2012;99(5) – ABC CARDIOL

ABC

ABC Family | ABC

Brief Communication

Validation of the short-version of Rose angina questionnaire in Brazil

Maria-Socorro Bastos et al. Paulo A. Lotufo Aristarcho L. Whitaker Isabela M. Bensenor

BACKGROUND: Stable angina pectoris is a serious condition with few epidemiological studies in Brazil. OBJECTIVE: To validate the short-version of the Rose angina questionnaire in Brazilian Portuguese for its implementation in surveys and longitudinal studies. METHODS: A total of 116 consecutive patients from an outpatient clinic without prior myocardial infarction and/or coronary revascularization were enrolled for application of three questions of the Rose angina questionnaire addressing chest pain after exertion. We used the treadmill test as the gold standard with the Ellestad protocol. RESULTS: The short-version of the Rose angina questionnaire of the 116 subjects submitted to the exercise treadmill test disclosed 89.7% of accuracy, 25% of sensitivity, 92.0% of specificity, 10.0% of positive predictive value, 97.2% of negative predictive value, and 3.1 of positive likelihood ratio and 0.82 of negative likelihood ratio. CONCLUSION: The Portuguese version with three items of the Rose angina questionnaire is suitable for epidemiological purposes.

Read Full Article

Editorial

Percutaneous left atrial appendage occlusion: putting the most lethal human attachment behind bars

Adriano Caixeta et al. Erlon O. de Abreu Silva Philippe Généreux

EDITORIAL

Percutaneous left atrial appendage occlusion: putting the most lethal human attachment behind bars

[…]

Read Full Article

Correlação Clínico-Radiográfica

Case 05/12: a 67 year-old hypertensive woman with atrial fibrillation who presented shock followed by cardiac arrest with pulseless electric activity two months after surgical repair of ascending aorta aneurysm

Fernanda Marinho Mangione et al. Thiago Nunes Pereira Leite Paulo Sampaio Gutierrez

ANATOMOPATHOLOGICAL SESSION

Case 05/12 – a 67 year-old hypertensive woman with atrial fibrillation who presented shock followed by cardiac arrest with pulseless electric activity two months after surgical repair of ascending aorta aneurysm

[…]

Read Full Article

Case Report

Supporting stent of coronary sinus lead in cardiac resynchronization: report of 5 cases

Jaime Giovany Arnez Maldonado et al. Carla Fank Simão Maduro Rodrigo Castro … Hernou Oliveira Andre Gomes

CASE REPORT

Supporting stent of coronary sinus lead in cardiac resynchronization report of 5 cases

[…]

Read Full Article

Letter to the Editor

True prevalence of resistant hypertension

Andréa Rodrigues Sabbatini et al. Vanessa Fontana Heitor Moreno Jr

LETTER TO THE EDITOR

True prevalence of resistant hypertension

[…]

Read Full Article

Case Report

Biventricular thrombus and endomyocardial fibrosis in antiphospholipid syndrome

Luiz Flávio Galvão Gonçalves et al. Fernanda Maria Silveira Souto Fernanda Nascimento Faro Joselina Luzia Menezes Oliveira … José Augusto Soares Barreto-Filho Antônio Carlos Sobral Sousa

CASE REPORT

Biventricular thrombus and endomyocardial fibrosis in antiphospholipid syndrome

[…]

Read Full Article

Review Article

Acute myocardial infarction after noncardiac surgery

Danielle Menosi Gualandro et al. Daniela Calderaro Pai Ching Yu Bruno Caramelli

Over 230 million surgeries are performed annually worldwide, cardiac complications being the most common causes of postoperative morbidity and mortality. As life expectancy has extended worldwide, a growing number of patients with multiple comorbidities have undergone noncardiac surgeries. Consequently, cardiovascular complications associated with those procedures are expected to increase, and perioperative acute myocardial infarction (AMI) might become a frequent problem. In Brazil, the number of noncardiac surgical procedures has also increased, and approximately three million surgeries are performed annually. Despite advances in surgical and anesthetic techniques, mortality and costs related to those procedures have also increased, thus, requiring the development of strategies to reduce mortality4. The occurrence of perioperative AMI prolongs the need for intensive care and the hospital length of stay, increases the cost of hospitalization, and reduces long-term survival. This literature review approaches the pathophysiology, incidence, diagnosis and treatment of perioperative AMI based on current evidence.

