Alterations In Cardiac Morphology Research Articles

Tcap deficiency impedes striated muscle function and heart regeneration with elevated ROS and autophagy

Telethonin/titin-cap (TCAP) encodes a Z-disc protein that plays important roles in sarcomere/T-tubule interactions, stretch-sensing and signaling. Mutations in TCAP are associated with muscular dystrophy and cardiomyopathy; however, the complete etiology and its roles in myocardial infarction and regeneration are not fully understood. Here, we generated tcap gene knockout zebrafish with CRISPR/Cas9 technology and observed muscular dystrophy-like phenotypes and abnormal mitochondria in skeletal muscles. The stretch-sensing ability was inhibited in tcap‐/‐ mutants. Moreover, Tcap deficiency led to alterations in cardiac morphology and function as well as increases in reactive oxygen species (ROS) and mitophagy. In addition, the cardiac regeneration and cardiomyocyte proliferation ability of tcap‐/‐ mutants were impaired, but these impairments could be rescued by supplementation with ROS scavengers or autophagy inhibitors. Overall, our study demonstrates the essential roles of Tcap in striated muscle function and heart regeneration. Additionally, elevations in ROS and autophagy may account for the phenotypes resulting from Tcap deficiency and could serve as novel therapeutic targets for muscular dystrophy and cardiomyopathy.

CARDIOVASCULAR TOXICITY IN METASTATIC PROSTATE CANCER TREATMENT: BALANCING RISKS, TREATING CONSEQUENCES

Abstract Introduction Enzalutamide inhibits the receptor of androgen hormones. It is administered for treating metastasized prostate cancer. Enzalutamide is known to have a cardiotoxic effect. Case Report A 76 year–old man on–treatment for hypertension and overall good health underwent radical prostatectomy and bilateral ileo–obturator lymphadenectomy in 2021 for prostate cancer. In July 2023, infiltrated lymph node and lung/bone metastases were identified. Therefore, oncologist started Enzalutamide administration, i.e. Androgen Deprivation Therapy. Ecocardiography before therapy showed no alterations in cardiac morphology with normal left ventricle ejection fraction (LVEF). Three months after Enzalutamide administration, he experienced worsening dyspnea and peripheral lower extremity edema. He was admitted to the emergency Department of our hospital due to worsening dyspnea at rest, diffuse crackles and increased values in brain natriuretic peptide (BNP, 3203 pg/mL) and troponins. He was transferred to Intensive Care Unit for acute heart failure. Instrumental findings: 2D ECHOCARDIOGRAPHY: LVEF ∼20%, marked global hypocontractility at strain evaluation (GLS –9.3%); LUNG ULTRASOUND: abundant bilateral basal pleural effusion on the right extending to the middle field with atelectasis of the contiguous parenchyma; 24h Holter ECG: frequent supraventricular and ventricular ectopic arrhythmias. He begins non–invasive ventilation (NIV), high–dose diuretics, and Levosimendan. We observed amelioration in symptoms, reduction in pleural effusion, peripheral edema, and BNP levels (from 3203 pg/ml to 468.6 pg/ml). We proceed with weaning from NIV by monitoring respiratory function and performance by means of blood gas analysis. Amelioration in congestion status was evaluated by bioimpedance. After clinical stabilization, coronary angiography was performed which highlighted a bi–vessel obstructive coronary artery disease (long critical stenosis, ∼80%, on the proximal–middle section of the left anterior descending artery, ∼70% at middle section of circumflex and proximal section of first margianl). Therefore, revascularization by PCI plus DES was performed on proximal–middle LAD and on CX–MO1. Patient was discharged soon after in stable condition and underwent outpatient follow–up. Conclusions Enzalutamide might provoke important cardiotoxic effects. It might induce acute cardiac impairment and/or coronary artery diseases. Further analysis and evaluations should be performed.

