A Multifactorial Analysis of Extracranial Carotid Disease: A Comprehensive Approach to Sonographic Criteria.

ABSTRACT: The present study brings a pictorial review aimed to discuss the multifactorial interpretation of extracranial carotid atheromatous disease, contemplating not only the degree of stenosis but also the arterial flow patterns, the intima-media thickness and the morphological characteristics of the atheromatous plaque. We merged the recommendations contained in the different reference literature on the topic to give a comprehensive approach to ultrasound criteria for diagnostic carotid examination. We infer that the carotid ultrasound evaluation must include important predictors of cardiovascular risk, which should be written in the ultrasound reports, thus allowing the adequate clinical approach to the disease.

Stroke Is Associated with Refractory Hypertension among Resistant and Refractory Patients in a Cross-Sectional Study

Abstract Background Refractory hypertension (RfH) is a severe phenotype of resistant hypertension (RH) linked to higher risk of stroke and other adverse cardiovascular events, but knowledge about it is still lacking. Objectives To evaluate the association between RfH and stroke. Methods We conducted a cross-sectional study in a referral clinic for patients with severe hypertension in the period from 2018 to 2020. RH was defined as uncontrolled blood pressure (BP) despite the use of 3 antihypertensive agents, including a diuretic, or the use of ≥ 4 agents regardless of BP control. RfH was defined as lack of BP control despite use of ≥ 5 antihypertensive agents. Individuals were classified as RfH or RH, and multivariate logistic regression models were constructed to examine the association between RfH and stroke. Results We evaluated a total of 137 patients; 81% were female, and 93,3% were Black or multiracial. The mean age was 64.4 years. Stroke was more prevalent in the RfH group (35.7%), in comparison to the RH group (12.8%) (p value = 0.01). Unadjusted odds ratio (OR) and 95% confidence interval (CI) for factors associated with stroke were RfH (OR 3.77; 95% CI 1.45 to 9.80), systolic BP (OR 1.02; 95% CI 1.002 to 1.04) and diastolic BP (OR 1.03; 95% CI 1.001 to 1.06). Adjusted OR for factors associated with stroke were RfH (OR 3.55; 95% CI 1.02 to 12.42), systolic BP (OR 1.02; 95% CI 0.99 to 1.05) and diastolic BP (OR 1.01; 95% CI 0.96 to 1.06). Conclusion RfH was associated with higher prevalence of stroke. Efforts are required to better understand this association to prevent adverse cardiovascular outcomes in these patients.

Simple Echocardiographic Parameters are Strong Predictors of the Cardiovascular Risk in Asymptomatic Individuals: Elsa-Brasil Cohort. / Parâmetros Ecocardiográficos Simples são Fortes Preditores de Risco Cardiovascular em Indivíduos Assintomáticos: Coorte Elsa-Brasil.

BACKGROUND: Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population. OBJECTIVE: This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume. METHODS: The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI). RESULTS: There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63-5.15) and LVH (PR = 2.20, 95% CI 1.62-3.00). CONCLUSION: Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.

FUNDAMENTO: vários estudos avaliam alterações ecocardiográficas como preditores de risco cardiovascular; entretanto, nenhum associa risco cardiovascular global com alterações ecocardiográficas em brasileiros. OBJETIVO: Este estudo avalia a associação entre risco cardiovascular global (ASCVD) e achados ecocardiográficos como hipertrofia ventricular esquerda (HVE), disfunção diastólica (DDVE) e aumento do volume do átrio esquerdo (AE). MÉTODOS: A população foi composta por participantes do ELSA-Brasil que realizaram ecocardiografia entre 2008 e 2010 (n = 2.973). Eram assintomáticos e não tinham história de doença cardiovascular (DCV). O escore ASCVD foi calculado em dois períodos: 2008-2010 e 2012-2014. Razões de prevalência (RP) foram estimadas com intervalos de confiança (IC) de 95%. RESULTADOS: Evidenciou-se associação entre alterações ecocardiográficas e alto risco cardiovascular global (escore ASCVD ≥ 7,5) nos dois períodos do estudo, separadamente. O risco global combinado (baixo risco no primeiro período e alto risco no segundo período) teve associação significativa apenas com DDVE (RP = 3,68; IC 95%: 2,63-5,15) e HVE (RP = 2,20; IC 95%: 1,62­3,00). CONCLUSÃO: Alterações ecocardiográficas (DDVE, HVE e aumento do volume do AE) são preditores independentes de risco cardiovascular em adultos brasileiros sem DCV prévias.

