Daily ROX index can predict transitioning to mechanical ventilation within the next 24 h in COVID-19 patients on HFNC.

INTRODUCTION: High flow nasal cannula (HFNC) is used to prevent invasive ventilation in COVID-19-associated hypoxemia. The respiratory rate­oxygenation (ROX) index has been reported to predict failure of HFNC in patients with COVID-19 pneumonia during the intensive care unit stay when measured in first hours of therapy. However, the clinical course of ICU patients may change substantially in the first days of admission. The objective of this study was to investigate whether ROX index obtained in the first four days of ICU admission could predict the need for invasive respiratory support within the next 24 h of measurements. METHODS: A retrospective cross-sectional study was performed using a database that included adult patients with COVID-19 pneumonia treated in the ICU. Patients were followed from ICU admission and ROX index was calculated daily on HFNC. Receiver operating characteristics curves (ROCs) were performed. RESULTS: Two hundred forty-nine patients were enrolled, 48% of whom require mechanical ventilation (MV). The area under the ROC of the pooled 4-day values of the ROX index as a predictor of transition from HFNC to MV within 24 h of measurements was 0.86 (95%CI 0.83 to 0.88, P < 0.001) with a cutoff point of 4.06. CONCLUSION: In COVID-19 patients in high flow nasal cannula, daily ROX index measurements successfully predicted transition to mechanical ventilation within the next 24 h.

New Insights on the Mechanisms of Myocardial Injury in Hypertensive Patients With COVID-19.

PURPOSE: Myocardial injury is common in hypertensive patients with 2019 coronavirus disease (COVID-19). Immune dysregulation could be associated to cardiac injury in these patients, but the underlying mechanism has not been fully elucidated. METHODS: All patients were selected prospectively from a multicenter registry of adults hospitalized with confirmed COVID-19. Cases had hypertension and myocardial injury, defined by troponin levels above the 99th percentile upper reference limit, and controls were hypertensive patients with no myocardial injury. Biomarkers and immune cell subsets were quantified and compared between the two groups. A multiple logistic regression model was used to analyze the associations of clinical and immune variables with myocardial injury. RESULTS: The sample comprised 193 patients divided into two groups: 47 cases and 146 controls. Relative to controls, cases had lower total lymphocyte count, percentage of T lymphocytes, CD8+CD38+ mean fluorescence intensity (MFI), and percentage of CD8+ human leukocyte antigen DR isotope (HLA-DR)+ CD38-cells and higher percentage of natural killer lymphocytes, natural killer group 2A (NKG2A)+ MFI, percentage of CD8+CD38+cells, CD8+HLA-DR+MFI, CD8+NKG2A+MFI, and percentage of CD8+HLA-DR-CD38+cells. On multivariate regression, the CD8+HLA-DR+MFI, CD8+CD38+MFI, and total lymphocyte count were associated significantly with myocardial injury. CONCLUSION: Our findings suggest that lymphopenia, CD8+CD38+MFI, and CD8+HLA-DR+MFI are immune biomarkers of myocardial injury in hypertensive patients with COVID-19. The immune signature described here may aid in understanding the mechanisms underlying myocardial injury in these patients. The study data might open a new window for improvement in the treatment of hypertensive patients with COVID-19 and myocardial injury.

Influenza Vaccination as Prevention Therapy for Stable Coronary Artery Disease and Acute Coronary Syndrome: A Meta-Analysis of Randomized Trials.

