diagnostic – ABC CARDIOL

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Editorial

Sickle Cell Anemia as the First in the Hierarchy for Cardiac Alterations, Drives Attention to the Whole Spectrum of Hemolytic Anemias

Ana Paula Marte Chacra et al. Anita L. R. Saldanha Tania Leme da Rocha Martinez

The focus on the cardiac repercussions of Hemolytic Anemias has been greatly emphasized by publications issued by academic and official government documents that are easily accessed by all health professionals, mainly articles that aim at Sickle Cell Anemia^, and Thalassemia.^,

Sickle cell disease is the most frequent genetic hemoglobinopathy worldwide. Thanks to the improvement of the medical management of these patients, their life expectancy has improved in recent years. However, cardiopulmonary complications remain one of the main causes of death in adult patients with sickle cell disease.

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ABC

Editorial

Utility of Biomarkers in Suspected Cardiac Amyloidosis: Opportunity for More Frequent and Early Diagnosis

João Marcos Barbosa-Ferreira et al. Andreza Araújo de Oliveira

The meta-analysis entitled “Diagnostic Role of NT-proBNP in Patients with Cardiac Amyloidosis Involvement: A Meta-Analysis” brings us an important review of the usefulness of NT-proBNP measurement in patients with cardiac involvement by amyloidosis. The demonstration of good sensitivity and specificity of this biomarker reinforces its usefulness in the diagnosis of cardiac amyloidosis (CA).

Cardiac amyloidosis has been increasingly diagnosed, especially in patients with the heart failure phenotype of preserved ejection fraction. Just over half of the patients with symptoms of heart failure have preserved ejection fraction, especially elderly individuals. This finding is usually considered only as age-related diastolic dysfunction and associated comorbidities. However, this factor should be one of the warning signs for diagnosing CA, especially when associated with high levels of biomarkers. A great variability in the frequency of diagnosis of CA in the general population has been described, ranging from 5 to 74% between the various studies. This variability may be related to factors such as low clinical suspicion or difficulties accessing complementary exams necessary for diagnosing cardiac involvement in amyloidosis. The diagnostic flowchart in patients with suspected cardiac involvement by amyloidosis is mainly based on imaging tests.^– These tests can be expensive, such as myocardial scintigraphy, strain echocardiography and cardiac magnetic resonance, and, often, they are only available at cardiology referral centers, making the diagnosis of CA more difficult and delayed. In addition, it is important to note that the late diagnosis of these patients can directly influence the prognosis by delaying the start of treatment, leading to a median of 6 months of survival after the development of symptoms in the AL form of amyloidosis for example.

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IJCS

Viewpoint

Smartphone-Based Screening for Cardiovascular Diseases: A Trend?

Thiago Mazzu-Nascimento et al. Danilo Nogueira Evangelista Obeedu Abubakar Meliza Goi Roscani … Rodrigo Santos Aguilar Silvana Gama Florêncio Chachá Priscila Raupp da Rosa Diego Furtado Silva

Abstract

Cardiovascular diseases are the leading cause of death in the world. People living in vulnerable and poor places such as slums, rural areas and remote locations have difficulty in accessing medical care and diagnostic tests. In addition, given the COVID-19 pandemic, we are witnessing an increase in the use of telemedicine and non-invasive tools for monitoring vital signs. These questions motivate us to write this point of view and to describe some of the main innovations used for non-invasive screening of heart diseases. Smartphones are widely used by the population and are perfect tools for screening cardiovascular diseases. They are equipped with camera, flashlight, microphone, processor, and internet connection, which allow optical, electrical, and acoustic analysis of cardiovascular phenomena. Thus, when using signal processing and artificial intelligence approaches, smartphones may have predictive power for cardiovascular diseases. Here we present different smartphone approaches to analyze signals obtained from various methods including photoplethysmography, phonocardiograph, and electrocardiography to estimate heart rate, blood pressure, oxygen saturation (SpO₂), heart murmurs and electrical conduction. Our objective is to present innovations in non-invasive diagnostics using the smartphone and to reflect on these trending approaches. These could help to improve health access and the screening of cardiovascular diseases for millions of people, particularly those living in needy areas.

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Research Letter

Double Outlet Right Ventricle with Unrelated Ventricular Septal Defect and Pulmonary Stenosis, in Natural Evolution, in a 36-Year-Old Woman

Edmar Atik

Introduction

The congenital defect, characterized by the exit of both large arteries from the right ventricle (RV), completely or even when overlapping more than 50% of one of the arteries over the interventricular septum, presents variable relationships between these arteries and the ventricular septal defect (VSD), as well as association with other anatomical and functional variables.

