Maternal Intake of Flaxseed During Lactation and Exercise Training Protect Against Salt Overload-Induced Aortic Remodeling in Adult Offspring

Abstract Background High dietary sodium intake can induce endothelial stiffness even without changes in blood pressure. Objectives To evaluate the effects of exercise training and chronic intake of sodium chloride solution on aortic morphology of male offspring of rat dams who consumed flaxseed during lactation. Methods Female rats were fed with a control diet or a flaxseed diet during lactation. At weaning, two male offspring of each rat dam were allocated into eight groups for 180 days: four groups received a control diet e four received a flaxseed diet, with /without exercise and with/without NaCl solution supply. Aorta was collected for histomorphometric analysis. The one-way analysis of variance was used and P value < 0.05 was considered statistically significant. Results The chronic use of 1% NaCl solution led to changes in aortic histoarchitecture in the control group: increase in aortic intima-media thickness (10,4%, p<0.0001) and reduced number of elastic lamellae (-8,1%, p<0.0001). Groups of offspring of mother that consumed flaxseed during lactation, the chronic use of 1% NaCl alone did not lead to an increase in the aortic intima-media thickness. Exercise training of adult offspring increased aortic intima-media thickness (13.3%, p<0.0001), with preservation of elastic components and aortic flexibility. Conclusion Chronic salt overload caused adverse effects on the aorta of rats, and maternal consumption of the flaxseed diet during lactation protected against aortic remodeling. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Functional magnetic resonance imaging in the evaluation of the elastic properties of ascending aortic aneurysm

Abstract Objective: To evaluate the aortic wall elasticity using the maximal rate of systolic distension (MRSD) and maximal rate of diastolic recoil (MRDR) and their correlation with the aortic size index (ASI). Methods: Forty-eight patients with thoracic aortic aneurysm were enrolled in this study. A standard magnetic resonance imaging (MRI) protocol was used to calculate MRSD and MRDR. Both MRSD and MRDR were expressed as percentile of maximal area/10-3 sec. ASI (maximal aortic diameter/body surface area) was calculated. A correlation between MRSD, MRDR, ASI, and the patient's age was performed using regression plot. Results: A significant correlation between MRSD (t=-4,36; r2=0.29; P≤0.0001), MRDR (t=3.92; r2=0.25; P=0.0003), and ASI (25±4.33 mm/m2; range 15,48-35,14 mm/m2) is observed. As ASI increases, aortic MRSD and MRDR decrease. Such inverse correlation between MRSD, MRDR, and ASI indicates increased stiffness of the ascending aorta. A significant correlation between the patient's age and the decrease in MRSD and MRDR is observed. Conclusion: MRSD and MRDR are significantly correlated with ASI and the patient's age. They seem to describe properly the increasing stiffness of aortas. These two new indexes provide a promising, accessible, and reproducible approach to evaluate the biomechanical property of the aorta.

Análise histomorfométrica da artéria aorta de ratas submetidas à administração repetida da associação de etinilestradiol e gestodeno / Histomorphometric analysis of the aorta of rats submitted to repeated administration of association of ethinylestradiol and gestodene

Introdução: Os anticoncepcionais orais vêm sofrendo alterações em suas concentrações de estrogênio e progestogênio, baseando-se no fato de que doses mais baixas estão associadas a menor incidência de alterações metabólicas e de efeitos adversos, como o comprometimento da morfologia e função da artéria aorta. O objetivo deste estudo é avaliar a influência dos anticoncepcionais nas propriedades morfofuncionais da artéria aorta, através do método histoquímico, demonstrando sua utilidade nas análises histopatológicas. Métodos: Para tanto, foram utilizadas 15 ratas divididas em 3 grupos; Grupo controle (GC), cujos animais não receberam tratamento hormonal; Grupo 2 (G2), onde os animais receberam tratamento diário de 15 µg de etinilestradiol + 60 µg de gestodeno; e Grupo 3 (G3), que recebeu 30 µg de etinilestradiol + 75 µg de gestodeno. Após o tratamento, os animais foram eutanasiados e as artérias retiradas para análise histológica. Resultados: Os valores encontrados com a técnica de coloração histológica de hematoxilina e eosina (HE), bem como na coloração específica em histoquímica com Alcian Blue, demonstram que no G3, tratados com uma dosagem superior de hormônio, 8% das ratas tem aumento relevante da espessura de suas artérias, ou seja, superior ao G2, que recebeu dosagem menor de hormônio, e GC, o qual não recebeu nenhum tipo de tratamento. Conclusão: Este estudo demonstra que existem relações entre o espessamento das artérias, de ratas submetidas a dosagens de etinilestradiol e gestodeno, com a grande quantidade de mucopolissacarídeos depositados entre as túnicas das artérias. (AU)

