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Ferreira RM, Ferron FVF, Borges VTM, Peraçoli JC, Ferron AJT, Roscani MG, Hueb JC, Bazan R, Martin LC, Bazan SGZ. Association of cardiovascular risk factors and myocardial hypertrophy in women with preeclampsia history. Life Sci 2024; 346:122646. [PMID: 38614304 DOI: 10.1016/j.lfs.2024.122646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/31/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
AIMS A historic of preeclampsia (PE) has been associated with cardiovascular disease (CVD) in women. There are substantial evidences that cardiovascular changes resulting from PE can persist even after pregnancy end. Therefore, the aims was to evaluate the prevalence of myocardial hypertrophy in young women 12 months after PE event as well as try to identify risk factors for these changes. MATERIALS AND METHODS Single-center observational prospective cross-sectional study that included 118 consecutive patients after 12 months of PE. Clinical and laboratory evaluations, echocardiogram were performed. Myocardial hypertrophy (LVH) was defined as an index myocardial mass ≥ 45 g/m2.7, for women. Classical risk factors for CVD were considered. Analysis included linear or logistic regression and Spearman's correlation coefficient. Significance level of 5 %. KEY FINDINGS Systemic arterial hypertension (SAH) was identified in 52 patients (44 %), overweight/obesity (OOB) in 82 (69 %), dyslipidemia in 68 (57 %) and metabolic syndrome in 47 patients (40 %). LVH was present in 35 cases (29 %) and associated with OOB (OR = 4.51; CI95%:1.18-17.17, p < 0.001), in a model corrected for age and SAH diagnosis. When only the metabolic syndrome components were analyzed, in the multiple logistic regression model, the abdominal circumference was the only clinical variable associated with LVH (OR = 17.65; CI95%:3.70-84.17; p < 0.001). SIGNIFICANCE It was observed a high prevalence of ventricular hypertrophy in young women with a history of pre-eclampsia. This condition was associated with the presence of obesity.
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Affiliation(s)
- Ricardo Mattos Ferreira
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | | | | | - José Carlos Peraçoli
- Department of Gynecology and Obstetrics, Botucatu Medical School - UNESP, São Paulo State University, Botucatu, Brazil
| | - Artur Junio Togneri Ferron
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | - Meliza Goi Roscani
- Department of Medicine, Federal University of Sao Carlos-UFSCar, São Carlos, Brazil
| | - João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | - Luis Cuadrado Martin
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu, Brazil.
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Hagemann R, Watanabe MT, Hueb JC, Martín LC, Silva VDS, Caramori JDSCT. Assessment of atherosclerosis and endothelial dysfunction risk factors in patients with primary glomerulonephritis. J Bras Nefrol 2024; 46:29-38. [PMID: 36638246 PMCID: PMC10962406 DOI: 10.1590/2175-8239-jbn-2022-0116en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Glomerulonephritis are the third cause of chronic kidney disease (CKD) requiring dialysis in Brazil. Mineral and bone disorder (MBD) is one of the complications of CKD and is already present in the early stages. Assessment of carotid intima-media thickness (CIMT) and flow-mediated vasodilatation (FMV) are non-invasive ways of assessing cardiovascular risk. HYPOTHESIS Patients with primary glomerulonephritis (PG) have high prevalence of atherosclerosis and endothelial dysfunction, not fully explained by traditional risk factors, but probably influenced by the early onset of MBD. OBJECTIVE To evaluate the main markers of atherosclerosis in patients with PG. METHOD Clinical, observational, cross-sectional and controlled study. Patients with PG were included and those under 18 years of age, pregnants, those with less than three months of follow-up and those with secondary glomerulonephritis were excluded. Those who, at the time of exams collection, had proteinuria higher than 6 grams/24 hours and using prednisone at doses higher than 0.2 mg/kg/day were also excluded. RESULTS 95 patients were included, 88 collected the exams, 1 was excluded and 23 did not undergo the ultrasound scan. Patients with PG had a higher mean CIMT compared to controls (0.66 versus 0.60), p = 0.003. After multivariate analysis, age and values for systolic blood pressure (SBP), FMV and GFR (p = 0.02); and FMV and serum uric acid (p = 0.048) remained statistically relevant. DISCUSSION AND CONCLUSION The higher cardiovascular risk in patients with PG was not explained by early MBD. Randomized and multicentric clinical studies are necessary to better assess this hypothesis.
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Affiliation(s)
- Rodrigo Hagemann
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
- Universidade Federal do Paraná, Complexo Hospital de Clínicas,
Departamento de Clínica Médica, Curitiba, Paraná, Brazil
| | - Marcela Tatiana Watanabe
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
| | - João Carlos Hueb
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
| | - Luis Cuadrado Martín
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
| | - Vanessa dos Santos Silva
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina de Botucatu, Departamento de Clínica Médica, Botucatu, São Paulo,
Brazil
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Antonelli Rossi DA, De Araujo Junior JA, Luvizutto GJ, Bazan R, Salmazo PS, Modolo GP, Hueb JC, Nunes HRDC, Hokama NK, Minicucci MF, Roscani MG, Zanati Bazan SG. Effect of a Physical Exercise Program on the Inflammatory Response, Cardiac Functions, Functional Capacity, and Quality of Life in Patients with Sickle Cell Disease. J Clin Med 2023; 12:3952. [PMID: 37373647 DOI: 10.3390/jcm12123952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/13/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The beneficial effects of physical exercise on functional capacity and inflammatory response are well-known in cardiovascular diseases; however, studies on sickle cell disease (SCD) are limited. It was hypothesized that physical exercise may exert a favorable effect on the inflammatory response of SCD patients, contributing to an improved quality of life. This study aimed to evaluate the effect of a regular physical exercise program on the anti-inflammatory responses in SCD patients. METHODS A non-randomized clinical trial was conducted in adult SCD patients. The patients were divided into two groups: 1-Exercise Group, which received a physical exercise program three times a week for 8 weeks, and; 2-Control Group, with routine physical activities. All patients underwent the following procedures initially and after eight weeks of protocol: clinical evaluation, physical evaluation, laboratory evaluation, quality of life evaluation, and echocardiographic evaluation. STATISTICAL ANALYSIS Comparisons between groups were made using Student's t-test, Mann-Whitney test, chi-square test, or Fisher's exact test. Spearman's correlation coefficient was calculated. The significance level was set at p < 0.05. RESULTS There was no significant difference in inflammatory response between the Control and Exercise Groups. The Exercise Group showed an improvement in peak VO2 values (p < 0.001), an increase in the distance walked (p < 0.001), an improvement in the limitation domain due to the physical aspects of the 36-Item Short Form Health Survey (SF-36) quality of life questionnaire (p = 0.022), and an increase in physical activity related to leisure (p < 0.001) and walking (p = 0.024) in the International Physical Activity Questionnaire (IPAQ). There was a negative correlation between IL-6 values and distance walked on the treadmill (correlation coefficient -0.444, p = 0.020) and the estimated peak VO2 values (correlation coefficient -0.480; p = 0.013) in SCD patients in both groups. CONCLUSIONS The aerobic exercise program did not change the inflammatory response profile of SCD patients, nor did it show unfavorable effects on the parameters evaluated, and patients with lower functional capacity were those with the highest levels of IL-6.
