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Andersson, Jonas. "Inflammation and lifestyle in cardiovascular medicine." Doctoral thesis, Umeå universitet, Medicin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-36221.
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Despite major advances in the treatment and prevention of atherosclerosis the last several decades, cardiovascular disease still accounts for the majority of deaths in Sweden. With the population getting older, more obese and with rising numbers of diabetics, the cardiovascular disease burden may increase further in the future. The focus in cardiovascular disease has shifted with time from calcification and narrowing of arteries to the biological processes within the atherosclerotic plaque. C-reactive protein (CRP) has emerged as one of many proteins that reflect a low grade systemic inflammation and is suitable for analysis as it is more stable and easily measured than most other inflammatory markers. Several large prospective studies have shown that CRP is not only an inflammatory marker, but even a predictive marker for cardiovascular disease. C-reactive protein is associated with several other risk factors for cardiovascular disease including obesity and the metabolic syndrome. Our study of twenty healthy men during a two week endurance cross country skiing tour demonstrated a decline in already low baseline CRP levels immediately after the tour and six weeks later. In a study of 200 obese individuals with impaired glucose tolerance randomised to a counselling session at their health care centre or a one month stay at a wellness centre, we found decreased levels of CRP in subjects admitted to the wellness centre. The effect remained at one, but not after three years of follow-up. In a prospective, nested, case-referent study with 308 ischemic strokes, 61 intracerebral haemorrhages and 735 matched referents, CRP was associated with ischemic stroke in both uni- and multivariate analyses. No association was found with intracerebral haemorrhages. When classifying ischemic stroke according to TOAST criteria, CRP was associated with small vessel disease. The CRP 1444 (CC/CT vs. TT) polymorphism was associated with plasma levels of CRP, but neither with ischemic stroke nor with intracerebral haemorrhage. A study on 129 patients with atrial fibrillation was used to evaluate whether inflammation sensitive fibrinolytic variables adjusted for CRP could predict recurrence of atrial fibrillation after electrical cardioversion. In multivariate iv models, lower PAI-1 mass was associated with sinus rhythm even after adjusting for CRP and markers of the metabolic syndrome. In conclusion, lifestyle intervention can be used to reduce CRP levels, but it remains a challenge to maintain this effect. CRP is a marker of ischemic stroke, but there are no significant associations between the CRP1444 polymorphism and any stroke subtype, suggesting that the CRP relationship with ischemic stroke is not causal. The fibrinolytic variable, PAI-1, is associated with the risk of recurrence of atrial fibrillation after electrical cardioversion after adjustment for CRP. Our findings suggest a pathophysiological link between atrial fibrillation and PAI-1, but the relation to inflammation remains unclear.
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Tamagnini, Elisabete Joyce Galhardo. "A psicodinâmica do paciente cardiopata: contribuições da psicanálise à cardiologia." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/47/47133/tde-27112014-163132/.
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Doenças cardiovasculares representam a principal causa de morte no mundo. É legítima a associação existente entre doenças cardiovasculares e eventos emocionais. Processos psíquicos podem ser desencadeados na DCV, provocando evolução desfavorável tanto dos sintomas afetivos quanto da doença clínica: promovem menor aderência às orientações terapêuticas e aumentam índices de morbi-mortalidade. Pacientes portadores de insuficiência cardíaca (IC) avançada, Classe Funcional (CF) III ou IV (NYHA) com sintomas graves, sem alternativa para tratamento clínico e com pior prognóstico são indicados ao transplante cardíaco (TC). A presente pesquisa teve como objetivo principal investigar a dinâmica psíquica envolvida nos diferentes estágios de DCV (especialmente de IC), identificando as particularidades psicodinâmicas encontradas em relação a pacientes que não apresentaram evidência da doença e avaliando a natureza das relações objetais e das fantasias inconscientes nas diferentes classes funcionais (NYHA). Método: estudo clínico, qualitativo, com delineamento observacional. Participantes: N=40, subdivididos em grupos: A) DCV não evidente / B) CF I ou II / C) CF III ou IV não - indicados ao TC / D) CF III ou IV indicados ao TC. Instrumentos: 1 entrevista clínica e Escala de Avaliação Global do Funcionamento AGF / DSM IV; 2 Teste de Relações Objetais de Phillipson TRO. Lâminas: A1(1), B3(4), AG(5), BG(10), C2(11) e Branca(13). Procedimento: amostra por conveniência e aplicação dos instrumentos individualmente. A teoria psicanalítica das relações objetais de Melanie Klein orientou o desenvolvimento do estudo e serviu de base para a análise do material. Resultados: fantasias inconscientes e processos psíquicos arcaicos podem ser encontrados em todos os estágios da DCV, porém, os grupos mais avançados de DCV, apresentaram aspectos psicossomáticos expressivos, relações objetais e fantasias inconscientes provenientes das fases arcaicas do desenvolvimento, esquizoparanóide e viscocárica. No grupo D, a frequência de relações de objeto da fase viscocárica foi mais expressiva, além de evidenciarem fantasias inconscientes específicas ligadas ao TC, como fantasias de mutilação. A avaliação psicanalítica foi fundamental para a compreensão da psicodinâmica do paciente cardiopata e identificou os FR psicossociais envolvidos no processo saúde doença, sugerindo atenção especial da equipe multidisciplinar e instauração imediata de psicoterapia para determinados grupos. A intervenção psicanalítica visa redução dos sintomas e promoção de saúde mental / psíquica: preserva o autocuidado, estimula o cumprimento das orientações de equipe e de protocolo, reforça a adesão ao tratamento. O controle dos FR observados pode determinar um prognóstico favorável quando considerado no tratamento dos pacientes cardiopatasCardiovascular diseases are the leading cause death worldwide. There is a clear association between cardiovascular disease and emotional events. Psychic processes can happen in CVD, causing unfavorable evolution of affective symptoms and clinical disease: resulting in lower adherence to medical guidelines and higher rates of morbidity and mortality. Patients with advanced heart failure (HF), in NYHA functional class III or IV with severe symptoms, no alternative to clinical treatment and a worse prognosis are listed for heart transplantation (HT). The main objective was investigate the psychodynamics at different stages of CVD (mainly in HF), identifying the psychodynamic characteristics found in relation to patients without evidence of disease and assessing the nature of object relations and unconscious fantasies in different functional classes (NYHA). Method: Clinical, qualitative and observational study design. Participants: N = 40, in groups: A) patients without cardiovascular disease / B) functional class I or II / C) functional class III or IV not listed for HT / functional class III or IV with indications for HT. Instruments: 1 clinical interview and assessment of global functioning / GAF DSM IV, 2 Object Relations Test (ORT) by Phillipson - A1(1), B3(4), AG(5), BG(10), C2(11), White (13). Procedure: convenience sample and individual application. The object relations theory of Melanie Klein guided the development of the study and analysis of the material. Results: unconscious fantasies and psychic processes archaic can be found in all stages of CVD, however, the most advanced CVD groups showed significant psychosomatic aspects, object relations and unconscious fantasies from very archaic development phases._ In group D, the frequency of object relations of viscumcarica position was more expressive and showed specific unconscious fantasies in relation to HT, as the fantasies of mutilation._ The psychoanalytic review was essential to understanding the cardiac patients psychodynamics and identified psychosocial risk factors (RF) involved in the health - disease process, suggesting special attention of the multidisciplinary team and immediate psychotherapy for some groups. Psychoanalytic intervention reduces symptoms and promotes mental health: improves self-care, execution of team guidelines and protocol and treatment adherence. The control some risk factors can determine a favorable prognosis when considered in the treatment of cardiac patients
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Resende, Marcelo de Aquino. "Avaliação do nível de atividade física, do nível de condicionamento cardio-respiratório e do risco cardiovascular em estudantes de medicina e educação física." Universidade Federal de Sergipe, 2007. https://ri.ufs.br/handle/riufs/3722.
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Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorRecent studies indicate a strong association among physical inactivity, low level of cardio-respiratory fitness and the presence of cardiovascular risk factors such as high blood pressure, diabetes and obesity. Medicine and Physical Education students are involved in the field of health rehabilitation, promotion and conservation, being physical activity a priority intervention to achieve this goal. However, little is known about the adoption of physical activity as part of the life style of Medicine and Physical Education students. The main goal of this paper is to compare the level of physical activity, the level of cardio-respiratory fitness and the cardiovascular risk in students of Medicine and Physical Education. The data collection took place at the Physical Education Department at the Federal University of Sergipe. In a first stage, the IPAQ questionnaire was applied to quantify the amount of physical activity in 126 students from the 7th and 8th periods of Medicine and Physical Education courses. In a second stage, 40 students were randomly selected, 20 from each course, to evaluate cardiovascular risk factors and cardio-respiratory fitness. We measured (a) blood pressure; (b) body mass index (BMI); (c) fat percentage (electrical bioimpedance); (d) waist circumference (WC); (e) biochemical lab tests and (f) cardio-respiratory fitness (Kline test). Comparing Medicine students versus Physical Education students, we noticed a higher frequency of subjects presenting: low level of physical activity (55 vs 15%; p=0,008); pre-high blood pressure by SBP (80 vs 25%; p=0,000) and by DBP (45 vs 5%; p=0,003); overweight (50 vs 10%; p=0,006); waist circumference (25 vs 0%; p=0,017); elevated total cholesterol (165±28 vs 142±28mg/dL; p=0,015); high LDLc (99±27 vs 81±23 mg/dL; p=0,026); high glycemia (81±8 vs 75±7 mg/dL; p=0,013); lower cardio-respiratory fitness (48±8 vs 56±7 L.min.-1; p=0,001). Even though the knowledge that practicing physical activities is an important preventive intervention for cardiovascular diseases, students of Medicine display a smaller amount of physical activities practice, lower level of cardio-respiratory fitness and, most importantly, higher frequency of cardiovascular risk, compared to those of Physical Education.
Estudos recentes indicam forte associação entre inatividade física, baixo nível de condicionamento cardio-respiratório e presença de fatores de risco cardiovascular como hipertensão arterial, diabetes e obesidade. O ensino da Medicina e da Educação Física está fundamentado com o campo da conservação, promoção e reabilitação da saúde, sendo a atividade física uma intervenção prioritária para este fim. Entretanto, pouco se sabe sobre a adoção da atividade física como parte do estilo de vida dos estudantes de Medicina e Educação Física. O objetivo principal do presente trabalho foi de comparar o nível de atividade física, o nível de condicionamento cardio-respiratório e o risco cardiovascular entre estudantes de Medicina e de Educação Física. A coleta de dados foi realizada no departamento de Educação Física da Universidade Federal de Sergipe. Em uma primeira etapa aplicou-se questionário IPAQ para quantificar atividade física em 126 alunos dos 7os e 8os períodos dos cursos de Educação Física e Medicina. Em uma segunda etapa, selecionou-se por intermédio de randomização, 40 alunos, 20 de cada curso, para avaliação de fatores de risco cardiovascular e avaliação do condicionamento cardio-respiratório. Foram mensurados: (a) pressão arterial; (b) índice de massa corpórea (IMC); (c) % de gordura (bioimpedância elétrica); (d) circunferência de cintura (CC), (e) testes bioquímicos laboratoriais e (f) condicionamento cardio-respiratório (Teste de Kline). Comparando-se estudantes de Medicina vs Educação Física foi observado maior freqüência de indivíduos apresentando: baixo nível de atividade física (55 vs 15%; p=0,008); pré-hipertensão pela PAS (80 vs 25%; p=0,000) e pela PAD (45 vs 5%; p=0,003); sobrepeso (50 vs 10%; p=0,006); circunferência de cintura (25 vs 0%; p=0,017); colesterol total elevado (165±28 vs 142±28 mg/dL; p=0,015); LDLc elevado (99±27 vs 81±23 mg/dL; p=0,026); glicemia elevada (81±8 vs 75±7 mg/dL; p=0,013); menor condicionamento cardio-respiratório (48±8 vs 56±7 ml/Kg/min; p=0,001). Apesar do conhecimento de que a prática de atividade física é uma importante intervenção preventiva para as doenças cardiovasculares, estudantes de Medicina apresentam menor quantitativo de prática de atividade física, menor nível de condicionamento cardio-respiratório e, mais importante, maior freqüência dos fatores de risco cardiovascular, comparados aos de Educação Física.
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Hariri, Essa H. "Are We Optimizing the Use of Dual Antiplatelet Therapy in Patients Hospitalized with Acute Myocardial Infarction?" eScholarship@UMMS, 2019. https://escholarship.umassmed.edu/gsbs_diss/1010.
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Background: Dual antiplatelet therapy (DAPT) is a mainstay treatment for hospital survivors of an acute myocardial infarction (AMI). However, there are extremely limited data on the prescribing patterns of DAPT among patients hospitalized with AMI.
Objective: To examine decade-long trends (2001-2011) in the use of DAPT versus antiplatelet monotherapy and patient characteristics associated with DAPT use.
Methods: The study population consisted of 2,389 adults hospitalized with an initial AMI at all 11 central Massachusetts medical centers on a biennial basis between 2001 and 2011. DAPT was defined as the discharge use of aspirin plus either clopidogrel or prasugrel. Logistic regression analysis was used to identify patient characteristics associated with DAPT use.
Results: The average age of the study population was 65 years, and 69% of them were discharged on DAPT. The use of DAPT at the time of hospital discharge increased from 49% in 2001 to 74% in 2011; this increasing trend was seen across all age groups, both sexes, types of AMI, and in those who underwent a PCI. After multivariable adjustment, older age was the only factor associated with lower odds of receiving DAPT, while being male, receiving additional evidence-based cardioprotective therapy and undergoing cardiac stenting were associated with higher odds of receiving DAPT.
Conclusions: Between 2001 and 2011, the use of DAPT increased markedly among patients hospitalized with AMI. However, a significant proportion of patients were not discharged on this therapy. Greater awareness is needed to incorporate DAPT into the management of patients with AMI.
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Hastings, Rob. "Using 'next-generation' sequencing in the identification of novel causes of inherited heart diseases." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:6555e02b-e0e9-4632-9f75-f403dfcc35a3.
