2006;86(4) – ABC CARDIOL

Editorial

Sirolimus-eluting stents for the treatment of stenoses in small coronary arteries: what have we learned?

Ricardo A. Costa et al. Alexandra J. Lansky

EDITORIAL

Sirolimus-eluting stents for the treatment of stenoses in small coronary arteries: what have we learned?

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Artigo Original

Technical aspects of coronary sinus catheterization based on the atrial component of the intracavitary electrogram and radiological anatomy during the implantation procedure of a biventricular pacemaker

Fernando Sérgio Oliva de Souza et al. Nicola Luciano Mortati Domingo Marcolino Braile Reinaldo Wilson Vieira … Salomon Ordinola Rojas Alessandre Caputo Rabelo Januário Manuel de Souza Sérgio Almeida de Oliveira

OBJECTIVE: To present a technical proposal based on the experience of 130 implantations using a simplified technique for coronary sinus catheterization, based on the atrial component of the intracavitary electrogram and radiological anatomy. METHODS: From October, 2001 to October, 2004, 130 biventricular pacemaker implantations were performed, using radiological anatomy and observation of the intracavitary electrogram, focusing on the atrial component. RESULTS: The implantation of the system using left ventricular pacing via coronary sinus was not possible in 8 patients. Difficulties on the cannulation of the coronary ostium were felt in 12 patients and difficulties of lead advancement through the coronary sinus were felt in 15 patients. The mean time of radioscopy utilization was 18.69 min. CONCLUSION: The implantation technique, using the atrial component morphology of the intracavitary electrogram and radiological anatomy showed to be workless, safe and effective for the cannulation of the coronary sinus ostium requesting reduced time of radioscopy.

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Image

Real time tridimensional echocardiography in a patient with hypertrophic cardiomyopathy

Marcelo Luiz Campos Vieira et al. Prasad Maddukuri Natesa G. Pandian Wilson Mathias Jr. José A. F. Ramires

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Real time tridimensional echocardiography in a patient with hypertrophic cardiomyopathy

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Spontaneous coronary artery dissection causing acute coronary syndrome

Francisco Juarez C. Vasconcelos Filho et al. José Erirtônio F. Barreto Raimundo Barbosa Barros Imara C. L. Queiroz Rômulo Ronkaly G. Lima

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Spontaneous coronary artery dissection causing acute coronary syndrome

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Correlação Anatomoclínica

Case 2/06 – heart failure in a 33 year-old woman in the late follow-up after myocardial infarction

Otavio Celeste Mangili et al. Paulo J. Moffa Luiz Alberto Benvenuti

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Case Report

Atrogenic pseudoaneurysm of axillary artery

Amélia Cristina Seidel et al. Fausto Miranda Jr. Leandro V. Fregadolli

CASE REPORT

Atrogenic pseudoaneurysm of axillary artery

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Artigo Original

The effects of nonsupervised exercise program, via internet, on blood pressure and body composition in normotensive and pré-hipertensive individuals

Ana Paula de Oliveira Barbosa Nunes et al. Aline Cristina dos Santos Rios Gisela Arsa da Cunha Antonio Carlos Pereira Barretto Carlos Eduardo Negrão

OBJECTIVE: To verify the effects of a six-month non-supervised physical training program followed via the Internet on blood pressure and body composition in normotensive and borderline hypertensive individuals. METHODS: One hundred and thirty five individuals were divided into two groups: 1) normotensive individual (n = 57), 43 ± 1 years of age, systolic blood pressure (SBP) < 120 and diastolic blood pressure (DBP) < 80 mmHg (GI); and 2) borderline hypertensive individual (n = 78), 46 ± 1 years of age, SBP 120 to 139 and DBP 80 to 89 mmHg (GII). RESULTS: After a three and six-month physical training, GII individuals showed a significant reduction in SBP (-3.6 ± 0.94 and -10 ± 0.94 mmHg, p < 0.05, respectively) and PAD (-6.5 ± 1 and -7.1 ± 0.9 mmHg, p < 0.05, respectively), body weight (-1.12 ± 0.26 and -1.25 ± 0.31 kg, p < 0.05, respectively), BMI (-0.79 ± 0.4 and -0.84 ± 0.41 kg/m², p < 0.05, respectively) and waist circumference (-1.12 ± 0.53 and -1.84 ± 0.56 cm, p < 0.05, respectively). In the GI group, the physical training led to a decrease in waist circumference at the sixth month (-1.6 ± 0.63 cm, p < 0.05). CONCLUSION: This program decreases blood pressure, body weight, BMI, and waist circumference in borderline hypertensive individuals, and is therefore a safe and low-cost strategy in the prevention of cardiovascular diseases and improvement of health status of the population.

