Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results.

BACKGROUND: Proper treatment of patients with diffuse, severe coronary artery disease (CAD) is a challenge due to its complexity. Thus, data on the outcomes after coronary artery bypass graft (CABG) in this population is scarce. In this study, we aimed to determine the impact of CABG on the clinical and functional status, as well as graft patency in those individuals. METHODS: Patients with severe and diffuse CAD who underwent incomplete CABG due to complex anatomy or extensive distal coronary involvement were evaluated preoperatively and 1 year after surgery. Postoperative coronary angiography was performed to evaluate graft patency. Graft occlusion was defined as the complete absence of opacification of the target vessel. Stratified analysis of graft occlusion was performed by graft type and territories, defined as left anterior descending artery (LAD), the left circumflex branch, and the right coronary artery territories; the latter two, grouped, were further classified as non-LAD territory. RESULTS: A total of 57 patients were included, in whom 131 grafts were placed. There was a significant improvement in Canadian Cardiovascular Society angina symptom severity (Z = -6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a corresponding decrease in the use of long-acting nitrates (p < 0.001). The overall graft occlusion rate was 19.1%, with no significant difference between LAD and non-LAD territories (p = 0.08). However, a significantly lower occlusion rate was noted for the internal mammary artery (IMA) grafts when compared with saphenous vein grafts (p = 0.01), though this difference was only significant in the LAD territory (p = 0.04). Overall, the use of venous graft was the only predictor occlusion at 1 year (odds ratio: 4.03; p = 0.016). CONCLUSION: In patients with diffuse CAD, incomplete CABG surgery resulted in a significant clinical improvement, with acceptable graft occlusion rates at 1 year, particularly for IMA grafts to the LAD territory.

Sex Differences in Prognosis of Heart Failure Due to Ischemic and Nonischemic Cardiomyopathy.

BACKGROUND: Limited research has explored sex-specific differences in death predictors of HF patients with ischemic (iCMP) and nonischemic (niCMP) cardiomyopathy. This study assessed sex differences in niCMP and iCMP prognosis. METHODS: We studied 7487 patients with HF between February 2017 and September 2020. Clinical features and echocardiographic findings were collected. We used Kaplan-Meier, Cox proportional hazard models, and chi-square scores of Cox regression to determine death predictors in women and men. RESULTS: The mean age was 64.3 ± 14.2 years, with 4417 (59%) males. Women with iCMP and niCMP exhibited a significantly higher mean age, higher mean left ventricular ejection fraction, and smaller left ventricular diastolic diameter than men. Over 2.26 years of follow-up, 325 (14.7%) women and 420 (15.7%) men, and 211 women (24.5%) and 519 men (29.8%) with niCMP (p = NS) and iCMP (p = 0.004), respectively, died. The cumulative incidence of death was higher in men with iCMP (log-rank p < 0.0001) but similar with niCMP. Cox regression showed chronic kidney disease, diabetes, stroke, atrial fibrillation, age, and myocardial infarction as the main predictors of death for iCMP in women and men. CONCLUSIONS: Women exhibited a better prognosis than men with iCMP, but similar for niCMP. Nevertheless, sex was not an independent predictor of death for both CMP.

Additional improvement in regional myocardial ischemia after intracardiac injection of bone marrow cells during CABG surgery.

