Case-Control Studies – ABC CARDIOL

IJCS

Original Article

Obstructive Sleep Apnea as a Risk Factor for Ischemic Heart Disease

Soham Samajpaty et al. Alexander Konstantinovich Zhuravlov Emilianovich Dmitrii Ilin Yuriy Sergeivich

Abstract

Background:

Obstructive sleep apnea (OSA) is increasingly recognized as a potential risk factor for ischemic heart disease (IHD), but its role remains underexplored. This study investigated the association between OSA and IHD using a case-control design.

Objectives:

The objective of this study was to establish OSA as a risk factor for developing IHD.

Methods:

A total of 122 participants were recruited and categorized into two groups: patients with a recent history of IHD (< 7 days) (wIHD group, n = 61) and controls without IHD but with hypertension (cIHD group, n = 61). The STOP-Bang questionnaire was used to assess OSA risk, and statistical analyses, including odds ratio (OR), relative risk (RR), and attributable risk (AR), were performed. A significance level of 0.05 was adopted for all statistical analyses.

Results:

Patients in the wIHD group had significantly higher STOP-Bang scores than the control group (p 1). The level of statistical significance was found to be 0.05.

Conclusion:

This study identifies OSA as an important risk factor for IHD, supporting the need for routine OSA screening in cardiovascular risk assessment. Larger studies are needed to further explore this relationship

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ABC

Original Article

Activities of Daily Living, Physical Activity, Physical Fitness and Quality of Life in Children with Congenital Heart Disease: A Case-Control Study

Berfin Kişin et al. Sema Savci Buse Ozcan Kahraman Aylin Tanriverdi … Hazer Erçan Bozyer Halise Zeynep Genç Mustafa Kir

Abstract

Background

Despite reports of reduced physical fitness in children with congenital heart disease (CHD), no specific performance evaluations for activities of daily living have been conducted.

Objectives

The aim was to compare the activities of daily living, quality of life, posture, physical fitness and physical activity levels of children with CHD with healthy controls (HC).

Methods

The study included 30 children aged 6-14 diagnosed with moderate or severe CHD and 30 age-sex-matched HC. The sociodemographic and clinical data of the participants were recorded. All participants went through several tests, namely the TGlittre-P test for activities of daily living, the 6-minute walk test (6MWT) for functional capacity, the Fitnessgram test battery for physical fitness, the hand dynamometer for measuring grip strength, the pedometer for measuring physical activity, and both the child and parents reported the Pediatric Quality of Life Inventory (PedsQL) for evaluating the quality of life, in addition to posture analyses. Values of p < 0.05 were considered statistically significant.

Results

Individuals with CHD had a longer TGlittre-P test completion time and a shorter 6MWT distance than HC (TGlittre-P: CHD 3.45 [3.24-4.02]min vs. HC 3.10 [2.57-3.23]min, 6MWT: CHD 514.00 [412.50-566.00]m vs. HC 591.50 [533.00-631.00]m). For the CHD group, sit-ups, push-ups, trunk lift, and sit-and-reach test scores within the Fitnessgram battery, grip strength, posture, and quality of life scores were lower than those for the HC group. Physical activity levels were similar in the groups.

Conclusions

The performance of activities of daily living, functional capacity, physical fitness, posture, and quality of life of children with moderate and severe CHD were affected compared to healthy peers.

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ABC

Editorial

Comparison of HEART, TIMI and GRACE Scores for Predicting Major Adverse Cardiovascular Events in the Era of High-Sensitivity Assay for Troponin I

Gabriel Porto Soares

Diseases of the circulatory system predominate as the leading cause of death in the world; among cardiovascular diseases, ischemic heart diseases are the first group of causes. Ischemic heart disease (IHD) is the leading global cause of death, accounting for more than 9 million deaths in 2016, according to estimates from the World Health Organization (WHO). Mortality from IHD in Western countries has decreased dramatically over the past few decades, with a greater focus on primary prevention and better diagnosis and treatment of IHD. However, developing countries present new challenges for public health — this scenario is reproduced in Latin America. In this study, carried out in Colombia, the mortality rate from IHD was 150 deaths per 100,000 inhabitants in 2015, representing the main cause of deaths in that country.

Developing scores capable of predicting death from the diseases responsible for the largest share of deaths in the world has always been among the objectives of cardiologists. The question “How likely is this patient with acute IHD to die?” is made, whether consciously or not, every time there is a diagnostic possibility of acute myocardial infarction (AMI) with or without ST-segment elevation or unstable angina.

[…]

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ABC

Original Article

Disparities In The Use Of Drug-eluting Stents For Diabetic Patients With ST-elevation Acute Myocardial Infarction Assisted In the Public versus Private Network – VICTIM Register

Jussiely Cunha Oliveira et al. Laís Costa Souza Oliveira Jeferson Cunha Oliveira Ikaro Daniel de Carvalho Barreto … Marcos Antonio Almeida-Santos Ticiane Clair Remacre Munareto Lima Larissa Andreline Maia Arcelino Isadora Soares Bispo Santos Silva Antônio Carlos Sobral Sousa José Augusto Soares Barreto-Filho

Abstract

Background:

Primary angioplasty (PA) with placement of either bare metal or drug-eluting stents (DES) represents the main strategy in the treatment of ST-elevation myocardial infarction (STEMI). Diabetic patients, however, represent a special population in STEMI, with high rates of restenosis and unfavorable clinical outcomes, and with the use of DES, level of evidence A and indication class II, being indicated to reduce these damages.

