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Oliveira S, Abreu A, Cunha P, Carmo MM, Valente B, Ricardo I, Delgado AS, Oliveira L, Pinto F, Oliveira MM. P542Cardiac autonomic dysfunction and inflammatory response in heart failure - markers for cardiac resynchronization therapy response? Europace 2020. [DOI: 10.1093/europace/euaa162.215] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
FCP
Introduction
Cardiac sympathetic activation and inflammatory response are involved in chronic heart failure (HF) pathophysiology. The severity of autonomic dysfunction and inflammation might be responsible for different responses to HF treatment.
Aim
To evaluate the impact of cardiac autonomic dysfunction, and it´s association with systemic inflammation, on cardiac resynchronization therapy (CRT) response in severe HF patients.
Methods
Single centre, prospective, longitudinal study, including consecutive patients, referred to CRT. Demographic data, HF aetiology and NYHA class were evaluated. Left ventricular (LV) function data (LV ejection fraction - LVEF) by echocardiography, heart to mediastinum early ratio (HMRe) by 123I-MIBG cardiac scintigraphy, and plasmatic TNF-α levels (pg/mL) were determined, at baseline and 4 months after CRT implantation. CRT response was defined by an absolute increase of at least 5% in LVEF at 4 months evaluation after CRT. Patients were divided in 4 groups according to HMRe and TNF-α cut-points: Group I (TNF-α > 2.0 pg/ml + HMRe ≥ 1.6), Group II (TNF-α > 2.0 pg/ml + HMRe < 1.6), Group III (TNF-α ≤ 2.0 pg/ml + HMRe ≥ 1.6) and Group IV (TNF-α ≤ 2.0 pg/ml + HMRe < 1.6). Data was analyzed using descriptive statistics and groups were compared by Fisher"s exact test.
Results
A total of 95 patients were included (age 68.6 ± 10.2 years), 67.4% male and 32.6% female, 40% with diabetes mellitus, 30.5% with ischemic cardiomyopathy, 23.2% in NYHA III/IV, baseline LVEF - 26 ± 7%. At 4 months, LVEF was 40 ± 11%. In total, 73.7% were responders and 26.3% were non-responders to CRT. There were 28 patients (29.5%) with HMRe ≥ 1.6, with 25 responders (89.3%) and 48 patients (50.5%) with TNF-α ≤ 2.0 pg/ml, with 38 responders (79.2%). Group I had 16 patients (16.8%), with 81.2% responders; Group II had 31 patients (32.7%), with 61.3% responders; Group III had 12 patients (12.6%), with 100% responders, and Group IV had 36 patients (37.9%), with 72.2% responders. Conclusion: In patients with severe HF submitted to CRT, combining cardiac autonomic dysfunction and inflammation, associated to high rate of CRT non response. Contrarily, those with preserved cardiac autonomic function and no increased levels of inflammation identified most significantly CRT responders.
