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

Edition: 28.5 - 13 Article(s)

Editorial

Percutaneous aortic valve bioprosthesis implantation

Implante percutâneo de bioprótese valvar aórtica

Hélio Roque Figueira

Int J Cardiovasc Sci. 2015;28(5):344-346

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

Original Article

TAVI: the game changer for the future! Are we ready to implant hope into patient's heart?

TAVI: visão do futuro! Já se pode implantar esperança no coração dos pacientes?

Amanda Rodrigues de Oliveira Siqueira; Sara Rodrigues de Oliveira Siqueira; Jose Armando Mangione; Salvador André Bavaresco Cristóvão; Maria Fernanda Zuliani Mauro; Fernando Augusto Alves da Costa

Int J Cardiovasc Sci. 2015;28(5):347-356

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BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been reported as a therapy choice for patients with severe inoperable or high surgical risk aortic stenosis (AoS).
OBJECTIVES: To analyze the characteristics of patients with severe AS undergoing TAVI and investigate the associated complications, describing the experience of a single center with its first procedures.
METHODS: Clinical nonrandomized, retrospective cross-sectional trial with 47 patients with severe AoS and high surgical risk who underwent TAVI from November 2008 to November 2014 at Hospital Beneficência Portuguesa de São Paulo, through analysis of medical records.
RESULTS:The average age of patients was 80.0±7.0. Transfemoral approach was used in all cases and CoreValve in 55.3% of the sample. Success rate was 95.7%. No death occurred during the procedure. Mortality rate was 17.0%. The main complication was the permanent pacemaker implantation (21.27%). When assessing mortality from all causes, association with older age (83.47±7.42 years (p=0.029) and the STS score (p=0.0047) was found. There was a significant reduction in peak aortic transvalvular gradient (84.1±21.5 mmHg to 20.0±10.0 mmHg) and average aortic transvalvular gradient (50.0±15.2 mmHg to 10.85±7.38 mmHg). In the follow-up, survival ranged from 85.1% at day 30 to 78.7% at year 1.
CONCLUSION: TAVI can be considered a reliable and effective therapeutic choice in patients with severe high-risk AoS.


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

Correlation between RDW, infarct size and coronary flow after primary angioplasty

Correlação entre RDW, tamanho do infarto e fluxo coronariano após angioplastia primária

Bruna Morais Barbosa; Maria Emilia Lueneberg; Roberto Leo da Silva; Tammuz Fattah; Gustavo Henrique Bregagnollo; Daniel Medeiros Moreira

Int J Cardiovasc Sci. 2015;28(5):357-362

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BACKGROUND: RDW is a laboratory parameter that measures the anisocytosis index. Its elevation may be related to inflammation, which is also considered primarily responsible for the reduction of post-angioplasty coronary flow.
OBJECTIVES: To correlate the RDW of patients with ST segment elevation acute myocardial infarction (AMI) and coronary flow, infarction size and post-angioplasty ventricular function.
METHODS: The IAM size was measured by the areas under the curve (AUC) and biomarker peaks. The correlation between RDW on admission and in 72 hours and other numerical variables was performed using Pearson's correlation coefficient for normal data or Kendall's correlation for non-normal data. In this study, p values <0.05 were considered statistically significant.
RESULTS: There was a negative correlation between the RDW on admission and the AMI size assessed by peak of CK-MB mass, r=-0.15 (p=0.04). The other parameters used to measure the area of infarction showed no significant relationship with RDW. There were no significant correlations between the RDW and post-angioplasty coronary flow, or with left ventricular ejection fraction (LVEF) or with negative cardiovascular outcomes.
CONCLUSIONS: There is a weak negative correlation between RDW and the AMI size assessed by CK-MB mass peak, but there is no correlation between RDW and CK or troponin I peak, or RDW and CK AUC, CK-MB mass or troponin I. There is no correlation between RDW and TIMI frame count or between RDW and LVEF.


