolínio (r2=0,42, β 2,79, p=0,027). Conclusões O SRrAE e o SRctAE foram os melhores fatores de discriminação de HVE secundária à CMH. O SRcdAE foi preditor do grau de fibrose ventricular esquerda avaliada por RMC. Esses achados sugerem que a mecânica do AE pode ser um potencial preditor de gravidade de doença na CMH.


Abstract Background Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. Objectives We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. Methods Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p<0.05. Results Mean LV ejection fraction was not different between the groups. The E/e' ratio was impaired in the HCM group and preserved in the control group. LA mechanics was significantly reduced in HCM, compared to the HTN group. LA strain rate in reservoir (LASRr) and in contractile (LASRct) phases were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in reservoir phase (LASr) (AUC 0.76). LASRr and LASR-ct had high specificity (89% and 91%, respectively) and LASr had sensitivity of 80%. A decrease in 2.79% of LA strain rate in conduit phase (LASRcd) predicted an increase of 1cm in LGE extension (r2=0.42, β 2.79, p=0.027). Conclusions LASRr and LASRct were the best discriminators for LVH secondary to HCM. LASRcd predicted the degree of LV fibrosis assessed by CMR. These findings suggest that LA mechanics is a potential predictor of disease severity in HCM.


Subject(s)
Humans , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/diagnostic imaging , Contrast Media , Fibrosis , Hypertrophy, Left Ventricular/complications , Hypertrophy, Left Ventricular/diagnostic imaging , Gadolinium
4.
Article in Chinese | WPRIM | ID: wpr-928065

ABSTRACT

This study was designed to assess the clinical efficacy of oral blood-activating and stasis-removing Chinese patent medicines in treating hypertensive left ventricular hypertrophy(LVH) based on network Meta-analysis. The clinical randomized controlled trials(RCTs) concerning the treatment of hypertensive LVH with oral blood-activating and stasis-removing Chinese patent medicines were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, and Cochrane Library from their inception to September 2021. Two researchers independently completed the literature screening, data extraction, and quality evaluation. The data were then analyzed by RevMan 5.3, Stata 15.1, and ADDIS 1.16.8. Finally, a total of 31 RCTs were included, involving 3 001 patients and four oral blood-activating and stasis-removing Chinese patent medicines. In terms of the alleviation of heart damage, the Chinese patent medicines combined with conventional western medicine groups were superior to the conventional western medicine groups in lo-wering the left ventricular mass index(LVMI). There was no significant difference in LVMI, left ventricular ejection fraction(LVEF), or the ratio of early diastolic peak flow velocity to late diastolic peak flow velocity(E/A) between different Chinese patent medicines combined with conventional western medicine groups. Xinnao Shutong Capsules/Tablets combined with conventional western medicine had the best efficacy in reducing LVMI and elevating LVEF, while Xinkeshu Capsules/Tablets combined with conventional western medicine had the best effect in improving E/A. In the control of blood pressure, when all Chinese patent medicines except for Xinnao Shutong Capsules/Tablets were combined with conventional western medicine, the resulting systolic blood pressure(SBP) and diastolic blood pressure(DBP) were significantly lower than those in the conventional western medicine group. Xinkeshu Capsules/Tablets combined with conventional western medicine produced the best effect in reducing SBP and DBP, followed by Xinnao Shutong Capsules/Tablets. In terms of safety, no serious adverse reactions occurred in all trials. The four oral blood-activating and stasis-removing Chinese patent medicines included in this study exhibited obvious advantages in the treatment of hypertensive LVH when they were combined with conventional western medicine, with the best effects observed in the Xinnao Shutong Capsules/Tablets combined with conventional western medicine group. However, due to the limitation of the quantity and quality of the included articles, the conclusion of this study still needs to be verified by more high-quality, multi-center, and large-sample RCTs.


Subject(s)
China , Humans , Hypertrophy, Left Ventricular/drug therapy , Medicine, Chinese Traditional , Network Meta-Analysis , Nonprescription Drugs , Stroke Volume , Ventricular Function, Left
5.
Annals of Medical Research and Practice ; 3(4)2022. tables, figures
Article in English | AIM | ID: biblio-1379217

ABSTRACT

OBJECTIVE: Systemic hypertension remains an important risk factors for cardiovascular diseases and a major global public health problem. Left ventricular hypertrophy (LVH) is a recognized complication of hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies evaluated the role of echocardiography in the diagnosis of LVHs among hypertensives. This study sets out to determine the prevalence of LVH among hypertensives as determined by echocardiography.MATERIAL AND METHODS: One hundred and seventy-eight hypertensives and eighty-nine age and sex-matched controls were recruited consecutively into the study. They all had echocardiography done to determine which among had LVH. The partition value for LVH for hypertensives was determined using the 97th percentile of the left ventricular mass for controls as a cutoff point. RESULTS:Echocardiographic determined the prevalence of LVH among hypertensives was 32.4%.CONCLUSION:The echocardiographic prevalence of LVH was 32.4% in the study population. This is a significant proportion among the study population considering the clinical impact of LVH among patients with hypertension.


