Review – ABC CARDIOL

IJCS

Editorial

Breast Cancer, Cardiotoxicity and Cardiovascular Disease Prevention: Where Are We in this Knowledge?

Maria Alayde Mendonça Rivera et al. Ivan Romero Rivera Glaucia Maria Moraes de Oliveira

In recent decades, significant advances have been made in the early detection and treatment of different types of cancer, which have led to a significant worldwide increase in the number of survivors of this group of diseases, with estimates that two-thirds of all survivors would be 65 years old or older in 2020.

There are currently more than 32 million cancer survivors worldwide and this number is expected to continue growing, due to efficient screening for the disease and increased patient life expectancy after definitive treatment, as well as increased life expectancy of populations, which increases the incidence of numerous neoplasms and is currently around 73.4 years worldwide for both sexes (70.8 years for men and 76 years for women).

[…]

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ABCHF

Review Article

Pharmacokinetics, Mechanism of Action, and Adverse Effects of the Main Drugs Used to Treat Heart Failure: A Practical Overview for the Clinical Cardiologist

Viviane Melo e Silva de Figueiredo et al. João Vitor Soares Santos Bruna Costa de Albuquerque Bogéa Amanda Gomes de Oliveira José Albuquerque de Figueiredo Neto

Angiotensin-converting enzyme inhibitors (ACEI)

[…]

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ABCIC

Review Article

PET-CT 18F-FDG applications in cardiac tumors

Simone Cristina Soares Brandão et al. Luca Terracini Dompieri

ABSTRACT

Cardiac neoplasms are divided into primary and secondary. Secondary neoplasms are 20 to 40 times more common than the primary ones. Although rare, primary cardiac neoplasms may be benign or malignant. Benign neoplasms are responsible for 75% of the cases. The main objectives of cardiovascular imaging are to define tumor morphology and etiology, identify potential complications and assist in the establishment of treatment. For the diagnosis of cardiac neoplasms, positron emission tomography combined with computed tomography (PET-CT) with fluorodeoxyglucose-F18 (¹⁸F-FDG) is a technique that is still little used, especially in primary cardiac tumors. However, it can help differentiate between malignant and benign tumors, thus preventing cardiac biopsies and unnecessary invasive treatments. For this review, we searched the PubMed database, considering the publications on this topic in the past 10 years. PET-CT ¹⁸F-FDG is a useful test to differentiate benign from malignant heart masses according to the higher degree of glycolytic metabolism found in malignant neoplasms. Moreover, in malignant tumors, PET-CT ¹⁸F-FDG plays a central role in disease staging and may help assess treatment response.

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ABC

Original Article

Effects of Different Types of Exercise Training on Endothelial Function in Prehypertensive and Hypertensive Individuals: A Systematic Review

Gustavo Waclawovsky et al. Marinei L. Pedralli Bruna Eibel Maximiliano I. Schaun Alexandre M. Lehnen

Abstract

Background:

Sustained high blood pressure can lead to vascular remodeling and endothelial cell injury, which may explain the endothelial dysfunction found in hypertensive individuals. Exercise training can improve vascular health in individuals with cardiovascular risk, but little is known about its effects in prehypertensive and hypertensive individuals.

Objective:

To review the literature showing evidence of changes in endothelial function in response to different modalities of exercise training in prehypertensive and hypertensive individuals.

Methods:

We conducted a systematic review of studies in the MEDLINE, Cochrane, LILACS, EMBASE, and SciELO databases following both the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the PICO framework (patient/population, intervention, comparison and outcomes). Randomized clinical trials (RCTs) published up to April 2019 were selected and assessed by four independent reviewers. The methodological quality was assessed using the PEDro (Physiotherapy Evidence Database) scale.

Results:

Our search yielded 598 abstracts, and 10 studies were eligible for review. All of them had acceptable methodological quality by PEDro scale. Of the 10 studies, 7 involved aerobic training, 1 isometric resistance training, and 2 aerobic training and dynamic resistance training separately. Seven studies used flow-mediated dilation (FMD) to assess the vascular health, and three used plethysmography. Most training protocols involved hypertensive individuals and consisted of low and moderate-intensity exercise.