Vortex formation time in female athletes

Regular, vigorous physical activity can have a significant impact on cardiac function, leading to cardiac morphological alterations that may be challenging to distinguish from pathological changes. Therefore, new screening methods are needed to accurately differentiate between adaptive changes and pathological alterations in athletes. Vortex formation time (VFT) is an emerging method that shows potential in this regard, as it involves the formation of a rotating vortex ring in the left ventricle during the early filling phase of diastole. In this study, we investigated the difference in VFT between two groups of women: professional handball players and healthy middle-aged female athletes, along with their corresponding control groups. By using echocardiography-Doppler analysis of the heart, VFT was calculated based on the left ventricular ejection fraction, the ratio between the end-diastolic volume and the diameter of the mitral annulus, and the ratio of the atrial contraction volume to the total inflow via the mitral valve. The study reveals a significant increase in VFT in both professional handball players and middle-aged female athletes compared to their respective control groups. Moreover, statistically significant differences between handball players and middle-aged female athletes were observed, indicating that the level of physical activity may affect the VFT. These results suggest that VFT could be a promising screening tool for identifying cardiac adaptations due to long-term vigorous training, potentially enabling more accurate diagnoses of cardiac morphological alterations in athletes.Graphical abstractRepresentation of the graphical abstract of the conducted research

Mice lacking growth-associated protein 43 develop cardiac remodeling and hypertrophy

Growth-associated protein 43 (GAP43) is found in skeletal muscle, localized near the calcium release units. In interaction with calmodulin (CaM), it indirectly modulates the activity of dihydropyridine and ryanodine Ca2+ channels. GAP43–CaM interaction plays a key role in intracellular Ca2+ homeostasis and, consequently, in skeletal muscle activity. The control of intracellular Ca2+ signaling is also an important functional requisite in cardiac physiology. The aim of this study is to define the impact of GAP43 on cardiac tissue at macroscopic and cellular levels, using GAP43 knockout (GAP43−/−) newborn C57/BL6 mice. Hearts from newborn GAP43−/− mice were heavier than hearts from wild-type (WT) ones. In these GAP43−/− hearts, histological section analyses revealed a thicker ventricular wall and interventricular septum with a reduced ventricular chamber area. In addition, increased collagen deposits between fibers and increased expression levels of myosin were observed in hearts from GAP43−/− mice. Cardiac tropism and rhythm are controlled by multiple intrinsic and extrinsic factors, including cellular events such those linked to intracellular Ca2+ dynamics, in which GAP43 plays a role. Our data revealed that, in the absence of GAP43, there were cardiac morphological alterations and signs of hypertrophy, suggesting that GAP43 could play a role in the functional processes of the whole cardiac muscle. This paves the way for further studies investigating GAP43 involvement in signaling dynamics at the cellular level.

Cardiac Alterations on 3T MRI in Young Adults With Sedentary Lifestyle-Related Risk Factors.

BackgroundYoung adult populations with the sedentary lifestyle-related risk factors overweight, hypertension, and type 2 diabetes (T2D) are growing, and associated cardiac alterations could overlap early findings in non-ischemic cardiomyopathy on cardiovascular MRI. We aimed to investigate cardiac morphology, function, and tissue characteristics for these cardiovascular risk factors.MethodsNon-athletic non-smoking asymptomatic adults aged 18–45 years were prospectively recruited and underwent 3Tesla cardiac MRI. Multivariate linear regression was performed to investigate independent associations of risk factor-related parameters with cardiac MRI values.ResultsWe included 311 adults (age, 32 ± 7 years; men, 49%). Of them, 220 subjects had one or multiple risk factors, while 91 subjects were free of risk factors. For overweight, increased body mass index (per SD = 5.3 kg/m2) was associated with increased left ventricular (LV) mass (+7.3 g), biventricular higher end-diastolic (LV, +8.6 ml), and stroke volumes (SV; +5.0 ml), higher native T1 (+7.3 ms), and lower extracellular volume (ECV, −0.38%), whereas the higher waist-hip ratio was associated with lower biventricular volumes. Regarding hypertension, increased systolic blood pressure (per SD = 14 mmHg) was associated with increased LV mass (+6.9 g), higher LV ejection fraction (EF; +1.0%), and lower ECV (−0.48%), whereas increased diastolic blood pressure was associated with lower LV EF. In T2D, increased HbA1c (per SD = 9.0 mmol/mol) was associated with increased LV mass (+2.2 g), higher right ventricular end-diastolic volume (+3.2 ml), and higher ECV (+0.27%). Increased heart rate was linked with decreased LV mass, lower biventricular volumes, and lower T2 values.ConclusionsYoung asymptomatic adults with overweight, hypertension, and T2D show subclinical alterations in cardiac morphology, function, and tissue characteristics. These alterations should be considered in cardiac MRI-based clinical decision making.

