2026;39 – ABC CARDIOL

IJCS

IJCS

Erratum

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

In the document Vital K, Pavanello R, Valente BP, Blaas BN, Arruda BFT, Rossi R et al. Myocardial Infarction with Non-Obstructive Coronary Arteries: Clinical Profile, Diagnostic Investigation, and Outcomes in a Tertiary Center Cohort. Int J Cardiovasc Sci. 2026; 39:e20260035. DOI: :

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ORIGINAL ARTICLE

Evaluation of Different Pharmacological Strategies and Intracranial Compliance in Hypertensive Patients

Thiago Oliveira Costa et al. Sayuri Inuzuka Mikaelle Costa Correia Matheus Martins da Costa … Priscila Valverde de Oliveira Vitorino Gustavo Frigieri Ana Luíza Lima Sousa Weimar Kunz Sebba Barroso

Abstract

Background:

Intracranial compliance (IC) refers to the brain’s ability to accommodate variations in intracranial volume without substantial increases in pressure. Alterations in compliance are associated with cardiovascular (CV) conditions such as hypertension. Understanding the relationship between blood pressure (BP) control, pharmacological treatment strategies, and IC may aid in managing cerebrovascular risk.

Objective:

To evaluate the association between IC parameters, BP control, and different antihypertensive therapeutic strategies in patients with systemic arterial hypertension (AH).

Methods:

This cross-sectional study included 140 hypertensive patients followed in a specialized outpatient clinic between November 2022 and August 2023. Clinical data, CV risk factors, antihypertensive drug classes, central and peripheral BP, and IC parameters obtained using the Brain4Care (B4C) system were collected. Patients were classified into Group A (vasodilators), Group B (non-vasodilators), and Group C (mixed therapy). Continuous variables were presented as mean and standard deviation and compared using Student’s t-test. Categorical variables were compared using Pearson’s chi-square or Fisher’s exact tests. Correlations were assessed using Pearson’s correlation coefficient. A significance level of 5% was adopted.

Results:

A total of 140 patients were included; 77.9% were women, with a mean age of 67.9 ± 11.1 years. All patients were using antihypertensive medication, predominantly combination therapy (62.1%), especially mixed therapy (65%). Uncontrolled peripheral BP was associated with higher P2/P1 values. Among those with P2/P1 > 1.4, 85.7% had uncontrolled BP (p = 0.002). There was no association between type of therapy and changes in IC parameters.

Conclusion:

In this sample of hypertensive patients followed in a specialized outpatient clinic, no statistically significant differences in IC parameters were observed across the therapeutic groups evaluated. Peripheral BP control was the factor most strongly associated with more favorable IC values. Prospective studies with more balanced groups are needed to confirm these findings.

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ORIGINAL ARTICLE

Prognostic Value of QTc Interval and Other Ventricular Repolarization Parameters in Acute Stroke

Catarine Benta Lopes dos Santos et al. Sérgio Ferreira de Ferreira Filho Marcelo Angst Anderson Donelli da Silveira … Sheila Cristina Ouriques Martins Mauricio Pimentel

Abstract

Background:

The electrocardiogram (ECG) is routinely used in stroke evaluation, although interactions within the brain–heart axis remain incompletely understood. The prognostic relevance of the QTc interval and other ventricular repolarization markers has gained increasing interest in stroke populations.

Objectives:

To evaluate the association of QTc interval, QTc dispersion (QTc-d), Tpeak–end interval (Tp-e), and Tp-e/QTc ratio with neurological disability and in-hospital mortality in acute stroke.

Methods:

This retrospective cohort included patients admitted with acute stroke between January 2018 and April 2020. QTc was analyzed as both a continuous and categorical variable, using a cutoff of 480 ms. Functional disability was assessed using the modified Rankin Scale (mRS) and categorized as no disability (mRS ≤ 2) or disability (mRS > 2). Sample size calculation indicated a minimum of 482 patients (85% power; 5% significance), based on functional outcome differences between prolonged and normal QTc. A 5% significance level was used for all analyses.

