RESUMO
Sirtuins (SIRTs) are a class of nicotine adenine dinucleotide (NAD+)-dependent proteins which participate in numerous molecular pathways involved in various age-related human diseases, such as type II diabetes, cardiovascular (CV) diseases and cancer. They have a major role in apoptosis, inflammation, oxidative stress and metabolism regulation, traits that have a great impact on CV physiology and pathology. Their unique profile of NAD+ energy dependency makes them an appealing target for human intervention in cellular and metabolic processes. This review focuses on the recent advances of SIRTs research aiming to shed light on the emerging roles of SIRTs in the pathophysiology of CV and metabolic diseases.
Assuntos
Doenças Cardiovasculares/fisiopatologia , Doenças Metabólicas/fisiopatologia , Sirtuínas/metabolismo , Fatores Etários , Animais , Fenômenos Fisiológicos Cardiovasculares , Metabolismo Energético/fisiologia , Humanos , NAD/metabolismoRESUMO
This review summarizes the data challenging the concept that cardiovascular protection through high-density lipoprotein (HDL) is only associated with its serum concentration. This conventional impression about its protective role now appears obsolete. New aspects of its mechanisms are revealed and novel therapeutic strategies are based on them. However, data from long-term cost-effectiveness studies of treating HDL are still needed. There is a need for biomarkers that represent the functional characteristics of HDL in order to better quantify the total cardiovascular risk.
RESUMO
Radial artery spasm is one of the most commonly encountered problems during transradial interventions with a reported incidence in the range of 6-10%. Balloon-assisted tracking (BAT) of guide catheter has recently been described as a novel technique to overcome difficult radial artery anatomies including tortuosity, loops and spasm. In this report, we describe the successful use of BAT in a patient with radial artery spasm during primary angioplasty.
Assuntos
Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Artéria Radial , Adulto , Feminino , Humanos , Artéria Radial/anatomia & histologia , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , RadiografiaRESUMO
Cardiogenic shock (CS) during elective percutaneous coronary intervention (PCI) is a rare but potentially lethal clinical condition. Pharmacological inotropic support and mechanical circulatory assistance with intra-aortic balloon pump (IABP) counterpulsation remains the gold-standard treatment. We report the case of a patient who developed refractory CS during elective PCI and was successfully managed with concomitant use of IABP and the Impella 2.5 L support device.
Assuntos
Coração Auxiliar , Hemodinâmica/fisiologia , Balão Intra-Aórtico , Choque Cardiogênico/terapia , Cardiotônicos , Terapia Combinada , Doença da Artéria Coronariana/terapia , Feminino , Hemofiltração , Humanos , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Resultado do TratamentoRESUMO
Pseudoexfoliation syndrome is a primarily ophthalmological disorder caused by deposition of whitish-gray protein on the lens, iris, and multiple other eye tissues. There is increasing evidence over the previous years that pseudoexfoliation syndrome is a systemic disorder with various extraocular manifestations and has recently been linked to several cardiovascular disorders. The present article aims to summarize the current knowledge on cardiovascular implications of this well-described clinical entity.
RESUMO
Vessel perforation is an undesirable and life-threatening complication during vein graft angioplasty. We report on a case of vein graft rupture during angioplasty, which was successfully managed with deployment of a polytetrafluoroethylene-covered stent.
Assuntos
Materiais Revestidos Biocompatíveis , Ponte de Artéria Coronária/efeitos adversos , Reestenose Coronária/cirurgia , Complicações Intraoperatórias , Politetrafluoretileno , Veia Safena/lesões , Stents , Idoso , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Reestenose Coronária/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Ruptura , Veia Safena/transplante , Tomografia Computadorizada por Raios XRESUMO
A right coronary artery origin from the left coronary sinus and a left coronary origin from the right sinus although rarely encountered during routine cardiac catheterization, they represent two relatively common autopsy findings in young patients suffering sudden cardiac death. The interarterial course of the aberrant artery, between the aortic root and the pulmonary artery has been considered as a malignant variant, because of the higher risk of myocardial ischemia and sudden death. We present two rare cases of ectopic coronary origin from the opposite sinus of Valsalva.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Seio Aórtico/anormalidades , Seio Aórtico/diagnóstico por imagem , Angiografia Coronária , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada MultidetectoresRESUMO
Little information exists regarding the prevalence of aberrant or ectopic aortic arch vessels in patients with different cardiovascular anomalies. We present a young patient with an aberrant right subclavian artery associated with an ectopic left vertebral artery and a bicuspid aortic valve.