Conclusion:

Our systematic review showed that moderate continuous aerobic training is effective to improve vascular health in hypertensive individuals. In prehypertensive individuals, vigorous interval aerobic training seems to be an alternative to determine vascular health benefits. Resistance exercise training, either isometric or dynamic, can be used as a secondary alternative, but still requires further investigation.

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ABC

Original Article

Prognostic Value of Lung Ultrasound for Clinical Outcomes in Heart Failure Patients: A Systematic Review and Meta-Analysis

Yushu Wang et al. Di Shi Fuqiang Liu Ping Xu Min Ma

Abstract

Background

There is conflicting information about whether lung ultrasound assessed by B-lines has prognostic value in patients with heart failure (HF).

Objectives

To evaluate the prognostic value of lung ultrasound assessed by B-lines in HF patients.

Methods

Four databases (PubMed, EMBASE, Cochrane Library, and Scopus) were systematically searched to identify relevant articles. We pooled the hazard ratio (HR) and 95% confidence interval (CI) from eligible studies and carried out heterogeneity, quality assessment, and publication bias analyses. Data were pooled using a fixed-effects or random-effect model. A p value < 0.05 was considered to indicate statistical significance.

Results

Nine studies involving 1,212 participants were included in the systematic review. B-lines > 15 and > 30 at discharge were significantly associated with increased risk of combined outcomes of all-cause mortality or HF hospitalization (HR, 3.37, 95% CI, 1.52-7.47; p = 0.003; HR, 4.01, 95% CI, 2.29-7.01; p 30 cutoff at discharge was significantly associated with increased risk of HF hospitalization (HR, 9.01, 95% CI, 2.80-28.93; p 3 cutoff significantly increased the risk for combined outcomes of all-cause mortality or HF hospitalization in HF outpatients (HR, 3.21, 95% CI, 2.09-4.93; I2 = 10%; p < 0.00001).

Conclusion

B-lines could predict all-cause mortality and HF hospitalizations in patients with HF. Further large randomized controlled trials are needed to explore whether dealing with B-lines would improve the prognosis in clinical settings.

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ABC

Original Article

Acute Effect of Interval vs. Continuous Exercise on Blood Pressure: Systematic Review and Meta-Analysis

Raphael José Perrier-Melo et al. Eduardo Caldas Costa Breno Quintella Farah Manoel da Cunha Costa

Abstract

Background

Continuous aerobic exercise (CE) is one of the main non-pharmacological recommendations for hypertension prevention and treatment. CE is safe and effective to reduce blood pressure chronically, as well as in the first few hours after its performance, a phenomenon known as post-exercise hypotension (PEH). Interval exercise (IE) also results in PEH.

Objective

This systematic review and meta-analysis sought to compare the magnitude of PEH between CE and IE in adults.

Methods

A systematic review of studies published in journals indexed in the PubMed, Web of Knowledge, Scopus and CENTRAL databases was performed until March 2020, which compared the magnitude of PEH between CE and IE. PEH was defined as between 45-60 minutes post-exercise. The differences between groups on blood pressure were analyzed using the random effects model. Data were reported as weighted mean difference (WMD) and 95% confidence interval (CI). A p-value <0.05 was considered statistically significant. The TESTEX scale (0-15) was used to verify the methodological quality of the studies.

Results

The IE showed a higher magnitude of PEH on systolic blood pressure (WMD: -2.93 mmHg [95% CI: -4.96, -0.90], p = 0.005, I2 = 50%) and diastolic blood pressure (WMD: -1,73 mmHg [IC95%: 2,94, -0,51], p= 0.005, I²= 0%) when compared to CE (12 studies, 196 participants). The scores of the studies on the TEXTEX scale varied from 10 to 11 points.

