Comorbidity – ABC CARDIOL

IJCS

Original Article

Exploring Risk Factors, Comorbidities, and Multiple Drug Therapy in Coronary Artery Disease Patients

Ketan Inamdar et al. Harshada Kajave Akash Shete Jayant Pawar … Anmaria Thomas Madhur Kulkarni

Abstract

Background:

Coronary artery disease (CAD) continues to be a predominant global cause of morbidity and mortality, with rising prevalence in developing nations like India, emphasizing the need to address risk factors, multimorbidity, and polypharmacy to implement effective lifestyle interventions and drug therapies to enhance patient outcomes.

Objectives:

To evaluate the risk factors, comorbidities, and multiple drug therapy patterns among patients diagnosed with CAD in a tertiary care setting.

Methods:

This prospective observational study used medical records to collect data on demographics, comorbidities, lifestyle factors, and medications. Descriptive statistics summarized findings, and Chi-square tests assessed associations between gender, risk factors, and CAD. The significance level adopted in the statistical analysis was 5%.

Results:

Out of 300 patients enrolled, 69.3% were male, and the highest disease prevalence was noted in the 66–75 age group. Hypertension was the most common comorbidity (71%), followed by diabetes mellitus (DM) (50%). Poor diet was the leading lifestyle risk factor (25.3%), followed by smoking (21%). A significant association existed between gender and CAD type (p = 0.002), with females showing higher angina prevalence and males showing more myocardial infarction (MI). For CAD management, aspirin (92.6%) and enoxaparin (59.3%) were most frequently prescribed, followed by atorvastatin (53.6%) and nicorandil (52%). For comorbidity management, beta-blockers (59.6%) and insulin (48.7%) were commonly prescribed. Increased use of ticagrelor and dapagliflozin was observed, indicating a greater alignment with evidence-based guideline recommendations.

Conclusion:

This study highlights the burden of multimorbidity and polypharmacy among CAD patients in India, emphasizing the need for individualized, evidence-based therapy.

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Original Article

Spatial Distribution of Patients in the Metropolitan Area of São Paulo Attending a Public Tertiary Cardiovascular Referral Hospital According to Diseases of the Circulatory, Respiratory, Endocrine, and Neoplastic Systems

Carlos Lederman et al. Sara Lopes de Moraes Antonio Carlos Pedroso de Lima Lucia Pereira Barroso … Lilian Cristina Correia Morais Magaly de Losso Perdigão Rosa Maria Vieira de Freitas Monica La Porte Teixeira Bernadette Cunha Waldvogel Marco Antonio Gutierrez Ligia Vizeu Barrozo Alfredo José Mansur

Abstract

Background

The spatial distribution of patients according to clinical characteristics, using geoprocessing techniques, enables the identification of disease clusters within a studied population. This approach supports the development of targeted interventions directed toward specific risk groups.

Objectives

To investigate geographical clusters of diseases of interest among patients attending a public tertiary hospital and to characterize their spatial distribution across the metropolitan area of São Paulo.

Methods

Based on the results of a previous study, two disease groups were defined: one representing the main diseases identified at the first hospital visit and another representing the main underlying causes of death. A detailed description is provided in the . Disease density was calculated by dividing the frequency of cases within each disease group by the population of each city/district and multiplying the result by 100,000 to enhance data visualization. Spatial data were subsequently analyzed and mapped to illustrate the spatial patterns and relationships identified in the study.

Results

Osasco and Taboão da Serra showed the highest density of underlying causes of death related to diseases of the circulatory system. Additionally, 12 cities/districts located at the borders of the study area showed no recorded neoplastic diseases.

Conclusions

Vargem Grande Paulista showed the highest case density for neoplasms as underlying causes of death and comorbidities. Notably, Embu das Artes, a city recognized for its extensive green areas, showed the highest density of diseases of the respiratory system.

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Original Article

Performance of the SHARPEN Score and the Charlson Comorbidity Index for In-Hospital and Post-Discharge Mortality Prediction in Infective Endocarditis

Sofia Giusti Alves et al. Fernando Pivatto Júnior Filippe Barcellos Filippini Gustavo Paglioli Dannenhauer … Gabriel Seroiska Helena Marcon Bischoff Luiz Felipe Schmidt Birk Diego Henrique Terra Daniel Sganzerla Marcelo Haertel Miglioranza

Abstract

Background

SHARPEN was the first dedicated score for in-hospital mortality prediction in infective endocarditis (IE) regardless of cardiac surgery.

