2018;31(5) – ABC CARDIOL

Original Article

Incidence and Characteristics Angiographic of Patients with Acute Myocardial

Cynthia Kallás Bachur et al. José Alexandre Bachur Juliana Pereira Machado Eugenia Velludo Veiga … Sarah da Silva Candido Ricardo Barbosa Julia Granado Carraro Danielle de Freitas Gonçalves Maria Georgina Marques Tonello

Abstract

Background:

Acute myocardial infarction (AMI) is defined as the death of cardiomyocytes due to prolonged ischemia, caused by thrombosis and / or vasospasm on an atherosclerotic plaque.

Objective:

To determine the incidence of patients with myocardial infarction undergoing primary angioplasty; characterize the anthropometric variables and identify the risk factors in this population.

Methods:

This was a cross-sectional, observational, retrospective study in which we collected secondary data from medical records of a hospital in a city in the state of São Paulo, where the largest number of interventions is via Public Health System, patients with a diagnosis of Myocardial Infarction, undergoing primary coronary angioplasty, from January 2011 to December 2013.

Results:

The total sample consisted of 437 subjects, 282 male and 155 female. In this study, there was predominance of myocardial infarction in the anterior descending artery ADA (45.51%), followed by right coronary artery RCA (38.46%), in carrying out the rescue angioplasty and stent implantation in 96.62% of cases. There was a predominance of high blood pressure as risk factors for 73.71%, followed by smoking with 41.66% of the sample.

Conclusion:

According to the present study data, it appears a higher prevalence of infarction occurred in the ADA, with individuals performing the rescue angioplasty procedure and the placement of the stent, and a growing incidence of drug stent placement. We observed a high incidence of risk factors, prevailing hypertension. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0).

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Original Article

Knock on the Right Door. How we are Treating the Patient with Acute Myocardial Infarction

Clóvis Hoepfner et al. Edilson Roma Jessé Vinicius Lana Ana Luysa Santin … Ana Lavratti Borga Ana Cláudia Yamamoto Juliana Vicente Techentin

Abstract

Background:

To reduce mortality of acute myocardial infarction, medical care must be provided within the first hours of the event.

Objective: To identify the “front door” to medical care of acute coronary patients and the time elapsed between patients’ admission and performance of myocardial reperfusion in the public health system of the city of Joinville, Brazil.

Methods:

The study was a retrospective analysis of the medical records of 112 consecutive patients diagnosed with acute myocardial infarction by coronary angiography. We identified the place of the first medical contact and calculated the time between admission to this place and admission to the referral hospital, as well as the time until coronary angiography, with or without percutaneous transluminal angioplasty. A descriptive analysis of data was made using mean and standard deviation, and a p < 0.05 was set as statistically significant.

Results:

Only 16 (14.3%) patients were admitted through the cardiology referral unit. Door-to-angiography time was shorter than 90 minutes in 50 (44.2%) patients and longer than 270 minutes in 39 (34.5%) patients. No statistically significant difference was observed in door-to-angiography time between patients transported directly to the referral hospital and those transferred from other health units (p<0.240). Considering the time between pain onset and angiography, only 3 (2.9%) patients may have benefited from myocardial reperfusion performed within less than 240 minutes.

Conclusion:

Management of patients with acute myocardial infarction is not in conformity with current guidelines for the treatment of this condition. The structure of the healthcare system should be urgently modified so that users in need of emergency services receive adequate care in accordance with local conditions.

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Original Article

Acute Myocardial Infarction and Primary Percutaneous Coronary Intervention at Night Time

Roberto Ramos Barbosa et al. Felipe Bortot Cesar Denis Moulin dos Reis Bayerl Renato Giestas Serpa … Vinicius Fraga Mauro Walkimar Ururay Gloria Veloso Roberto de Almeida Cesar Pedro Abilio Ribeiro Reseck

Abstract

Background:

Primary percutaneous coronary intervention is the preferred treatment in ST-elevation myocardial infarction. At night period, the delay until performing primary percutaneous coronary intervention may be determinant to prognosis worsening.

Objective:

To analyze the results of primary percutaneous coronary intervention performed at day and night periods.

Methods:

Cohort study that included patients admitted with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention from December 2013 until December 2016 in a ST-elevation myocardial infarction reference hospital of a metropolitan region in Brazil, followed from admission to hospital discharge or death, compared according to time of primary percutaneous coronary intervention (night or day). Statistical analysis comprehended the Chi-square test, the Fisher test, the Student’s t-test and the analysis of variance, with significance level of 5%.

