2006;87(2) – ABC CARDIOL

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Artigo Original

Carotid intimal-medial thickening and endothelial function in coronary artery disease

Graziela Chequer et al. Bruno Ramos Nascimento Túlio Pinho Navarro Eduardo Belisário Falqueto … Maria Clara N. Alencar Márcio Cristiano R. de Miranda Ari Mandil Jamil Abdalla Saad Cirilo Fonseca Antônio Luiz Pinho Ribeiro

OBJECTIVE: To investigate the correlation between the endothelial function and the carotid intimal-medial thickening (IMT) in a population of patients with coronary artery disease, as well as that between the endothelial function and carotid IMT with the severity of the coronary lesions. METHODS: Forty-three patients aged 60.5±9.2 years, (67.4% males) with coronary artery disease at the coronariography were studied. Endothelial function was assessed using the brachial artery reactivity test (BART), which measured the percentage of flow-mediated dilatation (%FMD). The carotid IMT was evaluated through vascular ultrasound. RESULTS: The mean %FDM was 4.7 ± 3.6 and the mean carotid IMT was 1.08 ± 0.23 mm. The carotid MIT and %FMD measurements showed a statistically significant correlation, with Spearman’s coefficient of 0.315, p= 0.042, demonstrating that lower %FMD values corresponded to an increased carotid IMT (r = -0.315, p = 0.042). There was no correlation between %FMD or IMT and the severity of coronary lesions. CONCLUSIONS: The presence of a correlation between carotid IMT and %FMD demonstrates a concomitance of anatomical and functional vascular alterations in coronary artery disease, regardless of the severity of the atherosclerotic lesions.

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Artigo Original

Serum NT-proBNP levels are a prognostic predictor in patients with advanced heart failure

Antonio Carlos Pereira-Barretto et al. Mucio Tavares de Oliveira Junior Célia Cassaro Strunz Carlos Henrique Del Carlo … Airton Roberto Scipioni José Antonio Franchini Ramires

OBJECTIVE: To verify if the determination of NT-proBNP values would help predict the prognosis in advanced heart failure (HF) patients. METHODS: One hundred and five subjects with average age of 52.4 years were evaluated, 66.6% of them males. Thirty-three (32.0%) subjects were outpatients and 70 (67.9%) were inpatients (functional class III/IV) admitted to the hospital for cardiac compensation. All patients had left ventricular systolic dysfunction and a mean ejection fraction of 0.29. The NT-proBNP levels were measured in all patients and they were followed-up over a period from 2 to 90 days (average 77 days). A ROC curve was drawn to determine the best cut-off point, as well as the corresponding Kaplan-Meyer survival curves. RESULTS: During the follow-up period, 22 patients died. The average NT-proBNP value of the patients who remained alive was 6,443.67±6,071.62 pg/ml, whereas that of those who died was 14,609.66±12,165.15 pg/ml (p=0.001). The ROC curve identified a cut-off point at 6,000 pg/ml with 77.3% sensitivity (area under the curve: 0.74). The survival curve for values below and above 6,000 pg/ml was significantly different (p=0.002): patients with values below 6,000 pg/ml had a 90.2% 90-day survival, and those patients with values above, a 66% survival. CONCLUSION: Patients with advanced HF, especially those admitted to the hospital for cardiac compensation, had much higher NT-proBNP values, with a two-fold increase among those who died during the follow-up period. Values above 6,000 pg/ml identify the patients most likely to die within 90 days after hospital discharge.

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Atualização

Great arteries contribution in orthostasis cardiovascular adaptation

Jorge Elias Neto

UPDATE

Great arteries contribution in orthostasis cardiovascular adaptation

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Artigo Original

Prognosis of duke treadmill score versus scintilography in patients at risk for coronary artery disease: one year follow-up

Carlos Alberto Gasperin et al. Caroline Pereira Bueno Airton Seiji Yamada Gilberto Alves da Rocha … Regina Célia Portugal Freixo Heinze Débora Cristina Fontoura de Mello Nunes Isabelle Vianna Trevisan Deisi Raquel Mostiack Lânia Romanzin Xavie Cláudia Maria Castelo Branco Silva

