Showing papers in "Arquivos Brasileiros De Cardiologia in 2018"

Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda.

Abstract: Parte 1: Diretriz Brasileira de Insuficiencia Cardiaca Cronica […] Diretriz Brasileira de Insuficiencia Cardiaca Cronica e Aguda

Cardiovascular Disease Epidemiology in Portuguese-Speaking Countries: data from the Global Burden of Disease, 1990 to 2016

Abstract: Background: Portuguese-speaking countries (PSC) share the influence of the Portuguese culture but have socioeconomic development patterns that differ from that of Portugal. Objective: To describe trends in cardiovascular disease (CVD) morbidity and mortality in the PSC between 1990 and 2016, stratified by sex, and their association with the respective sociodemographic indexes (SDI). Methods: This study used the Global Burden of Disease (GBD) 2016 data and methodology. Data collection followed international standards for death certification, through information systems on vital statistics and mortality surveillance, surveys, and hospital registries. Techniques were used to standardize causes of death by the direct method, as were corrections for underreporting of deaths and garbage codes. To determine the number of deaths due to each cause, the CODEm (Cause of Death Ensemble Model) algorithm was applied. Disability-adjusted life years (DALYs) and SDI (income per capita, educational attainment and total fertility rate) were estimated for each country. A p-value <0.05 was considered significant. Results: There are large differences, mainly related to socioeconomic conditions, in the relative impact of CVD burden in PSC. Among CVD, ischemic heart disease was the leading cause of death in all PSC in 2016, except for Mozambique and Sao Tome and Principe, where cerebrovascular diseases have supplanted it. The most relevant attributable risk factors for CVD among all PSC are hypertension and dietary factors. Conclusion: Collaboration among PSC may allow successful experiences in combating CVD to be shared between those countries.

Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction.

Abstract: Resumo Fundamento: Os pacientes com doenca cardiaca, depressao e transtornos de ansiedade sao altamente prevalentes e persistentes. A depressao e a ansiedade desempenham um papel significativo na progressao da doenca cardiovascular e sao reconhecidas como fatores de risco independentes. No entanto, ha muito pouca analise relacionada ao genero em relacao as doencas cardiovasculares e transtornos emocionais. Objetivo: Avaliar os niveis de depressao e ansiedade em pacientes com infarto do miocardio (IM) no primeiro mes apos o IM e avaliar a [...]

6ª DIRETRIZES DE MONITORIZAÇÃO AMBULATORIAL DA PRESSÃO ARTERIAL E 4ª DIRETRIZES DE MONITORIZAÇÃO RESIDENCIAL DA PRESSÃO ARTERIAL

Abstract: Apresentacao Reunem-se, novamente, representantes das sociedades brasileiras de Cardiologia (SBC), de Hipertensao (SBH) e de Nefrologia (SBN) para uma revisao e atualizacao das ultimas diretrizes de MAPA e MRPA. O processo para a producao obedeceu a um cronograma de trabalho exclusivamente realizado via web com dois grupos de trabalhos voltados para cada um dos metodos. […] 6a DIRETRIZES DE MONITORIZACAO AMBULATORIAL DA PRESSAO ARTERIAL E 4a DIRETRIZES DE MONITORIZACAO RESIDENCIAL DA PRESSAO ARTERIAL

Global Longitudinal Strain Accuracy for Cardiotoxicity Prediction in a Cohort of Breast Cancer Patients During Anthracycline and/or Trastuzumab Treatment

Abstract: Background: The high cardiotoxicity morbidity and mortality rates associated with the antineoplastic therapy for breast cancer could be reduced with the early use of cardioprotective drugs. However, the low sensitivity of left ventricular ejection fraction limits its use in that preventive strategy. New parameters, such as global longitudinal strain, are being used in the early detection of contractile function changes. Objectives: To assess the incidence of cardiotoxicity in patients treated for breast cancer, the independent factors associated with that event, and the ability of strain to identify it early. Methods: Prospective observational study of consecutive outpatients diagnosed with breast cancer, with no previous antineoplastic treatment and no ventricular dysfunction, who underwent anthracycline and/or trastuzumab therapy. The patients were quarterly evaluated on a 6- to 12-month follow-up by an observer blind to therapy. Cox regression was used to evaluate the association of cardiotoxicity with clinical, therapeutic and echocardiographic variables. A ROC curve was built to identify the strain cutoff point on the third month that could predict the ejection fraction reduction on the sixth month. For all tests, the statistical significance level adopted was p ≤ 0.05. Results: Of 49 women (mean age, 49.7 ± 12.2 years), cardiotoxicity was identified in 5 (10%) on the third (n = 2) and sixth (n = 3) months of follow-up. Strain was independently associated with the event (p = 0.004; HR = 2.77; 95%CI: 1.39-5.54), with a cutoff point for absolute value of -16.6 (AUC = 0.95; 95%CI: 0.87-1.0) or a cutoff point for percentage reduction of 14% (AUC = 0.97; 95%CI: 0.9-1.0). Conclusion: The 14% reduction in strain (absolute value of -16.6) allowed the early identification of patients who could develop anthracycline and/or trastuzumab-induced cardiotoxicity.

