2019;113(5) – ABC CARDIOL

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Editorial

D-Limonene: A Promising Molecule with Bradycardic and Antiarrhythmic Potential

Quiara Lovatti Alves et al. Darizy Flávia Silva

It is unquestionable that cardiovascular disease (CVD) is and will continue to be one of the main health problems of modern society. A significant portion of cardiovascular disease-related deaths is a direct or indirect consequence of cardiac arrhythmias.Cardiac arrhythmias are abnormal conditions that refer to any alteration in the normal sequence of cardiac electrical impulses, which can be classified according to frequency, mechanism, duration, and place of origin, resulting in inefficient pumping. More specifically, cardiac arrhythmias indicate alterations in the rate or regularity of the heart rhythm, as well as changes in the conduction sequence of physiological electrical impulses, from their origin in the sinoatrial node to their end, in the His-Purkinje system, and the ventricles.The structural mechanisms that result in cardiac arrhythmias, as well as limitations regarding the safety and efficacy of “classic” antiarrhythmic drugs, make this disease difficult to treat.

The use of medicinal plants for the treatment, cure and prevention of diseases is one of the oldest forms of human medicinal practice. Natural medicinal plant-based products have shown to be an abundant source of biologically active compounds, many of which have been the basis for the development of new chemical products by the pharmaceutical industry.Essential oils, extracted from aromatic plants, are natural products with a variety of biological actions, including cardiovascular properties.Monoterpenes are the most representative molecules, which constitute 90% of essential oils, and also produce relevant effects on measurable cardiovascular parameters, including vasorelaxation and hypotension promotion in anesthetized and non-anesthetized rats.^, Additionally, monoterpenes may attenuate the development of hypertension in spontaneously hypertensive rats, by decreasing cardiac hypertrophy. Thus, it is evident that monoterpenes are molecules that could be further developed for the prevention and / or treatment of cardiovascular diseases. A study developed by our research group showed that the monoterpene carvacrol has negative chronotropic and inotropic effects on rats, whereas pulegone and geraniol have a negative inotropic effect on mammals.^,

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Editorial

Real-Time Three-Dimensional Echocardiography and Myocardial Strain: Ready for Use in Clinical Practice

Frederico Jose Neves Mancuso

The ability of echocardiography to quantify volumes and to evaluate the contractile function of cardiac chambers has evolved greatly in recent years, particularly due to the development of real-time three-dimensional echocardiography (echo3D) and the possibility myocardial deformation (Strain) analysis by the speckle tracking technique.^–

Unlike two-dimensional echocardiography, where geometric inferences and mathematical calculations are required, the echo3D allows direct measurement of ventricular and atrial volumes, from which function data such as left and right ventricular ejection fraction, and left atrial function, including total emptying fraction and active emptying fraction parameters.^–

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Editorial

A New Rodent Model of Non-Alcoholic Steatohepatitis and Metabolic Syndrome

Fernando Gomes Romeiro et al. Lívia Alves Amaral Santos

Obesity is markedly linked to an increased risk of all-cause mortality and its prevalence has risen to unacceptable levels in the developed world.^, Obesity and insulin resistance compose the core of most cases of metabolic syndrome (MS), which is a group of conditions and traits associated with an increased risk of cardiovascular disease and diabetes (approximately 2-fold and 5-fold, respectively). Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of MS and has gained attention not only for obesity-related disorders but also for the progression to non-alcoholic steatohepatitis (NASH), liver cirrhosis, and hepatocellular carcinoma. Similar to the other metabolic components involved in MS, NAFLD treatment is based on lifestyle changes that are difficult to achieve in clinical trials, making preclinical studies an excellent option to increase the knowledge about the disease and to test the interventions proposed.

However, in vitro models have severe limitations to evaluate the hepatic and extrahepatic findings of human NASH due to its multifactorial etiology. As a result, data obtained from animals are largely assessed, with a growing interest in the development of mice models. Even if many of these models do not develop steatohepatitis as the strict definition applied to human liver tissue, they are still an outstanding source of knowledge about NAFLD and NASH.

