1997;69(3) – ABC CARDIOL

Artigo Original

Arterial dysfunction as a possible mechanism of cardiac injury in type II diabetic patients. A Doppler-echocardiographic study

Beatriz Bojikian Matsubara et al. Katashi Okoshi Marina Politi Okoshi Luiz Shiguero Matsubara … Walkyria P. Pimenta José C. Christovan Carlos R. Padovani Antonio Carlos Cicogna

PURPOSE: To evaluate the left ventricular structure and function and the arterial stiffness in type II diabetic patients. METHODS: Thirteen diabetic patients, men and women (age 55±8 years) were included in the study. None of the patients had any other clinical disorders. Doppler-echocardiography and non-invasive monitoring of arterial blood pressure were performed. All the results were compared to an age and sex matched control group (n=12). RESULTS: There were no differences between the groups for diastolic blood pressure, dimensions of cardiac chambers and ventricular systolic and diastolic function indexes. Diabetic patients had increased left ventricular mass index (101±10 vs 80±14g/m²; p<0.001) and increased arterial stiffness (0.86±0.26 vs 0.69±0.19mmHg/mL; p<0.05), when compared to control group. CONCLUSION: Diabetes mellitus is associated to increased systemic arterial stiffness and this may contribute to the adverse effects of diabetes on left ventricular morphology.

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Artigo Original

Symptoms, complications and hemodynamic effects related to dobutamine stress echocardiography

Rita Pinton et al. Walmor Lemke Lazaro G. Garcia

PURPOSE: This study focuses on the safety and hemodynamic effects of dobutamine stress echocardiography. METHODS: Seven hundred and thirty five consecutive patients underwent dobutamine stress echocardiography for the evaluation of coronary artery disease and or cardiomyopathy. Dobutamine was administered intravenously at incremental doses of 5, 10, 20, 30µg/kg/min, at 3min intervals. The maximal dose was 40 or 50µg/kg/min. RESULTS: Dobutamine significantly (p<0.0005) increased the heart rate (from 72±12bpm to 117±23bpm), systolic blood pressure (from 133±21 to 157±29mmHg) and the rate-pressure product (from 9.635±2.100 to 18.400±4.050, p<0.0001) from baseline to peak infusion rate, respectively. There was a significant increase in heart rate (p<0.05) at each infusion step, except for the 50µg/kg/min dose, when the heart became stable. There were no deaths myocardial infarctions, or episodes of sustained ventricular tachycardia. Common non cardiac side effects included nausea, anxiety, headache, tremors and urgency in 55 (7.4%) of the patients. Angina pectoris occured in 10 (1.4%) of the patients. The most common arrhytmias were usually mild. CONCLUSION: Dobutamine stress echocardiography is safe, and well tolerated. In this study complications such as myocardial infarction, death, ventricular tachycardia or fibrillation did not occur. There was no additional increase in heart rate with doses greater than 40µg/kg/min. The advantage of stress echocardiography protocol with peak doses of 50µg/kg/min is questionable.

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Comunicações Breves

Intermittent myocardial isquemia after surgical angioplasty of the left main coronary artery

Luís Roberto Gerola et al. Ivana Delamônica Freire Eckert José Alfredo Sejópolis Alberto Najjar … Luís Cesar N. Scala Ronaldo D. Fontes

Two 38 and 53-year old male patients with unstable angina, whose hemodynamic study showed an isolated stenosis of the left coronary artery ostium, were submitted to a surgical angioplasty of the left main coronary artery (LMCA) with saphenous vein patch. At the end of the operation, the patients presented intermitent myocardial isquemia. One of them led to abrupt cardiogenic shock which reversed completely. The postoperative hemodynamic study demonstrated excellent left main coronary artery patency and normal left ventricular . of LMCA has been proposed as an alternative technique to the treatment of ostial lesions, the surgical team should be prepared to face severe operative morbidity. The LMCA spasm has been considered as a possible etiology of that event.

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Relato de Caso

Thrombosis in normal coronary arteries causing acute myocardial infarction in an alcoholic patient

David Pamplona et al. Marcello Barduco Marcelo Luis C. Vieira Luciano Forlenza Luiz Antonio Machado César

A case of a young patient, heavy drinker, who suffered an acute myocardial infarction (AMI), and whose cinecoronariography, early post unsuccessful intravenous thrombolysis, showed the presence of thrombi in multiple arteries is reported. A second cinecoronariography performed on the 7th day post AMI revealed normal coronary arteries. There were no plasmatic lipid or coagulation abnormalities, nor other risk factors for coronary artery disease. We speculate about the role of the heavy alcohol ingestion in this particular case.

