Diastolic function and functional capacity after a single session of continuous positive airway pressure in patients with compensated heart failure

OBJECTIVE: The effects of acute continuous positive airway pressure therapy on left ventricular diastolic function and functional capacity in patients with compensated systolic heart failure remain unclear. METHODS: This randomized, double-blind, placebo-controlled clinical trial included 43 patients with heart failure and a left ventricular ejection fractio

Mecanismos envolvidos na cardiotoxidade aguda induzida pela doxorrubicina em ratos

A doxorrubicina, ou adriamicina, é uma droga utilizada como agente antineoplásico no tratamento de tumores sólidos e neoplasias hematológicas, principalmente. Apesar de seu amplo uso, apresenta como efeito colateral mais importante a cardiotoxicidade. A toxicidade crônica é bastante conhecida e estudada e cursa com miocardiopatia dilatada e quadro clínico clássico de insuficiência cardíaca. A toxicidade aguda, por cursar com quadro clínico pouco exuberante e manifestar-se através de alterações eletrocardiográficas, é muito pouco diagnosticada e seu mecanismo fisiopatológico não é totalmente conhecido. Os mecanismos envolvidos na toxicidade cardíaca são distintos dos mecanismos de ação da droga e são múltiplos: aumento do estresse oxidativo, aumento da apoptose e alteração na dinâmica intracelular do cálcio. Nossa hipótese é que ocorra lesão estrutural e funcional cardíaca, precocemente, após infusão da doxorrubicina. O objetivo do presente estudo foi avaliar a função ventricular esquerda agudamente após administração de doxorrubicina, a expressão gênica das proteínas reguladoras do trânsito de cálcio, a atividade de metaloproteinases 2 e 9 no miocárdio e alterações das citocinas inflamatórias no miocárdio de ratos tratados com a droga. Para isso, foram utilizados ratos Wistar machos adultos (n=35), que foram submetidos à infusão intraperitoneal de dose única de doxorrubicina de 20 mg/Kg ou volume equivalente de salina (grupo controle). Os animais foram eutanasiados 48 horas após injeção da droga. Todos os ratos foram submetidos ao ecocardiograma antes e 48 horas após a injeção da doxorrubicina. Além da avaliação da função cardíaca in vivo pelo ecocardiograma, a função ventricular esquerda foi avaliada in vitro através de estudo do coração isolado, segundo preparação...Doxorubicin, or adriamycin, is a drug used as an antineoplastic agent in the treatment of solid tumors and hematologic malignancies. Despite of its use, there are several side effects, and the most important is cardiotoxicity. Chronic toxicity is well known and studied. It presented with dilated cardiomyopathy and clinical features of heart failure. The acute toxicity has mild clinical signs manifesting usually as electrocardiographic changes. Probably, this acute effect is underdiagnosed and the pathophysiological mechanism is not fully understood. The mechanisms involved in cardiac toxicity are multiple, and include increased oxidative stress, increased apoptosis and alteration in intracellular calcium dynamics. Our hypothesis is that structural and functional damage occurs in the heart early after infusion of doxorubicin. The purpose of this study was to evaluate left ventricular function acutely after doxorubicin administration. In addition, gene expression of calcium regulatory proteins, activity of metalloproteinases 2 and 9, and inflammatory cytokines in the myocardium of rats treated with this drug will also be evaluated. Thus, we used adult male Wistar rats (n = 35) who received a single-dose, by intraperitoneal infusion, of doxorubicin (20 mg / kg) or equivalent volume of saline (control group). After 48 hours of drug injection the rats were euthanized. All animals were submitted to echocardiography before drug infusion and immediately before euthanasia. Besides in vivo cardiac function evaluation by echocardiography. In vitro left ventricular function was assessed by isolated perfusion heart study, according to Langendorff preparation. We evaluated interstitial collagen and myocyte hypertrophy by light microscopy, and cardiac tissue metalloproteinases 2 and 9 activity was assessed by zymography. In addition... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Protective Effects of Omega-3 Supplementation against Doxorubicin-Induced Deleterious Effects on the Liver and Kidneys of Rats

Anthracycline doxorubicin (DOX) is still widely used as a chemotherapeutic drug for some solid tumors. Although DOX is highly effective, its side effects are limiting factors, such as cardio, nephro and hepatotoxicity. As such, approaches used to mitigate these adverse effects are highly encouraged. Omega 3 (ω-3), which is a class of long-chain polyunsaturated fatty acids, has been shown to have anti-inflammatory and antioxidant effects in preclinical bioassays. Thus, we evaluated the protective effects of ω-3 supplementation on hepatotoxicity and nephrotoxicity induced by multiple DOX administrations in rodents. Male Wistar rats (10 rats/group) were treated daily with ω-3 (400 mg/kg/day) by gavage for six weeks. Two weeks after the first ω-3 administration, the rats received DOX (3.5 mg/kg, intraperitoneal, 1×/week) for four weeks. DOX treatment reduced body weight gain increased systemic genotoxicity and caused liver-related (increase in serum ALT levels, thickness of the Glisson’s capsule, compensatory proliferation and p65 levels) and kidney-related (increase in serum urea and creatinine levels, and incidence of tubular dilatation) deleterious outcomes. In contrast, ω-3 supplementation was safe and abrogated the DOX-related enhancement of systemic genotoxicity, serum urea and creatinine levels. Furthermore, ω-3 intervention reduced by 50% the incidence of kidney histological lesions while reducing by 40–50% the p65 protein level, and the proliferative response in the liver induced by DOX. Our findings indicate that ω-3 intervention attenuated the DOX-induced deleterious effects in the liver and kidney. Therefore, our findings may inspire future mechanistical investigations and clinical interventions with ω-3 on the reported outcomes

