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1.
Arq. bras. cardiol ; 118(2): 400-408, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364332

ABSTRACT

Resumo Fundamento Foi demonstrado que as subunidades de interleucina-35 (IL-35) estão fortemente expressas nas placas ateroscleróticas em humanos. Assim, considera-se que elas têm um papel na aterosclerose. Objetivos Neste estudo, os níveis de IL-35 foram comparados com o grupo controle em pacientes com doença arterial coronariana (DAC) estável, e a associação entre os níveis de IL-35 e o tipo, gravidade e extensão da lesão foram investigadas com o escore Gensini (GS) e o escore Syntax (SS) no grupo de pacientes Métodos Sessenta pacientes (18 mulheres e 42 homens) com DAC, diagnosticados por meio da angiografia coronária, que apresentaram dor no peito típica e teste de esforço não invasivo positivo, e 46 pacientes (18 mulheres e 28 homens) com luminograma normal, foram incluídos no estudo. Tanto o GS quanto o SS foram calculados para o grupo de pacientes, e esses valores foram comparados com os níveis de IL-35. Variáveis com distribuição não normal foram avaliadas com o teste U de Mann-Whitney, enquanto os parâmetros com distribuição normal foram analisados com o teste t de Student. A diferença entre as variáveis categóricas foi avaliada pelo teste de qui-quadrado ou de Fisher. Os valores de p<0,05 foram considerados como estatisticamente sinificativos. Resultados Não foram observadas diferenças significativas entre pacientes e o grupo controle em termos de características demográficas e achados laboratoriais. Em comparação ao grupo controle, os níveis de IL-35 no grupo com DAC foram consideravalmente menores (36,9±63,9 ng/ml vs. 33,2±13,2 ng/ml, p<0,008). Embora não tenha sido estatisticamente significativo, os níveis de IL-35 foram maiores em pacientes com SS mais baixo do que nos com SS mais alto (33,2±13,7 vs. 31,8±8,9, p=0,51). Os valores de IL-35 em pacientes com GS alto foram significativamente mais baixos do que em pacientes com GS baixo (35±17,4 vs. 30,7±8,6, p=0,043). Conclusão Demonstrou-se que os níveis de IL-35 podem ser um novo biomarcador para a DAC estável, e que a IL-35 está associada à extensão da DAC.


Abstract Background It has been shown that interleukin-35 (IL-35) subunits are strongly expressed in atherosclerotic plaques in humans. Therefore, it is considered to play a role in atherosclerosis. Objectives In this study, IL-35 levels were compared with the control group in patients with stable coronary artery disease (CAD), and the association between IL-35 levels and the lesion type, lesion severity and extension was investigated with the Gensini score (GS) and the Syntax score (SS) in the patient group. Methods Sixty patients (18 female and 42 male) with CAD diagnosed by coronary angiography, who presented with typical chest pain and positive noninvasive cardiac stress test, and 46 patients (18 female and 28 male) with normal coronary lumenogram, were included in this study. Gensini and Syntax scores were calculated in the patient group, and these values were compared with IL-35 levels. Non-normally distributed variables were analyzed by the Mann-Whitney U test, whereas normally distributed parameters were assessed by Student's t-test. The difference between categorical variables were evaluated by the Chi-square or Fisher test. P-values<0.05 were considered as statistically significant. Results No significant differences were observed between patients and the control group in terms of demographic characteristics and laboratory findings. Compared to the control group, IL-35 levels of the CAD group were considerably lower (36.9±63.9 ng/ml vs. 33.2±13.2 ng/ml, p<0.008). Although not statistically significant, IL-35 levels were higher in patients with low SS than among those with high SS (33.2±13.7 vs. 31.8±8.9, p=0.51). The IL-35 values of the patients with high GS were significantly lower than in patients with low GS (35±17.4 vs. 30.7±8.6, p=0.043). Conclusion It has been shown that IL-35 levels can be a new biomarker for stable CAD, and IL-35 is associated with the extension of CAD.


Subject(s)
Humans , Male , Female , Coronary Artery Disease/diagnosis , Interleukins/blood , Atherosclerosis/diagnosis , Severity of Illness Index , Biomarkers , Coronary Angiography
2.
Rev. cuba. med ; 60(3): e2134, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347515

ABSTRACT

Introducción: La aterosclerosis es la causa principal de enfermedad coronaria. Su presencia en la red vascular se manifiesta desde edades muy tempranas. Se asegura que está presente desde la vida intrauterina y se va haciendo cada vez mayor con el paso de los años, tanto por la acción del envejecimiento como por la presencia de otros factores que lo aceleran y perpetúan. La aterosclerosis subclínica es un término que debe ser usado para expresar que existe un grado de evidencia de lesión de la pared arterial sin expresión clínica. Objetivo: Identificar la presencia de aterosclerosis subclínica y su relación con factores de riesgo aterogénico. Método: Se realizó un estudio descriptivo de tipo transversal en trabajadores del Centro Internacional de Salud CIS La Pradera entre enero y diciembre de 2019. Resultados: Se detectó aterosclerosis subclínica en 129 pacientes (32,7 por ciento). Se asoció con la hipertensión, la diabetes mellitus, la dislipidemia y el hábito de fumar. Conclusiones: La enfermedad subclínica estuvo presente en los trabajadores de la salud, aparentemente sanos y jóvenes, que tuvieron al menos un factor de riesgo para la enfermedad aterosclerótica(AU)


Introduction: Atherosclerosis is the main cause of coronary disease. Its presence in the vascular network is shown from very early age. It is ensured that it is present from intrauterine life and becomes larger and larger over the years, both due to the action of aging and the presence of other factors that accelerate and perpetuate it. Subclinical atherosclerosis is a term that should be used to express that there is a degree of evidence of arterial wall injury without clinical appearance. Objective: To identify the presence of subclinical atherosclerosis and its relationship with atherogenic risk factors. Method: A descriptive cross-sectional study was carried out in workers of La Pradera International Health Center from January to December 2019. Results: Subclinical atherosclerosis was detected in 129 subjects (32.7 percent). It was associated with hypertension, diabetes mellitus, dyslipidemia, and smoking. Conclusions: Subclinical disease was present in health workers, apparently healthy and young, who had at least one risk factor for atherosclerotic disease(AU)


Subject(s)
Humans , Atherosclerosis/diagnosis , Heart Disease Risk Factors , Epidemiology, Descriptive , Cross-Sectional Studies
3.
Arq. bras. cardiol ; 114(2): 256-264, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088857

ABSTRACT

Abstract Background: The Instantaneous Wave-Free Ratio (iFR) is an invasive functional evaluation method that does not require vasoactive drugs to induce maximum hyperemia Objective: To evaluate the contribution of the iFR to the therapeutic decision-making of coronary lesions in the absence of non-invasive diagnostic methods for ischemia, or in case of discordance between these methods and coronary angiography. Method: We studied patients older than 18 years, of both sexes, consecutively referred for percutaneous treatment between May 2014 and March 2018. Coronary stenotic lesions were classified by visual estimation of the stenosis diameter into moderate (41-70% stenosis) or severe (71%-90%). An iFR ≤ 0.89 was considered positive for ischemia. Logistic regression was performed using the elastic net, with placement of stents as outcome variable, and age, sex, arterial hypertension, diabetes, dyslipidemia, smoking, family history, obesity and acute myocardial infarction (AMI) as independent variables. Classification trees, ROC curves, and Box Plot graphs were constructed using the R software. A p-value < 0.05 was considered statistically significant. Results: Fifty-two patients with 96 stenotic lesions (56 moderate, 40 severe) were evaluated. The iFR cut-off point of 0.87 showed a sensitivity of 0.57 and 1-specificity of 0.88, demonstrating high accuracy in reclassifying the lesions. Diabetes mellitus, dyslipidemia, and presence of moderate lesions with an iFR < 0.87 were predictors of stent implantation. Stents were used in 32% of lesions in patients with stable coronary artery disease and AMI with or without ST elevation (non-culprit lesions). Conclusion: The iFR has an additional value to the therapeutic decision making in moderate and severe coronary stenotic lesions, by contributing to the reclassification of lesions and decreasing the need for stenting.


