Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-09-20T11:23:05Z No. of bitstreams: 1 jaimeafonsosousanetto.pdf: 1492332 bytes, checksum: b3474331db3578ab3863a9ab3071334f (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-10-01T19:27:18Z (GMT) No. of bitstreams: 1 jaimeafonsosousanetto.pdf: 1492332 bytes, checksum: b3474331db3578ab3863a9ab3071334f (MD5) / Made available in DSpace on 2018-10-01T19:27:18Z (GMT). No. of bitstreams: 1 jaimeafonsosousanetto.pdf: 1492332 bytes, checksum: b3474331db3578ab3863a9ab3071334f (MD5) Previous issue date: 2018-07-31 / Introdução: Metade dos pacientes com insuficiência cardíaca (IC) apresentam disfunção diastólica (DD) e fração de ejeção preservada do ventrículo esquerdo (FEpVE). A hipertrofia ventricular esquerda (HVE) é a anormalidade cardíaca em pacientes com doença renal crônica (DRC). O diagnóstico por imagem da DD é tradicionalmente realizado com a ecocardiografia transtorácica (ETT), sendo o volume do átrio esquerdo indexado (IVAE) um dos principais componentes no algoritmo da avaliação da DD. A metodologia do speckle tracking através do strain longitudinal global do ventrículo esquerdo (SLGVE) e o strain atrial esquerdo (SAE), possibilitam quantificar a contratilidade miocárdica e a avaliação instantânea da função do átrio esquerdo, respectivamente. Objetivo: Avaliar, em pacientes com DRC estágios 3B a 5 (em tratamento conservador) e FEpVE, o uso do SAE na identificação da disfunção diastólica indeterminada pelo IVAE. Métodos: Estudo de caso controle que avaliou pacientes com DRC estágios 3B a 5, em tratamento conservador, e que apresentavam fração de ejeção normal através da ecocardiografia transtorácico (ETT). Os pacientes foram divididos em dois grupos, com e sem HVE. A disfunção diastólica (DD), baseado em recomendações recentes da ASE, 2016, foi avaliada inicialmente pela ETT e, posteriormente, através do SAE (valor normal de referência >23%) pelo método speckle tracking. Adicionalmente, também se avaliou o strain longitudinal global do ventrículo esquerdo (SLGVE). O diagnóstico da DRC seguiu os critérios do KDIGO de 2012. Resultados: No total, foram avaliados 114 pacientes (57 em cada grupo), com idade média de 66,3±8,65, sendo 52,7% do sexo feminino, 94% hipertensos e 46% diabéticos. A média da taxa de filtração glomerular (em mL/min/1,73 m2) nos pacientes com e sem HVE foi de 32,6±11,9 e 40,4±13,9, respectivamente. A presença da DD no grupo com HVE (24,6%) foi maior do que no grupo sem HVE. Entre os 29 pacientes com HVE e DD indeterminada pelo IVAE, o SAE reduzido foi observado em 10 casos, aumentando o percentual de DD para 42%. No grupo sem HVE e DD indeterminada (18 casos), o SEA reduzido foi observado em quatro pacientes, aumentando para 21% o DD. A relação E/e´ no ânulo mitral lateral não apresentou alteração significativa entre os grupos (10,75±3,3; 10,14±3,8; p>0,05 Conclusão: Em pacientes com DRC não dialítica, o uso do SAE potencialmente aumenta a identificação de casos indeterminados de DD. / Introduction: Half of patients with heart failure (HF) have diastolic dysfunction (DD) and preserved left ventricular ejection fraction (LVEF). Left ventricular hypertrophy (LVH) is the cardiac abnormality in patients with chronic kidney disease (CKD). DD imaging has traditionally been performed with transthoracic echocardiography (TTE), with indexed left atrium volume (VTE) being one of the main components in the DD assessment algorithm. The methodology of speckle tracking through left ventricular global longitudinal strain (SLGVE) and left atrial strain (SAE), allows quantification of myocardial contractility and the instantaneous evaluation of left atrial function, respectively. Objective: To evaluate the use of SAE in the identification of undetermined diastolic dysfunction by VTE in patients with CKD stages 3B to 5 (in conservative treatment) and FEpVE. Methods: A control case study that evaluated patients with CKD stages 3B to 5, in conservative treatment, and who presented normal ejection fraction through transthoracic