Results:

A total of 565 patients were included (50.1% male; mean age 65 ± 13 years). Of these, 280 (49.6%) had mRS > 2, and 69 (12.5%) died during hospitalization. Higher QTc values were associated with worse neurological outcomes in univariable (HR 1.01; 95% CI, 1.00–1.01; p 480 ms was also associated with disability in univariable (HR 2.43) and multivariable models (HR 2.67). QTc was not associated with in-hospital mortality.

Conclusion:

QTc prolongation, particularly QTc > 480 ms, was independently associated with unfavorable neurological outcomes.

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Case Report

Fascicular Ventricular Tachycardia in a Pediatric Patient: Case Report

Jessica Laureano Martins et al. Moises Galdino Barros Daniel Moreira Costa Moura

Abstract

A 10-year-old female patient, previously healthy, had been experiencing recurrent episodes of palpitations for three months. An electrocardiogram performed in the emergency department during one of these episodes initially raised suspicion of supraventricular tachycardia (SVT) due to the abnormally elevated heart rate (HR) and a relatively narrow QRS complex (100 ms). Pharmacological cardioversion with adenosine was attempted but unsuccessful. Reversion to sinus rhythm occurred only after the administration of intravenous amiodarone at a dose of 5 mg/kg.

During subsequent outpatient evaluation with a specialist, the diagnosis of fascicular ventricular tachycardia (FVT) was established based on characteristic electrocardiographic findings (regular tachycardia with a QRS complex widened for age, right bundle branch block (RBBB) pattern associated with an anterosuperior fascicular block (ASFB), fusion beats, and atrioventricular dissociation). Pharmacological treatment with verapamil was initiated; however, due to symptom recurrence, the patient successfully underwent radiofrequency ablation and has remained asymptomatic and free of recurrence during clinical follow-up.

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Review Article

Percutaneous Coronary Intervention With Ridaforolimus-Eluting Stents in Patients With Coronary Artery Disease: A Systematic Review and Single-Arm Meta-Analysis

Edmundo Damiani Bertoli et al. Christian Ken Fukunaga Vinicius Martins Everton Victor Belmiro da Silva … Ricardo Fonseca Oliveira Suruagy Motta Eric Katsuyama Isabela Tonon Floriano Marcos Danillo Oliveira Cristina Silveira Luis Augusto Dallan Marcelo Harada Ribeiro

Abstract

Background:

The ridaforolimus-eluting stent (RES) is a new-generation drug-eluting stent (DES) featuring thin struts and a durable polymer, designed to provide a high therapeutic-to-toxicity margin. However, its long-term clinical performance remains uncertain.

Methods:

We conducted a systematic review and meta-analysis following Cochrane and PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and prospective non-RCT studies evaluating RES in patients with coronary artery disease (CAD). Outcomes were expressed as event rates using a generalized linear mixed model (GLMM). Statistical significance was defined as P < 0.05.

Results:

Six studies with eight reports and 1,709 patients were included. The mean age was 63 years; 76% were men; 35% had a previous myocardial infarction (MI); and 41% presented with acute coronary syndrome. Mean lesion length was 27.84 mm, and ACC/AHA lesion class B2/C accounted for 61% of lesions. Target lesion failure (TLF) was 3.89% (95% confidence intervals [CI]: 2.58–5.82) at 1 year and 11.73% (95% CI: 9.94–13.73) at 5 years. Major adverse cardiac events (MACE) occurred in 4.82% (95% CI: 3.19–7.21) at 1 year and 16.22% (95% CI: 14.14–18.47) at 5 years. Cardiovascular mortality remained low, at 0.59% (95% CI: 0.28–1.02) at one year and 3.36% (95% CI: 2.40–4.57) at 5 years. MI occurred in 2.68% (95% CI: 1.50–4.76) at 1 year and 9.84% (95% CI: 8.18–11.70) at five years.

Conclusion:

In this single-arm meta-analysis, RES was associated with high procedural success and low observed rates of adverse clinical events across available studies.

