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    Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT)
    (Circulation, 2011) ACT Investigators; Tura, Bernardo R; Santos Junior, Bráulio dos; Cramer, Helena
    Background: It remains uncertain whether acetylcysteine prevents contrast-induced acute kidney injury. Methods and results: We randomly assigned 2308 patients undergoing an intravascular angiographic procedure with at least 1 risk factor for contrast-induced acute kidney injury (age >70 years, renal failure, diabetes mellitus, heart failure, or hypotension) to acetylcysteine 1200 mg or placebo. The study drugs were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). All analysis followed the intention-to-treat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 12.7% in the acetylcysteine group and 12.7% in the control group (relative risk, 1.00; 95% confidence interval, 0.81 to 1.25; P=0.97). A combined end point of mortality or need for dialysis at 30 days was also similar in both groups (2.2% and 2.3%, respectively; hazard ratio, 0.97; 95% confidence interval, 0.56 to 1.69; P=0.92). Consistent effects were observed in all subgroups analyzed, including those with renal impairment. Conclusions: In this large randomized trial, we found that acetylcysteine does not reduce the risk of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients undergoing coronary and peripheral vascular angiography. Clinical trial registration: http://www.clinicaltrials.gov. Unique identifier: NCT00736866.
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    Acute and subacute hemodynamic responses and perception of effort in subjects with chronic chagas cardiomyopathy submitted to different protocols of inspiratory muscle training: a cross-over trial
    (Disability and Rehabilitation, 2020) Frota, Aline Xavier; Mendes, Fernanda de Souza Nogueira Sardinha; Vieira, Marcelo Carvalho; Saraiva, Roberto Magalhães; Veloso, Henrique Horta; Silva, Paula Simplício da; Silva, Gilberto Marcelo Sperandio da; Sousa, Andréa Silvestre de; Mazzoli-Rocha, Flavia; Costa, Henrique Silveira; Rodrigues Junior, Luiz Fernando; Mediano, Mauro Felippe Felix
    Purpose: This study aimed to evaluate acute and subacute hemodynamic responses and perception of effort in individuals with CCC submitted to different IMT protocols. Materials and methods: This was a randomized cross-over trial conducted on CCC subjects with systolic left ventricular dysfunction (<45% left ventricular ejection fraction) without or with heart failure (stages B2 and C, respectively). Twenty-one participants performed two IMT protocols, one targeting 60% maximal inspiratory pressure with 3 × 10 repetitions (MIP60) and the other targeting 30% maximal inspiratory pressure (MIP30) with 3 × 20 repetitions with a 2 min recovery between sets for both. MIP60 and MIP30 were performed on the same day with a 2 h washout period. Measurements were taken at baseline, during and 60 min after IMT. Results: No differences in hemodynamic variables were observed across protocols. The perception of effort increased in both protocols, with higher scores for the MIP30 protocol (β = +1.6, p = 0.01; β = +1.1, p = 0.02; β = +0.9, p = 0.08 for the 1st, 2nd and 3rd sets, respectively). Conclusions: There were no differences in hemodynamic responses comparing MIP60 and MIP30 protocols in subjects with CCC. Despite the higher perception of effort during endurance protocol, both protocols can be considered a safe therapeutic strategy.IMPLICATIONS FOR REHABILITATIONDespite inspiratory muscle training may result in functional capacity improvements, no previous study evaluated the hemodynamic acute and subacute responses to inspiratory muscle training in chronic Chagas cardiomyopathy.The two inspiratory muscle training protocols (30% and 60% of maximal inspiratory pressure) did not cause significant hemodynamic repercussions in subjects with chronic Chagas cardiomyopathy.Inspiratory muscle training seems to be an effective strategy to improve functional capacity and can be implemented in the rehabilitation programs for patients with Chagas cardiomyopathy.Since no significant adverse responses were observed in any of the hemodynamic parameters during the inspiratory muscle training sessions, these two protocols of inspiratory muscle training (30% and 60% of maximal inspiratory pressure) seems to be safe in subjects with Chagas cardiomyopathy.
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    Acute cardiac injury in patients with covid-19
    (American Journal of Cardiovascular Disease, 2020) Lorenzo, Andrea De; Kasal, Daniel Barata; Tura, Bernardo Rangel; Rey, Helena Cramer; Lamas, Cristiane C.
