Logomarca do periódico: International Journal of Cardiovascular Sciences

Open-access International Journal of Cardiovascular Sciences

Publicação de: Sociedade Brasileira de Cardiologia
Área: Ciências Da Saúde Versão impressa ISSN: 2359-4802
Versão on-line ISSN: 2359-5647

Sumário

International Journal of Cardiovascular Sciences, Volume: 33, Número: 1, Publicado: 2020

International Journal of Cardiovascular Sciences, Volume: 33, Número: 1, Publicado: 2020

Document list
Editorial
Coarctation of the Aorta: Its Importance for Pediatricians and Cardiologists Herdy, Gesmar Volga Haddad
ORIGINAL ARTICLE
Coarctation of The Aorta: A Case-Series from a Tertiary Care Hospital Barreto, Joaquim Roda, Juliana Germano, Carlos Wustemberg Damiano, Ana Paula Quinaglia, Thiago

Resumo em Inglês:

Abstract Background: Coarctation of the aorta is a congenital segmental narrowing of the aortic arch with severe hemodynamic repercussions and increased cardiovascular mortality. Early surgical correction and life-time echocardiographic follow-up must be performed to improve prognosis. However, this goal has been challenged by high rates of underdiagnosis, which delay surgical correction, and by recoarctation in up to one third of operated patients. Objectives: The objectives of this study were: (i) to register the frequency of common clinical signs at diagnosis of coarctation of the aorta; (ii) to describe the course of echocardiographic parameters before and during the follow-up of coartectomized subjects; (iii) to analyze the clinical prognosis of patients according to baseline characteristics, occurrence of recoarctation and associated malformations. Methods: Case-series of 72 patients coarctectomized between June 1996 and November 2016 in a tertiary care hospital. Clinical, echocardiographic and surgical variables were considered. All patients were submitted to coarctectomy by posterolateral thoracotomy and end-to-end anastomosis. Data were classified as parametric or non-parametric by Kolmogorov-Smirnov test. Parametric data were expressed as mean and standard deviation, and non-parametric data as median and interquartile range. Continuous variables were analyzed using paired t-tests, and categorical variables were compared by chi-square test. For all analysis, a p-value of less than 0.05 was considered statistically significant. Statistical analysis was performed using SPSS, version 20.0 (IBM, Chicago, IL, USA). Results: The mean follow-up time was 5.8 years (range: 0-20 years). At diagnosis, most patients had heart murmur (88%), non-palpable pulse in the lower limbs (50%), left ventricular hypertrophy (78%), and bicuspid aortic valve (33%), with a mean aortic peak gradient of 55 mmHg. After surgical correction, those without recoarctation were less symptomatic (60 vs 4.5%; p < 0.001), had lower aortic peak gradient (54 ± 3.8 vs 13 ± 0.8; p = 0.01) and left ventricle mass (95 ± 9.2 vs. 63 ± 11; p = 0.01), and the most common complications were late hypertension (39.2%), and recoarctation (27.6%). Recoarcted patients did not show improvement of neither clinical nor echocardiographic variables. Age at repair and bicuspid aortic valve groups had comparable results with controls. Surgical procedure was safe; mean time of hospitalization was 10 days and mean surgery time 2.3 hours. Conclusions: Coarctectomy improves cardiac symptoms and left ventricular hypertrophy, with a slight effect on the incidence of hypertension. Recoarctation occurs in one-third of patients and draws attention for the need of lifelong surveillance by echocardiography.
EDITORIAL
Diabetes Mellitus, Insulin Use, and Infective Endocarditis Cruz Filho, Rubens Antunes
ORIGINAL ARTICLE
Association between Insulin use and Infective Endocarditis: An Observational Study Bezerra, Renato Lott Carvalho, Thales Figueiredo de Batista, Ricardo dos Santos Silva, Yago Machado da Campos, Bruno Fiuza Castro, João Henrique Máximo de Alves, Matheus de Carvalho Monteiro, Pedro Ivo Palhares Bezerra Filho, Raimundo Matos Machado, Eduardo Luis Guimarães

Resumo em Inglês:

