2017;109(5) – ABC CARDIOL

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Original Article

Pericardial Parietal Mesothelial Cells: Source of the Angiotensin-Converting-Enzyme of the Bovine Pericardial Fluid

Ilsione Ribeiro de Sousa Filho et al. Isabela Cabral Cavicchioli Pereira Lourimar José de Morais Livia das Graças Vieito Lombardi Teodoro … Maria Laura Pinto Rodrigues Roseli Aparecida da Silva Gomes

Abstract

Background:

Angiotensin II (Ang II), the primary effector hormone of the renin-angiotensin system (RAS), acts systemically or locally, being produced by the action of angiotensin-converting-enzyme (ACE) on angiotensin I. Although several tissue RASs, such as cardiac RAS, have been described, little is known about the presence of an RAS in the pericardial fluid and its possible sources. Locally produced Ang II has paracrine and autocrine effects, inducing left ventricular hypertrophy, fibrosis, heart failure and cardiac dysfunction. Because of the difficulties inherent in human pericardial fluid collection, appropriate experimental models are useful to obtain data regarding the characteristics of the pericardial fluid and surrounding tissues.

Objectives:

To evidence the presence of constituents of the Ang II production paths in bovine pericardial fluid and parietal pericardium.

Methods:

Albumin-free crude extracts of bovine pericardial fluid, immunoprecipitated with anti-ACE antibody, were submitted to electrophoresis (SDS-PAGE) and gels stained with coomassie blue. Duplicates of gels were probed with anti-ACE antibody. In the pericardial membranes, ACE was detected by use of immunofluorescence.

Results:

Immunodetection on nitrocellulose membranes showed a 146-KDa ACE isoform in the bovine pericardial fluid. On the pericardial membrane sections, ACE was immunolocalized in the mesothelial layer.

Conclusions:

The ACE isoform in the bovine pericardial fluid and parietal pericardium should account at least partially for the production of Ang II in the pericardial space, and should be considered when assessing the cardiac RAS.

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Special Article

2017 Guidelines for Arterial Hypertension Management in Primary Health Care in Portuguese Language Countries

Gláucia Maria Moraes de Oliveira et al. Miguel Mendes Marcus Vinícius Bolívar Malachias João Morais … Osni Moreira Filho Armando Serra Coelho Daniel Pires Capingana Vanda Azevedo Irenita Soares Alda Menete Beatriz Ferreira Miryan Bandeira dos Prazeres Cassandra Soares Mário Fernandes

Introduction

The World Health Organization (WHO) goal to reduce mortality due to chronic non-communicable diseases (CNCD) by 2% per year requires a huge effort from countries.^–This challenge for health professionals asks for a global political action on control of social measures, with cost-effective population interventions to reduce CNCD and their risk factors (RF). Health professionals should demand from their government the implementation of acceptable cost measures, such as tobacco cessation counseling, guidance on healthy feeding practices and need for regular physical exercise, systemic arterial hypertension (SAH) control, and promotion of teaching and updating activities in programs directed to those issues. Those measures would contribute with around 70% of the goal of 2% per year reduction in CNCD.^,Dyslipidemia, SAH and obesity are highly prevalent multifactorial diseases in Portuguese language countries (PLC).^,Systemic arterial hypertension is the major RF for complications, such as stroke, acute myocardial infarction and chronic kidney disease, corresponding in importance to dyslipidemia and obesity for the development of atherosclerotic diseases.^,In addition to their significant epidemiological impact, the non-pharmacological treatment of those cardiovascular RF plays a relevant economic role in the expenditures of the Ministries of Health, Social Security and Economy, because those affections are major causes directly or indirectly involved with absenteeism in the workplace. There is evidence that preventive actions are more promising in the primary health care setting.

The number of adults with SAH increased from 594 million in 1975 to 1.13 billion in 2015, being 597 million men and 529 million women. That increase might be due to both population aging and increase in number. When analyzing the trends in blood pressure (BP) levels of 19.1 million adults from several population studies in the past four decades (1975-2015), the elevated levels shifted from high-socioeconomic-level countries to low-intermediate-socioeconomic-level countries of South Asia and Sub-Saharan Africa. However, BP levels remain high in Eastern and Central Europe and Latin America.