The Effect of Garlic and Voluntary Exercise on Cardiac Angiogenesis in Diabetes: The Role of MiR-126 and MiR-210

Abstract: Fundamento: O diabetes mellitus (DM) e um dos principais fatores de risco para doencas cardiovasculares, levando a disfuncao endotelial e inibicao da angiogenese. O miRNA-126 e o miRNA-210 promovem a resposta angiogenica em celulas endoteliais. Objetivo: O presente estudo buscou explorar o efeito do alho e de exercicios fisicos voluntarios, isoladamente ou em conjunto, nas expressoes do miRNA-126 e do miR-210 e na angiogenese cardiaca em ratos com diabetes tipo 1. Metodos: Ratos Wistar machos foram divididos em cinco grupos [...]

Role of miRNAs on the Pathophysiology of Cardiovascular Diseases

Abstract: MiRNA (or microRNA) is a subclass of non-coding RNAs that is responsible for post-transcriptional gene regulation. It has approximately 22 nucleotides and regulates gene expression in plants and animals at the post-transcriptional level, by the cleavage of a target mRNA or by suppression of its translation. Although many of the processes and mechanisms have not yet been fully elucidated, there is a strong association between miRNA expression and several diseases. It is known that miRNAs are expressed in the cardiovascular system, but their role in cardiovascular diseases (CVDs) has not been clearly established. In this non-systematic review of the literature, we first present the definition of miRNAs and their action at the cellular level. Afterward, we discuss the role of miRNAs as circulating biomarkers of CVDs, and then their role in cardiac remodeling and atherosclerosis. Despite the complexity and challenges, it is crucial to identify deregulated miRNAs in CVDs, as it allows a better understanding of underlying cellular and molecular mechanisms and helps in the development of more accurate diagnostic and prognostic circulating biomarkers, and new therapeutic strategies for different stages of CVDs.

Adropin and Irisin in Patients with Cardiac Cachexia.

Abstract: Background: Cardiac cachexia is an important predictive factor of the reduction in survival of patients with heart failure with reduced ejection fraction. Objectives: The aims of the present study were to evaluate adropin and irisin levels in cachectic and non-cachectic subjects and the relationships between the levels of these proteins and clinical and laboratory parameters in patients with HFrEF. Methods: The clinical records of patients who were admitted to the cardiology outpatient clinic for heart failure with reduced ejection fraction were screened. Cachectic patients were identified and assigned to the study group (n = 44, mean age, 65.4 ± 11.2 y; 61.4% men). Heart failure with reduced ejection fraction patients without weight loss were enrolled as the control group (n = 42, mean age, 61.0 ± 16.5 y; 64.3% men). The serum adropin and irisin levels of all patients were measured. A p-value < 0.05 was considered significant. Results: Serum adropin and irisin levels were significantly higher in the cachexia group than in the controls (Adropin (ng/L); 286.1 (231.3-404.0) vs 213.7 (203.1-251.3); p < 0.001, Irisin (µg/mL); 2.6 (2.2-4.4) vs 2.1 (1.8-2.4); p = 0.001). Serum adropin and irisin levels were positively correlated with brain natriuretic peptide (BNP) levels and New York Heart Association (NYHA) class and negatively correlated with body mass index (BMI) and serum albumin levels (all p values: < 0.001). In a multivariate analysis, adropin was the only independent predictor of cachexia in the heart failure with reduced ejection fraction patients (OR: 1.021; 95% CI: 1.004−1.038; p = 0.017). Conclusions: The results suggest that adropin and irisin may be novel markers of cardiac cachexia in heart failure with reduced ejection fraction patients. Adropin and irisin are related with the severity of heart failure.

