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1.
Arq. bras. cardiol ; 118(2): 519-524, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364326

ABSTRACT

Resumo A hiperativação do sistema nervoso simpático desempenha um papel central na fisiopatologia da hipertensão. O objetivo deste estudo foi avaliar a atividade simpática cardíaca e investigar o papel da cintigrafia miocárdica com metaiodobenzilguanidina com 123I ([123I] MIBG) na estratificação de risco cardiovascular de pacientes com hipertensão resistente tratados com denervação renal (DR). Dezoito pacientes foram incluídos neste estudo prospectivo (média de idade de 56 ± 10 anos, 27,8% mulheres). Ecocardiograma transtorácico, análise geral do sangue e cintilografia miocárdica com [(123I) MIBG] foram realizados antes e seis meses após a DR. Um paciente era considerado respondedor (R) se uma diminuição ≥ 5 mmHg na pressão arterial sistólica (PAS) média ambulatorial fosse observada no seguimento de seis meses. 66,7% dos pacientes foram R (diminuição na PAS de 20,6 ± 14,5 mmHg, vs. menos 8 ± 11,6 mmHg em não-respondedores (NR), p = 0,001). A relação coração-mediastino (RCM) inicial foi significativamente menor na linha basal no grupo R (1,6 ± 0,1 vs. 1,72 ± 0,1, p <0,02), mas semelhante em seis meses. Considerando os dois momentos no tempo, o grupo R teve valores iniciais de RCM mais baixos do que o grupo NR (p <0,05). Tanto o RCM tardio quanto a taxa de washout foram idênticos e nenhuma correlação significativa entre a resposta à DR ou qualquer índice de imagem com MIBG foi encontrada. A denervação renal efetivamente reduziu a pressão arterial na maioria dos pacientes, mas a imagem com [123I] MIBG não foi útil na previsão da resposta. Entretanto, houve evidência de overdrive do sistema nervoso simpático e, tanto a RCM inicial quanto tardia estavam reduzidas em geral, provavelmente colocando essa população em um risco maior de eventos adversos.


Abstract Hyperactivation of the sympathetic nervous system plays a central role in the pathophysiology of hypertension. The aim of this study was to assess cardiac sympathetic activity and investigate the role of myocardial123I-labelled meta-iodo benzyl guanidine ([123I] MIBG) scintigraphy in cardiovascular risk stratification of patients with resistant hypertension treated with renal denervation (RDN). Eighteen patients were included in this prospective study (mean age 56 ± 10 years old, 27.8% females). Transthoracic echocardiogram, general blood analysis and myocardial ([123I] MIBG scintigraphy were performed before and six-months after RDN. A patient was considered a responder (R) if a drop ≥ 5mmHg on mean systolic ambulatory blood pressure (BP) monitoring was observed at the six-month follow-up. 66.7% of patients were R (drop in systolic BP of 20.6 ± 14.5mmHg, vs minus 8 ± 11.6mmHg in non-responders (NR), p=0.001). Early heart-mediastinum ratio (HMR) was significantly lower at baseline in the R group (1.6 ± 0.1 vs 1.72 ± 0.1, p<0.02) but similar at six months. Considering both instants in time, the R group had lower early HMR values than the NR group (p<0.05). Both the late HMR and the washout rate were identical and no significant correlation between response to RDN or any MIBG imaging index was found. Renal denervation effectively lowered blood pressure in the majority of patients but [123I] MIBG was not useful in predicting the response. However, there was evidence of sympathetic overdrive and, both early and late HMR were overall reduced, probably putting this population at a higher risk of adverse events.


Subject(s)
Humans , Male , Female , Aged , Blood Pressure Monitoring, Ambulatory , 3-Iodobenzylguanidine , Sympathetic Nervous System/diagnostic imaging , Prospective Studies , Risk Assessment , Radiopharmaceuticals , Denervation , Heart/physiology , Heart/diagnostic imaging , Iodine Radioisotopes , Middle Aged
2.
Arch. cardiol. Méx ; 91(1): 105-113, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1152867

ABSTRACT

Resumen Los exosomas tienen un papel clave en la comunicación intercelular. Debido a sus múltiples interacciones, estas estructuras cumplen con el papel de «mensajeros¼ de forma dinámica, transportando su contenido a células blanco específicas y generando nuevas señales celulares. En este artículo se describen algunas de las proteínas, lípidos y ácidos nucleicos que son transportados por estas vesículas y que se han relacionado con cardioprotección, con la finalidad de proporcionar información y generar interés sobre la relevancia de los exosomas como posibles blancos diagnósticos y terapéuticos.


Abstract Exosomes have a key role in intercellular communication. Due to their multiple interactions, these structures fulfill the role of “messengers” in a dynamic way, transporting their content to target-specific cells and generating new cellular signals. This article describes some of the proteins, lipids and nucleic acids that are transported by these vesicles and that have been related to cardioprotection, in order to provide information and generate interest in the relevance of exosomes as possible diagnostic and therapeutic targets.


Subject(s)
Humans , Exosomes/physiology , Heart/physiology
3.
Geriatr., Gerontol. Aging (Impr.) ; 14(1): 31-42, 31-03-2020.
Article in English, Portuguese | LILACS | ID: biblio-1097166

ABSTRACT

INTRODUÇÃO: O envelhecimento associa-se a alterações na estrutura e função do coração, havendo benefícios da prática de exercício físico no retardamento dessas alterações. OBJETIVOS: Caracterizar as alterações ecocardiográficas de uma população idosa submetida à intervenção multidisciplinar incluindo programa de exercício físico adaptado e avaliar as diferenças entre os melhores e piores níveis de adesão à atividade física. MÉTODOS: Estudo de intervenção não randomizado com um grupo de idosos da coorte AGA@4life. Realizaram-se duas avaliações ecocardiográficas, uma basal e outra após a implementação de um programa de intervenção multidisciplinar com um componente de exercício físico por três meses consecutivos. Os participantes foram divididos em dois grupos: grupo 1, com baixa adesão ao programa de exercício físico (< 20% das sessões); grupo 2, com elevada adesão ao programa de exercício físico (> 90% das sessões). RESULTADOS: Na avaliação basal, identificaram-se alterações ecocardiográficas associadas ao envelhecimento ­ 89,2% (n = 33) de casos com fibrose aórtica, 73% (n = 27) de casos com fibrose mitral, 51,2% (n = 19) de casos com regurgitação aórtica e 68% (n = 25) de casos com regurgitação mitral. Após a intervenção, verificaram-se variações significativas em diversos parâmetros funcionais no grupo 2, sobretudo nas velocidades máximas das ondas E' (p = 0,016) e S (p = 0,02) da válvula mitral e da onda E' da válvula tricúspide (p = 0,027). Observaram-se ainda modificações estruturais no grupo 2, nomeadamente redução na espessura parietal relativa (p = 0,033) e no diâmetro diastólico (p = 0,041) do ventrículo esquerdo. CONCLUSÕES: O exercício físico adaptado e implementado no âmbito de um programa de intervenção multidisciplinar constitui uma ferramenta não farmacológica útil para a manutenção de função e estrutura cardíacas adequadas no idoso.


