Reproducibility of Results

IJCS

Original Article

Cardioprotective Effects of Sodium-glucose Cotransporter 2 Inhibitors Regardless of Type 2 Diabetes Mellitus: A Meta-analysis

Lucas Silva Sousa et al. Felipe de Araújo Nascimento Juliano Rocha Michelle Rocha-Parise

Abstract

Background:

Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular impairment, increasing the rates of atherosclerotic and non-atherosclerotic events. Additionally, adverse kidney events are directly linked with T2DM and cardiovascular diseases. In this context, the sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated both cardioprotective and renoprotective effects in patients with or without T2DM. Therefore, the present meta-analysis aims to evaluate cardiovascular outcomes involving SGLT2i as monotherapy or other add-on antidiabetic agents (ADA) in patients with or without T2DM.

Objetive:

The present meta-analysis aims to evaluate cardiovascular outcomes involving SGLT2i as monotherapy or add-on other ADA in patients with or without T2DM.

Methods:

The entrance criteria to SGLT2i studies were: describing any data regarding cardiovascular effects; enrolling more than 1,000 participants; being approved by either the FDA or the EU, and having available access to the supplementary data. The trial had to exhibit at least one of the following results: major adverse cardiovascular events (MACE), cardiovascular death or hospitalization for heart failure, cardiovascular death, hospitalization for heart failure, renal or cardiovascular adverse events, or non-cardiovascular death. The significance level of 0.05 was adopted in the statistical analysis.

Results:

Nine trials with a total of 76,285 participants were included in the meta-analysis. SGLT2i reduced MACE (RR 0.75, 95% CI [0.55-1.01]), cardiovascular death or hospitalization for heart failure (RR 0.72, 95% CI [0.55-0.93]), cardiovascular death (RR 0.66, 95% CI [0.48-0.91]), hospitalization for heart failure (RR 0.58, 95% CI [0.46-0.73]), renal or cardiovascular adverse events (RR 0.55, 95% CI [0.39-0.78]), and non-cardiovascular death (RR 0.88, 95% CI [0.60-1.00]).

Conclusions:

Conjunction overall data suggests that these drugs can minimize the risk of cardiovascular events, thus decreasing mortality in patients, regardless of the presence of T2DM.

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ABC

Original Article

Test-Retest Reliability of Non-Invasive Cardiac Output Measurement during Exercise in Healthy Volunteers in Daily Clinical Routine

Michael Thomas Coll Barroso et al. Matthias Wilhelm Hoppe Philip Boehme Thomas Krahn … Christian Kiefer Frank Kramer Thomas Mondritzki Phillipe Pirez Wilfried Dinh

Abstract

Background:

Thoracic bioreactance (TB), a noninvasive method for the measurement of cardiac output (CO), shows good test-retest reliability in healthy adults examined under research and resting conditions.

Objective:

In this study, we evaluate the test-retest reliability of CO and cardiac power (CPO) output assessment during exercise assessed by TB in healthy adults under routine clinical conditions.

Methods:

25 test persons performed a symptom-limited graded cycling test in an outpatient office on two different days separated by one week. Cardiorespiratory (power output, VO_2peak) and hemodynamic parameters (heart rate, stroke volume, CO, mean arterial pressure, CPO) were measured at rest and continuously under exercise using a spiroergometric system and bioreactance cardiograph (NICOM, Cheetah Medical).

Results:

After 8 participants were excluded due to measurement errors (outliers), there was no systematic bias in all parameters under all conditions (effect size: 0.2-0.6). We found that all noninvasively measured CO showed acceptable test-retest-reliability (intraclass correlation coefficient: 0.59-0.98; typical error: 0.3-1.8). Moreover, peak CPO showed better reliability (intraclass correlation coefficient: 0.80-0.85; effect size: 0.9-1.1) then the TB CO, thanks only to the superior reliability of MAP (intraclass correlation coefficient: 0.59-0.98; effect size: 0.3-1.8).

Conclusion:

Our findings preclude the clinical use of TB in healthy subject population when outliers are not identified.

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ABC

Original Article

Fractional Flow Reserve-Guided Strategy in Acute Coronary Syndrome. A Systematic Review and Meta-Analysis

José Luís Martins et al. Vera Afreixo José Santos Lino Gonçalves

Abstract

Background:

There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR).

Objectives:

To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR.

Methods:

We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR).

Results:

We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3) and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS patients.

Conclusion:

The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.

