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1.
Heart Vessels ; 25(2): 113-20, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20339972

RESUMO

An unhealthy lifestyle can increase the risk of cardiovascular disease. However, the mechanism by which lifestyle influences the development of cardiovascular disease remains unclear. Since coronary endothelial function is a predictor of cardiovascular prognosis, the goal of this study was to characterize the effect of enjoying hobbies on coronary endothelial function and cardiovascular outcomes. A total of 121 consecutive patients (76 men, 45 women) with almost normal coronary arteries underwent Doppler flow study of the left anterior descending coronary artery following sequential administration of papaverine, acetylcholine, and nitroglycerin. On the basis of responses to questionnaires, patients were divided into two groups; the Hobby group (n = 71) who enjoyed hobbies, and the Non-hobby group (n = 50) who had no hobbies. Cardiovascular outcomes were assessed at long-term follow-up using medical records or questionnaire surveys for major adverse cardiovascular events (MACE).The average follow-up period was 916 +/- 515 days. There were no significant differences in demographics when comparing the two groups. The percent change in coronary blood flow and coronary artery diameter induced by acetylcholine was significantly greater in the Hobby group than in the Non-hobby group (49% +/- 77% vs 25% +/- 37%, P < 0.05, 4% +/- 13% vs -3% +/- 20%, P < 0.05, respectively). The MACE rate was significantly lower in the Hobby group than in the Non-hobby group (P < 0.01). Enjoyment of hobbies was the only independent predictor of MACE (odds ratio 8.1 [95% confidence interval 1.60, 41.90], P = 0.01) among the variables tested. In the early stages of arteriosclerosis, enjoying hobbies may improve cardiovascular outcomes via its favorable effects on coronary endothelial function.


Assuntos
Doenças Cardiovasculares/psicologia , Circulação Coronária , Vasos Coronários/fisiopatologia , Passatempos , Estilo de Vida , Prazer , Comportamento de Redução do Risco , Estresse Psicológico/complicações , Acetilcolina/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Angiografia Coronária , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/efeitos dos fármacos , Intervalo Livre de Doença , Ecocardiografia Doppler , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Nitroglicerina/administração & dosagem , Razão de Chances , Papaverina/administração & dosagem , Prognóstico , Modelos de Riscos Proporcionais , Qualidade de Vida , Medição de Risco , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Vasodilatação , Vasodilatadores/administração & dosagem , Adulto Jovem
2.
Heart Vessels ; 23(2): 83-90, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18389331

RESUMO

The comparative long-term antianginal efficacy of long-acting nitrates versus calcium channel antagonists remains unclear. The goal of the present study was to compare the coronary endothelial cell function and coronary artery vasoconstriction between patients with normal or mildly diseased coronary arteries treated with long-acting nitrates or calcium channel antagonists. Forty-two patients suspected to have angina pectoris and with normal or mildly diseased coronary arteries underwent Doppler flow study of the left anterior descending coronary artery. All patients were suspected to have angina pectoris and were receiving either long-acting nitrates (n = 18; Nitrates group) or calcium channel antagonists (n = 24; Ca-antagonists group) for at least 1 year. Vascular reactivity was assessed by intracoronary administration of papaverine, acetylcholine (Ach), and nitroglycerin using a Doppler guidewire. Segments that showed the greatest constrictive response to Ach were used for assessment of vasoconstriction. The percent increase in coronary blood flow (CBF) and coronary artery diameter (CAD) induced by Ach was significantly smaller in the Nitrates group than in the Ca-antagonists group (33% +/- 74% vs 83% +/- 77%, P < 0.05; -3% +/- 16% vs 11% +/- 12%, P < 0.01, respectively). The percent diameter reduction in the region of greatest constrictive response to Ach was significantly greater in the Nitrates group than in the Ca-antagonists group (44% +/- 39% vs 15% +/- 32%, P < 0.02). Long-term treatment with long-acting nitrates may produce less favorable effects on coronary endothelial function and the constrictive response to Ach when compared with long-acting calcium channel antagonists in patients with normal or mildly diseased coronary arteries.


Assuntos
Angina Pectoris/tratamento farmacológico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Circulação Coronária/efeitos dos fármacos , Vasos Coronários/efeitos dos fármacos , Nitratos/uso terapêutico , Vasoconstrição/efeitos dos fármacos , Vasodilatação/efeitos dos fármacos , Acetilcolina/administração & dosagem , Acetilcolina/efeitos adversos , Idoso , Angina Pectoris/patologia , Angina Pectoris/fisiopatologia , Angiografia Coronária , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/fisiopatologia , Vasoespasmo Coronário/induzido quimicamente , Vasoespasmo Coronário/fisiopatologia , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Feminino , Humanos , Fluxometria por Laser-Doppler , Masculino , Pessoa de Meia-Idade , Nitroglicerina/administração & dosagem , Papaverina/administração & dosagem , Índice de Gravidade de Doença , Estresse Mecânico , Resultado do Tratamento , Vasodilatadores/administração & dosagem , Vasodilatadores/efeitos adversos
3.
Int J Cardiol ; 126(1): 53-61, 2008 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-17477992