INTRODUCTION: Aging is associated with changes in heart structure and function, and there are benefits of physical exercise in delaying these changes. OBJECTIVES: To characterize the heart of a geriatric cohort at a structural and functional level, and to evaluate the potential cardiac benefits of a personalized exercise intervention program. METHODS: Non-randomized intervention study, including a group of old adults from the AGA@4life cohort. Two echocardiographic evaluations were performed, at baseline and 3 months after the implementation of a multidisciplinary intervention program, integrating the practice of adapted physical exercise. Participants were divided into 2 groups: group 1 with low adherence to the exercise program (< 20% of sessions); group 2 with high adherence to the exercise program (> 90% of sessions). RESULTS: Characteristic heart changes were observed at baseline, mainly at the valvular level, with 89.2% (n = 33) cases of aortic fibrosis, 73% (n = 27) cases of mitral fibrosis, 51.2% (n = 19) cases of aortic regurgitation, and 68% (n = 25) cases of mitral regurgitation. After the intervention, significant changes were observed in several functional parameters in group 2, namely in the maximum velocity of the E' (p = 0.01) and S' (p = 0.02) mitral valve waves, and maximum velocity of the E' tricuspid valve wave (p = 0.02). Positive structural changes were also observed in group 2, namely a reduction in relative wall thickness (p = 0.03) and left ventricular diastolic diameter (p = 0.04). CONCLUSION: Personalized physical exercise implemented as part of a multidisciplinary intervention program is a useful non-pharmacological tool for maintaining adequate cardiac function and structure in the old adult.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Aging/physiology , Echocardiography/methods , Exercise/physiology , Heart Diseases/prevention & control , Health of the Elderly , Physical Exertion , Heart/physiology
4.
Prensa méd. argent ; 105(9 especial): 644-651, oct 2019. fig
Article in English | LILACS, BINACIS | ID: biblio-1046879

ABSTRACT

The article introduces the findings of the analysis of the existing approaches to the development of mathematical models of acoustic heart phenomena. The analysis of mathematical methods that can be used to model heart sounds has been performed with the use of reference signals from the 3M Open Library (Littmann Library) and a set of signals obtained by the authors during their previous scientific efforts. The analysis findings have allowed revealing the approaches and methods that are most suitable for developing the mathematical models of human phonocardiograms (normal and pathological) for further research efforts meant to develop methods to single out heart beats against the high level of interference and creating intervalograms to characterize the heart rate at the current moments of time. In addition to the generation of model phonocardiograms, the article reviews the methods to analyze model and real-life phonocardiograms with the assessment of an input from random and deterministic components.


Subject(s)
Humans , Phonocardiography/instrumentation , Spectrum Analysis , Acoustics , Models, Statistical , Heart Rate Determination/methods , Heart/physiology
5.
Arq. bras. cardiol ; 113(3): 401-408, Sept. 2019. graf
Article in English | LILACS | ID: biblio-1038546

ABSTRACT

Abstract Background: Stress is defined as a complicated state that related to homeostasis disturbances, over-activity of the sympathetic nervous system and hypothalamus-pituitary-adrenal axis responses. Cardiac preconditioning reduces myocardial damages. Objective: This study was designed to assess the cardioprotective effects of acute physical stress against ischemia/reperfusion (I/R) injury through the activation of the sympathetic nervous system. Methods: Thirty-two male Wistar rats were divided into four groups; (1) IR (n = 8): rats underwent I/R, (2) Acute stress (St+IR) (n = 8): physical stress induced 1-hour before I/R, (3) Sympathectomy (Symp+IR) (n = 8): chemical sympathectomy was done 24-hours before I/R and (4) Sympathectomy- physical stress (Symp+St+IR) (n = 8): chemical sympathectomy induced before physical stress and I/R. Chemical sympathectomy was performed using 6-hydroxydopamine (100 mg/kg, sc). Then, the hearts isolated and located in the Langendorff apparatus to induce 30 minutes ischemia followed by 120 minutes reperfusion. The coronary flows, hemodynamic parameters, infarct size, corticosterone level in serum were investigated. P < 0.05 demonstrated significance. Results: Physical stress prior to I/R could improve left ventricular developed pressure (LVDP) and rate product pressure (RPP) of the heart respectively, (63 ± 2 versus 42 ± 1.2, p < 0.05, 70 ± 2 versus 43 ± 2.6, p < 0.05) and reduces infarct size (22.16 ± 1.3 versus 32 ± 1.4, p < 0.05) when compared with the I/R alone. Chemical sympathectomy before physical stress eliminated the protective effect of physical stress on I/R-induced cardiac damages (RPP: 21 ± 6.6 versus 63 ± 2, p < 0.01) (LVDP: 38 ± 4.5 versus 43 ± 2.6, p < 0.01) (infarct size: 35 ± 3.1 versus 22.16 ± 1.3, p < 0.01). Conclusion: Findings indicate that acute physical stress can act as a preconditional stimulator and probably, the presence of sympathetic nervous system is necessary.


