Núbia Welerson Vieira

Efeitos Cardiovasculares da Testosterona

A testosterona e secretada durante tresepocas da vida: 1) no primeiro trimestre da vida intra-uterina,transitoriamente; 2) na vida neonatal e 3) continuamenteapos a puberdade. O nivel de testosterona produzido podeser calculado pela depuracao metabolica, pela media dosniveis de testosterona circulante, por diferenca arteriove-nosa testicular ou pela taxa de fluxo testicular.

Efeitos agudos dos estrogênios associados a progestogênios sobre a trigliceridemia e reatividade vascular pós-prandial

OBJECTIVE: To assess whether hormone replacement therapy with estrogens in association with progestogens in postmenopausal hypertensive women alters postprandial triglyceridemia and vascular reactivity. METHODS: A double-blind, placebo-controlled, crossover study was carried out with 15 postmenopausal women (age range: 50 to 70 years, mean = 61.6 ± 6 years) randomly assigned to 2 weeks of placebo or oral ingestion of 0.625 mg of equine conjugated estrogens and 2.5 mg of medroxyprogesterone, fed a high-fat diet (897 calories; 50.1% fat). Vascular reactivity (VR - % of vessel diameter variation in the fasting period and 2 hours after meals) was measured by using the automated ultrasound method. Lipid profile and glycemia during the fasting period and 2 hours after a high-fat meal were measured. RESULTS: With placebo, vascular reactivity (VR) decreased from 3.20 ± 17% during the fasting period to -2.1 ± 30% 2 hours after the meal (P=0.041). With the hormone replacement therapy, vascular reactivity decreased from 6.14 ± 27% during the fasting period to - 0.05 ± 18% 2 hours after the meal (P=NS). Postprandial triglyceridemia increased as follows: 35 ± 25% with placebo; and 12 ± 10% with hormone replacement therapy (P < 0.05). CONCLUSION: In postmenopausal hypertensive women, 2 weeks of hormone replacement with an association of estrogens and progestogens decreased hypertriglyceridemia after a high-fat meal, an effect that may reduce the endothelial dysfunction occurring in the postprandial period.

Addition of long-distance heart procurement promotes changes in heart transplant waiting list status

Objective Evaluate the addition of long-distance heart procurement on a heart transplant program and the status of heart transplant recipients waiting list. Methods Between September 2006 and October 2012, 72 patients were listed as heart transplant recipients. Heart transplant was performed in 41 (57%), death on the waiting list occurred in 26 (36%) and heart recovery occurred in 5 (7%). Initially, all transplants were performed with local donors. Long-distance, interstate heart procurement initiated in February 2011. Thirty (73%) transplants were performed with local donors and 11 (27%) with long-distance donors (mean distance=792 km±397). Results Patients submitted to interstate heart procurement had greater ischemic times (212 min ± 32 versus 90 min±18; P<0.0001). Primary graft dysfunction (distance 9.1% versus local 26.7%; P=0.23) and 1 month and 12 months actuarial survival (distance 90.1% and 90.1% versus local 90% and 86.2%; P=0.65 log rank) were similar among groups. There were marked incremental transplant center volume (64.4% versus 40.7%, P=0.05) with a tendency on less waiting list times (median 1.5 month versus 2.4 months, P=0.18). There was a tendency on reduced waiting list mortality (28.9% versus 48.2%, P=0.09). Conclusion Incorporation of long-distance heart procurement, despite being associated with longer ischemic times, does not increase morbidity and mortality rates after heart transplant. It enhances viable donor pool, and it may reduce waiting list recipient mortality as well as waiting time.

Relation between the behaviors of P-wave and QT dispersions in elderly patients with heart failure

OBJECTIVE To assess the relation between P-wave and QT dispersions in elderly patients with heart failure. METHODS Forty-seven elderly patients (75.6+/-6 years) with stable heart failure in NYHA functional classes II or III and with ejection fractions of 37+/-6% underwent body surface mapping to analyze P-wave and QT dispersions. The degree of correlation between P-wave and QT dispersions was assessed, and P-wave dispersion values in patients with QT dispersion greater than and smaller than 100 ms were compared. RESULTS The mean values of P-wave and QT dispersions were 54+/-14 ms and 68+/-27 ms, respectively. The correlation between the 2 variables was R=0.41 (p=0.04). In patients with QT dispersion values > 100 ms, P-wave dispersion was significantly greater than in those with QT dispersion values < 100 ms (58+/-16 vs 53+/-12 ms, p=0.04 ). CONCLUSION Our results suggest that, in elderly patients with heart failure, a correlation between the values of P-wave and QT dispersions exists. These findings may have etiopathogenic, pathophysiologic, prognostic, and therapeutic implications, which should be investigated in other studies.

Evaluación intraoperatoria y planeamiento quirúrgico en la cardiomiopatía hipertrófica

Paciente de 45 anos del sexo masculino, con diagnostico de cardiomiopatia hipertrofica septal asimetrica, habiendo sido sometido a implante de cardiodesfibrilador en el pasado. A pesar del tratamiento clinico optimizado, evoluciono con progresivo deterioro clinico suscitando tratamiento invasivo. Entre tanto, no habia gradiente importante en la via de salida del ventriculo izquierdo (VSVI) al ecocardiograma de reposo y el test provocativo con dobutamina fue inconclusivo por no alcanzar la frecuencia cardiaca preconizada. La evaluacion intraoperatoria con ecocardiograma transesofagico en uso de isoproterenol fue fundamental en el diagnostico de obstruccion de la VSVI. La miectomia septal fue realizada con exito y el paciente presento buena evolucion postoperatoria.A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergone a cardiofibrilator implant in the past. Despite the optimized clinical treatment, he evolved to a progressive clinical deterioration that led to invasive treatment. However, there was not an important gradient in the exit pathway of the left ventricle (EPLV) at the echocardiogram in rest and the challenging test with dobutamine was non conclusive because it did not reach the preconized cardiac frequency. The intraoperative evaluation with a transesophageal echocardiogram using isoproterenol was fundamental for the diagnosis of the EPLV obstruction. The septum myectomy was performed successfully and the patient presented good post-operative evolution.

