2025;122(9) – ABC CARDIOL

ABC

ABC Family | ABC

Editorial

Beta-blockers for Hypertension: To Be or Not to Be a First-line Drug?

José Augusto Soares Barreto-Filho et al. Felipe Vieira Santana Thiago Augusto da Silva Nascimento Pedro Gabriel Melo de Barros e Silva

Nobel laureate Sir James Black pioneered the concept and design of beta-blockers for cardiovascular use. The first human data published on beta-blockers appeared in 1964, and ever since, beta-blockers have been widely utilized across various cardiovascular conditions. In hypertension, the landmark Medical Research Council (MRC) trial was the first to demonstrate that either propranolol or bendrofluazide reduced the risk of stroke in patients with mild hypertension; however, no significant reduction in mortality was observed. Comparative analyses between propranolol and bendrofluazide showed similar outcomes, with a non-significant trend favoring bendrofluazide for stroke prevention and propranolol for coronary event reduction in non-smokers.

Historically, beta-blockers became a mainstay in hypertension management. In 1984, the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC III) classified beta-blockers alongside thiazide diuretics as first-line therapy. In 1998, Messerli et al. published a systematic review questioning the appropriateness of beta-blockers as first-line agents, concluding that in elderly hypertensive patients, beta-blockers were inferior to diuretics in reducing cardiovascular outcomes.

[…]

Read Full Article

Viewpoint

Treating Numbers or Patients? Rethinking Supine Hypertension in Hospitalized Adults

Cassiano Teixeira

Abstract

In-hospital blood pressure (BP) monitoring often leads to the detection of isolated elevated readings, particularly in the supine position during nighttime checks. However, growing evidence suggests that these transient hypertensive values – frequently labeled as “supine hypertension” – may not warrant pharmacologic intervention in the absence of acute end-organ damage. This opinion piece argues against the reflexive treatment of supine hypertension in hospitalized patients and highlights the risks associated with aggressive management. Excessive monitoring and the lack of contextual interpretation of BP fluctuations may expose patients to unnecessary harm.

Read Full Article

Original Article

Handgrip Strength in Heart Failure: Developing a Reference Equation

Suena Medeiros Parahiba et al. Édina Caroline Ternus Ribeiro Ingrid da Silveira Knobloch Débowra Dapper … Ingrid Dalira Schweigert Perry Nadine Oliveira Clausell Vivian Luft Gabriela Corrêa Souza Eneida Rejane Rabelo-Silva

Abstract

Background:

Handgrip strength (HGS) is a key indicator of overall muscle strength and functional capacity in patients with heart failure (HF). However, no reference equations specific to this population have been previously published.

Objectives:

This study aimed to develop and validate a reference equation for predicting HGS in patients with HF.

Methods:

A cross-sectional study was conducted on patients with stable HF, aged 18–79 years, diagnosed for at least three months. Maximum HGS value was obtained from three consecutive measurements. Clinical data and anthropometric assessments were collected. The sample was randomly divided into two-thirds (n=174) for derivation and one third (n=100) for validation. A multivariate regression model was applied to develop the predictive equation, including variables with a p-value < 0.25 as determined by the Wald test.

Results:

Derivation and validation samples showed no significant differences at baseline. Patients were predominantly male, older adults, and white. The derived equation was: Predicted HGS = −39.732 + (10.771 * gender [female = 0; male = 1]) – (0.158 * age [years]) + (35.096 * height [m]) + (0.448 * calf circumference [cm]) – (4.224 * the New York Heart Association class [I /II = 0; III/IV = 1]). When applied to the validation sample, the equation underestimated actual HGS by 0.68 ± 8.93 Kg.

Conclusion:

Age, sex, height, calf circumference, and NYHA class were key determinants of HGS in HF patients. The derived equation showed good predictive accuracy and may serve as a useful reference for interpreting grip strength in this population.

Read Full Article

Original Article

Association between the Use of Fondaparinux Plus Radial Access and Clinical Outcomes in Patients with Non-ST Elevation Acute Coronary Syndrome

Luiz Eduardo Fonteles Ritt et al. Eduardo Sahade Darze Pedro Gabriel Melo de Barros e Silva Gilson Soares Feitosa-Filho … João Victor Santos Pereira Ramos Márcia A. Viana Priscila Neri Lacerda Emanoela Lima Freitas Queila Oliveira Borges Adriano Oliveira Martins Renato Delascio Lopes

Abstract

Background:

Both fondaparinux and radial access have been associated with lower rates of major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS).

Objective:

To evaluate the association between the use of fondaparinux plus radial access and clinical outcomes.

Methods:

In this study, 956 patients admitted with ACS and treated with an invasive strategy were analyzed. The primary outcome — a composite of major bleeding (according to OASIS-5 criteria) and MACE — was compared across groups defined by anticoagulation regimen (fondaparinux or enoxaparin) plus arterial access site (femoral vs. radial). A p-value < 0.05 was considered statistically significant.