Conclusions

The IE resulted in a higher magnitude of PEH when compared to CE between 45 and 60 minutes post-exercise. The absence of adverse event data during IE and CE in the studies prevents comparisons of the safety of these strategies. (Arq Bras Cardiol. 2020; 115(1):5-14)

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IJCS

Review Article

Effects of Exercise Training on Cardiovascular and Autonomic Parameters in Stroke Survivors: A Systematic Review

Bruno Bavaresco Gambassi et al. Fabiano de Jesus Furtado Almeida Ana Eugênia Araújo Furtado Almeida João Alberto Ribeiro … Tânia Maria Gaspar Novais Paulo Adriano Schwingel Ciro Oliveira Queiroz Clarcson Plácido Conceição dos Santos Bruno Rodrigues

Abstract

Negative changes in cardiovascular and autonomic variables in stroke survivors have encouraged the global scientific community to focus on investigating therapeutic strategies to mitigate stroke damage. The objective of the present study was to describe the effects of exercise training on cardiovascular and autonomic variables in stroke survivors. We used the PICO (population, intervention, control/comparison, and outcome variables) model for the search of articles in PubMed and Physiotherapy Evidence Databases from 2009 to December 2018. The following data were also recorded: type of study, author, year of publication, participants (time after stroke, sample size, and age) and benefits of exercise training. A total of 544 articles were initially selected, of which nine peer-reviewed articles met the search criteria. These nine studies enrolled 611 participants (middle-aged or elderly), and pointed to positive effects of training on maximal oxygen uptake, peak aerobic capacity, 6-minute walk test and resting heart rate. However, more well-controlled studies are needed to confirm the benefits of exercise training on cardiovascular and autonomic variables in this population.

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IJCS

Original Article

Physical Activity and Incidence of Atrial Fibrillation – Systematic Review and Meta-Analysis

Daniel Carlos Garlipp et al. Raphael Boesche Guimaraes Simone Louise Savaris Clovis Froemming Junior … Oscar Dutra Tiago Luiz Luz Leiria

Abstract

Background:

The relationship between exercise and atrial fibrillation (AF) is controversial.

Objectives:

To analyze the effects of physical activity on the incidence of atrial fibrillation using systematic review and meta-analysis.

Methods:

Systematic review and meta-analysis of studies that relate physical exercise and atrial fibrillation. The following databases were searched: PubMed, BVS Saúde and Cochrane. The following descriptors were used: “atrial fibrillation”, “exercise”, “physical activity” and “exercise therapy”. All prospective, retrospective, cross-sectional and cohort studies were investigated. All statistical analyzes were provided using Review Manager 5.3 to provide the mean difference (MD) and relative risk (RR) ratio with 95% confidence intervals (95% CI). The statistical method of heterogeneity index was used to assess heterogeneity. Level of significance was 5%.

Results:

Combined analysis of 11 studies totaling 276,323 participants aged between 12 and 90 years did not suggest a significant increase in AF in individuals submitted to physical exercise (RR = 0.914, 95% CI = 0.833-1.003, heterogeneity: p < 0.001).

Conclusions:

Physical exercise, lato sensu, without stratification by intensity, sex or age does not seem to be associated with an increase of atrial fibrillation.

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ABC

Original Article

Role of Myocardial Fibrosis in Hypertrophic Cardiomyopathy: A Systematic Review and Updated Meta-Analysis of Risk Markers for Sudden Death

Marcelo Imbroinise Bittencourt et al. Samária Ali Cader Denizar Vianna Araújo Ana Luiza Ferreira Salles … Felipe Neves de Albuquerque Pedro Pimenta de Mello Spineti Denilson Campos de Albuquerque Ricardo Mourilhe-Rocha

Abstract

Background:

Hypertrophic cardiomyopathy (HCM) is associated with sudden death (SD). Myocardial fibrosis is reportedly correlated with SD.

Objective:

We performed a systematic review with meta-analysis, updating the risk markers (RMs) in HCM emphasizing myocardial fibrosis.

Methods:

We reviewed HCM studies that addressed severe arrhythmic outcomes and the certain RMs: SD family history, severe ventricular hypertrophy, unexplained syncope, non-sustained ventricular tachycardia (NSVT) on 24-hour Holter monitoring, abnormal blood pressure response to exercise (ABPRE), myocardial fibrosis and left ventricular outflow tract obstruction (LVOTO) in the MEDLINE, LILACS, and SciELO databases. We used relative risks (RRs) as an effect measure and random models for the analysis. The level of significance was set at p < 0.05.

