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Biomedical subjects

José L Andrade

Publications and source records attributed to José L Andrade.

13 recordsLinked to original sources
PubMed2006

Left ventricular function after exercise training in young men.

The effects of endurance training have been extensively studied in athletes, but longitudinal studies of exercise-induced cardiac changes in normal patients are limited. To assess the effects of 6 months of moderate-intensity aerobic training (1 hour/day, 3 times/week) on normal hearts, 23 sedentary men aged 31.1 +/- 3.5 years were studied by standard and tissue Doppler echocardiography. Left ventricular (LV) systolic function was assessed by the ejection fraction and Doppler-measured stroke volume, and diastolic function was assessed by transmitral and pulmonary venous flow. Tissue Doppler systolic (Sm), early (Em), and late (Am) myocardial velocities were obtained at the septal and lateral mitral annulus. After training, there was a 14.5% increase in peak oxygen consumption (p = 0.000002) and a decrease in heart rate (60 +/- 7 to 56 +/- 8 beats/min, p = 0.01). Septal and posterior wall thickness increased (8.7 +/- 1.0 to 9.4 +/- 1.3 mm, p = 0.002, and 8.2 +/- 0.7 to 8.8 +/- 1.1 mm, p = 0.0009, respectively), with a 15% increase in LV mass index (p = 0.0002). LV diameters, stroke volumes, and ejection fractions were unchanged. Mitral inflow showed a decrease in late-wave velocity (p = 0.00004), thus increasing the early (E)/A ratio. Septal and lateral Sm (p = 0.02) and Em velocities (p <0.05) increased after training. In conclusion, the physiologic increase in LV mass in response to regular exercise in healthy young men occurs in parallel with a decrease in atrial contribution to flow. LV function estimated by tissue Doppler is improved despite the lack of changes in standard echocardiographic indexes.

Adult↗
PubMed2005

Noninvasive detection of coronary allograft vasculopathy by myocardial contrast echocardiography.

BACKGROUND: Noninvasive detection of coronary allograft vasculopathy is still challenging. To determine the accuracy of myocardial contrast echocardiography (MCE) in detecting coronary allograft vasculopathy after heart transplantation, we studied 35 asymptomatic patients (30 men, aged 46 +/- 12.7 years) with normal left ventricular function. METHODS: Patients underwent MCE with continuous contrast (perfluorocarbon-exposed sonicated dextrose albumin) administration. Images were obtained at baseline and during peak dobutamine (up to 40 mg/kg/min) with intermittent harmonic imaging. Areas failing to increase contrast enhancement during peak stress were regarded as abnormal. Coronary artery obstructions greater than 50% at angiography were considered significant. RESULTS: Seven out of 10 patients with coronary artery disease had a positive MCE and one patient with a positive MCE had no angiographically detected disease (sensitivity = 70%, specificity = 96%, accuracy = 88.6%). Agreement between the vascular territory and perfusion defects was good for the left anterior descending coronary artery (kappa = 0.56), but not for other arteries. Although 5 patients had multivessel disease, multiple perfusion defects were detected in only one patient. CONCLUSION: MCE showed good accuracy in detecting the presence of coronary allograft vasculopathy after heart transplantation; however, it failed to identify the extent of the disease.

Adolescent↗
PubMed2005

Contrast echocardiography can save nondiagnostic exams in mechanically ventilated patients.

Patients in an intensive care unit (ICU) under mechanical ventilation (MV) are very difficult to image by transthoracic echocardiography, diminishing the beneficial information that could be obtained by this noninvasive approach. The objective of this study is to assess whether the addition of a contrast agent to fundamental imaging (FI) can improve or change the initial diagnosis in cardiac postoperative patients under mechanical ventilation by enhancing endocardial border delineation and Doppler flow signal. Thirty mechanically ventilated post-cardiac surgery patients (20 men, mean age 61 +/- 13 years) were evaluated with FI before and after intravenous injection of contrast. Left ventricular endocardial border delineation score index (EBDSI), estimated left ventricular ejection fraction (LVEF), and color and spectral Doppler were analyzed. The use of contrast resulted in a significant increase in the number of well-delineated segments, with a salvage rate of 77% of nondiagnostic studies. EBDSI was 1.62 +/- 0.61, before contrast, increasing to 2.05 +/- 0.53 after it (P < 0.001). There was a change in the LVEF estimation in 5 exams, and a new wall motion abnormality was detected in other 4 exams, after the use of contrast. Moreover, a significant change was observed in the quantification of mitral regurgitation in 5 patients, in the aortic transvalvular peak gradient in 1 patient, and measurement of tricuspid regurgitation peak flow velocity in 8 patients. It is concluded that in cardiac postoperative patients under mechanical ventilation, intravenous injection of a contrast agent using FI resulted in a high salvage rate of studies and changed the initial diagnosis in a significant number of patients.

Albumins↗
PubMed2004

Comparison of safety and efficacy of the early injection of atropine during dobutamine stress echocardiography with the conventional protocol.

