Prevalencia de serología positiva para Trypanosoma cruzi en pacientes con diagnóstico clínico de miocardiopatía dilatada en el Estado de Campeche, México / Prevalence of positive serology to Trypanosoma cruzi in patients with clinical diagnosis of dilated myocardiopathy in the state of Campeche

Se desconoce la prevalencia de cardiopatía chagásica crónica como causa de miocardiopatía dilatada en el estado de Campeche, por lo que se decidió estudiar la prevalencia de serología positiva para Trypanosoma cruzi en pacientes con diagnóstico clínico de miocardiopatía dilatada. De un total de 127 enfermos diagnosticados con miocardiopatía dilatada, se estudiaron 91 con dos pruebas serológicas positivas para Trypanosoma cruzi. Se identificaron 14 casos positivos para una prevalencia de cardiopatía chagásica crónica de 15%. Esta prevalencia es similar a la informada para el resto de la península de Yucatán.

The prevalence of chronic Chagas' heart disease as a cause of dilated cardiomyopathy is unknown in the State of Campeche, Mexico. A study was conducted to determine the prevalence of positive serology for Trypanosoma cruzi in patients with clinical diagnosis of dilated cardiomyopathy. Of a total of 127 patients diagnosed with dilated cardiomyopathy, we studied 91 with two positive serological tests for T. cruzi. We identified 14 positive cases for a prevalence of 15 % of chronic Chagas' heart disease. This prevalence is similar to that reported for the rest of the Yucatan Peninsula.

Desempenho hemodinâmico e resposta inflamatória durante o uso do DAV-InCor como ponte para o transplante / Hemodynamic performance and inflammatory response during the use of VAD-InCor as a bridge to transplant

FUNDAMENTO: O transplante cardíaco enfrenta o grave problema da escassez de doadores. Estima-se que entre 20 por cento e 40 por cento dos pacientes falecem na fila de espera. Para esses pacientes, a utilização de dispositivos de assistência circulatória é, muitas vezes, a única possibilidade de sobrevivência durante a espera do doador. No Brasil, não existe nenhum programa regular de utilização desses dispositivos como ponte para transplante. OBJETIVO: Avaliar o desempenho hemodinâmico e a resposta inflamatória durante a utilização do DAV-InCor como ponte para transplante. MÉTODOS: Entre outubro de 2003 e abril de 2006, 11 pacientes, indicados em caráter de prioridade para o transplante cardíaco, evoluíram em choque cardiogênico refratário. O implante do DAV-InCor foi realizado em sete pacientes. O diagnóstico etiológico foi cardiopatia chagásica em cinco pacientes e cardiomiopatia dilatada idiopática em dois. RESULTADOS: A assistência mecânica ao ventrículo esquerdo foi mantida nos sete pacientes por períodos entre 14 e 42 dias (média 26,2). O desempenho hemodinâmico foi adequado, com a normalização do índice cardíaco, dos níveis de saturação venosa de O2 e do lactato. O transplante foi realizado em dois pacientes, os outros cinco faleceram por infecção sistêmica ou falência de múltiplos órgãos. CONCLUSÃO: O desempenho do DAV-Incor, no comportamento hemodinâmico dos pacientes estudados, foi adequado para a manutenção de uma condição circulatória satisfatória durante o período estudado. Houve melhora dos parâmetros de perfusão tecidual e manutenção de sinais de resposta inflamatória sistêmica. Houve alta incidência de complicações; contudo, não foram demonstradas complicações relacionadas ao dispositivo que comprometam a segurança da utilização do mesmo.

BACKGROUND: Cardiac transplantation faces the serious problem of lack of donors and it is estimated that 20 to 40 percent of the patients die while waiting for heart transplantation. For these patients, the use of mechanical circulatory assist devices is the only choice of survival while waiting for a donor. In Brazil, the experience with mechanical circulatory support is limited and there is no regular program regarding the use of these devices as a bridge to heart transplantation. OBJECTIVE: To evaluate the hemodynamic performance and the systemic inflammatory response during the clinical use of the InCor-type ventricular assist device (VAD-InCor) as a bridge to heart transplantation. METHODS: Between October 2003 and April 2006, 11 patients in the waiting list for heart transplantation presented hemodynamic deterioration due to refractory cardiogenic shock. Seven of these patients were submitted to VAD-InCor implantation for left ventricular assistance. The etiologic diagnosis was Chagas' disease in 5 patients and idiopathic dilated cardiomyopathy in 2. RESULTS: The duration of left ventricular assistance ranged from 14 to 42 days (mean 26.2 days). During this period, the hemodynamic performance of the DAV-InCor was adequate to support a normal hemodynamic state. There was normalization of central venous oxygen saturation and serum lactate. Two patients were submitted to heart transplantation, while the other 5 patients died under assistance due to infection and multiple organ failure. CONCLUSION: The performance of the VAD-InCor, in the hemodynamic behavior of the studied patients, was adequate for the maintenance of a satisfactory circulatory state during the studied period. There was improvement in the tissue perfusion parameters and maintenance of systemic inflammatory response signs. There was a high incidence of complications; however, complications related to the device, which could compromise the safety of its use, were not demonstrated.