echocardiography (ETT). Patients were divided into two groups, with and without LVH. Diastolic dysfunction (DD), based on recent ASE recommendations, 2016, was initially evaluated by ETT and, later, by the SAE (reference normal value> 23%) by the speckle tracking method. In addition, the overall longitudinal strain of the left ventricle (SLGLE) was also evaluated. Results: A total of 114 patients (57 in each group) were evaluated, with a mean age of 66.3 ± 8.65, of which 52.7% were female, 94 % hypertensive and 46% diabetic. The mean glomerular filtration rate (in mL / min / 1.73 m2) in patients with and without LVH was 32.6 ± 11.9 and 40.4 ± 13.9, respectively. The presence of DD in the group with LVH (24.6%) was higher than in the group without LVH. Among the 29 patients with LVH and DD undetermined by IVAE, reduced SAE was observed in 10 cases, increasing the percentage of DD to 42%. In the group without undetermined LVH and DD (18 cases), the reduced SEA was observed in four patients, increasing the DD to 21%. Conclusion: In patients with non-dialytic CKD, the use of E / e 'in the lateral mitral annulus did not present significant alteration between the groups (10.75 ± 3.3; 10.14 ± 3.8; p> 0.05 of SAE potentially increases the identification of indeterminate cases of DD.

Orientador: Wilson Nadruz Júnior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T18:22:05Z (GMT). No. of bitstreams: 1 Magalhaes_JoseAlexandrePio_D.pdf: 2033621 bytes, checksum: 4f4a904e259bcb7c5ef05e924b40b3f2 (MD5) Previous issue date: 2012 / Resumo: A aferição da circunferência do braço é uma medida necessária para a seleção de manguitos apropriados e é recomendada para que se faça uma aferição correta da pressão arterial. O objetivo deste estudo foi identificar e quantificar as relações entre a circunferência do braço e medidas antropométricas usuais de distribuição de gordura corporal e a estrutura cardíaca em indivíduos hipertensos. Nós avaliamos 339 pacientes (202 mulheres e 137 homens) por história médica, exame físico, antropometria, parâmetros metabólicos e inflamatórios e ecocardiografia. Resultados de análise de correlação parcial ajustada por idade e índice de massa corpórea revelaram que variáveis antropométricas se associaram significativamente com parâmetros ecocardiográficos apenas em mulheres. Neste sentido, a circunferência do braço se correlacionou com a espessura do septo interventricular e da parede posterior do ventrículo esquerdo e com a espessura relativa do ventrículo esquerdo ?0,45, enquanto que a circunferência abdominal se correlacionou com o diâmetro do ventrículo esquerdo. Análise multivariada incluindo idade, índice de massa corpórea, pressão arterial sistólica, homeostasis model assessment index, e uso de medicações anti-hipertensivas demonstraram que a circunferência do braço foi um preditor independente de espessura da parede ventricular esquerda e de hipertrofia concêntrica em mulheres. Análise multivariada adicional revelou que a circunferência abdominal foi um preditor independente do diâmetro diastólico final do ventrículo esquerdo e do átrio esquerdo. Em geral, estes achados sugerem que a circunferência do braço possa servir não só como um procedimento para permitir uma medida adequada da pressão arterial, mas também como um preditor de remodelamento cardíaco desfavorável em mulheres hipertensas / Abstract: Upper arm circumference measurement is necessary for the proper sizing of cuffs and is recommended for accurate blood pressure assessment. The aim of this report is to identify and quantify the relationships between upper arm circumference and the usual anthropometric measurements of body fat distribution and cardiac structure in hypertensive subjects. We evaluated 339 patients (202 women and 137 men) by medical history, physical examination, anthropometry, metabolic and inflammatory parameters, and echocardiography. Partial correlation analyses adjusted for age and body mass index revealed that anthropometric variables were significantly associated with