2017;30(2) – ABC CARDIOL

Review Article

Quantity of Aerobic Exercise Training for the Improvement of Heart Rate Variability in Older Adults

Luana Farinazzo Ferreira et al. Gabriel Dias Rodrigues Pedro Paulo da Silva Soares

Abstract

Cardiovascular autonomic markers such as cardiovagal baroreflex sensitivity (CBS) and heart rate variability (HRV) decline with the aging process. Aerobic training (AT) may be able to improve HRV, suggesting that AT can alter neuroregulatory control over the heart, improving autonomic markers and cardiac protection. Together, age and AT can influence HRV, but not revert the overall effects of aging on the decline of physical performance and HRV. The aim of this study was to review studies and describe the volume of AT necessary to produce modifications in HRV in elderly individuals. The review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The articles selected were indexed in PubMed/MEDLINE, Lilacs and Scopus. The used keywords were “aging”, “heart rate variability”, “exercise” combined with the Boolean descriptors “AND” and “OR” with the synonyms “elderly”, “cardiac autonomic modulation”, “aerobic training” and “endurance training”. The filters “languages”, “humans”, “age” and “clinical trial” were applied in the selection of the articles. Initially, 940 articles were found, PubMed (n = 729), Lilacs (n = 16) and Scopus (n = 195), filters and searches led to the 287 potential studies. The keyword combinations provided 24 articles that were in agreement with the inclusion criteria, and after full reading of the texts, 17 studies were excluded. From seven articles, four showed increases in HRV in response to AT. In an older population, 8 weeks of AT is enough to induce positive changes on HRV. However, longer exercise protocols and higher intensities also seem to have some influence.

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Brief Communication

Exercise Improves Cardiovascular Risk Factors, Fitness, and Quality Of Life in Hiv+ Children and Adolescents: Pilot Study

Luiz Rodrigo Augustemak de Lima et al. Isabela de Carlos Back Carmem Cristina Beck Bruno Caramelli

Abstract

Children and adolescents infected by HIV through mother-to-child transmission are at high risk of developing premature cardiovascular diseases due to dyslipidemia, insulin resistance and low-grade chronic inflammation. The aim of the pilot study was to verify the effect of a playful exercise program on cardiovascular, morphological, metabolic, fitness, and quality of life outcomes. A non-randomized clinical trial consisting of 24 sessions of playful aerobic and resistive exercises was applied to 10 children and adolescents living with HIV from Florianopolis, Brazil. The following variables were obtained before and after the program: fasting total cholesterol, HDL-c, LDL-c, triglycerides, glucose, C-reactive protein, blood pressure, common carotid artery intima-media thickness (CCA-IMT), flexibility, muscular endurance, aerobic fitness, anthropometry, and measured quality of life. After the intervention, a decrease in systolic blood pressure (-6.8 mmHg, 6.6%; p = 0.019) and CCA-IMT (-60.0 µm, 12.2%; p = 0.002) was observed after 24 sessions. There was an increase in upper-limb muscular endurance (+3.3 rep.min^-1, 63.5%; p = 0.002), flexibility (+5.7 cm, 26.0%; p = 0.001), and quality of life (+10.4 points, 27.5%; p = 0.003). In our sample of children and adolescents living with HIV, a short-term exercise program was associated with improvement in cardiovascular risk, fitness, and quality of life.

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Original Article

Correlation Between Cardiac Calcium Index and Coronary Artery Disease

Cintia Rocha Fortes de Sá et al. Ana Cristina Camarozano Wermelinger Daniane Rafael Rubens Zenóbio Darwich … Jerônimo Antonio Fortunato Junior Daniela de Castro Carmo Liz Andréa Villela Baroncini

Resumo

Introduction:

Valvular deposits of calcium quantified by transthoracic echocardiography are associated with the occurrence of systemic atherosclerotic disease, but its prognostic value and influence of associated cardiovascular risk factors have not been defined yet.

Objectives:

To correlate the valvular cardiac calcium index by transthoracic echocardiography with cardiovascular risk factors and presence of coronary artery disease (CAD).

