2010;94(6) – ABC CARDIOL

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Case Report

Robotic dissection of the right internal thoracic artery through median sternotomy

Fabio Biscegli Jatene et al. Paulo Manuel Pêgo-Fernandes Ramez Anbar Fábio Antonio Gaiotto … Marcello S. Barduco Roberto Kalil Filho

The use of robotic systems in cardiac surgeries aims at decreasing the surgical trauma. The totally endoscopic myocardial revascularization, assisted by the DaVinci robot (Intuitive Surgical, Sunnyvale, California) is feasible and the learning process must be carried out in steps. The first step is the preparation of the left internal thoracic artery, through the totally endoscopic approach. The case presented here proposes the dissection of the right internal thoracic artery through complete sternotomy. It proposes a new step directed at the totally endoscopic procedure, aiming at decreasing the injuries caused by the learning curve.

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Image

Giant left ventricular aneursym

Sait Demirkol et al. Uygar Cagdas Yuksel

IMAGE

Giant left ventricular aneursym

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Point of view

Angioplasty versus medical treatment in oligosymptomatic patients: is it time to stop it?

Pedro José Negreiros de Andrade

POINT OF VIEW

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Case Report

Anomalous origin of Coronary Artery (ALCAPA) in 64-channel TC scanner

Marcelo Souto Nacif et al. José Hugo Mendes Luz Denise Madeira Moreira Carlos Eduardo Rochitte Amarino Carvalho de Oliveira Júnior

Multidetector computed tomography (MDCT) with 64 channels provides to clinical practice an excellent method to detect coronary artery anomalies. The diagnosis of coronary anomalies consisting of origin of left coronary artery in the pulmonary trunk in adults with no history of congenital disease has few reports in literature. We report a case in a 30-year old female patient complaining of fatigue on major efforts and positive scintigraphy for ischemia. The diagnosis was made through 64-channel MDCT and thus it appears that the method can be used as baseline.

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Revisão

Adrenergic receptor polymorphisms in heart failure: what can genetics explain?

Sabrina Bernardez Pereira et al. Isabela Ambrósio Gava Camila Giro Evandro Tinoco Mesquita

REVIEW ARTICLE

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Correlação Anatomoclínica

Case 3: Elderly female patient with acute myocardial infarction presenting sudden shock during thrombolytic treatment

Márcio Sommer Bittencourt et al. Henrique Lane Staniak Vera Demarchi Aiello

ANATOMOPATHOLOGICAL SESSION

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Revisão

Should biatrial heart transplantation still be performed? A Meta-analysis

Rafael Fagionato Locali et al. Priscila Katsumi Matsuoka Tiago Cherbo Edmo Atique Gabriel Enio Buffolo

REVIEW ARTICLE

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Case Report

Cardiac involvement in Acute Chagas' Disease Cases in the Amazon region

João Marcos Barbosa-Ferreira et al. Jorge Augusto de Oliveira Guerra Franklin Simões de Santana Filho Belisa Maria Lopes Magalhães … Leíla I.A.R.C. Coelho Maria das Graças Vale Barbosa

The cardiac involvement of five patients from the Amazon region with Acute Chagas’ Disease (ACD) is described. Four of these patients presented probable oral transmission. All of them presented some degree of cardiac involvement, but there were no deaths.

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Atualização

Metabolic syndrome in coronary artery and occlusive vascular diseases: a systematic review

Daniela Reis Elbert Farias et al. Avany Fernandes Pereira Glorimar Rosa

REVIEW ARTICLE

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Artigo Original

A strategy to improve the cardiovascular risk factor profile in renal transplant patients