Abstract 9096: Young Adults With Early-Onset Cardiovascular Risk Factors Demonstrate Subclinical Alterations in Cardiac Morphology and Function

Background: Overweight, hypertension and type 2 diabetes (risk factors) are associated with subclinical alterations in cardiac morphology and function in asymptomatic mature adults (age >40 years). However, the time and extent of these cardiac alterations is unknown in the young adult (age 21-40 years) population with increasing early-onset risk factors, possibly overlapping findings in cardiomyopathy. Hypothesis: Risk factors already cause subclinical cardiac alterations in asymptomatic young adults. Methods: Non-smoking nonathletic adults aged 21-40 years without cardiac history underwent MRI for assessment of cardiac morphology and function. Multivariate linear regression analysis was performed to investigate the independent association of risk factor related parameters with cardiac outcomes. Results: In total, 279 subjects (49% male, mean age 31±6 years) were included. After adjustment for age, gender and height, all risk factors had significant impact on cardiac outcomes (Table+Figure). Most importantly, higher body mass index was associated with increases in left ventricular (LV) mass (ß=1.30), end-diastolic volumes (EDV) (LV, ß=1.82) and stroke volume (ß=1.04). Further, systolic blood pressure was positively associated with LV mass (ß=0.52), mass-volume ratio (ß=0.0024), stroke volume (ß=0.26) and LV ejection fraction (ß=0.073), and HbA1c with LV mass (ß=0.30) and right ventricular EDV (ß=0.43). Conclusions: In aysmptomatic young adults without cardiovascular disease, risk factors are associated with subclinical cardiac alterations. These alterations should be considered when evaluating clinical scans in young adults to avoid misdiagnosis.

Development of coronary dysfunction in adult progeny after maternal engineered nanomaterial inhalation during gestation

Maternal exposure to environmental contaminants during pregnancy can profoundly influence the risk of developing cardiovascular disease in adult offspring. Our previous studies have demonstrated impaired cardiovascular health, microvascular reactivity, and cardiac function in fetal and young adult progeny after maternal inhalation of nano-sized titanium dioxide (nano-TiO2) aerosols during gestation. The present study was designed to evaluate the development of cardiovascular and metabolic diseases later in adulthood. Pregnant Sprague–Dawley rats were exposed to nano-TiO2 aerosols (~ 10 mg/m3, 134 nm median diameter) for 4 h per day, 5 days per week, beginning on gestational day (GD) 4 and ending on GD 19. Progeny were delivered in-house. Body weight was recorded weekly after birth. After 47 weeks, the body weight of exposed progeny was 9.4% greater compared with controls. Heart weight, mean arterial pressure, and plasma biomarkers of inflammation, dyslipidemia, and glycemic control were recorded at 3, 9 and 12 months of age, with no significant adaptations. While no clinical risk factors (i.e., hypertension, dyslipidemia, or systemic inflammation) emerged pertaining to the development of cardiovascular disease, we identified impaired endothelium-dependent and -independent arteriolar dysfunction and cardiac morphological alterations consistent with myocardial inflammation, degeneration, and necrosis in exposed progeny at 12 months. In conclusion, maternal inhalation of nano-TiO2 aerosols during gestation may promote the development of coronary disease in adult offspring.

