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2.
Braz. J. Pharm. Sci. (Online) ; 56: e18326, 2020. tab, graf
Article in English | LILACS | ID: biblio-1132063

ABSTRACT

Hospitalized patients with left ventricular failure (LVF) are at high risk for potential drug-drug interactions (pDDIs) and its related adverse effects owing to multiple risk factors such as old age, comorbidities and polypharmacy. This cross-sectional study conducted in two tertiary care hospitals aim to identify frequency, levels and predictors of pDDIs in LVF patients. Data about patients' demographic, hospital stay, medication therapy, sign/symptoms and laboratory test results were collected for 385 patients with LVF. Micromedex Drug-Reax® was used to screen patients' medication profiles for pDDIs. Overall prevalence and severity-wise prevalence of pDDIs were identified. Chi-square test was performed for comparative analysis of various variables. Logistic regression was applied to determine the odds-ratios (OR) for predictors of pDDIs. The prevalence of pDDIs was 96.4% (n=371). Overall 335 drug-interacting pairs were detected, which were presented in a total of 2870 pDDIs. Majority of pDDIs were of major- (48.9%) and moderate-severity (47.5%). Logistic regression analysis shows significant association of >6 all types of pDDIs with >12 drugs as compared with <8 drugs (OR=16.5; p=<0.001). Likewise, there was a significant association of >4 major-pDDIs with men as compared with female (OR=1.9; p=0.007) and >12 drugs as compared with <8 drugs (OR=10.9; p=<0.001). Hypotension (n=57), impaired renal function (23) and increased blood pressure (22) were the most frequent adverse outcomes associated with pDDIs. This study shows high prevalence of pDDIs in LVF patients. Majority of pDDIs were of major- and moderate-severity. Male patients and those prescribed greater number of medicines were more exposed to major-pDDIs


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Patients , Pharmaceutical Preparations/analysis , Ventricular Dysfunction, Left/pathology , Drug Interactions , Tertiary Healthcare/ethics , Demography/classification , Cross-Sectional Studies/methods , Risk Factors , Patient Safety , Heart Diseases/classification , Hospitals
4.
Arq. bras. cardiol ; 110(3): 278-288, Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-888039

ABSTRACT

Abstract Many non-invasive methods, such as imaging tests, have been developed aiming to add a contribution to existing studies in estimating patients' prognosis after myocardial injury. This prognosis is proportional to myocardial viability, which is evaluated in coronary artery disease and left ventricular dysfunction patients only. While myocardial viability represents the likelihood of a dysfunctional muscle (resulting from decreased oxygen supply for coronary artery obstruction), hibernation represents post-interventional functional recovery itself. This article proposes a review of pathophysiological basis of viability, diagnostic methods, prognosis and future perspectives of myocardial viability. An electronic bibliographic search for articles was performed in PubMed, Lilacs, Cochrane and Scielo databases, according to pre-established criteria. The studies showed the ability of many imaging techniques in detecting viable tissues in dysfunctional areas of left ventricle resulting from coronary artery injuries. These techniques can identify patients who may benefit from myocardial revascularization and indicate the most appropriate treatment.


Resumo Diversos métodos não invasivos, como novos exames de imagem, vem sendo aprimorados, a fim de somar esforços com os atuais em estimar o prognóstico de pacientes pós-injúria miocárdica. Este prognóstico é proporcional à viabilidade miocárdica, a qual tem sua avaliação reservada para pacientes portadores de doença arterial coronariana e insuficiência ventricular esquerda. Enquanto a viabilidade miocárdica se mostra como a capacidade de recuperação funcional do músculo com disfunção por redução de oxigênio fornecido por artérias coronárias obstruídas, a hibernação consiste na própria recuperação funcional após intervenções. Este artigo propõe uma revisão sobre as bases fisiopatológicas do processo de viabilidade, métodos diagnósticos disponíveis, prognóstico e perspectivas para o futuro acerca dessa condição. Realizou-se pesquisa de busca bibliográfica informatizada em bases eletrônicas de dados, como PubMed, Lilacs, Cochrane e Scielo, onde foram selecionados os estudos de acordo com critérios pré-determinados. Os estudos demonstram a capacidade de várias técnicas de imagem de identificar tecido viável em regiões disfuncionais do ventrículo esquerdo em decorrência de lesões em artérias coronárias. Estas técnicas podem identificar pacientes com potencial benefício da revascularização miocárdica e orientar o tratamento mais adequado.


Subject(s)
Humans , Tissue Survival/physiology , Myocytes, Cardiac/pathology , Myocardial Infarction/pathology , Myocardial Infarction/diagnostic imaging , Myocardium/pathology , Prognosis , Coronary Artery Disease/physiopathology , Coronary Artery Disease/pathology , Coronary Artery Disease/diagnostic imaging , Magnetic Resonance Imaging/methods , Echocardiography/methods , Ventricular Dysfunction, Left/pathology , Ventricular Dysfunction, Left/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Heart/diagnostic imaging , Myocardial Infarction/physiopathology , Myocardial Revascularization
5.
Arq. bras. cardiol ; 108(1): 12-20, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-838670

ABSTRACT

Abstract Background: Radionuclide ventriculography (RV) is a validated method to evaluate the left ventricular systolic function (LVSF) in small rodents. However, no prior study has compared the results of RV with those obtained by other imaging methods in this context. Objectives: To compare the results of LVSF obtained by RV and echocardiography (ECHO) in an experimental model of cardiotoxicity due to doxorubicin (DXR) in rats. Methods: Adult male Wistar rats serving as controls (n = 7) or receiving DXR (n = 22) in accumulated doses of 8, 12, and 16 mg/kg were evaluated with ECHO performed with a Sonos 5500 Philips equipment (12-MHz transducer) and RV obtained with an Orbiter-Siemens gamma camera using a pinhole collimator with a 4-mm aperture. Histopathological quantification of myocardial fibrosis was performed after euthanasia. Results: The control animals showed comparable results in the LVSF analysis obtained with ECHO and RV (83.5 ± 5% and 82.8 ± 2.8%, respectively, p > 0.05). The animals that received DXR presented lower LVSF values when compared with controls (p < 0.05); however, the LVSF values obtained by RV (60.6 ± 12.5%) were lower than those obtained by ECHO (71.8 ± 10.1%, p = 0.0004) in this group. An analysis of the correlation between the LVSF and myocardial fibrosis showed a moderate correlation when the LVSF was assessed by ECHO (r = -0.69, p = 0.0002) and a stronger correlation when it was assessed by RV (r = -0.79, p < 0.0001). On multiple regression analysis, only RV correlated independently with myocardial fibrosis. Conclusion: RV is an alternative method to assess the left ventricular function in small rodents in vivo. When compared with ECHO, RV showed a better correlation with the degree of myocardial injury in a model of DXR-induced cardiotoxicity.


