2025;38 – ABC CARDIOL

IJCS

ABC Family | IJCS

Original Article

Effects of Noninvasive Electrostimulation on Symptoms of lower Limb Peripheral Arterial Disease: a Systematic Review

Ana Paula Ferreira et al. Ana Flávia Ferreira Plinio dos Santos Ramos Thiago Casali Rocha Djalma Rabelo Ricardo

Abstract

Background:

Peripheral arterial disease (PAD) is primarily characterized by intermittent claudication (IC), a symptom resulting from insufficient oxygen supply to skeletal muscles during physical activity. IC manifests as discomfort in the lower limbs during exertion due to muscle ischemia and is typically relieved by rest.

Objectives:

To evaluate the effects of noninvasive electrostimulation on walking distance and claudication-related pain in individuals with lower limb PAD.

Methods:

This systematic review was conducted in accordance with PRISMA guidelines. Clinical trials published in English, Portuguese, or Spanish were selected from the MedLine, PEDro, and SciELO databases up to December 2024. The search strategy was guided by the PICO framework, using descriptors related to “peripheral artery disease,” “intermittent claudication,” and “noninvasive electrostimulation.” Studies were included if they involved human participants diagnosed with PAD and presenting with Fontaine stage II intermittent claudication.

Results:

Seven clinical trials involving a total of 314 participants (mean age: 66.8 ± 3.6 years) were included. Four types of noninvasive electrostimulation were identified: neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), functional electrical stimulation (FES), and electroacupuncture. Most studies reported that electrostimulation improved both pain-free and maximum walking distances, as well as reduced claudication symptoms.

Conclusion:

Noninvasive electrostimulation appears to be a promising adjunctive therapy for individuals with peripheral arterial disease, offering potential benefits in symptom relief and walking capacity. Given its safety, low cost, and ease of application, this intervention may serve as a practical strategy to complement traditional treatment approaches. However, further high-quality clinical trials are needed to establish standardized protocols and optimize clinical outcomes.

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Case Report

Transcatheter Correction of Aortic-Right Ventricular Shunt Following Aortic Valve Replacement: A Case Report

Adnaldo da Silveira Maia et al. Mauro Henrique Batista Camacho Andresa Fernandes Perego Dayara Hoffmann Mayer José Honório Palma da Fonseca

Abstract

We describe the first case in the literature of transcatheter correction of aortic-right ventricular (Ao-RV) shunt after aortic valve replacement (AVR) with an Intuity^® prosthesis (Edwards Lifesciences). A 79-year-old patient with a history of coronary artery bypass grafting and aortic regurgitation underwent AVR using a rapid-release 25-mm Intuity^® prosthesis. After 45 days, he presented with severe heart failure, and an Ao-RV shunt was identified on transthoracic echocardiography. Given his history of previous cardiac surgeries, percutaneous correction was attempted. Initially, an attempt was made to catheterize the defect via the transapical approach, which was unsuccessful. The right femoral artery was punctured, and the shunt was catheterized via the aorta, with the implantation of a MemoPart ventricular septal defects (VSD) occluder, resulting in a significant reduction of the shunt. The patient was then transferred to the intensive care unit. However, there was no satisfactory clinical improvement, and transthoracic echocardiography revealed persistent Ao-RV shunt. Therefore, the surgical team opted for a new approach through the femoral artery and a second MemoPart VSD occluder was implanted. A transesophageal echocardiogram showed no leak, and the patient progressed satisfactorily and was discharged from the hospital. Shunts after AVR are rare. In these conditions, percutaneous management is a safe and feasible technical option. This is the first case reported in the literature of this type of complication after Intuity prosthesis implantation.

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Review Article

The Use of Simulation-Based Learning in Cardiology Education: A Systematic Review

André Luiz Lisboa Cordeiro et al. Washington Luiz Abreu de Jesus Tiago Veltri Osmastroni da Trindade Rodolfo Macedo Cruz Pimenta Rodolfo Prado da Silva

Abstract

The use of simulation in medical education is now a well-established practice. Many articles currently explore various simulation methods and the impacts reported by students. In cardiology, this is no exception; however, reviews on the topic do not focus on a specific area.

The objective of this study was to evaluate the existing evidence on the use of simulation in medical education, with a specific focus on cardiology.

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched the Ovid MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), CINAHL, and CENTRAL databases. Clinical trials reporting the use of realistic simulation for teaching cardiology were included. Two independent reviewers assessed the studies for eligibility. The simulation methods and topics, along with their evaluations, were analyzed.

