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1.
J Cosmet Dermatol ; 22(6): 1887-1892, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36762412

RESUMO

BACKGROUND: Behçet's disease is a systemic auto-immune and auto-inflammatory chronic disease in which genetic and environmental factors play a role. Patients with Behçet's are at significant risk for developing many comorbidities, including cardiovascular diseases. AIMS: It was aimed to investigate the relationship between serum lipid parameters and atherogenic indexes to evaluate the cardiovascular risk status in patients with Behçet's disease. PATIENTS/METHODS: This study was designed as a single-center, retrospective case-control study. The study was conducted with 212 patients over 18 years of age, 106 in the case group and 106 in the control group. RESULTS: There was a significant difference in lipid values between the patients with Behçet's disease and the control group. While the serum triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (NHC) levels were significantly higher, the high-density lipoprotein cholesterol (HDL-C) level was low in patients with Behçet's disease. From atherogenic indexes, Atherogenic Index of Plasma (AIP) (0.03 ± 0.27 vs. -0.07 ± 0.23, p = 0.003), Castelli Risk Index I (CRI-I) (4.24 ± 1.07 vs. 3.02 ± 0.96, p < 0.001), Castelli Risk Index II (CRI-II) (2.65 ± 0.81 vs. 1.84 ± 0.59, p < 0.001) and Atherogenic Coefficient (AC) (3.24 ± 1.07 vs. 2.02 ± 0.96, p < 0.001) levels were significantly higher in patients with Behçet's disease. CONCLUSION: Our study shows that patients with Behçet's have a higher pro-atherogenic lipid profile and atherogenic indexes at high risk. Patients with Behçet's have an increased risk of cardiovascular diseases associated with atherosclerosis.


Assuntos
Aterosclerose , Síndrome de Behçet , Doenças Cardiovasculares , Humanos , Adolescente , Adulto , Síndrome de Behçet/complicações , Estudos de Casos e Controles , Estudos Retrospectivos , Colesterol , Aterosclerose/epidemiologia , Aterosclerose/etiologia
2.
J Cosmet Dermatol ; 21(8): 3598-3602, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35384256

RESUMO

BACKGROUND: Psoriasis is a chronic, inflammatory skin disease that is common in both adult and childhood. Patients with psoriasis are at significant risk for the development of many comorbid conditions, including cardiovascular diseases. OBJECTIVES: We aimed to investigate the cardiovascular risk status and serum lipid parameters in patients with psoriasis and to determine the risk of cardiovascular disease by atherogenic indices obtained accordingly. METHODS: This retrospective case-control study was conducted with a total of 142 individuals, 72 patients with psoriasis vulgaris and 70 healthy volunteers over the age of 18 who were admitted to the dermatology outpatient clinic. Demographic information and laboratory values were retrieved from the hospital database. Afterward, atherogenic indexes such as Atherogenic index of plasma (AIP), Castelli Risk Index I and II (CRI-I and II), and Atherogenic coefficient (AC) were calculated. RESULTS: There was a significant difference in lipid profile between the psoriasis patients and the control group. In patients with psoriasis, triglyceride level (140.09 ± 71.20 mg/dl vs. 116.10 ± 63.95, p = 0.037) was higher, while HDL level (44.34 ± 11.77 mg/dl vs. 50.31 ± 11.62, p = 0.003) was lower. Regarding atherogenic indices; AIP (0.10 ± 0.24 vs. -0.04 ± 0.27, p = 0.001), CRI-I (4.63 ± 1.40 vs. 3.94 ± 1.02, p = 0.001), CRI-II (2.98 ± 1.01 vs. 2.61 ± 0.82, p = 0.019) and AC (3.63 ± 1.40 vs.. 2.94 ± 1.02, p = 0.001) were significantly higher in patients with psoriasis. CONCLUSION: Our study shows that patients with psoriasis have higher pro-atherogenic lipid profile and atherogenic indexes at a high risk level. Patients with psoriasis have an increased risk of cardiovascular diseases.