Although dobutamine-atropine stress echocardiography (DASE) is an established method for evaluating patients who have coronary artery disease (CAD), it can increase test duration and a patient's exposure to large doses of dobutamine. New protocols, including the early injection of atropine during dobutamine stress echocardiography (EA-DSE), have been proposed to decrease test duration. This study compared the safety, efficacy, and accuracy of EA-DSE with those of DASE. We retrospectively evaluated 3,163 patients who underwent DASE and 1,664 patients who underwent EA-DSE over a period of 12 years. In EA-DSE, atropine at a dose </=2 mg was started with 20 microg/kg/min of dobutamine if heart rate was <100 beats/min. Diagnostic accuracy for detecting CAD (>50% stenosis) was assessed in patients who underwent quantitative angiography </=3 months of stress testing. The dobutamine dose used in EA-DSE was smaller than that used in DASE (31 +/- 6 vs 36 +/- 6 microg/kg/min, p <0.0001), although the atropine dose was larger (0.8 +/- 0.5 vs 0.5 +/- 0.25 mg, p <0.0001). EA-DSE resulted in a significantly shorter duration of dobutamine infusion (12.4 +/- 2.0 vs 14.6 +/- 2.5 minutes, p <0.0001), more diagnostic studies (88% vs 81%, p <0.0001), and a lower incidence of minor adverse effects than did DASE. The rate of major adverse effects was similar in the 2 protocols. Sensitivities, specificities, positive predictive values, negative predictive values, and accuracies for detecting CAD were 84%, 90%, 93%, 76%, and 86% for EA-DSE and 86%, 78%, 84%, 79%, and 82% for DASE, respectively (p = NS). Therefore, EA-DSE is a safe and effective alternative to DASE and had a similar accuracy for the detection of CAD.

Aged↗
PubMed2004

[Left atrial myxoma: three-dimensional echocardiographic assessment].

The patient was a 70-year-old female with antecedents of diabetes mellitus and hypertension, being followed up in the outpatient care clinic due to chronic anemia after corrective surgery for angiodysplasia of the proximal jejunum, in whom an image suggestive of left atrial myxoma was found on routine transthoracic echocardiography. Then multiplanar transesophageal echocardiography and 3-dimensional echocardiography were performed, showing the latter better anatomical details of the tumor. The patient underwent exeresis of the mass with anatomicopathological confirmation of the tumor. Three-dimensional echocardiography proved to be a technique that can provide additional contributions to the diagnostic investigation of structural heart diseases.

Aged↗
PubMed2004

Value of myocardial contrast echocardiography for predicting left ventricular remodeling and segmental functional recovery after anterior wall acute myocardial infarction.

OBJECTIVE: We sought to study the value of microvascular perfusion assessed by myocardial contrast echocardiography in predicting left ventricular remodeling after anterior wall acute myocardial infarction. METHODS: In 31 patients myocardial contrast echocardiography was performed up to 48 hours after acute myocardial infarction with determination of end-diastolic and end-systolic volumes, wall-motion score index, and myocardial perfusion score index (MPSI) at rest and under dobutamine stress at 6 months. Patients were classified into remodeling group (RG) (n = 19) and non-RG (n = 12), and, according to number of segments without opacification, reflow (< or =2 segments, n = 15) and no-reflow (>2 segments, n = 16) groups. RESULTS: Wall-motion score index (1.84 +/- 0.22 vs 1.64 +/- 0.3; P =.049), MPSI (1.53 +/- 0.25 vs 1.26 +/- 0.17; P =.006), and number of segments without contrast (3.11 +/- 2.23 vs 1.08 +/- 1.38; P =.018) were higher in RG than in non-RG. End-diastolic and end-systolic volumes, and wall-motion score index, increased significantly in RG at 6 months and decreased in non-RG. MPSI increased in RG (1.53 +/- 0.25-1.66 +/- 0.21; P =.011) and was the only independent predictor of left ventricular remodeling (odds ratio = 1.8; 95% confidence interval = 1.15-2.82; P =.010). No-reflow group presented 27.8 +/- 19.9% of segments with resting functional recovery or contractile reserve, and reflow group presented 69.9 +/- 31.2% (P <.001). CONCLUSION: MPSI obtained 48 hours after acute myocardial infarction is an independent predictor of left ventricular remodeling. Patients with two or fewer segments without opacification revealed a better prognosis of resting ventricular function and contractile reserve.

Acute Disease↗
PubMed2004

Doppler flow evaluation can anticipate abnormal left lung perfusion after transcatheter closure of patent ductus arteriosus.

AIMS: Coil protrusion into the left pulmonary artery (LPA) has been described after transcatheter closure of the patent ductus arteriosus (PDA). The possible impact of such a finding in lung perfusion has not been completely clarified. We evaluated Doppler flow velocities and lung perfusion in patients submitted to that procedure. METHODS: After transcatheter closure of PDA with coils, 70 patients (mean age 8.6+/-3.4 years) were followed for a period of 3.6+/-0.9 years (range 2.1-5.9) and compared to 22 controls. Peak flow velocities and coil protrusion were assessed by Doppler echocardiography. A Doppler velocity index (DVI) was calculated by the difference between the LPA and right pulmonary artery (RPA) peak flow velocities relative to the pulmonary trunk (PT) expressed in percentage, as follows: DVI=(LPA velocity - RPA velocity)/PT velocity x 100. Lung scintigraphy was performed using (99m)Tc-labelled macro-aggregated albumin. RESULTS: Device protrusion was observed in 94% of the patients, 10% of whom presented abnormal left lung perfusion. Peak LPA velocity and DVI were significantly greater in patients (p=0.001) and correlated negatively with left lung perfusion values (R(2)=0.21 and R(2)=0.65, respectively). A cut-off value of 50% for the DVI showed high sensitivity and specificity for reduced lung perfusion. CONCLUSION: Impaired left lung perfusion may appear following transcatheter closure of PDA with coils and the determination of DVI may anticipate such alteration.

