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Aborted sudden cardiac death in A 12 old girl - a rare manifestation of a common disease
(Cambridge University Press, 2023) Machado, Hérica Falci Ferreira; Araujo, Yasmin Farias Rodrigues; Innocenze, Adriana Macintyre; Malan, Iara Atié; Tzirulnik, Pedro Cunha; Soares, Viviane Xavier; Faria, Catharina de Almeida Serra; Marins, Marina Conrado Riedel; Silva, Renata Mattos
Aerobic exercise simultaneous with non-invasive ventilation reduces the length of stay in intensive care in patients with heart failure: a randomised clinical trial
(EUROPEAN JOURNAL OF PHYSIOTHERAPY, 2024) Leone, Carolina Nigro Di; Diniz, Clara Pinto; Araújo, Thais Marvila Vieira de; Sant’ Anna Jr., Mauricio de; Lamas, Cristiane da Cruz; Mediano, Mauro Felippe Felix; Guimarães, Tereza Cristina Felippe; Rodrigues Jr., Luiz Fernando
Introduction: Early cardiac rehabilitation using non-invasive ventilation (NIV) and aerobic exercise may reduce the length of hospital stay in patients with heart failure (HF), however, there is still no evidence of this effect on patients in the intensive care unit (ICU). Objectives: to investigate the effects of aerobic exercise (AE) performed simultaneously with non-inva- sive ventilation (NIV) on the length of intensive care stay (LICUS) in patients diagnosed with decom- pensated heart failure (HF) admitted to the intensive care units (ICU). Methods: Twenty-eight patients admitted to the intensive care unit (ICU) because of decompensation of HF were randomised into two groups: the intervention group (AE þ NIV), and a control group. The intervention group’s treatment strategy involved simultaneous AE with NIV daily. The control group performed non-simultaneous AE and NIV daily during their ICU stay. The primary outcome was LICUS. The secondary outcomes were the length of hospital stay, peripheral and respiratory muscle strength, functional status, functional classification, and exercise tolerance. Results: The mean LICUS was shorter in AE þ NIV than in the control group (6.3 ± 4.7 days vs 8.3 ± 3.6 days, respectively; p 1⁄4 0.015). Secondary outcomes were similar between groups, except for exercise hemodynamics, which was improved in AE þ NIV, as showed by the decreased diastolic blood pressure immediately after the exercise tolerance test. Conclusion: The use of AE simultaneous with NIV reduced the LICUS of patients admitted to the ICU because of decompensated HF. This innovative approach is a promising tool for accelerating ICU dis- charge during the in-hospital rehabilitation of patients with HF.
AORTIC DISSECTION DIAGNOSED DURING TREATMENT OF HYDATIDIFORM MOLE: A CASE REPORT
(Journal of the American College of Cardiology, 2024) Monteiro, Thaissa; Deorsola, Breno; Leal, Stella; Brito, Izadora Bighetti; Velloso, Nathalia; Stockler, Márcia Olivares; Nishijuka, Fabio Akio
AORTIC DISSECTION WITH A BICUSPID AORTIC VALVE RESULTING IN ST-ELEVATION MYOCARDIAL INFARCTION
(Journal of the American College of Cardiology, 2024) Monteiro, Thaissa; Soares, Amanda Marinho; Reis, Leonardo; Brandão, Luiza Fonseca; Dantas, Carlos; Nishijuka, Fabio Akio
Biomarcadores na Avaliação de Pacientes Submetidos à Quimioterapia com Antraciclinas
(Arquivos Brasileiros de Cardiologia, 2024) Issa, Aurora Felice Castro
Cardiac and Liver Fibrosis Assessed by Multiparametric MRI in Patients with Fontan Circulation
(Pediatric Cardiology, 2024) Innocenzi, Adriana; Rangel, Isabela; Póvoa‐Corrêa, Mariana; Parente, Daniella Braz; Perez, Renata; Rodrigues, Rosana Souza; Fukuyama, Lúcia Tomoko; Barroso, Julia Machado; Oliveira Neto, Jaime Araújo; Sousa, Andréa Silvestre de; Luiz, Ronir Raggio; Barbosa, Rosa Célia Pimentel; Camargo, Gabriel Cordeiro; Moll‐Bernardes, Renata
