2021;117(3) – ABC CARDIOL

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Original Article

Atrial Fibrillation Diagnosis using ECG Records and Self-Report in the Community: Cross-Sectional Analysis from ELSA-Brasil

Itamar S. Santos et al. Paulo A. Lotufo Luisa Brant Marcelo M. Pinto Filho … Alexandre da Costa Pereira Sandhi Maria Barreto Antonio L. Ribeiro G Neil Thomas Gregory Y. H. Lip Isabela M. Bensenor

Abstract

Background:

Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America.

Objective:

The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment.

Methods:

This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%.

Results:

Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04–1.07), hypertension (OR:1.44; 95%CI: 1.14–1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85–6.79), heart failure (OR:7.37; 95%CI: 5.00–10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28–5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055).

Conclusions:

At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.

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Statement

Position Statement on Hypertension and Spirituality – 2021

Fernando Nobre et al. Roberto Esporcatte Andréa Araujo Brandão Álvaro Avezum Jr. … Audes Diógenes Magalhães Feitosa Celso Amodeo Eduardo Costa Duarte Barbosa Emilio Hideyuki Moriguchi Fernando Antônio Lucchese Hermilo Borba Griz José Carlos Nicolau Lucélia Batista Neves Cunha Magalhães Marco Antônio Mota-Gomes Mario Henrique Elesbão de Borba Mauro Ricardo Nunes Pontes Paulo César Brandão Veiga Jardim Pedro Pimenta de Mello Spineti Ricardo Mourilhe-Rocha Roberto Dischinger Miranda Sérgio Lívio Menezes Couceiro Weimar Kunz Sebba Barroso

Basic Concepts about Spirituality and Forms of Evaluation

The definitions of spirituality and religiosity vary in different cultural and religious environments. There is a diversity of concepts without a clear definition, and the term is used inaccurately and inconsistently, which impedes measurement.

The Brazilian Society of Cardiology’s Department of Spirituality Studies and Cardiovascular Medicine considers spirituality “a set of observable and measurable moral, mental. and emotional values that are motivated by the will and guide thoughts, behaviors, and attitudes in intra- and interpersonal relationships”. Spirituality should be valued and is applicable to all individuals, regardless of religious affiliation, including atheists, agnostics and those with no religious affiliation or who do not observe its precepts.

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Editorial

Should Patients with Heyde’s Syndrome Undergo Early Valve Intervention?

Marcelo Dantas Tavares de Melo et al. Jose Luiz Barros Pena Jorge de Oliveira Júnior Vera Maria Cury Salemi

The epidemiological profile of patients with aortic stenosis has changed with the aging of the population, characterized by an increase in associated comorbidities. Thanks to the revolution in percutaneous aortic valve treatment, many patients who previously would have limited survival and quality of life have benefited from the possibility of curative treatment. On the other hand, the clinical challenges that arise in this population reinforce not only the consolidated relevance of the heart team but also of other specialties such as oncology and hematology.

The interesting study published in the current issue reinforces the importance of the association between Heyde’s syndrome and aortic stenosis, with increased bleeding in this population. However, it is important to highlight in this context the frequently associated comorbidities that may contribute to eventual digestive bleeding, such as the association between aortic stenosis and neoplasm, since both share the same risk factors, particularly colon cancer neoplasm. This one presents with cardinal clinical signs: anemia and low gastrointestinal bleeding. In this context, the exclusion of neoplasm is mandatory, even in the suspicion of Heyde’s Syndrome. We can also describe other frequently associated comorbidities that add bleeding risk due to the therapy used, such as coronary artery disease, which usually uses antiplatelet therapy, or dual anti-aggregation after percutaneous coronary intervention with a drug-eluting stent.

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Editorial

Brazilian Population Presents Prevalence of Atrial Fibrillation Similar to Higher Income Countries, and a Low Use of Anticoagulation Therapy

Desiderio Favarato

Atrial fibrillation (AF) is the most incident arrhythmia and its frequency is increasing as a greater proportion of people over 60 years of age have been become a worldwide tendency.