Peripheral and Autonomic Neuropathy Status of Young Patients With Type 1 Diabetes Mellitus at the Time of Transition From Pediatric Care to Adult-Oriented Diabetes Care

IntroductionThe prevalence of neuropathic lesions in young patients with type 1 diabetes mellitus (T1DM) at the time of transition from pediatric care to adult-oriented diabetes care is poorly studied. A comparative study with healthy volunteers to assess the possible neuropathic condition of this special population and to identify the potential early screening needs has not been performed yet. The results may provide important feedback to pediatric diabetes care and a remarkable baseline reference point for further follow up in adult diabetes care.Patients and MethodsTwenty-nine young patients with T1DM [age: 22.4 ± 2.9 years; HbA1c: 8.5 ± 2.1%, diabetes duration: 12.2 ± 5.8 years; (mean ± SD)] and 30 healthy volunteers (age: 21.5 ± 1.6 years; HbA1c: 5.3 ± 0.3%) were involved in the study. Autonomic function was assessed by standard cardiovascular reflex tests. Complex peripheral neuropathic testing was performed by Neurometer®, Neuropad®-test, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests.ResultsT1DM patients had significantly higher diastolic blood pressure than controls (80 ± 9 vs. 74 ± 8 mmHg, p < 0.01), but there was no significant difference in systolic blood pressure (127 ± 26 vs. 121 ± 13 mmHg). Cardiovascular reflex tests had not revealed any significant differences between the T1DM patients and controls. No significant differences with Neurometer®, Neuropad®-test, and Monofilament® were detected between the two groups. The vibrational sensing on the radius on both sides was significantly impaired in the T1DM group compared to the controls with Rydel-Seiffer tuning fork test (right: 7.5 ± 1.0 vs. 7.9 ± 0.3; left: 7.5 ± 0.9 vs. 7.9 ± 0.3, p < 0.05). The Tiptherm®-test also identified a significant impairment in T1DM patients (11 sensing failures vs. 1, p < 0.001). In addition, the neuropathic complaints were significantly more frequently present in the T1DM patient group than in the controls (9 vs. 0, p < 0.01).ConclusionIn this young T1DM population, cardiovascular autonomic neuropathy and cardiac morphological alterations could not be found. However, Rydel-Seiffer tuning fork and Tiptherm®-tests revealed peripheral sensory neurological impairments in young T1DM patients at the time of their transition to adult diabetes care.

Sero-Biochemical and Cardiac Morphological Alterations in Broiler Chicken Triggered by Dietary Dexamethasone

Sero-Biochemical and Cardiac Morphological Alterations in Broiler Chicken Triggered by Dietary Dexamethasone

Exaggerated blood pressure response at mild exertional intensity is associated with lower exercise capacity and worsening of cardiac structural and functional profile

