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No description available.

Pulmonary hypertension is becoming a recognized complication of the hereditary and acquired haemolytic anaemias, associated with a poor prognosis. Recently we reported that patients with paroxysmal nocturnal haemoglobinuria (PNH) have high levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), a biomarker associated with both right and left ventricular dysfunction and cardiac dysfunction. In the current study we evaluated a cohort of patients (N = 29) with haemolytic PNH for elevated pulmonary artery systolic pressure and cardiac function by Doppler-echocardiography. Of the 29 patients, eight were further studied using cardiac magnetic resonance imaging (MRI), as well as two additional patients (number of patients studied using cardiac MRI = 10). Plasma from the first cohort (N = 29) demonstrated intravascular haemolysis associated with a 12-fold increase in median nitric oxide (NO) consumption when compared with healthy volunteers (P < 0·001). Doppler echocardiography demonstrated normal left ventricular function and elevated pulmonary artery systolic pressure in 41% of patients. Cardiac MRI from the second cohort (N = 10) demonstrated depressed right ventricular function in 80% of PNH patients tested, and 60% had findings suggestive of subclinical small pulmonary emboli. Together, these data suggest a high prevalence of haemolysis-associated NO scavenging, Doppler-estimated systolic pulmonary hypertension, and depressed right ventricular function in patients with PNH.

Abrupt decreases and increases in systolic arterial blood pressure produce baroreflex mediated shortening and lengthening, respectively, of the R-R interval. This phenomenon, otherwise known as the cardivagal baroreflex, is best described by the sigmoid relationship between R-R interval length and systolic blood pressure. The linear portion of this relationship is used to derive the slope or gain of the cardiovagal baroreflex. Importantly, lower levels of cardiovagal baroreflex have been associated with poor orthostatic tolerance and an increased cardiovascular disease-related mortality. The most commonly used and accepted technique to assess cardiovagal barorelex gain is the modified Oxford techinique. Bolus injections of sodium nitroprusside followed by phenylephrine HCL are used to decrease and raise blood pressure ~15 mmHg, respectively. The baroreflex control of the cardiac vagal outflow can then be assessed by the relation of the R-R interval to systolic blood pressure. However, the modified Oxford technique does not always reveal the nonlinear nature of baroreflex relations. The reasons for this has been unclear. Thus, analysis of baroreflex gain when nonlinearities are not revealed is problematic. Five classifications of baroreflex trials have been identified: acceptable, threshold-heavy, saturation-heavy, linear-heavy, and random trials. A new method of gain estimation was developed that combines the strengths of the current methods of gain estimation with the knowledge of the classifications of baroreflex trials. Using this method, cardiovagal baroreflex gain assessment can be maximized if threshold-heavy, saturation-heavy, and random trials are filtered out of the analysis and the manual method is used to estimate gain on the remaining trials. In addition, a link seems to exist between the variability of delta and the variability in baroreflex gain between different subjects. / Master of Science

Student Number :9900127Y - MSc (Eng) dissertation - Faculty of Engineering and the Built Environment / Arterial pulse wave analysis studies the wave shape of the blood pressure pulse. The pulse wave provides more information than the extreme systolic and dia- stolic pressures, measured with a cuff sphygmomanometer. The aim of the research is to investigate the design issues in a pulse wave analysis system, and to compare these to a commercially available system. The system was compared and validated by measuring the pulse wave at the radial artery (wrist) using the non-invasive technique of arterial tonometry. The design conformed to the IEC-601 safety standard to ensure patient safety. The data was compared against the data from the commercial system and analysis was performed in the time and frequency domain. The performance of the design suggests that, in some respects, the design was comparable to the commer- cial system, however, a number of performance characteristics fell short of the commercial system. Suggestions have been made to address these problems in further research.

