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Four months of exercise rehabilitation improved functional capacity, left atrial and left ventricular diastolic volumes, and quality of life in patients with endomyocardial fibrosis (EMF). In addition, exercise rehabilitation should be prescribed for EMF patients to improve their clinical condition.

Severe acute pancreatitis (AP) is a disease associated with high mortality and characterized by overwhelming systemic inflammation. Older people have a prolonged hospital stay and worst prognosis, when affected by this disease. Our group hypothesized, thus, that the systemic inflammatory response in the elderly would promote more organ damage when compared to the young. We sought to investigate the effect of systemic inflammation on the gene expression of cytokines, chemokines, and growth factors in the hearts of older and younger rats in an animal model of AP. AP was induced in all rats by injection of 0.5 mL of 2.5% taurocholate. There were two healthy age-matched control groups. An array of 79 cytokines, chemokines, and growth factors was measured in samples of cardiac tissue taken from the AP rats after 10 h, and from control rats. Older healthy rats had significantly higher levels of interleukin-10 (IL-10) and CCL1 gene expression than younger ones (P < 0.05), but all other measurements were similar among the study groups. This study indicates the systemic inflammation may show unique features for different organs in the body, but older animals with systemic inflammation are similar to the young regarding the cardiac inflammatory response.

The effect of performing aortic valve repair in combination with valve-sparing operation on the length of time for which patients are free from reoperation is unclear. The objective of this study was to determine if the performance of aortic valve repair during valve-sparing operation modified the freedom from reoperation time.

Endomyocardial fibrosis (EMF) is a disorder in which fibrous, nonfunctional tissue develops in the endocardium, the lining of the heart chambers, which eventually involves the muscles that control the valves regulating blood flow through the heart. Diagnosis is made on the basis of changes in the structure of heart chambers, with a decrease in volume of the ventricles (the pumping chambers of the heart) and restriction of the blood inflow tract. Regurgitation (back flow) of blood through the valves separating the heart chambers is common. EMF is a significant cause of heart dysfunction in many countries. It is unclear whether the fibrosis is an unchanging scar tissue occurring as a consequence of an old inflammation or clot formation, or whether it is an evolving tissue with active deposition. To clarify the process of fibrosis in EMF, 22 patients (18 female) with EMF were studied. Patients were chosen because they needed repeat replacements of heart valves, and this allowed inspection of heart tissue. Re-operations occurred from one to eight years after the first operations. No worsening of fibrosis was found, nor did anatomical features worsen, even in patients with poor function. New fibrotic tissue formation was not found in two patients who died following re-operation. The study suggests that ventricular fibrosis in EMF is a consequence of previously healed disease rather than a continually developing process. (Consumer Summary produced by Reliance Medical Information, Inc.)

Introduction:In the study of heart failure (HF), biomarkers have served as an important tool for diagnostic, therapeutic and prognostic assessment. Their main categories in the area of HF are markers of ventricular dysfunction, inflammation, metabolism, neurohormones, oxidative stress, myocardial injury and extracellular matrix remodeling.Areas covered:Leptin contributes to the modulation of metabolism, respiratory control and inflammation, which are factors associated with cardiovascular disease. Serum levels of leptin in patients with HF have shown conflicting results in previous studies. Most studies have suggested that serum leptin levels may be increased in patients without cachexia. On the other hand, leptin levels are decreased in patients with advanced HF and cardiac cachexia or specific HF etiologies such as Chagas' disease. Other studies have showed that leptin levels were related to exercise intolerance. The only exception of the direct correlation of serum leptin levels with severity of CHF is present in CHF with cardiac cachexia, because patients with cardiac cachexia have plasma leptin concentrations lower than those without cardiac cachexia.Expert opinion:These findings can make leptin an important diagnostic and prognostic marker for HF and be included in routine investigation of patients with HF.

Chagas' disease has spread throughout Latin America because of the high rate of migration among these countries. Approximately 30% of Chagas' patients will develop cardiomyopathy, and 10% of these will develop severe cardiac damage leading to heart failure. Beta-blockade improves symptoms and survival in heart failure patients; however, its efficacy has not been well established in Chagas' disease. We evaluated the role of carvedilol in cardiac remodeling and mortality in a Chagas' cardiomyopathy animal model.

Endocardial fibrous tissue (FT) deposition is a hallmark of endomyocardial fibrosis (EMF). Echocardiography is a first-line and the standard technique for the diagnosis of this disease. Although late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) allows FT characterization, its role in the diagnosis and prognosis of EMF has not been investigated.

