Heart Diseases – ABC CARDIOL

ABC

Letter to the Editor

Point-of-Care Ultrasound in Cardiology: When a Positioning Statement Does Not Reflect the State of the Art

Guilherme Pinheiro Machado et al. Guilherme Heiden Telo Gustavo Neves de Araujo Fernando Luis Scolari … Anderson Donelli da Silveira Rodrigo Wainstein Marco Wainstein

Dear Editor,

We read with interest the recently published Positioning Statement on the Use of Point-of-Care Ultrasound in Cardiovascular Medicine – 2026, in Arquivos Brasileiros de Cardiologia. This is a relevant initiative that acknowledges the growing role of point-of-care ultrasound (POCUS) as a fundamental tool in contemporary cardiovascular practice. Nevertheless, despite its merits, we believe that the document presents an important limitation: the lack of discussion and incorporation of a substantial body of evidence regarding the assessment of cardiac patients across different clinical scenarios, particularly ST-segment elevation myocardial infarction (STEMI).

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Original Article

Harmful Alcohol Consumption in Patients with Heart Disease: A Risk Analysis by Lifestyle Behavior – The Brazilian PROSA Project (Projeto Saúde e Álcool)

Martino Martinelli-Filho et al. Caio Vitale Spaggiari Roberta Vanalli Baroni Cinthya Ibrahim Guirao Gomes … Thiago Ovanessian Hueb Sergio Augusto Mezzalira Martins Anísio Alexandre Andrade Pedrosa Silvana Angelina Dório Nishioka Sergio Freitas de Siqueira

Abstract

Background

Moderate alcohol intake appears to have a protective cardiovascular effect, whereas harmful alcohol consumption (HAC) is associated with a high rate of chronic diseases and mortality. The amount of alcohol intake has been associated with lifestyle behaviors; however, this relationship has not been assessed in patients with heart disease (HD).

Objective

To evaluate the association between lifestyle behavior and HAC in HD patients.

Methods

This is an observational study that included one group of patients with HD and one group of volunteers designed to assess the association of HAC with lifestyle behavior using a score of lifestyle behavior (the LBS score). We assessed alcohol consumption using the AUDIT-C test. LBS was developed by assigning 1 point to each variable – smoking; overweight or obese (body mass index ≥24.9); anxiety; depression and lack of physical activity, and classified into healthy (0/1 point), regular (2/3 points), or unhealthy (4/5 points). Statistical analysis adopted as a significance level p-value <0.05.

Results

The study included 1,999 patients with HD and 2,081 volunteers. Regression analysis controlled for age and sex, revealed that regular and unhealthy LBS are independent predictors of HAC (OR= 1.35, p=0.04 and OR= 1.76, p=0.001, respectively) in HD patients, similar as volunteers. Good discrimination capability of the regression model was reported in the temporal validation (ROC 0.80). Furthermore, LBS improvements were associated with HAC reductions (p=0.02).

Conclusions

This study showed that risk assessment for HAC using a new lifestyle score is a reliable predictor in HD patients. Also, it was observed that improving lifestyle behavior may help to reduce HAC.

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Original Article

REBECGA: Brazilian Registry of Heart Disease and Pregnancy. Multicenter Epidemiological Study of Heart Diseases in Pregnancy: Retrospective Cohort

Walkiria Samuel Avila et al. Alexandre Jorge Gomes de Lucena Claudia Maria Vilas Freire Fabio Bruno da Silva … Ivan Romero Rivera Juliana Rodrigues Soares Oliveira Maria Alayde Mendonça Rivera Regina Coeli de Carvalho Vicente Avila Neto Flávio Tarasoutchi

Abstract

Background

Heart disease, which affects approximately 4% of pregnancies, is the leading non-obstetric cause of maternal death. It is estimated that 40% of these deaths could be prevented with a better understanding of pregnancy risks.

Objectives

To develop the Brazilian Registry of Heart Diseases in Pregnancy (REBECGA) to study the prevalence, complications, and maternal mortality associated with heart diseases during pregnancy and postpartum.