Objectives

To analyze the ability of the SHARPEN score to predict in-hospital and post-discharge mortality and compare it with that of the Charlson comorbidity index (CCI).

Methods

Retrospective cohort study including definite IE (Duke modified criteria) admissions from 2000 to 2016. The area under the ROC curve (AUC-ROC) was calculated to assess predictive ability. Kaplan-Meier curves and Cox regression was performed. P-value < 0.05 was considered statistically significant.

Results

We studied 179 hospital admissions. In-hospital mortality was 22.3%; 68 (38.0%) had cardiac surgery. Median (interquartile range, IQR) SHARPEN and CCI scores were 9(7-11) and 3(2-6), respectively. SHARPEN had better in-hospital mortality prediction than CCI in non-operated patients (AUC-ROC 0.77 vs. 0.62, p = 0.003); there was no difference in overall (p = 0.26) and in operated patients (p = 0.41). SHARPEN > 10 at admission was associated with decreased in-hospital survival in the overall (HR 3.87; p < 0.001), in non-operated (HR 3.46; p = 0.006) and operated (HR 6.86; p 3 at admission was associated with worse in-hospital survival in the overall (HR 3.0; p = 0.002), and in operated patients (HR 5.57; p = 0.005), but not in non-operated patients (HR 2.13; p = 0.119). Post-discharge survival was worse in patients with SHARPEN > 10 (HR 3.11; p 3 (HR 2.63; p < 0.001) at admission; however, there was no difference in predictive ability between these groups.

Conclusion

SHARPEN was superior to CCI in predicting in-hospital mortality in non-operated patients. There was no difference between the scores regarding post-discharge mortality.

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ABCHF

Review Article

Heart Failure with Preserved Ejection Fraction in Brazil: A Systematic Review

Edimar Alcides Bocchi et al. Andréa Araujo Brandão Evandro Tinoco Mesquita Juliana S. Nakamuta … André Valente Bichels Francisco José Forestiero

Abstract

Heart failure with preserved ejection fraction (HFpEF) is the most common condition of heart failure (HF) in patients over 65 years of age and is associated with high morbidity and mortality. Epidemiological data on this condition are still scarce in Brazil and these data are relevant for a better understanding of the impact and unmet needs in HFpEF and for the planning of actions to improve prevention, diagnosis, and treatment of this disease.

The objective of the study was to identify evidence on the epidemiology and clinical characteristics of Brazilian patients with HFpEF.

We systematically reviewed observational and clinical studies evaluating epidemiological and clinical data of Brazilian patients with HFpEF in the Pubmed/MEDLINE and LILACS databases, following PRISMA guidelines.

The prevalence of HFpEF in patients with confirmed HF ranged from 28.2 to 59.0% in the outpatient setting and from 20.0% to 53.1% in the hospital setting. Among patients with suspected HF, the prevalence of patients with LVEF>50% ranged from 29.0 to 37.6%. The most frequently reported comorbidities were systemic arterial hypertension and diabetes, with a prevalence of 57.4 to 100.0% in studies involving only patients with HFpEF, and from 10.2 to 49.1% in studies on patients with HF with normal ejection fraction (n = 14). Data on mortality and hospitalization rates were scarce.

Despite few and heterogeneous data on the prevalence of HFpEF in Brazil, the prevalence of this condition in primary care patients and in hospitalized patients was relatively high.

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Editorial

The Clinical Impact of Cardiovascular Symptoms on Post-Acute COVID-19 Syndrome

Giovanni Possamai Dutra et al. Bruno Ferraz de Oliveira Gomes

The COVID-19 pandemic has intensely impacted people’s lives worldwide, generating, in addition to high mortality, high late morbidity, and negatively affecting health systems, remaining a significant global challenge today. In February 2023, World Health Organization records point to more than 756 million confirmed cases and approximately 6,845,000 deaths. Until the abovementioned month, approximately 36,961,000 cases were reported in Brazil, with about 698,000 deaths. Considering the substantial challenges related to comorbidity between heart disease and COVID-19, which go beyond the acute phase of the disease, further studies are needed to address the high burden of cardiopulmonary symptoms comprehensively. These investigations must be carefully planned, considering cost-effectiveness and clinical benefits for patients, to minimize inequalities in health care. In addition, it is essential to optimize social and mental care for patients. Cardiopulmonary involvement in COVID-19 continues to pose a major public health challenge.^,

