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Int. j. cardiovasc. sci. (Impr.) ; 35(3): 329-339, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1375636


Abstract Background: Right ventricular dysfunction is a major complication in chronic obstructive pulmonary disease (COPD) and, despite its prognostic implications, is rarely considered in routine clinical analysis. Objectives: To compare RV function variables with standard and advanced echocardiographic techniques in patients with stable COPD and controls. Methods: Twenty COPD patients classified as GOLD ≥ II (13 men aged 68.4 ± 8.3 years) and 20 matched controls were compared. Myocardial strain/strain rate indices were obtained by tissue Doppler and two-dimensional speckle tracking echocardiography. Right ventricular ejection fraction was obtained with three-dimensional software. Free wall myocardial thickness (FWMT) and tricuspid annular systolic excursion (TAPSE) were also measured. Numerical variables were compared between groups with Student's t-test or the Mann-Whitney test. Associations between categorical variables were determined with Fisher's exact test. P-values < 0.05 were considered statistically significant. Results: All myocardial deformation indices, particularly global longitudinal strain (-17.2 ± 4.4 vs -21.2: ± 4.4 = 0.001) and 3D right ventricular ejection fraction (40.8 ± 9.3% vs 51.1 ± 6.4% p <0.001) were reduced in COPD patients. These patients presented higher right ventricular FWMT and lower TAPSE values than controls. Conclusion: Myocardial deformation indices, either tissue Doppler or speckle tracking echocardiography and 3D right ventricular ejection fraction, are robust markers of right ventricular dysfunction in patients with stable COPD. Assessing global longitudinal strain by speckle tracking echocardiography is a more practical and reproducible method.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Ventricular Dysfunction, Right/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Pulmonary Disease, Chronic Obstructive/diagnostic imaging , Case-Control Studies , Cross-Sectional Studies , Ventricular Dysfunction, Right/etiology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/therapy , Myocardium
Int. j. cardiovasc. sci. (Impr.) ; 35(3): 410-418, May-June 2022. graf
Article in English | LILACS | ID: biblio-1375650


Abstract An acute respiratory syndrome caused by SARS-CoV2 was declared a pandemic by the World Health Organization. Current data in the world and in Brazil show that approximately 40% of patients who died have some type of cardiac comorbidity. There are also robust reports showing an increase in IL-6 / IL-1B / TNF-alpha and the presence of lymphopenia in patients with COVID-19. Our team and others have shown that increased cytokines are the link between arrhythmias/Left ventricular dysfunction and the immune system in different diseases. In addition, it has been well demonstrated that lymphopenia can not only be a good marker, but also a factor that causes heart failure. Thus, the present review focused on the role of the immune system upon the cardiac alterations observed in the SARS-CoV2 infection. Additionally, it was well described that SARS-CoV-2 is able to infect cardiac cells. Therefore, here it will be reviewed in deep.

Arrhythmias, Cardiac/complications , SARS-CoV-2/pathogenicity , COVID-19/complications , Heart Failure/etiology , Myocardium/immunology , Arrhythmias, Cardiac/physiopathology , Cytokines , Cytokines/immunology , Coronavirus/pathogenicity , Ventricular Dysfunction, Left/physiopathology , Myocytes, Cardiac/pathology , Severe Acute Respiratory Syndrome , Heart Failure/complications , Lymphopenia/complications
Saúde Colet. ; 12(74): 10011-10026, mar.2022.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1412455


Objetivo: Avaliar a ansiedade e capacidade funcional nos pré-operatórios e pós-operatório da cirurgia de revascularização do miocárdio. Métodos: Pesquisa de caráter transversal e observacional realizada no período de dezembro/2018 a dezembro/2019. Foram incluídos pacientes em pré-operatório e pós-operatório de CRM, secundário ao infarto. Utilizou-se dois instrumentos: Questionário de Ansiedade Cardíaca e o Teste de Caminhada de 6 minutos. Resultados: Avaliou-se 41 pacientes, 25 (69%) do sexo masculino. A ansiedade no pré e pós-operatório mostrou significância estatística em ambos os sexos. O TC6' apresentou p≤0,05 na avaliação pré e pós-operatória, no sexo masculino e feminino quando avaliados separadamente, com DTC6'significativamente menor no pós-operatório. Conclusão: Níveis de ansiedade e redução da capacidade funcional foram observados em pacientes no pré e pós-operatório de CRM, podendo trazer importantes prejuízos para esse grupo. No entanto, sugerem-se estudos com a ampliação da amostra para confirmação dos dados obtidos(AU)

Objective: To assess anxiety and functional capacity in the preoperative and postoperative periods of coronary artery bypass graft surgery. Methods: Cross-sectional and observational survey conducted from december/2018 to december/2019. Patients in preoperative and postoperative CABG secondary to infarction were included. Two instruments were used: Heart Anxiety Questionnaire and the 6-minute walk test. Results: 41 patients were evaluated, 25 (69%) males. Pre- and postoperative anxiety showed statistical significance in both sexes. The 6MWT' presented p≤0.05 in the pre- and postoperative evaluation, in males and females when evaluated separately, with a significantly lower 6MWT in the postoperative period. Conclusion: Levels of anxiety and reduced functional capacity were observed in patients in the pre- and postoperative period of CABG, which could cause significant harm to this group. However, studies with the expansion of the sample are suggested to confirm the data obtained.(AU)

Objetivo: Evaluar la ansiedad y la capacidad funcional en el preoperatorio y postoperatorio de cirugía de revascularización miocárdica. Métodos: Investigación transversal y observacional realizada de diciembre/2018 a diciembre/2019. Se incluyeron pacientes en preoperatorio y postoperatorio de CABG secundaria a infarto. Se utilizaron dos instrumentos: el Cuestionario de Ansiedad Cardíaca y la prueba de marcha de 6 minutos. Resultados: Se evaluaron 41 pacientes, 25 (69%) eran del sexo masculino. La ansiedad en el pre y postoperatorio mostró significación estadísticaen ambos sexos. El 6MWT mostró p≤0.05 en la evaluación pre y postoperatoria, en hombres y mujeres cuando se evaluó por separado, conun 6MWD significativamente menor en el postoperatorio. Conclusión: Se observaron niveles de ansiedad y capacidad funcional reducida en pacientes en el pre y posoperatorio de CABG, lo que puede traer perjuicios significativos para este grupo. Sin embargo, se sugieren estudios con ampliación de la muestra para confirmar los datos obtenidos.(AU)