OBJECTIVE: The purpose was to determine the sensitivity, the specificity and a year-long risk of subsequent cardiovascular events in patients with low, intermediate and high risk prognostic Duke treadmill score (DTS) in comparison with the presence (or not) of the myocardial perfusion defects on radionuclide images. METHODS: A prospective study, with 173 consecutive patients with 02 or more risk factors to coronary artery disease (CAD), who underwent to exercise single photon – emission computed tomographic myocardial perfusion images using technetium-99m tetrophosmin (SPECT) and treadmill test (with DTS), from one neighbourhood of Curitiba city, between January 2003 and February 2004, were followed up for cardiac-cause mortality and major cardiac events. Follow-up was performed in 13± 1 months and in 162 patients was complete. RESULTS: The DTS mean those patients with cardiac event (18) over a year was -0.27 (95% CI= -3.97 to +3.91) and those free cardiac event patients (144) was +4.92 (95% CI= +4.03 to +5.81), with p<0.00069. The DTS sensitivity was 72.22% and the SPECT sensitivity was 77.78%, with no significant difference p=0.21. The DTS specificity was 54.17% and the SPECT specificity was 88.19%, with p<0.0001. The cumulative proportion free-events (Kaplan-Meier) curves demonstrated that 94% those patients with low-risk DTS remained free-cardiac events. In contrast, all high-risk DTS had adverse cardiac events. Those patients with intermediate-risk DTS had 15% of cardiac event over a year. CONCLUSIONS: The DTS was as sensitivity as SPECT in determine a year risk for CAD. Those patients with DTS <-0.27 had high-risk cardiac event.

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Artigo Original

Early results of bone marrow cell transplantation to the myocardium of patients with heart failure due to chagas disease

Fábio Vilas-Boas et al. Gilson S. Feitos Milena B.P. Soares Augusto Mota … Joel Alves Pinho-Filho Augusto José Gonçalves Almeida Marcus Vinicius Andrade Heitor G. Carvalho Adriano Dourado-Oliveira Ricardo Ribeiro-dos-Santos

OBJECTIVE: To evaluate early effects of bone marrow cell transplantation to the myocardium of patients with heart failure (CHF) due to Chagas disease. METHODS: We studied 28 patients (mean age 52.2 ± 9.9), of whom 24 were male. Despite optimized treatment, 25 patients were in NYHA class III and three patients, in NYHA class IV. The procedure consisted of aspiration of 50 mL of bone marrow, separation of the mononuclear fraction, and intracoronary injection. Effects on left ventricle ejection fraction (LVEF), distance walked in the six-minute walking test, quality-of-life, NYHA class, arrhythmogenic and biochemical parameters, were all evaluated. RESULTS: There were no complications directly related to the procedure. Baseline left ventricular ejection fraction was 20.1 ± 6.8%, and 60 days after transplantation it increased to 23.0 ± 9.0%, p = 0.02. Significant improvements were observed in the NYHA class (3.1 ± 0.3 to 1.8 ± 0.5; p < 0.0001); quality-of-life (50.9 ± 11.7 to 21.8 ± 13.4; p < 0.0001); and distance walked in six minutes (355 ± 136 m to 443 ± 110 m; p = 0,003). The number of ventricular premature beats in 24 hours tended to increase (5,322 ± 4,977 to 7,441 ± 7,955; p = 0,062), but without increase in ventricular tachycardia episodes (61 ± 127 to 54 ± 127; p = 0.27). CONCLUSION: Our data demonstrate for the first time that intracoronary injection of bone marrow mononuclear cells is feasible and suggest that it may be potentially safe and effective in patients with CHF due to Chagas disease.

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Correlação Anatomoclínica

Case 4/2006 – a 74 year-old woman presenting restrictive cardiomyopathy and cardiogenic schock

George Paulo Cobe Fonseca et al. Luiz Alberto Benvenuti

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Point of view

Contrast echocardiography: does it have a future?

Cláudio L. Pereira da Cunha

POINT OF VIEW

Contrast echocardiography. Does it have a future?

