Diagnostic Imaging – ABC CARDIOL

ABC

Research Letter

Idiopathic Primary Chylopericardium

Camila Helena Ruffo et al. Alfredo Aurélio Marinho Rosa Filho Guilherme Lima Favaro Juliana Sayuri Maia Hirose … Raissa Matias Lewinter Natan Melillo Leonardo Izzo Silva Ramez Anbar Murilo Martins Coelho Giuliano Generoso

Introduction

Chylopericardium is a rare entity, defined by the accumulation of chyle in the pericardial space, characterized by a high concentration of triglycerides and lymphocyte predominance. It was first described in 1954, and since then, this condition has remained infrequent, with most evidence coming from case reports and small series, which hinders early recognition and standardization of management.

The main causes include congenital lymphangiectasia, iatrogenic injury after cardiac or thoracic surgery, neoplasms, trauma, infection, radiation, pulmonary hypertension, subclavian vein thrombosis, and primary or idiopathic causes. Primary chylopericardium has a variable incidence in the literature and is a diagnosis of exclusion.

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Editorial

The Thickness That Deceives: The Role of Imaging, Biopsy, and Genetics in the Evaluation of Ventricular Hypertrophy

Murillo de Oliveira Antunes

Increased ventricular wall thickness is a common finding in cardiovascular practice and is frequently attributed either to secondary myocardial hypertrophy or to sarcomeric hypertrophic cardiomyopathy (HCM). However, this phenotype may conceal a broad spectrum of genetic, infiltrative, and storage diseases, each associated with distinct prognostic implications and therapeutic strategies. Accurate differentiation between true myocardial hypertrophy and HCM phenocopies—or genocopies—remains a major diagnostic challenge and requires a multimodality approach integrating advanced cardiac imaging, endomyocardial biopsy (EMB), and genetic testing.^–

Cardiac imaging has evolved beyond morphological assessment. Cardiac magnetic resonance (CMR) with tissue characterization has become a cornerstone of noninvasive evaluation in patients with increased myocardial thickness. Parametric mapping techniques, including T1 and T2 mapping and extracellular volume (ECV) quantification, allow the detection of myocardial compositional changes such as edema, fibrosis, and infiltration, providing important diagnostic clues for conditions such as cardiac amyloidosis, Fabry disease, and glycogen storage cardiomyopathies (e.g., PRKAG2-related disease).^– In addition, specific late gadolinium enhancement patterns may further support the suspicion of non-sarcomeric etiologies.^,

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ABCIC

Review Article

Infective Endocarditis in Brazil: A Narrative Review and Critical Analysis of Population and Hospital Case Data

Diego Augusto Medeiros Santos et al. Flávio Tarasoutchi João Ricardo Cordeiro Fernandes Milena Ribeiro Paixão … Tânia Mara Varejão Strabelli Karen Francine Köohler Alfredo José Mansur Rinaldo Focaccia Siciliano

Abstract

Infective endocarditis remains a serious condition with high morbidity and mortality rates despite advances in diagnostic and therapy. While the Global North has seen a shift toward older patients with prosthetic valve infections, Brazil’s understanding of the disease is hindered by reliance on fragmented, hospital-based data, primarily from the Southeast region. This narrative review synthesizes recent evidence to outline the national panorama. Population studies indicate an increase in incidence and mortality, primarily affecting men and the elderly, but with marked regional heterogeneity. Analyses of hospital case series reveal an epidemiological profile characterized by patients younger than international averages, with a high prevalence of comorbidities, underlying structural heart disease, and prosthetic valves. The microbiological landscape is diverse, with no consistent predominance between staphylococci and streptococci. Nevertheless, a particularly concerning finding is the high incidence of negative blood cultures. Severe complications are frequent, and variability exists in surgical intervention rates and in-hospital mortallity across studies. In light of this scenario, the authors propose a set of strategic actions to guide future advances: the creation of a Brazilian Registry of Infective Endocarditis, the development of Contextualized National Guidelines, the strengthening of multidisciplinary teams (Endocarditis Teams), and the implementation of measures with the potential to reduce regional disparities, such as telemedicine and the regionalization of care. The consolidation of these initiatives has the potential to transform the current landscape by enhancing epidemiological knowledge, standardizing care practices, and ultimately improving clinical outcomes nationwide.

