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

Edition: 28.3 - 13 Article(s)


Excess diagnosis in cardiology: the overdiagnosis issue

Excesso de diagnósticos em cardiologia: a questão do "overdiagnosis"

Cláudio Tinoco Mesquita

Int J Cardiovasc Sci. 2015;28(3):163-164


Keywords: Diagnosis; Cardiology; Myocardial infarction; Pulmonary embolism

Original Article

Left ventricular noncompaction in adulthood: heart failure clinic experience

Não compactação do ventrículo esquerdo no adulto: experiência de uma clínica de insuficiência cardíaca

José Emanuel Faria da Costa; Catarina Pereira; Filipa Gomes; Paulo Bettencourt; Pedro Bernardo Almeida

Int J Cardiovasc Sci. 2015;28(3):165-172


BACKGROUND: Left ventricular noncompaction (LVNC) is a distinct type of cardiomyopathy that presents several specific characteristics. The natural course of this condition is not totally known.
OBJECTIVES: To define the clinical characteristics, complications and survival of patients with LVNC assisted in heart failure (HF) healthcare service.
METHODS: Retrospective study that included patients with LVNC treated in a HF healthcare service from Hospital São João, in Porto, Portugal, from January 2006 to February 2014. Demographic data, symptoms of heart failure and ejection fraction at the beginning of treatment, the course of LVNC (changes in functional class), side effects and survival were recorded from medical records.
RESULTS: The study included 10 patients, 6 males, with a median of 63 years of age. Nine had symptoms of HF and started taking medication to modify prognosis. Everyone had left ventricular ejection fraction <45%. One patient did not start oral anticoagulation; 7 had some degree of recovery symptoms of HF; 3 were hospitalized with heart failure exacerbations; 1 had cardioembolic stroke; and 1 patient underwent heart transplant.
CONCLUSIONS: Patients with LVNC had similar comorbidities as the general population of their age group, except the apparent increase in the prevalence of AF. These patients responded well to therapy for IC with some clinical benefit. There were few complications, most remained clinically stable, without any hospitalization and low mortality rate. However, it is a small group of patients with short follow-up time.

Keywords: Heart failure, systolic; Heart failure; Isolated noncompaction of the ventricular myocardium

Clinical and molecular study on Duchenne muscular dystrophy

Estudo clínico e molecular na distrofia muscular de Duchenne

Gesmar Volga Haddad Herdy; Roberta Duarte Bezerra Pinto; Guilherme de Almeida Costa; Ana Flavia Malheiros Torbey; Vivianne Galante Ramos; Marcio Moacyr Vasconcelos

Int J Cardiovasc Sci. 2015;28(3):173-180


BACKGROUND: Duchenne Dystrophy is the most common and severe form of muscular dystrophy. It has an X chromosome-linked recessive inheritance and affects boys' striated muscles and myocardium. It is caused by mutations in the dystrophin gene, the largest human gene, composed of 79 exons.
OBJECTIVES: To check the early cardiac changes in pediatric patients with Duchenne muscular dystrophy (DMD) and carry out the molecular study of changes in the dystrophin gene.
METHODS: Prospective study involving pediatric patients with DMD, with clinical assessment, measurement of serum levels of creatine phosphokinase, electrocardiogram, Doppler echocardiography and dynamic electrocardiography and DNA genotyping, with amplification of the 18 most affected exons.
RESULTS: A group of 11 boys aged 6-14 years was studied. Clinical cardiological examination did not reveal any major changes. An increase in creatinine phosphokinase was detected in all patients. Electrocardiogram showed early changes, with high R waves in V1 (n=7) right bundle branch block (n=2), delta waves and short PR interval (n=1), and signs of disturbance of ventricular repolarization (n=1). Echocardiogram showed signs of systolic dysfunction. Dynamic electrocardiogram (Holter) showed changes in 4 patients: with many extrasystoles (n=3) and Wolff-Parkinson-White syndrome (n=1). All children received corticosteroid therapy. There was no significant correlation between exon 52 deletion and arrhythmias (p=0.43). The molecular study revealed an exon 52 deletion in 4 patients with dilated cardiomyopathy, of which 2 had concomitant deletion of exons 1 and 50, respectively. Other 7 patients had deletions of exons 48, 51, 52 and 57.
CONCLUSIONS: Electrocardiogram showed the first changes in pediatric patients with DMD. In cases with dilated cardiomyopathy and arrhythmia, the deletion of exon 52 was detected.

