2020;115(5) – ABC CARDIOL

ABC

ABC Family | ABC

Research Letter

Emerging Topics in Heart Failure: Heart Failure With Preserved and Mid-Range Ejection Fraction

Miguel Morita Fernandes-Silva et al. Ricardo Mourilhe-Rocha Flávio de Souza Brito Antonio José Lagoeiro Jorge … Victor Sarli Issa Luiz Cláudio Danzmann

Heart Failure with Preserved Ejection Fraction (HFpEF) Diagnosis

Current diagnostic recommendations require evidence of congestion or low cardiac output, considering a combination of clinical information, electrocardiogram, imaging, biomarkers, and, in selected cases, hemodynamic exercise testing.

A pretest clinical approach (step 1) followed by a confirmatory score (step 2) is recommended to confirm or rule out the diagnosis of HFpEF. Hemodynamic exercise testing (step 3) is indicated for patients with an intermediate score ().

[…]

Read Full Article

Original Article

Pulmonary Vascular Volume Estimated by Automated Software is a Mortality Predictor after Acute Pulmonary Embolism

Leonardo Soriano et al. Marcel Koenigkam Santos Danilo Tadeu Wada Kelvin Vilalva … Talita Tavares Castro Oliver Weinheimer Valdair Francisco Muglia Antonio Pazin Filho Carlos Henrique Miranda

Abstract

Background:

Acute pulmonary embolism (APE) has a variable clinical outcome. Computed tomography pulmonary angiography (CTPA) is the gold standard for this diagnosis.

Objective:

To evaluate if the pulmonary vascular volume (PVV) quantified by automated software is a mortality predictor after APE.

Methods:

Retrospective cohort study where the CTPA imaging of 61 patients with APE was reanalyzed. Pulmonary vascular volume (PVV) and pulmonary volume (PV) were automatically estimated using the Yacta software. We calculated the adjusted PVV by the ratio: PVV(cm³)/PV(liters). Classical prognostic CTPA parameters (clot load index, right ventricle/left ventricle diameter ratio, pulmonary artery/aorta diameter ratio, ventricular septal bowing, pulmonary infarction and reflux of contrast into the hepatic vein) were assessed. The outcome assessed was one-month mortality. We considered a p-value <0.05 as statistically significant.

Results:

Seven deaths (11%) occurred at one month among these 61 patients. PVV<23cm³/L was an independent predictor of one-month mortality in the univariate [odds ratio (OR): 26; 95% confidence interval (CI): 3-244; p=0.004] and multivariate analyses [adjusted OR: 19; 95%CI: 1.3-270; p=0.03]. The classical CTPA parameters were not associated with one-month mortality in this sample. The PVV<23cm³/L showed a sensitivity of 86%, a specificity of 82%, a negative predictive value of 94% and a positive predictive value of 64% to identify the patients who died.

Conclusion:

PVV<23cm³/L was an independent predictor of one-month mortality after APE. This parameter showed better prognostic performance than other classical CTPA findings. (Arq Bras Cardiol. 2020; 115(5):809-818)

Read Full Article

Research Letter

Emerging Topics in Heart Failure: New Paradigms in Cardiac Amyloidosis

Marcus Vinicius Simões et al. Silvia Marinho Martins Alves Fabio Fernandes Otávio Rizzi Coelho Filho Sandrigo Mangini

Abstract

Recent evidence suggests cardiac amyloidosis (CA) is a mostly underdiagnosed condition, particularly in the transthyretin-mediated form, and is a frequent cause of heart failure with preserved ejection fraction (HFpEF) in the elderly. New paradigms about CA also involve the development of disease-modifying specific therapies. This article summarizes these new concepts.

Read Full Article

Editorial

Ventricular Repolarization as a Tool to Monitor Electrical Activity of the Heart

Marcelo Souto Nacif

Acute pulmonary embolism has a heterogeneous clinical presentation and the development of clinical tools for better stratification of the patients prognosis is extremely desired. Being able to discern which patient is most likely to have complications or even death is critical in the age of precision medicine. This may assist in choosing a more intensive and individualized treatment.

Computed tomography pulmonary angiography (CTPA) is already the most used method in emergencies for the diagnosis and stratification of patients with APE. The great variability of clinical presentations, whether in patients with cancer or different thrombogenic conditions, makes some quantitative data more attractive than just the qualitative analysis of the exam.^–

[…]

Read Full Article

Original Article

Hospitalization for Acute Myocardial Infarction: A Population-Based Registry

Leonardo Alves et al. Carisi Anne Polanczyk

Abstract

Background:

ST-segment elevation myocardial infarction (STEMI) is one of the main clinical manifestations of ischemic heart disease. Population-based data are relevant to better understand the current epidemiology of this condition.