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Next-generation sequencing methods now allow rapid and cost-effective sequencing of DNA on a scale not previously possible. This offers great opportunities for the research of Mendelian disorders, but also significant challenges. The sequencing of exomes, or whole genomes, has emerged as a powerful clinical research tool, with targeted gene analyses generally being preferred in the clinical diagnostic setting. These methods have been employed here with the aim of identifying novel genetic causes of inherited heart disorders and to gain insights into the utility and limitations of these techniques for clinical diagnosis in these disorders. Data produced from the introduction of a targeted multi-gene next-generation sequencing test into clinical practice has been studied. Variation within the mitochondrial genome has been analysed to assess the importance of mitochondrial DNA variants in patients with hypertrophic cardiomyopathy. The m.4300A>G mutation is identified as an important cause of this disorder, with other previously cardiomyopathy-associated and novel variants also identified. Such multi-gene tests can facilitate interpretable and phenotype-relevant results, but at the expense of limiting more extensive data acquisition. Whole-genome sequencing has been performed in five families with different autosomal dominant inherited heart disease phenotypes of unknown genetic aetiology. In two of these likely pathogenic variants were identified, one in the gene encoding titin (TTN) and the other in the calcium channel subunit gene CACNA1C. In vitro studies were undertaken to support the pathogenicity of the TTN variant and understand the functional effects of this. In the other three families either multiple candidate gene variants were identified or no clear candidate variant was identified. This highlights the difficulties in interpreting these results, even in carefully selected families. Overall, although the research benefits of exome or genome studies are evident, the interpretation and validation of genetic variant data produced remains highly challenging for clinical diagnosis.
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Rariden, Brandi Scot. "Sedentary Time and the Cumulative Risk of Preserved and Reduced Ejection Fraction Heart Failure: from the Multi-Ethnic Study of Atherosclerosis." UNF Digital Commons, 2018. https://digitalcommons.unf.edu/etd/792.
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ABSTRACT
Purpose: The purpose of this study was to examine the relationship between self-reported sedentary time (ST) and the cumulative risk of preserved ejection fraction heart failure (HFpEF) and reduced ejection fraction heart failure (HFrEF) using a diverse cohort of U.S. adults 45-84 years of age.
Methods: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we identified 6,814 subjects (52.9% female). All were free of baseline cardiovascular disease. Cox regression was used to calculate the hazard ratios (HR) associated with baseline ST and risk of overall heart failure (HF), HFpEF, and HFrEF. Weekly self-reported ST was dichotomized based on the 75th percentile (1,890 min/wk).
Results: During an average of 11.2 years of follow-up there were 178 first incident HF diagnoses; 74 HFpEF, 69 HFrEF and 35 with unknown EF. Baseline ST >1,890 min/wk was significantly associated with an increased risk of HFpEF (HR [95% CI]; 1.87 [1.13 – 3.09], p= 0.01), but not HFrEF (HR [95% CI]; 1.30 [0.78 – 2.15], p= 0.32). The relationship with HFpEF remained significant in separate fully adjusted models including either waist circumference (HR [95% CI]; 2.16 [1.23 – 3.78], p < 0.01) or body mass index (HR [95% CI]; 2.17 [1.24 – 3.80], p < 0.01). Additionally, every 60 minute increase in weekly ST was associated with a significant 3% increased risk of HFpEF (HR [95% CI]; 1.03 [1.01 – 1.05], p < 0.01).
Conclusions: Sedentary time > 1,890 min/wk (~4.5 h/d) is a significant independent predictor of HFpEF, but not HFrEF.
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TÔRRES, Andréa Cintra Bastos. "Obesidade em cães: aspectos ecodopplercardiográficos, eletrocardiográficos, radiográficos e de pressão arterial." Universidade Federal de Goiás, 2009. http://repositorio.bc.ufg.br/tede/handle/tde/951.
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Previous issue date: 2009-02-27The obesity is a morbid condition commonnly incident in veterinary practice, generally associate to the companion animals reduction of time and quality of life. This factor, added to the regularity that it is observed, makes from obesity, nowadays, the most important metabolism disease in dogs, being still able to promote serious health problems, including cardiovascular disorders. For this study, 14 medium-sized neutered mongrel adult female dogs were divided in two groups and submitted to a program of weight gain. Group I, presenting highest percentage of weight gain (average 21.4% above the initial weight, in average) and Group II, with shortest weight gain percentage (15% above the initial weight, in average). Afterwards, both groups were submitted to a obesity correction food program, to reach the initial weight. During the food programs, in the initial phase (T1), obesity phase (T2) and final phase of weight reduction (T3), examinations carried out were: electrocardiographic, radiographic and mensurations of the blood pressure. During the phases T2 and T3, ecodopplercardiographic examinations of all dogs were also performed. At the end of the experimental phase, every variables obtained were statistically evaluated, comparing the groups and the different phases within the same group. The results revealed no significant eletrocardiographic and ecodopplercardiographic alterations, considering up to 21% of increment on body weight; increase of cardiac silhouette on radiographic evaluation during the obesity phase and decrease after the weight loss, and increase of arterial systolic pressure after the weight increment.
A obesidade é uma condição mórbida de ocorrência comum na prática veterinária, estando geralmente associada à redução do tempo e da qualidade de vida dos animais de companhia. Esse fator, unido à regularidade com que é observada, faz da obesidade, atualmente, a forma mais importante de doença do metabolismo em cães, podendo provocar sérios problemas de saúde, dentre eles os distúrbios cardiovasculares. Neste trabalho, 14 cadelas de porte médio, sem raça definida, adultas e castradas foram divididas em dois grupos e submetidas a um programa de ganho de peso. O Grupo I com maior porcentagem de ganho de peso (em média 21,4% acima do peso inicial) e o Grupo II com menor porcentagem de ganho de peso (em média 15% acima do peso inicial). Posteriormente foram submetidas a um programa alimentar de correção da obesidade até atingirem o peso inicial. Durante os programas alimentares, na fase inicial (T1), fase de obesidade (T2) e fase final de redução de peso (T3) foram realizados exames eletrocardiográficos, radiográficos e mensurações da pressão arterial e nas fases T2 e T3 exames ecodopplercardiográficos em todas as cadelas. Ao final da fase experimental, todas as variáveis obtidas foram avaliadas estatisticamente, comparando os grupos e as diferentes fases dentro do mesmo grupo. Os resultados revelaram que não ocorreram alterações eletrocardiográficas e nem ecodopplercardiograficas significativas, considerando incremento de peso corporal de até 21%; aumento significativo da silhueta cardíaca à avaliação radiográfica, na fase de obesidade, e diminuição da mesma após perda de peso e a pressão arterial sistólica dos cães aumenta com o incremento do peso.
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Kozor, Rebecca Alexandra. "Evolving applications of cardiovascular magnetic resonance in clinical cardiology." Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15858.
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ABSTRACT Cardiovascular magnetic resonance (CMR) is a non-invasive imaging technique with increasing use and demand worldwide both in the clinical and research arenas. Its strength is accurate quantification of cardiac structure and function, and unique abilities with tissue characterisation. The most common indications for CMR in general include the assessment of ischaemia and viability, and cardiomyopathy. This thesis explores the application of CMR in the assessment of cardiovascular disease in two distinct but uncommon populations encompassed in these categories – chronic social cocaine users and patients with Fabry disease, chosen because of the unique diagnostic challenges related to each, and persistent difficulties risk stratifying and targeting treatment in these settings. Chapter 1 provides an introduction with a literature review of the common and important clinical and research applications of CMR, as well as a detailed review of the cardiovascular effects of cocaine use and Fabry disease. It also states the overarching hypotheses and aim of this thesis. Chapter 2 outlines the general CMR methodologies utilised in the studies encompassed in this thesis. Chapter 3 reports the harmful cardiovascular effects of chronic social cocaine use in otherwise healthy young individual with the aid of CMR, including increases in systolic blood pressure, myocardial mass, and aortic stiffness, but no evidence of previous silent myocardial infarctions. Given precise measurements of left ventricular mass (LVM) are important both clinically and from a research perspective, Chapter 4 addresses the methods of quantifying myocardial mass in hypertrophied hearts by either including or excluding the left ventricular papillary muscles (LVPM) in the total mass. This pilot study includes male patients with Fabry disease and left ventricular hypertrophy (LVH) and shows that the LVPM are critical to total LVM quantification. To follow on from this, Chapter 5 explores the same concept but applied to a diverse range of patient cohorts with LVH. It shows that there is disproportionate hypertrophy of the LVPMs in Fabry disease with and without LVH. It also provides further insight into the disease biology in Fabry disease by characterising the papillary muscles with T1 mapping. Chapter 6 explores the utility of CMR in identifying cardiac involvement in patients with Fabry disease, and how it can potentially affect management by reclassifying patients and allowing consideration of targeted therapy. Finally, Chapter 7 uses a combination of CMR parametric mapping techniques and serum biomarkers to show that cardiac involvement of Fabry disease with late gadolinium enhancement is a chronic inflammatory cardiomyopathy. These findings offer potential for therapeutic targets and management guidance.
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Blackwelder, Reid B. "Cardiovascular Medicine." Digital Commons @ East Tennessee State University, 2000. https://dc.etsu.edu/etsu-works/6922.
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Cheng, Pak-ho. "P wave characteristics and QRS duration in patients after Fontan-type procedures." Click to view the E-thesis via HKUTO, 2010. http://sunzi.lib.hku.hk/hkuto/record/B43781627.
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Alves, Jorge Luís Guedes. "Utilização de Inteligência Artificial, através de inferência difusa, na correlação de métodos de diagnóstico de Insuficiência Cardíaca (IC)." Instituto Tecnológico de Aeronáutica, 2015. http://www.bd.bibl.ita.br/tde_busca/arquivo.php?codArquivo=3383.
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Esta pesquisa tem por objetivo investigar o estado da arte referente à Inteligência Artificial, através da utilização de lógica Fuzzy, endereçando-a ao domínio de conhecimento do grupo de pesquisadores da Universidade de São Paulo (USP), que atuam no Instituto do Coração (InCor) e criaram um novo biomarcador de diagnóstico de insuficiência cardíaca, baseado em acetona exalada. Com o desenvolvimento e implementação de um modelo computacional de Fuzzy, utilizando uma base de dados do InCor com 109 pacientes, através de inferência difusa, é possível propiciar uma análise mais refinada e com maior sensibilidade do diagnóstico de Insuficiência Cardíaca (IC) a partir dos dois biomarcadores da doença, a acetona exalada (recentemente descrita) e o Peptídeo Natriurético do tipo B (BNP). O resultado da correlação dos dois biomarcadores mostra ao profissional médico o diagnóstico de IC na forma linguística e pode ajudar na elaboração de uma melhor terapia no tratamento dos pacientes.
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Mumpower, Edward Lee. "Effect of disc angulation on the fluid dynamics of a tilting disc mitral valve prosthesis." Thesis, Georgia Institute of Technology, 1988. http://hdl.handle.net/1853/32827.
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Cheng, Pak-ho, and 鄭柏濠. "P wave characteristics and QRS duration in patients after Fontan-type procedures." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B43781627.
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Wang, Chunliang. "Computer Assisted Coronary CT Angiography Analysis : Disease-centered Software Development." Licentiate thesis, Linköping University, Linköping University, Radiology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-17783.
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The substantial advances of coronary CTA have resulted in a boost of use of this new technique in the last several years, which brings a big challenge to radiologists by the increasing number of exams and the large amount of data for each patient. The main goal of this study was to develop a computer tool to facilitate coronary CTA analysis by combining knowledge of medicine and image processing.Firstly, a competing fuzzy connectedness tree algorithm was developed to segment the coronary arteries and extract centerlines for each branch. The new algorithm, which is an extension of the “virtual contrast injection” method, preserves the low density soft tissue around the coronary, which reduces the possibility of introducing false positive stenoses during segmentation.Secondly, this algorithm was implemented in open source software in which multiple visualization techniques were integrated into an intuitive user interface to facilitate user interaction and provide good over¬views of the processing results. Considerable efforts were put on optimizing the computa¬tional speed of the algorithm to meet the clinical requirements.Thirdly, an automatic seeding method, that can automatically remove rib cage and recognize the aortic root, was introduced into the interactive segmentation workflow to further minimize the requirement of user interactivity during post-processing. The automatic procedure is carried out right after the images are received, which saves users time after they open the data. Vessel enhance¬ment and quantitative 2D vessel contour analysis are also included in this new version of the software. In our preliminary experience, visually accurate segmentation results of major branches have been achieved in 74 cases (42 cases reported in paper II and 32 cases in paper III) using our software with limited user interaction. On 128 branches of 32 patients, the average overlap between the centerline created in our software and the manually created reference standard was 96.0%. The average distance between them was 0.38 mm, lower than the mean voxel size. The automatic procedure ran for 3-5 min as a single-thread application in the background. Interactive processing took 3 min in average with the latest version of software. In conclusion, the presented software provides fast and automatic coron¬ary artery segmentation and visualization. The accuracy of the centerline tracking was found to be acceptable when compared to manually created centerlines.
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Klimis, Harry Emanuel. "Digital Health Interventions for Cardiovascular Disease Prevention Within a Rapid Access Cardiology Model of Care." Thesis, The University of Sydney, 2021. https://hdl.handle.net/2123/25555.
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Background
Cardiovascular disease (CVD) risk assessment can improve outcomes, but novel methods to identify high-risk patients and deliver prevention programs are needed. Rapid Access Cardiology (RAC) services can provide rapid risk assessment but have not been evaluated in Australia. Within RAC there is the potential to also implement systems that identify high-risk patients and manage risk using novel strategies. Mobile health (mHealth) provides a unique opportunity to deliver prevention programs and may influence behaviours. There is, however, limited evidence for mHealth efficacy in primary prevention.
Aims
To assess the utility of RAC to identify and manage patients at high-risk of CVD, and to leverage this opportunity to provide preventative care using mHealth.
Methods and results
Methods used include cohort studies, data audits, secondary analyses, and a randomised controlled trial (RCT). Part 1 evaluates the role of RAC for the assessment of suspected CVD and identifies gaps in risk factor assessment. RAC for chest pain and arrhythmia safely reduced unplanned hospitalisation. Many patients had multiple uncontrolled risk factors, but gaps exist in electronic data required to quantify risk. Part 2 examines the role of mHealth to improve CVD prevention, and identifies factors associated with effective text message-based programs. Message intent significantly influenced engagement. Patients with higher baseline risk were more likely to change behaviour. Part 3 evaluates text messages for CVD primary prevention via a RCT in higher risk patients from RAC. The primary outcome (difference in the proportion with 3 uncontrolled risk factors) was not significant at 6 months. However, the intervention improved risk factor control from baseline.
