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Gadioli LP, Schmidt A, Maciel BC, Volpe GJ, Simões MV, Marin-Neto JA. Chagas Cardiomyopathy and Myocardial Sympathetic Denervation. Curr Cardiol Rep 2024:10.1007/s11886-024-02057-y. [PMID: 38656586 DOI: 10.1007/s11886-024-02057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW More than a century since its discovery, the pathogenesis of Chagas heart disease (CHD) remains incompletely understood. The role of derangements in the autonomic control of the heart in triggering malignant arrhythmia before the appearance of contractile ventricular impairment was reviewed. RECENT FINDINGS Although previous investigations had demonstrated the anatomical and functional consequences of parasympathetic dysautonomia upon the heart rate control, only recently, coronary microvascular disturbances and sympathetic denervation at the ventricular level have been reported in patients and experimental models of CHD, exploring with nuclear medicine methods their impact on the progression of myocardial dysfunction and cardiac arrhythmias. More important than parasympathetic impaired sinus node regulation, recent evidence indicates that myocardial sympathetic denervation associated with coronary microvascular derangements is causally related to myocardial injury and arrhythmia in CHD. Additionally, 123I-MIBG imaging is a promising tool for risk stratification of progression of ventricular dysfunction and sudden death.
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Affiliation(s)
- Leonardo Pippa Gadioli
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - André Schmidt
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Benedito Carlos Maciel
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Jardim Volpe
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
- Interventional Cardiology Unit, Division of Cardiology, Medical School of Ribeirao Preto, University of Sao Paulo, Campus Universitário, Bairro Monte Alegre, S/N-Ribeirão Preto, Estado de São Paulo, CEP, 14048-900, Brazil.
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Zuppo Laper I, Camacho-Hubner C, Vansan Ferreira R, Leite Bertoli de Souza C, Simões MV, Fernandes F, de Barros Correia E, de Jesus Lopes de Abreu A, Silva Julian G. Assessment of potential transthyretin amyloid cardiomyopathy cases in the Brazilian public health system using a machine learning model. PLoS One 2024; 19:e0278738. [PMID: 38359001 PMCID: PMC10868784 DOI: 10.1371/journal.pone.0278738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/15/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES To identify and describe the profile of potential transthyretin cardiac amyloidosis (ATTR-CM) cases in the Brazilian public health system (SUS), using a predictive machine learning (ML) model. METHODS This was a retrospective descriptive database study that aimed to estimate the frequency of potential ATTR-CM cases in the Brazilian public health system using a supervised ML model, from January 2015 to December 2021. To build the model, a list of ICD-10 codes and procedures potentially related with ATTR-CM was created based on literature review and validated by experts. RESULTS From 2015 to 2021, the ML model classified 262 hereditary ATTR-CM (hATTR-CM) and 1,581 wild-type ATTR-CM (wtATTR-CM) potential cases. Overall, the median age of hATTR-CM and wtATTR-CM patients was 66.8 and 59.9 years, respectively. The ICD-10 codes most presented as hATTR-CM and wtATTR-CM were related to heart failure and arrythmias. Regarding the therapeutic itinerary, 13% and 5% of hATTR-CM and wtATTR-CM received treatment with tafamidis meglumine, respectively, while 0% and 29% of hATTR-CM and wtATTR-CM were referred to heart transplant. CONCLUSION Our findings may be useful to support the development of health guidelines and policies to improve diagnosis, treatment, and to cover unmet medical needs of patients with ATTR-CM in Brazil.
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Gadioli LP, Miranda CH, Marin-Neto JA, Volpe GJ, Filho ACLB, Filho AP, Pintya AO, de Figueiredo AB, Simões MV. Regional myocardial sympathetic denervation precedes the development of left ventricular systolic dysfunction in chronic Chagas' cardiomyopathy. J Nucl Cardiol 2022; 29:3166-3176. [PMID: 34981413 DOI: 10.1007/s12350-021-02869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/20/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Regional myocardial sympathetic denervation is a conspicuous and early disorder in patients with chronic Chagas' cardiomyopathy (CCC), potentially associated to the progression of myocardial dysfunction OBJECTIVE: To evaluate in a longitudinal study the association between the presence and the progression of regional myocardial sympathetic denervation with the deterioration of global and segmental left ventricular dysfunction in CCC. METHODS 18 patients with CCC were submitted at initial evaluation and after 5.5 years to rest myocardial scintigraphy with 123Iodo-metaiodobenzylguanidine and 99mTc-sestamibi and to two-dimensional echocardiography to assess myocardial sympathetic denervation, extent of fibrosis, and the left ventricular ejection fraction (LVEF) and wall motion abnormalities. RESULTS In the follow-up evaluation, compared to the initial one, we observed a significant decrease in LVEF (56 ± 11 to 49% ± 12; P = .01) and increased summed defects scores in the myocardial innervation scintigraphy (15 ± 10 to 20 ± 9; P < .01). The presence of regional myocardial sympathetic denervation in ventricular regions of viable non-fibrotic myocardium presented an odds ratio of 4.25 for the development of new wall motion abnormalities (P = .001). CONCLUSION Regional and global myocardial sympathetic denervation is a progressive derangement in CCC. In addition, the regional denervation is topographically associated with areas of future development of regional systolic dysfunction in patients with CCC.
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Affiliation(s)
- Leonardo Pippa Gadioli
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Carlos Henrique Miranda
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Gustavo Jardim Volpe
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Antonio Pazin Filho
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio Osvaldo Pintya
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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Vargas AL, Dias BDP, Moreira HT, Oliveira Filho ECD, Tanaka DM, Simões MV, Maciel BC, Schmidt A, Marin Neto JA, Romano MMD. Prospective study of ventricular function and myocardial deformation related to survival in acute Chagas disease: an experimental animal model. Rev Inst Med Trop Sao Paulo 2021; 63:e61. [PMID: 34378764 PMCID: PMC8357302 DOI: 10.1590/s1678-9946202163061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/23/2021] [Indexed: 11/22/2022] Open
Abstract
Chagas disease (CD) has been changing from an endemic Latino-American disease to a condition found outside endemic regions, due to migratory movements. Although often subclinical, its acute phase can be lethal. This study aimed to assess survival during the acute phase of CD and its relationship with ventricular function in an experimental model. To this end, 30 Syrian hamsters were inoculated with Trypanosoma cruzi (IG) and other 15 animals received saline solution (CG). Groups were monitored daily and submitted to echocardiography in two moments: before the challenge and 15 days post-infection. Left ventricular ejection fraction (LVEF) and global longitudinal myocardial strain (GLS) of the LV were measured. The IG was divided into groups of animals with and without clinical signs of disease. ANOVA for mixed models was used to compare ventricular function parameters. Survival analysis was studied using Kaplan-Meier curves and the log-rank test. The follow-up lasted 60 days. LVEF in IG was reduced through time (53.80 to 43.55%) compared to CG (57.86 to 59.73%) (p=0.002). There was also a reduction of GLS (-18.97% to -12.44%) in the IG compared to CG (p=0.012). Twelve animals from IG died compared to one animal from CG. Eleven out of the 12 animals from the IG group died before presenting with clinical signs of infection. Survival was reduced in the IG compared to CG over time (p=0.02). The reduced survival during the acute phase of this experimental model of Chagas disease was related to the significant reduction of LV function. The mortality rate in the IG was higher in the group presenting with clinical signs of infection.
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Affiliation(s)
- Arthur Lauand Vargas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - Beatriz de Paula Dias
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - Henrique Turin Moreira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - Edgard Camilo de Oliveira Filho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - Denise Mayumi Tanaka
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - Marcus Vinicius Simões
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - Benedito Carlos Maciel
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - André Schmidt
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - José Antônio Marin Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
| | - Minna Moreira Dias Romano
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Centro de Cardiologia, Ribeirão Preto, São Paulo, Brazil
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Bocchi EA, Moreira HT, Nakamuta JS, Simões MV. Implications for Clinical Practice from a Multicenter Survey of Heart Failure Management Centers. Clinics (Sao Paulo) 2021; 76:e1991. [PMID: 33503176 PMCID: PMC7798368 DOI: 10.6061/clinics/2021/e1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.
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Affiliation(s)
- Edimar Alcides Bocchi
- Nucleo de Insuficiencia Cardiaca, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Henrique Turin Moreira
- Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
| | | | - Marcus Vinicius Simões
- Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, BR
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Blacher M, Zimerman A, Engster PHB, Grespan E, Polanczyk CA, Rover MM, Neto JADF, Danzmann LC, Bertoldi EG, Simões MV, Beck-da-Silva L, Biolo A, Rohde LE. Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II. Heart 2020; 107:1487-1492. [PMID: 33361353 DOI: 10.1136/heartjnl-2020-317984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE New York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial. METHODS The ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient's self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0-100). RESULTS Of 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4-30) for class I vs 27.5 (11-49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248-1333) vs 778 (421-1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330-466) vs 351 m (286-408), p=0.028; overlap=64%). Among NYHA class I patients, 19%-34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%-10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14). CONCLUSIONS Most patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.
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Affiliation(s)
- Mariana Blacher
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - André Zimerman
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro H B Engster
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo Grespan
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carisi A Polanczyk
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Luiz C Danzmann
- Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil
| | | | | | - Luis Beck-da-Silva
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Andréia Biolo
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luis E Rohde
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil .,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Simões MV, Alves SMM, Fernandes F, Coelho Filho OR, Mangini S. Emerging Topics in Heart Failure: New Paradigms in Cardiac Amyloidosis. Arq Bras Cardiol 2020; 115:945-948. [PMID: 33295462 PMCID: PMC8452217 DOI: 10.36660/abc.20201126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 11/18/2022] Open
Abstract
Evidências recentes sugerem que a amiloidose cardíaca é uma doença amplamente subdiagnosticada, particularmente na sua forma ligada à transtirretina, podendo ser uma causa comum de insuficiência cardíaca com fração de ejeção preservada (ICFEP) no idoso. Os novos paradigmas sobre a doença incluem o desenvolvimento de novas terapias específicas que modificam a história natural da doença. Este artigo traz uma síntese destes novos conceitos.