Keywords: Myocardial infarction; Ventricular function; Inflammation; Angioplasty

Aspirin resistance in stable coronary disease

Resistência ao AAS na doença coronariana estável

Vinícius de Franceschi dos Santos; Fabrício Braga; Gustavo Luiz Gouvea de Almeida Junior; Paula de Medeiros Pache de Faria; Paula de Castro Carvalho Gorgulho; Milena Rego dos Santos Espelta de Faria; Roberto Hugo da Costa Lins; Rafael Lauria; Rodrigo Guerreiro; Ronaldo de Souza Leão Lima

Int J Cardiovasc Sci. 2015;28(5):363-369

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BACKGROUND: Coronary artery disease (CAD) has high morbidity and mortality rates. Coronary angioplasty and antiplatelet therapy with acetylsalicylic acid (ASA) are critical in treating CAD patients. Elective angioplasty lacks studies on the factors associated with resistance to ASA.
OBJECTIVE: To evaluate the prevalence and ASA resistance related factors in patients undergoing elective angioplasty.
METHODS: Retrospective cohort study of 198 patients undergoing elective angioplasty, evaluated for resistance to ASA by optical aggregometry with arachidonic acid as agonist.
RESULTS: Resistance to ASA in 6.56% of the cohort (13/198). C-reactive protein (CRP) levels indicated association with resistance to ASA (p=0.02).
CONCLUSIONS: Low prevalence of ASA resistance in patients undergoing elective angioplasty; C-reactive protein high levels are related to greater frequency of this resistance.


Keywords: Aspirin; Platelet aggregation; Coronary balloon angioplasty

Hypertension in elderly individuals from a city of Santa Catarina: a population-based study

Hipertensão arterial sistêmica em idosos do município de Tubarão, SC - Brasil: estudo populacional

Tuany Martins Nunes; Anneta Marcon Martins; André Luciano Manoel; Daisson José Trevisol; Fabiana Schuelter-Trevisol; Rodolfo Antônio Straioto Quirino Cavalcante; Felipe Zancan Espanhol; Tatiana Martins; Danúbia Felippe Grassi de Paula Machado; Roger Augusto Vieira e Silva

Int J Cardiovasc Sci. 2015;28(5):370-376

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BACKGROUND: Aging is a global phenomenon. With population aging, there is an increase in the prevalence of non-transmissible chronic diseases, among which systemic arterial hypertension (SAH) is the most prevalent one.
OBJECTIVE: To estimate the prevalence of systemic arterial hypertension and associated factors in elderly individuals from the city of Tubarão, Santa Catarina, Brazil.
METHODS:Population-based cross-sectional study conducted with elderly individuals (> 60 years old) living in the city of Tubarão, Santa Catarina, Brazil, from September 2010 to May 2011. The individuals were interviewed and had their blood pressure (BP), weight and height checked. The variables analyzed were sex, age group, education level, ethnicity, alcoholism, smoking, obesity, physical activity and family history. Elderly individuals with blood pressure levels >140/90 mmHg or those using anti-hypertensive medication were considered hypertensive.
RESULTS: A total of 805 elderly individuals were interviewed, of which 699 (86.8%) were considered hypertensive. Of these, 56.2% had isolated systolic hypertension. All elderly individuals aged > 80 had hypertension. The statistically significant variables were age, ethnicity, obesity and family history of hypertension.
CONCLUSION: The prevalence of hypertension in elderly individuals was higher than that reported in research studies carried out in the city of Tubarão, Santa Catarina. The factors associated with hypertension were older age, nonwhite ethnicity, presence of obesity and positive family history.


Keywords: Hypertension; Risk factors; Aged; Prevalence

Complications of coronary syndrome and stroke in cohort study

Complicações da síndrome coronariana e de acidente vascular encefálico em estudo de coorte

Juvenal Soares Dias da Costa; Rosângela Uebel; Euler Roberto Fernandes Manenti; Ruth Liane Henn; Vera Maria Vieira Paniz; Marcelo Felipe Nunes; Monique Adriane da Motta; Maria Teresa Anselmo Olinto

Int J Cardiovasc Sci. 2015;28(5):377-384

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BACKGROUND: The components of acute coronary syndrome and stroke have the involvement of atherothrombotic process in their etiology. Both diseases have risk factors in common and most of them are modifiable. Understanding that these diseases are consequences of the underlying vascular process enables the development of new therapeutic interventions and can help identify patients at risk and thus prevent manifestations of atherothrombosis.
OBJECTIVES: To check the incidence of complications of acute coronary syndrome or stroke and its risk factors in a cohort over one year of follow-up.
METHODS: Cohort prospective study that included patients aged > 30 years, of both sexes, diagnosed with acute coronary syndrome or stroke admitted to the hospital in Porto Alegre, state of Rio Grande do Sul. The outcome was the presence of complications up to one year after hospital discharge. The following were considered complications: the occurrence of new episode of stroke, reinfarction, heart failure or death. We used Poisson regression with robust variance in the adjusted analysis.
RESULTS: Of 512 participants, 130 had complications (27.6%; 95% CI 23.6-31.7). Participants aged > 80 (p=0.01), white color (p=0.008), smokers (p=0.01) and with diabetes mellitus (p=0.02) presented greater incidence of complications.
CONCLUSIONS: The incidence of complications for ACS or stroke was high. Diseases confirmed the severity of condition. The occurrence of deaths was the most frequent complication in the follow-up. There was an important association of diabetes mellitus and smoking with the occurrence of complications, even controlling for age and skin color.


