Orientador: Haroldo Wilson Moreira / Banca: Haroldo Wilson Moreira / Banca: Luiz Carlos de Mattos / Banca: Moacir Fernandes de Godoy / Banca: Paulo Inácio da Costa / Banca: Amauri Antiquera Leite / Resumo: A doença arterial coronariana representa uma das principais causas de morbidade e mortalidade das populações, principalmente naquelas que habitam regiões desenvolvidas. Os considerados fatores de risco para o desenvolvimento dessa doença são bastante conhecidos e analisados, sendo verificada uma importância cada vez maior com relação aos riscos genéticos e a verificação da associação de sistemas polimórficos humanos com a propensão a desenvolver uma determinada doença. A partir desses estudos foi possível imaginar a ocorrência dos denominados marcadores genéticos, onde os autores realizam uma tentativa com vistas às possibilidades de correlacionar esses marcadores com a doença analisada. Foi propósito do presente trabalho estabelecer e verificar a validade para o nosso laboratório de uma metodologia molecular capaz de caracterizar a mutação G1691A no gene do fator V da coagulação, a mutação G20210A no gene da protrombina e as mutações C677T e G1793A no gene da metilenotetrahidrofolato redutase. Com essa possibilidade, verificar e correlacionar as freqüências dessas mutações em portadores de doença arterial coronariana, de não portadores de doença arterial coronariana e em doadores de sangue em uma parcela da população paulista. Para tanto foram estabelecidos três grupos de estudo constituídos por moradores da região de São José do Rio Preto, Estado de São Paulo, sendo dois deles classificados por cinecoronariografia como portadores de doença arterial coronariana e como não portadores de doença arterial coronariana, enquanto um terceiro grupo foi constituído por doadores de sangue da mesma região. A idade dos pacientes variava dos 36 aos 84 anos de idade, enquanto a do terceiro grupo variava dos 18 aos 55 anos de idade... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The coronary artery disease is a major cause of morbidity and mortality of people, especially those who inhabit the developed regions. The considered risk factors for the development of this disease are quite known and analyzed, being observed an increasingly regard to the risks of genetic and a verification of human polymorphic systems' association to the propensity to develop a particular disease. From these studies it was possible to imagine the occurrence of so-called genetic markers, where the authors hold an attempt to view the possibilities of these markers be correlated to the disease examined. The purpose of this work was to establish and verify the validity of a molecular methodology capable of characterizing the mutation in G1691A in the gene of the clotting factor V, the mutation in the gene G20210A prothrombin and of the mutations in the gene C677T and G1793A of methylene-tetrahydrofolate reductase. With this option, check and correlate the frequency of these mutations in individuals with coronary artery disease, in non individuals with coronary artery disease and in blood donors in a share of the Paulista population. Hence, three groups of study were established, consisting in residents of the region of Sao Jose do Rio Preto, São Paulo, two of them classified by coronary angiography as bearers of coronary artery disease and non bearers individuals with coronary artery disease, while a third group was set by donors of blood in the same region. The patients' ages ranged from 36 to 84 years old, while the third group ranged from 18 to 55 years old. The genomic DNA was extracted with Amersham Pharmacia Biotech's Kit, and the characterization of alleles involved in the change G1691A (factor V Leiden), the prothrombin G20210A, and G1793A of MTHFR C677T determined by gene amplification, followed by the performance of restriction enzyme, in accordance with established protocol... (Complete abstract click electronic access below) / Doutor

