2005;84(4) – ABC CARDIOL

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Artigo Original

Myotonic dystrophy and heart disease: behavior of arrhythmic events and conduction disturbances

Silvana Angelina D'Orio Nishioka et al. Martino Martinelli Filho Suely Marie Mayana Zatz Roberto Costa

OBJECTIVE: To study the prevalence and natural evolution of arrhythmic events and conduction disturbances in myotonic dystrophy; to correlate the genetic defect with cardiovascular findings; to assess cardiac mortality, frequency, and predictive factors of sudden death; to correlate the severity of the neuromuscular and cardiac involvement; and to define the role of the electrophysiological study (EPS), in myotonic dystrophy. METHODS: Periodic clinical assessment and the following tests were performed in 83 consecutive patients with a mean follow-up of 42±30.63 months: complementary examinations, genetic tests, electrocardiography, echocardiography, and Holter; electrophysiological study was performed in 59 cases. RESULTS: Atrial tachyarrhythmia was observed in 10 (12%) patients, NSVT in 14 (17%), first-degree AVB in 24 (29%), LBBB in 19 (23%), and RBBB in 13 (16%). Symptoms, an increase in the PR interval, QRS enlargement, LVEF 70 ms in 34% and > 100 ms in 11% (postprocainamide). CONCLUSION: The prevalence of arrhythmic events and conduction disturbances ranged from 50% to 80% after 6 years, and did not correlate with the genetic defect. Atrial flutter was the most common sustained arrhythmia. Cardiac involvement increased as the neuromuscular disease became aggravated, but progression of the cardiac involvement was more rapid than that of the neuromuscular disease. Overall mortality was low (11%) and sudden death occurred in half of the cases. The EPS identified a group at risk for pacemaker implantation.

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Artigo Original

Prospective study of early and late morbidity and mortality in the abdominal aortic aneurysm surgical repair

Francine C. de Carvalho et al. Veridiana Porto Maggioli da Rocha Brito Elisângela Campaner Tribulatto Bonno van Bellen

OBJECTIVE: To prospectively assess early and late morbidity and mortality of patients undergoing elective surgical repair of abdominal infrarenal aortic aneurysms and to determine the independent predictors of cardiac events. METHODS: For 6 consecutive years, this study analyzed 130 patients, who underwent routine standardized preoperative assessment always with the same clinical, surgical, and anesthesia teams. RESULTS: In-hospital mortality was 3.1% (4 patients), and the major cause of death was mesenteric ischemia, which occurred in 3 patients. Forty-eight (37%) nonsurgical complications occurred as follows: 8.5% were cardiac complications and 28.5% were noncardiac complications. The most common complications were the pulmonary ones, which occurred in 14 (10.8%) patients. Survivals in the first, third, and sixth postoperative years were 95%, 87%, and 76%, respectively. The variables that significantly correlated with morbidity and mortality were clinical predictors, mean age of 70.5 years, and presence of heart failure and chronic renal failure. No predictor of late morbidity and mortality was identified. CONCLUSION: Although this is considered a highly complex surgery, mortality is low, the cardiac complications are not very significant, and the patients have a good long-term evolution.

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Image

Intramural haematoma of the descending aorta

Bruno Botelho Pinheiro et al. Walter Vosgrau Fagundes Rafael Haddad Maria Cardoso Ramos

IMAGEM

Intramural haematoma of the descending aorta

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Artigo Original

Survival and prognostic factors in systolic heart failure with recent symptom onset

Salvador Rassi et al. Antônio Carlos Pereira Barretto Celmo Celeno Porto Crésio Romeu Pereira … Bárbara Wosjunk Calaça Daniela C. Rassi