Introduction: Pharmacological development of hormonal contraceptives has been undergoing changes in estrogen and progesterone doses, based on the fact that lower doses are associated with a lower incidence of metabolic changes and adverse effects, such as impairment of morphology and function of the aortic artery. The aim of this study is to evaluate the influence of contraceptives on the morphofunctional properties of the aortic artery, using the histochemical method, demonstrating its usefulness in histopathological analyzes. Methods: For this purpose, 15 rats were divided into 3 groups; Control group (GC), whose animals did not receive hormonal treatment; Group 2 (G2), where the animals received a daily treatment of 15 µg of ethinylestradiol + 60 µg of gestodene; and Group 3 (G3), whose animals received 30 µg of ethinylestradiol + 75 µg of gestodene. After treatment, the animals were sacrificed and the arteries removed for histologic analysis. Results: The values found, with HE measurements and Alcian Blue histochemical staining, showed that in G3, treated with a higher hormone dosage, there are 8% of the rats with a relevant increase in the thickness of their arteries, that is, higher than that of G2, which received lower dosage of hormone and that of GC, which received no treatment. Conclusion: This study demonstrates that there are relations between the thickening of the arteries of rats submitted to dosages of ethinylestradiol and gestodene with the great amount of mucopolysaccharides deposited between the tunics of the arteries. (AU)

The effects of treatment in patients with childhood asthma on the elastic properties of the aorta

Introduction: The study aimed to investigate the effects of treatment in patients with childhood asthma on the elastic properties of the aorta and cardiovascular risk.Methods: The study was performed in 66 paediatric patients diagnosed with bronchial asthma (BA). All patients were administered the ß2 agonist, salbutamol, for seven days, followed by one month of montelukast and six months of inhaled steroid treatment. All patients underwent conventional transthoracic echocardiographic imaging before and after treatment. Aortic elasticity parameters were considered to be the markers of aortic function.Results: Aortic elasticity parameters, including aortic strain (15.2 ± 4.8 and 18.8 ± 9.5%, p = 0.043), aortic distensibility (7.26 ± 4.71 and 9.53±3.50 cm2/dyn, p = 0.010) and aortic stiffness index (3.2 ± 0.6 and 2.8 ± 0.5, p = 0.045 showed significant post-treatment improvement when compared to pre-treatment values. Tricuspid annular plane systolic excursion (TAPSE) was also observed to improve after treatment (1.81 ± 0.38 and 1.98 ± 0.43, p = 0.049). Conclusion: The study demonstrated that when provided at appropriate doses, medications used in BA may result in an improvement in aortic stiffness

Arterite de Takayasu com estenose de artéria renal diagnosticada em paciente com 65 anos de idade / Takayasu's arteritis with renal artery stenosis diagnosed in a patient with 65 years old

Resumo Arterite de Takayasu é uma doença rara, de etiologia desconhecida, que acomete a aorta e seus principais ramos. É uma patologia, geograficamente mais comum no Sudeste Asiático, que acomete principalmente mulheres em idade reprodutiva. A apresentação clínica é inespecífica, com sinais e sintomas que variam de acordo com o seguimento arterial acometido. O vaso mais comumente afetado é a artéria subclávia, enquanto a estenose de artéria renal é relativamente incomum. Comprometimento cardíaco e associação com outras patologias também podem estar presentes. Apresentamos neste relato o caso de uma paciente idosa com diagnóstico tardio de arterite de Takayasu e várias comorbidades ou complicações relacionadas.

Abstract Takayasu arteritis is a rare disease of unknown etiology that affects the aorta and its main branches. It is a condition, geographically more common in Southeast Asia, which mainly affects women of reproductive age. The clinical presentation is nonspecific, with signs and symptoms that vary according to the affected arterial segment. The most commonly affected vessel is the subclavian artery, while renal artery stenosis is relatively uncommon. Cardiac involvement and association with other diseases may also be present. We present in this report the case of an elderly patient with late diagnosis of Takayasu's arteritis and various comorbidities or related complications.