Anxiety , Cardiovascular Diseases , Functional Residual Capacity , Myocardium
Med. lab ; 26(1): 35-46, 2022. Grafs
Article in Spanish | LILACS | ID: biblio-1370947


COVID-19 es una enfermedad infecciosa respiratoria aguda, causada por el SARS-CoV-2, un nuevo coronavirus, que se extendió rápidamente por todo el mundo, dando como resultado una pandemia. Los pacientes presentan un amplio espectro de manifestaciones clínicas, entre ellas, la miocarditis, y de manera alterna, algunos pacientes sin síntomas de enfermedad cardíaca, tienen anomalías en las pruebas, como elevación de la troponina y arritmias cardíacas en el electrocardiograma, o anomalías en las imágenes cardíacas. La patogenia del compromiso miocárdico no es clara, pero las dos principales teorías prevén un papel directo de la enzima convertidora de angiotensina 2, que funciona como el receptor viral, y una respuesta hiperinmune, que también puede conducir a una presentación aislada. El estándar de oro del diagnóstico es la biopsia endomiocárdica, la cual no está disponible en la mayoría de los escenarios. En esta revisión, se pretende brindar al lector pautas para identificar las manifestaciones clínicas, ayudas diagnósticas y manejo de los pacientes con sospecha de miocarditis por COVID-19

COVID-19 is an acute respiratory infectious disease caused by a new coronavirus, SARS-CoV-2 virus, that spread rapidly around the world, resulting in a pandemic. Patients present with a wide spectrum of clinical manifestations, including myocarditis, and alternately, some patients without symptoms of heart disease have abnormalities in tests, such as elevated troponin, arrhythmias in the ECG orabnormalities in cardiac imaging testing. The pathogenesis of myocardial involvement is not completely clear, but the two main theories suggest a direct role of the angiotensin-converting enzyme, which functions as the virus receptor, and a hyperimmune response, which can also lead to an isolated presentation. The gold standard for the diagnosis is the endomyocardial biopsy, which is not available in most settings. In this review, we intend to provide the reader with guidelines to identify the clinical manifestations, diagnostic tools, and management of patients with suspected COVID-19 myocarditis

COVID-19 , Biopsy , Echocardiography , SARS-CoV-2 , Myocarditis , Myocardium
ABC., imagem cardiovasc ; 35(1): eabc274, 2022. tab
Article in Portuguese | LILACS | ID: biblio-1369861


O diabetes melito é o maior fator de risco para doença arterial coronariana. Além da longa duração de diabetes, outros fatores, como presença de doença arterial periférica e tabagismo são fortes preditores para anormalidades na cintilografia de perfusão do miocárdio. O objetivo deste estudo foi avaliar o impacto dos fatores de risco de pacientes diabéticos nos resultados da cintilografia de perfusão do miocárdio e comparar com os resultados de pacientes não diabéticos em uma clínica de medicina nuclear. Foi realizado um estudo transversal retrospectivo por meio da análise de prontuários de pacientes que realizaram cintilografia miocárdica no período de 2010 a 2019. Foram avaliados 34.736 prontuários. Analisando a fase de estresse da cintilografia de perfusão do miocárdio, os portadores de diabetes melito precisaram receber estímulo farmacológico duas vezes mais que os não diabéticos para sua realização. Também foram avaliados fatores que tivessem impacto negativo no resultado da cintilografia de perfusão do miocárdio, e foi visto que o diabetes melito (33,6%), a insulinoterapia (18,1%), a hipertensão arterial sistêmica (69,9%), a dislipidemia (53%), o sedentarismo (83,1%), o uso de estresse farmacológico (50,6%), a dor torácica típica (8,5%) e a angina limitante durante o teste (1,7%) estiveram associados significativamente (p<0,001) a anormalidades neste exame. (AU)

Diabetes mellitus (DM) is the greatest risk factor for coronary artery disease. In addition to a long duration of diabetes, the presence of peripheral arterial disease and smoking are strong predictors of abnormalities on myocardial perfusion scintigraphy (MPS). This study aimed to assess the impact of risk factors in diabetic patients on MPS results and compare them with those of non-diabetic patients in a nuclear medicine clinic. A retrospective cross-sectional study was performed through the analysis of the medical records of patients who underwent MPS in 2010­2019. A total of 34,736 medical records were evaluated. Analyzing the stress phase of MPS, DM patients required two-fold more pharmacological stimulation than non-diabetic patients for MPS. Factors that negatively impact the MPS results were also evaluated, and DM (33.6%), insulin therapy (18.1%), systemic arterial hypertension (69.9%), dyslipidemia (53%), sedentary lifestyle (83.1%), use of pharmacological stress (50.6%), typical chest pain (8.5%), and limiting angina during the test (1.7%) were significantly associated (p < 0.001) with test abnormalities. (AU)

Humans , Male , Middle Aged , Tobacco Use Disorder/complications , Diabetes Mellitus, Type 2/pathology , Peripheral Arterial Disease/complications , Ventilation-Perfusion Scan/methods , Myocardium/pathology , Tomography, Emission-Computed, Single-Photon/methods , Risk Factors , Myocardial Ischemia/diagnosis , Convulsive Therapy/methods , Dyslipidemias/complications , Sedentary Behavior , Hypertension/complications , Nuclear Medicine Department, Hospital
Article in Chinese | WPRIM | ID: wpr-941010