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Erratum

Erratum

Edition of August 2017, vol. 109 (2), Supl. 1, p. 1-76

In the “Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose – 2017”, published as a supplement to the Arquivos Brasileiros de Cardiologia [Arq Bras Cardiol 2017; 109(2Supl.1):1-76], the following corrections should be considered:

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Viewpoint

Limitations in the Diagnosis of Noncompaction Cardiomyopathy by Echocardiography

Viviane Tiemi Hotta et al. Sabrina Cunha Tendolo Ana Clara Tude Rodrigues Fábio Fernandes … Luciano Nastari Charles Mady

Critical analysis

The diagnostic criteria described by Jenni et al. and Chin et al. are based on the measurement of NCM and CM thicknesses. However, the criteria differ regarding the cardiac cycle point at which the measurements should be taken. Chin et al. propose the measurements of NCM and CM thickness be performed at end-diastole, while Jenni et al. propose them at end-systole.

The criteria proposed by Jenni et al. used an NCM/CM ratio > 2 at end-systole, generating higher specificity and lower sensitivity as compared to the criteria by Chin et al., who use the CM/(NCM + CM) ratio ≤ 0.5. However, the increase in sensitivity is due to a decrease in specificity, as compared to the criteria by Jenni et al.

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Clinicoradiological Session

Case 6/2017 – Extensive Giant Left Coronary Artery Aneurysm Due to Kawasaki Vasculitis in Asymptomatic 48-Year-Old Man

Edmar Atik et al. Roberto Kalil Filho Fabio Jatene Júlio Cesar S Marino

Additional Examinations

Electrocardiogram: sinus rhythm, without cavitary overloads, complete right bundle branch block and 1st degree atrioventricular block. PR: 0.22, QRS: 0.109 with complexes rSr´ in V1 and RS in V6; AP = + 0º, AQRS = + 220º, AT = + 66º.

Chest X-ray: normal cardiac area (cardiothoracic index = 0.50) and linear vascular image with increased density bordering the ventricular arch ().

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Image

Transcatheter Aortic Valve Implantation with Embolic Protection System in a Patient with Left Ventricle Apical Thrombus

João Gonçalves Almeida et al. Sara Ferreira Daniel Caeiro José Ribeiro Vasco Gama Ribeiro

A 68-year-old woman was admitted in our acute cardiac care unit due to cardiogenic shock. The transthoracic echocardiography (TTE) showed severe aortic stenosis, severe left ventricle (LV) systolic dysfunction (ejection fraction 20%) and a large apical thrombus (). We performed an emergent percutaneous aortic balloon valvuloplasty (). During the procedure, the coronary angiography revealed no epicardial coronary disease (). Despite some mild clinical and hemodynamic improvement (mean gradient reduced from 40 to 30 mmHg), she remained in New York Heart Association (NYHA) class IV.

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Letter to the Editor

Association between SYNTAX Score and Coronary Collateral Circulation

Dear Editor,

I have read the article entitled “Which Coronary Lesions Are More Prone to Cause Acute Myocardial Infarction?” by Sen et al. with great interest, recently published in journal. The investigators reported that more than 70% of the patients with acute myocardial infarction (MI) had coronary collateral circulation (CCC) with Rentrop scores of 1-3 during primary coronary angiography. This shows that most cases of acute MI in our study originated from underlying high-grade stenosis, challenging the common believe. Higher serum triglycerides levels, greater mean platelet volume, and increased white blood cell and neutrophil counts were independently associated with impaired development of collateral vessels.

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Case Report

Combined Mitral and Aortic Valvar Bioprosthesis Transcatheter Transapical Implant: First Description in Brazil

Roney Orismar Sampaio et al. Milena Ribeiro Paixão Thais Taveira Miranda Elinthon Tavares Veronese … José Honório de Almeida Palma Flávio Tarasoutchi

Introduction

From the earliest days of the heart surgery, the valves, when the reparation was not possible, were replaced by prosthetics using cardiopulmonary bypass. The good results of these procedures are well known. In the recent years, minimally invasive alternatives have been developed, aiming to make possible the treatment of individuals under high risk of complications and death caused by the conventional procedure. In 2002, the first transcatheter valvar implantation was made, which revolutionized the treatment of severe aortic stenosis. The equipment, techniques and skills have progressively evolved since then. More recently, from 2009, transcatheter mitral valvar implants for treatment of the prosthesis dysfunction (valve-in-valve) started to be performed. Currently, the transcatheter valvar implantation is one of the fields of greater development in cardiology.

