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1.
Rev. chil. cardiol ; 36(3): 249-253, dic. 2017. tab, ilus
Article in Spanish | LILACS | ID: biblio-899593

ABSTRACT

Abstracts: A 68 year-old male, with no past medical history, presented progressive shortness of breath on exertion and leg edema during the previous year. Trans-thoracic echocardiography depicted; severe left ventricular hypertrophy with mild systolic dysfunction (LVEF 50% biplane Simpson's method), severe diastolic dysfunction and moderate left atrial enlargement. Left ventricular myocardial deformation imaging by two-dimensional speckle-tracking was paramount for elucidating the differential diagnosis.


Subject(s)
Humans , Male , Aged , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Left Ventricular/diagnostic imaging , Echocardiography , Ventricular Dysfunction, Left/physiopathology , Amyloidosis
2.
Arq. bras. cardiol ; 109(3): 222-230, Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-887924

ABSTRACT

Abstract Background: Left ventricular hypertrophy (LVH) is very common in hemodialysis patients and an independent risk factor for mortality in this population. The myocardial remodeling underlying the LVH can affect ventricular repolarization causing abnormalities in QT interval. Objective: to evaluate the reproducibility and reliability of measurements of corrected QT interval (QTc) and its dispersion (QTcd) and correlate these parameters with LVH in hemodialysis patients. Methods: Case-control study involving hemodialysis patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, and electrocardiogram were performed. Intra- and interobserver correlation and concordance tests were performed by Pearson´s correlation, Cohen's Kappa coefficient and Bland Altman diagram. Linear regression was used to analyze association of QTc or QTcd with HVE. Results: Forty-one HD patients and 37 controls concluded the study. Hemodialysis patients tended to have higher values of QTc, QTcd and left ventricular mass index (LVMi) than controls but statistical significance was not found. Correlation and concordance tests depicted better results for QTc than for QTcd. In HD patients, a poor but significant correlation was found between QTc and LVMi (R2 = 0.12; p = 0.03). No correlation was found between values of QTcd and LVMi (R2= 0.00; p=0.940). For the control group, the correspondent values were R2= 0.00; p = 0.67 and R2= 0.00; p = 0.94, respectively. Conclusion: We found that QTc interval, in contrast to QTcd, is a reproducible and reliable measure and had a weak but positive correlation with LVMi in HD patients.


Resumo Fundamentos: A hipertrofia ventricular esquerda (HVE) é muito comum em pacientes em hemodiálise e um fator de risco independente de mortalidade nessa população. O remodelamento do miocárdio, subjacente à HVE, pode afetar a repolarização ventricular, causando anormalidades no intervalo QT. Objetivo: avaliar a reprodutibilidade e confiabilidade das medidas do intervalo QT corrigido (QTc) e sua dispersão (QTcd), e correlacionar esses parâmetros com HVE em pacientes em hemodiálise. Métodos: Estudo caso-controle envolvendo pacientes em hemodiálise e um grupo controle. Foram realizados avaliação clínica, coleta de sangue, ecocardiografia transtorácica, e eletrocardiograma. Testes de correlação e concordância intraobservador e interobservador foram realizados por correlação de Pearson, coeficiente kappa de Cohen e diagrama de Bland Altman. A regressão linear foi usada para analisar a associação entre QTc ou QTcd e HE. Resultados: Quarenta e um pacientes em hemodiálise e 37 controles completaram o estudo. Houve uma tendência de os pacientes apresentarem valores mais altos de QTc, QTcd e de índice de massa ventricular esquerda que os controles, mas sem significância estatística. Os testes de correlação e de concordância apresentaram melhores resultados para QTc que para QTcd. Em pacientes em hemodiálise, uma correlação fraca, mas significativa foi encontrada entre QTc e IMVE (R2 = 0,12; p = 0,03). Não foi encontrada correlação entre QTcd e IMVE (R2 = 0,00; p=0,940). Para o grupo controle, esses valores correspondentes foram R2 = 0,00; p = 0,67 e R2 = 0,00; p = 0,94, respectivamente. Conclusão: o intervalo QTc, diferentemente do intervalo QTcd, é uma medida reprodutível e confiável, e apresentou uma correlação fraca, mas positiva com o IMVE em pacientes em hemodiálise.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Hypertrophy, Left Ventricular/diagnosis , Heart Conduction System/physiopathology , Echocardiography , Case-Control Studies , Reproducibility of Results , Risk Factors , Renal Dialysis , Hypertrophy, Left Ventricular/complications , Hypertrophy, Left Ventricular/physiopathology , Electrocardiography , Renal Insufficiency/complications , Renal Insufficiency/physiopathology , Renal Insufficiency/therapy
3.
Arq. bras. cardiol ; 108(4): 331-338, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838717

ABSTRACT

Abstract Background: Hypertension is a chronic, low-grade inflammation process associated with the release of cytokines and development of target organ damage. Deregulated monocyte chemoattractant protein-1 (MCP-1) levels have been associated with high blood pressure and cardiovascular complications; however, the mechanisms involved are complex and not fully understood. Objective: This study aimed to compare the levels of MCP-1 in patients with resistant (RH) versus mild-to-moderate (HTN) hypertension and their association with the presence or absence of left ventricular hypertrophy (LVH) in all hypertensive subjects. Methods: We enrolled 256 hypertensive subjects: 120 RH and 136 HTN, investigating the relationship between circulating MCP-1 levels and blood pressure, biochemical data, hematologic profile, and cardiac damage within the RH and HTN groups. Plasma MCP-1 levels were measured by ELISA and LVH was assessed by echocardiography. Results: We found no difference in MCP-1 levels between RH and HTN subjects. On the other hand, we encountered lower MCP-1 levels in patients with LVH (105 pg/mL [100 - 260 pg/mL] versus 136 pg/mL (100 - 200 pg/mL), p = 0.005, respectively] compared with those without LVH. A logistic regression model adjusted for body mass index (BMI), age, race, aldosterone levels, and presence of diabetes and RH demonstrated that median levels of MCP-1 (2.55 pg/mL [1.22 - 5.2 pg/mL], p = 0.01) were independently associated with LVH in the entire hypertensive population. Conclusion: Since MCP-1 levels were similar in both RH and HTN subjects and decreased in hypertensive patients with existing LVH, our study suggests a possible downregulation in MCP-1 levels in hypertensive individuals with LVH, regardless of hypertension strata.


