2006;86(6) – ABC CARDIOL

Carta ao Editor

Ischemic heart disease lethalities in the State of Rio de Janeiro between 1999 and 2003

P. R. Benchimol-Barbosa et al. Philipp Von Issendorff

LETTERS TO THE EDITOR

Ischemic heart disease lethalities in the State of Rio de Janeiro between 1999 and 2003

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Artigo Original

Predictive value of ventilatory and metabolic variables for risk of death in patients with cardiac failure

Ana Maria F. Wanderley Braga et al. Maria Urbana P. B. Rondon Carlos Eduardo Negrão Maurício Wajngarten

OBJECTIVE: To analyze the predictive value of respiratory, metabolic, and hemodynamic variables obtained during the cardiopulmonary stress test for the risk of death in patients with heart failure. METHODS: Eighty-seven NYHA Functional Class II and III patients were analyzed, ages 51 ± 0.5 years, 26 of them with Chagas’ disease, 30 with coronary ischemia, and 31 with idiopathic etiology. The cardiopulmonary stress test consisted of a ramp-protocol with 5 to 15 W/min workload increments performed on a bicycle-ergonometer until exhaustion. RESULTS: In this study, the multiple Cox regression analysis of age, height, weight, body surface, and gender showed that these parameters were not statistically significant control factors. Oxygen uptake, ventilatory equivalent of oxygen, ventilatory equivalent of carbon dioxide production, oxygen pulse, and end-tidal partial pressure of carbon dioxide at the anaerobic threshold, respiratory compensation point, and peak exercise proved to be important death predictors in heart failure patients. The relationship between the increase in carbon dioxide output as a function of the increase in minute ventilation, and the association between the oxygen uptake increase and the elevation of the workload from the beginning of exercise to the anaerobic threshold were statistically significant predictors of death in heart failure patients (p<0.05). CONCLUSION: The cardiopulmonary stress test makes it possible to evaluate ventilatory, metabolic, and hemodynamic variables that may be utilized as important markers of life prognosis in these patients.

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Atualização

Cardiovascular comorbidities and obstructive sleep apnea

Fátima Dumas Cintra et al. Dalva Poyares Christian Guilleminault Antonio Carlos Carvalho … Sergio Tufik Angelo A. V. de Paola

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a prevalent condition in the general population. It is associated with increased cardiovascular risk and often goes unrecognized. Its diagnose requires a high degree of clinical suspicion, particularly on the part of cardiologists, and it may be confirmed by polysomnography. Continuous positive airway pressure (CPAP) therapy is highly effective, since it improves sleep breathing pattern, promotes restful sleep and thus enhances the quality of life of these patients, in addition to attenuating or reversing many cardiovascular complications related to OSAHS. This paper addresses the pathophysiology and clinical features of cardiovascular comorbidities associated with the syndrome.

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Artigo Original

Additional cardiovascular risk factors associated with excess weigth in children and adolescents: the Belo Horizonte heart study

Robespierre Q. C. Ribeiro et al. Paulo A. Lotufo Joel A. Lamounier Reynaldo G. Oliveira … José Francisco Soares Denise Aparecida Botter

OBJECTIVE: To examine the association of overweight and obesity with physical activity, blood pressure (BP) and serum lipid profiles. METHODS: Epidemiologic investigation of 1,450 students, between the ages of 6 and 18, in the city of Belo Horizonte, MG. Data: weight, height, BP, skinfold thickness, waist circumference, physical activity, total cholesterol (TC), LDL-c, HDL-c, and dietary habits. RESULTS: The prevalence rates for overweight and obesity were 8.4% and 3.1%, respectively. In relation to the students in the lower quartile (Q1) of the distribution of subscapular skinfold, the students in the upper quartile (Q4) presented a 3.7 times higher risk (odds ratio) of having elevated TC levels. Overweight and obese students had a 3.6 times higher risk of having elevated systolic blood pressure, and a 2.7 times higher risk of elevated diastolic blood pressure when compared to normal weight students. The less active students in the Q1 of distribution of MET presented a 3.8 times higher risk of having elevated TC levels compared to those who were more active (Q4). CONCLUSION: Students who were overweight, obese or in the upper quartiles for other adiposity variables, as well as students with low levels of physical activity or a sedentary lifestyle presented higher blood pressure levels and a lipid profile indicative of an increased risk of developing atherosclerosis.