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Artigo Original

Correlation and concordance between echocardiographic measurements obtained during echocardiography and digitized image measurements: transversal study

Maria Amélia Bulhões Hatem et al. Iran Castro Domingos M. Hatem Marcos Zuccolotto … Adalberto Schuck Júnior Lucia C. Pellanda Fernanda Pandolfo Flávia Feier

OBJECTIVE: To evaluate the correlation and concordance between the measurements of echocardiographic analysis of cardiac dimensions obtained through the Echo off-line applicative (software for obtaining digitized image measurements in a dedicated workstation) available to public domain, and those obtained through the conventional method. METHOD: Transversal contemporary study, of 56 randomized patients whose images were obtained during examina-tions. The measurements of the M mode and 2D, were done in the ventricles, left atrium, and aorta by the Echo off-line program. These measurements were compared to those obtained by another professional, through Pearson’s correlation test (r), alpha = 0.05 and by concordance analysis (Bland and Altman). RESULT: The measurements carried out by the Echo off-line system showed r that varied from 0.85 to 0.98. The analysis of concordance showed that for most measu-rements, the mean difference between the methods was approximately zero. The variation of absolute values did not show, in average, a clinical significance. The Echo off-line applicative allows a reduction of approximately 30% in the time spent to obtain the measurements. CONCLUSION: This study demonstrated the accuracy of the Echo off-line program to measure cardiac dimensions in a dedicated workstation, showing that it can be routinely used in echocardiography labs.

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Artigo Original

Clinical outcome of patients with neurocardiogenic syncope (NCS) after therapy interruption

Silvana Bastos et al. Mauricio Scanavacca Francisco Darrieux Ana Cristina Ludovice … Eduardo Sosa Denise Tessariol Hachul

OBJECTIVE: To evaluate the outcome of patients with NCS after interruption of pharmacological therapy and to investigate the possible clinical variables predicting recurrence. METHODS: Thirty-seven patients (age 31±16 years) with refractory recurrent NCS being 19 females where prospectively studied. All patients became asymptomatic and had a negative tilt table test (TT) after pharmacological therapy. The treatment was interrupted and one month later, a new TT with no medication was carried out. The probability free of symptoms recurrence was analyzed according to sex, age, number of syncope episodes previously to the treatment, clinical history time, treatment time, drug free from treatment time and TT result. RESULTS: Twenty-two patients (59%) presented recurrence during a mean follow-up of 21±19.7 months. The variables related to greater recurrence were number of previous syncope (p=0.0248), positive TT after interruption of the therapy (p=0.0002) and female gender (p= 0.0131). CONCLUSIONS: Most of the very symptomatic patients with NCS present recurrence after the suppression of a specific therapy. A TT carried out after treatment discontinuation can identify patients with higher risk of recurrence, specially in the first year of follow-up.

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Artigo Original

Clinical and therapeutics aspects of heart failure due to Chagas disease

Julio Cesar Vieira Braga et al. Francisco Reis Roque Aras Nei Dantas Costa … Claudilson Bastos Renata Silva Alana Soares Ademir Moura Júnior Silvana Ásfora Adriana Lopes Latado

OBJECTIVE: Describe the clinical and therapeutic characteristics of patients with heart failure (HF) secondary to chronic chagasic cardiomyopathy and evaluate if these characteristics are different from those found in other etiologies. METHODS: A prospective analysis of the patients treated between August 2003 and June 2004 at a HF referral outpatient clinic was conducted. RESULTS: Three hundred and fifty six patients diagnosed with HF were included in the study. Chagasic cardiomyopathy was the most common etiology (48% of the cases). Other etiologies included hypertensive cardiomyopathy in 19% of the patients, idiopathic dilated in 11% and ischemic in 9%. Patients with HF secondary to chagasic cardiomyopathy were more frequently from non-white ethnic groups (88 vs. 75%; p = 0.002), had a family history of Chagas disease (57 vs. 21%; p = 0.001), had the disease for a longer length of time (71 vs. 56 months; p = 0.034), had lower levels of education (4.4 ± 4.1 vs. 5.7 ± 4.2 years of study; p = 0.004), had a lower heart rate (69 ± 12 vs. 73 ± 13; p = 0.03) and a lower systolic blood pressure (121 ± 25 vs. 129 ± 28 mmHg; p = 0.006). There was also a higher incidence of the use of amiodarone (22 vs. 13%; p = 0.036) and artificial pacemakers (15 vs. 1%; p = 0.001). There was a lower usage of beta-blockers (39 vs. 59%; p = 0.001). CONCLUSION: In this sample of HF outpatients, in a state with a high prevalence of Chagas disease, chagasic cardiomyopathy was the most common etiology and they presented some unique clinical and therapeutic characteristics in comparison to other heart failure patients.

