2023;36 – ABC CARDIOL

IJCS

ABC Family | IJCS

Editorial

The COVID-19 Collateral Damage in ST-Elevation Myocardial Infarctions in Low/Middle-Income American Regions

Karen Alexandra Dueñas-Criado et al. Oscar Maurício Perez-Fernandez

For this issue of the International Journal of Cardiovascular Sciences, we would like to discuss the post-coronavirus disease 2019 (COVID-19) pandemic effects on performance measures in patients with ST-segment elevation myocardial infarction (STEMI) in a low/middle-income country.

In the Americas, cardiovascular diseases, mainly ischemic heart disease and cerebrovascular disease (stroke), are the leading causes of long-term disability and mortality. Over three quarters of heart disease and stroke-related deaths occur in low- and middle-income countries. In the Americas region, during the last 3 years, more than 190.3 million people have been diagnosed with COVID-19, and more than 2.9 million people have died, according to Pan American Health Organization statistics from March 2023. As of 12 July 2023, more than 2 billion doses of vaccination against COVID-19 had been applied in the region to about 700 million people with a 3-dose regimen.

[…]

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Original Article

Translation, Cross-Cultural Adaptation, and Validation of the Hypertension Self-Care Profile (HBP-SCP) for the Brazilian Population

Jussara Almeida de Oliveira Baggio et al. Beatriz Brito Ribeiro Jessica Lays Ferreira Ribeiro Fabricio Brito Silva … Lisiane Fernanda Simeão de Azevedo Renata Gonçalves Mendes Aldair Darlan Araújo Maria Claudia Gonçalves Rudys Rodolfo de Jesus Tavarez Denilson Menezes Almeida Daniela Bassi-Dibai

Abstract

Background

Self-care in the management of systemic arterial hypertension (SAH) is crucial, and validated instruments can help researchers and health professionals to plan strategies to improve self-care in people with SAH.

Objective

The main objective of this study was to translate, cross-culturally adapt, and validated the Hypertension Self-Care Profile (HBP-SCP) for Brazilian Portuguese.

Methods

The translation and cross-cultural adaptation was performed in five phases, and the pre-final version was tested in 30 individuals, native speakers of Portuguese with a diagnosis of hypertension. The final version was administered in 100 individuals. The inclusion criteria were: diagnosis of SAH, characterized by systolic arterial blood pressure ≥ 140 mmHg and/or diastolic arterial blood pressure ≥ 90mmHg, regular use of antihypertensive medications and over 18 years of age. The present study also used two other questionnaires, previously validated for the Brazilian population, to verify the validity of the construct, the Healthy Habits Perception Questionnaire (HHPQ) and the Quality of Life in Hypertension Mini-Questionnaire (MINICHAL-BRASIL).

Results

During the translation and cross-cultural adaptation phase, there were no disagreements. Adequate reliability — intraclass correlation coefficient (ICC) ≥ 0.89, standard error of measurement (SEM) % ≤ 4.34, minimum detectable change (MDC) % ≤ 12.04 — and internal consistency (Cronbach’s alpha ≥ 0.75) were observed. The behavior domain of HBP-SCP obtained significant correlations (p < 0.05) with the self-efficacy domain and HHPQ; the motivation domain with the self-efficacy domain; and the self-efficacy domain with the somatic manifestation domain of MINICHAL-BRASIL. No ceiling and floor effects were observed.

Conclusions

The Brazilian Portuguese version of the HBP-SCP has adequate psychometric properties, according to the best scientific recommendations.

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Viewpoint

The Role of MicroRNAs in the Pathogenesis of Chagas Disease

Cristiane Tefe-Silva et al. Laura de Oliveira Teixeira Laura Ramos Durigan Maria Clara Silva Cardoso … Maria Laura de Castro Davi Paula Altieri Pin Stephanie Milanez Veronica Cestari Lourenço Thálita Cristina de Sousa Beine Eloisa Yara Araujo Clemente

