2010;95(5) – ABC CARDIOL

Point of view

Angioplasty versus surgery: meta-analyses or registries?

Pedro José Negreiros de Andrade

POINT OF VIEW

[…]

Read Full Article

Letter to the Editor

Risk scores and acute coronary syndrome

Eduardo Maffini da Rosa et al. William Cenci Tormen William Schalins May

LETTER TO THE EDITOR

[…]

Read Full Article

Case Report

Amiodarone and thyrotoxicosis: case reports

Ana Beatriz Winter Tavares et al. Simone Kalil de Paula Mario Vaisman Patrícia de Fátima dos Santos Teixeira

Amiodarone-induced thyroid dysfunction has been reported to affect 2-24% of users. Despite the easy management of amiodarone-induced hypothyroidism, the development of thyrotoxicosis leads to a difficult approach in most cases. The aim of this study is to describe three different cases of patients with amiodarone-induced thyrotoxicosis and discuss the clinical and laboratorial aspects, and the different approaches to them. It is essential to carefully evaluate patients before and during amiodarone therapy, since the prompt diagnosis and treatment of this condition is essential in patients with high cardiovascular risk.

Read Full Article

Research Article

ERRATUM

December 2009 Issue, vol. 93 (6), Suppl.3, pp. e265-e302

[…]

Read Full Article

Letter to the Editor

Hormone replacement therapy: is it recommended by SBC guidelines or not?

Flávio Danni Fuchs

LETTER TO THE EDITOR

[…]

Read Full Article

Anatomopathological Session

Case 5/2010: a 41 year-old man with myocardial hypertrophy who evolved with congestive heart failure

Rafael Moura de Almeida et al. Lucas José Tachotti Pires José Soares Júnior Wilson Ichiki … Wilson André Ichiki Léa Maria Macruz Ferreira Demarchi

ANATOMOPATHOLOGICAL SESSION

[…]

Read Full Article

Letter to the Editor

Safety of the cardiopulmonary 6-minute walk test

Guilherme Veiga Guimarães et al. Vitor Oliveira Carvalho Juliana Fernanda Belli

LETTER TO THE EDITOR

[…]

Read Full Article

Review Article

Are drug-eluting stents safe and effective in the long term?

Sanjay Sastry et al. Marie-Claude Morice

The introduction of drug-eluting stents in 2002 revolutionized interventional cardiology by minimizing restenosis. Reports of increased late stent thrombosis with these stents compared with bare metal stents, probably due to delayed endothelialization, emerged late in 2006. These studies contained serious methodological flaws, however. Subsequent meta-analyses clearly showed only a small incremental risk of late stent thrombosis across all patient groups. Importantly, a significant and sustained benefit of drug-eluting stents due to reduced restenosis and thus repeat revascularization was also shown. Several ‘real-world’ registries have confirmed these results and suggested that the use of these stents in more complex situations is not associated with adverse outcomes. Stent thrombosis is a multifactorial problem, in which the stent is only one element. Further research is required to determine optimal procedural technique and antiplatelet regimens. Drug-eluting stents are safe and effective in the long-term, though intensive research continues into ways to reduce the risk of stent thrombosis in the next generation.

Read Full Article

Case Report

Giant atrial myxoma mimicking severe mitral stenosis in young patient

Eric Paiva Vilela et al. Leonardo Moura Danielle Pepe Edson Nunes … Fabio Erthal Erika Campana

The echocardiogram of a twenty-year-old man, previously healthy, suffering from paroxysmal nocturnal dyspnea and fatigue after moderate exertion that intensified over a period of about ten days, showed the left atrium myxoma working as severe mitral stenosis.

Read Full Article

Clinical Update

Physical exercise and endothelial dysfunction

Gabriela Lima de Melo Ghisi et al. Adriana Durieux Ricardo Pinho Magnus Benetti

The role of the endothelium was considered mainly as a selective barrier for the diffusion of macromolecules from the lumen of blood vessels to the interstitial space. During the last 20 years, many other functions have been defined for the endothelium, such as the regulation of the vagal tonus, the promotion and inhibition of neovascular growth and the modulation of inflammation, of platelet aggregation and coagulation. This finding is considered one of the most important concepts in modern vascular biology. Currently, atherosclerosis is the prototype of the disease characterized in all its phases by an endothelial dysfunction, defined as an insufficient offer of nitric oxide (NO), which predisposes the endothelium to oxidative stress, inflammation, erosion and vasoconstriction. In this sense, several experimental studies have demonstrated that physical exercise is capable of restoring and improving the endothelial function. The impact of exercise on the endothelium has been broadly discussed. Considering its vasodilating effect and the risk factors, the possibility of treating coronary artery disease and its outcomes without the inclusion of physical exercise became unconceivable. However, the literature is still controversial regarding the intensity of physical effort that is necessary to cause significant protective alterations in endothelial functions. Moreover, the association between intense physical exercises and increased oxygen consumption, with a consequent increase in free radical formation, is also discussed.