Assuntos
Anormalidades Múltiplas/diagnóstico , Aorta Torácica/anormalidades , Valva Aórtica/anormalidades , Aneurisma/diagnóstico , Anormalidades Cardiovasculares/diagnóstico , Transtornos de Deglutição/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Artéria Subclávia/anormalidades , Artéria Vertebral/anormalidades , Adulto JovemRESUMO
Traumatic dissection of the aorta is a well-documented entity with poor prognosis and broad spectrum of clinical presentations. We report a rare case of an asymptomatic late presentation of aortic dissection after a high-speed vehicle accident. This case highlights the importance of high clinical suspicion for the diagnosis of aortic dissection.
Assuntos
Aneurisma Aórtico/etiologia , Dissecção Aórtica/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnósticoRESUMO
High systolic blood pressure (SBP) has been linked to worse cardiovascular outcomes. However, emerging data suggest that in patients with heart failure (HF), low SBP correlates with increased mortality. The purpose was to examine the impact of baseline and post-exercise systolic and diastolic blood pressure (DBP), as well as pulse pressure (PP), on cardiac mortality in patients with systolic HF. One hundred sixty patients with systolic HF (left ventricular ejection fraction 33 ± 8) were studied. Blood pressure (BP) levels were determined at rest and at peak exercise during a cardiopulmonary exercise test. Patients were followed up for a period of 2.5 ± 0.8 years. During this period 22 patients died and 5 subjects underwent heart transplantation. Patients with higher SBP and DBP at rest, and patients with SBP ≥160 mmHg and PP ≥75 mmHg at peak exercise had the most favorable prognosis. There was a fourfold increase in cardiac mortality risk for patients with SBP <160 mmHg at peak exercise (hazard ratio: 3.97, 95% confidence interval: 1.60-9.84) and a threefold increase for patients with PP <75 mmHg at peak exercise (hazard ratio: 2.96, 95% confidence interval: 1.29-6.82). There is an inverse relationship between SBP and cardiac mortality in patients with systolic HF. BP response to exercise could serve as a simple risk stratification model in HF patients.
Assuntos
Pressão Sanguínea , Exercício Físico , Insuficiência Cardíaca Sistólica/fisiopatologia , Idoso , Distribuição de Qui-Quadrado , Teste de Esforço , Feminino , Grécia , Insuficiência Cardíaca Sistólica/mortalidade , Frequência Cardíaca , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Consumo de Oxigênio , Prognóstico , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Volume Sistólico , Função Ventricular EsquerdaRESUMO
We aimed to identify whether N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) at peak exercise can provide incremental clinical information over resting levels. A total of 90 patients with systolic heart failure were prospectively studied. Levels of plasma NT-proBNP were assessed at rest and at peak exercise during a cardiopulmonary exercise test. Patients were followed-up for 30 ± 10 months. Levels of NT-proBNP at baseline and peak exercise were significantly correlated with left ventricular ejection fraction ([LVEF] r = -.629, P < .001 and r = -.630, P < .001, respectively) and peak oxygen uptake ([Vo (2)] r = -.752, P < .001 and r = -.740, P < .001, respectively). Levels of plasma NT-proBNP at peak exercise demonstrated similar predictive ability for the detection of patients with low peak Vo (2) and LVEF <28%. Levels of plasma NT-proBNP can detect low-functional class patients and patients who may be the candidates for heart transplantation with high sensitivity and specificity. At baseline and peak exercise, NT-proBNP demonstrates similar prognostic and predictive ability.
Assuntos
Teste de Esforço , Insuficiência Cardíaca Sistólica/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Descanso , Disfunção Ventricular Esquerda/sangue , Adulto , Idoso , Biomarcadores/sangue , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Valor Preditivo dos Testes , Prognóstico , Volume Sistólico/fisiologiaRESUMO
Various electrocardiography (ECG) abnormalities have been reported in patients who present with pulmonary embolism (PE). Severe sepsis is also associated with ECG changes that may mimic ST elevation myocardial infarction. We report a case of an elderly patient with PE and septic shock associated with striking ECG changes.
RESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Radiografia Torácica , Ponte de Artéria Coronária/métodos , Embolia Pulmonar , Lobo Temporal/patologia , Lobo Temporal , Crânio/patologia , CrânioRESUMO
Extrusion of the generator is an infrequent complication following pacemaker implantation. Occlusion or stenosis of the deep venous system is common in elderly patients and can cause significant difficulties in transvenous pacing. The present study reports a rare case of pacemaker extrusion in an elderly patient with an inaccessible upper extremities deep venous system, requiring device reimplantation via the femoral route.
Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Embolia Pulmonar/etiologia , Adulto , Cistos Aracnóideos/complicações , Cistos Aracnóideos/cirurgia , Eletrocardiografia , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Lobo Temporal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Although Brevibacterium species used to be considered as nonpathogenic microorganisms until recently, it seems that they can cause a wide variety of clinical diseases by acting mostly as opportunistic pathogens. The present case is the second reported case of infective endocarditis by Brevibacterium species; however, it is the first reported infected native aortic valve in an immunocompetent patient.