Stress – ABC CARDIOL

IJCS

Original Article

Interdisciplinary Group Intervention on Nutritional Profile, Quality of Life, and Stress During Cardiopulmonary Rehabilitation: A Randomized Clinical Trial

Giana de Freitas Rodrigues et al. Daniela da Rosa Vieira Patrícia Pereira Ruschel Cynthia Seelig … Christian Coronel Sandra Mari Barbiero

Abstract

Background:

Participating in therapeutic operative groups with nutritional and psychological interventions might influence the recovery of patients in cardiopulmonary rehabilitation programs.

Objective:

To evaluate the effectiveness of group interventions on the nutritional profile, stress, and quality of life of patients in cardiopulmonary rehabilitation.

Methods:

In this randomized clinical trial, adult patients of the Cardiopulmonary and Metabolic Rehabilitation (CPMR) unit were randomized into control group (CG), receiving standard follow-up assessment by the CPMR unit, and intervention group (IG), which additionally participated in 6 meetings of an interdisciplinary group with a nutritionist and a psychologist. Anthropometric data and results from a food frequency questionnaire (FFQ), Lipp’s Inventory of Stress Symptoms for Adults (ISSL), and the 12-Item Short Form Health Survey (SF-12) were analyzed. Student’s t-tests, Generalized Estimation Equations (GEE), Mann-Whitney tests, and Bonferroni tests were used for statistical analyses, with a significance level of 5%.

Results:

The sample consisted of 76 patients: 31 in the IG (64±9.2 years old) and 45 in the CG (61.4±11.8 years old). There was a significant reduction (p<0.001) in weight, body mass index, and waist circumference, and an increase (p=0.010) in the consumption of healthy food only in the IG. The consumption of unhealthy food was reduced in both groups (p<0.001), the physical aspect of quality of life improved (p=0.018), and women presented better physical (p=0.011) and mental results (p=0.008).

Conclusions:

This group intervention was effective regarding the nutritional status of patients in cardiopulmonary rehabilitation. The physical aspect of quality of life showed improvements in both groups.

Read Full Article

ABCIC

Editorial

My approach of Diastolic Stress Echocardiography

Fabio Villaça Guimarães Filho et al. Alexandre Rodrigues

[…]

Read Full Article

ABC

Editorial

Chronological Age or Biological Age, Mainly a Matter of Lifestyle

Paulo César B. Veiga Jardim et al. Thiago de Souza Veiga Jardim

Despite the significant global socioeconomic disparities, the world’s population has grown exponentially, and the average life continues to increase significantly.^–

If at the beginning of the 19th century, life expectancy in Europe was around 35 years, at present, only the African continent has populations with an average life expectancy of fewer than 60 years.^–

[…]

Read Full Article

ABC

Original Article

Relationship between Right Ventricular Strain Signs in Electrocardiography and Levels of Biomarkers Associated with COVID-19 Pneumonia Severity

Veli Polat et al. Evin Bozcali Kadriye Kart Yasar Hayat Kumbasar Karaosmanoglu Ibrahim Faruk Akturk

Abstract

Background

The novel coronavirus disease (COVID-19) may lead to severe disease that can cause death. COVID-19 is known to affect the cardiovascular system. Early detection of the progression to the severe disease stage that affects the cardiovascular system may play a critical role in the treatment of COVID-19.

Objectives

To explore the possible relationship between the COVID-19 pneumonia and right ventricular strain findings on electrocardiography (ECG).

Methods

We conducted a retrospective study of 141 hospitalized patients with COVID-19. Spearman’s correlation and logistic regression analyses were applied to assess relationships between ECG manifestations of right ventricular strain and levels of biomarkers and other laboratory and chest imaging findings. The significance level was considered as < 0.05.

Results

The ECG signs of right ventricular stress were significantly more frequent and the levels of fibrinogen, CRP, and ferritin were significantly higher in COVID-19 patients with elevated levels of hs-cTnI, procalcitonin and D-dimer. The univariate analysis showed there are significant relations between the presence of bilateral pneumonia, most of the ECG signs of right ventricular strain and cardiac injury and inflammatory and thrombotic biomarkers. The multivariate analysis revealed that ST-segment elevation in V₁and the S₁Q₃T₃pattern are independent predictors of cardiac damage (odds ratio=0.23; 95% CI, 0.06 to 0.90; p=0.035) and elevated procalcitonin levels (odds ratio=0.19; 95% CI, 0.06 to 0.62; p=0.006), respectively.

Conclusion

The findings of the present study suggest that right heart damage is prevalent in COVID-19. In addition, our study shows the clinical value of ECG in evaluating and monitoring the patients with COVID-19 pneumonia.

