2021;34(2) – ABC CARDIOL

IJCS

Família ABC | IJCS

Brief Communication

Acute Effect of Resistance Exercise on Mucociliary Clearance in Active Smokers

Alessandra Mayumi Marques Masuda et al. Iara Buriola Trevisan Tamara dos Santos Gouveia Guilherme Yassuyuki Tacao … Ercy Mara Cipulo Ramos Dionei Ramos

Abstract

Background:

Nasal mucociliary clearance (NMC) responds to autonomic activity through exercise. However, there is a gap in the literature on how NMC responds to resistance exercise.

Objective:

To evaluate the acute effects of resistance tube exercise on NMC and the autonomic nervous system in smokers.

Methods:

Clinical trial was performed with 18 individuals. Personal, anthropometric, and smoking history data were collected, and a pulmonary function test was performed by spirometry. The fatigue resistance test was performed in order to obtain the number of repetitions for the prescription of exercise. Heart rate variability was captured using a monitor. Subsequently, the exhaled carbon monoxide (exCO) was measured and a saccharin transit test (STT) was performed for NMC.

Results:

The non-smoking group presented a significant decrease of 4.0±3.2 minutes in STT after P1 (p=0.021). Regarding HRV, the smoking group presented a significant decrease of mean RR (−90.3±53.0; p=0.011), SDNN (−560.0±1333.2; p=0.008), RMSSD (−13.6±10.5; p=0.011), LFms² (−567.3±836.1; p=0.008), HFms² (−223.8±231.8; p=0.008), SD1 (−9.7±7.4; p=0.011) and SD2 (−20.7±17.0; p=0.008), and an increase of mean HR (10.2±5.9; p=0.011) after P2. In the non-smoking group, a significant decrease was observed in the mean RR (−67.1±70.7; p=0.038), SDNN (−16.8±15.0; p=0.015), RMSSD (−12.3±14.7; p=0.011), LFms² (−831.2±1347.5; p=0.015), SD1 (−8.7±10.4; p=0.011), and SD2 (−22.0±19.1; p=0.015), while an increase in HR (7.1±7.3; p=0.028) was found after P1.

Conclusions:

The intensity of the resistance exercise applied to the patient was not enough to promote changes in smokers. By contrast, in non-smokers, the same intensity of exercise was effective in promoting alterations in the NMC and autonomic activity. (Int J Cardiovasc Sci. 2021; 34(2):223-230)

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Editorial

Mortality in the Elderly Due to Cerebrovascular Disease

Marco Antônio Mota Gomes et al. Annelise Machado Gomes de Paiva

Cardiovascular Diseases (CVD) are the main cause of death, hospitalization and outpatient care worldwide, including in developing countries like Brazil. More than 75% of deaths from these causes occur in low- or middle-income countries, and about 80% of deaths are due to acute myocardial infarction (AMI) and stroke. Vilela, PB et al. observed that mortality from cerebrovascular disease in Brazil is influenced by socioeconomic factors.

Although the aging process is not necessarily related to diseases and disabilities, elderly people have a high prevalence of chronic non-communicable diseases (NCDs). In the period from 2010 to 2050, the number of strokes is expected to more than double, with most of the increase among the elderly (≥75 years of age) and minority groups. Greater attention is needed to promote optimal cardiovascular health and healthy aging throughout life.

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Editorial

Home-Based Resistance Training in Heart Diseases: Don't Stop the Music, your Muscles are still Listening

Gabriel Dias Rodrigues et al. Pedro Paulo da Silva Soares

Cardiovascular diseases (CVDs) are a well-known cause of death and physical incapacity worldwide. Heart failure (HF) is a common disease resulting from multiple etiologies that contribute to decreasing physical capacity and quality of life (QOL).^, Not long ago physical exercises were discouraged in CVDs, but evidence-based exercise programs augment QOL, reduce mortality and hospital readmission in HF². Strength training is an important component of a cardiac rehabilitation program due to its close relationship with improvements in functional capacity reverberating in activities of daily living and QOL.