Background: Post-procedure residual ischemia is associated with worse prognosis in patients with coronary artery diasease (CAD). Objective: We evaluated whether autologous bone marrow-derived cells (BMC) contribute to additional reduction in regional stress-induced myocardial ischemia (SIMI) in patients undergoing incomplete coronary artery bypass graft surgery (CABG). Methods: In a double-blind, randomized, placebo-controlled trial, we enrolled 143 patients (82% men, 58 ± 11 years) with stable CAD and not candidates for complete CABG. They received 100 million BMC (n = 77) or placebo (n = 66) injected into ischemic non-revascularized segments during CABG. The primary outcome was improvement on SIMI quantified as the area at risk in injected segments assessed by cardiovascular magnetic resonance (CMR) 1, 6, and 12 months after CABG. Results: The reduction in global SIMI after CABG was comparable (p = 0.491) in both groups indicating sustained beneficial effects of the surgical procedure over 12 month period. In contrast, we observed additional improvement in regional SIMI in BMC treated group (p = 0.047). Baseline regional SIMI values were comparable [18.5 (16.2-21.0) vs. 18.5 (16.5-20.7)] and reached the lowest values at 1 month [9.74 (8.25; 11.49) vs. 12.69 (10.84; 14.85)] for BMC and placebo groups, respectively. The ischemia's improvement from baseline represented a 50% difference in regional SIMI in favor of the BMC transplanted group at 30 days. We found no differences in clinical and LVEF% between groups during the 12 month follow-up period. The 1 month rate of major adverse cerebral and cardiovascular events (MACCE) (p = 0.34) and all-cause mortality (p = 0.08) did not differ between groups 1 month post intervention. Conclusion: We provided evidence that BMC leads to additional reduction in regional SIMI in chronic ischemic patients when injected in segments not subjected to direct surgical revascularization. This adjuvant therapy deserves further assessment in patients with advanced CAD especially in those with microcirculation dysfunction. Clinical trial registration: https://clinicaltrials.gov/, identifier NCT01727063.

Which patients are more likely to benefit from renal transplantation?

BACKGROUND: We evaluated whether the advantages conferred by renal transplantation encompass all individuals or whether they favor more specific groups of patients. METHODS: One thousand and fifty-eight patients on the transplant waiting list and 270 receiving renal transplant were studied. End points were the composite incidence of CV events and death. Patients were followed up from date of placement on the list until transplantation, CV event, or death (dialysis patients), or from the date of transplantation, CV event, return to dialysis, or death (transplant patients). RESULTS: Younger patients with no comorbidities had a lower incidence of CV events and death independently of the treatment modality (log-rank=0.0001). Renal transplantation was associated with better prognosis only in high-risk patients (p=0.003). CONCLUSIONS: Age and comorbidities influenced the prevalence of CV complications and death independently of the treatment modality. A positive effect of renal transplantation was documented only in high-risk patients. These findings suggest that age and comorbidities should be considered indication for early transplantation even considering that, as a group, such patients have a shorter survival compared with low-risk individuals.

Medium light and medium roast paper-filtered coffee increased antioxidant capacity in healthy volunteers: results of a randomized trial.

We compared the effects of medium light roast (MLR) and medium roast (MR) paper-filtered coffee on antioxidant capacity and lipid peroxidation in healthy volunteers. In a randomized crossover study, 20 volunteers consumed 482 ± 61 ml/day of MLR or MR for four weeks. Plasma total antioxidant status (TAS), oxygen radical absorbance capacity (ORAC), oxidized LDL and 8-epi-prostaglandin F2α, erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) activity were measured at baseline and after the interventions. MLR had higher chlorogenic acids-(CGA; 334 mg/150 mL) and less caffeine (231 mg/150 ml) than MR had (210 and 244 mg/150 ml, respectively). MLR also had fewer Maillard reaction products (MRP) than MR had. Compared with baseline, subjects had an increase of 21 and 26 % in TAS, 13 and 13 % in CAT, 52 and 75 % in SOD, and 62 and 49 % in GPx after MLR and MR consumption (P < 0.001), respectively. ORAC increased after MLR (P = 0.004). No significant alteration in lipid peroxidation biomarkers was observed. Both coffees had antioxidant effects. Although MLR contained more CGA, there were similar antioxidant effects between the treatments. MRP may have contributed as an antioxidant. These effects may be important in protecting biological systems and reducing the risk of diseases related to oxidative stress.

Effects of Coffee on Sirtuin-1, Homocysteine, and Cholesterol of Healthy Adults: Does the Coffee Powder Matter?

