Comparative Study – ABC CARDIOL

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Original Article

Comparative Study between Subcutaneous and Endovascular Defibrillator Recipients Regarding Tolerance to the Implant Procedure and Perception of Quality of Life

Pablo Esteban Auquilla-Clavijo et al. Naiara Calvo-Galiano Marina Povar-Echeverría Teresa Oloriz-Sanjuan … Francisco Diaz-Cortejana Antonio Asso-Abadia

Abstract

Background

The totally subcutaneous implantable cardioverter-defibrillator (S-ICD) is a safe alternative to the conventional transvenous ICD (TV-ICD) system to prevent sudden death.

Objective

To compare the impact of the type of ICD system and surgical technique on patients’ quality of life, as well as the severity of discomfort and pain, between S-ICD and TV-ICD recipients.

Methods

Consecutively implanted patients with an S-ICD system were matched with patients with a TV-ICD system. In addition, patients undergoing S-ICD implantation after removal of a TV-ICD due to complications were included. Quality of life (measured with the 12-item short-form health survey) and severity of pain and discomfort were evaluated. Statistical significance was defined as p < 0.05.

Results

A total of 64 patients implanted with S-ICD or TV-ICD under local anesthesia and conscious sedation were analyzed. Patients with S-ICD and TV-ICD systems did not differ significantly in quality of life scores. S-ICD patients had a higher level of perioperative pain; no differences were found regarding severity of intraoperative pain. The magnitude of aesthetic discomfort and sleep disturbances did not differ between groups. An S-ICD was implanted in 7 additional patients after removal of a TV-ICD. All but one of these patients recommended the S-ICD system.

Conclusions

The type of ICD system and the surgical technique have negligible impact on patients’ quality of life. These results suggest that conscious sedation, provided by an experienced electrophysiology team, could be considered as an alternative to general anesthesia to manage patients undergoing S-ICD implantation.

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Research Letter

Reduction in the Number of Patients with Suspected and Confirmed Acute Coronary Syndrome during the early months of the Covid-19 Pandemic: Analysis of a Brazilian Network

Pedro Gabriel Melo de Barros e Silva et al. Ana Amaral Ferreira Dutra Adriana Bertolami Manfredi Pedro Paulo Nogueres Sampaio … Celso Musa Correa Hemilo Borba Griz Daniel Setta Valter Furlan

Introduction

The first reports of infections by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in December of 2019 in Wuhan, China.^, This disease (named as coronavirus disease-2019, Covid-19) rapidly spread globally and, on March 11, 2020, the World Health Organization (WHO) declared the state of pandemic.^, Lockdown was a common recommendation for countries affected by the outbreak.

Despite all the attention put on Covid-19 by the health authorities, other diseases could also be impacted by this new circumstance. Rates of acute cardiovascular diseases changed in countries such as Italy and United States, with a reduction in hospital admissions.^– Previous national data regarding acute coronary syndrome (ACS) is already well and largely described, but these studies did not include the Covid-19 period.^, Thus, despite the fact that Brazil was the second most affected country when it comes to number of Covid-19 cases,⁹ the impact in hospital admissions due to suspected or confirmed ACS is still not well defined in both private and public Brazilian healthcare systems.

[…]

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Original Article

Disease Severity Affects Ventricular Repolarization Parameters in Patients With COVID-19

Mevlut Koc et al. Hilmi Erdem Sumbul Erdinc Gulumsek Hasan Koca … Yurdaer Bulut Emre Karakoc Tuba Turunc Edip Bayrak Huseyin Ali Ozturk Muhammed Zubeyir Aslan Abdullah Orhan Demirtas Yahya Kemal Icen

Abstract

Background:

There is no study evaluating the T_peak-T_end (Tpe) interval, Tpe/QT ratio, and Tpe/QTc ratio to assess cardiac arrhythmias in patients with COVID-19.

Objective:

We aimed to examine whether there is a change in QT, QTc, Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio in patients with COVID-19.

Methods:

The study included 90 patients with COVID-19 infection and 30 age-and-sex-matched healthy controls. QT, QTc, Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were measured. The participants included in the study were divided into the following 4 groups: healthy controls (group I), patients with COVID-19 without pneumonia (group II), patients with COVID-19 and mild pneumonia (group III), and patients with COVID-19 and severe pneumonia (group IV). Statistical significance was set at p < 0.05.