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Review Article

Deposit Diseases as Differential Diagnosis of Left Ventricular Hypertrophy in Patients with Heart Failure and Preserved Systolic Function

Fábio Fernandes et al. Murillo Oliveira Antunes Viviane Tiemi Hotta Carlos Eduardo Rochitte Charles Mady

Fabry Disease

Fabry’s disease FD is a genetic, lysosomal storage disorder caused by total or partial alpha-galactosidase (α-Gal A) deficiency of the enzyme that degrades glycolipid globotriaosylceramide (Gb3) in lysosomes. Therefore Gb3 deposits accumulate in the endothelial cells and heart, resulting in organic dysfunction. The gene that causes FD is located in the long arm of the X chromosome (locus Xq22) and currently hundreds of pathogenic mutations have been described. Thus, male homozygous patients develop the classic disease, while female heterozygous patients present variable clinical manifestations from conditions without apparent clinical disease to the complete expression of the disease.^–

In clinical practice, early diagnosis is important because actually there are specific treatment with enzyme replacement therapy (ERT) that may change the natural history, reducing and/or stabilizing the progression of the disease.^,

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Guideline

Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology – 2019

Marcelo Antônio Cartaxo Queiroga Lopes et al. Gláucia Maria Moraes de Oliveira Antonio Luiz Pinho Ribeiro Fausto J. Pinto … Helena Cramer Veiga Rey Leandro Ioschpe Zimerman Carlos Eduardo Rochitte Fernando Bacal Carisi Anne Polanczyk Cidio Halperin Edson Correia Araújo Evandro Tinoco Mesquita José Airton Arruda Luis Eduardo Paim Rohde Max Grinberg Miguel Moretti Paulo Ricardo Avancini Caramori Roberto Vieira Botelho Andréa Araújo Brandão Ludhmila Abrahão Hajjar Alexandre Fonseca Santos Alexandre Siciliano Colafranceschi Ana Paula Beck da Silva Etges Bárbara Campos Abreu Marino Bruna Stella Zanotto Bruno Ramos Nascimento Cesar Rocha Medeiros Daniel Vitor de Vasconcelos Santos Daniela Matos Arrowsmith Cook Eduardo Antoniolli Erito Marques de Souza Filho Fábio Fernandes Fabio Gandour Francisco Fernandez Germano Emilio Conceição Souza Guilherme de Souza Weigert Iran Castro Jamil Ribeiro Cade José Albuquerque de Figueiredo Neto Juliano de Lara Fernandes Marcelo Souza Hadlich Marco Antonio Praça Oliveira Maria Beatriz Alkmim Maria Cristina da Paixão Maurício Lopes Prudente Miguel A. S. Aguiar Netto Milena Soriano Marcolino Monica Amorim de Oliveira Osvaldo Simonelli Pedro A. Lemos Neto Priscila Raupp da Rosa Renato Minelli Figueira Roberto Caldeira Cury Rodrigo Coelho Almeida Sandra Regina Franco Lima Silvio Henrique Barberato Thiago Inocêncio Constancio Wladimir Fernandes de Rezende

Presentation

In due time, the Brazilian Society of Cardiology decided to create a guideline on telemedicine applied to cardiology, also known as telecardiology. According to the Pan American Health Organization (PAHO) and the World Health Organization (WHO), telemedicine is “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.” Such a seemingly simple and altruistic definition carries a wide range of potential implications at various levels, from an ethical point of view to a potential impact on clinical practice and outcomes. Hence, the importance of guidelines, organized by the medical community through scientific societies, in offering to all of those involved in the process a reference based, as much as possible, on expert opinion, current scientific evidence, and on respect for medical ethical and deontological values.

Considering that cardiovascular diseases are the main cause of morbidity and mortality in the 21st century in Brazil and worldwide, the opportunity to use instruments to allow more effective actions in the prevention, diagnosis, treatment, and follow-up of these diseases paves the way to very relevant perspectives of better care for the populations and communities that we serve. At the same time, bioethical aspects and consequences should never be neglected, as they can (and should) undermine programs that, disguised as “medical,” fail to meet these ethical requirements. Therefore, regulated operating models based on guidelines organized by medical-scientific authorities are fundamental in striking a balance.

