2018;31(1) – ABC CARDIOL

Original Article

Expansion Pulmonary Therapy in Blood Oxygenation and Lactate Serum Level in Postoperative Cardiac Surgery

Silvana Souza Oliveira et al. Mansueto Neto Roque Aras Junior

Abstract

Background:

Cardiovascular and pulmonary complications often occur in the immediate post- surgery period and may be prevented and/or treated with lung expansion techniques.

Objective:

To evaluate the efficacy of lung expansion techniques in serum arterial lactate levels and oxygenation in patients in this surgical recovery phase.

Method:

A prospective and analytical study was carried out in postoperative cardiac surgery patients, hemodynamically stable. Measurements of artery lactate levels and partial pressure of oxygen were obtained from arterial blood samples drawn before and after lung expansion techniques, including alveolar recruiting maneuver and intermittent positive pressure breathing.

Results:

40 patients with average age of 51.1 ± 14.9 years, 55% female, were included. It is possible to observe the statistically significant difference (p < 0.05) in the comparison between values of baseline and post-operative arterial lactate, oxygen level, oxygen saturation/fraction of inspired oxygen in both procedures. In relation to the outcome of oxygen blood pressure, only the group on intermittent positive pressure breathing achieved significant improvement.

Conclusion:

The lung expansion techniques used have contributed with the reduction of lactate level, improvement in oxygenation and oxygen saturation in this population, but did not alter intensive care unit length of stay.

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Editorial

Cardiology and Sustainable Development

Claudio Tinoco Mesquita et al. Mauricio Leão

Brazil is one of the major economies of the planet, with a territory of continental extension (fifth greatest) and a population over 200 million inhabitants. Nevertheless, Brazil has a huge social inequality, evidenced by its health indicators. Ribeiro et al. have reported that cardiovascular diseases account for 31% of all deaths, most of which resulting from ischemic heart disease and cerebrovascular disease.

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Original Article

Assessment of the Relationship of Ankle-Brachial Index With Coronary Artery Disease Severity

Andrea Mabilde Petracco et al. Luiz Carlos Bodanese Gustavo Farias Porciúncula Gabriel Santos Teixeira … Denise de Oliveira Pellegrini Luiz Claudio Danzmann Ricardo Medeiros Pianta João Batista Petracco

Abstract

Background:

Peripheral Artery Disease (PAD) is associated with cardiovascular events and can be diagnosed and estimated by use of the Ankle-Brachial Index (ABI). ABI is a worsening factor in the stratification of cardiovascular risk, but its contribution to define the severity of coronary artery disease has not been well established.

Objectives:

To compare the ABI value with the coronary atherosclerotic disease severity by use of the Syntax Score (SS) in patients with Acute Coronary Syndrome (ACS).

Methods:

This prospective study measured the ABI of all patients with ACS consecutively admitted to the São Lucas Hospital of PUCRS from May to September 2016, and compared the ABI values with the SS and ACS types of those patients. The analyzes were performed considering the 95%confidence interval (a = 5%).

Results:

This study assessed 101 patients [mean age, 62.6 ± 12.0 years; 58 men (57.4%)], 74 (82.2%) were hypertensive, 33 (45.8%) had diabetes and 46 (45,5%) had ST-elevation acute myocardial infarction (STEMI). The PAD severity was not related to the anatomical severity of the coronary artery disease (CAD). We found a significant association of intermediate SS with non-ST-elevation acute myocardial infarction (NSTEMI), and of low SS with unstable angina (UA) [OR (95% CI): 1.11 (1.03-1.20) (p = 0.004)], which remained after multivariate analysis adjusted to age, smoking, family history of CAD and previous CAD [(OR 95%): 1.13 (1.02-1.25) (p = 0.019)].

Conclusions:

Patients with ABI < 0.9 showed no association with higher disease complexity determined by the SS in patients with ACS. Patients with NSTEMI were more associated with an intermediate risk on the SS.

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Case Report

Myocardial Infarction after Snake Bite

Rafael Alessandro Ferreira Gomes et al. Fabiano Lima Cantarelli Franklin Almeida Vieira Aluisio Roberto Andrade Macedo Jr. … Milena Motta de Almeida Gouveia Audes Diogenes de Magalhães Feitosa

Introduction

Cardiac events are rarely associated with ophidian accidents, especially those involving snakes of the Elapidae family. We report on a snake bite victim who, within a few hours after the accident, developed myocardial infarction in the inferior wall with good clinical evolution.

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Original Article

Mortality Trend Due to Cerebrovascular Accident in the City of Maringá, Paraná between the Years of 2005 to 2015

Jéssica Pizatto de Araújo et al. João Vinícius Valério Darcis Adriana Cunha Vargas Tomas Willian Augusto de Mello

Abstract

Background:

Stroke is the second largest cause of death in the world, responsible for 6.7 million deaths in 2012. In Brazil, among the leading causes of death, cerebrovascular diseases occupy the first place.

