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1.
Rev. habanera cienc. méd ; 19(4): e2380, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139176

ABSTRACT

RESUMEN Introducción: Las strain segmentaria y longitudinal constituyen excelentes parámetros para la cuantificación de la contractilidad miocárdica. Objetivo: Identificar los valores de strain segmentario y longitudinal de pacientes cubanos con drepanocitosis. Material y Método: Estudio descriptivo prospectivo en los 31 pacientes con drepanocitosis y 52 controles que asistieron al Instituto de Cardiología y Cirugía Cardiovascular entre junio de 2017 a enero de 2018, a los que se determinó strain segmentario y longitudinal como variables de estudio. Se compararon medias mediante la prueba t de Student y se realizó un análisis de varianza (ANOVA) con una prueba a posteriori de Tukey para p<0,05. Resultados: En los drepanocíticos las medias de strain segmentario estuvieron entre -17,7±3,4 porciento (p=0,0001*) y -28,6±4,1 por ciento(p=0,0005*) y -29,3±1,1 porciento (p=<0,0002*), fueron homogéneos todos sus segmentos y en el grupo control entre -19,3±2,9 por ciento (p=0,0001*), en general. Independientemente de que en los pacientes drepanocíticos las medias fueron más bajas estuvieron en el rango de lo normal. Los valores de las medias de strain longitudinal global oscilaron entre -19,2±3,3 y -25,2±2,7 fueron más negativos en el grupo control, respecto a los cubanos con drepanocitosis. Conclusiones: Los resultados obtenidos son los primeros de su tipo publicados en Cuba. Las strain segmentaria y longitudinal de los pacientes drepanocíticos cubanos analizados, con resultados significativamente diferentes que los individuos sanos, pero normales, coinciden con lo informado en la literatura internacional(AU)


ABSTRACT Introduction: Segmental and longitudinal strains are excellent parameters for the quantification of myocardial contractility. Objective: To identify the values ​​of segmental and longitudinal strain in Cuban patients with sickle cell disease. Material and Method: A prospective descriptive study was conducted in 31 patients with sickle cell disease and 52 controls who attended the Institute of Cardiology and Cardiovascular Surgery between June 2017 and January 2018, to which segmental longitudinal strain was determined as study variable. The means between the two groups were compared using the Student's t-test; an analysis of variance (ANOVA) was performed with a posteriori Tukey test for p <0.05. Results: In the patients with sickle cell disease, the means of segmental strain were between -17,7±3,4 percent (p=0,0001*) and -28,6±4,1 percent (p=0,0005*) and -29,3±1,1 percent (p=<0,0002*) with all segments being homogeneous; in the control group they were between -19,3±2,9 percent (p=0,0001*) in general. Despite the means were the lowest in Cuban patients with sickle cell disease, they were within the normal range. The mean values ​​of global longitudinal strain ranged between -19.2 ± 3.3 and -25.2 ± 2.7, being more negative in the control group with respect to Cuban patients with sickle cell disease. Conclusions: The results obtained are the first of its type published in Cuba. The segmental and longitudinal strain in Cuban patients with sickle cell disease analyzed, which have significantly different results from those obtained in healthy individuals, but normal, coincide with those reported in the international literature(AU)


Subject(s)
Humans , Male , Female , Adult , Stroke Volume , Echocardiography, Doppler/methods , Ventricular Dysfunction, Left/etiology , Anemia, Sickle Cell/complications , Epidemiology, Descriptive , Prospective Studies , Cuba , Observational Study
2.
Arq. bras. cardiol ; 113(6): 1084-1089, Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055075

ABSTRACT

Abstract Background: Obstructive sleep apnea (OSA) is a chronic progressive disorder with high mortality and morbidity rate, associated with cardiovascular diseases (CVD), especially heart failure (HF). The pathophysiological changes related to OSA can directly affect the diastolic function of the left ventricle. Objectives: To assess the association of the risk of OSA, evaluated by the Berlin Questionnaire (BQ), and echocardiographic (ECHO) parameters related to diastolic dysfunction in individuals without HF assisted in primary care. Methods: A cross-sectional study that included 354 individuals (51% women) aged 45 years or older. All individuals selected were submitted to an evaluation that included the following procedures: consultation, filling out the BQ, clinical examination, laboratory examination and transthoracic Doppler echocardiography (TDE). Continuous data are presented as medians and interquartile intervals, and categoric variables in absolute and relative frequencies. The variables associated with risk of OSA and at the 0.05 level integrated the gamma regression models with a log link function. A value of p < 0.05 was considered an indicator of statistical significance. Exclusion criteria were presence of HF, to fill out the BQ and patients with hypertension and obesity not classified as high risk for OSA by other criteria. All individuals were evaluated on a single day with the following procedures: medical appointment, BQ, laboratory tests and ECHO. Results: Of the 354 individuals assessed, 63% were classified as having high risk for OSA. The patients with high risk for OSA present significantly abnormal diastolic function parameters. High risk for OSA confirmed positive and statistically significant association, after adjustments, with indicators of diastolic function, such as indexed left atrium volume LAV-i (p = 0.02); E'/A' (p < 0.01), A (p = 0.02), E/A (p < 0.01). Conclusion: Our data show that patients at high risk for OSA present worsened diastolic function parameters measured by TDE.


