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

Edition: 25.3 - 11 Article(s)


Cardio-oncology: the price of aging

Cardio-oncologia: o preço do envelhecimento

Wolney de Andrade Martins; Edneia Tayt-Sohn Martuchelli Moço

Rev Bras Cardiol. 2012;25(3):164-166


Original Article

Acute coronary syndrome in a clinical practice at a university hospital in Rio de Janeiro

Síndrome coronariana aguda na prática clínica em hospital universitário do Rio de Janeiro

Paolo Blanco Villela; Gláucia Maria Morais de Oliveira; Carlos Henrique Klein; Nelson Albuquerque de Souza e Silva

Rev Bras Cardiol. 2012;25(3):167-176

Abstract PDF PORT

BACKGROUND: In Brazil, there are few appropriate records of acute coronary syndrome (ACS) with their in-hospital and post-discharge outcomes.
OBJECTIVES: To describe clinical characteristics, progress and lethality for ACS in-hospital and development within three years after discharge.
METHODS: Retrospective cohort study of adults with ACS admitted to the Clementino Fraga Filho University Hospital, Rio de Janeiro Federal University, evaluating clinical characteristics, treatment and hospital lethality, together with cardiovascular events, revascularization procedures, medications and lethality within three years.
RESULTS: The study encompassed 652 patients, 242 (37.1%) with ST elevation myocardial infarction (STEMI), 162 (24.9%) with non-ST elevation myocardial infarction (NSTEMI), 232 (35.6%) with unstable angina (UA) and 16 (2.4%) with secondary angina (SA). Overall hospital lethality rates were 9.5% and 12.4% for STEMI, 6.8% for NSTEMI, 8.2% for UA and 12.5% for SA. Most (58.1%) were male. Stratification with coronary angiography was performed in 67.3%, with non-invasive methods used for 4.9% of the cases; 281 patients did not receive any reperfusion strategy. Thrombolysis was used more than primary angioplasty, both with similar lethality (7.3% and 7.7% respectively); in STEMI without reperfusion, lethality was 20.3%. After discharge, adherence to treatment was higher among patients with STEMI, while UA had more coronary angiography and revascularization procedures. The lethality rates during follow-up were 20.8% for STEMI, 40.6% for NSTEMI, 30.5% for UA and 28.6% for SA.
CONCLUSIONS: Many cases did not undergo reperfusion during hospitalization, while STEMI posted higher inhospital lethality but with more favorable post-discharge outcomes.

Keywords: Acute coronary syndrome/mortality; Myocardial ischemia; Clinical competence; Letality; Follow-up studies

Critical evaluation of treadmill test accuracy in clinical practice: single center experience

Avaliação crítica sobre acurácia do teste ergométrico na prática clínica: experiência de centro único

Mayler Olombrada Nunes de Santos; Aline Vilela Mees; Álvaro de Moraes Júnior; Larissa Renovato dos Santos; Mariana Oliveira Leão; Patrícia Ferreira Rafael; Max Weyler Nery

Rev Bras Cardiol. 2012;25(3):177-184

Abstract PDF PORT

BACKGROUND: When evaluating coronary artery disease, treadmill tests must be interpreted through an analysis of clinical, hemodynamic and electrocardiographic data, but in clinical practice some of this information is not properly identified. Objectives: To analyze the practice of conducting treadmill tests for evaluating coronary atherosclerosis in relation to consensus recommendations.
METHODS: Case series, cross-sectional, observational and descriptive. Between May and June 2011, we examined the treadmill test results of 166 consecutive patients undergoing cineangiocoronography.
RESULTS: A predominantly male (60.8%) population underwent treadmill testing and cineangiocoronography, with high ratings for cardiovascular disease risk factors. Typical chest pain was observed infrequently (6.4%), with most (80.8%) of the tests not reporting chest pain. Maximum treadmill test for 17.5% of the sample and submaximum for the majority (60.8%); suggestive of ischemia in 63.9%, not suggestive or inconclusive for the others. Cineangiocoronography identified significant atherosclerotic disease in 60.2% (100/166) of the patients. The stress test sensitivity was 65% (95% CI 54.8 to 74.2), specificity of 37.8% (95% CI 26.2 to 50.6), positive predictive value of 61.3% (95% CI 51.3 to 70.6) and negative predictive value of treadmill testing in relation to the gold standard was 41.6% (95% CI 29.0 to 55.1). Accuracy was confirmed in only 54.2% (95% CI 43.6 to 66.6) of the stress tests. Important information required for proper analyses of treadmill tests was not found in most of these examinations.
CONCLUSIONS: Wide variations were found for information quality, with poor accuracy for treadmill tests, suggesting that clinical practice has moved away from the guideline recommendations.