Unfortunately, supervised-rehabilitation programs in fitness centers are not widely available for the majority of patients with heart disease. Nevertheless, home-based rehabilitation programs could be more accessible to most patients, because of its relatively low cost and feasibility. Especially during COVID-19 pandemic lockdown, many opportunities to exercise were suspended, including cardiac rehabilitation services and community health programs. Also, social distancing increased sedentarism numbers and several position statements have encouraged people to stay active at home, trying to reverse or counterbalance the additional impact of social distance on physical inactivity.^, In a practical perspective, resistance training is conventionally performed through free weights or weight machines that usually require extensive physical space and outside facilities (i.e., gym or rehabilitation centers). Thus, resistance exercises, in particular, are not easily adopted at home and could be omitted from home-based cardiac rehabilitation. To underscore, a question that must be made: How patients remain strong at home?

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Case Report

Double-lumen Aortic Arch: Persistence of the Fifth Aortic Arch?

Nathalia Mussi Monteze et al. Adriana Furletti Machado Guimarães Fatima Derlene da Rocha Araujo

Abstract

Double-lumen aortic arch is a rare congenital anomaly related to persistence of the fifth aortic arch. It may be found alone or in association with other anatomical changes of the heart. We report a case of double-lumen aortic arch associated with coarctation of the aorta and patent ductus arteriosus in a child with a congenital malformation known as the VACTERL association (vertebral defects, imperforate anus, cardiopathy, tracheoesophageal fistula, renal abnormalities and limb anomalies).

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Editorial

Epicardial Fat Thickness: a Promising Cardiovascular Risk Factor that Requires in-Depth Studies

Roberto M. Saraiva et al. Andréa Rodrigues da Costa

This issue of the International Journal of Cardiovascular Sciences presents a paper by Castanheira et al. that addresses epicardial fat (EF) thickness in an elderly Portuguese population. They describe the mean values of EF thickness and its correlation with anthropometric, echocardiographic, and clinical variables in these individuals.

EF is the visceral adipose tissue located between the myocardium and the visceral pericardium, and commonly found in the atrioventricular and interventricular grooves. EF has several physiological roles, including local effects on the heart, in a paracrine manner.^– EF can be measured non-invasively by echocardiography, and the measurement of EF thickness by 2D echocardiography has been proposed as a surrogate for visceral fat, since it is easier to perform as compared with direct measures such as computed tomography and magnetic resonance imaging (MRI). In addition, a significant correlation between EF and visceral fat measurements by MRI was demonstrated.

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Editorial

Rivaroxaban: is it Really Need to Monitor its Anticoagulant Effect in Clinical Practice?

Luiz Eduardo Montenegro Camanho et al. Gustavo Vignoli dos Santos

Oral anticoagulation (OAC) has been the cornerstone for the treatment of atrial fibrillation (AF) patients. The vitamin K antagonist warfarin has been considered the drug of choice in stroke prevention with proven efficacy for more than 60 years. The great inter-patient and intra-patient dose variability and need for routine International Normalized Ratio (INR), are among the main disadvantages of warfarin. The direct-acting oral anticoagulants (DOACs), including direct thrombin inhibitors (dabigatran) and factors Xa inhibitors (apixaban, edoxaban, and rivaroxaban), are currently the therapy of choice for preventing thromboembolic events in patients with atrial fibrillation. Unlike warfarin and other vitamin K antagonists, the DOACs are administered in fixed doses and do not require routine laboratory monitoring.

Rivaroxaban is an oral inhibitor of free and clot-associated factor Xa through reversible, competitive interactions with its active site. Bioavailability following oral administration is dose-dependent, and it is highly bound to plasma proteins. Plasma levels peak 2 to 4 h following oral administration, partially excreted by the kidneys, and has a half-life depending on the dose and age. Factor Xa inhibitors variably affect prothrombin time (PT), with concentration-dependent PT prolongation. The sensitivity of the different assays varies widely, depending on the thromboplastin reagent, and it is recommended to check the sensitivity of PT in each institution. At therapeutic doses, rivaroxaban has a relatively weak effect on PT, but there is a more pronounced effect on supratherapeutic doses.

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Case Report

Acute Myocardial Infarction as the Initial Clinical Manifestation of Pernicious Anemia

Leonardo Marostica Alves Silva et al. Assis Xavier da Silva Barros Junior João Antonio de Toledo Galina Alexandre Rodrigues … Igor Ribeiro de Castro Bienert Pedro Beraldo de Andrade

Introduction

Despite its lower prevalence in young individuals, acute myocardial infarction (AMI) causes significant morbidity and socioeconomic impact when occurs in this group. In 2010, considering only the hospitals accredited by the Brazilian Unified Health System, there were 8,368 hospitalizations and 2,556 deaths from ischemic heart diseases among patients younger than 40 years. Although hospitalization rates are lower at this age range, the importance of this theme lies mainly in the absolute numbers of cases.