OBJECTIVE@#To evaluate the protective effect of excretory-secretory proteins from Trichinella spiralis muscle larvae (Ts-MES) on sepsis-induced myocardial injury in mice.@*METHODS@#Eighty male BALB/C mice were randomized equally into sham-operated group, myocardial injury group, Ts-MES treatment group and dexamethasone treatment group. In the latter 3 groups, sepsis-induced myocardial injury models were established by cecal ligation and perforation; the sham operation was performed by exposure of the cecum without ligation or perforation. Forty minutes after the operation, the mice were given intraperitoneal injections 150 μL PBS, 20 μg TS-MES or 0.3 mg/kg dexamethasone as indicated. At 12 h after the operation, 6 mice were randomly selected from each group for echocardiography, and 8 mice were used for observing the survival rate within 72 h. The remaining 6 mice were examined for myocardial pathologies with HE staining and serum levels of NTPro-BNP and cTnI with ELISA; the expressions of TNF-α, IL-6, IL-10 and TGF-β in the serum and myocardial tissue were detected using ELISA and qRT-PCR.@*RESULTS@#Compared with the sham-operated mice, the septic mice showed significantly decreased cardiac function indexes (LVEF, LVFS, and E/A) with lowered survival rate within 72 h (P < 0.001) and significantly higher myocardial injury scores and serum levels of NTPro-BNP and cTnI (P < 0.01). Treatment with TS-MES significantly improved the cardiac function and 72-h survival rate (P < 0.05) and lowered the myocardial injury scores and serum levels of NTPro-BNP and cTnI (P < 0.05) in the septic mice. Compared with the sham-operated mice, the septic mice had obviously increased TNF-α and IL-6 levels in the serum and myocardial tissue (P < 0.001), which were significantly lowered by treatment with TS-MES (P < 0.05). TS-MES and dexamethasone both increased the levels of IL-10 and TGF-β in the septic mice, but the changes were significant only in TS-MES-treated mice (P < 0.05).@*CONCLUSION@#Ts-MES are capable of protecting against myocardial injury in septic mice by reducing the production of pro-inflammatory cytokines and enhancing the levels of regulatory cytokines.

Animals , Cytokines , Dexamethasone , Heart Injuries , Interleukin-10 , Interleukin-6 , Larva , Male , Mice , Mice, Inbred BALB C , Myocardium , Sepsis , Transforming Growth Factor beta , Trichinella spiralis , Tumor Necrosis Factor-alpha
Chinese Journal of Hepatology ; (12): 402-406, 2022.
Article in Chinese | WPRIM | ID: wpr-935958


Objective: To quantitatively evaluate myocardial work in patients with hepatitis B cirrhosis by using left ventricular pressure-strain loop. Methods: 70 cases with hepatitis B cirrhosis who were hospitalized in Henan Provincial People's Hospital from March to December 2020 were selected as the study group. Patients were divided into three subgroups according to the Child-Pugh score of liver cirrhosis (Child-Pugh class A, B, and C groups: 25, 25, and 20 patients, respectively). At the same time, 25 healthy volunteers were included as the control group. Global longitudinal strain (GLS), global myocardial work index (GWI), global work efficiency (GWE), global constructive work (GCW), and global wasted work (GWW) were obtained by applying pressure-strain loops. The differences were analyzed and compared among the four groups parameters. Results: Compared with the control group, the Child-Pugh class A group had decreased GLS, while Child-Pugh class B and C had decreased GLS, GWI, GWE, GCW, and increased GWW, and the differences were statistically significant (P<0.05). Compared with Child-Pugh class A group, Child-Pugh class B group had decreased GLS, GWE, and increased GWW, while Child-Pugh class C group had decreased GLS,GWI, GWE, GCW, and increased GWW, and the differences were statistically significant (P<0.05). Compared with Child-Pugh class B group, Child-Pugh class C group had decreased GLS, GWI, GWE, GCW, and increased GWW, and the differences were statistically significant (P<0.05). Conclusion: The pressure-strain loop can detect early myocardial dysfunction, and has a certain value in the diagnosis, treatment and prognosis evaluation of myocardial function changes in patients with hepatitis B cirrhosis.

Hepatitis B , Humans , Liver Cirrhosis , Myocardium , Stroke Volume , Ventricular Function, Left
Chinese Journal of Cardiology ; (12): 501-508, 2022.
Article in Chinese | WPRIM | ID: wpr-935176


Objective: To identify the differentially expressed circular RNA (circRNA) in the myocardium of diabetic cardiomyopathy (DCM) mice, and analyze their possible biological functions and related regulatory network. Methods: C57BL/6 mice, aged 8 weeks, and weighing were 21-27 g. Eight mice were selected as the control group and 15 mice were selected as the experimental group. The diabetic mice model was established by intraperitoneal injection of streptozotocin in the experimental group. One week after injection, the fasting blood glucose level of mice was measured, and 12 diabetic mice were included in the final experimental group. All mice were fed for 12 weeks under the same laboratory conditions. The cardiac structure and function were detected by echocardiography. Diabetic mice with the left ventricular ejection fraction less than 60% and the E/A less than 1.6 were selected as DCM group (n=3). Mice in DCM group and control group were then sacrificed under deep anesthesia. RNA was extracted from myocardial tissue. High-throughput RNA sequencing technology was used to sequence and identify the RNA in the myocardial tissue of DCM group and normal control group, and the difference was analyzed by DeSeq2. The analysis results were verified at the tissue level by RT-qPCR, and the differential circRNA were analyzed by GO and KEGG pathway analysis. The differentially expressed circRNA-microRNA(miRNA) interaction was predicted by the miRNA target gene prediction software. Results: A total of 63 differentially expressed circRNAs were found in the myocardium of DCM mice. The results of RT-qPCR showed that the tissue level expression of 8 differentially expressed circRNAs was consistent with the sequencing results, of which 7 were up-regulated and 1 was down-regulated. KEGG pathway analysis showed that the up-regulated circRNAs was mainly related to AMPK signal pathway and intercellular adhesion junction pathway, and the down-regulated circRNA was mainly related to cardiomyopathy. Go analysis showed that the up-regulated circRNA was mainly related to the binding process of ions, proteins, kinases and other factors in terms of molecular function, and was involved in regulating the intracellular structure, especially the composition of organelles in terms of cell components. The functional analysis of molecular function and cell components showed that the up-regulated circRNA were related to the cell component origin, recruitment and tissue, and thus participated in the regulation of cell biological process. The down regulated circRNA was related to catalytic activity in terms of molecular function, protein kinase binding process, transferase and calmodulin activity, and was closely related to the components of contractile fibers and the composition of myofibrils. These differentially expressed circRNAs were also related to biological processes such as lysine peptide modification, sarcomere composition, myofibril assembly, morphological development of myocardial tissue, myocardial hypertrophy and so on. Conclusions: In this study, we detected the novel differentially expressed circRNAs in the myocardium of DCM mice, and bioinformatics analysis confirmed that these circRNAs are related to oxidative stress, fibrosis and death of cardiomyocytes, and finally participate in the pathophysiological process of DCM.

