Obesity is a major public health problem affecting adults and children in both developed and developing countries. This condition often leads to metabolic syndrome, which increases the risk of cardiovascular disease. A large number of studies have been carried out to understand the pathogenesis of cardiovascular dysfunction in obese patients. Endothelial dysfunction plays a key role in the progression of atherosclerosis and the development of coronary artery disease, hypertension and congestive heart failure. Noninvasive methods in the field of cardiovascular imaging, such as measuring intima-media thickness, flow-mediated dilatation, tissue Doppler, and strain, and strain rate, constitute new tools for the early detection of cardiac and vascular dysfunction. These techniques will certainly enable a better evaluation of initial cardiovascular injury and allow the correct, timely management of obese patients. The present review summarizes the main aspects of cardiovascular dysfunction in obesity and discusses the application of recent noninvasive imaging methods for the early detection of cardiovascular alterations.

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Background: Patients with thalassemia major present chronic hemolysis and require regular blood transfusions which may cause iron overload cardiomyopathy and chronic heart failure. Hemochromatosis is characterized by excessive iron accumulation in tissues, and heart involvement is the main cause of death in patients with thalassemia.

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The decreased systolic reserve induced by a low dose of anthracycline in asymptomatic children and adolescents remains unaffected over a 5-year period, suggesting that positive outcomes in chronic cardiotoxicity would be expected in patients with mild impairment after anthracycline treatment.

BackgroundInterventional procedures via radial technique have progressively increased due to improved patient comfort, lower complication rates and reduced mortality in some scenarios. One area of interest is radiation exposure and ways of minimising it. Most studies focus on patient radiation risk with conflicting results, but there is reasonable consensus for increased operator exposure from the radial technique. The aim of this study was to evaluate radiological exposure under controlled radial and femoral access simulation tests, mapping radiation paths and developing a radiological protection device for the transradial technique.Methods and resultsRadiation exposure was simulated under controlled conditions for femoral and radial techniques using a pressurised ionisation chamber and water phantom. Different measurement points were defined according to standard positions to simulate radiation received by the operator in the gonads, thyroid and eyes at different angles during real procedures. The radial technique increased total exposure by 33% over the femoral technique. A protective device was developed and tested after radiation mapping. The protective device reduced cumulative radiation by 52% against the radial and 36% against the femoral technique.ConclusionsIn our study, operator exposure to cumulative ionising radiation was higher from the radial technique and the protective device reduced radiation exposure levels in the radial and femoral techniques. These results provided the basis for a clinical trial design to better define the impact of the protection device and radiation exposure during real world practice using different interventional techniques.Trial registration numberhttp://www.clinicaltrials.gov. Unique identifier: NCT02200783.

Introduction: The mortality rates associated with coronary atherosclerotic disease (CAD) have been declining over the past decades driven, in part, by advances in revascularization techniques.

A doença falciforme (DF) notabiliza-se como problema global de saúde pública, caracterizando-se pela mudança da hemácia para a forma de foice, além da anemia crônica verifica-se alteração da reologia dos glóbulos vermelhos, ocasionando um cenário deinflamação e estresse oxidativo, fazendo da DF uma enfermidade multissistêmica. O débito cardíaco (DC) encontra-se elevado, acarretando aumento das câmaras cardíacas globalmente e hipertrofia miocárdica tipo excêntrica. Essas alterações cardíacas eram atribuídas apenas a reações adaptativas ao estado anêmico crônico. Estudos recentes reconhecem de maneira patente aassociação com hipertensão pulmonar (HP), disfunção diastólica do ventrículo esquerdo, arritmias e morte súbita; e, nesse contexto, surge recentemente a hipótese da existência de uma cardiomiopatia falcêmica, caracterizada por disfunção diastólica e fisiologia restritiva. O ecocardiograma configura como instrumento fundamental na determinação dos volumes cavitários, da função diastólica e da estimativa da pressão pulmonar, e constitui recurso valioso no diagnóstico e na condução terapêutica na síndrome torácica aguda. A utilização do strain miocárdico, as variáveis rotacionais, o trabalho miocárdico e a ecocardiografia 3D podem ser utilizados na tentativa de auxiliar a identificação precoce dos pacientes que estão sob maior risco de desenvolverem complicações e morte relacionada à DF.