    Introduction: Cardiac complications of COVID-19 are potentially life-threatening. The occurrence of myocardial injury in the context of COVID-19 is multifactorial and has generated increasing interest. Methods: A systematic review with a meta-analysis of the literature was performed. MEDLINE and EMBASE were searched. Two independent reviewers evaluated the selected manuscripts for the outcome “myocardial injury”, defined by troponin elevation above the 99th percentile. The study heterogeneity and risk of bias were evaluated. Results: Eight studies, with a total of 1,229 patients, were included. The frequency of myocardial injury was 16% (95% CI: 9%-27%). The heterogeneity among the studies was high (93%). Conclusions: Myocardial injury may occur in patients with COVID-19, with a frequency of 16% according to current studies. Continuous research is needed to update these findings as the pandemic evolves and to define the implications of myocardial injury in the context of this infection.
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    Acute cellular rejection and HLA mismatch in heart transplantation: insights from a developing country
    (Clinical Transplantation, 2016) Schtruk, Lígia Beatriz Chaves Espinoso; Guimarães, Tereza Cristina Fellipe; Pôrto, Luis Cristóvão; Kuschnir, Maria Cristina Caetano; Colafranceschi, Alexandre Siciliano; Silva Filho, Paulo Moreira da; Lorenzo, Andrea De
    The notable evolution of heart transplant (HTX) has paralleled the capacity of diagnosing rejection and, consequently, initiating timely treatment. Acute cellular rejection, diagnosed by endomyocardial biopsy, is the most frequent in the first 6 months after HTX. HLA matching is not routinely performed in HTX due to the absence of consensus regarding its usefulness. However, the use of HLA typing might be underscored if it could predict an increased risk of rejection. Therefore, the aim of this study was to evaluate, at a public cardiology center in Brazil, the association between HLA mismatches and the incidence of acute cellular rejection in the first 6 months after HTX. Data were obtained from hospital records and from the National Transplant System. Overall, there was no association between the number of HLA mismatches and the frequency of acute cellular rejection, but there was a tendency toward a higher incidence of rejection with HLA-DR incompatibility.
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    Acute coronary syndrome, a rare manifestation of infective endocarditis: a case report
    (Heart, Vessels and Transplantation, 2020) Tagliari, Fabio; Ribeiro, Caio Leal; Carvalho, Gabriel Padua Valladao de; Tagliari, Lais Pedroso; Weksler, Clara; Lamas, Cristiane da Cruz
    Systemic embolization in infective endocarditis is common, occurring in 45-65% of cases. However, the septic coronary embolization is a complication rarely described as a cause of acute myocardial infarction (AMI). The presentation of chest pain as the first manifestation of endocarditis is associated with a poor prognosis. Mitral valve endocarditis with embolization to the left anterior descending coronary is the most common situation described in the literature. We present a case of a young male patient with typical angina caused by acute myocardial infarction, who had an obstructive lesion to the marginal branch of the circumflex artery in the angiography, and was later diagnosed with aortic valve endocarditis.
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    Adequação da ingestão de macronutrientes e micronutrientes e sua relação com o estado nutricional em um grupo de idosos frequentadores do centro de atenção à saúde do idoso e cuidador da UFF/RJ
    (Brazilian Journal of Health Review, 2020) Barroso, Taianah Almeida; Huguenin, Grazielle Vilas Boas; Lopes, Maylin da Silva; Amaral, Ludmila Ferreira Vieira do; Sá, Selma Chaves Petra; Barroso, Sérgio Girão; Rocha, Gabrielle de Souza; Medeiros, Renata Frauches