BACKGROUND: Influenza can cause a significant burden on patients with coronary artery disease. This meta-analysis assessed the effectiveness of influenza vaccination in patients with acute coronary syndrome and stable coronary artery disease. METHODS: We searched the Cochrane Controlled Register of Trials (CENTRAL), Embase, MEDLINE, www. CLINICALTRIALS: gov, and the World Health Organization International Clinical Trials Registry Platform from inception to September 2021. Estimates were summarized using the Mantel-Haenzel method and a random-effects model. To assess heterogeneity the I² statistic was used. RESULTS: Five randomized trials, comprising 4187 patients, were included, 2 of which included patients with acute coronary syndrome and 3 that included patients with stable coronary artery disease and acute coronary syndrome. Influenza vaccination significantly reduced the risk for all-cause mortality (relative risk [RR] = 0.56; 95% confidence interval [CI], 0.38-0.84), cardiovascular mortality (RR = 0.54; 95% CI, 0.37-0.80), major acute cardiovascular events (RR = 0.66; 95% CI, 0.49-0.88), and acute coronary syndrome (RR = 0.63; 95% CI, 0.44-0.89). On subgroup analysis, influenza vaccination remained effective for these outcomes in acute coronary syndrome but did not meet statistical significance in coronary artery disease. Furthermore, influenza vaccination did not reduce the risk for revascularization (RR = 0.89; 95% CI, 0.54-1.45), stroke or transient ischemic attack (RR = 0.85; 95% CI, 0.31-2.32), or heart failure hospitalization (RR = 0.91; 95% CI, 0.21-4.00). CONCLUSIONS: Influenza vaccine is a cheap and effective intervention to reduce the risk for all-cause mortality, cardiovascular mortality, major acute cardiovascular events, and acute coronary syndrome among coronary artery disease patients, especially in those with acute coronary syndrome.

Effects of phosphodiesterase 5 inhibition on cardiovascular function in resistant hypertension: A systematic review.

Approximately 12-18% of hypertensive patients are diagnosed with resistant hypertension (RH). The risk of having worse cardiovascular outcomes is twice higher in those patients. The low effectiveness of conventional antihypertensive drugs in RH emphasizes the need to evaluate complementary drug therapies to achieve blood pressure (BP) control. Previous studies have demonstrated that phosphodiesterase 5 (PDE-5) inhibitors improve hemodynamics and reduce BP on essential hypertension. So, the authors aimed to summarize current clinical trials-based evidence published concerning the use of PDE-5 inhibitors on BP, cardiovascular function, and hemodynamics of patients with RH. We searched MEDLINE, EMBASE, LILACS, ClinicalTrials.gov, and WHO International Clinical Trials Registry databases on May 15th, 2020 using pre-defined search terms. Two independent reviewers assessed and extracted data from clinical trials that evaluated the effect of PDE-5 inhibitors on BP. We have included five articles in this systematic review. Four of them developed a single-day protocol, while one has developed a 14-day study. The main findings indicate that PDE-5 inhibitors ameliorate BP, vascular hemodynamics, and diastolic function parameters. Some data demonstrated improvement of endothelial function, but it was not a consensus. The side effects seemed to be limited and well-tolerated. In brief, our systematic review highlights the potential of PDE-5 inhibitors as a therapeutic alternative in addition to the multiple-drug regime for RH. Larger studies are still needed to determine whether the beneficial effects of PDE-5 inhibitors on RH would be maintained with chronic administration.

Highlights of mechanisms and treatment of obesity-related hypertension.

The prevalence of obesity has increased two to three times from 1975 to 2015. Large-scale epidemiological and longitudinal prospective studies link obesity with hypertension. Research suggests that excessive weight gain, particularly when associated with visceral adiposity, may account for as much as 65% to 75% of the risk of incident hypertension. Also, exercise and bariatric/metabolic surgery significantly lowers blood pressure, whereas weight gain increases blood pressure, thus establishing a firm link between these two factors. The mechanisms underpinning obesity-related hypertension are complex and multifaceted, and include, but are not limited to, renin-angiotensin-aldosterone system/sympathetic nervous system overactivation, overstimulation of adipokines, insulin resistance, immune dysfunction, structural/functional renal, cardiac, and adipocyte changes. Though weight loss is the mainstay of treatment for obesity-related hypertension, it is often not a feasible long-term solution. Therefore, it is recommended that aggressive treatment with multiple antihypertensive medications combined with diet and exercise be used to lower blood pressure and prevent complications. The research regarding the mechanisms and treatment of obesity-related hypertension has moved at a blistering pace over the past ten years. Therefore, the purpose of this expert review is two-fold: to discuss the pathophysiological mechanisms underlying obesity-related hypertension, and to revisit pharmacotherapies that have been shown to be efficacious in patients with obesity-related hypertension.

