RESUMO
OBJECTIVE: The aim of this study was to evaluate the relationship between uterine leiomyoma and fragmented QRS, a non-invasive indicator of cardiovascular risk and myocardial ischemia, in women with uterine leiomyoma. METHODS: In this prospective case-control study, a total of 47 patients diagnosed with uterine leiomyoma (case group) and 47 healthy individuals without uterine leiomyoma (control group) who had undergone bilateral tubal ligation surgery were included. Various demographic, clinical, and laboratory parameters and the presence of fragmented QRS were recorded. RESULTS: The leiomyoma group showed significantly higher body mass index (27.46±2.18 vs. 25.9±2.87 kg/m2, p=0.005) and waist circumference (91.34±9.30 vs. 84.97±9.3 cm, p=0.001) compared with the control group. Uterine volumes were also significantly higher in the leiomyoma group (235.75±323.48 vs. 53.24±12.81 mm3, p<0.001). The presence of fragmented QRS was detected in 18.1% of the patients. Multiple regression analysis identified age, fasting blood glucose value, and the presence of fragmented QRS as independent risk factors for the presence of leiomyoma. CONCLUSION: This study provides valuable insights into the relationship between uterine leiomyoma and fragmented QRS. The presence of fragmented QRS was identified as an independent risk factor for the presence of leiomyoma. Further research is needed to better understand the underlying mechanisms connecting uterine leiomyoma and cardiovascular health.
Assuntos
Eletrocardiografia , Leiomioma , Neoplasias Uterinas , Humanos , Feminino , Leiomioma/fisiopatologia , Leiomioma/complicações , Estudos Prospectivos , Estudos de Casos e Controles , Adulto , Neoplasias Uterinas/fisiopatologia , Neoplasias Uterinas/complicações , Pessoa de Meia-Idade , Índice de Massa Corporal , Fatores de Risco , Isquemia Miocárdica/fisiopatologiaRESUMO
OBJECTIVES: Transient ischemic dilatation (TID) in myocardial perfusion single photon emission computed tomography (SPECT) is considered a marker of poor prognosis. However, it has been suggested that some cases are due to apparent volumetric changes secondary to differences in heart rate (HR) at the time of acquisition. We assessed the correlation between transient dilatation and HR in low risk patients with no perfusion defects. METHODS: We retrospectively analyzed patients sent for 99mTc-MIBI SPECT using a 2-day protocol. We recorded the median HR during acquisition and the HR difference (HRD) between the rest and post-stress. We obtained the medium ventricular volume, end-diastolic volume (EDV), and end-systolic volume (ESV). We included patients in which TID using medium ventricular volume (TIDMV) was ≥1.2. TID was also calculated for the EDV and ESV (TIDEDV, TIDESV). We excluded patients with known coronary artery disease, perfusion defects, various ECG disorders, positive stress test, or ESVâ <â 10â ml. RESULTS: From a total of 2006 patients, 63 (50 exercise, 13 dipyridamole) met the criteria for analysis (age 63.8â ±â 9.7, 44 men). TIDMV was 1.29â ±â 0.09 and HRD 9.8 beats per minute (BPM) (range -10 to 41). There was positive correlation between HRD and TIDMV ( r â =â 0.51, P â <â 0.001) and TIDEDV ( r â =â 0.5, P â <â 0.001), but not TIDESV ( r â =â 0.23, P â =â 0.07). Correlation was stronger when HRD was ≥10 BPM ( r â =â 0.67, P â <â 0.001). CONCLUSION: TID without perfusion defects should be interpreted with caution in the presence of HRDâ ≥â 10 BPM during post-stress acquisition.
Assuntos
Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Frequência Cardíaca , Imagem de Perfusão do Miocárdio , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/métodos , Idoso , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Tecnécio Tc 99m SestamibiAssuntos
Humanos , Cardiomiopatia Hipertrófica/diagnóstico , Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/tratamento farmacológico , Isquemia Miocárdica/fisiopatologia , Ablação por Radiofrequência/métodos , Cardiomiopatia Hipertrófica/cirurgia , Ecocardiografia/métodos , Cardiomegalia/complicações , Ecocardiografia Transesofagiana/métodos , Cateteres CardíacosRESUMO
ABSTRACT: Adult mammalian cardiomyocytes show scarce division ability, which makes the heart ineffective in replacing lost contractile cells after ischemic cardiomyopathy. In the past decades, there have been increasing efforts in the search for novel strategies to regenerate the injured myocardium. Among them, gene therapy is one of the most promising ones, based on recent and emerging studies that support the fact that functional cardiomyocyte regeneration can be accomplished by the stimulation and enhancement of the endogenous ability of these cells to achieve cell division. This capacity can be targeted by stimulating several molecules, such as cell cycle regulators, noncoding RNAs, transcription, and metabolic factors. Therefore, the proposed target, together with the selection of the vector used, administration route, and the experimental animal model used in the development of the therapy would determine the success in the clinical field.