Background: Coffee is one of the most popular beverages globally and contains several bioactive compounds that are relevant to human health. Many nutritional strategies modulate sirtuin-1, thereby impacting aging and cardiometabolic health. This study investigated the influence of different blended coffees on serum sirtuin-1, blood lipids, and plasma homocysteine. Methods: An eight-week randomized clinical trial that included 53 healthy adults of both sexes analyzed the effects of daily intake of 450 to 600 mL of pure Arabica or blended (Arabica + Robusta) coffee intake of filtered coffee on blood sirtuin-1, lipids, and homocysteine. Results: Both Arabica and blended coffees similarly increased serum sirtuin-1 concentration, from 0.51 to 0.58 ng/mL (p = 0.004) and from 0.40 to 0.49 ng/mL (p = 0.003), respectively, without changing plasma homocysteine, folic acid, glucose, and CRP. However, the blended coffee intake increased total cholesterol from 4.70 to 5.17 mmol/L (p < 0.001) and LDL-cholesterol from 2.98 to 3.32 mmol/L (p < 0.001), as well as HDL-c from 1.26 to 1.36 mmol/L (p < 0.001). Conclusion: Both coffee powders increased sirtuin-1 expression, but our results suggest that blended coffee had hypercholesterolemic effects which could increase cardiovascular risk. Therefore, preference should be given to Arabica coffee for the best cardiometabolic benefits of coffee.

Sex Differences in Cardiovascular Disease Mortality in Brazil between 1996 and 2019.

BACKGROUND: cardiovascular diseases (CVD) are Brazil's leading causes of death in women and men. This study analyzed age-adjusted death rate (DRaj) trends from all causes of death (ACD), CVD, ischemic heart disease (IHD), and stroke in women and men aged 35 to 74 years from 1996 to 2019. METHODS: We analyzed DRaj trends for all causes of death (ACD), CVD, IHD, and stroke. Data were from the Ministry of Health mortality database. Joinpoint Regression Program™ performed trend analysis and adjustments in death rates. Average annual percentage change (AAPC) determined the intensity of changes. RESULTS: In women, DRaj reduced for ACD (AAPC = -1.6%); CVD (AAPC = -2.6%); IHD (AAPC = -1.9%); and stroke (AAPC = -4.6%) (p < 0.001 for all). In men, ACD reduced from 1996 to 2004 (AAPC = -0.9%; p < 0.001), from 2012 to 2019 (AAPC = -1.9%; p < 0.001), and unchanged from 2004 to 2012; CVD (AAPC = -2.1%); IHD (AAPC = -1.5%); stroke (AAPC = -4.9%) (p < 0.001 for all) reduced from 1996 to 2019. From 1996 to 2019, the male/female ratio for ACD remained unchanged. CVD increased from 1.58 to 1.83, IHD from 1.99 to 2.30, and stroke from 1.52 to 1.83. CONCLUSION: ACD, CVD, IHD, and stroke were reduced more significantly in women, and the ratio of CVD, IHD, and CVD in men and women increased more in men. Future studies will be needed to determine the main factors responsible for a better outcome in women.

Sex Differences in Heart Failure Mortality with Preserved, Mildly Reduced and Reduced Ejection Fraction: A Retrospective, Single-Center, Large-Cohort Study.

BACKGROUND: Heart failure (HF) is one of the leading causes of death worldwide. Studies show that women have better survival rates than men despite higher hospitalizations. However, little is known about differences in mortality and predictors of death in women and men with HF with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF). METHODS: From February 2017 to September 2020, mortality and predictors of death were analyzed in women and men with HF. Baseline data included clinical characteristics and echocardiographic findings. RESULTS: A total of 11,282 patients, 63.9 ± 14.4 years, including 6256 (55.4%) males, were studied. Females were older, had a higher baseline mean left ventricular ejection fraction (LVEF) and lower left ventricular diastolic diameter. During follow-ups, 1375 (22%) men and 925 (18.4%) women died. Cumulative incidence of death was higher in men with HFrEF but similar for HFmrEF and HFpEF. Cox regression for death showed renal dysfunction, stroke, diabetes, atrial fibrillation, age, LVEF, valve disease, MI, and hypertensive CMP as independent death predictors for all HF patients. CONCLUSIONS: Women had a better prognosis than men in HFrEF and similar mortality for HFmrEF and HFpEF, but sex was not an independent predictor of death for all HF subtypes.