Resumo Fundamento: O estresse é definido como um estado complicado de distúrbios da homeostase, hiperatividade do sistema nervoso simpático e das respostas do eixo hipotálamo-hipófise-adrenal. O pré-condicionamento cardíaco diminui os danos do miocárdio. Objetivo: Esse estudo avaliou os efeitos cardioprotetores do estresse físico agudo contra a lesão por isquemia-reperfusão (I/R) através da ativação do sistema nervoso simpático. Métodos: Trinta e dois ratos machos Wistar foram divididos em quatro grupos; (1) IR (n = 8): ratos submetidos a I/R, (2) Estresse agudo (St+IR) (n = 8): estresse físico induzido 1 hora antes da I/R, (3) Simpatectomia (Symp+IR) (n = 8): a simpatectomia química foi realizada 24 horas antes da I/R e (4) Simpatectomia-estresse físico (Symp+St+IR) (n = 8): simpatectomia induzida antes do estresse físico e da I/R. A simpatectomia química foi realizada com 6-hidroxidopamina (100 mg/kg, SC). Em seguida, os corações foram isolados e colocados em aparato de Lagendorff por 30 minutos para induzir isquemia, seguida de reperfusão por 120 minutos. Os fluxos coronarianos, os parâmetros hemodinâmicos, o tamanho do infarto e os níveis de corticosterona plasmática foram investigados. Valores de p < 0,05 foram considerados significativos. Resultados: O estresse físico anterior à I/R pode melhorar a pressão desenvolvida no ventrículo esquerdo (PDVE) e duplo produto (DP), respectivamente, (63 ± 2 versus 42 ± 1,2, p < 0,05, 70 ± 2 versus 43 ± 2,6, p < 0,05) e reduzir o tamanho do infarto (22,16 ± 1,3 versus 32±1,4, p < 0,05) quando comparado com a I/R isoladamente. A simpatectomia química antes do estresse físico eliminou o efeito protetor do estresse físico sobre os danos cardíacos induzidos pela I/R (DP: 21 ± 6,6 versus 63 ± 2, p < 0,01) (PDVE: 38 ± 4,5 versus 43 ± 2,6, p < 0,01) (tamanho do infarto: 35 ± 3,1 versus 22,16 ± 1,3, p < 0,01). Conclusão: Os achados indicam que o estresse físico agudo pode funcionar como um estimulador pré-condicional e, provavelmente, a presença do sistema nervoso simpático é necessária.


Subject(s)
Animals , Male , Rats , Sympathetic Nervous System/physiopathology , Ischemic Preconditioning, Myocardial/methods , Heart/physiology , Myocardial Infarction/physiopathology , Corticosterone/blood , Reperfusion Injury/physiopathology , Rats, Wistar , Coronary Circulation/physiology
6.
Arq. bras. cardiol ; 112(2): 121-128, Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-983822

ABSTRACT

Abstract Background: Obesity is associated with an increased risk of type 2 diabetes mellitus (DM), ischemic heart disease (IHD) and cardiovascular mortality. Several studies have demonstrated the diagnostic and prognostic value of single photon computed tomography-myocardial perfusion scintigraphy (SPECT-MPI) in the evaluation of patients with suspected IHD, including in obese population. Data on clinical risk factors and their association with abnormal myocardial perfusion in obese patients are scarce in the Brazilian population. Objective: To determine the factors associated with abnormal myocardial perfusion in obese individuals without known IHD. Methods: We studied obese patients without known IHD who were referred for evaluation through SPECT-MPI between January 2011 and December 2016. Clinical variables and results of SPECT-MPI were obtained systematically. The distribution of continuous variables was assessed using the Shapiro-Wilk and Shapiro-Francia tests. We used the unpaired Student t test to compare the means of continuous variables with normal distribution and the Chi Square test for binomial variables analysis. A p value < 0.05 was considered statistically significant. The association of the clinical variables for the presence of factors associated with abnormal myocardial perfusion was determined by univariate and multivariate logistic regression analysis, and respective odds ratios (OR) and 95% confidence intervals (CI). Results: The study sample consisted of 5,526 obese patients. Mean body mass index (BMI) of our patients was 33.9 ± 3.7 kg/m2, 31% had DM, and myocardial perfusion abnormalities was observed in 23% of the total sample. The factors associated with abnormal myocardial perfusion on multivariate analysis were: age (OR: 1.02, 95% CI 1.01-1.03, p < 0.001), DM (OR: 1.57, 95% CI 1.31-1.88, p < 0.001), typical angina before the test (OR: 2.45, 95% CI: 1.82-3.31, p < 0.001), need for pharmacologic stress test (OR: 1.61, 95% CI: 1.26-2.07, p < 0.001), less physical effort evaluated in metabolic equivalents (METs) during the exercise treadmill test (OR: 0.89, 95% CI: 0.85-0.94, p < 0.001) and a lower post-stress left ventricular ejection fraction after stress (LVEF; OR: 0.989, 95% CI: 0.984-0.994, p < 0.001). Conclusion: The factors associated with abnormal myocardial perfusion in obese patients without known IHD were age, DM, presence of typical angina, ventricular dysfunction, and inability to undergo physical stress as clinical variables, in addition to functional capacity during physical stress.


Resumo Fundamento: A obesidade associa-se a um risco aumentado de diabetes mellitus do tipo 2 (DM), doença cardíaca isquêmica (DCI) e mortalidade cardiovascular. Vários estudos demonstraram o valor diagnóstico e prognóstico da cintilografia de perfusão miocárdica com tomografia computadorizada por fóton único (CPM-SPECT) na avaliação de pacientes com suspeita de DCI, inclusive na população de obesos. Dados sobre fatores de risco clínicos, e sua associação com perfusão miocárdica anormal em obesos, são escassos na população brasileira. Objetivo: Determinar quais são os fatores associados à anormalidade de perfusão miocárdica em obesos sem DCI conhecida. Métodos: Estudamos pacientes obesos sem DCI conhecida que foram encaminhados para avaliação por CPM-SPECT entre janeiro de 2011 até dezembro de 2016. Variáveis clínicas e resultados da CPM-SPECT foram obtidos de forma sistematizada. A distribuição das variáveis contínuas foi avaliada utilizando-se os testes de Shapiro-Wilk e Shapiro-Francia. Utilizou-se o teste t de Student não pareado para comparar as médias das variáveis contínuas com distribuição normal, e o teste do Chi quadrado para análise das variáveis binomiais. Considerou-se o valor de p < 0,05 como estatisticamente significativo. A associação das variáveis clínicas para a presença de anormalidade de perfusão miocárdica foi determinada por análise de regressão logística univariada e multivariada, calculando-se e apresentando-se os respectivos odds ratios (OR) e intervalos de confiança (IC) de 95. Resultados: A amostra do estudo foi de 5.526 pacientes obesos. O índice de massa corporal médio dos nossos pacientes foi de 33,9 ± 3,7 kg/m2, 31% eram portadores de DM, e anormalidades de perfusão foram observadas em 23% do total da amostra. Os fatores associados à anormalidade de perfusão miocárdica, após análise multivariada, foram: idade (OR: 1,02, IC 95%: 1,01-1,03, p < 0,001), DM (OR: 1,57, IC 95%: 1,31-1,88, p < 0,001), presença de angina típica antes do exame (OR: 2,45, IC 95%: 1,82-3,31, p < 0,001), necessidade de utilização de protocolo com estresse farmacológico (OR: 1,61, IC 95%: 1,26-2,07, p < 0,001), menor esforço físico avaliado em equivalentes metabólicos durante o teste ergométrico (OR: 0,89, IC 95%: 0,85-0,94, p < 0,001) e menor fração de ejeção do ventrículo esquerdo após estresse (OR: 0,989, IC 95%: 0,984-0,994, p < 0,001). Conclusão: Os fatores associados à anormalidade de perfusão miocárdica em pacientes obesos sem DCI conhecida foram idade, DM, presença de angina típica, disfunção ventricular e incapacidade para o estresse físico como variáveis clínicas, além da capacidade funcional durante o estresse físico.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Myocardial Ischemia/physiopathology , Heart/physiology , Myocardium , Obesity/physiopathology , Reference Values , Stroke Volume/physiology , Body Mass Index , Logistic Models , Sex Factors , Predictive Value of Tests , Prospective Studies , Risk Factors , Ventricular Function, Left/physiology , Statistics, Nonparametric , Risk Assessment/methods , Myocardial Perfusion Imaging/methods , Single Photon Emission Computed Tomography Computed Tomography/methods , Heart/diagnostic imaging
7.
Rev. chil. pediatr ; 89(5): 582-591, oct. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1042717