Resumo Fundamento: Instantaneous Wave-Free Ratio (iFR) é um método de avaliação funcional invasiva sem necessidade de droga vasoativa para indução de hiperemia máxima. Objetivo: Analisar a contribuição do iFR na terapêutica das lesões coronarianas com ausência ou discrepância entre os métodos diagnósticos não invasivos para isquemia e a angiografia coronária. Método: Foram estudados pacientes consecutivos com 18 anos ou mais, ambos os sexos, no período de maio de 2014 a março de 2018, com lesões coronarianas classificadas, por medição da porcentagem de diâmetro da estenose através de estimativa visual, em estenoses moderadas (41-70%) ou graves (71%-90%). O iFR ≤ 0,89 foi considerado positivo para isquemia. Empregou-se regressão logística com elastic net, tendo como variável desfecho o emprego de stent, e variáveis independentes: idade, sexo, hipertensão arterial, diabetes, dislipidemia, tabagismo, história familiar, obesidade e infarto agudo do miocárdio (IAM) prévio. Foram construídas Árvores de Classificação, Curva Roc, e gráficos Box Plot com o software R. O valor de p < 0,05 foi considerado significativo. Resultados: Foram avaliados 52 pacientes com 96 lesões obstrutivas (56 moderadas, 40 graves). O ponto de corte do iFR de 0,87 apresentou sensibilidade de 0,57 e 1-especificidade de 0,88, demonstrando boa acurácia para a reclassificação das lesões. Diabetes mellitus, dislipidemia, e presença de lesão moderada, com iFR < 0,87 foram preditores do implante de stents. Foram empregados stents em 32% das lesões de portadores de doença arterial coronariana estável e IAM com e sem supra de ST (lesões não culpadas). Conclusão: O iFR contribui para a reclassificação das lesões e diminuição do emprego de stents, auxiliando na abordagem das lesões moderadas e severas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Cardiac Catheterization/methods , Myocardial Ischemia/diagnosis , Myocardial Ischemia/physiopathology , Reference Values , Severity of Illness Index , Logistic Models , Stents , Pilot Projects , Reproducibility of Results , Sensitivity and Specificity , Coronary Angiography/methods , Statistics, Nonparametric , Atherosclerosis/diagnosis , Atherosclerosis/physiopathology , Clinical Decision-Making
5.
Rev. medica electron ; 41(6): 1354-1366, oct.-dic. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1094135

ABSTRACT

RESUMEN Introducción: actualmente, la enfermedad ateroesclerótica está entre las principales causas de muerte, incapacidad y demencia en adultos mayores. Su causalidad es multifactorial, pero es indiscutible la relación de la dislipidemia con los riesgos de eventos cardiovasculares. Objetivo: dotar de información necesaria a pacientes, para modificar estilos de vida y lograr un impacto positivo en la reducción de la morbimortalidad, producida por enfermedades ateroescleróticas. Materiales y métodos: se aplicó un proyecto de intervención a través de acciones educativas a un grupo de pacientes adultos (n=234) con dislipidemia. Atendidos en la Unidad de Salud Oziel Montecristo, por el equipo I (blanco) del municipio de Campinas, Departamento de São Paulo. Entre enero a julio del 2016. Los participantes fueron sometidos a una encuesta antes y después de recibir la información. Resultados: el grupo etáreo que predominó fue entre 20-50 años con 55,5 %. La escolaridad primaria fue más significativa en el 41 %. Otros factores de riesgo reportados fue obesidad, 46,5 %; fumadores, 9,4 %; con etilismo crónico, 8,5 % y sedentarismo 71,7 %. Las enfermedades crónicas presentes fueron: hipertensión arterial, 53,4 %; diabetes mellitus, 40,5 %; cardiopatía isquémica y enfermedad renal crónica el 20,9 % y 9,4 %, respectivamente. Se lograron resultados positivos en el auditorio, un número importante de pacientes continuaron en los grupos terapéuticos. Conclusiones: los pacientes se apropiaron de conocimientos importantes sobre la dislipidemia, para practicar estilos de vida saludables, que disminuyan el riesgo de eventos cardiovasculares (AU).


ABSTRACT Introduction: currently, atherosclerotic disease is among the main causes of death, disability and dementia in elder people. It is caused by multiple factors, but it is indisputable the relation of dyslipidemia with the risk of cardiovascular events. Objective: to provide the necessary information to patients for them to modify life styles and achieving a positive impact in the reduction of the morbidity and mortality caused by atherosclerotic diseases. Materials and methods: an intervention project was applied through educative actions in a group of adult patients (n=234) with dyslipidemia, treated in the Health Unit ¨Oziel Montecristo¨, by the team I (white), of the municipality Campinas, São Paulo Department, from January to July 2016. The participants answered an inquiry before and after receiving the information. Results: the predominant age group was the 20-50 years one, with 55.5 %. Primary scholarship was the most significant (41 %). Other reported factors were obesity, 46.5 %; smoking, 9.4 %; chronic alcoholism, 8.5 %; and sedentary life style, 71.7 %. The chronic diseases found were: arterial hypertension, 53.4 %; diabetes mellitus, 40.5 %; ischemic heart disease, 20.9 %; and chronic renal disease, 9.4 %. Positive results were achieved in the audience; an important number of patients continued in therapeutic groups. Conclusions: the patients assimilated important knowledge on dyslipidemia, to practice healthy life styles decreasing the risk of cardiovascular events (AU).