Abstract Background: The association between Diabetes Mellitus (DM) and Infective Endocarditis (IE) is controversial in the literature, since many controversial results have been published. However, when evaluating specifically the evidence on IE and individuals with DM using insulin, we found only two observational studies that considered this variable, with discordant results regarding the prognosis and prevalence of Staphylococcus sp in insulin users compared to non-users. Despite the lack of evidence, in clinical practice the insulin use could be interpreted as minor criteria "injection drug use", using the modified Duke criteria for IE diagnosis. Objectives: To compare the microbiological and valvar profile, as well as the outcome of non-diabetic and diabetic patients with IE who were insulin users or not. Methods: This was an observational, analytical and retrospective study of patients diagnosed with IE between 2003 and 2015 in three tertiary care centers. A total of 211 patients were included, of which 17 were diabetics and 9 were insulin users. Patients were compared using the Shapiro-Wilk normality test and Fisher's exact test, with a significance level of 5%. Results: The mortality from IE in diabetic individuals was higher than that of non-diabetic patients, but with no statistical significance (35.29% vs. 21.1%; p = 0.221), even when the groups were divided into insulin-user diabetic, non-insulin user diabetic and non-diabetic patients (33.3% vs. 37.5% vs. 21.1%, p = 0.229). There was a difference regarding the prevalence of IE caused by S. aureus (57.1% vs. 14.3% vs. 17.4%, p = 0.029) and the involvement of the tricuspid valve (33.3% vs. 0.00% vs. 10.0%, p = 0.034) among insulin users. Conclusion: In our sample, insulin use or the presence of DM did not mean higher in-hospital mortality from IE. It is not possible to generalize the microbiological and valvar findings due to the lack of studies evaluating insulin users in IE; however, particularities have been previously reported and may indicate a different behavior of IE in these patients. New studies considering the insulin use variable are required to elucidate the association between DM and IE.
Editorial
Pain after Cardiac Surgery David, Tirone E.
ORIGINAL ARTICLE
Minimally Invasive Cardiac Surgery versus Sternotomy - Pain Investigation Silva, Juliana Fernandes Cavalcante, Marcela Paula Montenegro, Roger Benevides Lira, Romulo Mel, Emanuel Carvalho Castro, Josue Viana

Resumo em Inglês:

Abstract Background: Treatment of postoperative (PO) pain is essential after surgery, as it contributes to a faster rehabilitation. Assessment of PO pain after minimally invasive (MI) surgery has not been regularly addressed, especially when compared with median sternotomy (MS). Objective: This study aims to evaluate the intensity of thoracic pain in the PO period in patients subjected to MI surgery and MS. Methods: This study compared the intensity of thoracic pain in 34 patients subjected to minimally invasive (MI; n = 17) and median sternotomy (MS; n = 17) from June 2015 to June 2016. The intensity and sites of pain in the PO period, assessed using the visual numeric pain scale, and the need for pain medications were analyzed using the Student’s t-test and the z test, with confidence level of 95% (p < 0.05). Results: Almost all patients reported pain on the third PO day (MS = 94.1% and MI = 88.2%; p = 0.5410). On the seventh PO day, there were significantly more patients free of pain in the group of patients subjected to the MI procedure (MS = 94.1% and MI = 64.7%; p = 0.0341). also, these patients reported fewer pain sites (3rd PO day: MS = 3.2 ± 1.5; MI = 1.5 ± 1.2; p = 0.001; 7th PO day: MS = 3.1 ± 1.4; MI = 0.9 ± 0.9; p = 0.000). Patients undergoing MS reported higher pain intensity and longer lasting pain (3rd PO: MS = 4.8 ± 2.2; MI = 3.0 ± 1.6; 7th PO: MS = 5.3 ± 2.0; MI = 1.2 ± 1.3; p = 0.001), with no difference in pain intensity between the third and the seventh PO days (p = 0.4931). In addition, patients subjected to MI procedure had a significant decrease in pain intensity from the third to the seventh PO days (p = 0.001). Conclusion: According to these results, we concluded that a MI procedure leads to lower intensity of pain in the PO period (from the third PO day on) when compared to a MS; also, patients undergoing MI patients reported fewer pain sites.
Editorial
Biological and Mechanical Heart Valves Under a New Spotlight: Paradigm Shift and New State of the Art Braile, Domingo Marcolino Zotarelli Filho, Idiberto José
ORIGINAL ARTICLE
Bioprosthesis versus Mechanical Valve Heart Prosthesis: Assessment of Quality of Life Molero Junior, José Carlos Raimundo,, Rodrigo Daminello Amaral, Joice Anaize Tonon do Abreu, Luiz Carlos de Breda, João Roberto