Introduction:Chagas disease (CD) is the major cause of morbidity and mortality in many regions of Latin America, and its importance has increased in other regions of the world owing to the global migration phenomenon.Areas covered:This article evaluates the application of heart failure, inflammatory and metabolic biomarkers in the clinical management of CD through a detailed review of the medical literature. Through this, the reader is shown that the identification of biomarkers is necessary not only to improve understanding of the pathophysiology of the disease, but also for prognostic stratification and therapeutic monitoring.Expert opinion:The poor prognosis of CD cardiomyopathy when compared with non-inflammatory cardiomyopathies as well as the lack of effective drugs for its treatment elucidates the need for new diagnostic and therapeutic strategies. The use of biomarkers in CD may allow us to improve the prognosis and target individuals at higher risk who need more intensive and earlier treatment.

Significant hemodynamic changes, including preload and afterload modifications, occur during the transition from the fetal to the neonatal environment. The ductus arteriosus closes, pulmonary vascular resistance decreases, and pulmonary blood flow increases. Strain rate (SR) and strain (ε) have been proposed as ultrasound indices for quantifying regional wall deformation. This study was designed to determine if these indices can detect variations in regional deformation between early and late neonatal periods.

Obesity increases triglyceride levels and decreases high-density lipoprotein concentrations in plasma. Artificial emulsions resembling lipidic plasma lipoprotein structures have been used to evaluate low-density lipoprotein metabolism. In grade III obesity, low density lipoprotein metabolism is poorly understood.

We evaluated the impairment of endothelium-dependent and endothelium-independent coronary blood flow reserve after administration of intracoronary acetylcholine and adenosine, and its association with hypertensive cardiac disease.

We compared left ventricular regional wall motion, the global left ventricular ejection fraction, and the New York Heart Association functional class pre- and postoperatively.

Background: Chagas disease is a significant public health problem in the Americas, despite efforts to decrease the number of new cases since 1990. Etiologic treatment of the disease's chronic phase is still controversial. Objective: We reviewed the strongest studies to evaluate the drugs used in the acute and chronic disease phases, with emphasis on benznidazole. Methods: A Medline search using the keywords ‘Chagas disease’ and ‘treatment,’ with no date limitations, was performed. Results: Study methods in completed trials varied greatly, with none being a randomized, double-blind, placebo-controlled study. The only trial using these methods is still ongoing. The treatment in acute phase is the major indication, but during chronic phase doubts still remain. Conclusion: Only patients in the acute phase of Chagas disease (whatever their age; including children and adolescents) who are treated have good outcomes, although the criteria defining ‘cure’ remain controversial.

Protozoan tropical diseases cause great suffering throughout developing countries, with high rates of morbidity and mortality. American Trypanosomiasis affects 16-18 million people in Latin America, representing a dramatic disease among symptomatic patients. Old, toxic and ineffective chemotherapeutic agents continue to be used for the treatment of Chagas' disease. Since the early days of medicine, chemical substances derived from plants and animals have been used to treat human diseases. In the marine ecosystem ecological pressures, such as competition for space and predation, may have favored several invertebrate organisms to select unique metabolites with an assortment of astonishing biological activities. In terrestrial ecosystems, amphibians present a unique efficient skin secretion system with a variety of glands which produce a myriad of potent bioactive compounds such as peptides, alkaloids, biogenic amines and lipids. Plants contribute with several antitrypanosomal compounds derived mainly from their secondary metabolism. Proteins and peptides from snake venoms have also been considered as novel drug candidates, showing effective activities. In this review, we broadly discuss the epidemiology, pathology, and current treatment of Chagas' disease as well as the contributions of pharmacologically tested marine invertebrate, amphibian, snake and plant compounds which have shown promising antitrypanosomal activities. We also explore these possibilities for developing new chemotherapeutics against Chagas' disease.

BackgroundTreatment for acromegaly decreases left ventricular (LV) mass, but it is not clear whether diastolic dysfunction is also reversible. With Doppler echocardiography, before and after effective therapy, we assessed the LV morphology and function of patients with acromegaly who were free of complications. MethodsIn 15 patients with active acromegaly (age range, 33.4 ± 9.3 years), we compared LV Doppler echocardiographic indices, before and after transsphenoidal surgery or radiotherapy or before and after both procedures, noting a significant drop in plasma levels of growth hormone (<2.0 ng/mL after oral glucose tolerance testing). Patients did not have arterial hypertension, diabetes mellitus, thyroid dysfunction, or coronary artery disease. Occasionally, in this series, patients had no symptoms of heart failure, and patients who underwent treatment with somatostatin analog drugs were not included because they did not have a significant hormonal drop. The follow-up period after hormonal control was 2.7 ± 1.7 years. We also studied 15 healthy control subjects matched for age, sex, and body surface area. ResultsPatients with acromegaly compared with healthy control subjects had increased LV mass index, relative wall thickness, and deteriorated diastolic function. After therapy, most of the abnormalities improved: LV mass index (104 ± 21 g/m2× 87 ± 21 g/m2; P<.01), LV relative wall thickness (0.40 ± 0.06 × 0.35 ± 0.04; P<.01), proto/telediastolic transmitral peak flow velocity ratio (1.17 ± 0.33 × 1.49 ± 0.34; P<.001), and isovolumetric relaxation period (126 ± 18 ms × 113 ± 13 ms; P<.05). ConclusionTreatment of acromegaly in patients without clinical heart failure improves both LV morphology and diastolic function. Avoidance of progression to more advanced forms of acromegalic cardiomyopathy should be possible. (Am Heart J 2002;143:873-6).