Assuntos
Aterosclerose , Doenças Cardiovasculares , Psoríase , Adulto , Aterosclerose/epidemiologia , Aterosclerose/etiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Criança , Humanos , Lipídeos , Pessoa de Meia-Idade , Psoríase/complicações , Psoríase/epidemiologia , Estudos Retrospectivos , Fatores de Risco
3.
Herz ; 46(Suppl 1): 69-74, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31796977

RESUMO

BACKGROUND: Angiotensin receptor neprilysin inhibitors (ARNI; sacubitril/valsartan combination) decrease morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). Increased P­wave duration and P­wave dispersion (Pd) reflect prolongation of atrial conduction and correlate with atrial fibrillation. Here, we aimed to assess the effects of switching from valsartan to ARNI treatment on the basis of P­wave indices. METHODS: A total of 28 patients with HFrEF (mean age, 64.8 ± 10.6 years; 18 males, 78.6% ischemic etiology) were included. All patients had New York Heart Association functional class II-III, left ventricular ejection fraction ≤35%, and had been switched from valsartan to ARNI treatment. Standard 12-lead electrocardiograms from patients on valsartan treatment and electrocardiograms 1 month after ARNI treatment were analyzed; heart rate, maximum P­wave duration (Pmax), minimum P­wave duration (Pmin), and Pd were calculated. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores and N­terminal pro-brain natriuretic peptide (NT-proBNP) values were recorded. RESULTS: The Pmax (135.6 ± 32.1 ms vs. 116.1 ± 14.1 ms, p = 0.041) and Pd (33.6 ± 7.9 vs. 28.6 ± 5.3, p = 0.006) values were significantly reduced after ARNI treatment. Furthermore, ARNI treatment was associated with an improvement in MLWHFQ scores (31.2 ± 6.2 ms vs. 23.2 ± 7.0 ms, p < 0.001) and with a reduction in NT-proBNP values (1827.3 ± 1287.3 pg/ml vs. 1074.4 ± 692.3 pg/ml, p < 0.001). There were moderately positive correlations between the reduction in Pd and the improvement in MLWHFQ scores (r = 0.408, p = 0.031) and the reduction in NT-proBNP values (r = 0.499, p = 0.007) CONCLUSION: Switching to ARNI treatment alters Pd and Pmax favorably in patients with HFrEF. The reduction in atrial inhomogeneous conduction assessed by Pd was correlated with clinical improvement and reduced NT-proBNP levels in patients with HFrEF.


Assuntos
Insuficiência Cardíaca , Neprilisina , Idoso , Aminobutiratos/uso terapêutico , Angiotensinas , Combinação de Medicamentos , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Angiotensina , Volume Sistólico , Tetrazóis/uso terapêutico , Função Ventricular Esquerda
4.
Acta Cardiol ; 75(1): 20-25, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30513267

RESUMO

Background: Angiotensin receptor neprilysin inhibitor (ARNI, sacubitril/valsartan) reduces sudden death in heart failure with reduced ejection fraction (HFrEF). Corrected QT (QTc), T-wave peak to T-wave end interval (Tp-e) and Tp-e/QTc are electrocardiographic indices of ventricular repolarization heterogeneity. We aimed to assess the effects of switching from ramipril to ARNI on electrocardiographic indices of ventricular repolarization.Methods: A total of 48 patients with HFrEF (mean age: 63.3 ± 11.7 years; 36 males, 77.1% ischaemic etiology) were enrolled. All patients had New York Heart Association functional class II-III, left ventricular ejection fraction ≤35% and previously switched from ramipril to ARNI treatment. The standard 12-lead electrocardiograms on ramipril treatment and 1 month after ARNI treatment were analysed; heart rate, QTc, Tp-e and Tp-e/QTc were calculated. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores and N-terminal pro-BNP (NT-proBNP) values were recorded.Results: QTc (415.2 ± 19.7 ms vs. 408.5 ± 20.8 ms, p = 0.022), Tp-e (100.7 ± 13.8 ms vs. 92.9 ± 12.1 ms, p < 0.001), Tp-e/QTc (0.242 ± 0.028 vs. 0.227 ± 0.029, p = 0.003) and heart rate (73.2 ± 4.7 bpm vs. 71.1 ± 4.9 bpm, p = 0.027) were reduced after ARNI. ARNI switch associated with improvement in MLWHFQ scores (32.4 ± 7.1 ms vs. 22.6 ± 7.0 ms, p < 0.001) and reduction of NT-proBNP (2457 ± 1879 pg/ml to 1377 ± 874 pg/ml, p < 0.001). Pearson's correlation analysis revealed moderate correlations of MLWHFQ score with Tp-e (r = 0.543, p = 0.001) and Tp-e/QTc (r = 0.556, p = 0.001).Conclusions: Switching from ramipril to ARNI favourably alters QTc, Tp-e and Tp-e/QTc in HFREF. ARNI reduces symptoms of HFREF assessed by MLWHFQ and lowers NT-proBNP levels. Reduction in Tp-e and Tp-e/QTc correlate with clinical improvement in patients with HFrEF.


