The Olympic Experimental Gymnasium Program and its Association with the Prevalence of Cardiovascular Risk Factors in Adolescents: A Cross-Sectional Study.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide. Physical activity (PA) and appropriate diet, if adopted in childhood and adolescence, may reduce the CVD burden in later life. The Olympic Experimental Gymnasium (OEG) project was implemented to increase the PA levels of students by means of regular physical exercise and healthy eating habits. OBJECTIVES: To estimate and compare the prevalence of CVD risk factors in OEG schools versus regular schools (RSch) and to examine associations between the school environment and CVD risk factors. METHODS: In this cross-sectional study with a comparator group, adolescents aged 12-13 years attending three OEG schools (n = 719) and three RSch (n = 394) were evaluated after one year of the ongoing program to estimate the prevalence of overweight, pre-hypertension/hypertension, altered glycemia, and lipid profile. An α level of 0.05 was set for statistical analysis. RESULTS: RSch students had higher odds to have high blood pressure (OR 1.86, 1.36-2.54) and to be overweight (OR 1.49, 1.13-1.98) than OEG students. Glucose levels were not altered in most cases regardless of school type, and no differences were found in lipid profile. In the sensitivity analysis stratified by gender, girls from RSch were more likely to have high body mass index than boys. CONCLUSIONS: Exposure of adolescents to the OEG policies was positively associated with an important reduction in CVD risk factors, including high blood pressure and overweight.

Sports Practices and Cardiovascular Risk in Teenagers.

BACKGROUND: Cardiovascular diseases are the leading cause of deaths in the world, and many events could be prevented by healthy life habits. OBJECTIVES: To compare the occurrence of cardiovascular risk factors in adolescents enrolled at public schools in the city of Rio de Janeiro, including a renowned school for sport practices. METHODS: Cross-sectional study, convenience sampling of 422 students enrolled at the Experimental Olympic Gymnasium (EOG) and at Figueiredo Pimentel School (FP). Using descriptive analyses, continuous variables were expressed as mean and standard deviation or median and interquartile ranges, and the Student's t-test or the chi-square test, respectively, was used for comparisons. The sports were classified according to the metabolic equivalent of task (MET) (below or above 5). RESULTS: We included 274 students enrolled at the EOG and 148 at FP. Mean age was similar between schools -12.5 ± 1.6 years at FP and 12.6 ± 0.9 at the EOG; 65.5% of the students at FP and 43.8% of the students at the EOG were female (p < 0.01). Significant differences in the prevalence of hypertension (20% vs. 6.3%, p < 0.01) and borderline cholesterol levels (27.7% vs. 17.3%, p = 0.01) were found between FP and EOG students, respectively. CONCLUSION: High prevalence of hypertension, overweight/obesity and altered blood lipid profile was found in this group of adolescents. Regular sports training program combined with little influence of their eating habits outside school may contribute to a better metabolic profile and reduction in cardiovascular risk factors in students. Public health measures are also need.

Transcatheter Aortic Valve Replacement: The Experience of One Brazilian Health Care Center.

OBJECTIVE: Transcatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period. METHODS: This prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included. RESULTS: Fifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%). CONCLUSION: Mortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up.

Cardiovascular effects of SPARK conducted electrical weapon in healthy subjects.

BACKGROUND: The increasing use of conducted electronic weapons (CEW) cause concern regarding its secure application, specially regarding the implications in the cardiovascular system. METHODS: The objective was to determine Spark CEW safety through cardiovascular parameters analysis of healthy volunteers subjected to its use. RESULTS: Volunteers over 18years without cardiovascular disease or recent use of illegal drugs were submitted, before and after being affected with Spark CEW, to clinical evaluation; blood collection for serum laboratory tests; transthoracic electrocardiography at rest, transthoracic echodopplercardiogram and 24hour Holter. RESULTS: All 71 patients reported being incapable of any voluntary reaction during the shock of the application time. No arrhythmia or myocardial necrosis was related to the use of non-lethal weapon SPARK. Reported adverse events were self-limited, and mostly mild. CONCLUSIONS: SPARK brand CEW is effective in incapacitating individuals by the shock of the application time, without causing.

Improved exercise capacity and ischemia 6 and 12 months after transendocardial injection of autologous bone marrow mononuclear cells for ischemic cardiomyopathy.