echocardiographic parameters exclusively in women. In this regard, upper arm circumference correlated with interventricular septum thickness, posterior wall thickness, and relative wall thickness >or=0.45, while waist circumference was related to left cardiac chamber diameter. Multivariate analyses including age, body mass index, systolic blood pressure, homeostasis model assessment index, and use of antihypertensive medications demonstrated that upper arm circumference was an independent predictor of left ventricular wall thickness and concentric hypertrophy in women. Further linear regression analyses revealed that waist circumference was an independent predictor of left ventricular end-diastolic and left atrial diameters in this gender. Overall, these findings suggest that upper arm circumference determination might serve not only as a routine approach preceding blood pressure evaluation but also as a simple and feasible predictor of adverse left ventricular remodeling in hypertensive women / Doutorado / Clinica Medica / Doutor em Clínica Médica

L’analyse de la fonction systolique en échocardiographie représente un challenge majeur depuis une vingtaine d’années dans le but d’améliorer la détection et la quantification des anomalies de la contraction myocardique. L’analyse des déformations myocardiques consiste à étudier le pourcentage d’étirement ou de raccourcissement myocardiques au cours du cycle cardiaque. Après le grand pas en avant dans ce domaine, consécutif à l’avènement du Doppler tissulaire il y a un quinzaine d’années, ces 4 dernières années ont vu naître une nouvelle technique d’analyse bidimensionnelle des déformations, porteuse de grands espoirs car s’affranchissant de la limitation liée à l’angle d’incidence Doppler et basée sur le suivi des marqueurs acoustiques de la paroi myocardique : le « speckle tracking echocardiography » ou « 2D strain ». Cette thèse rapporte tout d’abord une série de travaux orientés sur la validation de ce nouvel outil. Nous avons ensuite appliqué expérimentalement cette technique pour évaluer sa capacité à détecter l’ischémie myocardique lors d’un examen de stress sous dobutamine en comparaison à l’analyse de perfusion myocardique en échographie de contraste. Enfin, nous exposons plusieurs expériences cliniques qui témoignent de quelques applications potentielles de cette technique dans la prise en charge des patients porteurs de cardiopathies diverses : myocardiopathie hypertrophique, fibrillation auriculaire paroxystique et recherche de viabilité sous faibles doses de dobutamine chez les patients porteurs d’une cardiopathie ischémique. / For 20 years, analysis of systolic myocardial function by echocardiography is a major challenge to improve the detection and the quantification of myocardial contractility abnormalities. The principle of myocardial deformation analysis consists in evaluating the percentage of myocardial thickening or shortening during the cardiac cycle. After a big step forward with the advent of tissue Doppler imaging for 15 years, the 4 last years have seen the apparition of a new technique of bidimensional analysis, without angle dependency, based on the tracking of the acoustic markers of the myocardial wall, and called « speckle tracking echocardiography » or « 2D strain ». This thesis reports serial studies oriented on the validation of this new tool and on the experimental application of this technique in the detection of myocardial ischemia during pharmacological dobutamine stress echocardiography, in comparison with myocardial perfusion analysis by contrast echocardiography. Finally, we report some clinical experiences using the speckle tracking echocardiography which attest of some clinical potential applications of this technique in the management of the patients with different cardiomyopathies: hypertrophic cardiomyopathy, lone paroxysmal atrial fibrillation, and analysis of myocardial regional deformation during low doses dobutamine infusion to investigate viability in patients with ischemic cardiomyopathy.

Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) is a systemic disorder which includes abnormal bone chemistry, vascular or soft tissue calcification, and abnormal bone formation. Many of the parameters of CKD-MBD have been associated with an increased mortality risk in renal patients. There were three main facets to this research project. The first aim of this research was to perform two different studies using the Chronic Renal Insufficiency Standards Implementation Study (CRISIS) data. This prospective epidemiological study is designed to identify factors associated with renal progression and survival in the pre-dialysis CKD population. We have shown that for each 0.323mmol/L (1mg/dL) increase in serum phosphate there was a significant stepwise increased risk of death. (HR1.3 (1.1, 1.5) P=0.01). The association of baseline phenotypic data against vascular stiffness measurements was also investigated. Augmentation index measured at the radial artery was associated with a raised systolic blood pressure but no association with biochemical abnormalities was found.We hypothesised that the phosphate effect on survival was related to the effects within the CKD-MBD spectrum and therefore control of secondary hyperparathyroidism would improve bone and cardiovascular parameters. Therefore for the second part of this research we performed a randomised controlled trial to examine the effects of cinacalcet with standard therapy compared to standard therapy alone on bone and cardiovascular parameters in haemodialysis patients with uncontrolled hyperparathyroidism. The change of biochemical parameters and cardiovascular markers were also further explored in secondary analyses alongside survival data. The primary end point of change in vascular calcification at 52 weeks showed no significant difference between arms. As equivalent control of phosphate and iPTH was achieved in both arms secondary analyses were performed. This showed a significant regression of left ventricular hypertrophy and carotid intima-media thickness associated with phosphate but not iPTH reduction. Patients whose phosphate reduced during the study had a survival advantage when followed for 5 years (HR=10.2 (1.1, 104.5) P=0.049). The third part of this research was to investigate iPTH assay variability. We explored the variation in iPTH assays across the North West and paired this with regional audit data. This study showed that despite there being significant variation among iPTH assays across the region the variation in clinical management was still accounting for some variation in achieving PTH targets.In conclusion, serum phosphate, within the normal laboratory range, is associated with an increased mortality in CKD patients. Haemodialysis patients may have improvement of cardiovascular outcomes with tight control of secondary hyperparathyroidism, by whichever therapeutic means. Intact PTH assays variation may alter our clinical management but variation in practice still affects guideline achievement.

Made available in DSpace on 2016-05-02T13:55:32Z (GMT). No. of bitstreams: 1 DenisBuenodaSilva-dissertacao.pdf: 548077 bytes, checksum: a0097266c1d6f0990023e8b0c828c0e4 (MD5) Previous issue date: 2012-08-31 / Inflammatory process, endothelial dysfunction and oxidative stress in cardiovascular environment resulting from dyslipidemia are the conditions that promote and sustain atherosclerosis and cardiac hypertrophy. The present study verified the effect of propolis alone and its association with swimming in dyslipidemia, left ventricular hypertrophy and atherogenesis of hypercholesterolemic mice that were receiving a high-fat diet. 40 LDLr-/- mice, fed with high fat diet (20% total fat, 1.25% cholesterol and 0.5% cholic acid) ad libitum for 75 days, were used in the study. The animals were divided into 4 groups (n=10): hyperlipidic group (HL), sedentary, subjected to aquatic stress; hyperlipidic + swimming group (HL+NAT), submitted to a swimming protocol (1 hour per day, 5 times per week) from the 16th day of the experiment; hyperlipidic + propolis group (HL+PRO), sedentary, submitted to aquatic stress and which received oral propolis (70 µL of the propolis alcoholic extract of 85,71% every weekday) from the 16th day of the experiment; HL+NAT+PRO group, submitted to swimming protocol (1 hour per day, 5 times per week) from the 16th day of the experiment and which received oral propolis (70 µL of the propolis alcoholic extract of 85,71% every weekday) from the 16th day of the experiment. After 75 days of the experiment, the animals were weighed and anesthetized. Blood was collected and laboratory analyzes were performed for total cholesterol and fractions, and triglycerides. After thoracotomy, heart and aorta were removed. The heart was weighed and dissected, the left ventricle isolated, the ratio between the ventricular weight (mg) and the animal weight (g), was calculated and after, it was histologically processed. Ventricle and aorta slides were stained with hematoxina and eosin (HE) and picrosirius red for histological and histochemical analyzes; other