ABSTRACT
OBJECTIVE: Cardiac involvement in SSc is characterized by myocardial fibrosis, arrhythmias and pericarditis. Prevalence studies have shown variable results. The objective of this study was to determine the prevalence of cardiac involvement in SSc patients using the non-invasive, highly sensitive diagnostic methods of cardiac MRI and coronary angiotomography. METHODS: We included 62 SSc patients and excluded those with heart disease prior to the onset of SSc, renal failure, diabetes mellitus, hyperlipidaemia, arterial hypertension, untreated thyroid disease, cor pulmonale, pregnancy or contraindications to performing cardiac MRI. All underwent clinical and laboratory evaluation, ECG, coronary angiotomography and cardiac MRI. RESULTS: The prevalence of myocardial fibrosis was 45% and was higher in dcSSc (59%) than in lcSSc patients (33%; P = 0.04). The mean left ventricular ejection fraction (LVEF) was lower in patients with myocardial fibrosis (56%) than in those without fibrosis (63%; P = 0.0009); myocardial fibrosis on MRI was more frequent in the basal-septal segments of the LV. Seventy-nine per cent of patients had subendocardial perfusion defects and these were associated with higher ultrasensitive serum CRP values. There was no association of myocardial fibrosis or microvascular damage with atherosclerosis. CONCLUSION: The prevalence of myocardial fibrosis on MRI attributable to SSc is 45%, is more frequent and severe in dcSSc patients, is associated with lower LVEF and affects mainly basal LV walls. Microvascular damage in SSc is common and is associated with elevated ultrasensitive CRP levels. Cardiac damage due to SSc is not associated with coronary artery disease.
Subject(s)
Coronary Artery Disease/diagnosis , Microvessels/pathology , Myocardium/pathology , Scleroderma, Diffuse/diagnosis , Scleroderma, Limited/diagnosis , Adult , Cardiac Imaging Techniques , Coronary Angiography , Coronary Artery Disease/etiology , Coronary Artery Disease/physiopathology , Cross-Sectional Studies , Electrocardiography , Female , Fibrosis , Heart Diseases/diagnosis , Heart Diseases/etiology , Heart Diseases/physiopathology , Humans , Magnetic Resonance Imaging , Male , Microvessels/diagnostic imaging , Middle Aged , Myocardial Perfusion Imaging , Scleroderma, Diffuse/complications , Scleroderma, Limited/complications , Scleroderma, Systemic/complications , Scleroderma, Systemic/diagnosis , Stroke Volume , Tomography, X-Ray ComputedABSTRACT
Pulmonary arterial hypertension (PAH) is a rare disease. It is characterized by the progressive remodeling of the small pulmonary arteries that lead to an elevation of the pulmonary vascular resistance and right ventricular dysfunction. Early diagnosis and prompt treatment avoid the deterioration of the patient's quality of life. Statistics show that there are 15 cases per million people worldwide, the majority comprised of young women, with an age at diagnosis of 30 to 40 years. At present, the exact processes that initiate the pathophysiologic changes observed in PAH are unknown; it is thought to be multifactorial. Diagnosis in PAH must be done in a step by step manner. Under the suspicion of pulmonary hypertension (PH), the first thing to do is confirm the diagnosis. The second step is to identify the specific etiology and lastly evaluate the severity by echocardiography, hemodynamic parameters, biomarkers and exercise capacity. PH treatment, particularly PAH, has evolved over the last 2 decades due to the advance in disease knowledge and the availability of agents that act on different pathways. Concerning surgical treatment, it is indicated in PAH when there is not an adequate response to medical treatment. In conclusion, PAH is recognized worldwide as a rare or infrequent disease. The countries that have a registry for the diagnostics, treatment, follow-up and prevalence of PH are mainly in Europe. With the exception of the United States and Canada, there are no registries in America. Recent years have shown an important advance in Latin America.