Resumo em Inglês:

Abstract Background: The aim of this study was to evaluate the QoL of patients undergoing heart valve replacement using the SF-36 questionnaire, compare it between patients with mechanical prosthesis and patients with bioprosthesis, and correlate the results with sociodemographic variables. Objective: To assess the QoL of patients undergoing heart valve replacement and compare it between patients with bioprosthetic valves and patients with mechanical prosthetic valves. Methods: We included 36 consecutive patients (16 men) with a mean age of 51 years and six months, who underwent mitral or aortic valve replacement from September 2007 to December 2011. The study was conducted between March and May 2012 and involved the application of the SF-36 survey and a sociodemographic questionnaire. Statistical tests were performed, and data are expressed as absolute frequency and percentile, and median and interquartile range (P25 and P75) (Mann-Whitney test), considering a significance of 95%. Results: The average time of surgery was 32.5 months (8-61 months). Participants were asked about the practice of physical activity, and 41.7% were physically active. For the SF-36 domains, the highest scores were observed for the social domain whereas the lowest scores were found for mental health, with a mean of 89.25 and 54.44, respectively. In the statistical analysis, we found statistically higher values in emotional functional for patients with mechanical valve prosthesis (p = 0.0084). Conclusion: The QoL of the patients undergoing heart valve replacement improves considerably after the surgery, except for the mental health domain, probably due to the low practice of physical activity. The type of prosthesis seems not to influence the QoL or the patients in the late postoperative period.
Editorial
The Ejection Fraction Returns to Hyde Park Session's Speakers' Corner Martins, Wolney de Andrade Jorge, Antonio José Lagoeiro
ORIGINAL ARTICLE
Decompensated Heart Failure with Mid-Range Ejection Fraction: Epidemiology and In-Hospital Mortality Risk Factors Cavalcanti, Gabriela Paiva Sarteschi, Camila Gomes, Glory Eithne Sarinho Medeiros, Carolina de Araújo Pimentel, José Henrique Martins Lafayette, André Rabelo Almeida, Maria Celita Oliveira, Paulo Sérgio Rodrigues Martins, Silvia Marinho

Resumo em Inglês:

Abstract Background: Recently, a new HF entity, with LVEF between 40-49%, was presented to comprehend and seek better therapy for HF with preserved LVEF (HFpEF) and borderline, in the means that HF with reduced LVEF (HFrEF) already has well-defined therapy in the literature. Objective: To compare the clinical-therapeutic profile of patients with HF with mid-range LVEF (HFmrEF) with HFpEF and HFrEF and to verify predictors of hospital mortality. Method: Historical cohort of patients admitted with decompensated HF at a supplementary hospital in Recife/PE between April/2007 - August/2017, stratified by LVEF (< 40%/40 - 49/≥ 50%), based on the guideline of the European Society of Cardiology (ESC) 2016. The groups were compared and Logistic Regression was used to identify predictors of independent risk for in-hospital death. Results: A sample of 493 patients, most with HFrEF (43%), HFpEF (30%) and HFmrEF (26%). Average age of 73 (± 14) years, 59% men. Hospital mortality 14%, readmission within 30 days 19%. In therapeutics, it presented statistical significance among the 3 groups, spironolactone, in HFrEF patients. Hospital death and readmission within 30 days did not make difference. In the HFmrEF group, factors independently associated with death were: valve disease (OR: 4.17, CI: 1.01-9.13), altered urea at admission (OR: 6.18, CI: 1.78-11.45) and beta-blocker hospitalization (OR: 0.29, CI: 0.08-0.97). In HFrEF, predictors were: prior renal disease (OR: 2.84, CI: 1.19-6.79), beta-blocker at admission (OR: 0.29, CI: 0.12-0.72) and ACEI/ ARB (OR: 0.21, CI: 0.09-0.49). In HFpEF, only valve disease (OR: 4.61, CI: 1.33-15.96) and kidney disease (OR: 5.18, CI: 1.68-11.98) were relevant. Conclusion: In general, HFmrEF presented intermediate characteristics between HFrEF and HFpEF. Independent predictors of mortality may support risk stratification and management of this group.
Editorial
Obesity: A Risk Marker or an Independent Risk Factor for Coronary Artery Disease? Dippe Jr, Tufi Cerci, Rodrigo Julio
ORIGINAL ARTICLE
Relationship between Obesity and Coronary Artery Disease Defined by Coronary Computed Tomography Angiography Pereira, Lara Luiza Silvello Moraes, Gisele Marochi de Carneiro, Adriano Camargo de Castro Moreira, Valéria de Melo Bello, Juliana Hiromi Silva Matsumoto Prazeres, Carlos Eduardo Elias dos Rochitte, Carlos Eduardo Magalhaes, Tiago

