Bedömningen av höger kammares systoliska funktion kan med fördel göras med ekokardiografi, bl.a. med tekniker som tvådimensionell ekokardiografi, motion-mode (M-mode) och Tissue Doppler Imaging (TDI). Mätvärden som kan fås ut av dessa tekniker är Tricuspid Annular Plane Systolic Excursion (TAPSE) och s`. TAPSE beskriver annulus tricuspidalis longitudinella rörlighet. s´ beskriver den maximala systoliska hastigheten i annulus tricuspidalis. Syftet med examensarbetet var att undersöka sambandet mellan TAPSE och s´ vid högerkammarfunktionsbestämning. Studien är en retrospektiv tvärsnittsstudie och består av 99 deltagare i åldrarna 18–90 år. Både friska och hjärt-och kärlsjuka deltagare inkluderades, men inte patienter med förmaksflimmer eller individer som var yngre än 18 år. Deltagarna undersöktes med transthorakal ekokardiografi (TTE) vid Länssjukhuset Ryhov i Jönköping, vid undersökningen mättes TAPSE och s´. Det var samma biomedicinska analytiker (BMA) som utförde undersökningarna. McNemars test utfördes och ett Kappa-värde räknades ut. Resultatet visade signifikant skillnad och Kappa-värdet var lågt vilket talar för dåligt samband mellan de båda variablerna. Utfallet i studien visar att fler deltagare klassas med normal högerkammarfunktion mätt med TAPSE, medan samma individer klassas med högerkammardysfunktion mätt med s´. Orsaken till det dåliga sambandet mellan parametrarna är okänt och bör studeras vidare i kommande studier. / The assessment of right ventricular systolic function is done by echocardiography, with techniques as twodimensional echocardiography, motion-mode (M-mode) and Tissue Doppler Imaging (TDI). Measurements ​​obtained from these techniques are Tricuspid Annular Plane Systolic Excursion (TAPSE) and s`. TAPSE describes the longitudinal movement of annulus tricuspidalis. s´ describes annulus tricuspidalis maximal systolic velocity. The purpose of this essay was to explore the relationship between TAPSE and s´. The study consists of 99 participants between the ages of 18 and 90. The population was consisted of individuals with or without cardiovascular disease, but not individuals with atrial fibrillation. Participants were investigated with transthorakal echocardiography (TTE) at Länssjukhuset Ryhov in Jönköping. At the examination both TAPSE and s´ was measured. McNemar's test was performed and a Kappa value was calculated. The result showed a significant difference and the Kappa value was low which indicates a low relationship between the variables. The outcome of the study shows that several participants are classified with normal right ventricular function measured with TAPSE, but the same individuals are classified with right ventricular dysfunction measured by s'. The reason for the poor relationship between the parameters is unknown and should be studied further in future studies.

Background: The transposition of the great arteries (TGA) is a common congenital heart disease. In the 1980s the Senning procedure was the major approach in correction of TGA in the Czech Republic. Although the most recent operation technique called arterial switch is the method of first choice nowadays, patients after Senning procedure are still visiting the cardiology centre. The aim of this thesis was to evaluate the relationship between the selected parameters from the exercise test and quantified level of physical activity (PA) in these individuals. Methods: 71 patients after the Senning procedure underwent a cardiopulmonary exercise test and they completed an international physical activity questionnaire (IPAQ). Selected data from the questionnaire and the exercise test were evaluated by Pearson correlation coefficient (p < 0,05). Results: 56 patients meet criteria of IPAQ (71 % male, n = 40) and were included in the study. Total PA averaged 6576 ± 5204 MET-minutes/week (median 5271 MET-minutes/week) and 70 % individuals meet criteria for high level of PA according to IPAQ data. Peak VO2 averaged 31,9 ± 6,6 ml/min/kg, maximum heart rate was 177 ± 18,6 beats per minute, the highest work load was 2,7 ± 0,8 W/kg and systolic blood pressure was 185 ± 24,0 mmHg. We found statistically significant...

