2023;3(4) – ABC CARDIOL

Original Article

Evolution of Hematological Parameters in Patients with Vasoplegia Following Coronary Artery Bypass Graft Surgery

Nicolas Ramos et al. Marcos T. Faé Cristina B. Hebeda Franciani R. da Rocha … Caroline O. F. Bacca Marcelo V. Gambetta

Abstract

Background:

The utilization of extracorporeal circulation during a coronary artery bypass graft (CABG) surgery induces the secretion of inflammatory mediators associated with the onset of vasoplegic syndrome (VS). Blood cells contribute to the amplification of enzymatic mechanisms related to the development of VS, which is responsible for high mortality rates.

Objectives:

To investigate possible changes in hematological ratios to evaluate the evolution of VS in patients undergoing CABG.

Methods:

Analytical observational study of the retrospective cohort type, utilizing data collected from medical records in a reference cardiology hospital.

Results:

VS was associated with decreased monocyte rates (p = 0.02) 24 hours before the CABG, as well as elevated lymphocyte/monocyte ratio (LMR) (p = 0.01) and neutrophil/monocyte ratio (NMR) (p = 0.01) on the same period. Twenty-four hours after the procedure, increased neutrophil counts (p = 0.05) and platelet/lymphocyte ratio (PLR) (p = 0.03), as well as neutrophil/lymphocyte ratio (NLR) (p = 0.04), were associated with VS. Between 24 and 48 hours after CABG, neutrophil ratios (p = 0.01), PLR (p = 0.02), MLR (p = 0.04), and systemic inflammation response index (SIRI) (p = 0.02) were lower in patients who developed vasoplegia.

Conclusion:

A decreased monocyte count 24 hours before CABG was associated with the development of VS, as well as an elevated neutrophil count 24 hours after the procedure. Higher LMR and NMR 24 hours before the surgery, as well as PLR and MLR after the cardiac surgery were also associated with VS. Our data show different hematological changes at different times after CABG and highlight that new studies are essential to allow the use of hematological ratios in the monitoring of patients undergoing CABG.

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Tacrolimus-Associated Posterior Reversible Encephalopathy Syndrome after Heart Transplantation

Gabriel Gomes de Sousa et al. José Erirtônio Façanha Barreto Júnior Rivania Beatriz Novais Lima Pimentel Thiago Antônio Pessoa Carneiro Jefferson Luís Vieira

[…]

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Original Article

Availability of Natriuretic Peptide Testing in Primary Public Health Care in Brazil

Andressa Araujo Braga et al. Marisa da Silva Santos Bernardo Rangel Tura Bruno Monteiro Barros … Quenia Cristina Dias Morais Ione Gualandi Oliveira

Abstract

Background:

Early detection of heart failure makes it possible to intervene in risk factors, and treatment is capable of modifying the natural history of the disease. For diagnostic confirmation, natriuretic peptide (NP) testing or transthoracic echocardiography can be performed; the former is preferable when considering cost and accessibility. Although this test was incorporated into the Brazilian Unified Health System (SUS) in 2018, requests for this test were registered in only 4.63% of municipalities in the SUS Outpatient Information System (SIA/SUS) in 2022. This leads to difficulties in both heart failure diagnosis and access to specific treatments, given that the use of sacubitril valsartan sodium depends on the performance of this test.

Objective:

To evaluate the availability of NP testing in the SUS.

Methods:

Cross-sectional study carried out by means of telephone contact with a probabilistic sample of 255 Brazilian municipal health departments.

Results:

NP testing was reported as available in 20.78% (53/255) of contacts, either within the municipality (16.86% [43/255]) or in the reference municipality (3.92% [10/255]), while 78.04% (199/255) of interviewees reported that the test was not available through the SUS.

Conclusion:

Although NP testing has been incorporated into the SUS since 2018, we observed that the test was available in 12.23% of municipalities, in addition to those that actually registered a request in the SIA/SUS during the year studied (2022). This suggests that, in addition to the fact that the test is not offered in a uniform manner throughout the country, there are still municipalities where the test is available, but its use has not been registered.

