2009;93(6) – ABC CARDIOL

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Artigo Original

Transdermal estradiol and lipid profile: effects on a specific group of Brazilian postmenopausal women

Daniel R. Callejon et al. Danyelle Romana. A. Rios Sílvio A. Franceschini Maria Regina T. Toloi

BACKGROUND: In postmenopausal women, significant changes occur that can induce cardiovascular diseases, such as atherogenic lipid profile, due to an increase in total cholesterol and LDL levels, and a decrease in HDL cholesterol levels. The hormone replacement therapy (HRT) can prevent these changes in lipid profile. OBJECTIVE: Verify the effects of HRT consisting of transdermal estradiol gel associated with medroxyprogesterone acetate on the lipid profile and biochemical parameters in Brazilian postmenopausal women. METHODS: This study is an open prospective longitudinal study, in which thirty postmenopausal women received transdermal estradiol gel (1 mg/day) continuously combined with oral medroxyprogesterone acetate (MPA) (5 mg/day) for 12 days/month. The following parameters were determined: total cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gama glutamyl transferase (GGT) and follicle-stimulating hormone (FSH). RESULTS: The parameters of the lipid profile did not show a significant decrease, while the levels of GGT and FSH had a statistically significant decrease. CONCLUSIONS: the treatment with transdermal estradiol gel did not have a significant impact on the lipid profile, thus not resulting in a beneficial effect on cardiovascular disease markers, suggesting that the dose, administration route and the time of treatment were important for these results. Moreover, the treatment using small dose and the transdermal administration route also had a significant hepatic effect in this population. Therefore, this treatment might provide interesting effects on the lipid profile in Brazilian postmenopausal women.

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Review Article

Anti-inflammatory effect of physical training in heart failure: role of TNF-α and IL-10

Miguel Luiz Batista Júnior et al. Renato Delascio Lopes Marília Cerqueira Leite Seelaender Antonio Carlos Lopes

Over the past 50 years, the understanding of the deteriorative changes involved in the progression of heart failure (HF), initially described as resulting from changes in salt and fluid retention, or changes in hemodynamic parameters, have changed significantly. Recently, several studies conducted in HF patients showed altered plasma (or serum) levels of pro-inflammatory cytokines, such as tumor necrosis factor α (TNF-α), interleukins 1, 6, and 18, and cardiotropin-1, among other inflammatory markers. These changes were independent of HF etiology, suggesting a common pathogenic pathway. In response to these new findings, interventions to prevent and/or reduce these inflammatory changes have been proposed. The aerobic training-induced cardiovascular benefits of physical exercises performed at intensities ranging from mild to moderate have been previously reported. Moreover, it has been shown that moderate aerobic physical training seems to be able to modulate, in the presence of an abnormal chronic inflammatory condition, the overexpression of pro-inflammatory cytokines, soluble adhesion molecules, chemoattractant factors and oxidative stress. Altogether, these data indicate a possible anti-inflammatory effect induced by physical training. Therefore, this review aims to assess the role of physical training as an alternative non-pharmacological adjuvant to be administered in some pathological conditions in which TNF-α chronic changes are predominant, as in HF. The “anti-inflammatory effect” induced by physical training seems to be primarily mediated by IL-10.

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Case Report

Refractory heart failure in a patient with non-compacted myocardium

Humberto Villacorta et al. Jacqueline Miranda Sampaio Fernanda Beatriz Amador Dos Santos Valdo Carrera … Carlos Cleverson Pereira Evandro Tinoco Mesquita

The non-compacted myocardium is characterized by excessive trabeculation and ventricular recesses (usually of the left ventricle) due to the interruption of the myocardial fiber compaction during embryogenesis. This abnormality usually courses with heart failure, thromboembolic phenomena and cardiac arrhythmia, predicting a bad prognosis. We report the case of a 26-year-old male individual with refractory heart failure due to isolated left ventricular non-compacted myocardium that needed a heart transplant.

