Pre-treatment of the beta3-adrenergic receptor agonist BRL37344 reduces in vivo myocardial ischemia/reperfusion injury by improving AMPK and SIRT1 activity and by suppressing mTOR and p70S6K signaling pathways

Abstract This study aimed to investigate the role and signaling pathways of β3-AR in myocardial ischemia/reperfusion (I/R) injury, which is one of the leading causes of death worldwide. 47 male rats were randomly divided into two main groups to evaluate infarct size and molecular parameters. Rats in both groups were randomly divided into 4 groups. Control (sham), I/R (30 min ischemia/120 min reperfusion), BRL37344 (BRL) (A) (5 µg/kg single-dose pre-treatment (preT) before I/R) and BRL (B) (5 µg/kg/day preT for 10 days before I/R). Infarct size was determined with triphenyltetrazolium chloride staining and analyzed with ImageJ program. The levels of AMPK, SIRT1, mTOR, and p70SK6 responsible for cellular energy and autophagy were evaluated by western blot. Infarct size increased in the I/R group (44.84 ± 1.47%) and reduced in the single-dose and 10-day BRL-treated groups (32.22 ± 1.57%, 29.65 ± 0.55%; respectively). AMPK and SIRT1 levels were decreased by I/R but improved in the treatment groups. While mTOR and p70S6K levels increased in the I/R group, they decreased with BRL preT. BRL preT protects the heart against I/R injury. These beneficial effects are mediated in part by activation of AMPK and SIRT1, inhibition of mTOR and p70S6K, and consequently protected autophagy.

Qi-Tai-Suan, an oleanolic acid derivative, ameliorates ischemic heart failure via suppression of cardiac apoptosis, inflammation and fibrosis / 中国天然药物

Although anti-thrombotic therapy has been successful for prevention of deaths from acute myocardial infarction (MI), by far, there are few preventive and therapeutic options for ischemic heart failure (IHF) after MI. Qi-Tai-Suan (QTS) is an oleanolic acid (OA) derivative which once underwent a clinical trial for treating hepatitis. In this study, we investigated the potential cardioprotective effect of QTS on IHF. IHF mouse model was constructed by coronary artery ligation in male C57BL/6J mice, and the protective effects of QTS on IHF were examined by echocardiography measurement, histological and TUNEL analysis, etc. We found that QTS exhibited promising cardioprotective effect on IHF. QTS treatment significantly improved cardiac function of IHF mice and the symptoms of heart failure. Notably, QTS had much better oral bioavailability (F = 41.91%) in mice than its parent drug OA, and took effects mainly as its original form. Mechanistically, QTS ameliorated ischemic heart failure likely through suppression of cardiac apoptosis, inflammation and fibrosis. Taken together, QTS holds great promise as a preventive and therapeutic agent for ischemic heart failure and related diseases.

A case of intramural coronary amyloidosis associated with hemodialysis

Dialysis-related amyloidosis predominantly occurs in osteo-articular structures and dialysis-related amyloid (DRA) substances also deposit in extra-articular tissues. Clinical manifestations of DRA include odynophagia, gastrointestinal hemorrhage, intestinal obstruction, kidney stones, myocardial dysfunction, and subcutaneous tumors. The pathological characteristics of DRA in the heart of hemodialysis patients have rarely been reported. We report the case of a 73-year-old female with a history of cerebral palsy and end-stage renal disease status post two failed renal transplants who had been on hemodialysis for 30 years. The patient was admitted with the working diagnosis of pneumonia. An echocardiography showed markedly reduced biventricular function manifested by low blood pressure with systolic in the 70s and elevated pulmonary artery pressure of 45 mmHg, which did not respond to therapy. Following her demise, the autopsy revealed bilateral pulmonary edema and pleural effusions. There was cardiac amyloid deposition exclusively in the coronary arteries but not in the perimyocytic interstitium. Amyloids were also found in pulmonary and intrarenal arteries and the colon wall. Previous case reports showed that beta 2-microglobulin amyloid deposits in various visceral organs but less frequently in the atrial and/or the ventricular myocardium. In the present case, amyloids in the heart were present in the intramural coronary arteries causing myocardial ischemia and infarction, which was the immediate cause of death.

