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

Edition: 27.2 - 12 Article(s)

Editorial

I hereby declare that this patient may watch Fifa World Cup soccer games

Atesto para os devidos fins que o senhor está apto a assistir aos jogos da copa

Renata Rodrigues Teixeira de Castro

Rev Bras Cardiol. 2014;27(2):74-75

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Original Article

Factors associated with obstructive sleep apnea severity: obesity and excessive daytime sleepiness

Fatores associados à gravidade da apneia obstrutiva do sono: obesidade e sonolência diurna excessiva

Henyse Gomes Valente da Silva; Annie Seixas Bello Moreira; Vanessa Ramalho dos Santos; Suelen de Oliveira dos Santos; Andrea Frota Bacelar Rêgo

Rev Bras Cardiol. 2014;27(2):76-82

Abstract PDF PORT

BACKGROUND: Obstructive sleep apnea (OSA) is an underdiagnosed chronic disease associated with obesity and high morbidity and mortality rates. This study is justified by the high prevalence of obesity and its association with obstructive sleep apnea.
OBJECTIVE: To evaluate nutritional, polysomnographic and daytime sleepiness factors associated with OSA severity.
METHODS: Cross-sectional study comparing anthropometric and polysomnographic alterations in patients with and without OSA, assessing body mass index, subjective Epworth sleepiness scale (ESS) and polysomnography parameters. The OSA syndrome was classified as mild/moderate or severe, based on the apnea/hypopnea rates.
RESULTS: A total of 288 patients were included, with a mean age of 43.9±12.3 years and a body mass index of 29.4±6.38kg/m2. Among patients with severe OSA, almost 92.0% were overweight and more than half (55.6%) presented excessive daytime sleepiness. Obesity, excessive daytime sleepiness, snoring and sleep fragmentation were respectively 3, 2, 11 and 23 times greater with severe OSA than for mild/ moderate OSA.
CONCLUSION: People with severe OSA presented higher BMIs, more frequent daytime sleepiness, greater sleep fragmentation and more frequent snoring than those with mild/moderate OSA.


Keywords: Sleep apnea, obstructive; Anthropometry; Body mass index; Obesity; Polysomnography

Blood pressure and heart rate among soccer fans with coronary artery disease

Pressão arterial e frequência cardíaca em torcedores de futebol com doença coronariana

Tiago Martini; Daniel Medeiros Moreira

Rev Bras Cardiol. 2014;27(2):83-89

Abstract PDF PORT

BACKGROUND: The stress of watching soccer matches could increase the risk of cardiovascular events, particularly for patients with coronary artery disease.
OBJECTIVE: To evaluate hemodynamic responses among television viewers with coronary artery disease (CAD) when watching a match played by their favorite soccer team and during a comedy movie.
METHODS: Soccer fans were randomized to watch their team play a match or a movie, switching during the second stage. The primary outcome was the difference between the mean arterial pressure (MAP) values in the groups, with secondary outcomes being differences in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and double product (DP) values and the presence of angina.
RESULTS: With 17 randomized patients, the MAP p=0.002), SBP (p=0.002), DBP (p=0.027) and PD (p=0.009) values were higher during the soccer match. The difference between the baseline and mean SBP values during the comedy dropped by 8.9±14.9mmHg (p=0.038), with a non-significant uptrend of 4.3±16.5mmHg (p=0.326) during the soccer match. The PD fell by 1156.0±1140.4mmHg.bpm (p=0.002) during the movie, with a non-significant reduction of 1318.2±77.6mmHg.bpm (p=0.823) during the soccer match. In the course of the intervention, HR dropped significantly: down by 4.2±3.2bpm during the movie (p<0.001) and 2.7±4.5bpm (p=0.036) during the soccer match.
CONCLUSION: Soccer fans with CAD watching televised matches presented MAP, SBP, DBP and RPP values higher than those recorded when watching a comedy movie.