Subject(s)
Humans , Adult , Middle Aged , Cardiovascular Diseases/mortality , Atherosclerosis/complications , Dyslipidemias/prevention & control , Health Programs and Plans , Patient Education as Topic , Risk Factors , Atherosclerosis/diagnosis , Dyslipidemias/etiology , Dyslipidemias/mortality , Early Medical Intervention , Healthy Lifestyle
6.
Arch. endocrinol. metab. (Online) ; 63(1): 16-21, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-989293

ABSTRACT

ABSTRACT Objective: In this study, we aimed to evaluate serum irisin and apelin levels in patients with subclinical hypothyroidism (SCH) when they were subclinical hypothyroid and become euthyroid after levothyroxine therapy and association of these adipokines with markers of atherosclerosis such as serum homocysteine levels and carotid intima-media thickness (IMT). Subjects and methods: The study included 160 patients with newly diagnosed subclinical hypothyroidism due to Hashimoto's thyroiditis and 86 euthyroid healty subjects. Serum glucose and lipid profile, insulin, HOMA, TSH, free T3, free T4, anti-thyroperoxidase and anti-thyroglobulin antibodies, homocysteine, apelin and irisin levels were measured in all study subjects. Thyroid and carotid ultrasound examinations were performed. The subclinical hypothyroid group was reevaluated after 12-weeks of levothyroxine therapy when they became euthyroid. Results: Clinical characteristics of the patient and control group were similar. Glucose, insulin and HOMA levels, lipid parameters and free T3 were similar between the two groups.. Serum homocystein was higher and apelin was lower in patients with SCH, but irisin levels were similar between the two groups. While thyroid volume was lower, carotid IMT was significantly greater in patients with SCH (pCarotidIMT:0,01). After 12-weeks of levothyroxine therapy, all the studied parameters remained unchanged except, serum freeT4, TSH, homocystein and apelin. While homocystein decreased (p: 0,001), apelin increased significantly (p = 0,049). In multivariate analysis, low apelin levels significantly contributed to carotid IMT (p = 0,041). Conclusions: Apelin-APJ system may play a role in vascular and cardiac dysfunction in patients with SCH and treatment of this condition may improve the risk of cardiovascular disease.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Fibronectins/blood , Atherosclerosis/etiology , Hashimoto Disease/complications , Apelin/blood , Hypothyroidism/complications , Thyroid Function Tests , Thyroxine/therapeutic use , Biomarkers/blood , Case-Control Studies , Prospective Studies , Atherosclerosis/diagnosis , Atherosclerosis/blood , Hashimoto Disease/drug therapy , Hashimoto Disease/blood , Carotid Intima-Media Thickness , Hypothyroidism/drug therapy , Hypothyroidism/blood
7.
Adv Rheumatol ; 59: 49, 2019. tab
Article in English | LILACS | ID: biblio-1088634

ABSTRACT

Abstract Background: To investigate the link between carbamylated low-density lipoprotein (ca-LDL), atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli's risk indices I and II (CRI I and II) and subclinic atherosclerosis in psoriatic arthritis (PsA). Methods: Thirty-ninepatients and 19 age, sex, body mass index matched healthy controls were included. Insulin resistance (IR) was assessed with homeostasis of model assessment-IR (HOMA-IR). Carotid intima-media thickness (CIMT) was measured at both common carotid arteries and mean CIMT was calculated. Results: The mean age was 49.50 ± 11.86 years and 64.1% were females in PsA group. In the PsA group, CIMT and HOMA-IR were significantly higher (p = 0.003, p = 0.043, respectively). AIP, AC, TG/HDL, CRI-1, CRI-2 and ca- LDL levels were similar between groups. In PsA group, CIMT was positively correlated with HOMA-IR, TG/HDL and AIP. Although ca-LDL was positively correlated with serum amyloid A (r = 0.744, p <0.001), no correlation was detected between ca-LDL and CIMT (r =0.215, p = 0.195). PsA patients with IR tended to have higher ca-LDL levels than patients without IR, but this difference lacked statistical significance (33.65 ± 26.94, 28.63 ± 28.06, respectively, p = 0.237). Conclusions: A significant increase in CIMT was seen in PsA patients without clinically evident cardiovascular disease or any traditional atherosclerosis risk factors. CIMT was correlated with HOMA-IR, TG/HDL and AIP.


Subject(s)
Humans , Arthritis, Psoriatic/physiopathology , Atherosclerosis/diagnosis , Diet, Atherogenic , Carotid Intima-Media Thickness , Lipoproteins, LDL/analysis
8.
Arq. bras. cardiol ; 110(5): 402-410, May 2018. tab, graf
Article in English | LILACS | ID: biblio-950159

ABSTRACT

Abstract Background: AIDS as well as atherosclerosis are important public health problems. The longer survival among HIV-infected is associated with increased number of cardiovascular events in this population, and this association is not fully understood. Objectives: To identify the frequency of subclinical atherosclerosis in HIV-infected patients compared to control subjects; to analyze associations between atherosclerosis and clinical and laboratory variables, cardiovascular risk factors, and the Framingham coronary heart disease risk score (FCRS). Methods: Prospective cross-sectional case-control study assessing the presence of subclinical atherosclerosis in 264 HIV-infected patients and 279 controls. Clinical evaluation included ultrasound examination of the carotid arteries, arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx), laboratory analysis of peripheral blood, and cardiovascular risk according to FCRS criteria. The significance level adopted in the statistical analysis was p < 0.05. Results: Plaques were found in 37% of the HIV group and 4% of controls (p < 0.001). Furthermore, carotid intima-media thickness was higher in the HIV group than in controls (p < 0.001). Patients with carotid plaque had higher fasting glucose, total cholesterol, low-density lipoprotein cholesterol, and triglycerides than those without plaques. The presence of HIV, adjusted for age, overweight/obesity, and smoking increased by almost fivefold the risk of atherosclerotic carotid plaque (OR: 4.9; 95%CI: 2.5-9.9; p < 0.001). Exposure to protease inhibitors did not influence carotid intima-media thickness, was not associated with carotid plaque frequency, and did not alter the mechanical characteristics of the arterial system (PWV and AIx). Conclusions: HIV-infected patients are at increased risk of atherosclerosis in association with classical cardiovascular risk factors. Treatment with protease inhibitors does not promote functional changes in the arteries, and shows no association with increased frequency of atherosclerotic plaques in carotid arteries. The FCRS may be inappropriate for this population.


Resumo Fundamento: Aterosclerose e AIDS são importantes problemas de saúde pública. A maior sobrevida de indivíduos infectados pelo HIV acha-se associada com maior número de eventos cardiovasculares nessa população, mas tal associação ainda não foi completamente esclarecida. Objetivos: Identificar a frequência de aterosclerose subclínica em pacientes infectados pelo HIV em comparação a controles; analisar as associações entre aterosclerose e variáveis clínicas e laboratoriais, fatores de risco cardiovascular e escore de risco de Framingham (ERF) para doença coronariana. Métodos: Estudo prospectivo transversal caso-controle avaliando a presença de aterosclerose subclínica em 264 pacientes infectados pelo HIV e 279 controles. A avaliação clínica incluiu ultrassonografia das artérias carótidas, análise da rigidez arterial através da velocidade de onda de pulso (VOP) e augmentation index (AIx), exames laboratoriais do sangue periférico e determinação do risco cardiovascular segundo os critérios do ERF. O nível de significância adotado na análise estatística foi p < 0,05. Resultados: Placas foram identificadas em 37% do grupo infectado pelo HIV e em 4% dos controles (p < 0,001). A espessura médio-intimal carotídea foi maior no grupo HIV do que nos controles (p < 0,001). Pacientes com placa carotídea apresentaram maiores níveis de glicemia de jejum, colesterol total, colesterol da lipoproteína de baixa densidade e triglicérides do que aqueles sem placas. A presença do HIV, ajustada por idade, sobrepeso/obesidade e tabagismo aumentou em quase cinco vezes o risco de placa aterosclerótica carotídea (OR: 4,9; IC95%: 2,5-9,9; p < 0,001). Exposição aos inibidores da protease não influenciou a espessura médio-intimal carotídea, não se associou com frequência de placa carotídea e não alterou as características mecânicas do sistema arterial (VOP e AIx). Conclusões: Pacientes infectados pelo HIV apresentam maior risco de aterosclerose na associação com os clássicos fatores de risco cardiovascular. Tratamento com os inibidores da protease não promove alterações funcionais nas artérias, nem se associa com maior frequência de placas ateroscleróticas carotídeas. O ERF pode ser inadequado para essa população.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , HIV Infections/epidemiology , Atherosclerosis/epidemiology , Plaque, Atherosclerotic/epidemiology , Brazil/epidemiology , Carotid Arteries/physiopathology , Case-Control Studies , HIV Infections/complications , HIV Infections/drug therapy , Cross-Sectional Studies , Prospective Studies , Risk Factors , Age Factors , Atherosclerosis/diagnosis , Atherosclerosis/etiology , Plaque, Atherosclerotic/diagnosis , Plaque, Atherosclerotic/etiology
9.
Int. j. cardiovasc. sci. (Impr.) ; 31(1): f:47-l:55, jan.-mar. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-883765