Resumo Fundamento: A apneia obstrutiva do sono (AOS) é um transtorno crônico, progressivo, com alta morbimortalidade e associado às doenças cardiovasculares (DCV), entre elas a insuficiência cardíaca (IC). As alterações fisiopatológicas relacionadas com a AOS podem impactar diretamente a função diastólica do ventrículo esquerdo. Objetivo: Estimar a associação entre risco de AOS, avaliada pelo Questionário de Berlim (QB), e parâmetros do ecocardiograma, relacionados com a função diastólica, em indivíduos sem IC na atenção primária. Métodos: Estudo transversal que incluiu 354 indivíduos (51% mulheres) com idade igual ou superior a 45 anos. Todos os indivíduos selecionados foram submetidos a uma avaliação que constou dos seguintes procedimentos: consulta, preenchimento do QB e exame clínico, realização de exames laboratoriais e ecocardiograma Doppler transtorácico (EDT). Os dados contínuos são apresentados em medianas e intervalos interquartílicos e os categóricos em frequências absolutas e relativas. As variáveis que apresentaram associação ao risco de AOS em nível de 0,05 integraram os modelos de regressão gama com função de ligação log link. Análise bruta: Um valor de p < 0,05 foi considerado como indicador de significância estatística. Resultados: Dos 354 indivíduos analisados, 63% foram classificados como tendo alto risco para AOS. Os pacientes com alto risco para AOS apresentam alterações significativas dos parâmetros que avaliam a função diastólica. Alto risco para AOS confirmou sua associação positiva e estatisticamente significativa, após ajuste, a indicadores de disfunção diastólica - VAE-i (p = 0,02); E'/A' (p < 0,01); A (p = 0,02); E/A (p < 0,01). Conclusão: Nossos dados mostram que pacientes com alto risco de AOS apresentam piora dos parâmetros de função diastólica medidos pelo EDT.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Ventricular Dysfunction, Left/etiology , Sleep Apnea, Obstructive/complications , Echocardiography, Doppler , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Polysomnography , Ventricular Dysfunction, Left/diagnostic imaging , Diastole/physiology , Hypertension/complications
3.
Arq. bras. cardiol ; 113(6): 1129-1137, Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055060

ABSTRACT

Abstract Background: Left ventricular aneurysm (LVA) is an important complication of acute myocardial infarction. In this study, we investigated the role of N- Terminal pro B type natriuretic peptide level to predict the LVA development after acute ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 1519 consecutive patients with STEMI. Patients were divided into two groups according to LVA development within the six months after index myocardial infarction. Patients with or without LVAs were examined to determine if a significant relationship existed between the baseline N- Terminal pro B type natriuretic peptide values and clinical characteristics. A p-value < 0.05 was considered statistically significant. Results: LVA was detected in 157 patients (10.3%). The baseline N- Terminal pro- B type natriuretic peptide level was significantly higher in patients who developed LVA after acute MI (523.5 ± 231.1 pg/mL vs. 192.3 ± 176.6 pg/mL, respectively, p < 0.001). Independent predictors of LVA formation after acute myocardial infarction was age > 65 y, smoking, Killip class > 2, previous coronary artery bypass graft, post-myocardial infarction heart failure, left ventricular ejection fraction < 50%, failure of reperfusion, no-reflow phenomenon, peak troponin I and CK-MB and NT-pro BNP > 400 pg/mL at admission. Conclusions: Our findings indicate that plasma N- Terminal pro B type natriuretic peptide level at admission among other variables provides valuable predictive information regarding the development of LVA after acute STEMI.


Resumo Fundamento: O aneurisma do ventrículo esquerdo (AVE) é uma importante complicação do infarto agudo do miocárdio (IAM). Objetivo: Investigar o papel da porção N-terminal do pró-hormônio do peptídeo natriurético do tipo B (NT-proBNP) para predizer o desenvolvimento de AVE após infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Incluímos prospectivamente 1519 pacientes consecutivos com IAMCST. Os pacientes foram divididos em dois grupos de acordo com o desenvolvimento de AVE nos seis meses após o infarto do miocárdio. Os pacientes com ou sem AVE foram examinados para determinar se existia uma relação significativa entre os valores basais do NT-proBNP e as características clínicas. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: O AVE foi detectado em 157 pacientes (10,3%). O nível basal do NT-proBNP foi significativamente maior em pacientes que desenvolveram AVE após IAM (523,5 ± 231,1 pg/mL vs. 192,3 ± 176,6 pg/mL, respectivamente, p < 0,001). Os preditores independentes da formação de AVE após IAM foram idade > 65 anos, tabagismo, classe Killip > 2, cirurgia de revascularização miocárdica anterior, insuficiência cardíaca pós-infarto do miocárdio, fração de ejeção do ventrículo esquerdo < 50%, falha de reperfusão, fenômeno de no-reflow, pico de troponina I e CK-MB e NT-proBNP > 400 pg/mL na internação. Conclusões: Nossos achados indicam que o nível plasmático do fragmento N-terminal do peptídeo natriurético tipo B na admissão, entre outras variáveis, fornece informações preditivas valiosas sobre o desenvolvimento de AVE após o IAMCST agudo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Peptide Fragments/blood , Ventricular Dysfunction, Left/diagnosis , Natriuretic Peptide, Brain/blood , ST Elevation Myocardial Infarction/complications , Heart Aneurysm/diagnosis , Severity of Illness Index , Biomarkers/blood , Prospective Studies , ROC Curve , Sensitivity and Specificity , Coronary Angiography , Ventricular Dysfunction, Left/etiology , Heart Aneurysm/etiology
4.
Rev. bras. ter. intensiva ; 31(3): 368-378, jul.-set. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1042582

ABSTRACT

RESUMO A sepse persiste como importante sobrecarga à saúde pública nos Estados Unidos e em todo o mundo. Com o crescente uso de tecnologias laboratoriais, tem se renovado o interesse na utilização de biomarcadores na sepse, para auxiliar em um processo mais preciso e direcionado para tomadas de decisão. Os peptídeos natriuréticos vem sendo cada vez mais reconhecidos por seu papel que vai além da insuficiência cardíaca. Estes peptídeos estão comumente elevados em pacientes críticos que apresentam condições de disfunção cardiopulmonar e podem ter papel na identificação de pacientes com sepse e choque séptico. São poucos os dados disponíveis em relação ao papel destes biomarcadores no diagnóstico, no controle, nos desfechos e no prognóstico de pacientes sépticos. Esta revisão procura descrever o papel dos peptídeos natriuréticos na ressuscitação volêmica, no diagnóstico de disfunção ventricular, nos desfechos e no prognóstico de pacientes com sepse. Tem sido observado que o peptídeo natriurético tipo B (BNP) e o fragmento N-terminal do peptídeo natriurético tipo B (NT-proBNP) se associam com disfunção ventricular sistólica e diastólica, tanto esquerda quanto direita, em pacientes com cardiomiopatia séptica. O BNP e o NT-proBNP podem predizer a responsividade a volume, e as tendências de medidas seriadas destes peptídeos podem ser importantes na ressuscitação volêmica. A despeito da sugestão de correlação com mortalidade, o papel do BNP nos desfechos de mortalidade e prognóstico, durante a sepse, ainda necessita melhor avaliação.


