2023;120(3) – ABC CARDIOL

ABC

ABC Family | ABC

Editorial

Brazilian Initiatives Head Strong Scientific Cooperation to Address COVID-19 Issues: The Case of Coalition COVID-19 Brazil

Cláudio Tinoco Mesquita

The ongoing COVID-19 pandemic has highlighted the importance of collaborative scientific research like never before. With the world facing an unprecedented health crisis, it has become clear that scientific collaboration and knowledge sharing are critical to finding solutions to the challenges posed by the pandemic. Scientific cooperation increased during the pandemic bringing the ability to pool resources and expertise from across the globe.¹ Cooperative science can lead to a more comprehensive understanding of the virus, its transmission, and the disease it causes. With COVID-19, researchers worldwide have collaborated to share data, collaborate on studies, and develop new therapies and vaccines.

Collaborative scientific research is key to accelerating the pace of research. The traditional model of scientific research involves a slow and often fragmented process of discovery, validation, and dissemination. In Brazil, one seminal example of collaboration is the coalition initiative that congregates more than 70 centers around the country and has led several randomized clinical trials with more than 5000 participants. One good example of their results is the Coalition Covid Brazil III trial that demonstrated that dexamethasone improves patients with severe COVID-19.² These results are comparable to the landmark Recovery Trial that demonstrated for the first time that in patients hospitalized with Covid-19, dexamethasone resulted in lower 28-day mortality.³ Coalition studies also showed that hydroxychloroquine, with or without azithromycin, did not benefit mild-to-moderate⁴ or severe COVID-19 cases.⁵

[…]

Read Full Article

Editorial

Nuclear Cardiology in the Optimization of Resynchronization Therapy: Quo Vadis?

Gabriel Blacher Grossman

Myocardial Viability and Resynchronization Therapy

Several studies in the literature have shown that the absence of myocardial viability at the site where the electrode was positioned reduces the efficacy of CRT. Ypenburg et al. evaluated the presence of fibrosis using GATED-SPECT with Tc-99m-tetrofosmin before CRT. Patients without fibrosis at the electrode implantation site showed improvement in NYHA class, quality of life, 6-minute walk test, ventricular volumes, and ejection fraction at a 6-month follow-up compared to patients with fibrosis at the electrode implantation site for CRT RT. The extent of the viable myocardial area was related to the reduction of ventricular volumes and ejection fraction. Bose et al. also demonstrated in a retrospective study involving 160 patients with ischemic cardiomyopathy that those patients in which electrode placement was in a site with fibrosis or fibrosis and ischemia more often had the primary outcome (hospitalization for HF and death) at 3 years compared to those patients with normal myocardium. Therefore, the fibrosis and myocardial viability evaluation at the electrode implementation site should be considered before CRT.

[…]

Read Full Article

Editorial

Exercise-Based Cardiac Rehabilitation (ECBR): New Frontiers in the Post-Novel Coronavirus

Rosane Maria Nery et al. Antonio Cardoso dos Santos Eduardo Lima Garcia

The coronavirus disease 2019 (COVID-19) pandemic, in addition to physical, emotional, and social repercussions, has generated important changes in non-pharmacological measures to aid in treating patients with heart disease, such as Exercise-Based Cardiac Rehabilitation (ECBR). The disability associated with the post-COVID-19 syndrome seems to have a considerable impact on health services, as the treatment of these patients implies a very high demand for care and a high economic cost.

Scientific evidence has shown a close association between sedentary behavior and the development and worsening of cardiovascular disease (CVD) and early mortality. Many of these deaths could be avoided or postponed with preventive care and therapeutic measures, where EBCR is a fundamental pillar.^,

[…]

Read Full Article

Editorial

Does the BUN/Cr Ratio Confer a Worse Prognosis in All Ejection Fraction Spectra?

Giovanni Possamai Dutra et al. Bruno Ferraz de Oliveira Gomes

Neurohormonal activation is one of the most relevant pathophysiological features in Heart Failure (HF), promoting long-term deleterious effects that contribute to the development of cardiorenal syndrome. This hyperactivation is associated with the prognosis of acute heart failure; therefore, it is plausible to hypothesize that its activity is associated with the prognosis of heart failure.

