El efecto de los antihiperglicemiantes en los parámetros ecocardiográficos diastólicos y sistólicos / The effect of antihyperglycemic agents on diastolic and systolic echocardiographic parameters

Resumen La enfermedad metabólica diabetes mellitus tipo 2 ocasiona alteraciones en la estructura y en la funcionalidad miocárdica por diferentes mecanismos bioquímicos los cuales pueden ocasionar disfunción diastólica y sistólica, por lo cual el uso de los antihiperglicemiantes aparte de su efecto en la reducción de la hiperglicemia y la hemoglobina glicosilada, algunos han demostrado reducción en la mortalidad cardiovascular y de las hospitalizaciones por insuficiencia cardiaca, basado en estudios clínicos sobre este impacto en el miocardio. También se ha evaluado el efecto de estos fármacos por medio del ecocardiograma transtorácico. El objetivo de este articulo es analizar los valores de los parámetros ecocardiográficos sistólicos y diastólicos en pacientes diabéticos tipo 2 o alguna cardiopatía de base como antecedente de infarto al miocardio e insuficiencia cardiaca con el uso de metformina, sulfonilureas, los inhibidores de la dipeptidilpeptidasa 4 (sitagliptina, alogliptina y linagliptina, vildagliptina), los análogos de GLP1 (liraglutide, albiglutide y exenatide).

Abstract Metabolic disease type 2 diabetes mellitus causes alterations in both structure and myocardial functionality by different biochemical mechanisms which can cause diastolic and systolic dysfunction, which is why the use of antihyperglycemic agents apart from its effect in the reduction of hyperglycemia and glycosylated hemoglobin, some groups have shown reduction in cardiovascular mortality and hospitalizations for heart failure this based on clinical studies, by hypothesis, theories and pleiotropic mechanisms on this impact on the myocardium. On the other hand, the effect of these drugs on the myocardium has also been evaluated by transthoracic echocardiography. Therefore, the aim of this article is to analyze the values of systolic and diastolic echocardiographic parameters in type 2 diabetic patients or some underlying heart disease as a history of myocardial infarction and heart failure with the use of metformin, sulfonylureas, inhibitors of the dipeptidylpeptidase 4 (sitagliptin, alogliptin and linagliptin, vildagliptin), GLP1 analogues (liraglutide, albiglutide and exenatide).

Hipertensão arterial e arritmias ventriculares complexas: evoluçäo após tratamento de longo prazo da pressäo arterial / Hypertension and complex ventricular arrhythmias: evolution following a long-term blood pressure treatment

PURPOSE--To evaluate the effects of long-term antihypertensive treatment in the frequency as well as in the complexity of ventricular arrhythmias in arterial hypertension. METHODS--Twenty three patients, 14 males and 11 whites, with mean age of 46 years, were submitted to 24 hours ambulatory electrocardiographic monitoring and echocardiographic studies before and 9 months after antihypertensive treatment. RESULTS--There was no significant serum potassium level alteration, but significant reductions of both systolic (from 192 +/- 29mmHg to 161 +/- 25mmHg) and diastolic (from 122 +/- 17mmHg to 99 +/- 16mmHg) blood pressure. Left ventricular percent of fiber shortening significantly increased, even though only from 26 +/- 9 per cent to 30 +/- 9 per cent, and end-systolic wall stress did not change at all (before 258 +/- 94 10(3) dyn/cm2, after 255 +/- 101 10(3) dyn/cm2). Left ventricular mass index showed significant but also a discrete reduction from 211 +/- 75g/m2 to 196 +/- 70g/m2. Ambulatory electrocardiographic monitoring did not show any significant decrease in neither ventricular ectopic beats nor in couplets. Non-sustained ventricular tachycardia episodes remained unchanged too. Four out of 8 patients with more than 30 ventricular ectopic beats per hour reduced it by more than 70 per cent. On the other hand, the number of patients with couplets was reduced from 10 to 8 whilst those with non-sustained ventricular tachycardia increased from 5 to 7. Furthermore, in 7 patients reevaluated 24 months thereafter results were not expressively dissimilar. CONCLUSION--In hypertensive patients with either severe degree of left ventricular hypertrophy or myocardial dysfunction, long-term blood pressure treatment that produce no impressive changes in these abnormalities also do not modify complex ventricular arrhythmias, in spite of a great reduction in the increase blood pressure

Pulmonary valve echogram and portal pressure after as compared to before captopril therapeutic use in patients with both portal and pulmonary hypertension of bilharzial origin

The effect of captopril, a converting enzyme inhibitor, was investigated in 20 patients with schistosomal pulmonary hypertension [pH], 16 males and 4 females with age ranging from 16 to 42 years [mean 35-years]. Pulmonary valve and tricuspid valve echograms, were performed in all patients. According to the severity of pH, cases were divided into three subgroups utilizing the RVPEP/RVET ratio: [mild subgroup], with a ratio of 0.26 to 0.35. It comprised 10 patients, 7 males and 3 females, [moderate subgroup], with a ratio of 0.35 to 0.40. It comprised 5 patients, all were males. [severe subgroup], with a ratio more than 0.40. It comprised 5 patients, one male and 4 females. Again the 20 cases were classified radiologically according to the diameter of the main pulmonary artery [MPAD] into two subgroups: [the non-aneurysmal subgroup], with the MPAD from 4 - 6 cm. It comprised 12 patients, [the aneurysmal subgroup], with the MPAD more than 6 cm. It comprised 8 patients. One week following captopril therapy [75 mg/day] significant changes of RVEP/RVET were observed in the whole test group and its different-subgroups [P<0.001], which are indicative of a reduction in the pulmonary artery pressure. The pulmonary hypotensive action of captopril was marked in mild and moderate subgroups, while its effect was minimal in severe form of bilharzial pulmonary hypertension. This reduction was associated with definite, subjective symptomatic improvement. Significant reduction in right atrial diameter was also observed following captopril therapy [P<0.01], while mitral valve aortic valve and left ventricular functions did not change significantly [P>0.05] while under therapy. These results suggest that captopril may be of help in patients with schistosomal pulmonary hypertension

Echocardiographic and electrocardiographic short term effect of thrombolytic therapy in acute myocardial infarction

This prospective study was conducted in order to evaluate short term effects of thrombolytic therapy, in patients with AMI, on clinical, electrocardiographic and echocardiographic parameters. Sixty seven patients with AMI were randomized into 2 groups, test group treated with IV/SK and control group treated with conventional therapy. From the comparative analysis, the test group and its different subgroups show less incidence of recurrent chest pain and LVF, rapid resolution of electrocardiographic S-T segment and higher E.F as compared to control. Also, the earlier the start of thrombolytic therapy the more prominent this good progorestic changes So, it is mandatory to use this line of treatment on a wide scale in patients with AMI very early the prehospital phase if, possible, in order to improve the prognosis of such fatal disease