ABSTRACT

Resumen: Las Interacciones Cardiopulmonares (ICP) corresponden al conjunto de interrelaciones entre el sis tema respiratorio y el cardiovascular, durante el ciclo respiratorio y cardíaco. Estas interacciones varían dependiendo de si el paciente se encuentra en ventilación espontánea o mecánica, afectando en distintos grados la precarga y postcarga, tanto del ventrículo derecho e izquierdo. El entender estas interacciones, resulta esencial al momento de manejar pacientes críticamente enfermos, en donde las manipulaciones de la precarga y postcarga, son de especial importancia al momento de optimizar el débito cardíaco y la entrega de oxígeno a los tejidos. En este artículo se presentan los principios fisiológicos que permiten entender las interacciones cardiopulmonares en ventilación espontánea y en ventilación mecánica, aplicadas a situaciones clínicas específicas, lo que nos ayudará a utilizarlas como herramientas en el manejo de los pacientes.


Abstract: Cardiopulmonary Interactions (CPI) refer to the interplay between the respiratory and cardiovascu lar systems during the respiratory and cardiac cycle. These interactions vary depending on whether the patient is in spontaneous or mechanical ventilation and affect the preload and afterload of both ventricles at different levels. Understanding CPI is essential to the management of critically ill pa tients, where preload and afterload manipulations are specialy important to optimize cardiac output and oxygen delivery to the periphery. The present article reviews the physiological principles required to understand CPI in patients both in spontaneous and mechanical ventilation using specific clinical scenarios to facilitate its use as part of day to day clinical practice.


Subject(s)
Humans , Respiration, Artificial , Respiratory Physiological Phenomena , Cardiovascular Physiological Phenomena , Critical Illness , Heart/physiology , Heart/physiopathology , Lung/physiology , Lung/physiopathology
9.
J. bras. nefrol ; 40(2): 170-178, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-954544

ABSTRACT

ABSTRACT Although there is a general agreement on the recommendation for reduced salt intake as a public health issue, the mechanism by which high salt intake triggers pathological effects on the cardio-renal axis is not completely understood. Emerging evidence indicates that the renin-angiotensin-aldosterone system (RAAS) is the main target of high Na+ intake. An inappropriate activation of tissue RAAS may lead to hypertension and organ damage. We reviewed the impact of high salt intake on the RAAS on the cardio-renal axis highlighting the molecular pathways that leads to injury effects. We also provide an assessment of recent observational studies related to the consequences of non-osmotically active Na+ accumulation, breaking the paradigm that high salt intake necessarily increases plasma Na+ concentration promoting water retention


RESUMO Apesar de haver uma concordância geral sobre a necessidade de redução na ingestão de sal como questão de saúde publica, o mecanismo pelo qual a alta ingesta de sal deflagra efeitos patológicos sobre o eixo cardiorrenal não está ainda completamente elucidado. Cada vez mais evidencias indicam que o sistema renina-angiotensina-aldosterona (SRAA) seja o principal alvo da alta ingesta de Na+. Uma ativação inadequada do SRAA tecidual pode causar hipertensão e dano ao órgão. Nós revisamos o impacto da dieta com alto teor de sódio sobre o eixo cardiorrenal, destacando as vias moleculares que causam a lesão. Também fizemos uma avaliação de recentes estudos observacionais relacionados às consequências do acúmulo de Na+ não osmoticamente ativo, quebrando assim o paradigma de que a alta ingestão de sódio necessariamente aumenta a concentração sérica de Na+, assim promovendo a retenção de água.


Subject(s)
Humans , Animals , Rats , Renin-Angiotensin System/drug effects , Sodium, Dietary/adverse effects , Heart/drug effects , Heart/physiology , Kidney/drug effects , Kidney/physiology , Sodium, Dietary/administration & dosage
10.
Rev. med. Risaralda ; 23(2): 49-57, jul.-dic. 2017.
Article in Spanish | LILACS, COLNAL | ID: biblio-902081

ABSTRACT

La insuficiencia cardiaca es el resultado fisiopatológico de múltiples enfermedades. Además de la patologia isquémica, valvular, de la conducción o hipertensiva existen otras etiologías poco sospechadas. En la mayoría de ocasiones se realizan diagnósticos estructurales basados en la imagenologia como cardiomiopatía dilatada o cardiomiopatía restrictiva, lo que lleva al clínico a tratamientos sintomáticos, dejando de lado tratamientos etiológicos específicos que pudiesen preservar la función cardiaca, revertir el daño miocárdico y mejorar la calidad de vida de estos pacientes. Comprender y reconocer que existen factores nutricionales, hormonales, genéticos, infecciosos, medicamentosos, infiltrativos o autoinmunes en la patogénesis de la insuficiencia cardiaca permitirá optar por mejores tratamientos, mejorando las tasas de sobrevida.


