Luiz Carlos Bodanese

Associations among Metabolic Syndrome, Ischemia, Inflammatory, Oxidatives, and Lipids Biomarkers

CONTEXT Metabolic syndrome (MS) is described as a cluster of cardiometabolic risk factors. Studies suggest that ischemia-modified albumin (IMA) is a biomarker of cardiovascular diseases. IMA levels could be associated with cardiometabolic risks and represent a possible indication of microvascular dysfunction in MS patients. OBJECTIVE To confirm this possible association, we evaluated the association between IMA levels and MS. DESIGN We performed a case-control study (32 healthy individuals and 74 subjects with MS) to evaluate the association between MS, IMA, and other biomarkers [high-sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoprotein (OxLDL), oxidized low-density lipoprotein autoantibodies (anti-OxLDL), IL-6, lipid profile, and glucose]. RESULTS The MS group showed higher levels of IMA (0.618 +/- 0.1355) as well as higher levels of hs-CRP, OxLDL, anti-OxLDL, and IL-6 than did control subjects (IMA = 0.338 +/- 0.0486) (P < 0.01). Multivariate analysis showed that IMA and MS association was independent of sex, age, diabetes mellitus 2, and hypercholesterolemia. CONCLUSION We found an association between IMA and MS. Additional studies including prospective genetic variation approaches need to be performed to help elucidate this association between IMA and MS and its potential clinical role.

Risk score elaboration for mediastinitis after coronary artery bypass grafting

INTRODUCTION The mediastinitis is a serious postoperative complication of cardiac surgery, with an incidence of 0.4 to 5% and mortality between 14 and 47%. Several models were proposed to assess risk of mediastinitis after cardiac surgery. However, most of these models do not evaluate the postoperative morbidity. OBJECTIVE This study aims to develop a score risk model to predict the risk of mediastinitis for patients undergoing coronary artery bypass grafting. METHODS The study sample included data from 2,809 adult patients undergoing coronary artery bypass grafting between January 1996 and December 2007 at Hospital São Lucas -PUCRS. Logistic regression was used to examine the relationship between risk factors and the development of mediastinitis. Data from 1,889 patients were used to develop the model and its performance was evaluated in the remaining data (n=920). The definitive model was created with the data analysis of 2,809 patients. RESULTS The rate of mediastinitis was 3.3%, with mortality of 26.6%. In the multivariate analysis, five variables remained independent predictors of the outcome: chronic obstructive pulmonary disease, obesity, surgical reintervention, blood transfusion and stable angina class IV or unstable. The area under the ROC curve was 0.72 (95% CI, 0.67-0.78) and P = 0.61. CONCLUSION The risk score was constructed for use in daily practice to calculate the rate of mediastinitis after coronary artery bypass grafting. The score includes routinely collected variables and is simple to use.

Xanthine Oxidase Activity Is Associated with Risk Factors for Cardiovascular Disease and Inflammatory and Oxidative Status Markers in Metabolic Syndrome: Effects of a Single Exercise Session

Objective. The main goal of the present study was to investigate the xanthine oxidase (XO) activity in metabolic syndrome in subjects submitted to a single exercise session. We also investigated parameters of oxidative and inflammatory status. Materials/Methods. A case-control study (9 healthy and 8 MS volunteers) was performed to measure XO, superoxide dismutase (SOD), glutathione peroxidase activities, lipid peroxidation, high-sensitivity C-reactive protein (hsCRP) content, glucose levels, and lipid profile. Body mass indices, abdominal circumference, systolic and diastolic blood pressure, and TG levels were also determined. The exercise session consisted of 3 minutes of stretching, 3 minutes of warm-up, 30 minutes at a constant dynamic workload at a moderate intensity, and 3 minutes at a low speed. The blood samples were collected before and 15 minutes after the exercise session. Results. Serum XO activity was higher in MS group compared to control group. SOD activity was lower in MS subjects. XO activity was correlated with SOD, abdominal circumference, body mass indices, and hsCRP. The single exercise session reduced the SOD activity in the control group. Conclusions. Our data support the association between oxidative stress and risk factors for cardiovascular diseases and suggest XO is present in the pathogenesis of metabolic syndrome.

