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

Edition: 28.6 - 12 Article(s)


Cardiovascular developments in 2015

Avanços cardiovasculares em 2015

Claudio Tinoco Mesquita

Int J Cardiovasc Sci. 2015;28(6):437-439


Keywords: Hypertension; Coronary artery disease; Cardiovascular imaging

Original Article

Chagas' cardiomyopathy prognosis assessment through cardiopulmonary exercise testing

Avaliação do prognóstico na cardiomiopatia chagásica através do teste cardiopulmonar de exercício

Fernando Cesar de Castro e Souza; Andrea De Lorenzo; Salvador Manoel Serra; Alexandre Siciliano Colafranceschi

Int J Cardiovasc Sci. 2015;28(6):440-450


BACKGROUND: Chagas heart failure (CHF) seems to have higher mortality than other systolic dysfunction conditions. Cardiopulmonary exercise testing (CPET) is a prognostic assessment tool that is still little studied in Chagas heart disease.
OBJECTIVE: To assess whether CPET can discriminate the prognostic differences of CHF compared to non-Chagas heart failures (NCHF) and determine which of its variables are independent predictors of poor prognosis.
METHODS: Retrospective analysis of 21 patients with CHF and 76 patients with NCHF referred to CPET and followed up for mortality in two years.
RESULTS: During follow-up, 5 patients died in the Chagas group (CG) and 25 in the non-Chagas group (NCG). The Kaplan-Meier curve showed no difference in the survival curve between groups (p=0.43). Logistic regression found the circulatory power as an independent predictor of death for both groups, with a hazard ratio for the CG of 17.3 (95% CI 1.39-217.0; p=0.027) and for the NCG of 4.8 (95% CI 1.59-14.6; p=0.005). The ROC curve for this variable found an area of 0.91 (95% CI 0.78-1.00; p=0.006) with a cutoff value <1280 mmHg.mL.kg-1.min-1 in the CG and an area of 0.75 (95% CI 0.64-0.86; p<0.0001) with a cutoff value of <1245 mmHg.mL.kg-1.min-1 in the NCG.
CONCLUSION: Circulatory power was the variable associated with death in both groups and should be more widely used as an indicator of prognosis in heart failure.

Keywords: Exercise Test; Chagas Disease; Heart Failure; Prognosis

Impact of heart failure clinic on six-minute walk test

Impacto da clínica de insuficiência cardíaca no teste de caminhada de seis minutos

Roberto Ramos Barbosa; Márya Duarte Pagotti; Thiago Ceccatto de Paula; Tiago de Melo Jacques; Renato Giestas Serpa; Osmar de Araujo Calil; Andressa Corteletti; Luiz Fernando Machado Barbosa

Int J Cardiovasc Sci. 2015;28(6):451-459


BACKGROUND: The six-minute walk test (6MWT) is an easy-to-use low-cost test that is employed to objectively evaluate the degree of functional limitation and the prognosis of heart failure (HF).
OBJECTIVE: To evaluate the 6MWT of individuals with newly diagnosed HF, performed on admission and after six months, analyzing the minimal important difference - MID between the two tests.
METHODS: Historical cohort study. The first 6MWT was evaluated in patients with systolic HF referred to the HF clinic from July 2012 to October 2014 and the second 6MWT after six months. The group that reached the MID distance in the second test was compared to the group that did not reach it. Delta-distance and need for hospitalizations were assessed as adherence to treatment, functional class (FC) of the New York Heart Association at the first visit and degree of left ventricular dysfunction.
RESULTS: The difference in the distance covered between the 6MWT was 48.79 m in the study population and the MID distance calculated was 49 m. Thirty patients (58.8%) had lower delta-distance than the MID distance, with an average age higher than the other group (p=0.01). The average delta-distance was significantly higher in patients adhering to treatment and in those who were in FC III at the first visit.
CONCLUSION: There was general increase in the average distance covered from the first to the second 6MWT in patients with HF, but less than half of patients achieved significant increment.