Read Full Article

Artigo Original

Prevalence and anthropometric predictors of high blood pressure in schoolchildren from João Pessoa – PB, Brazil

Veruska Moreira de Queiroz et al. Patrícia Vasconcelos Leitão Moreira Tereza Helena Cavalcanti de Vasconcelos Rodrigo Pinheiro de Toledo Vianna

BACKGROUND: Arterial hypertension (AH) belongs to the group of cardiovascular diseases with the highest mortality in the world and its onset can occur in childhood. OBJECTIVE: To evaluate the prevalence of high blood pressure (BP) in schoolchildren from public schools and its association with anthropometric indicators. METHODS: The present was a cross-sectional study, consisting of a random sample of 750 schoolchildren aged 6 to 9 years from public schools of the city of Joao Pessoa, state of Paraiba, Brazil. The data were collected by a previously trained team. BP was measured by auscultation, using a stethoscope and an aneroid sphygmomanometer. The collected anthropometric data were weight, height and abdominal circumference. Chi-square and Student’s t association tests were used to compare means, both with a level of significance of 5%. Three logistic regression models were constructed, correlating high BP with the anthropometric variables to find a better prediction model. RESULTS: The prevalence of high BP levels was 13.6%. The body mass index (BMI) variable presented a significant association with the increase in BP levels (p < 0.0001) and a higher odds ratio (OR = 1.17). The increase in the BP levels also occurred with the increase in weight (p < 0.0001) and abdominal circumference (p < 0.0001). CONCLUSION: The identified association between excess weight with high BP levels emphasizes the need for intervention and for nutritional status control measures, such as dietary education programs aimed at the prevention and treatment of obesity as a risk factor for cardiovascular diseases in the pediatric and older age ranges. (Arq Bras Cardiol 2010; 95(5): 629-634)

Read Full Article

Artigo Original

Study of pro-thrombotic and pro-inflammatory factors in chagas cardiomyopathy

Leila Maria Magalhães Pessoa de Melo et al. Germano Emílio Conceição Souza Leandro Richa Valim Luiz Felipe Pinho Moreira … Elbio Antonio Damico Tania Rubia Flores da Rocha Antonio Carlos Pereira Barretto Celia Maria Cassaro Strunz Edimar Alcides Bocchi José Antonio Franchini Ramires

BACKGROUND: The relationship between inflammatory and prothrombotic activity in chagas cardiomyopathy and in other etiologies is unclear. OBJECTIVE: To study the profile of pro-thrombotic and pro-inflammatory markers in patients with Chagas’ heart failure and compare them with patients of non-chagas etiology. METHODS: Cross-sectional cohort. Inclusion criteria: left ventricle ejection fraction (LVEF) one month. The patients were divided into two groups: group 1 (G1) – seropositive for Chagas – and group 2 (G2) – seronegative for Chagas. Pro-inflammatory factor: Ultra-sensitive CRP. Pro-thrombotic factors: thrombin-antithrombin factor, fibrinogen, von Willebrand factor antigen, plasma P-selectin and thromboelastography. Sample calculated for 80% power, assuming a standard deviation difference of 1/3; significant p if it is < 0.05. Statistical analysis: Fisher's exact test for categorical variables; unpaired Student's t-test for parametric continuous variables and Mann-Whitney test for nonparametric continuous variables. RESULTS: Between January and June 2008, 150 patients were included, 80 in G1 and 70 in G2. Both groups maintained the averages of high sensitivity CRP above baseline values, however, there was no significant difference (p = 0.328). The fibrinogen levels were higher in G2 than in G1 (p = 0.015). Among the thromboelastography variables, the parameters MA (p=0.0013), G (p=0.0012) and TG (p =0.0005) were greater in G2 than in G1. CONCLUSION: There is no evidence of greater pro-thrombotic status among patients with Chagas disease. The levels of fibrinogen and the MA, G and TG parameters of the thromboelastography point to pro-thrombotic status among non-chagas patients. Both groups had increased inflammatory activity.