Objective:

To describe the incidence, therapeutic management, hospital clinical outcomes and cardiovascular events in the first year of follow-up of individuals hospitalized for STEMI.

Methods:

Population-based prospective cohort study with consecutive registries of hospitalization for STEMI in a city in southern Brazil from 2011 to 2014. It included patients with STEMI who presented acute myocardial ischemia symptoms in the last 72 hours. A p-value < 0.05 was considered significant.

Results:

The annual incidence of STEMI hospitalizations was 108 cases per 100,000 inhabitants. Adjusted incidence was higher among older individuals (relative risk 64.9; 95% CI 26.9–156.9; p for linear trend < 0.001) and among men (relative risk 2.8; 95% CI 2.3–3.3; p < 0.001). There were 530 hospitalizations in the period under evaluation and the reperfusion rate reached 80.9%. Hospital mortality and the one-year follow-up cardiovascular event rate were, respectively, 8.9% and 6.1%. The oldest patients had higher hospital mortality (relative risk 3.72; 95% CI 1.57–8.82; p for linear trend = 0.002) and more one-year follow-up cardiovascular events (hazard ratio 2.35; 95% CI 1.12–4.95; p = 0.03).

Conclusion:

This study shows that both the therapeutic approach and hospital mortality are similar to the ones found in developed countries. However, the hospitalization rate was higher in these countries.

Read Full Article

Brief Communication

Cardiodepressive Effect of Eugenyl Acetate in Rodent Heart

Leisiane Pereira Marques et al. Samuel Santos Beserra Danilo Roman-Campos Antonio Nei Santana Gondim

Introduction

Cardiovascular diseases are a public health problem being among the leading causes of death worldwide. In this perspective, there is a growing interest in the search for new substances with pharmacological actions on the cardiovascular system, including drugs of natural origin.

The Syzygium aromaticum (L.) Merr. & L.M. Perry, popularly known as clove, produces several chemical compounds that have a wide range of biological effects. Eugenol () is the most abundant bioactive compound found in clove essential oil, followed by eugenyl acetate (EA) ().

[…]

Read Full Article

Original Article

Frequency and Reasons for Non-Administration and Suspension of Drugs During an Acute Coronary Syndrome Event. The ERICO Study

Rafael C. O. Santos et al. Isabela M. Bensenor Alessandra C. Goulart Paulo A. Lotufo Itamar S. Santos

Abstract

Background:

Few studies have discussed the reasons for pharmacological undertreatment of Acute Coronary Syndrome (ACS).

Objectives:

To determine the frequency and reasons for the non-administration and suspension of medications during in-hospital treatments of ACS in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study.

Methods:

The present study analyzed the medical charts of the 563 participants in the ERICO study to evaluate the frequency and reasons for the non-administration and/or suspension of medications. Logistic regression models were built to analyze if sex, age ≥65 years of age, educational level, or ACS subtype were associated with (a) the non-administration of ≥1 medications; and (b) the non-administration or suspension of ≥1 medications. The significance level was set at 5%.

Results:

This study’s sample included 58.1% males, with a median of 62 years of age. In 183 (32.5%) participants, ≥1 medications were not administered, while in 288 (51.2%), ≥1 medications were not administered or were suspended. The most common reasons were the risk of bleeding (aspirin, clopidogrel, and heparin), heart failure (beta blockers), and hypotension (angiotensin-converting enzyme inhibitors and angiotensin receptor blockers). Individuals aged ≥65 (odds ratio [OR]:1.51; 95% confidence interval [95% CI]:1.05-2.19) and those with unstable angina (OR:1.72; 95% CI:1.07-2.75) showed a higher probability for the non-administration of ≥1 medication. Considering only patients with myocardial infarction, being ≥65 years of age was associated with both the non-administration and the non-administration or suspension of ≥1 medication.