Keywords: Heart Failure; Exercise therapy; Prognosis

Incidence of intramyocardial bridge in a population sample

Incidência de trajeto intramiocárdico em grupo populacional

Fabiana Ceribelli Nechar; Bianca Valentim Prado; Maria Eduarda Menezes de Siqueira; Milena Cristina Gravinatti; Laura Benhossi Floriano; Raquel Franchin Ferraz; Fernando Augusto Alves da Costa

Int J Cardiovasc Sci. 2015;28(6):460-463


BACKGROUND: The anomaly caused by intramyocardial bridge has been identified as a differential diagnosis of coronary artery disease.
OBJECTIVE: To analyze the incidence of intramyocardial bridge (IMB) in a population sample.
METHODS: Retrospective observational study that analyzed medical records of 200 patients diagnosed with intramyocardial bridge (IMB) or myocardial bridge (MB) using coronary computed tomography angiography (CCTA) from September 2010 to March 2015 at Hospital Beneficência Portuguesa de São Paulo and MedImagem - the Radiology service of the Hospital. The following variables were analyzed: sex, age, height, weight, skin color, family history of cardiovascular disease, smoking, presence or absence of stent, incidence of dyslipidemia, symptoms, systemic arterial hypertension (SAH) and diabetes mellitus (DM), and the coronary arteries mostly affected.
RESULTS: Of the 200 patient records reviewed, there was a higher incidence of IMB in male patients (63.7%, n=128); mean age 57.78±15.0 years; predominance of white color (85.0%); average weight 84.5 kg, with more than half (n=125, 62.5%) of patients below average weight; 15 (7.5%) patients were stented; 81 (40.5%) had symptoms (chest pain or dyspnea); 108 (54.0%) had a family history of cardiovascular disease; 73 (36.5%) presented dyslipidemia; 83 (41.5%) had SAH; 28 (14.0%) had MD; 98 (49.0%) patients had atherosclerosis; and 56 (28.0%) patients were smokers. The main affected artery was the left anterior descending artery (n=193, 96.0%).
CONCLUSIONS: The conclusion is that, in the study population, IMB is prevalent in male patients of white color, non-obese, older, with family history of cardiovascular disease. The main affected artery was the left anterior descending artery.

Keywords: Myocardial bridging; Incidence; Tomography; Coronary vessels

Association of fiber intake and cardiovascular risk in elderly patients

Associação do consumo de fibras e risco cardiovascular em pacientes idosos

Joana Maia Brandão; Camila dos Santos Fernandes; Sérgio Girão Barroso; Gabrielle de Souza Rocha

Int J Cardiovasc Sci. 2015;28(6):464-471


BACKGROUND: Cardiovascular disease is the leading cause of mortality. Through food, some risk factors may be modified and dietary fiber plays an important role in preventing these diseases.
OBJECTIVE: To assess fiber intake, cardiovascular risk factors and the association between them in elderly patients at a nutrition clinic.
METHODS: Descriptive retrospective study conducted by analyzing 24-hour dietary recall and survey of cardiovascular risk factors: waist circumference, lipid profile data and fasting glucose, physical inactivity and smoking. The participants were stratified into groups according to body mass index (BMI).
RESULTS: Forty records were evaluated and higher prevalence was found in overweight patients (45.0%) and obese patients (27.5%). In addition, 72.5% reported being physically inactive and 82.5% are non-smokers. The highest averages of total cholesterol, triglycerides and LDL cholesterol were observed in eutrophic patients: 194.5±48.5 mg/dL; 167.2±95.9 mg/dL and 130.0±37.7 mg/dL, respectively. Obese patients had lower average HDL-cholesterol levels (44.0±8.9 mg/dL) while the highest average fasting glucose (109.8±29.1 mg/dL) was observed in the overweight group. The total fiber intake (g/day) was: 25.1±6.6 in malnourished patients; 22.6±7.0 in eutrophic patients; 23.3±6.0 in the overweight group and 22.0±3.4 in obese patients. There was no significant association with any of the variables analyzed.
CONCLUSION: No association was found between fiber consumption and the cardiovascular risk factors analyzed in the elderly individuals of this study.

