Navegando por Palavras-chave "Infarto Do Miocárdio"

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    Comparação dos efeitos de duas estratégias hipolipemiantes sobre subclasses de lipoproteínas em pacientes com infarto agudo do miocárdio
    (Universidade Federal de São Paulo (UNIFESP), 2020-06-25) Pinto, Leticia Carolinni Dos Santos [UNIFESP]; Fonseca, Francisco Antonio Helfenstein [UNIFESP]; Universidade Federal de São Paulo
    BACKGROUND: Increased levels of low density lipoprotein-cholesterol (LDL-C) are related to cardiovascular disease. Prospective, randomized and controlled studies showed that statin treatment may decrease morbidity and mortality from atherosclerosis, specially from coronary disease. However, similar values of LDL-C can be distributed on many subclasses of LDL and intermediate lipoproteins (IDL) with possible implications for the residual cholesterol risk. OBJECTIVES: This study aimed to compare the effects of two highly effective lipid-lowering strategies on lipoprotein subclasses in subjects with acute myocardial infarction. In addition, associations between lipoprotein subclasses and the amount of myocardial infarction mass, as well as left ventricular function were evaluated by cardiac 3T magnetic resonance imaging (cMRI). METHODS: Prospective, randomized, open label study with blinded endpoints included 101 subjects with ST segment elevation myocardial infarction (STEMI) from nine hospitals of the city of São Paulo. All patients received tenecteplase in the first 6 h of STEMI and were hospitalized in the Hospital São Paulo of the Universidade Federal de São Paulo, in the first 24 h for coronary angiography (pharmacoinvasive strategy). At the hospital arrival, a written informed consent was obtained and the patients were randomized to receive a daily dose of rosuvastatin 20 mg or the combined simvastatin 40 mg/ezetimibe 10 mg. Blood samples were collected at admission and after 30 days of STEMI. Subclasses of lipoproteins were examined by polyacrylamid gel electroforesis. cMRI parameters were performed after 30 days of STEMI. RESULTS: Study population was composed predominantly by overweight males, smokers, and hypertensives. The two groups of patients had comparable coronary angiography with higher prevalence of the left anterior descending as culprit artery. After 30 days, cMRI revealed similar findings for both groups. The classical lipid profile (cholesterol, LDL-C, HDL-C, non-HDL-C, and triglycerides) was comparable between groups at baseline and after 30 days. Furthermore, both lipid-lowering strategies promoted similar changes on IDL and LDL subclasses. However, their effects were more pronounced on the less atherogenic lipoproteins (LDL 1-2), not changing the profile of small dense LDL particles (LDL3-7). There was an improvement with both therapies on the pattern of IDL subclasses. Finally, there was an association between baseline IDL subclasses and the amount of infarcted mass, especially IDL type C. CONCLUSIONS: Despite expressive decrease in the LDL-C levels, and improvement of IDL particles, both treatments did not improve the pattern of more atherogenic LDL particles. The infarcted myocardial mass seems related to the most atherogenic IDL subclass.
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    Efeitos do exercício resistido prévio ao infarto do miocárdio sobre a função cardíaca de ratas
    (Universidade Federal de São Paulo (UNIFESP), 2019-12-18) Silva, Flavio Andre [UNIFESP]; Tucci, Paulo Jose Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    There is evidence that aerobic exercise prior to myocardial infarction (MI) is capable of generating cardioprotection. However, the cardioprotective properties of resistance exercise (RE) in infarcted rats have been little investigated. Objective: To evaluate the effects of RE prior to myocardial infarction (MI) on cardiac morphology, cardiac function, and proteins that participate in calcium kinetics, associating them with muscle function and cardiorespiratory fitness in female rats. Methods: Wistar rats were distributed into the following groups: SSh: sedentary prior to false surgery (Sham) (n=9); SIM: sedentary prior to MI (n=19); TIM: previously trained to IM (n=13). The exercise program consisted of four sets of 8 to 12 movements carrying weights corresponding to 80% of the maximum load (CM g) five days a week for eight weeks on a rodent-adapted ladder. At the end of the eighth week, the animals underwent MI or sham surgery and were analysed four weeks later. p< 0,05 was considered to be statistically significant. Results: The TIM group rats presented smaller MI (TIM: 43±6,3% e SIM: 55±8,2) and the scar of MI (TIM: 1.2±0,21cm e SIM: 1.6±0,28). Mortality showed no statistical difference (SIM: 37% e TIM: 39). Previous ER mitigated atrial mass increase (mg/mm) (SSh: 1,1±0,1 SIM: 3,8±0,7; TIM: 2,7±0,6), right ventricle (mg/mm) (SSh: 4,5±0,5; SIM: 8,5±2,5; TIM: 6,2±1,0) and heart (mg/mm) (SSh: 22±1; SIM: 29±4; TIM: 26±2) compared to the rats of the SIM group. Left ventricular weight (mg/mm) was similar between groups (SSh: 16,2±0,7, SIM: 16,2±1,5; TIM: 16,9±0,8). The previous RE attenuated the enlargement of the left atrium area (cm²) (SSh: 0,37±0,03; SIM: 0,66±0,09; TIM: 0,52±0,13), wave E (m/s) (SSh: 0,86±0,09; SIM: 1,1±0,13; TIM: 0,97±0,16) and E/A ratio (SSh: 2,9±0,8; SIM: 5,9±1,7; TIM: 4,3±1,8) compared to the rats of the SIM group. The pulmonary water content (SSh: 79,8±0,27%; SIM: 80,71±1,7; TIM: 82,01±2,1) and hepatic (SSh: 70,56±0,1%; SIM: 70,34±0,9; TIM: 71,37±0,7) was superior in TIM. RE slowed down skeletal muscle mass decline (SSh: 0,12±0,01g; SIM: 0,13±0,01; TIM:0,15±0,04). The VO2pico (ml/kg/min) (SSh: 58±6; SIM: 51±10; TIM: 52±6) and maximum speed (Vmáx cm/s) (SSh: 85±12; SIM: 51±10; TIM: 52±6) were inferior in the infarcted. The protein expression (%Sham) of calcium sodium exchanger (NCX) (SSh: 100±32; SIM: 102±29; TIM: 123±39) and total phospholambam (tPLB) (SSh: 100±20; SIM: 86±8; TIM: 86±17) were not different between groups. The protein expression (%Sham) of SERCA2a (SSh: 100±13; SIM: 65±17; TIM:62±14,43) and phosphophorylated phospholambam (pPLB) (SSh: 100±32; SIM: 66±34; TIM: 58±23) were lower in infarcted animals. Conclusion: The RE performed prior to myocardial infarction minimized the size of the MI, alleviated left atrial dissection, attenuated myocardial hypertrophy, and increased muscle mass associated with better strength performance of the skeletal muscles.
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    Oxigenação hiperbárica melhora o controle redox e reduz a mortalidade na fase aguda do infarto do miocárdio em rato
    (Universidade Federal de São Paulo (UNIFESP), 2021) Oliveira, Mario Sergio De [UNIFESP]; Tucci, Paulo Jose Ferreira [UNIFESP]; Universidade Federal de São Paulo
    Introduction The potential of hyperbaric oxygenation to reduce cardiac lesions via redox homeostasis raises the possibility of extending the viability period of the at-risk myocardium. This circumstance is beneficial for late ischemic area reperfusion interventions. Aim The present study analyzed the changes in the redox system triggered by hyperbaric oxygenation therapy during acute myocardial infarction in rats. Material and methods Male Wistar EPM rats, weighing between 250 to 330 g (11-12 weeks of age) were used in the study. The rats (n = 138) were randomly separated into one of the following experimental groups: Sham (SH = 26), myocardial infarction (MI = 72), and infarction plus hyperbaric therapy (HBO = 40). The HBO therapy was carried out for 60 minutes on 2.5 absolute atmospheres. Heart samples were collected after 90 minutes of coronary occlusion and in a similar period for the SH group. Assays were performed to determine the total levels of superoxide dismutase, catalase, peroxiredoxin, and 3-nitrotyrosine proteins.Glutathione level was measured by indirect enzyme immunoassay. Superoxide anion was detected by the oxidation of dihydroethide on confocal microscopy. Nitrite and nitrate levels were evaluated by chemiluminiscence. Data are presented as mean + standard error of mean. Parametric data were analyzed with two-way ANOVA and Newman-Keuls post test. Kruskal-Wallis and Dunn’s post-test were applied to nonparametric data. The level of significance was set at p<0.05. Results Mortality was significantly higher in the MI group (37.5%) compared to the HBO group (15%). The infarction size was not significantly different between the HBO (38 ± 2.0%) and MI groups (43 ± 2.5%). Oxidized/reduced glutathione ratio (SH = 30+4; IM = 17+3; HBO = 10+1) and peroxiredoxin levels (SH = 1.45+0.26; MI = 1.24+0.18; HBO = 0.65+0.05; AU/ μg) were significantly higher in the SH and MI groups when compared to the HBO group. A significantly higher contente of superoxide dismutase (SH = xv 0.69+0.08; MI = 0.79+0.04; HBO = 1+0.06; AU/μg) and catalase (SH = 0.66+0.04; IM = 0.73+0.07; HBO = 0.97+0.06; AU/μg) was found in the HBO group compared to SH and MI groups. The 3-Nitrotyrosine (SH = 3.36+0.20; MI = 3.08+0.16; HBO = 2.40+0.18; AU) and superoxide radical (SH = 1.40+0.11; MI = 1.87+0.08; HBO = 0.86+0.08, AU) levels were significantly lower in the HBO group compared to the MI and SH groups. Conclusion The HBO therapy decreased mortality and improved redox control in the heart of rats in the acute phase of myocardial infarction.