Abstract

Chagas disease (CD) is caused by the protozoan Trypanosoma cruzi and affects about six to seven million individuals worldwide. The distribution of cases is concentrated mainly throughout Latin America, especially in rural areas. This study aims to evaluate microRNAs (miRNAs) as indicators in CD diagnosis for possible contributions to its management. This is a literature review study, carried out in the PubMed, SciELO, Bireme Library, NCBI, Science Direct, and Embase databases, through which a total of 12 articles were included for qualitative analysis. The discussion of this review was based on the thematic axes regarding the modulation of T. cruzi in the immune system and the expression of miRNAs, their production and action, the modulation mechanism of host gene expression, how they act as biomarkers, the importance of miRNAs in the diagnosis of CD, and how their regulation occurs in Chronic Chagas Cardiomyopathy (CCC). Moreover, T. cruzi infection is associated with the downregulation of several miRNAs, which directly related to the findings of hypertrophy and fibrosis. When quantified, these could be used as consistent indicators for CD to support the diagnosis of patients with CD complications, as well as a possible therapeutic target. However, the need for clinical studies that evaluate the usefulness of this biomarker in humans is emphasized, considering that in the present study, only experimental in vitro studies were evaluated, reflecting a lack of studies with practical applicability.

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Original Article

Evaluation of Antibiotic Prophylaxis Prescriptions for Infectious Endocarditis Before Oral Procedures Between Cardiologists and Dentists

Mariana Mattos Brandão et al. Luisa Latado Lívia Brito Oliveira Viviane Almeida Sarmento Adriana Lopes Latado

Abstract

Background

Infective endocarditis (IE) is a serious disease with a high mortality rate. Antibiotic prophylaxis for bacterial endocarditis before invasive procedures has been recommended in patients with predisposing cardiac conditions since 1960, but contemporary guidelines worldwide have proposed changes.

Objective

To evaluate the knowledge and pattern of prescription by cardiologists and dentists regarding antibiotic prophylaxis for bacterial endocarditis before risky oral procedures.

Methods

This is an observational and cross-sectional study. Data were obtained from an online questionnaire, sent to cardiologists and dentists linked to specialty societies, in the first semester of 2021. Data analysis was performed using descriptive statistics, and comparisons between variables were done in an exploratory approach. The significance level adopted was 5%.

Results

From 613 responders, 82.5% of cardiologists and 79.5% of dentists reported prescribing antibiotic prophylaxis for patients at high and moderate risk for IE. Of dental procedures capable of generating bacteremia, all were correctly identified by more than 50.0% of the sample. As for the habits of daily living, flossing and toothbrushing had almost 50.0% of correct answers, chewing had only 17.3%, and 40.9% reported that none of the actions presented a risk of bacteremia. When comparing variables, the correct prescription of amoxicillin (2 g, 30–60 minutes before the procedure) was more prevalent among cardiologists and in responders with less than 20 years of graduation (p<0.01).

Conclusion

In the present study, the prescription of antibiotic prophylaxis for IE were frequent for high- and moderate-risk patients, before oral/dental procedures. Partial knowledge was found about endocarditis, which highlights the need for continuous medical/dental education.

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Viewpoint

Coronary Artery Microfistulas: Historical Description and Contemporary Clinical Relevance

Stans Murad Netto et al. Rachel Vianna O'Neill de Souza Victor Murad Evandro Tinoco Mesquita

Introduction

Coronary microfistula was initially described as an anatomical finding in the late 1960s by Murad and colleagues, and it was later recognized as a morphofunctional abnormality of the coronary arteries capable of causing clinical findings (). This often asymptomatic entity is still poorly recognized in clinical practice, although it can be readily identified in the catheterization laboratory, cineangiography studies, and more recently by coronary CT angiography.

Initially, this condition was not taken into consideration, and it was justified as a possible “error” in cineangiography technique. Different studies have demonstrated its existence and its potential as a nosological entity responsible for myocardial ischemia, cardiac chamber overload, arrhythmias, and even heart failure.^,

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Original Article

Risk Factors for In-Hospital Mortality from Cardiac Causes After Acute Myocardial Infarction

Gabriel Vasconcelos Oliveira et al. Maria Beatriz Guimarães Raponi Patricia Magnabosco Maria Angélica Melo e Oliveira … Suely Amorim de Araújo Vanderlei José Haas Valéria Nasser Figueiredo

Abstract

Background:

Risk stratification on admission of patients with acute ST-elevation myocardial infarction (STEMI) is considered a clear strategy for effective treatment, early intervention, and survival.