A total of 435 articles were initially identified based on the search criteria. Seven articles were selected for detailed analysis. Three of these studies reported an improvement in cardiac auscultation skills through simulation. One study showed improved ability to recognize coronary anatomy; another demonstrated enhanced performance during catheterization, and one highlighted better outcomes during angioplasty. Only one study showed a slight improvement in the diagnosis of acute myocardial infarction. In addition to these clinical improvements, there was also a noted increase in student engagement and satisfaction.

Realistic simulation, when integrated as a complement to existing curricula, enhances the performance of cardiology students.

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Editorial

Red Wine and Vascular Reactivity: Evidence And Uncertainties

Aurora Felice Castro Issa

Despite the absence of long-term randomized clinical trials on alcohol consumption, several studies have found that light to moderate alcohol consumption is associated with reduced cardiovascular mortality and a decreased risk of Coronary Artery Disease (CAD) compared with no alcohol consumption or excessive alcohol consumption. However, other studies have questioned this benefit, and no level of alcohol consumption has been shown to be beneficial for other cardiovascular disease outcomes (stroke, hypertension, heart failure, etc.).

The French paradox, which states that mortality from CAD is lower in France than would be expected from the country’s high national prevalence of smoking and saturated fat consumption, has been attributed to the frequent consumption of red wine, which contains phenolic and flavonoid substances with antithrombotic and antioxidant properties. Its consumption has also been associated with improvements in heart rate variability, which may contribute to a better prognosis of CAD.

[…]

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Editorial

The Burden of Cardiovascular Disease in Brazil: Insights From a Decade of Emergency Hospital Admissions

Fernando Yue Cesena

Cardiovascular disease (CVD) remains the leading cause of death both globally and in Brazil.^, Although cancer has surpassed CVD as the top cause in some countries, projections indicate that CVD will continue to be the primary cause of mortality in Brazil for the decades to come.^,

Epidemiological analyses are essential for evaluating current public health strategies and informing future policy decisions. In this issue of the International Journal of Cardiovascular Sciences, an epidemiological study of recent emergency hospital admissions for CVD in Brazil is presented. Using data from the Department of Informatics of the Brazilian Unified Health System (DATASUS), the authors report data from over eight million hospital admissions from 2013 to 2023.

[…]

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Original Article

Left Versus Right Radial Access in Elderly Patients for Coronary Procedures: A Systematic Review and Meta-Analysis

Anna Loise da Cruz Gonçalves et al. Deivyd Vieira Silva Cavalcante Brenda de Adonai Rodrigues Martins Caroline de Oliveira Fischer Bacca … Júlia Gonçalves Gadelha Suelen Queiroz Gabriel Erzinger Octávio Drummond Guina

Abstract

Background:

Radial artery access is widely used in coronary procedures, but the optimal choice between left (LRA) and right (RRA) radial access remains controversial, especially in older patients.

Objective:

Compare LRA and RRA in patients ≥ 70 years undergoing coronary procedures.

Methods:

This study conducted a systematic review and meta-analysis of observational studies and randomized clinical trials (RCTs), adopting a significance level of 5% for all statistical analyses. We searched PubMed, Embase, and Cochrane Central for studies comparing LRA and RRA in patients aged ≥ 70 years. The main outcomes were fluoroscopy time, contrast volume, and procedure difficulty.

Results:

We included 1,094 patients from 4 studies, of which 3 were RCTs. Among them, 821 (75%) patients underwent the procedure via RRA. The LRA group showed a significantly shorter fluoroscopy time (standard mean difference [MD]: −0.41; 95% confidence interval [CI]: −0.67 to −0.42; p < 0.01; I² = 80%), and there was a significant reduction in the contrast volume between the groups, favoring LRA (MD: −13.04 milliliters; 95% CI: −18.0 to −8.20; p < 0.01; I² = 0%). However, there was no significant difference in the perceived difficulty level between the groups (risk ratio [RR]: 1.03; 95% CI: 0.61 to 1.73; p = 0.92; I² = 0%).

Conclusion:

LRA is associated with a significantly shorter fluoroscopy time, suggesting a greater efficiency in terms of radiation exposure. These findings imply that, while LRA may offer some efficiency benefits, the choice between LRA and RRA should consider other clinical and technical factors, such as operator preference and experience.