Acute coronary syndrome (ACS) in young patients has characteristics that differ from older patients. Although coronary atherosclerotic disease is a common cause, the prevalence of AMI without obstruction in the coronary arteries is higher among the young. Among the causes of AMI without atheromatous disease, thromboembolism is a differential diagnosis, with hypercoagulability correlated with formation of coronary embolism. Thus, it is important to identify alternative etiologies in the approach of AMI in young patients since modifiable factors can be diagnosed and treated. In this article, we present a case in which an autoimmune disease may be the cause of ACS in a young patient with few attributable risk factors for cardiovascular disease.

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Review Article

Nutrition and Cardiovascular Diseases: Programming and Reprogramming

Emiliana Barbosa Marques et al. Karyne Pollo de Souza Thaís Alvim-Silva Ivis Levy Fernandes Martins … Samuel Pedro Christianne Bretas Vieira Scaramello

Abstract

The Developmental Origin of Health and Disease (DOHaD) is an area of science dedicated to studying the processes by which insults during critical periods of mammals development leading to physiological changes resultig in diseases throughout life. Studies point to a complex interaction between nutritional status in early life and cardiovascular system homeostasis in which maternal malnutrition during gestation and/or lactation, as well as early weaning, are associated with development of cardiovascular diseases in adulthood. In this context, epigenetic changes, such as DNA methylation, histone acetylation, and change in microRNA expression have been considered molecular bases of cellular plasticity, which can also be gender-dependent. Experimental studies have demonstrated that interventions encompassing the consumption of functional food/bioactive compounds, as well as energetic and nutrients adjustments on the diet, may attenuate or even prevent consequences associated with plasticity of development, improving cardiovascular health. This review aimed to gather and discuss the findings within this context, published over the last ten years.

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Editorial

Can the Impact of the Excessive Use of Salt and its Chronic Consequences be Atenuated by Functional Foods?

Juliana Tomaz Pacheco Latini et al. Kátia Calvi Lenzi de Almeida

Significant evidence has been showing the strong impact that food has on health. Among the substances that have a great influence on food choices and preferences is sodium (salt), which has been associated with obesity and chronic diseases, such as diabetes mellitus, high blood pressure and cardiovascular diseases.^,

According to National Academies of Sciences, Engineering and Medicine (2019), a sodium intake below 2.3 g/day is recommended for adults to reduce the risk of chronic diseases, such as high blood pressure. Despite great educational efforts on the part of government and medical authorities, populations still maintain a higher than recommended sodium intake, which has led to the development of public health strategies to reduce this problem.

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Viewpoint

Research and Publication in Brazil: Where we are and Where we Head to

Marcelo Antônio Cartaxo Queiroga Lopes et al. David Brasil Gláucia Maria Moraes de Oliveira

In a report by Clarivate Analytics for the Brazilian Coordination for the Improvement of Higher-Level-Education Personnel (CAPES) about the Brazilian research productivity between 2013 and 2018, Brazil ranked 13th (250 680 publications) among countries with the highest research productivity, corresponding to 11% and 16% of the first ranked countries, United States and China, respectively.^, In that period, the publications in Brazil increased by 30%, twice the global mean, with over 50 000 articles published in 2018 only.

A good example of that increase has been described in the study analyzing the number of papers published in Nature and Science from the University of São Paulo, University of Campinas, and the Federal University of Rio de Janeiro, from 1980 onwards. The publication counts were categorized by decade from 1980 to 2010 and for 2017. The authors have reported that those institutions together published 0.08 papers, on average, in each edition of those two journals. The total number of papers from those universities increased by 2200% from 1980 to 2017, with a higher representativity in the past decade (from 7 papers in 2010 to 23 in 2017). It is worth noting the increase in partnership with international institutions for the publication of scientific papers.