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Editorial

Cardiac Autonomic Modulation – The Search for an Ultimate Technique

Esteban Rivarola et al. Mauricio Scanavacca

Abnormal parasympathetic activity on the heart has been implicated in several forms of symptomatic bradycardia, especially in young and otherwise healthy individuals. Neurally mediated syncope, sinus arrest and advanced atrioventricular (AV) block have high risk of injury and serious implications on quality of life. Nonetheless, until recently, their clinical management, mainly based on behavioral measures and pacing, have often proved to be ineffective or inadequate. An alternative approach to treat this specific population, avoiding device implants and continuous drug therapy seemed to be required.

Ganglionated plexus (GP) ablation was first described in 2005, with the purpose of targeting the main parasympathetic ganglia and promoting a vagal attenuation. During the last decade, several authors^– presented their clinical results, with significant remission of symptoms and electrocardiographic improvement, and autonomic modulation became an established therapeutic modality.

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Original Article

Comparison of Secondary Prevention Status between Percutaneous Coronary Intervention and Coronary Artery Bypass Patients

Xia-qing Gao et al. Yanfang LI Zhi-li Jiang

Abstract

Background:

Data are scarce regarding disparities in cardiovascular risk factor management between patients treated with percutaneous coronary intervention (PCI) and those treated with coronary artery bypass grafting (CABG).

Objective:

Whether the goal achievement rates of cardiovascular risk factors were different between PCI and CABG patients.

Methods:

We retrospectively reviewed the data retrieved from a clinical record database of patients admitted to Beijing Anzhen Hospital between January 1, 2014, and December 31, 2014, who underwent PCI or CABG.

Results:

Compared with the CABG group, low-density lipoprotein cholesterol (LDL-C) < 1.8 mmol/L (28.6% vs. 24.7%; p < 0.01), LDL-C < 2.07 mmol/L (43.5% vs. 39.4%; p < 0.01) and blood pressure (BP) < 140/90 mm Hg (85.6% vs. 77.7%; p < 0.01) goal achievement rates were significantly higher in the PCI group. Compared with patients ≥ 60 years old: patients < 60 years old had better BP < 140/90 mm Hg goal achievement rates (87.7% vs. 84.4%; p < 0.01) in the PCI group, and better fasting blood-glucose (FBG) < 7 mmol/L (79.4% vs.72.0%; p < 0.01) and HbA1c < 7% (79.4% vs. 70.1%; p < 0.01) goal achievement rates in the CABG group. Compared with females: males had better LDL-C < 2.07 mmol/L (24.7% vs. 28.5%; p < 0.01), FBG < 7 mmol/L (71.8% vs.75.2%; p < 0.01) and HbA1c < 7% (70.4% vs. 74.1%; p < 0.01) goal achievement rates in the PCI group.

Conclusion:

Patients in the PCI group were generally more likely than those in the CABG group to achieve LDL-C < 1.8 mmol/L and BP goals. The control of cardiovascular risk factors differed between patients ≥ 60 years old and < 60 years old. Female patients were less likely to achieve LDL-C, FBG and HbA1c goals.

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Review Article

Phytosterols in the Treatment of Hypercholesterolemia and Prevention of Cardiovascular Diseases

Carlos Eduardo Cabral et al. Márcia Regina Simas Torres Klein

Abstract

Phytosterols are bioactive compounds found in foods of plant origin, which can be divided into plant sterols and plant stanols. Clinical studies consistently indicate that the intake of phytosterols (2 g/day) is associated with a significant reduction (8-10%) in levels of low-density lipoprotein cholesterol (LDL-cholesterol). Thus, several guidelines recommend the intake of 2 g/day of plant sterols and/or stanols in order to reduce LDL-cholesterol levels. As the typical western diet contains only about 300 mg/day of phytosterols, foods enriched with phytosterols are usually used to achieve the recommended intake. Although phytosterols decrease LDL-cholesterol levels, there is no evidence that they reduce the risk of cardiovascular diseases; on the contrary, some studies suggest an increased risk of atherosclerosis with increasing serum levels of phytosterols. This review aims to address the evidence available in the literature on the relationship between phytosterols and risk of cardiovascular disease.

