International Journal of Cardiovascular Sciences – ABC CARDIOL

IJCS

SBC Journal | IJCS

Uma publicação científica da Sociedade Brasileira de Cardiologia, dedicada à divulgação da produção científica em Cardiologia e Ciências Cardiovasculares, com alcance internacional e publicação em língua inglesa.

ISSN (printed): 2359-4802 ISSN (online): 2359-5647

Submissão de artigos

Scimago (SJR 2025): 0.195
Qualis (2021-2024): B3

Current issue

2026

Volume 39

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Em Destaque

Inflammatory and Atherogenic Markers as Predictors of Coronary Artery Disease in Patients with Suspected Coronary Artery Disease Undergoing Coronary Angiography

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

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

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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Original Article

Genetic Evidence for the Association Between Sjögren's Syndrome and Cardiovascular Disease Risk

Yafang Gao et al. Guohua Wu Tianyu Jin Zhijie Shen … Nannan Zhou Xiaohong Huang

Abstract

Background:

Previous studies have indicated that patients with Sjögren’s syndrome (SS) exhibit an increased risk of cardiovascular disease (CVD). However, the causal association between SS and CVD risk remains to be elucidated.

Objectives:

This investigation explored the genetic relationship between SS and CVD risk through Mendelian randomization (MR).

Methods:

We identified the genetic association between SS and CVD incidence via two-sample MR analysis based on summary statistics from publicly available genome-wide association studies (GWAS). The inverse-variance weighting (IVW) method was used for the primary analysis in our study. Additionally, we conducted several sensitivity analyses to confirm the stability and reliability of the MR results.

Results:

MR analysis revealed that SS was not significantly associated with the risk of various CVDs, including atrial fibrillation (AF) (odds ratio [OR] = 0.98, 95% confidence interval [CI] = 0.95–1.01; p = 0.22), ischemic stroke (IS) (OR = 0.99, 95% CI = 0.93–1.05; p = 0.68), heart failure (HF) (OR = 1.00, 95% CI = 0.96–1.04; p = 0.91), coronary artery disease (CAD) (OR = 0.99, 95% CI = 0.94–1.04; p = 0.60), and myocardial infaion (MI) (OR = 1.01, 95% CI = 0.97–1.06; p = 0.61).

Conclusions:

Our MR study did not provide genetic evidence supporting a causal association between SS and CVD incidence. The associations reported in prior observational studies may be due to residual confounding and reverse causality.

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Original Article

Infant Feeding Practices and Their Association with Stunting, Overweight, Obesity, and Other Cardiometabolic Risks in African Children: A Systematic Review

Jude Eteneneng Enoh et al. Roland Tiagha Akah Benedicta Ngwenchi Nkeh-Chungag

Abstract

Introduction:

Feeding patterns among infants, particularly in Africa, play a central role in shaping child growth and long-term health outcomes such as stunting, overweight, and obesity in early childhood.

Objectives:

This systematic review assessed infant feeding practices and their association with stunting, overweight, obesity, and cardiometabolic risk in children in Africa.

Methods:

PubMed, Springer Link, Web of Science, Google Scholar, and Science Direct databases were searched for articles published between 2004 and 2024. Infant feeding indicators (exclusive breastfeeding, complementary feeding, and dietary variety) and outcomes of the children (stunting, overweight, obesity, blood pressure, and lipid profiles) were retrieved.

Results:

The review identified 12 studies (7 cohort, 5 cross-sectional) involving approximately 15,620 participants. Cardiometabolic risk markers such as hypertension were identified in 2 studies, with the prevalence ranging from 9.1% to 32.7%. Obesity was reported in 5 studies, with prevalence ranging from 4.0% to 21.0%. Six studies identified stunting and overweight, with their prevalence ranging from 9.3% to 42% and 9.1% to 30.0%, respectively. Diabetes was reported in just 1 of the studies in South Africa and was observed more in males (2.6%) than females (1.9%).

Conclusion:

Stunting and early cardiometabolic risk are common in Africa and are associated with suboptimal infant feeding patterns. Inappropriate complementary feeding and early weaning of breastfeeding are linked to stunting as well as early overweight/obesity. Exclusive breastfeeding for up to 6 months is still a poorly achieved target in most settings, even though it is crucial for optimal growth.