    A população idosa é um dos grupos etários de maior risco à desnutrição e deficiências nutricionais devido ao declínio das funções cognitivas e fisiológicas que prejudicam a ingestão alimentar e o metabolismo dos nutrientes. Dessa forma é necessário o monitoramento e a caracterização das práticas alimentares e de seus determinantes nessa população, com vistas à prevenção dos distúrbios nutricionais e doenças a eles relacionadas. Os objetivos foram avaliar se a ingestão de macronutrientes (carboidrato, proteínas e lipídios) e micronutrientes (cálcio e vitamina D) pelos idosos estavam de acordo com as recomendações, e verificar a relação das variáveis antropométricas com os nutrientes. O estudo foi aprovado pelo Comitê de Ética. Trata-se de um estudo transversal com 34 pacientes, com idade acima de 60 anos, de ambos os sexos. Foram realizadas medidas antropométricas (peso, estatura, índice de massa corporal (IMC); circunferência abdominal, cintura, pescoço e quadril). O recordatório alimentar de 24 horas foi utilizado para calcular a ingestão dos nutrientes e a prevalências de inadequação dos micronutriente foi estimada utilizando como ponto de corte os valores da Estimated Average Requirement (EAR). Participaram do estudo 34 voluntários sendo 30 mulheres (88,2%) e 4 homens (11,7%). A média de idade foi de 72,37±13,27 anos, do IMC foi 28,47±4,45 kg/m², o que caracteriza sobrepeso na amostra. Em relação aos macronutrientes eles se encontraram adequados em relação as recomendações, sendo proteínas (20,7%), carboidratos (52,7%), e lipídios (26,6%). A ingestão de cálcio entre as mulheres apresentou um percentual de adequação de 41,66% semelhante a dos homens que foi 41,84%. Em relação a vitamina D encontramos 12,66% de adequação para ambos. A ingestão de vitamina D apresentou uma correlação inversa e significativa com o perímetro abdominal (r= -0,3718), IMC (r= -0,4919) e perímetro do pescoço (r= -0,4038), e o cálcio com o perímetro do pescoço (r=-0,4129). Verificou-se que apesar dos macronutrientes se adequados, a ingestão dos micronutrientes estudados se encontravam abaixo da recomendação, e esse valores estão relacionados com os preditores de gordura corporal da população.
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    Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery
    (Revista Brasileira de Cirurgia Cardiovascular, 2012) Rocha, Antônio Sergio C. da; Pittella, Felipe; De Lorenzo, Andrea; Barzan, Valmir; Colafranceschi, Alexandre Siciliano; Brito, José Oscar R.; Mattos, Marco Antonio de; Silva, Paulo Roberto Dutra da
    Objetivo: Analisar os resultados da cirurgia de revascularização miocárdica (CRVM) isolada com circulação extracorpórea em pacientes com idade ³ 70 anos em comparação àqueles com < 70 anos. Métodos: Pacientes submetidos consecutivamente à CRVM isolada. Os pacientes foram agrupados em G1 (idade³ 70 anos) e G2 (idade < 70 anos). Os desfechos analisados foram letalidade hospitalar, infarto agudo miocárdio (IAM), acidente vascular encefálico (AVE), reoperação para revisão de hemostasia (RRH), necessidade de balão intra-aórtico (BIA), complicações respiratórias, insuficiência renal aguda (IRA), mediastinite, sepse, fibrilação atrial (FA) e bloqueio atrioventricular total (BAVT). Resultados: Foram estudados 1033 pacientes, 257 (24,8%) do G1 e 776 (75,2%) do G2. A letalidade hospitalar foi significantemente maior no G1 quando comparado ao G2 (8,9% vs. 3,6%, P=0,001), enquanto a incidência de IAM foi semelhante (5,8% vs. 5,5%; P=0,87). Maior número de pacientes do G1 necessitou de RRH (12,1% vs. 6,1%; P=0,003). Da mesma forma, no G1 houve maior incidência de complicações respiratórias (21,4% vs. 9,1%; P<0,001), mediastinite (5,1% vs. 1,9%; P=0,013), AVE (3,9% vs. 1,3%; P=0,016), IRA (7,8% vs. 1,3%, P<0,001), sepse (3,9% vs. 1,9%; P=0,003), fibrilação atrial (15,6% vs. 9,8%; P=0,016) e BAVT (3,5% vs. 1,2%; P=0,023) do que o G2. Não houve diferença significante na necessidade de BIA. Na análise regressão logística multivariada “forward stepwise”, a idade ³ 70 anos foi fator preditivo independente para maior.