Methods:

We selected 203 patients (61.2 ± 14.3 years; 57.6% females) who underwent transthoracic echocardiography with cardiac calcium index quantification. The presence or absence of CAD, hypertension, diabetes mellitus (DM), dyslipidemia, and smoking was assessed.

Results:

Age above 65 years (p < 0.001) and the presence of hypertension (p < 0.001) showed a significant correlation with the presence of cardiac calcification, whereas DM (p = 0.056) and CAD (p = 0.08) showed only a trend toward a correlation with calcification. Mitral valve calcification alone correlated significantly with age above 65 years (p 65 years (OR 1.05, 95%CI 1.02-1.08, p = 0.003) correlated significantly and independently with mitral valve calcification. Aortic valve calcification alone showed no correlation with the presence of CAD (p = 0.435), but correlated significantly with age above 65 years (p < 0.001) and hypertension (p < 0.001). On multivariate analysis, only age (OR 1.1, 95%CI 1.06-1.14, p < 0.001) remained independently and significantly correlated with aortic calcification.

Conclusion:

Age above 65 years and hypertension were independent risk factors for the presence of valvular cardiac calcification, with mitral valve calcification alone emerging as significantly and independently associated with the presence of CAD.

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Review Article

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

André Pereira Duque Estrada et al. Rosane de Oliveira Lopes Humberto Villacorta Junior

Abstract

The objective of this study is to make a review of the narrative of coronary artery tortuosity (CAT) approaching several situations in clinical practice where tortuosity can have a relevant role, and also evaluate if tortuosity can be related to the presence of myocardial ischemia in patients without coronary obstruction using scientific evidences in medical literature. Textbook of applied Physiology in Cardiology with study of coronary circulation, theoretical articles with studies of Hemodynamics, Fluid and Mechanical Dynamic, and experimental articles with simulation in computers were used as support to answer this last question.

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Original Article

Inadequacies of Sphygmomanometers Used in Emergency Care Services in a Large Capital City in Brazil

Kleisson Antonio Pontes Maia et al. Marcus Vinícius Bolívar Malachias Isabela Viana de Paiva Rafael da Mota Mariano Rodrigo Viana de Paiva

Abstract

Background:

Hypertension is the main risk factor for cardiovascular diseases. Technical quality of sphygmomanometers is a prerequisite for the correct measurement of arterial pressure.

Objectives:

To evaluate sphygmomanometers available in emergency services in the city of Belo Horizonte, Brazil.

Methods:

We performed a cross-sectional, observational, non-interventional study to evaluate characteristics of the sphygmomanometers available in adult emergency services of public and private hospitals in the city of Belo Horizonte, Brazil. We evaluated 337 sphygmomanometers of 25 hospitals – 15 (of 16) public hospitals and 10 (of 12) private hospitals.

Results:

Twenty-six percent (88/337) of devices were considered inadequate regarding the INMETRO (National Institute of Metrology, Quality and Technology) standards, 39.2% (132/337) for calibration dates, and 54% (188/337) for the mismatching between cuff’s and device’s brands. In 13 of 25 hospitals (52%), there were no spare cuffs in different sizes for different arm circumferences. Higher adequacy was found for aneroid and mercury sphygmomanometers used in private hospitals (p = 0.038 and p < 0.001, respectively) and electronic devices used in public hospitals (p < 0.001) compared with others.

Conclusion:

Seventy-eight percent of sphygmomanometers available in emergency services had technical inadequacies, and half of these services had no spare cuffs in different sizes available. These findings serve as a warning of the conditions of the equipment used in healthcare services provided to the general population in Brazil.

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Original Article

Interdisciplinary Therapy and Decrease of Cardiovascular Overload in Obese Patients

Leticia Andrade Cerrone et al. Vanessa Fadanelli Schoenardie Poli Ricardo Badan Sanches Stephan Garcia Andrade-Silva … João Pedro Novo Fidalgo Maythe Amaral Nascimento Amanda Santos Moraes Alessandra Medeiros Ricardo José Gomes Danielle Arisa Caranti

Abstract

Background:

Association between obesity, interdisciplinary therapy and intense physical exercise was described for obese patients. However, the study of physical activities representing daily tasks and cardiovascular risk in everyday activities becomes necessary to verify the occurrence of this association.