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Editorial

The Freedom of Clinicians and the Art of the Impossible

Systemic arterial hypertension – or simply hypertension, in casual language – is considered the major and most common risk factor for death and disability of non-communicable diseases.^, Its prevalence in Europe ranges from 30% to 45%. In the United States, two thirds of the adults older than 60 years are hypertensive. In South Asia and Sub-Saharan Africa, hypertension has increased rapidly. Recently, the world prevalence of hypertension was estimated at 31%.

The last three decades have witnessed the development of several effective and safe drugs to treat hypertensives. However, although a blood pressure reduction by only 10 mm Hg in those patients is known to reduce the risk of cardiovascular death and stroke by 25-40% throughout life, the threshold value or target value to be achieved in hypertensive adults in general, and in the elderly in particular, is controversial. In addition, several patients remain poorly controlled despite treatment, without reaching the target values of the ESC/ESH Recommendations or those suggested as a result of the SPRINT study.

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Original Article

First results of the Brazilian Registry of Percutaneous Left Atrial Appendage Closure

Ênio Eduardo Guérios et al. Francisco Chamié Márcio Montenegro Eduardo Benchimol Saad … Fabio Sandoli de Brito Junior Paulo Avancini Caramori Luiz Carlos Simões Flávio Roberto Azevedo de Oliveira Luiz Carlos Giuliano Cláudio Munhoz da Fontoura Tavares

Abstract

Background:

Left atrial appendage closure (LAAC) is an effective alternative to oral anticoagulation (OA) for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF).

Objective:

To present the immediate results and late outcomes of patients submitted to LAAC and included in the Brazilian Registry of Percutaneous Left Atrial Appendage Closure.

Methods:

91 patients with NVAF, high stroke risk (CHA₂DS₂VASc score = 4.5 ± 1.5) and restrictions to OAC (HAS-BLED score = 3.6 ± 1.0) underwent 92 LAAC procedures using either the Amplatzer cardiac plug or the Watchman device in 11 centers in Brazil, between late 2010 and mid 2016.

Results:

Ninety-six devices were used (1.04 device/procedure, including an additional non-dedicated device), with a procedural success rate of 97.8%. Associated procedures were performed in 8.7% of the patients. Complete LAAC was obtained in 93.3% of the successful cases. In cases of incomplete closure, no residual leak was larger than 2.5 mm. One patient needed simultaneous implantation of 2 devices. There were 7 periprocedural major (5 pericardial effusions requiring pericardiocentesis, 1 non-dedicated device embolization and 1 coronary air embolism without sequelae) and 4 minor complications. After 128.6 patient-years of follow-up there were 3 deaths unrelated to the procedure, 2 major bleedings (one of them in a patient with an unsuccessful LAAC), thrombus formation over the device in 2 cases (both resolved after resuming OAC for 3 months) and 2 strokes (2.2%).

Conclusions:

In this multicenter, real world registry, that included patients with NVAF and high thromboembolic and bleeding risks, LAAC effectively prevented stroke and bleeding when compared to the expected rates based on CHA₂DS₂VASc and HASBLED scores for this population. Complications rate of the procedure was acceptable considering the beginning of the learning curve of most of the involved operators.

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Original Article

Cardiac, Metabolic and Molecular Profiles of Sedentary Rats in the Initial Moment of Obesity

Bruno Barcellos Jacobsen et al. Ana Paula Lima Leopoldo Jóctan Pimentel Cordeiro Dijon Henrique Salomé de Campos … André Ferreira do Nascimento Mário Mateus Sugizaki Antônio Carlos Cicogna Carlos Roberto Padovani André Soares Leopoldo

Abstract

Background:

Different types of high-fat and/or high-energy diets have been used to induce obesity in rodents. However, few studies have reported on the effects observed at the initial stage of obesity induced by high-fat feeding on cardiac functional and structural remodelling.

Objective:

To characterize the initial moment of obesity and investigate both metabolic and cardiac parameters. In addition, the role of Ca²⁺ handling in short-term exposure to obesity was verified.