Keywords: Exercise test; Health evaluation; Coronary artery disease; Evidence-based practice

Six-minute walk test: evaluation on the functional capacity of sedentary individuals

Teste de caminhada de seis minutos: avaliação da capacidade funcional de indivíduos sedentários

Pâmela Matias Fernandes; Natália Herculano Pereira; Andréa Carla Brandão da Costa Santos; Maria Elma de Souza Maciel Soares

Rev Bras Cardiol. 2012;25(3):185-191

Abstract PDF PORT

BACKGROUND: The six-minute walk test has been used to evaluate the functional capacity of individuals though a range of protocols and reference equations based on international studies in order to calculate the predicted distance.
OBJECTIVES: To evaluate the functional capacities of sedentary individuals and compare their test performances with and without monitoring over the distances predicted by the Enright and Sherrill equations.
METHODS: Twenty-eight (28) male and female university students between 20 and 30 years old were evaluated. In order to determine the level of physical activity, using the short version of the International Physical Activity Questionnaire (IPAQ). The tests were performed in a corridor 30 meters long, with a finger oximeter, cones, a stadiometer and a digital scale. The statistical analyses were calculated using the SPSS 15.0 for Windows statistics program paired with the Student t test program with a 5% significance level for all analyses.
RESULTS: Significant differences were found between the predicted distance and the distances covered in the first and second tests of the women (p<0.001), for both types of standardization. There was no significant difference between the distances covered in the first and second tests for both genders: p=0.175 (males) and p=0.992 (females).
CONCLUSIONS: The sample showed a decrease in functional capacity, indicating that the Enright and Sherrill equations overestimated the values found. It is thus suggested that subsequent studies might draw up adequate reference equations for the young population, contributing to early evaluation and prevention of future complications arising from sedentary lifestyles.

Keywords: Exercise test; Walking; Exercise; Evaluation; Sedentary lifestyle

Angiotensin converting enzyme gene polymorphisms and cardiovascular evaluation in growth hormone deficient adults

Polimorfismos do gene da enzima conversora de angiotensina e avaliação cardiovascular em adultos com deficiência do hormônio do crescimento

João Manoel de Almeida Pedroso; Ana Beatriz Winter Tavares; Flávia Lucia Conceição; Beatriz Vaz de Melo Mendes; Rosane Silva; Turan Peter Urmenyi; Mario Vaisman; Edson Rondinelli; Nelson Albuquerque de Souza e Silva

Rev Bras Cardiol. 2012;25(3):192-199

Abstract PDF PORT

BACKGROUND: The angiotensin-converting enzyme (ACE) is an important blood pressure (BP) regulator, and ACE gene polymorphisms are associated with alterations in BP. No studies have yet been conducted on growth hormone (GH) replacement in adults with GH deficiency (GHD) according to ACE genotypes.
OBJECTIVE: To evaluate cardiovascular response to GH treatment in adults with GHD according to their ACE genotype.
METHODS: 18 patients with hypopituitarism were evaluated by baseline ACE genotype and after 24 months of GH replacement, compliant with clinical and cardiovascular parameters.
RESULTS: 10 women and 8 men were evaluated (mean age 44.9±10.9 yrs). The distribution of the ACE genotype was: DD genotype: 7 patients (38.9%); and ID: 11 patients (61.1%). Heart rate, systolic and diastolic BP, diastolic BP load, and systolic and diastolic functions were normal in all patients. For the baseline evaluation, DD genotype patients demonstrated higher levels of diurnal and 24-hour systolic and diastolic BP (p<0.05), and higher diastolic BP loads (p<0.05). Comparing the two genotypes at the end of the study, DD genotype patients showed a statistically significant decrease (p<0.005) in: 24-hour and diurnal diastolic BP, 24-hour and diurnal systolic and diastolic BP load; and also an increase in nocturnal heart rate (p<0.005).
CONCLUSION: The results suggest that patients with GHD and DD genotype present more benefits from GH replacement in relation to BP control.

