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de Souza Filho EM, Fernandes FDA, Wiefels C, de Carvalho LND, Dos Santos TF, Dos Santos AASMD, Mesquita ET, Seixas FL, Chow BJW, Mesquita CT, Gismondi RA. Machine Learning Algorithms to Distinguish Myocardial Perfusion SPECT Polar Maps. Front Cardiovasc Med 2021; 8:741667. [PMID: 34901207 PMCID: PMC8660123 DOI: 10.3389/fcvm.2021.741667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/29/2021] [Indexed: 12/18/2022] Open
Abstract
Myocardial perfusion imaging (MPI) plays an important role in patients with suspected and documented coronary artery disease (CAD). Machine Learning (ML) algorithms have been developed for many medical applications with excellent performance. This study used ML algorithms to discern normal and abnormal gated Single Photon Emission Computed Tomography (SPECT) images. We analyzed one thousand and seven polar maps from a database of patients referred to a university hospital for clinically indicated MPI between January 2016 and December 2018. These studies were reported and evaluated by two different expert readers. The image features were extracted from a specific type of polar map segmentation based on horizontal and vertical slices. A senior expert reading was the comparator (gold standard). We used cross-validation to divide the dataset into training and testing subsets, using data augmentation in the training set, and evaluated 04 ML models. All models had accuracy >90% and area under the receiver operating characteristics curve (AUC) >0.80 except for Adaptive Boosting (AUC = 0.77), while all precision and sensitivity obtained were >96 and 92%, respectively. Random Forest had the best performance (AUC: 0.853; accuracy: 0,938; precision: 0.968; sensitivity: 0.963). ML algorithms performed very well in image classification. These models were capable of distinguishing polar maps remarkably into normal and abnormal.
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Affiliation(s)
- Erito Marques de Souza Filho
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Department of Languages and Technologies, Universidade Federal Rural do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando de Amorim Fernandes
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Department of Nuclear Medicine, Hospital Universitário Antônio Pedro/EBSERH, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Christiane Wiefels
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Department of Cardiac Image, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Tadeu Francisco Dos Santos
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | | | - Evandro Tinoco Mesquita
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Flávio Luiz Seixas
- Institute of Computing, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Benjamin J W Chow
- Department of Cardiac Image, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Claudio Tinoco Mesquita
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.,Department of Nuclear Medicine, Hospital Pró-Cardíaco, Americas Serviços Medicos, Rio de Janeiro, Brazil
| | - Ronaldo Altenburg Gismondi
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
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de Souza Filho EM, Fernandes FDA, Portela MGR, Newlands PH, de Carvalho LND, Dos Santos TF, Dos Santos AASMD, Mesquita ET, Seixas FL, Mesquita CT, Gismondi RA. Machine Learning Algorithms to Detect Sex in Myocardial Perfusion Imaging. Front Cardiovasc Med 2021; 8:741679. [PMID: 34778403 PMCID: PMC8585770 DOI: 10.3389/fcvm.2021.741679] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022] Open
Abstract
Myocardial perfusion imaging (MPI) is an essential tool used to diagnose and manage patients with suspected or known coronary artery disease. Additionally, the General Data Protection Regulation (GDPR) represents a milestone about individuals' data security concerns. On the other hand, Machine Learning (ML) has had several applications in the most diverse knowledge areas. It is conceived as a technology with huge potential to revolutionize health care. In this context, we developed ML models to evaluate their ability to distinguish an individual's sex from MPI assessment. We used 260 polar maps (140 men/120 women) to train ML algorithms from a database of patients referred to a university hospital for clinically indicated MPI from January 2016 to December 2018. We tested 07 different ML models, namely, Classification and Regression Tree (CART), Naive Bayes (NB), K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Adaptive Boosting (AB), Random Forests (RF) and, Gradient Boosting (GB). We used a cross-validation strategy. Our work demonstrated that ML algorithms could perform well in assessing the sex of patients undergoing myocardial scintigraphy exams. All the models had accuracy greater than 82%. However, only SVM achieved 90%. KNN, RF, AB, GB had, respectively, 88, 86, 85, 83%. Accuracy standard deviation was lower in KNN, AB, and RF (0.06). SVM and RF had had the best area under the receiver operating characteristic curve (0.93), followed by GB (0.92), KNN (0.91), AB, and NB (0.9). SVM and AB achieved the best precision. Our results bring some challenges regarding the autonomy of patients who wish to keep sex information confidential and certainly add greater complexity to the debate about what data should be considered sensitive to the light of the GDPR.