Adolescent↗
PubMed2003

Anticancer activity of phenolic acids of natural or synthetic origin: a structure-activity study.

Several phenolic acids-caffeic and gallic acid derivatives-were synthesized and screened for their potential antiproliferative and cytotoxic properties, in different human cancer cell lines: mammary gland and cervix adenocarcinomas and lymphoblastic leukemia. The selected phenols were structurally related, which allowed us to gather important information regarding the structure-activity relationships underlying the biological activity of such compounds. This is proposed to be due to a balance between the antioxidant and pro-oxidant properties of this kind of agent. Distinct effects were found for different cell lines, which points to a significant specificity of action of the drugs tested. It was verified, for the types of cancer investigated, that the trihydroxylated derivatives yielded better results than the dihydroxylated ones. Tests in noncancerous cells, human lung fibroblasts, were also undertaken, in view of determining the toxic side effects of the compounds studied.

Adenocarcinoma↗
PubMed2003

Value of rapid beta-blocker injection at peak dobutamine-atropine stress echocardiography for detection of coronary artery disease.

OBJECTIVES: We studied the value of a rapid beta-blocker injection at peak dobutamine-atropine stress echocardiography (DASE) for the detection of coronary artery disease (CAD). BACKGROUND: The presence of tachycardia and hyperdynamic wall motion may make it difficult to recognize a new wall motion abnormality (NWMA) at peak stress. METHODS: We studied 101 patients (mean age 58.2 +/- 9.8 years) who underwent effective DASE and coronary angiography. All patients received a rapid intravenous injection of metoprolol immediately after peak DASE image acquisition. Positivity in combined peak plus post-metoprolol images was defined when there was only peak NWMA, maintenance of peak NWMA, or NWMA detected only after metoprolol injection. Significant CAD was defined as >or=50% stenosis by quantitative angiography. RESULTS: There were 37 patients without and 64 with CAD. The sensitivity, specificity, accuracy, and positive and negative predictive values for the detection of CAD at peak stress were 84%, 92%, 87%, 95%, and 77%, respectively. Five patients with CAD had negative peak images that became positive only after metoprolol. Extension of peak NWMA during metoprolol was observed in 14 patients, and multivessel CAD was detected in 10 of them. The sensitivity, specificity, accuracy, and positive and negative predictive values for peak plus metoprolol images were 92%, 89%, 91%, 94%, and 87%, respectively. CONCLUSIONS: The use of metoprolol injected at peak of dobutamine infusion improved the detection of CAD by DASE.

Adrenergic beta-Antagonists↗
PubMed2002

Endocardial border delineation during dobutamine infusion using contrast echocardiography.

BACKGROUND: A significant percentage of pharmacologic stress echocardiograms produce suboptimal images despite the use of second harmonic imaging. Intravenous continuous infusion of myocardial ultrasound contrast may enhance endocardial border delineation during dobutamine-atropine stress echocardiography (DASE), improving wall-motion analysis. PATIENTS AND METHODS: We prospectively studied 68 patients (41 males and 27 females), mean age 58 years, with DASE during intravenous infusion of contrast using second harmonic imaging. Dobutamine was infused in scalar doses of 5 microg/kg/min to 40 microg/kg/min, and atropine was administered in doses of up to 1 mg. We diluted 0.1 mL of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) microbubbles into 80 mL of saline solution, which was used for continuous intravenous infusion. Blinded reviewers used a 16-segment model at rest and peak DASE to analyze segmental wall delineation in two sets of images for each patient, with and without contrast. An endocardial delineation score of 0-3 (nondelineated to excellent delineation) was given to each segment. An endocardial delineation score index (EDSI), the number of endocardial delineation scores for each set of images divided by 16, was created. RESULTS: The analysis of the mean EDSI for the 2176 segments was 1.46 (+/- 0.43) at rest and 1.30 (+/- 0.48) at peak for noncontrast images and 2.22 (+/- 0.52) and 2.29 (+/- 0.52) for contrast images. Complete left ventricle opacification was obtained in all patients, with a mean dose of 4 mL/min, although in 15 (22%) patients, signs of apical bubble destruction occurred. There were 1768 (81%) of 2176 segments delineated without contrast enhancement and 2057 (95%) of 2176 with enhancement (P < 0.05). CONCLUSION: Continuous infusion of myocardial ultrasound contrast improves endocardial border delineation using second harmonic imaging in patients undergoing DASE.

Adult↗