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Artigo Original

Rationale and design for the PAINT randomized trial

Pedro A. Lemos et al. Bruno Moulin Marco A. Perin Ludmilla A.R.R. Oliveira … J. Airton Arruda Valter C. Lima Antonio A.G. Lima Paulo R.A. Caramori Cesar R. Medeiros Mauricio R. Barbosa Fabio S. Brito Jr Expedito E. Ribeiro Eulógio E. Martinez

BACKGROUND: We describe the rationale and design for the “PercutAneous INTervention with biodegradable-polymer based paclitaxel-eluting or sirolimus-eluting versus bare stents for de novo coronary lesions – PAINT trial”. OBJECTIVES: To evaluate two novel formulations of paclitaxel-eluting stent and the sirolimus-eluting stent against a stent with the same metallic structure but without polymer coating or drug elution. METHODS: The PAINT is a multicenter 3-arm randomized trial, conducted in Brazilian tertiary institutions, which included 275 patients allocated for the InfinniumR paclitaxel-eluting stent, the SupralimusR sirolimus-eluting stent or the Milennium MatrixR bare metal stent in a 2:2:1 ratio. Patients had de novo coronary lesions in native vessels with a diameter between 2.5 and 3.5 mm, amenable for treatment with a single stent of 29 mm or less in length. The primary objetive was to compare the in-stent late loss at 9 months of both paclitaxel- and sirolimus-eluting versus the late loss of control bare metal stents. Important secondary objectives included the comparison in outcomes between sirolimus and paclitaxel stents, as well as the analysis of the incidence of major adverse cardiac events. RESULTS AND CONCLUSIONS: The PAINT trial had a unique design that allowed for the evaluation of the safety and efficacy profiles of two novel drug-eluting stent formulations, with a biodegradable-polymer carrier and releasing paclitaxel or sirolimus, which were compared against a bare metal stent (primary objective). As the drug-eluting stents differed by the drug, but were identical otherwise, the trial also allowed the comparison of the anti-restenosis effects of sirolimus versus paclitaxel (secondary objective).

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Carta ao Editor

Mission accomplished

EDITOR’S LETTER

Mission accomplished

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Artigo Original

Etiological frequency of pulmonary hypertension in a reference outpatient clinic in Bahia, Brazil

Cesar Machado et al. Ísis Brito Denile Souza Luis Cláudio Correia

BACKGROUND: Pulmonary hypertension (PH) results from several etiologies, with possible geographic influences; however, few studies have described the etiological frequency of PH, especially in our country. It is not clear whether there is an association between etiology and pulmonary pressure level or symptom intensity. OBJECTIVES: 1) to describe the etiological prevalence of PH in the state of Bahia, Brazil; 2) to evaluate whether the etiology is a determinant factor for the pulmonary pressure level; 3) to evaluate whether the etiology is a determinant factor for functional class; 4) to identify the other predictors of pulmonary pressure level and functional class. METHODS: The present was an observational, cross-sectional study that analyzed individuals with PH treated at the Magalhaes Neto Outpatient Clinic, between June 2005 and December 2007. PH was defined as pulmonary artery systolic pressure (PASP) > 40 mmHg measure at the echocardiogram. Patients with chronic obstructive pulmonary disease or ventricular disease were excluded from the study. RESULTS: A total of 48 patients with PASP = 86 ± 24 mmHg were studied. Regarding the etiology, 42% of the patients were classified as idiopathic, followed by 25% as schistosomatic, 19% as congenital cardiopathy and 10% of chronic pulmonary embolism. A longer time of disease predicted higher pressures in patients with cardiopathy. Individuals with schistosomiasis had the best functional performance when compared to the others (456 ± 58 vs. 299 ± 138 meters, p=0.005). The schistosomatic etiology and younger age presented better functional class. CONCLUSIONS: 1) the idiopathic classification is the most prevalent, with schistosomiasis being the most frequent specific cause in our country; 2) patients with schistosomatic etiology and of younger age present better functional class. 3) the congenital cardiopathy results in a higher pressure level in the pulmonary artery, probably due to the longer duration of the disease.