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Affiliation(s)
- Marcus Vinicius Simões
- Divisão de Cardiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Fabio Fernandes
- Incor - Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Sandrigo Mangini
- Incor - Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil
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Simões MV, Tanaka DM, Marin-Neto JA. Nuclear Medicine Methods for Assessment of Chronic Chagas Heart Disease. International Journal of Cardiovascular Sciences 2020. [DOI: 10.36660/ijcs.20200153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Fernandes F, Ramires FJA, Fernandes FD, Simões MV, Mesquita ET, Mady C. Pericardial Affections in Patients with COVID-19: A Possible Cause of Hemodynamic Deterioration. Arq Bras Cardiol 2020; 115:569-573. [PMID: 33027382 PMCID: PMC9363091 DOI: 10.36660/abc.20200474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Fábio Fernandes
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração,São Paulo, SP - Brasil
| | - Felix José Alvarez Ramires
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração,São Paulo, SP - Brasil
| | | | - Marcus Vinicius Simões
- Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto,Ribeirão Preto, SP - Brasil
| | | | - Charles Mady
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração,São Paulo, SP - Brasil
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Migliavaca CB, Stein C, Colpani V, Eibel B, Bgeginski R, Simões MV, Rohde LE, Falavigna M. High-dose versus low-dose angiotensin converting enzyme inhibitors in heart failure: systematic review and meta-analysis. Open Heart 2020; 7:openhrt-2019-001228. [PMID: 32820054 PMCID: PMC7443275 DOI: 10.1136/openhrt-2019-001228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/07/2020] [Accepted: 07/13/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To systematically review evidence comparing the effect of low-dose versus high-dose ACE inhibitors (ACEIs) on all-cause and cardiovascular mortality and hospitalisation, functional capacity and side effects in patients with heart failure (HF). METHODS We searched PubMed, Embase, Cochrane CENTRAL and LILACS up to January 2019. We included randomised controlled trials (RCTs) comparing low-dose versus high-dose ACEIs in adults with HF with reduced left ventricular ejection fraction (HFrEF). Study selection and data extraction were performed by two independent reviewers. Risk of bias was assessed with RoB 2.0, and quality of evidence with Grading of Recommendations Assessment, Development and Evaluation (GRADE). We conducted random effects meta-analysis and trial sequential analysis. RESULTS We included eight RCTs (5829 patients with HF). In comparison with low-dose ACEIs, high-dose ACEIs showed a non-significant effect on all-cause mortality (8 RCTs, n=5828, relative risk (RR) 0.95, 95% CI 0.88 to 1.02; moderate quality of evidence), cardiovascular mortality (6 RCTs, n=4048, RR 0.93, 95% CI 0.85 to 1.01; moderate quality of evidence), all-cause hospitalisation (5 RCTs, n=5394, RR 0.95, 95% CI 0.82 to 1.10; moderate quality of evidence) and cardiovascular hospitalisation (4 RCTs, n=5242, RR 0.98, 95% CI 0.83 to 1.17; low quality of evidence). High-dose ACEI increased functional capacity (4 studies, n=555, standardised mean difference 0.38, 95% CI 0.20 to 0.55; low quality of evidence) and the risk of hypotension (4 RCTs, n=3783, RR 1.64, 95% CI 1.30 to 2.05; moderate quality of evidence). High-dose ACEI had no effect on dizziness (3 RCTs, n=4994, RR 1.37, 95% CI 0.97 to 1.93; low quality of evidence), but decreased the risk of cough (4 RCTs, n=5146, RR 0.85, 95% CI 0.73 to 0.98; moderate quality of evidence). CONCLUSIONS The magnitude of benefit of using high dose versus low to intermediate doses of ACEIs might be less than traditionally suggested in clinical guidelines. These findings might help clinicians address the complex task of HF management in a more rational and timely fashion, saving efforts to implement strategies with the greatest net clinical benefit.
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Affiliation(s)
- Celina Borges Migliavaca
- Institute for Education and Research, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil .,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Cinara Stein
- Institute for Education and Research, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
| | - Verônica Colpani
- Institute for Education and Research, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil
| | - Bruna Eibel
- Post Graduate Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS, Brazil.,Fisioterapia, Centro Universitário da Serra Gaúcha, Caxias do Sul, RS, Brazil
| | - Roberta Bgeginski
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | | | - Luiz Eduardo Rohde
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Maicon Falavigna
- Institute for Education and Research, Hospital Moinhos de Vento (HMV), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Barizon GC, Simões MV, Schmidt A, Gadioli LP, Murta Junior LO. Relationship between microvascular changes, autonomic denervation, and myocardial fibrosis in Chagas cardiomyopathy: Evaluation by MRI and SPECT imaging. J Nucl Cardiol 2020; 27:434-444. [PMID: 29696485 DOI: 10.1007/s12350-018-1290-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between microvasculopathy, autonomic denervation, and myocardial fibrosis, in Chagas cardiomyopathy is incompletely understood. The aim of this study was to explore the relative extent and anatomic distribution of myocardial hypoperfusion, autonomic denervation, and myocardial scarring using Single-Photon Emission Computerized Tomography (SPECT) imaging and Magnetic Resonance Imaging (MRI). METHODS Thirteen patients with Chagas disease all had Iodine-123-metaiodobenzylguanidine (MIBG) SPECT, 99mTc-Sestamibi (MIBI) rest-stress SPECT, and gadolinium late enhancement MRI imaging within a 2-month interval. The anatomic location and extent of denervation, of stress-induced hypoperfusion and fibrosis, were assessed through image co-registration and quantification of abnormal tissue areas as a percent of total myocardium. RESULTS The results showed a strong general anatomic concordance between areas of hypoperfusion, denervation, and fibrosis, suggesting that the three abnormal features may be correlated. Myocardial denervation was anatomically and quantitatively closely associated areas of stress hypoperfusion. CONCLUSION Combined myocardial analysis of the extent and location of autonomic denervation, hypoperfusion, and scarring may allow for better understanding of the pathophysiology of Chagas cardiomyopathy. Autonomic myocardial denervation may be a more sensitive marker of cardiac involvement in Chagas Disease than finding by other imaging modalities.
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Affiliation(s)
- Gustavo Canavaci Barizon
- Department of Computing and Mathematics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, 14040-901, Brazil.
| | - Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - André Schmidt
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Leonardo Pippa Gadioli
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Luiz Otávio Murta Junior
- Department of Computing and Mathematics, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, 14040-901, Brazil
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Nepomuceno E, Silva LN, Cunha DCPD, Furuya RK, Simões MV, Dantas RAS. Comparison of tools for assessing fatigue in patients with heart failure. Rev Bras Enferm 2018; 71:2404-2410. [DOI: 10.1590/0034-7167-2017-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/06/2017] [Indexed: 12/28/2022] Open
Abstract
ABSTRACT Objective: To compare the distributions of measurements of the Dutch Fatigue Scale (DUFS), Dutch Exertion Fatigue Scale (DEFS), and Fatigue Pictogram tools, according to the New York Heart Association (NYHA) Functional Classification and left ventricular ejection fraction (LVEF). Method: Methodological, cross-sectional study with 118 patients with heart failure. Variance analysis, Pearson's correlation, and Fisher's exact tests were carried out, with a significance level of 0.05. Results: There was an increase in the DUFS and DEFS means with worsening of the NYHA-FC (p<0.001, for both tools). Correlations among the LVEF resulted in positive and weak magnitude for the DEFS (r=0.18; p=0.05) and for the DUFS (r=0.16; p=0.08). Just the item A on the Fatigue Pictogram had an association with the NYHA-FC (p<0.001) and the LVEF (p=0.03). Conclusion: Three tools detected worsening in fatigue levels according to the illness severity assessed by the NYHA-FC.
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Lemos de Oliveira LF, Thackeray JT, Marin Neto JA, Dias Romano MM, Vieira de Carvalho EE, Mejia J, Tanaka DM, Kelly da Silva G, Abdalla DR, Malamut C, Bengel FM, de Lourdes Higuchi M, Schmidt A, Cunha-Neto E, Simões MV. Regional Myocardial Perfusion Disturbance in Experimental Chronic Chagas Cardiomyopathy. J Nucl Med 2018; 59:1430-1436. [DOI: 10.2967/jnumed.117.205450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/22/2018] [Indexed: 11/16/2022] Open
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Affiliation(s)
- Pedro V Schwartzmann
- Cardiology Centre, Internal Medicine Department, Medical School of RibeirãoPreto, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcus Vinicius Simões
- Cardiology Centre, Internal Medicine Department, Medical School of RibeirãoPreto, University of Sao Paulo, Sao Paulo, Brazil
| | - Luiz Tadeu Moraes Figueiredo
- Cardiology Centre, Internal Medicine Department, Medical School of RibeirãoPreto, University of Sao Paulo, Sao Paulo, Brazil
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Gadioli LP, Miranda CH, Pintya AO, de Figueiredo AB, Schmidt A, Maciel BC, Marin-Neto JA, Simões MV. The severity of ventricular arrhythmia correlates with the extent of myocardial sympathetic denervation, but not with myocardial fibrosis extent in chronic Chagas cardiomyopathy : Chagas disease, denervation and arrhythmia. J Nucl Cardiol 2018; 25:75-83. [PMID: 27381340 DOI: 10.1007/s12350-016-0556-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 04/28/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND To investigate the correlation between the extent of myocardial sympathetic denervation and fibrosis and the presence of degrees of severity of ventricular arrhythmias in chronic Chagas cardiomyopathy (CCC). METHODS Forty-three CCC patients with left ventricular ejection fraction (LVEF) ≥ 35% were divided into three groups: SVT group-presenting Sustained Ventricular Tachycardia (SVT) (n = 15), NSVT group-exhibiting episodes of non-SVT (NSVT) on 24-h Holter monitoring (n = 11), and Control group-exhibiting neither SVT nor episodes of NSVT (n = 17). The patients underwent SPECT imaging for myocardial sympathetic innervation with 123Iodine-MIBG (MIBG) and myocardial perfusion with 99mTc-Sestamibi (MIBI) for the evaluation of regional myocardial fibrosis. RESULTS The summed rest perfusion scores were similar in the three groups. The summed difference score between MIBG and MPI images, which evaluated the extent of denervated but viable myocardium, was significantly higher in SVT group (20.0 ± 8.0) as compared with the control group (2.0 ± 5.0, P < .0001) and with the NSVT group (11.0 ± 8.0, P < .05). CONCLUSIONS The occurrence of ventricular arrhythmias of different degrees of severity correlates quantitatively with the extent of cardiac sympathetic denervation, but not with the extent of fibrosis, suggesting that myocardial sympathetic denervation plays a major role in triggering ventricular arrhythmia in CCC.