Objective:

The purpose of this study was to determine the risk factors for in-hospital mortality from cardiac causes after STEMI.

Methods:

Observational, retrospective, longitudinal study, with a quantitative approach, based on data from the medical records of individuals diagnosed with STEMI treated at the Emergency Room of a large hospital in the state of Minas Gerais, Brazil, from January 2011 to July 2016. The outcome of interest was 30-day in-hospital mortality from after STEMI. For statistical analysis, the Pearson’s chi-square test, Spearman’s correlation and multivariable Cox-regression analysis were used, with a significance level of α = 0.05.

Results:

Of the 459 patients, 55 (12%) died from cardiac causes within 30 days after STEMI. Mean admission SBP of these patients was 109.08mmHg. The incidence of death was higher in women (23.7%), patients with systemic arterial hypertension (SAH) (13.8%) and elderly patients (16.5%). The elderly — heart rate (HR) = 3.54 — and women — HR = 2.55 — had a statistically significant higher risk of progressing to death when compared to younger adults and men. The highest admission SBP had a protective effect (HR = 0.97), reducing the chance of death by 3%.

Conclusion:

SBP on admission, female gender and advanced age were significant risk factors for death within 30 days after STEMI.

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Editorial

Is Spirituality a New or Renewed Tool?

Editorial referring to the article: Religiosity and Spirituality: The Relationship Between Psychosocial Factors and Cardiovascular Health

The topic of spirituality and religiosity has become more prevalent in scientific publications and clinical practice. Researchers recognize that studying this area can lead to a better understanding of physiology and potential therapeutic interventions. There are even discussions about establishing a prognosis based on spirituality and religiosity, and we are finding evidence related to this topic.

[…]

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Original Article

Clinical Profile and its Associations with Coronary Angiography Results in a Public University Hospital

Guilherme Costa et al. Esmeralci Ferreira Denilson Campos Albuquerque

Abstract

Background:

Ischemic heart disease is one of the most common causes of death worldwide. There are few data in the literature about the association of clinical profile and coronary angiography results in the Brazilian population.

Objectives:

To assess clinical variables and their associations with the results of coronary angiography and to evaluate the safety of coronary angiography in a public university hospital.

Methods:

From August 2015 to April 2018, 1 844 patients submitted to coronary angiography at the Pedro Ernesto University Hospital (HUPE, acronym in Portuguese) were enrolled in this cross-sectional study. They were evaluated by their clinical variables, angiographic results, and procedure complications. Logistic regression was used, and the criterion for determining significance was set at 5%.

Results:

The median age was 62 years, and most of the population (71%) were outpatients. Stable angina was the most common indication (62.9%). Only 19.7% underwent noninvasive cardiac testing. Arterial hypertension was the most prevalent (88.2%), followed by dyslipidemia (60.2%). Most patients (65%) had obstructive coronary artery disease (CAD). Left main coronary artery (LMCA) stenosis was found in 8.1% of patients. Older age, male sex, quantity of risk factors (RF), and peripheral artery disease were risk predictors for CAD. Death occurred only in 0.16% of the population, and acute coronary artery occlusion in 0.2%.

Conclusion:

Classic RF showed an association with CAD. The low incidence of complications suggests that coronary angiography is a safe procedure to be conducted in a public university hospital.

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Original Article

miR-27a/b Level is Associated with ABCA1 Expression and is a Potential PBMC-Based Biomarker for Coronary Artery Disease

Farshad Mirzavi et al. Safieh Ebrahimi Arezoo Rajabian Hossein Hosseini Behnam Alipoor

Abstract

Background:

Coronary artery disease (CAD) is the most common form of cardiac disease with high morbidity and mortality rates.

Objectives:

In this study, we evaluated the expression of miR-27a and miR-27b as biomarkers in peripheral blood mononuclear cells (PBMCs) of patients with CAD and investigated its correlation with cholesterol-efflux transporter, ATP-binding cassette transporter A1 (ABCA1).