Results:

The mean age of the study population was 65 ± 12.4 years, and 49.5% presented with non-ST segment elevation myocardial infarction (NSTEMI). Fondaparinux and radial access were used concurrently in 366 patients. The primary endpoint occurred in 78 patients (8.1%): MACE in 50 (5.2%) and major bleeding in 32 (3.3%). The event rate was lowest in the fondaparinux plus radial access group (3.3%), compared with enoxaparin plus radial access (9.8%), fondaparinux plus femoral access (8.6%), and enoxaparin plus femoral access (14.4%) (p < 0.001). Multivariable analysis showed that the use of fondaparinux was associated with a 43% reduction in the primary outcome (OR, 0.57; 95% CI, 0.34-0.96; p < 0.05), and radial access was independently associated with a 54% reduction (OR, 0.46; 95% CI, 0.26-0.83; p = 0.01).

Conclusion:

The combination of fondaparinux and radial access was associated with the lowest rates of MACE and major bleeding, compared to either strategy alone.

Read Full Article

Viewpoint

Adult Congenital Heart Disease. Follow-Up Pattern of Care

Fernando Amaral et al. Geraldo Luiz Figueiredo Rafael B. Pavão Paulo Henrique Manso … Luis Gustavo Gali Danilo Tadao Wada André Schmidt

After an early experience reported in this Journal in 2010 and a more detailed analysis published in 2020, there are now over 1600 patients registered in our outpatient clinic. This acquired eighteen years’ experience allowed us to face several situations related to the unit dynamics and to individual patient problems, which we believe might be useful for those particularly in charge of the new emerging unities and also for those already established. Adult congenital heart disease (ACHD) patients have a prevalence of 4 to 6/1.000 individuals^, and most of them have the peculiar profile of a long-standing disease frequently started at birth and often submitted to a cardiovascular intervention. Dr Joseph Perloff, in a landmark article in 1973, emphasized that ACHD patients would never be cured and sequelae and residua after invasive treatment should be expected in most of them. In fact, over the subsequent years, studies have shown that the incidence of residual lesions is almost uniform, justifying routine surveillance, except for a minority of individuals with very simple lesions. As discharge is rare, the number of patients is expected to increase progressively, which might interfere with proper care. Four topics seem to be crucial for us regarding follow-up and are briefly reminded below.

[…]

Read Full Article

Editorial

Radial Access and Fondaparinux: A Synergistic Interaction

Pedro Beraldo de Andrade et al. Leonardo Maróstica Alves Silva

The consolidation of antithrombotic treatment based on dual antiplatelet therapy with aspirin and P2Y₁₂ receptor inhibitors, the routine adoption of invasive risk stratification, the technical refinement of percutaneous coronary intervention (PCI), with greater use of intravascular imaging as an adjunctive tool to guide procedures, as well as the technological evolution of coronary stents, culminated in a temporal decline over the last two decades in the occurrence of ischemic complications in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEMI). In this context, the risk of bleeding is no longer tolerated as an inherent complication of anti-ischemic treatment. Still, it has come to play a central role in the search for a balance between efficacy and safety in the clinical management of this patient profile. The importance of bleeding risk was achieved through publications demonstrating that major bleeding, whether related to PCI arterial access or bleeding in the central nervous system, digestive tract, or genitourinary system, was associated with a worse prognosis, with morbidity and mortality similar to or exceeding recurrent ischemic events.^,

In 2010, the concept of “Bleeding Avoidance Strategies” emerged, consisting of a set of measures associated with high-quality, cost-effective clinical practice, whose metrics demonstrate its ability to mitigate major bleeding rates in patients undergoing invasive risk stratification ()..^,

[…]

Read Full Article

Guideline

Brazilian Guideline on Dyslipidemias and Prevention of Atherosclerosis – 2025

Fabiana Hanna Rached et al. Marcio Hiroshi Miname Viviane Zorzanelli Rocha André Zimerman … Fernando Henpin Yue Cesena Andrei Carvalho Sposito Raul Dias dos Santos Paulo Eduardo Ballvé Behr Henrique Tria Bianco Renato Jorge Alves André Arpad Faludi Elaine dos Reis Coutinho Francisco Antonio Helfenstein Fonseca Luiz Sérgio Fernandes de Carvalho Adriana Bertolami Aloísio Marchi da Rocha Ana Paula Marte Antonio Carlos Palandri Chagas Bruno Caramelli Carisi Anne Polanczyk Carlos Eduardo dos Santos Ferreira Carlos Vicente Serrano Junior Daniel Branco de Araujo Emilio Hideyuki Moriguchi Fausto J. Pinto Humberto Graner Moreira Isabela de Carlos Back Jose Rocha Faria Neto Kleisson Antônio Pontes Maia Marcelo Chiara Bertolami Marcelo Heitor Vieira Assad Maria Cristina de Oliveira Izar Mauricio Alves Barreto Natasha Slhessarenko Fraife Barreto Pedro Gabriel Melo de Barros e Silva Pedro Pimentel Filho Raul Cavalcante Maranhão Sergio Emanuel Kaiser Valeria Arruda Machado Jose Francisco Kerr Saraiva