The study by Kalil-Filho et al. included 480 survivors after hospitalization due to COVID-19 and evaluated the characteristics associated with the occurrence of cardiopulmonary symptoms and, especially, post-acute COVID-19 syndrome (PACS). It was a sample with a predominance of men, obese and with comorbidities such as hypertension, diabetes, and dyslipidemia. Almost a quarter of patients required intensive care admission, and only 12.2% required mechanical ventilation support. The prevalence of any of the symptoms was lower (32.1%) than that found in the literature, as well as PACS related to cardiopulmonary symptoms (16.3%). Notably, almost two-thirds of the population that underwent tomography (n=122) did not demonstrate pulmonary involvement. Thus, we observed that the analyzed population had a lower degree of severity related to COVID-19, justifying the lower prevalence of symptoms.

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Research Letter

Orthotopic Heart Transplantation in a Covid-19 Recipient

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

Introduction

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

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

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Original Article

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

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

Abstract

Background

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

Objective

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

Method

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

Results

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

Conclusion

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

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ABCHF

Viewpoint

The Importance of Controlling Comorbidities in HFpEF and How They Influence Disease Evolution

Conrado Roberto Hoffmann Filho et al. André R. Duraes Gilmar Sidnei Erzinger

Heart failure (HF) is a disease with high morbidity and mortality in Brazil and in the world, and HF with preserved ejection fraction (HFpEF) accounts for more than half of cases. Effective pharmacological treatment options for HFpEF are scarce, with poor outcomes and an annual mortality of 10 to 30%. Mortality from noncardiovascular causes is high, which is to be expected given the high number of comorbidities (). The syndromic diagnosis is composed of several etiologies and diseases, each one with a specific treatment but with common aspects regarding clinical presentation.

An approach based on the different phenotypes of the disease was proposed, which comprises multiple situations experienced by the group of patients with HFpEF. Each phenotype is dependent on the different presentations of comorbidity severity, which constitutes a challenge for the definitive clinical diagnosis of HFpEF by a clinical cardiologist. Diagnostic scores with probabilistic models were developed to facilitate HFpEF diagnosis, using clinical, echocardiographic, and biomarker variables, such as B-type natriuretic peptide (BNP) and N-terminal portion of BNP. A more detailed description of the diagnosis is beyond the scope of this article.

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Research Letter

Echocardiographic Findings in Patients with COVID-19 with and without Previous Cardiovascular Disease

Silvio Henrique Barberato et al. Rafael Borsoi Fabio Roston Hudson Laerte Machado Miranda … Pedro Patriota Maria Estefania Otto Adenalva Lima de Souza Beck Anderson da Costa Armstrong João Marcos Bemfica Barbosa Ferreira Ana Cristina Camarozano Letícia Braga Paciello da Silva Marcos Valério Coimbra Resende Marcelo Luiz Campos Vieira Miguel Morita Fernandes-Silva

Introduction

Coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) may result in severe respiratory distress and acute cardiac injury. Impaired cardiac function and/or prior cardiovascular disease (CVD) in patients with COVID-19 are associated with worse prognosis. Transthoracic echocardiography (TTE) has a central role in the management of patients, as it provides a crucial assessment of abnormalities in cardiac function and structure that impact on their prognosis and treatment. Studies have reported varied rates of left ventricular (LV) and right ventricular (RV) dysfunction, but it is unclear how often cardiac dysfunction result directly from COVID-19.^– We described the prevalence of the main abnormal echocardiographic findings in hospitalized patients with COVID-19 with and without previous cardiovascular disease (CVD) through a real-world, multicenter collaborative study (Brazilian Echocardiography Registry during COVID-19 pandemic, or ECOVID).

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ABC

Editorial

The Role of Inflammation in Post-TAVI Outcomes

Pedro H. M. C. de Melo et al. Rodrigo Modolo

In the early transcatheter aortic valve implantation (TAVI) experience with extreme/high risk for surgical aortic valve replacement (SAVR) patients, global mortality in one year was as high as 25% . Since then, access to TAVI has been extended to intermediate and low-risk patients, and the annual volume of procedures has markedly increased. Post-discharge mortality rates have declined in parallel with the introduction of new devices and the adoption of broader indications. However, the one-year mortality after TAVI remains relevant, exceeding 15% in contemporary practice .