Conclusion
The results support a novel healthcare model which utilises digital health to optimise CV risk assessment and provide continued support to patients at elevated risk extending beyond the traditional clinical interface.
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Sheikh, Omer, MohD Ibrahim, Joseph Maguire, Shama Bano, Pradnya Bhattad, Dhruvil Radadiya, Amiksha Kad, et al. "COPD exacerbation induced Takotsubo Cardiomyopathy." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/75.
Full textAbstract:
Introduction:
Takotsubo cardiomyopathy or stress cardiomyopathy is a syndrome of transient left ventricular (LV) dysfunction mimicking myocardial infarction, but lacking obstruction of coronary artery disease (CAD) or acute plaque rupture. A characteristic differentiation from CAD is that regional motional abnormality extends beyond a territory perfused with a single epicardial coronary artery. Clinically, it is characterized by apical ballooning of the LV due to due to depression of mid and apical segments, with hyperkinesis of cardiac basal walls. Women are affected more than men, predominantly in the postmenopausal age.
Case Report:
A 54-year-old Caucasian female with a history of COPD, hypertension, uncontrolled diabetes mellitus, hyperlipidemia, depression and ongoing tobacco use presented with complaints of worsening shortness of breath two days prior to admission. She denied chest pain, worsened cough, palpitations, nausea or vomiting. On examination, she was in distress and anxious, with labored breathing. Upon examining the chest, decreased air entry was present in both lung fields with bibasilar wheezing. Initial lab tests showed mild respiratory acidosis, with pH of 7.24, pCO2 of 47.4 and pO2 of 65. Troponins on the day of admission was
Soon after admission, she started complaining of severe right neck pain. Repeat EKG revealed localized lateral J point, anteroseptal q waves and 4mm ST-segment elevation in leads V3 and V4 reciprocal changes and without chest pain. Repeat troponins were slightly elevated to 0.42 ng/ml and CK-MB was elevated to 20.2 ng/ml. A transthoracic echocardiogram showed regional abnormalities in left ventricle with the apex, mid to distal septum and the anterior part of septum was akinetic.
Discussion:
Takotsubo cardiomyopathy presents in 1 to 2 percent of troponin-positive acute coronary syndrome (ACS) with various clinical manifestations and various outcomes. Some patients have favorable outcomes based on their clinical performance and extent of cardiac muscle involvement. As in the case we presented, this syndrome can be entirely idiopathic, without a definitive underlying cause. Supportive management while hospitalized and early identification of complications improve the prognosis.
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Lawson, Kenneth Daniel. "The Scottish cardiovascular disease policy model." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4695/.
Full textAbstract:
This thesis is concerned with economic evaluation in the primary prevention of cardiovascular disease. Policymakers are increasingly focussed on reducing the health and economic burden of CVD and to reduce health inequalities. However, the approach to primary prevention suffers from fundamental weaknesses that this research intends to help address. There is general lack of effectiveness and cost effectiveness evidence underpinning current primary prevention interventions. First, there is a policy impetus towards mass screening strategies to target individuals at high risk of developing CVD when more focussed approaches may be more cost effective. Second, clinicians prioritise individuals on the basis of 10-year risk scores, which are strongly driven by age, and not the potential benefits (or costs) from treatment. Third, targeted and population interventions are often still treated as competing approaches, whereas the key issue is how they might best combine. The key premise of this thesis is that the aims of primary prevention are the avoidance of premature morbidity, mortality and to close health inequalities - subject to a budget constraint. A CVD Policy Model was created using the same nine risk factors as used in the ASSIGN 10-year risk score, currently used in clinical practice in Scotland, to estimate life expectancy, quality adjusted life expectancy and lifetime hospital costs. This model can be employed to estimate the cost effectiveness of interventions and the impact on health inequalities. The model performed well in a comprehensive validation process in terms of face validity, internal validity, and external validity. Life expectancy predictions were re-calibrated to contemporary lifetables. This generic modelling approach (i.e. using a wide range of inputs and producing a wide range of outputs) is intended to avoid the need to build bespoke models for different interventions aimed at particular risk factors or to produce particular outputs. In application, the CVD Policy Model is intended to assist clinicians and policymakers to develop a more coherent approach to primary prevention, namely: to design more efficient screening strategies; prioritise individuals for intervention on the basis of potential benefit (rather than risk); and to assess the impact of both individually targeted and population interventions on a consistent basis. Using the model in these ways may enable primary prevention approaches to be more consistent with guidelines from health sector reimbursement agencies, which may result in a more efficient use of scarce resources.
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Neal, Ashley Elizabeth. "Measures of cardiovascular health in obese youth." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-144628/.
Full text
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Jhund, Pardeep S. "Socioeconomic deprivation and cardiovascular disease." Thesis, University of Glasgow, 2010. http://theses.gla.ac.uk/2213/.
Full textAbstract:
Socioeconomic deprivation (SED) is inversely associated with mortality. The most deprived are at a higher risk of all cause mortality and cardiovascular mortality. However, only limited study of the relationship between SED and non-fatal cardiovascular disease has been previously undertaken. In those studies that have examined the relationship between SED and non-fatal cardiovascular disease, analyses have been limited to one form of cardiovascular disease (CVD), such as myocardial infarction or stroke and often prevalent disease. Furthermore, these studies have often failed to examine the association between SED and CVD whilst adjusting analyses for cardiovascular risk factors which are more prevalent in the most deprived. The aim of this work was to examine the association between SED and a number of cardiovascular outcomes after adjusting for the traditional cardiovascular risk factors of age, sex, smoking, blood pressure, diabetes mellitus and cholesterol. To determine is SED is in fact a risk factor for CVD after adjustment for these other risk factors, the relationship between SED and a number of fatal and non-fatal cardiovascular outcomes was examined. A number of forms of CVD were examined, including all coronary heart disease, myocardial infarction, stroke and heart failure A cohort of over 15,000 men and women who participated in the Renfrew Paisley cohort study was examined. These individuals were enrolled between 1974 and 1976 and underwent comprehensive screening for cardiorespiratory risk factors. They have since been followed for hospitalisations and deaths for 28 years. SED was measured using the Registrar General’s social class system and the Carstairs Morris index of deprivation. Rates of fatal and non-fatal outcomes were calculated, as were a number of composite outcomes. Adjusted analyses using multivariable regression were conducted to account for the risk factors of age, sex, smoking, blood pressure, diabetes and cholesterol. Further adjustment for the risk factors of lung function as measured by forced expiratory volume in 1 second, cardiomegaly on chest x-ray, body mass index, and a history of bronchitis was also made. The association between SED and the risk of recurrent cardiovascular hospitalisations, the burden of cardiovascular disease, as well as mortality and premature mortality was assessed for SED. I found that SED was associated with higher rates of hospitalisation for CVD disease in men and women irrespective of the measure of SED, either social class or the area based score of the Carstairs Morris index. This association persisted after adjustment for the traditional cardiovascular risk factors of age, sex, smoking, systolic blood pressure and diabetes and cholesterol. Further adjustment for lung function, the presence of bronchitis, body mass index and cardiomegaly on a chest x-ray did not explain the relationship between SED and each outcome. This risk was long lasting and persisted to the end of follow up. The strength of association of SED with coronary heart disease, myocardial infarction and stroke and all cause mortality was similar. The risk of a recurrent CVD hospitalisation was not higher in the most deprived after adjustment for CVD risk factors. However, I observed that SED was associated with higher mortality following an admission to hospital with CVD, before and after adjustment for cardiovascular risk factors of age, sex, smoking, systolic blood pressure, cholesterol and diabetes and after adjusting for the year of first developing cardiovascular disease. All cause mortality and cardiovascular mortality was highest in the most deprived. Again this association persisted after adjustment for cardiovascular risk factors. The most deprived also experienced longer hospital stays than the least deprived for a number of cardiovascular diseases including myocardial infarction and stroke. As a result the costs associated with cardiovascular disease admissions to hospital were highest in the most deprived despite their higher risk of dying during follow up. The cost differential was also explained by the finding that the most deprived experienced a higher number of admissions per person. Finally, the population attributable risk associated with SED is comparable to that of other traditional cardiovascular risk factors. In conclusion, I have found that the risk of CVD in the most deprived is higher even after adjustment for a number of cardiovascular risk factors. The numbers of hospitalisations, costs and mortality are also highest in the most deprived. Efforts are required to redress this imbalance. This can be achieved at the level of the individual through health care interventions to reduce the absolute burden of cardiovascular risk factors and to treat disease. However, societal level interventions are also required to tackle this problem as SED exerts complex effects on health that seem to also be independent of risk factors.
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Shah, Anoop. "Novel applications of cardiac troponin in cardiovascular medicine." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/28749.
Full textAbstract:
Cardiac troponins are released into the circulation following myocardial injury with measurement of serum troponin concentration integral to the diagnosis of myocardial infarction. The next generation of high-sensitivity cardiac troponin assays have enhanced precision at very low concentrations and for the first time permit troponin concentrations to be reliably quantified outwith acute coronary syndromes. My aim was to evaluate the impact of more sensitive troponin assays on the diagnosis of myocardial infarction and to determine the potential for novel applications in stable cardiovascular diseases. In 2,929 consecutive hospitalised patients with myocardial injury I assessed the impact of implementing a contemporary sensitive troponin assay and a lower diagnostic threshold, on the incidence, management and outcome of patients with primary (type 1) and secondary (type 2) causes of myocardial infarction. Lowering the threshold improved outcomes in patients with type 1 myocardial infarction, but disproportionately increased the diagnosis of type 2 myocardial infarction, and identified a group of patients who remained at high-risk of death over the next 12 months. In 1,126 consecutive patients with suspected acute coronary syndrome I evaluated the impact of a high-sensitivity cardiac troponin I assay and sex-specific diagnostic thresholds on the diagnosis of myocardial infarction. Whilst having little effect in men, the use of sex-specific diagnostic thresholds would double the diagnosis of myocardial infarction in women, identifying those at increased risk of recurrent events. In a second cohort of 4,870 patients, I evaluated the optimal threshold to rule out myocardial infarction. The negative predictive value for myocardial infarction or cardiac death at 30 days was evaluated for a range of troponin concentrations. Troponin concentrations < 5 ng/L on presentation identified half of all patients with suspected acute myocardial infarction as low risk. Implementation of this assay and approach would markedly reduce hospital admissions and improve the diagnosis of myocardial infarction, particularly in women. High-sensitivity cardiac troponin assays may help us to manage patients with chronic cardiovascular diseases, such as aortic stenosis or stable angina pectoris. In patients with aortic stenosis, cardiac troponin was associated with an advanced hypertrophic response on electrocardiography and the presence of myocardial fibrosis on cardiac magnetic resonance imaging. Furthermore, cardiac troponin concentrations were a strong independent predictor of cardiovascular death or aortic valve replacement. In patients with stable angina, cardiac troponin was associated with transient ST-segment depression on ambulatory monitoring, suggesting that troponin concentrations may be modified by silent myocardial ischaemia. My findings suggest that high-sensitivity troponin assays have major potential to improve the assessment, treatment and outcome of patients with suspected acute coronary syndrome. The potential for cardiac troponins to improve risk stratification and monitoring of disease progression in patients with chronic cardiovascular disease now needs to be evaluated in prospective cohort studies.
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Costanzo, Pierluigi. "Strategies for cardiovascular prevention by evidence based medicine." Thesis, University of Hull, 2015. http://hydra.hull.ac.uk/resources/hull:14574.
Full textAbstract:
Cardiovascular prevention aims to early identify patients at higher risk of developing a cardiovascular event, Prompt identification and treatment of those can potentially reduce the risk of events to occur. The purpose of this study was to assess the efficacy of drug therapy in primary and secondary cardiovascular prevention using the evidence based medicine approach. In the first part of this thesis, the focus is on the role of two main surrogate end points for cardiovascular events, for which the prognostic role is still unclear (serial measurement of carotid intimamedia thickness (IMT) and left ventricular hypertrophy (LVH)). In the second part, the efficacy of drug therapy strategies for cardiovascular events prevention is assessed for three topics lacking of clear evidence: 1) Calcium Channel Blockers (CCBs) and clinical outcomes 2) The role of Ace Inhibitors (ACE-Is) vs Angiotensin Receptor Blockers (ARBs) in patients without left ventricular systolic dysfunction 3) The efficacy of statin therapy in primary prevention according to the gender. Literature review was performed by collecting all the articles relevant to the objectives of the study. A meta-regression analysis was performed to test the relationship between serial IMT or LVH changes and clinical outcomes. A meta-analysis was performed to calculate the overall estimates of effect of ACE-Is vs ARBs in patients without heart failure, of CCBs in hypertension or coronary artery disease and of statins in primary prevention according to gender. A publication bias test and sensitivity analysis were also performed. The results showed that neither carotid IMT or LVH change predict the risk of cardiovascular events. Furthermore, CCBs reduced the risk of myocardial infarction and were more effective than ACE-Is in preventing stroke, however they are possibly less effective than other medications in preventing heart failure. In patients without heart failure, ARBs were not as effective as ACE-is in reducing cardiovascular outcomes. Finally, statins in primary prevention of coronary heart disease appeared more effective in men than in women.
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Sathyapalan, Thozhukat. "Cardiovascular risk reduction in insulin resistant states." Thesis, University of Hull, 2009. http://hydra.hull.ac.uk/resources/hull:5768.