Methods

A multicenter retrospective study of pregnancy and postpartum follow up until 12 months after delivery in women with heart diseases, including analysis of predictive variables for maternal outcomes. A two-tailed significance level of 5% was adopted for statistical analysis.

Results

A total of 638 pregnant women were included, with the following diagnoses: valvular disease (37.8%), congenital heart diseases (35.7%), arrhythmias without structural heart damage (14.7%), cardiomyopathies (11.3%), and other heart diseases (6.4%). The main complications were heart failure (16.7%), arrhythmia (10.7%), and syncope (8.0%), with 18 maternal deaths (2.8%), 10 of which occurred during the postpartum period. Cesarean delivery was indicated in 62.9% of cases, with 25.7% preterm births and 3.2% fetal losses. Multivariate analysis identified WHO class IV risk classification (OR 3.51; 95% CI 1.75–7.04; p < 0.001); NYHA class III/IV (OR 2.27; 95% CI 1.12–4.60; p = 0.023), and pulmonary hypertension (OR 2.45; 95% CI 1.05–5.70; p = 0.037) as predictive variables for maternal complications and deaths.

Conclusions

REBECGA highlighted the prevalence of valvular disease, heart failure as the main complication, the postpartum period as a critical time for maternal deaths, and identified predictive risk variables for adverse pregnancy outcomes in women with heart disease.

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Editorial

Importance of the Correct Definition of Severe Heart Disease in the Prognosis of Individuals Considered with Retirement Due to Disability

Maria Helena Costa de Vasconcelos et al. Andreza Araújo de Oliveira Maria Eduarda da Silva Corrêa João Marcos Bemfica Barbosa Ferreira

The manuscript “The Impact of Severe Heart Disease on Causes of Death and Survival after Disability Retirement” demonstrates higher mortality in individuals retired due to severe heart disease when compared to those retired for other causes or proportional retirement. Furthermore, it showed coinciding diagnoses between the cause of retirement and death in full retirements due to severe heart disease, demonstrating that serious heart disease plays a fundamental role in the prognosis of retired individuals.

In 2006, the Sociedade Brasileira de Cardiologia published the II Brazilian Guideline on Severe Heart Disease, which standardized the classification of heart diseases as serious or not for expert assessment. The manuscript in question, demonstrating the association of the diagnosis of severe heart disease with a worse long-term prognosis, reinforces the need to define the severity of each patient in their assessment correctly.

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Original Article

The Impact of Severe Heart Disease on Causes of Death and Survival after Disability Retirement

Cesar Romaro Pozzobon et al. Gabriel Porto Soares Ronir Raggio Luiz Gláucia Maria Moraes de Oliveira

Abstract

Background:

Noncommunicable diseases contribute to premature deaths and limitations. Disability retirement is linked to chronic conditions, particularly cardiovascular diseases. The II Brazilian Guideline for Severe Heart Disease established criteria for cardiovascular disease classification. However, there is a lack of research in this topic within federal institutions.

Objectives:

Evaluate the survival and causes of death among disabled retirees at UFRJ, focusing on the impact of severe heart disease.

Methods:

A retrospective cohort study based on retirement and death records over 15 years. Retirements were categorized into three groups: full retirement due to severe heart disease, full retirement due to other diseases and proportional. Causes of death were obtained from death certificates. Mortality rates, survival and the presence of matching diagnoses between retirement and death were evaluated. Chi-square, log-rank, Cox models, Kaplan-Meier curves were utilized. Statistical significance with a 95% confidence interval, considering p<0.05.

Results:

There were 630 retirements, 368 (51.4%) in females, with an average age of 52.9 (SD=7.8) years, and 169 (26.8%) deaths. Mortality was higher in professors (37.0%; p=0.113), in the age group between 65 and 70 years (48.4%; p=0.004), in males (34.0%; p=0.001), and in full retirements due to severe heart disease (41.5%; p<0.001). Matching diagnoses between retirement and death were more frequent in professors (74.1%; p=0.026) and in full retirements due to severe heart disease (72.7%; p<0.001).