Subject(s)
Echocardiography , Tertiary Healthcare , Caribbean Public Health Agency , Hypertrophy, Left Ventricular , Hypertension
6.
Arq. bras. cardiol ; 117(5): 988-996, nov. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1350009

ABSTRACT

Resumo Fundamento: Em associação às estatinas, os inibidores da pró-proteína convertase subtilisina/kexina tipo 9 (PCSK9) demonstraram ser eficazes na redução de eventos cardiovasculares em pacientes de alto risco. Objetivo: Analisar a custo-efetividade da implementação de evolocumabe para pacientes com alto risco de eventos cardiovasculares no contexto do Sistema Único de Saúde (SUS) no Brasil. Métodos: Um modelo de Markov foi utilizado, baseando-se em uma amostra ambulatorial de pacientes com doença arterial coronariana. Os desfechos primários analisados foram infarto agudo do miocárdio, acidente vascular cerebral isquêmico (AVCi), revascularização do miocárdio e morte cardiovascular. O resultado foi expresso por meio da razão de custo-efetividade incremental (RCEI), considerando-se uma taxa de desconto de 5% ao ano, e uma análise de sensibilidade foi realizada, tendo em vista a imprecisão de valores. Resultados: Selecionaram-se 61 pacientes com risco cardiovascular estimado em 35% em 10 anos, se em uso de atorvastatina 80mg/dia, e em 22,75%, se adicionado o evolocumabe. O custo global por paciente no período de 10 anos foi de R$ 46.522,44 no grupo em monoterapia com atorvastatina versus R$ 236.141,85 na terapia combinada, com uma efetividade global de 0,54 e 0,73, respectivamente. Isso resultou em uma RCEI R$ 1.011.188,07 (R$ 864.498,95 a R$ 1.296.748,43) por desfecho cardiovascular evitado. Conclusões: Apesar de não existirem padrões nacionais para custo-efetividade, os dados encontrados sugerem que a estratégia de associação do evolocumabe à terapia com estatina não é, no momento, custo-efetiva.


Abstract Background: Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. Objectives: We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. Methods: Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p<0.05. Results: Mean LV ejection fraction was not different between the groups. The E/e' ratio was impaired in the HCM group and preserved in the control group. LA mechanics was significantly reduced in HCM, compared to the HTN group. LA strain rate in reservoir (LASRr) and in contractile (LASRct) phases were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in reservoir phase (LASr) (AUC 0.76). LASRr and LASR-ct had high specificity (89% and 91%, respectively) and LASr had sensitivity of 80%. A decrease in 2.79% of LA strain rate in conduit phase (LASRcd) predicted an increase of 1cm in LGE extension (r2=0.42, β 2.79, p=0.027). Conclusions: LASRr and LASRct were the best discriminators for LVH secondary to HCM. LASRcd predicted the degree of LV fibrosis assessed by CMR. These findings suggest that LA mechanics is a potential predictor of disease severity in HCM.


Subject(s)
Humans , Cardiomyopathy, Hypertrophic/prevention & control , Antibodies, Monoclonal, Humanized/therapeutic use , Hypertension/drug therapy , Anticholesteremic Agents/therapeutic use , State Medicine , Brazil , Cost-Benefit Analysis , Hypertrophy, Left Ventricular/prevention & control , Contrast Media , Antibodies, Monoclonal, Humanized/economics , Gadolinium , Anticholesteremic Agents/economics
7.
Rev. invest. clín ; 73(3): 138-144, May.-Jun. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1280450

