Systemic microvascular endothelial dysfunction is associated with left ventricular ejection fraction reduction in chronic Chagas disease patients.

OBJECTIVE: This study compares microvascular reactivity (MR) in chronic Chagas disease (CD) patients with healthy individuals, matched for sex and age. In addition, we evaluated the association between MR and left ventricular ejection fraction (LVEF) in patients. METHODS: Acetylcholine iontophoresis was performed on the forearm skin, using laser speckle contrast imaging, to evaluate endothelium-dependent vasodilation. Clinical data were obtained from medical records. RESULTS: Thirty-six patients were compared to 25 healthy individuals (controls). Vasodilation was higher in controls, when compared to patients (p < .0001). There was a significant association between LVEF, stratified into quartiles, and MR (p-value for linear trend = .002). In addition, there was no difference in MR between patients with normal LVEF and the control group. In patients, MR was independent of the presence of arterial hypertension or diabetes. CONCLUSIONS: We have shown for the first time that the reduction of MR is associated with a decrease of LVEF in a cohort of chronic CD patients. The results were not affected by comorbidities, such as hypertension or diabetes. The evaluation of systemic endothelial function may be useful to tailor therapeutic and preventive approaches, targeted at systolic left ventricular failure associated with chronic CD cardiomyopathy.

Effects of chronic type 5 phosphodiesterase inhibition on penile microvascular reactivity in hypertensive patients with erectile dysfunction: a randomized crossover placebo-controlled trial.

This randomized crossover and placebo-controlled trial evaluated the effects of daily use of sildenafil citrate (SIL, 1-month 50 mg twice daily) on penile and systemic endothelial microvascular function in hypertensive patients presenting with erectile dysfunction. The effects of SIL on arterial pressure were evaluated using ambulatory blood pressure monitoring (ABPM). Fifty patients diagnosed with primary arterial hypertension and erectile dysfunction (aged 57.4 ± 5.6 years), recruited in a tertiary public hospital, were treated with SIL (50 mg twice daily) or placebo (PLA) for two 30-day periods with a 30-day washout between them. Laser speckle contrast imaging coupled with acetylcholine skin iontophoresis was used to evaluate penile and systemic (forearm) cutaneous microvascular reactivity. SIL treatment increased penile basal microvascular flow (P = 0.002) and maximal endothelial-dependent peak response to skin iontophoresis of acetylcholine (ACh, P = 0.006). The area under the curve of microvascular vasodilation induced by ACh was also significantly increased (P = 0.02). Lastly, SIL treatment did not modify systemic microvascular reactivity. Twenty-four-hour ABPM (P = 0.0002) and daytime (P = 0.002) and nighttime (P = 0.001) mean diastolic blood pressure values were significantly reduced after SIL treatment. The scores of the Simplified International Index of Erectile Function (P < 0.0001) and the number of patients with positive responses to Sexual Encounter Profile question 3 (P < 0.0001) also increased after SIL treatment. Penile endothelium-dependent microvascular reactivity improved after continuous use of sildenafil in hypertensive patients with erectile dysfunction; the treatment also reduced blood pressure, suggesting that, in addition to improving erectile function, daily use of sildenafil could improve blood pressure control.

The evaluation of penile microvascular endothelial function using laser speckle contrast imaging in healthy volunteers.

OBJECTIVE: The primary aim of this study was to evaluate the effectiveness of laser speckle contrast imaging (LSCI) coupled with transdermal iontophoretic delivery of acetylcholine (ACh) for the assessment of penile microvascular function. Additionally, we tested systemic microvascular function using both LSCI and ACh iontophoresis on the forearm. METHODS: We assessed cutaneous, endothelium-dependent microvascular reactivity on the penis and forearm of healthy volunteers (aged 56.6 ± 1.0 years, n = 26) at rest and 60 min following the oral administration of the phosphodiesterase type 5 inhibitor (sildenafil: SIL, 100mg). LSCI was coupled with the iontophoresis of ACh using increasing anodal currents of 30, 60, 90, 120, 150 and 180 µA during 10-second intervals spaced 1 min apart. RESULTS: Basal skin microvascular flow in the penis increased significantly following SIL administration. The endothelium-dependent skin microvascular vasodilator responses induced by ACh were also significantly enhanced following SIL administration for each of the following parameters: peak values of cutaneous vascular conductance (CVC); increases in CVC; and the area under the curve for ACh-induced vasodilation. ACh-induced microvascular vasodilation in the forearm was not modified by SIL. Finally, the administration of electric current alone did not affect penile microvascular flow. CONCLUSION: LSCI appears to be a promising non-invasive technique for the evaluation of penile microvascular endothelial function. This methodology may be valuable for the evaluation of penile microvascular reactivity among patients with cardiovascular and metabolic diseases and to test the effectiveness of drugs used to treat vasculogenic erectile dysfunction.

Reduction of myocardial ischemia with simvastatin in addition to conventional treatment in patients with chronic coronary artery disease.

BACKGROUND: Coronary artery disease is becoming more prevalent every day. We now know that controlling the risk factors for this pathology is of the utmost importance, not only to prevent the formation of atheromatous plaques (primary prevention), but also to slow its progression, or even promote regression of existing plaques (secondary prevention). There is no longer any doubt that an increase in serum cholesterol is essential for the development and progression of atherosclerosis. Therefore, lowering cholesterol levels is a key factor in controlling this disease. It has been shown that cholesterol reduction with statins is associated with a reduction in cardiovascular morbidity and mortality. It has also been demonstrated that reducing cholesterol restores peripheral and coronary vasodilation even in subjects with no angiographic evidence of the disease. OBJECTIVE: The present study aimed at assessing the effect of simvastatin in reducing myocardial ischemia in patients with chronic atherosclerotic coronary artery disease. PATIENTS AND METHODS: Twenty-five patients with stable angina and dyslipidemia undergoing clinical treatment were studied prospectively. Their lipid profile was analyzed and the diagnosis of effort-induced ischemia was confirmed by means of exercise testing. They were then randomly distributed in two groups: the simvastatin group and the placebo group. After a four- to six-month follow-up period (average of 5.72 months), they underwent new laboratory and exercise tests. RESULTS: A significant reduction in the variation of total cholesterol (p < 0.0002) and LDL-C levels (p < 0.001) was observed in the simvastatin group, compared to the placebo group. The parameters assessed during the exercise test revealed a significant improvement in ST-segment depression during effort (p < 0.046), as well as a decrease in precordial pain in the treated group during exertion, when comparing pre- and post-treatment periods. Patients receiving simvastatin also improved their functional capacity (p < 0.016), subjectively assessed by the angina pectoris classification of the Canadian Cardiovascular Society. CONCLUSIONS: These results suggest that the association of simvastatin and conventional treatment in patients with stable angina reduces effort-induced ischemia, and can be used with this group of patients, particularly those considered ineligible for invasive therapeutic intervention.

Hipernatremia grave em paciente portadora de provável meningite asséptica / Acute hypernatremia in patient with probable asseptic meningitis

Nós descrevemos o caso de uma paciente que desenvolveu níveis séricos de sódio de 196 meq/L na véspera do óbito, e 202 meq/L nas amostras de sangue colhidas na manhä do óbito.