2020;33(2) – ABC CARDIOL

IJCS

Família ABC | IJCS

Original Article

Tonometric and Oscillometric Methods for Measurement of Central Blood Pressure Parameters: a Comparison in Patients with Borderline Hypertension or Stage 1 Hypertension

Weimar Kunz Sebba Barroso et al. Claudia Ferreira Gonçalves João Alexandre Costa Berigó Milena Andrade Melo … Ana Carolina Arantes Ellen De Souza Lelis Watila Moura Sousa Jeeziane Marcelino Rezende Thiago Jardim Paulo Cesar Jardim Ana Luiza Lima Sousa Priscila Valverde Oliveira Vitorino

Abstract

Background

Changes in arterial compliance are among the first changes detectable in hypertensive syndrome. Methods with good reproducibility as compared with the gold standard for identifying such changes are desirable in clinical practice.

Objectives

To compare central pressure measurements and arterial stiffness obtained by two non-invasive methods (tonometry and oscillometry).

Methods

This was a descriptive, cross-sectional study with a convenience sample of patients with borderline hypertension or stage 1 hypertension. Peripheral and central blood pressure measurements were obtained by tonometry (SphygmoCor®), considered the gold standard, and oscillometry (Mobil O´graph®). Comparisons of results were made by unpaired t-test, and p values < 0.05 were considered statistically significant.

Results

No difference was found in central pressure measurements obtained by SphygmoCor® (117 x 80.1 mmHg) compared with Mobil O’graph (112 x 81.4 mmHg). Mean augmentation index (AIx) was 26.1% and 21.3%, and mean pulse pressure (PP) amplification 10.7 mmHg and 10.0 mmHg by Sphygmocor® and Mobil O´graph®, respectively (p > 0.05). Mean pressure wave velocity (PWV), 8.4 m/s vs. 7.4 m/s (p = 0.013) and mean central pulse pressure, 37.7 mmmHg and 30.9 mmHg (p = 0.013) were significantly higher by SphygmoCor® than Mobil O´graph®.

Conclusion

Values of central systolic blood pressure, AIx and pulse pressure amplification obtained by oscillometry were not statistically different compared with tonometry; values of PWV and cPP, however, were underestimated by oscillometry. (Int J Cardiovasc Sci. 2020; 33(2):145-150)

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Editorial

Psoriatic March, Skin Inflammation and Cardiovascular Events – Two Plaques for one Syndrome

José Laerte Boechat

Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. Unfortunately, this is still the view among many doctors.

In this issue, Campos et al., published an interesting observational study on cardiovascular (CV) risk factors and risk measurement in patients with psoriatic arthritis, which allow us, in this editorial, to put the spotlight on some points of great interest in this area.

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Editorial

The Challenge of Controlling Resistant Hypertension

Marcus Vinicius Bolivar Malachias

Hypertension is the main risk factor for cardiovascular disease, stroke, disability and death. Despite the accumulated knowledge about hypertension and many treatment options, some hypertensive patients do not achieve the recommended blood pressure goals even receiving non-pharmacological treatment and three antihypertensive drugs. These individuals have the so-called “resistant hypertension” and are at increased risk of involvement of target organs, higher morbidity and mortality.

Several international scientific societies, including the Brazilian Society of Cardiology, have dedicated to publishing evidence-based guidelines for the management of arterial hypertension,^, and specific position statements on resistant hypertension have also been produced.^, The Department of Hypertension of the Brazilian Society of Cardiology is about to issue an updated statement on the subject.

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Editorial

Arterial Stiffness: The New Frontier in Hypertension and Cardiovascular Disease

Erika Maria Gonçalves Campana

Vascular age is a reflection of cardiovascular and non-cardiovascular factors that contribute to accelerated vascular aging (AVA) and stiffness of large elastic arteries, leading to increased cardiovascular morbidity and mortality. Arterial stiffness has been regarded as an important biomarker in the assessment of subclinical atherosclerosis and cardiovascular risk.^– The addition of pulse wave velocity (PWV) measurements to traditional risk factors has improved the prediction of the ten-year risk of cardiovascular diseases in 13% of individuals at intermediate risk.