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Review Article

Effects of Chloroquine and Hydroxychloroquine on the Cardiovascular System – Limitations for Use in the Treatment of COVID-19

Stephani Correia Brazão et al. Lis Jappour Autran Rosane de Oliveira Lopes Christianne Brêtas Vieira Scaramello … Fernanda Carla Ferreira de Brito Nadia Alice Vieira Motta

Abstract

Chloroquine (CQ) and Hydroxychloroquine (HCQ) are antimalarial drugs, with anti-inflammatory properties that justify their use in the treatment of systemic lupus erythematosus and rheumatic diseases. A pandemic caused by the new coronavirus led the entire world’s scientific community to look for drugs already available on the market, capable of exercising beneficial actions in the fight against the disease. Preliminary studies in patients, as well as in vitro studies, suggested possible therapeutic effects associated with the use of HCQ and CQ in the treatment of COVID-19. Despite controversies over the effects of these drugs in combating the “cytokine storm” associated with COVID and the dismal of results in different clinical trials in Brazil, their use has been encouraged and several ongoing investigative studies are underway. In addition to the possible beneficial effects on the prognosis of patients with SARS-CoV-2, such drugs include varied effects on the cardiovascular system, ranging from positive developments related to their vasodilator properties to potential negative effects, such as cardiotoxicity. This work presents the main effects exerted by these drugs on the cardiovascular system, in order to contribute to a scientific discussion about the repurposing of these drugs in the context of COVID-19.

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Editorial

Physical Activity, Exercise and Sports and Covid-19: What Really Matters

Claudio Gil Soares de Araújo

The ability to move is essential for an independent life. It is widely recognized that those who spend the most time either lying down or sitting and are physically inactive tend to have limited autonomy, poor health-related quality of life, and adverse prognosis of outcomes.

This editorial will briefly discuss the relationship between COVID-19 and physical movement. To better address this important relationship and for sake of clarity, some concepts should be defined first. In sport and exercise sciences, “physical activity” is defined as any bodily movement produced by skeletal muscles that results in energy expenditure, “exercise” is a subset of physical activity that is planned, structured, and repetitive and “sport” is an activity that most often, but not always, involves exercise and predetermined rules and participation in games or races or competitions.

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Original Article

Short-Term Effects of a Resistance Training Program Using Elastic Tubing in Patients with Heart Disease

João Pedro Lucas Neves Silva et al. Tamara Iasmin de Sá Ferreira Gabriela Côrtes Cavalleri Mayara Moura Alves da Cruz … Bianca Pinhal Galindo Natália Turri da Silva Bruna Spolador de Alencar Silva Marceli Rocha Leite Ana Paula Coelho Figueira Freire Ercy Mara Cipulo Ramos Luiz Carlos Marques Vanderlei Francis Lopes Pacagnelli

Abstract

Background

Resistance training is effective in cardiac rehabilitation; however, it is conventionally performed using free weights or machines, which can pose logistic challenges to patients with restricted mobility. For its ease of access and cost-effectiveness, elastic tubing is a particularly appealing alternative, but it remains underutilized for this purpose.

Objective

To evaluate muscle strength, functional capacity, aerobic capacity, and quality of life in patients with heart disease in phase II of cardiovascular rehabilitation after a resistance training intervention based solely on elastic tubing.

Methods

Thirteen patients with heart disease (age 63.33±10.80 years) trained with elastic tubing twice weekly for 6 weeks, with progressive load increase every 15 days. The following muscle groups were evaluated and trained: shoulder abductors and flexors, elbow flexors, and knee flexors and extensors. Muscle strength was evaluated using a dynamometer; functional capacity, with a 6-minute walk test and cardiopulmonary exercise test; and quality of life, using the SF-36 questionnaire. Data normality was assessed using the Shapiro–Wilk test. The paired Student’s t-test was used for comparisons before and after training, at a significance level of <5%.

Results

There were significant differences in muscle strength (except for elbow flexion) and functional capacity (485.5 ± 123.3 vs 578.7 ± 110.5; p=0.0399) after the intervention. No statistical differences were found in cardiorespiratory fitness or quality of life.

