Introdução. Pacientes com insuficiência cardíaca submetidos à ventriculectomia parcial esquerda apresentam melhora na função sistólica do ventrículo esquerdo em repouso, porém continuam apresentando limitação funcional. Objetivo. Para melhor compreender os mecanismos desta limitação funcional, estudamos a função sistólica e diastólica do ventrículo esquerdo em repouso e durante exercício submáximo em pacientes submetidos a ventriculectomia parcial esquerda e em pacientes com insuficiência cardíaca não operados, pareados para capacidade funcional máxima e submáxima. Métodos. Foram estudados 9 pacientes submetidos previamente a ventriculografia parcial esquerda (VPE) e 9 pacientes com insuficiência cardíaca não operados previamente (IC). Todos os pacientes foram submetidos inicialmente a um teste cardiopulmonar para determinação do consumo de oxigênio no limiar anaeróbio (LA) e de pico (VO2 pico). Após, foram estudados através da ventriculografia radioisotópica e analisadas a fração de ejeção (FE) e a taxa máxima de enchimento (TME) do ventrículo esquerdo, em repouso e exercício na intensidade do LA. Resultados. Os grupos apresentaram capacidade funcional semelhante avaliada pelo VO2 pico (VPE: [média ± DP] 13,1 ± 3,3 ml/kg.min; IC: 14,1 ± 3,6 ml/kg.min; P > 0,05) e LA (VPE: 7,9 ± 1.3 ml/kg.min; IC: 8,5 ± 1,6 ml/kg.min; P > 0,05). A frequência cardíaca máxima foi maior no grupo IC em comparação ao grupo da VPE (VPE: 119 ± 20 bpm; IC: 149 ± 21 bpm; P < 0.05) A FE em repouso era mais elevada no grupo VPE (VPE: 40 ± 12 %; IC: 32 ± 9 %; P < 0,0125), entretanto a FE elevou-se do repouso ao LA apenas no grupo IC (VPE: 44 ± 17 %; IC: 39 ± 11 %; P < 0,0125). A TME foi semelhante em repouso (VPE: 1,41 ± 0,55 VDF/s; IC: 1,39 ± 0,55 VDF/s; P > 0,05) e aumentou na intensidade do LA similarmente em ambos os grupos (VPE: 2,28 ± 0,55 VDF/s; IC: 2,52 ± 1,07 VDF/s; P < 0,0125). Conclusão. Pacientes submetidos a ventriculectomia parcial esquerda apresentam uma o limiar anaeróbio (LA) resposta anormal da função sistólica do ventrículo esquerdo ao exercício na intensidade do LA e uma resposta cronotrópica diminuida ao exercício máximo. Essas respostas anormais podem contribuir para a limitada capacidade ao exercício destes pacientes, a despeito da melhora na função ventricular sistólica em repouso. / Background. Patients with heart failure who have undergone partial left ventriculectomy improve resting left ventricular systolic function, but maintain limited functional capacity. Objective. In order to better understand the mechanisms associated with this limitation, we studied the systolic and diastolic left ventricular function at rest and during submaximal exercise in patients with previous partial left ventriculectomy and in patients with heart failure who had not been operated, matched for maximal and submaximal exercise capacity. Methods: Nine patients with heart failure who were previously submitted to partial left ventriculectomy (PLV) were compared with a group of 9 patients with heart failure who had not been operated. All patients performed a cardiopulmonary exercise testing with measurement of peak oxygen uptake (VO2 peak) and anaerobic threshold (AT). In a second evaluation, radionuclide left ventriculography was performed to analyze ejection fraction (EF) and peak filling rate (PFR) at rest and during exercise at the intensity corresponding to the AT. Results: Groups presented similar exercise capacity evaluated by VO2peak (PLV: [mean ± SD] 13.1 ± 3.3 mL/Kg.min; HF: 14.1 ± 3.6 mL/Kg.min; P > 0.05) and AT (PLV: 7.9 ± 1.3 mL/Kg.min; HF: 8.5 ± 1.6 mL/Kg.min; P > 0.05). Maximal heart rate was higher in the HF group when compared to the PLV group (PLV: 119 ± 20 bpm; HF: 149 ± 21 bpm; P < 0.05). EF at rest was higher in the PLV group (PLV: 40 ± 12 %; HF: 32 ± 9 %; P < 0.0125), however EF increased from rest to AT only in the HF group (PLV: 44 ± 17 %; HF: 39 ± 11 %; P < 0.0125). PFR was similar at rest (PLV: 1.41 ± 0.55 EDV/sec; HF: 1.39 ± 0.55 EDV/sec; P > 0.05) and increased in both groups at the AT intensity (PLV: 2.28 ± 0.55 EDV/sec; HF: 2.52 ± 1.07 EDV/sec; P < 0,0125). Conclusion: Patients who had partial left ventriculectomy present an abnormal response of left ventricular systolic function to exercise at the AT intensity and an impaired chronotropic response to maximal exercise. These abnormal responses may contribute to the limited exercise capacity of these patients, despite the improvement in resting left ventricular systolic function.