Le traitement combiné des facteurs de risque, notamment d’une hypertension artérielle et d’un diabète, reste insuffisant pour obtenir une réduction substantielle de la morbidité et de la mortalité cardiovasculaire. Ce risque résiduel peut être considéré comme le reflet d’une maladie artérielle infra clinique. La rigidité aortique et l’amplification de la pression pulsée sont des marqueurs hémodynamiques de l’atteinte artérielle et peuvent être étudiés de manière non invasive. L’objectif de ce travail a été dans un premier temps de décrire la maladie artérielle infra clinique et ses déterminants au sein de deux cohortes de patients à risque cardiovasculaire, hypertendus et/ou diabétiques et patients suivis pour une infection au virus de l’immunodéficience humaine (VIH). L’apport de la mesure non invasive de la rigidité aortique dans l’estimation du risque chez des patients diabétiques de type 2 a été évalué au sein d’une troisième cohorte. La deuxième partie de ce travail a été orientée vers le dépistage de la maladie coronaire. L'apport de la rigidité aortique dans l’amélioration de la valeur prédictive positive des examens de dépistage a été étudié dans le cadre d’un bilan cardiovasculaire réalisé en hôpital de jour. La conclusion principale de ce travail est que la maladie artérielle infra clinique permet d’une part de cibler le patient à haut risque et, d’autre part, d’améliorer le dépistage de la maladie coronaire à l’échelle individuelle. Le suivi de l’évolution, sous traitement, du degré de rigidité aortique et du niveau de pression pulsée centrale, en parallèle avec l’incidence des événements cardiovasculaires, doit permettre désormais de préciser l’importance de ces paramètres dans la prise en charge thérapeutique au-delà du contrôle des facteurs de risque « traditionnels ». / The combined treatment of risk factors, in particular hypertension and diabetes, appears insufficient to achieve substantial reduction in cardiovascular (CV) morbidity and mortality. This residual risk may be indicative of adverse responses of subclinical arterial damage, illustrated by aortic stiffness and pressure wave reflection. These hemodynamic parameters are considered to be associated with central pulse pressure level. Central blood pressure appears closely related to the developpment and complications of atherosclerosis as well as microvascular organ damage. Firstly, the objective of this work was to study subclinical arterial damage by noninvasive measurement of aortic stiffness and pressure wave reflection, and their determinants, in two cohort of patients with increased CV risk, hypertensive and/or diabetic patients and patients with HIV infection. In a third cohort, composed of patients with type 2 diabetes, we studied aortic stiffness as a independant maker of CV disease. Secondly, we investigate whether noninvasive aortic stiffness assessment improves diagnostic accuracy of coronary artery disease (CAD) screnning. The contribution of aortic stiffness in improving the detection of CAD was studied as part of a complete CV evaluation. The main conclusion of this work is that assessment of subclinical arterial damage provides a clinically useful tool to individualize high-risk patients and to improve CAD screening. Prospective evaluation of aortic stiffness and central pulse pressure in parallel with incidence of CV events would clarify the importance of these hemodynamic parameters in the management of the residual risk.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, 1998 / Coronary heart disease (CHD) is the most common cause of death in the western world (Roberts, 1992). A high incidence of CHD is also reported for the White and the Asian population of South Africa (Wyndham, 1979). Coronary artery bypass graft (CABG) SL ~..;ry continues to be a proven, effective therapy to relieve symptoms of angina, to improve the patient's quality of life and to prolong life in selected patients (Connolly and Guyton, 1992). This intervention is costly and the operative success of coronary revascularization is limited unless the patient understands and will adhere to the prescribed medical regimen, diet and exercise after surgery (Marshall et al, 1986). The problem is compounded as post-operatively, the symptoms of coronary artery disease are ameliorated and the patient may be unaware of the persistence of the disease process. In additlon, the World Health Organisation's definition of cardiac rehabilitation, puts (olward the concept that the patient must accept responsibility for his or her own recovery (Oldridge, 1986). The role that the patient plays post-operatively must therefore become important in the final outcome. In 1977 Ginzberg wrote: "No improvement in the health care system will be efficacious unless the citizen assumes responsibility k~ his/her own well-being", This statement implies that people must take charge of their own health and not abrogate this responsibility to the experts. This study was designed to determine whether the acceptance of selfresponsibility is all important determinant of the successful outcome of corollary artery bypass graft (CABG) surgery. The final study was preceded by five pilot studies to assist in formulating and identifying the concept of selfresponsibility. Questionnaires were designed to determine aspects of improved quality of life and self-responsibility. For the final study. 75 patients who had undergone CABG surgery, were selected from surgical patients in the private as well as the public sector. In order to assess the acceptance of self-responsibility, the spouses/care-givers of the patients were included in this study. Patients were interviewed 4 to 6 days after the operation, and again six months and 12 months later. Successful outcome was measured in terms of improved quality of life using the criteria suggested by the Coronary Artery Surgery Study (Coronary Artery Surgical Study Principal Investigators, 1983). Tine acceptance of self-responsibility was then investigated as a possible factor influencing the improvement of the quality of life of these patients .. It was found that the acceptance of self-responsibility for the successful outcome of CABG surgery was a significant factor in the group of patients with an improved quality of life (p<0.01). From the results of this study, a profile of South African patients with improved quality of life was identified. They are: Men, married, annual income> R50 000 (US $8 000), who had a normal sex-life prior to the operation. They differ significantly from the group without an improved quality of life in the following aspects: they had spent more hours participatinp in sport at school (p=0.04), had stopped their sporting activities for a shorter period of time prior to the operation (p<0.01) and were taller (p<O.01). They were not depressed 12 months after the operation (p<0.01). Patients who accept self-responsibility for their recovery after CABG surgery have the following characteristics: married (p<0.01), have a level of education> grade 12 (p=O.01), have an annual income: R50 000 (p=O.05). They differ from the group who are not responsible in that they and their spouses/care-givers have more knowledge about the disease and the risk factor modification (p=O.01; p<O.01), and twelve months after the operation the patients are satisfied with the outcome of the operation (p<0.01). A stepwise logistic regression established that the acceptance of selfresponsibility was the strongest predictive fsctor for an improved quality of life after CABG surqe.,: Patients who did not accept responsibility would not have an improved quality of life irrespective of the impact of all other parameters. Patients' satisfaction with the outcome of the operative procedure is an important predictor of the acceptance of self-responsibility. Realistic expectations of the outcome of CABG surgery will improve pati-mts' satisfaction with the outcome ..The knowledge of the spouse is a significant factor in the patients' acceptance of self-responsibility. The spouse of a patient is frequently neglected by health- care workers and yet this person is very important for the patient's successful lifestyle change. Knowledge of the chronic nature of their disease as well as risk factor modification and realistic expectations of the outcome of CABG surgery influences patients' acceptance of self-responsibility. Every effort should be made to assist patients in accepting the responsibility for their own recovery so that the outcome of CABG will be successful. / MT2017