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Editorial

C-Reactive Protein as a Prognostic Tool in Acute Heart Failure: Evidence from Low-Resource Settings

Cristhian Espinoza Romero et al. Hernán Patricio García Mejía Fábio Fernandes

Acute heart failure (AHF) remains a leading cause of hospitalization and cardiovascular mortality worldwide, with an even greater burden in low- and middle-income countries. In Brazil, in-hospital mortality for AHF is approximately 12%, compared to 4% reported in high-income countries.^,

In this context, the prospective study by Ferigato et al., conducted at a public hospital in São Paulo, assessed the prognostic value of C-reactive protein (CRP) in patients with AHF. This investigation is particularly relevant given the structural limitations of the Brazilian public healthcare system, where conventional biomarkers such as natriuretic peptides are often unavailable. Therefore, CRP—a low-cost and widely accessible inflammatory marker—emerges as a promising alternative for risk stratification during hospitalization.

[…]

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Original Article

Evaluation of Different Therapeutic Approaches for Acute Coronary Syndromes in Patients Undergoing Chronic Dialysis: A Retrospective Cohort Study

Matheus Eduardo França et al. Ana Luiza de Fragas Franciani Rodrigues da Rocha Leonardo Claudino Ribeiro Silvia R. Froes Toniazzo

Abstract

Background:

Cardiovascular disease (CVD) is the leading cause of death among individuals with chronic kidney disease (CKD), particularly those undergoing dialysis, accounting for approximately 40% of deaths. The prevalence of ischemic coronary disease among patients undergoing hemodialysis over the age of 45 reaches 41%.

Objective:

To analyze outcomes of symptomatic coronary artery disease (CAD) in patients undergoing chronic dialysis, stratified by invasive assessment, and treated with one of three approaches: medical therapy alone (MTA), percutaneous coronary intervention (PCI), or coronary artery bypass grafting.

Methods:

This was a retrospective, analytical, observational cohort study based on data from electronic medical records collected between 2013 and 2023, including a total of 68 patients. Quantitative variables were analyzed using one-way Analysis of Variance (ANOVA), and qualitative variables were assessed using Pearson’s chi-square test. A p-value <0.05 was considered statistically significant.

Results:

The mean age was 60.2 ± 13.1 years, with a male predominance of 42 patients (62.8%). The highest mortality was observed in the MTA group with 25 deaths (69.4%), followed by PCI with 10 deaths (56.6%), and the lowest in the coronary artery bypass grafting group with six deaths (42.9%). Among patients who did not use statins, 19 (82.6%) died (p < 0.01). The lowest rate of readmission due to coronary syndrome occurred in the MTA group (two patients; 18.2%), while the highest was in the PCI group (six patients; 54.5%) (p = 0.02).

Conclusion:

Although no statistically significant difference in mortality was found among the three therapeutic strategies, MTA was associated with lower rates of readmission and repeat cardiac catheterization. In contrast, PCI was linked to a higher risk of readmission due to coronary syndrome.

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Letter to the Editor

Defining Speckle Tracking Echocardiography (STE); used to Diagnose Systolic Subclinical Dysfunction

Janita Shabbir et al. Aamna Ahmed Alwina Shabbir Manahil Bahrawar Ahmad Akhtar

We read with great interest the article, “Systolic Subclinical Dysfunction in Anabolic Steroid Users: A Real-Life Study,” published in April 2025. The author used myocardial work analysis and speckle tracking echocardiography (STE) to assess and detect early systolic dysfunction in bodybuilders using anabolic steroids. While the term myocardial work analysis was defined, the author did not provide a definition for STE. According to the author, “Myocardial work analysis is a recent technique that incorporates left ventricular (LV) afterload data into global longitudinal strain (GLS) analysis. In addition to correlating with myocardial oxygen consumption, myocardial work enables the analysis of LV efficiency, proving to be a highly effective technique for ventricular performance analysis.” We commend the author for clarifying the decision to forgo conventional echocardiography, acknowledging that normal echocardiographic parameters do not rule out the presence of subclinical ventricular dysfunction on two-dimensional echocardiography.

We would like to provide a definition of STE to enhance conceptual clarity for readers.