Results:

Twenty-one studies were selected (14,901 patients aged 45 ± 16 years; men, 62.8%). Myocardial fibrosis was the major RISK MARKER (RR, 3.43; 95% CI, 1.95-6.03). The other RMs, except for LVOTO, were also predictors: SD family history (RR, 1.75; 95% CI, 1.39-2.20), severe ventricular hypertrophy (RR, 1.86; 95% CI, 1.26-2.74), unexplained syncope (RR, 2.27; 95% CI, 1.69-3.07), NSVT (RR, 2.79; 95% CI, 2.29-3.41), and ABPRE (RR, 1.53; 95% CI, 1.12-2.08).

Conclusions:

We confirmed the association of myocardial fibrosis and other RMs with severe arrhythmic outcomes in HCM and emphasize the need for new prediction models in managing these patients.

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IJCS

Review Article

Risk Factor Differences in Acute Myocardial Infarction between Young and Older People: A Systematic Review and Meta-Analysis

Liu Lei et al. Zeng Bin

Abstract

Acute myocardial infarction (AMI) is less frequent in young individuals (≤ 45 years) than in older ones (> 45 years). Young AMI patients differ from older AMI patients in different ways. This article aims to assess the differences between young and older AMI patients. A search was made in the database of Cochrane Library, PubMed, BioMed Central and Embase, sence their establishment to December 2016, using the key words: risk factors, clinical characteristics, acute myocardial infarction and young. Meta-analysis was performed by using the Review Manager 5.3 software, pooled odds ratios and 95% confidence intervals were used to assess the strength of differences. Eight studies with fairly quality, enrolling 13,358 patients in the analysis. Compared with older AMI patients, young AMI patients had a higher rate of smoking and obesity (OR = 2.71,95%CI:1.87 to 3.92; OR = 1.76,95%CI:1.13 to 2.74), higher rate of family history of coronary artery disease and alcohol consumption (OR = 2.36,95%CI:1.22 to 4.59; OR = 1.76,95%CI:1.04 to 2.97). Moreover, Young AMI patients had a lower rate of hypertension and diabetes mellitus (OR = 0.52,95%CI:0.37 to 0.73; OR = 0.58,95%CI:0.50 to 0.67). No significant differences were observed in hyperlipidemia, a subgroup data-analysis showed a higher total cholesterol, triglyceride lipase, and low-density lipoprotein levels (p < 0.05), and lower levels of high-density lipoprotein (p < 0.01) in young AMI patients. Smoking, family history of coronary artery disease, obesity and alcohol consumption are the most main risk factors of AMI among young individuals, and young AMI patients have better prognosis than older ones.

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ABC

Original Article

Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials

Alberto Takeshi Kiyose et al. Erica Aranha Suzumura Lígia Laranjeira Anna Maria Buehler … José Amalth Espírito Santo Otavio Berwanger Antonio Carlos de Camargo Carvalho Angelo Amato de Paola Valdir Ambrósio Moises Alexandre Biasi Cavalcanti

Abstract

Background:

The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus.

Objective:

We aimed to determine the clinical outcomes of MP or BP placement in those patients.

Methods:

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant.

Results:

A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar.

Conclusions:

The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.

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ABC

Editorial

Can We Consider PR Interval to Screen Patients for Cardiac Resynchronization Therapy?

Martino Martinelli Filho

The search for response markers to Cardiac Resynchronization Therapy (CRT) remains intensive. Currently, the main criteria for CRT indication are the QRS morphology and the absence of myocardial fibrosis.

The electrocardiogram remains an important tool for selecting CRT candidates, and new parameters, such as the PR interval, are interesting to discriminate the prognosis in this population. On this issue, we have a meta-analysis study concluding that the presence of prolonged PR interval is a marker of poor prognosis at baseline.

[…]

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ABC

Original Article

Baseline Prolonged PR Interval and Outcome of Cardiac Resynchronization Therapy: A Systematic Review and Meta-analysis

Pattara Rattanawong et al. Narut Prasitlumkum Tanawan Riangwiwat Napatt Kanjanahattakij … Wasawat Vutthikraivit Pakawat Chongsathidkiet Ross J Simpson

Abstract

Background:

Recent studies suggest that baseline prolonged PR interval is associated with worse outcome in cardiac resynchronization therapy (CRT). However, a systematic review and meta-analysis of the literature have not been made.