Keywords: Blood pressure; Coronary disease; Soccer

Initial impact of a disease management program on heart failure in a private cardiology hospital

Impacto inicial de uma clínica de insuficiência cardíaca em hospital cardiológico privado

Pedro Gabriel Melo de Barros e Silva; Douglas Jose Ribeiro; Viviane Aparecida Fernandes; Damiana Vieira dos Santos Rinaldi; Denise Louzada Ramos; Mariana Yumi Okada; Marcelo Jamus; Antonio Claudio do Amaral Baruzzi; Hugo Tannus Furtado de Mendonça Filho; Valter Furlan

Rev Bras Cardiol. 2014;27(2):90-96

Abstract PDF PORT

BACKGROUND: Heart failure still leads to frequent hospitalizations despite notable therapeutic advances. Programs that monitor and optimize care have the potential to enhance control of these patients, although evidence of their real benefits is still controversial.
OBJECTIVES: To describe the population with heart failure included in a Clinical Care Program, assessing the hypothesis of short-term benefits (6 months).
METHODS: Prospective study assessing heart failure patients in a private cardiology hospital from January to December 2012, divided into two groups: Group 1 - pre-Care Program patients with only data recorded; Group 2 - post-Care Program patients with the same data recorded, together with educational interventions through the Care Program run by the Heart Failure Clinic. The demographic characteristics of the population were analyzed, together with quality indicators and clinical outcomes.
RESULTS: Among the 762 patients assessed, the mean age was 70.4±11.0 years, with 56.0% male. Reduced ejection fraction was noted in 65.0%, hemodynamic profile B in 66.0%, ischemic etiology in 52.0% and infection as a decompensation factor in 29.0% of cases. The outcomes analyzed in Groups 1 and 2 were, respectively: hospital readmissions within 30 days (13.0% vs. 9.0%; p=0.1); average length of stay (9.0 days vs. 8.4 days, p=0.4); decompensation due to poor compliance (17.0% vs. 10.0%; p=0.004); and in-hospital mortality (9.0% vs. 8.0%; p=0.7).
CONCLUSIONS: Most of the enrolled patients were elderly males with reduced ejection fraction and infection as the main cause of decompensation. After the implementation of the Program, there were fewer hospitalizations due to poor compliance with treatment.


Keywords: Heart failure; Compliance with medication; Monitoring; Hospitalization

Quality of life analysis among men and women with heart failure

Análise da qualidade de vida em homens e mulheres portadores de insuficiência cardíaca

Roberto Ramos Barbosa; Rafaela Vieira Franklin; Anelise Venturini Stefenoni; Vanessa Delfino Moraes; Tiago de Melo Jacques; Renato Giestas Serpa; Osmar de Araujo Calil; Luiz Fernando Machado Barbosa

Rev Bras Cardiol. 2014;27(2):97-103

Abstract PDF PORT

BACKGROUND: Heart failure (HF) can severely impact the quality of life (QOL), and little is known about QOL and differences between men and women with HF. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is tool that assesses the QOL of HF patients.
OBJECTIVE: To assess the QOL of HF patients, comparing men and women.
METHODS: A single-center transversal descriptive study applying the MLHFQ to HF patients with reduced ejection fraction monitored at the HF Clinic of a University Hospital between October 2012 and March 2013. The MLHFQ findings were analyzed for these patients and compared by gender.
RESULTS: This study encompassed 74 patients: male (n=42; 56.8%) and female (n=32; 43.2%). A comparison of these two groups revealed no differences in their clinical characteristics and medications. The male group presented 0.27 hospitalizations/patient/year vs. 0.17 hospitalizations/patient/year in the female group (p=0.32). The average MLHFQ score was 35.6±18.9 for men and 47.8±24.0 for women (p=0.02).
CONCLUSIONS: Despite fewer hospitalizations, a poorer QOL was noted among female HF patients, compared to the male group.


