2022;35(4) – ABC CARDIOL

IJCS

Família ABC | IJCS

Editorial

Oral Contraception: Beyond What Meets the Eye. Sorry, the Ovaries!

Biljana Parapid et al. Snežana Rakić

The concept of oral contraception, historically, was supposed to enable control of unwanted pregnancies and facilitate family planning for women of reproductive age in an elegant fashion for everyone needing it. However, the influence of different prescriptions on women’s health during active use, as well as later on in life – beyond the quintessential fear of thromboses lay women worldwide have – has not been studied extensively or meticulously, despite the widespread use. Also, with some countries recently starting to embrace the over-the-counter concept for oral contraceptives in addition to the mechanical ones, a mandatory visit to a physician to get a personalized prescription will become a growing phenomenon and its public health consequences are unforeseeable, evidently.

In the current issue of IJCS, we had the pleasure of reading a paper by Gomes et al, who presented their original article with results of a cross-over study of the influence of high-intensity interval training (HIIT) on the lipid and inflammatory profile of women using combined oral contraceptives (COC) that showed a beneficial effect to the latter, but not the former.

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Editorial

Hyperthyroidism and Cardiac Contractility

Dhiãnah Santini de Oliveira Chachamovitz

Much information is lacking on hyperthyroidism and cardiac function, especially in isolated muscles. Certainly, the time the heart muscle is exposed to elevated thyroid hormones (TH) influences the magnitude of their effects. The primary changes seem to be related to increases in the heart mass/body mass ratio and in relaxation kinetics.

These cardiac changes may also be related not only to the time of exposure to excess thyroid hormones, but to the level or intensity of hyperthyroidism, as well as the underlying cardiac condition, which may reflect exercise conditioning and overload. In this sense, the cellular mechanisms of muscle adaptation, energy and oxygen consumption, certainly make differences. As well as muscle strength and sarcoplasmic/endoplasmic reticulum calcium (SRCa) activity, they may also have different individual adaptive characteristics.

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Erratum

ERRATUM

Int J Cardiovasc Sci. 2022 Issue vol 35(3), pages 297-301.

In Editorial “An Updated View on the Approach to Tricuspid Regurgitation”, with DOI number: , published in the journal International Journal of Cardiovascular Sciences, 35(3):297-301, in page 297, correct the title “An Uptated View on the Approach to Tricuspid Regurgitation” to “An Updated View on the Approach to Tricuspid Regurgitation”.

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Editorial

Is Patient Education about the Benefits of Physical Activity a Good Adjunct Treatment Strategy in Hypertension?

Dário C. Sobral Filho et al. Maria de Fátima Monteiro

Systemic arterial hypertension (SAH) is a chronic condition that is highly prevalent worldwide. It occurs without symptoms in most individuals and represents the main modifiable risk factor for cardiovascular disease. The adoption of behaviors that do not involve medication, such as changes in lifestyle and regular practice of physical exercise, along with strict adherence to prescribed medication, is a major challenge in the treatment of this disorder.^,

The guidelines of the American Heart Association and the American College of Cardiology on hypertension recommend the implementation of lifestyle changes as the first line of treatment for low- to moderate-risk groups, thereby emphasizing the importance of such measures.

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Editorial

The Medical Burden of Heart Failure and Cancer in Brazil. Fact or Fiction?

Ricardo Mourilhe-Rocha et al. Pedro Fernandes Ribeiro

Cardiovascular disease and cancer are the leading causes of mortality in most high-income countries around the globe. It is estimated by the Brazilian Ministry of Health that circulatory diseases and cancer are the leading causes of mortality in patients over 50 years of age, which makes them the main public health concerns in absolute numbers. This is not only true in treatment-related costs, but also in terms of social harm imposed on an economically productive population and the health system this population subsidizes.

Recently, Almeida et al. have published a comparative analysis on mortality rates for patients with heart failure. The paper performed a retrospective comparative analysis with data retrieved from DataSUS, an administrative database from brazilian’s public health system and was able to reach the conclusion that heart failure has a prognosis that is worse than many types of cancer. As the author himself says, the paper is limited by the administrative characteristics of the database itself, and, as already mentioned in the BREATHE registry, this kind of data has inherent limitations.