Conclusions:

Severe heart disease diagnosis is associated with higher mortality and shorter survival in disabled retirees. Its frequent occurrence in retirement and death diagnoses underscores its significance in this context.

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Original Article

Factors Associated with Variation in Time in Therapeutic Range in Two Anticoagulation Clinics in Brazil

Josiane Moreira da Costa et al. Milena S. Marcolino Carla Jorge Machado Leandro Pinheiro Cintra … Izabella Fernanda Bastos Siqueira Daniel Dias Ribeiro Maria Auxiliadora Parreiras Martins

Abstract

Background

Time in therapeutic range (TTR) plays an important role in the effectiveness of anticoagulant therapy with vitamin K antagonists.

Objective

To identify factors associated with variation in TTR.

Methods

The study sites were anticoagulation clinics at two university hospitals in Minas Gerais, with a total of 1357 patients studied. TTR was calculated using the Rosendaal method. Binary logistic regressions were carried out with the study variables, followed by multiple regression with those that were significant for the model, adopting a significance level of 5%.

Results

The outpatient clinics presented different values in mean TTR; one corresponded to the expected percentage, while the other did not. Multiple regression identified the variable male sex as a protective factor in relation to TTR < 60% (odds ratio [OR]: 0.42; p = 0).

Conclusion

The identification of variables associated with inadequate TTR contributes to identifying weaknesses in the care process and implementing improvement actions in the hospitals studied.

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ABC

Letter to the Editor

Cardio-Obstetrics: A Critical, Growing Subspecialty

Walkiria Samuel Avila et al. Alexandre Jorge Gomes de Lucena

In the last decades, cardiovascular diseases have become the leading cause of pregnancy-related deaths. This is due to the increasing prevalence of risk factors for cardiovascular disease in young women, late pregnancy planning, and the increasing number of cases of adult congenital heart disease.^,

In Brazil, it is estimated that 4% of pregnancies occur in women with heart disease, which represents the main non-obstetric cause of maternal death. In addition, the preventable and probably preventable causes of deaths reach up to 80%, and two thirds of deaths occur within 12 months after delivery.

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Original Article

Gait Spatiotemporal Characteristics of Hospitalized Adult Patients with Chronic Heart Failure

Emmanuelle Melo Sarraf de Souza et al. Thiago José Santos Tássia Oliveira Ribeiro Matheus Sales Nildo Manoel da Silva Ribeiro

Abstract

Background:

Patients with chronic heart failure (CHF) have a decreased ability to walk, which has been related to the occurrence of hospitalizations and mortality and appears to be associated with the severity of the disease.

Objective:

To describe spatiotemporal gait characteristics of adult patients hospitalized with CHF.

Method:

Cross-sectional observational study. Participants diagnosed with CHF, between 18 and 60 years old, functional classification II and III, who were medically authorized to walk as prescribed in their medical records, were included. The walking cycle was based on a distance of 10 meters in a flat, marked corridor.

Results:

30 individuals participated in the study. The sample was mostly composed of females (n=17; 56.7%) with an average age of 44.5 years. The main etiology was valvular heart disease (n=15;50%), with an average ejection fraction of 44.6%. A strong correlation was observed between gait speed and cadence (r=0.74; p<0.01)) and a moderate correlation between gait speed and stride length (r=0.56; p<0.01). Regarding gait speed, 36.6% of those assessed had values less than or equal to 0.8 meters/second, while 16.6% obtained results above 1m/s.

Conclusion:

A strong correlation was observed between walking speed and cadence, and a moderate correlation between walking speed and stride length. The other gait parameters were not correlated with each other. According to what was observed in the literature, speed, cadence, stride length, and swing phase were reduced, while there was a slight increase in the stance phase when compared to healthy individuals.