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Affiliation(s)
| | - Jonas Alves De Araujo Junior
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu 18618-687, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro, Uberaba 38065-430, Brazil
| | - Rodrigo Bazan
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, Botucatu 18618-970, Brazil
| | - Péricles Sidnei Salmazo
- Department of Medicine, Faculty of Medical and Health Sciences, Pontifical Catholic University of São Paulo, Sorocaba 18052-490, Brazil
| | - Gabriel Pinheiro Modolo
- Department of Neurology, Botucatu Medical School-UNESP, São Paulo State University, Botucatu 18618-970, Brazil
| | - João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu 18618-687, Brazil
| | | | - Newton Key Hokama
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu 18618-687, Brazil
| | - Marcos Ferreira Minicucci
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu 18618-687, Brazil
| | - Meliza Goi Roscani
- Department of Medicine, Federal University of Sao Carlos-UFSCar, São Carlos 13565-251, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School-UNESP, São Paulo State University, Botucatu 18618-687, Brazil
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Hagemann R, Watanabe MT, Hueb JC, Martín LC, Silva VDS, Caramori JDSCT. Avaliação dos fatores de risco de aterosclerose e disfunção endotelial em pacientes com glomerulopatias primárias. J Bras Nefrol 2023. [DOI: 10.1590/2175-8239-jbn-2022-0116pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Resumo Introdução: Glomerulopatias são a terceira causa de doença renal crônica (DRC) com necessidade de diálise no Brasil. Distúrbio mineral e ósseo (DMO) é uma das complicações da DRC e está presente já nos estágios iniciais. A avaliação da espessura médio-intimal de carótidas (EMIC) e da vasodilatação fluxo-mediada (VFM) são maneiras não invasivas de avaliação do risco cardiovascular. Hipótese: Pacientes com glomerulopatias primárias (GP) apresentam alta prevalência de aterosclerose e disfunção endotelial, não explicada totalmente pelos fatores de risco tradicionais, mas provavelmente influenciada pela instalação precoce do DMO. Objetivo: Avaliar os principais marcadores de aterosclerose em pacientes com GP. Método: Estudo clínico, observacional, transversal e controlado. Foram incluídos portadores de GP e excluídos menores de 18 anos, gestantes, menos de três meses de seguimento e os com glomerulopatia secundária. Também foram excluídos aqueles que, no momento da coleta, apresentavam proteinúria maior que 6 gramas/24 horas e uso de prednisona em doses superiores a 0,2 mg/kg/dia. Resultados: 95 pacientes foram incluídos, 88 colheram os exames, 1 foi excluído e 23 não realizaram a ultrassonografia. Os pacientes com GP apresentaram maior EMIC média em relação ao controle (0,66 versus 0,60), p = 0,003. Após análise multivariada, mantiveram relevância estatística a idade e os valores de pressão arterial sistólica (PAS), VFM e TFG (p = 0,02) e VFM e ácido úrico sérico (p = 0,048). Discussão e conclusão: Pacientes com GP apresentaram maior risco cardiovascular, entretanto esse risco não foi explicitado pelo DMO precoce. Estudos clínicos randomizados e multicêntricos são necessários para melhor determinação dessa hipótese.
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Affiliation(s)
- Rodrigo Hagemann
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brazil; Universidade Federal do Paraná, Brazil
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Malagutte KNDS, Silveira CFDSMPD, Reis FM, Rossi DAA, Hueb JC, Okoshi K, Nunes HRDC, Martin LC, Bazan R, Bazan SGZ. Qualidade da Anticoagulação Oral em Pacientes com Fibrilação Atrial em um Hospital Terciário no Brasil. Arq Bras Cardiol 2022; 119:363-369. [PMID: 35766618 PMCID: PMC9438533 DOI: 10.36660/abc.20210805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/08/2022] [Indexed: 12/03/2022] Open
Abstract
Fundamento A fibrilação atrial (FA) afeta de 0,5% a 2,0% da população geral e geralmente está associada a doenças estruturais cardíacas, comprometimento hemodinâmico e complicações tromboembólicas. A anticoagulação oral previne eventos tromboembólicos e é monitorada pela razão normalizada internacional (RNI). Objetivos Avaliar a estabilidade do RNI em pacientes com FA não valvar tratados com anticoagulante varfarina, avaliar complicações tromboembólicas ou hemorrágicas e identificar o grupo com risco mais alto de eventos tromboembólicos ou hemorrágicos. Métodos Dados de prontuários médicos de 203 pacientes atendidos em um hospital terciário no Brasil foram analisados e o tempo de intervalo terapêutico (TTR) foi calculado usando-se o método Rosendaal. Em seguida possíveis fatores que influenciam o TTR foram analisados e a relação entre TTR e eventos tromboembólicos ou hemorrágicos foi calculada. O nível de significância foi 5%. Resultados O TTR médio foi 52,2%. Pacientes com instabilidade de RNI na fase de adaptação tinham um TTR médio mais baixo (46,8%) do que aqueles sem instabilidade (53,9%). Entre os pacientes estudados, 6,9% sofreram eventos hemorrágicos e 8,4% tiveram um acidente vascular cerebral. O grupo com risco mais alto de acidente vascular cerebral e sangramento era composto de pacientes com instabilidade de RNI na fase de adaptação. Conclusões A qualidade da anticoagulação nesse hospital terciário no Brasil é semelhante à de centros de países em desenvolvimento. Pacientes com instabilidade de RNI maior na fase de adaptação evoluíram para um TTR médio mais baixo durante o acompanhamento, tinham uma chance de acidente vascular cerebral 4,94 vezes maior e uma chance de sangramento 3,35 vezes maior. Portanto, para esse grupo de pacientes, individualizar a escolha de tratamento anticoagulante seria recomendado, considerando-se a relação custo-benefício.