Conclusions:

Non-administration or suspension of ≥1 medication proved to be common in this ERICO study. Individuals of ≥65 years of age or with unstable angina showed a higher probability of the non-administration of ≥1 medication and may be undertreated in this scenario. (Arq Bras Cardiol. 2020; 115(5):830-839)

Read Full Article

Research Letter

Actions Against Covid-19 in the Down Syndrome Population

Giorgia Castilho Russo et al. Nathalia Bernardes Natália Rezende Baraldi Denise Jeanine Berlinger Saraiva … Kátia De Angelis Carla Janice Baister Lantieri José Francisco Saraiva

The World Health Organization (WHO) declared, on January 30, 2020, that the outbreak of the new coronavirus disease (COVID-19) constituted a Public Health Emergency of International Importance — the organization’s highest alert level as per its International Health Regulations. On March 11, 2020, COVID-19 was declared a pandemic. The fact that the lethality of COVID-19 is associated with common comorbidities has caused great concern among professionals who work with people with Down Syndrome (DS). The prevalence of cardiovascular diseases in people with DS is 40-50%,^, and they are also more prone to overweight and obesity; moreover, patients with DS present changes in airways that facilitate infection by the virus, which can worsen the effects of COVID-19. In addition, children with DS are more susceptible to infections due to changes in cytokines regulation, while adults frequently display increased proinflammatory biomarkers. These changes can impact the patients’ anatomical disorders and increase the incidence of chronic inflammatory conditions and mortality by sepsis.

Currently, the only recognized strategy to prevent infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is avoiding exposure to the virus. Social isolation was advised by several Brazilian states with the aim of separating healthy people from those with suspected COVID-19, or who had contact with suspected or confirmed COVID-19 cases. It is worth noting that socialization is a very important aspect of the treatment of people with DS that contributes to a better quality of life and autonomy; therefore, social isolation represents a major challenge for this population.

[…]

Read Full Article

Editorial

Angiotensin Receptor-Neprilysin Inhibition Therapy and Improved Exercise Parameters in Heart Failure with Reduced Ejection Fraction

Pedro Schwartzmann

Heart failure (HF) with reduced ejection fraction (HFrEF) has increased significantly in the last three decades and is associated with high morbidity and mortality. In patients with HF, exercise intolerance suggested by dyspnea or fatigue during exertion is the hallmark of the disease. Additionally, health-related quality of life is known to be markedly reduced in HFrEF patients. The severity of this exercise limitation and low quality of life has been shown to correlate to worse prognosis. For this functional and objective assessment, cardiopulmonary exercise testing (CPET) has played an important role on identifying those worse-prognosis patients and has been able to evaluate the effectiveness of different therapies for this HF population, such as the switch of angiotensin-converting enzyme inhibitors (ACEI) to angiotensin receptor neprilysin inhibition (ARNI).

The Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial randomized HFrEF patients with New York Heart Association functional class (NYHA) II-IV to the angiotensin receptor neprilysin inhibitor (sacubitril-valsartan) 200 mg twice daily or enalapril 10 mg twice daily and showed a consistent reduction on cardiovascular death, all-cause death and HF-related hospitalizations in the sacubitril-valsartan group. Moreover, the PARADIGM-HF showed improvement in overall quality of life as determined by the Kansas City Cardiomyopathy Questionnaire (KCCQ). Specifically, the greatest baseline limitations and improvements after sacubitril-valsartan were related to activities such as jogging and sexual intercourse, which might be a surrogate marker of better exercise capacity after switching the therapy, although very subjective.

[…]

Read Full Article

Research Letter

COVID-19 Infection in a Cardiopatic Pregnant Woman

Lucianna Serfaty de Holanda et al. Laíses Vieira Maria Talita Campos Vitor Bruno Teixeira de Holanda … Ivy Almeida Cavalcante e Silva Daniel Serfaty Feliciano Mendes Vieira Junior

Introduction

Regarding the obstetric aspects of COVID-19 infection, one should consider that it is a recent disease, with no specific knowledge on the theme to draft medical care protocols. For this reason, various guidelines are based on its comparison with infections caused by other viruses (SARS-CoV, MERS-CoV, and H1N1); therefore, all information concerning current evidence on the issue is subject to change due to new discoveries.

Infections caused by SARS-CoV and MERS-CoV have tended to be regionally bound, but the few obstetric cases published in the literature point to the need for advanced medical support for pregnant women with severe involvements identified in maternal prognoses. All of these highlight the importance of care against the dissemination of the virus.^–

[…]

Read Full Article

Editorial

Do Microvascular Reactivity Studies Contribute to Clinical Practice?

