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ISSN (Print): 2359-4802 | ISSN (Online): 2359-5647

Edition: 25.2 - 11 Article(s)

Editorial

Transcatheter aortic valve implants in Brazil and worldwide: from experimental procedure to medical practice

Implante de válvula aórtica por cateter no Brasil e no mundo: de procedimento experimental a prática clínica

André Luiz Silveira Sousa; Fábio Sândoli Britto Júnior

Rev Bras Cardiol. 2012;25(2):84-85

PDF PORT


Original Article

Prevalence of ankle-brachial index alterations in patients with asymptomatic peripheral arterial occlusive disease

Prevalência de alterações do índice tornozelo-braço em indivíduos portadores assintomáticos de doença arterial obstrutiva periférica

Ana Gabriela Menezes de Jesus Torres; Éric Guimarães Machado; Tiago de Souza Lopes; Paola Caobianco Gentile; Aline Costa Vieira2; Léo Guimarães Soares; Gabriel Porto Soares; Paulo Sérgio Lopes Soares

Rev Bras Cardiol. 2012;25(2):87-93

Abstract PDF PORT

BACKGROUND: Peripheral arterial occlusive disease is characterized by decreased blood flow to the lower limbs due to occlusive processes in the arterial beds, with intermittent claudication being the most common indication.
OBJECTIVES: To evaluate the prevalence of alterations in the average ankle-brachial index (ABI) in patients over 55 years old with no symptoms of peripheral arterial disease, ascertaining their relationship to cardiovascular risk factors.
METHODS: The sample for this observational transversal study consisted of 168 individuals more than 55 years old in Vassouras, Rio de Janeiro State. The average ABI was measured through a Doppler ultrasound and pressure aneroid devices, with interviews for assessing cardiovascular risk factors and completing the Edinburgh claudication questionnaire, in order to determine the presence of intermittent claudication.
RESULTS: Of the 161 participants studied, 102 (63.35%) presented rates of 0.90 to 1.30; 45 (27.95%) had ABI<0.90 with no complaints of intermittent claudication; and 14 (8.70%) had ABI<0.90 and intermittent claudication as a symptom of the disease. In terms of risk factors for participants with peripheral arterial disease, the following were prevalent in men: hypertension (64.28%), sedentary lifestyle (57.14%) and dyslipidemia (46.42%); among women: sedentary (48.38%), arterial hypertension (45.16%) and dyslipidemia (32.25%).
CONCLUSION: Alterations to the ABI were found frequently in subjects over 55 years in this study, although asymptomatic, showing that peripheral arterial disease remains underdiagnosed and undertreated. The main risk factors identified in both genders were hypertension, sedentary lifestyle and dyslipidemia.


Keywords: Ankle-brachial index; Peripheral arterial disease; Risk factors; Intermittent claudication

Ankle brachial index in patients at high cardiovascular risk

Índice tornozelo-braquial em pacientes de alto risco cardiovascular

Francielle Graus Frazão Nunes; Gabriela Cavalcante de Souza Leão; Ana Luiza Exel; Maria Celeste Campello Diniz

Rev Bras Cardiol. 2012;25(2):94-101

Abstract PDF PORT

BACKGROUND: Peripheral arterial disease (PAD) is a strong marker of cardiovascular disease, with a strong association between PAD and other atherosclerotic disorders, including coronary artery disease (CAD).
OBJECTIVE: To analyze the presence of PAD in patients undergoing cardiac catheterization using the Ankle Brachial Index (ABI) and its relationship with the CAD.
METHODS: A clinical evaluation questionnaire was drawn up and researchers were trained to take ABI measurements in a standardized manner. The device used to take these measurements was the Portable Vascular Doppler (DV610, MEDMEGA) and the sphygmomanometer (Diasyst).
RESULTS: In relation to cardiovascular risk factors associated with abnormal ABI, there was no statistically significant difference, but when analyzing the classification of the level of coronary lesions through cardiac catheterization, there was a statistically significant difference (p<0.05) compared to abnormal ABI with severe injury.
CONCLUSION: The ABI can be an effective screening tool for diffuse atherosclerosis, particularly in high risk patients, as a significant association was observed (>70%) between PAD and CAD through cardiac catheterization.


