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

Edition: 26.3 - 12 Article(s)


Silver jubilee of the Brazilian Journal of Cardiology!

Jubileu de prata da Revista Brasileira de Cardiologia!

Wolney de Andrade Martins

Rev Bras Cardiol. 2013;26(3):154


Risk score and frailty concepts in aortic stenosis treatment

Os conceitos de escores de risco e de fragilidade no tratamento da estenose aórtica

Mauro Paes Leme

Rev Bras Cardiol. 2013;26(3):155-157


Original Article

Apolipoproteins, lipids, high-sensitivity C-reactive protein and severity of coronary artery disease

Apolipoproteínas, lipídeos, proteína-C ultrassensível e gravidade da doença arterial coronariana

Mariana Aquino dos Santos Costa; José Albuquerque de Figueiredo Neto; Joseildes Castelo Branco Sousa; Aíza Leal de Almeida; Rosana Costa Casanovas

Rev Bras Cardiol. 2013;26(3):158-166

Abstract PDF PORT

BACKGROUND: Coronary artery disease (CAD) is one of the main causes of mortality worldwide. Dyslipidemia and ultrasensitive C-reactive protein are important risk factors.
OBJECTIVE: To evaluate lipid and C-reactive protein concentrations and CAD severity in a group of patients undergoing coronary angiography.
METHODS: Transversal analytical study examining the clinical, social and economic data and laboratory results of patients meeting the inclusion criteria and treated between February and October 2009 at the Hemodynamic Laboratory, University Hospital, Maranhão Federal University.
RESULTS: The CAD patient group presented significantly higher age (p=0.0003), male gender (p<0.0001), literacy (p=0.014), married (p=0.014), income above five minimum wages (p=0.017), hypertension (p=0.038), triglycerides (TRIG) 153.4±105.5 mg/dL (p=0.010), TC/HDL-c 5.38±1.69 (p=0.007) and VLDL-c 30.8±21.6 mg/dL (p=0.008) than the non-CAD group, with significantly lower HDL-c 34.7±9.6 mg/dL (p=0.005) and Apo A 1.17±0.275 g/L (p=0.004) than the non-CAD group. Patients with more affected blood vessels presented significantly higher TRIG (p=0.031) and VLDL-c (p=0.025) values, with significantly lower HDL-c (p=0.010) Apo A (p=0.005) than non-CAD patients. No significant differences were noted between CAD severity and the other lipids and lipid ratios. There was no significant association (p=0.91) between CRP levels and CAD severity.
CONCLUSION: More severe CAD was related directly to TRIG and VLDL-c levels and related inversely to HDL-c and Apo A levels.

Keywords: C-reactive protein; Lipids; Coronary artery disease

Severity of coronary artery disease and metabolic syndrome: is there an association?

Gravidade da doença arterial coronariana e síndrome metabólica: existe associação?

Joseildes Castelo Branco Souza; José Albuquerque de Figueiredo Neto; Gilberto Castelo Branco Souza; Márcio Mesquita Barbosa; Giselle Andrade dos Santos Silva; Marcelo Medeiros Mota dos Reis; Vera Lívia Xavier Rodrigues

Rev Bras Cardiol. 2013;26(3):167-173

Abstract PDF PORT

BACKGROUND: Metabolic syndrome is a complex disorder with a set of cardiovascular risk factors, usually related to insulin resistance.
OBJECTIVE: To assess the association between metabolic syndrome and the severity of coronary artery disease
METHODS: Cross sectional study with 322 patients undergoing elective coronary angiography. Laboratory data and risk factors were evaluated for coronary artery disease, as well as information obtained during the angiography. Metabolic syndrome was diagnosed according to the NCEP ATPIII criteria, using two aspects to rate CAD severity: the number of vessels involved and the level of occlusion in the artery. The association between these variables and metabolic syndrome was investigated, using the chi-square test; risk factors were defined through the OR and the association with severity was measured through the Poisson regression, with p<0.05 considered as significant.
RESULTS: The prevalence of metabolic syndrome reached 58.07%, and 59.13% in patients with coronary artery disease, with no statistical difference. Metabolic syndrome was not an independent risk fact for the presence of coronary artery disease. When assessing occlusion levels and the number of vessels involved, a trend towards greater severity was noted in patients with metabolic syndrome, but with no statistical significance. Among the metabolic syndrome components, hypertension was the only risk factor for coronary artery disease.
CONCLUSION: No association was noted between metabolic syndrome and the severity of coronary artery disease.