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Original Article

Transcatheter Aortic Valve Implantation in Nonagenarians: In-Hospital Complications and One-Year Follow-Up Mortality

Nelson Durval Ferreira Gomes de Mattos et al. Rafael Lauria de Oliveira Constantino Gonzalez Salgado André Luiz Silveira Sousa … Andre Luiz da Fonseca Feijó Rodrigo Verney Castello Branco Giovanna Zadra de Mattos José Carlos Pizzolante Secco Luiz Antonio Ferreira Carvalho Helena Cramer Rey

Abstract

Background:

Aortic Stenosis (AS) is prevalent among elderly individuals and is associated with high mortality when untreated. Transcatheter Aortic Valve Implantation (TAVI) has emerged as a viable therapeutic alternative, particularly for patients with surgical contraindications. However, its application in nonagenarians remains controversial due to limited data in this very elderly population.

Objective:

To evaluate clinical outcomes in nonagenarian patients undergoing TAVI at a private quaternary hospital, with emphasis on mortality and in-hospital as well as one-year complications.

Methods:

A retrospective cohort study with prospective follow-up was conducted between 2009 and 2023. A total of 265 patients with symptomatic severe AS who underwent TAVI were included, of whom 40 were nonagenarians (≥ 89 years). Data were obtained from an institutional database and from the Brazilian Registry of Aortic Bioprosthesis Implantation by Catheter – New Technologies (RIBAC-NT). Comparisons between nonagenarians and younger patients were performed using the Student’s t-test for continuous variables and the chi-square (χ²) test for categorical variables. A p-value < 0.05 was considered statistically significant.

Results:

Among nonagenarians, 55% were female, 72.5% had hypertension, and 95% had chronic kidney disease. The technical success rate was 55%. Major complications included permanent pacemaker implantation (35%) and adverse events (45%). In-hospital mortality was 7.9%, with no statistically significant differences at 30 days (p = 0.40), 6 months (p = 0.35), and one year (p = 0.06) compared to younger patients.

Conclusion:

TAVI proved to be a safe and effective therapeutic option in nonagenarians, showing clinical outcomes comparable to those of younger individuals.

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Case Report

Double-Orifice Mitral Valve with Severe Regurgitation Associated with Bicuspid Aortic Valve: A Case Report

Patricia Delgado Cedeño et al. Estefania Carolina Arteaga Herrera Cesar João Tumbaco Mite Elsie Valdivieso Valenzuela … Juan Javier Zuñiga Bohorquez Guillermo Navas Moreira

Introduction

Double-orifice mitral valve (DOMV) was first described in 1876 by the British pathologist William Smith Greenfield. It is a very rare congenital or acquired cardiac anomaly with limited epidemiologic data and no clear sex predilection.

Congenital DOMV rarely occurs in isolation and is commonly associated with other cardiac anomalies, such as aortic coarctation, patent ductus arteriosus, atrioventricular septal defects, and bicuspid aortic valve (BAV), among others. Functionally, it may behave normally and remain asymptomatic; however, symptoms may arise from mitral valve dysfunction, such as stenosis or regurgitation.

[…]

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Original Article

Myocardial Infarction with Non-Obstructive Coronary Arteries: Clinical Profile, Diagnostic Investigation, and Outcomes in a Tertiary Center Cohort

Kelvyn Vital et al. Ricardo Pavanello Barbara Porto Valente Bruno Noshang Blaas … Bianca Fernandes Tavora Arruda Raphael Rossi Maria Isabel Del Monaco Fausto Feres

Abstract

Background:

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical syndrome associated with diverse pathophysiological mechanisms and a non-negligible prognosis. Despite conceptual advances, diagnostic uncertainties and significant variations in etiological investigation and clinical management persist in real-world practice, particularly in centers with limited access to advanced imaging modalities.

Objectives:

To describe the clinical profile, diagnostic strategies employed, and clinical outcomes of patients with MINOCA followed at a Brazilian tertiary center.

