Orientador: Otavio Rizzi Coelho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T03:30:23Z (GMT). No. of bitstreams: 1 Santos_JoseLuizFerreirados_M.pdf: 3618112 bytes, checksum: 1a2061a28ce8e3a8e0218df5192db64e (MD5) Previous issue date: 2006 / Resumo: O presente trabalho teve como objetivo, analisar o comportamento sistólico e diastólico do miocá.rdio ventricular esquerdo em indivíduos obesos, hipertensos ou não, associados ou não com hipertrofia, utilizando-se o Doppler Pulsado Tecidual (DPT). Foram constituídos 7 grupos, formados por 20 indivíduos cada, incluindo homens e mulheres, idade entre 30 a 50 anos, divididos em: Não obesos (Grupos: 1= sem hipertensão e hipertrofia; II= com hipertensão, sem hipertrofia; III=com hipertensão e hipertrofia); Obesos (Grupos: IV= sem hipertensão e hipertrofia; V= sem hipertensão e com hipertrofia; VI= com hipertensão e sem hipertrofia; Vll= com hipertensão e hipertrofia). Considerado obeso, quando Índice de Massa Corpórea (IMC) = a 30 Kglm2; Hipertenso PA =140/90; Hipertrófico: para não obeso indexado a massa ventricular esquerda (MVE) pela superflcie corporal (homem> 134 mulher>110), obeso indexado MVE pela altura2. 7 (homem>49.2 e mulher>46.7). Comparados os grupos ( I x IV) (I x V) (ll x VI) e (Ill x Vll). Analisadas: as caracteósticas clínicas e cardíacas de cada grupo: IMC, idade, sexo, pressão arterial (sistólica, diastólica e média), septo interventricular, parede posterior, diâmetro diastólico, espessura relativa da parede posterior, MVE, função sistólica (tração de ejeção) e diastólica ( índices pelo Doppler transmitral e o tempo de relaxamento lsovolumétrico); a função cardíaca pelo DPT na região do miocárdio pelo desempenho sistólico (Sm) e diastólico (Em e Am) das paredes septal (PS), inferior(PI), anterior(P A), lateral(pL) e posterior(PP) nas regiões média e basal. Análise estatística pela ANOV A e teste de Tukey, encontraram alteração significativa (p<0.05) entre os grupos de interesse, principalmente em Em basal (Em-B) na PI, PS e PP. As estimativas da correlação de Pearson, foram para Em-B PS !MC (r= -0.56), MVE (r= -0.53) e idade (r= -0.31); para Em-B PI, foram !MC (r= -0.44 I) , MVE (r= -0.52) e idade (r= -0.31 01) e para Em-B PP foram: !MC (r= -0.59), MVE (r= -0.47) e idade (r= -0.25), com p<0.05 para todas correlações. A regressão linear múltipla identificou p<0.05 para Em-B em função do IMC, MVE e Idade: PS(_=0.51O9); PI(_=O.4277) e PP(_=0.4710). A regressão linear univariada mostrou Em-B na PS: !MC(r2= 30,8%), MVE(r2= 28,6%) e idade (r2= 9.8%), na PI: !MC (r2= 20.7%), MVE (r2= 27.5%) e idade (r2= 9.6%), e na PP: IMC(r2= 34.2%), MVE (r2= 22.5%) e Idade (r2= 6.1%), com p<0.O5 para todas relações. A obesidade pode alterar o comportamento diastólico basal das paredes septal, inferior e posterior do miocá.rdio ventricular esquerdo, em indivíduos normotensos ou hipertensos, associados ou não com hipertrofia / Abstract: The aim of this study is to analyze the left ventricular (LV) myocardial behavior in obese individuais, with or without hypertension, associating it (or not) with hypertrophy by means of pulse-wave tissue Doppler (pTD). The seven constitutive groups of this study were formed by 20 subjects each, including men and women whose age ranged between 30 and 50 years and were divided as follows: Non-obeses (Group I : no High Blood Pressure (HPB) an hypertrophy), (Group ll: with HPB and no hypertrophy), (Group ill: with HBP and hypertrophy) and obeses (Group IV: normotensive and hypertrophy), (Group V: normotensive and hypertrophy), (Group VI : with HBP and no hypertrophy) (Group Vll: obese with HBP and hypertrophy). individuais diagnosed with diabetes, nephropathy or with thyroid, coronary, myocardial or valve problems, through anamnesis, physicaI examination, electrocardiography, echocardiography and DPT, as well as through specific laboratory tests, were excluded. Subjects were considered obese when Body Mass Index (BMI)= 30 Kg/m2; hypertensive when HBP if BP;= 140/90; hypertrophic: non-obese had Left Ventricular Mass (LVM) indexed to body surface (men>134 and women>110) and obese had LVM indexed to height2.7 (men> 49.2 and women> 46.7). Compared groups (I x IV) (I x V) (lI x VI) and (m x VII). Carried out analyses: clinical and cardiac characteristics of each group: BMI, age, gender, blood pressure (systolic, diastolic, mean), interventricular sept, posterior wall, diastolic diameter, relative thickness of posterior wall, L VM., sistolic function (ejection fractions) and diastolic function ( proceeding from the Transmitral Doppler and isovolumetric relaxation time); cardiac function through PTD at the myocardiallevel through the systolic velocity (Sm) and diastolic velocity (Em and Am) of the septal walls (WS) - inferior (WI), anterior (WA), lateral (WL), posterior (WP) - in the medial and basal regions. Statistical analysis was conducted through ANOV A and Tukey test and showed significant alteration (P< 0.05) among the groups of interest, mainly in Em basal (Em-B) on WI, WS and WP. Pearson' s correlation bases were: for Em-B WP: BMI (r= -0.56 ), L VM (r= -0.53) and age (r= - 0.31); for Em-B WI: BMI (r= - 0.44 ), L VM (r= - 0.52 ) and age (r= - 0.31 ) and for Em-B WP: BMI (r= -0.59 ). L VM (r= - 0.47) and age (r= - 0.25) with p<0.05 for ali the correlations. Multivariate linear regression showed p<0.05: for Em-B WP related to BMI, LVM and age: fl = 0.5109 ; for Em-B WI related to BMI, LVM and age: fl = 0.4277 and for Em-B WP related to BMI, L VM and age: fl = 0.4710. PIain linear regression showed: for Em-B WS: BMI (fl= 30,8%), LVM (r2 28,6%) and age (fl= 9.8%), for Em-B WI: BMI (r= 20.7%), LVM (r2= 27.5%) and age (r= 9.6%) and for Em-B WP: BMI (.