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ABCIC

Case Report

Late Discovery of Left Ventricular Pseudoaneurysm: A Rare Clinical Case

Angélica Pedreira da Silva et al. Gilson Soares Feitosa Gabriel de Castro Vaz Leal Rilson Fraga Moitinho Jorge Andion Torreão

Abstract

Left ventricular (LV) pseudoaneurysm is a rare complication of acute myocardial infarction (AMI). We report the case of a 67-year-old male patient seen in 2024. Following an AMI in 2019, the patient was diagnosed with a LV pseudoaneurysm after complaining of dyspnea and undergoing imaging tests including echocardiogram and magnetic resonance imaging. The patient underwent aneurysmectomy and revascularization surgery, progressing satisfactorily during the postoperative period.

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Editorial

A Fresh Glimpse on Chest X-Ray: Revealing Significance of Aortic Arch Calcifications for Stroke Recurrence

The global impact of cardiovascular disease continues to be significant, despite improvements in diagnosis and treatment. The epidemiological significance and associated clinical outcomes emphasize the importance of risk stratification and preventive measures.

In the realm of medical diagnostics, every subtle observation holds the potential to unlock crucial insights into the prognosis and management of various health conditions. One such observation that has garnered attention is the presence of calcification in the aortic arch as detected on chest X-ray. While traditionally viewed as a marker of cardiovascular risk, recent studies have ignited a debate on whether aortic arch calcification (AAC) could serve as an independent predictor of recurrent stroke.

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ABCIC

Case Report

Exploring Complexities in Differential Diagnosis: Torn Chord Tendinea in the Aortic Valve

Alexandre Costa et al. Endy de Santana Alves Priscila Pinheiro Leonardo Flausino … Marcus Vinicius Freire Rodrigo Vieira Morel

Introduction

The prevalence of anomalous chordae in the aortic valve is rare in clinical practice. These anomalies, although uncommon, can have significant clinical implications, including valve insufficiency, arrhythmias and/or embolic risk. Accurate diagnosis and understanding of its pathophysiology are essential for adequate patient management.

The uncommon nature of anomalous chordae in the aortic valve means that their presence can often go unnoticed or misdiagnosed. Medical literature presents few reports on these structures of probable embryonic origin, leaving gaps in clinical knowledge. Furthermore, due to its ability to influence cardiac hemodynamics and potential to complicate clinical conditions, it is essential to expand the understanding of its incidence, clinical manifestations, and best management practices.

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ABCIC

Case Report

Prosthetic Aortic Valve Endocarditis With Extensive Para-Aortic Abscess: The Relevance of Multimodal Imaging

Bernardo Boccalon et al. André Barcellos Amon Thiago Ferreira Serafini Álvaro Schmidt Albrecht … Murilo Foppa Angela Barreto Santiago Santos

Introduction

Infectious endocarditis (IE) is defined as the infection of the endocardium or prosthetic material in the heart, whose pathogenesis is bacterial adherence to the vulnerable endocardium or implanted prosthetic material during a bacteremia. Its clinical presentation is highly variable, depending on the micro-organism that causes it, underlying heart conditions and preexisting comorbidities. The annual estimated incidence of IE is up to 10/100,000 in western countries, and mortality of up to 30% in 30 days.

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ABCHF

Review Article

Diagnosis and Treatment of Hypertrophic Cardiomyopathy

Fernando Saraiva et al. Fabio Fernandes Minna Moreira Dias Romano Juliano Novaes Cardoso … Marília Taily Soliani Mariani Mendes Madisson Bernardo André Schmidt Marcus Vinicius Simões

Abstract

The concept of hypertrophic cardiomyopathy has undergone profound changes with the advent of cardiogenomics and the increase in knowledge about the sarcomeric structure and the mutations that lead to cardiomyocyte hypertrophy. In this review article, we address the state of the art in terms of diagnosis, contemplating the genetic heart diseases responsible for differential diagnoses of hypertrophic cardiomyopathy, known as phenocopies, which are a major challenge in clinical practice. We also discuss the current evidence that guides treatment.

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IJCS

Original Article

Echocardiogram in Critically ill Patients with COVID-19: ECOVID Study

Bruno Ferraz de Oliveira Gomes et al. Armando Luis Cantisano Iliana Regina Ribeiro Menezes Anny de Sousa Azevedo … Thiago Moreira Bastos da Silva Valdilene Lima Silva Giovanni Possamai Dutra Suzanna Andressa Morais de Paula Barbara Ferreira da Silva Mendes Plinio Resende do Carmo Junior Basilio de Bragança Pereira Joao Luiz Fernandes Petriz Glaucia Maria Moraes de Oliveira

Abstract

Background

Literature is scarce on echocardiographic characteristics of COVID-19 patients admitted to the intensive care unit (ICU).