Objective:

to analyze the trend of deaths from cerebrovascular accident (CVA) in the city of Maringá, Paraná, Brazil, between the years of 2005 and 2015.

Methods:

Cross-sectional study of time series performed at the Municipal Health Department of Maringá. Secondary data on death certificates for stroke in the city of Maringá between 2005 and 2015, selected according to the specific MC for CID-10 presented with few variations in the time interval studied. The coefficient for ICD-10 – I69.4 was higher in 2011. The lowest coefficient for the whole period was I61.9. The trend of total mortality coefficients reached peak in the years 2007 and 2008, small variations occurred after this period until 2015. () (ICD-10) from I60 to I69 were used. For trend verification, the polynomial regression model was used. Mortality Coefficients (MC) by main cause of death were calculated using the total number of people who died of stroke divided by the population exposed to the risk, multiplied by one hundred thousand. The trends were analyzed using the Polynomial Regression model, considered significant when p < 0.05. Population data were obtained from the database of the Brazilian Institute of Geography and Statistics.

Results:

Stroke was responsible for 1,843 deaths in the study period, with ICD- 10 – I64, I69.4 and I61.9 being the most frequent. The years with the highest number of deaths from the disease were 2007 and 2008. 52% of deaths occurred in males and 74% in individuals over 65 years.

Conclusions:

The trend of general mortality was constant, but there was an increasing trend of deaths among white married males.

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Original Article

Correlation Between Physical Activity and Clinical Variables in Patients with Acute Myocardial Infarction

Ana Teresa Glaser Carvalho et al. Thays Fraga Duarte Andressa Sarda Maiochi Roberto Leo da Silva … Tammuz Fattah Daniel Medeiros Moreira

Abstract

Background:

Physical activity reduces the risk of coronary heart disease, one of the leading causes of death in the world.

Objectives:

This study intends to correlate physical activity and clinical variables of the patients hospitalized in public hospitals of Santa Catarina after the first acute myocardial infarction.

Methods:

The selected patients answered a questionnaire on different clinical variables. Physical activity was measured using the Baecke’s questionnaire. Data were tabulated and analyzed using the SPSS 13.0 for Windows software. Normality was assessed using the Kolmogorov-Smirnov test. Correlations between two quantitative variables were evaluated by Pearson’s correlation. Values of p < 0.05 were considered statistically significant.

Results:

The study showed a weak positive correlation between the Baecke score and years of schooling (r = 0.361; p = 0.001). There was a weak negative correlation between the Baecke score and the PHQ9 depression score (r = -0.252; p = 0.009). The study also showed a weak negative correlation between the PHQ9 depression score and the Mini Mental score (r = -0.258; p = 0.007), as well as a weak negative correlation between PHQ9 and schooling years with (r = -0.199, p = 0.039).

Conclusions:

There is a positive correlation between physical activity and years of schooling in hospitalized patients with first acute myocardial infarction. Negative correlations were found between physical activity and depression, between depression and the Mini-Mental State Examination, and between depression and years of schooling in these patients.

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Review Article

Improving Nuclear Medicine Practices in Cardiology in the Emerging Economies: Role of the International Atomic Energy Agency

Maurizio Dondi et al. Thomas Pascual Diana Paez

Abstract

Low- and middle-income countries (LMICs) are particularly affected by cardiovascular diseases (CVDs), as more than 75% of all CVD deaths occur in these countries. Global prognostic figures are alarming, as an estimated 23.6 million people will die each year due to CVDs by 2030. For this reason, one of the targets of the Sustainable Development Goals (SDGs) of the agenda of the United Nations (UN) aims at reducing premature mortality due to Non-Communicable Diseases (NCDs) by 30% by 2030.

Within the UN family, the International Atomic Energy Agency (IAEA) has the mandate to promote safe, secure and peaceful use of nuclear technologies. The IAEA is strongly committed to accomplish the 2030 UN Agenda and through its Human Health Division, contribute to the attainment of SDGs. One of the key objectives of the Human Health Division is to support Member States to tackle the burden of CVDs through its subprogram of Nuclear Medicine and Diagnostic Imaging. This is accomplished by supporting the establishment and strengthening of capabilities of Member States to provide appropriate and safe use of nuclear cardiology clinical applications. The support ranges from assisting countries in the planning and implementation stages, providing training, maintaining and improving quality of clinical practice, establishing quality management systems and advising on how to comply with international standards, as well as using the technology in an appropriate and safe manner. This review will cover the activities of the IAEA in promoting, implementing, and supporting nuclear applications in cardiology in LMICs.