Serum zinc level in dilated and ischemic cardiomyopathy

Serum trace element alteration has been reported in dilated and ischemic cardiomyopathy. The reports were controversial. We have studied serum Zinc level in cardiomyopathy patients in northern province of Mazandaran and compared them with healthy volunteers. Serum Zinc level was measured in 30 ischemic and 18 dilated cardiomyopathy patients against 27 healthy volunteers. It was measured using atomic absorption spectrophotometry. Statistical analysis was performed using SPSS for Windows version 14 and independent t-test was used for comparing serum Zinc level in ischemic and dilated cardiomyopathy. Pearson correlation and ANOVA tests were used for numeric variables in three different groups. P<0.05was considered as statistically significant. The mean serum Zinc level was 0.97 +/- 0.25, 1.05 +/- 0.27, 1.21 +/- 0.42 mg/L for idiopathic dilated cardiomyopathy, ischemic cardiomyopathy and healthy volunteers respectively. There was no significant difference between three groups. There was also no correlation between echocardiography data and serum Zinc level. This study showed serum Zinc level might not have a role in pathogenesis of ischemic and dilated cardiomyopathy. As intracellular Zinc level play a role in heart subjected to ischemia- reperfusion, measuring intracellular Zinc may give us a better clue about role of Zinc or other trace elements in pathogenesis of cardiomyopathy

vWf levels as a circulating marker of endothelial dysfunction in patients with hypertrophic cardiomyopathy.

BACKGROUND: The aim of the present study was to investigate whether the von Willebrand factor levels, as a possible indicator of endothelial dysfunction, is increased in hypertrophic cardiomyopathy, and also whether it is related to the clinical status of hypertrophic cardiomyopathy. METHODS AND RESULTS: The study group comprised 29 patients with hypertrophic cardiomyopathy and 29 healthy age- and gender-matched control subjects. There was no significant difference in von Willebrand factor levels between study group (77.0 +/- 23.1%) and control group (88.5 +/- 34.2%). There was no statistically significant difference between control group (88.5 +/- 34.2%) and functional class I/II group (82.0 +/- 24.3%), between control group and functional class III group (67.6 +/- 18.3%) and between functional class I/II group and functional class III group with respect to the von Willebrand factor levels. CONCLUSIONS: The results suggest that von Willebrand factor levels, as a possible indicator of endothelial dysfunction, are not increased in patients with hypertrophic cardiomyopathy and von Willebrand factor levels are not related to functional class in these patients.

Anticuerpos contra Trypanosoma cruzi en pacientes con miocardiopatía dilatada en Tuxtla Gutiérrez, Chiapas / Antibodies against Trypanosoma cruzi in patients with dilated cardiomyopathy in Tuxtla Gutierrez, Chiapas

La enfermedad de Chagas es causada por el protozoario flagelado Trypanosoma cruzi. Encuestas seroepidemiológicas realizadas en Chiapas informan individuos seropositivos en comunidades rurales, y cabe la posibilidad de que la forma crónica de la enfermedad ocurra en el estado. La expresión clínica dominante en la enfermedad de Chagas crónica es cardíaca. Material y métodos: Con el objeto de conocer la frecuencia de cardiopatía chagásica crónica (CCC) se hizo una encuesta serológica a pacientes con miocardiopatía dilatada (MD) internados entre octubre de 2002 a octubre de 2003, en el Servicio de Cardiología del Hospital General Regional "Dr. Rafael Pascacio Gamboa" de Tuxtla Gutiérrez, Chiapas. El diagnóstico fue establecido en forma independiente y el estudio seroinmunológico fue ciego. Resultados: Quince (54%) de 28 sujetos con MD tenían anticuerpos a T. cruzi. Todos provenían de medio rural pobre, su cuadro clínico incluyó insuficiencia cardíaca y/o trastornos del ritmo o conducción. Conclusiones: Esta evidencia sugiere que en Chiapas, una zona endémica de enfermedad de Chagas, hay CCC. Dentro del estudio de la MD, la etiología chagásica, debe ser considerada, ya que las condiciones socioeconómicas, culturales y regionales favorecen su presencia.

Chagas disease is caused by the flagellate protozoan T. cruzi. Seroepidemiological surveys in Chiapas, Mexico have shown seropositive individuals, therefore, we searched for people affected by the chronic form of Chagas disease which involves the heart, causing a chronic, progressive and fatal disease called Chronic Chagasic Cardiopathy (CCC). Material and methods: To establish the frequency of CCC we studied 28 patients seen at the Hospital General Regional "Dr. Rafael Pascacio Gamboa" during October 2002 through October 2003 in Tuxtla Gutierrez, Chiapas, the State capital city, with diagnosis of dilated cardiomyopathy (DC), a serological survey for antibodies against T. cruzi was done. This hospital cares for people from all parts of Chiapas, Mexico. Clinical diagnosis of DC was established there and blind serological studies were performed in Mexico City. Results: Fifteen out of 28 DC patients (54%) had anti T. cruzi antibodies. All of them came from poor rural villages and they had heart failure and/or arrhythmia or heart blockade on EKG. Conclusions: This observation suggest that in Chiapas were Chagas disease is endemic, there are CCC patients. Any case with a clinical diagnosis of DC should be tested for antibodies against T. cruzi. The low socioeconomic status, culture and environment in this Mexican State favour the presence and transmission of this parasitic disease.