Results:

It was found that baseline heart rate, presence of hypertension and diabetes, white blood cell count, blood urea nitrogen, creatinine, potassium, aspartate aminotransferase, alanine aminotransferase, NT-proBNP, high sensitive C reactive protein, D-dimer, hs-cTnI, Tpe, Tpe/QT, and Tpe/QTc increased from group I to group IV, and they were significantly higher in all patients in group IV (p < 0.05). Systolic-diastolic blood pressure, hemoglobin, and calcium levels were found to be lowest in group IV and significantly lower than in other groups (< 0.05). QT and QTc intervals were similar between groups. It was determined that increased heart rate, calcium, D-dimer, NT-proBNP and hs-CRP levels were significantly related to Tpe, Tpe/QT, and Tpe/QTc.

Conclusions:

In patients with COVID-19 and severe pneumonia, Tpe, Tpe/QT ratio, and Tpe/QTc ratio, which are among ventricular repolarization parameters, were found to be increased, without prolonged QT and QTc intervals. In this study, we cannot definitively conclude that the ECG changes observed are directly related to COVID-19 infection or inflammation, but rather associated with severe COVID-19 scenarios, which might involve other causes of inflammation and comorbidities. (Arq Bras Cardiol. 2020; 115(5):907-913)

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Original Article

Mortality and Survival in Aortic Arch Surgeries with Preservation of Supra-aortic Vessels: Thirteen Years of Experience

Paula Ferraz de Oliveira et al. Gustavo Luiz Gouvêa de Almeida Junior Fabrício Braga da Silva Mauro Paes Leme de Sá … Valdo José Carreira Bruno Soares da Silva Rangel Sicilia Pacheco e Silva

Abstract

Background:

The aortic arch diseases exhibit high morbidity and mortality rates. Some surgical strategies recommend partial preservation of the aortic arch and the supra-aortic vessels, but the immediate and medium-term mortality rates of patients undergoing this surgical strategy is uncertain.

Objectives:

To compare overall mortality and mid- term survival curve of patients undergoing surgical strategy of partial preservation of the aortic arch and supra-aortic vessels (group A) compared to conventional strategies of the aortic arch approach (group B); to assess cardiovascular mortality over time.

Methods:

Descriptive and retrospective study of the medical records of patients undergoing aortic arch repair surgery between February 2000 and July 2013. We analyzed 111 patients, 29 in group A and 82 in group B. The overall survival and survival from cardiovascular events were assessed by Kaplan-Meier test.

Results:

In- hospital mortality from any cause was 31% in group A and 29.3% in group B. At 1 year, 2 year, and 5 year general survival was similar between the groups. In-hospital, 2 years and 5 years mortality from cardiovascular causes was 13.8%, 14.8%, e 22.7% in group A and 26.8%, 34.6% e 50.9% in group B. The difference between the groups in 5 years showed statistical significance (p = 0.0234). Survival from cardiovascular causes in 2 years and 5 years was 85.2% and 77,3% in group A and 65.4% and 49,1% in group B. Occurrence of urgent and emergency procedures were greater in group A, but without statistical significance.

Conclusions:

There was no difference in all-cause mortality over time between the groups. Group A showed lower cardiovascular mortality at 5 years than group B. (Int J Cardiovasc Sci. 2018;31(5)466-482)

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Original Article

Comparison between Radionuclide Ventriculography and Echocardiography for Quantification of Left Ventricular Systolic Function in Rats Exposed to Doxorubicin

Luciano Fonseca Lemos de Oliveira et al. João Lucas O'Connell Eduardo Elias Vieira de Carvalho Érica Carolina Campos Pulici … Minna Moreira Dias Romano Benedito Carlos Maciel Marcus Vinicius Simões

Abstract

Background:

Radionuclide ventriculography (RV) is a validated method to evaluate the left ventricular systolic function (LVSF) in small rodents. However, no prior study has compared the results of RV with those obtained by other imaging methods in this context.

Objectives:

To compare the results of LVSF obtained by RV and echocardiography (ECHO) in an experimental model of cardiotoxicity due to doxorubicin (DXR) in rats.

Methods:

Adult male Wistar rats serving as controls (n = 7) or receiving DXR (n = 22) in accumulated doses of 8, 12, and 16 mg/kg were evaluated with ECHO performed with a Sonos 5500 Philips equipment (12-MHz transducer) and RV obtained with an Orbiter-Siemens gamma camera using a pinhole collimator with a 4-mm aperture. Histopathological quantification of myocardial fibrosis was performed after euthanasia.