ABSTRACT

ABSTRACT Background: The biomarker for left ventricular hypertrophy (LVH) in patients with essential hypertension (EH) remains an unmet clinical need. The microRNA-30 (miR-30) family has been associated with LVH in cellular and animal studies, but not in a clinical setting. Objective: The objective of the study was to investigate the clinical significance of circulating levels of miR-30 family as a biomarker for LVH in EH patients. Methods: A total of 239 EH patients and 239 healthy controls were enrolled in this study. Circulating levels of miR-30 family members, namely, miR-30a, miR-30b, miR-30c-1, miR-30c-2, miR-30d, and miR-30e, were evaluated using real-time polymerase chain reaction assays. Results: The circulating miR-30a, miR-30b, and miR-30e were significantly reduced in EH patients in contrast to controls. EH patients with LVH (EH-LVH) had substantially lower circulating miR-30b and miR-30e levels compared to EH patients without LVH (EH-nLVH). Moreover, the expression levels of miR-30b and miR-30e were positively related to LVMI, respectively. Receiver operating curve analysis showed that circulating miR-30e levels distinguished EH patients from controls, and EH-LVH from EH-nLVH patients. Logistic regression analysis identified the circulating miR-30e as a risk factor for LVH in EH patients. Conclusion: Circulating miR-30e level can be used as a biomarker in distinguishing EH-LVH from EH-nLVH. A further prospective study is warranted to validate this finding.

8.
Frontiers of Medicine ; (4): 416-437, 2021.
Article in English | WPRIM | ID: wpr-888751

ABSTRACT

Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.


Subject(s)
Aged , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Catheters , Humans , Transcatheter Aortic Valve Replacement , Treatment Outcome , Ventricular Remodeling
9.
Chinese Critical Care Medicine ; (12): 1327-1331, 2021.
Article in Chinese | WPRIM | ID: wpr-931771

ABSTRACT

Objective:To investigate the relationship between double mutations of myosin heavy chain gene (MYH6) p.Gly743Arg and p.Glu1389Lys and the cardiac phenotype.Methods:Patients carrying double mutations in the MYH6 gene p.Gly743Arg and p.Glu1389Lys were screened from 52 unrelated left ventricular hypertrophy (LVH) who were admitted to the Second Hospital of Chongqing Medical University from 2015 to 2020, and the genetic testing of peripheral blood of patients by second-generation whole-exome sequencing assay technology and genomic DNA of their family members Sanger sequencing was performed to validate the genomic DNA of the family members. The cardiac phenotype was evaluated by electrocardiogram, coronary computed tomography angiography (CTA), echocardiography, and cardiac magnetic resonance imaging (MRI) as adjuncts.Results:All whole-exome gene were detected in 52 unrelated patients with LVH, of which 1 patient (1.9%) had double mutations in MYH6 gene p.Gly743Arg and p.Glu1389Lys (proband). Two members of the maternal line of this patient carried p.Glu1389Lys mutation, but there was no obvious clinical phenotype. Two members of the paternal line carried p.Gly743Arg mutation and had obvious clinical phenotype of bradycardia, but there was no LVH. The male proband, aged 21 years old, presented with LVH and sinus bradycardia but no coronary artery stenosis on CTA before treatment, MRI showed that the left ventricular end diastolic diameter was 58 mm. After treatment with angiotensin receptor-enkephalinase inhibitor (ARNI), electrocardiogram showed that the heart rate increased significantly (from 43 bpm to 72 bpm). Echocardiography showed that the left ventricular end diastolic diameter decreased significantly (from 60 mm to 49 mm).Conclusions:The p.Glu1389Lys mutation of the MYH6 gene may not manifest the phenotype of heart disease. MYH6 gene p.Gly743Arg mutation may be manifested asymptomatic sinus bradycardia, but there is no LVH phenotype. The cardiac disease phenotype caused by the double mutations of p.Gly743Arg and p.Glu1389Lys in the MYH6 gene is more obvious. Asymptomatic LVH and sinus bradycardia can appear in adolescence, but the LVH phenotype can be reversed in a short period of time after ARNI treatment.

