Camillo de Lellis Carneiro Junqueira

Avaliação do grau de inflamação vascular em pacientes com síndrome metabólica

FUNDAMENTO: A sindrome metabolica e definida com um conjunto de fatores de risco cardiovasculares relacionados a obesidade visceral e resistencia insulinica, que levam a um aumento da mortalidade geral, especialmente cardiovascular. Os marcadores inflamatorios sao considerados fatores de risco emergentes e podem ser potencialmente utilizados na estratificacao clinica das doencas cardiovasculares estabelecendo valores prognosticos. OBJETIVO: Esta pesquisa tem por objetivo avaliar quais componentes da sindrome metabolica apresentam aumento de IL-6 e PCR-AS, identificando o marcador que melhor expressa o grau de inflamacao, e qual componente isoladamente apresenta maior interferencia nos marcadores inflamatorios estudados, a fim de identificar outros fatores de risco importantes na determinacao da inflamacao arterial. METODOLOGIA: Foram selecionados 87 pacientes, entre 26 e 85 anos, hipertensos, diabeticos e dislipidemicos que obedecessem aos criterios necessarios ao diagnostico de certeza da sindrome metabolica. Os pacientes foram avaliados atraves da MAPA de 24h e submetidos a dosagens de PCR-AS e IL-6, entre outras variaveis metabolicas. RESULTADOS: Os pacientes que apresentaram PCR > 0,3mg/dl mostraram correlacao significativa (p 102/88 cm em 83,7%; glicemia > 110mg/dl em 88%; e IMC > 30kg/m2 em 60,5% dos individuos estudados. CONCLUSAO: Concluiu-se que a PCR foi o marcador inflamatorio de maior expressao em relacao as variaveis estudadas, sendo tabagismo, albuminuria, historia de cardiopatia pessoal previa, IMC, perimetro abdominal e hiperglicemia as de maior relevância estatistica. A interleucina-6 nao mostrou correlacao com nenhuma variavel estudada.BACKGROUND Metabolic Syndrome (MS) is defined as a set of cardiovascular risk factors related to visceral obesity and insulin resistance that lead to an increase in general mortality, especially cardiovascular. The inflammatory markers are considered emergent risk factors and can be potentially used in the clinical stratification of cardiovascular diseases, establishing prognostic values. OBJECTIVE This study aims at evaluating which components of the MS present an increase of IL-6 and hs-CRP, identifying the marker that better expresses the degree of inflammation and which isolate component presents a higher degree of interference on the studied inflammatory markers, in order to identify other important risk factors when determining arterial inflammation. METHODS A total of 87 hypertensive, diabetic and dyslipidemic patients were selected, aged 26 to 85 years, who met the necessary criteria for the positive diagnosis of MS. The patients were assessed through 24-hour ambulatory blood pressure monitoring (ABPM) and underwent hs-CRP and IL-6 measurements, among other metabolic variables. RESULTS The patients that presented CRP > 0.3mg/dl showed a significant correlation (p<0.05) with abdominal perimeter >102/88 cm in 83.7%, glycemia > 110mg/dl in 88% and BMI > 30kg/m(2) in 60.5% of the studied individuals. CONCLUSION We concluded that the CRP was the inflammatory marker with the highest expression regarding the studied variables, with smoking, albuminuria, previous personal history of cardiopathy, BMI, abdominal perimeter and hyperglycemia being the ones with the highest statistical significance. Interleukin-6 did not present a correlation with any of the studied variables.