One-third of all Trypanosoma cruzi-infected patients eventually develop chronic Chagas' disease cardiomyopathy (CCC), a particularly lethal inflammatory dilated cardiomyopathy, where parasites are scarce and heart-infiltrating mononuclear cells seem to be the effectors of tissue damage. Since T. cruziis a major inducer of interleukin-12 production, the role of inflammatory cytokines in the pathogenesis of CCC was investigated. We assayed cytokine production by peripheral blood mononuclear cells (PBMC) from CCC and asymptomatic T. cruzi-infected (ASY) individuals, as well as by T cell lines from endomyocardial biopsies from CCC patients. PBMC from CCC and ASY patients produced higher IFN-γ levels than normal (N) individuals in response to B13 protein and phytohaemagglutinin PHA; IFN-γ high responders (≥1ng/ml) were 2–3 fold more frequent among CCC patients than ASY individuals. Conversely, IL-4 production in response to the same stimuli was suppressed among T. cruzi-infected patients. The frequency of PHA-induced IFN γproducing cells on PBMC was significantly higher among CCC than ASY and N individuals. IFN-γ and TNF-α were produced by ten out of ten PHAstimulated T cell lines from CCC patients; IL-2 and IL-10 were produced by four out of ten and one out of ten lines, respectively; IL-4, IL-1α, IL-1β, IL-6 and IL-12 were undetectable. Our results suggest that CCC and ASY patients may respond differentially to the IFN-γ-inducing stimulus provided by T. cruziinfection. Given the T1-type cytokine profile of heart-infiltrating T cell lines from CCC patients, the ability to mount a vigorous IFN-γ response may play a role on the differential susceptibility to CCC development.

Endomyocardial fibrosis has been treated surgically for many years. For complete removal of fibrosis from both ventricles by the classic technique, each atrioventricular (AV) valve was removed and replaced with a prosthesis. Relapse of endomyocardial fibrosis has not been observed after surgical correction. Reoperations have been carried out because of complications of valve prostheses.

To evaluate the effects of sympathectomy on the myocardium in an experimental model.

Introduction:Chagas disease (CD) is an endemic infectious disease that still remains a great economic burden. Three-dimensional speckle tracking (3D STE) may play a role in the evaluation of CD. We assessed the hypothesis that 3D STE may predict clinical events in patients with CD.Methods:This was a convenience sample. Eight hundred and eight patients with CD were evaluated but only seventy-two were included. Patients with any systemic disease were excluded. Clinical, electrocardiographic and comprehensive conventional and 3D echocardiography were performed. Patients were followed up for thirty-six up to sixty months. Clinical events were defined as hospitalization for heart failure, ventricular arrhythmias and cardiovascular death.Results:Seventy-two patients were enrolled in three groups: Group 1 (G1), patients with left ventricular ejection fraction (LVEF) < 0.35 (N=22); Group 2 (G2), LVEF between 0.35 and 0.55 (N=22); Group 3 (G3), normal LVEF (N=28). Gender distribution, mean age, anthropometric variables and risk factors were similar between the groups. 2D STE feasibility was 99.5, 99 and 100% in G1, G2 and G3. 3D Longitudinal strain feasibility was 93, 89 e 88% in G1, G2 and G3. Interobserver and intraobserver variabilities (Blant-Altman) for longitudinal (2D and 3D GLS), circumferential (3D GCS), radial (3D GRS) and area strain (3D AS) are displayed in Table 1. Hospitalization was related do indexed 2D left atrium volume (p = 0,03) in G1. In G2, non-sustained ventricular tachycardia were related to 2D GLS (p = 0,04); all clinical events were related do diastolic function (p = 0,30). In G1 and G2, hospitalization was related do indexed 2D left atrium volume (p = 0,01); all clinical events were related do diastolic function (p = 0,004) and 3D LVEF (p = 0,02). 3D STE parameters were not related to clinical events.Conclusions:In conclusion, 3D STE in patients with CD appears to be an accurate, reproducible and promising method but was not related to clinical events.

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