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- ItemAcesso aberto (Open Access)Anti-hypertensive drugs have different effects on ventricular hypertrophy regression(Faculdade de Medicina / USP, 2010-01-01) Ferreira Filho, Celso [UNIFESP]; Abreu, Luiz Carlos de; Valenti, Vitor Engrácia [UNIFESP]; Ferreira, Marcelo; Meneghini, Adriano; Silveira, José Alexandre; Perez Riera, Andrés Ricardo [UNIFESP]; Colombari, Eduardo [UNIFESP]; Murad, Neif; Santos-Silva, Paulo Roberto; Silva, Lovian José Henrique Pereira da; Vanderlei, Luiz Carlos Marques; Carvalho, Tatiana Dias de [UNIFESP]; Ferreira, Celso [UNIFESP]; Faculdade de Medicina do ABC Disciplina de Cardiologia Departamento de Clínica Médica; Faculdade de Medicina do ABC Departamento de Morfologia e Fisiologia; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual Paulista (UNESP)OBJECTIVES: There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS: The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS: The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca++ channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca++ channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective β1 receptor antagonist) with respect to LVH regression. CONCLUSION: The anti-hypertensive drugs induced various degrees of hypertrophic regression.
- ItemSomente MetadadadosCardiomegaly is a common arrhythmogenic substrate in adult sudden cardiac deaths, and is associated with obesity(Lippincott Williams & Wilkins, 2012-04-01) Tavora, Fabio [UNIFESP]; Zhang, Y.; Zhang, M.; Li, L.; Ripple, M.; Fowler, D.; Burke, Allen; Univ Maryland; Universidade Federal de São Paulo (UNIFESP); Armed Forces Inst PatholBackground: Both coronary artery disease (CAD) and cardiomyopathy may present with sudden cardiac death (SCD). It is generally accepted that CAD is the most common cause of SCD in adults, but the frequency of cardiomegaly as a primary or contributing cause is less known.Methods: We retrospectively studied the cardiac findings of all cases of adult SCD attributed to cardiomegaly, severe atherosclerosis, or both, in the absence of specific cardiomyopathy. Association between findings and risk factors was studied.Results: There were 484 sudden cardiac deaths, of which 402 met study criteria. Mean age was 49 +/- 13 years, with 289 men and 159 African Americans (AAs). Cardiomegaly with presumed hypertensive, multifactorial or unknown cause, was the sole arrhythmogenic substrate in 38% of men and 49% of women (p = 0.003); CAD was the sole cause of SCD in 19% of men and 26% of women, and mixed CAD + cardiomegaly the cause of death in 43% of men and 25% of women. Cardiomegaly was associated by univariate analysis with younger age (46 +/- 12 years versus 53 +/- 14 for CAD, p < 0.0001), AA race (p = 0.004), and body mass index (p < 0.0001).Conclusions: Among adults with a mean age of about 50 years, cardiomegaly is a frequent cause of sudden cardiac death, and is highly associated with obesity. Cardiomegaly is also frequent in SCD with severe CAD. the causes and classification of cardiomegaly in patients without specific cardiomyopathy, and in patients with and without hypertension or coronary disease need to be better studied.
- ItemSomente MetadadadosCardioprotective effect of dexrazoxane during treatment with doxorubicin: A study using low-dose dobutamine stress echocardiography(Wiley-Blackwell, 2005-12-01) Paiva, Marcelo Goulart [UNIFESP]; Petrilli, Antonio Sergio [UNIFESP]; Moises, Valdir Ambrosio [UNIFESP]; Macedo, Carla Renata Pacheco Donato [UNIFESP]; Tanaka, Cristiana [UNIFESP]; Campos, Orlando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); GRACCAim. To assess the late cardioprotective effect of dexrazoxane associated with doxorubicin during treatment of osteosarcoma by means of low-dose dobutamine stress echocardiography (LDDSE) in non-relapsed asymptomatic children and teenagers.Patients and Methods. the study population included 58 patients with osteosarcoma divided in three groups, with equivalent age range, gender proportion and body surface area. Group I (21 patients, 14 males, 15 +/- 4 years) was analyzed before chemotherapy and considered the control group; Group II (19 patients, 11 males, 19.7 +/- 4 years) was treated with 348.4 +/- 18 mg/m(2) of doxorubicin only and Group III (18 patients, 14 male, 16.8 +/- 5 years) treated with 396.5 +/- 55 mg/m(2) of doxorubicin with dexrazoxane in the ratio 10:1. the patients were submitted to LDDSE (maximal dose 5 mu g/ kg/min). No major side effects were observed. Heart rate, blood pressure, left ventricular diameters, end systolic wall stress (ESWS), and other diastolic and systolic function indexes were assessed at rest conditions and during LDDSE and compared between the three groups.Results. Group III received a doxorubicin dose significantly greater than Group II (P = 0.001). During LDDSE there were no significant changes in the diastolic function indexes in any of the groups, but there was a significant increase of systolic indexes and a decrease of ESWS in Group III compared to group II. There was no significant difference of any systolic functional parameters between Group I and III. Considering the ejection fraction (EF) at rest or at LDDSE, 13 patients (69.4%) in Group II and 5 patients (27.7%) in Group III were considered to have systolic dysfunction. (P = 0.02).Conclusion. Myocardial response to LDDSE in patients treated with doxorubicin and dexrazoxane was similar to patients without chemotherapy and better than those treated with doxorubicin only, suggesting less cardiotoxicity.