Denise Leite et al. Alexandre Holthausen Campos

BACKGROUND: Cardiovascular disease represents the leading cause of morbidity, mortality and graft function loss in renal transplant recipients (RTR). Aggressive treatment of risk factors is strongly advocated. However, there is a gap between recommended evidence-based therapy and effective cardiovascular management in that population. OBJECTIVE: To establish a cardiovascular risk factor control strategy for RTR. METHODS: The cardiovascular risk of 300 RTR of a renal transplant unit was assessed using the Framingham criteria. Interventions on modifiable risk factors were suggested to attending physicians by letters attached to patients’ charts, including lifestyle modifications, blood pressure control and use of antiplatelet and lipid-lowering therapy. Risk factor profiles were re-evaluated after 6 and 12 months. RESULTS: Most patients were at high cardiovascular risk (58%). After 12 months, the proportion of patients on antiplatelet, antihypertensive and lipid-lowering therapy was significantly increased (29 to 51%, 83 to 92% and 3 to 46%, p < 0.001, respectively). Total cholesterol and triglyceride levels decreased (237 to 215 mg/dl, p = 0.001 and 244 to 221 mg/dl, p = 0.03). Although a non-significant reduction in LDL levels was observed (136 to 116 mg/dl, p = 0.12), patients starting statins within the first 6 months of the study presented a significant 25% reduction in LDL (159 to 119 mg/dl, p < 0.001). The proportion of patients with complete plasma lipid evaluation was also increased (27% to 49%, p < 0.001). CONCLUSION: Our results suggest that a simple, inexpensive strategy significantly improves the cardiovascular risk profile of RTR, potentially translating into marked benefits for long-term graft function and life expectancy.

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Artigo Original

Life-habit intervention in a public institution

Carlos Scherr et al. Ademir Batista da Cunha Chyntia Karla Magalhães Rafael Aron Abitibol … Marcelo Barros Ivan Cordovil

BACKGROUND: Coronary disease is the major worldwide cause of death, according to the World Health Organization (WHO) and the second in Brazil. Sudden death occurs 4 to 6 times more frequently in those who have suffered an acute myocardial infarction (AMI); within 6 years, 18% of the men and 35% of the women will have a new AMI. The secondary prevention, of which effectiveness has been previously demonstrated, is of utmost importance. OBJECTIVE: To test the effectiveness of a multiprofessional program that aims at modifying risk factors for atherosclerosis in the public health system. METHODS: Of the 2,337 patients with coronary artery disease undergoing outpatient treatment, 513 with a coronary angiography study agreed to participate in the present study, which used lectures on how and why to control risk factors as therapeutic tool. Statistical analysis: significant variation pre and post-intervention; paired Student’s t test or Wilcoxon’s test ; existence of a significant difference between the two groups; Student’s t test for independent samples or Mann-Whitney test. Comparison among three groups: analysis of variance (ANOVA) or Kruskal-Wallis. RESULTS: Cholesterol, LDL, triglycerides, body mass index, Castelli indexes I and II and waist circumference showed a significant decrease, even in patients without hypolipemiant treatment. The assessment of the diet impact showed that 72% of the patients that did not follow a diet, started to do so. Physical activity: of the 55% sedentary patients, 71% started to exercise three or more times a week. Smoking: of the smokers, 60% (9% of the total) stopped smoking and 32% decreased the number of cigarettes. CONCLUSION: These results demonstrated the effectiveness of the programs to improve life habits when applied to the units of the public health system. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0)

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Artigo Original

Equations for predicting aerobic power (VO2) of young Brazilian adults

Paula Magrani et al. Fernando Augusto Monteiro Saboia Pompeu

BACKGROUND: VO2 may be predicted with base on anthropometric and physiological parameters for determined populations. OBJECTIVE: To propose models for submaximal and maximal VO2 prediction in young Brazilian adults. METHODS: A total of 137 volunteers (92 men) underwent graded maximal exercise test (GXT) in a cycle ergometer (MonarkTM, Br). Gas exchange and respiratory measurements were performed in an open circuit (AerosportTM TEEM 100, USA). In another group, 13 volunteers underwent GXT and a square wave test (SWT) in order to evaluate the external validity of Neder et al’s formula, ACSM’s formula, and of Åstrand-Ryhming nomogram. The study design chosen was a cross-validation and the significance level was set at p < 0.05. RESULTS: For men during submaximal exercises, a mathematical model was deduced with base on workload, body mass, and age, which explained 89% of the VO2 variation, with SEE (standard error of the estimate) = 0.33 l.min-1. For the maximum load in the male group, another model with the same variables explained 71% of VO2 variation, with SEE = 0.40 l.min-1. For women, 93% of VO2 variation could be explained, with SEE = 0.17 l.min-1, both in submaximal and maximal exercise, with only one equation by use e of the same independent variables. CONCLUSION: The models derived in the present study proved to be accurate to predict submaximal and maximal VO2 in young Brazilian adults. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0)

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Artigo Original

Prevalence of abdominal obesity in hypertensive patients registered in a Family Health Unit