Methods:

Observational, retrospective study including consecutive patients diagnosed with MINOCA, defined according to the Fourth Universal Definition of Myocardial Infarction and European guidelines. Clinical, angiographic, and complementary diagnostic data, as well as the treatment instituted and clinical outcomes during follow-up, were collected.

Results:

A total of 196 patients were included, with a mean age of 50.6 ± 11.8 years and a slight female predominance (52.6%). Systemic arterial hypertension (60.2%), dyslipidemia (45.9%), and current or former smoking (48.0%) were frequent. Cardiac magnetic resonance imaging was performed in 42.3% of cases, whereas intracoronary imaging methods were rarely used (2.6%). In 40.8% of patients, a definitive etiology could not be established. During follow-up (n = 183), mortality was 3.8%, reinfarction occurred in 6.6%, and new cardiovascular hospitalizations occurred in 16.9%.

Conclusions:

Patients with MINOCA present an intermediate-risk clinical profile and a relevant incidence of cardiovascular events during follow-up. The high proportion of cases without a defined etiological diagnosis reflects limitations in investigation and reinforces the need for more structured diagnostic strategies and individualized clinical management.

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Original Article

Protocol For Weaning From Mechanical Ventilation in Patients Undergoing Coronary Artery Bypass Grafting: Cohort Study

André Luiz Lisboa Cordeiro et al. Wallace Fernando de Souza Lopes Tainara Conceição de Jesus Ana Julia Gomes de Oliveira … Ana Cecília de Oliveira Coutinho André Raimundo França Guimarães

Abstract

Background:

Patients with heart disease often require mechanical ventilation (MV). Although weaning protocols may reduce the duration of MV, the literature presents contradictory findings regarding their effectiveness, and there is a lack of studies specifically involving cardiac patients.

Objective:

To evaluate whether a weaning protocol reduces the duration of MV compared with weaning based on clinical judgment in cardiac patients.

Methods:

A retrospective cohort study was conducted with patients undergoing myocardial revascularization. They were randomly assigned to either the protocol-driven (intervention) group or the conventional weaning group. Weaning time, MV duration, and length of stay in the Intensive Care Unit (ICU) were assessed. Comparisons between groups were performed using the unpaired Student’s t-test. A p-value <0.05 was considered statistically significant.

Results:

A total of 214 patients were evaluated. The mean duration of MV was shorter in the intervention group (4 vs. 9 hours, p < 0.001). The mean ICU length of stay was 2 vs. 5 days in the intervention and control groups, respectively (p = 0.02).

Conclusion:

The findings suggest that protocol-guided weaning may be associated with reductions in weaning time, duration of MV, and ICU length of stay, raising the hypothesis of a potential clinical benefit that warrants further investigation in future studies.

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Original Article

Associação Entre a Obesidade Central e a Incidência de Doenças e Fatores de Risco Cardiovascular

Taianah Almeida Barroso et al. Lucas Braga Marins Renata Alves Ana Caroline Souza Gonçalves Sérgio Girão Barroso Gabrielle de Souza Rocha

Resumo

Fundamento:

A obesidade tem sido apontada como um dos principais fatores de risco para doenças cardiovasculares.

Objetivo:

Avaliar a associação da obesidade central com a incidência de doenças e fatores de risco cardiovascular.

Métodos:

Estudo transversal, realizado com pacientes atendidos em um ambulatório de síndrome metabólica, que apresentavam índice de massa corporal ≥ 24,9 kg/m². Foram analisados o estado nutricional, os exames laboratoriais (perfil lipídico e glicemia) e o uso de anti-hipertensivos. Os participantes foram estratificados em grupos em relação à presença ou à ausência dos seguintes fatores de risco: diabetes, hipertensão e dislipidemia.

