2022;35(6) – ABC CARDIOL

Erratum

Int J Cardiovasc Sci. 2022 Issue vol 33(2), pages 192-6.

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Editorial

Atrial Fibrillation and Hemodialysis – Should we Anticoagulate These Patients? Ischemic Versus Hemorrhagic Risk

Iara Atié Malan

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and it is a very frequent cause of increased morbidity and mortality in adults. This arrhythmia favors the formation of thrombi, which can lead to systemic embolism, such as ischemic stroke.

To identify patients with thromboembolic risk, the most used score is the CHA2DS2VASC, which takes the following factors in consideration: heart failure, arterial hypertension, age, diabetes, previous stroke, vascular disease, and sex. It is worth emphasizing that this score does not take renal function or dialysis treatment into consideration.

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Editorial

Lipids and Sickle Cell Disease

Fernanda Azevedo-Silva

Sickle cell disease is a hereditary, autosomal recessive pathology caused by the replacement of adenine by thymin in position 6 of the beta globin gene, producing anomalous hemoglobin (hemoglobin S- HbS). It is characterized by a chronic inflammatory state with hemolytic anemia and vaso-occlusive phenomena and occurs when the HbS gene is in homozygosis (SS) or heterozygosis, in association with other variant hemoglobins (SD, SC, SE) or thalassemia (). Sickle cell disease is recognized by the World Health Organization (WHO) as a serious public health problem, and, despite advances in treatment, patients with sickle cell disease have a life expectancy of nearly 30 years lower than the general population.

About 4% of the Brazilian population has a sickle cell trait, and between 60,000 and 100,000 Brazilians have the disease, which translates into an economic burden of more than US$ 400,000,000/year for the Brazilian society. The number of patients affected by this pathology is increasing due to the evolution of treatment and improvement in early diagnosis, as a result of the institution of neonatal screening. Early identification of the disease is important in reducing its morbidity and mortality, especially with the prophylaxis of infections, which are a significant cause of death in children. This improvement in survival leads to the development of chronic complications resulting from vasculopathy and to more frequent cases of chronic ischemia.

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Editorial

Exercise-induced Bronchoconstriction and its Relevance in Public Health

Tales de Carvalho

The case report from Castro et al., entitles Exercise-Induced Bronchoconstriction: A Frequent, but Neglected Cause of Chest Pain, opportunely sheds light on a highly relevant question in terms of public health, as it treats important aspects that encompass from the diagnosis to the pharmacological treatment of Exercise-Induced Bronchoconstriction (EIB).^–

EIB often leads to an isolated cough, as well as thoracic and abdominal pain, which should always be contemplated after having discarded other causes of dyspnea and exercise-induced chest pain.^– It is an acute airway obstruction that is transitory and spontaneously reversible, and occurs during and after exercise and physical effort, regardless of the previous diagnosis of bronchial asthma. EIB normally arises 2 to 5 min after exercise, reaching a peak at 10 min and disappearing in up to 60 min.^,,

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Editorial

Oriented Magnetic Fields and Blood Pressure

Sayuri Inuzuka

Hypertension is a combination of genetic, environmental, and social factors, defined by blood pressure levels in which the benefits of treatment outweigh the risks. The global prevalence of hypertension is approximately 1.3 billion adults. The blood pressure control rates in developing countries in 2019 were 23% in women and 18% in men.

Treatments range from lifestyle modification, medication treatment, and use of medical devices. The prevalence of resistant arterial hypertension is estimated between 12% to 15% among patients with hypertension. Up to half of patients with resistant hypertension are partially or not adherent to pharmacological treatment. The World Health Organization (WHO) has identified five dimensions for treatment adherence, shown in .

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Editorial

Can Exercise Training Prevent Doxorubicin-induced Cardiomyopathy?

Marcus Vinicius Machado et al. Ronan Chapuis Aline Bomfim Vieira

Doxorubicin (DOX) is a cytotoxic antineoplastic agent of the anthracycline family. It has been used as the first-line chemotherapy drug for treating various types of cancer, such as breast, lung and bladder cancer, and lymphoblastic leukemia. As any anthracycline, DOX is an effective chemotherapeutic drug. However, it holds a potentially lethal dose-dependent cardiovascular toxicity, which can manifest immediately or many years after chemotherapy, limiting its clinical application.

After the discontinuation of DOX treatment, a seven-year follow-up of 1,807 patients reported 33% death from heart diseases. Similarly, a 7.5% incidence of some cardiomyopathies was reported in pediatric sarcoma patients within an average of 34 months post-DOX treatment.