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Editorial

Another Step in Medical Education in Portuguese Speaking Countries

Gláucia Maria Moraes de Oliveira et al. Fausto J. Pinto

In 2016 the Journal of the American Medical Association published a theme issue on medical education, which included an editorial by Golub emphasizing the importance of looking backward on past to advance towards the future. Golub went on to say that the changes in society, such as the shifts in ethnicities, in cultural norms and in health care systems, will lead to new comprehensive, creative and innovative educational models to improve the quality of medical education and patient care.

Therefore, medical training has recently undergone changes, aimed at adapting it to the new population demands, which present great challenges due to regional disparities in the health workforce distribution. Health professionals must be trained to address increasingly complex pathologies and to develop skills to lead interprofessional teams, which must be cost-effective regarding transcultural evidence, to better serve the populations taken care of.

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Editorial

Environmental Enrichment Effect on Oxidative Stress in Hypertensive Rats

Marcelo Diarcadia Mariano Cezar et al. Aline Regina Ruiz Lima Luana Urbano Pagan Ricardo Luiz Damatto

Arterial hypertension (AH) is frequently associated with metabolic disturbs, target-organs functional and/or structural alterations. In Brazil, it contributes, directly or indirectly, to 50% of cardiovascular disease death. AH experimental models have showed biochemical and cardiovascular alterations.^–

Among the most common experimental models of AH in rats are genetic hypertension developed by Okamoto and Aoki with the spontaneous hypertension model, Dahl salt-susceptible, a result of a defect in renal excrete sodium, neurogenic hypertension, defined as a permanent increase in blood pressure resulting from a fundamentally neural (central or peripheral) change. Renal hypertension may be renoprive, produced by severe reduction in renal function, renovascular hypertension that is due to partial obstruction of blood flow to the kidneys, or in some cases both.

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Original Article

Impact of One-Catheter Strategy with TIG I Catheter on Coronary Catheterization Performance and Economic Costs

Joan Costa-Mateu et al. Diego Fernández-Rodríguez Kristian Rivera Juan Casanova … Patricia Irigaray Marta Zielonka Eduardo Pereyra-Acha Albina Aldomá Fernando Worner

Abstract

Background:

Coronary angiography with two catheters is the traditional strategy for diagnostic coronary procedures. TIG I catheter permits to cannulate both coronary arteries, avoiding exchanging catheters during coronary angiography by transradial access.

Objective:

The aim of this study is to evaluate the impact of one-catheter strategy, by avoiding catheter exchange, on coronary catheterization performance and economic costs.

Methods:

Transradial coronary diagnostic procedures conducted from January 2013 to June 2017 were collected. One-catheter strategy (TIG I catheter) and two-catheter strategy (left and right Judkins catheters) were compared. The volume of iodinated contrast administered was the primary endpoint. Secondary endpoints included radial spasm, procedural duration (fluoroscopy time) and exposure to ionizing radiation (dose-area product and air kerma). Direct economic costs were also evaluated. For statistical analyses, two-tailed p-values < 0.05 were considered statistically significant.

Results:

From a total of 1,953 procedures in 1,829 patients, 252 procedures were assigned to one-catheter strategy and 1,701 procedures to two-catheter strategy. There were no differences in baseline characteristics between the groups. One-catheter strategy required less iodinated contrast [primary endpoint; (60-105)-mL vs. 92 (64-120)-mL; p < 0.001] than the two-catheter strategy. Also, the one-catheter group presented less radial spasm (5.2% vs. 9.3%, p = 0.022) and shorter fluoroscopy time [3.9 (2.2-8.0)-min vs. 4.8 (2.9-8.3)-min, p = 0.001] and saved costs [149 (140-160)-€/procedure vs. 171 (160-183)-€/procedure; p < 0.001]. No differences in dose-area product and air kerma were detected between the groups.