Expression of FAPalpha and TGF-beta1 in sudden deaths due to acute myocardial ischemia / 法医学杂志

OBJECTIVE@#To explore the expression of fibroblast activation protein alpha (FAPalpha) and transforming growth factor-beta1 (TGF-beta1) in myocardial cytoplasm for the cases of sudden death due to acute myocardial ischemia.@*METHODS@#The heart tissues of 47 cases were collected. All cases were divided into three groups: control group, acute myocardial infarction group and recurrent myocardial infarction group. FAPalpha and TGF-beta1 expressions were explored in myocardial cytoplasm by immunohistochemistry technology. The staining results were collected by image analysis system and then the positive area ratio and average optical density were detected. The positive signal differences were compared among the groups.@*RESULTS@#Strong FAPalpha and TGF-beta1 expressions were detected in myocardial cytoplasm in both acute and recurrent myocardial infarction groups. The expression of FAPalpha was not detected in myocardial cytoplasm in control group and TGF-beta1 expression showed a weak positive result. FAPalpha and TGF-beta1 expressions showed the statistical difference (P < 0.05) in myocardial infarction (acute and recurrent) groups and control group.@*CONCLUSION@#FAPalpha and TGF-beta1 can be the diagnostic markers for determing acute myocardial infarction.

Time-dependent expression of vascular endothelial growth factor after acute myocardial ischemia in rats / 法医学杂志

OBJECTIVE@#To investigate the immunohistochemical distributions and expressions of vascular endothelial growth factor (VEGF) in the model of rat myocardial ischemia.@*METHODS@#The model of myocardial ischemia was established by ligating the left anterior descending (LAD) coronary artery of rats. The changes of VEGF expression were detected by immunohistochemistry and Western blot at time points after myocardial ischemia. The electrocardiographic changes were evaluated uninterruptedly.@*RESULTS@#The expression of VEGF was not be found in control group. Fifteen minutes after LAD ligation, weak positive expression of VEGF were found in the ischemic myocardium. The expression of VEGF reached the peak at 3 hours after ligation. The VEGF distribution was mainly localized in the ischemic and peri-ischemic regions. Six hours after LAD ligation, the expression of VEGF decreased comparing with 3 hours and showed a relatively higher level. Fatal arrhythmia was found in nine rats by the electrocardiograph.@*CONCLUSION@#The immunohistochemical staining of VEGF could be helpful for investigating the location and severity of acute myocardial ischemia. Fatal arrhythmia may be secondary to myocardial ischemia.

Effect and mechanism of intermedin in acute rat cardiac ischemic injury / 法医学杂志

OBJECTIVE@#To investigate the effect and potential mechanism of intermedin (IMD) in acute cardiac ischemic injury and to provide a new approach for exploring mechanism of sudden cardiac death.@*METHODS@#Seventy-two healthy male rats were randomly divided into 3 groups: control, ischemic and the IMD-treated group. The activity of lactate dehydrogenase (LDH), malondialdehyde (MDA) and superoxide dismutase (SOD) in heart blood were tested by enzyme chemistry method. The mRNA changes of calcitonin receptor-like receptor (CRLR) and receptor activity-modifying proteins (RAMPs) in cardiac were measured by real-time PCR analysis. Myocardial cyclic adenosine monophosphate (cAMP) content was determined by enzyme linked immunosorbent assay (ELISA). Apoptosis related factors Bcl-2 and Bax were detected by immunohistochemistry.@*RESULTS@#Comparing with the control group, LDH and MDA activity of ischemic group in heart blood increased and SOD activity decreased. The concentration of cAMP increased in ventricular muscle, Bcl-2 and Bax proteins expression ratio level decreased. The intravenation of IMD decreased the level of increased activity of LDH and MDA, and lessened the level of decreased activity of SOD. The mRNA expression of CRLR and RAMPs obviously increased in ventricular muscle.@*CONCLUSION@#The protective effect of IMD against myocardial ischemic injury could be caused by decreasing the oxidative stress of ischemia and inhibiting the myocardial apoptosis.