Subject(s)
Hypertension, Pulmonary , Algorithms , Combined Modality Therapy , Endothelin Receptor Antagonists , Familial Primary Pulmonary Hypertension , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/therapy , Phosphodiesterase 5 Inhibitors/therapeutic use , Prostaglandins/therapeutic useABSTRACT
Liver cirrhosis is a complex and progressive disease associated with high mortality. In developing countries, alcoholic liver disease is the most common form of liver cirrhosis, followed by chronic viral disease, especially hepatitis C virus infection. Cirrhosis is associated with systemic and splanchnic hemodynamic abnormalities, including increased vascular volume, decreased systemic vascular resistance, and increased cardiac output. At the splanchnic vascular bed, increases in portal flow and intrahepatic resistance have been described, inducing portal hypertension. Pulmonary arterial hypertension is a progressive disease of pulmonary circulation, without left ventricle and valvular heart disease; it is closely related with structural changes in pulmonary arteries. Idiopathic pulmonary arterial hypertension is related to abnormalities in cellular signals, inducing arterial hypertrophy and increased vascular tone. Porto-pulmonary hypertension includes simultaneous portal and pulmonary arterial hypertension. To confirm disease, it is important to exclude concomitant heart disease. Porto-pulmonary hypertension requires important components: portal hypertension, shear vascular stress, and cellular activation with pulmonary arterial hypertrophy. In this short manuscript, the epidemiology, patho-physiology, and diagnostic criteria of the disease are reviewed to optimize early diagnosis and treatment.
Subject(s)
Hypertension, Pulmonary/etiology , Liver Cirrhosis/complications , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/physiopathology , PrognosisABSTRACT
Pulmonary embolism (PE) is an important disease entity in clinical medicine. It consists of obstruction of pulmonary arterial blood flow of a clot embolism from distant sites of the vasculature. Its incidence is variable depending on the source analyzed and most existing data is in hospitalized patients. The clinical presentation is a broad spectrum, from asymptomatic to cardiogenic shock with sudden death due to acute right heart failure. Recently it has been used to D-dimer as a useful laboratory test and a large negative predictive value in the diagnosis of PE. The current classification schemes recommended guided in clinical, laboratory and image. Chest angiotomography is currently the most commonly used diagnostic method for confirmation of pulmonary embolism, but the standard remains arteriography.
Subject(s)
Pulmonary Embolism/diagnosis , Algorithms , Humans , Tomography, X-Ray ComputedABSTRACT
La tromboembolia pulmonar (TEP) es una entidad patológica de importancia en la medicina clínica. Consiste en la obstrucción del flujo sanguíneo arterial pulmonar por embolismo de un coágulo desde sitios distantes de la vasculatura. Su incidencia es variable dependiendo de la fuente analizada, la mayoría de los datos existentes son de pacientes hospitalizados. La presentación clínica tiene un espectro amplio, desde asintomática hasta el choque cardiogénico con muerte súbita debido a falla ventricular derecha aguda. En forma reciente se ha empleado al dímero D como un ensayo de laboratorio útil y con un gran valor predictivo negativo en el diagnóstico de TEP. Los esquemas de clasificación actuales recomiendan guiarse en parámetros clínicos, de laboratorio e imagen. La angiotomografía de tórax actualmente es el método diagnóstico más empleado para la confirmación de TEP, sin embargo, el estándar sigue siendo la arteriografía.
Pulmonary embolism (PE) is an important disease entity in clinical medicine. It consists of obstruction of pulmonary arterial blood flow of a clot embolism from distant sites of the vasculature. Its incidence is variable depending on the source analyzed and most existing data is in hospitalized patients. The clinical presentation is a broad spectrum, from asymptomatic to cardiogenic shock with sudden death due to acute right heart failure. Recently it has been used to D-dimer as a useful laboratory test and a large negative predictive value in the diagnosis of PE. The current classification schemes recommended guided in clinical, laboratory and image. Chest angiotomography is currently the most commonly used diagnostic method for confirmation of pulmonary embolism, but the standard remains arteriography.
Subject(s)
Humans , Pulmonary Embolism/diagnosis , Algorithms , Tomography, X-Ray ComputedABSTRACT
Over the last few years, the use of exercise tests has come to be recognized as a convenient method of evaluating respiratory function, because the reserves of the various systems in the human body should be known in order to provide a more complete portrayal of the functional capacities of the patient. Because walking is one of the main activities of daily living, walk tests have been proposed in order to measure the state or the functional capacity of patients. The six-minute walk test has proven to be reproducible and is well tolerated by patients. It evaluates the distance a person can walk on a flat, rigid surface in six minutes. Its main objective is to determine exercise tolerance and oxygen saturation during submaximal exercise. In this review, we present various clinical areas in which the test can provide useful data.