There is an exponential increase of AF with the advancing of age from 50-59 years, of 5 fold in 60 – 69 years, of 7 fold in 70 – 79 years, and of 9 fold over 80 years.

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Statement

Position Statement on Diagnosis and Treatment of Cardiac Amyloidosis – 2021

Marcus V. Simões et al. Fabio Fernandes Fabiana G. Marcondes-Braga Philip Scheinberg … Edileide de Barros Correia Luis Eduardo P. Rohde Fernando Bacal Silvia Marinho Martins Alves Sandrigo Mangini Andréia Biolo Luis Beck-da-Silva Roberta Shcolnik Szor Wilson Marques Junior Acary Souza Bulle Oliveira Márcia Waddington Cruz Bruno Vaz Kerges Bueno Ludhmila Abrahão Hajjar Aurora Felice Castro Issa Felix José Alvarez Ramires Otavio Rizzi Coelho Filho André Schmidt Ibraim Masciarelli Francisco Pinto Carlos Eduardo Rochitte Flávio Henrique Valicelli Marcelo Luiz Campos Vieira Cláudio Tinoco Mesquita Celso Dario Ramos José Soares-Junior Minna Moreira Dias Romano Wilson Mathias Junior Marcelo Iório Garcia Junior Marcelo Westerlund Montera Marcelo Dantas Tavares de Melo Sandra Marques e Silva Pedro Manoel Marques Garibaldi Aristóteles Comte de Alencar Neto Renato Delascio Lopes Diane Xavier de Ávila Denizar Viana José Francisco Kerr Saraiva Manoel Fernandes Canesin Glaucia Maria Moraes de Oliveira Evandro Tinoco Mesquita

1. Introduction

Significant advances in understanding cardiac amyloidosis (CA) have been made in recent years, leading to a thorough reformulation of its clinical significance. In addition to convincing evidence that CA is a relatively common cause of heart failure with preserved ejection fraction (HFpEF), we are witnessing the emergence of specific therapies that can change the course of the disease and prolong the survival of affected patients.

In parallel, relevant advances in cardiovascular imaging techniques have greatly contributed to earlier and more accurate identification of the disease. Cardiac scintigraphy with bone-seeking radiotracers has allowed non-invasive diagnosis of transthyretin (TTR) cardiac amyloidosis (ATTR-CA), eliminating the need for endomyocardial biopsy, which has greatly simplified the diagnostic flow.

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Research Letter

Reduced Systemic Nitric Oxide Bioavailability Parallels Microvascular Endothelial Dysfunction during Cardiopulmonary Bypass

Viviana Ugenti et al. Ana Catarina Romano Andrea De Lorenzo Eduardo Tibirica

Introduction

Cardiopulmonary bypass (CPB) is currently performed in infants and newborns for surgical correction of congenital heart diseases (CHDs). CPB exposes the body to extreme, nonphysiologic conditions that initiate a systemic inflammatory response accompanied by vasomotor dysfunction, and can lead to multiple organ dysfunction. Additionally, CPB has been linked to activation and injury of endothelial cells, which is associated with global inflammatory response, triggering of the coagulation system and subsequent organ dysfunction, not only in adult patients, but particularly in infants and newborns.

Systemic microvascular dysfunction during CPB results in inadequate blood flow, organ perfusion and oxygen delivery to the tissues.⁴ We have shown, using laser Doppler perfusion monitoring (LDPM) (a non-invasive method coupled with local heating of the skin), that the microcirculatory bed of the skin of the forehead is an appropriate model for the study of microvascular reactivity and tissue perfusion in cardiovascular surgery with CPB in adults. Actually, local thermal hyperemia (LTH) is a useful method in the evaluation of systemic microvascular endothelial function.^, In addition, using LDPM, we demonstrated that microvascular dysfunction and hypoperfusion occur during CPB in surgical correction of congenital heart disease in infants and children, despite adequate macrohemodynamic parameters. The mismatch between macro- and microcirculation in severely ill patients with septic or cardiogenic shock, which can be misleading to an adequate clinical management of these patients, has also stimulated the search for new methods to monitor microcirculatory perfusion in the intensive care units.