Resumo Fundamento: A ventriculografia radioisotópica (VRI) é um método validado para avaliação da função sistólica do ventrículo esquerdo (FSVE) em pequenos roedores. Contudo, nenhum estudo prévio comparou os resultados obtidos com VRI com os obtidos por outros métodos de imagem neste contexto. Objetivos: Comparar os resultados de FSVE obtidos por VRI e por ecocardiografia (ECO) em modelo experimental de cardiotoxicidade por doxorrubicina (DXR) em ratos. Métodos: Ratos Wistar machos adultos controles (n = 7) e tratados com DXR (n = 22) em doses acumuladas de 8, 12 e 16 mg/kg, foram avaliados com ECO com equipamento Sonos 5500 Philips (transdutor de 12 MHz) e VRI adquirida em gama-câmara Orbiter-Siemens com colimador pinhole de 4 mm de abertura. Após eutanásia, foi realizada a quantificação histopatológica da fibrose miocárdica. Resultados: Os animais controles apresentaram valores comparáveis na análise da FSVE à ECO e à VRI (83,5 ± 5% e 82,8 ± 2,8%, respectivamente, p > 0,05). Os animais que receberam DXR apresentaram valores menores de FSVE quando comparados aos dos controles (p < 0,05); entretanto, observou-se neste grupo menores valores de FSVE obtidos por VRI (60,6 ± 12,5%) quando comparados aos obtidos pela ECO (71,8 ± 10,1%, p = 0,0004). A análise da correlação entre a FSVE e a fibrose miocárdica mostrou uma correlação moderada quando a FSVE foi estimada com a ECO (r = -0,69, p = 0,0002) e mais forte quando a FSVE foi obtida por VRI (r = -0,79, p < 0,0001). Apenas a VRI apresentou correlação de forma independente com a fibrose miocárdica à análise de regressão múltipla. Conclusão: A VRI é um método alternativo para avaliação da função ventricular esquerda in vivo em pequenos roedores, exibindo comparativamente à ECO melhor correlação com o grau de lesão miocárdica no modelo de cardiotoxicidade por DXR.


Subject(s)
Animals , Male , Echocardiography , Radionuclide Ventriculography , Ventricular Function, Left/drug effects , Ventricular Dysfunction, Left/diagnostic imaging , Reference Values , Fibrosis , Doxorubicin , Reproducibility of Results , Rats, Wistar , Ventricular Dysfunction, Left/chemically induced , Ventricular Dysfunction, Left/pathology , Statistics, Nonparametric , Disease Models, Animal , Cardiotoxicity/diagnostic imaging , Antibiotics, Antineoplastic
6.
Arq. bras. cardiol ; 107(1): 33-39, July 2016. tab, graf
Article in English | LILACS | ID: lil-792492

ABSTRACT

Abstract Background: Right-sided heart failure has high morbidity and mortality, and may be caused by pulmonary arterial hypertension. Fractal dimension is a differentiated and innovative method used in histological evaluations that allows the characterization of irregular and complex structures and the quantification of structural tissue changes. Objective: To assess the use of fractal dimension in cardiomyocytes of rats with monocrotaline-induced pulmonary arterial hypertension, in addition to providing histological and functional analysis. Methods: Male Wistar rats were divided into 2 groups: control (C; n = 8) and monocrotaline-induced pulmonary arterial hypertension (M; n = 8). Five weeks after pulmonary arterial hypertension induction with monocrotaline, echocardiography was performed and the animals were euthanized. The heart was dissected, the ventricles weighed to assess anatomical parameters, and histological slides were prepared and stained with hematoxylin/eosin for fractal dimension analysis, performed using box-counting method. Data normality was tested (Shapiro-Wilk test), and the groups were compared with non-paired Student t test or Mann Whitney test (p < 0.05). Results: Higher fractal dimension values were observed in group M as compared to group C (1.39 ± 0.05 vs. 1.37 ± 0.04; p < 0.05). Echocardiography showed lower pulmonary artery flow velocity, pulmonary acceleration time and ejection time values in group M, suggesting function worsening in those animals. Conclusion: The changes observed confirm pulmonary-arterial-hypertension-induced cardiac dysfunction, and point to fractal dimension as an effective method to evaluate cardiac morphological changes induced by ventricular dysfunction.


Resumo Fundamento: Insuficiência cardíaca direita apresenta grande morbimortalidade e pode ser causada por hipertensão arterial pulmonar. Um método diferenciado e inovador utilizado em avaliações histológicas é a dimensão fractal, que permite a caracterização de estruturas irregulares e complexas e pode quantificar alterações estruturais dos tecidos. Objetivo: Avaliar a utilização do método da dimensão fractal nos cardiomiócitos de ratos com hipertensão arterial pulmonar induzida por monocrotalina, associada com análise histológica e funcional. Métodos: Ratos Wistar machos foram divididos em 2 grupos: controle (C; n = 8) e hipertensão arterial pulmonar induzida por monocrotalina (M; n = 8). Após 5 semanas da indução da hipertensão arterial pulmonar pela monocrotalina, foi realizado ecocardiograma. Os animais foram eutanasiados, o coração dissecado e os ventrículos pesados para avaliação dos parâmetros anatômicos. Lâminas histológicas foram confeccionadas, coradas com hematoxilina/eosina para análise da dimensão fractal, realizada pelo método box-counting . Inicialmente foi testada a normalidade dos dados (teste Shapiro Wilk) e a comparação entre os grupos foi por meio do teste t de Student não pareado ou teste de Mann Whitney (p < 0,05). Resultados: Maiores valores da dimensão fractal foram observados no grupo M em comparação ao C (1,43 ± 0,06 vs. 1,37 ± 0,04; p < 0,05). O ecocardiograma apontou menores valores no grupo M para velocidade máxima pulmonar, tempo de aceleração pulmonar e tempo de ejeção, sugerindo piora funcional nesses animais, que também apresentaram hipertrofia cardíaca. Conclusão: As alterações observadas comprovam a disfunção cardíaca induzida pela hipertensão arterial pulmonar e apontam que a dimensão fractal é um método eficaz para avaliar alterações morfológicas cardíacas induzidas pela disfunção ventricular.