Machine Learning Algorithms to Distinguish Myocardial Perfusion SPECT Polar Maps.

Myocardial perfusion imaging (MPI) plays an important role in patients with suspected and documented coronary artery disease (CAD). Machine Learning (ML) algorithms have been developed for many medical applications with excellent performance. This study used ML algorithms to discern normal and abnormal gated Single Photon Emission Computed Tomography (SPECT) images. We analyzed one thousand and seven polar maps from a database of patients referred to a university hospital for clinically indicated MPI between January 2016 and December 2018. These studies were reported and evaluated by two different expert readers. The image features were extracted from a specific type of polar map segmentation based on horizontal and vertical slices. A senior expert reading was the comparator (gold standard). We used cross-validation to divide the dataset into training and testing subsets, using data augmentation in the training set, and evaluated 04 ML models. All models had accuracy >90% and area under the receiver operating characteristics curve (AUC) >0.80 except for Adaptive Boosting (AUC = 0.77), while all precision and sensitivity obtained were >96 and 92%, respectively. Random Forest had the best performance (AUC: 0.853; accuracy: 0,938; precision: 0.968; sensitivity: 0.963). ML algorithms performed very well in image classification. These models were capable of distinguishing polar maps remarkably into normal and abnormal.

Machine Learning Algorithms to Detect Sex in Myocardial Perfusion Imaging.

Myocardial perfusion imaging (MPI) is an essential tool used to diagnose and manage patients with suspected or known coronary artery disease. Additionally, the General Data Protection Regulation (GDPR) represents a milestone about individuals' data security concerns. On the other hand, Machine Learning (ML) has had several applications in the most diverse knowledge areas. It is conceived as a technology with huge potential to revolutionize health care. In this context, we developed ML models to evaluate their ability to distinguish an individual's sex from MPI assessment. We used 260 polar maps (140 men/120 women) to train ML algorithms from a database of patients referred to a university hospital for clinically indicated MPI from January 2016 to December 2018. We tested 07 different ML models, namely, Classification and Regression Tree (CART), Naive Bayes (NB), K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Adaptive Boosting (AB), Random Forests (RF) and, Gradient Boosting (GB). We used a cross-validation strategy. Our work demonstrated that ML algorithms could perform well in assessing the sex of patients undergoing myocardial scintigraphy exams. All the models had accuracy greater than 82%. However, only SVM achieved 90%. KNN, RF, AB, GB had, respectively, 88, 86, 85, 83%. Accuracy standard deviation was lower in KNN, AB, and RF (0.06). SVM and RF had had the best area under the receiver operating characteristic curve (0.93), followed by GB (0.92), KNN (0.91), AB, and NB (0.9). SVM and AB achieved the best precision. Our results bring some challenges regarding the autonomy of patients who wish to keep sex information confidential and certainly add greater complexity to the debate about what data should be considered sensitive to the light of the GDPR.

Comparison of clinical and histologic findings in daylight photodynamic therapy for skin field cancerization: A randomized controlled four-arm study on physical methods-assisted delivery of methyl aminolevulinate.