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Editorial

Natriuretic peptides as prognosticators in congestive heart failure

Susan Isakson et al. Alan Maisel

EDITORIAL

Natriuretic peptides as prognosticators in congestive heart failure

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Artigo Original

Analysis of electrocardiographic recordings associated with acute myocardial infarction

Paulo Henrique Garcia Mansur et al. Lacordaire Kemel Pimenta Cury João Batista Destro-Filho Elmiro Santos Resende … José Paulo Breda Destro Luana Michelli de Oliveira Diego Carvalho Gomes de Moraes Geraldo Rubens Ramos de Freitas Lucila Soares da Silva Rocha

OBJECTIVE: Evaluate correlations between variations in eletrocardiogram (ECG) recordings and acute myocardial infarction. METHODS: Use of a low-cost software to digitalize printed and/or “.pdf” file format ECG recordings. Calculation of ST-segment area and amplitudes of the J and Y points. RESULTS: The amplitude of the Y point holds maximum correlation with troponin concentration. ST-segment elevation is not a good statistical indicator of myocardial infarction severity. There is a strong negative correlation between the amplitude of the J point and the amount of magnesium ions, but no statistical correlation with sodium or calcium ions. Neither method for calculating the ST-segment area (pixel counts and interpolation) indicated any significant differences in the results. CONCLUSION: The software used proved to be functional and cost-effective. Y point amplitude is a sensitive marker of myocardial infarction, and is also a calculation method both simpler to use and less subject to error than the calculation of the ST-segment elevation area.

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Artigo Original

Aortic stenosis and coronary disease: analysis of risk factors

Claudio Magalhães Rangel et al. Max Grinberg Raul Cavalcante Maranhão Laura Inês Ventura

OBJECTIVE: To analyze clinical laboratorial aspects of the presence of coronary disease in patients with aortic stenosis and evaluate the influence of risk factors in the development of obstructive coronary disease. METHODS: We studied 65 patients who had severe aortic stenosis with an indication for surgery, ages 51 to 85 years, 40 of them women. The coronary angiography assessment resulted in two groups: 26 (40%) with obstructive coronary disease and 39 (60%) with no coronary artery lesion. Personal antecedents for coronary disease (smoking, dyslipidemia, diabetes mellitus, arterial hypertension, family antecedents, sedentarism, and alcoholism) were analyzed. Additionally, the following assessments were made: electrocardiogram, echocardiogram with Doppler, and laboratory tests (blood glucose, total cholesterol and fractions, triglycerides, Apo-A1 and B, fibrinogen, lipoprotein (a) and fraction of triglycerides and cholesterol removal in both groups. RESULTS: In the age analysis, the group with obstructive coronary disease belonged to an older age range with statistical significance (p<0.0001). Signs of ischemia of the anterior wall identified on the electrocardiogram showed a significant relationship with the obstruction of an anterior interventricular artery (p<0.002). The univariate analysis showed a significant difference between the groups regarding averages of the aortic (p= 0.041), HDL (p=0.042), and fibrinogen (p=0.047) gradients. The group with coronary disease presented an average gradient and HDL level lower than the group without obstructive coronary disease. For the fibrinogen variable, the average in the group with no coronary disease was lower compared to that of the coronariopathy group. The multivariate logistic regression analysis showed fibrinogen levels as an independent variable for coronary disease (p<0.039). CONCLUSION: Fibrinogen was an independent risk factor for the association between obstructive coronary disease and aortic stenosis.

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Case Report

Percutaneous closure of atrial septal defect using transhepatic puncture

Edmundo Clarindo Oliveira et al. Helder Machado Pauperio Bráulio Muzzi Ribeiro Oliveira Rogério Augusto Pinto da Silva … Fabrício Maia Torres Alves Gustavo Lobato Adjuto

The percutaneous closure of ostium secundum (OS) atrial septal defect (ASD) is a well-established procedure and is today considered the treatment of choice due to its good results and low morbidity and mortality. The procedure is routinely performed through the inferior vena cava (IVC). However, this route of access is not always available due to the obstruction or congenital absence of the IVC. We will present a case of ASD closure by means of transhepatic puncture due to the impossibility of using the IVC.