Edmarlon Girotto et al. Selma Maffei de Andrade Marcos Aparecido Sarriá Cabrera

BACKGROUND: Abdominal obesity is an important cardiovascular risk factor and, along with dyslipidemia, impaired glucose tolerance and hypertension, it makes up the metabolic syndrome. OBJECTIVE: To investigate the prevalence of abdominal obesity and associated factors in hypertensive patients. METHODS: Cross-sectional study with hypertensive patients aged 20 to 79 registered in a Family Health Unit in the city of Londrina, Paraná. Abdominal obesity was found through waist-hip ratio (WHR) and waist circumference (WC) according to the cutoff points recommended by the World Health Organization (WHR > 1.0 and > WC 102 cm for men and WHR > WC 0.85 and > 88 cm for women). RESULTS: Among 378 respondents, the prevalence of abdominal obesity determined by WHR was 65.3% in adults and 68.1% in the elderly, and 87.9% in females and 30.2% in males (p <0.001). In women, WHR was associated with reports of high cholesterol, failure to perform regular physical activity, lack of paid work and low education. There was no association of WHR with any variables in males. High waist circumference was present in 66.8% of adults and 64.3% of elderly patients, also with differences between sexes (p <0.001). High waist circumference was associated, in women, to diabetes and to nonsmoking, and in men, to diabetes and to physical inactivity. CONCLUSION: These results show a high prevalence of abdominal obesity, especially among women, reinforcing the need for strategies to reduce abdominal obesity among hypertensive patients.

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Artigo Original

Morbidity and mortality in patients aged over 75 years undergoing surgery for aortic valve replacement

Felipe H. Valle et al. Altamiro R. Costa Edemar M. C. Pereira Eduardo Z. Santos … Fernando Pivatto Júnior Luciano P. Bender Marcelo Trombka Thaís B. Modkovski Ivo A. Nesralla Renato A. K. Kalil

BACKGROUND: The greater longevity observed today has caused an increase in the number of elderly who need surgery. Aortic stenosis is a common condition in this age group. OBJECTIVE: To evaluate morbidity and mortality in people aged 75 years or older who have undergone valvuloplasty or valve replacement surgery for aortic stenosis alone or associated with other injuries. METHODS: We studied 230 consecutive cases between Jan/2002-Dec/2007. Patients were 79.5 ± 3.7 years (75 – 94), and 53.9% were men. In the sample, 68.7% had hypertension, 17.9% had atrial fibrillation, 15.9% were obese, and 14.4% had undergone previous heart surgery. At surgery, 87.4% underwent aortic stent placement, and 12.6% underwent aortic valvuloplasty. RESULTS: The mortality rate was 13.9% (9.4% with isolated aortic stenosis versus 20.9% with an associated procedure, p = 0.023) and the morbidity rate was 30.0% (25.2% with aortic stenosis alone versus 37.4% with an associated procedure, p = 0.068). The most common complications were: low cardiac output (20.2%), renal dysfunction (9.7%), and prolonged ventilatory support (7.9%). In the bivariate analysis, the main predictors of mortality were low cardiac output (RR 10.1, 95% CI: 5.02-20.3), use of intra-aortic balloon (RR 6.6, 95% CI: 3.83-11.4), sepsis (RR 6.77, 95%: 1.66-9.48) and renal dysfunction after surgery (RR 6.21, 95%: 3.47-11.1). As for morbidity, the predictors were: pre-operative renal dysfunction (RR 2.22, 95%: 1.25-3.95), atrial fibrillation (RR 1.74, 95%: 1.16-2.61), and chronic obstructive pulmonary disease (COPD) (RR 1.93, 95%: 1.25-2.97). CONCLUSION: Aortic valve surgery in the elderly is related to a slightly higher mortality rate than in younger patients, and its main risk factors were associated procedures, renal failure, atrial fibrillation, COPD, and sepsis.