slides were treated immunohistochemically with anti-protein proinflammatory CD40L antibodies to evaluate the inflammatory process. The HL animals showed severe dyslipidemia, atherogenesis and left ventricular hypertrophy, associated with a decrease in serum high density lipoprotein (HDL) levels and subsequent development of cardiovascular anti-inflammatory process, characterized by increased expression of CD40L in the left ventricle and aorta. Swimming and propolis separated and / or associated prevented left ventricular hypertrophy (HVE), atherogenesis, ventricular and arterial inflammation, decreasing the expression of CD40L and increased plasma levels of HDL-C. A propolis alone or associated with regular physical activity is beneficial in cardiovascular protection by anti-inflammatory action. / O processo inflamatório, a disfunção do endotélio e o estresse oxidativo no ambiente cardiovascular decorrente das dislipidemias são as condições que promovem e sustentam a aterosclerose e a hipertrofia cardíaca. O presente estudo verificou o efeito da própolis isolada e da sua associação com a natação na dislipidemia, na hipertrofia ventricular esquerda e na aterogênese de camundongos hipercolesterolêmicos que já recebiam dieta hiperlipídica. Foram utilizados 40 camundongos LDLr-/- alimentados com dieta hiperlipídica (20% de gordura total, 1,25% de colesterol e 0,5% de ácido cólico) ad libitum por 75 dias. Os animais foram divididos em 4 grupos (n=10): grupo hiperlipídico (HL), sedentário, submetido ao estresse aquático; grupo hiperlipídico + natação (HL NAT), submetido a um protocolo de natação (1 hora por dia, 5 vezes por semana) a partir do 16º dia do experimento; grupo hiperlipidico/própolis (HL PRO), sedentário, submetido ao estresse aquático e que recebeu própolis via oral (70 µL do extrato alcoólico de própolis a 85,71% todos os dias da semana) a partir do 16º dia do experimento; grupo HL NAT PRO, submetido a um protocolo de natação (1 hora por dia, 5 vezes por semana) a partir do 16º dia do experimento e que recebeu própolis via oral (70 µL do extrato alcoólico de própolis a 85,71% todos os dias da semana) a partir do 16º dia do experimento. Após os 75 dias de experimento, os animais foram pesados e anestesiados. O sangue foi coletado e foram realizadas as análises laboratoriais de colesterol total e frações, e triglicerídeos. Após a toracotomia, o coração e a artéria aorta foram removidos. O coração foi pesado e dissecado, o ventrículo esquerdo isolado, calculou-se a razão entre peso ventricular (mg) e peso animal (g), e, em seguida, foi processado histologicamente. Lâminas do ventrículo e aorta foram coradas com hematoxina e eosina (HE) e picrosírius red para análise histológica e histoquímica; outras lâminas foram tratadas imunohistoquimicamente com anticorpos antiproteína pró-inflamatória (CD40L) para avaliar o processo inflamatório. Os animais HL apresentaram dislipidemia severa, aterogênese e hipertrofia ventricular esquerda associada a uma diminuição dos níveis séricos da lipoproteína de alta densidade (HDL) e consequente desenvolvimento de processo anti-inflamatório cardiovascular caracterizado pelo aumento da expressão CD40L no ventrículo esquerdo e na aorta. A natação e a própolis separadas e/ou associadas preveniu a hipertrofia ventricular esquerda (HVE), a aterogênese, a inflamação ventricular e arterial, diminuindo a expressão de CD40L e aumentando os níveis plasmáticos da HDLc. A própolis isolada ou associada com uma atividade física regular é benéfica na proteção cardiovascular por ação anti-inflamatória.

A hipertrofia ventricular esquerda (HVE) é importante fator de risco cardiovascular. O objetivo deste estudo retrospectivo foi verificar a associação de critérios eletrocardiográficos de HVE com as características anatômicas e histológicas do coração, em 51 pacientes submetidos à necropsia. Procedeu-se à medição do diâmetro transverso dos cardiomiócitos e da porcentagem de fibrose do ventrículo esquerdo e direito. Entre os pacientes que apresentavam HVE anatômica, o critério de Romhilt foi positivo em 92,3%, sendo superior aos demais critérios avaliados, com especificidade de 89,5% e sensibilidade de 68,8%, Foi o único que se associou a características anatômicas e histológicas do coração / The left ventricular hypertrophy (LVH) is an important cardiovascular risk factor. The purpose of the present retrospective paper is to examine the association of LVH electrocardiographic criteria with both anatomical and histological characteristics of the heart on 51 patients submitted to the necropsy. The study carried out the measurement of the transverse diameter of cardiomyocytes, as well as the percentage of fibrosis at both left and right ventriculi. Among those patients who presented anatomic LVH, the Romhilt criterium resulted positive in 92.3% of the cases, thus surpassing the other criteria evaluated, with specificity and sensibility up to 89.5% and 68.8% respectively. This was the only criterium associated to both anatomic and histological characteristics of the heart

No description available.