Resumo Fundamentos: A hipertensão arterial é um processo crônico de baixo grau inflamatório, associado com liberação de citocinas e desenvolvimento de lesão em órgãos-alvo. A desregulação dos níveis de proteína quimiotática de monócitos-1 (MCP-1) tem sido associada com elevação da pressão arterial e complicações cardiovasculares; porém, os mecanismos envolvidos são complexos e ainda não foram inteiramente elucidados. Objetivo: O objetivo deste estudo foi comparar os níveis de MCP-1 em pacientes com hipertensão resistente (HR) versus pacientes com hipertensão de grau leve a moderado (HAS) e sua associação com a presença ou ausência de hipertrofia ventricular esquerda (HVE) em todos os indivíduos hipertensos. Métodos: Foram incluídos 256 indivíduos hipertensos: 120 com HR e 136 com HAS. Foi investigada a relação entre os níveis circulantes de MCP-1 e pressão arterial, dados bioquímicos, perfil hematológico e dano cardíaco nos grupos HR e HAS. Os níveis plasmáticos de MCP-1 foram medidos por ELISA e a HVE foi avaliada por ecocardiografia. Resultados: Não encontramos diferença nos níveis de MCP-1 entre indivíduos com HR e HAS. Por outro lado, encontramos níveis mais baixos de MCP-1 em pacientes com HVE (105 pg/mL [100 - 260 pg/mL] versus 136 pg/mL [100 - 200 pg/mL], respectivamente, p = 0,005] em comparação a pacientes sem HVE. Um modelo de regressão logística ajustado para o índice de massa corporal (IMC), idade, raça, níveis de aldosterona e presença de diabetes e HR mostrou que os níveis medianos de MCP-1 (2,55 pg/mL [1,22 - 5,2 pg/mL], p = 0,01) estiveram independentemente associados com HVE em toda a população de hipertensos. Conclusão: Como os níveis de MCP-1 foram semelhantes em indivíduos tanto com HR quanto HAS e estiveram diminuídos em pacientes hipertensos com HVE, nosso estudo sugere uma possível redução nos níveis de MCP-1 em indivíduos hipertensos com HVE, independe do grau da hipertensão.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Hypertrophy, Left Ventricular/physiopathology , Chemokine CCL2/analysis , Ventricular Remodeling/physiology , Hypertension/physiopathology , Severity of Illness Index , Cross-Sectional Studies , Blood Pressure Monitoring, Ambulatory
4.
Arq. bras. cardiol ; 108(1): 47-52, Jan. 2017. tab
Article in English | LILACS | ID: biblio-838678

ABSTRACT

Abstract Background: Left ventricular hypertrophy (LVH) is an important risk factor for cardiovascular events, and its detection usually begins with an electrocardiogram (ECG). Objective: To evaluate the impact of complete left bundle branch block (CLBBB) in hypertensive patients in the diagnostic performance of LVH by ECG. Methods: A total of 2,240 hypertensive patients were studied. All of them were submitted to an ECG and an echocardiogram (ECHO). We evaluated the most frequently used electrocardiographic criteria for LVH diagnosis: Cornell voltage, Cornell voltage product, Sokolow-Lyon voltage, Sokolow-Lyon product, RaVL, RaVL+SV3, RV6/RV5 ratio, strain pattern, left atrial enlargement, and QT interval. LVH identification pattern was the left ventricular mass index (LVMI) obtained by ECHO in all participants. Results: Mean age was 11.3 years ± 58.7 years, 684 (30.5%) were male and 1,556 (69.5%) were female. In patients without CLBBB, ECG sensitivity to the presence of LVH varied between 7.6 and 40.9%, and specificity varied between 70.2% and 99.2%. In participants with CLBBB, sensitivity to LVH varied between 11.9 and 95.2%, and specificity between 6.6 and 96.6%. Among the criteria with the best performance for LVH with CLBBB, Sokolow-Lyon, for a voltage of ≥ 3,0mV, stood out with a sensitivity of 22.2% (CI 95% 15.8 - 30.8) and specificity of 88.3% (CI 95% 77.8 - 94.2). Conclusion: In hypertensive patients with CLBBB, the most often used criteria for the detection of LVH with ECG showed significant decrease in performance with regards to sensitivity and specificity. In this scenario, Sokolow-Lyon criteria with voltage ≥3,0mV presented the best performance.


Resumo Fundamento: A hipertrofia ventricular esquerda (HVE) é importante fator de risco para eventos cardiovasculares, e sua identificação se inicia, geralmente, pela realização do eletrocardiograma (ECG). Objetivo: Avaliar, em hipertensos, o impacto do bloqueio completo do ramo esquerdo (BCRE) no desempenho diagnóstico da HVE pelo ECG. Métodos: Foram estudados 2.240 pacientes hipertensos. Todos realizaram ECG e ecocardiograma (ECO). Foram avaliados os critérios eletrocardiográficos mais utilizados para o diagnóstico de HVE: Cornell voltagem, Cornell voltagem produto, Sokolow-Lyon voltagem, Sokolow-Lyon produto, RaVL, RaVL produto, RaVL+SV3, Relação RV6/RV5, padrão strain, aumento atrial esquerdo e o intervalo QT. O padrão de identificação da HVE foi o índice de massa do ventrículo esquerdo (IMVE) obtido pelo ECO em todos participantes. Resultados: A média de idade foi de 11,3 anos ± 58,7 anos, 684 (30,5%) homens e 1.556 (69,5%) mulheres. Nos participantes sem BCRE, a sensibilidade do ECG para a presença de HVE variou de 7,6 a 40,9%, e a especificidade de 70,2 a 99,2%. Nos participantes com BCRE, a sensibilidade para a HVE variou de 11,9 a 95,2%, e a especificidade de 6,6 a 96,6%. Dentre os critérios com melhor desempenho para HVE com BCRE, destacou-se o de Sokolow-Lyon para voltagem ≥ 3,0mV com sensibilidade de 22,2% (IC 95% 15,8 - 30,8) e especificidade de 88,3% (IC 95% 77,8 - 94,2). Conclusão: Nos hipertensos com BCRE, os critérios mais utilizados para detecção da HVE pelo ECG apresentaram diminuição significativa de desempenho da sensibilidade e especificidade. Nesse cenário, o critério de Sokolow-Lyon com voltagem ≥3,0mV apresentou melhor comportamento.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Bundle-Branch Block/physiopathology , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/physiopathology , Electrocardiography/methods , Hypertension/physiopathology , Time Factors , Bundle-Branch Block/diagnosis , Echocardiography , Risk Factors , Sensitivity and Specificity , Hypertension/diagnosis
5.
Braz. j. med. biol. res ; 50(5): e5742, 2017. tab, graf
Article in English | LILACS | ID: biblio-839290

ABSTRACT

Cardiac remodeling is defined as changes in shape and function of the heart in response to aggression (pressure overload). The sarcoplasmic reticulum calcium ATPase cardiac isoform 2a (SERCA2a) is a known factor that influences function. A wide spectrum of studies report a decrease in SERCA2a in heart failure, but none evaluate it's the role in early isolated diastolic dysfunction in supravalvular aortic stenosis (AoS). Our hypothesis was that SERCA2a participates in such dysfunction. Thirty-day-old male Wistar rats (60-80 g) were divided into AoS and Sham groups, which were submitted to surgery with or without aorta clipping, respectively. After 6 weeks, the animals were submitted to echocardiogram and functional analysis by isolated papillary muscle (IPM) in basal condition, hypoxia, and SERCA2a blockage with cyclopiazonic acid at calcium concentrations of 0.5, 1.5, and 2.5 mM. Western-blot analyses were used for SERCA2a and phospholamban detection. Data analysis was carried out with Student's t-test and ANOVA. AoS enhanced left atrium and E and A wave ratio, with preserved ejection fraction. Basal condition in IPM showed similar increases in developed tension (DT) and resting tension (RT) in AoS, and hypoxia was similar between groups. After cyclopiazonic acid blockage, final DT was equally decreased and RT was similar between groups, but the speed of relaxation was decreased in the AoS group. Western-blot was uniform in all evaluations. The hypothesis was confirmed, since functional parameters regarding SERCA2a were changed in the AoS group.