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ABCHF

Brief Communication

Safety of COVID-19 Vaccines among Individuals with Cardiopathies

Ana Luisa Soares Chiaretti et al. Bianca de Almeida Nunes Lívia Brito Oliveira Fábio Figueiredo Costa Adriana Lopes Latado

Introduction

The first cases of COVID-19 were reported in December of 2019. The SARS-CoV-2 virus has infected over 664 million people and caused over 6,7 million deaths worldwide. Brazil was one of the most affected countries, with over 36 million confirmed cases and nearly 700 thousand reported obits.

Although most cases were characterized as oligosymptomatic and self-limited, people older than 60 years and with comorbidities were at higher risk of presenting with severe forms, including acute respiratory distress syndrome (ARDS), myocarditis, thromboembolic events, sepsis, and shock.

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IJCS

Viewpoint

Value-based Health Care Impact on Cardiovascular and Metabolic Diseases

Ana Paula Beck da Silva Etges et al. Gabriela Boff Comiran Anna Luiza Reinehr Ferreira Carisi Anne Polanczyk

Final considerations

The development of a value-based health system that is centered around individual needs and scaled to deliver the best health outcomes within a budget constraint is possible and favored by structural changes to the system, such as payment methods and a technology base that enables real-life data-driven management. PHC centralization and the interconnection with data shared between the assisted population and specialized care systems seem to be a requirement for greater capacity for tracking, diagnosing, and managing cardiometabolic diseases in the health system. For Brazil’s current scenario, the challenges start with the precarious measurement culture and remuneration strategies that are centered on payment for the service delivery rather than the impact they have on population health.

As primary steps to establish a value-based health model for cardiometabolic diseases in Brazil, seeking inspiration from existing evidence, the following are recommended: start by disseminating mobile technologies that provide education and self-care and can be easily accessed by the population; advance towards implementing a measurement culture in PHC, sharing results with specialized care institutions and funding sources; and establish a better capacity for longitudinal monitoring of individuals in the care pathways, which can be driven by a change in the specific reimbursement strategy for each of care pathways.

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ABCHF

Viewpoint

National Network of Cardiovascular Genomics: Implementing Genetic Diagnosis in Cardiology in the Brazilian Unified Health System

Tais Hanae Kasai-Brunswick et al. Dilza Balteiro Pereira de Campos Andressa Araújo Braga Raquel Tavares Boy da Silva … Eduardo Back Sternick Marisa da Silva Santos Helena Cramer Veiga Rey Adriana Bastos Carvalho

Genetic diagnosis is important

Hereditary cardiovascular diseases ( ) are the most frequent cause of sudden death in individuals under 35 years of age, and they remain an important cause of death up to 50 years of age. Although diagnosis of the proband, or index case, can be made clinically, it is only possible to screen family members who carry the gene variant that causes the disease by means of genetic diagnosis. This screening aims to institute measures that prevent sudden death and clinical surveillance in these family members, as well as reproductive counseling, when necessary. Several international guidelines recommend performing genetic diagnosis in different types of hereditary cardiovascular diseases. ^– In fact, hypertrophic cardiomyopathy guidelines consider genetic diagnosis a class I, level B-NR recommendation. Furthermore, genetic tests allow differential diagnosis with phenocopies of hypertrophic cardiomyopathy, such as Fabry disease, amyloidosis, PRKAG2 cardiomyopathy, among others. In pediatric patients, genetic testing may be even more important, as it allows the differential diagnosis with inborn errors of metabolism, for some of which there are therapeutic alternatives.

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IJCS

Original Article

Acceptance of Low-Sodium Hospital Diet by Cardiac Patients: A Randomized Controlled Crossover Trial

Bruna Fraga dos Santos et al. Bruna Eibel Ana Lúcia Grasel Antunes Cláudia Monster Martins … Renata Della Giustina Melina Borba Duarte Izabele Vian da Silveira Corrêa

Abstract

Background

Cardiovascular diseases are the major cause of hospitalization. Dietary salt restriction is indicated as part of clinical treatment, however, it is not always well accepted by the patients, resulting in low food intake and malnutrition.