Aneurisma gigante de tronco coronario izquierdo en un atleta de 26 años de edad: reporte de caso y revisión de la literatura / Giant left main coronary artery aneurysm in 26-year-old athlete: case report and review

El desarrollo de aneurismas en el tronco coronario izquierdo es una patología rara con una incidencia de 0,1% y cuya etiología puede ser congénita o adquirida. La importancia clínica de los aneurismas coronarios estriba en el riesgo de ruptura coronaria espontánea y de infarto de miocardio por trombosis, embolismo o espasmo. Este reporte describe el caso de un paciente de 26 años de edad, estudiante de licenciatura en educación física, con un aneurisma gigante sacular del tronco coronario izquierdo asociado con estenosis suboclusiva posaneurismática que condicionó la presencia de manifestaciones de isquemia miocárdica de alto riesgo. Presentamos la imaginología y una revisión sobre la etiología, los aspectos clínicos, diagnósticos y terapéuticos de los aneurismas del tronco coronario izquierdo.

The development of the left main coronary artery aneurysms is a rare pathologic process with an incidence of 0.1% and whose etiology can be either congenital or acquired. The clinical importance of the aneurysms of the left main coronary artery is based in the potential risk of spontaneous dissection and rupture and myocardial infarction for thrombosis, embolism or spasm. We report the case of a 26-year-old athlete with agiant aneurysm of the left main coronary artery associated with suboclusive stenosis and clinical manifestations of myocardiali schemia. We present the imagenological characteristics and bibliographic review about the clinical, diagnostic and therapeutic aspects of the left main coronary artery aneurysm.

Inflamação sistêmica causada pela periodontite crônica em pacientes vítimas de ataque cardíaco isquêmico agudo / Systemic inflammation caused by chronic periodontite in patients victims of acute ischemic heart attack

OBJETIVO: Processos inflamatórios e infecciosos mediados por bactérias em sítios distantes têm sido descritos como fator de risco à doença coronariana isquêmica aguda (DCIA). MÉTODOS: Cento e oitenta e um pacientes com DCIA, com e sem periodontites crônicas, foram incluídos neste estudo. Os pacientes foram admitidos no HC da UNICAMP e estratificados em três grupos: grupo 1 - pacientes com periodontite crônica grave (31 homens e 19 mulheres; média de idade 55,1 ± 11,29 anos); grupo 2 - pacientes com periodontite crônica leve (40 homens e 28 mulheres; média de idade 54,8 ± 10,37 anos); grupo 3 - pacientes desdentados (43 homens e 20 mulheres; média de idade 67,5 ± 8,55 anos). Amostras sanguíneas foram coletadas para mensurar os perfis lipídico, hematológico e glicêmico. Além disso, biópsias de 17 artérias coronárias com aterosclerose e igual número de artérias mamárias internas sem degeneração aterosclerótica no grupo 1 foram investigadas. Para análise estatística utilizou-se a análise de variância (ANOVA) e o teste de Scheffé para comparações múltiplas. RESULTADOS: Triglicérides e LDL estavam elevados no grupo 1 em relação ao grupo 2. O HDL apresentou-se reduzido em 20 por cento dos pacientes do grupo 1, e em 8 por cento nos desdentados. A glicemia estava elevada no grupo 1. DNA de bactérias periodontais foram detectados em 58,8 por cento das artérias coronárias. CONCLUSÕES: Pacientes com DCIA e periodontite crônica grave podem apresentar perfil lipídico alterado, como também microorganismos associados com as periodontites crônicas graves podem permear dentro de vasos coronarianos.

