Obesity, metabolic syndrome and diabetes: cardiovascular implications and therapy

Obesity, metabolic syndrome, and type-2 diabetes mellitus are 3 interrelated conditions that share a number of pathophysiological mechanisms and that are frequently observed to lead, in succession, to cardiovascular complications. The fact that their prevalence is increasing alarmingly should prompt all healthcare professionals urgently to implement measures to prevent these complications. The most effective, though also the least adopted, are those related to lifestyle modification. Drug treatment targeted at controlling risk factors (eg, hypertension, dyslipidemia, and thrombophilia), metabolic abnormalities, and excess weight is also necessary

Monitoring of biophysicochemical changes in a silty clay soil contaminated with LNAPLs

The interdependence between time domain induced polarization measurements at uncontaminated and artificially contaminated soil samples with diesel and biophysicochemical alterations caused by diesel degradation was investigated during 12 months. The research was performed on a slightly alkaline soil, with high content of organic matter (148 g/kg) and silty clay texture. Soil clay mineralogy was mainly composed of plagioclase, amphibole, biotite, interstratified mica-smectite, goethite and some vestigial kaolinite. A decrease on resistivity and induced polarization (IP) in contaminated soil was observed during the 12 months. This reduction on geoelectrical parameters was related to: 1) the increase on the electrolyte conductivity; 2) the increase on interfacial surface area, as result of biotite transformation and weathering of other ferromagnesian minerals and 3) a slight increase in soil aggregation, caused by diesel-degrading microorganisms (a significant increase of the numbers of specific carbon degraders was observed). After 4 months, the IP response was lowest in the contaminated soil which was explained by inhibition of the cation exchange capacity due to two possible processes: 1) clay particles coating by organic molecules and 2) attachment of microbial cells (biofilms) to clay particles and/or soil aggregates. The results suggest that the content and mineralogy of the clay fraction as well as the aggregation state of the soils contaminated with LNAPL's affect the IP response. This response is a diagnostic of the biophysicochemical alterations occurring during diesel degradation as a result of biological activit

Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes.

OBJECTIVES: The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND: Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS: The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS: Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS: Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year.info:eu-repo/semantics/publishedVersio

Genética Molecular e Citogenética

XXXII Congresso Brasileiro de Zoologia, Foz do Iguaçu, 2018. Tema: Desafios e perspectivas para a Zoologia na América LatinaCaderno de Resumos de Trabalhos da Área temática Genética Molecular e Citogenética, do XXXII Congresso Brasileiro de ZoologiaSociedade Brasileira de Zoologia (SBZ) e Universidade Federal da Integração Latino-Americana (Unila

An Unexpected Association in a Patient with Heart Failure Presenting a Surgical Challenge

Bicuspid aortic valve (BAV) is the most common form of congenital heart disease and frequently leads to premature valvular dysfunction. BAV is associated with aortic wall abnormalities and a high prevalence of ascending aorta dilatation and coarctation of the aorta (CoA). Consequently, in patients with BAV a careful assessment of the valve, and also of the aortic root and the ascending aorta, should be performed. The most feared complication is aortic dissection, however, the actual incidence of this complication is low. We report the case of a 58-year-old man who presented with New York Heart Association class III heart failure. The work-up revealed BAV with severe stenosis and severe compromise of left ventricle systolic function. In addition, CoA in the isthmus region, and type B dissection of the aorta were diagnosed.info:eu-repo/semantics/publishedVersio

Avances en la cardiopatía isquémica aguda y crónica

Atherothrombosis is a key concept in our new pathophysiologic understanding of cardiovascular disease. It has led to new preventive strategies, both pharmacologic and lifestyle-related, to more specific treatments and to emerging imaging modalities

Prevalencia del síndrome metabólico en población laboral española: registro MESYAS

Introducción y objetivos. Estudiar la prevalencia del síndrome metabólico (SM) en la población laboral activa española y analizar sus diferencias según las categorías laborales. Sujetos y método. Se recogieron los datos de 7.256 trabajadores activos (un 82,4% varones), con una edad media de 45,4 ± 9,8 años, empleados en una factoría de coches y unos grandes almacenes. El diagnóstico del SM se realizó mediante los criterios modificados del ATP-III (se utilizó el índice de masa corporal en lugar del perímetro abdominal). Resultados. La prevalencia bruta del SM fue del 10,2%. Ajustada por edad y sexo en una población plana (20-60 años) fue del 5,8% (intervalo de confianza [IC] del 95%, 4,1-7,6%), significativamente más alta en varones que en mujeres (el 8,7%; IC del 95%, 7,3-10,0 frente al 3,0%; IC del 95%, 0,8-5,1). Todos los componentes del SM fueron significativamente más prevalentes en varones, excepto las concentraciones de lipoproteínas de alta densidad, que fueron más bajas. La prevalencia aumentó con la edad y el sexo masculino (odds ratio [OR] = 1,7), la obesidad (OR = 9,6), la hipertensión (OR = 3,4) y la diabetes (OR = 15,4). Los trabajadores manuales presentaron la mayor prevalencia de SM (11,8%), seguidos por EPIDEMIOLOGÍA Y PREVENCIÓN Prevalencia del síndrome metabólico en población laboral española: registro MESYAS Eduardo Alegríaa, Alberto Corderoa, Martín Laclaustrab, Alberto Grimac, Montserrat Leónb, José A. Casasnovasb, Emilio Luengod, Alfonso del Ríob e Ignacio Ferreirab, en representación de los investigadores del registro MESYAS* aDepartamento de Cardiología. Clínica Universitaria de Navarra. Pamplona. Navarra. España. bUnidad de Investigación Cardiovascular. Hospital Clínico Universitario. Zaragoza. España. cServicio de Cardiología Preventiva. Asepeyo. Valencia. España. dServicio de Cardiología. Hospital Militar. Zaragoza. España. *Al final del artículo se relacionan los miembros del equipo de investigación MESYAS. Martín Laclaustra está contratado como investigador en el Instituto Aragonés de Ciencias de la Salud dentro del programa de ayudas a contratos para investigadores que han finalizado su formación médica especializada del Instituto de Salud Carlos III. El registro MESYAS cuenta con una beca de la Sociedad Española de Cardiología (Sevilla, 2003) y la Sección de Cardiología Preventiva y Rehabilitadora. Correspondencia: Dr. E. Alegría Ezquerra. Departamento de Cardiología. Clínica Universitaria de Navarra. Avda. Pío XII, 36. 31008 Pamplona. Navarra. España. Correo electrónico: [email protected] Recibido el 5 de octubre de 2004. Aceptado para su publicación el 18 de marzo de 2005. los trabajadores de oficina (9,3%) y los directivos (7,7%) (gradiente social inverso). Los trabajadores manuales tienen un riesgo superior de presentar SM, con independencia de la edad y el sexo (OR = 1,3); este efecto parece depender de las concentraciones de triglicéridos. Conclusiones. Uno de cada 10 trabajadores activos tiene SM; la prevalencia aumenta con la edad y el sexo masculino. La obesidad y la diabetes suponen gran incremento de la prevalencia. Los trabajadores manuales son el colectivo con mayor prevalencia