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Research Letter

The Congenital Heart Disease Diagnosis List for the eleventh iteration of the International Classification of Diseases (ICD11): Translation to Brazilian Portuguese

Vera Demarchi Aiello et al. Sandra da Silva Mattos

Background

The International Society for Nomenclature of Pediatric and Congenital Heart Disease (ISNPCHD) is an organization composed by specialists in Pediatric Cardiology, Cardiac Surgery and Morphology. It was created aiming at unifying the terminology of congenital and acquired pediatric heart disease across the world. The unified lexicon allows for inter-institutional and international diagnostic comparisons and exchange of information on the outcomes of children and adults with congenital heart defects.

Initially gathering annually, as the “The International Nomenclature Working Group for the Mapping and Coding of Nomenclatures for Pediatric and Congenital Heart Disease”, the members decided to create, in 2005, the International Society (ISNPCHD), extending the membership to incorporate professionals from underrepresented areas of the world.

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Editorial

Physical Activity and HDL-C: Are There Gender Differences in the Dose-response Effect?

Filipe Ferrari et al. Raul D. Santos

HDL: Basic Functions and Cardiovascular Controversies

High-density lipoproteins (HDL) are a heterogeneous group of particles whose primary function is to promote reverse cholesterol transport. Evidence generated over decades has taught us that having low plasma concentrations of HDL-cholesterol (HDL-C) does not seem to be healthy. Also in 1964, Kannel et al. demonstrated – through an analysis of the Framingham cohort – a strong inverse relationship between plasma levels of HDL-C and atherosclerotic cardiovascular disease. However, this paradigm has changed in recent years. The causal role of HDL in cardiovascular risk reduction has been challenged by Mendelian randomization studies, which failed to demonstrate reduced risk of myocardial infarction in individuals with some genetic variants that increased HDL-C.^, In addition, the elevation of HDL-C obtained pharmacologically with cholesterol ester transporter protein (CETP) inhibitors did not lead to a reduction in cardiovascular events either. Finally, studies showing an association of higher mortality with high and low HDL-C levels raised further questions about this situation. Thus, today it is believed that the cardiovascular protection of HDL is, to say the least, controversial, and that HDL-C seems to act much more as a cardiovascular risk marker than as a causal factor.

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Editorial

The Challenge of Assessing Sudden Cardiac Death Risk in Patients with Nonischemic Heart Failure

Pedro Pimenta de Mello Spineti et al. Rodrigo Souto da Silva Sá Bruno Reznik Wajsbrot

Sudden cardiac death (SCD) accounts for approximately 50% of deaths in patients with ischemic and nonischemic heart disease in the presence of severe left ventricular systolic dysfunction. Many clinical trials^– have evaluated the effectiveness of implantable cardioverter defibrillators (ICDs) in primary prevention of SCD in the last 20 years.

The Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure (SCD-HeFT) defined the principles for indication^, of ICDs in primary prophylaxis of SCD of patients with heart failure (HF) of ischemic etiology. On the other hand, clinical trials evaluating patients with HF of nonischemic origin^,^– have shown heterogeneous results and, so far, there are uncertainties on the best candidates for this type of therapy.

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Editorial

Chronological Age or Biological Age, Mainly a Matter of Lifestyle

Paulo César B. Veiga Jardim et al. Thiago de Souza Veiga Jardim

Despite the significant global socioeconomic disparities, the world’s population has grown exponentially, and the average life continues to increase significantly.^–

If at the beginning of the 19th century, life expectancy in Europe was around 35 years, at present, only the African continent has populations with an average life expectancy of fewer than 60 years.^–

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Review Article

Myocardial Injury after Non-cardiac Surgery – State of the Art

Antonio José Lagoeiro Jorge et al. Evandro Tinoco Mesquita Wolney de Andrade Martins