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Artigo Original

Early luminal diameter loss after percutaneous transluminal coronary angioplasty and its relation to the restenosis phenomenon

Adriano Mendes Caixeta et al. Fábio Sândoli de Brito Jr Pedro Eduardo Horta Miguel Rati … Mauro Fonseca Júlia Tizue Fukushima Siguemituzo Arie Fúlvio Pileggi

PURPOSE: To evaluate the early luminal diameter loss in the first 15min after percutaneous transluminal coronary angioplasty (PTCA) and its influence on coronary restenosis. METHODS: In a prospective study, we evaluated 86 patients. The patients were divided in two groups based on the presence or absence of coronary restenosis. Thirty one lesions developed restenosis and 55 lesions did not. RESULTS: Univariate analysis showed that balloon/artery ratio was lower in the group of restenosis (0.92±0,01 vs 1.00±0,11, P= .003). Absolute and relative elastic recoil at 1 min was greater in the group that developed restenosis (0.79±0.54 vs 0.68±0.59mm; P= .007 and 32.04±14.27 vs 22.15±16.65%; P= .006). Similarly, absolute and relative elastic recoil at 15 min were greater in the group with restenosis (1.25±0.59 vs 0.90±0.65mm, P= .017 e 46.75±15.69 vs 29.18±17.84%, P< .00001). Minimal luminal diameter( MLD) at 1min was lower in the group with restenosis (2.15±0.42 vs 2.43±0.58mm; P= .022). The very early loss was greater in the group with restenosis (0.46±0.34 vs 0.22±0.35mm, P= .004). MLD at 15 min was lower in the group of restenosis than in the group without restenosis (1.69±0.48 vs 2.20±0.61; P= .0001). Multivariate analisys revealed balloon/artery ratio and MLD at 15 min as independent correlates of the late outcome. CONCLUSION: The late outcome of PTCA is influenced by elastic recoil and the early MLD loss after PTCA. However, the strongest and most important predictors of late outcome by multivariate analysis were balloon/artery ratio and MLD at 15 min.

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Artigo Original

The effect of short term Aerobic physical training using upper limbs in paraplegic persons with mild to moderate hypertension

Sandra Haddad et al. Paulo Roberto Santos Silva Antonio Carlos Pereira Barretto Ivan Ferraretto

PURPOSE: To study the modifications induced by physical training (PT) using upper limbs in aerobic condition of short duration on cardiovascular and metabolic variables. METHODS: Eleven paraplegic persons, with a mean age of 59 years, 7 men and 4 women with lesions at T9 through T11 and mild hypertension (HAS) were studied. The patients were studied before and after 12 weeks of a supervised program of PT, through exercise tests in a mechanic ergometer (ST) adapted for the arms. We emploied an intermittent protocol with stress increments of 125 (20w) and 140kgm/min (25w) for women and men, respectively every 3min. The ergometric speed ranged from 83 to 95rpm. The oxygen consumption (VO2) was estimated according to American College of Sports Medicine equation for arms. The exercise intensity during the TF program was estimated through the Karvonen cardiac frequency reserve, with a variation of 65% to 85% and the Borg stress scale of subjetive perception during the stress test. RESULTS: The mean maximal aerobic capacity increased in 22% (930+349 vs 1138+290mL/min; p=0.003); there was a reduction of systolic and diastolic pressures at rest and after submaximal exercise of 4%,15% and 5% and 5%, respectively. CONCLUSION: Physical training of mild to moderate intensity using the upper limbs in paraplegic persons, besides inducing functional capacity increment , is an important model of non drug control of the hypertensive response.

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Artigo Original

Clinical therapeutics for stable coronary artery disease. Differences between primary and tertiary medical care centers

Antônio P. Mansur et al. Everli P. S. Gonçalves Gomes Desidério Favarato Angela Raineri … José Renato M. Martins José A. F. Ramires

PURPOSE: To observe the distribution of the main drugs used in patients with stable coronary heart disease, in primary and tertiary medical care centers (MCC). METHODS: We studied 300 consecutive out patients at the Hetat Institute with the diagnosis of stable coronary artery disease, 205 (68%) males and 95 (32%) female, aged from 31 to 80 (mean 58±8.0) years old. Drug intake was evaluated. RESULTS: We observed that the use of nitrates (48% vs 55%; p=NS) and calcium antagonists (46% vs 37%; p=NS), respectively in both primary and tertiary MCC was similar. The beta blockers were used more often in the primary MCC (50% vs 35%; p= 0,02). Angiotensin coverting enzyme inhibitors (11% vs 42%; p< 0.001), diuretics (30% vs 49%; p= 0.002) and aspirin (44% vs 76%; p= 0.0001) were more frequently used in the tertiary MCC. CONCLUSION: We observed similar frequency of use of nitrates and calcium antagonists in both centers. There was a higher use of beta blockers in primary MCC. The angiotensin coverting enzyme inhibitors and antiplatelet agents were more used in the tertiary MCC. In relation to the updated literature, the best pharmacotherapy to coronary artery disease should be optimized in both centers.

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Arterial dysfunction as a possible mechanism of cardiac injury in type II diabetic patients. A Doppler-echocardiographic study

Symptoms, complications and hemodynamic effects related to dobutamine stress echocardiography

Intermittent myocardial isquemia after surgical angioplasty of the left main coronary artery

Thrombosis in normal coronary arteries causing acute myocardial infarction in an alcoholic patient

Early luminal diameter loss after percutaneous transluminal coronary angioplasty and its relation to the restenosis phenomenon

The effect of short term Aerobic physical training using upper limbs in paraplegic persons with mild to moderate hypertension

Clinical therapeutics for stable coronary artery disease. Differences between primary and tertiary medical care centers

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