The current universal classification of heart failure, updated in 2021, modified the classification of HF according to ejection fraction (EF), replacing the mid-range EF (HFmrEF) with mildly reduced EF for those with an EF of 41% to 49%, maintaining the classification of reduced ejection fraction (HFrEF) for those with EF less than 40% and preserved (HFpEF) for patients with EF above 50%. The most used classification system today is based on this categorization of patients into groups based on left ventricular ejection fraction (LVEF), and this model has become the main model used by guidelines to provide recommendations for treatment.

[…]

Read Full Article

Editorial

Sepsis, Atrial Fibrillation, and Aging: A Dangerous Association

Evandro José Cesarino et al. Marildes Luiza de Castro Carolina Baraldi Araujo Restini

Atrial fibrillation (AF) is a common heart rhythm disorder often identified during sepsis’s progression.

Its prevalence increases in the general population with age, reaching 18% in the elderly over 85 years old.

[…]

Read Full Article

Research Letter

Cumulative Disorder of Myocardial Lipofuscin after Long-Term Heart Transplantation: A Study Based on Endomyocardial Biopsies

Luiz Alberto Benvenuti et al. Fabiana G. Marcondes-Braga Fernando Bacal

Introduction

Lipofuscin is a yellowish-brown, non-degradable cytoplasmic pigment composed of highly oxidized proteins, lipids, and metals. Lipofuscin accumulates over time in perennial post-mitotic cells such as cardiomyocytes and is also called “age pigment”.^–

Heart transplantation is an established treatment for patients with severe heart failure refractory to other forms of treatment. Its major long-term limitation is the development of cardiac allograft vasculopathy (CAV), which is relatively difficult to diagnose and for which few effective treatment options exist.^6,7 In this context, it is worth mentioning a previous study relating the amount of lipofuscin in the myocardium of heart transplant patients to the development of CAV.

[…]

Read Full Article

Editorial

Multi-Arterial Grafting in Surgical Coronary Revascularization. The Renewed Quest for Enhanced Outcomes

Walter J. Gomes

With a large body of contemporary and historic evidence strengthening coronary artery bypass surgery (CABG) as the most effective procedure for treating advanced atherosclerotic coronary artery disease (CAD), the quest for enhanced outcomes and quality improvement is steadily underway.

Long-term graft patency is crucial for the benefits afforded by surgery, averting spontaneous myocardial infarction rate (MI) and increasing long-term survival, which is demonstrated with the employment of internal thoracic artery (ITA) conduits anastomosed to the left anterior descending coronary artery.

[…]

Read Full Article

Editorial

The “Value of 0”: Is There an Added Value in Using the Calcium Score in the Stratification of Symptomatic Individuals with a Zero Score?

Catarina Ferreira

Coronary calcium score (CCS) is a good marker of cardiovascular risk, with an independent prognostic value that is incremental over traditional clinical risk factors.^– It is performed using non-contrast computed tomography with very low radiation exposure to patients.

Its use is now recommended in selected asymptomatic individuals to refine risk assessment and help initiate or prolong preventive pharmacotherapies.

[…]

Read Full Article

Editorial

Infective Endocarditis: New Spectra, Same Severity

Infective endocarditis is a rare disease with a high rate of serious complications and can often be seen as a syndrome. A cold assessment of data published internationally shows us that despite all the technological advances and an early trend towards surgical intervention, there was no great reduction in clinical outcomes, especially mortality, but a more detailed search for information may bring us other points of view.

The article by Jorge MS et al. corroborates the idea of early diagnoses and interventions in this broad spectrum of patients, and observing the epidemiological change of patients over the years is a fundamental key to a broad reading of the management of contemporary infective endocarditis.

[…]

Read Full Article

Letter to the Editor

Paraoxonase-1 Genotype and Angiogram Positive Coronary Artery Disease

Rujittika Mungmunpuntipantip et al. Viroj Wiwanitkit

Dear Editor,

We would like to share ideas on the publication “Association of Paraoxonase-1 Genotype and Phenotype with Angiogram Positive Coronary Artery Disease”. Soflaei et al. noted that The presence of the G allele of the rs662 single nucleotide polymorphism is independently associated with an increased risk of coronary artery disease (CAD). The effect of polymorphism is investigated in this study. CAD might or might not be impacted by the hereditary component studied in this report. We both concur that CAD may be related to the underlying genetic component under research. However, CAD has been linked to numerous genetic variations. Examples of gene polymorphisms include the effect of polymorphisms (M235T and T174M) on the angiotensinogen gene (AGT), TGFB1 rs1800469, and BCMO1 rs6564851.^– Future research should examine the implications of unexpected, possibly perplexing genetic variants.

