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

Edition: 28.4 - 13 Article(s)

Editorial

Choosing Wisely: decision making and scientific evidence

Choosing Wisely - tomada de decisão e evidências científicas

Cláudio Tinoco Mesquita

Int J Cardiovasc Sci. 2015;28(4):265-267

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Keywords: Quality assurance, health care; Quality improvement; Diagnostic techniques, cardiovascular

Original Article

Aging and cardiac magnetic resonance: correlation between biomarkers and age

Envelhecimento e ressonância magnética cardíaca: correlação entre biomarcadores e idade

Marcelo Souto Nacif; Adriana Dias Barranhas; Alair Augusto dos Santos; Fernanda Boldrini Assunção; Diogo Costa Leandro de Oliveira; Vitor Frauches Souza; Wilter dos Santos Ker; Daniel Gama das Neves; Edson dos Santos Marchiori

Int J Cardiovasc Sci. 2015;28(4):268-275

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BACKGROUND: Cardiovascular diseases are the leading cause of death worldwide. Their main risk factor is old age. Aging is associated with morphostructural cardiovascular abnormalities which may be used as risk markers of cardiac events.
OBJECTIVE: To describe biomarkers routinely used in cardiac magnetic resonance (MRI) that best correlate with aging in a sample population and in a group of low cardiovascular risk selected by the image.
METHODS: Descriptive and retrospective MRI study performed in a private hospital and in a private clinic in the city of Niterói, RJ, from May 2007 to April 2011. Clinical biomarker and imaging analyses were performed on the sample population and in the low-risk group.
RESULTS: Clinical indicators: weight (r=0.09) and systolic blood pressure (r=0.21) showed a significant positive correlation with age (p=0.01 and <0.001, respectively). Imaging indicators: all diameters of the large vessels were significantly correlated with age (p<0.001). However, in the analysis of the low-risk group, the only markers with significant correlation with age was the ascending aorta diameter (r=0.52, p<0.001) and greater right ventricular length (r=-0, 31, p=0.03). The latter is always inversely significant.
CONCLUSIONS: Several MRI biomarkers can be used for aging assessment, but among those presented in this paper, the diameter of the aorta and the right ventricle are the ones that best correlated for a sample or low cardiovascular risk population.


Keywords: Magnetic resonance imaging; Aging; Evidence-based medicine; Diagnostic imaging

Evolution of heart failure-related hospital admissions and mortality rates: a 12-year analysis

Insuficiência cardíaca: análise de 12 anos da evolução em internações hospitalares e mortalidade

Renato Kaufman; Vitor Manuel Pereira Azevedo; Regina Maria de Aquino Xavier; Mauro Geller; Rogério Brant Martins Chaves; Márcia Bueno Castier

Int J Cardiovasc Sci. 2015;28(4):276-281

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BACKGROUND: Heart failure (HF) is the final common event of all cardiac diseases. Technological advances have allowed for significant improvement to survival rates in cardiac patients. Correspondingly, an increase in the HF incidence has been observed. Few data are available on technological advances and their actual impact on the mortality rate of these patients.
OBJECTIVE: To assess the progress of hospital admission rates of adult patients with heart failure, average length of stay and mortality rate in the Brazilian SUS (Unified Health System).
METHODS: DATASUS data for the 2001-2012 period were obtained. An assessment was performed of data such as all-cause hospital admissions and heart failure-related admissions, average length of stay in hospital, mortality rate and hospital costs, after being stratified by sex, age and place of hospitalization.
RESULTS: Over the study period, there have been 91,272,037 hospital admissions, of which 3.96% were due to HF. Male patients accounted for 50.76%. The absolute number of HF-related hospital admissions decreased from 379,463, in 2001, to 240,280, in 2012. The average overall stay in hospital was 5.8 days, in 2001, and 6.6 days, in 2012. The mortality rate was on the rise, from 6.58%, in 2001, to 9.5%, in 2012 (a 46.1% increase). The average cost of AH increased from R$ 519.54, in 2001, to R$ 1,209.56, in 2012 (a 132.8% increase).
CONCLUSION: Despite the decline in hospital admissions, HF is a highly costly syndrome for the Brazilian Unified Health System, with high mortality rates, which paradoxically increased over time, despite technological advances.