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Editorial

Correlation of Diuretic use and Sarcopenia in Elderly Patients with Hypertension

Lídia Zytynski Moura et al. Camila Hartmann

Hypertension is a chronic disease with high prevalence in Brazil and worldwide. It is estimated that approximately 31% of the world population has blood pressure levels ≥ 140/90 mmHg or uses antihypertensive medication. Hypertension is also the main risk factor with an independent, linear, and continuous association for cardiovascular diseases. Cardiovascular diseases, in turn, are the leading cause of death, hospitalizations, and outpatient care worldwide, including in developing countries such as Brazil.

With aging, hypertension becomes an even more significant health problem. Around 61% of individuals over 60 years old have hypertension. In Brazil, the epidemiological transition with the increase in the number of elderly people (≥ 60 years) in the next decades will lead to a substantial increase in the prevalence of hypertension and its complications. Aging is still associated with other health disorders, including sarcopenia. As with hypertension, the prevalence of sarcopenia is higher in the elderly. It varies from 5% to 13% in people between 60 and 70 years of age, and from 11% to 50% in people ≥ 80 years of age.

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Editorial

And We Doctors, What do We Die of?

Gabriel Porto Soares et al. Thais Rocha Salim

We hardly ask ourselves what we will die from. The certainty of this fact can even pass through our thoughts, but it always seems to us something far away and impossible to predict. We can know the causes of death of our fellow human beings to try to predict our death and perhaps use measures to postpone it, since it is impossible to avoid. Societies need to know their numbers, how many we are, how many are born, how many die, how we die, and how we live. These are questions that gain importance with reports of demographic and epidemiological surveys dating back to 400 BC in some ancient civilizations like Greece, Rome, India, and China. The first modern publication in mortality studies dates from 1662 in England, carried out by a London councilor, John Graunt, who published the work entitled “Natural and Political Observations upon the Bills of Mortality” (), using data of burials in London as information. Through this study, it can be known, for example, that one third of London children died before turning sixteen.^,

In the last century, humanity has gone through an epidemiological transition in terms of causes of death. Infectious diseases are no longer the leading cause of death and have given way to chronic non-communicable diseases (NCDs), especially circulatory system diseases (CAD). NCDs are the main cause of death worldwide, and they are responsible for premature deaths, loss of quality of life, and adverse economic and social impacts. NCDs are responsible for about 70% of global deaths, equivalent to more than 38 million deaths per year, significantly exceeding deaths from external causes and infectious diseases. About 45% of all NCD deaths worldwide, more than 17 million, are caused by CAD. A similar distribution is observed in Brazil, where 72% of deaths result from chronic NCDs, with 30% due to CAD and 16% to neoplasms.

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Editorial

Neuropeptides Y and Other Promising Biomarkers in Acute Coronary Syndrome

Fernanda A. Andrade et al. Leonardo Carvalho Pedro Gabriel Melo de Barros Silva

Neuropeptide Y (NPY) is a very common neurotransmitter with 36 amino acids that acts as a stimulator of angiogenesis, inflammation and adipogenesis through the NPY2 receptor. The description of high plasma concentrations of NPY in acute coronary syndrome (ACS) and left ventricular dysfunction and its close relationship with the sympathetic nervous system reinforces the possibility of a new prognostic biomarker for risk stratification.^,

In recent years, changes in the NPY signalling pathway have been related to ACS. For example, the NPYc.20T>C mutation is associated with increased serum lipid levels and consequent increase in the risk of ACS, stroke, hypertension, and obesity.^, The NPYc.-485T>C variant has been linked to the development of early atherosclerosis and stroke, and possibly to insulin resistance reduction and development of type 2 diabetes mellitus.^–

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Original Article

Impact of Air Pollutant on Heart Rate Variability in Healthy Young Adults

Anita de Cássia Melinski et al. Aparecida Maria Catai Sílvia Cristina Garcia de Moura Juliana Cristina Milan-Mattos Monica Yuri Takito

Abstract

Background:

Air pollution and sex independently affect cardiac autonomic control, which can be assessed by heart rate variability (HRV). The research hypothesis is that individuals exposed to low concentrations of pollution have higher cardiac autonomic modulation compared to those exposed to high concentrations and that women have better cardiac autonomic control than men.