The Interplay of Sirtuin-1, LDL-Cholesterol, and HDL Function: A Randomized Controlled Trial Comparing the Effects of Energy Restriction and Atorvastatin on Women with Premature Coronary Artery Disease.

INTRODUCTION: HDL function has gained prominence in the literature as there is a greater predictive capacity for risk in early coronary artery disease when compared to the traditional parameters. However, it is unclear how dietary energy restriction and atorvastatin influence HDL function. METHODS: A randomized controlled trial with 39 women with early CAD divided into three groups (n = 13): energy restriction (30% of VET), atorvastatin (80 mg), and control. Analyses of traditional biochemical markers (lipid and glucose profile), circulating Sirt-1, and HDL function (lipid composition, lipid transfer, and antioxidant capacity). RESULTS: Participants' mean age was 50.5 ± 3.8 years. Energy restriction increased Sirt-1 by 63.6 pg/mL (95%CI: 1.5-125.7; p = 0.045) and reduced BMI by 0.8 kg/m2 (95%CI: -1.349--0.273; p = 0.004) in a manner independent of other cardiometabolic factors. Atorvastatin reduced LDL-c by 40.0 mg/dL (95%CI: -69.910--10.1; p = 0.010). Increased Sirt-1 and reduced BMI were independently associated with reduced phospholipid composition of HDL (respectively, ß = -0.071; CI95%:-0.136--0.006; p = 0.033; ß = 7.486; CI95%:0.350-14.622; p = 0.040). Reduction in BMI was associated with lower HDL-free cholesterol (ß = 0.818; CI95%:0.044-1.593; p = 0.039). LDL-c reduction by statins was associated with reduced maximal lipid peroxide production rate of HDL (ß = 0.002; CI95%:0.000-0.003; p = 0.022) and total conjugated diene generation (ß = 0.001; CI95%:0.000-0.001; p = 0.029). CONCLUSION: This study showed that energy restriction and atorvastatin administration were associated with changes in lipid profile, serum Sirt-1 concentrations, and HDL function.

Unexplained sudden death in patients on the waiting list for renal transplantation.

BACKGROUND: The incidence of unexplained sudden death (SD) and the factors involved in its occurrence in patients with chronic kidney disease are not well known. METHODS: We investigated the incidence and the role of co-morbidities in unexplained SD in 1139 haemodialysis patients on the renal transplant waiting list. RESULTS: Forty-four patients died from SD of undetermined causes (20% of all deaths; 3.9 deaths/1000 patients per year), while 178 died from other causes and 917 survived. SD patients were older and likely to have diabetes, hypertension, past/present cardiovascular disease, higher left ventricular mass index, and lower ejection fraction. Multivariate analysis showed that cardiovascular disease of any type was the only independent predictor of SD (P = 0.0001, HR = 2.13, 95% CI 1.46-3.22). Alterations closely associated with ischaemic heart disease like angina, previous myocardial infarction and altered myocardial scan were not independent predictors of SD. The incidence of unexplained SD in these haemodialysis patients is high and probably a consequence of pre-existing cardiovascular disease. CONCLUSIONS: Factors influencing SD in dialysis patients are not substantially different from factors in the general population. The role played by ischaemic heart disease in this context needs further evaluation.

Qualitative and quantitative real time myocardial contrast echocardiography for detecting hibernating myocardium.