Keywords: Heart failure; Mortality; Epidemiology; Adult

Continuous or interval training and inflammatory response in obese women

Treinamento contínuo ou intervalado e resposta inflamatória em mulheres obesas

Mário César Carvalho Tenório; Cloud Kennedy Couto de Sá; Mariana Matos Freitas; Gaya Ribeiro Ruas; João Felipe Pereira Câncio; Luiz Agnaldo Pereira de Souza; Ana Marice Teixeira Ladeia

Int J Cardiovasc Sci. 2015;28(4):282-289

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BACKGROUND: Recent studies have shown probable benefits of high intensity, predominantly anaerobic activities in fat oxidation capacity. However, the effect of predominantly anaerobic exercise in reducing obesity and inflammatory condition is still little known.
OBJECTIVES: To assess the effects of aerobic vs. anaerobic training on the levels of C-reactive protein (CRP) in women with central obesity, and the association of CRP levels with body composition.
METHODS: Randomized clinical trial with a population composed of adult, sedentary women with central obesity, enrolled at the Teaching-Care Outpatient Facility of Escola Bahiana de Medicina e Saúde Pública. A group of 19 women was randomly divided into two groups: Continuous training (CT - intensity at 20% of the ventilatory threshold - VT) or Interval Training (IT - 2-minute stimulus at 120% of VT and 2-minute recovery at 80% of VT) for 10 weeks, twice a week, 20-40-minute sessions. A medical and physical, laboratory and cardiopulmonary assessment was carried out before and after the intervention.
RESULTS: Median CRP levels were, respectively, before and after training: CT: 2.2 mg/L (0.6-4.1 mg/L) vs. 2.1 mg/L (0.8-5.5 mg/L) p=0.75; IT: 3.9 mg/L (0.7-8.6 mg/L) vs. 3.2 mg/L (1.2-5.7 mg/L) p=0.90. There was no significant difference when comparing the delta (Δ) CRP levels between groups, p=0.49. There was no association between CRP levels and other pre-intervention variables.
CONCLUSION: Low-volume exercise programs, regardless of their intensity, do not change CRP levels in women with central obesity.


Keywords: Abdominal obesity; Exercise; C-reactive protein

Influence of exercise on anthropometric indicators of cardiovascular risk in elderly women

Influência do exercício físico em indicadores antropométricos de risco cardiovascular em idosas

Gabriel Espinosa; Flávia Porto; Jonas Lírio Gurgel

Int J Cardiovasc Sci. 2015;28(4):290-297

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BACKGROUND: Although there is evidence of the benefits of physical exercise on cardiovascular health (CV), only a few studies evaluate the effectiveness of community exercise programs in reducing CV risk indicators.
OBJECTIVE: To compare anthropometric indicators of CV risk among elderly women who do not exercise.
METHODS: In this cross-sectional study, the sample consisted of two groups: EMIPOA composed of 305 women (68.19±2.82 years; 69.31±13.88 kg, 1.54±0.07 m; body mass index (BMI) 29.30±5.54 kg/m2) coming from the Porto Alegre Multidimensional Study on Elderly Individuals; and PEG, consisting of 50 elderly women (68.28±4.68 years; 66.08±9.48 kg, 1.56±0.06 m; and BMI 27.29±3.62 kg/m2) participating in an exercise program. There following items were assessed: body mass (BM), BMI, abdominal circumference (AC), waist circumference (WC), abdomen/hip ratio (AHR), waist/hip ratio (WHR), body shape index (BSI) and body fat. The groups were stratified (60-69 years and 70-79 years). Normality of data was tested (Shapiro-Wilk and Kolmogorov-Smirnov) and the groups were compared (Student's t test for independent samples or Mann-Whitney), considering p<0.05 as significance level.
RESULTS: The PEG (60-69 years) presented lower values than EMIPOA (60-69 years) for: BM, BMI, AC, WC, AHR, WHR and BSI. Height, the sum of skinfold thickness and body fat did not differ. For the 70-79 years stratum, only height difference was found (PEG>EMIPOA).
CONCLUSIONS: Participation in a physical exercise program influenced the levels of anthropometric indicators of CV risk and this influence was attenuated in older individuals.


Keywords: Health of the elderly; Exercise; Anthropometry; Risk factors

In-hospital mortality in patients with rheumatic heart disease undergoing double valve replacement

Mortalidade intra-hospitalar em pacientes com cardiopatia reumática submetidos a dupla-troca valvar

André Maurício Souza Fernandes; Rafael Marcelino Oliveira; Gustavo Maltez de Andrade; Gabriela Tanajura Biscaia; Fernando Azevedo Medrado Junior; Francisco Farias Borges dos Reis; Cristiano Ricardo Macedo; André Rodrigues Durães; Roque Aras Junior

