Background: Hyperthyroidism has substantial effects on the circulatory system. The cardiac biomarkers NT-proBNP and troponin I (cTNI) have proven useful in identifying cats with myocardial disease but have not been as extensively investigated in hyperthyroidism. Hypothesis: Plasma NT-proBNP and cTNI concentrations are higher in cats with primary cardiac disease than in cats with hyperthyroidism and higher in cats with hyperthyroidism than in healthy control cats. Animals: Twenty-three hyperthyroid cats, 19 cats with HCM without congestive heart failure, and 19 euthyroid, normotensive healthy cats eight years of age or older. Fourteen of the hyperthyroid cats were re-evaluated three months after administration of 131I. Methods: A complete history, physical examination, complete blood count, serum biochemistries, urinalysis, blood pressure measurement, serum T4 concentration, plasma concentrations of NT-proBNP and cTNI, and echocardiogram was prospectively obtained from each cat. Results: Hyperthyroid and HCM cats had plasma NT-proBNP and cTNI concentrations that were significantly greater than healthy older cats, but there was no significant difference between hyperthyroid and HCM cats with respect to concentration of either biomarker. In hyperthyroid cats that were re-evaluated three months after 131I treatment, plasma NT-proBNP and cTNI concentrations as well as ventricular wall thickness decreased. Conclusions and Clinical Relevance: Although there may be a role for NT-proBNP in monitoring the cardiac response to treatment of hyperthyroidism, neither NT-proBNP nor cTNI can be used to distinguish hyperthyroid cats from cats with HCM. Therefore, the thyroid status of older cats should be ascertained prior to interpreting results of cardiac biomarker testing. / Master of Science

INTRODUÇÃO: A estenose aórtica, doença valvar de grande prevalência, tem na avaliação clínica e ecocardiográfica as principais ferramentas para avaliação dos pacientes. Ferramentas auxiliares de avaliação são desejáveis e neste contexto surgem os peptídeos natriuréticos. Os peptídeos natriuréticos BNP e NT-proBNP podem ser usados como marcadores diagnósticos e prognósticos em diversas situações clínicas. Postulamos que os peptídeos pudessem ter papel diagnóstico, mas principalmente valor prognóstico em pacientes com estenose aórtica grave. OBJETIVO: primariamente, definir o papel prognóstico de sobrevida dos peptídeos natriuréticos BNP e NT-proBNP no acompanhamento prospectivo de uma população de pacientes com estenose aórtica grave. Secundariamente, comparar os níveis séricos de BNP e NT-proBNP entre pacientes com EAo grave assintomáticos e sintomáticos. MÉTODOS: Foram incluídos de forma consecutiva 66 pacientes com estenose aórtica grave, definida pela presença de gradiente médio de pressão transvalvar aórtica maior que 40 mmHg. Os critérios de exclusão foram fibrilação atrial, outra valvopatia, cardiopatia associada, infecções ativas, neoplasias, doenças auto-imunes ou inflamatórias, insuficiência renal e obesidade. Dos 66 pacientes incluídos, 76% eram sintomáticos (50/66). Os sintomas foram definidos como dispnéia aos esforços, síncope ou angina. Na inclusão, todos os pacientes foram submetidos à avaliação clínica inicial, realização de ecocardiograma e dosagem de BNP e NT-proBNP. Os pacientes sintomáticos recebiam a indicação de tratamento cirúrgico e os pacientes assintomáticos eram conduzidos clinicamente. Os pacientes foram acompanhados prospectivamente. O desfecho clínico avaliado foi óbito cardiovascular, definido por morte súbita, morte por insuficiência cardíaca e óbito peri-operatório. RESULTADOS: Os pacientes foram acompanhados por 869 + 397 dias. Houve 11 óbitos durante o acompanhamento. Na inclusão, os níveis de BNP e NT-proBNP foram similares em assintomáticos e sintomáticos: BNP 72 (41-175) pg/mL versus 104 (46-270) pg/mL; p = 0,275 e NT-proBNP 676 (235-1356) pg/mL vs. 871 (310-2230) pg/mL; p = 0,226. Houve diferença entre os níveis de BNP e NT-proBNP e classe funcional (p < 0,001 e p < 0,001, respectivamente). Através da curva ROC foi determinado um valor de corte de BNP (105 pg/mL) e NT-proBNP (1500 pg/mL) capazes de predizer classe funcional III e IV (New York Heart Association), com área sob a curva de 0,806 e 0,786 respectivamente. BNP e NT-proBNP foram preditores de mortalidade (p=0,007 e p=0,001 