BACKGROUND: Daylight photodynamic therapy (DL-PDT) has similar efficacy to conventional photodynamic therapy in treating actinic keratosis (AKs). Good clinical outcomes have been reported when associated with physical methods such as microneedles, but a comparison of different methods and histologic studies is lacking. OBJECTIVES: To evaluate clinical and histologic modifications induced by standard DL-PDT and compare with DL-PDT associated with physical methods in treating skin field cancerization of the face. METHODS: Forty patients with photodamaged skin and at least one AK lesion on the face were randomly distributed into four groups, ten patients in each (I: Standard DL-PDT; II: DL-PDT + microneedles; III: DL-PDT + CO2 laser; IV: DL-PDT + microdermabrasion) and underwent two DL-PDT sessions with methyl aminolevulinate cream and 2-hour daylight exposure. Skin biopsies were performed on all patients before and 3 months after. All fragments were stained using the hematoxylin-eosin, orcein, and picrosirius. RESULTS: All 40 patients completed the study. Group III had a higher AK-clearance after 1 (p = 0,002) and 3 (p = 0,034) months, but it was similar in every group at 6 months (p = 0,441). Group III and IV had better clinical global improvement on texture, pigmentation and fine lines. In the groups associated with physical methods, the improvement of the keratinocytes' atypia and solar elastosis were remarkable. Only group III showed a significant reduction in solar elastosis (p = 0.034) and increased collagen type I (p = 0.028) after treatment. CONCLUSION: DL-PDT-associated with physical methods had better clinical and histologic results. AK-clearance were significantly higher after 1 and 3 months with pretreatment-CO2 laser. Photorejuvenation were more evident with pretreatment-CO2 laser and microdermabrasion. Pretreatment-CO2 laser showed a significant reduction in solar elastosis and increase of collagen type 1. These results pointed to the pretreatment with laser as a potentially better option for skin field cancerization of the face.

Liver stiffness as measured by transient elastography is a predictor of outcomes in patients with chronic heart failure with reduced, mid-range, and recovered left-ventricular ejection fraction.

Background: Transient elastography is a noninvasive method for assessing liver stiffness (LS), which can reflect right-sided filling pressure associated with passive liver congestion in patients with HF. Methods: A prospective, single-center observational study in which LS was measured in consecutive ambulatory patients with heart failure with reduced, mid-range, and recovered left ventricular ejection fraction, between March 2018 and June 2019. Mean follow up was 219 ± 86 days. The primary endpoint was time to first event, which was defined as a composite of cardiovascular death or HF hospitalization. Results: Eighty-five patients were included in the final analysis. Mean age was 62 ± 10 and 68% were male. Mean ejection fraction and median NT-proBNP were, respectively, 38.7 ± 14.3% and 1140 pg/mL (interquartile range 224.3-2810.3). The median LS for the entire population was 6.3 (2.5-41.2) kPa. LS correlated with NT-proBNP (r = 0.46; p < 0.0001), total bilirubin (r = 0.47; p < 0.001), direct bilirubin (r = 0.43; p = 0.0001), gama-glutamyl-transpeptidase (r = 0.54; p < 0.0001), and alkaline phosphatase (r = 0.39; p = 0.0004). A Receiver Operating Characteristic (ROC) curve was performed and a cut point of 5.9 kPa showed sensitivity of 80% and specificity of 64.1% with area under the curve of 0.73. Using Cox proportional hazard model (independent variables: LS as a continuous variable, age, gender, NT-proBNP, LVEF, and creatinine), only LS was independently associated with the primary endpoint (hazard ratio 1.05, 95% confidence interval 1.01-1.09; for each increment of one unit of LS). Conclusion: LS correlates with biomarkers of myocardial stretch and several liver function tests and is an independent predictor of outcomes in ambulatory patients with HF.