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Artigo Original

Resistive exercise in the evaluation of endothelial dysfunction in heart failure

Ricardo Tavares de Carvalho et al. Marcelo Luis Campos Vieira Ângela Romano Liliane Kopel Silvia G. Lage

OBJECTIVE: To evaluate the use of resistive exercise in the study of endothelial dysfunction in heart failure (HF) comparatively to reactive hyperemia (RH). METHODS: Eighteen patients with heart failure and 15 normal volunteers were submitted to intermittent handgrip exercise in a pneumatic bag, at an intensity that corresponds to 75% of the previously assessed maximum load. Patients underwent high-resolution vascular ultrasonography for brachial artery diameter and flow evaluation as well as cardiac output determination at rest, RH and after exercise. The systolic flow index in the brachial artery and cardiac index were calculated. RESULTS: Systolic flow index increase in the brachial artery was observed after RH and physical exercise, with the latter presenting the highest increase. There was an increase in the cardiac index after the study conditions in comparison to resting conditions. CONCLUSION: Resistive exercise, performed at the assessed load, increases blood flow more intensively than RH, constituting a physiological option for the evaluation of endothelial function in HF.

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Artigo Original

Influence of preload reduction on Tei index and other Doppler echocardiographic parameters of left ventricular function

Silvio Henrique Barberato et al. Roberto Pecoits Filho

OBJECTIVE: To assess the influence of preload reduction by hemodialysis on Doppler Tei Index of myocardial performance and other parameters of cardiac function. METHODS: The Tei index and left ventricular (LV) systolic and diastolic function parameters were estimated, before and after a single hemodialysis session. Only subjects who were in sinus rhythm, without history of coronary artery disease, and no evidence of cardiac valve disease and pericardial effusion were included in the study. RESULTS: Fifteen patients (8 men, mean age 53 ± 14 years) completed the study. After an ultrafiltration of 2,2 ± 1,1 liters, peak mitral E velocity decreased (p< 0,05) and A velocity remained unchanged (p = ns), resulting in reduction of E/A ratio (p< 0,01). The Tei index increased (from 0,57 ± 0,07 to 0,65 ± 0,09, p< 0,01) because of significant prolongations in isovolumetric relaxation time (from 101 ± 14 to 113 ± 17 ms, p< 0,01) and ejection time (from 271 ± 22 to 252 ± 22, p< 0,05). The isovolumetric contraction time did not vary (p = ns). There was no change in diastolic tissue Doppler parameters, while systolic velocities increased (p< 0,05). CONCLUSION: The Tei index was affected by hemodialysis-induced preload alterations, as well as other mitral inflow Doppler-derived parameters. The diastolic parameters of mitral annulus Doppler tissue were independent of preload, while systolic velocities suggested improved systolic function.

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Artigo Original

Cardiovascular risk factors in adolescents: biological and behavioral indicators

Dartagnan Pinto Guedes et al. Joana Elisabete Ribeiro Pinto Guedes Decio Sabbatini Barbosa Jair Aparecido de Oliveira Luiz Cláudio Reeberg Stanganelli

OBJECTIVE: To provide descriptive information and investigate to what extent behavioral risk factors for cardiovascular diseases are associated with biological risk factors in the young population. METHODS: The sample included 452 adolescents (246 girls and 206 boys) between 15 and 18 years of age selected in a high school in the city of Londrina, Paraná. Risk factors of a behavioral nature were analyzed as regards insufficient physical activity, excessive intake of fat and cholesterol and smoking. As biological risk factor indicators we used overweight, high arterial pressure levels, and adverse concentration of serum lipids and lipoproteins. RESULTS: Approximately 20% of the girls and 16% of the boys presented at least one biological risk factor for development of cardiovascular diseases. Overweight was significantly associated with excessive intake of fats, while elevated arterial pressure was related to sedentary lifestyle and smoking. Excessive intake of fat and cholesterol indicated increased risk of undesirable concentrations of serum lipids and lipoproteins. The risk associated with altered blood pressure and serum lipids and lipoprotein was increased two-fold in smokers when compared with nonsmokers. CONCLUSION: The results reinforce the need for interventions targeted at the adoption of a healthy lifestyle, including the regular practice of physical exercise, appropriate dietary patterns, and abstention from smoking as of an early age.