Subject(s)
Exercise Test/methods , Exercise Tolerance/physiology , Lung Diseases/diagnosis , Pulmonary Heart Disease/diagnosis , Walking/physiology , Humans , Lung Diseases/physiopathology , Pulmonary Heart Disease/physiopathologyABSTRACT
Nos últimos anos, o uso de testes de exercício é reconhecido como um método conveniente na avaliação da função respiratória em função da necessidade de se conhecer as reservas dos vários sistemas corporais a fim de que uma ideia mais completa sobre as capacidades funcionais do paciente seja obtida. Visto que o ato de andar é uma das principais atividades da vida diária, os testes de caminhada têm sido propostos para medir o estado ou a capacidade funcional do paciente. O teste de caminhada de seis minutos provou ser reprodutível e é bem tolerado pelos pacientes. Ele avalia a distância que uma pessoa pode percorrer sobre uma superfície plana e rígida em seis minutos e tem como principal objetivo a determinação da tolerância ao exercício e da saturação de oxigênio durante um exercício submáximo. Nesta revisão, apresentamos várias áreas clínicas nas quais o teste pode fornecer informações úteis.
Over the last few years, the use of exercise tests has come to be recognized as a convenient method of evaluating respiratory function, because the reserves of the various systems in the human body should be known in order to provide a more complete portrayal of the functional capacities of the patient. Because walking is one of the main activities of daily living, walk tests have been proposed in order to measure the state or the functional capacity of patients. The six-minute walk test has proven to be reproducible and is well tolerated by patients. It evaluates the distance a person can walk on a flat, rigid surface in six minutes. Its main objective is to determine exercise tolerance and oxygen saturation during submaximal exercise. In this review, we present various clinical areas in which the test can provide useful data.
Subject(s)
Humans , Exercise Test/methods , Exercise Tolerance/physiology , Lung Diseases/diagnosis , Pulmonary Heart Disease/diagnosis , Walking/physiology , Lung Diseases/physiopathology , Pulmonary Heart Disease/physiopathologySubject(s)
Humans , Male , Adult , Aneurysm , Pulmonary Artery , Hypertension, Pulmonary , Echocardiography, Doppler , Radiography, Thoracic , Tomography, X-Ray ComputedABSTRACT
Objetivo: Caracterizar la situación de las revistas sobre enfermedades respiratorias publicadas en América Latina. Método: Se efectuó una encuesta en una reunión organizada por ALAT (Asociación Latinoamericana de Tórax). Cada editor presentó un informe sobre la revista a su cargo y contestó un cuestionario. Resultados: La principal motivación de las Sociedades de Enfermedades Respiratorias para publicar sus propias revistas es mejorar la adquisición de conocimientos. Las principales motivaciones de los autores para escribir artículos serían difundir el conocimiento médico e informar sobre una experiencia. La deficiencia más frecuente de los manuscritos enviados, es la falta de cumplimiento con las normas de publicación de la revista. El logro de una mejoría en la relación autor-editor-revisor, sería la mejor estrategia para mejorar la calidad de los manuscritos. Entre las sugerencias para mejorar las revistas latino-americanas destacaron: a) profesionalizar el trabajo editorial; b) aumentar la meticulosidad de los revisores de los manuscritos y c) insistir en el cumplimiento de las normas internacionales de edición de revistas médicas. Algunos de los principales problemas informados fueron: a) carencia de periodicidad regular y adecuada en la publicación de cada número de las revistas; b) carencia de manuscritos originales que signifiquen un aporte de real impacto para la especialidad; c) bajo porcentaje de rechazo de manuscritos enviados para su eventual publicación; d) el recambio de editores es elevado y frecuente. Recomendaciones: a) las revistas deberían mantener su formato impreso en papel, aunque estén disponibles en índices electrónicos; b) cada revista debería tener impreso el costo de su suscripción, aunque esté incluido en la cuota anual de membresía de la sociedad; c) no obstante cada país de América Latina pueda decidir publicar su propia revista de enfermedades respiratorias, debe explorarse la factibilidad de generar una revista multinacional...