-2= 34,2%), LVM (r= 22.5%) and age (r= 6.1%) with p<0.05 for alI the relations. The obesity can modify the basal diastolic behavior of the walls septal, inferior and posterior of the left myocardium ventricle, in normotensives or hypertensives individuais, associates or not with hypertrophy / Mestrado / Clinica Medica / Mestre em Clinica Medica

Orientador: Salomon Soriano Ordinola Rojas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T00:59:13Z (GMT). No. of bitstreams: 1 Miguel_GabrielAntonioStanisci_M.pdf: 2975905 bytes, checksum: c45b885c0ebe455da2be8fded7817e46 (MD5) Previous issue date: 2009 / Resumo: Introdução: O transplante (TX) cardíaco é uma alternativa para os indivíduos com doença cardíaca terminal. Na evolução pós-TX, a ocorrência de episódios de rejeição é um evento frequente, sendo responsável pelo aumento da morbimortalidade. Uma alternativa relevante seria o emprego de um exame não invasivo que tivesse uma boa acurácia na detecção das alterações da função sisto-diastólica do coração transplantado, pois a biópsia endomiocárdica (BEM) não é um procedimento isento de complicações. Objetivo: Comparar a função ventricular esquerda entre os pacientes transplantados com rejeição cardíaca e os pacientes transplantados sem rejeição; utilizando como referência o grupo controle e correlaciona-la com rejeição cardíaca imunológica. Métodos: Foram realizados ecocardiogramas transtorácicos no período de janeiro de 2006 a janeiro de 2008, para a avaliação prospectiva de 47 pacientes; sendo 17 pacientes (36,2 %) pertencentes ao grupo controle (grupo GC), 18 (38,3%) pertencentes ao grupo de pacientes transplantados sem rejeição (TX0) e 12 (25,5%) pertencentes ao grupo de pacientes transplantados com rejeição (TX1). Comparou-se a função sisto-diastólica entre os três grupos (GC, TX0, TX1). Para o estudo da homogeneidade entre proporções foi utilizado o teste exato de Fisher. Para a análise da hipótese de igualdade entre os grupos em relação às medianas, utilizou-se o teste não-paramétrico de Kruskal-Wallis seguido do teste de comparações múltiplas. O nível de significância utilizado para os testes foi de 5%. Resultados: Os grupos não diferiram em relação à idade [34,0 (29,5 - 44,0) X 46,0 (33,5 - 51,5) X 39,0 (32,5 - 54,5) p = 0,354], ao peso [70,0 (57,5 - 85,0) X 66,5 (57,5 - 88,0) X 61,0 (57,5 - 73,5) p = 0,661], altura [1,65 (1,59 - 1,73) X 1,66 (1,64 - 1,70) X 1,69 (1,64 - 1,72) p = 0,821] e superfície corpórea [1,84 (1,58 - 1,98) X 1,75 (1,62 - 2,03) X 1,69 (1,63 - 1,88) p = 0,758]. O grupo GC quando comparado com o grupo TX0, apresentou alteração da função sisto-diastólica do ventrículo esquerdo, expressa através do aumento do Índice de Performance Miocádica (IPM), sendo esta mais significativa nos pacientes do grupo TX1 [0,38 (0,29 - 0,44) X 0,47 (0,43 - 0,56) X 0,58 (0,52 - 0,74) p <0,001]. Conclusão: Foi evidenciado que o Índice de Performance Miocárdica encontra-se aumentado nos pacientes transplantados, em relação ao grupo controle e não houve diferença significativa entre os dois grupos de pacientes transplantados; portanto, o ecocardiograma mostrou-se como exame de boa acurácia na detecção das alterações da função sisto-diastólica do coração transplantado e não foi confiável como método substituto da biópsia endomiocárdica para o diagnóstico seguro de rejeição cardíaca. / Abstract: Introduction: The transplant (TX) cardiac is an alternative for the individuals with terminal cardiac illness. In the evolution after TX, the occurrence of rejection episodes is a frequent event, being responsible for the increase of morbi-mortality. An excellent alternative would be the job of a not invasive examination that had a good acurácia in the detention of the alterations of the diastolic function of the transplantated heart, therefore the endomyocardial biopsy (BEM) is not an exempt procedure of complications. Objective: Compare the left ventricular function between patients transplated with rejection and cardiac transplant patients without rejection, using as reference the control group and correlated it with immunological rejection rate. Methods: Transthoracic echocardiograms in the period of January of 2006 had been carried through the January of 2008, for the prospective evaluation of 47 patients; being 17 patients (36,2 %) pertaining to the group it has controlled (group GC), 18 (38,3%) pertaining to the group of patients transplantated without rejection (TX0) and 12 (25,5%) pertaining ones to the group of patients transplantated with rejection (TX1). It was compared sisto-diastolic function between the three groups (GC, TX0, TX1). To study the homogeneity of proportions was used Fisher's exact test. For the analysis the hypothesis of equality between the groups in relation to the medians, we used