Objectives

To describe echocardiographic characteristics of ICU COVID-19 patients and associate them with clinical signals/symptoms, laboratory findings and outcomes.

Methods

Patients with RT-PCR-confirmed COVID-19, admitted to the ICU, who underwent echocardiography were included. Clinical characteristics associated with an abnormal echocardiogram (systolic ventricular dysfunction of any degree — left and/or right ventricle — and/or high filling pressures and/or moderate to severe pericardial effusion) were analyzed. Groups were compared using the Student’s t-test, chi-square, and logistic regression. A p < 0.05 was considered statistically significant.

Results

A total of 140 patients met inclusion criteria, and 74 (52.9%) had an abnormal echocardiogram. A low number of left and right ventricular systolic dysfunction was observed, and 35% of the population had a normal diastolic function. In the univariate analysis, characteristics associated with abnormal echocardiogram were age, chronic kidney disease, elevated troponin, previous heart failure, and simplified acute physiology score 3 (SAPS 3). In the regression model, troponin and SAPS3 score were independent markers of abnormal echocardiogram. An abnormal echocardiogram was associated with a higher prevalence of in-hospital death (RR 2.10; 95% CI 1.04-4.24) and orotracheal intubation (RR 2.3; 95% CI 1.14-4.78).

Conclusions

COVID-19 has little effect on ventricular function, but it is common to find increased filling pressures. Elevated serum troponin level and SAPS3 score were the independent markers of an abnormal echocardiogram. In addition, the prevalence of in-hospital death and need for mechanical ventilation were higher in patients with abnormal echocardiogram.

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Tuberous Sclerosis: Unusual Findings in the Setting of a Rare Disease

Ines Oliveira et al. Rafaela Lopes Isabel Cruz Bruno Bragança … João Azevedo Aurora Andrade

Case Description

A 40-year-old woman diagnosed with tuberous sclerosis (TS) at the age of one, with cognitive impairment, epilepsy and renal angiomyolipomas, was referred to Cardiology for complaints of fatigue. She had no known family history of TS. Although her mother could not confirm if a genetic test had been performed, the patient had a definite diagnosis of TS, according to International Tuberous Sclerosis Consensus Group revised criteria, due to the presence of several major criteria, as hypomelanotic macules, facial angiofibromas, cortical dysplasia and subependymal nodules.

On cardiovascular evaluation, she had no dyspnea on exertion, chest pain, palpitations or history of syncope. On physical examination, she had multiple cutaneous angiofibromas and hypomelanotic macules, cardiac auscultation with no murmurs or signs of congestion. Electrocardiogram (ECG) showed nonspecific repolarization abnormalities ( ) and no arrhythmic events were detected by the Holter method. Transthoracic echocardiography revealed the presence of multiple intracardiac hyperechogenic lesions, with no blood flow obstruction or valvular impairment, and preserved ventricular systolic function ( ). Cardiac magnetic resonance (CMR) showed the nature of the lesions ( ) – homogeneous high signal intensity in T1 and T2-weighted images (A, B, C), with uniform suppression with the application of fat-saturation pulses, with an intensity similar to adipose tissue (D). The lesions also showed chemical shift , revealing its lipomatous nature (F). No evidence of perfusion, late gadolinium enhancement (E) or other masses. The patient remained asymptomatic after five years of follow-up, performing an annual ECG and echocardiogram, with no increase in the number or size of lipomas.

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ABCIC

Case Report

Primary Cardiac Angiosarcoma Evaluated on PET/CT

Pedro Henrique Rodrigues da Silva et al. Carlos Eduardo Lucena Montenegro Maria Eduarda Duarte de Mello Flamini Mariana Vila Nova de Oliveira Pontual Simone Cristina Soares Brandão

Introduction

Cardiac angiosarcoma is a rare malignant endothelial tumor that is aggressive and has an adverse prognosis.^, It features a high mortality rate because of the tendency for local recurrence and high incidence of systemic metastases. Therefore, its early diagnosis is very important, as is the determination of its local and distant extension, to ensure its proper therapeutic management. The objective of this case report was to show the value of positron emission tomography associated with computed tomography with 18-fluorodeoxyglucose (¹⁸F-FDG PET/CT) in the diagnosis and staging of cardiac angiosarcoma.