[…]

Read Full Article

Editorial

Chasing New Non-Invasive Parameters to Predict Atrial Fibrillation after Radiofrequency Catheter Ablation

Michael Ramon de Lima-Conceição et al. Jorge Lucas Teixeira-Fonseca Danilo Roman-Campos

The Framingham Heart Study showed that the incidence and prevalence of atrial fibrillation (AF) are increasing globally, with the prevalence increasing more than 3-fold from 1958 to 2007. In 2017 there were 37.57 million prevalent cases and 3.05 million incident cases of AF globally, contributing to 287241 deaths. Notorious that the estimation shows that these numbers may further increase in the future. The projection shows that only in the USA, 12.1 million people by 2050 may have AF. According to the 2020 European Society of Cardiology Guideline, AF is defined as a supraventricular tachyarrhythmia with uncoordinated atrial electrical activation and ineffective atrial contraction. Electrocardiographic characteristics of AF include irregularly irregular R-R intervals (when atrioventricular conduction is not impaired), absence of distinct repeating P waves, and 3 irregular atrial activations. The clinical diagnosis in symptomatic or asymptomatic AF patients is performed by surface electrocardiogram (ECG), with a minimum 30 s duration of an ECG containing a typical AF tracing.

Even though a clear definition of the clinical diagnostic of AF exists, however, at least five patterns of AF are distinguished, which are based on presentation, duration, and spontaneous termination of AF episodes.^, Most likely, the variety of clinical AF manifestations is related to the etiology of the disease, which is not fully elucidated yet. Several AF development and progression predictors exist, and the most relevant are body mass index, heart rate, age, systolic blood pressure, history of hyperthyroidism, stroke, and heart failure. Due to the complex nature of AF, proper patient management is challenging, which implies, in an ideal situation, a coordinated and well-defined agreement between patient-individualized care pathways to deliver the most adequate and optimized treatment. The current treatment approach for AF patients consists of the A(trial fibrillation), B(etter), C(are), a.k.a the (ABC) holistic pathway, which encompasses: the ‘A’ Anticoagulation/Avoid stroke; ‘B’ Better symptom management; and ‘C’ Cardiovascular and Comorbidity optimization. It is important to stress that the treatment is also subject to change over time, mostly because of the discovery of new risk factors, disease progression, symptoms, diagnostic tools and methods, predictors, and the development of new treatments.

[…]

Read Full Article

Editorial

Post-COVID Dysautonomias: The Importance of Early Recognition and Implementation of Recovery Programs

Denise Hachul et al. Tatiana Almeida Mauricio Scanavacca

The international scientific community has devoted all its efforts over the last three years to a better understanding and treatment of the SARS-COV-2 infection, which initially seemed to be limited to a severe acute respiratory syndrome. However, as time goes by, we are faced with a growing number of patients with multisystemic, persistent, intermittent, or late symptoms, which generate significant psycho-functional impairment of those affected and reveal to us the chronic and unpredictable nature of the disease.

The recognized Post-COVID Syndrome courses with a significant number of complaints described in case reports, population studies, and meta-analyses. Myocarditis, myocardial infarction, stroke, heart failure, arrhythmias, genitourinary, gastrointestinal, endocrinological, central, and peripheral neurological disorders of varying severities have been described in the subacute and chronic phases after contact with the virus.^–

[…]

Read Full Article

Original Article

Relationship between BUN/Cr and Prognosis of HF Across the Full Spectrum of Ejection Fraction

Yuan Kang et al. Conglin Wang Xiaojing Niu Zhijing Shi … Mingxue Li Jianli Tian

Abstract

Background

In patients with heart failure (HF), due to the relative deficiency of blood volume, neurohormone system activation leads to renal vasoconstriction, which affects the content of blood urea nitrogen (BUN) and creatinine (Cr) in the body, while BUN and Cr are easily affected by other factors. Therefore, BUN/Cr can be used as another marker for the prognosis of HF.