Keywords: Duchenne muscular dystrophy; Dystrophin; Child

The patient's knowledge about hypertension: an analysis based on cardiovascular risk

O entendimento do paciente sobre hipertensão arterial: uma análise com base no risco cardiovascular

Helbert do Nascimento Lima; Anderson Ricardo Roman Gonçalves; Amanda Lewandowski da Silva; Aline Fachin Olivo; Thais Yuri Miura; Lisiane Martins

Int J Cardiovasc Sci. 2015;28(3):181-188


BACKGROUND: The patient's knowledge about hypertension can contribute to the best control of it; however, the influence on such knowledge by the seriousness of the disease is unknown.
OBJECTIVE: Assessing the knowledge of individuals with arterial hypertension about their own disease based on the cardiovascular risk.
METHODS: Cross-sectional, quali-quantitative study, using semi-structured interview made with 113 individuals with hypertension, followed-up in a Basic Health Unit of Joinville, SC, Brazil. Social and economic, anthropometric, laboratorial data and blood pressure values were considered in each cardiovascular risk group, stratified based on the VI Brazilian Guidelines on Hypertension.
RESULTS: The mean age was of 57.8+10.0 years, 64.0% being women. The most advanced age, highest systolic blood pressure and hypertension time, as well as the higher rate of presence of diabetes, dyslipidemia and smoking were more predominant in the group with the highest cardiovascular risk. The knowledge about the risk factors and change in lifestyle was not different between the cardiovascular risk groups. Only the knowledge about the complications related to arterial hypertension was not as extensive in the group with very high cardiovascular risk (p<0.001).
CONCLUSION: The group with the highest cardiovascular risk is the one showing the poorest knowledge about the complications related to hypertension.

Keywords: Hypertension; Cardiovascular diseases; Health education; Patient education as topic

Metabolic syndrome is the main predictor of myocardial ischemia in SPECT

Síndrome metabólica é o principal preditor de isquemia miocárdica na SPECT

Maria Laura Rubbo-Blanco; Bernardo Nóbrega de Oliveira; Aristarco Gonçalves de Siqueira Filho; Ronir Raggio Luiz; Ronaldo de Souza Leão Lima

Int J Cardiovasc Sci. 2015;28(3):189-199


BACKGROUND: Data show that metabolic syndrome (MS) increases the risk of cardiovascular disease.
OBJECTIVES: To describe and compare the scintigraphic abnormalities and the predictive value of myocardial ischemia in individuals with and without MS referred for single photon emission computed tomography (SPECT) in a University Hospital using three diagnostic criteria.
METHODS: Prospective observational study of patients referred for SPECT from June to December 2010. Height, weight and waist circumference were measured. Risk factors were assessed and medical records were reviewed to look for parameters for laboratory diagnosis of MS and complete SPECT reports.
RESULTS: The study included 203 patients; 138 women (68.0%); mean age 63.6±11.5 years. Metabolic syndrome was found in 135 patients (66.5%). Of the 99 abnormal tests, 91.9% (n=91) occurred in patients with MS and 8.1% (n=8) in patients without MS. There was a significant association between MS and abnormal scintigraphy (67.0% vs. 11.8%; p<0.001) and patients with MS had abnormalities of greater extent and severity (summed stress score (SSS)=7.3±6.5 vs. 3.0±0.9; p<0.001 and summed difference score (SDS)=3.4±4.3 vs. 0.9±2.5; p<0.001). MS was an independent predictor of myocardial ischemia in the three definitions studied (OR=10.07, 6.25 and 4.26 for modified NCEP-ATP III, NCEP-ATP III and IDF, respectively).
CONCLUSIONS: Patients with MS had more perfusion defects on SPECT (both fixed and reversible); and MS defined by the modified NCEP-ATP III was the best independent predictor of myocardial ischemia on scintigraphy.