ABSTRACT

Fundamento: A Doença Arterial Periférica (DAP) está associada a eventos cardiovasculares, podendo ser diagnosticada e estimada através do Índice Tornozelo-Braquial (ITB). Está bem estabelecido que o ITB é fator agravante na estratificação de risco cardiovascular, mas sua contribuição para definir a gravidade do acometimento arterial coronariano não está bem estabelecida. Objetivos: Estudo testou o valor do ITB com a gravidade da doença aterosclerótica coronariana pelo Escore de Syntax (ES) em pacientes com Síndrome Coronariana Aguda (SCA). Métodos: Estudo prospectivo com medida do ITB de todos os pacientes internados com SCA no Hospital São Lucas da PUCRS, consecutivamente, de maio a setembro de 2016, e comparação de seu valor com o ES e tipos de SCA desses pacientes. As análises foram realizadas considerando-se o nível de confiança de 95% ( α = 5%). Resultados: 101 pacientes, com média de idade de 62,6±12,0 anos, 58 (57,4%) masculinos, 74 (82,2%) hipertensos, 33 (45,8%) diabéticos e 46 (45,5%) com infarto agudo do miocárdio com supradesnivelamento do ST (IAMCSST). A gravidade da DAP não teve relação com a gravidade anatômica da doença arterial coronariana (DAC). Encontramos uma associação significativa de ES intermediário com infarto agudo do miocárdio sem supradesnivelamento do ST (IAMSSST) e de ES baixo com angina instável (AI) [OR (IC95%): 1,11 (1,03-1,20); p = 0,004], que se manteve após análise multivariada, ajustada para idade, tabagismo, história familiar de DAC e DAC prévia [OR (IC95%): 1,13 (1,02-1,25); p = 0,019]. Conclusões: Analisando nossos resultados, encontramos que pacientes com ITB < 0,9 não apresentaram associação com maior complexidade determinada pelo ES em pacientes com SCA. Os pacientes com IAMSSST estiveram mais associados com ES intermediário


DOI: 10.5935/2359-4802.20170094 47 International Journal of Cardiovascular Sciences. 2018;31(1)47-55 ARTIGO ORIGINAL Correspondência: Andrea Mabilde Petracco Av. Ipiranga, 7464, sala 524. CEP: 91530-000, Jardim Botânico, Porto Alegre, RS ­ Brasil. E-mail: apetracco@terra.com.br; apetracco@cardiol.br Avaliação da Relação do Índice Tornozelo-Braquial com a Gravidade da Doença Arterial Coronária Assessment of the Relationship of Ankle-Brachial Index With Coronary Artery Disease Severity Andrea Mabilde Petracco, Luiz Carlos Bodanese, Gustavo Farias Porciúncula, Gabriel Santos Teixeira, Denise de Oliveira Pellegrini, Luiz Claudio Danzmann, Ricardo Medeiros Pianta, João Batista Petracco Hospital São Lucas, da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS ­ Brasil Artigo recebido em 28/02/2017; revisado em 12/08/2017; aceito em 21/08/2017 Resumo Fundamento: A Doença Arterial Periférica (DAP) está associada a eventos cardiovasculares, podendo ser diagnosticada e estimada através do Índice Tornozelo-Braquial (ITB). Está bem estabelecido que o ITB é fator agravante na estratificação de risco cardiovascular, mas sua contribuição para definir a gravidade do acometimento arterial coronariano não está bem estabelecida. Objetivos: Estudo testou o valor do ITB com a gravidade da doença aterosclerótica coronariana pelo Escore de Syntax (ES) em pacientes com Síndrome Coronariana Aguda (SCA). Métodos: Estudo prospectivo com medida do ITB de todos os pacientes internados com SCA no Hospital São Lucas da PUCRS, consecutivamente, de maio a setembro de 2016, e comparação de seu valor com o ES e tipos de SCA desses pacientes. As análises foram realizadas considerando-se o nível de confiança de 95% ( α = 5%). Resultados: 101 pacientes, com média de idade de 62,6±12,0 anos, 58 (57,4%) masculinos, 74 (82,2%) hipertensos, 33 (45,8%) diabéticos e 46 (45,5%) com infarto agudo do miocárdio com supradesnivelamento do ST (IAMCSST). A gravidade da DAP não teve relação com a gravidade anatômica da doença arterial coronariana (DAC). Encontramos uma associação significativa de ES intermediário com infarto agudo do miocárdio sem supradesnivelamento do ST (IAMSSST) e de ES baixo com angina instável (AI) [OR (IC95%): 1,11 (1,03-1,20); p = 0,004], que se manteve após análise multivariada, ajustada para idade, tabagismo, história familiar de DAC e DAC prévia [OR (IC95%): 1,13 (1,02-1,25); p = 0,019]. Conclusões: Analisando nossos resultados, encontramos que pacientes com ITB < 0,9 não apresentaram associação com maior complexidade determinada pelo ES em pacientes com SCA. Os pacientes com IAMSSST estiveram mais associados com ES intermediário. (Int J Cardiovasc Sci. 2018;31(1)47-55) Palavras-chave: Índice Tornozelo-Braço, Síndrome Coronariana Aguda, Doença da Artéria Coronariana, Índice de Severidade da Doença, Aterosclerose, Doença Arterial Periférica. Abstract Background: Peripheral Artery Disease (PAD) is associated with cardiovascular events and can be diagnosed and estimated by use of the Ankle-Brachial Index (ABI). ABI is a worsening factor in the stratification of cardiovascular risk, but its contribution to define the severity of coronary artery disease has not been well established. Objectives: To compare the ABI value with the coronary atherosclerotic disease severity by use of the Syntax Score (SS) in patients with Acute Coronary Syndrome (ACS). Methods: This prospective study measured the ABI of all patients with ACS consecutively admitted to the São Lucas Hospital of PUCRS from May to September 2016, and compared the ABI values with the SS and ACS types of those patients. The analyzes were performed considering the 95%confidence interval ( α = 5%). Results: This study assessed 101 patients [mean age, 62.6 ± 12.0 years; 58 men (57.4%)], 74 (82.2%) were hypertensive, 33 (45.8%) had diabetes and 46 (45,5%) had ST-elevation acute myocardial infarction (STEMI). The PAD severity was not related to the anatomical severity of the coronary artery disease (CAD). We found a significant association of intermediate SS with non-ST-elevation acute myocardial infarction (NSTEMI), and of low SS with unstable angina (UA) [OR (95% CI): 1.11 (1.03-1.20) (p = 0.004)], which remained after multivariate analysis adjusted to age, smoking, family history of CAD and previous CAD [(OR 95%): 1.13 (1.02-1.25) (p = 0.019)]. Conclusions: Patients with ABI < 0.9 showed no association with higher disease complexity determined by the SS in patients with ACS. Patients with NSTEMI were more associated with an intermediate risk on the SS