10.
Article in Chinese | WPRIM | ID: wpr-879163

ABSTRACT

To systematically evaluate the clinical efficacy and safety of Compound Danshen Dripping Pills combined with conventional antihypertensive drugs in the treatment of hypertensive left ventricular hypertrophy. China National Knowledge Infrastructure(CNKI), Wanfang, VIP, PubMed, EMbase, Cochrane Library, Ovid and Web of Science databases were searched by computer to retrieve the randomized controlled trials(RCTs) of Compound Danshen Dripping Pills combined with conventional antihypertensive drugs in the treatment of hypertensive left ventricular hypertrophy from the establishment of databases to July 2020. After two researchers performed data retrieval, data extraction, and risk assessment of bias, they used RevMan 5.3 software for Meta-analysis. A total of 10 RCTs were included, with a total of 979 patients. Meta-analysis results showed that in terms of interventricular septal thickness(MD=-0.70, 95%CI[-1.15,-0.24], P=0.003), left ventricular posterior wall thickness(MD=-0.81, 95%CI[-1.41,-0.21], P=0.008), left ventricular mass index(MD=-8.75, 95%CI[-17.40,-0.10], P=0.05), systolic blood pressure(MD=-8.97, 95%CI[-13.46,-4.48], P<0.000 1), diastolic blood pressure(MD=-5.87, 95%CI[-8.39,-3.34], P<0.000 01) and left ventricular end-diastolic diameter(MD=-1.73, 95%CI[-2.38,-1.08], P<0.000 01), Compound Danshen Dripping Pills combined with conventional antihypertensive drugs was superior to conventional antihypertensive drugs. In terms of left ventricular ejection fraction(MD=0.41, 95%CI[-0.74, 1.55], P=0.49), there was no statistical difference in treatment between the two groups. Because of the small amount of literatures included in the safety aspect, it is impossible to give an accurate conclusion. The GRADE score showed that the level of evidence was low and extremely low. The results show that the Compound Danshen Dripping Pills combined with conventional antihypertensive drugs may effectively improve the clinical efficacy for hypertensive ventricular hypertrophy, and the safety needs to be further explored. Due to the low quality of the included literatures, more high-quality RCTs are needed for verification.


Subject(s)
Antihypertensive Agents/adverse effects , China , Drugs, Chinese Herbal/adverse effects , Humans , Hypertrophy, Left Ventricular/drug therapy , Stroke Volume , Treatment Outcome , Ventricular Function, Left
11.
Arch. cardiol. Méx ; 90(4): 503-510, Oct.-Dec. 2020. graf
Article in Spanish | LILACS | ID: biblio-1152826

ABSTRACT

Resumen El síndrome cardiorrenal (SCR) es un trastorno en el que intervienen el corazón y los riñones, interactuando y produciendo una disfunción entre ellos en forma aguda o crónica. Existen diferentes fenotipos clínicos bien identificados como «desórdenes del corazón y riñón en los que la disfunción aguda o crónica en un órgano induce la disfunción aguda o crónica del otro¼. La alta incidencia de morbimortalidad cardiovascular presente en los pacientes con enfermedad renal crónica terminal (ERCT), en especial la insuficiencia cardiaca (IC), origina inicialmente una lesión miocárdica que conlleva remodelamiento ventricular, lo cual induce a la activación de mecanismos compensadores, entre los cuales el riñón es pieza fundamental, ya que regula la homeostasis hidroelectrolítica y así el volumen circulante, siendo esto en la etapa dialítica más evidente. Los cambios funcionales y anatómicos cardiovasculares que se producen en estos pacientes son muy prevalentes e incluyen las interacciones hemodinámicas del corazón y los riñones en la insuficiencia cardiaca, y el impacto de la enfermedad aterosclerótica en ambos sistemas de órganos. También describimos estrategias diagnósticas y terapéuticas aplicables al síndrome cardiorrenal, que determinan la importancia de la ecocardiografía como modelo de diagnóstico útil. Finalmente, se analizan las posibilidades de tratamiento y la remisión de las alteraciones funcionales cardiacas con el trasplante renal en los pacientes con ERCT.


Abstract Cardiorenal syndrome (CRS) is a disorder in which the heart and kidneys are involved, interacting and producing a dysfunction between them in an acute or chronic way. There are different clinical phenotypes well identified as "heart and kidney disorders in which acute or chronic dysfunction in one organ induces acute or chronic dysfunction in the other". The high incidence of cardiovascular morbimortality in patients with chronic terminal kidney disease (CKD), especially heart failure (HF), initially causes a myocardial lesion that leads to ventricular remodeling, which induces the activation of compensatory mechanisms, among which the kidney is a fundamental part since it regulates the hydroelectrolytic homeostasis and thus the circulating volume, being this in the dialytic stage more evident. The functional and anatomical changes at cardiovascular level that occur in these patients are very prevalent, and include hemodynamic interactions of the heart and kidneys in heart failure and the impact of atherosclerotic disease in both organ systems. We also describe diagnostic and therapeutic strategies applicable to cardiorenal syndrome, which determine the importance of echocardiography as a useful diagnostic model. Finally, we analyze the possibilities of treatment and remission of cardiac functional alterations with renal transplantation in patients with T-CKD.