Heart failure is a pathophysiologic result of several diseases and it's not only related to ischemic, valvular, arrhythmias or hypertensive. Most of the times structural diagnoses are made based on imaging, like dilated or restrictive cardiomyopathy, which leads to symptomatic treatments instead directed etiological therapies that could preserve heart function, reverse myocardial damage and improve life quality. Understands and recognize that there are nutritional, hormonal, genetic, infectious, drugs, infiltrative or autoimmune factors that could lead to heart failure would help clinicians to recognize them and propose targeted treatments, improving survival rates


Subject(s)
Humans , Male , Female , Cardiomyopathy, Restrictive , Cardiomyopathy, Dilated , Heart Diseases/etiology , Heart Failure , Quality of Life , Survival , Therapeutics , Pharmaceutical Preparations , Pathogenesis, Homeopathic , Heart/physiology
11.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(2): 109-122, abr.-jun. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-847898

ABSTRACT

A angiotomografia das artérias coronárias é um método diagnóstico não invasivo que pode ser utilizado para avaliação da doença arterial coronariana em pacientes selecionados e pode fornecer informações quanto às demais estruturas incluídas no campo de visão tomográfico. Por vezes são identificados achados extracardíacos que, em sua maior parte, representam achados incidentais de relevância variável. A adequada detecção, interpretação e comunicação de achados extracardíacos relevantes pode, em última análise, beneficiar pacientes na detecção precoce de doenças das quais não se suspeitava, sem a necessidade de dose adicional de radiação. Revisaremos achados extracardíacos e discutiremos os principais temas deste assunto: nódulos pulmonares; doenças difusas do parênquima pulmonar; alteração das vias aéreas; espaço pleural; aorta; artérias pulmonares; linfonodos; mediastino; fígado; esôfago/estômago; adrenal; mamas; cavidade peritoneal; baço; ossos. Finalmente, a excelência na capacitação, busca, detecção e adequada interpretação dos achados de imagem extracardíacos tem impacto significativo no cuidado com o paciente


Coronary artery angiotomography is a noninvasive diagnostic method that can be used to evaluate coronary artery disease in selected patients, and may provide information on other structures included in the tomographic field of vision. Extracardiac findings are occasionally identified, the majority of which represent incidental findings of varying relevance. Adequate detection, interpretation and reporting of relevant extracardiac findings may ultimately benefit patients through early detection of unsuspected diseases without the need for additional doses of radiation. Extracardiac findings will be reviewed, and main topics of the subject discussed: pulmonary nodules; diffuse pulmonary parenchyma disease; airway disease; pleural space; aorta; pulmonary arteries; lymph nodes; mediastinum; liver; esophagus/stomach; adrenal; breasts; peritoneal cavity; spleen; and bones. Finally, excellence in training, searching, detecting and adequate interpretation of extracardiac imaging findings has a significant impact on patient care


Subject(s)
Humans , Male , Female , Thorax/physiopathology , Coronary Artery Disease/physiopathology , Incidental Findings , Computed Tomography Angiography/methods , Cardiologists/trends , Pulmonary Artery/diagnostic imaging , Diagnostic Imaging/methods , Tomography, X-Ray Computed/methods , Lung Diseases, Interstitial/diagnosis , Diagnosis, Differential , Multiple Pulmonary Nodules , Heart/physiology
12.
Neumol. pediátr. (En línea) ; 11(4): 175-179, oct. 2016. tab, ilus
Article in Spanish | LILACS | ID: biblio-835077

ABSTRACT

To optimize the management of critically ill patients, it is essential to understand the principles of cardiopulmonary interaction.The ultimate goal of the interaction between pulmonary and circulatory systems from a physiological point of view is to optimize the delivery of oxygen to tissues in order to meet metabolic demand, especially in situations where normal physiology is altered, as is the case of pediatric critically ill patients. Thus, during a critical illness, if any of these systems fails (together or separately), the end result is an inadequate delivery of O2 to tissues, which can lead to ischemia, progressive organ dysfunction, and if untreated, to death.In this review we will address key physiological concepts involved in cardiopulmonary interactions and how they are affected by the management we perform in the pediatric critically ill patients.


Para optimizar el manejo de los pacientes críticos, es fundamental comprender los principios de la interacción cardiopulmonar. El objetivo úultimo desde el punto de vista fisiológico de la interacción entre los sistemas circulatorio y pulmonar es optimizar la entrega de oxígeno a los tejidos y dar cuenta de la demanda metabólica especialmente en situaciones donde la fisiología normal se ve alterada, como es el caso de los pacientes pediátricos críticamente enfermos. Es así como durante una enfermedad crítica, si alguno de estos dos sistemas falla, (juntos o por separado), el resultado final es una inadecuada entrega de O2 tisular, que puede conducir a isquemia, disfunción orgánica progresiva, y si no se trata, hasta la muerte.En esta revisión intentaremos abordar de forma didáctica los principales conceptos fisiológicos involucrados en las interaccionescardiopulmonares y cómo estos se ven afectados frente a las intervenciones que realizamos en el manejo de los pacientes críticos.


Subject(s)
Humans , Child , Critical Care , Heart/physiology , Lung/physiology , Heart/physiopathology , Ventricular Function/physiology , Positive-Pressure Respiration , Lung/physiopathology , Thorax/physiology
13.
Arq. bras. cardiol ; 107(3): 271-275, Sept. 2016. tab
Article in English | LILACS | ID: lil-796038

ABSTRACT

Abstract Myocardial infarction is the most significant manifestation of ischemic heart disease and is associated with high morbidity and mortality. Novel strategies targeting at regenerating the injured myocardium have been investigated, including gene therapy, cell therapy, and the use of growth factors. Growth factor therapy has aroused interest in cardiovascular medicine because of the regeneration mechanisms induced by these biomolecules, including angiogenesis, extracellular matrix remodeling, cardiomyocyte proliferation, stem-cell recruitment, and others. Together, these mechanisms promote myocardial repair and improvement of the cardiac function. This review aims to address the strategic role of growth factor therapy in cardiac regeneration, considering its innovative and multifactorial character in myocardial repair after ischemic injury. Different issues will be discussed, with emphasis on the regeneration mechanisms as a potential therapeutic resource mediated by growth factors, and the challenges to make these proteins therapeutically viable in the field of cardiology and regenerative medicine.