Assuntos
Proliferação de Células , Terapia Genética , Isquemia Miocárdica/terapia , Miócitos Cardíacos/patologia , Animais , Proteínas de Ciclo Celular/genética , Proteínas de Ciclo Celular/metabolismo , Regulação da Expressão Gênica , Humanos , Isquemia Miocárdica/genética , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Miócitos Cardíacos/metabolismo , RNA não Traduzido/genética , RNA não Traduzido/metabolismo , Recuperação de Função Fisiológica , Regeneração , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismoRESUMO
Polyphenols play a therapeutic role in vascular diseases, acting in inherent illness-associate conditions such as inflammation, diabetes, dyslipidemia, hypertension, and oxidative stress, as demonstrated by clinical trials and epidemiological surveys. The main polyphenol cardioprotective mechanisms rely on increased nitric oxide, decreased asymmetric dimethylarginine levels, upregulation of genes encoding antioxidant enzymes via the Nrf2-ARE pathway and anti-inflammatory action through the redox-sensitive transcription factor NF-κB and PPAR-γ receptor. However, poor polyphenol bioavailability and extensive metabolization restrict their applicability. Polyphenols carried by nanoparticles circumvent these limitations providing controlled release and better solubility, chemical protection, and target achievement. Nano-encapsulate polyphenols loaded in food grade polymers and lipids appear to be safe, gaining resistance in the enteric route for intestinal absorption, in which the mucoadhesiveness ensures their increased uptake, achieving high systemic levels in non-metabolized forms. Nano-capsules confer a gradual release to these compounds, as well as longer half-lives and cell and whole organism permanence, reinforcing their effectiveness, as demonstrated in pre-clinical trials, enabling their application as an adjuvant therapy against cardiovascular diseases. Polyphenol entrapment in nanoparticles should be encouraged in nutraceutical manufacturing for the fortification of foods and beverages. This study discusses pre-clinical trials evaluating how nano-encapsulate polyphenols following oral administration can aid in cardiovascular performance.
Assuntos
Antioxidantes/farmacologia , Cardiotônicos/farmacologia , Composição de Medicamentos/métodos , Hipertensão/tratamento farmacológico , Isquemia Miocárdica/tratamento farmacológico , Polifenóis/farmacologia , Elementos de Resposta Antioxidante , Antioxidantes/química , Antioxidantes/farmacocinética , Arginina/análogos & derivados , Arginina/antagonistas & inibidores , Arginina/metabolismo , Cardiotônicos/química , Cardiotônicos/farmacocinética , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/genética , Diabetes Mellitus/metabolismo , Diabetes Mellitus/fisiopatologia , Portadores de Fármacos , Dislipidemias/tratamento farmacológico , Dislipidemias/genética , Dislipidemias/metabolismo , Dislipidemias/fisiopatologia , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Hipertensão/genética , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Isquemia Miocárdica/genética , Isquemia Miocárdica/metabolismo , Isquemia Miocárdica/fisiopatologia , Fator 2 Relacionado a NF-E2/genética , Fator 2 Relacionado a NF-E2/metabolismo , Nanocápsulas/administração & dosagem , Nanocápsulas/química , Óxido Nítrico/antagonistas & inibidores , Óxido Nítrico/biossíntese , Estresse Oxidativo/efeitos dos fármacos , Polifenóis/química , Polifenóis/farmacocinética , Transdução de SinaisRESUMO
The current global prevalence of heart failure is estimated at 64.34 million cases, and it is expected to increase in the coming years, especially in countries with a medium-low sociodemographic index where the prevalence of risk factors is increasing alarmingly. Heart failure is associated with many comorbidities and among them, cancer has stood out as a contributor of death in these patients. This connection points out new challenges both in the context of the pathophysiological mechanisms involved, as well as in the quality of life of affected individuals. A hallmark of heart failure is chronic activation of the renin-angiotensin-aldosterone system, especially marked by a systemic increase in levels of angiotensin-II, a peptide with pleiotropic activities. Drugs that target the renin-angiotensin-aldosterone system have shown promising results both in the prevention of secondary cardiovascular events in myocardial infarction and heart failure, including a lower risk of certain cancers in these patients, as well as in current cancer therapies; therefore, understanding the mechanisms involved in this complex relationship will provide tools for a better diagnosis and treatment and to improve the prognosis and quality of life of people suffering from these two deadly diseases.