Conclusions

Short-term resistance training with elastic tubing improved peripheral muscle strength and functional capacity in patients with heart disease, and should be encouraged for this population. (Int J Cardiovasc Sci. 2020; xx(x):xxx-xxx)

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Original Article

The Association between Tp-e interval, Tp-e/QT , and Tp-e/QTc Ratios and Coronary Artery Disease Spectrum and Syntax Score

Serkan Kahraman et al. Ali Dogan Gokhan Demirci Arda Guler … Ali Kemal Kalkan Fatih Uzun Nuri Kurtoglu Mehmet Erturk Mehmet Emin Kalkan

Abstract

Background

Coronary artery disease (CAD) causes electrical heterogeneity on ventricular myocardium and ventricular arrhythmia due to myocardial ischemia linked to ventricular repolarization abnormalities.

Objective

Our aim is to investigate the impact of increased level of CAD spectrum and severity on ventricular repolarization via Tp-e interval, Tp-e/QT and Tp-e/QTc ratios.

Methods

127 patients with normal coronary artery (group 1), 129 patients with stable CAD (group 2) and 121 patients with acute coronary syndrome (group 3) were enrolled. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were evaluated as well as baseline demographic and clinical parameters. Kruskal-Wallis one-way ANOVA test was used for comparing quantitative variables with abnormal distribution while One-Way ANOVA test was used for comparing the means between groups with normal distribution. Tukey HSD and Welch tests were used for subgroups analyses with normal distribution. Spearman analysis was used to evaluate the correlation between clinical variables and repolarization markers. A p-value < 0.05 was considered statistically significant.

Results

Tp-e interval [66(50-83), 71(59-82) and 76(64-86); group 1,2 and 3 respectively, p<0.001], Tp-e/QT (0.170.02, 0.180.01 and 0,190.01; group 1,2 and 3 respectively, p<0.001) and Tp-e/QTc (0.150.02, 0.160.02 and 0.170.02; group 1,2 and 3 respectively, p<0.001) ratios were found to be associated with increased level of CAD spectrum. Syntax score was positively correlated with Tp-e interval (r=0.514, p<0.001), Tp-e/QT (r=0.407, p<0.001), and Tp-e/QTc ratios (r=0.240, p<0.001).

Conclusion

Prolonged Tp-e interval and increased Tp-e/QT and Tp-e/QTc ratios were detected in the presence of CAD and especially in patients with acute ischemic syndromes. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Original Article

Elderly Mortality from Cerebrovascular Disease in Alagoas, 2000-2016: Spatial-Temporal Analysis

Luiz Carlos Francelino Silva Junior et al. Euclides José Oliveira Da Cunha Carlos Dornels Freire de Souza Alysson Wagner Fernandes Duarte

Abstract

Background

Cerebrovascular diseases (CVDs) are the second leading cause of death in Brazil.

Objective

This study aimed to describe the epidemiological profile and to analyze the spatiotemporal dynamics of mortality from cerebrovascular disease in the elderly in Alagoas from 2000-2016.

Methods

This is a multilevel ecological study of all deaths from CVD in individuals aged 60 years or older. Data were collected from the Mortality Information System. The variables were submitted to descriptive analysis, trend analysis by Joinpoint Regression method and spatial analysis with Global Moran’s and local statistics; 95% confidence interval and significance of 5% were considered in the analysis.

Results

There were 21,440 deaths in the study period, 50.4% (n=10,797) male, 40.5% (n=8,670) aged ≥ 80 years, 44.5% (n=9,465) of “brown” race, 30.1% (n=6,448) married and 36.5% (n=7,828) with less than four years of schooling. Female and male mortality rates were 460.24/100,000 and 602.23 / 100,000, respectively. An annual decreasing trend of -1.4% (p<0.001) in overall and male mortality was observed from 2007 on. The highest mortality rates were concentrated in the eastern region of Alagoas (Moran’s I =0.766288; p=0.01). Twenty-two municipalities were in quadrant Q1 of Moran’s scattering diagram and considered priorities.

Conclusion

Death from CVD in Alagoas occurred equally in men and women in the study period, mostly in individuals of mixed race, married, and with low education attainment. The highest rates were observed in the eastern region of the state . The results highlight the need for public policies aimed at healthy aging in the state. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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Original Article

The Effect of Psychotherapy on Anxiety, Depression, and Quality of Life of Patients with Heart Failure: A Randomized Clinical Trial

Isaura Rocha et al. Ana Dantas Cavalcanti Lyvia Figueiredo Juliana Pereira … Samara de Oliveira Danilo da Cruz Rodrigo de Freitas Evandro Tinoco Mesquita

Abstract

Background

Patients with heart failure often experience depression, anxiety, and impacts on quality of life. Psychotherapeutic interventions have been used for chronic conditions, including cardiovascular diseases, showing improvement in mental health. However, no studies have assessed the effects of a psychological intervention using psychoanalysis on patients with heart failure.