Assessment of Perfusion Pattern and Extent of Perfusion Defect on Dual-Energy CT Angiography: Correlations between the Causes of Pulmonary Hypertension and Vascular Parameters

OBJECTIVE: To assess perfusion patterns on a dual-energy pulmonary CT angiography (DECTA) of pulmonary hypertension (PHT) with variable causes and to assess whether the extent of perfusion defect can be used in the severity assessment of PHT. MATERIALS AND METHODS: Between March 2007 and February 2011, DECTA scans of 62 consecutive patients (24 men, 38 women; mean age, 58.5 +/- 17.3 [standard deviation] years; range, 19-87 years) with PHT were retrospectively included with following inclusion criteria; 1) absence of acute pulmonary thromboembolism, 2) maximal velocity of tricuspid regurgitation jet (TR Vmax) above 3 m/s on echocardiography performed within one week of the DECTA study. Perfusion patterns of iodine map were divided into normal (NL), diffuse heterogeneously decreased (DH), multifocal geographic and multiple peripheral wedging patterns. The extent of perfusion defects (PD), the diameter of main pulmonary artery (MPA) and the ratio of ascending aorta diameter/MPA (aortopulmonary ratio, APR) were measured. Pearson correlation analysis was performed between TR Vmax on echocardiography and CT imaging parameters. RESULTS: Common perfusion patterns of primary PHT were DH (n = 15) and NL (n = 12). The perfusion patterns of secondary PHT were variable. On the correlation analysis, in primary PHT, TR Vmax significantly correlated with PD, MPA and APR (r = 0.52, r = 0.40, r = -0.50, respectively, all p < 0.05). In secondary PHT, TR Vmax significantly correlated with PD and MPA (r = 0.38, r = 0.53, respectively, all p < 0.05). CONCLUSION: Different perfusion patterns are observed on DECTA of PHT according to the causes. PD and MPA are significantly correlated with the TR Vmax.

A distensibilidade da aorta prediz o acidente vascular cerebral em pacientes hipertensos / Aortic stiffness is an independent predictor of stroke in hypertensive patients

FUNDAMENTO: A doença cardiovascular continua a ser principal causa de morte nos países desenvolvidos e não é inteiramente prevista por fatores de risco clássicos. O aumento da rigidez arterial constitui um importante determinante de morbidade e mortalidade cardiovascular. OBJETIVO: Avaliar se a velocidade da onda de pulso prediz a ocorrência de acidente vascular cerebral (AVC) em pacientes hipertensos. MÉTODOS: Estudo de coorte, observacional, prospetivo, multicêntrico, incluindo 1.133 pacientes hipertensos (586 homens), com uma média de idade de 51,05 ± 12,64 anos. Todos os pacientes foram submetidos à avaliação da VOP pelo método Complior, a uma avaliação clínica pormenorizada e à medição da pressão arterial. RESULTADOS: A incidência cumulativa de risco de AVC nos hipertensos com VOP aumentada foi de 3,25% (IC: 1,97%-5,25%), em comparação com 0,78% (IC: 0,28% - 1,87%) nos hipertensos com VOP normal (risco relativo (RR) = 4,15; IC: 1,53 - 11,26). Numa análise multivariável, ajustando o modelo aos fatores de risco cardiovasculares clássicos, a VOP foi um preditor independente de AVC, com um hazard ratio (HR) = 1,40 (IC: 1,13 - 1,73, p < 0,002), indicando um incremento de 40% no risco de AVC por cada incremento de 1 m/seg na VOP. A adição da VOP a um modelo composto pelos fatores de risco cardiovascular convencionais melhorou significativamente a sua capacidade discriminativa para o risco de AVC (C de Harrel aumentou de 0,68 para 0,71 após inclusão da VOP; p <0,01). CONCLUSÃO: A distensibilidade arterial aferida pela VOP aórtica é um fator de risco independente de AVC em pacientes hipertensos, sendo recomendável a sua integração em programas de follow-up de situações em que o risco cardiovascular é manifesto.

BACKGROUND: Cardiovascular disease remains the leading cause of death in developed countries and is not entirely predicted by classic risk factors. Increased arterial stiffness is an important determinant of cardiovascular morbidity and mortality. OBJECTIVE: To assess whether Aortic Pulse Wave Velocity (PWV) predicts the occurrence of stroke in hypertensive patients METHODS: A cohort, observational and prospective study, including 1133 hypertensive patients (586 men), with a mean age 51.05 ± 12.64 years, was designed. PWV with the Complior method was performed in all patients, as well as a detailed clinical evaluation and blood pressure measurement. RESULTS: The cumulative incidence of stroke in hypertensive patients with increased PWV was 3.25% (CI: 1.97% -5.25%), compared with 0.78% (CI: 0.28% -1.87%) in hypertensive patients with normal PWV (Risk Ratio (RR) =4.15; CI:1.53-11.26). In a multivariate analysis, adjusting the model to classical cardiovascular risk factors, PWV was an independent predictor of stroke, with a Hazard Ratio (HR) = 1.40 (CI:1.13-1.73, p<0.001), indicating a 40% increase in the risk of stroke per 1m/s increment in PWV. The addition of PWV to a model consisting of conventional cardiovascular risk factors significantly improved the discriminative capacity for stroke (Harrell's C increased from 0.68 to 0.71 after the inclusion of the PWV; p<0.01). CONCLUSION: Aortic PWV is a risk factor for stroke in hypertensive patients, and its integration into clinical follow-up programs in patients whose cardiovascular risk is manifest is strongly recommended.

