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Influência da hipertensão renovascular materna sobre a pressão arterial e o comportamento ingestivo espontâneo e induzido por privação hídrica e reidratação parcial

Wed, 01 Jan 2025 00:00:00 GMT

Título: Influência da hipertensão renovascular materna sobre a pressão arterial e o comportamento ingestivo espontâneo e induzido por privação hídrica e reidratação parcial Autor(es): Brasil, Raquel Nogueira de Almeida Abstract: Cardiovascular diseases, including arterial hypertension (AH), are among the leading causes of death worldwide. In its secondary form, renovascular hypertension can be experimentally reproduced using the two-kidney, one-clip (2K1C) model, characterized by the exacerbated activation of the renin-angiotensin-aldosterone system (RAAS). Considering that maternal activation of this system during pregnancy may influence the development of fetal neuroendocrine circuits, this study aimed to investigate the effects of maternal renovascular hypertension induced by the 2K1C model on offspring ingestive behavior and cardiovascular parameters after the water deprivation and partial rehydration (WD-PR) protocol. Wistar female rats underwent either 2K1C or sham surgery. After six weeks, females were mated, and the offspring (males and females) were monitored for 13 days in metabolic cages, with evaluations of food, water, and 0.3 M NaCl intake, urinary volume, and cardiovascular parameters. The 2K1C model induced increased systolic and mean arterial pressure in dams without significant changes in heart rate. Male offspring of hypertensive dams presented higher body weight, sodium intake and retention, and elevated mean arterial pressure, while female offspring of non hypertensive 2K1C dams showed similar ingestive behavior but lower blood pressure. These findings suggest that maternal RAAS activation during pregnancy influences the development of central mechanisms controlling hydroelectrolytic and cardiovascular regulation in offspring, supporting the hypothesis of fetal programming effects with sex-specific outcomes. Tipo: Dissertação

DAPA-HT: segurança e tolerabilidade da Dapagliflozina em transplantados cardíacos: ensaio controlado

Wed, 01 Jan 2025 00:00:00 GMT

Título: DAPA-HT: segurança e tolerabilidade da Dapagliflozina em transplantados cardíacos: ensaio controlado Autor(es): Sousa, Luma Maria Tavares de Abstract: Heart transplant recipients frequently develop cardiometabolic complications, including diabetes, weight gain, hyperuricemia, and renal dysfunction, which negatively affect long- term outcomes. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in the general population, but their safety and efficacy remain poorly studied in heart transplant recipients. We conducted a prospective, open-label, single-center clinical trial at Messejana Hospital, Brazil, including adult heart transplant recipients between 2015 and 2023 with at least 6 months of follow-up; patients with GFR <25 mL/min/1.73m² were excluded. A total of 56 patients were analyzed; 28 received dapagliflozin 10 mg daily and were matched 1:1 to controls by sex, age (±10 years), and time post-transplant (±12 months). Outcomes included cardiometabolic and renal parameters, as well as adverse effects. Vital signs and laboratory values were collected at baseline, 3, and 6 months. Continuous and categorical variables were summarized with standard descriptive statistics, and group comparisons were performed with parametric or non-parametric tests, as appropriate. Fifty-six heart transplant recipients were included (mean age 51.2 ± 11.9 years; mean time post transplant 43.7 ± 38.8 months; 79% male). Type 2 diabetes mellitus was present in 20%. Groups were comparable at baseline except for systemic hypertension. Body weight increased significantly in controls (+2.56 kg; 95% CI 1.16–3.96; p=0.001) but not in the intervention group (+0.50 kg; 95% CI −1.03–2.03; p=0.51), with a significant between-group difference (Δ −2.06 kg; 95% CI −4.08 to −0.05; p=0.045). Blood pressure, serum creatinine, urea, HbA1c, CRP, and NT-proBNP showed no significant differences. Uric acid showed a borderline reduction favoring intervention (Δ −0.87; 95% CI −1.77 to +0.02; p=0.056). Hematocrit increased significantly with dapagliflozin (+2.24; 95% CI 0.10–4.38; p=0.041). The risk of CMV infection was identical in both groups (17.9%). Only one episode of balanoposthitis occurred in the intervention group; no UTI, hypotension, amputation, or diabetic ketoacidosis were observed. In this sample of heart transplant recipients, SGLT2i use was associated with few adverse events, including one balanoposthitis in the intervention group; no UTI, hypotension, amputation, or ketoacidosis were observed. No significant changes in renal function. Benefits previously observed in the general population, including attenuation of weight gain, increased hematocrit, and a favorable trend in uric acid, were also noted, supporting safety and suggesting that cardiometabolic and renal benefits may extend to this population, independent of diabetes. Tipo: Dissertação