Endothelial Function and Physical Exercise

Abstract: O endotelio e considerado um tecido ativo e dinâmico com propriedades importantes como manutencao da circulacao sanguinea, regulacao do tonus vascular, permeabilidade microvascular, sinalizacao e angiogenese vascular e resposta inflamatoria. O endotelio permite a conexao entre componentes da circulacao e sistemas do organismo. As celulas endoteliais produzem e, dependendo do estimulo recebido, liberam fatores que levam a contracao ou relaxamento das celulas do tecido muscular liso dos vasos. O controle do tonus vascular pelo endotelio e modulado pela producao e [...]

Prevalence and Factors Associated with Metabolic Syndrome among Brazilian Adult Population: National Health Survey - 2013

Abstract: Background: In Brazil, population-based researches analyzing prevalence and factors associated with metabolic syndrome (MS), a recognized predictor of cardiovascular diseases (CVD), and an important cause of disability and death in the country are scarce. Objective: To evaluate prevalence of MS and its associated factors in Brazilian population. Methods: Secondary analysis of the 2013 National Health Survey, a cross-sectional survey with national representativeness of Brazilian adult population (n = 59,402). MS was the outcome variable, defined from harmonization of cardiology international consensus as load ≥ 3 of the following components: self-reported diabetes and hypercholesterolemia, high blood pressure and high waist circumference. Analysis were stratified by sex and prevalence ratios, with their respective 99% confidence intervals (PR [CI 99%]) calculated by simple and multiple Poisson regression models. Results: MS prevalence was 8.9%, being significantly higher among women compared to men; in general, this pattern was maintained in relation to exposure variables studied. Additionally, less than 25% of population did not present any MS component. In final multiple models, sociodemographic, behavioral and comorbidity variables were associated with MS, however, while low schooling (1.46 [1.23-1.74], cerebrovascular accident (1.36 [1], 00] (1.28 [1.03-1.62]) were associated among women, chronic renal failure (1.85 [2.23-2.76]) was associated exclusively among men. Conclusion: We identified MS high prevalence in Brazilian population; on the other hand, factors associated with this condition were different depending on sex.

Mortality for Critical Congenital Heart Diseases and Associated Risk Factors in Newborns. A Cohort Study.

Abstract: Background: Congenital heart diseases are the most common type of congenital defects, and account for more deaths in the first year of life than any other condition, when infectious etiologies are ruled out Objectives: To evaluate survival, and to identify risk factors in deaths in newborns with critical and/or complex congenital heart disease in the neonatal period Methods: A cohort study, nested to a randomized case-control, was performed, considering the Confidence Interval of 95% (95% CI) and significance level []

Endothelial Dysfunction and Inflammation Precedes Elevations in Blood Pressure Induced by a High-Fat Diet.

Abstract: Resumo Fundamento: A obesidade leva a um estado de inflamacao cronica, disfuncao endotelial e hipertensao. Objetivo: Estabelecer a sequencia de eventos relacionados a marcadores inflamatorios, disfuncao endotelial e pressao arterial sistolica (PAS) na obesidade em um modelo experimental. Metodos: Ratos Wistar machos (8 semanas de idade) receberam dieta padrao (Controle – CT, n = 35) ou uma dieta palatavel hiperlipidica (DHL, n = 35) por 24 semanas. A cada seis semanas, 7 animais de cada grupo foram aleatoriamente selecionados para [...]

High-Intensity Interval Training in Heart Transplant Recipients: A Systematic Review with Meta-Analysis.

Abstract: Heart transplantation (HTx) is considered an efficient and gold-standard procedure for patients with end-stage heart failure. After surgery, patients have lower aerobic power (VO2max) and compensatory hemodynamic responses. The aim of the present study was to assess through a systematic review with meta-analysis whether high-intensity interval training (HIIT) can provide benefits for those parameters. This is a systematic review with meta-analysis, which searched the databases and data portals PubMed, Web of Science, Scopus, Science Direct and Wiley until December 2016 (pairs). The following terms and descriptors were used: "heart recipient" OR "heart transplant recipient" OR "heart transplant" OR "cardiac transplant" OR "heart graft". Descriptors via DeCS and Mesh were: "heart transplantation'' OR "cardiac transplantation". The words used in combination (AND) were: "exercise training" OR "interval training" OR "high intensity interval training" OR "high intensity training" OR "anaerobic training" OR "intermittent training" OR "sprint training". The initial search identified 1064 studies. Then, only those studies assessing the influence of HIIT on the post-HTx period were added, resulting in three studies analyzed. The significance level adopted was 0.05. Heart transplant recipients showed significant improvement in VO2peak, heart rate and peak blood pressure in 8 to 12 weeks of intervention.

