2016;107(1) – ABC CARDIOL

ABC

ABC Family | ABC

Image

Unusual Form of Heart Failure!

Rita Ferreira et al. Silvia Monteiro Mariano Pego

An 80-year old woman was admitted to the emergency room due to severe dyspnea. She had no known history of cardiovascular disease, but in last month she complained to increasing fatigue and shortness of breath. Physical examination was notable for diffuse lungs crackles. The heart sounds were normal and no murmur could be heard. The 12-lead electrocardiogram demonstrated sinus rhythm with non-specific ST-segment changes. The chest radiograph showed congested lung and there was also a round shadow behind the heart (). The patient was admitted to Cardiology department for further investigation.

[…]

Read Full Article

Editorial

Hormone Therapy to Treat Cardiac Remodeling: Is There Any Evidence?

Luís Alexandre F. Cicchetto et al. Bertha F. Polegato Leonardo A. M. Zornoff

Cardiac remodeling can be defined as a set of molecular, cellular and interstitial cardiac variations, which manifest clinically as changes in heart size, mass, geometry and function in response to certain aggressions. That process has bad prognosis, because it is associated with ventricular dysfunction progression and malignant arrhythmias. Different therapeutic strategies have been assessed to prevent, or at least attenuate, cardiac remodeling.^, Some treatments, such as those using angiotensin-convert-enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, and aldosterone antagonists, have been well established. Other treatments, despite their pathophysiological potential, are still being studied. Of those, hormone therapy stands out, particularly with testosterone, thyroid hormone, and growth hormone (GH).

Testosterone has received great attention in recent years. From the pathophysiological viewpoint, in the presence of ventricular dysfunction, testosterone can modulate the cardiac remodeling process, strengthen skeletal musculature, enhance exercise capacity and reduce inflammatory activity.^, It is worth noting that a significant number of patients with heart failure have reduced testosterone levels. In addition, low testosterone levels in patients with heart failure are an independent risk factor for hospital readmission within 90 days and for mortality. Thus, testosterone supplementation seems an attractive strategy to manage heart failure.

[…]

Read Full Article

Case Report

Anatomopathological Aspects of Acute Chagas Myocarditis by Oral Transmission

Dilma do Socorro Moraes de Souza et al. Marialva TF Araujo Paulo Roberto Silva Garcez dos Santos Julio Cesar Branco Furtado … Maria Tereza Sanches Figueiredo Rui M.S. Povoa

Introduction

Vector transmission of Trypanosoma cruzi has declined in Latin America, which has been attributed to better epidemiological control of this form of transmission, estimated at 8 to 10 million chronic cases, in addition to reducing the number of new cases.^, However, there has been an increase in the incidence of acute cases, predominantly by oral transmission due to the ingestion of food contaminated with feces of triatomids, both in isolated cases and in family micro-outbreaks.

Necropsy studies that describe myocarditis in the acute phase of Chagas’ disease are scarce and the existing reports in the literature are of studies carried out in the past decades and involve vector transmission in endemic areas.

[…]

Read Full Article

Anatomopathological Session

Case 3/2016 – 58 Year-Old Hypertensive Male with End-Stage Renal Disease, Aortic Dissection, Fever and Hemoptysis

Desiderio Favarato et al. Paulo Sampaio Gutierrez

Clinical aspects

The patient had a previous diagnosis of arterial hypertension and chronic renal disease, with renal failure, being on renal replacement therapy via hemodialysis. He had chest pain and dyspnea. His clinical and laboratory assessments revealed coronary artery disease and chronic aortic dissection.

Chronic renal disease significantly progresses as age and cardiovascular disease advance, culminating with renal function worsening. The ARIC Study reports an increase in cardiovascular disease prevalence from 18% to 40% before the age of 65 years, from normal renal function to a glomerular filtration rate drop of 15 mL/min/1.73m², while, over the age of 65 years, that prevalence increases from 20% to 50%, with progressive renal function worsening.