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ABCHF

Review Article

Obstructive Cardiac Tumors

Sanderson Antonio Cauduro et al. João Pedro Passos Dutra Fabio Fernandes Marcely Bonatto … Maria Verônica Câmara Santos Letícia dos Santos de Oliveira Rocha Talita Ribeiro Mialski Ana Paula Konig da Nobrega Simone Cristina Soares Brandão Silvio Henrique Barberato

Abstract

Cardiac tumors are considered rare clinical entities and can affect any cardiac tissue. Metastatic (secondary) cardiac tumors are more frequently diagnosed than primary tumors (malignant or benign). Both types can cause valve and/or inflow and outflow tract obstructions in any cardiac chamber, leading to symptoms of heart failure, as well as embolization and arrhythmia. Treatment of benign tumors is usually surgical, and that of metastatic and primary malignant tumors will depend on their origin and type, with poor prognosis. Recurrence of benign tumors is frequent. The aim of this article is to provide the clinician with tools to optimize diagnosis, differential diagnosis, and treatment of tumors with obstructive features causing heart failure.

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ABC

Research Letter

Mitral Valve Perforated Aneurysm: An Issue of Inflammation or Pressure Gradients?

Inês Oliveira et al. Isabel Cruz Ana Neto Bruno Bragança … Glória Abreu João Azevedo Aurora Andrade

Case Report

Mitral valve aneurysms (MVA) are uncommon and usually develop acutely in the setting of infective endocarditis (IE). MVA as a late complication of IE in a patient with obstructive hypertrophic cardiomyopathy (HCM) is rather unusual, raising considerations regarding the role of the infectious process and the hemodynamic conditions inherent to the cardiomyopathy.^, We present a case report of a patient with HCM and a ruptured aneurysm of the mitral valve (MV) leaflet, secondary to previously treated IE.

A 68-year-old male patient with type 2 diabetes mellitus and dyslipidemia was admitted to a hospital with a 3-week history of malaise, fever, and recent left-sided abdominal pain. His physical examination revealed a grade II/VI systolic heart murmur at the cardiac apex, fever, abdominal tenderness in the left upper quadrant, and purpuric lesions in the inferior limbs. Blood analyses showed neutrophilia and C-Reactive Protein of 211mg/L. Positive blood cultures indicated Staphylococcus aureus methicillin-sensitive. Abdominal Computed Tomography revealed spleen embolization, with no abscess. Transthoracic (TTE) and transesophageal echocardiography (TEE) disclosed a highly mobile polypoid mass in the atrial side of the anterior MV leaflet, suggestive of a vegetation, with mild mitral regurgitation and no evidence of abscess, aneurysm, or valve perforation; asymmetrical left ventricular (LV) hypertrophy with the presence of an increased intraventricular systolic gradient (IVSG) and systolic anterior motion (SAM) of the MV ( ). The diagnosis of IE in HCM was established and treated accordingly with flucloxacillin, presenting a favorable clinical evolution. After three months of follow-up, cardiac magnetic resonance was performed, confirming the diagnosis of HCM: an increased LV mass (96g/m ) with asymmetrical left ventricular hypertrophy (maximal thickness of 20mm in the inferoseptal wall), with no perfusion defects but with evidence of intramural late gadolinium enhancement in the inferoseptal wall,and SAM of the MV ( ). Echocardiography was repeated and, in addition to evidence of obstructive HCM with a rest IVSG of 44 mmHg, an aneurysm of the anterior leaflet of the MV was identified. Two mitral regurgitant jets were observed, one due to incomplete coaptation of the leaflets and another through the perforated aneurysm, quantifying global mitral regurgitation (MR) in a moderate (grade II/IV) ( ). The beta-blocker dose was increased, and a strategy of close follow-up was adopted. Maintenance of the characteristics of the aneurysm was verified in outpatient follow-up after 2 years.

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Original Article

Association between Atrioventricular Block and Mortality in Primary Care Patients: The CODE Study

Gabriela Miana de Mattos Paixão et al. Emilly M. Lima André B. Quadros Daniel P. R. Cabral … Renato R. Coelho Derick M. Oliveira Jamil de Souza Nascimento Paulo R. Gomes Antonio L. Ribeiro

Abstract

Background

Atrioventricular block (AVB) describes an impairment of conduction from the atria to the ventricles. Although the clinical course of AVB has been evaluated, the findings are from high-income countries and, therefore, cannot be extrapolated to the Latinx population.