Over time, significant postprocedural paravalvular leak, acute renal failure, and comorbidities such as chronic obstructive pulmonary disease (COPD), heart failure, chronic kidney disease (CKD) and prior stroke were linked to higher rates of mortality ^,. Risk scores originally validated to estimate mortality after SAVR, and serum biomarkers related to congestive heart failure and others had their performance tested in patients who underwent TAVI . Nonetheless, there is no specific, widely adopted tool to predict late mortality of post-TAVI patients.

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Research Letter

Infective Endocarditis in the Elderly: Distinct Characteristics

Luiz Henrique Braga Lemos et al. Leonardo Ribeiro da Silva Marcelo Goulart Correa Wilma Golebiovski … Clara Weksler Rafael Quaresma Garrido Giovanna Ferraiuoli Barbosa Cristiane da Cruz Lamas

Introduction

Infectious endocarditis (IE) is a serious disease with a mean in-hospital mortality of 20%.^– It has shown an increasing incidence, and the rise in its prevalence among the elderly population deserves to be highlighted.^– In elderly patients with IE, there are differences regarding the clinical presentation, complications, presence of comorbidities, therapeutic approach and mortality.^{, –} IE guidelines do not specifically address the elderly population and it is not clear to what extent they can be appropriately used in these patients.^{, ,} The elderly population has clearly benefited from medical progress, with diagnostic-therapeutic techniques that influence the increase in life expectancy and less invasive procedures. One example is the transcatheter aortic valve implantation in the management of aortic valve diseases. However, these procedures, together with the increasing implantation of cardiovascular electronic devices (CED) contribute to infections such as IE. Comorbidities are found in more than half of the elderly, with the consequent need for long-term care from health professionals, which increases the probability of acquiring IE.^, The diagnosis of IE in the elderly is often delayed or forgotten. Manifestations may be nonspecific, attributed to aging and other conditions. Fever may be absent, with the presence of mental confusion only. IE can present with complications similar to those of other conditions, such as heart failure (HF), cerebrovascular accident (CVA) or systemic embolism attributable to atrial fibrillation.^, In Brazil, despite a growing elderly population, to date there is no published article about IE in this group. The aim of our study was to describe the elderly group in our adult IE cohort and compare them with non-elderly individuals, highlighting the differences between the groups.

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ABCHF

Brief Communication

The Challenge of HFpEF Diagnosis in Brazil

Luiz Cláudio Danzmann et al. Evgeny Belyavskiy Antônio José Lagoeiro Jorge Evandro Tinoco Mesquita Marco Antonio Rodrigues Torres

Abstract

Heart failure with preserved ejection fraction (HFpEF) is highly prevalent in Brazil and worldwide. However, the recent diagnostic criteria for this condition are complex and difficult to apply in the Brazilian health system. This review proposes adapting the modern diagnostic criteria to the needs of each patient, from the primary care to the most complex one, using a system of three steps of complexity and highlighting the importance of searching specific disease etiology.

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Original Article

Prevalence and Associated Factors of SARS by Covid-19 in Adults and Aged People with Chronic Cardiovascular Disease

Karina Mary de Paiva et al. Danúbia Hillesheim Cassiano Ricardo Rech Rodrigo Sudatti Delevatti … Rodrigo Vasconi Sáez Brown Ana Inês Gonzáles Patricia Haas

Abstract

Background

The presence of Cardiovascular Disease (CVD) in individuals infected with COVID-19 may imply a worse prognosis.

Objective

To describe the prevalence of Severe Acute Respiratory Syndrome (SARS) by COVID-19 and to analyze the factors associated with this condition in adults and the elderly with cardiovascular disease in Brazil until the 30th Epidemiological Week of 2020.

Methods

Cross-sectional study conducted with data from the Influenza Epidemiological Surveillance Information System (Sistema de Informação de Vigilância Epidemiológica da Gripe – SIVEP-Gripe), referring to the SARS notification forms of hospitalized individuals in Brazil, between the 1st and 30th Epidemiological Week of 2020. Adults and the aged (≥ 18 years old) with CVD. The dependent variable was SRAG confirmation by COVID-19 and factors related to sociodemographic characteristics, signs and symptoms, and clinical factors were analyzed. Poisson regression with robust variance was applied. The level of significance adopted was 5%.