Keywords: Dietary fiber; Elderly nutrition; Cardiovascular diseases

Association between sleep load pressure values with sleep apnea diagnosis

Associação entre valores de carga pressórica noturna na mapa com o diagnóstico de apneia do sono

Caroline Ghannage Massai; Lucas Fernandes Souza; Fernando Augusto Alves da Costa; Raquel Franchin Ferraz

Int J Cardiovasc Sci. 2015;28(6):472-479


BACKGROUND: Sleep apnea is a risk factor for many cardiovascular conditions, therefore, its diagnosis is essential.
OBJECTIVE: To check in patients with systemic arterial hypertension and sleep apnea whether there is an association between these diagnoses.
METHODS: Retrospective study with adult patients of both sexes from the database of Clínica Paulista de Doenças Cardiovasculares diagnosed with systemic arterial hypertension and sleep apnea from January 2011 to January 2015. Data from ambulatory blood pressure monitoring (ABPM) and polysomnography associated for the presence of increased pressure load and no pressure decrease during sleep and the presence of obstructive episodes that diagnosed sleep apnea. Patients were also evaluated for cardiovascular risk factors: physical inactivity, obesity, smoking, glucose level and lipid profile.
RESULTS: Altogether, 59 patients have been evaluated, 32 of which (54.2%) presented, during ABPM, stable or increased pressure load with no decline during sleep compared to wakefulness. Of these patients, 31 (96.9%) had sleep apnea in polysomnography, showing an association of 97.0%.
CONCLUSION: In this study, we observed a strong association between systemic arterial hypertension and sleep apnea.

Keywords: Sleep apnea syndromes; Masked hypertension; Blood pressure monitoring, ambulatory; Polysomnography

Physiological changes from walking and time of stay after heart surgery

Alterações fisiológicas da caminhada e tempo de internamento no pós-operatório de cirurgia cardíaca

André Luiz Lisboa Cordeiro; Nassany Marilyn Amorim; Pedro Henrique Andrade; Mateus Souza Esquivel; André Raimundo Guimarães; Thiago Araújo de Melo; Murillo Frazão; Giulliano Gardenghi

Int J Cardiovasc Sci. 2015;28(6):480-486


BACKGROUND: In the past decades, physical therapy has been outstanding in the management of patients undergoing heart surgery and walking is a type of exercise well tolerated by patients.
OBJECTIVES: To evaluate the physiological changes from walking and the correlation with hospital stay after heart surgery (HS).
METHODS: Cross-sectional quantitative observational clinical trial has been conducted. Thirty 30 patients were selected. The following hemodynamic variables have been evaluated: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and double product (DP); as well as the following respiratory variables: respiratory rate (RR), peripheral oxygen saturation (PO2S), one minute before walking and immediately after the end of the walk.
RESULTS: The following rates were increased: SBP 112.0±11.9 mmHg to 118.2±19.1 mmHg (p=0.06); end HR 94.1±17.6 bpm to 81.7±14.6 bpm (p=0.00); DP 9166.0±2041.6 to 11230.7±3441.3 (p=0.00); and DBP 74.0±18.7 mmHg to 77.3±11.7 mmHg (p=0.27). RR increased from 19.4±4.4 ipm to 24.0±4.4 ipm (p=0.00); and PO2S 95.3±2.4% to 94.9±3.2% (p=0.53). There was also a significant correlation between the variation of HR, DP and SBP after exercise.
CONCLUSIONS: Walking generated hemodynamic effects over HR, DP, and changes in RR. HR, DP and SBP after heart surgery had a direct relationship with the length of hospital stay.

Keywords: Walking; Thoracic surgery; Physiotherapy

Intensive glycemic control in patients with acute myocardial infarction: diabetes time duration counts!

Controle glicêmico intensivo em pacientes com infarto agudo do miocárdio: tempo de duração do diabetes conta!

Ana Rita Pereira Alves Ferreira; Sofia Lazaro Mendes; Francisco Gonçalves; Pedro Monteiro; Silvia Monteiro; Mariano Pêgo

Int J Cardiovasc Sci. 2015;28(6):487-495


BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in patients with diabetes. The presence of type 2 diabetes mellitus (T2DM) puts the patients with and without history of myocardial infarction at risk for significant cardiovascular risk.
OBJECTIVE: To evaluate the prognostic impact of the time of duration and metabolic control of T2DM in a population hospitalized for acute coronary syndrome.
METHODS: Retrospective study of 731 consecutive patients admitted for acute coronary syndrome from May 2007 to August 2013. Patients were stratified into: Group 1 (n=297) with known diabetes mellitus (DM) (prior to hospitalization) and hemoglobin A1c (HbA1c) <6.5%; Group 2 (n=383) with known DM and HbA1c >6.5%; Group 3 (n=39), with recently diagnosed DM (during hospitalization) and HbA1c <6.5% and Group 4 (n=12) recently diagnosed with DM and HbA1c >6.5%. The primary endpoint was death from all causes (cardiovascular and non-cardiovascular) at one year, and the secondary endpoint at two years of follow-up.
RESULTS: The distribution by sex and age was similar in both groups. In-hospital mortality was also higher in Group 2 (4.4%). Mortality from all causes over one year was higher in Groups 1 (8.3%) and 4 (8.3%), and at two years was higher in Group 1 (9.8%). Group 3 had better prognosis.
CONCLUSION: Of the data presented, the authors consider that the diabetes time of duration is important to decide the therapy and adjust the target of metabolic control of patients with ACS.