The Presence and Extension of Myocardial Fibrosis in the Undetermined Form of Chagas' Disease: A Study Using Magnetic Resonance.

Abstract: Resumo Fundamento: Dados previos tem demonstrado que pacientes na forma indeterminada podem apresentar fibrose miocardica a ressonância magnetica (RM). No entanto, sao poucas as informacoes disponiveis quanto ao grau de fibrose miocardica apresentada por esses individuos, o que guardaria relacao com o potencial dessa variavel na predicao de evolucao para a forma cardiaca da doenca de Chagas. Objetivos: Descrever a frequencia e extensao da fibrose miocardica avaliada por RM em pacientes da forma indeterminada, comparando com as outras formas da [...]

Subclinical Anthracycline-Induced Cardiotoxicity in the Long - Term Follow-Up of Lymphoma Survivors: A Multi-Layer Speckle Tracking Analysis.

Abstract: Resumo Fundamentos: A antraciclina gera uma disfuncao ventricular esquerda progressiva associada a um prognostico ruim. Objetivos: O proposito deste estudo foi avaliar se a analise layer especifico de strain poderia avaliar disfuncao ventricular esquerda subclinica apos exposicao a antraciclina. Metodos: Foram inscritos quarenta e dois sobreviventes tratados com antraciclina por linfoma nao Hodgkin de celulas B grandes, de 55,83 ± 17,92 anos (grupo de quimioterapia) e 27 voluntarios saudaveis, de 51,39 ± 13,40 anos (grupo controle). A dose cumulativa de [...]

Urbanization is Associated with Increased Trends in Cardiovascular Mortality Among Indigenous Populations: the PAI Study.

Abstract: Background: The cardiovascular risk burden among diverse indigenous populations is not totally known and may be influenced by lifestyle changes related to the urbanization process. Objectives: To investigate the cardiovascular (CV) mortality profile of indigenous populations during a rapid urbanization process largely influenced by governmental infrastructure interventions in Northeast Brazil. Methods: We assessed the mortality of indigenous populations (≥ 30 y/o) from 2007 to 2011 in Northeast Brazil (Bahia and Pernambuco states). Cardiovascular mortality was considered if the cause of death was in the ICD-10 CV disease group or if registered as sudden death. The indigenous populations were then divided into two groups according to the degree of urbanization based on anthropological criteria:9,10 Group 1 - less urbanized tribes (Funi-o, Pankararu, Kiriri, and Pankarare); and Group 2 - more urbanized tribes (Tuxa, Truka, and Tumbalala). Mortality rates of highly urbanized cities (Petrolina and Juazeiro) in the proximity of indigenous areas were also evaluated. The analysis explored trends in the percentage of CV mortality for each studied population. Statistical significance was established for p value < 0.05. Results: There were 1,333 indigenous deaths in tribes of Bahia and Pernambuco (2007-2011): 281 in Group 1 (1.8% of the 2012 group population) and 73 in Group 2 (3.7% of the 2012 group population), CV mortality of 24% and 37%, respectively (p = 0.02). In 2007-2009, there were 133 deaths in Group 1 and 44 in Group 2, CV mortality of 23% and 34%, respectively. In 2009-2010, there were 148 deaths in Group 1 and 29 in Group 2, CV mortality of 25% and 41%, respectively. Conclusions: Urbanization appears to influence increases in CV mortality of indigenous peoples living in traditional tribes. Lifestyle and environmental changes due to urbanization added to suboptimal health care may increase CV risk in this population.

Prognostic Differences between Men and Women with Acute Coronary Syndrome. Data from a Brazilian Registry

Abstract: Resumo Fundamento: Existem diferencas relatadas entre pacientes com sindrome coronariana aguda, de acordo com o sexo. A descricao deste achado comparativo em registro brasileiro ainda nao foi documentada. Objetivo: Comparar pacientes do sexo masculino vs. feminino quanto a caracteristicas basais, achados coronarianos, tratamento e prognostico intra-hospitalar e em longo prazo. Metodos: Trata-se de estudo retrospectivo, multicentrico e observacional, no qual foram incluidos 3.745 pacientes (2.437 do sexo masculino e 1.308 do sexo feminino) entre maio de 2010 e maio de [...]