Subject(s)
Humans , Male , Female , Middle Aged , Ankle Brachial Index , Coronary Artery Disease/mortality , Severity of Illness Index , Acute Coronary Syndrome/complications , Analysis of Variance , Atherosclerosis/complications , Atherosclerosis/diagnosis , Chest Pain/complications , Diabetes Mellitus , Electrocardiography/methods , Myocardial Infarction/complications , Peripheral Arterial Disease , Data Interpretation, Statistical , Surveys and Questionnaires , Tobacco Use Disorder/complications
10.
Rev. medica electron ; 39(4): 871-883, jul.-ago. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-902209

ABSTRACT

Introducción: la periodontitis y la infección subgingival anaerobia asociada representan injuria metastásica que disemina mediadores inflamatorios favorecedores de la ateroesclerosis. La alta tasa de mortalidad por enfermedades cardíacas y cerebrovasculares en Cuba demanda estudios sobre factores de riesgo emergentes, para dirigir esfuerzos a su prevención y control. Objetivo: caracterizar la asociación entre enfermedad periodontal inmunoinflamatoria crónica (EPIC) y un grupo de enfermedades derivadas de la aterosclerosis. Materiales y Métodos: entre enero y marzo del 2017 se realizó un estudio transversal descriptivo, de casos y controles, en el consultorio No 13 del Policlínico "19 de Abril", municipio Plaza de la Revolución. Se conformó el grupo de casos con pacientes que padecieron enfermedades seleccionadas derivadas de la ateroesclerosis; el grupo de controles con sujetos que no las habían presentado. Se homologaron según edad, sexo y color de la piel. Se exploraron factores de riesgo ateroescleróticos y prevalencia y severidad de la EPIC según el Índice Periodontal Revisado. Se respetaron normativas bioéticas para investigaciones biomédicas. Se emplearon medidas de resumen para datos cualitativos y la prueba de independencia de chi-cuadrado (x2) para variables cualitativas. Resultados: existió igual cantidad de hombres que de mujeres, mayoritariamente blancos, entre 61 y 70 años. Las complicaciones ateroescleróticas más frecuentes fueron la angina de pecho y el infarto del miocardio. El factor de riesgo más común fue la hipertensión arterial. Solo hubo 3 pacientes sanos según la Periodoncia. Conclusiones: la asociación entre la EPIC y el grupo de enfermedades estudiadas derivadas de la aterosclerosis no fue estadísticamente significativa (AU).


Introduction: Periodontitis and its associated anaerobic subgingival infection represent metastatic injury that disseminates inflammatory mediators, which favor atherosclerosis. The high mortality rate for heart and cerebrovascular diseases in Cuba requires studies on emerging risk factors to direct efforts to their control and prevention. Objective: To characterize the association between chronic immune inflammatory periodontal disease (CIIPD) and some entities derived from atherothrombotic disease. Materials and Methods: Between January and March 2017, a cross - sectional descriptive study of cases and controls was carried out in the Medical Office # 13 of the Policlinic "19 de Abril", municipality of Plaza de la Revolución. The cases group was formed with patients who have suffered the chosen diseases derived from arteriosclerosis. The control group was formed by 1 X 1 mating, with subjects who had not presented diseases derived from atherosclerosis. They were validated according to age, sex and skin color. Atherosclerotic risk factors were explored, and also the prevalence and severity of CIIPD according to the Revised Periodontal Index. Bioethical principles and regulations for biomedical research were fulfilled. Summary measures were used for qualitative data and independent chi square test (X2) for qualitative variables. Results: The amount of men and women was the same, mostly white persons, aged 61-70 years. The most frequent atherosclerotic complications were angina pectoris and myocardial infarction. The most common risk factor was hypertension. From the point of view of Periodontics, there were only 3 healthy patients. Conclusions: The association among CIIPD and the chosen diseases derived from arteriosclerosis was not statiscally significant (AU).


Subject(s)
Humans , Male , Female , Periodontal Diseases/complications , Risk Factors , Atherosclerosis/complications , Periodontal Diseases/diagnosis , Periodontal Diseases/pathology , Periodontal Diseases/epidemiology , Periodontics/methods , Periodontitis/complications , Periodontitis/diagnosis , Observational Studies as Topic , Atherosclerosis/diagnosis , Atherosclerosis/pathology
11.
Faludi, André Arpad; Izar, Maria Cristina de Oliveira; Saraiva, José Francisco Kerr; Chacra, Ana Paula Marte; Bianco, Henrique Tria; Afiune Neto, Abrahão; Bertolami, Adriana; Pereira, Alexandre C; Lottenberg, Ana Maria; Sposito, Andrei C; Chagas, Antonio Carlos Palandri; Casella Filho, Antonio; Simão, Antônio Felipe; Alencar Filho, Aristóteles Comte de; Caramelli, Bruno; Magalhães, Carlos Costa; Negrão, Carlos Eduardo; Ferreira, Carlos Eduardo dos Santos; Scherr, Carlos; Feio, Claudine Maria Alves; Kovacs, Cristiane; Araújo, Daniel Branco de; Magnoni, Daniel; Calderaro, Daniela; Gualandro, Danielle Menosi; Mello Junior, Edgard Pessoa de; Alexandre, Elizabeth Regina Giunco; Sato, Emília Inoue; Moriguchi, Emilio Hideyuki; Rached, Fabiana Hanna; Santos, Fábio César dos; Cesena, Fernando Henpin Yue; Fonseca, Francisco Antonio Helfenstein; Fonseca, Henrique Andrade Rodrigues da; Xavier, Hermes Toros; Mota, Isabela Cardoso Pimentel; Giuliano, Isabela de Carlos Back; Issa, Jaqueline Scholz; Diament, Jayme; Pesquero, João Bosco; Santos, José Ernesto dos; Faria Neto, José Rocha; Melo Filho, José Xavier de; Kato, Juliana Tieko; Torres, Kerginaldo Paulo; Bertolami, Marcelo Chiara; Assad, Marcelo Heitor Vieira; Miname, Márcio Hiroshi; Scartezini, Marileia; Forti, Neusa Assumpta; Coelho, Otávio Rizzi; Maranhão, Raul Cavalcante; Santos Filho, Raul Dias dos; Alves, Renato Jorge; Cassani, Roberta Lara; Betti, Roberto Tadeu Barcellos; Carvalho, Tales de; Martinez, Tânia Leme da Rocha; Giraldez, Viviane Zorzanelli Rocha; Salgado Filho, Wilson.
Arq. bras. cardiol ; 109(2,supl.1): 1-76, ago. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-887919
12.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(2): 88-95, abr.-jun. 2017. ilus, graf
Article in Portuguese | LILACS | ID: biblio-847873