Keywords: Metabolic syndrome; Coronary artery disease; Risk factors

Appropriateness of percutaneous intervention indications in stable coronary disease and inappropriate use predictors at a teaching hospital

Adequação das indicações da intervenção percutânea na doença coronariana estável e preditores do seu emprego inapropriado em um hospital de ensino

Francisco das Chagas Monteiro Júnior; Márcia Fabiane Sales de Oliveira; Nilton Santana de Oliveira; Francival Leite de Souza; Pedro Antônio Muniz Ferreira; Joyce Santos Lages; Natália Ribeiro Mandarino; Natalino Salgado Filho

Rev Bras Cardiol. 2013;26(3):174-179

Abstract PDF PORT

BACKGROUND: Percutaneous coronary intervention (PCI) results in improved symptoms and less need for antianginal medications for stable coronary artery disease, but does not reduce myocardial infarction and death rates.
OBJECTIVE: To assess the appropriateness of PCI indications in patients with stable coronary artery disease at a university hospital.
METHODS: The study involved 102 patients with stable coronary artery disease consecutively undergoing PCI at a university hospital, with a mean age of 65.9 ± 10.7 years and 67.3% male. Information was collected on the patient (clinical and epidemiological data, ischemia provocation test results and antianginal drug use) and the requesting physician (time since graduation and speciality). PCI indications were considered appropriate for patients with angina pectoris to clinical treatment, or for asymptomatic patients presenting large areas of myocardial ischemia in provocation tests.
RESULTS: PCI indications were considered appropriate for 34 (33.3%) patients, inappropriate for two others, and uncertain for the remaining 66. In the univariate analysis, the following variables were significantly associated with inappropriate/uncertain ICP indications: older (p=0.001), retired (p=0.006), non-smoker (p=0.041) and dyslipidemia (p=0.039), noting a trend towards sedentary lifestyles (p=0.094), lower income (p=0.013) and >10 years time since graduation (p=0.094). After the logistic regression analysis, only the older (OR=1.10 [1.06-11.1]; p=0.048), lower income (OR=2.84[1.5-7.6]; p=0.039) and longer time since graduation (OR=11.71[1.3-15.26]; p=0.028) variables remained significantly associated with inappropriate/uncertain indications.
CONCLUSION: PCI indications were rated as appropriate for only a third of the patients, with inappropriate/uncertain indication predictors being older, lower income and longer time since graduation.

Keywords: Coronary artery disease; Angina pectoris; Percutaneous transluminal coronary angioplasty

Effects of flow-oriented incentive spirometry after myocardial revascularization

Efeitos da inspirometria de incentivo a fluxo após revascularização do miocárdio

Talita Brugnaro Zangerolamo; Thiago Guimarães Barrientos; Letícia Baltieri; Marlene Aparecida Moreno; Eli Maria Pazzianotto-Forti

Rev Bras Cardiol. 2013;26(3):180-185

Abstract PDF PORT

BACKGROUND: Although several respiratory physiotherapy resources are used during the postoperative stage of cardiac surgery, little is known about their effectiveness compared to conventional respiratory physiotherapy.
OBJECTIVE: To evaluate the effect of conventional respiratory physiotherapy (CRP) on lung volumes and capacities, associated or not with a respiratory incentive device.
METHODS: A total of 16 volunteers were evaluated, undergoing coronary artery bypass graft surgery. Among them, 8 volunteers followed CRP and performed three sets of 10 repetitions for each lung expansion respiratory exercise, while 8 volunteers followed CRP associated with flow-oriented incentive spirometry (CRP+IS), also performing three sets of 10 repetitions. Both groups received treatment three times a day, from the first day postoperative through to release from the intensive care unit. A ventilometer was used to assess lung volumes and capacities, collecting: minute volume (MV), respiratory rate (RR), tidal volume (TV) and vital capacity (VC).
RESULTS: There was a significant increase in RR (from 14 ipm to 17 ipm) in the CRP+IS group, with patients remaining eupneic and maintenance of TV and MV for both groups. There were significant VC reductions in both groups (CRP: from 2.42 L to 1.4 L; CRP+IS: from 2.81 L to 1.68 L).
CONCLUSION: The use of flow-oriented incentive spirometry did not offer additional benefits when used as an adjunct to conventional physiotherapy in order to restore vital capacity.