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Affiliation(s)
- Leonardo Pippa Gadioli
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Carlos Henrique Miranda
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Antonio Osvaldo Pintya
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - André Schmidt
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Benedito Carlos Maciel
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - José Antonio Marin-Neto
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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Simões MV, Romano MMD, Schmidt A, Martins KSM, Marin-Neto JA. Chagas Disease Cardiomyopathy. International Journal of Cardiovascular Sciences 2018. [DOI: 10.5935/2359-4802.20180011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nunes MCP, Badano LP, Marin-Neto JA, Edvardsen T, Fernández-Golfín C, Bucciarelli-Ducci C, Popescu BA, Underwood R, Habib G, Zamorano JL, Saraiva RM, Sabino EC, Botoni FA, Barbosa MM, Barros MVL, Falqueto E, Simões MV, Schmidt A, Rochitte CE, Rocha MOC, Ribeiro ALP, Lancellotti P. Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI). Eur Heart J Cardiovasc Imaging 2017; 19:459-460n. [PMID: 29029074 DOI: 10.1093/ehjci/jex154] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 11/14/2022] Open
Abstract
Aims To develop a document by Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI) to review and summarize the most recent evidences about the non-invasive assessment of patients with Chagas disease, with the intent to set up a framework for standardized cardiovascular imaging to assess cardiovascular morphologic and functional disturbances, as well as to guide the subsequent process of clinical decision-making. Methods and results Chagas disease remains one of the most prevalent infectious diseases in Latin America, and has become a health problem in non-endemic countries. Dilated cardiomyopathy is the most severe manifestation of Chagas disease, which causes substantial disability and early mortality in the socially most productive population leading to a significant economical burden. Prompt and correct diagnosis of Chagas disease requires specialized clinical expertise to recognize the unique features of this disease. The appropriate and efficient use of cardiac imaging is pivotal for diagnosing the cardiac involvement in Chagas disease, to stage the disease, assess patients' prognosis and address management. Echocardiography is the most common imaging modality used to assess, and follow-up patients with Chagas disease. The presence of echocardiographic abnormalities is of utmost importance, since it allows to stage patients according to disease progression. In early stages of cardiac involvement, echocardiography may demonstrate segmental left ventricuar wall motion abnormalities, mainly in the basal segments of inferior, inferolateral walls, and the apex, which cannot be attributed to obstructive coronary artery arteries. The prevalence of segmental wall motion abnormalities varies according to the stage of the disease, reaching about 50% in patients with left ventricular dilatation and dysfunction. Speckle tracking echocardiography allows a more precise and quantitative measurement of the regional myocardial function. Since segmental wall motion abnormalities are frequent in Chagas disease, speckle tracking echocardiography may have an important clinical application in these patients, particularly in the indeterminate forms when abnormalities are more subtle. Speckle tracking echocardiography can also quantify the heterogeneity of systolic contraction, which is associated with the risk of arrhythmic events. Three-dimensional (3D) echocardiography is superior to conventional two-dimensional (2D) echocardiography for assessing more accurately the left ventricular apex and thus to detect apical aneurysms and thrombus in patients in whom ventricular foreshortening is suspected by 2D echocardiography. In addition, 3D echocardiography is more accurate than 2D Simpson s biplane rule for assessing left ventricular volumes and function in patients with significant wall motion abnormalities, including aneurysms with distorted ventricular geometry. Contrast echocardiography has the advantage to enhancement of left ventricular endocardial border, allowing for more accurate detection of ventricular aneurysms and thrombus in Chagas disease. Diastolic dysfunction is an important hallmark of Chagas disease even in its early phases. In general, left ventricular diastolic and systolic dysfunction coexist and isolated diastolic dysfunction is uncommon but may be present in patients with the indeterminate form. Right ventricular dysfunction may be detected early in the disease course, but in general, the clinical manifestations occur late at advanced stages of Chagas cardiomyopathy. Several echocardiographic parameters have been used to assess right ventricular function in Chagas disease, including qualitative evaluation, myocardial performance index, tissue Doppler imaging, tricuspid annular plane systolic excursion, and speckle tracking strain. Cardiac magnetic resonance (CMR) is useful to assess global and regional left ventricular function in patients with Chagas diseases. Myocardial fibrosis is a striking feature of Chagas cardiomyopathy and late gadolinium enhancement (LGE) is used to detect and quantify the extension of myocardial fibrosis. Myocardial fibrosis might have a role in risk stratification of patients with Chagas disease. Limited data are available regarding right ventricular function assessed by CMR in Chagas disease. Radionuclide ventriculography is used for global biventricular function assessment in patients with suspected or definite cardiac involvement in Chagas disease with suboptimal acoustic window and contraindication to CMR. Myocardial perfusion scintigraphy may improve risk stratification to define cardiac involvement in Chagas disease, especially in the patients with devices who cannot be submitted to CMR and in the clinical setting of Chagas patients whose main complaint is atypical chest pain. Detection of reversible ischemic defects predicts further deterioration of left ventricular systolic function and helps to avoid unnecessary cardiac catheterization and coronary angiography. Conclusion Cardiac imaging is crucial to detect the cardiac involvement in patients with Chagas disease, stage the disease and stratify patient risk and address management. Unfortunately, most patients live in regions with limited access to imaging methods and point-of-care, simplified protocols, could improve the access of these remote populations to important information that could impact in the clinical management of the disease. Therefore, there are many fields for further research in cardiac imaging in Chagas disease. How to better provide an earlier diagnosis of cardiac involvement and improve patients risk stratification remains to be addressed using different images modalities.
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Affiliation(s)
- Maria Carmo P Nunes
- Department of Internal Medicine, School of Medicine and Hospital das Clínicas of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130?100 Belo Horizonte, MG, Brazil
| | - Luigi Paolo Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - J Antonio Marin-Neto
- Department of Internal Medicine, School of Medicine of Ribeirão Preto of the University de Sao Paulo (USP), Av. Bandeirantes, 3900, Monte Alegre, Ribeiräo Preto, Säo Paulo 14049-900, Brazil
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Chiara Bucciarelli-Ducci
- Cardiovascular Biomedical Research Unit, Bristol Heart Institute, Bristol NIHR Biomedical Research Unit, University of Bristol, Bristol, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bucharest, Romania
| | - Richard Underwood
- Department of non-invasive cardiac imaging, Royal Brompton Hospital and Harefield Hospital, London, UK
| | - Gilbert Habib
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Jose Luis Zamorano
- Department of Cardiology, University Alcala Hospital Ramon y Cajal, Madrid, Spain
| | - Roberto Magalhães Saraiva
- Department of Cardiology; Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro 21040-360, Brazil
| | - Ester Cerdeira Sabino
- Department of Infectious Disease, School of Medicine of the University de Sao Paulo (USP), Av. Dr. Arnaldo, 455 Cerqueira César 01246903, Sao Paulo, Brazil
| | - Fernando A Botoni
- Department of Internal Medicine, School of Medicine and Hospital das Clínicas of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130?100 Belo Horizonte, MG, Brazil
| | - Márcia Melo Barbosa
- Department of Internal Medicine, School of Medicine and Hospital das Clínicas of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130?100 Belo Horizonte, MG, Brazil
| | - Marcio Vinicius L Barros
- Department of Internal Medicine, School of Medicine and Hospital das Clínicas of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130?100 Belo Horizonte, MG, Brazil
| | - Eduardo Falqueto
- Department of Cardiology, Hospital Felicio Rocho, Belo Horizonte, MG, Av. do Contorno, 9530 Prado, Belo Horizonte 21040-360, Brasil
| | - Marcus Vinicius Simões
- Department of Internal Medicine, School of Medicine of Ribeirão Preto of the University de Sao Paulo (USP), Av. Bandeirantes, 3900, Monte Alegre, Ribeiräo Preto, Säo Paulo 14049-900, Brazil
| | - André Schmidt
- Department of Internal Medicine, School of Medicine of Ribeirão Preto of the University de Sao Paulo (USP), Av. Bandeirantes, 3900, Monte Alegre, Ribeiräo Preto, Säo Paulo 14049-900, Brazil
| | - Carlos Eduardo Rochitte
- Department of Radiology, Instituto do Coração (InCor), School of Medicine of USP & Hospital do Coração, HCor, Heart Hospital, Associação do Sanatório Sírio, Av. Dr. Enéas de Carvalho Aguiar, 44 - Pinheiros, São Paulo 05403-900, Brazil
| | - Manoel Otávio Costa Rocha
- Department of Internal Medicine, School of Medicine and Hospital das Clínicas of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130?100 Belo Horizonte, MG, Brazil
| | - Antonio Luiz Pinho Ribeiro
- Department of Internal Medicine, School of Medicine and Hospital das Clínicas of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, 30130?100 Belo Horizonte, MG, Brazil
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium.,Department of Cardiology, Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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Oliveira LFLD, O'Connell JL, Carvalho EEVD, Pulici ÉCC, Romano MMD, Maciel BC, Simões MV. Comparison between Radionuclide Ventriculography and Echocardiography for Quantification of Left Ventricular Systolic Function in Rats Exposed to Doxorubicin. Arq Bras Cardiol 2017; 108:12-20. [PMID: 28146205 PMCID: PMC5245843 DOI: 10.5935/abc.20160194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/28/2016] [Indexed: 12/11/2022] Open
Abstract
Background Radionuclide ventriculography (RV) is a validated method to evaluate the left
ventricular systolic function (LVSF) in small rodents. However, no prior
study has compared the results of RV with those obtained by other imaging
methods in this context. Objectives To compare the results of LVSF obtained by RV and echocardiography (ECHO) in
an experimental model of cardiotoxicity due to doxorubicin (DXR) in rats.