OBJECTIVE: Infectious and inflammatory processes mediated by bacteria in distant sites have been described as a risk factor for acute ischemic heart disease (AIHD). METHODS: One hundred one patients with AIHD with and without chronic periodontitis (CP) were included in this study. Patients were admitted to the HC UNICAMP and stratified into three groups: in group 1, we selected patients with severe chronic periodontitis (31 men and 19 women, mean age 55.1 ± 11.29 years old); the group 2 with mild chronic periodontitis (40 men and 28 women, mean age 54.8 ± 10.37 years old) and group 3 represented by the toothless (43 men and 20 women, mean age 67.5 ± 8.55 years old). Blood samples were collected to measure the lipid profiles, hematological and blood glucose levels. In addition, biopsies of seventeen coronary arteries with atherosclerosis and an equal number of internal mammary arteries without atherosclerotic degeneration in group 1 were investigated. Statistical analysis by analysis of variance (ANOVA) and Scheffé test for multiple comparisons was performed. RESULTS: Triglyceride and LDL levels were elevated in group 1 than in group 2. HDL were reduced by 20 percent in group 1 and remained reduced by 8 percent in toothless. Blood glucose was higher in group 1. DNA of periodontal bacteria was detected in 58.8 percent of the coronary arteries. CONCLUSIONS: Patients with (AIHD) and severe chronic periodontitis may have altered lipid profile, as well as microorganisms associated with CP can permeate into coronary vessels.

Cardiovascular consequences of obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is a form of sleep disordered breathing with a high prevalence rate and is often underdiagnosed. OSA is associated with hypertension, coronary artery disease, stroke, peripheral vascular disease, heart failure, and arrhythmias. The presence of OSA may be a strong predictor of fatal cardiovascular events in patients with cardiovascular disease (CVD). Increased sympathetic drive, activation of metabolic and inflammatory markers, and impaired vascular function are some of the proposed mechanisms that could explain the association between OSA and cardiovascular diseases. Understanding these mechanisms is important for identifying treatment strategies. The presence of OSA should be considered in clinical practice, especially in patients with CVD. Randomized intervention studies are needed to establish whether early identification and treatment of OSA patients reduces cardiovascular morbidity.

Polyphenol (-)-Epigallocatechin Gallate during Ischemia Limits Infarct Size Via Mitochondrial K(ATP) Channel Activation in Isolated Rat Hearts

Polyphenol (-)-epigallocatechin gallate (EGCG), the most abundant catechin of green tea, appears to attenuate myocardial ischemia/reperfusion injury. We investigated the involvement of ATP-sensitive potassium (K(ATP)) channels in EGCG-induced cardioprotection. Isolated rat hearts were subjected to 30 min of regional ischemia and 2 hr of reperfusion. EGCG was perfused for 40 min, from 10 min before to the end of index ischemia. A nonselective K(ATP) channel blocker glibenclamide (GLI) and a selective mitochondrial K(ATP) (mK(ATP)) channel blocker 5-hydroxydecanoate (HD) were perfused in EGCG-treated hearts. There were no differences in coronary flow and cardiodynamics including heart rate, left ventricular developed pressure, rate-pressure product, +dP/dt(max), and -dP/dt(min) throughout the experiments among groups. EGCG-treatment significantly reduced myocardial infarction (14.5+/-2.5% in EGCG 1 micrometer and 4.0+/-1.7% in EGCG 10 micrometer, P<0.001 vs. control 27.2+/-1.4%). This anti-infarct effect was totally abrogated by 10 micrometer GLI (24.6+/-1.5%, P<0.001 vs. EGCG). Similarly, 100 micrometer HD also aborted the anti-infarct effect of EGCG (24.1+/-1.2%, P<0.001 vs. EGCG ). These data support a role for the K(ATP) channels in EGCG-induced cardioprotection. The mK(ATP) channels play a crucial role in the cardioprotection by EGCG.

Prevalencia de factores de riesgo de aterosclerosis en pacientes diabéticos tipo 2 / Prevalence of risk factors of atherosclerosis in type 2 diabetics patientsof policlínico Dr. Mario Muñoz Monroy