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    Association Between Work and Common Mental Disorders in School Adolescents: The ERICA Study
    (Clinics, 2020) Santos, Daniele Baptista dos; Mediano, Mauro Felippe Felix; Rodrigues Júnior, Luiz Fernando; Santos Junior, Braulio dos; Lorenzo, Andrea Rocha de; Kuschnir, Maria Cristina Caetano
    OBJECTIVES: Adolescence is characterized by continuing profound mental, physical, and social changes and entering into the labor market during this phase may have negative consequences on physical and mental health. Common mental disorders (CMD) are characterized as disorders of mental functions, including symptoms of depression and anxiety as well as various nonspecific and somatic complaints such as reduced ability to concentrate, tiredness, irritation, and forgetfulness. Despite its increasing prevalence, few studies have addressed CMD and its association with work, in adolescents. In the present study, we aimed to identify the main factors associated with CMD and evaluated its association with work, in school adolescents. METHODS: A cross-sectional study was conducted with 12 to 17-year-old adolescent students using a self-administered questionnaire with questions related to work. CMD was verified using the General Health Questionnaire of 12 items. In total, 3424 adolescents were studied. RESULTS: The prevalence of CMD and work in the last year was 28.72% and 19.63%, respectively. After adjustment for potential confounding variables, multivariate analysis showed associations of CMD with female gender (OR=2.72) and work (OR=1.70). CONCLUSION: In the present study, a high number of cases of CMD were observed among the studied adolescents. Female gender and work history in the last year were negatively and independently associated with the presence of CMD.
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    The association of selenium status with thyroid hormones and anthropometric values in dyslipidemic patients
    (Nutrición Hospitalaria, 2015) Carvalho, Roberta F; Rosa, Glorimar; Huguenin, Grazielle VB; Luiz, Ronir R; Moreira, Annie SB; Oliveira, Glaucia MM
    Background: Selenium (Se) is an essential micronu- trient that performs physiological functions in the meta- bolism of thyroid hormone and may have an association with anthropometric variables relevant to cardiovascu- lar disease. Aim: To study the associations between Se status, thyroid hormones and anthropometric variables in dyslipidemic patients.Methods: Eighty-three patients were assessed in a cross-sectional study. Blood samples were analyzed for Se and thyroid hormones. Anthropo- metric measurements were taken, and dietary Se intake was investigated. Results: Mean plasma Se concentrations were low in the patients, at 88.7 ± 16.7 μg/L. Patients with plasma Se ≥ 95 μg/L were found to have a higher body mass index (BMI) (30.74 ± 4.31 vs 27.68 ± 5.63 kg/m2 , P = 0.02) and waist-to-height ratio (0.65 ± 0.05 vs 0.59 ± 0.07, P = 0.003) when compared to those with concentrations between 80 and 94 μg/L. Se intake associated positively with T3 L/T4 L ratio (r = 0.273; P= 0.03), BMI (r= 0.257, P= 0.04) and WC (r= 0.299, P= 0.02). Conclusion: The patients with the highest normal plasma Se concentrations were found to have increases in the anthropometric variables we in- vestigated. There is a need for further study in order to elucidate these findings. Furthermore, we found a positi- ve association between Se intake and the most metaboli- cally active form of the thyroid hormones.
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    Associations between cardiac magnetic resonance T1 mapping parameters and ventricular arrhythmia in patients with chagas disease
    (The American Journal of Tropical Medicine and Hygiene, 2020) Pinheiro, Martha Valéria Tavares; Moll-Bernardes, Renata Junqueira; Camargo, Gabriel Cordeiro; Siqueira, Fabio Paiva; Azevedo, Clerio Francisco de; Holanda, Marcelo Teixeira de; Mendes, Fernanda de Souza Nogueira Sardinha; Sangenis, Luiz Henrique Conde; Mediano, Mauro Felippe Felix; Sousa, Andréa Silvestre de
    Chronic Chagas disease can progress to myocardial involvement with intense fibrosis, which may predispose patients to sudden cardiac death through ventricular arrhythmia. The associations of myocardial fibrosis detected by cardiac magnetic resonance (CMR) parameters with non-sustained ventricular tachycardia (NSVT) were evaluated. This cross-sectional study included patients in early stages of Chagas disease (n = 47) and a control group (n = 15). Patients underwent cardiac evaluation, including CMR examination. Myocardial fibrosis assessment by CMR with measurement of late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) was performed. There was an increase in myocardial fibrosis CMR parameters and ventricular arrhythmias among different stages of Chagas disease, combined with a decrease in the left ventricular ejection fraction (LVEF) by CMR and also in the right ventricular systolic function by S’ wave on tissue Doppler. Fibrosis mass and ECV were associated with the Rassi score, ventricular extrasystole, and E/e’ ratio in a logistic regression model adjusted for age and gender. The ECV maintained an association with the presence of NSVT, even after adjustments for fibrosis mass and LVEF assessed by CMR. The receiver-operating characteristic area under the curve for global ECV (0.85; 95% CI: 0.71–0.99) and NSVT was greater than that for fibrosis mass (0.75; 95% CI: 0.54–0.96), although this difference was not statistically significant. Extracellular volume could be an early marker of increased risk of ventricular arrhythmia in Chagas disease, presenting an independent association with NSVT in the initial stages of chronic Chagas cardiomyopathy, even after adjustment for fibrosis mass and LVEF.