Parâmetros Ecocardiográficos Simples são Fortes Preditores de Risco Cardiovascular em Indivíduos Assintomáticos: Coorte Elsa-Brasil / Simple Echocardiographic Parameters are Strong Predictors of the Cardiovascular Risk in Asymptomatic Individuals: Elsa-Brasil Cohort

Resumo Fundamento vários estudos avaliam alterações ecocardiográficas como preditores de risco cardiovascular; entretanto, nenhum associa risco cardiovascular global com alterações ecocardiográficas em brasileiros. Objetivo Este estudo avalia a associação entre risco cardiovascular global (ASCVD) e achados ecocardiográficos como hipertrofia ventricular esquerda (HVE), disfunção diastólica (DDVE) e aumento do volume do átrio esquerdo (AE). Métodos A população foi composta por participantes do ELSA-Brasil que realizaram ecocardiografia entre 2008 e 2010 (n = 2.973). Eram assintomáticos e não tinham história de doença cardiovascular (DCV). O escore ASCVD foi calculado em dois períodos: 2008-2010 e 2012-2014. Razões de prevalência (RP) foram estimadas com intervalos de confiança (IC) de 95%. Resultados Evidenciou-se associação entre alterações ecocardiográficas e alto risco cardiovascular global (escore ASCVD ≥ 7,5) nos dois períodos do estudo, separadamente. O risco global combinado (baixo risco no primeiro período e alto risco no segundo período) teve associação significativa apenas com DDVE (RP = 3,68; IC 95%: 2,63-5,15) e HVE (RP = 2,20; IC 95%: 1,62-3,00). Conclusão Alterações ecocardiográficas (DDVE, HVE e aumento do volume do AE) são preditores independentes de risco cardiovascular em adultos brasileiros sem DCV prévias.

Abstract Background Several studies have evaluated echocardiographic abnormalities as predictors of cardiovascular risk; however, none have associated the global cardiovascular risk with echocardiographic abnormalities in the Brazilian population. Objective This study evaluates the association between the global cardiovascular risk (ASCVD score) and three echocardiographic abnormalities: left ventricular hypertrophy (LVH), left ventricular diastolic dysfunction (LVDD), and increased left atrium (LA) volume. Methods The study population was composed of participants from ELSA-Brasil who underwent echocardiography between 2008 and 2010 (n = 2973). They were asymptomatic and had no history of cardiovascular disease. The ASCVD score was calculated in two periods: 2008-2010 and 2012-2014. Prevalence ratios (PR) were estimated with 95% confidence intervals (CI). Results There is an association between echocardiographic abnormalities and high global cardiovascular risk (ASCVD score ≥ 7.5) in both study periods, separately. The combined global risk (low risk in the first period and high risk in the second period) was significantly associated only with LVDD (PR = 3.68, CI 95% 2.63-5.15) and LVH (PR = 2.20, 95% CI 1.62-3.00). Conclusion Echocardiographic abnormalities (LVDD, LVH, and increased LA volume) are independent predictors of cardiovascular risk in Brazilian adults.

MicroRNAs in type 2 diabetes mellitus: potential role of physical exercise.