Subject(s)
Humans , Echocardiography , Cardio-Renal Syndrome/diagnostic imaging , Kidney Failure, Chronic/complications , Kidney Transplantation , Cardio-Renal Syndrome/physiopathology , Kidney Failure, Chronic/surgery , Kidney Failure, Chronic/diagnostic imaging
12.
J Pharm Biomed Sci ; 2020 Jan; 10(1): 6-9
Article | IMSEAR | ID: sea-215730

ABSTRACT

Background The association of metabolic syndrome with the subclinical changes in the function and structure ofthe heart has been established clinically. Additionally, diastolic dysfunction and left ventricular hypertrophy werealso found to be closely associated with the metabolic syndrome. It has been identified in many of the previousstudies that LV dysfunction and LV hypertrophy are major risk factors of heart failure with preserved ejectionfraction.Aim The study was carried out to identify whether preclinical LV diastolic dysfunction can occur independent ofLV hypertrophy in MS or not.Methods 100 patients were taken for the study with 50 patients in the case group having MS and 50 patients inthe control group without MS. The patients who had any exiting cardiovascular disease including (heart failure,left ventricular ejection fraction [LVEF]<50%, coronary artery disease, or valvular heart disease were excluded fromthe study.Results The mean age of the case group was 45±8.5 years and that of the control group was 42±7.5 years therewas statistically significant difference among the various baseline characteristics between the case and controlgroups as the p value was found to be <0.05. All the ecocardioghraphic parameters had statistically significantdifference among the two groups except Left ventricular end diastolic dimension.Conclusion The study depicted a positive correlation between diastolic dysfunction and metabolic syndrome.Furthermore, it was observed in the study that metabolic syndrome proved to the baseline indicator of prognosisto diastolic dysfunction in the near future.

13.
J. bras. pneumol ; 46(6): e20190136, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1134924

ABSTRACT

RESUMO Objetivo Verificar a associação entre massa e espessura do ventrículo esquerdo (VE) e presença de hipoxemia noturna significativa em pacientes portadores de DPOC com hipoxemia diurna leve. Métodos Estudo transversal realizado em pacientes ambulatoriais, clinicamente estáveis, portadores de DPOC e hipoxemia leve (saturação de oxigênio ≥ 90 a ≤ 94%, identificados por oximetria não invasiva) em um centro clínico especializado no atendimento de doenças respiratórias em Goiânia (GO). Todos foram submetidos a avaliação clínica, espirometria, polissonografia, ecocardiografia, gasometria arterial, teste de caminhada de 6 minutos e radiografia de tórax. Resultados Foram avaliados 64 pacientes com DPOC e hipoxemia noturna. Pacientes com hipoxemia noturna significativa apresentaram parâmetros ecocardiográficos associados a mais quantidade de musculatura do VE quando comparados a pacientes com hipoxemia noturna leve. A relação entre volume/massa do VE foi significativamente menor no grupo com hipoxemia noturna significativa (0,64 ± 0,13 versus 0,72 ± 0,12; p = 0,04) e a espessura diastólica do septo interventricular e a espessura diastólica da parede posterior do VE foram significativamente maiores nesse grupo (9,7 ± 0,92 versus 9,1 ± 0,90; p = 0,03) (9,7 ± 1,0 versus 8,9 ± 1,0; p = 0,01). O tempo de sono REM com saturação abaixo de 85% prediz significativamente a espessura do septo (ajuste para índice de massa corporal [IMC], idade e pressão arterial média; r2 = 0,20; p = 0,046). Conclusão Em indivíduos portadores de DPOC e hipoxemia noturna significativa, foi observada associação entre hipoxemia severa no sono REM e parâmetros ecocardiográficos que indicam aumento da massa do VE. Tal fato sugere que esse subgrupo de indivíduos pode se beneficiar de uma avaliação ecocardiográfica do VE.


ABSTRACT Objective To verify association between left ventricular (LV) mass and thickness and the presence of significant nocturnal hypoxemia in patients with COPD with mild diurnal hypoxemia. Methods A cross-sectional study carried out in clinically stable outpatients with COPD and mild hypoxemia (oxygen saturation ≥90 to ≤94%, identified by noninvasive oximetry) in a clinic specialized in the treatment of respiratory diseases in Goiânia-GO. All patients were submitted to clinical evaluation, spirometry, polysomnography, echocardiography, arterial blood gas analysis, 6-minute walk test and chest X-ray. Results Patients with significant nocturnal hypoxemia had echocardiographic parameters associated with increase of LV musculature when compared to patients with mild nocturnal hypoxemia. The LV volume/mass ratio was significantly lower in the group with significant nocturnal hypoxemia (ratio 0.64 ± 0.13 versus 0.72 ± 0.12, p = 0.04), the thickness diastolic diameter of the interventricular septum and the diastolic thickness of the LV posterior wall were significantly higher in this group (9.7 ± 0.92 versus 9.1 ± 0.90 p = 0.03), (9.7 ± 1.0 versus 8.9 ± 1.0, p = 0.01. The time in REM sleep with saturation below 85% significantly predicted septum thickness (adjustment for BMI, age and mean blood pressure, r2 = 0.20; p = 0.046). Conclusion We observed association between severe REM sleep hypoxemia and echocardiographic parameters indicating increased LV mass in individuals with COPD and significant nocturnal hypoxemia. This suggests that this subgroup of individuals may benefit from an echocardiographic evaluation of the left ventricle.