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    Avaliação do Prognóstico na Cardiomiopatia Chagásica através do Teste Cardiopulmonar de Exercício
    (International Journal of Cardiovascular Sciences, 2015) Souza, Fernando Cesar de Castro e; De Lorenzo, Andrea; Serra, Salvador Manoel; Colafranceschi, Alexandre Siciliano
    Fundamentos: A insuficiência cardíaca de etiologia chagásica (ICCh) parece ter maior mortalidade que a de outras com disfunção sistólica. O teste cardiopulmonar de exercício (TCPE) é uma ferramenta de avaliação prognóstica ainda pouco estudada na cardiopatia chagásica. Objetivo: Avaliar se o TCPE pode discriminar as diferenças prognósticas da ICCh em comparação às de etiologia não chagásica (ICNCh) e verificar quais das suas variáveis são preditoras independentes de mau prognóstico. Métodos: Análise retrospectiva de 21 pacientes com ICCh e 76 pacientes com ICNCh encaminhados ao TCPE, e seguidos quanto à sua mortalidade em dois anos. Resultados: No seguimento, houve óbito de 5 pacientes no grupo chagásico (GC) e 25 no grupo não chagásico (GNC). A curva de Kaplan-Meier não mostrou diferença na curva de sobrevida entre os grupos (p=0,43). A regressão logística encontrou a potência circulatória como uma variável preditora independente para óbito para ambos os grupos, com uma razão de risco para o GC de 17,3 (IC95% 1,39-217,0; p=0,027) e no GNC de 4,8 (IC95% 1,59-14,6; p=0,005). A curva ROC para esta variável encontrou uma área de 0,91 (IC95% 0,78-1,00; p=0,006) com um valor de corte ≤1280mmHg.mL.kg-1.min-1 no GC e uma área de 0,75 (IC95% 0,64-0,86; p<0,0001) com um valor de corte de ≤1245mmHg.mL.kg-1.min-1 no GNC. Conclusão: A potência circulatória foi a variável associada à morte em ambos os grupos, e deve ser mais amplamente utilizada como indicador de prognóstico na insuficiência cardíaca.
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    Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort
    (Open Forum Infectious Diseaes, 2020) Fernández Hidalgo, Núria; Gharamti, Amal A; Aznar, María Luisa; Almirante, Benito; Yasmin, Mohamad; Fortes, Claudio Querido; Plesiat, Patrick; Doco-Lecompte, Thanh; Rizk, Hussein; Wray, Dannah; Lamas, Cristiane; Durante-Mangoni, Emanuele; Tattevin, Pierre; Snygg-Martin, Ulrika; Hannan, Margaret M; Chu, Vivian H; Kanafani, Zeina A
    Background: Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE. Methods: The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators. Results: Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009). Conclusions: BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.
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    Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: The perspective of a developing country
    (Journal of Nuclear Cardiology, 2016) Santos, Mauro Augusto dos; Santos, Marisa Silva; Tura, Bernardo Rangel; Felix, Renata; Brito, Adriana Soares X; De Lorenzo, Andrea
    Myocardial perfusion imaging is widely used for the risk stratification of coronary artery disease. In view of its cost, besides radiation issues, judicious evaluation of the appropriateness of its indications is essential to prevent an unnecessary economic burden on the health system. We evaluated, at a tertiary-care, public Brazilian hospital, the appropriateness of myocardial perfusion scintigraphy indications, and estimated the budget impact of applying appropriateness criteria. An observational, cross-sectional study of 190 patients with suspected or known coronary artery disease referred for myocardial perfusion imaging was conducted. The appropriateness of myocardial perfusion imaging indications was evaluated with the Appropriate Use Criteria for Cardiac Radionuclide Imaging published in 2009. Budget impact analysis was performed with a deterministic model. The prevalence of appropriate requests was 78%; of inappropriate indications, 12%; and of uncertain indications, 10%. Budget impact analysis showed that the use of appropriateness criteria, applied to the population referred to myocardial perfusion scintigraphy within 1 year, could generate savings of $ 64,252.04 dollars. The 12% inappropriate requests for myocardial perfusion scintigraphy at a tertiary-care hospital suggest that a reappraisal of MPI indications is needed. Budget impact analysis estimated resource savings of 18.6% with the establishment of appropriateness criteria for MPI.