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Rodrigues CDSA, Bazan R, Reis FM, Silveira CFSMPD, Hueb LMS, Carvalho FCD, Nunes HRDC, Okoshi K, Hueb JC, Bazan SGZ. Carotid Artery Atherosclerotic Profile as Risk Predictor for Restenosis After Coronary Stenting. Arq Bras Cardiol 2021; 116:727-733. [PMID: 33886718 PMCID: PMC8121410 DOI: 10.36660/abc.20190650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 12/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The incidence of restenosis of the coronary artery after a bare-metal stent implant has been lower than in simple balloon angioplasty; however, it still shows relatively high rates. OBJECTIVE The aim of this study was to find new risk indicators for in-stent restenosis using carotid ultrasonography, that, in addition to the already existing indicators, would help in decision-making for stent selection. METHODS We carried out a cross-sectional prospective study including 121 consecutive patients with chronic coronary artery disease who had undergone percutaneous coronary intervention with repeat angiography in the previous 12 months. After all cases of in-stent restenosis were identified, patients underwent carotid ultrasonography to evaluate carotid intima-media thickness and atherosclerosis plaques. The data were analyzed by Cox multiple regression. The significance level was set a p<0.05. RESULTS Median age of patients was 60 years (1st quartile = 55, 3rd quartile = 68), and 64.5% of patients were male. Coronary angiography showed that 57 patients (47.1%) presented in-stent restenosis. Fifty-five patients (45.5%) had echolucent atherosclerotic plaques in carotid arteries and 54.5% had echogenic plaques or no plaques. Of patients with who had echolucent plaques, 90.9% presented coronary in-stent restenosis. Of those who had echogenic plaques or no plaques, 10.6% presented in-stent restenosis. The presence of echolucent plaques in carotid arteries increased the risk of coronary in-stent restenosis by 8.21 times (RR=8.21; 95%CI: 3.58-18.82; p<0.001). CONCLUSIONS The presence of echolucent atherosclerotic plaques in carotid artery constitutes a risk predictor of coronary instent restenosis and should be considered in the selection of the type of stent to be used in coronary angioplasty.
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Affiliation(s)
| | - Rodrigo Bazan
- Universidade Estadual Paulista Julio de Mesquita Filho - Faculdade de Medicina Campus de Botucatu, Botucatu, SP - Brasil
| | - Fabrício Moreira Reis
- Universidade Estadual Paulista Julio de Mesquita Filho - Faculdade de Medicina Campus de Botucatu, Botucatu, SP - Brasil
| | | | - Lívia Maria Severino Hueb
- Universidade Estadual Paulista Julio de Mesquita Filho - Faculdade de Medicina Campus de Botucatu, Botucatu, SP - Brasil
| | - Fábio Cardoso de Carvalho
- Universidade Estadual Paulista Julio de Mesquita Filho - Faculdade de Medicina Campus de Botucatu, Botucatu, SP - Brasil
| | - Hélio Rubens de Carvalho Nunes
- Universidade Estadual Paulista Julio de Mesquita Filho - Faculdade de Medicina Campus de Botucatu, Botucatu, SP - Brasil
| | - Katashi Okoshi
- Universidade Estadual Paulista Julio de Mesquita Filho - Faculdade de Medicina Campus de Botucatu, Botucatu, SP - Brasil
| | - João Carlos Hueb
- Universidade Estadual Paulista Julio de Mesquita Filho - Faculdade de Medicina Campus de Botucatu, Botucatu, SP - Brasil
| | - Silméia Garcia Zanati Bazan
- Universidade Estadual Paulista Julio de Mesquita Filho - Faculdade de Medicina Campus de Botucatu, Botucatu, SP - Brasil
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Bazan SGZ, Oliveira GOD, Silveira CFDSMPD, Reis FM, Malagutte KNDS, Tinasi LSN, Bazan R, Hueb JC, Okoshi K. Hypertrophic Cardiomyopathy: A Review. Arq Bras Cardiol 2020; 115:927-935. [PMID: 33295458 PMCID: PMC8452207 DOI: 10.36660/abc.20190802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A cardiomiopatia hipertrófica (CMH) é a doença cardíaca de origem genética mais comum, cuja principal característica consiste na hipertrofia ventricular esquerda que acontece na ausência de outras patologias que desencadeiam tal alteração. A CMH pode se apresentar desde formas assintomáticas até manifestações de morte cardíaca súbita e de insuficiência cardíaca refratária. Métodos de imagem contemporâneos de alta resolução e escores clínicos mais acurados vêm sendo utilizados e desenvolvidos no sentido de propiciar uma avaliação prognóstica e funcional mais adequada, bem como possibilitar a estratificação dos casos de maior gravidade. Nesta revisão, serão abordados esses aspectos, entre outros tópicos clássicos inerentes ao estudo dessa doença.
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Affiliation(s)
- Silméia Garcia Zanati Bazan
- Universidade Estadual Paulista Júlio de Mesquita Filho - Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP - Brasil
| | - Gilberto Ornellas de Oliveira
- Universidade Estadual Paulista Júlio de Mesquita Filho - Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP - Brasil
| | | | - Fabrício Moreira Reis
- Universidade Estadual Paulista Júlio de Mesquita Filho - Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP - Brasil
| | | | - Lucas Santos Nielsen Tinasi
- Universidade Estadual Paulista Júlio de Mesquita Filho - Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP - Brasil
| | - Rodrigo Bazan
- Universidade Estadual Paulista Júlio de Mesquita Filho - Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP - Brasil
| | - João Carlos Hueb
- Universidade Estadual Paulista Júlio de Mesquita Filho - Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP - Brasil
| | - Katashi Okoshi
- Universidade Estadual Paulista Júlio de Mesquita Filho - Faculdade de Medicina de Botucatu - UNESP, Botucatu, SP - Brasil
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Biondi RB, Salmazo PS, Bazan SGZ, Hueb JC, de Paiva SAR, Sassaki LY. Cardiovascular Risk in Individuals with Inflammatory Bowel Disease. Clin Exp Gastroenterol 2020; 13:107-113. [PMID: 32425576 PMCID: PMC7188070 DOI: 10.2147/ceg.s243478] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) patients present a higher risk of developing cardiovascular diseases due to the presence of chronic inflammation, which plays an essential role in atherogenesis. Therefore, the aim of the study was to evaluate the cardiovascular risk between patients with IBD and healthy control individuals. MATERIALS AND METHODS A total of 52 consecutive IBD outpatients from a tertiary hospital and 37 healthy controls were enrolled. Data collected included age, sex, smoking status, presence of comorbidities, disease activity, ongoing medical treatment, body mass index, arterial blood pressure, and cardiovascular risk. The cardiovascular risk was based on the Framingham risk score and ultrasonography variables, such as the carotid intima-media thickness and the presence of atherosclerotic plaque in the carotid. Multivariate logistic regression or multiple linear regression analysis was performed at a significance level of 5%. RESULTS No differences were observed between groups with regard to age, sex, smoking status, comorbidities, blood pressure, body mass index, lipid profile, and Framingham risk score. In the IBD group, fasting glucose [95 (86.2-107.3) mg/dL vs 86 (79-100) mg/dL, p=0.041], carotid intima-media thickness (0.69±0.12 mm vs 0.63±0.12 mm, p=0.031), and atherosclerotic carotid plaque (25% vs 5.4%, p=0.032) were higher compared with those in the control group. Multivariate logistic regression analysis showed that patients with IBD presented a 6.45-fold higher risk of carotid atherosclerotic plaque (odds ratio: 6.45; 95% confidence interval: 1.035-40.216; p<0.046). CONCLUSION Patients with IBD are at an increased risk of atherosclerosis and, consequently, an increased risk for cardiovascular diseases.