the nonparametric Kruskal-Wallis test followed by multiple comparisons. The significance level used for the tests was 5%. Results: The groups did not differ in age [34.0 (29.5 to 44.0) X 46.0 (33.5 - 51.5) X 39.0 (32.5 - 54.5) p = 0.354 ], weight [70.0 (57.5 to 85.0) X 66.5 (57.5 to 88.0) X 61.0 (57.5 to 73.5) p = 0.661], height [ 1.65 (1.59 to 1.73) X 1.66 (1.64 - 1.70) X 1.69 (1.64 - 1.72) p = 0.821] and body surface area [1.84 ( 1.58 to 1.98) X 1.75 (1.62 - 2.03) X 1.69 (1.63 to 1.88) p = 0.758]. The GC group compared with the group TX0, had an alteration of the systolic-diastolic function of left ventricle, expressed by increasing the Miocardic Performance Index (IPM), which is more significant for patients in group TX1 [0.38 (0, 29 to 0.44) X 0.47 (0.43 to 0.56) X 0.58 (0.52 to 0.74) p <0.001]. Conclusion: It was shown that the myocardial performance index is increased in transplant patients in the control group and no significant difference between the two groups of transplant patients, so the echocardiogram showed to be taking good accuracy in the detection of systolic-diastolic function of the transplanted heart and was not a reliable method of biopsy substitute for the confident diagnosis of cardiac rejection. / Mestrado / Cirurgia / Mestre em Cirurgia

O hamster sírio é utilizado como modelo experimental que permite explorar aspectos fisiopatológicos e avaliar a resposta terapêutica em diversas cardiopatias, algumas delas não tão bem reproduzidas em ratos. A avaliação cardiológica inclui a observação de aspectos fisiológicos e hemodinâmicos, assim como a utilização de exames complementares para análise estrutural e funcional cardíaca in vivo. Dentre esses exames destaca-se a ecocardiografia, que possibilita a avaliação da estrutura e função com elevada acurácia. Uma das formas de análise da função sistólica é por meio do cálculo da fração de ejeção do ventrículo esquerdo (FEVE), que leva em consideração os volumes estimados diastólico final e sistólico final do ventrículo esquerdo. Outro importante parâmetro de análise de função sistólica é a avaliação da deformação miocárdica. Os índices de deformação miocárdica podem ser obtidos utilizando o método de rastreamento de pontos. No entanto, até o presente momento, não existem dados a respeito de valores de referência a serem utilizados para a deformação miocárdica em hamsters. Diante disso, o presente estudo teve como objetivo definir a exequibilidade, os intervalos de referência e a variabilidade de parâmetros derivados da ecocardiografia convencional e da técnica de rastreamento de pontos em hamsters sírios adultos. Métodos: Foram incluídos no estudo 135 hamsters sírios fêmeas, anestesiados com ketamina/xilazina e submetidos à ecocardiografia em aparelho dedicado a pequenos animais, Vevo® 2100 utilizando transdutor linear de 30 MHz. Resultados: A exequibilidade da realização das medidas de ecocardiografia convencional foi superior a 93%. A análise da deformação endocárdica apresentou exequibilidade de 84% no eixo longo e, de 80% no eixo curto. A avaliação da deformação epicárdica nos eixos longo e curto apresentou baixa exequibilidade (42% e 62%, respectivamente). A FEVE pelo modo M, obtida no eixo longo, foi significativamente superior à obtida pelos métodos de área comprimento e de rastreamento de pontos (59,0±5,8; 53,8±4,7; 46,3±5,7; p<0,0001). Houve razoável correlação positiva da FEVE obtida pelos métodos de área comprimento e de rastreamento de pontos (r= +0,43; p<0,0001). A deformação longitudinal endocárdica global foi de -13,6(-7,5; -20,4)%, a deformação circunferencial endocárdica global foi de -20,5±3,1% e a deformação radial endocárdica global foi de +34,7±7,0%. A análise de regressão linear evidenciou influência da frequência cardíaca nos valores de deformação longitudinal e circunferencial, mas não da deformação radial (p=0,0003; p<0,0001 e p=0,83, respectivamente). Conclusões: Demonstrou-se que as medidas de ecocardiografia convencional e pelo método de rastreamento de pontos são exequíveis em hamsters. Foram definidos intervalos de referência para variáveis de ecocardiografia convencional e da deformação endocárdica global longitudinal, circunferencial e radial neste modelo experimental animal. / The Syrian hamster is an experimental model to study pathophysiology and to assess therapeutic response in several heart diseases, some of them not well reproduced in rats. The cardiologic evaluation includes observation of physiological and hemodynamic patterns, and complementary tests are used for in vivo cardiac structural and functional analysis. Among these, echocardiography allows the evaluation of structure and function with high accuracy. Analyzing systolic function can be done by calculating the left ventricular ejection fraction. Another important parameter of systolic function analysis is the assessment of the myocardial strain. Myocardial strain indices can be obtained using speckle tracking. However, there are no data regarding reference values for myocardial strain in hamsters. The present study aimed to determine feasibility, reference intervals and variability of parameters derived from conventional and speckle tracking echocardiography in adult Syrian hamsters. Methods: The study