Animals , Diabetes Mellitus, Experimental , Diabetic Cardiomyopathies/genetics , Gene Expression Profiling/methods , Mice , Mice, Inbred C57BL , MicroRNAs/genetics , Myocardium , RNA, Circular , Stroke Volume , Ventricular Function, Left
Chinese Journal of Cardiology ; (12): 361-368, 2022.
Article in Chinese | WPRIM | ID: wpr-935155


Objective: To investigate the representability and etiological diagnostic value of myocardium samples obtained from patients with hypertrophic cardiomyopathy (HCM) by transthoracic echocardiography-guided percutaneous intramyocardial septal biopsy (myocardial biopsy of Liwen procedure). Methods: This study was a retrospective case-series analysis. Patients with HCM, who underwent myocardial biopsy of Liwen procedure and radiofrequency ablation in Xijing Hospital, Air Force Military Medical University from July to December 2019, were included. Demographic data (age, sex), echocardiographic data and complications were collected through electronic medical record system. The histological and echocardiographic features, pathological characteristics of the biopsied myocardium of the patients were analyzed. Results: A total of 21 patients (aged (51.2±14.5) years and 13 males (61.9%)) were enrolled. The thickness of ventricular septum was (23.3±4.5)mm and the left ventricular outflow tract gradient was (78.8±42.6)mmHg (1 mmHg=0.133 kPa). Eight patients (38.1%) were complicated with hypertension, 1 patient (4.8%) had diabetes, and 2 patients (9.5%) had atrial fibrillation. Hematoxylin-eosin staining of myocardial samples of HCM patients before radiofrequency ablation evidenced myocytes hypertrophy, myocytes disarray, nuclear hyperchromatism, hypertrophy, atypia, coronary microvessel abnormalities, adipocyte infiltration, inflammatory cell infiltration, cytoplasmic vacuoles, lipofuscin deposition. Interstitial fibrosis and replacement fibrosis were detected in Masson stained biopsy samples. Hematoxylin-eosin staining of myocardial samples of HCM patients after radiofrequency ablation showed significantly reduced myocytes, cracked nuclear in myocytes, coagulative necrosis, border disappearance and nuclear fragmentation. Quantitative analysis of myocardial specimens of HCM patients before radiofrequency ablation showed that there were 9 cases (42.9%) with mild myocardial hypertrophy and 12 cases (57.1%) with severe myocardial hypertrophy. Mild, moderate and severe fibrosis were 5 (23.8%), 9 (42.9%) and 7 (33.3%), respectively. Six cases (28.6%) had myocytes disarray. There were 11 cases (52.4%) of coronary microvessel abnormalities, 4 cases (19.0%) of adipocyte infiltration, 2 cases (9.5%) of inflammatory cell infiltration,6 cases (28.5%) of cytoplasmic vacuole, 16 cases (76.2%) of lipofuscin deposition. The diameter of cardiac myocytes was (25.2±2.8)μm, and the percentage of collagen fiber area was 5.2%(3.0%, 14.6%). One patient had severe replacement fibrosis in the myocardium, with a fibrotic area of 67.0%. The rest of the patients had interstitial fibrosis. The myocardial specimens of 13 patients were examined by transmission electron microscopy. All showed increased myofibrils, and 9 cases had disorder of myofibrils. All patients had irregular shape of myocardial nucleus, partial depression, mild mitochondrial swelling, fracture and reduction of mitochondrial crest, and local aggregation of myofibrillary interfascicles. One patient had hypertrophy of cardiomyocytes, but the arrangement of muscle fibers was roughly normal. There were vacuoles in the cytoplasm, and Periodic acid-Schiff staining was positive. Transmission electron microscopy showed large range of glycogen deposition in the cytoplasm, with occasional double membrane surround, which was highly indicative of glycogen storage disease. No deposition of glycolipid substance in lysozyme was observed under transmission electron microscope in all myocardial specimens, which could basically eliminate Fabry disease. No apple green substance was found under polarized light after Congo red staining, which could basically exclude cardiac amyloidosis. Conclusion: Myocardium biopsied samples obtained by Liwen procedure of HCM patients are representative and helpful for the etiological diagnosis of HCM.

Biopsy/adverse effects , Cardiomegaly/pathology , Cardiomyopathy, Hypertrophic/diagnosis , Eosine Yellowish-(YS) , Fibrosis , Heart Defects, Congenital , Hematoxylin , Humans , Lipofuscin , Male , Myocardium/pathology , Retrospective Studies
Article in Chinese | WPRIM | ID: wpr-927990