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ORIGINAL ARTICLE

Physical-Functional Profile of Obese Individuals With or Without Metabolic Syndrome Classified by Cardiovascular Risk

Daniela Barreto de Moraes et al. Vanessa Kelly da Silva Lage Joyce Noelly Vitor Santos Jaqueline de Paula Chaves Freitas … Ana Carolina Barbosa Farnezi Gabriele Teixeira Gonçalves Maria Thereza Otoni Figueiró Tamara Cunha Thyago José Silva Jousielle Márcia dos Santos Elizabethe Adriana Esteves Alessandro Sartorio Redha Taiar Ana Cristina Rodrigues Lacerda Vanessa Amaral Mendonça

Abstract

Background:

Obesity is strongly associated with increased cardiovascular risk (CVR) and the development of metabolic syndrome (MS), conditions that negatively affect body composition, metabolic profile, and functional capacity. CVR stratification may contribute to a better understanding of these alterations and to the development of early intervention strategies.

Objectives:

To evaluate the physical–functional profile of obese individuals with and without MS, classified according to CVR, and to compare biochemical, body composition, and functional parameters among these groups.

Methods:

This cross-sectional study included 212 obese individuals allocated into four groups: control with low CVR (CLR, n = 63), control with intermediate/high CVR (CHR, n = 33), MS with low CVR (SLR, n = 55), and MS with intermediate/high CVR (SHR, n = 61). Body composition, blood metabolic parameters, and functional performance were assessed using sit-to-stand tests. Group comparisons were performed using one-way ANOVA or Kruskal–Wallis tests, followed by Tukey’s or Dunn’s post hoc tests, with significance set at p < 0.05.

Results:

MS was present in 54.7% of the sample, and approximately 44% exhibited intermediate/high CVR. The CLR group showed lower visceral adiposity and waist circumference (WC) values (p 0.05).

Conclusions:

Individuals with lower CVR showed better sit-to-stand performance, while poorer performance was observed in participants with MS, particularly when associated with higher CVR. Sit-to-stand tests may provide useful complementary information for assessing physical performance in this population.

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Case Report

Rare Occurrence of Syncope and Nodal Rhythm Caused by Left Anterior Descending Myocardial Bridge

Elma Kandic et al. Elif Vrajnko Nikola Manev Bozin Shopov Biljana Zafirovska Taleska

Conclusion

We describe a 59-year-old man with syncope and nodal rhythm due to a 9-mm mid-LAD myocardial bridge, marked by chest pain and troponin elevation. This rare presentation underscores the ischemic potential of myocardial bridging beyond angina, urging its consideration in unexplained syncope and arrhythmias. Tailored therapy with calcium channel blockers proved effective, supporting guideline-directed management. OCT and IVUS can help in evaluation of coronary muscle bridges and determine the correct treatment strategy.

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Case Report

Multivessel Coronary and Cerebral Vasospasm in a Post-Acute Myocardial Infarction Patient

Mateus Amorim Aboboreira et al. Julio Paiva Maia Vitória Burin Borges Felipe Hideaki Ueda Marcos Franchetti

Introduction

Coronary vasospasm was initially described by Prinzmetal et al. as angina that occurs at rest, without being provoked by an increase in oxygen demand, unlike classic Heberden’s angina, which is induced by physical or emotional stress. The pathophysiology of coronary vasospasm is multifactorial, and various precipitating factors exist.² The present case demonstrates an intriguing scenario that highlights the complexities of clinical management and etiological determination of vasospasm in a post-acute myocardial infarction patient.

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Erratum

ERRATUM: Efficacy of Cardiac Myosin Inhibitors in Symptomatic Hypertrophic Cardiomyopathy: An Updated Meta-Analysis and Systematic Review

In the document Fogaça PHT et al. Efficacy of Cardiac Myosin Inhibitors in Symptomatic Hypertrophic Cardiomyopathy: An Updated Meta-Analysis and Systematic Review. Int J Cardiovasc Sci. 2026; 39:e20250092. DOI: https://doi.org/10.36660/ijcs.20250092, in the Authors section.