Table of Contents

[…]

Read Full Article

Guideline

2025 Brazilian Evidence-based Guideline on the Management of Obesity and Prevention of Cardiovascular Disease and Obesity-Associated Complications: A Position Statement by Five Medical Societies

José Francisco Kerr Saraiva et al. Cynthia M. Valerio Fabiana H. Rached Simone Van de Sande-Lee … Viviane Z. Rocha Giraldez Fernando Valente Luciano F. Drager Bruno Halpern Wellington S. da Silva Junior Fabio R. Trujilho Neuton Dornellas Ruy Lyra da Silva Filho João Eduardo N. Salles Marcelo H. V. Assad Marcio C. Mancini Paulo A. C. Miranda Rodrigo O. Moreira Rodrigo N. Lamounier Sergio E. Kaiser Marcello C. Bertoluci

Table of contents

[…]

Read Full Article

Editorial

Functional RNA Applications in Cardiovascular Precision Medicine: Advances and Diagnostic Perspectives

Mariana Gatto et al. Gustavo Augusto Ferreira Mota Luana Urbano Pagan Marina Politi Okoshi

In recent years, advancements in diagnostic tools have revolutionized biomedical research, particularly in the identification and understanding of various diseases. High-precision technologies such as Next-Generation Sequencing (NGS), coupled with bioinformatics platforms, have enabled detailed analyses of genetic and transcriptomic profiles. This progress has facilitated the detection of genetic variants, molecular signatures, and gene expression patterns, thereby refining the diagnosis of complex diseases and unveiling novel therapeutic targets.

Among these technologies, RNA sequencing (RNA-Seq) —an NGS-based approach for sequencing and quantifying RNA transcripts—has emerged as a key tool. Transcripts can be classified into coding RNAs, such as messenger RNAs (mRNAs) that guide protein synthesis, and non-coding RNAs, including long non-coding RNAs (lncRNAs) and microRNAs (miRNAs), which play regulatory roles in gene expression.LncRNAs modulate transcriptional, epigenetic, and post-transcriptional activity of target genes, whereas miRNAs generally promote mRNA degradation or inhibit translation. The analysis of RNA expression and molecular interactions has broadened our understanding of gene regulatory networks, with promising applications in oncology, inflammatory diseases, and cardiovascular conditions.

[…]

Read Full Article

Original Article

Study on Urinary Caffeine and Caffeine Metabolite Levels in American Adults with Coronary Heart Disease: A Cross-Sectional NHANES Study (2009-2014)

Qianqian Li et al. Gan Ke Mengdie Liu Yanjun Chen … Ye Luo Liangxian Qiu

Abstract

Background:

In recent years, the impact of diet and lifestyle on coronary heart disease (CHD) has garnered significant attention. Caffeine, a common dietary component, and its metabolites may influence cardiovascular health.

Objective:

This study aimed to investigate the association between urinary levels of caffeine and its metabolites and the incidence of CHD as well as to assess how these associations vary across different population groups.

Methods:

Data from the NHANES database (2009-2014) were analyzed using multivariable logistic regression models and smooth curve fitting techniques. Participants were categorized into a control group (n = 5,005) and a CHD group (n = 222) based on CHD status. Urinary levels of caffeine and its metabolites were measured and recorded. Multivariable logistic regression was used to evaluate the association between urinary caffeine/metabolite levels and CHD incidence, while smooth curve fitting was employed to explore potential nonlinear relationships. A significance level of 5% was used to determine statistical significance.

Results:

Higher urinary paraxanthine levels were associated with a lower risk of CHD. In contrast, elevated urinary caffeine levels were positively associated with CHD incidence among Mexican Americans, an association not observed in other racial/ethnic groups.

Conclusion:

Lower urinary paraxanthine levels may reflect a reduced risk of CHD, while higher urinary caffeine levels could indicate an increased CHD risk in specific populations.

Read Full Article

Editorial

The Importance of Identifying Phenotypes in Arterial Hypertension

Assessing blood pressure (BP) levels involves understanding the relationship between BP and overall health. This requires accurate measurement, following the criteria recommended in the guidelines, to determine the true meaning of the measurement in the office and beyond. Within this hypertensive spectrum, with measurements at varying times, we can define various hypertensive phenotypes and their significance for cardiovascular risk. This knowledge has accumulated over time and has been increasingly refined with the advancement of medical and technological knowledge.

The first experimental measurement of BP was made in 1711 by Stephen Halles using a cannula in the crural artery of a horse and connecting it to a glass tube that raised the blood two and a half meters above the height of the animal. However, arterial hypertension was only clinically valued in 1896 with the invention of the first mercury column sphygmomanometer by the Italian Scipione Riva-Rocci, using a 4.4 cm wide cuff.