Objective

Explore the prognosis of adverse outcome of HF in the high BUN/Cr group compared with the low BUN/Cr group across the full spectrum of ejection fraction.

Methods

From 2014 to 2016, symptomatic hospitalized HF patients were recruited and followed up to observe adverse cardiovascular outcomes. Logistic analysis and COX analysis were performed to determine significance. p-values <0.05 were considered statistically significant.

Results

In the univariate logistic regression analysis, the high BUN/Cr group had a higher risk of adverse outcome in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Multivariate logistic regression analysis showed that the risk of cardiac death in the HFrEF group was higher than that in the low BUN/Cr group, while the risk of all-cause death was significant only in 3 months (p<0.05) (Central Illustration). The risk of all-cause death in the high BUN/Cr in the HFpEF group was significantly higher than that in the low BUN/Cr group at two years.

Conclusion

The high BUN/Cr group is related to the risk of poor prognosis of HFpEF, and is not lower than the predictive value of left ventricular ejection fraction (LVEF).

Read Full Article

Editorial

Is There a Role for Religion and Spirituality in Cardiac Rehabilitation?

Christina Grüne de Souza e Silva

Cardiac rehabilitation (CR) is a secondary prevention intervention offered to promote cardiac recovery by reducing morbidity, mortality, and disability. As such, CR has been recognized as integral to the comprehensive care of patients with cardiovascular disease, and, in most current guidelines of cardiovascular societies globally, CR is a class I recommendation.

At first, the standard “cardiac rehabilitation” approach focused almost exclusively on supervised exercise, since many previous studies had confirmed a positive impact of regular physical activities on cardiac outcomes. However, currently, the exercise-centric model of CR has been considered outdated. As increasing evidence has shown that cardiac events affect patients not only physically, but also emotionally, socially, and spiritually, contemporary CR programs are now viewed as a multidisciplinary intervention. Among well-recognized core components such as management and control of cardiovascular risk factors, physical activity counseling, and exercise prescription, specific approaches that aim to influence favorably mental and social conditions, improving quality of life and psychological well-being, are now considered key players to cardiac recovery.

[…]

Read Full Article

Research Letter

Orthotopic Heart Transplantation in a Covid-19 Recipient

Leonardo Rufino Garcia et al. André Monti Garzesi Julia Bazzo Sinatora Rejane Maria Tommasini Grotto … Andréia Cristina Passaroni Nelson Leonardo Kerdahi Leite de Campos Antônio Sérgio Martins Marcello Laneza Felicio Flávio de Souza Brito

Introduction

The coronavirus pandemic has affected more than 480 million people around the world. Solid organ recipients constitute a highly vulnerable group due to the need for immunosuppression and the various comorbidities that may be associated, many of which persist even after transplantation.

Transplanted patients can present a spectrum of clinical manifestations resulting from COVID-19: from asymptomatic, mild symptoms or acute respiratory failure and death. Some studies suggest that in the case of conditions with a favorable outcome, previous immunization and irreplaceable post-transplantation immunosuppression contribute to a response of less exacerbated inflammation and, consequently, less organic damage.^, Nonetheless, some reports and literature reviews show worse prognosis in transplanted patients, possibly due to comorbidities, advanced age, and lymphopenia often present.^,,

[…]

Read Full Article

Original Article

Feasibility of Left Ventricle Lead Implantation in Cardiac Resynchronization Therapy Guided by Gated SPECT and Ventricular Remodeling

Erivelton Alessandro do Nascimento et al. Fernando de Amorim Fernandes Pedro Augusto Carvalho Mira Zhuo He … Weihua Zhou Claudio Tinoco Mesquita

Abstract

Background

Cardiac resynchronization therapy (CRT) may benefit patients with advanced heart failure (HF). Abnormal eccentricity index by gated SPECT is related to structural and functional alterations of the left ventricle (LV).

Objective

The aim of this study is to evaluate the feasibility of LV lead implantation guided by phase analysis and its relationship to ventricular remodeling.

Methods

Eighteen patients with indication for CRT underwent myocardial scintigraphy for implant orientation, and eccentricity and ventricular shape parameters were evaluated. P < 0.05 was adopted as statistical significance.