Objective

To compare acceptance of a low-sodium diet cooked with salt with a standard low-sodium diet in cardiac inpatients.

Methods

A randomized controlled crossover trial in patients with low-sodium diet prescriptions (Clinical Trials NCT03481322). Patients were given a control standard low sodium diet (cooked without salt; salt [2g per meal] added by the patient at the time of consumption) on one day and on the next day patients were given the intervention diet – a low sodium diet cooked with salt (2 grams of salt, divided between preparations). Dietary acceptance was evaluated by weighing leftover food and calculating intake. A questionnaire was used to verify reasons that influenced acceptance. For data analysis, parametric data are presented as mean and standard deviation, Student’s t test was used to compare means, with significance defined as p<0.05.

Results

Sixty-four patients were evaluated, with a mean age of 66 ± 11.3 years; 64% were male. There were no differences in percentage acceptance between the standard low-sodium diet and the low-sodium diet cooked with salt at lunch (p= 0.876) or at dinner (p= 0.255). Around 80% of what was offered at each meal was consumed by the patients, with no significant difference between groups.

Conclusions

The low-sodium diet cooked with salt was well accepted, but there was no difference when compared with the standard low-sodium diet, which also had adequate acceptance.

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IJCS

Original Article

Abnormalities of Cardiac Situs and Heart Disease Diagnosed by Echocardiography in Patients with Biliary Atresia

Henrique de Assis Fonseca Tonelli et al. Zilda Maria Alves Meira Sandra Regina Tolentino Castilho Adriana Furletti Machado Guimarães … Tháis Costa Nascentes Queiroz Alexandre Rodrigues Ferreira

Abstract

Background:

Left isomerism (LI) is a common finding in patients with biliary atresia (BA), and it can be identified by echocardiography. Several comorbidities may be present in patients with LI, including heart disease.

Objective:

To investigate the prevalence of LI and heart disease in children (< 18 years of age) with BA followed-up at Hospital das Clínicas, UFMG.

Methods:

This is a cross-sectional study involving patients diagnosed with BA between February 2016 and April 2020 who underwent transthoracic echocardiography and, in case of situs abnormalities, also electrocardiography.

Results:

Our study recruited 58 patients (mean age: 3.08 years; female/male ratio: 1.5:1). The general prevalence of situs abnormalities was 8.6% (5/58) and the most common one was LI (4/5 or 80%). One patient had situs inversus. Among patients with situs abnormalities, the general prevalence of heart disease was 80% (4/5), apart from anomalies of the inferior vena cava), with pulmonary valve stenosis (PVS) as the only change seen (75% of mild forms and 25% of moderate forms). Among patients with situs abnormalities, the prevalence of rhythm changes was 80% (4/5), and low atrial rhythm was the most common finding (3/4 or 75%).

Conclusion:

The prevalence of situs abnormalities in our sample was similar to that described in the literature. We observed an exclusive prevalence of PVS and a high prevalence of rhythm changes among patients with LI. Although the diagnosis of isomerism does not initially add much cardiovascular risk to the sample, possible late deterioration should be considered.

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ABCHF

Review Article

Diuretics in Treatment of Heart Failure

Luis Fernando Bernal da Costa Seguro et al. José Leudo Xavier Júnior

Abstract

Heart failure is the leading cause of hospitalization in patients over 65 years of age, and, in most cases, patients present with signs and symptoms of congestion. Thus, diuretics play a prominent role and are among the most used drugs in heart failure. Although they have been used for decades, the lack of large controlled studies in the literature to support their use more adequately and the eventual development of resistance/tolerance are among the factors that make management of diuretics challenging.