Objectives:

To evaluate the DES rate of use in patients with STEMI and in the subgroup of diabetics assisted in the public versus private health network in Sergipe.

Methods:

This is a population-based, cross-sectional study with a quantitative approach using the data from the VICTIM Register. These were collected in the only four hospitals with capacity to perform PA in Sergipe, from December 2014 to March 2017.

Results:

A total of 707 patients diagnosed with STEMI were evaluated, of which 589 were attended at SUS and 118 at the private network. The use of DES in PA was lower in SUS compared to the private network in both the total sample (10.5% vs 82.4%, p<0.001) and in subgroup diabetic patients (8.7% vs 90.6%, p < 0.001), respectively. In all hypotheses tested, the level of significance was 5% (p < 0.05).

Conclusions:

The study reveals a disparity in the use of DES during the performance of PA between the public and private network, both in the total sample and the subgroup for diabetics, with lower rates for SUS users, demonstrating the challenges that need to be overcome in order to achieve quality improvements of the services provided.

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IJCS

Original Article

Carotid Atherosclerosis in Pre- and Post-Menopausal Women with a History of Pregnancy-Induced Hypertension: Case-Control Study

Rafael Alessandro Ferreira Gomes et al. Isly Maria Lucena de Barros Moacir de Novaes Lima Ferreira Laura Olinda Bregieiro Fernandes Costa

Abstract

Background:

Cardiovascular disease mortality among women remains high. Observational studies are controversial about the participation of a history of gestational hypertensive disorder in cardiovascular risk.

Objective:

To verify the association between carotid atherosclerosis in menopausal women who had pregnancy-induced hypertension.

Methods:

Case-control study, with cases consisting of women with carotid atherosclerosis, defined as carotid intima-media thickness > 1 mm and/or presence of carotid plaques; the controls did not have these alterations. The significance level was set at 95%.

Results:

A total of 504 women without previous cardiovascular disease were assessed, 126 cases and 378 controls. Of the total, 67% were hypertensive; 76% were dyslipidemic; and 16% were diabetic. Approximately 10% reported a history of hypertension during pregnancy. Women with carotid atherosclerosis had higher values of systolic blood pressure (134.18 mmHg vs. 128.59 mmHg, p = 0.008) and LDL-cholesterol (156.52 mg% vs. 139.97 mg%; p = 0.0005). No statistical difference was found regarding the presence of carotid atherosclerosis and history of hypertension during pregnancy (OR 1.672, 95% CI: 0.883-3.131).

Conclusion:

The history of hypertension during pregnancy was not associated with subclinical carotid atherosclerosis in menopausal women. However, an association was observed between carotid atherosclerosis and classic risk factors, such as elevated systolic blood pressure and LDL-cholesterol levels.

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ABC

Editorial

Editorial Considerations on the New Clinical and Surgical Perspectives of Brazilian Cardiology

Paulo Roberto B. Evora et al. Alfredo J. Rodrigues

The Arquivos Brasileiros de Cardiologia (ABC) has been the official publication of the Brazilian Society of Cardiology for more than 60 years, and has proved to be one of the most prestigious scientific journals in Latin America, approaching all aspects of cardiology, including the surgical ones. In August 1986, the Revista Brasileira de Cirurgia Cardiovascular (RBCCV), specifically directed to the surgical aspects of heart diseases, began to be published. Thus, the editorial policy of the ABC has progressively privileged publications focused on the clinical treatment of cardiovascular diseases over surgical publications of common interest to cardiologists and cardiac surgeons. Despite the substantial changes in the treatment of heart diseases, deriving from the appearance of new drugs and percutaneous devices, cardiac surgeries are still the treatment of choice to a substantial number of heart diseases, mainly the congenital, valvular and even coronary ones, whose onus of surgery indication is invariably on cardiologists. Thus, those specialists should be aware of several aspects of cardiac surgery, mainly those concerning their risks and results, so that they can base their indications on evidence.

The great majority of cardiologists might know that the use of bilateral internal thoracic arteries (BITA) for coronary artery bypass grafting improves survival as compared to the use of only one single internal thoracic artery (ITA). Thus, the optimization of arterial grafts has been widespread with the use of the radial artery (RA) and composite grafts. However, only few professionals are aware of the controversies involving risky situations, possible limitations to the use of BITA, the patency index of RA grafts and their influencing factors. The RA was the second arterial graft introduced in the clinical practice for coronary artery bypass grafting, and has drawn the interest of Brazilian surgeons since the 1990s. Skeletonization of the left ITA (LITA) can favorably change the flow capacity of the graft, leading to the assumption that the behavior of the RA, as a coronary graft, is similar to that of the skeletonized LITA. Considering the potential role of the RA as a second option of coronary grafting and the concept of complete coronary artery bypass grafting with the exclusive use of arterial grafts, Bonini et al have carried out a prospective randomized study comparing 40 patients distributed into two groups. In group I, skeletonized RA was used in 20 patients, and, in group II, RA with adjacent tissues was used in 20 patients. After the surgical procedure, flow velocity was measured. The results showed that the morphological and pathological characteristics, as well as the hemodynamic performance of the free RA grafts, regardless of being skeletonized or having adjacent tissues, were similar. However, a larger number of non-obstructive lesions was observed in the group with the RA graft preserving the adjacent tissues.