[…]

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Original Article

Innovative Health Education Strategies: Training Professionals in Hypertension and Diabetes Care in Primary Health Care

Thiago Barbabela de Castro Soares et al. Priscila Lenita Candida dos Santos Regina Márcia Faria de Moura Daisy Motta-Santos … Reginaldo Gonçalves Polianna Delfino Pereira Daniella Nunes Pereira Clara Rodrigues Alves de Oliveira Lilian Cristina Rezende Aline Cristine Souza Lopes Milena Soriano Marcolino

Abstract

Background:

Cardiovascular diseases (CVD) are the leading cause of death worldwide, and behavioral changes are a cornerstone of their prevention and treatment. However, implementing such changes can be challenging, and the use of validated protocols may support this process.

Objectives:

To develop, implement, and evaluate a continuing education protocol for primary care professionals focused on creating and monitoring action plans for the care of patients with arterial hypertension (AH) and diabetes mellitus (DM).

Methods:

The strategy involved 20 hours of in-person workshops and 15 hours of online training, based on Ministry of Health guidelines and covering topics such as physical activity, nutrition, and lifestyle. Evaluation was conducted through the development of team-based action plans and the administration of a satisfaction questionnaire.

Results:

The model was implemented in five municipalities, with 166 healthcare professionals participating in the in-person workshops. All teams developed action plans to implement the covered topics within their local contexts. The workshops on physical activity, nutrition, and lifestyle change were mostly rated as “good,” “very good,” or “excellent.” The most frequently mentioned terms in the qualitative assessments were “content,” “knowledge,” and “practices.” The strategy proved feasible, and partnerships with local public institutions enabled the active involvement of health professionals in proposing solutions to identified issues ().

Conclusion:

The action plans were tailored to local realities and reflected a high level of satisfaction with both the content and the hands-on approach of the sessions.

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Original Article

Impact of Updated Guidelines on TAVI Outcomes in a Health Maintenance Organization in Brazil: A Decade-Long Retrospective Study

Maria da Gloria Cruvinel Horta et al. Marcus Carvalho Borin Julia Teixeira Tupinambas Luciano Rios Scherrer … Mateus Goncalves Souza Matheus del-Valle Carina Rejane Martins Daniel Pitchon dos Reis Geraldo Jose Coelho Ribeiro Karina de Castro Zocrato Lelia Maria de Almeida Carvalho Marcela Pinto Freitas Mariana Michel Barbosa Mariza Cristina Torres Talim Fernando Biscione Martin Silvana Marcia Bruschi Kelles

Abstract

Background

Aortic stenosis is a progressive condition that leads to significant morbidity and mortality if untreated. Transcatheter aortic valve implantation (TAVI) provides a less invasive alternative to surgical aortic valve replacement (SAVR), particularly for high-risk patients.

Objectives

This study evaluates the outcomes of TAVI procedures performed in a Health Maintenance Organization (HMO) in Brazil from 2013 to 2023, focusing on the impact of clinical guidelines updated in 2018.

Methods

A retrospective cohort study included 325 patients diagnosed with severe symptomatic aortic stenosis who underwent TAVI. Patients were divided into two groups: those treated before January 2019 (n=56) and those treated from January 2019 onwards (n=269). The primary outcomes included all-cause mortality and major complications, while the secondary outcomes encompassed procedural success rates and specific complication rates. Continuous variables were analyzed using the Mann-Whitney test, and categorical variables were analyzed using the chi-square test or Fisher’s exact test. Statistical significance was defined as p < 0.05.

Results

After January 2019, the shift to self-expanding valves was associated with a statistically significant reduction in pacemaker implantation rates (from 28.6% to 18.2%, p=0.03), whereas other outcomes did not reach statistical significance.

Conclusions

The implementation of updated protocols was associated with improved TAVI outcomes, especially a reduced need for pacemaker implantation, supporting its expanded use in intermediate-risk patients.

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Original Article

Chocolate Consumption Does Not Reduce the Risk of Cardiovascular Events and Increases the Risk of Gastrointestinal Bleeding One Year After the First Myocardial Infarction

Daniel Medeiros Moreira et al. Lara Marcon Dandolini Tammuz Fattah Rodrigo de Moura Joaquim Roberto Leo da Silva

Abstract

Background

Coronary artery disease is the leading cause of death worldwide, with high social and financial costs. Although previous studies have demonstrated the potential of chocolate to reduce coronary events, data on its effects in patients who have suffered an acute myocardial infarction (AMI) are lacking.

Objective

To evaluate the impact of chocolate consumption on the incidence of events in patients with AMI followed for one year.

