2006;86(2) – ABC CARDIOL

Editorial

Hyperhomocysteinemia as a risk factor for coronary atherosclerotic disease in the elderly

Armênio Costa Guimarães

EDITORIAL

Hyperhomocysteinemia as a risk factor for coronary atherosclerotic disease in the elderly

[…]

Read Full Article

Artigo Original

Prognostic value of the six-minute walk test in heart failure

Valéria Siqueira Martins Rubim et al. Cantídio Drumond Neto José Luiz Martins Romeo Marcelo Westerlund Montera

OBJECTIVE: This study aimed to assess the true usefulness of the Six-Minute Walk Test as a prognostic indicator and its contribution to clinical practice with heart failure patients. METHODS: In order to investigate the actual value of the Six-Minute Walk Test as an objective measure of mortality probability in patients with heart failure, the test was applied to 179 stable patients (120 men and 59 women, mean age 58.32 ± 12.7 years, with NYHA class II and III heart failure and an ejection fraction (LVEF) of 34.91 ± 12.4%). Patients were instructed to walk for 6 minutes and then, four hours later, underwent a conventional exercise stress test (as per Naughton Protocol). Patients were followed for an average of eighteen months. RESULTS: The average distance walked was 521.11 ± 76.1 meters. During the follow-up period, 66 patients (36.9%) died. There was a significant correlation between the distance walked during the test and mortality (p < 0.0001). The logistic regression model identified the distance walked during the test as the most important independent predictor of mortality (p = 0.0001). A distance shorter than 520 meters identified the patients with an increased probability of death. There was a significant correlation between the number of metabolic equivalents (METs) measured during the conventional exercise stress testing and mortality rate (p = 0.0001). CONCLUSION: The Six-Minute Walk test is a simple, safe and powerful method to assess the prognosis of patients with NYHA class II and III heart failure. It is an objective examination that may replace the conventional ergometric test for the prognostic evaluation of these patients.

Read Full Article

Editorial

Stem cells for ischemic stroke: hope or panacea?

Hans Fernando Rocha Dohmann et al. Jamary Oliveira Filho

EDITORIAL

Stem cells for ischemic stroke: hope or panacea?

[…]

Read Full Article

Artigo Original

Increased rate-pressure product as predictor for the absence of significant obstructive coronary artery disease in patients with positive exercise test

Luis Domingos Fornitano et al. Moacir Fernandes de Godoy

OBJECTIVE: To correlate values of rate-pressure product (RPP) above 30,000 mmHg.bpm with or without significant obstructive coronary artery disease (CAD) in patients with positive exercise test. METHODS: A retrospective analysus of 246 patients that had been submitted to Exercise Treadmill Test (ETT) up to 30 days before coronary angiography on suspicion of obstructive disease. The 165 patients in which the ETT was positive were analyzed considering as positive the presence of horizontal or descending depression of the ST segment for at least 1 mm, 0.08 seconds after J point. RESULTS: Among the 165 appraised patients, 50 (30.3%) reached RPP > 30,000 mmHg.bpm, of which 38 (76%) had normal coronary vessel angiography or low degree obstructive coronary artery disease and 12 (24%) had significant. Among the remaining 115 appraised patients with positive ETT and RPP < 30,000 mmHg.bpm, 59 (51.3%) were normal or with low significance obstructive coronary artery disease, and 56 (48.7%) had significant disease. (Odds Ratio = 0.3327 CI 95% = 0.1579 to 0.7009; P=0.0034). CONCLUSION: Based on data collected in the present investigation, it has been demonstrated that RPP above 30,000 mmHg.bpm stands as a relevant variable to predict the absence of significant obstructive coronariopathy in individuals with positive ET and as a useful tool in making clinical decisions.