ABSTRACT Sepsis continues to be a leading public health burden in the United States and worldwide. With the increasing use of advanced laboratory technology, there is a renewed interest in the use of biomarkers in sepsis to aid in more precise and targeted decision-making. Natriuretic peptides have been increasingly recognized to play a role outside of heart failure. They are commonly elevated among critically ill patients in the setting of cardiopulmonary dysfunction and may play a role in identifying patients with sepsis and septic shock. There are limited data on the role of these biomarkers in the diagnosis, management, outcomes and prognosis of septic patients. This review seeks to describe the role of natriuretic peptides in fluid resuscitation, diagnosis of ventricular dysfunction and outcomes and the prognosis of patients with sepsis. B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have been noted to be associated with left ventricular systolic and diastolic and right ventricular dysfunction in patients with septic cardiomyopathy. BNP/NT-proBNP may predict fluid responsiveness, and trends of these peptides may play a role in fluid resuscitation. Despite suggestions of a correlation with mortality, the role of BNP in mortality outcomes and prognosis during sepsis needs further evaluation.


Subject(s)
Humans , Peptide Fragments/physiology , Sepsis/complications , Sepsis/etiology , Sepsis/mortality , Sepsis/therapy , Natriuretic Peptide, Brain/physiology , Prognosis , Shock, Septic/complications , Shock, Septic/etiology , Shock, Septic/mortality , Shock, Septic/therapy , Treatment Outcome , Ventricular Dysfunction, Left/etiology , Fluid Therapy
5.
J. pediatr. (Rio J.) ; 95(4): 475-481, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040340

ABSTRACT

Abstract Objective: Mucopolysaccharidosis is a rare genetic disease characterized by the intralysosomal deposition of glycosaminoglycans. Cardiovascular impairment is a common feature. Cardiac signs and symptoms are underestimated due to the disease involvement in other organs. Enzyme replacement therapy can be used in mucopolysaccharidosis I, II, IV, and VI. Thus, the knowledge about the use of new echocardiography tools is relevant to improve the care of this population. This study aimed to describe left ventricular function assessment by conventional echocardiography and left ventricular global longitudinal strain analysis and compare the alterations in patients receiving enzyme replacement therapy and who had different ages at the start of therapy. Method: Outpatient-based descriptive study. The patients were submitted to conventional echocardiography and left ventricular global longitudinal strain measurement. Results: Sixteen patients were evaluated; median age of 14.2 years (SD = 5.2 years). Left ventricular hypertrophy was found in nine patients (56.2%). All patients had preserved left ventricular systolic function (Simpson and Teichholz). Nine (56.2%) patients showed alterations in left ventricular global longitudinal strain. The study showed a positive association between left ventricular hypertrophy and alteration in the left ventricular global longitudinal strain, and late start of enzyme replacement therapy and alteration in the left ventricular global longitudinal strain. Conclusion: Echocardiographic alterations in patients with mucopolysaccharidosis were frequently observed, especially alterations in the left ventricular geometry and subclinical dysfunction. Patients who had a late enzyme replacement therapy start showed an association with worse left ventricular global longitudinal strain values, reinforcing the need for early diagnosis and treatment. The use of new echocardiographic tools may improve the follow-up of these patients.


Resumo Objetivo: A mucopolissacaridose é uma doença genética rara, caracterizada por depósito intralisossômico de glicosaminoglicanos. O comprometimento cardiovascular é frequente. Sinais e sintomas cardíacos são subestimados pelo envolvimento da doença em outros órgãos. A terapia de reposição enzimática pode ser usada em mucopolissacaridose I, II, IV e VI. Assim, o conhecimento da aplicação de novas ferramentas de ecocardiografia é relevante para melhorar a assistência dessa população. Este estudo visou descrever a função do ventrículo esquerdo pelo ecocardiograma convencional e pela análise do strain global longitudinal do ventrículo esquerdo e comparar as alterações em pacientes que fazem uso da terapia de reposição enzimática e que tiveram idades distintas de início da terapia. Método: Estudo descritivo de base ambulatorial. Os pacientes foram submetidos à ecocardiografia convencional e medida do strain global longitudinal do ventrículo esquerdo. Resultados: Foram avaliados 16 pacientes; mediana de 14,2 anos (desvio: 5,2 anos). Hipertrofia do ventrículo esquerdo foi encontrada em nove pacientes (56,2%). Todos os pacientes tiveram função sistólica do ventrículo esquerdo preservada (Simpson e Teichholz). Nove (56,2%) pacientes apresentaram alteração no strain global longitudinal do ventrículo esquerdo. O estudo mostrou associação positiva entre hipertrofia do ventrículo esquerdo e alteração no strain global longitudinal do ventrículo esquerdo e início tardio da terapia de reposição enzimática e alteração no strain global longitudinal do ventrículo esquerdo. Conclusão: Alterações ecocardiográficas em pacientes com mucopolissacaridose foram frequentes, especialmente alterações na geometria e disfunção subclínica do ventrículo esquerdo. Pacientes que iniciaram tardiamente a terapia de reposição enzimática apresentaram associação com piores valores de strain global longitudinal do ventrículo esquerdo, o que reforça a necessidade do diagnóstico e tratamento precoces. O uso de novas ferramentas de ecocardiografia pode melhorar o acompanhamento desses pacientes.