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Artigo Original

Perceptions of heart failure diagnosis and management: comparison between clinical cardiologists and family doctors

Leandro Reis Tavares et al. Luis Guilhermo Cocca Velarde Verônica Alcoforado de Miranda Evandro Tinoco Mesquita

OBJECTIVE: To compare the perceptions of heart failure (HF) diagnosis and management between clinical cardiologists (CC) and family doctors (FD) in the city of Niterói. METHODS: A qualitative questionnaire, validated by the EURO-HF study, was submitted to 54 FD and 62 CC. These professionals supplied the following information: HF diagnosis; availability of complementary tests; which tests were used more often; names, dosages and adverse effects of the medications prescribed; and which pharmaceuticals reduced mortality. RESULTS: FD and CC reported that the most common signs and symptoms identified by HF patients were: dyspnea, edema and fatigue (96.3% vs. 100%, 74% vs. 58% and 22.2% vs. 67.7%). The HF classification method used most often by FD was mild/moderate/severe (53.8%) while the CC used the NYHA method (72.7%) more often. CC request echocardiograms more often than FD (p < 0.001). CC differentiate HF with preserved systolic function from HF with systolic dysfunction more often than FD (p < 0.001). CC use beta-blockers (p < 0.001), angiotensin-converting enzyme inhibitors (p < 0.001) and spironolactone (p < 0.001) more often than FD. The angiotensin-converting enzyme (ACE) inhibitor dosages used by CC are greater than those used by FD (p < 0.001) and the spironolactone dosages used by CC are closer to those recommended in medical literature. CONCLUSION: CC use a more intensive investigative diagnosis and medications that are more effective in reducing morbidity and mortality rates for HF patients.

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Artigo Original

The portuguese version, cross-cultural adaptation and validation of specific quality-of-life questionnaire – AQUAREL – for pacemaker patients

Bruna Guimarães Oliveira et al. Jorge Gustavo Velasquez Melendez Rozana Mesquita Ciconelli Leonor Garcia Rincón … Ana Amélia Soares Torres Lidiane Aparecida Pereira de Sousa Antônio Luiz Pinho Ribeiro

OBJECTIVE: To translate, to make the cultural adaptation and to evaluate reproducibility and validity of the Portuguese version of the AQUAREL (Assessment of QUAlity of life and RELated events) questionnaire, which is a specific tool to assess quality of life in pacemaker patients. METHODS: We evaluated 202 pacemaker patients: 63 patients during the cross-cultural adaptation stage and 139 during the reproducibility and validity evaluation stages. The questionnaire translation was reviewed repeatedly until > 85% of patients correctly understood the questions. Reproducibility of the final version was tested in 69 patients in whom the interview was performed twice by the same researcher. Validity was checked by the correlation between scores obtained in AQUAREL domains and those obtained in SF36 domains, in the functional class and the distance walked in the six-minute test. RESULTS: The internal consistency of AQUAREL was adequate, with Cronbach’s alpha coefficient varying between 0.59 and 0.85. Reproducibility was good, with high correlation coefficients (0.68-0.89) and random distribution of data in Bland and Altman plots, without systematic bias. A significant association was observed among AQUAREL domains and those obtained in SF36 domains and the functional class (p<0.01), although significant correlations with the distance walked in the six-minute test were not found. CONCLUSION: The Portuguese version of the AQUAREL questionnaire is easy and rapid to apply, and could be used as a specific questionnaire to assess quality of life in pacemaker patients.