Resultados:

Mulheres (n = 39), com idade média de 44,18 ± 14,42 anos, sendo 70% obesos e 38% hipertensos corresponderam à maioria da amostra estudada. A circunferência abdominal encontrada foi de 110,19 cm ± 15,88 cm; os triglicerídeos de 153,72 mg/dL ± 7,07 mg/dL; a glicemia de jejum de 188,6 mg/dL ± 116 mg/dL. Foi encontrada associação significativa entre a relação cintura/estatura e os achados de hipertensão (p = 0,007); entre o volume de gordura visceral e diabetes (p = 0,01); entre o índice de conicidade e os achados de hipertensão (p = 0,009) e diabetes (p = 0,006). Não foi encontrada associação significativa entre o índice de massa corporal e circunferência abdominal com os achados de hipertensão, diabetes e dislipidemia.

Conclusão:

A obesidade central esteve associada a uma maior incidência de desenvolvimento de fatores de risco relacionados a doenças cardiovasculares.

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Review Article

Cardiomiopatia da Doença de Chagas

Marcus Vinicius Simões et al. Minna Moreira Dias Romano André Schmidt Káryta Suely Macedo Martins José Antonio Marin-Neto

Resumo

A cardiomiopatia crônica da doença de Chagas (CCDC) é resultante de miocardite fibrosante focal de baixa intensidade, mas incessante, causada pela infecção persistente do T cruzi, associada à inflamação mediada por mecanismos imunes adversos. Cerca de 30% dos infectados desenvolvem, ao longo da vida, a forma crônica cardíaca da doença de Chagas com manifestação clínica proteiforme, que pode incluir morte súbita, sintomas e sinais de insuficiência cardíaca, eventos cardioembólicos, arritmia e sintomas anginoides. A morte súbita e a progressão da insuficiência cardíaca (IC) são os mecanismos mais comuns de óbito nesta condição. Os aspectos prognósticos mais relevantes são sintomas de IC avançada (CF III/IV da NYHA), cardiomegalia, disfunção sistólica do VE e taquicardia ventricular não sustentada. A prevenção dos eventos cardioembólicos é aspecto importante no manejo dos pacientes com CCDC. Agentes anticoagulantes orais devem ser indicados para pacientes com risco elevado, conforme a presença de um conjunto de fatores de risco: disfunção sistólica do VE, aneurisma apical, alteração da repolarização ventricular ao ECG e idade avançada. O tratamento da IC na CCDC segue os mesmos princípios aplicados à IC secundária à cardiomiopatia dilatada de outras etiologias.

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Review Article

Entendendo a Hospitalização em Pacientes com Insuficiência Cardíaca

Evandro Tinoco Mesquita et al. Antonio José Lagoeiro Jorge Luciana Morais Rabelo Celso Vale Souza Jr

Resumo

A insuficiência cardíaca é um dos mais importantes e desafiadores problemas de saúde pública do século 21 e está associada com desfechos duros, como morte e internação hospitalar. Novos tratamentos para a insuficiência cardíaca, apesar da diminuição da mortalidade, não têm contribuído para a redução da hospitalização. Pacientes internados por insuficiência cardíaca têm uma elevada taxa de eventos (superior a 50%), com taxa de mortalidade entre 10 e 15% e taxa de reospitalização em até 6 meses após a alta de 30 a 40%. Três grandes causas parecem afetar diretamente a reospitalização de pacientes com insuficiência cardíaca: comorbidades, congestão e lesões em órgãos alvo. A transição do paciente internado para o paciente ambulatorial é um período de vulnerabilidade, devido à complexidade da natureza progressiva da insuficiência cardíaca, com impacto no prognóstico e que pode se estender por até 6 meses após a alta hospitalar. O médico tem um importante papel nas ações que podem minimizar o risco de internações por insuficiência cardíaca, e a abordagem multidisciplinar, associada à implementação de boas práticas embasadas em evidências científicas, pode reduzir o risco de internação. A aplicação de rotinas, que comprovadamente reduzem a internação hospitalar, deveria ser utilizada nos hospitais brasileiros. O objetivo desta revisão foi discutir as principais causas de hospitalização, seu impacto na evolução da insuficiência cardíaca e as estratégias que podem ser adotadas para sua redução.