Predictors of mediastinitis after cardiac surgery

OBJECTIVE: Mediastinitis is a serious complication of open-heart surgery, with an incidence that varies from 0.4% to 5%, mortality from 10% to 47% and a high morbidity rate. OBJECTIVE: To identify preoperative and trans-operative risk factors of mediastinitis after open-heart surgery in our hospital. METHOD: This was a prospective study of 1298 patients submitted to the open-heart surgery in Sao Lucas hospital in the period from March 1997 to May 2000. Nine potential risk factors associated with mediastinitis were studied (obesity, diabetes mellitus, chronic obstructive pulmonary disease -COPD-, internal mammary artery, cardiopulmonary bypass time, smoking, gender, ejection fraction and previous heart surgery) using univariate analysis, where necessary followed by multivariate logistic regression. RESULTS: Of the 1298 studied patients, 62.6% were men and 18.3 suffered from diabetes. Thirty-eight patients (2.9%) presented with mediastinitis postoperatively, and six (15.8%) of these died. Four variables identified as risk factors by univariate analysis (p<0.05) and were after analysed by logistic regression. Three variables were identified as independent predictors of mediastinitis: obesity (p=0.008), COPD (p=0.007) and diabetes mellitus (p= 0.009), even when gender and age were analysed. The internal mammary artery graft was observed as risk predictor only when associated to the obesity. CONCLUSION: In our hospital, mediastinitis occurs most frequently in patients suffering from obesity, diabetes, and/or COPD and in the obese patients in which internal mammary artery was used.OBJECTIVE: Mediastinitis is a serious complication of open-heart surgery, with an incidence that varies from 0.4% to 5%, mortality from 10% to 47% and a high morbidity rate. OBJECTIVE: To identify preoperative and trans-operative risk factors of mediastinitis after open-heart surgery in our hospital. METHOD: This was a prospective study of 1298 patients submitted to the open-heart surgery in Sao Lucas hospital in the period from March 1997 to May 2000. Nine potential risk factors associated with mediastinitis were studied (obesity, diabetes mellitus, chronic obstructive pulmonary disease -COPD-, internal mammary artery, cardiopulmonary bypass time, smoking, gender, ejection fraction and previous heart surgery) using univariate analysis, where necessary followed by multivariate logistic regression. RESULTS: Of the 1298 studied patients, 62.6% were men and 18.3 suffered from diabetes. Thirty-eight patients (2.9%) presented with mediastinitis postoperatively, and six (15.8%) of these died. Four variables identified as risk factors by univariate analysis (p<0.05) and were after analysed by logistic regression. Three variables were identified as independent predictors of mediastinitis: obesity (p=0.008), COPD (p=0.007) and diabetes mellitus (p= 0.009), even when gender and age were analysed. The internal mammary artery graft was observed as risk predictor only when associated to the obesity. CONCLUSION: In our hospital, mediastinitis occurs most frequently in patients suffering from obesity, diabetes, and/or COPD and in the obese patients in which internal mammary artery was used.

Association between interleukin-1 beta polymorphism (+3953) and obesity.

It now appears that obesity is associated with a low-grade inflammation of white adipose tissue resulting from chronic activation of the innate immune system as interleukin-1 beta (IL-1). Previous investigations have described a positive association between IL-1 beta +3953 (C>T) gene polymorphism (rs 1143634) and obesity, suggesting functional effects on fat mass, fat metabolism and body mass. However, it is necessary to determine if these results occur in other populations and if they are influenced by sex and age. Therefore, we performed a case-control study using 880 Caucasian subjects (59.7+/-11.9 years old) from the Brazilian Aging Research Program (non-overweight=283, overweight=334, obese=263) previously investigated in genetic studies, in whom we analyzed the IL-1 beta +3953C/T polymorphism. We observed higher T allele (CT/TT) frequency in non-overweight than overweight and obese groups. The odds ratio showed 1.340 (95% CI: 1.119-1.605) times more chance of the obese group being CC carriers compared to non-overweight group independent of sex and age. This study corroborates the idea that the IL-1 system is linked to the development of obesity.

Multicentre, randomized, double-blind trial of intracoronary autologous mononuclear bone marrow cell injection in non-ischaemic dilated cardiomyopathy (the dilated cardiomyopathy arm of the MiHeart study).

AIMS Pre-clinical and few clinical studies suggest that transplantation of autologous bone marrow mononuclear cells (BMNC) improves heart function in dilated cardiomyopathies. Our objective was to determine if intracoronary injection of autologous BMNC improves the left ventricular ejection fraction (LVEF) of patients with non-ischaemic dilated cardiomyopathy (NIDCM). METHODS AND RESULTS This study was a multicentre, randomized, double-blind, placebo controlled trial with a follow-up of 12 months. Patients with NIDCM and LVEF <35% were recruited at heart failure ambulatories in specialized hospitals around Brazil. One hundred and sixty subjects were randomized to intracoronary injection of BMNC or placebo (1:1). The primary endpoint was the difference in change of LVEF between BMNC and placebo groups as determined by echocardiography. One hundred and fifteen patients completed the study. Left ventricular ejection fraction decreased from 24.0% (21.6-26.3) to 19.9% (15.4-24.4) in the BMNC group and from 24.3% (22.1-26.5) to 22.1% (17.4-26.8) in the placebo group. There were no significant differences in changes between cell and placebo groups for left ventricular systolic and diastolic volumes and ejection fraction. Mortality rate was 20.37% in placebo and 21.31% in BMNC. CONCLUSION Intracoronary injection of autologous BMNC does not improve left ventricular function in patients with NIDCM. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00333827.

Association between periodontal disease and acute coronary syndrome.