Read Full Article

Artigo Original

Myocardial remodeling in chronic pressure or volume overload in the rat heart

Luiz Shiguero Matsubara et al. Silvia Narikawa Ana Lucia dos Anjos Ferreira Sergio Alberto Rupp de Paiva … Leonardo Mamede Zornoff Beatriz Bojikian Matsubara

OBJECTIVE: To compare cardiac structural changes in experimental pressure and volume overload models. METHODS: The study analysis included renovascular hypertensive rats (RVH, n=8), normotensive rats with volume overload caused by an aortocaval fistula (ACF, n=10) and control rats (CONT, n=8). After four weeks, tail cuff blood pressure (SBP) was recorded. Rats were killed, the hearts were excised and the right and left ventricles (RV&LV) were weighed (RVW&LVW). Using histological sections, myocyte cross sectional areas (MA). LV wall thickness (LVWT) LV cavity diameter (LVD), normalized LVWT (LVWT/LVD) and collagen volume fraction (CVF) were measured. The comparisons were made using the ANOVA and Tukey test for a significance level of 5%. RESULTS: Tail cuff blood pressure (mmHg) was higher in the RVH group (RVH = 187 ± 22; CONT = 125 ± 10; ACF = 122 ± 6, p<0.05). LV hypertrophy was observed in the RVH and ACF groups. The ACF group presented a significant increase in size of LVD, compared to CONT and RVH. The absolute and normalized ventricular wall thickness were similar among the groups. The RVH group presented a significant increase in CVF compared to CONT group and ACF group. CONCLUSION: Cardiac remodeling patterns following volume or pressure overload are distinct, suggesting that their implications on ventricular dysfunction are not interchangeable.

Read Full Article

Artigo Original

The use of preoperative intra-aortic balloon in myocardial revascularization surgery associated to severe ventricular dysfunction

Marcelo Kern et al. João Ricardo M. Santanna

OBJECTIVE: To evaluate the effectiveness of prophylactic intra-aortic balloon (IAB) in elective myocardial revascularization surgery (MRS), to prevent trans or post-operative infarction and reduce intra-hospital mortality in patients with low left ventricular ejection fraction. METHODS: Using a cohort study model, 239 patients with left ventricular ejection fraction <40%, submitted to elective MRS with extracorporeal circulation (ECC) were evaluated from March 1995 to February 2001. RESULTS: Of these, 58 patients received preoperative IAB and the remainder underwent surgery without circulatory assistance (control group). The two groups of patients had similar characteristics regarding factors associated to the pertaining outcomes. There were five demises (8.6%) in the group with IAB and 21 (11.6%) in the control group (non-significant difference). There were 2 (3.4%) infarctions in the IAB group and 28 (15.5%) in the control group (p< 0.05), relative risk of 0.22 with an interval of confidence of 95% from 0.05 to 0.85 CONCLUSION: The use of pre-operative IAB can significantly reduce the risk of trans or post-operative acute myocardial infarction (AMI) in patients with decreased systolic function, without increasing vascular complications. In this same situation, the IAB does not significantly decrease mortality. Randomized studies are necessary to establish more precise conclusions.

Read Full Article

Atualização

The role of echocardiography in the percutaneous treatment of septal defects

Simone Rolim F. Fontes Pedra et al. Sérgio Cunha Pontes Jr Renata de Sá Cassar Carlos Augusto Cardoso Pedra … Sérgio Luiz Navarro Braga César Augusto Esteves Maria Virgínia Tavares Santana Valmir Fernandes Fontes

UPDATE

The role of echocardiography in the percutaneous treatment of septal defects

[…]

Read Full Article

Artigo Original

Mechanical function is normal in remanent myocardium during the healing period of myocardial infarction – despite congestive heart failure

Alessandra P. O. N. Peron et al. Roberto M Saraiva Ednei L. Antonio Paulo José Ferreira Tucci