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Affiliation(s)
- Erito Marques de Souza Filho
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Brazil.,Department of Languages and Technologies, Universidade Federal Rural Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando de Amorim Fernandes
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Brazil.,Department of Nuclear Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil
| | | | | | | | - Tadeu Francisco Dos Santos
- Department of Nuclear Medicine, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brazil
| | | | - Evandro Tinoco Mesquita
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Brazil
| | - Flávio Luiz Seixas
- Institute of Computing, Universidade Federal Fluminense, Niterói, Brazil
| | - Claudio Tinoco Mesquita
- Post-graduation in Cardiovascular Sciences, Universidade Federal Fluminense, Niterói, Brazil
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Jorge AJL, Rosa MLG, Martins WDA, Leite A, Correia DMDS, Saad MAN, Villacorta H, Chermont S, Gismondi RA, Almeida BM, Mesquita ET. Prognosis of Heart Failure with Preserved Ejection Fraction in Primary Care by the H2FPEF Score. International Journal of Cardiovascular Sciences 2020. [DOI: 10.36660/ijcs.20200076] [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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Souza EMD, Fernandes FDA, Pereira NCDA, Mesquita CT, Gismondi RA. Ética, Inteligência Artificial e Cardiologia. Arq Bras Cardiol 2020; 115:579-583. [PMID: 33027384 PMCID: PMC9363099 DOI: 10.36660/abc.20200143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/30/2020] [Indexed: 01/18/2023] Open
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Braga D, Garcia Rosa ML, Altenburg Gismondi R, Lugon JR, Torres K, Nalin B, Kang H, Alcoforado V, Martínez Cerón DM. Uric acid and salt intake as predictors of incident hypertension in a primary care setting. Revista Colombiana de Cardiología 2020. [DOI: 10.1016/j.rccar.2019.07.011] [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: 11/26/2022] Open
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Souza Filho EMD, Fernandes FDA, Soares CLDA, Seixas FL, Santos AASMDD, Gismondi RA, Mesquita ET, Mesquita CT. Artificial Intelligence in Cardiology: Concepts, Tools and Challenges - "The Horse is the One Who Runs, You Must Be the Jockey". Arq Bras Cardiol 2020; 114:718-725. [PMID: 32491009 DOI: 10.36660/abc.20180431] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/28/2019] [Indexed: 11/18/2022] Open
Abstract
The recent advances at hardware level and the increasing requirement of personalization of care associated with the urgent needs of value creation for the patients has helped Artificial Intelligence (AI) to promote a significant paradigm shift in the most diverse areas of medical knowledge, particularly in Cardiology, for its ability to support decision-making and improve diagnostic and prognostic performance. In this context, the present work does a non-systematic review of the main papers published on AI in Cardiology, focusing on its main applications, potential impacts and challenges.