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Editoriais

Impact of the Brazilian scientific publications on the recent scientific developments in cardiology

EDITORIAL

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Artigo Original

Blood pressure in young individuals as a cardiovascular risk marker. The Rio de Janeiro study

Erika Maria Gonçalves Campana et al. Andréa Araújo Brandão Roberto Pozzan Maria de Fátima França … Flavia Lopes Fonseca Oswaldo L. Pizzi Maria Eliane Campos Magalhães Elizabete Viana de Freitas Ayrton Pires Brandão

BACKGROUND: The study of the cardiovascular risk variables in young populations is fundamental to establish primary prevention strategies. OBJECTIVE: To evaluate the blood pressure (BP), anthropometric and metabolic profile in young individuals from The Rio de Janeiro Study, followed by 17 years. METHODS: A total of 115 individuals (64 males) were evaluated at three different moments (follow-up: 212.23±16.0 months): A1 (12.97±1.48 years), A2 (21.90±1.71 years) and A3 (30.65±2.00 years) and divided in two groups: NG (n=84) with at least two normal BP measurements at the three assessments; HG (n=31) with at least two abnormal BP measurements at the three assessments. BP and body mass index (BMI) were obtained at the three assessments. Levels of glucose, triglycerides, total cholesterol and fractions were obtained at A2 and A3. Abdominal circumference (AC) was obtained only at A3. RESULTS: 1) The means of BP, BMI and AC (p<0.0001) as well as the prevalence of systemic arterial hypertension (SAH) and overweight/obesity (O/O) (p<0.003) were higher in the HG at the three assessments; 2) The means of LDL-c and glycemia (p<0.05) at A2 and the prevalence of metabolic syndrome (MS) at A3 were higher in the HG; 3) the association SAH+O/O was more prevalent in the HG, whereas the association NBP+NBMI was more prevalent in the NG (p<0.0001) at the three assessments; 4) SAH at A1 (RR=5.20 = 5.20; p<0.0007), male gender (RR=5.26 = 5.26; p<0.0019) and OO at A1 (RR=3.40 = 3.40; p<0.0278) determined an increased risk for AH at the young adult life (A3). CONCLUSION: After 17 years of follow-up, the BP of young individuals showed a significant association with the cardiovascular risk variables and the occurrence of MS at the young adult life.

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Artigo Original

Prevalence, control and treatment of arterial hypertension in Nobres – MT

Tânia Maria do Rosário et al. Luiz César Nazário Scala Giovanny Vinícius Araújo de França Márcia Regina Gomes Pereira Paulo César Brandão Veiga Jardim

BACKGROUND: Systemic Arterial Hypertension (SAH), considered a public health problem due to its high prevalence and difficult control, is also described as one of the most important risk factors for cardiovascular diseases. OBJECTIVE: This study aimed to determine the prevalence of SAH, as well as characteristics related to its control and treatment, among individuals aging between 18 and 90 years from the urban region of Nobres, MT. METHODS: Cross-sectional, population-based study, with random sampling and with replacement. For classification of SAH, criteria included blood pressure (BP) > 140/90 mmHg or current use of antihypertensive drugs. Individuals were interviewed with standardized questionnaires previously tested. Variables were described as means ± standard deviations and frequencies. Means were compared with the Student´s t test and associations were determined with the Pearson chi-square test, with a significance level of 5%. RESULTS: SAH has a prevalence of 30.1% in the sample, composed of 1,003 individuals older than 18 years. Among hypertensive individuals (N = 302), 73.5% knew about their condition, 61.9% were under treatment and for 24.2% the BP was under control. A positive association was observed between SAH and age; illiteracy; less than 8 years education; BMI > 25 kg/m²; high and very high waist circumference; waist-hip ratio (WHR) at risk level; sedentariness; and alcoholism. CONCLUSIONS: This study showed that SAH represents an important public health problem even in a small district in the interior region of Brazil. Levels of control and treatment of hypertension in the population were higher than those observed in similar studies, but were considered not satisfactory.