Introdução. Pacientes com insuficiência cardíaca submetidos à ventriculectomia parcial esquerda apresentam melhora na função sistólica do ventrículo esquerdo em repouso, porém continuam apresentando limitação funcional. Objetivo. Para melhor compreender os mecanismos desta limitação funcional, estudamos a função sistólica e diastólica do ventrículo esquerdo em repouso e durante exercício submáximo em pacientes submetidos a ventriculectomia parcial esquerda e em pacientes com insuficiência cardíaca não operados, pareados para capacidade funcional máxima e submáxima. Métodos. Foram estudados 9 pacientes submetidos previamente a ventriculografia parcial esquerda (VPE) e 9 pacientes com insuficiência cardíaca não operados previamente (IC). Todos os pacientes foram submetidos inicialmente a um teste cardiopulmonar para determinação do consumo de oxigênio no limiar anaeróbio (LA) e de pico (VO2 pico). Após, foram estudados através da ventriculografia radioisotópica e analisadas a fração de ejeção (FE) e a taxa máxima de enchimento (TME) do ventrículo esquerdo, em repouso e exercício na intensidade do LA. Resultados. Os grupos apresentaram capacidade funcional semelhante avaliada pelo VO2 pico (VPE: [média ± DP] 13,1 ± 3,3 ml/kg.min; IC: 14,1 ± 3,6 ml/kg.min; P > 0,05) e LA (VPE: 7,9 ± 1.3 ml/kg.min; IC: 8,5 ± 1,6 ml/kg.min; P > 0,05). A frequência cardíaca máxima foi maior no grupo IC em comparação ao grupo da VPE (VPE: 119 ± 20 bpm; IC: 149 ± 21 bpm; P < 0.05) A FE em repouso era mais elevada no grupo VPE (VPE: 40 ± 12 %; IC: 32 ± 9 %; P < 0,0125), entretanto a FE elevou-se do repouso ao LA apenas no grupo IC (VPE: 44 ± 17 %; IC: 39 ± 11 %; P < 0,0125). A TME foi semelhante em repouso (VPE: 1,41 ± 0,55 VDF/s; IC: 1,39 ± 0,55 VDF/s; P > 0,05) e aumentou na intensidade do LA similarmente em ambos os grupos (VPE: 2,28 ± 0,55 VDF/s; IC: 2,52 ± 1,07 VDF/s; P < 0,0125). Conclusão. Pacientes submetidos a ventriculectomia parcial esquerda apresentam uma o limiar anaeróbio (LA) resposta anormal da função sistólica do ventrículo esquerdo ao exercício na intensidade do LA e uma resposta cronotrópica diminuida ao exercício máximo. Essas respostas anormais podem contribuir para a limitada capacidade ao exercício destes pacientes, a despeito da melhora na função ventricular sistólica em repouso. / Background. Patients with heart failure who have undergone partial left ventriculectomy improve resting left ventricular systolic function, but maintain limited functional capacity. Objective. In order to better understand the mechanisms associated with this limitation, we studied the systolic and diastolic left ventricular function at rest and during submaximal exercise in patients with previous partial left ventriculectomy and in patients with heart failure who had not been operated, matched for maximal and submaximal exercise capacity. Methods: Nine patients with heart failure who were previously submitted to partial left ventriculectomy (PLV) were compared with a group of 9 patients with heart failure who had not been operated. All patients performed a cardiopulmonary exercise testing with measurement of peak oxygen uptake (VO2 peak) and anaerobic threshold (AT). In a second evaluation, radionuclide left ventriculography was performed to analyze ejection fraction (EF) and peak filling rate (PFR) at rest and during exercise at the intensity corresponding to the AT. Results: Groups presented similar exercise capacity evaluated by VO2peak (PLV: [mean ± SD] 13.1 ± 3.3 mL/Kg.min; HF: 14.1 ± 3.6 mL/Kg.min; P > 0.05) and AT (PLV: 7.9 ± 1.3 mL/Kg.min; HF: 8.5 ± 1.6 mL/Kg.min; P > 0.05). Maximal heart rate was higher in the HF group when compared to the PLV group (PLV: 119 ± 20 bpm; HF: 149 ± 21 bpm; P < 0.05). EF at rest was higher in the PLV group (PLV: 40 ± 12 %; HF: 32 ± 9 %; P < 0.0125), however EF increased from rest to AT only in the HF group (PLV: 44 ± 17 %; HF: 39 ± 11 %; P < 0.0125). PFR was similar at rest (PLV: 1.41 ± 0.55 EDV/sec; HF: 1.39 ± 0.55 EDV/sec; P > 0.05) and increased in both groups at the AT intensity (PLV: 2.28 ± 0.55 EDV/sec; HF: 2.52 ± 1.07 EDV/sec; P < 0,0125). Conclusion: Patients who had partial left ventriculectomy present an abnormal response of left ventricular systolic function to exercise at the AT intensity and an impaired chronotropic response to maximal exercise. These abnormal responses may contribute to the limited exercise capacity of these patients, despite the improvement in resting left ventricular systolic function.