A cardiomiopatia dilatada idiopática (CMD) é a segunda cardiopatia mais prevalente na espécie canina, acometendo principalmente raças grandes e gigantes, bem como o Cocker Spaniel. É uma doença que possui alta letalidade, além de comprometer substancialmente a qualidade de vida do animal. O diagnóstico definitivo é realizado por meio da ecocardiografia, onde se observam dilatação das cavidades cardíacas, mais freqüentemente do ventrículo e átrio esquerdos, e diminuição da função sistólica. Estudos realizados em seres humanos com CMD mostram que, além da sistólica, a função diastólica está comprometida, e que a análise do fluxo transmitral, importante para a detecção de alterações de relaxamento e/ou distensibilidade tem importante valor prognóstico para a sobrevida e evolução dos sintomas. O tratamento da CMD tradicionalmente baseia-se na utilização de digitálicos, diuréticos, e vasodilatadores. Contudo, nos últimos anos, visto a importância da ativação do sistema nervoso simpático sobre a fisiopatologia desta doença, os &beta;-bloqueadores têm sido empregados. Muitos trabalhos mostram que estes fármacos melhoram a função sistólica e/ou diastólica do ventrículo esquerdo, e com isso aumentam a sobrevida e diminuindo a progressão dos sintomas. Estudaram-se 45 cães com cardiomiopatia dilatada, que foram divididos em dois grupos (A e B). O grupo A (n=25) recebeu o tratamento convencional, ou seja, digitálicos, diuréticos e vasodilatadores, e o grupo B (n=20) recebeu estes mesmos medicamentos acrescidos do carvedilol, um &beta;-bloqueador de terceira geração. Os animais foram submetidos aos exames clínico e ecocardiográfico antes e após três, 13, 26 e 52 semanas do início do tratamento ou até o óbito. Não foram observadas diferenças nos valores dos índices de função sistólica e diastólica entre os grupos. Verificou-se que o grupo tratado com carvedilol apresentou maior tempo médio de sobrevida, porém esta diferença não foi estatisticamente significante. Quanto aos sintomas (classe funcional), observou-se que o grupo tratado com carvedilol apresentou evolução mais favorável, com maior número de animais classificados como &quot;sintomas leves&quot; após três meses de tratamento. Assim, embora o carvedilol tenha se mostrado benéfico, principalmente com relação aos sintomas, não se pode correlacionar esta melhora à ação do fármaco sobre as funções sistólica e diastólica / Dilated Cardiomyopathy (DCM) is the second more common heart disease in dogs, wherein large and giant breeds, as well as Cockers Spaniels, are predisposed. Such disease has a high mortality rate besides reducing the quality of life of the affected animals. The definitive diagnosis is based upon echocardiography which is characterized by dilation of cardiac chambers, mainly the left ones, and by reduced systolic function. Human medicine studies have reported that the diastolic dysfunction also plays an important role; so, an abnormal transmitral flow pattern, which represents the ventricular diastolic filling, has a great prognostic value in terms of survival and symptoms status (heart failure functional class) The management of DCM traditionally consists of digitalis, diuretics and vasodilators, however, in the late years, some attention has being paid to the importance of the sympathetic nervous system on the pathophysiology of this disorder; being so, &beta;-blockers have been included in the therapy. Many authors have reported that these drugs improve the left ventricle systolic and diastolic function, and so they increase the survival rate and reduce the symptoms progression. Forty-five dogs with idiopathic dilated cardiomyopathy, divided into two groups (A and B), were studied. The group A (n=25) consisted of dogs that were put on the traditional therapy (digitalis, diuretics and vasodilators) and the group B (n=20) included those who were treated with all these drugs plus carvedilol, a third generation &beta;-blocker. The animals went through clinical and echocardiographic assesment before and 3, 13, 26 and 52 weeks after starting the treatment or until death. The variables of systolic and diastolic function were not statistically different between the two groups. The median survival time of the dogs treated with carvedilol was higher, but the difference was not statistically significant. Concerning to the symptoms (heart failure funcional class), dogs who were put on carvedilol had a better progression, as more of them were classified as &quot;mild symptoms&quot; after three months of therapy. In conclusion, despite the beneficial effects of carvedilol on the symptoms, these can not be correlate with the systolic and diastolic functions