Resumo O infarto do miocárdio representa a manifestação mais significativa da cardiopatia isquêmica e está associado a elevada morbimortalidade. Novas estratégias vêm sendo investigadas com o intuito de regenerar o miocárdio lesionado, incluindo a terapia gênica, a terapia celular e a utilização de fatores de crescimento. A terapia com fatores de crescimento despertou interesse em medicina cardiovascular, devido aos mecanismos de regeneração induzidos por essas biomoléculas, incluindo angiogênese, remodelamento da matriz extracelular, proliferação de cardiomiócitos e recrutamento de células-tronco, dentre outros. Em conjunto, tais mecanismos promovem a reparação do miocárdio e a melhora da função cardíaca. Esta revisão pretende abordar o papel estratégico da terapia, com fatores de crescimento, para a regeneração cardíaca, considerando seu caráter inovador e multifatorial sobre o reparo do miocárdio após dano isquêmico. Diferentes questões serão discutidas, destacando-se os mecanismos de regeneração como recurso terapêutico potencial mediado por fatores de crescimento e os desafios para tornar essas proteínas terapeuticamente viáveis no âmbito da cardiologia e da medicina regenerativa.


Subject(s)
Humans , Regeneration/physiology , Myocardial Ischemia/physiopathology , Myocardial Ischemia/therapy , Intercellular Signaling Peptides and Proteins/therapeutic use , Regenerative Medicine/methods , Neovascularization, Physiologic/physiology , Myocytes, Cardiac/physiology , Regenerative Medicine/trends , Heart/physiology
14.
Arch. endocrinol. metab. (Online) ; 60(4): 341-347, Aug. 2016. tab
Article in English | LILACS | ID: lil-792947

ABSTRACT

ABSTRACT Objective Several studies have shown that left ventricular (LV) dysfunction is increased in individuals with diabetes. However, there are scarce data about LV function in prediabetics. This study assessed the early changes in LV diastolic and systolic myocardial function in normotensive prediabetics using tissue Doppler echocardiography (TDE). Subjects and methods We evaluated 94 patients with prediabetes (mean age of 50.8 ± 6.9 years, 78 female) without known cardiovascular diseases and 70 healthy volunteers with similar demographic characteristics. Systolic and diastolic function of the left ventricle was evaluated with transthoracic echocardiography according to the latest consensus recommendations including TDE. Results The mean results of septal and lateral parts of the mitral annulus Pulsed wave TDE showed that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em to atrial peak velocity (Am) ratio were significantly lower whereas early diastolic peak flow velocity (E) to Em ratio, myocardial isovolumetric relaxation time (IVRTm), myocardial isovolumetric contraction time (IVCTm) and myocardial performance index (MPI) values were significantly higher in patients with prediabetes (preDM). In addition, mean left atrium (LA) diameter measured with M-mode echocardiography was significantly higher in prediabetics than controls. Conclusion PreDM is associated with subclinical LV systolic and diastolic dysfunction as evaluated by TDE.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Prediabetic State/physiopathology , Ventricular Function, Left/physiology , Echocardiography, Doppler, Pulsed/methods , Reference Values , Stroke Volume/physiology , Systole/physiology , Time Factors , Blood Pressure/physiology , Case-Control Studies , Risk Factors , Statistics, Nonparametric , Diastole/physiology , Heart/physiology , Heart/diagnostic imaging
15.
Pesqui. vet. bras ; 36(6): 559-563, jun. 2016. tab, ilus
Article in English | LILACS, VETINDEX | ID: lil-792615

ABSTRACT

Considering the limited physiological information available on neotropical rodents and the importance of this information for pathophysiological and conservation studies of these species, the aim of this study was to evaluate the cardiac electric physiology of healthy captivity spotted pacas (Cuniculus paca) under chemical restraint, due to wild nature of these animals. Eleven adult female pacas were evaluated by blood count and biochemical dosage to rule out any associate disease. Each animal was evaluated in three periods every 15 days. After chemical restraint with intramuscular midazolam 0.5mg/kg and ketamine 25mg/kg, animals were subjected to a computerized electrocardiogram, where bipolar (DI, DII and DIII) and augmented unipolar leads (aVR, aVL, aVF) were obtained. Descriptive statistics were calculated for each parameter and built the confidence interval (CI) at significance level of 95%. The electrocardiographic examination was performed without difficult. ECG tracing in DII represents a QRS complex with positive polarity, preceded by a P wave of the same polarity and proceeded by T wave of variable polarity. Heart rate mean was 150±17 bpm, and cardiac electrical axis 33.4±21.9°. All animals showed sinusal rhythm. The ECG recording technique associated with chemical restraint was well tolerated, allowing quick acquisition of reliable ECG tracings with high repeatability, which produced sufficient results to determine the heart rhythm and suggest measures of ECG complexes duration and amplitude.(AU)


Considerando a limitada informação sobre a fisiologia cardíaca em roedores neotropicais e a importância desta informação para estudos fisiopatológicos e de conservação desta espécie, objetivou-se com este estudo avaliar a atividade elétrica cardíaca de pacas saudáveis mantidas em cativeiro, sob restrição química, devido à natureza selvagem destes animais. Onze fêmeas adultas foram avaliadas clinicamente e por meio do hemograma e testes bioquímicos no intuito de descartar qualquer co-morbidade associada. Cada animal foi submetido a três períodos experimentais a cada 15 dias. Após a restrição química com 25mg/kg de cetamina e 0,5mg/kg de midazolam pela via intramuscular, os animais eram submetidos a eletrocardiografia (ECG) computadorizada, aonde as derivações bipolares (DI, DII E DIII) e unipolares aumentadas (aVR, aVL, aVF) foram obtidas. A estatística descritiva foi calculada para cada parâmetro e o intervalo de confiança (CI), construído a um nível de significância de 95%. O exame eletrocardiográfico foi realizado sem dificuldade. O traçado eletrocardiográfico em DII apresentou QRS com polaridade positiva, precedido por onda P da mesma polaridade e seguida por onda T de polaridade variável. A frequência cardíaca média foi de 150±17 bpm e o eixo elétrico cardíaco de 33.4±21.9°. Todos os animais mostraram ritmo sinusal. A técnica eletrocardiográfica associada com restrição química foi bem tolerada permitindo a pratica aquisição de traçados de confiança e alta reprodutibilidade, que produziram resultados suficientes para determinar o ritmo cardíaco e sugerir medidas de duração e amplitude dos complexos de ECG.(AU)


