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PubMed | Federal University of Health Sciences, Porto Alegre, Institute Cardiologia Fundacao Of Cardiologia Ic Fuc, University of Sao Paulo and Lutheran University of Brazil
Type: | Journal: Cytokine | Year: 2016

New vessels are formed in response to stimuli from angiogenic factors, a process in which paracrine signaling is fundamental.To investigate the cooperative paracrine signaling profile in response to Vascular Endothelial Growth Factor (VEGF) gene therapy in patients with coronary artery disease (CAD) and refractory angina.A cohort study was conducted in which plasma was collected from patients who underwent gene therapy with a plasmid expressing VEGF 165 (10) and from surgical procedure controls (4). Blood samples were collected from both groups prior to baseline and on days 3, 9 and 27 after the interventions and subjected to systemic analysis of protein expression (Interleukin-6, IL-6; Tumor Necrosis Factor-, TNF-; Interleukin-10, IL-10; Stromal Derived Factor-1 , SDF-1; VEGF; Angiopoietin-1, ANGPT-1; and Endothelin-1, ET-1) using the enzyme-linked immunosorbent assay (ELISA).Analysis showed an increase in proinflammatory IL-6 (p=0.02) and ET-1 (p=0.05) on day 3 after gene therapy and in VEGF (p=0.02) on day 9. A strong positive correlation was found between mobilization of endothelial progenitor cells and TNF- on day 9 (r=0.71; p=0.03). Furthermore, a strong correlation between -blockers, antiplatelets, and vasodilators with SDF-1 baseline in the group undergoing gene therapy was verified (r=0.74; p=0.004).Analysis of cooperative paracrine signaling after VEGF gene therapy suggests that the immune system cell and angiogenic molecule expression as well as the endothelial progenitor cell mobilization are time-dependent, influenced by chronic inflammatory process and continuous pharmacological treatment.


Brum C.A.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Stein A.T.,Federal University of Health Sciences, Porto Alegre | Stein A.T.,Grupo Hospitalar Conceicao GHC | Stein A.T.,Lutheran University of Brazil | And 2 more authors.
Arquivos Brasileiros de Cardiologia | Year: 2015

Background: Infant mortality has decreased in Brazil, but remains high as compared to that of other developing countries. In 2010, the Rio Grande do Sul state had the lowest infant mortality rate in Brazil. However, the municipality of Novo Hamburgo had the highest infant mortality rate in the Porto Alegre metropolitan region. Objectives: To describe the causes of infant mortality in the municipality of Novo Hamburgo from 2007 to 2010, identifying which causes were related to heart diseases and if they were diagnosed in the prenatal period, and to assess the access to healthcare services. Methods: This study assessed infants of the municipality of Novo Hamburgo, who died, and whose data were collected from the infant death investigation records. Results: Of the 157 deaths in that period, 35.3% were reducible through diagnosis and early treatment, 25% were reducible through partnership with other sectors, 19.2% were non-preventable, 11.5% were reducible by means of appropriate pregnancy monitoring, 5.1% were reducible through appropriate delivery care, and 3.8% were ill defined. The major cause of death related to heart disease (13.4%), which was significantly associated with the variables ‘age at death’, ‘gestational age’ and ‘birth weight’. Regarding access to healthcare services, 60.9% of the pregnant women had a maximum of six prenatal visits. Conclusion: It is mandatory to enhance prenatal care and newborn care at hospitals and basic healthcare units to prevent infant mortality. © 2015, Arquivos Brasileiros de Cardiologia. All rights reserved.


PubMed | Federal University of Health Sciences, Porto Alegre, Institute Cardiologia Fundacao Of Cardiologia Ic Fuc and Institute Cardiologia do Rio Grande do Sul
Type: | Journal: Journal of the International Society of Sports Nutrition | Year: 2015

Conjugated linoleic acid (CLA) is highly found in fats from ruminants and it appears to favorably modify the body composition and cardiometabolic risk factors. The capacity of CLA to reduce the body fat levels as well as its benefic actions on glycemic profile, atherosclerosis and cancer has already been proved in experimental models. Furthermore, CLA supplementation may modulate the immune function, help re-synthetize of glycogen and potentiate the bone mineralization. CLA supplementation also could increase the lipolysis and reduce the accumulation of fatty acids on the adipose tissue; the putative mechanisms involved may be its action in reducing the lipase lipoprotein activity and to increase the carnitine-palmitoil-transferase-1 (CAT-1) activity, its interaction with PPAR, and to raise the expression of UCP-1. Although studies made in human have shown some benefits of CLA supplementation as the weight loss, the results are still discordant. Moreover, some have shown adverse effects, such as negative effects on glucose metabolism and lipid profile. The purpose of this article is to review the available data regarding the benefits of CLA on the energetic metabolism and body composition, emphasizing action mechanisms.