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Artigo Original

Congenital heart disease in adults: outpatient clinic profile at the Hospital das Clínicas of Ribeirão Preto

Fernando Amaral et al. Paulo Henrique Manso João Antonio Granzotti Walter Villela de Andrade Vicente Andre Schmidt

BACKGROUND: Service experiences for adults with congenital heart disease have not been reported in our country. OBJECTIVE: To describe the basic clinical profile of adults with congenital heart disease in an outpatient tertiary care center. METHODS: We compiled data on age, gender, place of residence, primary diagnosis, and secondary diagnoses of 413 patients treated for seven years. RESULTS: G1 (untreated): 195 patients, 51% women, 57% between 14 and 30 years, 80% living in the region. The most frequent heart diseases were ventricular septal defect (VSD) (31%), atrial septal defect (ASD) (29%), and pulmonary stenosis (7%). The predominant secondary diagnoses were hypertension (9%) and arrhythmias (5%). G2 (treated): 218 patients, 56% women, 57% between 14 and 30 years, 81% living in the region. The most frequently treated heart diseases were: ASD (36%), tetralogy of Fallot (14%), coarctation of the aorta (12%), and VSD (11%). Sixty-nine (32%) patients were operated on for congenital heart diseases in adulthood. Sixteen (7%) underwent an interventional catheterization. The predominant secondary diagnoses were hypertension (18%) and arrhythmias (8%). CONCLUSION: In the study, most patients were treated invasively, all of them were residents in the region, and most of them were under 40 years of age. Defects such as ASD, VSD, and pulmonary stenosis predominated in the untreated group, whereas in the treated group, most patients had undergone surgical correction of ASD, tetralogy of Fallot, aortic coarctation, and VSD. Hypertension and arrhythmias were relevant in both groups, and a large variety of other comorbidities were also observed.

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Artigo Original

Evaluation of longitudinal systolic function in heart failure with normal ejection fraction

Antonio José Lagoeiro Jorge et al. Eduardo Nani da Silva Luiz Cláudio Maluhy Fernandes Mário Luiz Ribeiro … Evandro Tinoco Mesquita Fernanda Volponi Licio

BACKGROUND: Heart failure with normal ejection fraction (HFNEF) is now the most prevailing model of HF in different epidemiological studies, and abnormalities in mild systolic function (subclinical) have been observed in those patients when the left ventricular contractility (LV) is evaluated in the longitudinal axis (S’) by tissue Doppler echocardiography (TDE), even in normal LV ejection fraction. OBJECTIVE: To evaluate whether patients with HFNEF, according to the new criteria set out by the European Society of Cardiology, present changes in systolic function detected by S’ measurement when compared with patients whose HFNEF has not been confirmed. METHODS: One hundred eighteen patients with signs or symptoms of HF underwent BNP measurement and TDE with measurements of longitudinal axis velocity during systole (S’) and diastole (E’) and measures of transmitral flow during diastole (E, A). RESULTS: HFNEF was confirmed in 38 patients (32.2%). Peak myocardial velocity during systole (S’) and myocardial velocity in early diastole (E’) were significantly reduced in patients with HFNEF compared to patients whose HFNEF was deleted (7.8 ± 2.3 cm/s vs 9.4 ± 2.5 cm/s p=0.002 – 7.7 ± 2.6 cm/s vs 9.4 ± 2.5 cm/s – p=0.001). Mean BNP values were higher in patients with HFNEF (140.5 ± 122.4 pg/ml vs 23.1 ± 25.0 pg/ml p <0.0001). S' correlated significantly with E' (r=0.457 – p<0.0001) revealing a strong link between ventricular contraction and relaxation. CONCLUSION: Our findings show a reduction of systolic function, as measured by S 'in HFNEF and a linear correlation between the systolic (E / E 'and E') and diastolic dysfunction degree.

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Artigo Original

Construction and validation of the CADE-Q for patient education in cardiac rehabilitation programs

Gabriela Lima de Melo Ghisi et al. Adriana Durieux Waldomiro Carlos Manfroi Artur Haddad Herdy … Tales de Carvalho Alexandre Andrade Magnus Benetti