Methods

A subanalysis of the Catarina Heart study, which evaluated patients hospitalized with a diagnosis of the first AMI, was conducted. During hospitalization, patients were asked about their chocolate consumption before the event. The incidence of events was compared between consumers and non-consumers of chocolate before the AMI. The analyzed outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiovascular mortality, reinfarction, stroke, in-stent restenosis, acute stent thrombosis, gastrointestinal bleeding, and bleeding requiring transfusion. Cox regression models were applied, and p < 0.05 was considered statistically significant.

Results

A total of 1404 patients were analyzed, of whom 490 (34.9%) consumed chocolate. Chocolate consumption neither reduced the risk of MACE (hazard ratio [HR] = 0.88 [0.57 – 1.37], p = 0.569) nor showed benefits in other outcomes, such as cardiovascular mortality, reinfarction, or stroke. However, its consumption was significantly associated with an increased risk of gastrointestinal bleeding (HR = 2.89 [1.16 – 7.24], p = 0.023) without increasing the risk of bleeding requiring transfusion or acute stent thrombosis.

Conclusion

Chocolate consumption before AMI did not reduce major cardiovascular events and was associated with an increased risk of gastrointestinal bleeding.

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Review Article

Challenges and Opportunities in Teaching and Training Pediatric Cardiac Critical Care in Developing Countries: A Narrative Review

Carolina Vieira de Campos et al. Carlos Roberto Ribeiro Carvalho

Abstract

Congenital heart disease (CHD) is a public health issue in developing countries. Effective teaching and training are vital for healthcare professionals to provide adequate care for critically ill cardiac children, but there are many obstacles to adequately training a cohort of healthcare professionals in low- and middle-income countries (LMIC), where education practice is not always aligned with current education evidence. Work overload, time constraints, language, and the healthcare structure itself hinder standardization of an optimal training process for this highly complex scenario. This narrative review aims to explore how current teaching methodologies may help overcome challenges in pediatric cardiac critical care (PCCC) education, thus helping clinical practice, with a special focus on developing countries and the Brazilian scenario.

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Case Report

Cerebral Thromboembolism as a Primary Manifestation of Severe Rheumatic Mitral Stenosis: A Clinical Case from Guayaquil, Ecuador

Patricia Delgado Cedeño et al. Estefania Carolina Arteaga Herrera Cesar Joao Tumbaco Mite Elsie Valdivieso Valenzuela … Boris Barreno Vera Karen Llimaico Del Pin

Abstract

Mitral stenosis (MS) is a valvular disease that predominantly affects women, with rheumatic fever being the most prevalent etiological cause. The hemodynamic consequences of rheumatic MS may include left atrial (LA) pressure overload and dilation, atrial fibrillation (AF), secondary pulmonary hypertension, heart failure, atrial thrombosis, and systemic thromboembolism. Echocardiography is the gold standard for diagnosing, quantifying severity, and evaluating the hemodynamic impact of MS.

We present the case of a 41-year-old female patient who arrived at the emergency department with a 6-hour history of dysarthria and right hemiparesis. Cardiovascular examination revealed sinus rhythm and a diastolic murmur with an opening snap at the mitral focus. Imaging studies revealed severe MS with LA dilation and a patent foramen ovale without hemodynamic impact. The patient underwent percutaneous balloon mitral valvuloplasty, which resulted in an increase in mitral valve area (MVA), a reduction in pulmonary pressure, and significant functional improvement.

Cerebral thromboembolism can be the first manifestation of severe MS, even in patients with sinus rhythm. Anticoagulation is crucial for those with severe atrial dilation to reduce the risk of embolic events. This case highlights the importance of early diagnosis and appropriate treatment based on clinical guidelines, as they improve patient quality of life and reduce the risk of future complications. It also serves as a reminder that stroke may be the sentinel event in silent but severe mitral valve pathology.

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Original Article

Left Ventricular Hypertrophy on Electrocardiography and Chronic Kidney Disease: A Case–Control Pilot Study

Nabil Hajar et al. Nabila Nuralya Joveazhari Shofa Chasani Zulfachmi Wahab … Galih Prakasa Adhyatma Indira Aura Balqis Zeidan Ahmad Fahdalhaq Bintang Adhiyoso Wicaksono

Abstract

Background:

Chronic kidney disease (CKD) is a condition characterized by abnormalities in kidney structure or function lasting more than 3 months. CKD is known to increase the risk of cardiovascular events, which may be predicted by electrocardiography (ECG) abnormalities, such as left ventricular hypertrophy (LVH). ECG is widely used in under-resourced health care settings due to its practicality and accessibility.