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Case Report

Atypical presentation of Kommerell's diverticulum

Adriana Dias Barranhas et al. João Mauricio Canavezi Indiani Edson Marchiori Alair Augusto S. M. D. dos Santos … Carlos Eduardo Rochitte Marcelo Souto Nacif

The authors report a case of a 65-year-old male patient who, after complaint about retrosternal discomfort and going through a thoracic radiography with mediastinal enlargement, was submitted to magnetic resonance angiography, which detected a right aortic arch with aberrant left subclavian artery and Kommerell diverticulum. A literature review was the basis for our clinical conduct, for the surgical treatment is complex. The patient presented improvement with clinical treatment and, currently, is under ambulatory follow-up care, with control proposed for three months later or in case of worsening.

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Artigo Original

Importance of the area of fibrosis at midterm evolution of patients submitted to ventricular reconstruction

Gustavo Calado de Aguiar Ribeiro et al. Mauricio Lopes Fernando Antoniali Ana Nunes … Cledicyon Eloy Costa Juliano L. Fernandes

BACKGROUND: Although it is acknowledged that the ventricular reconstruction surgery (VRS) can promote reverse remodeling, new studies are necessary to define the influence of the left ventricular (LV) area of fibrosis. OBJECTIVE: To evaluate whether the extension of the area of fibrosis of the LV is important in the LV functional recovery after the surgery and correlate it with clinical factors. METHODS: Prospective analysis of 82 patients with ventricular dysfunction submitted to VRS. We analyzed the importance of the clinical characteristics and the amount of fibrosis was assessed, measured by cardiac magnetic resonance (CMR) as small, medium and large. RESULTS: All patients were followed for 36 months, with a mortality of 6%. The amount of medium fibrosis was 25.8% ± 13.6%. There was improvement in the left ventricular ejection fraction (LVEF), from 36.9% ± 6.8% to 48.2% ± 8.2% (p < 0.001). There was an inverse association between the amount of fibrosis and the increase in LVEF (r = -0.83, p < 0.0001). There was a decrease in the LV end-systolic volume of 43.3 ± 8.2ml/m² (p < 0.001). There was an improvement in heart failure symptoms, except in patients with large areas of fibrosis (p = 0.45). The independent predictors for events were: fibrotic area (p = 0.01), age (p = 0.01), LV end-systolic volume (p = 0.03) and LVEF (p = 0.02). The event-free follow-up was different in relation to the area of fibrosis (p < 0.01). CONCLUSION: In patients with ventricular dysfunction, the extension of the area of fibrosis was an independent predictor of the LV functional recovery after the VRS. The combination of cardiac MRI and clinical parameters can help in the indication for VRS.

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Artigo Original

Prevalence of electrocardiographic findings in elderly individuals: the Sao Paulo aging & health study

Liz A. Kawabata-Yoshihara et al. Isabela M. Benseñor Vitor S. Kawabata Paulo R. Menezes … Marcia Scazufca Paulo A. Lotufo

BACKGROUND: The determination of the prevalence of electrocardiographic alterations in the older age strata of the Brazilian population represents important information with clinical and epidemiological purpose. OBJECTIVE: To verify the prevalence rates of atrial fibrillation, enlarged Q/QS waves (Minnesota code 1.1-1.2) and left bundle branch block. METHODS: In a population-based study, 1,524 participants (921 women and 603 men) aged > 65 years and living in Sao Paulo, Brazil, were submitted to electrocardiographic assessment at rest as well as anthropometric and blood pressure measurements, in addition to fasting blood collection for the measurement of glycemia, total cholesterol and fractions. RESULTS: The age-adjusted prevalence for enlarged Q/QS waves was12.1% (men, 17.2%; women, 9.6%), 2.4% for atrial fibrillation (men 3.9%; women, 2.0%); and 3.1% for left bundle branch block (men, 3.1%; women, 3.8%). For atrial fibrillation (both sexes), enlarged Q/QS waves (men) and left bundle branch block (women) there was an increase in frequency according to the age stratum. After adjusted for age, sex, diabetes mellitus and dyslipidemia, the odds ratio among the frequencies of enlarged Q/QS waves; arterial hypertension was 2.4 (95% CI: 1.4 -3.9) being 5.1 (95%CI: 1.8 -14.4) for women and 1.7 (95%CI: 0.95-3.1] for men. CONCLUSION: The comparison of these data with those from other studies showed a high prevalence of enlarged Q/QS waves in this population, with a direct association with the prevalence of arterial hypertension.