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Affiliation(s)
- Robertha Baccaro Biondi
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Pericles Sidnei Salmazo
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, Brazil
| | - João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Sergio Alberto Rupp de Paiva
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, Brazil
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Bazan R, Luvizutto GJ, Braga GP, Bazan SGZ, Hueb JC, de Freitas CCM, Hamamoto Filho PT, Módolo GP, Trindade AP, Sobreira ML, Nunes HRDC, Leite JP, Pontes-Neto OM. Relationship of spontaneous microembolic signals to risk stratification, recurrence, severity, and mortality of ischemic stroke: a prospective study. Ultrasound J 2020; 12:6. [PMID: 32048064 PMCID: PMC7013020 DOI: 10.1186/s13089-020-0156-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/26/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The presence of microembolic signals (MES) during the acute phase of stroke is poorly understood, and its role and clinical application in relation to risk stratification and prognosis in patients remain uncertain. We assessed the prevalence of spontaneous MES in acute stroke and their relationship with risk stratification, stroke recurrence, morbidity, and mortality. Patients and methods This was a prospective cohort study conducted in the Stroke Unit. The MES presence was evaluated by transcranial Doppler (TCD) in patients with ischemic stroke within 48 h. The outcomes (risk stratification, morbidity, mortality, and recurrence of a stroke) were followed up for 6 months. The relationship between risk stratification and MES was obtained by odds ratios and that between MES and stroke recurrence, morbidity, and mortality using multiple logistic regression; considering statistical significance at P < 0.05. Results Of the 111 patients studied, 70 were men (63.1%) and 90 were white (81.1%), with a median age of 68 years. The MES frequency was 7%. There was a significant relationship between MES and symptomatic carotid disease (OR = 22.7; 95% CI 4.1–125.7; P < 0.001), a shorter time to monitoring (OR = 12.4; 95% CI 1.4–105.4; P = 0.02), and stroke recurrence (OR = 16.83; 95% CI 2.01–141; P = .009). Discussion It was observed that the stroke recurrence adjusted for prior stroke was higher and earlier among patients with MES detection. In conclusion, MES demonstrated a significant correlation with symptomatic carotid disease and a shorter DELAY until monitoring, and could be a predictor for the early recurrence of stroke in the long term.
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Affiliation(s)
- Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Institute of Health Sciences, UFTM-Univ Federal do Triângulo Mineiro, Uberaba, Brazil
| | - Gabriel Pereira Braga
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | | | - João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Carlos Clayton Macedo de Freitas
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil.
| | - Gabriel Pinheiro Módolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - André Petean Trindade
- Department of Tropical Diseases and Imaging Diagnosis, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Marcone Lima Sobreira
- Department of Surgery and Orthopedics, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, UNESP-Univ Estadual Paulista, Campus de Botucatu, Distrito de Rubião Jr, s/n, Botucatu, Brazil
| | - João Pereira Leite
- Department of Neuroscience and Behavior, Ribeirão Preto School of Medicine, USP-Univ São Paulo, Ribeirão Preto, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior, Ribeirão Preto School of Medicine, USP-Univ São Paulo, Ribeirão Preto, Brazil
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Salmazo PS, Bazan SGZ, Shiraishi FG, Bazan R, Okoshi K, Hueb JC. Frequency of Subclinical Atherosclerosis in Brazilian HIV-Infected Patients. Arq Bras Cardiol 2018; 110:402-410. [PMID: 29641646 PMCID: PMC5967130 DOI: 10.5935/abc.20180058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/12/2017] [Indexed: 12/28/2022] Open
Abstract
Background AIDS as well as atherosclerosis are important public health problems. The
longer survival among HIV-infected is associated with increased number of
cardiovascular events in this population, and this association is not fully
understood. Objectives To identify the frequency of subclinical atherosclerosis in HIV-infected
patients compared to control subjects; to analyze associations between
atherosclerosis and clinical and laboratory variables, cardiovascular risk
factors, and the Framingham coronary heart disease risk score (FCRS). Methods Prospective cross-sectional case-control study assessing the presence of
subclinical atherosclerosis in 264 HIV-infected patients and 279 controls.
Clinical evaluation included ultrasound examination of the carotid arteries,
arterial stiffness by pulse wave velocity (PWV) and augmentation index
(AIx), laboratory analysis of peripheral blood, and cardiovascular risk
according to FCRS criteria. The significance level adopted in the
statistical analysis was p < 0.05. Results Plaques were found in 37% of the HIV group and 4% of controls (p < 0.001).
Furthermore, carotid intima-media thickness was higher in the HIV group than
in controls (p < 0.001). Patients with carotid plaque had higher fasting
glucose, total cholesterol, low-density lipoprotein cholesterol, and
triglycerides than those without plaques. The presence of HIV, adjusted for
age, overweight/obesity, and smoking increased by almost fivefold the risk
of atherosclerotic carotid plaque (OR: 4.9; 95%CI: 2.5-9.9; p < 0.001).
Exposure to protease inhibitors did not influence carotid intima-media
thickness, was not associated with carotid plaque frequency, and did not
alter the mechanical characteristics of the arterial system (PWV and
AIx). Conclusions HIV-infected patients are at increased risk of atherosclerosis in association
with classical cardiovascular risk factors. Treatment with protease
inhibitors does not promote functional changes in the arteries, and shows no
association with increased frequency of atherosclerotic plaques in carotid
arteries. The FCRS may be inappropriate for this population.