Full textAbstract:
Introduction: Insulin resistance is the hall mark of a number of pathological conditions and is thought to play a major role in the cardiovascular risk associated with them. This thesis critically evaluates two insulin resistant conditions - polycystic ovary syndrome (PCOS) and type 2 diabetes (T2DM) - where there are many unresolved issues. During the course of these studies, the effect of weight loss and medications in modifying cardiovascular risk in these conditions was evaluated. Methods: The first studies focused on a randomised open labelled parallel study of metformin and rimonabant in obese patients with PCOS. Subsquently, an extension to this study was undertaken where patients who were on rimonabant were changed over to metformin, whereas those on metformin were continued on metformin for another 3 months. As part of this study the effect of rimonabant and metformin on incretin hormones in patients with PCOS was studied. The next studies focused on a randomised double blind placebo controlled study on the pleotrophic effect of atorvastatin in patients with PCOS. Subsequent metformin therapy after atorvastatin treatment was undertaken. This study led to the investigation of the effect of simvastatin and atorvastatin on biological variation of lipids in patients with T2DM that has got implications in treating to lipid targets. A corollary to this study was whether the biological variation of LDL calculated using Friedewald formula differed from that of direct LDL. Results: In the first series of studies, after 12 weeks of rimonabant there was a significant reduction in anthropometric and metabolic parameters as well as biochemical hyperandrogenemia in patients with PCOS. There was no change in any of these parameters in the metformin treated group. In three months extension arm to this study, metformin maintained the weight loss as well as enhanced the metabolic and biochemical parameters achieved by treatment with rimonabant, compared to 6 months of metformin treatment alone. There was a significant and reversible increase in glucose-dependent insulinotropic polypeptide (GIF) levels after 3 months of rimonabant treatment. There were no changes in GIF or glucagon-like peptide-1 (GLP-1) levels with metformin. In the second series of studies it has shown that atorvastatin was effective in reducing inflammation, biochemical hyperandrogenemia and metabolic parameters in patients with polycystic ovary syndrome after a 12 week period compared to placebo. The subsequent effect of three months metformin treatment was augmented by atorvastatin pre-treatment compared to placebo pre-treatment. In the subsequent study it was shown that the coefficient of variation (CV) of TC, LDL, HDL and TG on simvastatin was significant but comparable to atorvastatin in patients with T2DM. However, subsequent directly measured LDL cholesterol was shown to be an order of magnitude more stable when taking equivalent doses of atorvastatin rather than simvastatin. Conclusion: Both weight loss using rimonabant and atorvastatin were effective in reducing biochemical hyperandrogenemia and metabolic profile in patients with PCOS. The effect of rimonabant might be partly mediated through modulating GIF levels.
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González, Seña Susana. "Interventions in patients at high cardiovascular risk." Thesis, University of Hull, 2011. http://hydra.hull.ac.uk/resources/hull:5599.
Full textAbstract:
Cardiovascular disease is a major cause of premature death in UK and an important contributor to escalating health costs. The risk of suffering a cardiovascular event is associated with multiple risk factors that can cluster in different pathological conditions such as type 2 diabetes, polycystic ovarian syndrome (PCOS) and hypopituitarism. Therefore, interventions in these patients at high risk of cardiovascular disease can be potentially beneficial to improve cardiovascular health and this is explored in the different chapters of this thesis. Current knowledge of what constitutes cardiovascular risk is reviewed in chapter one and the methods used to conduct the studies presented in this thesis are described in chapter two. Chapter three evaluates the effects of social deprivation in lipid management in a community setting. This study analysed lipid measurements and lipid lowering agents prescriptions across 34 electoral wards in Kingston Upon Hull and East Riding of Yorkshire with different deprivation scores. A ward is a primary territorial unit which represent a part of an electoral district. It showed that both lipid measurements and prescriptions were similar in deprived and wealthier wards (correlation values: r=0.18 and r=0.50 respectively) and this might represent service under provision in poorer areas. The effect of isoflavones on insulin resistance and cardiovascular risk factors in postmenopausal women with diet controlled type 2 diabetes is studied in chapter four. Oral supplementation with 132 mg/day for a three months period has no significant effects modulating glycaemic control (glucose, p=0.59; HbA1c, p=0.58), insulin 12 resistance (HOMA-IR method, p=0.24) or cardiovascular risk factors (total cholesterol, p=0.96; HDL cholesterol, p=0.93; LDL cholesterol, p=0.97; triglycerides, p=0.74; body mass index, p=0.97; systolic blood pressure, p=0.35 and diastolic blood pressure, p=0.38). This implies that either a combination of soy protein and isoflavones or soy protein on their own are needed to induce the beneficial effect reported in the literature. Chapter five evaluates the combined effect of a hypocaloric diet (1500 kcal/day) and metformin (500mg three times a day) on cardiovascular risk factors and on the biological variation of lipids in obese patients with PCOS. This intervention improved central obesity (waist/hip ratio, p=0.02; body mass index, p=0.008), blood pressure (systolic blood pressure=0.02; diastolic blood pressure, p=0.009) and LDL levels (p=0.03). However, the biological variation of lipids is similar to that in health and remained unchanged with this intervention. Therefore, reference value changes obtained from healthy individuals could be used to monitor serial lipids levels i.e. in response to a therapeutic intervention. The effects of subcutaneous recombinant growth hormone (rGH) in patients with adult onset growth hormone deficiency on exercise capacity, quality of life and general cardiovascular risk factors is explored in chapter six. Three months treatment with a fixed, low dose of rGH (dose=0.4 mg/day) improved total body fat (p=0.05) and normalised plasma IGF1 (p=0.0001) without a significant effect on cardiovascular risk factors, exercise capacity or quality of life. Mitochondrial succinate dehydrogenase (SDH) increased by a 2.7 fold in both the active and placebo phases when compared with baseline, possibly related to an increase in patient’s daily activities. Finally, chapter seven analyses the biological variation of N terminal probrain natriuretic peptide (NT-proBNP) in postmenopausal women with and without type 2 diabetes. Type 2 diabetes appears to have little influence in the biological variation of this natriuretic peptide. This implies that current guidelines on the use of NT-proBNP for the screening, diagnosis and evaluation of serial results in hearth failure would be applicable in type 2 diabetes. The reference change values obtained in this study could be used to determine if two NT-proBNP levels are different due to the effect of treatment rather than their biological variation.
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Huwa, Cornelius Kondwani. "An investigation of the symptom burden of paediatric cardiology outpatients in Blantyre, Malawi: The patient perspective." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27957.
Full textAbstract:
Introduction: Children suffering from cardiac disease present with an increasing burden of symptoms throughout the trajectory of their disease. There is little research describing symptom burden among children with cardiac disease in resource-limited settings in general and looking particularly from the patients' perspective. Social, spiritual and psychological symptom burden and challenges are rarely examined in literature. This study was designed to explore the symptom burden of children with cardiac disease by engaging the children in a discussion about their illness with reference to their social (family and school), physical, spiritual and psychological lives. This was done with the understanding that palliative care improves quality of life through alleviation of distressing symptoms. AIM: To determine symptom burden and palliative care needs of paediatric cardiology outpatients from the perspective of the patient. OBJECTIVES: 1. To describe the common physical symptoms of the children coming to cardiology clinic 2. To describe the psychosocial burden of paediatric cardiology patients in outpatient clinic 3. To describe the spiritual symptoms burden of paediatric cardiology patients in outpatient clinic Methods: This was a cross-sectional descriptive study, using qualitative methodology with semi-structured interviews. The study had twelve participants (aged between 8 years and 18 years) and was conducted at Queen Elizabeth Central Hospital (QECH)'s Paediatric Cardiac Clinic. Findings: Pain was a common physical symptom in all the participants. Only 2 participants received analgesia aimed at treating the pain. Other common physical symptoms were breathlessness, fatigue, vomiting and insomnia. Schooling challenges were common with 7 of the participants either repeating a class or starting school at an older age. Availability of a loving and caring family provided an enabling environment. Schools which had been informed of the cardiac condition of the participants were found to be helpful in supporting the children. Faith and religion were found to be important to most of the participants in coping with the disease. Conclusion: Children with cardiac disease have physical, social, psychological and spiritual challenges and symptoms. To alleviate the burden of symptoms, health workers must pay attention and aim to treat all possible reported symptoms and provide support to families. Living with a chronic cardiac condition affects the whole being of a child including relationships, schooling, family and faith.
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Preiss, David John. "The interplay between glycaemia and cardiovascular disease." Thesis, University of Glasgow, 2011. http://theses.gla.ac.uk/3038/.
Full textAbstract:
Numerous large clinical trials of cardiovascular risk lowering agents have been conducted in the hope of reducing the excess cardiovascular risk found in patients with diabetes mellitus. However, the relationship between glucose and cardiovascular disease remains complex and various areas require further study. Even in patients with diabetes, an individual’s cardiovascular risk is highly variable depending on other clinical characteristics, the assumption that glucose is a continuous risk factor has often been based on weak evidence from relatively short studies, the effect of commonly used cardiovascular risk lowering agents often has unexpected effects on new-onset diabetes and statins have not yet been studied in detail, and whether glucose-lowering therapies actually reduce cardiovascular risk has remained a contentious issue despite the conduct of large clinical trials. Furthermore, the realisation that the combination of diabetes and chronic heart failure, a common complication of coronary disease, carries a particularly poor prognosis suggests that prediction of diabetes in this population may be clinically valuable. Aims: I aimed to address the following different, though related, questions regarding glucose and cardiovascular disease: 1. Are anticipated cardiovascular event rates in diabetes endpoint trials actually achieved? Is it possible to easily identify patients with diabetes that are at particular risk of events (information that is crucial to investigators who wish to design clinical trials)? 2. Is fasting glucose concentration independently and convincingly associated with increased risk of cardiovascular events in those without diabetes? 3. Do statins, the most commonly prescribed medications worldwide, have any influence on the risk of developing diabetes? 4. If statins do indeed affect new-onset diabetes, is there any evidence of a dose-dependent effect? 5. How effectively can clinicians predict the development of diabetes in chronic heart failure using commonly recorded clinical information? 6. Does intensive glucose-lowering therapy reduce the risk of cardiovascular events in patients with diabetes? Methods: To address these questions three approaches were used, namely (i) systematic review of previously published data from large cardiovascular endpoint trials conducted in patients with diabetes; (ii) analyses of existing datasets from two large clinical trials; (iii) meta-analyses of published and unpublished data from large clinical trials. Results and interpretation: 1. In a systematic review of 29 trials with 116,790 patients with diabetes, it was apparent that the majority of large cardiovascular endpoint trials conducted in patients with diabetes vastly overestimated the likely cardiovascular event rates in initial power calculations. Introduction of (i) previous history of cardiovascular disease and/or (ii) presence of proteinuria, as binary trial inclusion criteria, provides a simple and effective way to identify patients at high risk, something that is sought after for appropriate clinical trial power calculations. 2. In a population of 6,447 men without diabetes at baseline, impaired fasting glycaemia was not associated with increased risk of cardiovascular events over 15 years. Similarly, when baseline fasting glucose values <7.0mmol/L were split into quintiles, patients in the highest quintile were at similar risk of all vascular endpoints to those in the lowest. By contrast, impaired fasting glycaemia was a powerful risk factor for developing diabetes. 3. A meta-analysis of published and unpublished data from most large placebo- and standard care-controlled statin trials, which included data for 91,140 trial participants without diabetes at baseline, revealed that statin therapy is associated with a 9% higher risk for developing diabetes. 4. A subsequent meta-analysis of unpublished data from five large trials comparing intensive statin therapy with moderate dose therapy found that intensive statin therapy increases the risk of developing diabetes by 12% compared to moderate dosing, in keeping with a dose-dependent effect. While statin therapy remains effective at reducing cardiovascular risk it appears that patients on statin therapy, especially those on intensive regimens, should be considered for diabetes screening. 5. In an analysis of data for 1,620 patients with chronic heart failure and no diabetes at baseline studied for 2.8 years, the strongest predictors of new-onset diabetes were similar to those in the general population. In particular, the combination of HbA1c and body mass index provided a c-statistic of 0.79. 6. In a meta-analysis of published data for 33,040 patients with diabetes who participated in clinical trials comparing intensive glucose-lowering therapy with standard therapy, non-fatal myocardial infarctions were reduced by 17% on intensive therapy but no other cardiovascular endpoints were reduced. Death rates were similar in both groups. Conclusion: While diabetes is associated with excess cardiovascular risk, risk varies considerably depending on other risk factors. Glucose is, at best, a weak risk factor in those without diabetes, and glucose-lowering in patients with diabetes has only yielded a modest reduction in non-fatal myocardial infarctions but not other events; by contrast, measures of glycaemia are powerful predictors of new-onset diabetes in patients with and without chronic heart failure. Finally, the relationship between glucose and vascular disease is further complicated by the fact that numerous medications designed to reduce cardiovascular risk appear to have surprising effects on the risk of developing diabetes.
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Hammer, Fabian. "Corticosteroid hormone action in the cardiovascular system." Thesis, University of Birmingham, 2011. http://etheses.bham.ac.uk//id/eprint/1436/.
Full textAbstract:
The cardiovascular system (CVS) has emerged as an important target of corticosteroid hormones. Mineralocorticoid receptor antagonists provide cardiovascular protection and are now routinely used in disorders such as primary hyperaldosteronism, resistant hypertension and congestive heart failure (CHF) but the underlying molecular mechanisms of corticosteroid hormone action remain unclear. We have characterised corticosteroid hormone action and metabolism by 11β- hydroxysteroid-dehydrogenases (11β-HSDs) in isolated adult rat cardiomyocytes (CM) and cardiac fibroblasts (cFb). We have detected 11β-HSD1 expression and activity in CM and cFb where it facilitates glucocorticoid hormone action, whereas 11β-HSD2 was absent. We have shown differential gene regulation by aldosterone (Aldo) and corticosterone in CM and identified novel Aldo target genes which may provide insights into the molecular mechanisms of Aldo action. We have also studied the role of corticosteroids in essential hypertension and the effect of spironolactone (Spiro) upon their secretion and metabolism in patients with chronic kidney disease. We have shown that mineralocorticoids but not glucocorticoids are involved in elevated blood pressure in essential hypertension and that Spiro treatment results in compensatory activation of the renin-angiotensinaldosterone system (RAAS), whereas glucocorticoid secretion and metabolism remain unchanged. In summary, these data provide novel molecular and clinical insights into corticosteroid hormone action in the CVS.
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Angell, Peter James. "Cardiovascular consequences of anabolic steroid use." Thesis, Liverpool John Moores University, 2011. http://researchonline.ljmu.ac.uk/6126/.