Subject(s)
Animals , Male , Fractals , Heart Failure/etiology , Heart Failure/pathology , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/pathology , Reference Values , Stroke Volume/physiology , Echocardiography , Reproducibility of Results , Monocrotaline , Rats, Wistar , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/pathology , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/pathology , Myocytes, Cardiac/pathology , Disease Models, Animal , Heart Failure/physiopathology , Hypertension, Pulmonary/physiopathology
8.
Clinics ; 66(8): 1437-1442, 2011. ilus, tab
Article in English | LILACS | ID: lil-598401

ABSTRACT

OBJECTIVES: To investigate the effects of hyperglycemia on left ventricular dysfunction, morphometry, myocardial infarction area, hemodynamic parameters, oxidative stress profile, and mortality rate in rats that had undergone seven days of myocardial infarction. INTRODUCTION: Previous research has demonstrated that hyperglycemia may protect the heart against ischemic injury. METHODS: Male Wistar rats were divided into four groups: control-sham, diabetes-sham, myocardial infarction, and diabetes + myocardial infarction. Myocardial infarction was induced 14 days after diabetes induction. Ventricular function and morphometry, as well as oxidative stress and hemodynamic parameters, were evaluated after seven days of myocardial infarction. RESULTS: The myocardial infarction area, which was similar in the infarcted groups at the initial evaluation, was reduced in the diabetes + myocardial infarction animals (23 ± 3 percent) when compared with the myocardial infarction (42 ± 7 percent, p<0.001) animals at the final evaluation. The ejection fraction (22 percent, p = 0.003), velocity of circumferential fiber shortening (30 percent, p = 0.001), and left ventricular isovolumetric relaxation time (26 percent, p = 0.002) were increased in the diabetes + myocardial infarction group compared with the myocardial infarction group. The diabetes-sham and diabetes + myocardial infarction groups displayed increased catalase concentrations compared to the control-sham and myocardial infarction groups (diabetes-sham: 32± 3; diabetes + myocardial infarction: 35± 0.7; control-sham: 12 ± 2; myocardial infarction: 16 ± 0.1 pmol min-1 mg-1 protein). The levels of thiobarbituric acid-reactive substances were reduced in the diabetes-sham rats compared to the control-sham rats. These positive adaptations were reflected in a reduced mortality rate in the diabetes + myocardial infarction animals (18.5 percent) compared with the myocardial infarction animals (40.7 percent, p = 0.001). CONCLUSIONS: These data suggest that short-term hyperglycemia initiates compensatory mechanisms, as demonstrated by increased catalase levels, which culminate in improvements in the ventricular response, infarcted area, and mortality rate in diabetic rats exposed to ischemic injury.


Subject(s)
Animals , Male , Rats , Diabetes Mellitus, Experimental/physiopathology , Hyperglycemia/physiopathology , Myocardial Infarction/physiopathology , Oxidative Stress/physiology , Ventricular Dysfunction, Left/physiopathology , Catalase/analysis , Diabetes Mellitus, Experimental/metabolism , Hyperglycemia/metabolism , Myocardial Infarction/metabolism , Myocardial Infarction/pathology , Rats, Wistar , Streptozocin , Survival Rate , Thiobarbituric Acid Reactive Substances/analysis , Ventricular Dysfunction, Left/metabolism , Ventricular Dysfunction, Left/pathology
9.
Arq. bras. cardiol ; 95(5): 635-639, out. 2010. tab
Article in Portuguese | LILACS | ID: lil-570434

ABSTRACT

FUNDAMENTO: A relevância do padrão de remodelamento no modelo de ratos infartados não é conhecida. OBJETIVO: Analisar a presença de diferentes padrões de remodelamento nesse modelo e suas implicações funcionais. MÉTODOS: Ratos infartados (n=46) foram divididos de acordo com o padrão de geometria, analisado pelo ecocardiograma: normal (índice de massa normal e espessura relativa normal), remodelamento concêntrico (índice de massa normal e espessura relativa aumentada), hipertrofia concêntrica (índice de massa aumentado e espessura relativa aumentada) e hipertrofia excêntrica (índice de massa aumentado e espessura relativa normal). Os dados estão em mediana e intervalo interquartil. RESULTADOS: Ratos infartados apresentaram apenas dois dos quatro padrões de geometria: padrão normal (15 por cento) e hipertrofia excêntrica - HE (85 por cento). Os grupos de padrão normal e HE não apresentaram diferenças nos valores de fração de variação de área (Normal = 32,1 - 28,8 a 50,7; HE = 31,3 - 26,5 a 36,7; p=0,343). Dos animais infartados, 34 (74 por cento) apresentaram disfunção sistólica, detectada pela fração de variação de área. Considerando os dois padrões de geometria, 77 por cento dos animais com hipertrofia excêntrica e 57 por cento com geometria normal apresentaram disfunção sistólica (p=0,355). A espessura relativa da parede, os padrões de geometria e o índice de massa não foram fator de predição de disfunção ventricular (p>0,05). Por outro lado, o tamanho do infarto foi fator de predição de disfunção ventricular na análise univariada (p<0,001) e na análise multivariada (p=0,004). CONCLUSÃO: Ratos submetidos à oclusão coronariana apresentam dois diferentes padrões de remodelamento, os quais não se constituem em fator de predição de disfunção ventricular.


BACKGROND: The relevance of the remodeling pattern in the model of infarcted rats is not known. OBJECTIVE: To analyze the presence of different patterns of remodeling in this model and its functional implications. METHODS: Infarcted rats (n=47) have been divided according to the geometry pattern, analyzed by echocardiogram: normal (normal mass index and normal relative thickness), concentric remodeling (normal mass index and increased relative thickness), concentric hypertrophy (increased mass index and increased relative thickness) and eccentric hypertrophy (increased mass index and normal relative thickness). Data are median and interquartile range. RESULTS: Infarcted rats showed only two of the four geometric patterns: normal pattern (15 percent) and eccentric hypertrophy - EH (85 percent). Groups of normal pattern and EH showed no differences in the values of fractional area change (Normal = 32.1 - 28.8 to 50.7; EH = 31.3 - 26.5 to 36.7; p = 0.343). Out of the infarcted animals, 34 (74 percent) had systolic dysfunction, detected by fractional area change. Considering these two geometry patterns, 77 percent of animals with eccentric hypertrophy and 57 percent with normal geometry presented systolic dysfunction (p=0.355). The relative wall thickness, the geometric patterns and the body mass index were not predictors of ventricular dysfunction (p> 0.05). On the other hand, infarct size was a predictive factor for ventricular dysfunction in univariate analysis (p<0.001) and multivariate analysis (p = 0.004). CONCLUSION: Rats that underwent coronary occlusion showed two different patterns of remodeling, which do not constitute a predictor of ventricular dysfunction.