Objective:

This study aimed to analyze the relationship between LVH and CKD using ECG.

Methods:

This analytical observational study used a case–control design. The case group included patients diagnosed with CKD, while the control group consisted of patients presenting with signs and symptoms suggestive of CKD but without a confirmed diagnosis. Each group included 35 participants. Simple random sampling was used for the case group, and stratified random sampling for the control group. ECG examinations were performed, and measurements were taken using calipers in millimeters (mm). The Sokolow–Lyon criteria were applied to identify LVH. Data were analyzed using an independent t-test, with statistical significance set at p < 0.05.

Results:

The Sokolow–Lyon score was significantly higher in the case group than in the control group (p = 0.03).

Conclusion:

There is a significant association between LVH, as identified on ECG, and CKD. These findings may assist health professionals in resource-limited settings, where access to ECG is restricted.

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Case Report

Transcatheter Bicaval Valve System in the Treatment of Torrential Tricuspid Regurgitation and Refractory Systemic Hypervolemia: 12-Month Outcome

Rômulo Francisco de Almeida Torres et al. Alessandro Kraemer Rafael de Almeida Torres Fernanda Proença Lepca Bozzi … Sarah Fagundes Grobe Eduardo Mendel Balbi Filho Guilherme Barreto Gameiro Silva

Abstract

Severe isolated tricuspid regurgitation (TR) is associated with limiting symptoms, negative impact on quality of life, and poor prognosis. The TricValve^® device is a transcatheter self-expanding biological valve system designed to mitigate systemic volume overload, improve quality of life, and improve congestive symptoms. We report a 12-month follow-up of a 61-year-old woman with signs of refractory systemic hypervolemia and torrential TR who underwent the procedure. The treatment resulted in significant weight loss, improvement in signs of hypervolemia, and improvement in functional class (FC).

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Original Article

Comparison Between Two Prevention and Control Programs for Risk Factors for Cardiovascular Diseases in an Oil Company

Maria Lúcia Ribeiro Rocha et al. Ana Marice Teixeira Ladeia

Abstract

Background:

Cardiovascular diseases (CVDs) are the leading cause of death in the world, and companies can implement prevention and control actions aimed at reducing risk factors among their workers.

Objectives:

To verify whether the result of model A of a CVD prevention and control program was superior to model B in reducing the cardiovascular risk (CVR) of individuals from an oil company.

Methods:

Retrospective evaluation of secondary data from a restricted and fixed cohort of 670 workers, from 01/01/2016 to 12/31/2018. The workers were divided by program model into Group A (514) and Group B (156). The 2016 CVR was compared with that of 2018, within and between groups, as well as the mean and prevalence of risk factors for CVD. Statistical analysis was set at a significance level of 5%.

Results:

Group A improved the level of physical activity (PAL), consumption of fruits and vegetables, and consumption of alcohol, but the “high” CVR increased from 0.4% in 2016 to 1.4% in 2018 (p<0.01). In Group B there was no change in the workers’ health profile, but the percentage of individuals with "intermediate" CVR increased from 14.1% to 16.7% (p=0.01).

Conclusions:

The actions developed by the company had a positive impact on the way of life of workers covered by the model A program; however, they were not sufficient to reduce CVR in this group.

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Original Article

Prognostic Implications of Increased C-Reactive Protein in Patients With Acute Heart Failure Admitted to a General Hospital Ward

Vinicius Ferigato et al. Fernanda Takeyama Mario De Divitiis Giulio Checchinato Facchini … Bruna Gandra Bruno Maciel Goncalves Helder Jorge Andrade Gomes Gustavo A. B. Boros Alcides Rocha de Figueredo Junior

Abstract

Background:

C-reactive protein (CRP) is a widely available inflammatory biomarker. Its prognostic role during hospitalization in patients with acute heart failure (HF) remains unclear.

Objective:

To assess whether CRP measured at hospital admission predicts in-hospital mortality in patients with acute HF admitted to a general public hospital ward.

Methods:

This prospective study enrolled patients (≥18 years old) admitted to a medical ward with a primary diagnosis of acute HF directly from the emergency department. CRP was measured within 72 hours of hospital admission. All patients underwent a structured clinical assessment by a cardiologist and transthoracic echocardiography (TTE). A p-value <0.05 was considered statistically significant.