Resumo em Inglês:

Abstract Background: Although associated with traditional cardiovascular risk factors, it is unclear whether obesity alone is associated with coronary artery disease (CAD). Objective: To investigate the role of obesity as a risk factor for CAD, defined by coronary computed tomography angiography (CCTA). Methods: This study retrospectively included 1,814 patients referred for CCTA in a hospital in São Paulo, from August 2010 to July 2012. CAD was identified by coronary calcium score and presence of coronary stenosis > 50%. Images were analyzed by two specialists, and the coronary findings were compared between obese and non-obese groups. A multivariate analysis model was used to assess obesity as an independent variable for the occurrence of obstructive CAD. Results: Among the study population, mean age was 58.5 +/- 11.5 years, 22.8% were obese (BMI = 30 kg/m2) and 66.3% were male. The prevalence of obstructive CAD was 18.4% in both groups. Obese patients had higher median calcium score compared to non-obese subjects (14.7 vs. 1.4, respectively, p = 0.019). In the multivariate analysis, obesity was not an independent factor for obstructive CAD (coefficient = -0.035, p = 0.102). Conclusion: Although no differences were observed in the prevalence of obstructive CAD between obese and non-obese individuals, coronary calcium scores were significantly in lower the latter group.
Editorial
Challenges for Anticoagulation in Atrial Fibrillation Bronchtein, Ana Inês da Costa
ORIGINAL ARTICLE
Trends and Predictors of Oral Anticoagulation in Patients with Atrial Fibrillation: A Serial Cross-Sectional Study from 2011 to 2016 Araújo Geraldes, Maria de Fátima de Darze, Eduardo Sahade Rocha, Paulo Novis

Resumo em Inglês:

Abstract Background: Despite the efficacy of vitamin K antagonists against stroke in patients with atrial fibrillation (AF), the underuse of this therapy is well documented. Objectives: To evaluate trends and predictors of oral anticoagulants utilization in patients with AF. Methods: Observational, retrospective, serial cross-sectional study between 2011-2016. Comparisons between groups were performed using the Student t, Mann-Whitney and Chi-square tests. Logistic regression was used to identify independent predictors of anticoagulation. A p value < 0.05 was considered significant. Results: A total of 377 patients were analyzed. The mean age was 70 ± 15 years; 52% were male and 75% were anticoagulated (20% with VKA and 55% with DOAC). Over 5 years, the overall frequency of anticoagulation increased by 22.4%. The use of DOACs increased from 29% to 70%, whereas the use of VKA decreased from 36% to 17%. The use of antiplatelet agents alone also fell from 21% to 6%. The predictors of anticoagulation were previous episodes of AF (OR 3.1, p < 0.001), hypertension (OR 3.0, p < 0.001) and HASBLED score (OR 0.5, p < 0.001). The predictors of DOAC use were serum creatinine (OR 0.2, p = 0.002), left atrial size (OR 0.9, p = 0.003) and biological valve prosthesis (OR 0.1, p = 0.007). Of the 208 patients using DOACs, 63 (30%) received inadequate prescriptions: 5 with severe drug interactions and 58 with incorrect dosing. Conclusions: Between 2011 and 2016, DOACs were rapidly incorporated into clinical practice, replacing AVKs and antiplatelets, and contributing to greater use of anticoagulation in patients with AF.
ORIGINAL ARTICLE
Cardiac Autonomic Modulation of Healthy Individuals and Patients with Chronic Obstructive Pulmonary Disease During Spontaneous and Controlled Breathing Paschoal, Mario Augusto Gianfrancesco, Livea Camargo, Luisa Torres Seixas, Náira Bueno Paschoal, Ana Beatriz