Keywords: Cardiac surgery; Lung volume measurements; Physical therapy specialty; Sternotomy

Importance of pre-operative anemia in patients undergoing cardiac surgery

Importância da anemia pré-operatória em pacientes submetidos à cirurgia cardíaca

Denise Riva; Juliana Schneider; Angela Beerbaum Steinke Bronzatti; Matias Nunes Frizzo; Eliane Roseli Winkelmann

Rev Bras Cardiol. 2013;26(3):186-192

Abstract PDF PORT

BACKGROUND: Anemia is an important predictor of post-operative recovery after cardiac surgery, directly influencing mortality and complications among these patients.
OBJECTIVES: To analyze the presence of anemia and compare intra- and post-operative variables in patients undergoing cardiac surgery.
METHODS: A cross-sectional, retrospective and analytical study assessed 79 male and female patients undergoing coronary artery bypass graft (CABG) or valve replacement surgery, between 30 and 77 years old. Female patients were rated as anemic with pre-surgical hemoglobin at less than 12 g/dL, and below 14 g/dL for men.
RESULTS: The mean age of anemic patients was 60.52±9.79 years and 58.15±10.81 for non-anemic patients. In the sample population (n=79), 51.9 % underwent CABG CRM, 44.3 % received valve replacements and 3.8 % underwent both procedures. Anemic patients required longer aortic clamping and mechanical ventilation. The average ICU stay was similar in both groups, but the length of time in bed and consequently the total duration spent in hospital was higher in the anemic group. There were five deaths, all in the anemic patient group.
CONCLUSION: Anemia may influence the recovery of patients undergoing cardiac surgery.

Keywords: Anemia; Cardiac surgery; Hemoglobin

Mortality predictors in coronary artery bypass grafting surgery

Preditores de mortalidade na cirurgia de revascularização do miocárdio

Antonio Rafael Wong Ramos; Mariana Bezerra das Flores; Rosana Maria Feio Libonati; Juarez Antonio Simoes Quaresma; Saul Rassy Carneiro

Rev Bras Cardiol. 2013;26(3):193-199

Abstract PDF PORT

BACKGROUND: High postoperative morbidity and mortality rates among patients undergoing coronary artery bypass surgery (CABG) during the acute phase of myocardial infarction may lead to the postponement of these procedures.
OBJECTIVES: To identify variables linked to mortality and risk factors related to death among patients undergoing coronary artery bypass grafting surgery.
METHODS: The survey was conducted from September 2011 to May 2012 at the Hospital de Clinicas Gaspar Vianna in Belém, Pará State, Brazil, using the medical records of 240 patients (223 assessed and 17 excluded) admitted from January 2008 through December 2011. Initially, the death frequency was calculated, followed by the pre-, intra- and post-operative variable frequencies and their respective confidence intervals, in order to characterize the study population.
RESULTS: Among all 223 patients, 12 (5.4%) died, with age being the most significant variable in the pre-operative period. During the intra-operative stage, this was urgent or emergency surgical procedures, followed by post-operative blood transfusions.
CONCLUSION: During the post-operative stage, cardiovascular complications and transfusions are risk factors, with the ICU constituting a protection factor against death.

Keywords: Coronary artery bypass surgery; In-hospital mortality; Risk factors

Long-term outcomes of single balloon mitral valvuloplasty: risk factors for major events

Evolução em longo prazo da valvoplastia mitral com balão único: fatores de risco para eventos maiores

Ricardo Trajano Sandoval Peixoto; Edison Carvalho Sandoval Peixoto; Rodrigo Trajano Sandoval Peixoto; Ivana Picone Borges; Aristarco Gonçalves Siqueira-Filho

Rev Bras Cardiol. 2013;26(3):200-208

Abstract PDF PORT

BACKGROUND: The single balloon (SB) technique is a low-cost option with outcomes similar to the Inoue balloon.
OBJECTIVES: To analyze the long term outcomes of SB Balt mitral valvuloplasty with risk factors for death and major events (death, further mitral balloon valvuloplasty, or mitral valve surgery).
METHODS: The single balloon was used in 256 procedures, with maximum balloon diameters of 25 mm for 5 (1.9 %) procedures and 30 mm for 251 (98.1 %) procedures. The mean follow-up period was 55±33 months.
RESULTS: The single balloon group presented: age 38.0±12.6 years, echocardiographic score 7.2±1.5 points, echocardiographic score >8.32 (12.5 %), female 222 (86.7 %), sinus rhythm 215 (84.0 %), survival for 245 (95.7 %) at the end of the follow-up period and survival with no major events for 211 (17.6 %). In a multivariate analysis, the independent death prediction factors were: age >50 years and echocardiographic score >8; major events: post-procedure <1.5 cm2 mitral valve area, prior commisurotomy and male; the seven independent death prediction variables were: age >50 years, echocardiographic score >8 and mitral valve surgery during the follow-up period.
CONCLUSIONS: Death or major event predictors were: age >50 years, echocardiographic score >8, post-procedure mitral valve area <1.50 cm2, prior commisurotomy, male and mitral valve surgery during the follow-up period.

