Serious infections among unselected patients with ST-elevation myocardial infarction treated with contemporary primary percutaneous coronary intervention.

BACKGROUND: Contemporary studies assessing the frequency, characteristics, and outcomes of serious infections (SIs) in patients presenting a ST-elevation myocardial infarction are scarce. METHODS: Prospective cohort of consecutive patients undergoing primary percutaneous coronary intervention (pPCI). Serious infection was defined as the presence of infection that prolonged hospitalization. Community-acquired infection (CAI) was defined by SI diagnosed in the first 72 hours of hospitalization, whereas hospital-acquired infections (HAI) were those diagnosed after 72 hours of hospital admission. RESULTS: From December 2009 to November 2012, 1,486 patients were included in the analysis. Serious infection was present in 58 (3.9%) individuals; 30 (2%) patients had CAI and 28 (1.9%) patients had HAI. Respiratory tract infection was responsible for 82% of the SI. Patients with SI were older, had more comorbidities, and had worse angiographic results of the pPCI procedure when compared with those without SIs. After multivariable adjustment, SI was associated with an approximately 10-fold risk of 30-day death. Patients with CAI had more often a history of smoking, Killip III/IV on hospital admission, worse pPCI, and angiographic results than did patients with HAI. However, no differences were seen in 30-day major cardiovascular outcomes between patients with CAI and HAI. CONCLUSION: In a contemporary cohort of unselected ST-elevation myocardial infarction patients representative of the daily practice, SI was uncommon but associated with worse pPCI results and high risk of mortality. The occurrences of CAI or HAI were similar, but CAI patients presented distinctly worse angiographic outcomes than did patients with HAI.

Donor-recipient predicted heart mass ratio and right ventricular-pulmonary arterial coupling in heart transplant.

OBJECTIVES: Right ventricular-pulmonary arterial (RV-PA) coupling interactions are largely unexplored in heart transplant patients. The outcome of this study was RV-PA coupling at 7 and 30 days after heart transplant and its association with donor-recipient size matching. METHODS: Clinical, echocardiographic and haemodynamic data from a retrospective cohort of heart transplant recipients and respective donors were reviewed. Coupling between RV-PA was examined by assessing the RV fractional area change and pulmonary artery systolic pressure ratio. Donor-recipient size matching was assessed by the predicted heart mass (PHM) ratio, and groups with a PHM ratio <1 and ≥1 were compared. RESULTS: Forty-four heart transplant recipients were included in this study (50 years, 57% male sex). Postoperative RV-PA coupling improved from 7 to 30 days (RV fractional area change/pulmonary artery systolic pressure 0.9 ± 0.3 vs 1.2 ± 0.3; P < 0.001). A positive association was found between an adequate PHM ratio and improvement of RV fractional area change/pulmonary artery systolic pressure at 30 days, independent of graft ischaemic time and pre-existent pulmonary hypertension (B coefficient 0.54; 95% confidence interval 0.11-0.97; P = 0.016; adjusted R2 = 0.24). CONCLUSIONS: These findings highlight the role of PHM as a metric to help donor selection and suggest its impact in RV-PA coupling interactions post-heart transplant.

Impaired Right Ventricular Function in Heart Transplant Rejection.

BACKGROUND: The practice of screening for complications has provided high survival rates among heart transplantation (HTx) recipients. OBJECTIVES: Our aim was to assess whether changes in left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) are associated with cellular rejection. METHODS: Patients who underwent HTx in a single center (2015 - 2016; n = 19) were included in this retrospective analysis. A total of 170 biopsies and corresponding echocardiograms were evaluated. Comparisons were made among biopsy/echocardiogram pairs with no or mild (0R/1R) evidence of cellular rejection (n = 130 and n = 25, respectively) and those with moderate (2R) rejection episodes (n=15). P-values < 0.05 were considered statistically significant Results: Most patients were women (58%) with 48 ± 12.4 years of age. Compared with echocardiograms from patients with 0R/1R rejection, those of patients with 2R biopsies showed greater LV posterior wall thickness, E/e' ratio, and E/A ratio compared to the other group. LV systolic function did not differ between groups. On the other hand, RV systolic function was more reduced in the 2R group than in the other group, when evaluated by TAPSE, S wave, and RV fractional area change (all p < 0.05). Furthermore, RV GLS (-23.0 ± 4.4% in the 0R/1R group vs. -20.6 ± 4.9% in the 2R group, p = 0.038) was more reduced in the 2R group than in the 0R/1R group. CONCLUSION: In HTx recipients, moderate acute cellular rejection is associated with RV systolic dysfunction as evaluated by RV strain, as well as by conventional echocardiographic parameters. Several echocardiographic parameters may be used to screen for cellular rejection.

