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

Edition: 26.4 - 11 Article(s)


The price of obesity

O preço da obesidade

Gláucia Maria Moraes de Oliveira; Wolney de Andrade Martins

Rev Bras Cardiol. 2013;26(4):238-240


Original Article

Oral anticoagulation stability assessment with warfarin and phenprocoumon

Avaliação da estabilidade de anticoagulação entre a varfarina e a femprocumona

Fabiana Silveira Copês; Eduardo Bartholomay; Carlos Kalil; Pablo Balbuena Nery; Renê Baccin; Manuela Cavalcanti; Luiz Carlos Bodanese

Rev Bras Cardiol. 2013;26(4):241-247

Abstract PDF PORT

BACKGROUND: Although warfarin and phenprocoumon are the most widely used oral anticoagulants, there are no randomized studies comparing the anticoagulation stability of these two drugs.
OBJECTIVES: To compare warfarin and phenprocoumon in terms of therapeutic anticoagulation maintenance stability (international normalized ratio [INR] between 2.0 and 3.0) and evaluate the incidence of thromboembolic and hemorrhagic complications arising from inadequate anticoagulation.
METHODS: Randomized double-blind clinical trial with patients undergoing current oral anticoagulant treatment but with INR below the therapeutic target during the past 3 weeks, randomized for warfarin or phenprocoumon. Medication dosages were adjusted in compliance with a predetermined algorithm.
RESULTS: With 62 patients randomized into two groups of 31 each during the first five weeks of the study, phenprocoumon was found to be more unstable than warfarin. From the sixth INR measurement onwards, the stability of the INR value improved in the phenprocoumon group, but with no statistical significance. There were no significant differences in the side effects of the drugs.
CONCLUSION: Warfarin demonstrated greater effectiveness for INR stability than phenprocoumon.

Keywords: Warfarin; Phenprocoumon; Anticoagulants; Drug stability; Comparison

Comparison of cardiovascular risk factors between cardiologists and non-cardiologists

Comparação de fatores de risco cardiovascular entre médicos cardiologistas e não cardiologistas

Luiz Humberto Marochi; Cyntia Woitexen Campos; Fernanda Pin Marcante; Daniel Medeiros Moreira

Rev Bras Cardiol. 2013;26(4):248-252

Abstract PDF PORT

BACKGROUND: There are few data in the literature on the prevalence of risk factors among physicians, especially cardiologists.
OBJECTIVE: To evaluate and compare the prevalence of cardiovascular disease risk factors between a group of cardiologists and a group of non-cardiologists.
METHODS: Cross-sectional study comparing cardiologists (C Group, n=32) and non-cardiologists (NC Group, n=32). Total cholesterol levels and fractions were evaluated, together with blood pressure, waist circumference, smoking, Body Mass Index (BMI) , blood glucose and lifestyle habits.
RESULTS: The lipid profile showed no differences: in the C Group, the mean values for total cholesterol, LDL and HDL were: 198.5±40.2mg/dL, 114.3±24.7mg/dL and 44.7±8,5mg/dL respectively; in the NC Group, these values were respectively 199.9±38.5mg/dL and 120.7±31.5mg/dL and 45.9±9.4mg/dL. Blood glucose was 100.0±16.7mg/dL for the C Group and 103.3±17.0mg/dL for the NC Group (p=0.548). The Framingham Risk Score was 6.7±5.4 for the C Group and 6.3±5.5 for the NC Group (p=0.89). Alcohol intake was higher for the C Group: 75.4 ± 66.4g/week vs. 42.2±33.2g/week for the NC Group (p=0.014). There was a trend towards lower waist circumference and lower BMI for the C Group: 91.7±7.1cm vs. 96.0±11.0cm for the NC Group (p=0.072), and 25.7±3.3kg/m2 vs. 27.4±4.8kg/m2 (p=0.089) respectively. There was also trend towards lower systolic blood pressure for the C Group: 121.2±13.0mmHg vs. 126.7±10.1mmHg (p=0.072).
CONCLUSION: There are no differences in cholesterol levels, waist circumference, BMI, blood pressure and Framingham risk, although cardiologists consume more alcohol.