Abstract Even with normal blood pressure (BP) measured at rest, some individuals may experience excessive BP elevation with exercise, termed as an “exaggerated BP response to exercise” (ExBPR). The most common definition of ExBPR is SBP ≥210 mm Hg in men and ≥190 mm Hg in women at peak exercise intensity (ExBPR-PI). However, evidence exists that increase in SBP ≥150 mm Hg at an early stage of exercise stress test (i.e. at mild exercise intensity, ExBPR-MI) can effectively identify hypertension not diagnosed by conventional methods. No studies exploring the pathophysiological significance of ExBPR-MI have been undertaken to date. Aim To investigate the association of ExBPR-MI with exercise capacity and cardiac morpho-functional characteristics. Methods A group of 109 subjects (mean age 52±13 yrs) with and without a pre-established diagnosis of hypertension, having clinical indications for an exercise stress test, with seated clinic BP &amp;lt;140/90 mm Hg, underwent resting echocardiographic imagining and cardiopulmonary exercise testing using a ramped Bruce protocol. Results Based on the BP response at 3 minutes of exercise, the population was divided into two subsets: ExBPR-MI+ and ExBPR-MI− (SBP ≥ and &amp;lt;150 mmHg, respectively). The ExBPR-MI+ group was characterized by lower peak oxygen uptake, higher LV mass and left atrial size, and more impaired LV diastolic function (lower E/A and e', and higher E/e'). When the study cohort was stratified using peak BP response, significant differences indicating an adverse impact of ExBPR-PI were demonstrated only for LV diastolic parameters but not for peak VO2 and cardiac morphology indices (Table 1). Conclusions ExBPR-MI predisposes to reduced exercise capacity and detrimental alterations in cardiac morphology and function. As mild exercise intensity is more frequently present during routine daily activities than peak exercise intensity, ExBPR-MI may be a more important pathophysiological contributor to target organ damage than peak BP response, and may represent a potential new target for preventive and therapeutic measures. Table 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Centre Poland

Intensive smolt production is associated with deviating cardiac morphology in Atlantic salmon (Salmo salar L.)

High pre-slaughter mortality rates of Atlantic salmon (Salmo salar L.) are a reoccurring welfare issue and economic burden in aquaculture. Sudden death immediately prior to slaughter is particularly problematic given the considerable resources invested to reach this stage. Although the underlying causes of such mortality are largely unknown, cardiac deformities and diseases have become increasingly prevalent observations in deceased fish. The factors leading to this pathology remains to be revealed. Thus, we presently examined if intensive smolt production and concordant fast growth rates in young fish is associated with altered cardiac morphology at later production stages in Atlantic salmon. The observed alterations were subsequently related to mortality risk following de-lousing in a facility with a cardiomyopathy syndrome (CMS) outbreak.We observed that intensive smolt production is indeed associated with slower growth rates at sea, distinct pathological cardiac morphological alterations, and expression of cardiac pathology markers. Moreover, the observed cardiac alterations co-occurred with CMS-related cardiac rupture at a different production facility. The present study demonstrates a clear link between pace of growth at early rearing stages and cardiac deformities later in life. Furthermore, these cardiac deformities are associated with cardiac rupture and mortality in individuals with CMS during delousing. We therefore believe that a slower pace of smolt production improves cardiac health and reduces the risk of mortality during CMS outbreaks.

Alterations to cardiac morphology and function among high-altitude workers: a retrospective cohort study

ObjectivesExposure to high altitude can affect human health, including the development of adverse cardiovascular effects. This study aimed to investigate alterations in cardiac morphology and function in high-altitude workers and...

Investigating Cardiac Morphological Alterations in a Pentylenetetrazol-Kindling Model of Epilepsy.

Epilepsy is a group of neurological disorders characterized by abnormal electrical activity in the central nervous system (CNS) and recurrent seizures representing the principal clinical manifestation. Sudden unexpected death in epilepsy (SUDEP) is the predominant cause of death in young epileptic patients. SUDEP patients displayed an increased cardiovascular (CV) risk, probably due to an impaired autonomic control of CV functions, but the underlying mechanisms need to be explored yet. Therefore, we aimed to examine the cardiac morphological alterations in a pentylenetetrazol (PTZ)-kindled rat model, a well-established tool for studying chronic epilepsy. To complete this, the distance between the atria, between the atrium and ventricle were measured, the heart was weighed, and the pathological morphology of dissected hearts was analyzed by histological assessment with hematoxylin and eosin staining. A significantly decreased distance between atria and a significant increase in heart weight were observed in PTZ-kindled rats which interestingly also displayed increased hemorrhagic content when compared with controls. Our findings provided evidence that changes in cardiac morphology may be related to autonomic CV dysfunctions occurring during SUDEP while also opening up more avenues to better develop novel drugs for the treatment of this disorder.

