Systolic Heart Function, Kidney Filtration and the Number of Coronary Atherosclerotic Plaques in Lean and Overweight Patients.

The objective of this study was to quantify the number of vessels with stenotic points in the coronary circulation of lean and overweight individuals submitted to coronary angiography and ventriculography to verify the possible associations with glomerular filtration and the systolic ventricular function. Eighty-six patients with a previous history of myocardial ischemia were studied. Two groups were formed: non-elderly (G1), n = 38, 52.8 ± 1.2 years old, and elderly (G2), n = 48, 70.1 ± 1.2 years old. Both groups were divided into 2 subgroups according to the estimated glomerular filtration rate (eGFR): ≥60 and <60 ml/min/m(2). The results showed that G1 had 0.36 ± 0.11 versus 1.25 ± 0.45 stenoses/patient (≥60 vs. <60 ml/min/m(2); p < 0.05, respectively) and G2 had 0.91 ± 0.28 versus 1.83 ± 0.33 stenoses/patient (≥60 vs. <60 ml/min/m(2), respectively). The other variables, such as central and brachial arterial blood pressures, did not manifest significant differences in relation to the eGFR. The following significant correlations were observed: between the quantity of coronary stenotic points and the eGFR (R(2) = 11.2%; r = -0.33; p < 0.001), and between eGFR and the ventricular ejection fraction (R(2) = 5.1%; r = 0.57; p < 0.0001). The ejection fraction correlated significantly with the number of vessels with stenoses in the coronary bed (R(2) = 13.4%; r = -0.36; p < 0.008). In conclusion, although the correlations are considered weak, interrelationships between heart and kidney were demonstrated in this study.

Mononitrato de isossorbida intracoronário versus placebo. Estudo duplo-cego através da angiografia coronária quantitativa / Intracoronary isosorbide mononitrate vs. placebo. A double blind study usingquantitative coronary angiography

PURPOSE: To evaluate the vasodilation effect of intracoronary isosorbide mononitrate (ISMN) on the coronary arteries, systolic aortic pressure (SAP) and cardiac rhythms. METHODS: Forty patients aged 61 (40-72) years, 30 (75) male, were randomized to receive on a double blind fashion, 20 mg of ISMN or placebo. The two groups had similar baseline characteristics. Quantitative coronary arteriography [by cardiovascular measurement system (CMS)] and SAP were compared before and after ISMN. We also observed the cardiac rhythm. RESULTS: There were no arrhythmias. Reference vessel diameter increased from 2.6 +/- 0.5 mm before to 2.9 +/- 0.4 mm after ISMN and did not change, mean 2.9 +/- 0.5 mm, before and after placebo. There was a difference between ISMN and placebo (p < 0.0001). There was no difference in the SAP change between the two groups, 4.2 +/- 0.7 mmHg with ISMN and 1.8 +/- 0.5 mmHg with placebo (p = NS). CONCLUSION: ISMN promotes a safe and effective vasodilation of the coronary arteries with no major effects in cardiac rhythm and systolic aortic pressure.

Objetivo - Avaliar o efeito do mononitrato-5 de isossorbida (MNIS) sobre as artérias coronárias, pressão arterial sistêmica média (PAS) e ritmo cardíaco, quando injetado intracoronário. Métodos - Quarenta pacientes, idade entre 40 a 72 (média 61) anos, 30 (75%) homens, foram sorteados para receber, de maneira cega, 20mg de MNIS ou placebo (PL). Os dois grupos tinham características basais semelhantes. A angiografia coronária quantitativa (através do sistema CMS - cardiovascular measurement system) a PAS e o ritmo cardíaco foram comparados antes e após a injeção de MNIS/PL. Resultados -Não houve arritmias. O diâmetro coronário variou de 2,6± 0,5mm, antes, para 2,9±0,4mm, após oMNIS, e nuo variou com a injeção de PL, permanecendo 2,9±0,5mm antes e após, havendo diferença significativa entre o MNIS e o PL (p<0,0001). A variação da PAS não foi diferente entre os 2 grupos, sendo 4,2±0,7mmHg no grupo MNIS e 1,85±0,5mmHg no grupo PL (p=NS). Conclusão - O MNIS promove eficaz e segura dilatação coronária, pois não induz à hipotensão arterial sistêmica ou alteração no ritmo cardíaco

Valor preditivo da tele-eletrocardiografia no infarto agudo do miocárdio / Myocardial infarction predictors as detected by teleelectrocardiography