Subject(s)
Animals , Male , Rats , Myocardial Infarction/pathology , Ventricular Dysfunction, Left/pathology , Ventricular Remodeling/physiology , Disease Models, Animal , Myocardial Infarction/complications , Random Allocation , Rats, Wistar , Statistics, Nonparametric , Ventricular Dysfunction, Left/etiology
12.
Arq. bras. cardiol ; 94(2): 224-228, fev. 2010. tab
Article in Portuguese | LILACS | ID: lil-544884

ABSTRACT

FUNDAMENTO: A relevância do padrão de remodelação no modelo de ratos expostos à fumaça do cigarro não é conhecida. OBJETIVO: Analisar a presença de diferentes padrões de remodelação nesse modelo e sua relação com a função ventricular. MÉTODOS: Ratos fumantes (n=47) foram divididos de acordo com o padrão de geometria, analisado pelo ecocardiograma: normal (índice de massa normal e espessura relativa normal), remodelação concêntrica (índice de massa normal e espessura relativa aumentada), hipertrofia concêntrica (índice de massa aumentado e espessura relativa aumentada) e hipertrofia excêntrica (índice de massa aumentado e espessura relativa normal). RESULTADOS: Os ratos fumantes apresentaram um dos quatro padrões de geometria: padrão normal, 51 por cento; hipertrofia excêntrica:,32 por cento; hipertrofia concêntrica, 13 por cento e remodelação concêntrica, 4 por cento. Os grupos normal e hipertrofia excêntrica apresentaram menores valores de fração de ejeção e porcentagem de encurtamento que o grupo hipertrofia concêntrica. Treze animais (28 por cento) apresentaram disfunção sistólica, detectada pela fração de ejeção e pela porcentagem de encurtamento. Na análise de regressão univariada, os padrões de geometria e o índice de massa não foram fator de predição de disfunção ventricular (p>0,05). Por outro lado, o aumento da espessura relativa da parede foi fator de predição de disfunção ventricular na análise univariada (p<0,001) e na análise multivariada, após ajuste para o índice de massa (p=0,003). CONCLUSÃO: Ratos expostos à fumaça do cigarro apresentam um dos quatro diferentes padrões de remodelação. Entre as variáveis geométricas analisadas, somente o aumento da espessura relativa da parede do ventrículo esquerdo foi fator de predição de disfunção ventricular nesse modelo.


BACKGROUND: The relevance of the remodeling pattern in the model of rats exposed to cigarette smoke is not known. OBJECTIVE: Analyzing the presence of different remodeling patterns in this model and its relation with the ventricular function. METHODS: Smoking rats (n=47) have been divided according to the geometry pattern, analyzed by echocardiogram: normal (normal mass index and normal relative wall thickness), concentric remodeling (normal mass index and increased relative wall thickness), concentric hypertrophy (increased mass index and increased relative wall thickness) and eccentric hypertrophy (increased mass index and normal relative wall thickness). RESULTS: Smoking rats presented one of the following geometry patterns: normal pattern, 51 percent; eccentric hypertrophy; 32 percent; concentric hypertrophy, 13 percent and concentric remodeling, 4 percent. The normal and eccentric hypertrophy groups presented smaller ejection fraction values and fractional shortening than the concentric hypertrophy group. Thirteen animals (28 percent) presented systolic dysfunction detected by the ejection fraction and by fractional shortening. In the single regression analysis, geometry patterns and mass index could not predict ventricular dysfunction (p<). On the other hand, the increased relative thickness of the wall could predict ventricular dysfunction in the single regression analysis (p<0,001) and in the multiple regression analysis after adjustment to the mass index (p=0,003). CONCLUSION: Rats exposed to cigarette smoke presented one of the four different remodeling patterns. Among the geometric variables analyzed, only the increased relative thickness of the left ventricle wall could predict ventricular dysfunction in this model.


FUNDAMENTO: No se conoce la relevancia del estándar de remodelación en el modelo de ratones expuestos al humo del cigarrillo. OBJETIVO: Analizar la presencia de diferentes estándares de remodelación en este modelo y su relación con la función ventricular. MÉTODOS: Ratones fumadores (n=47) se dividieron según el estándar de geometría, analizado por el ecocardiograma: normal (índice de masa normal y espesor relativo normal), remodelación concéntrico (índice de masa normal y espesor relativo aumentado), hipertrofia concéntrica (índice de masa aumentado y espesor relativo aumentado) y hipertrofia excéntrica (índice de masa aumentado y espesor relativo normal). RESULTADOS: Los ratos fumadores presentaron uno de los cuatro estándares de geometría: estándar normal, el 51 por ciento; hipertrofia excéntrica: el 32 por ciento; hipertrofia concéntrica, el 13 por ciento y remodelación concéntrica, el 4 por ciento. Los grupos normal e hipertrofia excéntrica presentaron menores valores de fracción de eyección y porcentaje de acortamiento que el grupo hipertrofia concéntrica. Trece animales (28 por ciento) presentaron disfunción sistólica, detectada por la fracción de eyección y por el porcentaje de acortamiento. En el análisis de regresión univariado, los estándares de geometría y el índice de masa no fueron factor de predicción de disfunción ventricular (p > 0,05). Por otro lado, el aumento del espesor relativo de la pared fue factor de predicción de disfunción ventricular en el análisis univariado (p < 0,001) y en el análisis multivariado, tras ajuste para el índice de masa (p = 0,003). CONCLUSIÓN: Ratones expuestos al humo del cigarrillo presentan uno de los cuatro diferentes estándares de remodelación. Entre las variables geométricas analizadas, solamente el aumento del espesor relativo de la pared del ventrículo izquierdo del factor de predicción de disfunción ventricular en este modelo.


Subject(s)
Animals , Male , Rats , Hypertrophy, Left Ventricular/pathology , Tobacco Smoke Pollution/adverse effects , Ventricular Dysfunction, Left/pathology , Ventricular Remodeling/physiology , Disease Models, Animal , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Rats, Wistar , Stroke Volume/physiology , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology
13.
Arq. bras. cardiol ; 94(1): 62-70, jan. 2010. graf, tab
Article in English, Spanish, Portuguese | LILACS | ID: lil-543861

ABSTRACT

Fundamento: A estenose aórtica supravalvar (EAo) é utilizada para o estudo da remodelação cardíaca (RC) por sobrecarga pressórica. Nesse modelo, não estão claramente estabelecidos o comportamento da RC desde a fase inicial, nem os melhores parâmetros para a identificação da disfunção ventricular. OBJETIVOS: 1) Caracterizar, precoce e evolutivamente, as modificações morfofuncionais durante a RC em ratos com EAo e 2) identificar o índice mais sensível para detecção do momento do aparecimento da disfunção diastólica e sistólica do ventrículo esquerdo (VE). Métodos: Ratos Wistar foram divididos em dois grupos - controle (GC, n=13) e EAo (GEAo, n=24) - e estudados nas 3ª, 6ª, 12ª e 18ª semanas pós-cirurgia. Os corações foram analisados por meio de ecocardiograma (ECO). Resultados: Ao final do experimento, as relações do VE, do ventrículo direito e dos átrios com o peso corporal final foram aumentadas no GEAo. O ECO mostrou que o átrio esquerdo sofreu uma remodelação significativa a partir da 6ª semana. No GEAo, a porcentagem de encurtamento endocárdico apresentou queda significativa a partir da 12ª semana e a porcentagem de encurtamento mesocárdico, na 18ª semana. A relação onda E e onda A (E/A) foi superior no GC em comparação ao GEAo em todos os momentos analisados. Conclusões: O ventrículo esquerdo dos ratos com EAo, durante o processo de remodelação, apresentou hipertrofia concêntrica, disfunção diastólica precoce e melhoria da função sistólica, com posterior deterioração do desempenho. Além disso, constatou-se que os índices ecocardiográficos mais sensíveis para a detecção da disfunção diastólica e sistólica são, respectivamente, a relação E/A e a porcentagem de encurtamento endocárdico.