included 135 female Syrian hamsters anesthetized with ketamine/xylazine and submitted to a small animal dedicated echocardiography, Vevo® 2100 using a 30 MHz linear transducer. Results: The analysis of the endocardial strain presented a feasibility of 84% in the long axis and 80% in the short axis. The evaluation of the epicardial strain in the long and short axes presented low feasibility (42% and 62%, respectively). The M-mode left ventricular ejection fraction obtained on the long axis was significantly higher than that obtained by the area-length and Speckle tracking methods (59.0±5.8, 53.8±4.7, 46.3±5.7, p<0.0001). There was a reasonable positive correlation of left ventricular ejection fraction obtained by the area length method and the Speckle tracking method (r=+0.43; p<0.0001). The endocardial longitudinal strain was -13.6(-7.5;-20.4)%, the endocardial circumferential strain was -20.5±3.1% and the endocardial radial strain was +34,7±7.0%. Linear regression analysis showed influence of heart rate on the values of longitudinal and circumferential strain, but not on radial strain (p=0.0003, p<0.0001 and p=0.83, respectively). Conclusions: it has been shown that measurements of conventional echocardiography and speckle tracking are feasible in hamsters. Reference intervals for conventional echocardiographic variables and longitudinal, circumferential and radial global endocardial strain were obtained in this experimental animal model.

A presente pesquisa avaliou as anomalias e/ou disfunções cardíacas através da determinação e comparação dos parâmetros ecocardiográficos e ecodopplercardiográficos do fluxo da valva pulmonar em bezerros da raça Nelore originados através de transferência nuclear de células somáticas adultas (TNCS) e concebidos por inseminação artificial ou monta natural durante os primeiros 30 dias de vida, com a finalidade de contribuir nos estudos na área de clonagem e no desenvolvimento da clínica de neonatos bovinos. O delineamento experimental envolveu a avaliação ecocardiográfica do coração e avaliação do fluxo da valva pulmonar através de ecocardiografia Doppler distribuídos nos seguintes intervalos: de 0 a 12 horas após o nascimento, de 12 a 24 horas após o nascimento, de 1 a 2 dias de vida, de 2 a 4 dias de vida, de 4 a 7 dias de vida, de 7 a 10 dias de vida, de 10 a 15 dias de vida, de 15 a 20 dias de vida e de 20 a 30 dias de vida. Os bezerros foram divididos em 2 grupos experimentais: 1- Grupo Controle composto por 10 bezerros obtidos por monta natural ou inseminação artificial e 2- Grupo Clones composto por 10 bezerros obtidos por meio de TNCS. Os parâmetros e índices ecocardiográficos foram: diâmetro interno do átrio esquerdo e direito em sístole, diâmetro interno de ventrículo direito em sístole e diástole, espessura do septo interventricular em sístole e diástole, diâmetro interno do ventrículo esquerdo em sístole e diástole, parede livre do ventrículo esquerdo em sístole e diástole, diâmetro da aorta em diástole, razão átrio esquerdo em sístole e aorta, tempo de ejeção do ventrículo esquerdo, separação septal do ponto E, encurtamento fracional, fração de ejeção, volumes sistólico, diastólico e de ejeção, débito cardíaco, razão septo interventricular em sístole pela parede livre do ventrículo esquerdo em sístole.A avaliação do fluxo da valva pulmonar foi feita através da mensuração da velocidade máxima, velocidade média, tempo de ejeção, tempo de aceleração, integral de velocidade, volume sistólico, débito cardíaco e frequência cardíaca. Dos 10 animais clonados, 3 morreram em até 48 horas de vida apresentando hipertrofia ventricular congênita concêntrica, comunicação interatrial por não oclusão do forame oval e hipertensão arterial pulmonar. Os clones vivos apresentaram fluxo colorido através de comunicação interatrial em até 10 dias de vida enquanto que os bezerros do grupo Controle apresentaram fluxo colorido em até 7 dias. O peso vivo dos animais apresentou alta correlação com o perímetro torácico. Os valores do ecocardiograma determinados para o grupo Controle não são indicados para serem usados como valores de referência para os clones, pois variam muito com o peso dos animais e os clones apresentam variação de peso acima do normal para a espécie. / The present research evaluated anomalies and/or cardiac dysfunctions through the determination and comparison of echocardiographic and echodopplercardiographic parameters of pulmonary valve flow on Nelore breed calves originated from the somatic cell nuclear transfer technique (SCNTT) and from form Nelore breed calves conceived trough artificial insemination or natural mating on its first 30 days of life, with the purpose of contributing on researches on the cloning technique field and on the bovine neonatal clinic development. The experimental design involved heart echocadiographic evaluation and the pulmanary valve echodopplercardiographic evaluation on the following intervals: 0 to 12 hours after birth, 12 to 24 hours after birth, 1 to 2 days old, 2 to 4 days old, 4 to 7 days old, 7 to 10 days old, 10 to 15 days old, 15 to 20 days old and 20 to 30 days old. Calves were allocated in two experimental groups: 1- Control Group composed of 10 calves conceived through artificial