Results:

The control animals showed comparable results in the LVSF analysis obtained with ECHO and RV (83.5 ± 5% and 82.8 ± 2.8%, respectively, p > 0.05). The animals that received DXR presented lower LVSF values when compared with controls (p < 0.05); however, the LVSF values obtained by RV (60.6 ± 12.5%) were lower than those obtained by ECHO (71.8 ± 10.1%, p = 0.0004) in this group. An analysis of the correlation between the LVSF and myocardial fibrosis showed a moderate correlation when the LVSF was assessed by ECHO (r = -0.69, p = 0.0002) and a stronger correlation when it was assessed by RV (r = -0.79, p < 0.0001). On multiple regression analysis, only RV correlated independently with myocardial fibrosis.

Conclusion:

RV is an alternative method to assess the left ventricular function in small rodents in vivo. When compared with ECHO, RV showed a better correlation with the degree of myocardial injury in a model of DXR-induced cardiotoxicity.

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Review Article

Network Meta-analysis to Synthesize Evidence for Decision Making in Cardiovascular Research

Leonardo Roever et al. Giuseppe Biondi-Zoccai

Abstract

Clinical decision-making requires synthesis of evidence from literature reviews focused on a specific theme. Evidence synthesis is performed with qualitative assessments and systematic reviews of randomized clinical trials, typically covering statistical pooling with pairwise meta-analyses. These methods include adjusted indirect comparison meta-analysis, network meta-analysis, and mixed-treatment comparison. These tools allow synthesis of evidence and comparison of effectiveness in cardiovascular research.

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Original Article

Variations in the Prevalence of Risk Factors for Coronary Artery Disease in Rio Grande do Sul-Brazil: A Comparative Analysis between 2002 and 2014

Iseu Gus et al. Rodrigo Antonini Ribeiro Sérgio Kato Juliano Bastos … Claudio Medina Claudio Zazlavsky Vera Lucia Portal Rita Timmers Melissa Medeiros Markoski Carlos Antônio Mascia Gottschall

Abstract

Background:

Due to the importance of coronary artery disease (CAD), continuous investigation of the risk factors (RFs) is needed.

Objective:

To evaluate the prevalence of RFs for CAD in cities in Rio Grande do Sul State, and compare it with that reported in a similar study conducted in the same cities in 2002.

Methods:

Cross-sectional study on 1,056 healthy adults, investigating the prevalence and absolute and relative frequencies of the following RFs for CAD: obesity, systemic arterial hypertension (SAH), dyslipidemias, smoking, sedentary lifestyle, diabetes mellitus, and family history, as well as age and sex. Data was collected in 19 cities, host of the Offices of the Regional Coordinators of Health, as in the 2002 study.

Results:

Twenty-six percent of the sample consisted of older adults and 57% were women. The prevalence of sedentary lifestyle was 44%, history family 50%, smoking 23%, overweight/obesity 68%, dyslipidemia (high cholesterol levels) 43%, SAH 40%, and diabetes 11%. When compared to the 2002 study, the prevalence of active smoking and sedentary behavior decreased, whereas the prevalence of hypertension, dyslipidemia and obesity increased. Obesity is the most prevalent RF in women, and SAH the most prevalent in men.

Conclusions:

The prevalence of RFs for CAD in Rio Grande do Sul State remains high. Hypertension, obesity and dyslipidemia are still prevalent and require major prevention programs. Smoking and physical inactivity have decreased in the state, suggesting the efficacy of related campaigns.

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Original Article

Mortality from Cardiovascular Diseases in the Elderly: Comparative Analysis of Two Five-year Periods

Grasiela Piuvezam et al. Wilton Rodrigues Medeiros Andressa Vellasco Costa Felipe Fonseca Emerenciano … Renata Cristina Santos Danilo Silveira Seabra

Background:

Cardiovascular diseases are the leading cause of death in Brazil. The better understanding of the spatial and temporal distribution of mortality from cardiovascular diseases in the Brazilian elderly population is essential to support more appropriate health actions for each region of the country.

Objective:

To describe and to compare geospatially the rates of mortality from cardiovascular disease in elderly individuals living in Brazil by gender in two 5-year periods: 1996 to 2000 and 2006 to 2010.