Results

At baseline, most patients were classified as NYHA 3 (n = 12). After CRT, 11 out of 18 patients were reclassified to a lower degree of functional limitation. In addition, patients’ quality of life was improved post-CRT. Significant reductions were observed in QRS duration, PR interval, end-diastolic shape index, end-systolic shape index, stroke volume, and myocardial mass post-CRT. The CRT LV lead was positioned concordant, adjacent, and discordant in 11 (61.1%), 5 (27.8%), and 2 (11.1%) patients, respectively. End-systolic and end-diastolic eccentricity demonstrated reverse remodeling post-CRT.

Conclusions

LV lead implantation in CRT guided by gated SPECT scintigraphy is feasible. The placement of the electrode concordant or adjacent to the last segment to contract was a determinant of reverse remodeling.

Read Full Article

Original Article

Rivaroxaban in Outpatients with Mild or Moderate COVID-19: Rationale and Design of the Study CARE (CARE – Coalition COVID-19 Brazil VIII)

Gustavo B. F. Oliveira et al. Precil Diego M. M. Neves Haliton A. Oliveira Daniela Ghidetti Mangas Catarino … Lucas B. O. Alves Alexandre B. Cavalcanti Regis G. Rosa Viviane C. Veiga Luciano C.P. Azevedo Otávio Berwanger Renato D. Lopes Álvaro Avezum

Abstract

Background

Previous studies have demonstrated a high risk of arterial and venous thromboembolic events as a consequence of direct viral damage to endothelial cells by SARS-CoV-2 and a procoagulant milieu due to increased biomarkers, such as D-dimer, fibrinogen, and factor VIII. Although randomized controlled trials of antithrombotic therapies have been conducted in hospitalized patients, few have evaluated the role of thromboprophylaxis in an outpatient setting.

Objective

To assess whether antithrombotic prophylaxis with rivaroxaban reduces the risk of venous or arterial thrombotic events, invasive ventilatory support, and death in COVID-19 outpatients.

Methods

The COVID Antithrombotic Rivaroxaban Evaluation (CARE) study, a multicenter, randomized, open-label, controlled trial of rivaroxaban 10 mg once daily for 14 days or local standard treatment alone to prevent adverse outcomes, is registered in clinicaltrials.gov (NCT04757857). The inclusion criteria are adults with confirmed or suspected SARS-CoV-2 infection and mild or moderate symptoms without indication for hospitalization, within 7 days of symptom onset, and 1 risk factor for COVID-19 complication (> 65 years, hypertension, diabetes mellitus, asthma, chronic obstructive pulmonary disease or other chronic lung diseases, smoking, immunosuppression, or obesity). The primary composite endpoint, which includes venous thromboembolism, invasive mechanical ventilation, major acute cardiovascular events, and mortality within 30 days of randomization, will be assessed according to the intention-to-treat principle. All patients will provide informed consent. A significance level of 5% will be used for all statistical tests.

Results

Major thrombotic and bleeding outcomes, hospitalizations, and deaths will be centrally adjudicated by an independent clinical events committee blinded to the assigned treatment groups.

Conclusion

The CARE study will provide relevant and contemporary information about the potential role of thromboprophylaxis in outpatients with COVID-19.

Read Full Article

Research Letter

Late-Onset Bioprosthetic Mitral Valve Thrombosis, Presenting with Significant Obstruction and Acute Heart Failure

Ana Filipa Cardoso et al. Tamara Pereira Filipa Cordeiro Marina Fernandes … Olga Azevedo António Lourenço

Introduction

Bioprosthetic valve thrombosis (BPVT) has an incidence ranging from 0.5% to 6%. However, it is most likely underreported given the technical limitations of 2D transthoracic echocardiography (TTE) and the unawareness of the condition.

Our study presents a case report of a middle-aged male who was admitted with acute heart failure and was diagnosed with BPVT. Recognition of the condition and prompt institution of parenteral anticoagulation allowed for the restoration of the normal functioning of the biological valve, avoiding invasive strategies.

[…]

Read Full Article

Original Article

Predicting Significant Coronary Obstruction in a Population with Suspected Coronary Disease and Absence of Coronary Calcium: CORE-64 / CORE320 Studies

Anderson C. Armstrong et al. Rodrigo Cerci Matthew B. Matheson Tiago Magalhães … Satoru Kishi Jeff Brinker Melvin E. Clouse Carlos E. Rochitte Christopher Cox João A. C. Lima Armin Arbab-Zadeh

Abstract

Background

Coronary artery calcium (CAC) scanning can be performed using non-contrast computed tomography to predict cardiovascular events, but has less value for risk stratification in symptomatic patients.