Introdução. Pacientes com insuficiência cardíaca submetidos à ventriculectomia parcial esquerda apresentam melhora na função sistólica do ventrículo esquerdo em repouso, porém continuam apresentando limitação funcional. Objetivo. Para melhor compreender os mecanismos desta limitação funcional, estudamos a função sistólica e diastólica do ventrículo esquerdo em repouso e durante exercício submáximo em pacientes submetidos a ventriculectomia parcial esquerda e em pacientes com insuficiência cardíaca não operados, pareados para capacidade funcional máxima e submáxima. Métodos. Foram estudados 9 pacientes submetidos previamente a ventriculografia parcial esquerda (VPE) e 9 pacientes com insuficiência cardíaca não operados previamente (IC). Todos os pacientes foram submetidos inicialmente a um teste cardiopulmonar para determinação do consumo de oxigênio no limiar anaeróbio (LA) e de pico (VO2 pico). Após, foram estudados através da ventriculografia radioisotópica e analisadas a fração de ejeção (FE) e a taxa máxima de enchimento (TME) do ventrículo esquerdo, em repouso e exercício na intensidade do LA. Resultados. Os grupos apresentaram capacidade funcional semelhante avaliada pelo VO2 pico (VPE: [média ± DP] 13,1 ± 3,3 ml/kg.min; IC: 14,1 ± 3,6 ml/kg.min; P > 0,05) e LA (VPE: 7,9 ± 1.3 ml/kg.min; IC: 8,5 ± 1,6 ml/kg.min; P > 0,05). A frequência cardíaca máxima foi maior no grupo IC em comparação ao grupo da VPE (VPE: 119 ± 20 bpm; IC: 149 ± 21 bpm; P < 0.05) A FE em repouso era mais elevada no grupo VPE (VPE: 40 ± 12 %; IC: 32 ± 9 %; P < 0,0125), entretanto a FE elevou-se do repouso ao LA apenas no grupo IC (VPE: 44 ± 17 %; IC: 39 ± 11 %; P < 0,0125). A TME foi semelhante em repouso (VPE: 1,41 ± 0,55 VDF/s; IC: 1,39 ± 0,55 VDF/s; P > 0,05) e aumentou na intensidade do LA similarmente em ambos os grupos (VPE: 2,28 ± 0,55 VDF/s; IC: 2,52 ± 1,07 VDF/s; P < 0,0125). Conclusão. Pacientes submetidos a ventriculectomia parcial esquerda apresentam uma o limiar anaeróbio (LA) resposta anormal da função sistólica do ventrículo esquerdo ao exercício na intensidade do LA e uma resposta cronotrópica diminuida ao exercício máximo. Essas respostas anormais podem contribuir para a limitada capacidade ao exercício destes pacientes, a despeito da melhora na função ventricular sistólica em repouso. / Background. Patients with heart failure who have undergone partial left ventriculectomy improve resting left ventricular systolic function, but maintain limited functional capacity. Objective. In order to better understand the mechanisms associated with this limitation, we studied the systolic and diastolic left ventricular function at rest and during submaximal exercise in patients with previous partial left ventriculectomy and in patients with heart failure who had not been operated, matched for maximal and submaximal exercise capacity. Methods: Nine patients with heart failure who were previously submitted to partial left ventriculectomy (PLV) were compared with a group of 9 patients with heart failure who had not been operated. All patients performed a cardiopulmonary exercise testing with measurement of peak oxygen uptake (VO2 peak) and anaerobic threshold (AT). In a second evaluation, radionuclide left ventriculography was performed to analyze ejection fraction (EF) and peak filling rate (PFR) at rest and during exercise at the intensity corresponding to the AT. Results: Groups presented similar exercise capacity evaluated by VO2peak (PLV: [mean ± SD] 13.1 ± 3.3 mL/Kg.min; HF: 14.1 ± 3.6 mL/Kg.min; P > 0.05) and AT (PLV: 7.9 ± 1.3 mL/Kg.min; HF: 8.5 ± 1.6 mL/Kg.min; P > 0.05). Maximal heart rate was higher in the HF group when compared to the PLV group (PLV: 119 ± 20 bpm; HF: 149 ± 21 bpm; P < 0.05). EF at rest was higher in the PLV group (PLV: 40 ± 12 %; HF: 32 ± 9 %; P < 0.0125), however