Abstract

Approximately 300 million non-cardiac surgeries are performed annually worldwide and adverse cardiovascular events are the main cause of morbidity and mortality in the peri- and postoperative period. Myocardial injury after non-cardiac surgery (MINS) is a new clinical entity associated with adverse cardiovascular outcomes. MINS is defined as myocardial injury that can result in necrosis due to ischemia, marked by increase in biomarker levels. It has prognostic relevance and occurs within up to 30 days after non-cardiac surgery. The diagnostic criteria for MINS are an elevated postoperative measure of troponin judged as secondary to myocardial ischemia, i.e., with no evidence of a non-ischemic etiology, during or within 30 days after non-cardiac surgery, and without the requirement of an ischemic symptom or electrocardiographic finding of ischemia. Recently, patients at higher risk for MINS have been recognized using clinical variables and biomarkers and established protocols for greater surveillance in relation to electrocardiographic monitoring and cardiac troponin dosage. Elderly patients with previous atherosclerotic disease need to measure troponin daily in the postoperative period. The aim of the present work is to describe this new public health problem, its clinical impact and contemporary therapeutic approach.

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Editorial

Thiol Homeostasis in Rheumatic Heart Disease: Biomarker or Risk Factor?

Ana Cecília de Almeida Valadares et al. Roney Orismar Sampaio

Rheumatic fever and rheumatic heart disease (RHD) lesions result from a complex network of several genes and proteins that control innate and adaptive immune responses following a Streptococcus pyogenes pharyngo-tonsillitis. The succeeding inflammatory process leads to the development of cardiac lesions with high production of inflammatory cytokines leading to calcification and valvular fibrosis. However, the cellular pathways beyond these immunoregulated phenomena have not been fully elucidated.

Oxidative stress is a biological condition marked by an imbalance between reactive oxygen species production and its reduction. Disturbances in this redox balance can cause the overproduction of peroxides and free radicals that damage all cellular components, including proteins, lipids and DNA.

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Editorial

Is It Time to Move From Diagnosis to Active Intervention in Brazilian Workplaces? A Call for Action

Fernando Nobre et al. André Schmidt

Arterial hypertension (AH) is a major contributing risk factor for heart failure, myocardial infarction, stroke, and chronic kidney disease. According to the 2013 Brazilian National Health Survey, 21.4% (95%CI 20.8-22.0) of adults self-reported having AH; however, considering their blood pressure (BP) measurements and the use of antihypertensive medications, the rate of adults with BP greater than or equal to 140/90 mm Hg reached 32.3% (95% CI 31.7-33.0). The prevalence of AH was higher among men, and, as expected, this rate was highly affected by aging, reaching 71.7% for individuals over 70 years of age.^,

Therefore, every study to determine the prevalence of AH is very important for prevention, treatment, and follow-up programs. Samples representing the workforce are of particular importance because they are younger, in the productive age and have a longer life expectancy.

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Editorial

A New Pathway to Coronary Occlusion with Elabela?

Ricardo Wang et al. Estevão Lanna Figueiredo Fernando Carvalho Neuschwander

Total coronary occlusion (TCO) is characterized by an obstruction with an estimated duration of more than 3 months and is present in approximately 15–18% of all coronary angiographies performed. Clinical manifestations can range from asymptomatic, through stable angina, to varying degrees of ventricular dysfunction. This mainly depends on the degree of collateral circulation. If it is poor, it may compromise the viability of myocytes and associate with various degrees of necrosis and/or hibernating myocardium. In the presence of well-developed collaterals (Rentrop grade III), the patient may be asymptomatic and have a preserved contractile function. Therefore, the formation of a well-developed collateral circulation, especially before vessel occlusion, is essential for the preservation of myocytes.

Despite advances in the clinical treatment of stable angina, many patients with TCO undergo interventional procedures. Of these, most are referred for coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI) with more advanced techniques, but also with a higher risk of complications. The study of mechanisms potentially stimulating arteriogenesis and angiogenesis (collateral circulation formation) opens up opportunities for the development of drugs that, in turn, would avoid unnecessary interventions and/or could benefit patients with symptoms refractory to optimized conventional clinical treatment and who are poor candidates for interventions (e.g., thin distal bed, diffuse coronary disease).