Assuntos
Potenciais de Ação/efeitos dos fármacos , Aminobutiratos/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Substituição de Medicamentos , Eletrocardiografia , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Inibidores de Proteases/uso terapêutico , Ramipril/uso terapêutico , Tetrazóis/uso terapêutico , Idoso , Aminobutiratos/efeitos adversos , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Compostos de Bifenilo , Combinação de Medicamentos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Neprilisina/antagonistas & inibidores , Valor Preditivo dos Testes , Inibidores de Proteases/efeitos adversos , Ramipril/efeitos adversos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Volume Sistólico/efeitos dos fármacos , Tetrazóis/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Valsartana , Função Ventricular Esquerda/efeitos dos fármacos
5.
Acta Cardiol Sin ; 34(6): 488-495, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30449989

RESUMO

PURPOSE: The objectives of this study were to: (i) evaluate endothelial function via fingertip reactive hyperemia peripheral arterial tonometry (RH-PAT) among heart failure (HF) patients receiving cardiac resynchronization therapy (CRT), (ii) assess the effects of CRT on RH-PAT score, and (iii) investigate whether RH-PAT score can identify CRT response. METHODS: A total of 63 patients (61.8 ± 10.3 years; 50 males; left ventricular (LV) ejection fraction 24.3 ± 3.9%) with HF who received CRT were enrolled. Endothelial function via RH-PAT was assessed 1 day before and 6 months after CRT. Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used to assess clinical improvements. CRT response was defined as a reduction in LV end-systolic volume ≥ 15% at 6 months. RESULTS: A RH-PAT score of < 1.7 signified a cut-off for endothelial dysfunction (ED). Baseline ED was observed among 43 (68.3%) patients and was more prevalent in responders (76.1% vs. 47.1%, p = 0.037). RH-PAT score improved 6 months after CRT (1.58 ± 0.35 vs. 1.71 ± 0.31, p = 0.012). A RH-PAT score of < 1.7 was a significant independent predictor of CRT response in multivariate logistic regression analysis (ß = 1.275, OR = 3.512, 95% CI = 1.231-11.477, p = 0.032). The severity of ED was an independent predictor of LV reverse remodeling (ß = -8.873, p = 0.015). Spearman's correlation analysis revealed moderate positive correlations between an improvement in RH-PAT (ΔRH-PAT) and LV reverse remodeling (r = 0.461, p = 0.001) and MLWHFQ score (r = 0.440, p = 0.001). CONCLUSIONS: ED detected via RH-PAT could predict the response to CRT. The RH-PAT score increased 6 months after CRT and was correlated with echocardiographic and clinical improvements.