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Artigo Original

QT interval dispersion analysis in acute myocardial infarction patients: coronary reperfusion effect

Neuza Helena Moreira Lopes et al. César Grupi Cleberson H. Dina Aécio F. T. de Gois … Ludhmila A. Hajjar Beatriz Ayub Carlos Eduardo Rochitte José Antonio Franchini Ramires Whady A. Hueb Roberto Kalil

OBJECTIVE: To study the effect of early reperfusion of infarct-related artery on QT(deltaQT) dispersion interval, as well as how valuable it is as a marker for coronary reperfusion and ventricular arrhythmias. METHODS: One hundred and six patients with reperfusion (WR) and 48 without reperfusion (WtR) who have received thrombolytic therapy in the acute phase of infarction were studied. ECG carried out on admission as well as on day 4 of patient’s course were analyzed. deltaQT – defined as the difference between maximum and minimum QT interval – was measured by 12-lead ECG. RESULTS: The reperfusion group showed significant deltaQT reduction – from 89.66±20,47ms down to 70.95±21.65ms (p<0.001). On the other hand, the group without reperfusion showed deltaQT significant increase – from 81.27±20.52ms up to 91.85±24.66ms (p<0.001). Logistic regression analysis showed that reduction magnitude beween pre- and post-thrombolysis deltaQT was the independent factor to most effectively identify coronary reperfusion (OR 1.045, p<0.0001; CI 95%). No significant difference was found in dispersion measures when patients with ventricular arrhythmias were compared with those with no arryhthmias in the course of the first 48 hours. CONCLUSION: The study shows that deltaQT is significantly reduced in patients with acute myocardial infarction submitted to successful thrombolysis, and is increased in infarcted patients with closed artery. deltaQT reduction between the pre- and post-thrombolysis condition was a predictor for coronary reperfusion of those patients, and did not show correlation to ventricular arrhythmias.

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Artigo Original

Score for nutritional status evaluation: the role played in the prognostic stratification of dilated cardiomyopathy and advanced heart failure patients

Luiz Guilherme Veloso et al. Antonio Carlos Pereira-Barretto Mucio Tavares de Oliveira Junior Robson Tadeu Munhoz … Paulo César Morgado José Antonio Franchini Ramires

OBJECTIVE: Develop a method for the evaluation of patient’s nutritional status through a score that expresses universal nutritional status, as well as investigate if that score would be efficient for the prognostic stratification of advanced heart failure (HF) pts. METHODS: The score was reached by the selection of evaluation methods that would quantify nutritional status: ideal body weight percentage, thickness of tricipital skinfold, percentiles for arm muscular mass circumference, albumin serum level, lymphocyte total count. In order to be validated, the score was applied to a group of 95 pts. Pts were under 65 years old no evidence of consumptive diseases. The score was analyzed to confirm whether it would keep correlation with HF clinical data and whether it would stratify its prognostic. RESULTS: Nutritional status suggesting moderate or severe malnutrition could be observed in 31/95 (32.6%). No correlation was found between nutritional score values and the duration of symptoms, or the level of ventricular dysfunction. Pts with high nutritional score showed a trend towards higher mortality rate (p=0.0606). CONCLUSION: Those data suggest malnutrition is reported by 1/3 of pts with advanced HF. A score comprising 5 parameters for nutritional status showed good correlation with the clinical, global evaluation of pts with HF. A score over 8 identified pts with higher probability of death as outcome, confirming that pts under higher malnutrition exhibit worse evolution.

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Artigo Original

Assessment of left ventricular diastolic function in hypertensive patients under different hemodynamic conditions: comparative study between transmitral and tissue doppler echocardiography

Luiz Cláudio Danzmann et al. Valéria Centeno de Freitas Luiz Felipe Araújo Marco Antonio Rodrigues Torres

OBJECTIVE: To evaluate the behavior of LV diastolic displacement velocities of basal posterior septum near mitral ring segment obtained by tissue Doppler in relation to mitral flow velocities of hypertensive subjects, submitted to preload increase by left inferior limbs elevation for 5 minutes, and during 1 minute of handgrip (conditions 1 and 2, respectively). METHODS: Twenty five outpatients (15 men, 52±11 years), with arterial hypertension > 3 years, by the transmitral flow Doppler variables: E, A and E/A, and of tissue Doppler: E’, A’ and E’/A’, in basal situation and in conditions 1 and 2. For comparison of results in basal situation with conditions 1 and 2 a paired t test was applied. RESULTS: E(cm/s) varied from 68,88 ± 11,94 to 75,82 ± 15,71* and E’(cm/s) varied from 8,22 ± 2,30 to 8,31 ± 2,24 in condition 1 (p<0.05). In addition, a comparison of variation percent (%) of Doppler transmitral indices with corresponding tissue Doppler indices variation % showed a significant difference between E and E’, with preload increase (p=0.01). CONCLUSION: Patients with left ventricular adaptation to systemic arterial hypertension showed less modification of the index E' than E, after preload increase maneuver, an evidence that may suggest its more ample utilization in the context of echocardiographic left ventricular diastolic function evaluation