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Original Article

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

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

Abstract

Background:

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

Objective:

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

Methods:

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

Results:

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

Conclusion:

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

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Original Article

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

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

Abstract

Introduction:

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

Objectives:

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

Methods:

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

Results:

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

Conclusion:

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

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Original Article

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

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

Abstract

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusions:

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

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Case Report

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

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

Introduction

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

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

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Original Article

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

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

Abstract

Background:

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

Objectives:

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

Methods:

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

Results:

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

Conclusions:

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

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Editorial

The Importance of Observational Studies

Paolo Blanco Villela et al. Larissa Franco de Andrade

Discussing coronary artery disease without beginning with the traditional phrase “cardiovascular diseases are the leading cause of death worldwide” becomes challenging – especially because that statement, unfortunately, is no longer sufficient. There is no way to avoid it except by expanding upon it: in addition to leading global mortality statistics, cardiovascular diseases represented the primary cause of disability-adjusted life years (DALYs) in 2023, accounting for 437 million (95% UI: 401–465 million) DALYs worldwide – a 1.4-fold increase compared with 1990.

Naturally, ischemic heart diseases are included in this group and ranked first, with 193 million DALYs in 2023 and an age-standardized mortality rate of 99.8 (89.9–108.4) per 100,000 inhabitants, according to data from the Global Burden of Disease (GBD).

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Case Report

Early Cascade Screening and Lipid-Lowering Therapy in Childhood: Challenges in the Management of Familial Hypercholesterolemia

Juliana Simões Zanotti et al. Eduardo Tomaz Quartero Martim Renato Jorge Alves

Abstract

This case highlights the importance of cascade screening for the early diagnosis of Familial Hypercholesterolemia (FH) in children. Early identification at the age of five enabled the timely initiation of lipid-lowering therapy and underscored the need for individualized treatment based on atherosclerotic risk. Despite a substantial reduction in LDL-C levels, the patient remained above recommended therapeutic targets, emphasizing the need for ongoing monitoring and treatment intensification. The detection of subclinical atherosclerosis further reinforces the importance of continuous cardiovascular surveillance. A comprehensive management strategy combining cascade screening, family-based risk assessment, and early intervention is essential to reduce long-term cardiovascular risk and improve clinical outcomes.

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Original Article

QT Prolongation Following Premature Ventricular Contractions: A Potential Marker of Concealed Long QT Syndrome

Khatuna Jalabadze et al. Pavle Machavariani Bachuki Tsiklauri Natalia Garuchava … Ia Avaliani Maya Chigogidze

Abstract

Background:

Long QT syndrome (LQTS) predisposes individuals to malignant ventricular arrhythmias and sudden cardiac death; however, diagnosis remains challenging in patients with borderline corrected QT (QTc) values. Premature Ventricular Contractions (PVCs) may unmask concealed abnormalities of ventricular repolarization.

Aim:

To determine whether post-PVC QTc prolongation can differentiate patients with confirmed LQTS, healthy controls, and borderline index cases.

Methods:

In this retrospective study, 24-hour electrocardiography (ECG) recordings from 84 subjects were analyzed, including 10 patients with confirmed LQTS, 72 healthy controls, and 2 index patients with borderline baseline QTc values. QTc intervals before and after PVCs were measured manually and corrected using Bazett’s formula. Between-group differences were evaluated using analysis of covariance (ANCOVA) adjusted for baseline QTc, whereas within-group changes were assessed with paired t-tests. A two-tailed p < 0.05 was considered statistically significant.

Results:

Post-PVC QTc intervals were longer in patients with LQTS than in healthy controls (488 ± 23 ms vs 391 ± 37 ms; adjusted p = 0.066). Overall, PVCs were associated with a mean QTc increase of +15.7 ms (95% CI 7.1–24.3; p = 0.0005), with larger increases observed in LQTS patients (+22.3 ms; p = 0.0019) compared with healthy controls (+10.0 ms; p = 0.0098). The two index patients exhibited marked QTc prolongation, rising from borderline baseline values (360–460 ms) to 540–600 ms (Δ≈165 ms).

Conclusion:

PVC-induced QTc prolongation may help distinguish healthy individuals from patients with overt or borderline LQTS. Whereas healthy controls demonstrated mild physiologic adaptation, patients with confirmed LQTS showed consistent QTc prolongation, and index patients exhibited marked post-PVC increases suggestive of concealed repolarization abnormalities. Assessment of QTc following PVCs may represent a simple bedside approach to improve diagnostic accuracy and risk stratification in LQTS; prospective studies in larger cohorts are warranted to confirm these findings.

