Partial external mitral annuloplasty in dogs with myxomatous mitral valve degeneration and congestive heart failure: Outcome in 9 cases

Objective: To report the outcome of partial external mitral annuloplasty in dogs with congestive heart failure (CHF) due to mitral regurgitation caused by myxomatous mitral valve degeneration (MMVD). Animals, materials and methods: Nine client-owned dogs with CHF due to mitral regurgitation caused by MMVD. Surgery consisted of a double row of pledget-butressed continuous suture lines placed into the left ventricle parallel and just ventral to the atrioventricular groove between the subsinuosal branch of the left circumflex coronary artery and the paraconal branch of the left coronary artery. Results: Two dogs died during surgery because of severe hemorrhage. Two dogs died 12 and 36 h after surgery because of acute myocardial infarction. Three dogs were euthanized 2 and 4 weeks after surgery because of progression of CHF, 1 was euthanized 30 days after surgery for non-cardiac disease, and 1 survived for 48 months. In the 5 dogs that survived to discharge there was no significant change in the left atrium to aortic ratio with surgery (3.6 ± 0.56 before surgery; 3.1 ± 0.4 after surgery; p = 0.182), and no significant change in mitral regurgitant fraction in 4 dogs in which this measurement was made (78.7 ± 2.0% before surgery; 68.7 ± 7.5% after surgery; p = 0.09). Conclusions: Partial external mitral annuloplasty in dogs with CHF due to MMVD was associated with high perioperative mortality and most dogs that survived to discharge failed to show clinically relevant palliation from this procedure. Consequently, partial external mitral annuloplasty is not a viable option for dogs with mitral regurgitation due to MMVD that has progressed to the stage of CHF. © 2011 Elsevier B.V. All rights reserved.

Anatomical features of the urethra and urinary bladder catheterization in female mice and rats. An essential translational tool

PURPOSE: To present fundamental anatomical aspects and technical skills necessary to urethra and urinary bladder catheterization in female mice and rats. METHODS: Urethral and bladder catheterization has been widely utilized for carcinogenesis and cancer research and still remains very useful in several applications: from toxicological purposes as well as inflammatory and infectious conditions to functional aspects as bladder dynamics and vesicoureteral reflux, among many others. RESULTS: Animal models are in the center of translational research and those involving rodents are the most important nowadays due to several advantages including human reproducibility, easy handling and low cost. CONCLUSIONS: Although technical and anatomical pearls for rodent urethral and bladder access are presented as tackles to the advancement of lower urinary tract preclinical investigation in a broaden sight, restriction to female animals hampers the male microenvironment, demanding future advances.

A snoring classifier based on heart rate variability analysis

The effect of snoring on the cardiovascular system is not well-known. In this study we analyzed the Heart Rate Variability (HRV) differences between light and heavy snorers. The experiments are done on the full-whole-night polysomnography (PSG) with ECG and audio channels from patient group (heavy snorer) and control group (light snorer), which are gender- and age-paired, totally 30 subjects. A feature Snoring Density (SND) of audio signal as classification criterion and HRV features are computed. Mann-Whitney statistical test and Support Vector Machine (SVM) classification are done to see the correlation. The result of this study shows that snoring has close impact on the HRV features. This result can provide a deeper insight into the physiological understand of snoring. © 2011 CCAL.

Gastrointestinal changes associated to heart failure

Over the last decade, several studies were conducted on the gastrointestinal changes associated to chronic heart failure. This article presents a literature review on the physiopathology and clinical consequences of pathological digestive changes of heart failure patients. Structural and functional abnormalities of the gastrointestinal tract, such as edema of absorptive mucosa and intestinal bacterial overgrowth, have been leading to serious clinical consequences. Some of these consequences are cardiac cachexia, systemic inflammatory activation and anemia. These conditions, alone or in combination, may lead to worsening of the pre-existing ventricular dysfunction. Although currently there is no therapy specifically earmarked for gastrointestinal changes associated to heart failure, the understanding of digestive abnormalities is germane for the prevention and management of systemic consequences.

Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients

Background: Decreased heart rate variability (HRV) is related to higher morbidity and mortality. In this study we evaluated the linear and nonlinear indices of the HRV in stable angina patients submitted to coronary angiography. Methods. We studied 77 unselected patients for elective coronary angiography, which were divided into two groups: coronary artery disease (CAD) and non-CAD groups. For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 40 minutes. We analyzed the linear indices in the time (SDNN [standard deviation of normal to normal], NN50 [total number of adjacent RR intervals with a difference of duration greater than 50ms] and RMSSD [root-mean square of differences]) and frequency domains ultra-low frequency (ULF) ≤ 0,003 Hz, very low frequency (VLF) 0,003 - 0,04 Hz, low frequency (LF) (0.04-0.15 Hz), and high frequency (HF) (0.15-0.40 Hz) as well as the ratio between LF and HF components (LF/HF). In relation to the nonlinear indices we evaluated SD1, SD2, SD1/SD2, approximate entropy (-ApEn), α1, α2, Lyapunov Exponent, Hurst Exponent, autocorrelation and dimension correlation. The definition of the cutoff point of the variables for predictive tests was obtained by the Receiver Operating Characteristic curve (ROC). The area under the ROC curve was calculated by the extended trapezoidal rule, assuming as relevant areas under the curve ≥ 0.650. Results: Coronary arterial disease patients presented reduced values of SDNN, RMSSD, NN50, HF, SD1, SD2 and -ApEn. HF ≤ 66 ms§ssup§2§esup§, RMSSD ≤ 23.9 ms, ApEn ≤-0.296 and NN50 ≤ 16 presented the best discriminatory power for the presence of significant coronary obstruction. Conclusion: We suggest the use of Heart Rate Variability Analysis in linear and nonlinear domains, for prognostic purposes in patients with stable angina pectoris, in view of their overall impairment. © 2012 Pivatelli et al.; licensee BioMed Central Ltd.

Heart rate variability in healthy adolescents at rest

Objective: to describe the cardiac autonomic function in healthy adolescents between 13 and 18 years old. Methods: data from 93 adolescents, of both sexes, were analyzed; they were divided into three groups according to age. Group A 13-14 years old (n=26), Group B 15-16 years old (n = 30) and Group C 17-18 years old (n = 17). The protocol consisted of raising the heart rate, beat by beat for twenty minutes of rest in supine position with spontaneous breathing. The cardiac autonomic behavior analysis was performed by the method of heart rate variability (HRV) through the indices of the Poincaré plot (SD1, SD2 and ratio SD1/SD2) and its qualitative analysis and indices in linear time domain (RMSSD and SDNN) and frequency (LFnu, HFnu and LF/HF). One-way ANOVA test or Kruskal-Wallis test was used for comparison between groups, with a significance level of 5%. Results: there was no significant difference in none of the indices compared the three groups. In addition,visual analysis of Poincaré plot has observed for all age groups large dispersion of RR intervals, indicating that these groups have good HRV. Conclusion: there were no changes in HRV in the different age groups analyzed, however the result allowed to establish a standard for each group that was studied, becomes an important tool for comparison of cardiac autonomic function between healthy and patients subjects or in different areas.

Relationship between incubation temperature and egg size with heart hypoplasy in broiler chicks at hatching

It was analyzed if the effects of continuous incubation temperature deviations during the second half on the development of body, organs and hematological respiratory and energetic parameters differ between male and female from 30- and 60-week-old breeder eggs. From day 13, Cobb eggs were exposed to 36°C, 37.5°C, or 39°C. At 3, 6, 12, 24, 48 and 72 h after this change in the temperature and at hatch, red cells count, hematocrit, hemoglobin, mean corpuscular volume, plasma glucose level and body, liver and heart weights were evaluated. Independent of incubation temperature, sexes and breeder ages, mean corpuscular volume decreased and the other variables increased during late incubation. In 30-week-old breeder eggs, body weights and erythrocytic parameters were not influenced by temperature but liver and heart weights decreased increasing incubation temperature and glucose level increased at 36 and 39°C. In 60-week-old breeder eggs, males were heavier at hatching with incubation at 36°C and females had smaller body weights with incubation at 39°C. In both sexes, liver weight decreased and glucose concentration was higher at 36 and 39°C and heart weights and erythrocytes parameters were not influenced by temperature. Independent of breeder age, hatchability was lower at 39°C. The data show that high temperature from day 13 of incubation reduced more intensively the hatching success and caused cardiac hypoplasia in chicks from 30-week-old breeder eggs only, revealing for the first time that the susceptibility for ascites syndrome, by reduced heart development at hatching, is associated to a relationship between incubation temperature and egg size. © Asian Network for Scientific Information, 2012.

Caring for heart transplant recipients: The lived experience of primary caregivers

Objective: To understand the experience of primary caregivers of heart transplant recipients. Methods: A phenomenological approach was used to understand the caregivers' experience of caring for a heart transplant patient. In-depth interviews were conducted with 11 caregivers, in a Brazilian hospital, from December 2008 to March 2009. Results: Following the transplant, caregivers' lives change drastically; their priority becomes providing care for their relative. Despite successful transplant results, the uncertainty about future remains, generating permanent distress. Anxiety is exacerbated by familial or economic problems and, consequently, many participants turn to their local communities for support. Some caregivers learn from the experience and plan return to regular activities. Others feel helpless, unable to overcome personal losses and difficulties. Conclusions: Nurses are ideally placed to lead the way by providing family-centered support and education for caregivers of heart recipients. Listening to the concerns of family caregivers seems to be an essential aspect of effective interventions. © 2013 Elsevier Inc.