Keywords: Peripheral vascular diseases; Heart catheterization; Ankle brachial index

Coronary angiograms without obstructive lesions in patients referred for examination

Coronariografias sem lesões obstrutivas em pacientes referidos com indicação para o exame

Roberto Muniz Ferreira; Nelson Albuquerque de Souza e Silva; Lúcia Helena Alvares Salis; William Roberto Ramalho de Miranda; Lívia Seixas Migowski; Pedro Cordeiro Moraes; Verena Andrade Balbi

Rev Bras Cardiol. 2012;25(2):102-110

Abstract PDF PORT

BACKGROUND: Studies in Brazil suggest that up to 60% of coronary angiographies (CA) are normal among patients in public health units (PHU).
OBJECTIVE: To determine whether cardiology consults reduced the percentage of examinations without obstructive coronary disease (OCD) among referred patients undergoing CA at a federal University Hospital (UH) in Rio de Janeiro (RJ).
METHODS: A quasi-experimental study with all patients referred by other PHUs and undergoing CA at the UH between January 2007 and December 2009. They were divided in two groups (with and without out-patient consults) and compared with the percentage of normal CAs without obstructive lesions (primary findings). Age, gender and cardiovascular risk factors were also analyzed.
RESULTS: Out of 207 patients, 74 did not have cardiology consults before the procedure. The mean age was 58.5 years and 58.9% were men. The prevalence of OCD (at least one lesion >70%) was 62.3%. Male, diabetes, dyslipidemia, smoking, myocardial infarction and ventricular dysfunction were associated with OCD. Previous cardiology consults were less frequent among patients with OCD (61.2% x 69.2%, p=0.24). In patients <51 years, the percentage of CA without OCD was higher among those with prior cardiology consults (66.7% x 33.3%, p=0.038).
CONCLUSION: The percentage of CA without OCD among patients referred to a federal UH in RJ between 2007 and 2009 was high compared to the goals established by the American College of Cardiology, and prior cardiology consults were unable to lower it.


Keywords: Heart catheterization; Coronary disease, Referral and consultation

Relationship between function evaluation and anthropometric indicators of obesity in adolescents, Teresina, Piauí State

Relação da avaliação funcional com indicadores antropométricos de obesidade em adolescentes de Teresina, PI

Vânia Silva Macedo Orsano; Ramires Alsamir Tibana; Jonato Prestes

Rev Bras Cardiol. 2012;25(2):111-117

Abstract PDF PORT

BACKGROUND: Poor aerobic fitness among children and adolescents is associated with larger body fat deposits and higher risks of cardiovascular disease as adults. Increased aerobic fitness may be a way of lowering the risks of comorbidities related to obesity.
OBJECTIVE: To analyze the influence of aerobic fitness on obesity indicators in among adolescents in Teresina, Piauí State.
METHODS: This study encompassed 141 boys (12.5±0.5 years) who were evaluated by: body mass, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), and triceps (TSF) and calf (CSF) skin folds. Aerobic fitness was evaluated by the 1600 meters test.
RESULTS: The adolescents were divided into three tertiles, with aerobic fitness rated higher in tertile 1 compared with tertiles 2 and 3. Volunteers from tertiles 1 and 2 presented lower body mass, BMI, WC, WHR, sum of TSF and CSF, and body fat percentages than those in tertile 3. Correlations were noted between aerobic fitness and the BMI, WC and WHR, and the sum of TSF and CSF.
CONCLUSION: Adolescents with poor aerobic fitness have higher body adiposity.


Keywords: Physical fitness; Exercise; Adiposity; Obesity, abdominal; Skinfold thickness

Assessment of autonomic cardiovascular function in spinal cord injury patients through the Valsalva and respiratory sinus arrhythmia ratios

Avaliação da função autonômica cardiovascular em portadores de lesão medular através dos índices de Valsalva e da arritmia sinusal respiratória

Jefferson Braga Caldeira; Alexandre Gomes Sancho; Felismar Manoel; Newton de Almeida Júnior; Denise Faria; João Luiz da Silva Rosa; Sérgio Nogueira Nemer