Read Full Article

Artigo Original

Study of breathing pattern and thoracoabdominal movement in mitral valve disease

Satiko Shimada Franco et al. Paula Nubiato Bardi Max Grinberg Maria Ignêz Zanetti Feltrim

BACKGROUND: patients with mitral valve disease can progress to having pulmonary congestion, which increases the work the respiratory muscles. This overload can change the breathing pattern with a predominance of rib cage displacement or presence of paradoxical movements. OBJECTIVE: a) to study the breathing pattern and thoracoabdominal movement of patients with mitral valve disease; b) to study the effect of body position on breathing parameters; and c) to correlate pulmonary hypertension with lack of coordination of thoracoabdominal movement. METHODS: the breathing pattern and thoracoabdominal movement of patients with mitral valve disease were assessed using respiratory inductive plethysmography during quiet breathing in the dorsal decubitus and sitting positions for two minutes. The variables assessed were tidal volume, breathing time and thoracoabdominal movement. RESULTS: of the 65 patients selected, 10 were excluded, 29 were in the mitral stenosis group and 26 in the mitral regurgitation group. Tidal volume, pulmonary ventilation and mean inspiratory flow significantly increased in the sitting position, with no difference between the groups. The thoracoabdominal movement remained coordinated in all groups and positions; except for five patients in the dorsal decubitus position, who lacked coordination (three in the mitral stenosis group; two in the mitral regurgitation group). A significant correlation with pulmonary artery pressure values was observed (r = 0.992; p = 0.007). CONCLUSION: No difference in breathing pattern or thoracoabdominal movement was found between patients with mitral stenosis and regurgitation. The sitting position increased tidal volume without altering breathing times. The lack of coordination of the thoracoabdominal movement in the dorsal decubitus position was associated with pulmonary hypertension.

Read Full Article

Artigo Original

Role of echocardiography in the ventricular assessment of the transplanted heart versus heart rejection

Gabriel Antonio Stanisci Miguel et al. Salomón Soriano Ordinola Rojas Reinaldo Wilson Vieira José Pedro da Silva Henry Abensur

BACKGROUND: Heart transplantation is an alternative for individuals with end-stage heart disease. However, episodes of heart rejection (HR) are frequent and increase morbidity and mortality, requiring the use of an accurate non-invasive exam for their diagnosis, since endomyocardial biopsy (EMB) is not a complication-free procedure. OBJECTIVE: To compare the parameters obtained by use of Doppler echocardiography in a group of transplanted patients with HR (TX1) and another group of transplanted patients without rejection (TX0), having as reference a control group (CG) and observing the behavior of the left ventricular systo-diastolic function expressed as the myocardial performance index (MPI) METHODS: Transthoracic echocardiographies were performed from January 2006 to January 2008 to prospectively assess 47 patients divided into three groups: CG (36.2%); TX0 (38.3%); and TX1 (25.5%). The MPI was compared between the groups, and data were analyzed by use of Fisher exact test and nonparametric Kruskal-Wallis test, both with significance level of 5%. RESULTS: The groups did not differ regarding age, weight, height, and body surface. When compared to GC, TX0 and TX1 showed a change in the left ventricular systo-diastolic function, expressed as an increase in MPI, which was greater in TX1 [0.38 (0.29 – 0.44); 0.47 (0.43 – 0.56); 0.58 (0.52 – 0.74), respectively; p < 0.001]. CONCLUSION: Echocardiography was a very accurate test to detect changes in the systo-diastolic function of the transplanted heart; however, it did not prove to be reliable to replace BEM in the safe diagnosis of HR.

Read Full Article

Artigo Original

ST-Elevation myocardial infarction network: systematization in 205 cases reduced clinical events in the public health care system

Ana Christina Vellozo Caluza et al. Adriano H. Barbosa Iran Gonçalves Carlos Alexandre L. de Oliveira … Lívia Nascimento de Matos Claus Zeefried Antonio Célio C. Moreno Elcio Tarkieltaub Cláudia Maria R. Alves Antonio Carlos Carvalho

BACKGROUND: The major cause of death in the city of São Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles. OBJECTIVE:To describe in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). METHODS: Health care teams of four emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé and Saboya) of the periphery of the city of São Paulo and advanced ambulances of the Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in 6 to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni- and multivariate analysis. RESULTS: From January 2010 to June 2011, 205 consecutive patients used the STEMI Network, and the findings were as follows: 87 anterior wall infarctions; 11 left bundle-branch blocks; 14 complete atrioventricular blocks; and 14 resuscitations after initial cardiorespiratory arrest. In-hospital mortality was 6.8% (14 patients), most of which due to cardiogenic shock, one hemorrhagic cerebrovascular accident, and one bleeding. CONCLUSION: The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.