ABSTRACT

O escore de cálcio coronariano (CAC) é obtido por meio de tomografia de tórax sem contraste, acoplada a eletrocardiograma com baixa dose de radiação e baixo custo. Atualmente, acessível na grande maioria de tomógrafos de múltiplos detectores, o exame tem como objetivo a identificação da carga de aterosclerose associada à presença de cálcio na topografia das artérias coronárias. Seu valor diagnóstico e prognóstico para doença arterial coronária subclínica foi demonstrado em diversos estudos pregressos envolvendo dezenas de milhares de pacientes com seguimento prolongado, de até 15 anos. O escore de cálcio mostrou-se superior aos escores clínicos tradicionais na predição de eventos cardiovasculares em indivíduos assintomáticos, sobretudo naqueles com risco intermediário pré-teste, em que pode haver dúvida sobre a melhor abordagem de tratamento. O achado de um escore de cálcio zero está associado a um risco cardiovascular significativamente baixo, enquanto um escore elevado re-estratifica o indivíduo para uma classe de risco superior. Grande parte das diretrizes clínicas indica o exame exatamente neste paciente ou nos indivíduos com risco inicial mais baixo, mas com antecedente familiar fortemente positivo. Embora não haja trabalhos randomizados com desfechos clínicos primários guiados pelo CAC, ao menos três estudos prospectivos demonstraram benefícios com seu uso, além dos inúmeros trabalhos observacionais e estudos de coorte que demonstraram excelente valor prognóstico. Recentemente, recomendações de como guiar a terapia de prevenção primária de acordo com o resultado do escore de cálcio foram publicadas com base em opiniões de especialistas, e uma proposta de estudo randomizado vem sendo discutida de forma intensa. Finalmente, o escore de cálcio também passou a ser visto como possível indicação para complementar outros exames, como tomografia de tórax, avaliação pulmonar ou em associação com exames funcionais, além de aumento de adesão à terapia


The coronary artery calcium score (CAC) is obtained through a computed tomography (CT) of the chest without the need for contrast, coupled with low radiation dose electrocardiogram and low cost. The exam is currently available in most multidetector tomographs, and its objective is to identify coronary atherosclerotic burden associated with the presence of calcium in the topography of the coronary arteries. Its diagnostic and prognostic value for subclinical coronary arterial disease has been demonstrated in many studies involving tens of thousands of patients, with long follow-up times of more than 15 years. The calcium score has been shown to be superior to most traditional clinical scores for predicting cardiovascular events in asymptomatic individuals, particularly those with moderate pre-test risk, where there might be more uncertainty in selecting the best treatment approach. A finding of a calcium score of zero is associated with a very low cardiovascular risk, while a high score re-stratifies an individual to a higher risk class. Most of the clinical guidelines recommend the exam in these patients, or in individuals with an initial low risk category but a strong positive familiar history for cardiovascular disease. Although there are currently no randomized controlled trials with outcomes guided by the use of CAC, at least three prospective studies have demonstrated the benefits of its use, and numerous observational works and cohort studies have demonstrated its excellent prognostic value. Recently, recommendations on how to guide primary preventive therapy based on the results of the calcium score have been published based on specialist opinions, and a randomized controlled trial is now in advanced discussions. Finally, the calcium score is now seen as a possible indication to complement other exams, such as chest CT, pulmonary evaluation, or in association with other functional stress exams, and adhesion to therapy has increased


Subject(s)
Humans , Tomography, X-Ray Computed/methods , Calcium/analysis , Coronary Vessels , Atherosclerosis/diagnosis , Prognosis , Radiation , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Calcification, Physiologic , Predictive Value of Tests , Dyslipidemias , Heart Rate
13.
J. vasc. bras ; 16(2): f:150-l:161, abr.-jun. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-859624

ABSTRACT

A doença renovascular aterosclerótica é a principal causa de hipertensão secundária. A história natural da doença demonstra taxas de progressão de 4 a 12% ao ano. Entre os métodos de tratamento existe a angioplastia com stent de artérias renais; porém, poucos estudos clínicos demonstraram seus resultados a longo prazo. Esta revisão sistemática da literatura se propõe a apresentar os resultados a longo prazo (acima de 24 meses) da angioplastia com stent de artérias renais na doença aterosclerótica em relação à função renal e aos níveis pressóricos no controle da hipertensão. Foi realizada uma ampla pesquisa, utilizando os termos apropriados, nas bases de dados LILACS, EMBASE, SCIELO, Cochrane Library e MEDLINE. De um total de 2.170 referências, apenas sete artigos contemplavam todos os critérios de inclusão. Conclui-se que, a longo prazo, há uma estabilização da função renal, redução dos níveis pressóricos e diminuição do número de classes de medicamentos anti-hipertensivos


Atherosclerotic renovascular disease is the most important cause of secondary hypertension. The natural history of the disease reveals progression rates of 4 to 12% per year. Angioplasty with renal artery stenting is one treatment option; but there are few studies that have reported long-term results. The objective of this systematic literature review is to discuss the long-term results (at least 24 months) of angioplasty with stenting of renal arteries for atherosclerotic disease, in terms of renal function and blood pressure levels for control of hypertension. A thorough search was conducted of LILACS, EMBASE, SCIELO, Cochrane Library, and MEDLINE using the appropriate terms. Just seven out of 2170 references identified met all inclusion criteria. It was concluded that over the long term renal function was stabilized, blood pressure levels were reduced, and the number of classes of antihypertensive medication decreased


Subject(s)
Humans , Male , Female , Aged , Angioplasty/methods , Atherosclerosis/diagnosis , Atherosclerosis/therapy , Renal Artery Obstruction/diagnosis , Renal Artery Obstruction/therapy , Stents , Treatment Outcome , Antihypertensive Agents/therapeutic use , Database , Hypertension, Renovascular/diagnosis , Hypertension, Renovascular/therapy , Kidney Diseases/diagnosis , Kidney Diseases/therapy , Renal Artery , Sex Factors
14.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 26(3): 158-161, jul.-set. 2016. tab
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-832378

ABSTRACT

A doença aterosclerótica compreende amplo espectro de entidades clínicas com envolvimento genético e ambiental. A exposição ao longo da vida a níveis elevados de colesterol e de sua fração LDL determinam um limiar a partir do qual a doença aterosclerótica se desenvolve. Assim, nas formas genéticas de dislipidemias, como a hipercolesterolemia familiar, a idade do aparecimento da doença aterosclerótica vai depender da carga cumulativa de exposição aos níveis de LDL-colesterol, sendo tanto mais precoce quanto maiores os níveis de LDL-colesterol e a presença de fatores de risco adicionais, e mais tardia na ausência destes, e no sexo feminino. A prevenção ao longo da vida parece ser extremamente efetiva, e a avaliação individual com a implementação de medidas preventivas precoces e terapêuticas deve ser estimulada. Assim, parece lógico que reduções de colesterol, por mudanças no estilo de vida ou pelo uso de fármacos na adolescência e ao longo da vida apresentem inestimável benefício para a redução dos desfechos cardiovasculares na vida adulta