Type 2 diabetes mellitus (T2DM) is a multifactorial metabolic disease, and its prevalence has grown worldwide. Several pathophysiological processes contribute to the development, progression and aggravating of the disease, for example, decreased insulin synthesis and secretion, insulin resistance, inflammation, and apoptosis, all these processes are regulated by various epigenetic factors, including microRNAs (miRNAs). MiRNAs are small non-coding RNAs, which are around 20 nucleotides in length and are regulators of gene expression at the post-transcriptional level, have a specific function of inhibiting or degrading a messenger RNA target. Thus, miRNAs modulate the expression of many associated genes with the pathophysiological processes in T2DM. On the other hand, miRNAs are also modulated through physical exercise (PE), which induces a change in their expression pattern during and after exercise. Some scientific evidence shows that PE modulates miRNAs beneficially and improves the signaling pathway of insulin resistance, however, little is known about the function of PE modulating miRNAs associated with the processes of insulin secretion, inflammation, and apoptosis. Thus, the objective of this review is to identify the miRNAs expression pattern in T2DM and compare it with the exercise-induced miRNAs expression pattern, identifying the signaling pathways that these miRNAs are regulating in the processes of insulin secretion, insulin resistance, inflammation, and apoptosis in T2DM, and how PE may have a potential role in modulating these signal transduction pathways, promoting benefits for patients with T2DM.

MicroRNAs Regulating Renin-Angiotensin-Aldosterone System, Sympathetic Nervous System and Left Ventricular Hypertrophy in Systemic Arterial Hypertension.

MicroRNAs are small non-coding RNAs that regulate gene and protein expression. MicroRNAs also regulate several cellular processes such as proliferation, differentiation, cell cycle, apoptosis, among others. In this context, they play important roles in the human body and in the pathogenesis of diseases such as cancer, diabetes, obesity and hypertension. In hypertension, microRNAs act on the renin-angiotensin-aldosterone system, sympathetic nervous system and left ventricular hypertrophy, however the signaling pathways that interact in these processes and are regulated by microRNAs inducing hypertension and the worsening of the disease still need to be elucidated. Thus, the aim of this review is to analyze the pattern of expression of microRNAs in these processes and the possible associated signaling pathways.

Physical Exercise and Immune System: Perspectives on the COVID-19 pandemic.

Physical exercise training (PET) has been considered an excellent non-pharmacological strategy to prevent and treat several diseases. There are various benefits offered by PET, especially on the immune system, promoting changes in the morphology and function of cells, inducing changes in the expression pattern of pro and anti-inflammatory cytokines. However, these changes depend on the type, volume and intensity of PET and whether it is being evaluated acutely or chronically. In this context, PET can be a tool to improve the immune system and fight various infections. However, the current COVID-19 pandemic, caused by SARS-CoV-2, which produces cytokine storm, inducing inflammation in several organs, with high infection rates in both sedentary and physically active individuals, the role of PET on immune cells has not yet been elucidated. Thus, this review focused on the role of PET on immune system cells and the possible effects of PET-induced adaptive responses on SARS-CoV-2 infection and COVID-19.

The Impact of COVID-19 on the Cardiovascular System.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19), has affected many people in Brazil and worldwide. This disease predominantly affects the organs of the respiratory system, but it also damages the brain, liver, kidneys and especially the heart. In the heart, scientific evidence shows that this virus can damage the coronary arteries, generating microvascular dysfunction, favoring acute myocardial infarction. Furthermore, with the increased expression of pro-inflammatory cytokines, it can lead to myocarditis and cardiac fibrosis, inducing changes in the electrical conduction system of the heart, generating cardiac arrhythmias. All these factors mentioned are protagonists in promoting the increase in the mortality outcome. This outcome may be even higher if the individuals are elderly, or if they have other diseases such as type 2 diabetes mellitus or hypertension, because they may already have cardiomyopathy. In this context, this review focused on the impact that COVID-19 can have on the heart and cardiovascular system and the association of this impact with aging, type 2 diabetes mellitus, cardiac arrhythmias and arterial hypertension.