Read Full Article

ABC

Review Article

GDF-15 as a Biomarker in Cardiovascular Disease

Bruna Miers May et al. Mauricio Pimentel Leandro Ioschpe Zimerman Luis Eduardo Rohde

Abstract

In the last years, several diagnostic and prognostic biomarkers have been studied in cardiovascular disease. Growth differentiation factor-15 (GDF-15), a cytokine belonging to the transforming growth factor- (TGF-) family, is highly up-regulated in stress and inflammatory conditions and has been correlated to myocardial injury and pressure cardiac overload in animal models. This new biomarker has been positively correlated with increased risk of cardiovascular events in population studies and shown an independent predictor of mortality in patients with coronary artery disease and heart failure. This review aimed to summarize the current evidence on the diagnostic and prognostic value of GDF-15 in different settings in cardiology.

Read Full Article

IJCS

Editorial

Association between the Average Ratio of Platelet Volume and the Presence of Mural Thrombus in Post-Myocardial Infarction

Fernando Augusto Alves da Costa

Cardiovascular disease is a serious public health problem, responsible for 31% of all deaths worldwide. Population growth, urbanization and the lack of proper policies to control modifiable risk factors lead to an increased number in cases. Associated with this, we have new factors such as stress, pollution, income, unemployment, among others, which, associated with classical factors, increase the speed of atherosclerosis development. Acute ischemic syndromes are some of the worst consequences of the evolution of atherosclerosis, with mortality rates varying according to the type of infarction, place of care and the healthcare resources available.

Among the types of infarction, those with ST segment elevation (STEMI), particularly in the anterior wall, present peculiarities in their natural history, and may lead to complications, such as sudden death, heart failure and embolic events, usually due to the formation of apical thrombus (AT) in the left ventricle.

[…]

Read Full Article

ABC

Artigo Original

Stress Alone or associated with Ethanol Induces Prostanoid Release in Rat Aorta via α2-Adrenoceptor

Rafaela de Fátima Ferreira Baptista et al. Elane de Fátima Taipeiro Regina Helena Costa Queiroz Agnaldo Bruno Chies Sandra Cordellini

Background:

Stress and ethanol are both, independently, important cardiovascular risk factors.

Objective:

To evaluate the cardiovascular risk of ethanol consumption and stress exposure, isolated and in association, in male adult rats.

Methods:

Rats were separated into 4 groups: Control, ethanol (20% in drinking water for 6 weeks), stress (immobilization 1h day/5 days a week for 6 weeks) and stress/ethanol. Concentration-responses curves to noradrenaline – in the absence and presence of yohimbine, L-NAME or indomethacin – or to phenylephrine were determined in thoracic aortas with and without endothelium. EC50 and maximum response (n=8-12) were compared using two-way ANOVA/Bonferroni method.

Results:

Either stress or stress in association with ethanol consumption increased the noradrenaline maximum responses in intact aortas. This hyper-reactivity was eliminated by endothelium removal or by the presence of either indomethacin or yohimbine, but was not altered by the presence of L-NAME. Meanwhile, ethanol consumption did not alter the reactivity to noradrenaline. The phenylephrine responses in aortas both with and without endothelium also remained unaffected regardless of protocol.

Conclusion:

Chronic stress increased rat aortic responses to noradrenaline. This effect is dependent upon the vascular endothelium and involves the release of vasoconstrictor prostanoids via stimulation of endothelial alpha-2 adrenoceptors. Moreover, chronic ethanol consumption appeared to neither influence noradrenaline responses in rat thoracic aorta, nor did it modify the increase of such responses observed as a consequence of stress exposure.

Read Full Article

ABC

Artigo Original

Stress echocardiography and major cardiac events in patients with normal exercise test

Flávia Ricci Calasans et al. Bruno Fernandes de Oliveira Santos Débora Consuelo Rocha Silveira Ana Carla Pereira de Araújo … Luiza Dantas Melo José Augusto Barreto-Filho Antônio Carlos Sobral Sousa Joselina Luzia Menezes Oliveira

BACKGROUND: Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events. OBJECTIVE: To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET. METHODS: 397 patients with intermediate CAD pretest probability , estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI). RESULTS: G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23). CONCLUSION: Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET.