Background: Supravalvar aortic stenosis (SVAS) is used to study overload-induced cardiac remodeling (CR). In this model, neither CR behavior since beginning stage nor the best parameters to identify ventricular dysfunction are clearly stated. Objective: 1) Characterizing, early and evolutively, morphological and functional modifications during CR in rats with SVAS and 2) identifying the most sensitive index for detecting the moment when the diastolic and systolic dysfunction first appeared in the left ventricle (LV). Methods: Wistar Rats were divided into two groups - control (CG, n=13) and SVAS (SVASG, n=24) - and studied in post-surgical 3rd, 6th, 12th and 18th weeks. Hearts were analyzed by means of an echocardiogram (ECHO). Results: By the end of the experiment, ratios between the LV, right ventricle and atria and the final body weight were increased in the SVASG. The ECHO showed that the left atrium underwent significant remodeling from the 6th on. The percent of endocardial shortening underwent significant drop as of the 12nd week and the percent of, as of the 18th week, in the SVASG. The ratio between E- wave and A-wave (E/A) was higher in CG compared to the SVASG in all events analyzed. Conclusions: During the remodeling process, the left ventricle of rats with SVAS presented concentric hypertrophy, early diastolic dysfunction and improvement of systolic function, with posterior performance deterioration. Besides this, the study found out the most sensitive echocardiographic indexes for detecting systolic and diastolic dysfunction are, respectively, the ratio E/A and the percent of endocardial shortening.


Fundamento: La estenosis aórtica supravalvular (EAo) se utiliza para el estudio de la remodelación cardiaca (RC) por sobrecarga de presión. En este modelo, no están claramente establecidos el comportamiento del RC desde la fase inicial, ni los mejores parámetros para la identificación de la disfunción ventricular. OBJETIVO: 1) Caracterizar, precoz y evolutivamente, las modificaciones morfofuncionales durante el RC en ratones con EAo, y 2) identificar el índice más sensible para detección del momento de la aparición de la disfunción diastólica y sistólica del ventrículo izquierdo (VI). Métodos: Ratones Wistar se dividieron en dos grupos - control (GC, n=13) y EAo (GEAo, n=24) - y estudiados en las 3ª, 6ª, 12ª y 18ª semanas post cirugía. Los corazones se analizaron por medio de ecocardiograma (ECO). Resultados: Al final del experimento, las relaciones del VI, del ventrículo derecho y de los atrios con el peso corporal final fueron aumentadas en el GEAo. El ECO mostró que el atrio izquierdo sufrió una remodelación significativa a partir de la 6ª semana. En el GEAo, el porcentaje de acortamiento endocárdico presentó disminución significativa a partir de la 12ª semana y el porcentaje de acortamiento mesocárdico, en la 18ª semana. La relación onda E y onda A (E/A) fue superior en el GC en comparación al GEAo en todos los momentos analizados. Conclusión: El ventrículo izquierdo de los ratones con EAo, durante el proceso de remodelación, presentó hipertrofia concéntrica, disfunción diastólica precoz y mejora de la función sistólica, con posterior deterioro del desempeño. Además de ello, se constató que los índices ecocardiográficos más sensibles para la detección de la disfunción diastólica y sistólica son, respectivamente, la relación E/A y el porcentaje de acortamiento endocárdico.


Subject(s)
Animals , Male , Rats , Aortic Stenosis, Supravalvular/complications , Ventricular Dysfunction, Left/pathology , Ventricular Dysfunction, Left , Ventricular Remodeling/physiology , Analysis of Variance , Body Weight/physiology , Cardiomegaly/pathology , Disease Models, Animal , Diastole/physiology , Early Diagnosis , Endocardium/pathology , Heart Atria/pathology , Heart Atria/physiopathology , Heart Ventricles/pathology , Heart Ventricles/physiopathology , Random Allocation , Rats, Wistar , Systole/physiology
14.
Arq. bras. cardiol ; 93(6): 610-616, dez. 2009. graf, tab
Article in English, Spanish, Portuguese | LILACS | ID: lil-542742

ABSTRACT

Fundamento: Embora se reconheça que a cirurgia de reconstrução ventricular (CRV) promova remodelamento reverso, são necessários novos estudos para definir a influência da área de fibrose do ventrículo esquerdo (VE). Objetivo: Avaliar se a extensão da área de fibrose do VE é importante na recuperação funcional ventricular após CRV e correlacionar com fatores clínicos. Método: Análise prospectiva de 82 pacientes com disfunção ventricular submetidos à CRV. Analisou-se a importância das características clínicas e foram avaliadas as quantidades de fibrose, mensuradas por ressonância magnética em pequena, média e grande. Resultados: Todos os pacientes foram acompanhados por 36 meses, com mortalidade de 6 por cento. A quantidade de fibrose média foi de 25,8 por cento ± 13,6 por cento. Houve melhora da fração de ejeção do VE (FEVE), de 36,9 por cento ± 6,8 por cento para 48,2 por cento ± 8,2 por cento (p < 0,001). Houve relação inversa entre a quantidade de fibrose o incremento da FEVE (r = -0,83, p < 0,0001). Houve diminuição do volume sistólico final do VE de 43,3 ± 8,2ml/m² (p < 0,001). Houve melhora dos sintomas de insuficiência cardíaca, exceto nos pacientes com grande área de fibrose (p = 0,45). Os preditores independentes para eventos foram: área fibrótica (p = 0,01), idade (p = 0,01), volume sistólico final do VE (p = 0,03) e fração de ejeção (p = 0,02). O seguimento livre de evento foi diferente em relação à área de fibrose (p < 0,01). Conclusão: Em pacientes com disfunção ventricular, a extensão da área fibrótica foi um preditor independente da recuperação funcional do VE após CRV. A combinação de RMC e parâmetros clínicos podem auxiliar na indicação para CRV.


