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Em todo o mundo, milhões de pacientes são atendidos em emergências por apresentarem dor torácica de início aguda, mas apenas uma parcela deve-se a síndrome coronariana aguda (SCA). Em situações como essa é de extrema importância distinguir quando a dor torácica é devido à isquemia do miocárdio, pois esta é de alto risco e o início do tratamento deve ser imediato. Novos biomarcadores são necessários para auxiliar no diagnóstico e conduta clínica a ser tomada diante de situações de emergência como esta. Recentemente a quantificação de troponinas através de ensaios ultrassensíveis tem sido amplamente utilizado para diagnósticos e prognóstico de isquemia cardíaca, porém esses ensaios não tiveram seus valores de referências estabelecidos e validados para diversas situações clínicas. O presente estudo identificou a troponina I cardíaca nitrada como um novo biomarcador para isquemia cardíaca. Através de experimentos de imunoluorecência, foi possível colocalizar a marcação de troponina I cardíaca e nitrotirosina em modelos celulares e murinos de isquemia cardíaca, sugerindo assim que a troponina I cardíaca é nitrada. A partir do soro de modelos porcinos de isquemia, foi realizado o enriquecimento de proteínas nitradas por imunoprecipitação seguido da identificação da troponina I cardíaca por western blot. Dessa maneira foi possível identificar a troponina I cardíaca nitrada no soro poucos minutos após o evento x isquêmico, a qual permaneceu circulante por até 24 horas. Nessas mesmas amostras outros biomarcadores de isquemia como CKMB, Troponina I e Troponina T ultrassensível foram dosados e nenhum marcador de elevou após a isquemia cardíaca seguida de reperfusão. A troponina I cardíaca nitrada foi caracterizada por espectrometria de massas. Esse proteína é um potencial marcador circulante sensível para o diagnóstico e prognóstico precoce de isquemia cardíaca com ou sem necrose do miocárdio / Worldwide, millions of patients are treated in emergencies because they had acute-onset chest pain, but only a portion is due to coronary syndrome. In situations like this is extremely important to distinguish when the chest pain is due to myocardial ischemia, as this is high risk and initiation of treatment should be immediate. New biomarkers are needed to assist clinical decision-making in ACS. Recently, the quantification of ultra-sensitive tests for troponins has been widely used for diagnosis and prognosis of myocardial ischemia, however the reference values was not well validated and established for different subjects groups. The present study identified the nitrated cardiac troponin I as a novel biomarker of cardiac ischemia. We performed immunofluorescence colocalization marking of cardiac troponin I and nitrotyrosine in cell and rat model of cardiac ischemia, suggesting that cardiac troponin I is a nitrated protein. From serum of porcine models cardiac ischemia was made enrichment of nitrated proteins by immunoprecipitation with anti-nitrotyrosine followed by detection of cardiac troponin I by western blot. It was possible to identify the cardiac troponin I in serum nitrated few minutes after the ischemic event, which remains current for up to 24 hours. In these samples, other markers of cardiac ischemia such as CK-MB, troponin I and ultra-sensitive troponin T did not increase after ischemia followed by reperfusion. Nitrated cardiac troponin I was characterized by MS/MS. The xii nitrated cardiac troponin I is a potential circulating marker sensitive for the diagnosis and prognosis for early cardiac ischemia with or without myocardial necrosis

Em todo o mundo, milhões de pacientes são atendidos em emergências por apresentarem dor torácica de início aguda, mas apenas uma parcela deve-se a síndrome coronariana aguda (SCA). Em situações como essa é de extrema importância distinguir quando a dor torácica é devido à isquemia do miocárdio, pois esta é de alto risco e o início do tratamento deve ser imediato. Novos biomarcadores são necessários para auxiliar no diagnóstico e conduta clínica a ser tomada diante de situações de emergência como esta. Recentemente a quantificação de troponinas através de ensaios ultrassensíveis tem sido amplamente utilizado para diagnósticos e prognóstico de isquemia cardíaca, porém esses ensaios não tiveram seus valores de referências estabelecidos e validados para diversas situações clínicas. O presente estudo identificou a troponina I cardíaca nitrada como um novo biomarcador para isquemia cardíaca. Através de experimentos de imunoluorecência, foi possível colocalizar a marcação de troponina I cardíaca e nitrotirosina em modelos celulares e murinos de isquemia cardíaca, sugerindo assim que a troponina I cardíaca