Smoking is associated with remodeling of gap junction in the rat heart: Smoker's paradox explanation?

Background: In a previous study utilizing the rat model, exposure to tobacco smoke for 5 weeks increased survival after AMI, despite similar age and infarct size between the smokers and nonsmokers, and absence of reperfusion. Objective: Thus, this study aimed to analyze the effects of exposure to tobacco smoke on intensity, distribution or phosphorylation of connexin 43 in the rat heart. Methods: Wistar rats weighing 100 g were randomly allocated into 2 groups: 1) Control (n = 25); 2) Exposed to tobacco smoke (ETS), n = 23. After 5 weeks, left ventricular morphometric analysis, immunohisthochemistry and western blotting for connexin 43 (Cx43) were performed. Results: Collagen volume fraction, cross-sectional areas, and ventricular weight were not statistically different between control and ETS. ETS showed lower stain intensity of Cx43 at intercalated disks (Control: 2.32 ± 0.19; ETS: 1.73 ± 0.18; p = 0.04). The distribution of CX43 at intercalated disks did not differ between the groups (Control: 3.73 ± 0.12; ETS: 3.20 ± 0.17; p = 0.18). ETS rats showed higher levels of dephosphorylated form of Cx43 (Control: 0.45 ± 0.11; ETS: 0.90 ± 0.11; p = 0.03). On the other hand, total Cx43 did not differ between control and ETS groups (Control: 0.75 ± 0.19; ETS: 0.93 ± 0.27; p = 0.58). Conclusion: Exposure to tobacco smoke resulted in cardiac gap junction remodeling, characterized by alterations in the quantity and phosphorylation of the Cx43, in rats hearts. This finding could explain the smoker's paradox observed in some studies.

The effects of combined aerobic and resistance training on heart rate variability in postmenopausal women

Model of the study: Controlled clinical trial. Objective: To verify the effects of 16 weeks of combined aerobic and resistance training on cardiac autonomic modulation in menopausal women. Methods: 17 menopausal women were divided into two groups: the training group (TG: n=11) and control group (CG: n=6). The body composition variables were estimated using dual-energy X-ray absorptiometry. The cardiac autonomic modulation was evaluated by heart rate variability using linear indexes. The training protocol consisted of 16 weeks of 50 minutes of resistance training and 30 minutes of aerobic training. Results: For the TG there was an increase in the rMSSD(ms) index (pre:17,4±3,7 and post:24,8±13,1, p<0,045), an increase in the duration of the intervals between the cardiac beats(ms) (pre:891,2±80,2 and post:974,1±71,4, p<0,003) and in the values of heart rate(bpm) (pre:68,1±6,4 and post:62,0±4,7, p<0,003), additionally for the spectral indexes in normalized units, changes for LF (pre:52,2±13,1 and post:44,5±12,4, p<0,025) and HF (pre:47,8±13,3 and post:55,5±12,4, p<0,025) were noticed, demonstrating increased parasympathetic and reduced sympathetic. There were no significant differences to CG. Conclusion: combined aerobic and resistance training promoted benefits to the autonomic modulation in menopausal women.

Morphological adaptations to arboreal habitats and heart position in species of the neotropical whipsnakes genus Chironius

The evolution of arboreality in snakes is accompanied by modifications that are remarkably similar across species. Gravity is one of the most important selective agents, and arboreal snakes present adaptations to circumvent the gradient of pressure, including modifications on heart position (HP) and body slenderness (BS). However, the degree to which different life-history traits influence the cardiovascular system of snakes remains unclear. Here, we used an ecological and a phylogenetic approach to explore the relationship between habitat, HP, BS, and heart size (HS) in five species of the neotropical whipsnakes genus Chironius that occupy terrestrial, semiarboreal, and arboreal habits. Our ecological comparison indicated that the arboreal species have the most posterior-positioned heart, the most slender body, and the smallest HS, whereas the terrestrial representative of the group exhibited the most anterior heart, the less flattened body, and the largest HS. After removing the phylogenetic effect, we found no difference in HP and BS between terrestrial and arboreal species. Habitat only differed when contrasting with HS. Body slenderness and HS were correlated with HP. Our results suggest that different restrictions, such as anatomical constraints, behavior, and phylogenetic inertia, may be important for the studied species. © 2013 The Royal Swedish Academy of Sciences.