Conclusions:

One-catheter strategy, with TIG I catheter, improves coronary catheterization performance and reduces economic costs compared to traditional two-catheter strategy in patients referred for coronary angiography.

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Case Report

A Rare Cause of Angina After Coronary Bypass Grafting; Left İnternal Mammary Artery to Pulmonary Artery Fistula and Successful Treatment with Transcatheter Coil Embolization

Ali Nazmi Calik et al. Can Yücel Karabay Evliya Akdeniz Yiğit Çanga … Baris Gungor Omer Kozan

Abstract

Fistula from left internal mammary artery (LIMA) to pulmonary artery (PA) is rarely encountered in daily practice. In recent years, endovascular therapy options have emerged for the treatment of fistula formations and replaced with surgery.

A 53-year-old man admitted to our outpatient clinic with symptoms of typical angina and shortness of breath despite optimal medical therapy. In his relevant history, he had a coronary artery bypass graft (CABG) operation in 2009 in which his LIMA was anastomosed to left anterior descending (LAD) and ramus artery sequentially. Coronary angiography including selective imaging of LIMA demonstrated a fistula formation originating from the proximal portion of the LIMA and draining to PA. After successful closure of fistula with transcatheter coil embolization, the patient was discharged without any complication and symptom.

In conclusion, although LIMA to PA fistula is an infrequent clinical condition, it should be considered as a potential cause of persistent angina after CABG operation. Treatment options include conservative medical therapy, surgical ligation and endovascular interventions. The best therapy should be individualised for each patient in respect to patient’s symptoms, surgical compatibility and anatomy of fistula.

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Editorial

One Catheter, Two Coronaries. Haven’t We Seen This Before?

Cesar Rocha Medeiros

Radial access is the default for diagnostic coronariography in many centers and, according to the latest consensus, should be in all.

Over these more than 60 years, coronariography has been performed by several techniques. One of them, ironically the very first one, using just one catheter to canulate both coronaries and enter the left ventricle.

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Editorial

Transesophageal Echocardiogram with Contrast in Pulmonary Intravascular Dilation in Hepatosplenic Schistosomiasis

Sandra Nívea dos Reis Saraiva Falcão

The Hepatopulmonary syndrome (HPS) is defined as a defect in arterial oxygenation induced by intrapulmonary vascular dilation (IPVD) associated with liver disease. The vascular component includes diffuse or localized capillary dilation and, less commonly, pulmonary arteriovenous malformations.

A sensitive approach for the early detection of altered arterial oxygenation is the calculation of the alveolar-arterial oxygen pressure difference (PA-aO₂). This difference can be elevated before arterial oxygen pressure becomes abnormal. At sea level, PA-aO₂ ≥ 15 mmHg is considered abnormal (it changes to 20 mmHg in individuals over 64 years).

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Viewpoint

Spontaneous Exercise-Related Coronary Artery Dissection among Young Patients Without Risk Factors or Atherosclerotic Disease

Pablo de Souza et al. Artur Haddad Herdy

Abstract

Spontaneous coronary artery dissection (SCAD) is considered an often underdiagnosed acute coronary syndrome, with few cases described in literature. Its association with physical exercise among young patients without risk factors or atherosclerotic disease (CAD) is even rarer. For this reason, a study was conducted on the subject, describing the clinical conditions, conduct and evolution regarding the suspicion of spontaneous exercise-related coronary artery dissection in three young patients without risk factors or CAD. Clinical conditions varied, with predominant recurrent chest pain. Age range from 20 to 31 years. All patients underwent coronary angiography, which showed no CAD but suggested SCAD. Investigations concerning other causes of coronary obstruction were negative. The right coronary artery was affected in two cases, and the anterior descending artery was affected in one case. Only one of the three patients had recurrent events within five years from the primary event. Technological advances will enable increased dissection identification in acute coronary syndromes. Improving the knowledge about the related clinical conditions is necessary, as an attempt to provide warnings and improve the suspicion of spontaneous exercise-related coronary artery dissection among those who have symptoms of coronary insufficiency, thus reducing the frequent underdiagnosis. The best treatment and prognosis for this disease remains uncertain.