Coronary artery disease remains the leading cause of death in the United States with over 1 million acute coronary events predicted to take place in 2019 alone. Heart failure, a common and deadly sequela of myocardial infarction (MI), is attributed to adverse ventricular remodeling driven by cardiomyocyte death, inflammation, and mechanical factors. Despite strong evidence suggesting the importance of myocardial mechanics in driving cardiac remodeling, many <i>in vivo</i> MI studies still rely on 2D analyses to estimate global left ventricular (LV) function and approximate strain using a linear definition. These metrics, while valuable in evaluating the overall impact of ischemic injury on cardiac health, do not capture regional differences in myocardial contractility. The objective of this work is therefore to expand upon existing ultrasound studies by enabling regional analysis of 3D myocardial strain. By integrating our recently developed four-dimensional ultrasound (4DUS) imaging technique with a direct deformation estimation algorithm for 3D strain, we identified unique remodeling patterns and regional strain differences between two murine models of MI with different infarct severities. By constructing 3D strain maps of the remodeling LVs, we were able to capture strain heterogeneity and characterize a sigmoidal strain profile at infarct border zones. Finally, we demonstrated that the maximum principal component of the 3D Green-Lagrange strain tensor correlates with LV remodeling severity and is predictive of final infarct size. Taken together, the presented work provides a novel and thorough approach to quantify regional 3D strain, an important component when assessing post-MI remodeling.

Background/objectives There are few studies investigating the long-term association between childhood blood pressure (BP) and adult cardiovascular remodeling. We seek to examine the effect of elevated childhood BP on cardiovascular remodeling in early or middle adulthood.Methods We used the "Beijing BP Cohort Study", where 1259 subjects aged 6-18 years old were followed over 24 years from childhood (1987) to early or middle adulthood (2011). Anthropometric measures and BP were obtained at baseline and follow-up examinations. Carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI) were measured to assess cardiovascular remodeling in early or middle adulthood. Multiple logistic regression models were used to assess the odds ratio (OR) and 95% confidence interval (CI) for cardiovascular remodeling.Results 82 out of 384 children with elevated BP (21.4%) had adult hypertension. Compared to those with normal BP, children with elevated BP were at 2.1 times (95% CI: 1.4-3.1) likely to develop hypertension in early or middle adulthood. Compared to those with normal BP, children with elevated BP were at higher OR of developing high cfPWV (OR = 1.8, 95% CI = 1.3-2.4), high cIMT (1.4, 1.0-1.9), or high LVMI (1.4, 1.0-1.9) in early or middle adulthood. The ORs for remodeling (for any measures) were 1.4 (0.9-2.0) in early adulthood for children age 6-11 years, and 1.6 (1.1-2.4) in middle adulthood for those aged 12-18 years.Conclusions Children with elevated BP from 6 years old have accelerated remodeling on both cardiac and arterial system in early or middle adulthood.

Osteopontin, also called cytokine Eta-1, is a multifunctional protein containing Arg-Gly-Asp-Ser (RODS) cell-binding sequence. It interacts with αvβ1, αvβ3 and αvβ5 integrins and CD44 receptors. OPN is suggested to play a role during inflammation via the recruitment and retention of macrophages and T-cells to inflamed sites. OPN regulates the production of inflammatory cytokines and nitric oxide in macrophages. In this review, we will discuss diverse roles of OPN related to cardiovascular diseases, including atherosclerosis, valvular stenosis, hypertrophy, myocardial infarction and heart failure.