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Original Article

Reversal of Therapeutic Recommendations in the American College of Cardiology Coronary Artery Disease Guidelines

Alessandra Carvalho Caldas et al. Denise Matias Daniel Medina Luis Claudio Lemos Correia

Abstract

Background:

Medical reversal is defined as the discontinuation of a procedure’s recommendation due to new evidence regarding its efficacy or safety. Cardiology is the specialty with the highest number of documented reversals, yet there is no information available about the probability of reversal.

Objectives:

To describe the frequency of medical reversal in the ischemic heart disease guidelines published by the American College of Cardiology/American Heart Association (ACC/AHA), according to levels of evidence.

Methods:

The most recent guidelines for stable coronary disease, non-ST-elevation acute coronary syndrome, and ST-elevation myocardial infarction were compared with the first version. Medical reversal was defined as a shift from a recommended procedure to a contraindicated one or the removal of the recommendation. The quality of evidence was categorized by the guidelines as high, moderate, or low.

Results:

A total of 224 therapeutic recommendations were identified, with 19% based on high-quality evidence, 42% on moderate-quality evidence, and 39% on low-quality evidence. Forty-nine medical reversals were observed, constituting 22% of all therapeutic recommendations included in the first version of the guidelines. The probability of reversal for procedures based on high-quality evidence was 2%, compared with 25% for procedures with moderate-quality evidence and 30% for procedures with low-quality evidence.

Conclusion:

In the ACC/AHA ischemic heart disease guidelines, medical reversal is common in recommendations based on moderate or low-quality evidence, but rare in those with high-quality evidence.

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Original Article

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

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

Abstract

Background:

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

Objective:

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

Methods:

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

Results:

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

Conclusion:

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

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Editorial

Cardiac Myosin Inhibitors in Patients with Hypertrophic Cardiomyopathy

Marcelo Imbroinise Bittencourt et al. Ricardo Mourilhe-Rocha

In recent years, we have witnessed a significant shift in the management of symptomatic Hypertrophic Cardiomyopathy (HCM). For decades, treatment relied on medications that provided hemodynamic support without directly addressing sarcomeric hypercontractility, the primary pathophysiological driver of the disease. The emergence of Cardiac Myosin Inhibitors (CMIs), particularly mavacamten and aficamten, has transformed this landscape.^, In an article published in this issue of the International Journal of Cardiovascular Sciences, Fogaça PHT et al. present an updated systematic review and meta-analysis that reinforces the efficacy of this class of medications while providing important insights into their effects in both obstructive and non-obstructive HCM.

The study pooled data from six randomized controlled trials. Five included patients with obstructive HCM, whereas one – the MAVERICK-HCM trial – included patients with non-obstructive HCM.^,,- The inclusion of non-obstructive patients represents a distinctive aspect of this analysis, as the benefits of CMIs in the absence of left ventricular outflow tract (LVOT) obstruction remain less well established.

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Viewpoint

Asymptomatic Patients With Suspected Coronary Artery Disease: What Are Clinicians Afraid Of?

Antônio Sérgio Cordeiro da Rocha et al. Dany Kruczan

Introduction

In contemporary practice, myocardial revascularization, particularly Percutaneous Coronary Intervention (PCI), is frequently performed in asymptomatic individuals with suspected Coronary Artery Disease (CAD). This occurs despite robust evidence from Randomized Clinical Trials (RCTs) over the past two decades demonstrating that, in patients with Chronic Coronary Syndromes (CCS), neither PCI nor Coronary Artery Bypass Grafting (CABG) reduces mortality when compared with Guideline-directed Medical Therapy (GDMT). In selected populations, revascularization confers symptomatic relief, particularly among patients with frequent angina, but without prognostic advantage.