Objective:

To analyze the impact of exposure to air pollutants, specifically smoke, and sex on HRV in healthy young people exposed to different concentrations of pollution over an average period of 22 years.

Methods:

From April to September 2011, 36 participants of both sexes (20-30 years old) were selected, grouped by levels of air pollution exposure according to indices provided by the Environmental Company of São Paulo State. The R-R intervals (R-Ri) of the electrocardiogram were captured using a heart rate monitor during supine rest. HRV was analyzed by spectral analysis and conditional entropy. The Queen’s College step test was used to characterize functional capacity. A between-group comparison was performed using the two-way ANOVA statistical test (post hoc Tukey) and p<0.05.

Results:

Significant differences were found in mean R-Ri (p<0.01) and cardiac parasympathetic modulation between sexes in the same city (p=0.02) and between groups exposed to different air pollution concentrations (p<0.01).

Conclusion:

Our results suggest that long-term exposure to air pollutants, specifically smoke, has an unfavorable impact on HRV, with reduced cardiac vagal autonomic modulation in healthy young adults, especially females.

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Original Article

The Medical Burden of Heart Failure: A Comparative Delineation with Cancer in Brazil

Dirceu Rodrigues de Almeida et al. Antonio Carlos Pereira-Barretto Francisco Jose Forestiero Juliana S. Nakamuta André Bichels

Abstract

Background:

Due to its poor prognosis and mortality rates, heart failure (HF) has been recognized as a malignant condition, comparable to some cancers in developed countries.

Objectives:

To compare mortality from HF and prevalent cancers using data from a nationwide database in Brazil.

Methods:

This was a descriptive, cross-sectional study using secondary data obtained from Brazilian administrative databases of death records and hospitalization claims maintained by the Ministry of Health. Data were analyzed according to main diagnosis, year of occurrence (2005-2015), sex and age group. Descriptive analyses of absolute number of events, hospitalization rate, mortality rate, and in-hospital mortality rate were performed.

Results:

The selected cancers accounted for higher mortality, lower hospitalization and higher in-hospital mortality rates than HF. In a group analysis, HF showed mortality rates of 100-150 per 100,000 inhabitants over the period, lower than the selected cancers. However, HF had a higher mortality rate than each type of cancer, even when compared to the most prevalent and deadly ones. Regarding hospitalization rates, HF was associated with a higher risk of hospitalization when compared to cancer-related conditions as a group.

Conclusions:

Our findings indicate that HF has an important impact on mortality, hospitalization and in-hospital mortality, comparable to or even worse than some types of cancer, representing a potential burden to the healthcare system.

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Original Article

Effects of Physical Exercise on Lipid and Inflammatory Profile of Women Using Combined Oral Contraceptive: A Cross-Over Study

Vinícius Afonso Gomes et al. Marvyn de Santana do Sacramento Lucas Mendes Santa Cecilia Daniela Santos de Jesus … Juliane Santos Barbosa Fernanda Oliveira Baptista de Almeida Elaine Carvalho de Oliveira Jefferson Petto

Abstract

Background:

The use of combined oral contraceptives (COC) is a risk factor for atherosclerotic disease, and physical exercise can minimize this condition.

Objective:

To verify if high intensity interval training (HIIT) promotes changes in the lipid and inflammatory profile of women using COC.

Methods:

Sequential crossover study with women aged 20-30 years, classified as irregularly active by the international physical activity questionnaire (IPAQ), when using COC. A physical-clinical assessment was performed with anthropometric measurements, VO_2max, and analysis of lipid and inflammatory profile. Participants were divided into 2 groups: the initial intervention group (GII), which began practicing HIIT for 2 months, and the posterior intervention group (GIP), which remained inactive for the same period. The GII and GIP would then alternate their conditions. The collected data was divided into: Initial moment (IM), post-exercise moment (PEM) and post-inactivity (PIM). The statistical analyses were performed using the Statistical Package for the Social Sciences, adopting a significance level of p <0.05 .

Results:

Twelve women were evaluated. After crossing the GII and GIP data, there was a difference in the C-reactive protein values between the IM of 4 (1.6-6.3 mg/dL) vs. PEM 2 (1.5-5 mg/dL); as well as between the PEM vs. the PIM= 4 (1.5-5.8 mg/dL), with a p -value = 0.04 in the comparisons. There was no change between the “moments” of the lipid profile, although it was possible to notice a reduction in resting HR and an increase in indirect VO_2max.