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ABCIC

Original Article

Comparison of Block-Matching and Optical Flow in Strain Echocardiography Analysis

Renata Rejane Linhares et al. Rodrigo Bellio de Mattos Barreto Carlos Eduardo Suaide Silva David Costa de Souza Le Bihan … Luciana Braz Peixoto Andresa Paes da Cruz Luara Piovan Garcia Claudia Gianini Monaco Manuel Adán Gil

Abstract

Introduction

Different technologies have been used to evaluate left ventricular systolic function. Of particular interest is the two-dimensional strain echocardiography (2DSTE). Two different methods have been used to quantify myocardial strain by 2DSTE: block matching and optical flow. Both are present in commercially available echocardiographs. However, there is no consensus as to whether the longitudinal strain measures using these methods are overlapping.

Objective

To compare the longitudinal myocardial strain peak values obtained through 2DSTE using two different methods (block matching x optical flow).

Method

Strain measurements in 16 left ventricular myocardial segments were taken as recommended by the American Society of Echocardiography using block matching (Vivid 7, GE, Horten, Norway) and, immediately after, using optical flow (My Lab 60, Esaote, Florence, Italy) in a randomized way and their values were compared.

Results

There were 28 individuals aged 27.9 ± 7.7, of whom 50% were male and all with an ejection fraction greater than 55%. Global longitudinal strain was higher using block matching (p = 0.02). In the analysis of the 16 segments, 10 segments had different values, especially the apical segments.

Conclusion

Longitudinal myocardial strain values obtained by different methods are not overlapping and must be used with caution. Normality values also vary according to the manufacturer and the method used. (Arq Bras Cardiol: Imagem cardiovasc. 2017;30(3):87-91)

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ABCIC

Case Report

Differential Diagnosis of Biatrial Masses on Hemodialitic Patient with Secondary Hyperparathyroidism

Andréa Bezerra de Melo da Silveira Lordsleem et al. Sandro Gonçalves de Lima Eveline Barros Calado Marcelo Antônio Oliveira Santos-Veloso … Lucas Soares Bezerra Talma Tallyane Dantas Bezerra

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ABCIC

Point of view

The importance of echocardiogram for cardiologists in the clinical practice

Paulo de Lara Lavítola

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IJCS

Editorial

Exercise-based Cardiovascular Rehabilitation in Chronic Heart Failure: does Exercise Intensity Matter?

Gabriel Dias Rodrigues

It is well recognized that chronic heart failure (CHF) is a multifactorial syndrome that reduces physical exercise tolerance. Exercise-based cardiac rehabilitation program is on the frontline of non-pharmacological therapies for CHF patients, counterbalancing the disease-induced issues of physical capacity.

Since a successful exercise rehabilitation program should be efficient and safe, the search for optimal combinations of exercise volume and intensity has sparked interest in the current literature. Although studies have shown feasible combinations of low volume and high intensity, and vice versa, the optimal dose-response of exercise in cardiovascular rehabilitation remains unknown. Classically, aerobic training with moderate intensity (i.e., between 60% and 80% VO_2peak or heart rate reserve – HRreserve) is a safe approach to improve physical capacity and provide a cardioprotective effect in CHF disease. As a promising method, short bouts of high-intensity exercise, called high-intensity interval training, seems to be superior than moderate continuous training to reverse left ventricle remodeling and improve aerobic capacity, endothelial function, and quality of life in post-infarction heart failure patients.