BACKGROUND: Real time myocardial contrast echocardiography (RTMCE) is an emerging imaging modality for assessing myocardial perfusion that allows for noninvasive quantification of regional myocardial blood flow (MBF). AIM: We sought to assess the value of qualitative analysis of myocardial perfusion and quantitative assessment of myocardial blood flow (MBF) by RTMCE for predicting regional function recovery in patients with ischemic heart disease who underwent coronary artery bypass grafting (CABG). METHODS: Twenty-four patients with coronary disease and left ventricular systolic dysfunction (ejection fraction <45%) underwent RTMCE before and 3 months after CABG. RTMCE was performed using continuous intravenous infusion of commercially available contrast agent with low mechanical index power modulation imaging. Viability was defined by qualitative assessment of myocardial perfusion as homogenous opacification at rest in ≥2 segments of anterior or ≥1 segment of posterior territory. Viability by quantitative assessment of MBF was determined by receiver-operating characteristics curve analysis. RESULTS: Regional function recovery was observed in 74% of territories considered viable by qualitative analysis of myocardial perfusion and 40% of nonviable (P = 0.03). Sensitivity, specificity, positive and negative predictive values of qualitative RTMCE for detecting regional function recovery were 74%, 60%, 77%, and 56%, respectively. Cutoff value of MBF for predicting regional function recovery was 1.76 (AUC = 0.77; 95% CI = 0.62-0.92). MBF obtained by RTMCE had sensitivity of 91%, specificity of 50%, positive predictive value of 75%, and negative predictive value of 78%. CONCLUSION: Qualitative and quantitative RTMCE provide good accuracy for predicting regional function recovery after CABG. Determination of MBF increases the sensitivity for detecting hibernating myocardium.

Training Non-Cardiologists Could Improve the Treatment Results of ST Elevation Myocardial Infarction. / Treinamento de Não-Cardiologistas pode Melhorar os Resultados do Tratamento de Infarto Agudo do Miocárdio com Supra de ST.

BACKGROUND: According to the World Health Organization, emerging countries will have an enormous growth in the number of heart attacks and related deaths. The main medical issue in Brazil is mortality caused by acute ST elevation myocardial infarction (STEMI). The Society of Cardiology in the State of São Paulo has never trained non-cardiologists as emergency personnel. Patients usually seek help from emergency departments instead of calling for an ambulance. OBJECTIVES: We aimed at reducing in-hospital death rates from acute myocardial infarction by training emergency personnel in the city of Sao Paulo. METHODS: We used a training program for the personnel of five hospitals with >100 patients admitted with STEMI per year, and at least 15% in-hospital STEMI-associated mortality rate. We performed internet training, biannual-quarterly symposia for up to 400 participants, informative folders and handouts. Statistical analysis used the two proportion comparison test with p <0.05. RESULTS: Nearly 200 physicians and 350 nurses attended at least one training from May 2010 to December 2013. Initially, many emergency physicians could not recognize an acute myocardial infarction on the electrocardiogram, but tele-electrocardiography is used in some emergency departments to determine the diagnosis. The death rate in the five hospitals decreased from 25.6%, in 2009, to 18.2%, in 2010 (p=0.005). After the entire period of training, the STEMI-associated death rate in all public hospitals of São Paulo decreased from 14.31%, in 2009, to 11.25%, in 2014 (p<0.0001). CONCLUSION: Even simple training programs for emergency personnel can greatly reduce acute myocardial infarction death rates in undeveloped countries.