Avaliação da eficácia dos testes para diagnóstico de disautomia cardiovascular

Wed, 01 Jan 2025 00:00:00 GMT

Título: Avaliação da eficácia dos testes para diagnóstico de disautomia cardiovascular Autor(es): Brasil, Helena Nogueira Abstract: Autonomic nervous system dysfunction encompasses a wide spectrum of clinical syndromes that are often underdiagnosed and carry significant implications for morbidity and mortality. Among them, cardiovascular autonomic neuropathy (CAN) stands out, particularly in individuals with diabetes mellitus (DM), and is considered an independent marker of cardiovascular risk. This study aimed to evaluate the performance of the seven-test protocol—comprising four classical cardiovascular autonomic reflex tests (CARTs) and three spectral heart rate variability (HRV) tests—in diagnosing CAN in a population with clinical suspicion of autonomic dysfunction, not exclusively diabetic. A total of 177 patients referred for autonomic assessment between 2017 and 2024 were analyzed. In addition to using statistical tests such as Student’s t-test and Mann-Whitney, we assessed diagnostic accuracy through ROC curves, calculating the area under the curve (AUC), sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). A p-value < 0.05 was considered statistically significant. The mean age was 53.3 ± 21.5 years, with a predominance of females. The most prevalent autonomic syndrome was neurogenic orthostatic hypotension (58.8%). The prevalence of established CAN (≥3 positive tests) was only 18%. The spectral HRV components outperformed the CARTs. The very low-frequency (VLF) component showed an AUC of 0.854, with 81.2% sensitivity and 89.5% specificity; the high-frequency (HF) component presented an AUC of 0.842, sensitivity of 78.1%, and specificity of 90.2%, with an overall diagnostic accuracy of 88%. In contrast, respiratory-based reflex tests had low sensitivity but maximum specificity (100%). The classic CARTs score also showed low sensitivity (25%), limiting its utility as a standalone screening tool. Age was the only demographic factor significantly associated with CAN. Based on these findings, we propose a two-stage assessment model. The first stage—screening—includes the three spectral HRV components (VLF, LF, and HF), given their high sensitivity. The presence of at least one abnormal component indicates the need for further diagnostic investigation. The second stage—confirmation—is based on the reflex tests with the highest specificity: Valsalva ratio, 30:15 coefficient, and the 3-minute orthostatic blood pressure response. The diagnosis of CAN is supported when at least one confirmatory test is abnormal. This strategy aims to enhance the efficiency and reduce the cost of autonomic evaluation compared to the full seven-test protocol. This study contributes to the ongoing discussion on standardizing CAN diagnosis and proposes a more sensitive, objective, and clinically applicable approach. Tipo: Dissertação

Avaliação da técnica do strain do átrio esquerdo em pacientes portadores de fibrilação atrial antes e após ablação

Wed, 01 Jan 2025 00:00:00 GMT

Título: Avaliação da técnica do strain do átrio esquerdo em pacientes portadores de fibrilação atrial antes e após ablação Autor(es): Reis, Patrícia Feitosa Frota dos Abstract: Introduction: Diastolic assessment in patients with atrial fibrillation (AF) is a complex task. As the most common arrhythmia worldwide, affecting approximately 2% of the population, left atrial strain has emerged as a valuable tool in evaluating patients with heart failure with preserved ejection fraction and AF. This non-invasive technique can characterize and quantify the regional deformation of the left atrium, reflecting its compliance and potential fibrosis. It is composed of reservoir strain, conduit strain, and contraction strain. This technology has been investigated to predict successful response to AF ablation, its association with the presence of thrombus in the left atrial appendage, and the occurrence of incidental AF in patients with cryptogenic stroke. Objective: To compare left atrial strain in patients with atrial fibrillation before and after ablation. Methods: A prospective cohort study was conducted between June 2023 and January 2025 at the echocardiography department of Hospital Oto Aldeota, Fortaleza, Ceará, Brazil. Data were analyzed from patients referred to the service for transesophageal echocardiography prior to AF ablation. Multiple echocardiographic variables were assessed: j y S ’ ’ w k emptying velocity in the left atrial appendage, left atrial strain (reservoir, conduit, and contraction) in apical 4- and 2-chamber views. After three months, the same variables were obtained and compared. For the analysis of continuous variables with normal distribution, comparisons between two dependent groups were performed using the paired t-test. For non- normally distributed variables, the Wilcoxon test was applied, and the McNemar test was used for comparisons between categorical variables before and after ablation. Results: Thirty-nine patients with AF (61.5% paroxysmal AF and 38.5% persistent AF) were analyzed before and after ablation. A statistically significant increase was observed in reservoir, conduit, and contraction strain parameters after ablation and maintenance of sinus rhythm. Improvement in w w E/ ’ ’ w values, as well as reductions in left atrial volume and diameter and improvements in left ventricular global longitudinal strain values. Conclusion: Left atrial strain is a valuable tool in patients with AF, showing a marked improvement after restoration of sinus rhythm and increased values associated with reduced left atrial volume and improved diastolic function. Tipo: Dissertação