Keywords: Metabolism; Cardiac imaging techniques; Molecular imaging

Mortality in cardiac surgeries in a tertiary care hospital of south Brazil

Mortalidade em cirurgias cardíacas em hospital terciário do sul do Brasil

Guilherme Maia Monteiro; Daniel Medeiros Moreira

Int J Cardiovasc Sci. 2015;28(3):200-205


BACKGROUND: The prevalence of cardiovascular diseases is very high and cardiac surgeries are common in tertiary centers for cardiovascular care.
OBJECTIVE: Evaluate the surgical mortality and compare the mortality level expected by EuroSCORE in patients from tertiary centers for cardiovascular care.
METHODS: Historical cohort study evaluating patients who have undergone cardiac surgeries in 2011 and 2012, at a renowned tertiary cardiology hospital in southern Brazil. The primary outcome was all-cause mortality during hospitalization. Secondary outcomes were surgery-related mortality, total and procedure-related EuroSCOREs, the adjusted mortality rate by EuroSCORE and the risk profile of patients.
RESULTS: The study comprised 364 patients. Coronary artery bypass graft (CABG) surgery alone was the procedure performed in 59.9% of patients, followed by the valve procedure (VP) (valve replacement or repair) in 33.0%, and CABG + VP in 7.1% of patients. The mortality rate was 14.2%, with 5.2% in the first 24 hours. The mortality rate expected by EuroSCORE, in turn, was 5.7 ± 7.4%. The adjusted mortality rate was thus 2.5 times higher than the expected, however within the range of two standard deviations of the expected mortality rate. Mortality associated with combined procedures, however, was 5.2 times higher than the EuroSCORE expected, and higher than the range of two standard deviations of EuroSCORE.
CONCLUSION: Patients undergoing cardiac surgery at the center under study showed higher mortality than the expected rate, especially those undergoing combined procedures.

Keywords: Thoracic surgery; Myocardial revascularization; Heart valve prosthesis implantation

Metabolic syndrome in patients with chronic heart failure

Síndrome metabólica em pacientes com insuficiência cardíaca

Juliana Frigeri da Silva; Denise Tavares Giannini; Ricardo Mourilhe-Rocha

Int J Cardiovasc Sci. 2015;28(3):206-214


BACKGROUND: Heart failure is the final common pathway of most diseases involving the heart. It is considered one of the most important current clinical challenges in health care. Epidemiological evidence increasingly demonstrates the association between metabolic syndrome and the presence of cardiovascular disorders, since, in an independent manner, risk factors related to heart failure are the same that comprise metabolic syndrome, substantially contributing to the increase of cardiovascular morbidity and mortality.
OBJECTIVE: To evaluate the presence of metabolic syndrome in patients with chronic heart failure assisted in the heart failure service.
METHODS: This cross-sectional study evaluated patients with chronic heart failure treated at the heart failure Clinic of a University Hospital. Data collection included anthropometric, clinical and biochemistry evaluation. Diagnosis of metabolic syndrome was established by the criteria of the International Diabetes Federation.
RESULTS: The study evaluated 90 patients, including 51% (n=46) males with a mean age of 62.7±12.3 years. The study found a high frequency of metabolic syndrome (71%; n=64) correlating significantly with increased body mass index (p<0.001). By comparing the two groups, it was observed that diabetes mellitus was significantly more frequent in patients with metabolic syndrome (p<0.001).
CONCLUSION: Individuals with heart failure showed high frequency of metabolic syndrome, and diabetes mellitus was the most frequent alteration in the group with metabolic syndrome.

Keywords: Heart failure; Metabolic syndrome X; Cardiovascular diseases

Postprandial lipemia and subclinical inflammation on active women taking oral contraceptive

Lipemia pós-prandial e inflamação subclínica em mulheres ativas que utilizam contraceptivo oral

Jefferson Petto; Djeyne Wagmacker Silveira; Alan Carlos Nery dos Santos; Candice Rocha Seixas; Douglas Gibran Cerqueira do Espirito Santo; Francisco Tiago Oliveira de Oliveira; Cleber Santos Luz; Ana Marice Teixeira Ladeia

Int J Cardiovasc Sci. 2015;28(3):215-223


BACKGROUND: Women taking oral contraceptives (OC) have higher fasting lipid profile, postprandial lipemia (PPL) and C-reactive protein (CRP) than women not taking OC. Exercise has shown good results in controlling lipid and inflammatory levels.
OBJECTIVE: To compare fasting lipid, PPL and CRP levels among regularly active and irregularly active women taking OC.
METHODS: The study evaluated forty-four women taking OC, from the city of Salvador, BA, stratified into two groups: active group (AG; n=22), composed of physically active women and irregularly active group (IAG; n=22) composed of irregularly active women. In both groups, after 12-hour fasting, fasting lipid profile and CRP were assessed. Then, the volunteers took a compound containing 25 g fat and triglycerides were measured to check PPL. Mann-Whitney's test was used to compare PPL and CRP.
RESULTS: The delta values of triglycerides representing PPL respectively for the AG and the IAG were: 93±38.4 mg/dL vs. 163±49.6 mg/dL and 89±50.9 mg/dL vs. 156±47.6 mg/dL (p<0.01). The CRP values respectively for the AG and the IAG were: 1.1 mg/L (0.4-2.1 mg/L) and 2.1 mg/L (0.8-3.4 mg/L) (p=0.04).
CONCLUSION: In this study, physically active women taking OC presented triglycerides and fasting LDL, PPL and CRP significantly lower than irregularly active women taking OC.