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Affiliation(s)
| | | | | | - Rodrigo Bazan
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
| | - Katashi Okoshi
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
| | - João Carlos Hueb
- Faculdade de Medicina de Botucatu (UNESP), Botucatu, SP - Brazil
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11
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Suman AC, Costa ÉAPND, Bazan SGZ, Hueb JC, Carvalho FCD, Martin LC, Yoo HHB. Evaluating respiratory musculature, quality of life, anxiety, and depression among patients with indeterminate chronic Chagas disease and symptoms of pulmonary hypertension. Rev Soc Bras Med Trop 2017; 50:194-198. [PMID: 28562755 DOI: 10.1590/0037-8682-0198-2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/24/2017] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION: Chagas disease (CD) is progressive and incapacitating, especially when cardiopulmonary function is affected. For example, respiratory muscle weakness can cause dyspnea upon exertion and fatigue, which may be exacerbated when it is associated with pulmonary hypertension (PH). The present study aimed to evaluate respiratory musculature, quality of life, anxiety, and depression among patients with indeterminate chronic CD and symptoms of PH. METHODS: All individuals completed a clinical evaluation, spirometry, a 6-min walking test, respiratory musculature testing using maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax), the Hospital Anxiety and Depression Scale, and the SF-36 questionnaire. RESULTS: We evaluated 107 patients who were assigned to a control group with only CD (G1, 8 patients), a group with CD and possible PH (G2, 93 patients), and a group with CD and echocardiography evidence of PH (G3, 6 patients). The three groups had similar values for PImax and PEmax. Compared to the G1 and G2 groups, the G3 group covered significantly less distance during the 6-min walking test and had a significantly shorter predicted distance (p < 0.05 vs. the G1 group). All three groups had similar values for their spirometry results, Hospital Anxiety and Depression Scale scores, and SF-36 questionnaire results. CONCLUSIONS: Patients with indeterminate chronic CD and symptoms of PH did not experience significant impairment in the studied variables, with the exception of the 6-min walking test, which suggests a low exercise tolerance.
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Affiliation(s)
- Alícia Cristina Suman
- Programa de Pós Graduação em Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Érika Alessandra Pellison Nunes da Costa
- Programa de Pós Graduação em Doenças Tropicais, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.,Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Silméia Garcia Zanati Bazan
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - João Carlos Hueb
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Fabio Cardoso de Carvalho
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Luis Cuadrado Martin
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | - Hugo Hyung Bok Yoo
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
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12
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Yoo HHB, Dos Reis R, Telini WM, Telini LR, Hueb JC, Bazan SGZ, Barretti P, Martin LC, Queluz TT. Association of Pulmonary Hypertension With Inflammation and Fluid Overload in Hemodialysis Patients. Iran J Kidney Dis 2017; 11:303-308. [PMID: 28794293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/20/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Pulmonary hypertension (PH) has been reported in hemodialysis patients, but data regarding its pathogenesis are scarce. This study aimed to evaluate the role of fluid overload in PH and its interrelationships with the usual biomarkers of micro-inflammatory state in hemodialysis patients. MATERIALS AND METHODS In is a cross-sectional and prospective study, 119 consecutive hemodialysis patients at a Brazilian referral university hospital were evaluated between March 2007 and February 2013. Based on the presence of echocardiographic parameters of PH, patients were allocated to two groups of the PH group and the non-PH group. Clinical parameters, site and type of vascular access, bio-impedance, and laboratory findings were compared between the two groups and a logistic regression model was elaborated. RESULTS Pulmonary hypertension was found in 23 (19.0%) of 119 patients. The groups significantly differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. Additionally, laboratory data associated with PH were alpha-1-acid glycoprotein (140.0 ± 32.9 versus 116.0 ± 35.5; P < .001); C-reactive protein (median, 1.1 versus 1.6; P = .01) and B-type natriuretic peptide (median, 328 versus 77; P = .03). The adjusted logistic regression model, including alpha-1-acid glycoprotein and B-type natriuretic peptide, showed significant associations for both (odds ratio, 1.023; 95% confidence interval, 1.008 to 1.043; P = .004 and odds ratio, 3.074; 95% confidence interval, 1.49-6.35; P = .002, respectively). CONCLUSIONS Pulmonary hypertension, cardiac hypertrophy, fluid overload, and inflammation were associated to each other in hemodialysis patients, providing insight into its pathogenesis. Longitudinal studies are warranted.
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Affiliation(s)
- Hugo Hyung Bok Yoo
- Division of Pulmonology, Botucatu School of Medicine, Sao Paulo State University, Botucatu, Brazil.
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13
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Roscani MG, Duarte JDC, Augusto GN, Salgueiro TRDM, Meireles MN, Gobbi JIF, Okoshi K, Hueb JC. Association Between Left Ventricle Diastolic Dysfunction and Unfavorable Prognostic Markers in Patients with Aortic Insufficiency. J Clin Diagn Res 2017; 11:OC09-OC11. [PMID: 28764216 DOI: 10.7860/jcdr/2017/23463.9974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/19/2016] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The presence of symptoms, systolic dysfunction and Left Ventricle (LV) dilation are considered unfavourable prognostic markers in Aortic Valve Insufficiency (AVI). The role of diastolic dysfunction, which is considered unfavourable outcome marker in cardiac pathologies, is not well established in AVI. AIM To evaluate if the presence of diastolic dysfunction may be associated with unfavourable prognostic markers in AVI patients. MATERIALS AND METHODS A cross-sectional prospective study was performed on 22 patients with moderate or severe AVI. They underwent clinical evaluation and transthoracic echocardiography. Associations between clinical, epidemiological and echocardiographic were evaluated by Student t-test for normally distributed variables or Mann-Whitney test for non-normal distribution. Comparison between proportions was performed by Chi-square test. RESULTS There was an association between increased LV filling pressure, assessed by E' and E/E' of Mitral Tissue Doppler, and impaired LV systolic function, respectively: R = 0.563, R2 = 0.281; p = 0.008 and R = 0.639, R2 = 0.378; p = 0.002. The LV indexed mass also was inversely associated with the LV ejection fraction (R = 0.62, R2 = 0.35 and p = 0.003). CONCLUSION There was an association of LV diastolic dysfunction and ventricular hypertrophy with impaired left ventricle systolic function. Increased LV filling pressure and LV indexed mass should be considered in the management of AVI patients.