Cardiac remodeling induced by smoking: Concepts, relevance, and potential mechanisms

Cardiac or ventricular remodeling is characterized by molecular, cellular, and interstitial alterations that lead to changes in heart size, mass, geometry and function in response to a given insult. Currently, tobacco smoke exposure is recognized as one of these insults. Indeed, tobacco smoke exposure induces the enlargement of the left-sided cardiac chambers, myocardial hypertrophy, and ventricular dysfunction. Potential mechanisms for these alterations include hemodynamic and neurohormonal changes, oxidative stress, inflammation, nitric oxide bioavailability, matrix metalloproteinases and mitogen-activated protein kinase activation. This review will focus on the concepts, relevance, and potential mechanisms of cardiac remodeling induced by tobacco smoke. © 2012 Bentham Science Publishers

Cardiac cachexia and muscle wasting: definition, physiopathology, and clinical consequences

Cachexia and muscle wasting are frequently observed in heart failure patients. Cachexia is a predictor of reduced survival, independent of important parameters such as age, heart failure functional class, and functional capacity. Muscle and fat wasting can also predict adverse outcome during cardiac failure. Only more recently were these conditions defined in International Consensus. Considering that heart failure is an inflammatory disease, cardiac cachexia has been diagnosed by finding a body weight loss .5%, in the absence of other diseases and independent of other criteria. Muscle wasting has been defined as lean appendicular mass corrected for height squared of 2 standard deviations or more below the mean for healthy individuals between 20 years and 30 years old from the same ethnic group. The etiology of heart failure-associated cachexia and muscle wasting is multifactorial, and the underlying physiopathological mechanisms are not completely understood. The most important factors are reduced food intake, gastrointestinal alterations, immunological activation, neurohormonal abnormalities, and an imbalance between anabolic and catabolic processes. Cachexia and muscle wasting have clinical consequences in several organs and systems including the gastrointestinal and erythropoietic systems, and the heart, previously affected by the primary disease. We hope that a better understanding of the mechanisms involved in their physiopathology will allow the development of pharmacological and nonpharmacological therapies to effectively prevent and treat heart failure-induced cachexia and muscle wasting before significant body weight and muscle wasting occurs.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction

Exercise capacity and quality of life (QOL) are important outcome predictors in patients with systolic heart failure (HF), independent of left ventricular (LV) ejection fraction (LVEF). LV diastolic function has been shown to be a better predictor of aerobic exercise capacity in patients with systolic dysfunction and a New York Heart Association (NYHA) classification >II. We hypothesized that the currently used index of diastolic function E/e' is associated with exercise capacity and QOL, even in optimally treated HF patients with reduced LVEF. This prospective study included 44 consecutive patients aged 55±11 years (27 men and 17 women), with LVEF,0.50 and NYHA functional class I-III, receiving optimal pharmacological treatment and in a stable clinical condition, as shown by the absence of dyspnea exacerbation for at least 3 months. All patients had conventional transthoracic echocardiography and answered the Minnesota Living with HF Questionnaire, followed by the 6-min walk test (6MWT). In a multivariable model with 6MWT as the dependent variable, age and E/e' explained 27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis). No association was found between walk distance and LVEF or mitral annulus systolic velocity. Only normalized left atrium volume, a sensitive index of diastolic function, was associated with decreased QOL. Despite the small number of patients included, this study offers evidence that diastolic function is associated with physical capacity and QOL and should be considered along with ejection fraction in patients with compensated systolic HF

Echocardiographic predictors of ventricular remodeling after acute myocardial infarction in rats

Background: The prediction of the ventricular remodeling process after acute myocardial infarction (AMI) may have important clinical implications. Objetive: To analyze echocardiographic variables predictors of remodeling in the infarction model in rats. Methods: The animals underwent echocardiography in two moments, five days and three months after infarction (AMI group) or sham surgery (control group). Linear regression was used to identify the echocardiographic variables on the fifth day after the infarction, which were predictive of remodeling after three months of coronary occlusion. We considered as a criterion of remodeling in this study, the values of left ventricular diastolic diameter (LVDD) after three months of infarction. Results: The infarction induced increase in the left chambers, associated with changes in systolic and diastolic functions. The variables body weight, left ventricular wall stress index (LVWSI), systolic area (SA), diastolic area (DA), LVDD, left ventricular systolic diameter (LVSD), fractional area change (FAC), ejection fraction (EF), fractional shortening (%Short), posterior wall shortening velocity (PWSV) and infarct size assessed five days after infarction were predictors of LVDD after three months. At the multivariate regression analysis, we included the size of infarction, the LVWSI and PWSV. The LVWSI (coefficient: 4.402, standard error: 2.221, p = 0.05), but not the size of infarction and PWSV, was a predictor of remodeling after three months of infarction. Conclusion: LVPSI was an independent predictor of remodeling three months after the myocardial infarction and could be included in the clinical stratification after the coronary occlusion