2025;122(12) – ABC CARDIOL

Research Letter

Phenotypic Variability in a Family with Andersen-Tawil Syndrome

Samuel Ulisses Chaves Nogueira do Nascimento et al. Jussara de Oliveira Pinheiro Duarte Luiz Pereira de Magalhães Alex Teixeira Guabiru … Adimeia Souza Santos Enderson Cavalvanti Victoria Bastos Rodrigues Roque Aras

Introduction

Cardiac channelopathies are genetic disorders caused by pathogenic variants in genes encoding ion channels, resulting in alterations in cardiac electrophysiology and a predisposition to potentially fatal arrhythmias. Among these conditions, Long QT Syndrome (LQTS) stands out as a heterogeneous clinical entity, characterized by prolonged QT interval and an increased risk of ventricular tachyarrhythmia and sudden death.

Some hereditary forms of LQTS occur in the context of genetic syndromes, such as Andersen-Tawil Syndrome (ATS), which is caused by variants in the KCNJ2 gene, encoding the Kir2.1 potassium channel. In addition to long QT and a predisposition to ventricular arrhythmia, ATS manifests with periodic paralysis and craniofacial dysmorphisms, forming a diagnostic triad. Although the diagnosis may be clinical, molecular confirmation is essential for risk stratification, genetic counseling, and differentiation from other conditions with phenotypic overlap.

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Original Article

Geographic Variation in Door-to-Needle Time among Patients with STEMI from the Metropolitan Region of Rio de Janeiro: Results of the EQUITY-MI Cohort

Eric Costa de Almeida et al. Felipe Neves Albuquerque Esmeralci Ferreira Roberto Pozzan … Pedro Pimenta de Mello Spineti Pâmela Sousa Monteiro Williana Oliveira de Araújo Rhayana Vitória da Rosa Silva Carla Maciel Caminhas Thales Cardoso Whately João Gabriel Monteiro Junqueira Denilson Campos de Albuquerque

Abstract

Background

There is a gap in information regarding the reperfusion strategies used and the evolution of patients with ST-segment elevation myocardial infarction (STEMI) in the state of Rio de Janeiro.

Objective

To assess thrombolysis time in the diverse regions of the state capital and metropolitan area of Rio de Janeiro, as well as the outcome of post-infarction heart failure.

Methods

EQUITY-MI is a prospective cohort study of patients diagnosed with STEMI and referred to a single reperfusion center. Continuous variables were analyzed using the Kruskal–Wallis test, and categorical variables were analyzed using the chi-square test. In order to estimate the effect of door-to-needle time (DNT), generalized linear regression models with gamma distribution and log link function were applied, in addition to quantile regression to estimate the effect at the 25%, 50%, and 75% quantiles, both adjusted for sex, age, race, and education level. The significance level applied was 0.05.

Results

The study included 457 patients, with a mean age of 60.4 years, 79% of whom received thrombolysis, with a median DNT of 77 minutes, and 20.9% were thrombolyzed within 30 minutes, with no statistical difference between regions (p = 0.23). The Baixada Fluminense region presented the highest adjusted mean DNT (165.9 minutes), with a time difference compared to the North Zone (0.61; 0.44 to 0.87; p = 0.003) and West Zone (0.69; 0.51 to 0.96; p = 0.022). It also presented the highest DNT in all intervals (Q25, Q50, Q75). After infarction, 63.5% of patients presented heart failure.

Conclusion

There was a general delay in DNT for patients included in the EQUITY-MI study, with worse systematic performance in the Baixada Fluminense region, in addition to a high incidence of post-infarction heart failure.

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Original Article

Comparison of Blood Pressure Values and Antihypertensive Medications Used in Non-Afro-Descendant and Afro-Descendant Brazilians with Hypertension

Maicon Borges Euzébio et al. Priscila Valverde de Oliveira Vitorino Andrea A. Brandão Eduardo Costa Duarte Barbosa … Celso Amodeo Audes Feitosa Marcus Vinicius Bolivar Malachias Marco Antonio MotaGomes Rui Manoel dos Santos Póvoa Renato Delascio Lopes Paulo Cesar B Veiga Jardim Ana Luiza Lima Souza Antonio Coca Weimar Kunz Sebba Barroso

Abstract

Background

The prevalence of hypertension (HTN) is high in ethnic communities, particularly among Afro-descendant adults in the United States. Moreover, there is a lack of studies addressing this issue in the Brazilian Afro-descendant population.