Method:

This study was performed on 54 men with CAD and 51 healthy, sex- and age-matched control participants. The expression of miR-27a/b and ABCA1 genes in PBMCs were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The protein expression of ABCA1 was assessed by Western blotting. Concurrently, the specificity and sensitivity of miR-27a/b was evaluated through receiver operating characteristic (ROC) curve. The significance level adopted in the statistical analysis was 5%.

Results:

We found that miR-27a and miR-27b expression were significantly increased, while both mRNA and protein expression of ABCA1 were markedly reduced in the PBMCs of CAD patients in comparison to non-CAD controls. miR-27a/27b expression was also shown to be inversely correlated with ABCA1. ROC analysis showed that the miR-27a had an area under the ROC curve (AUC) of about 92.6 (sensitivity 83.3٪ and specificity 86.6٪) and miR-27b had an AUC of about 93.0 (sensitivity 86.6٪ and specificity 80.0 (%, suggesting the diagnostic potential of miR-27a/b in CAD patients.

Conclusions:

Our data suggested a possible role of miR-27a/b in CAD pathogenesis. Additionally, we proposed that miR-27a/b expression in PBMCs may have potential clinical implications in the diagnosis of CAD patients, but further validations in large cohorts are required.

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Original Article

Elevated D-Dimer as a Marker For Thromboembolic Events in Pediatric Patients With Covid-19: A Systematic Review

Jade Zarichta Costa et al. Pietro Preis Casagrande Franciely Vanessa Costa Maíra Cola Roberta de Paula Martins

Abstract

Background:

The 2019 Coronavirus disease is known to cause thromboembolic events. There is little information on the severe COVID-19 consequences in children.

Objectives:

To determine whether elevated D-dimer levels in the pediatric population with COVID-19 are a risk marker for the development of thromboembolic events. If so, D-dimer levels could be used to determine prophylactic anticoagulation measures if needed.

Methods:

This is a systematic review, performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. The last database search update was on December 14, 2021, resulting in 79 documents for analysis. Data were taken from various databases and queried by topic, keyword, or abstract.

Results:

Of the 79 articles found, only seven were selected for this analysis. Of these articles, only one had thromboembolic events. In the other articles, D-dimer levels were elevated but were considered controversial in terms of predicting events, with no clear association between the magnitude of D-dimer change and the magnitude of thrombosis risk.

Conclusions:

Although used for adults, D-dimer was not a good parameter for assessing the risk of thromboembolic events in individuals younger than 21 years. The main shortcomings are the fact that D-dimer increases with any type of inflammation and is, therefore, not a specific marker, and that it is elevated in many patients even without the occurrence of thromboembolic events.

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Original Article

The Relationship Between Carcinoembryonic Antigen and Epicardial Adipose Tissue

Abdulrahman Naser et al. Khagani Isgandarov Tolga Sinan Güvenç İbrahim Demir … Murat Kirişci Ahmet Ekmekçi Müslüm Şahin

Abstract

Background:

Inflammation, which is associated with an unhealthy lifestyle, plays a critical role in the development of both cardiometabolic diseases (CMD) and cancer. Carcinoembryonic antigen (CEA) is a tumor marker which also has proinflammatory properties. Recent studies have reported CEA to be associated with atherosclerosis, metabolic syndrome, and visceral adiposity. Epicardial adipose tissue (EAT) can exhibit highly inflammatory and pathogenic properties, and is a known risk factor for CMD. However, its relationship with CEA is still unknown.

Objectives:

This study aimed to investigate the possible association of CEA with EAT.

Methods:

A total of 134 Caucasian (males = 56, females = 78) individuals, aged (22-83 years), who were admitted for routine health control, were enrolled in this cross-sectional study. CEA was measured with chemiluminescent microparticle immunoassay (CMIA). EAT was measured by transthoracic echocardiography, and the visceral fat rating (VFR) was assessed by a body composition analyzing machine. The p-value <0.05 was considered statistically significant.

Results:

CEA levels were categorized as tertiles: T1, 0.5-1.04; T2, 1.06–1.69; and T3, ≥1.7 ng/ml. The mean age, weight, VFR, EAT, and fasting glucose, as well as the median of systolic blood pressure (SBP), creatinine, and AST increased with the increasing CEA tertiles. CEA was significantly associated with EAT (r = 0.55, P<0.001) and VFR (r = 0.36, P<0.001). Multivariate linear regression analysis confirmed that gender, age, and EAT were the significant independent variables associated with CEA.

