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Left ventricular function in chronic anemia: Evidence of noncatecholamine positive inotropic factor in the serum

The enhanced left ventricular (LV) performance observed in anemia has been attributed to changes in preload and afterload. Whether there is a concomitant increase in contractility is controversial. Seventeen patients with chronic anemia (hematocrit range 17 to 30%) and 17 control subjects, matched by age and sex, were studied. In 10 patients and 10 control subjects (group I), a noninvasive evaluation of LV function through M-mode echocardiography and cuff blood pressure recording was performed. In patients with anemia, stroke volume increased 43% (p less than 0.01), fractional shortening 21% (p less than 0.001), and mean rate of circumferential shortening 32% (p less than 0.001). In patients with anemia, end-systolic stress decrease 27% (p less than 0.05) and diastolic blood pressure 21% (p less than 0.001). The effect of serum from these patients and control subjects on the development of isometric tension by isolated cat papillary muscles was assessed compared with the basal (Ringer-Locke bath) values. Anemia serum increased maximal developed tension 21% and maximal rate of tension development 20% relative to basal levels. These changes were significantly higher (p less than 0.001) than the increases produced by control serum (8% and 7%, respectively). In the 7 patients with anemia in group II and their matched controls, the in vitro isometric tension characteristics were assessed before and after blocking beta adrenoreceptors with propranolol, 10(-6) M. The observed increase in the developed tension persisted after beta blockade, as well as the enhancement of the maximal rate of tension development. Plasma catecholamine levels in this group II were within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomyopathies produced by toxoplasma gondii

Abstract Eleven cases of cardiomyopathy are presented in which the toxoplasmic infection was ascertained by serologic study. The parasite was recovered from the heart in one of them. All other common etiologies were ruled out by clinical and laboratory procedures. Results showed 2 different groups of patients: one without and one with cardiac failure. One patient of the first group died as a consequence of pulmonary embolism, and in another, cardiac involvement was part of a generalized acute toxoplasmosis. Two patients of the second group died in refractory insufficiency. Treatment results were generally good. This study suggests that failure might be due to a late complication of the toxoplasmic infection of the heart and that it is most important that proper diagnosis be made as early as possible.

Clinical perspective: Have the results of recent clinical trials of lipid-lowering therapies influenced the way we should practice? A Latin American perspective of current issues in clinical lipidology

Traditional tools to evaluate cardiovascular disease risk may underestimate the risk of cardiovascular events. Although reduction of low-density lipoprotein cholesterol (LDL-C) is the mainstay of therapy to mitigate cardiovascular risk from atherosclerosis, noninvasive imaging techniques and biomarkers are now allowing us to identify subclinical atherosclerosis, or high-risk patients, and are providing clinical researchers with new target end points for randomized controlled clinical trials. Current surrogates include carotid intima-media thickness, coronary artery calcification, and high-sensitivity C-reactive protein levels. There is evidence that these biomarkers are useful in clinical practice to improve risk quantification in subjects considered at intermediate risk of coronary events according to clinical risk stratification. Some studies, but not all, have demonstrated achievement of surrogate end points with lipid-lowering therapy in addition to LDL-C reductions. A group of clinical lipidologists from Latin American countries convened to give a perspective on recent clinical trials in clinical lipidology, their designs, and data regarding currently used biomarkers. It was noted that the success of some surrogate end points as possible markers of clinical efficacy has relied heavily on patient selection and trial design. On the basis of current evidence, we believe that correcting elevated LDL-C levels should remain the primary target of therapy for patients with dyslipidemia. The group also agreed that the evidence from recent clinical trials supports the potential role of new biomarkers for the screening and identification of patients at high cardiovascular risk in the absence of overt hyperlipidemia.

Adherencia farmacológica y prevención secundaria cardiovascular: una de las principales barreras en el tratamiento de la enfermedad ateroesclerótica. Posición del Departamento de Prevención Cardiovascular de SOCHICAR en el uso de la polipíldora en prevención secundaria

Revista Chilena de Cardiología Vol. 35 Número 3, Diciembre 2016 Correspondencia: Dra. Mónica Acevedo Cardióloga Departamento de Prevención Cardiovascular, Sociedad Chilena de Cardiología y Prevención Cardiovascular macevedo@med.puc.cl Adherencia farmacológica y prevención secundaria cardiovascular: una de las principales barreras en el tratamiento de la enfermedad ateroesclerótica. Posición del Departamento de Prevención Cardiovascular de SOCHICAR en el uso de la polipíldora en prevención secundaria