[…]

Read Full Article

Guideline

Brazilian Guideline for the Evaluation and Diagnosis of Chest Pain in the Emergency Department – 2025

Pedro Gabriel Melo de Barros e Silva et al. Alexandre de Matos Soeiro Carlos Eduardo Ornelas Gilson Soares Feitosa-Filho … Renato D. Lopes Danielli Oliveira da Costa Lino Remo Holanda de Mendonça Furtado Hélio Penna Guimarães André Volschan Bruno Ferraz de Oliveira Gomes Carisi Anne Polanczyk Carlos Eduardo Rochitte Carlos Vicente Serrano Jr. Cláudio Marcelo Bittencourt das Virgens Claudio Tinoco Mesquita Edgardo Jorge Menendez Eduardo Leal Adam Fabio Mastrocola Fábio Serra Silveira Felipe Souza Maia da Silva Giovanni Possamai Dutra Humberto Graner Moreira Isly Maria Lucena de Barros João Luiz Fernandes Petriz José Roberto de Oliveira Silva Filho Julio Flavio Meirelles Marchini Louis Nakayama Ohe Ludhmila Abrahão Hajjar Maria Camila Lunardi Mucio Tavares de Oliveira Junior Nivaldo Menezes Filgueiras Filho Odilson Marcos Silvestre Paolo Blanco Villela Paulo Rogério Soares Pedro Paulo Nogueres Sampaio Renée Sarmento de Oliveira Ronaldo de Souza Leão Lima Sandro Pinelli Felicioni Sergio Timerman Tatiana de Carvalho Andreuci Torres Leal Wilson Mathias Junior

Table of contents

[…]

Read Full Article

Editorial

Peripheral Cuff Measurements for the Estimation of Mean Aortic Pressure

Weimar Kunz Sebba Barroso et al. Sayuri Inuzuka

For more than a century, the simple, office-based method of measuring blood pressure in the upper arm with a sphygmomanometer has remained the established standard for its measurement and management. Accordingly to hemodynamic principles, the primary function of the cardiovascular system is to ensure continuous perfusion of vital organs and tissues. The cardiac function and vascular dynamics generate the force known as arterial pressure. Aortic pressure describes the dynamic, pulsatile force exerted within the body’s largest artery, reflecting the beat-to-beat interaction between the heart and the arterial tree. In contrast, mean arterial pressure (MAP) represents the time-averaged pressure that serves as the steady driving force for systemic blood flow. A comprehensive grasp of their core distinctions, underlying physiological mechanisms, and clinical significance is crucial for the proper diagnosis and treatment of a broad spectrum of cardiovascular diseases.

MAP is the average pressure that ensures a steady, continuous flow of blood to your body’s tissues and organs. This constant perfusion is essential for delivering the oxygen cells need to function properly. The clinical concern is that to perfuse vital organs, there is a requirement of a minimum MAP of 60mmHg. If MAP drops below 60mmHg for an extended period, it may result in manifestations such as ischemia and infarction. There are several formulas for MAP calculation, and Gauer’s formula was the first suggested.

[…]

Read Full Article

Diretrizes

Brazilian Guidelines of Hypertension – 2025

Andréa Araujo Brandão et al. Cibele Isaac Saad Rodrigues Luiz Aparecido Bortolotto Anderson da Costa Armstrong … Rogério Andrade Mulinari Audes Diógenes de Magalhães Feitosa Marco Antonio Mota-Gomes Eduardo Costa Duarte Barbosa José Andrade Moura Neto Mario Fritsch Toros Neves Kunz Sebba Barroso Weimar Claudia Lucia de Moraes Forjaz Márcia Regina Simas Torres Klein Fernando Nobre Paulo César Brandão Veiga Jardim Celso Amodeo Rogério Baumgratz de Paula Sebastião Rodrigues Ferreira Filho João Roberto Gemelli José Fernando Vilela-Martin Elizabeth Silaid Muxfeldt Décio Mion Júnior Marcus Vinicius Bolivar Malachias Carlos Alberto Machado Fernando Antonio de Almeida Alexandre Jorge Gomes de Lucena Alvaro Avezum Amaury Zatorre Amaral Ana Flavia Moura Ana Lúcia Rego Fleury de Camargo Andrea Pio de Abreu Andrei C. Sposito Angela Maria Geraldo Pierin Annelise Machado Gomes de Paiva Antonio Gabriele Laurinavicius Carlos Eduardo Poli-de-Figueiredo Dilma do Socorro Moraes de Souza Elizabete Viana de Freitas Emilton Lima Júnior Erika Maria Gonçalves Campana Fábio Argenta Fernanda Marciano Consolim Colombo Fernanda Salomão Gorayeb Polacchini Flavio Antonio de Oliveira Borelli Frida Liane Plavnik Giovanio Vieira da Silva Grazia Maria Guerra Heno Ferreira Lopes José Augusto Soares Barreto Filho Juan Carlos Yugar Toledo Leda Aparecida Daud Lotaif Lílian Soares da Costa Lucelia Batista Neves Cunha Magalhães Luciano Ferreira Drager Luis Cuadrado Martin Luiz César Nazário Scala Maria Eliane Campos Magalhães Maria Eliete Pinheiro Maria Emília Figueiredo Teixeira Nelson Dinamarco Osni Moreira Filho Oswaldo Passarelli Junior Otavio Rizzi Coelho Renault Mattos Ribeiro Júnior Roberto Dischinger Miranda Rodrigo Bezerra Rodrigo Pinto Pedrosa Rogério Toshiro Passos Okawa Rui Manuel dos Santos Povoa Sandra Lia do Amaral Cardoso Sayuri Inuzuka Sergio Emanuel Kaiser Sheyla Cristina Tonheiro Ferro da Silva Tânia Plens Shecaira Vera Hermina Kalika Koch Wilson Nadruz