Rev Bras Cardiol. 2012;25(2):118-125

Abstract PDF PORT

BACKGROUND: Spinal cord trauma can irreversibly damage the spinal cord and nerve roots, producing changes in autonomic neural circuitry with effects on cardiovascular functions.
OBJECTIVE: To evaluate the cardiovascular repercussions of the autonomic nervous system through the Valsalva maneuver and respiratory sinus arrhythmia in individuals with complete spinal cord injuries at different levels.
METHODS: The sample consisted of 32 subjects, divided into three groups: 13 tetraplegic patients (G1), 8 paraplegic patients (G2) and 11 healthy subjects forming the control group (CG). All were submitted to the Valsalva maneuver (VM) and the respiratory sinus arrhythmia (RSA) test, measuring the Valsalva (IV) ratio and the expiratory / inspiratory (E/I) index respectively. Data normality was ascertained through the Kolmogorov - Smirnov test and the data were analyzed by variance analysis and the Bonferroni post hoc test, with a significance level of 5%.
RESULTS: We noted that the IV was similar when comparing the control (1.9±0.0) and paraplegic (2.0±0.1) groups, dropping significantly in the tetraplegic group (1.2±0.0; p=0.00001). The E/I index was similar for the control (1.5±0.0) and paraplegic (1.4±0.0) groups, but was significantly lower for the tetraplegic group (1.3±0.0; p=0.005).
CONCLUSION: The results reflected a significant decrease or absence of cardiac sympathetic innervation in tetraplegic patients and the integrity of cardiac autonomic innervation in paraplegic patients through the arrhythmia test and the Valsalva maneuver.


Keywords: Spinal cord injuries; Motor activity; Cardiovascular physiological phenomena; Valsalva maneuver; Arrhythmias, cardiac

Diabetes and cardiovascular disease: prognosis five years after percutaneous revascularization

Diabetes e doença cardiovascular: prognóstico após cinco anos de revascularização percutânea

Hugo Filipe de Mendonça Arruda Gonçalves Café; Bruno Francisco Taborda Oliveira Silva; Nuno Miguel Marçalo Santos; Marco Filipe Gomes Serrão; Ana Paula Moreira Faria; António Manuel Drummond Freitas; Décio Higino Silva Pereira; José Jorge Rodrigues Araújo

Rev Bras Cardiol. 2012;25(2):126-131

Abstract PDF PORT

BACKGROUND: Diabetes Mellitus (DM) is a recognized cardiovascular risk factor, and knowing that percutaneous coronary intervention (PCI) improves prognoses of coronary artery disease (CAD), we intend to ascertain whether this effect is similar in diabetic (D) and nondiabetic (ND) patients.
OBJECTIVE: To analyze the long term impact of DM in patients undergoing PCI.
METHODS: Retrospective unicentric cohort study of consecutive patients undergoing elective or urgent PCI between January 2002 and December 2003, divided into two groups: diabetic (D) and non-diabetic (ND). Clinical, angiographic and coronary intervention PCI profiles were compared to clinical outcome at 5 years. Major cardiovascular events (MACE) were defined as death, new acute coronary syndrome (ACS), stroke (S), and new surgical (CABG) or percutaneous (PCI) revascularization. The stent thrombosis, target vessel revascularization (TVR) and target lesion revascularization (TLR) rates were also evaluated.
RESULTS: The five year follow-up rate was 94%. During the study, 446 PCIs were performed on 406 patients; 63.0±11 years old, 70.4% male. Among them, 128 (31.5%) were D. At the five-year follow-up, the MACE rate was 50.7% for D and 36.7% for ND (p=0.01). The global mortality rates were 28.1% vs 14.4% (p=0.0016) and the cardiovascular mortality rates were 15.6% vs. 8.3% (p=0.039) for D and ND respectively. The remaining parameters were not statistically significant. No differences were noted between stent thrombosis and the stent types used in both groups.
CONCLUSION: DM constituted a risk factor for long term outcome in D patients undergoing PCI.


Keywords: Diabetes mellitus; Risk factors; Coronary disease; Prognosis; Angioplasty; Cohort studies

Correlation between clinical and nutritional variables in elderly patients with heart disease

Correlação entre variáveis nutricionais e clínicas de idosos cardiopatas

Priscila Matos de Pinho; Ana Carla Moreira da Silva; Marília de Souza Araújo; Cássio Pinho dos Reis; Silvia dos Santos de Almeida; Luiza Costa Alvares Barros; Fernanda Henriques Cavalcantes; Edson Marcos Leal Soares Ramos