- ItemSomente MetadadadosExercise training delays cardiac dysfunction and prevents calcium handling abnormalities in sympathetic hyperactivity-induced heart failure mice(Amer Physiological Soc, 2008-01-01) Medeiros, Alessandra; Rolim, Natale Pinheiro Lage; Oliveira, Rodrigo da Silva Fermino de; Rosa, Kaleizu Teodoro; Mattos, Katt Coelho; Casarini, Dulce Elena [UNIFESP]; Irigoyen, Maria Claudia; Krieger, Eduardo Moacyr; Krieger, Jose Eduardo; Negrao, Carlos Eduardo; Brum, Patricia Chakur; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Exercise training (ET) is a coadjuvant therapy in preventive cardiology. It delays cardiac dysfunction and exercise intolerance in heart failure (HF); however, the molecular mechanisms underlying its cardioprotection are poorly understood. We tested the hypothesis that ET would prevent Ca2+ handling abnormalities and ventricular dysfunction in sympathetic hyperactivity-induced HF mice. A cohort of male wildtype (WT) and congenic (alpha 2A/alpha 2C)-adrenoceptor knockout ((alpha 2A/alpha 2C)ARKO) mice with C57BL6/J genetic background (3-5 mo of age) were randomly assigned into untrained and exercise-trained groups. ET consisted of 8-wk swimming session, 60 min, 5 days/wk. Fractional shortening (FS) was assessed by two-dimensional guided M-mode echocardiography. the protein expression of ryanodine receptor (RyR), phospho-Ser(2809)-RyR, sarcoplasmic reticulum Ca2+ ATPase (SERCA2), Na+/Ca2+ exchanger (NCX), phospholamban (PLN), phospho-Ser(16)-PLN, and phospho-Thr(17)-PLN were analyzed by Western blotting. At 3 mo of age, no significant difference in FS and exercise tolerance was observed between WT and (alpha 2A/alpha 2C)ARKO mice. At 5 mo, when cardiac dysfunction is associated with lung edema and increased plasma norepinephrine levels, (alpha 2A/alpha 2C)ARKO mice presented reduced FS paralleled by decreased SERCA2 (26%) and NCX (34%). Conversely, (alpha 2A/alpha 2C)ARKO mice displayed increased phospho-Ser(16)-PLN (76%) and phospho-Ser(2809)-RyR (49%). ET in (alpha 2A/alpha 2C)ARKO mice prevented exercise intolerance, ventricular dysfunction, and decreased plasma norepinephrine. ET significantly increased the expression of SERCA2 (58%) and phospho-Ser(16)-PLN (30%) while it restored the expression of phospho-Ser(2809)-RyR to WT levels. Collectively, we provide evidence that improved net balance of Ca2+ handling proteins paralleled by a decreased sympathetic activity on ET are, at least in part, compensatory mechanisms against deteriorating ventricular function in HF.