BACKGROUND: Being aware of the coronary artery disease can be considered the first step to reduce the risk of cardiac complications. OBJECTIVE: Building and validating a tool to assess and describe coronary patients’ awareness in cardiac rehabilitation programs, with the purpose of education. METHODS: For the construction, we analyzed articles and field studies to submit items to multidisciplinary team associated to cardiac rehabilitation. After this analysis, we generated the version tested in a pilot study. The tool, named CADE-Q (Questionnaire for Coronary Patient Education) was applied in 155 patients aged 61 ± 9 (min = 36, max = 86) in response to cardiac rehabilitation programs. Out of the 155 patients, 114 were men. Internal consistency was measured by Cronbach’s alpha coefficient. Reproducibility was tested by the intraclass correlation coefficient (ICC) and construct validity was performed by exploratory factor analysis. The analysis compared the total scores as a function population characteristics and rehabilitation groups (private and public). RESULTS: The final version has 19 questions with 4 alternatives, with 4 quadrants of awareness. Cronbach’s alpha was 0.68 and ICC was 0.783. The factor analysis revealed 6 factors, covering three areas of awareness, which demonstrates the multifactorial nature of the instrument. The population characteristics as a function of the total score showed significant differences depending on the socioeconomic status variables (type of rehabilitation, household income and education level). CONCLUSION: CADE-Q has proper validity and reliability to be used in the Brazilian population in future research.

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Artigo Original

Reproducibility of the determination of anaerobic threshold in patients with heart failure

Danielle Aparecida Gomes Pereira et al. Danielle Soares Rocha Vieira Giane Amorim Ribeiro Samora Fernanda Lima Lopes … Maria Clara Norman Alencar Susan Martins Lage Verônica Franco Parreira Marcelo Velloso Maria da Consolação Vieira Moreira Raquel Rodrigues Britto

BACKGROUND: The anaerobic threshold (AT) provides information on functional capacity in heart failure (HF). However, the visual determination of the AT by ventilatory methods is subjective, being susceptible to differences between examiners. OBJECTIVE: To evaluate the inter- and intra-examiner reproducibility in the determination of the AT in patients with mild to moderate HF, using visual-graphic and V-slope methods. To compare and correlate the results. METHODS: After performing a cardiopulmonary exercise test on a treadmill, visual-graphic and V-slope methods were used for the analysis of the AT. To assess the reproducibility, three examiners determined the AT twice by each method, on different days. For statistical analysis, we used intra-class correlation coefficient (ICC) with p <0.05. RESULTS: We evaluated a total of 16 subjects, with a mean age of 45.9 ± 9.7 years, left ventricle ejection fraction of 20.5 ± 8.1%, and peak exercise oxygen consumption of 20.6 ± 7.8 mL/kg•min-1. The intra-examiner reproducibility was high in both methods for the three examiners, with ICC values between 0.87 and 0.99. The inter-examiner reproducibility was moderate in both visual-graphic method (ICC = 0.69) and V-slope method (ICC = 0.64). When comparing methods, the ICC found was 0.91. CONCLUSION: AT determination by visual-graphic and V-slope methods showed high and moderate inter- and intra-examiner reproducibility, respectively. Moreover, both methods showed good agreement when compared with each other. These results suggest that both methods can be used in a reproducible way in AT assessment of patients with mild to moderate HF.

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Artigo Original

Comparison analysis of blood pressure, obesity, and cardio-respiratory fitness in schoolchildren

Miria Suzana Burgos et al. Cézane Priscila Reuter Leandro Tibiriçá Burgos Hildegard Hedwig Pohl … Liane Teresinha Schuh Pauli Jorge André Horta Miriam Beatris Reckziegel Silvia Isabel Rech Franke Daniel Prá Marcelo Camargo

BACKGROUND: During childhood and adolescence, physical inactivity, excess weight, and poor nutrition are risk factors for chronic diseases, especially obesity, hypertension, and diabetes mellitus. Early intervention can prevent the development of these complications. OBJECTIVE: To determine the presence of cardiovascular risk (obesity and hypertension) in schoolchildren and its potential interactions with cardio-respiratory fitness. METHODS: This was a cross-sectional study conducted in a stratified cluster sample of 1,666 schoolchildren, aged between 7 and 17 years, 873 (52.4%) of them male and 793 (47.6%) of them female. The following variables were evaluated: systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), body fat percentage (BF %), and cardio-respiratory fitness. SBP and DBP were correlated with waist circumference (WC), waist-hip ratio (WHR), sum of skin folds (ΣSF), and cardio-respiratory fitness. RESULTS: A BMI assessment of the students showed that 26.7% of them were overweight or obese, and 35.9% had body fat percentage over moderately high. As to blood pressure, we found that 13.9% and 12.1% of the students were borderline or hypertensive, for SBP and DBP, respectively. There was an association among hypertension, obesity, and cardio-respiratory fitness. There was a significant correlation of SBP and DBP with all variables, and also a weak to moderate correlation with age, weight, height, BMI, and waist circumference. CONCLUSION: The presence of hypertension associated with obesity and its effects on cardio-respiratory fitness stress the importance of recommending, since childhood, a more active and healthy lifestyle.