Objective

Evaluate the association between AVB and mortality.

Methods

Patients from the CODE (Clinical Outcomes in Digital Electrocardiology) study, older than 16 years who underwent digital electrocardiogram (ECG) from 2010 to 2017 were included. ECGs were reported by cardiologists and by automated software. To assess the relationship between AVB and mortality, the log-normal model and the Kaplan-Meier curves were used with two-tailed p-values < 0.05 considered statistically significant.

Results

The study included 1,557,901 patients; 40.2% were men, and mean age was 51.7 (standard deviation ± 17.6) years. In a mean follow-up of 3.7 years, the mortality rate was 3.35%. The AVB prevalence was 1.38% (21,538). Patients with first-, second-, and third-degree AVB were associated with 24% (relative survival rate [RS] = 0.76; 95% confidence interval [CI]: 0.71-0.81; p < 0.001), 55% (RS = 0.45; 95% CI: 0.27-0.77; p = 0.01), and 64% (RS = 0.36; 95% CI: 0.26-0.49; p < 0.001) lower survival rate when compared to the control group, respectively. Patients with 2:1 AVB had 79% (RS = 0.21; 95% CI: 0.08-0.52; p = 0.005) lower survival rate than the control group. Only Mobitz type I was not associated with higher mortality (p = 0.27).

Conclusion

AVB was an independent risk factor for overall mortality, with the exception of Mobitz type I.

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Rare Presentation of Yolk Sac Tumor with Cardiac Involvement: Characteristics Detected by MRI

Cristhian Espinoza Romero et al. Williams Roberto Lata Guacho Kevin Rafael de Paula Robert Paladines Jimenez Eduardo Kaiser Ururahy Nunes Fonseca

Introduction

Primary cardiac tumors are extremely rare, with their incidence varying between 0.0017 and 0.28%, among which is the malignant germ cell yolk sac tumor (YST).

Although transthoracic echocardiography (TTE) is often the first line in the evaluation of cardiac tumors, currently, due to its good spatial resolution and tissue characterization, cardiac magnetic resonance (CMR) imaging is the technique of choice for the evaluation of these tumors.^, The intracardiac YST is a rare neoplasm, with few reported cases.^–

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Original Article

Assessment of the Relationship Between the Adropin Levels and the Coronary Collateral Circulation in Patients wıth Chronic Coronary Syndrome

Hasan Akkaya et al. Ertuğrul Emre Güntürk Fulya Akkaya Uğur Karabıyık … İnayet Güntürk Samet Yılmaz

Abstract

Background

Coronary collateral circulation (CCC) provides an alternative blood flow to myocardial tissue exposed to ischemia and helps to preserve myocardial functions. Endothelial-derived nitric-oxide (NO) production and vascular endothelial growth factor (VEGF) have been suggested as the most important factors in the development of CCC. Adropin is a peptide hormone responsible for energy hemostasis, and is known for its positive effects on the endothelium through NO and VEGF.

Objective

The aim of this study is to investigate the association between adropin and the presence of CCC in patients with chronic coronary syndrome (CCS).

Methods

A total of 102 patients with CCS, who had complete occlusion of at least one major epicardial coronary artery, were included in the study and were divided into two groups: the group of patients (n:50) with poor CCC (Rentrop 0-1) and the group of patients (n:52) with good CCC (Rentrop 2-3). The level of significance adopted in the statistical analysis was 5%.

Results

Mean adropine levels were found as 210.83±17.76 pg/mL and 268.25±28.94 pg/mL in the poor and good CCC groups, respectively (p<0.001). Adropin levels proved to be positively correlated with neutrophil-to-lymphocyte ratios (r:0.17, p:0.04) and the rentrop scores (r:0.76, p<0.001), and negatively correlated with age (r:-0.23, p:0.01) and Gensini scores (r:-0.19, p:0.02). Adropin level is a strong independent predictor of good CCC development (OR:1.12, 95% CI:(1.06–1.18), p<0.001).

Conclusion

This study suggests that adropin levels may be a possible factor associated with the presence of CCC in CCS patients.