To investigate the effects of leonurine(Leo) on abdominal aortic constriction(AAC)-induced cardiac hypertrophy in rats and its mechanism. A rat model of pressure overload-induced cardiac hypertrophy was established by AAC method. After 27-d intervention with high-dose(30 mg·kg~(-1)) and low-dose(15 mg·kg~(-1)) Leo or positive control drug losartan(5 mg·kg~(-1)), the cardiac function was evaluated by hemodynamic method, followed by the recording of left ventricular systolic pressure(LVSP), left ventricular end-diastolic pressure(LVESP), as well as the maximum rate of increase and decrease in left ventricular pressure(±dp/dt_(max)). The degree of left ventricular hypertrophy was assessed based on heart weight index(HWI) and left ventricular mass index(LVWI). Myocardial tissue changes and the myocardial cell diameter(MD) were measured after hematoxylin-eosin(HE) staining. The contents of angiotensin Ⅱ(AngⅡ) and angiotensin Ⅱ type 1 receptor(AT1 R) in myocardial tissue were detected by ELISA. The level of Ca~(2+) in myocardial tissue was determined by colorimetry. The protein expression levels of phospholipase C(PLC), inositol triphosphate(IP3), AngⅡ, and AT1 R were assayed by Western blot. Real-time quantitative PCR(qRT-PCR) was employed to determine the mRNA expression levels of β-myosin heavy chain(β-MHC), atrial natriuretic factor(ANF), AngⅡ, and AT1 R. Compared with the model group, Leo decreased the LVSP, LVEDP, HWI, LVWI and MD values, but increased ±dp/dt_(max) of the left ventricle. Meanwhile, it improved the pathological morphology of myocardial tissue, reduced cardiac hypertrophy, edema, and inflammatory cell infiltration, decreased the protein expression levels of PLC, IP3, AngⅡ, AT1 R, as well as the mRNA expression levels of β-MHC, ANF, AngⅡ, AT1 R, c-fos, and c-Myc in myocardial tissue. Leo inhibited AAC-induced cardiac hypertrophy possibly by influencing the RAS system.

Angiotensin II/metabolism , Animals , Cardiomegaly/genetics , Gallic Acid/analogs & derivatives , Hypertrophy, Left Ventricular/pathology , Myocardium/pathology , Rats
Chinese Medical Journal ; (24): 557-570, 2022.
Article in English | WPRIM | ID: wpr-927535


Cardiovascular disease (CVD) remains the leading cause of death worldwide. Therefore, exploring the mechanism of CVDs and critical regulatory factors is of great significance for promoting heart repair, reversing cardiac remodeling, and reducing adverse cardiovascular events. Recently, significant progress has been made in understanding the function of protein kinases and their interactions with other regulatory proteins in myocardial biology. Protein kinases are positioned as critical regulators at the intersection of multiple signals and coordinate nearly every aspect of myocardial responses, regulating contractility, metabolism, transcription, and cellular death. Equally, reconstructing the disrupted protein kinases regulatory network will help reverse pathological progress and stimulate cardiac repair. This review summarizes recent researches concerning the function of protein kinases in CVDs, discusses their promising clinical applications, and explores potential targets for future treatments.

Cardiovascular Diseases , Heart , Humans , Myocardium , Protein Kinases
Arq. bras. cardiol ; 117(5): 999-1007, nov. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1350014


Resumo Fundamento Alterações do substrato elétrico e anatômico do coração são fatores que originam e perpetuam a fibrilação atrial (FA), porém, os mecanismos envolvidos não foram totalmente elucidados ainda. Objetivo: Avaliar o papel do remodelamento do sistema nervoso cardíaco intrínseco (SNCI), incluindo fibras nervosas e receptores muscarínicos e β-adrenérgicos, na FA permanente humana. Métodos Foram avaliadas 4 amostras em átrios de 13 corações obtidos em necrópsias de pacientes com doença cardíaca e FA permanente, e em 13 controles com as mesmas doenças, porém, sem FA. Utilizando imunoperoxidase e histomorfometria, quantificamos a densidade das fibras do SNCI, bem como a porcentagem positiva de miocárdio para receptores β-adrenérgicos 1, 2 e 3, receptor quinase 5 acoplado à proteína G (GRK-5), e receptores muscarínicos 1 a 5. Os resultados foram comparados usando ANOVA e ANOVA hierarquizada e ajustados pelo volume do átrio esquerdo e, para avaliação da expressão de receptores β e GRK-5, pelo uso de β-bloqueadores. Adotamos como significativo α = 0,05. Resultados Houve aumento na densidade das fibras ( p <0,01), especialmente nas fibras simpáticas ( p =0,02). Quanto aos receptores muscarínicos, só houve diferença nos M1, que estavam aumentados (5,87±4,52 vs 2,85±2,40; p =0,03). Quanto aos componentes do sistema adrenérgicos analisados, houve expressão aumentada de β-3 (37,41 vs 34,18, p =0,04) e GRK-5 (51,16 vs 47,66; p<0,01). O uso de β-bloqueadores não teve impacto na expressão de receptores beta. Conclusão O aumento na inervação do SNCI e a alteração na expressão de receptores em regiões suscetíveis de desencadear FA podem ter um papel na fibrilação atrial permanente.

Abstract Background The primary factors that originate and perpetuate atrial fibrillation (AF) are electrical and anatomical substrate alterations. However, the central mechanisms governing AF perpetuation have not been elucidated yet, which is reflected on the modest results of the treatment in patients with long persistent AF. Objective To evaluate if human intrinsic cardiac autonomic nervous system (ICANS) remodeling, including nervous system fibers and muscarinic and β-adrenergic receptors, play a role in permanent AF. Methods Heart necropsy samples from thirteen patients with heart disease and permanent AF and thirteen controls without AF were used. By using immunoperoxidase and histomorphometry quantification, we identified the following: the density of all fibers of the ICANS, sympathetic and parasympathetic fibers; and the percentage of myocardium positive for β-adrenergic receptors 1, 2 and 3; G protein-coupled receptor kinase-5 (GRK-5); and muscarinic receptors M1 to M5. The results were compared using ANOVA and nested ANOVA and were adjusted according to the left atrium volume for all variables, and β-blocker use to evaluate the expression of β-receptors and GRK-5. Results There was an overall increase in the density of fibers of the ICANS (p=0.006), especially in atrial sympathetic nerve fibers (p=0.017). Only M1 muscarinic receptors were increased (5.87 vs 2.35, p=0.032). For adrenergic receptors, the results were positive for increased expression of β-3 (37.41 vs 34.18, p=0.039) and GRK-5 (51.16 vs 47.66; p<0.001). β-blocker use had no impact on β-receptor expression. Conclusion Increased ICANS innervation and remodeling receptor expression in regions prone to triggering AF may play a role in permanent AF.

