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Blume C.A.,Cardiology Institute of Rio Grande Do Sul | Boni C.C.,Cardiology Institute of Rio Grande Do Sul | Casagrande D.S.,Federal University of Rio Grande do Sul | Casagrande D.S.,Grande Rio University | And 4 more authors.
Obesity Surgery | Year: 2012

Background Bariatric surgery is considered the most effective treatment for obesity class II and III. However, postoperative side effects may occur, such as nutritional deficiencies resulting from reduced gastric capacity and alterations in nutrient absorption along the gastrointestinal tract. Methods A total of 170 patients (136 women and 34 men) submitted to Roux-en-Y gastric bypass (RYGB) between 2000 and 2005 were retrospectively assessed. Anthropometric and laboratory data were evaluated and the use of vitamin and mineral supplements, before and 1, 6, 12, 24, and 36 months following surgery, was assessed, as well. Results Mean excess weight loss at 24 and 36 months was 81.5±19.2 and 78.5±20.8 %, respectively. Anemia was present in 6.5 % of subjects prior to the surgery and increased to 33.5 % at 36 months. The levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and glycemia were reduced, while high-density lipoprotein cholesterol was increased. Albumin and vitamin B12 levels showed no significant differences at the end of the study compared to the preoperative evaluation. Folic acid levels increased significantly during the follow-up. Almost 6 % of the patients had used standard vitamin and mineral supplements in the preoperative period and 72.4, 85.3, 74.7, 77.1, and 72.4 % at 1, 6, 12, 24, and 36 months following RYGB, respectively. Conclusions Bariatric surgery is an effective treatment for long-term weight loss. However, nutritional deficiency is one of its side effects and should be properly diagnosed and handled, aimed at improving the patient's quality of life and preventing severe complications. © Springer Science + Business Media, LLC 2012. Source


Miglioranza M.H.,Cardiology Institute of Rio Grande Do Sul | Gargani L.,National Research Council Italy | Sant'Anna R.T.,Cardiology Institute of Rio Grande Do Sul | Rover M.M.,Cardiology Institute of Rio Grande Do Sul | And 10 more authors.
JACC: Cardiovascular Imaging | Year: 2013

Objectives The aim of this study was to define the performance of lung ultrasound (LUS) compared with clinical assessment, natriuretic peptides, and echocardiography, to evaluate decompensation in patients with systolic heart failure (HF) in an outpatient clinic. Background Evaluation of pulmonary congestion in chronic HF is challenging. LUS has been recently proposed as a reliable tool for the semiquantification of extravascular lung water through assessment of B-lines. Methods This was a cohort study of patients with moderate to severe systolic HF. Receiver-operating characteristic (ROC) analyses were performed to compare LUS with a previously validated clinical congestion score (CCS), amino-terminal portion of B-type natriuretic peptide (NT-proBNP), E/e′ ratio, chest x-ray, and 6-min walk test. Results Ninety-seven patients were enrolled. Decompensation was present in 57.7% of patients when estimated by CCS, 68% by LUS, 53.6% by NT-proBNP, and 65.3% by E/e′ ≥15. The number of B-lines was correlated to NT-proBNP (r = 0.72; p < 0.0001), E/e′ (r = 0.68; p < 0.0001), and CCS (r = 0.43; p < 0.0001). In ROC analyses, considering as reference for decompensation a combined method (E/e′ ≥15 and/or NT-proBNP >1,000 pg/ml), LUS yielded a C-statistic of 0.89 (95% confidence interval: 0.82 to 0.96), providing the best accuracy with a cutoff ≥15 B-lines (sensitivity 85%, specificity 83%). A systematic approach using CCS, E/e′, NT-proBNP, chest x-ray, and 6-min walk test in different combinations as reference for decompensation also corroborated this cutoff and found a similar accuracy for LUS. Conclusions In an HF outpatient clinic, B-lines were significantly correlated with more established parameters of decompensation. A B-line ≥15 cutoff could be considered for a quick and reliable assessment of decompensation in outpatients with HF. © 2013 By The American College of Cardiology Foundation. Source


Miglioranza M.H.,University of Padua | Miglioranza M.H.,Cardiology Institute of Rio Grande Do Sul | Mihil S.,University of Padua | Mihil S.,Carol Davila University of Medicine and Pharmacy | And 4 more authors.
Journal of the American Society of Echocardiography | Year: 2015