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Original Article

Evaluation the In Vitro Action of Ciprofloxacin Hydrochloride, Naproxen, and Folic Acid on Trypanosoma cruzi, using Benznidazole as a Gold Standard

Cristiane Castro Faccini et al. Angela Maria Lourenço Abilio Augusto Fragata Filho

Abstract

Background:

Benznidazole is the only drug against Trypanosoma cruzi (T. cruzi) available in Brazil. However, it has limited efficacy and frequent side effects. Recent studies suggest that ciprofloxacin hydrochloride, naproxen, and folic acid may have beneficial effects in treating the Chagas disease.

Objective:

To assess the in vitro parasiticidal action of ciprofloxacin, naproxen, and folic acid on the Y strain of T. cruzi, using benznidazole as a gold standard.

Methods:

Tablets of benznidazole, ciprofloxacin hydrochloride, naproxen, and folic acid were macerated, weighed, and added to test tubes with a culture medium containing 100,000 forms per ml of T. cruzi trypomastigotes (strain Y). Samples from each tube were analyzed and counted in a Neubauer hemocytometer under an optical microscope for four days after adding the drugs. Thus, the minimum effective dose of each drug was determined.

Results:

As compared with benznidazole, higher concentrations of ciprofloxacin and naproxen were effective as in vitro parasiticides. In contrast, folic acid showed no direct in vitro parasiticidal action. Hence, previous observations reporting its effectiveness are probably due to indirect action.

Conclusion:

In our experiment, ciprofloxacin and naproxen showed a trypanosomicidal effect in vitro, but folic acid did not show this effect.

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Original Article

Gait Spatiotemporal Characteristics of Hospitalized Adult Patients with Chronic Heart Failure

Emmanuelle Melo Sarraf de Souza et al. Thiago José Santos Tássia Oliveira Ribeiro Matheus Sales Nildo Manoel da Silva Ribeiro

Abstract

Background:

Patients with chronic heart failure (CHF) have a decreased ability to walk, which has been related to the occurrence of hospitalizations and mortality and appears to be associated with the severity of the disease.

Objective:

To describe spatiotemporal gait characteristics of adult patients hospitalized with CHF.

Method:

Cross-sectional observational study. Participants diagnosed with CHF, between 18 and 60 years old, functional classification II and III, who were medically authorized to walk as prescribed in their medical records, were included. The walking cycle was based on a distance of 10 meters in a flat, marked corridor.

Results:

30 individuals participated in the study. The sample was mostly composed of females (n=17; 56.7%) with an average age of 44.5 years. The main etiology was valvular heart disease (n=15;50%), with an average ejection fraction of 44.6%. A strong correlation was observed between gait speed and cadence (r=0.74; p<0.01)) and a moderate correlation between gait speed and stride length (r=0.56; p<0.01). Regarding gait speed, 36.6% of those assessed had values less than or equal to 0.8 meters/second, while 16.6% obtained results above 1m/s.

Conclusion:

A strong correlation was observed between walking speed and cadence, and a moderate correlation between walking speed and stride length. The other gait parameters were not correlated with each other. According to what was observed in the literature, speed, cadence, stride length, and swing phase were reduced, while there was a slight increase in the stance phase when compared to healthy individuals.

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Brief Communication

Safety of COVID-19 Vaccines among Individuals with Cardiopathies

Ana Luisa Soares Chiaretti et al. Bianca de Almeida Nunes Lívia Brito Oliveira Fábio Figueiredo Costa Adriana Lopes Latado

Introduction

The first cases of COVID-19 were reported in December of 2019. The SARS-CoV-2 virus has infected over 664 million people and caused over 6,7 million deaths worldwide. Brazil was one of the most affected countries, with over 36 million confirmed cases and nearly 700 thousand reported obits.

Although most cases were characterized as oligosymptomatic and self-limited, people older than 60 years and with comorbidities were at higher risk of presenting with severe forms, including acute respiratory distress syndrome (ARDS), myocarditis, thromboembolic events, sepsis, and shock.

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