Results

Notifications from 116,343 individuals were analyzed. Of these, 61.9% were diagnosed with SARS by COVID-19. The prevalence of the outcome was 4% lower in women (95%CI: 0.94–0.99) and 18% lower in rural areas (95%CI: 0.77–0.87). There was a higher prevalence in the 50 to 59 age group (95%CI: 1.09–1.48) and in the northeast region (95%CI: 1.72–1.91). Fever, cough, admission to the ICU, use of ventilatory support, and nosocomial cases were also significantly associated with a higher probability of SRAS by COVID-19 in these individuals.

Conclusion

There is a high prevalence of SARS by COVID-19 in adults and aged people with CVD in Brazil. Factors associated with sociodemographic and clinical characteristics, signs, and symptoms were associated.

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IJCS

Case Report

Renal Sympathetic Denervation Using a Novel Device: A Clinical Case Discussion and Literature Update

Esmeralci Ferreira et al. Valerio Fuks Rodolfo Staico Roberto Esporcatte … Andréa Araujo Brandão Denilson Campos Albuquerque

Introduction

Resistant hypertension (RH) is directly related to increased mortality, severe renal changes, and cardiac and cerebrovascular diseases, due to lack of adequate drug treatment. Cardiovascular disease mortality increases progressively and linearly as BP increases, whereas BP lowering is associated with significantly reduced risks.^– Increased sympathetic tone in renal arteries is one of the major components of RH, and catheters have been developed using several technologies which allow for radiofrequency ablation (RA) and blood pressure (BP) reduction. The discussions and controversies about the effectiveness of this treatment are quite broad, especially when associated with the use of new devices. In this clinical case study, with an 18-month follow-up, we describe the development of knowledge regarding this technique and its evidence basis.

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Research Letter

COVID-19 Infection in Heart Transplantation: Case Reports

Ligia Espinoso Schtruk et al. Jacqueline Miranda Vitor Salles Ana Sales … Luciana Lobbe Vaisnava Cavalcante Elisangela Reis Sharon Kugel Bruno Marques Gabrielle Carvalho Ruth Maia Filipe Oliveira dos Reis Danielle Rodrigues

Case Report

Case 1: 47-year-old male, Caucasian, with Chagas’ Disease, heart transplantation on 08/08/2012, without comorbidities, using tacrolimus (4 mg/day), sodium mycophenolate (1440 mg/day).

On 04/12/2020, he had myalgia, fever, headache, mild dyspnea, dry cough, diarrhea and anosmia. He lives in a community with confirmed cases of COVID-19. On 04/14/2020 (D3 of symptoms) he sought emergency care. Physical examination: feverish (axillary T: 38ºC), without hemodynamic instability (BP: 100 x 60 mmHg, HR: 60 bpm), borderline oxygen saturation (SpO₂: 93%). Arterial blood gases showed mild hypoxia. Other exams are shown in . Chest computed tomography (CT) was performed on admission, and showed a bilateral ground-glass image, with a multilobar distribution, predominantly peripheral, with a crazy paving pattern, associated with foci and areas of consolidation, located in the lower lobes, <25% involvement (). Nasopharyngeal secretion was collected for RT-PCR SARS-COV2 test, which was positive. The patient was hospitalized. Sodium mycophenolate was suspended (thrombocytopenia/leukopenia), tacrolimus was maintained, and prophylactic anticoagulation prescription was started. On the 3^rd day of hospitalization (D6 of symptoms), the patient remained clinically stable (94% SatO₂), with fever and worsening of the radiological image, with consolidation in the right hemithorax, and intensification of the ground glass opacification in the left hemithorax (). Azithromycin (500 mg/d – 5 days) and Ceftriaxone (2 g/day- 7 days) were started. On the 6^th day of hospitalization, the serum tacrolimus level was 4,3 ng/dL, and the dose was adjusted. On the 6^th day of hospitalization (D9 of symptoms), the fever persisted. A CT scan showed disease progression, with impairment of <50% of the lung parenchyma (). Hydroxychloroquine was started (dose of 400 mg 12/12h 1^st/day, 400mg/day- 4 days). On the 6^th day of hospitalization, leukopenia/lymphopenia/thrombocytopenia improved, and mycophenolate sodium was reintroduced. On this date, an increase in D-dimer levels was observed (<500 ug/L to 2.270 ug/L). Vascular Doppler of lower limbs did not show any alterations. He was discharged on the 12^th day of hospitalization, being asymptomatic. Laboratory tests are shown in .