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    Budget Impact of Cryoablation Versus Radiofrequency Ablation of Atrial Fibrillation in the Brazilian Public Healthcare System
    (Value in Health Regional Issues, 2019) Paço, Patricia; Tura, Bernardo; Santos, Marisa; Amparo, Pedro; De Lorenzo, Andrea
    Background: Cryoablation is a new technology for ablation of atrial fibrillation (AF), effective and safe when compared with standard radiofrequency (RF) ablation. Nevertheless, the economic impact of its incorporation is unknown, especially considering the public health system of a developing country. This study analyzed the budget impact of cryoablation incorporation for treatment of paroxysmal AF in the Brazilian public health system. Methods: The budget impact was calculated as the cost difference between the current scenario (RF ablation guided by electroanatomic mapping) and the new scenario (cryoablation). The cost of each intervention was obtained by multiplying the price of a single procedure by the number of candidates for it. Other technologies (RF ablation guided by intracardiac echocardiography or with a nonirrigated catheter) were considered in a sensitivity analysis. Results: The budget impact showed savings of $43 097 096.84 with cryoablation. In the sensitivity analysis, cryoablation resulted in cost savings compared with RF ablation guided by intracardiac echocardiography, whereas in comparison to RF ablation with the nonirrigated catheter, cryoablation was more expensive. A market share assessment, performed using an incorporation rate of 3% per year, indicated savings of approximately $800 000 per 5 years. Conclusions: Cryoablation of AF resulted in cost savings compared with the current scenario (RF ablation guided by electroanatomic mapping). When alternative technologies were considered, cryoablation was more expensive than RF ablation with a nonirrigated catheter, but it also resulted in savings compared with RF ablation guided by intracardiac echocardiography. Overall, cryoablation of AF may reduce expenditures in the Brazilian public health system.
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    Características antropométricas e metabólicas em obesos com transtorno alimentar
    (HUPE - Hospital Universitário Pedro Ernesto, 2015) Silva, Henyse G. V. da; Magalhães, Vera Cristina; Oliveira, Beatriz A.; Rosa, Juliana S.; Santos, Thaíza T; Moreira, Annie B
    O transtorno de compulsão alimentar periódica (TCAP) é um distúrbio psiquiátrico com alta morbidade, associado à obesidade e ao alto risco cardiovascular. O objetivo deste trabalho foi identificar alterações antropométricas e/ou metabólicas em obesos com TCAP e compará-las àqueles sem TCAP. Estudo transversal realizado no ambulatório do Napta/ UERJ, envolvendo 39 adultos obesos, sem doenças malignas ou consumptivas e medicamentos que interferissem nos re- sultados, sendo 22 com e 17 sem TCAP. As variáveis coletadas foram peso, estatura, perímetro da cintura, pressão arterial; e foram analisadas glicemia, perfil lipídico, dosagem de leptina, adiponectina e insulina, sendo calculado o Índice HOMA IR. Os dados foram expressos como média (desvio-padrão), sendo utilizados os testes: Qui-quadrado e t-Student. O valor de signi- ficância foi 5%. Amostra composta por 82% de mulheres, com elevada prevalência de hipertensão arterial, resistência insu- línica e sedentarismo, sem diferenças entre os grupos com ou sem TCAP. Todos apresentaram o perímetro da cintura acima da recomendação, mais de 60% apresentaram HDL-colesterol baixo e um terço, triglicerídeos elevados. Não houve diferença dos níveis de adiponectina nem de leptina entre obesos com ou sem TCAP, apesar de os valores estarem fora dos limites normais. Obesos, independentemente do diagnóstico de TCAP, têm elevado risco cardiovascular com alta prevalência de hipertensão arterial, dislipidemia, circunferência de cintura alterada e sedentarismo. Além disso, apresentam inflamação crônica de baixo grau com baixos níveis de adiponectina e altos de leptina. Entretanto, apesar de estas afirmativas terem sido confirmadas, não foram identificadas diferenças signifi- cativas entre obesos com o transtorno alimentar.