Conclusion:

The HIIT program was able to reduce the inflammatory profile, but it did not alter the lipid profile of irregularly active women using COC.

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Original Article

Use of Diuretics is Associated with Higher Risk of Sarcopenia in Older Adults with Hypertension

Francisco de Assis Dias Martins Junior et al. Dahany Pamela Acta Mateo Fábio Junior de Miranda Silva Samara Silva de Moura … Emerson Cruz Oliveira Daniel Barbosa Coelho Eduardo Bearzoti Kelerson Mauro de Castro Pinto Lenice Kappes Becker

Abstract

Background:

Sarcopenia is a disease that involves skeletal muscle mass loss and is highly prevalent in the older adult population. Moreover, the incidence of sarcopenia is increased in patients with hypertension.

Objectives:

The study aimed to evaluate the association between the classes of the drugs used for arterial hypertension treatment and the presence or absence of sarcopenia.

Methods:

129 older adults with hypertension were evaluated by the researchers who registered the participants medication for arterial hypertension treatment. Sarcopenia level was measured by anthropometric parameters, muscular strength, and functional capacity. The data were analyzed by one-way ANOVA followed by post-hoc test and Fisher’s exact test; statistical significance was set at 0.05.

Results:

Age was not different between women with different levels of sarcopenia, but significant differences were observed between men with absent sarcopenia (66.8±4.2 years) and men with probable sarcopenia (77.0±10.2 years). Individuals with absent sarcopenia showed higher handgrip strength (men: 33.8±7.4, women: 23.2±4.6 Kgf) in comparison with those with sarcopenia (men with probable sarcopenia: 9.5±3.3 Kgf, women with probable, confirmed, and severe sarcopenia: 11.7±2.5, 12.2±3.0, 11.8±1.8 Kgf, respectively). The analysis showed an association between the type of medication and degree of sarcopenia; diuretics were significantly associated with probable sarcopenia, and angiotensin II receptor blockers (alone or in combination with diuretics) was associated with absence of sarcopenia.

Conclusion:

In conclusion, handgrip strength was a good method to diagnose sarcopenia, and diuretics were associated with increased risk of sarcopenia in older adults with hypertension.

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Original Article

Mortality from Cardiovascular Diseases: A Comparative Analysis between the Medical and Non-Medical Populations in Brazil

Giulia Guimarães Matos et al. Roberta Luise Carrilho Bittencourt Pacheco Lucélia Batista Neves Cunha Magalhães Katia de Miranda Avena

Abstract

Background:

Cardiovascular disease (CVD) is the leading cause of death worldwide, including among physicians. Professional peculiarities increase cardiovascular risk in this population, making it relevant to analyze mortality in the medical population (MPop) and non-medical population (NMPop).

Objectives:

To compare the CVD mortality coefficient (MC) in between MPop and NMPop in Brazil by analyzing the epidemiological profile and the main causes of deaths from CVD.

Methods:

Time-series study with data obtained from the Mortality Information System of the Federal Council of Medicine and the Brazilian Institute of Geography and Statistics, from 2014 to 2018. The variables age group, sex, race, occupation, and CVD that caused the death were assessed in MPop and NMPop. MC, relative risk and odds ratio between the populations were calculated. Tests for difference in proportions, with approximation to the normal distribution, and chi-squared tests were performed, assuming p<0.01 as statistically significant.

Results:

Both MPop and NMPop had a predominance of men (86.7% and 52.3%), senior citizens (85.9% and 79.7%) and white individuals (86.4% and 52.2%). The MCs of the MPop and NMPop was 92.2 and 255.1 deaths/100,000 individuals, respectively. The main cause of death was acute myocardial infarction (AMI) (32.5% and 24.6% in MPop and NMPop, respectively) followed by cerebrovascular accident (CVA) (5.1% and 10.5% in MPop and NMPop, respectively).

Conclusion:

In Brazil, mortality from CVD was more prevalent in white elderly males, and mainly caused by AMI and CVA. Being a doctor, man and over 60 years old represents a greater chance of death from CVD in comparison with non-physicians.