Bakgrund: I hälso-och sjukvården är blodtrycksmätning en viktig och grundläggande metod vid korrekt diagnostik och hantering av högt blodtryck. Forskning har under flera år påvisat att olika komponenter påverkar noggrannheten av blodtrycksmätningen. Eftersom auskultatorisk och oscillometrisk blodtrycksmätning utförs på två olika sätt finns en risk att blodtrycksvärdet kan variera mellan metoderna. Syfte: Syftet med studien var att undersöka om det finns någon skillnad mellan auskultatorisk och oscillometrisk blodtrycksmätning utfört i både vila och efter ansträngning. Material och metod: Studien bestod av 20 slumpmässigt utvalda studenter från Hälsohögskolan i Jönköping. Blodtrycksmätning utfördes med hjälp av auskultatorisk blodtrycksmanschett med handmanometer och stetoskop samt oscillometrisk modalitet (OMRON M7). Resultat: Statistisk signifikant skillnad observerades mellan auskultatorisk och oscillometrisk modalitet, både i vila och efter ansträngning. Skillnaden är som störst efter ansträngning för auskultatorisk och oscillometrisk mätmetod, i både systoliskt och diastoliskt blodtrycksvärde. Diskussion: I vården har användning av oscillometrisk blodtrycksmodalitet ökat och därmed finns en risk för minskad reliabilitet och validitet av blodtrycksvärdet. Slutsatser: Statistisk signifikant skillnad föreligger mellan modaliteterna, både i vila och efter ansträngning. / Background: Blood pressure measurement is an important and fundamental method for correct diagnosis and management of high blood pressure, in healthcare. For several years, research has shown that different components affect the accuracy of blood pressure measurement. There is a risk that the blood pressure value may vary between auscultatory and oscillometric measurements because they are performed in two different ways. Purpose: The purpose was to investigate whether there is any difference between auscultatory and oscillometric blood pressure values performed in both rest and after stress. Material and method: The study consists of 20 randomly selected students from the School of Health and Welfare of Jönköping. The measurement was performed using auscultatory blood pressure cuff, sphygmomanometer with stethoscope and oscillometric modality (OMRON M7). Result: Statistically significant difference was observed between auscultatory and oscillometric values, both in rest and stress. The difference is greater after stress for both methods, in systolic and diastolic values. Discussion: In healthcare, use of oscillometric modality has increased thus there is a risk of reduced reliability and validity of the blood pressure value. Conclusion: Statistically significant difference was observed between auscultatory and oscillometric values, both in rest and after stress.

Submitted by Bruno Cristian Rodrigues (bcr.bruno@hotmail.com) on 2018-05-24T17:50:20Z No. of bitstreams: 1 Dissertação Versão Final.pdf: 1282289 bytes, checksum: 220b5b70a270e2a384dab8b94d207bdc (MD5) / Approved for entry into archive by Alexandra Maria Donadon Lusser Segali null (alexmar@fcav.unesp.br) on 2018-05-28T13:42:27Z (GMT) No. of bitstreams: 1 rodrigues_bc_me_jabo.pdf: 1282289 bytes, checksum: 220b5b70a270e2a384dab8b94d207bdc (MD5) / Made available in DSpace on 2018-05-28T13:42:27Z (GMT). No. of bitstreams: 1 rodrigues_bc_me_jabo.pdf: 1282289 bytes, checksum: 220b5b70a270e2a384dab8b94d207bdc (MD5) Previous issue date: 2018-04-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A degeneração mixomatosa da válvula mitral (DMVM) é a enfermidade mais comum na clínica de pequenos animais no âmbito das cardiopatias, cuja evolução pode resultar em alterações hemodinâmicas importantes decorrentes dos mecanismos neuro-hormonais compensatórios. Embora seu diagnóstico seja relativamente simples, as alterações intrínsecas podem ser subestimadas pelos exames convencionais, a exemplo da disfunção sistólica e reserva miocárdica que podem passar despercebidas à ecocardiografia. Desta forma, o objetivo do presente estudo foi avaliar a ocorrência de disfunção sistólica em cães com DMVM por meio do teste de estresse farmacológico com dobutamina. Para tanto, foram utilizados três grupos de cães: G1 (n=8) grupo controle, G2 (n=7) animais com DMVM e diâmetro interno do ventrículo esquerdo em diástole indexado à aorta (DIVEd/Ao) < 2,37 e G3 (n=6) animais com DMVM e DIVEd/Ao ≥ 2,37 em um total de 21 animais. O ecocardiograma foi realizado antes (T0) e após (T1) infusão contínua com dobutamina, que foi realizada da seguinte forma: 5μg/kg/minuto por cinco minutos e 10μg/kg/minuto durante 10 minutos (T1). Os resultados foram avaliados pelo teste de Tukey com nível de significância de 5% quanto às variáveis fração de ejeção (FEJ%) (variação percentual média (VPM) de FEJ% antes e após a infusão de dobutamina), VPM de fração de encurtamento (FEC%) e diâmetros internos do ventrículo esquerdo em sístole e diástole indexados pelo diâmetro da aorta (DIVEs/Ao e DIVEd/Ao). Os resultados acerca da VPM FEC% e VPM FEJ%,demonstraram que houve diferença estatística quanto à primeira variável entre os grupos G1 com G3, bem como entre G2 e G3, enquanto