The Origin of Proinflammatory Cytokines in Patients with Idiopathic Dilated Cardiomyopathy

Proinflammatory cytokines and their receptors are increased in the peripheral blood of patients with heart failure. We measured cytokines and their receptors in systemic artery (SA), coronary sinus (CS) and infra-renal inferior vena cava (IVC), in order to investigate their origin and influential factors. Thirty patients with idiopathic dilated cardiomyopathy were performed echocardiography at admission, and right heart catheterization after stabilization. Blood was drawn from 3 sites for measurement of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and soluble tumor necrosis factor- receptor (sTNFR) I, II. TNF-alpha at CS (3.25+/-0.34 pg/mL) was higher than those of SA (1.81+/-0.39 pg/mL) and IVC (1.88+/-0.38 pg/mL, p<0.05). IL-6 at CS (18.3+/-3.8 pg/mL) was higher than that of SA (5.8+/-1.2 pg/mL, p<0.01). The levels of sTNFR I, II showed increasing tendency in sequence of SA, IVC and CS. TNF-alpha and sTNFR I, II from all sites were proportional to worsening of functional classes at admission (p<0.05). E/Ea by Doppler study at admission, which reflects left ventricular end-diastolic pressure (LVEDP) was positively correlated with TNF-alpha from SA (R=0.71, p<0.01), CS (R=0.52, p<0.05) and IVC (R=0.46, p<0.05). Thus, elevated LVEDP during decompensation might cause cytokine release from myocardium in patients with idiopathic dilated cardiomyopathy.

A Case of Polymyositis with Dilated Cardiomyopathy Associated with Interferon alpha Treatment for Hepatitis B

Polymyositis is a rare complication of interferon alpha treatment as a result of immunemodulating role of the drug itself. In this case, interferon alpha induced polymyositis and cardiomyopathy is diagnosed in a 33-yr-old male patient with history of chronic hepatitis B. To treat hepatitis B, interferon alpha was administered until the proximal muscle weakness developed. Thereafter, sixteen cycles of immunoglobulin treatment (400 mg/kg) along with corticosteroids were instituted and led to an improvement in subjective symptoms with decreases in level of CPK and LDH. However, dilated cardiomyopathy has not improved in spite of the cessation of interferon treatment. Unlike the persistently elevated serum HBV DNA level, the serum ALT and AST levels have gradually decreased. Our case shows that clinical symptoms of polymyositis improved with steroid and immunoglobulin treatment without deterioration of the hepatitis B. To our knowledge, this is the first case of polymyositis associated with dilated cardiomyopathy after the administration of interferon in a patient with hepatitis B.

Selenium levels in dilated cardiomyopathy.

Thirty-seven dilated cardiomyopathy cases have been studied and compared with 20 normal controls. Serum selenium levels in relation to coronary risk factors were studied. Serum samples were analysed for selenium, total cholesterol, high density lipoprotein(HDL) cholesterol, triglycerides and glucose levels. Smoking, alcohol intake, positive family history, psychosocial tension, obesity, hypercholesterolaemia, hypertriglyceridaemia and hyperglycaemia were found in the following percentages 27%, 8%, 5%, 73%, 41%, 38%, 81%, 46% respectively in dilated cardiomyopathy patients. Low selenium (< 4.5 micrograms/dl) and HDL cholesterol levels and high total cholesterol, triglycerides, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and glucose levels were observed in dilated cardiomyopathy cases compared to controls. The present results support the concept that low selenium levels along with other risk factors play an important role in developing dilated cardiomyopathy.

Utilidad de la determinación de mioglobina,isoenzima MB de creatinina fosfocinasa, deshidrogenasa lactica y aspartato amino transferasa, en el diagnostico de infarto agudo del miocardio / Biomarkers in the diagnosis of acute myocardial infarction

El diagnóstico de infarto agudo del miocardio mediante biomarcadores incluye ahora la cuantificación de proteínas estructurales del miocardio como la mioglobina (MG), y de enzimas, algunas de ellas selectivas, creatina fosfocinasa en su isoenzima MB (CKMB) y otras no selectivas, como la deshidrogenasa láctica (DHL) y la aspartato aminotransferasa (AST). Se encontró que las dos primeras tienen sensibilidad (71 por ciento-50 por ciento), especifidad 886 por ciento-100 por ciento respectivamente) y valores predictivos de utilidad clínica, en tanto que DHL y AST son inútiles en el concepto actual de diagnóstico temprano