Subject(s)
Animals , Male , Aortic Stenosis, Supravalvular/complications , Hypertrophy, Left Ventricular/physiopathology , Sarcoplasmic Reticulum Calcium-Transporting ATPases/physiology , Ventricular Dysfunction, Left/physiopathology , Aortic Stenosis, Supravalvular/metabolism , Calcium-Binding Proteins/analysis , Collagen/analysis , Diastole/physiology , Disease Models, Animal , Echocardiography , Heart Ventricles/pathology , Heart Ventricles/physiopathology , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/metabolism , Hypoxia/metabolism , Hypoxia/physiopathology , Indoles , Myocardial Contraction/physiology , Rats, Wistar , Sarcoplasmic Reticulum Calcium-Transporting ATPases/analysis , Sarcoplasmic Reticulum Calcium-Transporting ATPases/metabolism , Time Factors , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/metabolism , Ventricular Remodeling/physiology
6.
Braz. j. med. biol. res ; 50(9): e6146, 2017. tab, graf
Article in English | LILACS | ID: biblio-888999

ABSTRACT

Elevated salt intake induces changes in the extracellular matrix collagen, leading to myocardial stiffness and impaired relaxation. Resistance training (RT) has been used as a remarkably successful strategy in the treatment of heart disease. Therefore, the aim of this study was to investigate the effects of RT on preventing pathological adaptation of the left ventricle (LV) induced by salt overload. Male Wistar rats (10 weeks old) were distributed into four groups (n=8/group): control (CO), control+1% salt (CO+SALT), RT and RT+1% salt (RT+SALT). The RT protocol consisted of 4×12 bouts of squat training, 5/week for 8 weeks, with 80% of one repetition maximum (1RM). Echocardiographs were analyzed and interstitial collagen volume fraction (CVF) was determined in the LV. The 1RM tests in the RT and RT+SALT groups increased 145 and 137%, respectively, compared with the test performed before the training program. LV weight-to-body weight ratio and LV weight-to-tibia length ratio were greater in the RT and RT+SALT groups, respectively, compared with the CO group. Although there was no difference in the systolic function between groups, diastolic function decreased 25% in the CO+SALT group compared with the CO group measured by E/A wave ratio. RT partially prevented this decrease in diastolic function compared with the CO+SALT group. A 1% salt overload increased CVF more than 2.4-fold in the CO+SALT group compared with the CO group and RT prevented this increase. In conclusion, RT prevented interstitial collagen deposition in LV rats subjected to 1% NaCl and attenuated diastolic dysfunction induced by salt overload independent of alterations in blood pressure.


Subject(s)
Animals , Male , Rats , Physical Conditioning, Animal/physiology , Hypertrophy, Left Ventricular/etiology , Sodium Chloride, Dietary/adverse effects , Ventricular Remodeling/drug effects , Resistance Training , Echocardiography , Rats, Wistar , Hypertrophy, Left Ventricular/physiopathology , Sodium Chloride, Dietary/administration & dosage , Ventricular Remodeling/physiology , Disease Models, Animal
7.
ABC., imagem cardiovasc ; 29(2): 42-46, abr.-jun. 2016. tab
Article in Portuguese | LILACS | ID: lil-786645

ABSTRACT

Fundamento: O diagnóstico ecocardiográfico de hipertrofia ventricular esquerda (HVE) em crianças baseia-se no cálculo damassa do ventrículo esquerdo (VE) indexada. Entretanto, o critério de indexação ainda não é consenso.Objetivo: Comparar diferentes critérios usados no diagnóstico de HVE à ecocardiografia em crianças.Método: Foram incluídas crianças com doença renal crônica (DRC) em diálise (grupo DI) ou em tratamento conservador (grupoTC). Foram obtidas as medidas e calculada a massa do VE conforme recomendado. Os critérios de HVE utilizados foram: 1)massa (g) – HVE conforme gênero e área da superfície corporal (ASC); 2) massa (g) indexada à ASC (g/m2) – HVE conforme gênero e ASC; 3) massa em gramas indexada à altura (m) à potência de 2,7 (g/m2,7) – diagnóstico de HVE conforme nomograma de idade, gênero e altura; 4) escore z http://parameterz.blogspot.com/2008/09/lv-mass-z-scores – HVE se > 2 desvios-padrão).As proporções de HVE foram comparadas por teste do X2; significante se p < 0,05.Resultados: Sessenta crianças com DRC foram incluídas; 34 no grupo DI (17 meninos; mediana da idade = 109 meses) e 26no grupo TC (15 meninos; mediana da idade = 80 meses). Conforme o critério, no grupo total, as proporções de HVE foram, respectivamente, 31/60, 33/60, 41/60 e 31/60 (p = 0,049), menor pelo critério 2 em relação ao 3 (p = 0,026); no grupo DI foram23/34; 23/34; 31/34 e 29/34 (p = 0,006), maior com o critério 3 em relação aos critérios 1 (p = 0,033) e 2 (p = 0,004) e com ocritério 4 em relação ao 2 (p = 0,029); no grupo TC foram 8/26; 10/26; 10/26 e 2/26 (p = 0,038), menor pelo critério 4 em relaçãoaos critérios 2 (p = 0,038) e 3 (p = 0,009).


Background: the echocardiographic diagnosis of left ventricular hypertrophy (LVH) in children is based on the indexed left ventricle mass calculation.However, the indexation criterion is still not defined.Objective: to compare different criteria used for the diagnosis of LVH by echocardiography in children.Method: The study included children with chronic renal disease (CRD) in dialysis (DI) or in conservative treatment (CT). Measures for left ventriclemass calculation were obtained as recommended. The criteria used for LVH were: 1) mass (g) – LVH according to gender and body surface area(BSA, m2) – based on large study of normal Brazilian children; 2) mass indexed to body surface area (g/m2) – LVH according to gender and bodysurface area (BSA, m2) – based on large study of normal Brazilian children; 3) g/altura2,7 but diagnosis of LVH by a nomogram of age, gender andheight; 4) z score (http://parameterz.blogspot.com/2008/09/lv-mass-z-scores) – LVH if > 2 standard-deviation. The proportion of LVH among thegroups were compared by X2; significant if p < 0.05.Results: 60 children with CKD were included; 34 in DI (17 boys; median of age= 109 months) and 26 in CT (15 boys; median of age= 80 months).According to each criteria, in the hole group, the proportions of LVH were, respectively, 31/60, 33/60, 41/60 e 31/60 (p=0.049), lower for criterion2 compared to 3 (p=0.026); in DI group were 23/34; 23/34; 31/34 e 29/34 (p=0.006), higher with criterion 3 compared to criteria 1 (p=0.033)and 2 (p=0.004), and with 4 compared to 2 (p=0.029); in TC group were 8/26; 10/26; 10/26 e 2/26 (p=0.038), lower for criterion 4 comparedto criteria 2 (p=0.038) and 3 (p=0.009). Conclusion: in children with CKD the proportion of LVH by echocardiography was different according to the criterion used. (Arq Bras Cardiol:Imagem cardiovasc. 2016;29(2):42-46).


Subject(s)
Humans , Male , Female , Child , Child , Echocardiography/methods , Hypertrophy, Left Ventricular/physiopathology , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/diagnosis , Age Factors , Renal Dialysis/methods , Cardiovascular Diseases/complications , Cardiovascular Diseases/diagnosis , Sex Factors , Statistical Analysis , Heart Ventricles/physiopathology
8.
J. bras. pneumol ; 41(5): 427-432, tab, graf
Article in English | LILACS | ID: lil-764565

ABSTRACT

Objective: To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy.Methods: This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010.Results: Of the 192 patients evaluated, 39 (10 males and 29 females) met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = −0.355 and r = −0.349, respectively) after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area).Conclusions: A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight), gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals.