Validation of the Brazilian-Portuguese Version of a Short Questionnaire to Assess Knowledge in Cardiovascular Disease Patients (CADE-Q SV).

Abstract: Resumo Fundamento: A educacao e parte essencial do atendimento dos pacientes cardiovasculares, visando ao autocuidado, para reduzir os fatores de risco. Assim, uma ferramenta curta e confiavel para avaliar o conhecimento dos pacientes no Brasil e necessaria. Objetivo: Traduzir, adaptar culturalmente e validar psicometricamente a versao em portugues do Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). Metodos: CADE-Q SV portugues foi revisado por cinco especialistas em doencas cardiovasculares bilingues e testado em 21 pacientes, avaliando clareza dos itens [...]

Hypertension Prevalence, Treatment and Control in Older Adults in a Brazilian Capital City.

Abstract: Background: The diagnosis, treatment and control of arterial hypertension are fundamental for a reduction in cardiovascular outcomes, especially in the elderly. In Brazil, there are few studies that specifically identified these rates in the elderly population. Objective: To verify rates of prevalence, treatment and control of hypertension in elderly people living in the urban area of a Brazilian capital city. Methods: A cross-sectional, population-based, randomized, cluster-based study with 912 non-institutionalized elderly individuals (≥ 60 years), living in urban areas in the city of Goiania, Midwest Brazil. Predictor variables were: age, gender, socioeconomic and lifestyle aspects. Blood pressure measurements were performed at home; patients were considered as having arterial hypertension when SBP and/or DBP ≥ 140/90 mmHg or when using antihypertensive drugs (dependent variable). Rates of hypertension treatment and control were evaluated. Variable association analyses were performed by multivariate logistic regression and level of significance was set at 5%. Results: The prevalence of arterial hypertension was 74.9%, being higher (78.6%) in men (OR 1.4, 95% CI: 1.04-1.92); the treatment rate was 72.6%, with higher rates being observed in smokers (OR 2.06, 95% CI: 1.28-3.33). The rate of hypertension control was 50.8%,being higher in women (OR 1.57, 95% CI: 1.19-2.08). Conclusion: The prevalence rates were high. Treatment and control rates were low and associated with gender, age and lifestyle, indicating the need for early and individual interventions.

The Effects of Trimetazidine on QT-interval Prolongation and Cardiac Hypertrophy in Diabetic Rats

Abstract: Fundamento: A trimetazidina (TMZ) e uma droga anti-isquemica. Apesar de seus efeitos protetores sobre o sistema cardiovascular, nao ha estudos cientificos sobre a utilidade do tratamento com TMZ para o intervalo QT prolongado e a hipertrofia cardiaca induzida pelo diabetes. Objetivo: Avaliar os efeitos da TMZ no prolongamento do intervalo QT e na hipertrofia cardiaca em ratos diabeticos. Metodos: Vinte e quatro ratos machos Sprague-Dawley (200-250 g) foram distribuidos aleatoriamente em tres grupos (n = 8) pelo metodo de amostragem [...]

1º Posicionamento Brasileiro sobre o Impacto dos Distúrbios de Sono nas Doenças Cardiovasculares da Sociedade Brasileira de Cardiologia

Abstract: 1o Posicionamento Brasileiro sobre o Impacto dos Disturbios de Sono nas Doencas Cardiovasculares da Sociedade Brasileira de Cardiologia

Cardiovascular Risk in Xavante Indigenous Population.

Abstract: Resumo Fundamento: A prevalencia de fatores de risco cardiovascular ainda e pouco estudada em populacoes indigenas brasileiras. Nas duas ultimas decadas, observaram- se importantes mudancas no estilo de vida e no perfil epidemiologico dos Xavante. Objetivo: Avaliar a prevalencia de fatores de risco cardiovascular na populacao adulta Xavante das Reservas Indigenas de Sao Marcos e Sangradouro/Volta Grande – MT. Metodos: Estudo transversal realizado com 925 indigenas Xavante com 20 ou mais anos de idade, no periodo de 2008 a 2012. [...]