Results:

A total of 44 patients were included (mean age 68 ± 16 years). TTE showed left ventricular ejection fraction (LVEF) <50% in 43% of patients, preserved LVEF in 43%, and specific causes of HF in the remaining 14%. The median CRP level (2.5 mg/dL) was used to define high and low CRP groups. Reduced LVEF (<50%) was more common, and heart failure with preserved ejection fraction (HFpEF) was less frequent, in the high CRP group (p = 0.014). Clinical assessment showed no differences in hemodynamic profiles (congestion vs. perfusion). Comorbidities, renal function, and infection diagnoses were also similar between groups. In-hospital mortality was 30% in the high CRP group versus 4.8% in the low CRP group (p = 0.046). In multivariable analysis, increased CRP remained independently associated with in-hospital mortality.

Conclusion:

CRP measured near the time of hospital admission may serve as a prognostic marker for in-hospital mortality in patients with acute HF.

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Editorial

ST-Segment Elevation Myocardial Infarction: Assessment of Quality of Care Before and After the COVID-19 Pandemic

Fernando Oswaldo Dias Rangel

In this article, Tavares et al. comparatively analyze quality indicators of care for 193 patients with ST-segment elevation myocardial infarction (STEMI) and relevant clinical outcomes before and during the COVID-19 pandemic.

An increase in mortality rates associated with cardiovascular diseases was observed in Brazil after the onset of the COVID-19 pandemic. Many patients did not leave their homes to seek hospital care, contributing to increased cardiovascular mortality.

[…]

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Original Article

Feasibility and Safety of One-Minute Step Test in Patients with Heart Failure Hospitalized in the Cardio-Intensive Care Unit: A Pilot Study.

Andresa Narcizo Volotão et al. Clara Pinto Diniz Ana Carolina Cossio Rodriguez Vivian de Freitas Martins da Silva … Juliana Rega de Oliveira Ana Paula Nunes Carneiro Mariana Barcellos de Avila Carolina Nigro Di Leone

Abstract

Background:

The One-Minute Step Test (1MST) seems to be a useful tool for exploring the component of energy metabolism used in Activities of Daily Living (ADL), but it is still little explored in patients with Heart Failure (HF) in the hospital environment.

Objective:

To evaluate the feasibility and safety of performing 1MST in hospitalized patients with HF.

Methods:

Data were collected using electronic medical records and evaluative tests from patients with HF. The safety of the 1MST was assessed through vital signs records, perceived exertion, adverse events, and feasibility based on the ability to complete the test. The paired Student’s T-test and Wilcoxon test were employed to compare the data before and after the test, depending on the distribution of the data, while the relationship between the variables was examined using Pearson’s correlation test. The significance level set was p < 0.05.

Results:

Twenty patients were evaluated between May and December 2022. All patients completed the test, and no adverse events were recorded. Heart rate (HR) (p < 0.001), systolic blood pressure (SBP) (p = 0.01), mean arterial pressure (MBP) (p = 0.03), and respiratory rate (p < 0.001), and peripheral oxygen saturation showed a reduction (p = 0.04). A negative correlation was observed between 1MST and age (r = −0.46; p = 0.03) and a positive correlation between 1MST and length of stay in the CICU (r = 0.44; p = 0.04).

Conclusion:

It is concluded that the 1MST is a safe and viable tool for assessing the anaerobic metabolism of patients with HF.

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Original Article

Comparison of the Effects of Alcoholic and Non-Alcoholic Red Wine on Flow-Mediated Dilation and Brachial Artery Vasodilation

Daniel Medeiros Moreira et al. Luiza Frassetto Martins Lucca Antonini Savas Rafael Cegielka

Abstract

Background:

Cardiovascular diseases are the leading cause of mortality worldwide. Wine consumption has been associated with cardiovascular benefits, which are attributed to the presence of flavonoids.

Objectives:

To assess the effects of alcoholic and non-alcoholic red wine on endothelial function by measuring variations in brachial artery flow-mediated dilation (FMD) and analyzing changes in arterial diameter, heart rate, and blood pressure.

Methods:

A randomized, parallel, controlled clinical trial was conducted with 22 participants assessed at 2 distinct time points. Participants consumed 200 mL of red wine and, after a 7-day washout period, received 200 mL of non-alcoholic wine. Data were analyzed using Student’s t test. P values < 0.05 were considered statistically significant.