respectivamente). BNP > 105 pg/mL aumentou o risco de óbito cardiovascular de forma independente [OR= 6,3 (IC95%: 1,36 - 29,25)]. NT-proBNP > 1500 pg/mL aumentou o risco de óbito cardiovascular de forma independente [OR = 6,5 (IC95%: 1,73 - 24,63)]. CONCLUSÃO: O BNP e o NTproBNP foram preditores independentes de mortalidade em pacientes com estenose aórtica grave em um acompanhamento de quatro anos. O BNP e o NT-proBNP foram preditores de classe funcional III e IV (New York Heart Association) em pacientes com estenose aórtica grave. O BNP e o NT-proBNP não permitiram diferenciar pacientes sintomáticos de assintomáticos / BACKGROUND: Aortic valve stenosis is a high prevalent cardiac valve disease, in which clinical and echocardiographic parameters are the most common approach of diagnosis and risk evaluation. Complementary methods are desirable and the natriuretic peptides BNP and NT-proBNP, both diagnostic and prognostic markers in multiple clinical situations, could improve patient assessment. We postulate that these peptides may have diagnostic purpose, but mainly a prognostic value in patients with severe aortic stenosis. OBJECTIVE: primarily, define the survival prognostic role of natriuretic peptides BNP and NT-proBNP in monitoring a population of patients with severe aortic stenosis prospectively. Secondarily, compare the serum levels of BNP and NT-proBNP among patients with symptomatic and asymptomatic severe aortic stenosis. METHODS: 66 consecutive patients with severe aortic stenosis, defined by the presence of gradient mean transvalvular aortic pressure greater than 40 mmHg were included. Exclusion criteria were concomitant atrial fibrillation, other valve disease, other myocardiopathies, active infections, autoimmunity diseases, inflammatory diseases, neoplasia, renal failure or obesity. 76% of patients were symptomatic (50/66), defined as dyspnea on exertion, syncope or angina. All patients underwent initial clinical evaluation, echocardiography and BNP and NT-proBNP measurement. Symptomatic patients were referred for surgical treatment and asymptomatic patients were clinically managed. (Patients were followed up prospectively). The clinical outcome was cardiovascular death, defined by sudden death, death from heart failure and peri-operative death. RESULTS: Patients were followed up for 869 + 397 days. There were 11 deaths during followup. On admission, levels of BNP and NT-proBNP were similar in asymptomatic and symptomatic individuals: BNP 72 (41-175) pg / mL vs. 104 (46-270) pg / mL, p = 0.275 and NT-proBNP 676 (235-1356) pg / mL vs. 871 (310-2230) pg / ml, p = 0.226. There were differences between the levels of BNP and NT-proBNP and functional class (p <0.001 p <0.001, respectively). ROC-curve analysis demonstrated a cut-off value of BNP (105 pg / mL) and NT-proBNP (1500 pg / mL) capable of predicting NYHA functional class III and IV, with an area under the curve of 0.806 and 0.786 respectively. BNP and NT-proBNP could predict mortality (p = 0.007 and p = 0.001 respectively). BNP > 105 pg/mL independently increased the risk of cardiovascular death [OR = 6.3 (95% CI: 1.36 to 29.25)]. NT-proBNP > 1500 pg/mL independently increased the risk of cardiovascular death [OR = 6.5 (95% CI: 1.73 to 24.63)]. CONCLUSION: BNP and NT-proBNP were independent predictors of mortality in patients with severe aortic stenosis after a follow up of 4 years. BNP and NT-proBNP were predictors of NYHA functional class III and IV in patients with severe aortic stenosis. BNP and NT-proBNP alone did not distinguish symptomatic from asymptomatic patients

INTRODUÇÃO: A estenose aórtica, doença valvar de grande prevalência, tem na avaliação clínica e ecocardiográfica as principais ferramentas para avaliação dos pacientes. Ferramentas auxiliares de avaliação são desejáveis e neste contexto surgem os peptídeos natriuréticos. Os peptídeos natriuréticos BNP e NT-proBNP podem ser usados como marcadores diagnósticos e prognósticos em diversas situações clínicas. Postulamos que os peptídeos pudessem ter papel diagnóstico, mas principalmente valor prognóstico em pacientes com estenose aórtica grave. OBJETIVO: primariamente, definir o papel prognóstico de sobrevida dos peptídeos natriuréticos BNP e NT-proBNP no acompanhamento prospectivo de uma população de pacientes com estenose aórtica grave. Secundariamente, comparar