Prognosis of Heart Failure with Preserved Ejection Fraction in Primary Care by the H2FPEF Score

Abstract Background: Primary care physicians have difficulty dealing with patients who have HF with preserved LVEF(HFpEF). The prognosis of HFpEF is poor, and difficult to predict on primary care. Objective: The aim of the study is to apply the H2FPEF score to primary care patients and verify its power to assess the risk of death or hospitalization due to cardiovascular disease. Methods: This longitudinal study included 402 individuals, with signs or symptoms of HF, aged≥45 years and, underwent an evaluation which included clinical examination, BNP and echocardiogram. The diagnosis of HFpEF was confirmed by the criteria of the European Society of Cardiology. After five years, the patients were reassessed as to the occurrence of the composite outcome, death from any cause or hospitalization for cardiovascular disease. H2FPEF used six variables: body mass index, medications for hypertension, age, pulmonary artery systolic pressure, atrial fibrillation and E/e' ratio ranged from 0 to 9 points. The level of statistical significance was p<0.05. Results: HFpEF was diagnosed in 58(14.4%). Among patients with H2FPEF≥4, 30% had HFpEF and in those with a score≤4, HFpEF was present in 12%. Patients with HFpEF and H2FPEF≥4 had 53% of outcomes, whereas patients with HFpEF and a score ≤4 had a 21% of outcomes. BNP values were higher in patients with HFpEF compared to those without HFpEF(p<0.0001). Conclusion: H2FPEF≥4 indicated a worse prognosis in patients with HFpEF assisted in primary care. H2FPEF may be a simple and useful tool for risk stratification in patients with HFpEF at the primary care.

Uric acid and salt intake as predictors of incident hypertension in a primary care setting / Ácido úrico e ingesta de sal como factores predictivos de la hipertensión arterial incidental en un centro de atención primaria

Abstract Background: Hypertension is responsible for a substantial number of deaths due to cardiovascular disease and stroke. A crucial step toward its control is the identification of modifiable predictors of hypertension. Objectives: To estimate the relationship between salt intake, serum uric acid and incident hypertension in a primary care setting. Methods: Retrospective cohort of the CAMELIA study in which a non-randomized sample of 1098 participants who were ≥ 20 year-old was recruited from a primary care program. Originally, the sample consisted of hypertensive, diabetic and non-diabetic/non-hypertensive subjects. For the analysis, 258 participants with blood pressure (BP) lower than 140/90 mm Hg not using antihypertensive drugs and without diabetes mellitus were included. Five years after the first visit, their medical records were reviewed. Patients were divided into two groups according to BP in the first visit: normal BP group (systolic BP ≤ 120 mm Hg and diastolic BP ≤ 80 mm Hg) and high-normal BP group (systolic BP 121-139 mm Hg and/or diastolic BP 81-89 mm Hg). Results: In multivariate analysis, high-normal BP, hyperuricemia and salt intake ≥ 6 g/day predicted incident hypertension. In participants of thenormal BP group, high salt intake conferred the highest risk. In the high-normal BP group, smoking and serum uric acid were found to be the most important ones. Conclusion: In a healthy, multiethnic, and normotensive population from an urban primary care program, high-normal BP, hyperuricemia and high salt intake were found to be predictors of incident hypertension.

Resumen Antecedentes: La hipertensión es responsable de un gran número de muertes debido a cardiopatías e ictus. Un paso esencial para su control es la identificación de factores modificables predictivos de la hipertensión. Objetivos: Calcular la relación entre ingesta de sal, ácido úrico sérico e hipertensión incidental en un centro de atención primaria. Métodos: Cohorte retrospectiva del estudio CAMELIA, en el que se incluyó una muestra no aleatorizada de 1.098 participantes con edades ≥ 20 años, obtenida de un programa de atención primaria. Originalmente, la muestra incluía sujetos hipertensos, diabéticos y no diabéticos/no hipertensos. Para el análisis, se estudiaron 258 participantes con presión arterial (PA) inferior a 140/90 mm Hg, sin prescripción de fármacos antihipertensivos, y no diabéticos. Transcurridos cinco años de la primera visita, se revisaron sus historias médicas. Se dividió a los pacientes en dos grupos, con arreglo a su PA en la primera visita: grupo con PA normal (PA sistólica ≤ 120 mm Hg y PA diastólica ≤ 80 mm Hg), y grupo con PA alta-normal BP (PA sistólica 121-139 mm Hg y/o PA diastólica 81-89 mm Hg). Resultados: En el análisis multivariante, la PA alta-normal, hiperuricemia e ingesta de sal ≥ 6 g/día predijeron la hipertensión incidental. En los participantes del grupo de PA normal, la ingesta elevada de sal confirió el mayor riesgo. En el grupo de PA alta-normal, el tabaquismo y el ácido úrico sérico fueron los factores más importantes. Conclusión: En una población sana, multiétnica y normotensa, procedente de un programa de atención primaria urbana la PA alta-normal, hiperuricemia e ingesta elevada de sal constituyeron los factores predictivos de la hipertensión incidental.