Full textAbstract:
With the increase in the prevalence of anabolic steroid (AS) use for non-medical performance and image enhancement purposes, the impact of AS on cardiovascular health is an issue of growing public concern. AS use has long been associated with a number of negative CV outcomes such as acute myocardial infarction, stroke, thrombo-embolisms and sudden death. These associations, however, are largely assumed from case study findings where no cause and effect can be apportioned. Small cohort studies have suggested a negative effect of AS on a number of established CV disease risk factors including, blood pressure (BP), lipid profiles (e.g total cholesterol, LDL and HDL), C-reactive proteins and homocysteine, although data is limited both in number of studies and number of participants and is often contradictory. Another potential mechanism to link AS use to cardiac events has been to assess cardiac structure and function. Available data is contradictory but recent developments in imaging technologies suggest that new mechanistic insights could be developed and/or tested. In study one we investigated the impact of AS use on a broad profile of CV risk factors as well as an in-depth cardiac assessment utilising speckle tracking echocardiography which can assess regional and global cardiac deformation in multiple planes. In AS users we observed an increase in resting heart rate and low- density lipoprotein concomitant to a decrease in high-density lipoprotein levels. 2D and speckle-tracking echocardiography revealed a significant effect of AS use on cardiac function, most notably a decreased diastolic (relaxation) function that suggests a stiffer left ventricle in the AS users. This imposes a greater workload on the heart and increases the risk of CV events. In study two we developed the assessment of cardiac structural assessment in AS users by adopting state-of-the-art magnetic resonance imaging that provides a greater accuracy in morphology assessment as well as allowing us to determine the presence of perfusion defects and interstitial fibrosis. We observed that AS users had a hypertrophy of both the left and right ventricles that was concomitant with diastolic dysfunction in the left ventricle and a reduction in right ventricular contractility. Despite these findings no AS user presented with any perfusion defect or evidence of interstitial fibrosis, suggesting that these pathways to CV events were not apparent in the current group of AS users. The final study comprised two pilot or feasibility studies of the impact of resistance exercise on left ventricular function in AS users. Trial 1 assessed blood pressure and cardiac tissue velocities during an acute leg press with and without valsalva. Systolic blood pressure was significantly elevated even after one repetition and this was mediated by AS use. In trial 2 cardiac function and blood biomarkers of cardiac cell damage were assessed before and after a standard resistance exercise training session. Left ventricular systolic function was maintained in recovery in both AS and NAS participants. Diastolic function was reduced in both groups with some evidence that AS use exaggerated this effect. Multiple technical, design and participant lessons were gained to take these feasibility studies forward to full studies. Overall we add new data to the concept that AS use can place the participant at an increased CV risk. It is probably not obligatory that AS use leads to increased CV risk but in some the route from AS use to CV event may be mediated by changes in structure and function of both the L V and RV. Exercise stress may add an additional CV risk to the AS user.
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Malik, Muhammad Omar. "Insulin resistance, ethnicity and cardiovascular risk." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6517/.
Full textAbstract:
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality. The literature supports a series of established risk factors for CVD: age, gender, family history of CVD, ethnicity (un-modifiable); and high blood pressure, blood cholesterol, TGs, LDL, diabetes, pre-diabetes, obesity, smoking, physical inactivity, stress and unhealthy diet (modifiable). High blood pressure (hypertension) shares many of these risk factors. However, much of the variance/risk in both conditions cannot be explained. This has led to a search for novel risk factors, including insulin resistance and subclinical inflammation, the significance of which at present are controversial, particularly in relation to hypertension. There are also ethnic differences in the incidence, prevalence, risk factors and progression of cardiovascular disease. In some populations CVD occurs at an earlier age and progresses more rapidly. In this thesis I worked on two datasets in relation to hypertension, cardiovascular disease and their risk factors: (i) the RISC (Relationship between Insulin Sensitivity and Cardiovascular disease) study (chapters 2, 3, 5 and 6); and (ii) routinely-collected national data in Scotland via the SDRN (Scottish Diabetes Research Network) and SCI-Diabetes (chapter 2 and 7). Work on data from the RISC cohort focused on the relation between clamp-measured insulin sensitivity (its unique feature), inflammatory markers and hypertension; the SDRN work addressed ethnic differences in relation to diabetes and CVD. The first study (Chapter 3) examined the importance of insulin sensitivity/resistance in the development of hypertension and change in blood pressure over three years of follow-up in the healthy European (EU) RISC population. Systolic BP (SBP) was higher at baseline in insulin resistant (IR) women. There was no difference in BP in relation to IR in men. After adjustment for age, BMI, baseline BP and other covariates, low insulin sensitivity (M/I) predicted a longitudinal rise in SBP in women but not men, and SBP over time did not increase in insulin sensitive women. The second study (Chapter 4) was a systematic review of the relationships between two markers of low grade inflammation (IL-6 and CRP) and BP/hypertension, considering the roles of adiposity and insulin resistance. The systematic review showed evidence of considerable variation in the relationships amongst low grade inflammation, adiposity, insulin resistance and the development of hypertension. There appeared to be a positive association in the literature between CRP and DBP in younger individuals, although none of the studies were adjusted for insulin sensitivity determined by clamp technique. This association was further explored using RISC study data in Chapter 5 with stratification by sex and adjusting for clamp-derived insulin sensitivity. The third study (Chapter 5) examined the relationship of inflammatory markers with the development of hypertension and change in blood pressure over three years in the same healthy European population and whether any relationship was independent of clamp-measured insulin sensitivity (IS). High sensitivity C reactive protein (hsCRP) predicted prospective change in diastolic BP independent of insulin sensitivity and BMI whereas IL-6 had no relation with BP (both systolic and diastolic) or the incidence of hypertension. The fourth study (Chapter 6) evaluated all available predictors of BP rise over time (both systolic and diastolic) in a healthy EU population; moreover the significance of different predictors was examined within subgroups defined by age and sex. This analysis showed that baseline BP was the principal determinant of follow-up BP in all age and sex groups. Obesity was the second most important predictor (BMI in adults aged 30-44 years; percent change in BMI in middle age people aged 45-60 years). Lifestyle factors influenced BP via their effect on BMI. People who maintained their BMI during the three year follow-up did not exhibit a rise in BP (whether systolic or diastolic). Other important predictors identified in this analysis were insulin sensitivity in middle aged women and hsCRP in adult men. The fifth study (chapter 7) evaluated the role of ethnicity in the development of cardiovascular disease in people with type 2 diabetes living in Scotland. Over a follow-up of seven years, Pakistani people had increased risk of CVD and Chinese people had decreased risk of CVD as compared to White population. Pakistanis had an increased risk of CVD at a younger age independent of other conventional risk factors. In summary, insulin sensitivity and inflammation influence blood pressure, but their role is not generalised across different age and sex groups. BMI and change in BMI are important predictors of follow-up BP in adults and middle age healthy people, supporting a role for maintenance of BMI in preserving cardiovascular health. In addition to the known ethnic differences in the development of diabetes, I identified ethnic differences in the development of CVD.
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McNulty, Clare. "Ageing, inflammation and cardiovascular function." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/6541/.
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Age is associated with the development of multi-system function loss including the musculoskeletal, immune and cardiovascular system, as well as body composition changes. These age-related alterations lead to frailty development and disease progression, reducing quality of life. A major lifestyle change occurring in later years is reduced physical activity levels. This thesis sought to examine the associations between physical activity and multi-system function loss in a cohort of elderly individuals, and to better understand the neural mechanisms underpinning the circulatory responses to exercise. It was observed that high daily physical activity levels attenuate some but not all of the age-related changes in elderly individuals. High physical activity was associated with superior physical functioning, lower total body fat and visceral adiposity, and plasma plasminogen activator inhibitor 1 (PAI-1) concentrations. Left ventricular (LV) diastolic function was negatively associated with mean arterial pressure (MAP) and visceral adiposity, suggesting that elderly individuals with higher MAP and visceral adiposity may have inferior LV diastolic function. In terms of neural mechanisms related to circulatory responses to exercise, in models of metaboreflex over-activity whereby BP is elevated as observed in heart failure patients, left atrial systolic function is enhanced in order to maintain end-diastolic volume and SV.
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Tomson, Joseph. "Vitamin D and cardiovascular disease." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/87895/.
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Cardiovascular disease (CVD) is the leading cause of death worldwide. Vitamin D is important for bones and for other body functions. Whether insufficient vitamin D causes CVD is unclear. Previous trials of vitamin D were unable to evaluate effects on CVD. This thesis will (i) review the literature on vitamin D and CVD; (ii) evaluate the observational associations between plasma 25(OH)D levels and CVD; and (iii) describe the design and results of the BEST-D trial. (i) Associations between baseline 25(OH)D levels and cause-specific mortality were evaluated in the Whitehall Resurvey of survivors undertaken in 1995, and findings included in a meta-analysis of similar studies. (ii) The BEST-D study was a randomised trial in older healthy volunteers of the effects of two doses of vitamin D3 (4000 IU or 2000 IU daily) compared to placebo, on blood 25(OH)D concentrations and CVD risk factors including blood pressure and arterial stiffness. (i) The Whitehall Resurvey of 5409 men with mean age of 77 years, among whom there were 3215 deaths showed an approximately linear (log-log scale) inverse association of plasma 25(OH)D concentrations and both CVD and non-vascular causes of death between 30 to 90 nmol/L. The meta-analysis confirmed the associations of 25(OH)D with CVD mortality. (ii) The BEST-D trial showed marked increases in 25(OH)D blood concentrations but no effects of taking higher doses of vitamin D3 for 12 months on blood pressure or arterial stiffness, compared to placebo. Plasma 25(OH)D is inversely associated with both CVD and non-vascular mortality. No effects were found after oral intake of vitamin D3 on blood pressure or arterial stiffness after 1 year. Randomised trials using adequate doses of vitamin D3 are needed, to evaluate causal effects of taking vitamin D on CVD outcomes.
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Manuchehri, Alireza Monshizadeh. "The impact of thyroid dysfunction on cardiovascular risk." Thesis, University of Hull, 2008. http://hydra.hull.ac.uk/resources/hull:1745.
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Thyroid dysfunction syndromes (hypo and hyperthyroidism) have major impacts on the cardiovascular system. Whilst the short term effects of thyroid dysfunction on the cardiovascular system are clinically obvious and well studied, the long term effects and particularly the size of its effects on the cardiovascular system remain controversial. The author concludes that the effects of thyroid dysfunction on the cardiovascular system are subtle, these effects do not always translate into adverse cardiovascular outcomes, and the magnitude of the effect is proportional to the severity of thyroid dysfunction.
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Butterfield, M. C. "Cardiovascular receptor changes induced by drugs and diseases." Thesis, University of Liverpool, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316867.
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Jennings, Catriona Sian. "Concordance for cardiovascular risk changes within families of patients with coronary disease participating in a preventive cardiology programme." Thesis, Imperial College London, 2013. http://hdl.handle.net/10044/1/12920.
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Aims: To investigate concordance for lifestyle – smoking, diet and physical activity - between married couples when one has developed coronary disease, and concordance for lifestyle change over one year in a nurse-led, multidisciplinary, family centred, prevention programme across six countries. Methods: In the EUROACTION trial consecutive coronary patients were recruited from hospitals, with their partners, to this programme. Concordance for smoking, diet and physical activity, and cardiovascular risk factors, was investigated at the initial assessment, at 16 weeks and one year. Findings: 645 couples attended the initial assessment and 65% of couples returned at one year. At the time of the coronary event, there were nearly two times as many couples, than expected by chance, currently smoking. Couples were also concordant at baseline for saturated fat (r=0.41) fruit and vegetables (r=0.67) and for physical activity (r=0.25). With the exception of total cholesterol, cardiovascular risk factors in couples were all significantly correlated: body mass index (BMI) r=0.22; waist circumference (WC) r=0.12; systolic blood pressure (SBP) r=0.20; total cholesterol (TC) r=0.07; LDL-C r=0.13; HDL-C r=0.27 and fasting blood glucose (FBG) r=0.20 reflecting concordance for lifestyle. The smoking quit rate at one year was significantly higher at 74% in patients with a partner who was a non-smoker compared to 50% in patients with a partner who smoked (p=0.03). There was significant concordance for change at one year between patients and partners for: saturated fat r=0.43; fruit and vegetables r=0.61; physical activity r=0.40; BMI r=0.21; WC r=0.22; SBP r=0.13; TC r=0.21 and HDL-C r=0.34. Patients making the healthiest lifestyle changes were associated with partners making similarly healthy changes. Interpretation: Couples had an unhealthy concordant lifestyle at baseline but became healthier during the course of the preventive cardiology programme, with concordance for change between couples at both 16 weeks and one year. As couples are concordant for lifestyle, with observational evidence of concordance for change, we should focus on couples rather than patients alone.
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Baker, J. E. "Ethnicity and cardiovascular disease prevention." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6524/.
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Background Public health interventions need to both improve health and reduce health inequalities, whilst using limited health care resources efficiently. Well-established ethnic differences in cardiovascular disease (CVD) raise the possibility that CVD prevention policies may not work equally well across ethnic groups. The aim of this thesis was to explore whether there are ethnic differences in the potential impact of two CVD prevention policy choices – the choice between mass and targeted screening for high cardiovascular risk, including the use of area deprivation measures to target screening, and the choice between population and high-risk approaches. Methods Cross-sectional data from the Health Survey for England 2003 and 2004 were used. Three sets of analyses were carried out – first, calculation of ethnic differences in the utility of area deprivation measures to identify individual socioeconomic deprivation; second, investigation of ethnic differences in the cost-effectiveness of mass and targeted screening for high cardiovascular risk; third, analysis of ethnic differences in the potential impact of population and high-risk approaches to CVD prevention. Results Area deprivation measures worked relatively effectively and efficiently at identifying individual socioeconomic deprivation in ethnic minority groups compared to the white group. In ethnic groups at high risk of CVD, cardiovascular risk screening programmes were a relatively cost-effective option, screening programmes targeted at deprived areas were particularly cost-effective, and population approaches were found to be an effective and equitable way of preventing CVD despite potential underestimation of their impact. Discussion This thesis found that ethnic minority groups in the UK are unlikely to be systematically disadvantaged by a range of CVD prevention policies that have been proposed, or implemented, for the general population. Additional CVD prevention policies, in particular those based on the population approach, should be implemented.
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Приступа, Людмила Никодимівна, Людмила Никодимовна Приступа, Liudmyla Nykodymivna Prystupa, Владислава Володимирівна Дитко, Владислава Владимировна Дитко, Vladyslava Volodymyrivna Dytko, І. Ю. Двоєглазова, and І. І. Савенко. "Хвороби ситеми кровообігу: клініко-епідеміологічні дані по Сумській області." Thesis, Видавництво СумДУ, 2011. http://essuir.sumdu.edu.ua/handle/123456789/14712.