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Affiliation(s)
- Erito Marques de Souza Filho
- Universidade Federal Fluminense, Niterói, RJ, Brasil.,Universidade Federal Rural do Rio de Janeiro - Departamento de Tecnologias e Linguagens, Nova Iguaçu, RJ – Brazil
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Viegas EC, Ávila DXD, Silva EN, Mocarzel LOC, Gismondi RA. Complete Atrioventricular Block and Cardiopulmonary Involvement in Rapidly
Progressive Systemic Sclerosis. International Journal of Cardiovascular Sciences 2019. [DOI: 10.5935/2359-4802.20190069] [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: 11/20/2022] Open
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Rodrigues AB, Gismondi RA, Lagoeiro A, Cecilio AM, Vasques D, Arita R, Folegatti T, Rosa ML. Association between B-type natriuretic peptide and within-visit blood pressure variability. Clin Cardiol 2018; 41:778-781. [PMID: 29604077 DOI: 10.1002/clc.22953] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/18/2018] [Accepted: 03/27/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Blood pressure variability (BPV) has been shown to predict cardiovascular events. Within-visit BPV is the simplest and easiest measure of BPV, but previous studies have shown conflicts as to whether within-visit BPV correlates with target organ damage. We aimed to evaluate whether within-visit BPV correlates with B-type natriuretic peptide (BNP) in a general population. HYPOTHESIS Within-visit BPV correlates with BNP in a general population. METHODS This was a cross-sectional study that included 633 individuals, randomly selected, age 45 to 99 years, registered in the primary care program from an urban medium-sized town. Patients were scheduled for a single-day visit that consisted of clinical evaluation and laboratory tests. Three blood pressure (BP) readings, 1 minute apart, were done, and within-visit BPV was determined as the coefficient of variation (CV) of the 3 BP measures. Our main outcome was to correlate BNP and within-visit BPV. A multivariable model was estimated using a generalized linear model to evaluate the independent effects of different variables on BNP levels. RESULTS The median age was 57 years. Median BNP was 16 pg/mL, and the median systolic and diastolic BP-CV were, respectively, 3.9% and 3.5%. There was a weak but positive correlation between BNP and both systolic BP-CV and diastolic BP-CV (r = 0.107 and P = 0.007 and r = 0.092 and P = 0.019, respectively). In multiple regression equation, systolic BP, diastolic BP-CV, body mass index, and estimated glomerular filtration rate were associated with BNP. CONCLUSIONS In the present study, there was a positive, albeit weak, correlation between within-visit BPV and BNP. In addition, diastolic BPV was associated with BNP even after adjustment for multiple confounders.
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Affiliation(s)
- Ana Beatriz Rodrigues
- Department of Epidemiology and Statistics, Institute of Public Health, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Ronaldo Altenburg Gismondi
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Antonio Lagoeiro
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Angela Mendes Cecilio
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Delvo Vasques
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Rafael Arita
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Thabata Folegatti
- Department of Clinical Medicine, Antonio Pedro University Hospital, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Maria Luiza Rosa
- Department of Epidemiology and Statistics, Institute of Public Health, Fluminense Federal University, Rio de Janeiro, Brazil
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Neves MF, Cunha AR, Cunha MR, Gismondi RA, Oigman W. The Role of Renin-Angiotensin-Aldosterone System and Its New Components in Arterial Stiffness and Vascular Aging. High Blood Press Cardiovasc Prev 2018; 25:137-145. [PMID: 29476451 DOI: 10.1007/s40292-018-0252-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 12/29/2017] [Accepted: 02/12/2018] [Indexed: 01/13/2023] Open
Abstract
Many cardiovascular diseases present renin-angiotensin-aldosterone system (RAAS) hyperactivity as an important pathophysiological mechanism to be target in the therapeutic approaches. Moreover, arterial stiffness is currently considered as a new independent risk factor for cardiovascular disease in different clinical conditions, including hypertension and chronic kidney disease. In fact, excessive stimulation of angiotensin type 1 (AT1) receptors, as well as mineralocorticoid receptors, results in cellular growth, oxidative stress and vascular inflammation, which may lead to arterial stiffness and accelerate the process of vascular aging. In the last decades, a vasoprotective axis of the RAAS has been discovered, and now it is well established that new components with antioxidant and anti-inflammatory properties play important roles promoting vasodilation, natriuresis and reducing collagen deposition, thus attenuating arterial stiffness and improving endothelial function. In this review, we will focus on these pathophysiological mechanisms and the relevance of RAAS inhibition by different strategies to increase arterial compliance and to decelerate vascular aging.