Humans , Atrial Fibrillation/etiology , Autonomic Nervous System , Sympathetic Nervous System , Heart Atria , Myocardium
Arq. bras. cardiol ; 116(5): 919-925, nov. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1248908


Resumo Fundamento: Fibrose cardíaca difusa é fator importante na avaliação prognóstica dos pacientes com disfunção ventricular. Mapeamento T1 nativo pela ressonância magnética cardíaca (RMC) apresenta elevada sensibilidade e é considerado preditor independente de mortalidade por todas as causas e desenvolvimento de insuficiência cardíaca (IC) nos pacientes com cardiomiopatia. Objetivos: Avaliar aplicabilidade da avaliação com mapa T1 nativo em pacientes com IC em um hospital de referência de cardiologia e sua associação com parâmetros estruturais e perfil funcional. Métodos: Estudo transversal com pacientes adultos com IC classes funcionais NYHA I e II, isquêmicos e não isquêmicos, acompanhados em hospital de referência, que realizaram RMC. Os valores de T1 nativo foram analisados em relação a parâmetros estruturais, comorbidades, etiologia e categorização da IC pela fração de ejeção do ventrículo esquerdo (FEVE). Análises foram realizadas com nível de significância de 5%. Resultados: Analisados 134 pacientes. Valores de T1 nativo elevados foram encontrados em pacientes com maior dilatação (1004,9 vs 1042,7ms, p=0,001), volume (1021,3 vs 1050,3ms, p<0,01) e disfunção ventricular (1010,1 vs 1053,4ms, p<0,001), mesmo quando analisados isoladamente os não isquêmicos. Pacientes classificados com IC com fração de ejeção reduzida apresentaram maiores valores T1 em relação aos com IC e fração de ejeção preservada (ICFEP) (992,7 vs 1054,1ms, p<0,001). Dos com ICFEP, 55,2% apresentavam T1 elevado. Conclusões: Mapeamento T1 por RMC é factível para avaliação da IC clínica. Houve associação direta entre maior valor nativo de T1 e menor fração de ejeção, maiores diâmetros e volumes do VE, independentemente da etiologia da IC.

Abstract Background: Diffuse cardiac fibrosis is an important factor in the prognostic assessment of patients with ventricular dysfunction. Cardiovascular magnetic resonance imaging (CMR) native T1 mapping is highly sensitive and considered an independent predictor of all-cause mortality and heart failure (HF) development in patients with cardiomyopathy. Objectives: To evaluate the feasibility of native T1 mapping assessment in patients with HF in a cardiology referral hospital and its association with structural parameters and functional profile. Methods: Cross-sectional study with adult patients with HF NYHA functional classes I and II, ischemic and non-ischemic, followed in a referral hospital, who underwent CMR. Native T1 values were analyzed for structural parameters, comorbidities, etiology, and categorization of HF by left ventricular ejection fraction (LVEF). Analyses were performed with a significance level of 5%. Results: Enrollment of 134 patients. Elevated native T1 values were found in patients with greater dilation (1004.9 vs 1042.7ms, p = 0.001), ventricular volumes (1021.3 vs 1050.3ms, p <0.01) and ventricular dysfunction (1010.1 vs 1053.4ms, p <0.001), also present when the non-ischemic group was analyzed separately. Patients classified as HF with reduced ejection fraction had higher T1 values than those with HF and preserved ejection fraction (HFPEF) (992.7 vs 1054.1ms, p <0.001). Of those with HFPEF, 55.2% had higher T1. Conclusions: CMR T1 mapping is feasible for clinical HF evaluation. There was a direct association between higher native T1 values and lower ejection fraction, and with larger LV diameters and volumes, regardless of the etiology of HF.

Humans , Adult , Heart Failure/diagnostic imaging , Referral and Consultation , Stroke Volume , Cross-Sectional Studies , Predictive Value of Tests , Ventricular Function, Left , Magnetic Resonance Imaging, Cine , Myocardium
Rev. costarric. cardiol ; 23(1)jun. 2021.
Article in Spanish | LILACS-Express | LILACS, SaludCR | ID: biblio-1389031


Resumen Los receptores del cotransportador de sodio-glucosa han demostrado una gran relevancia en la función miocárdica. Los receptores tipo 1 se encuentran en el miocardio en valores bajos, sin embargo, se elevan en patologías cardiacas por medio de distintos mecanismos moleculares. Por otra parte, los receptores tipo 2 están ausentes en el miocardio. Los fármacos que inhiben este receptor tienen beneficio cardiovascular evidente en estudios clínicos y experimentales, principalmente en pacientes con diabetes mellitus tipo 2 e insuficiencia cardiaca, en los que se ha demostrado una reducción de la mortalidad por causas cardiovasculares y reducción en hospitalización por insuficiencia cardiaca. Existen interrogantes sobre el mecanismo de acción directo de este grupo antihiperglicemiantes sobre el cardiomiocito y se han desarrollado hipótesis y teorías para explicar este efecto. El objetivo de este artículo es revisar y analizar los diferentes mecanismos metabólicos, estructurales, funcionales y mitocondriales en un contexto molecular de los inhibidores del cotransportador sodio-glucosa tipo 2. La acción fisiopatológica del receptor tipo 1 en el miocardio también es importante y se encuentran en desarrollo estudios clínicos para establecer el efecto de su inhibición a nivel cardíaco.