Objetivo: Verificar a existência de correlações entre variáveis de função pulmonar e de dimensões cardíacas em obesos mórbidos, buscando testar a hipótese de que o tamanho relativo das pequenas vias aéreas correlaciona-se com hipertrofia cardíaca esquerda de forma independente.Métodos: Estudo retrospectivo de 192 prontuários médicos que continham um protocolo clínico de candidatos à cirurgia bariátrica entre janeiro de 2006 a dezembro de 2010.Resultados: Dos 192 pacientes avaliados, 39 (29 mulheres) preencheram os critérios de inclusão. A média do IMC foi de 49,2 ± 7,6 kg/m2, e a média de idade foi de 35,5 ± 7,7 anos. As correlações da FEF25-75/CVF, % com a espessura da parede posterior do ventrículo esquerdo e a espessura relativa da parede posterior do ventrículo esquerdo se mantiveram estatisticamente significativas após ajuste para peso, sexo e história de hipertensão arterial sistêmica (r = −0,355 e r = −0,349, respectivamente). Após análise de regressão linear multivariada stepwise, a CVF e o VEF1foram os principais determinantes da massa ventricular esquerda (em gramas ou indexada para área de superfície corporal).Conclusões: Uma redução no tamanho relativo das pequenas vias aéreas parece apresentar uma correlação independente com hipertrofia cardíaca relacionada à obesidade, independente de fatores que afetam a mecânica respiratória (IMC e peso), sexo ou história de hipertensão arterial sistêmica. O VEF1 e a CVF, por outro lado, podem ser importantes determinantes preditivos da massa ventricular esquerda em obesos mórbidos.


Subject(s)
Adult , Female , Humans , Male , Bariatric Surgery , Hypertrophy, Left Ventricular/physiopathology , Lung/physiopathology , Obesity, Morbid/physiopathology , Anthropometry , Hypertension/physiopathology , Hypertrophy, Left Ventricular , Linear Models , Reference Values , Respiratory Function Tests , Retrospective Studies , Sex Factors , Smoking/adverse effects
9.
Int. j. cardiovasc. sci. (Impr.) ; 28(3): 224-233, mai.-jun. 2015. tab, ilus, graf
Article in Portuguese | LILACS | ID: lil-775245

ABSTRACT

Fundamentos: A síndrome do PRKAG2 é classificada como uma doença de armazenamento de glicogênio, caracterizada pela presença da síndrome de Wolff-Parkinson-White (WPW), hipertrofia ventricular (HV) e doençado sistema de condução (DSC).Objetivos: Identificar potenciais fatores prognósticos para eventos em indivíduos acometidos por essa doença edescrever as características clínicas. Métodos: Sessenta indivíduos foram acompanhados de março de 2005 a março de 2015, estratificados em doisgrupos: Grupo 1 (G1) - portadores de WPW, HV ou ambos; e Grupo 2 (G2) - indivíduos assintomáticos, comexame físico, eletrocardiograma e ecocardiograma normais. Realizados anamense, exame físico, eletrocardiograma e ecocardiograma. Quando necessário, realizou-se Holter e estudo eletrofisiológico. Resultados: Dos 60 indivíduos selecionados, 18 constituíram o G1. Destes, 11 (61,1%) tinham HV associada à WPW, 6 (33,3%) apresentavam WPW isolada e 1 (5,6%) paciente apresentava HV isolada. A média de idade foi 27,0±16,0 anos e 32 (53,3%) eram do sexo masculino. Apenas indivíduos do Grupo 1 apresentaram eventos isolados: 3 (17,0%) paradas cardíacas, 2 (11,0%) mortes súbitas, 6 (33,0%) implantes de marca-passo, 4 (22,0%) acidentes isquêmicos encefálicos transitórios e 9 (50,0%) eventos combinados. Os potenciais preditores de eventos combinados foram: tamanho de átrio esquerdo (p=0,07) diabetes mellitus (p=0,05) e os bloqueios atrioventriculares (p=0,019). Esses fatores não evidenciaram significância estatística, quando comparados na análise de regressão de Cox. Conclusões: Em portadores de WPW com hipertrofia ventricular ocorreu associação entre diabetes mellitus, bloqueio atrioventricular e tamanho de átrio esquerdo com os principais desfechos.


Background: The PRKAG2 syndrome is classified as a glycogen storage disease, characterized by the presence of the Wolff Parkinson-Whitesyndrome (WPW), ventricular hypertrophy (VH) and conduction system disease (CSD). Objectives: Finding potential prognostic factors for events in individuals affected by this disease and describing the clinical characteristics. Methods: Sixty individuals were monitored from March 2005 to March 2015, being divided into two groups: Group 1 (G1) - patients with WPW, VH or both; and Group 2 (G2) - asymptomatic patients, with normal physical examination, electrocardiogram and echocardiography. It included the performance of medical history, physical examination, electrocardiogram and echocardiogram. Holter and electrophysiological study were performed when necessary. Results: G1 was made of 18 out of the 60 patients selected. Of these, 11 (61.1%) had VH related to WPW, 6 (33.3%) had isolated WPW and 1 (5.6%) patient had isolated VH. The mean age was 27.0±16.0 years and 32 (53.3%) were male. Only the patients in Group 1 had isolated events: 3 (17.0%) cardiac arrests, 2 (11.0%) sudden deaths, 6 (33.0%) pacemaker implants, 4 (22.0%) transient ischemic attacks and 9 (50.0%) combined events. The events predictors in potential combined were: left atrium size (p=0.07) diabetes mellitus (p=0.05) and the atrioventricular blocks (p=0.019). Those factors did not have statistic significance when compared in the Cox regression analysis. Conclusions: In WPV patients with ventricular hypertrophy there was an association of diabetes mellitus, atrioventricular blockand left atrium size with the main outcomes.


Subject(s)
Humans , Male , Female , Adult , Death, Sudden, Cardiac , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/physiopathology , Risk Factors , Wolff-Parkinson-White Syndrome/diagnosis , Wolff-Parkinson-White Syndrome/physiopathology , Cohort Studies , Diabetes Mellitus , Echocardiography/methods , Electrocardiography/methods , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Kaplan-Meier Estimate , Multivariate Analysis , Prognosis , Prospective Studies , Treatment Outcome
10.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 24(1): 66-70, jan.-mar. 2014. graf
Article in Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: lil-729296

ABSTRACT

A prática regular de exercícios de alta intensidade tem sido relacionada com alterações no tamanho e no ritmo cardíaco de atletas há séculos. Mais recentemente, com o avanço dos exames complementares no século 20, tais alterações foram bem descritas e definidas como adaptações fisiológicas, sendo conhecidas como "coração de atleta". Entretanto, até meados da década de 90 estas adaptações não tinham sido descritas em mulheres. Acredita-se que isso se deva não só à presença de menos atletas do sexo feminino até aquele período e com uma intensidade menor de treinamento, mas também à quantidade inferior de androgênios circulantes. Atualmente, as adaptações do coração de atleta também, têm sido evidenciadas nas mulheres atletas, porém, parecem ocorrer de maneira diferente e em menor proporção do que os homens atletas.


Regular intensive physical training has been associated with changes in cardiac size and heart rate for centuries. Recently, with the advancement of multimodality imaging in the 20th century, such changes have been well described and defined as physiological adaptations, known as the "athlete's heart", However, until the middle of the 90's these adaptations had never been described in women, not only because of the small number of female athletes until that time, but also due to the lower amount of circulating androgens. Recently, adaptations of the athlete's heart have also been demonstrated in women, but it seems to occur differently and less extensive than in men athletes.