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Original Article

Effects of Hyperthyroidism on Contractility and Na+/Ca2+ Exchanger Activity in the Isolated Papillary Muscle of Rats

Angela Mara Rambo et al. João Victor Capelli Peixoto Rebeca Alves Lins de Albuquerque Ilana Kassouf Silva Rosalvo Tadeu Hochmueller Fogaça

Abstract

Background:

Hyperthyroidism (Hy) is an endocrine disorder, in which the thyroid hormones markedly alter the cardiac function. Increased myocardial contractility and cardiac output, improvement in diastolic relaxation, changes in electrical activity, increments in ventricular mass, and arrhythmias have been reported. However, the influences of thyroid hormones upon molecular mechanisms of cardiac functions have not yet been fully understood.

Objectives:

To evaluate changes in cardiac contractile parameters and the Na+/Ca2+ exchanger (NCX) function in induced hyperthyroid rats.

Methods:

Hy was induced by intraperitoneal injections of T3 (15 μg/100 g) for 10 days. Contractile parameters and NCX function were evaluated in the isolated papillary muscle. Data normality was confirmed by the Shapiro-Wilk test. The comparison between groups was performed through an unpaired Student’s t-test. Results are expressed as mean ± SD. The accepted significance level was p < 0.05.

Results:

Our data revealed, in the Hy group, an increase of 30.98% in the maximum speed of diastolic relaxation (–284.64 ± 70.70 vs. –217.31 ± 40.30 mN/mm2/sec (p = 0.027)) and a boost of 149% in the NCX function in late phase of relaxation (20.17 ± 7.90 vs. 50.22 ± 11.94 minutes (p = 0.002)), with no changes in the maximum twitch force (p = 0.605) or maximum speed of systolic contraction (p = 0.208) when compared to the control.

Conclusion:

The improvement in relaxation parameters is hypothetically attributed to an increase in Sarco-Endoplasmic Reticulum Ca2+ATPase isoform 2 (SERCA2) expression and an increased calcium flow through L-type channels that boosted the NCX function.

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Original Article

9p21 Locus Polymorphisms: Risk and Severity Factors of Coronary Artery Disease in Venezuelan Patients

Susana Blanco Sobrino et al. Eva Salazar Alcalá Asdrúbal Alfonzo Reyes Jesus Flores-Soler … Romina Leras Mirabal Yettana Luti Ingrid Márquez Mercedes Teresita Fernandez Mestre

Abstract

Background:

The 9p21 region is the most relevant locus associated with coronary heart disease in different populations. However, there are no studies that prove that this region is a risk factor in the Venezuelan population.

Objectives:

To analyze whether or not the 9p21 rs1333049 polymorphism is a risk factor for acute myocardial infarction (AMI) in Venezuelan patients, as well as to investigate its correlation with cardiovascular risk factors (CVRF), age of occurrence, type and severity of infarction, and the correlation of the rs10757274 polymorphism with severity of coronary artery disease.

Methods:

This was an association study, including 487 unrelated Venezuelan individuals, grouped in 354 patients with AMI and 133 controls. The rs1333049 and rs10757274 polymorphisms were determined using the polymerase chain reaction (PCR) technique with sequence-specific primers. The analysis of association was determined using the SNPStats tool. The continuous variable description and the correlations were performed using the SPSS statistical software. Significance was established at p<0.05.

Results:

A positive correlation was observed between the rs1333049 polymorphism and the presence of hypertension ( r: 0.145, p: 0.006), and between hypertension and heart infarction ( r: 0.318, p: <0.0001). A positive correlation was found between the rs10757274 polymorphism and the number of coronary vessels that presented obstructive lesions in patients aged ≤ 55 years ( r: 0.276, p: 0.0078).

Conclusion:

The rs1333049 polymorphism at the 9p21 locus is correlated with hypertension in Venezuelan patients, while the rs10757274 polymorphism is associated with the progression of coronary atherosclerosis, suggested by the correlation with the number of coronary vessels that presented significant obstructive lesions.