The situation of respiratory diseases journals published in Latin America was analized by the editors of these journals, convoked by ALAT (Latin American Association of Thoracic Diseases) al Lima, Peru, on February 4th, 2007. Each editor presented a report about his/her journal and answered a survey about to get better manuscripts. Results of the survey improve information acquisition would be the main motivation of national respiratory societies for editing their own journals Disseminate medical knowledge and report an experience, would be the main motivations of authors to submit papers. The most frequent deficiency of manuscripts submitted is bad adherence to journal's requirements. An improvement in the relationship between author-editor-reviewer should be the best strategy to enhance the quality of the manuscripts. Suggestions on how to improve the Latin American journals included: a) professionalize editorial work; b) increase meticulousness of manuscripts reviewers and c) reinforce international norms for editing medical journals. Major problerns reported by editors a) Lack of a regular and adequate periodicity (at least quarterly) in publishing the issues: b) Lack of original papers submitted that mean a "milestone" for the specialty; c) Low percentage of rejection in submitted papers (5 to 39%) indicating an scarce capacity to select excellent papers; d) high and frequent turnover of editors (each two years) which implies a poor accomplishment of editorial regulations and policies. Recommendations a) Although several journals are available in electronic indices, they should be maintained in their printed form, because it is unknown for how long the information could be preserved in an electronic support; b) Each journal should have printed its subscription fee, in spite its subscription is included in the annual society membership fee...
Subject(s)
Bibliometrics , Biomedical Research , Publishing/standards , Pulmonary Medicine , Periodicals as Topic/standards , Editorial Policies , Internet , Latin America , Peer Review , Societies, ScientificABSTRACT
Objetivo: Analizar la situación de las Revistas de Enfermedades Respiratorias publicadas en América latina. Métodos: Un estudio fue conducido en una reunión patrocinada por la sociedad torácica latinoamericana ALAT, en Lima Perú. Cada redactor de diario presentó un informe y contestó a un cuestionario. La motivación principal para que las sociedades médicas respiratorias editen sus propios diarios, es mejorar la adquisición de la información, además la motivación principal para que los autores publiquen sus artículos, es que diseminan el conocimiento médico y divulgan las experiencias de la salud respiratoria. La deficiencia más frecuente de los manuscritos enviados a publicación fueron el incumplimiento de las normas y requerimientos de las revistas. La estrategia más frecuentemente utilizada por los editores para mejorar la calidad de los manuscritos es mejorar las relaciones entre autor-redactor-revisor. Las sugerencias para mejorar los diarios latinoamericanos incluyeron el siguiente: promover profesionalismo en tareas editoriales; revisores del manuscrito que animan a ser más meticulosos; y abrazando las normas internacionales para corregir los diarios médicos. Los problemas principales siguientes fueron divulgados: una carencia de la periodicidad y regularidad, ediciones apropiadas; una escasez de los artículos originales que se consideran los hitos en la especialidad; una tarifa baja del rechazo para los manuscritos evaluados; un alto volumen de ventas de redactores. De acuerdo con nuestros resultados, podemos hacer las recomendaciones siguientes: aunque muchos diarios están disponibles en forma electrónica, deben también ser mantenidos en forma impresa; ...
Objective: To characterize the situation of pulmonology journals published in Latin America. Methods: A survey was conducted in a meeting sponsored by the Latin American Thoracic Society. Each journal editor presented a report and answered a questionnaire. Results: Improving information acquisition is the main motivation for pulmonology societies to edit their own journals, where as disseminating medical knowledge and reporting experiences are the main motivations for authors to submit papers. The most common failing in the manuscripts submitted is poor compliance with the journal guidelines. Improving author-editor-reviewer relationships would be the best strategy for improving the qua lity of manuscripts. Suggestions for improving Latin American journals included the following: promoting professionalism in editorial tasks; encouraging manuscript reviewers to be more meticulous; and embracing international norms for editing medical journals. The following major problems were reported: a lack of regular, appropriate periodicity of issues; a shortage of original papers that are considered 'milestones' in the specialty; a low rejection rate for submitted papers; a high turn over of editors. Conclusion: Based on our findings, we can make the following recommendations: although many journals are available in electronic form, they should also be maintained in print form; each journal should divulge its subscription fee, even if it is included in the annual society membership dues; although each Latin American country might decide to publish its own pulmonology journal, the feasibility of publishing a multinational Latin American pulmonology journal should be explored.