insemination and natural mating and 2- Clone Group composed of 10 calves originated from SCNTT. The echocardiographic parameters and indices were: systolic left and right atrium diameters, systolic and diastolic internal diameter, interventricle septum thickness during the systolic and diastolic movement, systolic and diastolic left ventricle internal diameter, left ventricle free wall during systolic and diastolic movement, diastolic aorta diameter, systolic left atrium and aortic root ratio, left ventricle ejection timing, E-point septal separation, fractional shortening, ejection fraction, systolic volume, diastolic volume, ejection volume, systolic interventricle septum and systolic left ventricle ratio. The pulmonary valve flow evaluation was performed through the measurement of the maximum velocity, the average velocity, ejection time, acceleration time, velocity integral, systolic volume, cardiac debit and cardiac frequency. 3 from 10 clones died up to 48 hours after birth, presented congenital concentric ventricle hipertrophy, interatrial communication due to non occlusive oval foramen and pulmonary artery hypertension. The living clones presented colored flow through the interatrial communication until 10 days old while animals from Control Group presented it until 7 days old. Animals´ body weight and thoracic perimeter showed high correlation. The echocardiographic values determined for Control Group are not supposed to be used as reference for clones, because body weight causes great variation on these values and clones present much bigger body weight than what is normal for the species.

Orientador: Wilson Nadruz Júnior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T22:15:29Z (GMT). No. of bitstreams: 1 Cipolli_JoseAlexandreAddeo_D.pdf: 1894085 bytes, checksum: feaa70799935fe151af270ee9d8ad0af (MD5) Previous issue date: 2013 / Resumo: A dilatação da raiz da aorta é observada mais frequentemente em indivíduos hipertensos e está associada de modo independente à hipertrofia do ventrículo esquerdo. Embora a estrutura do ventrículo esquerdo tenha determinantes gênero-específicos, ainda se desconhece a existência de diferenças ligadas ao sexo nos preditores do diâmetro da raiz da aorta em indivíduos portadores de hipertensão arterial. Nós avaliamos 438 pacientes hipertensos com hipertrofia do ventrículo esquerdo (266 mulheres e 172 homens) através de exame clínico, antropometria, parâmetros laboratoriais, hemodinâmicos e inflamatórios, exame de fundo de olho e ecocardiograma. Mulheres com dilatação da raiz da aorta tiveram maior débito cardíaco (p=0,0004), menor resistência vascular periférica (p=0,009), maior prevalência de regurgitação aórtica leve (p=0,02) e maior circunferência abdominal (p=0,04), enquanto homens com dilatação da raiz da aorta apresentaram maior prevalência de hipertrofia concêntrica do ventrículo esquerdo (p=0,0008), de regurgitação aórtica leve (p=0,005) e maiores níveis de Proteína C-reativa (p=0,02), quando comparados com sujeitos do mesmo sexo e sem dilatação da raiz da aorta. Entre as mulheres, a dilatação da raiz da aorta associou-se ao débito cardíaco, circunferência abdominal e regurgitação aórtica moderada, em um modelo de análise multivariada que incluía como variáveis independentes: idade, superfície corpórea, altura, índice de massa ventricular, HOMA (homeostasis model assessment), pressão arterial diastólica, menopausa e uso de anti-hipertensivos. Por outro lado, a dilatação da raiz da aorta associou-se a espessura relativa da parede do ventrículo esquerdo, Proteína C-reativa e regurgitação aórtica leve, sem contribuição de pressão arterial diastólica, altura, superfície corpórea, índice de massa ventricular, resistência vascular periférica e uso de anti-hipertensivos em homens. Em conjunto, esses resultados sugerem que a sobrecarga de volume e a obesidade central podem desempenhar um papel significativo na fisiopatogênese da dilatação da raiz da aorta nas mulheres hipertensas com hipertrofia de ventrículo esquerdo, enquanto o aumento da raiz da aorta nos homens hipertensos com hipertrofia de ventrículo esquerdo está mais associado a parâmetros inflamatórios e ao crescimento das células miocárdicas / Abstract: Aortic root (AoR) dilatation is more frequently observed in hypertensive individuals and is independently associated with left ventricular (LV) hypertrophy. Although the LV structure has sex-specific predictors, it remains unknown whether there are gender-related differences in the determinants of AoR size. We carried out a cross-sectional analysis of clinical, laboratory, anthropometric, funduscopic and echocardiographic features of 438 hypertensive patients with LV hypertrophy (266 women and 172 men). Women with enlarged AoR had higher cardiac output (P=0.0004), decreased peripheral vascular resistance (P=0.009), higher prevalence of mild aortic regurgitation (P=0.02) and increased waist circumference (P=0.04), whereas AoR-dilated men presented with a higher prevalence of concentric LV hypertrophy (P=0.0008) and mild aortic regurgitation (P=0.005) and increased log C-reactive protein levels (P=0.02), compared with sex-matched normal AoR subjects. In women, AoR dilatation associated with cardiac output, mild