Intra-aortic Balloon Pump: Reviewing its Role in Cardiogenic Shock

Cardiogenic shock is a high-mortality condition caused, mostly, by ST-elevation myocardial infarction. When the adequate therapy is implemented in a timely fashion, recovery can be achieved. Treatment is based on intensive care measures, vasoactive drugs, early revascularization and the use of assist circulatory devices. In this review, the authors aim to discuss the available evidence on the use of intra-aortic balloon pump (IABP) in this clinical setting

Diet and Inflammation: Effects of Macronutrients and Dietary Patterns

Cardiovascular disease (CVD) has already been demonstrated to be related to a chronic and complex inflammatory process, in which the loss of endothelial protective properties - the so-called endothelial dysfunction - plays a central role. A number of different approaches, both pharmacological and non-pharmacological, have been tested with inconclusive results so far. One field of special interest is the impact of the different macronutrients and dietary patterns in the inflammatory response that, ultimately, leads to endothelial dysfunction and increased cardio-metabolic risk. Although apparently simple, interventions regarding dietary habits have complex implications and involve a number of covariates that may interfere in the final results. To date, results about the protective effects of diet - in general - regarding cardio-metabolic risk remain to be fully proven

Effects of Physical Activity on The Inflammatory Process Related to Insulin Resistance and Obesity

Atherosclerosis, the pathophysiological substrate for cardiovascular disease (CVD), is the final stage of an inflammatory cascade. During the process, endothelial dysfunction ensues and the inflammatory state is perpetuated. A number of traditional risk factors, as obesity and insulin resistance/type 2 diabetes, are characterized by a proinflammatory state as well, with increased levels of cytokines, interleukins, vasoactive peptides and enhanced expression of specific cellular receptors. The anti-inflammatory properties of physical exercise and its positive effects as a strategy for obesity and insulin resistance have already been shown in terms of cardiovascular protection and survival

iWONDER (Imaging WhOle vessel coroNary tree with intravascular ultrasounD and iMap® in patiEnts with acute myocaRdial infarction) study: rationale and study design

BACKGROUND: Intravascular ultrasound (IVUS) provides a sensitive and reproducible measurement of coronary artery dimensions, atherosclerotic plaque, and arterial lumen. Advances in IVUS technology now allow the characterization of the composition and morphology of atherosclerotic plaques. Although previous studies have reported data using IVUS radiofrequency analysis, the use of a new modality (iMap®, Boston Scientific, Santa Clara, USA) of atherosclerotic plaque characterization is very little known. Our objective is to analyze the morphological, phenotypic and tissue characteristics of culprit and non-culprit atherosclerotic plaques determined by angiography in patients undergoing coronary angiography due to acute myocardial infarction (AMI). METHODS: Prospective, cross-sectional, single center study (Hospital São Paulo - Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP)/UNIFESP, São Paulo, SP, Brazil). Fifty patients will be selected for ultrasound analysis according to the following inclusion criteria: age < 75 years, non-ST-segment elevation AMI or recent ST-segment elevation AMI, with or without previous fribrinolytic agents. CONCLUSIONS: The present study is aimed at obtaining morphological, phenotypic and tissue characteristics of the atherosclerotic plate using an imaging modality not extensively evaluated in patients with AMI.INTRODUÇÃO: O ultrassom intracoronário (USIC) é um método capaz de fornecer medida sensível e reprodutível das dimensões da artéria coronária, da placa aterosclerótica e do lúmen arterial. Avanços em sua tecnologia permitem agora a caracterização da composição e da morfologia das placas ateroscleróticas. Embora estudos prévios tenham reportado dados utilizando USIC com análise de radiofrequência, o uso de uma nova modalidade (iMap®, Boston Scientific, Santa Clara, Estados Unidos) de caracterização da placa aterosclerótica é muito pouco conhecida. Nosso objetivo será analisar as características morfológicas, teciduais e fenotípicas das placas ateroscleróticas consideradas angiograficamente culpadas e não-culpadas em pacientes submetidos a angiografia coronária decorrente de infarto agudo do miocárdio (IAM). MÉTODOS: Estudo prospectivo, transversal, em único centro (Hospital São Paulo - Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP)/UNIFESP, São Paulo, SP, Brasil). Serão selecionados 50 pacientes para análise ultrassonográfica, de acordo com os seguintes critérios de inclusão: idade < 75 anos, IAM sem supradesnivelamento do segmento ST ou IAM com supradesnivelamento do segmento ST recente, com ou sem uso de fibrinolítico prévio. CONCLUSÕES: O presente estudo objetivará a caracterização morfológica, tecidual e fenotípica da placa aterosclerótica utilizando uma nova modalidade de imagem ainda pouco estudada em pacientes com IAM.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Setor de Hemodinâmica e Cardiologia IntervencionistaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaBoston Scientific Setor de Imagem em Cardiologia IntervencionistaHospital Israelita Albert EinsteinUNIFESP, EPM, Setor de Hemodinâmica e Cardiologia IntervencionistaUNIFESP, EPMSciEL