Read Full Article

Artigo Original

Postmenopausal therapy reduces catalase activity and attenuates cardiovascular risk

Vera S. Castanho et al. Rui Tsutomu Nakamura Aarão M. Pinto-Neto Eliana Cotta De Faria

BACKGROUND: Menopause can lead to alterations in women’s health, with changes in the oxidative status of postmenopausal women in whom information regarding the influence of hormone therapy (HT) on antioxidant enzyme activities is limited. OBJECTIVE: To evaluate the influence of HT on catalase activity; concentrations of lipids and lipoprotein, cholesteryl ester transfer protein, thiobarbituric acid-reactive substances, nitrates, high-sensitivity C-reactive protein and carotid thickness in postmenopausal women. METHODS: Ninety-four consecutive women were allocated to one of four groups, without HT and with HT. The latter group was subdivided into women using estrogen and those using estrogen plus progestogen therapy. Plasma biochemical parameters and common carotid intima-media thickness measurements were performed. RESULTS: HT antagonized the decrease in catalase activity after menopause, but had no effect on the levels of cholesteryl ester transfer protein, thiobarbituric acid-reactive substances, lipid peroxide, nitrate, high-sensitivity C-reactive protein, or on the common carotid intima-media thickness. Multivariate analysis showed that estrogen-based HT attenuated the relationship between cardiovascular risk factors and the intima-media thickness of the common carotid. CONCLUSION: This study indicates that HT in postmenopausal women produces beneficial antioxidant and anti-atherosclerotic effects by ameliorating the plasma lipid and lipoprotein profiles, increasing plasma catalase activity and attenuating the association between cardiovascular risk factors and early atherosclerosis.

Read Full Article

Artigo Original

Rosuvastatin and ciprofibrate in the treatment of dyslipidemia in patients with HIV

Hamilton Domingos et al. Rivaldo Venâncio da Cunha Anamaria Mello Miranda Paniago Albert Schiaveto de Souza … Renata London Rodrigues João Américo Domingos

BACKGROUND: Dyslipidemia secondary to highly active antiretroviral therapy in patients with HIV is associated with a significant increase in cardiovascular morbidity and mortality due to atherosclerotic disease, requiring, thus, immediate and effective treatment. OBJECTIVE: To demonstrate the effectiveness and safety of rosuvastatin and ciprofibrate in the treatment of dyslipidemia associated with highly active antiretroviral therapy in patients with HIV. METHODS: Three hundred and forty-six patients with dyslipidemia underwent pharmacological treatment as follows: 200 patients with hypertriglyceridemia received ciprofibrate (Group I); 79 patients with hypercholesterolemia received rosuvastatin (Group II); and 67 patients with mixed dyslipidemia received ciprofibrate associated with rosuvastatin (Group III). The lipid profile was assessed before and after the lipid-lowering treatment, and the Wilcoxon test was used for statistical comparison. Liver transaminases and creatine phosphokinase were measured to assess liver and muscle toxicity. RESULTS: The serum concentrations of triglycerides and total cholesterol were significantly lower than those obtained before the lipid-lowering treatment in the three experimental groups (p < 0.002). A significant increase in HDL-cholesterol was observed in Groups I and III (p < 0.002). In Groups I and II, LDL-cholesterol was significantly lower (p < 0.001). None of the patients experienced elevations in transaminases or creatine phosphokinase to significantly toxic levels. CONCLUSION: The results of this study show that ciprofibrate and rosuvastatin or a combination of both can be considered an effective, safe and well-tolerated lipid-lowering treatment for patients with AIDS on highly active antiretroviral therapy.