6.
Blood Press Monit ; 23(4): 203-209, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29738357

RESUMO

OBJECTIVE: The aim of the present cross-sectional study was to evaluate the autonomic nervous system by dynamic pupillometry (DP) in normotensive and hypertensive individuals with either a non-dipper-type or a dipper-type circadian rhythm of blood pressure (BP). PATIENTS AND METHODS: A total of 80 patients were allocated into four groups: normotensive/dipper (n=23), normotensive/nondipper (n=19), hypertensive/dipper (n=18), and hypertensive/nondipper (n=20). Pupil diameters (R0, R1, R2, and R%): latency (Lc), amplitude (Ac), velocity (Vc), and duration (Tc) of pupil contraction: latency (Ld), velocity (Vd), and duration (Td) of pupil dilatation were measured by DP. Among the DP parameters, Vc and Ac were known parasympathetic indices and R% was the major sympathetic index. RESULTS: Vc and Ac were higher in the dipper normotensives with respect to nondipper normotensives (Vc=5.19±0.85 vs. 4.58±0.71, P=0.017; Ac=1.66±0.27 vs. 1.49±0.28, P=0.048). Vc and Ac were higher in dipper hypertensives with respect to the nondipper subgroup of hypertensive cases (Vc=4.44±0.81 vs. 3.94±0.45, P=0.024; Ac=1.47±0.26 vs. 1.27±0.11, P=0.004). R% was higher in the nondipper subgroup of hypertensives than the dipper subgroup of hypertensive cases (36.7±4.8 vs. 33.5±3.8, P=0.033). Correlation analyses showed moderate positive correlations of night-time decline in BP with Vc (r=0.460, P=0.001) and Ac (r=0.420, P=0.001). There was also a negative correlation between night-time decline in BP and R% (r=-0.259, P=0.001). CONCLUSION: Nondipping in BP is associated with lower parasympathetic activity both in normotensive and in hypertensives cases. Furthermore, in the nondipper subgroup of hypertensive cases, there is higher sympathetic activity than the dipper subgroup.


Assuntos
Pressão Arterial/fisiologia , Hipertensão/fisiopatologia , Sistema Nervoso Parassimpático/fisiopatologia , Pupila/fisiologia , Reflexo Pupilar , Adulto , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano/fisiologia , Estudos Transversais , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Cardiol J ; 23(5): 524-531, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27387063

RESUMO

BACKGROUND: Heart rate (HR) recovery (HRR) reflects autonomic activity and predicts cardiovascular events. The aim of this study was to assess HRR in patients with myocardial bridge (MB). METHODS: Medical recordings of 93 patients with MB and appropriate age, compared to 78 sex-matched healthy subjects were analyzed. MB was diagnosed via coronary computed tomography angiography after a positive exercise stress test (EST). HRR indices were calculated by subtracting 1st (HRR1), 2nd (HRR2) and 3rd (HRR3) minute HR from the maximal HR during EST. RESULTS: HRR1 (30.2 ± 13.3 bpm vs. 35.8 ± 10.4 bpm, p = 0.001) and HRR2 (52.3 ± 13.3 bpm vs. 57.1 ± 11.6 bpm, p = 0.013) were lower in patients with MB. In addition, HRR1 was lower in patients with left anterior descending (LAD) MB than non-LAD MB (28.5 ± 13.2 vs. 37.1 ± 11.4, p = 0.013). Presence of MB, deep MB, LAD MB and multi-vessel MB were predictors of HRR1 (p < 0.01 for all). In a multivariate analysis, LAD MB was the only significant independent predictor of HRR1 (b = -8.524, p = 0.009). CONCLUSIONS: Patients with MB have impairment in HRR indices which is more pronounced among patients with LAD MB. Cardiac autonomic dysfunction in MB might be due to recurrent myocardial ischemia.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Ponte Miocárdica/fisiopatologia , Recuperação de Função Fisiológica , Adulto , Teste de Esforço/métodos , Feminino , Seguimentos , Humanos , Masculino , Ponte Miocárdica/diagnóstico , Prognóstico , Estudos Retrospectivos
10.
Cardiol J ; 23(3): 242-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27173681