Background: Although it is acknowledged that the ventricular reconstruction surgery (VRS) can promote reverse remodeling, new studies are necessary to define the influence of the left ventricular (LV) area of fibrosis. Objective: To evaluate whether the extension of the area of fibrosis of the LV is important in the LV functional recovery after the surgery and correlate it with clinical factors. Methods: Prospective analysis of 82 patients with ventricular dysfunction submitted to VRS. We analyzed the importance of the clinical characteristics and the amount of fibrosis was assessed, measured by cardiac magnetic resonance (CMR) as small, medium and large. Results: All patients were followed for 36 months, with a mortality of 6 percent. The amount of medium fibrosis was 25.8 percent ± 13.6 percent. There was improvement in the left ventricular ejection fraction (LVEF), from 36.9 percent ± 6.8 percent to 48.2 percent ± 8.2 percent (p < 0.001). There was an inverse association between the amount of fibrosis and the increase in LVEF (r = -0.83, p < 0.0001). There was a decrease in the LV end-systolic volume of 43.3 ± 8.2ml/m² (p < 0.001). There was an improvement in heart failure symptoms, except in patients with large areas of fibrosis (p = 0.45). The independent predictors for events were: fibrotic area (p = 0.01), age (p = 0.01), LV end-systolic volume (p = 0.03) and LVEF (p = 0.02). The event-free follow-up was different in relation to the area of fibrosis (p < 0.01). Conclusion: In patients with ventricular dysfunction, the extension of the area of fibrosis was an independent predictor of the LV functional recovery after the VRS. The combination of cardiac MRI and clinical parameters can help in the indication for VRS.


Fundamento: Si bien se reconoce que la cirugía de reconstrucción ventricular (CRV) promueve remodelación reversa, son necesarios nuevos estudios para definir la influencia del área de fibrosis del ventrículo izquierdo (VE). Objetivo: Evaluar si la extensión del área de fibrosis del VI es importante en la recuperación funcional ventricular tras la CRV y correlacionarlo con factores clínicos. Método: Análisis prospectivo de 82 pacientes con disfunción ventricular sometidos a CRV. Se analizó la importancia de las características clínicas y se evaluaron las áreas de fibrosis, medidas por resonancia magnética y ponderadas como pequeña, mediana y grande. Resultados: Se realizó un seguimiento de 36 meses a todos los pacientes, con mortalidad del 6 por ciento. La cantidad de fibrosis promedio fue del 25,8 por ciento ± 13,6 por ciento. Existió una mejora de la fracción de eyección del VI (FEVI), del 36,9 por ciento ± 6,8 por ciento al 48,2 por ciento ± 8,2 por ciento (p < 0,001). Existió relación inversa entre la cantidad de fibrosis y el incremento de la FEVI (r = -0,83, p < 0,0001). Hubo una disminución del volumen de fin de sístole del VI de 43,3 ± 8,2ml/m² (p < 0,001). Se produjo una mejoría en los síntomas de insuficiencia cardiaca, excepto en los pacientes con gran área de fibrosis (p = 0,45). Los predictores independientes para eventos fueron: área de fibrosis (p = 0,01), edad (p = 0,01), volumen de fin de sístole del VI (p = 0,03) y fracción de eyección (p = 0,02). El seguimiento libre de eventos fue diferente en relación con el área de fibrosis (p < 0,01). Conclusión: En pacientes con disfunción ventricular, la extensión del área de fibrosis fue un predictor independiente de la recuperación funcional del VI luego de la CRV. La combinación de RMC y parámetros clínicos puede auxiliar en la indicación de CRV.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Endomyocardial Fibrosis/pathology , Recovery of Function/physiology , Stroke Volume/physiology , Ventricular Dysfunction, Left/surgery , Ventricular Remodeling/physiology , Epidemiologic Methods , Magnetic Resonance Imaging , Treatment Outcome , Ventricular Dysfunction, Left/pathology , Ventricular Dysfunction, Left/physiopathology
15.
Rev. méd. Chile ; 137(11): 1457-1462, nov. 2009. tab, graf
Article in Spanish | LILACS | ID: lil-537008

ABSTRACT

Background: Cardiac dyssynchrony is common in advanced heart failure (HF), but the changes in cardiac synchrony after myocardial infarction (MI) have not been adequately descríbed. Aim: To study the relationship between cardiac synchrony and left ventricular remodeling after acute myocardial infarction. Material and methods: Forty nine patients aged 59±10 years (77 percent men) with a first episode of a ST segment elevation MI, were studied. Scintigraphic left ventricular function and synchrony analyses were performed at baseline and after a six months follow-up. Determinations were compared with 33 healthy subjects. Results: At baseline, patients with MIhad a decreased left ventricular ejection fraction (LVEF) and significant dyssynchrony, when compared with controls. LVEF was 36.4 percent±10 percent, left ventricular end-diastolic volume (LVEDV) 127±38 mL, interventricular delay (IEV) 29±35 miliseconds (ms), and intraventricular delay (IAV), 234±89 ms. After 6 months, LVEF significantly improved (38 percent±10 percent, p =0.042) without significant changes in LVEDV (129±32 mL, p =0.97), IEV (24±17, p =0.96) or IAV (231±97, p =0.34). At baseline there were significant correlations between IAV and LVEF, and between IAV and LVEDV (r =0.48, p =0.001 and r =0.41, p =0.004, respectively). These correlations remained significant after 6 months. There was a positive correlation between IAV and LVEDV changes at six months (r =0.403, p =0.04). Conclusions: The development of cardiac dyssynchrony correlates with adverse left ventricular remodeling after MI.


Subject(s)
Female , Humans , Male , Middle Aged , Myocardial Infarction/complications , Ventricular Dysfunction, Left/etiology , Ventricular Remodeling/physiology , Epidemiologic Methods , Myocardial Infarction/physiopathology , Stroke Volume/physiology , Ventricular Dysfunction, Left/pathology , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left
16.
Arq. bras. cardiol ; 92(6): 479-483, jun. 2009. tab
Article in English, Spanish, Portuguese | LILACS | ID: lil-519969