Intervenciones de enfermería al paciente durante el retiro del balón de contrapulsación intraaórtico / Nursing interventions to the patient during removal of intra-aortic balloon counterpulsation", "_i": "

La utilización de la tecnología en la atención de las personas en estado crítico busca mejorar su condición de salud. Ante este escenario, el profesional de enfermería debe poseer las competencias esenciales y específicas para otorgar cuidados de calidad y seguridad, incluso requiere demostrar autonomía en la toma de decisiones en el ámbito de su competencia profesional, factor que fortalece la valoración, el seguimiento e identificación de posibles complicaciones. Por lo tanto, en el presente artículo se abordan las intervenciones de enfermería oportunas dirigidas al paciente durante el retiro del balón de contrapulsación intraaórtico con la finalidad de establecer una guía que oriente la práctica segura, y así delimitar las complicaciones vasculares posteriores.

The use of technology in the care of people in critical condition seeks to improve their health. Given this scenario, the nursing professional must possess specific core competences to provide quality care and show autonomy in decision-making in the field of their professional competence, a factor that strengthens the assessment, monitoring and identification of complications. Therefore, this article addresses the appropriate nursing interventions directed to the patient during withdrawal of intra-aortic balloon counterpulsation in order to establish a guide that orients safe practice and thus keep down subsequent vascular complications.

Crohn's disease activity assessed by doppler sonography: the role of aortic flow parameters

OBJECTIVES: Intestinal neovascularization and abnormal abdominal arterial flow rates have been reported in Crohn's disease. The aim of this study was to evaluate Doppler sonography as a method for assessing Crohn's disease activity based on changes in splanchnic hemodynamics. METHODS: Forty-eight patients with Crohn's disease, 22 healthy volunteers and 12 patients with irritable bowel syndrome were evaluated by Doppler ultrasound for flow parameters of the aorta and superior mesenteric artery. This evaluation included the cross-sectional area, maximum flow volume, peak systolic velocity, end diastolic velocity, resistance and the pulsatility index. Disease activity was classified according to the Crohn's disease activity index. RESULTS: Most measurements in the aorta and superior mesenteric artery were significantly different between Crohn's disease patients and both control groups. Only the aortic maximum flow volume (CC = 0.37, p = 0.009) and aortic peak systolic velocity (CC = 0.30, p = 0.035) showed a significant positive correlation with the Crohn's disease activity index. The determination of cut-off points for the aortic maximum flow volume and peak systolic velocity measurements increased the sensitivity (80 and 75% for flow volume and velocity, respectively), specificity (57 and 75%), accuracy (67 and 75%) and positive (57 and 68%) and negative (80 and 81%) predictive values. These cut-off values permitted the correct classification of most of the patients with Crohn's disease with respect to disease activity. None of the superior mesenteric artery measurements were able to discriminate patients in relation to disease activity. CONCLUSION: The aortic maximum flow volume and peak systolic velocity levels estimated by Doppler sonography reflected disease activity in Crohn's disease. Doppler sonography of the aorta is therefore a novel noninvasive adjunct method that may be ...

Assessment of the elasticity properties of the ascending aorta in patients with subclinical hypothyroidism by tissue Doppler imaging / Avaliação das propriedades de elasticidade da aorta ascendente por Doppler tecidual em pacientes com hipotireoidismo subclínico