RESUMO

BACKGROUND: Ventricular arrhythmias can be seen in systemic sclerosis (SSc) patients and are thought to be a result of fibrosis or ischemia of the ventricular myocardium. Tp-e interval and Tp-e/QT ratio are electrocardiographic (ECG) indices to predict ventricular tachyarrhythmia and cardiovascular mortality. We aimed to evaluate Tp-e interval and Tp-e/QT ratio in patients with SSc. METHODS: A total of 107 patients with SSc (mean age, 48.6 ± 14.0 years; 96 females) and 100 healthy controls (mean age, 49.4 ± 8.6 years; 90 females) were enrolled. The standard 12-lead ECG was recorded; QTc, Tp-e interval and Tp-e/QT ratio were measured. Modified Rodnan skin severity score (MR-SSS) calculated for all SSc patients. RESULTS: Tp-e interval (90.7 ± 23.8 ms vs. 84.0 ± 20.6 ms, p = 0.032) and Tp-e/QT ratio (0.20 ± 0.05 vs. 0.18 ± 0.04, p = 0.007, respectively) were significantly prolonged in SSc patients than in the control group. Pearson's correlation analyses revealed positive correlations of MR-SSS with QTc (r = 0.427, p = 0.001), Tp-e interval (r = 0.620, p = 0.001) and Tp-e/ /QT ratio (r = 0.615, p = 0.001). MR-SSS (b = 2.108, p = 0.001) and CRP (b = 2.273, p = 0.027) were found to be significant independent predictors of Tp-e interval. Similarly, MR-SSS (b = 0.004, p = 0.001) was only a significant independent predictor of Tp-e/QT ratio among patients with SSc. CONCLUSIONS: The patients with SSc had a prolonged Tp-e interval and Tp-e/QT ratio compared with normal subjects. Furthermore, this prolongation was well correlated with clinical severity score among patients with SSc. Ventricular repolarization dispersion as a predictor of ventricular arrhythmias was found to be diminished in patients with SSc. Patients with SSc, particularly with higher MR-SSS, should be followed closely for adverse cardiovascular outcomes.


Assuntos
Arritmias Cardíacas/diagnóstico , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Ventrículos do Coração/fisiopatologia , Escleroderma Sistêmico/complicações , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/fisiopatologia , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/fisiopatologia
11.
J Thromb Thrombolysis ; 42(3): 399-404, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27085540

RESUMO

Atrial fibrillation (AF) is a common cardiac arrhythmia. Dabigatran etixalate (DE) is one of the new oral anticoagulant drugs being used in nonvalvular AF (NVAF). There is no adequate real world data in different populations about DE. The aim of this registry was to evaluate the efficacy and safety of DE Consecutive NVAF patients treated with warfarin or both DE doses were enrolled during 18 months study period. The patients were re-evaluated at regular 6-month intervals during the follow-up period. During the follow-up period outcomes were documented according to RELY methodology A total of 555 patients were analyzed. There was no significant difference in ischemic stroke rates (p = 0.73), death rates (p = 0.15) and MI rates (p = 0.56) between groups. The rate of major bleeding was significantly higher in warfarin and dabigatran 150 mg group than dabigatran 110 mg (p < 0.001). Intracranial bleeding rate and relative risk were significantly lower in dabigatran 110 mg group than warfarin group (p = 0.004). Dyspepsia was significantly higher in both DE doses than warfarin (p = 0.004) Both DE doses are as effective as warfarin in reducing stroke rates in NVAF patients, without increasing MI rates. Intracranial bleeding rates are significantly lower in warfarin than both doses of DE and gastrointestinal bleeding risk increases with increased DE doses.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Dabigatrana/farmacologia , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/farmacologia , Fibrilação Atrial/complicações , Dabigatrana/administração & dosagem , Dispepsia , Feminino , Seguimentos , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Hemorragias Intracranianas/induzido quimicamente , Masculino , Infarto do Miocárdio , Sistema de Registros , Acidente Vascular Cerebral/prevenção & controle , Varfarina/administração & dosagem , Varfarina/farmacologia
12.
Am J Case Rep ; 16: 315-8, 2015 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-26008865

RESUMO

Background Various pathophysiological mechanisms such as microvascular and endothelial dysfunction, small vessel disease, diffuse atherosclerosis, and inflammation have been held responsible in the etiology of coronary slow flow. It is also thought to be a reflection of a systemic slow-flow phenomenon in the coronary arterial tree. Case Report A 44-year-old man presented with chest pain causing fatigue, together with blurred vision for the last 2 years, which disappeared after resting. He had used corticosteroid therapy for facial paralysis 1 month ago. Coronary slow flow was detected in all 3 major coronary arteries on coronary angiography. TIMI measurements for the left anterior descending artery, circumflex, and right coronary artery were 64, 72, and 55, respectively. In fundus fluorescein angiography, retinal vascularity was normal, the arm-to-retina circulation time was 21.8 s, and the arteriovenous transit time was 4.3 s. In the early arteriovenous phase, choroidal filling was long, with physiological patchy type. Diltiazem 90 mg/day and acetylsalicylic acid 100 mg/day were given. His chest pain and visual symptoms disappeared after medical treatment. Conclusions Physicians should be aware that glucocorticoids might cause an increase in the symptoms of coronary slow flow and some circulation problems, which might lead to systematic symptoms.