Artificial Intelligence in Cardiology: Concepts, Tools and Challenges - "The Horse is the One Who Runs, You Must Be the Jockey". / Inteligência Artificial em Cardiologia: Conceitos, Ferramentas e Desafios ­ "Quem Corre é o Cavalo, Você Precisa ser o Jóquei".

The recent advances at hardware level and the increasing requirement of personalization of care associated with the urgent needs of value creation for the patients has helped Artificial Intelligence (AI) to promote a significant paradigm shift in the most diverse areas of medical knowledge, particularly in Cardiology, for its ability to support decision-making and improve diagnostic and prognostic performance. In this context, the present work does a non-systematic review of the main papers published on AI in Cardiology, focusing on its main applications, potential impacts and challenges.

Hipertensão mascarada: qual o verdadeiro risco cardiovascular? / Masked hypertension: what is the real cardiovascular risk?

Entende-se como hipertensão mascarada (HM) a existência de níveis pressóricos aumentados fora do consultório em pessoas supostamente normotensas e não tratadas. A hipertensos medicados, aplica-se a denominação de "hipertensão mascarada não controlada" (HMNC). Estas condições expõem expressivo contingente de indivíduos a um risco não identificado para eventos cardiovasculares. O presente trabalho teve como objetivo realizar uma revisão sistemática da literatura a fim de identificar os principais estudos de associação entre HM, HMNC e o risco de eventos cardiovasculares. De um total de 566 estudos, 19 foram incluídos na revisão. Dentre estes, apenas 4 não documentaram associação entre HM/HMNC e maior risco cardiovascular. Um estudo observou apenas associação com risco de infarto agudo do miocárdio (IAM) e outro apenas com o risco de acidente cerebrovascular (AVC). Os demais 13 estudos mostraram relação entre presença de HM e/ou HMNC e maior risco de eventos cardiovasculares como AVC, IAM e/ou morte. Em conclusão, existe associação entre a presença de hipertensão mascarada e o aumento no risco de eventos cardiovasculares. Alguns fenótipos especialmente vulneráveis e possíveis estratégias diagnósticas são também objeto de discussão.

Masked hypertension (MH) is defined as a normal ambulatory blood pressure, though elevated in the outpatient setting, in supposedly normotensive patients. For hypertensive patients, the term "uncontrolled masked hypertension" (MUCH) applies. Previous data suggest that subjects who present either MH or MUCH may be exposed to higher cardiovascular risk. The authors sought to carry out a systematic review of the literature regarding the association between MH, MUCH and risk of cardiovascular events. Among 566 studies retrieved,19 were included in the review. Only 4 studies did not document an association between MH/MUCH and risk of cardiovascular events. One study found an association only with the risk of acute myocardial infarction (AMI) and another with the risk of cerebrovascular events. The remaining 13 studies revealed a relationship between the presence of MH/MUCH and a higher risk of cardiovascular events such as stroke, AMI and/or death. In conclusion, there is an association between the presence of MH/MUCH and an increased risk of cardiovascular events. Some especially vulnerable phenotypes as well as possible diagnostic strategies are also discussed.