Subject(s)
Pulmonary Medicine , Periodicals as TopicABSTRACT
Objetivo: Caracterizar la situación de las revistas de enfermedades respiratorias publicadas en América Latina. Métodos: El estudio se realizó en una reunión patrocinada por ALAT (Asociación Latinoamericana de tórax). Cada editor presentó un reporte sobre su revista y contestó un cuestionario. Resultados: Mejorar la adquisición de información sería la principal motivación de las sociedades respiratorias para editar sus propias revistas; diseminar el conocimiento médico y reportar sus experiencias sería la principal motivación para los autores al enviar sus escritos. La principal deficiencia de los artículos sometidos es la mala adherencia a los requisitos de publicación. Una mejoría en la relación entre autor, editor, revisor podría ser la mejor estrategia para mejorar la calidad de los artículos. Sugerencias para mejorar las revistas latinoamericanas incluyen: a) Profesionalizar el trabajo editorial, b) Incrementar la meticulosidad de los revisores y c) Reforzar las normas internacionales para la publicación de revistas médicas. Los mayores problemas reportados fueron: a) Falta de periodicidad adecuada en la publicación de la revista. b) Falta de artículos originales lo que significa un hito para la especialidad, c) Bajo porcentaje de rechazo de los artículos sometidos d) cambio frecuente de los editores. Recomendaciones: Aunque muchas revistas estan disponibles en medio electrónico debería conservarse la impresión en físico, b) Cada revista debería tener impreso el costo de la suscripción independiente de que este incluida en el costo anual de la membresía a la sociedad. c) No obstante que cada país latinoamericano puede decidir el publicar su propia revista, la factibilidad de generar una revista Latinoamericana de Enfermedades respiratorias.
Subject(s)
Literature , Periodical , Pulmonary Medicine , Review , Serial Publications , Latin AmericaABSTRACT
Acute vasodilator tests with prostacyclin (PGI2) or inhaled nitric oxide (iNO) are used to select patients with pulmonary arterial hypertension (PAH) who should be treated with oral vasodilators. The haemodynamic effects of PGI2 and iNO are different, and the limits for considering a vasodilator response as significant are controversial. The study was aimed to investigate the diagnostic performance of acute vasodilator testing with iNO and PGI2 in predicting the clinical outcome after 1 year treatment with oral vasodilators. Twenty-seven patients with severe PAH were studied. Nineteen patients were treated with oral vasodilators and their outcome after 1 year was qualified as favourable or unfavourable. The diagnostic performance of vasodilator tests in predicting this outcome was evaluated using receiver operating characteristics (ROC) curves. The acute effects of iNO and PGI2 on pulmonary artery pressure (PAP) were similar. By contrast, PGI2 produced more marked changes on cardiac output and pulmonary vascular resistance than iNO (P<0.05). The evolution at 1 year was favourable in 11 patients and unfavourable in 8. Patients with favourable evolution showed greater decrease of PAP with iNO than with PGI2 (P<0.05). The decrease of PAP with iNO had the greatest predictive value on the clinical outcome (area under ROC curve, 0.83). We conclude that in patients with PAH, acute vasodilator testing with iNO is preferable to PGI2 because it reflects more consistently the changes in pulmonary vascular tone. The acute decrease of PAP with iNO is the best predictor of the long-term response to oral vasodilator treatment.
Subject(s)
Antihypertensive Agents , Epoprostenol , Nitric Oxide , Vasodilator Agents/administration & dosage , Administration, Inhalation , Administration, Oral , Adult , Female , Humans , Hypertension, Pulmonary/drug therapy , Long-Term Care , Male , Prognosis , Prospective StudiesABSTRACT
Chronic obstructive pulmonary disease (COPD) is associated with structural and functional changes in the pulmonary circulation that commence at an early stage. To investigate whether vascular endothelial growth factor (VEGF) might be implicated as a mediator in COPD-associated pulmonary vascular changes, we studied surgical specimens obtained from 19 nonsmokers, 21 smokers with normal lung function, 28 patients with moderate COPD, and 10 patients with severe emphysema. The expression of VEGF in pulmonary muscular arteries was evaluated by immunohistochemistry, its protein content in lung tissue by Western blot analysis, and VEGF mRNA and its isoforms were analyzed by reverse transcription-polymerase chain reaction. The immunohistochemical expression of VEGF was increased in pulmonary arteries of smokers (median, 68% [interquartile range, 60-88]) and patients with moderate COPD (77% [63-82]), compared with nonsmokers (53% [40-63]) (p < 0.05 each). The expression of VEGF in smooth muscle cells correlated with the thickness of the vessel wall (r = 0.38, p < 0.01). VEGF protein content in lung tissue was reduced in severe emphysema, where reverse transcription-polymerase chain reaction demonstrated a lower proportion of the VEGF189 isoform. In conclusion, the expression of VEGF varies according to the severity of COPD and might be involved in the pathogenesis of pulmonary vascular remodeling at early stages of the disease.