Subject(s)
Middle Aged , Aged , Aged, 80 and over , Echocardiography/methods , Polysomnography/adverse effects , Hypertrophy, Left Ventricular/etiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Heart Ventricles/diagnostic imaging , Hypoxia/physiopathology , Sleep Apnea Syndromes/physiopathology , Spirometry , Cross-Sectional Studies , Pulmonary Disease, Chronic Obstructive/complications , Heart Ventricles/anatomy & histology , Hypoxia/etiology
14.
Article | IMSEAR | ID: sea-194458

ABSTRACT

Background: Based on Glomerular Filtration Rate (GFR) Chronic Kidney Disease patients are classified into five stages. It starts with early stage of CKD and finally ends with End Stage Kidney Disease (ESKD). Anemia and inflammation are major medical complication in End Stage Kidney Disease and leads cardio vascular complications like LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh, India 120 in which 60 are normal healthy individuals and 60 are End stage kidney Disease. In all the participants Serum creatinine, blood urea, Serum Iron, TIBC, TSAT% Serum ferritin, Serum CRP, IL-6 and TNF-α was measured. All the EDTA blood samples were analyzed for complete blood count. Results: The diagnostic criteria for CKD like blood urea and serum creatinine were significantly higher in ESKD. There is a significantly increased level of Left ventricular mass index in ESKD when compared with Control. The mean erythrocyte indices are decreased in ESKD. The mean serum iron, TIBC and TSAT% decreased ESKD. Whereas serum ferritin significant increase in ESKD group and the mean serum CRP IL-6 and TNF-α significant increase in ESKD group when compared with controlConclusion: Present study finding suggested that there is a raised inflammatory marker in ESKD patients due to inflammation and it further changes serum ferritin, serum iron and TIBC. The above altered factors leads to changes in erythrocyte indices and leads to anemia which ends with cardiovascular complication like Left Ventricular Hypertrophy.

15.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1390190

ABSTRACT

RESUMEN Introducción: el electrocardiograma constituye la primera prueba que ofrece datos para determinar la existencia de hipertrofia ventricular izquierda en la hipertensión arterial. Objetivo: determinar el valor diagnóstico de los criterios electrocardiográficos de hipertrofia del ventrículo izquierdo en comparación a la ecocardiografía transtorácica en personas adultas con hipertensión arterial. Material y método: diseño observacional, descriptivo, retrospectivo de corte transversal, tipo prueba diagnóstica, que incluyó a pacientes adultos con diagnóstico de hipertensión arterial internados en la Tercera Catedra de Clínica Médica desde enero del 2017 a junio del 2018. Se determinaron las variables demográficas, criterios electrocardiográficos y ecocardiográficos de hipertrofia ventricular izquierda. Resultados: se incluyeron 150 pacientes, 84 (56%) fueron mujeres, edad media de 60±16 años; 103 (68,6%) tuvieron hipertrofia ventricular leve, 45 (30%) moderada y 2 (1,3%) grave. En pacientes con hipertrofia ventricular leve se obtuvo una sensibilidad de 8,7% para el criterio de Sokolow-Lyon y especificidad de 76,6% mientras que para el criterio de Cornell la sensibilidad fue 17,4% y especificidad 53,1%. En la hipertrofia ventricular moderada la sensibilidad fue 22,2% y especificidad 90,4% para Sokolow-Lyon y para Cornell la sensibilidad fue 46,6% y especificidad 73,6%. En la hipertrofia ventricular grave la sensibilidad fue 50% y especificidad 87,1% para el criterio de Sokolow-Lyon mientras que la sensibilidad fue 50% y especificidad 73,6% para el criterio de Cornell. Conclusión: el criterio electrocardiográfico con mejor rendimiento para determinar la hipertrofia ventricular izquierda es el de Cornell. Los criterios de Sokolow-Lyon y de Cornell son eficaces para el grado de hipertrofia grave.


