systematic review

IJCS

Original Article

Evaluation of Cardiovascular Risks Associated with Calcium Use: A Systematic Review and Meta-Analysis

Paulo Henrique Gouveia et al. Joyce da Silva Guimarães Astrid Wiens

Abstract

Background

Calcium plays vital roles in both physiological and pathological processes, and its use as a therapeutic agent is primarily indicated for osteoporosis and osteopenia. It may increase cardiovascular risk, thereby increasing cardiovascular morbidity and mortality.

Objective

To synthesize the available evidence on cardiovascular risks in patients using calcium-based medications and supplements.

Methods

This systematic review and meta-analysis utilized three major international databases and included intervention studies and comparative observational studies with data on the intake of calcium-based medications or supplements in adult populations and associated cardiovascular outcomes. A p-value < 0.05 was considered for all analyses, and the certainty of evidence was assessed using the GRADE approach.

Results

A total of fourteen articles were included: three pivotal intervention studies, four post hoc analyses, and seven observational studies. The outcomes assessed were mortality from cardiovascular events, myocardial infarction, stroke, and coronary artery disease. Although an increased incidence of coronary artery disease was observed among users of calcium-based medications or supplements when considering only observational studies (RR 1.08; 95% CI 1.02–1.15), this finding was not confirmed in interventional studies. Therefore, further investigation is warranted. No increased risk of cardiovascular mortality, myocardial infarction, or stroke was observed. The quality of the evidence was considered low or very low for all outcomes due to the risk of bias and limitations inherent to the meta-analyses themselves.

Conclusions

Caution is recommended when interpreting the results, particularly in the development of clinical protocols. The importance of pharmacotherapeutic monitoring for patients using these medications is emphasized, and further research to explore additional outcomes is suggested.

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Editorial

The Growing Role of Simulation-Based Learning in Cardiology Education

Diandro Marinho Mota et al. Fabiano Barcellos Filho

Introduction

Simulation-based learning has emerged as a cornerstone in modern medical education, offering a safe and controlled environment for trainees to acquire and refine complex clinical skills.^– This pedagogical approach is particularly pertinent in dynamic and high-stakes specialties such as cardiology, where precision, rapid decision-making, and technical proficiency are paramount. The systematic review by Silva, Souza, and Santos titled “The Use of Simulation-Based Learning in Cardiology Education: A Systematic Review” provides a comprehensive overview of the current evidence supporting the integration of simulation into cardiology curricula. This mini-editorial aims to reflect on the significant contributions of this review and to articulate the journal’s perspective on the evolving landscape of simulation in cardiovascular education.

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Original Article

Adherence and Quality of Life in Non-Valvular Atrial Fibrillation With Direct Oral Anticoagulants Versus Vitamin K Antagonists: A Systematic Review

Vanelise Zortea et al. Karine Duarte Curvello Diogo Pilger Antonios Douros … Lisiane Freitas Leal Tatiana da Silva Sempé Tatiane da Silva Dal Pizzol

Abstract

Background

Direct anticoagulants (DOACs) and vitamin K antagonists (VKAs) differ in pharmacokinetic characteristics, intensity of required laboratory monitoring, and costs. These differences could affect patients’ adherence to treatment and quality of life (QoL).

Objective

To assess whether patients with non-valvular atrial fibrillation (AF) using DOACs have better treatment adherence and QoL when compared to patients using VKAs.

Methods

We conducted a systematic review in Medline, Embase, LILACS, SciELO, CINAHL, and Cochrane Central, until June 9, 2021. We included studies that estimated and compared treatment adherence and QoL between DOACs and VKAs in adults with non-valvular AF. The methodological quality of the studies was assessed using the Joanna Briggs Institute (JBI) tools. The protocol was registered in the PROSPERO (CRD 42020165238).

Results

Sixteen studies, including 122,458 patients with non-valvular AF, evaluated adherence, and eleven studies, including 5,687 patients, assessed QoL. A variety of methods was used to measure adherence. Eleven studies showed no difference in adherence between DOACs and VKAs, while three studies favored VKAs over DOACs and two studies favored DOACs over VKAs. QoL was measured by specific (n = 3) or generic questionnaires (n = 8); results favored DOACs over VKAs in four studies, while in the other seven studies the results showed no difference between the groups. Meta-analyses were not performed due to high methodological heterogeneity among studies.