Abstract Sodium-glucose cotransporter receptors have demonstrated relevance in myocardial function. Type 1 receptors are found in the myocardium in low values, however, they are elevated in cardiac pathologies by means of different molecular mechanisms. On the other hand, type 2 receptors are absent in the myocardium. The drugs that inhibit this receptor have been shown to have a cardiovascular benefit demonstrated in clinical and experimental studies, mainly in patients with type 2 diabetes mellitus and heart failure, presenting a reduction in mortality due to cardiovascular causes and a reduction in hospitalization due to heart failure. Due to the above, many questions arise about the mechanism of direct action of this antihyperglycemic group on cardiomyocyte, which is why they have been developed from hypotheses and theories to clarify this action by medicines. The objective of this article is to analyze the different metabolic, structural, functional and mitochondrial mechanisms in a molecular context of the inhibitors of the sodium-glucose cotransporter type 2. On the other hand, to analyze the pathophysiological action of the type 1 receptor in the myocardium, since that future clinical studies will be developed to establish the effect with its inhibition at the cardiac level.

Humans , Diabetes Mellitus, Type 2 , Sodium-Glucose Transporter 1 , Sodium-Glucose Transporter 2 Inhibitors , Myocardium
REME rev. min. enferm ; 25: e1354, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1287714


RESUMO Introdução: observando a diferença de perfil dos pacientes submetidos à cirurgia de revascularização do miocárdio daqueles submetidos à correção cirúrgica de valvopatias, considera-se importante a avaliação do estado emocional de acordo com a cirurgia a ser realizada. Objetivo: comparar os sintomas de ansiedade, depressão e ansiedade cardíaca de pacientes no pré-operatório, segundo o tipo de cirurgia cardíaca a ser realizada: revascularização do miocárdio ou cirurgia de correção de valvopatias. Método: estudo observacional, analítico, de corte transversal, realizado nas enfermarias de cirurgia de um hospital universitário do interior paulista. Uma amostra consecutiva e não probabilística foi constituída pelos pacientes maiores de idade que vieram de casa para a internação e cujo agendamento para a realização da cirurgia foi eletivo. Para a avaliação dos sintomas de ansiedade e depressão, foi utilizado o instrumento Hospital Anxiety and Depression Scale; já para a avaliação da ansiedade cardíaca, foi utilizado o "Questionário de Ansiedade Cardíaca". Para a comparação das medidas dos sintomas, segundo o tipo de cirurgia, foi realizado o teste de Mann-Whitney para amostras independentes, com nível de significância de 5%. Resultados: os grupos foram homogêneos entre si, quanto à caracterização sociodemográfica, exceto para idade. Pacientes em pré-operatório de correção de valvopatias apresentaram escore maior para os sintomas de ansiedade cardíaca quando comparados com pacientes em pré-operatório de revascularização do miocárdio, e a diferença encontrada foi estatisticamente significativa (p=0,020). Conclusão: pacientes em pré-operatório de correção de valvopatias apresentaram mais sintomas de ansiedade cardíaca quando comparados com pacientes em pré-operatório de revascularização do miocárdio.

RESUMEN Introducción: al observar la diferencia en el perfil de los pacientes sometidos a cirugía de revascularización miocárdica respecto a los sometidos a corrección quirúrgica de valvulopatías, se considera importante evaluar el estado emocional de acuerdo con la cirugía a realizar. Objetivo: comparar los síntomas de ansiedad, depresión y ansiedad cardíaca de los pacientes en el período preoperatorio, según el tipo de cirugía cardíaca a realizar: revascularización miocárdica o cirugía de corrección de valvulopatías. Método: estudio observacional, analítico, transversal, realizado en las salas de recuperación de cirugía de un hospital universitario del interior de São Paulo. Una muestra consecutiva y no probabilística estuvo conformada por pacientes mayores que acudieron a su domicilio para ser hospitalizados y cuya cita para la cirugía fue electiva. Para evaluar los síntomas de ansiedad y depresión se utilizó el instrumento Escala Hospitalaria de Ansiedad y Depresión; para la evaluación de la ansiedad cardíaca se utilizó el "Cuestionario de Ansiedad Cardíaca". Para comparar las medidas de síntomas, según el tipo de cirugía, se realizó la prueba de Mann-Whitney para muestras independientes, con un nivel de significancia del 5%. Resultados: los grupos fueron homogéneos entre sí, encuanto a caracterización sociodemográfica, excepto por edad. Los pacientes en el período preoperatorio para la corrección de valvulopatías tuvieron una puntuación más alta para los síntomas de ansiedad cardíaca en comparación con los pacientes en el período preoperatorio de revascularización miocárdica, y la diferencia encontrada fue estadísticamente significativa (p=0,020). Conclusión: los pacientes en período preoperatorio de corrección de valvulopatías presentaron más síntomas de ansiedad cardíaca en comparación con los pacientes en el período preoperatorio de revascularización miocárdica.

ABSTRACT Introduction: observing the difference in profile of patients undergoing coronary artery bypass graft surgery from those undergoing surgical correction of valvular heart disease, it is considered important to assess the emotional state according to the surgery to be performed. Objective: to compare the symptoms of anxiety, depression, and cardiac anxiety of patients in the preoperative period, according to the type of cardiac surgery to be performed: myocardial revascularization or surgery to correct valvular heart diseases. Method: observational, analytical, cross-sectional study carried out in the surgery wards of a university hospital in the countryside of São Paulo. A consecutive and non-probabilistic sample was made up of older patients who came home for hospitalization and whose appointment for the surgery was elective. To evaluate the symptoms of anxiety and depression, the Hospital Anxiety and Depression Scale instrument was used; for the assessment of cardiac anxiety, the "Heart Anxiety Questionnaire" was used. To compare the measures of symptoms, according to the type of surgery, the Mann-Whitney test was performed for independent samples, with a significance level of 5%. Results: the groups were homogeneous among themselves, in terms of sociodemographic characterization, except for age. Patients in the preoperative period for correction of valvular heart disease had a higher score for the symptoms of cardiac anxiety when compared with patients in the preoperative period of myocardial revascularization, and the difference found was statistically significant (p=0.020). Conclusion: patients in the preoperative period for correction of valvular heart disease presented more symptoms of cardiac anxiety when compared with patients in the preoperative period of myocardial revascularization.