RESUMO

BACKGROUND: Previous studies have demonstrated that decreased levels of circulating adiponectin correlate with endothelial dysfunction in peripheral arteries. However, the relationship between adiponectin levels and endothelial function in coronary arteries remains unclear. The goal of the present study was to determine whether circulating adiponectin concentrations are a useful predictor of coronary endothelial function. METHODS: Thirty-six consecutive non-diabetic patients with normal or mildly diseased coronary arteries were enrolled in this study. Coronary endothelial function was evaluated by coronary vascular response to acetylcholine (Ach). The relationship between coronary vasoreactivity and adiponectin or other biochemical or anthropometric parameters was investigated. The predictive value of adiponectin level for assessment of coronary endothelial dysfunction was assessed at the best cut-off point. RESULTS: In a simple regression analysis, log-transformed adiponectin concentrations positively correlated with the percent change in coronary blood flow (CBF) and coronary artery diameter (CAD) induced by Ach (r=0.62, p<0.0001; r=0.63, p<0.0001, respectively). Insulin resistance index (HOMA-R), body mass index, immunoreactive insulin, and triglycerides concentrations also significantly correlated with the percent change in CBF and CAD. However, in a multiple regression analysis, log-transformed adiponectin concentration was the only independent predictor of the percent change in CBF and CAD (p<0.0001; p<0.0001, respectively). Furthermore, patients with adiponectin concentrations <6.3 mg/L demonstrated coronary endothelial dysfunction with high specificity both in terms of CBF and CAD response (85%; 88%, respectively). CONCLUSIONS: Adiponectin is a better predictor of coronary endothelial function than other factors such as HOMA-R, body mass index, immunoreactive insulin, and triglycerides.


Assuntos
Adiponectina/sangue , Índice de Massa Corporal , Circulação Coronária/fisiologia , Vasos Coronários/fisiologia , Endotélio Vascular/fisiologia , Anticorpos Anti-Insulina/sangue , Resistência à Insulina/imunologia , Triglicerídeos/sangue , Idoso , Biomarcadores/sangue , Feminino , Homeostase/fisiologia , Humanos , Anticorpos Anti-Insulina/biossíntese , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Valor Preditivo dos Testes
4.
Coron Artery Dis ; 18(1): 31-8, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17172927

RESUMO

OBJECTIVES: Toll-like receptors mediate the innate immune response triggered by pathogen-associated molecular patterns, and atherosclerosis can be considered a state of chronic inflammation whereby immune system cells accumulate within the intima of the arterial wall. The goal of this study was to determine the relation of Toll-like receptors to the extent and severity of coronary artery disease. METHODS: Angiographic vessel score and Gensini score were used to evaluate the extent and severity of coronary atherosclerosis. Sixty-two consecutive patients with stable angina were grouped as follows: those with insignificant (<50%) coronary stenosis (group 1), and those with 1 (group 2), 2 (group 3), or 3-vessel disease (group 4). The expression of Toll-like receptor 1, 2, and 4 on circulating CD14+ monocytes was analyzed by flow-cytometry in all patients. RESULTS: Toll-like receptor 2 had a positive correlation with the vessel score and Gensini score (r=0.46, P<0.001; r=0.32, P<0.02, respectively). Toll-like receptor 4 also positively correlated with the vessel score and Gensini score (r=0.47, P<0.001; r=0.29, P<0.05, respectively). No significant correlation existed between the expression of Toll-like receptor 1 and the vessel score or Gensini score. Further, there was no significant correlation between high-sensitivity C-reactive protein and the vessel score or Gensini score. CONCLUSION: These data suggest that Toll-like receptor 2 and 4 expression correlates with the extent and severity of coronary artery disease.


Assuntos
Angina Pectoris/complicações , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/imunologia , Receptores Toll-Like/imunologia , Idoso , Angina Pectoris/imunologia , Proteína C-Reativa/imunologia , Angiografia Coronária , Doença da Artéria Coronariana/patologia , Progressão da Doença , Feminino , Humanos , Receptores de Lipopolissacarídeos/imunologia , Masculino , Monócitos/imunologia , Receptor 1 Toll-Like/imunologia , Receptor 2 Toll-Like/imunologia , Receptor 4 Toll-Like/imunologia
5.
J Cardiol ; 48(3): 125-32, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17007237