The atherosclerotic process comprises a broad spectrum of clinical entities, with genetic and environmental involvement. Lifetime exposure to high levels of cholesterol and LDL-cholesterol determine a trigger that can lead to the development of atherosclerotic disease. Therefore, in genetic forms of dyslipidemia, such as familial hypercholesterolemia, the age of onset of atherosclerotic disease will depend on the cumulative burden of exposure to LDL-cholesterol levels, being earlier with higher levels of LDL-cholesterol, the presence of other risk factors and later, in the absence of risk factors, and in females. Prevention throughout life appears to be extremely effective, and individual assessment, with the implementation of early preventive measures, should be encouraged. Thus, it seems logical that cholesterol reductions, changes in lifestyle, or the use of specific medications in adolescence and throughout life present inestimable benefit in reducing cardiovascular outcomes in adulthood


Subject(s)
Humans , Male , Female , Coronary Artery Disease/physiopathology , Cholesterol/blood , Risk Factors , Diagnosis, Differential , Quality of Life , Cardiovascular Diseases/prevention & control , Sex Factors , Chronic Disease , Age Factors , Atherosclerosis/complications , Atherosclerosis/diagnosis , Hypercholesterolemia/complications , Hypercholesterolemia/therapy , Life Style , Lipoproteins, LDL/analysis , Cholesterol, LDL/analysis , Cholesterol, LDL/blood
16.
Rev. cuba. angiol. cir. vasc ; 17(1): 0-0, ene.-jun. 2016. ilus
Article in Spanish | LILACS | ID: lil-783747

ABSTRACT

Introducción: las enfermedades cardiovasculares son la principal causa de muerte prematura en la mayoría de las poblaciones del mundo; y Venezuela no escapa de ello, es el factor de mayor morbilidad y pérdida de la calidad de vida. Se ha planteado que es la aterosclerosis la causa subyacente de estas enfermedades. Objetivos: determinar el comportamiento de los factores de riesgo aterogénico en población adulta venezolana. Métodos: investigación observacional, descriptiva, de corte transversal en muestra de 340 personas, de 50 años y más de ambos sexos. Las variables fueron: la edad, sexo, tensión arterial, hábito de fumar, sedentarismo, estado nutricional y el alcoholismo. Se aplicó una encuesta a los pacientes y las respuestas se recogieron en un modelo diseñado con ese objetivo. A todos se les tomó el peso y la talla para calcular el índice de masa corporal. Los datos fueron analizados en modelo estadístico. Resultados: el sexo femenino fue la población mayoritaria. El 35,9 por ciento conocía que eran hipertensos, pero el 26,5 por ciento no lo sabía, fueron considerados como casos nuevos. El 60,9 por ciento presentaba tabaquismo, el 73,5 por ciento eran sedentarios, el 32,9 por ciento tenía sobrepeso y el 47,9 por ciento obesos. Presentaba la asociación de cuatro factores de riesgo el 39,7 por ciento; contribuyendo a este resultado la tensión arterial alta, el sedentarismo, el hábito de fumar y el alcoholismo Conclusiones: el encontrar cuatro factores de riesgo cardiovasculares en la población general, sugiere el abordaje de una estrategia global para la prevención de estas enfermedades y reducción de su incidencia(AU)


Introduction: cardiovascular illnesses are the main cause of premature death worldwide and Venezuela is not the exception since they are the highest morbidity and low quality of life factor. It has been said that atherosclerosis is their underlying cause. Objectives: to determine the behavior of atherogenic risk factors in the Venezuelan adult population. Methods: cross-sectional, observational and descriptive research study carried out in a sample of 340 patients aged 50 years and over of both sexes. The study variables were age, sex, blood pressure, smoking, sedentary lifestyle, nutritional status and alcoholism. The patients were surveyed and their answers were collected in a model designed to this end. Their weight and size measurements were used to estimate their body mass index. Data were analyzed using the usual statistical models. Results: females prevailed in the sample. In the group, 35.9 percent knew about their hypertension, but 26.5 percent did not, so they were considered as new cases. Smoking affected 60.9 percent, 73.5 percent had sedentary lifestyle, 32.9 percent were overweighed and 47.9 percent obese. Four risk factors were related in 39.7 percent of these patients and contributing to this result were blood hypertension, sedentary lifestyle, smoking, alcoholism and obesity. Conclusions: the finding of four cardiovascular risk factors in the general population indicates that a global prevention strategy to reduce the incidence of such diseases should be implemented(AU)


Subject(s)
Adult , Atherosclerosis/diagnosis , Cardiovascular Diseases/complications , Risk Factors , Cross-Sectional Studies , Epidemiology, Descriptive , Observational Study , Venezuela/ethnology
17.
Rev. bras. cardiol. invasiva ; 23(2): 134-138, abr.-jun. 2016. ilus, tab
Article in Portuguese | LILACS | ID: lil-786997

ABSTRACT

Introdução: A reconstrução tridimensional coronária com a combinação do ultrassom intracoronário e da angiografia apresenta vantagens em relação à angiotomografia de coronárias. Objetivamos apresentara fase piloto de validação de um novo modelo de reconstrução tridimensional de artérias coronárias. Métodos: Foram utilizados exames de angiografia e ultrassom intracoronário já realizados por indicação clínica em indivíduos com suspeita ou diagnóstico de doença arterial coronária estável. O processamento das imagens, a segmentação e a reconstrução tridimensional foram realizados seguindo metodologia específica. Para fins de caracterização geométrica, foram obtidas as linhas de centro tridimensionais. Resultados: Foram reconstruídos três vasos, sendo duas artérias descendentes anteriores e uma artéria circunflexa. O volume da luz do vaso e a carga de placa global puderam ser visualizados com facilidade com a reconstrução tridimensional. A caracterização geométrica revelou aumento dos valores absolutos do comprimento, tortuosidade, curvatura e torsão, caracterizando uma maior complexidade da linha de centro da luz doente, em relação à linha de centro da membrana elástica externa. Conclusões: Essa nova metodologia, que integrou angiografia convencional e ultrassom intracoronário, aumentou a praticidade das reconstruções, com ganho em acurácia volumétrica do vaso e visualização global de aspectos-chave da doença aterosclerótica, como remodelamento e distribuição da placa.