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Review Article

Depression and Cardiovascular Disease in Women

Maria Alayde Mendonça Rivera et al. Ivan Romero Rivera Walkiria Avila Celi Marques-Santos … Francisco Assis Costa Carlos Romério Ferro Jose Maria Gonçalves Fernandes

Abstract

The prevalence of depression varies from 1 to 17% in different geographic regions, and its incidence is 70% higher in women than men. Today, depression affects more than 300 million people worldwide, affecting twice as many women from adolescence to adulthood. In addition to this earlier onset, depression in women tends to be more severe. Cardiovascular disease and depression are chronic diseases that have a major impact on cardiovascular and all-cause morbidity and mortality, with evidence of a two-way relationship between them, in which depression is a predictor of cardiovascular disease and vice versa. In females, the degree of illness and prognosis are more severe when both diseases are present, than when diagnosed alone. In patients with acute or chronic cardiovascular disease, especially women, a systematic screening for depression should be considered as a preventive strategy of cardiovascular events, aiming to reduce the risk of future events. There are still no clinical studies designed to assess the impact of antidepressant treatment on cardiovascular outcomes in women.

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Original Article

Epicardial Fat Tissue Thickness and Omentin in Patients with Atrial Fibrillation

Ibrahim Etem Dural et al. Ersel Onrat Sefa Çelik Serkan Gokaslan … Ayhan Vurmaz Sadık Volkan Emren Zafer Yalım Alaeddin Avşar

Abstract

Background:

Although electrical and structural remodeling has been recognized to be important in the pathophysiology of atrial fibrillation, the mechanisms underlying remodeling process are unknown. There has been increasing interest in the involvement of inflammatory molecules and adipokines released from the epicardial fat tissue in the pathophysiology of atrial fibrillation.

Objectives:

In our study, we aimed to investigate the relationship of atrial fibrillation with increased epicardial adipose tissue, inflammatory molecules released from this tissue and omentin.

Methods:

Thirty-six patients who were followed up with a diagnosis of permanent AF at the cardiology outpatient clinic 33 individuals without atrial fibrillation (controls) were included in the study. Epicardial adipose tissue thickness of patients was measured by echocardiography. Serum omentin, IL 6, IL 1 beta, TNF alpha and CRP levels were measured. Man-Whitney U test was performed for comparisons and significance was established at 5% (p<0.05).

Results:

Epicardial adipose tissue thickness was significantly greater in the patient group (6mm [4-5.5]) than controls (4mm [3-5.5]) (p <0.001). No significant difference was found in the concentrations of omentin or inflammatory molecules between the groups.

Conclusion:

No relationship was found between atrial fibrillation and serum levels or omentin or inflammatory markers. A relationship between epicardial adipose tissue thickness measured by echocardiography and atrial fibrillation was determined.

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Original Article

Influence of Neuropeptide Y and Neuropeptide Y 2 Receptor Variants in Acute Coronary Syndrome

Fábia C. S. Soares et al. Romário M. Araújo Roberto P. Werkhauser George T. Diniz … Lakkakula V.K.S Bhaskar Viviane D. C. V. Carvalho Tetsuo Tashiro Ester A. S. Amorim Lilian C. A. Silva Sergio Tavares Montenegro Heytor V. P. C. Neco Clarice N. L. Moraes Danyelly B. G. Martins Silvia M. L. Montenegro

Abstract

Background

The neuropeptide Y (NPY) is one of the most abundant neurotransmitters in the nervous system. NPY acts as a potent stimulator of angiogenesis, inflammation, and adipogenesis, through the NPY 2 receptor (NPY2R). Changes in the NPY signaling pathway have been linked to Acute Coronary Syndrome (ACS).

Objectives

The purpose of this study is to determine the association between variants in the NPY and NPY2R genes, as well as the severity of acute coronary syndrome (ACS).

Methods

Approximately 221 ACS patients and 278 healthy controls were selected for this study. Four variants in NPY and two variants in NPY2R genes were genotyped using Taqman allelic discrimination and sequencing. The Chi-square and Fisher’s exact tests were used to verify the genotype frequencies. The logistic regression analyses were used for the evaluation of the studied variables. Haplotype analysis was used to evaluate the linkage disequilibrium (LD) between the variants (p<0.05).

Results

An association of NPY c.20T>C variant was found with the ACS group when compared to the healthy group. In the analysis between variants and risk factors in the ACS group, NPY c.84G>A was associated with hypertension. The analysis between TIMI risk showed a significance for NPY c.20T>C between the low and intermediate/high TIMI risk groups. In the haplotype analysis, strong linkage disequilibrium (LD) was found between the variants NPY c.150G>A and NPY c.-485T>C.