Read Full Article

Artigo Original

Prevalence of cardiovascular risk factors in elderly individuals treated in the Brazilian Public Health System in Goiânia

Carla Cristina da Conceição Ferreira et al. Maria do Rosário Gondim Peixoto Maria Alves Barbosa Érika Aparecida Silveira

BACKGROUND: Cardiovascular risk factors (CVRF) present a high prevalence and have an impact on the morbimortality of the elderly; however, this question is still unknown by the elderly treated in the Brazilian Public Health System (SUS). OBJECTIVE: To investigate the prevalence of CVRF among the elderly treated by SUS in the city of Goiânia, state of Goiás, Brazil. METHODS: Cross-sectional study using a multiple-stage sampling method, carried out through a home-based interview with 418 elderly individuals aged > 60 years treated by SUS in the city of Goiânia, state of Goiás, Brazil. Socioeconomic and demographic data, as well as data on lifestyle, weight, height, waist circumference, blood pressure and medications used were collected. The studied CVRF were: arterial hypertension, diabetes mellitus, total obesity, central obesity, dyslipidemias, smoking, sedentary lifestyle and alcohol consumption. The Chi-square test was used for the analyses of the associations, with significance being set at 5%. RESULTS: The prevalences of the CVRF were: 80.4% of arterial hypertension; 83.3% of central obesity; 59.8% of sedentary lifestyle; 32.2% of total obesity; 23.4% of dyslipidemias; 19.1% of diabetes mellitus; 10.0% of smoking and 5.9% of alcohol consumption. As for the simultaneity, 2.4% of the elderly did not present CVRF. The simultaneity of two or more CVRF occurred in 87.3% of the elderly and was more frequent among women. CONCLUSION: The CVRF occur simultaneously in more than half of the elderly individuals, and the most prevalent ones were: arterial hypertension, central obesity and sedentary lifestyle. It is necessary to foster the strategies of health promotion and prevention of cardiovascular injury in elderly individuals treated by SUS in the city of Goiânia, especially among those with simultaneous CVRF.

Read Full Article

Artigo Original

Cardiovascular responses during isokinetic muscle assessment in claudicant patients

Lucas Caseri Câmara et al. Raphael Mendes Ritti-Dias Claudia Lúcia de Moraes Forjaz Júlia Maria Greve … José Maria Santarém Wilson Jacob-Filho Pedro Puech-Leão Nelson Wolosker

BACKGROUND: Isokinetic dynamometry is becoming increasingly important for the assessment of muscle function in individuals with intermittent claudication. However, there is still little information available about the cardiovascular responses of these patients during this type of assessment. OBJECTIVE: To assess and compare the cardiovascular responses recorded during the assessment of muscle strength and endurance for two exercises commonly used in patients with IC (plantar flexion/dorsiflexion and knee flexion/extension). METHODS: The sample consisted of 17 claudicant patients with stable disease for at least 6 months. During the isokinetic dynamometer testing, non-invasive measurements of heart rate, blood pressure and double product at rest and at peak exertion were obtained according to specific protocols established for muscle strength and endurance assessment. RESULTS: Except for diastolic blood pressure, heart rate, systolic blood pressure and double product values rose during the exercise compared to the resting stage (p < 0.05). Elevations in heart rate and double product values were higher during knee extension/flexion than during plantar flexion/dorsiflexion (p < 0.05). Increases in heart rate were also higher during the endurance assessment protocol than during muscle strength assessment. CONCLUSION: Isokinetic strength and endurance testing in patients with IC results in elevation of heart rate, systolic blood pressure and double product values during the exercises. These increases are higher during the muscle endurance exercises and in those involving greater muscle mass, suggesting that strength testing of small muscle groups causes less cardiovascular overload in these patients.