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Original Article

Reproducibility of Gadolinium Enhancement Patterns and Wall Thickness in Hypertrophic Cardiomyopathy

Gaston A. Rodriguez-Granillo et al. Alejandro Deviggiano Carlos Capunay Macarena C. De Zan Patricia Carrascosa

Abstract

Background:

Reproducibility data of the extent and patterns of late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy (HCM) is limited.

Objective:

To explore the reproducibility of regional wall thickness (WT), LGE extent, and LGE patterns in patients with HCM assessed with cardiac magnetic resonance (CMR).

Methods:

The extent of LGE was assessed by the number of segments with LGE, and by the total LV mass with LGE (% LGE); and the pattern of LGE-CMR was defined for each segment.

Results:

A total of 42 patients (672 segments) with HCM constituted the study population. The mean WT measurements showed a mean difference between observers of -0.62 ± 1.0 mm (6.1%), with limits of agreement of 1.36 mm; -2.60 mm and intraclass correlation coefficient (ICC) of 0.95 (95% CI 0.93-0.96). Maximum WT measurements showed a mean difference between observers of -0.19 ± 0.8 mm (0.9%), with limits of agreement of 1.32 mm; -1.70 mm, and an ICC of 0.95 (95% CI 0.91-0.98). The % LGE showed a mean difference between observers of -1.17 ± 1.2 % (21%), with limits of agreement of 1.16%; -3.49%, and an ICC of 0.94 (95% CI 0.88-0.97). The mean difference between observers regarding the number of segments with LGE was -0.40 ± 0.45 segments (11%), with limits of agreement of 0.50 segments; -1.31 segments, and an ICC of 0.97 (95% CI 0.94-0.99).

Conclusions:

The number of segments with LGE might be more reproducible than the percent of the LV mass with LGE.

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Artigo Original

Reproducibility of the determination of anaerobic threshold in patients with heart failure

Danielle Aparecida Gomes Pereira et al. Danielle Soares Rocha Vieira Giane Amorim Ribeiro Samora Fernanda Lima Lopes … Maria Clara Norman Alencar Susan Martins Lage Verônica Franco Parreira Marcelo Velloso Maria da Consolação Vieira Moreira Raquel Rodrigues Britto

BACKGROUND: The anaerobic threshold (AT) provides information on functional capacity in heart failure (HF). However, the visual determination of the AT by ventilatory methods is subjective, being susceptible to differences between examiners. OBJECTIVE: To evaluate the inter- and intra-examiner reproducibility in the determination of the AT in patients with mild to moderate HF, using visual-graphic and V-slope methods. To compare and correlate the results. METHODS: After performing a cardiopulmonary exercise test on a treadmill, visual-graphic and V-slope methods were used for the analysis of the AT. To assess the reproducibility, three examiners determined the AT twice by each method, on different days. For statistical analysis, we used intra-class correlation coefficient (ICC) with p <0.05. RESULTS: We evaluated a total of 16 subjects, with a mean age of 45.9 ± 9.7 years, left ventricle ejection fraction of 20.5 ± 8.1%, and peak exercise oxygen consumption of 20.6 ± 7.8 mL/kg•min-1. The intra-examiner reproducibility was high in both methods for the three examiners, with ICC values between 0.87 and 0.99. The inter-examiner reproducibility was moderate in both visual-graphic method (ICC = 0.69) and V-slope method (ICC = 0.64). When comparing methods, the ICC found was 0.91. CONCLUSION: AT determination by visual-graphic and V-slope methods showed high and moderate inter- and intra-examiner reproducibility, respectively. Moreover, both methods showed good agreement when compared with each other. These results suggest that both methods can be used in a reproducible way in AT assessment of patients with mild to moderate HF.

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Artigo Original

Assessment of a short food frequency questionnaire as predictor of hypercholesterolemia in adolescents

Márcia Henriques Teixeira et al. Gloria Valeria da Veiga Rosely Sichieri

OBJECTIVE: To evaluate a short questionnaire as predictor of serum cholesterol obtained from a probabilistic sample of adolescents. METHODS: A probabilistic sample of 5th to12th grade students from state public schools in Niteroi, state of Rio de Janeiro, Brazil was drawn based on 28 classes. Five hundred seventy-seven subjects had their blood collected, and 539 answered the simplified questionnaire (23.7% of non-respondents). The questionnaire internal consistence was evaluated through Cronbach’s alpha, and agreement between cholesterol levels and food intake was assessed through weighted Kappa (Kw). RESULTS: Weighted Kappa value was very low ( 0.66). CONCLUSION: The results show that the short questionnaire was not a predictor of cholesterol concentration.

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