Chapters and participations:

[…]

Read Full Article

Statement

Position Statement on Cardiometabolic Health Across the Woman's Life Course – 2025

Gláucia Maria Moraes de Oliveira et al. Maria Cristina Costa de Almeida Cynthia Melissa Valério Fernando Giuffrida … Larissa Espíndola Neto Maria Cristina de Oliveira Izar Celi Marques-Santos Claudia Maria Vilas Freire Carlos Japhet da Matta Albuquerque Antonio Carlos Pallandri Chagas Dalton Bertolim Précoma Evandro Tinoco Mesquita José Francisco Kerr Saraiva Maria Elizabeth Navegantes Caetano Costa Viviana de Mello Guzzo Lemke Alexandre Jorge Gomes de Lucena Andréa Araujo Brandão Antonio Aurelio de Paiva Fagundes Junior Ariane Vieira Scarlatelli Macedo Carisi Anne Polanczyk Cristiane Bauermann Leitão Daniel Souto Silveira Elaine dos Reis Coutinho Eliana Aguiar Petri Nahas Elizabeth Regina Giunco Alexandre Erika Maria Gonçalves Campana Erika Olivier Vilela Bragança Fernanda Marciano Consolim Colombo Imara Correia de Queiroz Barbosa Ivan Romero Rivera Jaime Kulak Junior João Eduardo Nunes Salles João Roberto de Sá José Maria Soares Júnior Larissa de Almeida Dourado Lidia Zytynski Moura Lucelia Batista Neves Cunha Magalhães Luciano de Melo Pompei Luiz Guilherme Passaglia Marcelo Heitor Vieira Assad Marcio Alexandre Hipólito Rodrigues Maria Alayde Mendonça Rivera Maria Antonieta Albanez Albuquerque de Medeiros Lopes Maria Sanali Moura de Oliveira Paiva Marildes Luiza de Castro Milena dos Santos Barros Campos Olga Ferreira de Souza Orlando Otávio de Medeiros Rafaela Andrade Penalva Freitas Regina Coeli Marques de Carvalho Sheyla Cristina Tonheiro Ferro da Silva Thais de Carvalho Vieira Rodrigues Walkiria Samuel Avila Wellington Santana da Silva Júnior Willyan Issamu Nazima Lucia Helena Simões da Costa-Paiva Maria Celeste Osorio Wender

Table of contents

[…]

Read Full Article

Diretrizes

Guideline for Chronic Coronary Syndrome – 2025

Luiz A. Machado Cesar et al. Luis Henrique W. Gowdak Ricardo Pavanello João Fernando M. Ferreira … Bruno M. Mioto Nilson T. Poppi Caio Menezes M. de Mendonça Adenalva Lima de Souza Beck Adriana Soares Xavier de Brito Alexandre Abizaid Andréa Araujo Brandão Andrea Maria Gomes Marinho Falcão Andrei Sposito Antônio Carlos Sobral Sousa Antonio de Padua Mansur Ariane Vieira Scarlatelli Macedo Áurea Jacob Chaves Breno de Alencar Araripe Falcão Brivaldo Markman Filho Bruno Ramos Nascimento Camila Paixão Jordão Carlos Augusto Homem de Magalhães Campos Carlos Eduardo Lucena Montenegro Carlos Eduardo Rochitte Carlos Vicente Serrano Jr. Celia Maria Cassaro Strunz Daniel Medeiros Moreira Danielle Misumi Watanabe Eduardo Gomes Lima Eduardo Nagib Gaui Elizabeth Regina Giunco Alexandre Fabiana Hanna Rached Fabio Biscegli Jatene Gentil Barreira de Aguiar Filho Gilson Soares Feitosa-Filho Henrique Patrus Mundim Pena Ibraim Masciarelli Francisco Pinto Iran Castro Jaqueline R. Scholz João Carlos Ferreira Leal José Armando Mangione José Jayme Galvão de Lima Jose Rocha Faria Neto José Soares Junior Kleisson Antônio Pontes Maia Lara Cristiane Terra Ferreira Carreira Luciana Diniz Nagem Janot de Matos Luciana Oliveira Cascaes Dourado Luhanda Leonora Cardoso Monti Sousa Luis Alberto Oliveira Dallan Luiz Eduardo Mastrocola Marcia Maria Godoy Gowdak Olimpio Ribeiro França Neto Otavio Rizzi Coelho Otávio R. Coelho-Filho Paulo Eduardo Ballvé Behr Paulo Ricardo Avancini Caramori Pedro Alves Lemos Neto Pedro Silvio Farsky Raul Dias dos Santos Filho Renato D. Lopes Salvador Manoel Serra Sarah Fagundes Grobe Sérgio Tavares Montenegro Silvio Henrique Barberato Tania Mara Varejão Strabelli Ursula Maria Moreira Costa Burgos Vinicius José da Silva Nina Walter Jose Gomes William Azem Chalela Wilson Mathias Junior