Objective

To assess the effect of short-term psychotherapy on depressive symptoms, anxiety, and quality of life of patients seen at a specialty clinic.

Method

A randomized clinical trial with scales to assess outcomes before and after psychotherapy, under the perspective of psychoanalysis, with 12 weekly sessions. The Beck Depression Inventory, the Beck Anxiety Inventory, and the Minnesota Living with Heart Failure Questionnaire were used. The mean initial and final scores for quality of life, anxiety, and depression were compared using Student’s t-test for independent samples when distribution was normal, or Mann-Whitney test when distribution was non-normal. A bivariate p-value < 0.05 was considered statistically significant for all analyses.

Results

This study involved 32 patients, 50% were female, mean age was 64.3±11.6, and most participants were New York Heart Association (NYHA) functional class I (56.3%). For anxiety (p = 0.196), there was no statistically significant difference between groups. For quality of life and depression, there was a statistical difference (p = 0.009 and 0.035, respectively), with a medium effect (Cohen’s d = 0.593) on quality of life.

Conclusion

Short-term psychotherapy in outpatients with heart failure showed an impact on depression and quality of life but did not improve anxiety. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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Original Article

Maternal Intake of Flaxseed During Lactation and Exercise Training Protect Against Salt Overload-Induced Aortic Remodeling in Adult Offspring

Simoni Silva-Couto et al. André Manoel Correia-Santos Gabriela Câmara Vicente Caroline Luiza Codonho Castro … Vanessa de Lana Melo Barreto Joyce Eduarda Campos Martins Queila Lenzi Gilson Teles Boaventura Maurício Alves Chagas

Abstract

Background

High dietary sodium intake can induce endothelial stiffness even without changes in blood pressure.

Objectives

To evaluate the effects of exercise training and chronic intake of sodium chloride solution on aortic morphology of male offspring of rat dams who consumed flaxseed during lactation.

Methods

Female rats were fed with a control diet or a flaxseed diet during lactation. At weaning, two male offspring of each rat dam were allocated into eight groups for 180 days: four groups received a control diet e four received a flaxseed diet, with /without exercise and with/without NaCl solution supply. Aorta was collected for histomorphometric analysis. The one-way analysis of variance was used and P value < 0.05 was considered statistically significant.

Results

The chronic use of 1% NaCl solution led to changes in aortic histoarchitecture in the control group: increase in aortic intima-media thickness (10,4%, p<0.0001) and reduced number of elastic lamellae (-8,1%, p<0.0001). Groups of offspring of mother that consumed flaxseed during lactation, the chronic use of 1% NaCl alone did not lead to an increase in the aortic intima-media thickness. Exercise training of adult offspring increased aortic intima-media thickness (13.3%, p<0.0001), with preservation of elastic components and aortic flexibility.

Conclusion

Chronic salt overload caused adverse effects on the aorta of rats, and maternal consumption of the flaxseed diet during lactation protected against aortic remodeling. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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Original Article

Correlation between Epicardial Fat Thickness and Clinical and Anthropometric Variables in an Elderly Population

Joaquim Castanheira et al. Cristiana Nunes Telmo Pereira

Abstract

Background

Epicardial fat (EF) thickness is a marker of visceral adiposity and consequently considered an important predictive marker of cardiovascular and metabolic risk.

Objective

To describe echocardiographic features of the heart in an elderly population and to study the correlation between EF thickness and clinical and anthropometric variables.

Methods

A sample of 34 individuals (25 women) aged between 65 and 92 years, who attended a private institution in the central region of Continental Portugal, was analyzed. A standardized sociodemographic questionnaire was applied, and anthropometric assessment, echocardiography and blood pressure measurement were performed in all subjects. A correlational analysis of EF thickness with anthropometric and clinical parameters was performed. The association between variables was tested by Pearson’s correlation and point-biserial correlation. A value of p < 0.05 was defined as statistically significant.

