Heart failure due to Chagas cardiomyopathy (HFCC) differs from failure with other etiologies because of the occurrence of intense inflammatory infiltrate and right ventricle compromise. This article investigates correlations of B-type natriuretic peptide (BNP) levels with parameters of severity in HFCC. Twenty-eight patients and 8 normal controls underwent heart catheterization and clinical and laboratory analyses. BNP levels were higher in patients with HFCC (P<.0001) and correlated with New York Heart Association (NYHA) class; right atrial pressure; wedge pressure; cardiac output; levels of serum sodium, hemoglobin, urea, and tumor necrosis factor-alpha; and ejection fraction. Interferon-gamma and transforming growth factor-beta did not correlate with BNP level. The authors conclude that BNP levels are elevated in patients experiencing HFCC, irrespective of NYHA class, and that the occurrence of HFCC correlates with severity of disease.
Background: Heart failure due to Chagas' disease (HFCD) is a progressive inflammatory cardiomyopathy that affects millions of individuals in Latin America. Studies using mice models of HFCD indicate that bone marrow mononuclear cell transplantation (BMCT) may reduce inflammation, fibrosis, and improve myocardial function.
OBJECTIVETo evaluate early effects of bone marrow cell transplantation to the myocardium of patients with heart failure (CHF) due to Chagas disease.
METHODSWe studied 28 patients (mean age 52.2 ± 9.9), of whom 24 were male. Despite optimized treatment, 25 patients were in NYHA class III and three patients, in NYHA class IV. The procedure consisted of aspiration of 50 mL of bone marrow, separation of the mononuclear fraction, and intracoronary injection. Effects on left ventricle ejection fraction (LVEF), distance walked in the six-minute walking test, quality-of-life, NYHA class, arrhythmogenic and biochemical parameters, were all evaluated.
RESULTSThere were no complications directly related to the procedure. Baseline left ventricular ejection fraction was 20.1 ± 6.8%, and 60 days after transplantation it increased to 23.0 ± 9.0%, p = 0.02. Signifi cant improvements were observed in the NYHA class (3.1 ± 0.3 to 1.8 ± 0.5; p < 0.0001); quality-of-life (50.9 ± 11.7 to 21.8 ± 13.4; p < 0.0001); and distance walked in six minutes (355 ± 136 m to 443 ± 110 m; p = 0,003). The number of ventricular premature beats in 24 hours tended to increase (5,322 ± 4,977 to 7,441 ± 7,955; p = 0,062), but without increase in ventricular tachycardia episodes (61 ± 127 to 54 ± 127; p = 0.27).
CONCLUSIONOur data demonstrate for the fi rst time that intracoronary injection of bone marrow mononuclear cells is feasible and suggest that it may be potentially safe and effective in patients with CHF due to Chagas disease.
BackgroundThrombotic disorders remain one of the leading causes of death in the Western
world. Dabigatran appeared as an alternative to warfarin for anticoagulation
in the treatment of atrial fibrillation (AF). The risk associated with
bleeding due to its use has been documented in several randomized clinical
trials, but no large study has examined in detail the risk of bleeding
during dental extraction and other dental procedures involving bleeding.ObjectiveTo compare the intensity of bleeding in individuals taking dabigatran or
vitamin K antagonist (warfarin) and undergoing dental procedures.MethodsProspective, single-center, controlled study with one single observer.
Patients diagnosed with nonvalvular AF, on warfarin or dabigatran, cared for
at a cardiology referral center, and requiring single or multiple dental
extractions, were evaluated up to seven days post-extraction. The following
outcomes were assessed: bleeding time between the beginning and the end of
suture and complete hemostasis; bleeding before the procedure, after 24
hours, 48 hours, 7 days, during and after suture removal (late); p<0.05
was defined as of statistical relevance.ResultsWe evaluated 37 individuals, 25 in the warfarin group and 12 in the
dabigatran group. Age, sex, weight, height, blood pressure, color,
schooling, family income and comorbidities were similar between the two
groups. Regarding bleeding after 24 hours of the procedure, no one in the
dabigatran group had bleeding, whereas 32% in the warfarin group had
documented bleeding (p = 0.028). The other variables analyzed did not differ
between the groups.ConclusionsThis study suggests that, regarding dental extraction, there is no
statistically significant difference in the intensity of bleeding of
patients taking dabigatran as compared to those taking warfarin. Bleeding 24
hours after the procedure was less frequent among patients on
dabigatran.
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