Association between Albuminuria, Glomerular Filtration Rate and Mortality or Recurrence in Stroke Patients

&lt;i&gt;Background/Aims:&lt;/i&gt; In an attempt to find new predictors of stroke prognosis, we evaluated the association of albuminuria (AUr) and the estimated glomerular filtration rate (eGFR) with the recurrence of stroke and mortality. &lt;i&gt;Methods:&lt;/i&gt; We evaluated and followed for at least 7 months patients with first-ever stroke or transient ischemic attack admitted to a prospective cohort from March 2005 to December 2007. We analyzed traditional CV risk factors, albumin-to-creatinine ratio and eGFR (ml/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;) as predictors of mortality or recurrence. &lt;i&gt;Results:&lt;/i&gt; From a total of 185 patients included [57% (104/185) men, 64 ± 13 years], 38 patients suffered from a recurrent stroke or died, with a mean follow-up of 25.1 ± 8.7 months. AUr (≧30 mg/g) was found in 50.2% (93/185), and 38.9% (72/185) presented an eGFR &lt;60. In univariate analysis, age &gt;65 years, eGFR ≤50, atrial fibrillation (AF), no alcohol intake and AUr &gt;17 mg/g were associated with the composite endpoint. In a multivariate analysis, AF and AUr &gt;17 mg/g were independent predictors of the composite endpoints, but eGFR ≤50 was not. &lt;i&gt;Conclusion:&lt;/i&gt; The presence of AUr &gt;17 mg/g is independently associated with death or recurrence after stroke. Further studies should consider the AUr as a predictor for a worse prognosis in these patients.</jats:p

Effects of late aerobic exercise on cardiac remodeling of rats with small myocardial infarction

Abstract Background Physical exercise has been highlighted as an important non-pharmacological therapy for prevention and treatment of several cardiovascular diseases. However, its effects on hearts with minor cardiac remodeling are not clear. Purpose To evaluate the influence of aerobic physical exercise on functional capacity, cardiac structure, left ventricular (LV) function, and gene expression of NADPH oxidase subunits in rats with small-sized myocardial infarction (MI). Methods Three months after MI induction, Wistar rats were divided into three groups: Sham; sedentary MI (MI-SED); and aerobic exercised MI (MI-EA). Rats exercised three times a week for 12 weeks on a treadmill. Echocardiogram was performed before and after experimental period. Infarction size and cardiomyocyte diameters were evaluated by histology. Gene expression was assessed by RT-PCR. Results Only rats with MI size lower than 30% of LV total area were included in the study. Functional capacity was higher in MI-AE than the other groups. Infarction size did not differ between groups. Infarcted rats had increased LV diastolic and systolic diameter, left atrial diameter, and LV mass, with systolic dysfunction. LV diastolic posterior wall thickness was higher in MI-AE than Sham, and relative wall thickness was lower in MI-SED than MI-AE and Sham groups. Cardiomyocyte diameter was smaller in infarcted groups than Sham. Myocardial gene expression of the NADPH oxidase subunits NOX2, NOX4, p22phox, and p47phox did not differ between groups. Conclusion Small-sized myocardial infarction changes cardiac structures and left ventricular systolic function. Late aerobic physical exercise improves functional capacity and cardiac remodeling by preserving left ventricular geometry. NADPH oxidase subunits gene expression is not involved in cardiac remodeling or modulated by aerobic exercise in rats with small myocardial infarction. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): CNPq; CAPES </jats:sec

Heart failure-induced skeletal myopathy in spontaneously hypertensive rats

AbstractBackgroundAlthough skeletal muscle atrophy and changes in myosin heavy chain (MyHC) isoforms have often been observed during heart failure, their pathophysiological mechanisms are not completely defined. In this study we tested the hypothesis that skeletal muscle phenotype changes are related to myogenic regulatory factors and myostatin/follistatin expression in spontaneously hypertensive rats (SHR) with heart failure.MethodsAfter developing tachypnea, SHR were subjected to transthoracic echocardiogram. Pathological evidence of heart failure was assessed during euthanasia. Age-matched Wistar–Kyoto (WKY) rats were used as controls. Soleus muscle morphometry was analyzed in histological sections, and MyHC isoforms evaluated by electrophoresis. Protein levels were assessed by Western blotting. Statistical analysis: Student'st test and Pearson correlation.ResultsAll SHR presented right ventricular hypertrophy and seven had pleuropericardial effusion. Echocardiographic evaluation showed dilation in the left chambers and left ventricular hypertrophy with systolic and diastolic dysfunction in SHR. Soleus weight and fiber cross sectional areas were lower (WKY 3615±412; SHR 2035±224μm2; P<0.001), and collagen fractional volume was higher in SHR. The relative amount of type I MyHC isoform was increased in SHR. Myogenin, myostatin, and follistatin expression was lower and MRF4 levels higher in SHR. Myogenin and follistatin expression positively correlated with fiber cross sectional areas and MRF4 levels positively correlated with I MyHC isoform.ConclusionReduced myogenin and follistatin expression seems to participate in muscle atrophy while increased MRF4 protein levels can modulate myosin heavy chain isoform shift in skeletal muscle of spontaneously hypertensive rats with heart failure