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Artigo Original

Evidence of healthcare quality improvement in acute myocardial infarction

Antônio Sérgio Cordeiro da Rocha et al. Mônica Peres de Araújo André Volscham Luiz Antonio Ferreira Carvalho … Ary Ribeiro Evandro Tinoco Mesquita

BACKGROUND: The monitoring of healthcare quality indicators (HCQI) is a process of utmost importance in patient healthcare services. OBJECTIVE: To evaluate whether the monitoring of HCQI and the root-cause analysis improve the healthcare quality in acute myocardial infarction (AMI). METHODS: A cross-sectional and comparative analysis of HCQI was performed in patients with AMI in the years 2006 and 2007. Of the 1,461 patients admitted with chest pain, 172 (11.7%) had a diagnosis of AMI and were included in the analysis. RESULTS: The rate of primary angioplasty was 8.47% higher in 2007 (97.3%) when compared to that in 2006 (89.7%), but this difference was not statistically significant (p = 0.35). Moreover, there was no difference regarding the time of hospitalization (4 vs 5 days, p = 0.15) and the in-hospital mortality (7.8% vs 5.1%, p = 0.67) between 2007 and 2006, respectively. However, the time to the first troponin level was 27% shorter in 2007 (69 min.; 95%CI = 44-94 min.) when compared to 2006 (95 min.; 53-136 min.) (p = 0.025). The door-to-balloon time was 12% shorter (72 ± 29 min. vs 109 ± 85 min.; p = 0.03), the rate of ASA prescription at hospital discharge was 35% higher (94.7% vs 70.3%; p = 0.002) and the rate of PCA shorter than 90 minutes was 52% higher (78.3 vs 51.4%; p = 0.03) in 2007, when compared to 2006. CONCLUSION: Our results suggest that the strategy of monitoring the HCQI and the implementation of the root-cause analysis methodology can improve the healthcare process in patients with AMI.

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Artigo Original

Anemia, renal dysfunction and malnutrition associated with heart failure in patients with valvulopathy

Wysllenny Nascimento de Souza et al. Cristiane Maria Sá de Araújo Silvia Alves da Silva Marina de Moraes Vasconcelos Petribú

BACKGROUND: Valvular disease can course with heart failure (HF), anemia and renal dysfunction (RD), increasing the nutritional risk and worsening patient prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RD in patients with valvulopathy with or without HF, as well as establish a correlation with the nutritional status. METHODS: A total of 104 patients admitted at the Clinic of Valvulopathy of PROCAPE/UPE, during the period of Aug-Oct/2008. The data were obtained from the nutritional and medical follow-up files. The collected variables were: sex, age, nutritional status according to the body mass index (BMI), presence of HF, anemia and RD. Anemia was considered when hemoglobin values were < 13 g/dl in men and < 12 g/dl in women. RD was established according to the glomerular filtration rate (GFR) and it was calculated through the formula proposed by Cockcroft and Gault. RESULTS: The prevalence of anemia and RD was 71.1% and 68.8%, and 48.1% and 60.0%, in patients with and without HF, respectively, with a statistically significant difference for anemia (p = 0.022). Of the patients, 48.1% were eutrophic, 26.9% had excess weight and 25.0% presented some degree of malnutrition. The patients with HF presented a higher frequency of low weight (p = 0.020). The nutritional status was not associated with anemia (p = 0.117), but it was associated with RD, with renal function being decreased more often in patients with low weight (p = 0.000). CONCLUSION: When the prevalence of malnutrition, anemia and RD was compared between patients with and without HF, it showed statistical significance.