Physical Exercise Training and Chagas Disease: Potential Role of MicroRNAs. / Treinamento com Exercício Físico e Doença de Chagas: Função Potencial dos MicroRNAs.

Chagas disease (CD) is caused by Trypanosoma Cruzi. This parasite can infect several organs of the human body, mainly the heart, causing inflammation, fibrosis, arrhythmias, and cardiac remodeling, promoting long-term Chronic Chagas Cardiomyopathy (CCC). However, little scientific evidence has elucidated the molecular mechanisms that govern the pathophysiological processes in this disease. MicroRNAs (miRNAs) are regulators of post-transcriptional gene expression that modulate signaling pathways, participating in pathophysiological mechanisms in CD, but the understanding of miRNAs in this disease is limited. On the other hand, a wide range of scientific evidence shows that physical exercise training (PET) modulates the expression of miRNAs by modifying different signaling pathways in healthy individuals. Some studies also show that PET is beneficial for individuals with CD; however, these did not evaluate the miRNA expressions. Thus, there is no evidence showing the role of PET in the expression of miRNAs in CD. Therefore, this review aimed to identify miRNAs expressed in CD that could potentially be modified by PET.

A doença de Chagas (DC) é causada pelo Trypanosoma Cruzi. Esse parasita pode infectar vários órgãos do corpo humano, especialmente o coração, causando inflamação, fibrose, arritmias e remodelação cardíaca, e promovendo a cardiomiopatia chagásica crônica (CCC) no longo prazo. Entretanto, poucas evidências científicas elucidaram os mecanismos moleculares que regulam os processos fisiopatológicos nessa doença. Os microRNAs (miRNAs) são reguladores de expressão gênica pós-transcricional que modulam a sinalização celular, participando de mecanismos fisiopatológicos da DC, mas o entendimento dos miRNAs nessa doença é limitado. Por outro lado, há muitas evidências científicas demonstrando que o treinamento com exercício físico (TEF) modula a expressão de miRNAs, modificando a sinalização celular em indivíduos saudáveis. Alguns estudos também demonstram que o TEF traz benefícios para indivíduos com DC, porém esses não avaliaram as expressões de miRNA. Dessa forma, não há evidências demonstrando o papel do TEF na expressão dos miRNAs na DC. Portanto, essa revisão teve o objetivo de identificar os miRNAs expressos na DC que poderiam ser modificados pelo TEF.

Prognostic power of conventional echocardiography in individuals without history of cardiovascular diseases: A systematic review and meta-analysis.

Echocardiographic abnormalities are associated with a higher incidence of adverse cardiovascular outcomes. This systematic review and meta-analysis aimed to evaluate whether echocardiographic abnormalities are predictors of cardiovascular events in individuals without previous cardiovascular diseases. The PubMed, Scopus, and SciELO databases were searched for longitudinal studies investigating the association between echocardiographic abnormalities and cardiovascular events among individuals without known cardiovascular diseases. Two independent reviewers analyzed data on the number of participants, age and sex, echocardiographic alterations, follow-up time, and cardiovascular outcomes. The meta-analysis estimated the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity was assessed using I2 test. Twenty-two longitudinal studies met the eligibility criteria, comprising a total of 55,603 patients. Left ventricular hypertrophy (LVH) was associated with non-fatal cardiovascular events (RR 2.16; 95% CI 1.22-3.84), death from cardiovascular disease (RR 2.58; 95% CI 1.83- 3.64), and all-cause mortality (RR 2.02; 95% CI 1.34-3.04). Left ventricular diastolic dysfunction (LVDD) and left atrial dilation (LA) were associated with fatal and non-fatal cardiovascular events (RR 2.01; 95% CI 1.32-3.07) and (RR 1.78; 95% CI 1.16-2.73), respectively. Aortic root dilation was associated with non-fatal cardiovascular events (RR 1.25; 95% CI 1.09-1.43). In conclusion, LVH, LVDD, dilations of the LA, and of the aortic root were associated with an increased risk of adverse events in individuals without previous cardiovascular diseases. This study suggests that simple data obtained on conventional echocardiography can be an important predictor of cardiovascular outcomes in a low-risk population.