Read Full Article

Artigo Original

Noninvasive assessment of patients undergoing percutaneous intervention in myocardial infarction

Rica Dodo Delmar Buchler et al. Expedito E. Ribeiro Antonio de Padua Mansur Paola Smanio … Romeu Sergio Meneghelo William Azem Chalela Carlos Alberto Buchpiguel Jorge Roberto Buchler Eric R. Bates Eulogio E. Martinez

BACKGROUND: Restenosis after primary percutaneous coronary intervention (PPCI) remains an important clinical problem, even with stent implantation. The ability of noninvasive testing to diagnose restenosis has had only inconsistent demonstration. OBJECTIVE: Our objective was to evaluate the ability of exercise treadmill testing (ETT) and myocardial perfusion imaging (MPI) to diagnose restenosis in patients treated by PPCI within 12 hours of ST-elevation myocardial infarction (STEMI). METHODS: From August 2003 to January 2006, 64 patients (mean age of 56.2±10.2 years, 53 males) were enrolled after PPCI. Only patients with left ventricular ejection fraction (LVEF) > 40%, as assessed by resting transthoracic echocardiography (TTE), were included. ETT with 12-lead ECG monitoring and right precordial leads, as also MPI were performed at 6 weeks, 6 months, and one year after intervention. Coronary angiography was performed at six months. RESULTS: Single-vessel disease was observed in 46.9% of the patients. The left anterior descending coronary artery was treated in 48.4% of the patients. Angiographic restenosis occurred in 28.8%. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of ETT in detecting restenosis were not significant. Right precordial leads did not add information. MPI sensitivity, specificity, PPV, NPV, and accuracy correlated with restenosis only in the 6-month follow-up, both when considering summed difference score >2 (p=0.006) and >4 (p=0.014). CONCLUSION: ETT did not discriminate restenosis in this population. MPI performed at 6 months correlated with restenosis and proved useful during follow-up.

Read Full Article

Artigo Original

Ministernotomy in myocardial revascularization preserves postoperative pulmonary function

Solange Guizilini et al. Douglas W. Bolzan Sonia M. Faresin Francisco A. Alves Walter J. Gomes

BACKGROUND: In coronary artery bypass graft (CABG) surgery, the need to perform a midsternotomy has been considered a factor for the decrease in postoperative pulmonary function. OBJECTIVE: To prospectively evaluate early postoperative (PO) pulmonary function in patients submitted to off-pump CABG, comparing the conventional midsternotomy with the ministernotomy approach. METHODS: A total of 18 patients were evaluated and assigned to the two groups: Group Conventional Midsternotomy (CMS, n=10) and Group Ministernotomy (MS, n=8). Spirometric results of the forced vital capacity (FVC) and the Forced Expiratory Volume in one second (FEV1) were obtained on the 1st, 3rd and 5th PO days and the arterial gasometry was obtained before and on the 1st PO day. The pulmonary shunt percentage and the pain score were also assessed. RESULTS: When compared in terms of percentage of the preoperative value, the FVC was higher in the MS group than in the CMS group on the 1st, 3rd and 5th PO days (p<0.001). Similar results were obtained for FEV1. The recovery of the FVC between the 1st and the 5th PO days was higher in the MS than in the CMS group (p=0,043). The PaO2 decreased on the 1st PO day in both groups (p<0.05), with a higher decrease in the CMS group (p=0.002). The shunt increased in the two groups on the 1st PO day (p<0.05); however, it was lower in the MS group (p=0.02). The reported pain score was lower and the duration of the hospital stay was shorter in the MS group. CONCLUSION: Patients submitted to CABG by MS present better preservation and recovery of pulmonary function than those submitted to CMS.

Read Full Article

Artigo Original

Profile of patients with hypertension included in a cohort with HIV/AIDS in the state of Pernambuco, Brazil

Evanizio Roque de Arruda Júnior et al. Heloisa Ramos Lacerda Líbia Cristina Rocha Vilela Moura Maria de Fátima Pessoa Militão de Albuquerque … Demócrito de Barros Miranda Filho George Tadeu Nunes Diniz Valéria Maria Gonçalves de Albuquerque Josefina Cláudia Zirpoli Amaral Verônica Soares Monteiro Ricardo Alencar de Arraes Ximenes