Conclusion:

Individuals with increased EAT have higher levels of CEA, suggesting that this biomarker is most likely produced by EAT; however, additional investigations are required to improve the present work.

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Original Article

Frequent Cardiovascular Manifestations Associated With SARS Cov-2 Infection: Experience at a Tertiary Hospital In Cali, Colombia

Duvan Arley Galindes-Casanova et al. Edith Norela Benitez-Escobar Luis Álvaro Melo-Burbano Nelson Eduardo Murillo-Benitez … Juan Carlos Avila-Valencia Jorge Enrique Daza-Arana

Abstract

Background:

Coronavirus disease 2019 (COVID-19) mainly affects the respiratory system, while the most common extrapulmonary complication of COVID-19 is cardiovascular involvement.

Objective:

To identify the frequency of electrocardiographic changes and cardiac arrhythmias in patients hospitalized with COVID-19 infection.

Methods:

This was a cross-sectional study, including patients aged >18 years with diagnosis of severe acute respiratory syndrome coronavirus 2 infection in a high-complexity hospital in Santiago de Cali, Colombia, from March to September 2020. A descriptive analysis with an analytical component and multiple logistic regression analysis were performed; all estimates were established with a 95% confidence level (CI) and a 5% significance level.

Results:

This study included 183 individuals; of whom 160 were considered for electrocardiographic analysis, 63% of which evidenced significant findings, the most frequent being sinus tachycardia (29.4%). The frequency of myocardial injury was 21.9% and was more common among non-survivors than among survivors (41.7% vs. 12.2%, p < 0.001). Myocardial injury was also significantly more common in patients who presented electrocardiographic findings than those who did not (26.5% vs. 12.1%, p = 0.032) and in those who required intensive care admission (31.8% vs 10.5%, p < 0.001). The strongest mortality-associated factor was the need for mechanical ventilation — odds ratio (OR), 9.14; 95% confidence interval, 3.4–24.5.

Conclusions:

Electrocardiographic findings in patients with COVID 19 are frequent, including newly diagnosed arrhythmias, justifying the use of cost-effective tools for the initial approach and follow-up of this affected population. Worse outcomes depend on factors such as invasive mechanical ventilation, comorbidities, age, and superinfection.

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Editorial

ST-Elevation Myocardial Infarction and COVID-19: Is There a Synergistic Effect?

Eduardo Martelli Moreira et al. Bernardo Augusto Rosário Pedro Felipe Gomes Nicz

The SARS-CoV-2 pandemic has widely and profoundly impacted cardiovascular care worldwide. In Brazil, a decrease in emergency department visits for chest pain has been witnessed in both public and private healthcare providers.^, There has been a 23% reduction in weekly emergency department visits for chest pain, from 13.0 to 10.1 per 100.000 habitants, in public health services in Curitiba, Paraná. Private emergency departments have reported an even higher 42% reduction in suspected acute coronary syndrome presentations. A meta-analysis of 12 international studies, conducted with50,123 patients, has shown a nearly 25% decline, from 11.0 to 8.2, in ST-elevation myocardial infarction (STEMI) daily admissions during the pandemic. Although no increase in symptom onset to first medical contact (patient delay) was reported, there was an increase in door-to-balloon time, and no change in mortality was reported.

In this edition of the International Journal of Cardiovascular Sciences, Vargas et al. report on the impact of the COVID-19 pandemic concerning the reperfusion times of 336 patients who underwent primary angioplasty for STEMI at a single, mid-sized, tertiary center in Passos, Minas Gerais, Brazil. This was a retrospective, before-and-after study carried out between January 1, 2018, and August 31, 2021.

[…]

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Original Article

Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia

Mehmet Zulkuf Karahan et al. Adem Aktan Tuncay Güzel Fethullah Kayan Serhat Günlü

Abstract

Background:

Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE.

Objectives:

The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE.

Methods:

Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student’s t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine.

Results:

The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04.

Conclusion:

The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE.