Results:

446 patients were submitted to primary percutaneous coronary intervention, 159 (35.6%) at night time and 287 (64.4%) at day time. No differences were found between the two groups concerning clinical baseline characteristics. Door-to-balloon time (101 ± 81 minutes vs. 99 ± 78 minutes; p = 0,59) and onset-to-ballon time (294 ± 158 minutes vs. 278 ± 174 minutes; p = 0,32) did not differ between the groups. The incidence of combined major adverse cardiac events (15.1% vs. 14.3%; p = 0,58) and in-hospital mortality (9.4% vs. 8.0%; p = 0,61) were similar between the groups, as well as length of hospital stay (6.0 ± 4 days vs. 4.9 ± 4 days; p = 0,91).

Conclusion:

Primary percutaneous coronary intervention at night time showed similar results as the procedure performed at day time, without significant increase of in-hospital adverse events, length of stay or mortality.

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Original Article

Cardiovascular Risk Estimation by the ASCVD Risk Estimator Application in a University Hospital

Thalita dos Anjos Azevedo et al. Marlos Luiz Villela Moreira Ana Paula Cassetta dos Santos Nucera

Abstract

Background:

Cardiovascular diseases (CVDs) are responsible for many deaths in Brazil and in the world, especially in the economically active population. Risk factors for these diseases include comorbidities such as high blood pressure (HBP), diabetes mellitus (DM) and dyslipidemia. Innovation of portable technology combined with the high prevalence of CVDs motivated the development of the ASCVD Risk Estimator by the American Heart Association/American College of Cardiology.

Objectives:

Estimate the cardiovascular risk of patients hospitalized in the internal medicine wards of Gaffrée e Guinle University Hospital (HUGG) using the ASCVD Risk Estimator, and describe the main risk factors in this population.

Methods:

A prospective, cross-sectional study was conducted, the following data were collected from the medical records: sex, age, ethnicity, presence of HBP, DM, systolic arterial pressure, smoking habits, total cholesterol and HDL levels. Statistical analysis was performed by the chi-square test, with calculation of p-value, relative risk and confidence interval in the correlations.

Results:

A total of 339 medical records were reviewed, and 72 (21.2%) fulfilled the inclusion and exclusion criteria. Twenty-three (32%) patients were classified as at high cardiovascular risk by the application. The main risk factors in the high risk group were age greater than or equal to 60 years (n = 21; 91.30%), dyslipidemia (n = 15; 65,2%), high blood pressure (n = 15; 65.2%), male sex (n = 13; n = 56.5%) and smoking (n = 11; 47.8%).

Conclusion:

Approximately one third of the study population had a high cardiovascular risk; HBP and dyslipidemia were the most prevalent modifiable risk factor in the high risk group. We may say that there is no single protocol or score available able to estimate the cardiovascular risk of all individuals in the same way, and therefore, the physician must individually evaluate the patients and be updated on the best methods of disease prevention to improve current approaches.

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Review Article

Cardiovascular Complications of HIV

Hugo Ribeiro Zanetti et al. Leonardo Roever Alexandre Gonçalves Elmiro Santos Resende

Abstract

With the advent of the antiretroviral therapy (ART), people infected with HIV are experiencing a significant increase in life expectancy. However, as this population ages, the morbidity and mortality due to events not related to HIV infection and/or treatment become increasingly clear. Cardiovascular diseases are among the major causes of death, and, thus, understanding the factors that trigger this situation is necessary. This review article will assess how the intrinsic and extrinsic factors related to HIV, ART and the associated risk factors can aid the epidemiological transition of mortality in this population. Moreover, we will present the studies on the epidemiology and pathogenesis of each clinical condition related to HIV-infected individuals, in addition to introducing the major markers of cardiovascular disease in this population. Finally, we will point the main issues to be addressed by health professionals for an adequate prognosis.

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Original Article

Influence of Pulmonary Rehabilitation on Clinical Characteristics in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease

Ganna S. Smyrnova et al. Tetiana M. Babkina Gennadii G. Taradin Mykola T. Vatutin

Abstract

Background:

The improvement of treatment strategies in patients with chronic obstructive pulmonary disease (COPD) and especially with comorbid pathology should provide rational conversion of standard schemes of therapy and rehabilitation in accordance with their clinical, pathogenic, functional and economic feasibility.