BACKGROUND: Hypertension (HBP) is modifiable risk factor, whose control may reduce cardiovascular disease in patients with human immunodeficiency virus (HIV). OBJECTIVE: To estimate the prevalence of hypertension and describe the characteristics of patients with hypertension infected by HIV/AIDS. METHODS: A cross-sectional study aligned to a cohort of patients with HIV/AIDS. The study considered hypertension at levels > 140/90 mmHg or use of antihypertensive drugs and pre-hypertension at levels > 120/80 mmHg. RESULTS: Out of 958 patients, 388 (40.5%) were normotensive, 325 (33.9%) were pre-hypertensive, and 245 (25.6%) were hypertensive. Out of these 245 patients, 172 (70.2%) were aware of the fact there they were hypertensive, and 36 (14.8%) had blood pressure controlled. Sixty-two (62) patients (54.4%) were diagnosed with hypertension after HIV diagnosis. Lipodystrophy occurred in 95 (46.1%) patients; overweight/obesity in 129 (52.7%). Use of antiretrovirals occurred in 184 (85.9%), 89 (41.6%) with protease inhibitors (PI) and 95 (44.4%) without PI. Out of these patients, 74.7 used antivirals > 24 months. Age, family history of hypertension, waist circumference, body mass index and triglyceride levels were higher among hypertensive patients. Time of HIV infection, CD4 count, viral load, time and type of antiretroviral regimen were similar in hypertensive and prehypertensive patients. CONCLUSION: The high frequency of uncontrolled hypertensive patients and cardiovascular risks in HIV-infected patients point out to the need for preventive and therapeutic measures against hypertension in this group.

Read Full Article

Artigo Original

Lipid profile of schoolchildren from Recife, PE

Patrícia Brazil Pereira et al. Ilma Kruze Grande de Arruda Ana Márcia Tenório de Souza Cavalcanti Alcides da Silva Diniz

BACKGROUND: The occurrence of dyslipidemia is increasing in pediatric populations. Altered lipid profiles are related to a higher incidence of hypertension and atherosclerotic disease. OBJECTIVE: To evaluate the extent of dyslipidemia and investigate its association with overweight and abdominal obesity in adolescent students from Recife, Brazil. METHODS: Personal data, socioeconomic level, anthropometric measurements and lipid profile of 470 adolescents, aged 10 to 14 years, of both sexes, students at the Public School system in the city of Recife, state of Pernambuco, Brazil, were obtained. The statistical analysis was carried out using the Epi-info 6.04 and SPSS 13.0 software. The level of significance was set at 5%. RESULTS: The majority of the population was dyslipidemic (63.8%; 95%CI: 59.3 – 68.2), with hypoalphalipoproteinemia being the most prevalent dyslipidemia (56%; 95%CI: 51.3 – 60.5). Adolescents who were overweight or who had abdominal obesity presented higher levels of triglycerides and lower levels of HDL-cholesterol (p < 0.05). Levels of total cholesterol and fractions were not different between sexes. CONCLUSION: A high incidence of unfavorable lipid profile was shown in this series, demonstrating the necessity to measure the lipid profile as early as this age range. Healthy lifestyle measures should be encouraged in this population.

Read Full Article

Artigo Original

Cost-effectiveness of implantable cardioverter defibrillators in Brazil in the public and private sectors

Rodrigo Antonini Ribeiro et al. Steffan Frosi Stella Leandro Ioschpe Zimerman Maurício Pimentel … Luis Eduardo Rohde Carisi Anne Polanczyk

BACKGROUND: Many randomized clinical trials have demonstrated the effectiveness of the implantable cardioverter-defibrillator (ICDs) in death reduction of chronic heart failure (CHF) patients. Some developed countries studies have evaluated its cost-effectiveness, but these data are not applicable to Brazil. OBJECTIVE: To evaluate the cost-effectiveness of ICD in CHF patients under two perspectives in Brazil: public and supplementary health systems. METHODS: A Markov model was developed to analyze the incremental cost-effectiveness ratio (ICER) of ICD compared to conventional therapy in patients with CHF. Effectiveness was measured in quality-adjusted life years (QALYs). We searched the literature for data regarding effectiveness and complications. Costs were retrieved from public and health insurances reimbursement codebooks and from mean cost of admissions from a public and a private hospital. One-way sensitivity analysis was performed in all variables of the model. RESULTS: ICER was R$ 68,318/QALY in the public and R$ 90,942/QALY in the private perspective. These values are much higher than the one suggested by the World Health Organization of 3 times the gross domestic product per head (R$ 40,545 in Brazil). The results were sensitive to the cost of the device, battery replacement interval and ICD effectiveness. In a simulation resembling MADIT-I population survival and ICD benefit, ICER was R$ R$ 23,739/QALY in the public and R$ 33,592/QALY in the private perspective. CONCLUSION: The ICER aof ICD is elevated in the general ICC population, in either the public or private perspective. A more favorable result occurs in patients with a high sudden death risk.