Results

EF thickness was higher in males (6.0 ± 1.4 mm vs 5.2 ± 0.9 mm in females), and ranged from 4 to 9 mm. There were statistically significant correlations between EF thickness and weight (r = 0.4; p = 0.02), body surface area (r = 0.4; p = 0.02), lean mass (r = 0.4; p = 0.03), calf circumference (r = 0.5; p = 0.01) and left ventricular end-diastolic diameter (r = 0.3; p = 0.04).

Conclusion

EF thickness was higher in males and was significantly correlated with anthropometric parameters of adiposity and left ventricular end-diastolic diameter. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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Original Article

Cardiovascular Risk Factors in Patients with Chronic Kidney Disease Under Conservative Treatment

Cássia Oliveira et al. Priscila Moreira de Lima Pereira Iris Teixeira Soares Melina Gabriela Monteiro … Marcus Gomes Bastos Ana Paula Carlos Cândido

Abstract

Background

Cardiovascular disease (CVD) is commonly associated with chronic kidney disease (CKD). These diseases have a significant impact on life expectancy. Individuals with CKD are more likely to die from CVD than to progress to end-stage kidney disease.

Objective

To assess cardiovascular risk factors of patients with CKD under conservative treatment.

Methods

This was an observational, cross-sectional study. Socioeconomic, anthropometric, biochemical, and physical inactivity data were assessed, and 10-year risk for CVD were estimated using the Framingham Score in patients with CKD under conservative treatment. For statistical analysis, the Student’s t-test and Pearson’s chi-square test were performed.

Results

A total of 172 individuals were evaluated, 57% of whom were male, with an average age of 68.85 ± 11.41 years. The prevalence of hypertension and diabetes were 87.2% and 53.5%, respectively; 62.2% were physically inactive; 9.9% of men were smokers and 12.8% consumed alcohol. According to BMI, 82.4% of adults <60 years old and 60.6% of those older than 60 years were overweight. High waist circumference and a high waist-hip ratio were highly prevalent in females (91.9% and 83.8%, respectively) and males (64.3% and 39.8%, respectively); 92.4% had a high body fat percentage and 73.3% high uric acid levels. According to the Framingham score, 57% have a medium or high risk of developing CVD in 10 years.

Conclusion

There was a high prevalence of cardiovascular risk factors in the population studied. The assessment of cardiovascular risk factors in patients with CKD makes it possible to guide the conduct of health professionals to prevent mortality from cardiovascular causes. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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Original Article

Atrial Fibrillation and Use of Rivaroxaban: Performance of the Prothrombin Time / INR as a Function of Time After Blood Collection

Rita Carolina Figueiredo Duarte et al. Priscila Samara Sérgio Moreira Cláudia Natália Ferreira Estevão Lanna Figueiredo … Eduardo Sternick Francisco Rezende Silveira Luan Carlos Vieira Alves Ana Paula Lucas Mota Edna Afonso Reis Maria das Graças Carvalho Helton José dos Reis

Abstract

Background

Traditionally, the most effective therapy in the prevention of stroke in patients with atrial fibrillation (AF) has been oral anticoagulation with vitamin K inhibitors, particularly warfarin, whose disadvantages and adverse effects have led to their replacement by “direct oral anticoagulants”, as factor X inhibitor.

Objectives

This study aimed to conduct a brief approach on atrial fibrillation (AF) and use of Rivaroxaban, and to comparatively evaluate the prothrombin time / International Normalized Ratio (PT/INR) in patients with AF in use of this oral anticoagulant, depending on the time elapsed between the last administration of the drug and the time of blood sample venipuncture.

Methods

We evaluated 34 patients with AF in use of Rivaroxaban by using PT / INR, distributed into a subgroup with blood collection time ≤ 12 hours (n = 7) and > 12 hours after the last drug intake (n = 27). Mann-Whitney test was used to compare the groups and p < 0.05 was considered significant.

Results

An analysis as a function of time between the Rivaroxaban intake and blood collection, revealed that PT / INR suffers the greatest effect up to 12 hours after ingestion of the drug, dropping to levels close to normal in subsequent hours before the next dose.

Conclusion

We concluded that, in contrast to warfarin, the knowledge of the time interval between drug intake and blood collection from patients taking Rivaroxaban is essential to properly interpret a laboratory test to assess hemostasis, particularly PT and its derivatives. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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