Objective:

To investigate whether a period of 18 weeks of interdisciplinary therapy is capable of promoting benefits in cardiovascular parameters at rest and during exercise in obese adults.

Methods:

Sample of 32 individuals of both sexes with body mass index of 30 to 39.9 kg/m² and age between 30 and 50 years. Intervention with interdisciplinary therapy (physical education, psychology, nutrition and physiotherapy), duration of 18 weeks and measurement of anthropometric data of body mass, height, waist and hip circumferences, maximum exercise ergometer evaluation before and after the therapy period.

Results:

Interdisciplinary therapy decreased systolic blood pressure (SBP): 125.83 ± 9.86 (baseline) vs 120.28 ± 16.82 (final), heart rate (HR): 74.75 ± 11.02 (baseline) ) Vs 72.77 ± 10.72 (final), and double-product (DP) at rest. Reduced also during the submaximal PAS stress stages 1: 143.44 ± 9.28 (baseline) vs 131.56 ± 15.26; Stage 2: 152.23 ± 21.91 (baseline) vs. 141.56 ± 17.43 (final), PAD stage 2: 89.89 ± 9.58 (baseline) vs 83.13 ± 9.65 (final) , FC stage 1: 118.40 ± 12.90 (baseline) vs 110.87 ± 7.66 (final); Stage 2: 137.09 ± 16.54 (baseline) vs 130.37 ± 11.51 (final) and the PD referring to the initial stages.

Conclusion:

Interdisciplinary therapy reduced the overload of the cardiovascular system at rest and submaximal effort in obese adults, optimizing rest and daily activities.

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Original Article

Rescue Therapy with Nifurtimox and Dipyridamole for Severe Acute Chagas Myocarditis with Congestive Heart Failure in NMRI Albino Mice

Daniela Yustiz Aparicio et al. María González-Hernández Greybis Hernández-Forero María Guédez-Ortiz … Sonia Santeliz Loredana Goncalves Rafael Bonfante Cabarcas

Abstract

Background:

Chagas disease is a global health problem; therefore, the development of new therapeutic protocols is necessary. Our group recently demonstrated that nifurtimox associated with dipyridamole has curative effects in mice with acute Chagas disease. In this study, we assess the effect of this therapeutic protocol in chagasic mice with heart failure.

Objective:

To evaluate whether nifurtimox and dipyridamole are useful to rescue mice with severe acute chagasic myocarditis with heart failure.

Methods:

42 mice with acute chagasic myocarditis and congestive heart failure were divided into three groups: control chagas (n = 11), Nif-Dip treated with nifurtimox and dipyridamole (n = 14) and Nif-Dip-heart failure treated with nifurtimox and dipyridamole associated with digoxin, furosemide, and captopril (n = 17). Nifurtimox and dipyridamole doses were 40 and 30 mg/kg/day, respectively, for 6 weeks. Mice underwent clinical, electrocardiographic, hemoparasitological and histopathological assessments.

Results:

Lower mortality in Nif-Dip (28.57%; n = 4) compared to control chagas (54.54%; n = 6) and Nif-Dip-heart failure (52.9%; n = 9) was observed. Clinically, nifurtimox and dipyridamole-treated mice increased body weight and improved heart failure without splenomegaly. In these groups, parasitemia and tissue parasites were eradicated; fibrosis, myocytolysis, inflammatory cell infiltrate and mast cells decreased. Repolarization disorders, prolonged QRS and QT intervals, increase of S wave amplitude and atrioventricular dissociation were reversed by the treatment.

Conclusion:

Nifurtimox with dipyridamole can rescue NMRI mice from severe acute chagas disease, as nifurtimox showed trypanocidal activity and dipyridamole potentiated its effect. Dipyridamole would be useful in chagasic heart failure.