OBJECTIVE: To study survival and prognostic factors associated with mortality in patients with systolic heart failure followed up since symptom onset. METHODS: We carried out a study with a cohort of 204 consecutive patients with systolic heart failure, whose symptom onset occurred within the 6 weeks preceding the first medical visit. They were followed up for 46 months. The prognostic variables analyzed were collected when the patients were included in the study and were correlated with cardiovascular mortality. An EF < 40% on echocardiography characterized systolic ventricular dysfunction. RESULTS: The overall survival rates according to the Kaplan-Meier technique were 98.0%, 90.6%, and 70.2% at 3, 12, and 48 months of follow-up, respectively. The multivariate analysis identified the independent effect of 6 variables on the risk of cardiovascular death. Functional classes III and IV increased risk 2.7 times as compared with class II; 10-mmHg increments in systolic blood pressure reduced the risk of death by 25%; each 10-bpm increase in heart rate increased the risk of death 1.6 times; and each 0.25-mg/dL increment in serum creatinine caused a 60% increase in risk. The presence of the third cardiac sound caused a 3-fold increase in the risk of death, and chagasic etiology was also associated with cardiovascular mortality (P<0.0001). CONCLUSION: Evidence shows that mortality in the initial phase is not elevated, and that etiology, advanced functional class, arterial hypotension, tachycardia, presence of the third cardiac sound, and elevated serum creatinine lead to a worse prognosis.

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Atualização

Determination of hemodynamic parameters using Doppler two-dimensional echocardiography: a searching tool for therapeutic optimization in patients with congestive heart failure on an outpatient care follow-up

Dora V. Palombini et al. Luis E. Rohde Leticia Crestana Lívia Goldraich … Marta Pereira Lima Candice Campos Nadine Clausell

UPDATE

Determination of hemodynamic parameters using Doppler two-dimensional echocardiography: a searching tool for therapeutic optimization in patients with congestive heart failure on an outpatient care follow-up

[…]

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Correlação Clínico-Radiográfica

Four-month-old infant with ventricular septal defect

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Artigo Original

Effects of atorvastatin, fluvastatin, pravastatin, and simvastatin on endothelial function, lipid peroxidation, and aortic atherosclerosis in hypercholesterolemic rabbits

Paulo Afonso Ribeiro Jorge et al. Eros Antonio de Almeida Michiko R. Ozaki Mariana Jorge Adriano Carneiro

OBJECTIVE: To compare the effects of atorvastatin, fluvastatin, pravastatin, and simvastatin on endothelial function, aortic atherosclerosis, and the content of malondialdehyde (MDA) in native and oxidized LDL and in the arterial wall of hypercholesterolemic rabbits after adjusting the dosages of those statins to reduce total serum cholesterol levels to similar values. METHODS: Male rabbits were divided into the following 6 groups of 10 animals (n=10): 1) GH (control) – hypercholesterolemic animals; 2) GA – atorvastatin; 3) GF – fluvastatin; 4) GP – pravastatin; 5) GS – simvastatin; and 6) GN – normal. The animals were fed a standard food preparation enriched with 0.5% cholesterol and 2% coconut oil for 45 days. Fifteen days after beginning the experiment, atorvastatin, fluvastatin, pravastatin and simvastatin were administered for 15 days through gavage, and the dosages were adjusted to obtain similar cholesterol values in each group. At the end of the experiment, a blood sample was withdrawn for determining total cholesterol and separating the lipoproteins, and a segment of the thoracic aorta was removed to be used for studying endothelial function and lipid peroxidation, and for measuring aortic atherosclerosis in histological sections. RESULTS: The statins significantly reduced total serum cholesterol levels, LDL-cholesterol levels, and aortic atherosclerosis. The MDA content was also significantly reduced in native and oxidized LDL, as well as in the arterial wall. Endothelium-dependent relaxation was significantly greater in the treated group compared with that in the hypercholesterolemic group. CONCLUSION: The statins, at dosages adjusted, had a significant and similar effect in reducing lipid peroxidation in native and oxidized LDL-C and in arterial walls, in decreasing aortic atherosclerosis, and in reverting endothelial dysfunction.

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Relato de Caso

Transient ventricular dysfunction (Takotsubo cardiomyopathy)

José Marconi Almeida de Sousa et al. Marcos Knobel Gustavo Buchelle José Augusto M. de Sousa … Cláudio H. Fisher Daniel Born Nelson Akamine Elias Knobel

The patient was a male with myasthenia gravis, hospitalized with acute respiratory failure due to decompensation of the underlying disease. He evolved with findings suggestive of acute myocardial infarction, with electrocardiographic and enzymatic alterations compatible with that diagnosis. The patient underwent emergency coronary angiography, which showed no severe coronary obstruction, although his left ventricle had significant systolic dysfunction with characteristic alterations, on ventriculography, of the syndrome described as transient ventricular dysfunction or Takotsubo syndrome. On evolution, complete recovery of the electrocardiographic alterations and systolic ventricular function assessed on echocardiography occurred, confirming the syndrome.