Objective:

To assess the influence of pulmonary rehabilitation on clinical characteristics in patients with chronic heart failure (CHF) and concomitant COPD.

Methods:

The study included 102 patients with CHF and concomitant COPD (males, 62%; mean age, 68.2 ± 4.5 years). All patients were divided into two groups: control group (CG) (n = 54), received only standard therapy of CHF and COPD; and intervention group (IG) (n = 48) were additionally taught the full yogic breathing as a program of pulmonary rehabilitation. Calculation of points by clinical evaluation scale (CES), assessment of CHF functional class (FC) (NYHA) and 6-minute walk test (6MWT – with the evaluation of dyspnea by the Borg scale) were performed in all patients on admission to the department and at discharge. Significant association was defined by p value < 0.05.

Results:

At baseline, there were no significant differences in clinical characteristics of the patients and studied parameters between the groups. At discharge both groups showed significant reduction of dyspnea by the Borg scale (in CG: from 7.2 ± 0.8 points to 5.2 ± 0.3; in IG: from 7.4 ± 0.6 points to 3.2 ± 0.4), the number of points by CES (in CG: from 10.8 ± 0.3 points to 7.2 ± 0.4; in IG: from 10.7 ± 0.6 points to 5.9 ± 0.6). Increase in exercise tolerance (by the distance of 6MWT) was observed in both groups (in CG: from 215 ± 24 m to 275 ± 22 m; in IG: from 219 ± 21 m to 308 ± 24 m). The changes were more significant in IG compared to CG. We observed the prominent decrease in CHF FC and length of hospital stay in IG.

Conclusions:

Application of full yogic breathing as the program of pulmonary rehabilitation in addition to standard therapy of the patients with CHF and COPD is associated with a significant decrease in CHF FC, an increase in exercise tolerance and a reduced length of hospital stay.

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Original Article

Protective Effects of Accumulated Aerobic Exercise in Infarcted Old Rats

Daniele Jardim Feriani et al. Hélio José Coelho-Júnior Maria Cláudia Irigoyen Bruno Rodrigues

Abstract

Background:

Aerobic exercise exerts cardioprotective effects on myocardial infarction. However, there is lack of information about the possible protective effects of continuous or accumulated aerobic exercise performed prior to myocardial infarction in aging.

Objective:

To evaluate the preventive effects of continuous or accumulated aerobic exercise on physical capacity, pulmonary congestion and ventricular weight in rats submitted to myocardial infarction.

Methods:

Old male Wistar rats were divided into four groups: sham control, sedentary infarcted, continuous aerobic exercise submitted to myocardial infarction, and accumulated aerobic exercise submitted to myocardial infarction. Body weight and maximum speed were evaluated at the beginning and at the end of the protocol. Trained groups performed continuous (1 h a day) or accumulated (30 minutes in the morning and 30 minutes in the afternoon) exercise. All groups, except the sham control, were submitted to myocardial infarction surgery at the end of the protocol. Heart, skeletal muscles, as well as wet and dry lung were weighed. The significance level in statistical analysis was established at p < 0.05.

Results:

Both continuous and accumulated exercise caused an increase in physical capacity in rats, as well as prevented its further impairment after myocardial infarction, and in the accumulated exercise group this prevention was greater. The continuous exercise group demonstrated an increase in lung water content, while the accumulated exercise group presented a reduction in body weight and an increase in left ventricle relative weight.

Conclusion:

In conclusion, the data of the present study indicate that accumulated aerobic exercise present a better protective effect than continuous aerobic training in the context of myocardial infarction and aging.

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Original Article

SAMe-TT2R2 Score: A Useful Tool in Oral Anticoagulation Decision-Making for Venous Thromboembolism Patients?

Fernando Pivatto Júnior et al. Rafaela Fenalti Salla Lísia Cunha Cé Andréia Biolo … André Luís Ferreira Azeredo da Silva Bruno Führ Luís Carlos Amon Marina Bergamini Blaya Rafael Selbach Scheffel

Abstract

Background:

The SAMe-TT₂R₂ score was introduced to identify atrial fibrillation patients with a high risk of not achieving a good time in therapeutic range (TTR) during vitamin K antagonists (VKA) therapy.

Objective:

The aim of this study was to evaluate this score in venous thromboembolism (VTE) patients.

