Therapeutic decision-making for patients with fluctuating mitral regurgitation

Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve)

Phase transition in the collisionless regime for wave-particle interaction

Gibbs statistical mechanics is derived for the Hamiltonian system coupling self-consistently a wave to N particles. This identifies Landau damping with a regime where a second order phase transition occurs. For nonequilibrium initial data with warm particles, a critical initial wave intensity is found: above it, thermodynamics predicts a finite wave amplitude in the limit of infinite N; below it, the equilibrium amplitude vanishes. Simulations support these predictions providing new insight on the long-time nonlinear fate of the wave due to Landau damping in plasmas.Comment: 12 pages (RevTeX), 2 figures (PostScript

Thermodynamics of self-gravitating systems

Self-gravitating systems are expected to reach a statistical equilibrium state either through collisional relaxation or violent collisionless relaxation. However, a maximum entropy state does not always exist and the system may undergo a ``gravothermal catastrophe'': it can achieve ever increasing values of entropy by developing a dense and hot ``core'' surrounded by a low density ``halo''. In this paper, we study the phase transition between ``equilibrium'' states and ``collapsed'' states with the aid of a simple relaxation equation [Chavanis, Sommeria and Robert, Astrophys. J. 471, 385 (1996)] constructed so as to increase entropy with an optimal rate while conserving mass and energy. With this numerical algorithm, we can cover the whole bifurcation diagram in parameter space and check, by an independent method, the stability limits of Katz [Mon. Not. R. astr. Soc. 183, 765 (1978)] and Padmanabhan [Astrophys. J. Supp. 71, 651 (1989)]. When no equilibrium state exists, our relaxation equation develops a self-similar collapse leading to a finite time singularity.Comment: 54 pages. 25 figures. Submitted to Phys. Rev.

ESC core curriculum for the general cardiologist (2013)

[No abstract available

Long-time discrete particle effects versus kinetic theory in the self-consistent single-wave model

The influence of the finite number N of particles coupled to a monochromatic wave in a collisionless plasma is investigated. For growth as well as damping of the wave, discrete particle numerical simulations show an N-dependent long time behavior resulting from the dynamics of individual particles. This behavior differs from the one due to the numerical errors incurred by Vlasov approaches. Trapping oscillations are crucial to long time dynamics, as the wave oscillations are controlled by the particle distribution inhomogeneities and the pulsating separatrix crossings drive the relaxation towards thermal equilibrium.Comment: 11 pages incl. 13 figs. Phys. Rev. E, in pres

Combined treatment with caffeic and ferulic acid from Baccharis uncinella C. DC. (Asteraceae) protects against metabolic syndrome in mice

Fractionation of the EtOH extract from aerial parts of Baccharis uncinella C. DC. (Asteraceae) led to isolation of caffeic and ferulic acids, which were identified from spectroscopic and spectrometric evidence. These compounds exhibit antioxidant and anti-inflammatory properties and have been shown to be effective in the prevention/treatment of metabolic syndrome. This study investigated whether the combined treatment of caffeic and ferulic acids exhibits a more significant beneficial effect in a mouse model with metabolic syndrome. The combination treatment with caffeic and ferulic acids was tested for 60 days in C57 mice kept on a high-fat (40%) diet. The data obtained indicated that treatment with caffeic and ferulic acids prevented gain in body weight induced by the high-fat diet and improved hyperglycemia, hypercholesterolemia and hypertriglyceridemia. The expression of a number of metabolically relevant genes was affected in the liver of these animals, showing that caffeic and ferulic acid treatment results in increased cholesterol uptake and reduced hepatic triglyceride synthesis in the liver, which is a likely explanation for the prevention of hepatic steatosis. In conclusion, the combined treatment of caffeic and ferulic acids displayed major positive effects towards prevention of multiple aspects of the metabolic syndrome and liver steatosis in an obese mouse model.CAPESFAPESPMackPesquisaUniv Presbiteriana Mackenzie, Programa Posgrad Disturbios Desenvolvimento, Ctr Ciencias Biol & Saude, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Med Translac, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed ABC, Ctr Ciencias Nat & Humanas, Sao Paulo, SP, BrazilEscola Ciencias Med, Dept Ciencias Patol, Sao Paulo, SP, BrazilUniv Presbiteriana Mackenzie, Escola Engn, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Inst Ciencias Ambientais Quim & Farmaceut, Sao Paulo, SP, BrazilRush Univ & Med Ctr, Dept Internal Med, Div Endocrinol & Metab, Chicago, IL 60612 USAUniv Fed Sao Paulo, Inst Ciencias Ambientais Quim & Farmaceut, Sao Paulo, SP, BrazilFAPESP: 2011/21847-6Web of Scienc