Impaired Right Ventricular Function in Heart Transplant Rejection / Disfunção Ventricular Direita e Rejeição em Transplante Cardíaco

Abstract Background: The practice of screening for complications has provided high survival rates among heart transplantation (HTx) recipients. Objectives: Our aim was to assess whether changes in left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) are associated with cellular rejection. Methods: Patients who underwent HTx in a single center (2015 - 2016; n = 19) were included in this retrospective analysis. A total of 170 biopsies and corresponding echocardiograms were evaluated. Comparisons were made among biopsy/echocardiogram pairs with no or mild (0R/1R) evidence of cellular rejection (n = 130 and n = 25, respectively) and those with moderate (2R) rejection episodes (n=15). P-values < 0.05 were considered statistically significant Results: Most patients were women (58%) with 48 ± 12.4 years of age. Compared with echocardiograms from patients with 0R/1R rejection, those of patients with 2R biopsies showed greater LV posterior wall thickness, E/e' ratio, and E/A ratio compared to the other group. LV systolic function did not differ between groups. On the other hand, RV systolic function was more reduced in the 2R group than in the other group, when evaluated by TAPSE, S wave, and RV fractional area change (all p < 0.05). Furthermore, RV GLS (−23.0 ± 4.4% in the 0R/1R group vs. −20.6 ± 4.9% in the 2R group, p = 0.038) was more reduced in the 2R group than in the 0R/1R group. Conclusion: In HTx recipients, moderate acute cellular rejection is associated with RV systolic dysfunction as evaluated by RV strain, as well as by conventional echocardiographic parameters. Several echocardiographic parameters may be used to screen for cellular rejection.

Resumo Fundamento: A prática de triagem para complicações tem proporcionado altas taxas de sobrevida entre pacientes que receberam transplante cardíaco (TC). Objetivos: Visamos avaliar se alterações no strain longitudinal global (SLG) do ventrículo esquerdo (VE) e do ventrículo direito (VD) estão associadas à rejeição celular. Métodos: Pacientes que foram submetidos à TC em um único centro (2015 - 2016; n = 19) foram incluídos nesta análise retrospectiva. Foram avaliados um total de 170 biópsias com ecocardiogramas correspondentes. Foram realizadas comparações entre pares de biópsia/ecocardiograma com nenhuma ou leve (0R/1R) evidência de rejeição celular (n = 130 e n = 25, respectivamente) e aqueles com episódios de rejeição moderada (2R) (n = 15). Foram considerados estatisticamente significativos os valores de p < 0,05. Resultados: A maioria dos pacientes eram mulheres (58%) com idade média de 48 ± 12,4 anos. Em comparação com os ecocardiogramas dos pacientes com rejeição 0R/1R, os pacientes com biópsias 2R apresentaram maior espessura da parede posterior do VE, relação E/e' e relação E/A, em comparação com o outro grupo. A função sistólica do VE não diferiu entre os grupos. Por outro lado, a função sistólica do VD foi reduzida no grupo 2R em comparação ao outro grupo, quando avaliada por TAPSE, onda S e variação fracional da área do VD. Adicionalmente, SLG VD (−22,97 ± 4,4% no grupo 0R/1R vs. −20,6 ± 4,9% no grupo 2R, p = 0,038) foi reduzido no grupo 2R, em comparação com o grupo 0R/1R. Conclusão: Em pacientes de TC, rejeição celular aguda moderada está associada à disfunção sistólica do VD, avaliado pelo strain do VD, bem como por parâmetros ecocardiográficos convencionais. Vários parâmetros ecocardiográficos podem ser utilizados para realizar triagem para rejeição celular.

Preoperative serum fibrinogen as a predictor of myocardial infarction in the surgical myocardial revascularization.

OBJECTIVE: Determine the predictive level of preoperative serum fibrinogen level for the occurrence of MI in perioperative surgical myocardial revascularization (SMR), as well as for other impacting outcomes, such as stroke, pulmonary thromboembolism (PTE), and death, separately or in combination. METHODS: A retrospective cohort study based on the heart surgery database analysis from São Lucas Hospital, at Rio Grande do Sul Catholic University with 1,471 consecutive patients submitted to extracorporeal SMR between January, 1998 and December, 2002. RESULTS: Perioperative MI occurred in 14% of sample patients. No association was shown between preoperative fibrinogen and perioperative MI (410.60 +/- 148.83 mg/dl for the study group x 401.57 +/- 135.23 mg/dl for control group--p = 0.381--RC = 1.000--CI95%: 0.998-1.002--p = 0.652), combined outcome for MI, stroke, PTE, and death (411.40 +/- 153.52 mg/dL for the group reporting outcome x 400.31 +/- 131.98 mg/dL for the group with no outcome--p = 0.232) and neither separately. CONCLUSION: In that sample, preoperative serum fibrinogen level did not show any association with the occurrence of perioperative MI in SMR, neither with other impacting outcomes, stroke, PTE, and mortality, whether separately or as composite endpoints.