OBJECTIVE To evaluate the relationship between PD and ACS and the association of PD and periodontitis in ACS patients. METHODS Fifty-eight ACS patients and 57 controls with no history of coronary artery disease (CAD) were included in the study. VARIABLES arterial hypertension, diabetes, dyslipidemia, obesity, history of CAD, cigarette smoking, and interleukin-1beta gene polymorphism. RESULTS One hundred and fifteen subjects were enrolled in the study. In the ACS group, 58 patients were evaluated, 32 of whom (55.2%) were male and 26 (44.8%), female. In the control group, 57 subjects were evaluated, 32 (56.1%) of whom were male and 25 (43.9%), female. Periodontal disease was diagnosed in 26 (44.8%) ACS patients and 15 (26.6%) control patients (beta2 = 4.43, p = 0.04). In a logistic regression analysis, the odds ratio for association between PD and ACS was 1.8 (95% CI: 1.0-5.0); p = 0.24. The odds ratio for association of periodontitis with ACS was 4.5 (95% CI: 1.3-15.6); p = 0.019. CONCLUSION No independent association was found between PD and ACS. There was an independent association between periodontitis and ACS.

Association between 894G>T endothelial nitric oxide synthase gene polymorphisms and metabolic syndrome

Metabolic syndrome (MS) is a cluster of cardiovascular risk factors such as hypertension, dyslipidemia, obesity and type II diabetes. Here, we performed a case-control study analyzing the association between 894G>T endothelial nitric oxide synthase gene polymorphism (NOS3) and MS in 616 subjects. Genotype frequencies were TT= 9.3%, GG= 37.2 and TG= 53.6% and the allelic frequencies were T=0.36 and G= 0.64. We observed a higher TT genotype frequency in the male MS group than control subjects (p=0.02), independent of other variables. We found an association between hypertension and TT genotype in females. Our data suggests that 894G>T plays a significant role in the mechanistic interaction between metabolic risk such as hypertension and MS, although sex-related differences may exist.

A score proposal to evaluate surgical risk in patients submitted to myocardial revascularization surgery

INTRODUCTION Scores to predict surgical risk in patients submitted to myocardial revascularization surgery are broadly used. OBJECTIVE To develop a score capable to predict mortality in patients submitted to myocardial revascularization surgery. METHODS From January 1996 to December 2007, data were collected from 2809 patients submitted to myocardial revascularization surgery at PUC-RS São Lucas Hospital. In 2/3 of the sample (n = 1875), the score was developed, after uni and mutivariated analyses. In the remaining 1/3 (n = 934) the score was validated. The final score was developed with the total sample, using the same variables (n = 2809). The accuracy of the model was tested using the area under the ROC curve. RESULTS The mean age was 61.3 ± 10.1 years and 34% were women. The risk factors identified as independent predictors of surgical mortality and used for score development (parentheses) were: age > 60 years (2), female (2), extracardiac vasculopathy (2), heart failure functional class III and IV (3), ejection fraction<45% (2), atrial fibrillation (2), chronic obstructive pulmonary disease (3), aortic stenosis (3), creatinine 1.5-2.4 (2), creatinine > 2.5 or dialysis (4), emergency/urgency surgery (16). The area obtained under the ROC curve was 0.86 (CI 0.81-0.9). CONCLUSION The score developed, using clinical variables easy to obtain (age, sex, extracardiac vasculopathy, functional class, ejection fraction, atrial fibrillation, chronic obstructive pulmonary disease, aortic stenosis, creatinine and emergency/urgency surgery) showed capability to predict mortality in patients submitted to myocardial revascularization surgery in our Hospital.

Interaction between endothelial nitric oxide synthase gene polymorphisms (-786T>C, 894G>T and intron 4 a/b) and cardiovascular risk factors in acute coronary syndromes.

BACKGROUND AND AIMS Endothelial rupture of coronary plaque can represent the pathomorphological substratum of acute coronary syndrome (ACS). Polymorphisms in the NOS3 gene (eNOS) -786T>C, 894G>T and intron 4 a/b VNTR can be associated with a higher susceptibility for ACS. The present study is focused on the investigation of the interaction of these polymorphisms and cardiovascular risk factors in 135 patients with ACS and 115 control subjects. METHODS Case-control study where the allele and genotype frequencies of the polymorphisms -786T> C, 894G> T and intron 4 VNTR of the gene encoding eNOS were determined by PCR-RFLP associated with cardiovascular risk factors. RESULTS An association of the 894TT genotype and 894GT+GG (OR 1.4; 95% CI 1.0-1.8) in ACS has been observed. Subjects without dyslipidemia and intron 4 a/b genotype present a lower chance for ACS development, whereas subjects without diabetes and 894TT genotype show a higher risk for ACS (OR 1.7; 95% CI 1.2-2.3). In patients without dyslipidemia, the 894GG genotype presented a tendency to behave as a protector factor against ACS. Also, the 894GG genotype has been a protective factor for ACS in females (OR 0.5; CI 95% 0.2-0.9). CONCLUSIONS Our results suggest that eNOS polymorphisms may be an additional risk factor in development of ACS.