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Editorial

Does Gluten Decrease (or Increase) Metabolic Syndrome Risk?

Sérgio Girão Barroso et al. Caroline Luiza Codonho Castro

Overall, weight gain and obesity are consequences of chronic energy imbalance, in which energy intake exceeds energy expenditure and leads to excessive energy (fat) storage. If gluten is a causative factor for weight gain, the underlying mechanisms remain unknown, and studies on non-coeliac individuals are scarce. Over recent years, gluten free diet (GFD) has become popular as books and social media have suggested that gluten consumption causes overweight and metabolic syndrome (MS) parameters. However, data supporting such statement are often feeble and questionable.

Firstly, due to its gluten content, wheat has likely been one of the most maligned foods over the past years. Nonetheless, whole wheat products are held as a good source of indigestible dietary fiber and other bioactive components. Avoiding wheat consumption could thus be associated with decreasing fiber and other beneficial constituents in the diet, and increasing glycemic index. Currently, three conditions require treatment with GFD: wheat allergy, non-coeliac gluten-sensitivity, and coeliac disease (CD).^,

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Original Article

Hemorrhagic Versus Ischemic Risk in Patients with Atrial Fibrillation on Hemodialysis

Mariana Sousa et al. Gonçalo Cruz Sara Vilela Catarina Cardoso … Pedro Bravo José Paulo Santos Cristina Santos Jorge Silva

Abstract

Background

Hemodialysis (HD) patients with atrial fibrillation (AF) have a particularly high risk of stroke and bleeding, but no high-quality evidence-based recommendations exist to properly manage these patients.

Objectives

We aim to evaluate the ischemic versus the hemorrhagic risk in a HD population with AF.

Methods

We selected incident patients that started hemodialysis between 2011 and 2015. All patients that had AF before HD, or developed AF during the follow-up, were included. Both CHA₂DS₂ -VASC and HAS-BLED scores were calculated at the time of beginning of HD or AF diagnosis and correlated with the outcomes using a logistic regression model. The outcomes were hemorrhagic events, ischemic events and death related to any of these events. A p-value < 0.05 was set as statistically significant.

Results

Forty-six patients were included. Most of them had had AF before they started hemodialysis. Twenty-two patients were on oral anticoagulation (OAC). There was no significant difference between the incidence of ischemic and hemorrhagic events, regardless of the use of OAC. Previous stroke, transient ischemic attack, and thromboembolic event significantly increased the risk of an ischemic event (OR 6.78, p=0.028).

Conclusions

In this population, we did not observe any difference between the incidence of ischemic and hemorrhagic events, which was also true in patients with OAC. Therefore, the benefit of OAC in such patients remains questionable. However, patients with previous stroke, transient ischemic attack, or thromboembolic event seem to have a higher risk of new ischemic events and might benefit from anticoagulation.

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Original Article

HDL-Cholesterol in Children and Adolescents with Congenital Heart Disease

Matheus Alves Pacheco et al. Silvia Meyer Cardoso Michele Honicky Yara Maria Franco Moreno … Luiz Rodrigo Augustemak de Lima Camila Souza Marcos Isabela de Carlos Back

Abstract

Background

Children and adolescents with congenital heart disease may be more likely to develop atherogenic cardiovascular diseases in adulthood. Therefore, the early identification of risk factors and intervention in childhood may be crucial for a good quality of life and longevity.

Objectives

To describe the distribution of high-density lipoprotein-cholesterol (HDL-c) levels and its association with socioeconomic, clinical and cardiovascular risk factors in children and adolescents with congenital heart disease.

Methods

Cross-sectional study with children and adolescents aged between 5 and 18 years, with congenital heart disease. Socioeconomic, clinical and cardiovascular risk factors were evaluated. HDL-c concentrations were evaluated by the direct method and categorized as desirable (>45 mg/dL), borderline (40-45 mg/dL) and low (<40 mg/dL). We also assessed the “undesirable” levels, consisting of the sum of “borderline” and “low” values for comparative purposes. The multivariate logistic regression analysis was used to evaluate the factor associated with undesirable HDL-c levels. A p<0.05 value was adopted as statistically significant.