Claudio Leinig Pereira da Cunha

We appraise in this publication the article “Microvascular Reactivity in Hypertensive Patients with High Body Adiposity”, by D’El-Rei et al. This is a complex investigation, assessing patients with Arterial Hypertension undergoing treatment, with the inclusion of several models for obesity assessment and several hemodynamic and circulatory parameters, which are studied in this scenario. Microvascular reactivity was evaluated using the Laser Speckle Contrast Image method in combination with Post-occlusive Reactive Hyperemia, therefore studying the endothelial function in this patient population.

Endothelial cells constitute an organ that is distributed throughout the body, comprising a dynamic interface with all other organs. The endothelium mediates vasomotor tone, regulates cell and nutrient traffic, maintains body fluidity, contributes to the balance between pro- and anti-inflammatory mediators, modulates procoagulant and anticoagulant activity, participates in the formation of new blood vessels, orchestrates organ development, participates in immunity, interacts with circulating blood cells and undergoes programmed cell death.

[…]

Read Full Article

Original Article

Disease Severity Affects Ventricular Repolarization Parameters in Patients With COVID-19

Mevlut Koc et al. Hilmi Erdem Sumbul Erdinc Gulumsek Hasan Koca … Yurdaer Bulut Emre Karakoc Tuba Turunc Edip Bayrak Huseyin Ali Ozturk Muhammed Zubeyir Aslan Abdullah Orhan Demirtas Yahya Kemal Icen

Abstract

Background:

There is no study evaluating the T_peak-T_end (Tpe) interval, Tpe/QT ratio, and Tpe/QTc ratio to assess cardiac arrhythmias in patients with COVID-19.

Objective:

We aimed to examine whether there is a change in QT, QTc, Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio in patients with COVID-19.

Methods:

The study included 90 patients with COVID-19 infection and 30 age-and-sex-matched healthy controls. QT, QTc, Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were measured. The participants included in the study were divided into the following 4 groups: healthy controls (group I), patients with COVID-19 without pneumonia (group II), patients with COVID-19 and mild pneumonia (group III), and patients with COVID-19 and severe pneumonia (group IV). Statistical significance was set at p < 0.05.

Results:

It was found that baseline heart rate, presence of hypertension and diabetes, white blood cell count, blood urea nitrogen, creatinine, potassium, aspartate aminotransferase, alanine aminotransferase, NT-proBNP, high sensitive C reactive protein, D-dimer, hs-cTnI, Tpe, Tpe/QT, and Tpe/QTc increased from group I to group IV, and they were significantly higher in all patients in group IV (p < 0.05). Systolic-diastolic blood pressure, hemoglobin, and calcium levels were found to be lowest in group IV and significantly lower than in other groups (< 0.05). QT and QTc intervals were similar between groups. It was determined that increased heart rate, calcium, D-dimer, NT-proBNP and hs-CRP levels were significantly related to Tpe, Tpe/QT, and Tpe/QTc.

Conclusions:

In patients with COVID-19 and severe pneumonia, Tpe, Tpe/QT ratio, and Tpe/QTc ratio, which are among ventricular repolarization parameters, were found to be increased, without prolonged QT and QTc intervals. In this study, we cannot definitively conclude that the ECG changes observed are directly related to COVID-19 infection or inflammation, but rather associated with severe COVID-19 scenarios, which might involve other causes of inflammation and comorbidities. (Arq Bras Cardiol. 2020; 115(5):907-913)

Read Full Article

Letter to the Editor

Cardiovascular Imaging in Patients with COVID-19

Gabriel Blacher Grossman et al. Ronaldo de Souza Leão Lima

Dear Editor,

In the latest issue of the Arquivos Brasileiros de Cardiologia, Costa et al. reviewed the role of cardiovascular imaging and interventional procedures in patients with novel coronavirus infection.

[…]

Read Full Article

Original Article

Neck Circumference and 10-Year Cardiovascular Risk at the Baseline of the ELSA-Brasil Study: Difference by Sex

Acácia Antônia Gomes de Oliveira Silva et al. Larissa Fortunato de Araujo Maria de Fátima Haueisen Sander Diniz Paulo Andrade Lotufo … Isabela Martins Bensenor Sandhi Maria Barreto Luana Giatti

Abstract

Background:

Neck circumference (NC), an indirect measure of upper-body subcutaneous adipose tissue, has been pointed out as an independent predictor of cardiometabolic diseases.

Objectives:

To assess the association between NC and 10-year cardiovascular risk in men and in women.