Keywords: Acute coronary syndrome; Stroke; Mortality; Myocardial infarction; Cohort studies

Influence of early ambulation in postoperative hospitalization following cardiac surgery

Influência da deambulação precoce no tempo de internação hospitalar no pós-operatório de cirurgia cardíaca

André Luiz Lisboa Cordeiro; Thiago Araújo de Melo; Alina Ávila; Mateus Souza Esquivel; André Raimundo França Guimarães; Daniel Lago Borges

Int J Cardiovasc Sci. 2015;28(5):385-391

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BACKGROUND: Despite the technological advances aimed to extend the quality of life of patients undergoing cardiac surgery, such procedure is still deemed a highly complex intervention. Early ambulation is an alternative to improve lung capacity, cardiovascular fitness and increased functional performance.
OBJECTIVE: Assess the impact of early ambulation on the length of stay in intensive care unit (ICU) and in hospital, for patients undergoing cardiac surgery.
METHODS: Cross-sectional study of 49 patients undergoing cardiac surgery and admitted to the ICU from October 2014 to April 2015. Patients were stratified into two groups: with and without early ambulation. Early ambulation is the act of walking up to the third day of ICU admission. Statistical analysis performed to check for changes in the length of stay in ICU and in hospital between the two groups of ambulation.
RESULTS: The study observed 49 patients (55.1% men) with mean age of 55.2±13.9 years, admitted to the ICU due to cardiac surgery carried out during the study period. No statistical correlation was found between early ambulation and the length of stay in cardiac ICU (3.0±1.5 days vs. 2.8±1.1 days, p=0.819) and in hospital (5.4±3.3 days vs. 5.3±2.6 days, p=0.903).
CONCLUSION: Early ambulation is not related to a shorter length of stay in ICU or in hospital.


Keywords: Early ambulation; Intensive care unit; Cardiac surgery; Physiotherapy; Intensive care

Association between anthropometric, biochemical and hemodynamic variables in cardiac patients

Relação entre variáveis antropométricas, bioquímicas e hemodinâmicas de pacientes cardiopatas

Mayara Negrão Gomes; Michel Garcia Maciel; Rosileide de Souza Torres; Socorro Nazaré Araújo Almeida Barbosa

Int J Cardiovasc Sci. 2015;28(5):392-399

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BACKGROUND: Cardiovascular diseases (CVD) are one of the leading causes of morbidity and mortality in the world and, in Brazil, they have been the first cause of death for at least four decades. They are a major cause of prolonged hospital stay and are responsible for the primary allocation of public funds in hospitalizations in Brazil. The analysis of anthropometric, hemodynamic and biochemical variables may show their importance as risk factors for CVD.
OBJECTIVE:To assess the correlation of anthropometric, biochemical and hemodynamic variables of cardiac patients with chances of a new cardiovascular event.
METHODS:A prospective, cross-sectional study with 50 patients >45 years of age, of both sexes, from April to July 2014, at Fundação Hospital de Clínicas Gaspar Vianna, in Belém, PA. Information relating to stages of life, lifestyle, anthropometry, laboratory tests and hemodynamic profile were collected.
RESULTS: The following the anthropometric, biochemical and hemodynamic indicators were significantly high: body mass index (BMI), waist circumference (WC) and blood glucose and triglycerides (TG). There was a positive and significant correlation between the following variables: BMI with WC, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC) and LDL with blood glucose. BMI was the variable that most correlated in the study; WC with glucose; SBP with DBP and LDL; TC with TG and LDL.
CONCLUSIONS: BMI was the measure that most correlated with other anthropometric, biochemical and hemodynamic variables. The chances of a new cardiovascular event increase as BMI and its correlation with the other variables increase as well.