- ItemSomente MetadadadosHeart Failure Survival Score in Patients With Chagas Disease: Correlation With Functional Variables(Ediciones Doyma S A, 2012-06-01) Ritt, Luiz E. [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Feitosa, Gilson S.; Pinho-Filho, Joel A.; Macedo, Cristiano R. B.; Vilas-Boas, Fabio; Andrade, Marcus V. S.; Feitosa-Filho, Gilson S.; Almeida, Augusto J. G.; Barojas, Marcos; Lopes, Renato D. [UNIFESP]; Duke Clin Res Inst; Universidade Federal de São Paulo (UNIFESP); Hosp Santa Izabel; Brazilian Clin Res InstIntroduction and objectives: Chagas disease is a prevalent cause of heart failure in Latin America, and its prognosis is worse than other etiologies. the Heart Failure Survival Score has been used to assess prognosis in patients with heart failure; however, this score has not yet been studied in patients with Chagas cardiopathy.Methods: the Heart Failure Survival Score was calculated in 55 patients with severe left ventricular systolic dysfunction due to Chagas disease. Correlations were assessed between the Heart Failure Survival Score and variables obtained from echocardiograms, cardiopulmonary exercise tests, quality-of-life measures, and 6-minute walking tests.Results: Patients were distributed among New York Heart Association classes II-IV; 89% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 62% were taking beta-blockers, 86% were taking diuretics, and 74% were taking aldosterone receptor blockers. the mean Heart Failure Survival Score was 8.75 (0.80). the score correlated well with cardiopulmonary test variables such as peak oxygen uptake (0.662; P<.01), oxygen uptake at the anaerobic threshold (0.644; P<.01), ventilation carbon dioxide efficiency slope (-0.417; P<.01), oxygen pulse (0.375; P<.01), oxygen uptake efficiency slope (0.626; P<.01), 6-minute walking test (0.370; P<.01), left ventricle ejection fraction (0.650; P=.01), and left atrium diameter (-0.377; P<.01). There was also a borderline significant correlation between the Heart Failure Survival Score and quality of life (-0.283; P<.05).Conclusions: in heart failure patients with Chagas disease, the Heart Failure Survival Score correlated well with the main prognostic functional test variables. (c) 2011 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L. All rights reserved.
- ItemSomente MetadadadosHeart Rate Variability and Cardiopulmonary Dysfunction in Patients with Duchenne Muscular Dystrophy: A Systematic Review(Springer, 2018) Silva, Talita Dias da [UNIFESP]; Massetti, Thais; Crocetta, Tania Brusque; Monteiro, Carlos Bandeira de Mello; Carll, Alex; Vanderlei, Luiz Carlos Marques; Arbaugh, Carlie; Oliveira, Fernando Rocha; Abreu, Luiz Carlos de; Ferreira Filho, Celso [UNIFESP]; Godleski, John; Ferreira, Celso [UNIFESP]Duchenne muscular dystrophy (DMD) is a genetic recessive disorder with progressive muscle weakness. Despite the general muscle wasting, degeneration and necrosis of cardiomyocytes have been the main causes of morbidity and death in individuals with DMD. Cardiac failure is generally preceded by disturbances in heart rate variability (HRV), and non-invasive measurement of the autonomic nervous system has been an important tool to predict adverse cardiovascular events. Hence, the application of HRV to study autonomic modulation in DMD individuals, and the establishment of correlations between HRV and heart/lung diseases, age, and mortality will have the potential to improve quality of life and life expectancy of individuals with DMD. In order to evaluate the state of the art in this field, we conducted a systematic search in Medline/PubMed and BVS (virtual library in health) databases. We selected 8 studies using pre-defined criteria and meta-analysis revealed decreased parasympathetic activity and increased sympathetic predominance in individuals with DMD as major observations. Moreover, there is a strong association between diminished HRV and myocardial fibrosis with DMD. These patterns are evident in patients at early-stage DMD and become more prominent as disease severity and age increase. Thus, data minning clearly indicates that HRV assessment can be used as a predictor for sudden death in individuals with DMD. The use of the HRV, which is inexpensive, ubiquitously available in clinics and hospitals, and a non-invasive analysis tool, can save lives and decrease the morbity in DMD by alerting care givers to consider autonomic nervous system intervention.