In the most common associated defect, the isolated VSD, in a subaortic position or in that unrelated to the large arteries, the functional condition is expressed with a predominance of volume overload of the heart as a whole, increased by pressure overload, causing early heart failure.

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Artigo Original

Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies

Aline Fusco Fares et al. Jorge Fares Gislaine Fusco Fares José Antônio Cordeiro … Marcelo Arruda Nakazone Patrícia Maluf Cury

BACKGROUND: Discrepancies between clinical and autopsy diagnoses persists worldwide. OBJECTIVE: We evaluated autopsies in a university hospital in order to assess the accuracy of clinical cardiovascular diagnosis compared to postmortem findings. METHODS: Four hundred nine consecutive autopsies between 2003 and 2006 were analyzed in a tertiary-care hospital in São José do Rio Preto, SP, Brazil. The comparison of clinic-pathological cardiovascular findings was performed using Goldman’s discrepancies classification. RESULTS: Autopsy rate at the hospital was 8%. Cardiovascular causes of death represented 42.8% (175 out of 409 patients) of autopsy diagnoses. In 98 (56%) patients, there were major discrepancies (class I and II), representing a large proportion of misdiagnoses for mesenteric infarction (84.6%), acute myocardial infarction (64.7%), aorta dissection (64.2%), and pulmonary embolism (62.5%). Highest concordance rates were observed in congestive heart failure (59%) and acute ischemic stroke (58.8%). Age, sex, length of stay and the last admission unit at the hospital were not associated with Goldman criteria. CONCLUSION: Clinic-autopsy discrepancies concerning cardiovascular death remain high in Brazil, despite technological resources available. Moreover, our findings reinforce the importance of postmortem examination in contributing to medical care improvement.

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ABC

Letter to the Editor

Risk scores and acute coronary syndrome

Eduardo Maffini da Rosa et al. William Cenci Tormen William Schalins May

LETTER TO THE EDITOR

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Artigo Original

The importance of a normal ECG in non-ST elevation acute coronary syndromes

Rogério Teixeira et al. Carolina Lourenço Natália António Sílvia Monteiro … Rui Baptista Elisabete Jorge Maria João Ferreira Pedro Monteiro Mário Freitas Luís A Providência

BACKGROUND: Admission ECG has a major impact on the diagnosis and management of non-ST elevation acute coronary syndromes (ACS). OBJECTIVE: To assess the impact of the admission ECG on prognosis over non-ST ACS. Population: prospective, continuous, observational study of 802 non-ST ACS patients from a single center. METHODS: Patients were divided in 2 groups: A (n=538) – Abnormal ECG and B (n=264) – Normal ECG. Normal ECG was synonymous of sinus rhythm and no acute ischemic changes. A one-year clinical follow up was performed targeting all causes of mortality and the MACE rate. RESULTS: Group A patients were older (68.7±11.7 vs. 63.4±12.7Y, p<0.001), had higher Killip classes and peak myocardial necrosis biomarkers. Furthermore, they had lower left ventricular ejection fraction (LVEF) (52.01±10.55 vs. 55.34± 9.51%, p<0.001), glomerular filtration rate, initial hemoglobin, and total cholesterol levels. Group B patients were more frequently submitted to invasive strategy (63.6 vs. 46.5%, p<0.001) and treated with aspirin, clopidogrel, beta blockers and statins. They also more often presented normal coronary anatomy (26.2 vs. 18.0%, p=0.45). There was a trend to higher in-hospital mortality in group A (4.6 vs. 1.9%, p=0.054). Kaplan-Meyer analysis showed that at one month and one year (95.1 vs. 89.5%, p=0.012) survival was higher in group B and the result remained significant on a Cox regression model (normal ECG HR 0.45 (0.21 – 0.97). There were no differences regarding the MACE rate. CONCLUSION: In our non-ST elevation ACS population, a normal ECG was an early marker for good prognosis.

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Sickle Cell Anemia as the First in the Hierarchy for Cardiac Alterations, Drives Attention to the Whole Spectrum of Hemolytic Anemias

Utility of Biomarkers in Suspected Cardiac Amyloidosis: Opportunity for More Frequent and Early Diagnosis

Smartphone-Based Screening for Cardiovascular Diseases: A Trend?

Abstract

Double Outlet Right Ventricle with Unrelated Ventricular Septal Defect and Pulmonary Stenosis, in Natural Evolution, in a 36-Year-Old Woman

Introduction

Clinical and pathological discrepancies and cardiovascular findings in 409 consecutive autopsies

Risk scores and acute coronary syndrome

The importance of a normal ECG in non-ST elevation acute coronary syndromes

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