Methods:

Thirty-day-old male Wistar rats were randomized into two groups (n = 19 each): control (C; standard diet) and high-fat diet (HF, unsaturated high-fat diet). The initial moment of obesity was defined by weekly measurement of body weight (BW) complemented by adiposity index (AI). Cardiac remodelling was assessed by morphological, histological, echocardiographic and papillary muscle analysis. Ca²⁺ handling proteins were determined by Western Blot.

Results:

The initial moment of obesity occurred at the 3^rd week. Compared with C rats, the HF rats had higher final BW (4%), body fat (20%), AI (14.5%), insulin levels (39.7%), leptin (62.4%) and low-density lipoprotein cholesterol (15.5%) but did not exhibit alterations in systolic blood pressure. Echocardiographic evaluation did not show alterations in cardiac parameters. In the HF group, muscles were observed to increase their +dT/dt (C: 52.6 ± 9.0 g/mm²/s and HF: 68.0 ± 17.0 g/mm²/s; p < 0.05). In addition, there was no changes in the cardiac expression of Ca²⁺ handling proteins.

Conclusion:

The initial moment of obesity promotes alterations to hormonal and lipid profiles without cardiac damage or changes in Ca²⁺ handling.

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Original Article

Association of Inflammation and Endothelial Dysfunction with Coronary Microvascular Resistance in Patients with Cardiac Syndrome X

Ming Long et al. Zhibin Huang Xiaodong Zhuang Zena Huang … Yue Guo Xinxue Liao Chufan Luo

Abstract

Background:

Although a proportion of CSX patients have impaired brachial artery flow-mediated dilatation (FMD) in response to hyperemia, suggesting that endothelial dysfunction in these patients may be systemic and not just confined to the coronary circulation; the underlying mechanisms triggering endothelial dysfunction in these patients are still incompletely understood.

Objectives:

To assess the association of the index of Microcirculatory Resistance (IMR) with endothelial dysfunction and inflammation in patients with CSX.

Methods:

We studied 20 CSX patients and 20 age and gender-matched control subjects. Thermodilution-derived coronary flow reserve (CFR) and IMR were measured using a pressure-temperature sensor-tipped guidewire. Brachial artery FMD was measured using high-resolution, two-dimensional ultrasound images obtained with a Doppler ultrasound device (HDI-ATL 5000, USA) with a 5 MHz to 12 MHz linear-array transducer.

Results:

Compared with in control subjects, CFR was significantly lower (2.42 ± 0.78 vs. 3.59 ± 0.79, p < 0.001); IMR was higher (32.2 ± 8.0 vs. 19.5 ± 5.5, p < 0.001); the concentration of hs-CRP and FMD was higher (4.75 ± 1.62 vs. 2.75 ± 1.50; 5.24 ± 2.41 vs. 8.57 ± 2.46, p < 0.001) in CSX patients. The Duke treadmill score (DTS) was correlated positively to CFR and FMD (0.489 and 0.661, p < 0.001), it was negative to IMR and hsCRP (-0.761 and -0.087, p < 0.001) in CSX patients.

Conclusions:

The main finding in this study is that the DTS measured in patients with CSX was associated to hsCRP and FMD. Moreover, the independent effects of exercise tolerance can significantly impair FMD and hsCRP in CSX patients; especially it is particularly important to whom where FMD was associated negatively with IMR.

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Original Article

Electrocardiographic Findings in Brazilian Adults without Heart Disease: ELSA-Brasil

Marcelo Martins Pinto Filho et al. Luisa C. C. Brant José Luiz Padilha-da-Silva Murilo Foppa … Paulo A. Lotufo José Geraldo Mill Paulo R. Vasconcelo-Silva Maria da Conceição C. Almeida Sandhi Maria Barreto Antônio Luiz Pinho Ribeiro

Abstract

Background:

The electrocardiogram (ECG) is widely used in population-based studies. However, there are few studies on electrocardiographic findings in Latin America and in Brazil. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) comprised 15,105 participants (35-74 years) from six Brazilian capitals.

Objectives:

To describe electrocardiographic findings in Brazilian adults without heart disease, stratified by sex, age and race/skin color.