ABSTRACT

FUNDAMENTO: O papel do sistema adrenérgico na remodelação induzida pelo tabagismo é desconhecido. OBJETIVO: Investigar a influência do propranolol na remodelação induzida pela exposição à fumaça de cigarro. MÉTODOS: Ratos foram alocados em três grupos: 1) C, n=10 - animais controle; 2) F, n=10 - animais expostos à fumaça de cigarro; 3) BB, n=10 - animais expostos à fumaça de cigarro e que receberam propranolol (40 mg/kg/dia). Após dois meses, os animais foram submetidos a estudo ecocardiográfico e morfométrico. Utilizou-se análise de variância (ANOVA) de uma via (média ± desvio padrão) ou Kruskal-Wallis (mediana e intervalo interquartil). RESULTADOS: O Grupo BB apresentou menor frequência cardíaca que o Grupo F (C = 358 ± 74 btm, F = 374 ± 53 bpm, BB = 297 ± 30; P = 0,02). O Grupo F apresentou maiores diâmetros diastólicos (C = 18,6 ± 3,4 mm/kg, F = 22,8 ± 1,8 mm/kg, BB = 21,7 ± 1,8 mm/kg; P = 0,003) e sistólicos (C = 8,6 ± 2,1 mmkg, F = 11,3 ± 1,3 mm/kg, BB = 9,9 ± 1,2 mm/kg; P = 0,004) do ventrículo esquerdo (VE), ajustado ao peso corporal (PC) e tendência de menor fração de ejeção (C = 0,90 ± 0,03, F = 0,87 ± 0,03, BB =0,90 ± 0,02; P = 0,07) que o Grupo C. O Grupo BB apresentou tendência de menor relação VE/PC que o Grupo F (C = 1,94 (1,87 - 1,97), F = 2,03 (1,9-2,1) mg/g, BB = 1,89 (1,86-1,94); P = 0,09). CONCLUSÃO: A administração de propranolol atenuou algumas variáveis da remodelação ventricular induzida pela exposição à fumaça do cigarro em ratos.


BACKGROUND: The role of the adrenergic system on ventricular remodeling induced by cigarette smoking is unknown. OBJECTIVES: To investigate the influence of propranolol on ventricular remodeling induced by exposure to tobacco smoke. METHODS: Rats were divided into three groups: 1) C, n=10 - control group; 2) F, n=10 - animals exposed to tobacco smoke; 3) BB, n=10 - animals receiving propranolol and exposed to tobacco smoke (40 mg/kg/day). After 2 months, the animals underwent echocardiographic and morphometric analyses. One-way ANOVA (mean ± standard deviation) or the Kruskal-Wallis test (median and interquartile interval) was used. RESULTS: Group BB showed a lower heart rate than group F (C = 358 ± 74 bpm, F = 374 ± 53 bpm, BB = 297 ± 30; P = 0.02). Group F showed greater end-diastolic diameters (C = 18.6 ± 3.4 mm/kg, F = 22.8 ± 1.8 mm/kg, BB = 21.7 ± 1.8 mm/kg; P = 0.003) and left ventricular (LV) end-systolic diameters (C = 8.6 ± 2.1 mm/kg, F = 11.3 ± 1.3 mm/kg, BB = 9.9 ± 1.2 mm/kg; P = 0.004), adjusted for body weight (BW) and a tendency towards a lower ejection fraction (C = 0.90 ± 0.03, F = 0.87 ± 0.03, BB =0.90 ± 0.02; P = 0.07) than group C. Group BB showed a tendency towards a lower LV/BW ratio than group F (C = 1.94 (1.87 - 1.97), F = 2.03 (1.9-2.1) mg/g, BB = 1.89 (1.86-1.94); P = 0.09). CONCLUSION: Administration of propranolol attenuated some of the variables of ventricular remodeling induced by the exposure to tobacco smoke in rats.


FUNDAMENTO: Aún se desconoce el rol del sistema adrenérgico en la remodelación inducida por el tabaquismo. OBJETIVO: Investigar la influencia del propranolol en la remodelación inducida por la exposición al humo del cigarrillo. MÉTODOS: Se dividieron las ratas en tres grupos: 1) C, n=10 - animales control; 2) F, n=10 - animales expuestos al humo de cigarrillo; 3) BB, n=10 - animales expuestos al humo de cigarrillo y que recibieron propranolol (40 mg/kg/día). Tras dos meses, los animales fueron sometidos a estudio ecocardiográfico y morfométrico. Se empleó el análisis de varianza (ANOVA) de una vía (promedio ± desviación estándar) o Kruskal-Wallis (mediana e intervalo intercuartil). RESULTADOS: El Grupo BB presentó menor frecuencia cardiaca que el Grupo F (C = 358 ± 74 lpm, F = 374 ± 53 lpm, BB = 297 ± 30; P = 0,02). El Grupo F presentó mayores diámetros diastólicos (C = 18,6 ± 3,4 mm/kg, F = 22,8 ± 1,8 mm/kg, BB = 21,7 ± 1,8 mm/kg; P = 0,003) y sistólicos (C = 8,6 ± 2,1 mm/kg, F = 11,3 ± 1,3 mm/kg, BB = 9,9 ± 1,2 mm/kg; P = 0,004) del ventrículo izquierdo (VI), ajustado al peso corporal (PC) y tendencia de menor fracción de eyección (C = 0,90 ± 0,03, F = 0,87 ± 0,03, BB =0,90 ± 0,02; P = 0,07) que el Grupo C. El Grupo BB presentó tendencia de menor relación VI/PC que el Grupo F (C = 1,94 (1,87 - 1,97), F = 2,03 (1,9-2,1) mg/g, BB = 1,89 (1,86-1,94); P = 0,09). CONCLUSIÓN: La administración de propranolol atenuó algunas variables de la remodelación ventricular inducida por la exposición al humo del cigarrillo en ratas.


Subject(s)
Animals , Male , Rats , Adrenergic beta-Antagonists/pharmacology , Inhalation Exposure/adverse effects , Propranolol/pharmacology , Tobacco Smoke Pollution/adverse effects , Ventricular Dysfunction, Left/etiology , Ventricular Remodeling/drug effects , Models, Animal , Rats, Wistar , Ventricular Dysfunction, Left/drug therapy , Ventricular Dysfunction, Left/pathology
17.
Indian Heart J ; 2007 Nov-Dec; 59(6): 482-90
Article in English | IMSEAR | ID: sea-5507

ABSTRACT

AIM: To assess the safety and feasibility of transfusing autologous bone marrow stem cells (ABMSC) into the culprit coronary artery after an acute anterior wall myocardial infarction (MI) and further to see the ability of ABMSC to promote improvement in Left Ventricular lsqb;LV] function at follow-up. METHODS: In an ongoing phase I clinical trial, twenty-seven patients of uncomplicated acute anterior wall MI treated as per the current practicing guidelines have been included. Among these, seventeen patients received intra-coronary unfractionated ABMSCs from 77ndash;15 days after acute MI (ABMSC group) and ten patients acted as controls. RESULTS: All the procedures carried out were without any complications. After 6 months, cardiac function analysis of ten patients from the ABMSC group by LV angiography and Cardiac Magnetic Resonance Imaging (MRI) demonstrated a significant rise of 12.74% (p = 0.001) and 7.1% (p = 0.001), respectively in the LV ejection fraction [LVEF]. There was an improvement in the LV systolic function wherein LV end systolic volume (LVESV) decreased significanty to 28.75% (p = 0.010) and 16.49% (p = 0.022) by LV angiography and cardiac MRI, respectively. LV end diastolic volume (LVEDV) decreased marginally by LV angiography (p = 0.548) and by cardiac MRI (p = 0.514). Five patients of the control group by LV angiography demonstrated non-significant rise of 1.0% (p = 0.706) in LVEF, 12.79% (p = 0.332) in LVEDV and 22.56% (p = 0.308) in LVESV. By cardiac MRI controls demonstrated significant rise in EF of 3.2% (p = 0.0367rpar; but non-significant fall of only 2.32% (p = 0.812) in LVEDV and 6.47% (p 7equals; 0.508) in LVESV. CONCLUSION: This study shows that intracoronary infusion of ABMSC is safe and feasible after acute MI and shows a favourable trend towards the improvement of LV function and prevention of ventricular remodeling which determines long-term survival.