OBJECTIVE: We aimed to investigate whether aortic elastic properties were affected in subclinical hypothyroidism (SCH) by using tissue Doppler imaging (TDI). SUBJECTS AND METHODS: Forty-three patients with newly diagnosed SCH and forty-eight healthy controls were included to the study. Systolic and diastolic diameters of the ascending aorta were measured by M-mode transthoracic echocardiography, and the upper wall velocities of ascending aorta and mitral annulus velocities were measured by TDI. Aortic stiffness index (ASI) and aortic distensibility were computed using the formulas accepted in literature. RESULTS: The clinical and demographic features of both groups were comparable. Aortic distensibility was significantly lower, and ASI was significantly higher in SCH patients than in controls. Systolic aortic upper wall velocity (Sao) was also significantly lower in SCH patients. Early (Eao) and late diastolic aortic upper wall (Aao) velocities did not differ between the two groups. Mitral annulus (Sm, Em, and Am) velocities were also similar between the groups. Sao was negatively correlated with ASI, and positively correlated with aortic distensibility. TSH level was positively correlated with ASI, total cholesterol and low-density lipoprotein-cholesterol, and negatively correlated with aortic distensibility and Sao. CONCLUSIONS: In this study, our results showed that SCH is associated with impaired elasticity of the ascending aorta. Elastic properties of the ascending aorta can be directly evaluated by the reproducibly measurement of the upper wall movements of the ascending aorta by TDI in SCH patients.

OBJETIVO: Nosso objetivo foi investigar se as propriedades elásticas da aorta são afetadas no hipotireoidismo subclínico (HSC), utilizando o Doppler tecidual (UDT). SUJEITOS E MÉTODOS: Quarenta e três pacientes com diagnóstico recente de HSC e 48 indivíduos saudáveis ​​foram incluídos no estudo. Os diâmetros sistólico e diastólico da aorta foram medidos por ecocardiografia transtorácica modo M e as velocidades de fluxo da parede superior da aorta ascendente e de fluxo transvalvar mitral foram medidas por UDT. O índice de rigidez da aorta (IRA) e a distensibilidade aórtica foram calculados usando fórmulas aceitas na literatura. RESULTADOS: As características clínicas e demográficas dos dois grupos foram comparáveis. A distensibilidade aórtica foi significativamente menor e IRA significativamente maior nos pacientes com HSC do que nos controles. A velocidade de fluxo sistólico na parede aórtica superior (Sao) foi significantemente menor em pacientes com HSC. A velocidade de fluxo diastólico inicial (Eao) e tardio (Aao) na parede aórtica superior e as velocidades de fluxo transvalvar (Sm, Em e Am) não diferiram entre os dois grupos. Sao foi negativamente correlacionada com IRA e positivamente correlacionada com a distensibilidade aórtica. O nível de TSH foi positivamente correlacionado com IRA, colesterol total e lipoproteína de baixa densidade-colesterol e negativamente correlacionado com a distensibilidade aórtica e Sao. CONCLUSÕES: Os resultados do presente estudo demonstraram que o HSC é associado com elasticidade deficiente da aorta ascendente. Propriedades elásticas da aorta ascendente podem ser diretamente avaliadas por medições reprodutíveis dos movimentos da parede superior da aorta por UDT em pacientes com HSC.

Válvula aórtica bicúspide y dilatación de la raíz de la aorta o de la aorta ascendente / Dilatation of the aortic root and the ascending aorta in patients with bicuspid aortic valve disease

La dilatación de la aorta ascendente es un acompañante muy frecuente de la valvulopatía aórtica bicúspide, y a su vez la cardiopatía congénita más frecuente. Entre las teorías acerca de su origen, la más establecida es la que la liga al efecto de metaloproteinasas sobre la pared arterial. En este editorial se hace referencia a la publicación simultánea en este número del artículo de Dayan et al., que describen la evolución de la dilatación aórtica post reemplazo valvular.

Aortic root and ascending aorta dilatacion is a common consequence of bicsupid aortic valve disease, in turn the most frequent form of congenital heart disease. Among the different theories proposed to explain this finding, the action of metallo proteinases upon the aortic wall seems to be well established. In this Editorial, the concurrent work by Dayan et al published in this issue, dealing with aortic root dilatation post aortic valve replacement in patients with bicuspid aortic valve is analyzed.