Fibrinogênio sérico pré-operatório como preditor de infarto do miocárdio na cirurgia de revascularização miocárdica / Preoperative serum fibrinogen as a predictor of myocardial infarction in the surgical myocardial revascularization / Preoperative serum fibrinogen as a predictor of myocardial infarction in the surgical myocardial revascularization

OBJETIVO: Determinar o valor preditivo do nível sérico de fibrinogênio pré-operatório para a ocorrência de infarto do miocárdio (IM) no período perioperatório de cirurgia de revascularização miocárdica (CRM), bem como para outros desfechos de impacto, como acidente vascular encefálico isquêmico (AVEI), tromboembolismo pulmonar (TEP) e morte, isoladamente e de maneira composta. MÉTODOS: Estudo de coorte retrospectivo com análise do banco de dados de cirurgia cardíaca do Hospital São Lucas da PUC-RS, com 1.471 pacientes consecutivos que realizaram CRM com circulação extracorpórea entre janeiro de 1998 e dezembro de 2002. RESULTADOS: IM perioperatório ocorreu em 14 por cento dos pacientes da amostra. Não foi observada associação entre o fibrinogênio pré-operatório e IM perioperatório (410,60 ± 148,83 mg/dl para o grupo em estudo x 401,57 ±135,23 mg/dl para o grupo controle - p = 0,381 - RC = 1,000 - IC95 por cento: 0,998-1,002 - p = 0,652), o desfecho combinado de IM, AVEI, TEP e morte (411,40 ± 153,52 mg/dl para o grupo com o desfecho x 400,31 ± 131,98 mg/dl para o grupo sem o desfecho - p = 0,232) e nem com cada um destes isoladamente. CONCLUSÃO: Nesta amostra, o nível sérico de fibrinogênio pré-operatório não apresentou associação com a ocorrência de IM perioperatório nas CRM, nem mesmo com outros desfechos de impacto, incluindo AVEI, TEP e morte, isoladamente ou em conjunto.

OBJECTIVE: Determine the predictive level of preoperative serum fibrinogen level for the occurrence of MI in perioperative surgical myocardial revascularization (SMR), as well as for other impacting outcomes, such as stroke, pulmonary thromboembolism (PTE), and death, separately or in combination. METHODS: A retrospective cohort study based on the heart surgery database analysis from São Lucas Hospital, at Rio Grande do Sul Catholic University with 1,471 consecutive patients submitted to extracorporeal SMR between January, 1998 and December, 2002. RESULTS: Perioperative MI occurred in 14 percent of sample patients. No association was shown between preoperative fibrinogen and perioperative MI (410.60 ± 148.83 mg/dl for the study group x 401.57 ± 135.23 mg/dl for control group - p = 0.381 - RC = 1.000 - CI95 percent: 0.998-1.002 - p = 0.652), combined outcome for MI, stroke, PTE, and death (411.40 ± 153.52 mg/dL for the group reporting outcome x 400.31 ± 131.98 mg/dL for the group with no outcome - p = 0.232) and neither separately. CONCLUSION: In that sample, preoperative serum fibrinogen level did not show any association with the occurrence of perioperative MI in SMR, neither with other impacting outcomes, stroke, PTE, and mortality, whether separately or as composite endpoints.

Síndrome metabólica / Metabolic Syndrome

A Síndrome Metabólica é um transtorno complexo representado por um conjunto de fatores de risco cardiocirculatórios, geralmente relacionado à deposição de gordura intra-abdominal e à resistência à Insulina, responsável pelo aumento da mortalidade cardiovascular

Hirsutismo, hipertricose e alopécia / Hirsutism, hypertrichosis and alopecia

Embora as anomalias dos pêlos sejam primariamente um problema cosmético, elas podem representar um sinal cutâneo de uma doença sistêmica. Exemplos são a desnutrição, avitaminoses, emagrecimento excessivo, doença toxêmica, alterações hormonais. No presente trabalho, os autores fazem uma revisão das principais tricoses (alopecia, hipertricose e hirsutismo), enfatizando conceito, epidemiologia, diagnóstico, clínica e tratamento