os níveis séricos de BNP e NT-proBNP entre pacientes com EAo grave assintomáticos e sintomáticos. MÉTODOS: Foram incluídos de forma consecutiva 66 pacientes com estenose aórtica grave, definida pela presença de gradiente médio de pressão transvalvar aórtica maior que 40 mmHg. Os critérios de exclusão foram fibrilação atrial, outra valvopatia, cardiopatia associada, infecções ativas, neoplasias, doenças auto-imunes ou inflamatórias, insuficiência renal e obesidade. Dos 66 pacientes incluídos, 76% eram sintomáticos (50/66). Os sintomas foram definidos como dispnéia aos esforços, síncope ou angina. Na inclusão, todos os pacientes foram submetidos à avaliação clínica inicial, realização de ecocardiograma e dosagem de BNP e NT-proBNP. Os pacientes sintomáticos recebiam a indicação de tratamento cirúrgico e os pacientes assintomáticos eram conduzidos clinicamente. Os pacientes foram acompanhados prospectivamente. O desfecho clínico avaliado foi óbito cardiovascular, definido por morte súbita, morte por insuficiência cardíaca e óbito peri-operatório. RESULTADOS: Os pacientes foram acompanhados por 869 + 397 dias. Houve 11 óbitos durante o acompanhamento. Na inclusão, os níveis de BNP e NT-proBNP foram similares em assintomáticos e sintomáticos: BNP 72 (41-175) pg/mL versus 104 (46-270) pg/mL; p = 0,275 e NT-proBNP 676 (235-1356) pg/mL vs. 871 (310-2230) pg/mL; p = 0,226. Houve diferença entre os níveis de BNP e NT-proBNP e classe funcional (p < 0,001 e p < 0,001, respectivamente). Através da curva ROC foi determinado um valor de corte de BNP (105 pg/mL) e NT-proBNP (1500 pg/mL) capazes de predizer classe funcional III e IV (New York Heart Association), com área sob a curva de 0,806 e 0,786 respectivamente. BNP e NT-proBNP foram preditores de mortalidade (p=0,007 e p=0,001 respectivamente). BNP > 105 pg/mL aumentou o risco de óbito cardiovascular de forma independente [OR= 6,3 (IC95%: 1,36 - 29,25)]. NT-proBNP > 1500 pg/mL aumentou o risco de óbito cardiovascular de forma independente [OR = 6,5 (IC95%: 1,73 - 24,63)]. CONCLUSÃO: O BNP e o NTproBNP foram preditores independentes de mortalidade em pacientes com estenose aórtica grave em um acompanhamento de quatro anos. O BNP e o NT-proBNP foram preditores de classe funcional III e IV (New York Heart Association) em pacientes com estenose aórtica grave. O BNP e o NT-proBNP não permitiram diferenciar pacientes sintomáticos de assintomáticos / BACKGROUND: Aortic valve stenosis is a high prevalent cardiac valve disease, in which clinical and echocardiographic parameters are the most common approach of diagnosis and risk evaluation. Complementary methods are desirable and the natriuretic peptides BNP and NT-proBNP, both diagnostic and prognostic markers in multiple clinical situations, could improve patient assessment. We postulate that these peptides may have diagnostic purpose, but mainly a prognostic value in patients with severe aortic stenosis. OBJECTIVE: primarily, define the survival prognostic role of natriuretic peptides BNP and NT-proBNP in monitoring a population of patients with severe aortic stenosis prospectively. Secondarily, compare the serum levels of BNP and NT-proBNP among patients with symptomatic and asymptomatic severe aortic stenosis. METHODS: 66 consecutive patients with severe aortic stenosis, defined by the presence of gradient mean transvalvular aortic pressure greater than 40 mmHg were included. Exclusion criteria were concomitant atrial fibrillation, other valve disease, other myocardiopathies, active infections, autoimmunity diseases, inflammatory diseases, neoplasia, renal failure or obesity. 76% of patients were symptomatic (50/66), defined as dyspnea on exertion, syncope or angina. All patients underwent initial clinical evaluation, echocardiography and BNP and NT-proBNP measurement. Symptomatic patients were referred for surgical treatment and asymptomatic patients were clinically managed. (Patients were followed up prospectively). The clinical outcome was cardiovascular death, defined by sudden death, death from heart failure and peri-operative death. RESULTS: Patients were followed up for 869 + 397 days. There were 11 deaths during followup. On admission, levels of BNP and NT-proBNP were similar in asymptomatic and symptomatic individuals: BNP 72 (41-175) pg / mL vs. 104 (46-270) pg / mL, p = 0.275 and NT-proBNP 676 (235-1356) pg / mL vs. 871 (310-2230) pg / ml, p = 0.226. There were differences between the levels of BNP and NT-proBNP and functional class (p <0.001 p <0.001, respectively). ROC-curve analysis demonstrated a cut-off value of BNP (105 pg / mL) and NT-proBNP (1500 pg / mL) capable of predicting NYHA functional class III and IV, with an area under the curve of 0.806 and 0.786 respectively. BNP and NT-proBNP could predict mortality (p = 0.007 and p = 0.001 respectively). BNP > 105 pg/mL independently increased the risk of cardiovascular death [OR = 6.3 (95% CI: 1.36 to 29.25)]. NT-proBNP > 1500 pg/mL independently increased the risk of cardiovascular death [OR = 6.5 (95% CI: 1.73 to 24.63)]. CONCLUSION: BNP and NT-proBNP were independent predictors of mortality in patients with severe aortic stenosis after a follow up of 4 years. BNP and NT-proBNP were predictors of NYHA functional class III and IV in patients with severe aortic stenosis. BNP and NT-proBNP alone did not distinguish symptomatic from asymptomatic patients

Herzinsuffizienz ist eine sehr häufige Erkrankung vor allem des höheren Lebensalters. Biomarker wie NT-proBNP, BNP, hsCRP haben neben ihrer Bedeutung für die Diagnose einer akuten Herzinsuffizienz einen großen Stellenwert in der Abschätzung der Prognose eines Patienten. Die prognostische Relevanz dieser Marker konnte auch bei nicht herzinsuffizienten, anderweitig kranken Patienten gezeigt werden. Unklar und wenig erforscht ist die Aussagekraft von Biomarkern in einem Kollektiv nicht akut dekompensierter Patienten, welche sich ambulant bei ihrem Hausarzt vorstellen. Die Handheld-BNP-Studie untersuchte im primärärztlichen Bereich das diagnostische Potential von BNP und der miniaturisierten Echokardiographie. Die vorliegende Follow-up-Studie untersucht die prognostische Relevanz von BNP sowie vergleichend den prognostischen Wert von NT-proBNP und der Kardiologendiagnose. Auch die prognostische Aussagekraft der inflammatorischen Marker hsCRP und TNF-ɑ, ebenso wie die Frage, ob durch eine Kombination der Marker die prognostische Abschätzung weiter gesteigerter werden kann, ist Gegenstand dieser Arbeit. Zuletzt wurde eine multivariate Regressionsanalyse durchgeführt, um den unabhängigen prognostischen Wert der Biomarker zu untersuchen. Es konnte gezeigt werden, dass bei diagnostisch naiven Patienten mit dem klinisch-anamnestischen Verdacht auf das Vorliegen einer Herzinsuffizienz das kardiale wie auch das nicht-kardiale Mortalitätsrisiko sowie die Rate an Hospitalisierungen gegenüber der Allgemeinbevölkerung gleichen Alters erhöht sind, unabhängig vom Vorliegen einer Herzinsuffizienz. Eine Bestimmung der Biomarker BNP, NT-proBNP, hsCRP und TNF-ɑ erwies sich in diesem Kollektiv als hilfreich, diejenigen mit erhöhtem Risiko zu erkennen. / Heart failure is a very common disease especially among old people. In addition to their importance for the diagnosis of acute heart failure, biomarkers such as NT-proBNP, BNP, hsCRP and TNF-ɑ play a major role in the assessment of patients prognosis. The prognostic relevance of these markers could even be demonstrated on ill patients with a diagnosis other than heart failure. The significance of biomarkers in a group of not acutely decompensated patients, who consult their general practitioner, is unclear and little explored. The Handheld-BNP-study examined the diagnostic potential of BNP an the miniaturized echokardiography in a primary care setting. The follow-up-study at hand investigates the prognostic relevance of BNP and compares the prognostic value of NT-proBNP and the cardiologist diagnosis. The prognostic value of the inflammatory markers hsCRP and TNF-ɑ, as well as the question of wether the prognostic assessment can further be enhanced by a combination af these markers, are subject of this thesis. At last, a multivariate regression analysis was performed to investigate the independent prognostic value of biomarkers. The thesis shows that the cardiac and non-cardiac mortality risk and the hospitalization rate in diagnostically naive patients with diffuse symptoms who are potentially indicative of heart failure is high, compared to other people of similar age, irrespective of the presence of heart failure. A determination of the biomarkers BNP, NT-proBNP, hsCRP and TNF-ɑ in this cohort proved to be helpful to identify those at increased risk.