Read Full Article

Artigo Original

Decrease in blood pressure, body mass index and glycemia after aerobic training in elderly women with type 2 diabetes

Luciana Zaranza Monteiro et al. Cássio Ricardo Vaz Fiani Maria Cristina Foss de Freitas Maria Lúcia Zanetti Milton César Foss

BACKGROUND: The aging process is associated with the development of several diseases, which can be attenuated by the practice of physical activities. Aerobic training is an effective method to maintain and improve cardiovascular function. Additionally, it has a crucial role in the prevention and treatment of several chronic-degenerative diseases, especially diabetes mellitus. }OBJECTIVE: To verify the effect of a 13-week aerobic training program on blood pressure (BP), body mass index (BMI) and glycemia levels in elderly women with type-2 diabetes mellitus (DM2). METHODS: Eleven sedentary elderly women with DM2, aged 61.0 ± 9.1 years, were submitted a 13-week aerobic training program, constituting group G2. Eleven controlled elderly women (aged 60.2 ± 6.8 years) were not submitted to the aerobic training, constituting the control group (G1). G1 attended educational lectures once a week, whereas G2 walked three times a week. RESULTS: Both groups presented a significant decrease in glycemia and diastolic blood pressure levels. No significant decreases in BMI were observed after the aerobic training in either group. CONCLUSION: The 13-week aerobic training program was enough to promote significant decrease in the diastolic blood pressure and glycemia levels; therefore, this type of exercise training decreases the risk factors for cardiovascular and metabolic diseases.

Read Full Article

Artigo Original

Biopsychosocial variables and attitudes towards treatment influence complicated hypertension

Angela Maria Geraldo Pierin et al. Elaine dos Santos Jesus Mônica Aparecida de Oliveira Augusto Josiane Gusmão … Kátia Ortega Décio Mion Jr

BACKGROUND: Complicated hypertension can be influenced by the characteristics of hypertensive patients. OBJECTIVE: To associate the condition of complicated hypertension with biosocial variables such as attitudes and beliefs about the disease and treatment and subjective well-being. METHODS: We studied 251 uncomplicated hypertensive patients (SBP > 140 mmHg and/or 90 < DBP < 110 mmHg for patients under no treatment and DBP 110 mmHg with or without treatment, with target organ damage or other diseases). RESULTS: Complicated hypertensive patients were significantly different from uncomplicated ones (p <0.05) in relation to: 1 – Prevalence of men, not white (53.0%), higher body mass index (29.5 ± 4.6 vs 28.5 ± 4.0 kg/m²), over 10 years of disease (54.0%), completion of previous treatment (53.0%) and reports of sadness about life as a whole (74.0%) 2 – Complicated hypertensive patients never bring the drugs when they travel (59.0%), nor do they buy them before running out the drugs (71.0%) and rarely follow eating guidelines (69.0%) 3 – Uncomplicated hypertensive patients showed no more migraines, joint pain and, among women, menopausal status and hormone replacement therapy, and 4 – Of those who had pressure control (< 140/90 mmHg), 61.9% were uncomplicated hypertensive patients; and 5 – Complicated hypertensive patients were not aware that treatment can prevent kidney problems and they thought that young people do not have high blood pressure. CONCLUSION: Complicated hypertensive patients showed more negative structural and psychosocial characteristics, more negative attitudes towards treatment and are unaware of the disease.

Read Full Article

Artigo Original

Relevance of the ventricular remodeling pattern in the model of myocardial infarction in rats

Marcos F. Minicucci et al. Paula S. Azevedo Lidiane P. Ardisson Katashi Okoshi … Beatriz B. Matsubara Luiz S. Matsubara Sergio A. R. Paiva Leonardo A. M. Zornoff