Results:

Pre-ischemia brachial artery diameter increased after both interventions: with alcoholic wine (3.21 ± 0.46 mm before versus 3.51 ± 0.53 mm after; p < 0.001) and non-alcoholic wine (3.16 ± 0.48 mm before versus 3.31 ± 0.58 mm after; p = 0.003). FMD showed a decrease after consumption of alcoholic wine (11.88% ± 8.40% before versus 5.98% ± 5.34% after; p = 0.007), whereas consumption of non-alcoholic wine did not result in significant changes (7.26% ± 6.39% before versus 6.01% ± 5.85% after; p = 0.572). Other parameters, such as heart rate and blood pressure, did not show any significant differences.

Conclusion:

Consumption of red wine, with and without alcohol, increased brachial artery diameter. However, alcoholic red wine was associated with reduced FMD, suggesting that ethanol may negatively affect endothelial function.

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Editorial

Anabolic-Androgenic Steroids and Cardiotoxicity

José Antônio Caldas Teixeira et al. Joelma Dominato Rocha Carvalho Mateus Freitas Teixeira

Anabolic-androgenic steroids (AAS) are a class of natural and synthetic hormones, which owe their name to their chemical structure (steroid nucleus) and their biological, anabolic, and androgenic effects. Misuse of AAS for aesthetic and performance purposes has become widespread, as they provide increases in muscle mass and strength. It is estimated that approximately 3.5% of the world’s population uses AAS.

Use of AAS dates back to ancient Greece, followed by the Second World War. They were detected in sports competitions in 1954 and later disseminated among bodybuilders and identified in various sports in the Tokyo 1964 Olympic Games. Currently, we are witnessing a growing encouragement of AAS use for aesthetic purposes, through “beauty chips” and disguised as hormone replacement therapy. This indiscriminate use culminated in a resolution by the Brazilian Federal Council of Medicine against the prescription of these hormones for aesthetic purposes.

[…]

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Case Report

Intermittent Left Bundle Branch Block and Cardiac Memory in a Patient with Dengue Fever: A Case Report and Literature Review

Muchtar Nora Ismail Siregar et al. Jasmine Ibtisamah Alkatiri

Abstract

Background:

Arrhythmias and Electrocardiography changes in Dengue Fever (DF) cases can mimic electrocardiogram (ECG) appearance of threatening clinical conditions such as myocardial ischemia, albeit no significant ischemic injury at the heart muscle.

Case Presentation:

We report a case of subsequent cardiac memory (CM) in a 50-year-old female with DF. A 12-lead ECG on admission revealed sinus rhythm with Left Bundle Branch Block (LBBB), and it resolved on day 4 of hospitalization. However, deep symmetric T wave inversions (TWI), which were later recognized as CM, occurred. The patient received treatment with Ringer’s lactate and paracetamol infusion. A routine 12-lead ECG performed on day 7 of hospitalization revealed the resolution of TWI and normal sinus rhythm.

Conclusion:

This case report highlights one intriguing phenomenon associated with LBBB in DF, which is CM TWI, where the T wave ‘remembers’ the direction of the QRS complex during prior abnormal ventricular activation. Due to its similarity with TWI caused by myocardial ischemia, understanding of this phenomenon may prevent unnecessary interventions.

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Editorial

Literacy in Cardiovascular Health: A Strategic Tool in Anticoagulation

Dalton Bertolim Precoma

Oral anticoagulation (OAC) with warfarin is still widely used in various clinical situations, such as in metallic prostheses. However, managing warfarin presents well-known challenges, including its narrow therapeutic range, long half-life, frequent drug and food interactions, and genetic variations. Additionally, poor adherence to treatment and lack of awareness about atrial fibrillation (AF) and anticoagulation itself significantly contribute to unfavorable clinical outcomes. Even with the use of direct oral anticoagulants (DOACs), there are still peculiarities among the different therapeutic options, which are often poorly communicated to the patient. This compromises the necessary understanding for effective disease management and highlights gaps in patient knowledge.

Social determinants of health play a fundamental role in individuals’ health conditions. Factors such as race/ethnicity, socioeconomic status, education level, environment, and climate, among others, have a direct impact on the incidence and management of chronic diseases, such as AF. Several studies indicate that people in situations of socioeconomic vulnerability — including low income, low education levels, and unemployment — show a higher prevalence of AF.^–

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