Objective

To identify and validate predictors of significant coronary obstruction (SCO) in symptomatic patients without coronary artery calcification.

Methods

A total of 4,258 participants were screened from the CORE64 and CORE320 studies that enrolled patients referred for invasive angiography, and from the Quanta Registry that included patients referred for coronary computed tomography angiography (CTA). Logistic regression models evaluated associations between cardiovascular risk factors, CAC, and SCO. An algorithm to assess the risk of SCO was proposed for patients without CAC. Significance level of 5% was used in the analyses.

Results

Of the 509 participants of the CORE study, 117 (23%) had zero coronary calcium score; 13 (11%) patients without CAC had SCO. Zero calcium score was related to younger age, female gender, lower body mass index, no diabetes, and no dyslipidemia. Being a current smoker increased ~3.5 fold the probability of SCO and other CV risk factors were not significantly associated. Considering the clinical findings, an algorithm to further stratify zero calcium score patients was proposed and had a limited performance in the validation cohort (AUC 58; 95%CI 43, 72).

Conclusion

A lower cardiovascular risk profile is associated with zero calcium score in a setting of high-risk patients. Smoking is the strongest predictor of SCO in patients without CAC.

Read Full Article

Original Article

Spirituality, Functional Gain, and Quality of Life in Cardiovascular Rehabilitation

Maria do Rosário Toscano von Flach et al. Luiz Eduardo Fonteles Ritt Fábio Gonçalves de Santana Junior Marina von Flach Correia … Thaissa Costa Claro Ana Marice Ladeia Queila Borges de Oliveira Mario Seixas Rocha Cristiane Miura Feitosa Maeve Santos Ricardo Stein

Abstract

Background

Religiosity and spirituality have been associated with higher recovery rates, greater adherence to treatments, and better levels of quality of life in patients with heart disease.

Objectives

To evaluate the association between spirituality, functional gain, and improved quality of life in patients in a cardiovascular rehabilitation program.

Methods

This prospective cohort study evaluated the association between functional and quality of life gains during a cardiovascular rehabilitation program and a religiosity/spirituality index based on a validated scale. Depression, anxiety, and stress symptoms were screened for control purposes. P values < 0.05 were considered significant for all analyses.

Results

The study followed 57 patients (66 ± 12 years old; 71.7% male; 76% with coronary artery disease). The Spearman correlation coefficient did not show any associations between increases in functional capacity and organizational (rs = 0.110; p = 0.421), non-organizational (rs = −0.007; p = 0.421), or intrinsic (rs = −0.083; p = 0.543) religiosity. Furthermore, no associations were detected between the results of a quality of life score and organizational (rs = 0.22; p = 0.871), non-organizational (rs = 0.191; p = 0.159), or intrinsic (rs = 0.108; p = 0.429) religiosity.

Conclusion

No association was detected between functional and quality of life gains and organizational, non-organizational, or intrinsic religiosity in this sample of patients undergoing cardiovascular rehabilitation.

Read Full Article

Review Article

Brugada Syndrome: 30 Years of Scientific Ventures

Abstract

Thirty years ago, a distinctly new clinical-electrocardiographic syndrome was described, today known as Brugada Syndrome (BrS). Typical treatment for this type of syndrome is electrocardiography with ST-segment elevation in the direct precordial derivations. The clinical presentation of the disease is highly variable: the patients can remain completely asymptomatic, but they can also develop episodes of syncope, atrial fibrillation (AF), sinus node dysfunction (SNF), conduction disorders, asystole, and ventricular fibrillation (VF). This disease is caused by mutations in the genes responsible for the potential action of cardiac cells. The most commonly involved gene is SCN5A, which controls the structure and function of the heart’s sodium channel. The description of this new syndrome has shown highly positive implications in all fields of medicine.

