Assuntos
Cateterismo Cardíaco/efeitos adversos , Doença das Coronárias/terapia , Vasos Coronários/lesões , Hemostáticos/administração & dosagem , Stents , Trombina/administração & dosagem , Ferimentos Penetrantes/tratamento farmacológico , Idoso de 80 Anos ou mais , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Feminino , Hemostáticos/uso terapêutico , Humanos , Injeções Intralesionais , Preparações Farmacêuticas/administração & dosagem , Trombina/uso terapêutico , Ferimentos Penetrantes/etiologiaRESUMO
OBJECTIVES: This study was designed to quantify the prevalence of abnormal glucose tolerance and insulin resistance in patients with idiopathic dilated cardiomyopathy (IDCM). BACKGROUND: Insulin resistance is an independent risk factor for mortality in patients with heart failure (HF) and is a known risk factor for ischemic cardiomyopathy. Though potential physiologic links between insulin resistance and HF have been hypothesized, the relationship between insulin resistance and IDCM remains unclear. METHODS: A total of 230 consecutive patients from a university HF clinic were screened for IDCM, the absence of diabetes mellitus, and the lack of significant co-morbid conditions. Oral glucose tolerance tests were performed in the 43 patients with IDCM who met these criteria, and their plasma glucose and insulin responses were compared with those of 40 healthy volunteers, matched for age, gender, and body mass index. RESULTS: Plasma glucose responses were higher during the oral glucose tolerance tests in patients with IDCM (p < 0.01), associated with significantly higher plasma insulin concentrations following the oral glucose challenge (p < 0.01). In addition, abnormalities of glucose tolerance were significantly (p < 0.05) more common in patients with IDCM (49% vs. 23%). CONCLUSIONS: Insulin resistance and abnormal glucose tolerance are more prevalent in patients with IDCM and represent potentially reversible metabolic derangements in these individuals.
Assuntos
Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/fisiopatologia , Resistência à Insulina/fisiologia , Adulto , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Cardiomiopatia Dilatada/epidemiologia , Feminino , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/etiologia , Intolerância à Glucose/fisiopatologia , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
The case of a 71-year-old woman who presented with dyspnea and palpitations is presented. Workup yielded a diagnosis of Fabry's disease, and the patient was referred for therapy. Fabry's disease is a disorder of glycosphingolipid metabolism and has forms that are limited to the myocardium. There is evidence that it has been underrecognized as a cause of cardiac hypertrophy. Because screening can be done with a simple blood test and new treatment options appear promising, we recommend consideration of Fabry's disease in the workup of patients with cardiac hypertrophy.