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    Reabilitação cardíaca não supervisionada baseada em caminhadas progressivas melhora endurance muscular respiratória após infarto agudo do miocárdio - ensaio clínico controlado e randomizado
    (Universidade Federal de São Paulo (UNIFESP), 2017-08-22) Garcia, Bruna Caroline Matos [UNIFESP]; Guizilini, Solange [UNIFESP]; http://lattes.cnpq.br/1563905009199506; http://lattes.cnpq.br/3927525142193704; Universidade Federal de São Paulo (UNIFESP)
    The purpose of this study was to: evaluate respiratory muscle strength and endurance in patients recently suffering myocardial infarction (MI) at inpatient period and investigate the effects of a home-based walking program on respiratory strength and endurance in post-MI patients with low risk. Methods: Patients were randomized into: Usual Care Group (UCG) entailing regular care (n=23); and Intervention group (IG) entailing an outpatient home-based walking program (n=31). Healthy subjects gender and age-matched served as a control group for respiratory endurance variables. Respiratory muscle strength was evaluated through maximal inspiratory pressure (MIP) and endurance during the inpatient period, 15-days and 60-days after MI. Submaximal functional capacity was determined by 6-minute walk test (6MWT) at hospital discharge and 60 days after MI. Results: Both groups showed impaired inspiratory muscle strength at hospital discharge. When compared with healthy subjects, post MI patients had worse respiratory muscle endurance pressure (PTHMAX= 73.02 ±8.40 vs 44.47±16.32, p<0.05) and time (Tlim= 324.1±12.2 vs 58.7±93.3, p<0.05). Only the IG showed a significant improvement in MIP and PTHMAX in 15 days and 60 days after MI (p<0.05). When comparing groups, the IG achieved higher values for MIP, PTHMAX and Tlim 15 and 60 days after MI (p<0.01). The 60-day assessment revealed that the 6MWT distance and level of physical activity was significantly higher in the IG compared to the UCG. Conclusion: Low riskxii patients recently suffering a MI demonstrate impaired MIP and respiratory endurance compared to healthy subjects. A home-based walking program improved respiratory endurance and functional capacity.
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    Segurança Da Aplicação Precoce Do Teste De Caminhada De Seis Minutos Pós-Infarto Agudo Do Miocárdio
    (Universidade Federal de São Paulo (UNIFESP), 2018-09-12) Martinhao, Graciana Santos [UNIFESP]; Guizilini, Solange [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To Evaluate The Safety Of The 6mwt Performed On The Third Day After The Recent Acute Myocardial Infarction (Ami); To Evaluate Whether The Degree Of Coronary Obstruction Interferes With The Distance Covered And The Adverse Events And Whether There Is A Difference Between Patients With Uni Or Biarterial Versus Multiarterial Lesions In Relation To The Occurrence Of Adverse Events During The 6mwt". Method: This Is A Cross-Sectional Study, Carried Out At Hospital São Paulo - Unifesp. We Evaluated 184 Individuals Of Both Sexes, Aged 18 Years Or Older, On The Third Day After Ami. Individuals Were Divided Into Uni Or Biarterial And Multiarterial Groups According To The Number Of Compromised Arteries. The 6mwd" Were Measured In Meters And The Adverse Events Were Divided Into: Clinical And Hemodynamic. Complications That Could Aggravate The Patient's Condition Or Demand Immediate Action Were Considered Serious. Results: The Mean Age Was 57.9 Years And 76% Of The Individuals Were Male. 6mwd" Was 413.4 Meters
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    O Syntax Score como ferramenta de predição de eventos adversos em pacientes submetido à estratégia fármaco-invasiva no infarto agudo do miocárdio
    (Universidade Federal de São Paulo (UNIFESP), 2019-08-29) Cintra, Guilherme Fernandes [UNIFESP]; Caixeta, Adriano Mendes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Syntax Score (SS) is an excellent tool for assessing the anatomical severity of coronary disease and is a good predictor of post-treatment adverse events in stable patients as well as in acute coronary syndrome. However, there are no data in the literature about SS to assess the in-hospital prognosis of patients with ST-segment elevation myocardial infarction submitted to the pharmacoinvasive strategy as treatment. Objective: This study provides a retrospective analysis of the SS and residual Syntax Score (SSr), as well as other angiographic and clinical data of patients submitted to Pharmacoinvasive Strategy (PIS) through the STEMI protocol in the city of São Paulo with UNIFESP / HSP and to develop a new tool for adverse event prediction. Methods: Correlation of clinical data with anatomic and functional angiographic evaluation before and after angioplasty to evaluate the prognostic accuracy related to intrahospital mortality. A total of 679 consecutive patients were selected through this protocol, 530 of whom met the inclusion criteria (fibrinolysis prior to angioplasty and without previous history of coronary artery bypass graft). Results: Overall in-hospital mortality was 5.3%. The average Syntax Score was 11.8. However, when we associate the functional variables related to the culprit artery flow (TIMI Flow Initial/Final), we obtain a new and accurate prognostic tool for this population - the Syntax-Flow Score. Syntax-Flow Score demonstrates superior calibration and performance in the ROC curve and, when > 22, demonstrates superior statistical performance to predict adverse events in patients submitted to PIS (p <0.01), when compared with SS ≥ 15 (p = 0.11) or residual SS ≥ 7 (p = 0.04) analyzed alone. Conclusion: Due to a better accuracy compared to other prognostic scores, the Syntax-Flow score is a prognostic tool with superior performance for in-hospital mortality in patients undergoing PIS.