Keywords: Heart failure; Quality of life; Gender and health; Questionnaires

Cardiovascular responses during resistance exercise with blood flow restriction

Respostas cardiovasculares durante exercício resistido com restrição de fluxo sanguíneo

Roberto Poton; Marcos Doederlein Polito

Rev Bras Cardiol. 2014;27(2):104-110

Abstract PDF PORT

BACKGROUND: Recent studies have shown that low-intensity resistance exercises (<50% 1RM) with blood flow restriction (BFR) can cause morphological and physiological changes similar to higher-intensity exercises without BFR.
OBJECTIVE: To compare cardiovascular and hemodynamic responses during resistance exercises, with and without BFR.
METHODS: Seventeen volunteers (25.9±6.6 years) performed three sets of 15 repetitions of unilateral biceps curls (dominant arm) at 20% 1RM, with and without BFR, in two sessions undertaken at random on the same day with a 20 minute interval. BFR was induced during the exercises with a standard inflated sphygmomanometer, kept at 200 mmHg throughout the session. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), cardiac output (CO) and total peripheral vascular resistance (TPR) variables were monitored continuously and non-invasively by beat-to-beat measurements.
RESULTS: Exercises with and without BFR presented significant differences only in the third set for: SBP (195.1±21.3 mmHg vs. 150.5±14.1 mmHg, respectively), DBP (126.7±18.6mmHg vs. 94.9±10.3 mmHg, respectively) and HR (132.0±23.7 mmHg vs. 97.0±9.7 mmHg, respectively).
CONCLUSION: Exercises with BFR did not present any significant differences until the second set, compared to exercises without BFR, showing that they are relatively safe in this field.


Keywords: Blood pressure; Exercise; Blood circulation

Relationship between C825T polymorphism of the GNB3 gene and difficult-to-treat hypertension

Relação do polimorfismo C825T do gene GNB3 e hipertensão arterial sistêmica de difícil controle

Lucas Kraeski Krum; Joelmir Colman; Mara Cristina de Almeida; Roberto Ferreira Artoni; Marcelo Ricardo Vicari; Gabriela Cordeiro da Costa; Mário Augusto Cray da Costa; Viviane Nogaroto

Rev Bras Cardiol. 2014;27(2):111-119

Abstract PDF PORT

BACKGROUND: C825T polymorphism of the GNB3 gene is associated with systemic arterial hypertension (SAH) in some studied populations, although certain studies are controversial in terms of this relationship.
OBJECTIVE: To evaluate the relationship between C825T polymorphism of the GNB3 gene and difficult-to-treat SAH among hypertensive patients in Campos Gerais, Paraná State, Brazil.
METHODS: With regard to C825T polymorphism of the GNB3 gene, the genotypes were defined for sixty hypertensive patients divided in 2 groups (easy and difficult-to-treat with drugs), using the Polymerase Chain Reaction - Restriction Fragment Length Polymorphism (PCR-RFLP) technique. The allele and genotype frequencies were assessed through the Pearson chi-square test, with Yates correction and odds ratio (OR).
RESULTS: There were no differences between the groups when comparing the allele and genotype frequencies, indicating that the population is in equilibrium. The probability that a patient has polymorphism with difficult-to-treat SAH reached 53.5% (OR=1.15, 95%CI = 0.41-3.26), analyzing the genotypes. A separate allele analysis showed an association of 55.4% (OR=1.24, 95%CI = 0.59-2.57).
CONCLUSION: No relationship was found in this population between C825T polymorphism of the GNB3 gene and difficult-to-treat SAH, indicating that other factors are influencing the appearance of this disease among these patients.