Read Full Article

ABC

Artigo Original

Prognostic value of exercise stress echocardiography in patients with left bundle branch block

Francis de Lima Vasconcelos et al. Bruno Fernandes de Oliveira Santos Nathalie de Oliveira Santana Gustavo Baptista de Almeida Faro … Romerito de Oliveira Rocha Vinício Vieira Leal José Augusto Barreto-Filho Antônio Carlos Sobral Sousa Joselina Luzia Menezes Oliveira

BACKGROUND: The literature lacks studies about the prognostic value of exercise stress echocardiography (ESE) in patients with complete left bundle branch block (LBBB) of the bundle of His. OBJECTIVE: To assess the prognostic value of ESE in patients with LBBB. METHODS: This is a retrospective cohort that evaluated 135 patients with LBBB, from January 2001 to October 2009, of which 37.8% were men, mean age 63.6 ± 11.5 years submitted to ESE according to Bruce protocol on a treadmill. Cox regression was used, considering these outcomes: death from all causes and from cardiac events, defined as acute myocardial infarction (AMI), percutaneous angioplasty (PA), coronary artery bypass grafting (CABG) and death from cardiac causes. RESULTS: Positive ESE was observed in 42 patients (31%). The mean follow-up was 45.8 ± 4.7 months. During this period, there were 9 deaths from all causes and 9 cardiac events (3 deaths from cardiac causes, 3 myocardial infarctions, 2 PA and one CABG). The mortality rate from all causes during five years was 16.1% in the group with positive ESE and 2.5% in the group with negative test (p = 0.171), whereas the rate of cardiac events in the same period was 15.1% for the positive ESE and 1.6% in the group with negative test (p = 0.009). CONCLUSION: ESE showed to be a predictor of cardiac events in patients with LBBB.

Read Full Article

ABC

Artigo Original

Different levels of Hsp72 in female rat myocardium in response to voluntary exercise and forced exercise

Stéphano Freitas Soares Melo et al. Wellington Lunz Elizabeth Pacheco Batista Fontes Cristina Maria Ganns Chaves Dias … Miguel Araujo Carneiro Júnior Anselmo Gomes de Moura Ricardo Junqueira Del Carlo Antonio Jose Natali

BACKGROUND: Physical exercise induces hemodynamic stress. OBJECTIVE: To evaluate if voluntary running and forced running induced different levels of stress protein (Hsp72) in the myocardium of female Wistar rats. METHODS: Female rats were randomly assigned to the following groups: forced treadmill running group (FR; n= 6), voluntary running group (VR; n=6) and control group (C; n=6). VR group animals had free access to running wheels, and those from FR group underwent a running program on a treadmill (18 m/min, 60 min/day, 5 days/wk) for 8 weeks. Left ventricle (LV) and right ventricle (RV) fragments were collected at sacrifice, and the relative immunoblot contents of stress protein (Hsp72) were determined. RESULTS: VR animals ran on average 4.87 km/wk, and FR rats ran 4.88 km/wk. Animals from VR and FR groups had less body weight gain (p0.05) among VR, FR and C groups (4.54 ± 0.79 mg/g vs 4.94 ± 0.89 mg/g vs 4.34 ± 0.87 mg/g, respectively). FR group animals had levels of Hsp72 (p<0.05) higher than those from VR, both in LV (287.45 ± 35.86 % vs 135.59 ± 5.10 %, respectively) and RV (241.31 ± 25.83 % vs 137.91 ± 45.20 %, respectively). CONCLUSION: Voluntary running and forced running induced different levels of Hsp72 in the myocardium of female Wistar rats.

Read Full Article

ABC

Original Article

Stress During ACLS Courses: Is it Important for Learning Skills?

Emilton Lima Júnior et al. José Knopfholz Carla M. Menini

OBJECTIVE: To determine the influence of stress on teaching medical emergencies in an Advanced Cardiac Life Support (ACLS) course and to verify this influence on learning, and the efficiency of emergency care training. METHODS: Seventeen physicians signed up for an ACLS course. Their pulses were taken and blood pressure (BP) verified on the first day, before the beginning of the course, and on the second day, during the theoretical and practical test (TPT). Variations in pulse rates and BP were compared with students’ test grades. Then, students answered a questionnaire of variables (QV) about the amount of sleep they had during the course, the quantity of study material and the time spent studying for the course, and a stress scale graphic. RESULTS: Seven students had a pulse variation less than 10% between the 2 periods and 10 had a 10% or more variation. Grades on TPT were, respectively, 91.4±2.4 and 87.3±5.2 (p<0.05). Six students had a BP variation less than 20 mmHg, and in 11 it varied more than 21 mmHg. Grades on the TPT were 92.3±3.3 and 86.2± 8.1, respectively (p<0.05). The QV dates did not significantly influence grades. CONCLUSION: Stress, as an isolated variable, had a negative influence on the learning process and on the efficiency of emergency training in this situation.

Read Full Article