The abnormal hemodynamics in Fontan circulation due to persistently increased systemic venous pressure results in hepatic venous congestion and Fontan-associated liver disease. Combined assessment of cardiac and liver fbrosis and cardiac remodeling using multiparametric MRI in this context have not been fully explored. To evaluate cardiac and liver fbrosis and cardiac remodeling using multiparametric MRI in patients who have undergone Fontan procedures. Thirty-eight patients and 23 controls underwent cardiac and liver MRI examinations in a 3.0-T scanner. Mann–Whitney, Fisher exact test, and Spearman’s correlation were applied to evaluate myocardial volumes, function, native cardiac and liver T1 mapping, ECVs and liver stifness. The mean native cardiac T1 value (p=0.018), cardiac ECV (p<0.001), liver native T1 (p<0.001), liver ECV (p<0.001), and liver stifness (p<0.001) were higher in patients than controls. The indexed end-diastolic volume (EDVi) correlated with the myocardial ECV (r=0.356; p=0.033), native liver T1 (r=0.571; p<0.001), and with liver stif- ness (r=0.391; p=0.015). In addition, liver stifness correlated with liver ECV (r=0.361; p=0.031) and native liver T1 (r=0.458; p=0.004). An association between cardiac remodeling and cardiac and liver fbrosis were found in this population. The usefulness of MRI to follow cardiac and liver involvement in these patients is critical to improve treatment strategies and to prevent the need for combined liver and heart transplantation.
Challenges in the approach to a patient with aortic stenosis and cardiac amyloidosis with ATTR mutation associated with negative scintigraphy - A case report
(American Heart Journal Plus, 2024) Magalhães, Gabriela Carvalho Monnerat; Bezerra, Luciana Coutinho; Binensztok, Beny; Vilela, Maysa Ramos; Braga, Ellen Fernanda das Neves; Brito, Adriana Soares Xavier de; Camargo, Gabriel Cordeiro; Camillis, Luiz Felipe; Rey, Helena Cramer Veiga; Weksler, Clara
Introduction: Cardiac amyloidosis (CA) poses significant diagnostic and therapeutic challenges. In this case report, we detail a patient with CA due to a rare transthyretin (CA-TTR) mutation, manifesting with negative myocardial scintigraphy and requiring genetic testing for diagnosis. The patient also had severe aortic stenosis (AS), necessitating discussion with a heart team to determine the optimal treatment strategy. Case report: A 70-year-old male with a family history of sudden death was previously diagnosed with third-degree atrioventricular block and treated with a pacemaker. He presented with worsening exertional dyspnoea, and examination revealed a third heart sound, a systolic murmur indicative of AS and bilateral muscular atrophy in the thenar region. Transthoracic echocardiography indicated severe AS and moderate left ventricular dysfunc tion, with images suggesting infiltrative disease. Pyrophosphate scintigraphy revealed no abnormal cardiac tracer uptake. Cardiac magnetic resonance imaging (MRI) revealed extensive, heterogeneous, subendocardial late gadolinium enhancement in both the atria and ventricles, which was consistent with CA. Genetic testing identified the Phe84Leu mutation in the TTR gene. Following heart team discussions, the patient underwent successful transcatheter aortic valve implantation (TAVI) and remained asymptomatic in follow-up, being monitored at an outpatient clinic specializing in CA and using tafamidis. Discussion: CA-TTR can be an autosomal dominant disease with variable penetrance involving abnormal amyloid protein deposition in tissues and can often be diagnosed noninvasively via myocardial scintigraphy. However, some TTR mutations do not affect scintigraphy results, necessitating genetic testing when clinical suspicion is high, potentially avoiding endomyocardial biopsy. Moreover, AS occurs in up to 16 % of TTR amyloidosis pa tients, with the conditions mutually exacerbating each other. Recent consensus suggests that TAVI reduces mortality in patients with severe AS and amyloidosis. Conclusions: Various diagnostic algorithms emphasize the use of myocardial scintigraphy for suspected CA-TTR. Genetic testing is crucial when scintigraphy results are negative, but clinical suspicion remains high, potentially circumventing invasive procedures. Compared with medical management alone, TAVI has been shown to improve quality of life and survival in patients with concurrent severe AS and CA.