Evaluation of the degree of vascular inflammation in patients with metabolic syndrome

FUNDAMENTO: A sindrome metabolica e definida com um conjunto de fatores de risco cardiovasculares relacionados a obesidade visceral e resistencia insulinica, que levam a um aumento da mortalidade geral, especialmente cardiovascular. Os marcadores inflamatorios sao considerados fatores de risco emergentes e podem ser potencialmente utilizados na estratificacao clinica das doencas cardiovasculares estabelecendo valores prognosticos. OBJETIVO: Esta pesquisa tem por objetivo avaliar quais componentes da sindrome metabolica apresentam aumento de IL-6 e PCR-AS, identificando o marcador que melhor expressa o grau de inflamacao, e qual componente isoladamente apresenta maior interferencia nos marcadores inflamatorios estudados, a fim de identificar outros fatores de risco importantes na determinacao da inflamacao arterial. METODOLOGIA: Foram selecionados 87 pacientes, entre 26 e 85 anos, hipertensos, diabeticos e dislipidemicos que obedecessem aos criterios necessarios ao diagnostico de certeza da sindrome metabolica. Os pacientes foram avaliados atraves da MAPA de 24h e submetidos a dosagens de PCR-AS e IL-6, entre outras variaveis metabolicas. RESULTADOS: Os pacientes que apresentaram PCR > 0,3mg/dl mostraram correlacao significativa (p 102/88 cm em 83,7%; glicemia > 110mg/dl em 88%; e IMC > 30kg/m2 em 60,5% dos individuos estudados. CONCLUSAO: Concluiu-se que a PCR foi o marcador inflamatorio de maior expressao em relacao as variaveis estudadas, sendo tabagismo, albuminuria, historia de cardiopatia pessoal previa, IMC, perimetro abdominal e hiperglicemia as de maior relevância estatistica. A interleucina-6 nao mostrou correlacao com nenhuma variavel estudada.BACKGROUND Metabolic Syndrome (MS) is defined as a set of cardiovascular risk factors related to visceral obesity and insulin resistance that lead to an increase in general mortality, especially cardiovascular. The inflammatory markers are considered emergent risk factors and can be potentially used in the clinical stratification of cardiovascular diseases, establishing prognostic values. OBJECTIVE This study aims at evaluating which components of the MS present an increase of IL-6 and hs-CRP, identifying the marker that better expresses the degree of inflammation and which isolate component presents a higher degree of interference on the studied inflammatory markers, in order to identify other important risk factors when determining arterial inflammation. METHODS A total of 87 hypertensive, diabetic and dyslipidemic patients were selected, aged 26 to 85 years, who met the necessary criteria for the positive diagnosis of MS. The patients were assessed through 24-hour ambulatory blood pressure monitoring (ABPM) and underwent hs-CRP and IL-6 measurements, among other metabolic variables. RESULTS The patients that presented CRP > 0.3mg/dl showed a significant correlation (p<0.05) with abdominal perimeter >102/88 cm in 83.7%, glycemia > 110mg/dl in 88% and BMI > 30kg/m(2) in 60.5% of the studied individuals. CONCLUSION We concluded that the CRP was the inflammatory marker with the highest expression regarding the studied variables, with smoking, albuminuria, previous personal history of cardiopathy, BMI, abdominal perimeter and hyperglycemia being the ones with the highest statistical significance. Interleukin-6 did not present a correlation with any of the studied variables.

Uso do escore de propensão na análise de custo-efetividade com utilização seletiva de stents farmacológicos e não-farmacológicos

BACKGROUND: Studies on the cost-effectiveness ratio of drug-eluting stents (DES) are rare. Our objective was to evaluate the results and compare costs (incremental cost-effectiveness ratio - ICER) per restenosis avoided between DES and bare metal stents (BMS) using the propensity score. METHODS: Two hundred and twenty consecutive patients were included in the study, of which 111 were treated with DES and 109 with BMS. The propensity score was used to adjust the effect of the intervention, by means of matching, stratification and weighing. RESULTS: Most patients were male (67.7% vs. 66.9%; P = 0.53), with a mean age of 65.9 years. Patients treated with the DES had a higher rate of diabetes (54% vs. 17.4%; P 72 years, diabetes and lesions with diameter 18 mm. CONCLUSIONS: Although DES were not cost-effective in the overall population, the propensity score showed that in elderly patients, diabetics and patients with long lesions or small vessels, the use of DES was cost-effective.