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Case Report

Differential Diagnosis of Marfan Syndrome in a Teenage Volleyball Athlete

Fabrissio Portelinha Graffunder et al. Sabrina Weiss Sties Ana Inês Gonzáles Tales de Carvalho

Introduction

Marfan syndrome (MFS) is an autosomal dominant hereditary disease mainly caused by mutations in the fibrillin-1 (FBN1) gene. It is characterized by the occurrence of thoracic aortic aneurysm and/or dissection, ectopia lentis, and systemic abnormalities.

The highest risk of death associated with the syndrome is attributed to cardiovascular abnormalities, in particular, progressive aortic root aneurysm, leading to aortic dissection and rupture if not corrected surgically. The clinical diagnosis of MFS may be established by the revised Ghent nosology, although this can be challenging, since many characteristics of this disease are dependent on the age of the patient, while others are frequently seen in the general population, with substantial phenotypic variability. In addition, MFS has considerable overlap with other connective tissue diseases.^,

[…]

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Original Article

Assessment of the Lifestyle of University Students in the Healthcare Area Using the Fantastic Questionnaire

Carolina Campos Tassini et al. Gabriela Ribeiro do Val Sarah da Silva Candido Cynthia Kallás Bachur

Abstract

Background:

The constant concern about quality of life nowadays has incited individuals to seek parameters for disease prevention. Along with that, arise a need to investigate and the ability to measure elements that characterize an appropriate lifestyle.

Objective:

To compare the factors determining the quality of life of students in the healthcare area using the Fantastic questionnaire.

Methods:

Descriptive, cross-sectional, population study. The sample was obtained by convenience and comprised medical and physical therapy students of both sexes and any ethnicity, attending a private institution of higher education, who agreed to fill out the questionnaire voluntarily. The Fantastic instrument used in this study has 25 closed questions that explore nine domains including physical, psychological, and social lifestyle components.

Results:

In total, 57 university students participated, of whom 28 (15%) were physical therapy students and 29 (50.8%) were medical students. The mean age was 23 ± 2 years, and 40 (70.1%) were female and 17 (28.8%) were male. The overall rating was “regular”, and none of the participants scored in the “very good” and “excellent” categories. The domains that mostly required change among medical students related to nutrition and physical activity, while among physical therapy students they related to cigarette, drugs, and alcohol.

Conclusion:

According to the data collected using the Fantastic questionnaire, there was a remarkable need for improvement in the management of the quality of life of physical therapy and medical students, therefore allowing some social and educational measures through health promotion and disease prevention.

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Original Article

Assessment of Right Ventricle Function and Myocardial Fibrosis by Cardiovascular Magnetic Resonance in Patients with Inferior Wall Myocardial Infarction

Priscila Neri Lacerda et al. Rafael Fernandes Almeida Fernanda Gabriella Figueiredo Pinto Adilson Machado Gomes Júnior … Jéssica Mendes Santos Cristiano Ricardo Bastos de Macêdo André Maurício Souza Fernandes Roque Aras Júnior

Abstract

Background:

Right ventricular dysfunction (RVD) can be found in 30-50% of patients with inferior wall myocardial infarction (I-MI) and predicts early mortality. Myocardial fibrosis is associated with progressive ventricular dysfunction and severe prognosis. In these patients, cardiovascular magnetic resonance (CMR) is an important risk stratification method.

Objectives:

This study sought to evaluate the association between RVD and myocardial fibrosis in patients with I-MI, using CMR.

Methods:

Cohort study conducted in a prominent center of cardiology. Forty individuals with I-MI were included in the study. CMR was performed during hospitalization to estimate parameters of right ventricle function and to quantify myocardial fibrosis through late gadolinium enhancement (LGE) technique. Patients were stratified by ventricular function, and clinical characteristics were compared between study groups.

Results:

Forty patients were included in the study, 75% were male and 43% elderly (age ≥ 60 years). Hypertension (45%) and smoking (33%) were the most prevalent cardiovascular risk factors. RVD was found in 33% of patients. Mean fibrosis mass was 22 ± 12 g in patients with RVD compared with 15 ± 8 g in patients with preserved ventricular function (p = 0.051).