Assuntos
Aterosclerose/complicações , Velocidade do Fluxo Sanguíneo/fisiologia , Circulação Coronária/fisiologia , Vasos Coronários/fisiopatologia , Desoxicorticosterona/uso terapêutico , Angina Microvascular/fisiopatologia , Baixa Visão/fisiopatologia , Adulto , Aterosclerose/diagnóstico , Aterosclerose/tratamento farmacológico , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Angiografia Coronária , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/efeitos dos fármacos , Glucocorticoides/uso terapêutico , Humanos , Masculino , Angina Microvascular/tratamento farmacológico , Angina Microvascular/etiologia , Baixa Visão/tratamento farmacológico , Baixa Visão/etiologia
15.
J Chemother ; 24(5): 285-91, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23182048

RESUMO

The aim of this prospective clinical study is to evaluate the relationship between changes in functional cardiac parameters following anthracycline therapy and carbonyl reductase 3 (CBR3p.V244M) and glutathione S transferase Pi (GSTP1p.I105V) polymorphisms. Seventy patients with normal cardiac function and no history of cardiac disease scheduled to undergo anthracycline chemotherapy were included in the study. The patients' cardiac function was evaluated by gated blood pool scintigraphy and echocardiography before and after chemotherapy, as well as 1 year following therapy. Gene polymorphisms were genotyped in 70 patients using TaqMan probes, validated by DNA sequencing. A deteriorating trend was observed in both systolic and diastolic parameters from GG to AA in CBR3p.V244M polymorphism. Patients with G-allele carriers of GSTP1p.I105V polymorphism were common (60%), with significantly decreased PFR compared to patiens with AA genotype. Variants of CBR3 and GSTP1 enzymes may be associated with changes in short-term functional cardiac parameters.


Assuntos
Oxirredutases do Álcool/genética , Antraciclinas/efeitos adversos , Antineoplásicos/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Glutationa S-Transferase pi/genética , Adolescente , Adulto , Idoso , Antraciclinas/uso terapêutico , Antineoplásicos/uso terapêutico , Doenças Cardiovasculares/genética , Feminino , Genótipo , Testes de Função Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/genética , Polimorfismo Genético , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
16.
Anadolu Kardiyol Derg ; 11(8): 666-73, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22037100

RESUMO

OBJECTIVE: The aim of present study was to assess the clinical utility and diagnostic accuracy of diastolic dysfunction criteria that were recommended in current American Society of Echocardiography and European Association of Echocardiography recommendations for prediction of increased LVEDP (>16 mmHg) in patients with coronary artery disease and normal EF. METHODS: Forty-five consecutive patients (mean age=61.5±10.3 years) referred for cardiac catheterization were enrolled in this prospective study. All patients underwent transthoracic echocardiography and tissue Doppler imaging within 24 hours before cardiac catheterization. Patients were divided into 2 groups according to left ventricular end diastolic pressure (LVEDP) (LVEDP>16 mmHg, n=23; LVEDP≤16 mmHg, n=22). Receiver operating characteristics curve analyses were performed and sensitivity, specificity, positive predictive value and negative predictive value were calculated for indices to detect high LVEDP. RESULTS: Among the indices, left atrial volume index (LAVI) ≥34 ml/m2 (sensitivity=60.0% and specificity=90.0%) and ratio of transmitral to septal annular velocities during early filling (septal E/e' ratio) ≥15 (sensitivity=30.4% and specificity=95.5%) had more reasonable sensitivity and specificity. Receiver operating characteristics curve analysis revealed that best predictors of high LVEDP were septal E/e' [area under curve (AUC)=0.694, standard error (SE)=0.66, p=0.01] and LAVI (AUC=0.669, SE=0.63, p=0.045]. There were statistically significant correlations between LVEDP and septal E/e' (r=0.541, p=0.001) and LAVI (r=0.461, p=0.002). A proposed algorithm consisting LAVI ≥34 ml/m2 and septal E/e' >8 could determine diastolic dysfunction with a 95.6% sensitivity and 54.5% specificity. CONCLUSION: Septal E/e' (≥15) and LAVI (≥ 34 ml/m2) were the better predictors of the increased LVEDP than the other echocardiographic parameters. There were statistically significant moderate positive correlations of LVEDP with septal E/ e' and LAVI. Combination of LAVI and septal E/e' is useful to detect diastolic dysfunction.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Cateterismo Cardíaco , Doença da Artéria Coronariana/complicações , Diástole , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/complicações
17.
Cardiol J ; 18(6): 639-47, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22113751