In addition, the altered behavior of central hemodynamic parameters, such as central systolic blood pressure (cSBP) and the (heart rate-corrected) augmentation index (AI), is influenced by arterial stiffness and plays a crucial role in the interface between the traditional cardiovascular continuum vascular aging continuum, which represents the current view of the pathophysiology of cardiovascular diseases.^– ()

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Original Article

Factors Associated with Quality of Life in Patients with Systemic Arterial Hypertension

Gustavo O. Silva et al. Aluísio Andrade-Lima Antônio Henrique Germano-Soares Dalton de Lima-Junior … Sergio L. C. Rodrigues Raphael M. Ritti-Dias Breno Q. Farah

Abstract

Background

Hypertensive patients present, in addition to worse cardiovascular health, lower health-related quality of life compared to normotensive subjects. Factors such as functional capacity, functional status, pain, participation in social activities, mental and emotional health, fatigue and energy level, along with perception of general health, seem to be relevant for evaluation in this population. However, evidence is unclear in hypertensive patients.

Objective

To analyze the factors associated with quality of life in hypertensive patients.

Methods

Forty-five patients were recruited. The dependent variables of the present study are the quality of life domains. Demographic data and clinical conditions were considered independent variables. The Medical Outcomes Short-Form Health Survey (SF-36) questionnaire was used to measure quality of life. Handgrip strength, blood pressure and anthropometric indicators were evaluated. Crude and adjusted linear regression analysis was used.

Results

It was verified that education level, body mass index and muscle strength were associated with the functional capacity domain (p < 0,05), whereas systolic blood pressure was associated with the physical domain (p < 0,05). Women presented lower quality of life on the pain domain compared to men and educational level was associated with the social domain (p < 0,05).

Conclusion

Hypertensive patients with lower levels of body mass index, higher levels of education and muscle strength presented a better quality of life on the physical domain, while the social aspects presented a positive relationship with education level. Women presented a worse quality of life on the pain domain compared to men. (Int J Cardiovasc Sci. 2020; 33(2):133-142)

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Original Article

Predictors of Post-Discharge 30-Day Hospital Readmission in Decompensated Heart Failure Patients

Camila Sarteschi et al. Wayner Vieira de Souza Carolina Medeiros Paulo Sergio Rodrigues Oliveira … Silvia Marinho Martins Eduarda Ângela Pessoa Cesse

Abstract

Background

Heart failure (HF) is worldwide known as a public health issue with high morbimortality. One of the issues related to the evolution of HF is the high rate of hospital readmission caused by decompensation of the clinical condition, with high costs and worsening of ventricular function.

Objective

To quantify the readmission rate and identify the predictors of rehospitalization in patients with acute decompensated heart failure.

Methods

Hospital-based historic cohort of patients admitted with acute decompensated HF in a private hospital from Recife/PE, from January 2008 to February 2016, followed-up for at least 30 days after discharge. Demographic and clinical data of admission, hospitalization, and clinical and late outcomes were analyzed. Logistic regression was used as a strategy to identify the predictors of independent risks.

Results

312 followed-up patients, average age 73 (± 14), 61% males, 51% NYHA Class III, and 58% ischemic etiology. Thirty-day readmission rate was 23%. Multivariate analysis identified the independent predictors ejection fraction < 40% (OR = 2.1; p = 0.009), hyponatremia (OR = 2.9; p = 0.022) and acute coronary syndrome (ACS) as the cause of decompensation (OR = 1.1; p = 0,026). The final model using those three variables presented reasonable discriminatory power (C-Statistics = 0.655 – HF 95%: 0.582 – 0.728) and good calibration (Hosmer-Lemeshow p = 0.925).