Assuntos
Isquemia Miocárdica/fisiopatologia , Neoplasias/fisiopatologia , Sistema Renina-Angiotensina/fisiologia , Aldosterona/metabolismo , Angiotensina II/metabolismo , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Humanos , Infarto do Miocárdio/fisiopatologia , Isquemia Miocárdica/metabolismo , Neoplasias/metabolismo , Renina/metabolismoRESUMO
Background: Echocardiographic predictors for new onset heart failure in patients with ischemic heart disease with reduced left ventricular ejection fraction (HFrEF) or with preserved left ventricular ejection fraction (HFpEF) in Ethiopian and Sub-Saharan African is not well-known.Methods: Two hundred twenty-eight patients with ischemic heart disease were retrospectively recruited and followed. Analysis on baseline clinical and echocardiographic characteristics of patients, and risk factors for new onset HFpEF and new onset HFrEF were done. The exclusion criteria were known heart failure at baseline and those who did not have echocardiography data.Results: During the follow up period, heart failure developed in 62.2% (61/98) of ischemic heart disease patients with preserved left ventricular ejection fraction and in 70.1% (92/130) of ischemic heart disease patients with reduced left ventricular ejection fraction. We did not find significant difference between HFrEF and HFpEF in time to new onset heart failure. Systolic blood pressure, diastolic blood pressure, diabetes, left atrium and diastolic left ventricular dimension had significant association with new onset HFrEF on univariate regression analysis. Whereas new onset HFpEF was significantly associated with age, sex, presence of hypertension, Systolic blood pressure and diastolic left ventricular dimension. On cox regression analysis diastolic left ventricular dimension was associated with both new onset HFpEF and HFrEF. Age, diabetes, and dimension of left atrium were also associated with HFrEF.Conclusion: This cohort study in ischemic heart disease patients suggests a key role for the diastolic left ventricular dimension, left atrium size, diabetes, sex and age as predictors of new onset HFrEF and HFpEF. Strategies directed to prevention and early treatment of diabetes, dilatation of left ventricle and left atrium may prevent a considerable proportion of HFrEF or HFpEF.
Antecedentes: Los predictores ecocardiográficos de nuevos eventos de insuficiencia cardiaca en pacientes con cardiopatía isquémica con fracción de eyección ventricular preservada (HFpEF) o con fracción de eyección ventricular reducida (HFrEF) no son bien conocidos en la Africa etíope y subsahariana.Métodos: Doscientos veintiocho pacientes con cardiopatía isquémica fueron reclutados y seguidos retrospectivamente. Se realizaron análisis sobre las características clínicas y ecocardiográficas basales de los pacientes, así como los factores de riesgo para un nuevo evento de HFpEF y un nuevo evento de HFrEF. Los criterios de exclusión fueron insuficiencia cardíaca conocida al inicio del estudio y aquellos que no tenían datos de ecocardiografía.Resultados: Durante el período de seguimiento, la insuficiencia cardíaca se desarrolló en el 62,2% (61/98) de pacientes con cardiopatía isquémica con fracción de eyección ventricular izquierda preservada y en el 70,1% (92/130) de pacientes con cardiopatía isquémica con fracción de eyección ventricular izquierda reducida. No encontramos diferencias significativas entre HFrEF y HFpEF en el tiempo hasta la nueva aparición de insuficiencia cardíaca. La presión arterial sistólica, la presión arterial diastólica, la diabetes y las dimensiones de la aurícula iquierda y del ventrículo izquierdo en diástole tuvieron una asociación significativa con nuevos eventos de HFrEF en el análisis de regresión univariada. Mientras que un nuevo evento de HFpEF se asoció significativamente con la edad, el sexo, la presencia de hipertensión, la presión arterial sistólica y la dimensión ventricular izquierda diastólica. En el análisis de regresión de cox, la dimensión ventricular izquierda diastólica se asoció con HFpEF de nuevo inicio y HFrEF. La edad, la diabetes y la dimensión de la aurícula izquierda también se asociaron con HFrEF. Conclusión: Este estudio de cohorte en pacientes con cardiopatía isquémica sugiere un papel clave para la dimensión ventricular izquierda diastólica, el tamaño de la aurícula izquierda, la diabetes, el sexo y la edad como predictores de un nuevo evento de HFrEF y HFpEF. Las estrategias dirigidas a la prevención y el tratamiento temprano de la diabetes, la dilatación del ventrículo izquierdo y la aurícula izquierda pueden prevenir una proporción considerable de HFrEF o HFpEF.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Ecocardiografia/métodos , Isquemia Miocárdica/diagnóstico por imagem , Volume Sistólico , Tabagismo , Análise Multivariada , Valor Preditivo dos Testes , Análise de Regressão , Estudos Retrospectivos , Estudos de Coortes , Seguimentos , Função Ventricular Esquerda , Fatores Etários , Isquemia Miocárdica/fisiopatologia , Medição de Risco/métodos , Fatores de Risco de Doenças CardíacasRESUMO
Novel coronavirus disease 2019 (COVID-19) causes pulmonary and cardiovascular disorders and has become a worldwide emergency. Myocardial injury can be caused by direct or indirect damage, particularly mediated by a cytokine storm, a disordered immune response that can cause myocarditis, abnormal coagulation, arrhythmia, acute coronary syndrome, and myocardial infarction. The present review focuses on the mechanisms of this viral infection, cardiac biomarkers, consequences, and the possible therapeutic role of purinergic and adenosinergic signalling systems. In particular, we focus on the interaction of the extracellular nucleotide adenosine triphosphate (ATP) with its receptors P2X1, P2X4, P2X7, P2Y1, and P2Y2 and of adenosine (Ado) with A2A and A3 receptors, as well as their roles in host immune responses. We suggest that receptors of purinergic signalling could be ideal candidates for pharmacological targeting to protect against myocardial injury caused by a cytokine storm in COVID-19, in order to reduce systemic inflammatory damage to cells and tissues, preventing the progression of the disease by modulating the immune response and improving patient quality of life.