Physical exercise effects on the brain during COVID-19 pandemic: links between mental and cardiovascular health.

The current pandemic was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The quarantine period during corona virus disease 19 (COVID-19) outbreak might affect the quality of life leading thousands of individuals to diminish the daily caloric expenditure and mobility, leading to a sedentary behavior and increase the number of health disorders. Exercising is used as a non-pharmacological treatment in many chronic diseases. Here, we review the molecular mechanisms of physical exercise in COVID-19 pandemic on mental health. We also point links between exercise, mental, and cardiovascular health. The infection caused by SARS-CoV-2 affects host cells binding to angiotensin-converting enzyme-2 (ACE2), which is the receptor for SARS-CoV-2. If there is not enough oxygen supply the lungs and other tissues, such as the heart or brain, are affected. SARS-CoV-2 enhances ACE2 leading to inflammation and neuronal death with possible development of mood disorders, such as depression and anxiety. Physical exercise also enhances the ACE2 expression. Conversely, the activation of ACE2/Ang 1-7/Mas axis by physical exercise induces an antiinflammatory and antifibrotic effect. Physical exercise has beneficial effects on mental health enhancing IGF-1, PI3K, BDNF, ERK, and reducing GSK3ß levels. In addition, physical exercise enhances the activity of PGC-1α/ FNDC5/Irisin pathway leading to neuronal survival and the maintenance of a good mental health. Thus, SARS-CoV-2 infection leads to elevation of ACE2 levels through pathological mechanisms that lead to neurological and cardiovascular complications, while the physiological response of ACE2 to physical exercise improves cardiovascular and mental health.

Demographic and professional profile of Brazilian women in vascular surgery: final results / Perfis demográfico e profissional de mulheres brasileiras na cirurgia vascular: resultados finais

Abstract Background Gender diversity in health teams is associated with better productivity. As women's participation in surgery has been growing, it is important to improve knowledge about the elements that guide their professional development. Objectives The aim of this study was to outline the demographic and professional features of female vascular surgeons in Brazil. Methods A cross-sectional study was designed, in which a questionnaire was made available online for 60 days. Invitations to participate were distributed by institutional e-mail sent from the Brazilian Society of Angiology and Vascular Surgery (SBACV) to associate women surgeons. Results are presented as numbers and percentages. Odds ratios and chi-square tests were used for analysis. Results From a total of 810 invitations sent out, 281 questionnaires were completed. The most prevalent age groups were 25-35 years (n = 115) and 36-45 years (n = 114). Among those who worked exclusively in the private sector, 79.8% had at least one board certification (OR: 0.76, 95% CI: 0.65-0.89; p = 0.001). Regarding workload distribution, 64.4% and 34.2% reported that they spend more time in the clinic and hospital, respectively. Respondents with more years of experience reported a predominance of office practice (p = 0.002). Although 67.3% (n = 189) had published scientific papers, 68% (n = 191) had never held leadership roles. Conclusions The study respondents consisted of highly qualified women surgeons with respect to training, certification, and scientific engagement, but they remain underrepresented in professional management positions. Surgical societies and health institutions should act to promote inclusive and diverse leadership.