ABSTRACT Introduction: The electrocardiogram is the first test that offers data to determine the existence of left ventricular hypertrophy in arterial hypertension. Objective: To determine the diagnostic value of the electrocardiographic criteria of left ventricular hypertrophy compared to transthoracic echocardiography in adults with hypertension. Material and method: Observational, descriptive, retrospective cross-sectional design, diagnostic test type, which included adult patients diagnosed with arterial hypertension admitted to the Third Department of Medical Clinic from January 2017 to June 2018. Demographic variables, electrocardiographic and echocardiographic criteria of left ventricular hypertrophy were determined. Results: One hundred fifty patients were included, 84 (56%) were women, the mean age was 60±16 years, 103 (68.6%) had mild ventricular hypertrophy, 45 (30%) moderate and 2 (1.3%) severe. In patients with mild ventricular hypertrophy, a sensitivity of 8.7% was obtained for Sokolow-Lyon criteria and a specificity of 76.6% while for Cornell criteria the sensitivity was 17.4% and the specificity 53.1%. In moderate ventricular hypertrophy, the sensitivity was 22.2% and the specificity 90.4% for Sokolow-Lyon while for Cornell the sensitivity was 46.6% and specificity 73.6%. In severe ventricular hypertrophy, the sensitivity was 50% and the specificity 87.1% for the Sokolow-Lyon criterion while the sensitivity was 50% and the specificity 73.6% for the Cornell criterion. Conclusion: The best performance electrocardiographic criteria for determining left ventricular hypertrophy were those of Cornell. The Sokolow-Lyon and Cornell criteria were effective for a degree of severe hypertrophy.

16.
Article | IMSEAR | ID: sea-194417

ABSTRACT

Background: Atrial Fibrillation is the most common arrhythmia encountered in our clinical practice accounting for 1/3rd of the total hospital admissions for cardiac rhythm disturbances. Recent worldwide epidemiological data have reaffirmed that AF is a global epidemic and has adverse effects on long term morbidity and mortality. This study is aimed to assess the clinical profile and etiology along with Echocardiographic evaluation of patients presenting with Atrial Fibrillation.Methods: Total of 100 patients of Atrial Fibrillation were enrolled for the study, who got admitted in hospital from March 2017 to June 2018. These patients were evaluated clinically, and detailed Cardiovascular, Neurological examination was done to evaluate etiology and for any evidence of thromboembolism. Echocardiography was also done.Results: Mean Age of the patients enrolled was 67.02±12.50 yrs. There was male predominance. The presenting complaints were dyspnea, palpitations, chest pain & pedal edema. On Echocardiography, Hypertensive Heart Disease was found to be the most common etiology. Mean LA size was 46.18±9.49 mm. LA clot was present in 4% patients. Most common complication was congestive cardiac failure followed by stroke. CHA2DS2- VASc score was ?2 in 86% patients.Conclusions: Increasing age and hypertension are associated with occurrence of AF. Hypertensive heart disease was the most common etiology in elderly age group. Presence of LVH or left atrial enlargement in patients with hypertensive heart disease requires early management to improve the outcomes.

17.
Indian Heart J ; 2019 May; 71(3): 199-206
Article | IMSEAR | ID: sea-191690

ABSTRACT

Objectives The aim of the study was to evaluate the correlation between left ventricular hypertrophy and the gene polymorphism of angiotensin-converting enzyme (ACE) intron deletion (I/D) and ACE G2350A. Methods Information related to the sample size and genotype frequencies was extracted from each study. Results Our results found that the D allele (p = 0.0180) and DD genotype (p = 0.0110) of ACE I/D had a significant association with increasing the risk of left ventricular hypertrophy, whereas the I allele (p = 0.0180), but not II (p = 0.1660) and ID genotypes (p = 0.1430), was associated with decreasing the risk of left ventricular hypertrophy. On other hand, we found that the A allele (p = 0.0020) and GA genotype of ACE G2350A (p = 0.0070) had the correlation with increasing the risk of left ventricular hypertrophy. Conclusions Our meta-analysis reveals that the D allele of ACE I/D and the A allele of ACE G2350A are associated with increasing the risk of left ventricular hypertrophy.