Keywords: Risk factors; Myocardial ischemia; Physicians

Vitamin D deficiency among patients with suspected heart failure with normal ejection fraction

Deficiência de vitamina D em pacientes com suspeita de insuficiência cardíaca e fração de ejeção normal

Antonio José Lagoeiro Jorge; Maria Luiza Garcia Rosa; Monica Di Calafiori Freire; Dayse Mary da Silva Correia; Luiz Claudio Maluhy Fernandes; Mario Luiz Ribeiro; Bruno Afonso Lagoeiro Jorge; Pedro Gemal; Evandro Tinoco Mesquita

Rev Bras Cardiol. 2013;26(4):253-258

Abstract PDF PORT

BACKGROUND: Studies have shown a strong association between vitamin D (VitD) deficiency and the risk of cardiovascular disease. Widely prevalent, VitD deficiency is considered as a poor prognosis factor for heart failure (HF).
OBJECTIVE: To assess VitD deficiency among patients with heart failure with normal ejection fraction (HFNEF) and correlations with systolic and diastolic function markers.
METHODS: A cross-section study with 85 outpatients (age 70.8±11.5 years, female 72 %, Rio de Janeiro, latitude -22ºS) with suspected HF and normal EF, dosed with 25-hydroxy vitamin D (25(OH)D) and BNP measurements, with echocardiograms, tissue Doppler and electrocardiograms for investigating HFNEF, in compliance with the criteria established by the European Society of Cardiology.
RESULTS: HFNEF was confirmed in 32 patients (38 %) with higher BNP values (135.1 median 109 pg/mL vs. 23.4 median 16.4 pg/mL; p<0.0001) and diastolic dysfunction rates (volume AE-I 44.2±8.9 mL/m2 vs. 29.3±7.4 mL/m2, E/E' 14.5±6.6 vs. 7.5±2.1; p<0.0001). The VitD values were lower in the HFNEF group, with statistical significance (34.9±14.9 mcg/L vs. 45.0±17.6 mcg/L; p=0.008). A binary logistic regression revealed age (p=0.001) and vitamin D (p=0.036) as independent factors significant for HFNEF. A negative correlation was noted between the E/E' ratio and the VitD values (r=-0.300 p=0.005).
CONCLUSION: HFNEF patients had lower serum VitD levels and almost half were VitD deficient. A negative correlation was noted between VitD and the E/E' ratio, an LV filling pressure marker.

Keywords: Vitamin D; Diastole; Heart failure; Prevalence

Insulin resistance and anthropometric indexes among patients with acute coronary syndrome

Resistência à insulina e indicadores antropométricos em pacientes com síndrome coronariana aguda

Aline Marcadenti; Verônica Guattini de Oliveira; Vanessa Maria Bertoni; Estefânia Wittke; Laura Petry Dourado; Rafael Brum de Souza; Tiago Moscarelli Pinto; Pedro Pimentel Filho; Justo Antero Sayão Lobato Leivas

Rev Bras Cardiol. 2013;26(4):259-266

Abstract PDF PORT

BACKGROUND: The prevalence of insulin resistance (IR) is high among patients with acute coronary syndrome (ACS); its association with specific anthropometric indicators has not been established, nor has the best parameter been identified for detecting IR among these patients.
OBJECTIVES: To detect the prevalence of IR through assorted indicators and correlate them with anthropometric parameters for patients with ACS.
METHODS: Cross-sectional study of 28 patients, measuring their weight (kg), height (m), waist (WC) and hip circumferences and calculating their Body Mass Index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and Body Adiposity Index (BAI). Biochemical data were obtained from their medical records and IR was detected by the glucose-insulin ratio (GIR), HOMA-IR index and the Stern clinical criterion. Multiple linear regression and generalized linear models were used for associations.
RESULTS: The prevalence of IR based on different criteria was: HOMA-IR 67.9 %; GIR 57.1 % and clinical criteria 43.4 %. The WHtR, WC, and BAI were significantly correlated with HOMA and GIR. With regard to the Stern criterion, only the WC presented significantly different measurements, being lower among individuals classified as non-IR (95.8±9.9 vs. 106.4±12.5, p=0.02). All the anthropometric indexes were associated with IR after adjustments for age, gender and previous medical diagnosis of diabetes mellitus.
CONCLUSIONS: The prevalence of insulin resistance is high among patients with ACS, regardless of the criteria used; however, HOMA-IR seems to be the best predictor. The central obesity and BAI indicators presented a better association with IR.

Keywords: Myocardial infarction; Unstable angina; Obesity; Abdominal obesity; Anthropometry; Insulin resistance

Hypertension among children and adolescents in the Caparaó region, Espírito Santo state, Brazil

Hipertensão arterial em crianças e adolescentes moradores da região do Caparaó, ES - Brasil