A hipertensão arterial pulmonar é uma síndrome caracterizada por vasoconstrição e remodelamento vascular pulmonar, levando a um aumento progressivo na resistência vascular pulmonar, que eleva a pós-carga imposta ao ventrículo direito, gerando consequente hipertrofia e insuficiência cardíaca direita. Essa doença acomete duas vezes mais mulheres do que homens. O estresse oxidativo está envolvido na patogênese da hipertensão arterial pulmonar. O hormônio estrogênio, comportando-se como scavenger de radicais livres, é capaz de modular o estresse oxidativo. O modelo experimental de hipertensão arterial pulmonar induzido por monocrotalina vem sendo utilizado por mimetizar as alterações que decorrem desta patologia em humanos. Dessa maneira, o objetivo desse estudo foi testar a hipótese de que o estrogênio poderia atenuar a hipertrofia do ventrículo direito e sua progressão para insuficiência cardíaca, modulando o estresse oxidativo, nos animais que receberam a monocrotalina. Ratas wistar fêmeas com 60 dias foram ovariectomizadas ou sofreram simulação da mesma. Após sete dias, receberam implantação de pellets subcutâneos com 17β-estradiol ou óleo de girassol. Neste momento, foi também administrada injeção intraperitoneal de monocrotalina ou salina. Os grupos experimentais foram: sham (S) - simulação da cirurgia de ovariectomia, não submetidas ao tratamento com MCT; sham + MCT (SM) - simulação da cirurgia de ovariectomia, e tratadas com MCT; ovariectomia (O) - cirurgia de ovariectomia, não submetidas ao tratamento com MCT; ovariectomia + MCT (OM) - cirurgia de ovariectomia, e tratadas com MCT; ovariectomia + MCT + reposição estrogênio (OMR) - cirurgia de ovariectomia, tratadas com MCT e estrogênio. As medidas hemodinâmicas foram realizadas 21 dias após a administração da monocrotalina ou salina nos animais ovariectomizados e, nos outros grupos, na fase do diestro. Foi verificada a pressão diastólica final do ventrículo direito, pressão sistólica do ventrículo direito e frequência cardíaca. Após a análise, as ratas foram mortas por deslocamento cervical e o coração, pulmão, fígado e útero foram coletados. As análises morfométricas foram realizadas após a retirada dos órgãos para avaliar hipertrofia cardíaca, congestão pulmonar e hepática. Amostras de ventrículo direito foram utilizadas para analisar a concentração de peróxido de hidrogênio, a razão da glutationa reduzida/oxidada, lipoperoxidação e defesas antioxidantes enzimáticas. O imunoconteúdo de ANP (peptídeo natriurético atrial) foi também avaliado em homogeneizado cardíaco. Os dados de pressão sistólica, hipertrofia cardíaca, defesa antioxidante enzimática, concentração de peróxido de hidrogênio e lipoperoxidação não mostraram diferença entre os grupos. Houve congestão pulmonar no grupo OM, sendo esta diminuída no grupo OMR. Isto sugere que o estrogênio esteja atenuando a resistência vascular pulmonar. Também houve aumento da pressão diastólica final do ventrículo direito nos grupos OM e OMR. A razão das glutationas se mostrou diminuída nos grupos O, OM e OMR, assim como a glutationa reduzida nos grupos O e OM, sugerindo a influência do estrogênio na modulação do estado redox celular. Os dados sugerem que o estrogênio possa exercer grande influência no equilíbrio redox celular, podendo este efeito contribuir para evitar o surgimento do edema pulmonar, característico deste modelo de hipertensão arterial pulmonar e insuficiência do ventrículo direito. / Pulmonary arterial hypertension is a syndrome characterized by vasoconstriction and pulmonary vascular remodeling, leading to a progressive increase in pulmonary vascular resistance, which increases the afterload imposed on the right ventricle, causing consequent hypertrophy and heart failure. This disease affects twice as many women as men. The oxidative stress is involved in pulmonary artery hypertension, as well as the estrogen hormone modulating the oxidative stress, behaving like scavenger of free radicals. The experimental model of pulmonary hypertension induced by monocrotaline has been used to mimic the changes from this pathology. Thus, the objective of this study was to test