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Affiliation(s)
- Meliza Goi Roscani
- Consultant, Department of Medical Medicine, São Carlos Federal University, São Carlos, São Paulo, Brazil
| | - Juliana da Cunha Duarte
- Consultant, Department of Internal Medicine, Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Gustavo Nicolodi Augusto
- Consultant, Department of Internal Medicine, Botucatu Medical School, Botucatu, São Paulo, Brazil
| | | | - Mariana N Meireles
- Consultant, Department of Internal Medicine, Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - Juliana I F Gobbi
- Professor, Department of Biosciences Institute, São Paulo State University, Botucatu, São Paulo, Brazil
| | - Katashi Okoshi
- Consultant, Department of Internal Medicine, Botucatu Medical School, Botucatu, São Paulo, Brazil
| | - João Carlos Hueb
- Professor, Department of Internal Medicine, Botucatu Medical School, Botucatu, São Paulo, Brazil
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14
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Ganan CS, Moreira DA, Bazan R, Hueb JC, Bragante ALSES, Magalhães CG, Roscani MG, Peraçoli JC, Reis GS, Borges VTM, Bazan SGZ. 98 Evolution of cardiac remodeling associated with pregnancy in hypertensive women six months postpartum. Pregnancy Hypertens 2016. [DOI: 10.1016/j.preghy.2016.08.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Ferreira RM, Borges V, Hueb JC, Bazan R, da Silva Ferreira S, Roscani MG, Peraçoli JC, Martin LC, Zanati Bazan SG. 1 Cardiovascular risk factors in women with preeclampsia history and their association with myocardial hypertrophy and intima-media thickening of the carotids. Pregnancy Hypertens 2016. [DOI: 10.1016/j.preghy.2016.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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França MM, Nogueira CR, Hueb JC, Mendes AL, Padovani CR, Mazeto GMFDS. Higher Carotid Intima-Media Thickness in Subclinical Hypothyroidism Associated with the Metabolic Syndrome. Metab Syndr Relat Disord 2016; 14:381-385. [PMID: 27228324 DOI: 10.1089/met.2016.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The subclinical hypothyroidism (SH) and the metabolic syndrome (MS) have been associated with increased risk of atherosclerosis and cardiovascular disease (CVD). The measurement of carotid intima-media thickness (IMT) is capable of detecting early signs of atherosclerotic disease. The goal of the study was to compare the carotid IMT of patients with SH with and without the MS. METHODS Twenty-nine SH patients were subdivided into two groups: one with MS (SH + MS) and one without MS (SH - MS). The study also assessed a group of euthyroid patients (n = 31), also subdivided into two groups: one with MS (EU + MS) and one without MS (EU - MS). The clinical and laboratory data and the mean and maximum carotid IMT of the groups were compared. RESULTS Maximum (P = 0.012) and mean (P = 0.025) IMT were higher in the SH + MS group than in the SH-MS group. Maximum IMT was higher in the SH + MS group than in the EU + MS group (P = 0.048). Maximum IMT was positively correlated with fasting glucose (FG; R = 0.621; P < 0.01) and body mass index (R = 0.258; P = 0.041) and negatively correlated with low-density lipoprotein cholesterol (LDL-C) (R = -0.297; P = 0.017). Mean IMT was positively correlated with FG (R = 0.580; P < 0.01), systolic blood pressure (R = 0.292; P = 0.02), and triglycerides (R = 0.250; P = 0.048) and negatively correlated with LDL-C (R = -0.288; P = 0.022). CONCLUSIONS SH + MS patients have higher IMT than SH - MS or EU + MS patients, suggesting that SH may be one more CVD risk factor in patients with the MS.
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Affiliation(s)
- Mariana Martins França
- 1 Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University , UNESP, Botucatu, Brazil
| | - Célia Regina Nogueira
- 1 Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University , UNESP, Botucatu, Brazil
| | - João Carlos Hueb
- 1 Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University , UNESP, Botucatu, Brazil
| | - Adriana Lúcia Mendes
- 1 Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University , UNESP, Botucatu, Brazil
| | - Carlos Roberto Padovani
- 2 Department of Biostatistics, Biosciences Institute, Sao Paulo State University , UNESP, Botucatu, Brazil
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Cavalcante LG, Ricardo de Souza C, Kochi AC, Okoshi K, Basan SGZ, Hueb JC, Martin RDSES, Oliveira RCD, Banin VB, Barretti P, Franco RJDS, Martin LC. Left ventricular mass behaviour in hemodialysis patients during 17 years. J Bras Nefrol 2015; 37:341-8. [PMID: 26398644 DOI: 10.5935/0101-2800.20150054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Ventricular hypertrophy is frequent in dialysis patients and is associated with an ominous prognosis. It is not knowledge if this ventricular change is growing or decreasing in hemodialysis patients. OBJECTIVE To assess left ventricular hypertrophy behaviour during 17 years in patients of a university dialysis center, as well as to verify the possible causes of this behavior. METHODS There was performed a retrospective longitudinal study that evaluated the echocardiographic left ventricular mass in hemodialysis patients in our dialysis facility over 17 years. Examinations of 250 patients aged 18 years or more who underwent routine echocardiography were included. RESULTS There was a progressive reduction of ventricular mass over studied period. This reduction was associated with blood pressure reduction. In multivariate analysis, ventricular mass was associated with blood pressure and hemoglobin. CONCLUSION Left ventricular hypertrophy underwent significant reduction over 17 years in our hemodialysis patients. The factors associated with this reduction that could be identified in the current study were the progressive reduction of blood pressure and hemoglobin increase.
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18
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Bazan R, Braga GP, Luvizutto GJ, Hueb JC, Hokama NK, Zanati Bazan SG, de Carvalho Nunes HR, Leite JP, Pontes-Neto OM. Evaluation of the Temporal Acoustic Window for Transcranial Doppler in a Multi-Ethnic Population in Brazil. Ultrasound Med Biol 2015; 41:2131-2134. [PMID: 25964064 DOI: 10.1016/j.ultrasmedbio.2015.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to relate the presence of a temporal acoustic window (TAW) to the variables sex, age and race. This observational study was conducted in patients under etiologic investigation after stroke, sickle-cell anemia and hospitalization in an intensive therapy neurologic unit. TAW presence was confirmed by bilateral assessment by two neurologists via transcranial Doppler (TCD). Multiple logistic regression was performed to explain the presence of the window as a function of sex, age and race. In 20% of the 262 patients evaluated, a TAW was not present. The incidence of TAW presence was greater in men (odds ratio [OR] = 5.4, 95% confidence interval [CI] = 2.5-11.7, p < 0.01); lower with increased age (OR = 0.9, 95% CI = 0.92-0.97, p < 0.01); and lower among those of African and Asian descent (OR = 0.32, 95% CI = 0.14-0.70, p = 0.005). On the basis of the results, more men than women had TAWs, and the decrease in TAWs was associated with increased age and African or Asian descent.