Cardiac resynchronization therapy and valvular cardiomyopathy after corrective surgery

Cardiac resynchronization therapy (CRT) has been shown to have clinical benefits in certain groups of patients with advanced heart failure (HF). However, patients with valvular cardiomyopathy are underrepresented in randomized clinical studies. The aim of this study was to assess the medium-term (i.e., at 6 months) effects of CRT in patients with HF exclusively due to valvular disease. The study included 40 consecutive patients who underwent CRT device implantation. At 6 months, there were improvements in functional class, left ventricular remodeling, and intraventricular dyssynchrony parameters in treated patients. In this particular subgroup of patients, the benefits of CRT were similar to those observed in patients with HF due to other etiologies

Tratamiento de la insuficiencia cardíaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos

Recent data suggest that biventricular pacing may play an important role in treating advanced heart failure in the presence of a significant interventricular and/or intraventricular conduction disorder by correcting cardiac dysynchrony. In this article, we review the initial technical and clinical experience with cardiac resynchronization therapy in an electrophysiology laboratory. METHODS: The first 22 consecutive patients with severe congestive heart failure, ejection fraction < 0.35, NYHA functional class III or IV, and QRS duration > 120 ms who were implanted biventricular pacemakers were studied. Clinical, electrocardiographic, and echocardiographic evaluations were made before and three months after pacemaker implantation. Acute functional capacity testing with peak oxygen uptake was measured during biventricular pacing and during intrinsic rhythm or right ventricular pacing three months after the implantation procedure. RESULTS: The success rate of pacemaker implantation was 95%. Pre-discharge left ventricular pacing was achieved in 91%, with an average pacing threshold of 1.53 (1.04) volts. NYHA functional class improved (p = 0.039) from 3.4 (0.7) to 2.3 (0.78). The rate of hospitalization for heart failure decreased from an average of 3.12 (0.58) three months before the procedure to 1.38 (0.34) three months after the procedure. Peak oxygen uptake was significantly greater (p = 0.028) during biventricular pacing: 14.89 (2.1) ml/min/kg, than during intrinsic rhythm or right ventricular pacing: 12.65 (2.3) ml/min/kg. CONCLUSIONS: Cardiac resynchronization therapy can be performed safely and with a high success rate in the electrophysiology laboratory. Biventricular pacing seems to improve the symptoms of congestive heart failure in patients with evidence of atrioventricular and/or interventricular/intraventricular dysynchrony. An acute benefit in peak oxygen uptake was associated with biventricular pacing after the implantation procedure

Efecto de la localización del electrodo ventricular izquierdo sobre los parámetros ecocardiográficos de asincronía en pacientes sometidos a terapia de resincronización cardíaca

Introduction and objectives. Cardiac resynchronization therapy has been shown to be an option in the treatment of patients with congestive heart failure. The current indication for this treatment is based on clinical and electrocardiographic criteria, although echocardiography has also been shown to be a useful tool for the diagnosis of ventricular dyssynchrony. The aim of this study was to assess left ventricular dyssynchrony by echocardiography and to evaluate the effect of the stimulation site on the magnitude of resynchronization. Patients and method. We studied 25 patients with biventricular stimulation (left ventricular lead located in a lateral position in 13 patients, and in an anterior position in 12). A complete echo-Doppler evaluation, including left ventricular ejection fraction, ventricular diameters and parameters of inter- and intraventricular dyssynchrony, was performed before implantation and 3 months after the procedure, with the device connected and disconnected. Results. Left ventricular ejection fraction increased significantly from 23.7 (6.5) to 27.8 (5.5) (P=.007) at 3 months. In the group as a whole, biventricular pacing was associated with a significant decrease in all intraventricular dyssynchrony parameters (septal-to-lateral wall motion delay and septal-to-posterior wall motion delay). This decrease in septal-to-posterior wall motion delay and septalto- lateral wall motion delay was significantly greater in patients with the electrode implanted in the lateral position (58.1 ms vs 118 ms; P=.02) than with the lead in the anterior position (39.5 ms vs 86.5 ms; P=.04). Three patients, all with the electrode in an anterior location, were considered non-responders. Conclusions. Left lateral free wall stimulation provided significantly better intraventricular resynchronization compared to stimulation at an anterior site. Echocardiography is a useful tool to evaluate changes in intra- and interventricular synchrony related to the pacing site