Humans , Anxiety , Cardiac Surgical Procedures , Myocardial Revascularization , Cardiovascular Nursing , Myocardium
ABC., imagem cardiovasc ; 34(3)2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1292072


Fundamentos: O papel da cintilografia de perfusão miocárdica em pacientes assintomáticos permanece restrito a situações clínicas muito específicas, muitas delas abordadas nos Critérios de Uso Apropriado (AUC) de Cintilografia de Perfusão Miocárdica. Objetivo: Realizar uma análise crítica da aplicação desses critérios nas indicações de exames realizados em pacientes assintomáticos do Instituto Dante Pazzanese de Cardiologia, cuja população é notadamente de alto risco cardiovascular. Métodos: Foram selecionados pacientes assintomáticos que realizaram cintilografia de perfusão miocárdica para pesquisa de isquemia. As indicações dos exames foram classificadas em apropriadas, inapropriadas ou incertas. Hipocaptação fixa, hipocaptação transitória ou dilatação isquêmica transitória foram consideradas exames alterados. Na análise estatística, buscou-se avaliar a correlação entre o grau de recomendação das indicações e a presença de exames alterados. Resultados: A partir de uma seleção inicial de 2.999 prontuários, 490 foram considerados assintomáticos e incluídos conforme critérios de inclusão estabelecidos previamente. Apenas 9,8% das indicações foram inapropriadas, enquanto que 61,4% foram apropriadas, e 28,8% foram incertas. A hipocaptação fixa do radiofármaco ocorreu em 43,5% dos casos e a hipocaptação transitória, em 16,1%. Solicitar o exame de maneira apropriada ou incerta foi fator preditor de exame com resultado alterado nesta população. Conclusão: O uso dos critérios de uso apropriado da cintilografia de perfusão miocárdica mostrou-se eficaz em predizer exames alterados em uma população assintomática de alto risco cardiovascular, especialmente no grupo de pacientes com indicação incerta, o que pode significar que algumas das indicações consideradas incertas talvez sejam apropriadas para uma população de alto risco cardiovascular. (AU)

Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Myocardial Ischemia/diagnostic imaging , Myocardial Perfusion Imaging/methods , Asymptomatic Diseases , Heart Disease Risk Factors , Fibrosis , Cross-Sectional Studies , Multivariate Analysis , Retrospective Studies , Myocardium/pathology
ABC., imagem cardiovasc ; 34(3)2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1292025


Fundamento: A identificação precoce do dano miocárdico parece ser importante na abordagem do paciente com doença de Chagas. A ecocardiografia com strain obtida por speckle tracking e a avaliação da fibrose miocárdica por meio da ressonância magnética cardíaca podem ser métodos diagnósticos promissores nesse sentido. Objetivo: Avaliar o acometimento miocárdico especificamente na forma crônica cardíaca leve da doença de Chagas por meio do strain por speckle tracking e da fibrose miocárdica pela ressonância magnética cardíaca, além de suas correlações. Método: Estudo de corte transversal que analisou portadores da forma cardíaca crônica leve da doença de Chagas (fração de ejeção preservada) submetidos à ecocardiografia com strain por speckle tracking e à ressonância magnética cardíaca. Resultados: Foram incluídos 21 participantes (mulheres: 62%; idade: 54 ± 5 anos). A prevalência de fibrose miocárdica por meio do realce tardio miocárdico foi de 50%. O strain longitudinal global encontrava-se diminuído em 17 pacientes (81%), com mediana de 14,1% (intervalo interquartil de 12,1 a 16,3). Os valores do mapa T1 encontravam-se, em média, elevados nos portadores de doença de Chagas (993 ± 163 ms). O mapa T1 foi significativamente correlacionado com o strain longitudinal global (r= 0,634; p = 0,015). Além disso, o índice de dispersão mecânica, obtido por strain, estava aumentado (> 55 ms) em 84%, com a maior área sob a curva Característica de Operação do Receptor (área sob a curva de 0,696; intervalo de confiança de 95% de 0,412-0,981) para discriminação de fibrose pelo realce tardio miocárdico. Conclusão: O strain miocárdico e o mapa T1 se comportam como marcadores precoces do dano miocárdico na cardiopatia chagásica crônica leve. O índice de dispersão mecânica estava elevado e foi o parâmetro que melhor se correlacionou com o realce tardio miocárdico. (AU)

Background: The early identification of myocardial damage seems important in the management of patients with Chagas disease. However, it is unknown whether speckle tracking echocardiography strain and cardiac magnetic resonance imaging are promising methods for assessing myocardial involvement and fibrosis, respectively. Objective: To evaluate myocardial involvement in the mild chronic cardiac form of Chagas disease using speckle tracking strain and myocardial fibrosis by cardiac magnetic resonance and assess their correlations. Method: This cross-sectional study analyzed patients with the mild chronic cardiac form of Chagas disease (preserved ejection fraction) using speckle tracking echocardiography and cardiac magnetic resonance. Results: The study included 21 participants (women: 62%; age: 54 ± 5 years). The prevalence of myocardial fibrosis was 50% on delayed myocardial enhancement. The median global longitudinal strain was decreased (14.1%; interquartile range, 12.1­16.3%) in 17 patients (81%). The mean T1 mapping value was high in patients with Chagas disease (993 ± 163 ms). The T1 map was significantly correlated with the global longitudinal strain (r = 0.634; p = 0.015). In addition, the mechanical dispersion index obtained by strain was increased (>55 ms) by 84%, with the largest area under the receiver operating characteristic curve (area under the curve, 0.696; 95% confidence interval, 0.412­0.981) for fibrosis discrimination by delayed myocardial enhancement. Conclusion: Myocardial strain and T1 mapping are early markers of myocardial damage in mild chronic Chagas heart disease. The mechanical dispersion index was high and the most closely correlated with delayed myocardial enhancement. (AU)

Humans , Male , Female , Middle Aged , Chagas Cardiomyopathy/physiopathology , Chagas Cardiomyopathy/diagnostic imaging , Heart/diagnostic imaging , Myocardium/pathology , Prognosis , Stroke Volume , Fibrosis , Magnetic Resonance Imaging , Echocardiography/methods , Linear Models , Chronic Disease , Cross-Sectional Studies , ROC Curve