Carlos Eduardo Faria Ferreira; Ronaldo Jose Faria; Patrícia Silva Bazoni

Rev Bras Cardiol. 2013;26(4):267-271

Abstract PDF PORT

BACKGROUND: Hypertension is a highly prevalent non-transmittable chronic disease. Many studies have shown that adult hypertension often develops during childhood, underscoring the importance of routinely measuring the blood pressure of children and adolescents.
OBJECTIVES: Early identification of possible high blood pressure levels among children and adolescents.
METHODS: Quantitative study with data collected at schools located in municipalities in the Caparaó region of Espírito Santo State, Brazil, measuring the blood pressure of children and adolescents between 7 and 14 years old. Three blood pressure measurements were taken at different times between May and August 2012. This study began with 1 647 schoolchildren for the first measurement, dropping to 1 474 for the second measurement and 1 342 for the third and final measurement, resulting in a total of 4 463 measurements.
RESULTS: The prevalence of hypertension among children and adolescents in schools located in municipalities in the Caparaó region reached 1.49 %, with 1.79 % of them presenting borderline blood pressure.
CONCLUSION: Although below the national average, hypertension is a disease that is prevalent among children and adolescents in the Caparaó region of Espírito Santo State, Brazil.

Keywords: Hypertension; Prevalence; Children and adolescents

Psychological aspects of patients with implantable cardioverter defibrillator

Aspectos psicológicos de pacientes portadores de cardioversor desfibrilador implantável

Ricardo Gorayeb; Poliana de Lima de Almeida; Carla Camillo; Renata Tamie Nakao

Rev Bras Cardiol. 2013;26(4):272-280

Abstract PDF PORT

BACKGROUND: The implantable cardioverter defibrillator (ICD) is the most efficient alternative for sudden death prophylaxis, but may cause difficulties for patients.
OBJECTIVES: To evaluate anxiety, depression and quality of life among patients fitted with ICDs and investigate associations between these variables and shocks.
METHODS: This descriptive survey was conducted at the ICD outpatient clinic of government-run University Hospital, involving 42 male and female patients more than 18 years old, following a semi-structured interview guide, completing a quality of life questionnaire (SF-36), and using the general hospital anxiety and depression scale.
RESULTS: The sample consisted of 80.95 % men, 35.71 % between 61 and 70 years old, with 64.29 % completing junior high school and 66.67 % with family incomes below four minimum wages. Shocks were reported by 64.29 %, with 21.43 % mentioning phantom shocks, with physical discomfort, pain, fear and sensation of death. Although 73.81 % stated that they had received guidance about ICD, 45.24 % demonstrated partial knowledge and 26.19 % had no knowledge at all. Most (90.48 %) reported post-implantation changes related to physical, psychological and cognitive aspects. In this sample, 33.33 % presented symptoms of anxiety and 19.05 % depression. The SF-36 averages were higher for mental health and social aspects, and lower for pain and physical aspects. No association was ascertained between the occurrence of shocks and social, demographic and psychological variables.
CONCLUSIONS: ICD implants produced important impacts on patients, underscoring the need for psychological monitoring and assessment among these patients in order to ensure good adaptation to treatment and enhanced quality of life.

Keywords: Defibrillators, implantable; Psychology; Depression; Anxiety; Quality of life

Creatine supplement effects on body composition among patients with heart failure

Suplementação de creatina na composição corporal de pacientes com insuficiência cardíaca

Ana Paula Perillo Ferreira Carvalho; Inaiana Marques Filizola Vaz; Krislainy de Sousa Corrêa; Maria Luiza Ferreira Stringhini; Salvador Rassi

Rev Bras Cardiol. 2013;26(4):281-290

Abstract PDF PORT

BACKGROUND: Regardless of total body mass, muscle mass loss is a frequent co-morbidity among patients with heart failure, which may worsen clinical symptoms, with reduced functional capacity and consequent progression of the disease.
OBJECTIVE: To evaluate the body composition of patients with HF supplemented with creatine.
METHODS: Prospective, randomized, double-blind study with 33 patients, male, age over 18 years, HF functional class II to IV as classified by the New York Heart Association, seen at a reference hospital in the Center-West Brazil. The patients were randomly divided into an experimental group (CRE, n=17), supplemented with creatine monohydrate and a placebo group (PLA, n=16), which received maltodextrin, taking 5 g of the supplement or placebo daily for six months. The patients underwent anthropometric and food consumption evaluations before and after taking the supplement. The Ancova statistical model was used to analyze the groups and forms of treatment.
RESULTS: Total body mass, lean body mass and body fat percentage showed no significant differences between the groups. With regard to calorie value, total energy and macronutrients in the diet, only the average amounts of lipids in the CRE group were statistically lower (p=0.0268).
CONCLUSION: Adding a creatine supplement to their diet did not alter the body composition of patients with HF.