Resumo Contexto A diversidade de gênero em equipes médicas está associada a uma melhor produtividade. Com o aumento da participação feminina na cirurgia, é importante conhecer melhor os elementos que orientam o desenvolvimento dessas profissionais. Objetivos Delinear as características demográficas e profissionais das cirurgiãs vasculares no Brasil. Métodos Estudo de caráter transversal, em que foi disponibilizado um questionário on-line por 60 dias. O convite foi enviado pelo e-mail institucional da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV) às cirurgiãs associadas. Os resultados são apresentados como números e porcentagens. Os testes de odds ratio (OR) e do qui-quadrado foram utilizados para a análise. Resultados De 810 convites enviados, 281 questionários foram respondidos. Os grupos etários predominantes foram 25-35 anos (n = 115) e 36-45 anos (n = 114). Entre as que trabalhavam exclusivamente no setor privado, 79,8% possuíam ao menos um Título de Especialista (OR: 0,76; intervalo de confiança de 95% 0,65-0,89; p = 0,001). Em relação à distribuição da carga horária, 64,4% e 34,2% relataram que passavam mais tempo no ambulatório e no hospital, respectivamente. Entre as com mais anos de experiência, houve predomínio da prática em consultório (p = 0,002). Embora 67,3% (n = 189) tenham publicado artigos científicos, 68% (n = 191) nunca ocuparam cargos de liderança. Conclusões As participantes do estudo consistiram em cirurgiãs altamente qualificadas em relação a treinamento, certificação e engajamento científico. No entanto, permanecem pouco representadas em cargos de gestão profissional. As sociedades cirúrgicas e as instituições de saúde devem agir para promover uma liderança inclusiva e diversa.

The Impact of COVID-19 on the Cardiovascular System

SUMMARY The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19), has affected many people in Brazil and worldwide. This disease predominantly affects the organs of the respiratory system, but it also damages the brain, liver, kidneys and especially the heart. In the heart, scientific evidence shows that this virus can damage the coronary arteries, generating microvascular dysfunction, favoring acute myocardial infarction. Furthermore, with the increased expression of pro-inflammatory cytokines, it can lead to myocarditis and cardiac fibrosis, inducing changes in the electrical conduction system of the heart, generating cardiac arrhythmias. All these factors mentioned are protagonists in promoting the increase in the mortality outcome. This outcome may be even higher if the individuals are elderly, or if they have other diseases such as type 2 diabetes mellitus or hypertension, because they may already have cardiomyopathy. In this context, this review focused on the impact that COVID-19 can have on the heart and cardiovascular system and the association of this impact with aging, type 2 diabetes mellitus, cardiac arrhythmias and arterial hypertension

Comparação entre classificação funcional e fração de ejeção em pacientes com insuficiência cardíaca na Doença de Chagas / Functional classification versus ejection fraction in patients with heart failure and Chagas Disease

Introdução: A doença de Chagas é uma infecção causada pelo protozoário Trypanosoma cruzi. É considerada um importante problema de saúde do mundo, tendo como manifestações a dilatação cardíaca, arritmias e morte. A insuficiência cardíaca é uma síndrome complexa e de elevada morbimortalidade, que evolui com complicações semelhantes. Para categorizar a gravidade da insuficiência cardíaca, utilizamos a classificação funcional da New York Heart Association, para estratificar risco e terapias para cardiopatias. Além disso, a reduzida fração de ejeção do ventrículo esquerdo, medida pelo ecocardiograma, tem relação direta com mau prognóstico. Objetivo: Comparar a relação entre a classificação funcional pela New York Heart Association e a medida da fração de ejeção do ventrículo esquerdo em pacientes ambulatoriais chagásicos e não chagásicos. Metódos: Estudo de corte transversal na coorte, composto de pacientes acompanhados em ambulatório de insuficiência cardíaca. Foram realizadas avaliação de prontuários, entrevista clínica e verificação da classificação funcional e da fração de ejeção do ventrículo esquerdo pelo ecocardiograma. Os dados foram arquivados em banco de dados e analisados pelo Statistical Package for the Social Sciences. Resultados: No período de agosto de 2018 a julho de 2019, foram selecionados 127 indivíduos com insuficiência cardíaca. Destes, 34 (26,8%) eram portadores da doença de Chagas e 93 (73,3%) eram não Chagas. Observou-se predominância do sexo masculino (53,5%) e de idade >60 anos (61,4%). Houve predomínio da classe funcional II nos grupos. Em relação à fração de ejeção dos pacientes chagásicos e não chagas, observou-se que, respectivamente, 71% contra 93% dos pacientes tinham fração de ejeção reduzida, 21% versus 6% tinham fração de ejeção intermediária e 8% versus 1% fração de ejeção preservada. Conclusão: Houve associação entre classe funcional avançada e reduzida fração de ejeção do ventrículo esquerdo principalmente em chagásicos, podendo ser usada para acompanhamento evolutivo ambulatorial. (AU)