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Value of18F-FDG PET/CT in the Diagnosis and Assessment of Response to Treatment of Lupus Myocarditis

Alvaro M. Perazzo et al. Larissa G. F. Andrade Leonardo G. A. Venancio Pedro Alves da Cruz Gouveia … Mariana Feitosa Ramalho Galvão Esdras M. Lins Fernando Moraes Neto Simone Cristina Soares Brandão

Systemic Lupus Erythematosus (SLE) is an autoimmune disease with a wide spectrum of clinical manifestations. The cardiovascular system has relevant clinical importance among the affected organs because it is associated with higher mortality in these patients. The heart can be affected in any structure, and lupus myocarditis is a major diagnostic challenge in clinical practice.

Non-invasive tests such as electrocardiograms and echocardiograms are not sensitive or specific enough for this diagnosis. Cardiac magnetic resonance imaging (CMR) is the preferred imaging modality for diagnosing myocarditis, but it has contraindications, such as patients with metallic implants or using gadolinium in chronic kidney disease.

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Research Letter

An Unusual Manifestation of Rejection

Carlos Xavier Correia de Resende et al. Pedro Grilo Diogo Sandra Amorim Gonçalo Pestana … José Pinheiro Torres Filipe Macedo

Introduction

Orthotopic heart transplantation is the current treatment of choice for selected patients with end-stage heart failure. With the improvement of surgical techniques and the efficiency of new immunosuppressive treatments, short-term survival has markedly improved throughout the years. However, these patients still suffer from important comorbidities caused by chronic transplant complications such as rejection, coronary allograft vasculopathy (CAV) and malignancy. Rhythm disorders are common in heart transplant patients and in some circumstances, they can be the first clinical manifestation of rejection. Coronary vasospasm has been recently associated with acute rejection and CAV, but the mechanisms underlying this phenomenon are still speculative.

We present a clinical case of acute heart transplant rejection, manifested by coronary vasospasm and advanced rhythm disorder.

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Editorial

Aortic Stiffness by Cardiac Magnetic Resonance: Prognostic tool or Bystander?

Sérgio Figueiredo Câmara et al. Henrique Barbosa Ribeiro

Arterial stiffness increases with age and may relate to higher rates of cardiovascular events, including mortality.^– This predictive capacity has been demonstrated in various longitudinal cohorts, including ‘healthy’ community population studies and those with diabetes, hypertension, chronic kidney disease, and established coronary artery disease.^, There are several ways to measure arterial stiffness, such as doppler-ultrasound, carotid-femoral tonometer, and cardiac magnetic resonance (CMR). CMR provides information regarding cardiac function, perfusion, and myocardial scarring in a single exam and may also be the preferred method for assessing arterial stiffness using aortic pulse wave velocity (PWV).^– While the association between aortic stiffness and myocardial ischemia has been demonstrated, as well as the prognostic value of aortic stiffness using CMR, there is limited data regarding the prognostic value of PWV by CMR in elderly patients in whom cardiovascular diseases (CVD) account for the vast majority of mortality causes.

In this issue of the journal, Kaolawanich and Boonyasirinant evaluated the occurrence of major adverse cardiac and cerebrovascular events (MACCE), including cardiac mortality, nonfatal myocardial infarction, hospitalization for heart failure, late revascularization (>180 days after CMR) and ischemic stroke in elderly patients (> 70 years) with suspected or confirmed CAD undergoing adenosine stress CMR including PWV. The main objective was to determine the prognostic value of aortic stiffness using CMR-based PWV in elderly patients with CAD. Two hundred sixty-three consecutive patients (55% female; 77±5 years) between 2010 and 2014 were included with a median follow-up of 59.6 months and a mean PWV of 13.98 ± 9.00 m/s. A higher PWV (>13.98 m/s) was associated with greater MACCE rates (HR 1.75; 95% CI 1.05 – 2.94; p=0.03), as compared to non-elevated PWV (<13.98 m/s). By multivariable analysis, diastolic blood pressure, left ventricular ejection fraction (LVEF), myocardial ischemia and elevated PWV were independent predictors of MACCE at long-term follow-up (p<0.05 for all). PWV had an incremental prognostic value concerning clinical history, LVEF and ischemia (increased global chi-square = 7.25; p=0.01). In this evaluation, elderly patients with elevated PWV also had a higher prevalence of hypertension, diabetes mellitus and higher systolic blood pressure than those with non-elevated PWV, consistent with prior studies in younger populations.