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Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (M.S.)--University of Michigan, 1986.

A novel technique for saphenous vein (SV) graft harvesting, the No-touch technique (NT), has been developed at the Dept. of Cardiovascular surgery, Örebro University hospital. With NT the SV is harvested with a pedicle of surrounding tissue. This avoids graft spasm and eliminates the need for distension. The surrounding tissue acts as a structural support and is a rich source of vaso-dilating agents. A randomized controlled trial (RCT) has shown a significantly higher patency rate for NT SV grafts compared to SV grafts harvested with conventional technique (CT). This thesis evaluates some of the properties of the surrounding tissue and compares patency rates between NT SV and radial artery (RA) grafts and patency rates for internal thoracic artery (ITA) grafts harvested with and without surrounding tissue. Paper I investigated vasa vasorum (VV) in SV grafts and showed that the NT preserves an intact VV whereas CT does not. This could be one of the mechanisms underlying the improved patency for NT SV grafts. Paper II evaluated VV and associated nitric oxide (NO) in SV and arterial grafts. SV grafts showed a higher number and larger VV, which correlated with NO production, compared to arterial grafts. NT SV grafts showed higher activity for e-NOS compared to CT SV grafts. Paper III is a RCT comparing patency rates between NT SV and RA grafts, three years after surgery, showing a significantly higher patency rate for NT SV grafts. Paper IV is a RCT comparing patency rates for ITA graft harvested with and without surrounding tissue and did not show any difference between graft preparations. In conclusion, the NT for SV graft harvesting preserves an intact vasa vasorum and associated NO production. NT SV grafts show a higher patency rate than RA grafts. Harvesting of ITA with or without surrounding tissue does not affect patency rate.

No description available.

No description available.