18.
Article | IMSEAR | ID: sea-211421

ABSTRACT

Background: In Chronic kidney Disease (CKD) a significant risk factor for mortality is Cardiovascular disease (CVD) and the most prevalent cardiovascular risk factor is left ventricular hypertrophy (LVH). Anemia, hypertension and volume overload are risk factors for LVH in CKD. So, the present was aimed at comparing the risk factors between CKD with and without LVH.Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh. A total of 120 patients are included in this study and divided in to CKD stage III to V based on estimated GFR. Based on 2D echocardiography data CKD cases are further divided in to CKD with LVH and CKD without LVH.Results: The Left ventricular mass index was significant higher in CKD with LVH (128.89±19.28) when compared with CKD without LVH (108.20±10.28). The left ventricular mass index was noted in more number in stage V of CKD. It is also observed that the left ventricular mass index was negatively correlated with haemoglobin and eGFR and was positively correlated with systolic blood pressure and serum NT-proBNP.Conclusions: Present study finding suggested that the incidence of LVH is higher in CKD patients. LVH was positively correlated with hypertension and NT-proBNP and negatively correlated with anemia and estimated GFR.

19.
Article | IMSEAR | ID: sea-203117

ABSTRACT

Objective: The annual mortality of cardiovascular diseases of dialysis patients is higher than the general population. The tranc-thoracic echocardiography allows the evaluation of the heart structure and function within the trated patients by hemodialysis in order to identify patients with cardiovascular high risk. Methods: This work is a descriptive retrospective study. The objective is to determine the major cardiac abnormalities diagnosed with echocardiography in patients with chronic hemodialysis and to list their epidemiological, clinical and biological characteristics at the time of the study. Results: The average age of our patients is of 50.2 ± 7 years with an average hemodialysis endurance of 12.1± 2.4 years. The main etiologies of the chronic renal failure were essentially the diabete type 2, the arterial hypertension and chronic nephritis tubule-interstitial. The most cardiac abnormalities was the left ventricular hypertrophy. The presence of a systolic or diastolic arterial hypertension has been noted as a significant factor fostering the LVH within the chronic hemodialysis (p=0.002).The anemia is not said to be associated to the development of the left ventricular hypertrophy(p=0.09). Conclusions: This study revealed the etiology leading to chronic renal failure insufficiency. Echocardiography accurately diagnosed cardiac abnormalities such as left ventricular hypertrophy. The study allowed to detect the factors involved in the development of this HVG especialy systolic arterial hypertension. This result permit us to act on these factors in order to prevent the cardiovascular events to which hemodialysis patients will be exposed.

20.
Chinese Journal of Cardiology ; (12): 215-220, 2019.
Article in Chinese | WPRIM | ID: wpr-810504

ABSTRACT

Objective@#Previous studies have shown that plasma microRNA-29a (miRNA-29a) is associated with myocardial fibrosis and the degree of cardiac hypertrophy in patients with hypertrophic cardiomyopathy. However, the relationship between plasma miRNA-29a and hypertensive left ventricular hypertrophy (LVH) has not yet been reported. So the purpose of this study is to investigate the relationship between the plasma miRNA-29a and hypertensive LVH.@*Method@#Enrolled 168 hypertensive patients and classified the patients into 2 groups: those with LVH (LVH group, n=41) and those without LVH (NLVH group, n=127). All patients underwent echocardiography examination. Left ventricular mass index (LVMI) was calculated by interventricular septal thickness (IVSd), left ventricular posterior wall thickness(LVPWTd), left ventricular end diastolic dimension (LVEDD) and left ventricular mass index (LVMI) were obtained. Plasma levels of miRNA-29a were assessed by quantitative real-time polymerase chain reaction (qRT-PCR). The relationship between plasma miRNA-29a levels and LVH was analyzed.@*Results@#Plasma miRNA-29a was significantly higher in LVH group than in NLVH group (0.52±0.10 vs. 0.37±0.07, t=9.788, P<0.01) . Pearson correlation analysis evidenced a positive correlation between plasma miRNA-29a levels and IVSd(R=0.459, P<0.01), LVPWTd (R=0.398, P<0.01), and LVMI (R=0.745, P<0.01). After adjustment for gender, age, systolic blood pressure, diastolic blood pressure, body mass index, hypertension duration, antihypertensive drugs, multiple regression analysis showed that there were still positive correlations between plasma miRNA-29a level and IVSd (β=0.535, P<0.01), LVPWTd (β=0.085, P<0.01), and LVMI (β=0.806, P<0.01).@*Conclusion@#Plasma miRNA-29a level is positively associated with LVH in hypertensive patients, and future studies are warranted to explore if miRNA-29a could be used as a potential biomarker for LVH assessment in hypertensive patients.

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