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Editorial

Quality of Life Assessment in Patients With ST-Elevation Myocardial Infarction (STEMI): An Opportunity to Improve the Quality of Care That Should Not Be Missed

Ana Teresa Timóteo

In chronic diseases, the Quality of Life (QoL) is one of the most important patient-reported outcomes. Cardiovascular diseases are the main cause of death worldwide and ischemic heart disease represents an important health burden. In a large population-based cohort, individuals with self-reported previous myocardial infarction (MI) presented worse self-perceived health statuses in all domains, particularly in mobility and anxiety / depression. However, QoL was not independently associated with MI but instead was associated with age, sex and number of comorbidities, which were significantly higher in patients with prior MI. In this study, long-term QoL was more impaired in men, as compared to women. Nevertheless, in population-based cohorts, we have many possible pitfalls, considering that a diagnosis of MI and other chronic diseases is self-reported; therefore, it is impossible to confirm this diagnosis. It is also impossible to differentiate between ST-elevation MI (STEMI) and non-STEMI, and it is rarely possible to assess the QoL at the same point in time after MI. In fact, we can expect QoL to be much different in the first few months after MI when compared with the QoL several years later.

A more structured study was performed in Australia, in which the QoL was assessed at earlier time points (4 weeks and 6 months). The study sample consisted primarily of males (representing more than 75%), but with a mean age similar to previous studies in MI populations. Health-related QoL improved at 6 months following primary percutaneous coronary intervention for physical and mental health. All aspects of cardiac-specific health status had improved (physical limitation, anginal frequency, treatment satisfaction, and QoL), except for angina stability. Patients aged ≥ 70 years had poorer physical QoL and physical limitations, but better mental QoL at both time points. However, patients were from a specific remote geographic region and were included in 2010 and 2011. Therefore, this did not represent a contemporary sample of patients, and it does not reflect current treatment standards. All in all, those results are not comparable with current populations of STEMI patients from different regions around the world.

[…]

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Case Report

Bentall-De Bono Reoperation Associated With Pseudoaneurysm and Infectious Endocarditis

Janayna Rabelato et al. Iuri Betuel Gomes Antonio Adnaldo da Silveira Maia Daniel Chagas Dantas … Antonio Flávio de Almeida Mario Issa

Abstract

We present the case of a 55-year-old patient who underwent the Bentall-De Bono procedure with mechanical prosthesis in 2005 and was admitted to the emergency department in July 2020 with mixed shock. Complementary exams showed an abscess involving the prosthetic tube, two thirds of the aortic valve circumference and the left ventricle, with a neocavity of about 45 mm in diameter from the aortic sinus to the ascending aorta. The patient underwent surgical repair, with a new procedure using the Bentall-De Bono technique, now associated with coronary artery bypass grafting with a great saphenous vein graft between the aorta and the anterior descending artery. Culture of samples collected intraoperatively showed Staphylococcus epidermidis. The patient received antibiotic therapy for 30 days, evolving favorably, and is under regular outpatient follow-up.

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Editorial

Cardiorespiratory Optimal Point: A New Kid in the Block or an Established Star?

Summary

COP researchers have already conducted very important research that must be expanded, including larger and more diverse and better defined populations, with patients around the world, different cardiovascular and non-cardiovascular diseases, tests using a treadmill (more experience with treadmill CPET is needed), and evaluation of the prognostic values of sub-maximal parameters, such as COP and eventually VO ₂ at VT1, versus the maximal parameters, such as pVO ₂ , VE/VCO ₂ slope, and OUES.

A clear answer is needed: Is the information obtained from a submaximal CPET enough, or should it be considered only as an alternative when it is not possible to perform a maximal CPET or when peak VO ₂ was not reached?

[…]

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Original Article

Association Between Active Commuting and Cardiometabolic Diseases in Primary Health Care Users

Lucas Bressan Pes et al. Gustavo Olszanski Acrani Ivana Loraine Lindemann Shana Ginar da Silva

Abstract

Background

Although active commuting is inversely related to cardiovascular disease risk factors, these associations are unknown among Brazilian primary health care users.

Objective

To investigate the association between active commuting to daily activities and the prevalence of cardiometabolic diseases.