Patients and methods:

A retrospective cohort study of patients receiving care at the outpatient anticoagulation clinic of a tertiary care teaching hospital. Patients were classified as having low (score 0-1) or high risk (score ≥ 2) of not achieving a good TTR. The area under the ROC curve was calculated to assess the ability of the score to predict a TTR ≥ 65%. Adverse event-free survival curves according to the SAMe-TT₂R₂ score were calculated by the Kaplan-Meier method and compared by the log-rank test. A p-value < 0.05 was considered statistically significant.

Results:

We investigated 111 patients during a median follow-up of 2.3 (0.7-6.4) years. Mean age was 54.1 ± 15.7 years and 71 (64.0%) were women. Low- and high-risk groups had similar mean TTR (51.9 vs. 49.6%; p = 0.593). The two groups did not differ significantly in the percentage of patients achieving a TTR ≥ 65% (35.6 vs. 25.8%; p = 0.370). The c-statistic was 0.595 (p = 0.113) for TTR ≥ 65%. Adverse event-free survival during anticoagulation was also similar in both groups (p = 0.136).

Conclusions:

The SAMe-TT₂R₂ score does not seem to be a useful tool in oral anticoagulation decision-making for patients with VTE and should not be used in this setting.

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Review Article

[ARTIGO RETRATADO] Relação Neutrófilo-Linfócitos na Avaliação do Risco para Desenvolvimento de Doença Cardiovascular

Heitor Oliveira Santos et al. Luiz Fernando Moreira Izidoro

Resumo

O desenvolvimento das doenças cardiovasculares de origem aterosclerótica está relacionado com severo processo inflamatório. Neutrófilos e linfócitos são células sensíveis a esse tipo de distúrbio, e sua relação, conhecida como NLR (do inglês neutrophil/lymphocyte ratio) vem se mostrando útil na clínica. O objetivo deste trabalho foi averiguar a NLR como risco para desenvolvimento de doenças cardiovasculares. Por meio de revisões literárias nas bases de dados PubMed, abrangendo artigos publicados entre 2001 e 2017, constatou-se que a NLR realmente é um marcador útil para doenças cardiovasculares. Adotar a verificação da NLR em pacientes com risco cardiovascular seria ferramenta útil para traçar o prognóstico dos pacientes portadores desse padrão de doença.

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Editorial

Environmental Pollution and Cardiovascular Diseases: Identify and Prevent!

Claudio Tinoco Mesquita

Exposure to environmental pollution is a key factor in the development and worsening of cardiovascular diseases. This alert was issued in a 2004 statement from the American Heart Association (AHA). A large body of new scientific evidence has been accumulated since then, allowing for a better understanding of the aspects related to this modifiable risk factor for cardiovascular diseases.

[…]

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Original Article

Mortality and Survival in Aortic Arch Surgeries with Preservation of Supra-aortic Vessels: Thirteen Years of Experience

Paula Ferraz de Oliveira et al. Gustavo Luiz Gouvêa de Almeida Junior Fabrício Braga da Silva Mauro Paes Leme de Sá … Valdo José Carreira Bruno Soares da Silva Rangel Sicilia Pacheco e Silva

Abstract

Background:

The aortic arch diseases exhibit high morbidity and mortality rates. Some surgical strategies recommend partial preservation of the aortic arch and the supra-aortic vessels, but the immediate and medium-term mortality rates of patients undergoing this surgical strategy is uncertain.

Objectives:

To compare overall mortality and mid- term survival curve of patients undergoing surgical strategy of partial preservation of the aortic arch and supra-aortic vessels (group A) compared to conventional strategies of the aortic arch approach (group B); to assess cardiovascular mortality over time.

Methods:

Descriptive and retrospective study of the medical records of patients undergoing aortic arch repair surgery between February 2000 and July 2013. We analyzed 111 patients, 29 in group A and 82 in group B. The overall survival and survival from cardiovascular events were assessed by Kaplan-Meier test.

Results:

In- hospital mortality from any cause was 31% in group A and 29.3% in group B. At 1 year, 2 year, and 5 year general survival was similar between the groups. In-hospital, 2 years and 5 years mortality from cardiovascular causes was 13.8%, 14.8%, e 22.7% in group A and 26.8%, 34.6% e 50.9% in group B. The difference between the groups in 5 years showed statistical significance (p = 0.0234). Survival from cardiovascular causes in 2 years and 5 years was 85.2% and 77,3% in group A and 65.4% and 49,1% in group B. Occurrence of urgent and emergency procedures were greater in group A, but without statistical significance.

