RESUMOEstudaram-se os parâmetros eletrocardiográficos utilizando-se os métodos convencional, computadorizado e computadorizado impresso de 30 cães da raça Beagle clinicamente normais. As medidas eletrocardiográficas dos três diferentes traçados foram analisadas na derivação DII. A comparação entre os métodos revelou diferença nos valores da onda P, onda R, complexo QRS, intervalo QT e intervalo PR e na polaridade da onda T. Este fato deve ser levado em consideração, na dependência do método a ser utilizado. Palavras-chave: cão, eletrocardiograma ABSTRACTElectrocardiographic parameters were studied in thirty healthy adult Beagles, using conventional and computerized methods and reading the computerized registration printed on paper. The electrocardiographic measurements of the three different tracings were analyzed in lead II. The results obtained showed that there are differences among the three methods for P wave, R wave, QRS complex, QT interval, PR interval and polarity of the T wave. Special attention should be given to these differences, depending on the chosen method.
RESUMENEl desarrollo de una cardiomiopatía dosis dependiente es la principal limitación para el uso de doxorrubicina en protocolos de quimioterapia tanto en seres humanos como en animales. En estos casos, la función global del miocardio puede ser cedida, teniendo como resultado signos atribuibles a la insuficiencia cardíaca congestiva. En este estudio, nosotros investigamos la capacidad del índice de desempeño miocárdico de Tei para identificar disfunción de miocardio en perros sanos tratados con doxorrubicina a una dosis cumulativa de 210 mg/m 2 en un periodo de 147 días, comparándolo con otros indicadores ecográficos estándar de función sistólica y diastólica. Nuestros resultados indicaron que el índice de Tei, el tiempo de relajación isovolumétrica, el período de pre-eyección, y la relación período de pre-eyección/tiempo de eyección ventricular izquierda pudieron identificar los efectos cardiotóxicos de doxorrubicina en la función cardíaca cuando sólo 60 mg/m 2 habían sido administrados, mientras los parámetros estándar sistólicos y diastólicos, incluso el diámetro sistólico del ventrículo izquierdo, la fracción de eyección y la fracción de acortamiento, necesitaron por lo menos 120 mg/mg 2 para empeorar. Se concluye que la terapia prolongada con antraciclinas perjudica las funciones sistólica y diastólica, que pueden ser documentadas antes adicionándose el índice de Tei a la evaluación ecográfica estándar en animales que reciben doxorrubicina.Palabras clave: cardiotoxicidad, antraciclinas, disfunción cardiaca, quimioterapia. SUMMARYThe development of a dose-dependent cardiomyopathy is the main limitation for the use of doxorubicin in chemotherapy protocols in both humans and animals. In this setting, the global myocardial function may be compromised resulting in signs of congestive heart failure. In this study, we investigated the ability of the Tei index of myocardial performance to identify myocardial dysfunction in healthy dogs receiving doxorubicin to a cumulative dose of 210 mg/m 2 over 147 days, comparing it with other standard echocardiographic indicators of systolic and diastolic function. Our results indicated that the Tei index, the isovolumic relaxation time, pre-ejection period and the pre-ejection period-to-left ventricular ejection time ratio were able to identify the cardiotoxic effects of doxorubicin on cardiac function when only 60 mg/m 2 had been administered, while the standard systolic and diastolic parameters, including left ventricular diameter at systole, ejection fraction, and fractional shortening needed at least 120 mg/mg 2 to deteriorate. We concluded that prolonged anthracycline therapy compromises both systolic and diastolic functions, which may be documented earlier by including the Tei index evaluation to the standard echocardiographic assessment of animals receiving doxorubicin.
Background: We hypothesized that one single episode of acute kidney injury (AKI) reduces long-term survival compared with no acute kidney injury (No AKI) following recovery from critical illness. Materials and methods: A prospective cohort of 2,010 patients admitted to the ICU between 2000 and 2009 at a provincial referral hospital was followed to determine whether AKI influences long-term survival. Results: Of the 1,844 eligible patients, 18.4% had AKI stage 1, 12.1% had stage 2, 26.5% had stage 3, and 43.0% had No AKI, using the KDIGO classification. The mean and median follow-up time was 8.1 and 8.7 years. The 28-day, 1-year, 5-year and 10-year survival rates were 59.6%, 44.9%, 37.4%, and 33.4%, in patients with any AKI (stage 1, stage 2, stage 3), which was significantly worse compared with the critically ill patients with no AKI at any time (P < 0.01). The adjusted 10-year mortality risk associated with AKI was 1.44 (95% CI = 1.2 to 1.7) among 28-day survivors. Patients who had mild AKI (stage 1) had significantly worse survival at 28 days, 1 year, 3 years, 5 years and 10 years compared with No AKI (P < 0.01) (Figure 1A). Patients with sepsis and AKI who survived 28 days had significantly poorer 5-year and 10-year survival compared with nonseptic AKI (P < 0.01) (Figure 1B). Conclusions: Patients with one episode of mild (stage 1) AKI have significantly lower survival rates over 10 years than critically ill patients without AKI. The causes and mechanisms of this association warrant further careful study. Close medical follow-up of these patients may be warranted and mechanistic research required understanding how AKI influences distant events.
ABSTRACT. The Tei index of myocardial performance is a noninvasive echocardiographic parameter that combines systolic and diastolic time intervals to assess global cardiac performance. It was demonstrated to be a reliable indicator of myocardial dysfunction in dogs with varying clinical conditions. Because only a few studies focused on the measurement of the index in healthy dogs, this cross-sectional study was conceived to investigate how it performs in a large population of clinically healthy Beagle dogs. Our results showed no correlation between the index and body weight, heart rate, and several standard echocardiographic measures which are estimates of preload and afterload. There was no difference between de index calculated for males or females. Also, results indicated strong intra-observer and inter-observer correlations. In conclusion, the Tei index was shown to perform independently of loading conditions, besides being a straightforward and easily reproducible parameter.Key words: echocardiography, cardiac function, Doppler, dog. RESUMEN.El índice de rendimiento miocárdico es un parámetro ecocardiográfico no invasivo que combina intérvalos de tiempo sistólico y diastólico para evaluar el rendimiento cardiaco total. Se ha demostrado que es un indicador fiable de disfunción miocárdica en perros con diferentes condiciones clínicas. Debido a que pocos estudios se centraron en la medición de este índice en perros sanos, este estudio transversal fue concebido para investigar este rendimiento en una gran población de perros Beagle clínicamente sanos. Nuestros resultados no muestran correlación entre el índice y el peso corporal, la frecuencia cardiaca, y varias medidas ecocardiográficas que son estimaciones estándar de precarga y poscarga. No hubo diferencia entre machos y hembras para el índice calculado. Además, los resultados indicaron notorias correlaciones intraobservador e interobservador. En conclusión, el índice de Tei se mostró como un parámetro independiente de las condiciones de la carga, que además de ser fácil de calcular también es un parámetro de fácil reproducción.
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