Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance.

AIM: Our aim was to assess: 1) the impact of the eccentric left ventricular hypertrophy (ELVH) on exercise performance in patients diagnosed with chronic heart failure (CHF) alone and in patients with co-existing CHF and chronic obstructive pulmonary disease (COPD) and 2) the relationship between left and right cardiac function measurements obtained by doppler echocardiography, clinical characteristics and primary measures of cardiorespiratory fitness. METHODS: The current study included 46 patients (CHF:23 and CHF+COPD:23) that performed advanced pulmonary function tests, echocardiography and symptom-limited, incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. RESULTS: Patients with CHF+COPD demonstrated a lower work rate, peak oxygen uptake (VO2), oxygen pulse, rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with CHF. In addition, significant correlations were observed between VP and relative wall thickness (r: 0.45 p: 0.03),VE/VCO2 intercept and Mitral E/e' ratio (r: 0.70 p: 0.003) in the CHF group. Significant correlations were found between indexed left ventricle mass and RPP (r: -0.47; p: 0.02) and relative VO2 and right ventricle diameter (r: -0.62; p: 0.001) in the CHF+COPD group. CONCLUSION: Compared to a diagnosis of CHF alone, a combined diagnosis of CHF+COPD induced further impairments in cardiorespiratory fitness. Moreover, echocardiographic measures of cardiac function are related to cardiopulmonary exercise performance and therefore appear to be an important therapeutic target when attempting to improve exercise performance and functional capacity.

Is There Safety in the Use of Clopidogrel Loading Dose in Patients Over 75 Years of Age with Acute Coronary Syndrome?

There is limited evidence in the literature regarding the administration of clopidogrel to acute coronary syndrome (ACS) in patients over 75 years of age. Most studies excluded this age group, making the subject controversial due to the increased risk of bleeding in this population. Objective: This is a retrospective, unicentric, and observational study aimed at assessing whether the administration of clopidogrel loading dose increases bleeding rates in patients over 75 years of age. Methods: Patients were divided into two groups: group I: 75 mg of clopidogrel; group II: 300-to 600-mg loading dose of clopidogrel. A total of 174 patients (129 in group I and 45 in group II) were included between May 2010 and May 2015. Statistical analysis: The primary outcome was bleeding (major and/or minor). The secondary outcome was combined events (cardiogenic shock, reinfarction, death, stroke and bleeding). The comparison between groups was performed through Q-square and T-test. The multivariate analysis was performed by logistic regression, being considered significant p < 0.05. Results: Comparisons between groups I and II showed differences in the prevalence of diabetes (46.5% vs. 24.4%, p = 0.01), arterial hypertension (90.7% vs. 75, p = 0.01), dyslipidemia (62% vs. 42.2%, p = 0.021), ST segment elevation (11.6% vs. 26.6%, p = 0.016) and coronary intervention percutaneous (16.5% vs. 62.2%, p < 0.0001), respectively. In the multivariate analysis, significant differences were observed between groups I and II in relation to the occurrence of bleeding (8.5% vs. 20%, OR = 0.173, 95% CI: 0.049 - 0.614, p = 0.007). Conclusion: A loading dose of 300 mg or more of clopidogrel

[Prevalence of diabetes and impaired glucose tolerance in the urban population of 30 to 79 years of the city of São Carlos, São Paulo]. / Prevalência de diabetes melito e tolerância à glicose diminuída na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo.

OBJECTIVE: To assess the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the urban population aged 30-79 years of the city of São Carlos, São Paulo, Brazil. METHODS: It was performed a population survey, from August 2007 to June 2008. Non diabetic individuals, excluding pregnant women, and those with fasting capillary glycemia

Prevalência de diabetes melito e tolerância à glicose diminuída na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo / Prevalence of diabetes and impaired glucose tolerance in the urban population of 30 to 79 years of the city of São Carlos, São Paulo

OBJETIVO: Estimar a prevalência de diabetes melito (DM) e tolerância à glicose diminuída (TGD) na população urbana de 30 a 79 anos da cidade de São Carlos, São Paulo. MÉTODOS: Foi realizado estudo de base populacional entre agosto de 2007 e junho de 2008. Todos os indivíduos, exceto mulheres grávidas, não diabéticos e aqueles com glicemia capilar em jejum < 199 mg/dl foram submetidos a teste oral de tolerância à glicose e classificados em diabéticos, com TGD ou com tolerância normal à glicose. RESULTADOS: Participaram da pesquisa 1.116 voluntários. As prevalências gerais de DM e TGD foram 13,5 por cento e 5 por cento, respectivamente. Houve associação entre DM e TGD e as variáveis "idade", "escolaridade", "índice de massa corpórea" e "circunferência abdominal". Não houve associação entre DM ou TGD e as variáveis "gênero", "cor da pele" e "rendimento mensal". CONCLUSÕES: Houve aumento na prevalência de DM em comparação a estudos anteriores no Brasil e na região. Embora tenha havido avanços no diagnóstico, o tratamento do DM requer otimização.

OBJECTIVE: To assess the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in the urban population aged 30-79 years of the city of São Carlos, São Paulo, Brazil. METHODS: It was performed a population survey, from August 2007 to June 2008. Non diabetic individuals, excluding pregnant women, and those with fasting capillary glycemia < 199 mg/dl were administered oral glucose tolerance test and classified as diabetic, with IGT or with normal glucose tolerance. RESULTS: The number of individuals who participated in the study was 1,116. The overall rates of DM and IGT were 13.5 percent and 5 percent, respectively. DM and IGT were associated with age, education, body mass index and waist. They were not associated with gender, race or income. CONCLUSIONS: The prevalence of DM has increased when compared with previous studies in Brazil and in the state. Improvement in the diagnosis has occurred, however, treatment requires optimization.