2001;76(5)

Ponto de Vista

A medicina baseada nos brasileiros

Paulo Andrade Lotufo

Ponto de Vista

A Medicina Baseada nos Brasileiros

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Original Article

Characteristics associated with the dropout of hypertensive patients followed up in an outpatient referral clinic

Renné Gusmão Busnello et al. Raquel Melchior Carlo Faccin Daniela Vettori … Juliano Petter Leila Beltrami Moreira Flávio Danni Fuchs

OBJECTIVE: To determine the characteristics associated with the dropout of patients followed up in a Brazilian out patient clinic specializing in hypertension. METHODS: Planned prospective cohort study of patients who were prescribed an antihypertensive treatment after an extensive initial evaluation. The following parameters were analyzed: sex, age, educational level, duration of disease, pressure level used for classifying the patient, previous treatment, physical activity, smoking, alcohol consumption, familial history of hypertension, and lesion in a target organ. RESULTS: We studied 945 hypertensive patients, 533 (56%) of whom dropped out of the follow-up. The mean age was 52.3±12.9 years. The highest probabilities of dropout of the follow-up were associated with current smoking, relative risk of 1.46 (1.04-2.06); educational level equal to or below 5 years of schooling, relative risk of 1.52 (1.11-2.08); and hypertension duration below 5 years, relative risk of 1.78 (1.28-2.48). Age increase was associated with a higher probability of follow-up with a relative risk of 0.98 (0.97-0.99). CONCLUSION: We identified a group at risk for dropping out the follow-up, which comprised patients with a lower educational level, a recent diagnosis of hypertension, and who were smokers. We think that measures assuring adherence to treatment should be directed to this group of patients.

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Original Article

Plasma levels of immunoinflammatory markers in De Novo coronary atherosclerosis and coronary restenosis postangioplasty

Alexandre Schaan de Quadros et al. Jorge Pinto Ribeiro Waldomiro Carlos Manfroi Cristiane Leitão … Karen Ordovás Letícia Weiss Nadine Clausell

OBJECTIVE: To compare circulating plasma levels of immunoinflammatory markers in patients with known de novo coronary artery disease and patients with postangioplasty restenosis. METHODS: Using enzymatic immunoabsorbent assay, we measured plasma levels of soluble interleukin-2 receptosr, tumor necrosis factor alpha, and soluble tumor necrosis alpha receptors I and II in 11 patients with restenosis postcoronary angioplasty (restenosis group), in 10 patients with primary atherosclerosis (de novo group) who were referred for coronary angiography because of stable or unstable angina, and in 9 healthy volunteers (control group). Levels of soluble interleukin-2 receptors were significantly higher in the de novo group compared with that in the restenosis and control groups. Levels were also higher in the restenosis group compared with that in the control group. Plasma levels of tumor necrosis alpha and receptor levels were significantly higher in the de novo group compared to with that in the restenosis and control groups, but levels in the restenosis group were not different from that in the controls. CONCLUSION: Coronary artery disease, either primary or secondary to restenosis, is associated with significant immunoinflammatory activity, which can be assessed by examining the extent of circulating plasma levels of inflammatory markers. Moreover, patients with de novo lesions appear to have increased inflammatory activity compared with patients with restenosis.

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Updated

Congenital heart disease in adults. Considerations about evolution, natural and in operated patients

Edmar Atik et al. Fernando Antibas Atik

Update

Congenital Heart Disease in Adults. Considerations about Evolution, Natural and in Operated Patients

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Original Article

Transradial approach for coronary interventions

José Carlos Brito et al. Antônio Azevedo Júnior Adriano Oliveira Roberto Von Sohsten … Ademar Santos Filho Heitor Carvalho

OBJECTIVE: To assess the feasibility and safety of coronary interventions performed through the radial artery. METHODS: We studied 103 patients with ages from 38 to 86 years (57±8.7), 90 (87%) males, and: radial pulse with a good amplitude, presence of ulnar pulse, a good collateral flow through the palmar arch assessed with the Allen’s test. RESULTS: The vascular approach was obtained in 97 (94%) patients, 88 (91%) treated electively and 9 (9%) during acute myocardial infarction, for primary angioplasty; 56 (64%) unstable angina; 22 (25%) stable angina; 10 (11%) were asymptomatic, 6 referred for recanalization of chronic occlusion and 4 silent ischemia in the first week after acute myocardial infarction. We approached 107 arteries: anterior descending artery, 49 (46%); right coronary artery, 27 (25%); circumflex artery, 25 (23%); diagonal artery, 6 (6%); and 2 saphenous vein bypass grafts. We treated 129 lesions: 80 (62%) B2 type; 23 (18%) B1 type; 17 (13%) C type; and 9 (7%). A type. There were 70 stents , and 59 balloon angioplasties performed. Thirty-two (33%) patients used GP IIb/IIIa inhibitors. The mean duration of the elective procedure was 42.3±12.8 min. Success, correct stent deployment and residual lesion <20%, was reached in 100% of the lesions treated with stent implantation; arterial dilation with residual lesion <50% was obtained in 96% of the lesions treated with transluminal coronary angioplasty (TCA). Complications, were: 1 (1.0%) non-Q-wave acute myocardial infarction; 2 (2%) hematomas in the forearm; and 2 losses of radial pulse. CONCLUSION: Radial artery aproach is practical and safe for percutaneous coronary interventions there was a low incidence of complications.