Subject(s)
Humans , Male , Female , Athletes , Physical Exertion/physiology , Exercise/physiology , Heart Rate/physiology , Hypertrophy, Left Ventricular/physiopathology , Women , Echocardiography, Doppler/methods , Electrocardiography/methods , Exercise Test/methods , Stroke Volume
11.
J. pediatr. (Rio J.) ; 90(1): 71-77, jan-feb/2014. tab, graf
Article in English | LILACS | ID: lil-703632

ABSTRACT

OBJECTIVE: Children with ventricular septal defects (VSD) can have chronic volume overload, which can result in changes of left heart echocardiographic parameters. To evaluate the changes before and after surgical closure, the children were divided into three groups according to the degree of mitral regurgitation (MR), and their echocardiographic characteristics were reviewed at serial follow-up after surgical closure. METHODS: The preoperative, and one-, three-, and 12-month postoperative echocardiographic data of 40 children who underwent surgical closure of VSD were retrospectively reviewed. Left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), mitral valvular characteristics, including degree of MR and mitral valve annulus, and left atrial (LA) characteristics, including volume and dimensions, were observed. RESULTS: Preoperative LVEDV, LVEDD, LVESD, mitral valvular annulus, LA volume, and LA dimensions were significantly larger in children with MR. Additionally, there were significant decreases in LVEDV, LVEDD, LA volume, and LA dimensions at one, three, and 12 months postoperatively. The degree of MR also improved to a lower grade after surgical closure of the VSD without additional mitral valve repair. CONCLUSION: The echocardiographic parameters of left heart dilation and MR in children with VSD improved within the first year after surgical closure without additional mitral valve repair. Furthermore, in all of the patients with VSD, regardless of MR, LA dilation was reduced within three months after surgical closure of the VSD; however, LV and mitral valve annular dilatation decreased within 12 months. .


OBJETIVO: Crianças com defeito do septo ventricular (DSV) podem apresentar sobrecarga devolume crônica, que pode resultar em mudanças nos parâmetros ecocardiográficos do curacao esquerdo. Para avaliar as mudanças antes e depois do fechamento cirúrgico, as crianças foram divididas em 3 grupos segundo o grau de regurgitação mitral (RM) e suas características eco-cardiográficas foram analisadas com acompanhamento em série após o fechamento cirúrgico. MÉTODO: Revisamos retrospectivamente os dados ecocardiográficos de 40 crianças submetidas afechamento cirúrgico de DSV antes da cirurgia e nos meses 1, 3 e 12 após a cirurgia. Observamos o volume diastólico final do ventrículo esquerdo (VDFVE), dimensão diastólica final do ventrículo esquerdo (DDFVE) e dimensão sistólica final do ventrículo esquerdo (DSFVE), características da válvula mitral, incluindo grau de RM e o anel da válvula mitral, e características do átrio esquerdo (AE), incluindo volume e dimensões. RESULTADOS: Os resultados para VDFVE, DDFVE, DSFVE, anel da válvula mitral, volume do AE e dimensões do AE foram significativamente maiores em crianças com RM. Além disso, não houveredução significativa no VDFVE, DDFVE, volume do AE e nas dimensões do AE nos meses 1, 3e 12 após a cirurgia. O grau de RM também apresentou melhoria para um grau menor após o fechamento cirúrgico do DSV sem reparo adicional da válvula mitral. CONCLUSÃO: Os parâmetros ecocardiográficos de dilatação do coração esquerdo e a RM em crianças com DSV haviam apresentado melhora no primeiro ano após o fechamento cirúrgicos em reparo adicional da válvula mitral. Além disso, em todos os pacientes com DSV, independentemente ...


Subject(s)
Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Heart Septal Defects, Ventricular/surgery , Hypertrophy, Left Ventricular , Mitral Valve Insufficiency/physiopathology , Ventricular Dysfunction, Left/surgery , Atrial Function, Left/physiology , Heart Septal Defects, Ventricular , Hypertrophy, Left Ventricular/physiopathology , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency , Retrospective Studies , Remission Induction/methods , Time Factors , Ventricular Dysfunction, Left , Ventricular Function, Left/physiology
12.
Article in English | WPRIM | ID: wpr-70750

ABSTRACT

It is known that blood pressure variability (BPV) can independently affect target organ damage (TOD), even with normal blood pressure. There have been few studieson chronic kidney disease (CKD) patients. We evaluated the relationship between BPV and TOD in a cross-sectional, multicenter study on hypertensive CKD patients. We evaluated 1,173 patients using 24-hr ambulatory blood pressure monitoring. BPV was defined as the average real variability, with a mean value of the absolute differences between consecutive readings of systolic blood pressure. TOD was defined as left ventricular hypertrophy (LVH) (by the Romhilt-Estes score > or =4 in electrocardiography) and kidney injury (as determined from an estimated glomerular filtration rate [eGFR]<30 mL/min/1.73 m2 and proteinuria).The mean BPV of the subjects was 15.9+/-4.63 mmHg. BPV displayed a positive relationship with LVH in a univariate analysis and after adjustment for multi-variables (odds ratio per 1 mmHg increase in BPV: 1.053, P=0.006). In contrast, BPV had no relationship with kidney injury. These data suggest that BPV may be positively associated with LVH in hypertensive CKD patients.


Subject(s)
Adult , Aged , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory , Cross-Sectional Studies , Electrocardiography , Female , Glomerular Filtration Rate , Humans , Hypertension/complications , Hypertrophy, Left Ventricular/physiopathology , Kidney/injuries , Male , Middle Aged , Odds Ratio , Proteinuria/complications , Renal Insufficiency, Chronic/complications
13.
Rev. méd. Chile ; 141(12): 1520-1527, dic. 2013. graf, tab
Article in English | LILACS | ID: lil-705570

ABSTRACT

Background: High blood pressure causes left ventricular hypertrophy, which is a negative prognostic factor among hypertensive patients. Aim: To assess left ventricular geometric remodeling patterns in patients with essential hypertension or with hypertension secondary to parenchymal renal disease. Material and Methods: We analyzed data from echocardiograms performed in 250patients with essential hypertension (150 females) and 100 patients with secondary hypertension (60 females). The interventricular septum and the left ventricular posterior wall thickness were measured in the parasternal long-axis. Left ventricular mass was calculated using the Devereaux formula. Results: The most common remodeling type in females and males with essential hypertension were eccentric and concentric left ventricular hypertrophy (cLVH), respectively. Among patients with secondary arterial hypertension, cLVH was most commonly observed in both genders. The prevalence of left ventricular hypertrophy was higher among patients with secondary hypertension. The left ventricular mass index and the relative left ventricular wall thickness were higher in males and also in the secondary hypertension group. Age, blood pressure values and the duration of hypertension, influenced remodeling patterns. Conclusions: We documented a higher prevalence of LVH among patients with secondary hypertension. The type of ventricular remodeling depends on gender, age, type of hypertension, blood pressure values and the duration of hypertension.


Antecedentes: La hipertensión arterial causa hipertrofia ventricular izquierda, un factor de mal pronóstico en pacientes hipertensos. Objetivo: Evaluar patrones de remodelación ventricular en pacientes con hipertensión arterial esencial y secundaria a daño renal. Material y Métodos: Análisis de ecocardiogramas efectuados a 250 pacientes con hipertensión arterial primaria (150 mujeres) y 100 pacientes con hipertensión secundaria (60 mujeres). Se midió el grosor del septum interventricular y de la pared ventricular posterior. La masa ventricular izquierda se calculó usando la fórmula de Devereaux. Resultados: Los tipos más frecuentes de remodelación ventricular en mujeres y hombres con hipertensión esencial fueron la hipertrofia ventricular excéntrica y concéntrica, respectivamente. En pacientes con hipertensión arterial secundaria, la hipertrofia concéntrica fue más frecuente. La prevalencia de hipertrofia ventricular izquierda fue más alta en pacientes con hipertensión secundaria. El índice de masa ventricular izquierda y el grosor relativo de la pared ventricular izquierda fueron mayores en pacientes con hipertensión secundaria. La edad, los valores de presión arterial y la duración de la hipertensión influyeron en los patrones de remodelación. Conclusiones: Documentamos una mayor prevalencia de hipertrofia ventricular izquierda en pacientes con hipertensión secundaria. El tipo de remodelación depende de la edad, género, tipo de hipertensión, valores de presión arterial y duración de la hipertensión.