Objective

To analyze blood pressure control and the use of antihypertensive medications among Afro-descendant and non-Afro-descendant Brazilians.

Methods

This cross-sectional study evaluated data from the First Brazilian Registry of Hypertension, which included individuals over 18 years of age, self-identified as Afro-descendant or non-Afro-descendant, with HTN for at least four weeks or using antihypertensive medication. Comparisons were performed using t-tests or the Mann-Whitney test. A significance level of p < 0.05 was adopted.

Results

A total of 2,643 participants were included, of whom 82.8% were non–Afro-descendant and 17.1% were Afro-descendant. The rates of uncontrolled HTN were 44.68% among non–Afro-descendants and 54.64% among Afro-descendants. Median values of systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI) were higher in Afro-descendants compared to non–Afro-descendants (p < .001). The distribution of antihypertensive medication classes varied between the populations. No significant differences in HTN control were observed between beta-blocker users in the Afro-descendant and non–Afro-descendant groups, even when stratified by sex.

Conclusion

The Afro-descendant population in Brazil demonstrated a higher prevalence of uncontrolled HTN and higher SBP, DBP, and BMI values compared to the non–Afro-descendant population. The choice of antihypertensive medications differed between groups, with thiazides more commonly prescribed for Afro-descendants and ARBs for non–Afro-descendants. However, no significant differences in blood pressure control were observed between groups using beta-blockers, regardless of sex.

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Original Article

Conduction System Pacing vs Biventricular Pacing in Chronic Heart Failure: Protocol for the Economic Analysis of the PhysioSync-HF Trial

Sérgio R. R. Decker et al. Ana Paula Beck da S Etges André Zimerman Fernanda D. Alves … Caique M. Ternes Juliana S. Santos Leandro Zimerman Luis Eduardo Rohde Alexander Dal Forno André d’Avila Dhruv S. Kazi Eduardo G. Bertoldi Carisi A. Polanczyk

Abstract

Background

Conduction system pacing (CSP) has emerged as an alternative to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT), with potential clinical benefits and lower costs. PhysioSync-HF is a multicenter, randomized trial comparing these strategies from both clinical and economic perspectives in patients with heart failure with reduced ejection fraction (HFrEF).

Objective

To describe the rationale and design of the trial-based economic evaluation embedded within the PhysioSync-HF trial.

Methods

The PhysioSync-HF trial enrolled 179 patients with 1-year follow-up. Procedural cost data will be collected using a time-driven activity-based costing approach. Costs associated with the device, adverse clinical events, and ambulatory care during follow-up will be estimated using resource-based accounting methods. Appropriate methods will address missing data, and statistical analyses will account for the skewed distribution of cost variables.

Results

The primary economic outcome is the between-group difference in total direct medical costs per patient over the 1-year follow-up (CSP vs BVP). Secondary outcomes include component-level cost breakdowns of direct medical expenses and a budget impact analysis estimating the annual effect on Brazil’s health care system if all eligible patients received CSP instead of BVP.

Conclusion

By leveraging a multicenter cardiovascular trial to measure costs of CSP versus BVP, this economic evaluation aims to identify cost-saving opportunities that could expand equitable access to CRT for individuals with HFrEF in Brazil, while providing insights relevant to other health care settings worldwide.

Trial Registration

NCT05572736.

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Original Article

Safety and Efficacy of Exercise-based Cardiac Rehabilitation in Patients with Refractory Angina

Luciana Oliveira Cascaes Dourado et al. Camila Paixão Jordão Marcelo Luiz Campos Vieira Luis Henrique Wolff Gowdak … Carlos Eduardo Negrão Luiz Antonio Machado Cesar Luciana Diniz Nagem Janot de Matos

Abstract

Background

Evidence on the safety and anti-ischemic effects of exercise-based cardiac rehabilitation (ECR) in patients with refractory angina (RA) remains limited.

Objective

To evaluate the safety and efficacy of a 12-week ECR program in patients with RA, focusing on improvements in symptoms, functional capacity, and ischemic burden assessed by exercise stress echocardiography (ESE).

Methods

This was a prospective, single-center, randomized controlled trial evaluating a 12-week ECR program in patients with RA. Forty-five patients were randomized to either the rehabilitation group (RG), receiving ECR, or the control group (CG), receiving medical treatment (MT) alone. Outcomes included mortality, cardiovascular events, anginal symptoms, and parameters from ESE and cardiopulmonary exercise testing (CPET). Statistical significance was set at p < 0.05.