é nitrada. A partir do soro de modelos porcinos de isquemia, foi realizado o enriquecimento de proteínas nitradas por imunoprecipitação seguido da identificação da troponina I cardíaca por western blot. Dessa maneira foi possível identificar a troponina I cardíaca nitrada no soro poucos minutos após o evento x isquêmico, a qual permaneceu circulante por até 24 horas. Nessas mesmas amostras outros biomarcadores de isquemia como CKMB, Troponina I e Troponina T ultrassensível foram dosados e nenhum marcador de elevou após a isquemia cardíaca seguida de reperfusão. A troponina I cardíaca nitrada foi caracterizada por espectrometria de massas. Esse proteína é um potencial marcador circulante sensível para o diagnóstico e prognóstico precoce de isquemia cardíaca com ou sem necrose do miocárdio / Worldwide, millions of patients are treated in emergencies because they had acute-onset chest pain, but only a portion is due to coronary syndrome. In situations like this is extremely important to distinguish when the chest pain is due to myocardial ischemia, as this is high risk and initiation of treatment should be immediate. New biomarkers are needed to assist clinical decision-making in ACS. Recently, the quantification of ultra-sensitive tests for troponins has been widely used for diagnosis and prognosis of myocardial ischemia, however the reference values was not well validated and established for different subjects groups. The present study identified the nitrated cardiac troponin I as a novel biomarker of cardiac ischemia. We performed immunofluorescence colocalization marking of cardiac troponin I and nitrotyrosine in cell and rat model of cardiac ischemia, suggesting that cardiac troponin I is a nitrated protein. From serum of porcine models cardiac ischemia was made enrichment of nitrated proteins by immunoprecipitation with anti-nitrotyrosine followed by detection of cardiac troponin I by western blot. It was possible to identify the cardiac troponin I in serum nitrated few minutes after the ischemic event, which remains current for up to 24 hours. In these samples, other markers of cardiac ischemia such as CK-MB, troponin I and ultra-sensitive troponin T did not increase after ischemia followed by reperfusion. Nitrated cardiac troponin I was characterized by MS/MS. The xii nitrated cardiac troponin I is a potential circulating marker sensitive for the diagnosis and prognosis for early cardiac ischemia with or without myocardial necrosis

The aim of this work was to develop the method for classification of ECG beats into two classes, namely ischemic and non-ischemic beats. Heart beats (P-QRS-T cycles) selected from animals orthogonal ECGs were preprocessed and used as the input signals. Spectral features vectors (values of cross spectral coherency), principal component and HRV parameters were derived from the beats. The beats were classified using feedforward multilayer neural network designed in Matlab. Classification performance reached the value approx. from 87,2 to 100%. Presented results can be suitable in future studies aimed at automatic classification of ECG.

Spinal cord stimulation (SCS) inhibits substance P (SP) release and decreases the expression of the transient receptor potential vanilloid 1 (TRPV1) in the spinal cord at thoracic 4 (T4) during cardiac ischemia in rat models (. Ding et al., 2007). We hypothesized that activation of TRPV1 in the T4 spinal cord segment by intermittent occlusion of the left anterior descending coronary artery (CoAO) mediates spinal cord SP release. Experiments were conducted in urethane-anesthetized Sprague-Dawley male rats using SP antibody-coated microprobes to measure SP release at the central terminal endings of cardiac ischemic-sensitive afferent neurons (CISAN) in the spinal T4 dorsal horns. Vehicle, capsaicin (CAP; TRPV1 agonist) and capsazepine (CZP; TRPV1 antagonist) were injected into the left T4 prior to stimulation of CISAN by intermittent CoAO (with or without upper cervical SCS). CAP induced endogenous SP release from laminae I and II in the T4 spinal cord above baseline. Conversely, CZP injections significantly inhibited SP release from laminae I-VII in the T4 spinal cord segment below baseline. CZP also attenuated CoAO-induced SP release, while T4 injections of CZP with SCS completely restored SP release to basal levels during CoAO activation. CAP increased the number of c-Fos (a marker for CISAN activation) positive T4 dorsal horn neurons compared to sham-operated animals, while CZP (alone or during CoAO and SCS. +. CoAO) significantly reduced the number of c-Fos positive neurons. These results suggest that spinal release of the putative nociceptive transmitter SP occurs, at least in part, via a TRPV1 mechanism.