Subject(s)
Female , Humans , Male , Middle Aged , Hypertension , Hypertrophy, Left Ventricular , Ventricular Remodeling , Age Factors , Blood Pressure/physiology , Echocardiography/methods , Hypertension/complications , Hypertension/physiopathology , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Kidney Diseases/physiopathology , Kidney Diseases , Prevalence , Sex Factors , Time Factors , Ventricular Remodeling/physiology , Ventricular Septum/physiology
14.
Arq. bras. cardiol ; 100(6): 518-523, jun. 2013. tab
Article in Portuguese | LILACS | ID: lil-679142

ABSTRACT

FUNDAMENTO: A relevância do padrão de geometria após o infarto do miocárdio não é conhecida. OBJETIVOS: Analisar a presença de diferentes padrões de geometria ventricular esquerda (VE) e seu impacto como preditor de remodelação em pacientes com infarto do miocárdio. MÉTODOS: Pacientes com infarto agudo anterior (n = 80) foram divididos de acordo com o padrão de geometria: normal (índice de massa [IMVE] normal e espessura relativa da parede [ERP] normal), remodelação concêntrica (IMVE normal e ERP aumentada), hipertrofia concêntrica (IMVE e ERP aumentadas) e hipertrofia excêntrica (IMVE aumentado e ERP normal). Após seis meses, foi repetido o ecocardiograma. RESULTADOS: Quatro pacientes foram a óbito. Dos sobreviventes, 41 apresentaram remodelação (R+), enquanto 39 não remodelaram (R-). Considerando-se o padrão geométrico, houve a seguinte distribuição: 24 pacientes com padrão normal, 13 com remodelação concêntrica, 29 com hipertrofia concêntrica e 14 com hipertrofia excêntrica. Os pacientes que remodelaram apresentaram maiores tamanhos de infarto analisados pelo pico da CPK (R+ = 4.610 (1.688 - 7.970), R- = 1.442 (775 - 4.247), p < 0,001) e da CK-MB (R+ = 441 (246 - 666), R- = 183 (101 - 465), p < 0,001), tendência a maior prevalência de remodelação concêntrica (R+ = 10, R- = 3, p = 0,08) e menor prevalência de hipertrofia excêntrica (R+ = 2, R- = 12, p = 0,006). Na análise de regressão multivariada, o tamanho do infarto foi preditor (OR = 1,01; p = 0,020) e a hipertrofia excêntrica foi fator protetor (OR = 0,189; p = 0,046) de remodelação ventricular após a oclusão coronariana. CONCLUSÃO: O padrão de geometria ventricular pode ter impacto no processo de remodelação em pacientes com infarto do miocárdio.


BACKGROUND: The relevance of left ventricular (LV) geometric pattern after myocardial infarction is not known. OBJECTIVES: To analyze the presence of different LV geometric patterns and teir impact as a predictor of remodeling in patients with myocardial infarction. METHODS: Patients with anterior acute myocardial infarction (n = 80) were divided according to the geometric pattern: normal (normal left ventricular mass index [LVMI] and normal relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT) and eccentric hypertrophy (increased LVMI and normal RWT). After six months, echocardiographic assessment was repeated. RESULTS: Four patients died. Of the survivors, 41 showed remodeling (R +), whereas 39 did not (R-). Considering the geometric pattern, the cases were distributed as follows: 24 patients with normal pattern, 13 with concentric remodeling, 29 with concentric hypertrophy and 14 with eccentric hypertrophy. Patients who showed remodeling had larger infarction sizes analyzed by peak CPK (R + = 4,610 (1,688-7,970), R- = 1,442 (775-4247), p <0.001) and CK-MB (R + = 441 (246 - 666), R- = 183 (101-465), p <0.001), trend towards higher prevalence of concentric remodeling (R+ = 10, R- = 3, p = 0.08) and lower prevalence of eccentric hypertrophy (R + = 2 R- = 12, p = 0.006). In the multivariate regression analysis, infarction size was a predictor (OR = 1.01, p = 0.020) and eccentric hypertrophy was a protective factor (OR = 0.189, p = 0.046) of ventricular remodeling after coronary occlusion. CONCLUSION: The LV geometric pattern of can have an impact on the remodeling process in patients with myocardial infarction.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anterior Wall Myocardial Infarction/physiopathology , Heart Ventricles/physiopathology , Ventricular Remodeling/physiology , Age Factors , Anterior Wall Myocardial Infarction , Echocardiography , Heart Ventricles , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Left Ventricular , Predictive Value of Tests , Prospective Studies , Risk Factors , Sex Factors
15.
Arq. bras. cardiol ; 100(3): 261-268, mar. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-670867

ABSTRACT

FUNDAMENTO: Os indivíduos com insuficiência renal crônica terminal estão sujeitos a um elevado estresse cardíaco pelo carácter repetitivo e intermitente da terapia dialítica. As alterações na sístole elétrica ventricular induzidas pela necessária terapia dialítica são um contributo importante na predição da ocorrência de morte súbita arrítmica na insuficiência renal crônica terminal. OBJETIVO: O objetivo principal desta investigação é avaliar o comportamento da repolarização ventricular em face da terapia dialítica, mediante o estudo do intervalo QTc e dispersão do QTc. MÉTODOS: A amostra em estudo inclui 47 indivíduos sujeitos a hemodiálise (61,7% do sexo masculino e 38,3% do sexo feminino) com idade média de 66,79 ± 13,16 anos. Todos os indivíduos foram sujeitos a três eletrocardiogramas realizados em três momentos durante a terapia dialítica (pré, durante e após a sessão), sendo posteriormente analisada a sístole elétrica ventricular. RESULTADOS: Ocorreu um aumento do intervalo QTc máximo e da dispersão do QTc associado à terapia dialítica. Aliado ao aumento desses intervalos ocorreu um aumento do número de indivíduos com critérios eletrocardiográficos para hipertrofia ventricular esquerda, registando-se no período pós-diálise uma média superior do intervalo QTc máximo (473 ± 27,63 mseg) e da dispersão do QTc (58,95 ± 18,87 mseg) desses indivíduos, comparativamente aos indivíduos sem HVE, 455,21 ± 26,85 mseg e 44 ± 16,41 mseg, respectivamente. CONCLUSÃO: O presente estudo confirmou um aumento do intervalo QTc e da dispersão do QTc associado à terapia dialítica. Esse aspecto reforça a dependência da repolarização ventricular em relação ao equilíbrio hídrico e eletrolítico e sugere um perfil de maior vulnerabilidade arrítmica associada à terapia dialítica.