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Affiliation(s)
- Mario Fritsch Neves
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil.
| | - Ana Rosa Cunha
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
| | - Michelle Rabello Cunha
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
| | - Ronaldo Altenburg Gismondi
- Centro de Ciências Médicas, Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Niterói, RJ, 24033-900, Brazil
| | - Wille Oigman
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
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10
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Mocarzel LOC, Rossi MM, Miliosse BDM, Lanzieri PG, Gismondi RA. Cirrhotic Cardiomyopathy: A New Clinical Phenotype. Arq Bras Cardiol 2017; 108:564-568. [PMID: 28699978 PMCID: PMC5489327 DOI: 10.5935/abc.20170066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/01/2016] [Indexed: 12/28/2022] Open
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11
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de Rezende RPV, Gismondi RA, Maleh HC, de Miranda Coelho EM, Vieira CS, Rosa MLG, Mocarzel LO. Distinct mortality profile in systemic sclerosis: a death certificate study in Rio de Janeiro, Brazil (2006-2015) using a multiple causes of death analysis. Clin Rheumatol 2017; 38:189-194. [PMID: 29249014 DOI: 10.1007/s10067-017-3951-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 10/18/2022]
Abstract
The objective of this study was to assess the mortality profile related to SSc in the state of Rio de Janeiro, Brazil. We retrospectively examined all registered deaths in the region (2006-2015 period) in which the diagnosis of SSc was mentioned on any line of the death certificates (underlying cause of death [UCD], n = 223; non-UCD, n = 151). Besides the analysis of gender, age, and the causes of death, we also compared the mortality from UCDs between individuals whose death causes included SSc (cases) and those whose death causes did not include SSc (deceased controls). For the latter comparison, we used the mortality odds ratio to approximate the cause-specific standardized mortality ratio. We identified 1495 death causes among the 374 SSc cases. The mean age at death of the SSc cases (85% women) was significantly lower than that of the controls (n = 1,294,117) (58.7 vs. 65.5 years, respectively). The main death causes were circulatory system diseases, infections, and respiratory diseases (36%, 34%, and 21% of SSc cases, respectively). Compared to the deceased controls, there were proportionally more deaths among the SSc cases from pulmonary arterial hypertension, lung fibrosis, septicemia, gastrointestinal hemorrhage, other systemic connective tissue diseases, and heart failure (for death age < 50 years). We confirmed the high burden of cardiovascular, respiratory, and infectious causes in this predominantly non-Caucasian sample of SSc patients. Of interest, the percentage of infection-related deaths in our report was about three times higher than that in SSc studies with predominantly Caucasian populations.
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Affiliation(s)
- Rodrigo Poubel Vieira de Rezende
- Departamento de Medicina Clínica (MMC), Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rua Marques do Paraná, 303, 6° andar, Niterói, Rio de Janeiro, CEP 24033-900, Brazil.
| | - Ronaldo Altenburg Gismondi
- Departamento de Medicina Clínica (MMC), Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rua Marques do Paraná, 303, 6° andar, Niterói, Rio de Janeiro, CEP 24033-900, Brazil
| | - Haim Cesar Maleh
- Departamento de Medicina Clínica (MMC), Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rua Marques do Paraná, 303, 6° andar, Niterói, Rio de Janeiro, CEP 24033-900, Brazil
| | - Elisa Mendes de Miranda Coelho
- Departamento de Medicina Clínica (MMC), Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rua Marques do Paraná, 303, 6° andar, Niterói, Rio de Janeiro, CEP 24033-900, Brazil
| | - Carol Sartori Vieira
- Departamento de Medicina Clínica (MMC), Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rua Marques do Paraná, 303, 6° andar, Niterói, Rio de Janeiro, CEP 24033-900, Brazil
| | - Maria Luiza Garcia Rosa
- Departamento de Epidemiologia e Bioestatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Luis Otavio Mocarzel
- Departamento de Medicina Clínica (MMC), Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rua Marques do Paraná, 303, 6° andar, Niterói, Rio de Janeiro, CEP 24033-900, Brazil
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Lanzieri PG, Gismondi RA, Chimelli MDCAR, Cysne RP, Guaraná T, Mesquita CT, Mocarzel LO. Cirrhotic Patients with Child-Pugh C Have Longer QT Intervals. International Journal of Cardiovascular Sciences 2017. [DOI: 10.5935/2359-4802.20170084] [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: 11/20/2022] Open