Methods:

This is an ecological study, for which rates of mortality were obtained from DATASUS and the population rates from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística). An average mortality rate for cardiovascular disease in elderly by gender was calculated for each period. The spatial autocorrelation was evaluated by TerraView 4.2.0 through global Moran index and the formation of clusters by the index of local Moran-LISA.

Results:

There was an increase, in the second 5-year period, in the mortality rates in the Northeast and North regions, parallel to a decrease in the South, South-East and Midwest regions. Moreover, there was the formation of clusters with high mortality rates in the second period in Roraima among females, and in Ceará, Pernambuco and Roraima among males.

Conclusion:

The increase in mortality rates in the North and Northeast regions is probably related to the changing profile of mortality and improvement in the quality of information, a result of the increase in surveillance and health care measures in these regions.

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Original Article

Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction

Luis C. L. Correia et al. Guilherme Garcia Felipe Kalil Felipe Ferreira … Manuela Carvalhal Ruan Oliveira André Silva Isis Vasconcelos Caio Henri Márcia Noya-Rabelo

Background:

The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome.

Objective:

Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI.

Methods:

We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death.

Results:

The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) – p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately.

Conclusion:

Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

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Artigo Original

Miniaturized self-expanding drug-eluting stent in small coronary arteries: late effectiveness

Flavio Roberto Azevedo de Oliveira et al. Luiz Alberto Piva e Mattos Alexandre Abizaid Andrea S. Abizaid … J. Ribamar Costa Ricardo Costa Rodolfo Staico Roberto Botelho J. Eduardo Sousa Amanda Sousa

BACKGROUND: Small vessels represent a risk factor for restenosis in percutaneous coronary angioplasty (PCA). The Sparrow® self-expanding drug-eluting stent, which has a lower profile than the current systems, has never been tested in this scenario. OBJECTIVES: To evaluate the late effectiveness of the Sparrow® drug-eluting stent, regarding in-stent late lumen loss (LLL). METHODS: Patients with ischemia, symptomatic or documented, were submitted to PCA in vessels with reference diameter < 2.75 mm, divided into two groups regarding Sparrow® stent type: group 1: Sparrow® drug-eluting stent (DES), group 2: Sparrow® bare metal stent (BMS). Clinical follow-up duration was 12 months. Evaluation using quantitative coronary angiography (QCA) was performed immediately and at 8 months. A decrease of over 65% of in-stent LLL with DES was estimated to calculate sample size. IBM® SPSS software, release 19 (Chicago, Illinois, USA) was used for the statistical analysis. RESULTS: A total of 24 patients were randomized, 12 in each group. The DES and BMS groups were similar in age (63.25 ± 10.01 vs. 64.58 ± 11.54, p = 0.765), male gender (58.3% vs. 33.3%, p = 0.412), risk factors and all angiographs aspects. Immediate results were satisfactory in both groups. At 8 months in-stent late lumen loss was significantly lower in DES than in BMS group (DES vs. BMS 0.25 ± 0.16 0.97 ± 0.76, p = 0.008). CONCLUSION: In small-vessel PCA, the Sparrow® DES determined significant reduction in in-stent LLL, when compared to Sparrow® BMS.

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Special Article

Clinical outcomes at 30 days in the brazilian registry of acute coronary syndromes (ACCEPT)

Luiz A lberto Piva e Mattos et al. Otávio Berwanger Elizabete Silva dos Santos Helder José Lima Reis … Edson Renato Romano João Luiz Fernandes Petriz Antônio Carlos Sobral Sousa Fernando C. Neuenschwander Jorge Ilha Guimarães Jadelson Pinheiro de Andrade