Methods Adult male Wistar rats serving as controls (n = 7) or receiving DXR (n = 22)
in accumulated doses of 8, 12, and 16 mg/kg were evaluated with ECHO
performed with a Sonos 5500 Philips equipment (12-MHz transducer) and RV
obtained with an Orbiter-Siemens gamma camera using a pinhole collimator
with a 4-mm aperture. Histopathological quantification of myocardial
fibrosis was performed after euthanasia. Results The control animals showed comparable results in the LVSF analysis obtained
with ECHO and RV (83.5 ± 5% and 82.8 ± 2.8%, respectively, p
> 0.05). The animals that received DXR presented lower LVSF values when
compared with controls (p < 0.05); however, the LVSF values obtained by
RV (60.6 ± 12.5%) were lower than those obtained by ECHO (71.8
± 10.1%, p = 0.0004) in this group. An analysis of the correlation
between the LVSF and myocardial fibrosis showed a moderate correlation when
the LVSF was assessed by ECHO (r = -0.69, p = 0.0002) and a stronger
correlation when it was assessed by RV (r = -0.79, p < 0.0001). On
multiple regression analysis, only RV correlated independently with
myocardial fibrosis. Conclusion RV is an alternative method to assess the left ventricular function in small
rodents in vivo. When compared with ECHO, RV showed a better correlation
with the degree of myocardial injury in a model of DXR-induced
cardiotoxicity.
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Affiliation(s)
| | | | | | | | | | - Benedito Carlos Maciel
- Centro de Cardiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
| | - Marcus Vinicius Simões
- Centro de Cardiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
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Schwartzmann PV, Simões MV, Moraes Figueiredo LT. In Reply-Zika Virus Meningoencelphalitis. Mayo Clin Proc 2017; 92:1313-1314. [PMID: 28778267 DOI: 10.1016/j.mayocp.2017.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/10/2017] [Accepted: 05/23/2017] [Indexed: 11/23/2022]
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Tanaka DM, Romano MMD, Carvalho EEV, Oliveira LFL, Souza HCD, Maciel BC, Salgado HC, Fazan-Júnior R, Simões MV. Effect of different anesthetic agents on left ventricular systolic function assessed by echocardiography in hamsters. ACTA ACUST UNITED AC 2016; 49:e5294. [PMID: 27580004 PMCID: PMC5007073 DOI: 10.1590/1414-431x20165294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/08/2016] [Indexed: 11/23/2022]
Abstract
Determination of left ventricular ejection fraction (LVEF) using in vivo imaging is the cardiac functional parameter most frequently employed in preclinical research. However, there is considerable conflict regarding the effects of anesthetic agents on LVEF. This study aimed at assessing the effects of various anesthetic agents on LVEF in hamsters using transthoracic echocardiography. Twelve female hamsters were submitted to echocardiography imaging separated by 1-week intervals under the following conditions: 1) conscious animals, 2) animals anesthetized with isoflurane (inhaled ISO, 3 L/min), 3) animals anesthetized with thiopental (TP, 50 mg/kg, intraperitoneal), and 4) animals anesthetized with 100 mg/kg ketamine plus 10 mg/kg xylazine injected intramuscularly (K/X). LVEF obtained under the effect of anesthetics (ISO=62.2±3.1%, TP=66.2±2.7% and K/X=75.8±1.6%) was significantly lower than that obtained in conscious animals (87.5±1.7%, P<0.0001). The K/X combination elicited significantly higher LVEF values compared to ISO (P<0.001) and TP (P<0.05). K/X was associated with a lower dispersion of individual LVEF values compared to the other anesthetics. Under K/X, the left ventricular end diastolic diameter (LVdD) was increased (0.60±0.01 cm) compared to conscious animals (0.41±0.02 cm), ISO (0.51±0.02 cm), and TP (0.55±0.01 cm), P<0.0001. The heart rate observed with K/X was significantly lower than in the remaining conditions. These results indicate that the K/X combination may be the best anesthetic option for the in vivo assessment of cardiac systolic function in hamsters, being associated with a lower LVEF reduction compared to the other agents and showing values closer to those of conscious animals with a lower dispersion of results.
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Affiliation(s)
- D M Tanaka
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M M D Romano
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E E V Carvalho
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L F L Oliveira
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - H C D Souza
- Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - B C Maciel
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - H C Salgado
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R Fazan-Júnior
- Departamento de Fisiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M V Simões
- Departamento de Medicina Interna, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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de Morais SDBV, da Silva LEV, Lataro RM, Silva CAA, de Oliveira LFL, de Carvalho EEV, Simões MV, da Silva Meirelles L, Fazan R, Salgado HC. Mesenchymal Stem Cells Improve Heart Rate Variability and Baroreflex Sensitivity in Rats with Chronic Heart Failure. Stem Cells Dev 2015; 24:2181-92. [PMID: 26059001 DOI: 10.1089/scd.2014.0573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Heart failure induced by myocardial infarct (MI) attenuates the heart rate variability (HRV) and baroreflex sensitivity, which are important risk factors for life-threatening cardiovascular events. Therapies with mesenchymal stem cells (MSCs) have shown promising results after MI. However, the effects of MSCs on hemodynamic (heart rate and arterial pressure) variability and baroreflex sensitivity in chronic heart failure (CHF) following MI have not been evaluated thus far. Male Wistar rats received MSCs or saline solution intravenously 1 week after ligation of the left coronary artery. Control (noninfarcted) rats were also evaluated. MI size was assessed using single-photon emission computed tomography (SPECT). The left ventricular ejection fraction (LVEF) was evaluated using radionuclide ventriculography. Four weeks after MSC injection, the animals were anesthetized and instrumented for chronic ECG recording and catheters were implanted in the femoral artery to record arterial pressure. Arterial pressure and HRVs were determined in time and frequency domain (spectral analysis) while HRV was also examined using nonlinear methods: DFA (detrended fluctuation analysis) and sample entropy. The initial MI size was the same among all infarcted rats but was reduced by MSCs. CHF rats exhibited increased myocardial interstitial collagen and sample entropy combined with the attenuation of the following cardiocirculatory parameters: DFA indices, LVEF, baroreflex sensitivity, and HRV. Nevertheless, MSCs hampered all these alterations, except the LVEF reduction. Therefore, 4 weeks after MSC therapy was applied to CHF rats, MI size and myocardial interstitial fibrosis decreased, while baroreflex sensitivity and HRV improved.
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Affiliation(s)
| | | | - Renata Maria Lataro
- 1 Department of Physiology, Medical School of Ribeirao Preto, University of Sao Paulo , Ribeirão Preto, Brazil
| | - Carlos Alberto Aguiar Silva
- 1 Department of Physiology, Medical School of Ribeirao Preto, University of Sao Paulo , Ribeirão Preto, Brazil
| | | | | | - Marcus Vinicius Simões
- 2 Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo , Ribeirão Preto, Brazil
| | - Lindolfo da Silva Meirelles
- 3 Graduate Program in Cellular and Molecular Biology Applied to Health, Lutheran University of Brazil , Ribeirão Preto, Brazil
| | - Rubens Fazan
- 1 Department of Physiology, Medical School of Ribeirao Preto, University of Sao Paulo , Ribeirão Preto, Brazil
| | - Helio Cesar Salgado
- 1 Department of Physiology, Medical School of Ribeirao Preto, University of Sao Paulo , Ribeirão Preto, Brazil
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Felix ACS, Dutra SGV, Tezini GCSV, Simões MV, de Souza HCD. Aerobic physical training increases contractile response and reduces cardiac fibrosis in rats subjected to early ovarian hormone deprivation. J Appl Physiol (1985) 2015; 118:1276-85. [DOI: 10.1152/japplphysiol.00483.2014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 03/17/2015] [Indexed: 11/22/2022] Open
Abstract
We investigated the effects of early ovarian hormone deprivation on the heart and the role of physical training in this condition using different approaches: cardiac autonomic tone, contractility, morphology and function, and cardiac fibrosis. Female Wistar rats ( n = 48) were assigned into two groups: ovariectomized (Ovx; 10-wk-old) and control rats (Sham; 10-wk-old). Each group was further divided into two subgroups, sedentary and trained (aerobic training by swimming for 10 wk). The sedentary groups showed similar cardiac autonomic tone values; however, only the Sham group had an increase in vagal participation for the determination of the basal heart rate after physical training. The contractile responses to cardiac β-agonists of the sedentary groups were similar, including an increased response to a β1-agonist (dobutamine) observed after physical training. The Ovx sedentary group presented changes in cardiac morphology, which resulted in decreases in the ejection fraction, fractional shortening, and cardiac index compared with the Sham sedentary group. Physical training did little to alter these findings. Moreover, histology analysis showed a significant increase in cardiac fibrosis in the sedentary Ovx group, which was not observed in the trained Ovx group. We conclude that early ovarian hormone deprivation in rats impairs autonomic control, cardiac morphology, and cardiac function and increases cardiac fibrosis; however, it does not affect the contractility induced by dobutamine and salbutamol. Furthermore, this model of physical training prevented an increase in fibrosis and promoted an increase in the cardiac contractile response but had little effect on cardiac autonomic control or morphological and functional parameters.