Subject(s)
Emphysema/pathology , Endothelial Growth Factors/analysis , Gene Expression Regulation/genetics , Intercellular Signaling Peptides and Proteins/analysis , Lymphokines/analysis , Pulmonary Artery/chemistry , Pulmonary Disease, Chronic Obstructive/pathology , Smoking/pathology , Aged , Blood Gas Analysis , Blotting, Western , Case-Control Studies , Emphysema/classification , Endothelial Growth Factors/genetics , Endothelial Growth Factors/physiology , Forced Expiratory Volume , Humans , Immunohistochemistry , Intercellular Signaling Peptides and Proteins/genetics , Intercellular Signaling Peptides and Proteins/physiology , Lymphokines/genetics , Lymphokines/physiology , Middle Aged , Pulmonary Diffusing Capacity , Pulmonary Disease, Chronic Obstructive/classification , RNA, Messenger/analysis , RNA, Messenger/genetics , Reverse Transcriptase Polymerase Chain Reaction , Severity of Illness Index , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth Factors , Vital CapacitySubject(s)
Humans , Female , Middle Aged , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/etiology , Pneumothorax/etiology , Bird Fancier's Lung/complications , Bird Fancier's Lung/pathology , Pulmonary Embolism/complications , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/pathology , Sepsis/mortalitySubject(s)
Humans , Female , Adult , Amenorrhea/etiology , Multiple Organ Failure/etiology , Multiple Organ Failure/pathology , Pleural Effusion , Systemic Inflammatory Response Syndrome/etiology , Systemic Inflammatory Response Syndrome/pathology , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/mortality , Tuberculosis, Pulmonary/pathologyABSTRACT
El síndrome de Sjögren primario es una enfermedad autoinmune con sustrato inmunopatológico caracterizado por aumento en la actividad de la inmunidad celular y humoral, que determina el depósito de complejos inmunes a nivel multisistémico. Las principales alteraciones morfológicas y funcionales, que se asocian con este síndrome a nivel cardiovascular, sólo se han descrito en casos aislados. En el presente trabajo, se estudiaron mediante ecocardiografía transtorácica las alteraciones cardiovasculares que presentaron 23 pacientes con diagnóstico de síndrome de Sjögren primario. El análisis consistió en relacionar el tiempo de evolución de la enfermedad, el sexo y la edad, con el tipo de alteraciones encontradas, para determinar si existía algún vínculo entre estas variables. Todos los pacientes fueron mujeres, con edad promedio de 58 años (límites de 39 y 76 años), el tiempo de evolución máximo del síndrome de Sjögren fue de 20 años y el menor de 2. Las principales alteraciones observadas se localizaron a nivel valvular y estaban representadas por dos patrones de engrosamiento: 1) el que abarcó toda la extensión de una o más valvas y; 2) el nodular, que se encontró en el vértice o en el borde libre de una o más valvas. Las válvulas alteradas incluyeron a la mitral, aórtica y tricúspide, pero en ninguna de ellas se determinó compromiso funcional significativo. No se logró establecer asociación del tipo de alteración valvular con la edad o el tiempo de evolución del síndrome de Sjögren primario. Se concluye, que la gama de alteraciones morfológicas a nivel valvular tuvieron relación con los factores degenerativos asociados con la edad en varios casos, pero en otros, no se descarta que su desarrollo pudiera estar relacionado con el sustrato inmunopatológico del síndrome de Sjögren primario. Lo anterior debe comprobarse en futuros estudios en donde el tejido afectado pueda ser susceptible de análisis mediante pruebas inmunohistoquímicas