BACKGROUND: There are few registries documenting clinical practice in Brazilian patients with acute coronary syndrome. OBJECTIVES: Demography description, occurrence of major clinical adverse events and comparative analysis in patients submitted or not to an invasive strategy (coronary angiography and myocardial revascularization) in a Brazilian multicenter registry of acute coronary syndrome. METHODS: The ACCEPT/SBC registry prospectively collected data on acute coronary syndrome patients from 47 Brazilian hospitals. The current analysis reports the occurrence of major clinical outcomes and according to the performance or not of a procedure for myocardial revascularization at the end of 30 day follow-up. RESULTS: Between August 2010 and December 2011, 2.485 patients were enrolled in this registry. Of these, 31.6% had unstable angina, 34.9% and 33.4% had acute coronary syndrome without and with ST-segment elevation. At 30 days, the performance of a myocardial revascularization procedure was progressively higher according to the severity of clinical presentation (38.7% vs. 53.6% vs. 77.7%, p < 0.001). Cardiac mortality among those submitted or not to myocardial revascularization procedure was 1.0% vs. 2.3% (p = 0.268), 1.9% vs. 4.2% (p = 0.070) and 2.0% vs. 8.1% (p < 0.001), in those with unstable angina, acute coronary syndrome without and with ST-segment elevation, respectively. CONCLUSIONS: The prescription of a myocardial revascularization procedure was progressively more frequent according to the severity of clinical presentation; for those treated during acute coronary syndrome without and with ST-segment elevation, there was a trend and significant decrease in mortality rate at 30 day of follow-up, respectively.

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Artigo Original

Anemia and heart failure in a community-based cohort: comparison with a specialized outpatient clinic

Eduarda Barcellos dos Santos et al. Bolívar Saenz Tello Humberto Villacorta Ana Luisa Ferreira Sales … Christiane Wiefels Pedro Soares Teixeira Luis Costa Lima Filho Evandro Tinoco Mesquita

BACKGROUND: Anemia is common in patients with heart failure (HF). Its prevalence in patients with HF from a community-based cohort is unknown in our country. OBJECTIVE: evaluate the prevalence and characteristics of patients with anemia in a non-selected population with HF from a community-based cohort, comparing it with that of a HF population treated at a specialized outpatient clinic. METHODS: This was a transversal, prospective, observational study, carried out from January 2006 to March 2007. The patients with HF met the Boston criteria, with a score > 8. Anemia was defined through the criteria of the World Health Organization as hemoglobin levels < 13 g/dL for men and <12 g/dl for women. Patients treated at a primary care program in the community were randomly selected, as well as patients treated at a Heart Failure Outpatient Clinic in a university hospital. RESULTS: A total of 206 patients were assessed, with a mean age of 61.3±13.1 years, of which 53.4% were females. The prevalence of anemia in the community-based cohort (n=114) was 21% and at the outpatient clinic (n=92), of 25% (p=0.50). The patients from the community-based cohort presented a lower rate of kidney dysfunction (GFR<60 ml/min/1,73-5), predominance of HF with normal ejection fraction and female sex. Kidney function parameters (urea or creatinine) independently correlated with anemia in both populations. CONCLUSION: The prevalence of anemia was similar in the studied populations. Kidney function was the only factor that independently correlated with anemia in both populations.

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Artigo Original

Cardiorespiratory responses during progressive maximal exercise test in healthy children

Danilo Marcelo Leite do Prado et al. Ana Maria F. Wanderley Braga Maria Urbana Pinto Rondon Luciene Ferreira Azevedo … Luciana D. N. J. Matos Carlos Eduardo Negrão Ivani Credidio Trombetta

BACKGROUND: Little is known about cardiorespiratory and metabolic response in healthy children during progressive maximal exercise test. OBJECTIVE: To test the hypothesis that children show different responses in cardiorespiratory and metabolic parameters during progressive maximal exercise test when compared with adults. METHODS: Twenty-five healthy children (gender, 15M/10F; age, 10.2 ± 0.2) and 20 healthy adults (gender, 11M/9F; age, 27.5 ± 0.4) underwent a progressive treadmill cardiopulmonary test until exhaustion to determine the maximal aerobic capacity and ventilatory anaerobic threshold (VAT). RESULTS: The peak workload (5.9±0.1 vs 5.6±0.1 mph, respectively; p>0.05), exercise time (9.8±0.4 vs 10.2±0.4 min, respectively; p>0.05), and relative aerobic fitness (VO2peak, 39.4±2.1 vs 39.1±2.0 ml.kg-1.min-1, respectively; p>0.05) were similar in children and adults. At ventilatory anaerobic threshold, the heart rate, VO2 ml.kg-1.min-1, respiratory rate (RR), functional estimate of dead space (VD/VT), ventilatory equivalent for oxygen (VE/VO2) and end-tidal pressure for oxygen (PETO2) were higher in children, while tidal volume (VT), O2 pulse and end-tidal pressure for carbon dioxide (PETCO2) were lower. At peak of exercise, children showed higher RR and VD/VT. However, O2 pulse, VT, pulmonary ventilation, PETCO2 and respiratory exchange ratio were lower in children than adults. CONCLUSION: Cardiorespiratory and metabolic responses during progressive exercise test are different in children as compared to adults. Specifically, these differences suggest that children have lower cardiovascular and ventilatory efficiency. However, children showed higher metabolic efficiency during exercise. In summary, despite the differences observed, children showed similar levels of exercising capacity when compared with adults.