RESUMO

BACKGROUND: Plasma levels of brain natriuretic peptide (BNP) correlate with left ventricular remodeling, but the relationship between BNP induction and coronary function remains unclear. OBJECTIVES: The present study assessed BNP production in response to left ventricular enlargement and investigated the relationship between BNP production and coronary vasodilating function in patients with left ventricular remodeling. METHODS: Patients (n = 63) with normal or mildly diseased coronary arteries underwent Doppler flow study of the left anterior descending coronary artery. Vascular reactivity was examined using intracoronary acetylcholine, papaverine and nitroglycerin using a Doppler guidewire. RESULTS: Left ventricular end-diastolic dimension was positively correlated with BNP (r = 0.45, p < 0.001) in all patients. BNP was significantly and inversely correlated with percentage change in coronary artery diameter induced by acetylcholine (r = -0.56, p < 0.001) but not by nitroglycerin (r = -0.20, p = 0.28) in patients with left ventricular end-diastolic dimension > or = 55 mm (n = 32). By contrast, BNP was not significantly correlated with percentage change in coronary artery diameter induced by either acetylcholine or nitroglycerin in patients with left ventricular end-diastolic dimension < 55 mm (n = 31). Further, BNP was not correlated with the percentage change in coronary blood flow induced by acetylcholine or by papaverine in patients with or without left ventricular remodeling. CONCLUSIONS: The elevation in plasma BNP levels that occurs in association with left ventricular enlargement is a predictor of impaired endothelium-dependent vasodilation in conductance coronary arteries.


Assuntos
Doença das Coronárias/diagnóstico , Doença das Coronárias/fisiopatologia , Endotélio Vascular/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Remodelação Ventricular/fisiologia , Adulto , Idoso , Biomarcadores/sangue , Vasos Coronários/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Vasodilatação
6.
Coron Artery Dis ; 17(5): 401-7, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16845246

RESUMO

BACKGROUND: The relationship between coronary remodeling, shear stress and endothelial function remains unclear. OBJECTIVE: The present study investigated the effects of mechanical factors on structure and function of epicardial coronary arteries. METHODS: Patients (group 1: %area stenosis<40%, n=55; or group 2: %area stenosis>or=40%, n=17) with a discrete mildly stenotic lesion (%diameter stenosis<30%) underwent intravascular ultrasound examination of the left anterior descending coronary artery for determination of vessel area, lumen area, plaque area, cross-sectional areas at reference segments, and remodeling index (the ratio of vessel area at the culprit lesion to vessel area at the proximal reference site). Further, vascular reactivity was examined using intracoronary administration of acetylcholine, papaverine, and nitroglycerin. RESULTS: Vessel area significantly correlated with plaque area in both groups (r=0.65, P<0.0001 and r=0.85, P<0.0001). Group 1 showed significantly greater acetylcholine-induced percentage changes in coronary blood flow (67+/-70 vs. 16+/-75%, P<0.05) and coronary artery diameter (-7+/-18 vs.-32+/-31%, P<0.01) and also significantly smaller coronary wall shear stress (65+/-27 vs. 81+/-32 dynes/cm, P<0.05) than group 2. The percentage increase in coronary blood flow induced by acetylcholine was significantly and positively correlated with remodeling index in group 1 (r=0.64, P<0.0001) but not in group 2 (r=-0.03, P=0.90) and was also significantly and positively correlated with coronary wall shear stress in group 1 (r=0.46, P<0.001) but not in group 2 (r=-0.33, P=0.19). CONCLUSIONS: Endothelium-dependent vasodilation in the resistance coronary artery correlates with remodeling via increased wall shear stress when target lesions %area stenosis is <40%.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Vasos Coronários/fisiopatologia , Endotélio Vascular/fisiopatologia , Estresse Mecânico , Remodelação Ventricular/fisiologia , Adulto , Idoso , Circulação Sanguínea , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vasodilatação
7.
Am J Cardiol ; 94(4): 484-7, 2004 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-15325935

RESUMO

This study assessed the impact of coronary vascular adaptive remodeling and coronary vascular reactivity on myocardial ischemia in patients with hypertension and left ventricular hypertrophy. Myocardial ischemia is associated with impaired endothelium-independent vasodilation of resistance coronary arteries and increased minimal coronary resistance. These changes may occur in association with lumen reduction caused by attenuated adaptive remodeling in response to plaque accumulation.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Circulação Coronária/fisiologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Isquemia Miocárdica/fisiopatologia , Resistência Vascular/fisiologia , Remodelação Ventricular/fisiologia , Acetilcolina , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Volume Cardíaco/fisiologia , Angiografia Coronária , Endotélio Vascular/fisiopatologia , Teste de Esforço , Feminino , Câmaras gama , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nitroglicerina , Papaverina , Estatística como Assunto , Radioisótopos de Tálio , Ultrassonografia de Intervenção , Vasodilatação/fisiologia , Vasodilatadores
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