CRT response according to HMRe and TNFα HMRe ≥ 1.6 (n = 28) HMRe < 1.6 (n = 67) Responders NO Respondersn (%) Responders NO Respondersn (%) TNF α > 2 pg/mL (n = 47) G I: 13 (81.2%) 3 (18.8%) GII: 19 (61.3%) 12 (38.7%) * TNF α ≤ 2 pg/mL (n = 48) G III: 12 (100%) 0 (0%)* G IV: 26 (72.2%) 10 (27.8%)
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Affiliation(s)
- S Oliveira
- Faculty of Medicine of the University of Lisbon, Cardiovascular Exercise & Rehabilitation Laboratory, Cardiovascular Centre of the University of Lisb, Lisbon, Portugal
| | - A Abreu
- Faculty of Medicine of the University of Lisbon, Cardiovascular Exercise & Rehabilitation Laboratory, Cardiovascular Centre of the University of Lisb, Lisbon, Portugal
| | - P Cunha
- Hospital de Santa Marta, Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central , Lisbon, Portugal
| | - M M Carmo
- University of Lisbon, Nova Medical School, CEDOC Chronic Diseases, Lisbon, Portugal, Lisbon, Portugal
| | - B Valente
- Hospital de Santa Marta, Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central , Lisbon, Portugal
| | - I Ricardo
- Faculty of Medicine of the University of Lisbon, Cardiovascular Exercise & Rehabilitation Laboratory, Cardiovascular Centre of the University of Lisb, Lisbon, Portugal
| | - A S Delgado
- Hospital de Santa Marta, Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central , Lisbon, Portugal
| | - L Oliveira
- Quadrantes Clinic, Nuclear Medicine Department, Clinic Quadrantes, Lisbon, Portugal, Lisbon, Portugal
| | - F Pinto
- Faculty of Medicine of the University of Lisbon, Cardiovascular Exercise & Rehabilitation Laboratory, Cardiovascular Centre of the University of Lisb, Lisbon, Portugal
| | - M M Oliveira
- Hospital de Santa Marta, Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Central , Lisbon, Portugal
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Zé-Zé L, Tenreiro R, Duarte A, Salgado MJ, Melo-Cristino J, Lito L, Carmo MM, Felisberto S, Carmo G. Case of aortic endocarditis caused by Lactobacillus casei. J Med Microbiol 2004; 53:451-453. [PMID: 15096557 DOI: 10.1099/jmm.0.05328-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [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: 11/18/2022] Open
Abstract
A case of Lactobacillus aortic valve endocarditis in a 53-year-old immunocompetent patient with past history of rheumatic fever is reported. Clinical symptoms began after a dental extraction and the patient's diet included several yogurts per day. Blood, bone marrow cultures and the replaced aortic valve were positive for Lactobacillus: The clinical isolate was identified as Lactobacillus casei by 16S rDNA sequencing.
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Affiliation(s)
- L Zé-Zé
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - R Tenreiro
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - A Duarte
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - M J Salgado
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - J Melo-Cristino
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - L Lito
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - M M Carmo
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - S Felisberto
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - G Carmo
- Departamento de Biologia Vegetal e Centro de Genética e Biologia Molecular, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal 2Departamento de Microbiologia, Faculdade de Farmácia, Universidade de Lisboa, 1649-019 Lisboa, Portugal 3,5Laboratório de Bacteriologia3 and Departamento de Doenças Infecto-Contagiosas5, Hospital de Santa Maria, 1649-035 Lisboa, Portugal 4Laboratório de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
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Carmo MM, Ferreira T, Lousada N, Bárbara C, Neves PR, Correia JM, Rendas AB. [The repercussions of pulmonary congestion on ventilatory volumes, capacities and flows]. Rev Port Cardiol 1994; 13:763-8; 736. [PMID: 7833063] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To evaluate the effects of pulmonary congestion on pulmonary function. STUDY DESIGN Prospective study performed in patients with left ventricular failure or mitral stenosis. MATERIAL AND METHODS Forty-eight hospitalized patients were included suffering from pulmonary congestion either from left ventricular failure or mitral stenosis. While in hospital all patients were submitted to right heart catheterization by the Swan-Ganz method and also to an echocardiographic examination. Within 48 hours after the patients were submitted to the following lung function studies: lung volumes and capacities by the multi-breath helium dilution method and airway flows by pneumotachography. Respiratory symptoms were evaluated by the Medical Research Council Questionnaire and the functional class classified according to the NYHA. Correlations were made between the functional and clinical data. RESULTS Regarding the cardiac evaluation patients presented with a mean pulmonary wedge pressure of 19.9 +/- 8.6 mmHg, a cardiac index of 2.5 +/- 0.8 l/min/m2, an end diastolic dimension of the left ventricle of 65.9 +/- 10.1 mm, and end systolic dimension of 51.2 +/- 12.2 mm, with a shortening fraction of 21.8 +/- 9.5%. The pulmonary evaluation showed a restrictive syndrome with a reduction in the mean values of the following parameters: total pulmonary capacity 71 +/- 14.4% of the predicted value (pv), forced vital capacity (FVC) 69.8 +/- 20.5% pv, and forced expiratory volume (FEV1) of 64 +/- 21.8% vp. The index FEV1/FVC was within the normal value of 72.7 +/- 9.7%. These lung function results did not correlate significantly with either the clinical, the hemodynamic or echocardiographic findings. CONCLUSION In these group of patients pulmonary congestion led to the development of a restrictive syndrome which failed to correlate in severity with the duration of the disease, the pulmonary wedge pressure and the left ventricular function.