[…]

Read Full Article

Letter to the Editor

Prophylactic Left Internal Mammary Artery Graft In Mildly-Stenosed Coronary Lesions. Still an Open Discussion

I have read the article entitled “Prophylactic Left Internal Mammary Artery Graft in Mildly-Stenosed Coronary Lesions. Still An Open Discussion” by Evora et al.1 with great interest, recently published in Arquivos Brasileiros de Cardiologia. The investigators reported that the idea of a prophylactic left internal mammary artery (LIMA) on left anterior descending in mild-stenosed vessels is not confirmed yet by clinical evidence.

Berger at al. reported that all moderate coronary lesions should be LIMA grafted during primary coronary bypass surgery.

[…]

Read Full Article

Editorial

Role of the International Journal of Cardiovascular Sciences in the Increase of Brazilian publications in Cardiology and Cardiovascular Sciences

Luiz Felipe P. Moreira

The number of Brazilian scientific publications in the field of Cardiology and Cardiovascular Sciences in international indexing journals, different from other areas of Medicine, has remained largely stable over the past eight years. This situation does not reflect the significant increase in the number of senior researchers and the number of studies carried out in the several fields of activity that constitute our medical specialty. We currently observe the development of our Postgraduate Programs, as well as the opening of new research centers focused on the study of cardiovascular diseases in several universities of the country.

On the other hand, in spite of the increased number of international journals in our area, with the creation of “families of journals” associated to the periodicals of highest significance, the publication of Brazilian articles of greater impact on the area of cardiology remains limited. Additionally, we have not had the incorporation of new journals published in Brazil in the field of cardiovascular science, which prevents the access of Brazilian researchers to the scientific dissemination of their work. The Arquivos Brasileiros de Cardiologia, the journal responsible for the disclosure of approximately 20% of national publications indexed in our area of operation, can now publish only 25% of the submitted articles, of which approximately 10% comes from foreign research centers.

[…]

Read Full Article

Original Article

Trends in Mortality from Cerebrovascular and Hypertensive Diseases in Brazil Between 1980 and 2012

Paolo Blanco Villela et al. Carlos Henrique Klein Gláucia Maria Moraes de Oliveira

Abstract

Background:

Cerebrovascular and hypertensive diseases are among the main causes of death worldwide. However, there are limited data about the trends of these diseases over the years.

Objective:

To evaluate the temporal trends in mortality rates and proportional mortality from cerebrovascular and hypertensive diseases according to sex and age in Brazil between 1980 and 2012.

Methods:

We evaluated the underlying causes of death between 1980 and 2012 in both sexes and by age groups for circulatory diseases (CD), cerebrovascular diseases (CBVD), and hypertensive diseases (HD). We also evaluated death due to all causes (AC), external causes (EC), and ill-defined causes of death (IDCD). Data on deaths and population were obtained from the Department of Information Technology of the Unified Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS/MS). We estimated crude and standardized annual mortality rates per 100,000 inhabitants and percentages of proportional mortality rates.

Results:

With the exception of EC, the mortality rates per 100,000 inhabitants of all other diseases increased with age. The proportional mortality of CD, CBVD, and HD increased up to the age range of 60-69 years in men and 70-79 years in women, and reached a plateau in both sexes after that. The standardized rates of CD and CBVD declined in both sexes. However, the HD rates showed the opposite trend and increased mildly during the study period.

Conclusion:

Despite the decline in standardized mortality rates due to CD and CBVD, there was an increase in deaths due to HD, which could be related to factors associated with the completion of the death certificates, decline in IDCD rates, and increase in the prevalence of hypertension.

Read Full Article

Original Article

Physical Activity and Lipid Profile in the ELSA- Brasil Study

Raquel Caroline da Silva et al. Maria de Fátima Haueisen Sander Diniz Sheila Alvim Pedro Guatimosim Vidigal … Ligia Maria Giongo Fedeli Sandhi Maria Barreto

Abstract

Background:

Regular physical activity (PA) induces desirable changes in plasma levels of high- and low-density lipoproteins (HDL and LDL, respectively) and triglycerides (TG), important risk factors for cardiometabolic diseases. However, doubts whether intensity and duration have equivalent benefits remain.