Int J Cardiovasc Sci. 2015;28(4):298-304

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BACKGROUND: Rheumatic heart disease is a major public health issue. Data on the influence of surgical variables in mortality in rheumatic patients undergoing double valve replacement (DVR) are scarce.
OBJECTIVE: Identify potential surgical variables associated with mortality in rheumatic patients undergoing DVR.
METHODS: Retrospective cross-sectional study including 104 patients over 18 years, previously diagnosed with rheumatic heart-valve disease, and undergoing DVR surgery from January 2007 to December 2011. Data collection: medical records of patients from Hospital Ana Nery, Salvador, Brazil.
RESULTS: Outcome groups (in-hospital death vs. hospital discharge) had a significant statistical difference in relation to variables, respectively: anoxia time (in minutes) of 149.17±40.99 and 123.99±24.12 (p=0.001); CPB time 185.53±54.59 and 157.34±34.62 (p=0.006); and total surgical time 350.29±56.69 and 295.23±63.98 (p=0,002). Patients who underwent another procedure associated with DVR for the same surgical time showed higher mortality rates (n=10; 31.2%) compared to those who underwent DVR only (n=9, 12.8%) (p=0.027). There was also a significant association when comparing patients with surgical rapprochement with those who underwent one surgery only (p<0.001). There was no statistical difference between hospital outcome and the types of prostheses used (p=0.219).
CONCLUSIONS: The surgical variables that influenced mortality were: anoxia, CPB and total surgical times, with potential cutoff points of 150, 100 and 300 minutes, respectively. The need for rapprochement during the in-hospital postoperative period, and the performance of another associated procedure in the same surgery were also significant.


Keywords: Rheumatic fever; Heart valve diseases; Operative time; Hospital mortality; Thoracic surgery

Sodium amount in hospital meals in Rio de Janeiro

Quantidade de sódio em refeições de unidade hospitalar no Rio de Janeiro

Cristina Schmidt de Souza; Elenice Ribeiro Veras; Odete Delmária dos Santos; Luana Limoeiro Ferrão; Ana Rosa da Cunha Machado

Int J Cardiovasc Sci. 2015;28(4):305-312

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BACKGROUND: In the treatment of hospitalized hypertensive patients, the use of drugs should be combined with drug therapy. As for food, sodium contributes to increased blood pressure and is widely used in the preparation of processed products and the meals served to the patients. These meals should follow the guidelines for hypertension, since hospital stay is designed to promote and restore health.
OBJECTIVES: To analyze the amount of sodium offered to hospitalized patients, including hypertensive patients, in the meals of a hospital and propose adjusted menus if necessary.
METHODS: By observing the menus offered over seven days, the amount of sodium was assessed considering the food servings by cooking measurements and comparing with the food composition table. Subsequently, two menus have been proposed in which the amount of sodium did not exceed the recommendation of 2 000 mg/day.
RESULTS: Considering the daily sodium amount of 2 000 mg recommended for hypertensive patients, 3 475±174 mg was found in the meals, which is 73.0% higher than the recommended amount. The adjusted menus were appropriate compared to that adopted by the hospital, with a reduction of 66.0% (1 682 mg) and another one with reduction of 47.0% (1 994 mg).
CONCLUSIONS: It was observed that the hospital studied offered excess amounts of sodium in the patients' meals, including those with hypertension. Simple interventions such as the removal of processed foods and control of added salt allowed a significant reduction in the amount of sodium considering the menu offered by the hospital.


Keywords: Sodium chloride, dietary; Hypertension; Food service, hospital; Sodium, dietary

Study on lifestyles and stress levels in medicine students

Estudo sobre estilos de vida e níveis de estresse em estudantes de medicina

Roberto Ramos Barbosa; Mariana Carvalho Gomes Martins; Felipe Poubel Timm do Carmo; Tiago de Melo Jacques; Renato Giestas Serpa; Osmar de Araujo Calil; Luiz Fernando Machado Barbosa

Int J Cardiovasc Sci. 2015;28(4):313-319

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BACKGROUND: Unhealthy lifestyles are preventable risk factors for chronic diseases. Intervening on them is a fundamental strategy of preventive health.
OBJECTIVE: To evaluate lifestyle, stress levels, diseases and cardiovascular risk factors of medical students.
METHODS: Cross-sectional, observational study with students from a medical school stratified into: Group 1 (G1) - from the 1st to the 4th period of the course, Group 2 (G2) - from the 5th to the 8th and Group 3 (G3) - from the 9th to the 12th. Two questionnaires were given: Fantastic Lifestyle and another one related to stress levels, diseases and cardiovascular risk factors.
RESULTS: The study included 482 students, average age 21.7±2.7 years. The average score on the Fantastic Lifestyle questionnaire ranked G1 and G3 at Very good (72.1 and 71.3 points, respectively) and G2 in Good (69.2 points) (p=0.007). As for the stress levels, they responded High or Very High 22.3% in G1, 34.9% in G2 and 30.7% in G3 (p=0.008). The most prevalent diseases were dyslipidemia (7.4%), hypertension (2.6%) and depressive disorder (2.2%).
CONCLUSIONS: There was considerable worsening of lifestyle and stress levels from the 5th period, with partial improvement in the last two years of the course. There was a significant prevalence of dyslipidemia, hypertension and depressive disorder.