Background: Tricuspid annular (TA) size and function play important roles in planning the need for associated TA annuloplasty in patients undergoing cardiac surgery for left-sided heart valve diseases. However, TA diameter normative values and the extent of TA dynamic changes during cardiac cycle remain to be established. Methods: This was a prospective, cross-sectional study of 219 healthy volunteers (mean age, 43 ± 15 years; 57% women), using conventional two-dimensional transthoracic echocardiographic (2DE) imaging to assess the variability of TA diameter measurement in relation to 2DE view and timing during cardiac cycle. TA diameter was obtained from apical right ventricular (RV)-focused four-chamber, parasternal long-axis RV inflow, and parasternal short-axis at aortic plane 2DE views at five time points during the cardiac cycle. Right atrial and RV volumes were measured using three-dimensional echocardiography. Results: TA diameters differed significantly among the three 2DE views and changed significantly during the cardiac cycle in all views. Moreover, mean fractional shortening of TA diameter was 24 ± 6% in the four-chamber view, 20 ± 7% in the parasternal long-axis RV inflow view, and 29 ± 11% in the parasternal short-axis at aortic plane view. One multivariate linear regression analysis, age, gender, and right atrial and RV volumes were independently correlated with TA diameters and accounted for 55% of the variance of midsystolic TA diameter in the four-chamber view. Conclusions: This study provides references values for TA diameters and dynamics using 2DE imaging. Age, gender, and right chamber sizes, as well as the 2DE view and time during the cardiac cycle, significantly influenced TA diameters in healthy individuals. These data may help better identify TA dilatation using 2DE imaging for surgical planning. © 2015 American Society of Echocardiography. Source


Souza C.G.,Federal University of Rio Grande do Sul | Riboldi B.P.,Federal University of Rio Grande do Sul | Hansen F.,Federal University of Rio Grande do Sul | Moreira J.D.,Federal University of Rio Grande do Sul | And 5 more authors.
Food and Function | Year: 2013

Obesity and insulin resistance are the key factors underlying the etiology of major health problems such as hypertension, diabetes and stroke. These important health issues lead researchers to investigate new approaches to prevent and treat obesity and insulin resistance. Good candidates are the phytochemical compounds that have been extensively studied in the field. Therefore, the aim of this study was to test whether sulforaphane (SFN, 1 mg kg-1, 4 months treatment), a potent inducer of antioxidant enzymes present in cruciferous vegetables, had some beneficial effects on obesity and insulin resistance induced by a highly palatable (HP) diet in male Wistar rats. Glucose tolerance, serum and hepatic lipid levels, lipid profile, ALT, AST, urea and creatinine, GLUT1 and GLUT3 levels in the cerebral cortex, hippocampus and hypothalamus were analyzed. Glucose tolerance was lower in the HP diet groups, especially in the HP group treated with SFN. Except for the liver triacylglycerols, no differences were found in serum lipids, hepatic and kidney markers of the HP diet groups. Although expression of GLUT1 was similar between groups for all three brain structures analyzed, expression of GLUT3 in the cortex and hypothalamus had a tendency to decrease in the HP diet group treated with SFN. In conclusion, SFN at the specific dose was able to accentuate glucose intolerance and may affect GLUT3 expression in the cerebral cortex and hypothalamus. © 2013 The Royal Society of Chemistry. Source


Muraru D.,University of Padua | Cucchini U.,University of Padua | Mihaila S.,University of Padua | Mihaila S.,Carol Davila University of Medicine and Pharmacy | And 9 more authors.
Journal of the American Society of Echocardiography | Year: 2014

Background Despite growing interest in applying three-dimensional (3D) speckle-tracking echocardiography (STE) to measure left ventricular (LV) myocardial deformation in various diseases, normative values for 3D speckle-tracking echocardiographic parameters and the effects of demographic, hemodynamic, and technical factors on these values are unknown. Methods In 265 healthy volunteers (age range, 18-76; 57% women), longitudinal strain (3DLε), circumferential strain (3DCε), radial strain (3DRε), and area strain (3DAε) were measured by using vendor-specific (Vsp) 3D speckle-tracking echocardiographic equipment. LV strain was also measured by using Vsp two-dimensional (2D) and vendor-independent 3D speckle-tracking echocardiographic software packages, for comparison. Results Reference values (lower limit of normality) for Vsp 3D STE were -17% to -21% (-15%) for 3DLε, -17% to -20% (-14%) for 3DCε, -31% to -36% (-26%) for 3DAε, and 47% to 59% (38%) for 3DRε. Three-dimensional longitudinal strain decreased, whereas 3DCε increased, with aging (P <.003), with different trends in men and women. Men had lower 3DLε, 3DRε, 3DAε, and 2D longitudinal strain than women (P <.02). LV 3D strain parameters were also influenced by LV volumes and mass, image quality, and temporal resolution (P <.02). Reference values obtained by Vsp 2D STE were -20% to -23% (-18%) for 2D longitudinal strain, -20% to -24% (-17%) for 2D circumferential strain, and 39% to 54% (28%) for 2D radial strain (P <.001 vs Vsp 3D STE). Significantly different 3DCε and 3DRε values were obtained with vendor-independent versus Vsp 3D STE (P <.001). Conclusions In healthy subjects, reference values of LV 3D strain parameters were significantly influenced by demographic, cardiac, and technical factors. Limits of normality of LV strain by Vsp 3D STE should not be used interchangeably with Vsp 2D STE or with Vin 3D STE software. © 2014 by the American Society of Echocardiography. Source

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