Subject(s)
Animals , Cuniculidae/physiology , Heart/physiology , Ketamine , Midazolam , Electrocardiography/veterinary , Rodentia
16.
Arq. bras. cardiol ; 106(2): 92-96, Feb. 2016. tab
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-775097

ABSTRACT

Abstract Background: Prolonged aerobic exercise, such as running a marathon, produces supraphysiological stress that can affect the athlete's homeostasis. Some degree of transient myocardial dysfunction ("cardiac fatigue") can be observed for several days after the race. Objective: To verify if there are changes in the cardiopulmonary capacity, and cardiac inotropy and lusitropy in amateur marathoners after running a marathon. Methods: The sample comprised 6 male amateur runners. All of them underwent cardiopulmonary exercise testing (CPET) one week before the São Paulo Marathon, and 3 to 4 days after that race. They underwent echocardiography 24 hours prior to and immediately after the marathon. All subjects were instructed not to exercise, to maintain their regular diet, ingest the same usual amount of liquids, and rest at least 8 hours a day in the period preceding the CPET. Results: The athletes completed the marathon in 221.5 (207; 250) minutes. In the post-marathon CPET, there was a significant reduction in peak oxygen consumption and peak oxygen pulse compared to the results obtained before the race (50.75 and 46.35 mL.kg-1 .min-1; 19.4 and 18.1 mL.btm, respectively). The echocardiography showed a significant reduction in the s' wave (inotropic marker), but no significant change in the E/e' ratio (lusitropic marker). Conclusions: In amateur runners, the marathon seems to promote changes in the cardiopulmonary capacity identified within 4 days after the race, with a reduction in the cardiac contractility. Such changes suggest that some degree of "cardiac fatigue" can occur.


Resumo Fundamento: O exercício aeróbico prolongado, como correr uma maratona, produz um estresse suprafisiológico que pode ter impacto na homeostase do atleta. Algum grau de disfunção miocárdica transitória ("fadiga cardíaca") pode ser observado ao longo de vários dias após a prova. Objetivos: Verificar se ocorrem alterações na capacidade cardiopulmonar, no inotropismo e no lusitropismo cardíaco de maratonistas amadores após a realização de uma maratona. Métodos: A amostra foi composta por 6 corredores amadores masculinos. Todos realizaram teste cardiopulmonar de exercício (TCPE) uma semana antes da Maratona de São Paulo e 3 a 4 dias após a mesma. Realizaram ecocardiograma 24 horas antes e imediatamente após a prova. Todos foram orientados a não se exercitar, manter dieta regular, ingerir a mesma quantidade habitual de líquidos e descansar pelo menos 8 horas ao dia no período anterior ao TCPE. Resultados: Os atletas completaram a maratona em 221,5 (207; 250) minutos. No TCPE pós-maratona, ocorreu redução significativa no consumo de oxigênio e no pulso de oxigênio de pico em relação àqueles obtidos antes da prova (50,75 e 46,35 ml.kg-1.min-1; 19,4 e 18,1 ml.btm, respectivamente). Ao ecocardiograma, encontramos redução significativa na onda s' (marcador do inotropismo). A relação E/e' não apresentou alteração significativa após a maratona (marcador do lusitropismo). Conclusões: Em atletas amadores, a maratona parece promover alterações na capacidade cardiopulmonar identificadas pelo menos em até 4 dias após a prova, com redução na contratilidade e, portanto, no inotropismo cardíaco. Tais modificações sugerem que algum grau de "fadiga cardíaca" possa ocorrer.


Subject(s)
Humans , Male , Adult , Middle Aged , Heart/physiology , Muscle Fatigue/physiology , Oxygen Consumption/physiology , Running/physiology , Echocardiography , Exercise Test , Myocardial Contraction/physiology , Reference Values , Statistics, Nonparametric , Time Factors , Ventricular Function
17.
Braz. j. med. biol. res ; 48(11): 996-1003, Nov. 2015. graf
Article in English | LILACS | ID: lil-762900

ABSTRACT

Exercise is known to cause a vasodilatory response; however, the correlation between the vasorelaxant response and different training intensities has not been investigated. Therefore, this study evaluated the vascular reactivity and lipid peroxidation after different intensities of swimming exercise in rats. Male Wistar rats (aged 8 weeks; 250-300 g) underwent forced swimming for 1 h whilst tied to loads of 3, 4, 5, 6, and 8% of their body weight, respectively (groups G3, G4, G5, G6 and G8, respectively; n=5 each). Immediately after the test, the aorta was removed and suspended in an organ bath. Cumulative relaxation in response to acetylcholine (10−12-10−4 M) and contraction in response to phenylephrine (10−12-10−5 M) were measured. Oxidative stress was estimated by determining malondialdehyde concentration. The percentages of aorta relaxation were significantly higher in G3 (7.9±0.20), G4 (7.8±0.29), and G5 (7.9±0.21), compared to the control group (7.2±0.04), while relaxation in the G6 (7.4±0.25) and G8 (7.0±0.06) groups was similar to the control group. In contrast, the percentage of contraction was significantly higher in G6 (8.8 ±0.1) and G8 (9.7±0.29) compared to the control (7.1±0.1), G3 (7.3±0.2), G4 (7.2±0.1) and G5 (7.2±0.2%) groups. Lipid peroxidation levels in the aorta were similar to control levels in G3, G4 and G5, but higher in G6 and G8, and significantly higher in G8 (one-way ANOVA). These results indicate a reduction in vasorelaxing activity and an increase in contractile activity in rat aortas after high-intensity exercise, followed by an increase in lipid peroxidation.