Comparação entre os valores da pressão arterial central e braquial de pacientes com hipertensão arterial submetidos à cineangiocoronariografia / Comparison between the central and brachial blood pressure values in patients with hypertension undergoing cineangiocoronarography

INTRODUÇÃO: Durante o envelhecimento, a pressão arterial sistólica (PS) e a pressão de pulso (PP) se elevam gradativamente, consequente à redução da elasticidade arterial. A medida da pressão arterial sistêmica (PAS) aferida na raiz da aorta tem sido considerada como um determinante independente da mortalidade cardiovascular superior aos valores PAS braquial. OBJETIVO: Comparar os valores da PAS central e PAS braquial em portadores de hipertensão arterial nas diversas faixas etárias. MÉTODO: Avaliamos a PAS central na raiz da aorta e a PAS braquial no braço esquerdo pelo método oscilométrico em 244 pacientes com hipertensão submetidos à cineangiocoronariografia. Foram constituídos cinco grupos de pacientes: Grupo I, 39-49 anos, n = 36; Grupo II, 50-59 anos, n = 67; Grupo III, 60-69 anos, n = 69; Grupo IV, 70-79 anos, n = 46; e o Grupo V, > 80 anos, n = 26. RESULTADOS: Ao comparar a PS central versus PS braquial, foi possível encontrar significância a partir dos 50 anos de vida. Não encontramos diferença estatística entre a pressão diastólica central versus diastólica braquial, exceto nos pacientes com idade entre 60-69 anos. Na comparação entre a PP central e PP braquial, observamos que a PP central foi significativamente maior (entre 11 a 15 mmHg) em todos os pacientes com idade superior a 50 anos. CONCLUSÃO: Com o envelhecimento, os valores das PS e de PP, aferidas diretamente na raiz da aorta, são superiores àqueles obtidos por método indireto na artéria braquial. Essas diferenças são significantes a partir dos 50 anos de idade.

INTRODUCTION: Systolic blood pressure (SP) and pulse pressure (PP) rise gradually during the aging process as a consequence of a reduction in arterial elasticity. The measure of systemic arterial pressure (SAP) taken at the root of the aorta has been considered an independent determinant of cardiovascular mortality superior to the values of brachial SAP. AIM: To compare the values of SAP central to those of braquial SAP in patients of different age brackets who have systemic hypertension. METHOD: We evaluated the central SAP at the root of the aorta and the brachial SAP in the left arm using the ocillometric method 244 hypertensive patients who had been submitted to cineangiocoronarography. Five groups of patients were constituted: Group I, 39-49 years-old (y.o.), n = 36; Group II, 50-59 y.o., n = 67; Group III, 60-69 y.o., n = 69; Group IV, 70-79 y.o., n = 46; Group V, > 80 y.o., n = 26. RESULTS: When central SP was compared to brachial SP, it was possible to find significance in patients who were 50 y.o and upwards. It was not possible to find a statistical difference between central diastolic pressure and brachial except in patients between the ages of 60-69 y.o. When comparing central to brachial PP, we observed that central PP was significantly greater (between 11 and 15 mmHg) in all patient above the age of 50 y.o. CONCLUSION: In older people, the values of SP and PP, taken directly at the root of the aorta, are superior to those obtained by indirect means from the brachial artery. These differences are significant from the age of 50 y.o. onwards.

Análisis cuantitativo de variables hemodinámicas de la aorta obtenidas de 4D flow / Quantitative analysis of hemodynamic variables of the aorta by 4D flow MRI

Objective: Hemodynamic parameters are critical to perform a proper diagnosis. However, due to the large number of variables that can be obtained, overall analysis may represent a complex task. To facilitate this, we propose to create a model for classifying different hemodynamic variables between those belonging to a healthy individual and to a pathological patient. For this purpose, we employed data mining techniques to identify relationships among various aortic hemodynamic parameters obtained through multi-dimensional (4D flow) MR imaging. Method: A 4D flow sequence of whole heart and great vessels was acquired using MRI in 19 healthy volunteers and 2 patients (one with aortic coarctation and one with repaired coarctation of the aorta). Retrospectively, data were reformatted along the aorta; three MRI acquisitions were performed for volunteers and 30 sequences for each patient. In each slice the aorta was segmented and various parameters were quantified: area, maximum velocity, minimum velocity, flow and volumen, with following values being calculated for last four parameters: maximum, average, standard deviation, kurtosis, skewness, proportion of time to reach the maximum value, among others. A total of 26 variables for each acquisition were obtained. In order to classify data, the CART Technique (Classification and Regression Trees) was applied. To validate the model, two extra projections were generated per each volunteer and 20 slice per each patient. Results: By using only 7 variables, the CART Technique allows discrimination between images performed either on volunteers or patients with an error rate of 14.1 percent, a sensitivity of 82.5 percent, and a specificity of 89.4 percent. Conclusions: 4D flow MR imaging provides a wealth of hemodynamic data that can be difficult to analyze. In this paper we demonstrate that by using data mining techniques it is possible to classify images from relevant hemodynamic parameters and their relationships in order...