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) has been shown to reduce heart failure-related morbidity and mortality. However, approximately one in three patients do not respond to CRT. The aim of the current study was to determine the parameter(s) which predict reverse remodeling and clinical improvement after CRT. METHODS: A total of 54 patients (43 male, 11 female; mean age 61.9 ± 10.5 years) with heart failure and New York Heart Association (NYHA) class III-IV symptoms and in whom left ventricular ejection fraction (LVEF) was £ 35% and QRS duration was ≥ 120 ms, despite optimal medical therapy, were enrolled. An echocardiographic examination was performed before, and six months after, CRT. An echocardiographic response was defined as a reduction of end-systolic volume ≥ 10% after six months, and a clinical response was defined as a reduction ≥ 1 in the NYHA functional class score. RESULTS: An echocardiographic response was observed in 38 (70.4%) of the patients and a clinical response occurred in 41 (75.9%) of the patients. Of the dyssynchrony parameters, only the aortic pre-ejection interval (APEI) was observed to significantly predict the clinical response (p = 0.048) and echocardiographic response (p = 0.037). A 180.5 ms cut-off value for the APEI predicted the clinical response with a sensitivity of 92.3% and a specificity of 39%, and the echocardiographic response with a sensitivity of 93.0% and a specificity of 42%. CONCLUSIONS: APEI derived from pulsed-wave Doppler, which is available in every echocardiography machine, is a simple and practical method that could be used to select patients for CRT.


Assuntos
Valva Aórtica/fisiopatologia , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Disfunção Ventricular Esquerda/terapia , Função Ventricular Esquerda , Remodelação Ventricular , Idoso , Valva Aórtica/diagnóstico por imagem , Distribuição de Qui-Quadrado , Ecocardiografia Doppler em Cores , Ecocardiografia Doppler de Pulso , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Seleção de Pacientes , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Turquia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
18.
Ann Noninvasive Electrocardiol ; 16(4): 365-72, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22008492

RESUMO

BACKGROUND: Although predictive value of heart rate recovery (HRR) has been tested in large populations, the reproducibility of HRR in treadmill exercise test has not been assessed prospectively. This prospective study examined whether HRR index has test-retest stability in the short term. METHODS: A total of 52 healthy volunteers without cardiovascular risk factors (mean age, 30 ± 10 years, 30 females) underwent standardized graded treadmill exercise test, and the test was repeated on the 7th and the 30th days. The subjects' maximal heart rates and the decrease of heart rate from the peak exercise level to the level of 1, 2, 3, 4, and 5 minutes after the termination of the exercise were examined on each test, and heart rates for each minute from the first, second, and third tests were compared for each individual. RESULTS: The maximal heart rates on the 1st, 7th, and the 30th days were 179 ± 11, 177 ± 10, 178 ± 10 beats/min, respectively [P = 0.07, intraclass correlation coefficient (ICC) = 0.92], and the 1st minute HRR indices after peak exercise were 33 ± 10, 33 ± 10, 33 ± 11, respectively (P = 0.66, ICC = 0.88). There was no statistical difference in the 2nd, 3rd, 4th, and 5th minute heart rates of the recovery phase among the 1st, 7th, and 30th day treadmill exercise tests, either. CONCLUSION: Maximal heart rates and the decline of heart rate to the 5th minute on recovery phase after treadmill exercise test have short-term reproducibility.