Keywords: Hypertension; Restriction fragment length polymorphism; Renin-angiotensin system

Review Article

Study of endothelial function in Brazil: cardiovascular disease prevention

Estudo da função endotelial no Brasil: prevenção de doenças cardiovasculares

Jorgileia Braga de Melo; José Albuquerque de Figueiredo Neto; Roberta Cristina Almeida Campos; Mariana Ferreira Meireles; Eulália Cristina Costa e Costa; Márcia Cristina Machado Leal

Rev Bras Cardiol. 2014;27(2):120-127

Abstract PDF PORT

Endothelial function assessments help identify alterations to the endothelium and can be evaluated by biochemical and biophysical methods. These include flow-mediated dilation (FMD) of the brachial artery by ultrasonography, a technique that is a safe and non-invasive marker of early cardiovascular disease, indicating the health of the endothelium at an early stage, before the onset of atheroma. This review describes studies conducted in Brazil investigating endothelial function assessments. A search was performed through the databases of the Virtual Health Library (BIREME) and SciELO. Papers on projects conducted in Brazil and published by August 2012 were included in this study, assessing endothelial functions by FMD. Of the sixteen papers found, seven studies included only patients at cardiovascular risk; eight included patients with and without cardiovascular risk and only one included subjects without cardiovascular risk. All the studies evaluating endothelial functions in patients rated as at-risk for cardiovascular disease found FMD values below 10%. These findings suggest that this method is trustworthy for assessing endothelial functions in patients with or without cardiovascular risk factors.


Keywords: Cardiovascular diseases; Ultrasonography; Endothelium

Point of View

Importance of etiological diagnosis in idiopathic heart failure

Importância do diagnóstico etiológico na insuficiência cardíaca idiopática

Marcelo Bittencourt; Fernando Carlos Vetromille Ribeiro; Ricardo Mourilhe Rocha; Denilson Campos Albuquerque

Rev Bras Cardiol. 2014;27(2):128-130

Abstract PDF PORT

Heart failure is an extremely serious condition that is important to public health from the epidemiological standpoint. Resulting from several cardiovascular or systemic diseases, it accounts for many hospitalizations each year. Despite its high prevalence, the etiology is not defined in a considerable proportion of cases. The ability to identify its etiology offers the possibility of better therapeutic and preventive approaches.


Keywords: Heart failure; Dilated cardiomyopathy; Diagnosis

Case Report

Valve-in-valve implant: an option

Implante valve-in-valve: uma opção

Josiane Motta e Motta; Marco Antônio Perim; Flavio Tarasoutchi; Marcelo Luis Campos Vieira; Heno Ferreira Lopes

Rev Bras Cardiol. 2014;27(2):131-134

Abstract PDF PORT

Although valve-in-valve implantation reports are still sparse in Brazil, they are becoming more frequent in the developed countries. This case report addresses a 73-year-old female patient who underwent a transcutaneous aortic valve-in-valve prosthesis implant four years ago, subsequent to an aortic bioprosthesis implant operation 24 years earlier that degenerated, with the patient refusing to replace the valve through a further open surgery. After evaluation, a multidisciplinary team recommended a transcutaneous aortic valve-in-valve prosthesis implant. Four years later, the functional class of her heart failure has improved and the durability of the prosthesis has been satisfactory.


Keywords: Aortic valve stenosis; Aortic valve; Heart valve prosthesis implantation

Takotsubo cardiomyopathy: case report and review of the literature

Cardiomiopatia de Takotsubo: relato de caso e revisão de literatura

Vinícius Lustosa de Araújo Rodrigues; José Flávio Sette de Souza; Allan Longhi; Marco Antonio Yukishigue Kaimoti

Rev Bras Cardiol. 2014;27(2):135-138

Abstract PDF PORT

Takotsubo cardiomyopathy (TCM) is a disease characterized by acute left ventricular dysfunction in response to physical or emotional stress. This report addresses the case of an 82-year-old woman hospitalized for chest pain and dyspnea. The patient presented electrocardiographic alterations, elevated heart enzymes and left ventricular (LV) wall motion changes, mimicking acute coronary syndrome (ACS), but with angiographically normal coronary arteries. The complications resulting from TCM were: left side heart failure with acute pulmonary edema, mitral valve disorder and thrombus formation in the LV apex. The left ventricular function was recovered completely in three weeks.


Keywords: Takotsubo cardiomyopathy; Catecholamines; Ventricular dysfunction

Erratum

Erratum

Rev Bras Cardiol. 2014;27(2):139

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