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Artigo Original

Vascular reactivity response to mental stress in pregnant women with mitral stenosis

Walkiria Samuel Avila et al. Osmar Araújo Calil Ivani C. Trombetta Carlos Eduardo Negrão … Max Grinberg Marcelo Zugaib José Antonio Franchini Ramires

OBJECTIVE: To study vascular reactivity according to the analysis of blood flow and peripheral vascular resistance at rest and during mental stress in pregnant women with mitral stenosis. METHODS: Twenty two women with mitral stenosis, 13 of whom were pregnant (PS) and 9 were non-pregnant (MIS), and 9 healthy pregnant women (NP) were studied. During gestation, 9 out of the 13 patients of the PS group required a beta-blocker (PSB) and the remaining 4 progressed without medication (PSWB). Plethysmography at rest and during mental stress analyzed muscle blood flow, peripheral vascular resistance (PVR), mean arterial pressure (MAP) and heart rate (HR) during gestation and puerperium. RESULTS: During gestation of PSWB, muscle blood flow and HR were higher in 1.6% and 20.5% (p = 0.05), and PVR and MAP were lower in 19.3% and 4.4%, respectively, in comparison to the puerperium; during mental stress, the muscle blood flow increased by 55.9%, HR decreased by 30.2% and PVR and MAP were similar. In PSB, muscle blood muscle blood flow and HR were greater in 5.9% and 14.9% (p= 0.001) and MAP and PVR were lower in 10.3% and 9.1%, respectively, when compared to the puerperium. During mental stress, muscle blood flow and MAP increased by 69.8% and 174.1%, respectively. HR was similar and PVR decreased by 53.7%. The comparative study showed that in the NP group the muscle blood flow was higher, PVR was lower, and MAP and HR were similar in relation to the PS group, and that the PS, NP, MIS groups had a similar response to mental stress. CONCLUSIONS: Vascular reactivity in pregnant women with mitral stenosis was preserved and the analysis of measurements showed lower values of muscle blood flow and higher values of PVR when compared to those of healthy pregnant women.

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Artigo Original

Predictors of in-hospital lethality in patients with advanced heart failure

Adriana Lopes Latado et al. Luiz Carlos Santana Passos Julio C. V. Braga Alessandra Santos … Rodrigo Guedes Simone S. Moura Daniela Almeida

OBJECTIVE: Describe the clinical characteristics and identify potential risk factors for in-hospital lethality in patients with decompensated heart failure admitted to an intensive care unit. METHODS: Decompensated heart failure patients consecutively admitted to an intensive care unit between June 2001 and December 2003 were selected and followed during hospitalization until discharge or death. Clinical characteristics at admission were recorded and evaluated as independent risk predictors for in-hospital mortality by multiple logistic regression analysis. RESULTS: A total of 299 patients (69±13 years of age and 54% men) were enrolled. Coronary artery disease was the main cause of heart failure in 49% of the cases. Diabetes mellitus and systemic arterial hypertension occurred in 37.5% and 78% of the patients, respectively. At admission, 22% of them had atrial fibrillation, 21.5% had renal dysfunction, and 48% anemia (16.5% with severe anemia). Severe systolic dysfunction (left ventricular ejection fraction 70 years, and hyponatremia were independently associated with in-hospital mortality. CONCLUSION: Patients admitted to an intensive care unit due to decompensated heart failure have high in-hospital lethality. In this study, variables recorded at admission, such as previous stroke, atrial fibrillation, hyponatremia, renal failure, and age > 70 years were predictors of in-hospital lethality.