Conclusion

The NPY c.20T>C variant appears to contribute to the development of ACS. The NPY2R c.-1116A>G variant may contribute to the early development of ACS and the NPY c.84G>A variant appears to contribute to the development of hypertension. In addition, the NPY c.20T>C is associated with a protective effect in ACS severity.

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Original Article

Epidemiological Profile of Patients with Infective Endocarditis at three Tertiary Centers in Brazil from 2003 to 2017

Renato Lott Bezerra et al. Lucas Sousa Salgado Yago Machado da Silva Gustavo Guimarães Rocha Figueiredo … Raimundo Matos Bezerra Filho Eduardo Luís Guimarães Machado Isabel Cristina Gomes Ângelo Geraldo José Cunha

Abstract

Background

Infective endocarditis (IE) is a disease with high morbimortality and an increasing incidence. With improved diagnosis and treatment, a number of epidemiological changes have been reported over time.

Objectives

We sought to describe the epidemiological profile, mortality predictors, and analysis of a possible microbiological transition in patients admitted to three tertiary centers in Brazil.

Methods

In this cross-sectional retrospective study, data from 211 patients with definite or probable IE were analyzed according to the modified Duke criteria between 2003 and 2017. The association between categorical variables was assessed using the chi-square or Fisher’s exact test, and binary logistic models were built to investigate mortality. We considered p <0.05 statistically significant.

Results

The median age of the sample was 48 (33-59) years old, 70.6% were men, and the most prevalent pathogen was Staphylococcus spp. (19%). Mortality was 22.3%, with increasing age being the leading risk factor for death (p = 0.028). Regarding the location of the disease, native valves were the most affected site, with the aortic valve being more affected in men than women (p = 0.017). The mean number of cases of Staphylococcus spp. (τ = 0.293, p = 0.148) and Streptococcus spp. (τ = -0.078, p = 0.727) has remained stable over the years.

Conclusion

No trend towards reduced or increased mortality was evident between 2003 and 2017. Although Staphylococcus spp. were the most prevalent pathogen, the expected epidemiological transition could not be observed.

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Case Report

Takotsubo Cardiomyopathy and Myocardial Perfusion Image: Unusual Binomial in the Investigation of Acute Coronary Syndrome without Obstructive Lesions

Mathias Silvestre de Brida et al. Raphael Boesche Guimaraes Leonardo Rothlisberger Matheus Patricio

Introduction

Takotsubo cardiomyopathy (TC), also known as broken heart syndrome or stress-induced cardiomyopathy, was primarily described in Japan in 1990, is named after its morphological similarity to the vase used by Asian people to catch octopuses, which has a rounded bottom and a narrow bottleneck. This condition is characterized by transient left ventricular (LV) systolic dysfunction, commonly preceded by physical or emotional stress, mimicking the presentation of acute myocardial infarction. In the present article, we describe a case of TC focusing on its updated approach, highlighting the applicability of myocardial perfusion scintigraphy (MPS) in the acute phase of chest pain and presenting images rarely described in this scenario.

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Case Report

Vascular Spectrum of Imaging Findings in COVID-19: Ischemic, Hemorrhagic, and Thromboembolic Complications

Pedro Neves Paiva de Castro et al. Lucia Antunes Chagas Eduardo Wajnberg Roberto Santos … Pedro Cougo Dequitier Carvalho Machado

Abstract

Ischemic strokes secondary to occlusion of large vessels have been described in patients with COVID-19. Also, venous thrombosis and pulmonary thromboembolism have been related to the disease. Vascular occlusion may be associated with a prothrombotic state due to COVID-19-related coagulopathy and endotheliopathy. Intracranial hemorrhagic lesions can additionally be seen in these patients. The causative mechanism of hemorrhage could be associated with anticoagulant therapy or factors such as coagulopathy and endotheliopathy. We report on cases of ischemic, thrombotic, and hemorrhagic complications in six patients diagnosed with SARS-CoV-2 infection. Chest computed tomography (CT) showed typical SARS-CoV-2 pneumonia findings in all the cases, which were all confirmed by either serology or reverse transcription polymerase chain reaction (RT-PCR) tests.

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