em relação à segunda, apenas o G1 e G3 diferiram estatisticamente. Por outro lado não houve diferença significativa (p>0,05) para as médias obtidas pré e pós dobutamina da FEC% e FEJ% entre todos os grupos, no entanto, houve diferença significativa dentro os grupos G1 e G2 quando analisados os momentos T0 e T1. Outrossim, verificando as médias obtidas do DIVEd/Ao, conclui-se que houve diferença entre os grupos G1 e G3 como também entre G2 e G3 (p<0,05). Por sua vez, as médias obtidas do DIVEs/Ao diferiram significativamente (p<0,05) em todos os grupos pré (T0) e pós dobutamina (T1), exceto no G3. Entre os grupos, as médias no T0, têm diferença estatística significante entre os grupos G1 e G3 (p<0,05). Ademais, Em relação ao VVEs/m², dentro dos grupos houve diferença significativa apenas entre G1 e G3. Já entre os tempos, apenas o G1 houve diferença entre T0 e T1. Por fim, constatou-se significância estatística (p<0,05) quando se correlacionou DIVEd/Ao com a VPM FEC% e VPM FEJ%, demonstrando que quanto maior o DIVEd/Ao menores são estas variáveis. Desta forma, conclui-se que a dobutamina é capaz de evidenciar disfunção sistólica em animais com DMVM, principalmente naqueles que têm um remodelamento maior (G3), sendo capaz de inferir uma forte relação entre o tamanho do DIVEd/Ao e disfunção sistólica. Além disso, notou -se que em animais com menor remodelamento do ventrículo esquerdo (VE), como os do grupo G2, a resposta inotrópica ao desafio farmacológico foi satisfatória, revelando a presença de reserva contrátil nestes pacientes. Por fim, o teste de estresse com dobutamina mostrou-se eficaz, seguro e aplicável na rotina clínica. / Myxomatous mitral valve disease (MMVD) is the most common cardiopathy in small animals, which evolution may result in important hemodynamic changes due to compensatory neurohormonal mechanisms. Although its diagnosis is relatively simple, intrinsic changes may be underestimated by conventional exams, as systolic dysfunction and myocardial reserve that may go unnoticed by echocardiograph. Therefore, the objective of the present study was to evaluate the occurrence of systolic dysfunction in dogs with MMVD through pharmacological stress test with dobutamine. The dogs were distributed in three groups: G1 (n = 8) control group, G2 (n = 7) animals with MMVD and left ventricular diastolic diameter indexed to the aorta (LVIDd:Ao) < 2.37 and G3 (n = 6) animals with MMVD and LVIDd:Ao ≥ 2.37. The echocardiograph was performed before (T0) and after (T1) continuous infusion of dobutamine, as follows: 5μg/kg/minute for five minutes and 10μg/kg/minute for 10 minutes (T1). The results were evaluated by Tukey test with significance level of 5% for the following variables: ejection fraction (EF%) (mean percentage variation (MPV) of EF% before and after dobutamine infusion), MPV of shortening fraction FS% and internal diameters of left ventricle in systole and in diastole indexed by aortic diameter (LVIDs:Ao and LVIDd:Ao). The results about the MPV FS% and the MPV EF% showed that there was statistical difference between the G1 and G3 groups, as well as between G2 and G3, while the G1 and G3 differed statistically from the G1 and G3 groups. On the other hand, there was no significant difference (p> 0.05) for the averages obtained before and after dobutamine of the FS% and EF% among all groups, however, there was a significant difference between groups G1 and G2 when the T0 moments and T1. In addition, it was concluded that there were differences between the G1 and G3 groups as well as between G2 and G3 (p <0.05). Also, by means of the LVIDd:Ao means, it was concluded that there was a difference between the G1 and G3 groups as well as between G2 and G3 (p <0.05). In it’s turn, the means obtained from LVIDs:Ao differed significantly (p <0.05) in all groups before (T0) and post-dobutamine (T1), except in G3. Among the groups, the averages at T0, have significant statistical difference between the G1 and G3 groups (p <0.05). In addition, with respect to ESV/m², within the groups there was a significant difference only between G1 and G3. Among the times, only G1 showed differences between T0 and T1. Finally, statistical significance (p <0.05) was found when DIVEd / Ao correlated with MPV FS% and EF%, demonstrating that the higher the LVIDd:Ao the lower these variables. Therefore, it was determined that dobutamine can point to systolic dysfunction in animals with MMVD, especially those showing greater remodeling (G3), also inferring a strong relationship between LVIDd:Ao size and systolic dysfunction. Furthermore, in animals with less left ventricular (LV) remodeling, such as those in group G2, inotropic response to pharmacological challenge was satisfactory, revealing the presence of contractile reserve in these patients. To conclude, dobutamine stress test showed effective, safe and applicable in clinical routine.