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Editorial

The New Paradigm of Blood Pressure Measurement

Marcus Vinicius Bolivar Malachias

Hypertension (HTN) is the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide.^,

Accuracy in blood pressure (BP) measurement is essential for the diagnosis, risk stratification, and adequate treatment of HTN. The evidence shows that the traditional casual assessment of BP in the doctor’s office is not, in most cases, the best tool for diagnosis or clinical decision-making in individuals with high BP, or even for monitoring response to antihypertensive treatment.^,

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Original Article

Predictors of Total Mortality and Serious Arrhythmic Events in Non-Ischemic Heart Failure Patients: The Role of Galectin-3

Adriano Nunes Kochi et al. Mauricio Pimentel Michael Andrades Tiago Zimerman … Leandro Ioschpe Zimerman Luis Eduardo Rohde

Abstract

Background:

Risk stratification remains clinically challenging in patients with heart failure (HF) of non-ischemic etiology. Galectin-3 is a serum marker of fibrosis that might help in prognostication.

Objective:

To determine the role of galectin-3 as a predictor of major arrhythmic events and overall mortality.

Methods:

We conducted a prospective cohort study that enrolled 148 non-ischemic HF patients. All patients underwent a comprehensive baseline clinical and laboratory assessment, including levels of serum galectin-3. The primary outcome was the occurrence of arrhythmic syncope, appropriate implantable cardioverter defibrillator therapy, sustained ventricular tachycardia, or sudden cardiac death. The secondary outcome was all-cause death. For all statistical tests, a two-tailed p-value<0.05 was considered significant.

Results:

In a median follow-up of 941 days, the primary and secondary outcomes occurred in 26 (17.5%) and 30 (20%) patients, respectively. Serum galectin-3>22.5 ng/mL (highest quartile) did not predict serious arrhythmic events (HR: 1.98, p=0.152). Independent predictors of the primary outcome were left ventricular end-diastolic diameter (LVEDD)>73mm (HR: 3.70, p=0.001), exercise periodic breathing (EPB) on cardiopulmonary exercise testing (HR: 2.67, p=0.01), and non-sustained ventricular tachycardia (NSVT)>8 beats on Holter monitoring (HR: 3.47, p=0.027). Predictors of all-cause death were galectin-3>22.5 ng/mL (HR: 3.69, p=0.001), LVEDD>73mm (HR: 3.35, p=0.003), EPB (HR: 3.06, p=0.006), and NSVT>8 beats (HR: 3.95, p=0.007). The absence of all risk predictors was associated with a 91.1% negative predictive value for the primary outcome and 96.6% for total mortality.

Conclusions:

In non-ischemic HF patients, elevated galectin-3 levels did not predict major arrhythmic events but were associated with total mortality. Absence of risk predictors revealed a prevalent subgroup of HF patients with an excellent prognosis.

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Editorial

The Double-Orifice Technique in Mitral Valve Repair: 35 Years of History

Pablo Maria Alberto Pomerantzeff et al. Carlos Manuel de Almeida Brandão Arlindo Riso Fabio Biscegli Jatene

The advantages of mitral valve repair are lower morbidity and mortality, reduced risk of thromboembolism and endocarditis, improved survival, and better preservation of left ventricular function. The most common cause of degenerative mitral regurgitation is a myxomatous valve with segmental prolapse of the posterior leaflet, a lesion that can be corrected by classical techniques such as quadrangular resection, but other lesions may require more complex surgical techniques, for instance, correction of anterior leaflet prolapse or Barlow disease. Mitral valve repair in rheumatic patients is still a challenge.

In December 1984, Adib Domingos Jatene MD, PhD performed the first “duplication of the mitral orifice”, in a female patient with mitral insufficiency due to rupture of anterior leaflet chordae (). The technique restored mitral competence by anchoring the free edge of the prolapsing leaflets to the corresponding free edge of the opposing leaflet with a 5-0 polypropylene stitch reinforced with pledgets. The patient presented good immediate and long-term evolution.