Abelin A.P.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | David R.B.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Gottschall C.A.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Quadros A.S.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc
Canadian Journal of Cardiology | Year: 2014

Background: Comparisons between dedicated risk scores in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) in real-world clinical practice are scarce. The aim of this study was to assess the diagnostic performance of the Global Registry of Acute Coronary Events (GRACE), Primary Angioplasty in Myocardial Infarction (PAMI), Thrombolysis in Myocardial Infarction (TIMI), and Zwolle scores in STEMI patients undergoing pPCI in contemporary clinical practice. Methods: This was a prospective cohort study of consecutive patients with STEMI undergoing pPCI between December 2009 and November 2010 in a high-volume tertiary referral centre. The outcomes assessed were major cardiovascular events (MACEs) and death within 30 days. The diagnostic accuracy of the scores was assessed using receiver operating characteristic curves, and scores were compared using the DeLong method. Results: During the study period, 501 patients were included. Within 30 days, 62 patients (12.4%) presented a MACE and 39 individuals (7.8%) died. All scores were statistically associated with death and MACE within 30 days (P < 0.01). The c-statistic and 95% confidence intervals for 30-day mortality were: GRACE, 0.84 (0.78-0.90); TIMI, 0.81 (0.74-0.87); Zwolle, 0.80 (0.73-0.87); and PAMI, 0.75 (0.68-0.82) (P < 0.01). There was no statistically significant difference regarding the accuracy of the TIMI, GRACE, and Zwolle scores for 30-day mortality, but the GRACE score was superior to the PAMI score (P < 0.01). Conclusions: The TIMI, GRACE, and Zwolle scores performed equally well as predictors of mortality in patients who underwent pPCI in current practice. These results suggest that these scores are suitable options for risk assessment in a real-world setting. © 2014 Canadian Cardiovascular Society.


Bertoletti J.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Marx G.C.,Federal University of Health Sciences, Porto Alegre | Hattge Junior S.P.,Federal University of Health Sciences, Porto Alegre | Pellanda L.C.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Pellanda L.C.,Federal University of Health Sciences, Porto Alegre
Arquivos Brasileiros de Cardiologia | Year: 2014

Advances in cardiac surgery techniques and early diagnosis have enabled the increased survival of individuals with congenital heart disease. The investigation of the quality of life in children and adolescents with congenital heart disease provides complementary information to clinical data that can assist in decision making on the part of health professionals. Although many studies have been conducted to investigate the quality of life of children and adolescents with congenital heart disease, the results prove to be contradictory; while some studies show that congenital heart disease can impact the quality of life, others describe a better perception of quality of life among children and adolescents who suffer from the disease when compared with healthy control subjects. The purpose of this study is to review the literature on the assessment of health related quality of life in children and adolescents with congenital heart disease, in order to systematize the existing knowledge on this topic today. It is observed that research seeks to investigate aspects of personality in cardiac patients, their coping strategies used and perceived social support, aiming at better understanding the association of these variables with the level of quality of life in this population.


David R.B.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Almeida E.D.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Cruz L.V.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Sebben J.C.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | And 5 more authors.
Arquivos Brasileiros de Cardiologia | Year: 2014

Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01).Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate.Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention.Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. © 2014, Arquivos Brasileiros de Cardiologia. All rights reserved.