aortic regurgitation and waist circumference in a multivariate model including age, body surface area, height, homeostasis model assessment index, LV mass index, diastolic blood pressure, menopause status and use of antihypertensive medications as independent variables. Conversely, AoR dilatation associated with LV relative wall thickness, log C-reactive protein and mild aortic regurgitation without contributions from diastolic blood pressure, height, body surface area, LV mass index, peripheral vascular resistance and antihypertensive medications in men. Taken together, these results suggest that both volume overload and abdominal obesity are related to AoR dilatation in hypertensive women, whereas AoR enlargement is associated more with inflammatory and myocardial growth-related parameters in hypertensive men with LV hypertrophy / Doutorado / Clinica Medica / Doutor em Clínica Médica

Orientador: Salomón Soriano Ordinola Rojas / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T03:31:12Z (GMT). No. of bitstreams: 1 Miguel_GabrielAntonioStanisci_D.pdf: 3265608 bytes, checksum: 8e5fab35107186e1c25936f84d45682f (MD5) Previous issue date: 2013 / Resumo: Introdução: O transplante (TC) cardíaco é uma alternativa para os indivíduos com doença cardíaca terminal. Na evolução pós-TC, a ocorrência de episódios de rejeição é um evento frequente, sendo responsável pelo aumento da morbi-mortalidade. Uma alternativa relevante seria o emprego de um exame não invasivo que tivesse uma boa acurácia na detecção das alterações da função sisto-diastólica do coração transplantado, pois a biópsia endomiocárdica (BEM) não é um procedimento isento de complicações. Objetivo: Analisar o Índice de Performance Miocárdica como ferramenta para o diagnóstico de rejeição cardíaca e demonstrar sua possibilidade de triagem na seleção de pacientes para BEM. Método: Foram realizados ecocardiogramas transtorácicos no período de janeiro de 2006 a janeiro de 2008, para a avaliação prospectiva de 58 pacientes; sendo 17 pacientes (29,3 %) pertencentes ao grupo controle (grupo GC), 22 (37,9%) pertencentes ao grupo de pacientes transplantados sem rejeição (TX0) e 19 (32,9%) pertencentes ao grupo de pacientes transplantados com rejeição (TX1). Comparou-se a função sisto-diastólica entre os três grupos (GC, TX0, TX1). O teste de Qui-quadrado foi utilizado para verificar se as proporções de gênero e raça eram homogêneas. Para a comparação entre os três grupos, foi utilizado a ANOVA, em caso de normalidade (verificada por meio do teste de Kolmogorov-Smirnov) e homocedasticidade (verificada por meio do teste de Levene) entre as variáveis; caso contrário, optou-se por utilizar o teste não-paramétrico de Kruskal-Wallis. O nível de significância utilizado para os testes foi de 5%. Resultados: Os grupos não diferiram em relação à idade [38,47 (±11,17) X 41,18 (±13,83) X 45,95 (±12,87) p = 0,212], ao peso [71,95 (±15,90) X 68,68 (±13,14) X 66,09 (±11,91) p = 0,442], altura [1,66 (±0,11) X 1,67 (±0,05) X 1,68 (±0,06) p = 0,894] e superfície corpórea [1,82 (±0,25) X 1,78 (±0,18) X 1,75 (±0,17) p = 0,603]. O grupo GC quando comparado com o grupo TX0, apresentou alteração da função sisto-diastólica do ventrículo esquerdo, expressa através do aumento do IPM, sendo esta mais intensa nos pacientes do grupo TX1 [0,38 (0,29 - 0,39) X 0,47 (0,42 - 0,49) X 0,60 (0,52 - 0,71) p <0,001]. Conclusão: Foi evidenciado que o ÍPM encontra-se bastante aumentado nos pacientes transplantados com rejeição em relação aos pacientes transplantados sem rejeição e também em relação ao controle; portanto, este índice mostrou-se como informação não invasiva e de boa acurácia na detecção das alterações da função sisto-diastólica do coração transplantado, podendo auxiliar na triagem de pacientes transplantados, clinicamente descompensados e que anteriormente seriam submetidos à biópsia de rotina / Abstract: Introduction: The transplant (TC) cardiac is an alternative for the individuals with terminal cardiac illness. In the evolution after TC, the occurrence of rejection episodes is a frequent event, being responsible for the increase of morbi-mortality. An excellent alternative would be the job of a not invasive examination that had a good acurácia in the detention of the alterations of the diastolic function of the transplantated heart, therefore the endomyocardial biopsy (EMB) is not an exempt procedure of complications. Objective: Analyze the Myocardial Performance Index (MPI) as a tool for the diagnosis of cardiac rejection and demonstrate their ability to triage in the selection of patients for EMB. Methods: Transthoracic echocardiograms in the period of January of 2006 had been carried through the January of 2008, for the prospective evaluation of 58 patients; being 17 patients (29,3%) pertaining to the group it has controlled (group GC), 22 (37,9%) pertaining to the group of patients transplantated without rejection (TX0) and 19 (32,9%) pertaining ones to the group of patients transplantated with rejection (TX1). It was compared sisto-diastolic function between the three groups (GC, TX0, TX1). The Qui-quadrado test was used to verify that the proportions of gender and race were homogeneous. For comparison between groups, ANOVA was used, in