BACKGROUND: We recently reported the safety and feasibility of autologous bone marrow mononuclear cell (ABMMNC) injection into areas of ischemic myocardium in patients with end-stage ischemic cardiomyopathy. The present study evaluated the safety and efficacy of this therapy at 6- and 12-month follow-up. METHODS AND RESULTS: Twenty patients with 6- and 12-month follow-up (11 treated subjects; 9 controls) were enrolled in this prospective, nonrandomized, open-label study. Complete clinical and laboratory evaluations as well as exercise stress (ramp treadmill), 2-dimensional Doppler echocardiography, single-photon emission computed tomography (SPECT) perfusion scanning, and 24-hour Holter monitoring were performed at baseline and follow-up. Transendocardial delivery of ABMMNCs was performed with the aid of electromechanical mapping to identify viable myocardium. Each patient received 15 ABMMNC injections of 0.2 mL each. At 6 and 12 months, total reversible defect, as measured by SPECT perfusion scanning, was significantly reduced in the treatment group as compared with the control group. At 12 months, exercise capacity was significantly improved in the treatment group. This improvement correlated well with monocyte, B-cell, hematopoietic progenitor cell, and early hemapoietic progenitor cell phenotypes. CONCLUSIONS: The 6- and 12-month follow-up data in this study suggest that transendocardial injection of ABMMNCs in patients with end-stage ischemic heart disease may produce a durable therapeutic effect and improve myocardial perfusion and exercise capacity.

Transendocardial, autologous bone marrow cell transplantation for severe, chronic ischemic heart failure.

BACKGROUND: This study evaluated the hypothesis that transendocardial injections of autologous mononuclear bone marrow cells in patients with end-stage ischemic heart disease could safely promote neovascularization and improve perfusion and myocardial contractility. METHODS AND RESULTS: Twenty-one patients were enrolled in this prospective, nonrandomized, open-label study (first 14 patients, treatment; last 7 patients, control). Baseline evaluations included complete clinical and laboratory evaluations, exercise stress (ramp treadmill), 2D Doppler echocardiogram, single-photon emission computed tomography perfusion scan, and 24-hour Holter monitoring. Bone marrow mononuclear cells were harvested, isolated, washed, and resuspended in saline for injection by NOGA catheter (15 injections of 0.2 cc). Electromechanical mapping was used to identify viable myocardium (unipolar voltage > or =6.9 mV) for treatment. Treated and control patients underwent 2-month noninvasive follow-up, and treated patients alone underwent a 4-month invasive follow-up according to standard protocols and with the same procedures used as at baseline. Patient population demographics and exercise test variables did not differ significantly between the treatment and control groups; only serum creatinine and brain natriuretic peptide levels varied in laboratory evaluations at follow-up, being relatively higher in control patients. At 2 months, there was a significant reduction in total reversible defect and improvement in global left ventricular function within the treatment group and between the treatment and control groups (P=0.02) on quantitative single-photon emission computed tomography analysis. At 4 months, there was improvement in ejection fraction from a baseline of 20% to 29% (P=0.003) and a reduction in end-systolic volume (P=0.03) in the treated patients. Electromechanical mapping revealed significant mechanical improvement of the injected segments (P<0.0005) at 4 months after treatment. CONCLUSIONS: Thus, the present study demonstrates the relative safety of intramyocardial injections of bone marrow-derived stem cells in humans with severe heart failure and the potential for improving myocardial blood flow with associated enhancement of regional and global left ventricular function.

Catheter-based transendocardial delivery of autologous bone-marrow-derived mononuclear cells in patients listed for heart transplantation.

Growing evidence suggests that transplantation of autologous bone-marrow mononuclear cells (ABMMNCs) can improve the perfusion and contractile function of ischemic myocardium. This procedure could potentially benefit transplant candidates awaiting a donor heart. To study the safety and feasibility of ABMMNC injection, we performed a prospective, nonrandomized, open-label study in 5 heart transplant candidates with severe ischemic heart failure. Each patient underwent baseline single-photon emission computed tomography, a ramp treadmill protocol, 2-dimensional echocardiography, 24-hour Holter monitoring, and signal-averaged electrocardiography, which were repeated at 2 and 6 months. Transendocardial delivery of ABMMNCs was done with the aid of electromechanical mapping to identify viable myocardium. Each patient received 15 ABMMNC injections of 0.2 cc each. There were no deaths, significant arrhythmias, or other major complications. The ABMMNC injection reduced the amount of ischemic myocardium (not statistically significant). More important, exercise test results improved significantly. Myocardial volume oxygen consumption increased from 10.6 +/- 3 mL/kg/min (baseline) to 16.3 +/- 7 mL/kg/min (2 months) and 23 +/- 7 mL/kg/min (6 months) (P = 0.0091). In 4 of the 5 cases, this was such an improvement that the patients were no longer eligible for cardiac transplantation. In addition, metabolic equivalents improved from 3.03 +/- 0.66 (baseline) to 4.65 +/- 1.99 (2 months) and 6.5 +/- 2.0 (6 months) (P = 0.0092). In conclusion, ABMMNC injections were performed safely and resulted in improved exercise capacity. This technique may hold promise as an alternative to medical management in patients with severe ischemic heart failure who are ineligible for conventional revascularization.