Results

Mean HDL-c was 51.2 mg/dL (SD 12.6), with a prevalence of 33.2% of undesirable HDL-c. In the multivariate analysis, C-reactive protein levels ≥ 3mg/dL (OR 3.26; 95% CI 1.32-8.04), age ≥ 10 years old (OR: 2.11; 95% CI 1.12-3.99) and undesirable levels of triglycerides (OR 2.21; 95% CI 1.13-4.75) were associated with undesirable HDL-c.

Conclusion

In this sample of children and adolescents with congenital heart disease, almost one third presented low or borderline HDL-c levels. Age ≥10 years, C-reactive protein and triglycerides were associated with undesirable HDL-c levels. These factors should be considered in the prevention of cerebrovascular diseases in adulthood in this population.

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Original Article

Association Between Lipid Profile and Clinical Manifestations in Sickle Cell Anemia: A Systematic Review

Marina Tejo Dantas et al. Andressa Lopes Ana Marice Teixeira Ladeia

Abstract

Introduction

Sickle cell anemia (SCA) is a genetic disease associated with frequent episodes of acute illness. Changes in the lipid profile and a chronic inflammatory process make up the molecular aspects observed in this disease. Associations between these mechanisms and clinical manifestations could thus define severity profiles and therapeutic strategies.

Objectives

To verify whether there is an association between lipid profile and clinical manifestations in patients with SCA and if there is a correlation between lipid profile and laboratory markers in this disease.

Methodology

According to the PRISMA guidelines, a systematic review of the literature was conducted by searching the MEDLINE/PubMed, LILACS, SciELO, Scopus, and Cochrane databases. Articles were screened by reading the titles and abstracts, reaching those selected for full-text reading. The included studies were published between 2010 and 2020, were fully available in the databases, and addressed the proposed theme. The risk of individual bias was assessed by using the Joanna Briggs Institute checklist and the Newcastle-Ottawa scale.

Results

Out of the 144 identified articles, 15 were selected for analysis, resulting in a sample size of 2,230 individuals. HDL-C, LDL-C, total cholesterol , and triglycerides were the main variables analyzed in the lipid profiles. A correlation was observed between these variables and some of the most relevant clinical events in the disease, including vaso-occlusive seizures and acute thoracic syndrome.

Conclusion

Lipid metabolism disorders, especially hypocholesterolemia and hypertriglyceridemia, are linked to clinical events observed in SCA, suggesting they play a relevant role in the multifactorial pathogenesis of this disease.

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Original Article

Strain Magnitude Assessed at Rest and During Stress Echocardiography in Patients with Normal Coronary Flow Reserve

José Sebastião de Abreu et al. Tereza Cristina Pinheiro Diógenes Marília Esther Benevides Abreu Henrique Maia Costa … Ana Gardenia Liberato Ponte Farias Marcia Maria Carneiro

Abstract

Background

Coronary flow and myocardial contractile performance assessed by strain magnitude increase during a dobutamine stress echocardiogram (DSE). Normal coronary flow reserve (CFR) can be attained upon completion of a DSE at age-predicted maximum heart rate (HR) (HRmax = 220 – age)] or submaximal HR [(0.85) HRmax] or before completion (early CFR).

Objective

To ascertain the association between delta strain and HR in patients with early normal CFR.

Methods

This prospective study included patients whose normal CFR was obtained before the DSE was completed. Percentage of resting HR (%HRrest) = [(HRrest ÷ HRmax) 100]% and %HR CFR = [(HR at the time of CFR attainment) ÷ (HRmax) 100]% were recorded. Strain was assessed in the left ventricular region of interest, and delta strain was calculated as the difference between the measures obtained at HRrest and after the DSE was completed. Strain agreement analysis for HRrest, %HRrest, and %HR CFR was performed using the kappa coefficient. The Shapiro-Wilk test was used to assess data normality, and the Mann-Whitney test was used to compare the groups. A p-value < 0.05 was considered statistically significant.

Results

Strain measured -23.3% ± 4.3% at baseline and -31.1% ± 4.9% during the DSE. In delta strain > 8 absolute points, the ROC curves showed an area under the curve of 0.874 ± 0.07 for %HRrest (p = 0.001) and an area under the curve of 0.862 ± 0.07 for %HR CFR (p = 0.001). In delta strain > 8 points, %HRrest ≤ 42.6% of HRmax and %HR CFR ≤ 62.5% of HRmax showed an accuracy of 82.9% and 79.8%, respectively.

Conclusion

In this study, lower HRrest and HR at the time of CFR attainment had a good association with better myocardial contractile performance, according to the change in strain magnitude.