Spinal cord stimulation (SCS) is used to reduce angina that accompanies cardiac ischemia, but little is known about the molecular mechanisms mediating this effect. We studied the expression of SP, neurokinin-1 (NK-1) receptor, and transient receptor potential vanilloid type 1 (TRPV1) mRNA in the rat spinal cord at thoracic 4 (T4), cervical 2 (C2) and caudal brain stem by RT-PCR during intermittent occlusion of the left anterior descending coronary artery (CoAO), during sustained SCS by itself at the C2 spinal segment, and during sustained SCS plus intermittent CoAO. Only SP mRNA was increased significantly in T4 and brainstem during CoAO, while SCS decreased the mRNA levels of SP, NK-1 and TRPV1 significantly in T4 and the brainstem. SCS attenuated the increase of SP and TRPV1 mRNA levels at T4 level induced by intermittent CoAO when the stimulation was applied prior to the initiation of the cardiac ischemia. These results support the role for SP as a putative neurotransmitter for the myocardial ischemia-sensitive afferent neuron signal to the spinal level. They suggest that modification of the ischemic cardiac nociceptive afferent signal by SCS involves a change in SP and TRPV1 expression.

Mirbazel SH. Jämförelse mellan kvinnor och mäns överlevnad baserad på resultat från arbetsprov och myokardscintigrafi. Examensarbete i Biomedicinsk Laboratorievetenskap, 15 högskolepoäng. Malmö högskola: Hälsa och Samhälle, utbildningsområde för Biomedicinsk Laboratorievetenskap, 2011.En av de vanligaste orsakerna till död både i utvecklingsländerna och i västvärlden är hjärtinfarkt som drabbar vanligtvis individer över 65 år. Hjärtischemi är den vanligaste orsaken till hjärtinfarkt/ plötsligt hjärtstopp. För diagnostik av hjärtischemi används oftast arbetsprov som förstahandsval, eftersom metoden är billig, icke-invasiv och relativt ofarlig. Myokardscintigrafi utförs ofta efter arbetsprovet, om detta varit inkonklusivt. Syftet i denna retrospektiva studie var att ta reda på om prognosen och överlevnaden skiljer sig åt mellan kvinnor och män beroende på undersökningsresultat från arbetsprov och myokardscintigrafi. I denna studie analyserades 2045 patienter som var registrerade att utföra arbetsprov för misstänkt eller tidigare känd koronarkärlssjukdom under 2006 & 2007. Patienternas resultat delades i tre grupper: normalt, patologiskt och intermediärt enligt bestämda kriterier. Intermediärgruppen analyserades också om de hade utfört ett myokardscintigrafi inom 6 månader. Intermediärgruppen delades därefter in i tre grupper: de med normal myokardscintigrafi, de med patologisk och de som inte hade utfört någon. Patienter med normalt arbetsprov var 1110, med intermediärt arbetsprov 540 och med patologiskt arbetsprov 254 personer. Det finns statistiskt signifikanta skillnader av antal levande och avlidna mellan män och kvinnor i intermediärt arbetsprov (p < 0,001) och i undergruppen, intermediär utan utförd myokardscintigrafi (p < 0,001). Det finns också en statistiskt signifikant skillnad i överlevnad i huvudgruppen med intermediärt arbetsprov(p < 0,01). Inga analyser av överlevad utfördes för undergrupperna. Sammanfattningsvis har denna studie visat att det inte finns några statistiskt säkerställda skillnader i överlevnad mellan män och kvinnor med normalt och patologiskt arbetsprov däremot finns det en signifikant skillnad i intermediärgruppen. / Mirbazel SH. Comparison between men and women’s survival based on the results from the exercise tests and myocardial perfusion imaging. Degree Project in Biomedical Laboratory Science, 15 points. Malmö University: Health and Society, Department of Biomedical Laboratory Science, 2011.One of the most common causes of death in both developing countries and in the Western world is heart attack that hits usually individuals over 65 years. Cardiac ischemia is the most common cause of myocardial infarction/sudden cardiac arrest. For the diagnosis of cardiac ischemia, exercise test is the first choice, because the method is inexpensive, non-invasive and relatively harmless. Myocardial perfusion imaging is often performed after an inconclusive exercise test. The purpose of this retrospective study was to determine if the prognosis and survival differ between women and men depending on the outcome of the investigation from the exercise test, and the myocardial