Chronic Dissection Of The Ascending Aorta Leading To Heart Failure
(Journal of the American College of Cardiology, 2024) MONTEIRO, THAISSA; ZORZI, MARIANA; JUSTINIANO, MARINA; PAES, LUIZA DE MOARES PIRES; VIANNA, DIEGO SARTY; NISHIJUKA, FABIO
Diretriz Brasileira de Ergometria em População Adulta – 2024
(Arquivos Brasileiros de Cardiologia, 2024) Carvalho, Tales de; Freitas, Odilon Gariglio Alvarenga de; Chalela, William Azem; Hossri, Carlos Alberto Cordeiro; Milani, Mauricio; Buglia, Susimeire; Precoma, Dalton Bertolim; Falcão, Andréa Maria Gomes Marinho; Mastrocola, Luiz Eduardo; Castro, Iran; Albuquerque, Pedro Ferreira de; Coutinho, Ricardo Quental; Brito, Fabio Sandoli de; Alves, Josmar de Castro; Serra, Salvador Manoel; Santos, Mauro Augusto dos; Colombo, Clea Simone Sabino de Souza; Stein, Ricardo; Herdy, Artur Haddad; Silveira, Anderson Donelli da; Castro, Claudia Lucia Barros de; Silva, Miguel Morita Fernandes da; Meneghello, Romeu Sergio; Ritt, Luiz Eduardo Fonteles; Malafaia, Felipe Lopes; Pena, José Luiz Barros; Almeida, Antônio Eduardo Monteiro de; Vieira, Marcelo Luiz Campos; Júnior, Arnaldo Laffitte Stier
Diretriz de Tomografia Computadorizada e Ressonância Magnética Cardiovascular da Sociedade Brasileira de Cardiologia e do Colégio Brasileiro de Radiologia – 2024
(Arquivos Brasileiros de Cardiologia, 2024) Magalhães, Tiago Augusto; Carneiro, Adriano Camargo de Castro; Moreira, Valéria de Melo; Trad, Henrique Simão; Lopes, Marly Maria Uellendahl; Hadlich, Marcelo Souza
Diretriz sobre Diagnóstico e Tratamento da Cardiomiopatia Hipertrófica – 2024
(Arquivos Brasileiros de Cardiologia, 2024) Fernandes, Fabio; Simões, Marcus V.; Correia, Edileide de Barros; Marcondes-Braga, Fabiana Goulart; Coelho-Filho, Otavio Rizzi; Colafranceschi, Alexandre Siciliano
Diretrizes da Sociedade Brasileira de Cardiologia: Novas Normas, Novos Desafios
(Arquivos Brasileiros de Cardiologia, 2024) Polanczyk, Carisi A.; Luna, Leonardo Castro; Rey, Helena Cramer Veiga; Moreira, Humberto Graner; Arruda, José Airton de; Silva, Pedro Gabriel Melo de Barros e; Rocha, Mario de Seixas
DNA damage and repair in patients undergoing myocardial perfusion single‐photon emission computed tomography
(Scientifc Reports, 2024) Lorenzo, Andrea de; Fernandes, Maria Clara dos Santos; Romeiro, Francisco; Arpini, Anna Paula; Dias, Glauber Monteiro
As patient exposure to ionizing radiation from medical imaging and its risks are continuing issues, this study aimed to evaluate DNA damage and repair markers after myocardial perfusion single-photon emission computed tomography (MPS). Thirty-two patients undergoing Tc-99m sestamibi MP were studied. Peripheral blood was collected before radiotracer injection at rest and 60–90 min after injection. The comet assay (single-cell gel electrophoresis) was performed with peripheral blood cells to detect DNA strand breaks. Three descriptors were evaluated: the percentage of DNA in the comet tail, tail length, and tail moment (the product of DNA tail percentage and tail length). Quantitative PCR (qPCR) was performed to evaluate the expression of fve genes related to signaling pathways in response to DNA damage and repair (ATM, ATR, BRCA1, CDKN1A, and XPC). Mann–Whitney’s test was employed for statistical analysis; p< 0.05 was considered signifcant. Mean Tc-99m sestamibi dose was 15.1 mCi. After radiotracer injection, comparing post-exposure to pre-exposure samples o each of the 32 patients, no statistically signifcant diferences of the DNA percentage in the tail, tail length or tail moment were found. qPCR revealed increased expression of BRCA1 and XPC, without any signifcant diference regarding the other genes. No signifcant increase in DNA strand breaks was detected after a single radiotracer injection for MPS. There was activation of only two repair genes, which may indicate that, in the current patient sample, the efects of ionizing radiation on the DNA were not large enough to trigger intense repair responses, suggesting the absence of signifcant DNA damage.