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Review Article

Métodos de Investigação da Função Endotelial: Descrição e suas Aplicações

Amanda Sampaio Storch et al. João Dario de Mattos Renata Alves Iuri dos Santos Galdino Helena Naly Miguens Rocha

Introdução

O endotélio é a monocamada celular que reveste o interior dos vasos sanguíneos, incluindo artérias, veias e as câmaras do coração, atuando como uma camada protetora entre os demais tecidos e o sangue circulante. Essas células são denominadas células endoteliais. O endotélio exerce função determinante no controle da homeostase vascular, participando da regulação de sinais intracelulares, permeabilidade e tônus vascular, cascata de coagulação e angiogênese, entre outros. Uma das principais funções do endotélio é a liberação de substâncias frente a estímulos, que atuam de forma autócrina e/ou parácrina. Dessa forma, agressões ao endotélio geram uma resposta inflamatória, com atuação de diversos tipos celulares (linfócitos, monócitos, plaquetas e células musculares lisas), levando a um quadro de disfunção da célula endotelial, enrijecimento da parede vascular e formação da placa de aterosclerose.

A disfunção endotelial é uma característica precoce chave no desenvolvimento e progressão da placa aterogênica e suas respectivas complicações. Essa condição é caracterizada por uma redução na biodisponibilidade de vasodilatadores derivados do endotélio, tais como o óxido nítrico (NO), e um aumento, relativo ou absoluto, da biodisponibilidade de vasoconstritores. Este desequilíbrio prejudica a vasodilatação dependente endotélio, marca funcional que caracteriza a disfunção endotelial.

[…]

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Editorial

Infodemia, Fake News and Medicine: Science and The Quest for Truth

Claudio Tinoco Mesquita et al. Anderson Oliveira Flávio Luiz Seixas Aline Paes

“Falsehood flies, and the truth comes limping after it.”

Jonathan Swift

[…]

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Original Article

Perfil dos Pacientes Internados por Insuficiência Cardíaca em Hospital Terciário

Milton Ricardo Poffo et al. Amberson Vieira de Assis Maíra Fracasso Ozir Miguel Londero Filho Sulyane Matos de Menezes Alves Ana Paula Bald Camila Bussolo Schmitt Nilton Rogério Alves Filho

Resumo

Fundamentos:

A insuficiência cardíaca é uma doença de alta prevalência, responsável por grande número de hospitalizações e altas taxas de mortalidade em nosso país. O tratamento instituído tem influência nos índices de mortalidade e na qualidade de vida dos pacientes.

Objetivo:

Identificar e comparar o perfil clínico-epidemiológico e o tratamento instituído entre os pacientes sobreviventes e não sobreviventes internados com insuficiência cardíaca aos dados da literatura internacional.

Métodos:

Estudo transversal, retrospectivo, de 816 pacientes com insuficiência cardíaca que sobreviveram ou não à internação. Foram registradas características clínicas, epidemiológicas, dados laboratoriais, ecocardiográficos e o tratamento instituído.

Resultados:

A maioria dos pacientes encontrava-se em classe funcional III/IV. A idade média foi de 66,5 ± 13,8 anos. Metade era do sexo masculino e 88,3%, brancos. A mortalidade intra-hospitalar foi de 11,2%. Idade avançada, etnia branca, classe funcional elevada, reinternações, internações prolongadas, presença de doença arterial coronariana, fibrilação atrial crônica, insuficiência mitral grave, disfunção diastólica do tipo restritivo, disfunção renal e peptídeo natriurético elevado tiveram associação com maior mortalidade, assim como pacientes que, durante a internação, apresentaram tromboembolismo pulmonar, síndrome isquêmica aguda, infecção pulmonar ou necessidade de diálise. O uso de inibidores da enzima conversora de angiotensina ou de bloqueadores dos receptores da angiotensina na admissão hospitalar foi significativamente maior entre os sobreviventes.

Conclusão:

A mortalidade intra-hospitalar foi elevada quando comparada à média internacional, mas foi semelhante a de outros serviços de referência brasileiros. Vários indicadores de maior gravidade foram observados no grupo não sobrevivente.