Conclusions

Among hospitalized patients with acute decompensated heart failure, the rate of readmission was high. Hyponatremia, reduced ejection fraction and ACS as causes of decompensation were robust markers for the prediction of hospital readmission within 30 days of discharge. (Int J Cardiovasc Sci. 2020; 33(2):175-184)

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Viewpoint

A Different Heart in Children´s Literature: The Juvenile Literature in Medical Education

Ana Mallet et al. Fátima Geovanini Luciana Andrade David Kestenberg

Abstract

José Saramago, Nobel Prize in Literature, is the author of a statement that provokes adult readers: “What if children’s stories become mandatory reading for adults? Would they really learn what they’ve been teaching for so long?”. 1 It is in this context that literary texts dedicated to children have been used at times in medical education and clinical practice to bring up often invisible subjectivities.

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Editorial

Factors Associated With Quality of Life in Patients with Systemic Arterial Hypertension

Armando da Rocha Nogueira

In 1966, Avedis Donabedian published a seminal article showing the importance of measuring health care quality. Donabedian also defined that it should be done in the dimensions of structure, process or results. The author showed that the “results” dimension is not necessarily related to the other two. While the measurement of some results, such as mortality, is easy to be carried out, other results are difficult to be measured, such as quality of life and patients’ satisfaction.

In the early 80’s, I became interested in the subject of health care quality. My thesis to obtain the master’s degree in Internal Medicine from the Federal University of Rio de Janeiro Medical School was entitled “Hypertension: health care quality at the HU-UFRJ”.

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Original Article

Medical Behavior in Cardiorespiratory Arrest before and After Simulation Based on Advanced Cardiac Life Support (ACLS) Course

Douglas Marostica Catolino et al. José Knofholz

Abstract

Background:

The Advanced Cardiac Life Support (ACLS) course is designed to teach cardiovascular emergency, aiming to promote a harmonious and synchronized work of the entire hospital team, making the multidisciplinary job more effective in the execution of cardiopulmonary resuscitation (CPR).

Objective:

To compare the effectiveness of CPR performed between physicians trained on ACLS and non-trained physicians.

Methods:

A questionnaire was applied to physicians working at the emergency room of hospitals in Curitiba, state of Paraná, whose resolution required theoretical and practical knowledge about CPR. For analysis, descriptive statistics and Fisher’s association analysis were used, and the medians of the groups were evaluated by Mann-Whitney/Kruskal-Wallis with significance of 5%.

Results:

Thirty-four physicians were volunteers, of whom 20 had taken the ACLS course (Group A) and 14 had not (Group B). The trained physicians obtained the highest median (4.00 vs. 3.00, p = 0.06) of correct answers. Group A scored at least 3 of the 5 questions in the questionnaire, showing better performance than Group B (OR = 6.75, 95% CI, 1.1 < OR < 41.0, p = 0.04). The year of the course did not significantly change the performance in the questionnaire.

Conclusion:

It is suggested that the ACLS course was effective in qualifying physicians to handle situations of cardiorespiratory arrest properly, which was reproduced by the better performance in the resolution of the questionnaire. It is believed that when the sample of volunteers is increased, the trends found materialize the other hypotheses proposed.

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Original Article

Internal Validation of a Risk Score for Prediction of Postoperative Atrial Fibrillation after Cardiac Surgery

Rafael de March Ronsoni et al. Tiago Luiz Luz Leiria Leonardo Martins Pires Marcelo Lapa Kruse … Edemar Pereira Rogerio Gomes da Silva Gustavo Glotz de Lima

Abstract

Background:

Postoperative atrial fibrillation (POAF) after cardiac surgery has great clinical and economic implications. Many attempts have been made to identify risk factors aiming at a better evaluation of prophylactic treatment strategies.

Objective:

To perform an internal validation of a risk score for POAF.