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Artigo Original

Maximal workload prediction models in the clinical cardio-pulmonary effort test

Fernando dos Santos Nogueira et al. Fernando Augusto Monteiro Sabóia Pompeu

OBJECTIVE: This study sought to derive generalized equations for predicting maximal workload for young men and women. METHODS: Direct ergospirometry (Aerosport® TEEM 100, USA) was used to determine VO2máx and the maximal work load (Wmax) on the cycle ergometer test (Monark®, Brazil) of thirty men (25 ± 5 years, 75.0 ± 10.7 kg; 48.4 ± 8.8 mL . kg -1 . min -1 and 243 ± 51 Watts) and thirty women (26 ± 5 years, 56.7 ± 5.9 kg, 39.8 ± 7.6 mL . kg -1 . min -1 and 172 ± 37 Watts). Age and body mass were used as independent variables. For all statistic tests, a p < 0.05 significance level was adopted. RESULTS: In the multiple linear adjustment, the maximal workload was explained by age and body mass as 54% (r = 0.73) for men, and as 76% (r = 0.87) for women, with standard errors of 0.66 W . kg -1 and 25 Watts. The proposed equations were cross-validated using another sample with similar age and VO2máx characteristics comprised of fifteen men and fifteen women. The intraclass correlation between the predicted Wmax values and those measures by ergospirometry were 0.70 and 0.69, with standard errors of 28.4 and 15.8 Watts, respectively, for men and women. CONCLUSIONS: This study exhibits valid generalized equations for determining the maximal cycle ergonometer workload for men and women.

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Artigo Original

Angiographic geometric predictors of myocardial infarction are not associated with ultrasonographic markers of plaque vulnerability

Celso Kiyochi Takimura et al. Pedro Alves Lemos Marco Antonio Perin Expedito Eustáquio Ribeiro da Silva … John Ambrose José Antonio Franchini Ramires Eulógio Emílio Martinez Filho

OBJECTIVE: Some angiographic geometric features of coronary lesions have recently been described as independent predictors of myocardial infarction. The purpose of this study was to correlate these geometric markers with intravascular ultrasound findings known to be associated with greater vulnerability to plaque rupture. METHODS: A total of 30 patients with stable coronary syndromes and de novo lesions (31 lesions) underwent coronary angiography and intravascular ultrasound (IVUS). For each lesion, angiographic geometric features (degree of symmetry, degree of stenosis, lesion length, and outflow angle) were correlated with the following ultrasound variables: type of plaque (soft, fibrous, mixed, or calcified), plaque burden and remodeling index. RESULTS: Mean lesion length was 9.2 ± 4.4 mm, percent stenosis was 50.0% to 89.0% (mean 67.7 ± 12.1%), inflow angles ranged from 8.48º to 48.78º (mean 24.0 ± 11.4º), outflow angles ranged from 8.30º to 53.03º (mean 23.8 ± 11.7º), and the symmetry index ranged from 0 to 1 (mean 0.56 ± 0.32). On ultrasound evaluation, frequency of soft or calcified plaques, positive remodeling, and magnitude of plaque burden were not associated with any angiographic geometric feature (p > 0.05 for all analysis). CONCLUSION: Angiographic geometric features that predispose to acute occlusion do not correlate with IVUS morphologic and quantitative findings associated with plaque vulnerability.

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Correlação Clínico-Radiográfica

Case 2/2006 – three-year-old child with subaortic stenosis, mitral stenosis due to parachute mitral valve, supravalvular mitral stenosis, coarctation of the aorta (Shone syndrome) associated with ventricular septal defect and ductus arteriosus

CLINICORADIOLOGICAL SESSION

Case 2/2006 three-year-old child with subaortic stenosis, mitral stenosis due to parachute mitral valve, supravalvular mitral stenosis, coarctation of the aorta (Shone syndrome) associated with ventricular septal defect and ductus arteriosus

[…]

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Editorial

Bone marrow cells and cardiac repair

Annarosa Leri et al. Jan Kajstura Piero Anversa

EDITORIAL

Bone marrow cells and cardiac repair

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