Methods:

Cross-sectional analysis of 13,920 participants of the (baseline) Longitudinal Study of Adult Health (ELSA-Brasil). The association between NC (used as continuous variable and grouped into quartiles) and the 10-year cardiovascular risk was estimated by the Framingham Global Risk Score and analyzed by generalized linear models after adjustments for sociodemographic characteristics, health behaviors, body mass index and waist circumference. The significance level adopted was 5%.

Results:

Mean NC was 39.5 cm (SD± 3.6) in men and 34.0 cm (SD±2.9) in women. After adjustments, a one-centimeter increase in NC was associated with an increment of 3% (95%CI1.02-1.03) and 5% (95% 1.04-1.05) in the arithmetic mean of the 10-year CVD risk in men and women, respectively. Men and women in the last quartile showed an increment of 18% (95%CI 1.13-1.24) and 35% (95%CI 1.28-1.43), respectively in the arithmetic mean of the 10-year CVD risk, after adjustments.

Conclusions:

We found a positive, independent association between NC and the 10-year cardiovascular disease risk. NC may contribute to the prediction of cardiovascular risk, over and above traditional anthropometric measures.

Read Full Article

Editorial

Lifestyle in the Very Elderly Matters

Fernando H. Y. Cesena

According to the estimates and projections of the 2019 Revision of World Population Prospects, life expectancy will continue to rise in the following 30 years worldwide, the percentage of the population aged 65 years or over will jump from 9% in 2020 to 16% in 2050, and the number of persons aged 80 years or over will triple up to 2050.

The biology of aging and implicated genes has been studied for a long time as a basis for the search for therapies that may mitigate age-related processes, such as dementia and cardiovascular disease. Among the multitude of aspects that have been explored, the research involving apolipoprotein E (apoE) assumes particular relevance. ApoE is a 299-amino acid protein mainly synthesized by the hepatocytes. Like any other apolipoprotein, apoE is a constituent of lipoproteins and, therefore, has a role in lipid metabolism. In the plasma, apoE is primarily carried by triglyceride-rich lipoproteins and mediates the clearance of their remnants by the low-density lipoprotein receptor. In the brain, in situ produced apoE acts on the redistribution of lipids to neurons, as well as in the clearance of β-amyloid, much known for its association with Alzheimer disease.^,

[…]

Read Full Article

Research Letter

Emerging Topics in Heart Failure: Interventional Heart Failure Therapies

João Manoel Rossi Neto et al. Dirceu Rodrigues de Almeida Fernando Antibas Atik Monica Samuel Avila Marcely Gimenes Bonatto

Treatment of Secondary Mitral Regurgitation

Before considering percutaneous treatment of mitral regurgitation (MR) for patients with heart failure (HF) with reduced ejection fraction (HFrEF) and severe MR, we recommend that guideline-directed medical therapy be optimized, including cardiac resynchronization therapy and revascularization, where appropriate.

The use of the edge-to-edge device could benefit patients with moderately severe or severe secondary MR (effective regurgitant orifice area [EROA] ≥ 30 mm² and/or regurgitant volume > 45 mL) with a left ventricular ejection fraction (LVEF) of 20 to 50%, left ventricular (LV) end-systolic diameter < 7.0 cm, and persistent symptoms despite maximized evidence-based medical therapy, with the participation of an experienced multidisciplinary team in the evaluation and treatment of HF and MR.

[…]

Read Full Article

Original Article

Aerobic Exercise and Cardiac Function of Murines Exposed to Doxorubicin: a Meta-Analysis

Mariana Inocêncio Matos et al. Ercole da Cruz Rubini Frederico de Oliveira Meirelles Elirez Bezerra da Silva

Abstract

Background:

Cardiotoxicity may be a consequence of treatments with doxorubicin (DOX).

Objectives:

To investigate the effect of aerobic exercise on the prevention of cardiac dysfunction in murines exposed to DOX.

Method:

A comprehensive search was conducted in 9 databases in December 2017. Studies that evaluated the cardiac function of murines exposed to DOX were included. The significance level adopted was 5%.

Results:

In a comparison between 230 murines that underwent aerobic exercise plus DOX treatment and 222 control murines (DOX treatment only), fractional shortening showed an improvement of 5.33% in favor of the experimental group (p = 0.00001). Left ventricle developed pressure also showed an increase of 24.84 mm Hg in favor of the group of 153 murines that performed exercise in comparison to the control group of 166 murines (p = 0.00001).