Objective:

To assess the association of PA intensity and duration with HDL, LDL and TG levels.

Methods:

Cross-sectional study with 12,688 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline, who were not on lipid-lowering medication. After adjustment for important covariates, multiple linear regression was used to assess the association of PA intensity and duration with HDL, LDL and TG (natural logarithm) levels.

Results:

Both moderate and vigorous PA and PA practice ≥ 150 min/week were significantly associated with higher HDL and lower TG levels. Vigorous PA was associated with lower LDL only on univariate analysis. After adjustments, moderate and vigorous PA increased mean HDL level by 0.89 mg/dL and 1.71 mg/dL, respectively, and reduced TG geometric mean by 0.98 mg/dL and 0.93 mg/dL, respectively. PA practice ≥ 150 min/week increased mean HDL level by 1.05 mg/dL, and decreased TG geometric mean by 0.98 mg/dL.

Conclusion:

Our findings reinforce the benefits of both PA parameters studied on HDL and TG levels, with a slight advantage for vigorous PA as compared to the recommendation based only on PA duration.

Read Full Article

Original Article

Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

Carlos Passos Pinheiro et al. Daniele Rezek Eduardo Paiva Costa Edvagner Sergio Leite de Carvalho … Freddy Antonio Brito Moscoso Percy Richard Chavez Taborga Andreia Dias Jeronimo Alexandre Antonio Cunha Abizaid Auristela Isabel de Oliveira Ramos

Abstract

Background:

Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair.

Objectives:

To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure.

Methods:

This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure.

Results:

The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08).

Conclusion:

Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk.

Read Full Article

Original Article

Reproducibility of Gadolinium Enhancement Patterns and Wall Thickness in Hypertrophic Cardiomyopathy

Gaston A. Rodriguez-Granillo et al. Alejandro Deviggiano Carlos Capunay Macarena C. De Zan Patricia Carrascosa

Abstract

Background:

Reproducibility data of the extent and patterns of late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) is limited.

Objective:

To explore the reproducibility of regional wall thickness (WT), LGE extent, and LGE patterns in patients with HCM assessed with cardiac magnetic resonance (CMR).

Methods:

The extent of LGE was assessed by the number of segments with LGE, and by the total LV mass with LGE (% LGE); and the pattern of LGE-CMR was defined for each segment.

Results:

A total of 42 patients (672 segments) with HCM constituted the study population. The mean WT measurements showed a mean difference between observers of -0.62 ± 1.0 mm (6.1%), with limits of agreement of 1.36 mm; -2.60 mm and intraclass correlation coefficient (ICC) of 0.95 (95% CI 0.93-0.96). Maximum WT measurements showed a mean difference between observers of -0.19 ± 0.8 mm (0.9%), with limits of agreement of 1.32 mm; -1.70 mm, and an ICC of 0.95 (95% CI 0.91-0.98). The % LGE showed a mean difference between observers of -1.17 ± 1.2 % (21%), with limits of agreement of 1.16%; -3.49%, and an ICC of 0.94 (95% CI 0.88-0.97). The mean difference between observers regarding the number of segments with LGE was -0.40 ± 0.45 segments (11%), with limits of agreement of 0.50 segments; -1.31 segments, and an ICC of 0.97 (95% CI 0.94-0.99).

Conclusions:

The number of segments with LGE might be more reproducible than the percent of the LV mass with LGE.

Read Full Article

Original Article

A Prospective Cohort Study on Cardiotoxicity of Adjuvant Trastuzumab Therapy in Breast Cancer Patients

Erika Matos et al. Borut Jug Rok Blagus Branko Zakotnik

Abstract

Background:

Cardiotoxicity is an important side effect of trastuzumab therapy and cardiac surveillance is recommended.

Objectives:

The aim of our study was to prospectively assess baseline patients’ characteristics, level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic parameters as possible predictors of trastuzumab-related cardiac dysfunction.