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Artigo Original

Aerobic exercise improves physical capacity in patients under chronic hemodialysis

Diane Michela Nery Henrique et al. Maycon de Moura Reboredo Alfredo Chaoubah Rogério Baumgratz de Paula

BACKGROUND: In the general population, regular practice of physical exercises is associated with improved physical capacity and reduction of cardiovascular events. Concerning patients with chronic kidney disease, a population with significant impairment of physical capacity and high rates of cardiovascular mortality, few studies have evaluated the effects of physical activity. OBJECTIVE: To evaluate the effect of aerobic exercise during hemodialysis on the physical capacity and blood pressure of patients with chronic renal failure. METHODS: We evaluated 14 patients with chronic kidney disease under hemodialysis, before and after 12 weeks of aerobic exercise performed during hemodialysis sessions. Patients underwent ambulatory blood pressure monitoring for 24 hours, 6-minute walk test and cardiopulmonary exercise test before and after the exercise period. RESULTS: After the exercise, there was a significant increase in the distance walked during the 6-minute walk test from 509 ± 91.9 m to 555 ± 105.8 m, and a significant reduction in systolic blood pressure of 151 ± 18.4 mmHg to 143 ± 14.7 mmHg, diastolic blood pressure of 94 ± 10.5 mmHg to 91 ± 9.6 mmHg and average arterial pressure from 114 ± 13.0 mmHg to 109 ± 11.4 mmHg. CONCLUSION: Aerobic exercise conducted during hemodialysis sessions contributed to the improvement of physical capacity and control of hypertension in patients with chronic kidney disease.

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Artigo Original

Ambulatory blood pressure monitoring in normotensive patients with subclinical hypothyroidism

Marcia Martins Ferreira et al. Patricia de Fatima dos Santos Teixeira Vera Aleta R. Mansur Vaneska Spinelli Reuters … Cloyra Paiva Almeida Mario Vaisman

BACKGROUND: Overt hypothyroidism is associated with elevation of diastolic blood pressure; however the association of subclinical hypothyroidism (SH) with arterial blood pressure (ABP) alteration is unknown. OBJECTIVE: The aim of the present study was to evaluate ambulatory blood pressure monitoring (ABPM), over 24 hours, in normotensive patients with SH in comparison to euthyroid (EU) normotensive individuals. METHODS: A cross-sectional study was performed with 50 participants (SH = 30 and EU = 20) that did not differ regarding risk factors for hypertension. The ABPM was carried out with a DINAMAPA TM monitor, using the oscillometric method validated by AAMI (Association for the Advancement of Medical Instrumentation) and by the BHS (British Hypertension Society). RESULTS: The mean serum TSH and FT4 were respectively 6.9 ± 2.2 µUI/ml and 1.1 ± 0.2 ng/dl in SH patients. Although there was no difference in the mean values of systolic and diastolic blood pressure between the two groups, there was a positive correlation between the mean values of diastolic blood pressure (DBP) and serum TSH levels in SH patients (r:0.477; p = 0.004). These correlations were detected at daytime (r:0.498; p = 0.002) and sleep-time (r:0.322; p = 0.032) measurements. CONCLUSION: The blood pressure was not different between patients with or without SH; however, the results suggest that the progression of subclinical hypothyroidism to higher levels of TSH may increase the cardiovascular risk by increasing diastolic blood pressure.

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Artigo Original

Spatial analysis of hospitalization for heart diseases in Vale do Paraíba

Paula A. Soares et al. Luiz Fernando C. Nascimento

BACKGROUND: Ischemic heart diseases (IHD) are important causes of death in the Vale do Paraíba paulista. OBJECTIVE: To identify patterns of spatial distribution of hospitalizations for acute myocardial infarction (AMI) and IHD in the Vale do Paraíba paulista. METHODS: This was an ecological study using exploratory spatial analysis of hospitalization data for acute myocardial infarction and ischemic heart disease in the Vale do Paraíba between 2004 and 2005. The statistical analysis used spatial georeferenced databases of 35 municipalities and spatial statistics routines. The admission data were obtained from the Portal Datasus of the Ministry of Health. The variables were the number of admissions for males and females aged over 30 years. To evaluate the spatial dependence we used the autocorrelation coefficients of Global Moran and Local Moran’s index. We also analyzed the correlations between variables, using the TerraView program. The level of significance was 5%. RESULTS: Among 6,287 admissions, the rates were 161.66/100 thousand. Of the total of 35 municipalities, 31.4% had rates above average. The coefficient of Moran (global) showed a statistical significance. Local indexes showed clusters, indicating a cluster of 9 municipalities in which there was spatial dependence with their own dynamics. CONCLUSION: In the mid Vale do Paraíba paulista, the spatial analysis identified spatial clusters of hospitalizations due to acute myocardial infarction and ischemic heart disease, allowing intervention to reduce rates. (Arq Bras Cardiol 2007;88(6):624-628)

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