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Artigo Original

Comparative analysis of intimal hyperplasia after sirolimus-eluting stent and thin-strut bare-metal stent implantation in small coronary arteries

Fernando Stuchi Devito et al. Amanda G. M. R. Sousa Fausto Feres Alexandre Antonio Cunha Abizaid … Rodolfo Staico Luis Alberto Piva Mattos Luis Fernando Leite Tanajura Andréa C. L. S. Abizaid Áurea Jacob Chaves J. Eduardo M. R. Sousa

OBJECTIVE: This study aimed at evaluating reduction in intimal hyperplasia volume following angioplasty using sirolimus-eluting stents (Cypher™) compared with thin-strut bare-metal stents (Pixel™) in patients with small vessels. METHODS: Eighty patients with coronary artery disease were prospectively included in two consecutive series, the first using sirolimus-eluting stents (50) and the second using bare-metal stents (30). RESULTS: The use of sirolimus-eluting stents reduced: in-stent net volume obstruction [5.0% (SE = 0.77) x 39.0% (SE = 4.72), p < 0.001], in-stent late loss [0.25 mm (SE = 0.03) x 1,11 mm (SE = 0.13), p < 0,001], in-segment late loss [0.30 mm (SE = 0.04) x 0.83 mm (SE = 0.11), p < 0.001], in-stent restenosis (0% x 33.3%, p < 0.001) and in-segment restenosis (4% x 36.7%, p < 0.001). The event-free survival rate was 96% in the sirolimus-eluting stent group versus 86.7% in the bare-metal stent group (BMS) (p = 0.190). CONCLUSION: Sirolimus-eluting stents are superior to thin-strut bare-metal stents in reducing intimal hyperplasia (less in-stent obstruction and less late lumen loss) in patients with small vessels. The use of these stents significantly reduced angiographic restenosis at eight months.

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Atualização

Clinical applications of B-type natriuretic peptide assays

Humberto Villacorta Júnior et al. Evandro Tinoco Mesquita

UPDATE

Clinical applications of B-type natriuretic peptide assays

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Artigo Original

Cigarette smoke exposure intensifies ventricular remodeling process following myocardial infarction

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

OBJECTIVE: To evaluate the role of cigarette smoke exposure (CSE) on ventricular remodeling following acute myocardial infarction (AMI). METHODS: Rats were submitted to myocardial infarction and divided into two groups: C (control, n = 31) and F (CSE: 40 cigarettes/day, n = 22). After 6 months, the survivors were submitted to echocardiogram, functional study with isolated heart, and morphometric analysis. For comparison purposes, we used the t test (mean ± standard deviation) or the Mann-Whitney test (with median and 25th and 75th percentiles). RESULTS: The CSE animals tended to have larger diastolic (C = 1.5 ± 0.4 mm², F = 1.9 ± 0.4 mm²; p = 0.08) and systolic (C = 1.05 ± 0.3 mm², F = 1.32 ± 0.4 mm²; p = 0.08) left ventricular(LV) areas. The systolic function of the LV, assessed according to the fractional area change, tended to be impaired in CSE animals (C = 31.9 ± 9.3%, F = 25.5 ± 7.6%; p = 0.08). The – dp/dt values for CSE animals were statistically lower (C = 1474 ± 397 mmHg, F = 916 ± 261 mmHg; p = 0.02) than for control animals. The CSE animals presented higher right ventricle (RV) weight adjusted for body weight (C = 0.8 ± 0.3 mg/g, F = 1.3 ± 0.4 mg/g; p = 0.01), higher content of water in lungs (C = 4.8 (4.3-4.8)%, F = 5.4 (5.1-5.5); p = 0.03), and larger LV myocyte cross-sectional areas (C = 239.8 ± 5.8 µm², F = 253.9 ± 7.9 µm²; p = 0.01). CONCLUSION: Cigarette smoke exposure intensifies ventricular remodeling following acute myocardial infarction.