Subject(s)
Humans , Male , Female , Child , Adolescent , Mucopolysaccharidoses/complications , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/diagnostic imaging , Myocardium/pathology , Echocardiography/methods , Cross-Sectional Studies , Mucopolysaccharidoses/drug therapy , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/drug therapy , Enzyme Replacement Therapy
6.
Clinics ; 74: e859, 2019. tab, graf
Article in English | LILACS | ID: biblio-1011903

ABSTRACT

OBJECTIVES: To evaluate cardiovascular involvement in children and adolescents with End Stage Renal Disease (ESRD) and to characterize the main risk factors associated with this outcome. METHODS: Cross-sectional study of 69 children and adolescents at renal transplantation and 33 healthy individuals matched by age and gender. The study outcomes were left ventricular mass z-score (LVMZ) and carotid artery intima-media thickness (CIMT). The potential risk factors considered were age, gender, CKD etiology, use of oral vitamin D and calcium-based phosphate binders, systolic and diastolic blood pressure, body mass index z-score, time since diagnosis, dialysis duration, serum levels of ionic calcium, phosphorus, parathyroid hormone, fibroblast growth factor (FGF 23), uric acid, homocysteine, cholesterol, triglycerides, C-reactive protein (CRP), vitamin D and hemoglobin. RESULTS: In the multivariate analysis, the factors associated with LVMZ were dialysis duration, age, systolic blood pressure, serum hemoglobin and HDL cholesterol levels. Regarding CIMT, in the multivariate analysis, systolic blood pressure was the only factor associated with the outcome. CONCLUSION: Children exhibited important cardiovascular involvement at the time of the renal transplantation. Both of the studied outcomes were independently associated with systolic blood pressure. For this reason, controlling blood pressure seems to be the main therapy to minimize cardiovascular involvement in children with ESRD.


Subject(s)
Humans , Male , Female , Child , Adolescent , Cardiovascular Diseases/etiology , Kidney Failure, Chronic/complications , Time Factors , Echocardiography , Case-Control Studies , Linear Models , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , Ventricular Function, Left , Ventricular Dysfunction, Left/etiology , Risk Assessment , Dialysis/adverse effects , Carotid Intima-Media Thickness , Hypertension/complications , Kidney Failure, Chronic/therapy
7.
Arq. bras. cardiol ; 111(3): 364-372, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973751

ABSTRACT

Abstract Background: Chagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America. Objective: To investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD. Methods: Consecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Holter monitoring, echocardiogram and ambulatory blood pressure monitoring. Results: We evaluated 135 patients [age: 56 (45-62) years; 30% men; BMI: 26 ± 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, ≥ 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0.01; larger left atrial diameter [37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log10 (AHI) (b = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 - 1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01). Conclusions: OSA is independently associated with atrial and ventricular remodeling in patients with CD.


Resumo Fundamento: A doença de Chagas (DC) é uma causa importante de morbimortalidade por insuficiência cardíaca e arritmias malignas em todo o mundo, especialmente na América Latina. Objetivo: Investigar a associação entre apneia obstrutiva do sono (AOS) com remodelação cardíaca e arritmias cardíacas em pacientes com DC. Métodos: Foram incluídos pacientes consecutivos com DC, com idade entre 30 e 65 anos. Os participantes foram submetidos à avaliação clínica, estudo do sono, Holter de 24 horas, ecocardiograma e monitorização ambulatorial da pressão arterial. Resultados: Foram avaliados 135 pacientes [idade: 56 (45-62) anos; 30% homens; IMC: 26 ± 4 kg/m2, cardiomiopatia chagásica: 70%]. AOS moderada a grave (índice de apneia-hipopneia, IAH, ≥ 15 eventos/h) estava presente em 21% dos pacientes. AOS não estava associada a arritmias nessa população. Em comparação com pacientes com AOS leve ou ausente, pacientes com AOS moderada a grave apresentaram maior frequência de hipertensão (79% vs. 72% vs. 44%, p < 0,01) e pressão arterial sistólica noturna mais alta: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0,01; diâmetro do átrio esquerdo maior [37 (33‑42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0,01]; e maior proporção de disfunção ventricular esquerda [FEVE < 50% (39% vs. 28% vs. 11%), p < 0,01], respectivamente. O preditor de dimensão do átrio esquerdo foi Log10 (IAH) (β = 3,86, IC 95%: 1,91 a 5,81; p < 0,01). Os preditores de disfunção ventricular foram IAH >15 eventos/h (OR = 3,61, IC 95%: 1,31 - 9,98; p = 0,01), pressão arterial sistólica (OR = 1,06, IC95%: 1,02 - 1,10; p < 0,01) e sexo masculino (OR = 3,24, IC 95%: 1,31 - 8,01; p = 0,01). Conclusões: A AOS está independentemente associada à remodelação atrial e ventricular em pacientes com DC.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Arrhythmias, Cardiac/etiology , Chagas Cardiomyopathy/complications , Ventricular Remodeling , Sleep Apnea, Obstructive/etiology , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/pathology , Reference Values , Severity of Illness Index , Echocardiography , Chagas Cardiomyopathy/physiopathology , Chagas Cardiomyopathy/pathology , Anthropometry , Multivariate Analysis , Analysis of Variance , Electrocardiography, Ambulatory , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Statistics, Nonparametric , Blood Pressure Monitoring, Ambulatory , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/pathology , Heart Atria/physiopathology , Heart Atria/pathology
9.
Rev. bras. cir. cardiovasc ; 32(6): 542-544, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-897956

ABSTRACT

Abstract Left atrial dissection is a rare factor that may cause left ventricular assist device obstruction. Prompt diagnosis and surgical repair are essential. This case report describes our experience and a successful surgical management in a patient after HeartMate 3 implantation and mitral valve inflow obstruction due to a left atrial dissection.


Subject(s)
Humans , Male , Adult , Atrial Fibrillation/surgery , Heart-Assist Devices/adverse effects , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/diagnostic imaging , Heart Atria/surgery , Atrial Fibrillation/diagnostic imaging , Echocardiography , Ventricular Dysfunction, Left/surgery , Extracorporeal Circulation , Heart Atria/diagnostic imaging , Heart Failure , Cardiac Surgical Procedures/methods
10.
Rev. bras. cir. cardiovasc ; 32(6): 492-497, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-897955

ABSTRACT

Abstract Introduction: Chronic stimulation of the right ventricle with pacemaker is associated with ventricular dyssynchrony and loss of contractility, even in subjects without previous dysfunction. In these patients, there is a debate of which pacing site is less associated with loss of ventricular function. Objective: To compare pacemaker-induced dyssynchrony among different pacing sites in right ventricular stimulation. Methods: Cross-sectional study of outpatients with right ventricle stimulation higher than 80% and preserved left ventricular ejection fraction. Pacing lead position (apical, medial septum or free wall) was assessed through chest X-rays. Every patient underwent echocardiogram to evaluate for dyssynchrony according to CARE-HF criteria: aortic pre-ejection time, interventricular delay and septum/posterior wall delay on M mode. Results: Forty patients were included. Fifty-two percent had apical electrode position, 42% mid septum and 6% free wall. Mean QRS time 148.97±15.52 milliseconds. A weak correlation between the mean QRS width and pre-aortic ejection time (r=0.32; P=0.04) was found. No difference in QRS width among the positions could be noted. Intraventricular delay was lower in apical patients against mid septal (34.4±17.2 vs. 54.3±19.1 P<0.05) - no difference with those electrode on the free wall. No difference was noted in the pre-aortic ejection time (P=0.9). Conclusion: Apical pacing showed a lower interventricular conduction delay when compared to medial septum site. Our findings suggest that apical pacing dyssynchrony is not ubiquitous, as previously thought, and that it should remain an option for lead placement.