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ABC

Letter to the Editor

Does Existence of Prior Circulatory System Diseases Accelerate Mortality Due to COVID-19?

Carlos Dornels Freire de Souza et al. Thiago Cavalcanti Leal Lucas Gomes Santos

Dear Editor,

The first cases of coronavirus disease 2019 (COVID-19) were identified in the metropolis of Wuhan, the capital of the province of Hubei, in the People’s Republic of China. An outbreak of rapidly progressive pneumonia of undetermined origin associated with common exposure to the city’s seafood market was observed. On December 31, 2019, China notified the World Health Organization (WHO) of the outbreak. One month later, on January 30, 2020, the WHO declared the situation an international emergency, and, on March 11, the disease was declared a pandemic.

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Editorial

Physical Activity Knowledge and Levels among Children with Congenital Heart Disease

Adilson Marques et al. Bruna Gouveia

The benefits of physical activity are well documented. Among children and adolescents, physical activity improves cardiovascular, bone and metabolic health, fitness levels, weight status, and sleep. Also, there is evidence of the cognitive, psychological and social benefits of physical activity.The health benefits of physical activity are transversal to all children, including those living with a chronic disease, such as congenital heart disease (CHD), preventing comorbidities, while improving quality of life.^,

The importance of physical activity for children with CHD has been documented for a long time. Engagement in physical activity is of high importance for children with CHD because they are at risk of developing other cardiovascular and metabolic diseases,^, increasing signs of depression and anxiety. In addition, when present, these health problems can be mitigated by an active lifestyle.^–

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Review Article

The Effect of Coronavirus Disease 2019 on Cardiovascular Diseases

Lutfu Askin et al. Okan Tanrıverdi Husna Sengul Askin

Abstract

Coronavirus disease 2019 (COVID-19) is a global pandemic affecting the world, seen in more than 1,300,000 patients. COVID-19 acts through the angiotensin-converting enzyme 2 (ACE2) receptor. Cardiovascular comorbidities are more common with COVID-19, and nearly 10% of cases develop myocarditis (22% of critical patients). Further research is needed to continue or discontinue ACE inhibitors and angiotensin receptor blockers, which are essential in hypertension and heart failure in COVID-19. Intensive research is promising for the treatment and prevention of COVID-19.

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Original Article

Prediction of Stress Map in Ascending Aorta – Optimization of the Coaxial Position in Transcatheter Aortic Valve Replacement

Diego Celis et al. Bruno Alvares de Azevedo Gomes Ivan Ibanez Pedro Nieckele Azevedo … Pedro Soares Teixeira Angela Ourivio Nieckele

Abstract

Backgroud

Transcatheter aortic valve replacement (TAVR) can reduce mortality among patients with aortic stenosis. Knowledge of pressure distribution and shear stress at the aortic wall may help identify critical regions, where aortic remodeling process may occur. Here a numerical simulation study of the influence of positioning of the prosthetic valve orifice on the flow field is presented.

Objective

The present analysis provides a perspective of great variance on flow behavior due only to angle changes.

Methods

A 3D model was generated from computed tomography angiography of a patient who had undergone a TAVR. Different mass flow rates were imposed at the inlet valve.

Results

Small variations of the tilt angle could modify the nature of the flow, displacing the position of the vortices, and altering the prerssure distribution and the location of high wall shear stress.

Conclusion

These hemodynamic features may be relevant in the aortic remodeling process and distribution of the stress mapping and could help, in the near future, the optimization of the percutaneous prosthesis implantation. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

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IJCS

Viewpoint

Coronavirus Disease (COVID-19) Pandemic: An Opportunity Window to Implement Home-Based Cardiac Rehabilitation

Renata Rodrigues Teixeira de Castro

The World Health Organization declared that the new coronavirus outbreak is a public health emergency of pandemic proportions. The outbreak has caused various governments to take protective measures such as lockdown of cities, travel bans, prohibition of group gatherings and public events, and social distancing. Many health and exercise training facilities were closed, as well as cardiac rehabilitation services. These restrictions are disrupting people’s daily activities.

Although staying at home can contain virus spread, it will certainly reduce regular physical activity and increase sedentary behavior, which can increase the risk of development and worsening of chronic conditions.^– Therefore, there is a strong evidence for continuing physical activity at home even during the pandemic situation.