BACKGROUND: Patients with end-stage kidney disease (ESKD) experience elevated cardiac stress because of the repetitive and intermittent character of dialysis. Changes in ventricular electrical systole induced by necessary dialysis significantly contribute to predict sudden death due to arrhythmia in ESKD. OBJECTIVE: The major objective of this study was to assess the behavior of ventricular repolarization in dialysis by analyzing QTc interval and QTc dispersion. METHODS: This study sample consisted of 47 patients undergoing hemodialysis (61.7% males and 38.3% females), whose mean age was 66.79±13.16 years. All of them underwent three electrocardiograms performed before, during and after one dialysis session. Ventricular electrical systole was analyzed later. RESULTS: An increase in maximum QTc interval and QTc dispersion associated with dialysis was observed. In addition, an increase in the number of individuals meeting the electrocardiographic criteria for left ventricular hypertrophy (LVH) was observed. After dialysis, higher means of the maximum QTc interval (473 ± 27.63 mseg) and of the QTc dispersion (58.95 ± 18.87 mseg) were observed in individuals with LVH as compared with those in individuals without LVH (455.21 ± 26.85 mseg and 44 ± 16.41 mseg, respectively). CONCLUSION: This study confirmed an increase in the QTc interval and QTc dispersion associated with dialysis. That emphasizes the dependence of ventricular repolarization on fluid and electrolyte balance, and suggests a profile of higher vulnerability to arrhythmia associated with dialysis .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Heart Conduction System/physiopathology , Hypertrophy, Left Ventricular/physiopathology , Kidney Failure, Chronic/physiopathology , Renal Dialysis/adverse effects , Ventricular Function/physiology , Arrhythmias, Cardiac/prevention & control , Chi-Square Distribution , Death, Sudden, Cardiac/prevention & control , Electrocardiography , Hypertrophy, Left Ventricular/pathology , Kidney Failure, Chronic/therapy , Linear Models , Systole/physiology
16.
Article in English | WPRIM | ID: wpr-173141

ABSTRACT

The current study proposes a model of the cardiovascular system that couples heart cell mechanics with arterial hemodynamics to examine the physiological role of arterial blood pressure (BP) in left ventricular hypertrophy (LVH). We developed a comprehensive multiphysics and multiscale cardiovascular model of the cardiovascular system that simulates physiological events, from membrane excitation and the contraction of a cardiac cell to heart mechanics and arterial blood hemodynamics. Using this model, we delineated the relationship between arterial BP or pulse wave velocity and LVH. Computed results were compared with existing clinical and experimental observations. To investigate the relationship between arterial hemodynamics and LVH, we performed a parametric study based on arterial wall stiffness, which was obtained in the model. Peak cellular stress of the left ventricle and systolic blood pressure (SBP) in the brachial and central arteries also increased; however, further increases were limited for higher arterial stiffness values. Interestingly, when we doubled the value of arterial stiffness from the baseline value, the percentage increase of SBP in the central artery was about 6.7% whereas that of the brachial artery was about 3.4%. It is suggested that SBP in the central artery is more critical for predicting LVH as compared with other blood pressure measurements.


Subject(s)
Aorta/physiology , Arteries/physiology , Blood Pressure , Cardiovascular System/physiopathology , Computer Simulation , Hemodynamics , Humans , Hypertrophy, Left Ventricular/physiopathology , Models, Biological , Ventricular Function
18.
Arq. bras. cardiol ; 98(1): 84-86, jan. 2012. graf, tab
Article in Portuguese | LILACS | ID: lil-613426

ABSTRACT

O Índice Tornozelo-Braquial (ITB) é marcador de doença arterial obstrutiva periférica. Raros relatos correlacionam esse índice com hipertrofia ventricular esquerda (HVE), capacidade funcional (CF) e escore de risco coronariano de Framingham (ERCF). O objetivo do trabalho foi verificar a correlação entre ITB, HVE, CF e ERCF em homens com hipertensão arterial (HA). Estudo prospectivo e transversal de pacientes do sexo masculino (n = 40), com idade média de 57,92 ± 7,61 anos, sem complicações cardiovasculares. Essa população foi submetida às medidas de ITB, ecocardiograma (ECO), teste ergométrico (TE) e exames laboratoriais. O ITB (direito e esquerdo) foi considerado anormal quando a relação entre a maior média das pressões sistólicas dos tornozelos e dos braços foi inferior ou igual a 0,9 ou superior a 1,3 mmHg. A HVE foi identificada pelo ECO transtorácico; e a CF, pelo TE. Amostras sanguíneas periféricas foram colhidas para o cálculo do ERCF. Valores normais de ITB foram encontrados em 33 pacientes (82,5 por cento), os quais foram incluídos no Grupo I; sete pacientes (17,5 por cento) com ITB anormal constituíram o Grupo II. Os índices de massa do índice de massa do ventrículo esquerdo (IMVE) ao ECO foram de 111,18 ± 34,34 g/m² (Grupo I) e de 150,29 ± 34,06 g/m2 (Grupo II) (p = 0,009). A prevalência de HVE foi de 4 por cento (Grupo I) e de 35,3 por cento (Grupo II) (p = 0,01), constatando-se diferenças significativas entre os grupos. Quanto à CF no TE, não se registrou diferença entre os grupos. Em relação ao ERCF, a média do Grupo I foi inferior à média do Grupo II: 13,18 ± 2,11 versus 15,28±1,79 (p = 0,019). Em HA, a presença de HVE definida pelo IMVE esteve mais presente nos casos com ITB anormal, identificando maior risco cardiovascular.


The ankle-brachial index (ABI) is a marker of peripheral arterial disease. Very few reports have correlated this index with left ventricular hypertrophy (LVH), functional capacity (FC) and Framingham risk score (FRS). The objective of this study was to verify the correlation between ABI, LVH, FC and FRS in men with arterial hypertension (AH). Prospective and cross-sectional study of male patients (n = 40) with a mean age of 57.92 ± 7.61 years and no cardiovascular complications. This population was submitted to ABI measurements, echocardiography (ECHO), exercise test (ET) and laboratory tests. The ABI (right and left) was considered abnormal when the ratio between the highest mean systolic pressures of the ankles and arms was 0.9 or higher than 1.3 mmHg. LVH was identified by transthoracic ECHO and the FC by the ET. Peripheral blood samples were collected to calculate the FRS. Normal ABI values were observed in 33 patients (82.5 percent), who were included in Group I; seven patients (17.5 percent) with abnormal ABI constituted Group II. Left ventricular mass index (LVMI) at the ECO were 111.18 ± 34.34 g/m2 (Group I) and 150.29 ± 34.06 g/m² (Group II) (p = 0.009). The prevalence of LVH was 4 percent (Group I) and 35.3 percent (Group II) (p = 0.01), demonstrating a significant difference between the groups. As for the FC in ET, there was no difference between the groups. Regarding the FRS, the mean in Group I was below that in Group II: 13.18 ± 2.11 versus 15.28 ± 1.79 (p = 0.019). In hypertensive patients, the presence of LVH defined by the LVMI was more frequent in cases with abnormal ABI, identifying a higher cardiovascular risk.