Rev Bras Cardiol. 2012;25(2):132-140

Abstract PDF PORT

BACKGROUND: Aging is a process characterized by specific pathophysiological conditions, with changes in organic structures and metabolisms, as well as nutrition and function mechanisms. This increases susceptibility to disease, including non-transmittable chronic diseases, particularly cardiovascular disorders.
OBJECTIVE: To examine the correlation between clinical and nutritional variables in elderly patients with heart disease.
METHODS: A cross-section survey collected data on biochemical examinations and blood pressure analyses from patient records. A semi-quantitative questionnaire on eating frequency was completed, taking anthropometric measurements (weight, height, body mass index and waist circumference) using the Bioestat program version 5.0 and applying the t Student test and Pearson's linear correlation among anthropometric and biochemical variables, blood pressure and dietary intake, with a significance level of 5%.
RESULTS: In a sample of 50 elderly people (70% female), biochemical data were altered in the lipids and glucose profiles. Anthropometric data were adequate, except for waist circumferences in women. Average consumption was significantly high in the following food groups: sugars and sweets, fats and oils, beans and seeds, cereals, meat and eggs. There was a positive correlation between food intake and the anthropometric and biochemical variables.
CONCLUSION: Inadequate nutrition, especially excessive consumption of sugars and fats, causes alterations to anthropometric and biochemical profiles.


Keywords: Cardiovascular diseases; Aged; Nutrition assessment; Eating

Review Article

Accuracy of multi-detector computed tomography for diagnosing coronary artery disease: systematic review

Acurácia da tomografia computadorizada de múltiplos detectores no diagnóstico da doença arterial coronariana: revisão sistemática

Myrna Santos Rocha; Lia Roque Assumpção; Denizar Vianna Araújo

Rev Bras Cardiol. 2012;25(2):141-148

Abstract PDF PORT

Coronary artery disease (CAD) is one of the most prevalent conditions among cardiovascular diseases. Invasive coronary angiography (ICA) is the gold standard for CAD diagnosis, indicated for patients with suspected coronary stenosis and high probabilities of CAD. Coronary angiography through multi-detector computed tomography (MDCT) is a new non-invasive diagnostic technique offering direct views of the coronary artery. Its indication has been reported for diagnosing CAD in symptomatic patients with intermediate pre-test probability for this condition. However, only small-scale singlecenter studies were presented through to 2008, with selected patients and frequently excluding unclear image segments from the analyses. The purpose of this systematic review is to evaluate the accuracy of MDCT for CAD diagnoses in patients with intermediate probability of this condition. From the 414 papers found, 13 studies were selected that included patients with intermediate probability of CAD who underwent both ICA and coronary MDCT64 with 64 detectors. A total of 1992 patients were examined in 12 of the 13 studies selected, with only 8 studies offering available data for analyzing the 14725 coronary segments. There was no statistically significant difference in accuracy in analyses by patient or by segment (p<0.05). The 64 detector coronary MDCT presented a good diagnostic performance for patients with intermediate probability of CAD. This method can help dismiss the possibility of the patient not having CAD through negative results, with the advantage of being non-invasive.


Keywords: Coronary diseases; Coronary angiography; Positron emission tomography; Sensibility and specificity; Review

Case Report

Acalculous cholecystitis in a patient complicated by endomyocardial fibrosis

Colecistite acalculosa complicada em paciente com endomiocardiofibrose

Glauco Franco Santana; Danilo César Leite; Roberto Sávio Soares; Leonardo de Aguiar Santos

Rev Bras Cardiol. 2012;25(2):149-152

Abstract PDF PORT

This paper addresses the case of a young female with clinical acalculous cholecystitis and biventricular endomyocardiofibrosis, not previously diagnosed. The relationship between these diseases is discussed, examining the possibility of eosinophilia or heart failure as an etiopathogenic or aggravating factor common to both entities. The patient progressed to death, whose cause was not determined.


Keywords: Acalculous cholecystitis; Cardiomyopathy, restrictive; Endomyocardial fibrosis; Heart failure

Coronary artery perforation with cavity spilling in the right ventricle during angioplasty

Perfuração da artéria coronária durante angioplastia com cavity spilling para o ventrículo direito

Rodrigo Gimenez Pissutti Modolo; André Eduardo Gomes; Maurício Pais Bussoletto; Eduardo Arantes Nogueira

Rev Bras Cardiol. 2012;25(2):153-156

Abstract PDF PORT

Coronary artery perforation is a rare but much-feared complication in percutaneous coronary interventions. With the advent of new angioplasty techniques and devices such as ablative atherectomies, the increase in procedures for arteries previously viewed as unsuitable for intervention and the expansion of the platelet inhibitor arsenal, this complication is becoming more frequent. Its rapid identification and immediate treatment improves the survival rate of these patients. This case study describes a patient with acute anterior myocardial infarction with an occluded anomalous large septal branch who presented a cavity spilling type of coronary artery perforation during angioplasty, with the formation of a left-right shunt, treated successfully.


Keywords: Angioplasty; Heart catheterizarion; Coronary vessels; Cardiac tamponade

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