BACKGROND: The relevance of the remodeling pattern in the model of infarcted rats is not known. OBJECTIVE: To analyze the presence of different patterns of remodeling in this model and its functional implications. METHODS: Infarcted rats (n=47) have been divided according to the geometry pattern, analyzed by echocardiogram: normal (normal mass index and normal relative thickness), concentric remodeling (normal mass index and increased relative thickness), concentric hypertrophy (increased mass index and increased relative thickness) and eccentric hypertrophy (increased mass index and normal relative thickness). Data are median and interquartile range. RESULTS: Infarcted rats showed only two of the four geometric patterns: normal pattern (15%) and eccentric hypertrophy – EH (85%). Groups of normal pattern and EH showed no differences in the values of fractional area change (Normal = 32.1 – 28.8 to 50.7; EH = 31.3 – 26.5 to 36.7; p = 0.343). Out of the infarcted animals, 34 (74%) had systolic dysfunction, detected by fractional area change. Considering these two geometry patterns, 77% of animals with eccentric hypertrophy and 57% with normal geometry presented systolic dysfunction (p=0.355). The relative wall thickness, the geometric patterns and the body mass index were not predictors of ventricular dysfunction (p> 0.05). On the other hand, infarct size was a predictive factor for ventricular dysfunction in univariate analysis (p<0.001) and multivariate analysis (p = 0.004). CONCLUSION: Rats that underwent coronary occlusion showed two different patterns of remodeling, which do not constitute a predictor of ventricular dysfunction.

Read Full Article

Artigo Original

Expiratory positive airway pressure in postoperative cardiac hemodynamics

Ana Claudia Borges dos Santos Sena et al. Sérgio Pinto Ribeiro Robledo Leal Condessa Sílvia Regina Rios Vieira

BACKGROND: Expiratory positive airway pressure (EPAP) is used in after cardiac surgeries. However, its hemodynamic effects have not been clearly studied. OBJECTIVE: To evaluate the hemodynamic changes caused by EPAP in patients after cardiac surgery monitored by Swan-Ganz. METHODS: Patients at the first or second cardiac surgery postoperative period hemodynamically stable with a Swan-Ganz catheter were included in the study. They were assessed at rest and after using 10 cmH2O EPAP at random. The variables studied were: oxygen saturation, heart rate and respiratory rate, mean artery pressures and pulmonary artery mean pressures (MAP and PAMP), central venous pressure (CVP) and pulmonary capillary wedge pressure (PAOP), cardiac output and index, and systemic and pulmonary vascular resistances. Patients were divided into subgroups (with ejection fraction 50%) and data were compared by t test and ANOVA. RESULTS: Twenty-eight patients were studied (22 men, aged 68 ± 11 years). Comparing the period of rest versus EPAP, the changes observed were: PAOP (11.9 ± 3.8 to 17.1 ± 4.9 mmHg, p < 0.001), PVC (8.7 ± 4.1 to 10.9 ± 4.3 mmHg, p = 0.014), PAMP (21.5 ± 4.2 to 26.5 ± 5.8 mmHg, p < 0.001), MAP (76 ± 10 for 80 ± 10 mmHg, p = 0.035). The other variables showed no significant differences. CONCLUSION: EPAP was well tolerated by patients and the hemodynamic changes found showed an increase in pressure measurements of right and left ventricular filling, as well as mean arterial pressure.

Read Full Article

Artigo Original

Chronic and regular use of statin prevents atrial fibrillation in period after cardiac surgery

Renato Jorge Alves et al. Rodrigo Noronha Campos Kenji Nakiri

BACKGROND: Atrial fibrillation is a common complication after cardiac surgery. The previous use of statins may reduce the incidence of this arrhythmia. OBJECTIVE: To evaluate whether the chronic and regular use of statins, for a period of six months, prevents atrial fibrillation after elective cardiac surgery. METHODS: A study carried out with 107 patients that underwent cardiac surgery, including 66% of males and their mean age was 60.4 years (25 to 84). We evaluated the presence of atrial fibrillation among patients that used statins or not on a regular basis in the preoperative period. We excluded patients with urgent heart surgery, kidney failure, inflammatory diseases, previous atrial fibrillation, patients with thyroid disease and those using a permanent pacemaker. RESULTS: In the postoperative period, atrial fibrillation was present in 42 patients (39%) of the sample, including 11 (26%) people that had used statins on a regular basis in the preoperative period and 31 (74%) who had not. It was possible to observe that, in 22% of the patients that were using statin, there was no development of atrial fibrillation, while 45% of those who did not take statin had arrhythmia (ρ = 0.02). In the isolated myocardial revascularization, 47% of the patients that did not take statin and 23% of those that took statin developed atrial fibrillation ( ρ = 0.02). There was no statistically significant difference in the analysis of groups with or without statin for the presence of risk factors for the development of atrial fibrillation (ρ = 0.34). CONCLUSION: The regular use of statin, for six months or more in the preoperative period, reduced the incidence of atrial fibrillation after elective cardiac surgery.

Read Full Article