Introduction: Chagas disease, an infection caused by the protozoan Trypanosoma cruzi, is an important health problem worldwide that causes cardiac dilation, arrhythmias, and death. Heart failure is a complex syndrome with high morbidity and mortality rates that progresses with similar complications. The New York Heart Association functional classification is used to categorize heart failure severity and stratify heart disease risks and therapies. A reduced left ventricular ejection fraction measured by echocardiography is directly related to a poor prognosis. Objective: To compare the relationship between New York Heart Association functional classification and left ventricular ejection fraction in Chagas versus no Chagas disease outpatients. Methods: Cross-sectional study in a cohort of patients followed at a heart failure clinic. Medical records, clinical interviews, functional classification, and left ventricular ejection fraction by echocardiography were analyzed. The data were filed in a database and analyzed using SPSS software. Results: A total of 127 patients with heart failure were selected from August 2018 to July 2019. Of them, 34 (26.8%) had Chagas disease and 93 (73.3%) had no Chagas disease. There was a predominance of men (53.5%) and patients aged > 60 years (61.4%). There was also a predominance of functional class II. Of the Chagas and no Chagas disease patients, 71% versus 93% had a reduced ejection fraction, 21% versus 6% had a mid-range ejection fraction, and 8% versus 1% had a preserved ejection fraction, respectively. Conclusion: There was an association between advanced functional class and reduced left ventricular ejection fraction, especially in Chagas patients, information that can be used for outpatient follow-up. (AU)

Prognostic power of conventional echocardiography in individuals without history of cardiovascular diseases: A systematic review and meta-analysis

Echocardiographic abnormalities are associated with a higher incidence of adverse cardiovascular outcomes. This systematic review and meta-analysis aimed to evaluate whether echocardiographic abnormalities are predictors of cardiovascular events in individuals without previous cardiovascular diseases. The PubMed, Scopus, and SciELO databases were searched for longitudinal studies investigating the association between echocardiographic abnormalities and cardiovascular events among individuals without known cardiovascular diseases. Two independent reviewers analyzed data on the number of participants, age and sex, echocardiographic alterations, follow-up time, and cardiovascular outcomes. The meta-analysis estimated the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity was assessed using I2 test. Twenty-two longitudinal studies met the eligibility criteria, comprising a total of 55,603 patients. Left ventricular hypertrophy (LVH) was associated with non-fatal cardiovascular events (RR 2.16; 95% CI 1.22-3.84), death from cardiovascular disease (RR 2.58; 95% CI 1.83- 3.64), and all-cause mortality (RR 2.02; 95% CI 1.34-3.04). Left ventricular diastolic dysfunction (LVDD) and left atrial dilation (LA) were associated with fatal and non-fatal cardiovascular events (RR 2.01; 95% CI 1.32-3.07) and (RR 1.78; 95% CI 1.16-2.73), respectively. Aortic root dilation was associated with non-fatal cardiovascular events (RR 1.25; 95% CI 1.09-1.43). In conclusion, LVH, LVDD, dilations of the LA, and of the aortic root were associated with an increased risk of adverse events in individuals without previous cardiovascular diseases. This study suggests that simple data obtained on conventional echocardiography can be an important predictor of cardiovascular outcomes in a low-risk population.

The effects of the COVID-19 pandemic on levels of physical fitness.