O presente estudo procurou avaliar, prospectivamente, a segurança do sistema de tele-eletrocardiografia para a liberação de pacientes que se apresentem a postos de saúde com queixa de dor torácica. Avaliamos a incidência de infarto do miocárdio dessa população ao longo de seis meses. Como objetivo secundário, correlacionamos, retrospectivamente, a razão das probabilidades entre diferentes indicadores clínicos e eletrocardiográficos e a ocorrência do infarto do miocárdio. Entre junho e dezembro de 2006, 32444 pacientes foram atendidos em postos de saúde pública, carentes de cardiologistas e tiveram o seu tele-eletrocardiograma transmitido até uma central de telemedicina, através de linha telefônica fixa. Selecionaram-se 1535 pacientes atendidos devido a dor torácica, que tinham mais de 50 anos e apresentavam exame clínico, laboratorial (troponina I ou creatino fosfoquinase fração MB-CKMB) e tele-eletrocardiográfico normais além de consentirem em repetir o tele-eletrocardiograma após um e seis meses. Todos os pacientes foram seguidos durante seis meses. Não houve eventos durante o primeiro mês. No segundo mês houve 12 (0,8%) infartos; no terceiro mês, 18 (1,2%); no quarto mês, 38 (2,4%) e no sexto, 18 (1,2%). Ao longo dos seis meses houve 15(1%) óbitos, sendo 9(0,6%) de origem cardíaca; 9 (0,6%) acidentes vasculares encefálicos e 86 (5,6%) infartos agudos do miocárdio. Entre as variáveis que se correlacionaram, independentemente, com maior chance de infarto agudo do miocárdio, encontrou-se a obesidade grau I [p=0,009 RC 4,5 IC 95%(1,5-13,8)], a dislipidemia [p< 0,0001 RC 3,4 IC 95%(2,0-5,8)], a baixa amplitude da onda T em V2 [p<0,001 RC 2,9 IC 95%(2,4-3,5)] e o sobrepeso [p=0,019 RC 2,6 IC 95%(1,2-5,7)]...

The present study aimed at prospectively evaluating the reliability of teleeletrocardiography for the discharge of chest pain patients who present themselves at remote medical centers. The incidence of acute myocardial infarction among this population was evaluated during a period of six months. As a secondary objective, the correlation between different clinical and electrocardiographic features and the occurrence of myocardial infarction was retrospectively checked. Between June and December of 2006, 32.444 patients were treated in public medical centers which lacked the assistance of cardiologists. Those patients had their electrocardiogram transmitted to a telemedicine center over a fixed-wired telephone line. Among them 1535 patients who had been assisted due to chest pain were selected. Those patients were all older than 50 years and showed normal clinical and laboratorial (troponine I or creatine phosphokinase MB-CKMB fraction) exams, as well as normal tele-electrocardiograms. They also agreed to repeat the teleelectrocardiogram in a six-month period. All patients were followed up to the sixth-month. In the second month, there were 12 (0,8%) infarctions; in the third month there were 18 (1,2%) infarctions; in the fourth month there were 38 (2,4%) infarctions, and in the sixth month there were 18 (1,2%) infarctions. Over that six month period, there were 15 (1%) deaths, 9 (0,6%) of which were related to cardiac causes; 9 (0,6%) strokes, and 86 (5,6%) acute myocardial infarctions. Among the variables which independently correlated with greater risk of acute myocardial infarction, we found grade I obesity [p=0,009 RC 4,5 IC95%(1,5-13,8)]; dyslipidemia [p<0,0001 RC 3,4 IC 95%(2,0-5,8)]; low T-wave amplitude in V2 [p<0,001 RC 2,9 IC 95%(2,4-3,5)], and overweight [p=0,019 RC 2,6 IC 95%(1,2-5,7)]...

Diabetes pancreático fibrocalculoso: uma forma rara de diabetes na América do Sul. relato de caso / Fibrocalculous pancreatic diabetes : an rare form of diabetes in South of American. Report of a case

Os autores apresentam um caso de diabetes pancreático fibrocalculoso que evoluiu por 12 anos sem cetose, mas com complicaçoes crônicas oculares, neurológicas e insuficiência pancreática exócrina. A histologia do pâncreas evidenciou calcificaçoes, fibrose e despopulaçao de ilhotas de Langerhans. Chamam a atençao para os múltiplos fatores que poderiam estar implicados na etiologia desta forma de diabetes, como o consumo de alimentos de baixo valor proteico (mandioca), a desnutriçao crônica, parasitoses intestinais, associados a uma predisposiçao familiar ao diabetes. Trata-se de uma forma incomum de diabetes na América do Sul.