A six-time Ultraman winner and a normal heart: A case report.

Number of subjects currently participating in high-endurance aerobic exercise training regimens and competitions has substantially increased in recent years. While there is no doubt that regular exercise practice is fundamental for the maintenance of a good health, there have been reports of cardiac structural changes of subjects exposed to strenuous endurance physical exercise. This article reports a case of a 47-year-old male very successful sportsman-including being a six-time Ultraman winner-who has accumulated more than 50,000 h of training and competition in his 35-year career, averaging 25-30 h/week. Despite this huge amount of aerobic exercise, about 25 times larger than typically recommended dose for health purposes (i.e. 75 min of vigorous exercise per week), no major abnormalities were detected in electrocardiograms (rest and maximal exercise), transthoracic echocardiogram, and magnetic resonance imaging. In fact, after this complete evaluation, his heart was found to be quite normal.

The Olympic Experimental Gymnasium Program and its Association with the Prevalence of Cardiovascular Risk Factors in Adolescents: A Cross-Sectional Study / Programa do Ginásio Experimental Olímpico e sua Associação com a Prevalência de Fatores de Risco Cardiovascular em Adolescentes: Estudo Transversal

Abstract Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Physical activity (PA) and appropriate diet, if adopted in childhood and adolescence, may reduce the CVD burden in later life. The Olympic Experimental Gymnasium (OEG) project was implemented to increase the PA levels of students by means of regular physical exercise and healthy eating habits. Objectives: To estimate and compare the prevalence of CVD risk factors in OEG schools versus regular schools (RSch) and to examine associations between the school environment and CVD risk factors. Methods: In this cross-sectional study with a comparator group, adolescents aged 12-13 years attending three OEG schools (n = 719) and three RSch (n = 394) were evaluated after one year of the ongoing program to estimate the prevalence of overweight, pre-hypertension/hypertension, altered glycemia, and lipid profile. An α level of 0.05 was set for statistical analysis. Results: RSch students had higher odds to have high blood pressure (OR 1.86, 1.36-2.54) and to be overweight (OR 1.49, 1.13-1.98) than OEG students. Glucose levels were not altered in most cases regardless of school type, and no differences were found in lipid profile. In the sensitivity analysis stratified by gender, girls from RSch were more likely to have high body mass index than boys. Conclusions: Exposure of adolescents to the OEG policies was positively associated with an important reduction in CVD risk factors, including high blood pressure and overweight.

Resumo Fundamento: A doença cardiovascular (DCV) é a principal causa de morte em todo o mundo. A atividade física (AF) e uma dieta adequada, quando adotadas na infância e na adolescência, podem reduzir a carga da DCV na fase adulta. O projeto "Ginásio Experimental Olímpico (GEO)" foi implementado para aumentar os níveis de AF dos estudantes por meio de AF regular e hábitos alimentares saudáveis. Objetivos: estimar e comparar a prevalência dos fatores de risco para DCV em GEOs versus escolas regulares (ERs), e avaliar associações entre o meio escolar e os fatores de risco cardiovascular. Métodos: Neste estudo transversal que incluiu um grupo de comparação, estudantes com idade entre 12 e 13 anos de três GEOs (n = 719) e três ERs (n = 394) foram avaliados após um ano de participação no programa para estimar a prevalência de sobrepeso, pré-hipertensão/hipertensão, e de glicemia e perfil lipídico alterados. Um α de 0,05 foi usado para inferências estatísticas. Resultados: Estudantes de ERs apresentaram maior chance de serem hipertensos (OR 1,86; 1,36-2,54) e apresentarem sobrepeso (OR 1,49; 1,13-1,98) que estudantes de GEOs. A glicemia não estava alterada na maioria dos casos, independentemente do tipo da escola, e não houve diferenças quanto ao perfil lipídico. Na análise de sensibilidade estratificada por gênero, estudantes do sexo feminino das ERs apresentaram maior probabilidade de apresentarem índice de massa corporal elevado que os do sexo masculino. Conclusão: A exposição dos adolescentes às políticas adotadas pelos GEOs associou-se positivamente com uma importante redução nos fatores de risco para DCV, incluindo hipertensão e sobrepeso.