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Artigo Original

Scale of VO2peak in obese and non-obese adolescents by different methods

Gerusa Eisfeld Milano et al. André Rodacki Rosana Bento Radominski Neiva Leite

BACKGROUND: Peak oxygen uptake (VO2peak) can be defined as the highest oxygen rate consumed during exhaustive or maximal exercise. The evaluation of the aerobic fitness can be expressed as relative to body mass, but this procedure may not fully remove differences when heavy subjects are assessed. Thus, the allometric scaling procedure is an attractive strategy to compare individuals with large differences in body mass. OBJECTIVE: Investigate VO2peak in obese and non-obese individuals using body mass correction (conventional) and allometric scaling (allometric) methods and how these methods apply when subjects of different genders exercise on a treadmill. METHODS: VO2peak relative to body weight and measured by the allometric method were compared in 54 obese and 33 non-obese adolescents (10 a 16 years). Indirect calorimetry was used to assess VO2peak during a maximal test. The allometric exponent was calculated taking into account individual body mass. Then, VO2peak was corrected by the allometric exponent. The comparisons were performed using a repeated measures two-way ANOVA (p<0.05). RESULTS: The absolute VO2peak was higher (p0.05). However, VO2peak calculated by the conventional method was higher (p0.05) between the groups. CONCLUSION: The obese showed lower VO2peak values than non-obese individuals when assessed by the conventional method. However, when the allometric scaling method was applied, differences disappeared.

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Artigo Original

Proposal of cut points for the indication of abdominal obesity among adolescents

Rômulo Araújo Fernandes et al. Diego Giulliano Destro Chritofaro Jamile Sanches Codogno Camila Buonani … Denise Rodrigues Bueno Arli Ramos de Oliveira Clara Suemi da Costa Rosa Ismael Forte Freitas Júnior

BACKGROUND: The absence of critical values for the cardiovascular risk identification among Brazilian adolescents represents an important limitation. OBJECTIVES: To prepare critical values for the waist circumference and to analyze its efficiency in indicating increased values of the arterial pressure. METHODS: Transversal study that evaluated 1,145 adolescents, from 11 to 17 years old (536 of the male sex and 609 of the female), their body weight values, stature, resistance, reactance, tricipital cutaneous fold, waist circumference and arterial pressure (n = 334) were collected. The abdominal obesity was indicated by waist circumference values. RESULTS: The obese adolescents presented higher waist circumference values and, independently of the gender and age group, there was a significant relation between the waist circumference values and all the adiposity indicators adopted in the study. The proposed critical values presented higher sensibility in indicating increased values of the arterial pressure. CONCLUSIONS: The critical values proposed for the waist circumference were more sensitive in the indication of increased values of the blood pressure. However, other studies to investigate their efficacy in the indication of other clinical and laboratorial parameters are still needed.

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Editoriais

Cardiovascular health of the brazilian male: the view of the Brazilian Society of Cardiology

Antonio Carlos Palandri Chagas et al. Emilio César Zilli João Fernando Monteiro Ferreira Miguel Antonio Moretti Rui Fernando Ramos

EDITORIAL

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Case Report

Influenza A (H1N1) pneumonia in an immunossupressed patient after heart transplantation

Fernando Bacal et al. Luis Fernando Seguro Tania Ogawa Sandrigo Mangini … Alfredo Fiorelli Edimar Bocchi

The role of the immune response during Influenza H1N1 virus infection is not yet fully established, but it is believed that it decisively participates in the severity of the disease as well as in the development of acute respiratory distress syndrome. The role of immunomodulating therapies in the control of viral infections is not a consensus either, and data from the literature defining the indications for their use are lacking. The present report is, to our knowledge, the first on a heart transplant patient who developed H1N1 virus infection and had a favorable outcome, thus generating discussion on the real role of immunosuppressive therapy as a risk factor for the severe form of the disease.