- ItemSomente MetadadadosLeft Atrial Dysfunction in Chagas Cardiomyopathy Is More Severe Than in Idiopathic Dilated Cardiomyopathy: A Study with Real-Time Three-Dimensional Echocardiography(Elsevier B.V., 2011-05-01) Mancuso, Frederico José Neves [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Moisés, Valdir Ambrósio [UNIFESP]; Oliveira, Wercules Antonio [UNIFESP]; Mello, Eduardo S. [UNIFESP]; Poyares, Dalva [UNIFESP]; Tufik, Sergio [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Campos, Orlando [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Although there is anatomopathologic evidence of atrial involvement in Chagas cardiomyopathy (CCM), the impact in left atrial (LA) function is unknown. the aim of this study was to evaluate LA function in patients with CCM with real-time three-dimensional echocardiography (RT3DE) and to compare it with patients with idiopathic dilated cardiomyopathy (DCM).Methods: A total of 30 patients with CCM, 30 patients with DCM, and 20 normal subjects used as the control group were studied. With the use of RT3DE, we measured LA maximum (maxLAV), minimum, and pre-atrial contraction volumes and calculated total and active LA emptying fractions.Results: Left ventricular ejection fraction and mitral regurgitation were similar in both groups. MaxLAV/m(2) was larger in the CCM group than in the DCM group (76.9 +/- 21.9 mL vs. 59.1 +/- 26.0 mL; P < .01), and both were significantly larger than in the control group (P < .01). Total LA emptying fraction was lower in the CCM group than in the DCM group (0.30 +/- 0.10 vs. 0.40 +/- 0.12; P < .01), and both were lower than in the control group (P = .01). Active LA emptying fraction was also lower in the CCM group than in the DCM group (0.22 +/- 0.09 vs. 0.28 +/- 0.11; P < .01), and both were lower than in the control group (P = .01). the E/e' ratio was higher in the CCM group than in the DCM group (21 +/- 10 vs. 15 +/- 6; P < .01), and both were greater than in the control group (P < .01). in a multiple regression model, the E/e' ratio was the only independent predictor of a worsening active LA emptying fraction.Conclusion: LA function is more compromised in patients with CCM than in patients with DCM. This finding indicates a more diffuse and severe myocardial impairment in Chagas disease that is probably related to increased left ventricular filling pressures and atrial myopathy. (J Am Soc Echocardiogr 2011;24:526-32.)
- ItemSomente MetadadadosMyocardial dysfunction in mitochondrial diabetes treated with coenzyme Q10(Elsevier B.V., 2006-04-01) Salles, João Eduardo Nunes [UNIFESP]; Moises, Valdir Ambrosio [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Chacra, Antonio Roberto [UNIFESP]; Moises, Regina Celia Mello Santiago [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Maternally-inherited diabetes and deafness (MIDD) has been related to an A to G transition in the mitochondrial tRNA Leu (UUR) gene at the base pair 3243. Although some previous articles have reported that this mutation may be a cause of cardiomyopathy in diabetes, the degree of cardiac involvement and a specific treatment has not been established. Here, we reported a case of a patient with MIDD who developed congestive heart failure and the therapeutic usefulness of Coenzyme Q10 (CoQ10). in our patient, after the introduction of Coenzyme Q10 150 mg/day, there was a gradual improvement on left ventricular function evaluated by echocardiography. the fractional shortening (FS) and ejection fraction (EF) increased from 26 to 34% and from 49 to 64%, respectively. No side effects were noted. Three months after CoQ10 discontinuation, the parameters of systolic function evaluated by echocardiography decreased, suggesting that CoQ10 had a beneficial effect. Identification of diabetes and cardiomyopathy due to mitochondrial gene mutation may have therapeutic implications and Coenzyme Q10 is a possible adjunctive treatment in such patients. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
- ItemSomente MetadadadosMyocarditis in children and detection of viruses in myocardial tissue: Implications for immunosuppressive therapy(Elsevier B.V., 2011-04-14) Camargo, Paulo Roberto; Okay, Thelma Suely; Yamamoto, Lidia; Barbaro Del Negro, Gilda Maria; Lopes, Antonio Augusto; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Background: There is scarce information on the potential benefits of immunosuppression in children with myocarditis and viral genomes in myocardium. We investigated the occurrence of myocarditis in children with a preliminary diagnosis of dilated cardiomyopathy, the frequency of cardiotropic viruses in the myocardium, and the response to immunosuppression.Methods: Thirty patients (nine months to 12 years) with left ventricular ejection fraction of 22.8 +/- 4.1% were subjected to right cardiac catheterization and endomyocardial biopsy. Specimens were analyzed for the presence of inflammatory elements (Dallas criteria) and viral genome (polymerase chain reaction). Patients with active myocarditis received immunosuppressants (azatioprine and prednisone) and were recatheterized nine months later. A historical control group of nine patients