OBJECTIVE: The temporal relation between ventricular dysfunction (VD) after myocardial infarction (MI) and remanent myocardium mechanics is not yet clear. The present work investigated – through Doppler echocardiography (ECHO) – ventricular function in rats with extensive MI, as well as the mechanical function of papillary muscles (PM) at the end of the healing period. METHODS: ECHO and PM of 9 Wistar rats (MI) were studied against 9 controls (C) three weeks after LV myocardial infarction. The following were determined: developed tension (DT) and its first negative and positive derivative, time-to-peak tension (TPT), resting tension (RT), and relaxation time at 50% of DT at 0.5, 1.0, 1.5, 2.0 and 2.5 calcium concentrations (mM). Tetanic contractions were carried out after ryanodine administration at 1.5, 2.5 and 5.0 calcium concentrations. RESULTS: VD was characterized by ECHO, with marked abnormality of diastolic volume and LV and ejection fraction in addition to clear restrictive pattern of blood flow through the mitral valve. No significant difference was found in myocardial mechanics data either for MI or for C rats. CONCLUSION: The heart failure (HF) reported by MI rats with > 40% MI at the end of the healing period is not myocardial function dependent. Chamber structural changes and lower population of myocites should base VD and HF.

Read Full Article

Artigo Original

Symptomatic severe chronic aortic valve disease: a comparative study of cardiac magnetic resonance imaging and echocardiography

Marcelo Nigri et al. Carlos Eduardo Rochitte Flávio Tarasoutchi Guilherme S Spina … José Rodrigues Parga Luiz Francisco Ávila Roney Orismar Sampaio José Antonio Franchini Ramires Max Grinberg

OBJECTIVE: To show the real value of cardiac magnetic resonance imaging (CMRI) in the evaluation of patients with symptomatic chronic aortic valve disease. METHODS: Seventy patients – 35 with aortic stenosis (AoS) and 35 with aortic regurgitation (AoR) with surgical indication, who underwent preoperative echocardiogram (ECHO) and CMRI to assess ventricular function, volumes, and left ventricular mass index using cine magnetic resonance imaging, were studied. RESULTS: No statistically significant difference was observed between the AoS and AoR groups when ECHO and CMRI variables were compared. When compared with the type of symptom, ECHO and CMRI variables showed the same pattern. CONCLUSION: CMRI data were in agreement with ECHO data regarding the assessment of left ventricular volume and ejection fraction, and with the clinical presentation of patients with chronic aortic valve disease.

Read Full Article

Correlação Anatomoclínica

Case 01/2006: progressive heart failure in a 44-year old man

Tiago Senra Garcia dos Santos et al. Ariane Vieira Scarlatelli Macedo Paulo J Moffa Maria Clementina Giorgi … Léa Maria Macruz Ferreira Demarchi Jussara Bianchi Castelli

Read Full Article

Artigo Original

Comparison of coronary angiography findings in diabetic and non-diabetic women with non-ST-segment-elevation acute coronary syndrome

José Marconi Almeida de Sousa et al. João L. V. Herrman Marco Teodoro Sergio Diogo … Bernardino Bandeira Terceiro Angelo Amato Vincenzo de Paola Antonio Carlos Camargo Carvalho

OBJECTIVE: Compare hemodynamic and angiographic patterns, as well as atherosclerotic lesion morphology, in diabetic and non-diabetic females with unstable angina or non-ST-segment-elevation myocardial infarction (UA/NSTEMI). METHODS: Two interventional cardiologists determined the presence of severe atherosclerotic lesion, defined as those > 70%; plaque morphology, according to the American Heart Association classification; collateral circulation; plus ventricular and aortic pressures. Ejection fraction was calculated by angiography or echocardiography. RESULTS: During eight and a half years, 645 coronary angiographies were performed in women with UA/NSTEMI. In the present study, 593 female patients were assessed (215 diabetic – 36%). This group differed from the non-diabetic in the following aspects: older age (61 ± 10.6 x 58.1 ± 11.4), higher prevalence of postmenopausal women and lower prevalence of the smoking habit. Severe three-vessel disease was significantly more frequent in diabetic patients (28% x 10%), as well as totally occluded vessels: 51 (23%) x 54 (14.3%), p < 0.005. Additionally, ejection fraction < 50% was more common in diabetic patients. CONCLUSION: These findings confirm the diffuse pattern of atherosclerotic disease in diabetic patients, as well a greater deterioration of ventricular function, which may be associated to the poorer prognosis seen in this population both in the short- and long-term.

Read Full Article