Keywords: Mitral stenosis; Balloon valvuloplasty; Single balloon

Case Report

Pseudoaneurysm and VSD concomitant after AMI: severe and rare presentation

Pseudoaneurisma e CIV pós-IAM concomitantes: apresentação grave e rara

André Silva Rodrigues; Mauro Isolani Pena; Roberto José Queiroz Crepaldi; Alexandre Jackson von Sperling de Vasconcellos; Renê de Alcântara Miranda; Luis Felipe Cintra Pereira

Rev Bras Cardiol. 2013;26(3):209-212

Abstract PDF PORT

We report a rare case of double mechanical complication after anterior myocardial infarction: pseudoaneurysm and ventricular septal defect (VSD). Female patient, 66 years old, presented with typical chest pain and underwent coronary angiography, which showed total occlusion in the middle third of left anterior descending artery (DA) with angioplasty performed 10 days after onset of symptoms. Evolved after three weeks with recurrence of chest pain, dyspnea, systolic murmur new, hemodynamically stable. Diagnostic coronary angiography and echocardiography pseudoaneurysm of the anterior wall of the left ventricle and apical VSD. Performed surgical repair with resection of the aneurysm and VSD correction, obtaining excellent results despite the gravity of the case.

Keywords: Pseudoaneurysm; Ventricular septal rupture; Acute myocardial infarction

Review Article

Interindividual changes in cardiotonic clinical pharmacokinetics

Variações interindividuais na farmacocinética clínica de cardiotônicos

Felipe Costa de Souza; Emiliana Barbosa Marques; Christianne Bretas Vieira Scaramello

Rev Bras Cardiol. 2013;26(3):213-220

Abstract PDF PORT

Heart failure (HF) is a complex clinical syndrome whose pharmacological treatment includes the use of ACE inhibitors, ARBs, beta blockers, diuretics and aldosterone antagonists. Among drugs with inotropic activity, the drug of choice for use in chronic phase HF is digoxin, while dobutamine and milrinone are used for decompensated HF. Pharmacokinetics is the science studying the absorption, distribution, biotransformation and excretion of drugs. When inserted into clinical practice, its fundamental hypothesis is the relationship between the pharmacological effects of a drug and its concentration in the blood or plasma. The establishment of rational drug regimens is achieved through their pharmacokinetic parameters, such as bioavailability, distribution volume, clearance rate and half-life, which can be modified by countless factors. This study reviews the pharmacokinetics of digoxin, dobutamine and milrinone, assessing changes in their pharmacokinetic parameters that depend on factors such as age, gender, presence of HF and drug interactions. Applied to different groups of individuals, this knowledge will contribute to the rationalization of treatment, moving towards individualized regimens.

Keywords: Pharmacokinetics; Pharmacotherapy; Cardiotonics

Atherothrombosis and antiplatelet drugs

Aterotrombose e antiagregantes plaquetários

Marcos Vinicius Ferreira Silva; Karine Silvestre Ferreira; Cristina de Mello Gomide Loures; Luci Maria Sant'Ana Dusse; Lauro Mello Vieira; Arthur Gonçalves Assini; Josianne Nicácio Silveira; Maria das Graças Carvalho

Rev Bras Cardiol. 2013;26(3):221-230

Abstract PDF PORT

Atherothrombosis is a circulatory system disease whose most significant clinical manifestations (myocardial infarction and stroke) are today the leading causes of death worldwide, expected to increase over the coming years. The clinical use of antiplatelet agents is firmly established as the therapy of choice in primary and secondary prevention of clinical events related to atherothrombosis. This review offers a description of the general aspects of atherothrombosis and the main antiplatelet drugs, with a brief outline of their pharmacodynamic and pharmacokinetic aspects.

Keywords: Atherothrombosis; Cardiovascular diseases; Platelet aggregation inhibitors