Conclusions:

The findings of our study indicate a possible association between RVD and myocardial fibrosis in patients with I-MI. However, further studies with larger series are needed to confirm our findings.

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Case Report

Caseous Necrosis of the Mitral Valve: Imaging Methods Allow the Diagnosis and Prevent Surgery

Rodrigo de Moura Joaquim et al. Edileide de Barros Correia Suéllen Lacerda Bezerra Ibraim Masciarelli Francisco Pinto … Tiago Senra Garcia dos Santos Fabiano de Castro Albrecht

Introduction

Calcification of the mitral annulus (CMA) is defined as a chronic degeneration of the mitral annulus fibrous involving mainly the posterior annulus. It is a common condition in the elderly, especially in women, and is associated with hypertension. Caseous necrosis of the mitral valve (CNMV) is a rare and less known CMA variant with a prevalence of 0.64%, which can reach up to 2.7% in autopsy studies of patients with CMA.^–

On echocardiography, CNMV appears as a large rounded or semilunar echodense mass, with a liquid filling and central echolucency, similar to a periannular tumor.^, The mechanism of liquefaction and caseification are still not well understood, but it is believed to occur due to changes in calcium metabolism.

[…]

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Original Article

Correlation between Length of Hospital Stay and Gait Speed in Patients Submitted to Cardiac Surgery

André Luiz Lisboa Cordeiro et al. Daniel Lago Borges Max Paulo Peruna André Raimundo Guimarães Lucas de Assis Cacau

Abstract

Background:

Cardiovascular diseases have been increasing worldwide in recent decades due to the increased occurrence of triggering factors. In the postoperative period of cardiovascular surgery, patients experience a functional decline, which may be potentiated by the length of hospital stay. Therefore, it is important to evaluate these patients’ functional capacity.

Objective:

To compare the length of hospital stay with the gait speed in patients undergoing cardiac surgery.

Method:

Prospective, cohort study carried out at the Instituto Nobre de Cardiologia (Incardio) at Santa Casa de Misericórdia (Feira de Santana, Bahia). Upon discharge, all patients were evaluated with the 6-minute walk test (6MWT). The length of hospital stay in the postoperative period was also recorded at the same time and correlate with the gait speed. We used the Kolmogorov-Smirnov test to evaluate the assumption of normality, and Spearman’s correlation to correlate the gait velocity with age, length of hospital stay, and duration of cardiopulmonary bypass (CPB) and invasive mechanical ventilation (IMV). All conclusions were based on a significance level of 5%.

Results:

In all, 64 patients were included (33 males [51.5%], mean age 57.2 ± 14.06 years). The mean distance walked by the patients was 375.8 ± 197.6 meters, the mean gait speed was 0.98 ± 0.53 m/s, and the mean hospital stay was 8.2 ± 2.3 days. A weak correlation was observed between the length of hospital stay and gait speed (r = 0.27 and p = 0.02).

Conclusion:

The length of hospital stay correlated weakly with the gait speed upon hospital discharge in a sample of patients undergoing cardiac surgery.

Trial registration:

Registered at CAAE (41151214.5.0000.5654) on June 26, 2015.

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Editorial

The Accuracy of Blood Pressure Measurement

Claudio Tinoco Mesquita

The act of measuring a patient’s blood pressure with a stethoscope and a sphygmomanometer is among the most important because of the various clinical implications that may occur. Failure to detect elevated blood pressure levels may expose a patient to the risk of various complications such as stroke, heart failure, kidney failure, and premature atherosclerosis. Conversely, obtaining falsely elevated measures may lead to diagnostic investigations and use of costly and life-threatening drugs. The concern with the proper calibration and validation of blood pressure measurement devices is constant and fundamental for clinical practice. Turner et al., in a detailed computational study, demonstrated that the error resulting from the decalibrated sphygmomanometer accounts for 20% to 28% of cases of undetected systolic and diastolic hypertension and 15% and 31% of cases of falsely diagnosed systolic and diastolic hypertension, respectively.

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