EBSTEIN ANOMALY - WHEN NOT TO TRUST THE RIGHT VENTRICLE
(Journal of the American College of Cardiology, 2024) Nishijuka, Fabio Akio; Brito, Izadora Bighetti; Santos, Barbara; Callado, Luana; Anzanello, Maritza; Oliveira, Denoel; Cola, Maria; Monteiro, Thaissa
Efects of mixed nuts as part of a Brazilian Cardioprotective diet on LDL‐cholesterol in adult patients after myocardial infarction: a multicenter randomized controlled clinical trial
(Nutrition Journal, 2024) Bersch-Ferreira, Ângela Cristine; Weschenfelder, Camila; Machado, Rachel Helena Vieira; Santos, Renato Hideo Nakagawa; Riley, Terrence M.; Moreira, Annie Seixas Bello
Background: Nuts consumption is related to cardioprotective effects on primary cardiovascular prevention, but studies conducted in secondary prevention are small, scarce and controversial. The objective of this trial was to evaluate the effects of a regional and sustainable cardioprotective diet added or not with an affordable mixed nuts on cardiometabolic features in patients with previous myocardial infarction. Methods: DICA-NUTS study is a national, multi-center, and superiority-parallel randomized clinical trial. Males and females over 40 years old diagnosed with previous myocardial infarction in the last 2 to 6 months were included. Patients were allocated into two groups: the Brazilian Cardioprotective diet (DICA Br) supplemented with 30 g/day of mixed nuts (10 g of peanuts; 10 g of cashew; 10 g of Brazil nuts) (intervention group, n = 193); or only DICA Br prescription (control group, n = 195). The primary outcome was low-density lipoprotein cholesterol means (in mg/dL) after 16 weeks. Secondary outcomes were other lipid biomarkers, glycemic and anthropometric data and diet quality. Results: After adjustment for baseline values, participating study site, time since myocardial infarction and statin treatment regimen (high potency, moderate and low potency/no statins), no significant difference was found between the groups in low-density lipoprotein cholesterol concentrations (intervention-control difference: 3.48 mg/dL [-3.45 to 10.41], P = 0.32). Both groups improved their overall diet quality at the end of the study without differences between them after 16 weeks (intervention-control difference: 1.05 (-0.9 to 2.99); P = 0.29). Other lipids, glycemic profile and anthropometrics were also not different between study groups at the end of the study. Conclusion: Adding 30 g/day of mixed nuts to the DICA Br for 16 weeks did not change lipid, glycemic and anthropometric features in the post-myocardial infarction setting. Trial registration: This study is registered on ClinicalTrials.gov website under number NCT03728127 and its World Health Organization Universal Trial Number (WHO-UTN) is U1111-1259-8105.
Estatística Cardiovascular – Brasil 2023
(Arquivos Brasileiros de Cardiologia, 2024) Oliveira, Gláucia Maria Moraes de; Brant, Luisa Campos Caldeira; Polanczyk, Carisi Anne; Malta, Deborah Carvalho; Biolo, Andreia; Lorenzo, Andrea de
Evaluation of myocardial contraction fraction in transcatheter aortic valve replacement
(Heart, Vessels and Transplantation, 2024) Machado, Luana da Graça; Salgado, Angelo; Lorenzo, Andrea de
Objective: Myocardial contraction fraction (MCF), a costless, easy-to-perform echocardiographic measure, which estimates cardiac function through the volumetric measurement of myocardial shortening, may be a useful prognostic indicator in patients undergoing transcatheter aortic valve replacement (TAVR). This study aimed to evaluate MCF in patients who underwent TAVR at a public hospital in Rio de Janeiro, Brazil. Methods: This was a retrospective cohort study. Clinical and echocardiographic data were obtained from medical records. MCF was calculated as FDV in mL/FSV in mL x100, where FDV= final diastolic volume and FSV= final systolic volume. These were derived from the dimensions of the left ventricle. The FDV was estimated as 4.5 x (final diastolic diameter of the left ventricle) and the FSV was estimated as 3.72 x (final systolic diameter of the left ventricle). Patients were followed for 66 months, and all-cause mortality was registered. Results: Overall, 78 patients were studied. Median age was 78 years. Mortality was 56.4% over 9 years, with 29% of deaths in the first year. Pre-TAVR median MCF (45.9%) was low, while mean left ventricular ejection fraction (LVEF) was normal (57.0%). In patients who survived after the procedure, MCF increased post-TAVR, but in those who died, it decreased (49.3% vs 45.1%). Conclusions: MCF may demonstrate left ventricular dysfunction unrecognized by LVEF measurement in patients undergoing TAVR, and may be a prognostic marker in this patient population.