Association of glycemic status and segmental left ventricular wall thickness in subjects without prior cardiovascular disease: a cross-sectional study

BackgroundLeft ventricular (LV) hypertrophy and changes in LV geometry are associated with increased cardiovascular mortality. Subjects with type 2 diabetes have an increased risk of such alterations in cardiac morphology. We sought to assess the association of glycemic status and LV wall thickness measured by cardiac magnetic resonance (CMR), and potential interactions of hypertension and diabetes.MethodsCMR was performed on 359 participants from a cross-sectional study nested in a population-based cohort (KORA FF4) free of overt cardiovascular disease. Participants were classified according to their glycemic status as either control (normal glucose metabolism), prediabetes or type 2 diabetes. Segmentation of the left ventricle was defined according to the American Heart Association (AHA) 16-segment model. Measurements of wall thickness were obtained at end-diastole and analyzed by linear regression models adjusted for traditional cardiovascular risk factors.ResultsLV wall thickness gradually increased from normoglycemic controls to subjects with prediabetes and subjects with diabetes (8.8 ± 1.4 vs 9.9 ± 1.4 vs 10.5 ± 1.6 mm, respectively). The association was independent of hypertension and traditional cardiovascular risk factors (β-coefficient: 0.44 mm for prediabetes and 0.70 mm for diabetes, p-values compared to controls: p = 0.007 and p = 0.004, respectively). Whereas the association of glycemic status was strongest for the mid-cavity segments, the association of hypertension was strongest for the basal segments.ConclusionAbnormal glucose metabolism, including pre-diabetes, is associated with increased LV wall thickness independent of hypertension.

Neonatal Growth Restriction Slows Cardiomyocyte Development and Reduces Adult Heart Size.

Prematurity is associated with reduced cardiac dimensions and an increased risk of cardiovascular disease. While prematurity is typically associated with ex utero neonatal growth restriction (GR), the independent effect of neonatal GR on cardiac development has not been established. We tested the hypothesis that isolated neonatal GR decreases cardiomyocyte growth and proliferation, leading to long-term alterations in cardiac morphology. C57BL/6 mice were fostered in litters ranging in size from 6 to 12 pups to accentuate normal variation in neonatal growth. Regardless of litter size, GR was defined by a weight below the 10th percentile. On postnatal day 8, Ki67 immunoreactivity, cardiomyocyte nucleation status and cardiomyocyte profile area were assessed. For adult mice, cardiomyocyte area was determined, along with cardiac dimensions by echocardiography and cardiac fibrosis by Masson's trichrome stain. On day 8, cardiomyocytes from GR versus control mice were significantly smaller and less likely to be binucleated with evidence of persistent cell cycle activity. As adults, GR mice continued to have smaller cardiomyocytes, as well as decreased left ventricular volumes without signs of fibrosis. Neonatal GR reduces cardiomyocyte size, delays the completion of binucleation, and leads to long-term alterations in cardiac morphology. Clinical studies are needed to ascertain whether these results translate to preterm infants that must continue to grow and mature in the midst of the increased circulatory demands that accompany their premature transition to an ex utero existence. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.

Evaluation of the Cardiac Morphologic Alterations Secondary to Autoimmune Thyroid Disorder Using Cardiac Magnetic Resonance Imaging.

Purpose:Thyroid functional disease is associated with clinically significant cardiovascular changes. The aim of this study was to assess changes in the cardiac magnetic resonance imaging of patients with autoimmune thyroid disorders (AITs).Materials and Methods:Forty patients with AIT (12 men, 28 women; age range, 20 to 82 y; mean age, 59 y) were identified and included in our study. In addition, 20 controls (12 men, 8 women; age range, 21 to 76 y; mean age, 50 y) without AIT or cardiac disorders were included.Results:In patients with AIT, the mean value calculated for the end diastolic volume was 161.2 mL, the mean end systolic volume value was 95.3 mL, and the mean left ventricular ejection fraction value was 45.2%. In comparing AIT patients with the control group, we found a significant difference in the end systolic volume, ejection fraction, stroke index, cardiac output, cardiac index, and left ventricular diameter (P<0.05).Conclusions:We conclude that our data show that there is a correlation between thyroid function and cardiac function, as evaluated with cardiac magnetic resonance imaging. This can be useful in the diagnosis of cardiovascular changes associated with AIT.