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Correlação Anatomoclínica

Circulatory shock in a 103 year-old man with a history of long lasting heart failure following acute myocardial infarction ten years before

Thiago Marchini Naves et al. Tarso Augusto D. Accorsi Paulo Sampaio Gutierrez

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Artigo Original

Correction of thoracic and thoracoabdominal aortic aneurysms: central cannulation technique

Salomón Soriano Ordinola Rojas et al. Viviane Cordeiro Veiga Januário Manoel de Souza Marcos Fassheber Berlinck … Dante Fanganiello Senra Reinaldo Wilson Vieira Luiz Alberto Magna Domingo Marcolino Braile Sérgio Almeida de Oliveira

OBJECTIVE: To demonstrate the viability of the use of extracorporeal circulation established between the left atrium and ascending aorta to induce deep hypothermia for correcting thoracic and thoracoabdominal aortic aneurysms. METHODS: From January 1994 to July 2001, 38 patients (mean age, 54.6 ± 12.7 years) were operated on as follows: 12 (31.6%) patients underwent repair of thoracoabdominal aortic aneurysm, and 26 patients underwent repair of descending thoracic aneurysms. Deep hypothermia was induced by use of extracorporeal circulation, with pharyngeal temperature ranging from 15 to 25ºC (20.6 ± 3.2ºC). RESULTS: Of the neurological complications, paraplegia occurred in 2 (5.3%) patients. One patient developed paraparesis, and another evolved with convulsion. Twelve (31.6%) patients had respiratory complications, and 2 (16.7%) patients died. Two other patients were operated on on an emergency basis and ended up dying. Total mortality was 18.4% (7 patients). CONCLUSION: Repair of descending thoracic and thoracoabdominal aortic aneurysms with deep hypothermia by use of extracorporeal circulation established between the left atrium and ascending aorta proved to be a viable method for correcting those aneurysms.

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Artigo Original

Blockade of renin-angiotensin system attenuates cardiac remodeling in rats undergoing aortic stenosis

Giancarlo Gonçalves et al. Leonardo A. M. Zornoff Henrique B. Ribeiro Marina P. Okoshi … Fernando R. S. Cordaro Katashi Okoshi Carlos R. Padovani Flávio F. Aragon Antonio C. Cicogna

OBJECTIVE: To assess the role of the AT1 receptor blocker and the angiotensin-converting enzyme inhibitor in cardiac remodeling induced by aortic stenosis in rats. METHODS: Wistar rats were divided into the following 4 groups: 1) C – control (n=13); 2) AoS – aortic stenosis (n=11); 3) LIS – AoS treated with lisinopril, 20 mg/kg/day (n=11); and 4) LOS – AoS treated with losartan, 40 mg/kg/day (n=9). The treatments were initiated 3 days before surgery. After 6 weeks, the animals underwent echocardiographic study, and quantification of the hydroxyproline (HOP) concentration and the left ventricular (LV) myocyte cross-sectional area (CSA). RESULTS: Aortic stenosis induced an increase in left ventricular wall thickness. The LIS and LOS groups showed no difference as compared with the control group. The AoS and LIS rats had greater left atrial diameters than the control rats did, while no difference was observed in the LOS animals. The AoS animals had greater values of shortening percentage than control animals did. This fact was modified with neither LIS nor LOS. The cross-sectional area of the animals in the AoS group was greater than that in the control group. However, treatment with LOS and LIS attenuated the AoS-induced increase in area. Aortic stenosis caused an increase in HOP concentration, while the LOS group showed no difference as compared with the control group. CONCLUSION: Blockade of the renin-angiotensin system with AT1 blocker and ACEI may attenuate the development of heart hypertrophy, but only the blockade of AT1 receptors attenuates left ventricular interstitial fibrosis.