perfusion imaging. In this study 2045 patients were analyzed who were registered to perform the exercise tests for a suspected or previously known coronary artery disease in 2006/2007. Patient’s results were divided into three groups: normal, pathological and intermediate findings. The intermediary group was further divided according to results of myocardial perfusion imaging within 6 months of the exercise test: those with normal, those with pathologic and those who had not carried out any myocardial perfusion imaging. Patients with normal exercise test were 1110, with intermediate exercise test 540 and with pathologic exercise test were 254 people. There are statistically significant differences in the number of living and deceased between men and women in intermediate exercise tests (p < 0, 001) and in the subgroup, intermediary without myocardial perfusion imaging (p < 0,001). There is also a statistically significant difference in survival in the main group with the intermediate exercise tests (p < 0.01). No analysis was performed for sub-groups. In conclusion, this study has shown that there are no statistically significant differences in survival between men and women with normal and pathological exercise test. However there is a significant difference in intermediary group.

La stabilité métabolique des cellules cardiaques est dépendante d'une organisation fonctionnelle qui favorise le transfert des liaisons phosphate depuis les sites de synthèse de l'ATP (mitochondries) jusqu'aux sites d'utilisation de l'énergie. Au niveau mitochondrial, cette fonction est principalement assurée par l'Interactosome Mitochondrial, comprenant les complexes respiratoires, l'ATP synthasome fonctionnellement couplé à la créatine kinase mitochondriale et le pore de la membrane mitochondriale externe VDAC qui régit la diffusion des nucléotides adényliques sous le contrôle de protéines du cytosquelette. Il est communément admis que la situation d'ischémie/reperfusion (IR) du myocarde affecte l'organisation intracellulaire des cardiomyocytes, les phosphorylations oxydatives (OxPhos), ainsi que le transfert de l'énergie cellulaire.L'objectif de ce travail était d'étudier les mécanismes de régulation de la fonction mitochondriale par les interactions entre la tubuline BII et la membrane mitochondriale externe (MME) d'une part et l'organisation de supercomplexes respiratoires (SCR) d'autre part. Différents types de muscles striés (cardiaque et squelettique) ont été utilisés pour étudier le lien entre la tubuline BII et la perméabilité de la MME pour les nucléotides adényliques. De plus, le rôle de la tubuline BII et de l'organisation des SCR ont été étudiés dans la situation physiopathologique de l'IR cardiaque.Dans les cardiomyocytes, comme dans les cellules issues de muscles squelettiques oxydatifs de rats adultes, la tubuline BII est colocalisée avec les mitochondries et la perméabilité de la MME pour l'ADP est faible. A l'aide du système pyruvate kinase/phosphoénolpyruvate, destiné à piéger l'ADP extramitochondrial, nous avons montré que l'affinité apparente d'OxPhos pour l'ADP est directement liée à la perméabilité de la MME. Ainsi, dans le muscle cardiaque comme dans les muscles squelettiques oxydatifs, un fort Km apparent pour l'ADP est associé à une faible perméabilité de la MME à l'ADP et à une forte expression de tubuline BII, présente sous une forme non-polymérisée. A l'inverse, dans les muscles glycolytiques, la très faible teneur en tubuline BII non-polymérisée est associée à une forte perméabilité de la MME aux nucléotides adényliques (faible Km apparent pour l'ADP).Les effets de l'ischémie (20 ou 45 minutes) et de la reperfusion cardiaque (30 minutes) ont été étudiés sur un modèle de coeur isolé perfusé de rat. Les principaux résultats sont que la séquence d'IR induit un réarrangement de la tubuline BII, associé à une réduction du Km apparent pour l'ADP, une baisse du contrôle de la respiration par la créatine et une diminution de la capacité d'OxPhos. Les modifications observées étaient dépendantes de la durée de l'ischémie et variables d'un cœur à l'autre. De plus, le groupe soumis à 20 minutes d'ischémie était caractérisé par la présence de SCR incluant le complexe I et l'absence de perte de cytochrome c (suggérant l'absence d'apoptose cellulaire). A l'inverse, 45 minutes d'ischémie