Resting heart rate: Its correlations and potential for screening metabolic dysfunctions in adolescents

Background: In pediatric populations, the use of resting heart rate as a health index remains unclear, mainly in epidemiological settings. The aims of this study were to analyze the impact of resting heart rate on screening dyslipidemia and high blood glucose and also to identify its significance in pediatric populations.Methods: The sample was composed of 971 randomly selected adolescents aged 11 to 17 years (410 boys and 561 girls). Resting heart rate was measured with oscillometric devices using two types of cuffs according to the arm circumference. Biochemical parameters triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and glucose were measured. Body fatness, sleep, smoking, alcohol consumption and cardiorespiratory fitness were analyzed.Results: Resting heart rate was positively related to higher sleep quality (β = 0.005, p = 0.039) and negatively related to cardiorespiratory fitness (β = -0.207, p = 0.001). The receiver operating characteristic curve indicated significant potential for resting heart rate in the screening of adolescents at increased values of fasting glucose (area under curve = 0.611 ± 0.039 [0.534 - 0.688]) and triglycerides (area under curve = 0.618 ± 0.044 [0.531 - 0.705]).Conclusion: High resting heart rate constitutes a significant and independent risk related to dyslipidemia and high blood glucose in pediatric populations. Sleep and cardiorespiratory fitness are two important determinants of the resting heart rate. © 2013 Fernandes et al.; licensee BioMed Central Ltd.

Energy Metabolism in Cardiac Remodeling and Heart Failure

Fatty acids are the main substrates used by mitochondria to provide myocardial energy under normal conditions. During heart remodeling, however, the fuel preference switches to glucose. In the earlier stages of cardiac remodeling, changes in energy metabolism are considered crucial to protect the heart from irreversible damage. Furthermore, low fatty acid oxidation and the stimulus for glycolytic pathway lead to lipotoxicity, acidosis, and low adenosine triphosphate production. While myocardial function is directly associated with energy metabolism, the metabolic pathways could be potential targets for therapy in heart failure. © 2013 by Lippincott Williams & Wilkins.

Insulin Suppresses Atrophy- and Autophagy-related Genes in Heart Tissue and Cardiomyocytes Through AKT/FOXO Signaling

Insulin is an important regulator of the ubiquitin-proteasome system (UPS) and of lysosomal proteolysis in cardiac muscle. However, the role of insulin in the regulation of the muscle atrophy-related Ub-ligases atrogin-1 and MuRF1 as well as in autophagy, a major adaptive response to nutritional stress, in the heart has not been characterized. We report here that acute insulin deficiency in the cardiac muscle of rats induced by streptozotocin increased the expression of atrogin-1 and MuRF1 as well as LC3 and Gabarapl1, 2 autophagy-related genes. These effects were associated with decreased phosphorylation levels of Akt and its downstream target Foxo3a; this phenomenon is a well-known effect that permits the maintenance of Foxo in the nucleus to activate protein degradation by proteasomal and autophagic processes. The administration of insulin increased Akt and Foxo3a phosphorylation and suppressed the diabetes-induced expression of Ub-ligases and autophagy-related genes. In cultured neonatal rat cardiomyocytes, nutritional stress induced by serum/glucose deprivation strongly increased the expression of Ub-ligases and autophagy-related genes; this effect was inhibited by insulin. Furthermore, the addition of insulin in vitro prevented the decrease in Akt/Foxo signaling induced by nutritional stress. These findings demonstrate that insulin suppresses atrophy- and autophagy-related genes in heart tissue and cardiomyocytes, most likely through the phosphorylation of Akt and the inactivation of Foxo3a. © Georg Thieme Verlag KG.

Identification of poisonous plants in the heart of public squares of ribeirão Preto SP

Toxic plants, many ornamentals, may be present in gardens, backyards, parks, vases, squares and vacant lots around the cities. Some of these plants are well known and exuberant, with strong color and decorative aspects, but when swallowed or handled, can cause severe intoxication specially in children. The main objective was to identify the poisonous plants found in public squares of Ribeirão Preto downtown, among five squares: XV de Novembro Square, Carlos Gomes Square, Bandeiras Square, Luís de Camões Square and Sete de Setembro Square. In this study, a literature review was performed in order to know the species that have been recorded as toxic plant. For the species in question, the common name and therapeutic indication were recorded. Over all evaluated squares toxic species were found. Sete de Setembro Square was the most frequent species in a total of seven toxical species. The most common species in the surveyed places were: Euphorbia pulcherrima, Buxus semprevirens and Dracaena fragrans, popularly known as Poinsettia, Boxwood and Cornstalk Dracaena, respectively. The importance of doing studies in urban squares is to improve care to ensure the afforestation process of the cities.