1. Introduction

One of the primary activities of the Brazilian Society of Cardiology (Sociedade Brasileira de Cardiologia, SBC) is the development of guidelines for several cardiovascular (CV) diseases (CVDs), based on the most recent scientific evidence and grounded in robust clinical data. These guidelines aim to assist health care professionals in the prevention, diagnosis, and treatment of CVDs. This guideline on chronic coronary syndrome (CCS) was developed by volunteer members of SBC, without any commercial support, and with a strong emphasis on ethical principles to guide clinical cardiology practices and the involvement of all stakeholders.

CVDs are the leading cause of death in the Brazilian population, and CCS stands out as the most significant in terms of morbidity and mortality among noncommunicable diseases. Therefore, this guideline plays a crucial role in supporting health professionals, particularly cardiologists, with recommendations for managing a number of clinical scenarios encountered in patients with CCS.

[…]

Read Full Article

Diretrizes

Brazilian Atrial Fibrillation Guidelines – 2025

Fatima Dumas Cintra et al. Cristiano Faria Pisani André Gustavo da Silva Rezende Benhur Davi Henz … Luciana Vidal Armaganijan Maurício Pimentel Renato D. Lopes Thais Aguiar do Nascimento Adalberto Menezes Lorga Filho Afonso Luiz Tavares de Albuquerque Alexsandro Fagundes Almir Alamino Lacalle Ana Luisa Calixto Rodrigues Andre d’Avila Angelo Amato Vincenzo De Paola Anibal Pires Borges Carlos Antônio Abunader Kalil Carlos Eduardo de Souza Miranda Carlos Eduardo Duarte Carlos Manuel de Almeida Brandão Dalmo Antonio R. Moreira Dário Celestino Sobral Filho Denise Tessariol Hachul Eduardo Benchimol Saad Elerson Arfelli Enrique Indalécio Pachón Mateo Érika Olivier Vilela Bragança Fernando Ribeiro de Moraes Neto Francisco Carlos da Costa Darrieux Guilherme Fenelon Gustavo Glotz de Lima Jacob Atié João Carlos Ferreira Leal Jose Carlos Moura Jorge José Carlos Pachón Mateos José Marcos Moreira José Tarcísio Medeiros de Vasconcelos Leandro Ioschpe Zimerman Luciana Sacilotto Luiz Pereira de Magalhães Luiz Roberto Leite da Silva Marcelo Garcia Leal Marcio Augusto Silva Marcio Jansen de Oliveira Figueiredo Martha Valéria Tavares Pinheiro Mauricio Ibrahim Scanavacca Olga Ferreira de Souza Ricardo Alves da Costa Ricardo Ryoshim Kuniyoshi Rui Manuel de Sousa Sequeira Antunes de Almeida Silvia Helena Cardoso Boghossian Tan Chen Wu Thiago da Rocha Rodrigues Veridiana Silva de Andrade

Table of Contents

[…]

Read Full Article

Editorial

Analysis of Cardiopulmonary Exercise Test in Pre- and Post-COVID-19

José Antônio Caldas Teixeira

The SARS-CoV-2 (COVID-19) pandemic that began in December 2019 in the city of Wuhan, Hubei Province, China, quickly became a pandemic affecting over 600 million people, resulting in over 6 million deaths. COVID-19 has been associated with significant mortality and morbidity, including adverse pulmonary and cardiac sequelae.

It is known that COVID-19 symptoms persist beyond the acute phase, leading to post-acute sequelae, known as Long COVID Syndrome, which lasts for more than 60 days or indefinitely. Although the precise mechanisms are not fully elucidated, it is associated with various symptoms, with fatigue and exercise intolerance being the most prevalent.