Assuntos
Frequência Cardíaca/fisiologia , Adulto , Pressão Sanguínea/fisiologia , Teste de Esforço , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
19.
Int J Rheum Dis ; 14(4): 379-83, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22004236

RESUMO

OBJECTIVE: The six minute walk test (6MWT) is used for the assessment of functional capacity in pulmonary and cardiovascular diseases. Left ventricular diastolic dysfunction (LVDD) is the most common cardiac abnormality in systemic sclerosis (SSc). The aim of this study was to define the effect of LVDD on 6MWT parameters in patients with SSc. METHODS: We studied 45 (female : male 40 : 5) SSc patients. Patients with obvious conditions that can affect 6MWT distance (6MWD) were excluded. All subjects were evaluated by 6MWT. Additionally, 6MWD of the participants was calculated as the percentage of normal predicted values. LVDD was assessed by using echocardiographic findings and classified into three categories: impaired relaxation, pseudonormal or restrictive. RESULTS: There were 12 (27%) patients with LVDD. SSc patients with LVDD were older than SSc patients without LVDD (50 ± 12 years vs. 41 ± 10 years; P = 0.017). In all, the mean 6MWD was 487.9 ± 98.3 m. The 6MWD was shorter in SSc patients with LVDD as compared to those without LVDD (438.0 ± 94.7 m vs. 506.0 ± 94.5 m; P = 0.039). There was significant difference between the groups regarding the percentage of the predicted 6MWD (74.1 ± 10.1%vs. 82.8 ± 13.1%; P = 0.041). CONCLUSION: The presence of LVDD alters 6MWD in SSc patients. Reduction of 6MWD in a patient with SSc should prompt the investigation of LVDD.


Assuntos
Teste de Esforço/métodos , Escleroderma Sistêmico/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Caminhada/fisiologia , Adulto , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico , Fatores de Tempo , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico
20.
Pacing Clin Electrophysiol ; 34(2): 200-7, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20883514

RESUMO

BACKGROUND: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function in heart failure (HF). However, the effects of CRT on right ventricular (RV) systolic function are not fully understood. OBJECTIVE: We aimed to determine echocardiographic correlates of improvement in RV systolic function after CRT. METHODS: Fifty-four patients (61.9 ± 10.5 years; 43 men; LV ejection fraction 24.6 ± 4.0%; QRS duration > 120 ms) with HF were enrolled. Standard echocardiography, strain rate (SR), and tissue Doppler imaging were performed in all patients before and 6 months after CRT. Pulsed-wave TDI-derived systolic indices of RV included systolic (RV(S) ) and isovolumic velocity (RV(IVV)) and isovolumic acceleration (RV(IVA)). Response to CRT was defined as decline in LV end-systolic volume (LVESV) ≥ 10%. RESULTS: When indices of RV systolic function were assessed between responders and nonresponders, in responders (38 patients, 70.4%) RV end-diastolic diameters (RVD1-3), mid-RV strain, and mid-RV SR improved significantly (P < 0.01, for all). RV(S) (10.77 ± 4.29 vs 12.62 ± 4.10 cm/sec, P = 0.005), RV(IVV) (14.71 ± 5.88 vs 18.52 ± 6.62 cm/sec, P < 0.001), and RV(IVA) (1.69 ± 0.70 vs 2.39 ± 0.77 m/sec(2) , P < 0.001) significantly increased among responders. There was no significant change in these parameters among nonresponders. Pearson's analyses revealed moderate positive correlations between reduction of LVESV and ΔRV(IVV) (r = 0.467, P = 0.001) and ΔRV(IVA) (r = 0.473, P = 0.001), respectively. CONCLUSIONS: RV diameters and systolic indices after CRT improved only in the responder group. Improvement in RV systolic performance after CRT is correlated with the reduction of LVESV.


Assuntos
Terapia de Ressincronização Cardíaca/métodos , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/prevenção & controle , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/prevenção & controle , Remodelação Ventricular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estatística como Assunto , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Direita/diagnóstico
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