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Affiliation(s)
- Ana Carolina S. Felix
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and
| | - Sabrina G. V. Dutra
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and
| | - Geisa C. S. V. Tezini
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and
| | - Marcus Vinicius Simões
- Division of Cardiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Hugo Celso Dutra de Souza
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and
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Schwartzmann PV, Carvalho EEV, de Figueiredo AB, Marin-Neto JA, Simões MV. The presence of contractile reserve predicts the left ventricular systolic function improvement after prolonged oral dipyridamole use in patients with non-ischemic dilated cardiomyopathy. Int J Cardiol 2014; 172:622-3. [DOI: 10.1016/j.ijcard.2014.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/18/2014] [Indexed: 11/16/2022]
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Morais S, Lataro R, Silva CA, Oliveira L, Carvalho E, Simões MV, Meirelles L, Silva LE, Salgado H, Fazan R. Heart rate variability and cardiac function in heart failure rats treated with allogeneic mesenchymal stem cells (547.21). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.547.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sharon Morais
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
| | - Renata Lataro
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
| | - Carlos Alberto Silva
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
| | - Luciano Oliveira
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
| | - Eduardo Carvalho
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
| | - Marcus Vinicius Simões
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
| | - Lindolfo Meirelles
- Graduate Program IN Cellular and Molecular Biology Applied to Health Lutheran University of Brazil CanoasBrazil
| | - Luiz Eduardo Silva
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
| | - Hélio Salgado
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
| | - Rubens Fazan
- Department of Physiology Medical School of Ribeirao PretoUniversity of Sao Paulo RIBEIRAO PRETOBrazil
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Pereira Júnior GA, Muglia VF, Dos Santos AC, Miyake CH, Nobre F, Kato M, Simões MV, de Andrade JI. Late evaluation of the relationship between morphological and functional renal changes and hypertension after non-operative treatment of high-grade renal injuries. World J Emerg Surg 2012; 7:26. [PMID: 22852875 PMCID: PMC3441361 DOI: 10.1186/1749-7922-7-26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/26/2012] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the anatomical and functional renal alterations and the association with post-traumatic arterial hypertension. Methods The studied population included patients who sustained high grades renal injury (grades III to V) successfully non-operative management after staging by computed tomography over a 16-year period. Beyond the review of medical records, these patients were invited to the following protocol: clinical and laboratory evaluation, abdominal computed tomography, magnetic resonance angiography, DMSA renal scintigraphy, and ambulatory blood pressure monitoring. The hypertensive patients also were submitted to dynamic renal scintigraphy (99mTc EC), using captopril stimulation to verify renal vascular etiology. Results Of the 31 patients, there were thirteen grade III, sixteen grade IV (nine lacerations, and seven vascular lesions), and two grade V injuries. All the patients were asymptomatic and an average follow up post-injury of 6.4 years. None had abnormal BUN or seric creatinine. The percentage of renal volume reduction correlates with the severity as defined by OIS. There was no evidence of renal artery stenosis in Magnetic Resonance angiography (MRA). DMSA scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (42.2 ± 5.5% for grade III, 35.3 ± 12.8% for grade IV, 13.5 ± 19.1 for grade V). Six patients (19.4%) had severe compromised function (< 30%). There was statistically significant difference in the decrease in renal function between parenchymal and vascular causes for grade IV injuries (p < 0.001). The 24-hour ambulatory blood pressure monitoring detected nine patients (29%) with post-traumatic hypertension. All the patients were male, mean 35.6 years, 77.8 % had a familial history of arterial hypertension, 66.7% had grade III renal injury, and average post-injury time was 7.8 years. Seven patients had negative captopril renography. Conclusions Late results of renal function after conservative treatment of high grades renal injuries are favorable, except for patients with grades IV with vascular injuries and grade V renal injuries. Moreover, arterial hypertension does not correlate with the grade of renal injury or reduction of renal function.
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Affiliation(s)
- Gerson Alves Pereira Júnior
- Department of Surgery and Anatomy, Division of Trauma and Emergency Surgery, University of São Paulo, Sao Paulo, Brazil.
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Macedo LGDR, Lemos DC, Lago IM, Figueiredo GLD, Lima Filho MDO, Schmidt A, Simões MV, Maciel BC, Marin-Neto JA. Base racional e plano de estudo prospectivo para avaliar o efeito de terapêutica antiplaquetária e vasodilatadora microcirculatória em pacientes com cardiopatia chagásica crônica e distúrbios microvasculares coronários. ACTA ACUST UNITED AC 2012. [DOI: 10.1590/s2179-83972012000100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mejia J, Galvis-Alonso OY, Castro AAD, Braga J, Leite JP, Simões MV. A clinical gamma camera-based pinhole collimated system for high resolution small animal SPECT imaging. Braz J Med Biol Res 2010; 43:1160-6. [PMID: 21085887 DOI: 10.1590/s0100-879x2010007500128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 11/03/2010] [Indexed: 11/22/2022] Open
Abstract
The main objective of the present study was to upgrade a clinical gamma camera to obtain high resolution tomographic images of small animal organs. The system is based on a clinical gamma camera to which we have adapted a special-purpose pinhole collimator and a device for positioning and rotating the target based on a computer-controlled step motor. We developed a software tool to reconstruct the target's three-dimensional distribution of emission from a set of planar projections, based on the maximum likelihood algorithm. We present details on the hardware and software implementation. We imaged phantoms and heart and kidneys of rats. When using pinhole collimators, the spatial resolution and sensitivity of the imaging system depend on parameters such as the detector-to-collimator and detector-to-target distances and pinhole diameter. In this study, we reached an object voxel size of 0.6 mm and spatial resolution better than 2.4 and 1.7 mm full width at half maximum when 1.5- and 1.0-mm diameter pinholes were used, respectively. Appropriate sensitivity to study the target of interest was attained in both cases. Additionally, we show that as few as 12 projections are sufficient to attain good quality reconstructions, a result that implies a significant reduction of acquisition time and opens the possibility for radiotracer dynamic studies. In conclusion, a high resolution single photon emission computed tomography (SPECT) system was developed using a commercial clinical gamma camera, allowing the acquisition of detailed volumetric images of small animal organs. This type of system has important implications for research areas such as Cardiology, Neurology or Oncology.
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Affiliation(s)
- J Mejia
- Departamento de Biologia Molecular, São José do Rio Preto, SP, Brasil.
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Figueiredo ABD, Cupo P, Pintya AO, Caligaris F, Marin-Neto JA, Hering SE, Simões MV. Avaliação da perfusão e função miocárdicas em vítimas de escorpionismo utilizando o Gated-SPECT. Arq Bras Cardiol 2010; 94:444-51. [DOI: 10.1590/s0066-782x2010000400003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 07/09/2009] [Indexed: 11/21/2022] Open
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Mejia J, Galvis-Alonso OY, Braga J, Corrêa R, Leite JP, Simões MV. Methodological approaches to planar and volumetric scintigraphic imaging of small volume targets with high spatial resolution and sensitivity. Braz J Med Biol Res 2010; 42:692-9. [PMID: 19649396 DOI: 10.1590/s0100-879x2009000800001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 06/26/2009] [Indexed: 11/21/2022] Open
Abstract
Single-photon emission computed tomography (SPECT) is a non-invasive imaging technique, which provides information reporting the functional states of tissues. SPECT imaging has been used as a diagnostic tool in several human disorders and can be used in animal models of diseases for physiopathological, genomic and drug discovery studies. However, most of the experimental models used in research involve rodents, which are at least one order of magnitude smaller in linear dimensions than man. Consequently, images of targets obtained with conventional gamma-cameras and collimators have poor spatial resolution and statistical quality. We review the methodological approaches developed in recent years in order to obtain images of small targets with good spatial resolution and sensitivity. Multipinhole, coded mask- and slit-based collimators are presented as alternative approaches to improve image quality. In combination with appropriate decoding algorithms, these collimators permit a significant reduction of the time needed to register the projections used to make 3-D representations of the volumetric distribution of target's radiotracers. Simultaneously, they can be used to minimize artifacts and blurring arising when single pinhole collimators are used. Representation images are presented, which illustrate the use of these collimators. We also comment on the use of coded masks to attain tomographic resolution with a single projection, as discussed by some investigators since their introduction to obtain near-field images. We conclude this review by showing that the use of appropriate hardware and software tools adapted to conventional gamma-cameras can be of great help in obtaining relevant functional information in experiments using small animals.
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Affiliation(s)
- J Mejia
- Departamento de Biologia Molecular, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil.
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Bocchi EA, Braga FGM, Ferreira SMA, Rohde LEP, Oliveira WAD, Almeida DRD, Moreira MDCV, Bestetti RB, Bordignon S, Azevedo C, Tinoco EM, Rocha RM, Issa VS, Ferraz A, Cruz FDD, Guimarães GV, Montera VDSP, Albuquerque DC, Bacal F, Souza GEC, Rossi Neto JM, Clausell NO, Martins SM, Siciliano A, Souza Neto JDD, Moreira LF, Teixeira RA, Moura LZ, Beck-da-Silva L, Rassi S, Azeka E, Horowitz E, Ramires F, Simões MV, Castro RBPD, Salemi VMC, Villacorta Junior H, Vila JH, Simões R, Albanesi F, Montera MW. [III Brazilian Guidelines on Chronic Heart Failure]. Arq Bras Cardiol 2009; 93:3-70. [PMID: 20963312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Edimar Alcides Bocchi
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.