Fundamento y diseño del test randomizado PAINT

FUNDAMENTO: Descrevemos as bases teóricas e o formato do "Estudo PAINT - Intervenção percutânea com stents com eluição de paclitaxel ou sirolimus em polímero biodegradável comparados com stents sem recobrimento no tratamento de lesões coronárias de novo". OBJETIVO: Avaliar duas novas formulações de stents com eluição de paclitaxel ou sirolimus em comparação com um stent de estrutura metálica idêntica, porém sem recobrimento polimérico ou eluição de droga. MÉTODOS: O PAINT é um estudo randomizado, multicêntrico, de 3 braços, conduzido em centros terciários brasileiros, que incluiu 275 pacientes alocados para tratamento com os stents InfinniumR (paclitaxel), the SupralimusR (sirolimus) ou Milennium MatrixR (sem recobrimento) na proporção 2:2:1 ratio. Os pacientes apresentavam lesões coronarianas de novo em vasos nativos com um diâmetro entre 2,5 e 3,5 mm, passíveis de tratamento com um único stent com comprimento de 29 mm ou menos. O objetivo primário era comparar a perda tardia aos nove meses de ambos stents com paclitaxel- ou sirolimus versus a perda luminal dos stents convencionais de controle. Objetivos secundários importantes incluíam a comparação angiográfica entre os dois tipos de stents farmacológicos, bem como a análise da ocorrência de eventos clínicos adversos. RESULTADOS E CONCLUSÕES: O estudo PAINT apresenta um formato peculiar e único que permitiu a avaliação da segurança e eficácia de duas novas formulações de stents farmacológicos, com carreador polimérico biodegradável, e liberação de paclitaxel ou sirolimus, os quais foram comparados contra um stent metálico convencional (objetivo primário). Uma vez que os stents farmacológicos diferiram entre sí somente pela droga, mas eram idênticos nas suas outras características, os estudo também permitiu a comparação do efeito anti-restenótico entre sirolimus e paclitaxel (objetivo secundário).BACKGROUND: We describe the rationale and design for the "PercutAneous INTervention with biodegradable-polymer based paclitaxel-eluting or sirolimus-eluting versus bare stents for de novo coronary lesions - PAINT trial". OBJECTIVES: To evaluate two novel formulations of paclitaxel-eluting stent and the sirolimus-eluting stent against a stent with the same metallic structure but without polymer coating or drug elution. METHODS: The PAINT is a multicenter 3-arm randomized trial, conducted in Brazilian tertiary institutions, which included 275 patients allocated for the InfinniumR paclitaxel-eluting stent, the SupralimusR sirolimus-eluting stent or the Milennium MatrixR bare metal stent in a 2:2:1 ratio. Patients had de novo coronary lesions in native vessels with a diameter between 2.5 and 3.5 mm, amenable for treatment with a single stent of 29 mm or less in length. The primary objetive was to compare the in-stent late loss at 9 months of both paclitaxel- and sirolimus-eluting versus the late loss of control bare metal stents. Important secondary objectives included the comparison in outcomes between sirolimus and paclitaxel stents, as well as the analysis of the incidence of major adverse cardiac events. RESULTS AND CONCLUSIONS: The PAINT trial had a unique design that allowed for the evaluation of the safety and efficacy profiles of two novel drug-eluting stent formulations, with a biodegradable-polymer carrier and releasing paclitaxel or sirolimus, which were compared against a bare metal stent (primary objective). As the drug-eluting stents differed by the drug, but were identical otherwise, the trial also allowed the comparison of the anti-restenosis effects of sirolimus versus paclitaxel (secondary objective).FUNDAMENTO: Describimos las bases teóricas y el formato del "Estudio PAINT - Intervención percutánea con stents recubiertos de paclitaxel o sirolimus en polímero biodegradable comparados con stents no recubiertos en el tratamiento de lesiones coronarias de novo". OBJETIVO: Evaluar dos nuevas formulaciones de stents con liberación de paclitaxel o sirolimus en comparación con un stent de estructura metálica idéntica, pero sin recubierto polimérico o liberación de droga. MÉTODOS: El PAINT es un estudio randomizado, multicéntrico, de 3 brazos, llevado a cabo en centros terciaros brasileños, que incluyó a 275 pacientes destinados a tratamiento con los stents InfinniumR (paclitaxel), the SupralimusR (sirolimus) o Milennium MatrixR (no recubierto) en la proporción 2:2:1. Los pacientes presentaban lesiones coronarias de novo en vasos nativos con un diámetro entre 2,5 y 3,5 mm, pasibles de tratamiento con un único stent de hasta 29 mm de longitud. El objetivo primario era comparar la pérdida luminal tardía a los nueve meses de ambos stents con paclitaxel- o sirolimus versus la pérdida luminal de los stents convencionales de control. Los objetivos secundarios importantes incluían la comparación angiográfica entre los dos tipos de stents farmacológicos, así como el análisis de la ocurrencia de eventos clínicos adversos. RESULTADOS Y CONCLUSIONES: El estudio PAINT presenta un formato peculiar y único que permitió la evaluación de la seguridad y eficacia de dos nuevas formulaciones de stents farmacológicos, con transportador polimérico biodegradable, y liberación de paclitaxel o sirolimus, los que fueron comparados con un stent metálico convencional (objetivo primario). Dado que los stents farmacológicos diferían entre sí solamente por la droga, pero eran idénticos en sus otras características, el estudio también permitió la comparación del efecto antireestenótico entre sirolimus y paclitaxel (objetivo secundario)