Methods

This cross-sectional study, conducted between May and August 2019, included primary health care users from all 34 primary health care centers in Passo Fundo, a city in southern Brazil. Cardiometabolic diseases (type 2 diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, cardiovascular diseases, and overweight/obesity) were measured by self-reported medical diagnosis using a questionnaire. Active commuting was analyzed dichotomously: daily commuting on foot or by bicycle was considered active, while daily commuting by car, motorcycle, or bus was considered passive. To determine the association between cardiometabolic diseases and active commuting, crude and adjusted prevalence ratios (PR) were estimated using Poisson regression, considering p <0.05 significant.

Results

The sample consisted of 1443 patients. There was an inverse association between active commuting and type 2 diabetes (PR: 0.59; 95% CI [Confidence Interval]: 0.39-0.90) and overweight/obesity (PR: 0.83: 95% CI: 0.71-0.98).

Conclusion

A lower prevalence of type 2 diabetes and obesity/overweight was observed in people who actively commute. These findings indicate that changes in urban infrastructure to enable safe active commuting will positively impact the health of the population.

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Original Article

Analysis of the SHARPEN Score in the Prediction of In-Hospital Mortality of Patients With Infective Endocarditis Undergoing Cardiac Surgery

Mateus Correa Lech et al. Joel Stefani Lucas Fernando Fabra Miguel Gus Fernando Pivatto Júnior

Abstract

Background

The SHARPEN score was developed to predict in-hospital mortality in patients hospitalized for infective endocarditis (IE), undergoing or not undergoing cardiac surgery. A comparison with other available scores has not yet been carried out.

Objective

To evaluate the performance of the SHARPEN score in predicting in-hospital mortality in patients hospitalized for IE undergoing cardiac surgery and compare it with that of both nonspecific and IE-specific surgical scores.

Methods

Retrospective cohort study including all admissions of patients ≥18 years who underwent cardiac surgery due to active IE (modified Duke criteria) at a tertiary care university hospital between 2007 and 2016. The SHARPEN score was compared to the EuroSCORE, EuroSCORE II, STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E scores. Differences P<0.05 were considered statistically significant.

Results

A total of 105 hospitalizations of 101 patients (mean age 57.4±14.6 years; 75.2% male) were included. The median SHARPEN score was 11 (9-13) points. The observed in-hospital mortality was 29.5%. There was no statistically significant difference in observed vs. estimated mortality (P = 0.147), with an area under the ROC curve of 0.66 (P = 0.008). In comparison with the other scores, no difference was observed in discriminative ability. The statistics of the SHARPEN score at a cutoff >10 points — positive predictive value (PPV): 38.1%, 95%CI:30.4-46.6; negative predictive value (NPV): 80.0%, 95%CI:69.8-87.4; and accuracy: 58.1%, 95%CI:48.1-67.6 — showed overlapping 95%CIs, indicating no significant difference between scores.

Conclusions

The SHARPEN score did not present parameters with a significant difference in relation to the other scores analyzed; despite the easy obtainment of its few variables, it has limited applicability in clinical practice, like other existing scores.

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Original Article

Ischemic Stroke and Acute Myocardial Infarction: Trends in in-Hospital Mortality in Brazil from 1998 to 2018

Júlio Martinez Santos et al. Alessandra Barboza Resende Martinez Emerson de Jesus Silva Gustavo Roberto Santana … Romero Henrique de Almeida Barbosa David Fernandes Lima Matheus Rodrigues Lopes Johnnatas Mikael Lopes

Abstract

Background

Ischemic stroke and acute myocardial infarction (AMI) are cardiovascular diseases with high morbidity and mortality rates in Brazil and worldwide. Their outcomes are influenced by public policies aimed at mitigating risk factors and by investments in infrastructure of emergency support and quality of hospital care.

Objective

To analyze the trend in the proportion of in-hospital deaths from ischemic stroke and AMI in Brazil as a way of evaluating the effectiveness of urgency and emergency services.

Methods

Ecological time series study using data from the Hospital Information System. The outcome was the proportion of in-hospital deaths from ischemic stroke and AMI with stratification by sex and state. Prais-Winsten regression was used to analyze the trend between 1998-2018 with α≤0,05.