case of normality (verified by the Kolmogorov-Smirnov test) and homoscedasticity (verified by Levene's test) between the variables; otherwise opted to using the nonparametric Kruskal-Wallis test. The significance level used for the tests was 5% Results: The groups did not differ in age [38,47 (±11,17) X 41,18 (±13,83) X 45,95 (±12,87) p = 0,212], weight [71,95 (±15,90) X 68,68 (±13,14) X 66,09 (±11,91) p = 0,442], height [1,66 (±0,11) X 1,67 (±0,05) X 1,68 (±0,06) p = 0,894] and body surface area [1,82 (±0,25) X 1,78 (±0,18) X 1,75 (±0,17) p = 0,603]. The GC group compared with the group TX0, had an alteration of the systolic-diastolic function of left ventricle, expressed by increasing the Miocardic Performance Index (IPM), which is more significant for patients in group TX1 [0,38 (0,29 - 0,39) X 0,47 (0,42 - 0,49) X 0,60 (0,52 - 0,71) p <0,001]. Conclusion: It was shown that the PMI is greatly increased in patients with transplant rejection compared to patients transplanted without rejection and also in relation to the control, so this index proved to be as non-invasive and accurate method for the detection of changes in systolic and diastolic function of the transplanted heart to assist in screening transplant patients clinically decompensated and who previously underwent biopsy would be routine / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Haemodialysis (HD) patients have a high mortality risk and most have echocardiographic evidence of abnormal cardiac structure or function. Markers, such as left ventricular hypertrophy (LVH), show association with adverse outcome in the general population and can aid in clinical decision making. The aim of this research was to explore the prognostic utility of established and novel two-dimensional (2DE) and three-dimensional transthoracic echocardiographic (RT3DE) techniques in HD patients. Adult maintenance HD patients from a single tertiary nephrology centre including satellite dialysis units were enrolled. Exclusion criteria were if patients were clinically unstable, unable to consent, or if required ambulance transportation for echocardiography visits. Consented patients underwent 2DE with speckle tracking (STE), RT3DE and VicorderTm measurements of pulse wave velocity (PWV) on a non-dialysis day, after the short inter-dialytic break. Clinical phenotype data, 3-month averaged blood results and dialysis prescriptions were obtained from the hospital electronic patient records. All patients screened were followed-up until death, renal transplantation, moving out of the region, or 16th November 2015. Regression analysis was used to assess the cross-sectional relationship between echocardiographic parameters. Relationship of echocardiographic parameters with outcome was assessed by Cox regression analysis. The first study explored whether patients recruited had similar characteristics and survival compared with patients who declined consent or who were excluded from the study. Patients who declined consent had an adjusted hazard ratio (HR) for all-cause mortality compared with recruited patients of 1.70, 95% confidence interval (CI) 1.10-2.52, and excluded patients had an adjusted HR of 1.30, 95% CI 0.75-2.25. Recruited patients may be a 'fitter' population and this needs to be considered when interpreting results. The second study reports that when global longitudinal strain (GLS) is combined in a multivariable model with PWV; PWV is superior to GLS in its association with mortality (adjusted HR 1.23, 95% CI 1.03-1.47 versus HR 1.00, 95% CI 0.86-1.17). When this analysis was repeated in a sub-group of patients with LVH, neither GLS nor PWV were associated with mortality, whilst both were prognostically significant in a preserved LVEF sub-group (PWV: HR 1.23, 95% CI 1.04-1.4 and GLS: HR 1.16, 95% CI 1.01-1.33). Therefore GLS has different prognostic implications in different patient sub-groups. The third study explored whether tissue motion mitral annular displacement (TMAD) measured by STE may be a more useful alternative to GLS as it measures strain but is quicker and less user-dependent. TMAD was closely correlated to GLS (r=-0.614, p<0.001), but had no prognostic power for mortality (adjusted HR 1.04,95% CI 0.91-1.19). The correlation between 2DE and RT3DE determined LV mass and volume measurements and the prognostic significance of RT3DE measurements were assessed. Although there was good correlation between 2DE and RT3DE LV volume measurements, 2DE overestimated LV mass compared to RT3DE. RT3DE measures gave no added prognostic value, and there were added difficulties in obtaining adequate images for RT3DE (35% of patients who had adequate 2D images). Furthermore, although RT3DE determined LV mechanical dyssynchrony index was prolonged in HD patients compared with published general population controls, it failed to show any prognostic significance (HR 2.16, 95% CI 0.96-4.89) for mortality, but was associated with hospitalisation for heart failure (HR 1.03, 95% CI 1.00-1.06). These results indicate that novel measurements of sub-clinical cardiac dysfunction have the potential to aid prognostication in this high risk population. Follow-up studies exploring the longitudinal change in these parameters is ongoing.