the hypothesis that estrogen could attenuate ventricular hypertrophy law and its progression to heart failure, modulating oxidative stress in animals received monocrotaline. Female Wistar rats aged 60 days were ovariectomized or underwent sham same, 7 days after implantation of pellets were subcutaneous 17β-estradiol or sunflower oil more intraperitoneal injection of monocrotaline or saline. The experimental groups (n = 9-13 per group) were: SHAM (S) – sham surgery, ovariectomy, no treated with MCT, MCT + SHAM - simulation of ovariectomy surgical and treated with MCT; OVARIECTOMY (O) – ovariectomy surgical, no treated with MCT, MCT + OVARIECTOMY (OM) –ovariectomy surgical, and treated with MCT; MCT + + OVARIECTOMY ESTROGEN REPLACEMENT (OMR) - surgery, ovariectomy, and treated with MCT estrogen. Hemodynamic measurements were performed 21 days after administration of saline or monocrotaline in ovariectomized animals and other groups in diestrus phase with anesthetized animals. The ventricular end diastolic pressure right ventricular systolic pressure and right heart rate was verified. After analyzing, the rats were killed by cervical dislocation and the heart, lung, liver and uterus were collected. Analyses morphometry were performed after withdrawal of agencies to evaluate cardiac hypertrophy, congestion lung and liver. The right ventricular mass was used to analyze the redox status (hydrogen peroxide and glutathione ratio) antioxidant enzymatic defenses and protein expression of ANP. The Data for systolic blood pressure, cardiac hypertrophy, antioxidant defense enzyme concentration hydrogen peroxide and lipid peroxidation showed no difference between the groups, which may be related with normal distribution. There was congestion pulmonary CO group and decreased in group OMR, suggesting that estrogen is attenuating the pulmonary vascular resistance, as well as increased end-diastolic pressure in the right ventricle OMR and OM groups. The glutathione ratio was shown decreased in groups O, CO and OMR, as well as reduced glutathione in groups O and CO, suggesting the influence of estrogen on modulation of cellular redox state. The data suggest that estrogen can exert great influence on the cellular redox balance and this effect may help to avoid the appearance of pulmonary edema, a characteristic of pulmonary hypertension and right ventricular failure.

Statistical data from clinical studies indicate that the death rate caused by heart disease has decreased due to an increased use of evidence-based medical therapies. This includes the use of magnetic resonance imaging (MRI), which is one of the most common non-invasive approaches in evidence-based health care research. In the current work, I present 3D Lagrangian strains and torsion in the left ventricle of healthy and isoproterenol-stimulated rats, which were investigated using Displacement ENcoding with Stimulated Echoes (DENSE) cardiac magnetic resonance (CMR) imaging. With the implementation of the 12-segment model, a detailed profile of regional cardiac mechanics was reconstructed for each subject. Statistical analysis revealed that isoproterenol induced a significant change in the strains and torsion in certain regions at the mid-ventricle level. In addition, I investigated right ventricular cardiac mechanics with the methodologies developed for the left ventricle. This included a comparison of different regions within the basal and mid-ventricular regions. Despite no regional variation found in the peak circumferential strain, the peak longitudinal strain exhibited regional variation at the anterior side of the RV due to the differences in biventricular torsion, mechanism of RV free wall contraction, and fiber architecture at RV insertions. Future applications of the experimental work presented here include the construction and validation of biventricular finite element models. Specifically, the strains predicted by the models will be statistically compared with experimental strains. In addition, the results of the present study provide an essential reference of RV baseline evaluated with DENSE MRI, a highly objective technique.