EF increased from rest to AT only in the HF group (PLV: 44 ± 17 %; HF: 39 ± 11 %; P < 0.0125). PFR was similar at rest (PLV: 1.41 ± 0.55 EDV/sec; HF: 1.39 ± 0.55 EDV/sec; P > 0.05) and increased in both groups at the AT intensity (PLV: 2.28 ± 0.55 EDV/sec; HF: 2.52 ± 1.07 EDV/sec; P < 0,0125). Conclusion: Patients who had partial left ventriculectomy present an abnormal response of left ventricular systolic function to exercise at the AT intensity and an impaired chronotropic response to maximal exercise. These abnormal responses may contribute to the limited exercise capacity of these patients, despite the improvement in resting left ventricular systolic function.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2014-12-18T13:43:38Z No. of bitstreams: 1 Dissertação - Rogério Gomes Furtado - 2013.pdf: 8231426 bytes, checksum: 27a3b18b8a08192dc1223e0b4a48c1b8 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-12-18T14:07:17Z (GMT) No. of bitstreams: 1 Dissertação - Rogério Gomes Furtado - 2013.pdf: 8231426 bytes, checksum: 27a3b18b8a08192dc1223e0b4a48c1b8 (MD5) / Made available in DSpace on 2014-12-18T14:07:19Z (GMT). No. of bitstreams: 1 Dissertação - Rogério Gomes Furtado - 2013.pdf: 8231426 bytes, checksum: 27a3b18b8a08192dc1223e0b4a48c1b8 (MD5) Previous issue date: 2013-06-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Objective: To evaluate the prevalence of systolic and diastolic right ventricular (RV) in patients with indeterminate form of Chagas Disease (FDIC) and compare with asymptomatic patients without this condition. Methods: An observational, case-control, descriptive and prevalent study in which 91 patients were divided into 2 groups: group I (normal n = 31) and group II (FIDC normal cardiac n = 61). Were performed 2D Doppler echocardiography in adult patients, applying the criteria assessment of systolic and diastolic RV. Results: The general characteristics of both groups: age (39.73 ± 12.94 vs 45.32 ± 12.36, p = 0.071), weight in kg (71.29 ± 14.91 vs 67.66 ± 12, 37 with p = 0.270), Height in cm (159.24 ± 32.63 vs 156.88 ± 30.56, p = 0.749), ISC (1.77 ± 0.24 vs 1.69 ± 0.19 with p = 0.174) , female sex (24/77, 4% vs 45/73, 8%, p = 0.190) ,heart rate (FC) in bpm ( 71,90 ± 10,43 vs 70,36 ± 9,83), diastolic dimension of LV ( LVDD) em mm ( 46,71± 5,21 vs 46,05 ± 5,22) e ejection fracion of LV ( % por Teicholz) (73,55 ± 6,66 vs 73,56 ± 7,35). The prevalence of RV systolic dysfunction in normal patients and FIDC, using criteria such as FAC <35%, TAM <16mm and systolic S wave velocity <10 cm / s tissue Doppler was: FAC (- / 0.0% vs 1 / 0.6%, p = 0.663), TAM (- / 0.0% vs. - / 0.0%, p = 1.00) and S wave (2/6,4% vs 16/26% with p = 0.016) and a weak correlation (r = 0.31) between age and S wave (p = 0.019). The prevalence of RV global dysfunction in normal patients and FIDC : RIPM of TD(5/16,1% vs 17/27,8% , p=0,099) and RIPM of DP(19/61,3% vs 42/68,8%,p 0,141).The prevalence of RV diastolic dysfunction in groups I and II respectively, according to the criteria established by guideline43: abnormal relaxation AR (- / 0.0% vs 4/ 6.0%, p = 0.187), pseudonormal pattern PP (-/0,0 vs. -/0,0% p = 1,00) and restrictive pattern PR (-/0,0% vs -/0,0%, p = 1,000), with no significant difference in diastolic dysfunction in both groups. Conclusion: The prevalence of RV systolic dysfunction was estimated at 26% (S-wave velocity compared to other variables with p significant, with a weak correlation between the S wave velocity and age) and was not observed statistically significant criteria for diastolic dysfunction between groups. / Objetivo: Avaliar a prevalência de disfunção sistólica e diastólica do Ventrículo Direito (VD) em pacientes com forma indeterminada da doença de Chagas (FIDC) e comparar com pacientes assintomáticos sem esta patologia. Métodos: Estudo observacional, caso-controle, descritivo e de prevalência, na qual 91 pacientes foram divididos em dois grupos: grupo I (normal com n = 31) e grupo II (FIDC/normalidade cardíaca n = 61). Foram realizados nos pacientes adultos Dopplerecocardiograma 2D, aplicando os critérios de avaliação da função sistólica e diastólica do VD. Resultados: As características gerais de ambos grupos foram : idade (39,73 ± 12,94 vs 45,32 ± 12,36 com p = 0,071), peso em Kg (71,29 ± 14,91 vs 67,66 ± 12,37 com p = 0,270), altura em cm (159,24 ± 32,63 vs 156,88 ± 30,56 com p = 0,749), índice de superfície corpórea (ISC) (1,77 ± 0,24 vs 1,69 ± 0,19 com p = 0,174), sexo feminino (24/77,4% vs 45/73,8% com p = 0,190), frequência cardíaca (FC) em bpm ( 71,90 ± 10,43 vs 70,36 ± 9,83), dimensão diastólica do VE ( DDVE) em mm ( 46,71± 5,21 vs 46,05 ± 5,22) e fração de ejeção do VE ( % por Teicholz) (73,55 ± 6,66 vs 73,56 ± 7,35). A prevalência da disfunção sistólica do VD em pacientes normais e FIDC, utilizando critérios como Mudança de Área Fracional (MAF) < 35%, Mobilidade do Anel Tricuspídeo (MAT) < 16mm e velocidade da onda sistólica ao Doppler tecidual (ondaS) < 10 cm/s foi: MAF (- /0,0% vs 1/0.6% com p = 0,663), MAT (- / 0,0% vs - / 0,0% com p = 1,00) e onda S (2/6,4% vs 16/26,0% com p = 0.016). Houve fraca correlação (r = 0,31) entre a idade e a onda S (p = 0,019). A prevalência da disfunção global do VD no grupo I e II respectivamente foi: Índice de Performance Miocárdica Direita do Doppler Tecidual IPMD do DT (5/16,1% vs 17/27,8% com p =0,099) e IPMD do Doppler Pulsado DP:(19/61,3% vs 42/68% com p= 0,141), sem diferença estatística significativa entre os grupos. A prevalência de disfunção diastólica do VD nos grupos I e II respectivamente, conforme os critérios estabelecidos pelas diretrizes 43: alteração do relaxamento AR (- / 0,0% vs 4 / 6,0%, p = 0,187), padrão pseudonormal PP (-/ 0,0% vs -/ 0,0%, p =1,00) e padrão restritivo PR (-/0,0% vs -/0,0%, p = 1,00), sem diferenças significativas de disfunção diastólica em ambos grupos. Conclusão: A prevalência de disfunção sistólica do VD foi estimada em 26% (velocidade da onda S em comparação a outras variáveis com p significante e fraca correlação entre a velocidade da onda S e idade) e não foram observados critérios estatisticamente significantes para disfunção diastólica e global entre os grupos.

INTRODUÇÃO: A doença de Chagas tem patogênese não totalmente conhecida. Ao contrário das funções sistólica e diastólica do ventrículo esquerdo, a função do átrio esquerdo carece de informações. OBJETIVOS: Em portadores de doença de Chagas, com ou sem alterações eletrocardiográficas, com ou sem disfunção sistólica de ventrículo esquerdo, verificar se há diferença nos parâmetros de função atrial esquerda e se há correlação entre dados de função de átrio esquerdo e parâmetros ecodopplercardiográficos de função ventricular sistólica e diastólica de ventrículo esquerdo MÉTODOS: 85 indivíduos: 10 controles (GC), 26 na forma indeterminada (GI), 30 com alterações eletrocardiográficas somente (GII) e 19 com disfunção ventricular (GIII), submetidos a ecocardiograma para avaliação da função atrial e das funções sistólicas e diastólicas ventriculares. Para analise estatística foi utilizado teste de Kruskal-Wallis e o coeficiente de Spearman. RESULTADOS: Função de reservatório (FET: fração de esvaziamento total): Houve diferença entre os grupos (p < 0,0001), média menor no GIII comparado ao GC (p = 0,003), ao GI (p < 0,001) e GII (p < 0,001), sem diferença entre GC, GI e GII. Fluxo de veias pulmonares: na onda S houve diferença entre os grupos (p = 0,003), média menor no GIII comparada ao GC (p = 0,01). Função de conduto (FEP: fração de esvaziamento passivo): houve diferença entre os grupos (p = 0,004), média menor no GIII, sem significância estatística