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Pádua RDSD, Oliveira LFD, Marques PMDA, Groote JJGSD, Castro AAD, Ana LW, Simões MV. Auxílio à detecção de anormalidade perfusional miocárdica utilizando atlas de SPECT e registro de imagens: resultados preliminares. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000600010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Criar um atlas de cintilografia de perfusão miocárdica e verificar sua aplicabilidade no auxílio computadorizado à detecção de defeitos perfusionais miocárdicos em pacientes portadores de cardiopatia isquêmica. MATERIAIS E MÉTODOS: O atlas foi criado com imagens de cintilografia de perfusão miocárdica, em condições de repouso e estresse, de 20 pacientes de ambos os gêneros com baixa probabilidade de doença arterial coronariana e julgadas normais por dois observadores experientes. Técnicas de registro de imagens e operações matemáticas sobre imagens foram utilizadas para obtenção de modelos de média e desvio-padrão da captação miocárdica percentual de cada gênero e condição fisiológica. RESULTADOS: Imagens de um paciente masculino e um feminino foram alinhadas com os atlas correspondentes, e os voxels apresentando valores de captação percentual dois desvios-padrão abaixo da média da respectiva região do atlas foram destacados nos cortes tomográficos e confirmados como defeitos de perfusão por dois observadores experientes. CONCLUSÃO: Demonstramos a criação de um atlas de cintilografia de perfusão miocárdica e obtivemos resultados promissores na sua utilização para auxílio à detecção de defeitos perfusionais. Entretanto, uma validação prospectiva com um número mais representativo de casos é necessária.
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Dutra RA, Dos Santos JS, de Araújo WM, Simões MV, de Paixão-Becker ANP, Neder L. Evaluation of hepatobiliary excretion and enterobiliary reflux in rats with biliary obstruction submitted to bilioduodenal or biliojejunal anastomosis. Dig Dis Sci 2008; 53:1138-45. [PMID: 17934838 DOI: 10.1007/s10620-007-9955-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 08/01/2007] [Indexed: 12/09/2022]
Abstract
Bilioduodenal and biliojejunal anastomoses are effective for the treatment of biliary obstruction. The objective of this study was to compare the effects of these anastomoses on hepatobiliary excretion and enterobiliary reflux. Enterobiliary reflux and biliary excretion were evaluated respectively after oral administration of technetium ((99m)Tc) in combination with sodium phytate and intravenous infusion of (99m)Tc with diisopropyl-iminodiacetic acid. Enterobiliary reflux occurred to an equal degree in the bilioduodenal and biliojejunal groups. Maximum hepatic activity time (T(max)) and radiotracer clearance half-time (T(1/2)) were similar in both groups. However, when compared with that found for the sham-operated group, T(max), and T(1/2) were higher in the biliojejunal group (P = 0.02 and P = 0.01, respectively). Histopathological analysis showed marked reduction in ductal proliferation in both groups. These data undermine the theoretical advantages attributed to biliojejunal anastomosis and further the understanding of the pathophysiology of cholangitis that occurs even with patent anastomosis.
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Affiliation(s)
- Robson Azevedo Dutra
- Department of Surgery and Anatomy, University of São Paulo at Ribeirão Preto School of Medicine, Ribeirao Preto, Sao Paulo 14049-900, Brazil
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Simões MV, Marin-Neto JA, Maciel BC. Variable regional left ventricular dysfunction in takotsubo cardiomyopathy syndrome. Echocardiography 2008; 24:893; author reply 894. [PMID: 17767545 DOI: 10.1111/j.1540-8175.2007.00548.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Simões MV, Marin-Neto JA, Romano MMD, OConnell JL, Santi GLD, Maciel BC. Disfunção ventricular esquerda transitória por cardiomiopatia induzida por estresse. Arq Bras Cardiol 2007; 89:e79-83. [DOI: 10.1590/s0066-782x2007001600012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 06/28/2007] [Indexed: 11/22/2022] Open
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Simões MV, Oliveira LFD, Hiss FC, Figueiredo ABD, Pintya AO, Maciel BC, Marin-Neto JA. Caracterização do aneurisma apical da cardiopatia chagásica crônica mediante uso de corregistro de imagens cintilográficas. Arq Bras Cardiol 2007; 89:119-21, 131-4. [PMID: 17874019 DOI: 10.1590/s0066-782x2007001400010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marcus Vinicius Simões
- Divisão de Cardiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, SP, Brasil
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Murta LO, Ruiz EES, Pazin-Filho A, Schmidt A, Almeida-Filho OC, Simões MV, Marin-Neto JA, Maciel BC. Automated grading of left ventricular segmental wall motion by an artificial neural network using color kinesis images. Braz J Med Biol Res 2006; 39:1-7. [PMID: 16400459 DOI: 10.1590/s0100-879x2006000100001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
The present study describes an auxiliary tool in the diagnosis of left ventricular (LV) segmental wall motion (WM) abnormalities based on color-coded echocardiographic WM images. An artificial neural network (ANN) was developed and validated for grading LV segmental WM using data from color kinesis (CK) images, a technique developed to display the timing and magnitude of global and regional WM in real time. We evaluated 21 normal subjects and 20 patients with LVWM abnormalities revealed by two-dimensional echocardiography. CK images were obtained in two sets of viewing planes. A method was developed to analyze CK images, providing quantitation of fractional area change in each of the 16 LV segments. Two experienced observers analyzed LVWM from two-dimensional images and scored them as: 1) normal, 2) mild hypokinesia, 3) moderate hypokinesia, 4) severe hypokinesia, 5) akinesia, and 6) dyskinesia. Based on expert analysis of 10 normal subjects and 10 patients, we trained a multilayer perceptron ANN using a back-propagation algorithm to provide automated grading of LVWM, and this ANN was then tested in the remaining subjects. Excellent concordance between expert and ANN analysis was shown by ROC curve analysis, with measured area under the curve of 0.975. An excellent correlation was also obtained for global LV segmental WM index by expert and ANN analysis (R2 = 0.99). In conclusion, ANN showed high accuracy for automated semi-quantitative grading of WM based on CK images. This technique can be an important aid, improving diagnostic accuracy and reducing inter-observer variability in scoring segmental LVWM.
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Affiliation(s)
- L O Murta
- Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Simões MV, de Almeida-Filho OC, Pintya AO, de Figueiredo AB, Antloga CM, Salis FV, Batista NDP, Lima-Filho MDO, Maciel BC, Marin-Neto JA. Prediction of left ventricular wall motion recovery after acute myocardial infarction by Tl-201 gated SPECT: incremental value of integrated contractile reserve assessment. J Nucl Cardiol 2002; 9:294-303. [PMID: 12032477 DOI: 10.1067/mnc.2002.120636] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This investigation tested the application of low-dose dobutamine (LDD) gated single photon emission computed tomography (SPECT) with thallium 201 for myocardial viability detection early after acute myocardial infarction (AMI). METHODS AND RESULTS Thirty-two hemodynamically stable post-AMI patients (aged 55 +/- 5 years [mean +/- SEM]; 20 men) who were exhibiting regional left ventricular dysfunction underwent stress-redistribution Tl-201 scanning within 4 to 8 days, followed by 2 additional gated SPECT acquisitions after Tl-201 reinjection, at rest and during LDD. A visual 5-point score was computed for segmental radiotracer uptake (0, normal; 4, absent) and a 4-point score for left ventricular wall motion (1, normal; 4, dyskinesis). Predominant viable myocardium in dyssynergic regions was predicted by a mean Tl-201 uptake score of 2 or less or ischemic area of 30% or greater. These indices showed a significant association with wall motion improvement in follow-up echocardiographic studies (overall accuracy = 0.69, sensitivity = 0.93, and specificity = 0.50). Regarding the response to LDD stimulus, an increase in mean wall motion score of 30% or greater was predictive of predominant viable myocardium. Contractile reserve assessment yielded a significant increment in the predictive accuracy for function recovery (overall accuracy = 0.84, sensitivity = 0.71, and specificity = 0.94). CONCLUSIONS Evaluation of contractile reserve by means of LDD gated SPECT with Tl-201 is safely feasible early after AMI, with incremental value over perfusion assessment alone for myocardial viability detection.
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Affiliation(s)
- Marcus Vinicius Simões
- Division of Cardiology, Medical School of Ribeirão Preto, Ribeirão Preto Campus, University of São Paulo, CEP: 14048-900 Ribeirão Preto, São Paulo, Brazil
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Abstract
We investigated two genetic polymorphisms in the tumor necrosis factor locus (TNF-alpha -308 G-->A and LT-alpha +252 A-->G) as risk factors for coronary atherothrombotic disease (CAD) by determining its prevalence in 148 survivors of myocardial infarction (MI) with angiographically-proven severe CAD, and in 148 age-, gender- and race-matched controls. The odds ratio (OR) for MI related to the mutant TNF-alpha and LT-alpha alleles was 0.8 (CI95: 0.4-1.3) and 1. 3 (CI95: 0.8-2.0), respectively. We also sought interaction of smoking and metabolic risk factors for MI with each mutant genotype. Smokers not carrying the LT-alpha +252 A-->G mutation had a risk of MI of 2.7 (CI95: 1.4-5.4) whereas in smoking carriers the risk was 6. 9 (CI95: 3.4-14.1). An interactive effect of the LT-alpha mutation may also exist with dyslipidemia (OR for MI in non-carriers was 12 [CI95: 3.2-41.3] and in carriers the OR was 39, [CI95: 5.1-301] and with obesity (OR for MI was 2.7, [CI95: 1-7.2] in non-carriers and in carriers the OR was 6 [CI95: 2.1-16.8]). Lastly, the OR for MI in obese non-carriers of TNF-alpha -308 G-->A was 2.8 (CI95: 1.3-6) and in obese carriers the OR was 14.5 (CI95: 1.8-113). Although significant interactive effects could not be detected, the findings suggest that interaction of polymorphisms in the TNF locus with major risk factors for CAD may exist, and should be explored in larger studies.