Resumo em Inglês:

Abstract Background: Lung diseases and different forms of breathing may interfere with cardiac autonomic modulation (CAM). Objective: To compare CAM in individuals with chronic obstructive pulmonary disease (COPD) with healthy individuals during spontaneous breathing (SB) and controlled breathing (CB). Methods: Cross-sectional study involving 30 individuals selected by convenience, divided into COPD group (n = 19) and control group (CG; n = 12). All participants were submitted to heart beat recordings during five minutes at rest (SB) and another five minutes during CB performed at six cycles/min. CAM was made by assessment of the heart rate variability (HRV) through time domain (TD) and frequency domain (FD). Comparisons between groups were performed by Mann Whitney test, and significance level was set at p < 0.05. Results: During SB, HRV TD and FD indices were higher in the controls than in the COPD group, respectively - RR intervals (53.2 ms versus 36.6 ms), RMSSD (42.1 ms versus 26.6 ms) (p < 0.05), total power (28322.8 ms2/Hz versus 2011.6 ms2/Hz), and high-frequency band (800.5 ms(2) versus 330.7 ms2). During CB, the CG also showed higher values for the TD parameters pNN50 (11.7% versus 5.1%), RMSSD (48.3 ms versus 26.7 ms), and SD of RRi (64.9 ms versus 44.7 ms), as well as for the low-frequency component of FD analysis (2848.6 ms2 versus 1197.9 ms2). Conclusion: COPD patients have different CAM when compared with healthy individuals during spontaneous (SB) and controlled breathing (CB).
REVIEW ARTICLE
Molecular Imaging in the Diagnosis of Infectious Endocarditis - the Role of PET and SPECT Albano, Domenico Bertagna, Francesco Giubbini, Raffaele

Resumo em Inglês:

Abstract 18-fluorine-fluorodeoxyglucose positron emission computed tomography (18F-FDG PET/CT) and singlephoton emission computed tomography (SPECT) using radiolabeled white blood cells (WBC) are non-invasive techniques widely used in the diagnosis of infections, like endocarditis. The aim of our paper was to provide a systematic review of the published data on the use of 18F-FDG PET/CT and SPECT in infective endocarditis (IE). A comprehensive literature search of the PubMed/ MEDLINE, Scopus, Embase and Cochrane library databases was conducted to find relevant published articles about the diagnostic performance of SPECT using WBC and 18F-FDG PET/CT in the diagnosis of infectious endocarditis. Twenty papers were included, with a total of 1,154 patients (166 studies with WBC SPECT and 988 with 18F-FDG PET/CT). From the analyses of the studies, the following results were obtained: both SPECT and PET/CT had good diagnostic accuracy in the study of endocarditis. 18F-FDG PET/CT had good specificity (85.8%) and lower sensitivity (68%), with high heterogeneity among the studies; WBC SPECT/ CT had an overall sensitivity of 80% and specificity of 98%. Specific preparations for PET/CT can affect the diagnostic accuracy of the test. Both 18F-FDG PET/CT and WBC SPECT are useful for the diagnosis of IE, and WBC SPECT appears to be slightly more specific than 18F-FDG PET/CT. A specific diet could influence the diagnostic performance of PET/CT.
BRIEF COMMUNICATION
Takotsubo Syndrome in the Context of Transmural Acute Myocardial Infarction: Prevalence and How to Differentiate? Costa, João Paulo Soares Ritt, Luiz Eduardo Fonteles Fernandes, Rafael Modesto Campos, Felipe Alvarenga Duarte Borges, Queila Darzé, Eduardo Sahade
CASE REPORT
A Rare Case of Cardiorespiratory Arrest after Metoclopramide Infusion Rodrigues, Cássio Alexandre Oliveira Cunha, Eduardo Queiroz da Paula, Priscila Ribeiro de Martins, Rand Randall
CASE REPORT
Complete Interruption of Aortic Arch and Non-Immune Hydrops Fetalis: A Case Report with Autopsy Ponce, Cesar Cilento
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