Objective:

To assess the association between baseline prolonged PR interval and adverse outcomes of CRT by a systematic review of the literature and a meta-analysis.

Methods:

We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2017. The included studies were published prospective or retrospective cohort studies that compared all-cause mortality, HF hospitalization, and composite outcome of CRT with baseline prolonged PR (> 200 msec) versus normal PR interval. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the risk ratios and 95% confidence intervals.

Results:

Six studies from January 1991 to May 2017 were included in this meta-analysis. All-cause mortality rate is available in four studies involving 17,432 normal PR and 4,278 prolonged PR. Heart failure hospitalization is available in two studies involving 16,152 normal PR and 3,031 prolonged PR. Composite outcome is available in four studies involving 17,001 normal PR and 3,866 prolonged PR. Prolonged PR interval was associated with increased risk of all-cause mortality (pooled risk ratio = 1.34, 95 % confidence interval: 1.08-1.67, p < 0.01, I²= 57.0%), heart failure hospitalization (pooled risk ratio = 1.30, 95 % confidence interval: 1.16-1.45, p < 0.01, I²= 6.6%) and composite outcome (pooled risk ratio = 1.21, 95% confidence interval: 1.13-1.30, p < 0.01, I²= 0%).

Conclusions:

Our systematic review and meta-analysis support the hypothesis that baseline prolonged PR interval is a predictor of all-cause mortality, heart failure hospitalization, and composite outcome in CRT patients.

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IJCS

Review Article

Telerehabilitation for Cardiac Patients: Systematic Review

Danieli de Cristo et al. Natan Pinto do Nascimento Alexandre Simões Dias Amanda Sachetti

Abstract

Cardiovascular rehabilitation is one nonpharmacological intervention used to treat cardiovascular diseases. Despite the proven benefits of cardiovascular rehabilitation, the adherence of patients with heart disease is low. Thus, the alternative of telerehabilitation has gained importance, and many studies are being carried out to verify its efficacy.

To review the literature and assess the efficacy of telerehabilitation for the cardiac population.

This is a systematic review of the literature. The search was conducted in the electronic databases MEDLINE/PubMed (Medical Literature Analysis and Retrieval System Online), PubMed Central^® (PMC), Cochrane Library, and Physiotherapy Evidence Database (PEDro), using the combination of descriptors, including terms of the Medical Subject Headings (MeSH) and its entry terms. The MeSH terms used in combination were: “telerehabilitation” AND “cardiac rehabilitation” (). Then, a manual search by use of the articles selected, as well as a search in the gray literature, was conducted.

The search strategy collected 154 studies, of which 109 were excluded because of duplication in the databases and 29 for not being clinical studies. Sixteen clinical studies were included for full analysis, of which 2 were excluded for being prospective, 2 for being duplicate and 5 for not including any outcome. Thus, 7 studies were included.

Cardiac rehabilitation using telerehabilitation is a feasible and safe alternative to conventional rehabilitation, and has high adherence of patients with heart disease. It can be added to conventional cardiovascular rehabilitation programs or used in isolation.

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ABC

Review Article

Functional Capacity in Congenital Heart Disease: A Systematic Review and Meta-Analysis

Camila Wohlgemuth Schaan et al. Aline Chagastelles Pinto de Macedo Graciele Sbruzzi Daniel Umpierre … Beatriz D. Schaan Lucia Campos Pellanda

Abstract

Background:

Children and adolescents with congenital heart disease often have alterations in their exercise capacity that can be evaluated by various functional testing.

Objective:

To evaluate the functional capacity of children and adolescents with congenital heart disease (CHD) with systematic review and meta-analyses.

Methods:

The review included observational studies, data from the first evaluation of randomized clinical trials or observational follow-up periods after clinical trials which evaluated functional capacity by cardiopulmonary exercise test, stress testing, six-minute walk test or step test, in children and adolescents with CHD, aged between six and 18 years, and comparisons with healthy controls in the same age group. The quantitative assessment was performed by meta-analysis, by comparing the maximal oxygen consumption (VO₂max) of children and adolescents with CHD and respective control groups.