Keywords: Creatine; Heart failure; Body composition; Dietary supplement

Implications of admission hyperglycemia in acute coronary syndrome

Significado da hiperglicemia de admissão em síndrome coronariana aguda

Marcelo Bettega; André de Castro Linhares; Deize Caldeira; Aniele Cristine Ott Clemente; Mirnaluci Paulino Ribeiro Gama; Paulo Roberto Ferreira Rossi

Rev Bras Cardiol. 2013;26(4):291-299

Abstract PDF PORT

BACKGROUND: The presence of admission hyperglycemia in acute coronary syndrome among non-diabetic patients is known as stress hyperglycemia, with studies suggesting that ischemia is more severe among them.
OBJECTIVES: To investigate the prevalence of stress hyperglycemia among patients with acute coronary syndrome and correlations to cardiovascular metabolic profiles and extent of myocardial necrosis.
METHODS: 150 patients were allocated to three groups: diabetics, stress hyperglycemics and control. The following were analyzed in order to evaluate their metabolic cardiovascular profiles: age, gender, length of hospital stay, death, blood glucose on admission, fasting blood glucose, glycated hemoglobin, presence of systemic arterial hypertension, total cholesterol, non-HDL cholesterol, HDL, LDL, triglycerides and ultrasensitive C-reactive protein. Myocardial necrosis was assessed by the CK-MB activity peak value.
RESULTS: Stress hyperglycemia was found in 38 %of the patients and diabetes mellitus in 36 %. Comparing the three groups, there were significant differences in: admission glycemia (p<0.001), fasting blood glucose (p=0.007), glycated hemoglobin (p<0.001) and CK-MB activity (p=0.021), with higher absolute values in the hyperglycemics group, with the highest mean CK-MB peak activity level: 89.02 U/L.
CONCLUSIONS: Stress hyperglycemia was highly prevalent in patients with acute coronary syndrome, associated with poorer metabolic cardiovascular profiles and more extensive myocardial necrosis.

Keywords: Hyperglycemia; Diabetes mellitus; Acute coronary syndrome

Case Report

Spontaneous hematoma of the abdominal wall as a complication of anticoagulation in atrial fibrillation

Hematoma espontâneo de parede abdominal como complicação de anticoagulação na fibrilação atrial

Geovana Bertoldi Defaveri; Fabiano Bianchi; Aline dos Santos Nogueira; Luiz Vinícius Andrade Hipolito; Bruno Sá Antunes de Souza; Maria Luanda Berriel Pontes

Rev Bras Cardiol. 2013;26(4):300-302

Abstract PDF PORT

This case study describes a spontaneous hematoma of the abdominal wall as a complication of anticoagulation with unfractionated heparin (UFH) in a patient with atrial fibrillation and at high risk for a thromboembolic event. Hematoma of the rectus abdominis muscle is a disease with low prevalence and a different diagnosis with other acute abdominal conditions. Its appearance is most commonly associated with anticoagulation indicated as prophylaxis for thromboembolic events. In the case described, conservative clinical treatment was selected.

Keywords: Atrial fibrillation; Heparin; Hematoma

Review Article

Exercise in heart failure with normal ejection fraction

Exercício na insuficiência cardíaca de fração de ejeção normal

José Antônio Caldas Teixeira; Pedro Soares Teixeira; Antonio Claudio Lucas da Nóbrega; Denizar Vianna Araújo

Rev Bras Cardiol. 2013;26(4):303-312

Abstract PDF PORT

Today, 50 % of Heart Failure (HF) patients have normal systolic functions or with minimal reductions, diagnosed with diastolic dysfunction and classified as HF with diastolic dysfunction or HF with Normal Ejection Fraction (HFNEF) of the left ventricle (LV). The purpose of this project is to review papers describing HFNEF behavior during exercise, especially for patients undergoing Cardiopulmonary Exercise Testing (CPET), in order to obtain a better understanding of the pathophysiology of their signs and symptoms. Papers dated between 2008 and 2012 in the PubMed and Medline databases were reviewed for projects with human beings, also selecting counter-references of historical relevance. Results: The main and peripheral mechanisms proposed as contributing to the development and clinical manifestations of HFNEF are: modified diastolic performance; systolic dysfunction; altered ventricular-arterial coupling associated with an impaired arterial vasodilator reserve; chronotropic incompetence with a lower chronotropic reserve; increased pulmonary vascular reactivity; reduction in LV chamber dimensions and reduction in active relaxation during diastole with decreased capacitance. Several of these mechanisms may be identified through the CPET through the following indicators: peak VO2 reduction; excessive increase in the VE/VCO2slope rate; EOB occurrence; lower anaerobic threshold VO2; lower VO2/workload ratio; lower VO2/HR; lower chronotropic reserve and recovery HR; and greater effort dyspnea.

Keywords: Heart failure; Exercise; Diastolic heart failure