Methods:

Cross-sectional study with baseline data of 11,094 adults (44.5% men) without heart disease from ELSA-Brasil. The ECGs were recorded with the Burdick Atria 6100 machine and stored at the Pyramis System. ECG analysis was automatically performed using the Glasgow University software. A descriptive analysis of heart rate (HR), P, QRS and T waves’ duration, PR and QT intervals, and P, R and T axes was performed. After stratification by sex, race/color and age, the groups were compared by the Wilcoxon and Kruskal-Wallis test at a significance level of 5%. Linear regression models were used to evaluate the behavior of electrocardiographic parameters over age. Major electrocardiographic abnormalities defined by the Minnesota code were manually revised.

Results:

Medians values of the electrocardiographic parameters were different between men and women: HR 63 vs. 66 bpm, PR 164 vs.158 ms, QT corrected 410 vs. 421 ms, QRS duration 92 vs. 86 ms, P-wave duration 112 vs. 108 ms, P-wave axis 54 vs. 57 degrees, R-wave axis 35 vs. 39 degrees, T-wave axis 39 vs. 45 degrees (p < 0.001 for all). The 2^nd and the 98^th percentiles of each variable were also obtained, and graphs were constructed to illustrate the behavior of the electrocardiographic findings over age of participants stratified by sex and race/skin color.

Conclusions:

The values for the electrocardiographic measurements herein described can be used as reference for Brazilian adults free of heart disease, stratified by sex. Our results suggest that self-reported race/skin color have no significant influence on electrocardiographic parameters.

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Original Article

Evaluation of Left Ventricular Diastolic Function by Echocardiography with Tissue Doppler in Systemic Sclerosis

Marina Carneiro de Freitas Roque et al. Percival D. Sampaio-Barros Ana Lucia Arruda Sergio Barros-Gomes … Derly Becker José Lazaro de Andrade Ana Clara Tude Rodrigues

Abstract

Background:

Systemic sclerosis (SS) is a connective tissue abnormality characterized by fibrosis of the skin and internal organs. Cardiac involvement with consequent myocardial dysfunction in SS is associated with increased morbidity and mortality.

Objective:

To investigate the left ventricular (LV) diastolic function in patients with SS and preserved systolic function.

Methods:

Patients with SS were evaluated with two-dimensional echocardiography with tissue Doppler for analysis of chamber diameters, LV mass index (LVMI), indexed left atrial volume (iLAV), systolic function of both ventricles, and presence and degree of diastolic dysfunction (DD).

Results:

We evaluated 50 patients, divided according to the presence of DD into Group 1 (n = 25; normal diastolic function, E/A ratio ≥ 0.8, deceleration time [DT] > 150 ms and 8 cm/s) and Group 2 (n = 25; with DD, subdivided into type I DD [E/A 200 ms], type II [E/A ≥ 0.8, septal e’ 34 mL/m²], and type III [E/A > 2, DT < 150 ms, septal e’ < 8 cm/s]). Type I DD was the most frequent (34%), followed by type II DD (16%). LVMI and iLAV were similar in both groups, but septal and lateral e’ were reduced only in Group 2. In Group 2, we observed that patients with moderate DD had longer disease duration (p = 0.02).

Conclusion:

The prevalence of type I DD was elevated in SS and associated with aging. Disease duration emerged as an important factor in moderate DD.

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Original Article

Importance of Clinical and Laboratory Findings in the Diagnosis and Surgical Prognosis of Patients with Constrictive Pericarditis

Fábio Fernandes et al. Dirceu Thiago Pessoa de Melo Felix José Alvarez Ramires Ricardo Ribeiro Dias … Marcio Tonini Vinicius dos Santos Fernandes Carlos Eduardo Rochitte Carlos Henrique Valente Moreira Charles Mady

Abstract

Background:

International studies have reported the value of the clinical profile and laboratory findings in the diagnosis of constrictive pericarditis. However, Brazilian population data are scarce.

Objective:

To assess the clinical characteristics, sensitivity of imaging tests and factors related to the death of patients with constrictive pericarditis undergoing pericardiectomy.

Methods:

Patients with constrictive pericarditis surgically confirmed were retrospectively assessed regarding their clinical and laboratory variables. Two methods were used: transthoracic echocardiography and cardiac magnetic resonance imaging. Mortality predictors were determined by use of univariate analysis with Cox proportional hazards model and hazard ratio. All tests were two-tailed, and an alpha error ≤ 5% was considered statically significant.