Results:

Twenty-five of 2.683 studies identified in the search met the inclusion criteria. The VO₂max measurement showed that patients with CHD have a decrease of 9.31 ml/Kg/min (95% CI. -12.48 to -6.13; I², 94.3%, P for heterogeneity < 0.001) compared with the control group. The meta-analysis of the data of maximum heart rate (HR) reached during cardiopulmonary test and stress testing, retrieved from 18 studies, showed a HR value of -15.14 bpm (95% CI. -20.97 to -9.31; I², 94.3%, P for heterogeneity < 0.001) compared with the control group.

Conclusion:

Children and adolescents with CHD have lower VO₂max and HR compared to controls.

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ABC

Review Article

Association between Obstructive Sleep Apnea and Myocardial Infarction: A Systematic Review

Fernanda Porto et al. Yuri Saho Sakamoto Cristina Salles

Abstract

Obstructive sleep apnea (OSA) has been associated to cardiovascular risk factors. However, the association between OSA and cardiovascular disease is still controversial. The objective of the present study was to verify the association between OSA and myocardial infarction (MI). This is a systematic review of the literature performed through electronic data sources MEDLINE/PubMed, PubMed Central, Web of Science and BVS –Biblioteca Virtual em Saúde (Virtual Health Library). The descriptors used were: ‘obstructive sleep apnea’ AND ‘polysomnography’ AND ‘myocardial infarction’ AND ‘adults NOT ‘treatment.’ The present work analysed three prospective studies, selected from 142 articles. The studies followed a total sample of 5,067 OSA patients, mostly composed by male participants. All patients underwent night polysomnography, and all studies found an association between OSA and fatal and non-fatal cardiovascular outcomes. Thus, we were able to observe that 644 (12.7%) of the 5,067 patients suffered MI or stroke, or required a revascularization procedure, and 25.6% of these cardiovascular events were fatal. MI was responsible for 29.5% of all 644 analysed outcomes. There is an association between OSA and MI, in male patients, and apnea and hypopnea index (AHI) are the most reliable markers.

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ABC

Review Article

Non-Invasive Ventilation in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Hugo Souza Bittencourt et al. Helena França Correia dos Reis Melissa Santos Lima Mansueto Gomes Neto

Abstract

Non-invasive ventilation (NIV) may perfect respiratory and cardiac performance in patients with heart failure (HF).

The objective of the study to establish, through systematic review and meta-analysis, NIV influence on functional capacity of HF patients.

A systematic review with meta-analysis of randomized studies was carried out through research of databases of Cochrane Library, SciELO, Pubmed and PEDro, using the key-words: heart failure, non-invasive ventilation, exercise tolerance; and the free terms: bi-level positive airway pressure (BIPAP), continuous positive airway pressure (CPAP), and functional capacity (terms were searched for in English and Portuguese) using the Boolean operators AND and OR. Methodological quality was ensured through PEDro scale. Weighted averages and a 95% confidence interval (CI) were calculated. The meta-analysis was done thorugh the software Review Manager, version 5.3 (Cochrane Collaboration).

Four randomized clinical trials were included. Individual studies suggest NIV improved functional capacity. NIV resulted in improvement in the distance of the six-minute walk test (6MWT) (68.7m 95%CI: 52.6 to 84.9) in comparison to the control group.

We conclude that the NIV is an intervention that promotes important effects in the improvement of functional capacity of HF patients. However, there is a gap in literature on which are the most adequate parameters for the application of this technique.