Subject(s)
Humans , Male , Female , Aged , Pacemaker, Artificial/adverse effects , Cardiac Pacing, Artificial/adverse effects , Ventricular Dysfunction, Right/etiology , Arrhythmias, Cardiac/physiopathology , Stroke Volume , Echocardiography , Cardiac Pacing, Artificial/methods , Cross-Sectional Studies , Ventricular Function, Right , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Left/etiology , Electrocardiography , Heart Ventricles , Myocardial Contraction
11.
Arq. bras. cardiol ; 109(5): 410-415, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-887956

ABSTRACT

Abstract Background: Systemic sclerosis (SS) is a connective tissue abnormality characterized by fibrosis of the skin and internal organs. Cardiac involvement with consequent myocardial dysfunction in SS is associated with increased morbidity and mortality. Objective: To investigate the left ventricular (LV) diastolic function in patients with SS and preserved systolic function. Methods: Patients with SS were evaluated with two-dimensional echocardiography with tissue Doppler for analysis of chamber diameters, LV mass index (LVMI), indexed left atrial volume (iLAV), systolic function of both ventricles, and presence and degree of diastolic dysfunction (DD). Results: We evaluated 50 patients, divided according to the presence of DD into Group 1 (n = 25; normal diastolic function, E/A ratio ≥ 0.8, deceleration time [DT] > 150 ms and < 200 ms, and septal e' > 8 cm/s) and Group 2 (n = 25; with DD, subdivided into type I DD [E/A < 0.8, DT > 200 ms], type II [E/A ≥ 0.8, septal e' < 8 cm/s, iLAV > 34 mL/m2], and type III [E/A > 2, DT < 150 ms, septal e' < 8 cm/s]). Type I DD was the most frequent (34%), followed by type II DD (16%). LVMI and iLAV were similar in both groups, but septal and lateral e' were reduced only in Group 2. In Group 2, we observed that patients with moderate DD had longer disease duration (p = 0.02). Conclusion: The prevalence of type I DD was elevated in SS and associated with aging. Disease duration emerged as an important factor in moderate DD.


Resumo Fundamento: A esclerose sistêmica (ES) é uma anomalia do tecido conjuntivo caracterizada por fibrose da pele e dos órgãos internos. O envolvimento cardíaco com consequente disfunção miocárdica na ES está associado a uma maior morbimortalidade. Objetivo: Investigar a função diastólica do ventrículo esquerdo (VE) em pacientes com ES e função sistólica preservada. Método: Pacientes com ES foram estudados com ecocardiografia bidimensional com Doppler tecidual para análise dos diâmetros cavitários, índice de massa do VE (IMVE), volume indexado do átrio esquerdo (VAEi), função sistólica biventricular e presença, além de grau de disfunção diastólica (DD) pelo Doppler convencional e tecidual. Resultados: Estudamos 50 pacientes, divididos conforme presença de DD em Grupo 1 (n = 25; função diastólica normal, razão E/A ≥ 0,8, tempo de desaceleração [TD] > 150 ms e < 200 ms e e' septal > 8 cm/s) e Grupo 2 (n = 25; com presença de DD, subdividido em DD tipo I [E/A < 0,8, TD > 200 ms], tipo II [E/A ≥ 0,8, e' septal < 8 cm/s, VAEi > 34 mL/m2] e tipo III [E/A > 2, TD < 150 ms, e' septal < 8 cm/s]. A DD tipo I foi a mais frequente (34%), seguida de DD tipo II (16%). O IMVE e o VAEi foram similares entre os grupos, porém a e' septal e lateral estiveram reduzidas apenas no Grupo 2. No Grupo 2, observamos que os pacientes com DD moderada apresentavam maior duração da doença (p = 0,02). Conclusão: A prevalência de DD tipo I foi elevada na ES e esteve associada ao envelhecimento. No caso da DD moderada, a duração da doença despontou como um fator importante.


Subject(s)
Humans , Male , Female , Middle Aged , Scleroderma, Systemic/complications , Ventricular Dysfunction, Left/etiology , Severity of Illness Index , Echocardiography, Doppler , Ventricular Dysfunction, Left/diagnosis
12.
Int. j. morphol ; 35(2): 654-660, June 2017. ilus
Article in English | LILACS | ID: biblio-893036

ABSTRACT

Complications of chronic stress including cardiovascular disease are among the common public health problems that affect the lives of millions of people around the globe. We sought to determine whether the anti-oxidant and anti-apoptotic agent, quercetin can inhibit chronic stress-induced left ventricular dysfunction (LVD). Chronic unpredictable stress (CUS) was induced in rats using a variety of stressors in the presence and absence of quercetin (50 mg/kg body weight/day). Harvested tissues from the left ventricles (LV) of these animals were examined using basic histological staining. In addition, LV tissue homogenates were assayed for markers of oxidative and anti-oxidative stress that are known to be modulated in cardiac dysfunction. Furthermore, LV pressure was monitored by a pressure catheter inserted directly into the LV. Histopathological examinations of the LV in the model group (CUS) showed a profound damage to LV compared to the control group as demonstrated by a severe damage of cardiomyocytes and an increase of inflammatory cell infiltration, which was prevented by quercetin. CUS increased LV end-diastolic pressure that was significantly blocked by quercetin. In addition, quercetin significantly (p<0.05) blocked CUS-induced inhibition of the anti-oxidant superoxide dismutase (SOD) and the survival Bcl-2 proteins. Quercetin also significantly (p<0.05) inhibited CUS-induced augmentation of the oxidative stress TBARS and the apoptotic protein caspase-3. We conclude that LVD induced by CUS possibly via activation of oxidative and apoptosis pathways can be inhibited by quercetin; thus may offer therapeutic potential in humans.