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Abstract
BACKGROUND The clinical manifestations of amyloidosis depend on the type of insoluble protein as well as the location of amyloid deposits in tissues or organs. In the gastrointestinal tract, the small intestine is the most common site of amyloid deposits, whereas peritoneal involvement and ascites are rare. CASE REPORT We report on a case of ascites due to peritoneal amyloidosis. A 65-year-old patient was admitted to our institution due to anasarca and pulmonary congestion, mimicking heart failure. We started the patient on diuretics and vasodilators. Despite improvement in pulmonary congestion and peripheral edema, his ascites was not reduced. Echocardiogram revealed restrictive cardiomyopathy and a speckle-tracking pattern suggestive of cardiac amyloidosis. Subcutaneous and peritoneal biopsies revealed amyloidosis. CONCLUSIONS Amyloidosis is rare in the peritoneum and is usually asymptomatic. Ascites occurs in only 20% of patients with peritoneal amyloidosis. We searched PubMed using "ascites" and "amyloidosis" and identified only eight case reports of amyloidosis with ascites. Physicians should be particularly careful in heart failure and anasarca cases when ascites is disproportional or not responsive to diuretic treatment. To date, there is no specific treatment for peritoneal amyloidosis.
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Affiliation(s)
- Fernanda Stofer
- Department of Clinical Medicine, Fluminense Federal University, Niterói, Brazil
| | | | - Ana Luisa Gouvea
- Department of Pathology, Fluminense Federal University, Niterói, Brazil
| | - Mario Ribeiro
- Department of Clinical Medicine, Fluminense Federal University, Niterói, Brazil
| | - Marcio Neves
- Department of Clinical Medicine, Fluminense Federal University, Niterói, Brazil
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15
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Gismondi RA, Bedirian R, Pozzobon CR, Ladeira MC, Oigman W, Neves MF. Renin-Angiotensin System Blockade Associated with Statin Improves Endothelial Function in Diabetics. Arq Bras Cardiol 2015; 105:597-605. [PMID: 26465872 PMCID: PMC4693664 DOI: 10.5935/abc.20150123] [Citation(s) in RCA: 5] [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: 01/24/2015] [Accepted: 05/11/2015] [Indexed: 01/22/2023] Open
Abstract
Background Studies suggest that statins have pleiotropic effects, such as reduction in blood
pressure, and improvement in endothelial function and vascular stiffness. Objective To analyze if prior statin use influences the effect of
renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial
function, and vascular stiffness. Methods Patients with diabetes and hypertension with office systolic blood pressure
≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their
antihypertensive medications replaced by amlodipine during 6 weeks. They were then
randomized to either benazepril or losartan for 12 additional weeks while
continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure
monitoring), endothelial function (brachial artery flow-mediated dilation), and
vascular stiffness (pulse wave velocity) were evaluated before and after the
combined treatment. In this study, a post hoc analysis was performed to compare
patients who were or were not on statins (SU and NSU groups, respectively). Results The SU group presented a greater reduction in the 24-hour systolic blood pressure
(from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated
dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137
to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no
statistically significant difference in pulse wave velocity (SU group: from 9.95
to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586). Conclusion Combined use of statins, amlodipine, and renin-angiotensin-aldosterone system
inhibitors improves the antihypertensive response and endothelial function in
patients with hypertension and diabetes.
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Affiliation(s)
| | - Ricardo Bedirian
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Wille Oigman
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Mesquita ET, Marchese LDD, Dias DW, Barbeito AB, Gomes JC, Muradas MCS, Lanzieri PG, Gismondi RA. Nobel prizes: contributions to cardiology. Arq Bras Cardiol 2015; 105:188-96. [PMID: 25945466 PMCID: PMC4559129 DOI: 10.5935/abc.20150041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 11/20/2022] Open
Abstract
The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize's history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.
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