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Affiliation(s)
- Rodrigo Bazan
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Gabriel Pereira Braga
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Gustavo José Luvizutto
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
| | - João Carlos Hueb
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Newton Key Hokama
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Hélio Rubens de Carvalho Nunes
- Botucatu Medical School, Department of Neurology and Department of Internal Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - João Pereira Leite
- Ribeirão Preto Medical School, Department of Neuroscience and Behavior, University of São Paulo, São Paulo, Brazil
| | - Octávio Marques Pontes-Neto
- Ribeirão Preto Medical School, Department of Neuroscience and Behavior, University of São Paulo, São Paulo, Brazil
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Hueb JC, Bazan R, Pereira Braga G, Fusco DR, Zanati Bazan SG, Bojikian Matsubara B. Carotid artery atherosclerotic profile as a predictor of the aorta atherosclerotic profile in patients with cerebrovascular events. Cerebrovasc Dis 2013; 36:26-32. [PMID: 23920380 DOI: 10.1159/000351150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is well known that the presence of atheroma of the thoracic aorta is a risk factor for cerebrovascular events. We sought to evaluate whether the presence and the morphology of atherosclerotic plaque in the carotid artery detected by duplex ultrasonography is associated with disease in the proximal aorta visualized by transesophageal echocardiogram in patients with a cerebrovascular event. METHODS We carried out a cross-sectional prospective study including 147 consecutive patients with prior stroke or transient ischemic attack (TIA). Neurological evaluations were performed by an expert neurologist using clinical and tomographic diagnostic criteria including the definition of etiology and whether the patient suffered from stroke or TIA. Transthoracic and transesophageal echocardiograms and carotid artery duplex ultrasonography were performed by the same examiner. Patients with and without plaque in the carotid artery were compared using Student's t test or the χ2 test. Regression analysis was used to determine whether the presence of plaque in the carotid artery was predictive of the presence of plaque in the proximal aorta and to analyze the relationship between the echogenicity of carotid and aortic plaques. The significance level was set at p < 0.05. RESULTS All 147 patients (95 men) were included in the analysis. Patients' ages ranged from 23 to 85 years (65 ± 12.4 years). Most of the patients (58.5%) were Caucasian, while 41.5% were African-Brazilian. Arterial hypertension, diabetes and tobacco use were more frequent among patients with atherosclerotic plaque in the aorta. A normal carotid intima-media thickness halved the risk of atherosclerotic plaque in the aorta [odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23-0.91; p = 0.026]. The presence of carotid plaque increased the risk of aortic plaque by 70-fold (OR 73.2, 95% CI 25.6-2,018.6; p < 0.001) in univariate analysis. The absence of atherosclerotic plaque in the carotid artery reduced the risk of plaque in the aorta to almost 0 (OR 0.014, 95% CI 0.004-0.041; p < 0.001). Considering the 86 patients with both aortic and carotid plaques, the presence of hypoechoic plaque in the carotid artery was a predictor of hypoechoic plaque in the aorta (OR 10.1, 95% CI 3.3-31.2; p < 0.001). CONCLUSIONS The carotid artery atherosclerotic profile defined by ultrasonography is a strong predictor of the atherosclerotic profile of the proximal aorta. This should be taken into consideration before referring patients with acute cerebrovascular events for transesophageal echocardiogram.
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Affiliation(s)
- João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School - Universidade Estadual Paulista, São Paulo State University, São Paulo, Brazil
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Hueb JC, Salmazo P, Barbosa AN, Terribilli R, Matsubara B. P5.108 Atherosclerotic Carotid Disease and Cardiovascular Risk in HIV-Infected Patients. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Zanati Bazan SG, Borges VM, Martin LC, Magalhães CG, Hueb JC, de Arruda Silveira LV, Peraçoli JC, Matsubara BB. Disproportionate pregnancy-induced myocardial hypertrophy in women with essential hypertension. Am J Hypertens 2013; 26:816-21. [PMID: 23475699 DOI: 10.1093/ajh/hpt023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pregnancy and arterial hypertension (AH) have a prohypertrophic effect on the heart. It is suspected that the 2 conditions combined cause disproportionate myocardial hypertrophy. We sought to evaluate myocardial hypertrophy (LVH) and left ventricular function in normotensive and hypertensive women in the presence or absence of pregnancy. METHODS This prospective cross-sectional study included 193 women divided into 4 groups: hypertensive pregnant (HTP; n = 57), normotensive pregnant (NTP; n = 47), hypertensive nonpregnant (HTNP; n = 41), and normotensive nonpregnant (NTNP; n = 48). After clinical and echocardiographic evaluation, the variables were analyzed using 2-way analysis of variance with pregnancy and hypertension as factors. Left ventricular mass (LVM) was compared using nonparametric analysis of variance and Dunn's test. Predictors of LVH and diastolic dysfunction were analyzed using logistic regression (significance level, P < 0.05). RESULTS Myocardial hypertrophy was independently associated with hypertension (odds ratio (OR) = 11.1, 95% confidence interval (CI) = 3.2-38.5; P < 0.001) and pregnancy (OR = 6.1, 95% CI = 2.6-14.3; P < 0.001) in a model adjusted for age and body mass index. Nonpregnant women were at greater risk of LVH in the presence of AH (OR = 25.3, 95% CI = 3.15-203.5; P = 0.002). The risk was additionally increased in hypertensive women during pregnancy (OR = 4.3, 95% CI = 1.7-10.9; P = 0.002) in the model adjusted for stroke volume and antihypertensive medication. Although none of the NTNP women presented with diastolic dysfunction, it was observed in 2% of the NTP women, 29% of the HTNP women, and 42% of the HTP women (P < 0.05). CONCLUSIONS Hypertension and pregnancy have a synergistic effect on ventricular remodeling, which elevates a woman's risk of myocardial hypertrophy.
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Affiliation(s)
- Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School-Unesp, São Paulo State University, São Paulo, Brazil.
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Roscani MG, Zanati SG, Salmazo PS, Carvalho FC, Magalhães CG, Borges VTM, Bregagnollo EA, Matsubara BB, Hueb JC. Congenital aneurysmal circumflex coronary artery fistula in a pregnant woman. Clinics (Sao Paulo) 2012; 67:1523-5. [PMID: 23295614 PMCID: PMC3521823 DOI: 10.6061/clinics/2012(12)30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Meliza Goi Roscani
- Universidade Estado de São Paulo, Botucatu Medical School, Department of Internal Medicine, Botucatu/SP, Brazil.