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Affiliation(s)
- J C Padovani
- Department of Clinical Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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Simões MV, Pintya AO, Bromberg-Marin G, Sarabanda AV, Antloga CM, Pazin-Filho A, Maciel BC, Marin-Neto JA. Relation of regional sympathetic denervation and myocardial perfusion disturbance to wall motion impairment in Chagas' cardiomyopathy. Am J Cardiol 2000; 86:975-81. [PMID: 11053710 DOI: 10.1016/s0002-9149(00)01133-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Impairment of sinus node autonomic control and myocardial perfusion disturbances have been described in patients with chronic Chagas' cardiomyopathy. However, it is not clear how these conditions contribute to myocardial damage. In this investigation, iodine-123 (I-123) meta-iodobenzylguanidine (MIBG) and thallium-201 myocardium segmental uptake were studied in correlation with the severity of left ventricular (LV) dysfunction detected in various phases of Chagas' heart disease. Group I consisted of 12 subjects (43 +/- 4 years, 7 men) with no symptoms and no cardiac involvement on electrocardiogram (ECG) or echocardiography; group II consisted of 13 patients (48 +/- 3 years, 9 men) with abnormal resting ECG and/or echocardiographic segmental abnormalities, and LV ejection fraction of > or = 0.5; group III was comprised of 12 patients (59 +/- 3 years, 10 men) with more severe heart disease, LV dilation, and LV ejection fraction of < 0.5. Eighteen control volunteers (38 +/- 3 years, 9 men) were also included in the study. I-123 MIBG single-photon emission computed tomographic (SPECT) segmental uptake defects were observed in group I (33%), group II (77%), and group III (92%). Quantitative analysis showed mean areas of reduced LV I-123-MIBG uptake: group I was 3.7 +/- 2.1%; group II was 8.3 +/- 2.3%; and group III was 19.0 +/- 3.3%. The differences between group I and both groups II and III were statistically significant (p < 0.001, analysis of variance test). Myocardial perfusion defects (reversible, fixed, and paradox) were observed in group I (83%), group II (69%), and group III (83%). A marked topographic association between perfusion, innervation, and wall motion abnormalities (assessed by gated-SPECT perfusion studies) was observed in all the groups. Defects predominated in the inferior, posterior lateral, and apical LV regions. Thus, extensive impairment of cardiac sympathetic function at the ventricular level occured early in the course of Chagas' cardiomyopathy and was related to regional myocardial perfusion disturbances, before wall motion abnormalities. Both conditions are associated with progression of ventricular dysfunction.
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Affiliation(s)
- M V Simões
- Division of Cardiology, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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Abstract
Although iron can catalyze the production of free radicals involved in LDL lipid peroxidation, the contribution of iron overload to atherosclerosis remains controversial. The description of two mutations in the HFE gene (Cys282Tyr and His63Asp) related to hereditary hemochromatosis provides an opportunity to address the question of the association between iron overload and atherosclerosis. We investigated the prevalence of HFE mutations in 160 survivors of myocardial infarction with angiographically demonstrated severe coronary atherosclerotic disease, and in 160 age-, gender- and race-matched healthy control subjects. PCR amplification of genomic DNA followed by RsaI and BclI restriction enzyme digestion was used to determine the genotypes. The frequency of the mutant Cys282Tyr allele was identical among patients and controls (0.022; carrier frequency, 4.4%), whereas the mutant His63Asp allele had a frequency of 0.143 (carrier frequency, 27.5%) in controls and of 0.134 (carrier frequency, 24.5%) in patients. Compound heterozygotes were found in 2 of 160 (1.2%) controls and in 1 of 160 (0.6%) patients. The finding of a similar prevalence of Cys282Tyr and His63Asp mutations in the HFE gene among controls and patients with coronary atherothrombotic disease, indirectly questions the possibility of an association between hereditary hemochromatosis and atherosclerosis.
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Affiliation(s)
- R T Calado
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Franco RF, Pazin-Filho A, Tavella MH, Simões MV, Marin-Neto JA, Zago MA. Factor XIII val34leu and the risk of myocardial infarction. Haematologica 2000; 85:67-71. [PMID: 10629595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Recent studies have suggested an association between a genetic variation in the coagulation factor XIII (FXIII Val34Leu) and decreased risk of vascular thrombosis. DESIGN AND METHODS We investigated the frequency of the FXIII Val34Leu polymorphism in 150 consecutive, unrelated and relatively young (<55 years) survivors of myocardial infarction (MI) with angiographically-proven severe coronary atherosclerosis and in 150 age-, gender- and race-matched controls. RESULTS FXIII Val34Leu was detected in 54/150 patients and 73/150 controls, yielding an overall odds ratio (OR) for MI of 0.6 (CI95: 0.4-0.9). Homozygosity for FXIII Val34Leu was found in 4/150 patients and in 12/150 controls, yielding an OR for MI of 0.26 (CI95: 0.08-0.9). The OR for heterozygotes was 0.65 (CI95: 0.4-1.1). FXIII Val34Leu carriership decreased the risk of MI related to metabolic risk factors (RF) (hypertension, diabetes, dyslipidemia, and obesity): non-carriers in the presence of a metabolic RF had a 13.9-fold higher risk of MI, whereas in carriers with a metabolic RF the risk was reduced to 6.8. FXIII Val34Leu also attenuated the risk of MI among smokers. Non-carrier smokers had a 6.1-fold higher risk (CI95: 3.1-11.9), whereas the risk among smokers carrying FXIII Val34Leu was 3.9 (CI95: 1.9-8.1). INTERPRETATION AND CONCLUSIONS FXIII Val34Leu confers a significant protective effect against the occurrence of MI in relatively young patients. FXIII Val34Leu exhibits a gene dosage effect: the protective effect was particularly strong in homozygous carriers, and heterozygosity conferred moderate protection. Finally, FXIII Val34Leu seems to reduce the risk of MI related to major cardiovascular risk factors.
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Affiliation(s)
- R F Franco
- Laboratory of Haematology, Department of Clinical Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, 14048-900 Ribeirão Preto - SP, Brazil.
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Affiliation(s)
- J A Marin Neto
- Depto de Clínica Médica, Hospital das Clínicas, FMRP-USP
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Abstract
Patients with Chagas' disease often have chest pain as a prominent symptom. The objective of this study was to compare the results of intraesophageal balloon distension in chagasic and nonchagasic patients with chest pain not caused by coronary obstruction. We studied 40 patients with chest pain and angiographically normal coronary arteries, 25 with a positive serologic test for Chagas' disease (Chagas group, 16 women, mean age 53+/-10 years), and 15 with a negative serologic test (control group, 11 women, mean age 46+/-10 years). All patients had radiologic and endoscopic examinations of esophagus, stomach, and duodenum, esophageal manometry with the acid infusion test in the distal esophagus, and intraesophageal balloon distension. None of them had esophageal dilation or any signs of cardiovascular disease. A 25-mm-long latex balloon located 10 cm above the lower esophageal sphincter was inflated and deflated over a period of 10 sec at 1-ml increments of air until the subjects reported chest pain or to a maximum volume of 20 mi. The test caused chest pain in 14 subjects in the control group (93%) and in 12 in the Chagas' disease group (48%, P < 0.05). The mean volume of air that caused chest pain was 10+/-3 ml in the control group and 15+/-4 ml in the Chagas' disease group (mean+/-SD, P < 0.05). The maximum intraesophageal pressure during the examination was higher in Chagas' disease patients with chest pain during balloon distension (60 +/- 21 mm Hg) than in patients who did not have chest pain (37 +/-18 mm Hg, P < 0.05) and did not differ from the control group (48+/-16 mm Hg, P > 0.05). With the other examinations there was no difference between groups or between patients with or without chest pain during the balloon distension test. Although esophagitis was observed in 47% of patients in the control group and in 40% of the Chagas' disease group, the acid infusion test was positive in 27% of patients in the control group and in 4% of patients in the Chagas' disease group. We conclude that, as compared to a group of patients with similar chest pain, chagasic patients are less sensitive to esophageal distension. Thus, it is unlikely that their chest pain is related to esophageal mechanisms.