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Artigo Original

Evaluation of segmentary contractility in Chagas' disease by using the integral of the myocardial velocity gradient (myocardial strain) obtained through tissue Doppler echocardiography

Carlos Eduardo Suaide Silva et al. Luiz Darcy Cortez Ferreira Luciana Braz Peixoto Claudia Gianini Monaco … Manuel Adán Gil Juarez Ortiz Bárbara Maria Ianni José Lázaro Andrade Wilson Mathias Júnior Antônio Carlos Pereira Barretto

OBJECTIVE: To quantify the percentage of contractility of different myocardial segments in patients with Chagas’ disease by measuring myocardial strain and to assess the differences in the radial and longitudinal ventricular contractile function in the undetermined and dilated forms of chronic chagasic cardiomyopathy as compared with those in a group of healthy individuals. METHODS: The study comprised 39 individuals [20 (51.3%) of the male sex] divided into the following 4 groups: 1) Nl: 17 (43.6%) healthy individuals; 2) Und: 7 (17.9%) patients with the undetermined form of Chagas’ disease; 3) C1: 7 (17.9%) patients with the chronic form of Chagas’ disease with ejection fraction 50%. After performing baseline echocardiography, Doppler tissue images were recorded to measure myocardial strain in different segments on longitudinal and transversal parasternal, and apical 2- and 4-chamber views. RESULTS AND CONCLUSION: The percentage of contractility in the different myocardial segments, both the radial and longitudinal components, is greater in healthy individuals than in patients with the chronic form of Chagas’ disease, and in those with the undetermined form of the disease as compared with that of chronic chagasic patients with EF < 50%. Left ventricular radial contractility is greater than left ventricular longitudinal contractility in all groups (Nl, Und, and Chronic). The data presented allow us to propose a progressive character of myocardial impairment in patients with Chagas' disease.

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Relato de Caso

Percutaneous transluminal coronary angioplasty in a patient with idiopathic thrombocytopenic purpura

Luis Gustavo M. Marques et al. Murillo Kenji Furukawa Thenyson Pereira Leitão José Luis A. Quiñones … Fernando César de Queiroz Rogerio Felippe Tiossi Virgílio Ribeiro Franco Jr Carlos Eduardo M. Domingues Decio Salvadori Jr

The association between coronary heart disease and thrombocytopenic purpura is rare and poses some difficulties when myocardial revascularization is necessary. We report a case with this association and significant coronary impairment, which was percutaneously treated with stent implantation.

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Artigo Original

Chronic cigarette smoke exposure results in cardiac remodeling and impaired ventricular function in rats

Édson Castardeli et al. Sergio A. R. Paiva Beatriz B. Matsubara Luiz S. Matsubara … Marcos F. Minicucci Paula S. Azevedo Álvaro O. Campana Leonardo A. M. Zornoff

OBJECTIVE: To determine the cardiac structural and functional alterations caused by cigarette smoke exposure in rats. METHODS: The animals were randomly distributed into the following 2 groups: 1) smokers (S), comprising 10 animals exposed to cigarette smoke at a rate of 40 cigarettes/day; and 2) control (C), comprising 10 animals not exposed to cigarette smoke. After 4 months, the animals underwent morphological and functional study with echocardiography. The variables studied were analyzed by use of the t test or the Mann-Whitney test. RESULTS: The smoking rats had a greater left atrium (S=4.2±0.7mm; C=3.5±0.6mm; P<0.05), and greater left ventricular diastolic (S=7.9±0.7mm; C=7.2±0.5mm; P<0.05) and systolic (S=4.1±0.5; C=3.4±0.5; P<0.05) diameters. The left ventricular mass index was greater in the smoking animals (S=1.5mg/kg±0.2; C=1.3mg/kg±0.2; P<0.05), and the ejection fraction (S=0.85±0.03; C=0.89±0.03; P<0.05) and the shortening fraction (S=47.8%±3.7; C=52.7%±4.6; P<0.05) were greater in the control group. No differences were observed in the diastolic transmitral flow variables (E wave, A wave, and E/A ratio). CONCLUSION: Chronic cigarette smoke exposure results in cardiac remodeling with a decrease in ventricular functional capacity.

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Editorial

The prognosis of heart failure in Brazil: the search for reliable and representative data

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Editorial

Adrenergic cardiomyopathy: can stress cause acute heart disease?

Cláudio Tinoco Mesquita et al. Antonio Claudio Lucas da Nóbrega

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