Complete Atrioventricular Block and Cardiopulmonary Involvement in Rapidly Progressive Systemic Sclerosis

Abstract The heart and lung are target organs in systemic sclerosis (SSc) and similar symptoms (dyspnea and cough) may make the differential diagnosis between the two lesions difficult. In addition, complete atrioventricular block (CAVB) is a rare complication of this disease. This case report is about a patient with SSc and pulmonary fibrosis who was admitted to the emergency room with CAVB, heart failure (HF) and progressive worsening of the underlying disease.

Inteligência Artificial em Cardiologia: Conceitos, Ferramentas e Desafios - Quem Corre é o Cavalo, Você Precisa ser o Jóquei / Artificial Intelligence in Cardiology: Concepts, Tools and Challenges - The Horse is the One Who Runs, You Must Be the Jockey

Resumo Os recentes avanços ao nível de hardware e a crescente exigência de personalização dos cuidados associados às necessidades urgentes de criação de valor para os pacientes contribuíram para que a Inteligência Artificial (IA) promovesse uma mudança significativa de paradigma nas mais diversas áreas do conhecimento médico, em particular em Cardiologia, por sua capacidade de apoiar a tomada de decisões e melhorar o desempenho diagnóstico e prognóstico. Nesse contexto, o presente trabalho faz uma revisão não-sistemática dos principais trabalhos publicados sobre IA em Cardiologia, com foco em suas principais aplicações, possíveis impactos e desafios.

Abstract The recent advances at hardware level and the increasing requirement of personalization of care associated with the urgent needs of value creation for the patients has helped Artificial Intelligence (AI) to promote a significant paradigm shift in the most diverse areas of medical knowledge, particularly in Cardiology, for its ability to support decision-making and improve diagnostic and prognostic performance. In this context, the present work does a non-systematic review of the main papers published on AI in Cardiology, focusing on its main applications, potential impacts and challenges.

Characterization of dyspnea in chronic diseases and heart failure in patients in a Family Health Program / Caracterización de la disnea en pacientes con enfermedades crónicas e insuficiencia cardíaca de un Programa de Salud Familiar

Abstract Background: Dyspnea is the most common symptom in heart failure. In the elderly, it is common in chronic obstructive pulmonary disease and depression. Objective: To estimate the prevalence of dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea and its association with chronic diseases in primary care. Methods: A cross-sectional study, part of the Digitalis Study, including 633 individuals, between 45 to 99 years old, registered in a primary care program in Niteroi, Brazil. All participants underwent clinical evaluations, blood and urine collection, and responded to a questionnaire in a single day. Self-reports were used for the diagnosis of diseases. Results: Of the 633 individuals, 30% had dyspnea. In the crude analysis, chronic obstructive pulmonary disease showed the strongest associations with the three types of dyspnea, followed by depression and heart failure. Chronic obstructive pulmonary disease alone did not present any cases of paroxysmal nocturnal dyspnea, and heart failure alone showed a very strong relationship with this type of dyspnea. Conclusions: The different behavior of the associations of the types of dyspnea with major chronic diseases in patients in primary care can help in the better characterization of patients with heart failure.

Resumen Introducción: La disnea es el síntoma más común en la insuficiencia cardíaca. En los ancianos es común en la enfermedad pulmonar obstructiva crónica y la depresión. Objetivo: Estimar la prevalencia de disnea de esfuerzo, ortopnea y disnea paroxística nocturna y su asociación con enfermedades crónicas en la atención primaria. Métodos: Estudio transversal, parte del estudio Digitalis, que incluyó a 633 individuos, entre 45 y 99 años de edad, registrados en un programa de atención primaria en Niterói, Brasil. Todos los participantes se sometieron a evaluaciones clínicas, recolección de sangre y orina, y respondieron a un cuestionario en un solo día. Se usaron autorrelatos para el diagnóstico de las enfermedades. Resultados: De los 633 individuos, el 30% presentó disnea. En el análisis crudo la enfermedad pulmonar obstructiva crónica mostró las asociaciones más fuertes con los tres tipos de disnea, seguidos por la depresión y la insuficiencia cardíaca. La enfermedad pulmonar obstructiva crónica, evaluada de forma aislada, no presentó ningún caso de disnea paroxística nocturna, y la insuficiencia cardíaca por sí sola mostró una relación muy fuerte con este tipo de disnea. Conclusiones: El comportamiento diferente de las asociaciones de los tipos de disnea con las principales enfermedades crónicas en pacientes en atención primaria puede ayudar a una mejor caracterización de los pacientes con insuficiencia cardíaca.