Read Full Article

Original Article

Left Atrial Appendage Volume Predicts Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation: A Meta-Analysis

Zhenghao Liu et al. Xiaofei Mei Hezi Jiang Yujie Cui … Weiwei Yin Kuangyi Wang Tan Chen Yafeng Zhou

Abstract

Background

The influence of left atrial appendage volume (LAAV) on the recurrence of atrial fibrillation (AF) following radiofrequency catheter ablation remains unclear.

Objectives

We performed a meta-analysis to assess whether LAAV is an independent predictor of AF recurrence following radiofrequency catheter ablation.

Methods

The PubMed and the Cochrane Library databases were searched until March 2022 to identify publications evaluating LAAV in association with AF recurrence after radiofrequency catheter ablation. Seven studies that fulfilled the specified criteria of our analysis were found. We used the Newcastle-Ottawa Scale to evaluate the quality of the studies. The pooled effects were evaluated depending on standardized mean differences (SMDs) or hazard ratios (HRs) with 95% confidence intervals (CIs). P values < 0.05 were considered statistically significant.

Results

A total of 1017 patients from 7 cohort studies with a mean follow-up 16.3 months were included in the meta-analysis. Data from 6 studies (943 subjects) comparing LAAV showed that the baseline LAAV was significantly higher in patients with AF recurrence compared to those without AF (SMD: −0.63; 95% CI: −0.89 to −0,37; all p values < 0.05; I²= 62.6%). Moreover, higher LAAV was independently associated with a significantly higher risk of AF recurrence after radiofrequency catheter ablation (HR: 1.10; 95% CI: 1.02 to 1.18).

Conclusions

The meta-analysis showed that there is a significant correlation between LAAV and AF recurrence after radiofrequency catheter ablation, and the role of LAAV in AF patients should not be ignored in clinical practice.

Read Full Article

Original Article

Immediate Results after Multiple Arterial Grafts in Coronary Artery Bypass Graft Surgery in the São Paulo State: Cross Cohort Study

Raúl Armando Micalay Paredes et al. Gabrielle Barbosa Borgomoni Anny Kátia Puchalski Micalay José Carlos Arteaga Camacho … Luís Roberto Palma Dallan Luiz Augusto Ferreira Lisboa Luís Alberto de Oliveira Dallan Omar Asdrúbal Vilca Mejia Grupo de estudos REPLICCAR

Abstract

Background

The short-term results after using arterial grafts still raise questions and doubts for medical society.

Objective

To compare the immediate outcomes of patients undergoing single arterial graft versus multiple arterial grafts coronary artery bypass grafting surgery.

Methods

Cross-sectional cohort study in the São Paulo Registry of Cardiovascular Surgery II (REPLICCAR II). Perioperative data from 3122 patients were grouped by the number of arterial grafts used, and their outcomes were compared: reoperation, deep sternal wound infection (DSWI), stroke, acute kidney injury, prolonged intubation (>24 hours), short hospital stay (14 days), morbidity and mortality. Propensity Score Matching (PSM) matched 1062 patients, adjusted for the mortality risk.

Results

After PSM, the single arterial graft group showed patients with advanced age, more former smokers, hypertension, diabetes, stable angina, and previous myocardial infarction. In the multiple arterial grafts, there was a predominance of males, recent pneumonia, and urgent surgeries. After the procedure, there was a higher incidence of pleural effusion (p=0.042), pneumonia (p=0.01), reintubation (p=0.006), DSWI (p=0.007), and sternal debridement (p=0.015) in the multiple arterial grafts group, however, less need for blood transfusion (p=0.005), extremity infections (p=0.002) and shorter hospital stays (p=0.036). Bilateral use of the internal thoracic artery was not related to increased DSWI rate, but glycosylated hemoglobin >6.40% (p=0.048).

Conclusion

Patients undergoing the multiarterial technique had a higher incidence of pulmonary complications, and DSWI, where glycosylated hemoglobin ≥6.40%, had a greater influence on the infectious outcome than the choice of grafts.

Read Full Article

Original Article

Infective Endocarditis Surgery. Insights from 328 Patients Operated in a University Tertiary Hospital

Marcelo Serafim Jorge et al. Alfredo J. Rodrigues Walter Vilella A. Vicente Paulo Roberto B. Evora

Abstract

Background

Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves.

Objective

This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo–Brazil.

Method

Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020

Results

The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis.

Conclusion

For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.

Read Full Article

See all articles