Background: Coronary three-dimensional reconstruction with the combination of intravascular ultrasound and angiography offers advantages over computed tomography angiography of coronary arteries. The authors aimed to present the pilot phase of the validation of a new model of three-dimensional reconstruction of coronary arteries. Methods: This study used angiography and intravascular ultrasound examinations already performed by clinical indication in individuals with known or suspected stable coronary artery disease. Image processing, segmentation, and three-dimensional reconstruction were conducted following specific methodology. For geometrical characterization purposes, tridimensional center lines were obtained. Results: Three vessels were reconstructed: two left anterior descending arteries and one left circumflex artery. The vessel lumen volume and the overall plaque burden could be easily viewed with threedimensional reconstruction. The geometric characterization revealed increased absolute values of length, tortuosity, curvature, and torsion, featuring a greater complexity of the center line of the diseased lumen relative to the center line of the external elastic membrane. Conclusions: This new methodology, which integrates conventional angiography and intravascular ultrasound, has increased the practicality of the reconstructions, with a gain in volumetric accuracy of the vessel and overall visualization of key aspects of atherosclerotic disease, such as plaque remodeling and distribution.


Subject(s)
Humans , Coronary Angiography/methods , Imaging, Three-Dimensional/methods , Ultrasonography, Interventional/methods , Coronary Vessels , Atherosclerosis/diagnosis , Atherosclerosis/therapy , Catheters
18.
Braz. j. med. biol. res ; 49(12): e5734, 2016. tab
Article in English | LILACS | ID: biblio-828180

ABSTRACT

The ankle-brachial index (ABI) is a marker of subclinical atherosclerosis related to health-adverse outcomes. ABI is inexpensive compared to other indexes, such as coronary calcium score and determination of carotid artery intima-media thickness (IMT). Our objective was to identify how the ABI can be applied to primary care. Three different methods of calculating the ABI were compared among 13,921 men and women aged 35 to 74 years who were free of cardiovascular diseases and enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The ABI ratio had the same denominator for the three categories created (the highest value for arm systolic blood pressure), and the numerator was based on the four readings for leg systolic blood pressure: the highest (ABI-HIGH), the mean (ABI-MEAN), and the lowest (ABI-LOW). The cut-off for analysis was ABI<1.0. All determinations of blood pressure were done with an oscillometric device. The prevalence of ABI<1% was 0.5, 0.9, and 2.7 for the categories HIGH, MEAN and LOW, respectively. All methods were associated with a high burden of cardiovascular risk factors. The association with IMT was stronger for ABI-HIGH than for the other categories. The proportion of participants with a 10-year Framingham Risk Score of coronary heart disease >20% without the inclusion of ABI<1.0 was 4.9%. For ABI-HIGH, ABI-MEAN and ABI-LOW, the increase in percentage points was 0.3, 0.7, and 2.3%, respectively, and the relative increment was 6.1, 14.3, and 46.9%. In conclusion, all methods were acceptable, but ABI-LOW was more suitable for prevention purposes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Ankle Brachial Index/methods , Atherosclerosis/diagnosis , Atherosclerosis/complications , Cardiovascular Diseases/etiology , Longitudinal Studies , Predictive Value of Tests , Risk Factors , Socioeconomic Factors
19.
Rev. Soc. Bras. Clín. Méd ; 14(2): 75-78, 2016.
Article in English | LILACS | ID: biblio-1246

ABSTRACT

Objective: To evaluate serum concentrations of interleukin 17A (IL17A) in mansonic schistosomiasis patients, while the secondary objectives were to detect atherosclerotic disease, and to evaluate serum concentrations of interleukin 22 (IL22). Methods: This study included 30 patients with an established diagnosis of hepatosplenic mansonic schistosomiasis and 10 healthy volunteers. Comparative analyses of IL17A and IL22 concentrations were performed on the sera of patients and controls. Atherosclerosis was evaluated through carotid artery intima-media thickness measurement of the first 15 patients enrolled. Results: There were no differences in IL17 A concentrations (15.63±0.00pg/mL vs. 15.63±0.00pg/mL; p=1) and in IL22 concentrations (7.81±0.00pg/mL vs. 7.81±0.00pg/ mL, p=1) between patients and controls. The overall mean of intima-media thickness was 0.7±0.2mm. Conclusions: Serum concentrations of IL17A and IL22 were equal between patients and controls (undetectable or low concentrations). No patients had atheroma.


Objetivo: Avaliar as concentrações séricas de interleucina 17A (IL17A) em pacientes com esquistossomose mansônica, enquanto os objetivos secundários foram detectar a doença aterosclerótica e avaliar as concentrações séricas de interleucina 22 (IL22). Métodos: Este estudo incluiu 30 pacientes com diagnóstico estabelecido de esquistossomose mansônica em sua forma hepatoesplênica e 10 voluntários saudáveis. Análises comparativas de concentrações de IL17A e IL22 foram realizadas em soros de pacientes e controles. A aterosclerose foi avaliada pela medida do complexo íntima-média dos primeiros 15 pacientes recrutados. Resultados: Não houve diferença nas concentrações de IL17A (15,63±0,00pg/mL vs. 15,63±0,00pg/mL; p=1) e nas concentrações IL 2 (7,81±0,00pg/mL vs. 7,81±0,00pg/mL; p=1) entre os pacientes e controles. A média geral da espessura da camada média da íntima foi de 0,7±0,2mm. Conclusões: As concentrações séricas de IL17A e IL22 foram iguais entre pacientes e controles (concentrações indetectáveis ou baixa). Nenhum dos pacientes apresentou ateroma.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Interleukin-17/blood , Schistosomiasis mansoni/immunology , Atherosclerosis/diagnosis , Interleukin-17/immunology
20.
Arch. endocrinol. metab. (Online) ; 59(2): 171-180, 04/2015. tab
Article in English | LILACS | ID: lil-746455

ABSTRACT

There are numerous particles, enzymes, and mechanisms in the lipid metabolism that are involved in the genesis of cardiovascular disease (CVD). Given its prevalence in populations and its impact on mortality, it is relevant to review the lipid metabolism as it may potentially provide subsidies to better prediction. This article reviews the importance of traditional cardiovascular risk factors and comments on the potential of novel lipid biomarkers involved in the physiopathology of CVD. The Framingham cohorts proved the role of traditional risk factors (physical inactivity, smoking, blood pressure, total cholesterol, LDL-C, HDL-C, plasma glucose) in the prediction of cardiovascular events. However, a significant number of individuals that suffer from a cardiovascular event has few or none of these factors. Such finding indicates the need for new biomarkers able to identify plaques that are more susceptible to rupture. Some of bloodstream biomarkers related to lipid metabolism are modified LDL particles, apolipoprotein AI (apo AI), apolipoprotein B, lipoprotein (a) [Lp (a)], cholesteryl ester transfer protein (CETP), subtypes of LDL and HDL particles, and lipoprotein-associated phospholipase A2 (Lp-PLA2). These factors participate in the atherosclerotic process, and are abnormal in individuals at high risk, or in those who suffered from a cardiovascular event. Lp (a) determination is already employed in clinical practice and should be included as a reference parameter for CVD monitoring. Furthermore, there are expectations for wider use of apo B, non-HDL cholesterol and total cholesterol / HDL-C determination to improve cardiovascular risk assessment.


Subject(s)
Humans , Apolipoproteins/blood , Atherosclerosis/diagnosis , Cardiovascular Diseases/etiology , Lipid Metabolism , /blood , Atherosclerosis/epidemiology , Biomarkers/blood , Cardiovascular Diseases/prevention & control , Cholesterol Ester Transfer Proteins/blood , Risk Factors
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