Results

The proportion of deaths from AMI and ischemic stroke declined in the time series (p<0.001), decreasing annually by 0.17% and 0.25%, respectively. In 20 years, it reduced 43.76% (ischemic stroke) and 32.39% (AMI) in both sexes. However, the decline was more evident in the South and Southeast regions.

Conclusion

The reduction in hospital deaths from AMI and ischemic stroke was heterogeneous among Brazilian regions, which may be related to inequality in emergency services and hospital support.

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Erratum

ERRATUM

Int J Cardiovasc Sci. 2022; 35(4), 530-536

In Original Article “Epicardial Fat Tissue Thickness and Omentin in Patients with Atrial Fibrillation”, with DOI number: , published in International Journal of Cardiovascular Science, 35(4). Correct the Orcid of the author Alaeddin Avşar from “” to “”.

[…]

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Review Article

The Role of Digital Technology and New Strategies in Engagement and Adherence Among Patients With Cardiometabolic Disease

Márcio Krakauer et al. Marcella Flores Renata Vital do Nascimento Lima Lara Abrão Sachetti

Abstract

This article explores challenges and barriers to managing cardiometabolic conditions, highlighting strategies and technologies for improving patient adherence. Approaches such as simplifying prescriptions, patient empowerment, health education, setting short-term goals, understanding social context, self-monitoring, and gamification have been effective in promoting adherence. The use of health apps for chronic diseases has also been increasing, facilitating medication adherence and self-monitoring. Integrating these approaches into clinical practice can lead to consistent outcomes and reduce care-associated costs.

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Original Article

First Evaluation of the Brazilian Advanced Life Support Training (TECA A)

Fabrício Nogueira Furtado et al. Antonio Carlos de Camargo Carvalho Iran Gonçalves Junior Manoel Fernandes Canesin … Sergio Timerman Rodrigo Marques Gonçalves Daniela Frizon Alfieri Dirceu Almeida

Abstract

Background

Cardiac arrest (CA) is a common condition associated with high mortality. The Brazilian advanced life support training TECA A (Treinamento em Emergências Cardiovasculares Avançado — Advanced Cardiovascular Emergency Training) was created to train healthcare professionals in the management of CA. However, there are no studies evaluating the effectiveness of TECA A.

Objective

To assess the impact of TECA A on the management of CA using a simulated CA situation.

Methods

Fifty-six students underwent a simulated case of CA in a manikin. The students’ performance in the management of CA was assessed for the time to first chest compression and defibrillation and for a global assessment score using a structured tool. These items were assessed and compared before and after the TECA A. Exclusion criteria were previous participation in CA trainings and absence from class. Categorical variables were compared using the McNemar test and quantitative variables using the Wilcoxon test. All tests were two-tailed, and statistical significance was set at p < 0.05.

Results

Compared with before TECA A, median global assessment scores were higher after TECA A (pre-training: 4.0 points [2.0-5.0] vs. 10 points [9.0-10.0]; p<0.001), the time to start chest compressions was shorter (pre-training: 25 seconds [15-34] vs. 19 seconds [16.2-23.0]; p=0.002) and so was the time to defibrillation (pre-training: 82.5 seconds [65.0-108.0] vs. 48 seconds [39.0-53.0]; p<0.001).

Conclusions

The TECA A promoted a higher adherence to cardiopulmonary resuscitation (CPR) guidelines and a reduction in the time elapsed from CA to first chest compression and defibrillation.

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Editorial

Publication of a Scientific Article: What Authors Need to Know

Marcella dos Santos Lopes da Silva et al. Cláudio Tinoco Mesquita

What are the first steps to write a scientific article?

It is always important to remember who the authors of a scientific article should be, namely, the people who: (1) helped to conceive or design the work; or obtained, analyzed, or interpreted research data; and (2) participated in writing the manuscript or critically reviewed it for important intellectual content; and (3) gave final approval of the version of the text to be published; and (4) agreed to ensure that questions regarding the accuracy or completeness of any part of the work are properly investigated and resolved.

A scientific article is structured to allow other researchers to understand the context, objectives, methods used, results obtained, and conclusions of the study ().

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