comparando entre os grupos (GIII e GC, p = 0,06, GI e GII, p = 0,06, e GII e GIII, p = 0,07). Função de bomba propulsora (FEA: fração de esvaziamento ativo): houve diferença entre os grupos (p = 0,0001), média menor no GIII comparado ao GC (p = 0,05), ao GI (p < 0,0001) e ao GII (p = 0,002). Correlações: E/e\'média e FET: fraca correlação negativa (r = - 0,263; p = 0,02), moderada correlação negativa no GIII (r = - 0,58; p = 0,02). E/e\'média e FEP: não houve correlação (r = - 0,09; p = 0,44). E/e\'média e FEA: moderada correlação negativa (r = -0,36; p = 0,002) e no GIII (r = - 0,57; p = 0,04). e\'média e FET: moderada correlação positiva (r = 0,53; p < 0,0001). e\'média e FEP: moderada correlação positiva (r = 0,49; p < 0,0001). e\'média e FEA: moderada correlação positiva (r = 0,39; p = 0,001). Fração de ejeção do VE e FET: moderada correlação positiva (r = 0,35; p = 0,003) e no GIII (r = 0,52; p = 0,04). Fração de ejeção do VE e FEP: moderada correlação positiva (r = 0,42; p < 0,0001). Fração de ejeção do VE e FEA: moderada correlação positiva (r = 0,35; p = 0,003). CONCLUSÕES: Em pacientes com miocardiopatia chagásica com disfunção sistólica de ventrículo esquerdo, houve comprometimento das funções de reservatório, de conduto e bomba propulsora do átrio esquerdo e aqueles com função sistólica normal não apresentaram alterações nessas funções / BACKGROUND: Chagas disease (CD) pathogenesis is not fully known. Unlike the systolic and diastolic function of the left ventricle, the left atrial function still lacks information. OBJECTIVES: The aim of this study was to observe differences in patients with CD regarding the parameters of left atrial function and correlate them with Doppler echocardiographic parameters CASUISTIC AND METHODS: 85 subjects: 10 controls (GC), 26 in the indeterminate form (GI), 30 with ECG changes and normal left systolic function (GII) and 19 with left ventricular dysfunction (GIII) underwent echocardiography to assess left atrial and ventricular systolic and diastolic functions RESULTS: Reservoir function (TEF: total emptying fraction): there was a difference between groups (p <0.0001), lower mean in GIII compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001) with no difference between GC, GI and GII. Pulmonary veins flow: the S wave was no difference between groups (p = 0.003), lower mean in GIII compared to the CG (p = 0.01). Conduit function (PEF: passive emptying fraction): there was a difference between groups (p = 0.004), lower mean in GIII, without statistical significance between groups (GIII and GC, p = 0.06, GI and GII, p = 0.06, and GII and GIII, p = 0.07). Pump function (AEF: active emptying fraction): there was a difference between groups (p = 0.0001), lower mean in GIII compared to CG (p = 0.05), GI (p <0.0001) and GII (p = 0.002). Correlations: E/e\'mean and TEF: weak negative correlation (r = - 0.263, p = 0.02), moderate negative correlation in GIII (r = - 0.58, p = 0.02). E/e\'mean and PEF: no correlation (r = - 0.09, p = 0.44). E/e\'mean and AEF: moderate negative correlation (r = -0.36, p = 0.002) and GIII (r = - 0.57, p = 0.04). e\'mean and TEF: moderate positive correlation (r = 0.53, p <0.0001). e\'mean and PEF: moderate positive correlation (r = 0.49, p <0.0001). e\'mean and AEF: moderate positive correlation (r = 0.39, p = 0.001). LV ejection fraction and TEF: moderate positive correlation (r = 0.35, p = 0.003) and GIII (r = 0.52, p = 0.04). LV ejection fraction and PEF: moderate positive correlation (r = 0.42, p <0.0001). LV ejection fraction and AEF: moderate positive correlation (r = 0.35, p = 0.003). CONCLUSIONS: In patients with Chagas\' cardiomyopathy with left ventricular systolic dysfunction, there was impairment of the functions of reservoirs, conduit and pump of the left atrium

No description available.