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Artigo Original

Venous endothelial dysfunction in Chagas' disease patients without heart failure

Rodrigo Della Méa Plentz et al. Maria Claudia Irigoyen Andreia Simone Muller Dulce Elena Casarini … Marcelo Custodio Rubira Heitor Moreno Junior Charles Mady Bárbara Maria Ianni Eduardo Moacir Krieger Fernanda Consolim-Colombo

OBJECTIVE: To analyze the venous endothelial function in Chagas’ disease patients without heart failure. METHODS: The Chagas’ disease Group (G1) was composed by 14 women and 2 men aged 46 ± 2,7 and the Control Group (G0) by 7 women and 1 man matched by age, weight and height. Dorsal Hand Vein Compliance Technique was used to evaluate the venous endothelial function. Crescent doses of phenylephrine were infused to get a 70% pre-constriction of the vein; after that, acetylcholine and sodium nitroprusside were respectively administrated to analyze the endothelium-dependent and -independent venodilation. RESULTS: No significant systemic hemodynamic changes were observed in both groups during the experiment. The necessary phenylephrine dose to reach 70% pre-constriction of the vein was significantly higher in the G1 (1116 ± 668,2 ng/ml) compared to G0 (103 ± 28 ng/ml) p = 0,05. The endothelium-dependent venous dilation was significantly lower in G1 (65,5 ± 8%) compared to G0 (137 ± 20 %) p = 0,009. No difference was observed in the endothelium-independent venous dilatation between groups. CONCLUSION: Patients with Chagas’ disease without heart failure presented venous endothelial dysfunction.

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Artigo Original

Concentration of serum lipids and apolipoprotein B in newborns

Sirlei Donegá et al. Jane Oba Raul C. Maranhão

OBJECTIVE: To determine the concentrations of serum lipids and apolipoprotein B (apo-B) in a population of normal full-term and preterm newborns in a city in Southern Brazil, and assess the impact of gestational age and birth weight on these values. METHODS: Two hundred and twelve newborns of both genders were studied, 142 of whom were full-term (>37 weeks of gestation) and 70 preterm (<37 weeks of gestation). According to their birth weights, the full-term and preterm newborns were classified as small for gestational age or appropriate for gestational age. Umbilical cord blood was collected for biochemical analysis. RESULTS: The total cholesterol, LDL-C, HDL-C and apo-B values were higher in preterm newborns (79±34, 26±6, 45±15 and 36±14 mg/dL, respectively ) than in full-term newborns (58±19, 20±10, 31±14 and 28±7 mg/dL, respectively; p < 0.0001). Inversely, triglyceride values were lower in preterm newborns (36±14 mg/dL) than in full-term newborns (43±25 mg/dL; p < 0.0018). Gender and size at birth did not have any impact on the values of total cholesterol and fractions, triglycerides, and apo-B. CONCLUSION: Plasma concentrations of lipids and apo-B in the population of newborns studied are similar to those in newborns from other countries and continents reported in medical literature and, as expected, are markedly lower than the values mentioned in literature for infants over two years of age. Fetal maturity has an impact on the concentration of lipids in newborns, but birth weight does not have any effect on these parameters.

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Artigo Original

Echocardiographic criteria for the definition of ventricular dysfunction severity in aortic banded rats

Vanessa Oliveira Moreira et al. Ana Valéria Barros de Castro Marcelle Yumi Yaegaschi Antonio Carlos Cicogna … Marina Politi Okoshi Camila Alves Pereira Flávio Ferrari Aragon Mário Batista Bruno Carlos Roberto Padovani Katashi Okoshi

OBJECTIVE: The purpose of this study was to identify echocar-diographic parameters that allow distinguishing different levels of cardiac dysfunction in aortic banded rats. METHODS: Wistar male rats (90-100 g) were subjected to aortic banding (n=23) or a sham operation (n=12). The following echocardiographic parameters were evaluated and used to group rats into groups with similar characteristics using cluster analysis: absolute values and after normalization to body weight of left ventricular end-diastolic diameter (LVDD) and left atrial systolic diameter; left ventricular end-systolic diameter (LVSD); LV weight to body weight ratio (LVW/BW); three indexes of left ventricular shortening (endocardial fractional shortening, EFS; midwall FS, MFS; and posterior wall shortening velocity, (PWSV). RESULTS: The cluster analysis could group aortic banded rats into two groups: mild (n=13) and severe (n=9) stage of heart failure. There was no overlapping among the values of the 95% confidence interval of the following parameters between the two groups: LVDD, LVSD, EFS, MFS, LVW/BW, and PWSV. CONCLUSION: It is feasible to distinguish two groups of aortic banded rats according to the level of cardiac dysfunction using those echocardiographic parameters. This allows to perform longitudinal studies in homogeneous groups of rats with aortic banding and cardiac dysfunction.

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