FUNDAMENTO: De acordo com a Organização Mundial da Saúde, países emergentes terão um crescimento considerável no número de ataques cardíacos e mortes relacionadas. Um dos principais problemas médicos no Brasil é a mortalidade causada por infarto agudo do miocárdio com supra de ST (IAMCSST). A Sociedade de Cardiologia do Estado de São Paulo nunca treinou não-cardiologistas para atendimentos de emergência. Os pacientes normalmente buscam ajuda em prontos-socorros, em vez de chamar a ambulância. OBJETIVO: Nosso objetivo foi reduzir as taxas de mortalidade hospitalar causada por infarto agudo do miocárdio ao treinar profissionais da emergência na cidade de São Paulo. MÉTODOS: Utilizamos um programa de treinamento para as equipes de cinco hospitais com > 100 pacientes internados com IAMCSST por ano, e pelo menos 15% de mortes hospitalares relacionadas ao IAMCSST. Realizamos treinamentos online, organizamos de dois a quatro eventos para até 400 participantes, fizemos folders e panfletos informativos. A análise estatística utilizou o teste para comparação de duas proporções, com p <0,05. RESULTADOS: Quase 200 médicos e 350 enfermeiros participaram de pelo menos um treinamento de maio de 2010 até dezembro de 2013. Inicialmente, muitos médicos da emergência não reconheciam um infarto agudo do miocárdio no eletrocardiograma, mas a tele-ecocardiografia é usada em alguns departamentos da emergência para determinar o diagnóstico. A taxa de mortalidade nos cinco hospitais caiu de 25,6%, em 2009, para 18,2%, em 2010 (p=0,005). Depois da conclusão do período de treinamento, as mortes relacionadas ao IAMCSST em todos os hospitais públicos de São Paulo diminuíram de 14,31%, em 2009, para 11,25%, em 2014 (p<0,0001). CONCLUSÃO: Mesmo programas simplificados de treinamento de pessoal da emergência pode reduzir muito as taxas de morte por infarto agudo do miocárdio em países em desenvolvimento.

Prospective, case-controlled study evaluating serum concentration of sirtuin-1 and mannose-binding lectin in patients with and without periodontal and coronary artery disease.

BACKGROUND: Atherosclerosis and periodontal disease (PD) are inflammatory diseases that have been shown in studies to have a direct association. Mannose-binding lectin (MBL) is an immune system protein that binds to periodontal pathogens favoring phagocytosis. Conversely, increased serum sirtuin-1 (SIRT1) concentration reduces the inflammatory process. METHODS: This was a prospective, case-controlled study that analyzed serum concentration of biomarkers in patients with or without coronary artery disease (CAD) and PD. A total of 78 patients were evaluated: 20 healthy individuals, 18 patients with CAD, 20 patients with PD, and 20 patients with both PD and CAD. Clinical and laboratory characteristics were analyzed before and after nonsurgical treatment of PD and also at two equivalent times in patients without PD. Serum MBL and SIRT1 concentration were analyzed by enzyme-linked immunosorbent assay. RESULTS: A negative correlation was observed between changes in serum concentration of MBL and SIRT1 (r = -0.30; p = 0.006). Comparison between pre- and post-treatment of PD showed a reduction in MBL levels (886.27 ± 906.72 versus 689.94 ± 808.36; p = 0.002) and an increase in SIRT1 values (0.80 ± 1.01 versus 1.49 ± 1.55; p = 0.005) in patients with PD and without CAD. The same result was observed in patients with PD and CAD for MBL and SIRT1, respectively, of 1312.43 ± 898.21 versus 1032.90 ± 602.52 (p = 0.010) and 1.32 ± 1.0 versus 1.82 ± 1.75 (p = 0.044). CONCLUSION: PD treatment reduced MBL serum concentration and increased SIRT1 serum concentration in patients with and without CAD.

Influence of the treatment of periodontal disease in serum concentration of sirtuin 1 and mannose-binding lectin.

BACKGROUND: Increased levels of periodontal pathogens disrupt the homeostasis between the host and its microbiota and increase susceptibility to periodontal diseases. Periodontitis increases the serum concentration of mannose-binding lectin (MBL), which exacerbates local inflammatory processes. In animal studies, sirtuin 1 (SIRT1) was associated with protection against inflammation. This study analyzed the influence of non-surgical periodontal treatment on serum levels of MBL and SIRT1. METHODS: Forty patients with periodontitis and 38 periodontally healthy individuals (aged 45 to 79 years) were included. Periodontitis patients received scaling and root planing using machine driven and hand instruments. Clinical parameters, inflammatory biomarkers, MBL, and SIRT1 levels were measured at baseline and at post-treatment. RESULTS: For all patients, an inverse correlation was observed between serum concentrations of MBL and SIRT1 (r = -0.30; P = 0.006). Periodontal treatment reduced serum concentrations of MBL (1,099.35 ± 916.59 to 861.42 ± 724.82 ng/mL; P < 0.001) and C-reactive protein (6.05 ± 8.99 to 2.49 ± 2.89 mg/L; P = 0.009). By contrast, SIRT1 serum levels increased (1.06 ± 1.03 to 1.66 ± 1.64 ng/mL; P < 0.001) following periodontal treatment. CONCLUSIONS: Periodontal treatment was associated with decreased serum concentrations of MBL and CRP and increased serum levels of SIRT1. Prospective studies are needed to assess the impact of these biomarkers on pathophysiology of periodontitis.