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Original Article

VEGF121 Mediates Post-Hypoxia Cardioprotective Effects Via CaSR and Mitochondria-Dependent Protease Pathway

Yan Zhang et al. Wei-hua Yin Fan Yang Yun-qiang An … Wei Zhou Hui Yu Hong Xie Yan-ling Zhang Yue Zhu Xiang-chun Shen Ruiqing Tian

Abstract

Background:

Cardiovascular disease is the major cause of death worldwide. Hypoxia-mediated apoptosis in cardiomyocytes is a major cause of cardiovascular disorders. Treatment with vascular endothelial growth factor (VEGF) protein has been tested but operational difficulties have limited its use. However, with the advancements of gene therapy, interest has risen in VEGF-based gene therapy in cardiovascular disorders. However, the precise mechanism by which VEGF replenishment rescues post-hypoxia damage in cardiomyocytes is not known.

Objectives:

To investigate the effect of post-hypoxia VEGF121 expression using neonatal rat cardiomyocytes.

Methods:

Cardiomyocytes isolated from neonatal rats were used to establish an in vitro model of hypoxia-induced cardiac injury. The effect of VEGF overexpression, alone or in combination with small-molecule inhibitors targeting calcium channel, calcium sensitive receptors (CaSR), and calpain on cell growth and proliferation on hypoxia-induced cardiomyocyte injury were determined using an MTT assay, TUNEL staining, Annexin V/PI staining, lactate dehydrogenase and caspase activity. For statistical analysis, a value of P<0.05 was considered to be significant.

Results:

The effect of VEGF121 was found to be mediated by CaSR and calpain but was not dependent on calcium channels.

Conclusions:

Our findings, even though using an in vitro setting, lay the foundation for future validation and pre-clinical testing of VEGF-based gene therapy in cardiovascular diseases.

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Editorial

Active Assessment of Sleep and Depression for elderly Patients in the Outpatient Cardiology Setting: What Are We Waiting for?

Ana Vitória Vitoreti Martins et al. Luciano F. Drager

The relationships between sleep disturbances, depression and cardiovascular disease have gained growing interest in the last decades. Most evidence available suggests that several sleep disturbances (including sleep deprivation, insomnia and obstructive sleep apnea) are not only innocent bystanders, but may contribute to increase the cardiovascular risk.^– The prevalence and impact of sleep disorders may vary depending on some clinical characteristics (for instance: age, gender and comorbidities). Aging is clearly a risk factor for developing sleep disturbances; consistent evidence have shown greater number of complaints associated with sleep with aging, including insomnia and obstructive sleep apnea.^, The reduction in the number of hours of sleep and poor sleep quality may impair multiple domains related to the quality of life in the elderly.^– Similarly, depression is associated with several cognitive and cardiovascular consequences. Based on the biological plausibility linking sleep disorders and depression with cardiovascular risk,^, and the high prevalence of cardiovascular diseases among elderly, it is reasonable to assume that sleep disorders add to the high cardiovascular burden observed in this subset of patients.

In this issue of the Arquivos de Brasileiro de Cardiologia, Lopes et al. reported a prospective cohort study of 160 elderly patients (between 60 and 98 years old) aiming to estimate the risk of death and cardiovascular events after eight years of follow-up (from 2009 to 2017) in those who presented insomnia and excessive daytime sleepiness detected at baseline. Excessive daytime sleepiness, sleep quality and presence of depressive symptoms were evaluated by the Epworth Sleepiness scale, the Pittsburgh Sleep Quality Index and the Sheikh and Yesavage Geriatric Depression Scale, respectively.

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Editorial

Elevated Thiol Levels: A New Marker of Ventricular Arrhythmias in Acute Coronary Syndrome?

Bruno Ferraz de Oliveira Gomes

Ventricular arrhythmias in patients with acute coronary syndrome are not frequent, but they lead to a greater occurrence of complications and death.^, Its prevalence is higher in infarction with ST-segment elevation (STEMI) and has a worse prognosis when it occurs 48 hours after admission. Thus, a marker capable of predicting the occurrence of these events is welcome.