Conclusion:

Preclinical studies included in this meta-analysis indicated that exercise is a good nonpharmacological strategy for preserving post-DOX cardiac function.

Read Full Article

Letter to the Editor

Epicardial Adipose Tissue: A New Cardiovascular Imaging Parameter Deeply Connected with Cardiovascular Diseases

Eduardo Thadeu de Oliveira Correia et al. Letícia Mara dos Santos Barbetta

Dear Editor,

We read with great interest the article entitled “The Relationship Between Epicardial Adipose Tissue and Insulin Resistance in Obese Children”. In that paper, the authors performed tissue doppler echocardiography to evaluate epicardial adipose tissue (EAT) thickness, electromechanical delay (EMD) and other standard measurements in 94 obese pediatric patients. Patients with Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) greater than the 90^th percentile in an age and sex-specific percentile curve were labeled as having insulin resistance (IR). This study found that the group with IR had significant higher thickness of EAT than patients included without IR (7.15 vs. 5.5 mm, p<0.004, respectively) and inter and intra-atrial EMD was prolonged in the IR group compared to the non-IR group (p3.85 mm could predict IR with 92.5% specificity and 68.5% sensitivity (p=0.002). The study then concluded that EAT could be used to identify IR among children, as it is stated that EAT is a cheap and accessible parameter that could be easily measured with echocardiography.

[…]

Read Full Article

Editorial

Pre-Clinical Meta-Analysis: Another Brick in the Wall

Amanda Gomes Pereira et al. André Monti Garzesi Sergio Alberto Rupp Paiva Bertha Furlan Polegato

Currently, systematic review and meta-analysis are considered level 1 of scientific evidence and it is widely used in epidemiology and evidence-based medicine. The term meta-analysis comes from the Greek and means “analysis of analyses”, referring to its definition “statistical analysis of a large collection of analysis results from individual studies for the purpose of integrating the findings” proposed by the statistician Gene V. Glass in 1976.

Despite the similarities, it is important to note that meta-analysis and systematic review are not synonymous. Meta-analysis is often, but not always, preceded by a systematic review, which aim to gather similar studies that meet the strict approach eligibility criteria in order to answer a specific research question, whereas meta-analysis integrates the results of included studies by statistical techniques.^,

[…]

Read Full Article

Research Letter

Emerging Topics in Heart Failure: New Era of Pharmacological Treatment

Fabiana G. Marcondes-Braga et al. Felix J. A. Ramires Estêvão Lanna Figueiredo José Albuquerque Figueiredo Neto … Luís Beck-da-Silva Salvador Rassi

Introduction

In recent decades, advances in pharmacological treatment and implantable devices have impacted the prognosis of heart failure (HF) with reduced ejection fraction (HFrEF). However, there remains high residual risk to be addressed. New therapies with different pathophysiologic targets can enhance the action of medications on the neurohormonal system and remodeling, and these benefits occur in addition to those of standard medical therapy. depicts the main results of randomized clinical trials on HF treatment.

[…]

Read Full Article

Diretrizes

Brazilian Cardio-oncology Guideline – 2020

Ludhmila Abrahão Hajjar et al. Isabela Bispo Santos da Silva da Costa Marcelo Antônio Cartaxo Queiroga Lopes Paulo Marcelo Gehm Hoff … Maria Del Pilar Estevez Diz Silvia Moulin Ribeiro Fonseca Cristina Salvadori Bittar Marília Harumi Higuchi dos Santos Rehder Stephanie Itala Rizk Dirceu Rodrigues Almeida Gustavo dos Santos Fernandes Luís Beck-da-Silva Carlos Augusto Homem de Magalhães Campos Marcelo Westerlund Montera Sílvia Marinho Martins Alves Júlia Tizue Fukushima Maria Verônica Câmara dos Santos Carlos Eduardo Negrão Thiago Liguori Feliciano da Silva Silvia Moreira Ayub Ferreira Marcus Vinicius Bolivar Malachias Maria da Consolação Vieira Moreira Manuel Maria Ramos Valente Neto Veronica Cristina Quiroga Fonseca Maria Carolina Feres de Almeida Soeiro Juliana Barbosa Sobral Alves Carolina Maria Pinto Domingues Carvalho Silva João Sbano Ricardo Pavanello Ibraim Masciarelli F. Pinto Antônio Felipe Simão Marianna Deway Andrade Dracoulakis Ana Oliveira Hoff Bruna Morhy Borges Leal Assunção Yana Novis Laura Testa Aristóteles Comte de Alencar Filho Cecília Beatriz Bittencourt Viana Cruz Juliana Pereira Diego Ribeiro Garcia Cesar Higa Nomura Carlos Eduardo Rochitte Ariane Vieira Scarlatelli Macedo Patricia Tavares Felipe Marcatti Wilson Mathias Junior Evanius Garcia Wiermann Renata do Val Helano Freitas Anelisa Coutinho Clarissa Maria de Cerqueira Mathias Fernando Meton de Alencar Camara Vieira André Deeke Sasse Vanderson Rocha José Antônio Franchini Ramires Roberto Kalil Filho