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Hueb JC, Vicentini JTR, Roscani MG, Fusco D, Mattos R, Zanatti SG, Okoshi K, Matsubara BB. Impact of hypertension on ventricular remodeling in patients with aortic stenosis. Arq Bras Cardiol 2011; 97:254-9. [PMID: 21808850 DOI: 10.1590/s0066-782x2011005000081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 01/26/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a marker of increased cardiovascular risk and is frequently associated with both arterial hypertension (AH) and aortic stenosis (AoS). Also, these two maladies may co-exit in a same patient. However, in these cases, it is not clear the impact of each one in LVH. OBJECTIVE To evaluate LVH and ventricular geometry in patients with AS associated or not with arterial hypertension. METHODS This was a retrospective, observational and transversal study, including 298 consecutive patients with echocardiographic diagnosis of AoS. LVH was defined as myocardial mass > 224 g for men and > 162 g for women. Patients were classified as having mild (peak gradient < 30 mmHg), moderate (between 30 and 50 mmHg) or severe (> 50 mmHg) AoS and separated into two subgroups: with and without hypertension. RESULTS AH was associated with increased ventricular mass in all three levels of aortic stenosis (mild AS: 172 ± 45 g vs 223 ± 73 g, p < 0.0001 moderate AoS: 189 ± 77 g vs 245 ± 81 g, p = 0.0313 severe AoS: 200 ± 62 g vs 252 ± 88 g, p = 0.0372), and increased risk of LVH (OR = 2.1 CI95%:1.2-3.6 p = 0.012). Regarding to geometric remodeling, hypertensive patients with severe AS presented a significant increase in frequency of concentric hypertrophy, when compared with those without hypertension (p = 0.013). CONCLUSION Hypertension is an additional factor of increased left ventricular mass in patients with AS. Also, hypertension was influential in ventricular geometry.
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Affiliation(s)
- João Carlos Hueb
- Hospital das Clínicas, Faculdade de Medicina de Botucatu-Unesp, Botucatu, SP, Brasil.
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Silva MADM, Martins AS, Campos NLKLD, Andrade RRD, Tohi LM, Hueb JC. Primary idiopathic chylopericardium--case report. Arq Bras Cardiol 2010; 92:e40-3, e67-70. [PMID: 19629298 DOI: 10.1590/s0066-782x2009000600004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 07/11/2008] [Indexed: 11/21/2022] Open
Abstract
The accumulation of chyle in the pericardial space, or chylopericardium, is a condition occurring most frequently after trauma, cardiac and thoracic surgery, or in association with tumors, tuberculosis or lymphangiomatosis. When its precise cause cannot be identified, it is called primary or idiopathic chylopericardium. This is a rare clinical entity. We report the case of a surgically treated 20-year-old female patient. A brief review of the literature and comments on the clinical presentation, etiopathogenesis, ancillary diagnostic tests and treatment options are also presented.
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Silva MADM, Martins AS, Campos NLKLD, Andrade RRD, Tohi LM, Hueb JC. Quilopericárdio idiopático primário: relato de caso. Arq Bras Cardiol 2009. [DOI: 10.1590/s0066-782x2009000600015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Zanati SG, Hueb JC, Cogni AL, de Morais MGT, de Almeida Prado Franceschi LE, Morceli M, Cicogna AC, Matsubara BB. Cardiac hemangioma of the right atrium. Eur J Echocardiogr 2008; 9:52-3. [PMID: 17030020 DOI: 10.1016/j.euje.2006.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Primary cardiac tumors are rare, with an incidence range between 0.001% and 0.030% at autopsy. Recent technical advances have facilitated diagnosis and surgical treatment of such lesions. Patients with a resectable tumor usually have a good prognosis, but patients with an unresectable tumor may have a poor prognosis. This report shows a case of right atrial hemangioma growing like an extracardiac mass, with cardiac tamponade the only clinical presentation.
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Affiliation(s)
- Silméia Garcia Zanati
- Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (UNESP), CEP18618-000, Botucatu, São Paulo, Brazil.
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de Almeida LA, Hueb JC, de Moraes Silva MA, Bazan R, Estrozi B, Raffin CN. Cerebral ischemia as initial neurological manifestation of atrial myxoma: case report. Arq Neuropsiquiatr 2007; 64:660-3. [PMID: 17119814 DOI: 10.1590/s0004-282x2006000400027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 04/19/2006] [Indexed: 11/22/2022]
Abstract
Cerebral infarctions of cardiac etiology are observed in around 20% of patients with ischemic stroke. Cerebral ischemia is the first clinical manifestation in 1/3 of cases of atrial myxomas. Although almost half of patients with atrial myxoma show changes at neurological exam, non-hemorrhagic cerebral infarction is seen in computed tomography in practically all cases. We present the case of a 40 year-old woman whose first clinical manifestation of atrial myxoma was an ischemic stroke. We point out to the possibility of silent cerebral infarction in atrial myxoma patients.
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Hueb JC, Zanati SG, Okoshi K, Raffin CN, Silveira LVDA, Matsubara BB. Association Between Atherosclerotic Aortic Plaques and Left Ventricular Hypertrophy in Patients With Cerebrovascular Events. Stroke 2006; 37:958-62. [PMID: 16528002 DOI: 10.1161/01.str.0000208112.18484.e6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this research was to evaluate whether an association exists between the presence of atherosclerotic plaque in the thoracic aorta and left ventricular hypertrophy (LVH) in patients with a cerebrovascular event. METHODS We included 116 consecutive patients (79 men; mean age, 62+/-12.4 years) with previous history of stroke or transient ischemic attack in a cross-sectional study. Transthoracic echocardiogram was performed to diagnose LVH and transesophageal echocardiogram for the detection of atheromas of the thoracic aorta. Continuous variables were analyzed by Student t or Mann-Whitney tests and categorized variables by Goodman test. From the significant association of LVH and age with atheromatous disease of the aorta, an adjustment to the multivariate logistic model was made using high blood pressure history or age as covariates. All of the statistical tests were carried out at a level of 5% significance. RESULTS Almost half of the patients (43.1%) presented atherosclerotic lesions in the aorta. LVH was present in 90.0% of patients with plaque and in only 30.3% of patients without plaque. Using high blood pressure as a covariate, the risk of patients with LVH presenting atherosclerotic plaque in the aorta was 18.23-fold greater than the risk for patients without LVH (95% CI, 5.68 to 58.54; P<0.0001). Adding age into the model, the risk increased to 26.36 (95% CI, 7.14 to 97.30; P<0.0001). CONCLUSIONS LVH detected by conventional echocardiogram is associated with high risk of atherosclerotic plaque in the aorta and would be used as a criterion for indication of transesophageal echocardiography in patients with previous stroke or transient ischemic attack LVH.
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Affiliation(s)
- João Carlos Hueb
- Department of Internal Medicine, otucatu Medical School-Unesp, Sao Paulo, Brazil.
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