Serum Uric Acid Levels are Associated with Cardiometabolic Risk Factors in Healthy Young and Middle-Aged Adults.

Abstract: Resumo Fundamento: Estudos observacionais tem destacado uma associacao entre niveis de acido urico serico (AUS) e fatores de risco cardiovascular Apesar do crescente conjunto de evidencias, varios estudos foram realizados em individuos mais velhos ou em portadores de doencas passiveis de influenciar os niveis de AUS e marcadores de risco cardiometabolico Objetivo: Avaliar a relacao do AUS com adiposidade corporal, perfil metabolico, estresse oxidativo, biomarcadores de inflamacao, pressao arterial e funcao endotelial em adultos jovens e de meia-idade saudaveis Metodos: []

Physical Exercise and Regulation of Intracellular Calcium in Cardiomyocytes of Hypertensive Rats

Abstract: Resumo Fundamento: A regulacao intracelular de calcio (Ca2+) em cardiomiocitos e alterada pela hipertensao, e o exercicio fisico aerobico traz beneficios para hipertensos. Objetivo: Verificar os efeitos do treinamento fisico aerobico sobre a contratilidade e a concentracao intracelular de Ca2+ transitoria em miocitos e a expressao do microRNA 214 no ventriculo esquerdo (VE) de ratos espontaneamente hipertensos (SHR). Metodos: SHR e ratos Wistar normotensos com 16 semanas de idade foram divididos em 4 grupos de 13 animais cada: hipertenso sedentario [...]

Pulmonary Ultrasound in Patients with Heart Failure - Systematic Review.

Abstract: Pulmonary congestion is an important clinical finding in patients with heart failure (HF). Physical examination and chest X-ray have limited accuracy in detecting congestion. Pulmonary ultrasound (PU) has been incorporated into clinical practice in the evaluation of pulmonary congestion. This paper aimed to perform a systematic review of the use of PU in patients with HF, in different scenarios. A search was performed in the MEDLINE and LILACS databases in February 2017 involving articles published between 2006 and 2016. We found 26 articles in the present review, 11 of which in the emergency setting and 7 in the outpatient setting, with diagnostic and prognosis defined value and poorly studied therapeutic value. PU increased accuracy by 90% as compared to physical examination and chest X-ray for the diagnosis of congestion, being more sensitive and precocious. The skill of the PU performer did not interfere with diagnostic accuracy. The presence of B-lines ≥ 15 correlated with high BNP values (≥ 500) and E/e' ratio ≥ 15, with prognostic impact in IC patients at hospital discharge and those followed up on an outpatient basis. In conclusion, when assessing pulmonary congestion in HF, PU has an incremental value in the diagnostic and prognostic approach in all scenarios studied.

Assessment of the Relationship between Monocyte to High-Density Lipoprotein Ratio and Myocardial Bridge

Abstract: Background: Assessing the monocyte to high-density lipoprotein ratio (MHR) is a new tool for predicting inflamation, which plays a major role in atherosclerosis. Myocardial bridge (MB) is thought to be a benign condition with development of atherosclerosis, particularly at the proximal segment of the brigde. Objective: To evaluate the relationhip between MHR and the presence of MB. Methods: We consecutively scanned patients referred for coronary angiography between January 2013- December 2016, and a total of 160 patients who had a MB and normal coronary artery were enrolled in the study. The patients’ angiographic, demographic and clinic characteristics of the patients were reviewed from medical records. Monocytes and HDL-cholesterols were measured via complete blood count. MHR was calculated as the ratio of the absolute monocyte count to the HDL-cholesterol value. MHR values were divided into three tertiles as follows: lower (8.25 ± 1.61), moderate (13.11 ± 1.46), and higher (21.21 ± 4.30) tertile. A p-value of < 0.05 was considered significant. Results: MHR was significantly higher in the MB group compared to the control group with normal coronary arteries. We found the frequency of MB (p = 0.002) to increase as the MHR tertiles rose. The Monocyte-HDL ratio with a cut-point of 13.35 had 59% sensitivity and 65.0% specificity (ROC area under curve: 0.687, 95% CI: 0.606-0.769, p < 0.001) in accurately predicting a MB diagnosis. In the multivariate analysis, MHR (p = 0.013) was found to be a significant independent predictor of the presence of MB, after adjusting for other risk factors. Conclusion: The present study revealed a significant correlation between MHR and MB.