Assuntos
Trifosfato de Adenosina/metabolismo , COVID-19/imunologia , Doenças Cardiovasculares/virologia , Receptores Purinérgicos/metabolismo , SARS-CoV-2 , Agonistas do Receptor A2 de Adenosina/farmacologia , COVID-19/metabolismo , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/fisiopatologia , Citocinas/metabolismo , Humanos , Isquemia Miocárdica/imunologia , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/virologia , Pandemias , Antagonistas Purinérgicos/farmacologia , Receptor A2A de Adenosina/metabolismo , Receptor A3 de Adenosina/metabolismo , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/imunologia , Tratamento Farmacológico da COVID-19RESUMO
La cardiopatía isquémica es la causa más frecuente de morbimortalidad a nivel mundial. La artritis reumatoide (AR) se asocia con el desarrollo prematuro de enfermedades cardiovasculares y la esperanza de vida se reduce principalmente debido a un incremento en la muerte cardiovascular. Se realizó un estudio retrospectivo de revisión de historias médicas con el objetivo de describir el perfil clínico de los pacientes con cardiopatía isquémica y AR que acudieron a la Unidad de Prevención Secundaria y Rehabilitación Cardiovascular del Centro Cardiovascular Regional Centro Occidental desde enero 2013 hasta diciembre 2018. Se incluyeron 37 pacientes con diagnóstico de AR que presentaron algún evento coronario. Ell 62% de los pacientes eran del sexo femenino con una edad media de 59 ± 11 años; el 65% tenían menos de 10 años de diagnóstico de AR. El sedentarismo representó el factor más frecuente (92%), seguido de HTA (76%), tabaquismo (73%), DM (43%), antecedentes familiares de cardiopatía isquémica (24%), obesidad (22%), dislipidemia (16%) y ERC (11%); el tipo de evento coronario más frecuente fue el IMsEST (43%). El análisis multivariado no mostró relación estadísticamente significativa entre número de factores de riesgo y tiempo de duración de la AR con la presencia de lesiones coronarias. El sedentarismo fue el factor de riesgo más frecuente en esta población especial sin embargo el comportamiento de los factores de riesgo tradicionales para cardiopatía isquémica en los pacientes con AR no difiere del de la población general...(AU)
Ischemic heart disease is the most frequent cause of morbidity and mortality worldwide. Rheumatoid arthritis (RA) is associated with premature development of cardiovascular disease and life expectancy is mainly reduced due to an increase in cardiovascular death. A descriptive and retrospective review of medical charts was conducted with the objective of describing the clinical profile of patients with ischemic heart disease and RA who attended the Unidad de Prevención Secundaria y Rehabilitación Cardiovascular del Centro Cardiovascular Regional Centro Occidental from January 2013 to December 2018. 37 patients with RA diagnosis who presented a coronary event were included. The results show that 62% of patients were female with a mean age of 59 ± 11 years; 65% had less than 10 years of diagnosis of RA. Sedentary lifestyle represented the most frequent factor (92%), followed by HTA (76%), smoking (73%), DM (43%), family history of ischemic heart disease (24%), obesity (22%), dyslipidemia (16%) and finally CKD (11%); the most frequent type of coronary event was the IMsEST (43%). The multivariate analysis showed no statistically significant relationship between the number of risk factors and the duration of RA with the presence of coronary lesions. Sedentary lifestyle was the most frequent risk factor in this population however the behavior of traditional risk factors for ischemic heart disease in patients with RA does not differ from the general population...(AU)