with myocarditis who did not receive immunosuppressants was included.Results: Active myocarditis was diagnosed in ten patients (five with viral genomes detected). Immunosuppression resulted in a significant increase in left ventricular ejection fraction from 25.2 +/- 2.8% to 45.7 +/- 8.6% (versus 20.0 +/- 4.0% to 22.0 +/- 9.0% in historical controls, p < 0.01) and cardiac index from 3.28 +/- 0.51 L/min/m(2) to 4.40 +/- 0.49 L/min/m(2) (versus 3.50 +/- 0.40 L/min/m(2) to 3.70 +/- 0.50 L/min/m(2) in controls, p < 0.01), regardless of the presence of viral genomes (p - 0.98 and p - 0.22, respectively for the two variables). No relevant clinical events were observed. Non-inflammatory cardiomyopathy was diagnosed in 20 patients (seven with viral genomes). While on conventional therapy, there were four deaths and three assignments to transplantation, and no improvement of left ventricular ejection fraction in the remaining ones (22.5 +/- 3.6% to 27.5 +/- 10.6%).Conclusion: Children with chronic myocarditis seem to benefit from immunosuppressive therapy, regardless of the presence of viral genome in the myocardium. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
- ItemAcesso aberto (Open Access)Realce tardio miocárdico por ressonância magnética cardíaca identifica risco para taquicardia ventricular na cardiopatia chagásica crônica(Universidade Federal de São Paulo (UNIFESP), 2016-10-20) Mello, Ronaldo Peixoto de [UNIFESP]; Paola, Angelo Amato Vincenzo de [UNIFESP]; http://lattes.cnpq.br/6259836166380719; http://lattes.cnpq.br/5327559642116666; Universidade Federal de São Paulo (UNIFESP)Background: Invasive and non-invasive tests have been used to identify the risk of ventricular tachycardia in patients with Chagas' Cardiomyopathy. Cardiac Magnetic Resonance Imaging using the Delayed Enhancement technique can be useful to select patients with global or segmentary ventricular dysfunction, with high degree of fibrosis and at higher risk for clinical Ventricular Tachycardia. Objective: To improve the identification of predictors of Ventricular Tachycardia in patients with Chagas? Cardiomyopathy. Methods: This study assessed 41 patients with Chagas? Cardiomyopathy [30 (72%) males; mean age, 55.1 ± 11.9 years]. Twenty-six patients had history of Ventricular Tachycardia (VT group), and 15 had no Ventricular Tachycardia (non-VT group). All patients enrolled had Delayed Enhancement and segmentary ventricular dysfunction. In each case, the following variables were determined: left ventricular percentage of ventricular wall thickness impairment; percentage and Delayed Enhancement distribution in each segment. Results: No statistical difference regarding the Delayed Enhancement percentage between both groups was observed: VT group = 30.0 ± 16.2%; non-VT group = 21.7 ± 15.7%; p = 0.118. The presence of two or more contiguous transmural fibrosis segments was a predictor of Ventricular Thachycardia. Conclusion: The identification of two or more segments of transmural Delayed Enhancement by use of Cardiac Magnetic Resonance Imaging is associated with the occurrence of clinical Ventricular Tachycardia in patients with Chagas? Cardiomyopathy.
- ItemSomente MetadadadosSynchronous Ventricular Pacing without Crossing the Tricuspid Valve or Entering the Coronary Sinus-Preliminary Results(Wiley-Blackwell, 2009-12-01) Henz, Benhur Davi [UNIFESP]; Friedman, Paul A.; Bruce, Charles J.; Okumura, Yasuo; Johnson, Susan B.; Danielsen, Andrew; Packer, Douglas L.; Asirvatham, Samuel J.; Mayo Clin; Universidade Federal de São Paulo (UNIFESP); Nihon UnivBackground: Right ventricular apical (RVA) pacing promotes tricuspid regurgitation (TR), electromechanical dyssynchrony, and ventricular dysfunction. We tested a novel intramyocardial bipolar lead to assess whether stimulation of the atrioventricular septum (AVS) produces synchronous ventricular activation without crossing the tricuspid valve (TV).Methods: A lead with an active external helix and central pin was placed on the AVS and the RVA in three dogs. High-density electroanatomic (EA) mapping was performed of both ventricles endocardially and epicardially. Intracardiac echocardiography was used to access ventricular synchrony.Results: the lead was successfully deployed into the AVS in all cases with consistent capture of the ventricular myocardium without atrial capture or sensing. the QRS duration was less with AVS compared with RVA pacing (89 +/- 4 ms vs. 100 +/- 11 ms [P < 0.0001, GEE P = 0.03]). There was decreased delay between color Doppler M-mode visualized peak contraction of the septum and the mid left ventricular free wall with AVS compared with RVA pacing (89 +/- 91 ms vs. 250 +/- 11 ms [P < 0.0001, GEE P = 0.006]). Activation time between the mid septum and mid free wall was shorter with AVS versus RVA pacing (20.4 +/- 7.7 vs. 30.8 +/- 11.6 [P = 0.01, GEE P = 0.07]). the interval between QRS onset to earliest free wall activation was shorter with AVS vs. RVA pacing (19.2 +/- 6.4 ms vs. 31.1 +/- 11.7 ms [P = 0.005, GEE P = 0.02]).Conclusion: the AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV.(J Cardiovasc Electrophysiol, Vol. 20, pp. 1391-1397, December 2009).