[…]

Read Full Article

Editorial

Hypertension in Indigenous Brazilians: A Rapidly Emerging Public Health Crisis

Allan K. N. Alencar

The increasing burden of systemic arterial hypertension among Brazil’s Indigenous populations is a clear indicator of the country’s ongoing epidemiological transition, marked by a shift from infectious diseases and malnutrition to non-communicable chronic diseases (NCDs) such as hypertension. In the recent study by Araújo et al., conducted in a specialized outpatient clinic for Indigenous health in Passo Fundo (RS), 26.0% of Indigenous adults were found to be hypertensive. This prevalence is consistent with previous reports from other Indigenous populations in Brazil, such as those from the Xingu Indigenous Park (26.7%) and the Upper Rio Negro region (29.0%), suggesting that the findings reflect a broader national trend of increasing cardiovascular risk among Indigenous communities. Multiple studies highlight this transition, noting that Indigenous communities are experiencing rising rates of hypertension and other cardiometabolic conditions as a result of rapid cultural, economic, and lifestyle changes, including urbanization, dietary shifts, and increased interaction with non-Indigenous society.^– National surveys confirm the emergence of obesity, hypertension, and diabetes in a growing number of Indigenous communities across all regions of Brazil, further underscoring the epidemiological transition.^, Once considered virtually absent in these communities, hypertension is now emerging as a critical health concern, with prevalence rates approaching or even surpassing national averages.

The study by Araújo et al. adds nuance to this epidemiological picture by identifying factors independently associated with hypertension: age ≥60 years, having a spouse, and diabetes mellitus. The finding that 58% of older individuals in this population are hypertensive is especially troubling when juxtaposed with demographic data showing that only 20.1% of Indigenous people in Rio Grande do Sul are over 60 years old. This suggests a high disease burden among the elderly and reinforces the urgency of implementing age-specific preventive strategies.

[…]

Read Full Article

Original Article

Cardiopulmonary Resilience in Highly Active Individuals: Pre–Post COVID-19 Cardiopulmonary Exercise Testing Analysis

Fabrício Braga et al. Gabriel Espinosa Amanda Monteiro Mauricio Milani … Juliana Paiva Juliana Goulart Prata Oliveira Milani Leandro Franzoni Ricardo Stein Gerson Cipriano Jr. Jonas Lírio Gurgel Ricardo Mourilhe-Rocha

Abstract

Background:

The COVID-19 pandemic has affected millions globally, with persistent impacts extending beyond the acute phase. One such effect is post-COVID (long COVID), characterized by symptoms such as fatigue and exercise intolerance lasting more than 60 days. Although regular exercise is associated with reduced risk of severe outcomes, reports of decreased athletic performance after COVID-19 — even among highly active individuals (HAIs) — have raised concerns regarding the long-term effects on physical health. Cardiopulmonary exercise testing (CPET) is a valuable tool to assess exercise intolerance and to investigate the metabolic and ventilatory consequences of COVID-19.

Objectives:

To evaluate the impact of COVID-19 on cardiopulmonary function in HAIs by analyzing metabolic and ventilatory responses using CPET before and after infection.

Methods:

CPET data were retrospectively analyzed from HAIs of both sexes. Primary outcomes included changes in peak oxygen uptake (O₂peak) and ventilatory efficiency (E/CO₂ slope). Statistical significance was set at 5% (p < 0.05).

Results:

A total of 43 HAIs (72.1% male; 44 ± 10 years) were included. The median interval between CPETs was 479 days, with testing performed a mean of 44 ± 27 days after COVID-19. O₂peak decreased by a mean of 1.5 mL/kg/min (p = 0.017), representing a 3.84% reduction in predicted O₂peak values (p = 0.045). E/CO₂ slope increased by 1.2 (p = 0.017).

Conclusion:

Although HAIs are not immune to the effects of COVID-19, their high baseline physical activity levels appear to confer substantial cardiopulmonary resilience. Only minimal post-infection alterations were observed, which suggests that maintaining fitness may provide protective benefits against long-term sequelae of COVID-19.

Read Full Article

Editorial

A Step Forward in the Assessment of Handgrip Strength in Heart Failure

Evandro José Cesarino et al. Marildes Luiza de Castro Regina Célia Garcia de Andrade Carolina Baraldi Araujo Restini

Significance of Handgrip Strength in HF

HGS is a simple, non-invasive measure of muscle strength, correlating with physical condition and considered a prognostic marker in HF.^, A systematic review of 7,350 HF patients revealed that a 1 kg reduction in HGS increases mortality risk by 8% (RR 1.08, 95% CI 1.05–1.11). Unlike complex measures, such as cardiopulmonary exercise testing, HGS is low-cost, accessible, and feasible in all clinical settings, making it a straightforward tool to assess frailty and guide rehabilitation.^, However, existing HGS reference equations are mainly derived from healthy populations, failing to account for HF-specific factors, such as reduced cardiac output (CO) and muscle atrophy, leading to inaccurate conclusions. The manuscript’s development of an HF-specific HGS equation represents a timely advance.

[…]

Read Full Article

Letter to the Editor

Reflections on Survival Rates in Patients with Brugada Phenocopy

Gabriel Scarpioni Barbosa et al. José Nunes de Alencar Adrian Baranchuk

We read with great interest the article “Survival in Patients with Brugada Phenocopy. Case Series” by Fonseca et al. The authors describe a case series of patients with Brugada Phenocopy (BrP) and report in-hospital survival. We commend the authors for addressing an important topic related to BrP; however, we would like to comment on methodological considerations and propose recommendations that may strengthen interpretation and guide future BrP reports.