Keywords: Exercise; Basal metabolism; Hormones; Primary prevention; Dyslipidemias

Wolff-Parkinson-White syndrome and ventricular hypertrophy: events predictors

Síndrome de Wolff-Parkinson-White com hipertrofia ventricular: preditores de eventos

Lenises de Paula van der Steld; Mario de Seixas Rocha

Int J Cardiovasc Sci. 2015;28(3):224-233


BACKGROUND: The PRKAG2 syndrome is classified as a glycogen storage disease, characterized by the presence of the Wolff-Parkinson-White syndrome (WPW), ventricular hypertrophy (VH) and conduction system disease (CSD).
OBJECTIVES: Finding potential prognostic factors for events in individuals affected by this disease and describing the clinical characteristics.
METHODS: Sixty individuals were monitored from March 2005 to March 2015, being divided into two groups: Group 1 (G1) - patients with WPW, VH or both; and Group 2 (G2) - asymptomatic patients, with normal physical examination, electrocardiogram and echocardiography. It included the performance of medical history, physical examination, electrocardiogram and echocardiogram. Holter and electrophysiological study were performed when necessary.
RESULTS: G1 was made of 18 out of the 60 patients selected. Of these, 11 (61.1%) had VH related to WPW, 6 (33.3%) had isolated WPW and 1 (5.6%) patient had isolated VH. The mean age was 27.0±16.0 years and 32 (53.3%) were male. Only the patients in Group 1 had isolated events: 3 (17.0%) cardiac arrests, 2 (11.0%) sudden deaths, 6 (33.0%) pacemaker implants, 4 (22.0%) transient ischemic attacks and 9 (50.0%) combined events. The events predictors in potential combined were: left atrium size (p=0.07) diabetes mellitus (p=0.05) and the atrioventricular blocks (p=0.019). Those factors did not have statistic significance when compared in the Cox regression analysis.
CONCLUSIONS: In WPV patients with ventricular hypertrophy there was an association of diabetes mellitus, atrioventricular block and left atrium size with the main outcomes.

Keywords: Hypertrophy, left ventricular; Wolff-Parkinson-White syndrome; Death, sudden, cardiac

Cardiovascular risk factors and their relationship with educational level in a university population

Fatores de risco cardiovascular e sua relação com o nível de escolaridade numa população universitária

Rute Pires Costa; Pedro Antônio Muniz Ferreira; Francisco das Chagas Monteiro Junior; Adalgisa de Sousa Paiva Ferreira; Valdinar Sousa Ribeiro; Gilvan Cortês Nascimento; Gustavo de Jesus Pires da Silva; Fernando Mauro Muniz Ferreira; Jair Alves Pereira Neto; Leonardo de Souza Carneiro

Int J Cardiovasc Sci. 2015;28(3):234-243


BACKGROUND: The lower level of education in the population appears to be associated with a higher prevalence of cardiovascular risk factors (CVRF). However, few studies have assessed this fact by means of clinical and laboratory analysis in universities.
OBJECTIVE: To evaluate the prevalence of cardiovascular risk factors in public servants at a public university.
METHODS: Cross-sectional, analytical and randomized study, with 319 participants of a cohort composed of university public servants. CVRF prevalence was assessed by measuring blood glucose and blood pressure levels, lipid profile and anthropometric indices, and comparative analyses were made of subgroups with different education levels. A multivariate logistic regression analysis was used to assess the independent association between education level and presence of CVRF.
RESULTS: Mean age 46.0±10.0 years old, 52.5% women, 56.0% with higher education level, 85.6% belonging to B and C socioeconomic classes. Prevalence of CVRF: diabetes mellitus (DM) - 9.4%; systemic hypertension (SH) - 36.7%; dyslipidemia - 50.5%; smoking - 21.9%; overweight - 59.6%; obesity - 13.2%; sedentary lifestyle - 27.9%. The group with the lowest level of education had an independent association, with higher prevalence of DM and sedentary lifestyle, as compared to the group of public servants with higher level of education (teachers and non-teachers). DM=odds ratio 2.4 (95% CI 1.05 to 5.5) and p=0.036; sedentary lifestyle=odds ratio 2.2 (95% CI 1.3 to 3.7) and p=0.003. The subgroups showed no differences regarding the other variables.
CONCLUSION: In this study, individuals with higher levels of education showed lower prevalence of diabetes and sedentary lifestyle.