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Editorial

Self-Monitoring with or Without Telemonitoring: Is a New Time for Diagnosis and Management Hypertension?

Cibele Isaac Saad Rodrigues

According to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline for the prevention, detection, evaluation, and management of high blood pressure (BP) in adults, 46% of US adults have hypertension (HTN). In Brazil, because the levels of systolic and diastolic BP that define HTN differ from ACC/AHA Guideline, the percentage is about 25%, according to VIGITEL.

HTN is an important public health issue and the major risk factor for heart disease, stroke, and chronic kidney disease. Heart disease and stroke are among the most prevalent and costly health problems worldwide, and controlling BP is the best effective intervention in life-saving, preventing deleterious comorbidities, but only about half of those with HTN have it under control even in developing countries.^,^,

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Clinicoradiological Correlation

Case 6/2019 – Total Atrioventricular Septal Defect, 12 Years After Operative Correction, No Residual Defects

Edmar Atik et al. Maria Angélica Binotto Alessandra Costa Barreto

Clinical Data

A 14-year-old patient was asymptomatic in all routine postoperative evaluations and in full physical activity, compared to others. During this period, which began when the patient was 21 months old, due to the type A atrioventricular (AV) septal defect totally corrected, no cardiac murmur was heard, the cardiac area remained normal and did not require the use of specific medication. An Echocardiography showed no residual defects, normal heart cavities and no valve regurgitation. The defect was diagnosed from birth and follow-up before the surgery was marked by obvious signs of heart failure due to the volume overload imposed by valve insufficiency and intercavity communications.

Physical exam: good general conditions, eupneic, acyanotic, normal 4-limb pulses. Weight: 30 Kg, Height: 140 cm, BP: 105 x 60 mmHg, HR = 76 bpm, O₂ Sat = 95%.

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Editorial

Clinical Management of Patients with First-Episode Atrial Fibrillation Detected in the Acute Phase of Myocardial Infarction

Mauricio Scanavacca et al. Tan Chen Wu

Atrial fibrillation (AF) episodes have been traditionally observed in up to 20% of the patients who suffer an acute myocardial infarction (AMI); 5-10% of them, as a “first episode”, during hospital admission. The etiology of AF, in this phase of AMI, includes several factors, such as elevated atrial pressure resulting from acute ventricular dysfunction, associated atrial ischemia (more common in inferior wall AMI), secondary inflammatory reaction, changes in autonomic nervous system behavior and in the neurohumoral pattern related to the pathophysiology of AMI, especially in those with ventricular dysfunction.^–

A recent study published in the Arquivos Brasileiros de Cardiologia by Congo et al. suggest that, in the last years, the incidence of AF in the acute phase of AMI may be decreasing, due to the greater access of patients to early reperfusion and to better clinical treatment, associated with the more frequent use of angiotensin converting enzyme inhibitors (ACE inhibitors), beta blockers, statins and antiplatelet therapy. In addition, the study corroborates previous observations that new onset AF is associated to poorer clinical evolution and raises awareness of the clinical management of these patients, in particular in relation to the non-use of oral anticoagulants at hospital discharge.

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Original Article

Value of Contrast Transesophageal Echocardiography in the Detection of Intrapulmonary Vascular Dilatations in Hepatosplenic Schistosomiasis

Aparecida de Gouvea et al. Claudio Henrique Fischer Jaquelina Sonoe Ota Arakaki Frederico José Mancuso … Paulo Brant Valdir Ambrósio Moisés Orlando Campos Filho

Abstract

Background:

Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis.

Objective:

To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS.

Methods:

cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student’s t-test and the chi-square test (p < 0.05).

Results:

cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09).

Conclusion:

In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.

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Original Article

New-Onset Atrial Fibrillation in St-Segment Elevation Myocardial Infarction: Predictors and Impact on Therapy And Mortality

Kisa Hyde Congo et al. Adriana Belo João Carvalho David Neves … Rui Guerreiro João António Pais Diogo Brás Mafalda Carrington Bruno Piçarra Ana Rita Santos José Aguiar

Abstract

Backgrund:

New-onset atrial fibrillation complicating acute myocardial infarction represents an important challenge, with prognostic significance.