<p>Background: Stem cell therapy can facilitate cardiac repair after healed myocardial infarction but the optimal cell type remains uncertain. <p>Aims: To investigate the pathophysiology of heart failure in a canine model of healed myocardial infarction and to compare the efficacy and the safety of autologous bone marrow mononuclear cell (BMNC) transfer and mesenchymal stem cell (MSC) transfer in this model. It was a blind, randomized and placebo control study.<p>Methods: Eleven weeks after coronary ligation, 24 dogs received intramyocardial injections of BMNC, MSC or Placebo (n = 8 per groups). Echocardiography, conductance method, magnetic resonance imaging, serum neurohormones, holter monitoring, macromorphometry, histology and real time quantitative polymerase chain reaction were used to assess cardiac performance, safety and remodelling in healthy animals, before cell transplantation and up to 16 weeks’ follow-up. <p>Results: The model was characterized by decreased left ventricular end-systolic elastance and ventricular-arterial uncoupling without alteration of compliance. <p>Four months after BMNC transfer, the regional systolic function measured at echocardiographic showed a sustained improvement. This improvement was associated with an improved left ventricular end-systolic elastance and a decreased infarct size. Although the left ventricular ejection fraction stayed unchanged, the serum level of N-terminal B-type natriuretic propeptide level decreased. Mononuclear cell transfer was also associated with increased left ventricular relative wall area, increased vascular density, intramyocardial vascular remodelling and upregulation of angiogenic factors gene expression. Mesenchymal stem cell transfer only improved lately and moderately the regional systolic function, without improvement of cardiac contractility or decreased infarct size. <p>Conclusions: In a canine model of chronic myocardial infarction, BMNC transfer is superior to MSC transfer in improvement of cardiac contractility and regional systolic function, and to reduce the infarct size and plasma N-terminal B-type natriuretic propeptide level. Functional improvement is associated with a favourable angiogenic environment and neovascularization. <p> / Doctorat en Sciences biomédicales et pharmaceutiques / info:eu-repo/semantics/nonPublished

Abstract Intracoronary administration of autologous bone marrow derived stem cells (BMC) has been postulated to repair the myocardial damage in patients who have suffered acute ST-elevation myocardial infarction (STEMI). The aim of this study was to find determinants for the left ventricular functional recovery after BMC treatment of STEMI and to study the effect of BMC treatment on different biochemical and clinical parameters associated with the outcome of STEMI patients. In this study, STEMI patients treated with thrombolysis were randomly assigned to receive either intracoronary BMC (n=39) or placebo (n=39) into the infarct related artery at the time of percutaneous coronary intervention. The efficacy of the BMC treatment was assessed by measurement of the change of left ventricular ejection fraction (LVEF) from baseline to six months after STEMI. Two-dimensional echocardiography was used to assess PA pressure, LV systolic and diastolic function. Blood samples were drawn for biochemical determinations at several time points and BMCs were cultured in the laboratory for in vitro analyses. In the BMC group, the most powerful determinant of the change of LVEF was the baseline LVEF. Patients with baseline LVEF at or below the median (≤62.5%) experienced a more marked improvement of LVEF than those above the median. Elevated levels of N-terminal probrain natriuretic peptide (NT-proBNP) and N-terminal proatrial natriuretic peptide (NT-proANP) were also associated with an improvement of LVEF in the BMC group. However, no difference was observed between the BMC group and the placebo group in the changes of the levels of NT-proANP, NT-proBNP or any of the inflammatory markers measured. The BMC group showed a trend toward a reduction of peak PA pressure, while the placebo group had a significant increase of peak PA pressure at 6 months. In addition, there was a greater improvement in the LV diastolic function, assessed in quartiles, in the BMC group. The in vitro studies of BMCs revealed that exposure to tumor necrosis factor alpha (TNF-α) significantly enhanced the proliferation of BMCs and resulted in activation of immunosuppression by altering the expression of several immunosuppressive proteins. In conclusion, low baseline LVEF as well as high levels of natriuretic peptides NT-proANP and NT-proBNP, which reflect the severity of the hemodynamic and neurohumoral reactions evoked by the myocardial damage, have a considerable association to a better response to stem cell therapy after an acute STEMI. BMC therapy also