Read Full Article

Artigo Original

Ventricular repolarization in diabetic patients: characterization and clinical implications

David Clemente et al. Telmo Pereira Susana Ribeiro

BACKGROUND: Diabetes mellitus is a chronic and very common condition, and there has been lately a considerable increase in its prevalence and incidence. Diabetic patients have increased cardiovascular mortality, in which malignant ventricular arrhythmias seem to be implicated. OBJECTIVE: To study the effects of diabetes on ventricular repolarization parameters responsible for an increased susceptibility to malignant ventricular arrhythmias and/or sudden death. METHODS: We selected a group of 110 diabetic patients and a group of 110 controls with the same distribution of age, gender and race. We evaluated the following parameters of ventricular repolarization: QTmax, QTmean, QTmin, QTc max, QTc mean, QTc min, QT and QTc dispersions, Tpeak-Tend and jTpeak-jTend intervals (D II, V2 and V5), Tpeak-Tend and jTpeak-jTend dispersions. The electrocardiograms (ECG) were performed by the same operator and reviewed by the same observers. QT intervals were corrected according to Bazzet’s formula. RESULTS: We found significantly higher values of QTc max (p < 0.001), QTc mean (p < 0.001), QT dispersion (p < 0.001), QTc dispersion (p < 0.001), Tpeak-Tend dispersion ( p < 0.001), and jTpeak-jTend dispersion (p < 0.001) in diabetic patients than in controls. In diabetic patients, we observed prolonged values of QTc interval (5.5%), QT dispersion (0.9%), QTc dispersion (0%), Tpeak-Tend interval (7.3%), jTpeak-jTend interval (6.4%), Tpeak-Tend dispersion (16.4%), and jTpeak-jTend dispersion (12.7%). In the controls there were no prolonged values of any of the parameters. CONCLUSION: We concluded that diabetes causes prolongation and spatial dispersion of repolarization, and it may contribute to a greater ventricular electrical instability, whose expected clinical expression may be malignant ventricular arrhythmias.

Read Full Article

Artigo Original

Issuing electrocardiographic reports remotely: experience of the telemedicine network of Santa Catarina

Isabela de Carlos Back Giuliano et al. Cloves Langendorf Barcellos Junior Aldo von Wangenheim Mário Sérgio Soares de Azeredo Coutinho

BACKGROUND: A growing use of telemedicine has been observed, especially as regards the sending and evaluation of electrocardiograms (ECG); this is a low-cost procedure with a high potential to save lives. OBJECTIVES: To describe the form of systematic analysis and user profile of the Telemedicine Network of Santa Catarina during the time when the report was issued freely. METHODS: Observational cross-sectional study determining the associations between patient characteristics and electrocardiographic diagnoses issued among users of the Telemedicine Network of Santa Catarina during the time when the report was issued freely. This system was connected to 287 cities in Santa Catarina; the tests were done in the places of origin and the reports were issued in three tertiary-care hospitals. From 2005 to 2010 the reports were issued freely and a probabilistic method for data analysis was created. An experienced cardiologist evaluated all ECGs to assess the chances of abnormality. RESULTS: 243,363 ECGs were evaluated. The majority (58%) was performed on patients older than 50 years from primary care services (72%). There were differences in the frequency per region; this was partly related to the number of cardiologists/region (r = -0.551), to the distance from tertiary-care centers and potential differences of acceptance of the method. Approximately 53% of the ECGs were abnormal with greater frequency with increasing age (r² = 0.8166) and with significant regional differences (p < 0.0001). CONCLUSIONS: We built a data analysis system integrating prevalent terms, probabilistic analysis and specialized dictionaries. The system has covered a significant portion of the population of Santa Catarina, mainly elderly patients from the network of primary healthcare centers and remote regions of the State.

Read Full Article

Artigo Original

Association of biomarkers with atherosclerosis and risk for coronary artery disease in patients with HIV

Maria da Conceição Brandão de Arruda Falcão et al. Josefina Cláudia Zírpoli Valéria Maria de Albuquerque Brivaldo Markman Filho … Nelson Antônio Moura de Araújo Creso Abreu Falcão Demócrito de Barros Miranda-Filho Ricardo Alencar de Arraes Ximenes Maria de Fátima Militão de Albuquerque Heloísa Ramos Lacerda