Cathepsin K knockout protects against cardiac dysfunction in diabetic mice

Diabetes is a major risk factor for cardiovascular disease and the lysosomal cysteine protease cathepsin K plays a critical role in cardiac pathophysiology. To expand upon our previous findings, we tested the hypothesis that, knockout of cathepsin K protects against diabetes-associated cardiac anomalies. Wild-type and cathepsin K knockout mice were rendered diabetic by streptozotocin (STZ) injections. Body weight, organ mass, fasting blood glucose, energy expenditure, cardiac geometry and function, cardiac histomorphology, glutathione levels and protein levels of cathepsin K and those associated with Ca2+ handling, calcineurin/NFAT signaling, insulin signaling, cardiac apoptosis and fibrosis were determined. STZ-induced diabetic mice exhibited distinct cardiac dysfunction, dampened intracellular calcium handling, alterations in cardiac morphology, and elevated cardiomyocyte apoptosis, which were mitigated in the cathepsin K knockout mice. Additionally, cathepsin K knockout mice attenuated cardiac oxidative stress and calcineurin/NFAT signaling in diabetic mice. In cultured H9c2 myoblasts, pharmacological inhibition of cathepsin K, or treatment with calcineurin inhibitor rescued cells from high-glucose triggered oxidative stress and apoptosis. Therefore, cathepsin K may represent a potential target in treating diabetes-associated cardiac dysfunction.

Estudo clínico e de fatores de risco associados às alterações cardiovasculares em cães1

RESUMO: O conhecimento clínico das alterações cardíacas em cães é de fundamental importância na formulação de diagnósticos diferenciais e instituição terapêutica na rotina da Clínica Médica de Pequenos Animais. Objetivaram-se com este estudo descrever os aspectos clínicos, epidemiológicos e radiográficos inerentes as alterações cardiovasculares de cães cardiopatas atendidos no Hospital Veterinário de Patos-PB (HV). Para isso foram avaliados os prontuários clínicos de todos os animais atendidos no período de Janeiro de 2007 a Dezembro de 2012, selecionando-se 131 cães (GCARD) que apresentavam histórico, alterações clínicas e radiográficas compatíveis com cardiopatia. Para fins comparativos, um grupo controle sem cardiopatia de igual número foi criado (GCON). Para análise estatística foram utilizados o teste de qui-quadrado ou teste exato de Fisher e regressão logística múltipla, com nível de significância de 5%, utilizando-se o programa SPSS 20.0 for Windows. Edema pulmonar e alterações morfológicas cardíacas foram os achados radiográficos mais frequentes. Não houve diferença quanto ao sexo e prevaleceram os animais mais velhos e da raça poodle. Tosse, cansaço e tristeza foram as queixas mais comuns. Sopro, tártaro e alterações oculares foram os sinais clínicos de maior ocorrência. As variáveis relacionadas ao engasgo, tontura/fraqueza, creptação pulmonar, ascite, obesidade, tumor e tártaro foram identificadas como associadas às cardiopatias. O modelo final apresentou ajuste satisfatório (teste de Hosmer e Lemeshow: χ2=0,221; P=0,994; R2 = 0,46). Mesmo que não seja possível determinar o diagnóstico etiológico das cardiopatias, faz-se necessário que um amplo conhecimento clínico e epidemiológico destes seja cada vez mais consolidado, de modo que as consequências fisiopatológicas dos distúrbios cardíacos sejam rapidamente identificados, trazendo qualidade de vida a todos os pacientes cardiopatas.