Are there normal values of phase analysis parameters for left ventricular dyssynchrony in patients with no structural cardiomyopathy?: a systematic review.

BACKGROUND: ECG-gated single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy combined with phase analysis allows for the assessment of left ventricular dyssynchrony. However, there are several software programs available thereby introducing variability in outcome and normal values. The aim of this systematic review was to evaluate the variability between different programs as currently available in literature with a focus on normal values. METHODS: A systematic review was performed using the Embase, LILACS and Medline databases looking for articles reporting on normal values of the most used phase analysis parameters. The search resulted in 110 articles from Medline, 349 from Embase and one from LILACS. After exclusion of duplicate articles, 370 documents remained. Of these only 13 were deemed eligible for the systematic review. RESULTS: Phase SD and bandwidth are the main parameters used in dyssynchrony analysis. Most articles reviewed here used the Emory Cardiac ToolBox (ECTb) to determine the phase analysis parameters values, which varied greatly among the four software tested. The bandwidth and phase SD calculated by the Quantitative Gated SPECT (QGS) tends to be smaller than that calculated by the ECTb. In relation to the bandwidth, ECTb and cardioREPO (cREPO) have higher values than the other software programs. The value of entropy obtained from 4DM is lower than those obtained from QGS and cREPO. CONCLUSION: We found that normal values of phase analysis can vary among software programs and can be different even when the same software is used.

Endothelial dysfunction and pulse wave reflection in women with Polycystic Ovarian Syndrome / Disfunção endotelial e reflexão de ondas de pulso em mulheres com Síndrome do Ovário Policístico

Background: Patients with polycystic ovarian syndrome (PCOS) have an increased prevalence of metabolic syndrome and traditional atherosclerotic risk factors, such as dyslipidemia, diabetes and hypertension. Endothelial function and vascular stiffness are surrogate markers of early atherosclerosis, able to predict cardiovascular events. Objective: To compare endothelial function and pulse wave reflection between women with PCOS and healthy controls. Methods: Observational and cross-sectional study that included women with PCOS, age between 18 and 40 years-old and body mass index between 25.0 and 35.0 kg/m2, and healthy controls. Rotterdan criteria was used to diagnose PCOS. Subjects underwent clinical and anthropometric evaluation, laboratory and hormonal assays and imaging tests to measure pulse wave velocity (PWV), augmentation index (AIx) and brachial artery flow-mediated vasodilation (FMD). Kolmogorov-Smirnov test showed normal distribution of most parameters. Unpaired Student t-test was used with significance level established at p < 0.05.Results: A total of 52 patients were included, 29 (56%) in PCOS group and 23 (44%) in control group. Clinical and laboratory parameters were similar between the groups. Women with PCOS had lower FMD (8.8 ± 1.0 vs 12.8 ± 1.2%, p = 0.021); PWV and AIx were similar between the groups (7.5 ± 0.2 vs 7.5 ± 0.3 m/s, p = 0.671 and 21.0 ± 1 vs. 20 ± 2%, p = 0.716, respectively). In the PCOS group, women with higher testosterone levels had higher AIx (25 ± 2 vs. 17 ± 3%, p = 0.045). Conclusions: PCOS women had endothelial dysfunction and those with higher testosterone levels had higher pulse wave reflection as compared with controls