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Point of view

How much do we pay for a benefit? A descriptive cost analysis of the use of statins. The need for a national cost-effectiveness analysis

José Luiz da Costa Vieira et al. Vera Lúcia Portal Emílio H. Moriguchi

Point of View

How much do we pay for a benefit? A Descriptive Cost Analysis of the Use of Statins. The Need for a National Cost-Effectiveness Analysis

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Case Report

Cholesterol pericarditis. A specific but rare cause of pericardial disease

Fábio Fernandes et al. Glacy Sabra Vieira Edmundo Arteaga Barbara Maria Ianni … Paulo Pêgo- Fernandes Charles Mady

During a diagnostic investigation in a 40-year-old male with pericardial effusion associated with hypothyroidism, cholesterol pericarditis was detected. We report a brief review on the etiopathogeny, clinical findings, and therapeutical possibilities of this entity.

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Correlação Clínico-Radiográfica

Edmar Atik

Correlação Clínico-Radiográfica

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Case Report

Histoplasmosis as a late infectious complication following heart transplantation in a patient with Chagas' disease

Fernando Bacal et al. Ana Cristina Magalhães Andrade Bruno Cupertino Migueletto Edimar Alcides Bocchi … Noedir A. G. Stolf Alfredo Inácio Fiorelli Tânia Mara V. Strabelli Luis Alberto Benvenuti Carlos Manuel Brandão Giovanni Bellotti José Antônio Franchini Ramires

Infectious complications following heart transplantation are an important cause of morbidity and mortality. Generally, bacterial infections are predominant; however, fungal infections can be responsible for up to 25% of infectious events. We report the case of a patient who presented with histoplasmosis as an infectious complication five years after heart transplantation due to a chagasic cardiopathy. This association has rarely been reported in the international literature.

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Original Article

Distribution of cardiac geometric patterns on echocardiography in essential hypertension. Impact of two criteria of stratification

Eduardo Cantoni Rosa et al. Valdir Ambrósio Moisés Ricardo Cintra Sesso Nárcia E. B. Kohlmann … Frida Liane Plavnik Maria Teresa Zanella Artur Beltrame Ribeiro Osvaldo Kohlmann Júnior

PURPOSE: To evaluate 2 left ventricular mass index (LVMI) normality criteria for the prevalence of left ventricular geometric patterns in a hypertensive population ( HT ) . METHODS: 544 essential hypertensive patients, were evaluated by echocardiography, and different left ventricular hypertrophy criteria were applied: 1 – classic : men – 134 g/m² and women – 110 g/m² ; 2- obtained from the 95th percentil of LVMI from a normotensive population (NT). RESULTS: The prevalence of 4 left ventricular geometric patterns, respectively for criteria 1 and 2, were: normal geometry – 47.7% and 39.3%; concentric remodelying – 25.4% and 14.3%; concentric hypertrophy – 18.4% and 27.7% and excentric hypertrophy – 8.8% and 16.7%, which confered abnormal geometry to 52.6% and 60.7% of hypertensive. The comparative analysis between NT and normal geometry hypertensive group according to criteria 1, detected significative stuctural differences,”( *p < 0.05):LVMI- 78.4 ± 1.50 vs 85.9 ±0.95 g/m² *; posterior wall thickness -8.5 ± 0.1 vs 8.9 ± 0.05 mm*; left atrium – 33.3 ± 0.41 vs 34.7 ± 0.30 mm *. With criteria 2, significative structural differences between the 2 groups were not observed. CONCLUSION: The use of a reference population based criteria, increased the abnormal left ventricular geometry prevalence in hypertensive patients and seemed more appropriate for left ventricular hypertrophy detection and risk stratification.

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Case Report

Submitral left ventricular aneurysm. Case report and review of published Brazilian cases

Paulo José de Freitas Ribeiro et al. Rosana G. G. Mendes Walter Vilella de A. Vicente Antonio Carlos Menardi Paulo Roberto Barbosa Evora

Submitral left ventricular aneurysm is a cardiac pathology widely recognized, but relatively unknown, occurred almost exclusively in African black patients. Although still this idea of racial prevalence exists, cases have been described in patients of all the races. Ten Brazilian cases were reported. One of them was presented inside an Italian paper that refers the surgical treatment of a Brazilian patient of black race. We reported one more submitral left ventricular aneurysm case in a brown female patient, with antecedents of peripheral thromboembolism initially not identified as consequence of the cardiac pathology.

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