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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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Original Article

Inflammatory and Atherogenic Markers as Predictors of Coronary Artery Disease in Patients with Suspected Coronary Artery Disease Undergoing Coronary Angiography

Veysi Can et al. Fuat Polat

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

Endocarditis – A 27-Year Epidemiological Analysis of Mortality in Brazil

Leticia da Costa Santana Silva et al. Luana Yasmim Fernández Avelaneda Castanheira Maria Dalila Santos Salim Ruy Felipe Melo Viegas Gilson Fernandes Ruivo Sheila Cavalca Cortelli Davi Romeiro Aquino Taciana Mara Rezende Fortes Viégas

Abstract

Background:

Infective endocarditis (IE) is frequently caused by viridans streptococci. Short-term in-hospital mortality in high-income settings ranges from 11% to 25%. In Brazil, rheumatic heart disease remains a leading valvular substrate; however, its declining prevalence in developing nations has limited country-specific analyses.

Objective:

To describe the epidemiological profile of mortality from IE in Brazil, characterizing its magnitude and temporal trend.

Methods:

We conducted a retrospective, exploratory epidemiological study with descriptive and analytic components using data from the Mortality Information System of the Department of Informatics of Brazil’s Unified Health System. Chi-square tests of independence were applied (p < 0.05), and results were summarized in tables and figures. Variables included International Statistical Classification of Diseases and Related Health Problems, 10th Revision categories, year of death, region, and sex.

Results:

From 1996 to 2022, 40,157 deaths associated with IE were recorded in Brazil (chi-square = 1,701.43). The Southeast region accounted for the greatest burden, with 21,429 deaths (53.36%; chi-square = 15,236.00). By sex (chi-square = 999.32), men were more affected than women (55.57% [22,315] vs 44.41% [17,835]); in 0.02% of records, sex was unspecified.

Conclusions:

IE remains a condition of national and international concern, with substantial mortality in Brazil over the last 27 years. This overview of mortality patterns highlights regional disparities and sex differences and can inform public-health strategies and evidence-based interventions.

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Original Article

Long-Term Clinical Outcomes of Catheter Ablation in Hypertrophic Cardiomyopathy and Atrial Fibrillation: A Systematic Review and Meta-Analysis

Acácio Fernandes Cardoso et al. Fernanda Cristina Poscai Ribeiro Luiz Claudio Behrmann Martins Glaucylara Reis Geovanini Cynthia Aparecida da Silva Rocha Nemer Luiz Pichara Áleff Mascarenhas da Silva

Abstract

Background:

Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of atrial fibrillation (AF). However, the benefits of catheter ablation (CA) for reducing adverse clinical outcomes in this population are not well established.

Objective:

To assess the long-term impact of CA on clinical outcomes in patients with HCM and AF through a systematic review and meta-analysis.

Methods:

Controlled studies of patients with HCM and AF undergoing CA were identified through PubMed/MEDLINE, Embase, LILACS, and Cochrane. Meta-analysis employed a random-effects model in R Studio, version 4.3.2, with p < 0.05 considered significant.

Results:

Four retrospective cohort studies met inclusion criteria, all with long follow-up period (5.52 ± 0.91 years). Arrhythmia-free survival after multiple CA ranged from 36.3% to 82%. Combined event analysis (mortality, stroke, and heart failure) yielded odds ratio 0.22 (95% confidence interval 0.08 to 0.60; p < 0.05; I² = 64%). In individual analysis, only heart failure hospitalizations were significantly lower in the CA group (odds ratio 0.32; 95% confidence interval 0.13 to 0.82; p = 0.01).

Conclusions:

This study suggests that CA may improve clinical outcomes in patients with HCM and AF, particularly by improving heart failure hospitalizations. Studies with greater methodological rigor are needed to prove this hypothesis, since only four studies were included in this systematic review.

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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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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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Mensagem do Editor

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…

mensagem completa

Editor chefe

Wolney de Andrade Martins

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

Editor Assistente

Cristiano Marciano Duarte

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

Most Active Reviewer for the Month of August – Irving Bispo

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setembro 11, 2026 by apiki

Most Active Reviewer for the Month of August – Irving Bispo

It is with great pleasure that the editorial team of IJCS congratulates and acknowledges the exemplary work of Irving Bispo, who has been recognized as the most active reviewer of the month of August.

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