Methods:

A prospective cohort of 1,054 patients who underwent myocardial revascularization and/or valve surgery was included. The risk score model was developed in 448 patients, and its performance was tested in the remaining 606 patients. Variables with a significance level of 5% in the cohort were included and subjected to a multiple logistic regression model with backward selection. Performance statistics was performed using the c-statistic, the chi-square and the Hosmer-Lemeshow (HL) goodness-of-ﬁt, Pearson’s correlation coefﬁcient.

Results:

Four variables were considered predictors of outcome: age (≥ 70 years), mitral valve disease, the non-use or discontinuation of beta-blockers and a positive water balance (> 1,500 mL). The ROC curve was 0.76 (95% confidence interval [CI]: 0.72-0.79). The risk model showed a good ability according to the performance statistics – HL test x⁽²⁾ = 0.93; p = 0.983 and r = 0.99 (Pearson’s coefficient). There was an increase in the frequency of POAF with the increase of the score: very low risk = 0.0%; low risk = 3.9%; intermediate risk = 10.9%; and high risk = 60.0%; p < 0.0001.

Conclusion:

The predictive variables of POAF allowed us to construct a simplified risk score. This scoring system showed good accuracy and can be used in routine clinical practice.

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Original Article

Association between Therapeutic Adherence and the Profile of Patients with Resistant Hypertension

Luciana Baltazar da Silveira de Araújo et al. Roque Aras Junior

Abstract

Background:

Resistant hypertension (RH) consists of increased blood pressure (BP) despite the use of 3 or more antihypertensives or BP control only when is use of 4 or more antihypertensives. It is fundamental to exclude pseudoresistance, which can be attributed to poor therapeutic adherence. Adherence evaluation, generally by the Morisky-Grenn test, is important because, when appropriate, it is associated with fewer cardiovascular complications and better BP control.

Objectives:

To evaluate the adherence of patients with RH and to investigate its relation with epidemiological, anthropometric and clinical characteristics, as well as to estimate the prevalence of pseudoresistance and to outline strategies to improve adherence.

Methods:

Retrospective observational cohort from an interview with patients followed at an outpatient clinic for RH. Therapeutic adherence, demographic, anthropometric data, cardiovascular risk factors, comorbidities, complementary exams and BP level were collected. One-way ANOVA and Student’s t-tests were used for normal variables, and the Kruskal-Wallis and Mann-Whitney tests were used for non-normal tests. Categorical variables were compared using the Chi-Square test. We considered a 5% significance level in all tests.

Results:

217 individuals were included. Of these, 17% had poor adherence. Epidemiological and clinical characteristics, complications, comorbidities, BP level or drugs used were statistically insignificant between groups. The poor adherence group used significantly more drugs (p = 0.0313) and 28% of pseudoresistance was estimated.

Conclusions:

Most of the individuals presented good therapeutic adherence by the Morisky test. Only the number of antihypertensive drugs had a statistically significant influence on adherence, while the epidemiological, anthropometric and clinical characteristics were statistically insignificant.

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Original Article

Factors Associated to the Knowledge of Cardiac Arrest by Health Professionals

Eduardo Moreira Novaes Neto et al. Kátia Santana Freitas

Abstract

Background:

Knowledge of cardiac arrest by health professionals is associated with sociodemographic, occupational and training characteristics.

Objectives:

To evaluate the factors associated with the knowledge of health professionals on Cardiac Arrest.

Methods:

A cross-sectional study conducted in a large public hospital in the countryside of Bahia – Brazil. The sample consisted of 18 doctors, 32 nurses and 50 nursing technicians. To evaluate the knowledge of the professionals, a questionnaire was constructed according to the current guidelines for resuscitation of the American Heart Association of 2015, and after that, it was submitted to three judges with expertise in PCR to verify content validity. Data were analyzed through descriptive statistics with univariate, bivariate and multivariate analyses using the logistic regression model. A value of p < 0.05 was adopted as level of significance.