Keywords: Sedentary lifestyle; Risk factors; Cardiovascular diseases

Review Article

Vascular and renal protection in the presence of increased prevalence of type 2 diabetes

Proteção vascular e renal no atual cenário de aumento da prevalência de diabetes mellitus tipo 2

Bruno Caramelli; Danielle Menosi Gualandro

Int J Cardiovasc Sci. 2015;28(4):320-326

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Type 2 diabetes mellitus is currently an important risk factor for cardiovascular diseases. Therefore, diabetic patients considered at high risk should receive more aggressive preventive treatment. The intensity and severity of micro and macrovascular conditions associated with diabetes mellitus are the focus of investigation of the genetic, molecular and clinical mechanisms involved. One of the most important characteristics is that the time window for the development of atherosclerosis is smaller, showing more clearly the clinical outcomes and a potential therapeutic response. The best treatment for diabetic patients is interdisciplinary treatment through which the cardiologist and the endocrinologist investigate the consequences of the disease, any possible drug interactions and their adverse effects. The creation of a language and a common agenda for these two medical specialties can bring huge gains for the patient. The purpose of this review is to update the concepts related to the treatment and prevention of diabetes complications for non-endocrinologists.


Keywords: Diabetes mellitus, type 2; Atherosclerosis; Primary prevention; Secondary prevention; Risk factors

Cardiovascular mortality in chronic kidney patients: the role of uremic toxins

Mortalidade cardiovascular em pacientes renais crônicos: o papel das toxinas urêmicas

Gabriela Filgueiras Storino; Cristiane Moraes; Juliana Saldanha; Denise Mafra

Int J Cardiovasc Sci. 2015;28(4):327-334

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The cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD) in the world. Several factors are associated with this high mortality. Recently, the uremic toxins produced by intestinal microbiota have received extensive attention from researchers, since kidney failure evolves with the accumulation of these toxins in the plasma. These toxins are related to oxidative stress, inflammation, endothelial dysfunction, and induction of atherosclerosis, and recent studies have noted that patients with high levels of these toxins have increased mortality due to CVD. Therefore, the purpose of this review was to discuss the role of uremic toxins from the intestinal microbiota and their impact on cardiovascular mortality in CKD patients, as well as the possible therapeutic perspectives that can be explained based on an in-depth understanding of the subject.


Keywords: Cardiovascular diseases; Renal insufficiency, chronic; Mortality

Point of View

Literature and cardiology

Literatura e cardiologia

Ana Luisa Rocha Mallet; Luciana Andrade; Maria Clara Marques Dias

Int J Cardiovasc Sci. 2015;28(4):335-337

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In the 64th Cardiology Session of the American College of Cardiology, held in March 2015 in California, the opening lecture was given by Dr. Abraham Verghese, certainly not known for his publications in cardiology journals. By reading a poem, this professor of Internal Medicine at Stanford University discussed the relationship between science and literature, encouraging the cardiologists to entertain a unique moment of deep thinking about the work and the daily connection of medical professionals with the hearts of patients.


Keywords: Teaching; Humanities; Cardiology; Medicine in literature

Case Report

Transcatheter mitral valve repair, mitraclip, in a nonagenarian patient with acute regurgitation

Reparo mitral percutâneo pelo mitraclip em paciente nonagenária com insuficiência mitral aguda

Denise Castro de Souza Côrtes; Paulo Roberto Dutra da Silva; Antonio Sérgio Cordeiro da Rocha; Alexandre Siciliano Colafrancheschi; Carolina Garbin Comandulli; Eduarda Barcellos

Int J Cardiovasc Sci. 2015;28(4):338-341

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MitraClip transcatheter implant is a promising option for treating mitral regurgitation (MR) in patients with high surgical risk. This report describes the case of a nonagenarian patient with acute MR for chordae rupture that, due to prohibitive surgical risk, underwent a successful MitraClip transcatheter implant.


Keywords: Mitral valve insufficiency; Mitral valve prolapse; Vascular access devices

Letter to the editor

Mortality in cardiac surgeries: why publish?

Mortalidade em cirurgias cardíacas: por que divulgar?

Daniel Medeiros Moreira; Guilherme Maia Monteiro

Int J Cardiovasc Sci. 2015;28(4):342-343

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

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