Subject(s)
Animals , Male , Aorta/physiology , Lipid Peroxidation/physiology , Oxidative Stress/physiology , Physical Exertion/physiology , Vasodilation/physiology , Analysis of Variance , Aorta/metabolism , Exercise Test , Heart/physiology , Isometric Contraction/physiology , Lactic Acid/blood , Malondialdehyde/analysis , Rats, Wistar , Swimming/physiology
18.
Braz. j. phys. ther. (Impr.) ; 19(4): 257-263, July-Aug. 2015. tab, ilus
Article in English | LILACS | ID: lil-761612

ABSTRACT

OBJECTIVE: The aim of the present study was to compare the effects of continuous versus interval aerobic exercise training on hemodynamic parameters, cardiac remodeling, and maximal exercise capacity (MEC) in chronic heart failure (CHF) rats.METHOD: Twenty-four male Wistar rats were subjected to myocardial infarction (MI) surgery. Five weeks post MI, the animals were assigned to one of three groups: sedentary group (CHF-Sed, n=8), aerobic continuous training group (CHF-ACT, n=8), and aerobic interval training group (CHF-AIT, n=8). Treadmill training was performed five times a week for 8 weeks (ACT: 50 min/day at 15 m/min and AIT: 40 min/day with 8 min of warm-up at 10 m/min and exercise at 15 m/min 4×4 min interspersed with 4×4 min at 23 m/min). MEC was evaluated pre and post exercise program.RESULTS: Left ventricular end-diastolic pressure (LVEDP), left ventricular mass/body mass ratio (LVM:BM), and total collagen volume fraction were lower in the trained groups compared with the sedentary group, but no difference was found between the trained groups. Systolic ventricular pressure (SVP) and maximum positive derivative of LV pressure (+dP/dtmax) were higher in the trained groups, but CHF-ACT showed higher +dP/dtmax compared to CHF-AIT. Both training regimens were able to increase MEC. However, the aerobic interval training was superior for improving MEC.CONCLUSION: Aerobic training is an important intervention to improve cardiac function and remodeling and physical capacity in CHF rats. Interval training is a potential strategy to maximize the results, but exercise type and intensity are still topics to be explored.


Subject(s)
Animals , Rats , Blood Pressure/physiology , Exercise Therapy/methods , Heart/physiology , Heart Failure/physiopathology , Hemodynamics/physiology , Rats, Wistar , Exercise Test
19.
Ann Card Anaesth ; 2015 Jul; 18(3): 299-305
Article in English | IMSEAR | ID: sea-162327

ABSTRACT

Background: Changes in heart position are occasionally observed on the transesophageal echocardiography (TEE) image screen after changing the body position from supine to lateral, although the magnitude of change in cardiac position varies individually. We hypothesized that this variation is associated with certain patient characteristics and evaluated how lateral positioning affects visualization of the heart on TEE and whether the magnitude of change in the heart position correlates with patient characteristics. Methods: Fifty‑three lung resection patients were enrolled. Two angle and two length parameters (ΔθTV, ΔθAP, ΔLTV, and ΔLAP) were defined to describe location change of the lateral tricuspid annulus and right ventricular apex on the TEE image between supine and lateral position. The correlation coefficients were calculated between these four parameters and patient characteristics, including age, body mass index (BMI), epicardial fat thickness, and pulmonary function variables. Results: The ΔθTV correlated positively and inversely with BMI in both right and left lateral patients (right: r = 0.6365, P = 0.0034; left: r = −0.6616, P < 0.0001, respectively). In left lateral patients, the ΔθTV correlated inversely with epicardial fat thickness (r = −0.4879, P = 0.0182), and the ΔLAP correlated positively with the forced vital capacity percent predicted (r = 0.5736, P = 0.0082). Conclusions: Lateral body positioning affects cardiac visualization on TEE, and the BMI, epicardial fat thickness, and pulmonary function moderate this effect.


Subject(s)
Aged , Echocardiography, Transesophageal/methods , Female , HEART--ANATOMY & , Heart/physiology , Humans , Male , Posture/physiology , Pneumonectomy , Prospective Studies , Respiratory Function Tests
20.
ABC., imagem cardiovasc ; 28(1): 3-16, jan.-mar. 2015. tab, graf
Article in Portuguese | LILACS | ID: lil-747456

ABSTRACT

Introdução: Este estudo descreve a relação entre índice de massa corpórea (IMC) e a geometria e função cardíacaanalisada por ecocardiografia transtorácica. Materiais e métodos: Analisaram-se 5.898 estudos ecocardiográficos, numa faixa de idade entre 18,0 e 98,6 anos. Resultados: O IMC variou de 15,23 a 49,61 Kg/m2. O aumento do IMC teve uma associação direta estatisticamente significativa com a massa ventricular esquerda, observando-se inicialmente hipertrofia concêntrica leve, que se faz excêntrica na medida em que aumenta, especialmente quando se normaliza pela relação alométrica (altura2,7). Também observou-se aumento do volume de ejeção e do débito cardíaco e evidenciou-se associação inversa entre o índice de massa corpórea e a relação E/A de enchimento mitral, com diminuição sigificativa da velocidade de e’ doDoppler tecidual, demonstrando-se disfunção diastólica do tipo alteração do relaxamento do ventrículo esquerdono indivíduo com sobrepeso ou obeso. Observou-se aumento discreto, porém significativo, da área e do volumeindexado do átrio esquerdo para a massa corpórea. Não houve diferenças na geometria e função do ventrículo direito. Conclusões: O presente estudo evidenciou uma associação direta significativa entre o índice de massa corpórea (IMC) e a massa miocárdica ventricular esquerda. A indexação da massa do VE à altura2,7 evita artefatos relacionados à normalização pela área de superfície corpórea, principalmente em indivíduos com obesidade grau II e III.


Introduction: This study describes the relationship between Body Mass Index (BMI) and the cardiac geometry and heart function assessed bytransthoracic echocardiography.Materials and methods: We analyzed 5,898 echocardiographic studies in an age range between 18.0 and 98.6 years.Results: The BMI ranged from 15.23 to 49.61 kg/m2 . The increased BMI had a statistically significant direct association with left ventricular mass initially observing a light concentric hypertrophy, which becomes eccentric as it increases, especially when allometric ratio is normalized (Height2.7). An increase in ejection volume and cardiac output was observed, as well as an inverse association between body mass index and the E/A ratio of mitral filling, with a significant reduction of e’ velocity of tissue Doppler, showing a relaxation-type diastolic dysfunction in overweight or obese individuals. We observed a slight yet significant increase in the left atrial area and volume indexed to body mass. There were no differences in the right ventricular geometry and function.Conclusions: The present study demonstrated a significant direct association between the increase in BMI and LV myocardial mass. IndexingLV mass to height 2.7 avoids artifacts related to body mass index, especially in subjects with grade II and III obesity.


Subject(s)
Humans , Male , Female , Young Adult , Middle Aged , Aged, 80 and over , Body Mass Index , Heart/physiology , Echocardiography/methods , Obesity/complications , Ventricular Function , Age Distribution , Atrial Function , Cardiac Output , Cardiovascular Diseases , Diabetes Mellitus , Hypertension , Hypertrophy, Left Ventricular , Sex Distribution
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