Keywords: Diabetes mellitus; Myocardial infarction; Blood glucose

Hospital evolution of patients with infective endocarditis in public hospital in Belém, Pará, Brazil

Evolução hospitalar de pacientes com endocardite infecciosa em hospital público de Belém, Pará - Brasil

Lucianna Serfaty de Holanda; Juliana Fonseca de Araújo Daher; Alberto Freire Sampaio Costa; Dilma Costa de Oliveira Neves; Vitor Bruno Teixeira de Holanda

Int J Cardiovasc Sci. 2015;28(6):496-503


BACKGROUND: The time course of disease knowledge enables advances in techniques that promote early diagnosis which, consequently, is important for the survival of patients with infective endocarditis (IE).
To describe the hospital evolution of patients with infective endocarditis in a public hospital in Belém, Pará, Brazil.
METHODS: Observational, descriptive, prospective case series study. The study included a review of the medical records of 18 patients with IE from Hospital de Clínicas Gaspar Vianna (HCGV), who were part of the hospital's spontaneous demand and who met the inclusion criteria adopted. Social and demographic data and clinical evolution were analyzed.
RESULTS: Of the 18 patients studied, there was predominance of males (72.2%), aged between 39-59 years (50.0%), level of education: incomplete primary education (61.1%) and monthly income two to four minimum wages (55.5%). The most prevalent risk factor was the presence of biological valve prosthesis (36.0%), 66.5% of blood cultures were negative, the aortic valve was the most affected (44.4%). Valve dysfunction was the most frequent complication (26.5%), the medical and surgical treatment was the most used (55.5%), criterion for surgery was severe impairment (33.3%). The time to diagnosis was 27.7 days, time to treatment after diagnosis was 2.4 days and the outcome most found was death (50.0%).
CONCLUSION: Half of the patients died with a percentage well above what is found in the literature.

Keywords: Endocarditis, bacterial; Endocarditis; Clinical evolution

Review Article

Myocardial infarction analysis based on ST-segment elevation and scores

Análise do infarto do miocárdio com ênfase no supradesnivelamento do segmento ST e escores

Laíse Oliveira Resende; João Batista Destro Filho; Rodrigo Varejão Andreão; Elmiro Santos Resende; Lucila Soares da Silva Rocha; Geraldo Rubens Ramos de Freitas

Int J Cardiovasc Sci. 2015;28(6):504-510


This review focuses on the major issues regarding ST segment abnormalities during acute myocardial infarction (AMI), which may be estimated from electrocardiogram (ECG) tests. Diagnosis, prognosis, treatment and the drawbacks associated to this methodology are discussed. Finally, the major AMI quantitative assessments based on ECG deviations are compared and discussed in the context of telemedicine systems.

Keywords: Electrocardiography; Myocardial infarction; Telemedicine

Point of View

New horizons for approach of ST-segment elevation myocardial infarction

Novos horizontes para abordagem do infarto agudo do miocárdio com supradesnivelamento do segmento ST

Marcelo Rivas; Ana Amaral Ferreira Dutra; João Luiz Fernandes Petriz

Int J Cardiovasc Sci. 2015;28(6):511-513


In the past decades, there was a reduction in mortality from ST segment elevation acute myocardial infarction (STEMI) associated with a set of actions combining technological advances and public policies. However, its characteristic of a time-dependent disease is still responsible for a high number of cases of sudden death and the consequences of late or inefficient reperfusion are related to heart failure and increased morbidity and mortality. From this point of view, three different aspects were reviewed: the impact of ventricular arrhythmias in prehospital care; the influence of Von Willebrand factor and the role of microparticles in the diagnosis of the disease.

Keywords: Myocardial Infarction; Ventricular fibrillation; Acute coronary syndrome; Von Willebrand Factor; Cell-derived microparticles