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Affiliation(s)
- F H Ejima
- Department of Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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Marin-Neto JA, Bromberg-Marin G, Pazin-Filho A, Simões MV, Maciel BC. Cardiac autonomic impairment and early myocardial damage involving the right ventricle are independent phenomena in Chagas' disease. Int J Cardiol 1998; 65:261-9. [PMID: 9740483 DOI: 10.1016/s0167-5273(98)00132-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cardiac autonomic impairment and right side heart failure are prominent features in patients with Chagas' disease, but no causal relationship between these phenomena has been disclosed and the pathophysiology of such manifestations is unclear. Aim of study was to assess the cardiac autonomic control and biventricular function in chagasic patients in early stages of the disease, using radionuclide angiography, Valsalva manoeuvre, head-up tilt and baroreflex sensitivity evaluation. Thirty-one chagasic patients with no clinical signs of Chagas' heart disease-16 in the indeterminate phase and 15 with sole organic digestive involvement-were studied, and results compared with those obtained in 14 normal volunteers. No significant differences were observed among the three groups, in regard to any systolic or diastolic parameter of LV function, including ejection fraction, peak ejection and filling rates and correspondent times, time to end-systole, and the standard deviation of phase values. The indeterminate and digestive groups of chagasics had significantly lower right ventricular ejection fraction (45.7 +/- 6.3 and 46.2 +/- 10.1 respectively) and peak ejection rate (respectively 2.8 +/- 0.6 and 2.9 +/- 0.6) and higher right ventricular phase standard deviation (22.4 +/- 5.9 and 20.1 +/- 5.6 degrees, respectively), as compared with the control group (53.6 +/- 4.3, 3.5 +/- 0.5, and 15.8 +/- 3.8 respectively for right ventricular ejection fraction, peak ejection rate and phase standard deviation). No significant differences were found between the results of autonomic evaluation in the control and indeterminate groups of chagasic patients. The group of digestive disease patients showed abnormally lower Valsalva ratio (1.5 +/- 0.15), baroreflex sensitivity (8.85 +/- 2.05 ms/mmHg) and parasympathetically-dependent heart rate response to tilt (8.85 +/- 8.42 beats/mm) and higher Valsalva delay (15.67 +/- 1.35 s) values, compared with the control group (respectively 1.85 +/- 0.49, 20.23 +/- 12.66 ms/mmHg, 21.61 +/- 5.77 beats/mm and 10.1 +/- 2.5 s). Thus, cardiac autonomic impairment is a prominent feature in chagasic patients with the digestive but not the indeterminate form of Chagas' disease. It bears no causative relationship to the early myocardial damage that is apparent only regarding right ventricular function, in both groups of patients. Early right ventricular dysfunction is a likely mechanism for the marked predominance of systemic over pulmonary congestion when heart failure supervenes in patients with Chagas' disease.
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Affiliation(s)
- J A Marin-Neto
- Cardiology Division, University of São Paulol Medical School in Ribeirão Preto, Brazil.
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Abstract
A inadvertently administrated high dose of sympathomimetic drug induced cardiogenic shock manifestations in a previously healthy woman. This state was characterized by EKG subendocardial injury, serum cardiac enzymes elevation, extensive regional left ventricular wall motion abnormalities on echocardiogram. Therapeutics included oxygen, systemic vasodilators and diuretics. Clinical recovery occurred over a four days period and parallels the normalization of echocardiogram and EKG alterations.
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Affiliation(s)
- M V Simões
- Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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Veludo ET, Marques VC, Simões MV, Furuta MS, Figueiredo GL, Viviani LF, Maciel BC, Marin Neto JA. [Clinical profile, coronary angiography findings and early outcome in young patients with acute myocardial infarction in the thrombolytic era]. Arq Bras Cardiol 1997; 68:401-5. [PMID: 9580333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess the clinical, angiographic and early follow-up findings of young patients suffering an acute myocardial infarction, in comparison with older patients with infarction, in the thrombolytic era. METHODS A retrospective analysis of the medical records of 46 patients < 40 years-old (group I) at the time of an acute myocardial infarction was compared with that of 46 older patients, randomly selected, presenting with this syndrome between february, 1991 and february, 1996 (group II). In both groups a comparison was conducted regarding the proportions of gender, risk factors, type of infarction (Q vs non-Q), left ventricular function, coronary anatomy and early mortality (1 month). The medical treatment was comparable for both groups, including the utilization of thrombolytics. RESULTS The groups were discriminated only by: higher prevalence of smoking, of angiographically normal coronary arteries, and of non-critical (< 75% reduction of luminal diameter) coronary stenosis in group I; in the older group a higher proportion of patients had multivessel disease. Although not reaching statistical significance, a trend was observed to a more benign early course of the infarction in the patients less than < 40 years-old. CONCLUSION The present findings are similar to those described in the pre-thrombolytic era, for young patients suffering an acute myocardial infarction.
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Affiliation(s)
- E T Veludo
- Divisão de Cardiologia-HCFMRP-USP, Ribeirão Preto
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Simões MV, Maciel BC, de Castro RB, Schmidt A, de Figueiredo GL, Gandolphi PP, Ayres-Neto EDM, dos Santos JL, Marin-Neto JA. [Risk stratification in acute myocardial infarction survivors. Exercise stress test versus coronary angiography]. Arq Bras Cardiol 1997; 68:167-74. [PMID: 9435354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To compare the predictive accuracy for future ischemic events of heart rate limited treadmill exercise test (HET) and coronary angiography (CA) applied to survivors of an uncomplicated myocardial infarction. METHODS 142 consecutive patients (55 +/- 11 years, 80% males), presenting a non complicated acute myocardial infarction (AMI) were included. HET was performed 10 +/- 3 days after AMI, and CA during hospital stay or within 4-6 weeks. HET positivity criteria were: 1) horizontal or down-sloping ST segment displacement > or = 1 mm; 2) angina; 3) arterial pressure drop during exercise; 4) low workload (< 6 METS); 5) complex ventricular arrhythmia. At CA lesions causing > or = 50% of luminal reduction were considered significant. HET and CA results were correlated to ischemic events occurring during the follow-up (unstable angina in 20%, cardiac death 6%, and reinfarction 6%). RESULTS HET was positive in 69 (49%) patients, exhibiting a positive predictive value for ischemic events (PV+) of 26% and a negative predictive value (PV-) of 77%. The mean event-free time was 43 +/- 3 months for positive HET and 46 +/- 3 months for a negative one (p = 0.48). CA showed 0-1 vessel involvement in 93 (66%) patients and > or = 2 vessels in 49 (34%) patients. The presence of multivascular disease at CA presented a PV+ of 37% and PV- of 82%; the mean event-free time was 37 +/- 4 months for patients with multivascular involvement and 48 +/- 2 months for patients without this pattern (p = 0.007). CONCLUSION The predictive accuracy of HET for future ischemic events in the thrombolytic era is markedly reduced. This population of AMI survivors presents an overall good prognosis that seems to justify the poor predictive accuracy of this test.
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Affiliation(s)
- M V Simões
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USP
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Abstract
An unusual form of reagudization of Chagas' disease, from its indeterminate phase, was documented in an immunocompromised patient. Long-standing progressive visceral aggression due to extensive intracellular proliferation of T. cruzi manifested by severe isolated right ventricular failure and esophageal ulcerations. Antiparasite chemotherapy was effective in the control of the disease.
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Affiliation(s)
- M V Simões
- Cardiology Division of Medical School of Ribeirão Preto, University of São Paulo, Brazil
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Abstract
Pathogenesis of chronic Chagas' heart disease may include various disturbances in the coronary circulation, that could be responsible for the myocardial lesions seen in human hearts and in experimental models of the disease. In this paper we critically reviewed the anatomical and functional abnormalities described in chronic chagasic patients, pertaining to the so-called vascular pathogenetic theory of Chagas' disease. The epicardial coronary arteries are usually free of significant obstructive disease in nonselected groups of chagasic patients examined at autopsy or by coronary angiography. However, chagasic patients who were studied after an episode of acute myocardial infarction, show the same patterns of atherosclerotic coronary artery disease seen in the general nonchagasic population. Studies of chagasic patients with angiographically normal coronary arteries, by several scintigraphy methods, revealed myocardial perfusion abnormalities which may be caused by the microcirculatory derangements described in animals experimentally infected with the T. cruzi. Since hypoperfusion has been detected in regions with normal or mildly impaired wall motion, it is likely that the microvascular disturbances precede and may be causative mechanism for the subsequent myocardial damage. We speculate that hibernating ventricular areas may occur in chagasic patients, on the basis of the evidence gathered from these studies. Recent investigations of chronic patients with Chagas' disease and chest pain showed attenuation of the vasomotor responses to physiological and pharmacological stimuli, in the epicardial coronary arteries.
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Affiliation(s)
- J A Marin-Neto
- Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil
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Simões MV, Dantas RO, Ejima FH, Meneghelli UG, Maciel BC, Marin-Neto JA. [Esophageal origin of precordial pain in chagasic patients with normal subepicardial coronary arteries]. Arq Bras Cardiol 1995; 64:103-8. [PMID: 7575153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To study the chest pain of esophageal origin in chagasic patients (CH) and non-chagasic subjects (NCH) with normal coronary arteries. METHODS The study comprised 48 patients: 33 CH (age 56 years, 50% male) and 15 NCH (age 47 years, 25 male), with precordial chest pain and normal subepicardial coronary arteries. They were assigned to upper digestive tract radiologic and endoscopic study, esophageal manometric evaluation at baseline and after provocative tests (Bernstein and intravenous edrophonium). RESULTS Radiologic study: 14 (42%) CH and 4 (27%) NCH had esophageal dilation (p > 0.05). Hiatal hernia was documented in 7 (21%) CH and 6 (40%) NCH (p > 0.05). 2) Digestive endoscopy: In 15 (45%) CH and 6 (40%) NCH distal esophagitis were seen. In the NCH, esophagitis occurred with hiatal hernia; however only 30% of CH with esophagitis had also hiatal hernia while another 30% had esophageal dilation. 3) Esophageal motility disorders (EMD): 11 (33%) CH showed EMD: 8 with inferior esophageal sphincter achalasia (IESA) and 3 with diffuse esophageal spasm. Among NCH, 2 (13%) had IESA (p > 0.05). 4) Bernstein test--a positive test was seen in 5 (15%) CH and 3 (20%) NCH-p > 0.05. CH with esophageal dilation had 14% of positive results, while CH without esophageal dilation had 16%-p > 0.05. 5) Intravenous edrophonium-esophageal contraction amplitude enhancement provoked by the drug infusion was clearly attenuated in the chagasic (6.9 +/- 12.7 mmHg) when compared with the NCH group (18.8 +/- 21.4 mmHg). A positive test (i.e. chest pain) was obtained in only one patient who was NCH. CONCLUSION Esophageal pain could be elicited at a relatively low and comparable rate in both groups of patients.
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Affiliation(s)
- M V Simões
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, USP
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