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IJCS

Viewpoint

Exercise Training: A Hero that Can Fight two Pandemics at Once

Renata Rodrigues Teixeira de Castro et al. João Giffoni da Silveira Neto Roberta Rodrigues Teixeira de Castro

The sedentarism pandemic

The WHO recommends that adults aged 18 years and older should accumulate at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or a combination of both per week. People who do not meet these requirements are considered sedentary. The health benefits of physical exercise include lower risks of cardiovascular disease, hypertension, diabetes, obesity, dementia and breast and colon cancer.^– Despite all these benefits, sedentarism is a pandemic, affecting 27.5% of people globally.

Sedentarism increases the risk of the world´s major non-communicable diseases. I-Min Lee et al., estimated that physical inactivity is responsible for 6% of the burden of coronary artery disease, 7% of type 2 diabetes, 10% of breast cancer and colon cancers. Thus, inactivity is considered responsible for 9% of premature mortality, globally. Actually, sedentarism kills more people annually than the COVID-19 infection.

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IJCS

Editorial

Psoriatic March, Skin Inflammation and Cardiovascular Events – Two Plaques for one Syndrome

José Laerte Boechat

Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. Unfortunately, this is still the view among many doctors.

In this issue, Campos et al., published an interesting observational study on cardiovascular (CV) risk factors and risk measurement in patients with psoriatic arthritis, which allow us, in this editorial, to put the spotlight on some points of great interest in this area.

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Editorial

Heart Failure Trends in Paraíba: Earlier Diagnosis or Better Treatment? – That is One of the Questions

Ana Teresa Timóteo

Heart Failure (HF) is a clinical syndrome with high prevalence, morbidity and mortality worldwide.^– It is also one of the main causes for hospital admissions with elevated direct and indirect costs.^– The prevalence of HF is expected to increase due to the increase in cardiovascular risk factors in the general population and to the increase in life expectancy. Elderly patients are more prone to the development of HF, as well as of admissions for HF. For that reason, an increase in the economic burden of HF is expected in the next decades.^–

Previously published data showed, however, some epidemiological differences according to the world region, when comparing developing and developed countries. Recently published data from the European Society of cardiology Heart Failure Long-term Registry, a registry that included a wide spectrum of countries with very different socio-economic backgrounds, from Southern, Western, Northern and Eastern Europe, as well as Middle East and Northern Africa, showed significant between-region differences in baseline characteristics, clinical characteristics and also treatment and outcomes in patients with acute and chronic HF.

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Original Article

A 10-Year Trend Analysis of Heart Failure in the Less Developed Brazil

Amanda D. F. Fernandes et al. Gilson C. Fernandes Manuel Rivera Mazza Leonardo M. Knijnik … Gustavo Soares Fernandes Andre Telis de Vilela Amit Badiye Sandra V. Chaparro

Abstract

Background:

Data on heart failure (HF) epidemiology in less developed areas of Brazil are scarce.

Objective:

Our aim was to determine the HF morbidity and mortality in Paraiba and Brazil and its 10-year trends.

Methods:

A retrospective search was conducted from 2008 to 2017 using the DATASUS database and included patients ≥ 15 years old with a primary diagnosis of HF. Data on in-hospital and population morbidity and mortality were collected and stratified by year, gender and age. Pearson correlation and linear-by-linear association test for trends were calculated, with a level of significance of 5%.

Results:

From 2008 to 2017, HF admissions decreased 62% (p = 0.004) in Paraiba and 34% (p = 0.004) in Brazil. The in-hospital mortality rate increased in Paraiba and Brazil [65.1% (p = 0.006) and 30.1% (p = 0.003), respectively], but the absolute in-hospital mortality had a significant decrease only in Paraiba [37.5% (p = 0.013)], which was maintained after age stratification, except for groups 15-19, 60-69 and > 80 years. It was observed an increase in the hospital stay [44% (p = 0.004) in Paraiba and 12.3% (p = 0.004) in Brazil]. From 2008 to 2015, mortality rate for HF in the population decreased 10.7% (p = 0.047) in Paraiba and 7.7% (p = 0.017) in Brazil.

Conclusions:

Although HF mortality rate has been decreasing in Paraiba and Brazil, an increase in the in-hospital mortality rate and length of stay for HF has been observed. Hospital-based clinical studies should be performed to identify the causes for these trends of increase.

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