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IJCS

Review Article

Cardiotoxicity of Doxorubicin Treatment and Physical Activity: A Systematic Review

Tauan Nunes Maia et al. Gustavo Bento Ribeiro de Araujo José Antônio Caldas Teixeira Edmundo de Drummond Alves Junior Kátia Pedreira Dias

Abstract

The present study investigated whether the practice of exercise has a protective effect against cardiac toxicity induced by doxorubicin (DOX). A systematic review of randomized clinical trials evaluating the role of exercise in the control or prevention of DOX-induced cardiotoxicity was performed in MEDLINE and LILACS databases. Studies that did not address the main subject of this review, did not mention physical exercise or DOX, studies that evaluated other types of anthracycline-induced toxicities only (muscle, hepatic and renal toxicity) or other effects of exercise on DOX toxicity (fatigue) were excluded. With respect to the variables related to aerobic exercise prescription, there was no direct relationship between the frequency of exercise and the results of the studies. Also, intensity of exercise was not decisive for preservation of cardiac function, although a more intense exercise was associated with improvements in the antioxidant system, which was not observed in studies on lower intensity exercises. No significant differences in exercise effects were observed when it was performed before, during or after the treatment. Therefore, aerobic exercise may exert a protective effect of cardiac functions when performed before, during or after treatment with DOX. However, the mechanisms of this effect are still unknown.

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IJCS

Review Article

Effects of Hypoxia on Heart Rate Variability in Healthy Individuals: A Systematic Review

André Luiz Musmanno Branco Oliveira et al. Philippe de Azeredo Rohan Thiago Rodrigues Gonçalves Pedro Paulo da Silva Soares

Abstract

Background:

Hypoxia is a physiological condition that may affect the cardiac autonomic modulation, which can be assessed by spontaneous fluctuations in heart rate, know as heart rate variability (HRV). Studies have reported reductions or maintenance of HRV in hypoxic situation presenting controversial effects. There is a knowledge gap in relation to changes in HRV during hypoxia.

Objective:

The aim of this study was to systematically review the effects of hypoxia on HRV in unacclimatized healthy adults at rest.

Methods:

This systematic review was performed according to PRISMA guidelines. Search terms used in MEDLINE, SCOPUS, LILACS and EUROPE PMC database were: “heart rate variability” OR “cardiac autonomic modulation” OR “cardiac autonomic regulation” AND NOT intermittent NOT sleep (hypoxia OR altitude). Records were filtered by species, age group and language. Results: At the end of the screening and eligibility, 13 manuscripts remained for qualitative synthesis.

Discussion:

The studies used different experimental protocols involving difference in barometric pressure, oxygen level, time of exposure to hypoxia and control of respiratory rate. Possibly the influence of these factors and also the interindividual variation to hypoxia may justify different responses in HRV.

Conclusion:

Based on the investigated studies, hypoxia has been capable of generating a decrease in HRV, either by reduction or maintenance of vagal modulation, or by sympathetic predominance or even the combination of these responses in healthy adults unacclimatized to hypoxia. This effect appears to be dependent on altitude level and barometric pressure. (Int J Cardiovasc Sci. 2017;30(3):251-261)

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Review Article

Network Meta-analysis to Synthesize Evidence for Decision Making in Cardiovascular Research

Leonardo Roever et al. Giuseppe Biondi-Zoccai

Abstract

Clinical decision-making requires synthesis of evidence from literature reviews focused on a specific theme. Evidence synthesis is performed with qualitative assessments and systematic reviews of randomized clinical trials, typically covering statistical pooling with pairwise meta-analyses. These methods include adjusted indirect comparison meta-analysis, network meta-analysis, and mixed-treatment comparison. These tools allow synthesis of evidence and comparison of effectiveness in cardiovascular research.

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ABC

Review Article

A Systematic Review on Sleep Duration and Dyslipidemia in Adolescents: Understanding Inconsistencies

Gabriela de Azevedo Abreu et al. Laura Augusta Barufaldi Katia Vergetti Bloch Moyses Szklo

Introduction

Although many questions about the role of sleep remain unanswered, it is known that sleep is not only a physiological function, but also performs an important role in promoting growth, maturation and general health of children and adolescents, contributing significantly to cognitive, emotional functions and school performance. Currently, there is a tendency for the young population to have irregular sleeping hours, with differences in bed and wake-up times between weekdays and weekends, especially as they get older^–.