Keywords: Cardiovascular diseases; Anthropometry; Risk factors; Heart diseases

Effects of functional foods consumption on the lipid profile and nutritional status of elderly

Efeitos do consumo de alimentos funcionais no perfil lipídico e estado nutricional de idosos

Manuela Dolinsky; Renata Moreira da Silva Corrêa de Oliveira; Gabrielle de Souza Rocha; Sergio Girão Barroso; Silvia Maria Custodio das Dores; Vilma Blondet Azeredo

Int J Cardiovasc Sci. 2015;28(5):400-408

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BACKGROUND: The consumption of functional foods (FF), as oat and linseed, is a safe and efficient strategy for reducing the risk of non-transmissible chronic diseases (NTCD).
OBJECTIVE: Analyzing the effect of food supplementation with brown linseed flour or oat in flakes on the body mass index (BMI), on the waist circumference (WC) and on the lipid profile of elderly.
METHODS: Longitudinal controlled, randomized study, with duration of eight weeks, made with 60 senior individuals (age > 60 years), evaluated at three moments: baseline (T0), four weeks (T1) and eight weeks (T2) after the study started. Weight, height and WC were measured and blood samples were collected. Volunteers were randomly divided into control group (CG), linseed group (LG) and oat group (OG).
RESULTS: BMI and WC have not changed significantly throughout the study in any group. OG showed reduction of 18.4% in the total cholesterol (TC) levels in the plasma compared to LG in the end of the study period (p<0.05). OG showed also, at T2, values 30.4% lower for LDL cholesterol than LG and CG (p<0.05). On the other hand, LG showed increase of 12.0% in the triglycerides levels from T0 to T2 (p<0.05).
CONCLUSION: The supplementation with functional foods was beneficial for reducing the TC and LDL cholesterol.


Keywords: Functional food; Elderly; Flax; Avena sativa; Nutritional status

Pulse pressure as a marker of prognosis in acute coronary syndrome

Pressão de pulso como marcador prognóstico na síndrome coronariana aguda

Ana Rita Gonçalves Romão Almeida Rodrigues; Catarina Sá; Leandro Rassi; Sara Gonçalves; Filipe Seixo; Investigadores do Registro Nacional de Síndromes Coronárias Agudas

Int J Cardiovasc Sci. 2015;28(5):409-416

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BACKGROUND: Pulse pressure (PP) is the difference between the systolic and the diastolic blood pressure. In the acute coronary syndrome (ACS), PP at the admission is potentially related to the prognosis.
OBJECTIVE: Evaluating the PP prognosis impact at the hospital admission due to ACS.
METHODS: The study featured 8152 patients, included in the Portuguese National Record of ACS, calculating the PP at the hospital admission. Two groups were created under a cut-off PP value from which the presence of intra-hospital adverse events [death, reinfarction, bleeding, heart failure (HF)] is more significant. Then, the occurrence of adverse events and the coronary disease seriousness were evaluated.
RESULTS: The cut-off value was 50 mmHg. Group 1 (PP >50 mmHg) featured 5459 (67.0%) patients, being significantly older (67.0±13.0 years vs. 63.0±14.0 years; p<0.001) with more hypertension (75.0% vs. 59.4%; p<0.001), diabetes (33.0% vs. 23.1%; p<0.001), and multiarterial disease (56.1% vs. 51.9%). PP values <50 mmHg (Group 2) are related to a higher rate of adverse events - a combination of death, reinfarction, bleeding and HF (56.2% vs. 47.0%; p<0.001). PP <50 mmHg was independent predictor of HF (OR 1.3 CI95% 1.1-1.4) and of the combination of events (OR 1.2 CI95% 1.1-1.4).
CONCLUSION: Despite higher PP values being significantly related to worst cardiovascular risk profile, lower PP values were more associated to intra-hospital adverse events.