Results:

We studied 84 patients (mean age, 44 ± 17.9 years; 67% male). Signs and symptoms of predominantly right heart failure were present with jugular venous distention, edema and ascites in 89%, 89% and 62% of the cases, respectively. Idiopathic etiology was present in 69.1%, followed by tuberculosis (21%). Despite the advanced heart failure degree, low BNP levels (median, 157 pg/mL) were found. The diagnostic sensitivities for constriction of echocardiography and magnetic resonance imaging were 53.6% and 95.9%, respectively. There were 9 deaths (10.7%), and the risk factors were: anemia, BNP and C reactive protein levels, pulmonary hypertension >55 mm Hg, and atrial fibrillation.

Conclusions:

Magnetic resonance imaging had better diagnostic sensitivity. Clinical, laboratory and imaging markers were associated with death.

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Original Article

Large Accumulation of Collagen and Increased Activation of Mast Cells in Hearts of Mice with Hyperlipidemia

Yunpeng Cheng et al. Yanqiu Zhu Jiashu Zhang Xingping Duan Ying Zhang

Abstract

Background:

Hyperlipidemia, which is characterized by an elevation of lipids in the bloodstream, is a major risk factor for cardiac disease.

Objectives:

The present study investigated the role of fibrosis in the progression of hyperlipidemia in the mice heart, and whether mast cell activation was associated with the fibrosis process.

Methods:

Hyperlipidemia was produced in C57BL / 6 mice by feeding them on a high-fat diet for 8 weeks.To assess tissue fibrosis, picrosirius red staining was performed. Hematoxylin & eosin (H&E) staining was performed to identify the histopathological changes in the hearts. Immunohistochemistry was also accomplished to determine the localization of transforming growth factor (TGF)-β and α-smooth muscle actin (α-SMA). Western blotting was performed to analyze the expression of chymase, tryptase, TGF-β, α-SMA and activity of Wnt/β-catenin pathway. At the end, serum total cholesterol (TC) and triglycerides (TG) levels were measured. All the values were expressed as means ± SD, the statistical significance level adopted was 5%.

Results:

Hyperlipidemia mice showed significantly increased collagen deposition in the hearts compared with normal mice. In addition, H&E staining showed significant cellular degeneration. Cardiac muscle was arranged in disorder with fracture in mice of the model group. Immunohistochemistry and western blot analysis revealed that expression levels of tryptase, chymase, β-catenin, TGF-β and α-SMA were significantly increased in the hyperlipidemia mice compared with the control group.

Conclusions:

The results indicated that mast cell activation might induce cardiac fibrosis by tryptase and chymase in hyperlipidemia, which had a close relationship with the increased activity of TGF-β/Wnt/β-catenin pathway.

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Original Article

Endostatin a Potential Biomarker for Heart Failure with Preserved Ejection Fraction

Michael Coll Barroso et al. Philip Boehme Frank Kramer Thomas Mondritzki … Till Koehler Jan-Erik Gülker Martin Karoff Wilfried Dinh

Abstract

Background:

Endostatin is a circulating endogenous angiogenesis inhibitor preventing neovascularization. Previous studies demonstrated the prognostic value of Endostatin among patients with heart failure with reduced ejection fraction (HFrEF). However, the role of Endostatin among patients with heart failure with preserved ejection fraction (HFpEF) remains unclear.

Objective:

This study aimed to investigate the association between serum Endostatin levels, natriuretic peptide levels and the severity of left ventricular diastolic dysfunction and the diagnosis of HFpEF.

Methods:

Endostatin serum concentrations were measured in 301 patients comprising 77 HFpEF patients, 169 patients with asymptomatic left ventricular diastolic dysfunction (ALVDD), and 55 controls with normal cardiac function.

Results:

Endostatin serum levels were significantly elevated in patients with HFpEF (median/interquartile range 179.0 [159-220]) and ALVDD (163.8 [145.4-191.3]) compared to controls (149.1 [130.6-176.9]), p < 0.001 and p = 0.004, respectively) and significant correlated with N-terminal pro B-type natriuretic peptide (NT-proBNP).

Conclusions:

This hypothesis-generating pilot study gives first evidence that Endostatin correlates with the severity of diastolic dysfunction and may become a novel biomarker for HFpEF. We hypothesize a rise in Endostatin levels may reflect inhibition of adaptive angiogenesis and adverse cardiac remodeling.

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