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Original Article

Physical Training Improves Cardiac Structure and Function of Rats After Doxorubicin-Induced Cardiomyopathy

Fernanda Rodrigues Souza et al. Érica Carolina Campos Leandro Teixeira Paranhos Lopes Clesnan Mendes Rodrigues … Danilo Lemes Naves Gonçalves Marcelo Emílio Beletti Matheus Matioli Mantovani Poliana Rodrigues Alves Duarte Alexandre Gonçalves Elmiro Santos Resende

Abstract

Background:

The use of doxorubicin in chemotherapy has been associated with cardiotoxicity and heart failure. Physical exercise produces favorable morphofunctional adaptations in the cardiovascular system and may reverse cardiac dysfunction in patients undergoing chemotherapy.

Objective:

To assess the effects of physical training on myocardial structure, cardiac function, and exercise tolerance in Wistar rats initiated after the onset of cardiotoxicity-induced cardiotoxicity.

Methods:

This study investigated 30 adult male Wistar rats randomly divided into four groups: control (C), exercise (EX), doxorubicin (DX), and doxorubicin and exercise (DXEX). The DX and DXEX groups received six doses of doxorubincin from 1.25 mg/kg body weight up to a cumulative dose of 7.5 mg/kg. Injections were administered intraperitoneally three times a week for two weeks; after this stage, the EX and DXEX groups started physical training (swimming) sessions three times a week with a load of 5% of their body weight. Echocardiography and exercise tolerance tests were performed. Generalized linear models were used in statistical analysis, and a p<0.05 was set as statistically significant.

Results:

Left ventricular shortening fraction and ejection fraction were reduced in the DX group compared to C, EX, and DXEX. The DXEX group showed greater tolerance to effort when compared to the DX and C groups.

Conclusion:

Physical training, initiated after the onset of doxorubicin-induced cardiotoxicity, improved cardiac function and exercise tolerance in rats.

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Original Article

Demographic and Epidemiological Profile of Aging and Elderly Patients Receiving Heart Transplant During the Period from 2009 to 2018

Joseane de Souza Ribeiro et al. Maria Liz Cunha de Oliveira

Abstract

Background:

The aging process may be associated with the accumulation of a wide variety of health damages, such as cardiovascular diseases. HF is the final common path of the majority of these diseases, and, in its refractory form, heart transplantation continues to be the best treatment choice.

Objective:

To describe the demographic and epidemiological profile of aging and elderly patients receiving heart transplant from 2009 to 2018.

Methods:

Retrospective, descriptive longitudinal study on heart transplantation in aging and elderly patients using data from medical records and institutional documents.

Results:

From a total of 234 transplant recipients, 127 were 45 years or older. For the demographic profile, the variables used were sex, age, marital status, home state, and profession. For the epidemiological profile, the variables used were previous diagnosis, comorbidities before and after transplantation, and survival. Age varied from 45 to 74 years, with a mean of 57 years. The male sex accounted for 58.27% of recipients, and 59.84% were from the Federal District. Chagas, dilated, and ischemic cardiomyopathy accounted for 66.14%, 18.9%, and 14.17% of transplants, respectively. The main comorbidities were Chagas disease (66.14%), malignant arrhythmia requiring cardioverter-defibrillator implantation (28.35%), arterial hypertension (27.56%), and dyslipidemia (15.75%). Mean survival was 3 years and 4 months.

Conclusion:

The demographic profile showed that the majority of patients were aging, male, married, and from the Federal District. The epidemiological profile showed that Chagas cardiomyopathy was the main cause of HF, followed by dilated cardiomyopathy.

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Original Article

Possible Effects of Oriented Magnetic Fields on Human Blood Pressure

Eugenio E. Vogel et al. Nataly Belmar Benjamín Stockins

Abstract

Background:

There have been scattered reports indicating the possibility that applied magnetic fields can lower human blood viscosity, which has been considered as encouraging for decreasing blood pressure as a result of greater fluidity. Additional motivation comes from partial studies in animals showing some response of vascular variables to magnetic fields. Recently developed FeNbB magnets enable topical application to appropriate sites of much stronger permanent magnetic fields than previously available.

Objectives:

To establish whether powerful magnetic fields permanently applied along important arteries of the human body can lower blood pressure and, if so, to what extent.