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Hankey, Catherine Ruth. "Cardiovascular health effects of moderate weight loss." Thesis, University of Glasgow, 1998. http://theses.gla.ac.uk/5513/.
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This thesis describes the results of dietetic led weight management for weight loss in three different groups of subjects: overweight; overweight with angina; and those whose body weight was close to the healthy upper BMI of 25 kg/m2. It forms part of a growing literature examining moderate weight loss as a success outcome in weight management. The work in this thesis addresses an important general research question; whether the effect of modest weight loss per se on established risk factors for IHD was similar across a number of subject groups. The specific aims were to examine the effect of moderate weight loss on the established IHD risk factors, fibrinogen, factor VII activity, plasma and whole blood viscosity, PAI activity and t-PA antigen. The role of modest weight loss on the adrenal hormone DHEAS was also studied. The conclusion of this thesis is that modest weight loss, (around 4%) which can be achieved through well planned dietetic management, does produce important reductions in IHD risk. The weight loss achieved was similar in groups with BMI > 28 kg/m2, with or without IHD, but less in absolute terms in individuals with baseline weights near the top of the healthy (acceptable range). Reductions in factor VII activity and RCA were related to the amount of weight loss, but the reductions were not greater in those with higher baseline values and existing IHD. The falls in factor VII activity and RCA were accompanied by falls in other established IHD risk factors, plasma lipid concentrations and blood pressure.
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Mordi, Ify Raphael. "The clinical utility of cardiovascular magnetic resonance." Thesis, University of Glasgow, 2015. http://theses.gla.ac.uk/6200/.
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The use of cardiovascular magnetic resonance (CMR), particularly in the cardiovascular research setting, has grown exponentially in the past 20 years. While CMR is increasingly used in clinically, it has yet to be incorporated into routine clinical practice and guidelines in the majority of conditions. One of the main reasons for this is the relative paucity of evidence for its diagnostic and prognostic utility and cost-effectiveness compared to more established non-invasive imaging techniques such as echocardiography and nuclear imaging. For CMR to become part of routine clinical care, more evidence of its utility is required. The aim of this thesis was to demonstrate the clinical utility of CMR by using it to examine 5 clinical questions that pose a relevant dilemma to physicians in a cohort of patients referred for clinically indicated CMR studies. CMR has two major advantages over echocardiography, the most commonly used technique in our centre (and most worldwide). Firstly, it is the gold standard for assessment of left ventricular volumes and function, and secondly, it has the ability to characterise the myocardium using specific imaging sequences and intravenous gadolinium contrast (known as late gadolinium enhancement – LGE). The first study in this thesis explored the potential benefit of a CMR protocol using these benefits to predict prognosis in an unselected cohort of patients. In this study I found that the assessment of myocardial function using ejection fraction and deformation imaging (strain) and assessment of the presence of fibrosis using LGE had incremental prognostic significance in addition to clinical predictors of outcome in all patients, including in those with ejection fractions greater than 35% (commonly thought to predict higher risk patients). During scanning of this cohort of patients, it became apparent that CMR imaging of myocardial scar in patients with a history of prior myocardial infarction (MI) had the ability to identify fat within the infarcted territory, known as lipomatous metaplasia, which had been recognised pathologically but is not identified by echocardiography. The tissue characterisation ability of CMR has for the first time allowed this to be identified non-invasively ante-mortem. Pathological studies had suggested that lipomatous metaplasia was associated with adverse remodeling, while recent animal studies had suggested that the presence of myocardial fat within infarcts was pro-arrhythmogenic. In this study I showed that the presence of lipomatous metaplasia was indeed independently associated with mortality and ventricular arrhythmias, suggesting that it perhaps provides an arrhythmogenic substrate. The next study explored the use of LGE in addition to established clinical markers in patients undergoing implantable cardioverter-defibrillator (ICD) implantation for ischaemic or dilated cardiomyopathy. These patients met the current clinical criteria for ICD implantation and also had testing of NT-proBNP, a marker of cardiac strain that is associated with adverse prognosis. The patients all underwent pre-implantation CMR. I found that the presence of LGE and a high NT-proBNP was associated with a higher risk of death and ICD activation, perhaps hinting at a role for CMR in providing further risk stratification in this group of patients. Following on from this, I looked at the diagnostic capabilities of CMR. Characterisation of patients with mildly impaired left ventricular systolic function is important as early identification of cardiomyopathy can potentially allow early institution of life-saving therapies. Mild left ventricular impairment can however also be associated with the normal myocardial adaptations to exercise, known as athlete’s heart. This poses a diagnostic dilemma, which may not be easily solved using current imaging techniques. I found that the use of a further CMR parameter to characterise tissue, T1 mapping, was able to discriminate between patients with early DCM and exercisers with normal physiological myocardial adaptation, perhaps providing a solution to this diagnostic challenge. The final study explored the utility of dobutamine stress CMR (DSCMR) to diagnose significant coronary artery disease (CAD) in patients with left bundle branch block (LBBB) and clinically suspected CAD. CAD is the most common cause of LBBB, yet LBBB causes myocardial abnormalities that can make it difficult diagnose CAD non-invasively, leading many patients to be referred for invasive coronary angiography (ICA) to confirm the diagnosis. Despite this, a substantial proportion of the patients with LBBB will not have significant CAD, meaning that ICA would be unnecessary. This study compared DSCMR with dobutamine stress echocardiography, with ICA as the gold standard. I found that DSCMR was significantly more accurate in diagnosis than dobutamine stress echocardiography, perhaps providing a technique that could be used as a gatekeeper to ICA. This thesis shows that CMR can provide important diagnostic and prognostic information in a variety of cardiac conditions and can potentially help guide clinical decision-making. Larger studies should be performed to confirm these findings, allowing for determination of cost-effectiveness and incorporation of CMR into routine clinical management.
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Roberts, Will. "Assessment of coronary artery disease by computed tomography." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8708.
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Computed Tomography Coronary Angiography (CTCA)is a technique for imaging coronary arteries with increasing indications in clinical cardiology. AIMS 1.Develop a heart rate (HR) lowering regime for CTCA and to measure its association with image quality. 2.Examine the diagnostic accuracy of 64 slice CTCA (CTCA64) in patients with known coronary artery disease (CAD). 3.Examine the diagnostic accuracy of CTCA64 for assessment of stent restenosis 4.Demonstrate utility of CTCA as an endpoint in assessment of novel diagnostic biomarkers of CAD. METHODS I developed a HR reducing strategy using metoprolol and assessed its effectiveness for improving CTCA64 image quality. The diagnostic value of CTCA in patients with suspected angina was evaluated by comparison with invasive coronary angiography. The diagnostic value of CTCA for quantifying stent restenosis was evaluated by comparison with intravascular ultrasound. The utility of CTCA for evaluating the diagnostic value of B-type natriuretic peptide (BNP) and high sensitivity cardiac troponin I (hs- TnI) was evaluated by blood sampling in patients with suspected angina who subsequently underwent CTCA. RESULTS 1.In 121 patients undergoing CTCA, 75 required rate control. This was achieved (rate ≤60 bpm) in 83% using a systematic regimen of oral and IV metoprolol (n=71) or verapamil (n=4). I demonstrated a significant relation between HR reduction and graded image quality (p<0.001). 2.80 patients underwent CTCA64 and invasive coronary angiography. 724 coronary arterial segments were available for analysis. The sensitivity and specificity of CTCA for significant luminal stenosis was 83.3% (95% CI 67.1-92.5%) and 96.7% (95% CI 95.1-97.9%), respectively, but the positive predictive value was only 63.5% (95% CI 50.4-75.3%). 3.80 patients with 125 stented segments underwent CTCA64 and invasive coronary angiography. Additional intravascular ult rasound (IVUS) examination of stented segments was performed in 48 patients. Using IVUS as the gold-standard for stent restenosis, CTCA and invasive coronary angiography had comparable diagnostic specificities for binary stent restenosis: 82.7% (95% confidence intervals 69.7- 91.84%)and 78.9% (95% confidence intervals 65.3-88.9%), respectively. Sensitivities were lower, particularly the sensitivity of CTCA which was only 11.8% (95% confidence intervals 1.5-36.4%) compared with 58.8% (95% confidence intervals 32.9-81.6%) for invasive coronary angiography. 4. In 93 patients with suspected angina CTCA64 provided a useful endpoint for assessing the diagnostic value of novel circulating biomarkers. BNP levels were higher in the 13 patients shown to have significant (≥50% stenosis) coronary artery disease compared with patients who had unobstructed coronary arteries (18.08pg/ml (IQR 22) vs 9.14pg/ml (IQR 12.62), p=0.024) and increased significantly with exercise, particularly in the group with anatomic coronary artery disease (2.73 ± 5.69 pg/ml vs 1.27±3.29 pg/ml, p=0.16). Conversely I found no association between hs-TnI and the presence of CAD. CONCLUSION Image quality of CTCA64 is enhanced by heart rate reduction below 60 bpm which can be achieved safely by a regimen of oral and intravenous metoprolol. Although CTCA64 is a useful non-invasive method for diagnosis of coronary artery disease, it has a low positive predictive value for identifying severe (≥50%) luminal stenosis which limits its clinical value. Its value for assessment of stent restenosis is even more limited but it finds useful application as an endpoint for diagnostic evaluation of novel biomarkers, allowing confirmation of an association between circulating BNP levels and stable coronary artery disease.
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Wahl, Elizabeth R. "Older adults' understanding of cardiovascular risk and preventive medication benefit." [New Haven, Conn. : s.n.], 2008. http://ymtdl.med.yale.edu/theses/available/etd-12092008-165627/.
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Neisius, Ulf. "Proteomic, circulating and functional biomarkers of cardiovascular disease." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4740/.
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Cardiovascular disease is the leading cause of morbidity and mortality in the Western world, mainly through cerebrovascular and coronary artery related events. Cardiovascular disease is a chronic progressive disease with different stages. These stages can be assessed by a variety of biomarkers. Biomarker quantification can be used for different purposes: screening, prediction of disease recurrence, therapeutic monitoring, diagnosis and prognostication. Noninvasive, inexpensive diagnostic tests currently applied in clinical practice have a relative high rate of false positive and false negative results. Therefore further refinement of the diagnostic process could improve clinical care. Regarding prognostication the need for improvement also remains as current risk models only predict a small quantity of occurring cardiovascular events. The concept of the cardiovascular continuum postulates that cardiovascular disease consists of a chain of events, is initiated by numerous cardiovascular risk factors and subsequently progresses through pathophysiological processes, ultimately leading to end-stage heart failure. For that reason cardiovascular diseases are chronic progressive conditions and can be divided into different stages, such as early tissue dysfunction or subclinical atherosclerosis prior to development of clinically overt disease. Biomarkers suitable for prognostication and diagnosis can differ at each stage. The general aim of this thesis was therefore the investigation of a variety of biomarkers in diagnosis and prediction of cardiovascular disease at different stages of the cardiovascular continuum, as covered by three different study cohorts contributing to this thesis. This included several approaches: the comparison of central and peripheral pulse pressure in middle aged hypertensive patients in regards of their prognostic potential; the application of established circulating, functional and structural biomarkers to the diagnostic process of coronary artery disease in stable angina patients; the development/refinement of a urinary proteomic biomarker for coronary artery disease and the examination of its diagnostic potential in stable angina patients. Biomarkers successful in the diagnosis of coronary artery disease were included in multiple biomarker models. Aside from biomarker development for the general population, investigations of specific cohorts, such as patients with certain diseases and belonging to certain age groups or sharing specific biochemical features provided advances in the past. To estimate the potential of a biomarker in risk prediction association studies with surrogate biomarkers are applicable. We collected a cohort of middle-aged hypertensive patients to assess if central pulse pressure, derived from non-invasive assessment of arterial stiffness, could improve risk prediction. Central pulse pressure has been previously shown to have prognostic value in populations with end-stage renal failure, coronary artery disease and high prevalence of diabetes mellitus. Considering the prognostic information of peripheral pulse pressure in the elderly, the hypothesis that central pulse pressure could improve risk prediction is comprehensive and was investigated as part of this thesis. This was accomplished by comparing the strength of correlation between central or peripheral pulse pressure and these surrogate biomarkers. When compared to peripheral pulse pressure, central pulse pressure had stronger associations with aortic pulse wave velocity, carotid intima-media thickness, and left ventricular mass index, but equal association with the albumin:creatinine ratio. In contrast, after adjustment for age, mean arterial pressure, heart rate and hypertension status there was no significant difference between central and peripheral pulse pressure for prediction of listed surrogate biomarkers in multivariate analysis. These results suggested that central pulse pressure is unlikely to provide more prognostic information than peripheral pulse pressure in middle-aged hypertensive patients. The diagnosis of coronary artery disease is clinically relevant in symptomatic patients, either acute or stable. The diagnosis of stable flow limiting coronary artery disease is especially challenging as non-cardiac as well as other cardiac conditions can mimic symptoms. Non-invasive diagnostic tools have either moderate sensitivities or specificities, or are not widely available. Therefore new biomarkers for the diagnosis of flow limiting coronary artery disease have the potential to improve current diagnostic strategies. This could be accomplished adjacent to existing biomarkers or by replacement of such, due to cost effectiveness, better discriminatory etc. As part of this thesis, a biomarker identification and validation study was conducted into urinary proteomics of coronary artery disease. First we tried to replicate a study conducted by our research group in the past. Therein, an established coronary artery disease specific polypeptide pattern was unable to differentiate between patients with severe coronary artery disease and healthy controls despite strong cohort similarities to the original study. We therefore recalibrated the urinary polypeptide pattern using an enlarged biomarker discovery cohort and adjusted the pattern for lipid lowering and angiotensin converting enzyme inhibitor treatment effects. We calculated a score from the resulting polypeptide pattern, which identified coronary artery disease patients with a sensitivity of 79% and a specificity of 88% in a biomarker validation cohort. As the next step of biomarker development we performed a diagnostic validation study. The investigated clinical cohort consisted of stable angina patients with or without coronary artery disease. The new polypeptide pattern score was unable to differentiate between these two groups. The score however correlated strongly with coronary artery disease extent as measured by the Gensini score, implying that urinary proteomics in the diagnosis of coronary artery disease is promising, yet requires further effort before clinical employment. In addition to the urinary proteomic biomarker development second diagnostic approach was selected. As coronary artery disease is a complex chronic disease, the combination of different biomarkers should result in a better discrimination between stable angina patients with or without coronary artery disease. This approach attempts to position the individual as precisely as possible on the cardiovascular continuum including serologic, functional vascular and imaging biomarkers of subclinical atherosclerosis. Serologic markers thereby present a plasma proteomic approach covering pathophysiological processes with known correlation or causative for coronary artery disease. Functional and structural changes of the peripheral vasculature resemble the coronary artery system. We investigated circulating biomarkers and vascular biomarkers separately. A variety of circulating biomarkers differentiated patients with severe coronary artery disease from healthy control subjects. When patients with stable angina and with or without coronary artery disease as diagnosed by coronary angiography were investigated no statistically significant differences could be detected for circulating biomarkers. In the same study a microvascular biomarker, the reactive hyperaemia index, and a macrovascular biomarker, the carotide plaque score, were able to differentiated between cases and controls. Both markers either added separately or together improved the risk classification of exercise treadmill test results. This suggests that a multiple biomarker approach in the diagnosis of coronary artery disease in stable angina patients could be successful. Different aspects of the cardiovascular continuum can be applied to diagnosis and prognostication of cardiovascular disease.