Objetivo: Los parámetros hemodinámicos son de gran utilidad para realizar un adecuado diagnóstico. Sin embargo, debido a la gran cantidad de variables que pueden obtenerse, el análisis global de todas ellas puede ser complejo. Para facilitar esta tarea, nosotros proponemos crear un modelo que permita clasificar distintas variables hemodinámicas entre las pertenecientes a un individuo sano o a uno patológico. Para ello, usaremos técnicas de minería de datos que permitan identificar y encontrar relaciones entre distintos parámetros hemodinámicos de la aorta obtenidos a través de flujo multidimensional (4D flow) por resonancia magnética. Método: Una secuencia 4D flow de todo el corazón y los grandes vasos fue adquirida utilizando resonancia magnética en 19 voluntarios sanos y 2 pacientes (uno con una coartación aórtica y otro con una coartación aórtica reparada). Retrospectivamente, los datos fueron reformateados a lo largo de la aorta, originándose 3 cortes en los voluntarios y 30 cortes en cada paciente. En cada corte la aorta fue segmentada y distintos parámetros fueron cuantificados: área, velocidad máxima, velocidad mínima, flujo y volumen, calculándose en los cuatro últimos su valor máximo, promedio, desviación estándar, curtosis, sesgo, proporción de tiempo en alcanzar el valor máximo, entre otros. Teniendo un total de 26 variables por cada corte. Se aplicó la técnica de árboles de decisión tipo CART (por sus siglas en inglés) para clasificar los datos. Para validar el modelo, 2 cortes extras fueron generados por cada voluntario y 20 cortes por cada paciente. Resultados: La técnica CART, mediante la utilización de sólo 7 variables, puede clasificar las imágenes de los voluntarios y pacientes con una tasa de error del 14,1 por ciento, una sensibilidad de 82,5 por ciento y una especificidad de 89.4 por ciento. Conclusiones: 4D flow provee una gran cantidad de datos hemodinámicos que son difíciles de analizar. En este trabajo demostramos que al utilizar...

Efecto del sulodexide sobre la capacidad de relajación y alteraciones estructurales de la arteria aorta en ratas diabéticas por estreptozotocina / Effect of sulodexide on aortic vasodilation capacity and associated morphological changes in rats with streptozotocin-induced diabetes

La disfunción endotelial (DE) se presenta en pacientes con hipercolesterolemia, hipertensión arterial, obesidad y diabetes mellitus. Evidencias sugieren un papel de los glicosaminoglicanos en la DE. Evaluamos el efecto del sulodexide (SLD), un glicosaminoglicano utilizado en el tratamiento de la albuminuria y la enfermedad isquémica en pacientes diabéticos, sobre la relajación arterial y los cambios morfológicos en un modelo experimental de diabetes tipo 1. La diabetes se indujo a ratas Sprague Dawley administrando estreptozotocina (STZ), 60 mg/kg, i.v. Los animales fueron distribuidos en los siguientes grupos: I= control, II= diabéticas, III: control + sulodexide, IV= diabéticas + sulodexide (15 mg/kg/día s.c). A los 3 meses fueron sacrificados, las aortas extraídas para evaluar la relajación vascular inducida por acetilcolina (Ach) y nitroprusiato de sodio en anillos precontraídos con fenilefrina. Fueron evaluadas histológicamente mediante microscopía de luz y coloraciones diversas. El SLD in vitro no modificó la tensión basal de los anillos arteriales en reposo o precontraídos con fenilefrina. La diabetes disminuyó la capacidad de relajación arterial en respuesta a la Ach en un 28,8-35,1% vs control, efecto que fue prevenido por SLD. No se observó diferencia significativa en la relajación inducida por nitroprusiato sódico entre los grupos. El estudio histológico en los animales diabéticos mostró alteraciones estructurales, particularmente en la íntima y la adventicia, cambios que fueron prevenidos por el tratamiento con SLD. Nuestros resultados apoyan la potencial utilidad terapéutica del SLD en el tratamiento de la disfunción endotelial.