The persistence of invasive strategies in asymptomatic patients appears to be driven largely by two cognitive biases: the “oculostenotic reflex”, the impulse to correct angiographically visible stenoses, and the “oculoischemic reflex”, the perceived need to revascularize documented ischemia irrespective of symptoms. Both are rooted in the fear that untreated coronary obstructions inevitably herald sudden cardiac death or Acute Myocardial Infarction (AMI).^,

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Review Article

Home-Based Vs. Usual and Center-Based Cardiac Rehabilitation: Effects on Aerobic Fitness and Quality of Life

Cauã Teixeira Mota et al. Claudia Lucia de Moraes Forjaz

Abstract

Home-based cardiac rehabilitation has been proposed as an alternative to expand access to treatment for patients with cardiovascular diseases. This systematic review evaluated the effects of home-based cardiac rehabilitation, with emphasis on physical exercise, on aerobic fitness, quality of life, and adverse events compared with usual cardiac rehabilitation and center-based cardiac rehabilitation. A literature search was conducted in the PubMed database, including only randomized controlled clinical trials involving adults and older adults with coronary artery disease or heart failure. Twenty-three studies conducted in different countries were identified; however, none was performed in Brazil. The total sample comprised 2,298 participants, of whom 24% were women. All studies implemented aerobic training, either alone or combined with resistance training, and the vast majority maintained remote contact with participants every one to two weeks. Comparisons between pre- and post-intervention outcomes showed that home-based cardiac rehabilitation improved aerobic fitness and/or quality of life in 22 studies, with greater improvements than those observed with usual cardiac rehabilitation and outcomes comparable to those achieved with center-based cardiac rehabilitation. Furthermore, the incidence of adverse events was low and similar across the three rehabilitation models. Overall, home-based cardiac rehabilitation improves aerobic fitness and quality of life more effectively than usual cardiac rehabilitation and provides benefits comparable to those of center-based cardiac rehabilitation without increasing the risk of adverse events, supporting its use in the treatment of cardiovascular diseases. Nevertheless, the absence of studies conducted in Brazil highlights the need for further research on this rehabilitation model in the Brazilian context.

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Letter to the Editor

Metabolic Challenges in The Semiarid Region: A Critical Analysis of Nutritional Transition and Early Cardiovascular Risk

Leonardo Alves Santos et al. Álvaro Eduardo Santos Oliveira Beatriz Vitória Carvalho Lordêlo Luis Antonio Cavalcanti Matias … Rodrigo Mendes Pedro Pereira Tenório

Dear Editor,

We had the opportunity to review the article entitled “Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Area in the Backlands of Bahia.” We would like to congratulate the authors for their initiative in investigating a pediatric cohort in a region marked by social and climatic vulnerability, frequently underrepresented in scientific literature, as well as for highlighting the relevance of addressing childhood obesity and arterial hypertension – two major cardiovascular risk factors with direct impact on future morbidity and mortality.

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Original Article

Evaluation of Cardiovascular Risks Associated with Calcium Use: A Systematic Review and Meta-Analysis

Paulo Henrique Gouveia et al. Joyce da Silva Guimarães Astrid Wiens

Abstract

Background

Calcium plays vital roles in both physiological and pathological processes, and its use as a therapeutic agent is primarily indicated for osteoporosis and osteopenia. It may increase cardiovascular risk, thereby increasing cardiovascular morbidity and mortality.

Objective

To synthesize the available evidence on cardiovascular risks in patients using calcium-based medications and supplements.

Methods

This systematic review and meta-analysis utilized three major international databases and included intervention studies and comparative observational studies with data on the intake of calcium-based medications or supplements in adult populations and associated cardiovascular outcomes. A p-value < 0.05 was considered for all analyses, and the certainty of evidence was assessed using the GRADE approach.

Results

A total of fourteen articles were included: three pivotal intervention studies, four post hoc analyses, and seven observational studies. The outcomes assessed were mortality from cardiovascular events, myocardial infarction, stroke, and coronary artery disease. Although an increased incidence of coronary artery disease was observed among users of calcium-based medications or supplements when considering only observational studies (RR 1.08; 95% CI 1.02–1.15), this finding was not confirmed in interventional studies. Therefore, further investigation is warranted. No increased risk of cardiovascular mortality, myocardial infarction, or stroke was observed. The quality of the evidence was considered low or very low for all outcomes due to the risk of bias and limitations inherent to the meta-analyses themselves.

Conclusions

Caution is recommended when interpreting the results, particularly in the development of clinical protocols. The importance of pharmacotherapeutic monitoring for patients using these medications is emphasized, and further research to explore additional outcomes is suggested.

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