Background: It is well known that performance of the right ventricle (RV) determines exercise capacity and may confer prognostic information in different cardiopulmonary diseases. To allow optimal patient management, ideal methods to assess right heart function are therefore important. Echocardiography is an attractive investigation for that purpose, although limited by the anatomical and functional complexities of the RV. The aim of the present thesis was to present applicable methods useful in clinical practice by traditional 2D/Doppler echocardiography and Doppler tissue imaging (DTI) in the assessment of global and regional RV function in both health and disease. Methods: The studies were performed on 4 different groups; (1) 255 healthy subjects (125 females), (2) 92 consecutive patients with different cardiac diseases (36 females), (3) 26 patients with systemic sclerosis, (SSc) (21 females) and (4) 26 consecutive patients with heart failure (8 females) undergoing cardiac catheterisation. Results: RV outflow tract fractional shortening (RVOT fs), which is a new method in the assessment of RV function, correlated significantly with RV systolic long axis motion (r= 0.66, p&lt; 0.001), pulmonary artery acceleration time (r= 0.80, p&lt; 0.001) and RV-right atrial peak systolic pressure drop gradient (r= -0.53, p&lt; 0.001). Furthermore, RVOT fs was reduced in patients with pulmonary hypertension whereas RV systolic long axis motion was not in difference. This finding was confirmed after comparing RV function with invasive pressures. In healthy subjects, while the systolic myocardial velocities were preserved over age, the peak isovolumic contraction velocity (IVCv) was weakly increased with advanced age (r= 0.34, p&lt; 0.01). Furthermore, both global and regional E/A ratios were reduced (r= -0.57, r= -0.67, p&lt; 0.001 for both) with age whereas no alteration was found in the myocardial isovolumic relaxation time (IVRt). In patients with systemic sclerosis (SSc) both global (64± 23 vs. 39± 12 ms, p&lt; 0.001) as well as regional (83± 40 vs. 46± 24 ms, p&lt; 0.001) IVRt were prolonged. After evaluating echocardiographic parameters with invasive pressures we found a significant correlation between DTI derived IVRt and pulmonary artery systolic pressures (r= 0.83, p&lt; 0.01) while the IVCv was related to the state of contractility (r= 0.77, p&lt; 0.001). Furthermore, an IVCv below 6 cm/s was shown to be an accurate marker of increased right atrial pressure (&gt;6 mm Hg). In conclusion, RVOT fs can be used as a complementary measurement of RV systolic function, being more sensitive to elevated pulmonary artery systolic pressures than the systolic longitudinal RV motion. Right heart function, mainly the diastolic function, is relatively weakly influenced by age compared to the left heart function. In patients with SSc, we found diastolic disturbances, including a prolonged IVRt and proposed the findings to be early markers related to intermittent pulmonary hypertension. This observation was strengthened after evaluating IVRt against invasive pulmonary artery systolic pressures. IVCv can be used to determine the state of RV contractility and also be used to identify patients with elevated filling pressures. The presented methods can be used to detect early signs of RV dysfunction which might prohibit right heart failure. All presented methods are non-invasive, reproducible, easy obtainable, and thus useful in clinical practice.

Echocardiography is a well established technique when evaluating the size and function of the heart. One of the most common ways to measure the size of the right ventricle (RV) is to measure the RV outflow tract 1(RVOT1). Several ways to measure RVOT1 are described in the literature.These ways were compared with echocardiography on 27 healthy subjects.The result showed significant differences in RVOT1, depending on the way it was measured, concluding that the same site, method and body positionshould be used when comparing RVOT1 in the same subject over time.One parameter to evaluate the RV diastolic function (RVDF) is to measure the RV isovolumetric relaxation time (RV-IVRT), a sensitive marker ofRV dysfunction. There are different ways to measure this. In this thesis two ways of measuring RV-IVRT and their time intervals were compared in 20 patients examined with echocardiography. There was a significant difference between the two methods indicating that they are not measuring the same interval.Another way to assess the RVDF is to measure the maximal early diastolicvelocity (MDV) in the long-axis direction. MDV can be measured bydifferent methods, hence 29 patients were examined and MDV was measured according to two methods. There was a good correlation but a poor agreement between the two methods meaning that reference values cannot be used interchangeably.Takotsubo cardiomyopathy is characterized by apical wall motion abnormalities without coronary stenosis. The pathology of this condition remains unclear. To evaluate biventricular changes in systolic long-axisfunction and diastolic parameters in the acute phase and after recovery, 13 patients were included and examined with echocardiography at admission and after recovery. The results showed significant biventricular improvementof systolic long-axis function while most diastolic parameters remainedunchanged.