No description available.

NT-proBNP is a biproduct derived from the synthesis of BNP, a synthesis stimulated when cardiomyocytes are stretched such as in heart failure. Heart failure is defined as the hearts inability to supply the blood volume the body acquires. It is advantageous to monitor changes for adequate treatment. NT-proBNP has proven to be an excellent marker for this purpose. The purpose of the study was to compare the two immunochemical methods for measuring NT-proBNP: Roche Elecsys proBNP II analyzed with Cobas e601 and Siemens IMMULITE 2000 NT-proBNP analyzed with IMMULITE 2000 XPi. For this comparison 60 lithium heparin plasma samples from 36 men (60 – 90 years old) and 24 women (65 – 94 years old) was used. IMMULITE 2000 XPi served as the reference method. Results from the assays were compared in a correlation diagram, which indicated good correlation (R: 0.98). Cobas e601 yielded results on average 17.4 % lower than the reference method. A paired t test was used to prove significant diference at 95 % confidence level between the methods on a 95 % confidence level. Precision regarding Roche Elecsys proBNP II, based on measurings of plasma with low and high analyte concentration, 25 replicates one day and 5 replicates 4 days gave imprecisions &lt;3 % (CV%). Reference method imprecision (CV%) &lt;5 % was calculated from control analysis. Good correlation between the two methods and lower imprecision when using proBNP II indicate that Cobas e601 can be used. / NT-proBNP är en restprodukt vid syntes av brain natriuretic peptide (BNP), vars syntes stimuleras av att hjärtats myocyter töjs ut såsom vid hjärtsvikt. Hjärtsvikt innebär att hjärtat inte orkar pumpa den volym blod som motsvarar systemkretsloppets behov. Det är fördelaktigt att kunna följa förändringar i hjärtmuskelns funktion för adekvat behandling. NT-proBNP har visat sig vara en bra markör i detta syfte. Studiens syfte var att jämföra två immunokemiska metoder: Roches Elecsys proBNP II i analysinstrumentet Cobas e601 med Siemens IMMULITE 2000 NT-proBNP i analysinstrumentet IMMULITE 2000 XPi. Studiematerialet kom att bestå av 60 patientprover av litiumheparinplasma från 36 män (60 – 90 år) samt 24 kvinnor (65 - 94 år). IMMULITE 2000 Xpi fungerade som referensmetod. Resultat av kalibrering överensstämde med erhållna masterkurvor och analys av kontroller gav resultat inom 1 SD. Analysresultaten från de båda metoderna jämfördes i ett korrelationsdiagram. Spridningsdiagrammen indikerade en korrelation om R: 0,98. Jämförd metod gav dock i genomsnitt 17,8 % lägre resultat. Signifikant skillnad metoderna emellan vid 95 % konfidensnivå påvisades genom ett parat t-test. Precision avseende Roches Elecsys proBNP II undersöktes genom analys av plasma med hög respektive låg analytkoncentration (25 replikat samma dag och 5 replikat om dagen i ytterligare 4 dagar) vilket totalt gav en imprecision om &lt;3 % uttryckt i CV. Referensmetodens imprecision beräknades utifrån analyserade kontroller och gav en CV &lt;5 %. God korrelation mellan de båda metoderna samt lägre imprecision vid användning av Elecys proBNP II talar för att den jämförda metoden kan tas i bruk.

No description available.