Results

In ESE, exercise duration was significantly greater in RGpost (after ECR) compared to RGpre (before ECR) (∆ = 63.24 ± 19.87 s; p < 0.01). Angina quantification was lower in RGpost than in RGpre, CGpost (after MT alone), and CGpre (before MT alone) (∆ = –1.64 ± 0.48 n, p < 0.01; –3.10 ± 0.97 n, p < 0.01; and –2.73 ± 0.92 n, p = 0.01, respectively). The angina threshold was higher in RGpost than in RGpre and CGpost (∆ = 89.66 ± 33.16 s, p = 0.04; and 111.76 ± 42.25 s, p = 0.04, respectively). Improvement in ischemic burden on ESE was demonstrated by increased time to ischemic threshold in RGpost compared to RGpre, CGpost, and CGpre (∆ = 83.23 ± 21.84 s, p < 0.01; 98.44 ± 35.11 s, p = 0.03; and 109.34 ± 34.00 s, p < 0.01, respectively). In CPET, RGpost showed increased exercise duration (∆ = 104.54 ± 28.09 s, p < 0.01) and distance covered (∆ = 131.23 ± 30.48 m, p < 0.01) compared to RGpre. No significant differences in VO₂ were observed between groups. Two patients in the CG group died. One patient in the RG group experienced prolonged angina during training. No significant differences in major cardiovascular events were observed between groups.

Conclusion

The 12-week ECR-program was safe and effective in improving exercise duration, distance covered and ischemic burden on ESE in patients with RA.

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Original Article

Physiological Characterization of Coronary Endotypes: Potential Links with Myocardial Ischemia

Lucía Matute-Blanco et al. Thalia Belmonte Kristian Rivera Marcos García-Guimaraes … Juan Casanova-Sandoval Iván D. Benítez Georgina Fuertes-Ferre Ainhoa Pérez Guerrero Raúl Millán Segovia Fernando Worner David De Gonzalo-Calvo Diego Fernández-Rodríguez

Abstract

Background

Comprehensive physiological characterization of coronary endotypes remains limited, especially in epicardial dysfunction.

Objectives

To describe hemodynamic profiles across the full spectrum of coronary endotypes and explore potential links with ischemia.

Methods

Patients with suspected chronic coronary syndromes who underwent invasive physiological assessment in the ANFIBIO Project (NCT05374694) were classified according to fractional flow reserve [(FFR)≤0.80] and index of microcirculatory resistance [(IMR)≥25] in the left anterior descending artery into four groups: normal indices, isolated epicardial, isolated microvascular, and combined dysfunction. Coronary pressure, flow, and resistance indices were compared between groups.

Results

A total of 130 patients were finally included. A gradual decrease in hyperemic coronary flow [(Q_cor) in mL/min; normal indices: 387±192, isolated epicardial: 278±153, isolated microvascular: 130±41, combined: 96±33; p<0.001] and a progressive increase in total coronary resistance [(R_Total) in Wood units (WU); normal indices: 238±139, isolated epicardial: 373±167, isolated microvascular: 694±210, combined: 999±342; p<0.001] were observed as more compartments were involved. Also, epicardial dysfunction was primarily associated with reduced distal coronary pressure (Pd) and elevated epicardial resistance [(R_Epi) in WU; normal indices: 25±18, isolated epicardial: 145±113, isolated microvascular: 66±34, combined: 389±282; p<0.001], whereas microvascular dysfunction was characterized by preserved Pd but markedly decreased Q_cor and increased microvascular resistance [(R_Micro) in WU; normal indices: 213±124, isolated epicardial: 228±73, isolated microvascular: 628±195, combined: 610±137; p<0.001]. Combined dysfunction shares mechanisms of both epicardial and microvascular dysfunction.

Conclusions

Coronary endotypes exhibit distinct hemodynamic patterns with specific pressure- and flow-related ischemic mechanisms. Integrated physiological assessment is essential for accurate endotype characterization and personalized therapeutic strategies.

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Original Article

Exploring the Correlations between Initial Clinical and Radiological Manifestations in Takayasu’s Arteritis

Anísio Uchoa Leite Santana et al. Samuel Katsuyuki Shinjo

Abstract

Background

Initial clinical and imaging associations in Takayasu’s arteritis (TAK) are poorly defined.

Objectives

To characterize initial manifestations, their associations, and long-term outcomes in a TAK cohort.

Methods

A single-center retrospective cohort study (2000 to 2024) included patients diagnosed with TAK. The significance level was set at p<0.05.