A cardiomiopatia dilatada idiopática (CMD) é a segunda cardiopatia mais prevalente na espécie canina, acometendo principalmente raças grandes e gigantes, bem como o Cocker Spaniel. É uma doença que possui alta letalidade, além de comprometer substancialmente a qualidade de vida do animal. O diagnóstico definitivo é realizado por meio da ecocardiografia, onde se observam dilatação das cavidades cardíacas, mais freqüentemente do ventrículo e átrio esquerdos, e diminuição da função sistólica. Estudos realizados em seres humanos com CMD mostram que, além da sistólica, a função diastólica está comprometida, e que a análise do fluxo transmitral, importante para a detecção de alterações de relaxamento e/ou distensibilidade tem importante valor prognóstico para a sobrevida e evolução dos sintomas. O tratamento da CMD tradicionalmente baseia-se na utilização de digitálicos, diuréticos, e vasodilatadores. Contudo, nos últimos anos, visto a importância da ativação do sistema nervoso simpático sobre a fisiopatologia desta doença, os &beta;-bloqueadores têm sido empregados. Muitos trabalhos mostram que estes fármacos melhoram a função sistólica e/ou diastólica do ventrículo esquerdo, e com isso aumentam a sobrevida e diminuindo a progressão dos sintomas. Estudaram-se 45 cães com cardiomiopatia dilatada, que foram divididos em dois grupos (A e B). O grupo A (n=25) recebeu o tratamento convencional, ou seja, digitálicos, diuréticos e vasodilatadores, e o grupo B (n=20) recebeu estes mesmos medicamentos acrescidos do carvedilol, um &beta;-bloqueador de terceira geração. Os animais foram submetidos aos exames clínico e ecocardiográfico antes e após três, 13, 26 e 52 semanas do início do tratamento ou até o óbito. Não foram observadas diferenças nos valores dos índices de função sistólica e diastólica entre os grupos. Verificou-se que o grupo tratado com carvedilol apresentou maior tempo médio de sobrevida, porém esta diferença não foi estatisticamente significante. Quanto aos sintomas (classe funcional), observou-se que o grupo tratado com carvedilol apresentou evolução mais favorável, com maior número de animais classificados como &quot;sintomas leves&quot; após três meses de tratamento. Assim, embora o carvedilol tenha se mostrado benéfico, principalmente com relação aos sintomas, não se pode correlacionar esta melhora à ação do fármaco sobre as funções sistólica e diastólica / Dilated Cardiomyopathy (DCM) is the second more common heart disease in dogs, wherein large and giant breeds, as well as Cockers Spaniels, are predisposed. Such disease has a high mortality rate besides reducing the quality of life of the affected animals. The definitive diagnosis is based upon echocardiography which is characterized by dilation of cardiac chambers, mainly the left ones, and by reduced systolic function. Human medicine studies have reported that the diastolic dysfunction also plays an important role; so, an abnormal transmitral flow pattern, which represents the ventricular diastolic filling, has a great prognostic value in terms of survival and symptoms status (heart failure functional class) The management of DCM traditionally consists of digitalis, diuretics and vasodilators, however, in the late years, some attention has being paid to the importance of the sympathetic nervous system on the pathophysiology of this disorder; being so, &beta;-blockers have been included in the therapy. Many authors have reported that these drugs improve the left ventricle systolic and diastolic function, and so they increase the survival rate and reduce the symptoms progression. Forty-five dogs with idiopathic dilated cardiomyopathy, divided into two groups (A and B), were studied. The group A (n=25) consisted of dogs that were put on the traditional therapy (digitalis, diuretics and vasodilators) and the group B (n=20) included those who were treated with all these drugs plus carvedilol, a third generation &beta;-blocker. The animals went through clinical and echocardiographic assesment before and 3, 13, 26 and 52 weeks after starting the treatment or until death. The variables of systolic and diastolic function were not statistically different between the two groups. The median survival time of the dogs treated with carvedilol was higher, but the difference was not statistically significant. Concerning to the symptoms (heart failure funcional class), dogs who were put on carvedilol had a better progression, as more of them were classified as &quot;mild symptoms&quot; after three months of therapy. In conclusion, despite the beneficial effects of carvedilol on the symptoms, these can not be correlate with the systolic and diastolic functions