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IJCS

Editorial

Women and Cardiac Disease: A Special Issue

Roxana Mehran et al. Birgit Vogel

Cardiovascular disease is the leading cause of death in women worldwide. Despite improvements in awareness on heart disease in women through various campaigns and initiatives, cardiovascular risk in women still tends to be underestimated by health care professionals and women themselves. With respect to the latter, a study from the United States has even shown a decline in awareness regarding the fact that heart disease is the leading cause of death among women over recent years. Especially young women are affected by low awareness about cardiovascular risk as confirmed by the data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, which also found that women are less likely than men to have a discussion about their cardiovascular risk and potential risk modification with their health care provider. Health care providers’ preparedness to assess women’s cardiovascular risk appears to be suboptimal, and according to survey data the majority of primary care physicians and cardiologists do not comprehensively implement cardiovascular disease prevention guidelines in women. Accurate and timely diagnosis of various cardiovascular diseases, especially ischemic heart disease, are less frequent in women compared with men. In addition, women with established cardiovascular disease have repeatedly been documented to be less likely to receive guideline-recommended therapies.^, Sex-related differences in disease presentation and comorbidities may contribute to these disparities, and uncertainties persist with respect to diagnosis and treatment of certain disease states that disproportionally affect women (e.g. ischemia with non-obstructive coronary arteries [INOCA], myocardial infarction in the absence of obstructive coronary artery disease [MINOCA], spontaneous coronary artery dissection [SCAD], and takotsubo syndrome).

One of the major issues is the lack of robust study data on cardiovascular disease in women. Women remain underrepresented in the majority of cardiovascular clinical trials, and sex-specific study data reporting is often absent, which results in uncertainty about the safety and efficacy of many cardiovascular therapies. In addition, it leads to knowledge gaps in the sex-specific pathophysiological mechanisms and the natural history of cardiovascular disease in women.

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IJCS

Editorial

REBECGA Registry: A Multicenter Study for the Reduction of Maternal Mortality Due to Heart Diseases Manifested During Pregnancy

Karyne Pollo de Souza et al. Christianne Brêtas Vieira Scaramello

According to the literature, although the prevalence of heart disease in pregnancy varies considerably among countries, cardiovascular disease is responsible for 1% to 4% of complicated pregnancies in industrialized countries. This pattern is related to cardiovascular risk factors, such as smoking, diabetes, obesity, and hypertension, especially in low- and middle-income countries, as well as late motherhood and the presence of congenital heart disease, mainly in high-income countries.^,

Improved diagnostic methods and therapeutic alternatives have encouraged maternity by promoting safer pregnancies. However, heart disease is still the leading non-obstetric cause of maternal mortality worldwide. Although the rate of maternal mortality has decreased in Brazil over the last three decades, it continues to be higher than estimated for this millennium.

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IJCS

Original Article

The REBECGA Brazilian Registry of Pregnancy and Heart Disease: Rationale and Design

Walkiria Samuel Avila et al. Maria Alayde Mendonça Rivera Celi Marques-Santos Ivan Romero Rivera … Maria Elizabeth Navegantes Caetano Costa Alexandre Jorge Gomes de Lucena Claudia Maria Vilas Freire Regina Coeli Marques de Carvalho Daniel Born Felipe Favorette Campanharo Fabio Bruno Silva

Abstract

Background:

Maternal mortality rates in Brazil remain above the goals established by the United Nations Sustainable Development Goals. Heart disease is estimated to affect 4% of all pregnancies and remains by itself the main indirect obstetric cause of maternal death. In the last decades, a significant improvement in the prognosis of heart diseases has made pregnancy possible in women with heart disease and provided better maternal and fetal outcomes.

Objective:

To establish a multicenter Brazilian Registry of pregnant women with heart disease; to study the causes of immediate and late maternal mortality; and to assess the prevalence of heart disease in the country’s macro-regions.

Method:

This is an observational study, with retrospective and prospective stages, of the clinical and obstetric progression of pregnant women with heart disease. These women consecutively received care during pregnancy and will be followed up for up to a year after delivery at public and private hospitals with infrastructure for the execution of this project, a principal investigator, and approval by Ethics and Research Committees.

Results:

Our results will be presented after data collection and statistical analysis, aiming to demonstrate immediate and late maternal mortality rates, as well as the prevalence of heart disease in the country and its cardiovascular and obstetric complications during pregnancy.

Conclusion:

REBECGA will be the Brazilian Registry of heart disease and pregnancy and it will contribute to planning preventive measures, raising financial resources for the improvement of high-risk prenatal care, and reducing immediate and late maternal mortality due to heart disease.