Keywords: Acute coronary syndrome; Blood pressure; Patient acuity; Emergency shelter

Diagnostic accuracy of the P wave in the Lewis and Gallop leads for atrial enlargement detection

Acurácia diagnóstica da onda P nas derivações de Lewis/Gallop para detecção das sobrecargas atriais

Carlos Henrique Miranda; Gustavo P Gerolim; Ana Marta Salgado Gali; Antônio Pazin-Filho

Int J Cardiovasc Sci. 2015;28(5):417-423

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BACKGROUND: The diagnostic accuracy (DA) of the conventional electrocardiogram (ECG) for detecting atrial enlargement (AE) is low. Lewis (L) and Gallop (G) enable better viewing the P wave in the ECG.
OBJECTIVE:Checking whether the P wave parameters in the leads of Lewis and Gallop increase the diagnostic accuracy of the conventional ECG AE criteria.
METHODS:The P wave characteristics in the L and G leads were standardized in 27 healthy individuals. The percentile of 99 was considered as limit of normality for those parameters. These new criteria were evaluated in 117 patients through conventional ECG and the L and G leads. The atrial sizes under the echocardiogram were considered as golden standard for defining the AE. The area under the ROC (receiver operating characteristic) curve (AUC) was used for determining the DA of each parameter.
RESULTS:Conventional ECG presented low DA for detecting the AE. Morris index was the only showing significant DA: AUC 0.57 (95%CI: 0.48-0.66); p=0.03. The inclusion of the P wave >100 ms (L and G) has not increased the DA for detecting left AE compared to the traditional criteria: AUC 0.58 (95%CI: 0.50-0.65) vs. AUC 0.57 (95%CI: 0.49-0.65); p=0.80. Including P wave with amplitude >2 mm (L) and/or >3 mm (G) has not increased DA for detecting right AE either: AUC 0.53 (95%CI: 0.46-0.61) vs. AUC 0.53 (95%CI: 0.45-0.60); p=0.31.
CONCLUSION: Including the P wave in the accessory leads of L and G did not result in increment of DA for detecting AE.


Keywords: Electrocardiography; Atrial function, left; Atrial function, right

Review Article

Adiponectin: characterization, metabolic and cardiovascular action

Adiponectina: caracterização, ação metabólica e cardiovascular

Jefferson Petto; Alan Carlos Nery dos Santos; Marcelo Trotte Motta; Roberto Santos Teixeira Filho; Douglas Gibran Cerqueira do Espirito Santo; José Lázaro Lins Ribas; Ana Marice Teixeira Ladeia

Int J Cardiovasc Sci. 2015;28(5):424-432

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In the last two decades, the understanding of adipose tissue biology underwent revolutionary changes, from a major energy storage site to an important endocrine organ responsible for the production and secretion of proteins, peptides and non-bioactive peptides. Among the proteins secreted by adipocytes, adiponectin (APN) is the most abundant, with important physiological actions in the cardiovascular and endocrine system, involving the sensitization of insulin action and regulation of body energy metabolism, including the heart. This review aims to describe the action of APN on the cardiovascular system. It includes original manuscripts with humans or animals. The databases PubMed and Medline, from years 1994 to 2013, were searched. Case reports, pilot studies or review studies have not been included. The health science descriptors and MeSH specific for Medline were used as keywords. The following cross searches were carried out: Adiponectin AND Obesity, Adiponectin AND Metabolism and Adiponectin AND Cardiovascular Disease. We found 303 manuscripts, excluded 204 and selected 31 manuscripts that were included this study. In the general context of this review, APN presents anti-inflammatory and ateroprotector effects in the vascular tissue and an insulin sensitizing action in tissues involved in glucose and lipid metabolism. It is thus considered an important biomarker for the development of cardiovascular diseases.


Keywords: Adiponectin; Adipose tissue; Basal metabolism; Cardiovascular diseases

Case Report

Bioresorbable device implantation in left main in patients with limitation for long-term using of dual antiplatelet therapy

Angioplastia no tronco calcificado com suporte biorreabsorvível por limitação para antiagregação

Esmeralci Ferreira; Alcides Ferreira Júnior; Cyro Vargues Rodirgues; Camillo de Lellis Carneiro Junqueira; Guilherme Nossar Matheus da Rocha; Leandro de Souza Duarte

Int J Cardiovasc Sci. 2015;28(5):433-436

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Male patient with unstable angina and critical calcified lesion in the left main coronary artery (LMCA). Background: coronary artery bypass grafting and anemia. The intention to treat was angioplasty with drug-eluting stents (DES) in the LMCA. The patient presented gastrointestinal bleeding and worsening of anemia, which were treated. Angina was refractory to medical therapy. Because of antiplatelet therapy limitation, bioresorbable vascular support (BVS) was implanted in the LMCA. This case report discusses the use of BVS in complex lesion, enabling absorption of the device and better management of antiplatelet therapy and future follow-up of the obstruction treated using by non-invasive imaging methods.


Keywords: Angioplasty; Coronary artery disease; Myocardial revascularization

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