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Bellenger, Nicholas Gilmore. "Cardiovascular magnetic resonance in the assessment of cardiac remodelling." Thesis, Imperial College London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271981.
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Bobak, Martin. "Determinants of the epidemic of cardiovascular diseases in Czechoslovakia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.362820.
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Alventosa, i. Zaidin Marina. "Bloqueig de branca dreta i morbimortalitat cardiovascular." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/668092.
Full textAbstract:
INTRODUCCIÓ:
El bloqueig de branca dreta (BBD) és una de les alteracions electrocardiogràfiques més freqüents.
La significació clínica que pot tenir el BBD en pacients sans sense evidència de malaltia cardiovascular coneguda és controvertida des de fa anys. La majoria d’estudis observen un augment d’esdeveniments cardiovasculars però sense resultats estadísticament significatius o només significatius per un esdeveniment concret.
OBJECTIUS:
PRINCIPAL: Estimar si la presència del BBD en població general sense malaltia
cardiovascular augmenta la morbimortalitat cardiovascular. ESPECÍFICS:
- Determinar el risc relatiu de patir esdeveniments cardiovasculars en pacients amb BBD respecte a pacients amb ECG normal.
- Determinar el risc relatiu de patir mortalitat en pacients amb BBD respecte als pacients amb ECG normal.
SECUNDARIS:
- Estimar la prevalença de BBD i les característiques de la població que el presenta.
- Estimar la incidència de BBD.
- Estudiar la concordança diagnòstica del BBD entre metgesses d’Atenció Primària i un cardiòleg.
MATERIAL I MÈTODES:
Estudi de cohorts retrospectiu realitzat en 29 centres d’Atenció Primària de l’àrea metropolitana de Barcelona (Barcelona Ciutat, Barcelonès Nord i Maresme)
POBLACIÓ DIANA: Pacients de més de 49 anys, sense malaltia cardiovascular a l’inici
de l’estudi i amb un ECG llegible i sense alteracions (excepte el bloqueig de branca dreta)
RESULTATS:
S’han inclòs 2981 pacients, el 58% dones (n=1729) amb una edat mitjana de 65,9 anys (DE 8.8). El 92,2% (n=2752) té un ECG normal (ECG-N), 4,6 %(n=134) un BBD
incomplet i un 3,2% (n=95) un BBD complet. Els subjectes han estat seguits una mitjana de 5 anys. Els factors associats a la presència del BBD complet són el sexe masculí (OR=3,8, IC95% 2,4-6,1) i l’edat (OR=1,05 per any, IC95% 1,03-1,08). El BBD complet
s’associa a un augment de mortalitat per qualsevol causa (HR 2,60 IC 95% 1,65-4,09) i al bloqueig bifascicular (HR 21,40, IC95% 7,18-63,80). A l’ajustar per edat, sexe i comorbiditats prevalent només el bloqueig bifascicular s’ha mantingut estadísticament significatiu (p<0.001). Els pacients amb BBD complet han presentat més esdeveniments cardiovasculars respecte els pacients amb un ECG normal com la fibril·lació auricular, l’arteriopatia perifèrica, accidents vasculocerebrals i la insuficiència cardíaca, però els resultats no han estat estadísticament significatius. Els pacients amb BBD incomplet que han progressat a bloqueig complet han presentat un augment d’insuficiència cardíaca i d’insuficiència renal respecte els pacients que sempre tenen un ECG normal, un bloqueig incomplet o bé un bloqueig complet.
La incidència del BBD incomplet ha estat de 3,5 casos per 1000 persones-any (n=15) (IC95% 2,0-5,8) i del BBD complet de 4.3 casos per per 1000 persones-any (n=19) (IC95% 2,6-6,7)
A nivell de la concordança, s’ha estudiat 160 pacients diagnosticats pel seu metge d’Atenció Primària de BBD. El 54% són homes amb una edat mitjana de 64,8 anys. La
concordança del diagnòstic del BBD incomplet entre els 5 investigadors (4 metgesses d’Atenció Primària i 1 cardiòleg) ha obtingut un índex Kaapa de 0,71 i de 0,85 entre les 4 investigadores d’Atenció Primària.
L’índex Kappa pel diagnòstic de BBD complet entre els 5 investigadors ha estat de 0,93 i entre les investigadores d’Atenció Primària de 0,96. Els paràmetres amb més discordança diagnòstica entre els investigadors són la duració i morfologia del complex QRS, possiblement perquè la lectura dels ECG s’ha realitzat de forma manual.
CONCLUSIONS:
La presència del BBD complet s’associa a més edat i al sexe masculí. El bloqueig complet augmenta la mortalitat per qualsevol causa i l’aparició de nous esdeveniments cardiovasculars però sense obtenir resultats estadísticament significatius. Els pacients amb bloqueig incomplet que han progressat a bloqueig complet han presentat més esdeveniments cardiovasculars.BACKGROUND: Right bundle branch block (RBBB) is one of the most common electrocardiographic abnormalities. The objective of this research is to establish the prevalence and incidence of RBBB in the general population without a cardiovascular history and to determine whether the presence of RBBB in a general healthy population increases cardiovascular morbidity and mortality compared with patients with a normal ECG. METHODS: A retrospective cohort study. RESULTS: We included 2981 patients,58% were women. The mean (SD) age was 65.9(8.8). Of the sample,92.2%(n=2752) had a normal ECG,4.6%(n=134) incomplete right bundle branch block (iRBBB) and 3.2%(n=95) complete right bundle branch block (cRBBB). The subjects were followed for a mean of 5 years. The factors associated with the appearance of cRBBB were male sex (odds ratio [OR],3.8;95%CI,2.4-6.1) and age (OR,1.05 per year;95%CI,1.03-1.08). cRBBB was associated with an increase in all- cause mortality (hazard ratio [HR],2.60; 95% CI,1.65-4.09) and bifascicular block (HR,21.40;95%CI7.18-63.80). When the results were adjusted for age, sex and prevalent comorbidities, only bifascicular block maintained a statistically significant association with cRBBB (P < 0.001). Patients with iRBBB had more cardiovascular events such as atrial fibrillation, peripheral arterial disease, cerebrovascular accident and heart failure but the results were not statistically significant. Patients with iRBBB who progressed to cRBBB showed a higher incidence of heart failure and chronic kidney disease than patients who always had a normal ECG, iRBBB or cRBBB. CONCLUSION: cRBBB is more common in men and elderly patients. cRBBB tends to increase all-cause mortality and the appearance of cardiovascular events, but the results were not statistically significant. Patients with iRBBB who progressed to cRBBB had more cardiovascular events.
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McKellar, Gayle Elspeth. "The assessment and modification of cardiovascular risk in inflammatory arthritis." Thesis, University of Glasgow, 2012. http://theses.gla.ac.uk/3681/.
Full textAbstract:
Background Rheumatoid arthritis (RA) is a chronic inflammatory disorder that primarily affects synovial joints and is the commonest form of inflammatory polyarthritis. RA potentially confers significant morbidity, loss of function and reduced quality of life. It is a multisystem disorder with extra-articular manifestations affecting skin, cardiovascular, respiratory and haematological systems. There is an associated premature mortality associated with RA which is mainly attributable to cardiovascular disease (CVD). Much has been published on the associated increased CVD risk which RA confers, which includes increased incidence of myocardial infarction, congestive cardiac failure and hypertension. Active RA is associated with a higher burden of both traditional cardiovascular (CV) risk factors (cigarette smoking, dyslipidaemia and hypertension) and novel risk factors (endothelial dysfunction, arterial stiffness and insulin sensitivity) than would be expected in the general population. Furthermore, chronic inflammation may be atherogenic. Certain drug therapies may contribute to CV risk, such as steroids and anti-inflammatories. Whereas other drug therapies, such as anti-tumour necrosis factor agents, may modulate CV risk. There have been many recent controversies regarding anti-inflammatories, both non-selective non-steroidal anti-inflammatory drugs (NSAID) and cyclooxygenase2 (COX2) inhibitors. These include gastrointestinal system side-effects, renal dysfunction and hypertension. The most publicised of these issues was the withdrawal of rofecoxib in 2004 by its manufacturers after clinical trial data emerged which showed a 3.5% incidence of myocardial infarction or ischaemic stroke in patients with no pre-existing CVD who were receiving therapy. This lead to a scrupulous review in the medical journals of the relative CV risks of both NSAID and COX2 inhibitor groups as whole; as well as sub-analysis and comparison of individual preparations. In 2006 the American Heart Association recommended that in order to minimise CV risk, any patient prescribed an anti-inflammatory should have the lowest dose administered for the shortest possible time. Furthermore, it is clear from the literature that it is not just underlying disease processes and medication that can impact on CV risk. Dietary modification can have a large bearing on health outcomes. Large epidemiological studies from Greece and other countries of southern Europe have confirmed that adherence to a Mediterranean-type diet is associated with increased longevity and reduced CVD. A Mediterranean-type diet is typically rich in olive oil, fruit, vegetables, legumes and fish, with a low intake of red-meat. This type of diet is often complemented by a modest amount of alcohol, usually red wine, taken alongside meals. This contrasts starkly with the typical diet of the west of Scotland – ‘famed’ for its high amount of saturated fat and sugar and relatively low consumption of fruit and vegetables. Of late, much interest has been generated regarding the potential relationship between social deprivation and effect on health in general, particularly: diet, cardiovascular disease and RA outcomes. This is of particular relevance to Glasgow which has some of the most deprived areas in Scotland. While traditional CV risk assessment calculators have focussed on traditional markers such as blood pressure and cholesterol, newer validated scores include a score of deprivation, higher areas of social deprivation are associated with higher incidence of CVD, and family history of CVD. Aims In this thesis my aims were to explore the effect of novel interventions on various aspects of RA, predominately to assess CV risk further and review whether certain aspects of risk could be modified. First of all, I investigated the feasibility and effect of anti-inflammatory withdrawal in patients with well-controlled RA (that is to say, patients with mild disease activity scores). The rationale to the NSAID withdrawal study was that removal of therapy plus any required active intervention would provide equivalent symptom control to that achieved by continuing NSAID. Other prescribed RA therapies were continued. The impact of this intervention was assessed by disease activity score, pain score and functional assessments. Secondary study outcomes included the effect of drug withdrawal on blood pressure control, gastrointestinal symptoms and renal function. Subsequently, the impact of a Mediterranean-type diet on disease activity within the Glasgow RA population was reviewed. The study was set up to assess if existing resources could be used as much as possible and replicate a Mediterranean-type diet in a real-life setting, predominately in areas of social deprivation in the east end and south side of Glasgow. Feasibility and acceptability to participants was explored. Additionally, the impact of such a dietary intervention on disease activity, CV parameters and haematological markers was assessed. Finally, given recent evidence linking social deprivation with CV risk as well as poor RA outcomes, an analysis was undertaken using the cohort recruited to the Mediterranean-type diet. Results of CVD risk calculations according to conventional and new algorithms were compared. Results Thirty patients with RA and a 44-joint disease activity score of ≤2.8 were recruited to a 12-week anti-inflammatory withdrawal study. All completed the study period without requiring re-introduction of anti-inflammatories and all continued on their previously prescribed RA therapy. Eleven patients required a steroid injection at either the 6 or 12-week study visit and only 1 required escalation of disease modifying therapy. There was no significant deterioration in disease activity score or components at the 12-week assessment. A significant improvement in blood pressure was recorded with a maximal median reduction of 7 millimetres of mercury (p=0.037). Seventy-five patients with RA were recruited to the intervention arm of the Mediterranean-type dietary study and attended weekly cookery classes over a 6 week period. Fifty-five patients with RA were recruited to the control arm and received basic printed information only. All routine medication was continued and patients assessed at baseline, 3 and 6 months. Significant benefits were seen in the intervention group with regards to features of RA activity: reduced duration of early morning stiffness at 6 months (p=0.041), patient global health assessment score at 6 months (p=0.002) and pain score at 3 and 6 months (p= 0.011 and 0.049 respectively). Then intervention group demonstrated a benefit in systolic blood pressure. There was a significant increase in fruit, vegetable and legume consumption as assessed by food frequency questionnaire. The substantial amount of baseline demographic and CV data collected from the Mediterranean-type diet study allowed a comprehensive assessment of the influence of social deprivation on CV risk scores in a cohort of female patients with RA living in the Glasgow area to be undertaken. Three different CV risk calculators were used: Joint British Societies Coronary Risk Prediction, Framingham and the newer, Scottish, ASSIGN score which incorporates social deprivation. ASSIGN was more likely to classify an individual with a >20% 10-year CVD risk (23% of total cohort) than Framingham or JBSCRP. By using ASSIGN, an additional 16 individuals were identified as having a >20% 10-year CV risk than would have been identified by using traditional JBSCRP alone. Conclusions The anti-inflammatory withdrawal intervention was limited by an open-label design and small participant numbers (n=30). However, it was well tolerated and did not result in the need for significant medical intervention, nor loss of disease control. A significant improvement in systolic blood pressure was noted over the study follow-up.
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Coucelo, Pedro Parreira Cruz. "Avaliação de Índices de Função Sistólica do Ventrículo Esquerdo em Canis lupus familiaris por Técnica de Ecocardiografia Doppler." Master's thesis, 2012. http://hdl.handle.net/10437/3667.