Subject(s)
Adult , Aged , Angioplasty, Balloon, Coronary , Bone Marrow Transplantation/methods , Coronary Angiography , Coronary Vessels/pathology , Feasibility Studies , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Myocardial Infarction/pathology , Risk Factors , Safety , Treatment Outcome , Ventricular Dysfunction, Left/pathology , Ventricular Remodeling/physiology
18.
Article in English | WPRIM | ID: wpr-48771

ABSTRACT

The purpose of this study was to analyze left ventricular (LV) torsion and untwisting, and to evaluate the correlation between torsion and other components of LV contraction in children with dilated cardiomyopathy (DCM). Segmental and global rotation, rotational rate (Vrot) were measured at three levels of LV using the twodimensional (2D) speckle tracking imaging (STI) method in 10 DCM patients (range 0.6-15 yr, median 6.5 yr, 3 females) and 17 age- and sex-matched normal controls. Global torsion was decreased in DCM (peak global torsion; 10.9+/-4.6degrees vs. 0.3+/-2.1degrees, p<0.001). Loss of LV torsion occurred mainly by the diminution of counterclockwise apical rotation and was augmented by somewhat less reduction in clockwise basal rotation. In DCM, the normal counterclockwise apical rotation was not observed, and the apical rotation about the central axis was clockwise or slightly counterclockwise (peak apical rotation; 5.9+/-4.1degrees vs. -0.9+/-3.1degrees, p<0.001). Systolic counterclockwise Vrot and early diastolic clockwise Vrot at the apical level were decreased or abolished. In DCM, decreased systolic torsion and loss of early diastolic recoil contribute to LV systolic and diastolic dysfunction. The STI method may facilitate the serial evaluation of the LV torsional behavior in clinical settings and give new biomechanical concepts for better management of patients with DCM.


Subject(s)
Adolescent , Cardiomyopathy, Dilated/pathology , Child , Child, Preschool , Echocardiography, Doppler/methods , Female , Humans , Infant , Male , Reproducibility of Results , Ventricular Dysfunction, Left/pathology
19.
Rev. chil. cardiol ; 25(1): 57-64, ene.-mar. 2006. ilus, tab
Article in Spanish | LILACS | ID: lil-485649

ABSTRACT

Antecedentes: El ventrículo izquierdo no compactado (VINC) corresponde a una miocardiopatía caracterizada por trabeculaciones prominentes con recesos intertrabeculares en continuidad con la cavidad ventricular. Objetivo: Identificar características clínicas, métodos de diagnóstico, seguimiento y analizar índices fijos y variables de pruebas diagnósticas. Material y método: Ocho niños con diagnóstico de VINC entre octubre de 2001 a diciembre de 2004. Se registraron datos clínicos, electrocardiograma (ECG), ecocardiograma bidimensional Doppler color, en siete resonancias nucleares magnéticas (RNM) y biopsia miocárdica. Seguimiento a la totalidad del grupo. Comparación de proporciones según t de student e índices kappa para análisis de concordancia interobservador y cálculo de índices fijos y variables. Resultados: Edad media de 5,9 años. En 4 pacientes la primera manifestación clínica fue insuficiencia cardíaca, y ECG anormal en 8 niños. En 6 pacientes el compromiso ecocardiográfico fue de ventrículo izquierdo (VI) en forma aislada (p<0.01). La fracción de acortamiento de ventrículo izquierdo (FAVI) media fue de 25 por ciento. El radio no compactado/compactado promedio fue de 2.8, mientras que la localización de las trabeculaciones fueron: pared apical (100 por ciento), pared lateral (75 por ciento) Sensibilidad de un 100 por ciento con valor predictivo positivo de 0.83. En 2 niños la FAVI se recuperó en forma significativa durante el primer año de seguimiento. Un fallecimiento por insuficiencia cardíaca refractaria.Conclusiones: VINC constituye un nuevo tipo de enfermedad miocárdica cuyas manifestaciones clínicas no difieren de las de otra etiología, constituyendo la insuficiencia cardíaca la presentación más frecuente. La ecocardiografía es una buena técnica diagnóstica y presenta un alto grado de acuerdo con la RNM y los hallazgos histológicos.


Background: Isolated non-compactation of left ventricular myocardium is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The characteristic echocardiographic findings consist of multiple, prominent myocardial trabeculations and deep intertrabecular recesses communicating with the left ventricular cavity. Aim: The purpose of this study was to identify the clinical characteristics and follow up in children with left ventricular no compaction (LVNC) and analyze fixed and variable indexes of different diagnostics test. Methods: Eight children with LVNC from October 2001 to December 2004 were included. Review of Clinical data, electrocardiogram and echocardiography were consigned. In seven patients Magnetic Resonance Imaging was done and myocardial biopsy in six. Proportion comparison with t student test, Kappa index comparison for concordance (acceptable agreement degree of >0.8) and fixed and variable calculation were made. Results: Six patients were male. Median age of presentation was 5.9 years (range 0.3 -11 years). In four patients the first clinical manifestation was heart failure, two in functional capacity III-IV (NYHA). Six patients presented ecocardiographic compromise of the left ventricle only (p< 0.01). Median shortening fraction (SF) at diagnosis was 25 percent (range 15 percent-30 percent) Average no compaction/ compaction ratio was 2.8 (range 2.1-4). Localization of the non compactation in the left ventricle was located at the apical wall (100 percent) and lateral wall (75 percent). In comparison to myocardial biopsy Echocardiography sensitivity was 100 percent with positive predictive value of 0.83. Median follow up was 30.7 months (range 1- 50 months). In two children SF improved during follow up. One patient required the implant of a cardiac defibrillator. One death was due to refractory heart failure. Conclusions: Heart failure was the most frequent presentation of LVNC and the cause of...


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Ventricular Dysfunction, Left/pathology , Ventricular Dysfunction, Left , Heart Ventricles/pathology , Heart Ventricles , Ventricular Dysfunction, Left/diagnosis , Echocardiography, Doppler, Color , Follow-Up Studies , Predictive Value of Tests , Sensitivity and Specificity
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