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Brief Communication

Chronic chagasic cardiopathy in Amazon region: an etiology to remember

João Marcos Bemfica Barbosa Ferreira et al. Jorge Augusto de Oliveira Guerra Belisa Maria Lopes Magalhães Leíla I. A. R. C. Coelho … Marcel Gonçalves Maciel Maria das Graças Vale Barbosa

This study assessed the frequency of chronic chagasic cardiopathy (CCC) in 37 autochthonus patients from Amazon region with left ventricular systolic dysfunction of undefined etiology. Three cases were diagnosed in the studied sample, with an 8.1% frequency.

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Artigo Original

Permanent Education in BLS and ACLS: impact on the knowledge of nursing professionals

Sandro Gonçalves de Lima et al. Larissa Araripe de Macedo Marcela de Lima Vidal Michel Pompeu Barros de Oliveira Sá

BACKGROUND: The theoretical knowledge and practical skills of the Basic Life Support (BLS) and the Advanced Life Support (ALS) are among the most important determining factors of the cardiopulmonary reanimation success rates. OBJECTIVE: Assess the impact of a permanent training program in BLS and ALS on the knowledge of nursing professionals. METHOD: Cross-sectional study. Population was made of nursing professionals of a tertiary level hospital. Assessments were carried out before and after training. The critical points of the International Liaison Committee on Resuscitation (ILCOR) analysis were addressed. RESULTS: 213 professionals were assessed (76 nurses, 35.7%; 38 assistants, 17.8%; and 99 technicians, 46.7%). Pre-course assessment average grades were statistically different (p<0.001) among assistants (3.25), technicians (3.96) and nurses (4.69). Single professional without kids showed performance significantly superior to married professional with kids (p=0.02 and 0.004 respectively). Pre-training level of knowledge was inversely proportional to the time elapsed since the completion of undergraduate course or technical course. Main deficiencies were related to the initial approach of airways, to post-resuscitation cares and to the external cardiac massage technique. The post-course general average grade was 7.26. Assistants achieved a performance of 131.2%, technicians, of 78.9% and the nurses, of 85%, with no significant statistic difference (p=0.43). CONCLUSION: The permanent training program in BLS and ALS resulted in important increment in the level of knowledge of nursing professionals.

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Case Report

18F-FDG in distinction of atherosclerotic plaque: Innovation in PET/MRI technology

Raquel Benedetto et al. Michel Pontes Carneiro Flávia Albuquerque Junqueira Antônio Coutinho Jr. … Arno von Ristow Lea Mirian Barbosa da Fonseca

CASE REPORT

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Página do Presidente

Lots of accomplishments at the end of the year for SBC

Antonio Carlos Palandri Chagas

THE PRESIDENT’S PAGE

Lots of accomplishments at the end of the year for SBC

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Case Report

Aortic valvuloplasty with balloon catheter in maternal-fetal emergency in adolescence

Walkiria Samuel Avila et al. Ludhmila Abrahao Hajjar Tatiana da Rocha e Souza Manuel Pereira M Gomes Junior … Max Grinberg Marcelo Zugaib

The increase of cardiac output during pregnancy is the cause of heart failure in women with severe aortic valvular stenosis. Percutaneous aortic valvuloplasty has been associated with severe complications and short-term valvar restenosis. This case showed that percutaneous aortic valvuloplasty allowed both mother and fetus to survive after childbirth, and that postpartum treatment interruption resulted in maternal death in late postpartum care.