El Índice Tobillo-Braquial (ITB) es un marcador de enfermedad arterial obstructiva periférica. Raros relatos correlacionan ese índice con la hipertrofia ventricular izquierda (HVI), capacidad funcional (CF) y puntación de riesgo coronario de Framingham (PRCF). El objetivo de este estudio fue verificar la correlación entre ITB, HVI, CF y PRCF en hombres con hipertensión arterial (HA). Estudio prospectivo y transversal de pacientes del sexo masculino (n = 40), con edad promedio de 57,92 ± 7,61 años, sin complicaciones cardiovasculares. Esa población fue sometida a las medidas de ITB, ecocardiograma (ECO), test ergométrico (TE) y exámenes de laboratorio. El ITB (derecho e izquierdo), se consideró anormal cuando la relación entre la mayor media de las presiones sistólicas de los tobillos y de los brazos fue inferior o igual a 0,9 o superior a 1,3 mmHg. La HVI fue identificada por el ECO transtorácico; y la CF por el TE. Muestras sanguíneas periféricas se recogieron para el cálculo del PRCF. Valores normales de ITB fueron encontrados en 33 pacientes (82,5 por ciento), los cuales se incluyeron en el Grupo I; siete pacientes (17,5 por ciento) con ITB anormal formaron el Grupo II. Los índices de masa del índice de masa del ventrículo izquierdo (IMVI) al ECO fueron de 111,18 ± 34,34 g/m² (Grupo I) y de 150,29 ± 34,06 g/m² (Grupo II) (p = 0,009). La prevalencia de HVI fue de 4 por ciento (Grupo I) y de 35,3 por ciento (Grupo II) (p = 0,01), siendo comprobadas las diferencias significativas entre los grupos. En cuanto a la CF en el TE, no se registró ninguna diferencia entre los grupos. Con relación al PRCF, el promedio del Grupo I quedó por debajo del promedio del Grupo II: 13,18 ± 2,11 versus 15,28±1,79 (p = 0,019). En HA, la presencia de HVI definida por el IMVI estuvo más presente en los casos con ITB anormal, identificando un mayor riesgo cardiovascular.


Subject(s)
Humans , Male , Middle Aged , Ankle Brachial Index , Hypertension/physiopathology , Hypertrophy, Left Ventricular/physiopathology , Epidemiologic Methods , Heart Ventricles/pathology , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/pathology , Reference Values , Risk Factors
19.
Rev. chil. cardiol ; 31(3): 184-188, 2012. tab
Article in Spanish | LILACS | ID: lil-670189

ABSTRACT

Background: Tissue Doppler imaging (TDI) could improve the prognostic evaluation of patients with arterial hypertension in whom systolic function is normal as well as in those with diasto-lic dysfunction. Low values of peak systolic myo-cardial velocity (Sm) are associated with systolic function impairment, hypertensive cardiomyopathy and mortality from cardiac causes. Nevertheless, the association of Sm wave with increased end-diastolic pressure is not clear yet. Aim: to estimate the correlation between Sm wave and several echocardiography morphologic and functional parameters in patients with arterial hypertension and preserved ejection fraction. Methods: in a retrospective analysis (2007-2010) of 1198 hypertensive patients with preserved ejection fraction, Sm wave was evaluated and correlated with ejection fraction, left ventricular mass index (VMI), left atrium indexed volume (LAIV), pulmonary artery systolic pressure (PAPs) and E/e' ratio. Results: a decrease Sm was observed as VMI increased (p<0.01). Among patients with Sm <6cm/s, 76.6% had E/e' >13 (p<0.01). Normal Sm values were observed in 93% of patients with E/e' ratio <13, 92% of patients with LAID < 32ml/m2 and 71% of patients with PAPs <35mmHg (p<0.01). Conclusion: Sm wave measurement gives valuable information about systolic function as well as end-diastolic pressure in hypertensive patients with left ventricular hypertrophy.


Antecedentes: El doppler tisular podría mejorar la evaluación pronostica en pacientes hipertensos con función sistólica normal o aparentemente normal como en la disfunción diastólica Valores bajos de velocidad de desplazamiento miocárdico en sístole (Sm) están asociados con deterioro de la función sistólica, cardiopatía hiper-tensiva y mortalidad de causa cardíaca. No obstante, la asociación de la onda Sm con parámetros de aumento de presión de fin de diástole aún no es clara. Objetivos: Estimar la asociación entre la onda Sm y diferentes parámetros ecocardiográficos morfológicos, de función sistólica y diastólica en pacientes con hipertensión arterial que poseen fracción de eyección conservada. Métodos: En un análisis retrospectivo de 1198 pacientes hipertensos (con fracción de eyección preservada) entre los años 2007 y 2010, se evaluó onda Sm y su asociación con la fracción de eyección, índice de masa ventricular (IMV), volumen de aurícula izquierda indexado (VAI), presión de arteria pulmonar en sístole (PAPS) y la relación E/e'. Resultados: Se observó una tendencia al descenso de la onda Sm a medida que aumenta el IMV (p<0,01). De los pacientes con Sm <6 cm/s, el 76,6% de presentó E/e' >13 cm/s (p<0,01). Además, Sm normal se asoció con E/e' <13 cm/s, VAI <32 ml/m2 y PAPS <35 mmHg en un 93%, 71% y 92% respectivamente (p<0,01). Conclusiones: La medición de la onda Sm aporta valiosa información, no sólo de función sistólica, sino también de función diastólica, en pacientes hipertensos con hipertrofia ventricular izquierda.


Subject(s)
Humans , Male , Female , Aged , Echocardiography, Doppler/methods , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Left Ventricular , Stroke Volume
20.
Arq. bras. cardiol ; 97(3): 225-231, set. 2011. ilus, graf, tab
Article in Portuguese | LILACS | ID: lil-601807

ABSTRACT

FUNDAMENTO: Sabe-se que vários fatores interferem na sensibilidade do Eletrocardiograma (ECG) no diagnóstico da Hipertrofia Ventricular Esquerda (HVE), sendo o gênero e a massa cardíaca alguns dos principais. OBJETIVO: Avaliar a influência do sexo na sensibilidade de alguns dos critérios utilizados para a detecção de HVE, de acordo com a progressão do grau de hipertrofia ventricular. MÉTODOS: De acordo com o gênero e com o grau de HVE ao ecocardiograma, os pacientes foram divididos em três grupos: HVE leve, moderada e severa. Avaliou-se a sensibilidade do ECG para detectar HVE entre homens e mulheres, conforme o grau de HVE. RESULTADOS: Dos 874 pacientes, 265 eram homens (30,3 por cento) e 609, mulheres (69,7 por cento). Os critérios [(S + R) X QRS], Sokolow-Lyon, Romhilt-Estes, Perúgia e padrão strain mostraram alto poder discriminatório no diagnóstico de HVE entre homens e mulheres nos três grupos de HVE, com desempenho superior na população masculina e destaque para os escores [(S + R) X QRS] e Perúgia. CONCLUSÃO: A sensibilidade diagnóstica do ECG é maior com o aumento da massa cardíaca. O exame é mais sensível entre homens, destacando-se os escores [(S + R) X QRS] e Perúgia.


BACKGROUND: Several factors are known to interfere with electrocardiogram (ECG) sensitivity when diagnosing Left Ventricular Hypertrophy (LVH), with gender and cardiac mass being two of the most important ones OBJECTIVE: To evaluate the influence of gender on the sensitivity of some of the criteria used to detect LVH, according to the progression of ventricular hypertrophy degree. METHODS: According to gender and the degree of LVH at the echocardiogram, the patients were divided in three groups: mild, moderate and severe LVH. ECG sensitivity to detect LVH was assessed between men and women, according to the LVH degree. RESULTS: Of the 874 patients, 265 were males (30.3 percent) and 609, females (69.7 percent). The [(S + R) X QRS], Sokolow-Lyon, Romhilt-Estes, Perugia and strain criteria showed high discriminatory power in the diagnosis of LVH between men and women in the three groups with LVH, with a superior performance in the male population and highlighting the importance of the [(S + R) X QRS] and Perugia scores. Conclusion: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores. CONCLUSION: The diagnostic sensitivity of the ECG increases with the cardiac mass. The examination is more sensitive in men, highlighting the importance of the [(S + R) X QRS] and Perugia scores.


Subject(s)
Female , Humans , Male , Middle Aged , Electrocardiography , Hypertrophy, Left Ventricular/diagnosis , Sex Factors , Echocardiography , Heart Ventricles , Hypertrophy, Left Ventricular/physiopathology , Sensitivity and Specificity
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