Sports Practices and Cardiovascular Risk in Teenagers / Práticas Esportivas e Risco Cardiovascular em Adolescentes

Abstract Background: Cardiovascular diseases are the leading cause of deaths in the world, and many events could be prevented by healthy life habits. Objectives: To compare the occurrence of cardiovascular risk factors in adolescents enrolled at public schools in the city of Rio de Janeiro, including a renowned school for sport practices. Methods: Cross-sectional study, convenience sampling of 422 students enrolled at the Experimental Olympic Gymnasium (EOG) and at Figueiredo Pimentel School (FP). Using descriptive analyses, continuous variables were expressed as mean and standard deviation or median and interquartile ranges, and the Student's t-test or the chi-square test, respectively, was used for comparisons. The sports were classified according to the metabolic equivalent of task (MET) (below or above 5). Results: We included 274 students enrolled at the EOG and 148 at FP. Mean age was similar between schools -12.5 ± 1.6 years at FP and 12.6 ± 0.9 at the EOG; 65.5% of the students at FP and 43.8% of the students at the EOG were female (p < 0.01). Significant differences in the prevalence of hypertension (20% vs. 6.3%, p < 0.01) and borderline cholesterol levels (27.7% vs. 17.3%, p = 0.01) were found between FP and EOG students, respectively. Conclusion: High prevalence of hypertension, overweight/obesity and altered blood lipid profile was found in this group of adolescents. Regular sports training program combined with little influence of their eating habits outside school may contribute to a better metabolic profile and reduction in cardiovascular risk factors in students. Public health measures are also need.

Resumo Fundamento: As doenças cardiovasculares são a maior causa de mortes no mundo e muitos eventos poderiam ser evitados por meio de hábitos saudáveis de vida. Objetivos: Comparar a ocorrência de fatores de risco cardiovascular em adolescentes de escolas públicas do município do Rio de Janeiro, sendo uma delas, modelo em práticas esportivas. Métodos: Estudo transversal; amostra de conveniência de 422 escolares do Ginásio Experimental Olímpico (GEO) e da Escola Municipal Figueiredo Pimentel (FP). Foi realizada análise descritiva dos dados utilizando média e desvio-padrão (DP) ou mediana e intervalo interquartil para variáveis contínuas (testes t de Student e qui-quadrado para comparação, respectivamente). As modalidades esportivas foram classificadas de acordo com o equivalente metabólico (MET), se abaixo ou acima de 5. Resultados: duzentos e setenta e quatro alunos eram do GEO e 148 da FP. A média de idade era semelhante - 12,5 ± 1,6 na EMFP e 12,6 ± 0,9 no GEO; 65,5% dos alunos eram do sexo feminino na FP e 43,8% no GEO (p < 0,01). Da amostra geral, 40% apresentaram sobrepeso ou obesidade. Observaram-se diferenças entre a prevalência de hipertensão (20% vs. 6,3%; p < 0,01 nos alunos da FP e do GEO, respectivamente) e de níveis de colesterol total considerados limítrofes (27,7% vs. 17,3%; p = 0,01 na FP e no GEO, respectivamente). Conclusão: Hipertensão, sobrepeso/obesidade e lipidograma capilar alterado foram muito prevalentes nos adolescentes. Um programa de treinamento esportivo regular com menos interferência alimentar extraescola parece contribuir para um melhor perfil metabólico e menor risco cardiovascular entre estudantes. Ainda, medidas efetivas de saúde pública são necessárias.