Schommer V.A.,Federal University of Health Sciences, Porto Alegre | Barbiero S.M.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Cesa C.C.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Oliveira R.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | And 3 more authors.
Arquivos Brasileiros de Cardiologia | Year: 2014

Background: The prevalence of hypertension among children and adolescents is estimated to range between 1% and 13%. Excess weight and central obesity are related to blood pressure levels in adults, and may be important in the early pathogenesis of SH when present in childhood. Objectives: To study the association between anthropometric variables and blood pressure levels in schoolchildren from the 5th and 8th grades, and to identify which parameter was more strongly correlated with blood pressure levels. Methods: Contemporary cross-sectional study with probabilistic population-based cluster sampling of schoolchildren enrolled from the 5th to the 8th grades in public elementary schools of Porto Alegre. Data on familial risk factors and anthropometry were collected. Statistical analysis included correlations and cluster-adjusted confidence intervals. Results: The mean age of participants was 12.57 (± 1.64) years, and 55.2% of them were females. Abnormal blood pressure levels were found in 11.3% of the sample and borderline values, in 16.2%. Among the anthropometric variables analyzed, hip circumference was the one with the strongest correlation with increased blood pressure (r = 0.462, p < 0.001), followed by waist circumference (r = 0.404, p < 0.001) and abdominal skinfold (r = 0.291, p < 0.001). Conclusion: We observed an association of waist circumference and skinfolds with increased blood pressure levels in the schoolchildren of the sample. Therefore, it is of the utmost importance that early measurements of blood pressure, and waist and hip circumferences become a routine in health services in order to prevent this condition.


Mascia Gottschall C.A.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Sarmento-Leite R.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | Welter D.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc | De Quadros A.S.,Institute Cardiologia Fundacao Of Cardiologia Ic Fuc
Revista Brasileira de Cardiologia Invasiva | Year: 2010

Background: Clinical restenosis after coronary stenting is generally treated by target vessel revascularization (TVR). This study was aimed at reporting the clinical profile and outcomes of patients with symptomatic in-stent restenosis (ISR) who were not submitted to a TVR. Method: Patients who presented clinical restenosis after coronary stenting between January 1997 and December 2001 were identified. Clinical and angiographic characteristics and clinical outcomes of patients who did not undergo a new revascularization (no-TVR group) were compared with revascularized patients (TVR group). All of the patients had at least 2 years of follow-up for the occurrence of major adverse cardiac events (MACE) after stent implantation. Results: In the study period, 1,221 stents were implanted in 1,149 patients. ISR was observed in 135 patients (12%), of which 104 had complete clinical and angiographic follow-up, 23 in the no-TVR group and 81 in the TVR group. The mean follow-up period after coronary stenting was 30.8 ± 7.5 months. Patients in the no-TVR group had a significantly higher percent of one vessel disease (82% vs. 47%; P < 0.01). Patients in the no-TVR group had a long-term MACE rate of 21.7% (5 patients: 2 deaths, 3 myocardial infarctions), whereas those submitted to a new revascularization showed a subsequent MACE rate of 9.8% (8 patients: 1 death, 4 myocardial infarctions, 3 coronary artery bypass graft surgery; P = 0.11). Conclusion: Patients with clinical ISR not treated with a TVR more frequently presented one-vessel disease and a trend towards higher incidence of MACE when compared to those treated with a new TVR.


PubMed | Institute Cardiologia Fundacao Of Cardiologia Ic Fuc
Type: | Journal: American heart journal | Year: 2016

Contemporary studies assessing the frequency, characteristics, and outcomes of serious infections (SIs) in patients presenting a ST-elevation myocardial infarction are scarce.Prospective cohort of consecutive patients undergoing primary percutaneous coronary intervention (pPCI). Serious infection was defined as the presence of infection that prolonged hospitalization. Community-acquired infection (CAI) was defined by SI diagnosed in the first 72 hours of hospitalization, whereas hospital-acquired infections (HAI) were those diagnosed after 72 hours of hospital admission.From December 2009 to November 2012, 1,486 patients were included in the analysis. Serious infection was present in 58 (3.9%) individuals; 30 (2%) patients had CAI and 28 (1.9%) patients had HAI. Respiratory tract infection was responsible for 82% of the SI. Patients with SI were older, had more comorbidities, and had worse angiographic results of the pPCI procedure when compared with those without SIs. After multivariable adjustment, SI was associated with an approximately 10-fold risk of 30-day death. Patients with CAI had more often a history of smoking, Killip III/IV on hospital admission, worse pPCI, and angiographic results than did patients with HAI. However, no differences were seen in 30-day major cardiovascular outcomes between patients with CAI and HAI.In a contemporary cohort of unselected ST-elevation myocardial infarction patients representative of the daily practice, SI was uncommon but associated with worse pPCI results and high risk of mortality. The occurrences of CAI or HAI were similar, but CAI patients presented distinctly worse angiographic outcomes than did patients with HAI.

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