There is a growing interest about the impact of sleep and its disorders on regulation of inflammatory processes and morbidities, particularly in the context of metabolic and cardiovascular diseases (CVD) and their complications. In children and adolescents, cross-sectional^– and prospective^, studies have shown an association between overweight or obesity and few hours of sleep. In adults, there is evidence supporting this association, as well as correlations with insulin resistance, diabetes and cardiovascular diseases^–.

[…]

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ABC

Artigo Original

Dietary Interventions and Blood Pressure in Latin America – Systematic Review and Meta-Analysis

Caroline Cantalejo Mazzaro et al. Flávia Caroline Klostermann Bruna Olandoski Erbano Nicolle Amboni Schio … Luiz César Guarita-Souza Marcia Olandoski José Rocha Faria-Neto Cristina Pellegrino Baena

Background:

High blood pressure is the major risk factor for cardiovascular disease. Low blood pressure control rates in Latin American populations emphasize the need for gathering evidence on effective therapies.

Objective:

To evaluate the effects of dietary interventions on blood pressure in Latin American populations.

Methods:

Systematic review. Electronic databases (MEDLINE/PubMed, Embase, Cochrane Library, CINAHL, Web of Science, Scopus, SciELO, LILACS and VHL) were searched and manual search for studies published up to April 2013 was performed. Parallel studies about dietary interventions in Latin American adult populations assessing arterial blood pressure (mm Hg) before and after intervention were included.

Results:

Of the 405 studies identified, 10 randomized controlled trials were included and divided into 3 subgroups according to the proposed dietary intervention. There was a non-significant reduction in systolic blood pressure in the subgroups of mineral replacement (-4.82; 95% CI: -11.36 to 1.73) and complex pattern diets (-3.17; 95% CI: -7.62 to 1.28). Regarding diastolic blood pressure, except for the hyperproteic diet subgroup, all subgroups showed a significant reduction in blood pressure: -4.66 mmHg (95% CI: -9.21 to -0.12) and -4.55 mmHg (95% CI: -7.04 to -2.06) for mineral replacement and complex pattern diets, respectively.

Conclusion:

Available evidence on the effects of dietary changes on blood pressure in Latin American populations indicates a homogeneous effect of those interventions, although not significant for systolic blood pressure. Samples were small and the quality of the studies was generally low. Larger studies are required to build robust evidence.

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ABC

Clinical Update

Hypertension control in brazilian publications

Natália de Alencar Pinho et al. Angela Maria Geraldo Pierin

Hypertension is a major public health problem due to its high prevalence and cardiovascular complications. Its treatment is aimed at reducing cardiovascular morbidity and mortality, its goal being to maintain blood pressure levels below 140/90 mm Hg. Hypertension control in Brazil is low, and nationwide rates are unknown. The objective of this review was to provide an overview on hypertension control in Brazil from publications in a database. We identified 45 publications. In population-based studies, the highest control rate (57.6%) was reported in a multicenter study in 100 municipalities and the city of São José do Rio Preto, São Paulo state (52.4%), while the lowest rates (around 10%) were identified in microregions of the Rio Grande do Sul state and in the city of Tubarão, Santa Catarina state. In conclusion, the studies assessed showed a wide variation in hypertension control rates. It is worth noting that the comparison between studies was a major limiting factor, because of the different methods used.

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Review Article

Holiday heart syndrome revisited after 34 years

David Tonelo et al. Rui Providência Lino Gonçalves

The cardiovascular effects of alcohol are well known. However, most research has focused on the beneficial effects (the “French paradox”) of moderate consumption or the harmful consequences, such as dilated cardiomyopathy, associated with heavy consumption over an extended period. An association between the ingestion of acute alcohol and onset of cardiac arrhythmias was first reported in the early 70’s. In 1978, Philip Ettinger described “Holiday heart syndrome” (HHS) for the first time, as the occurrence, in healthy people without heart disease known to cause arrhythmia, of an acute cardiac rhythm disturbance, most frequently atrial fibrillation, after binge drinking. The name is derived from the fact that episodes were initially observed more frequently after weekends or public holidays. Since the original description of HHS, 34 years have passed and new research in this field has increased the volume of knowledge related to this syndrome. Throughout this paper the authors will comprehensively review most of the available data concerning HHS and highlight the questions that remain unresolved.

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