INTRODUCTION: The COVID-19 pandemic, caused by infections from a novel human coronavirus, has been reported since December 2019 in China but was only made official in March 2020. Since then, it has had an impact worldwide, both due to its aggressiveness and its fast propagation. Society has been facing this pandemic by following the recommendations and determinations of the WHO and the strategies deployed by governmental institutions. Among these, social isolation has been shown to be the most important, because when isolating, society tends to move less, with a consequent increase in physical inactivity and sedentary behavior, affecting its levels of physical fitness. The objectives of this review were: to review the most important effects of physical inactivity and sedentary behavior on the physical fitness levels of the population during the COVID-19 pandemic. CONCLUSION: The role of a regular practice of activities on the levels of physical fitness is fundamental to define the balance of quality of life during a COVID-19.

Modulation of MicroRNAs as a Potential Molecular Mechanism Involved in the Beneficial Actions of Physical Exercise in Alzheimer Disease.

Alzheimer disease (AD) is one of the most common neurodegenerative diseases, affecting middle-aged and elderly individuals worldwide. AD pathophysiology involves the accumulation of beta-amyloid plaques and neurofibrillary tangles in the brain, along with chronic neuroinflammation and neurodegeneration. Physical exercise (PE) is a beneficial non-pharmacological strategy and has been described as an ally to combat cognitive decline in individuals with AD. However, the molecular mechanisms that govern the beneficial adaptations induced by PE in AD are not fully elucidated. MicroRNAs are small non-coding RNAs involved in the post-transcriptional regulation of gene expression, inhibiting or degrading their target mRNAs. MicroRNAs are involved in physiological processes that govern normal brain function and deregulated microRNA profiles are associated with the development and progression of AD. It is also known that PE changes microRNA expression profile in the circulation and in target tissues and organs. Thus, this review aimed to identify the role of deregulated microRNAs in the pathophysiology of AD and explore the possible role of the modulation of microRNAs as a molecular mechanism involved in the beneficial actions of PE in AD.

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes / Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants

Resumo Fundamentos Afrodescendentes têm sido associados a uma maior gravidade da hipertensão arterial e maior incidência de complicações cardiovasculares. Características na apresentação da hipertensão resistente (HR) ou hipertensão refratária (HRf), especificamente nessa etnia, não têm sido devidamente estudadas. Objetivos O estudo compara características clínicas e epidemiológicas e prevalência de eventos cardiovasculares em afrodescendentes com diagnóstico de HR ou de HRf. Métodos: Estudo transversal realizado em ambulatório de referência para pacientes com Hipertensão Grave. O nível de significância foi de 5%. Resultados Avaliados 146 pacientes consecutivos, dos quais 68,7% eram do sexo feminino. A média de idade foi de 61,8 anos, sendo 88,4% afrodescendentes (pardos ou negros). 51% apresentavam HRf. Houve alta prevalência de fatores de risco cardiovascular: 34,2% tinham diabetes, 69,4% dislipidemia, 36,1% obesidade e 38,3% história de tabagismo. Função renal reduzida foi observada em 34,2%. Eventos cardiovasculares prévios ocorreram em 21,8% para infarto do miocárdio e em 19,9% para acidente vascular cerebral. O escore de risco de Framingham foi moderado/alto em 61%. Os pacientes com HRf eram mais jovens (média de idade de 59,38±11,69 anos versus 64,10±12,23 anos, p=0,02), tinham mais dislipidemia (83,8 versus 66,7%, p=0,021) e acidente vascular cerebral (30,4 versus 12,3%, p=0,011) quando comparados aos com HR. O uso de combinação de ACEi/BRA+CCB+Diurético, clortalidona e espironolactona também foi mais frequente em indivíduos com HRf. Conclusão Afrodescendentes com HR apresentaram alto risco cardiovascular, alta prevalência de HRf, maior frequência de dislipidemia e de acidente vascular cerebral, compatível com alta incidência de lesão a órgãos-alvo. (Arq Bras Cardiol. 2020; 115(1):31-39)

Abstract Background Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol.2020; 115(1):31-39)