Keywords: Diabetes mellitus; Obesity; Sedentary lifestyle; Level of education

Assessment of the quality of hypoenergetic diet in overweight women

Avaliação da qualidade da dieta hipoenergética em mulheres com excesso de peso

Elizabeth de Paula Franco; Glorimar Rosa; Ronir Raggio Luiz; Gláucia Maria Moraes de Oliveira

Int J Cardiovasc Sci. 2015;28(3):244-250


BACKGROUND: The number of deaths attributable to unhealthy diet has increased in recent decades, and the instruments for their assessment have several limitations.
OBJECTIVE: Evaluate the effect of the hypoenergetic diet in anthropometric and biochemical data, and check its quality based on the diet quality index revised for the Brazilian population (DQI-R), and on the consumption of ultra-processed food products (UPP) in women with overweight.
METHODS: This study covered 44 women with overweight undergoing a hypoenergetic diet for 180 days. Monthly appraisals: blood pressure (BP), anthropometric, biochemical and dietary data. The DQI-R and the consumption of UPP and additives were used as criteria to assess the diet quality. The Wilcoxon and Mann-Whitney tests were employed, with statistical significance of p<0.05.
RESULTS: The mean age found was 47.0±11.0 years, and the body mass index (BMI) was 36.0±7.3 kg/m2. It was observed a decrease in body mass, BMI, neck and waist circumferences, waist-to-height ratio, visceral adiposity index, systolic blood pressure, and in the concentrations of glucose, triglycerides and very low-density lipoproteins (VLDL-C). The quality of diet improved in both groups with significant reduction in the consumption of protein, total lipids, fatty acids and sodium in the adequate diet; and there was a reduction in energy, glucose, VLDL-C and BP in the inadequate diet. There was a significant decrease in the consumption of UPP, such as soft drinks, instant noodles, processed juices, and added sugar foods.
CONCLUSION: The hypoenergetic diet reduced anthropometric and biochemical parameters and these changes were not explained by DQI-R, but by the evaluation of UPP and additives.

Keywords: Obesity; Hypo energetic diet; Diet quality

Review Article

Systemic lupus erythematosus: review of cardiovascular aspects

Lúpus eritematoso sistêmico: revisão das manifestações cardiovasculares

Luis Otávio Cardoso Mocarzel; Pedro Gemal Lanzieri; Ricardo Azêdo Montes; Ronaldo Altenburg Odebrecht Curi Gismondi; Cláudio Tinoco Mesquita

Int J Cardiovasc Sci. 2015;28(3):251-261


Systemic lupus erythematosus (SLE) is an autoimmune condition with a complex pathophysiological process in which its inflammatory activity is an enhancer of coronary disease by systemic inflammation, endothelial dysfunction and predisposition to thrombosis. The cardiovascular involvement in SLE is not a diagnostic criterion and is considered only as damage established in the long-term of the disease. The objective of this study is to highlight the importance of clinical vision for the early identification of cardiovascular involvement in SLE. A critical analysis of the cardiac approach in SLE, with emphasis on clinical aspects, cardiovascular biomarkers and genetics and rational request of additional tests. The particularity of patients with lupus nephritis and antiphospholipid antibody syndrome is also highlighted. The perception of subclinical cardiac damage is critical for interrupting the cycle of myocardial injury and to avoid progression of heart disease.

Keywords: Lupus erythematosus, systemic; Cardiovascular diseases; Inflammation

Point of View

Thoracic aortic aneurysm: genetic and image evaluation for elective surgeries

Aneurismas da aorta torácica: avaliação genética e de imagem para cirurgias eletivas

Mauro Paes Leme de Sá

Int J Cardiovasc Sci. 2015;28(3):262-264


Evidence shows that genetic variations in a single gene called gene mutations predispose individuals to aneurysms and dissections of the aorta and its branches. With the identification of these mutations, guidelines suggest that diagnosis management is the ideal time for surgical correction and the identification of individuals at high risk of rupture or dissection and their families. These mutations may be present in a syndromic way with simple phenotypic identification or family presentation. In individuals without phenotypic characteristics, familial occurrence of genetic mutation should be investigated through the family history, imaging scans and through genetic markers.

Keywords: Aortic aneurysm, thoracic; Aorta; Marfan syndrome; Loeys-Dietz syndrome