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    Características Clínicas, Antropométricas e Bioquímicas de Pacientes com ou sem Diagnóstico Confirmado de Hipercolesterolemia Familiar
    (Arquivos Brasileiros de Cardiologia, 2018) De Lorenzo, Andrea; Silva, Juliana Duarte Lopes da; James, Cinthia E.; Pereira, Alexandre C.; Moreira, Annie Seixas Bello
    Fundamentos: A hipercolesterolemia familiar (HF) é uma doença autossômica dominante, caracterizada por altos níveis plasmáticos do colesterol da lipoproteína de baixa densidade (LDL-C) e pelo alto risco de desenvolvimento prematuro de doenças cardiovasculares. Objetivo: Avaliar características clínicas e antropométricas de pacientes com fenótipo para hipercolesterolemia familiar (HF), com ou sem diagnóstico genético de HF. Métodos: Quarenta e cinco pacientes com LDL-C > 190 mg/dL foram genotipados para seis genes relacionados com a HF: LDLR, APOB, PCSK9, LDLRAP1, LIPA e APOE. Pacientes que apresentaram resultado positivo para qualquer uma das mutações foram diagnosticados com HF por confirmação genética. O fenótipo para HF foi classificado pelo critério da Dutch Lipid Clinic Network. Resultados: Comparando os pacientes com a HF geneticamente confirmada com aqueles sem a confirmação, os primeiros apresentaram maior pontuação do escore para HF, uma maior frequência de xantelasma e maiores níveis de LDL-C e apo B. Houve correlações significativas entre o LDL-C e a pontuação do escore para HF (R = 0,382, p = 0,037) e entre LDL-C e gordura corporal (R = 0,461, p = 0,01). Os pacientes com mutações, no entanto, não apresentaram qualquer correlação entre o LDL-C e outras variáveis, enquanto aqueles sem mutação apresentaram correlação entre o LDL-C e a pontuação do escore. Conclusão: O LDL-C correlacionou-se com a pontuação do escore e com a gordura corporal, tanto na população total de pacientes quanto nos pacientes sem a confirmação genética de HF. Naqueles com HF geneticamente confirmada, não houve correlação entre o LDL-C e outras variáveis clínicas ou bioquímicas dos pacientes.
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    A cardiac rehabilitation exercise program potentially inhibits progressive inflammation in patients with severe chagas cardiomyopathy: a pilot single-arm clinical trial
    (Journal of Research in Medical Sciences, 2020) Rodrigues Junior, Luiz Fernando; Mendes, Fernanda de Souza Nogueira Sardinha; Pinto, Vivian Liane Mattos; Silva, Paula Simplicio da; Silva, Gilberto Marcelo Sperandio da; Pinheiro, Roberta Olmo; Sousa, Andréa Silvestre de; Mediano, Mauro Felippe Felix
    Background: Cardiac rehabilitation exerts anti‑ inflammatory effect on several cardiovascular diseases; however, these effects were not described for Chagas cardiomyopathy, which is associated with pro‑ inflammatory imbalance. Materials and Methods: Ten patients with severe Chagas cardiomyopathy performed 8 months of exercise training in a cardiac rehabilitation program. Interleukin‑ 1 beta (IL‑ 1β ), IL‑ 8, IL‑ 10, interferon gamma (IF‑ γ ), tumor necrosis factor alpha (TNF‑ α ), and monocyte chemoattractant protein‑ 1 (MCP‑ 1) serum levels were measured using enzyme‑ linked immunosorbent assay at baseline, 4, and 8 months. The influence of exercise on cytokine levels was evaluated using the one‑ way analysis of variance for repeated measurements, with Bonferroni posttest for multiple comparisons. Results: Levels of pro‑ inflammatory (TNF‑ α , IL‑ 1β , IL‑ 8, IF‑ γ , and (MCP‑ 1) and anti‑ inflammatory (IL‑ 10) cytokines did not vary significantly during the observation period. Conclusion: Exercise may benefit patients with severe Chagas cardiomyopathy by curbing the production of pro‑ inflammatory cytokines in this disease characterized by a continuous state of inflammation.