Conclusions

Available evidence regarding treatment adherence and QoL with DOACs and VKAs is characterized by methodological heterogeneity and conflicting findings.

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Original Article

General Approach to Acute Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Systematic Review

Marcos Aurélio Barboza de Oliveira et al. Alan Vinicius Gamero Ósti Bruno Vargas Teixeira Cavalheiro Déborah Barbosa Naves … Emanuelle Ribeiro de Oliveira Gabriel Freitas de Campos Gabriel Mael Sussuarana Silva Lobo Gabriely de Oliveira Marcela Paula Mainardi Marília Cardoso Guimarães Robert Filipe Barbosa Vilian Veloso de Moura Fé

Abstract

Background

Acute myocardial infarction (AMI) without obstructive coronary arteries (MINOCA) is a medical condition of great relevance, with clinical characteristics of AMI, but without evidence of coronary artery obstruction. The mechanism involved in the pathophysiology of the disease and its possible etiologies are important objects of study due to their impact on the morbidity and mortality of affected patients.

Objectives

The aim of this study was to systematically review MINOCA and its characteristics, with emphasis on the clinical profile of patients, etiology, pathophysiology, diagnosis, and treatment of the syndrome.

Methods

Relevant articles related to MINOCA were analyzed in the PubMed and LILACS databases. In the initial search stage, 619 eligible articles were obtained, with final inclusion criteria being: original systematic reviews with clinical, epidemiological, diagnostic, or treatment data on MINOCA, published in Portuguese or English, with an abstract, and a publication date limit of September 2020.

Results

A total of 10 articles classified as systematic reviews that considered clinical data on MINOCA were included in this review.

Conclusion

After analyzing various literature, the present study provided a tool to better understand MINOCA, not only regarding its casuistry but also in grouping parameters and information that contribute to a healthy approach to this clinical situation. It was possible to identify and better outline the clinical profile of patients who presented this condition and the use of appropriate tools for correct diagnosis and ideal treatment.

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Original Article

Covid-19 and Heart Involvement: A Systematic Review of Literature

Francisco Cezar Aquino de Moraes et al. Rafael Reis do Espírito Santos Joel Campos de Moraes Aline Carolina Castro Mota … Fernando Rocha Pessoa Dayanne Coutinho Sarges Davi Alexandrino Moraes Dilma do Socorro Moraes de Souza

Abstract

Background

Recent reports in the literature have indicated that infection by coronavirus disease 2019 (COVID-19) causes cardiac complications, such as heart failure, arrhythmia, myocardial infarction, and even fulminant myocarditis. These complications have been identified as the cause of death in some patients infected with SARS-CoV-2.

Objectives

To analyze echocardiographic and electrocardiographic changes, treatments used, and clinical outcomes in patients with myocarditis and COVID-19.

Methods

The items described for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed. This review included articles in English, Portuguese, and Spanish that reported cardiac involvement, injury, or myocardial inflammation in patients who acquired COVID-19 (SARS-CoV-2).

Results

Five databases were consulted to find 1,726 articles. After applying the eligibility criteria, a total of 22 studies were considered qualified. ST-segment (section of the electrocardiogram corresponding the end of the S wave to the beginning of the T wave) elevation and tachyarrhythmia were the most common changes found in the electrocardiographic analysis of patients affected with COVID-19. Concerning echocardiography, there was a high frequency of decreased ejection fraction and occurrence of pericardial effusion.

Conclusion

This systematic review provides a potential tool for the analysis of cardiac changes and implications caused in patients affected by SARS-CoV-2 infection, with emphasis on the presence of tachyarrhythmia on electrocardiogram (ECG) and decreased ejection fraction on echocardiogram.

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Original Article

Efficacy and Risks of Therapeutic Hypothermia after Pediatric Cardiac Arrest: A Systematic Review

Anna Luíza Machado Nogueira et al. Ana Luísa dos Santos Maciel Amanda Campos Querubino Roberta Teixeira Prado Jussara Regina Martins

Abstract

Background:

Therapeutic hypothermia is used in adults and neonates after cardiac arrest, but its efficiency in children under 18 years old is still uncertain.

Objective:

To evaluate the effectiveness and risks of therapeutic hypothermia after cardiac arrest in children under 18 years of age through a systematic review.