Endothelial dysfunction (ED) is observed in patients with hypercholesterolemia, arterial hypertension, obesity and diabetes mellitus. Recent evidences suggest the involvement of glycosaminoglycans(GSG) in ED. We evaluated the effect of sulodexide (SLD), a natural GSG used in albuminuria and ischemic diabetes treatment, on arterial relaxation and vascular morphological changes in a diabetic type I model. Diabetes was induced, in Sprague-Dawley rats by streptozotocine (STZ) administration, 60 mg, iv. Rats were divided into four groups; I: control, II: diabetics, III: control + SLD, IV: diabetics treated with SLD (15 mg/day). After three months, phenylephrine precontracted aortic rings were used to evaluate acetylcholine (ACh) and sodium nitroprusside (NPS) relaxation capacities. Light microscopy of aorta was done with several staining procedures. In vitro, SLD did not change smooth muscle tone in resting or phenylephrine precontracted aortic rings. In diabetic rats, ACh relaxation was 28.8-35.1% lower than in control rats. Diabetic rats treated with SLD showed aortic ACh relaxation similar to control rats. No significative statistical difference was found in endothelium-independent NPS relaxation, between the different groups. Light microscopy histological studies revealed important morphological alterations, particularly in intima and adventitia layers of aortic artery; those changes were dramatically reversed in SLD treated rats. Our experiments support the conclusion that SLD is a potential drug for improving endothelial dysfunction in diabetes.

Ruptura dos vasa vasorum e hematoma intramural da aorta: um paradigma em mudança / Rupture of vasa vasorum and intramural hematoma of the aorta: a changing paradigm

A ruptura dos vasa vasorum tem sido reconhecida como uma das causas do hematoma intramural da aorta há 90 anos. Esta breve revisão apresenta sistematicamente a fisiologia desses vasos e o seu papel na fisiopatologia das alterações parietais da aorta que ocorrem na hipertensão arterial, na arteriosclerose e na síndrome aórtica aguda. A hipótese defendida aqui é a de que a ruptura dos vasa vasorum ocorre como um fenômeno secundário e não como um dos fatores causais na fisiopatologia do hematoma intramural.

Rupture of vasa varorum has been recognized as one cause of intramural hematoma of the aorta for 90 years. This brief revision presents systematically, the physiology of these vessels and its role in the physiopathology of the alterations in the aortic wall secondary to hypertension, arteriosclerosis and in Acute Aortic Syndrome. The hypothesis is that rupture of vasa vasorum is a secondary phenomenon and not one causal factor in the physiopathology of intramural hematoma.

Systemic evaluation on ischemia and reperfusion injury of splanchnic organs in rats / Alterações sistêmicas na isquemia e reperfusão de órgãos esplâncnicos em ratos

PURPOSE: To evaluate hemodynamic and systemic changes during and after splanchnic ischemia and reperfusion (I/R). METHODS: Rats were divided into two groups: a) control: animals submitted to surgery, but not to I/R, treated with saline (5 ml/kg/h) for 150 min; b) group I/R: animals continuously infused with saline, and submitted to occlusion of the celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric artery for 30 min, followed by a 120-min reperfusion. Mean arterial blood pressure (MABP), venous pressure, aortic and SMA blood flow, heart rate, esophageal temperature and hematocrit were evaluated. RESULTS: During reperfusion in I/R groups, there was a progressive decrease in MABP, aortic blood flow, SMA blood flow, heart rate and esophageal temperature; vein pressure and hematocrit remained unchanged during the experiment. CONCLUSION: The model of ischemia used causes systemic changes, which are evidenced by hypotension, decrease in mesenteric blood flow, heart rate and esophageal temperature.

OBJETIVO: Avaliar as alterações hemodinâmicas e sistêmicas decorrentes de isquemia e reperfusão (I/R) esplâncnica em ratos. MÉTODOS: Vinte ratos foram divididos em dois grupos: grupo controle: os animais foram submetidos à cirurgia, mas não a I/R e foram tratados com solução fisiológica (5 ml/kg/h) por 150 minutos; grupo I/R: os animais foram submetidos à administração contínua de solução fisiológica e à oclusão do tronco celíaco, artéria mesentérica superior e artéria mesentérica inferior por 30 minutos, seguidos por 120 minutos de reperfusão. Avaliou-se a pressão arterial média, pressão venosa, fluxo sangüíneo na aorta e na artéria mesentérica superior, freqüência cardíaca, temperatura esofágica e hematócrito. RESULTADOS: Durante a reperfusão, no grupo I/R, houve uma diminuição progressiva da pressão arterial média, fluxo sangüíneo na aorta e artéria mesentérica superior, freqüência cardíaca e temperatura esofágica; pressão venosa e hematócrito não sofreram alteração. CONCLUSÃO: O modelo de isquemia provocado por oclusão da artéria mesentérica superior, artéria mesentérica inferior e tronco celíaco por 30 minutos seguidos por 120 minutos de reperfusão provoca alterações sistêmicas evidenciadas por hipotensão, diminuição do fluxo sangüíneo mesentérico, da freqüência cardíaca e da temperatura esofágica.