suivies de reperfusion ont conduit à une perte de cytochrome c et à un remodelage de l'ultrastructure mitochondriale, sans modification de l'organisation des SCR.En conclusion, nos résultats soulignent l'importance des interactions mitochondrie-cytosquelette, et plus particulièrement celles impliquant la tubuline BII, dans la compartimentation intracellulaire des nucléotides adényliques et les transferts d'énergie dans les muscles striés oxydatifs. Par ailleurs, la séquence d'IR myocardique induit une désorganisation de la tubuline BII, qui contribue à la dysfonction mitochondriale. Enfin, l'absence de réorganisation des SCR quand la lésion d'IR est irréversible (45 minutes d'ischémie) suggère que le réarrangement des SCR observé après 20 minutes d'ischémie pourrait être l'un des mécanismes adaptatifs mis en jeu pour prévenir la dysfonction mitochondriale à la suite d'une séquence d'IR. / Cardiac metabolic stability is highly dependent on the intracellular functional organization which favors compartmentalized phosphoryl flux transfer between sites of mitochondrial ATP synthesis and sites of ATP hydrolysis (mainly myofibrillar ATPases). At the level of mitochondria, this function is provided by Mitochonrial Interactosom (IM) which includes respiratory complexes, ATP Synthasom coupled functionally to Mitochondrial Creatine Kinase (MtCK) and Voltage-Dependent Anion Channel (VDAC) regulating ATP/ADP diffusion through its interaction with cytoskeleton proteins. Cardiac ischemia/reperfusion (IR) injury alters intracellular organization, oxidative phosphorylation (OxPhos) and compartmentalized intracellular phosphoryl flux transfer.The aim of this work was to study the regulation of mitochondrial activity by B tubulin II interaction with MOM and by respiratory supercomplex (RSC) organization, under physiological conditions as well as in ischemia/reperfusion in striated muscles. For this purpose, different types of striated muscles (cardiac and skeletal) were used for studying the link between B tubulin II and MOM permeability to adenine nucleotides. In addition, the role of B tubulin II and RSC organization was studied in the pathophysiological context of cardiac ischemia/reperfusion.In cardiac and oxidative skeletal muscles from adult Wistar rats, B tubulin II is colocalized with mitochondria and associated with low MOM permeability to ADP. Using pyruvate kinase and phosphoenolpyruvate trapping system for ADP, we show that the apparent affinity of OxPhos for ADP can be directly linked to the permeability of MOM. High apparent Km for ADP in cardiac and oxidative skeletal muscle is associated with low MOM permeability to ADP and high expression of non-polymerized B tubulin II. Very low expression of non-polymerized B tubulin II in glycolytic muscles is associated with high MOM permeability for adenine nucleotides (low apparent Km for ADP).The effect of the IR-injury was studied by subjecting isolated and perfused Wistar rat hearts to total ischemia (for 20 min and 45 min) followed by 30 min of reperfusion (I20R and I45R groups, respectively). The IR-injury induced intracellular rearrangement of B tubulin II was associated with decreased apparent Km for ADP, creatine-control of respiration and reduced OxPhos capacity. Observed changes were dependent on the duration of ischemia and were heterogeneously present across hearts. Additionally, in the I20R group we evidenced an increase in the content of the RSC embodying complex I in the absence of cytochrome c release (evidencing the absence of apoptosis). Forty five minutes of ischemia followed by reperfusion resulted in increased cytochrome c release and mitochondrial cristae remodeling without alteration of RSC organization.The results of this study highlight the importance of cytoskeleton-mitochondria interactions, and particularly that of B tubulin II, for adenine nucleotide intracellular compartmentalization and phosphoryl flux transfer in oxidative striated muscles. In addition, cardiac IR was shown to induce B tubulin II disorganization contributing to mitochondrial dysfunction. The absence of the RSC reorganization after irreversible IR injury (45 minutes of ischemia) suggests that the rearrangement of RSC observed after 20 minutes of ischemia could be an adaptive mechanism to overcome the IR-induced alterations of mitochondrial function.