Methods:

In a prospective cohort study, clinical, echocardiographic and neurohumoral assessment was performed at baseline, after 4, 8 and 12 months in breast cancer patients undergoing post-anthracycline (3-4 cycles) adjuvant therapy with trastuzumab. Trastuzumab-related cardiac dysfunction was defined as a decline of ≥ 10% in left ventricular ejection fraction (LVEF).

Results:

92 patients (mean age, 53.6 ± 9.0 years) were included. Patients who developed trastuzumab-related LVEF decline ≥ 10% (20.6%) during treatment had significantly higher baseline LVEF (70.7 ± 4.4%) than those without (64.8 ± 5.5%) (p = 0.0035). All other measured baseline parameters (age, body mass index, arterial hypertension, level of NT-proBNP and other echocardiographic parameters) were not identified as significant.

Conclusions:

Our findings suggest that baseline patient’ characteristics, level of NT-proBNP and echocardiographic parameters, as long as they are within normal range, are not a reliable tool to predict early trastuzumab-related cardiac dysfunction in patients undergoing post-low dose anthracycline adjuvant trastuzumab therapy. A LVEF decline in patients with high-normal baseline level although statistically significant is not clinically relevant.

Read Full Article

Review Article

Carlos Chagas Discoveries as a Drop Back to Scientific Construction of Chronic Chagas Heart Disease

Reinaldo B. Bestetti et al. Carolina Baraldi A. Restini Lucélio B. Couto

Abstract

The scientific construction of chronic Chagas heart disease (CCHD) started in 1910 when Carlos Chagas highlighted the presence of cardiac arrhythmia during physical examination of patients with chronic Chagas disease, and described a case of heart failure associated with myocardial inflammation and nests of parasites at autopsy. He described sudden cardiac death associated with arrhythmias in 1911, and its association with complete AV block detected by Jacquet’s polygraph as Chagas reported in 1912. Chagas showed the presence of myocardial fibrosis underlying the clinical picture of CCHD in 1916, he presented a full characterization of the clinical aspects of CCHD in 1922. In 1928, Chagas detected fibrosis of the conductive system, and pointed out the presence of marked cardiomegaly at the chest X-Ray associated with minimal symptomatology. The use of serological reaction to diagnose CCHD was put into clinical practice in 1936, after Chagas’ death, which along with the 12-lead ECG, revealed the epidemiological importance of CCHD in 1945. In 1953, the long period between initial infection and appearance of CCHD was established, whereas the annual incidence of CCHD from patients with the indeterminate form of the disease was established in 1956. The use of heart catheterization in 1965, exercise stress testing in 1973, Holter monitoring in 1975, Electrophysiologic testing in 1973, echocardiography in 1975, endomyocardial biopsy in 1981, and Magnetic Resonance Imaging in 1995, added to the fundamental clinical aspects of CCHD as described by Carlos Chagas.

Read Full Article

Original Article

Colchicine to Reduce Atrial Fibrillation in the Postoperative Period of Myocardial Revascularization

Camila Stuchi Zarpelon et al. Miguel Chomiski Netto José Carlos Moura Jorge Cátia Carolina Fabris … Dieli Desengrini Mariana da Silva Jardim Diego Guedes da Silva

Abstract

Background:

The high prevalence of atrial fibrillation (AF) in the postoperative period of myocardial revascularization surgery increases morbidity and mortality.

Objective:

To assess the efficacy of colchicine to prevent AF in the postoperative period of myocardial revascularization surgery, the impact of AF on hospital length of stay and death, and to identify its risk factors.

Methods:

Between May 2012 and November 2013, 140 patients submitted to myocardial revascularization surgery were randomized, 69 to the control group and 71 to the colchicine group. Colchicine was used at the dose of 1 mg orally, twice daily, preoperatively, and of 0.5 mg, twice daily, until hospital discharge. A single dose of 1 mg was administered to those admitted 12 hours or less before surgery.