Keywords: Peptidyl - dipeptidase A/genetics; Human growth hormone/deficiency; Adult; Polymorphism, Genetic; Renin-angiotensin system

Relationship between anthropometric variables and pressure/lipid profiles in adults with chronic non-communicable diseases

Relação de variáveis antropométricas com os perfis pressórico e lipídico em adultos portadores de doenças crônicas não transmissíveis

Wanderson André Alves Mendes; Sérgio Eduardo Moura Carmin; Priscila Matos de Pinho; Ana Carla Moreira da Silva; Liliane Maria Messias Machado; Marília de Souza Araújo

Rev Bras Cardiol. 2012;25(3):200-209

Abstract PDF PORT

BACKGROUND: Chronic non-communicable diseases (CNCDs) are a serious public health problem, whereby it is essential to identify factors that increase their occurrence.
OBJECTIVE: To assess the relationship between anthropometric variables and pressure / lipid profiles in adults with CNCDs, treated at a nutrition out-patient clinic in a university hospital.
METHODS: Cross-sectional clinical study of male and female patients (n=50) with CNCDs, aged 20-59 years. Weight, height, waist (WC) and brachial (BC) circumferences, body mass index (BMI), conicity index (C index) and body fat percentage were measured by two methods: Deurenberg et al., 1991 (BFD%) and Lean et al., 1991 (BFL%), glucose, total cholesterol, LDL-c, HDL-C, triglycerides and blood pressure.
RESULTS: the BMI was the most closely correlated with other variables: WC (p<0.0001, r=0.89), BC (p<0.0001, r=0.91), BFD% (p<0.0001, r=0.77), BFL% (p<0.0001, r=0.65), and C index (p=0.009, r=0.36). The WC also showed significant correlations, although not as strong as those of the BMI, except for the C index (p<0.0001, r=0.66). The odds of elevated triglyceride levels were found to be significantly higher with increased BMI (OR=3.02, p=0.020), WC (OR=3.88, p=0.005) and BF% (p<0.0001, OR=6.24 - BFD%, p<0.005, OR=3.88 - BFL%). There were also more likely to decrease for HDL-C when WC (OR=3.57, p=0.009), BFD% (p<0.0001, OR=5.76), BFL% (p<0.009, OR=3.57) and C index (OR=4.82, p=0.002) increased.
CONCLUSION: The BMI and WC were the most closelycorrelated with other variables. The chances of dyslipidemia rise with an increase in the anthropometric variables studied.

Keywords: Anthrpometry; Hypertension , Dyslipidemias; Health profile; Body mass index

Drug-eluting stents versus coronary artery bypass-graft surgery: meta-analysis of prospective clinical trials

Stents farmacológicos versus cirurgia de revascularização miocárdica: meta-análise de ensaios clínicos prospectivos

Pedro José Negreiros de Andrade; Ricardo Pereira Silva; Antonio Augusto Guimarães Lima; Antonio Thomaz de Andrade; Carlos Roberto Martins Rodrigues Sobrinho

Rev Bras Cardiol. 2012;25(3):210-217

Abstract PDF PORT

BACKGROUND: Comparisons between percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) result in controversial findings.
OBJECTIVE: To conduct a meta-analysis of clinical trials comparing PCI with drug-eluting stents (DES) and CABG.
METHODS: Electronic databases were searched to identify clinical trials published between January 2000 and December 2011 presenting this comparison. Nine clinical trials were found: ARTS II, ERACI III, LE MANS, SYNTAX, CARDia and PRECOMBAT, as well as studies by Boudriot et al., Thiele et al. and Hong et al.
RESULTS: Overall, these nine studies (n=5179 patients) did not indicate any significant differences for one year mortality (2.8% vs 3.6%; p=0.1) nor for the 2-3 year mortality rate (5.7% vs 5.8%). There was no difference in the non-fatal myocardial infarction rate (6.7% vs 5.3%; p=0.12). The incidence of stroke was significantly higher in the surgery group (0.4% vs 1.5%; p<0.001) with more revascularization procedures in the PCI group (10.5% vs 4.3%; p<0.001). The rates for death, stroke or non-fatal acute myocardial infarction were similar in both groups (9.9% vs 10.3%; p=0.9). Individual analyses of the findings suggest that PCI posted better outcomes in patients with less angiographic complexity and CABG for patients with more angiographic complexity.
CONCLUSION: PCI with drug-eluting stents proved comparable to CABG in terms of more serious adverse outcomes (death, infarction and stroke) in the nine prospective clinical trials assessed. Surgery remains the preferred revascularization procedure for patients with greater angiographic complexity, being better able to avoid new coronary artery bypass graft surgery.