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Case Report

Heart Transplantation in Becker Muscular Dystrophy Patient: Case-Report of a 15-Year Follow-up

Marcio Madeira et al. Sara Ranchordás Tiago Nolasco Marta Marques … Maria José Rebocho José Neves

Introduction

Becker muscular dystrophy is a rare genetic disease with a birth incidence of approximately 1:30000 in males. The disease results from a X-linked recessive mutation on the gene located at Xp21, which encodes the dystrophin protein. Clinical manifestations include progressive skeletal muscle weakness and dilated cardiomyopathy which can lead to refractory heart failure. There is no correlation between the severity of cardiac manifestations and the genetic abnormalities.

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Original Article

Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in the Emergency Department

Irlaneide da Silva Tavares et al. Carlos José Oliveira de Matos Marco Antonio Prado Nunes Antonio Carlos Sobral Sousa … Divaldo Pereira de Lyra Júnior Joselina Luzia Menezes Oliveira

Abstract

Background:

The high prevalence of CAD, as well as your impact on health expenditure and the various treatment options to reduce morbidity and mortality related to CAD, comes to develop a diagnostic tool precis and with important findings in the Emergency Department.

Objetive:

To conduct an overview with meta-analysis to compile evidence from multiple systematic reviews (SR) on the diagnostic and prognostic value of coronary computed tomography angiography (CCTA) to assess acute chest pain in the emergency department (ED).

Methods:

We included SR of primary studies that evaluated the diagnostic and prognostic value of CCTA ≥ 64 channels in the ED. The studies were conducted in patients at low and intermediate risk for coronary artery disease (CAD). Quality assessment was performed using PRISMA and approved reviews that scored ≥ 80%. Two authors independently extracted data using a standardized form. Spearman correlation test, Chi-square test, Cochran’s Q test or Higgins and Thompson statistical I² were used. For meta-analysis, “mada” package statistical software R Core Team, 2015, was used. The significance level adopted was 95%.

Results:

Four reviews were eligible for inclusion in this overview, resulting in 13 articles after applying the exclusion criteria, and only 10 of these were used for meta-analysis, adding up to a total of 4831 patients (mean age, 54 ± 6 years; 51% male), of whom 46% were hypertensive, 32% had dyslipidemia, 13% had diabetes and 26% had a family history of premature CAD. In the meta-analysis, 9 studies defined CCTA positive in the presence of luminal lesions ≥ 50%, while 1 study defined it as luminal lesions ≥ 70%. Sensitivity ranged from 77% to 98%, and specificity, from 73% to 100%. The univariate analysis showed homogeneity of diagnostic odds ratio (DOR) [Q = 8.5 (df = 9), p = 0.48 and I² = 0%]. The pooled mean DOR for CCTA in primary analyses was 4.33 (95% CI: 3.47 – 5.18). The area under the curve (AUC) was 0.982 (95% CI: 0.967 – 0.999). There was no death, 29 (0.6%) infarcts, 92 (1.9%) revascularizations and 312 (6.4%) invasive coronary angiographies. The diagnosis of acute coronary syndrome occurred in 7.3% of the 1655 patients included in the meta-analysis.

Conclusions:

The use of CCTA as a tool for stratification of patients at low or intermediate cardiovascular risk, who are in the ED with chest pain, has high accuracy, safety, reduces length of hospital stay and probably the costs, producing an early diagnosis and more effective decision making. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0)

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Original Article

Prognosis of Dilated Cardiomyopathy with Severe Heart Failure according to Functional Classification Scales in Childhood

Fátima Derlene da Rocha Araújo et al. Rose Mary Ferreira Lisboa da Silva Henrique de Assis Fonseca Tonelli Adriana Furletti M Guimarães … Sandra Regina Tolentino Castilho Zilda Maria Alves Meira

Abstract

Background:

Heart failure is the main manifestation of dilated cardiomyopathy in childhood, and the systematic evaluation of signs and symptoms allows monitoring the treatment outcome.

Objective:

To evaluate the use of three functional classification scales of heart failure in children and adolescents with dilated cardiomyopathy.

Methods:

Longitudinal and observational study including patients from zero to 18 years with dilated cardiomyopathy and severe initial heart failure. All of them were followed up using the New York Heart Association (NYHA), The New York University Pediatric Heart Failure Index (The NYU PHFI) and Ross version 2012 scales. Statistical analyzes were done using Statistical Package for Social Science, version 14.0, with Mann-Whitney test, Chi-Square test or Fisher’s test, application of the Operating Characteristic Curve, Wilcoxon test and Kappa coefficient for comparison of scales and Kaplan-Meier curve for survival evaluation. The level of significance adopted was 5%.