Fontan Associated Liver Disease (FALD) - When Should We Consider Combined Heart-lung Transplant
(Journal of Cardiac Failure, 2024) MONTEIRO, THAISSA SANTOS; ZORZ, MARIANA; JUSTINIANO, MARINA; PAES, LUIZA; INNOCENZI, ADRIANA; SILVA, RENATA MATTOS; PEREIRA, NELSON BONIFACIO; NISHIJUKA, FABIO
From bench to bedside: A review of the application and potential of microcirculatory assessment by hand-held videomicroscopy
(International Journal of Cardiology, Heart & Vasculature, 2024) Lorenzo, Andrea de; Fernandes, Marcos; Tibirica, Eduardo
In clinical practice, there is vast knowledge regarding the evaluation of macrocirculatory parameters, such as systemic blood pressure and cardiac output, for the hemodynamic monitoring of patients. However, assessment of the microcirculation has not yet been incorporated into the bedside armamentarium. Hand-held intravital video microscopy enables the direct, noninvasive, evaluation of the sublingual microcirculation at the bedside, offering insights into the status of the systemic microcirculation. It is easily performed and may be employed in several clinical settings, providing immediate results that may help guide patient management. Therefore, the incorporation of hand-held intravital video microscopy into clinical practice may lead to tremendous improve ments in the quality of care of critical, unstable patients or offer new data in the evaluation of patients with chronic diseases, especially those with microcirculatory involvement, such as occurs in diabetes.
Guide catheter extension use are associated with higher procedural success in chronic total occlusion percutaneous coronary interventions
(Catheterization and Cardiovascular Interventions, 2024) Filho, Evandro M.; Araujo, Gustavo N.; Machado, Guilherme P.; Padilla, Lucio; Paula, João E. T. de; Botelho, Antonio C.; Campos, Carlos M.; Quesada, Franklin L. H.; Alcantara, Marco; Santiago, Ricardo; Santos, Félix D. de los; Oliveira, Marcos D.; Ribeiro, Marcelo H.; Perez, Luiz; Pinto, Mauro E.; Côrtes, Leandro A.; Piccaro, Pedro; Brilakis, Emmanouil S.; Quadros, Alexandre S.
Background: Guide catheter extensions (GCEs) increase support and facilitate equipment delivery, but aggressive instrumentation may be associated with a higher risk of complications. Aim: Our aim was to assess the impact of GCEs on procedural success and complications in patients submitted to chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods: We analyzed data from the multicenter LATAM CTO Registry. Procedural success was defined as <30% residual stenosis and TIMI 3 distal flow. Major adverse cardiac and cerebrovascular events (MACCE) was defined as the composite of all‐cause death, myocardial infarction, target vessel revascularization, and stroke. Propensity score matching (PSM) was used to compare outcomes with and without GCE use. Results: From August 2010 to August 2021, 3049 patients were included. GCEs were used in 438 patients (14.5%). In unadjusted analysis, patients in the GCE group were older and had more comorbidities. The median J‐CTO score and its components were higher in the GCE group. After PSM, procedural success was higher with GCE use (87.7% vs. 80.5%, p = 0.007). The incidence of coronary perforation (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 0.78–2.71, p = 0.230), bleeding (OR: 1.99, 95% CI: 0.41–2.41, p = 0.986), in‐hospital death (OR: 1.39, 95% CI: 0.54–3.62, p = 0.495) and MACCE (OR: 1.07, 95% CI: 0.52–2.19, p = 0.850) were similar in both groups. Conclusion: In a contemporary, multicenter cohort of patients undergoing CTO PCI, GCEs were used in older patients, with more comorbidities and complex anatomy. After PSM, GCE use was associated with higher procedural success, and similar incidence of adverse outcomes.

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