Methods:

Ambulatory blood pressure tests were performed on 70 patients, half of them wearing real magnets, while the other 35 patients were wearing a similar placebo. Magnets or placebo devices were assigned at random. Each patient underwent two consecutive ambulatory 24-hour blood pressure (BP) tests; the first without a device and the second one with a device.

Results:

Results were compiled and analyzed only after the last measurement was completed. Individual responses, average values, standard deviations, information content, and Student’s t test showed that no difference was found between measurements in either group.

Conclusion:

Permanent strong magnetic fields applied along the main arteries of the human body do not alter blood pressure. This was observed both in statistical terms and in individuals as well.

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Viewpoint

COVID-19 and the Beat-To-Beat Heart

Diego Santos Souza et al. Aimée O Durço Camila Souza Gama Rocha Lino Sérgio Rocha Conceição

Introduction

Since December 2019, the coronavirus disease (COVID-19) has caused an exponential increase in acute respiratory syndrome cases and has rapidly spread to more than 210 regions, countries and territories, resulting in considerable morbidity and mortality in more than 100 countries worldwide.

Over this period, several studies describing the clinical and epidemiological characteristics of COVID-19 have been published, allowing rapid dissemination of knowledge and helping health care professionals and policy makers to help patients with the disease.

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Original Article

Is Frailty Syndrome a Predictor of Morbimortality in Postoperative Cardiac Surgery? – A Retrospective Cohort Study

Daniela Meirelles do Nascimento et al. Cíntia Ehlers Botton Felipe Vargas Santos Márcia Cristina Rover … Marília Santos Moura Bruna Müller Leão Beatriz D. Schaan

Abstract

Background

Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age.

Objective

To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery.

Methods

A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted.

Results

The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015).

Conclusions

Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.

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Original Article

Dysautonomia Evaluation by Holter in Chagas Heart Disease

Michele Alves Rocha de Oliveira et al. Thais Aguiar Nascimento Gilson Soares Feitosa-Filho Luiz Eduardo Fonteles Ritt … Constança Margarida Sampaio Cruz Mário de Seixas Rocha

Abstract

Background

Sudden cardiac death is the main lethal mechanism associated with Chagas cardiomyopathy. Studies suggest that dysautonomia may represent a relevant, intense, independent, and early phenomenon in the natural history of the disease, even when ventricular systolic function is preserved, and may also be the mechanism that triggers malignant ventricular arrhythmias.

Objective

To evaluate the degree of dysautonomia and its possible association with ventricular arrhythmias in patients with Chagas cardiomyopathy, according to different categories of mortality risk, as defined by the score proposed by Rassi, used as a surrogate outcome for death.

Methods

A cross-sectional study involving 43 patients with Chagas cardiomyopathy stratified into risk categories based on the Rassi score, with 23 being classified as low risk and 20 as intermediate-to-high risk. Heart rate variability (HRV) was assessed using Holter monitoring for long-term recordings of 24 hours (time domain) and for short-term recordings of 5 minutes (frequency domain) at rest and after autonomic tests: deep breathing and Valsalva maneuver. The HRV variables were compared between the groups using the Student’s t-test and α=0.05.

Results

Comparison of the results between the risk stratification groups showed no differences in HRV indexes, either in the time or frequency domain. However, results showed a significant increase in the number of arrhythmias as a function of increased risk (p=0.02).

Conclusion

There was no association between the degree of dysautonomia, evaluated by Holter monitoring, and the categories of mortality risk, despite a direct association between the rate of arrhythmias and the higher risk group.

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Review Article

Does a Gluten-free Diet Improve Metabolic Syndrome Parameters? A Systematic Review

Luciana Gonçalves Orange et al. Maria Izabel Siqueira de Andrade Cybelle Rolim Lima Keila Fernandes Dourado … Thayná Menezes Santos Marina Moraes Petribu Priscilla Regia de Andrade Calaça Silvia Alves Silva

Abstract

To review scientific evidence on the effects of a gluten-free diet on body composition and improvement of clinical and biochemical parameters of metabolic syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes – PRISMA guidelines were followed. A literature search was performed in the PubMed, ScienceDirect, Trip Database, Bireme and Scielo databases, without language restriction, until March 2021. The terms “gluten-free diet”, “obesity”, “metabolic syndrome”, and “weight loss”, and Boolean operators (AND/OR) were used. The clinical hypothesis was structured according to the acronym PICOT. Randomized clinical trials with adult and elderly humans without a diagnosis of celiac disease, consuming a gluten-free diet, evaluating associations of the effects of this diet on weight loss and metabolic syndrome components were considered eligible. To assess the risk of bias, the RoB2 was used. A total of 3,198 articles were identified and, after the screening and evaluation of pre-defined eligibility criteria, four studies were included in the qualitative analysis. Weight loss was not associated with a gluten-free diet. However, individuals under a gluten-free diet had lower mean waist circumference, fat percentage (-2.3%) and serum triglyceride levels. The impact of a gluten-free diet on metabolic syndrome parameters is still controversial. In individuals without gluten sensitivity or celiac disease, the consumption of a gluten-free diet appears to provide no nutritional benefit.