Results:

The primary endpoint was AF rate in the postoperative period of myocardial revascularization surgery. Colchicine group patients showed no reduction in AF incidence as compared to control group patients (7.04% versus 13.04%, respectively; p = 0.271). There was no statistically significant difference between the groups regarding death from any cause rate (5.6% versus 10.1%; p = 0,363) and hospital length of stay (14.5 ± 11.5 versus 13.3 ± 9.4 days; p = 0.490). However, colchicine group patients had a higher infection rate (26.8% versus 8.7%; p = 0.007).

Conclusion:

The use of colchicine to prevent AF after myocardial revascularization surgery was not effective in the present study. Brazilian Registry of Clinical Trials number RBR-556dhr.

Read Full Article

Original Article

Trends in Mortality Rate from Cardiovascular Disease in Brazil, 1980-2012

Antonio de Padua Mansur et al. Desidério Favarato

Abstract

Background:

Studies have questioned the downward trend in mortality from cardiovascular diseases (CVD) in Brazil in recent years.

Objective:

to analyze recent trends in mortality from ischemic heart disease (IHD) and stroke in the Brazilian population.

Methods:

Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. Risk of death was adjusted by the direct method, using as reference the world population of 2000. We analyzed trends in mortality from CVD, IHD and stroke in women and men in the periods of 1980-2006 and 2007-2012.

Results:

there was a decrease in CVD mortality and stroke in women and men for both periods (p < 0.001). Annual mortality variations for periods 1980-2006 and 2007-2012 were, respectively: CVD (total): -1.5% and -0.8%; CVD men: -1.4% and -0.6%; CVD women: -1.7% and -1.0%; DIC (men): -1.1% and 0.1%; stroke (men): -1.7% and -1.4%; DIC (women): -1.5% and 0.4%; stroke (women): -2.0% and -1.9%. From 1980 to 2006, there was a decrease in IHD mortality in men and women (p < 0.001), but from 2007 to 2012, changes in IHD mortality were not significant in men [y = 151 + 0.04 (R² = 0.02; p = 0.779)] and women [y = 88-0.54 (R² = 0.24; p = 0.320).

Conclusion:

Trend in mortality from IHD stopped falling in Brazil from 2007 to 2012.

Read Full Article

Original Article

Fractal Dimension in Quantifying Experimental-Pulmonary-Hypertension-Induced Cardiac Dysfunction in Rats

Francis Lopes Pacagnelli et al. Ana Karênina Dias de Almeida Sabela Thaoan Bruno Mariano Guilherme Akio Tamura Ozaki … Robson Chacon Castoldi Edna Maria do Carmo Robson Francisco Carvalho Loreta Casquel Tomasi Katashi Okoshi Luiz Carlos Marques Vanderlei

Abstract

Background:

Right-sided heart failure has high morbidity and mortality, and may be caused by pulmonary arterial hypertension. Fractal dimension is a differentiated and innovative method used in histological evaluations that allows the characterization of irregular and complex structures and the quantification of structural tissue changes.

Objective:

To assess the use of fractal dimension in cardiomyocytes of rats with monocrotaline-induced pulmonary arterial hypertension, in addition to providing histological and functional analysis.

Methods:

Male Wistar rats were divided into 2 groups: control (C; n = 8) and monocrotaline-induced pulmonary arterial hypertension (M; n = 8). Five weeks after pulmonary arterial hypertension induction with monocrotaline, echocardiography was performed and the animals were euthanized. The heart was dissected, the ventricles weighed to assess anatomical parameters, and histological slides were prepared and stained with hematoxylin/eosin for fractal dimension analysis, performed using box-counting method. Data normality was tested (Shapiro-Wilk test), and the groups were compared with non-paired Student t test or Mann Whitney test (p < 0.05).

Results:

Higher fractal dimension values were observed in group M as compared to group C (1.39 ± 0.05 vs. 1.37 ± 0.04; p < 0.05). Echocardiography showed lower pulmonary artery flow velocity, pulmonary acceleration time and ejection time values in group M, suggesting function worsening in those animals.

Conclusion:

The changes observed confirm pulmonary-arterial-hypertension-induced cardiac dysfunction, and point to fractal dimension as an effective method to evaluate cardiac morphological changes induced by ventricular dysfunction.

Read Full Article