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Natriuretic Peptides and Heart Stress: Time to Screen the Asymptomatic High-Risk Population to Prevent Incident Heart Failure?

Humberto Villacorta et al. Davyson Gerhardt de Souza Antonio José Lagoeiro Jorge

Heart failure (HF) is the final common pathway of many cardiac disorders. It is highly prevalent, especially in the elderly, and has high morbidity and mortality if not treated properly.^– Although the treatment of HF has evolved, the number of affected individuals is still large and represents a burden on the healthcare system, globally and also in Brazil.^, The number of cases is expected to increase over the coming decades, due to the aging of the population and increased survival from cardiovascular conditions, such as acute coronary syndromes, valvular heart diseases, arrhythmias, congenital heart diseases, among others. Therefore, it is imperative to prevent HF.

Natriuretic peptides – BNP and NT-proBNP – are the gold standard biomarkers in HF.^– It was used to diagnose HF in patients with Acute Dyspnea.^– It was soon demonstrated that they were also excellent prognostic markers in patients with acute HF.^, Its use was then expanded to outpatients with HF, being recommended in the main guidelines for ruling out ambulatory HF in patients with symptoms suggestive of HF and also as a prognostic marker.^–

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Original Article

Incidence and Morphological Study of Myocardial Bridge in the State of Ceará: A Cadaveric Study

Jalles Dantas de Lucena et al. Hudson Martins de Brito João Victor Souza Sanders Jonathan Barros Cavalcante … Michelly Carneiro Collyer Cecília de Lima Leite Helson Freitas da Silveira Julio Cesar Campos Ferreira Filho

Abstract

Background

Myocardial bridges (MB) are anatomical anomalies with possible clinical repercussions; hence, their understanding deserves attention.

Objective

To determinate the prevalence and characterize MB in human hearts from the state of Ceará. Methods: Fifty hearts of adult human cadavers from the Medicine School of Federal University of Ceará, Brazil. The hearts were dissected to identify MBs that pass over part of the coronary artery. The segment of the artery (proximal, middle, and distal) with a bridge was identified. The external diameter of the artery at the proximal and distal points of the MB was measured. The length and thickness of the MB were also measured with an electronic caliper. The muscle index (MMI) of the MB was calculated as the product of length and thickness expressed in millimeters. The significance level adopted in the statistical analysis was 5%.

Results

MB was confirmed in 40% of sample. Approximately one third of the sample had only 1 MB. MB was most frequently found over the anterior interventricular branch of the left coronary artery (59.25%, p=0.02), and its prevalence in other branches was much lower (22.23%). The most affected segments of arteries were the superior (44.44%) and medium (40.74%). The mean diameter of arteries proximal to the MB was 2.38±0.97mm (range=0.78-5.15mm), and the diameter distal to the MB was 1.71±0.75mm (range=0.42-3.58mm). The length was measured as mean=8.55±5.27mm, while the mean thickness was 0.89±0.33mm.

Conclusion

A high prevalence of MB is more likely to affect the left coronary artery system with larger MMI than other affected branches.