BrP refers to clinical conditions that lead to Brugada-ECG pattern (Br-ECGp) without the genetic substrate of Brugada Syndrome (BS) and an underlying condition that justifies the ECG change. The term was first used to describe the Br-ECGp caused by the propofol infusion syndrome; however, after several corrections to the concept, drugs that do block the sodium channels were no longer considered part of the BrP spectrum. BrP represents a diagnostic challenge even for experts. The mean accuracy to identify BrP based only on the 12-lead ECGs was 43±33% among 10 international experts. Therefore, the clinical context is essential to differentiate BrP from BS. Anselm et al. presented a systematic diagnostic criterion () for the diagnosis of BrP. Emphasis was placed on the recognition of the underlying clinical condition and the low pretest probability for BrP, in addition to the resolution of the Br-ECGp immediately after resolving the underlying condition. Based on the limited description provided by Fonseca et al., we cannot exclude the possibility that some cases represented concealed BS unmasked by hyperthermia or other triggers. This misclassification bias could alone skew the observed mortality.

[…]

Read Full Article

Original Article

Analysis of Mortality from Multiple Causes in Heart Failure Categorized by Ejection Fraction

Giovanni Possamai Dutra et al. Bruno Ferraz de Oliveira Gomes Thiago Moreira Bastos da Silva Leticia Souza Peres … Marco Antônio Netto Armando Rangel João Luiz Fernandes Petriz Plinio Resende do Carmo Junior Emilia Matos Nascimento Basilio de Bragança Pereira Gláucia Maria Moraes de Oliveira

Abstract

Background:

Mortality in heart failure (HF) may be underestimated when analyses rely solely on the underlying cause of death from death certificates (DCs), whereas including multiple causes of death enables a broader examination of mortality and its determinants.

Objective:

To analyze the multiple causes of in-hospital and late death in patients with decompensated HF and reduced ejection fraction (EF) (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF).

Methods:

Retrospective analysis of a prospective cohort of patients admitted for decompensated HF to a cardiac intensive care unit at a private hospital. The analysis included multiple causes of in-hospital and late deaths. A significance level of 5% was adopted.

Results:

The analysis included 519 individuals with a mean age of 74.87 ± 13.56 years, of whom 57.6% were male. The distribution of HFpEF, HFmrEF, and HFrEF was 25.4%, 27%, and 47.6%, respectively. Cardiovascular diseases (I) were the main causes of in-hospital and late death across all three EF groups, with no significant differences among them. The primary isolated causes of in-hospital and late death were septicemia (A41), HF (I50, I50.0, I50.9), and pneumonia (J12-J18). In late death, septicemia and pneumonia showed significant differences among the groups. Chronic respiratory causes were more frequent in patients with lower EF (HFrEF and HFmrEF). Correspondence analysis revealed an association between circulatory causes and HFrEF, neoplastic causes and HFpEF, and endocrine and metabolic causes and HFmrEF.

Conclusion:

The analysis of multiple causes of death reveals a high rate of non-circulatory deaths in patients with decompensated HF, regardless of EF, linked to age and chronic comorbidities.

Read Full Article

Editorial

Post-discharge Mortality in Heart Failure: Insights from a Multiple-Cause Analysis

Danielle Louvet Guazzelli et al. Monica S. Avila

Heart failure (HF) ranks among the leading causes of hospital admission and death. Nevertheless, the factors precipitating mortality—particularly after a decompensation-related admission—are far more heterogeneous than once assumed. In the article “Multiple Cause of Death Analysis in Heart Failure According to Ejection Fraction” published in this issue of the Arquivos Brasileiros de Cardiologia, 519 patients hospitalised for decompensated HF between 2011 and 2019 had their death certificates examined with a multiple-cause-of-death (MCOD) approach. Over a mean follow-up of 2.9 years, 52 % of patients died; however, only 36 % of the 977 recorded mentions were cardiovascular, a proportion clearly lower than the 50% previously reported in Brazilian series. Sepsis, HF itself, and pneumonia were the most frequent specific causes, and—contrary to studies linking reduced ejection fraction to worse prognosis—survival did not differ across preserved, mildly reduced, or reduced ejection-fraction groups. Remarkably, code I50 (HF), historically the leading line on Brazilian death certificates (≈ 23 % of mentions),³ ranked only third, surpassed by sepsis and pneumonia.

The post-discharge period is characterized by heightened vulnerability and multiple competing threats. International registries already show 20–30 % mortality in the first year, with a growing dominance of non-cardiovascular causes in late deaths.^, The Brazilian study reinforces this shift. Although in-hospital lethality was 14.5 %, infections and respiratory complications accounted for most post-discharge deaths, mirroring patterns seen in trials of SGLT2 inhibitors and sacubitril/valsartan.^,

[…]

Read Full Article

See all articles