[…]

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ABC

Original Article

Value of the Qrs-T Angle in Predicting the Induction of Ventricular Tachyarrhythmias in Patients with Chagas Disease

Hugo Bizetto Zampa et al. Dalmo AR Moreira Carlos Alberto Brandão Ferreira Filho Charles Rios Souza … Camila Caldas Menezes Henrique Seichii Hirata Luciana Vidal Armaganijan

Background:

The QRS-T angle correlates with prognosis in patients with heart failure and coronary artery disease, reflected by an increase in mortality proportional to an increase in the difference between the axes of the QRS complex and T wave in the frontal plane. The value of this correlation in patients with Chagas heart disease is currently unknown.

Objective:

Determine the correlation of the QRS-T angle and the risk of induction of ventricular tachycardia / ventricular fibrillation (VT / VF) during electrophysiological study (EPS) in patients with Chagas disease.

Methods:

Case-control study at a tertiary center. Patients without induction of VT / VF on EPS were used as controls. The QRS-T angle was categorized as normal (0-105º), borderline (105-135º) or abnormal (135-180º). Differences between groups for continuous variables were analyzed with the t test or Mann-Whitney test, and for categorical variables with Fisher’s exact test. P values < 0.05 were considered significant.

Results:

Of 116 patients undergoing EPS, 37.9% were excluded due to incomplete information / inactive records or due to the impossibility to correctly calculate the QRS-T angle (presence of left bundle branch block and atrial fibrillation). Of 72 patients included in the study, 31 induced VT / VF on EPS. Of these, the QRS-T angle was normal in 41.9%, borderline in 12.9% and abnormal in 45.2%. Among patients without induction of VT / VF on EPS, the QRS-T angle was normal in 63.4%, borderline in 14.6% and abnormal in 17.1% (p = 0.04). When compared with patients with normal QRS-T angle, those with abnormal angle had a fourfold higher risk of inducing ventricular tachycardia / ventricular fibrillation on EPS [odds ratio (OR) 4; confidence interval (CI) 1.298-12.325; p = 0.028]. After adjustment for other variables such as age, ejection fraction (EF) and QRS size, there was a trend for the abnormal QRS-T angle to identify patients with increased risk of inducing VT / VF during EPS (OR 3.95; CI 0.99-15.82; p = 0.052). The EF also emerged as a predictor of induction of VT / VF: for each point increase in EF, there was a 4% reduction in the rate of sustained ventricular arrhythmia on EPS.

Conclusions:

Changes in the QRS-T angle and decreases in EF were associated with an increased risk of induction of VT / VF on EPS.

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ABC

Artigo Original

Prospective double-blind crossover study of Camellia sinensis (green tea) in dyslipidemias

Gesiani de Almeida Pierin Batista et al. Cláudio L. Pereira da Cunha Mariléia Scartezini Raul von der Heyde … Murílo G Bitencourt Sandra Fabrício de Melo

BACKGROUND: Epidemiological studies have established an association between dyslipidemias and atherosclerosis. Nutritional therapy is a key point in the prevention strategy for individuals who present with risk factors for atherosclerotic disease. OBJECTIVES: To investigate the effects of green tea (Camellia sinensis) in patients with dyslipidemias. METHODS: The study included 33 patients aged between 21 and 71 years who had a low-fat diet (25-35% of total calories and 200 mg of cholesterol per day). They were randomized for two sequential treatments: 250-mg capsules of green tea dry extract or placebo for a total period of 16 weeks; each patient received green tea (Camellia sinensis) for eight weeks and placebo for another eight weeks. RESULTS: Baseline lipid values (mg/dL) were: HDL-cholesterol 60.7 ± 7.3; total cholesterol 255 ± 30.9; LDL-cholesterol 158.8 ± 29.0; triglycerides 169.0 ± 61.3 and Apo-B 120.2 ± 18.9. Mean lipid variations induced by the use of green tea (Camellia sinensis) showed a 3.9% reduction (p = 0.006) in total cholesterol concentrations and a 4.5% reduction (p = 0.026) in LDL-cholesterol. The intake of green tea did not significantly influence HDL-cholesterol, triglyceride, and Apo-B levels. Non-significant results were found in the assessment of blood lipids (total cholesterol and LDL-cholesterol) with the use of placebo. CONCLUSION: A beneficial effect of green tea (Camellia sinensis) was demonstrated, with a significant reduction of total cholesterol and LDL-cholesterol levels in eight weeks, in the patients studied.

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