nÃo hà / As doenÃas cardiovasculares, incluindo a cardiopatia isquÃmica aterosclerÃtica, sÃo a princi-pal causa de morte no Brasil. A aterosclerose à doenÃa inflamatÃria crÃnica que se inicia na infÃncia, progride lentamente e se expressa dÃcadas depois. Ela principia por disfunÃÃo do endotÃlio, tem patogÃnese multifatorial e tem, como principais fatores de risco, o sexo mascu-lino, a idade, o tabagismo, a hipercolesterolemia, a hipertensÃo arterial sistÃmica (HAS), o diabetes mellitus (DM) e o antecedente familiar de doenÃa aterosclerÃtica precoce. A elevaÃÃo de vÃrios marcadores bioquÃmicos sinaliza a participaÃÃo da inflamaÃÃo na aterosclerose. O peptÃdeo natriurÃtico tipo B e o fragmento amino-terminal do pro-peptÃdeo natriurÃtico tipo B (NT-proBNP) tambÃm aumentam na aterosclerose coronÃria. Esse trabalho à um estudo ob-servacional, transversal, de uma sÃrie consecutiva de 153 pacientes internados na Enfermaria de Cardiologia do HUWC-UFC, no perÃodo de 01.08.2007 a 31.03.2008, com hipÃtese diag-nÃstica de cardiopatia isquÃmica â angina estÃvel (AE), angina instÃvel (AI) ou infarto agudo do miocÃrdio (IAM) â submetidos à cineangiocoronariografia, comparando-se o grupo porta-dor de obstruÃÃo aterosclerÃtica coronÃria angiogrÃfica (grupo A) com aquele de artÃrias co-ronÃrias angiograficamente normais (grupo B). Os critÃrios de exclusÃo foram revasculariza-ÃÃo miocÃrdica prÃvia â cirÃrgica ou percutÃnea â insuficiÃncia renal dialÃtica aguda ou crÃni-ca, neoplasia maligna, infecÃÃo, doenÃa inflamatÃria aguda ou crÃnica, doenÃa pulmonar, he-pÃtica ou hematolÃgica e cardiopatia valvar, congÃnita ou cardiomiopatia associada. Ambos os grupos foram analisados, de modo semelhante, quanto ao sexo, à idade, à escolaridade, ao Ãndice de massa corporal (IMC), à circunferÃncia abdominal (CA), ao tabagismo, ao DM, à HAS, à histÃria familiar positiva para aterosclerose precoce, ao uso de estatina, à presenÃa de sÃndrome metabÃlica (SM) e à apresentaÃÃo clÃnica como AE, AI ou IAM. Eles tambÃm fo-ram analisados em relaÃÃo ao eletrocardiograma, à radiografia do tÃrax e ao ecocardiograma, quanto à presenÃa ou nÃo de disfunÃÃo sistÃlica; ao colesterol nÃo-HDL, à HDL-colesterol, à relaÃÃo do colesterol total / HDL-colesterol < 5 e do LDL-colesterol / HDL-colesterol < 3,5; à creatinina e o ao fibrinogÃnio, ao nÃmero de leucÃcitos totais e ao de monÃcitos, à proteÃna C reativa ultra-sensÃvel e ao NT-proBNP. A comparaÃÃo dos dois grupos revelou, com signifi-cÃncia estatÃstica, à anÃlise univariada, que os pacientes do grupo A tinham prevalÃncia maior de DM e de disfunÃÃo sistÃlica, NT-proBNP &#8805; 250 pg/ml, fibrinogÃnio acima de 500 mg/dl; mais frequentemente usavam estatina e tinham monÃcitos 501 ou mais por mm3 do que aque-les do grupo B. Curiosamente, o IMC &#8805; 30 e a CA aumentada foram mais prevalentes no gru-po com artÃrias coronÃrias normais. No entanto, pela regressÃo logÃstica multivariada, os fato-res independentes para oclusÃo aterosclerÃtica coronariana angiogrÃfica foram o NT-proBNP &#8805; 250 pg/ml, o DM e o aumento do fibrinogÃnio e dos monÃcitos, mesmo consideradas a creatinina e a disfunÃÃo sistÃlica. Na amostra estudada, o modelo com ajuste de prevalÃncia desses fatores teve sensibilidade de 80,4%, especificidade de 76,9 e 79,7% de acurÃcia para o diagnÃstico de oclusÃo coronariana aterosclerÃtica angiogrÃfica. / Cardiovascular diseases, including ischemic heart disease, are the main causes of death in Brazil. Atherosclerosis is a chronic inflammatory disease that starts in the childhood, progresses slowly and shows up many decades later. It begins as an endothelial dysfunction and has as its main risk factors the male sex, age, smoking, hypercholesterolemia, arterial hypertension, diabetes mellitus and a background of early family atherosclerotic disease. The rise of many biochemical markers in the plasma signals the presence of inflammation in the atherosclerosis. The brain natriuretic peptide and the amino-terminal pro-B-type natriuretic peptide (NT-proBNP) also increase in coronary atherosclerosis. This is a cross-sectional and observational study of 153 in-patients at the Cardiology Ward of HUWC-UFC from 08.01.2007 to 03.31.2008 with the diagnostic hypothesis of Ischemic Heart Disease, i.e., stable angina, unstable angina or acute myocardial infarction. All of