Results

Among 203 patients identified, 54 were excluded due to incomplete data. The final cohort comprised 149 patients (89.9% female), with a median age at diagnosis of 31 years. At diagnosis, 92.6% were symptomatic. Claudication of upper (36.2%) and lower (30.9%) limbs was frequent, alongside advanced vascular damage like stenosis (85.9%) and occlusions (52.3%). Upper limb claudication was independently predicted by reduced upper limb pulses (OR=4.83; 95%CI=2.08-11.24; p=0.001) and right subclavian artery occlusion (OR=8.06; 95%CI=1.94-33.44; p=0.004). Lower limb claudication was predicted by right subclavian artery occlusion (OR=6.65; 95%CI=2.05-21.61; p=0.002), right subclavian artery thickening (OR=5.12; 95%CI=1.18-22.71; p=0.029), and left subclavian artery stenosis (OR=2.71; 95%CI=1.21-60.56; p=0.016). Over a median 10-year follow-up, despite 91.3% remission, cardiovascular comorbidities increased, and 26.8% required surgery.

Conclusions

Limb claudication is a key prognostic indicator of advanced radiological damage and diagnostic delay. This is reinforced by a long-term dissociation between high clinical remission and progressive vascular disease, demanding vigilant monitoring.

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Original Article

Cost-Effectiveness Analysis of Coronary Computed Tomography Angiography as the Preferred Exam in the Investigation of Stable Chest Pain in the Brazilian Private Healthcare System

Afonso Shiozaki et al. Jorge Torreão Isabela Bispo Santos da Silva Costa Anuncia Bouzas Suarez … Marcelo Tozatti da Silva Thiago Godoy de Oliveira Luana Emanuelly Sinhori Lopes Marcelo Eidi Nita Henrique Trad Carlos E. Rochitte

Abstract

Background

Cardiovascular disease is the leading cause of mortality worldwide. Strategies that prioritize early diagnosis can reduce the incidence of related complications and cost.

Objective

To assess the cost-effectiveness of coronary computed tomography angiography (CCTA) as the initial diagnostic strategy for stable chest pain in patients with intermediate pre-test probability of stable coronary artery disease (CAD), in comparison with invasive coronary angiography (ICA).

Methods

A cost-effectiveness analysis was conducted comparing CCTA and ICA, considering data from the Brazilian private healthcare system. The model considered the direct costs of diagnostic exams, medical supplies, hospitalization for myocardial infarction, and myocardial revascularization in the 5 regions of Brazil. A budget impact analysis was performed regarding the gradual incorporation of CCTA over 5 years, considering 100,000 lives as the eligible population.

Results

The cost-effectiveness analysis comparing CCTA to ICA, estimated for a population of 100,000 lives, demonstrated cost savings of BRL 1,021.00 per life or a total of BRL 102,069,703.00 by the end of the fifth year. When considering the regional average cost of CCTA, for a population of 100,000 over 5 years, we observed the following cost savings per life and in 5 years, respectively: BRL 1,226.00 and BRL 122,577,793.00 in the North Region; BRL 1,460.00 and BRL 145,988,367.00 in the Northeast Region; BRL 1,625.00 and BRL 162,502,626.00 in the Central-West Region; BRL 1,313.00 and BRL 131,270,230.00 in the Southeast Region; and BRL 1,043.00 and BRL 104,268,937.00 in the South Region.

Conclusion

As an initial strategy for investigating stable chest pain, CCTA is cost-effective compared to ICA and is associated with significant cost reductions in the Brazilian private healthcare system.

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Original Article

Association of the Severity of Pulmonary Valve Regurgitation on Biomarkers, Functional Capacity, and Complications in Patients with Heart Failure

Fatih Aydin et al. Bektas Murat Selda Murat Muhammet Burak Daghan

Abstract

Background

Pulmonary valve regurgitation (PR) is often encountered in cardiac conditions, including heart failure (HF). Although typically tolerated, severe PR can lead to right ventricular dysfunction and negative clinical outcomes; however, its specific impact within the wider HF population needs further clarification.

Objectives

This study was designed to evaluate the association between the severity of PR and N-terminal pro-B-type natriuretic peptide (pro-BNP) levels, its effect on functional capacity measured by the six-minute walk test (6MWT), and the incidence of significant clinical problems in patients with HF.

Methods

Between 2016 and 2023, we conducted a retrospective study involving 579 HF patients who underwent echocardiography at two tertiary institutions. Based on semi-quantitatively evaluated PR severity, patients were classified into four groups: No PR, Mild PR, Moderate PR, and Severe PR. Group comparisons used Chi-square tests and Kruskal-Wallis. Multivariate linear regression and Spearman correlation analyses were performed to assess associations.