Results:

A total of 57 patients, aged from 1 to 200 months (mean of 48.7 ± 55.9) and follow-up of 6 to 209 months (mean of 63.6 ± 48.4) were included. There was substantial agreement between the Ross 2012 scales, The NYU PHFI and NYHA (Kappa = 0.71 and 0.82, respectively). Paired analysis by the Wilcoxon test, comparing the scales before and after treatment, was significant (p < 0.0001). The greatest survival was found in patients with class I/II by NYHA or scores lower than 11 points in the others.

Conclusion:

The use of functional assessment scales of heart failure proved to be useful in the follow-up and evaluation of the therapeutic response and there was no difference between them. Patients who remained in functional classification III or IV NYHA or scores ≥ 11 in Ross 2012 or The NYU PHFI had worse prognosis.

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Original Article

Comparison of Anatomical and Clinical Scores in Predicting Outcomes in Primary Percutaneous Coronary Intervention

Fernando Pivatto Júnior et al. Gustavo Neves de Araújo Felipe Homem Valle Luiz Carlos Corsetti Bergoli … Guilherme Pinheiro Machado Bruno Führ Elvis Pellin Cassol Ana Maria Rocha Krepsky Rodrigo Vugman Wainstein Marco Vugman Wainstein

Abstract

Background:

Different scores based on anatomical and/or clinical features have been developed for risk stratification of patients undergoing percutaneous coronary intervention (PCI). Studies comparing the ability of these different models in predicting major adverse cardiac and cerebrovascular events (MACCE) in patients submitted to primary PCI are limited.

Objectives:

The aim of this study was to compare the ability of the scores SYNTAX (SS), Clinical SYNTAX (CSS), ACEF, and modified ACEF (ACEF_Mod) to predict MACCE in patients with ST-elevation myocardial infarction (STEMI) submitted to primary PCI.

Methods:

We analyzed 311 consecutive patients with STEMI submitted to primary PCI between April/2011 and December/2015. The area under the ROC curve was calculated to evaluate the ability of these scores in predicting MACCE. P-values were considered significant at < 0.05.

Results:

Mean age of the patients was 60.2 ± 12.0 years, 35.4% were females, and 22.5% had diabetes. MACCE occurred in 23.8% of the patients. The area under the ROC curve was 0.586 (p = 0.028) for ACEF, 0.616 (p = 0.003) for SS, 0.623 (p = 0.002) for ACEF_Mod, and 0.658 (p < 0.001) for CSS. In multivariate analysis, only high SS (p = 0.011) and CSS (p = 0.002) were independent predictors of MACCE.

Conclusions:

High SS and CSS were independent predictors of MACCE. In our cohort of STEMI patients undergoing primary PCI, pure anatomical SS calculated at the baseline coronary angiography was a useful tool to predict MACCE. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0)

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Original Article

Cardiovascular Risk Factors in Climacteric Women with Coronary Artery Disease

Jorgileia Braga de Melo et al. Roberta Cristina Almeida Campos Philippe Costa Carvalho Mariana Ferreira Meireles … Maria Valneide Gomes Andrade Tânia Pavão Oliveira Rocha Wilma Karlla dos Santos Farias Maria Jozelia Diniz Moraes Josete Costa dos Santos José Albuquerque de Figueiredo Neto

Abstract

Background:

The increased incidence of cardiovascular disease in women occurs during the climacteric period, especially after menopause.

Objective:

The aim of this study was to identify risk factors among climacteric women with and without coronary artery disease (CAD).

Method:

This cross-sectional study was performed in the Catheterization Laboratory at the Federal University Hospital of Maranhão, in the Northeast region of Brazil, between March 2012 and July 2013. We included 31 climacteric women who went to the care center for cardiac catheterization. They were divided into groups after catheterization results: Group I (with DAC) and Group II (without CAD). Statistical analysis: Categorical variables were described by means of frequencies and percentages, numerical variables by mean ± standard deviation or median (Quartile.3 – Quartile.1); the Shapiro-Wilk test was used to verify the normality of quantitative data. Fisher’s exact test was used for categorical data comparisons. For continuous data, we used Student’s test or the Mann-Whitney for unpaired samples; statistical significance was set at p < 0.05.

Results:

We evaluated groups with CAD (n = 13) and without CAD (n = 18). The results showed a mean age between the groups of 57.92 ± 5.15 and 51.72 ± 4.63 years, respectively. Among the cardiovascular risk factors, the most prevalent among women with CAD were menopause (84.62%), systemic arterial hypertension (SAH) (69.23%) and sedentary life style (69.23%).

Conclusion:

We concluded that, in addition to menopause itself, SAH and sedentary lifestyle were the most prevalent cardiovascular risk factors among women with CAD.

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