Echocardiographic assessment of right ventricular function by two-dimensional strain in patients with left-sided valvular heart disease: comparison whit three-dimendional echocardiography / Avaliação ecocardiográfica da função ventricular direita por strain bidimensional em pacientes com valvopatia à esquerda: comparação com ecocardiografia tridimensional

Background: Right ventricular (RV) dysfunction is a well-known predictor of mortality in patients with valvular heart disease (VHD). The assessment of RV function is often difficult due to complex geometry and hemodynamic factors. Objective: We aim to analyze RV function in patients with severe mitral and/or aortic valve disease using two-dimensional strain (2DS) imaging and conventional echocardiographic parameters, comparing it with right ventricular ejection fraction (RVEF) measured by three-dimensional echocardiography (3DE). Methods: Fifty-three patients with severe mitral and/or aortic VHD underwent complete transthoracic echocardiogram in the preoperative setting for cardiac surgery, including conventional echocardiographic parameters of RV function and speckle-tracking derived 2DS indices: RV global longitudinal strain (RVGS) and RV free wall longitudinal strain (RVFWS). Conventional echocardiographic and 2DS parameters were compared with real-time 3DE RVEF using Spearman correlation test. For comparison between two groups of patients based on the presence of RV dysfunction (normal RVEF ≥ 44% - A, abnormal RVEF < 44% - B), we used nonparametric Mann-Whitney U test. ROC (receiver operating characteristic) curve analysis was used to assess the clinical utility of all RV function variables in defining RV dysfunction. P values <0,05 were considered statistically significant.Results: We found a significant correlation between all parameters and RVEF (p<0.05), with best results for RV fractional area change (FAC), RVGS, and RVFWS. Dividing the population into two-groups based on RVEF, we found 14 patients with RV dysfunction (27.4%), and significant differences between the groups for all RV function variables. For detection of RV dysfunction defined by 3DE, ROC curve analysis showed the best area under the curve (AUC) for RVGS (0.872), RVFWS (0.851) and FAC (0.932). Conclusions: We observed significant correlation between RVGS, RVFWS and RVEF, with good accuracy in detecting RV dysfunction, comparable to FAC and better than other conventional parameters of RV function assessment. The evaluation of RV myocardial deformation with 2DS may have additional diagnostic and prognostic value in patients with severe left-sided VHD

Transcatheter aortic valve replacement: the experience of one brazilian health care center

Abstract Objective: Transcatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period. Methods: This prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included. Results: Fifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%). Conclusion: Mortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up.

Functional and transcriptomic recovery of infarcted mouse myocardium treated with bone marrow mononuclear cells.

Although bone marrow-derived mononuclear cells (BMNC) have been extensively used in cell therapy for cardiac diseases, little mechanistic information is available to support reports of their efficacy. To address this shortcoming, we compared structural and functional recovery and associated global gene expression profiles in post-ischaemic myocardium treated with BMNC transplantation. BMNC suspensions were injected into cardiac scar tissue 10 days after experimental myocardial infarction. Six weeks later, mice undergoing BMNC therapy were found to have normalized antibody repertoire and improved cardiac performance measured by ECG, treadmill exercise time and echocardiography. After functional testing, gene expression profiles in cardiac tissue were evaluated using high-density oligonucleotide arrays. Expression of more than 18% of the 11981 quantified unigenes was significantly altered in the infarcted hearts. BMNC therapy restored expression of 2099 (96.2%) of the genes that were altered by infarction but led to altered expression of 286 other genes, considered to be a side effect of the treatment. Transcriptional therapeutic efficacy, a metric calculated using a formula that incorporates both recovery and side effect of treatment, was 73%. In conclusion, our results confirm a beneficial role for bone marrow-derived cell therapy and provide new information on molecular mechanisms operating after BMNC transplantation on post ischemic heart failure in mice.

A avaliação do dissincronismo cardíaco pela ecocardiografia após o Estudo Prospect / Echocardiographic cardiac dyssinchrony evaluation after the Prospect Study

A terapia de ressincronização cardíaca (RSC) tornou-se um importante recurso para o tratamento de pacientes com insuficiência cardíaca, que não respondem às medidas habituais e, apresentam distúrbios de condução, bloqueio de ramo esquerdo (BRE). Seguindo as recomendações atuais, cerca de 30 por cento dos pacientes não apresentam resposta satisfatória. A ecocardiografia, em suas diversas modalidades, foi proposta como método capaz de melhor selecionar o grupo dos chamados respondedores. O estudo multicêntrico Prospect avaliou 12 critérios ecocardiográficos para confirmar os achados de estudos isolados. Concluiu que nenhum critério ecocardiográfico seria capaz de ajudar nessa seleção ou influênciar essa decisão. Este artigo de revisão mostra os resultados do estudo, faz comentários sobre a metodologia empregada e as implicações que levaram a esses resultados, os quais contrariam diversos estudos anteriores. A revisão também propõe um protocolo usado pelos autores para avaliar pacientes candidatos à RSC, assim como discute novas tecnologias que estão surgindo com a mesma finalidade.