Keywords: Drug-eluting stents; Myocardial revascularization; Meta-analysis; Clinical trials/methods

Psychosocial characterization of patients in a cardiac ward

Caracterização psicossocial de pacientes internados em enfermaria de cardiologia

Ricardo Gorayeb; Giovana Bovo Facchini; André Schmidt

Rev Bras Cardiol. 2012;25(3):218-225

Abstract PDF PORT

BACKGROUND: Cardiovascular diseases (CVD) account for more than half of all deaths worldwide. Despite broad-ranging advances in technology and clinical expertise, psychosocial risk factors (RF) are still little known. Objective: To describe the prevalence of psychosocial alterations, quality of life and level of knowledge about CVD risk factors in a sample of cardiac inpatients.
METHODS: Descriptive cross-sectional exploratory study of a convenience sample of male and female adults over 18 years old (n=100) with diagnoses of any CVD. The following tools were used: semi-structured interview (social, demographic and lifestyle data), Hospital Anxiety and Depression (HAD) Scale and WHO Quality of Life assessment instrument (WHOQoL-Bref). Descriptive statistics were prepared for the collected data.
RESULTS: There was a slight predominance of women (54%), <60 years (58%), poorly educated (74%), low income (48%) and retired (49%). Among the patients, 77% claimed to know the RFs for CVD; 51% mentioned emotional aspects more frequently; and 32% felt they were harder to control. On this sample, 47% were former smokers and 61% were sedentary. Depressive symptoms appeared in 39% and anxiety in 41%. In terms of quality of life, the Social Relations field rated highest, with Physical aspects posting the lowest score.
CONCLUSIONS: This study demonstrated a high prevalence of symptoms indicating anxiety and depression in a sample of cardiac patients.

Keywords: Cardiovascular diseases/mortality; Inpatients/ psychology; Quality of life; Hospitalization

Case Report

Combined procedure in young patient with severe aortic and coronary disease

Cirurgia combinada em paciente jovem com grave doença de aorta e coronária associadas

Shirley Fernanda Caldeira; Renata Corio Mazi; Fernando Augusto Alves da Costa; Marcos Cairo Vilela

Rev Bras Cardiol. 2012;25(3):226-229

Abstract PDF PORT

This case study is intended to demonstrate the possibility of a combined surgical and percutaneous approach for patients with severe associated arterial atherosclerotic disease: abdominal aortic aneurysm and coronary artery disease. For a 48-year-old patient with an infra-renal abdominal aortic aneurysm (9.4x8.7cm) and multivessel coronary disease, a combined surgical procedure was selected: initially percutaneous treatment of the aneurysm, followed by myocardial revascularization. Although there is a trend towards addressing the coronary disease first, it was decided to implant the endoprothesis first in order to treat a huge aneurism at imminent risk of rupture. Despite this unusual strategy, the patient progressed satisfactorily.

Keywords: Aortic aneurysm, abdominal/surgery; Coronary artery disease/surgery; Adult

Review Article

Role of echocardiography in the evaluation of cardiac tumors and non-infectious cardiac masses

Papel da ecocardiografia na avaliação dos tumores cardíacos e de massas cardíacas não infecciosas

Angelo Antunes Salgado; Camila Aparecida de Souza Segrégio Reis; Vinicius de Lemos Silva; Márcia Bueno Castier

Rev Bras Cardiol. 2012;25(3):230-240

Abstract PDF PORT

The echocardiogram is a non-invasive examination, practical and readily available, which can be performed at the bedside, revealing not only noninfectious intracardiac masses, but also helping define their etiology. The role of echocardiography in the evaluation of intracardiac masses, especially tumorous masses, is important for defining etiology and assessing possible therapeutic approaches through either invasive methods or expectant management. This paper reviews the role of echocardiography and attempts to demonstrate how echocardiography can help distinguish histological tumor types, in addition to defining non-tumorous and non-infectious intracardiac masses.

Keywords: Heart neoplasms; Echocardiography/methods; Diagnostic techniques, cardiovascular

Direct renin inhibitor and hypertension: a review

Inibidor direto da renina e hipertensão arterial: uma revisão

Karla Fabiana Goessler; Marcos Doederlein Polito

Rev Bras Cardiol. 2012;25(3):241-255

Abstract PDF PORT

Rated as a public health problem, hypertension is also a risk factor for developing cardiovascular disease. Treatment measures should thus be taken in order to improve this situation. The direct renin inhibitor (DRI) is a new alternative antihypertensive treatment marketed by its active ingredient: aliskiren. This study reviews the literature on the effects of treatment with a DRI as monotherapy or combined with other classes of antihypertensive drugs, in animals and humans. Through the MEDLINE database search engine, eleven articles were selected involving animals and 28 articles involving humans. The DRI was effective in reducing blood pressure, whether administered alone or in combination therapy, with higher doses seeming to be more efficient than lower doses. Moreover, it seems to offer some additional advantages compared to other renin angiotensin system blockers, with fewer adverse effects. The physiological mechanisms involved in aliskiren responses are still being studied, but there is evidence of a drop in plasma renin activity.

Keywords: Hypertension/physiopathology; Antihypertensive agents; Renin-angiotensin system/physiology