A hipertensão arterial pulmonar é uma síndrome caracterizada por vasoconstrição e remodelamento vascular pulmonar, levando a um aumento progressivo na resistência vascular pulmonar, que eleva a pós-carga imposta ao ventrículo direito, gerando consequente hipertrofia e insuficiência cardíaca direita. Essa doença acomete duas vezes mais mulheres do que homens. O estresse oxidativo está envolvido na patogênese da hipertensão arterial pulmonar. O hormônio estrogênio, comportando-se como scavenger de radicais livres, é capaz de modular o estresse oxidativo. O modelo experimental de hipertensão arterial pulmonar induzido por monocrotalina vem sendo utilizado por mimetizar as alterações que decorrem desta patologia em humanos. Dessa maneira, o objetivo desse estudo foi testar a hipótese de que o estrogênio poderia atenuar a hipertrofia do ventrículo direito e sua progressão para insuficiência cardíaca, modulando o estresse oxidativo, nos animais que receberam a monocrotalina. Ratas wistar fêmeas com 60 dias foram ovariectomizadas ou sofreram simulação da mesma. Após sete dias, receberam implantação de pellets subcutâneos com 17β-estradiol ou óleo de girassol. Neste momento, foi também administrada injeção intraperitoneal de monocrotalina ou salina. Os grupos experimentais foram: sham (S) - simulação da cirurgia de ovariectomia, não submetidas ao tratamento com MCT; sham + MCT (SM) - simulação da cirurgia de ovariectomia, e tratadas com MCT; ovariectomia (O) - cirurgia de ovariectomia, não submetidas ao tratamento com MCT; ovariectomia + MCT (OM) - cirurgia de ovariectomia, e tratadas com MCT; ovariectomia + MCT + reposição estrogênio (OMR) - cirurgia de ovariectomia, tratadas com MCT e estrogênio. As medidas hemodinâmicas foram realizadas 21 dias após a administração da monocrotalina ou salina nos animais ovariectomizados e, nos outros grupos, na fase do diestro. Foi verificada a pressão diastólica final do ventrículo direito, pressão sistólica do ventrículo direito e frequência cardíaca. Após a análise, as ratas foram mortas por deslocamento cervical e o coração, pulmão, fígado e útero foram coletados. As análises morfométricas foram realizadas após a retirada dos órgãos para avaliar hipertrofia cardíaca, congestão pulmonar e hepática. Amostras de ventrículo direito foram utilizadas para analisar a concentração de peróxido de hidrogênio, a razão da glutationa reduzida/oxidada, lipoperoxidação e defesas antioxidantes enzimáticas. O imunoconteúdo de ANP (peptídeo natriurético atrial) foi também avaliado em homogeneizado cardíaco. Os dados de pressão sistólica, hipertrofia cardíaca, defesa antioxidante enzimática, concentração de peróxido de hidrogênio e lipoperoxidação não mostraram diferença entre os grupos. Houve congestão pulmonar no grupo OM, sendo esta diminuída no grupo OMR. Isto sugere que o estrogênio esteja atenuando a resistência vascular pulmonar. Também houve aumento da pressão diastólica final do ventrículo direito nos grupos OM e OMR. A razão das glutationas se mostrou diminuída nos grupos O, OM e OMR, assim como a glutationa reduzida nos grupos O e OM, sugerindo a influência do estrogênio na modulação do estado redox celular. Os dados sugerem que o estrogênio possa exercer grande influência no equilíbrio redox celular, podendo este efeito contribuir para evitar o surgimento do edema pulmonar, característico deste modelo de hipertensão arterial pulmonar e insuficiência do ventrículo direito. / Pulmonary arterial hypertension is a syndrome characterized by vasoconstriction and pulmonary vascular remodeling, leading to a progressive increase in pulmonary vascular resistance, which increases the afterload imposed on the right ventricle, causing consequent hypertrophy and heart failure. This disease affects twice as many women as men. The oxidative stress is involved in pulmonary artery hypertension, as well as the estrogen hormone modulating the oxidative stress, behaving like scavenger of free radicals. The experimental model of pulmonary hypertension induced by monocrotaline has been used to mimic the changes from this pathology. Thus, the objective of this study was to test the hypothesis that estrogen could attenuate ventricular hypertrophy law and its progression to heart failure, modulating oxidative stress in animals received monocrotaline. Female Wistar rats aged 60 days were ovariectomized or underwent sham same, 7 days after