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Original Article

Simple Echocardiographic Parameters are Strong Predictors of the Cardiovascular Risk in Asymptomatic Individuals: Elsa-Brasil Cohort

Luciana Pereira Fernandes et al. Maria da Conceição Chagas de Almeida Sheila Alvim de Matos Ana Clara Paixão Campos … Edmundo José Nassri Câmara Murilo Foppa Antônio Luiz Pinho Ribeiro Sandhi Maria Barreto Roque Aras Júnior

Abstract

Background

Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population.

Objective

This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume.

Methods

The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI).

Results

There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63–5.15) and LVH (PR = 2.20, 95% CI 1.62–3.00).

Conclusion

Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.

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IJCS

Case Report

First-degree Atrioventricular Block as an Early Marker of Advanced Disease of the Conduction System in a Patient with Hereditary Val142Ile Cardiac Amyloidosis

Nágela S. V. Nunes et al. Evandro Tinoco Mesquita Claudio Tinoco Mesquita Paulo Roberto Benchimol-Barbosa

Introduction

Cardiac amyloidosis (CA) is a type of restrictive cardiomyopathy secondary to amyloid infiltration in the heart. The most common clinical forms are immunoglobulin light chain amyloidosis (AL) and amyloidosis resulting from amyloid deposits secondary to the destabilization of the protein tetramer transthyretin (ATTR), which is divided into two types: the hereditary form (ATTRm) and the wild type (ATTRwt).

Cardiac impulse conduction disorders and atrial arrhythmias are more frequent in ATTR than in the AL form, and this seems to reflect the longer survival of patients affected by ATTR, given that the AL form manifests with high mortality up to 6 months from diagnosis, because conduction system disease appears to be a later manifestation.

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Research Letter

Acute Myocarditis Following mRNA COVID-19 Vaccine

Daniel A. Gomes et al. Rita R. Santos Pedro Freitas Mariana S. Paiva … Jorge Ferreira Marisa Trabulo

Introduction

Vaccination is one of the most important breakthroughs of modern medicine and constitute a major advance in the prevention of infectious diseases.Overall, vaccines are effective and have an excellent general safety profile.In fact, reports of severe adverse effects following vaccination are extremely rare and idiosyncratic.

As the vaccine’s mechanism of action is based on the host immune response, a close relationship with autoimmunity cannot be disregarded.Cases of immunologic reactogenicity, such as Guillain-Barré syndrome and acute myocarditis following vaccination have been previously reported.^,

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IJCS

Case Report

Cardiac Magnetic Resonance and Positron Emission Tomography in the Diagnosis and Follow-Up of Acute Rheumatic Fever – Case Report

David Salazar et al. Cristhian Espinoza Romero Mariana Pezzute Lopes Carlos Eduardo de Barros Branco … José Soares Junior Antonio de Santis Roney Orismar Sampaio Flávio Tarasoutchi

Introduction

Rheumatic fever (RF) is a prevalent condition in developing countries, accounting for a cardiac mortality of rate 7.9% in Brazil (DATASUS). Cases of rheumatic fever are often underdiagnosed and recognized only after permanent valve damage due to previous carditis. Secondary prevention of RF aims to limit the development and/or progression of valvular lesions and their complications. However, even on therapy with benzathine penicillin every 21 days, patients may experience recurrence of acute RF, making diagnosis a greater challenge. The development of new diagnostic methods can contribute to the early detection of rheumatic carditis (RC) considering that 90% of cases are subclinical. In addition, not only the usual gallium-67 scintigraphy, but also, tests such as cardiac nuclear magnetic resonance imaging (MRI) and positron emission tomography (PET-CT) may have the potential to be diagnostic tools in acute rheumatic carditis. However, more studies are needed to validate these methods.^,

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Editorial

Interleukin 35 (IL35): A New Biomarker for Coronary Artery Disease?

Gilson Soares Feitosa

In general terms, biomarkers are biologic parameters associated with an illness’s presence and severity. Biomarkers can be detected by several means, including the physical exam and evaluation by laboratory tests or by image.

A more recent and objectively directed definition restricts its realms to a proteic substance – enzyme, hormone or without known function- that relates to health status, indicating a good status of health or disease, thus allowing for diagnosing a given disease, or its severity, or else being a therapeutic target, or serving the purpose of therapeutic guidance, that can be obtained from the blood, urine, saliva or other body fluids or tissues.

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