Se realizó un estudio corte transversal a 219 pacientes con diagnóstico de Diabetes Mellitus tipo 2, con el objetivo de identificar la frecuencia de hipertensión arterial, sedentarismo, hipercolesterolemia, hábito de fumar y obesidad, determinar si existe asociación entre la hipertensión y la presencia de gran crisis de aterosclerosis. Para el análisis comparativo se empleó el test de Chi cuadrado. En todos los casos, se trabajó con un nivel de significación de 0,05. Se encontró una frecuencia de 74 por ciento de hipertensos, sedentarismo 69.8 por ciento, hipercolesterolemia 29.7 por ciento, hábito de fumar 29.2 por ciento y la obesidad 26.9 por ciento. Las combinaciones de factores de riesgo más frecuentes: hipertensión_hipercolesterolemia (37.7 por ciento) y hipertensión-obesidad (30.2 por ciento); la asociación de la hipertensión arterial con la cardiopatía isquémica fue estadísticamente significativa (p =0.000), como para la enfermedad cerebrovascular (p = 0.005). Se concluye que existe una alta prevalencia de factores de riesgo para la aterosclerosis, la hipertensión arterial es el factor de riesgo más frecuente. Las consecuencias de la aterosclerosis se asociaron fuertemente a la hipertensión arterial.

A transversal study was carried out in 219 patients with diagnosis of Type 2 Diabetes Mellitus with the purpose of identifying the frequency of hypertension, sedentary habits, hypercholesterolemia, smoking habit and obesity; to determine if there is an association between hypertension and great atherosclerosis crisis. For the comparative analysis the Chi square test was utilized. In all cases the significance levels were of the 0, 05. There was a frequency of 74percent of hypertensive patients, sedentary habit in the 69, 8 percent, hypercholesterolemia in 29, 7 percent and obesity in 26, 9 percent. The most frequent combination of risk factors were hypertension -hypercholesterolemia (37, 7 percent) and hypertension _obesity (30, 2 percent); the association of arterial hypertension with Ischemic cardiopathy was relevant (p= 0,000), as it was for the cerebrovascular disease (p=0,005). It was concluded that a high prevalence of risk factors of atherosclerosis exists; arterial hypertension is the most frequent risk factor. The consequences of atherosclerosis were strongly associated with arterial hypertension.

Correlação do colágeno intersticial miocárdico do septo do ventrículo direito com a função ventricular em pacientes com cardiomiopatia isquêmica / Correlación del colágeno intersticial miocárdico del septo del ventrículo derecho con la función ventricular en pacientes con cardiomiopatía isquémica / Correlation of myocardial interstitial collagen in the right ventricular septum with ventricular function of patients with ischemic cardiomyopathy

FUNDAMENTO: O conteúdo de colágeno intersticial (CI) no miocárdio exerce influência no relaxamento e na contração ventricular. A sua relação com a função ventricular em pacientes (pcts) com cardiomiopatia isquêmica (CMPI) não está plenamente estudada em humanos. OBJETIVO: Avaliar a relação da quantidade de CI nas áreas não-infartadas no septo do ventrículo direito com a função ventricular na CMPI. MÉTODOS: 31pcts com doença arterial coronariana foram classificados em quatro grupos: Grupo C (Controle): 7pcts com as frações de ejeção dos ventrículos esquerdo (FEVE) e direito (FEVD) normais; Grupo 1: 5 pcts com FEVD < 40 por cento;Grupo 2: 9 pcts com FEVE < 40 por cento; Grupo 3: 10 pcts com disfunção de ambos os ventrículos. A FEVD e a FEVE foram calculadas por meio da angiocardiografia radionuclídica. As amostras para análise do por centoCI foram obtidas por meio de biópsia endomiocárdica do ventrículo direito e coradas pela técnica do picrosirius red. RESULTADOS: A média do por centoCI foi significativamente maior no grupo 3 quando comparada com o grupo-c e com os grupos 1 e 2 (30,2 ± 7,9 por cento vs. 6,8 ± 3,3 por cento vs. 15,8 ± 4,1 por cento vs. 17,5 ± 7,7 por cento, respectivamente; p = 0,0001). O por centoCI foi também significativamente maior nos pacientes do grupo 2 quando comparado com o controle(17,5 ± 7,7 por cento vs. 6,8 ± 3,3 por cento, p = 0.0001). O por centoCI apresentou correlação inversa com a FEVD (r = -0,50, p = 0.003) e FEVE (r = -0,70, p = 0,0001). CONCLUSÃO: Na CMPI, o por centoCI encontra-se elevado nas áreas não-infartadas no septo do ventrículo direito e apresenta correlação inversa com o a função ventricular direita e esquerda.