Full textAbstract:
Orientação: Pedro Bragança Parreira ; co-orientação: Ana GodinhoA função cardíaca é fortemente condicionada pela mioarquitectura do coração, pelo que o estudo da relação morfologia-função ventricular nos mamíferos é de grande importância no diagnóstico e tratamento de patologias cardíacas. O cálculo dos volumes cardíacos durante todo o ciclo cardíaco tem uma importância fundamental para o estudo da função ventricular e para a definição dos padrões hemodinâmicos. Foi objectivo deste trabalho, o estudo de índices de função sistólica ventricular esquerda, em 25 cães (Cannis lupus familiaris), através da utilização de diferentes técnicas ecocardiográficas, como o Modo M, ecocardiografia bidimensional, Doppler tecidular e a ecocardiografia de contraste. Foi utilizado contraste ultrasonográfico, para melhorar a definição do endocárdio e possibilitar maior rigor no cálculo dos volumes ventriculares, e na avaliação da função ventricular sisto-diastólica global e regional. Os resultados apresentados foram sujeitos a tratamento estatístico com software Analyze-it. O Doppler tecidular mostrou ser um método robusto para avaliar a função sistólica. A ecocardiografia de contraste permitiu não só obter uma melhor definição endocárdica, como obter valores de fracção de ejecção com diferença estatisticamente significativa. Como os três métodos utilizados avaliam diferentes aspectos da função sistólica, função ventricular radial, circunferencial e longitudinal, não podem ser comparados directamente entre si.
Cardiac function is strongly determined by heart's myo-architecture, so that the study of the relationship morphology-ventricular function in mammals is of great importance in the diagnosis and treatment of heart disease. Cardiac volumes evaluation throughout the cardiac cycle is of fundamental importance for the study of ventricular function and to define the hemodynamic patterns. The objective was to analyze echocardiographic left ventricular systolic function indices in 25 dogs (Cannis lupus familiaris), applying different methodologies such as M mode, 2D, tissue Doppler and contrast echocardiography. Also contrast ultrasound was used to improve endocardium border definition and to increase ventricular volumes calculation accuracy, as better systolic and diastolic ventricular global and regional function. The results were subjected to statistical analysis with Analyze-it software. Different systolic function indices were calculated such as fractional shortening, ejection fraction and systolic tissue velocity. Tissue Doppler did show to be a strong and reliable method to assess systolic function. Contrast left ventricular opacification improved ventricular border endocardium definition, and allowed statistical significance ejection fraction assessment. Because all three used methods really evaluate different aspects of systolic function, radial, circumferential and longitudinal ventricular function, they cannot be compared side by side.
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Gargiulo, Giuseppe. "Personalized medicine in interventional cardiology: pharmacologic and mechanical strategies to balance ischemic and bleeding complications during and after percutaneous cardiovascular interventions -- Searching for and fighting with a Chimera --." Tesi di dottorato, 2018. http://www.fedoa.unina.it/12474/1/Thesis_Gargiulo.pdf.
Full textAbstract:
In the Greek mythology, the Chimera was a monstrous firebreathing hybrid creature of Lycia in Asia Minor, composed of the parts of more than one animal (usually depicted as a lion, with the head of a goat arising from its back, and a tail of snake). Homer's brief description in the Iliad is the earliest surviving literary reference. The term Chimera has come to describe any mythical or fictional animal with parts taken from various animals, or to describe anything composed of very disparate parts, or perceived as wildly imaginative, implausible, difficult to realize or utopian. Bellerophon was the hero who fought and killed the Chimera. When he arrived in Lycia, the Chimera was truly ferocious, and he could not harm the monster even while riding on Pegasus. He felt the heat of the breath the Chimera expelled, and was struck with an idea. He got a large block of lead and mounted it on his spear.
Then he flew head-on towards the Chimera, holding out the spear as far as he could. Before he broke off his attack, he managed to lodge the block of lead inside the Chimera's throat. The beast's firebreath melted the lead, and blocked its air passage. The Chimera suffocated, and Bellerophon returned victorious to King Iobates.
Percutaneous cardiovascular interventions are the cornerstone treatment of cardiovascular diseases. Antithrombotic therapy during and after these interventions
is fundamental to prevent ischemic recurrences, but has the risk to increase bleeding complications. To find the optimal strategy to prevent ischemia without affecting bleeding in all patients is matter of ongoing discussion and research, and probably remains a chimera. Like Bellerophon searching for and fighting with the Chimera, clinicians should be aware of the trade-off of both bleeding and ischemia and their impact on patients’ health, thus searching for the optimal therapy which has not to face with a single animal (ischemia or bleeding), rather must account and balance for the effects on both these entities. In such a context, personalized medicine characterized by individualization of therapies patient-by-patient based on the individual risk/benefit profile appears to be a promising approach that clinicians might adopt to kill this nightmare.
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Grasso, Mario Jorge. "Función ventricular derecha en pacientes hipotiroideos evaluada por ecocardiografía." Tesis, 2008. http://hdl.handle.net/10915/5397.
Full textAbstract:
El Hipotiroidismo (H) es una patología frecuente que afecta alrededor del 6 al 8% de la población. Se lo define como la situación clínica caracterizada por el déficit de hormonas tiroideas, triiodotironina (t3) y/o tiroxina (t4), con hormona tirotrófica (TSH) elevada, presentándose habitualmente con síntomas evidentes. Una forma del hipotiroidismo es el conocido como Hipotiroidismo Subclínico, sin síntomas claros, donde el diagnóstico recae en análisis de laboratorio, caracterizado por TSH elevada y t3–t4 normales.
Existen múltiples referencias en la bibliografía acerca del compromiso cardíaco producto de la enfermedad, en niños y adultos, evaluado por Ecocardiografía en sus distintas formas: Modo M, Bidimensional y Doppler. Sin embargo la mayoría de las publicaciones están enfocadas al análisis de las alteraciones del Ventrículo Izquierdo (VI) donde se puede observar aumento del espesor parietal septal, aumento de la masa ventricular, disfunción diastólica, disminución de la fracción de eyección en respuesta al esfuerzo, entre otras.
Estos hallazgos son atribuidos a los cambios producidos a nivel miocárdico y sistémico por el déficit hormonal, como el aumento del agua y proteínas en el intersticio, cambios en el metabolismo del calcio celular, alteración de ciertos receptores e intercambiadores de membrana, aumento en las resistencias periféricas y otros. (2 -21).
Existen sin embargo escasos datos en la bibliografía que expresen cambios en relación a la anatomía y función ventricular derechas. Sólo está propuesto el aumento del espesor de la pared libre del Ventrículo Derecho (VD) en casos de hipotiroidismo.(13) La fisiopatología que explica las alteraciones producidas por el déficit hormonal en el miocardio del VI es aplicable al miocardio del VD, por lo que resulta probable la hipótesis que expresa que durante el hipotiroidismo, la anatomía y función de esta cámara ventricular puede mostrar cambios relacionados a la enfermedad.
Dado que la función ventricular del VD es difícil de evaluar por su forma geométrica compleja, la Ecocardiografía es un método no invasivo útil para tal fin.
Sus modalidades Bidimensional y Modo M tienen alta resolución espacial y temporal.
El Doppler Pulsado evalúa el flujo de la sangre y el Doppler Pulsado Tisular el movimiento del tejido cardíaco; ambos son simples de aplicar, reproducibles y poco dependientes de la calidad de ventana acústica del paciente.
Además estos métodos están extensamente validados para esta aplicación.
Por tal motivo se estudió en hipotiroideos la función ventricular derecha, sistólica y diastólica, con Ecocardiografía Bidimensional, Modo M y Doppler.
Se hipotetizó que en el hipotiroidismo existen cambios anatómicos y disfunción ventricular derechos que serán objetivados por ecocardiografía y que las alteraciones guardarán relación al grado de déficit hormonal.
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Prakaschandra, D. R. "The echocardiographic manifestations of an urban, working class community with a high cardiovascular risk profile." Thesis, 2013. http://hdl.handle.net/10413/10790.
Full textAbstract:
The metabolic syndrome (MS), consequent upon the pandemic of obesity and diabetes, is associated with an increased risk for cardiovascular (CV) disease. Development of sub-clinical cardiac structural and functional changes associated with CV disease risk factors may be detected on echocardiography. The extent to which these structural changes and CV risk factors are dependent on genetic factors is not clearly established. This project was designed to investigate the relationship between CV disease risk factors, cardiac structural and functional changes and underlying genetic abnormalities. Specifically, the risk factor profile and the presence of the MS were determined. This was then correlated with the echocardiographic findings and gene polymorphisms.
Method:
A randomly selected cohort of 1428 subjects from the Phoenix community was studied. Demographic data was collected using the WHO STEPS instrument. Blood samples for biochemistry and genetic analysis, together with anthropometric measurements, were collected. Blood pressure and echocardiography was performed on all subjects. The metabolic syndrome was classified according to the National Cholesterol Education Panel (NECP) Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. The Lipoprotein Lipase and Human Paraoxonase-1 genes were genotyped on a Light Cycler 480 Real-Time PCR instrument, using allele-specific probes and sequencing.
Results:
There was a high prevalence of CV risk factors in this sample; particularly increased waist circumference (79%), obesity (64%) insulin resistance (58%) and hypertension (50%) across the age groups. This translated into a high prevalence of MS (38% using NCEP ATPIII and 46% using IDF criteria). There were significant echocardiographic differences between subjects with and without MS for chamber dimensions (p<0.001), left ventricular wall thickness (p<0.001) and mass (p<0.001), diastolic indices (E-wave {p<0.001}, trans-mitral ratio {p=0.017}) and sub-epicardial adipose tissue (SEAT) thickness (p<0.001). Stepwise multivariate analysis identified age (95% CI 0.975; 0.998), gender (95%CI 0.48; 0.9) and hypertension (95% CI 0.53; 0.99) as independent risk factors for diastolic abnormalities. Logistic regression identified age as the most significant contributor to diastolic abnormalities (OR=1.02; 95%CI 1.009; 1.03; Wald=13.4), followed by the waist circumference (OR=1.025; 95%CI 1.014; 1.037) and BMI (OR=1.075; 95% CI 1.035; 1.117). Genetic analysis showed significant associations between the heterozygous variant of Q192R genotype (PON-1 gene) and elevated HDL levels and also between this variant and obese women (p= <0.05).
Conclusion:
The high prevalence of CV risk factors and MS in this community has reached epidemic proportions. Although the MS was associated with significant remodelling of cardiac structure, alteration of diastolic indices and increased sub-epicardial adipose tissue thickness, BMI and waist circumference were stronger promoters of altered cardiac
physiology. This augurs poorly for this population group unless intervention is introduced to address the markedly high prevalence of these culprit drivers.Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.
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(9875123), AJ Hoey. "Sodium channel modulators: potential for treatment of heart failure." Thesis, 1995. https://figshare.com/articles/thesis/Sodium_channel_modulators_potential_for_treatment_of_heart_failure/13425089.
Full textAbstract:
Explores the sodium channel modulating drugs DPI 201-106 and BDF 9148 to investigate in detail their potential for the treatment of heart failure.. Heart failure is a significant cause of morbidity and mortality in our society. Many current therapeutic compounds exhibit reduced efficacy in diseased myocardium, or produce toxic side effects. A drug that remains effective in the failing heart and possesses no side effects is still required. The sodium channel modulating drugs DPI 201-106 and BDF 9148 have been examined in detail to investigate their potential for the treatment of heart failure. First the effects of these compounds were investigated. In atrial tissues from guinea-pigs, rats and humans, these compounds induced positive inotropic responses, and in healthy guinea-pig and rat ventricular preparations both compounds produced significant increases in force of contraction and action potential duration (APD). Similar effects of BDF 9148 were also seen in healthy and diseased human ventricular tissues. The positive inotropic effects were maintained in ventricular preparations from hyperthyroid, hypothyroid, dwarf, diabetic, Wistar-Kyoto and spontaneously hypertensive rats. In contrast, BDF 9148 produced a negative inotropic effect in atria from hyperthyroid rats, but retained its positive inotropic effective-ness in atria from rats with other disease states. Next the mechanisms of action of these compounds were elucidated. These compounds inhibit the inactivation of the Na+ channel, thus allowing enhanced influx of Na+ into the cell. This increases the intracellullar Na+ concentration, thereby modifying the activity of the Na/Ca exchanger to inhibit Ca²+ efflux and/or promote Ca²+ influx. The prolongation of the APD also promotes Ca²+ influx by a longer duration of; (i) the calcium current and; (ii) the Na/Ca exchanger promoting Ca²+ accumulation. The accumulated intracellular Ca²+ is taken up into the sarcoplasmic reticulum released subsequent beats to produce a positive inotropic effect. Differences in APD prolongation between DPI 201-106 and BDF 9148 were evident in the guinea-pig ventricular tissues only. This difference was not due to differing effects on Na+ or Ca²+ currents, but was due to DPI 201-106 producing greater inhibition of the delayed and inward rectifier K+ currents than BDF 9148. Experiments in vivo have shown DPI 201-106 may promote arrhythmogenesis by excessively prolonging the APD, and via neural mechanisms. BDF 9148 also prolongs the human APD, but its effect on neural mechanisms are unclear. Clinical trials with BDF 9148 will determine its final usefulness. The work described above has shown sodium channel modulating drugs are effective positive inotropic compounds that maintain full efficacy, even in severely diseased myocardium. Their mechanisms of action have now been elucidated, and together with beneficial effects of positive inotropy, vasodilation (calcium channel antagonism) and Class III anti-arrhythmic protection (APD prolongation), the present results suggest that this group of drugs has potential for the treatment of heart failure.
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Farías, Fernando. "Intercambio Cl-/HCo3-, Na+ independiente en la hipertrofia miocárdica hipertensiva." Tesis, 2009. http://hdl.handle.net/10915/5452.
Full textAbstract:
Objetivos de este trabajo:
1) Explorar mediante un anticuerpo policlonal antiAE3 con acción inhibitoria, si esta isoforma es responsable de la mayor actividad AE observada en el MH.
2) Determinar si la hiperactividad AE causa hiperactividad compensatoria del NHE-1.
3) Verificar si la inhibición prolongada de la AE modifica la hipertrofia del MH.