Results:

The prevalence of insufficient knowledge of cardiac arrest among health professionals was 78%. After logistic regression, belonging to the professional category of nursing technician (p = 0.003) and nurse (p = 0.001) and working in the form of on-call duty for 24h (p = 0.005) was associated to insufficient knowledge.

Conclusions:

Insufficient knowledge of cardiac arrest among health professionals is high, which is a problem that requires urgent interventions in order to guarantee the quality of care. These actions should be based on realistic scenarios involving theoretical and practical activities. The periodicity of training should be short, given the deterioration of knowledge. The creation and validation of the data collection instrument allows for its applicability in other studies.

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Original Article

Cardiovascular Risk Factors and Risk Measurement in Patients with Psoriatic Arthritis in a University Hospital

Beatriz Pinto e Siqueira Campos et al. Gustavo Daniel dos Santos Gomes Alessandra de Sousa Braz Andre Telis de Vilela

Abstract

Background:

Psoriatic Arthritis is the spondyloarthritis associated with psoriasis, which is often related to high mortality due to cardiovascular causes.

Objectives:

To quantify cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity and smoking) and to measure risk by the Global Cardiovascular Risk Score in patients with psoriatic arthritis.

Methods:

Patients with psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis, aged between 30 and 74 years and without any other clinically manifest chronic inflammatory disease, atherosclerotic disease or heart failure were included. After an interview, clinical examination and data extraction from medical records, risk stratification was performed using a calculator available on the online platform of the Framingham Heart Study. We considered p < 0.05 as significant. Chi-square test and Fisher’s exact test were used to compare frequencies, as well as correlation measurements.

Results:

45 patients were included, 68,9% of which were women and the mean age was 53,94 years. Dyslipidemia was confirmed in approximately 93%, hypertension in 46%, obesity in 40%, 33.3% were diabetics and, 13.3%, smokers; 95% had increased abdominal circumference. It was observed that 53% had high cardiovascular risk, 29% had intermediate risk and 18% had low risk. Individuals with altered C-reactive protein and erythrocyte sedimentation rate presented, respectively, higher levels of LDL-C and total cholesterol.

Conclusions:

There was a high occurrence of risk factors and the majority of the sample was stratified into high or intermediate cardiovascular risk.

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Case Report

Quantification of Myocardial Ischemia: Comparison between Myocardial SPECT and 13NH3 PET/TC

Angelica Mazzoletti et al. Francesco Dondi Maria Gazzilli Raffaele Giubbini

Introduction

Myocardial perfusion is a very important tool to diagnose and quantify hypoperfusion related to coronary artery disease (CAD). Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a widely available nuclear medicine imaging tool. Cardiac ¹³N-ammonia positron emission tomography/computed tomography (¹³NH₃ PET/CT) has increased its capability to provide quantitative measures of myocardial blood flow at rest and under stress, as well as of coronary flow reserve (CFR), in addition to better image quality.

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Case Report

Coronary Artery Disease Associated with Coronary Anomaly and Situs Inversus Totalis in Man Submitted to Angioplasty

Alexandre Fuchs et al. Leandro Bonecker Lora João Renato Cardoso Mourão Fernando César da Costa Duarte … Igor André Telles da Cunha Claudia Regina de Oliveira Cantanheda

Introduction

Dextrocardia associated with situs inversus totalis is a rare condition with an incidence of 1:10,000 in the general population.^, It is characterized by a complete left-to-right reversal of the abdominal organs, including the abnormal position of the heart, resulting from changes in embryological development during the gastrulation stage (third week), characterized by the establishment of the craniocaudal, dorsoventral and right-left axes in the embryo.

This condition is transmitted by autosomal recessive genes, located in the long arm of chromosome 14, which affects the genetic cascade responsible for left-right differentiation. It should be noted that most affected individuals can have normal lives.

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