BACKGROUND: Myocardial collagen content influences ventricular relaxation, contraction, and morphology. Its relationship with ventricular function in patients (Pts) with ischemic cardiomyopathy (ICMP) has not yet been fully studied in humans. OBJECTIVE: To assess the relationship between interstitial collagen content in non-infarcted areas of the right ventricular septum and ventricular function in ICMP. METHODS: 31 pts with coronary artery disease were divided into four groups as follows:The control group consisted of 7 pts with normal left (LVEF) and right (RVEF) ventricular ejection fraction (group C); Group 1: 5 patients with RVEF < 40 percent; Group 2: 9 pts with LVEF < 40 percent; and Group 3, 10 pts with biventricular dysfunction. RVEF and LVEF were measured by radionuclide angiography. For quantitative analysis of interstitial collagen volume fraction (CVF), endomyocardial biopsy specimens were taken from the right ventricle and stained with picrosirius red. RESULTS: Mean CVF was significantly higher in group 3, compared with the control group and with groups 1 and 2 (30.2 ± 7.9 percent vs. 6.8 ± 3.3 percent vs. 15.8 ± 4.1 percent vs. 17.5±7.7 percent, respectively; p =0.0001). It was also significantly higher in patients belonging to group 2, compared with those in the control group (17.5 ± 7.7 percent vs. 6.8 ± 3.3 percent, p =0.0001). CVF was inversely correlated with RVEF (r = - 0.50, p = 0.003) and LVEF (r = -0.70, p = 0.0001). CONCLUSION: In ICMP, CVF is elevated in non-infarcted areas of the right ventricular septum and inversely correlated with right and left ventricular function.

FUNDAMENTO: El contenido de colágeno intersticial (CI) en el miocardio ejerce influencia en la relajación y en la contracción ventricular. Su relación con la función ventricular en pacientes (pcts) con cardiomiopatía isquémica (CMPI) no está plenamente estudiada en humanos. OBJETIVO: Evaluar la relación de la cantidad de CI en las áreas no infartadas en el septo del ventrículo derecho con la función ventricular en la CMPI. MÉTODOS: Se clasificaron a 31 pcts con enfermedad arterial coronaria en cuatro grupos: Grupo C (Control): 7 pcts con fracción de eyección de los ventrículos izquierdo (FEVI) y derecho (FEVD) normales; Grupo 1:5 pcts con FEVD < 40 por ciento; Grupo 2:9 pcts con FEVI < 40 por ciento; Grupo 3:10 pcts con disfunción de ambos los ventrículos. La FEVD y la FEVI se calcularon por medio de la angiocardiografía con radionúclidos. Las muestras para análisis del porcentaje de colágeno intersticial ( por cientoCI) se obtuvieron mediante biopsia endomiocárdica del ventrículo derecho y se colorearon con la técnica del picrosirius red. RESULTADOS: El promedio del por cientoCI fue significativamente mayor en el grupo 3 cuando comparado al grupo-c y a los grupos 1 y 2 (30,2 ± 7,9 por ciento vs. 6,8 ± 3,3 por ciento vs. 15,8 ± 4,1 por ciento vs. 17,5 ± 7,7 por ciento, respectivamente; p = 0,0001). El por cientoCI fue asimismo significativamente mayor en los pacientes del grupo 2 cuando comparado al control (17,5 ± 7,7 por ciento vs. 6,8 ± 3,3 por ciento, p = 0.0001). El por cientoCI presentó correlación inversa con la FEVD (r = -0,50, p = 0.003) y la FEVI (r = -0,70, p = 0,0001). CONCLUSIÓN: En la CMPI, el por cientoCI se encuentra elevado en las áreas no infartadas en el septo del ventrículo derecho y presenta correlación inversa con la función ventricular derecha e izquierda.