Conclusions:

There was no difference in all-cause mortality over time between the groups. Group A showed lower cardiovascular mortality at 5 years than group B. (Int J Cardiovasc Sci. 2018;31(5)466-482)

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Brief Communication

The Influence of Comorbid Conditions on Graft Stenosis in Patients with Coronary Artery Bypass Graft Operation

Turgut Karabag et al. Belma Kalayci Bahar Sahin Elif Coskun … Mustafa Umut Somuncu Mustafa Ozan Cakir

Abstract

The primary goal of coronary artery bypass grafting is to achieve complete revascularization with grafts that will remain patent throughout the patient’s lifetime. This study investigated the association between bypass graft patency and comorbidity burden determined by Charlson comorbidity index (CCI) among patients with previous bypass operation who underwent a control angiography. One-hundred and two patients who had undergone CABG in the past were included to the study. Critical stenosis was defined as 50% or greater coronary luminal obstruction of any coronary vessel or its lateral branch. Patients were divided into 2 groups group 1; critical graft stenosis; (54 pts; 41M, mean age 66.5 ± 7.8 years), group 2; graft patent (48 pts; 31M, mean age; 65.9 ± 8.2 years). Charlson comorbidity index (CCI) and modified CCI scores were used for detecting comorbidities. The comparison of continuous variables between the control and critical CAD groups was performed by the independent sample test. A p value less than 0.05 was considered statistically significant. The two groups were statistically similar with respect to demographic properties, time since bypass operation, cardiovascular risk factors, systolic blood pressure, heart rate, medications used, complete blood counts parameters, and lipid profiles. CCI was significantly higher in Group 1 compared to Group 2 (7.14 ± 2.02 vs 4.72 ± 1.58; p < 0.001). Modified CCI scores were also higher in Group 1 than in Group 2 (6.14 ± 2.02 vs 3.73 ± 1.60; p < 0.001). Graft occlusion was more common among patients with a high comorbidity burden. CCI scoring system may be helpful for determining patients at increased risk at both the preoperative and postoperative periods.

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Case Report

Persistent Primitive Hypoglossal Artery Associated with Brain Stem Ischemia in an Elderly Patient

Rafael Mansur Souto et al. Alair Augusto Sarmet Moreira Damas dos Santos Marcelo Souto Nacif

Introduction

The primitive hypoglossal artery (PHA) crosses the hypoglossal canal, being one of the four vessels that acts as anastomosis between the primitive dorsal aorta and longitudinal neural arteries. The PHA typically retracts 40 days after pregnancy but may persist in some situations.

Direct anastomoses between the basilar and carotid arteries are rare.^– These vessels retreat during the fortieth day of fetal development, when the emergence of the posterior communicating arteries occurs unicating vessels are the trigeminal, the primitive hypoglossal, the proatlantal and the ophthalmic vessels.^,^, The persistence of the primitive hypoglossal artery has an incidence of 0.01% to 0.03%, being the second most frequent among the four vessels.^–

[…]

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Case Report

Monomorphic Ventricular Tachycardia as the First Manifestation in a Patient with Anomalous Coronary Artery

Júlio César Vieira de Sousa et al. Raiana Maciel Miranda Gabriela Melchuna Madruga Domitila Costa de Farias … Paula de Medeiros Nacácio e Silva Nastassja Morgana de Sousa Figueiredo

Introduction

Coronary artery anomalies comprise a heterogeneous group of rare congenital heart defects, being classified according to their origin, course and distal bed, with an incidence ranging between 0.3% and 1.5% in the overall population. Dodge-Khatami et al. subdivided them into seven categories, according to their clinical complexity: coronary arteries originating from the pulmonary artery, coronary arteries with anomalous aortic origin, congenital atresia of the left main coronary artery, coronary arteriovenous fistulas, coronary arteries forming myocardial bridges, coronary artery aneurysms and coronary stenosis. The Texas Children’s Hospital classification uses angiotomography with virtual angioscopy and divides the classification into three topics: origin of the anomalous coronary artery, coronary artery course and ostium morphology. From the viewpoint of anatomical risk, the anomalous left coronary artery with an interarterial course, presence of intramurality and a slit-like ostium are the main predictive factors of severity.^–

A specific type is the anomalous origin of the left coronary artery from the right coronary sinus with an interarterial course, which is associated with hard outcomes in approximately 60% of the cases. Clinically, patients may present with nonspecific symptoms, ranging from palpitations, chest pain, post-exertion syncope or remain asymptomatic throughout life, with sudden death being the first and only manifestation of this condition.

[…]

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