Three mechanisms justify the occurrence of arrhythmias in the acute phase of the infarction:

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Original Article

Association of Body Composition with Arterial Stiffness in Long-lived People

Flávia Veríssimo Melo e Silva et al. Franciellen Bruschi Almonfrey Cinthia Medice Nishide de Freitas Flávia Kurebayashi Fonte … Mariana Bellaguarda de Castro Sepulvida Clineu de Mello Almada-Filho Maysa Seabra Cendoroglo Egli Belinazzi Quadrado Celso Amodeo Rui Povoa Roberto Dischinger Miranda

Abstract

Background

Arterial stiffness, obesity and sarcopenia correlate with each other and with cardiac outcomes in younger adults. However, there is little evidence of the association between body composition and markers of central arteries stiffness in long-lived people.

Objective

To evaluate the relationship between arterial stiffness and body composition in functionally independent long-lived individuals.

Methods

This is a cross-sectional analysis of the association between markers of arterial stiffness and body composition among participants in a longitudinal cohort of elderly individuals aged 80 years or older who were functionally independent and lived in the community . Body composition measurements were performed using dual energy X-ray absorptiometry (DEXA) and central circulation parameters (CCP) obtained by a non-invasive oscillometric method through the Mobil-O-Graph 24h PWA Monitor® device. The central parameters evaluated were: pulse wave velocity (PWV), augmentation Index (AIx), pulse pressure amplification index (PPAi) and central pulse pressure (cPP). These were correlated to total lean mass (LM) and appendicular lean mass (aLM), body fat percentage, and Baumgartner’s Index (BI). The level of significance was set at 5% for all tests.

Results

Data from 124 elderly people with a mean age of 87.1 years (SD ± 4.3 years) were analyzed, with 74.2% of women and 57.3% of white. There was a statistically significant inverse correlation of AIx with LM (r = -0.391, p <0.001), aLM (r = -0.378, p <0.001), and BI (r = -0.258, p = 0.004). Also, cPP had an inversely proportional association with LM (r = -0.268, p = 0.003), aLM (r = -0.288, p = 0.001), and BI (r = -0.265, p = 0.003). When assessing the relationship between fat mass and CCP, a statistically significant direct relationship was observed only between AIx and body fat percentage (r = 0.197, p = 0.029).

Conclusion

In long-lived people, body fat percentage is directly associated with arterial stiffness and inversely associated with the amount of LM. These findings may be associated with increased cardiovascular risk.

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Original Article

Association between Plasma Thiol Parameters and Troponin Levels in Patients with Acute Coronary Syndrome and Prediction of In-Hospital Ventricular Arrhythmia

Mehmet Erdoğan et al. Selcuk Ozturk Elçin Özdemir Tutar Esma Arslan … Muhammet Cihat Çelik Serdal Baştuğ Salim Neşelioğlu

Abstract

Background

Ventricular arrhythmias (VAs) are the main cause of in-hospital mortality and morbidity in acute coronary syndrome (ACS) patients and its relationship with thiol is not known.

Objective

To investigate the relationship between plasma thiol levels and troponin levels in patients with ACS and to estimate in-hospital VA development during hospital stay.

Method

The study included 231 consecutive ST-segment elevation ACS (STE-ACS) and non-ST-segment elevation ACS (NSTE-ACS) patients. After application of exclusion criteria, 191 patients were included in the statistical analysis. Patients were classified into two groups: STE-ACS group (n=94) and NSTE-ACS group (n=97). Plasma thiol, disulphide and troponin levels were measured and troponin-to-native thiol ratio (TNTR) was calculated. A two-sided p value of less than 0.05 was considered to be statistically significant.

Results

Plasma native thiol, total thiol, disulphide and their ratios were similar between the groups. TNTR was significantly higher in the STE-ACS group compared to the NSTE-ACS group. Troponin and thiol levels correlated negatively and significantly. Native thiol was found to be an independent predictor of VA development in STE-ACS patients and in all ACS patients. TNTR was found to be an independent predictor of VA development in NSTE-ACS patients and in all ACS patients.