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Artigo Original

Late enhancement and myocardial perfusion in hypertrophic cardiomyopathy (comparison betw een groups)

Clarissa Almeida Sarmento Barbosa et al. Cláudio Campi de Castro Luiz Francisco Rodrigues de Ávila José Rodrigues Parga Filho … Domingos Mohanad Hattem Edmundo Arteaga Fernandez

BACKGROUND: The magnetic resonance imaging (MRI) is an effective method to study hypertrophic cardiomyopathy (HCM). OBJECTIVE: To evaluate, using MRI, the parameters of systolic function, perfusion and myocardial viability in patients with HCM, comparing the groups with and without obstruction of the left ventricular outflow tract. METHODS: Twenty-one patients with a diagnosis of HCM underwent the assessment of myocardial function, viability and perfusion under stress and at rest through MRI. RESULTS: The ventricular segments most severely impaired by hypertrophy were those of the septal region. The obstructive group presented segmental myocardial thickening distribution similar to the non-obstructive group, but with higher means than the first group. The mean ejection fraction of the patients in the obstructive group was higher than in the non-obstructive group, whereas the means of the end systolic and diastolic volumes were lower in the obstructive group. There was a positive correlation between the ventricular segmental thickening and the late enhancement segmental mass. The stress induction resulted in an increase in the number of segments with perfusion alterations and this alteration was more evident in the obstructive group. CONCLUSION: The thickest ventricular segments are the septal ones. The hypertrophic regions are associated to a greater extension of late enhancement. There was a positive correlation between the areas of ventricular hypertrophy and altered myocardial perfusion and these findings were more evident in the obstructive group.

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Artigo Original

Angiotensin-converting enzyme in pericardial fluid: comparative study with serum activity

Roseli Aparecida da Silva Gomes et al. Lívia das Graças Vieito Lombardi Teodoro Isabel Cristina Rezende Lopes Patrícia Alessandra Bersanetti … Adriana Karaoglanovic Carmona Valdemar Hial

BACKGROUND: The characterization of an angiotensin-converting enzyme (ACE) in human pericardial fluid is relevant, considering its role in the angiotensin II release and thus, the role of the pericardium in cardiovascular homeostasis. OBJECTIVE: To isolate and characterize an ACE from human pericardial fluid and to compare the angiotensin I converting activities of the pericardial fluid with that of the serum in patients submitted to cardiovascular surgery. METHODS: The enzyme from human pericardial fluid was purified through chromatographic steps and characterized by polyacrylamide gel electrophoresis (SDS-PAGE), hydrolysis of angiotensin I, bradykinin, Hip-His-Leu and synthetic substrates with internal fluorescence suppression. Lisinopril was used as inhibitor. The ACE activity was measured in blood and pericardial fluid samples of 23 patients submitted to cardiovascular surgery. RESULTS: The purified ACE (MM = 140 kDa), releases angiotensin II, hydrolyses bradykinin and the Hip-His-Leu substrate. The kinetic parameters k cat,(s-1) and k cat/Km (µM-1. s-1) were, respectively: Hip-His-Leu (1.14 and 7 x 10 -4) ; Abz-YRK(Dnp)P-OH (2.60 and 0.77), Abz-LFK(Dnp)-OH (2.77 and 0.36) and Abz-SDK(Dnp)P-OH (1.92 and 0.19). The angiotensin I converting activities (mean ± SD) in the pericardial fluid and in blood, were, respectively: 3.16 ± 0.90 mU x mg -1x min-1 and 0.33 ± 0.11 mU x mg -1x min-1. The difference was significant between the two fluids. CONCLUSION: An ACE that bears great similarity with the somatic enzyme was isolated from human pericardial fluid. The angiotensin I converting activity is higher in the pericardial fluid when compared to the serum activity. These data are important evidence of the role of the pericardial fluid in the metabolism of active peptides.

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