Las complicaciones del estrés crónico, incluyendo las enfermedades cardiovasculares, se encuentran entre los problemas comunes de salud pública que afectan la vida de millones de personas en todo el mundo. En este trabajo se buscó determinar si la quercetina, agente antioxidante y antiapoptótico, puede inhibir la disfunción ventricular izquierda (DVI) inducida por estrés crónico. Se indujo estrés crónico impredecible (ECI) en ratas utilizando una variedad de factores de estrés, en presencia y ausencia de quercetina (50 mg / kg de peso corporal / día). Las muestras recolectadas de los ventrículos izquierdos (VI) de estos animales se examinaron usando tinción histológica básica. Además, los homogenados de tejido de VI se utilizaron para detectar marcadores de estrés oxidativo y anti-oxidativo que se conocen están modulados en la disfunción cardíaca. Además, la presión del VI se controló mediante un catéter de presión insertado directamente en el VI. Los exámenes histopatológicos del VI en el grupo modelo (ECI) mostraron un daño profundo al VI en comparación con el grupo control, como lo demuestra un grave daño de los cardiomiocitos y un aumento de la infiltración de células inflamatorias, que fue evitado por la quercetina. El ECI aumentó la presión diastólica final del VI, que fue bloqueada significativamente por la quercetina. Además, la quercetina bloqueó en forma significativa (p <0,05) el ECI inducida por la inhibición de la antioxidante superóxido dismutasa (SOD) y la supervivencia de proteínas Bcl-2. Quercetina también inhibió en forma significativa (p <0,05) el ECI inducido por el aumento de la tensión oxidativa y la proteína apoptótica caspasa-3. Llegamos a la conclusión de que la DVI inducida por ECI, posiblemente a través de la activación de las vía oxidativa y la apoptosis, pueden ser inhibidos por la quercetina, pudiendose ofrecer entonces como un potencial terapéutico en los seres humanos.


Subject(s)
Animals , Male , Rats , Antioxidants/administration & dosage , Quercetin/administration & dosage , Stress, Psychological , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/etiology , Apoptosis/drug effects , Oxidative Stress/drug effects , Rats, Wistar
13.
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
14.
Medicina (B.Aires) ; 76(5): 321-325, Oct. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-841602

ABSTRACT

La estimulación por marcapasos se asocia con eventos adversos graves. En la siguiente serie de casos se evaluó la disincronía mecánica intraventricular izquierda (DMVI) en la estimulación endocárdica prolongada del ventrículo derecho a nivel septal. Se estudiaron 6 personas con marcapasos implantados no antes de un año utilizando SPECT gatillado con 99mTc-MIBI y análisis de fase en reposo. Se registraron variables clínicas, duración del QRS, tasa y modo de estimulación ventricular, presencia y extensión de isquemia y/o infarto, volúmenes cavitarios y FEVI en reposo. Utilizando V-Sync de Emory Cardiac Toolbox se obtuvieron el ancho de banda (AB) y el desvío estándar de fase (DEF) en reposo (grados), comparándolos con una población control. La estimulación endocárdica prolongada en el septum ventricular derecho se asoció con marcada DMVI, aun cuando la función sistólica estaba conservada. Aquellos con FEVI moderada/gravemente disminuida (caracterizados por diámetros cavitarios mayores, infarto o isquemia grave) exhibieron mayor disincronía que aquellos con FEVI conservada/levemente disminuida (AB: 177.3o vs. 88.3o; DEF: 53.1o vs. 33.8o). En los casos con cardiopatía isquémica portadores de marcapasos, el AF es una herramienta válida de potencial utilidad para evaluar la disincronía asociada al infarto y, eventualmente, aportar a la decisión oportuna del pasaje al modo de estimulación biventricular.


Pacemaker stimulation is associated with unpredictable severe cardiac events. We evaluated left ventricular mechanical dyssynchrony (LVMD) during prolonged septal right ventricular pacing. We performed 99mTc-MIBI gated-SPECT and phase analysis in 6 patients with pacemakers implanted at least one year before scintigraphy due to advanced atrioventricular block. Using V-Sync of Emory Cardiac Toolbox we obtained phase bandwidth (PBW) and standard deviation (PSD) from rest phase histogram. Clinical variables, QRS duration, rate and mode of pacing in septal right ventricle wall, chamber diameters, presence and extension of myocardial scar and ischemia and rest LVEF were recorded. Prolonged septal endocardial pacing is associated with marked LVMD, even when systolic function was preserved. More severe dyssynchrony was found in patients with impaired LVEF, higher left ventricle diameters, extensive infarct or severe ischemia than in patients with preserved LVEF (PBW: 177.3o vs. 88.3o; PSD: 53.1o vs. 33.8o). In the patients with ischemic heart disease and pacemaker, gated-SPECT phase analysis is a valid and potentially useful technique to evaluate LMVD associated with myocardial scar and to decide the upgrading to biventricular pacing mode.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Pacemaker, Artificial/adverse effects , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Septum/physiopathology , Severity of Illness Index , Ventricular Dysfunction, Left/diagnostic imaging , Electrocardiography , Ventricular Septum/diagnostic imaging , Atrioventricular Block/surgery , Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography , Myocardial Infarction/etiology , Myocardial Infarction/diagnostic imaging
15.
Arq. bras. cardiol ; 107(1): 63-70, July 2016. graf
Article in English | LILACS | ID: lil-792493

ABSTRACT

Abstract The scientific construction of chronic Chagas heart disease (CCHD) started in 1910 when Carlos Chagas highlighted the presence of cardiac arrhythmia during physical examination of patients with chronic Chagas disease, and described a case of heart failure associated with myocardial inflammation and nests of parasites at autopsy. He described sudden cardiac death associated with arrhythmias in 1911, and its association with complete AV block detected by Jacquet's polygraph as Chagas reported in 1912. Chagas showed the presence of myocardial fibrosis underlying the clinical picture of CCHD in 1916, he presented a full characterization of the clinical aspects of CCHD in 1922. In 1928, Chagas detected fibrosis of the conductive system, and pointed out the presence of marked cardiomegaly at the chest X-Ray associated with minimal symptomatology. The use of serological reaction to diagnose CCHD was put into clinical practice in 1936, after Chagas' death, which along with the 12-lead ECG, revealed the epidemiological importance of CCHD in 1945. In 1953, the long period between initial infection and appearance of CCHD was established, whereas the annual incidence of CCHD from patients with the indeterminate form of the disease was established in 1956. The use of heart catheterization in 1965, exercise stress testing in 1973, Holter monitoring in 1975, Electrophysiologic testing in 1973, echocardiography in 1975, endomyocardial biopsy in 1981, and Magnetic Resonance Imaging in 1995, added to the fundamental clinical aspects of CCHD as described by Carlos Chagas.