Waist Circumference Percentiles and Cut-Off Values for Obesity in a Large Sample of Students from 6 To 10 Years Old Of The São Paulo State, Brazil. / Os Percentis e Pontos de Corte da Circunferência Abdominal para Obesidade em uma Ampla Amostra de Estudantes de 6 a 10 Anos de Idade do Estado de São Paulo, Brasil.

BACKGROUD: The prevalence of obesity has systematically been increased in the population, including children and adolescents, around the world. OBJECTIVES: To describe reference percentile curves for waist circumference (WC) in Brazilian children and provide cut-off values of WC to identify children at risk for obesity. METHODS: A multicenter, prospective, cross-sectional study was performed with children aged from 6 to 10 years old, enrolled in public and private elementary schools from 13 cities of the São Paulo State. Height, weight, and WC were measured in duplicate in 22,000 children (11,199 boys). To establish the WC best cut-off value for obesity diagnosis, ROC curves with children classified as normal weight and obese were calculated, according to BMI curves, stratified by gender and age, and the Youden Index was utilized as the maximum potential effectiveness of this biomarker. A p < 0.05 was considered statistically significant. RESULTS: WC values increased with age in both boys and girls. The prevalence of obesity in each age group varied from 17% (6 years old) to 21.6% (9 years old) among boys, and from 14.1% (7 years old) to 17.3 % (9 years old) among girls. ROC analyses have shown the 75th percentile as a cut-off for obesity risk, and the diagnosis of obesity is classified on the 85th percentile or more. CONCLUSION: Age and gender specific reference curves of WC for Brazilian children and cut-off values for obesity risk may be used for national screening and interventional studies to reduce the obesity burden in Brazil. (Arq Bras Cardiol. 2020; 114(3):530-537).

FUNDAMENTO: A prevalência da obesidade vem aumentando sistematicamente na população, inclusive nas crianças e adolescentes, ao redor do mundo. OBJETIVOS: Descrever curvas percentílicas de referência para a circunferência abdominal (CA) nas crianças brasileiras e fornecer pontos de corte da CA para identificar crianças com risco de obesidade. MÉTODOS: Um estudo multicêntrico, prospectivo, tranversal foi realizado em crianças com idades entre 6 e 10 anos, matriculadas no ensino fundamental de escolas públicas e particulares de 13 cidades do estado de São Paulo. A estatura, o peso e a CA foram medidos em duplicata em 22.000 crianças (11.199 meninos). Para estabelecer o melhor ponto de corte da CA para o diagnóstico da obesidade, foram calculadas curvas ROC com crianças classificadas como com peso normal e obesas, de acordo com as curvas do IMC, estratificadas por gênero e idade, e o índice Youden foi utilizado como a eficácia potencial máxima desse biomarcador. Valores de p < 0,05 foram considerados estatisticamente significativos. RESULTADOS: Os valores da CA aumentaram com a idade, tanto nos meninos quanto nas meninas. A prevalência de obesidade em cada grupo variou de 17% (6 anos de idade) a 21,6 % (9 anos de idade), dentre os meninos, e de 14,1% (7 anos de idade) a 17,3 % (9 anos de idade), dentre as meninas. As análises ROC mostraram o percentil 75 como ponto de corte para o risco de obesidade, e o diagnóstico de obesidade está classificado no percentil 85 ou acima. CONCLUSÃO: Curvas de referência da CA específicas para idade e sexo em crianças brasileiras e pontos de corte para o risco de obesidade podem ser usados em triagem nacional e estudos intervencionais para reduzir a carga da obesidade no Brasil. (Arq Bras Cardiol. 2020; 114(3):530-537).

Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest.

CONTEXT: Advanced cardiac life support (ACLS) training was introduced to bring order and a systematic approach to the treatment of cardiac arrest by professional responders. In spite of the wide dissemination of ACLS training, it has been difficult to demonstrate improved outcome following such training. OBJECTIVE: To determine the value of formal ACLS training in improving survival from in-hospital cardiac arrest. DESIGN, SETTING, AND PARTICIPANTS: A multi-center, prospective cohort study examined patient outcomes after resuscitation efforts by in-hospital rescue teams with and without ACLS-trained personnel. A total of 156 patients, experiencing 172 in-hospital cardiopulmonary arrest events over a 38-month period (January 1998 to March 2001) were studied. MAIN OUTCOME MEASURES: Primary endpoints included return of spontaneous circulation (ROSC), survival to hospital discharge, 30-day survival, and 1-year survival. RESULTS: The immediate success of resuscitation efforts for all patients was 39.7% (62/156). There was a significant increase in ROSC with ACLS-trained personnel (49/113; 43.4%) versus no ALCS-trained personnel (16/59; 27.1%; p=0.04). Likewise, patients treated by ACLS-trained personnel had increased survival to hospital discharge (26/82; 31.7% versus 7/34; 20.6%; p=0.23), significantly better 30-day survival (22/82; 26.8% versus 2/34; 5.9%; p<0.02), and significantly improved 1-year survival (18/82; 21.9% versus 0/34; 0%; p<0.002). CONCLUSION: The presence of at least one ACLS-trained team member at in-hospital resuscitation efforts increases both short and long-term survival following cardiac arrest.

[Heart rate and cardiovascular risk]. / Freqüência cardíaca e risco cardiovascular.

Heart rate (HR) is known to be one of the factors that in the animal world are related to mortality. When one multiplies resting HR by the average life time, for each animal species, the result is almost the same number, similar to a constant. Apparently, each class of living beings has its "maximal number of heart beats for a life". Herein considerations are made about the relationship between HR and survival in human beings. Some epidemiological studies are reviewed, especially those related to cardiovascular and coronary diseases correlated to deaths and discussions are directed towards the perspective of living longer by lowering the HR.

Ischemic Heart Disease in German Immigrants and Their Descendants in a Region of Southern Brazil: A Comparison of Initial Symptoms Reported between two Generations

Abstract Background Nothing is known about ischemic heart disease (IHD) in the Germans who emigrated to Brazil during the last century. Objective We sought to compare age at diagnosis and IHD manifestations between German immigrants and their first-generation descendants in the region of Blumenau, Brazil. Methods We reviewed medical records of hospitals in Blumenau. Comparison of the groups in the evaluation times was made by analysis of variance (ANOVA) with repeated measures, and comparison of two factors was made by two-way ANOVA. The level of significance was set at p <0.05. Results Study population comprised 68 patients who were born in Germany (group G) and 99 descendants (group D). Twenty-nine patients of group D had two German parents and 70 had one. Mean age at diagnosis was 66.8 ± 10.6 years, with a significant difference between the groups, four years higher in Group G than group D (69.0 ± 8.8 vs 65.4 ± 11.5 years old) (p = 0.025). There was no significant difference in risk factors or coronary angiography data between the groups. HDL cholesterol levels were significantly higher in group G than in group D (48.4 ± 11.1 mg/dL vs 43.3 ± 11.2 mg/dL, p = 0.005). Conclusion At the time of first IHD diagnosis, mean age of the group G was significantly higher than group D, with no differences between groups in sex, risk factors, LDL levels, or clinical and angiographic manifestations. An earlier manifestation of the disease could be part of lifestyle changes in descendants, in this population that mantained eating habits characterized by high saturated fat consumption.