Results

Pro-BNP levels significantly increased across PR severity groups (Median: 2,157 pg/mL [No PR] to 23,541 pg/mL [Severe PR], p<0.0001). In contrast, 6MWT distance significantly decreased with deteriorating PR severity (Median: 254 m [No PR] to 72 m [Severe PR], p<0.0001). The prevalence of orthopnea and pleural effusion also increased with PR severity. After multivariate adjustment, PR severity remained independently associated with higher pro-BNP levels (β=0.48, p=0.002) and lower 6MWT distance (β=-0.39, p=0.008).

Conclusion

In patients with HF, increasing severity of PR is independently associated with elevated pro-BNP levels, reduced functional capacity, and a higher burden of clinical complications.

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Review Article

I – Evaluation of Cardiovascular Autonomic Function in Healthy Individuals

Benedito Carlos Maciel et al. Lourenço Gallo-Jr André Schmidt José Antonio Marin-Neto

Abstract

This first part of the review presents nearly 60 years of experience from our laboratory in standardizing cardiovascular autonomic tests in healthy individuals. The wide range of tests includes pharmacological blockade of both the sympathetic and parasympathetic divisions, baroreflex sensitivity assessment through transient hypertension and hypotension, the Valsalva maneuver, head-up tilt testing, isometric and dynamic exercise, facial immersion in cold water, respiratory sinus arrhythmia, heart rate variability analysis in the frequency domain, and imaging with ¹²³I-metaiodobenzylguanidine. Autonomic function was evaluated based on test responses under baseline conditions in healthy individuals. The analysis also covers physiological adaptations to endurance training and aging, providing a reference framework for identifying autonomic dysfunction involving both parasympathetic and adrenergic components in patients with various pathophysiological conditions, as discussed in the second part of this review.

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Original Article

Palliative Care in Decompensated Heart Failure Requiring Inotropic Therapy: Opportunities for Integration to Improve Outcomes

Daniel Battacini Dei Santi et al. Mucio Tavares de Oliveira Jr Ricardo Tavares de Carvalho

Abstract

Background

Advanced heart failure (HF) is associated with high morbidity and mortality rates, compromising the functionality and quality of life of patients and their families. Hospitalizations exacerbate disease severity, particularly when inotropic therapy is required. Palliative care (PC) supports the management of suffering caused by severe illnesses but is infrequently utilized in cardiology.

Objective

To evaluate the integration of PC in the management of decompensated HF, identifying opportunities to enhance patient care.

Method

This unicentric, retrospective, observational study was conducted between February 2015 and May 2018 with HF patients undergoing inotropic therapy. The study analyzed referrals for PC, the approach adopted by the PC-consultation team, and patient outcomes, including an analysis of 5-year survival rates. Statistical significance level: 5%.

Results

A total of 492 patients were included (66.9% male, median age 63 years, IQR 52-72). PC referral occurred in 23% of cases, with a median of 8.0 days (IQR 4.0-20) before death. Only 14% of intensive care patients were referred, and no transplant patients received PC evaluations. Patients assessed by the PC team were more involved in decision-making and received more opioid prescriptions for symptom management than those managed exclusively by cardiologists (p<0.01). In-hospital and 5-year mortality rates were 42% and 80%, respectively.

Conclusions

Patients experiencing decompensated HF demonstrate high mortality rates and are rarely referred to PC, often in the final days of life, limiting the potential benefits of this approach. Enhanced medical education in PC and the development of strategies to promote its integration may improve patient outcomes.

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Review Article

II – Evaluation of Autonomic Control of Heart Rate in Various Clinical Conditions

Benedito Carlos Maciel et al. Lourenço Gallo-Jr André Schmidt José Antonio Marin-Neto

Abstract

Through the comparison of responses of normal volunteers, assessment of autonomic function under abnormal clinical conditions focused on the detection of dysautonomia involving both the parasympathetic and adrenergic limbs in patients with Chagas heart disease, post-cardiac surgery, chronic heart failure, mitral valve prolapse, and hyperthyroidism. In particular, the autonomic impairment observed in Chagas disease patients involved predominantly the parasympathetic control of heart rate at the sinus node level, and the adrenergic innervation at the myocardial ventricular level. The autonomic derangements observed in Chagas cardiomyopathy patients have only recently been explored in terms of their prognostic relevance, and their potential clinical implications for therapeutic purposes remain to be investigated.