Diagnostic significance of tissue doppler imaging in patients with acute inferior myocardial infarction and precordial ST segment depression

To evaluate patients presenting with acute inferior myocardial infarction [IMI] and ST segment depression in the chest leads and to identify patients with anterior ischemia from those with reciprocal ECG changes using Tissue Doppler Imaging [TDI] derived variables. Cohort observational study. Department of Medicine, Sabah and Farwania Hospitals, Kuwait. One hundred and fifty patients with acute ST segment elevation IMI, stratified into: Group 1:105 patients with acute IMI and precordial ST segment depression and Group II: 45 patients with acute IMI without precordial ST segment depression. Transthoracic echocardiography with TDI and coronary angiography. Predictive indices revealed that impaired Systolic velocity [Sm] is a predictor for coronary artery stenosis in the non-infarcted region. Sensitivity was 86%, specificity 80%, accuracy 84%, positive predictive value 88% and negative predictive value 77%. Multivariate logistic analysis revealed that the site and persistence of ST-segment depression, ST-depression > 2 mm, coronary collaterals, left circumflex coronary artery dominance and 0.2 SWM score index increment are significantly associated with impaired Sm velocity of TDI corresponding to anterior non-infarct region, [p < 0.05]. Receiver operating characteristic [ROC] curve data revealed that the best cutoff value of Sm was 7.1 cm/sec with sensitivity 86%, false positive 17%, positive likelihood ratio 4.78 and negative likelihood ratio 0.160 for prediction of likelihood of multivessel coronary artery disease. TDI can be used to identify patients with likelihood of significant coronary artery disease in the non-infarcted region after acute IMI

The application of biochemical indexes detecting in sudden cardiac death in forensic autopsy / 法医学杂志

Sudden cardiac death(SCD) from early myocardial ischemia is often lack of typically morphological findings and clinical manifestation, thus cases of SCD may be suspected as criminal cases. It is necessary to clarify the cause of death, which is significance for medico-legal investigation. This article reviewed the latest advancement in the studies on the application of inorganic ions, CK-MB, cTn, ANP and BNP for certification of death from SCD in order to provide a practical way for diagnosis of SCD in forensic pathology.

Cardiodefibrilador automático implantable: incidencia, causas y predictors de mortalidad. Valor de los registros prospectivos / Implantable automatic cardiodefibrillator: incidence causes and predictors of mortality. Value of the prospective records

The implantable automatic cardiodefibrilator (IACD) has proved to be an effective tool in the prevention of both primary and secondary sudden death. Even so, the mortality of patients receiving an IACD still remains elevated. Recent data, obtained from the secondary analysis of different studies, suggest that the discharges of the deice, between other clinical variables, both electrocardiiographic and ultrasonographic could be associated to a higher mortality, maybe due to a contribution to the progression of the cardiac insufficiency. The aims of this report were to evaluate the incidence of mortality, causes of death and the time since the implantation till the death, to analyze appropriate an inappropriate shocks and other variaables as potential predictors of mortality in patients with IACD. The results obtained in this study are detailed in the article

Electrocardiograma de alta resolución / Electrocardiogram of high resolution

El electrocardiograma de alta resolución es una técnica valiosa para estudiar la patología cardiovascular y determinar su influencia en los factores de riesgo. Trata de registrar aquellos potenciales alterados que son de conducción lenta y muy bajo voltaje, denominados micropotenciales, requiriendo cierto sustrato anatómico para fijar ciertos circuitos relacionados con taquicardia ventricular. Para estudiar y separar los diferentes componentes de las señales de un electrocardiograma de alta resolución se utilizan diferentes técnicas matemáticas: señales promediadas, transformada de Fourier, transformada de Gabor, transformada de ondícula, mapeo espectro-temporal. Es importante recalcar que esta técnica de estudio de los micropotenciales en pacientes pos-infarto, por ejemplo, tiene un valor predictivo negativo cercano al 90 por ciento y el valor predictivo positivo es cercano al 20 por ciento, por lo que se recomienda su estudio en combinación con fracción de eyección, Holter de arritmia. Con la presente revisión se establecen conceptos y su utilidad en la práctica clínica: cardiopatía isquémica, displasia arritmogénica del ventrículo derecho, síndrome de Brugada, miocardiopatía dilatada, prolapso mitral, enfermedad de Chagas, fibrilación auricular, hipertensión arterial, obesidad, síndrome de QT congénito y Wolf Parkinson White.