Cardiac Evaluation in the Acute Phase of Chagas' Disease with Post-Treatment Evolution in Patients Attended in the State of Amazonas, Brazil.

Abstract: Background In the past two decades, a new epidemiological profile of Chagas' disease (CD) has been registered in the Brazilian Amazon where oral transmission has been indicated as responsible for the increase of acute cases. In the Amazonas state, five outbreaks of acute CD have been registered since 2004. The cardiac manifestations in these cases may be characterized by diffuse myocarditis, with alteration in the electrocardiogram (ECG) and transthoracic echocardiogram (TTE). Objective To perform a cardiac evaluation in autochthonous patients in the acute phase and at least one year after submitted to treatment for acute CD and evaluate the demographic variables associated with the presence of cardiac alterations. Methods We evaluated patients diagnosed with acute CD through direct parasitological or serological (IgM) methods from 2007 to 2015. These patients were treated with benznidazole and underwent ECG and TTE before and after treatment. We assumed a confidence interval of 95% (CI 95%, p Results We observed 63 cases of an acute CD in which oral transmission corresponded to 75%. Cardiac alterations were found in 33% of the cases, with a greater frequency of ventricular repolarization alteration (13%), followed by pericardial effusion (10%) and right bundle branch block and left anterior fascicular block (2%). The follow-up occurred in 48 patients with ECG and 25 with TTE for a mean period of 15.5 ± 4.1 months after treatment. Of these, 8% presented normalization of the cardiac alterations in ECG, 62.5% remained with the normal exams. All of the patients presented normal results in TTE in the post-treatment period. As for the demographic variables, isolated cases presented more cardiac alterations than outbreaks (p = 0.044) as well as cases from Central Amazonas mesoregion (p = 0.020). Conclusions Although cardiac alterations have not been frequent in most of the studied population, a continuous evaluation of the clinical-epidemiological dynamics of the disease in the region is necessary in order to establish preventive measures.

Left Ventricular Regional Wall Motion Abnormality is a Strong Predictor of Cardiotoxicity in Breast Cancer Patients Undergoing Chemotherapy

Abstract: Background Chemotherapeutic agents of anthracyclines class and humanized monoclonal antibodies are effective treatments for breast cancer, however, they present a potential risk of cardiotoxicity. Several predictors have been recognized as predictors in the development of cardiac toxicity, and the evaluation of left ventricular segmental wall motion abnormalities (LVSWMA) has not been studied. Objective To analyze prospectively the role of LVSWMA among echocardiographic parameters in the prediction of development of cardiotoxicity in breast cancer patients undergoing treatment with chemotherapy. Methods Prospective cohort of patients diagnosed with breast cancer and in chemotherapy treatment with potential cardiotoxicity medications including doxorubicin and trastuzumab. Transthoracic echocardiograms including speckle tracking strain echocardiography were performed at standard times before, during and after the treatment to assess the presence (or lack thereof) of cardiotoxicity. Cardiotoxicity was defined by a 10% decrease in the left ventricular ejection fraction, on at least one echocardiogram. Multivariate logistic regression models were used to verify the predictors related to the occurrence of cardiotoxicity over time. Results Of the 112 patients selected (mean age 51,3 ± 12,9 years), 18 participants (16.1%) had cardiotoxicity. In the multivariate analysis using the logistic regression model, those with LVWMA (OR = 6.25 [CI 95%: 1.03; 37.95], p Conclusion In the present study, we showed that LVWMA, in addition to global longitudinal strains, were strong predictors of cardiotoxicity and could be useful in the risk stratification of these patients.

Indicators of Abdominal Adiposity and Carotid Intima-Media Thickness:Results from the Longitudinal Study of Adult Health(ELSA-Brazil)

Abstract: Fundamento: A adiposidade abdominal e um fator de risco para doenca cardiovascular. Objetivo: Determinar a magnitude da associacao entre a adiposidade abdominal, segundo cinco diferentes indicadores, e a espessura medio-intimal de carotidas (EMI-C). Metodos: Usou-se dados de 8.449 participantes de 35 a 74 anos do ELSA-Brasil. Foi avaliado o efeito da circunferencia da cintura (CC), razao cintura quadril (RCQ), indice de conicidade (Indice C), produto da acumulacao lipidica (LAP) e indice de adiposidade visceral (IAV) sobre EMI-C. Os dados foram [...]