Evaluation of endothelial function by VOP and inflammatory biomarkers in patients with arterial hypertension

Hypertension is associated with microcirculatory impairment. Our objectives were to evaluate endothelial function and inflammatory biomarkers in patients with resistant (RH) and mild to moderate (MMH) arterial hypertension in comparison to normotensives (control group—CG). Three groups, 25 patients each, have been investigated, by anamnesis, venous occlusion plethysmography (VOP) and serum determination of adhesion molecules (VCAM, ICAM), adiponectin, endothelin and C-reactive protein (CRP). Patients not using statins and with or without blood pressure control were also analyzed. RH group showed smaller percentage increase of maximum forearm blood flow (FBF) (endothelial-dependent vasodilatation) than controls (p < 0.05), but no significant difference could be detected between MMH and CG groups on maximum FBF and minimum vascular resistance post-ischemia. RH and MMH groups showed higher resistance averages compared to controls (p < 0.05). Uncontrolled BP in hypertensive patients showed worse results for blood flow and resistance. Endothelial-independent vasodilatation was not affected. Endothelin levels were higher in RH and MMH groups (p < 0.05) not using statins. CRP was significantly higher only in RH compared to CG (p < 0.05). In conclusion patients with severe hypertension and lack of blood pressure control showed greater impairment of endothelial function with higher CRP and endothelin levels.

Microcirculation and biomarkers in patients with resistant or mild-to-moderate hypertension: a cross-sectional study

Microcirculation influences peripheral vascular resistance and therefore contributes to arterial blood pressure. The aim of this study was to investigate the correlation between serum markers of inflammation and microcirculatory parameters observed by nailfold videocapillaroscopy (NVC) in patients with resistant (RH, 58 [50–63] years, n = 25) or mild-to-moderate hypertension (MMH, 56 [47–64] years, n = 25) compared to normotensive patients (control group (CG), 33 [27–52] years, n = 25). C-reactive protein (CRP), endothelin, adiponectin, I-CAM and V-CAM levels were obtained by laboratory analysis. Functional capillary density (FCD; the number of capillaries with flowing red blood cells by unit tissue area), capillary diameters, maximum red blood cell velocity (RBCVmax) during the reactive hyperemia response/RBCVbaseline after 1 min of arterial occlusion at the finger base and time to reach RBCVmax were determined by NVC. A sub-analysis was also conducted on hypertensive patients not taking statins, with controlled/uncontrolled blood pressure. The RH group showed lower RBCV and RBCVmax values and longer TRBCVmax compared to MMH and CG patients, with worse values in those with uncontrolled blood pressure. FCD and diameters showed no significant differences among the three groups, with higher CRP values in the RH and MMH groups. An increase in endothelin was observed only in patients not taking statins in both hypertensive groups. Patients with severe hypertension and uncontrolled blood pressure levels presented more pronounced microvascular dysfunction, as well as higher serum values for CRP and endothelin (without statin treatment), suggesting that the use of statins decreases endothelin release.

Bioresorbable Device Implantation in Left Main in Patients with Limitation For Long-Term Using of Dual Antiplatelet Therapy

Male patient with unstable angina and critical calcified lesion in the left main coronary artery (LMCA). Background: coronary artery bypass grafting and anemia. The intention to treat was angioplasty with drugeluting stents (DES) in the LMCA. The patient presented gastrointestinal bleeding and worsening of anemia, which were treated. Angina was refractory to medical therapy. Because of antiplatelet therapy limitation, bioresorbable vascular support (BVS) was implanted in the LMCA. This case report discusses the use of BVS in complex lesion, enabling absorption of the device and better management of antiplatelet therapy and future follow-up of the obstruction treated using by non-invasive imaging methods.