Resumo A construção científica da doença de Chagas crônica (DCC) começou em 1910, quando Carlos Chagas salientou a presença de arritmia cardíaca em exames físicos de pacientes com doença de Chagas crônica, e descreveu um caso de insuficiência cardíaca associada à inflamação do miocárdio e à presença de ninhos de parasitas durante a autópsia. Ele descreveu morte súbita cardíaca associada a arritmias em 1911, e sua associação ao bloqueio AV total detectado com o polígrafo de Jacquet, conforme reportou em 1912. Chagas mostrou a presença de fibrose do miocárdio como subjacente ao quadro clínico da DCC em 1916, e apresentou uma caracterização completa dos aspectos clínicos da DCC em 1922. Em 1928, Chagas detectou fibrose do sistema condutor, e apontou a presença de cardiomegalia acentuada no raio X do tórax, associada a sintomatologia mínima. O uso da reação sorológica no diagnóstico de DCC foi posta em prática clínica em 1936, após a morte de Chagas, e juntamente com o ECG de 12 derivações, revelou a importância epidemiológica da DCC em 1945. Em 1953, ficou comprovado o longo período de tempo entre a infecção inicial e o aparecimento de DCC, enquanto que a incidência anual de DCC na forma indeterminada da doença foi estabelecida em 1956. Os aspectos clínicos fundamentais de DCC descritos por Carlos Chagas foram complementados pelo uso de cateterismo cardíaco em 1965, teste ergométrico em 1973, Holter em 1973, teste eletrofisiológico em 1975, ecocardiografia em 1975, biópsia endomiocárdica em 1981 e ressonância magnética em 1995.


Subject(s)
Humans , History, 20th Century , Chagas Cardiomyopathy/diagnosis , Chagas Cardiomyopathy/history , Arrhythmias, Cardiac/etiology , Biopsy , Brazil , Echocardiography , Chagas Cardiomyopathy/complications , Chronic Disease , Ventricular Dysfunction, Left/etiology , Electrocardiography , Exercise Test , Heart Failure/etiology
16.
Arq. bras. cardiol ; 106(2): 105-112, Feb. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-775094

ABSTRACT

Background: Heart failure prediction after acute myocardial infarction may have important clinical implications. Objective: To analyze the functional echocardiographic variables associated with heart failure in an infarction model in rats. Methods: The animals were divided into two groups: control and infarction. Subsequently, the infarcted animals were divided into groups: with and without heart failure. The predictive values were assessed by logistic regression. The cutoff values predictive of heart failure were determined using ROC curves. Results: Six months after surgery, 88 infarcted animals and 43 control animals were included in the study. Myocardial infarction increased left cavity diameters and the mass and wall thickness of the left ventricle. Additionally, myocardial infarction resulted in systolic and diastolic dysfunction, characterized by lower area variation fraction values, posterior wall shortening velocity, E-wave deceleration time, associated with higher values of E / A ratio and isovolumic relaxation time adjusted by heart rate. Among the infarcted animals, 54 (61%) developed heart failure. Rats with heart failure have higher left cavity mass index and diameter, associated with worsening of functional variables. The area variation fraction, the E/A ratio, E-wave deceleration time and isovolumic relaxation time adjusted by heart rate were functional variables predictors of heart failure. The cutoff values of functional variables associated with heart failure were: area variation fraction < 31.18%; E / A > 3.077; E-wave deceleration time < 42.11 and isovolumic relaxation time adjusted by heart rate < 69.08. Conclusion: In rats followed for 6 months after myocardial infarction, the area variation fraction, E/A ratio, E-wave deceleration time and isovolumic relaxation time adjusted by heart rate are predictors of heart failure onset.


Fundamento: A predição de insuficiência cardíaca após o infarto agudo do miocárdio pode ter importantes implicações clínicas. Objetivo: Analisar as variáveis funcionais ecocardiográficas associadas com insuficiência cardíaca no modelo do infarto em ratos. Métodos: Os animais foram divididos em dois grupos: infarto e controle. Após, os animais infartados foram divididos em grupos com e sem insuficiência cardíaca. Os valores preditivos foram avaliados por regressão logística. Os valores de corte preditivos de insuficiência cardíaca foram determinados por meio de curvas ROC. Resultados: Após 6 meses da cirurgia, 88 animais com infarto e 43 animais controle foram incluídos no estudo. O infarto aumentou os diâmetros das cavidades esquerdas, a massa e a espessura da parede do ventrículo esquerdo. Adicionalmente, o infarto resultou em disfunção sistólica e diastólica, caracterizada por menores valores da fração de variação de área, velocidade de encurtamento da parede posterior, tempo de desaceleração da onda E, associada com maiores valores da relação E/A e tempo de relaxamento isovolumétrico ajustado pela frequência cardíaca. Dentre os animais infartados, 54 (61%) desenvolveram insuficiência cardíaca. Ratos com insuficiência cardíaca apresentaram maiores índices de massa e diâmetros das cavidades esquerdas, associadas com piora das variáveis funcionais. A fração de variação de área, relação E/A, tempo de desaceleração da onda E e tempo de relaxamento isovolumétrico ajustado pela frequência cardíaca foram variáveis funcionais preditoras de insuficiência cardíaca. Os valores de corte das variáveis funcionais associados com insuficiência cardíaca foram: fração de variação de área < 31,18%; E/A > 3,077; tempo de desaceleração da onda E < 42,11 e tempo de relaxamento isovolumétrico ajustado pela frequência cardíaca < 69,08. Conclusão: Em ratos acompanhados por 6 meses após o infarto, a fração de variação de área, relação E/A, tempo de desaceleração da onda E e tempo de relaxamento isovolumétrico ajustado pela frequência cardíaca são preditores do aparecimento de insuficiência cardíaca.