Objective:

To study the incidence, impact on therapy and mortality, and to identify predictors of development of new-onset atrial fibrillation during hospital stay for ST-segment elevation myocardial infarction.

Methods:

We studied all patients with ST-elevation myocardial infarction included consecutively, between 2010 and 2017, in a Portuguese national registry and compared two groups: 1 – no atrial fibrillation and 2 – new-onset atrial fibrillation. We adjusted a logistic regression model data analysis to assess the impact of new-onset atrial fibrillation on in-hospital mortality and to identify independent predictors of its development. A p value < 0.05 was considered significant.

Results:

We studied 6325 patients, and new-onset atrial fibrillation was found in 365 (5.8%). Reperfusion was successfully accomplished in both groups with no difference regarding type of reperfusion. In group 2, therapy with beta-blockers and angiotensin-conversion enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) was less frequent, 20.6% received anticoagulation at discharge and 16.1% were on triple therapy. New-onset atrial fibrillation was associated with more in-hospital complications and mortality. However, it was not found as an independent predictor of in-hospital mortality. We identified age, prior stroke, inferior myocardial infarction and complete atrioventricular block as independent predictors of new-onset atrial fibrillation.

Conclusion:

New-onset atrial fibrillation remains a frequent complication of myocardial infarction and is associated with higher rate of complications and in-hospital mortality. Age, prior stroke, inferior myocardial infarction and complete atrioventricular block were independent predictors of new onset atrial fibrillation. Only 36.7% of the patients received anticoagulation at discharge.

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Original Article

Environmental Enrichment Promotes Antioxidant Effect in the Ventrolateral Medulla and Kidney of Renovascular Hypertensive Rats

Luiz Eduardo Sousa et al. Iuri Ferrari Del Favero Frank Silva Bezerra Ana Beatriz Farias de Souza Andreia Carvalho Alzamora

Abstract

Background:

Arterial hypertension is a precursor to the development of heart and renal failure, furthermore is associated with elevated oxidative markers. Environmental enrichment of rodents increases performance in memory tasks, also appears to exert an antioxidant effect in the hippocampus of normotensive rats.

Objectives:

Evaluate the effect of environmental enrichment on oxidative stress in the ventrolateral medulla, heart, and kidneys of renovascular hypertensive rats.

Methods:

Forty male Fischer rats (6 weeks old) were divided into four groups: normotensive standard condition (Sham-St), normotensive enriched environment (Sham-EE), hypertensive standard condition (2K1C-St), and hypertensive enriched environment (2K1C-EE). Animals were kept in enriched or standard cages for four weeks after all animals were euthanized. The level of significance was at p < 0.05.

Results:

2K1C-St group presented higher mean arterial pressure (mmHg) 147.0 (122.0; 187.0) compared to Sham-St 101.0 (94.0; 109.0) and Sham-EE 106.0 (90.8; 117.8). Ventrolateral medulla from 2K1C-EE had higher superoxide dismutase (SOD) (49.1 ± 7.9 U/mg ptn) and catalase activity (0.8 ± 0.4 U/mg ptn) compared to SOD (24.1 ± 9.8 U/mg ptn) and catalase activity (0.3 ± 0.1 U/mg ptn) in 2K1C-St. 2K1C-EE presented lower lipid oxidation (0.39 ± 0.06 nmol/mg ptn) than 2K1C-St (0.53 ± 0.22 nmol/mg ptn) in ventrolateral medulla. Furthermore, the kidneys of 2K1C-EE (11.9 ± 2.3 U/mg ptn) animals presented higher superoxide-dismutase activity than those of 2K1C-St animals (9.1 ± 2.3 U/mg ptn).

Conclusion:

Environmental enrichment induced an antioxidant effect in the ventrolateral medulla and kidneys that contributes to reducing oxidative damage among hypertensive rats.