Characterized by excessive myocardial glycogen deposition, cardiac hypertrophy, frequent cardiac arrhythmias and progressive conduction system disease, the PRKAG2 cardiac syndrome stems from a genetic mutation in the γ2-subunit of AMP-activated protein kinase (AMPK). Although functionally diverse, the main role of AMPK is to modulate cardiac metabolism in response to depleted ATP levels. A comprehensive study of the dysfunctional regulation of AMPK activity involved in the progression of the human PRKAG2 cardiac syndrome is hindered by the limitations of in vitro techniques. Positron emission tomography (PET) imaging with the glucose analogue, FDG, offers a quantitative assessment of myocardial glucose uptake non-invasively. The aim of this thesis was to determine the ability of FDG to detect changes in glucose uptake, storage and metabolism in the heart in relation to AMPK activity and provide insights into the mechanism of PRKAG2 cardiac hypertrophy. To achieve this aim, a transgenic AMPK γ2-subunit Arg302Gln mouse model was evaluated with small animal FDG PET with correlation to biochemical assays of cardiac AMPK activity and the glycogen metabolism pathway. Using the vena cava blood input function, FDG myocardial glucose uptake was reliably assessed in mice for the first time with Patlak modeling. Reduced FDG uptake in the Arg302Gln PRKAG2 mouse model suggested a feedback pathway reducing exogenous glucose uptake due to excessive intracellular glycogen stores. Despite an increase in FDG uptake in the skeletal muscle of the PRKAG2 mutant mice following insulin stimulation, there was no change in cardiac uptake, signifying myocardial insulin resistance. Increased reliance on glucose oxidation by TMZ inhibition of fatty acid oxidation reduced glycogen stores, restored cardiac function and eliminated ventricular preexcitation. The observed reduction in mouse myocardial FDG uptake mirrors the reduction previously observed in the human PRKAG2 patients. The potential now exists to evaluate both progression and therapeutic interventions for the PRKAG2 cardiac syndrome with the transgenic mouse model with translation to the affected patients using FDG cardiac imaging.

As the most commonly diseased heart valve, the mitral valve (MV) has been the subject of extensive research for many years. Unfortunately, the only treatment options currently available are surgical repair and replacement. Although repair is almost always preferable to replacement, it is often underperformed due to the complexity of MV repair surgeries. Consequently, there is significant interest in generating patient-specific finite element models of the MV for the purpose of simulating mitral repairs. For practical purposes transesophageal echocardiographic (TEE) images are most commonly used to reconstruct the mitral apparatus. However, limitations in ultrasound technology have prevented the detection of leaflet thicknesses. In the current study, a method was developed to accurately model variations in leaflet thicknesses using TEE datasets. Nine healthy datasets were modeled and the leaflet thicknesses were found to closely match previously reported results. As anticipated, normal valve function was also observed over the entire cardiac cycle.

In today’s society, we experience an increasing challenge to provide healthcare to everyone in need due to the increasing number of patients and the shortage of medical staff. Computers have contributed to mitigating this challenge by offloading the medical staff from some of the tasks. With the rise of deep learning, countless new possibilities have opened to help the medical staff even further. One domain where deep learning can be applied is analysis of ultrasound images. In this thesis we investigate the problem of classifying standard views of the heart in ultrasound images with the help of deep learning. We conduct mainly three experiments. First, we use NasNet mobile, InceptionV3, VGG16 and MobileNet, pre-trained on ImageNet, and finetune them to ultrasound heart images. We compare the accuracy of these networks to each other and to the baselinemodel, a CNN that was proposed in [23]. Then we assess a neural network’s capability to generalize to images from ultrasound machines that the network is not trained on. Lastly, we test how the performance of the networks degrades with decreasing amount of training data. Our first experiment shows that all networks considered in this study have very similar performance in terms of accuracy with Inception V3 being slightly better than the rest. The best performance is achieved when the whole network is finetuned to our problem instead of finetuning only apart of it, while gradually unlocking more layers for training. The generalization experiment shows that neural networks have the potential to generalize to images from ultrasound machines that they are not trained on. It also shows that having a mix of multiple ultrasound machines in the training data increases generalization performance. In our last experiment we compare the performance of the CNN proposed in [23] with MobileNet pre-trained on ImageNet and MobileNet randomly initialized. This shows that the performance of the baseline model suffers the least with decreasing amount of training data and that pre-training helps the performance drastically on smaller training datasets.