1. Introduction

Cardiovascular disease (CVD) and cancer are currently the leading causes of mortality worldwide and in Brazil.^– The recent demographic and epidemiological transitions in Brazil have determined an increase in the population’s life expectancy, today around 76 years, and a change in the health profile, in which chronic diseases and their complications prevail.

These factors pose important challenges and require the development of a health policy agenda for the management of the ongoing transitions. The technological advances, the shortage of cost-effectiveness analyses and, in higher education settings, the little value attributed to health access and promotion, as well as to disease prevention, require the implementation of guidelines and consensus statements. These guidelines and consensus statements are aimed at helping the use of systematized protocols to adapt the clinical practice regardless of the geographic location of the health facilities and the heterogeneity of their resources.

[…]

Read Full Article

Editorial

The legacy of Prof. Eduardo Sosa

José Antonio Franchini Ramires et al. Cesar Grupi Mauricio Ibrahim Scanavacca

A Short Background

Eduardo Argentino Sosa was born in Corrientes, Argentina, on January 25, 1942. He started a medical course at the School of Medical Sciences of Universidad Nacional del Nordeste, in his hometown, but due to the political situation that affected the university in Argentina at that time, he transferred to the School of Medical Sciences of Córdoba and later to the School of Medical Sciences of Universidad Nacional del Litoral, in the city of Rosário, where he completed studies in April 1965.

His interest in cardiology arose during his internship, when he was fascinated by the existing diagnostic methods, such as electrocardiography, vetocardiography, phono-cardiography and cardiac catheterization, which began at the time. Hence his first scientific study, presented at the 1^st National Cardiology Day at the Argentine Federation of Cardiology, in the city of Carlos Paz, in Córdoba, entitled “Intermittent Left Branch Block. Phonographic and Polygraphic Study.” He was soon hired as an assistant physician in the cardiology service, where he met Miguel Barbero Marcial, who later became his personal friend and changed the course of his life.

[…]

Read Full Article

Editorial

The Unapparent Non-COVID Consequences of the COVID-19 Pandemic

The world has been facing a COVID-19 pandemics of enormous proportion. Most places were unprepared to cope with this situation and considering its occurrence in the current scenario of fast, widespread and occasionally unfiltered information, the considerable growth of fear has affected most people worldwide. Mainly considering the rapid contamination of people in the hospitals and in the communities, as announced by the news, and potentialized by pictures of unassisted patients waiting outside the medical facilities, due to the lack of adequate support.

This apocalyptic scenario was seen in many places that were considered as adequately equipped for the regular treatment of ordinary health problems. All attention was diverted to provide installations and equipment to take care of the COVID-19 affected patients and their relatives.

[…]

Read Full Article

Review Article

Hypertrophic Cardiomyopathy: A Review

Silméia Garcia Zanati Bazan et al. Gilberto Ornellas de Oliveira Caroline Ferreira da Silva Mazeto Pupo da Silveira Fabrício Moreira Reis … Karina Nogueira Dias Secco Malagutte Lucas Santos Nielsen Tinasi Rodrigo Bazan João Carlos Hueb Katashi Okoshi

Abstract

Hypertrophic cardiomyopathy (HCM) is the most common heart disease with a genetic origin, and its main characteristic is left ventricular hypertrophy that occurs in the absence of other conditions that trigger this change. HCM may present from asymptomatic forms to manifestations of sudden cardiac death and severe heart failure. Contemporary high-resolution imaging methods and more accurate clinical scores have been used and developed to provide a prognostic assessment and adequate functional assessments, as well as to allow for the stratification of clinical severity. These aspects will be addressed in this review, along with other classic topics inherent to the study of this disease.

Read Full Article

See all articles