International Journal of Cardiovascular Sciences

Abstract

Background:

Coronary artery disease (CAD) remains a leading cause of death worldwide, with inflammation playing a key role in its pathophysiology. Inflammatory biomarkers may offer valuable insights into disease mechanisms and risk stratification, potentially informing therapeutic decisions.

Objectives:

This study aimed to investigate the association between key inflammatory markers — C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) — and both the presence and severity of coronary artery stenosis (CAS) in patients with suspected CAD undergoing coronary angiography.

Methods:

This retrospective study included 767 patients referred for coronary angiography due to suspected CAD. The primary outcome was the presence of significant CAS. Demographic data, medical history, and blood samples were collected. Statistical analyses included descriptive methods and regression modeling as well as receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values for biomarkers, with area under the curve (AUC) used to assess predictive performance. A p-value < 0.05 was considered statistically significant.

Results:

Of the 767 patients (mean age 58.3±12.4 years; 56.7% men), 496 had significant CAS (≥ 50%) and 271 had nonsignificant CAS (< 50%). Levels of CRP (0.44 vs. 0.13 mg/dL, p = 0.01) and NLR (2.6 vs. 2.0, p = 0.05) were significantly higher in patients with CAS. No significant difference was observed for PLR (129.4 vs. 118.6, p = 0.13). In multivariable analysis, CRP (OR = 1.188, p = 0.044) and NLR (OR=1.567, p = 0.03) were identified as independent predictors of significant CAS. However, ROC curve analysis showed limited discriminative ability for both CRP (AUC = 0.526) and NLR (AUC = 0.510), with values only slightly above chance.

Conclusion:

Increased levels of CRP and NLR are significantly associated with CAS and may serve as potential biomarkers for detecting CAD.

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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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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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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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Editor chefe

Wolney de Andrade Martins

Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ – Brasil

Editores associados

Ana Carolina do A. H. de Souza

Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts – EUA

Christianne Bretas Vieira Scaramello

Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ, Brasil

Fausto J. Pinto

Faculdade de Medicina da Universidade de Lisboa, Lisboa – Portugal, Portugal

Fernando Augusto Alves da Costa

Hospital Beneficência Portuguesa de São Paulo, Clínica Paulista de Doenças Cardiovasculares, São Paulo, SP – Brasil

Fernando Stuardo Wyss Quintana

Servicios y Tecnología Cardiovascular de Guatemala – Guatemala

Gláucia Maria Moraes de Oliveira

Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brasil, Brasil

Guilherme Vianna e Silva

Texas Heart Institute, Houston, Texas – EUA

Isabel Cristina Britto Guimarães

Departamento de Pediatria, Faculdade de Medicina da Bahia (FMB), Universidade Federal da Bahia (UFBA), Salvador, BA – Brasil

Maria Alexandra Arias Mendoza

Instituto Nacional de Cardiología – México

Maria Sanali Moura de Oliveira Paiva

Universidade Federal do Rio Grande do Norte, Natal, RN – Brasil

Miguel Mendes

Hospital de Santa Cruz, Carnaxide – Portugal

Pedro Adragão

Hospital da Luz, Lisboa – Portugal

Ricardo Alkmim Teixeira

Hospital Renascentista, Pouso Alegre, MG – Brasil, Brasil

Ricardo Mourilhe-Rocha

Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ – Brasil

Sandro Cadaval Gonçalves

Universidade Federal do Rio Grande do Sul (UFRGS), Hospital Moinhos de Vento e Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil

Solange Amorim Nogueira

Hospital Israelita Albert Einstein (HIAE), Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, SP – Brasil

Thais Rocha Salim

Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil

Editor Assistente

Cristiano Marciano Duarte

Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu, SP – Brazil, Brasil

Editor Convidado

Marcus Vinicius Simões

Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, SP – Brasil

Conselho Editorial da Família de Revistas ABC

Alvaro Avezum Junior

Universidade de São Paulo (USP), Faculdade de Medicina (FMUSP), São Paulo, SP – Brasil

Angelo Amato Vincenzo de Paola

Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP – Brasil

Evandro Tinoco Mesquita

Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ – Brasil, Brasil

Germano Emílio Conceição Souza

Hospital Regional São José dos Campos, SP, Brasil

Gláucia Maria Moraes de Oliveira

Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ – Brasil, Brasil

Marcelo Dantas Tavares de Melo

Universidade Federal da Paraíba, João Pessoa, PB, Brasil

Wolney de Andrade Martins

Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ – Brasil

Mensagem do Editor

O International Journal of Cardiovascular Sciences (IJCS) é um periódico oficial da Sociedade Brasileira de Cardiologia. A missão do IJCS é publicar manuscritos sobre questões cardiovasculares, com ênfase em manuscritos originais, abrangendo aspectos epidemiológicos, estudos…

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