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    Caries experience in young children with congenital heart disease in a developing country
    (Epidemiology, 2013) Pimentel, Elizangela Lins Cavalcanti; Azevedo, Vitor Manuel Pereira; Azevedo, Vitor Manuel Pereira; Azevedo, Vitor Manuel Pereira
    Oral care is frequently suboptimal in children from developing countries, especially those suffering from severe systemic diseases. The aim of the present study was to analyze the oral epidemiological profile of 3-to-5-year-old children with congenital heart disease. Dental and medical records of children evaluated at the Dental Service of the National Institute of Cardiology, Rio de Janeiro, Brazil, were reviewed. Caries experience was reported using the dmft index. Negative behavior towards dental management was recorded. The sample consisted of 144 children aged 4.41 ± 0.95 years. The mean dmft value was 5.4 ± 4.9, and 80.5% had at least one caries lesion. Dmft index was greater in the presence of cyanotic cardiac disease and in children with negative behavior. An increase in the “missing” component of the dmft index was also found in children using medicine on a daily basis. A higher caries experience was associated with children whose fathers had only an elementary education. In conclusion, children with congenital heart disease had high levels of caries experience at a young age. Cyanosis, negative behavior, daily use of medicine, one-parent family and the educational level of fathers seem to influence caries experience in children with congenital cardiac disease.
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    Chikungunya fever: How accurate is the clinical-epidemiological diagnosis compared to the gold standard of molecular and serological laboratory diagnosis?
    (Journal of Clinical Virology, 2020) Paula, Hury Hellen Souza de; Martins, André Frederico; Chagas, Raphael Rangel das; Moreira, José; Aguiar, Renato Santana de; Lamas, Cristiane da Cruz; Cardozo, Sergian Vianna
    Objective To evaluate the accuracy of the current World Health Organization' (WHO) Chikungunya fever (CHIKF) clinical-epidemiological case definition against the gold standard of laboratory diagnosis. Methods This was a prospective study of patients seeking medical care at an Emergency Department in the metropolitan area of Rio de Janeiro, Brazil, from January to June 2018. Clinical features were recorded. Screening for CHIKF was performed using the RT-qPCR and ELISA-IgM antibody assay. Clinical features of CHIKF RT-qPCR/IgM positive cases were compared with those with other febrile illnesses. Results 27,900 ED visits were recorded, of which 172 (0.61 %) patients were screened for arboviral illness. The prevalence of laboratory-confirmed CHIKF (Lab-CHIKF) was 110/172 [64 %]. Chikungunya virus RNA was detected in 92/172 (53.5 %) patients, while in 18/80 (10.5 %), only IgM was positive. Compared to CHIKV-negative subjects, patients with CHIKF presented much earlier after the onset of symptoms (2 [[1], [2], [3], [4]] vs. 3.5 [2.5−5], p = 0.007), and more frequently reported arthritis (61.8 % vs. 33.9 %, p < 0.0001), arthralgia (96.4 % vs. 79 %, p < 0.0001), and conjunctivitis (35.5 % vs. 16.1 %, p = 0.007). After adjustments for other clinical predictors, arthritis/arthralgia [aOR: 6 (95 % CI 1.8–19.7)] and the presence of conjunctivitis [aOR: 2.85 (95 % CI 1.30−6.24] were positively associated with lab-CHIKF. The sensitivity, specificity, positive predictive value, and negative predictive value of the WHO CHIKF clinical case definition was 96.3 %, 20.9 %, 68.3 % and 76.4 %, respectively, and accuracy was 0.69 [AUC: 0.69 (95 % CI 0.61−0.75)]. Conclusion The WHO case definition needs to be improved for better accuracy, especially in areas in epidemics in areas with co-circulation of arboviruses.
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    Comprehensive care for patients with Chagas cardiomyopathy during the coronavirus disease pandemic
    (Revista da Sociedade Brasileira de Medicina Tropical, 2020) Mazzoli-Rocha, Flavia; Mendes, Fernanda de Souza Nogueira Sardinha; Silva, Paula Simplicio; Silva, Gilberto Marcelo Sperandio da; Mediano, Mauro Felippe Felix; Sousa, Andréa Silvestre de
    Chagas disease is a neglected tropical disease according to the World Health Organization1. The most common clinical complication of Chagas disease is Chagas cardiomyopathy, that represents the main cause of non-ischemic cardiomyopathy in Latin America, affecting 20% to 40% of infected people2. The chronic form, with a slow and persistent course, results from the destruction of the myocardial fibers, caused by a chronic inflammatory process. It is associated with intense reparative fibrosis and progressive ventricular remodeling and manifests as heart failure and/or arrhythmic and thromboembolic syndromes3