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Original Article

Bradycardic and Antiarrhythmic Effects of the D-Limonene in Rats

Gildenisson Araújo do Nascimento et al. Diego Santos de Souza Bruno Santos Lima Carla Maria Lins de Vasconcelos … Adriano Antunes de Souza Araújo Aimée Obolari Durço Lucindo José Quintans-Junior Jackson Roberto Guedes da Silva Almeida Aldeída Pereira Oliveira Valter Joviniano de Santana-Filho André Sales Barreto Márcio Roberto Viana dos Santos

Abstract

Background:

D-limonene (DL) is a monoterpene and is the major component in the essential oil of citrus fruit. It presents antihyperglycemic and vasodilatation activities.

Objectives:

This study evaluated the cardiovascular effects and potential antiarrhythmic of DL in rats.

Methods:

Hemodynamic and electrocardiographic (ECG) parameters were measured in male Wistar rats, which under anesthesia had been cannulated in the abdominal aorta and lower vena cava and had electrodes subcutaneously implanted. In the in vitro approach, the heart was removed and perfused using the Langendorff technique. The significance level adopted was 5% (p < 0.05).

Results:

DL, in doses of 10, 20, and 40 mg/kg (i.v), produced intense and persistent bradycardia associated with hypotension. Bradycardia with prolonged QTc was observed in the ECG in vivo recording. In the in vivo model of arrhythmia induced by Bay K8644, DL (10 mg/kg) decreased the arrhythmia score from 15.33 ± 3.52 to 4.0 ± 2.64 u.a (p < 0.05, n = 4). In isolated perfused hearts, DL (10^-3 M) promoted significant reductions in heart rate (from 228.6 ± 8.5 ms to 196.0 ± 9.3 bpm; p < 0.05) and left ventricular development pressure (from 25.2 ± 3.4 to 5.9 ± 1.8 mmHg; n = 5, p < 0.05).

Conclusions:

DL produces bradycardia and antiarrhythmic activity in rat heart.

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Original Article

High-Lard and High-Cholesterol Diet, but not High-Lard Diet, Leads to Metabolic Disorders in a Modified Dyslipidemia Model

Lidiane B. Muniz et al. Aline M. Alves-Santos Fabricio Camargo Danieli Brolo Martins … Mara Rubia N. Celes Maria Margareth V. Naves

Abstract

Background:

In view of the increased global prevalence of cardiovascular and hepatic diseases, the diet lipid content and its relationship with the accumulation of fat in hepatocytes have been investigated as key factors in preventing these diseases.

Objective:

To evaluate the metabolic effects of a high-lard diet supplemented or not with cholesterol on a modified dyslipidemia model.

Methods:

We divided 24 adult male Wistar rats into three groups: standard diet (STD – 4% lipids), high-lard diet (HLD – 21% lard), and high-lard and high-cholesterol diet (HL/HCD – 20% lard, 1% cholesterol, 0.1% cholic acid). After six weeks of treatment, blood and liver were collected for biochemical (serum lipid profile and liver enzymes) and morphological analyses. Statistical analysis included one-way analysis of variance (ANOVA), followed by Tukey test for mean comparisons, and a 5% probability was considered statistically significant.

Results:

Animals fed HL/HCD showed increased total cholesterol, triacylglycerol, LDL-c, non-HDL-c, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) serum levels compared to those fed STD. In addition, the HL/HCD animals presented higher relative liver weight, with moderate macrovesicular hepatic steatosis and inflammatory infiltrate.

Conclusion:

A high-fat diet with lard (20%) and cholesterol (1%) triggered dyslipidemia with severe liver damage in rats in a shorter experimental time than the previously reported models. The high-lard diet without supplementation of cholesterol led to body weight gain, but not to dyslipidemia.

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Original Article

3-Dimensional Echocardiography and 2-D Strain Analysis of Left Ventricular, Left Atrial and Right Ventricular Function in Healthy Brazilian Volunteers

Roberto M. Saraiva et al. Eliza Maria B. Scolin Nicole P. Pacheco Maria Eduarda Bouret … Mauro Felippe Felix Mediano Marcelo T. Holanda Andréa R. da Costa

Abstract

Background:

New echocardiographic techniques are used in the diagnosis and prognosis of many heart diseases. However, reference values in different populations are still needed for several of these new indexes. We studied these new echocardiographic parameters in a group of Brazilians with no known cardiovascular disease.