implantation of pellets were subcutaneous 17β-estradiol or sunflower oil more intraperitoneal injection of monocrotaline or saline. The experimental groups (n = 9-13 per group) were: SHAM (S) – sham surgery, ovariectomy, no treated with MCT, MCT + SHAM - simulation of ovariectomy surgical and treated with MCT; OVARIECTOMY (O) – ovariectomy surgical, no treated with MCT, MCT + OVARIECTOMY (OM) –ovariectomy surgical, and treated with MCT; MCT + + OVARIECTOMY ESTROGEN REPLACEMENT (OMR) - surgery, ovariectomy, and treated with MCT estrogen. Hemodynamic measurements were performed 21 days after administration of saline or monocrotaline in ovariectomized animals and other groups in diestrus phase with anesthetized animals. The ventricular end diastolic pressure right ventricular systolic pressure and right heart rate was verified. After analyzing, the rats were killed by cervical dislocation and the heart, lung, liver and uterus were collected. Analyses morphometry were performed after withdrawal of agencies to evaluate cardiac hypertrophy, congestion lung and liver. The right ventricular mass was used to analyze the redox status (hydrogen peroxide and glutathione ratio) antioxidant enzymatic defenses and protein expression of ANP. The Data for systolic blood pressure, cardiac hypertrophy, antioxidant defense enzyme concentration hydrogen peroxide and lipid peroxidation showed no difference between the groups, which may be related with normal distribution. There was congestion pulmonary CO group and decreased in group OMR, suggesting that estrogen is attenuating the pulmonary vascular resistance, as well as increased end-diastolic pressure in the right ventricle OMR and OM groups. The glutathione ratio was shown decreased in groups O, CO and OMR, as well as reduced glutathione in groups O and CO, suggesting the influence of estrogen on modulation of cellular redox state. The data suggest that estrogen can exert great influence on the cellular redox balance and this effect may help to avoid the appearance of pulmonary edema, a characteristic of pulmonary hypertension and right ventricular failure.

A hipertensão arterial pulmonar é uma síndrome caracterizada por vasoconstrição e remodelamento vascular pulmonar, levando a um aumento progressivo na resistência vascular pulmonar, que eleva a pós-carga imposta ao ventrículo direito, gerando consequente hipertrofia e insuficiência cardíaca direita. Essa doença acomete duas vezes mais mulheres do que homens. O estresse oxidativo está envolvido na patogênese da hipertensão arterial pulmonar. O hormônio estrogênio, comportando-se como scavenger de radicais livres, é capaz de modular o estresse oxidativo. O modelo experimental de hipertensão arterial pulmonar induzido por monocrotalina vem sendo utilizado por mimetizar as alterações que decorrem desta patologia em humanos. Dessa maneira, o objetivo desse estudo foi testar a hipótese de que o estrogênio poderia atenuar a hipertrofia do ventrículo direito e sua progressão para insuficiência cardíaca, modulando o estresse oxidativo, nos animais que receberam a monocrotalina. Ratas wistar fêmeas com 60 dias foram ovariectomizadas ou sofreram simulação da mesma. Após sete dias, receberam implantação de pellets subcutâneos com 17β-estradiol ou óleo de girassol. Neste momento, foi também administrada injeção intraperitoneal de monocrotalina ou salina. Os grupos experimentais foram: sham (S) - simulação da cirurgia de ovariectomia, não submetidas ao tratamento com MCT; sham + MCT (SM) - simulação da cirurgia de ovariectomia, e tratadas com MCT; ovariectomia (O) - cirurgia de ovariectomia, não submetidas ao tratamento com MCT; ovariectomia + MCT (OM) - cirurgia de ovariectomia, e tratadas com MCT; ovariectomia + MCT + reposição estrogênio (OMR) - cirurgia de ovariectomia, tratadas com MCT e estrogênio. As medidas hemodinâmicas foram realizadas 21 dias após a administração da monocrotalina ou salina nos animais ovariectomizados e, nos outros grupos, na fase do diestro. Foi verificada a pressão diastólica final do ventrículo direito, pressão sistólica do ventrículo direito e frequência cardíaca. Após a análise, as ratas foram mortas por deslocamento cervical e o coração, pulmão, fígado e útero foram coletados. As análises morfométricas foram realizadas após a retirada dos órgãos para avaliar hipertrofia cardíaca, congestão pulmonar e hepática. Amostras de ventrículo