prevents the increase of PA pressure and improves the cardiac diastolic function. Based on in vitro studies, the inflammatory cytokine TNF-α seems to evoke an enhanced proliferation of the bone marrow-derived mesenchymal stem cells and activation of several immunosuppressive defence mechanisms. / Tiivistelmä Sydäninfarktipotilaiden sepelvaltimoon pallolaajennuksen yhteydessä injektoitujen kantasolujen tiedetään parantavan hieman sydämen pumppauskykyä, mutta taustalla olevaa mekanismia ei tunneta. Kantasoluhoidon onnistumiseen vaikuttavia tekijöitä on tutkittu vasta vähän, eikä myöskään sitä tiedetä, miksi kaikki potilaat eivät hyödy kantasoluhoidosta. Tämän tutkimuksen tavoitteena oli selvittää infarktialueelle annetun kantasoluhoidon vaikutuksia äkillisen ST-nousuinfarktin (STEMI) sairastaneissa potilaissa, ja etsiä hoidon onnistumiseen vaikuttavia tekijöitä. Tutkimuksessa käytettiin potilasaineistoa, johon otettiin 78 äkilliseen sydäninfarktiin sairastunutta potilasta, jotka hoidettiin liuotushoidolla ja sen jälkeen pallolaajennuksella. Puolet potilaista satunnaistettiin saamaan lumeliuosta ja puolet omaa luuydinsolukkoaan (BMC), joka ruiskutettiin pallolaajennuksen yhteydessä sepelvaltimon kautta infarktialueelle. Hoidon vaikusta tutkittiin mittaamalla angiografian avulla vasemman kammion ejektiofraktion (LVEF) muutosta lähtötilanteen ja kuuden kuukauden seurannan välillä. Lisäksi sydämen ultraäänitutkimuksella määritettiin keuhkovaltimopainetta ja vasemman kammion systolista ja diastolista toimintaa. Potilaista otettiin lisäksi verinäytteitä, joista määritettiin erilaisia tulehdusmerkkiaineita ja natriureettisia peptidejä. Lisäksi potilaista kerättyjä luuydinkantasoluja viljeltiin laboratoriossa in vitro-analyyseja varten. Tutkimuksessa todettiin, että LVEF ennen kantasoluhoitoa oli voimakkain ennustetekijä suotuisalle LVEF:n muutokselle kantasoluhoidon jälkeen. Potilaat, joilla LVEF oli ennen kantasoluhoitoa alle mediaaniarvon (≤62.5%), hyötyivät kantasoluhoidosta enemmän kuin potilaat, joilla LVEF oli yli mediaanin. Myös natriureettisten peptidien NT-proBNP:n ja NT-proANP:n korkea taso infarktin jälkeen oli yhteydessä suurempaan LVEF:n paranemiseen BMC-potilailla. Natriureettisten peptidien ja tulehdusmerkkiaineiden pitoisuuksien muutoksissa kantasoluhoidon jälkeen ei kuitenkaan todettu eroa BMC- ja kontrolliryhmän välillä. Sydämen diastolisen toiminnan havaittiin paranevan enemmän BMC-ryhmässä kuin kontrolliryhmässä. Lisäksi BMC-ryhmässä havaittiin lievää laskua keuhkovaltimopaineessa, kun taas kontrolliryhmässä se nousi merkittävästi. In vitro-tutkimukset luuytimestä erilaistetuilla mesenkymaalisilla kantasoluilla puolestaan osoittivat, että tuumorinekroositekijä alfa (TNF-α)-altistus lisäsi solujakautumista ja monien immunosupressiivisten proteiinien tuottoa soluissa. Matala LVEF sekä natriureettisten peptidien NT-proBNP:n ja NT-proANP:n korkea taso sydäninfarktin jälkeen kuvaavat infarktivaurion aiheuttamien hemodynaamisten ja neurohumoraalisten reaktioiden vakavuutta, ja tässä tutkimuksessa niiden osoitettiin olevan vahvasti yhteydessä äkillisen ST-nousuinfarktin jälkeen annetun kantasoluhoidon hyötyyn. Kantasoluhoito saattaa myös suojata infarktipotilaita haitalliselta keuhkovaltimopaineen nousulta ja parantaa sydämen diastolista toimintaa. Tulehdusvälittäjäaine TNF-α näytti in vitro-kokeiden perusteella lisäävän luuytimen mesenkymaalisten kantasolujen jakautumista ja aktivoivan niissä monia immunosuppressiivisia puolustusmekanismeja tulehdusta vastaan.

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Short summary: Background: High cardiovascular risk in patients with chronic kidney disease is partly due to mineral dysbalance, microinflammation and oxidative stress. CKD patients accumulate traditional and non-traditional CV risk factors. FGF23, MMPs and PlGF belong among these non-traditional biomarkers of CV risk. FGF23 is a phosphaturic hormone and inhibitor of calcitriol synthesis. It is associated with vascular calcifications. Matrix-metalloproteinases (e.g. MMP-2, MMP-9) are proteolytic, proinflammatory enzymes, contributing to myocardial remodelation. Placental growth factor (PlGF) is a proangiogenic cytokine that is associated with LV hypertrophy in animal model. Plasmatic FGF23, MMPs and PlGF are elevated in CKD. Aim: We aimed to describe dynamic changes between several novel biomarkers of CV risk (FGF23, MMP-2, MMP-9 and PlGF) in CKD stages 1-5, to describe their mutual correlations and possible association with traditional CV risk markers. We studied possible association of laboratory and echocardiographic parameters in patients with CKD stages 2-4. Methods: In a cross-sectional study we evaluated 80 patiens with CKD 1-5 and 44 healthy controls. In a prospective study we evaluated echocardiographic and laboratory parameters in 62 patients with CKD 2-4 for an average study period of 36±10...