them underwent heart catheterization and coronary angiography. They were classified respectively as group A or B in accordance with the presence or not of angiographic atherosclerotic coronary occlusion. Patients were not included in the analysis if they had been submitted to surgical or percutaneous revascularization; had an acute or chronic dialytic kidney disease; cancer or infection; a lung, hepatic or hematopoietic disease; an acute or chronic inflammatory illness or associated myocardial, valvular or congenital heart disease. The two groups were analyzed in a similar way with regard to gender, age, level of education, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, an early atherosclerosis family history, the use of statin, presence of metabolic syndrome and clinical presentation of stable angina, unstable angina or acute myocardial infarction. The HDL-cholesterol, non HDL-cholesterol, a total cholesterol/HDL-cholesterol ratio < 5, a LDL-cholesterol/HDL-cholesterol ratio < 3.5, the creatinine and fibrinogen plasma concentration, the total leukocyte and monocyte count, the high-sensitivity C reactive protein, the NT-proBNP, the electrocardiogram, the chest radiography and the echocardiogram, with regard to the presence or not of systolic dysfunction, were also analyzed. The univariety analysis comparing both groups revealed that group Aâ patients more frequently were diabetics and had systolic dysfunction, NT-proBNP &#8805; 250 pg/ml, fibrinogen higher than 500 mg/dl, more frequent use of statin and 501 or more monocytes/mm3 than patients group B. Curiously, the body mass index &#8805; 30 and abnormal abdominal circumference were more frequently found among patients with angiographic normal coronary arteries. Nevertheless, by multivariety regression logistic analysis the independent factors for angiographic atherosclerotic coronary occlusion were the NT-proBNP &#8805; 250 pg/ml, diabetes mellitus, an increase of monocyte number and of fibrinogen plasma concentration, in spite of creatinine level and presence of systolic dysfunction. The model takes into account these factors has 80.4% sensitivity, 76.9% specificity and 79.7% of accuracy for the diagnostic of angiographic atherosclerotic coronary occlusion.

Orientador: Maria Lucia Gomes Lourenço / Resumo: Ambulatorial electrocardiographic monitoring, or Holter method, has been shown to be an effective tool in veterinary medicine to detect early heart lesions, not only to monitor the electrical activity of the heart, but also to control the autonomic nervous system of this organ. It is also known that the main infectious diseases of dogs, such as canine distemper and canine monocytic ehrlichiosis (CME) cause considerable lesions in the heart, proven by histopathological examination. It has already been proven the occurrence of myocarditis in the CME, leading to frequent presence of changes in the generation and conduction of the cardiac electrical impulse. The present study analyzed the electrical activity of the heart during 24 hours, focusing on the prevalence of arrhythmias, heart rate variability study and the biomarkers concentration of dogs with chronic CME (sick group) compared to healthy animals (control group). Forty-five percent of the animals in the diseased group had a high frequency of arrhythmias during the study. The mean concentration of cardiac troponin I and creatinokinase MB (CK-MB) was significant (0.24 ng / mL ± 0.5; 229 ± 205 IU / mL) compared to the control group (0.042 ± 0.07 ng / ML, 126 ± 46.12 IU / mL). The standard deviation of the mean of all NN (SDNN) intervals and the percentage of adjacent RR intervals with a duration difference greater than 50 milliseconds (pnn50%) were also extremely significant (83 ± 65 and 14.56 ± 20) when compared to Healthy... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Submitted by Maurício Gianfrancesco Filippi null (mauriciofilippi@terra.com.br) on 2017-02-13T18:05:19Z No. of bitstreams: 1 Dissertação Maurício G Filippi oficial.pdf: 3286618 bytes, checksum: 2e08ac3322153696d51497bfacf1f0f8 (MD5) / Rejected by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo a orientação abaixo: O arquivo submetido está sem a ficha catalográfica. A versão submetida por você é considerada a versão final da dissertação/tese, portanto não poderá ocorrer qualquer alteração em seu conteúdo após a aprovação. Corrija esta informação e realize uma nova submissão com o arquivo correto. Agradecemos a compreensão. on 2017-02-15T17:11:59Z (GMT) / Submitted by Maurício Gianfrancesco Filippi null (mauriciofilippi@terra.com.br) on 2017-02-16T22:41:18Z No. of bitstreams: 1 Dissertação Maurício G Filippi.pdf: 3283472 bytes, checksum: fa27139485cf995a23ebdca2e069dd69 (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-02-20T18:00:33Z (GMT) No. of bitstreams: 1 fillipi_mg_me_bot.pdf: 3283472 bytes, checksum: fa27139485cf995a23ebdca2e069dd69 (MD5) / Made available in DSpace on 2017-02-20T18:00:33Z (GMT). No. of bitstreams: 1 fillipi_mg_me_bot.pdf: 3283472 bytes, checksum: fa27139485cf995a23ebdca2e069dd69 (MD5) Previous issue date: 2016-12-12 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A monitorização eletrocardiográfica ambulatorial, ou método Holter, vem se mostrando como uma ferramenta eficaz na Medicina Veterinária para detectar lesões cardíacas precoces, não só por monitorar a atividade elétrica do coração, como também o controle do sistema nervoso autônomo desse órgão. Sabe-se também que as principais enfermidades infecciosas de cães, como a cinomose e a erliquiose monocítica canina (EMC) provocam lesões consideráveis no coração, comprovadas por exame histopatológico. Já está comprovada a ocorrência de miocardite na EMC, levando a frequente presença de alterações na geração e condução do impulso elétrico cardíaco. O presente estudo analisou a atividade elétrica do coração durante 24 horas, com enfoque na prevalência de arritmias, estudo da variabilidade da frequência cardíaca e na concentração de biomarcadores de cães com EMC crônica (grupo doente) em comparação à animais saudáveis (grupo controle). Quarenta e cinco por cento dos animais do grupo doente possuíram alta frequência de arritmias durante o estudo. A média da concentração de troponina cardíaca I e de creatinokinase MB (CK-MB) foi significativa (0,24 ng/mL ± 0,5; 229 ± 205 UI/mL) em comparação ao grupo controle (0,042 ± 0,07 ng/mL; 126 ± 46,12 UI/mL). O desvio padrão da média de todos os intervalos NN (SDNN) e a porcentagem de intervalos RR adjacentes com diferença de duração superior a 50 milissegundos (pnn50%) também foram extremamente singificativos (83 ± 65 e 14,56 ± 20) quando comparado aos animais saudáveis (268 ± 74,6 e 55,87 ± 12,8), respectivamente. Podemos concluir que a EMC crônica possui caráter arritmôgenico, onde há persistente lesão miocárdica e intensa estimulação do sistema nervoso autônomo simpático no coração. / Ambulatorial electrocardiographic monitoring, or Holter method, has been shown to be an effective tool in veterinary medicine to detect early heart lesions, not only to monitor the electrical activity of the heart, but also to control the autonomic nervous system of this organ. It is also known that the main infectious diseases of dogs, such as canine distemper and canine monocytic ehrlichiosis (CME) cause considerable lesions in the heart, proven by histopathological examination. It has already been proven the occurrence of myocarditis in the CME, leading to frequent presence of changes in the generation and conduction of the cardiac electrical impulse. The present study analyzed the electrical activity of the heart during 24 hours, focusing on the prevalence of arrhythmias, heart rate variability study and the biomarkers concentration of dogs with chronic CME (sick group) compared to healthy animals (control group). Forty-five percent of the animals in the diseased group had a high frequency of arrhythmias during the study. The mean concentration of cardiac troponin I and creatinokinase MB (CK-MB) was significant (0.24 ng / mL ± 0.5; 229 ± 205 IU / mL) compared to the control group (0.042 ± 0.07 ng / ML, 126 ± 46.12 IU / mL). The standard deviation of the mean of all NN (SDNN) intervals and the percentage of adjacent RR intervals with a duration difference greater than 50 milliseconds (pnn50%) were also extremely significant (83 ± 65 and 14.56 ± 20) when compared to Healthy animals (268 ± 74.6, 55.87 ± 12.8), respectively. It can be concluded that chronic CME has an arrhythmogenic character, where there is persistent myocardial injury and intense stimulation of the sympathetic autonomic nervous system of the heart. / FAPESP: 2014/11219-6