Importância do eco color Doppler na avaliação de fístulas arteriovenosas / The importance of color doppler imaging in the evaluation of patients with arteriovenous fistulas

Fundamentos: Grande número de pacientes com insuficiência renal terminal possuem fístulas arteriovenosas (FAVs) para realização de hemodiálise, e essas podem apresentar altas taxas de falência no 1º ano (até 40%). Objetivo: Avaliar FAVs, utilizando o Eco Color Doppler (ECD), tentando identificar possíveis anormalidades. Delineamento: Trabalho de análise exploratória, observacional, transversal de uma série de casos. Métodos: Foram estudadas 45 FAVs, sendo 30 pacientes, entre os quais 16 homens, (grupo A) que apresentavam dificuldades na hemodiálise; e 15 pacientes, entre os quais 10 homens, (grupo B), que não apresentavam dificuldades na hemodiálise. Foram utilizados aparelhos Vivid7 da GE Ultrasound, com transdutor linear (banda larga), com frequência de 7/10 Mhz e aplicativo para ultrassom vascular com Doppler pulsado, colorido e Power-Doppler. O estudo das FAVs, conforme nosso protocolo, inclui a avaliação da(s) artéria(s) do inflow e do seguimento arterial distal à fístula, a(s) anastomose(s) arterial e venosa em caso de enxerto, a veia do outflow, bem como as veias profundas e centrais de deságue daquele membro. Resultados: Identificamos anormalidades em todas as FAVs do grupo A e em 06 casos do grupo B. Conclusão: O ECD é excelente ferramenta na identificação de anormalidades dos pacientes com FAVs.

Importância do eco color Doppler no mapeamento arterial e venoso para confecção de fístulas arteriovenosas / The importance of preoperative arterial and venous color Doppler mapping for arteriovenous fistulas

Pacientes com insuficiência renal terminal, em sua grande maioria, são encaminhados para hemodiálise. Para tanto, necessitam de um bom acesso (fístulas arteriovenosas (FAVs) para realização da diálise. As fístulas arteriovenosas podem apresentar altas taxas de falência no 1º ano (40 por cento), quando mal confeccionadas ou mal planejadas. Objetivo: Demonstrar a importância do Eco Color Doppler no planejamento de FAVs, buscando identificar vasos adequados para a anastomose. Delineamento: Trabalho observacional prospectivo. Metodologia: Foram estudados 42 membros de 25 pacientes (09 homens), com idade variando entre 25 e 77 anos. Foram utilizados aparelhos Vivid7 da GE UltraSound, com transdutor linear de banda larga, frequência de 7/10 MHz e aplicativo para ultrassom vascular com Doppler pulsado, colorido e Power-Doppler. No protocolor de exame, avaliaram-se as artérias daquele membro (diâmetros, velocidade e morfologia do fluxo), bem como a patência e a funcionalidade do arco palmar. Examinou-se, também, a rede venosa (superficial, profunda e central), de deságue daquele membro. Resultados: Foram identificadas variações anatômicas, alterações de diâmetro, acometimento aterosclerótico importante, oclusões arteriais, assim como tromboses venosas, que poderiam comprometer o funcionamento da FAV. Conclusão: O ECD é ferramenta imprescindível no mapeamento para confecção FAVs.

Comparação do parâmetros ecocardiográficos de dissincronia entre uma população normal e outra com bloqueio de ramo esquerdo / Comparison of echocardiographic dyssincrony parameters between normals and individuals with left bundle branch block

Introdução: A terapia de ressincronização cardíaca (TRC) tem sido usada para tratar pacientes com duração aumentada do complexo QRS e insuficiência cardíaca, para corrigir a perda do sincronismo cardíaco. Pelos critérios atuais clínicos e eletrocardiográficos (ECG) de indicação da TRC, cerca de 30 por cento dos pacientes não apresentam melhora com essa terapêutica. A ecocardiografia (ECG) tem sido proposta como uma técnica que poderia selecionar melhor os pacientes. Objetivo: Comparar os critérios ecocardiográficos para a evidência de dissincronismo átrio-ventricular (AV), interventricular (INTER) e intraventricular (INTRA) entre uma população normal com uma portadora de bloqueio de ramo esquerdo (BRE)...