Subject(s)
Animals , Male , Heart Failure/etiology , Heart Failure/physiopathology , Myocardial Infarction/complications , Myocardial Infarction/physiopathology , Case-Control Studies , Disease Models, Animal , Diastole/physiology , Heart Failure , Heart Rate/physiology , Myocardial Infarction , Rats, Wistar , Risk Factors , Sensitivity and Specificity , Systole/physiology , Time Factors , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology
18.
Rev. bras. ter. intensiva ; 27(4): 333-339, out.-dez. 2015. tab
Article in English | LILACS | ID: lil-770035

ABSTRACT

RESUMO Objetivo: Avaliar a prevalência de disfunção miocárdica e seu valor prognóstico em pacientes com sepse grave e choque séptico. Métodos: Pacientes sépticos adultos, admitidos em uma unidade de terapia intensiva, foram estudados de forma prospectiva por meio de ecocardiografia transtorácica dentro das primeiras 48 horas após sua admissão e, então, entre o sétimo e o décimo dias. As variáveis ecográficas de função biventricular, inclusive a relação E/e', foram comparadas entre sobreviventes e não sobreviventes. Resultados: Foi realizado um total de 99 ecocardiogramas (53 na admissão e 46 entre os dias 7 e 10) em 53 pacientes com média de idade de 74 anos (desvio padrão de 13 anos). Estava presente disfunção sistólica em 14 (26%); disfunção diastólica foi observada em 42 (83%) pacientes; e ambos os tipos de disfunção estavam presentes em 12 (23%) pacientes. A relação E/e', ou índice de disfunção diastólica, foi o melhor preditor de mortalidade hospitalar segundo a área sob a curva ROC (0,71) e se constituiu em um preditor independente do desfecho, conforme determinado pela análise multivariada (odds ratio - OR = 1,36 [1,05 - 1,76]; p = 0,02). Conclusão: Em pacientes sépticos admitidos em uma unidade de terapia intensiva, a disfunção sistólica determinada ecograficamente não se associa com aumento da mortalidade. Em contraste, a disfunção diastólica foi um preditor independente do desfecho.


ABSTRACT Objectives: To evaluate the prevalence of myocardial dysfunction and its prognostic value in patients with severe sepsis and septic shock. Methods: Adult septic patients admitted to an intensive care unit were prospectively studied using transthoracic echocardiography within the first 48 hours after admission and thereafter on the 7th-10th days. Echocardiographic variables of biventricular function, including the E/e' ratio, were compared between survivors and non-survivors. Results: A total of 99 echocardiograms (53 at admission and 46 between days 7 - 10) were performed on 53 patients with a mean age of 74 (SD 13) years. Systolic and diastolic dysfunction was present in 14 (26%) and 42 (83%) patients, respectively, and both types of dysfunction were present in 12 (23%) patients. The E/e' ratio, an index of diastolic dysfunction, was the best predictor of hospital mortality according to the area under the ROC curve (0.71) and was an independent predictor of outcome, as determined by multivariate analysis (OR = 1.36 [1.05 - 1.76], p = 0.02). Conclusion: In septic patients admitted to an intensive care unit, echocardiographic systolic dysfunction is not associated with increased mortality. In contrast, diastolic dysfunction is an independent predictor of outcome.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Shock, Septic/complications , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Left/etiology , Sepsis/complications , Prognosis , Shock, Septic/mortality , Systole/physiology , Echocardiography , Prospective Studies , Cohort Studies , Hospital Mortality , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/mortality , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/mortality , Sepsis/metabolism , Diastole/physiology , Intensive Care Units , Middle Aged
19.
Ann Card Anaesth ; 2015 Jul; 18(3): 441-444
Article in English | IMSEAR | ID: sea-162399

ABSTRACT

We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.


Subject(s)
Atrial Fibrillation/etiology , Cardiac Catheterization/adverse effects , Cardiac Catheterization/complications , Female , Heart Septal Defects, Atrial/surgery , Humans , Hypertension, Pulmonary/etiology , Middle Aged , Pulmonary Edema/epidemiology , Pulmonary Edema/etiology , Septal Occluder Device , Ventricular Dysfunction, Left/etiology
20.
Article in English | IMSEAR | ID: sea-157703

ABSTRACT

Impaired diastolic filling of left ventricle may be the important cause of symptoms ranging from mild to severe form of dyspnea with overt features of pulmonary edema which may be wrongly imparted to systolic failure. To study prevalence and severity of diastolic dysfunction and its relation with various risk factors. Methods: Patients from in and out patients department were subjected to detail history, estimation of BMI, blood sugar levels, BP measurement, echocardiographic assessment of cardiac function. Patients of isolated diastolic dysfunction were identified and the degree of diastolic dysfunction was correlated with functional class (NYHA grade) of the patients as well as various risk factors. Results: Out of 400 patients 16 (12.5%) asymptomatic patients had diastolic dysfunction (DD). Severity of diastolic dysfunction increased as the presenting NYHA grade was higher. In NYHA grades III and IV, 59% and 57% of the patients respectively had diastolic dysfunction .DD was significantly associated with diabetes (p<.0001), BMI (p =0.0002), dyslipidemia (p =0.0491), hypertension (p=0.0489). Conclusion: DD is a significant cardiac morbidity. Hypertension, diabetes, dyslipidemia and obesity have significant association with diastolic dysfunction. There is no randomized control trials for treatment for DD. Whether asymptomatic DD needs treatment is not known.


Subject(s)
Adolescent , Adult , Aged , Dyspnea/complications , Female , Humans , India/epidemiology , Male , Metabolic Syndrome/complications , Middle Aged , Prevalence , Risk Factors , Severity of Illness Index , Systole , Ventricular Dysfunction, Left/classification , Ventricular Dysfunction, Left/epidemiology , Ventricular Dysfunction, Left/etiology , Ventricular Function, Left/physiology , Young Adult
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