Over the last nearly seven decades, our laboratory has accumulated significant expertise using several tests described above to evaluate autonomic control of heart rate, now focusing on various pathophysiological clinical conditions. The effect of endurance physical training and of aging was mostly focused on studies of normal volunteers whose responses at baseline served as controls to be compared during tests employed in individuals with some morbid clinical conditions. By far, the pathophysiology of Chagas heart disease involving the autonomic nervous system was the most predominant subject studied in our laboratory, since the early studies in the 1960s until the late studies just recently published in international journals (Central Illustration). Other pathological conditions focused on our studies were mitral valve prolapse, heart failure, post-cardiac surgery, and hyperthyroidism.

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Original Article

Impact of Contrast Volume Used After Percutaneous Coronary Procedures in Patients at Risk for Contrast-Induced Nephropathy

Rafaela Andrade Penalva Freitas et al. Luiz Fernando Leite Tanajura Amanda Guerra M. R Sousa Fausto Feres José Ribamar Costa

Abstract

Background

Contrast-induced nephropathy (CIN) is a common complication following angiographic procedures, potentially related to the volume of contrast agent administered. However, it is unclear whether the type of contrast also influences its occurrence.

Objective

To evaluate the interaction between contrast volume and contrast type (iso-osmolar vs low-osmolar) in the development of CIN.

Methods

A post hoc subanalysis was performed on patients undergoing diagnostic or therapeutic coronary procedures who were randomized 1:1 to receive low-osmolar or iso-osmolar contrast media. The overall sample (n = 2,268) was stratified by contrast volume: Group I (< 150 mL; n = 1,985) and Group II (≥ 150 mL; n = 283), and groups were compared by contrast type. The primary endpoint was CIN at 48- and 96-hours post-procedure. CIN was defined as a ≥ 25% or ≥ 0.5 mg/dL increase in serum creatinine from baseline at 48 hours. The effects of contrast type and volume were tested with logistic regression including an interaction term, adjusted for acute coronary syndrome, ventricular dysfunction, baseline creatinine, sex, and age (p < 0.05).

Results

We included 2,268 consecutive patients; two-thirds were male; hypertension was present in 85%, diabetes in 52%, and chronic kidney disease in 31%. Mean contrast volume was 75.3 ± 28.0 mL in Group I and 188.6 ± 46.9 mL in Group II. The incidence of CIN was higher with greater volume (14.8% vs 17.7%) but not statistically significant (adjusted odds ratio = 1.25; 95% CI = 0.89-1.73; p = 0.191). The model with the interaction term showed no evidence of an interaction between the type of contrast and volume (p > 0.999).

Conclusion

The type of contrast was not associated with CIN, even among patients exposed to higher contrast volumes.

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Original Article

Profile of Mortality Due to All Causes and Patterns of Diseases of the Circulatory System in Childhood Between 2019 and 2022 in Brazil

Thayanne Mendes de Andrade et al. Mariara Lopes da Costa Marques Julia Pereira Cavalcante Marques Maria Eduarda Miranda de Souza … Gláucia Maria Moraes de Oliveira Thais Rocha Salim

Abstract

Background

Between 2020 and 2023, the COVID-19 pandemic had a direct impact on population health. In Brazil, there is a lack of studies on the correlation between mortality from diseases of the circulatory system (DCS) and cardiorespiratory arrest (CRA) among people younger than 20 years during this period.

Objective

To analyze, using DCS and CRA, the mortality rates (MRs) due to underlying causes of death among people younger than 20 years in Brazil from 2019 to 2022 to understand the impact of the pandemic.

Methods

Ecological time-series study conducted between 2019 and 2022, focusing on deaths among people younger than 20 years. The analysis included the MRs and proportional mortality (PM) by cause of death, with data obtained from the DATASUS. Stata and Excel were used for statistical analysis.

Results

Between 2019 and 2022, there were 243,358 deaths among people younger than 20 years, with an MR of 101.7 per 100,000 inhabitants, which was higher among children younger than 1 year. The main causes of death were perinatal, external, and congenital malformations. There was a 9% reduction in MR between 2019 and 2020, followed by a 4.08% increase between 2021 and 2022, along with a 10% decrease in the number of live births. The highest MRs were in the North and Northeast regions. The MRs by DCS decreased between 2019 and 2021 but increased in 2022. Reporting of CRA as the cause of death was infrequent.

Conclusion

There was a reduction in MRs due to all causes and an increase in DCS in people older than 15 years during the pandemic, with disparities in lower-income regions.

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