Objective:

To study values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age.

Methods:

Cross-sectional study that included healthy individuals who underwent three-dimensional echocardiography (3DE) and two-dimensional speckle tracking echocardiography (STE) strain (e) analysis. Left atrial (LA) and left ventricular (LV) function were analyzed by 3DE and STE, and right ventricular (RV) function by STE. P values < 0.05 were considered significant.

Results:

Seventy-seven subjects (46.7% men; 40.4 ± 10.4 years) were included. Maximum, minimum and pre-atrial contraction (pre-A) LA volumes (ml/m²) were 21.2 ± 5.5, 7.8 ± 2.5, and 11.0 ± 3.1, respectively. Peak positive global LA e (LAScd), peak negative global LA e and total global LA e (LASr) were 17.4 ± 5.2%, -13.2 ± 2.0% and 30.5 ± 5.9%, respectively. LV end-diastolic and end-systolic volumes (ml/m²) measured 57 ± 12 and 24 ± 6, and 3D LV ejection fraction measured 58 ± 6%. Global LV longitudinal, circumferential and radial e were -19 ± 2%, -19 ± 3%, and 46 ± 12%, respectively. LV torsion measured 1.6 ± 0.7⁰ /cm. Global longitudinal RV e (RV-GLS) and RV free wall strain were -22 ± 3% and -24 ± 5%. Minimum LA and pre-A volumes, LV apical rotation, torsion and RV-GLS increased with age, while total and passive LA emptying fractions, LAScd, LASr, LV end-diastolic and end-systolic volumes decreased with age.

Conclusion:

Values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age are presented.

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Original Article

Prevalence of Masked and White-Coat Hypertension in Pre-Hypertensive and Stage 1 Hypertensive patients with the use of TeleMRPA

Weimar Kunz Sebba Barroso et al. Audes Diógenes Magalhães Feitosa Eduardo Costa Duarte Barbosa Roberto Dischinger Miranda … Andréa Araújo Brandão Priscila Valverde Oliveira Vitorino Lúcio Paulo de Souza Ribeiro Marco Mota Gomes

Abstract

Background:

The diagnosis of arterial hypertension based on measurements of blood pressure in the office has low accuracy.

Objective:

To evaluate the prevalence of masked hypertension (MH) and white-coat hypertension through home blood pressure monitoring (HBPM) in pre-hypertensive and stage 1 hypertensive patients.

Method:

Retrospective study, of which sample consisted of individuals with BP ≥ 120/80 mmHg and < 160/100 mmHg at the medical office without the use of antihypertensive medication and who underwent exams on the HBPM platform by telemedicine (TeleMRPA) between May 2017 and September 2018. The four-day MRPA protocol was used, with 24 measurements, using automated, validated, calibrated equipment with a memory function.

Results:

The sample consisted of 1,273 participants, of which 739 (58.1%) were women. The mean age was 52.4 ± 14.9 years, mean body mass index (BMI) 28.4 ± 5.1 kg/m². The casual BP was higher than the HBPM in 7.6 mmHg for systolic blood pressure (SBP) and 5.2 mmHg for diastolic blood pressure (DBP), both with statistical significance (p < 0.001). There were 558 (43.8%) normotensive individuals; 291 (22.9%) with sustained hypertension; 145 (11.4%) with MH and 279 (21.9%) with white-coat hypertension (WCH), with a diagnostic error by casual BP in the total sample in 424 (33.3%) patients. In stage 1 hypertensive individuals, the prevalence of WCH was 48.9%; in prehypertensive patients, the prevalence of MH was 20.6%.

Conclusion:

MH and WCH have a high prevalence rate in the adult population; however, in prehypertensive or stage 1 hypertensive patients, the prevalence is higher. Out-of-office BP measurements in these subgroups should be performed whenever possible to prevent misdiagnosis.

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