Conclusion

Plasma thiol levels can be used to identify ACS patients at high risk for in-hospital VA development. Correlation between troponin and thiol levels may suggest that thiols may be an important marker for diagnosis and prognosis of ACS with the help of future studies.

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Original Article

Association between Leisure Time Physical Activity and HDL-C in the Elsa-Brasil Study Participants: Are There Any Gender Differences in the Dose-Response Effect?

Francisco José Gondim Pitanga et al. Rosane Harter Griep Maria da Conceição Almeida Maria de Jesus Mendes da Fonseca … Andreia Rios de Souza Raiane de Carvalho Silva Sheila Maria Alvim Matos

Abstract

Background

High levels of high-density lipoprotein (HDL-C) are known for their protective effect against cardiovascular diseases and the regular practice of leisure time physical activity (LTPA) may be associated with their increase.

Objective

To verify the existence of differences between genders in the dose-response effect regarding the association between LTPA and HDL-C in the ELSA-Brasil study cohort.

Methods

Cross-sectional study with data from wave 2 of 13,931 participants of both genders (7,607 women) from the Longitudinal Study of Adult Health ELSA-Brasil. The LTPA was measured using the International Physical Activity Questionnaire (IPAQ) and classified into four categories: sedentary, low active, active and very active. The discriminatory power of LTPA at different intensities analyzed for high HDL-C was tested using ROC curves. Associations, adjusted for confounders between LTPA and HDL-C were analyzed by logistic regression. A 95% confidence interval was used.

Results

A positive association, with a dose-response effect, was observed between LTPA and HDL-C in both men and women. With regard to intensity, only vigorous physical activity discriminated high HDL-C in men, while both walking and moderate and vigorous physical activity discriminated high HDL-C in women.

Conclusions

LTPA shows a positive association with gradient dose-response and HDL-C, but in men, the association is not observed for those classified as physically unfit. In women, both walking intensity and moderate or vigorous physical activity can discriminate high HDL-C levels, whereas only vigorous intensity-exercise discriminate elevated HDL-C levels in men, demonstrating that males need to do more physical activity for this benefit to be observed.

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Original Article

Serum Thiol Levels and Thiol/Disulfide Homeostasis in Patients with Rheumatic Mitral Valve Disease and Healthy Subjects

Ahmet Korkmaz et al. Birsen Doğanay Funda Basyigit Cem Çöteli … Abdulkadir Yildiz Tugba Gursoy Umit Guray Ozgul Ucar Elalmis

Abstract

Background

Rheumatic mitral valve disease (RMVD) is the most common presentation of rheumatic heart disease (RHD). Inflammation and fibrosis processes also play significant roles in its pathogenesis. Recent studies showed that thiols and thiol-disulfide are promising novel oxidative stress markers.

Objectives

The present study aimed to evaluate differences in the serum thiol and thiol-disulfide levels in patients with RMVD and the control group.

Methods

Ninety-two patients with RMVD were enrolled in the study. Fifty-four healthy subjects, age, and gender-matched with the study group, were also included in the study as a control group. This study investigated thiol levels in patients with RMVD and the control group. P-values lower than 0.05 were considered statistically significant.

Results

The patients with RMVD presented higher systolic pulmonary artery pressure (SPAP) and left atrial (LA) diameter levels than the control group. Native thiol (407±83 μmol/L vs. 297±65 μmol/L, p<0.001) and total thiol (442±82 μmol/L vs. 329±65 μmol/L, p<0.001) levels were higher in the control group. Disulfide (16.7±4.9 μmol/L vs. 14.8±3.7 μmol/L, p=0.011) levels were higher in the group of patients with RMVD. A positive correlation was found between disulfide/native and disulfide/total thiols ratio with SPAP, LA diameter, and MS severity. Disulfide/total thiols ratio was significantly higher in patients with severe MS than with mild to moderate MS patients.

Conclusions

To the best of our knowledge, this is the only study of its kind that has evaluated thiol/disulfide homeostasis as a novel predictor, which was more closely related to RMVD and the severity of MS.

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