BACKGROUND: The massive use of Highly-Active Antiretroviral Therapy (HAART) in individuals with human immunodeficiency virus (HIV) coincided with an increase in cardiovascular disease, a major cause of morbidity and mortality in this group. OBJECTIVE: To determine the frequency of carotid atherosclerosis and the association between biomarker levels and carotid intimal-medial thickening in HIV-positive individuals treated for HIV at referral centers in Pernambuco. METHODS: This was a cross-sectional study of 122 HIV-positive patients. Subclinical carotid atherosclerosis was considered with the presence of increased intimal-medial thickness of the common carotid artery > 0.8 mm or plaques in the carotid ultrasound. The following inflammatory biomarkers were analyzed: IL6, IL1-β, TNF-α, high-sensitivity CRP, sVCAM-1 and sICAM-1. RESULTS: Of the 122 patients analyzed, most were men (60.7%) aged > 40 years (57.4%) receiving HAART (81.1%). The prevalence of atherosclerosis was 42.6% (52 cases). Patients older than 40 years and intermediate or high Framingham score were more likely to develop atherosclerosis at the univariate analysis. Age older than 40 years (OR = 6.57, 95%CI: 2.66 to 16.2, p = 0.000), male gender (OR = 2.76, 95%CI: 1.12 to 6.79, p = 0.027) and presence of syndrome metabolic (OR = 2.27, 95%CI: 0.94 to 5.50, p = 0.070) were associated with atherosclerosis at the multivariate analysis. Elevated levels of inflammatory cytokines and adhesion molecules were not associated with the presence of atherosclerosis. CONCLUSION: There was no association between inflammatory biomarkers, adhesion molecules and presence of carotid atherosclerosis. However, a higher chance of subclinical atherosclerosis was observed in men, those older than 40 years, with intermediate / high Framingham score or metabolic syndrome.

Read Full Article

Artigo Original

Aerobic training does not alter blood pressure in menopausal women with metabolic syndrome

Aluísio Henrique Rodrigues de Andrade Lima et al. Henrique Eduardo Couto Glêbia Alexa Cardoso Lidiane Tavares Toscano … Alexandre Sérgio Silva Maria Paula Gonçalves Mota

BACKGROUND: Arterial Hypertension (AH) is an aggravating condition for Metabolic Syndrome (MS), as well as being aggravated by it. Menopause can make hypertension treatment more difficult, as it favors the worsening of MS components. Although there is evidence that exercise training reduces blood pressure, whether menopause and SM affect the exercise-induced benefits is yet to be elucidated. OBJECTIVE: To compare the effects of aerobic training on blood pressure in non-menopausal and menopausal women with MS METHODS: A total of 44 women were recruited and divided into four groups: non-menopausal control (NMC: 39.5 ± 3.6 years, n = 11); menopausal control (MC: 54.9 ± 5.9 years, n = 12), non-menopausal aerobics (NMA: 43.1 ± 6.8 years, n = 11) and menopausal aerobics (MA: 52.1 ± 5 years, n = 10). The exercise groups performed aerobic training for three months, five times a week, at an intensity between 60% and 70% of heart rate reserve. The resting blood pressure and blood pressure response after 60 minutes of exercise were measured before and after the training period. The two-way ANOVA test was used, considering a p value 0.05). CONCLUSION: Three months of aerobic training improved MS components, but did not alter resting blood pressure or the BP response after an acute exercise session in women with MS.

Read Full Article

Artigo Original

Cardiorespiratory optimal point: a submaximal variable of the cardiopulmonary exercise testing

Plínio Santos Ramos et al. Djalma Rabelo Ricardo Claudio Gil Soares de Araújo

BACKGROUND: At the maximal Cardiopulmonary Exercise Testing (CPET), several ventilatory variables are analyzed, including the ventilatory equivalent for oxygen (VE/VO2). The minimum VE/VO2 value reflects the best integration between the respiratory and cardiovascular systems and may be called “Cardiorespiratory Optimal Point (COP)”. OBJECTIVE: To determine the behavior of the COP according to gender and age in healthy adults and verify its association with other CPET variables. METHODS: Of 2,237 individuals, 624 were selected (62% men and 48 ± 12 years), non- athletes, healthy, who were submitted to maximal CPET. COP or minimum VE/VO2 was obtained from the analysis of ventilation and oxygen consumption in every minute of CPET. We investigated the association between age and COP for both genders, as well as associations with: VO2max, VO2 at anaerobic threshold (VO2AT), oxygen uptake efficiency slope (OUES) and with maximum VE. We also compared the intensity of exertion (MET) at the COP, AT and VO2max. RESULTS: COP increases with age, being 23.2 ± 4.48 and 25.0 ± 5.14, respectively, in men and women = (p < 0.001). There are moderate and inverse associations with VO2max (r = -0.47; p < 0.001), with VO2AT (r = -0.42; p < 0.001) and with OUES (r = -0.34; p < 0.001). COP occurred, on average, at 44% do VO2max and before AT (67% of VO2max) (p < 0.001). CONCLUSION: COP, a submaximal variable, increases with age and is slightly higher in women. Being modestly associated with other ventilation measures, there seems to be an independent contribution to the interpretation of the cardiorespiratory response to CPET.

Read Full Article