The electrocardiogram of high resolution is a technique valuable to study the cardiovascular pathology and to determine its influence in the risk factors. It tries to register those altered potentials that are of slow conduction and very under voltage, determinated micropotential, requiring certain anatomical substrate no fix certain circuits related to ventricular tachycardia. In order to study and to separate the different components from the signals of an electrocardiogram of high resolution different mathematical techniques are used: signal averaged, transformed of Fourier, transformed of Gabor, transformed of wavelet, spectral-temporary map. It is important to stress that techniques of study of the micropotential in patients post-infarct, for example, has a negative predictive value near 90% and the positive predictive value is near 20%, reason why in combination with fraction of ejection. Holter of arrhythmia is recommended. With the present revision concepts and their actually clinical utility settle down: isquemic cardiopathy, displasya arrhythmogenic of the right ventricle, syndrome of Brugada, dilated miocardiopathy, mitral prolanse, disease of Chagas, auricular fibrilation, arterial hyspertension, obesity, congenital QT syndrome and Wolf Parkinson White syndrome.

Caracterização tecidual ultra-sônica em síndromes coronarianas agudas / Ultrasonic tissue characterization in acute coronary syndromes

FUNDAMENTO: A caracterização tecidual ultra-sônica (CTU), avaliada pelo integrated backscatter, tem o potencial de detectar precocemente alterações estruturais no tecido miocárdico. Nas síndromes coronarianas agudas (SCA) esta técnica tem atraído atenção pelo potencial de detectar viabilidade miocárdica. OBJETIVO: Analisar o potencial da CTU em detectar alterações precoces na sala de urgência. MÉTODOS: Foram estudados 28 indivíduos, divididos em três grupos: grupo I (13; 52,2±15,5 anos) composto por pacientes encaminhados para a sala de urgência com suspeita clínica de SCA, que foi descartada na evolução; grupo II (9; 54,2±10 anos) com infarto agudo de coronária direita e grupo III (6; 62,1±9,1 anos) com infarto agudo de ramo descendente anterior da coronária esquerda. Para cada indivíduo incluído no estudo, foram avaliados quatro segmentos no eixo curto no plano dos músculos papilares (1 - anterior médio; 2 - ântero-lateral médio; 3 - inferior médio e 4 - septal médio), obtendo-se o coeficiente corrigido, a amplitude de variação do IBS, o índice de retardo da variação e o padrão da variação. RESULTADOS: As alterações decorrentes do processo isquêmico em sua fase inicial não foram detectadas pelo coeficiente corrigido ou pela alteração da amplitude de variação do IBS. Os parâmetros de sincronicidade (índice de retardo e padrão de variação), no entanto, por serem mais sensíveis, foram parcialmente capazes em regiões de infartos mais extensos. CONCLUSÃO: Maiores estudos sobre o comportamento destes índices na fase aguda das SIMI são necessários.

BACKGROUND: Ultrasonic tissue characterization (UTC), as evaluated through integrated backscatter, has the potential to detect precocious structural damage to myocardial tissue. In acute coronary syndromes (ACS) this technique is attracting attention due to its potential to evaluate myocardial viability. OBJECTIVE: To evaluate the role of UTC in the emergency department. METHODS: We studied 28 individuals, classified in three groups: Group I (13; 52.2±15.5 years) with patients admitted with chest pain who have negative evaluation for acute coronary syndrome; Group II (9; 54.2±10.0 years) with acute myocardial infarction in right coronary artery territory; and Group III (6; 62.1±9.1 years) with acute myocardial infarction in the anterior descendent branch territory. For each individual, we analyzed four segments in the short axis view at the papillary muscle level (1 - anterior; 2 - anterior-lateral; 3 - inferior e 4 - septal), for the following parameters: corrected coefficient, amplitude, delay index and IBS pattern. RESULTS: The acute myocardial isquemic process in its initial phase was not detected by the corrected coefficient or by the IBS amplitude. The sincronicity parameters (delay index and IBS pattern), more sensible, were partially able to identify changes in more extension regions of myocardial infarction. CONCLUSION: More studies should be conducted to evaluate these parameters in the early phase of acute coronary syndromes.