Methods:

A systematic review was performed in January 2022 in the MEDLINE, SciELO, Cochrane, and LILACS databases. Inclusion criteria: randomized controlled trials (RCTs) performed in humans. Articles from other typologies, published more than 10 years ago, or with volunteers over 18 years old were excluded.

Results:

Four studies were identified, of which 3 were analyzed; all of them were of moderate quality according to the Jadad Scale and the Cochrane Collaboration tool. The studies indicated that lowering the temperature did not improve data on mortality and adverse events. Two studies did not identify statistically significant differences (p > 0.05) considering hypothermia in relation to normothermia in terms of survival, safety, and global neurobehavioral and cognitive function. The other study did not show improved serum biomarker concentrations.

Conclusion:

The results found in this review do not support the use of therapeutic hypothermia after pediatric cardiac arrest, as this intervention did not provide any apparent benefits in terms of safety, adverse events, survival, and neurological impact. We recommend the conduction of new RCTs using the measurement of serum biomarkers to better evaluate the effectiveness of the intervention.

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Original Article

Accuracy of Self-Reported Arterial Hypertension in Brazil: Systematic Review and Meta-Analysis

Jessica Pronestino de Lima Moreira et al. Renan Moritz Varnier Rodrigues de Almeida Ronir Raggio Luiz

Abstract

Background

Self-reported hypertension is a useful method to estimate prevalence in the population. However, it is necessary to evaluate its accuracy, in relation to the gold-standard diagnostic methods of the disease.

Objectives

To estimate combined measures of sensitivity and specificity for self-reported hypertension, using Brazilian validation studies that included gold standard methods.

Methods

A systematic review and a meta-analysis were developed. Two independent examiners evaluated 1389 and read 113 potentially eligible articles. Since self-reported morbidity is influenced by the cultural and economic characteristics of a population, as well as by its accessibility to medical care, only studies from one country (Brazil) were included. First, a qualitative analysis was performed, evaluating the relationship between self-reported hypertension and its measurement through gold-standard methods. Subsequently, a meta-analysis estimated the combined sensitivity and specificity for the included studies. Due to a high heterogeneity among studies, the meta-analysis used a random effects model. Bias risks were evaluated by the QUADAS-2 protocol and the standard significance level of 10% was used in all modelling.

Results

Five studies were included in the qualitative analysis; and four had the necessary information for inclusion in the meta-analysis. Patient selection and Index Test (the question allowing for self-reporting) were the domains with the highest risk of bias. In the meta-analysis, combined sensitivity and specificity were 77%(95%CI:[74.5-79.0%]) and 88%(95%CI:[86.3-88.6%]), respectively.

Conclusions

The analysed studies allowed for the estimation of more reliable values for combined sensitivity and specificity. These values were higher than those usually found in studies with greater population heterogeneity.

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Review Article

Aromatherapy in Patients with Cardiovascular Diseases: A Systematic Review

Lissandra de Souza Lopes et al. Daiana Bündchen Felipe Cardozo Modesto Monica Quintão … Sergio Chermont Ana Carla Dantas Cavalcanti Evandro Tinoco Mesquita

Abstract

Background

Aromatherapy consists in the use of volatile aromatic compounds of plant essential oils. Application methods include massage, baths, and mainly inhalation. Lavender essential oil is considered the most effective treatment for emotional disorders, such as stress and anxiety, due to its anxiolytic and sedative agents, which are known to interfere with physiological cardiovascular reactions.

Objectives

To investigate the effects of aromatherapy using lavender essential oil on hemodynamic responses and emotional aspects of patients with cardiovascular diseases.

Methods

A systematic review was conducted using Embase, Bireme, MEDLINE, PEDro, and Scopus electronic databases. Randomized clinical trials that evaluated hemodynamic and emotional outcomes using interventions with lavender essential oil in patients with cardiovascular diseases were selected. Of 539 studies initially identified, 51 were read in full and only 5 were eligible for inclusion.

Results

Reductions were demonstrated in hemodynamic responses, such as systolic and diastolic blood pressure, mean arterial pressure, and heart rate, as well as a decrease in anxiety, depression, stress, and fatigue compared with the control group. Statistical significance was set at p<0.05. Conclusion: Aromatherapy with the use of lavender essential oil provided benefits to hemodynamic parameters, such as anxiety, stress, depression, and fatigue levels, in patients with cardiovascular diseases. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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