Avaliação intraoperatória e planejamento cirúrgico na cardiomiopatia hipertrófica

Paciente de 45 anos del sexo masculino, con diagnostico de cardiomiopatia hipertrofica septal asimetrica, habiendo sido sometido a implante de cardiodesfibrilador en el pasado. A pesar del tratamiento clinico optimizado, evoluciono con progresivo deterioro clinico suscitando tratamiento invasivo. Entre tanto, no habia gradiente importante en la via de salida del ventriculo izquierdo (VSVI) al ecocardiograma de reposo y el test provocativo con dobutamina fue inconclusivo por no alcanzar la frecuencia cardiaca preconizada. La evaluacion intraoperatoria con ecocardiograma transesofagico en uso de isoproterenol fue fundamental en el diagnostico de obstruccion de la VSVI. La miectomia septal fue realizada con exito y el paciente presento buena evolucion postoperatoria.A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergone a cardiofibrilator implant in the past. Despite the optimized clinical treatment, he evolved to a progressive clinical deterioration that led to invasive treatment. However, there was not an important gradient in the exit pathway of the left ventricle (EPLV) at the echocardiogram in rest and the challenging test with dobutamine was non conclusive because it did not reach the preconized cardiac frequency. The intraoperative evaluation with a transesophageal echocardiogram using isoproterenol was fundamental for the diagnosis of the EPLV obstruction. The septum myectomy was performed successfully and the patient presented good post-operative evolution.

Intraoperative evaluation and surgical planning in the hypertrophic cardiomyopathy

Paciente de 45 anos del sexo masculino, con diagnostico de cardiomiopatia hipertrofica septal asimetrica, habiendo sido sometido a implante de cardiodesfibrilador en el pasado. A pesar del tratamiento clinico optimizado, evoluciono con progresivo deterioro clinico suscitando tratamiento invasivo. Entre tanto, no habia gradiente importante en la via de salida del ventriculo izquierdo (VSVI) al ecocardiograma de reposo y el test provocativo con dobutamina fue inconclusivo por no alcanzar la frecuencia cardiaca preconizada. La evaluacion intraoperatoria con ecocardiograma transesofagico en uso de isoproterenol fue fundamental en el diagnostico de obstruccion de la VSVI. La miectomia septal fue realizada con exito y el paciente presento buena evolucion postoperatoria.A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergone a cardiofibrilator implant in the past. Despite the optimized clinical treatment, he evolved to a progressive clinical deterioration that led to invasive treatment. However, there was not an important gradient in the exit pathway of the left ventricle (EPLV) at the echocardiogram in rest and the challenging test with dobutamine was non conclusive because it did not reach the preconized cardiac frequency. The intraoperative evaluation with a transesophageal echocardiogram using isoproterenol was fundamental for the diagnosis of the EPLV obstruction. The septum myectomy was performed successfully and the patient presented good post-operative evolution.

Effect of combined hormone replacement therapy on thrombotic and fibrinolytic potentials and Lp(a) levels in elderly women

ABSTRACTS - Hypertension, Vascular Disease, and Prevention 269A 1201-81 N-Terminal Pro Brain Natrlureti¢ Peptide (NT-proBNP) Predicts Left Ventriculer Function and Mortality in Hemodlalysis Patients but Not Cardiac Death: A Two- Year Outcome Study Joseoh P. Lonohitano. William L. Henhch, Paul D. Light, Eric Tiblier, Heidi Sparger, Mathew M. Smilay, John Badalamenti, Juergen Trawinski, Christopher R. deFilippi, University of Maryland, Baltimore, Maryland, University of Texas Medical Branch, Galveston, Texas. NT-proBNP is a stable marker of left ventricular (LV) dysfunction in the general popula- tion, but its predictive value in patients on chronic hemodialysis (HD), a group with chronic volume overload as well as a large burden of ischemic heart disease and cardio- vascular death, is unknown. This prospective study of 224 HD patients was designed to learn the predictive value of NT-proBNP for death, LV function and the magnitude of CAD. HD pts from 5 HD centers (age 60±15 years, 54% male, 48% diabetic) in whom NT-proBNP levels (mean of two values, one month apart, normal 0.40 (9956±11420 vs. 4853±5940, p=0.0013). The Table depicts NT-proBNP by quartiies, and shows the corresponding mortality (%), depressed LVEF (%), mean LV mass, multives- sel CAD (%) and cardiac death or non-fatal MI (%). Overall mortality, LV dysfunction and LV mass increased with risifig NT-proBNP levels but NT-proBNP was not predictive of multivessel CAD or cardiac death. We conclude that NT-proBNP levels are high in most HD pts, and that levels >2800 pmol/ L are associated with a marked decrease in LVEF and risk of all cause mortality in a large percentage of pts but are not a marker of atheroscierotic burden or CV death, Quartile 1 2 3 4 pvaluefortrend NT-proBNP (pmol/L) 87-1246 1247-27662792-66986730-55164 Death (% pts) 23.2 23.2 46.4 44.6 0.006 LVEF< 0.40 (% pts) 2.6 9.8 22.6 27.3 0.008 LV mass (g/m 2) 130-~31 133+31 137±44 160±39 0.002 Multivessel CAD (% pts) 42.1 18.1 5.6 47.6 0.790 CV Death or Non-Fatal MI 16.1 17.9 16.1 22.6 0.450 (% pts)