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Artigo Original

Clinical and demographic profile and quality indicators for heart failure in a rural area

Henrique Miller Balieiro et al. Raphael Kasuo Osugue Samuel Pereira Rangel Raphael Brandão … Tatiana Leal Balieiro Sabrina Bernardez Evandro Tinoco Mesquita

BACKGROUND: data on heart failure (HF) in Brazil are ensued from tertiary centers. This information can not be extended to the rural population, for it reflects distinct social, economic and cultural characteristics. OBJECTIVE: To establish the clinical and demographic profile and quality indicators for HF in rural areas. METHODS: Transversal cohort study that included 166 patients from the rural area of Valença, Rio de Janeiro, Brazil. After the evaluation of clinical, laboratorial and echocardiograph data, chi-square and Fisher’s exact tests were used for analysis of proportion, as well as the Student’s t-test for numeric variables, in order to establish the population’s characteristics. RESULTS: Mean age was 61±14 years old, as 85 of them (51%) were men, 88 (53%) were afro-Brazilian and 85 (51%) had heart failure with reduced ejection fraction (HFREF). Systemic arterial hypertension (151 patients, 91%) and metabolic syndrome (103 patients, 62%) were prevalent comorbidities. The most common etiologies were: hypertensive (77 patients, 46%) and ischemic (62 patients, 37%). Quality indicators in HF were: 43 patients (26%) with previous echocardiogram, 102 patients (62%) were in use of beta-blockers, 147 patients (88%) received angiotensin converter enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB), and 22% of the patients with atrial fibrillation (AF) were under treatment with oral anticoagulation. For heart failure with normal ejection fraction (HFNEF), females (p=0.001; OD: 0.32; CI=0.17-0.60), metabolic syndrome (p=0.004; OD: 0.28; CI=1.31-4.78) and hypertensive etiology (p<0.0001; OD: 6.83; CI=3.45-13.5) were predominant. For CIREF, males (p=0.001; OD: 0.32; CI=0.170-0.605) and ischemic etiology (p<0.0001; OD: 0.16; CI=0.079-0.330) were predominant. CONCLUSION: In rural areas, HF shows similarity with regard to sex, ethnicity and classification. Hypertensive etiology was the most commonly present. HFNEF was prevalent among women and in the presence of metabolic syndrome, while HFREF was associated with males and ischemic etiology.

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Artigo Original

Effective dose of sedation in transesophageal echocardiography: relation to age, body surface area and left ventricle function

Guilherme Moreira José et al. Carlos Eduardo Suaide Silva Luiz Darcy Cortez Ferreira Yara Prosdossini Soares de Novaes … Claudia Gianini Monaco Manuel Adán Gil Renata Rejane Linhares Marcelo Sgrott Rodrigues Antônio S. S. de Moraes Juarez Ortiz

BACKGROUND: Sedation with midazolam and meperidine is widely used in transesophageal echocardiography. However, no mean dose is established for each individual case. OBJECTIVE: To correlate the mean midazolam and meperidine doses for proper sedation for transesophageal echocardiography with age range, body surface area, and left ventricular ejection fraction. METHODS: Retrospective study comprising 1,841 patients undergoing sedation based on the Ramsay scale, with a solution containing midazolam 1.5 mg (1.5 ml), meperidine 1 mg (1 ml) and distilled water (7.5 ml). Four age groups were analyzed: G1: 65 years. Body surface area was calculated using the formula {[(height x 100)0.725] x (weight0.425) x 0.0071}. As regards the left ventricular ejection fraction, two groups were studied: GA: 55%. The statistical analysis was carried out using the Kruskal-Wallis test for the correlation with age and left ventricular ejection fraction, and simple linear correlation for body surface area. RESULTS: As regards age, the mean doses of sedation required were significantly lower in G3 and G4 (p<0.01). The analysis of left ventricular ejection fraction showed that this was significantly lower in GA (p<0.01). The linear correlation coefficient between dose of sedation and body surface area was 0.09 (null). CONCLUSION: The mean dose of sedatives required was lower in older individuals and in those with left ventricular systolic dysfunction. No correlation with body surface area was found.

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Editoriais

Risk scores in acute coronary syndrome: separating the wheat from the chaff

Antonio Carlos Carvalho et al. Iran Gonçalves Jr.

EDITORIAL

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