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Carmo MM, Soares R, Ferreira T, Ferreira R, Ferreira L, Quininha J, Salomão S. [Flow in the entry chamber of the left ventricle. Changes with age]. Rev Port Cardiol 1990; 9:319-22. [PMID: 2386634] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To evaluate the influence of aging in the parameters of the left ventricle diastolic function, using 2D-Doppler echocardiography. STUDY DESIGN Prospective study of normals subjects. MATERIAL AND METHODS They were studied 38 normals subjects aged between 23-70 years divided in two groups: group A--20 subjects aged less than 45 years (34.5 +/- 6) and group B--18 subjects aged greater than 45 years (55.7 +/- 8.4); we registered the left ventricle inflow flows by 2D-pulsed Doppler Echocardiography and analyzed the following indexes: E and A Velocities, E/A ratio, relations of areas under the curves of flow, E Area/Total Area (EAr/TAr), A Area/Total Area (AAr/TAr), 33% Area/Total Area (33Ar/TAr), 50% Area/Total Area (50Ar/TAr) and A Area/E Area (AAr/EAr). RESULTS E Vel and E/A ratio are significantly higher in the group A (p less than 0.001), both decreasing with aging, respectively r = -0.71 and r = 0.63; on the other way, the relative contribution of atrial systole to the left ventricle diastolic filling is significantly higher in the group B(ArA/ArT p less than 0.001; AAr/EAr p less than 0.001), increasing significantly with aging, r = 0.64 and r = 0.69, respectively. CONCLUSIONS There is an increasing of atrial contribution to the left ventricular diastolic filling in the elderly, so in comparative studies it must be used control groups with the same age.
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Affiliation(s)
- M M Carmo
- Serviço de Cardiologia do Hospital de Santa Marta, H.C.L., Lisboa
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Carmo MM, Ferreira T, Ferreira L, Ferreira R, Quininha J, Salomão S. [Flow in the entry chamber of the right ventricle: diastolic function indexes in a normal population]. Rev Port Cardiol 1990; 9:19-23. [PMID: 2328135] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To define normal values of indexes of diastolic function of right ventricle by bidimensional pulsed doppler echocardiography. STUDY DESIGN Prospective study of normal individuals. MATERIALS AND METHODS Thirty normal subjects by physical examination, electrocardiographic, radiological and echocardiographic criteria, aged between 22-48 (mean 31.2 +/- 6.7) were evaluated. We determined 16 different indexes and correlated them with heart rate, age and body surface; 27% of cases owing to the poor quality of records, were excluded. RESULTS Eight indexes were heart rate dependent and for their use is necessary the respective correction; none of them correlated with age or body surface. Areas determined under the curves of flow are very time consuming and require great accuracy determination. So, we had correlated areas with other different indexes in order to obtain other parameters to give us the same information on a easier and quickly way. E/A relation correlated with all areas relations. CONCLUSIONS The indexes determined can be considered as normal standard in order to evaluate, by a non-invasive way, right ventricle diastolic function. Nevertheless, the great proportion of records of poor quality is a limitation of the method.
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Affiliation(s)
- M M Carmo
- Serviço de Cardiologia, Hospital de Santa Marta (H.C.L.)
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