Small BGK waves and nonlinear Landau damping

Consider 1D Vlasov-poisson system with a fixed ion background and periodic condition on the space variable. First, we show that for general homogeneous equilibria, within any small neighborhood in the Sobolev space W^{s,p} (p>1,s<1+(1/p)) of the steady distribution function, there exist nontrivial travelling wave solutions (BGK waves) with arbitrary minimal period and traveling speed. This implies that nonlinear Landau damping is not true in W^{s,p}(s<1+(1/p)) space for any homogeneous equilibria and any spatial period. Indeed, in W^{s,p} (s<1+(1/p)) neighborhood of any homogeneous state, the long time dynamics is very rich, including travelling BGK waves, unstable homogeneous states and their possible invariant manifolds. Second, it is shown that for homogeneous equilibria satisfying Penrose's linear stability condition, there exist no nontrivial travelling BGK waves and unstable homogeneous states in some W^{s,p} (p>1,s>1+(1/p)) neighborhood. Furthermore, when p=2,we prove that there exist no nontrivial invariant structures in the H^{s} (s>(3/2)) neighborhood of stable homogeneous states. These results suggest the long time dynamics in the W^{s,p} (s>1+(1/p)) and particularly, in the H^{s} (s>(3/2)) neighborhoods of a stable homogeneous state might be relatively simple. We also demonstrate that linear damping holds for initial perturbations in very rough spaces, for linearly stable homogeneous state. This suggests that the contrasting dynamics in W^{s,p} spaces with the critical power s=1+(1/p) is a trully nonlinear phenomena which can not be traced back to the linear level

Sleep patterns over 15-day period in rats with spinal cord injury

Study design: Experimental, controlled trial.Objectives: the purpose of this study was to evaluate over a 15-day period alterations in sleep pattern of rats after spinal cord injury (SCI).Setting: Federal University of São Paulo, Department of Psychobiology.Methods: in total, 20 male Wistar rats were used. the rats were divided in two groups: SHAM and SCI. the rats were submitted to the following procedures: electrode insertion surgery, 24 h duration baseline sleep recording, SCI (level T9) and subsequent sleep recording for 15 consecutive days.Results: the results showed a reduction in sleep efficiency in the light period for Days 1-3, 5, 10 and 12 after SCI in relation to the SHAM group, with alterations in total waking time and sleep stages. Limb movements were observed 4 days after SCI.Conclusion: the present findings suggest that SCI may be heavily involved in altering sleep pattern in SCI subjects and that the inactivity caused by SCI may be exacerbating this altered sleep pattern.Universidade Federal de São Paulo, Dept Psychobiol, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Ctr Psychobiol & Exercise Res, BR-04020060 São Paulo, BrazilSanta Casa, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04020060 São Paulo, BrazilUniversidade Federal de São Paulo, Ctr Psychobiol & Exercise Res, BR-04020060 São Paulo, BrazilWeb of Scienc

Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics

Importance: The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era. Objective: To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database. Design, Setting, and Participants: This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50% at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018. Main Outcomes and Measures: Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations. Results: Of the 1375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6%) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6%) died under observation, including 57 patients (54.8%) from cardiovascular causes. The crude rate of sudden death was 0.65% over the duration of the study. A total of 542 patients (39.4%) underwent AVR, including 388 patients (71.6%) with severe AS at study entry and 154 (28.4%) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54% (2%) and 32% (3%), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9%. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients). Conclusions and Relevance: In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60% have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk patients

3D echocardiographic reference ranges for normal left ventricular volumes and strain: Results fromthe EACVI NORRE study

Aim To obtain the normal ranges for 3D echocardiography (3DE) measurement of left ventricular (LV) volumes, function, and strain from a large group of healthy volunteers. Methods and results A total of 440 (mean age: 45613 years) out of the 734 healthy subjects enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study had good-quality 3DE data sets that have been analysed with a vendor-independent software package allowing homogeneous measurements regardless of the echocardiographic machine used to acquire the data sets. Upper limits of LV end-diastolic and end-systolic volumes were larger in men (97 and 42 mL/m2) than in women (82 and 35 mL/m2; P<0.0001). Conversely, lower limits of LV ejection fraction were higher in women than in men (51% vs. 50%; P<0.01). Similarly, all strain components were higher in women than in men. Lower range was -18.6% in men and -19.5% in women for 3D longitudinal strain, -27.0% and -27.6% for 3D circumferential strain, -33.2% and -34.4% for 3D tangential strain and 38.8% and 40.7% for 3D radial strain, respectively. LV volumes decreased with age in both genders (P<0.0001), whereas LV ejection fraction increased with age only in men. Among 3DE LV strain components, the only one, which did not change with age was longitudinal strain. Conclusion The NORRE study provides applicable 3D echocardiographic reference ranges for LV function assessment. Our data highlight the importance of age- and gender-specific reference values for both LV volumes and strain. All rights reserved