direito foram utilizadas para analisar a concentração de peróxido de hidrogênio, a razão da glutationa reduzida/oxidada, lipoperoxidação e defesas antioxidantes enzimáticas. O imunoconteúdo de ANP (peptídeo natriurético atrial) foi também avaliado em homogeneizado cardíaco. Os dados de pressão sistólica, hipertrofia cardíaca, defesa antioxidante enzimática, concentração de peróxido de hidrogênio e lipoperoxidação não mostraram diferença entre os grupos. Houve congestão pulmonar no grupo OM, sendo esta diminuída no grupo OMR. Isto sugere que o estrogênio esteja atenuando a resistência vascular pulmonar. Também houve aumento da pressão diastólica final do ventrículo direito nos grupos OM e OMR. A razão das glutationas se mostrou diminuída nos grupos O, OM e OMR, assim como a glutationa reduzida nos grupos O e OM, sugerindo a influência do estrogênio na modulação do estado redox celular. Os dados sugerem que o estrogênio possa exercer grande influência no equilíbrio redox celular, podendo este efeito contribuir para evitar o surgimento do edema pulmonar, característico deste modelo de hipertensão arterial pulmonar e insuficiência do ventrículo direito. / Pulmonary arterial hypertension is a syndrome characterized by vasoconstriction and pulmonary vascular remodeling, leading to a progressive increase in pulmonary vascular resistance, which increases the afterload imposed on the right ventricle, causing consequent hypertrophy and heart failure. This disease affects twice as many women as men. The oxidative stress is involved in pulmonary artery hypertension, as well as the estrogen hormone modulating the oxidative stress, behaving like scavenger of free radicals. The experimental model of pulmonary hypertension induced by monocrotaline has been used to mimic the changes from this pathology. Thus, the objective of this study was to test the hypothesis that estrogen could attenuate ventricular hypertrophy law and its progression to heart failure, modulating oxidative stress in animals received monocrotaline. Female Wistar rats aged 60 days were ovariectomized or underwent sham same, 7 days after implantation of pellets were subcutaneous 17β-estradiol or sunflower oil more intraperitoneal injection of monocrotaline or saline. The experimental groups (n = 9-13 per group) were: SHAM (S) – sham surgery, ovariectomy, no treated with MCT, MCT + SHAM - simulation of ovariectomy surgical and treated with MCT; OVARIECTOMY (O) – ovariectomy surgical, no treated with MCT, MCT + OVARIECTOMY (OM) –ovariectomy surgical, and treated with MCT; MCT + + OVARIECTOMY ESTROGEN REPLACEMENT (OMR) - surgery, ovariectomy, and treated with MCT estrogen. Hemodynamic measurements were performed 21 days after administration of saline or monocrotaline in ovariectomized animals and other groups in diestrus phase with anesthetized animals. The ventricular end diastolic pressure right ventricular systolic pressure and right heart rate was verified. After analyzing, the rats were killed by cervical dislocation and the heart, lung, liver and uterus were collected. Analyses morphometry were performed after withdrawal of agencies to evaluate cardiac hypertrophy, congestion lung and liver. The right ventricular mass was used to analyze the redox status (hydrogen peroxide and glutathione ratio) antioxidant enzymatic defenses and protein expression of ANP. The Data for systolic blood pressure, cardiac hypertrophy, antioxidant defense enzyme concentration hydrogen peroxide and lipid peroxidation showed no difference between the groups, which may be related with normal distribution. There was congestion pulmonary CO group and decreased in group OMR, suggesting that estrogen is attenuating the pulmonary vascular resistance, as well as increased end-diastolic pressure in the right ventricle OMR and OM groups. The glutathione ratio was shown decreased in groups O, CO and OMR, as well as reduced glutathione in groups O and CO, suggesting the influence of estrogen on modulation of cellular redox state. The data suggest that estrogen can exert great influence on the cellular redox balance and this effect may help to avoid the appearance of pulmonary edema, a characteristic of pulmonary hypertension and right ventricular failure.

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.

Chapitre 1. Introduction<p><p>\ / Doctorat en sciences médicales / info:eu-repo/semantics/nonPublished