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Case Report

Exercise-Induced Bronchoconstriction: A Frequent, but Neglected Cause of Chest Pain

Renata Rodrigues Teixeira de Castro et al. João Giffoni Silveira Neto Adalgiza Mafra Moreno Marco Orsini

Introduction

Chest pain is one of the most common complaints in emergency departments, and internal medicine and cardiology clinics. Patients’ comorbidities and the clinical characterization of chest pain are cornerstones to guide symptom differentiation. Information about pain intensity, duration, localization, changes with posture/movement, and its reaction to nitroglycerin helps diagnose cardiac chest pain. Typical angina pectoris is the presence of substernal chest pain or discomfort provoked by exertion or emotional stress, and is relieved by rest and nitroglycerin. Angina pectoris is attributed to myocardial ischemia due to the unbalance between myocardial oxygen supply and myocardial oxygen demand elicited during exercise or emotional stress.

The diagnosis and treatment workup in patients with moderate to high cardiovascular risk presenting angina pectoris is quite straight-forward. Nevertheless, exertional chest pain in a young man can be challenging and yield a common but overlooked diagnosis, as in the present case report.

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Original Article

Efficacy and Risks of Therapeutic Hypothermia after Pediatric Cardiac Arrest: A Systematic Review

Anna Luíza Machado Nogueira et al. Ana Luísa dos Santos Maciel Amanda Campos Querubino Roberta Teixeira Prado Jussara Regina Martins

Abstract

Background:

Therapeutic hypothermia is used in adults and neonates after cardiac arrest, but its efficiency in children under 18 years old is still uncertain.

Objective:

To evaluate the effectiveness and risks of therapeutic hypothermia after cardiac arrest in children under 18 years of age through a systematic review.

Methods:

A systematic review was performed in January 2022 in the MEDLINE, SciELO, Cochrane, and LILACS databases. Inclusion criteria: randomized controlled trials (RCTs) performed in humans. Articles from other typologies, published more than 10 years ago, or with volunteers over 18 years old were excluded.

Results:

Four studies were identified, of which 3 were analyzed; all of them were of moderate quality according to the Jadad Scale and the Cochrane Collaboration tool. The studies indicated that lowering the temperature did not improve data on mortality and adverse events. Two studies did not identify statistically significant differences (p > 0.05) considering hypothermia in relation to normothermia in terms of survival, safety, and global neurobehavioral and cognitive function. The other study did not show improved serum biomarker concentrations.

Conclusion:

The results found in this review do not support the use of therapeutic hypothermia after pediatric cardiac arrest, as this intervention did not provide any apparent benefits in terms of safety, adverse events, survival, and neurological impact. We recommend the conduction of new RCTs using the measurement of serum biomarkers to better evaluate the effectiveness of the intervention.

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Case Report

Takotsubo Syndrome as a Complication of Mild COVID-19: A Case Report

Jéssica Mayara Oséas et al. William Santos de Oliveira Bruna Aparecida Oliveira Jayson Marcus Miranda … Raissa Gabriela Vieira Barros Nestor Rodrigues de Oliveira Neto

Introduction

As the number of cases of coronavirus disease 2019 (COVID-19) has reached tens of millions worldwide, the understanding of its clinical manifestations has grown. These have been described as a range of systemic repercussions resulting from an interplay between direct organ damage and exaggerated host immune response.^, In a descriptive case series study of COVID-19 patients in Wuhan, 44% of patients had either elevated cardiac biomarkers or new changes in electrocardiogram (ECG) and imaging exams, and 34% of all cases had acute heart failure. Systemic diseases with increased adrenergic response may lead to stress cardiomyopathy, or Takotsubo syndrome, which is a rare condition with challenging diagnosis in the course of COVID-19. Herein we present a case of an elderly woman with mild COVID-19 who presented classical features of takotsubo syndrome on the 5th day of illness.

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