Dissecção aguda de aorta ascendente e de tronco de coronária esquerda durante implante eletivo de stents coronários

Paciente com angina pos-infarto, associada a lesoes graves, em arterias circunflexa e marginal esquerda. Foi submetida a angioplastia com implante de stents, mas apresentou grave disseccao do tronco de coronaria esquerda (TCE), que se estendeu para o segmento ascendente da aorta, evoluindo com hipotensao, parada cardiorrespiratoria e posterior instabilidade hemodinâmica. Houve resolucao imediata do quadro clinico com implante de stent no TCE.

Evaluación del grado de inflamación vascular pacientes con síndrome metabólico

FUNDAMENTO: A sindrome metabolica e definida com um conjunto de fatores de risco cardiovasculares relacionados a obesidade visceral e resistencia insulinica, que levam a um aumento da mortalidade geral, especialmente cardiovascular. Os marcadores inflamatorios sao considerados fatores de risco emergentes e podem ser potencialmente utilizados na estratificacao clinica das doencas cardiovasculares estabelecendo valores prognosticos. OBJETIVO: Esta pesquisa tem por objetivo avaliar quais componentes da sindrome metabolica apresentam aumento de IL-6 e PCR-AS, identificando o marcador que melhor expressa o grau de inflamacao, e qual componente isoladamente apresenta maior interferencia nos marcadores inflamatorios estudados, a fim de identificar outros fatores de risco importantes na determinacao da inflamacao arterial. METODOLOGIA: Foram selecionados 87 pacientes, entre 26 e 85 anos, hipertensos, diabeticos e dislipidemicos que obedecessem aos criterios necessarios ao diagnostico de certeza da sindrome metabolica. Os pacientes foram avaliados atraves da MAPA de 24h e submetidos a dosagens de PCR-AS e IL-6, entre outras variaveis metabolicas. RESULTADOS: Os pacientes que apresentaram PCR > 0,3mg/dl mostraram correlacao significativa (p 102/88 cm em 83,7%; glicemia > 110mg/dl em 88%; e IMC > 30kg/m2 em 60,5% dos individuos estudados. CONCLUSAO: Concluiu-se que a PCR foi o marcador inflamatorio de maior expressao em relacao as variaveis estudadas, sendo tabagismo, albuminuria, historia de cardiopatia pessoal previa, IMC, perimetro abdominal e hiperglicemia as de maior relevância estatistica. A interleucina-6 nao mostrou correlacao com nenhuma variavel estudada.BACKGROUND Metabolic Syndrome (MS) is defined as a set of cardiovascular risk factors related to visceral obesity and insulin resistance that lead to an increase in general mortality, especially cardiovascular. The inflammatory markers are considered emergent risk factors and can be potentially used in the clinical stratification of cardiovascular diseases, establishing prognostic values. OBJECTIVE This study aims at evaluating which components of the MS present an increase of IL-6 and hs-CRP, identifying the marker that better expresses the degree of inflammation and which isolate component presents a higher degree of interference on the studied inflammatory markers, in order to identify other important risk factors when determining arterial inflammation. METHODS A total of 87 hypertensive, diabetic and dyslipidemic patients were selected, aged 26 to 85 years, who met the necessary criteria for the positive diagnosis of MS. The patients were assessed through 24-hour ambulatory blood pressure monitoring (ABPM) and underwent hs-CRP and IL-6 measurements, among other metabolic variables. RESULTS The patients that presented CRP > 0.3mg/dl showed a significant correlation (p<0.05) with abdominal perimeter >102/88 cm in 83.7%, glycemia > 110mg/dl in 88% and BMI > 30kg/m(2) in 60.5% of the studied individuals. CONCLUSION We concluded that the CRP was the inflammatory marker with the highest expression regarding the studied variables, with smoking, albuminuria, previous personal history of cardiopathy, BMI, abdominal perimeter and hyperglycemia being the ones with the highest statistical significance. Interleukin-6 did not present a correlation with any of the studied variables.