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IJCS

Original Article

Metabolic Syndrome and Risk of Cardiovascular Diseases in Female Breast Cancer Survivors

Leandro Marque da Silva et al. José Albuquerque de Figueiredo Neto

Abstract

Background

The implementation of intensive therapy protocols increases the probability of adverse events in patients with breast cancer (BC). Components of metabolic syndrome (MS) are among these events.

Objective

To verify the prevalence of MS and cardiovascular disease (CVD) risk in female BC survivors.

Materials and Methods

This is a descriptive, observational, cross-sectional study. Our sample comprised 60 women without BC (G1) and 60 women who had survived BC (G2). We collected sociodemographic, anthropometric, tumor, and clinical data. After variable analysis, the participants received positive or negative MS diagnoses and a 10-year CVD risk stratification. The significance level adopted for the analyses was 5% ( p < 0.05) and the confidence interval (CI) was 95%. For comparing categorical data, we used the chi-squared, Fisher’s exact, or G tests; for comparing continuous data, we used the parametric Student’s t-test and the non-parametric Mann-Whitney test.

Results

Both groups presented overweight and an increased waist-to-hip ratio. Weight, body mass index, abdominal circumference, hip circumference, and low-density cholesterol were variables that presented statistically significant differences between groups. MS was diagnosed in 32% of women in G1 and 45% of those in G2. Regarding the 10-year risk for CVD, most women were in the low-risk stratum: the mean total risk of CVD occurrences was 7.48% in G1 and 7.70% in G2.

Conclusion

We observed a higher prevalence of MS among women who survived BC, possibly due to overweight, as well as a low 10-year risk for CVD after cancer treatment. Although we did not observe a statistically significant difference, we suggest the adoption of a healthy lifestyle and rigorous control of cardiometabolic risk factors.

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ABCIC

Case Report

Cardiac Intimal Sarcoma: A Rare Cardiac Tumor Entity

Rhavena Brasil de Andrade et al. Carlos José Mota de Lima Ingrid Alves de Freitas Larissa Chagas Corrêa … Danielli Oliveira da Costa Lino Ana Carolina Brito de Alcantâra

Introduction

Malignant cardiac neoplasia is a rare entity with an extremely low incidence that has a nonspecific clinical presentation that may mimic other conditions. It can present arrhythmias and complications such as ischemia due to coronary flow obstruction.

More than 75% of primary cardiac tumors are benign. Of the 25% of malignant tumors, 75% are sarcomas.^– Primary cardiac tumors can have a primary or metastatic origin and are diagnosed by imaging methods. Primary tumors occur more frequently in the left chamber, especially in the atrial myxoma, while metastatic tumors originate from malignant melanomas, which occur more frequently in the right chambers.

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ABC

Editorial

Exercise and Garlic Modulate microRNAs Involved in Diabetic Cardiopathy

Aline Regina Ruiz Lima

Diabetes mellitus (DM) is a major risk factor for cardiovascular disorders and stroke development and is associated with increased morbidity and mortality. The prevalence of diabetes is increasing at an alarming rate worldwide. Indeed, according to estimates of the International Diabetes Federation, 552 million people are expected to be diabetic in 2030. Although a definitive cure is not on the horizon, with proper management, diabetic patients can attenuate the development of serious complications that reduce life quality and expectancy. Facing a considerable rate of occurrence and prognosis complications, studies focusing on high efficiency and low toxicity treatments are of great importance.

MicroRNAs are small non-coding RNAs controlling gene expression and participating in many physiopathological processes. These small molecules are getting a lot of attention nowadays since they are universally recognized as major regulators of gene expression and as key controllers of several biological and pathological processes. They are essential intracellular mediators in a variety of cellular processes, such as inflammation, mitochondrial metabolism, apoptosis, among others. Therefore, miRNAs could be potential targets to treat some chronic diseases. Besides, these molecules can also be used as early biomarkers, once they are released in urine and blood when in presence of tissue lesion. Recently, it was verified that miRNAs are also involved in cardiovascular disorders, especially those which impaired angiogenesis is observed.

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