Reversible alterations in cardiac morphology and functions in a patient with Cushing's syndrome.

SummaryA 45-year-old female was referred for endocrine evaluation of an incidental mass (31×24 mm in diameter) on the right adrenal gland. The patient was normotensive and nondiabetic, and had no history of generalised obesity (body weight, 46 kg at 20 years of age and 51.2 kg on admission); however, her waist-to-hip ratio was 0.97. Elevated urinary free cortisol levels (112–118 μg/day) and other findings indicated adrenocorticotrophic hormone-independent Cushing's syndrome due to right adrenocortical adenoma. Echocardiography before adrenalectomy revealed concentric left ventricular (LV) hypertrophy with a particular increase in interventricular septum thickness leading to impaired systolic and diastolic functions. Upon surgical remission of hypercortisolism, the asymmetric hypertrophy disappeared and the cardiac dysfunctions were considerably ameliorated. Although the mechanism(s) by which excessive cortisol contributes to LV wall thickness remain(s) unclear, serial echocardiography and cardiac multidetector-row computed tomography may support the notion that abnormal fat deposition in the myocardium owing to hypercortisolism appears to be an important factor for the reversible change in the cardiac morphology.Learning points Patients with Cushing's syndrome occasionally exhibit severe LV hypertrophy related to systolic and diastolic dysfunctions although they have neither hypertension nor diabetes mellitus.Biological remission of hypercortisolism can normalise structural and functional cardiac parameters and help in differentiating the cardiac alterations induced by excessive cortisol from those induced by other diseases.Excessive lipid accumulation within the heart before myocardial fibrosis may be implicated in reversible alterations in the cardiac morphology by Cushing's syndrome.Early diagnosis and treatment of Cushing's syndrome appear to be pivotal in preventing irreversible cardiac dysfunctions subsequent to cardiovascular events and heart failure.

Impact of prehypertension on left ventricular structure, function and geometry.

Awareness of prevalence, determinants, and prognosis of asymptomatic untreated prehypertension is still lacking especially in India and subcontinent. The present study was to assess the effects of prehypertension on structure, function and geometrical pattern of left ventricle on the basis of left ventricular mass (LVM), left ventricular mass indexed to height (LVMI/Ht), and relative wall thickness (RWT) recorded by echocardiography based on the American society of echocardiography (ASE) convention. The study population included prehypertensives (n 61; 31 M, 30 F) and normotensives (n 38; 19 M, 19 F) between age 25 and 65 years, and were assessed by echocardiography. It was observed that the stroke volume (SV), cardiac output (CO), cardiac index (CI), body mass index (BMI), body surface area (BSA), were found to be little elevated but was not significant in hypertensive females compared to normotensives. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse pressure (PP), mean arterial pressure (MAP), end systolic stress (ESS), and end isovolumetric systolic stress (EISS) were significantly elevated (p<0.001) in female prehypertensives compared to normotensives. Left ventricular mass (LVM) was significantly (p< 0.05) elevated, indicating alterations in cardiac morphology and functions even during prehypertensive stage. However, in prehypertensive males, SBP, DBP, HR, PP, MAP, ESS, and EISS were significantly (<0.001) raised; ejection fraction (EF%) and fractional fibre shortening (FS%) were noted to be within normal range in both sexes. Prehypertensive males showed changes in left ventricular geometry in the form of concentric remodeling (CR-3.44%), eccentric hypertrophy (EH-3.44%) and concentric hypertrophy (CH-13.79%). Prehypertensive females showed (CR-6.45%), (EH-3.22%) and (CH-6.4%). Such findings carry prognostic implication and require further population survey involving a larger group. Early diagnosis of prehypertension will help to take necessary preventive measures to reduce mainly the future cardiovascular complications. The care of prehypertensive subjects should include, to reduce the afterload in order to improve the left ventricular contractile state as early as possible. So it is advisable to do routine echocardiography after the age of 40 years.